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<1>
Accession Number
23485658
Authors
Erdogan A.
Institution
(Kol) Department of Nursing, Akdeniz University, School of Medicine,
Antalya, Turkey. Electronic address: ekol@akdeniz.edu.tr
(Alpar) Department of Nursing, Marmara University, Faculty of Health
Sciences, Istanbul, Turkey
(Erdogan) Department of Thoracic Surgery, Akdeniz University, School of
Medicine, Antalya, Turkey
Title
Preoperative education and use of analgesic before onset of pain routinely
for post-thoracotomy pain control can reduce pain effect and total amount
of analgesics administered postoperatively.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 15 (1) (pp 331-339), 2014. Date of Publication: 01 Mar
2014.
Abstract
The purpose of this study was to investigate the efficiency of
preoperative pain management education and the role of analgesics
administration before the onset of pain postoperatively. The study was a
prospective, randomized, and single-blind clinical trial, which was
conducted January 1, 2008 through October 1, 2008 in the Thoracic Surgery
Unit of Akdeniz University Hospital. A total of 70 patients who underwent
thoracotomy (35 in the control group and 35 in the study group) were
included in the study. Of the patients, 70% (n = 49) were male and 30% (n
= 21) were female. Mean age was 51 +/- 10 years (range = 25-65). The same
analgesia method was used for all patients; the same surgical team
performed each operation. Methods, including preemptive analgesia and
placement of pleural or thoracic catheter for using analgesics, that were
likely to affect pain level, were not used. The same analgesia medication
was used for both patient groups. But the study group, additionally, was
educated on how to deal with pain preoperatively and on the
pharmacological methods to be used after surgery. An intramuscular
diclofenac Na 75 mg was administered to the study group regardless of
whether or not they reported pain in the first two postoperative hours.
The control group did not receive preoperative education, and analgesics
were not administered to them unless they reported pain in the
postoperative period. The routine analgesics protocol was as follows:
diclofenac Na 75 mg (once a day) intramuscular administered upon the
complaint of pain following extubation in the postoperative period and 20
mg mepederin intravenously (maximum dose, 100 mg/day), in addition, when
the patient expressed pain. Pain severity was assessed during the second,
fourth, eighth, 16th, 24th, and 48th hours, and marked using the Verbal
Category Scale and the Behavioral Pain Assessment Scale. Additionally, the
total dose of daily analgesics was calculated. The demographic
characteristics showed a homogeneous distribution in both patient groups.
The rate of pain, which was defined as sharp, stabbing, and exhausting,
was higher in the control group than in the study group, and the
difference between the two groups was statistically significant (p < .05).
As the doses of analgesics used for pain management in both groups were
compared, it was determined that analgesic consumption was lower in the
study group than in the control group, and the difference was
statistically significant (p < .05). As a result, it was determined that
preoperative thoracic pain management education and analgesics
administered postoperatively, before the onset of pain, reduced the amount
of analgesics used in the first postoperative 48 hours.

<2>
Accession Number
24619042
Authors
Luger T.J. Kammerlander C. Luger M.F. Kammerlander-Knauer U. Gosch M.
Institution
(Luger, Kammerlander, Luger, Kammerlander-Knauer, Gosch) Department of
Anaesthesiology and Critical Care Medicine, Innsbruck Medical University,
Anichstr. 25, 6020, Innsbruck, Austria, thomas.luger@i-med.ac.at
Title
Mode of anesthesia, mortality and outcome in geriatric patients.
Source
Zeitschrift fur Gerontologie und Geriatrie. 47 (2) (pp 110-124), 2014.
Date of Publication: 01 Feb 2014.
Abstract
BACKGROUND: In older non-cardiac surgery patients, the influence of the
mode of anesthesia on late-term outcome (rehabilitation, mobility,
independence) is a controversial issue in the medical literature. In light
of an aging society, this review assessed the association between regional
(RA), local (LA) and general anesthesia (GA) and mortality and morbidity.
METHODS: A literature search within the PubMed and Cochrane databases
yielded 47 clinical trials and 35 reviews/meta-analyses published between
1965 and 2013. Potential outcome-influencing factors such as mortality,
risk factors, early complications (e.g. postoperative confusion,
aspiration, vomiting), adverse events (e.g. deep vein thrombosis,
pulmonary embolism), discharge, rehabilitation and mobilization were
evaluated in relation to the mode of anesthesia (RA, LA or GA).
RESULTS: The current literature contains 82 references covering 74,476
non-cardiac surgery patients. Analysis shows that the particular mode of
anesthesia influences mortality and morbidity. RA is associated with
reduced early mortality and morbidity, e.g. fewer incidents of deep vein
thrombosis and less acute postoperative confusion, as well as a tendency
toward fewer myocardial infarctions and fatal pulmonary embolisms. GA has
the advantages of a lower incidence of hypotension and reduced surgery
time.
CONCLUSION: Strictly speaking, true anesthesia-related complications
appear to be rare and many adverse outcomes may be multifactorial.
Postoperative complications are largely related to the perioperative
procedure and not to the anesthesia itself. GA and RA are both useful for
older non-cardiac patients, but for some procedures, e.g. hip fracture
surgery, RA seems to be the technique of choice. The mode of anesthesia
may only play a secondary role in mobility, rehabilitation and discharge
destination. In general, due to the many different possible
outcomes--which are often very difficult or impossible to compare--no
other specific recommendations can be made with regard to the type of
anesthesia to be preferred for older non-cardiac patients.

<3>
Accession Number
24621972
Authors
Velazquez E.J.
Institution
(Carson) Washington DC VA Medical Center, Washington DC. Electronic
address:
(Wertheimer) Pennsylvania Heart and Vascular Group, Philadelphia,
Pennsylvania
(Miller) University of Florida-Shands Jacksonville, Jacksonville, Florida
(O'Connor) Duke University Medical Center/Duke Clinical Research
Institute, Durham, North Carolina
(Pina) Montefiore Medical Center, Bronx, New York
(Selzman) University of Utah School of Medicine, Salt Lake City, Utah
(Sueta) University of North Carolina, Chapel Hill, North Carolina
(She) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Greene) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Lee) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Jones) Duke University Medical Center/Duke Clinical Research Institute,
Durham, North Carolina
(Velazquez) Duke University Medical Center/Duke Clinical Research
Institute, Durham, North Carolina
Title
The STICH trial (Surgical Treatment for Ischemic Heart Failure):
mode-of-death results.
Source
JACC. Heart failure. 1 (5) (pp 400-408), 2013. Date of Publication: 01 Oct
2013.
Abstract
OBJECTIVES: This study sought to assess the effect of the addition of
coronary artery bypass grafting (CABG) to medical therapy on mode of death
in heart failure.
BACKGROUND: Although CABG therapy is widely used in ischemic
cardiomyopathy patients, there are no prospective clinical trial data on
mode of death.
METHODS: The STICH (Surgical Treatment for Ischemic Heart Failure ) trial
compared the strategy of CABG plus medical therapy to medical therapy
alone in 1,212 ischemic cardiomyopathy patients with reduced ejection
fraction. A clinical events committee adjudicated deaths using
pre-specified definitions for mode of death.
RESULTS: In the STICH trial, there were 462 deaths over a median follow-up
of 56 months. The addition of CABG therapy tended to reduce cardiovascular
deaths (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.68 to
1.03; p = 0.09) and significantly reduced the most common modes of death:
sudden death (HR: 0.73; 95% CI: 0.54 to 0.99; p = 0.041) and fatal pump
failure events (HR: 0.64; 95% CI: 0.41 to 1.00; p = 0.05). Time-dependent
estimates indicate that the protective effect of CABG principally occurred
after 24 months in both categories. Deaths post-cardiovascular procedures
were increased in CABG patients (HR: 3.11; 95% CI: 1.47 to 6.60), but
fatal myocardial infarction deaths were lower (HR: 0.07; 95% CI: 0.01 to
0.57). Noncardiovascular deaths were infrequent and did not differ between
groups.
CONCLUSIONS: In the STICH trial, the addition of CABG to medical therapy
reduced the most common modes of death: sudden death and fatal pump
failure events. The beneficial effects were principally seen after 2
years. Post-procedure deaths were increased in patients randomized to
CABG, whereas myocardial infarction deaths were decreased.

<4>
Accession Number
24621971
Authors
Nicholls S.J.
Institution
(Kobashigawa) Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center,
Los Angeles, California. Electronic address: Kobashigawaj@cshs.org
(Pauly) Division of Cardiovascular Medicine, University of Florida College
of Medicine, Gainesville, Florida
(Starling) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
(Eisen) Division of Cardiology, Drexel University College of Medicine,
Philadelphia, Pennsylvania
(Ross) Division of Experimental Therapeautics, Toronto Medical Hospital,
Toronto, Ontario, Canada
(Wang) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taipei, Taiwan
(Cantin) Lipid Research Center, Laval University Medical Center, Quebec,
Canada
(Hill) Division of Cardiovascular Medicine, University of Florida College
of Medicine, Gainesville, Florida
(Lopez) Novartis Pharma AG, Basel, Switzerland
(Dong) Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
(Nicholls) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
Title
Cardiac allograft vasculopathy by intravascular ultrasound in heart
transplant patients: substudy from the Everolimus versus mycophenolate
mofetil randomized, multicenter trial.
Source
JACC. Heart failure. 1 (5) (pp 389-399), 2013. Date of Publication: 01 Oct
2013.
Abstract
METHODS: Study patients were a pre-specified subgroup of the 553-patient
Everolimus versus mycophenolate mofetil in heart transplantation: a
randomized, multicenter trial who underwent heart transplantation and were
randomized to everolimus 1.5 mg or MMF 3 g/day. IVUS was performed at
baseline and at 12 months. Evaluable IVUS data were available in 189
patients (34.6%).
RESULTS: Increase in average maximal intimal thickness (MIT) from baseline
to month 12 was significantly smaller in the everolimus 1.5 mg group
compared with the MMF group (0.03 mm vs. 0.07 mm, p < 0.001). The
incidence of CAV, defined as an increase in MIT from baseline to month 12
of greater than 0.5 mm, was 12.5% with everolimus versus 26.7% with MMF (p
= 0.018). These findings remained irrespective of sex, age, diabetic
status, donor disease, and across lipid categories.
CONCLUSIONS: Everolimus was significantly more efficacious than MMF in
preventing CAV as measured by IVUS among heart-transplant recipients after
1 year, a finding, which was maintained in a range of patient
subpopulations. CV surgery: transplantation, ventricular assistance,
cardiomyopathy.
OBJECTIVES: A pre-planned substudy of a larger multicenter randomized
trial was undertaken to compare the efficacy of everolimus with
reduced-dose cyclosporine in the prevention of cardiac allograft
vasculopathy (CAV) after heart transplantation to that of mycophenolate
mofetil (MMF) with standard-dose cyclosporine.
BACKGROUND: CAV is a major cause of long-term mortality following heart
transplantation. Everolimus has been shown to reduce the severity and
incidence of CAV as measured by first year intravascular ultrasound
(IVUS). MMF, in combination with cyclosporine, has also been shown to have
a beneficial effect in slowing the progression of CAV.

<5>
Accession Number
2015681351
Authors
Verdoia M. Schaffer A. Suryapranata H. De Luca G.
Institution
(Verdoia, Schaffer, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Effects of HDL-modifiers on cardiovascular outcomes: A meta-analysis of
randomized trials.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 25 (1) (pp 9-23), 2015.
Date of Publication: 01 Jan 2015.
Publisher
Elsevier
Abstract
Background and aim: High density lipoproteins (HDL) have been addressed as
a potential strategy for cardiovascular prevention, with great
controversies on pharmacological approaches for HDL-elevation. Our aim was
to compare HDL-rising treatment with niacin or CETP-inhibitors with
optimal medical therapy in cardiovascular outcome. Methods and results:
Randomized trials were searched. Primary endpoint was cardiovascular
death, secondary were: non fatal myocardial infarction; coronary
revascularization; cerebrovascular accidents and safety endpoints. As many
as 18 randomized trials, for a total of 69,515 patients, were included.
HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR
[95%CI]=0.96 [0.87-1.05], p=0.37, phet=0.58), with no benefit from
niacin/CETP inhibitors according to patients' risk profile (beta
[95%CI]=-0.14 [-0.29 to 0.02], p=0.09) or the amount of HDL increase (beta
[95%CI]=0.014 [-0.008 to 0.04], p=0.21). Niacin but not CETP-I reduced
myocardial infarction and coronary revascularization, but higher rate of
SAE occurred with HDL-modifiers (OR [95%CI]=1.24 [1.18-1.31], p<0.00001,
phet=0.02), in particular new onset of diabetes with niacin and worsening
of hypertension with CETP-inhibitors. Conclusions: Niacin and CETP
inhibitors do not influence cardiovascular mortality. Significant benefits
in MI and coronary revascularization were observed with niacin, despite
the higher occurrence of diabetes.

<6>
Accession Number
2015671981
Authors
Zhu H.-C. Li Y. Guan S.-Y. Li J. Wang X.-Z. Jing Q.-M. Wang Z.-L. Han
Y.-L.
Institution
(Zhu) Second Affiliated Hospital of Dalian Medical University, Dalian,
Shandong Province 116023, China
(Zhu, Li, Guan, Li, Wang, Jing, Wang, Han) Cardiovascular Institute,
General Hospital of Shenyang Military Region, Department of Cardiology,
Shenyang, Liaoning Province 110016, China
Title
Efficacy and safety of individually tailored antiplatelet therapy in
patients with acute coronary syndrome after coronary stenting: A single
center, randomized, feasibility study.
Source
Journal of Geriatric Cardiology. 12 (1) (pp 23-29), 2015. Date of
Publication: 2015.
Publisher
Science Press
Abstract
Background: Low responsiveness to clopidogrel (LRC) is associated with
increased risk of ischemic events. This study was aimed to explore the
feasibility of tailored antiplatelet therapy according to the
responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive
patients with acute coronary syndromes (ACS) undergoing coronary stenting
were randomly assigned to receive standard (n = 151) or tailored (n = 154)
antiplatelet therapy. The ADP-induced platelet aggregation tests by light
transmission aggregometry were performed to identify LRC patients assigned
to the tailored group. The standard antiplatelet regimen was dual
antiplatelet therapy with aspirin and clopidogrel. The tailored
antiplatelet therapy was standard regimen for non-LRC patients and an
additional 6-month cilostazol treatment for LRC patients. The primary
efficacy outcome was the composite of cardiovascular death, myocardial
infarction or stroke at one year. Results: LCR was present in 26.6%
(41/154) of patients in the tailored group. The percentage platelet
aggregation for LCR patients was significantly decreased at three days
after adjunctive cilostazol treatment (77.5% +/- 12.1% vs. 64.5% +/-
12.1%, P < 0.001). At one year follow-up, a non-significant 37% relative
risk reduction of primary events were observed in the tailored group as
compared to the standard group (5.8% vs. 9.3%, P = 0.257). There were no
differences in the rates of stent thrombosis and hemorrhagic events
between the two groups. Conclusions: Tailored antiplatelet therapy for ACS
patients after coronary stenting according to responsiveness to
clopidogrel is feasible. However, its efficacy and safety need further
confirmation by clinical trials with larger sample sizes.

