EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
24142329
Authors
Kong H.Y. Wen X.H. Huang S.Q. Zhu S.M.
Institution
(Kong) Department of Anesthesiology, 1st Affiliated Hospital of Medical
College, Zhejiang University, Hangzhou, China,
Title
Epsilon-aminocaproic acid improves postrecirculation hemodynamics by
reducing intraliver activated protein C consumption in orthotopic liver
transplantation.
Source
World journal of surgery. 38 (1) (pp 177-185), 2014. Date of Publication:
Jan 2014.
Abstract
Activated protein C (APC) is related to regulating the inflammatory
response and hemodynamic stability upon reperfusion in cardiac operations
and orthotopic liver transplantation (OLT). Epsilon-aminocaproic acid
(EACA) is frequently used to treat fibrinolysis during OLT. It also has
inhibitory effects related to the inflammatory response. However, it
remains to be determined whether EACA can attenuate intraliver APC
consumption and improve hemodynamic stability after reperfusion during
OLT. Fifty-nine recipients were randomized to receive either EACA (150 mg
kg(-1) given intravenously prior to incision, followed by 15 mg kg(-1)
h(-1) infusion until 2 h after the graft reperfusion) or the same volume
of saline. Blood samples to assess plasma APC and protein C were obtained
immediately before and after reperfusion from the inferior caval effluent
or the portal veins for calculation of transliver differences (DELTA).
Hemodynamics and vasoactive medication use during the reperfusion period
were observed in both groups. No transhepatic changes in protein C were
found in either group. Immediately after reperfusion, a marked intraliver
consumption of APC was noted in all recipients (P < 0.001), and intraliver
consumption of APC in the control group was greater than that in the
EACA-treated group (P < 0.05). Fewer requirements for vasoactive
medication use after reperfusion and better initial graft function were
noted in the EACA-treated group (P < 0.05). EACA can attenuate intraliver
APC consumption and improve hemodynamic stability after reperfusion and
initial graft function during OLT.

<2>
Accession Number
24129801
Authors
Cai G.L. Chen J. Hu C.B. Yan M.L. Xu Q.H. Yan J.
Institution
(Cai) Intensive Care Unit of ZheJiang Hospital, No. 12, LingYin Road, Xihu
District, Hangzhou City, 310013, Zhejiang, China.
Title
Value of plasma brain natriuretic peptide levels for predicting
postoperative atrial fibrillation: a systemic review and meta-analysis.
Source
World journal of surgery. 38 (1) (pp 51-59), 2014. Date of Publication:
Jan 2014.
Abstract
Blood natriuretic peptide (NP) levels have been reported to be useful for
predicting postoperative atrial fibrillation (AF). We aimed to
quantitatively synthesize the current evidence of the accuracy of using NP
levels in predicting postoperative AF. Medline, Embase, and reference
lists were searched. Studies were included if either brain natriuretic
peptide (BNP) or N-terminal pro-b type natriuretic peptide (NT-proBNP) had
been evaluated perioperatively to predict postoperative AF. Data were
analyzed to obtain summary accuracy estimates. Data from 1,844 patients in
10 studies were analyzed. Summary estimates for the sensitivity and
specificity of using NP levels for predicting postoperative AF were 75 %
[95 % confidence interval (CI) 67-79 %] and 80 % (95 % CI 62-91 %),
respectively. The overall diagnostic odds ratio was 3.28 (95 % CI
2.23-4.84). Subgroup analysis showed that elevated NP levels in the
perioperative period were a strong independent predictor of postoperative
AF. NT-proBNP appeared to have better predictive value than BNP, as did
postoperative assessment over preoperative assessment. BNP had a better
correlation with postoperative AF in patients undergoing thoracic surgery
than in patients undergoing cardiac surgery. Perioperative assessment of
the natriuretic peptide level in patients undergoing major cardiothoracic
surgery could be a valuable diagnostic aid for identifying patients at
high risk of developing postoperative AF, and for providing critical
clinical information to guide prophylactic antiarrhythmic therapy in the
perioperative period.

