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<1>
Accession Number
2014002814
Authors
Beattie G.W. Jeffrey R.R.
Institution
(Beattie, Jeffrey) Department of Cardiothoracic Surgery, Aberdeen Royal
Infirmary, Aberdeen AB25 2ZN, United Kingdom
Title
Is there evidence that fresh frozen plasma is superior to antithrombin
administration to treat heparin resistance in cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (1) (pp 117-120),
2014. Date of Publication: January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, 'in [patients with
heparin resistance] is [treatment with FFP] superior [to antithrombin
administration] in [achieving adequate anticoagulation to facilitate safe
cardiopulmonary bypass]?' More than 29 papers were found using the
reported search, of which six represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Antithrombin (AT) binds to heparin and increases the
rate at which it binds to thrombin. The levels of antithrombin in the
blood are an important aspect of the heparin dose-response curve. When the
activated clotting time (ACT) fails to reach a target >480, this is
commonly defined as heparin resistance (HR). Heparin resistance is usually
treated with a combination of supplementary heparin, fresh frozen plasma
(FFP) or antithrombin III concentrate. There is a paucity of evidence on
the treatment of heparin resistance with FFP, with only five studies
identified, including one retrospective study, one in vitro trial and
three case reports. AT has been studied more extensively with multiple
studies, including a crossover trial comparing AT to supplemental heparin
and a multicentre, randomized, double blind, placebo-controlled trial.
Antithrombin (AT) concentrate is a safe and efficient treatment for
heparin resistance to elevate the activated clotting time (ACT). It avoids
the risk of transfusion-related acute lung injury (TRALI), volume
overload, intraoperative time delay and viral or vCJD transmission.
Antithrombin concentrates are more expensive than fresh frozen plasma and
may put patients at risk of heparin rebound in the early postoperative
period. Patients treated with AT have a lower risk of further FFP
transfusions during their stay in hospital. We conclude that the treatment
of HR with FFP may not restore the ACT to therapeutic levels with adequate
heparinization, but AT is efficient with benefits including lower volume
administration, less risk of TRALI and lower risk of transfusion-related
infections. 2013 The Author.

<2>
Accession Number
2014050178
Authors
Nicholls S.J. Kastelein J.J.P. Schwartz G.G. Bash D. Rosenson R.S.
Cavender M.A. Brennan D.M. Koenig W. Jukema J.W. Nambi V. Wright R.S.
Menon V. Lincoff A.M. Nissen S.E.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Schwartz) Veterans Affairs Medical Center, University of Colorado,
Denver, CO, United States
(Bash, Brennan, Menon, Lincoff, Nissen) Cleveland Clinic Coordinating
Center for Clinical Research, Cleveland, OH, United States
(Rosenson) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Cavender) Brigham and Women's Hospital, Boston, MA, United States
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Jukema) Interuniversity Cardiology Institute of the Netherlands, Utrecht,
Netherlands
(Nambi) Michael E. DeBakey Veterans Affairs Hospital, Baylor College of
Medicine, Houston, TX, United States
(Wright) Mayo Clinic, Rochester, MN, United States
Title
Varespladib and cardiovascular events in patients with an acute coronary
syndrome: The VISTA-16 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (3) (pp 252-262),
2014. Date of Publication: 2014.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
IMPORTANCE: Secretory phospholipase A₂ (sPLA₂)
generates bioactive phospholipid products implicated in atherosclerosis.
The sPLA₂ inhibitor varespladib has favorable effects on lipid
and inflammatory markers; however, its effect on cardiovascular outcomes
is unknown. OBJECTIVE: To determine the effects of sPLA₂
inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING,
AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362
academic and community hospitals in Europe, Australia, New Zealand, India,
and North America of 5145 patients randomized within 96 hours of
presentation of an acute coronary syndrome (ACS) to either varespladib (n
= 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and
March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS:
Participants were randomized to receive varespladib (500 mg) or placebo
daily for 16 weeks, in addition to atorvastatin and other established
therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a
composite of cardiovascular mortality, nonfatal myocardial infarction
(MI), nonfatal stroke, or unstable angina with evidence of ischemia
requiring hospitalization at 16 weeks. Six-month survival status was also
evaluated. RESULTS: At a prespecified interim analysis, including 212
primary end point events, the independent data and safety monitoring board
recommended termination of the trial for futility and possible harm. The
primary end point occurred in 136 patients (6.1%) treated with varespladib
compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR],
1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with
a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39;
log-rank P = .005). The composite secondary end point of cardiovascular
mortality, MI, and stroke was observed in 107 patients (4.6%) in the
varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36;
95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with
recent ACS, varespladib did not reduce the risk of recurrent
cardiovascular events and significantly increased the risk of MI. The
sPLA₂ inhibition with varespladib may be harmful and is not a
useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014
American Medical Association. All rights reserved.

