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<1>
Accession Number
2014167796
Authors
Attar A.S. Tabari M. Rahnamazadeh M. Salehi M.
Institution
(Attar, Tabari, Rahnamazadeh) Department of Anesthesiology, Ghaem
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Salehi) Department of Community Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Title
A comparison of effects of propofol and isoflurane on arterial oxygenation
pressure, mean arterial pressure and heart rate variations following
one-lung ventilation in thoracic surgeries.
Source
Iranian Red Crescent Medical Journal. 16 (2) , 2014. Article Number:
e15809. Date of Publication: February 2014.
Publisher
Iranian Red Crescent Society
Abstract
Background: Hypoxia occurs during one-lung ventilation (OLV) due to the
arteriovenous shunt of unsaturated pulmonary venous blood. Hypoxic
pulmonary vasoconstriction (HPV) acts as a defense mechanism against
shunting. In thoracic surgery, anesthetics with minimal inhibitory effect
on HPV and minimal hemodynamic changes are preferred. Objectives: The
present study aimed to evaluate the Effects of propofol and isoflurane on
patients' arterial oxygen pressure following one-lung ventilation during
thoracic surgeries. Materials and Methods: In this randomized clinical
trial study which was conducted in Iran, sixty patients with ASA (The
American Society of Anesthesiologists) class I & II who were candidates
for right elective thoracotomy were divided in two groups. Induction of
anesthesia in the two groups was conducted using the same method, and left
double-lumen endotracheal tube was inserted. In the first group propofol
was used for the maintenance of anesthesia, and isoflurane for the second
group. During two-lung ventilation and at minutes 5 and 10 after OLV, ABG
(arterial blood gas) (for detecting the mean pressure of arterial oxygen),
mean arterial pressure and heart rate were recorded. Results: Sixty
patients (mean age = 4124.18 + 18.63 years) were divided into two groups.
The age and gender of the subjects were not statistically different
between the two groups. In the propofol group, the arterial oxygen
pressure during two-lung ventilation and at 5th and 10th minutes after OLV
was 263.14 + 136.19, 217.40 + 133.99 and 182.34 + 122.39; in the
isoflurane group, it was reported as 206.29 + 135.59, 164.78 + 118.90 and
155.35 + 109.21 mmHg, respectively. In the propofol group, mean arterial
pressure during two-lung ventilation, and 5th and 10th minutes after OLV,
was 84.01 + 20.67, 88.15 + 20.23 and 86.10 + 19.13, respectively;
regarding the isoflurane group, it was reported as 79.66 + 17.04, 84.78 +
20.19 and 86.50 + 17.07 mmHg, respectively. In the propofol group, heart
rate during two-lung ventilation, and 5th and 10th minutes after OLV was
92.77 + 17.20, 94.0 + 18.34 and 94.33 + 21.03, respectively; In the
isoflurane group, it was reported as 92.87 + 16.96, 91.8 + 18.75 and 91.05
+ 17.20 min, respectively. These values were statistically similar in the
two study groups. Conclusions: The Effects of propofol on hemodynamics and
arterial oxygen pressure during one- or two-lung ventilation were not
different from those of isoflurane. 2014, Iranian Red Crescent Medical
Journal; Published by Kowsar Corp.

<2>
Accession Number
2013657082
Authors
Soltani G. Abbasi Tashnizi M. Moeinipour A.A. Ganjifard M. Esfahanizadeh
J. Sepehri Shamloo A. Purafzali Firuzabadi S.J. Zirak N.
Institution
(Soltani, Ganjifard) Department of Anesthesiology, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Abbasi Tashnizi, Moeinipour, Esfahanizadeh, Sepehri Shamloo, Purafzali
Firuzabadi, Zirak) Department of Cardiac Surgery, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Comparing the effect of preoperative administration of methylprednisolone
and its administration before and during surgery on the clinical outcome
in pediatric open heart surgeries.
Source
Iranian Red Crescent Medical Journal. 15 (6) (pp 483-487), 2013. Date of
Publication: June 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: Cardiac surgery under Cardiopulmonary bypass causes a systemic
inflammatory response with a multifactorial etiology including direct
tissue damage, ischemia and stimulation of immune system induced by
cardiopulmonary bypass. This study was designed due to the high prevalence
and complications of this stimulated immune system in mortality,
morbidity, length of ICU stay, and mechanical ventilation. Objectives:
This study was aimed to compare preoperative and intraoperative
methylprednisolone (MP) to intraoperative MP alone with respect to
postbypass inflammation and clinical outcome. Patients and Methods: Sixty
pediatric patients (age < 5years) undergoing cardiopulmonary bypass
surgery between September 2011-2012 at Imam Reza hospital-Mashhad were
randomly assigned to receive preoperative and intraoperative MP (group 1:
30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or
intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative
temperature (peak temperature and average temperature during the first 24
hours), amount of inotropic, duration of mechanical ventilation, ICU stay,
WBC, BUN, creatinine, and CRP were recorded and compared in both groups.
Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if
necessary, and Chi-squared distribution. Results: Patient characteristics
including age, weight, gender, and duration of bypass were almost similar
in both groups (P > 0.05). No significant difference in amount of
inotropic medications used for hemodynamic supports, duration of
mechanical ventilation, peak and average temperature and length of ICU
stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP)
only WBC counts raised more in group 2 when compared to group 1(P < 0.05).
Conclusions: There was no difference in clinical outcome after cardiac
surgery when we administered an additional dose of methylprednisolone
compared to a single dose of methylprednisolone. 2013, Iranian Red
Crescent Medical Journal.

<3>
Accession Number
2013657066
Authors
Taghipour H. Shafiei H. Assar O. Ghiasi M.S.
Institution
(Taghipour) Trauma research center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Shafiei) Cardiac Surgery Ward, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Assar) Cardiovascular Research Center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ghiasi) Jamaran Heart Hospitals, Tehran, Iran, Islamic Republic of
Title
The effect of systemic arterial-line leukocyte filtration on the outcome
of adult patients undergoing cardiac surgery.
Source
Iranian Red Crescent Medical Journal. 15 (5) (pp 414-417), 2013. Date of
Publication: May 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: It is known that cardiopulmonary bypass causes an inflammatory
reaction with associated morbidity and mortality. Several
anti-inflammatory strategies have been implemented to reduce this
response, including leukocyte removal from the circulation using
specialized filters. Objectives: The aim of this randomized clinical study
was to assess the impact of arterial-line systemic leukocyte filtration on
the postoperative outcome of adult patients undergoing elective cardiac
surgery. Patients and Methods: 114 patients undergoing CABG or valve
replacement in Baqiyatallah hospital, Tehran, Iran from May to August 2011
were randomly assigned to two groups: with and without leukocyte
filtration and their outcomes were compared. Results: The postoperative
intubation time was significantly shorter in patients with leukocyte
filters (0.014). There was no significant difference between two groups
regarding other outcome relatedvariables. Conclusions: Systemic arterial
leukocyte filtration reduces the intubation time but has no other
beneficial effect on the outcome of patients undergoing CABG or valve
surgery. 2013, Iranian Red Crescent Medical Journal.

<4>
Accession Number
2013656960
Authors
Tabari M. Alipour M. Esalati H.
Institution
(Tabari, Alipour, Esalati) Department of Anesthesiology, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Evaluation of oral tiazinidine effects on [intraoperative] hemodynamic
responses during direct laryngoscopy under general anesthesia.
Source
Iranian Red Crescent Medical Journal. 15 (7) (pp 541-546), 2013. Date of
Publication: July 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: Direct laryngoscopy and tracheal intubation can result in
blood pressure and heart rate increase which in turn may lead to
myocardial ischemia, cerebral hemorrhage, and even death in susceptible
patients. Tizanidine is alpha2-receptor agonists that suppresses central
sympathetic system. Objectives: This study evaluates the effects of oral
Tizanidine on hemodynamic responses during operations and aims to
determine the appropriate Propofol dosage to maintain anesthesia under BIS
monitoring. Materials and Methods: A double-blind clinical trial has been
performed on 70 candidates for elective abdominal surgery undergoing
general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35
randomly selected patients (the case group) were given 4 mg of oral
Tizanidine 90 minutes before the induction of anesthesia whereas the
remaining subjects (the control group) were given placebo. Blood pressure
and heart rate before and after induction of anesthesia, and after
intubation and extubation, existence of postoperative shivering, and the
needed Propofol dosage were measured and recorded. Data analysis was done
with T-test and Chi-squared test, using SPSS software version 16. Results:
Variations of blood pressure and heart rate after anesthesia induction,
intubation and extubation were less in Tizanidine group generally.
Postoperative shivering was reported in 28.6% and 11.4% of patients in
control and case group respectively. Average propofol needed dose for
anesthesia maintenance in case group was 25% less than the needed amount
in the control group. Conclusions: Using oral Tizanidine as a
premedication, yielded stability in blood pressure and heart rate during
surgery and decreased required Propofol. Considering its short duration of
action, Tizanidine use as a premedication is recommended for sedation and
stabilization of hemodynamic responses during the operations. 2013,
Iranian Red Crescent Medical Journal.

