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<1>
Accession Number
23179678
Authors
Whalley B. Thompson D.R. Taylor R.S.
Institution
(Whalley) School of Psychology, University of Plymouth, Plymouth, UK.
Title
Psychological interventions for coronary heart disease: cochrane
systematic review and meta-analysis.
Source
International journal of behavioral medicine. 21 (1) (pp 109-121), 2014.
Date of Publication: Feb 2014.
Abstract
Depression and anxiety are common in cardiac patients, and psychological
interventions may also be used as part of general cardiac rehabilitation
programs. This study aims to estimate effects of psychological
interventions on mortality and psychological symptoms in this group,
updating an existing Cochrane Review. Systematic review and
meta-regression analyses of randomized trials evaluating a psychological
treatment delivered by trained staff to patients with a diagnosed cardiac
disease, with a follow-up of at least 6 months, were used. There was no
strong evidence that psychological intervention reduced total deaths, risk
of revascularization, or non-fatal infarction. Psychological intervention
did result in small/moderate improvements in depression and anxiety, and
there was a small effect for cardiac mortality. Psychological treatments
appear effective in treating patients with psychological symptoms of
coronary heart disease. Uncertainty remains regarding the subgroups of
patients who would benefit most from treatment and the characteristics of
successful interventions.

<2>
Accession Number
2014331916
Authors
Pu J. Liu Z. Yang L. Wang Y. Jiang J.
Institution
(Pu, Yang, Wang, Jiang) Department of Anesthesiology, Changzheng Hospital,
Second Military Medical University, 415 Fengyang Road, Shanghai, China
(Liu) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
College, Xuzhou, 221002, China
Title
Applications of pressure control ventilation volume guaranteed during
one-lung ventilation in thoracic surgery.
Source
International Journal of Clinical and Experimental Medicine. 7 (4) (pp
1094-1098), 2014. Date of Publication: 30 Apr 2014.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To explore the effects of ventilatory mode "pressure controlled
ventilation-volume guaranteed" (PCV-VG) on the inspiratory pressures,
oxygenation parameters and hemodynamics of patients during one lung
ventilation (OLV) for thoracic surgery, compared with volume controlled
ventilation (VCV). Methods: Twenty participants were recruited and equally
assigned into two groups in a controlled, randomized, crossover design.
Group A: VCV was performed initially and changed into PCV-VG after 30 min;
Group B: In the reverse order. Blood gas analysis, peak inspiratory
pressure (Ppeak), mean inspiratory pressure (Pmean), plateau inspiratory
pressure (Plateau) were measured at four different time points: (1) 30 min
after total lung ventilation (TLV); (2) 30 min after one lung ventilation
(VCV or PCV-VG); (3) 30 min after shifting to the other ventilatory mode,
and (4) 30 min after reconstruction of TLV. Results: The Ppeak, Plateau,
and Pmean were significantly lower in PCV-VG compared with VCV. There was
significant increase in arterial partial pressure of oxygen under PCV-VG.
Conclusion: In patients undergoing thoracic surgery with OLV, pressure
controlled volume guaranteed mode of ventilation may have better effects
by decreasing inspiratory pressure parameters and improving arterial
oxygenation than volume controlled ventilation.

<3>
Accession Number
2014337036
Authors
Lombardi J.V. Cambria R.P. Nienaber C.A. Chiesa R. Mossop P. Haulon S.
Zhou Q. Jia F.
Institution
(Lombardi) Department of Surgery, Cooper University Hospital, Camden, NJ,
United States
(Cambria) Department of Surgery, Massachusetts General Hospital, Boston,
MA, United States
(Nienaber) Department of Medicine, University Hospital Rostock, Rostock,
Germany
(Chiesa) Department of Surgery, Hospital San Raffaele, Milan, Italy
(Mossop) Department of Radiology, St. Vincent's Hospital, Melbourne, VIC,
Australia
(Haulon) Department of Surgery, Hospital Cardiologique, Chru de Lille,
Lille, France
(Zhou, Jia) MED Institute, West Lafayette, IN, United States
Title
Aortic remodeling after endovascular treatment of complicated type B
aortic dissection with the use of a composite device design.
Source
Journal of Vascular Surgery. 59 (6) (pp 1544-1554), 2014. Date of
Publication: June 2014.
Publisher
Mosby Inc.
Abstract
Objective The purpose of this study is to report updated clinical and
aortic remodeling results from the Study for the Treatment of complicated
Type B Aortic Dissection using Endoluminal repair (STABLE) trial, a
prospective, multicenter study evaluating safety and effectiveness of a
pathology-specific endovascular system (proximal stent graft and distal
bare metal stent) for the treatment of complicated type B aortic
dissection. Methods All 86 enrolled patients (mean age, 59 years; 73.3%
men) were treated within 90 days of symptom onset (55 with acute
dissections and 31 with nonacute dissections). Inclusion criteria were
branch vessel obstruction/compromise, impending rupture as evidenced by
periaortic effusion/hematoma, resistant hypertension, persistent
pain/symptoms, or aortic growth >5 mm within 3 months (or transaortic
diameter >40 mm). Remodeling of the dissected aorta, including thrombosis
of the false lumen and changes in the true lumen, false lumen, and
transaortic diameter, were assessed in patients with available computed
tomographic imaging through 2 years. Results The 30-day mortality rate was
4.7% (4/86) in the overall patient group (5.5% in acute patients and 3.2%
in non-acute patients). Freedom from all-cause mortality was 88.3% at 1
year and 84.7% at 2 years (no significant difference between acute and
nonacute patients). From baseline to 2 years, the true lumen diameter
increased significantly in the descending thoracic aorta and the more
distal abdominal aorta, along with a decrease in the false lumen diameter
in both aortic segments. A majority of patients had either a stable or
shrinking transaortic diameter in the thoracic (80.3% at 1 year and 73.9%
at 2 years) or abdominal aorta (79.1% at 1 year and 66.7% at 2 years).
Transaortic growth (>5 mm) occurred predominantly in acute dissections.
Consistently, a shorter time from symptom onset to treatment was found to
predict transaortic growth in the abdominal aorta (P =.03). Conclusions
Endovascular repair of complicated type B aortic dissection with the use
of a composite construct demonstrates favorable early clinical outcomes
and aortic remodeling. However, patients treated in the acute setting may
be prone to aortic growth and may require close observation. Follow-up
through 5 years is ongoing. 2014 by the Society for Vascular Surgery.
Published by Elsevier Inc. All rights reserved.

<4>
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Accession Number
2014333627
Authors
Gielen M. Vanhorebeek I. Wouters P.J. Mesotten D. Wernerman J. Van Den
Berghe G. Rooyackers O.
Institution
(Gielen, Vanhorebeek, Wouters, Mesotten, Van Den Berghe) Clinical
Department and Laboratory of Intensive Care Medicine, Division of Cellular
and Molecular Medicine, KU Leuven, Leuven, Belgium
(Wernerman, Rooyackers) Department of Anaesthesiology and Intensive Care,
Karolinska University Hospital, Huddinge, Sweden
(Wernerman, Rooyackers) Department of Clinical Science Intervention and
Technology, CLINTEC, Karolinska Institutet, Huddinge, Sweden
Title
Amino acid concentrations in critically Ill children following cardiac
surgery.
Source
Pediatric Critical Care Medicine. 15 (4) (pp 314-328), 2014. Date of
Publication: May 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Guidelines for administering amino acids to critically ill
children are largely based on uncontrolled observational studies and
expert opinion, without support from rigorous outcome studies. Also, data
on circulating amino acid concentrations during critical illness are
scarce. We thoroughly studied the time profiles of circulating amino acid
concentrations in critically ill children who received standard
nutritional care according to international guidelines. Design: This is a
subanalysis of pediatric critically ill patients included in a large (n =
700) randomized controlled study on intensive insulin therapy. Setting:
The study was conducted at a university hospital PICU. Patients: We
studied 100 patients in PICU for at least 3 days following cardiac
surgery. Interventions: Patients were assigned to intensive insulin
therapy targeting normal-for-age fasting blood glucose concentrations or
insulin infusion only to prevent excessive hyperglycemia. Measurements and
Main Results: Plasma amino acid concentrations were measured at admission,
day 3, and day 7 in PICU. At admission, the concentrations of most amino
acids were comparable to those reported for healthy children. Total amino
acid concentrations remained stable during ICU stay, but individual amino
acids showed different time profiles with eight of them showing an
increase and five a decrease. Nonsurviving children had higher total amino
acid concentrations and individual amino acids compared with survivors at
admission and/or during ICU stay. Intensive insulin therapy lowered the
concentrations of total amino acids and several individual amino acids.
Neonates showed somewhat different amino acid profiles with rather
increased concentrations from baseline with time in ICU for total amino
acids and several individual amino acids as compared with older infants
and children. Conclusions: Circulating amino acid concentrations in
critically ill children after cardiac surgery differ according to survival
status, blood glucose control with intensive insulin therapy, and age.
Copyright 2014 by the Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies.

