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<1>
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Accession Number
2014448593
Authors
Greve A.M. Dalsgaard M. Bang C.N. Egstrup K. Ray S. Boman K. Rossebo A.B.
Gohlke-Baerwolf C. Devereux R.B. Kober L. Wachtell K.
Institution
(Greve, Dalsgaard, Bang, Kober) Department of Medicine, B2142, the Heart
Center, Rigshospitalet, Blegdamsvej, DK-2100 Copenhagen, Denmark
(Egstrup) Department of Cardiology, OUH Svendborg Sygehus, Denmark
(Ray) Department of Cardiology, Manchester Academic Health Sciences
Center, Manchester, United Kingdom
(Boman) Department of Medicine, Institution of Public Health and Clinical
Medicine, Umea University, Skellefta, Sweden
(Rossebo) Department of Cardiology, Oslo University Hospital, Ulleval,
Oslo, Norway
(Gohlke-Baerwolf) Department of Cardiology, Herz-Zentrum Bad Krozingen,
Bad Krozingen, Germany
(Devereux, Wachtell) Department of Cardiology, Weill Cornell Medical
College, New York, NY, United States
(Wachtell) Department of Cardiology, Glostrup University Hospital,
Copenhagen, Denmark
Title
Stroke in patients with aortic stenosis: The simvastatin and ezetimibe in
aortic stenosis study.
Source
Stroke. 45 (7) (pp 1939-1946), 2014. Date of Publication: July 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND AND PURPOSE - : There are limited data on risk stratification
of stroke in aortic stenosis. This study examined predictors of stroke in
aortic stenosis, the prognostic implications of stroke, and how aortic
valve replacement (AVR) with or without concomitant coronary artery bypass
grafting influenced the predicted outcomes. METHODS - : Patients with
mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe
in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic
disease, and oral anticoagulation were exclusion criteria. Ischemic stroke
was the primary end point, and poststroke survival a secondary outcome.
Cox models treating AVR as a time-varying covariate were adjusted for
atrial fibrillation and congestive heart failure, hypertension, age 75
years, diabetes mellitus, stroke/transient ischemic attack, vascular
disease, age 65-74 years and female sex (CHA
₂DS₂-VASc) scores. RESULTS - : One thousand five
hundred nine patients were followed for 4.3+0.8 years (6529
patient-years). Rates of stroke were 5.6 versus 21.8 per 1000
patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%)
died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval
[CI], 1.1-6.6), CHA₂DS₂-VASc score (HR 1.4 per unit;
95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI,
1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR,
3.2; 95% CI, 1.4-7.2, all P<0.026) were independently associated with
stroke. Incident stroke predicted death (HR, 8.1; 95% CI, 4.7-14.0;
P<0.001). CONCLUSIONS - : In patients with aortic stenosis not prescribed
oral anticoagulation, atrial fibrillation, AVR with concomitant coronary
artery bypass grafting, and CHA₂DS₂-VASc score were
the major predictors of stroke. Incident stroke was strongly associated
with mortality. 2014 American Heart Association, Inc.

<2>
Accession Number
2014454731
Authors
Dharma S. Wardeh A.J. Soerianata S. Firdaus I. Jukema J.W.
Institution
(Dharma, Soerianata, Firdaus) Department of Cardiology and Vascular
Medicine, University of Indonesia, National Cardiovascular Center Harapan
Kita, Jalan Letjen S. Parman Kav 87, Slipi, Jakarta Barat, Jakarta 11420,
Indonesia
(Wardeh) Department of Cardiology, M.C. Haaglanden, Hague, Netherlands
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
Title
A Randomized comparison between everolimus-eluting stent and cobalt
chromium stent in patients with acute ST-elevation myocardial infarction
undergoing primary percutaneous coronary intervention using routine
intravenous eptifibatide: The X-MAN (X ience vs M ulti-Link stent in a
cute myocardial infarctio n) trial, a pilot study.
Source
International Journal of Angiology. 23 (2) (pp 93-100), 2014. Date of
Publication: June 2014.
Publisher
Thieme Medical Publishers, Inc.
Abstract
The objective of this study is to determine the efficacy and safety of an
everolimus-eluting stent (EES/Xience; Abbott Vascular, Santa Clara, CA)
compared with a cobalt chromium stent (CoCr/Multi-Link Vision; Abbott
Vascular) in patients with acute ST-elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI) with
routine administration of eptifibatide infusion. This is a prospective,
single center, randomized trial comparing EES (n=75) and CoCr stent (n=75)
implantation in patients with acute STEMI undergoing primary PCI.
