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<1>
Accession Number
23849046
Authors
Happell B. Stanton R. Hoey W. Scott D.
Institution
(Happell, Stanton, Scott) Central Queensland University, Institute for
Health and Social Science Research, Centre for Mental Health Nursing
Innovation, Bruce Highway, Rockhampton, QLD 4702, Australia
(Scott) NorthWest Academic Centre, University of Melbourne, Melbourne, VIC
3001, Australia
(Hoey) Central Queensland Mental Health Alcohol and Other Drugs Service,
Central Queensland Hospital and Health Service, Rockhampton, QLD 4700,
Australia
Title
Cardiometabolic health nursing to improve health and primary care access
in community mental health consumers: Protocol for a randomised controlled
trial.
Source
International Journal of Nursing Studies. 51 (2) (pp 236-242), 2014. Date
of Publication: February 2014.
Abstract
Background: People with a serious mental illness are at significantly
greater risk of poor cardiometabolic health with recent studies showing a
greater than two-fold increase in the risk of obesity, infectious
diseases, diabetes and cardiovascular disease. Contributing factors to
this disparity include poorer health behaviours such as suboptimal
physical activity, poor diet, smoking, alcohol and illicit drug misuse. In
particular, the limited access to primary health care experienced by
people with a serious mental illness has been highlighted. Persons with a
serious mental illness are around 30% less likely than those without
serious mental illness to receive health assessments, hospital admissions
or procedures for cardiovascular disease and diabetes, and are less likely
to undergo cancer screening or receive vaccinations. Studies show that
mental health consumers may be more likely to use mental health services
rather than primary care for contact with the health care system. However
mental health nurses report several barriers to their capacity to provide
cardiometabolic health care crucial for the treatment of people with a
serious mental illness. Objectives: To assess the impact of a specialist
Cardiometabolic Health Nurse on the physical health care of community
based mental health consumers. Setting: Community mental health facility
in a large regional centre in Central Queensland, Australia.
Design/methods: Community based mental health consumers will be randomised
to receive either usual care, or consultations with a Cardiometabolic
Health Nurse. The Cardiometabolic Health Nurse will be responsible for
assessing the client and coordinating cardiometabolic health care as
required. Post intervention review of health records will be performed
with the primary outcome measure being self-reported physical health.
Secondary outcomes include the utilisation of primary care services and
changes in health behaviours. We hypothesise that the Cardiometabolic
Health Nurse will increase the utilisation of health care services for
mental health consumers. Results: Data collection commenced in March 2013
and will conclude September 2013. Preliminary finding are expected in
December 2013. 2013 Elsevier Ltd.

<2>
Accession Number
2014531749
Authors
Schulman S. Hwang H.-G. Eikelboom J.W. Kearon C. Pai M. Delaney J.
Institution
(Schulman, Eikelboom, Kearon, Pai) Thrombosis and Atherosclerosis Research
Institute, Hamilton, ON, Canada
(Schulman, Hwang, Eikelboom, Kearon, Pai, Delaney) Department of Medicine,
Thrombosis Service, Hamilton, ON, Canada
(Schulman) Karolinska Institutet, Stockholm, Sweden
(Hwang) Department of Medicine, Soonchunhyang University Gumi's Hospital,
Soonchunhyang, South Korea
(Eikelboom) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Title
Loading dose vs. maintenance dose of warfarin for reinitiation after
invasive procedures: A randomized trial.
Source
Journal of Thrombosis and Haemostasis. 12 (8) (pp 1254-1259), 2014. Date
of Publication: August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: There is uncertainty regarding the optimal dosing regimen for
the resumption of warfarin after interruption for invasive procedures.
Aim: To determine the efficacy and safety of warfarin resumption with
loading doses or with the most recent maintenance dose. Methods: Patients
receiving warfarin treatment and planned for invasive procedures with an
expected hospital stay of < 1 day were randomized to resume warfarin on
the day of the procedure, defined as day 1, with most recent maintenance
dose or with 2 initial days of double maintenance dose. Efficacy outcomes
were proportion of international normalized ratio (INR) levels > 2.0 on
day 5 (primary outcome) and day 10. Safety outcomes were bleeding and
thromboembolic events. In addition, D-dimer levels were analyzed on days 5
and 10 in a subset of the population. Results: There were 49 patients
analyzed in each group. INR of > 2.0 had been achieved by day 5 for 13% in
the maintenance-dose group and for 50% in the loading-dose group (relative
risk [RR] 0.27, 95% confidence interval [CI] 0.10-0.60) and by day 10 for
68% and 87%, respectively (RR 0.78, 95% CI 0.65-1.00). There were no
thromboembolic events, and there was one major bleed before resumption of
warfarin and one minor bleed, both in the maintenance-dose group. There
was no difference between the groups in the proportion of patients with
excessive INRs or elevated D-dimer levels or in the median D-dimer level.
Conclusion: Resumption of warfarin after minor-moderately invasive
procedures with two loading doses achieves therapeutic INR faster than
does only maintenance dose. 2014 International Society on Thrombosis and
Haemostasis.

<3>
Accession Number
2014532673
Authors
Zhang W. Fang C. Li J. Geng Q.-T. Wang S. Kang F. Pan J.-H. Chai X.-Q. Wei
X.
Institution
(Zhang, Fang, Li, Geng, Wang, Kang, Pan, Chai, Wei) Department of
Anesthesiology, Anhui Medical University Affiliated Auhui Provincial
Hospital, No 9 Lujiang Road, 230001 Hefei, China
Title
Single-dose, bilateral paravertebral block plus intravenous sufentanil
analgesia in patients with esophageal cancer undergoing combined
thoracoscopic-laparoscopic esophagectomy: A safe and effective
alternative.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 978-984),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objective Paravertebral block (PVB) has been shown to be an ideal aid for
analgesia after thoracic or abdominal surgery. The authors studied the
safety and efficacy of the single-dose and bilateral ultrasound-guided
(USG)-PVB before combined thoracoscopic-laparoscopic esophagectomy (TLE)
along with intravenous sufentanil analgesia as a method of pain relief in
comparison with intravenous sufentanil as a sole analgesic agent. Design
Prospective, randomized study. Setting Single university hospital.
Participants Fifty-two patients undergoing TLE. Interventions A USG-PVB
was performed before surgery using a solution of 30 mL of 0.5% ropivacaine
by 3 injections of 10 mL each at the right T5 and bilateral T8 (PVB
group,n = 26) or the saline injection of 10 mL at every site (control
group, n = 26). Measurements and Main Results Successful PVBs were
achieved in all patients of the PVB group. Intraoperative mean
remifentanil usage and end-tidal sevoflurane concentration were lower in
the PVB group (p<0.001). Hemodynamic parameters were stable in both
groups. Postoperative pain scores both at rest and on coughing were lower
during the first 8 hours in the PVB group than those in the control group
(p<0.05). Cumulative sufentanil consumption delivered by
patient-controlled analgesia (PCA) was significantly lower in the PVB
group at all time points (p<0.05). Postoperative pulmonary function was
better at the third postoperative day in the PVB group (p<0.05), with
quicker hospital discharge and lower hospital costs (p< 0.05). Conclusions
The single-dose and bilateral PVB given before TLE combined with
sufentanil may provide better postoperative analgesia and early discharge
in patients undergoing TLE. 2014 Elsevier Inc.

<4>
Accession Number
2014532665
Authors
Kang W.-S. Kim S.-H. Woo Chung J.
Institution
(Kang, Kim) Department of Anaesthesiology and Pain Medicine, Konkuk
University Hospital, Konkuk University Medical Center, 120-1,
Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea
(Kang, Kim) Research Institute of Medical Science, Konkuk University
School of Medicine, Seoul, South Korea
(Woo Chung) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
Title
Comparison of pulmonary gas exchange according to intraoperative
ventilation modes for mitral valve repair surgery via thoracotomy with
one-lung ventilation: A randomized controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 920-925),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objective Impaired pulmonary gas exchange after cardiac surgeries with
cardiopulmonary bypass (CPB) often occurs, and the selection of mechanical
ventilation mode, pressure-controlled ventilation (PCV) or
volume-controlled ventilation (VCV), may be important for preventing
hypoxia and improving oxygenation. The authors hypothesized that patients
with PCV would show better oxygenation, compared with VCV, during one-lung
ventilation (OLV) for mitral valve repair surgery (MVP) via thoracotomy.
Design Randomized controlled trial. Setting University teaching hospital.
Participants Sixty patients in each group. Interventions MVP was performed
using thoracotomy with OLV by PCV or VCV. Measurements and Main Results
Arterial partial pressure of oxygen (PaO ₂) and fraction of
inspired oxygen (F_IO₂) were measured before
anesthesia induction (T0), at skin incision (T1), after administration of
heparin (T2), at 30 minutes after CPB weaning (T3), just before departure
from the operating room to the intensive care unit (ICU) (T4), and 1 hour
after ICU admission (T5), and PaO₂/F_IO ₂
ratio was calculated. Peak inspiratory pressure (PIP) and mean inspiratory
pressure (P_mean) were recorded at T1, T2, T3, and T4. No
significant difference was noted in the PaO₂/F_IO
₂ ratio between the groups at any measured point. PIP in the
PCV group at all measured points was lower than that in the VCV group (T1,
p<0.001; T2, p<0.001; T3, p<0.001; T4, p = 0.025, respectively). P
_mean was not different between the two groups at any measured
point. Conclusions PCV during OLV in patients undergoing MVP via a
thoracotomy with OLV showed lower PIP compared with VCV, but this did not
improve pulmonary gas exchange. 2014 Elsevier Inc.

<5>
Accession Number
2014532661
Authors
Al Shehri A.M. El-Tahan M.R. Al Metwally R. Qutub H. El Ghoneimy Y.F.
Regal M.A. Zien H.
Institution
(Al Shehri) Department of Cardiology, King Fahd Hospital, University of
Dammam, Al Khubar, Saudi Arabia
(El-Tahan, Al Metwally, Zien) Department of Anaesthesia and Surgical ICU,
King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia
(Qutub) Department of Pulmonology and Intensive Care Unit, King Fahd
Hospital, University of Dammam, Al Khubar, Saudi Arabia
(El Ghoneimy, Regal) Cardiothoracic Surgery, King Fahd Hospital,
University of Dammam, Al Khubar, Saudi Arabia
Title
Right ventricular function during one-lung ventilation: Effects of
pressure-controlled and volume-controlled ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 892-896),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objectives To test the effects of pressure-controlled (PCV) and
volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for
thoracic surgery on right ventricular (RV) function. Design A prospective,
randomized, double-blind, controlled, crossover study. Setting A single
university hospital. Participants Fourteen pairs of consecutive patients
scheduled for elective thoracotomy. Interventions Patients were assigned
randomly to ventilate the dependent lung with PCV or VCV mode, each in a
randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1:
2.5, positive end-expiratory pressure (PEEP) of 5 cm H₂O and
respiratory rate adjusted to maintain normocapnia. Measurements and Main
Results Intraoperative changes in RV function (systolic and early
diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV),
end-diastolic volume (EDV) and fractional area changes (FAC)), airway
pressures, compliance and oxygenation index were recorded. The use of PCV
during OLV resulted in faster systolic (10.1+2.39 vs. 5.8+1.67 cm/s,
respectively), diastolic TAV (9.2+1.99 vs. 4.6+1.42 cm/s, respectively)
(p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05)
than during the use of VCV. Oxygenation indices were similar during the
use of VCV and PCV. Conclusions The use of PCV offers more improved RV
function than the use of VCV during OLV for open thoracotomy. These
results apply specifically to younger patients with good ventricular and
pulmonary functions. 2014 Elsevier Inc.

<6>
Accession Number
2014532649
Authors
Lei Q. Zeng Q.-S. Zhang X.-S. Xie B. Luo Z.-C. Guo H.-M. Chen J.-M. Zhuang
J.
Institution
(Lei, Zeng, Zhang, Xie, Luo, Guo, Chen, Zhuang) Department of Cardiac
Surgery and Anesthesiology, Guangdong General Hospital, Guangdong Academy
of Medical Sciences, 106 ZhongShanEr Road, Guangzhou 510080, China
Title
Superior vena cava drainage during thoracoscopic cardiac surgery:
Bilateral internal jugular vein sheaths versus one percutaneous superior
vena cava cannula.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 926-930),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objective To evaluate bilateral internal jugular vein sheaths as a
replacement of one percutaneous superior vena cava cannula for superior
vena cava drainage during thoracoscopic cardiac surgery. Design A
prospective and randomized study. Setting Single cardiovascular institute.
Participants Adults undergoing thoracoscopic cardiac surgery.
Interventions Patients were randomized into a percutaneous superior vena
cava cannula group and a bilateral internal jugular vein sheaths group.
The superior vena cava drainage for cardiopulmonary bypass was performed
with one percutaneous superior vena cava cannula (14-18 Fr) or the
bilateral internal jugular vein sheaths (8 Fr). Measurements and Main
Results Both interventions reached theoretic flow rate in all patients. In
patients weighing<50 kg (n = 38) and 50-70 kg (n = 64), the average
central venous pressure values during cardiopulmonary bypass of both
groups showed no significant differences. The patients weighing>70 kg (n =
15) in the bilateral internal jugular vein sheaths group had a normal
average central venous pressure value, but it was significantly higher
than that of percutaneous superior vena cava cannula group ([10.5+3.1]
mmHg vs. [4.5+4.4] mmHg, p = 0.013). The patient satisfaction scale scores
for the cervical incisions were significantly higher in the bilateral
internal jugular vein sheaths group than in the percutaneous superior vena
cava cannula group ([2.6+0.9] vs. [2.1+0.8], p = 0.002). Conclusions The
bilateral internal jugular vein sheaths were a feasible and effective
option to replace one percutaneous superior vena cava cannula during
thoracoscopic cardiac surgery, with better patient satisfaction. 2014
Elsevier Inc.

<7>
Accession Number
2014532640
Authors
Bermejo S. Gallart L. Silva-Costa-Gomes T. Valles J. Aguilo R. Puig M.M.
Institution
(Bermejo, Gallart, Silva-Costa-Gomes, Valles, Puig) Department of
Anesthesiology, Hospital Del Mar, Passeig Maritim 25, 08003 Barcelona,
Spain
(Aguilo) Department of Thoracic Surgery, Hospital Del Mar, Universitat
Autonoma de Barcelona, Spain
Title
Almitrine fails to improve oxygenation during one-lung ventilation with
sevoflurane anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 931-936),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objective Almitrine enhances hypoxic pulmonary vasoconstriction (HPV) and
can improve hypoxemia related to one-lung ventilation (OLV). Studies using
almitrine have been conducted without inhaled anesthetics because they
could inhibit HPV, counteracting the effect of almitrine. This hypothesis,
however, has not been confirmed. This study's aim was to evaluate whether
almitrine could improve oxygenation when administered during OLV with
sevoflurane anesthesia. Design A prospective, randomized, double-blind,
placebo-controlled trial. Setting A tertiary care, university teaching
hospital. Participants Thirty adult patients undergoing open-chest
thoracic surgery. Interventions Patients were assigned randomly to receive
almitrine or placebo during OLV. Respiratory and hemodynamic variables
were recorded continuously. Anesthesia was maintained with sevoflurane and
remifentanil. Intraoperative techniques and medical teams were the same
all over the study. Measurements and Main Results Respiratory and
hemodynamic variables were measured during two-lung ventilation and during
open-chest OLV. Two-way repeated-measures analysis of variance was used to
compare the effects of almitrine and placebo. During OLV, PaO₂
and shunt fraction worsened in all patients without significant
differences between groups. At 30-minutes of OLV, PaO₂ was
184+67 mmHg in the almitrine group and 145+56 mmHg in the placebo group,
while shunt fraction were 31%+6% and 36%+13%, respectively. Mean pulmonary
artery pressure was higher in the almitrine group (31+5 v 24+5 mmHg, p
<0.001). Conclusions During anesthesia with sevoflurane for open-chest
OLV, almitrine failed to improve oxygenation and increased pulmonary
artery pressure. The combination of sevoflurane and almitrine should,
therefore, be avoided. 2014 Elsevier Inc.

<8>
Accession Number
2014532637
Authors
Kus A. Hosten T. Gurkan Y. Gul Akgul A. Solak M. Toker K.
Institution
(Kus, Hosten, Gurkan, Solak, Toker) Medical Faculty, Kocaeli University,
Department of Anesthesiology and Reanimation, Umuttepe/Kocaeli 41100,
Turkey
(Gul Akgul) Department of Thoracic Surgery, Medical Faculty of Kocaeli
University, Umuttepe, Kocaeli, Turkey
Title
A comparison of the EZ-blocker with a cohen flex-tip blocker for one-lung
ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 908-911),
2014. Date of Publication: August 2014.
Publisher
W.B. Saunders
Abstract
Objectives: The EZ-Blocker (IQ Medical Ventures BV, Rotterdam,
Netherlands) is a newly designed device for one-lung ventilation. The aim
of this study was to compare the effectiveness of the Cohen Flex-Tip
bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung
ventilation during thoracic surgery. Design: Randomized and prospective.
Setting: A university hospital. Participants: This study included 40
patients undergoing thoracic surgical procedures. Interventions: Patients
were assigned to 2 study groups: Patients who received the Cohen Flex-Tip
blocker were assigned to the Cohen group, and patients who received the
EZ-Blocker were assigned to the EZ group. In both groups, fiberoptic
guidance was used during placement of the bronchial blockers. Comparisons
between the groups included the time to correct placement, the incidence
of malpositioning, and the satisfaction level of the surgeon (good, fair,
poor). Measurements and Main Results: One-lung ventilation was achieved
successfully for all patients. The time to correct placement (mean+SD) was
significantly shorter in the EZ group (146+56 seconds) compared with the
Cohen group (241+51 seconds; p = 0.01). The incidence of malpositioning
was significantly lower in the EZ group compared with the Cohen group (p =
0.018). Surgeon satisfaction was similar in both groups. Conclusions: In
this study, both bronchial blockers provided similar surgical exposure
during thoracic procedures. The EZ-Blocker had a shorter time to correct
positioning and less frequent intraoperative malpositioning. 2014
Elsevier Inc.