<5>
Accession Number
2013571761
Authors
Pourmehdi Z. Tabatabaei S. Salimbahrami S. Borzouei S.
Institution
(Pourmehdi) Razi Hospital, Ahwaz University of Medica Sciences, Ahwaz,
Iran, Islamic Republic of
(Tabatabaei) Emam Khomeini Hospital, Ahwaz University of Medical Sciences,
Ahwaz, Iran, Islamic Republic of
(Salimbahrami) Besat Hospital, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
(Borzouei) Shahid beheshti Hospital, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
Title
The efficacy of intrathecal bupivacaine in combination with general
anesthesia versus general anesthesia alone on time to extubation in
patients with Coronary Artery Bypass Graft (CABG) surgery.
Source
Shiraz E Medical Journal. 14 (1) , 2013. Date of Publication: January
2013.
Publisher
Shiraz University of Medical Sciences (School of Medicine, 8th floor,
Shiraz, Iran, Islamic Republic of. E-mail: semj@sums.ac.ir)
Abstract
Objective: we compared the use of intrathecal bupivacaine in combination
with general anesthesia to general anesthesia alone in patients undergoing
coronary artery bypass grafting (CABG) surgery for its impact on time to
extubation. Methodology: In this case control double blind study we
compared 34 patients in Imam Khomeini Hospital, Ahwaz, Iran, from May 2011
to September 2011.The patients were randomly assigned to receive general
anesthesia with prior administration of intrathecal bupivacaine 0.5% at a
dosage of 20 mg (bupivacaine or case group n = 17) or general anesthesia
alone (control group n = 17) according to a simple computer-generated
list. Results: Mean extubation time in bupivacaine group was213.00 + 3.06
(3h and 33m) and in control group was 257.12 + 4.49 minutes (4h and
17m).the difference between two groups was significant(P < 0.05).
Conclusion: Intrathecal bupivacaine offers promise as a useful adjunct in
reducing postoperative time to extubation in coronary artery bypass
grafting (CABG) surgery. 2013, Shiraz E Medical Journal, Shiraz, Iran.
All rights reserved.

<6>
Accession Number
2011137999
Authors
Taghipour H.R. Naseri M.H. Safiarian R. Dadjoo Y. Pishgoo B. Mohebbi H.A.
Daftari Besheli L. Malekzadeh M. Kabir A.
Institution
(Taghipour, Naseri, Safiarian, Dadjoo, Pishgoo, Mohebbi, Malekzadeh)
Trauma Research Center, Department of Cardiology and Cardiothoracic
Surgery, Bagiyatallah University of Medical Sciences, Iran, Islamic
Republic of
(Daftari Besheli, Kabir) Department of Epidemiology, Shahid Beheshti
University of Medical Sciences, Iran, Islamic Republic of
(Kabir) Center for Educational Research in Medical Sciences, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Quality of life one year after coronary artery bypass graft surgery.
Source
Iranian Red Crescent Medical Journal. 13 (3) (pp 171-177), 2011. Date of
Publication: 2011.
Publisher
Iranian Red Crescent Society
Abstract
Background: Coronary artery bypass graft (CABG) is a treatment strategy to
relieve the symptoms of coronary artery disease (CAD). Based on
determining the long term outcome of CABG using SF-36 Health Related
Quality Of Life (HRQOL) questionnaire, the present study was conducted in
our center to determine the CABG results one-year after the operation.
Methods: Between March 2005 and August 2009, 112 patients with coronary
heart disease (CHD) who underwent coronary artery bypass graft (CABG) were
enrolled. Patients completed SF-36 HRQOL general health status
questionnaire. Stepwise multiple linear regression models were used to
detect independent variables predicting changes in each eight subscales of
SF-36 questionnaire. Results: The mean age of patients was 61.4+0.9 years
and most of them were male with three vessel diseases that were on pump
CABG. The mean physical and mental component summary scores were 59.5+0.9
and 60.2+0.9, respectively. Physical functioning (PF) and role physical
(RP) improved in males. Regression models showed that there were some
statistical models with low R-square to predict role emotional (RE),
general health (GH), PF and RP according to ejection fraction after
surgery, diabetes, pump type of CABG and male gender. Conclusion: CABG has
led to higher and more satisfactory outcomes for PF, RP and RE but lower
in other scales comparing with normative data of the society and one-year
post-operative scores of other studies. It could mostly be attributed to
unmodified risk factors and progression of existing comorbidities.
Iranian Red Crescent Medical Journal.

<7>
Accession Number
2010396011
Authors
Mahjoubifar M. Boroojeny S.B.
Institution
(Mahjoubifar, Boroojeny) Clinical Research Development Center,
Ali-ebn-Abitaleb Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
Title
Hemodynamic changes during orotracheal intubation with the glidescope and
direct laryngoscope.
Source
Iranian Red Crescent Medical Journal. 12 (4) (pp 406-408), 2010. Date of
Publication: 2010.
Publisher
Iranian Red Crescent Society
Abstract
Background: Hemodynamic changes during intubation are extremely important
especially in patients with a history of coronary artery disease and
arrhythmia. The aim of this study was to compare the hemodynamic changes
during video laryngoscopy (glidescope) and the conventional method of
direct laryngoscopy. Methods: This randomized double-blind clinical trial
recruited 200 male patients undergoing elective orthopaedic surgery. Heart
Rate (HR) and Mean Arterial Blood Pressure (MABP) were measured before, at
the time of induction and every minute for 10 minutes following
intubation. Results: Changes of MABP were significantly less in the
glidescopy group as compared to direct laryngoscopy group. No significant
change was observed between the HR in the two groups. Conclusion:
Glidescopic method of orotracheal intubation is considered advantageous
over the conventional method for its less alteration of MABP. Iranian Red
Crescent Medical Journal.

<8>
Accession Number
2010324203
Authors
Vaziri M.T.M. Jouibar R. Akhlagh S.H.A. Janati M.
Institution
(Vaziri, Jouibar, Akhlagh) Department of Anesthesiology, Faghihi Hospital,
Nemazee Hospital Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Janati) Department of Surgery, Division ofCardiovascular Surgery, Nemazee
Hospital Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Title
The effect of lidocaine and magnesium sulfate on prevention of ventricular
fibrillation in coronary artery bypass grafting surgery.
Source
Iranian Red Crescent Medical Journal. 12 (3) (pp 298-301), 2010. Date of
Publication: 2010.
Publisher
Iranian Red Crescent Society
Abstract
Background: One of the most common events, after the release of aortic
cross-clamp in patients undergoing coronary artery bypass grafting surgery
is reperfusion induced ventricular fibrillation, which occurs in 74% of
96% of patients. Regarding the controversies over the use of lidocaine or
magnesium sulfate for the prevention of ventricular fibrillation following
the release of aortic cross-clamp, this study was designed to compare the
effectiveness of magnesium sulfate and lidocaine to suppress ventricular
fibrillation. Methods: In a double blind, prospective, randomized,
controlled trial study, 76 patients who were candidates for elective
coronary artery bypass grafting surgery were divided into three groups
including Group A (lidocaine, n=26), group B (magnesium sulfate, n=25),
and group C (normal saline, n=26). Lidocaine (1.5 mg/Kg), magnesium
sulfate (30 mg/Kg) and normal saline were administered 5 minutes before
the release of aortic cross clamp. Results: The incidence of ventricular
fibrillation significantly decreased in patients receiving magnesium
sulfate (12% vs. 26.9% and 44% in patients who received lidocaine and
normal saline, respectively) There was no statistically significant
difference between the groups with respect to age, ejection fraction (L/
min), anesthetic time (min), cross-clamping time (min), PH, HCT (%), and
serum K+ level (meq). Conclusion: The administration of lidocaine and
magnesium sulfate before the release of aortic cross-clamp reduces the
incidence of postoperative ventricular fibrillation in adult patients
undergoing coronary artery bypass grafting surgery with cardiopulmonary
bypass. In our study, magnesium sulfate was more efficient in prevention
of ventricular fibrillation than lidocaine. Administration of magnesium
sulfate (30 mg/kg) caused no toxic effect and wais safe for patients
undergoing coronary artery bypass grafting surgery with cardiopulmonary
bypass. Iranian Red Crescent Medical Journal.