<5>
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Accession Number
2014336595
Authors
Singh M. Singh P. Grewal P. Kovacs D. Molnar J. Arora R. Khosla S.
Institution
(Singh, Singh, Grewal, Kovacs, Molnar, Arora, Khosla) Department of
Cardiology, Chicago Medical School, 3333, Green Bay Road, North Chicago,
IL 60068, United States
Title
Clinical outcomes after percutaneous coronary intervention in patients
with mild versus moderate renal insufficiency at 30-day and 1-year
follow-up.
Source
American Journal of Therapeutics. 21 (3) (pp 184-192), 2014. Date of
Publication: May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Percutaneous coronary intervention (PCI) is a standard of care in the
management of coronary artery disease in patients with renal insufficiency
(RI). However, outcomes of PCI in these patients remain suboptimal with
high cardiovascular morbidity and mortality. The studies comparing target
vessel revascularization (TVR) after PCI in patients with mild and
moderate RI have shown conflicting results. Hence, a meta-Analysis of
these studies comparing 30-day and 1-year outcomes after PCI was
performed. A systematic review of literature revealed 5 studies involving
16,262 patients. Based on the creatinine clearance (CrCl), patients were
divided into 2 groups (mild RI, CrCl > 60 mL/min and moderate RI, CrCl of
30-60 mL/min). End points extracted were all-cause mortality, TVR,
myocardial infarction, and major adverse cardiac events at 30-day and
1-year follow-up. Combined relative risks (RR) across all the studies and
95% confidence intervals (CIs) were computed. A 2-sided alpha error of
<0.05 was considered statistically significant. Both groups had similar
baseline characteristics. Rate of TVR at 30 days was significantly lower
in the mild RI group than in the moderate RI group (RR, 1.45; 95% CI,
1.04-2.02; P < 0.05). However, rate of TVR at 1-year follow-up was similar
in both groups (RR, 1.02; 95% CI, 0.94-1.11; P, nonsignificant). Incidence
of all-cause mortality, TVR, myocardial infarction, and major adverse
cardiac events remained higher in the moderate RI group both at 30-day and
1-year follow-up (P < 0.05 for all outcomes). Patients with moderate RI
have higher morbidity and mortality at 30 days and 1 year after PCI
compared with patients with mild RI. However, there is no difference in
the incidence of TVR after PCI at 1 year between the 2 groups. 2013
Lippincott Williams & Wilkins.

<6>
Accession Number
2014338881
Authors
Saczkowski R. Malas T. Mesana T. de Kerchove L. El Khoury G. Boodhwani M.
Institution
(Saczkowski, Malas, Mesana, Boodhwani) Division of Cardiac Surgery,
University of Ottawa Heart Institute, Ottawa, ON, Canada
(de Kerchove, El Khoury) Department of Thoracic and Cardiovascular
Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium
Title
Aortic valve preservation and repair in acute type A aortic dissection.
Source
European Journal of Cardio-thoracic Surgery. 45 (6) (pp e220-e226), 2014.
Article Number: ezu099. Date of Publication: February 2014.
Publisher
Elsevier
Abstract
Objectives: Repair and preservation of the aortic valve in Type A aortic
dissection (AAD) remains controversial. We performed a meta-analysis of
outcomes for aortic valve (AV) repair and preservation in AAD focusing on
long-term valve-related events. Methods: Structured searches were
performed in Embase (1980-2013) and PubMed (1966-2013) for studies
reporting AV repair or preservation in AAD. Early mortality and linearized
rates for late mortality and valve-related events were derived. Outcome
data were pooled with an inverse-variance-weighted random-effects model.
RESULTS: Of 5325 screened articles, 19 observational studies met the
eligibility criteria consisting of 2402 patients with a median follow-up
of 4.1 [range: 3.1-12.6 years, total 13 733 patient-years (pt-yr)]. The
cohort was principally male (median = 68.1%, range: 39-89) with a median
age of 59 (range: 55-68) years and Marfan's syndrome was present in 2.5%.
AV resuspension was performed in 95% of the patients and the remainder
underwent valve-sparing root replacement (reimplantation = 2.5% and
remodelling = 2.5%). Pooled early mortality rate was 18.7% [95% confidence
interval (95% CI): 12.2-26.2%], and linearized late mortality rate was
4.7%/pt-yr (95% CI: 3.4-6.3). Linearized rate for AV reintervention was
2.1%/pt-yr (95% CI: 1.0-3.6), recurrent aortic insufficiency (>2+) was
0.9%/pt-yr (95% CI: 0.3-2.2) and endocarditis was 0.2%/pt-yr (95% CI:
0.1-0.5). The composite rate of thromboembolism and bleeding was
1.4%/pt-yr (95% CI: 0.7-2.2). Conclusions: Patients surviving an AAD have
a limited long-term survival. Preservation and repair of the aortic valve
is associated with a moderate risk of reoperation, but a low risk of
thromboembolism, bleeding and endocarditis. The Author 2014. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2014338843
Authors
Steinthorsdottir K.J. Wildgaard L. Hansen H.J. Petersen R.H. Wildgaard K.
Institution
(Steinthorsdottir, Hansen, Petersen) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University, Copenhagen, Denmark
(Wildgaard) The Royal School of Library and Information Science,
University of Copenhagen, Copenhagen, Denmark
(Wildgaard) Section for Surgical Pathophysiology, Rigshospitalet,
Copenhagen University, Copenhagen, Denmark
Title
Regional analgesia for video-assisted thoracic surgery: A systematic
review.
Source
European Journal of Cardio-thoracic Surgery. 45 (6) (pp 959-966), 2014.
Article Number: ezt525. Date of Publication: February 2014.
Publisher
Elsevier
Abstract
Video-assisted thoracic surgery (VATS) is emerging as the standard
surgical procedure for both minor and major oncological lung surgery.
Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are
established analgesic golden standards for open surgery such as
thoracotomy; however, there is no gold standard for regional analgesia for
VATS. This systematic review aimed to assess different regional techniques
with regard to effect on acute postoperative pain following VATS, with
emphasis on VATS lobectomy. The systematic review of PubMed, The Cochrane
Library and Embase databases yielded 1542 unique abstracts; 17 articles
were included for qualitative assessment, of which three were studies on
VATS lobectomy. The analgesic techniques included TEA, multilevel and
single PVB, paravertebral catheter, intercostal catheter, interpleural
infusion and long thoracic nerve block. Overall, the studies were
heterogeneous with small numbers of participants. In comparative studies,
TEA and especially PVB showed some effect on pain scores, but were often
compared with an inferior analgesic treatment. Other techniques showed no
unequivocal results. No clear gold standard for regional analgesia for
VATS could be demonstrated, but a guide of factors to include in future
studies on regional analgesia for VATS is presented. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
2014331314
Authors
Kotb A. Hsieh S. Wells G.A.
Institution
(Kotb, Wells) Department of Epidemiology and Community Medicine,
University of Ottawa, Ottawa, ON, Canada
(Kotb, Hsieh, Wells) Cardiovascular Research Methods Centre, University of
Ottawa Heart Institute, Ottawa, ON, Canada
Title
The effect of telephone support interventions on Coronary Artery Disease
(CAD) patient outcomes during cardiac rehabilitation: A systematic review
and meta-analysis.
Source
PLoS ONE. 9 (5) , 2014. Article Number: e96581. Date of Publication: 05
May 2014.
Publisher
Public Library of Science
Abstract
Background: Cardiac rehabilitation is offered to individuals after cardiac
events to aid recovery and reduce the likelihood of further cardiac
illness. However, patient participation remains suboptimal and the
provision of high quality care to an expanding population of patients with
chronic heart conditions is becoming increasingly difficult. A systematic
review and meta-analysis was conducted to determine the effect of
telephone support interventions compared with standard post-discharge care
on coronary artery disease patient outcomes. Methods: The Cochrane
Library, MEDLINE, EMBASE, and CINAHL were searched and randomized
controlled trials that directly compared telephone interventions with
standard post-discharge care in adults following a myocardial infarction
or a revascularization procedure were included. Study selection, data
extraction and quality assessment were completed independently by two
reviewers. Where appropriate, outcome data were combined and analyzed
using a random effects model. For each dichotomous outcome, odds ratios
(OR) and 95% confidence intervals (CI) were derived for each outcome. For
continuous outcomes, weighted mean differences (WMD) and standardized mean
differences (SMD) and 95% CI were calculated. Results: 26 studies met the
inclusion criteria. No difference was observed in mortality between the
telephone group and the group receiving standard care OR 1.12 (0.71,
1.77). The intervention was significantly associated with fewer
hospitalizations than the comparison group OR 0.62 (0.40, 0.97).
Significantly more participants in the telephone group stopped smoking OR
1.32 (1.07, 1.62); had lower systolic blood pressure WMD -0.22 (-0.40,
-0.04); lower depression scores SMD -0.10 (-0.21, -0.00); and lower
anxiety scores SMD -0.14 (-0.24, -0.04). However, no significant
difference was observed for low-density lipoprotein levels WMD -0.10
(-0.23, 0.03). Conclusions: Compared to standard post-discharge care,
regular telephone support interventions may help reduce feelings of
anxiety and depression as well as, improve systolic blood pressure control
and the likelihood of smoking cessation. 2014 Kotb et al.

<9>
[Use Link to view the full text]
Accession Number
2014329353
Authors
Caiazzo G. De Rosa S. Torella D. Spaccarotella C. Mongiardo A. Giampa S.
Micieli M. Palella E. Gulletta E. Indolfi C.
Institution
(Caiazzo, De Rosa, Torella, Spaccarotella, Mongiardo, Giampa, Micieli,
Indolfi) Division of Cardiology, Department of Medical and Surgical
Sciences, Catanzaro 88100, Italy
(Palella, Gulletta) Clinical Pathology Unit, Department of Health
Sciences, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
(Indolfi) Department of Medicine, Consiglio Nazionale delle Ricerche,
Catanzaro 88100, Italy
Title
Administration of a loading dose has no additive effect on platelet
aggregation during the switch from ongoing clopidogrel treatment to
ticagrelor in patients with acute coronary syndrome.
Source
Circulation: Cardiovascular Interventions. 7 (1) (pp 104-112), 2014. Date
of Publication: February 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Ticagrelor outperforms clopidogrel in preventing cardiovascular
events in acute coronary syndrome. Despite the inclusion of a loading dose
in the Platelet Inhibition and Patient Outcomes (PLATO) trial for all
patients randomized to ticagrelor, it may not be necessary in patients
receiving ongoing clopidogrel therapy. The aim of the present study was to
assess whether a ticagrelor loading dose is associated with a further
platelet inhibition during the switch from clopidogrel to ticagrelor in
patients with acute coronary syndrome receiving ongoing antiplatelet
treatment. Methods and Results-Fifty patients with acute coronary syndrome
receiving aspirin and clopidogrel treatment were randomly assigned to a
starting dose of ticagrelor (group 1, 90 mg; group 2, 180 mg). Platelet
aggregation was measured using multiple electrode aggregometry and
standard light transmission aggregometry just before the switch and at 2,
6, 24, and 72 hours. No relevant difference in platelet aggregation was
observed between the 2 study arms at baseline (P=0.256). Residual platelet
aggregation was significantly reduced in both arms 2 hours after the first
administration of ticagrelor (P<0.001 for both), with no difference in
aggregation between groups (multiple electrode aggregometry, 17.6+7.2
versus 18.1+6 U; P=0.281). Similar results were observed with LTA.
Conclusions-Switching from clopidogrel to ticagrelor without a reloading
dose is feasible, and it does not hinder platelet aggregation inhibition
in patients with acute coronary syndrome. Further prospective studies are
needed to assess the clinical relevance of our findings. 2014 American
Heart Association, Inc.