<3>
Accession Number
2014043792
Authors
Macrae D. Grieve R. Allen E. Sadique Z. Morris K. Pappachan J. Parslow R.
Tasker R.C. Elbourne D.
Institution
(Macrae) Royal Brompton and Harefield NHS Foundation Trust, London School
of Hygiene and Tropical Medicine, London, United Kingdom
(Grieve, Sadique) Departments of Health Services Research and Policy,
London School of Hygiene and Tropical Medicine, London, United Kingdom
(Allen, Elbourne) Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Allen, Elbourne) Clinical Trials Unit, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Morris) Birmingham Children's Hospital, Birmingham, United Kingdom
(Pappachan) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Parslow) Division of Epidemiology, Leeds Institute of Genetics and
Therapeutics, University of Leeds, Leeds, United Kingdom
(Tasker) Departments of Neurology and Anesthesia, Boston Children's
Hospital, Harvard Medical School, Boston, United States
Title
A randomized trial of hyperglycemic control in pediatric intensive care.
Source
New England Journal of Medicine. 370 (2) (pp 107-118), 2014. Date of
Publication: 2014.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Whether an insulin infusion should be used for tight control
of hyperglycemia in critically ill children remains unclear. METHODS: We
randomly assigned children (<16 years of age) who were admitted to the
pediatric intensive care unit (ICU) and were expected to require
mechanical ventilation and vasoactive drugs for at least 12 hours to
either tight glycemic control, with a target blood glucose range of 72 to
126 mg per deciliter (4.0 to 7.0 mmol per liter), or conventional glycemic
control, with a target level below 216 mg per deciliter (12.0 mmol per
liter). The primary outcome was the number of days alive and free from
mechanical ventilation at 30 days after randomization. The main
prespecified subgroup analysis compared children who had undergone cardiac
surgery with those who had not. We also assessed costs of hospital and
community health services. RESULTS: A total of 1369 patients at 13 centers
in England underwent randomization: 694 to tight glycemic control and 675
to conventional glycemic control; 60% had undergone cardiac surgery. The
mean between-group difference in the number of days alive and free from
mechanical ventilation at 30 days was 0.36 days (95% confidence interval
[CI], -0.42 to 1.14); the effects did not differ according to subgroup.
Severe hypoglycemia (blood glucose, <36 mg per deciliter [2.0 mmol per
liter]) occurred in a higher proportion of children in the
tight-glycemic-control group than in the conventional-glycemic- control
group (7.3% vs. 1.5%, P<0.001). Overall, the mean 12-month costs were
lower in the tight-glycemic-control group than in the conventional-
glycemiccontrol group. The mean 12-month costs were similar in the two
groups in the cardiac-surgery subgroup, but in the subgroup that had not
undergone cardiac surgery, the mean cost was significantly lower in the
tight-glycemic-control group than in the conventional-glycemic-control
group: -$13,120 (95% CI, -$24,682 to -$1,559). CONCLUSIONS: This
multicenter, randomized trial showed that tight glycemic control in
critically ill children had no significant effect on major clinical
outcomes, although the incidence of hypoglycemia was higher with tight
glucose control than with conventional glucose control. Copyright 2014
Massachusetts Medical Society.

<4>
Accession Number
2014002832
Authors
Brickwedel J. Gulbins H. Reichenspurner H.
Institution
(Brickwedel, Gulbins, Reichenspurner) Department of Cardiovascular
Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246
Hamburg, Germany
Title
Long-term follow-up after autologous skeletal myoblast transplantation in
ischaemic heart disease.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (1) (pp 61-66), 2014.
Date of Publication: January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Short-term follow-up after autologous skeletal myoblasts (ASM)
transplantation (Tx) (Myoblast Autologous Grafting in Ischaemic
Cardiomyopathy (MAGIC) Phase II Study) for the treatment of ischaemic
cardiomyopathy revealed improved left ventricular (LV) remodelling. Our
study reports the longest long-term worldwide follow-up of a single-centre
cohort, focusing on the safety and efficacy of ASM-Tx. METHODS: The
multicentre MAGIC Phase II Study involved 120 patients and was conducted
between 2004 and 2006. Out of the 120 patients involved in the entire
study, the cohort treated at our institution contained 7 patients only.
These 7 patients received ASM-Tx (injection volume: 400 million cells, n =
2 low dosage; 800 million cells, n = 2 high dosage) or placebo (n = 3)
injections, in addition to coronary artery bypass grafting (CABG). After
closure of the MAGIC registry, we conducted a long-term follow-up for our
7-patient cohort. The mean follow-up was 72.0 + 5.3 months. The follow-up
was complete for echo data, implanted cardioverter defibrillator (ICD)
report, clinical investigation and New York Heart Association (NYHA)
class. RESULTS: At final follow-up, all the patients were alive, and 5
were in NYHA class 1 or 2. There were 6 hospitalizations for congestive
heart failure during the follow-up (1 patient from each group). One
patient (placebo group) was treated twice for ventricular fibrillation by
the ICD. The LV ejection fraction remained stable in all the three groups
(31.1 + 3.9% preoperative vs 29.4 + 4.4% at final follow-up). The LV
volumes were reduced in the high-dosage group, remained unchanged in the
low-dosage group and deteriorated in the placebo group. CONCLUSIONS: Our
long-term data confirm the findings of the MAGIC study. The LV function
did not improve, but the long-term LV volumes in the high-dosage group
were reduced. During the follow-up, there were also no additional
arrhythmogenic incidences. Our data could imply that CABG in combination
with ASM-Tx is safe and has beneficial therapeutic effects in the
long-term. However, due to the small patient number, the clinical impact
is limited. 2013 The Author.

<5>
Accession Number
2014002819
Authors
Vohra H.A. Armstrong L.A. Modi A. Barlow C.W.
Institution
(Vohra, Armstrong, Modi, Barlow) Wessex Cardiothoracic Centre, Southampton
University Hospitals NHS Trust, Tremona Road, Southampton, Hampshire SO16
6YD, United Kingdom
Title
Outcomes following cardiac surgery in patients with preoperative renal
dialysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (1) (pp 103-111),
2014. Date of Publication: January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was that whether patients who
are dependent on chronic dialysis have higher morbidity and mortality
rates than the general population when undergoing cardiac surgery. These
patients often require surgery in view of their heightened risk of cardiac
disease. Altogether 278 relevant papers were identified using the below
mentioned search, 16 papers represented the best evidence to answer the
question. The author, journal, date and country of publication, patient
group studied, study type, relevant outcomes,-RESULTS:-and study
weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing
coronary artery bypass grafting (CABG) or valve replacement have higher
morbidity but acceptable outcomes. There is some evidence to show that
outcomes after off-pump coronary artery bypass grafting (OPCAB) are better
than after on-pump coronary artery bypass grafting (ONCAB) and
that-RESULTS:-are worse in DD patients with diabetic nephropathy. Patients
undergoing combined procedures have a higher mortality. 2013 The Author.