<9>
Accession Number
2014531744
Authors
Castilho F.M. De Sousa M.R. Mendonca A.L.P. Ribeiro A.L.P. Caceres-Loriga
F.M.
Institution
(Castilho, De Sousa, Mendonca, Ribeiro) Programa de Pos-graduacao em
Ciencias Aplicadas a Saude do Adulto, Departamento de Clinica Medica, Uni.
Federal de Minas Gerais (UFMG), Fac. de Med. e Servico de Cardiologia e
Cirurgia Cardiovascular do Hos. das Clinicas da, Belo Horizonte, Minas
Gerais, Brazil
(Caceres-Loriga) Instituto de Cardiologia y Cirurgia Cardiovascular
(ICCC), La Habana, Cuba
Title
Thrombolytic therapy or surgery for valve prosthesis thrombosis:
Systematic review and meta-analysis.
Source
Journal of Thrombosis and Haemostasis. 12 (8) (pp 1218-1228), 2014. Date
of Publication: August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Prosthetic heart valve thrombosis is a life-threatening
condition for which treatment has not been evaluated by randomized trials.
Objectives: To compare surgery with thrombolytic therapy for the treatment
of prosthetic valve thrombosis. Methods: A comprehensive systematic review
was carried out by independent researchers using PubMed, Web of Knowledge,
HINARI, LILACS and EMBASE, including papers indexed up to 23 October 2013
with at least 10 patients, evaluating one or both treatment options.
Outcomes of interest were death, stroke, bleeding, embolic events and
success. Study quality was assessed by the Newcastle-Ottawa Scale (ranges
from 0 to 9). Comprehensive Meta Analysis Software was used to pool study
results, for publication bias analysis and for meta-regression. Results:
Forty-eight studies were included (2302 patients). No randomized study was
identified, and all were observational in design. Study quality varied
from 4 to 6 stars using the Newcastle-Ottawa Scale. Mortality for surgery
was 18.1% (95%CI, 14.6-22.1; I², 62% [42-75]), while mortality
for thrombolytic therapy was 6.6% (95% CI, 4.8-8.9; I², 0%
[0-13]). Surgical mortality appeared to increase with NYHA-class,
according to meta-regression. Other results related to surgery and
thrombolytic therapy, respectively, were: embolic events, 4.6% (2.9-7.3)
and 12.8% (10.8-15.2); stroke, 4.3%,(2.7-6.6%) and 5.6%,(4.3-7.4%);
success rate, 81.9% (77.2-85.8) and 80.7% (75.6-85.0); bleeding, 4.6%
(2.9-7.1) and 6.8% (5.4-8.6); and death or stroke, 19.0% (14.8-24.2) and
11.4% (8.7-14.7). Conclusion: Mortality in patients treated by
thrombolytic therapy for valve prosthesis thrombosis is significantly
lower than in patients treated surgically. As we cannot yet ascertain
whether this difference is due to the treatment alone, more studies are
now necessary to further clarify these findings. 2014 International
Society on Thrombosis and Haemostasis.

<10>
Accession Number
2014532567
Authors
Altenberger J. Parissis J.T. Costard-Jaeckle A. Winter A. Ebner C.
Karavidas A. Sihorsch K. Avgeropoulou E. Weber T. Dimopoulos L. Ulmer H.
Poelzl G.
Institution
(Altenberger) Department of Cardiology, Cardiac Rehabilitation Center
Grossgmain, Paracelsus Medical Private University (PMU), Salzburg, Austria
(Parissis) Second Cardiology Department, University of Athens, Attikon
University Hospital, Athens, Greece
(Costard-Jaeckle) Department of Cardiology, University Heart Centre
Hamburg, Hamburg, Germany
(Winter) Department of Cardiology, Hospital of the Sisters of Charity
Linz, Linz, Austria
(Ebner) Department of Cardiology, St. Elisabeth Hospital Linz, Linz,
Austria
(Karavidas) Cardiology Department, G. Gennimatas General Hospital, Athens,
Greece
(Sihorsch) Department of Cardiology, General Hospital Linz, Linz, Austria
(Avgeropoulou) Department of Cardiology, Ippokration General Hospital,
Athens, Greece
(Weber) Department of Cardiology, Klinikum Wels-Grieskirchen,
Wels-Grieskirchen, Austria
(Dimopoulos) Department of Cardiology, Danube Hospital, Vienna, Austria
(Ulmer) Department of Medical Statistics, Informatics and Health
Economics, Innsbruck Medical University, Innsbruck, Austria
(Poelzl) Department of Cardiology and Angiology, Innsbruck Medical
University, Innsbruck, Austria
Title
Efficacy and safety of the pulsed infusions of levosimendan in outpatients
with advanced heart failure (LevoRep) study: A multicentre randomized
trial.
Source
European Journal of Heart Failure. 16 (8) (pp 898-906), 2014. Date of
Publication: August 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims The aim of this study was to determine whether intermittent
ambulatory treatment with levosimendan would improve functional capacity,
quality of life, and event-free survival in patients with advanced heart
failure. Methods and results This was a prospective, randomized,
double-blind, placebo-controlled, multicentre, parallel-group trial of
pulsed infusions of levosimendan in 120 outpatients with advanced heart
failure (EF <35%, NYHA class III or IV). The study was conducted at 11
centres in Austria, Greece, and Germany. Levosimendan (0.2 mug/kg/min) or
placebo was administered for 6 h at 2-week intervals over 6 weeks, in
addition to standard care therapy. The primary outcome was the proportion
of patients with a >20% improvement in the 6 min walk test and a >15%
score increase on the Kansas City Cardiomyopathy Questionnaire at the end
of the 24-week study period. Secondary outcomes included event-free
survival after 24 weeks. Analyses were performed on an intention-to-treat
basis. The primary endpoint was reached in 19% of patients receiving
levosimendan and 15.8% of patients receiving placebo (odds ratio 1.25; 95%
confidence interval 0.44-3.59; P = 0.810). Cardiac death (four vs. one),
heart transplants (two vs. one), and acute heart failure (14 vs. nine)
were more frequent with placebo as compared with levosimendan. The
incidence of side effects was comparable between groups. Conclusion
Intermittent ambulatory treatment with levosimendan in patients with
advanced heart failure did not improve significantly functional capacity
or quality of life as compared with placebo. An adequately powered,
event-driven trial is warranted to enlarge on our findings. Trial
registration: NCT01065194. 2014 The Authors. European Journal of Heart
Failure 2014 European Society of Cardiology.

<11>
Accession Number
2014533315
Authors
Forouzannia S.K. Karimi-Bondarabadi A.A. Bagherinasab M.
Sarebanhassanabadi M.
Institution
(Forouzannia, Karimi-Bondarabadi, Bagherinasab, Sarebanhassanabadi) Yazd
Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Karimi-Bondarabadi) Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
Title
Comparison of the effectiveness of continuous versus intermittent
cefazolin for the prevention of infection after off-pump coronary artery
bypass graft.
Source
Journal of Tehran University Heart Center. 9 (3) (pp 120-123), 2014. Date
of Publication: 2014.
Publisher
Tehran Heart Center
Abstract
Background: Surgical site infection is known as a common complication
after cardiac surgery, and Cefazolin is the best prophylactic antibiotic
to prevent this complication. The goal of this study was to evaluate the
effect of continuous and intermittent Cefazolin for the prevention of
superficial surgical site infection following off-pump coronary artery
bypass (OPCAB). Methods: This prospective randomized clinical trial study
was conducted on 141 patients candidated for OPCAB and divided into two
groups. This study was performed between February 2011 and February 2012
in the Iranian city of Yazd. Patients in both groups received 2 g of
Cefazolin as a starting dose and at 30 minutes before incision. Definition
of surgical site infections was according to the Centers for Disease
Control and Prevention Criteria (CDC-criteria). In the continuous infusion
group (n = 74), 3 g of Cefazolin was infused over a 24-hour period after
surgery. In the intermittent group (n = 67), 1 g of Cefazolin was
administered at 3, 11, and 19 hours after the starting dose.
Hyperlipidemia, diabetes, hypertension, smoking, history of heart disease,
and incidences of superficial infection were compared between the two
groups. Duration of followup was 4 weeks. Results: The mean age of the
patients was 60.49 + 10.63 years. The patients were 30.5% female and 69.5%
male. There were no significant differences in age, body surface area,
duration of operation, number of distal grafts, number of proximal grafts,
and duration of hospital stay before heart surgery between two groups. The
incidence of infection in intermittent group was (7.5%) and in continuous
groups was (2.7%). There was no significant difference in the incidence of
infection between the two groups (p value = 0.26). Conclusion: Our
findings in this study showed no significant differences between
continuous and intermittent Cefazolin for the prevention of superficial
surgical site infections after OPCAB.

<12>
Accession Number
2014532125
Authors
Panza J.A. Velazquez E.J. She L. Smith P.K. Nicolau J.C. Favaloro R.R.
Gradinac S. Chrzanowski L. Prabhakaran D. Howlett J.G. Jasinski M. Hill
J.A. Szwed H. Larbalestier R. Desvigne-Nickens P. Jones R.H. Lee K.L.
Rouleau J.L.
Institution
(Panza) Westchester Medical Center, New York Medical College, Valhalla,
NY, United States
(Velazquez) Duke Clinical Research Institute, Department of
Medicine-Cardiology, Duke University School of Medicine, Durham, NC,
United States
(She, Lee) Duke Clinical Research Institute, Department of Biostatistics
and Bioinformatics, Duke University School of Medicine, Durham, NC, United
States
(Smith, Jones) Duke Clinical Research Institute, Department of
Surgery-Cardiothoracic, Duke University School of Medicine, Durham, NC,
United States
(Nicolau) InCor Heart Institute, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Favaloro) University Hospital Favaloro Foundation, Buenos Aires,
Argentina
(Gradinac) Belgrade University School of Medicine, Belgrade, Serbia
(Chrzanowski) Department of Cardiology, Medical University of Lodz, Lodz,
Poland
(Prabhakaran) Centre for Chronic Disease Control, New Delhi, India
(Howlett) Foothills Medical Centre, Calgary, Canada
(Jasinski) Medical University of Silesia, Katowice, Poland
(Hill) Shands Hospital at the University of Florida, Gainesville, FL,
United States
(Szwed) Institute of Cardiology, Warsaw, Poland
(Larbalestier) Royal Perth Hospital, Perth, Australia
(Desvigne-Nickens) National Heart, Lung and Blood Institute, Bethesda, MD,
United States
(Rouleau) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
Title
Extent of coronary and myocardial disease and benefit from surgical
revascularization in LV dysfunction.
Source
Journal of the American College of Cardiology. 64 (6) (pp 553-561), 2014.
Date of Publication: 12 Aug 2014.
Publisher
Elsevier USA
Abstract
Background Patients with ischemic left ventricular dysfunction have higher
operative risk with coronary artery bypass graft surgery (CABG). However,
those whose early risk is surpassed by subsequent survival benefit have
not been identified. Objectives This study sought to examine the impact of
anatomic variables associated with poor prognosis on the effect of CABG in
ischemic cardiomyopathy. Methods All 1,212 patients in the STICH (Surgical
Treatment of IsChemic Heart failure) surgical revascularization trial were
included. Patients had coronary artery disease (CAD) and ejection fraction
(EF) of <35% and were randomized to receive CABG plus medical therapy or
optimal medical therapy (OMT) alone. This study focused on 3 prognostic
factors: presence of 3-vessel CAD, EF below the median (27%), and
end-systolic volume index (ESVI) above the median (79 ml/m;bsupe).
Patients were categorized as having 0 to 1 or 2 to 3 of these factors.
Results Patients with 2 to 3 prognostic factors (n = 636) had reduced
mortality with CABG compared with those who received OMT (hazard ratio
[HR]: 0.71; 95% confidence interval [CI]: 0.56 to 0.89; p = 0.004); CABG
had no such effect in patients with 0 to 1 factor (HR: 1.08; 95% CI: 0.81
to 1.44; p = 0.591). There was a significant interaction between the
number of factors and the effect of CABG on mortality (p = 0.022).
Although 30-day risk with CABG was higher, a net beneficial effect of CABG
relative to OMT was observed at 2 years in patients with 2 to 3 factors
(HR: 0.53; 95% CI: 0.37 to 0.75; p<0.001) but not in those with 0 to 1
factor (HR: 0.88; 95% CI: 0.59 to 1.31; p = 0.535). Conclusions Patients
with more advanced ischemic cardiomyopathy receive greater benefit from
CABG. This supports the indication for surgical revascularization in
patients with more extensive CAD and worse myocardial dysfunction and
remodeling. (Comparison of Surgical and Medical Treatment for Congestive
Heart Failure and Coronary Artery Disease [STICH]; NCT00023595). 2014 by
the American College of Cardiology Foundation.

<13>
Accession Number
2014532114
Authors
Pokushalov E. Kozlov B. Romanov A. Strelnikov A. Bayramova S. Sergeevichev
D. Bogachev-Prokophiev A. Zheleznev S. Shipulin V. Salakhutdinov N.
Lomivorotov V.V. Karaskov A. Po S.S. Steinberg J.S.
Institution
(Pokushalov) State Research Institute of Circulation Pathology, Arrhythmia
Department, Rechkunovskaya 15, 630055 Novosibirsk 55, Russian Federation
Title
Botulinum toxin injection in epicardial fat pads can prevent recurrences
of atrial fibrillation after cardiac surgery: Results of a randomized
pilot study.
Source
Journal of the American College of Cardiology. 64 (6) (pp 628-629), 2014.
Date of Publication: 12 Aug 2014.
Publisher
Elsevier USA

