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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.

<23>
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.