<3>
Accession Number
24745020
Authors
Tugcugil E.
Institution
(Erturk) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Aydogdu Kaya) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Kutanis) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Besir) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Akdogan) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Geze) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Tugcugil) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey
Title
The effectiveness of preemptive thoracic epidural analgesia in thoracic
surgery.
Source
BioMed research international. 2014 (pp 673682), 2014. Date of
Publication: 2014.
Abstract
BACKGROUND: The aim of this study is to investigate the effectiveness of
preemptive thoracic epidural analgesia (TEA) comparing conventional
postoperative epidural analgesia on thoracotomy.
MATERIAL AND METHODS: Forty-four patients were randomized in to two groups
(preemptive: Group P, control: Group C). Epidural catheter was inserted in
all patients preoperatively. In Group P, epidural analgesic solution was
administered as a bolus before the surgical incision and was continued
until the end of the surgery. Postoperative patient controlled epidural
analgesia infusion pumps were prepared for all patients. Respiratory rates
(RR) were recorded. Patient's analgesia was evaluated with visual analog
scale at rest (VASr) and coughing (VASc). Number of patient's demands from
the pump, pump's delivery, and additional analgesic requirement were also
recorded.
RESULTS: RR in Group C was higher than in Group P at postoperative 1st and
2nd hours. Both VASr and VASc scores in Group P were lower than in Group C
at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's
delivery count for bolus dose in Group P were lower than in Group C in all
measurement times. Total analgesic requirements on postoperative 1st and
24th hours in Group P were lower than in Group C.
CONCLUSION: We consider that preemptive TEA may offer better analgesia
after thoracotomy.

<4>
Accession Number
24488821
Authors
Baidya D.K. Khanna P. Maitra S.
Institution
(Baidya, Khanna, Maitra) Department of Anaesthesiology and Intensive Care,
All India Institute of Medical Sciences, New Delhi, India
Title
Analgesic efficacy and safety of thoracic paravertebral and epidural
analgesia for thoracic surgery: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 18 (5) (pp 626-635),
2014. Date of Publication: 01 May 2014.
Abstract
Though once considered the gold standard, epidural anaesthesia has
complications that may be significant and include hypotension, urinary
retention, partial or patchy block and, in rare cases, devastating
neurological injuries also. Paravertebral block (PVB) is an alternative
technique for unilateral surgical procedures like thoracotomy, which may
offer similar analgesic effectiveness and a more favourable side-effect
profile than epidural analgesia. This systematic review and meta-analysis
of published randomized clinical trials aims to compare thoracic
paravertebral with thoracic epidural analgesia (TEA) in thoracotomy for
lung surgery. Five hundred and forty-one patients from 12 clinical trials
have been included in this systematic review and meta-analysis. We found
that visual analogue scale (VAS) scores at rest and during
activity/coughing at 4-8, 24 and 48 h postoperatively were similar in both
the PVB and TEA groups. Considering studies not included in the previous
meta-analysis, a VAS score on activity at 48 h is significantly better in
the PVB group (mean difference 0.40 cm; 95% confidence interval [95% CI]
0.77, 0.02; Mantel-Haenszel (M-H) fixed). Hypotension (odds ratio 0.13;
95% CI 0.06, 0.31; M-H fixed) and urinary retention are more common in the
epidural analgesia group. So, we conclude that thoracic PVB may be as
effective as thoracic epidural analgesia for post-thoracotomy pain relief
and is also associated with fewer complications.

<5>
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Accession Number
25261549
Authors
Alexander J.H.
Institution
(Hess) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Lopes) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Gibson) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Hager) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Wojdyla) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Englum) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Mack) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Califf) From the Duke Clinical Research Institute, Duke Medicine, Durham,
NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical
School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care
System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke
Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St.
Louis, MO (N.T.K.)
(Kouchoukos) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Peterson) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.)
(Alexander) From the Duke Clinical Research Institute, Duke Medicine,
Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard
Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health
Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute,
Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center,
St. Louis, MO (N.T.K.). john.h.alexander@duke.edu
Title
Saphenous vein graft failure after coronary artery bypass surgery:
insights from PREVENT IV.
Source
Circulation. 130 (17) (pp 1445-1451), 2014. Date of Publication: 21 Oct
2014.
Abstract
BACKGROUND: Coronary artery bypass grafting success is limited by vein
graft failure (VGF). Understanding the factors associated with VGF may
improve patient outcomes.
METHODS AND RESULTS: We examined 1828 participants in the Project of Ex
Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial
undergoing protocol-mandated follow-up angiography 12 to 18 months
post-coronary artery bypass grafting or earlier clinically driven
angiography. Outcomes included patient- and graft-level angiographic VGF
(>75% stenosis or occlusion). Variables were selected by using Fast False
Selection Rate methodology. We examined relationships between variables
and VGF in patient- and graft-level models by using logistic regression
without and with generalized estimating equations. At 12 to 18 months
post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had
VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and
clinical characteristics were similar between patients with and without
VGF, although VGF patients had longer surgical times, worse target artery
quality, longer graft length, and they more frequently underwent
endoscopic vein harvesting. After multivariable adjustment, longer
surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence
interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95%
confidence interval, 1.16-1.71), poor target artery quality (odds ratio,
1.43; 95% confidence interval, 1.11-1.84), and postoperative use of
clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval,
1.07-1.69) were associated with patient-level VGF. The predicted
likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%.
CONCLUSIONS: VGF is common and associated with patient and surgical
factors. These findings may help identify patients with risk factors for
VGF and inform the development of interventions to reduce VGF.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00042081.