<14>
Accession Number
2014529854
Authors
Donndorf P. Park H. Vollmar B. Alms A. Gierer P. Steinhoff G. Kaminski A.
Institution
(Donndorf, Park, Steinhoff, Kaminski) Department of Cardiac Surgery,
University of Rostock, Schillingallee 35, 18057 Rostock, Germany
(Vollmar) Institute of Experimental Surgery, University of Rostock,
Rostock, Germany
(Alms) Department of Anesthesiology and Intensive Care Medicine,
University of Rostock, Rostock, Germany
(Gierer) Department of Trauma and Reconstructive Surgery, University of
Rostock, Rostock, Germany
Title
Impact of closed minimal extracorporeal circulation on microvascular
tissue perfusion during surgical aortic valve replacement: Intravital
imaging in a prospective randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (2) (pp 211-217),
2014. Date of Publication: August 2014.
Publisher
Oxford University Press
Abstract
OBJECTIVES Closed minimal extracorporeal circulation (MECC) systems
currently do not represent the standard of surgical care for open-heart
surgery. Yet, considering the beneficial results reported for coronary
artery bypass graft (CABG) surgery, we used an MECC system in aortic valve
replacement (AVR) and analysed the effects on intraoperative microvascular
perfusion in comparison with conventional open extracorporeal circulation
(CECC). METHODS In the current study, we analysed alterations in
microvascular perfusion at 4 predefined time points (T1-T4) during
surgical AVR utilizing orthogonal polarization spectral (OPS) imaging.
Twenty patients were randomized for being operated on utilizing either
MECC or CECC. Changes in functional capillary density (FCD,
cm/cm²), mircovascular blood flow velocity (mm/s) and vessel
diameter (mum) were analysed by a blinded investigator. RESULTS After the
start of extracorporeal circulation and aortic cross-clamping (T2), both
groups showed a significant drop in FCD, but with a significantly higher
FCD in the MECC group (153.1 + 15.0 cm/cm2 in the CECC group vs 160.8 +
12.2 cm/cm2 in the MECC group, P = 0.034). During the late phase of the
cardiopulmonary bypass (CPB) (T3), the FCD was still significantly
depressed in both treatment groups (153.5 + 14.6 cm/cm2 in the CECC group,
P <0.05 vs 'T1'; 159.5 + 12.4 cm/cm2 in the MECC group, P <0.05 versus
'T1'). After termination of CPB (T4), the FCD recovered in both groups to
baseline values. Microvascular blood flow velocity tended to remain at a
higher level in the MECC group, whereas haemodilution during CPB was
significantly reduced in the MECC group. CONCLUSIONS The use of MECC in
AVR did not affect procedural safety and, resulted in beneficial
preservation of microvascular blood flow velocity and significantly
reduced haemodilution during CPB. In contrast to CABG surgery, the use of
MECC did not improve FCD during surgical AVR. Clinical advantages possibly
resulting from attenuated haemodilution and preservation of microvascular
blood flow velocity require further validation in larger patient cohorts.
2014 The Author 2014. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<15>
Accession Number
2014529849
Authors
Rodriguez-Larrad A. Lascurain-Aguirrebena I. Abecia-Inchaurregui L.C. Seco
J.
Institution
(Rodriguez-Larrad, Lascurain-Aguirrebena) Department of Physiology,
University of the Basque Country, Leioa, Spain
(Abecia-Inchaurregui) Department of Preventive Medicine and Public Health,
Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz,
Spain
(Seco) Institute of Biomedicine (IBIOMED), University of Leon, Campus de
Vegazana S/n, C.P. 24071 Leon, Spain
(Seco) Visiting Researcher, University of the Basque Country, Leioa, Spain
Title
Perioperative physiotherapy in patients undergoing lung cancer resection.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (2) (pp 269-281),
2014. Date of Publication: August 2014.
Publisher
Oxford University Press
Abstract
Physiotherapy is considered an important component of the perioperative
period of lung resection surgery. A systematic review was conducted to
assess evidence for the effectiveness of different physiotherapy
interventions in patients undergoing lung cancer resection surgery. Online
literature databases [Medline, the Cochrane Central Register of Controlled
Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until
June 2013. Studies were included if they were randomized controlled
trials, compared 2 or more perioperative physiotherapy interventions or
compared one intervention with no intervention, included only patients
undergoing pulmonary resection for lung cancer and assessed at least 2 or
more of the following variables: functional capacity parameters,
postoperative pulmonary complications or length of hospital stay. Reviews
and meta-analyses were excluded. Eight studies were selected for inclusion
in this review. They included a total of 599 patients. Seven of the
studies were identified as having a low risk of bias. Two studies assessed
preoperative interventions, 4 postoperative interventions and the
remaining 2 investigated the efficacy of interventions that were started
preoperatively and then continued after surgery. The substantial
heterogeneity in the interventions across the studies meant that it was
not possible to conduct a meta-analysis. The most important finding of
this systematic review is that presurgical interventions based on
moderate-intense aerobic exercise in patients undergoing lung resection
for lung cancer improve functional capacity and reduce postoperative
morbidity, whereas interventions performed only during the postoperative
period do not seem to reduce postoperative pulmonary complications or
length of hospital stay. Nevertheless, no firm conclusions can be drawn
because of the heterogeneity of the studies included. Further research
into the efficacy and effectiveness of perioperative respiratory
physiotherapy in this patient population is needed. 2014 The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<16>
Accession Number
2014529844
Authors
Soylu E. Harling L. Ashrafian H. Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY,
United Kingdom
Title
Should we consider off-pump coronary artery bypass grafting in patients
undergoing coronary endarterectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (2) (pp 295-301),
2014. Date of Publication: August 2014.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether off-pump coronary
artery bypass grafting with coronary endarterectomy (OPCAB-CE) is a safe
and feasible method of myocardial revascularization in patients presenting
with diffuse coronary artery disease. Seventy-one papers were identified
by a systematic search, of which nine were judged to best answer the
clinical question. All were observational studies. Of these, two were
comparative and the remaining seven were case series. The authors,
journal, date, country of publication, patient group, study type, relevant
outcomes and results were tabulated. In total, these 9 studies included
341 patients (225 OPCAB-CE, 116 ONCAB-CE) undergoing coronary
endarterectomy in combination with coronary artery bypass grafting. CE was
performed either by an open method whereby the atheroma is removed through
an arteriotomy made along the length of the stenosis or by a closed method
whereby the atheroma is removed by gentle traction through a small
arteriotomy made over a proximal area of the plaque. Overall, OPCAB-CE was
associated with a low perioperative mortality ranging from zero in smaller
case series to 2.8% in the largest study (n = 70). Two comparative studies
demonstrate at least equivalent 30-day mortality between OPCAB-CE and
ONCAB-CE, although the sample sizes are small. The overall incidence of
postoperative myocardial infarction (MI) was 6.1% (11/180) and seems
comparable between OPCAB-CE and ONCAB-CE. Notably, both postoperative MI
and mortality appeared higher in patients undergoing multiple
endarterectomies performed using a closed technique and CE to the right
coronary artery was associated with increased postoperative MI. In
summary, OPCAB-CE in the setting of diffuse coronary artery disease
appears both safe and feasible, yielding comparable results to ONCAB-CE.
Where possible, open arteriotomy with on-lay patch angioplasty may improve
postoperative outcomes. Large, prospective database studies are now
required with explicit sub-group criteria and stratification to number,
territory and technique of endarterectomy in order to isolate the patients
in whom OPCAB-CE may confer the greatest benefit. 2014 The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2014529808
Authors
Guedon-Moreau L. Lacroix D. Sadoul N. Clementy J. Kouakam C. Hermida J.-S.
Aliot E. Kacet S.
Institution
(Guedon-Moreau, Lacroix, Kouakam, Kacet) Centre Hospitalier Regional
Universitaire, F-59037 Lille, France
(Sadoul, Aliot) Centre Hospitalier Universitaire Brabois, F-54500 Nancy,
France
(Clementy) Centre Hospitalier Universitaire Haut-Leveque, F-33064 Pessac,
France
(Hermida) Centre Hospitalier Universitaire, F-80054 Amiens, France
Title
Costs of remote monitoring vs. ambulatory follow-ups of implanted
cardioverter defibrillators in the randomized ECOST study.
Source
Europace. 16 (8) (pp 1181-1188), 2014. Date of Publication: August 2014.
Publisher
Oxford University Press
Abstract
Aims The Effectiveness and Cost of ICD follow-up Schedule with
Telecardiology (ECOST) trial evaluated prospectively the economic impact
of long-term remote monitoring (RM) of implantable cardioverter
defibrillators (ICDs). Methods and results The analysis included 310
patients randomly assigned to RM (active group) vs. ambulatory follow-ups
(control group). Patients in the active group were seen once a year unless
the system reported an event mandating an ambulatory visit, while patients
in the control group were seen in the ambulatory department every 6
months. The costs of each follow-up strategy were compared, using the
actual billing documents issued by the French health insurance system,
including costs of (i) (a) ICD-related ambulatory visits and
transportation, (b) other ambulatory visits, (c) cardiovascular treatments
and procedures, and (ii) hospitalizations for the management of
cardiovascular events. The ICD and RM system costs were calculated on the
basis of the device remaining longevity at the end of the study. The
characteristics of the study groups were similar. Over a follow-up of 27
months, the mean non-hospital costs per patient-year were 1695 + 1131 in
the active, vs. 1952 + 1023 in the control group (P = 0.04), a 257
difference mainly due to device management. The hospitalization costs per
patient-year were 2829 + 6382 and 3549 + 9714 in the active and control
groups, respectively (P = 0.46). Adding the ICD to the non-hospital costs,
the savings were 494 (P = 0.005) or, when the monitoring system was
included, 315 (P = 0.05) per patient-year. Conclusion From the French
health insurance perspective, the remote management of ICD patients is
cost saving. Clinical trials registration NCT00989417,
www.clinicaltrials.gov 2014 The Author 2014. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<18>
Accession Number
2014526775
Authors
Ding L. Wu H.-L. Zhu J.-H. Ding M. Wang Y.-L. Xu X.-J.
Institution
(Ding) Nursing College of Nantong University, Nantong City, Jiangsu
Province, China
(Wu, Zhu, Ding, Xu) Nursing Department, Affiliated Hospital of Nantong
University, Nantong City, Jiangsu Province, China
(Wang) The Second Affiliated Hospital of Nantong University, Nantong City,
Jiangsu Province, China
Title
Superiority of 5% nahco3 for preoperative hair removal in patients
undergoing coronary artery bypass graft surgery with a limb vein: A
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 46 (2) (pp e28-e32), 2014.
Article Number: ezu203. Date of Publication: August 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: Compared with a dry environment with talcum powder, a wet,
alkaline environment with NaHCO. ₃ solution is better for hair
removal, as it can soften and expand the hair, decrease the friction and
shear forces on the skin, and make hair removal easier and more efficient.
The purpose of this study was to compare the effects of a preoperative
skin preparation of 5% NaHCO. ₃ with that of talcum powder for
softening hair in patients undergoing coronary artery bypass graft (CABG)
surgery with the saphenous vein. Methods: A prospective randomized,
single-blinded, controlled study was established. Between March 2012 and
June 2013, 120 patients who met the inclusion and exclusion criteria
underwent elective CABG surgery with the saphenous vein in our hospital.
The same doctor obtained the saphenous vein of each patient by a uniform
method. CABG surgery was performed through an open or endoscopic
technique, according to each patient's condition. Patients were divided
into two groups of 60 patients each, according to whether the preoperative
skin preparation procedure was performed with a 5% solution of NaHCO.
₃ at 45-50degreeC (experimental group) or with talcum powder
(control group). Main outcome measures were the incision inflammation
rate, skin preparation time, presence of shaving-induced macroscopic
haemorrhagic spots, verbal rating scale (VRS) pain score and satisfaction.
Results: Neither group had any evidence of incision inflammation. The
average (mean + standard deviation) skin preparation time of the
experimental group was shorter than that of the control group (5.58 + 1.52
vs 9.74 + 1.23 min, P < 0.001). Three patients in the experimental group
and 17 in the control group had shaving-induced macroscopic haemorrhagic
spots after skin preparation (P = 0.001). The VRS pain scores were
different between the two groups (P < 0.001). In the control group, 40% of
patients and 37% of nurses were satisfied with the skin preparation
procedure, compared with 95 and 90%, respectively, in the experimental
group (both P < 0.001). Conclusions: Hair softening with a 5% NaHCO.
₃ solution protected the skin integrity, alleviated pain and
improved patient satisfaction to a greater extent than talcum powder.
Nurses found the 5% NaHCO. ₃ solution to be more convenient and
less time-consuming to use. The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<19>
[Use Link to view the full text]
Accession Number
2014524664
Authors
Mori Y. Kamada T. Ochiai R.
Institution
(Mori, Kamada) Department of Anesthesia, Kawasaki Saiwai Hospital, 31-27
Omiya, Saiwai, Kawasaki 212-0014, Japan
(Ochiai) Department of Anesthesiology, School of Medicine, Toho
University, Oota-ku, Tokyo, Japan
Title
Reduction in the incidence of acute kidney injury after aortic arch
surgery with low-dose atrial natriuretic peptide: A randomised controlled
trial.
Source
European Journal of Anaesthesiology. 31 (7) (pp 381-387), 2014. Date of
Publication: July 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Acute kidney injury (AKI) after surgery is associated with an
increased risk of adverse events and death. Atrial natriuretic peptide
(ANP) dilates the preglomerular renal arteries and inhibits the
renin-angiotensin axis. A low-dose ANP infusion increases glomerular
filtration rate after cardiovascular surgery, but it is not known whether
it reduces the incidence of AKI or the mortality rate. OBJECTIVE To
evaluate whether an intravenous ANP infusion prevents AKI in patients
undergoing aortic arch surgery requiring hypothermic circulatory arrest.
DESIGN A randomised controlled study. SETTING Operating room and intensive
care unit at Kawasaki Saiwai Hospital, Kanagawa, Japan. PATIENTS Forty-two
patients with normal preoperative renal function undergoing elective
repair of an aortic arch aneurysm. INTERVENTION Patients were assigned
randomly to receive a fixed dose of ANP (0.0125mgkg1 min1) or placebo. The
infusion was started after induction of anaesthesia and continued for 24 h
postoperatively. MAIN OUTCOME MEASURES The primary end-point was the
incidence of AKI within 48 h after surgery. RESULTS AKI developed in 30%
of patients who received ANP compared with 73% of patients who received
placebo (P=0.014). Intraoperative urine output was almost 1 l greater in
patients who received ANP (1865-1299 versus 991-480 ml in the control
group, P=0.005). However, there were no differences in mean arterial
pressure or number of episodes of hypotension between the groups. Length
of hospital and intensive care stays were not significantly different, nor
was there a difference in 30-day mortality. No patients required
haemodialysis or continuous renal replacement therapy. CONCLUSION We found
that an intravenous infusion of ANP at 0.0125mgkg1 min1 is an effective
intervention for reducing the incidence of postoperative AKI, and appears
to afford a degree of renal protection during and after cardiovascular
surgery. 2014 Copyright European Society of Anaesthesiology.

<20>
Accession Number
2014521491
Authors
Mullen J.C. Kuurstra E.J. Oreopoulos A. Bentley M.J. Wang S.
Institution
(Mullen, Kuurstra, Oreopoulos, Bentley, Wang) Division of Cardiac Surgery,
University of Alberta Hospital, Edmonton, AB, Canada
(Mullen) Division of Cardiac Surgery, University of Alberta Hospital,
2D2.18 WMC, 8440 112 Street, Edmonton, AB T6G 2B7, Canada
Title
A randomized controlled trial of daclizumab versus anti-thymocyte globulin
induction for heart transplantation.
Source
Transplantation Research. 3 (1) , 2014. Article Number: 14. Date of
Publication: 30 Jul 2014.
Abstract
Background: The purpose of this study was to test the efficacy and safety
of daclizumab (DZM) versus anti-thymocyte globulin (ATG) as a component of
induction therapy in heart transplant recipients.Methods: Thirty heart
transplant patients were randomized to receive either ATG or DZM during
induction therapy. Patients in the DZM group received an initial dose of 2
mg/kg intravenous (IV) at the time of transplant and 1 mg/kg IV on
postoperative day 4.Discussion: Recipient, donor, and intraoperative
variables did not differ significantly between groups. The cost of
induction therapy, total drug cost, and hospital ward costs were
significantly less for the DZM group. Average absolute lymphocyte and
platelet counts were significantly higher in the DZM group. There were no
significant differences in the incidence of rejection, infection,
malignancy, or steroid-induced diabetes. One year survival was excellent
in both groups (87%, P = 0.1). Daclizumab is a safe component of induction
therapy in heart transplantation. 2014 Mullen et al.

<21>
Accession Number
2014522260
Authors
Fitzmaurice G.J. McWilliams B. Nolke L. Redmond J.M. McGuinness J.G.
O'Donnell M.E.
Institution
(Fitzmaurice, Nolke, Redmond, McGuinness) Department of Cardiothoracic
Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
(Fitzmaurice, McWilliams) Department of Anaesthetics, Intensive Care and
Pain Medicine, School of Medicine, Cardiff University, Cardiff, United
Kingdom
(O'Donnell) Sports and Exercise Sciences Research Institute, Faculty of
Life and Health Sciences, University of Ulster, Ulster, Ireland
(O'Donnell) Division of Vascular and Endovascular Surgery, Mayo Clinic,
Phoenix, AZ, United States
Title
Do statins have a role in the promotion of postoperative wound healing in
cardiac surgical patients?.
Source
Annals of Thoracic Surgery. 98 (2) (pp 756-764), 2014. Date of
Publication: August 2014.
Publisher
Elsevier USA
Abstract
Cardiac surgical patients often have associated comorbidities that can
impede normal wound healing; however, statin therapy has the potential to
improve this process through augmentation of the normal inflammatory
response. Outcomes included a 30% earlier rate of wound epithelialization
and an 80% greater wound-breaking strength combined with faster wound
healing rates (13.0 days vs 18.7 days, p < 0.0001). Inhibition of farnesyl
pyrophosphate may hold a key role in the mediation of such advantageous
effects. This systematic review suggests that there is sufficient evidence
to warrant completion of a human trial to assess the effects of statins on
wound healing. 2014 by The Society of Thoracic Surgeons Published by
Elsevier Inc.

<22>
Accession Number
2014522294
Authors
Chaudhry U.A.R. Harling L. Rao C. Ashrafian H. Ibrahim M. Kokotsakis J.
Casula R. Athanasiou T.
Institution
(Chaudhry, Harling, Rao, Ashrafian, Ibrahim, Casula, Athanasiou)
Department of Surgery and Cancer, Imperial College London, St. Mary's
Hospital Campus, South Wharf Road, London, W2 1NY, United Kingdom
(Kokotsakis) Second Department of Cardiac Surgery, Evangelismos General
Hospital, Athens, Greece
Title
Off-pump versus on-pump coronary revascularization: Meta-analysis of mid-
and long-term outcomes.
Source
Annals of Thoracic Surgery. 98 (2) (pp 563-572), 2014. Date of
Publication: August 2014.
Publisher
Elsevier USA
Abstract
Background Early outcomes for off-pump coronary artery bypass grafting
(OPCAB) have been extensively compared with on-pump coronary
revascularization (ONCAB); however, the long-term effects of OPCAB
continue to be debated. This study aims to compare the mid-term (>1year;
<5 years) and long-term (>5 years) survival and major adverse
cardiovascular and cerebrovascular events of OPCAB versus ONCAB. Methods A
systematic search identified 32 studies meeting our inclusion criteria.
These were analyzed using random effects modeling, with subgroup
evaluation according to study type. Primary outcomes were mid- and
long-term survival over a follow-up period greater than 1 year. Secondary
outcomes were mid- and long-term events including repeat
revascularization, myocardial infarction, angina, heart failure, and
cerebrovascular accidents. Results Off-pump coronary artery bypass
grafting confers similar overall mid-term survival when compared with
ONCAB (hazard ratio, 1.06; 95% confidence interval, 0.95 to 1.19; p =
0.31). On-pump coronary artery bypass grafting was associated with a
significant trend towards a long-term survival advantage (hazard ratio,
1.06; 95% confidence interval, 1.00 to 1.13; p = 0.05); however, this was
no longer present when subgroup analysis of only randomized controlled
trials, registry-based studies, and propensity-matched studies was
performed. There was an increase in angina recurrence among two studies
after OPCAB, but no difference was seen in 11 other studies reporting data
as odds ratio. No significant differences were observed in other secondary
outcomes. Conclusions This analysis demonstrates comparable mid-term
mortality and mid- to long-term morbidity between OPCAB and ONCAB. On-pump
coronary artery bypass grafting may be associated with improved long-term
survival when all study types are analyzed; however, analysis of only
randomized controlled trials and propensity-matched studies demonstrates
comparable long-term mortality between OPCAB and ONCAB. 2014 by The
Society of Thoracic Surgeons Published by Elsevier Inc.