<7>
Accession Number
2014825028
Authors
Suehiro K. Tanaka K. Yamada T. Matsuura T. Funao T. Mori T. Nishikawa K.
Institution
(Suehiro, Tanaka, Yamada, Matsuura, Funao, Mori, Nishikawa) Department of
Anaesthesiology, Osaka City University, Graduate School of Medicine,
Osaka, Japan
Title
The utility of intra-operative three-dimensional transoesophageal
echocardiography for dynamic measurement of stroke volume.
Source
Anaesthesia. 70 (2) (pp 150-159), 2015. Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Summary Measurement of left ventricular stroke volume and cardiac output
is very important for managing haemodynamically unstable or critically ill
patients. The aims of this study were to compare stroke volume measured by
three-dimensional transoesophageal echocardiography with stroke volume
measured using a pulmonary artery catheter, and to examine the ability of
three-dimensional transoesophageal echocardiography to track stroke volume
changes induced by haemodynamic interventions. This study included 40
cardiac surgery patients. Haemodynamic variables were measured before and
2 min after haemodynamic interventions, which consisted of phenylephrine
100 mug or ephedrine 5 mg. We used Bland-Altman analysis to assess the
agreement between the stroke volume measured by three-dimensional
transoesophageal echocardiography and by the pulmonary artery catheter.
Polar-plot and 4-quadrant plot analyses were used to assess the trending
ability of three-dimensional transoesophageal echocardiography compared
with the pulmonary artery catheter. Bias and percentage error were -1.2 ml
and 20%, respectively. The concordance rate in the 4-quadrant analysis
after phenylephrine and ephedrine administration was 75% and 84%,
respectively. In the polar-plot analysis, the angular concordance rate was
66% and 73% after phenylephrine and ephedrine administration,
respectively. Three-dimensional transoesophageal echocardiography was
clinically acceptable for measuring stroke volume; however, it was not
sufficiently reliable for tracking stroke volume changes after
haemodynamic interventions.

<8>
Accession Number
2015672891
Authors
Haddadzadeh M. Motavaselian M. Rahimianfar A.A. Forouzannia S.K. Emami M.
Barzegar K.
Institution
(Haddadzadeh, Motavaselian, Rahimianfar, Forouzannia, Emami, Barzegar)
Department of Surgery, Cardiovascular Research Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
The effect of posterior pericardiotomy on pericardial effusion and atrial
fibrillation after off-pump coronary artery bypass graft.
Source
Acta Medica Iranica. 53 (1) (pp 57-61), 2015. Date of Publication: 2015.
Publisher
Medical Sciences University of Teheran
Abstract
The most common type of arrhythmia following coronary artery bypass graft
(CABG) is atrial fibrillation (AF) with an incidence rate of 20-30%.
Pericardial effusion is one of the etiologic factors of atrial
fibrillation occurring after CABG. Posterior pericardiotomy (PP) causes
the drainage of blood and fluids from the pericardial space into the
pleural space leading to a decreased pericardial effusion. Most of the
studies dealing with the occurrence of AF in the surgical operation of
CABG have focused on patients undergoing on-pump CABG. The purpose of the
present study was to determine the effect of posterior pericardiotomy on
pericardial effusion and atrial fibrillation following the off-pump CABG.
This study was a clinical trial conducted on 207 patients. The patients
were randomly assigned to groups A, and B. Posterior pericardiotomy was
performed on the patients in Group A. This was not done on patients in
Group B. Following general anesthesia and median sternotomy, the left
internal mammary artery (LIMA) and saphenous vein were harvested
simultaneously. Following the injection of heparin, distal and proximal
anastomosis was performed and at the end of surgery, a longitudinal
incision with a length of 4 cm was performed parallel and posterior to the
left phrenic nerve from the left vein to diaphragm for patients in the
pericardiotomy group. 105 patients in the pericardiotomy group and 102
patients in the control group were examined regarding demographic
variables, AF incidence, and pericardial effusion. There was no
statistically significant correlation between two groups. There was no
statistically significant difference between the two groups regarding the
rate of AF incidence (P=0.719) and the rate of pericardial effusion (P=1).
Posterior pericardiotomy has no effect on postoperative AF incidence and
pericardial effusion in patients undergoing the off-pump CABG.

<9>
Accession Number
2015667879
Authors
Candilio L. Malik A. Ariti C. Barnard M. Di Salvo C. Lawrence D. Hayward
M. Yap J. Roberts N. Sheikh A. Kolvekar S. Hausenloy D.J. Yellon D.M.
Institution
(Candilio, Malik, Hausenloy, Yellon) Hatter Cardiovascular Institute,
University College London, 67 Chenies Mews, London WC1E 6HX, United
Kingdom
(Ariti) Nuffield Trust, London, United Kingdom
(Barnard, Di Salvo, Lawrence, Hayward, Yap, Roberts, Sheikh, Kolvekar)
Heart Hospital, University College London Hospital, London, United Kingdom
Title
Effect of remote ischaemic preconditioning on clinical outcomes in
patients undergoing cardiac bypass surgery: A randomised controlled
clinical trial.
Source
Heart. 101 (3) (pp 185-192), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives Remote ischaemic preconditioning (RIPC), using brief cycles of
limb ischaemia/reperfusion, is a non-invasive, low-cost intervention that
may reduce perioperative myocardial injury (PMI) in patients undergoing
cardiac surgery. We investigated whether RIPC can also improve short-term
clinical outcomes. Methods One hundred and eighty patients undergoing
elective coronary artery bypass graft (CABG) surgery and/ or valve surgery
were randomised to receive either RIPC (2-5 min cycles of simultaneous
upper arm and thigh cuff inflation/deflation; N=90) or control (uninflated
cuffs placed on the upper arm and thigh; N=90). The study primary end
point was PMI, measured by 72 h area under the curve (AUC) serum
high-sensitive troponin-T (hsTnT); secondary end point included short-term
clinical outcomes. Results RIPC reduced PMI magnitude by 26% (-9.303
difference (CI - 15.618 to - 2.987) 72 h hsTnT-AUC; p=0.003) compared with
control. There was also evidence that RIPC reduced the incidence of
postoperative atrial fibrillation by 54% (11% RIPC vs 24% control;
p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0%
RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1 day
(2.0 days RIPC (CI 1.0 to 4.0) vs 3.0 days control (CI 2.0 to 4.5);
p=0.043). In a post hoc analysis, we found that control patients
administered intravenous glyceryl trinitrate (GTN) intraoperatively
sustained 39% less PMI compared with those not receiving GTN, and RIPC did
not appear to reduce PMI in patients given GTN. Conclusions RIPC reduced
the extent of PMI in patients undergoing CABG and/or valve surgery. RIPC
may also have beneficial effects on short-term clinical outcomes, although
this will need to be confirmed in future studies. Trial registration
number ClinicalTrials.gov ID: NCT00397163.

<10>
Accession Number
2015672755
Authors
Ranjbaran S. Dehdari T. Sadeghniiat-Haghighi K. Majdabadi M.M.
Institution
(Ranjbaran) Department of Health Education and Health Promotion, School of
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Dehdari) Department of Health Education and Health Promotion, School of
Health, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sadeghniiat-Haghighi) Occupational Sleep Research Center, Baharloo
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Majdabadi) Department of Biostatistics, School of Health, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Poor sleep quality in patients after coronary artery bypass graft surgery:
An intervention study using the PRECEDE-PROCEED model.
Source
Journal of Tehran University Heart Center. 10 (1) (pp 1-8), 2015. Date of
Publication: 2015.
Publisher
Tehran Heart Center
Abstract
Background: Poor sleep quality (SQ) is common among patients after
coronary artery bypass graft surgery (CABG). This study attempted to
determine the status of SQ following an intervention based on the
PRECEDE-PROCEED model in patients with poor SQ after CABG.
Methods: This study was a randomized clinical trial. The study sample,
including 100 patients referred to the Cardiac Rehabilitation Clinic of
Tehran Heart Center, was assigned either to the intervention (recipient of
exercise and lifestyle training plus designed intervention based on the
PRECEDE-PROCEED model) or to the control group (recipient of exercise and
lifestyle training). Eight training sessions over 8 weeks were conducted
for the intervention group. Predisposing, enabling, and reinforcing
factors as well as social support and SQ were measured in the intervention
group before and one month after the intervention and compared to those in
the control group at the same time points.
Results: The mean age of the patients in the intervention (24% women) and
control (24% women) groups was 59.3 +/- 7.3 and 59.5 +/- 9.3 years,
respectively. The results showed that the mean scores of SQ (p value <
0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep
self-efficacy (p value < 0.001), enabling factors (p value < 0.001),
reinforcing factors (p value < 0.001), and social support (p value <
0.001) were significantly different between the intervention and control
groups after the intervention.
Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to
the cardiac rehabilitation program may further improve the SQ of patients.

<11>
Accession Number
2015668179
Authors
Cramariuc D. Rogge B.P. Lonnebakken M.T. Boman K. Bahlmann E.
Gohlke-Barwolf C. Chambers J.B. Pedersen T.R. Gerdts E.
Institution
(Cramariuc, Rogge) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Rogge, Lonnebakken, Gerdts) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Boman) Research Unit, Medicine, Umeaa University, Skellefteaa, Sweden
(Bahlmann) Asklepios Clinic St. Georg, Hamburg, Germany
(Gohlke-Barwolf) Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
(Chambers) Guy's and St Thomas Hospitals, London, United Kingdom
(Pedersen) Department of Preventive Cardiology, Ulleval University
Hopital, Oslo, Norway
Title
Sex differences in cardiovascular outcome during progression of aortic
valve stenosis.
Source
Heart. 101 (3) (pp 209-214), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Objective Women with severe aortic valve stenosis (AS) have better LV
systolic function and more concentric LV geometry than their male
counterparts. However, sex differences in cardiovascular (CV) outcome
during progression of AS have not been reported from a longitudinal
prospective study. Methods Doppler echocardiography and CV events were
recorded during a median of 4.0 years in 979 men and 632 women aged 28-86
(mean 67+/-10) years in the Simvastatin Ezetimibe in Aortic Stenosis
(SEAS) study. LV systolic function was assessed by EF and midwall
shortening (MWS). Study outcomes were ASrelated events, ischaemic CV
events and total mortality. Results The annular cumulative incidence of AS
events, ischaemic CV events and death was 8.1%, 3.4% and 2.8% in women,
and 8.9%, 4.4% and 2.4% in men, respectively. Women and men had similar AS
progression rate whether measured by peak jet velocity, mean gradient or
valve area. In multivariate analyses, female sex independently predicted
less reduction in LV MWS and EF during follow-up (both p<0.05). In
time-varying Cox analyses, women had a 40% lower rate of ischaemic CV
events (95% CI 21% to 54%), in particular, more than 50% lower rate of
stroke and coronary artery bypass grafting, and a 31% lower allcause
mortality (95% CI 1% to 51%), independent of active study treatment, age
and hypertension, as well as time-varying valve area, low systolic
function and abnormal LV geometry. AS event rate did not differ by sex.
Conclusions In the SEAS study, women and men had similar rates of AS
progression and AS-related events. However, women had lower total
mortality and ischaemic CV event rate than men independent of confounders.
Trial registration number ClinicalTrials.gov identi fier: NCT00092677.
Funding The SEAS (Simvastatin Ezetimibe in Aortic Stenosis)
Echocardiography Core Laboratory was supported by MSP Singapore Company,
LLC, Singapore, a partnership between Merck Co, and the Schering-Plough
Corporation.

<12>
Accession Number
2015663117
Authors
Lenarczyk R. Jedrzejczyk-Patej E. Mazurek M. Szulik M. Kowalski O.
Pruszkowska P. Sokal A. redniawa B. Boidol J. Kowalczyk J. Podolecki T.
Mencel G. Kalarus Z.
Institution
(Lenarczyk, Jedrzejczyk-Patej, Mazurek, Szulik, Kowalski, Pruszkowska,
Sokal, redniawa, Boidol, Kowalczyk, Podolecki, Mencel, Kalarus) Department
of Cardiology Congenital Heart Disease and Electrotherapy, Silesian
Medical University, Silesian Centre for Heart Diseases, Sklodowskiej-Curie
9, Zabrze 41-800, Poland
Title
Quality of life in cardiac resynchronization recipients: Association with
response and impact on outcome.
Source
PACE - Pacing and Clinical Electrophysiology. 38 (1) (pp 8-17), 2015. Date
of Publication: 01 Jan 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background The prognostic impact of improvement in health-related quality
of life (QoL) and its relation to response in cardiac resynchronization
therapy (CRT) recipients remains unknown. Aim To assess the correspondence
between response to CRT and improvements in QoL and to verify if a change
in QoL after pacing influences outcome in CRT patients. Methods
Ninety-seven participants of the Triple-Site Versus Standard Cardiac
Resynchronization Therapy Trial (TRUST CRT) randomized trial, in New York
Heart Association class III-IV, QRS width > 120 ms, left ventricular
ejection fraction <35%, and significant mechanical dyssynchrony were
included. Subjects filled out the Minnesota-QoL questionnaire prior to and
6 months after CRT with defibrillator (CRT-D) implantation. Data on major
adverse cardiac events (MACEs: death, heart failure hospitalization, heart
transplant) collected within the next 2.5 years and adjudicated blindly
constituted the censoring variables. Results Within the first 6 months of
resynchronization QoL improved in 81%, while worsening in 19% of patients.
Clinical response, but not the echocardiographic one, was associated with
improved QoL. During subsequent 2.5 years MACEs occurred in 37% of
patients (23% died). Subjects without QoL improvement were significantly
(both P < 0.05) more prone to experience MACE (61% vs 32%) and die (44% vs
18%) within the follow-up. Unimproved QoL increased the probability of
future MACE by 2.7 times (95% confidence intervals [CI]: 1.26-5.83; P =
0.01) and death by 3.2 times (95% CI: 1.23-8.32; P = 0.02) independently
from clinical and echocardiographic response. Conclusions Clinical
response, but not the echocardiographic one, was associated with improved
QoL in CRT recipients. These preliminary data suggest that lack of
improvement in QoL after CRT was associated with a strongly unfavorable
prognosis, regardless of functional or echocardiographic response. Our
results merit further studies with a larger number of patients.