<6>
[Use Link to view the full text]
Accession Number
2014064590
Authors
Zsebo K. Yaroshinsky A. Rudy J.J. Wagner K. Greenberg B. Jessup M. Hajjar
R.J.
Institution
(Zsebo, Rudy, Wagner) Celladon Corporation, San Andreas, CA, United States
(Yaroshinsky) AY Statistical Consulting, San Andreas, CA, United States
(Greenberg) University of California, San Diego Medical Center, San Diego,
United States
(Jessup) Penn Heart and Vascular Center, Hospital of the University of
Pennsylvania, Philadelphia, United States
(Hajjar) Cardiovascular Research Center, Icahn School of Medicine at Mount
Sinai, Sinai, One Gustave Levy Place, Box 1030, New York, NY 10029, United
States
Title
Long-term effects of AAV1/SERCA2a gene transfer in patients with severe
heart failure: Analysis of recurrent cardiovascular events and mortality.
Source
Circulation Research. 114 (1) (pp 101-108), 2014. Date of Publication: 03
Jan 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Rationale: The Calcium Up-Regulation by Percutaneous Administration of
Gene Therapy In Cardiac Disease (CUPID 1) study was a phase 1/phase 2
first-in-human clinical gene therapy trial using an adeno-associated virus
serotype 1 (AAV1) vector carrying the sarcoplasmic reticulum calcium
ATPase gene (AAV1/SERCA2a) in patients with advanced heart failure. The
study explored potential benefits of the therapy at 12 months, and results
were previously reported. Objective: To report long-term (3-year) clinical
effects and transgene expression in the patients in CUPID 1. Methods and
results: A total of 39 patients with advanced heart failure who were on
stable, optimal heart failure therapy were randomized to receive
intracoronary infusion of AAV1/SERCA2a in 1 of 3 doses (low-dose,
6x10¹¹ DNase-resistant particles; mid-dose, 3x10 ¹²
DNase-resistant particles; and high-dose, 1x10¹³
DNase-resistant particles) versus placebo. The following recurrent
cardiovascular and terminal events were tracked for 3 years in all groups:
myocardial infarction, worsening heart failure, heart failure-related
hospitalization, ventricular assist device placement, cardiac
transplantation, and death. The number of cardiovascular events, including
death, was highest in the placebo group, high but delayed in the low-and
mid-dose groups, and lowest in the high-dose group. Evidence of long-term
transgene presence was also observed in high-dose patients. The risk of
prespecified recurrent cardiovascular events was reduced by 82% in the
high-dose versus placebo group (P=0.048). No safety concerns were noted
during the 3-year follow-up. Conclusions: After a single intracoronary
infusion of AAV1/SERCA2a in patients with advanced heart failure, positive
signals of cardiovascular events persist for years. 2013 American Heart
Association, Inc.

<7>
[Use Link to view the full text]
Accession Number
2014061485
Authors
Iwata K. Nakagawa S. Ogasawara K.
Institution
(Iwata, Nakagawa) Section of Radiological Technology, Department of
Medical Technology, Asahikawa Medical University, Asahikawa, Japan
(Iwata) Graduate School of Health Sciences, Hokkaido University, Hokkaido,
Sapporo, Japan
(Ogasawara) Faculty of Health Sciences, Hokkaido University, Hokkaido,
Sapporo, Japan
Title
The prognostic value of normal stress cardiovascular magnetic resonance
imaging.
Source
Journal of Computer Assisted Tomography. 38 (1) (pp 36-43), 2014. Date of
Publication: January-February 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES: The purpose of our study was to determine the prognostic value
of normal stress cardiovascular magnetic resonance imaging (CMR) by a
systematic literature review and meta-analysis. METHODS: A comprehensive
literature search of published studies through November 2011 in MEDLINE
database and Cochrane Library, regarding prognostic value of stress CMR in
patients with known or suspected coronary artery disease, was performed.
RESULTS: Ultimately, we identified 11 studies. The summary relative risk
ratio for major adverse cardiac events was 0.50 (95% confidence interval
[CI], 0.44-0.58) for normal cine CMR and 0.09 (95% CI, 0.02-0.35) for
normal perfusion CMR. The summary relative risk ratio for hard cardiac
events was 0.36 (95% CI, 0.16-0.8) for normal cine CMR and 0.22 (95% CI,
0.07-0.66) for normal perfusion CMR. CONCLUSIONS: Normal stress CMR for
patients known or suspected of having coronary artery disease has good
prognostic value in predicting cardiac events. Copyright 2014 by
Lippincott Williams Wilkins.

<8>
Accession Number
2014045165
Authors
de Assumpcao M.S. Goncalves R.M. Krygierowicz L.C. Orlando A.C.T.
Schivinski C.I.S.
Institution
(de Assumpcao, Goncalves, Schivinski) Udesc, Florianopolis, SC, Brazil
(Krygierowicz, Orlando) Hospital Pequeno Principe, Curitiba, PR, Brazil
Title
Manual vibrocompression and nasotracheal suctioning in post-operative
period of infants with heart deffects.
Source
Revista Paulista de Pediatria. 31 (4) (pp 507-515), 2013. Date of
Publication: December 2013.
Publisher
Sao Paulo Pediatric Society (Alameda Santos 211, Cerq cesar, Sao Paulo
01419-000, Brazil)
Abstract
Objective: To evaluate the impact of manual vibrocompression and
nasotracheal suctioning on heart (hr) and respiratory (rr) rates,
peripheral oxygen saturation (SpO₂), pain and respiratory
distress in infants in the postoperative period of a cardiac surgery.
Methods: Randomized controlled trial, in which the assessments were
performed by the same physiotherapist in two moments: before and after the
procedure. The infants were randomly divided into two groups: Intervention
(IG), with manual chest vibrocompression, nasotracheal suctioning and
resting; and Control CG), with 30 minutes of rest. Cardiorespiratory data
(SpO₂; hr; rr) were monitored and the following scales were
used: Neonatal Infant Pain Scale (NIPS), for pain evaluation, and Bulletin
of Silverman-Andersen (BSA), for respiratory distress assessment. The data
were verified by analysis of variance (ANOVA) for repeated measures, being
significant p<0.05. Results: 20 infants with heart disease, ten in each
group (seven acyanotic and three cyanotic) were enrolled, with ages
ranging from zero to 12 months. In the analysis of the interaction between
group and time, there was a significant difference in the variation of
SpO₂ (p=0.016), without changes in the other variables.
Considering the main effect on time, only rr showed a significant
difference (p=0.001). As for the group main effect, there were no
statistical differences (SpO₂ - p=0.77, hr - p=0.14, rr -
p=0.17, NIPS - p=0.49 and BSA - p=0.51). Conclusions: The manual
vibrocompression and the nasotracheal suctioning applied to infants in
postoperative of cardiac surgery did not altered SpO₂ and rr,
and did not trigger pain and respiratory distress. [Brazilian Registry of
Clinical Trials (ReBEC): REQ: 1467].