<23>
Accession Number
2014522255
Authors
Pompili C. Detterbeck F. Papagiannopoulos K. Sihoe A. Vachlas K. Maxfield
M.W. Lim H.C. Brunelli A.
Institution
(Pompili) Department of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona,
Italy
(Detterbeck, Maxfield) Department of Thoracic Surgery, Yale-New Haven
Hospital, Yale University, New Haven, CT, United States
(Pompili, Papagiannopoulos, Vachlas, Brunelli) Division of Thoracic
Surgery, St. James's University Hospital, Bexeley Wing, Beckett St, Leeds
LS9 7TF, United Kingdom
(Sihoe, Lim) Department of Thoracic Surgery, Li Ka Shing Faculty of
Medicine, University of Hong Kong, Hong Kong, Hong Kong
Title
Multicenter international randomized comparison of objective and
subjective outcomes between electronic and traditional chest drainage
systems.
Source
Annals of Thoracic Surgery. 98 (2) (pp 490-497), 2014. Date of
Publication: August 2014.
Publisher
Elsevier USA
Abstract
Background The aim of this study was to assess the impact of digital
versus traditional drainage devices on chest tube removal and patient
satisfaction. Methods A randomized trial of digital versus traditional
devices after lobectomy/segmentectomy was conducted at 4 international
centers (United Kingdom, Europe, Asia, United States). Patients were
managed with overnight suction followed by gravity drainage. Chest tubes
were removed when an air leak was not evident anymore and the drained
fluid was less than 400 mL/d. Results The groups (digital, 191 patients;
traditional, 190 patients) were well matched for baseline and surgical
characteristics. There were 325 lobectomies/ bilobectomies and 56
segmentectomies, 308 of which were performed by video-assisted thoracic
surgery (VATS). Patients randomized to digital systems had a significantly
shorter air leak duration (1.0 versus 2.2 days; p = 0.001), duration of
chest tube placement (3.6 versus 4.7 days; p = 0.0001), and postoperative
length of stay (4.6 versus 5.6 days; p < 0.0001). Subjective end points
revealed a perceived improved ability to arise from bed (p = 0.008),
system convenience for patients and personnel (p = 0.02), and the
potential for being comfortable when discharged home with the device (p =
0.06). A mean difference of 2.6 days from air leak cessation to tube
removal was observed, which was similar in the 2 groups (p = 0.7).
Multivariable regression analysis showed that duration of chest tube
placement after air leak cessation was directly associated with the amount
of fluid drained during the first 48 hours (p = 0.01) and the duration of
air leak (p = 0.008), independent of hospital location. Conclusions
Patients managed with digital drainage systems experienced a shorter
duration of chest tube placement, shorter hospital stays, and higher
satisfaction scores compared with those managed with traditional devices.
(Clinical Trial Registration Number: NCT01747889.) 2014 by The Society of
Thoracic Surgeons Published by Elsevier Inc.

<24>
Accession Number
2014526870
Authors
Ghavidel A.A. Mirmesdagh Y. Samiei N. Dehaki M.G.
Institution
(Ghavidel, Mirmesdagh, Samiei) Heart Valve Disease Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Dehaki) Rajaie Cardiovascular Medical and Research Center, Cardiac
Surgery Department, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Haemostatic role of tachoSil surgical patch in cardiac surgery.
Source
Journal of Cardiovascular and Thoracic Research. 6 (2) (pp 91-95), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Excessive bleeding presents a risk for the patient in
cardiovascular surgery. Local haemostatic agents are of great value to
reduce bleeding and related complications. TachoSil (Nycomed, Linz,
Austria) is a sterile, haemostatic agent that consists of an equine
collagen patch coated with human fibrinogen and thrombin. This study
evaluated the safety and efficacy of TachoSil compared to conventional
technique. Methods: Forty-two patients scheduled for open heart surgeries,
were entered to this study from August 2010 to May 2011. After primary
haemostatic measures, patients divided in two groups based on surgeon's
judgment. Group A: 20 patients for whom TachoSil was applied and group B:
22 patients that conventional method using Surgicel (13 patients) or wait
and see method (9 cases), were performed in order to control the bleeding.
In group A, 10 patients were male with mean age of 56.95+15.67 years and
in group B, 9 cases were male with mean age of 49.95+14.41 years. In case
group 70% (14/20) of the surgeries were redo surgeries versus 100% (22/22)
in control group. Results: Baseline characteristics were similar in both
groups. In TachoSil group 75% of patients required transfusion versus
90.90% in group B (P=0.03).Most transfusions consisted of packed red blood
cell; 2+1.13 units in group A versus 3.11+1.44 in group B (P=0.01),
however there were no significant differences between two groups regarding
the mean total volume of intra and post-operative bleeding. Re-exploration
was required in 10% in group A versus 13.63% in group B (P=0.67).
Conclusion: TachoSil may act as a superior alternative in different types
of cardiac surgery in order to control the bleeding and therefore reducing
transfusion requirement. 2014 The Author(s).

<25>
Accession Number
2014526868
Authors
Porhomayon J. Kolesnikov S. Nader N.D.
Institution
(Porhomayon, Kolesnikov, Nader) University at Buffalo, Buffalo, NY, United
States
Title
The impact of stress hormones on post-traumatic stress disorders symptoms
and memory in cardiac surgery patients.
Source
Journal of Cardiovascular and Thoracic Research. 6 (2) (pp 79-84), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
The relationship and interactions between stress hormones and
post-traumatic stress disorder (PTSD) are well established from both
animal and human research studies. This interaction is especially
important in the post-operative phase of cardiac surgery where the
development of PTSD symptoms will result in increased morbidity and
mortality and prolong length of stay for critically ill cardiac surgery
patients. Cardiopulmonary bypass itself will independently result in
massive inflammation response and release of stress hormones in the
perioperative period. Glucocorticoid may reduce this response and result
in reduction of PTSD symptom clusters and therefore improve health
outcome. In this review, we plan to conduct a systemic review and analysis
of the literatures on this topic. 2014 The Author(s).

<26>
Accession Number
2014520792
Authors
Yoo Y.-C. Shim J.-K. Song Y. Yang S.-Y. Kwak Y.-L.
Institution
(Yoo, Shim, Song, Kwak) Department of Anesthesiology and Pain Medicine,
Yonsei University, College of Medicine, Seoul, South Korea
(Yoo, Shim, Song, Kwak) Anesthesia and Pain Research Institute, Yonsei
University, College of Medicine, Seoul, South Korea
(Yang) Department of Anesthesiology and Pain Medicine, Chung-Ang
University, College of Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Department of
Anesthesiology and Pain Medicine, Yonsei University College of Medicine,
250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea
Title
Anesthetics influence the incidence of acute kidney injury following
valvular heart surgery.
Source
Kidney International. 86 (2) (pp 414-422), 2014. Date of Publication:
August 2014.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Propofol has been shown to provide protection against renal
ischemia/reperfusion injury experimentally, but clinical evidence is
lacking. Here we studied the effect of propofol anesthesia on the
occurrence of acute kidney injury following heart surgery with
cardiopulmonary bypass. One hundred and twelve patients who underwent
valvular heart surgery were randomized to receive either propofol or
sevoflurane anesthesia, both with sufentanil. Using Acute Kidney Injury
Network criteria, significantly fewer patients developed acute kidney
injury postoperatively in the propofol group compared with the sevoflurane
group (6 compared with 21 patients). The incidence of severe renal
dysfunction was significantly higher in the sevoflurane group compared
with the propofol group (5 compared with none). The postoperative cystatin
C was significantly lower in the propofol group at 24 and 48 h. Serum
interleukin-6 at 6 h after aorta cross-clamp removal, C-reactive protein
at postoperative day 1, and segmented neutrophil counts at postoperative
day 3 were also significantly lower in the propofol group. Thus, propofol
anesthesia significantly reduced the incidence and severity of acute
kidney injury in patients undergoing valvular heart surgery with
cardiopulmonary bypass compared with sevoflurane. This beneficial effect
of propofol may be related to its ability to attenuate the perioperative
increase in proinflammatory mediators. 2014 International Society of
Nephrology.

<27>
Accession Number
71566971
Authors
Lushaj E. Schreiner A. Jonuzi B. Lozonschi L.
Institution
(Lushaj, Schreiner, Jonuzi, Lozonschi) University of Wisconsin, Madison,
WI, United States
Title
Short-term clinical outcomes after off-pump coronary artery bypass graft
at a single VA medical center.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 17th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2014 Boston, MA United
States. Conference Start: 20140528 Conference End: 20140531. Conference
Publication: (var.pagings). 9 (3) (pp 236), 2014. Date of Publication:
May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Coronary artery bypass graft (CABG) procedure has been the most
effective treatment for ischemic heart disease, traditionally done with
cardiopulmonary bypass (CPB) and cardioplegic arrest. To avoid the side
effects of CPB and reduce the risk of stroke, off-pump CABG technique has
evolved as an alternative strategy to revascularize the ischemic heart.
Methods: We retrospectively studied 260 consecutive patients at our
Veterans Hospital, between October, 2007, and September, 2010.
Demographics, short-term clinical outcomes including 30-day operative
mortality and perioperative morbidity were evaluated. Results: One hundred
seventy (170) patients underwent an off-pump CABG and 82 patients
underwent an on-pump CABG procedure. There were more patients with COPD
(p=0.04), LVEF of 35-44% (p<0.01) and smokers (p<0.01) in the off-pump
group. None of the patients who underwent CABG off-pump required a new
mechanical support device (p=0.01) or had a stroke (p=0.04). Off-pump CABG
patients had a significant lower 30-day composite risk of morbidity and
mortality (p<0.01). None of the off-pump CABG patients were converted to
on-pump surgery (rate as high as 12.4% in ROOBY trial). Other short-term
end points such as 30-day mortality, the number of bypass grafts, rate of
infections or reoperations for bleeding were not significant between the 2
groups. Conclusions: The on-pump conversion rate in our study is the
lowest reported in a consecutive patient series or randomized controlled
trial. VA patients may benefit from an off-pump approach, including a
lower stroke risk when they face higher risks with on-pump CABG approach.

<28>
Accession Number
71566925
Authors
Jacobs S. Sundermann S.H. Falk V.
Institution
(Jacobs, Sundermann, Falk) University Heartcenter Zurich, Zurich,
Switzerland
Title
Mitral valve surgery: Right lateral minithoracotomy or sternotomy? A
systematic review and meta-analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 17th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2014 Boston, MA United
States. Conference Start: 20140528 Conference End: 20140531. Conference
Publication: (var.pagings). 9 (3) (pp 220), 2014. Date of Publication:
May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To update the current evidence of mitral valve surgery through
a lateral minithoracotomy versus median sternotomy. Methods: We performed
a comprehensive literature research regarding studies comparing mitral
valve surgery through a right-lateral minithoracotomy and median
sternotomy in MEDLINE, EMBASE, Cochrane Central, CTSNet and Google Scholar
for the most recent literature up to April, 2013. From the studies found
in the literature we performed a systematic review and meta-analysis.
Results: 20,000 patients out of 46 studieswere included in this study.
Stroke rate and all-causemortality up to 30 days was similar in both
groups. The length of stay in the ICU, respirator dependence and hospital
staywere significantly shorter in the minimally invasive (MIVS)-group.
Furthermore, blood drainage volume and blood transfusions were decreased
in the MIVS-group. On the contrary, cardiopulmonary bypass time,
cross-clamp time and procedure's length were longer in the MIVS-group.
Postoperative new atrial fibrillation was less in the MIV-group. Aortic
dissections occurred more in theMIVS-group. The rate of re-thoracotomies
and postoperative renal failure was similar in both groups. Conclusions:
MIVS and conventional mitral valve surgery show a similar perioperative
outcome. Minimally invasive mitral valve surgery seems to be favorable in
regards of resource related outcome.

<29>
[Use Link to view the full text]
Accession Number
71566803
Authors
Van Brakel T.J. Verhagen A.F.
Institution
(Van Brakel, Verhagen) Radboud University Nijmegen Medical Center,
Nijmegen, Netherlands
Title
Do we still need a randomized prospective trial comparing vats to open
lobectomy?.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 17th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2014 Boston, MA United
States. Conference Start: 20140528 Conference End: 20140531. Conference
Publication: (var.pagings). 9 (3) (pp 180), 2014. Date of Publication:
May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Lobectomy by video-assisted thoracic surgery (VATS) has become
a widely adopted treatment for early stage non-small cell lung cancer.
However, the percentage of VATS over OPEN lobectomies remains less than
40%, with a considerable variation between centers. Furthermore, a
guideline indicating a preferential procedure is still lacking. The
objective of this study was to evaluate the evidence comparing VATS to
OPEN lobectomy and to investigate the need for a randomized controlled
trial (RCT). Methods: We performed a systematic review of the available
literature from 1994 to present. All studies comparing VATS lobectomy with
OPEN surgery (thoracotomy) for non-small cell lung cancer (stage I/IIa)
with data on oncologic completeness of resection, hospital length of stay
(LOS), postoperative complications and quality of life, were included. 880
references were identified and after systematic exclusion of irrelevant
studies, 190 were abstracted by two independent reviewers. Two RCTs and 48
observational studies were selected for data extraction. Results: 33 of 48
were retrospective studies without case matching (69%). In 14 studies a
historical control group was used (29%). Conversion to thoracotomy was
reported in 11 studies (22%) and 45 out of 50 studies (including both
RCTs) did not follow an intention to treat principle. Both RCTs (1995,
n=61 and 2013, n=66) reported no differences on primary endpoints
(LOS/complications and number of lymph nodes/stations respectively). Ten
studies (20%) reported on number of dissected lymph nodes/stations or
completeness of resection. Only 3 studies reported data on functional
outcome or quality of life. Overall (50 studies), VATS compared to open
lobectomy was associated with a shorter median LOS (5.1 versus 7 days).
Postoperative complication rate as composite endpoint was lower for VATS
compared to open lobectomy (median 27 versus 39%). Conclusions: Although
VATS lobectomy has become a common procedure in many centers, the
available evidence is based on comparative non randomized cohort- and
patient control studies, resulting in imbalanced patient groups. To
recommend VATS lobectomy as a standard of care, randomized controlled
trials are necessary both with regard to functional- and oncologic
outcome. Currently, we conduct a multi-center RCT (SCOPE trial,
NCT01933828) comparing VATS to OPEN lobectomy.

<30>
Accession Number
71566790
Authors
Burns D.J.P. Swinamer S.A. Fox S.A. Romsa J. Vezina W. Akincioglu C.
Warrington J. Guo L.-R. Wa Chu M. Quantz M.A. Novick R.J. Kiaii B.
Institution
(Burns, Swinamer, Fox, Romsa, Vezina, Akincioglu, Warrington, Guo, Wa Chu,
Quantz, Novick, Kiaii) London Health Sciences Center, London, ON, Canada
Title
Long term patency of endoscopically harvested radial artery from a
randomized control trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 17th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2014 Boston, MA United
States. Conference Start: 20140528 Conference End: 20140531. Conference
Publication: (var.pagings). 9 (3) (pp 175-176), 2014. Date of Publication:
May-June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: From 2005-2007, 119 patients were enrolled in a prospective
randomized controlled trial comparing open and endoscopically harvested
radial arteries for coronary artery bypass grafting (CABG). This trial
showed equivalent postoperative arm disability, and in the endoscopic
group, postoperative arm pain, cosmesis, and patient satisfaction were
significantly improved, with a trend toward a significant decrease in
wound infections observed. The objective of the current study was to
compare graft patency between open and endoscopically harvested radial
arteries at greater than 5 years from involvement in the stated trial. We
hypothesized that endoscopically harvested radial arteries would show
equivalent patency. Methods: All patients received calcium channel blocker
therapy for at least 6 months postoperatively. The mean duration of
follow-up was 79.2 (+/- 8.6) months for all patients. At 5 years or
greater from their operation, all consenting patients underwent a
single-day anatomic and functional cardiac assessment with CT angiography
and sestamibi myocardial perfusion scanning. Medical Outcomes Study
36-Item Short Form Health Surveys and Seattle Angina Questionnaires were
completed to assess overall quality of life. Results: Two deaths occurred
within 30 days of CABG (one in each treatment group) and 8 additional
non-cardiac deaths occurred over the study timeframe. Of 119 patients, 66
consented to follow-up. Thirty-two had open radial artery harvest and 34
had endoscopic radial artery harvest. In the open group, there were 11
obtuse marginal, 16 posterior descending, 1 posterolateral, and 4 right
coronary grafts. In the endoscopic group, there were 7 obtuse marginal, 14
posterior descending, 3 posterolateral, 1 circumflex, 1 diagonal, 1 ramus
intermedius, and 7 right coronary grafts. There were 28 (87.5%) patent
conventionally harvested radial arteries and 31 (91.2%) patent
endoscopically harvested radial arteries (p=0.705). Measured quality of
life was comparable between groups. Conclusions: Endoscopic radial artery
harvest is safe and effective when compared to open radial artery harvest,
with equivalent graft patency shown at greater than 5 years.