<13>
Accession Number
2014724502
Authors
Bowater R.J. Hartley L.C. Lilford R.J.
Institution
(Bowater) Faculty of Engineering, Universidad Autonoma de Queretaro, Cerro
de las Campanas s/n, Col. Las Campanas, C.P., Santiago-de Queretaro,
Queretaro 76010, Mexico
(Hartley) Statistics and Epidemiology, Division of Health Sciences,
University of Warwick, Coventry, United Kingdom
(Lilford) Department of Public Health, Epidemiology and Biostatistics,
University of Birmingham, Edgbaston, Birmingham, United Kingdom
Title
Are cardiovascular trial results systematically different between North
America and Europe? A study based on intra-meta-analysis comparisons.
Source
Archives of Cardiovascular Diseases. 108 (1) (pp 23-38), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France. E-mail: infos@masson.fr)
Abstract
Background. - It is often assumed that differences in the efficacy of
treatments between countries (or regions) will be neither negligible nor
minor and therefore cannot be overlooked when assessing the potential
benefit of treatments in one country (or region) on the basis of trials
conducted in another country (or region). Aim. - To assess differences in
the results of cardiovascular trials between Europe and North America on
the basis of data from an extensive collection of trials. Methods. - A
systematic search was conducted of Medline (from the year 2005 to 2008)
and the Cochrane Library (from 2000 to 2008) for all meta-analyses of
randomized controlled tri-als aimed at treating and preventing
cardiovascular disease. Within each meta-analysis that satisfied given
criteria, trial results were compared between Europe and North America
with respect to a fatal and/or non-fatal endpoint by forming separate
estimates of treatment efficacy for each of these continents. Results. -
The literature search found 59 meta-analyses that satisfied all the
inclusion criteria. For most meta-analyses, it was the case that relative
to the control, the intervention was more favoured in trials conducted in
Europe than in North America with regard to both fatal endpoints(28 out of
43 meta-analyses) and non-fatal endpoints (28 out of 40 meta-analyses).
However, it was only with regard to non-fatal endpoints that this
imbalance turned out to be statistically significant at the 5% level (P =
0.017). Also, the lack of statistically significant differences in trial
results between Europe and North America within individual meta-analyses
meant that it was not possible to determine for which types of
intervention these intercontinental differences are likely to be more
pronounced than others. Conclusion. - There is some evidence to support
the theory that, relative to controls, interventions are more favoured in
cardiovascular trials conducted in Europe than in North America, when
treatment efficacy is measured in terms of a non-fatal endpoint. However,
the overall support for systematic differences in cardiovascular trial
results between Europe and North America is weak, which may be surprising
given the amount of data collected.

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<1>
Accession Number
23238507
Authors
Maaroos M. Halonen J. Kiviniemi V. Hartikainen J. Hakala T.
Institution
(Maaroos, Halonen, Kiviniemi, Hartikainen, Hakala) Heart Center of Kuopio
University Hospital, Kuopio, Finland. martin.maaroos@kuh.fi
Title
Intravenous metoprolol versus biatrial pacing in the prevention of atrial
fibrillation after coronary artery bypass surgery: a prospective
randomized open trial.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 101 (4) (pp
292-296), 2012. Date of Publication: 2012.
Abstract
BACKGROUND AND AIMS: Atrial fibrillation (AF) is the most common
arrhythmia after coronary artery bypass surgery (CABG). Intravenous
metoprolol and biatrial pacing have been reported to be effective in AF
prophylaxis after cardiac surgery. The purpose of this trial was to
compare the efficacy of intravenous metoprolol versus biatrial pacing
combined with oral metoprolol in the prevention of AF after CABG.
METHODS: A single-centre prospective randomized open trial of 165
consecutive patients undergoing their first CABG. Patients were randomized
to receive either intravenous metoprolol infusion 1-3 mg per hour or
biatrial overdrive pacing and oral metoprolol (50-150 mg) daily for 72
hours after CABG starting immediately after the surgery. AAI pacing with a
pacing rate of 10 beats/minute above the baseline heart rate was used.
Patients had continuous ECG-monitoring. The primary end point was the
first episode of AF.
RESULTS: The incidence of postoperative AF in the intravenous metoprolol
and biatrial pacing groups did not differ from each other (14% vs. 18%
respectively, p=0.66). There was no difference in the time of AF onset
between the groups (28.2 +/- 16.2 h vs. 30.1 +/- 21.2 h respectively, p =
0.8). Intravenous metoprolol infusion had to be temporarily interrupted
for one hour in eleven patients because of hypotension or bradycardia. One
case of bleeding from the left atria related to the pacemaker electrode
wire was found.
CONCLUSION: We found no difference in the incidence of AF between patients
treated with intravenous metoprolol or the combination of biatrial pacing
and oral metoprolol.

<2>
Accession Number
2014621889
Authors
Kupelian V. Araujo A.B. Wittert G.A. McKinlay J.B.
Institution
(Kupelian, Araujo, McKinlay) New England Research Institutes, Inc., 480
Pleasant St., Watertown, MA 02472, United States
(Wittert) Department of Medicine, University of Adelaide, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Araujo) Eli Lilly and Co., Indianapolis, IN, United States
Title
Association of moderate to severe lower urinary tract symptoms with
incident type 2 diabetes and heart disease.
Source
Journal of Urology. 193 (2) (pp 581-586), 2015. Date of Publication: 01
Feb 2015.
Publisher
Elsevier Inc.
Abstract
Purpose Increasing evidence suggests a possible link between lower urinary
tract symptoms and chronic illnesses. We determined whether lower urinary
tract symptoms are associated with incident type 2 diabetes and heart
disease in a population based study. Materials and Methods BACH is a
population based epidemiological survey of urological symptoms. A
multistage, stratified, cluster sample design was used to obtain a random
sample of 4,144 men and women 30 to 79 years old at baseline. Median
followup was 4.8 years between baseline (2002 to 2005) and followup (2006
to 2010). Type 2 diabetes and heart disease were assessed by self-report.
Lower urinary tract symptoms were assessed by the AUA-SI, and voiding and
storage subscores. Logistic regression was used to estimate the OR and 95%
CI, and adjust for potential confounders. Results In participants with a
body mass index of 30 kg/m² or greater the adjusted ORs for
incident heart disease were 1.89 (95% CI 1.05, 3.39) for AUA-SI 8 or
greater and 2.32 (95% CI 1.33, 4.05) for a storage score of 4 or greater.
In participants with abdominal obesity the adjusted ORs for incident type
2 diabetes were 2.06 (95% CI 1.19, 3.55) for AUA-SI 8 or greater and 1.81
(95% CI 1.04, 3.15) for a storage score of 4 or greater. Lower urinary
tract symptoms (AUA-SI 8 or greater) were also predictive of type 2
diabetes in men and women younger than 50 years (adjusted OR 2.37, 95% CI
1.18, 4.80). Conclusions Longitudinal results of BACH suggest that lower
urinary tract symptoms are a marker of increased risk for type 2 diabetes
and heart disease in obese men and women. The increased risk in younger
men and women suggests that lower urinary tract symptoms may be an
indicator of impending disease.

<3>
Accession Number
2015659120
Authors
Vermeijden W.J. Van Klarenbosch J. Gu Y.J. Mariani M.A. Buhre W.F.
Scheeren T.W.L. Hagenaars J.A.M. Tan M.E.S.H. Haenen J.S.E. Bras L. Van
Oeveren W. Van Den Heuvel E.R. De Vries A.J.
Institution
(Vermeijden) Department of Intensive Care, Thorax Centre Twente, Medisch
Spectrum Twente Enschede, Enschede, Netherlands
(Van Klarenbosch) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
(Gu, Mariani, Van Oeveren) Department of Cardiothoracic Surgery,
University Medical Centre Groningen, Groningen, Netherlands
(Scheeren, Hagenaars, De Vries) Department of Anesthesiology, University
Medical Centre Groningen, Groningen, Netherlands
(Van Den Heuvel) Department of Epidemiology, University Medical Centre
Groningen, Groningen, Netherlands
(Buhre) Department of Anesthesiology and Pain Therapy, Maastricht
University Medical Centre, Maastricht, Netherlands
(Tan) Department of Cardiothoracic Surgery, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Haenen) Department of Cardiac Anesthesia, Medisch Centrum Leeuwarden,
Leeuwarden, Netherlands
(Bras) Department of Anesthesia, St. Antonius Ziekenhuis, Nieuwegein,
Netherlands
Title
Effects of cell-saving devices and filters on transfusion in cardiac
surgery: A multicenter randomized study.
Source
Annals of Thoracic Surgery. 99 (1) (pp 26-32), 2015. Date of Publication:
01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background Cell-saving devices (CS) are frequently used in cardiac surgery
to reduce transfusion requirements, but convincing evidence from
randomized clinical trials is missing. Filtration of salvaged blood in
combination with the CS is widely used to improve the quality of
retransfused blood, but there are no data to justify this approach.
Methods To determine the contribution of CS and filters on transfusion
requirements, we performed a multicenter factorial randomized clinical
trial in two academic and four nonacademic hospitals. Patients undergoing
elective coronary, valve, or combined surgical procedures were included.
The primary end point was the number of allogeneic blood products
transfused in each group during hospital admission. Results From 738
included patients, 716 patients completed the study (CS+filter, 175; CS,
189; filter, 175; neither CS nor filter, 177). There was no significant
effect of CS or filter on the total number of blood products (fraction
[95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96,
1.43]). Use of a CS significantly reduced red blood cell transfusions
within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86
[0.71, 1.05]). Use of a CS was significantly associated with increased
transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with
platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the
percentage of patients who received any transfusion (odds ratio [95%
confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92
[0.68, 1.25]). Conclusions Use of a CS, with or without a filter, does not
reduce the total number of allogeneic blood products, but reduces the
percentage of patients who need blood products during cardiac surgery.

<4>
Accession Number
2015658955
Authors
Almassi G.H. Wagner T.H. Carr B. Hattler B. Collins J.F. Quin J.A.
Ebrahimi R. Grover F.L. Bishawi M. Shroyer A.L.W.
Institution
(Almassi) Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United
States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
(Wagner) Veterans Affairs Palo Alto Health Economics Resource Center,
Menlo Park, CA, United States
(Wagner) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
(Carr, Bishawi, Shroyer) Northport Veterans Affair Medical Center,
Northport, NY, United States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Department
of Veterans Affairs, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Ebrahimi) Greater Los Angeles VA Medical Center, Los Angeles, CA, United
States
Title
Postoperative atrial fibrillation impacts on costs and one-year clinical
outcomes: The veterans affairs randomized on/off bypass trial.
Source
Annals of Thoracic Surgery. 99 (1) (pp 109-114), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background New-onset postoperative atrial fibrillation (POAF) after
coronary artery bypass graft surgery (CABG) is associated with worse
in-hospital morbidity and mortality, extended hospital stays, and higher
costs. Beyond the initial hospital discharge, the cost and outcomes of
POAF have not been well studied. Methods For CABG patients with and
without new-onset POAF, a retrospective propensity-matched, multivariable
regression analysis was performed to compare 1-year outcomes (including
health-related quality of life [HRQoL] scores and mortality rates) and
costs (standardized to 2010 dollars). Regression models controlled for
site and patient factors, with propensity matching used to adjust for
differences in POAF versus no-POAF patients' risk profiles. Results Using
the existing CABG trial database, 2,096 patient records were analyzed,
including POAF patients (n = 549) versus no-POAF patients (n = 1,547). For
the index CABG hospitalization, POAF patients had longer postoperative
length of stay (+3.9 days) and higher discharge costs (+$13,993) than
no-POAF patients. At 1 year, POAF patients had more than twice the
adjusted odds of dying (p < 0.01), with higher 1-year total cumulative
costs. This 1-year cost difference (+$15,593) was largely attributable to
hospital-based costs during the index surgery hospitalization. There was
no difference in 1-year HRQoL scores (or HRQoL score changes) between POAF
patients and no-POAF patients. Conclusions Compared with no-POAF patients,
POAF patients had higher discharge and 1-year costs along with higher
1-year mortality rates, but no differences were observed in 1-year HRQoL
scores. Additional research appears warranted to improve the longer-term
survival rates for POAF CABG patients, targeting future POAF-specific
postdischarge interventions.

<5>
Accession Number
2014949261
Authors
Borger M.A. Moustafine V. Conradi L. Knosalla C. Richter M. Merk D.R.
Doenst T. Hammerschmidt R. Treede H. Dohmen P. Strauch J.T.
Institution
(Borger, Merk, Dohmen) University of Leipzig, Leipzig, Germany
(Moustafine, Strauch) University Hospital of the Ruhr University of
Bochum, North-Rhine-Westphalia, Germany
(Conradi, Treede) University Heart Center Hamburg, Hamburg, Germany
(Knosalla, Hammerschmidt) German Heart Institute Berlin, Berlin, Germany
(Richter, Doenst) Jena University Hospital, Jena, Germany
Title
A randomized multicenter trial of minimally invasive rapid deployment
versus conventional full sternotomy aortic valve replacement.
Source
Annals of Thoracic Surgery. 99 (1) (pp 17-24), 2015. Date of Publication:
01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background Minimally invasive surgical procedures (MIS) may offer several
advantages over conventional full sternotomy (FS) aortic valve replacement
(AVR). A novel class of aortic valve prostheses has been developed for
rapid-deployment AVR (RDAVR). We report a randomized, multicenter trial
comparing the outcomes for MIS-RDAVR with those of conventional FS-AVR.
Methods A total of 100 patients with aortic stenosis were enrolled in a
prospective, multicenter, randomized comparison trial (CADENCE-MIS).
Exclusion criteria included ejection fraction below 25%, AVR requiring
concomitant procedures, and recent myocardial infarction or stroke.
Patients were randomized to undergo MIS-RDAVR through an upper
hemisternotomy (n = 51) or AVR by FS with a conventional stented
bioprosthesis (n = 49). Three patients were excluded before the procedure,
and 3 more patients who were randomized to undergo RDAVR were excluded
because of their anatomy. Procedural, early clinical outcomes, and
functional outcomes were assessed for the remaining 94 patients.
Hemodynamic performance was assessed by an echocardiography core
laboratory. Results Implanted valve sizes were similar between groups
(22.9 +/- 2.1 vs 23.0 +/- 2.1 mm, p = 0.9). MIS-RDAVR was associated with
significantly reduced aortic cross-clamp times compared with FS-AVR (41.3
+/- 20.3 vs 54.0 +/- 20.3 minutes, p < 0.001), although cardiopulmonary
bypass times were similar (68.8 +/- 29.0 vs 74.4 +/- 28.4 minutes, p =
0.21). Early clinical outcomes were similar between the two groups,
including quality of life measures. The RDAVR patients had a significantly
lower mean transvalvular gradient (8.5 vs 10.3 mm Hg, p = 0.044) and a
lower prevalence of patient-prosthesis mismatch (0% vs 15.0%, p = 0.013) 3
months postoperatively compared with the FS-AVR patients. Conclusions
RDAVR by the MIS approach is associated with significantly reduced
myocardial ischemic time and better valvular hemodynamic function than
FS-AVR with a conventional stented bioprosthesis. Rapid deployment valves
may facilitate the performance of MIS-AVR.

