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<1>
Accession Number
24054755
Authors
Sun G. Wang X. Chen J. Ma R. Li F. Chen L. Xiao Y.
Institution
(Sun, Wang, Chen, Ma, Li, Chen, Xiao) Department of Cardiovascular
Surgery, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao
Street, Chongqing 400037, China
Title
Primary repair of tetralogy of Fallot in infants: Transatrial/
transpulmonary or transventricular approach.
Source
Asian Journal of Surgery. 36 (4) (pp 137-143), 2013. Date of Publication:
October 2013.
Abstract
Objective: Right ventricular (RV) dysfunction is a significant cause of
morbidity and mortality after surgical correction of tetralogy of Fallot
(TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in
contrast to the transventricular approach) in order to preserve the
structure and function of the right ventricle. We performed a pilot
prospective randomized controlled trial in infants with TOF undergoing
primary repair. Methods: A pilot prospective controlled clinical trial was
conducted in infants with TOF undergoing primary repair between January
2008 and December 2009. One hundred and six patients were recruited in the
trial and divided into a transatrial-transpulmonary approach group (Group
A; n = 53) and a transventricular approach group (Group B; n = 53),
depending on the different surgical techniques used. Results: Preoperative
patient characteristics and procedure-related variables were similar.
There were no deaths in Group A, while two patients died in Group B. There
were significant differences in cardiopulmonary bypass time (95.02 + 23.8
vs. 85.23 + 22.63 minutes, p = 0.032), cross-clamp time (69.4 + 10.36 vs.
61.17 + 9.38 minutes, p = 0.035), inotropic support (1.63 + 0.97 vs. 2.1 +
1.09 days, p = 0.02), intubation time (26.62 + 12.48 vs. 33.02 + 17.55
hours, p = 0.033), duration of stay in the intensive care unit (ICU) (2.25
+ 1.28 vs. 2.85 + 1.46 days, p = 0.026), and the incidence of arrhythmia
[3 patients (5.7%) vs. 10 patients (18.9%), p = 0.038]. No significant
differences in right/left ventricular pressure ratio and hospital stay
were observed. Conclusion: Transatrial/transpulmonary repair of TOF is
associated with excellent surgical results and immediately follow-up.
2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All
rights.

<2>
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Accession Number
2014381972
Authors
Agus M.S.D. Asaro L.A. Alexander J.L. Costello J.M. Curley M.A.Q. Del Nido
P. Duggan C. Jaksic T. Laussen P.C. Langer M. Newburger J.W. Pigula F.A.
Sadhwani A. Shukla A. Silverman M. Steil G.M. Ware J. Wypij D. Gaies M.G.
Charpie J.R. Goldberg C.S. Ohye R.G.
Institution
(Agus, Steil, Alexander, Silverman) Division of Medicine Critical Care,
Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave,
Boston, MA 02115, United States
(Asaro, Wypij) Department of Cardiology, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Gaies, Del Nido, Duggan, Jaksic, Laussen, Langer, Newburger, Pigula,
Sadhwani, Shukla, Silverman, Steil, Ware, Wypij) Division of Pediatric
Cardiology, C.S. Mott Children's Hospital, University of Michigan Medical
School, Ann Arbor, United States
(Costello, Curley) University of Pennsylvania, School of Nursing, United
States
Title
Tight glycemic control after pediatric cardiac surgery in high-risk
patient populations: A secondary analysis of the safe pediatric euglycemia
after cardiac surgery trial.
Source
Circulation. 129 (22) (pp 2297-2304), 2014. Date of Publication: 03 Jun
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND - : Our previous randomized, clinical trial showed that
postoperative tight glycemic control (TGC) for children undergoing cardiac
surgery did not reduce the rate of health care-associated infections
compared with standard care (STD). Heterogeneity of treatment effect may
exist within this population. METHODS AND RESULTS - : We performed a post
hoc exploratory analysis of 980 children from birth to 36 months of age at
the time of cardiac surgery who were randomized to postoperative TGC or
STD in the intensive care unit. Significant interactions were observed
between treatment group and both neonate (age <30 days; P=0.03) and
intraoperative glucocorticoid exposure (P=0.03) on the risk of infection.
The rate and incidence of infections in subjects <60 days old were
significantly increased in the TGC compared with the STD group (rate: 13.5
versus 3.7 infections per 1000 cardiac intensive care unit days, P=0.01;
incidence: 13% versus 4%, P=0.02), whereas infections among those >60 days
of age were significantly reduced in the TGC compared with the STD group
(rate: 5.0 versus 14.1 infections per 1000 cardiac intensive care unit
days, P=0.02; incidence: 2% versus 5%, P=0.03); the interaction of
treatment group by age subgroup was highly significant (P=0.001).
Multivariable logistic regression controlling for the main effects
revealed that previous cardiac surgery, chromosomal anomaly, and delayed
sternal closure were independently associated with increased risk of
infection. CONCLUSIONS - : This exploratory analysis demonstrated that TGC
may lower the risk of infection in children >60 days of age at the time of
cardiac surgery compared with children receiving STD. Meta-analyses of
past and ongoing clinical trials are necessary to confirm these findings
before clinical practice is altered. 2014 American Heart Association,
Inc.