<31>
Accession Number
71562457
Authors
Guo Z. Wang D. Yuan X. Ju W. He X.
Institution
(Guo, Wang, Yuan, Ju, He) Organ Transplant Center, First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, China
Title
Changes in patient/graft survival and death causes of liver, kidney and
heart transplantation over time, according to age, sex, region: A
meta-analysis.
Source
Liver Transplantation. Conference: 2014 Joint International Congress of
ILTS, ELITA and LICAGE London United Kingdom. Conference Start: 20140604
Conference End: 20140607. Conference Publication: (var.pagings). 20 (pp
S194-S195), 2014. Date of Publication: June 2014.
Publisher
John Wiley and Sons Ltd
Abstract
Background We aimed to assess the patient/graft survivals and death causes
of liver, kidney and heart transplantation in relation to age, sex, region
and time period. Methods A search of PubMed and Embase with predefined
inclusion criteria identified prospective studies published between
January 1980, and March 2013. Patient/graft survivals were pooled in a
random-effects binomial metaanalysis. Time trends of patient/graft
survivals and death causes, and the effect of age, sex and region were
assessed with weighted linear regression analysis. Results 66 eligible
studies described 22 time periods with 12589 liver transplant recipients,
35 studies described 18 time periods with 10296 renal transplant
recipients, and 39 studies described 19 time periods with 14831 cardiac
transplant recipients, were included. Patient/graft survivals in three
types of SOT all had increasing trends per year and every five years over
time. There were no regional differences found in 1-year patient/graft
survival of kidney transplantation worldwide, but Asia had higher 5-year
kidney transplant recipient survival (94%) than Europe (82%). No regional
survival disparities were found in both liver and heart transplantation.
Malignancy has become more dominating to patient deaths, while the impact
of infection/sepsis and cardiovascular factors has reduced yearly in the
three different organ transplantations. Furthermore, the role of rejection
as a death cause has been decreasing overtime in liver and heart
transplantation. Conclusion Post-transplant patient/graft survivals have
been improving although not significantly in the past three decades, and
are not affected by patient age, sex, and region. (Figure Presented).

<32>
Accession Number
71561462
Authors
Higgins M. Kingdom J.
Institution
(Higgins) Obstetrics and Gynaecology, University College Dublin, National
Maternity Hospital, Dublin, Ireland
(Higgins, Kingdom) Maternal Fetal Medicine, Mount Sinai Hospital, Toronto,
Canada
Title
Fetal monitoring in non-obstetric surgery: Systematic review of the
evidence.
Source
Archives of Disease in Childhood: Fetal and Neonatal Edition. Conference:
Perinatal Medicine 2014 Harrogate United Kingdom. Conference Start:
20140609 Conference End: 20140611. Conference Publication: (var.pagings).
99 (pp A102), 2014. Date of Publication: June 2014.
Publisher
BMJ Publishing Group
Abstract
Use of fetal heart rate monitoring (FHRM) on the labour ward is common but
obstetricians are less familiar with its use in theatre for non-obstetric
surgery. In comparison, obstetric anaesthesia literature largely supports
monitoring as an adjunct to maternal observations. The aim of this study
was to systematically review the evidence on intra-operative FHRM during
non-obstetric surgery. Literature was searched between 1966 and 2013 for
all reports of FHRM in non-obstetric surgery; multiple sources were
searched. All studies were considered; those meeting criteria underwent
data extraction and quality appraisal. Forty-three cases were identified
within the literature, the majority either undergoing maternal general (n
= 23) or cardiovascular (n = 17) surgery. Cases were identified either
from case reports or case series. Several reports discussed changes with
fetal heart rate patterns on induction of anaesthesia, including reduced
variability. Nearly all cases of FHRM in cardiovascular surgery reported
profound fetal bradycardias on initiation of maternal by pass, which often
persisted for the duration of surgery. There were three reports of
delivery of the fetus as a result of the FHRM; one of these cases was
reported as an inappropriate response to reduced variability. Despite the
relatively high numbers of women undergoing non-obstetric surgery during
pregnancy, only small numbers are reported in the literature, which may be
as a result of literature bias. Practitioners considering FHRM during
non-obstetric surgery need to be aware of the reported changes in FHRM
with onset of general anaesthesia and maternal cardiopulmonary bypass.
Individualisation of the decision to use FHRM is appropriate.

<33>
Accession Number
71561013
Authors
Jones J. Mitsudo K. Patel B. Palmer N. Andron M. Khand A.
Institution
(Jones) University Hospital Aintree NHS Trust, United Kingdom
(Mitsudo) Kurashiki Central Hospital, United Kingdom
(Patel, Palmer, Andron) Liverpool Heart and Chest Hospital, United Kingdom
(Khand) University Hospital Aintree and Liverpool Heart, Lung Institute,
United Kingdom
Title
Retrograde wiring of collateral channels of the heart in chronic total
occlusions: A systematic review and meta-analysis of safety, feasibility
and incremental value in achieving revascularisation.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2014
Manchester United Kingdom. Conference Start: 20140602 Conference End:
20140604. Conference Publication: (var.pagings). 100 , 2014. Date of
Publication: June 2014.
Publisher
BMJ Publishing Group
Abstract
Background and aims Increasingly collateral channels have been used for
retrograde wiring as a means of improving success rates in the
recanalisation of complex CTOs.However the feasibility of wiring variable
collateral channels and the risk of injury to important collateral
channels is still to be definedTo conduct a systematic review and
meta-analysis on the anatomy of the collateral circulation of the heart
with specific reference to retrograde wiring in chronic total occlusions
(CTO). Methods and Results We searched publications from 1966 to June 2013
in PubMed, Ovid, EMBASE and the Cochrane database inserting a number of
terms relating to the collateral circulation of the heart in CTOs. 17 case
series (n range17-378) with a total of 1818 CTO revascularisation attempts
fulfilled criteria for a study of retrograde wiring of collateral channels
in CTOs. There were no randomised studies comparing a primary antegrade
with a retrograde approach in any anatomical subset of CTO or those with
previous failed antegrade wiring. Procedural CTO revascularisation success
rates ranged from 67-90.6% and was strongly predicted by success of
retrograde wiring. There was no temporal pattern in success rates of
retrograde wiring or overall successful revascularisation or collateral
channel used. (2007-2013), Figure 1. The septal perforator collaterals and
epicardial channels were used in 75%(n = 1356) and 21%(n = 384) of cases
respectively. Extraction of individual and group data according to
operator selected collateral channel revealed greater success of
retrograde wiring withseptal perforating channels (80%, n = 430/535) as
compared to epicardial collateral channels (68.8%, n = 106/154). RR 1.16
(95% CI: 1.04, 1.30; p = 0.010). (Figure 2, forest plot) Although
collateral/coronary perforation was not infrequent (n = 90, 5%) serious
acute complications were uncommon; in the combined population 12 cases of
cardiac tamponade (0.7%) requiring pericardiocentesis, and 2 deaths
(0.1%). Conclusions Our analysis demonstrates for the first time that
septal perforator channels are significantly more likely to be
successfully retrogradely wired compared to epicardial vessels when either
is selected, on account of their anatomy, by the operator, as a route of
access to the distal cap of a CTO. Successful retrograde wiring of
collateral channels in selected patients undertaken by experienced CTO
operators can significantly enhance the chances of revascularisation of
complex CTOs with a low risk of acute serious complications. (Figure
Presented).

<34>
Accession Number
71559399
Authors
Haluzik M. Lips M. Drapalova J. Mraz M. Dobias M. Kopecky P. Lindner J.
Svacina S.
Institution
(Haluzik, Lips, Drapalova, Mraz, Dobias, Kopecky, Lindner, Svacina)
PragueCzech Republic
Title
The exenatide in patients undergoing coronary artery bypass grafting for
improved glucose control and hemodynamic values (executive) study: A
randomized, controlled trial.
Source
Diabetes. Conference: 74th Scientific Sessions of the American Diabetes
Association San Francisco, CA United States. Conference Start: 20140613
Conference End: 20140617. Conference Publication: (var.pagings). 63 (pp
A261), 2014. Date of Publication: June 2014.
Publisher
American Diabetes Association Inc.
Abstract
Experimental as well as some clinical data have suggested that GLP-1
receptor agonists may in addition to improvement of glucose control also
exert direct positive effects on cardiac function and metabolism. To this
end, we performed a randomized trial to assess the effect of perioperative
administration of the GLP-1 receptor agonist exenatide on cardiac function
and glucose control in subjects undergoing elective cardiac surgery.
Thirty eight subjects (63.2% diabetics) with decreased left ventricular
systolic function (ejection fraction < 50%) scheduled for elective CABG
(coronary artery by-pass grafting) were randomized to receive either
exenatide or placebo in a continuous 72-hour i.v. infusion on top of
standard perioperative insulin therapy. Cardiac function assessed by
transthoracic echocardiography, perioperative hemodynamic parameters, the
need of antiarrhythmic treatment and inotropic drug dosage and parameters
of glucose control were collected as primary endpoints. Compared to
placebo group subjects receiving exenatide showed improved perioperative
glucose control (average glycemia 6.1+2.5 vs. 6.8+2.8 mmol/l, p<0.001;
time in target range of 4.5-6.5 mmol/l 55.0+3.4 vs. 38.6+3.3%, p=0.001;
time above target range 39.7+3.3 vs. 53.5+3.6%, p<0.01) without an
increased risk of hypoglycemia (2 episodes of hypoglycemia < 3,3 mmol/l in
exenatide vs. 4 episodes in placebo group) and decreased need for
temporary pacing (16.7 vs. 47.4% of subjects, p<0.05). No significant
difference in perioperative hemodynamic, postoperative echocardiographic
parameters or the need of inotropic medication was found between the
groups. We conclude that perioperative administration of i.v. exenatide in
subjects undergoing elective CABG improved glucose control without
increased risk of hypoglycemia, decreased need for temporary pacing and
did not significantly affect parameters of cardiac function.

<35>
Accession Number
71558412
Authors
Umpierrez G.E. Cardona S. Pasquel F.J. Smiley D. Farrokhi F. Newton C.A.
Unigwe M. Jacobs S. Peng L. Halkos M. Puskas J.D. Guyton R. Thourani V.
Institution
(Umpierrez, Cardona, Pasquel, Smiley, Farrokhi, Newton, Unigwe, Jacobs,
Peng, Halkos, Puskas, Guyton, Thourani) AtlantaGAUnited States
Title
Randomized, controlled trial of intensive vs. conservative glucose control
in patients undergoing coronary artery bypass graft surgery (GLUCO-CABG).
Source
Diabetes. Conference: 74th Scientific Sessions of the American Diabetes
Association San Francisco, CA United States. Conference Start: 20140613
Conference End: 20140617. Conference Publication: (var.pagings). 63 (pp
A2), 2014. Date of Publication: June 2014.
Publisher
American Diabetes Association Inc.
Abstract
This randomized controlled trial aimed to determine whether intensive
glucose control (intensive, BG target: 100-140 mg/dl) reduces
perioperative complications compared to conservative glucose control
(conservative, BG target: 141-180 mg/dl) in hyperglycemic patients
undergoing CABG. After ICU care, subjects were transitioned to the same
treatment regimen targeting BG<140 mg/dl before meals during the hospital
stay and 90 days post discharge. The primary outcome was differences in a
composite score of hospital complications including mortality, wound
infection, pneumonia, bacteremia, respiratory failure, acute renal
failure, and major cardiovascular events. A total of 302 patients were
randomized to intensive (n=151) or conservative (n=151) glucose control
following a computerized insulin infusion algorithm. The groups were well
balanced. The mean ICU daily BG was 132+14 mg/dl (IQR 124-139) in the
intensive group and 154+20 mg/dl (IQR 142-164) in the conservative group
(p0.99), or hospital length of stay (11.4+11 vs. 9.5+6 days, p=0.13). In
the ICU, a BG <70 mg/dl occurred in 8% and 2% of the intensive and
conservative groups (p=0.03), with no BG <40 mg/dl. After ICU care, there
were no differences between intensive and conservative groups in mean
daily BG (143+28 mg/dl and 141+29 mg/dl), patients with hypoglycemia
(0.99; <40 mg/dl: 1% vs. 3%, p=0.68), or hospital readmissions (18% vs.
20%, p=0.62). In summary, intensive control targeting a BG of 100-140
mg/dl in the ICU did not reduce perioperative complications, mortality or
hospital length of stay compared to a less strict glucose target of
141-180 mg/dl in hyperglycemic patients undergoing CABG surgery.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 23

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<1>
Accession Number
2014519906
Authors
Sharma A. Vallakati A. Einstein A.J. Lavie C.J. Arbab-Zadeh A.
Lopez-Jimenez F. Mukherjee D. Lichstein E.
Institution
(Sharma, Lichstein) Department of Medicine, Maimonides Medical Center,
1016 50th St, Brooklyn, NY 11219, United States
(Vallakati) Division of Cardiology, University of Kansas Medical Center,
Kansas City, United States
(Einstein) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York, NY, United States
(Lavie) Department of Cardiovascular Diseases, Ochsner Clinical School,
University of Queensland School of Medicine, New Orleans, LA, United
States
(Lavie) Department of Preventive Medicine, Pennington Biomedical Research
Center, Louisiana State University System, Baton Rouge, United States
(Arbab-Zadeh) Division of Cardiology, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Lopez-Jimenez) Division of Cardiology, Mayo College of Medicine,
Rochester, MN, United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, United
States
Title
Relationship of body mass index with total mortality, cardiovascular
mortality, and myocardial infarction after coronary revascularization:
Evidence from a meta-analysis.
Source
Mayo Clinic Proceedings. 89 (8) (pp 1080-1100), 2014. Date of Publication:
August 2014.
Publisher
Elsevier Ltd
Abstract
Objective To investigate the relationship of body mass index (BMI) with
total mortality, cardiovascular (CV) mortality, and myocardial infarction
(MI) after coronary revascularization procedures (coronary artery bypass
grafting [CABG] and percutaneous coronary intervention [PCI]). Patients
and Methods Systematic search of studies was conducted using PubMed,
CINAHL, Cochran CENTRAL, Scopus, and the Web of Science databases. We
identified studies reporting the rate of MI, CV mortality, and total
mortality among coronary artery disease patients' postcoronary
revascularization procedures in various BMI categories: less than 20
(underweight), 20-24.9 (normal reference), 25-29.9 (overweight), 30-34.9
(obese), and 35 or more (severely obese). Event rates were compared using
a random effects model assuming interstudy heterogeneity. Results A total
of 36 studies (12 CABG; 26 PCI) were selected for final analyses. The risk
of total mortality (relative risk [RR], 2.59; 95% CI, 2.09-3.21), CV
mortality (RR, 2.67; 95% CI, 1.63-4.39), and MI (RR, 1.79; 95% CI,
1.28-2.50) was highest among patients with low BMI at the end of a mean
follow-up period of 1.7 years. The risk of CV mortality was lowest among
overweight patients (RR, 0.81; 95% CI, 0.68-0.95). Increasing degree of
adiposity as assessed by BMI had a neutral effect on the risk of MI for
overweight (RR, 0.92; 95% CI, 0.84-1.01), obese (RR, 0.99; 95% CI,
0.85-1.15), and severely obese (RR, 0.93; 95% CI, 0.78-1.11) patients.
Conclusion After coronary artery disease revascularization procedures (PCI
and CABG), the risk of total mortality, CV mortality, and MI was highest
among underweight patients as defined by low BMI and CV mortality was
lowest among overweight patients. 2014 Mayo Foundation for Medical
Education and Research.

<2>
Accession Number
2014508249
Authors
Kim S.-J. Samad Z. Bloomfield G.S. Douglas P.S.
Institution
(Kim, Bloomfield, Douglas) Duke Clinical Research Institute, Durham, NC,
United States
(Samad, Bloomfield, Douglas) Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Kim) Division of Cardiology, Ulsan University Hospital, University of
Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan,
South Korea
Title
A critical review of hemodynamic changes and left ventricular remodeling
after surgical aortic valve replacement and percutaneous aortic valve
replacement.
Source
American Heart Journal. 168 (2) (pp 150-159.e7), 2014. Date of
Publication: August 2014.
Publisher
Mosby Inc.
Abstract
Background The introduction of transcatheter aortic valve replacement
(TAVR) in clinical practice has widened options for symptomatic patients
at high surgical risk; however, it is not known whether TAVR has
equivalent or prolonged benefits in terms of left ventricular (LV)
remodeling. Methods To explore the relative hemodynamic benefits and
postoperative LV remodeling associated with TAVR and surgical aortic valve
replacement (SAVR), we performed a critical review of the available
literature. A total of 67 studies were included in this systematic review.
Results There is at least equivalent if not slightly superior hemodynamic
performance of TAVR over SAVR, and TAVR showed lower prosthesis-patient
mismatch compared with SAVR. However, LV mass appears to regress to a
greater degree after SAVR compared with TAVR. Aortic regurgitation,
paravalvular in particular, is more common after TAVR than SAVR, although
it is rarely more than moderate in severity. Improvements in diastolic
function and mitral regurgitation are reported in only a handful of
studies each and could not be compared across prosthesis types.
Conclusions The published data support the hemodynamic comparability of
SAVR and TAVR, with the higher incidence of prosthesis-patient mismatch in
SAVR offset by higher incidence of paravalvular leak in TAVR. These
results highlight the need for further studies focusing on hemodynamic
changes after valve therapy. 2014 Mosby, Inc.