<6>
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Accession Number
25205802
Authors
Leon M.B.
Institution
(Kapadia) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.). kapadis@ccf.org
(Tuzcu) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Makkar) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Svensson) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Agarwal) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Kodali) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Fontana) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Webb) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Mack) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Thourani) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Babaliaros) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Herrmann) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Szeto) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Pichard) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Williams) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Anderson) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Akin) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Miller) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Smith) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
(Leon) From the Cleveland Clinic Foundation, Cleveland, OH (S.R.K.,
E.M.T., L.G.S., S.A.); Cedars Sinai Medical Center, Los Angeles, CA
(R.R.M.); Columbia University Medical Center/New York Presbyterian
Hospital, New York, NY (S.K., M.R.W., C.R.S., M.B.L.); Lenox Hill
Hospital, New York, NY (G.P.F.); St. Paul's Hospital, Vancouver, BC,
Canada (J.G.W.); Baylor Healthcare System, Plano, TX (M.M.); Emory
University School of Medicine, Atlanta, GA (V.H.T., V.C.B.); Hospital of
the University of Pennsylvania, Philadelphia, PA (H.C.H., W.S.); Medstar
Washington Hospital Center, Washington, DC (A.D.P.); Edwards Lifesciences,
Irvine, CA (W.N.A., J.J.A.); and Stanford University, Stanford, CA
(D.C.M.)
Title
Long-term outcomes of inoperable patients with aortic stenosis randomly
assigned to transcatheter aortic valve replacement or standard therapy.
Source
Circulation. 130 (17) (pp 1483-1492), 2014. Date of Publication: 21 Oct
2014.
Abstract
BACKGROUND: The long-term outcomes of transcatheter aortic valve
replacement (TAVR) in inoperable patients with severe aortic stenosis
remain unknown.
METHODS AND RESULTS: In the Placement of Aortic Transcatheter Valves
(PARTNER) study, 358 patients were randomly assigned to TAVR or standard
therapy. We report the 3-year outcomes on these patients, and the pooled
outcomes for all randomly assigned inoperable patients (n=449) in PARTNER,
as well, including the randomized portion of the continued access study
(n=91). The 3-year mortality rate in the TAVR and standard therapy groups
was 54.1% and 80.9%, respectively (P<0.001; hazard ratio, 0.53; 95%
confidence interval, 0.41-0.68; P<0.001). In survivors, there was
significant improvement in New York Heart Association functional class
sustained at 3 years. The cumulative incidence of strokes at 3-year
follow-up was 15.7% in TAVR patients versus 5.5% in patients undergoing
standard therapy (hazard ratio, 2.81; 95% confidence interval, 1.26-6.26;
P=0.012); however, the composite of death or strokes was significantly
lower after TAVR versus standard therapy (57.4% versus 80.9%, P<0.001;
hazard ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.001).
Echocardiography showed a sustained increase in aortic valve area and
decrease in transvalvular gradient after TAVR. Analysis of the 449 pooled
randomly assigned patients (TAVR, n=220; standard therapy, n=229)
demonstrated significant improvement in all-cause mortality and functional
status during early and 3-year follow-up. The results of the pooled cohort
were similar to the results obtained from the pivotal PARTNER trial.
CONCLUSIONS: TAVR resulted in better survival and functional status in
inoperable patients with severe aortic stenosis with durable hemodynamic
benefit on long-term follow-up. However, high residual mortality, even in
successfully treated TAVR patients, highlights the need for more strategic
patient selection.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00530894.