<3>
Accession Number
2014388418
Authors
Jiang G. Li B. Zhang G. Xu E. Liu Y. Xu Z.
Institution
(Xu) Department of Cardiothoracic Surgery, Changhai Hospital, Second
Military Medical University, Shanghai 200433, China
Title
Effects of Sildenafil on Prognosis in Patients with Pulmonary Hypertension
After Left-sided Valvular Surgery.
Source
Heart Lung and Circulation. 23 (7) (pp 680-685), 2014. Date of
Publication: July 2014.
Publisher
Elsevier Ltd
Abstract
Introduction: Sildenafil (Viagra, Pfizer) is being used to treat pulmonary
hypertension (PH). However, there are limited data on the effects of
sildenafil on patients with PH after left-sided valvular surgery. The
purpose of this study was to determine the optimal dosage and the effects
of sildenafil on prognosis of patients with PH after left-sided valvular
surgery. Methods: This randomised controlled trial, double-blind study
enrolled patients with PH undergoing left-sided valvular surgery in our
hospital from January to December, 2010. Ninety patients were enrolled.
And 0.5. mg/kg sildenafil citrate or placebo was administered through
nasogastric tubes, the haemodynamics changes in the 0.5/1/2/4. hours were
assessed. The sildenafil citrate/placebo was continued to the discharges
and the early prognoses of these patients were compared. Results: Compared
with placebo, a 0.5. mg/kg dose of sildenafil significantly reduced the
time of mechanical ventilation, stay-in-ICU and hospitalisation duration.
Conclusions: Sildenafil might be beneficial to the early prognosis of
patients with PH after left-sided valvular surgery. 2014 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<4>
Accession Number
2014382846
Authors
Strychowsky J.E. Rukholm G. Gupta M.K. Reid D.
Institution
(Strychowsky, Rukholm, Gupta, Reid) Department of Surgery, Division of
Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main St
West, Hamilton, ON L8N 3Z5, Canada
(Rukholm) Peterborough Regional Health Centre, Peterborough, ON, Canada
Title
Unilateral vocal fold paralysis after congenital cardiothoracic surgery: A
meta-analysis.
Source
Pediatrics. 133 (6) (pp e1708-e1723), 2014. Date of Publication: 01 Jun
2014.
Publisher
American Academy of Pediatrics (141 Northwest Point Blvd, P.O. Box 927,
Elk Grove Village IL 60007-1098, United States)
Abstract
BACKGROUND AND OBJECTIVE: There is variation in the literature in regard
to the occurrence of unilateral vocal fold paralysis (UVFP) after
congenital cardiothoracic surgery. The objective of this study was to
identify and appraise the evidence for the occurrence of UVFP after
congenital cardiothoracic surgery in a meta-analysis. METHOD: A
comprehensive search strategy in Medline, Embase, and the Cochrane Library
was conducted, limited to English publications. Two independent reviewers
screened studies for eligibility criteria. Of the 162 identified studies,
32 (20%) met the inclusion criteria. Using the Oxford Centre for
Evidence-Based Medicine guidelines, 2 reviewers appraised the level of
evidence, extracted data, and resolved discrepancies by consensus.
Weighted pooled proportion and 95% confi dence intervals (CIs) are
reported. RESULTS: Thirty-two studies (n = 5625 patients) were included.
Levels of evidence varied from level 3 to 4. Among all studies, the
weighted pooled proportion of UVFP was 9.3% (95% CI, 6.6% to 12.5%), and
among 11 studies (n = 584 patients) that postoperatively evaluated
patients with flexible nasopharyngolaryngoscopy to document presence of
UVFP, the weighted pooled proportion of UVFP was 29.8% (95% CI, 18.5% to
42.5%). Twenty-one studies (n = 2748 patients) evaluated patients
undergoing patent ductus arteriosus ligation surgery, and the weighted
pooled proportion of UVFP was 8.7% (95% CI, 5.4% to 12.6%). Six of these
(n = 274 patients) assessed all patients postoperatively, and the weighted
pooled proportion of UVFP was 39% (95% CI, 18% to 63%). Pooled analyses of
risk factors and comorbidities are reported. Heterogeneity and publication
bias were detected. CONCLUSIONS: UVFP is a demonstrated risk of congenital
cardiothoracic surgery. Routine postoperative nasopharyngolaryngoscopy for
vocal fold assessment by an otolaryngologist is suggested. Copyright 2014
by the American Academy of Pediatrics.

<5>
Accession Number
2014382578
Authors
Foroughi M. Argani H. Hassntash S.A. Hekmat M. Majidi M. Beheshti M.
Mehdizadeh B. Yekani B.
Institution
(Foroughi, Mehdizadeh) Cardiovascular Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Argani) Urology and Nephrology Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hassntash, Hekmat, Majidi, Beheshti, Yekani) Department of Cardiac
Surgery, Modarres Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Lack of renal protection of ultrafiltration during cardiac surgery: A
randomized clinical trial.
Source
Journal of Cardiovascular Surgery. 55 (3) (pp 407-413), 2014. Date of
Publication: June 2014.
Publisher
Edizioni Minerva Medica
Abstract
Aim. The objective of this study was to determine the intraoperative
ultrafiltration effect on postoperative AKI. Methods. In this prospective
randomized clinical trail, 159 patients scheduled for elective cardiac
surgery, were randomly assigned to either hemofilter (N.=87) or control
group (N.=72). The primary and secondary outcomes were AKI (defined as
>50% increase in the serum creatinine level) and increased urinary
neutrophil gelatinase-associated lipocalin (NGAL) in the postoperative
period, respectively. Results. The two groups were similar with respect to
comorbidities and also surgical procedure, except ultrafiltration. The
incidence of AKI was equal in the both groups (11% vs. 5%, P=0.2,
respectively). Creatinine increased after surgery (P=0.00) without
significant differences between the both groups (P=0.2). Urinary NGAL also
showed no significant difference between the groups. Age, euroscore,
hyperlipidemia, pulmonary disease and urinary volume during operation
correlated with the development of AKI. Postoperative blood loss was less
in the hemofilter than control group (820+550 ml vs. 1100+630 ml, P=0.04).
There was no difference in the length of intubation and stay in intensive
care unit. Conclusion. Routine use of ultrafiltration during cardiac
surgery offers no advantages in renal protection and reduction of AKI
incidence.