<3>
Accession Number
2014505113
Authors
Li X.-M. Li D.-Z. Yang Y.-N. Ma Y.-T. Zheng H. Yang Y.-Z. Chen Q.-J. Li
W.-M. Xie X. Zhao Y.
Institution
(Li, Li, Yang, Ma, Chen, Xie) Department of Cardiology, Xinjiang Medical
University, No 1 Liyushan Road, Urumqi 830054, China
(Li, Li, Yang, Ma, Chen, Xie) Xinjiang Key Laboratory of Cardiovascular
Disease Research, Urumqi 830054, China
(Zheng) Department of Anesthesiology, Xinjiang Medical University, Urumqi,
China
(Yang) Department of Infectious Diseases, Harbin Medical University,
Harbin 150081, China
(Li) Intensive Care Unit, Xinjiang Medical University, Urumqi 830054,
China
(Zhao) Library, Xinjiang Medical University, Urumqi 830054, China
Title
Meta-analysis of randomized controlled trials of intracoronary versus
intravenous administration of tirofiban during percutaneous coronary
intervention for acute coronary syndrome.
Source
Experimental and Clinical Cardiology. 20 (7) (pp 1084-1104), 2014. Date of
Publication: 2014.
Publisher
Cardiology Academic Press
Abstract
It remains unclear whether intracoronary (IC) or intravenous (IV)
administration of Tirofiban is superior for patients with acute coronary
syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
Therefore, we conducted a meta-analysis of randomized controlled trials
(RCTs) to compare the effects of IC versus IV administration of Tirofiban
in patients with acute coronary syndromes. Eight RCTs involving 673
patients met our inclusion criteria. Primary end-points were short-term
(1-3 months) major adverse cardiovascular events (MACEs) [e.g., mortality,
reinfarction, target vessel revascularization (TVR)]. Secondary end-points
included thrombolysis in myocardial infarction (TIMI) grade flow and TIMI
myocardial perfusion grade (TMPG) flow. Bleeding complications were
evaluated as safety end-points. IC administration of Tirofiban was found
to decrease short-term MACEs, including mortality, reinfarction, and TVR
(OR: 0.24, 95% CI: 0.13-0.44, P < 0.0001). Short-term mortality (OR: 0.40,
95% CI: 0.12-1.33, P = 0.13), reinfarction rate (OR: 0.48, 95% CI:
0.18-1.27, P = 0.14), and TVR rate (OR: 0.46, 95% CI: 0.10-2.03, P = 0.30)
also showed an apparent decrease with IC versus IV administration of
Tirofiban, although the differences were not statistically significant.
However, a significant increase in TIMI grade 3 flow (OR: 3.67, 95% CI:
2.26-5.95, P < 0.00001) and TMPG grade 2-3 flow (OR: 3.88, 95% CI:
2.44-6.15, P < 0.00001) were observed for IC versus IV administration. In
contrast, no significant difference was observed in bleeding complications
reported for the two groups. In conclusion, IC administration of Tirofiban
in patients with ACS undergoing PCI can significantly increase target
coronary flow and myocardial reperfusion without increasing the risk of
bleeding complications. It can also decrease total short-term MACEs, yet
does not improve clinical outcome compared with IV administration.

<4>
Accession Number
2014508256
Authors
Gibson M.C. Krucoff M. Fischell D. Fischell T.A. Keenan D. Abueg C. Patel
C. Holmes D.
Institution
(Gibson, Abueg, Patel) Department of Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319,
Boston, MA 02215, United States
(Krucoff) Duke Clinical Research Institute, Durham, NC, United States
(Fischell, Keenan) Angel Medical Systems, Shrewsbury Township, NJ, United
States
(Fischell) Heart Institute at Borgess, Kalamazoo, MI, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
Title
Rationale and design of the AngeLmed for early recognition and treatment
of STEMI trial: A randomized, prospective clinical investigation.
Source
American Heart Journal. 168 (2) (pp 168-174), 2014. Date of Publication:
August 2014.
Publisher
Mosby Inc.
Abstract
Significant improvements in door-to-balloon times have led to a reduction
in mortality in ST-segment elevation myocardial infarction; however, mean
symptom-to-door times remain at 2 to 3 hours. An intracardiac electrogram
monitoring device may be beneficial in high-risk patients by alerting them
to rapidly progressive ST-segment changes indicative of acute coronary
occlusion. The Cardiosaver and DETECT phase I clinical studies
demonstrated the safety, feasibility, and potential benefit of using an
intracardiac electrogram monitoring device to alert the patient to seek
medical attention. The goal of the randomized, prospective ALERTS Trial
(Clinicaltrials.gov no. NCT00781118) is to evaluate the efficacy of an
implantable monitoring device (IMD) in reducing the composite of either
cardiac or unexplained death, new Q-wave myocardial infarction, or
symptom-to-door time of >2 hours for confirmed thrombotic events. The IMD
alerts the patient in real time when ST-segment deviation from a
personalized baseline exceeds the trigger threshold. The trial is designed
to enroll high-risk post-acute coronary syndrome patients or patients with
previous multivessel coronary artery bypass surgery. All patients have the
IMD implanted, with 1:1 unblinded randomization to the alerting feature
being either turned on versus turned off for the first 6 months.
Randomization occurs at the first follow-up visit, 7 to 14 days after the
implantation of the IMD. Subjects then return for follow-up visits at
months 1, 3, and 6 and thereafter every 6 months until closure of the
investigational device exemption. Subjects who cannot be implanted
successfully or who have the device explanted are removed from the study
and followed up for a minimum of 30 days post-procedure. If a subject
experiences a device-related complication and/or adverse experience, the
subject is followed up until resolution or until the condition becomes
stable and no further change is anticipated. 2014 Mosby, Inc.

<5>
Accession Number
2014510289
Authors
Serpil U.O.Z. Fevzi T. Murat O. Umit G. Esin E. Pinar U. Sahin S. Hasan K.
Cem A.
Institution
(Cem, Murat, Umit, Sahin, Hasan, Cem) Department of Cardiovascular
Surgery, Acibadem University, School of Medicine, Atasehir, Istanbul,
Turkey
(Serpil, Fevzi) Department of Anesthesiology and Reanimation, Acibadem
University, School of Medicine, Atasehir, Istanbul, Turkey
(Esin, Pinar) Department of Cardiovascular Surgery, Acibadem Healthcare
Group, Acibadem Kadikoy Hospital, Kadikoy, Istanbul, Turkey
Title
Efficacy of near-infrared spectrometry for monitoring the cerebral effects
of severe dilutional anemia.
Source
Heart Surgery Forum. 17 (3) (pp E154-E159), 2014. Date of Publication:
June 2014.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Introduction: Clear guidelines for red cell transfusion during cardiac
surgery have not yet been established. The current focus on blood
conservation during cardiac surgery has increased the urgency to determine
the minimum safe hematocrit for these patients. The aim of this study was
to determine whether monitoring of cerebral regional oxygen saturation
(rSO₂) via near-infrared spectrometry (NIRS) is effective for
assessing the cerebral effects of severe dilutional anemia during elective
coronary arterial bypass graft surgery (CABG). Methods: The prospective
observational study involved patients who underwent cerebral
rSO₂ monitoring by NIRS during elective isolated first-time
CABG: an anemic group (N=15) (minimum Hemoglobin (Hb) <7 g/dL at any
period during cardiopulmonary bypass (CPB) and a control group (N=15) (Hb
>8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood
lactate level, pCO₂, pO₂ at five time points and
cross-clamp time, extracorporeal circulation time were recorded for each
patient. Group results statistically were compared. Results: The anemic
group had significantly lower mean preoperative Hb than the control group
(10.3 mg/dL versus 14.2 mg/dL; P = .001). The lowest Hb levels were
observed in the hypothermic period of CPB in the anemic group. None of the
controls exhibited a >20% decrease in cerebral rSO₂. Eleven
(73.3%) of the anemic patients required an increase in pump blood flow to
raise their cerebral rSO₂. Conclusions: In this study, the
changes in cerebral rSO ₂ in the patients with low Hb were
within acceptable limits, and this was in concordance with the blood
lactate levels and blood-gas analysis. It can be suggested that NIRS
monitoring of cerebral rSO₂ can assist in decision making
related to blood transfusion and dilutional anemia during CPB.

<6>
Accession Number
2014510037
Authors
Schaffer A. Verdoia M. Cassetti E. Marino P. Suryapranata H. De Luca G.
Institution
(Schaffer, Verdoia, Cassetti, Marino, De Luca) Division of Cardiology,
Azienda Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Relationship between homocysteine and coronary artery disease. Results
from a large prospective cohort study.
Source
Thrombosis Research. 134 (2) (pp 288-293), 2014. Date of Publication:
2014.
Publisher
Elsevier Ltd
Abstract
Background Coronary artery disease (CAD) still represents the major cause
of mortality in developed countries. Large research programs have been
focused on the identification of new risk factors to prevent CAD, with
special attention to homocysteine (Hcy), due to the known associated
increased thrombogenicity, oxidative stress status and endothelial
dysfunction. However, controversy still exists on the association between
Hcy and CAD. Therefore, aim of the current study was to investigate the
association of Hcy with the prevalence and extent of CAD in a large
consecutive cohort of patients undergoing coronary angiography. Methods
Our population is represented by a total of 3056 consecutive patients
undergoing coronary angiography between at the Azienda Ospedaliera
"Maggiore della Carita", Novara, Italy. Fasting samples were collected for
homocysteine levels assessment. Coronary disease was defined for at least
1 vessel stenosis > 50% as evaluated by QCA. Results Study population was
divided according to Hcy tertiles (< 13,3, 13,3-18.2, > 18.2 nmol/ml).
High plasmatic level of homocysteine was related with age (p < 0.001),
male gender (p < 0.001), hypertension (p < 0.001) renal failure (p <
0.001), family history of CAD (p < 0.001), previous cerebrovascular
accident (p < 0.001), previous MI (p = 0.002), previous CABG (p = 0.003),
ejection fraction (p < 0.001), higher baseline creatinine (p < 0.001), in
treatment with nitrates (p < 0.001), calcium antagonists (p < 0.001),
diuretics (p < 0.001), Ace inhibitors (ACE-I) (p = 0.006), Clopidogrel (p
= 0.05), haemoglobin (p = 0.001), white blood cells (WBC) count (p =
0.008), total cholesterol (p = 0.04), Low-Density Lipoproteins (LDL) (p =
0.01). A significant relationship was found between Hcy levels and the
extent of coronary artery disease (71.8% vs 77.8% vs 77.4%, OR[95%CI] =
1.18[1.11-1.252.], p < 0.001 and severe CAD (23.6% vs 29.5% vs 32.1%, OR
[95%CI] = 1.275 [1.209-1.344], p < 0.001). Elevated Hcy was significantly
associated with increased risk of CAD (adjusted OR[95%CI] =
1.087[1.009-1.171], p = 0.02 and severe CAD (adjusted OR [95%CI] = 1.07
[1.01-1.16, P = 0.04]). The results were confirmed in the majority of high
risk subsets of patients. Conclusions This study showed that high levels
of plasmatic Hcy are independently associated with CAD. Further large
studies are certainly needed to explore the adjunctive benefits from
vitamin administration in patients with elevated Hcy to prevent the
occurrence and progression of CAD. 2014 Elsevier Ltd.

<7>
Accession Number
2014508286
Authors
Stone P.A. Aburahma A.F. Mousa A.Y. Phang D. Hass S.M. Modak A. Dearing D.
Institution
(Stone, Aburahma, Mousa, Phang, Hass, Dearing) Department of Surgery,
Robert C. Byrd Health Sciences Center of West Virginia University,
Charleston, WV, United States
(Modak) Department of Surgery, Charleston Area Medical Center, Health
Education and Research Institute, Charleston, WV, United States
Title
Prospective randomized trial of ACUSEAL versus vascu-guard patching in
carotid endarterectomy.
Source
Annals of Vascular Surgery. 28 (6) (pp 1530-1538), 2014. Date of
Publication: August 2014.
Publisher
Elsevier Inc.
Abstract
Background Multiple studies have been conducted that demonstrate the
superiority of patch angioplasty over primary closure for carotid
endarterectomy (CEA). Patch angioplasty with polytetrafluorethylene
patches (ACUSEAL) have shown results comparable to patch angioplasty with
saphenous vein and polyester patches. This is a prospective randomized
study to compare the clinical outcomes of CEA using ACUSEAL versus bovine
pericardium patching (Vascu-Guard). Methods Two hundred patients were
randomized (1:1) to either ACUSEAL or Vascu-Guard patching. Demographic
data/clinical characteristics were collected. Intraoperative hemostasis
times and the frequency of reexploration for neck hematoma were recorded.
All patients received immediate and 1-month postoperative duplex
ultrasound studies, which were repeated at 6-month intervals. A
Kaplan-Meier analysis was used to estimate the risk of restenosis and the
stroke-free survival rates. Results The demographics were similar in both
groups, except for a higher incidence of current smokers in the ACUSEAL
group and more patients with congestive heart failure in the Vascu-Guard
group (P = 0.02 and 0.03, respectively). The mean operative internal
carotid artery diameter and the mean arteriotomy length were similar in
both groups. The mean hemostasis time was 4.90 min for ACUSEAL patching
vs. 3.09 min for Vascu-Guard (P = 0.027); however, the mean operative
times were similar for both groups (ACUSEAL 2.09 hr vs. Vascu-Guard 2.16
hr, P = 0.669). The incidence of reexploration for neck hematoma was
higher in the Vascu-Guard group; 6.12% vs. 1.03% (P = 0.1183). The
incidence of perioperative ipsilateral neurologic events was 3.09% for
ACUSEAL patching vs. 1.02% for Vascu-Guard patching (P = 0.368). The mean
follow-up period was 15 months. The respective freedom from >70% carotid
restenosis at 1, 2, and 3 years were 100%, 100%, and 100% for ACUSEAL
patching vs. 100%, 98%, and 98% for Vascu-Guard patching (P = 0.2478). The
ipsilateral stroke-free rates at 1, 2, and 3 years were 96% for ACUSEAL
and 99% for Vascu-Guard patching. Conclusions Although CEA patching with
ACUSEAL versus Vascu-Guard differed in hemostasis time, the frequency of
reexploration for neck hematomas was more frequent in the pericardial
patch group; however, only 1 patient had documented suture line bleeding
and the surgical reexploration rate is not likely to be patch related.
There were not any significant differences in perioperative/late
neurologic events and late restenosis in the 2 groups. 2014 Elsevier Inc.
All rights reserved.

<8>
Accession Number
2014506839
Authors
Ansari D. Bucin D. Nilsson J.
Institution
(Ansari, Nilsson) Department of Clinical Sciences Lund, Lund University,
Skane University Hospital, 221 85 Lund, Sweden
(Bucin) Department of Clinical Sciences in Malmo, Lund University, Skane
University Hospital, Malmo, Sweden
Title
Human leukocyte antigen matching in heart transplantation: Systematic
review and meta-analysis.
Source
Transplant International. 27 (8) (pp 793-804), 2014. Date of Publication:
August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Allocation of donors with regard to human leukocyte antigen (HLA) is
controversial in heart transplantation. This paper is a systematic review
and meta-analysis of the available evidence. PubMed, Embase, and the
Cochrane Library were searched systematically for studies that addressed
the effects of HLA matching on outcome after heart transplantation.
Fifty-seven studies met the eligibility criteria. 34 studies had graft
rejection as outcome, with 26 of the studies reporting a significant
reduction in graft rejection with increasing degree of HLA matching.
Thirteen of 18 articles that reported on graft failure found that it
decreased significantly with increasing HLA match. Two multicenter studies
and nine single-center studies provided sufficient data to provide summary
estimates at 12 months. Pooled comparisons showed that graft survival
increased with fewer HLA-DR mismatches [0-1 vs. 2 mismatches: risk ratio
(RR) = 1.09 (95% confidence interval (CI): 1.01-1.19; P = 0.04)]. Having
fewer HLA-DR mismatches (0-1 vs. 2) reduced the incidence of acute
rejection [(RR = 0.81 (0.66-0.99; P = 0.04)]. Despite the considerable
heterogeneity between studies, the short observation time, and older data,
HLA matching improves graft survival in heart transplantation. Prospective
HLA-DR matching is clinically feasible and should be considered as a major
selection criterion. 2014 Steunstichting ESOT.

