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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.