<9>
Accession Number
2014055029
Authors
Skhirtladze K. Base E.M. Lassnigg A. Kaider A. Linke S. Dworschak M.
Hiesmayr M.J.
Institution
(Skhirtladze, Base, Lassnigg, Linke, Dworschak, Hiesmayr) Division of
Cardiothoracic and Vascular Anaesthesiology and Intensive Care Medicine,
Department of Anaesthesiology, General Intensive Care and Pain Medicine,
Medical University of Vienna, Vienna, Austria
(Kaider) Centre for Medical Statistics, Informatics and Intelligent
Systems, Section for Clinical Biometrics, Medical University of Vienna,
Vienna, Austria
Title
Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%,
and Ringer's lactate on blood loss and coagulation after cardiac surgery.
Source
British Journal of Anaesthesia. 112 (2) (pp 255-264), 2014. Date of
Publication: February 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundInfusion of 5% human albumin (HA) and 6% hydroxyethyl starch
130/0.4 (HES) during cardiac surgery expand circulating volume to a
greater extent than crystalloids and would be suitable for a restrictive
fluid therapy regimen. However, HA and HES may affect blood coagulation
and could contribute to increased transfusion requirements.MethodsWe
randomly assigned 240 patients undergoing elective cardiac surgery to
receive up to 50 ml kg^-1 day^-1 of either HA, HES, or
Ringer's lactate (RL) as the main infusion fluid perioperatively. Study
solutions were supplied in identical bottles dressed in opaque covers. The
primary outcome was chest tube drainage over 24 h. Blood transfusions,
thromboelastometry variables, perioperative fluid balance, renal function,
mortality, intensive care unit, and hospital stay were also
assessed.ResultsThe median cumulative blood loss was not different between
the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL
patients required blood products, compared with 62% (HA) and 64% (HES
group; P=0.0003). Significantly, more study solution had to be
administered in the RL group compared with the colloid groups. Total
perioperative fluid balance was least positive in the HA group [6.2 (2.5)
litre] compared with the HES [7.4 (3.0) litre] and RL [8.3 (2.8) litre]
groups (P<0.0001). Both colloids affected clot formation and clot strength
and caused slight increases in serum creatinine.ConclusionsDespite equal
blood loss from chest drains, both colloids interfered with blood
coagulation and produced greater haemodilution, which was associated with
more transfusion of blood products compared with crystalloid use only.
2013 The Author [2013]. Published by Oxford University Press on behalf of
the British Journal of Anaesthesia. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.

<10>
Accession Number
2014053011
Authors
Gurer O. Haberal I. Ozsoy D. Cetin G.
Institution
(Gurer) Department of Cardiovascular Surgery, Hospitalium Hospitals
Camlica, Suadiye, Camli Sokak, Adalar Apt No 27 D:20, Istanbul, Turkey
(Haberal, Ozsoy, Cetin) Department of Cardiovasculary Surgery, Istanbul
University Cardiology Institute, Istanbul, Turkey
Title
Does pulmonary artery venting decrease the incidence of postoperative
atrial fibrillation after conventional aortocoronary bypass surgery?.
Source
Heart Surgery Forum. 16 (6) (pp E303-E308), 2013. Date of Publication:
December 2013.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objectives: In this study, we tested the hypothesis that pulmonary artery
venting would decrease the incidence of atrial fibrillation after coronary
artery bypass surgery. Methods: This prospective study included 301
patients who underwent complete myocardial revascularization with
cardiopulmonary bypass in our department during a 2-year period. The
patients were randomly divided into 2 groups: group I included 151
patients who underwent aortic root venting and group II included 150
patients who underwent pulmonary arterial venting for decompression of the
left heart. Pre-, peri-, and postoperative risk factors for atrial
fibrillation were assessed in both groups. Results: The mean age was
similar in the 2 groups. The mean number of anastomoses was significantly
higher in group I (2.8 + 0.8) than in group II (2.4 + 0.8) (P = 0.001).
The mean cross-clamp time was 42.7 + 17.4 minutes in group I and 54.1 +
23.8 minutes in group II (P = 0.001). The mean cardiopulmonary bypass time
was 66.4 + 46.1 minutes in group I and 77.4 + 28.6 minutes in group II (P
= 0.08). The incidence of atrial fibrillation was 14.5% (n = 21) in group
I and 6.5% (n = 10) in group II (P = 0.02). Multivariate regression
analysis showed that pulmonary artery venting decreased the postoperative
incidence of atrial fibrillation by 17.6%. Conclusions: Pulmonary arterial
venting may be used as an alternative to aortic root venting during
on-pump coronary bypass surgery, especially in patients at high risk of
postoperative atrial fibrillation. 2013 Forum Multimedia Publishing, LLC.

<11>
Accession Number
2014055780
Authors
Youn Y.J. Lee J.-W. Ahn S.G. Lee S.-H. Choi H. Yu C.W. Hong Y.J. Kwon H.M.
Hong M.-K. Jang Y. Yoon J.
Institution
(Youn, Lee, Ahn, Lee, Yoon) Division of Cardiology, Department of Internal
Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan, Wonju,
220-701, South Korea
(Choi) Division of Cardiology, Inje University Ilsan Paik Hospital,
Goyang, South Korea
(Yu) Division of Cardiology, Sejong General Hospital, Bucheon, South Korea
(Hong) Division of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Kwon) Division of Cardiology, Yonsei University Gangnam Severance
Hospital, Yonsei University Gangnam, Seoul, South Korea
(Hong, Jang) Division of Cardiology, Yonsei University Severance
Cardiovascular Hospital, Yonsei University Severance, Seoul, South Korea
Title
Multicenter randomized trial of 3-month cilostazol use in addition to dual
antiplatelet therapy after biolimus-eluting stent implantation for long or
multivessel coronary artery disease.
Source
American Heart Journal. 167 (2) (pp 241-248.e1), 2014. Date of
Publication: February 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background There are conflicting data on the use of cilostazol as triple
antiplatelet therapy (TAPT) for improving clinical outcomes after
drug-eluting stent implantation. We aimed to evaluate whether 3-month use
of cilostazol in addition to dual antiplatelet therapy (DAPT) improved
clinical outcomes in patients with long or multivessel coronary artery
disease (CAD) after biolimus-eluting stent (BES) implantation. Methods
Patients (n = 630) who had been successfully treated with BES implantation
for lesions with >28 mm in stent length or >2 stents for different
coronary arteries were enrolled in this prospective randomized multicenter
trial. All patients were randomly assigned to receive either DAPT (aspirin
and clopidogrel for 12 months, n = 314) or TAPT (DAPT plus 3-month
cilostazol use, n = 316). The primary end point was a device-oriented
composite consisting of cardiac death, myocardial infarction (not clearly
attributable to a nontarget vessel), and ischemia-driven target lesion
revascularization at 1-year follow-up. Results A total of 314 patients in
DAPT and 308 patients in TAPT were analyzed. Multivessel CAD was present
in 65.7% of patients. Stents >28 mm in length were implanted in 58.1% of
lesions. There were no significant differences in baseline and
angiographic characteristics between the 2 groups. The primary end point
was similar between the 2 groups (2.3% in DAPT vs 1.9% in TAPT, log-rank P
=.799). Conclusions In patients treated with BES implantation for long or
multivessel CAD, 3 months of cilostazol use in addition to DAPT did not
improve clinical outcome at 1-year follow-up. 2014 Mosby, Inc.