<9>
Accession Number
2009033480
Authors
Kereiakes D.J.
Institution
(Kereiakes) The Christ Hospital Heart and Vascular Center, The Lindner
Center, 2123 Auburn Avenue, Cincinnati, OH 45219, United States
Title
Medical and catheter-based therapies for managing stable coronary disease:
Lessons from the courage trial.
Source
Current Treatment Options in Cardiovascular Medicine. 11 (1) (pp 45-53),
2009. Date of Publication: 2009.
Publisher
Springer Healthcare
Abstract
Medical and catheter-based therapies play complementary roles in treating
patients with stable coronary atherosclerosis. The choice of therapy (or
therapies) must be made for each patient based on coronary anatomic
suitability and in the context of the patient's lifestyle, functional
capacity, level of symptom limitation, and ability to take the prescribed
treatment. Objective evidence of myocardial ischemia on nuclear myocardial
scintigraphy is quantitatively correlated with the occurrence of death or
myocardial infarction in late follow-up, and percutaneous coronary
intervention added to optimal medical therapy is more effective than
medical therapy alone in reducing ischemia. Coronary angiography and
definition of the coronary anatomy should be performed in patients with
stable angina pectoris to help in selecting the optimal treatment
strategy. Springer Science+Business Media, LLC 2009.

<10>
Accession Number
2014923718
Authors
Qian J. Zhang Y.-J. Xu B. Yang Y.-J. Yan H.-B. Sun Z.-W. Zhao Y.-L. Tang
Y.-D. Gao Z. Chen J. Cui J.-G. Mintz G.S. Gao R.-L.
Institution
(Qian, Xu, Yang, Yan, Sun, Zhao, Tang, Gao, Chen, Cui, Gao) Department of
Cardiology, FuWai Hospital, National Center for Cardiovascular Diseases,
Beijing, China
(Zhang) Department of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
Title
Optical coherence tomography assessment of a PLGA-polymer with
electro-grafting base layer versus a PLA-polymer sirolimus-eluting stent
at three-month follow-up: The BuMA-OCT randomised trial.
Source
EuroIntervention. 10 (7) (pp 806-814), 2014. Date of Publication: 01 Nov
2014.
Publisher
EuroPCR
Abstract
Aims: To compare stent strut coverage using optical coherence tomography
(OCT) at three-month follow-up between a PLGA-polymer with
electro-grafting base layer sirolimus-eluting stent (SES) (BuMA) and a
PLA-polymer SES (EXCEL). Methods and results: This prospective,
single-centre, non-inferiority randomised BuMA-OCT trial enrolled patients
with de novo coronary artery lesions, treated with either the BuMA or the
EXCEL stent. The study primary endpoint was OCT-evaluated stent strut
coverage at three months. Secondary endpoints were neointimal thickness of
stent struts, and incomplete stent apposition evaluated with OCT. A total
of 80 patients were randomly assigned to receive the BuMA (n=40) or the
EXCEL (n=40) stent. In OCT follow-up (achieved in 86.3% of cases: BuMA,
n=33; EXCEL, n=36), the percentage of stent strut coverage was
significantly higher in the BuMA vs. the EXCEL group (strut level: 94.2%
vs. 90.0%, p<0.01; pnoninferiority <0.0001; psuperiority <0.0001), while
the proportion of malapposed struts (strut level: 1.28% vs. 1.80%, p=0.51)
and the mean neointimal thickness (strut level: 0.07+0.03 mm vs. 0.06+0.02
mm, p=0.31) were similar. Rates of myocardial infarction (periprocedural
non-Q-wave, 7.5% vs. 7.5%, p=1.00) and target lesion failure (7.5% vs.
7.5%, p=1.00) were similar between groups, with no cardiac death or stent
thrombosis. Conclusions: In the BuMA-OCT randomised trial, the novel BuMA
PLGA-polymer with electro-grafting base layer SES was superior to the
EXCEL PLA-polymer SES in the primary endpoint of stent strut coverage at
three-month follow-up.

<11>
Accession Number
2014916153
Authors
Sherwood M.W. Peterson E.D.
Institution
(Sherwood, Peterson) Division of Cardiovascular Medicine, Duke University
Medical Center, Duke Clinical Research Institute, 2400 Pratt St, Durham,
NC 27715, United States
Title
Revascularization in stable coronary artery disease.
Source
JAMA - Journal of the American Medical Association. 312 (19) (pp
2028-2030), 2014. Date of Publication: 19 Nov 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE Recent trials of percutaneous coronary intervention (PCI) vs
coronary artery bypass grafting (CABG) for multivessel disease were not
designed to detect a difference in mortality and therefore were
underpowered for this outcome. Consequently, the comparative effects of
these 2 revascularization methods on long-term mortality are still
unclear. In the absence of solid evidence for mortality difference, PCI is
oftentimes preferred over CABG in these patients, given its less invasive
nature. OBJECTIVES To determine the comparative effects of CABG vs PCI on
long-term mortality and morbidity by performing a meta-analysis of all
randomized clinical trials of the current era that compared the 2
treatment techniques in patients with multivessel disease. DATA SOURCES
Asystematic literature searchwas conducted for all randomized clinical
trials directly comparingCABGwith PCI. STUDY SELECTION To reflect current
practice, we included randomized trials with 1 or more arterial grafts
used in at least 90%, and 1 or more stents used in at least 70% of the
cases that reported outcomes in patients with multivessel disease. DATA
EXTRACTION Numbers of events at the longest possible follow-up and sample
sizes were extracted. DATA SYNTHESIS Atotal of 6 randomized trials
enrolling a total of 6055 patientswere included, with aweighted average
follow-up of 4.1 years. Therewas a significant reduction in total
mortality withCABGcompared with PCI (I2 = 0%; risk ratio [RR],0.73
[95%CI,0.62-0.86]) (P >.001). Therewere also significant reductions
inmyocardial infarction (I2 = 8.02%; RR, 0.58 [95%CI,0.48-0.72]) (P >.001)
and repeat revascularization (I2 = 75.6%; RR,0.29 [95%CI,0.21-0.41]) (P
>.001) with CABG. Therewas a trend toward excess strokes withCABG(I2 =
24.9%; RR, 1.36 [95%CI,0.99-1.86]), but thiswas not statistically
significant (P =.06). For reduction in total mortality, therewas no
heterogeneity between trials thatwere limited to and not limited to
patients with diabetes or whether stentswere drug eluting or not. Owing to
lack of individual patient-level data, additional subgroup analyses could
not be performed. CONCLUSIONS AND RELEVANCE In patients with multivessel
coronary disease, compared with PCI, CABG leads to an unequivocal
reduction in long-term mortality andmyocardial infarctions and to
reductions in repeat revascularizations, regardless of whether patients
are diabetic or not. These findings have implications for management of
such patients.