<6>
Accession Number
2014917014
Authors
Keski-Nisula J. Suominen P.K. Olkkola K.T. Peltola K. Neuvonen P.J.
Tynkkynen P. Salminen J.T. Andersson S. Pesonen E.
Institution
(Keski-Nisula, Suominen, Peltola, Tynkkynen) Department of Anesthesia and
Intensive Care, Children's Hospital, Helsinki University Central Hospital,
Helsinki, Finland
(Olkkola) Department of Anesthesiology, Intensive Care, Emergency Care and
Pain Medicine, University of Helsinki, Helsinki University Central
Hospital, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
(Salminen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Central Hospital, Helsinki, Finland
(Andersson) Department of Neonatal Intensive Care, Children's Hospital,
Helsinki University Central Hospital, Helsinki, Finland
(Pesonen) Department of Anaesthesiology, Intensive Care, Emergency Care
and Pain Medicine, Meilahti Hospital, Helsinki University Central
Hospital, Helsinki, Finland
Title
Effect of timing and route of methylprednisolone administration during
pediatric cardiac surgical procedures.
Source
Annals of Thoracic Surgery. 99 (1) (pp 180-185), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background We compared the antiinflammatory and cardioprotective effects
of the two most common regimens of corticosteroid administration in
pediatric cardiac surgical procedures: a single dose delivered either at
anesthesia induction or by cardiopulmonary bypass (CPB) prime. Methods
Forty-five children, aged between 1 and 18 months and undergoing
ventricular septal or atrioventricular septal defect correction, were
randomized in double-blind fashion into three groups. The anesthesia
induction group received 30 mg/kg methylprednisolone intravenously after
anesthesia induction, and the CPB-prime group received 30 mg/kg
methylprednisolone by CPB circuit. The placebo group received saline
solution. Plasma concentrations of methylprednisolone, interleukin (IL)-6,
IL-8 and IL-10, and troponin were measured at anesthesia induction before
the study drug, 30 minutes on CPB, after patients were weaned from CPB,
and 6 hours after cessation of CPB. Results Equally high
methylprednisolone concentrations were detected in both methylprednisolone
groups, but the measured peak concentration occurred earlier in the
induction group. Significantly lower IL-8 concentrations were observed
just after patients were weaned from and 6 hours after CPB in the
anesthesia induction group compared with the placebo (p = 0.002, p =
0.001) and prime groups (p = 0.003, p = 0.006). Significant reductions of
troponin were detected in both methylprednisolone groups compared with
placebo (induction, p = 0.001; prime, p = 0.002) 6 hours after patients
were weaned from CPB. Conclusions Methylprednisolone administration at
anesthesia induction was superior in terms of antiinflammatory action.
Methylprednisolone administration in CPB-prime only a few minutes before
aortic cross-clamping and cardioplegia resulted in mean troponin
reductions similar to those of administration at anesthesia induction.
Corticosteroids may have direct cardioprotective properties, as reported
in experimental studies.

<7>
Accession Number
2015659723
Authors
Abbate A. Kontos M.C. Abouzaki N.A. Melchior R.D. Thomas C. Van Tassell
B.W. Oddi C. Carbone S. Trankle C.R. Roberts C.S. Mueller G.H. Gambill
M.L. Christopher S. Markley R. Vetrovec G.W. Dinarello C.A. Biondi-Zoccai
G.
Institution
(Abbate, Kontos, Abouzaki, Melchior, Thomas, Van Tassell, Oddi, Carbone,
Trankle, Roberts, Mueller, Gambill, Christopher, Markley, Vetrovec) VCU
Pauley Heart Center, Victoria Johnson Research Laboratories, Virginia
Commonwealth University, Richmond, VA, United States
(Dinarello) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Italy
Title
Comparative safety of interleukin-1 blockade with anakinra in patients
with ST-segment elevation acute myocardial infarction (from the VCU-ART
and VCU-ART2 pilot studies).
Source
American Journal of Cardiology. 115 (3) (pp 288-292), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Inc.
Abstract
Two pilot studies of interleukin-1 (IL-1) blockade in ST-segment elevation
myocardial infarction (STEMI) showed blunted acute inflammatory response
and overall favorable outcomes at 3 months follow-up. We hereby present a
patient-level pooled analysis with extended follow-up of 40 patients with
clinically stable STEMI randomized to anakinra, a recombinant IL-1
receptor antagonist, 100 mg/day for 14 days or placebo in a double-blinded
fashion. End points included death, cardiac death, recurrent acute
myocardial infarction (AMI), stroke, unstable angina, and symptomatic
heart failure. Median follow-up was 28 (interquartile range 3 to 38)
months. Sixteen patients (40%) had a total of 22 adverse cardiovascular
events: 1 cardiac death, 4 recurrent AMI, 5 episodes of unstable angina
pectoris requiring hospitalization and/or urgent revascularization, and 11
new diagnoses of heart failure. Treatment with anakinra was associated
with a hazard ratio of 1.08 (95% confidence interval 0.31 to 3.74, p =
0.90) for the combined end point of death, recurrent AMI, unstable angina
pectoris, or stroke and a hazard ratio of 0.16 (95% confidence interval
0.03 to 0.76, p = 0.008) for death or heart failure. In conclusion, IL-1
blockade with anakinra for 2 weeks appears, therefore, to have a neutral
effect on recurrent ischemic events, whereas it may prevent new-onset
heart failure long term after STEMI.

<8>
Accession Number
2015660288
Authors
Xiong Y. Sun Y. Ji B. Liu J. Wang G. Zheng Z.
Institution
(Xiong, Sun, Ji, Liu) Department of Cardiopulmonary Bypass, Cardiovascular
Institute, Fuwai Heart Hospital, Beijing, China
(Xiong) Department of Cardiopulmonary Bypass, Second XiangYa Hospital,
Central South University, ChangSha, China
(Wang) Department of Anesthesiology, Cardiovascular Institute, Fuwai Heart
Hospital, Beijing, China
(Zheng) Department of Cardiovascular Surgery, Cardiovascular Institute,
Fuwai Heart Hospital, Beijing, China
Title
Systematic Review and Meta-Analysis of benefits and risks between
normothermia and hypothermia during cardiopulmonary bypass in pediatric
cardiac surgery.
Source
Paediatric Anaesthesia. 25 (2) (pp 135-142), 2014. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background The controversy over the benefits between normothermic and
hypothermic cardiopulmonary bypass (CPB) for children is still uncertain.
The purpose of this systematic review and meta-analysis is to investigate
the benefits and risks of normothermia comparing with hypothermia in
pediatric cardiac surgery by randomized controlled trials. Methods Pubmed,
Embase, and the Cochrane Central Register of Controlled Trials were
searched for studies reported in English up to September 28, 2013.
Eligible studies were those in which investigators enrolled pediatric
patients, who had cardiac surgery, randomized them to normothermic or
hypothermic CPB. We prespecified the use of random-effects models to
calculate risk ratios and 95% CIs for binary variables, weighted mean
difference (WMD) or standard mean difference and 95% CIs for continuous
variables. We assessed heterogeneity using I². When
heterogeneity was absent (I² = 0%), we used fixed-effects
models. The endpoints were serum lactate, serum creatinine, duration of
clamp, and duration of CPB in pediatrics who had cardiac surgery in
normothermic CPB compared with those in hypothermic CPB. Results The
initial search strategy identified 3910 citations, of which 10 trials
compared pediatrics and seven trails were eligible. These seven trials
included 419 participants from seven countries. The serum lactate and the
serum creatinine had three time points. The outcomes had no different
between normothermic group and hypothermic group. Duration of clamp (WMD =
-10.793, 95% CI -28.89, 7.304; P = 0.242; I² = 86.6%; 204
patients, three trials) and duration of CPB (WMD = -41.780, 95% CI
-89.523, 5.963; P = 0.086; I² = 95.6%; 199 patients, three
trials) also had no significant differences between two groups. Conclusion
Normothermic CPB is as safe as hypothermic CPB in children requiring
correction of simple congenital cardiac defects.

<9>
Accession Number
2014740136
Authors
Afshani N. Schulein S. Biccard B.M. Thomas J.M.
Institution
(Afshani) Department of Anaesthetics, University of Cape Town, Groote
Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
(Schulein) Department of Anesthetics, Toronto General Hospital, University
of Toronto, Toronto, Canada
(Schulein) McMaster University, ON, Canada
(Biccard) Perioperative Research Group, Department of Anaesthetics,
University of Kwazulu-Natal, Durban, South Africa
(Thomas) Department of Anaesthetics, Red Cross War Memorial Children's
Hospital, Cape Town, South Africa
Title
Clinical utility of B-type natriuretic peptide (NP) in pediatric cardiac
surgery - A systematic review.
Source
Paediatric Anaesthesia. 25 (2) (pp 115-126), 2014. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background NP is a biomarker that has been used in the diagnosis,
management, and prognostication of a number of cardiovascular disorders in
the pediatric population. The physiological role of this hormone is to
allow the myocardium to adapt to stress or strain imposed by a volume
and/or pressure load. Objective The aim of this study was to determine the
utility of preoperative and postoperative NP to predict outcome in
pediatric patients undergoing cardiac surgery for structural congenital
heart disease. Method We conducted a systematic review by searching three
electronic databases using the search terms 'paediatric' or 'pediatric'
and 'B-type natriuretic peptide'. Twenty peer-reviewed papers were
included in the study. Results Preoperative NP levels were associated with
the severity of cardiac failure in several studies. Preoperative NPs also
correlated with early postoperative outcome measures such as duration of
cardiopulmonary bypass, duration of mechanical ventilation, presence of
low cardiac output syndrome, length of stay in the intensive care unit and
in one study, death. Early (within 24 h) postoperative NPs showed a
stronger correlation than preoperative NPs to early postoperative adverse
events. Conclusion NPs provide a simple, noninvasive and complementary
tool to echocardiography that can be used to assist clinicians in the
assessment and management of pediatric patients with congenital heart
disease in the perioperative period.

<10>
Accession Number
2015661414
Authors
Clive A.O. Wilson P. Taylor H. Morley A.J. De Winton E. Panakis N. Rahman
N. Pepperell J. Howell T. Batchelor T.J.P. Jordan N. Lee Y.C.G. Dobson L.
Maskell N.A.
Institution
(Clive, Morley, Jordan, Maskell) Respiratory Research Unit, North Bristol
NHS Trust, Southmead Hospital, Bristol, United Kingdom
(Clive, Maskell) Academic Respiratory Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Wilson) University Hospitals Bristol NHS Trust, Bristol, United Kingdom
(Taylor) Research Design Service South West, Bristol, United Kingdom
(De Winton) Royal United Hospital, Bath, United Kingdom
(Panakis, Rahman) Oxford University Hospitals NHS Trust, Oxford, United
Kingdom
(Pepperell) Musgrove Park Hospital, Taunton, United Kingdom
(Howell) Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
(Batchelor) University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Lee) Allergy and Respiratory Research, School of Medicine and
Pharmacology, University of Western Australia, Perth, Australia
(Dobson) South Devon Healthcare NHS Foundation Trust, Torbay, United
Kingdom
Title
Protocol for the surgical and large bore procedures in malignant pleural
mesothelioma and radiotherapy trial (Smart Trial): An RCT evaluating
whether prophylactic radiotherapy reduces the incidence of procedure tract
metastases.
Source
BMJ Open. 5 (1) , 2015. Article Number: e006673. Date of Publication: 01
Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Patients with malignant pleural mesothelioma (MPM) may develop painful
'procedure tract metastasis' (PTM) at the site of previous pleural
interventions. Prophylactic radiotherapy has been used to minimise this
complication; however, three small randomised trials have shown
conflicting results regarding its effectiveness. The surgical and large
bore procedures in malignant pleural mesothelioma and radiotherapy trial
(SMART Trial) is a suitably powered, multicentre, randomised controlled
trial, designed to evaluate the efficacy of prophylactic radiotherapy
within 2 days of pleural instrumentation in preventing the development of
PTM in MPM. Methods and analysis: 203 patients with a histocytologically
proven diagnosis of MPM, who have undergone a large bore pleural
intervention (thoracic surgery, large bore chest drain, indwelling pleural
catheter or local anaesthetic thoracoscopy) in the previous 35 days, will
be recruited from UK hospitals. Patients will be randomised (1:1) to
receive immediate radiotherapy (21 Gy in 3 fractions over 3 working days
within 42 days of the pleural intervention) or deferred radiotherapy (21
Gy in 3 fractions over 3 working days given if a PTM develops). Patients
will be followed up for 12 months. The primary outcome measure is the rate
of PTM until death or 12 months (whichever is sooner), as defined by the
presence of a clinically palpable nodule of at least 1 cm diameter felt
within cm of the margins of the procedure site as confirmed by two
assessors. Secondary outcome measures include chest pain, quality of life,
analgaesic requirements, healthcare utilisation and safety (including
radiotherapy toxicity). Ethics and dissemination: The trial has received
ethical approval from the Southampton B Research Ethics Committee
(11/SC/0408). There is a Trial Steering Committee, including independent
members and a patient and public representative. The trial results will be
published in a peer-reviewed journal and presented at international
conferences. Trial registration number: ISRCTN72767336.