<12>
Accession Number
2014021967
Authors
Umpierrez G.E. Gianchandani R. Smiley D. Jacobs S. Wesorick D.H. Newton C.
Farrokhi F. Peng L. Reyes D. Lathkar-Pradhan S. Pasquel F.
Institution
(Umpierrez, Smiley, Jacobs, Newton, Farrokhi, Reyes, Pasquel) Department
of Medicine, Emory University, School of Medicine, Atlanta, GA, United
States
(Gianchandani, Wesorick, Lathkar-Pradhan) Department of Internal Medicine,
University of Michigan Health System, Ann Arbor, MI, United States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA,
United States
Title
Safety and efficacy of sitagliptin therapy for the inpatient management of
generalmedicine and surgery patients with type 2 diabetes: A pilot,
randomized, controlled study.
Source
Diabetes Care. 36 (11) (pp 3430-3435), 2013. Date of Publication: November
2013.
Publisher
American Diabetes Association Inc. (1701 North Beauregard St., Alexandria
VA 22311, United States)
Abstract
OBJECTIVE-This study investigated the safety and efficacy of sitagliptin
(Januvia) for the inpatient management of type 2 diabetes (T2D) in general
medicine and surgery patients. RESEARCHDESIGNANDMETHODSdIn this pilot,
multicenter, open-label, randomized study, patients (n = 90) with a known
history of T2D treated with diet, oral antidiabetic agents, or low total
daily dose of insulin (#0.4 units/kg/day) were randomized to receive
sitagliptin alone or in combination with glargine insulin (glargine) or to
a basal bolus insulin regimen (glargine and lispro) plus supplemental
(correction) doses of lispro. Major study outcomes included differences in
daily blood glucose (BG), frequency of treatment failures (defined as
three or more consecutive BG >240 mg/dL or a mean daily BG >240 mg/dL),
and hypoglycemia between groups. RESULTS-Glycemic control improved
similarly in all treatment groups. There were no differences in the mean
daily BG after the 1st day of treatment (P = 0.23), number of readings
within a BG target of 70 and 140 mg/dL (P = 0.53), number of BG readings
>200 mg/dL (P = 0.23), and number of treatment failures (P > 0.99). The
total daily insulin dose and number of insulin injections were
significantly less in the sitagliptin groups compared with the basal bolus
group (both P < 0.001). There were no differences in length of hospital
stay (P = 0.78) or in the number of hypoglycemic events between groups (P
= 0.86). CONCLUSIONS-Results of this pilot indicate that treatment with
sitagliptin alone or in combination with basal insulin is safe and
effective for the management of hyperglycemia in general medicine and
surgery patients with T2D. 2013 by the American Diabetes Association.

<13>
Accession Number
2014030035
Authors
Acker M.A. Parides M.K. Perrault L.P. Moskowitz A.J. Gelijns A.C. Voisine
P. Smith P.K. Hung J.W. Blackstone E.H. Puskas J.D. Argenziano M. Gammie
J.S. Mack M. Ascheim D.D. Bagiella E. Moquete E.G. Ferguson T.B. Horvath
K.A. Geller N.L. Miller M.A. Woo Y.J. D'Alessandro D.A. Ailawadi G.
Dagenais F. Gardner T.J. O'Gara P.T. Michler R.E. Kron I.L.
Institution
(Acker, Woo) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, United States
(Parides, Moskowitz, Gelijns, Ascheim, Bagiella, Moquete) International
Center for Health Outcomes and Innovation Research (InCHOIR), Department
of Health Evidence and Policy, Mount Sinai School of Medicine, 1 Gustave
L. Levy Pl., New York, NY 10029, United States
(Argenziano) Division of Cardiothoracic Surgery, College of Physicians and
Surgeons, Columbia University, New York, United States
(D'Alessandro, Michler) Department of Cardiothoracic Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, United
States
(Perrault) Montreal Heart Institute, University of Montreal, Montreal, NY,
United States
(Voisine, Dagenais) Institut Universitaire de Cardiologie de Quebec,
Hopital Laval, Quebec, QC, Canada
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
(Ferguson) Department of Cardiovascular Sciences, East Carolina Heart
Institute, East Carolina University, Greenville, NC, United States
(Hung) Echocardiography Core Lab., Massachusetts General Hospital, Boston,
United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
(Blackstone) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Puskas) Clinical Research Unit, Division of Cardiothoracic Surgery, Emory
University School of Medicine, Atlanta, United States
(Gammie) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, United States
(Mack) Baylor Research Institute, Dallas, United States
(Horvath) National Institutes of Health (NIH) Heart Center, Suburban
Hospital, NIH, Bethesda, MD, United States
(Geller) Office of Biostatistics Research, NIH, Bethesda, MD, United
States
(Miller) Division of Cardiovascular Sciences, NIH, Bethesda, MD, United
States
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery,
University of Virginia School of Medicine, Charlottesville, United States
(Gardner) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
Title
Mitral-valve repair versus replacement for severe ischemic mitral
regurgitation.
Source
New England Journal of Medicine. 370 (1) (pp 23-32), 2014. Date of
Publication: 2014.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Ischemic mitral regurgitation is associated with a substantial
risk of death. Practice guidelines recommend surgery for patients with a
severe form of this condition but acknowledge that the supporting evidence
for repair or replacement is limited. METHODS: We randomly assigned 251
patients with severe ischemic mitral regurgitation to undergo either
mitral-valve repair or chordal-sparing replacement in order to evaluate
efficacy and safety. The primary end point was the left ventricular
end-systolic volume index (LVESVI) at 12 months, as assessed with the use
of a Wilcoxon rank-sum test in which deaths were categorized below the
lowest LVESVI rank. RESULTS: At 12 months, the mean LVESVI among surviving
patients was 54.6+25.0 ml per square meter of body-surface area in the
repair group and 60.7+31.5 ml per square meter in the replacement group
(mean change from baseline, -6.6 and -6.8 ml per square meter,
respectively). The rate of death was 14.3% in the repair group and 17.6%
in the replacement group (hazard ratio with repair, 0.79; 95% confidence
interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no
significant between-group difference in LVESVI after adjustment for death
(z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of
mitral regurgitation at 12 months was higher in the repair group than in
the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant
between-group differences in the rate of a composite of major adverse
cardiac or cerebrovascular events, in functional status, or in quality of
life at 12 months. CONCLUSIONS: We observed no significant difference in
left ventricular reverse remodeling or survival at 12 months between
patients who underwent mitral-valve repair and those who underwent
mitral-valve replacement. Replacement provided a more durable correction
of mitral regurgitation, but there was no significant between-group
difference in clinical outcomes. Copyright 2014 Massachusetts Medical
Society. All rights reserved.