<6>
Accession Number
2014375465
Authors
Dormuth C.R. Filion K.B. Paterson J.M. James M.T. Teare G.F. Raymond C.B.
Rahme E. Tamim H. Lipscombe L.
Institution
(Dormuth) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Victoria, BC V8W 1Y2, Canada
(Filion) Centre for Clinical Epidemiology, McGill University, Jewish
General Hospital, Montreal, Canada
(Paterson, Lipscombe) Institute for Clinical Evaluative Sciences, Toronto,
Canada
(James) Department of Medicine, University of Calgary, Calgary, Canada
(Teare) Health Quality Council, Saskatoon, Canada
(Raymond) Manitoba Centre for Health Policy, University of Manitoba,
Winnipeg, Canada
(Rahme) Department of Medicine, McGill University, Montreal, Canada
(Tamim) School of Kinesiology and Health Science, York University,
Toronto, Canada
Title
Higher potency statins and the risk of new diabetes: Multicentre,
observational study of administrative databases.
Source
BMJ (Online). 348 , 2014. Article Number: g3244. Date of Publication: 29
May 2014.
Publisher
BMJ Publishing Group
Abstract
Objective To evaluate the incremental increase in new onset diabetes from
higher potency statins compared with lower potency statins when used for
secondary prevention. Design Eight population based cohort studies and a
meta-analysis. Setting Six Canadian provinces and two international
databases from the UK and US. Participants 136 966 patients aged >40 years
newly treated with statins between 1 January 1997 and 31 March 2011.
Methods Within each cohort of patients newly prescribed a statin after
hospitalisation for a major cardiovascular event or procedure, we
performed as-treated, nested case-control analyses to compare diabetes
incidence in users of higher potency statins with incidence in users of
lower potency statins. Rate ratios of new diabetes events were estimated
using conditional logistic regression on different lengths of exposure to
higher potency versus lower potency statins; adjustment for confounding
was achieved using high dimensional propensity scores. Meta-analytic
methods were used to estimate overall effects across sites. Main outcome
measures Hospitalisation for new onset diabetes, or a prescription for
insulin or an oral antidiabetic drug. Results In the first two years of
regular statin use, we observed a significant increase in the risk of new
onset diabetes with higher potency statins compared with lower potency
agents (rate ratio 1.15, 95% confidence interval 1.05 to 1.26). The risk
increase seemed to be highest in the first four months of use (rate ratio
1.26, 1.07 to 1.47). Conclusions Higher potency statin use is associated
with a moderate increase in the risk of new onset diabetes compared with
lower potency statins in patients treated for secondary prevention of
cardiovascular disease. Clinicians should consider this risk when
prescribing higher potency statins in secondary prevention patients.

<7>
Accession Number
2014374577
Authors
Acarturk H. Oztekin I. Oztek S.D. Issever H. Canik S.
Institution
(Acarturk, Canik) Department of Anesthesiology and Reanimation, Siyami
Ersek Heart Surgery Hospital, Istanbul, Turkey
(Oztekin) Department of Anesthesiology and Reanimation, Trakya University,
Edirne, Turkey
(Oztek) Department of Surgical Nursing, Istanbul University Florence
Nightingale Highschool of Nursing, Turkey
(Issever) Department of Public Health, Istanbul University, Istanbul,
Turkey
Title
Effects of propofol and midazolam infusions on serum lipid and glucose
levels in hyperlipidemic patients undergoing coronary artery bypass
surgery.
Source
Turkiye Klinikleri Journal of Medical Sciences. 34 (2) (pp 267-272), 2014.
Date of Publication: 2014.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Objective: Propofol has been accused for increasing plasma lipid levels
during continuous infusion due to its lipid content. We aimed to show the
effect and the risk of propofol infusion on plasma lipid and glucose
levels in patients with hyperlipidemia undergoing coronary artery bypass
graft surgery (CABG), and to compare them with a midazolam used control
group. Material and Methods: In this randomized controlled study, 15
patients in the propofol group had anesthesia induction with intravenous
propofol 1%, 2 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1 mg/kg, and
the anesthesia was maintained with 1% 2-5 mg/kg/h propofol infusion,
fentanyl 5-10 mcg/kg/hr, and an hourly pancuronium dose of 0.03 mg/kg The
anesthetia management of 15 patients in midazolam group included induction
with midazolam 0.1 mg/kg, fentanyl 10-15 mcg/kg, pancuronium 0.1 mg/kg,
and infusion of midazolam 0.05-0.07 mg/kg/hr, fentanyl 5-10 mcg/kg/hr, and
an hourly pancuronium dose of 0.03 mg/kg Plasma lipid [total cholesterol
(CHL), triglyceride (TRG), high density lipoprotein (HDL), low density
lipoprotein (LDL), very low density lipoprotein (VLDL)] and glucose
concentrations were measured in both groups perioperatively, at seven
different time points until 72 hours after the operation. Results: The
decreases of TRG and HDL levels were statistically significant in the
midazolam group. There were no significant differences for the decreases
in CHL, LDL and VLDL levels between the groups. In both groups, plasma
glucose levels increased significantly, independent from the propofol and
midazolam infusions. Conclusion: We observed that propofol and midazolam
anesthesia used in patients with hyperlipidemia undergoing to CABG did not
have any effect on plasma lipid or glucose levels. 2014 by Turkiye
Klinikleri.