<12>
Accession Number
2014910259
Authors
Yu L. Gu T. Shi E. Wang C. Fang Q. Yu Y. Zhao X. Qian C.
Institution
(Yu, Gu, Shi, Wang, Fang, Yu, Zhao, Qian) Dept. of Cardiac Surgery, First
Affiliated Hospital, China Medical University, Nanjingbei street 155#,
Shenyang 110001, China
Title
Off-pump versus on-pump coronary artery bypass surgery in patients with
triple-vessel disease and enlarged ventricles.
Source
Annals of Saudi Medicine. 34 (3) (pp 222-228), 2014. Date of Publication:
01 May 2014.
Publisher
King Faisal Specialist Hospital and Research Centre
Abstract
Background and objectives: Off-pump coronary artery bypass grafting
(OPCAB) is a popular treatment for patients with ischemic heart disease,
especially for high-risk patients. However, whether OPCAB can lead to
better clinical outcomes than on-pump coronary artery bypass grafting
(ONCAB) in patients with enlarged ventricles remains controversial. This
prospective randomized study was designed to characterize comparison of
early clinical outcome and mid-term follow-up following ONCAB versus OPCAB
in patients with triple-vessel disease and enlarged ventricles. DESIGN AND
SETINGS: Prospective randomized trial of patients treated at The First
Affiliated Hospital, China Medical University, over a 3-year period
(2007-2010). Methods: A total of 102 patients with triple-vessel disease
and enlarged ventricles (end-diastolic dimension >6.0 cm) were randomized
to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital
outcomes were analyzed. The study included a mid-term follow-up, with a
mean follow-up time of 49.40 (12.88 months). Results: No significant
differences were recorded in the baseline clinical characteristics of
ONCAB and OPCAB groups. A statistical difference was found between the two
groups at the time of extubation, intensive care unit stay, hospital stay,
blood requirements, incidence of intra-aortic balloon pump support,
pulmonary complications, stroke, reoperation for bleeding, and inotropic
requirements >24 hours (P<.05). The number of anastomoses performed per
patient, the incidence of postoperative ventricular arrhythmia, myocardial
infarction, new-onset atrial fibrillation, hemodialysis, infective
complications, recurrent angina, and percutaneous reintervention were
similar between the 2 groups (P>05). The left ventricular end-diastolic
dimension was significantly smaller at 6 months' follow-up in the 2 groups
than it was before operation (<.05). No differences in hospital mortality
and mid-term mortality between OPCAB and ONCAB groups were found. During
the follow-up, no patient in either group had undergone repeat coronary
artery bypass grafting. Conclusion: No differences in early and mid-term
mortality were found between OPCAB and ONCAB in patients with
triple-vessel disease and enlarged ventricles. However, OPCAB seems to
have a beneficial effect on postoperative complications.

<13>
Accession Number
2014790529
Authors
Olivier C.B. Schnabel K. Brandt C. Weik P. Olschewski M. Zhou Q. Bode C.
Diehl P. Moser M.
Institution
(Olivier, Schnabel, Brandt, Weik, Zhou, Bode, Diehl, Moser) Cardiology and
Angiology I, Heart Center Freiburg University, Hugstetter Str. 55,
Freiburg 79106, Germany
(Olschewski) Department of Medical Biometry and Statistics, Institute of
Medical Biometry and Medical Informatics, Medical Center Freiburg
University, Freiburg, Germany
Title
A high ratio of ADP-TRAP induced platelet aggregation is associated more
strongly with increased mortality after coronary stent implantation than
high conventional ADP induced aggregation alone.
Source
Clinical Research in Cardiology. 103 (12) (pp 968-975), 2014. Date of
Publication: 18 Nov 2014.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objective: This study aimed to evaluate whether a high relative ADP
induced aggregation (r-ADP-agg) is associated with an increased mortality
in patients after coronary stent implantation.
Background: Several trials were not able to improve clinical outcome by
adapting platelet inhibition in patients after coronary stent implantation
and high platelet reactivity (HPR). Platelet monitoring is complex and
conventional definition of adenosindiphosphate (ADP) induced aggregation
alone might not transfer the whole picture of adequate platelet inhibition
in vivo.
Methods: In a prospective single-centre observational trial multiple
electrode aggregometry was performed in whole blood of patients after
stent implantation. r-ADP-agg was defined as the ADP-thrombin receptor
activating peptide ratio to reflect an individual degree of
P2Y₁₂ dependent platelet inhibition with a cut-off value for
HPR of >50 %. The primary end point was mortality.
Results: Follow-up was completed in 176 of 184 patients (96 %) with a mean
follow-up time of 3.7 years. 35 (20 %) patients revealed an r-ADP-agg >50
%. An r-ADP-agg >50 % was associated with an increased mortality
[unadjusted hazard ratio (HR) 7.006 (2.561-19.17); p = 0.0001]. In a
multivariable Cox regression analysis mortality was independently
associated with an r-ADP-agg >50 % [HR 3.324 (1.542-7.165); p = 0.0022],
ACS-setting [HR 3.249 (1.322-7.989); p = 0.0102] and severely reduced LV
function [HR 5.463 (2.098-14.26); p = 0.0005].
Conclusion: An r-ADP-agg >50 % is associated with an increased mortality
in patients after coronary stent implantation. Furthermore, r-ADP-agg
might represent a better tool to predict clinical outcome than the
conventional ADP induced platelet aggregation alone.

<14>
Accession Number
2014848215
Authors
Xiao C. Zhou S. Liu Y. Hu H.
Institution
(Xiao, Hu) College of life Science, Sichuan University, Chengdu, China
(Xiao, Zhou, Liu, Hu) Department of Medicine, Sichuan Scientific and
Cellular Biotechnology Research Institute, Chengdu, China
(Xiao, Zhou, Liu, Hu) Emei Mid-level Qiliping Anti-aging Research Center,
Qiliping, Emei Mountain, Sichuan, China
Title
Efficacy and safety of bone marrow cell transplantation for chronic
ischemic heart disease: A meta-analysis.
Source
Medical Science Monitor. 20 (pp 1768-1777), 2014. Date of Publication: 01
Oct 2014.
Publisher
International Scientific Literature Inc.
Abstract
Background: Although bone marrow-derived cells (BMCs) have shown great
therapeutic potential in patients with chronic ischemic heart disease
(CIHD), the exact efficacy and safety of BMCs therapy is still not
completely defined.
Material/Methods: We searched PubMed, OVID, EMBASE, the Cochrane Library,
and ClinicalTrials.gov and finally identified 20 qualified trials in this
meta-analysis. Assessment of efficacy was based on left ventricular
ejection fraction (LVEF), left ventricular end-systolic volume (LVESV),
and left ventricular end-diastolic volume (LVEDV) improvement, by weighted
mean difference (WMD) with 95% confidence intervals (CIs). Results of
all-cause death, ventricular arrhythmia, recurrent myocardial infarction,
and cerebrovascular accident were pooled to assess safety. Subgroup
analysis was performed by stratifying RCTs into 2 subgroups of those with
revascularization and without revascularization.
Results: BMC transplantation significantly improved LVEF in patients with
revascularization (3.35%, 95% CI 0.72% to 5.97%, p=0.01;
I²=85%) and without revascularization (3.05%, 95% CI 0.65% to
5.45%, p=0.01; I²=86%). In patients without revascularization,
BMC transplantation was associated with significantly decreased LVESV
(-11.75 ml, 95% CI -17.81 ml to -5.69 ml, p=0.0001; I²=81%),
and LVEDV (-7.80 ml, 95% CI -15.31 ml to -0.29 ml, p=0.04;
I²=39%). Subgroup analysis showed that the route of
transplantation, baseline LVEF, and type of cells delivered could
influence the efficacy of BMC transplantation.
Conclusions: Autologous transplantation of BMCs was safe and effective for
patients who were candidates for revascularization with CABG/PCI and those
who were not. However, large clinical trials and long-term follow-up are
required to confirm these benefits.