<14>
Accession Number
2014037832
Authors
Samadikhah J. Golzari S.E.J. Sabermarouf B. karimzadeh I. Tizro P. Khanli
H.M. Ghabili K.
Institution
(Samadikhah, karimzadeh, Tizro, Khanli) Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Golzari) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Golzari) Students' Research Committee, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Sabermarouf) Neurosciences Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Ghabili) Physical Medicine and Rehabilitation Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
Efficacy of combination therapy of statin and vitamin C in comparison with
statin in the prevention of post-CABG atrial fibrillation.
Source
Advanced Pharmaceutical Bulletin. 4 (1) (pp 97-100), 2014. Date of
Publication: March 2014.
Publisher
Tabriz University of Medical Sciences (Daneshgah St, Tabriz 5166614713,
Iran, Islamic Republic of)
Abstract
Purpose: Atrial fibrillation (AF) is the most frequent arrhythmia that
follows coronary artery bypass graft (CABG). Patients developing
postoperative AF (POAF) have significantly higher mortality rates. The
consistent prophylactic effectiveness of statins and vitamin C are
well-accepted; however, no evaluation on combined therapy has been
performed. We aimed at assessing the efficacy of combination therapy with
statin and vitamin C in comparison with statin alone in the prevention of
post CABG-AF. Methods: In a randomized double blind clinical trial, 120
candidates of CABG were recruited in Tabriz Madani Educational Center in a
15-month period of time. Patients were randomized into two groups of 60
receiving oral atorvastatin (40mg) plus oral vitamin C (2g/d operation day
and 1g/d for five consequent days) for intervention group and oral
atorvastatin (40mg) for control group. Occurrence of post CABG AF was
compared between the two groups. Results: There were 60 patients, 43 males
and 17 females with a mean age of 61.0+11.5 (29-78) years, in the
intervention group and sixty patients, 39 males and 21 females with a mean
age of 60.5+11.3 (39-81) years, in the control group. The post CABG AF
occurred in 6 cases (10%) in the interventional group and 15 patients
(25%) in the controls (P=0.03, odds ratio=0.33, 95% confidence interval
0.12-0.93). Conclusion: Based on our findings, combination prophylaxis
against post CABG AF with oral atorvastatin plus vitamin C is
significantly more effective than single oral atorvastatin. 2014 by
Tabriz University of Medical Sciences.

<15>
Accession Number
2014057808
Authors
Lambert L.M. Pike N.A. Medoff-Cooper B. Zak V. Pemberton V.L.
Young-Borkowski L. Clabby M.L. Nelson K.N. Ohye R.G. Trainor B. Uzark K.
Rudd N. Bannister L. Korsin R. Cooper D.S. Pizarro C. Zyblewski S.C.
Bartle B.H. Williams R.V.
Institution
(Lambert) Primary Children's Medical Center, Salt Lake City, UT, United
States
(Pike) University of California, Los Angeles, CA, United States
(Medoff-Cooper) University of Pennsylvania, School of Nursing, Children's
Hospital of Philadelphia, Philadelphia, PA, United States
(Zak) New England Research Institutes, Watertown, MA, United States
(Pemberton) National Institutes of Health, National Heart, Lung and Blood
Institute, Bethesda, MD, United States
(Young-Borkowski, Rudd) Medical College of Wisconsin, Children's Hospital
of Wisconsin, Milwaukee, WI, United States
(Clabby) Emory University, Children's Healthcare of Atlanta, Atlanta, GA,
United States
(Nelson) University of Michigan, C. S. Mott Children's Hospital Congenital
Heart Center, Ann Arbor, MI, United States
(Ohye) University of Michigan School of Medicine, C. S. Mott Children's
Hospital Congenital Heart Center, Ann Arbor, MI, United States
(Trainor) Boston Children's Hospital, Boston, MA, United States
(Uzark) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Bannister) Hospital for Sick Children, Toronto, ON, Canada
(Korsin) Columbia University, New York, NY, United States
(Cooper) Congenital Heart Institute of Florida, Orlando, FL, United States
(Pizarro) Nemours Cardiac Center, Alfred I. DuPont Hospital for Children,
Wilmington, DE, United States
(Zyblewski) Medical University of South Carolina, Charleston, SC, United
States
(Bartle) Duke University, Durham, NC, United States
(Williams) University of Utah School of Medicine, Salt Lake City, UT,
United States
Title
Variation in feeding practices following the Norwood procedure.
Source
Journal of Pediatrics. 164 (2) (pp 237-242.e1), 2014. Date of Publication:
February 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives To assess variation in feeding practice at hospital discharge
after the Norwood procedure, factors associated with tube feeding, and
associations among site, feeding mode, and growth before stage II. Study
design From May 2005 to July 2008, 555 subjects from 15 centers were
enrolled in the Pediatric Heart Network Single Ventricle Reconstruction
Trial; 432 survivors with feeding data at hospital discharge after the
Norwood procedure were analyzed. Results Demographic and clinical
variables were compared among 4 feeding modes: oral only (n = 140),
oral/tube (n = 195), nasogastric tube (N-tube) only (n = 40), and
gastrostomy tube (G-tube) only (n = 57). There was significant variation
in feeding mode among sites (oral only 0%-81% and G-tube only 0%-56%, P
<.01). After adjusting for site, multivariable modeling showed G-tube
feeding at discharge was associated with longer hospitalization, and
N-tube feeding was associated with greater number of discharge medications
(R² = 0.65, P <.01). After adjusting for site, mean pre-stage
II weight-for-age z-score was significantly higher in the oral-only group
(-1.4) vs the N-tube-only (-2.2) and G-tube-only (-2.1) groups (P =.04
and.02, respectively). Conclusions Feeding mode at hospital discharge
after the Norwood procedure varied among sites. Prolonged hospitalization
and greater number of medications at the time of discharge were associated
with tube feeding. Infants exclusively fed orally had a higher
weight-for-age z score pre-stage II than those fed exclusively by tube.
Exploring strategies to prevent morbidities and promote oral feeding in
this highest risk population is warranted.