<9>
[Use Link to view the full text]
Accession Number
2014506485
Authors
Morales C.H. Mejia C. Roldan L.A. Saldarriaga M.F. Duque A.F.
Institution
(Morales, Mejia, Roldan, Saldarriaga, Duque) Department of Surgery,
Universidad de Antioauia, Medellin, Colombia
(Morales) St. Vincent Paul University Hospital (HUSVP), Medellin, Colombia
Title
Negative pleural suction in thoracic trauma patients: A randomized
controlled trial.
Source
Journal of Trauma and Acute Care Surgery. 77 (2) (pp 251-255), 2014. Date
of Publication: August 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The study aimed to establish the benefits of using chest tubes
with negative pleural suction against trapped water in patients with
penetrating or blunt chest trauma who underwent tube thoracostomy, in
terms of the incidence of complications, such as persistent air leak,
clotted hemothorax, empyema, and duration of stay. METHODS: Patients who
underwent tube thoracostomy because of traumatic pneumothorax, hemothorax,
or hemopneumothorax were randomly assigned into one of two groups: in
Group 1, the three-bottle drainage system was connected to a negative
suction; in Group 2, no suction was given. Patients who required
mechanical ventilation or emergency surgery (thoracotomy or thoracoscopy)
either at the time of admission to the institution or immediately after
the tube thoracostomy, patients who had histories of thoracic procedures
or chronic pulmonary diseases (chronic obstructive pulmonary disease,
diffuse interstitial lung disease), and patients with multiple injuries
with severe traumatic brain injury and a Glasgow Coma Scale (GCS) score
less than 8 of 15 were excluded from the study. Hospital stay, duration of
tube thoracostomy, prolonged fistula, and other clinical variables were
compared. RESULTS: One hundred ten patients were included, 56 in the group
with suction and 54 in the group without suction. There were no
differences in the demographic characteristics of each group. There were
no differences between the groups in terms of hospital stay (p = 0.22),
duration of tube thoracostomy (p = 0.35) (3 days in each group), or
complications. However, the probability of air leak presence in time was
greater for the Group 1 patients with negative suction versus the Group 2
patients (p = 0.023). CONCLUSION: The use of negative pleural suction did
not demonstrate advantages over the three-bottle chest drainage system
without suction in patients with uncomplicated traumatic pneumothorax,
hemothorax, or hemopneumothorax. LEVEL OF EVIDENCE: Therapeutic study,
level II. 2014 Lippincott Williams & Wilkins.

<10>
Accession Number
2014510911
Authors
Chi N.-H. Chou N.-K. Yu Y.-H. Yu H.-Y. Wu I.-H. Chen Y.-S. Huang S.-C. Ko
W.-J. Wang S.-S.
Institution
(Chi, Chou, Yu, Wu, Chen, Huang, Ko, Wang) Department of Surgery, National
Taiwan University Hospital and National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Yu) Institute of Epidemiology and Preventive Medicine, College of Public
Health, National Taiwan University, Taipei, Taiwan (Republic of China)
Title
Heart transplantation in endstage rheumatic heart disease - Experience of
an endemic area.
Source
Circulation Journal. 78 (8) (pp 1900-1907), 2014. Date of Publication:
2014.
Abstract
Background: Rheumatic heart disease (RHD) remains a significant cause of
cardiovascular disease in developing countries. The nonsuppurative
cardiovascular sequel of group A streptococcal infection is sustained
inflammatory and immune reactions toward the myocardium and valves. This
study attempted to determine the long-term outcome of heart
transplantation in endstage RHD patients. Methods and Results: The 23
patients with endstage RHD at National Taiwan University Hospital between
June 1987 and March 2012 were enrolled. In the same period, 226 dilated
cardiomyopathy (DCM) patients were enrolled as the control group. The RHD
group experienced more right ventricular failure and higher central venous
pressure than the control group, which resulted in impaired liver and
kidney function. The RHD patients had a lower 15-year survival rate than
the DCM patients after transplantation (22.7% vs. 45.7%, P=0.038) and
higher incidence of tricuspid regurgitation than the control group (32.2%
vs. 11.4%). No differences existed between the groups for the mitral
regurgitation rate (RHD 37.7% vs. DCM 29.4%, P=0.562). Conclusions:
Preoperatively, the RHD patients suffered more tricuspid regurgitation
than the control group. The aortic and mitral valves in both groups
functioned well over the long term. Heart transplantation for endstage RHD
had a long-term survival rate that was inferior to that for DCM patients.

<11>
[Use Link to view the full text]
Accession Number
2014503531
Authors
Chiari P. Angoulvant D. Mewton N. Desebbe O. Obadia J.-F. Robin J. Farhat
F. Jegaden O. Bastien O. Lehot J.-J. Ovize M.
Institution
(Chiari, Desebbe, Bastien, Lehot) Department of Anesthesiology and
Critical Care, Lyon, France
(Mewton, Ovize) Clinical Investigation Center, Lyon, France
(Mewton, Ovize) Department of Cardiology, Lyon, France
(Obadia, Robin, Farhat, Jegaden) Department of Cardiothoracic Surgery,
Centre Hospitalier Universitaire Louis Pradel, Lyon, France
(Chiari, Mewton, Obadia, Jegaden, Ovize) Lyon University, Inserm U1060,
CarMeN Laboratory, Univ Lyon-1, Lyon, France
(Angoulvant) Department of Cardiology, Centre Hospitalier Universitaire de
Tours, EA 4245 Francois Rabelais University, Tours, France
Title
Cyclosporine protects the heart during aortic valve surgery.
Source
Anesthesiology. 121 (2) (pp 232-238), 2014. Date of Publication: August
2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND:: Part of the myocardial damage occurring during cardiac
surgery is a consequence of reperfusion injury. Cyclosporine, a potent
inhibitor of the opening of the mitochondrial permeability transition
pore, attenuates reperfusion injury in patients with acute ST-segment
elevation myocardial infarction. This study investigated whether the
administration of cyclosporine just before the aortic cross-unclamping
would reduce myocardial injury in patients undergoing aortic valve
surgery. METHODS:: This study was a monocentric, prospective, randomized,
single-blinded, controlled trial. Sixty-one patients, scheduled for
elective aortic valve surgery, were randomly assigned (computer-generated
randomization sequence) to receive either an intravenous bolus of
cyclosporine (2.5 mg/kg, cyclosporine group, n = 30) or normal saline
(control group, n = 31) 10 min before aortic cross-unclamping. The primary
endpoint was the 72-h area under the curve for cardiac troponin I.
RESULTS:: Both groups were similar with respect to baseline
characteristics and aortic cross-clamping duration. A significant 35%
reduction of area under the curve for cardiac troponin I was observed in
the cyclosporine group compared with the control group (242 + 225 vs. 155
+ 71 arbitrary units, mean + SD; mean difference, -86.2 + 42.5; 95% CI,
-172.3 to -0.1; P = 0.03). Cyclosporine beneficial effect remained
significant after adjustment for aortic cross-clamping duration in each
group (mean difference, -88 + 34, 95% CI, -157 to -19; P = 0.01). None of
the treated patients had significant side effects (odds ratio, 0.64; 95%
CI, 0.16 to 2.55; P = 0.52). CONCLUSIONS:: Cyclosporine administration at
the time of reperfusion protects against reperfusion injury in patients
undergoing aortic valve surgery. The clinical benefit of this protection
requires confirmation in a larger clinical trial. Copyright 2014, the
American Society of Anesthesiologists, Inc.

<12>
Accession Number
2014504088
Authors
Kumar P. Pillai R. Sreedharan M. Davidson D. Manjunath C.N. Fischer L.
Balakrishnan K.P. D'Ascenzo F. Sheiban I.
Institution
(Kumar) Meditrina Hospital, Trivandrum, India
(Pillai) KIMS Hospital, Trivandrum, India
(Sreedharan) NIMS Hospital, Trivandrum, India
(Davidson) Pushpagiri Hospital, Trivandrum, India
(Manjunath) Jayadeva Hospital, Bangalore, India
(Fischer) Medical Mission Hospital, Kolenchery, India
(Balakrishnan) PVS Hospital, Calicut, India
(D'Ascenzo, Sheiban) Division of Cardiology, University of Torino, Torino,
Italy
(Sheiban) Interventional Cardiology, Pederzoli Hospital, 37019 Peschiera
D/G, Italy
Title
RAPSTROM first-in-man study long-term results of a biodegradable polymer
sustained-release sirolimus-eluting stent in de novo coronary stenoses.
Source
Journal of Interventional Cardiology. 27 (4) (pp 373-380), 2014. Date of
Publication: August 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background Durable polymers used for first-generation drug-eluting stents
(DES) potentially contribute to persistent inflammation and late DES
thrombosis. We report the first real-life human experience with the
rapamycin-eluting biodegradable polymer-coated Rapstrom stent. Methods All
consecutive patients with single de novo native coronary stenosis (<30mm
and between 2.5 and 4.0mm) were enrolled. Major adverse cardiac events
(MACE) at 1 year (cardiac death, myocardial infarction [Q and non-Q], or
ischemia-driven target lesion revascularization) were the primary
end-point. Results A total of 123 patients were enrolled. The stent was
implanted without complications in all patients, and no MACE were recorded
at 30 days. At 12-month follow-up 9 patients (7.3%) experienced a MACE and
4 (3.2%) required a target lesion revascularization, while 1 (1%) stent
thrombosis was recorded. A planned angiographic follow-up (FU) was
performed in 73 patients (59%) at 9.4+2.6 months following the index
procedure. In-stent late loss was 0.16+0.09mm, and in-segment late loss
was 0.18+0.8mm. Conclusion The Rapstrom biodegradable polymer
rapamycin-eluting stent appeared safe and efficacious in this first
real-life human experience, due to a low late lumen loss. Larger
randomized studies are required to confirm these preliminary results. (J
Interven Cardiol 2014;27:373-380) 2014, Wiley Periodicals, Inc.

<13>
Accession Number
2014509926
Authors
Kovamees O. Shemyakin A. Pernow J.
Institution
(Kovamees, Shemyakin, Pernow) Department of Medicine, Karolinska
Institutet, Stockholm, Sweden
Title
Effect of arginase inhibition on ischemia-reperfusion injury in patients
with coronary artery disease with and without diabetes mellitus.
Source
PLoS ONE. 9 (7) , 2014. Article Number: e103260. Date of Publication: 29
Jul 2014.
Publisher
Public Library of Science
Abstract
Background: Arginase competes with nitric oxide synthase for their common
substrate L-arginine. Up-regulation of arginase in coronary artery disease
(CAD) and diabetes mellitus may reduce nitric oxide bioavailability
contributing to endothelial dysfunction and ischemia-reperfusion injury.
Arginase inhibition reduces infarct size in animal models. Therefore the
aim of the current study was to investigate if arginase inhibition
protects from endothelial dysfunction induced by ischemia-reperfusion in
patients with CAD with or without type 2 diabetes (Clinical trial
registration number: NCT02009527). Methods: Male patients with CAD (n =
12) or CAD + type 2 diabetes (n = 12), were included in this cross-over
study with blinded evaluation. Endothelium-dependent vasodilatation was
assessed by flow-mediated dilatation (FMD) of the radial artery before and
after 20 min ischemia-reperfusion during intra-arterial infusion of the
arginase inhibitor (N-hydroxy-nor-L-arginine, 0.1 mg/min) or
saline. Results: The forearm ischemia-reperfusion was well tolerated.
Endothelium-independent vasodilatation was assessed by sublingual
nitroglycerin. Ischemia-reperfusion decreased FMD in patients with CAD
from 12.7+5.2% to 7.9+4.0% during saline administration (P<0.05).
N-hydroxy-nor-L-arginine administration prevented the decrease
in FMD in the CAD group (10.3+4.3% at baseline vs. 11.5+3.6% at
reperfusion). Ischemia-reperfusion did not significantly reduce FMD in
patients with CAD + type 2 diabetes. However, FMD at reperfusion was
higher following nor-NOHA than following saline administration in both
groups (P<0.01). Endothelium-independent vasodilatation did not differ
between the occasions. Conclusions: Inhibition of arginase protects
against endothelial dysfunction caused by ischemia-reperfusion in patients
with CAD. Arginase inhibition may thereby be a promising therapeutic
strategy in the treatment of ischemia-reperfusion injury. 2014 Kovamees
et al.

<14>
Accession Number
2014497556
Authors
Erb J. Beutlhauser T. Feldheiser A. Schuster B. Treskatsch S. Grubitzsch
H. Spies C.
Institution
(Erb) Department of Anaesthesia, Surgical Intensive Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital of Basel, Basel,
Switzerland
(Beutlhauser, Feldheiser, Schuster, Treskatsch, Spies) Department of
Anaesthesiology and Intensive Care Medicine, Campus Charite Mitte and
Campus Virchow-Klinikum, Charite - Universitatsmedizin Berlin, Berlin,
Germany
(Grubitzsch) Department of Cardiovascular Surgery, Campus Charite Mitte,
Charite - Universitatsmedizin Berlin, Berlin, Germany
Title
Influence of levosimendan on organ dysfunction in patients with severely
reduced left ventricular function undergoing cardiac surgery.
Source
Journal of International Medical Research. 42 (3) (pp 750-764), 2014. Date
of Publication: June 2014.
Publisher
SAGE Publications Ltd
Abstract
Objectives: Levosimendan is an inotropic drug with organ-protective
properties due to its activation of mitochondrial K_ATP
channels. This prospective, randomized, double-blind, placebocontrolled
study investigated whether administration of levosimendan prior to
cardiopulmonary bypass could reduce organ dysfunction and influence
subsequent secondary endpoints. Patients and methods: Patients with left
ventricular ejection fraction <30% scheduled for elective coronary artery
bypass surgery (with or without valve surgery) received either
levosimendan (12.5 mg, 0.1 mug kg¹ per min; n=17) or placebo
(n=16) central venous infusion, immediately after anaesthesia induction,
as add-on medication to a goal-orientated treatment algorithm. Results: A
total of 33 patients completed the study. There were no statistically
significant differences in Sequential Organ Failure Assessment scores,
survival, haemodynamic parameters, time to extubation, time in intensive
care unit, need for haemodialysis or health-related quality-oflife at 6
months post operation. The levosimendan group compared with the placebo
group had significantly lower use of epinephrine (35% versus 81%) and
nitroglycerine (6% versus 44%) 24 h postoperation, and significantly less
frequent serious adverse events (13% versus 47%). The Author(s) 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

<15>
Accession Number
2014497548
Authors
Kim K. Kim W.-J. Choi D.-K. Lee Y.K. Choi I.-C. Sim J.-Y.
Institution
(Kim, Kim, Choi, Choi, Sim) Department of Anaesthesia and Pain Medicine,
Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South
Korea
(Lee) Department of Anaesthesia and Pain Medicine, Hangang Sacred Heart
Hospital, College of Medicine, Hallym University, Seoul, South Korea
Title
The analgesic efficacy and safety of nefopam in patient-controlled
analgesia after cardiac surgery: A randomized, double-blind, prospective
study.
Source
Journal of International Medical Research. 42 (3) (pp 684-692), 2014. Date
of Publication: June 2014.
Publisher
SAGE Publications Ltd
Abstract
Objective: The efficacy and side-effects of nefopam were prospectively
compared with those of fentanyl for patient-controlled analgesia (PCA)
following cardiac surgery. Methods: Patients scheduled to undergo cardiac
surgery were randomly assigned between three PCA groups (nefopam, fentanyl
or nefopam + fentanyl). Pain was assessed at rest and during movement at
12, 24, 36, 48 and 72 h after surgery using a visual analogue scale (VAS).
Total infused PCA volume, number of rescue drug injections, duration of
intubation and length of stay in the intensive care unit were recorded.
The incidence of adverse effects was noted at 48 h postoperatively.
Results: There were no significant between-group differences in VAS score,
total PCA infusion volume or number of rescue injections (n=92 per group).
Nausea was significantly more common in the fentanyl group compared with
both other groups. Conclusions: PCA with nefopam alone provides suitable
postoperative analgesia after cardiac surgery. The Author(s) 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

<16>
Accession Number
2014509468
Authors
Cassese S. Fusaro M. Byrne R.A. Tada T. Hoppmann P. Joner M. Laugwitz
K.-L. Schunkert H. Kastrati A.
Institution
(Cassese, Fusaro, Byrne, Tada, Joner, Schunkert, Kastrati) Deutsches
Herzzentrum, Technische Universitat Munchen, Lazarettstrasse, 36, Munich,
Germany
(Cassese, Fusaro, Byrne, Tada, Hoppmann, Joner, Laugwitz, Schunkert,
Kastrati) DZHK (German Center for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Hoppmann, Laugwitz) Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat Munchen, Munich, Germany
Title
Clinical outcomes of patients treated with Nobori biolimus-eluting stent:
Meta-analysis of randomized trials.
Source
International Journal of Cardiology. 175 (3) (pp 484-491), 2014. Date of
Publication: 20 Aug 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Backgrounds The Nobori is a new-generation, biodegradable-polymer coated,
biolimus-eluting stent (BES) that has recently been investigated in
several randomized trials with inconsistent results. The aim of this study
was to assess the efficacy and safety of Nobori BES versus other
drug-eluting stents (DES) in patients treated with percutaneous coronary
intervention (PCI). Methods We undertook a meta-analysis of randomized
trials investigating Nobori BES versus other DES. Primary efficacy and
safety outcomes were target lesion revascularization (TLR) and
definite/probable stent thrombosis (ST), respectively. Secondary outcomes
were the composite of cardiac death/myocardial infarction (MI)/target
vessel revascularization (TVR), MI and death. Results A total of 9114
PCI-patients randomly received Nobori BES (n = 5080) or other DES (n =
4034). This latter group comprised patients receiving everolimus- (n =
2533), sirolimus- (n = 1376) or paclitaxel-eluting stents (n = 125).
Median follow-up was 11 months [interquartile range 9-12]. The Nobori BES
versus other DES showed comparable risk of TLR (odds ratio [95% confidence
interval] = 0.91 [0.57-1.46], p = 0.71). There was significant
heterogeneity across trials due to significant lower TLR risk with Nobori
BES versus paclitaxel-eluting stent (0.32 [0.10-0.98], p = 0.046; p for
interaction = 0.009). Nobori BES versus other DES showed comparable risk
of definite/probable ST (1.40 [0.66-2.97], p = 0.39), cardiac death/MI/TVR
(1.05 [0.88-1.25], p = 0.59), MI (1.13 [0.87-1.48], p = 0.37) and death
(1.09 [0.81-1.48], p = 0.56). Conclusions Nobori BES has comparable
efficacy with other limus-eluting stents at 1-year follow-up. There is no
difference in terms of safety profile between these stent platforms. 2014
Elsevier Ireland Ltd. All rights reserved.