<10>
Accession Number
2014333030
Authors
Rashidi A. Fisher S.I.
Institution
(Rashidi) Division of Oncology, Washington University School of Medicine,
St. Louis, MO, United States
(Fisher) Pathology Sciences Medical Group/Sentara Laboratory Services,
Norfolk, VA, United States
Title
Acute myeloid leukemia following solid organ transplantation: Entity or
novelty?.
Source
European Journal of Haematology. 92 (6) (pp 459-466), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Due to the rarity of the disease, the characteristics of acute myeloid
leukemia following solid organ transplantation (post-transplant AML;
PT-AML) are unclear; furthermore, it is not known for certain whether
PT-AML is a separate entity or not. We provide a systematic review of all
previously reported cases of PT-AML in the English literature (n = 51).
45% of cases occurred after renal transplantation, and 72% were males. The
median age at diagnosis of AML was 50 yr, with a median transplant-to-AML
interval of 3.8 yr and a rapid decline in incidence after 5 yr. 26% of
patients were asymptomatic at the time of presentation, and 42% were
pancytopenic. M0/M1/M2, M3, M4/M5, and M6/M7 subtypes comprised 17%, 25%,
39%, and 19% of all cases, respectively. 36% of patients had unfavorable
cytogenetic risk disease. The median overall survival was only 3 months.
We observed several transplant-specific features: (i) The
transplant-to-AML interval follows two very different patterns between
renal vs. liver transplant patients. (ii) All 4 cases of donor cell
leukemia occurred after liver transplant. (iii) Unfavorable risk disease
was marginally significantly more common among renal compared with liver
transplant patients (P = 0.057). Our results suggest that PT-AML is a
separate entity with distinct characteristics, which need to be
investigated further in future research. Heavy post-transplant
immunosuppression likely plays a key role in the pathogenesis of PT-AML.
2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<11>
Accession Number
2014329669
Authors
Kok W.F. Van Harten A.E. Koene B.M.J.A. Mariani M.A. Koerts J. Tucha O.
Absalom A.R. Scheeren T.W.L.
Institution
(Kok, Van Harten, Absalom, Scheeren) Department of Anaesthesiology,
University Medical Centre, Groningen University of Groningen, Groningen,
Netherlands
(Koene, Mariani) Department of Cardiothoracic Surgery, University Medical
Centre Groningen, University of Groningen, Groningen, Netherlands
(Koerts, Tucha) Department of Clinical and Developmental Neuropsychology,
University of Groningen, Groningen, Netherlands
Title
A pilot study of cerebral tissue oxygenation and postoperative cognitive
dysfunction among patients undergoing coronary artery bypass grafting
randomised to surgery with or without cardiopulmonary bypass.
Source
Anaesthesia. 69 (6) (pp 613-622), 2014. Date of Publication: June 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Coronary artery bypass surgery, performed with or without cardiopulmonary
bypass, is frequently followed by postoperative cognitive decline.
Near-infrared spectroscopy is commonly used to assess cerebral tissue
oxygenation, especially during cardiac surgery. Recent studies have
suggested an association between cerebral desaturation and postoperative
cognitive dysfunction. We therefore studied cerebral oxygen desaturation,
defined as area under the cerebral oxygenation curve < 40% of > 10 min.%,
with respect to cognitive performance at 4 days (early) and 3 months
(late) postoperatively, compared with baseline, using a computerised
cognitive test battery. We included 60 patients, of mean (SD) age 62.8
(9.4) years, scheduled for elective coronary artery bypass grafting, who
were randomly allocated to surgery with or without cardiopulmonary bypass.
Cerebral desaturation occurred in only three patients and there was no
difference in cerebral oxygenation between the two groups at any time.
Among patients who received cardiopulmonary bypass, 18 (62%) had early
cognitive decline, compared with 16 (53%) in the group without
cardiopulmonary bypass (p = 0.50). Three months after surgery, 11 patients
(39%) in the cardiopulmonary bypass group displayed cognitive dysfunction,
compared with four (14%) in the non-cardiopulmonary bypass group (p =
0.03). The use of cardiopulmonary bypass was identified as an independent
risk factor for the development of late cognitive dysfunction (OR 6.4 (95%
CI 1.2-33.0) p = 0.027. In conclusion, although cerebral oxygen
desaturation was rare in our population, postoperative cognitive decline
was common in both groups, suggesting that factors other than hypoxic
neuronal injury are responsible. 2014 The Association of Anaesthetists of
Great Britain and Ireland.

<12>
Accession Number
2014325912
Authors
Maekawa K. Baba T. Otomo S. Morishita S. Tamura N.
Institution
(Maekawa) Department of Anesthesiology, Graduate School of Medical
Sciences, Kumamoto University, Kumamoto, Japan
(Maekawa, Baba, Otomo) Department of Anesthesiology, Kumamoto Chuo
Hospital, Kumamoto, Japan
(Morishita) Department of Radiology, Kumamoto Chuo Hospital, Kumamoto,
Japan
(Tamura) Department of Cardiovascular Surgery, Kumamoto Chuo Hospital,
Kumamoto, Japan
Title
Low pre-existing gray matter volume in the medial temporal lobe and white
matter lesions are associated with postoperative cognitive dysfunction
after cardiac surgery.
Source
PLoS ONE. 9 (1) , 2014. Article Number: e87375. Date of Publication: 27
Jan 2014.
Publisher
Public Library of Science
Abstract
Objectives: Postoperative cognitive dysfunction (POCD) is recognized as a
complication in the elderly after cardiac surgery. Imaging of the brain
provides evidence of neurodegeneration in elderly patients; however,
abnormalities in brain structure and their relation to POCD are uncertain.
This pilot study investigated whether loss of gray matter in the bilateral
medial temporal lobe (MTL), seen in preoperative MRI, was associated with
POCD. Methods: Data were collected prospectively on 28 elderly patients
scheduled for elective cardiac surgery. MRI of the brains of all patients
were assessed for prior cerebral infarctions, and carotid and intracranial
arterial stenosis. Patients also completed six neuropsychological tests of
memory, attention and executive function before and after surgery. POCD
was defined as an individual decrease in more than two tests of at least 1
standard deviation from the group baseline mean for that test. The degree
of gray matter loss in the MTL of each patient was calculated using
voxel-based morphometry with three-dimensional, T1-weighted MRI. This
represented the degree of gray matter change as a Z score. Results:
Postoperative cognitive dysfunction was identified in 8 of the 28 patients
(29%). Patients with POCD had significantly more white matter lesions on
MRI, and greater loss of gray matter in the bilateral MTL (average Z score
2.0+0.9) than patients without POCD. An analysis by stepwise logistic
regression identified gray matter loss in the MTL and cerebral infarctions
on MRI as independent predictors of POCD. Conclusions: These preliminary
findings suggested that reduced gray matter in the bilateral MTL and white
matter lesions existed in brains of elderly cardiac surgery patients who
experienced POCD. Additional studies with larger sample sizes are needed
to confirm these findings. 2014 Maekawa et al.