<8>
Accession Number
2014374020
Authors
Visser M. Davids M. Verberne H.J. Kok W.E.M. Tepaske R. Cocchieri R.
Kemper E.M. Teerlink T. Jonker M.A. Wisselink W. De Mol B.A.J.M. Van
Leeuwen P.A.M.
Institution
(Visser, Wisselink, Van Leeuwen) Department of Surgery, VU University
Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands
(Davids, Teerlink) Departments of Clinical Chemistry, Amsterdam,
Netherlands
(Jonker) Epidemiology and Biostatistics, VU University Medical Center,
Amsterdam, Netherlands
(Visser, Cocchieri, De Mol) Departments of Cardio-thoracic Surgery,
Amsterdam, Netherlands
(Verberne) Departments of Nuclear Medicine, Amsterdam, Netherlands
(Kok) Departments of Cardiology, Amsterdam, Netherlands
(Kemper) Departments of Pharmacy, Amsterdam, Netherlands
(Tepaske) Intensive Care Unit, Academic Medical Center University of
Amsterdam, Amsterdam, Netherlands
Title
Nutrition before, during, and after surgery increases the arginine:
Asymmetric dimethylarginine ratio and relates to improved myocardial
glucose metabolism: A randomized controlled trial.
Source
American Journal of Clinical Nutrition. 99 (6) (pp 1440-1449), 2014. Date
of Publication: 01 Jun 2014.
Publisher
American Society for Nutrition
Abstract
Background: Nitric oxide (NO) is essential for the optimal perfusion of
the heart and its vasculature. NO may be insufficient in surgical patients
because its precursor arginine is decreased, and the inhibitor of NO
synthesis asymmetric dimethylarginine (ADMA) is increased. Besides
arginine, the presence of other amino acids essential for the proper
metabolism of cardiac cells may be decreased too. Supplementation of these
amino acids with enteral and parenteral nutrition before, during, and
after surgery may augment the myocardial and plasma arginine:ADMA ratio
and availability of amino acids. Myocardial glucose metabolism and
nutritional conditioning may result in a reduction of cardiac injury and
support rapid recovery after major surgery. Objective: We investigated the
effect of nutrition before, during, and after surgery on amino acids and
the myocardial arginine:ADMA ratio and its relation to myocardial glucose
metabolism. Design: In this trial, 33 patients who were undergoing
off-pump coronary artery bypass grafting (CABG) were randomly assigned
between enteral, parenteral, or no nutrition (control) from 2 d before,
during, and until 2 d after surgery. Both enteral and parenteral solutions
were prepared with commercially available products and included proteins
or amino acids, glucose, vitamins, and minerals. Concentrations of amino
acids including ADMA were analyzed in myocardial tissue and plasma
samples. ¹⁸F- fluorodeoxyglucose positron emission tomography
was performed before and after surgery to assess myocardial glucose
metabolism. Results: The myocardial arginine:ADMA ratio increased during
surgery and was significantly higher in the enteral and parenteral groups
than in the control group [median (IQR): 115.0 (98.0-142.2) (P = 0.012),
116.9 (100.3-135.3) (P = 0.004), and 93.3 (82.7- 101.1), respectively].
Furthermore, the change in the preoperative to postoperative plasma
arginine:ADMA ratio correlated with the change in myocardial glucose
metabolism in positron emission tomography (r = 0.427, P = 0.033).
Conclusion: Enteral or parenteral nutrition before, during, and after CABG
may positively influence myocardial glucose metabolism by increasing the
plasma and myocardial arginine:ADMA ratio. This trial was registered at
http://www.trialregister.nl as NTR2183. 2014 American Society for
Nutrition.

<9>
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Accession Number
2014381577
Authors
Allison M.A. Aragaki A. Eaton C. Li W. Van Horn L. Daviglus M.L. Berger
J.S.
Institution
(Allison) Department of Family and Preventive Medicine, University of
California at San Diego, 9500 Gilman Dr, San Diego, CA 92093-0965, United
States
(Aragaki) WHI Coordinating Center, Fred Hutchinson Cancer Research Center,
Seattle, WA, United States
(Eaton) Department of Family Medicine and Epidemiology, Brown University,
Providence, RI, United States
(Li) Department of Medicine, University of Massachusetts, Boston, United
States
(Van Horn) Department of Preventive Medicine, Northwestern University,
Evanston, IL, United States
(Daviglus) Department of Medicine, University of Illinois at Chicago,
United States
(Berger) Department of Medicine, New York University, United States
Title
Effect of dietary modification on incident carotid artery disease in
postmenopausal women: Results from the women's health initiative dietary
modification trial.
Source
Stroke. 45 (6) (pp 1748-1756), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose: Because the diagnosis and treatment of carotid
artery disease may reduce the rate of stroke, the aim of this study was to
determine whether a diet intervention was associated with incident carotid
artery disease. METHODS-: Participants were 48 835 postmenopausal women
aged 50 to 79 years who were randomly assigned to either the intervention
or comparison group in the Women's Health Initiative Diet Modification
Trial. Incident carotid artery disease was defined as an overnight
hospitalization with either symptoms or a surgical intervention to improve
flow. RESULTS-: After a mean follow-up of 8.3 years from 1994 to 2005,
there were 297 (0.61%) incident carotid artery events. In contrast to the
comparison group, the risk of incident carotid disease did not differ from
those assigned to the intervention group (hazard ratio, 1.08; 95%
confidence interval, 0.9-1.4). In secondary analysis, there was no
significant effect of the intervention on the risk for incident carotid
disease during the 5 years of postintervention follow-up from 2005 to 2010
(hazard ratio, 1.24; 95% confidence interval, 0.9-1.7) and no significant
effect during cumulative follow-up from 1994 to 2010 (hazard ratio, 1.13;
95% confidence interval, 0.9-1.4). CONCLUSIONS-: Among postmenopausal
women, a dietary intervention aimed at reducing total fat intake and
encouraging increased intake of fruit, vegetables, and grains did not
significantly change the risk for incident carotid artery disease. 2014
American Heart Association, Inc.