<15>
Accession Number
2014909385
Authors
Treasure T. Milosevic M. Fiorentino F. Pfannschmidt J.
Institution
(Treasure) Clinical Operational Research Unit, University College London,
Gower St., London WC1E 6BT, United Kingdom
(Milosevic) Clinic for Thoracic Surgery, Institute for Pulmonary Diseases
of Vojvodina, University of Novi Sad, Novi Sad 402920, Serbia
(Fiorentino) Department of Cardiothoracic Surgery, National Heart and Lung
Institute, Imperial College, London W12 0NN, United Kingdom
(Pfannschmidt) HELIOS Klinikum Emil Von Behring, Lungenklinik Heckeshorn,
Berlin 14165, Germany
Title
History and present status of pulmonary metastasectomy in colorectal
cancer.
Source
World Journal of Gastroenterology. 20 (40) (pp 14517-14526), 2014. Date of
Publication: 28 Oct 2014.
Publisher
WJG Press
Abstract
Clinical practice with respect to metastatic colorectal cancer differs
from the other two most common cancers, breast and lung, in that routine
surveillance is recommended with the specific intent of detecting liver
and lung metastases and undertaking liver and lung resections for their
removal. We trace the history of this approach to colorectal cancer by
reviewing evidence for effectiveness from the 1950s to the present day.
Our sources included published citation network analyses, the documented
proposal for randomised trials, large systematic reviews, and
meta-analysis of observational studies. The present consensus position has
been adopted on the basis of a large number of observational studies but
the randomised trials proposed in the 1980s and 1990s were either not
done, or having been done, were not reported. Clinical opinion is the
mainstay of current practice but in the absence of randomised trials there
remains a possibility of selection bias. Randomised controlled trials
(RCTs) are now routine before adoption of a new practice but RCTs are
harder to run in evaluation of already established practice. One such
trial is recruiting and shows that controlled trial are possible.

<16>
Accession Number
2014911816
Authors
Kazmierski J. Banys A. Latek J. Bourke J. Jaszewski R.
Institution
(Kazmierski) Department of Old Age Psychiatry and Psychotic Disorders,
Medical University of Lodz, Czechoslowacka 8/10, Lodz 92-216, Poland
(Banys) Department of Anaesthesiology and Intensive Cardiologic Care,
Medical University of Lodz, Lodz, Poland
(Latek) Central Veterans Hospital, Lodz, Poland
(Bourke) Centre for Psychiatry, Barts and the London School of Medicine
and Dentistry, Queen Mary University of London, London, United Kingdom
(Jaszewski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
Title
Raised IL-2 and TNF-alpha concentrations are associated with postoperative
delirium in patients undergoing coronary-artery bypass graft surgery.
Source
International Psychogeriatrics. 26 (5) (pp 845-855), 2014. Date of
Publication: 2014.
Publisher
Cambridge University Press
Abstract
Background: The knowledge base regarding the pathogenesis of postoperative
delirium is limited. The primary aim of this study is to investigate
whether increased levels of IL-2 and TNF-alpha are associated with
delirium in patients who underwent coronary-artery bypass graft (CABG)
surgery with cardiopulmonary bypass (CPB). The secondary aim is to
establish whether any association between raised cytokine levels and
delirium is related to surgical and anesthetic procedures or mediated by
pre-existing conditions associated with raised cytokine levels, such as
major depressive disorder (MDD), cognitive impairment, or aging. Methods:
Patients were examined and screened for MDD and cognitive impairment one
day preoperatively, using the Mini International Neuropsychiatric
Interview and The Montreal Cognitive Assessment and Trail Making Test Part
B. Blood samples were collected postoperatively for cytokine levels.
Results: Postoperative delirium screening was found positive in 36% (41 of
113) of patients. A multivariate logistic regression revealed that an
increased concentration of pro-inflammatory cytokines is associated with
delirium, and related to advancing age, preoperative cognitive decline of
participants, and duration of CPB. According to receiver operating
characteristic analysis, the most optimal cut-off for IL-2 and TNF-alpha
concentrations in predicting the development of delirium were 907.5 U/ml
and 10.95 pg/ml, respectively. Conclusions: The present study suggests
that raised postoperative cytokine concentrations are associated with
delirium after CABG surgery. Postoperative monitoring of pro-inflammatory
markers combined with regular surveillance may be helpful in the early
detection of postoperative delirium in this patient group.

<17>
Accession Number
71693237
Authors
Ramirez M. Guerrero-Orriach J. Bellido I. Galan M. Iglesias P. Rubio M.
Cruz J.
Institution
(Ramirez, Guerrero-Orriach, Galan, Iglesias, Rubio, Cruz) Service of
Anaesthesia, Virgen De La Victoria University Hospital, Malaga, Spain
(Bellido) Department of Pharmacology, School of Medicine, Malaga, Spain
Title
Sevoflurane induced lower postoperative release of troponin 1 and
NT-proBNP than propofol in patient subjected to off-pump coronary artery
bypass graft surgery.
Source
Basic and Clinical Pharmacology and Toxicology. Conference: 35th Congress
of the Spanish Society of Pharmacology Madrid Spain. Conference Start:
20140924 Conference End: 20140926. Conference Publication: (var.pagings).
115 (pp 26-27), 2014. Date of Publication: September 2014.
Publisher
Blackwell Publishing Ltd
Abstract
The effect of general anaesthesia with sevoflurane vs. propofol in
perioperative cardiac function of patients undergoing elective off-pump
coronary artery bypass graft surgery (CAGB) was evaluated by NTproBNP
quantification. Methods: A prospective, longitudinal, double-blind,
randomized and controlled clinical trial was done in ASA class II-IV
patients undergoing elective off-pump CAGB surgery under general
anaesthesia. Exclusion criteria were Euroscore scale value >7, combined
surgery, hemodynamic instability, heart failure and need for vasoactive
drugs before surgery. Patients were randomized in three groups: SEV
intraoperative+ postoperative (SEV), SEV intraoperative+ PRO postoperative
(SP), or PRO intraoperative+ postoperative (PRO). Cardiopulmonary
function, cardiac troponin 1, NT-proBNP and inotropic drugs were recorded
perioperatively during 48 h of follow up. Results: Sixty patients, 48.3%
male, aged 61-74 years old, n = 20/ group, have been followed. The groups
were comparables at the initial evaluation. Anaesthesia with SEV induced
lower postoperative release of troponin 1 and NT-proBNP than PRO. At 24 h
of follow up the troponin 1 ranking order was: i): SEV 0.5 + 0.4 ng/mL*
<<SP 1.61 + 1.30 ng/mL <PRO 2.27 + 1.5 ng/mL (P < 0.05). At 24 h of
following the NT-proBNP ranking order was: SEV 501 + 280 pg/ mL*<<SP 1270
+ 498 pg/mL =PRO 1775 + 527 pg/mL (P < 0.05). Lesser inotropic drug
requirements were associated to SEV with respect to PRO, patients treated
with inotropic were (%): i) At 24 h SEV 10%* =SP 19% <<PRO 51%; and ii) At
48 h: SEV 5%* <<SP 34% <PRO 47% (P < 0.05). Conclusion: Sevoflurane exert
higher cardioprotective effect than propofol perioperatively in patients
undergoing elective off-pump coronary artery bypass graft.

<18>
Accession Number
71690212
Authors
S Yang L. Shan L.L. Saxena A. Morris D.L.
Institution
(S Yang, Shan) Melbourne Medical School, University of Melbourne,
Melbourne, VIC, Australia
(Saxena, Morris) Department of Surgery, South Eastern Sydney and Illawarra
Health Network, Wollongong, NSW, Australia
Title
Liver transplantation: A systematic review of long-term quality of life.
Source
Journal of Gastroenterology and Hepatology (Australia). Conference:
Australian Gastroenterology Week 2014 Broadbeach, QLD Australia.
Conference Start: 20141022 Conference End: 20141024. Conference
Publication: (var.pagings). 29 (pp 83), 2014. Date of Publication:
October 2014.
Publisher
Blackwell Publishing
Abstract
Background: Liver transplantation is the only curative intervention for
terminal liver disease. Accurate long-term quality of life data are
required in the context of improved surgical outcomes and increasing
posttransplant survival. Objectives: This study reviews the long-term
quality of life after primary liver transplantation in adult patients
surviving 5 or more years after surgery. Methods: A literature search was
conducted on PubMed for all studies matching the eligibility criteria
between January 2000 and October 2013. Bibliographies of included studies
were also reviewed. Two authors independently performed screening of
titles and abstracts. Quality appraisal and data tabulation were performed
using pre-determined forms. Results were synthesized by narrative review.
Results: Twenty-three studies (5402 patients) were included. Quality of
life following liver transplantation remains superior to pre-operative
status up to 20 years post-operatively. More post-operative complications
predicted worse quality of life scores especially in physical domains.
Benefits in functional domains persist long-term with independence in
self-care and mobility. Employment rates recover in the short-term but
decline after 5 years, and differ significantly between various etiologies
of liver disease. Overall quality of life improves to a similar level as
the general population, but physical function remains worse. Participation
in post-operative physical activity is associated with superior quality of
life outcomes in liver transplant recipients compared to the general
population. Quality of life improvements are similar compared to lung,
kidney and heart transplantation. Heterogeneity between studies precluded
quantitative analysis. Conclusions: Liver transplantation confers specific
long-term quality of life and functional benefits when compared to
pre-operative status. This information can assist in providing a more
complete estimate of the overall health of liver transplant recipients and
the effectiveness of surgery. Guidelines for future studies are provided.