<13>
Accession Number
2014314368
Authors
White H.D. Held C. Stewart R. Tarka E. Brown R. Davies R.Y. Budaj A.
Harrington R.A. Steg P.G. Ardissino D. Armstrong P.W. Avezum A. Aylward
P.E. Bryce A. Chen H. Chen M.-F. Corbalan R. Dalby A.J. Danchin N. De
Winter R.J. Denchev S. Diaz R. Elisaf M. Flather M.D. Goudev A.R. Granger
C.B. Grinfeld L. Hochman J.S. Husted S. Kim H.-S. Koenig W. Linhart A.
Lonn E. Lopez-Sendon J. Manolis A.J. Mohler III E.R. Nicolau J.C. Pais P.
Parkhomenko A. Pedersen T.R. Pella D. Ramos-Corrales M.A. Ruda M. Sereg M.
Siddique S. Sinnaeve P. Smith P. Sritara P. Swart H.P. Sy R.G. Teramoto T.
Tse H.-F. Watson D. Weaver W.D. Weiss R. Viigimaa M. Vinereanu D. Zhu J.
Cannon C.P. Wallentin L.
Institution
(White, Stewart) Green Lane Cardiovascular Service, Auckland City
Hospital, University of Auckland, Auckland, New Zealand
(Held, Wallentin) Department of Medical Sciences, Uppsala University,
Uppsala Clinical Research Center, Uppsala, Sweden
(Tarka, Davies) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, King of Prussia, PA, United States
(Brown, Smith, Watson) Metabolic Pathways and Cardiovascular Therapeutic
Area, GlaxoSmithKline, Research Triangle Park, NC, United States
(Granger) Duke University Medical Center, Durham, NC, United States
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Steg) INSERM Unite 1148, Departement Hospitalo-Universitaire FIRE,
Hopital Bichat, Paris, France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
(Danchin) Hopital Europeen Georges Pompidou, Assistance Publique-Hopitaux
de Paris, Universite Paris Descartes, Paris, France
(Steg) NHLI Imperial College, ICMS, Royal Brompton Hospital, London,
United Kingdom
(Ardissino) Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Lonn) Department of Medicine, Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(Avezum) Dante Pazzanese Institute of Cardiology, University of Sao Paulo
Medical School, Sao Paulo, Brazil
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, SA, Australia
(Bryce) Cardiogolf/Clinica El Golf, Lima, Peru
(Chen) Department of Cardiology, Peking University People's Hospital,
Beijing, China
(Chen) Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Corbalan) Cardiovascular Division Pontificia Universidad Catolica de
Chile, Santiago, Chile
(Dalby) Milpark Hospital, Johannesburg, South Africa
(De Winter) Department of Cardiology, Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(Denchev) Clinic of Cardiology, University Hospital Alexandrovska, Sofia,
Bulgaria
(Goudev) Cardiology Department, Queen Giovanna University Hospital, Sofia,
Bulgaria
(Diaz) ECLA Estudios Cardiologicos Latinoamerica, Rosario, Argentina
(Elisaf) Department of Internal Medicine, School of Medicine, University
of Ioannina, Ioannina, Greece
(Flather) Norwich Medical School, Norwich, United Kingdom
(Flather) Norfolk and Norwich University Hospital, Norwich, United Kingdom
(Grinfeld) University of Buenos Aires, School of Medicine, Buenos Aires,
Argentina
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Husted) Medical Department, Hospital Unit West, Herning/Holstbro, Denmark
(Kim) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Linhart) 2Nd Department of Medicine, Department of Cardiovascular
Medicine, General University Hospital, Prague, Czech Republic
(Linhart) 1St Faculty of Medicine, Charles University in Prague, Prague,
Czech Republic
(Lopez-Sendon) Department of Cardiology, Hospital Universitario la Paz,
IdiPaz, Madrid, Spain
(Manolis) Cardiology Department, Asklepeion Hospital, Athens, Greece
(Mohler III) University of Pennsylvania, Perelman School of Medicine,
Philadelphia, PA, United States
(Pais) St. John's Medical Collage, Bangalore, India
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Pedersen) University of Oslo, Oslo University Hospital, Center for
Preventive Medicine, Oslo, Norway
(Pella) 1St Department of Medicine, Faculty of Medicine Pavel Josef
Safarik University, Kosice, Slovakia
(Ramos-Corrales) San Jose Satelite Hospital, Naucalpan, Mexico
(Ruda) Russian Cardiologic Research and Production Complex of
Rosmedtechnology, Moscow, Russian Federation
(Sereg) LIFE Health Center, St. George Hospital, Szekesfehervar, Hungary
(Siddique) Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
(Sinnaeve) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Sritara) Department of Medicine, Faculty of Medicine, Mahidol University,
Bangkok, Thailand
(Swart) Department of Cardioresearch, Antonius Hospital, Sneek,
Netherlands
(Sy) Department of Medicine, College of Medicine, University of the
Philippines, Manila, Philippines
(Teramoto) Teikyo Academic Research Center, Itabashi-ku, Tokyo, Japan
(Tse) Department of Medicine, Queen Mary Hospital, University of Hong
Kong, Hong Kong, Hong Kong
(Weaver) Henry Ford Heart and Vascular Institute, Detroit, United States
(Weiss) Maine Research Associates, Auburn, United States
(Viigimaa) Tallinn University of Technology, North Estonia Medical Center,
Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy, Carol Davila, University
and Emergency Hospital, Bucharest, Romania
(Zhu) Zhongshan Hospital, Fudan University, Shanghai, China
(Cannon) Thrombolysis in Myocardial Infarction Study Group, Brigham and
Women's Hospital, Harvard Medical School, Boston, United States
Title
Darapladib for preventing ischemic events in stable coronary heart
disease.
Source
New England Journal of Medicine. 370 (18) (pp 1702-1711), 2014. Date of
Publication: 2014.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Elevated lipoprotein-associated phospholipase A₂
activity promotes the development of vulnerable atherosclerotic plaques,
and elevated plasma levels of this enzyme are associated with an increased
risk of coronary events. Darapladib is a selective oral inhibitor of
lipoprotein-associated phospholipase A₂. METHODS: In a
double-blind trial, we randomly assigned 15,828 patients with stable
coronary heart disease to receive either once-daily darapladib (at a dose
of 160 mg) or placebo. The primary end point was a composite of
cardiovascular death, myocardial infarction, or stroke. Secondary end
points included the components of the primary end point as well as major
coronary events (death from coronary heart disease, myocardial infarction,
or urgent coronary revascularization for myocardial ischemia) and total
coronary events (death from coronary heart disease, myocardial infarction,
hospitalization for unstable angina, or any coronary revascularization).
RESULTS: During a median follow-up period of 3.7 years, the primary end
point occurred in 769 of 7924 patients (9.7%) in the darapladib group and
819 of 7904 patients (10.4%) in the placebo group (hazard ratio in the
darapladib group, 0.94; 95% confidence interval [CI], 0.85 to 1.03; P =
0.20). There were also no significant between-group differences in the
rates of the individual components of the primary end point or in
all-cause mortality. Darapladib, as compared with placebo, reduced the
rate of major coronary events (9.3% vs. 10.3%; hazard ratio, 0.90; 95% CI,
0.82 to 1.00; P = 0.045) and total coronary events (14.6% vs. 16.1%;
hazard ratio, 0.91; 95% CI, 0.84 to 0.98; P = 0.02). CONCLUSIONS: In
patients with stable coronary heart disease, darapladib did not
significantly reduce the risk of the primary composite end point of
cardiovascular death, myocardial infarction, or stroke. Copyright 2014
Massachusetts Medical Society.

<14>
Accession Number
2014326629
Authors
Mirhosseini S.J. Forouzannia S.K. Ali-Hassan-Sayegh S. Hadad-Zadeh M.
Abdollahi M.H. Moshtaghiom H. Hosseini H.
Institution
(Mirhosseini, Forouzannia, Hadad-Zadeh) Department of Cardiovascular
Surgery, Afshar Hospital, Shahid Sadoughi University of Medical Sciences,
Yazd, Iran, Islamic Republic of
(Ali-Hassan-Sayegh) Medical Student and Researcher of Cardiac Surgery,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Abdollahi, Moshtaghiom, Hosseini) Department of Anesthesiology, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
On pump versus off pump coronary artery bypass surgery in patients over
seventy years old with triple vessels disease and severe left ventricle
dysfunction: Focus on early clinical outcomes.
Source
Acta Medica Iranica. 51 (5) (pp 320-323), 2013. Date of Publication: 2013.
Publisher
Medical Sciences University of Teheran
Abstract
Cardiovascular disease is the leading reason of morbidity in older people.
Coronary artery bypass graft (CABG) surgery is the most common type of
operations in world. This study was designed to characterize comparison of
early clinical outcome following on pump vs. off pump in patients over 70
years old with triple vessels disease and severe left ventricle
dysfunction. 80 patients were divided into two groups: In group A (n=40)
on pump CABG was performed with hypothermic cardiopulmonary bypass and
cold blood cardioplegic arrest and in group B (n=40) the patients had off
pump coronary artery bypass (OPCAB) surgery. Exclusion criteria included
emergency or urgent operation, combined valve surgery, history of renal
insufficiency (Cr >2 mg/dl), stroke. Early postoperative complications
such as occurrence, duration and frequency of recurrence of atrial
fibrillation were recorded. All patients underwent Holter monitoring after
ICU discharge during their hospital stay. The average age of patients was
79.5+7.5 years. Post operative atrial fibrillation (POAF) occurred in 24
cases (30%); 17 cases (42.5%) related to on pump CABG group and 7 cases
(17.5%) related to OPCAB group (P=0.03). The frequency of the recurrence
of AF in the on pump group was 3.8+1.3 days and in the off pump group was
2.4+1.1 days (P=0.02). ICU stay in on pump group was 3.6+1.80 days, while
for the off pump was 2.5+0.6 days (P=0.001). Also hospital stay duration
was 8.5+2.1 days for the on pump group compared to the other group that
was 6.34+1.06 days. Off pump in patients over 70 years old with triple
vessels disease and severe LV dysfunction is safer than on pump and can
reduce POAF, ICU and hospital stay and some early surgical complications.
2013 Tehran University of Medical Sciences. All rights reserved.

<15>
Accession Number
2014326552
Authors
Hadadzadeh M. Hosseini S.H. Mostafavi-Pour-Manshadi S.M.Y. Naderi N.
Emami-Meybodi M.
Institution
(Hadadzadeh) Department of Cardiovascular Surgery, Afshar Hospital, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Hosseini) Department of Anesthesiology, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Mostafavi-Pour-Manshadi, Naderi) Department of Medicine, Ali ben Abitaleb
Medical College, Islamic Azad University, Yazd, Iran, Islamic Republic of
(Emami-Meybodi) Department of Cardiology, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Effect of milrinone on short term outcome of patients with myocardial
dysfunction undergoing off-pump coronary artery bypass graft: A randomized
clinical trial.
Source
Acta Medica Iranica. 51 (10) (pp 681-686), 2013. Date of Publication:
2013.
Publisher
Medical Sciences University of Teheran
Abstract
Myocardial dysfunction is a major complication in cardiac surgery that
needs inotropic support. This study evaluates the effect of milrinone on
patients with low ventricular ejection fraction undergoing offpump
coronary artery bypass graft (OPCAB). The present study is designed to
evaluate the effect of milrinone on myocardial dysfunction. Eighty
patients with low ventricular ejection fraction (<35%), candidate for
elective OPCAB, were enrolled in this study. They were randomly assigned
to two groups. One group received milrinone (50 mug/kg) intravenously and
another group received a saline as placebo followed by 24 hours infusion
of each agent (0.5 mug/kg/min). Short outcome of patients such as
hemodynamic parameters and left ventricular ejection fraction were
variables evaluated. Serum levels of creatine phosphokinase, the MB
isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration
of mechanical ventilation were significantly lower in milrinone group
(P<0.05). The mean post operative left ventricular ejection fraction was
significantly higher in milrinone group (P=0.031). There were no
statistical significant differences between the two groups in terms of
intra-aortic balloon pump, inotropic support requirement, myocardial
ischemia, myocardial infarction, duration of inotropic support, duration
of intensive care unit stay, mortality and morbidity rate. Administration
of milrinone in patients undergoing OPCAB with low ventricular ejection
fraction is useful and effective. 2013 Tehran University of Medical
Sciences. All rights reserved.