<11>
Accession Number
2015657396
Authors
Goto T. Kadota Y. Mori T. Yamashita S.-I. Horio H. Nagayasu T. Iwasaki A.
Institution
(Goto, Kadota, Mori, Yamashita, Horio, Nagayasu, Iwasaki) Guidelines
Committees of Japanese Association for Chest Surgery, Kyoto, Japan
(Goto) Division of General Thoracic Surgery, Department of Surgery, School
of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan
(Kadota) Department of General Thoracic Surgery, Osaka Prefectural Medical
Center for Respiratory and Allergic Diseases, Osaka, Japan
(Mori) Department of Thoracic Surgery, Kumamoto University Hospital,
Kumamoto, Japan
(Yamashita, Iwasaki) Department of General Thoracic, Breast, and Pediatric
Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
(Horio) Department of General Thoracic Surgery, Tokyo Metropolitan Cancer
and Infectious Diseases Center, Tokyo, Japan
(Nagayasu) Division of Surgical Oncology, Department of Surgery, Nagasaki
University Graduate School of Biomedical Sciences, Nagasaki, Japan
Title
Video-assisted thoracic surgery for pneumothorax: republication of a
systematic review and a proposal by the guideline committee of the
Japanese Association for Chest Surgery 2014.
Source
General Thoracic and Cardiovascular Surgery. 63 (1) (pp 8-13), 2014. Date
of Publication: 2014.
Publisher
Springer-Verlag Tokyo
Abstract
Objective: The purpose of this consensus conference was to determine
whether video-assisted thoracic surgery (VATS) improves clinical outcomes
compared with conventional thoracotomy in patients undergoing surgery for
pneumothorax, and to outline evidence-based recommendations for the use of
VATS. Methods: Before the consensus conference, the best available
evidence was reviewed, with systematic reviews, randomized trials, and
nonrandomized trials all taken into consideration in descending order of
validity and importance. At the consensus conference, evidence-based
interpretative statements were created, and consensus processes were used
to determine the ensuing recommendations. The Medical Information Network
Distribution Service in Japan (Minds) system was used to label the levels
of evidence for the references and the classes of recommendations. Results
and recommendations: The consensus panel agreed upon the following
statements and recommendations for patients with pneumothorax undergoing
surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS
is judged to be less invasive, as it results in minimal postoperative
pain, the periods of chest tube placement and hospitalization are short,
and it shows a trend toward early realization of social integration. 3.
There is no difference in terms of safety and complications between VATS
and open thoracotomy. 4. As it is anticipated that VATS will result in a
higher recurrence rate than open thoracotomy, it may be desirable to add a
supplemental procedure during surgery. In summary, VATS can be recommended
as pneumothorax surgery (Recommendation grade: Level B).

<12>
Accession Number
2015650157
Authors
Serruys P.W. Chevalier B. Dudek D. Cequier A. Carrie D. Iniguez A.
Dominici M. Van Der Schaaf R.J. Haude M. Wasungu L. Veldhof S. Peng L.
Staehr P. Grundeken M.J. Ishibashi Y. Garcia-Garcia H.M. Onuma Y.
Institution
(Serruys) International Centre for Cardiovascular Health, Imperial
College, London, United Kingdom
(Chevalier) Institut Jacques Cartier, Massy, France
(Dudek) Jagiellonian University, Department of Cardiology and Cardio
Vascular Interventions, University Hospital, Krakow, Poland
(Cequier) Bellvitge University Hospital, Barcelona, Spain
(Carrie) Hopital de Rangueil, Toulouse, France
(Iniguez) Hospital de Meixoeiro, Vigo, Spain
(Dominici) S Maria University Hospital, Terni, Italy
(Van Der Schaaf) OLVG, Amsterdam, Netherlands
(Haude) Stadtisches Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Germany
(Wasungu, Veldhof) Abbott Vascular, Diegem, Belgium
(Peng, Staehr) Abbott Vascular, Santa Clara, CA, United States
(Grundeken) Academic Medical Centre, Amsterdam, Netherlands
(Ishibashi, Garcia-Garcia, Onuma) Erasmus MC, Rotterdam, Netherlands
(Garcia-Garcia, Onuma) Cardialysis BV, Rotterdam, Netherlands
Title
A bioresorbable everolimus-eluting scaffold versus a metallic
everolimus-eluting stent for ischaemic heart disease caused by de-novo
native coronary artery lesions (ABSORB II): An interim 1-year analysis of
clinical and procedural secondary outcomes from a randomised controlled
trial.
Source
The Lancet. 385 (9962) (pp 43-54), 2015. Date of Publication: 03 Jan 2015.
Publisher
Lancet Publishing Group
Abstract
Background Despite rapid dissemination of an everolimus-eluting
bioresorbable scaffold for treatment for coronary artery disease, no data
from comparisons with its metallic stent counterpart are available. In a
randomised controlled trial we aimed to compare an everolimus-eluting
bioresorbable scaffold with an everolimus-eluting metallic stent. Here we
report secondary clinical and procedural outcomes after 1 year of
follow-up. Methods In a single-blind, multicentre, randomised trial, we
enrolled eligible patients aged 18-85 years with evidence of myocardial
ischaemia and one or two de-novo native lesions in different epicardial
vessels. We randomly assigned patients in a 2:1 ratio to receive treatment
with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott
Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting
metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA).
Randomisation was stratified by diabetes status and number of planned
target lesions. The co-primary endpoints of this study are vasomotion
(change in mean lumen diameter before and after nitrate administration at
3 years) and difference between minimum lumen diameter (after nitrate
administration) after the index procedure and at 3 years. Secondary
endpoints were procedural performance assessed by quantitative angiography
and intravascular ultrasound; composite clinical endpoints based on death,
myocardial infarction, and coronary revascularisation; device and
procedural success; and angina status assessed by the Seattle Angina
Questionnaire and exercise testing at 6 and 12 months. Cumulative angina
rate based on adverse event reporting was analysed post hoc. This trial is
registered at ClinicalTrials.gov, number NCT01425281. Findings Between Nov
28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned
them to the bioresorbable scaffold group (335 patients, 364 lesions) or
the metallic stent group (166 patients, 182 lesions). Dilatation pressure
and balloon diameter at the highest pressure during implantation or
postdilatation were higher and larger in the metallic stent group, whereas
the acute recoil post implantation was similar (019 mm for both, p=085).
Acute lumen gain was lower for the bioresorbable scaffold by quantitative
coronary angiography (115 mm vs 146 mm, p<00001) and quantitative
intravascular ultrasound (285 mm² vs 360 mm²,
p<00001), resulting in a smaller lumen diameter or area post procedure. At
1 year, however, cumulative rates of first new or worsening angina from
adverse event reporting were lower (72 patients [22%] in the bioresorbable
scaffold group vs 50 [30%] in the metallic stent group, p=004), whereas
performance during maximum exercise and angina status by SAQ were similar.
The 1-year composite device orientated endpoint was similar between the
bioresorbable scaffold and metallic stent groups (16 patients [5%] vs five
patients [3%], p=035). Three patients in the bioresorbable scaffold group
had definite or probable scaffold thromboses (one definite acute, one
definite sub-acute, and one probable late), compared with no patients in
the metallic stent group. There were 17 (5%) major cardiac adverse events
in the bioresorbable scaffold group compared with five (3%) events in the
metallic stent group, with the most common adverse events being myocardial
infarction (15 cases [4%] vs two cases [1%], respectively) and clinically
indicated target-lesion revascularisation (four cases [1%] vs three cases
[2%], respectively). Interpretation The everolimus-eluting bioresorbable
scaffold showed similar 1-year composite secondary clinical outcomes to
the everolimus-eluting metallic stent. Funding Abbott Vascular.

<13>
Accession Number
2015643239
Authors
Kim H.-J. Kim W.H. Kim G. Kim E. Park M.-H. Shin B.S. Sim W.S. Kim C.S.
Lee Y.T. Cho H.S.
Institution
(Kim, Kim) Department of Anesthesiology and Pain Medicine, Samsung
Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
South Korea
(Kim, Kim, Kim, Park, Shin, Sim, Kim, Cho) Department of Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Title
A comparison among infusion of lidocaine and dexmedetomidine alone and in
combination in subjects undergoing coronary artery bypass graft: A
randomized trial.
Source
Contemporary Clinical Trials. 39 (2) (pp 303-309), 2014. Date of
Publication: November 01, 2014.
Publisher
Elsevier Inc.
Abstract
Background: Previous studies have reported the cardioprotective effect of
dexmedetomidine and lidocaine. We compared the effect of lidocaine and
dexmedetomidine infusion during off-pump coronary artery bypass graft
(OPCAB). Methods: 153 patients undergoing OPCAB were enrolled. The
lidocaine group (n = 36, Group LIDO) received an infusion of lidocaine 2.
mg/kg/h after bolus 1.5. mg/kg; the dexmedetomidine group (n = 40, Group
DEX) received dexmedetomidine 0.3-0.7. mug/kg/h; the combined group (n =
39, Group Combined) received infusion of both drugs; and the control group
(n = 38) received nothing. We measured serum creatinine kinase-myocardial
band (CK-MB) and cardiac troponin I (cTnI) concentration before and
immediately after the surgery, postoperative day (POD)#1 and #2. The
complication rate and clinical outcomes were compared. Results: The
concentration of cTnI was significantly lower in the Group LIDO and Group
Combined than the control group on POD#2. The concentration of CK-MB was
significantly lower in the Group LIDO and Group Combined compared to the
control group on POD#1 and #2 [CK-MB on POD#1: 7.67 (5.78-11.92) vs. 7.18
(5.01-11.72) vs. 13.19 (6.85-23.87) in the Group LIDO, combined and
control, respectively, Group LIDO vs. control: p = 0.003, Group Combined
vs. control: p = 0.015]. The AUC of CK-MB was significantly lower in the
Group LIDO and Group Combined than the control group. However, clinical
variables including complication rate, ICU stay and one-year mortality
were not different. Conclusions: Lidocaine infused at 2. mg/kg/h, but not
dexmedetomidine infused at 0.3-0.7. mug/kg/h reduced postoperative
myocardial injury marker levels compared with the control group. However,
no other clinical benefits were observed.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 22

Results Generated From:
Embase <1980 to 2015 Week 03>
Embase (updates since 2015-01-09)

<1>
Accession Number
2015637346
Authors
Peycelon M. Audry G. Irtan S.
Institution
(Peycelon, Audry, Irtan) Department of Paediatric Surgery, Trousseau
Hospital, 26 rue Arnold Netter, Paris 75012, France
(Audry, Irtan) Sorbonnes Universites, UPMC University, Paris, France
Title
Minimally invasive surgery in childhood cancer: A challenging future.
Source
European Journal of Pediatric Surgery. 24 (6) (pp 443-449), 2014. Date of
Publication: December 2014.
Publisher
Georg Thieme Verlag
Abstract
Introduction Minimally invasive surgery (MIS) has emerged as an
alternative to open approach for cancer diagnosis in children ~20 years
ago, but only recently for tumor resection. The purpose of this review is
to update the use of MIS in pediatric oncological surgery over the past
five years.
Methods The authors conducted a systematic review of papers published
between 2009 and 2014 focusing on indications and results of the
technique.
Results New indications in Wilms tumor, pheochromocytoma, and lung nodules
have emerged, thanks to the growing use of MIS in benign urological and
thoracic surgery with satisfactory results. Case control studies comparing
MIS to open approach have been published for the first time in more
classical indications such as neurogenic tumors, while robot-assisted
procedure has shown concern in results about its early experience in solid
tumors.
Conclusion MIS is a promising method for removal of thoracic and abdominal
malignancies as long as oncological principles are strictly followed.
Long-term follow-up is mandatory to further delineate objective
indications.

<2>
Accession Number
2015648879
Authors
Ozkul S. Turna A. Demirkaya A. Aksoy B. Kaynak K.
Institution
(Ozkul, Turna, Demirkaya, Aksoy, Kaynak) Department of Thoracic Surgery,
Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
Title
Rapid pleurodesis is an outpatient alternative in patients with malignant
pleural effusions: A prospective randomized controlled trial.
Source
Journal of Thoracic Disease. 6 (12) (pp 1731-1735), 2014. Date of
Publication: 2014.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: Chemical pleurodesis can be palliative for recurrent,
symptomatic pleural effusions in patients who are not candidate for a
thoracic surgical procedure. We hypothesized that effective pleurodesis
could be accomplished with a rapid method of pleurodesis as effective as
the standard method. Methods: A prospective randomized 'non-inferiority'
trial was conducted in 96 patients with malignant pleural effusion (MPE)
who are not potentially curable and/or not amenable to any other surgical
intervention. They were randomly allocated to group 1 (rapid pleurodesis)
and to group 2 (standard protocol). In group 1, following complete fluid
evacuation, talc slurry was instilled into the pleural space. This was
accomplished within 2 h of thoracic catheter insertion, unless the drained
fluid was more than 1,500 mL. After clamping the tube for 30 min, the
pleural space was drained for 1 h, after which the thoracic catheter was
removed. In group 2, talc-slurry was administered when the daily drainage
was lower than 300 mL/day. Results: No-complication developed due to
talc-slurry in two groups. Complete or partial response was achieved in 35
(87.5%) and 33 (84.6%) patients in group 1 and group 2 respectively
(P=0.670). The mean drainage time was 40.7 and 165.2 h in group 1 and
group 2 respectively (P<0.001). Conclusions: Rapid pleurodesis with talc
slurry is safe and effective and it can be performed in an outpatient
basis.

<3>
Accession Number
2015646817
Authors
Green C.A. Yarborough B.J.H. Leo M.C. Yarborough M.T. Stumbo S.P. Janoff
S.L. Perrin N.A. Nichols G.A. Stevens V.J.
Institution
(Green, Yarborough, Leo, Yarborough, Stumbo, Janoff, Perrin, Nichols,
Stevens) Center for Health Research, Kaiser Permanente Northwest,
Portland, OR, United States
Title
The STRIDE weight loss and lifestyle intervention for individuals taking
antipsychotic medications: A randomized trial.
Source
American Journal of Psychiatry. 172 (1) (pp 71-81), 2015. Date of
Publication: 01 Jan 2015.
Publisher
American Psychiatric Association
Abstract
Objectives: The STRIDE study assessed whether a lifestyle intervention,
tailored for individuals with serious mental illnesses, reduced weight and
diabetes risk. The authors hypothesized that the STRIDE interventionwould
be more effective than usual care in reducing weight and improving glucose
metabolism. Method: The study design was a multisite, parallel two-arm
randomized controlled trial in community settings and an integrated health
plan. Participantswho met inclusion criteria were >;18 years old, were
taking antipsychotic agents for >;30 days, andhad a body mass index >;27.
Exclusionswere significant cognitive impairment, pregnancy/breastfeeding,
recent psychiatric hospitalization, bariatric surgery, cancer, heart
attack, or stroke. The intervention emphasizedmoderate caloric reduction,
the DASH (Dietary Approaches to Stop Hypertension) diet, and physical
activity. Blindedstaffcollecteddataatbaseline,6months,and12months.
Results: Participants (men, N=56; women, N=144; mean age=47.2 years
[SD=10.6]) were randomly assigned to usual care (N=96) or a 6-month weekly
group intervention plus six monthly maintenance sessions (N=104). A total
of 181 participants (90.5%) completed 6-month assessments, and 170 (85%)
completed 12-month assessments,without differential attrition.
Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat
analyses revealed that intervention participants lost 4.4 kg more than
control participants from baseline to 6 months (95% CI=-6.96 kg to -1.78
kg) and 2.6 kg more than control participants from baseline to 12 months
(95% CI=-5.14 kg to -0.07 kg). At 12 months, fasting glucose levels in the
control group had increased from 106.0 mg/dL to 109.5 mg/dL and decreased
in the intervention group from 106.3 mg/dL to 100.4 mg/dL. No serious
adverse events were study-related; medical hospitalizations were reduced
in the intervention group (6.7%) compared with the control group (18.8%).
Conclusions: Individuals taking antipsychotic medications can loseweight
and improve fasting glucose levels. Increasing reach of the intervention
is an important future step.