<19>
Accession Number
71689508
Authors
Pilarczyk K. Jakob H.G. Langebartels G. Boning A. Markewitz A. Haake N.
Heringalke M. Trummer G.
Institution
(Pilarczyk, Jakob) Department of Thoracic and Cardiovascular Surgery, West
German Heart Center Essen, Essen, Germany
(Langebartels) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Koln, Germany
(Boning) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giesen, Germany
(Markewitz) Department of Cardiovascular Surgery, Bundeswehr Central
Hospital Koblenz, Koblenz, Germany
(Haake) Department of Cardiovascular Surgery, School of Medicine,
University of Schleswig-Holstein, Kiel, Germany
(Heringalke) Department of Anesthesiology, University of Lubeck, Lubeck,
Germany
(Trummer) Department of Cardiovascular Surgery, Heart Center Freiburg
University, Bad Krozingen, Germany
Title
Preoperative intra-aortic balloon pumping in high-risk patients undergoing
cardiac surgery: A meta-analysis of randomised controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S92), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Abstract Objectives: In contrast to the results of previous studies,
recent randomised controlled trials (RCTs) failed to show a benefit of
prophylactic aortic counterpulsation in high-risk patients undergoing
cardiac surgery. The present analysis aims to redefine the effects of this
treatment modality in the light of this new evidence. Methods: MEDLINE,
Embase, Central/CCTR, Google Scholar, and reference lists of relevant
articles were searched for full text articles of RCTs in English/German.
Assessments for eligibility, relevance, study validity and data extraction
were performed by two reviewers independently using prespecified criteria.
The primary outcome was hospital mortality. Results: A total of 9 eligible
RCTs with 1171 patients were identified (8 on-pump, 1 off-pump): 577
patients were treated preoperatively with intra-aortic balloon pump (IABP)
and 594 patients served as controls. The pooled odds ratio (OR) for
hospital mortality (22 hospital deaths in the intervention arm, 54 in the
control group) was 0.38 [fixed effects model, 95% confidence interval (CI)
0.23-0.63, P < 0.001, z = 3.77]. The pooled analyses of 6 RCTs including
only patients undergoing isolated on-pump CABG [n (IABP) = 403, n
(control) = 402] also showed a statistically significant improvement in
mortality for preoperative IABP implantation (fixed effects model: OR
0.30, CI 0.162-0.567, z = 3.73, P < 0.001. The pooled OR for hospital
mortality from 2 randomised off-pump trials was 0.42 (fixed effects model,
CI 0.09-1.85; z = 1.143, P = 0.23). Conclusion: Despite seemingly
contradictory results from recent trials, the present study confirms the
findings of previous meta-analyses that prophylactic aortic
counterpulsation reduces hospital mortality in high-risk-patients
undergoing on-pump cardiac surgery.

<20>
Accession Number
71689501
Authors
Je H.G. Ad N.
Institution
(Je, Ad) Cardiac Surgery Research, Inova Heart and Vascular Institute,
Falls Church, United States
Title
Systematic review comparing endocardial full maze to epicardial ablation
and hybrid procedure on safety and efficacy of minimally invasive surgical
ablation for lone atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S90), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Abstract Objectives: There is a growing trend to perform off-bypass
surgical ablation (SA) for atrial fibrillation (AF) as it is perceived
safer and more effective compared to Cox maze (CM) with cardiopulmonary
bypass (CPB). The purpose of this systematic review was to compare three
minimally invasive SA procedures for stand alone AF. Methods: Relevant
studies were identified in MEDLINE and the Cochrane Database of Systematic
Reviews. Exclusion/inclusion criteria were applied to select publications
for screening. From 565 initial citations, 37 studies were included in
this review. Total number of patients was 1877 (range = 10-139). Results:
Endocardial CM was reported in 2 studies (n = 145), epicardial SA was in
26 studies (n = 1382) and hybrid SA was in 9 studies (n = 350). Operative
mortality rate was 0%, 0.4% and 0.7% and perioperative permanent pacemaker
insertion rate was 3.7%, 4.1%, 1.0% in CM, epicardial, and hybrid
procedures, respectively. Incidence of conversion was 0%, 0.7%, 3.6% and
reoperation for bleeding was 1.0%, 3.4%, and 2.5% in CM, epicardial, and
hybrid, respectively. Mean length of stay (days) was 4.9, 5.6, and 5.7 in
CM, epicardial, and hybrid, respectively. At 12 months, sinus rhythm
restoration was 90.5%, 77.7% and 77.4% and off antiarrhythmic medication
was 87%, 76.6%, 66.1% in CM, epicardial, and hybrid, respectively.
Conclusion: In this systematic review, minimally invasive CM was found to
be most effective to treat lone AF along with important safety advantages
in conversion to sternotomy and bleeding. In respect to safety and
efficacy, minimally invasive endocardial CM with CPB support is
advantageous when it comes to outcome and resource utilisation.

<21>
Accession Number
71689461
Authors
Ueki C. Sakaguchi G. Akimoto T. Shintani T. Ohashi Y. Sato H.
Institution
(Ueki, Sakaguchi, Akimoto, Shintani, Ohashi, Sato) Cardiovascular Surgery,
Shizuoka General Hospital, Shizuoka, Japan
Title
Influence of previous percutaneous coronary intervention on clinical
outcome of coronary artery bypass grafting: A meta-analysis of comparative
studies.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S79), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: The prognostic significance of previous percutaneous coronary
intervention (PCI) in patients undergoing coronary artery bypass grafting
(CABG) is still unclear. We conducted this first meta-analysis to assess
whether previous PCI increases postoperative mortality in CABG Methods:
MEDLINE and Embase were searched through April 2014. Studies satisfying
the following criteria were included in this meta-analysis: (1) comparing
CABG patients with previous PCI versus without previous PCI and (2)
reporting hospital mortality Results: Our search identified 19 comparative
studies including 159,337 patients: 141,048 without previous PCI, 18,289
with previous PCI. Pooled analysis demonstrated that previous PCI had an
adverse effect on hospital mortality: odds ratio (OR) 1.48, 95% confidence
interval (CI) 1.14-1.92 (Fig. 1). Further, the subgroup analysis divided
by the proportion of multiple previous PCI (= number of patients with
multiple previous PCI/number of patients with single or multiple previous
PCI) was performed. In the subgroup of studies with the proportion <40%,
the adverse effect was not significant: OR 0.89 (95% CI 0.56-1.40).
However, in the subgroup of studies with the proportion >40%, the adverse
effect of previous PCI was significant: OR 2.26 (95% CI 1.60-3.20). A
meta-regression coefficient was significantly positive for the proportion
of patients with multiple PCI history (coefficient 0.833; 95% CI
0.023-1.640; P = 0.044) Conclusion: This meta-analysis would suggest that
as the proportion of patients with multiple previous PCI in CABG cohort
increases, postoperative mortality also increases. This result
re-emphasises the importance of the heart team approach to coronary
revascularisation .