<16>
Accession Number
2014327133
Authors
Valkenet K. Trappenburg J.C.A. Gosselink R. Sosef M.N. Willms J. Rosman C.
Pieters H. Scheepers J.J.G. de Heus S.C. Reynolds J.V. Guinan E. Ruurda
J.P. Rodrigo E.H.E. Nafteux P. Fontaine M. Kouwenhoven E.A. Kerkemeyer M.
van der Peet D.L. Hania S.W. van Hillegersberg R. Backx F.J.G.
Institution
(Valkenet, Trappenburg, Rodrigo, Backx) Department of Rehabilitation,
Nursing Science and Sports, University Medical Center Utrecht, PO Box
85500, Utrecht 3508 GA, Netherlands
(Gosselink) Department of Rehabilitation Sciences, KU Leuven, University
Hospital Leuven, Tervuursevest 101, Leuven 3001, Belgium
(Sosef) Department of Surgery, Atrium Medical Center, PO Box 4446, Heerlen
6401 CX, Netherlands
(Willms) Department of Physical Therapy, Atrium Medical Center, PO Box
4446, Heerlen 6401 CX, Netherlands
(Rosman) Department of Surgery, Canisius Wilhelmina Hospital, PO Box 9015,
Nijmegen 6500 GS, Netherlands
(Pieters) Department of Physical Therapy, Canisius Wilhelmina Hospital, PO
Box 9015, Nijmegen 6500 GS, Netherlands
(Scheepers) Department of Surgery, Reinier de Graaf Hospital, PO Box 5011,
Delft 2600 GA, Netherlands
(de Heus) Department of Physical Therapy, Reinier de Graaf Hospital, PO
Box 5011, Delft 2600 GA, Netherlands
(Reynolds) Department of Surgery, St James's Hospital, Trinity Centre for
Health Sciences, Dublin 8, Ireland
(Guinan) Discipline of Physiotherapy, St James's Hospital, Trinity Centre
for Health Sciences, Dublin 8, Ireland
(Ruurda, van Hillegersberg) Department of Surgery, University Medical
Center Utrecht, PO Box 85500, Utrecht 3508 GA, Netherlands
(Nafteux) Department of Thoracic Surgery, University Hospitals Leuven,
Herestraat 49, 3000, Leuven, Belgium
(Fontaine) Department of Physical Therapy, University Hospitals Leuven,
Herestraat 49, 3000, Leuven, Belgium
(Kouwenhoven) Department of Surgery, Hospital Group Twente (ZGT), PO Box
7600, Almelo 7600 SZ, Netherlands
(Kerkemeyer) Department of Physical Therapy, Hospital Group Twente (ZGT),
PO Box 7600, Almelo 7600 SZ, Netherlands
(van der Peet) Department of Surgery, VU University Medical Center, PO Box
7057, Amsterdam 1007 MB, Netherlands
(Hania) Department of Physical Therapy, VU University Medical Center, PO
Box 7057, Amsterdam 1007 MB, Netherlands
Title
Preoperative inspiratory muscle training to prevent postoperative
pulmonary complications in patients undergoing esophageal resection
(PREPARE study): Study protocol for a randomized controlled trial.
Source
Trials. 15 (1) , 2014. Article Number: 144. Date of Publication: 27 Apr
2014.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Esophageal resection is associated with a high incidence of
postoperative pneumonia. Respiratory complications account for almost half
of the readmissions to the critical care unit. Postoperative complications
can result in prolonged hospital stay and consequently increase healthcare
costs. In cardiac surgery a preoperative inspiratory muscle training
program has shown to prevent postoperative pneumonia and reduce length of
hospital stay. While in some surgical centers inspiratory muscle training
is already used in the preoperative phase in patients undergoing
esophageal resection, the added value of this intervention on the
reduction of pulmonary complications has not yet been investigated in
large surgical populations other than cardiac surgery in a randomized and
controlled study design.Methods/Design: The effect of a preoperative
inspiratory muscle training program on the incidence of postoperative
pneumonia in patients undergoing esophageal resection will be studied in a
single blind multicenter randomized controlled trial (the PREPARE study).
In total 248 patients (age >18 years) undergoing esophageal resection for
esophageal cancer will be included in this study. They are randomized to
either usual care or usual care with an additional inspiratory muscle
training intervention according to a high-intensity protocol which is
performed with a tapered flow resistive inspiratory loading device.
Patients have to complete 30 dynamic inspiratory efforts twice daily for 7
days a week until surgery with a minimum of 2 weeks. The starting training
load will be aimed to be 60% of maximal inspiratory pressure and will be
increased based on the rate of perceived exertion.The main study endpoint
is the incidence of postoperative pneumonia. Secondary objectives are to
evaluate the effect of preoperative inspiratory muscle training on length
of hospital stay, duration of mechanical ventilation, incidence of other
postoperative (pulmonary) complications, quality of life, and on
postoperative respiratory muscle function and lung function.Discussion:
The PREPARE study is the first multicenter randomized controlled trial to
evaluate the hypothesis that preoperative inspiratory muscle training
leads to decreased pulmonary complications in patients undergoing
esophageal resection.Trial registration: NCT01893008. 2014 Valkenet et
al.; licensee BioMed Central Ltd.

<17>
Accession Number
2014322965
Authors
Chang C.Y. Challa C.K. Shah J. Eloy J.D.
Institution
(Chang, Challa, Shah, Eloy) Department of Anesthesia, Rutgers New Jersey
Medical School, 185 South Orange Avenue, MSB E-538, Newark, NJ 07101-1709,
United States
Title
Gabapentin in acute postoperative pain management.
Source
BioMed Research International. 2014 , 2014. Article Number: 631756. Date
of Publication: 2014.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Gabapentin (1-aminomethyl-cyclohexaneacetic acid) is an amino acid that
has the structure of the neurotransmitter -aminobutyric acid (GABA). It is
a novel drug used for the treatment of postoperative pain with
antihyperalgesic properties and a unique mechanism of action. Gabapentin
and the related, more potent compound pregabalin have been shown to be
beneficial in the treatment of neuropathic pain as well as postoperative
pain following spinal surgery and hysterectomy. This study reviews five
aspects of gabapentin: (1) chemical and structural characteristics; (2)
pharmacokinetics and pharmacodynamics; (3) application in acute pain
management; (4) adverse effects; and (5) drug safety. Overall, gabapentin
has been reported to be a safe and efficacious drug for the treatment of
postoperative pain. 2014 Connie Y. Chang et al.

<18>
Accession Number
2014318098
Authors
van Buuren S. Hulzebos E.H.J. Valkenet K. Lindeman E. van Meeteren N.L.U.
Institution
(van Buuren, van Meeteren) Netherlands Organisation for Applied Scientific
Research TNO, Leiden, Netherlands
(van Buuren) University of Utrecht, Utrecht, Netherlands
(Hulzebos) Child Development and Exercise Centre, Division of Paediatrics,
University Children's Hospital Utrecht, Utrecht, Netherlands
(Valkenet, Lindeman) Department of Rehabilitation, Nursing Science and
Sport, Rudolf Magnus Institute of Neurosciences, University Medical Centre
Utrecht, Utrecht, Netherlands
Title
Reference chart of inspiratory muscle strength: A new tool to monitor the
effect of pre-operative training.
Source
Physiotherapy (United Kingdom). 100 (2) (pp 128-133), 2014. Date of
Publication: June 2014.
Publisher
Elsevier
Abstract
Objectives: To develop a reference chart to monitor inspiratory muscle
strength during pre-operative inspiratory muscle training for patients at
high risk of developing postoperative pulmonary complications awaiting
coronary artery bypass graft (CABG) surgery. Design: Secondary data
analysis using patients from the intervention arm of a randomised clinical
trial. Setting: University medical centre. Participants: Patients at high
risk of developing postoperative pulmonary complications awaiting CABG
surgery. Interventions: Patients performed inspiratory muscle training
seven times per week for at least 2 weeks before surgery. Main outcome
measures: Maximal inspiratory muscle strength. Results: A new reference
chart was produced using a non-linear time trend model with a normal error
structure. Conclusions: The chart is a novel tool for monitoring the
progress of inspiratory muscle training for physiotherapy practice. Wider
use of this chart is recommended. 2013 Chartered Society of
Physiotherapy.