<4>
Accession Number
2015640937
Authors
Liu B. Duan C.-Y. Luo C.-F. Ou C.-W. Sun K. Wu Z.-Y. Huang H. Cheng C.-F.
Li Y.-P. Chen M.-S.
Institution
(Liu, Wu, Li, Chen) Department of Cardiovascular Medicine, Zhu Jiang
Hospital, Southern Medical University, China
(Liu, Ou, Chen) Southern Medical University, China
(Duan) Department of Biostatistics, Southern Medical University, China
(Luo, Huang, Cheng) Department of Cardiovascular Medicine, Second
Affiliated Hospital of Guangzhou Medical University, China
(Sun) Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, China
Title
Effectiveness and safety of selected bone marrow stem cells on left
ventricular function in patients with acute myocardial infarction: A
meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 177 (3) (pp 764-770), 2014. Date of
Publication: 20 Dec 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background Concerns regarding the use of selected bone marrow stem cells
(BMSCs) in the field of cardiac repair after acute ischemic events have
been raised. The current meta-analysis aimed to assess the efficacy and
safety of selected BMSC transplantation in patients with acute myocardial
infarction (AMI) based on published randomized controlled trials (RCTs).
Methods A systematic literature search of PubMed, Ovid LWW, BIOSIS
Previews, and the Cochrane library from 1990 to 2014 was conducted.
Results from RCTs involving subjects with AMI receiving selected BMSC
therapy and followed up for at least 6 months were pooled.
Results Eight trials with a total of 262 participants were included. Data
were analyzed using a random effects model. Overall, selected BMSC therapy
improved left ventricular ejection fraction (LVEF) by 3.17% (95%
confidence interval [CI] 0.57-5.76, P = 0.02), compared with the controls.
There were trends toward reduced left ventricular end-systolic volume
(LVESV) and fewer major adverse cardiac events (MACEs). Subgroup analysis
revealed a significant difference in LVEF in favor of selected BMSC
therapy with bone marrow mesenchymal stem cells (BMMSCs) as the cell type.
Conclusions Transplantation of selected BMSCs for patients with AMI is
safe and induces a significant increase in LVEF with a limited impact on
left ventricular remodeling.

<5>
Accession Number
2015638799
Authors
Guida P. Mastro F. Scrascia G. Whitlock R. Paparella D.
Institution
(Guida, Mastro, Scrascia, Paparella) Division of Cardiac Surgery,
Department of Emergency and Organ Transplant, University of Bari Aldo
Moro, Piazza Giulio Cesare 11, Bari 70100, Italy
(Whitlock) Department of Surgery, McMaster University, Hamilton, Canada
(Whitlock) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, Canada
Title
Performance of the European System for Cardiac Operative Risk Evaluation
II: A meta-analysis of 22 studies involving 145,592 cardiac surgery
procedures.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3049-3057),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives A systematic review of the European System for Cardiac
Operative Risk Evaluation (euroSCORE) II performance for prediction of
operative mortality after cardiac surgery has not been performed. We
conducted a meta-analysis of studies based on the predictive accuracy of
the euroSCORE II.
2014 The American Association for Thoracic Surgery Methods We searched
the Embase and PubMed databases for all English-only articles reporting
performance characteristics of the euroSCORE II. The area under the
receiver operating characteristic curve, the observed/expected mortality
ratio, and observed-expected mortality difference with their 95%
confidence intervals were analyzed.
Results Twenty-two articles were selected, including 145,592 procedures.
Operative mortality occurred in 4293 (2.95%), whereas the expected events
according to euroSCORE II were 4802 (3.30%). Meta-analysis of these
studies provided an area under the receiver operating characteristic curve
of 0.792 (95% confidence interval, 0.773-0.811), an estimated
observed/expected ratio of 1.019 (95% confidence interval, 0.899-1.139),
and observed-expected difference of 0.125 (95% confidence interval, -0.269
to 0.519). Statistical heterogeneity was detected among retrospective
studies including less recent procedures. Subgroups analysis confirmed the
robustness of combined estimates for isolated valve procedures and those
combined with revascularization surgery. A significant overestimation of
the euroSCORE II with an observed/expected ratio of 0.829 (95% confidence
interval, 0.677-0.982) was observed in isolated coronary artery bypass
grafting and a slight underestimation of predictions in high-risk patients
(observed/expected ratio 1.253 and observed-expected difference 1.859).
Conclusions Despite the heterogeneity, the results from this meta-analysis
show a good overall performance of the euroSCORE II in terms of
discrimination and accuracy of model predictions for operative mortality.
Validation of the euroSCORE II in prospective populations needs to be
further studied for a continuous improvement of patients' risk
stratification before cardiac surgery.

<6>
Accession Number
2015638825
Authors
Sepehri A. Beggs T. Hassan A. Rigatto C. Shaw-Daigle C. Tangri N. Arora
R.C.
Institution
(Sepehri) Faculty of Medicine, University of British Columbia, Vancouver,
BC, Canada
(Beggs) School of Medicine, Royal College of Surgns. in Ireland, Dublin,
Ireland
(Hassan) Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
(Rigatto, Tangri) Renal Program, Seven Oaks General Hospital, Winnipeg,
MB, Canada
(Rigatto, Tangri) Section of Nephrology, Department of Medicine,
University of Manitoba, Winnipeg, MB, Canada
(Shaw-Daigle) St Boniface General Hospital, Winnipeg, MB, Canada
(Arora) University of Manitoba Health Sciences Libraries, Winnipeg, MB,
Canada
Title
The impact of frailty on outcomes after cardiac surgery: A systematic
review.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3110-3117),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objective Current preoperative assessments for cardiac surgery, such as
the European System for Cardiac Operative Risk Evaluation II and the
Society of Thoracic Surgeons risk score, are limited in their ability to
predict postoperative outcomes. This is thought to be due to the reliance
on chronological age as a predictor of health. In geriatrics, frailty
assessments have been developed as a tool in determining physiologic
functioning capacity. Whether or not frailty predicts postoperative
outcomes independent of existing cardiac preoperative risk scores remains
unknown.
2014 The American Association for Thoracic Surgery Methods We performed a
systematic review to determine the association of frailty with negative
postoperative outcomes such as major adverse cardiac and cerebrovascular
events (MACCE) in patients undergoing cardiac surgery. We searched PubMed,
EMBASE, the Cochrane library, and Ageline from inception until July 2013
and screened 5913 abstracts for potential inclusion. Of these, 6 studies
examined the relationship between objective frailty assessments and
postoperative outcomes. Our included studies evaluated 4756 patients
undergoing cardiac surgery.
Results Frailty, defined using multiple criteria, had a strong positive
relationship with the risk of MACCE (odds ratio, 4.89; 95% confidence
interval, 1.64-14.60). Relationships were stronger in older patients
undergoing transcatheter aortic valve replacement (TAVR) than younger
patients undergoing coronary artery bypass grafting and valvular surgery
(hazard ratio for frailty in TAVR, 3.31-4.89 vs hazard ratio for non-TAVR,
1.10-3.16).
Conclusions Patients deemed frail, determined using an objective
assessment tool, have a higher likelihood of experiencing mortality,
morbidity, functional decline, and MACCE following cardiac surgery,
regardless of definition. Further study is needed to determine which
components of frailty are most predictive of negative postoperative
outcomes before integration in risk prediction scores.

<7>
Accession Number
2015638792
Authors
He S. Chen B. Li W. Yan J. Chen L. Wang X. Xiao Y.
Institution
(He, Chen, Li, Yan, Chen, Wang, Xiao) Department of Cardiovascular
Surgery, Xinqiao Hospital, Third Military Medical University, Xinqiao St,
Shapingba District, Chongqing 400037, China
(He) Department of Cardiovascular Surgery, Chengdu Military General
Hospital, Chengdu, China
Title
Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and
systematic review.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3148-3155),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Results Eleven studies on VAP after cardiac surgery were included. When
the results were merged the VAP rate was 21.27/1000 ventilator-days. The
prevalence reached 6.37% of all patients and 35.2% of patients who were on
mechanical ventilation for more than 48 hours. Among the isolated
pathogens, Pseudomonas aeruginosa had the highest detection rate, with an
average of 23.19%, followed by Staphylococcus aureus (20.15%), Haemophilus
influenzae (19.53%), Acinetobacter baumannii (10.68%), Escherichia coli
(10.18%), Klebsiella pneumoniae (9.52%), and Candida albicans (7.20%).
Risk factors were also analyzed. We found that New York Heart Association
cardiac function class IV, pulmonary hypertension, chronic obstructive
pulmonary disease, peripheral vascular disease, renal disease, emergency
surgery, intra-aortic balloon counterpulsation, cardiopulmonary bypass
time, aortic crossclamp time, mechanical ventilation time, reintervention,
and reintubation were closely related to the occurrence of VAP; there was
no association with gender and diabetes mellitus. Once patients had VAP,
mortality and length of stay in the intensive care unit were significantly
increased.
Conclusions VAP in patients after cardiac surgery is common and has a poor
prognosis. It is mainly caused by gram-negative bacteria, and could be
affected by a series of factors.
Objective Ventilator-associated pneumonia (VAP) is the most common and
serious nosocomial infection that threatens patients who have undergone
cardiac surgery. This article summarizes its clinical characteristics and
provides theoretical evidence for prevention and treatment.
2014 The American Association for Thoracic Surgery Methods A literature
search was conducted using PubMed, Embase, the Cochrane Library, and Web
of Knowledge databases and by manual search. Data involving the
prevalence, etiology, risk factors, or clinical outcomes were extracted
for systematic review and meta-analysis.

<8>
Accession Number
2015638823
Authors
Holly T.A. Bonow R.O. Arnold J.M.O. Oh J.K. Varadarajan P. Pohost G.M.
Haddad H. Jones R.H. Velazquez E.J. Birkenfeld B. Asch F.M. Malinowski M.
Barretto R. Kalil R.A.K. Berman D.S. Sun J.-L. Lee K.L. Panza J.A.
Institution
(Holly, Bonow) Northwestern University, Feinberg School of Medicine, 251
East Huron St, Galter 8-134, Chicago, IL 60611, United States
(Arnold) University of Western Ontario, London, ON, Canada
(Oh) Mayo Clinic, Rochester, MN, United States
(Varadarajan) Loma Linda University, Loma Linda, CA, United States
(Pohost) University of Southern California, Los Angeles, CA, United States
(Haddad) Ottawa Heart Institute, Ottawa, ON, Canada
(Jones, Velazquez, Sun, Lee) Duke University, Durham, NC, United States
(Birkenfeld) Department of Nuclear Medicine PUM, Szczecin, Poland
(Asch) MedStar Washington Hospital Center, Washington, DC, United States
(Malinowski) Medical University of Silesia, Katowice, Poland
(Barretto) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Kalil) Instituto de Cardiologia, Porto Alegre, Brazil
(Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Panza) Westchester Medical Center, Valhalla, NY, United States
Title
Myocardial viability and impact of surgical ventricular reconstruction on
outcomes of patients with severe left ventricular dysfunction undergoing
coronary artery bypass surgery: Results of the Surgical Treatment for
Ischemic Heart Failure trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 2677-2684),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives In the Surgical Treatment for Ischemic Heart Failure trial,
surgical ventricular reconstruction plus coronary artery bypass surgery
was not associated with a reduction in the rate of death or cardiac
hospitalization compared with bypass alone. We hypothesized that the
absence of viable myocardium identifies patients with coronary artery
disease and left ventricular dysfunction who have a greater benefit with
coronary artery bypass graft surgery and surgical ventricular
reconstruction compared with bypass alone.
2014 The American Association for Thoracic Surgery Methods Myocardial
viability was assessed by single photon computed tomography in 267 of the
1000 patients randomized to bypass or bypass plus surgical ventricular
reconstruction in the Surgical Treatment for Ischemic Heart Failure.
Myocardial viability was assessed on a per patient basis and regionally
according to prespecified criteria.
Results At 3 years, there was no difference in mortality or the combined
outcome of death or cardiac hospitalization between those with and without
viability, and there was no significant interaction between the type of
surgery and the global viability status with respect to mortality or death
plus cardiac hospitalization. Furthermore, there was no difference in
mortality or death plus cardiac hospitalization between those with and
without anterior wall or apical scar, and no significant interaction
between the presence of scar in these regions and the type of surgery with
respect to mortality.
Conclusions In patients with coronary artery disease and severe regional
left ventricular dysfunction, assessment of myocardial viability does not
identify patients who will derive a mortality benefit from adding surgical
ventricular reconstruction to coronary artery bypass graft surgery.

<9>
Accession Number
2014628724
Authors
Cosse C. Sabbagh C. Kamel S. Galmiche A. Regimbeau J.-M.
Institution
(Cosse, Sabbagh, Kamel) INSERM U1088, Jules Verne University of Picardie,
Amiens 80054, France
(Cosse, Sabbagh, Regimbeau) Department of Digestive and Oncological
Surgery, Amiens University Hospital, Jules Verne University of Picardie,
Place Victor Pauchet, Amiens cedex 01 F-80054, France
(Cosse, Regimbeau) Clinical Research Center, Amiens University Hospital,
Amiens Cedex 01 80054, France
(Kamel, Galmiche) Department of Biochemistry, Amiens University Hospital,
Jules Verne University of Picardie, Amiens F-80054, France
(Regimbeau) EA4294, Jules Verne University of Picardie, Amiens F-80054,
France
Title
Procalcitonin and intestinal ischemia: A review of the literature.
Source
World Journal of Gastroenterology. 20 (47) (pp 17773-17778), 2014. Date of
Publication: 21 Dec 2014.
Publisher
WJG Press
Abstract
Intestinal ischemia is common after emergency gastrointestinal or
cardiovascular surgery. At present, there are no diagnostic tools for the
early diagnosis of intestinal ischemia. In the last decade, procalcitonin
(PCT) has been suggested as a marker of this condition. Here, we review
the use of PCT as a diagnostic tool for intestinal ischemia. Two reviewers
independently searched the PubMed and EMBASE databases for articles on
intestinal ischemia and PCT. They then considered (1) the criteria
applicable to preclinical and clinical data; and (2) PCT's predictive
value in the diagnosis of intestinal ischemia. Article quality was rated
according to the STAndards for Reporting of Diagnostic accuracy. Between
1993 and 2014, seven studies (including two preclinical studies and five
clinical studies) dealt with the use of PCT to diagnose intestinal
ischemia. Procalcitonin's sensitivity, specificity, positive predictive
value and negative predictive value ranged between 72% and 100%; 68% and
91%; 27% and 90% and 81% and 100%, respectively. The area under the
receiver operating characteristic curve ranged from 0.77 to 0.92. In view
of the preclinical and clinical data, we consider that PCT can be used in
daily practice as a tool for diagnosing intestinal ischemia.