<22>
Accession Number
71689458
Authors
Deppe A.C. Choi Y. Arbash W. Kuhn E.W. Scherner M. Slottosch I. Rahmanian
P. Liakopoulos O.J. Wahlers T.
Institution
(Deppe, Choi, Arbash, Kuhn, Scherner, Slottosch, Rahmanian, Liakopoulos,
Wahlers) Department of Cardiothoracic Surgery, Heart Center of the
University of Cologne, Cologne, Germany
Title
Current evidence of coronary artery bypass grafting off-pump versus
on-pump: A systematic review with meta-analysis of more than 16,500
patients investigated in 66 randomised controlled trials.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S78), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: The present systematic review with meta-analysis aims to
determine the current strength of evidence for or against off-pump and
on-pump coronary artery bypass grafting (CABG) in regard to hard clinical
endpoints, graft patency and cost effectiveness Methods: A meta-analysis
of randomised control trials (RCT) that reported at least one of the
desired endpoints was performed. Analysed postoperative outcomes included
major adverse cardiac and cerebrovascular events (MACCE), all-cause
mortality, myocardial infarction, cerebrovascular accident, repeat
revascularisation, graft patency and cost effectiveness. Pooled treatment
effects [odds ratio (OR) or weighted mean difference (WMD), 95% confidence
intervals (95% CI)] were assessed using a fixed or random effects model
Results: A total of 16,663 patients from 66 RCTs were identified after a
literature search of major databases using a predefined keywords list.
Incidence of composite MACCE did not differ between groups during the
first 30 days (OR 0.93; 95% CI 0.82-1.04) or for the longest available
follow-up (OR 1.01; 95% CI 0.92-1.12). While incidence of mid-term graft
failure (OR 1.37; 95% CI 1.09-1.72) and need for repeat revascularisation
(OR 1.55; 95% CI 1.33-1.80) was increased after off-pump surgery, on-pump
surgery was associated with increased risk of stroke (OR 0.76; 95% CI
0.59-0.99), renal impairment (OR 0.78; 95% CI 0.65-0.93) and mediastinitis
(OR 0.44; 95% CI 0.31-0.62). No impact of revascularisation technique on
hard endpoints such as myocardial infarction or mortality was seen
Conclusion: The present systematic review emphasises that both strategies,
off-pump and on-pump, are suitable alternatives for CABG. The choice for
either procedure should be individualised for each single patient with
regard to comorbidities, life expectancy, and the surgeon's experience.

<23>
Accession Number
71689431
Authors
Deo S. Lim J.Y. Altarabsheh S.E. Rababah A. Cho Y.H. Park S.J.
Institution
(Deo) Cardiovascular Surgery, Adventist Wockhardt Heart Hospital, Surat,
India
(Lim) Cardiac Surgery, Asan Medical Center, Seoul, South Korea
(Altarabsheh) Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan
(Rababah) Pharmacology, Jordan Institute of Science and Technology, Irbid,
Jordan
(Cho) Cardiac Surgery, Samsung Medical Center, Seoul, South Korea
(Park) Cardiac Surgery, Case Medical Center, Cleveland, United States
Title
Levosimendan does not improve outcome in patients after adult cardiac
surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S69), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: Levosimendan is utilised for the treatment of low cardiac
output after adult cardiac surgery. However, opinion regarding its benefit
is divided. Hence we performed a systematic review to answer this question
Methods: Systematic review of MEDLINE was performed (inception to April
2014) to identify randomised controlled trials comparing levosimendan and
alternative therapy/placebo after adult cardiac surgery. Pooled analysis
was performed to obtain the odds ratio (OR) using the Peto method.
Continuous data was combined as the weighted mean difference (WMD).
Publication bias was analysed with the funnel plot; heterogeneity was
quantified as the Egger's I2. Results were also presented stratified as
per normal or low ejection fraction Results: Eleven studies (856 patients)
fulfilled search criteria; early mortality (5.3% and 5.7% in the
levosimendan and control cohorts, respectively) was comparable [OR 0.76
(0.36, 1.59); P = 0.47; I2 = 33%]. This result was true even in patients
with low ejection fraction (LVEF < 35%). Postoperative renal failure
(levosimendan 429, control 427 patients) was also similar in both cohorts
[OR 0.76 (0.36, 1.59); P = 0.47]. Hospital stay was lower with
levosimendan therapy [WMD -0.93 days (-1.59, -0.28); P < 0.01] Conclusion:
Levosimendan administration does not benefit patients after adult cardiac
surgery, even those with low ejection fraction. Although it does result in
reduced hospital stay, our review of published randomised controlled
trials did not find any other clinical benefit supporting the role of
levosimendan in patients with low cardiac output syndrome after adult
cardiac surgery.

<24>
Accession Number
71689426
Authors
Menicanti L. Mocanu I. Miraldi F. Marasco S. Hinson A. Lee R.J. Sabbah
H.N. Mann D.L.
Institution
(Menicanti) CardioThoracic Surgery, I.R.C.C.S. Policlinico San Donato, San
Donato, Italy
(Mocanu) CardioThoracic Surgery, Army's Center for Cardiovascular Disease,
Bucharest, Romania
(Miraldi) Department of Surgery, University of Rome La Sapienza, Rome,
Italy
(Marasco) Cardiothoracic Unit, Alfred Hospital, Melbourne, Australia
(Hinson) Cardiovascular Research, LoneStar Heart, Inc, Laguna Hills,
United States
(Lee) Cardiac Electrophysiology, UCSF, San Francisco, United States
(Sabbah) Cardiovascular Research, Henry Ford Health System, Detroit,
United States
(Mann) Cardiovascular Division, Washington University, School of Medicine,
St. Louis, United States
Title
Safety of a novel surgical therapy for the treatment of advanced heart
failure: Review of surgical morbidity and mortality of algisyl-LVR from
the augment-HF trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S68), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: Therapeutic options for patients with severe heart failure
(HF), refractory to pharmacological therapies, are limited. Algisyl-LVR is
a novel device under development for left ventricular (LV) augmentation of
patients with advanced HF secondary to dilated cardiomyopathy. Algisyl-LVR
is a proprietary biopolymer that is injected into the LV-free-wall as a
permanent implant. Preclinical and clinical studies of Algisyl-LVR suggest
that the addition of non-contractile material to the failing myocardium
increases wall thickness, reduces wall stress and attenuates
LV-remodelling with improvements in LV function Methods: AUGMENT-HF is a
multicentre randomised controlled trial of Algisyl-LVR in patients with HF
of ischaemic or non-ischaemic origin. Thirty patients with an LVEDDi of
30-40 mm/m², mean NYHA class 3.0 + 0.4, and a mean ejection
fraction (EF) of 25.9 + 5.7% were randomised to LV augmentation with
Algisyl-LVR via limited anterior thoracotomy. Algisyl-LVR hydrogel
implants were placed into the LV wall along the circumference of the LV
free wall as a total of 10-18 implants (0.3 ml each). Thirty patients with
LVEDDi of 30-40 mm/m², mean NYHA class 2.9 + 0.5, and a mean EF
of 26.5 + 5.6% were randomised to stable, evidence-based therapy (no
surgery) as controls Results: Algisyl-LVR implants were successfully
performed in all 30 active treatment patients. Table 1 summarises
procedural morbidity and mortality observed in patients receiving
Algisyl-LVR along with the post-procedural changes in functional capacity.
Conclusion: These results demonstrate the safety of this novel surgical
procedure employing Algisyl-LVR implants via a limited anterior
thoracotomy in patients with severe HF. (Table Presented).