<19>
Accession Number
2014316898
Authors
Perez-Granda M.J. Barrio J. Munoz P. Hortal J. Rincon C. Rabadan P.M.
Pernia M.S. Bouza E.
Institution
(Perez-Granda, Barrio, Hortal, Rincon) Department of Anesthesiology,
School of Medicine, Universidad Complutense, Madrid, Spain
(Munoz, Rabadan, Bouza) Department of Clinical Microbiology and Infectious
Diseases, School of Medicine, Universidad Complutense, Madrid, Spain
(Pernia) Department of Pharmacy, Hospital General Universitario Gregorio
Maranon, Madrid, Spain
(Munoz, Rabadan, Bouza) Medicine Department, School of Medicine,
Universidad Complutense, Madrid, Spain
(Perez-Granda, Barrio, Munoz, Hortal, Rabadan, Bouza) Instituto de
Investigacion Biomedica Gregorio Maranon, Madrid, Spain
(Perez-Granda, Barrio, Munoz, Hortal, Rabadan, Bouza) CIBER Enfermedades
Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
Title
Ethanol lock therapy (E-lock) in the prevention of Catheter-Related
Bloodstream Infections (CR-BSI) after Major Heart Surgery (MHS): A
randomized clinical trial.
Source
PLoS ONE. 9 (3) , 2014. Article Number: e91838. Date of Publication: 27
Mar 2014.
Publisher
Public Library of Science
Abstract
Background: Lock-therapy with antimicrobials has been used for the
treatment and prevention of catheter-related bloodstream infections
(CR-BSI). Experiences with Ethanol-Locks (E-locks) have included
therapeutic interventions with variable results. Patients undergoing Major
Heart Surgery (MHS) are a high-risk population for CR-BSI.The aim of this
study was to assess the efficacy and tolerance to E-Locks in the
prevention of CR-BSI of patients undergoing MHS. Methods and Findings:
This is an academic, prospective, randomized, non-blinded and controlled
clinical trial assessing the incidence of CR-BSI of patients with E-locks
(E-lock) and the tolerance to the procedure in comparison with patients
receiving conventional catheter-care (CCC). Patients undergoing MHS with
intravascular catheters for more than 48 hours were randomly assigned into
treatment or control group by a computer-generated list of randomly
assigned numbers. In the treatment group, all their catheter lumens were
locked with an ethanol solution at 70% for two hours, every three days
(E-Locks). The control group received conventional catheter-care (CCC).
Overall, 200 patients with 323 catheters were included in the study, which
was stopped after 10 months due to adverse events. Of them, 179 catheters
(113 patients) had E-Locks and 144 catheters (87 patients) were CCC.
Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94
respectively. The results for the E-Locks and CCC were as follows:
Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33), catheter
tip colonization 14 (7.8%) vs 6 (4.2%) patients (p = 0.17), median length
of hospital stay, 15 vs 16 days (p = 0.77). Seven patients (6.19%), all in
the ethanol branch, had to discontinue the trial due to intolerance or
adverse events. Conclusions: We do not recommend prophylaxis of CR-BSI
with ethanol-lock on a routine basis in patients undergoing Major Heart
Surgery. Trial Registration: Clinical Trials.gov NCT01229592. 2014 P
Perez-Granda et al.

<20>
Accession Number
2014317455
Authors
Macrae D. Grieve R. Allen E. Sadique Z. Betts H. Morris K. Pappachan V.J.
Parslow R. Tasker R.C. Baines P. Broadhead M. Duthie M.L. Fortune P.-M.
Inwald D. Mcmaster P. Peters M.J. Schindler M. Guerriero C. Piercy D.
Slavik Z. Snowdon C. Van Dyck L. Elbourne D.
Institution
(Macrae, Betts, Slavik) Royal Brompton Hospital, London, United Kingdom
(Grieve, Sadique, Guerriero) Department of Health Services Research and
Policy, London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Allen, Piercy, Snowdon, Van Dyck, Elbourne) Medical Statistics
Department, London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Morris) Birmingham Children's Hospital, Birmingham, United Kingdom
(Pappachan) Southampton General Hospital, Southampton, United Kingdom
(Parslow) University of Leeds, Leeds, United Kingdom
(Tasker) Boston Children's Hospital, Boston, MA, United States
(Baines) Alder Hey Hospital, Liverpool, United Kingdom
(Broadhead, Peters) Great Ormond Street Hospital for Children, London,
United Kingdom
(Duthie) Glenfield Hospital and Leicester Royal Infirmary, Leicester,
United Kingdom
(Fortune) Royal Manchester Children's Hospital, Manchester, United Kingdom
(Inwald) St Mary's Hospital, London, United Kingdom
(Mcmaster) University Hospital of North Staffordshire, Stoke-on-Trent,
United Kingdom
(Schindler) Bristol Royal Hospital for Children, Bristol, United Kingdom
Title
A clinical and economic evaluation of control of hyperglycaemia in
paediatric intensive care (CHiP): A randomised controlled trial.
Source
Health Technology Assessment. 18 (26) (pp 1-209), 2014. Date of
Publication: 2014.
Publisher
National Co-ordinating Centre for HTA
Abstract
Background: Early research in adults admitted to intensive care suggested
that tight control of blood glucose during acute illness can be associated
with reductions in mortality, length of hospital stay and complications
such as infection and renal failure. Prior to our study, it was unclear
whether or not children could also benefit from tight control of blood
glucose during critical illness. Objectives: This study aimed to determine
if controlling blood glucose using insulin in paediatric intensive care
units (PICUs) reduces mortality and morbidity and is cost-effective,
whether or not admission follows cardiac surgery. Design: Randomised open
two-arm parallel group superiority design with central randomisation with
minimisation. Analysis was on an intention-to-treat basis. Following
random allocation, care givers and outcome assessors were no longer blind
to allocation. Setting: The setting was 13 English PICUs. Participants:
Patients who met the following criteria were eligible for inclusion: > 36
weeks corrected gestational age; < 16 years; in the PICU following injury,
following major surgery or with critical illness; anticipated treatment >
12 hours; arterial line; mechanical ventilation; and vasoactive drugs.
Exclusion criteria were as follows: diabetes mellitus; inborn error of
metabolism; treatment withdrawal considered; in the PICU > 5 consecutive
days; and already in CHiP (Control of Hyperglycaemia in Paediatric
intensive care). Intervention: The intervention was tight glycaemic
control (TGC): insulin by intravenous infusion titrated to maintain blood
glucose between 4.0 and 7.0 mmol/l. Conventional management (CM): This
consisted of insulin by intravenous infusion only if blood glucose
exceeded 12.0 mmol/l on two samples at least 30 minutes apart; insulin was
stopped when blood glucose fell below 10.0 mmol/l. Main outcome measures:
The primary outcome was the number of days alive and free from mechanical
ventilation within 30 days of trial entry (VFD-30). The secondary outcomes
comprised clinical and economic outcomes at 30 days and 12 months and
lifetime cost-effectiveness, which included costs per quality-adjusted
life-year. Results: CHiP recruited from May 2008 to September 2011. In
total, 19,924 children were screened and 1369 eligible patients were
randomised (TGC, 694; CM, 675), 60% of whom were in the cardiac surgery
stratum. The randomised groups were comparable at trial entry. More
children in the TGC than in the CM arm received insulin (66% vs. 16%). The
mean VFD-30 was 23 [mean difference 0.36; 95% confidence interval (CI)
-0.42 to 1.14]. The effect did not differ among prespecified subgroups.
Hypoglycaemia occurred significantly more often in the TGC than in the CM
arm (moderate, 12.5% vs. 3.1%; severe, 7.3% vs. 1.5%). Mean 30-day costs
were similar between arms, but mean 12-month costs were lower in the TGC
than in CM arm (incremental costs -3620, 95% CI -7743 to 502). For the
non-cardiac surgery stratum, mean costs were lower in the TGC than in the
CM arm (incremental cost -9865, 95% CI -18,558 to -1172), but, in the
cardiac surgery stratum, the costs were similar between the arms
(incremental cost 133, 95% CI -3568 to 3833). Lifetime incremental net
benefits were positive overall (3346, 95% CI -11,203 to 17,894), but close
to zero for the cardiac surgery stratum (-919, 95% CI -16,661 to 14,823).
For the non-cardiac surgery stratum, the incremental net benefits were
high (11,322, 95% CI -15,791 to 38,615). The probability that TGC is
cost-effective is relatively high for the non-cardiac surgery stratum,
but, for the cardiac surgery subgroup, the probability that TGC is
cost-effective is around 0.5. Sensitivity analyses showed that the results
were robust to a range of alternative assumptions. Conclusions: CHiP found
no differences in the clinical or cost-effectiveness of TGC compared with
CM overall, or for prespecified subgroups. A higher proportion of the TGC
arm had hypoglycaemia. This study did not provide any evidence to suggest
that PICUs should stop providing CM for children admitted to PICUs
following cardiac surgery. For the subgroup not admitted for cardiac
surgery, TGC reduced average costs at 12 months and is likely to be
cost-effective. Further research is required to refine the TGC protocol to
minimise the risk of hypoglycaemic episodes and assess the long-term
health benefits of TGC. Queen's Printer and Controller of HMSO 2014.

<21>
Accession Number
2014322244
Authors
Kang S.-H. Park K.W. Kang D.-Y. Lim W.-H. Park K.T. Han J.-K. Kang H.-J.
Koo B.-K. Oh B.-H. Park Y.-B. Kandzari D.E. Cohen D.J. Hwang S.-S. Kim
H.-S.
Institution
(Kang, Park, Kang, Lim, Park, Han, Kang, Koo, Oh, Park, Kim) Department of
Internal Medicine and Cardiovascular Center, Seoul National University
Hospital, 28 Yeongeon-Dong, Chongno-gu, Seoul 110-744, South Korea
(Kandzari) Piedmont Heart Institute, Altanta, GA, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Hwang) Department of Social and Preventive Medicine, Inha University
School of Medicine, Incheon, South Korea
Title
Biodegradable-polymer drug-eluting stents vs. bare metal stents vs.
durable-polymer drug-eluting stents: A systematic review and Bayesian
approach network meta-analysis.
Source
European Heart Journal. 35 (17) (pp 1147-1158), 2014. Date of Publication:
May 2014.
Publisher
Oxford University Press
Abstract
Background The aim of this study was to compare the safety and efficacy of
biodegradable-polymer (BP) drug-eluting stents (DES), bare metal stents
(BMS), and durable-polymer DES in patients undergoing coronary
revascularization, we performed a systematic review and network
meta-analysis using a Bayesian framework. Methods and results Study stents
included BMS, paclitaxel-eluting (PES), sirolimus-eluting (SES), endeavor
zotarolimus-eluting (ZES-E), cobalt-chromium everolimus-eluting
(CoCr-EES), platinium-chromium everolimus-eluting (PtCr-EES), resolute
zotarolimus-eluting (ZES-R), and BP biolimus-eluting stents (BP-BES).
After a systematic electronic search, 113 trials with 90 584 patients were
selected. The principal endpoint was definite or probable stent thrombosis
(ST) defined according to the Academic Research Consortium within 1 year.
Results Biodegradable polymer-biolimus-eluting stents [OR, 0.56; 95%
credible interval (CrI), 0.33-0.90], SES (OR, 0.53; 95% CrI, 0.38-0.73),
CoCr-EES (OR, 0.34; 95% CrI, 0.23-0.52), and PtCr-EES (OR, 0.31; 95% CrI,
0.10-0.90) were all superior to BMS in terms of definite or probable ST
within 1 year. Cobalt-chromium everolimus-eluting stents demonstrated the
lowest risk of ST of all stents at all times after stent implantation.
Biodegradable polymer-biolimus-eluting stents was associated with a higher
risk of definite or probable ST than CoCr-EES (OR, 1.72; 95% CrI,
1.04-2.98). All DES reduced the need for repeat revascularization, and all
but PES reduced the risk of myocardial infarction compared with BMS.
Conclusions All DESs but PES and ZES-E were superior to BMS in terms of ST
within 1 year. Cobalt-chromium everolimus-eluting stents was safer than
any DES even including BP-BES. Our results suggest that not only the
biodegradability of polymer, but the optimal combination of stent alloy,
design, strut thickness, polymer, and drug all combined determine the
safety of DES. The Author 2014.