<17>
Accession Number
2014503242
Authors
Antoniou G.A. Karkos C.D. Antoniou S.A. Georgiadis G.S.
Institution
(Antoniou) Department of Vascular Surgery, Hellenic Red Cross Hospital,
Souniou 11, 19001 Keratea, Athens, Greece
(Karkos) 5th Department of Surgery, Hippocrateio Hospital, Aristotle
University of Thessaloniki, Thessaloniki, Greece
(Antoniou) Department of Surgery, University Hospital of Heraklion,
University of Crete, Heraklion, Greece
(Georgiadis) Department of Vascular and Endovascular Surgery, Democritus
University of Thrace, Alexandroupolis, Greece
Title
Can an accessory renal artery be safely covered during endovascular aortic
aneurysm repair?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 1025-1027),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether coverage of an accessory renal artery
(ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is
associated with increased risk of renal impairment. Altogether, 106 papers
were located using the reported searches, of which 5 represented the best
evidence to answer the question. The authors, journal, date and country of
publication, study type, patient group studied, relevant outcomes
parameters and results of these papers are tabulated. Our best evidence
analysis included 116 patients who had one or more ARA excluded during
EVAR. Segmental renal infarction occurred in varying numbers of patients
(ranging from 0 to 84%). The authors consistently demonstrate that loss of
renal mass is not associated with functional renal impairment, expressed
by various outcome parameters such as serum creatinine, glomerular
filtration rate (GFR), renal failure requiring dialysis and worsening
hypertension. Comparisons of groups of patient with covered or preserved
ARAs by one of the selected studies showed no difference in any of these
renal outcome parameters, apart from a significantly higher renal infarct
volume in the former group (P< 0.001). Subgroup analysis of patients with
pre-existing renal dysfunction (GFR < 60 ml/h/m²) showed no
difference in GFR change when comparing covered with uncovered ARA patient
cohorts. No type II endoleak related to the covered ARA was reported in
any of these studies. In conclusion, current evidence supports the safety
of coverage of ARAs located in the proximal fixation zone to achieve seal
in EVAR. The Author 2013. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<18>
Accession Number
2014503241
Authors
Watson R.A. Hamza M. Tsakok T.M. Tsakok M.T.
Institution
(Watson, Tsakok) Green Templeton College, University of Oxford, Oxford OX2
1HG, United Kingdom
(Hamza) King's College London School of Medicine, London, United Kingdom
(Tsakok) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
Title
Radial artery for coronary artery bypass grafting: Does proximal
anastomosis to the aorta or left internal mammary artery achieve better
patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 1020-1024),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'in coronary artery bypass
grafting using radial artery grafts, does proximal anastomosis to the
aorta or left internal mammary artery achieve better patency'. Altogether
> 183 papers were found using the reported search, of which 9 represented
the best evidence to answer the clinical question. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these papers are tabulated. Radial artery
grafts typically have a narrower lumen than vein grafts, and as such there
is some concern that anastomosing them directly to the aorta during
coronary artery bypass grafting (CABG) may impair graft patency. As such,
some surgeons prefer to anastomose radial artery grafts to a second-order
vessel such as the left internal mammary artery (LIMA). We sought to
assess the evidence for this. A handful of papers directly addressing the
issue of the effect of the site of proximal anastomosis on graft patency
were found, with three showing no significant difference. One such study
reported an insignificant difference in angiographic patency at 32 months
postoperatively, with 94.1% of off-Aorta grafts remaining patent vs 87.2%
of off-LIMA grafts (p = 0.123). However, a large-scale well-designed study
was able to demonstrate a statistically significant difference at five
years postoperatively, with 74.3% of off-Aorta grafts patent, compared
with 65.2% of off-LIMA (p = 0.004). Nonetheless, a number of papers that
report patency for either off-Aorta or off-LIMA grafts give comparable
figures for each technique. Additionally, different centres and
investigators report very different patency results for grafts that have
the same site of proximal anastomosis. One centre was able to achieve
patency rates for off-LIMA grafts of 88% up to a mean of 7.7 years
postoperatively while another centre reported a patency rate of only 78.6%
at three years. Given this, and the plethora of other factors influencing
graft patency, we conclude that the best evidence suggests that the site
of proximal anastomosis has little or no effect on radial artery graft
patency following CABG. The Author 2013. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<19>
Accession Number
2014503237
Authors
Tennyson C. Lee R. Attia R.
Institution
(Tennyson) Ulster Hospital, South Eastern Trust, Belfast, United Kingdom
(Lee) Cardiothoracic Surgery Unit, London Chest Hospital, London, United
Kingdom
(Attia) Department of Cardiovascular Surgery and Academic Surgery, Guy's
and St Thoma's Hospital London, London, United Kingdom
Title
Is there a role for HbAlc in predicting mortality and morbidity outcomes
after coronary artery bypass graft surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 1000-1008),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was is there a role for HbAlc
in predicting morbidity and mortality outcomes after coronary artery
bypass surgery? Eleven studies presented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. The studies presented analyse the relationship
between preoperative HbAlc levels and postoperative outcomes following
coronary artery bypass graft (CABG) in diabetic, non-diabetic or mixed
patient groups. Four studies found significant increases in early and late
mortality at higher HbAl c levels, regardless of a preoperative diagnosis
of diabetes. One study demonstrated that 30-day survival outcomes were
significantly worse in patients with previously undiagnosed diabetes and
elevated HbAlc compared with those with good control [HbAl c > 6%; odds
ratio 1.53, confidence interval (CI) (1.24-1.91); P = 0.0005]. However,
four studies of early mortality outcomes in diabetic patients only showed
no significant differences between patients with normal and those with
deranged HbAlc levels (P= 0.99). There were mixed reports on morbidity
outcomes. Three studies identified a significant increase in infectious
complications in patients with poorly controlled HbAlc, two of which were
irrespective of previous diabetic status [deep sternal wound infection (P
= 0.014); superficial sternal wound infection (P = 0.007) and minor
infections (P = 0.006) in poorly controlled diabetics only]. Four studies
presented outcomes for total length of stay (LOS). Three of these papers
looked specifically at diabetic patients, of which two found no
significant differences in length of stay between good and poor
preoperative glycaemic control [LOS: P= 0.59 and 0.86 vs P < 0.001].
However, elevated HbAlc vs normal HbAlc was associated with prolonged stay
in hospital and in intensive care unit (ICU) in patients irrespective of
previous diabetic status [total LOS (P< 0.001)]. Elevated HbAlc levels
were also a significant predictor of reduced intraoperative insulin
sensitivity in diabetic patients (R =-0.527; P< 0.001). Furthermore,
higher HbAlc levels were associated with a reduced incidence of
postoperative atrial fibrillation (P = 0.001). We conclude that elevated
HbA1 c is a strong predictor of mortality and morbidity irrespective of
previous diabetic status. In particular, the mortality risk for CABG is
quadrupled at HbAl c levels > 8.6%. Some studies have called into question
the predictive value of HbAl c on short-term outcomes in well-controlled
diabetics; however, long-term outcomes in this population have not been
reported.

<20>
Accession Number
2014503234
Authors
Reeb J. Falcoz P.-E. Olland A. Massard G.
Institution
(Reeb, Falcoz, Olland, Massard) Department of Thoracic Surgery, University
Hospital, Hopitaux Universitaires de Strasbourg, 1 place de l'Hopital, BP
426, 67091 Strasbourg Cedex, France
Title
Are daily routine chest radiographs necessary after pulmonary surgery in
adult patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 995-998),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic was constructed according to a structured protocol.
The question addressed was whether daily routine (DR) chest radiographs
(CXRs) are necessary after pulmonary surgery in adult patients. Of the 66
papers found using a report search, seven presented the best evidence to
answer the clinical question. Four of these seven studies specifically
addressed post-cardiothoracic adult patients. Three of these seven studies
addressed intensive care unit (ICU) patients and included
post-cardiothoracic adult patients in well-designed studies. Six of these
seven studies compared the DR CXRs strategy to the clinically indicated,
on-demand (OD) CXRs strategy. Another study analysed the clinical impact
of ceasing to perform the DR, postoperative, post-chest tubes removal
CXRs. The authors, journal, date and country of publication, study type,
group studied, relevant outcomes and results of these papers are given. We
conclude that, on the whole, the seven studies are unanimously in favour
of forgoing DR CXRs after lung resection and advocate OD CXRs. One study
suggested that hypoxic patients could benefit from a DR CXRs strategy,
while other studies failed to identify any subgroup for whom performing DR
CXRs was beneficial. Indeed, DR CXRs, commonly taken after thoracic
surgery, have poor diagnostic and therapeutic value. Eliminating them for
adult patients having undergone thoracic surgery significantly decreases
the number of CXRs per patient without increasing mortality rates, length
of hospital stays (LOSs), readmission rates and adverse events. Hence,
current evidence shows that DR CXRs could be forgone after lung resection
because OD CXRs, recommended by clinical monitoring, have a better impact
on management and have not been proved to negatively affect patient
outcomes. Moreover, an OD CXRs strategy lowers the cost of care.
Nevertheless, an OD CXRs strategy requires close clinical monitoring by
experienced surgeons and dedicated intensivists. However, given the
published studies' low level of evidence, prospective and randomized
trials, specifically after thoracic surgery, are necessary in order to
confirm these results. The Author 2013. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<21>
Accession Number
2014503233
Authors
Moen C.A. Burrell A. Dunning J.
Institution
(Moen) Department of Clinical Science, University of Bergen, Bergen,
Norway
(Burrell, Dunning) Department of Cardiothoracic Surgery, James Cook
University Hospital, Middlesbrough, United Kingdom
Title
Does tranexamic acid stop haemoptysis?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 991-994),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does tranexamic acid stop
haemoptysis'? Altogether 49 papers were found using the reported search
strategy, of which 13 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. This consisted of one systematic review including a
meta-Analysis of two double-blind randomized controlled trials (RCTs), the
two RCTs, one cohort study, two case-series and seven case reports. Main
outcomes included bleeding time, bleeding volume and occurrence of
thromboembolic complications after start of treatment. Based on results
from the meta-Analysis, no difference in remission of bleeding within 1
week was found between tranexamic acid (TA) and placebo groups (odds ratio
1.56, 95% CI: 0.44-5.46). However, overall bleeding time was significantly
shorter for the TA group (weighted mean difference -19.47, 95% CI: -26.90,
-12.03 h). In one RCT, TA reduced both the duration and the volume of
bleeding compared with patients receiving placebo (both P< 0.0005).
However, the other RCT failed to find a difference in bleeding time (P =
0.2). In these studies, no patient suffered from thromboembolic
complications. Two case reports, however, describe development of
pulmonary embolism during TA treatment. Several case reports on the use of
TA for treatment of haemoptysis secondary to cystic fibrosis were found.
In general, they suggest that TA may be a useful and well-tolerated
medication for the treatment of intractable haemoptysis in this patient
group. We conclude that limited research on the use of TA for treatment of
haemoptysis exists. As aetiology of haemoptysis as well as length of
treatment, dosage and form of TA administration varied between the
studies, strong recommendations are difficult to give. Current best
evidence, however, indicates that TA may reduce both the duration and
volume of bleeding, with low risk of short-term thromboembolic
complications, in patients with haemoptysis. The Author 2013. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<22>
Accession Number
2014503223
Authors
El Midany A.A.H. Mostafa E.A. Azab S. Hassan G.A.
Institution
(El Midany, Mostafa, Azab) Department of Cardiovascular and Thoracic
Surgery, Ain Shams University, Ramses Str., Abbassia, PO Code 11588 Cairo,
Egypt
(Hassan) Department of Anesthesia and Critical Care, Menoufeya University,
Cairo, Egypt
Title
Perioperative sildenafil therapy for Pulmonary hypertension in infants
undergoing congenital cardiac defect closure.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (6) (pp 963-968),
2013. Date of Publication: December 2013.
Publisher
Oxford University Press
Abstract
OBJECTIVES: Pulmonary hypertension in paediatric patients with ventricular
septal defect remains one of the most important determinants of
perioperative morbidity and mortality. Sildenafil is an oral,
well-tolerated pulmonary vasodilator with few drug interactions. We
studied the effect of oral sildenafil, when given before and after
surgical closure compared with starting it postoperatively, on the
pulmonary artery pressure and patients' outcome. METHODS: We enrolled 101
infants with large ventricular septal defects who had moderate-to-severe
pulmonary hypertension scheduled for surgical closure. They were randomly
assigned to the sildenafil group (n = 51, mean age 10 months and mean
weight 6.5 kg), in which oral sildenafil was started 2 weeks before
surgery to be continued postoperatively, and to the control group (n = 50,
mean age 11 months and mean weight 7.3 kg), in which sildenafil was
started only postoperatively. It was started at 0.5 mg/kg and increased
gradually to a maximum dose of 2 mg/kg in both groups. RESULTS: Overall
hospital mortality was 4.9%. Mean pulmonary artery pressure decreased
significantly at all time points of recording in both groups (P< 0.0001).
In the sildenafil group, it decreased preoperatively after sildenafil
administration from 75.4 to 59.4 mmHg and postoperatively from 50.4 mmHg
immediate post-cardiopulmonary bypass to reach 44.2 mmHg before discharge.
In the control group, it decreased from 74.6 mmHg to 51 mmHg immediate
post-cardiopulmonary bypass to reach 42.7 mmHg before discharge. No
adverse effects have been recorded. Although there was no difference in
the duration of mechanical ventilation and hospital stay between the two
groups, intensive care unit stay was significantly shorter in the
sildenafil group. Dobutamine doses were significantly higher in the
sildenafil group; however, milrinone and epinephrine have been used more
significantly in the control group. CONCLUSIONS: The low cost, the oral
availability and the good tolerability of sildenafil make it a suitable
and simple alternative therapy for secondary pulmonary hypertension
including persistent postoperative pulmonary hypertension associated with
ventricular septal defect in resource limited places. However, starting
sildenafil early before surgery does not add a great benefit in terms of
improving postoperative pulmonary hypertension or patients' outcome. The
Author 2013. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

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Accession Number
71555950
Authors
Salvatici M. Cardinale D. Facchi G. Colombo A. Spaggiari L. Sandri M.T.
Institution
(Salvatici, Cardinale, Facchi, Colombo, Spaggiari, Sandri) European
Institute of Oncology, Italy
Title
NtproBNP identifies patients at high risk of postoperative atrial
fibrillation suitable of preventive therapy.
Source
Clinical Chemistry and Laboratory Medicine. Conference: 22nd International
Congress of Clinical Chemistry and Laboratory Medicine, 22nd Balkan
Clinical Laboratory Federation Meeting, BCLF 2014, 26th National Congress
of the Turkish Biochemical Society, TBS 2014, IFCC WORLDLAB 2014 Istanbul
Turkey. Conference Start: 20140622 Conference End: 20140626. Conference
Publication: (var.pagings). 52 (pp S577), 2014. Date of Publication: July
2014.
Publisher
Walter de Gruyter GmbH and Co. KG
Abstract
BACKGROUND: Postoperative atrial fibrillation (AF) is one of the most
frequent complications of thoracic surgery for lung cancer, with an
incidence ranging from 8 to 42%. In some studies, postoperative AF has
been found to be a benign and self-limiting complication, whereas, in
others, it has been related to significantly increased morbidity and
mortality. The development of postoperative AF is associated with a
prolonged length of hospitalization and high related costs. The
identification of patients at high risk that could benefit from preventive
strategies, represents a clear need. Several risk indexes have been
evaluated, and recently the N-terminal pro-BNP (NT-proBNP) has emerged as
an early marker predictive of post-operative AF in different surgical
settings. This study was aimed at the evaluation of the efficacy of
treatment with a beta-blocker or angiotensin receptor blocker, in patients
with elevated perioperative values of Nt-proBNP at higher risk for AF.
METHODS: We conducted a prospective randomized controlled study in
patients undergoing elective thoracic surgery for lung cancer. Patients
with elevated perioperative values of NT-proBNP were randomized to receive
a cardio protective therapy (Metoprolol or Losartan) or no therapy
(control subjects). The primary end point was a decrease of the incidence
of postoperative AF. RESULTS: of the 1116 cancer patients undergoing
thoracic surgery enrolled from April 2008 to June 2013, 315 showed a
perioperative NT-proBNP increase and were randomized to receive Metoprolol
n=104 or Losartan n=101, while 110 represented the control group. All
patients remained under continuous ECG monitoring until discharge.
Sixty-three patients (20%) develop a postoperative AF. A significant
reduction of postoperative AF events was observed in treated patients: 7%
(= 7 patients) and 11% (=12 patients) in the groups receiving metoprolol
or losartan respectively, compared to 40% (n=44) in the control group
(P<0.001). CONCLUSIONS: In patients undergoing elective thoracic surgery
for lung cancer, a perioperative increased value of NtproBNP could
represent an early marker useful to candidate patients to receive a
therapy with beta-blocker or angiotensin to prevent the development of a
postoperative AF.