<10>
Accession Number
2014944699
Authors
Weisel R.D. Nussmeier N. Newman M.F. Pearl R.G. Wechsler A.S. Ambrosio G.
Pitt B. Clare R.M. Pieper K.S. Mongero L. Reece T.L. Yau T.M. Fremes S.
Menasche P. Lira A. Harrington R.A. Ferguson T.B.
Institution
(Weisel, Yau) Division of Cardiac Surgery, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Nussmeier) Massachusetts General Hospital, Harvard University, Boston,
MA, United States
(Newman, Clare, Pieper, Reece) Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
(Pearl, Harrington) Stanford University School of Medicine, Palo Alto, CA,
United States
(Wechsler) Drexel University, College of Medicine, Philadelphia, PA,
United States
(Ambrosio) Division of Cardiology, University of Perugia School of
Medicine, Perugia, Italy
(Pitt) University of Michigan School of Medicine, Ann Arbor, MI, United
States
(Mongero) New York Presbyterian - Columbia University Medical Center, New
York, NY, United States
(Fremes) Division of Cardiac Surgery, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Menasche) Departement de Chirurgie Cardiovasculaire, Assistance Publique
- Hopital Europeen Georges Pompidou, Universite Paris Descartes, Paris,
France
(Lira) Novartis, Basel, Switzerland
(Ferguson) East Carolina Heart Institute, Greenville, NC, United States
Title
Predictors of contemporary coronary artery bypass grafting outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 2720-2726),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives The study objective was to identify the predictors of outcomes
in a contemporary cohort of patients from the Reduction in cardiovascular
Events by acaDesine in patients undergoing CABG (RED-CABG) trial. Despite
the increasing risk profile of patients who undergo coronary artery bypass
grafting, morbidity and mortality have remained low, and identification of
the current predictors of adverse outcomes may permit new treatments to
further improve outcomes.
2014 The American Association for Thoracic Surgery Methods The RED-CABG
trial was a multicenter, randomized, double-blind, placebo-controlled
study that determined that acadesine did not reduce adverse events in
moderately high-risk patients undergoing nonemergency coronary artery
bypass grafting. The primary efficacy end point was a composite of
all-cause death, nonfatal stroke, or the need for mechanical support for
severe left ventricular dysfunction through postoperative day 28. Logistic
regression modeling with stepwise variable selection identified which
prespecified baseline characteristics were associated with the primary
outcome. A second logistic model included intraoperative variables as
potential covariates.
Results The 4 independent preoperative risk factors predictive of the
composite end point were (1) a history of heart failure (odds ratio, 2.9);
(2) increasing age (odds ratio, 1.033 per decade); (3) a history of
peripheral vascular disease (odds ratio, 1.6); and (4) receiving aspirin
before coronary artery bypass grafting (odds ratio, 0.5), which was
protective. The duration of the cardiopulmonary bypass (odds ratio, 1.8)
was the only intraoperative variable that contributed to adverse outcomes.
Conclusions Patients who had heart failure and preserved systolic function
had a similar high risk of adverse outcomes as those with low ejection
fractions, and new approaches may mitigate this risk. Recognition of
patients with excessive atherosclerotic burden may permit perioperative
interventions to improve their outcomes. The contemporary risks of
coronary artery bypass grafting have changed, and their identification may
permit new methods to improve outcomes.

<11>
Accession Number
2014712950
Authors
Beohar N. Whisenant B. Kirtane A.J. Leon M.B. Tuzcu E.M. Makkar R.
Svensson L.G. Miller D.C. Smith C.R. Pichard A.D. Herrmann H.C. Thourani
V.H. Szeto W.Y. Lim S. Fischbein M. Fearon W.F. O'Neill W. Xu K. Dewey T.
Mack M.
Institution
(Beohar) Cardiac Catheterization Laboratory, Columbia University, Mount
Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33138, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Kirtane, Leon, Smith, Xu) Columbia University Medical Center, New York
Presbyterian Hospital, New York, NY, United States
(Tuzcu, Svensson) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Miller, Fischbein, Fearon) Stanford University, Stanford, CA, United
States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Herrmann, Szeto) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Lim) University of Virginia, Charlottesville, VA, United States
(O'Neill) Center for Structural Heart Disease, Henry Ford Healthcare
System, Detroit, MI, United States
(Dewey, Mack) Baylor Healthcare System, Dallas, TX, United States
Title
The relative performance characteristics of the logistic European System
for Cardiac Operative Risk Evaluation score and the Society of Thoracic
Surgeons score in the Placement of Aortic Transcatheter Valves trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 2830-2837),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives The logistic European System for Cardiac Operative Risk
Evaluation (LES) score and the Society of Thoracic Surgeons (STS) score
are validated to predict 30-day outcomes following surgical aortic valve
replacement (SAVR) with or without coronary artery bypass grafting. Their
performance when applied to patients undergoing transcatheter aortic valve
replacement (TAVR) is controversial.
2014 The American Association for Thoracic Surgery Methods We compared
predicted and observed 30-day/in-hospital and 1-year mortality of patients
undergoing TAVR in the first Placement of Aortic Transcatheter Valves
trial and continued access registry (N = 2466). The performance of the LES
and STS scores (prospectively calculated) was evaluated using standard
assessments of discrimination and calibration. Performance of STS and LES
scores among 307 patients undergoing SAVR from the high-risk cohort of the
randomized trial were also examined.
Results In patients undergoing TAVR, the observed 30-day/in-hospital
mortality was 6.5%, whereas the predicted 30-day mortality was higher by
both STS score (11.4% +/- 3.9%) and LES score (26.6% +/- 16.2%). The
discrimination for both scores was poor for 30-day/in-hospital and 1-year
mortality. Calibration was better for STS score than for LES at 1 year but
poor for both at 30 days among TAVR cohort. These results were consistent
among the subgroups of patients undergoing transfemoral and transapical
access; however, the STS score had better performance among the high-risk
patients who underwent SAVR at 30 days but not 1 year.
Conclusions The STS and LES surgical risk scores overestimated
30-day/in-hospital mortality and were poor discriminators of post-TAVR
mortality, but the calibration of the STS score was better in these
high-risk patients. These data highlight the need for TAVR-specific risk
models to optimize patient selection.

<12>
Accession Number
2014758885
Authors
Decker M.R. Leverson G.E. Jaoude W.A. Maloney J.D.
Institution
(Decker, Leverson, Maloney) Wisconsin Surgical Outcomes Research Program,
Department of Surgery, University of Wisconsin, Madison, WI, United States
(Jaoude, Maloney) Division of Cardiothoracic Surgery, Department of
Surgery, University of Wisconsin, Madison, WI, United States
Title
Lung volume reduction surgery since the National Emphysema Treatment
Trial: Study of Society of Thoracic Surgeons Database.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 2651-2658),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives The National Emphysema Treatment Trial demonstrated that lung
volume reduction surgery is an effective treatment for emphysema in select
patients. With chronic lower respiratory disease being the third leading
cause of death in the United States, this study sought to assess practice
patterns and outcomes for lung volume reduction surgery on a national
level since the National Emphysema Treatment Trial.
2014 The American Association for Thoracic Surgery Methods Aggregate
statistics on lung volume reduction surgery reported in the Society of
Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to
assess procedure volume, preoperative and operative characteristics, and
outcomes. Comparisons with published data from the National Emphysema
Treatment Trial were made using chi-square and 2-sided t tests.
Results In 8.5 years, 538 patients underwent lung volume reduction
surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons
Database per year. When compared with subjects in the National Emphysema
Treatment Trial, subjects in the Society of Thoracic Surgeons Database
were younger (P <.001), a larger proportion underwent the procedure
thoracoscopically (P <.001), and forced expiratory volume in 1 second was
31% versus 28% of predicted (P <.001). When mortality was compared between
subjects in the Society of Thoracic Surgeons Database and all subjects in
the National Emphysema Treatment Trial randomized to surgery, there were
no significant differences. However, mortality was 3% higher in subjects
in the Society of Thoracic Surgeons Database when compared with the
non-high-risk National Emphysema Treatment Trial subset (P =.005).
Conclusions This study demonstrates the importance of patient selection
and the need to develop consensus on appropriate benchmarks for mortality
rates after lung volume reduction surgery. It underscores the need for
dedicated centers to increasingly address the heavy burden of chronic
lower respiratory disease in the United States in a multidisciplinary
fashion, particularly for preoperative evaluation and postoperative
management of emphysema.

<13>
Accession Number
2014739400
Authors
Benedetto U. Raja S.G. Amrani M. Pepper J.R. Zeinah M. Tonelli E.
Biondi-Zoccai G. Frati G.
Institution
(Benedetto, Raja, Amrani, Pepper) Department of Cardiac Surgery, Harefield
Hospital, London UB9 6JH, United Kingdom
(Zeinah) Ain Shams University, Cairo, Egypt
(Tonelli, Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
Title
The impact of arterial cannulation strategy on operative outcomes in
aortic surgery: Evidence from a comprehensive meta-analysis of comparative
studies on 4476 patients.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 2936-2943),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objectives There is a growing perception that peripheral cannulation
through the femoral artery, by reversing the flow in the thoracoabdominal
aorta, may increase the risk of retrograde brain embolization in aortic
surgery. Central cannulation sites, including the right axillary artery,
have been reported to improve operative outcomes by allowing antegrade
blood flow. However, peripheral cannulation still remains largely used
because a consensus for the routine use of central cannulation approaches
has not been reached.
2014 The American Association for Thoracic Surgery Methods A
meta-analysis of comparative studies reporting operative outcomes using
central cannulation versus peripheral cannulation was performed. Pooled
weighted incidence rates for end points of interest were obtained using an
inverse variance model.
Results A total of 4476 patients were included in the final analysis.
Central cannulation was used in 2797 patients, and peripheral cannulation
was used in 1679 patients. Central cannulation showed a protective effect
on in-hospital mortality (risk ratio, 0.59; 95% confidence interval,
0.48-0.7; P <.001) and permanent neurologic deficit (risk ratio, 0.71; 95%
confidence interval, 0.55-0.90; P =.005) when compared with peripheral
cannulation. A trend toward an increased benefit in terms of reduced
in-hospital mortality was observed when only the right axillary artery was
used as the central cannulation approach (risk ratio, 0.35; 95% confidence
interval, 0.22-0.55; P <.001; I² = 0%).
Conclusions Central cannulation was superior to peripheral cannulation in
reducing in-hospital mortality and the incidence of permanent neurologic
deficit. This superiority was particularly evident when the axillary
artery was used for central cannulation.

<14>
Accession Number
2014741846
Authors
Cao C. Indraratna P. Ang S.C. Manganas C. Park J. Bannon P.G. Yan T.D.
Institution
(Cao, Indraratna, Ang, Park, Bannon, Yan) Systematic Review Unit,
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Cao, Bannon, Yan) Baird Institute for Applied Heart and Lung Surgical
Research, Sydney, Australia
(Cao, Manganas) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, NSW 2011, Australia
(Bannon, Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia
Title
Should clopidogrel be discontinued before coronary artery bypass grafting
for patients with acute coronary syndrome? A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3092-3098),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objective Patients presenting with acute coronary syndrome (ACS) are
treated with dual antiplatelet agents, including aspirin and clopidogrel,
to prevent mortality and recurrent ischemia. However, those who require
coronary artery bypass grafting (CABG) could have increased postoperative
bleeding and bleeding-related adverse outcomes. The current guidelines on
clinical management differ significantly. The present meta-analysis
examined the evidence for clopidogrel in the treatment of patients
presenting with ACS requiring CABG, with a focus on the timing of
medication cessation before surgery.
2014 The American Association for Thoracic Surgery Methods A systematic
review of 9 electronic databases was performed to identify all relevant
studies with comparable outcomes for patients with ACS treated with
clopidogrel before CABG. The endpoints included reoperation, major
bleeding, mortality, and a composite endpoint of mortality and recurrent
myocardial infarction.
Results Five relevant studies were identified according to the predefined
selection criteria. Patients who had received clopidogrel had a
significantly lower incidence of composite endpoints than those who had
not. However, patients who underwent CABG < 5 days after the last dose of
clopidogrel had a significantly greater incidence of reoperation, major
bleeding, and combined adverse outcomes than those who had had a washout
period >5 days.
Conclusions The results from the present meta-analysis suggest that
patients who present with ACS should be treated with dual antiplatelet
therapy, including clopidogrel. However, for patients subsequently
referred for CABG, a minimum washout period of 5 days should be observed
to minimize perioperative bleeding and bleeding-related complications,
unless emergency indications exist. These results differ from those of
previous studies and guidelines.

<15>
Accession Number
2014874368
Authors
Cai J. Xu R. Yu X. Fang Y. Ding X.
Institution
(Cai, Yu, Fang, Ding) Department of Nephrology, Zhongshan Hospital, Fudan
University, 180 Fenglin Rd, Shanghai 200032, China
(Xu) Department of Cardiology, Zhongshan Hospital, Fudan University,
Shanghai, China
(Cai, Yu, Fang, Ding) Kidney and Dialysis Institute of Shanghai, Shanghai,
China
(Yu, Fang, Ding) Kidney and Blood Purification Laboratory of Shanghai,
Shanghai, China
Title
Volatile anesthetics in preventing acute kidney injury after cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3127-3136),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objective Acute kidney injury is a common clinical complication of cardiac
surgery. Volatile anesthetics have been shown to protect against it in
animal experiments. Clinically, however, the effect of volatile
anesthetics has been unclear. We conducted a systematic review and
meta-analysis of randomized, controlled trials to explore whether volatile
anesthetics could provide renal protection to patients undergoing cardiac
surgery.
2014 The American Association for Thoracic Surgery Methods Randomized,
controlled trials were identified in PubMed, Ovid, Excerpta Medica
Database, Cochrane Library, Current Controlled Trials Register, reviews,
and reference lists of relevant articles. Ten trials with 1600 total
participants were eligible. Data were analyzed with both fixed- and
random-effects models.
Results Relative to control data, volatile anesthetics significantly
reduced acute kidney injury incidence (relative risk [RR], 0.65; 95%
confidence interval [CI], 0.43-0.97; P =.04). Although there was no
significant difference between groups in absolute postoperative serum
creatinine level and mortality, patients receiving volatile anesthetics
had significantly (or borderline) lower increase in serum creatinine level
from baseline on the first (weighted mean difference, -0.04 mg/dL; 95% CI,
-0.07 to -0.01 mg/dL; P =.002) and second (weighted mean difference, -0.07
mg/dL, 95% CI, -0.14 to -0.00 mg/dL; P =.05) postoperative days and
reduced incidences of prolonged intensive care unit stay (RR, 0.46; 95%
CI, 0.34-0.64; P <.001) and hospitalization (RR, 0.47; 95% CI, 0.27-0.83;
P =.009).
Conclusions Current evidence shows that volatile anesthetics may provide
renal protection in patients undergoing cardiac surgery and supports
further randomized, controlled trials with larger sample sizes and high
methodologic quality.