<16>
Accession Number
2014055778
Authors
Woudstra P. Grundeken M.J. Kraak R.P. Hassell M.E.C.J. Arkenbout E.K. Baan
Jr. J. Vis M.M. Koch K.T. Tijssen J.G.P. Piek J.J. De Winter R.J.
Henriques J.P.S. Wykrzykowska J.J.
Institution
(Woudstra, Grundeken, Kraak, Hassell, Arkenbout, Baan Jr., Vis, Koch,
Tijssen, Piek, De Winter, Henriques, Wykrzykowska) Heartcenter, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
Title
Amsterdam Investigator-initiateD Absorb strategy all-comers trial (AIDA
trial): A clinical evaluation comparing the efficacy and performance of
ABSORB everolimus-eluting bioresorbable vascular scaffold strategy vs the
XIENCE family (XIENCE PRIME or XIENCE Xpedition) everolimus-eluting
coronary stent strategy in the treatment of coronary lesions in
consecutive all-comers: Rationale and study design.
Source
American Heart Journal. 167 (2) (pp 133-140), 2014. Date of Publication:
February 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background The Absorb everolimus-eluting bioresorbable vascular scaffold
(AbsorbBVS) is a completely resorbable device engineered to overcome the
limitations of permanent metallic stents, providing temporary scaffolding
and antiproliferative drug delivery for the treatment of obstructive
coronary artery disease. Methods The objective of the AIDA trial is to
evaluate the efficacy and performance in an contemporary all-comer
population of the AbsorbBVS strategy vs the XIENCE family
everolimus-eluting metallic coronary stent system in the treatment of
coronary lesions. The AIDA trial is a prospective, randomized (1:1),
active-control, single-blinded, all-comer, noninferiority trial. A total
of 2,690 subjects will be enrolled with broad inclusion and limited
exclusion criteria according to the "Instructions for Use" of the
AbsorbBVS strategy. The study population includes both simple and complex
lesions, in patients with stable and acute coronary syndrome. The
follow-up continues for 5 years. The primary end point of the trial is
target vessel failure, defined as the composite of cardiac death,
myocardial infarction, and target vessel revascularization, at 2 years.
This study is registered on ClinicalTrials.gov with number NCT01858077.
Conclusion The AIDA trial will provide the first randomized direct
comparison between the everolimus-eluting bioresorbable vascular scaffold
and the everolimus-eluting metallic stent in contemporary percutaneous
coronary intervention practice. 2014 Mosby, Inc.

<17>
Accession Number
2014055764
Authors
Dalsgaard M. Iversen K. Kjaergaard J. Grande P. Goetze J.P. Clemmensen P.
Hassager C.
Institution
(Dalsgaard, Kjaergaard, Grande, Goetze, Clemmensen, Hassager) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, DK-2100
Copenhagen O, Denmark
(Iversen) Department of Cardiology, Copenhagen University Hospital,
Hillerod Hospital, Hillerod, Denmark
Title
Short-term hemodynamic effect of angiotensin-converting enzyme inhibition
in patients with severe aortic stenosis: A placebo-controlled, randomized
study.
Source
American Heart Journal. 167 (2) (pp 226-234), 2014. Date of Publication:
February 2014.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background In patients with severe aortic stenosis (AS), treatment with
angiotensin-converting enzyme inhibitors has previously been considered
contraindicated. However, there is a lack of clinical evidence to confirm
these potential hemodynamic risks and benefits. Methods Forty-four
patients with severe AS (aortic valve area <1 cm²) were
randomized to treatment with trandolapril 22 mg daily/placebo (1:1). Right
heart catheterization and echocardiography were performed at rest and
during exercise at baseline and on day 3. Follow-up was performed before
valve replacement or after a maximum of 8 weeks, when exercise
echocardiography was repeated. Results Compared with placebo, systolic
blood pressure and systemic arterial compliance significantly changed at
day 3 (-14 + 11 vs -5 + 13 mm Hg, P =.02, and 0.08 + 0.16 vs -0.05 + 0.86
mL/m² per mm Hg, P =.03, respectively). Changes in left
ventricular end systolic volume (LVESV) was nonsignificant (-8 + 9 vs -3 +
11 mL, P =.17). At a median of 49 days of follow-up, changes in LVESV and
N-terminal pro-brain natriuretic peptide were even lower revealing
significant differences between the groups (-7.8 + 2.6 vs -0.5 + 2.5 mL, P
=.04, and -19 + 7 vs 0.8 + 6 pmol/L, P =.04, respectively). No episodes of
symptomatic hypotension were noted, and other hemodynamic parameters
remained unchanged. Conclusion Angiotensin-converting enzyme inhibition in
severe AS caused a decrease in LVESV and N-terminal pro-brain natriuretic
peptide with other hemodynamic parameters preserved both at rest and
during exercise implying hemodynamic improvement with left ventricular
unloading. 2014 Mosby, Inc.