Intravenous eptifibatide administration was mandatory by protocol in this
pilot study. The primary efficacy endpoint was major adverse cardiac
events (MACE) at 30 days, defined as the composite of death, reinfarction,
and target vessel revascularization. Secondary safety endpoints were stent
thrombosis at 30 days and in-hospital bleeding event. Acute reperfusion
parameters were also assessed. One-month MACE rate did not differ between
EES and CoCr group (1.3 vs. 1.3%, p=1.0). No stent thrombosis cases were
observed in the EES group. The groups did not differ with respect to
in-hospital bleeding events (5 vs. 9%, p=0.37), achievement of final
thrombolysis in myocardial infarction flow 2 or 3 (p=0.21), achievement of
myocardial blush grade 2 or 3 (p=0.45), creatine kinase-MB level at 8 to
12 hours after stenting (p=0.29), and left ventricular ejection fraction
(p=0.21). This pilot study demonstrates that after one-month follow-up,
the use of EES is as safe and effective as the use of CoCr stents in
patients with acute STEMI undergoing primary PCI with routine
administration of intravenous eptifibatide. 2014 by Thieme Medical
Publishers, Inc.

<3>
Accession Number
2014457646
Authors
Daniels L.A. Krol A.D.G. De Graaf M.A. Scholte A.J.H.A. Van't Veer M.B.
Putter H. de Roos A. Schalij M.J. Creutzberg C.L.
Institution
(Daniels, Krol, Creutzberg) Department of Clinical Oncology, Leiden
University Medical Center, Leiden, Netherlands
(De Graaf, Scholte, Schalij) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Van't Veer) Department of Hematology, Leiden University Medical Center,
Leiden, Netherlands
(Putter) Department of Medical Statistics and Bio-informatics, Leiden
University Medical Center, Leiden, Netherlands
(de Roos) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
(De Graaf) The Interuniversity Cardiology Institute, Utrecht, Netherlands
Title
Screening for coronary artery disease after mediastinal irradiation in
Hodgkin lymphoma survivors: Phase II study of indication and acceptance.
Source
Annals of Oncology. 25 (6) (pp 1198-1203), 2014. Date of Publication: June
2014.
Publisher
Oxford University Press
Abstract
Background: Cardiovascular diseases are the most common nonmalignant cause
of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal
irradiation. We investigated the role of computed tomographic coronary
angiography (CTA) as a screening tool for coronary artery disease (CAD) in
asymptomatic HL survivors, and related CTA findings to exercise testing
and subsequent interventions. Patients and methods: Patients were eligible
for this phase II study if at least 10 years disease-free and treated with
mediastinal radiotherapy. Screening consisted of electrocardiogram,
exercise testing and CTA. Primary end point was significant CAD (stenosis
>50%) on CTA. CTA screening was considered to be indicated for testing in
a larger population if >6 of 50 CTA scanned patients (12%) would need
revascularization. Screening was evaluated with a questionnaire before and
after screening. Results: Fifty-two patients were included, and 48
patients underwent CTA. Median age was 47 years, time since HL diagnosis
21 years. There were 45 evaluable scans. Significant CAD on CTA was found
in 20% (N = 9), significantly increased compared with the 7% expected
abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N
= 5), significant stenosis was confirmed at coronary angiography, and
revascularization was carried out. Additionally, two patients were treated
with optimal medical therapy. Ninety percent of patients were content with
screening, regardless whether the CTA showed abnormalities. Conclusions:
Prevalence of significant CAD among HL survivors is high, while
asymptomatic even in the presence of life-threatening CAD. This might
justify screening by CTA in asymptomatic HL survivors who had mediastinal
radiotherapy, but needs to be evaluated in a larger cohort. The trial
protocol was approved by the Ethics Committee of the LUMC and registered
with ClinicalTrials.gov, NCT01271127. The Author 2014. Published by
Oxford University Press on behalf of the European Society for Medical
Oncology. All rights reserved.

<4>
Accession Number
2014455276
Authors
Holmes D.R. Kar S. Price M.J. Whisenant B. Sievert H. Doshi S.K. Huber K.
Reddy V.Y.
Institution
(Holmes) Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United
States
(Kar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Price) Scripps Clinic, San Diego, CA, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Sievert) Cardiovasculares Centrum, Frankfurt, Germany
(Doshi) Pacific Heart Institute, Santa Monica, CA, United States
(Huber) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Reddy) Mount Sinai School of Medicine, New York, NY, United States
Title
Prospective randomized evaluation of the watchman left atrial appendage
closure device in patients with atrial fibrillation versus long-term
warfarin therapy: The PREVAIL trial.
Source
Journal of the American College of Cardiology. 64 (1) (pp 1-12), 2014.
Date of Publication: 08 Jul 2014.
Publisher
Elsevier USA
Abstract
BACKGROUND: In the PROTECT AF (Watchman Left Atrial Appendage Closure
Technology for Embolic Protection in Patients With Atrial Fibrillation)
trial that evaluated patients with nonvalvular atrial fibrillation (NVAF),
left atrial appendage (LAA) occlusion was noninferior to warfarin for
stroke prevention, but a periprocedural safety hazard was identified.