<16>
Accession Number
2014723133
Authors
Liberman M. Khereba M. Goudie E. Kazakov J. Thiffault V. Lafontaine E.
Ferraro P.
Institution
(Liberman, Khereba, Goudie, Kazakov, Thiffault, Lafontaine, Ferraro) CETOC
- CHUM Endoscopic Tracheobronchial and Oesophageal Center, Department of
Surgery, University of Montreal, Montreal, QC, Canada
Title
Pilot study of pulmonary arterial branch sealing using energy devices in
an ex vivo model.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (6) (pp 3219-3223),
2014. Date of Publication: 01 Dec 2014.
Publisher
Mosby Inc.
Abstract
Objective Vascular endostaplers are bulky and can be dangerous when
dividing small pulmonary arterial (PA) branch vessels during
video-assisted thoracoscopic lobectomy. We aimed to evaluate and compare
the immediate efficacy of modern energy sealing devices in an ex vivo PA
sealing model.
2014 The American Association for Thoracic Surgery Methods Patients
undergoing anatomical lung resection or lung transplantation were
recruited for a prospective cohort pilot study. Four devices were
evaluated: Harmonic Ace (Ethicon, Cincinnati, Ohio), Thunderbeat (Olympus,
Tokyo, Japan), LigaSure (Covidien, Boulder, Colo), and Enseal (Ethicon;
Cincinnati, Ohio). After anatomical lung resection, the PA branches were
dissected in vitro. Sealing was then performed with 1 of the sealing
devices, the vessel was slowly pressurized, and the bursting pressure was
recorded.
Results Forty-nine PA branches were sealed in 14 patients. The mean PA
branch diameter was 7.4 mm (1.8-14.5 mm). Ten patients had normal PA
pressure and 3 had PA hypertension. The mean bursting pressure in each was
as follows: Harmonic Ace group, 415.5 mm Hg (137.1-1388.4 mm Hg),
Thunderbeat group, 875 mm Hg (237.1-2871.3 mm Hg); LigaSure group, 214.7
mm Hg (0-579.6 mm Hg); Enseal group, 133.7 mm Hg (0-315.38 mm Hg). There
were 2 complete sealing failures: LigaSure (diameter 6.78 mm) and Enseal
(diameter 8.3 mm).
Conclusions In this pilot study to examine energy sealing of PA branches
in a simulated ex vivo model, vascular sealing using energy was effective
and was able to sustain high intraluminal bursting pressures. Further
research is needed to determine the in vivo and long-term safety of PA
branch energy sealing.

<17>
Accession Number
2015647750
Authors
Iliuta L. Rac-Albu M.
Institution
(Iliuta, Rac-Albu) "Carol Davila" University of Medicine and Pharmacy,
Bucharest, Romania
Title
Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities
or Left Ventricular Dysfunction Undergoing Cardiac Surgery.
Source
Cardiology and Therapy. 3 (1-2) (pp 13-26), 2013. Date of Publication:
2013.
Publisher
Springer Healthcare
Abstract
Introduction: In patients with conduction abnormalities or left ventricle
(LV) dysfunction the use of beta-blockers for post cardiac surgery rhythm
control is difficult and controversial, with a paucity of information
about other drugs such ivabradine used postoperatively. The objective of
this study was to compare the efficacy and safety of ivabradine versus
metoprolol used perioperatively in cardiac surgery patients with
conduction abnormalities or LV systolic dysfunction.
Methods: This was an open-label, randomized clinical trial enrolling 527
patients with conduction abnormalities or LV systolic dysfunction
undergoing coronary artery bypass grafting or valvular replacement,
randomized to take ivabradine or metoprolol, or metoprolol plus
ivabradine. The primary endpoints were the composites of 30-day mortality,
in-hospital atrial fibrillation (AF), in-hospital three-degree
atrioventricular block and need for pacing, in-hospital worsening heart
failure (HF; safety endpoints), duration of hospital stay and
immobilization and the above endpoint plus in-hospital bradycardia,
gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy
plus safety endpoint).
Results: Heart rate reduction and prevention of postoperative AF or
tachyarrhythmia with combined therapy was more effective than with
metoprolol or ivabradine alone during the immediate postoperative
management of cardiac surgery patients. In the Ivabradine group, the
frequency of early postoperative pacing and HF worsening was smaller than
in the Metoprolol group and in combined therapy group. The frequency of
primary combined endpoint was lower in the combined Ivabradine +
Metoprolol group compared with the monotherapy groups.
Conclusion: Considering efficacy and safety, the cardiac rhythm reduction
after open heart surgery in patients with conduction abnormalities or LV
dysfunction with ivabradine plus metoprolol emerged as the best treatment
in this trial.

<18>
Accession Number
2014622688
Authors
Neto A.S. Hemmes S.N.T. Barbas C.S.V. Beiderlinden M. Fernandez-Bustamante
A. Futier E. Hollmann M.W. Jaber S. Kozian A. Licker M. Lin W.-Q. Moine P.
Scavonetto F. Schilling T. Selmo G. Severgnini P. Sprung J. Treschan T.
Unzueta C. Weingarten T.N. Wolthuis E.K. Wrigge H. de Abreu M.G. Pelosi P.
Schultz M.J.
Institution
(Neto, Hemmes, Wolthuis, Schultz) Department of Intensive Care, Academic
Medical Centre, University of Amsterdam, Amsterdam, Netherlands
(Hemmes, Hollmann) Department of Anaesthesiology, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
(Schultz) Laboratory of Experimental Intensive Care and Anaesthesiology,
Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
(Neto, Sprung, Weingarten) Medical Intensive Care Unit, ABC Medical School
(FMABC), Santo Andre, Brazil
(Neto, Barbas) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Beiderlinden, Treschan) Department of Anaesthesiology, Dusseldorf
University Hospital, Heinrich-Heine University, Dusseldorf, Germany
(Beiderlinden) Department of Anaesthesiology, Marienhospital Osnabruck,
Osnabruck, Germany
(Fernandez-Bustamante, Moine) Department of Anesthesiology, University of
Colorado, Aurora, CO, United States
(Futier) Department of Aneasthesiology and Critical Care Medicine, Estaing
University Hospital, Clermont-Ferrand, France
(Jaber) Department of Critical Care Medicine and Anaesthesiology (SAR B),
Saint Eloi University Hospital, Montpellier, France
(Kozian, Schilling) Department of Anaesthesiology and Intensive Care
Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
(Licker) Department of Anaesthesiology, Pharmacology and Intensive Care,
Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
(Lin) State Key Laboratory of Oncology of South China, Sun Yat-sen
University Cancer Center, Guangzhou, Guangdong, China
(Scavonetto) Department of Anesthesiology and Anesthesia Clinical Research
Unit, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United
States
(Selmo) Department of Anaesthesia, Azienda Ospedaliera Fondazione Macchi,
Ospedale di Circolo, Varese, Italy
(Severgnini) Department of Biotechnology and Life Sciences, University of
Insubria, Varese, Italy
(Unzueta) Department of Anaesthesiology, Hospital de Sant Pau, Barcelona,
Spain
(Wrigge) Department Anaesthesiology and Intensive Care Medicine,
University of Leipzig, Leipzig, Germany
(de Abreu) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Carl Gustav Carus, Dresden, Germany
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics, IRCCS
San Martino IST, University of Genoa, Genoa, Italy
Title
Incidence of mortality and morbidity related to postoperative lung injury
in patients who have undergone abdominal or thoracic surgery: A systematic
review and meta-analysis.
Source
The Lancet Respiratory Medicine. 2 (12) (pp 1007-1015), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Lancet Publishing Group
Abstract
Background: Lung injury is a serious complication of surgery. We did a
systematic review and meta-analysis to assess whether incidence,
morbidity, and in-hospital mortality associated with postoperative lung
injury are affected by type of surgery and whether outcomes are dependent
on type of ventilation. Methods: We searched MEDLINE, CINAHL, Web of
Science, and Cochrane Central Register of Controlled Trials for
observational studies and randomised controlled trials published up to
April, 2014, comparing lung-protective mechanical ventilation with
conventional mechanical ventilation during abdominal or thoracic surgery
in adults. Individual patients' data were assessed. Attributable mortality
was calculated by subtracting the in-hospital mortality of patients
without postoperative lung injury from that of patients with postoperative
lung injury. Findings: We identified 12 investigations involving 3365
patients. The total incidence of postoperative lung injury was similar for
abdominal and thoracic surgery (34% vs 43%, p=0198). Patients who
developed postoperative lung injury were older, had higher American
Society of Anesthesiology scores and prevalence of sepsis or pneumonia,
more frequently had received blood transfusions during surgery, and
received ventilation with higher tidal volumes, lower positive
end-expiratory pressure levels, or both, than patients who did not.
Patients with postoperative lung injury spent longer in intensive care (80
[SD 124] vs 11 [37] days, p<00001) and hospital (209 [181] vs 147 [143]
days, p<00001) and had higher in-hospital mortality (203% vs 14% p<00001)
than those without injury. Overall attributable mortality for
postoperative lung injury was 19% (95% CI 18-19), and differed
significantly between abdominal and thoracic surgery patients (122%, 95%
CI 120-126 vs 265%, 262-270, p=00008). The risk of in-hospital mortality
was independent of ventilation strategy (adjusted HR 071, 95% CI 041-122).
Interpretation: Postoperative lung injury is associated with increases in
in-hospital mortality and durations of stay in intensive care and
hospital. Attributable mortality due to postoperative lung injury is
higher after thoracic surgery than after abdominal surgery.
Lung-protective mechanical ventilation strategies reduce incidence of
postoperative lung injury but does not improve mortality. Funding: None.

<19>
Accession Number
2014622674
Authors
Cypel M. Fan E.
Institution
(Cypel) Division of Thoracic Surgery, University of Toronto, Toronto, ON
M5G2C4, Canada
(Fan) Interdepartmental Division of Critical Care Medicine, University of
Toronto, Toronto, ON M5G2C4, Canada
Title
Lung injury after abdominal and thoracic surgery.
Source
The Lancet Respiratory Medicine. 2 (12) (pp 949-950), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Lancet Publishing Group

<20>
Accession Number
2014616971
Authors
Efremov S.M. Lomivorotov V.V. Shmyrev V.A. Ponomarev D.N. Deryagin M.N.
Boboshko V.A. Shilova A.N.
Institution
(Efremov, Lomivorotov, Shmyrev, Ponomarev, Deryagin, Boboshko, Shilova)
Novosibirsk State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
Title
Prevention of gastrointestinal injury by glutamine in cardiac surgery:
Negative results of pilot double-blind, placebo-controlled, randomized
study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (6) (pp e51-e52),
2014. Date of Publication: 01 Dec 2014.
Publisher
W.B. Saunders

<21>
Accession Number
2014616962
Authors
Biancari F. Juvonen T. Onorati F. Faggian G. Heikkinen J. Airaksinen J.
Mariscalco G.
Institution
(Biancari, Juvonen, Heikkinen) Department of Surgery, Oulu University
Hospital, PL 21, Oulu 90029, Finland
(Onorati, Faggian) Division of Cardiac Surgery, University of Verona
Medical School, Verona, Italy
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
(Mariscalco) Cardiac Surgery Unit, Varese University Hospital, Varese,
Italy
Title
Meta-analysis on the performance of the EuroSCORE II and the society of
thoracic surgeons scores in patients undergoing aortic valve replacement.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (6) (pp 1533-1539),
2014. Date of Publication: 01 Dec 2014.
Publisher
W.B. Saunders
Abstract
Measurements and Main Results Ten studies validated these scores in 13,856
patients who underwent either TAVR or SAVR. Operative mortality was 5.9%
(SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15,
SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was
6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The
area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR
patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and
0.63 for STS). The difference between observed/expected mortality was not
significant for ESII (Peto's OR 0.99, p = 0.88) and was significant for
STS (Peto's OR 0.86, p = 0.008). ESII (Peto's OR 1.35, p<0.00001) and STS
(Peto's OR 1.23, p<0.00001) significantly underestimated the mortality
risk in TAVR patients. The STS (Peto's OR 0.74, p<0.0001) and, to a lesser
extent, the ESII (Peto's OR 0.86, p = 0.0.04) overestimated the mortality
risk in SAVR patients.
Conclusions The ESII and STS scores have good O/E ratios for either TAVR
or SAVR patients, but both scores significantly underpredicted the risk of
TAVR patients. ESII seemed to be accurate in predicting the risk of SAVR
patients.
Objective To evaluate the performance of the EuroSCORE II (ESII) and the
Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or
transcatheter aortic valve replacement (TAVR).
Design Systematic review of the literature and meta-analysis.
Setting University hospitals.
Participants Studies reporting data on the performance of ESII and STS
scores in patients undergoing SAVR or TAVR.
Interventions SAVR or TAVR.

<22>
Accession Number
2014616956
Authors
Zuo Y. Cheng X. Gu E. Liu X. Zhang L. Cao Y.
Institution
(Zuo, Cheng, Gu, Liu, Zhang, Cao) Department of Anesthesiology, First
Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei
230022, China
Title
Effect of aortic root infusion of sufentanil on ischemia-reperfusion
injury in patients undergoing mitral valve replacement.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (6) (pp 1474-1478),
2014. Date of Publication: 01 Dec 2014.
Publisher
W.B. Saunders
Abstract
Objective This study investigated the effects of aortic root infusion of
sufentanil on myocardial ischemia/reperfusion injury in patients
undergoing elective mitral valve replacement (MVR) with cardiopulmonary
bypass (CPB).
Design A prospective, randomized, clinical study.
Setting A university-affiliated teaching hospital.
Participants Fifty-three adult patients undergoing elective MVR with CPB.
Interventions Bolus infusions of sufentanil (0.2 mug/kg, n = 24) or normal
saline (n = 29) were administered through the aortic root cardioplegia
perfusion catheter 5 minutes before aortic unclamping.
Measurements and Main Results Plasma concentrations of CK-MB and cTnI and
variables including heart rate, mean arterial pressure, central venous
pressure, cardiac output, stroke volume, duration of mechanical
ventilation, length of ICU stay, length of hospital stay, and 24-hour
postoperative inotropic scores were recorded. Plasma concentrations of
CK-MB and cTnI were significantly lower 4 and 8 hours after aortic
unclamping in the sufentanil postconditioning group compared to control
(p<0.05). Inotropic drug use, duration of mechanical ventilation, and
length of ICU and hospital stays were reduced significantly in the
sufentanil postconditioning group compared to control (p< 0.05).
Conclusions The present study demonstrated that sufentanil can attenuate
myocardial ischemia-reperfusion injury in patients undergoing elective MVR
with CPB.