<22>
Accession Number
2014310196
Authors
Santana-Santos E. Gowdak L.H.W. Gaiotto F.A. Puig L.B. Hajjar L.A.
Zeferino S.P. Drager L.F. Shimizu M.H.M. Bortolotto L.A. De Lima J.J.G.
Institution
(Santana-Santos, Gowdak, Gaiotto, Puig, Hajjar, Zeferino, Drager, Shimizu,
Bortolotto, De Lima) Heart Institute (InCor), Hospital das Clinicas,
University of Sao Paulo Medical School, Sao Paulo, Brazil
Title
High dose of N-acetylcystein prevents acute kidney injury in chronic
kidney disease patients undergoing myocardial revascularization.
Source
Annals of Thoracic Surgery. 97 (5) (pp 1617-1623), 2014. Date of
Publication: May 2014.
Publisher
Elsevier USA
Abstract
Background The renoprotective effect of N-acetylcystein in patients
undergoing coronary artery bypass graft surgery is controversial. Methods
We assessed the renoprotective effect of the highest dose of
N-acetylcystein sanctioned for clinical use in a prospective,
double-blind, placebo-controlled study including 70 chronic kidney disease
patients, stage 3 or 4, who underwent coronary artery bypass graft
surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly
allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg
for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was
defined by the Acute Kidney Injury Network classification. Results The
incidence of kidney injury was reduced in the N-acetylcystein group (57.1%
versus 28.6%, p = 0.016). Nonuse of N-acetylcystein (relative risk 3.58,
95% confidence interval: 1.04 to 12.33, p = 0.04) and cardiopulmonary
bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p =
0.02) were independent predictors of kidney injury. In patients treated
with CPB, N-acetylcystein reduced the incidence of kidney injury from 63%
to 46%. Oxidative stress was increased in control subjects (p = 0.01) and
abolished in patients receiving N-acetylcystein. Conclusions Maximum
intravenous doses of N-acetylcystein reduce the incidence of acute kidney
injury in patients with kidney disease undergoing coronary artery bypass
graft surgery, abolish oxidative stress, and mitigate the negative effect
of CPB on renal function. 2014 by The Society of Thoracic Surgeons.

<23>
Accession Number
71466032
Authors
Kalantarian S. Buonanno F.S. Gollub R. Retzepis K. Mansour M. Ruskin J.N.
Institution
(Kalantarian, Mansour, Ruskin) Cardiology, Massachusetts General Hosp.,
Boston, MA, United States
(Buonanno) Neurology, Massachusetts General Hosp., Boston, MA, United
States
(Gollub, Retzepis) Psychiatric Neuroscience, Massachusetts General Hosp.,
Charlestown, MA, United States
Title
Atrial fibrillation is associated with increased risk of silent cerebral
infarction: A systematic review and meta-analysis.
Source
Stroke. Conference: 2014 International Stroke Conference and
State-of-the-Science Stroke Nursing Symposium of the American Heart
Association/American Stroke Association San Francisco, CA United States.
Conference Start: 20140211 Conference End: 20140214. Conference
Publication: (var.pagings). 45 , 2014. Date of Publication: February
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Several studies report an association between atrial
fibrillation (AF) and silent cerebral infarcts (SCIs), but no
meta-analysis has been done to provide a pooled estimate. Methods: We
searched 5 electronic databases -MEDLINE, PsycINFO, Cochrane Library,
CINAHL, and EMBASE- and manually screened bibliographies of pertinent
articles. The main outcome of interest was evidence of brain infarcts on
imaging or autopsy with no attributable clinical symptoms. Only
peer-reviewed prospective and non-prospective studies of patients with no
clinical history of stroke or prosthetic valves were included. Random
effects meta-analyses using the DerSimonian and Laird method were
performed. A sensitivity analysis was carried out restricted to studies
which reported adjusted risk estimates. To examine the proportionate
excess risk of SCIs associated with AF, we estimated the
population-attributable risk (PAR) for each study and reported the pooled
PAR. Results: Of 964 retrieved abstracts, 12 were included (Image). A
total of 8461 patients (786 with AF and 7675 without AF) were included in
the analysis. 366 (46.56%) patients with AF and 1633 (21.28%) patients
without AF had SCIs. AF was significantly associated with SCIs in patients
with no clinical stroke history (odds ratio (OR) [95% confidence interval
(CI)] = 2.11[1.23, 3.61], I2=80.9%). Pooled PAR [95%CI] was 0.16[0.09,
0.23]. Removing one study at a time did not change the significance of the
results or the heterogeneity. The result of the analysis restricted to
studies with adjusted ORs remained similar (OR [95% CI] = 2.58 [1.30,
5.14], I2= 73.1%). Among the studies with adjusted ORs, only one included
lesions of< 3mm in their definition of SCIs. Removing this study from the
secondary analysis eliminated the heterogeneity without changing the
results substantially. Conclusions: AF is associated with a more than
twofold increase in the odds of SCI. Similar to clinical stroke, about 16%
of SCIs are attributable to AF.

<24>
Accession Number
71460896
Authors
Higgs M. Fernandez R.
Institution
(Higgs, Fernandez) Centre for Research in Nursing and Health, St George
Hospital, University of Wollongong, Sydney, Australia
Title
The effect of insulin therapy algorithms on blood glucose levels in
post-operative patients following cardiac surgery: A systematic review.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e334), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: Current literature suggests that hyperglycaemia occurs
almost universally after cardiac surgery, and glycaemic control to a mean
blood glucose of 5.7mmol/L lowers morbidity and mortality by up to 50%.
Objectives: The objective of the systematic reviewwas to determine the
effect of insulin therapy algorithms on blood glucose levels in
post-operative patients following cardiac surgery. Methods: Clinical
trials were identified by searching the electronic medical and nursing
databases, reference lists and grey literature. Trials were included if
they were undertaken on adult patients, aged 18 years and over, who were
admitted to a critical care unit following cardiac surgery and who
received insulin therapy for glycaemic control during the acute
postoperative phase (5 days) of admission. Results: Fourteen clinical
trials were identified through the search. Blood glucose targets ranged
from 4.4-11.1 mmol/L. The majority of the studies used arterial or venous
samples to monitor blood glucose levels. Frequency of monitoring of blood
glucose levels ranged from one to four hours. In all trials insulin was
administered via infusion with doses ranging from 0.1-10 IU per hour. The
mean blood glucose levels following the insulin therapy algorithms in the
trials ranged from 4.4-9.7 mmol/L. The incidence of hypoglycaemia ranged
from 0.2-7.1% Conclusion: Insulin therapy algorithms in the post-operative
period are effective in maintaining optimal blood glucose levels in
patients following cardiac surgery.

<25>
Accession Number
71460389
Authors
Sarathy K. Nagaraja V. Raval J. Eslick G.D. Denniss A.R.
Institution
(Sarathy, Nagaraja) Prince of Wales Hospital, University of Sydney,
Sydney, Australia
(Raval, Denniss) Cardiology, Blacktown Hospital, Sydney, Australia
(Eslick) University of Sydney, Sydney, Australia
Title
Target-vessel versus multivessel revascularization in ST-elevation
myocardial infarction A meta-analysis of randomized trials.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e192), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: In acute ST-segment elevation myocardial infarction (STEMI),
coronary reperfusion with percutaneous coronary intervention (PCI) to
treat the culprit lesion responsible for infarction improves clinical
outcomes in nearly all patients. In patients with acute STEMI who undergo
primary PCI,a strategy of treatment of significant non-infarct stenoses
(preventive PCI) in addition to the culprit lesion responsible for
infarction results in improved cardiovascular outcomes and reduced overall
mortality. Objectives: To compare target-vessel and multivessel
revascularization in ST-elevation myocardial infarction Methods: A
systematic search was conducted using MEDLINE, PubMed, EMBASE, Current
Contents Connect, Cochrane library, Google Scholar, Science Direct, and
Web of Science. Original data were abstracted from each study and used to
calculate a pooled odd ratio (OR) and 95% confidence interval (95% CI).
Results: Only four randomised trials comprising of 775 patients met full
criteria for analysis. The incidence of nonfatal MI (OR: 0.376, 95% CI:
0.192-0.763), refractory angina (OR: 0.400, 95% CI: 0.241-0.741) and
repeat revascularisation (OR: 0.336, 95% CI: 0.202-0.661) was lower in
multivessel revascularization cohort. Death from cardiac causes or non
fatal MI(OR: 0.336, 95% CI: 0.223-0.505) and from non cardiac outcomes
(OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the
multivessel revascularization cohort. The Median Contrast Volume and
Procedure Length were similar in both cohorts. Conclusion: In patients
with acute STEMI who undergo primary PCI,a strategy of treatment of
significant non-infarct stenoses (preventive PCI) in addition to the
culprit lesion responsible for infarction results in improved
cardiovascular outcomes and reduced overall mortality.