OBJECTIVES: The goal of this study was to assess the safety and efficacy
of LAA occlusion for stroke prevention in patients with NVAF compared with
long-term warfarin therapy. METHODS: This randomized trial further
assessed the efficacy and safety of the Watchman device. Patients with
NVAF who had a CHADS₂ (congestive heart failure, hypertension,
age >75 years, diabetes mellitus, and previous stroke/transient ischemic
attack) score >2 or 1 and another risk factor were eligible. Patients were
randomly assigned (in a 2:1 ratio) to undergo LAA occlusion and subsequent
discontinuation of warfarin (intervention group, n = 269) or receive
chronic warfarin therapy (control group, n = 138). Two efficacy and 1
safety coprimary endpoints were assessed. RESULTS: At 18 months, the rate
of the first coprimary efficacy endpoint (composite of stroke, systemic
embolism [SE], and cardiovascular/unexplained death) was 0.064 in the
device group versus 0.063 in the control group (rate ratio 1.07 [95%
credible interval (CrI): 0.57 to 1.89]) and did not achieve the
prespecified criteria noninferiority (upper boundary of 95% CrI >1.75).
The rate for the second coprimary efficacy endpoint (stroke or SE >7 days'
postrandomization) was 0.0253 versus 0.0200 (risk difference 0.0053 [95%
CrI: -0.0190 to 0.0273]), achieving noninferiority. Early safety events
occurred in 2.2% of the Watchman arm, significantly lower than in PROTECT
AF, satisfying the pre-specified safety performance goal. Using a broader,
more inclusive definition of adverse effects, these still were lower in
PREVAIL (Watchman LAA Closure Device in Patients With Atrial Fibrillation
Versus Long Term Warfarin Therapy) trial than in PROTECT AF (4.2% vs.
8.7%; p = 0.004). Pericardial effusions requiring surgical repair
decreased from 1.6% to 0.4% (p = 0.027), and those requiring
pericardiocentesis decreased from 2.9% to 1.5% (p = 0.36), although the
number of events was small. CONCLUSIONS: In this trial, LAA occlusion was
noninferior to warfarin for ischemic stroke prevention or SE >7 days'
post-procedure. Although noninferiority was not achieved for overall
efficacy, event rates were low and numerically comparable in both arms.
Procedural safety has significantly improved. This trial provides
additional data that LAA occlusion is a reasonable alternative to warfarin
therapy for stroke prevention in patients with NVAF who do not have an
absolute contraindication to short-term warfarin therapy. 2014 by the
American College of Cardiology Foundation.

<5>
Accession Number
2014441803
Authors
Sharma P. Malhotra A. Gandhi S. Garg P. Bishnoi A. Gandhi H.
Institution
(Sharma, Malhotra, Gandhi, Garg, Bishnoi, Gandhi) Department of
Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and
Research Center, New Civil Hospital Campus, Asarwa, Ahmedabad 380016,
Gujarat, India
Title
Preoperative levosimendan in ischemic mitral valve repair.
Source
Asian Cardiovascular and Thoracic Annals. 22 (5) (pp 539-545), 2014. Date
of Publication: June 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: Levosimendan is a new calcium sensitizing drug with
vasodilatory and inotropic properties, which is used for the treatment of
postoperative low cardiac output syndrome and difficult weaning from
cardiopulmonary bypass. Objective: To evaluate the hemodynamic effects of
levosimendan during and after coronary artery bypass grafting on
cardiopulmonary bypass and mitral valve repair in patients with low left
ventricular ejection fractions (<30%). Methods: 40 patients were enrolled
in this double-blind prospective randomized controlled trial. They
received either levosimendan or a placebo preoperatively (n=20) for 24 h.
Clinical parameters were measured before and after administration. Any
adverse events during and after drug administration and postoperative
complications were evaluated. Results: Patients treated with levosimendan
exhibited a higher cardiac index and mean arterial pressure intraoperative
and in the early postoperative period, compared to the control group.
Patients treated with levosimendan required less ventilatory support
(p<0.0001) and had shorter intensive care unit (p<0.0001) and hospital
stay (p<0.0001). Conclusions: Preoperative treatment with levosimendan in
patients undergoing coronary artery bypass grafting and mitral valve
repair resulted in improved hemodynamics and a stable postoperative
course. The Author(s) 2013.

<6>
Accession Number
2014449130
Authors
Robbers L.F.H.J. Nijveldt R. Beek A.M. Hirsch A. Van Der Laan A.M. Delewi
R. Van Der Vleuten P.A. Tio R.A. Tijssen J.G.P. Hofman M.B.M. Piek J.J.
Zijlstra F. Van Rossum A.C.