<10>
Accession Number
2014375838
Authors
Deo S.V. Sharma V. Shah I.K. Erwin P.J. Joyce L.D. Park S.J.
Institution
(Deo, Sharma, Shah, Joyce) Division of Cardiovascular Surgery, Mayo Clinic
Rochester, Rochester, MN, United States
(Deo) Department of Cardiovascular Surgery, Wockhardt Adventist Heart
Institute, Surat Gujarat, India
(Erwin) Mayo Clinic Libraries, Mayo Clinic Rochester, Rochester, MN,
United States
(Shah) Division of Surgery, University of Minnesota, Minneapolis-St. Paul,
MN, United States
(Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, United States
Title
Minimally invasive direct coronary artery bypass graft surgery or
percutaneous coronary intervention for proximal left anterior descending
artery stenosis: A meta-analysis.
Source
Annals of Thoracic Surgery. 97 (6) (pp 2056-2065), 2014. Date of
Publication: June 2014.
Publisher
Elsevier USA
Abstract
Background We conducted a metaanalysis comparing early and midterm
cardiovascular adverse events associated with minimally invasive direct
coronary artery bypass graft surgery (MIDCABG) and percutaneous coronary
intervention (PCI), with a focus on drug-eluting stents (DES). Methods A
systematic literature review (MEDLINE, EMBASE, Scopus, and so forth)
yielded 12 studies (7 randomized controlled trials; 5 observational)
pooling more than 2,000 patients. A random effect, inverse variance
metaanalysis was conducted, and a subgroup analysis of the PCI-DES cohort
was performed. Events were compared as risk ratios using a 95% confidence
interval (CI). Heterogeneity of results was evaluated by Eggers
I² test. Results are presented as early (0 to 1 year) and
midterm (2 to 5 years). Results Midterm mortality in the PCI and MIDCABG
groups (3.6% and 2.6%, respectively) was comparable (1.24, 95% CI: 0.66 to
2.33; p = 0.5; I² = 0%). Risk of early restenosis was lower in
the MIDCABG cohort compared with PCI (0.40, 95% CI: 0.16 to 0.99; p =
0.05; I ² = 57%). Although the early risk of recurrence of
angina was comparable, over time it was 61% (43% to 74%) lower for MIDCABG
patients (p < 0.001). Midterm results on analysis of the entire cohort
demonstrated an increased risk for target vessel reinterventions (3.84,
95% CI: 2.7 to 5.5; p < 0.001) in the PCI cohort. Subgroup analysis
revealed that the PCI-DES cohort (4 studies; 456 patients) had a higher
risk of recurrent angina (risk ratio 3.4, 95% CI: 1.9 to 6.2; p < 0.001;
I² = 0%) and target vessel reinterventions (risk ratio 4.16,
95% CI: 2.7 to 6.6; p < 0.001; I² = 0%) at midterm follow-up (2
to 5 years). Conclusions Survival rates are comparable after either
MIDCABG or PCI for proximal LAD disease. However, even the use of DES was
associated with significantly higher rates of angina recurrence and the
need for target vessel reintervention as compared with MIDCABG. 2014 by
The Society of Thoracic Surgeons Published by Elsevier Inc.

<11>
Accession Number
2014370786
Authors
Nasso G. Bonifazi R. Romano V. Bartolomucci F. Rosano G. Massari F.
Fattouch K. Del Prete G. Riccioni G. Del Giglio M. Speziale G.
Institution
(Nasso, Bonifazi, Romano, Del Prete, Speziale) Division of Cardiac
Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba
35-37, IT-70124 Bari, Italy
(Bartolomucci) Division of Cardiology, L. Bonomo Hospital, Andria, Italy
(Del Giglio) Division of Cardiac Surgery, Maria Cecilia Hospital, GVM Care
and Research, Cotignola, Italy
(Rosano) Department of Internal Medicine, IRCCS San Raffaele, Rome, Italy
(Massari) Division of Cardiology, 'Umberto i' Hospital, Altamura, Italy
(Fattouch) Division of Cardiac Surgery, Maria Eleonora Hospital, GVM Care
and Research, Palermo, Italy
(Riccioni) Division of Cardiology, San Camillo de Lellis Hospital, Foggia,
Italy
Title
Three-year results of repaired barlow mitral valves via right
minithoracotomy versus median sternotomy in a randomized trial.
Source
Cardiology (Switzerland). 128 (2) (pp 97-105), 2014. Date of Publication:
May 2014.
Publisher
S. Karger AG
Abstract
Objectives: To clarify whether the results of repair of a complex mitral
lesion (Barlow valve) at the intermediate-term follow-up are independent
of the mode of surgical access [minithoracotomy vs. median sternotomy
(MS)]. Methods: In a prospective randomized study of mitral repair for
Barlow disease using either a minimally invasive (MI) approach or MS, we
achieved an average follow-up of 3 years (echocardiography, physical
examination and quality of life). Mitral repair was achieved with
polytetrafluoroethylene chordal implantation for both leaflets. Results:
Both groups included 80 patients. Mechanical ventilation time and
intensive care unit and hospital stay were shorter in the MI group (p =
0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5
patients in each group (6.25%) displayed mild mitral regurgitation, while
2 patients in each group (2.5%) developed recurrent regurgitation graded
as at least moderate/severe. The rate of mitral reoperation was 2.5% in
the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up
mortality was 3.75% in both the MI and the MS groups. Conclusions: The
3-year results of repair of Barlow valves were satisfactory irrespective
of the approach used to repair the valve. The advantages of MI surgery can
be achieved in patients with mitral Barlow disease without concerns over
the durability of repair. 2014 S. Karger AG, Basel.