<26>
Accession Number
71460296
Authors
Fotoohi N. Mirzaei M. Haddadzadeh M.
Institution
(Fotoohi, Mirzaei) Yazd Cardiovascular Research Centre, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Haddadzadeh) Department of Cardiac Surgery, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Effect of preaortic fat pad removal on atrial fibrillation post off-pump
coronary artery bypass grafting (CABG): A randomized controlled trial.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e166), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: An anterior periaortic fat pad (AFP) in human containing
parasympathetic ganglia has been described in the aorto-pulmonary window.
Changes in the autonomic nervous system (ANS) tone can lead to
postoperative atrial fibrillation (POAF). The AFP is usually removed
during coronary bypass grafting (CABG) to fully expose the aortic root.
Objectives: The purpose of this study was to evaluate the effect of AFP
removal during CABG on the ANS tone, incidence of POAF, length of hospital
stay in-hospital morbidity and mortality. Methods: In this double blind
randomized controlled trial, a total of 184 patients who were nominated
for off pump CABG were randomized in to either removal (n =90) or
maintenance (n =94) of the AFP arms during their first CABG. All patients
underwent continuous telemetry monitoring after surgery. POAF was defined
as fibrillation for more than five minutes or fibrillation causing
hemodynamic instability. Results: The mean of participants was 60 years,
and 69.6% were male. There was no difference in the incidence of POAF
between the retained and removed AFP arms (12.2% Vs. 5.3% respectively; P
=0.12). Length of-hospital stay, and postoperative morbidity and mortality
were similar in both arms, except for the bleeding incidence which was
higher in the retained AFP arm (P=0.014). Conclusions: Removal of AFP
during CABG has no significant effect on the incidence of POAF, other
arrhythmia, and postoperative morbidity or mortality.

<27>
Accession Number
71460274
Authors
Alshualah R.
Institution
(Alshualah) Education and Training Department, Royal Commission Hospital,
Jubail, Saudi Arabia
Title
Groin dressing post cardiac catheterization: Traditional pressure vs
transparent film.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e160), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: Post cardiac catheterization puncture site care is usually
done with a tight pressure dressing in many institutions and cardiac
centers due to the belief that it should prevent the bleeding. This
practice is uncomfortable to the patients. Nurses have also described
difficulty in assessing the sheath insertion site in the groin when
pressure dressing is in place . A new way of dressing using transparent
film dressing (TFD) has approved and rated better with regard to: comfort,
less pain, decrease hematoma formation and facilitates nurses assessment
of puncture wound site after femoral sheath removal. Objectives: To
determine the efficacy of using a small transparent non pressure dressing
compared with the traditional controlled pressure dressing applied to the
femoral artery puncture wound site to maintain haemostasis following
cardiac catheterization procedures. Methods: Design: An experimental
design, randomized controlled trial. Setting: King Fahd University
Hospital in Khober, Saudi Arabia. Patients: 80 post cardiac
catheterization patients were randomized to have their groins dressed
either with pressure dressing (N = 40) or Transparent Film Dressing (N =
40). Patients ambulated 8 hours after the procedures. Outcome variables
were hematoma formation or bleeding, patient discomfort, and
nurse-reported ease of observation of the groin puncture site after the
procedure. Five instruments were used for data collection: 1) Demographic
and medical data sheet, 2) Hematoma Formation and Bleeding Scale, 3) Skin
Integrity Scale, 4) Patient Discomfort and Pain Scale & 5) Nurses Ease of
Assessment Scale. Results: Results of the study show that 100% in TFD
group vs 55% in pressure dressing group reported feeling very comfortable
( p value of 0.003). Hematoma formation was equal in the two dressing
groups with no incidence of bleeding complications. Nurses rated the ease
of assessing the groin significantly higher for TFD than for pressure
dressings ( p value of 0.000). Conclusion: Dressing of the puncture site
after cardiac catheterization with TFD was more comfortable than the
conventional pressure dressing without any difference in hematoma or
bleeding complications. So TFDcan be used safely and comfortably after
achieving hemostasis.

<28>
Accession Number
71459986
Authors
Nagaraja V. Raval J. Eslick G.D. Denniss A.R.
Institution
(Nagaraja) Cardiology, Prince of Wales Hospital, University of Sydney,
Sydney, Australia
(Raval, Denniss) Cardiology, Blacktown Hospital, Sydney, Australia
(Eslick) University of Sydney, Sydney, Australia
Title
Approaches for transcatheter aortic valve replacement: A systematic review
and meta-analysis.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e82), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: Retrograde transfemoral and antegrade transapical approaches
are mostly used for transcatheter aortic valve replacement. Objectives:
This meta-analysis is designed to assess the performance of the
transfemoral and transapical approach. Methods: A systematic search was
conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect,
Cochrane library, Google Scholar, Science Direct, and Web of Science.
Original data was abstracted from each study and used to calculate a
pooled odd ratio (OR) and 95% confidence interval (95% CI). Results: Only
14 studies comprising of 6965 patients met full criteria for analysis. The
mean duration of hospitalisation and procedure duration were similar among
the 2 cohorts. The 30 days mortality (OR:0.70, 95% CI:0.531-0.921), major
bleeding incidence rates (OR:0.77, 95% CI: 0.488-1.225), coronary
obstruction (OR:0.74, 95% CI:0.234-2.311), myocardial infarction (OR:
0.75, 95% CI: 0.28-2.00), conversion to open cardiac surgery (OR: 0.29,
95% CI: 0.062-1.343), successful implantation (OR: 0.67, 95% CI:
0.394-1.149), the need for haemodialysis (OR: 0.29, 95% CI:0.157-0.525)
and one year mortality (OR:0.72, 95% CI: 0.564-0.927) were lower in the
transfemoral cohort. The frequency of stroke at 30 days and new pacemaker
insertion were comparable. However, the prevalence of aortic regurgitation
(OR: 1.25, 95% CI: 0.844-1.855), vascular complication (OR: 2.88, 95% CI:
1.821-4.563) and valve embolization (OR: 2.00, 95% CI: 0.622-6.448) was
higher in the transfemoral group. Conclusion: In the absence of a
randomized controlled study, the ability to discriminate true differences
is challenging. Even though the complications rate was much lower in
transfemoral group as compared to transapical group, the current
literature does not support a clear superiority of one approach to TAVR
over the other.

<29>
Accession Number
71459985
Authors
Nagaraja V. Raval J. Eslick G.D. Ong A.T.
Institution
(Nagaraja) Cardiology, Prince of Wales Hospital, University of Sydney,
Sydney, Australia
(Raval) Cardiology, Blacktown Hospital, Sydney, Australia
(Eslick) University of Sydney, Sydney, Australia
(Ong) Cardiology, Westmead Hospital, Sydney, Australia
Title
Transcatheter vs. surgical aortic valve replacement: A systematic review
and meta-analysis of randomized and non-randomized trials.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e82), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: Many patients deemed inoperable for surgical aortic valve
replacement (SAVR) have been treated successfully by transcatheter
aortic-valve replacement (TAVR). Objectives: This meta-analysis is
designed to evaluate the performance of TAVR in comparison with SAVR.
Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE,
Current Contents Connect, Cochrane library, Google Scholar, Science
Direct, and Web of Science. Original data was abstracted from each study
and used to calculate a pooled odd ratio (OR) and 95% confidence interval
(95% CI). Results: Among the two randomized controlled trials (RCTs): the
frequency of stroke (OR: 1.94, 95% CI: 0.813-4.633) was higher in the TAVR
cohort, while the incidence of myocardial infarction, (OR: 0.765, 95% CI:
0.05-11.76) 30 day mortality rate and acute kidney injury incidence rate
were comparable. The results of the 36 non RCTs demonstrated that the TAVR
group had an amplified frequency of pacemaker insertion (OR: 3.169, 95%
CI: 2.338-4.294), major vascular complication (OR: 7.117, 95% CI:
2.287-22.149) and aortic regurgitation at discharge (OR: 7.412, 95% CI:
3.695-14.868). While the incidence rate of 30 day mortality and myocardial
infarction were comparable. A lower incidence of new-onset atrial
fibrillation, patients needing transfusion and was observed in the TAVR
cohort. The subgroup analysis of statistically sound studies did not
differ from the crude analysis considerably. Conclusion: Results
demonstrate both the future promise and current problems of the TAVR
approach. The future is expected to be more prosperous as new developments
and data from ongoing trials will provide the background to expand TAVR
applications and establish their position in a broader spectrum of
patients.

<30>
Accession Number
71459908
Authors
Indraratna P. Cao C. Ang S.
Institution
(Indraratna, Cao, Ang) Cardiothoracic Surgery, St George Hospital,
Kogarah, Australia
Title
Should clopidogrel be discontinued prior to coronary artery bypass graft
surgery for patients with acute coronary syndrome? - A systematic review
and metaanalysis of randomized and non-randomized trials.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2014, WCC 2014 Melbourne, VIC Australia. Conference Start: 20140504
Conference End: 20140507. Conference Publication: (var.pagings). 9 (1
SUPPL. 1) (pp e61), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Introduction: Patients presenting with acute coronary syndrome (ACS) are
treated with dual antiplatelet agents including aspirin and clopidogrel.
However, those who require CABG may have increased postoperative bleeding
and bleeding-related adverse outcomes. Objectives: The present
meta-analysis aimed to examine the evidence on clopidogrel in the
treatment of patients presenting with ACS requiring CABG, with focus on
the timing of medication cessation prior to surgery. Methods: A systematic
review of 9 electronic databases was performed to identify all relevant
studies with comparable outcomes for patients treated with clopidogrel
prior to CABG. Endpoints included reoperation, major bleeding, mortality
and composite endpointincluding mortality and recurrent myocardial
infarction. Results: Five relevant studies were identified. Patients
treated with clopidogrel had a significantly lower incidence of composite
endpoints compared to those who were not treated with clopidogrel.
However, patients who underwent CABG less than 5 days after the last dose
of clopidogrel were found to have significantly higher incidences of
reoperation, major bleeding and combined adverse outcomes than those who
had more than 5 days washout. Conclusion: The present meta-analysis
confirms that patients should be treated with dual antiplatelet therapy
including clopidogrel. However, for patients subsequently referred for
CABG, a minimum washout period of 5 days should be observed to minimize
perioperative bleeding and bleeding-related complications unless emergency
indications exist. These results differ from previous studies and
guidelines.