Institution
(Robbers, Nijveldt, Beek, Hofman, Van Rossum) Department of Cardiology, VU
University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV,
Amsterdam, Netherlands
(Robbers, Nijveldt, Hirsch, Van Der Laan, Delewi, Van Der Vleuten)
ICIN-Netherlands Heart Institute (ICIN-NHI), Utrecht, Netherlands
(Hirsch, Van Der Laan, Delewi, Tijssen, Piek) Department of Cardiology,
Academic Medical Center, Amsterdam, Netherlands
(Van Der Vleuten, Tio) Department of Cardiology, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Zijlstra) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Title
Cell therapy in reperfused acute myocardial infarction does not improve
the recovery of perfusion in the infarcted myocardium: A cardiac MR
imaging study.
Source
Radiology. 272 (1) (pp 113-122), 2014. Date of Publication: July 2014.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States. E-mail: Subscrib@rsna.org)
Abstract
Purpose: To investigate the effects of cell therapy on myocardial
perfusion recovery after treatment of acute myocardial infarction (MI)
with primary percutaneous coronary intervention (PCI). Materials and
Methods: In this HEBE trial substudy, which was approved by the
institutional review board (trial registry number ISRCTN95796863), the
authors assessed the effects of intracoronary infusion with bone
marrow-derived mononuclear cells (BMMCs) or peripheral blood-derived
mononuclear cells (PBMCs) on myocardial perfusion recovery by using
cardiac magnetic resonance (MR) imaging after revascularization. In 152
patients with acute MI treated with PCI, cardiac MR imaging was performed
after obtaining informed consent - before randomization to BMMC, PBMC, or
standard therapy (control group) - and repeated at 4-month follow-up.
Cardiac MR imaging consisted of cine, rest firstpass perfusion, and late
gadolinium enhancement imaging. Perfusion was evaluated semiquantitatively
with signal intensity- time curves by calculating the relative upslope
(percentage signal intensity change). The relative upslope was calculated
for the MI core, adjacent border zone, and remote myocardium. Perfusion
differences among treatment groups or between baseline and follow-up were
assessed with the Wilcoxon signed rank or Mann-Whitney U test. Results: At
baseline, myocardial perfusion differed between the MI core (median, 6.0%;
interquartile range [IQR], 4.1%-8.0%), border zone (median, 8.4%; IQR,
6.4%-10.2%), and remote myocardium (median, 12.2%; IQR, 10.5%-15.9%) (P <
.001 for all), with equal distribution among treatment groups. These
interregional differences persisted at follow-up (P < .001 for all). No
difference in perfusion recovery was found between the three treatment
groups for any region. Conclusion: After revascularization of ST-elevation
MI, cell therapy does not augment the recovery of resting perfusion in
either the MI core or border zone. RSNA, 2014.

<7>
Accession Number
2014438694
Authors
Cools E. Missant C.
Institution
(Cools, Missant) Department of Anesthesiology, University Hospitals Leuven
and the Department of Cardiovascular Sciences, KU Leuven, Belgium
Title
Junctional ectopic tachycardia after congenital heart surgery.
Source
Acta Anaesthesiologica Belgica. 65 (1) (pp 1-8), 2014. Date of
Publication: 2014.
Publisher
ARSMB-KVBMG (Avenue W. Churchill-laan 11/30, Brussels B-1180, Belgium.
E-mail: aob.edit@skynet.be). amb@skynet.be)
Abstract
Purpose : In this literature review, we try to give anesthesiologists a
better understanding about Junctional Ectopic Tachycardia (JET), a narrow
complex tachycardia that frequently occurs during and after surgery for
congenital heart disease. Source : Information was found in the databases
of Pubmed, Science Direct, Medline and the Cochrane Library, by using the
mesh terms "Tachycardia, Ectopic Junctional", combined with "Diagnosis",
"Etiology", "Physiopathology", "Complications" and "Therapy". The
publication date of the articles ranged from 1990 to 2012. Principal
Findings : Risk factors for the development JET are surgery near the AV
node, a duration of cardiopulmonary bypass longer than 90 minutes, young
age, the use of inotropic drugs and hypomagnesaemia. The diagnosis of
Junctional Ectopic Tachycardia can be made on a 12-lead ECG, demonstrating
a narrow-complex tachycardia with inverted P-waves and VA dissociation.
Adenosine administration and an atrial electrocardiogram can help to
confirm the diagnosis. If JET has a minimal impact on the hemodynamic
status of the patient, risk factors should be avoided and the adrenergic
tonus should be reduced. Hemodynamic unstable JET can be treated by
amiodarone, hypothermia and pacing. Extracorporeal membrane oxygenation
(ECMO) and radiofrequency or cryoablation are treatment options for
life-threatening and resistant JET. Conclusion : JET is the most frequent
arrhythmia during and after congenital cardiac surgery. The ECG is the
only available method to diagnose JET, demonstrating inverted P-waves and
VA-dissociation. Amiodarone seems to be the most effective treatment
option, because it can restore sinus rhythm and reduces the JET rate.