<25>
Accession Number
71689350
Authors
Lang P. Manickavasagar M. Burdett C. Fiorentino F. Treasure T.
Institution
(Lang, Manickavasagar) Department of Cardiac Surgery, Royal Sussex County
Hospital, Brighton, United Kingdom
(Burdett) Department of Cardiothoracic Surgery, James Cook Hospital,
Middlesbrough, United Kingdom
(Fiorentino) Department of Cardiothoracic Surgery, Imperial College
London, London, United Kingdom
(Treasure) Clinical Operational Research Unit, University College London,
Badlesmere, United Kingdom
Title
Suction on chest drains following lung resection: Evidence and practice
are not aligned.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S46-S47), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: A Best Evidence Topic in the Interactive CardioVascular and
Thoracic Surgery journal (2006) looked at application of suction to chest
drains following pulmonary lobectomy. After screening 391 papers, the
authors analysed 6 studies (5 RCTs) and found no evidence in favour of
postoperative suction in terms of air leak duration, time to chest drain
removal or length of stay. Indeed, suction was found to be detrimental in
4 studies. We sought to determine whether clinical practice is consistent
with published evidence by surveying thoracic units nationally. Methods:
We performed a meta-analysis of the 6 "best evidence" papers and generated
a forest plot using RevMan. Members of a national trainees' research
network were emailed a survey concerning chest drain management following
non-pneumonectomy lung resection. A clinical representative from each unit
was asked if there was a written unit protocol concerning suction on chest
drains and whether suction was routinely applied. Results: Meta-analysis
showed that when no suction was used, mean chest tube duration (3.0 days,
n = 123) and length of stay (4.1 days, n = 84) were shorter compared to
when suction was used (4.5 days, n = 154; 7.4 days, n = 84, respectively)
(Table 1). The forest plot, similarly, showed a non-significant difference
but in favour of no suction (Fig. 1). Results of national thoracic survey
Conclusion: Application of suction to chest drains following
non-pneumonectomy lung resection is common practice nationally. Suction
has an effect in hastening removal of air and fluid in clinical
experience, but a policy of suction after lobectomy has not been shown to
have benefit. Clinical practice is not aligned with Level 1a evidence.
(Table Presented).

<26>
Accession Number
71689345
Authors
Benedetto U. Biondi-Zoccai G. Tonelli E. Frati G.
Institution
(Benedetto, Biondi-Zoccai, Tonelli, Frati) Cardiac Surgery, Sapienza
University of Rome, Rome, Italy
Title
European real-world transcatheter aortic valve implantation: Systematic
review and meta-analysis of european national registries.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S45), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) has been
adopted rapidly in Europe despite the paucity of randomised studies
conducted on super-selected patients who do not reflect the daily
practice. TAVI registries represent a real-world scenario to assess
outcomes and guide the decision making process for TAVI. Methods: A
systematic review and meta-analysis of European national TAVI registries
was performed. The review focused on the comparison of the following TAVI
technologies: SAPIEN transapical valve (STA), SAPIEN transfemoral valve
(STF) and CoreValve (CV). Individual event rates for outcomes of interest
were pooled using a mixed-effect model and compared using Q-Cochrane total
between-groups test. Results: A total of seven European national TAVI
registries (UK, Swiss, Belgium, Italy, Spain, France, Germany) were
identified, including a total of 9860 patients who received STA (n =
2337), STF (n = 2874) and CV (n = 4649) implantation. STA showed a trend
towards an increased 30-day mortality (12.3%, P = 0.04) when compared to
STF (5.1%) and CV (7.0%). The incidence of periprocedural stroke was
comparable among the 3 technologies (STA 2.9%, STF 3.6%, CV 4.3%, P =
0.8). CV was associated with an increased need for permanent pacemaker
implantation (18%, P = 0.003) when compared to STA (6.9%) and STF (8.1%).
Paravalvular leak incidence >2+ grade was comparable among the 3 groups
(overall rate 6%; P = 0.15). An increased 1-year mortality was found for
STA (23.1%, P = 0.03) when compared to STF (18.1%) and CV (13.4%). These
results were confirmed when adjusted for baseline patient risk profile
(meta-regression-P = 0.09). High heterogeneity among countries was
observed for all outcomes investigated (P < 0.001). Conclusion: In the
European real-world practice, transvascular TAVI approaches were
associated with a lower early mortality regardless of the type of device
used and did not increase the risk of stroke or significant paravalvular
leak.

<27>
Accession Number
71689273
Authors
Altarabsheh S.E. Deo S. Rabab'h A. Sharma V. Lim J.Y. Cho Y.H. Park S.J.
Institution
(Altarabsheh) Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan
(Deo) Cardiac Surgery, Adventist Wockhardt Heart Hospital, Surat, India
(Rabab'h) Pharmacology, Jordan institute of Science and Technology, Irbid,
Jordan
(Sharma) Surgery, Wellspan York Hospital, York, United States
(Lim) Cardiac Surgery, Asan Medical Center, Seoul, South Korea
(Cho) Cardiac Surgery, Samsung Hospital, Seoul, South Korea
(Park) Cardiac Surgery, Case Medical Center, Cleveland, United States
Title
Off-pump coronary artery bypass reduces early stroke in octogenarians: A
meta-analysis of 18,000 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S22-S23), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Abstract Objectives: Data comparing results of off-pump and conventional
surgery in octogenarians is very limited. Thus we chose to compare early
adverse events between off-pump (OPCABG) and on-pump coronary artery
bypass grafting (ONCABG) in patients above 80 years. Methods: A systematic
review of multiple databases was performed to obtain original studies
fulfilling search criteria. End-points (early mortality, stroke,
respiratory failure, atrial fibrillation and myocardial infarction) were
compared between the two cohorts. A random-effect Mantel-Haenszel analysis
was performed using the trim-fill adjustment where necessary. Results are
presented as risk ratios (95% confidence interval); P < 0.05 is considered
statistically significant. Results: Sixteen retrospective studies (9744
ONCABG and 8566 OPCABG patients) were included in the systematic review.
OPCAGB patients had significantly lower grafts (2.54 + 0.16) as compared
to ONCABG (3.22 + 0.41). Early mortality was comparable at 4.6% and 5.2%
in the OPCABG and ONCABG cohorts respectively [RR 0.91 (0.64-1.28); P =
0.598]. Stroke rates (8566 OPCABG; 9744 ONCABG) were higher with
conventional surgery [RR 0.65 (0.49-0.87); P < 0.01]. Respiratory failure
was higher with ONCABG as compared to OPCABG [RR = 0.74 (0.57-0.97); P =
0.03]. New onset renal failure (P = 0.99), atrial fibrillation (P = 0.27)
and myocardial infarction (P = 0.99) were comparable. Conclusion: Coronary
artery bypass in octogenarians can be performed with low early mortality.
Number of grafts is lesser in the OPCABG cohort. While stroke rates are
higher with conventional surgery, all other adverse events are comparable.
Future randomised trials are needed to define the role of off-pump surgery
in this high-risk cohort.

<28>
Accession Number
71689241
Authors
Lijkendijk M. Licht P.B. Neckelmann K.
Institution
(Lijkendijk, Licht, Neckelmann) Department of Cardiothoracic Surgery,
Odense University Hospital, Odense, Denmark
Title
Digital versus analogue chest tube drainage following lobectomy: A
randomised trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 28th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2014 Milan Italy. Conference Start: 20141011 Conference End: 20141015.
Conference Publication: (var.pagings). 19 (pp S13), 2014. Date of
Publication: October 2014.
Publisher
Oxford University Press
Abstract
Abstract Objectives: Digital drainage systems (DDS) have shown superiority
compared with analogue (water seal) drainage systems (ADS) following
various lung resections, but the number of studies is limited. As part of
a medico-technical evaluation before switching to DDS for routine thoracic
surgery, we conducted a randomised controlled trial (RCT) investigating
chest tube duration and length of stay. Methods: Patients undergoing
lobectomy for non-small-cell lung cancer (NSCLC) were included in a
prospective open label RCT. A strict algorithm was designed for early
chest tube removal and this decision was delegated to nurses in charge of
postoperative care. Kaplan-Meier survival analysis with log-rank test was
performed on an intention-to-treat basis. Time was distinguished as
possible (optimal) and actual time for chest tube removal. Results: A
total of 105 patients were randomised. We found no significant difference
between DDS and ADS in length of hospitalisation (P = 0.84), actual chest
tube duration (P = 0.49) or optimal chest tube duration (P = 0.32). No
chest tubes had to be reinserted. Conclusion: Digital drainage systems did
not reduce length of hospitalisation or chest tube duration significantly
compared with standard water seal when a strict algorithm for chest tube
removal was used. However, they allowed removal of chest tubes, which
could be delegated to staff nurses, and in some patients chest tubes could
be removed safely on the day of surgery.