<12>
Accession Number
2014375942
Authors
Devereaux P.J.
Institution
(Devereaux) Perioperative Medicine and Surgical Research Unit, David
Braley Cardiac, Vascular, and Stroke Research Institute, C/o Hamilton
General Hospital, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
Title
Rationale and design of the PeriOperative ISchemic Evaluation-2 (POISE-2)
trial: An international 2 x 2 factorial randomized controlled trial of
acetyl-salicylic acid vs placebo and clonidine vs placebo in patients
undergoing noncardiac surgery.
Source
American Heart Journal. 167 (6) (pp 804-809.e4), 2014. Date of
Publication: June 2014.
Publisher
Mosby Inc.
Abstract
Background Worldwide, 200 million adults undergo major noncardiac surgery
annually, and 10 million of these patients will have a major vascular
complication. Low-dose clonidine and low-dose acetyl-salicylic acid (ASA)
may prevent major perioperative vascular complications. We therefore
initiated the POISE-2 trial to establish the perioperative effects of
these 2 interventions. Methods The POISE-2 trial is a 2 x 2 factorial
randomized controlled trial of low-dose ASA vs placebo and low-dose
clonidine vs placebo in 10,000 patients at risk for a perioperative
cardiovascular event who are undergoing noncardiac surgery. Both study
drugs are initiated prior to surgery (goal 2-4 hours) and are continued
after surgery. Patients, health care providers, data collectors, and
outcome adjudicators are blinded to treatment allocation. The primary
outcome is a composite of mortality and nonfatal myocardial infarction at
30 days after randomization. Results To date, the POISE-2 trial has
recruited more than 9,000 patients from 135 centers in 23 countries. Among
the first 7,500 patients recruited, patients' mean age was 68.2 years,
53.4% were male, 34.0% had a history of vascular disease, and 38.3% had
diabetes that was treated. Participants had orthopedic (38.1%), general
(27.0%), urologic or gynecologic (17.2%), vascular (6.6%), thoracic
(5.7%), and other (5.4%) surgery. Conclusions POISE-2 is a large
international trial that will rigorously evaluate the effects of low-dose
clonidine and ASA in patients having noncardiac surgery. 2014 The Author.

<13>
Accession Number
2014362124
Authors
Treasure T. Takkenberg J.J.M. Golesworthy T. Rega F. Petrou M. Rosendahl
U. Mohiaddin R. Rubens M. Thornton W. Lees B. Pepper J.
Institution
(Treasure) Clinical Operational Research Unit, UCL, 4 Taviton Street,
London WC1H 0BT, United Kingdom
(Takkenberg) Department of CardioThoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Golesworthy, Thornton) Exstent Ltd, Tewkesbury, United Kingdom
(Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven,
Belgium
(Petrou) John Radcliffe Hospital, Oxford, United Kingdom
(Rosendahl) Department of Cardiac Surgery, Royal Brompton Hospital,
London, United Kingdom
(Mohiaddin) Department of Cardiac MRI, Royal Brompton Hospital, Imperial
College London, London, United Kingdom
(Rubens) Department of Radiology, Royal Brompton Hospital, London, United
Kingdom
(Lees) CTEU, Royal Brompton Hospital, London, United Kingdom
(Pepper) NIHR Cardiovascular Biomedical Research Unit, Royal Brompton
Hospital, London, United Kingdom
Title
Personalised external aortic root support (PEARS) in Marfan syndrome:
Analysis of 1-9 year outcomes by intention-to-treat in a cohort of the
first 30 consecutive patients to receive a novel tissue and
valve-conserving procedure, compared with the published results of aortic
root replacement.
Source
Heart. 100 (12) (pp 969-975), 2014. Date of Publication: June 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: Among people with Marfan syndrome who have a typical aortic
root aneurysm, dissection is a characteristic cause of premature death. To
pre-empt Type A dissection, composite root replacement with a mechanical
valve became the standard of care in the 1980s and 1990s. This is being
superseded by valvesparing aortic root replacement to avoid lifelong
anticoagulation. In 2004, a total root and valve-sparing procedure,
personalised external aortic support, was introduced. We report here
results among the first 30 recipients. Methods: From cross-sectional
digital images, the patient's own aorta is modelled by computer aided
design and a replica is made in thermoplastic by rapid prototyping. On
this, a personalised support of a macroporous polymer mesh is
manufactured. The mesh is positioned around the aorta, closely applied
from the aortoventricular junction to beyond the brachiocephalic artery.
The operation is performed with a beating heart and usually without
cardiopulmonary bypass. Results: Between 2004 and 2011, 30 patients,
median age 28 years (IQR 20-44) had this operation and have been
prospectively followed for 1.4-8.8 years by February 2013. During a total
of 133 patient-years there were no deaths or cerebrovascular, aortic or
valve-related events. These early outcomes are better than published
results for the more radical extirpative root replacement operations.
Conclusions: The aortic valve, the root architecture, and the
blood/endothelia interface are conserved. The perioperative burden is less
and there has been freedom from aortic and valvular events. A prospective
comparative study is planned.

<14>
Accession Number
2014364320
Authors
Gawecka A. Mierzewska-Schmidt M.
Institution
(Gawecka, Mierzewska-Schmidt) Department of Paediatric Anaesthesiology and
Intensive Therapy, Medical University of Warsaw, ul. Marszalkowska 24,
00-576 Warszawa, Poland
Title
Tolerance of, and metabolic effects of, preoperative oral carbohydrate
administration in children - A preliminary report.
Source
Anaesthesiology Intensive Therapy. 46 (2) (pp 61-64), 2014. Date of
Publication: April-June 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
viamedica@viamedica.com.pl)
Abstract
Background: The need for long preoperative fasting has been questioned.
Recent data shows that intake of an oral carbohydrate-containing clear
fluid prior to anaesthesia is safe and may have a positive impact on
recovery and metabolic status and could improve glucose tolerance. Such
solutions are routinely used in adults but not children. The aim of this
study was to evaluate the safety, tolerance and influence of oral
carbohydrate on selected metabolic parameters in children. Methods: With
ethics committee approval and parental informed consent, 20 children, aged
4-17 years, ASA status I or II, scheduled for abdominal or thoracic
surgery were randomised either to Group 1 - receiving a 12.6%
carbohydrate-containing drink (10 mL kg^-1 the evening before
surgery and two hours before anaesthesia), or the control Group 2 -
fasting. Serum glucose and insulin concentration were measured four times:
before and after anaesthesia, in the evening after surgery, and the
following morning. IGF-1 concentration was measured once, before surgery.
Insulin resistance was assessed by the HOMA-IR equation. Results: Oral
carbohydrate solution was well tolerated and no adverse events were noted.
Glucose concentrations were within the normal range in both groups.
Insulin concentration did not show significant differences between groups,
however before surgery it tended to be lower in Group 1. Insulin
resistance after surgery was significantly higher in Group 2 (2.0 vs.
0.62, P = 0.03), also the increase in insulin resistance after operation
was significant only in the control group (P = 0.03). Conclusion: Oral
carbohydrates are safe, well tolerated and do not cause any perioperative
adverse events. They seem to improve postoperative metabolism by
decreasing insulin resistance.