Acta Anaesthesiologica Belgica, 2014.

<8>
Accession Number
2014438584
Authors
Jensen K. Ringsted C. Hansen H.J. Petersen R.H. Konge L.
Institution
(Jensen, Hansen, Petersen) Department of Cardiothoracic Surgery,
University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100
Copenhagen, Denmark
(Ringsted) Wilson Centre, University of Toronto, University Health
Network, Toronto, ON, Canada
(Konge) Centre for Clinical Education, University of Copenhagen,
Copenhagen, Denmark
Title
Simulation-based training for thoracoscopic lobectomy: A randomized
controlled trial: Virtual-reality versus black-box simulation.
Source
Surgical Endoscopy and Other Interventional Techniques. 28 (6) (pp
1821-1829), 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
Background: Video-assisted thoracic surgery is gradually replacing
conventional open thoracotomy as the method of choice for the treatment of
early-stage non-small cell lung cancers, and thoracic surgical trainees
must learn and master this technique. Simulation-based training could help
trainees overcome the first part of the learning curve, but no
virtual-reality simulators for thoracoscopy are commercially available.
This study aimed to investigate whether training on a laparoscopic
simulator enables trainees to perform a thoracoscopic lobectomy. Methods:
Twenty-eight surgical residents were randomized to either virtual-reality
training on a nephrectomy module or traditional black-box simulator
training. After a retention period they performed a thoracoscopic
lobectomy on a porcine model and their performance was scored using a
previously validated assessment tool. Results: The groups did not differ
in age or gender. All participants were able to complete the lobectomy.
The performance of the black-box group was significantly faster during the
test scenario than the virtual-reality group: 26.6 min (SD 6.7 min) versus
32.7 min (SD 7.5 min). No difference existed between the two groups when
comparing bleeding and anatomical and non-anatomical errors. Conclusion:
Simulation-based training and targeted instructions enabled the trainees
to perform a simulated thoracoscopic lobectomy. Traditional black-box
training was more effective than virtual-reality laparoscopy training.
Thus, a dedicated simulator for thoracoscopy should be available before
establishing systematic virtual-reality training programs for trainees in
thoracic surgery. 2014 Springer Science+Business Media.

<9>
Accession Number
2014448289
Authors
Kim W.H. Shim H.S. Kim G. Lee J.E. Lee Y.T. Cho H.S.
Institution
(Kim, Shim) Department of Anesthesiolgy and Pain Medicine, Samsung
Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
South Korea
(Kim, Lee, Cho) Department of Anesthesiolgy and Pain Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong,
Gangnam-Gu, Seoul 135-710, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Title
A comparison of the infusion of dexmedetomidine versus remifentanil in
patients undergoing off-pump coronary artery bypass graft: A randomized
trial.
Source
Experimental and Clinical Cardiology. 20 (6) (pp 4234-4251), 2014. Date of
Publication: 2014.
Publisher
Cardiology Academic Press
Abstract
Objective: To compare the infusion of dexmedetomidine (Group DEX) and
remifentanil (Group REMI) during off-pump coronary artery bypass graft
(OPCAB) regarding cardioprotective effect, hemodynamics and incidence of
hypokalemia and arrhythmia. Methods: During OPCAB, Group DEX (n=23)
received an infusion of dexmedetomidine 0.1-0.7 mug/kg/hr; Group REMI
(n=24) received an infusion of remifentanil 0.01-0.5 mug/kg/min; the
control group (n=25) received none. We measured serum creatinine
kinase-myocardial band and cardiac troponin I (cTnI) concentration before
and immediately after the surgery, postoperative day (POD)#1 and #2. Serum
potassium concentration, incidence of hypokalemia and arrhythmia and
hemodynamic variables were measured. Results: The concentration of cTnI
were significantly lower in the Group DEX and REMI than the control group
on POD#1 and #2 [cTnI on POD#1: 1.86 ng/ml (0.76-3.84) vs. 2.62 ng/ml
(0.98-4.99) vs. 4.33 ng/ml (2.52-7.98), in Group DEX, REMI and control,
respectively, p=0.001]. Other variables were not different among groups.
Conclusions: Dexmedetomidine or remifentanil similarly reduced
postoperative myocardial injury marker levels compared with control group.
There was no difference between their infusion in parameters measured in
this study. Dexmedetomidine appears to be a safe and effective alternative
to remifentanil during OPCAB.

<10>
Accession Number
2014441555
Authors
Brunetti M.A. Jennings J.M. Easley R.B. Bembea M. Brown A. Heitmiller E.
Schwartz J.M. Brady K.M. Vricella L.A. Everett A.D.