<18>
Accession Number
2014055062
Authors
Hong D.M. Lee E.-H. Kim H.J. Min J.J. Chin J.-H. Choi D.-K. Bahk J.-H. Sim
J.-Y. Choi I.-C. Jeon Y.
Institution
(Hong, Kim, Min, Bahk, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Daehakro 101 Seoul 110-744,
South, South Korea
(Lee, Chin, Choi, Sim, Choi) Department of Anesthesiology and Pain
Medicine, Asan Medical Centre, University of Ulsan College of Medicine,
Seoul, South Korea
Title
Does remote ischaemic preconditioning with postconditioning improve
clinical outcomes of patients undergoing cardiac surgery? Remote Ischaemic
Preconditioning with Postconditioning Outcome Trial.
Source
European Heart Journal. 35 (3) (pp 176-183), 2014. Date of Publication:
January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims The aim of this study was to evaluate whether remote ischaemic
preconditioning (RIPC) combined with remote ischaemic postconditioning
(RIPostC) improves the clinical outcomes of patients undergoing cardiac
surgery. Methods and resultsFrom June 2009 to November 2010, 1280 patients
who underwent elective cardiac surgery were randomized into the RIPC with
RIPostC group or the control group in the morning of the surgery. In the
RIPC with RIPostC group, four cycles of 5-min ischaemia and 5-min
reperfusion were administered twice to the upper limb-before
cardiopulmonary bypass (CPB) or coronary anastomoses for RIPC and after
CPB or coronary anastomoses for RIPostC. The primary endpoint was the
composite of major adverse outcomes, including death, myocardial
infarction, arrhythmia, stroke, coma, renal failure or dysfunction,
respiratory failure, cardiogenic shock, gastrointestinal complication, and
multiorgan failure. Remote ischaemic preconditioning with RIPostC did not
reduce the composite outcome compared with the control group (38.0 vs.
38.1%, respectively; P = 0.998) and there was no difference in each major
adverse outcome. The intensive care unit and hospital stays were not
different between the two groups. However, in the off-pump coronary artery
bypass surgery subgroup, multivariate logistic regression analysis
revealed that RIPC with RIPostC was related to increased composite outcome
(odds ratio: 1.54; 95% confidence interval: 1.02-2.30; P =
0.038).Conclusion Remote ischaemic preconditioning with RIPostC by
transient upper limb ischaemia did not improve clinical outcome in
patients who underwent cardiac surgery.Clinical Trial Registration
clinicaltrials.gov, NCT00997217. 2013 The Author.

<19>
Accession Number
71301079
Authors
Rattanasiri S. McDaniel D. Viwatwongkaseam C. Rojanavipart P. Thakkinstian
A.
Institution
(Rattanasiri, Thakkinstian) Section for Clinical Epidemiology and
Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
(McDaniel) Department of Surgery, University of Mississippi Medical
Center, Jackson, MS, United States
(Viwatwongkaseam, Rojanavipart) Department of Biostatistics, Faculty of
Public Health, Mahidol University, Bangkok, Thailand
Title
Meta-analysis of cytokine gene polymorphisms and outcome of heart
transplantation.
Source
European Journal of Epidemiology. Conference: EuroEpi 2013 and NordicEpi
2013: Non-Communicable Disease Epidemic: Epidemiology in Action Aarhus
Denmark. Conference Start: 20130811 Conference End: 20130814. Conference
Publication: (var.pagings). 28 (1 SUPPL. 1) (pp S150-S151), 2013. Date of
Publication: August 2013.
Publisher
Springer Netherlands
Abstract
Background: It has been reported that cytokine gene polymorphisms were
associated with graft rejection after heart transplantation. However, gene
effects were controversial, i.e., some studies found positive associations
while others did not. Objectives: To perform a systematic review and
meta-analysis with the aim at assessing effects of cytokine polymorphisms
on graft rejection in heart transplantation. Methods: We identified
relevant studies from Medline and Embase since inception to February 2013.
Data extraction and risk of bias assessment were independently performed
by two reviewers. Allele frequencies were pooled, genotypic effects were
assessed using a mixed-logit model. Heterogeneity and publication bias
were assessed. Results: Four to five studies were included in the pooling
of TNFa- 308, TGFb1-c10, and TGFb1-c25 polymorphisms. The pooled
prevalence of the minor A, C, and C alleles in the control groups for
TNFa-308, TGFb1-c10, and TGFb1-c25 were respectively 0.166 (95 % CI 0.129,
0.203), 0.413 (95 % CI 0.363, 0.462), and 0.082 (95 % CI 0.054, 0.111).
Carrying the A allele for the TNFa-308 had 18 % (95 % CI of OR 0.46, 3.01)
increased risk but not significant for graft rejection than the G allele.
For the genotype effects, carrying AA and GA genotypes were respectively
1.98 (95 % CI 0.30, 13.12) and 1.11 (95 % CI 0.61, 2.02) times
non-significantly higher odds of graft rejection than those carrying the
GG genotype. The effect of TGFb1 at c10 and c25 polymorphisms were
conversely; carrying the C alleles for both TGFb1 at c10 and c25 were
non-significantly lower odds of graft rejection with the pooled ORs of
0.87 (95 % CI 0.65, 1.18) and 0.70 (95 % CI 0.40, 1.23), than those
carrying the T and G alleles, respectively. The CC and TC genotypes for
TGFb1-c10 were 0.76 (95 % CI 0.40, 1.46) and 0.84 (95 % CI 0.53, 1.33)
times non-significantly lower odds of graft rejection than those carrying
the TT genotype, respectively. The OR for TGFb1-c25 was 0.63 (95 % CI
0.35, 1.14), that is carrying CC/GC were approximately at 37 %
nonsignificance lower risk of graft rejection than those with GG genotype.
The genotypic effects of the 3 polymorphisms were mild to moderately
heterogeneous. There was no evidence of publication bias for all poolings.
Conclusions: Although none of these 3 polymorphisms were significantly
associated with graft rejection in heart transplantation, this review
suggested signals of associations. An updated meta-analysis is required
when more studies have been published to increase the power of detection
for the association between these polymorphisms and allograft rejection.