<15>
Accession Number
71493246
Authors
Theologou T. Kennedy D. Whiteley J. Bashir M. Rengarajan A. Khan O. Spyt
T. Richens D. Field M.
Institution
(Theologou, Kennedy, Whiteley, Bashir, Field) Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Rengarajan) Department of Cardiothoracic Surgery, Nothern General
Hospital, Sheffield, United Kingdom
(Khan) Department of Cardiothoracic Surgery, Nottingham City Hospital
Nottingham, Nottingham, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield General Hospital,
Leicester, United Kingdom
(Richens) Department of Cardiothoracic Surgery, Nottingham City Hospital,
Nottingham, United Kingdom
Title
Preoperative IABP in high risk patients undergoing CABG. Metanalysis
update.
Source
European Surgical Research. Conference: 49th Congress of the European
Society for Surgical Research Budapest Hungary. Conference Start: 20140521
Conference End: 20140524. Conference Publication: (var.pagings). 52 (3-4)
(pp 132), 2014. Date of Publication: May 2014.
Publisher
S. Karger AG
Abstract
Background: There is increasing evidence that certain cardiac surgery
patients benefit from a period of preoperative augmentation with the intra
aortic balloon pump. The aim for this update metanalysis is to look for
new RCTs since 2010 and update the decision making process when using IABP
during CABG for high risk cases. Material and Methods: Randomised
controlled trials (RCTs) of any size or length were included. Data
collection and analysis papers were assessed for inclusion by two authors
independently and differences were settled by consensus with a third
author. Date are presented in the form of odds ratios (OR) and 95%
confidence intervals (CI). Result: In the last metanalysis six trials were
included. This update adds the results of four further trials. Data from a
total of 556 patients were included in the meta-analysis of mortality
outcomes; 7 studies on-pump and 3 studies off pump. Generally, the
patients were considered as "high risk" and 286 were treated
preoperatively with IABP and 240 served as controls. There were fourteen
hospital deaths in the intervention arm and 32 in the non-intervention arm
(OR 0.18, 95% CI 0.08 to 0.41; P<0.0001).Clear Benefit has been recorded
of the use of the IABP in female population. Conclusion: Evidence suggests
that preoperative IABP may have a beneficial effect on mortality and
morbidity in specific high risk patient groups undergoing on or off pump
coronary artery bypass grafting. The use of the IABP on the female high
risk cases looks to be beneficial.

<16>
Accession Number
71491753
Authors
Huang T.-M. Wu V.-C.
Institution
(Huang) National Taiwan University, Hospital Yun-Lin Branch, College of
Medicine, Dou-liu City, Taiwan (Republic of China)
(Huang) Graduate Institute of Epidemiology and Preventive Medicine,
Taipei, Taiwan (Republic of China)
(Wu) National Taiwan University Hospital, College of Medicine, Taipei,
Taiwan (Republic of China)
Title
Hyperuricemia and incident acute kidney injury after invasive cardiac
procedures.
Source
Nephrology Dialysis Transplantation. Conference: 51st ERA-EDTA Congress
Amsterdam Netherlands. Conference Start: 20140531 Conference End:
20140603. Conference Publication: (var.pagings). 29 (pp iii110-iii111),
2014. Date of Publication: May 2014.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Invasive cardiac procedures such as coronary
angiography and percutaneous interventions, and cardiac surgeries have
substantially improve patients' outcomes in modern era. However, these
procedures are also associated with several adverse outcomes; one of the
most notable ones is acute kidney injury (AKI). Efforts are made to
prevent this devastating outcomes. One of the methods is to identify
patients at high risk for AKI. Hyperuricemia is associated with
post-procedural AKI in some case controlled studies, but the role of
pre-procedural hyperuricemia in incident AKI is largely in-conclusive.We
plan to conduct a systematic review and meta-analysis to answer this
question. Methods:We searched PubMED, EMBASE, andWeb of Science to
identify relevant citations. Manual search from conference proceedings and
references from eligible articles were performed. The two authors
independently performed the search and summaries the findings by
discussion.We used I-square to summarize the heterogeneity among studies.
Meta-analysis was done with random effect models, for the heterogeneity
from included studies (cardiac catheterization and cardiac surgeries).
Both univariate and multi-variate adjustments were done. A p value less
than 0.05 is judged significant. Results: A total of 3391 patients in 8
studies were included in this systematic review, and 971 (23.2%) of them
acquired AKI after procedures. In unadjusted models, the heterogeneity
across studies was low: the I-square was 0.0%. Hyperuricemia, as defined
in individual studies, carried an odds ratio of 2.70 (95% confidence
interval [CI] was 1.23 to 5.90) in unadjusted models (Figure 1). After
adjustment with important parameters, hyperuricemia was significantly
associated with post procedural AKI (OR = 3.38; 95% CI = 1.25 to 9.16).
The heterogeneity across included studies was low (I-square = 0.0%, Figure
2). Conclusions: Hyperuricemia is an important risk factor for AKI after
invasive cardiac procedures. Efficacy of treating hyperuricemia to prevent
AKI is promising, yet further clinical trial is warranted to prove its
efficacy. (Figure presented).