Institution
(Brunetti, Bembea, Brown, Heitmiller, Schwartz) Department of
Anesthesiology, Critical Care Medicine, Johns Hopkins School of Medicine,
Baltimore, MD, United States
(Jennings) Departments of Pediatrics and Biostatistics, Johns Hopkins
School of Medicine and Johns Hopkins Bloomberg, School of Public Health,
Baltimore, MD, United States
(Easley, Brady) Department of Anesthesiology and Critical Care Medicine,
Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Vricella) Department of Cardiac Surgery, Johns Hopkins School of
Medicine, Baltimore, MD, United States
(Everett) Department of Pediatrics, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Title
Glial fibrillary acidic protein in children with congenital heart disease
undergoing cardiopulmonary bypass.
Source
Cardiology in the Young. 24 (4) (pp 623-631), 2014. Date of Publication:
August 2014.
Publisher
Cambridge University Press
Abstract
Objective: To determine whether blood levels of the brain-specific
biomarker glial fibrillary acidic protein rise during cardiopulmonary
bypass for repair of congenital heart disease. Methods: This is a
prospective observational pilot study to characterise the blood levels of
glial fibrillary acidic protein during bypass. Children <21 years of age
undergoing bypass for congenital heart disease at Johns Hopkins Hospital
and Texas Children's Hospital were enrolled. Blood samples were collected
during four phases: pre-bypass, cooling, re-warming, and post-bypass.
Results: A total of 85 patients were enrolled between October, 2010 and
May, 2011. The median age was 0.73 years (range 0.01-17). The median
weight was 7.14 kilograms (range 2.2-86.5). Single ventricle anatomy was
present in 18 patients (22%). Median glial fibrillary acidic protein
values by phase were: pre-bypass: 0 ng/ml (range 0-0.35); cooling: 0.039
(0-0.68); re-warming: 0.165 (0-2.29); and post-bypass: 0.112 (0-0.97).
There were significant elevations from pre-bypass to all subsequent
stages, with the greatest increase during re-warming (p = 0.0001). Maximal
levels were significantly related to younger age (p = 0.03), bypass time
(p = 0.03), cross-clamp time (p = 0.047), and temperature nadir (0.04).
Peak levels did not vary significantly in those with single ventricle
anatomy versus two ventricle repairs. Conclusion: There are significant
increases in glial fibrillary acidic protein levels in children undergoing
cardiopulmonary bypass for repair of congenital heart disease. The highest
values were seen during the re-warming phase. Elevations are significantly
associated with younger age, bypass and cross-clamp times, and temperature
nadir. Owing to the fact that glial fibrillary acidic protein is the most
brain-specific biomarker identified to date, it may act as a rapid
diagnostic marker of brain injury during cardiac surgery. Cambridge
University Press 2013.

<11>
Accession Number
2014426204
Authors
Bidar E. Maesen B. Nieman F. Verheule S. Schotten U. Maessen J.G.
Institution
(Bidar, Maesen, Maessen) Department of Cardiothoracic Surgery, Maastricht
University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht,
Netherlands
(Bidar, Maesen, Verheule, Schotten) Department of Physiology, Maastricht
University Medical Centre, Maastricht, Netherlands
(Nieman) Department of Clinical Epidemiology and Medical Technology
Assessment (KEMTA), Maastricht University Medical Centre, Maastricht,
Netherlands
Title
A prospective randomized controlled trial on the incidence and predictors
of late-phase postoperative atrial fibrillation up to 30 days and the
preventive value of biatrial pacing.
Source
Heart Rhythm. 11 (7) (pp 1156-1162), 2014. Date of Publication: July 2014.
Publisher
Elsevier
Abstract
Background Postoperative atrial fibrillation (POAF) is considered to be a
transient arrhythmia in the first week after cardiac surgery. Objective To
determine the 30-day incidence and predictors of POAF and the value of
postoperative overdrive biatrial pacing in the prevention of POAF. Methods
Patients (n = 148) without a history of atrial fibrillation undergoing
aortic valve replacement or coronary artery bypass graft (CABG) were
randomized into a pacing group (n = 75) and a control group. Patients were
treated with standardized sotalol postoperatively. Rhythm was continuously
monitored for 30 days by a transtelephonic event recorder. Results POAF
occurred in 73 (49.3%) patients, of whom 60 (40.5%) patients showed POAF
during postoperative days (PODs) 0-5 and 37 (25%) patients during PODs
6-30. Prolonged aortic cross-clamp time was an important univariate
predictor of 30-day and of late POAF (PODs 6-30; P =.017 and P =.03,
respectively). Best-fit model analysis using 15 predetermined risk factors
for POAF showed different positive interactive effects for early POAF (ie,
baseline C-reactive protein levels with a history of myocardial infarction
or low body mass index) and late POAF (ie, high body mass index, diabetes
mellitus, baseline C-reactive protein, early POAF, creatinine levels, type
of operation, smoking, and male gender). Biatrial pacing reduced the late
POAF incidence in patients with aortic cross-clamp time >50 minutes (P
=.006). Conclusion POAF is not limited to the first week after cardiac
surgery but also occurs frequently in the postoperative month. It is
desirable to regularly follow patients with POAF for atrial fibrillation
recurrences after discharge. 2014 Heart Rhythm Society.

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[Use Link to view the full text]
Accession Number
2014425424
Authors
Englberger L. Dietrich W. Eberle B. Erdoes G. Keller D. Carrel T.
Institution
(Englberger, Keller, Carrel) Department of Cardiovascular Surgery,
University Hospital Berne, Freiburgstrasse, CH-3010 Bern, Switzerland
(Dietrich) Department of Anesthesiology, Working Group of Perioperative
Hemostasis, University of Munich, Munich, Germany
(Eberle, Erdoes) Department of Anesthesiology and Pain Therapy, University
Hospital Berne, Bern, Switzerland
Title
A novel blood-sparing agent in cardiac surgery? First in-patient
experience with the synthetic serine protease inhibitor MDCO-2010: A phase
II, randomized, double-blind, placebo-controlled study in patients
undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Source
Anesthesia and Analgesia. 119 (1) (pp 16-25), 2014. Date of Publication:
July 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Antifibrinolytics have been used for 2 decades to reduce
bleeding in cardiac surgery. MDCO-2010 is a novel, synthetic, serine
protease inhibitor. We describe the first experience with this drug in
patients. METHODS: In this phase II, double-blind, placebo-controlled
study, 32 patients undergoing isolated primary coronary artery bypass
grafting with cardiopulmonary bypass were randomly assigned to 1 of 5
increasing dosage groups of MDCO-2010. The primary aim was to evaluate
pharmacokinetics (PK) with assessment of plasmatic concentrations of the
drug, short-term safety, and tolerance of MDCO-2010. Secondary end points
were influence on coagulation, chest tube drainage, and transfusion
requirements. RESULTS: PK analysis showed linear dosage-proportional
correlation between MDCO-2010 infusion rate and PK parameters. Blood loss
was significantly reduced in the 3 highest dosage groups compared with
control (P = 0.002, 0.004 and 0.011, respectively). The incidence of
allogeneic blood product transfusions was lower with MDCO-2010 4/24 (17%)
vs 4/8 (50%) in the control group. MDCO-2010 exhibited dosage-dependent
antifibrinolytic effects through suppression of D-dimer generation and
inhibition of tissue plasminogen activator-induced lysis in ROTEM analysis
as well as anticoagulant effects demonstrated by prolongation of activated
clotting time and activated partial thromboplastin time. No systematic
differences in markers of end organ function were observed among treatment
groups. Three patients in the MDCO-2010 groups experienced serious adverse
events. One patient experienced intraoperative thrombosis of venous grafts
considered possibly related to the study drug. No reexploration for
mediastinal bleeding was required, and there were no deaths. CONCLUSIONS:
This first-in-patient study demonstrated dosage-proportional PK for
MDCO-2010 and reduction of chest tube drainage and transfusions in
patients undergoing primary coronary artery bypass grafting.
Antifibrinolytic and anticoagulant effects were demonstrated using various
markers of coagulation. MDCO-2010 was well tolerated and showed an
acceptable initial safety profile. Larger multi-institutional studies are
warranted to further investigate the safety and efficacy of this compound.
Copyright 2014 International Anesthesia Research Society.

<13>
Accession Number
2014436243
Authors
Wong R.J. Kanwal F. Younossi Z.M. Ahmed A.
Institution
(Wong, Ahmed) Division of Gastroenterology and Hepatology, Stanford
University School of Medicine, Stanford, CA, United States
(Wong) Division of Gastroenterology and Hepatology, Stanford University
School of Medicine, 750 Welch Road, Palo Alto, CA 94304, United States
(Kanwal) Department of Medicine, Baylor College of Medicine, Michael E.
DeBakey Veteran Affairs Medical Center, 2002 Holcombe Blvd. (152),
Houston, TX, United States
(Younossi) Department of Medicine, Inova Fairfax Hospital, VCU-Inova
Campus, 3300 Gallows Road, Falls Church, VA, United States
Title
Hepatitis C virus infection and coronary artery disease risk: A systematic
review of the literature.
Source
Digestive Diseases and Sciences. 59 (7) (pp 1586-1593), 2014. Date of
Publication: April 2014.