<17>
Accession Number
71488136
Authors
Kumar G. Eaton J.N. Ceballos R. Gay J.G. Tierrablanca L.E.
Institution
(Kumar) ICON Health Economics, Oxford, United Kingdom
(Eaton) Oxford Outcomes Ltd, Oxford, United Kingdom
(Ceballos) Medtronic, Mexico
(Gay, Tierrablanca) TI Salud, Mexico, Mexico
Title
Economic assessment of the use of transcatheter aortic valve replacement
in inoperable stenotic patients in Mexico.
Source
Value in Health. Conference: ISPOR 19th Annual International Meeting
Montreal, QC Canada. Conference Start: 20140531 Conference End: 20140604.
Conference Publication: (var.pagings). 17 (3) (pp A115), 2014. Date of
Publication: May 2014.
Publisher
Elsevier Ltd
Abstract
Objectives: To identify the incremental cost-effectiveness ratio (ICER)
for the treatment of inoperable patients with severe symptomatic aortic
valve stenosis (SAS) using transcatheter aortic valve replacement (TAVR),
compared to the standard of care (SoC), from the Mexican public payer
perspective. Methods: A previously published decision analytical model was
adapted to the Mexican setting to predict clinical endpoints and costs
over 10 years and discounted at 5%. Mexican epidemiological data were
applied. We performed a systematic review of published clinical trials to
obtain the necessary clinical information to evaluate the impact of TAVR
and SoC in the short and long term evolution of patients. Direct public
health care costs were estimated from published literature and
governmental databases. Resource utilization patterns were derived from
Mexican Clinical Practice Guidelines. The ICER was computed as incremental
cost per life-year gained (LYG). Probabilistic and deterministic
sensitivity analyses were conducted to estimate the confidence around the
results. Results: Over the time horizon, compared to SoC, TAVR produced an
additional 1.61 Life years at an additional cost to the health care sector
of $777,414 MXP. The ICER was thus $483,022 MXP (35,779 USD) per LYG. The
sensitivity analysis identified time horizon, discount rate on health
benefits, probability of leaving intensive care and time of stay in
intensive care, as the variables with the most impact. The model was
insensitive to changes in the TAVR acquisition cost, device related
complication rates and the probability/ cost of additional pacing.
Conclusions: In comparison with SoC, TAVR produces an increase in life
expectancy in patients with SAS that are ineligible for cardiac surgery,
at an ICER below an internationally accepted cost-effectiveness threshold
value. These results, and the improvements in health and quality of life
observed in the clinical studies, identify TAVR as both a clinically
effective and cost-effective therapy for Mexican patients.

<18>
Accession Number
71486667
Authors
Giulio Binaghi G. Boi A. Congia D. Lilliu M. Loi B. Pani A. Pilleri A.
Scorcu G. Serra E. Porcu M.
Institution
(Giulio Binaghi, Boi, Congia, Loi, Pani, Pilleri, Scorcu, Serra, Porcu) G.
Brotzu Hospital, Department of Cardiology, Cagliari, Italy
(Lilliu) University of Cagliari, Cagliari, Italy
Title
Use of intra-aortic balloon pump counterpulsation in the real world: A
7-year experience of a referral cardiological centre.
Source
European Journal of Heart Failure. Conference: Heart Failure Congress 2014
and the 1st World Congress on Acute Heart Failure Athens Greece.
Conference Start: 20140517 Conference End: 20140520. Conference
Publication: (var.pagings). 16 (pp 134), 2014. Date of Publication: May
2014.
Publisher
Oxford University Press
Abstract
Background. Cardiogenic shock (CS) is a condition with a poor prognosis,
regardless of its aetiology or treatment. In the past, following the
results of several trials, the use of intra-aortic balloon pump (IABP) was
included in the guidelines (GL). However, its effectiveness has been
questioned by recent meta-analysis and randomized trials (RCT), especially
in acute myocardial infarction (AMI). Aim and methods. We evaluated
retrospectively the use of IABP in a consecutive cohort of patients (pts)
admitted to an 8-bed Cardiac Care Unit (CCU) of a tertiary referral
cardiovascular centre from 2007 to 2013. The IABP was indicated on the
basis of clinical profile of each patient, according to the available GL.
Results. During the study period, 3928 pts were hospitalized in our CCU
for any reason. Among them, 46 (1,2%) underwent IABP. The mean age was
61+13 years, 65% (n=30) were male and 72% (n=33) had and ischaemic
aetiology of CS. The remaining 13 pts (28%) had different aetiologies,
including acute myocarditis, dilated cardiomyopathy and pulmonary
embolism. A 3-vessel and/or left main coronary artery disease was detected
in 28 pts (61%) and 27 (59%) underwent percutaneous coronary intervention
in emergency. In the whole population, 6 (13%) were also treated with
mechanical circulatory support (MCS), ECMO or LVAD, 30 (65%) with invasive
mechanical ventilation and 6 (13%) with continuous renal replacement
treatment. In-hospital mortality was 41% (n=19): 17/19 died from CS, of
which 14 in CCU, 2 after MCS and 1 following coronary artery bypass graft
(CABG) plus ventricular septal defect repair, while 2/19 deceased from
stroke. Out of the 27 survivors, 2 underwent elective CABG and 5 were
transplanted (4 of them after MCS). Conclusions. In our experience, the
use of IABP was rather uncommon even in a tertiary referral setting.
Similarly to pts enrolled in RCT, the treated population had a critical
risk profile and a very high mortality rate. In this 7-year series, IABP
has been used primarily in ischemic CS, although the recent data from the
IABP-SHOCK II trial indicate some concern in AMI pts. Further studies
should investigate the effectiveness of IABP in the non-ischemic CS, even
in combination with other LV-assistance techniques.