Publisher
Springer New York LLC
Abstract
Background and Aims: While hepatitis C virus (HCV) infection has been
implicated in increasing the risk of coronary artery disease (CAD),
conflicting reports exist regarding this association. We performed a
systematic review to further investigate this association. Methods: We
conducted a PubMed search of original research articles from January 1,
1995 to June 30, 2013 to identify case-control and cohort studies
evaluating the association between HCV and CAD using keyword terms
["hepatitis c" or "HCV"] and ["coronary artery disease" or "heart disease"
or "atherosclerosis."] The primary CAD-related endpoints included
myocardial infarction, congestive heart failure, need for coronary artery
bypass grafting, or transluminal percutaneous coronary angioplasty. Binary
outcomes are reported as odds ratios (OR) with 95 % confidence interval
(CI). Results: We identified five studies (four cohort studies and one
case-control study) that met our inclusion criteria. A significant
association between HCV and CAD was demonstrated in one cohort study
(adjusted HR 1.27; 95 % CI 1.22-1.31). One cohort study demonstrated a
decreased risk of CAD associated with HCV (adjusted OR 0.74; 95 % CI
0.71-0.76). The remaining studies did not find a significant association
between HCV and risk of CAD. Conclusions: The current systematic review
demonstrates that the association between HCV and CAD remains unclear. We
need more large, long-term cohort studies with clear definitions of
patient population and endpoints to better ascertain the association
between HCV and CAD. 2014 Springer Science+Business Media.

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Accession Number
2014435972
Authors
Mounsey A. Roque J.M. Egan M.
Institution
(Mounsey, Roque) Department of Family Medicine, University of North
Carolina Chapel Hill, United States
(Egan) Department of Family Medicine, University of Chicago, United States
Title
Why you shouldn't start beta-blockers before surgery.
Source
Journal of Family Practice. 63 (6) (pp E15-E16), 2014. Date of
Publication: June 2014.
Publisher
Dowden Health Media,Inc

<15>
Accession Number
71521903
Authors
Rojnuckarin P. Akkawat B. Vichitratchaneekorn R. Chanswangphuwana C.
Institution
(Rojnuckarin, Akkawat, Vichitratchaneekorn, Chanswangphuwana) Department
of Medicine, Faculty of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
Title
A low probability 4Ts score is unsafe to exclude heparin-induced
thrombocytopenia in critically ill patients.
Source
Thrombosis Research. Conference: 23rd Biennial International Congress on
Thrombosis - MLTD Congress 2014 Valencia Spain. Conference Start: 20140514
Conference End: 20140517. Conference Publication: (var.pagings). 133 (pp
S50), 2014. Date of Publication: May 2014.
Publisher
Elsevier Ltd
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a serious
immunological complication of heparin. Rapid diagnosis and prompt
anticoagulant change are essential to prevent fatal outcomes. Several
studies including the recent meta-analysis (Blood 2012;120:4160-7)
demonstrated that a low pre-test probability 4Ts score (score 0-3)
conferred a high negative predictive value of 99.8%. Some experts propose
a diagnostic algorithm that excludes HIT in patients with a low
probability 4Ts score without the need of confirmatory testing for HIT.
However, HIT is a clinical challenge in critically ill patients.
Thrombocytopenia is very common in these patients, and its etiologies are
usually multifactorial and may interfere with the diagnosis of HIT.
Methods: Clinical and laboratory data of consecutive cases diagnosed HIT
in intensive care units (ICU) were reviewed. The diagnosis was based on
the consistent clinical courses of thrombocytopenia and positive
heparin-induced platelet aggregaion on aggregometry. Results: There were
13 diagnosed HIT in King Chulalongkorn Memorial Hospital between 2006 to
2013. Eight of them (61.5%) were ICU patients. Of 8 ICU cases, 3 (37.5%),
3 (37.5%) and 2 (25%) yielded low, intermediate and high probability 4Ts
score, respectively. Of 3 with a low probability score, 2 yielded score of
3, and the other yielded score of 2. Case 1 was ST-segment elevation
myocardial infarction with lobar pneumonia. Case 2 underwent coronary
artery bypass graft and aortic valve replacement due to coronary artery
disease and severe aortic stenosis. Case 3 underwent aortoplasty due to
aortic aneurysm. They developed thrombocytopenia on day 3, 4 and 1
(without previous heparin exposure) of heparin administration,
respectively. Case 1 and Case 3 suffered from recurrent and new thrombosis
with platelet count nadirs of 15,000/mL and 4,000/mL, respectively. Both
received fondaparinux when HIT was suspected. However, the former expired
shortly due to intractable ventricular tachycardia, while the latter whose
platelet count rapidly recovered after fondaparinux underwent amputation
due to gangrene of both lower limbs and expired 3 months later from
multiple organ failure. Case 2 did not receive fondaparinux as the patient
expired from multiple organ failure before HIT diagnosis. All cases had
multiple potential causes of thrombocytopenia, such as severe infections,
DIC, augmentation of intra-aortic balloon pump and recent cardiopulmonary
bypass, contributing to a rapid onset of thrombocytopenia and very low
platelet count nadirs. Conclusions: In complicated and/or critically ill
patients with other concomitant causes of thrombocytopenia, a low
probability 4Ts score is apparently unsafe for excluding HIT.