<7>
Accession Number
24433612
Authors
Zhao Q.
Institution
(Zhang) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China
(Zhou) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China
(Li) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China
(Zhou) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China
(Chen) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China
(Zhao) Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, People's Republic of China.
Electronic address: zq11607@rjh.com.cn
Title
Remote ischemic preconditioning does not improve the clinical outcomes in
patients undergoing coronary artery bypass grafting: a meta-analysis of
randomized controlled trials.
Source
International journal of cardiology. 172 (1) (pp e36-e38), 2014. Date of
Publication: 01 Mar 2014.

<8>
Accession Number
23738675
Authors
Oel C. Gerhards H. Gehlen H.
Institution
(Oel, Gerhards, Gehlen) Equine Clinic, Free University of Berlin,
Oertzenweg 19b, 14163, Berlin, Germany
Title
Effect of retrobulbar nerve block on heart rate variability during
enucleation in horses under general anesthesia.
Source
Veterinary ophthalmology. 17 (3) (pp 170-174), 2014. Date of Publication:
01 May 2014.
Abstract
OBJECTIVE: Analysis of any effect of retrobulbar block during ocular
surgery on heart rate variability and oculocardiac reflex.
STUDY DESIGN: Prospective study.
ANIMAL STUDIED: Horses (n = 16) undergoing eye enucleation due to chronic
ophthalmologic diseases.
PROCEDURE: Eye enucleation was performed under general anesthesia. The
horses were randomly assigned to the first (inhalation anesthesia only, n
= 10) or second group (inhalation and local retrobulbar anesthesia, n =
6). The retrobulbar block was performed using 12 mL of mepivacaine
hydrochloride 2%. ECG data were taken by a Telemetric ECG before, during,
and after surgery. Heart rate variability was analyzed in the time domain
as mean heart rate, mean beat-to-beat interval duration, and standard
deviation of continuous beat-to-beat intervals. The frequency domain
analysis included the low- and high-frequency components of heart rate
variability and the sympathovagal balance (low/high frequency). The low
frequency represents mainly sympathetic influences on the heart, whereas
high frequency is mediated by the parasympathetic tone.
RESULTS: All horses without a retrobulbar block showed a significant
decrease in the heart rate during traction on the globe and pressure on
the orbital fat pad for homoestasis (P = 0.04). Simultaneously,
high-frequency power, as an indicator of vagal stimulation, increased
significantly. High-frequency and low-frequency power in the retrobulbar
block group increased in five horses, and heart rate decreased in only one
horse. Both were not significant within the group, but there was a
significant difference between both groups relating to the incidence of
heart rate decrease occurring at globe traction.
CONCLUSIONS AND CLINICAL RELEVANCE: Heart rate variability is a sensitive,
non-invasive parameter to obtain sympathovagal stimulations during general
anesthesia. The retrobulbar block can prevent heart rate decrease
associated with initiation of the oculocardiac reflex.

<9>
Accession Number
24780450
Authors
Elbourne D.
Institution
(Macrae) Royal Brompton Hospital, London, UK
(Grieve) Department of Health Services Research and Policy, London School
of Hygiene and Tropical Medicine, London, UK
(Allen) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, UK
(Sadique) Department of Health Services Research and Policy, London School
of Hygiene and Tropical Medicine, London, UK
(Betts) Royal Brompton Hospital, London, UK
(Morris) Birmingham Children's Hospital, Birmingham, UK
(Pappachan) Southampton General Hospital, Southampton, UK
(Parslow) Faculty of Medicine and Health, University of Leeds, Leeds, UK
(Tasker) Boston Children's Hospital, Boston, MA, USA
(Baines) Alder Hey Hospital, Liverpool, UK
(Broadhead) Great Ormond Street Hospital for Children, London, UK
(Duthie) Glenfield Hospital and Leicester Royal Infirmary, Leicester, UK
(Fortune) Royal Manchester Children's Hospital, Manchester, UK
(Inwald) St Mary's Hospital, London, UK
(McMaster) University Hospital of North Staffordshire, Stoke-on-Trent, UK
(Peters) Great Ormond Street Hospital for Children, London, UK
(Schindler) Bristol Royal Hospital for Children, Bristol, UK
(Guerriero) Department of Health Services Research and Policy, London
School of Hygiene and Tropical Medicine, London, UK
(Piercy) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, UK
(Slavik) Royal Brompton Hospital, London, UK
(Snowdon) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, UK
(Van Dyck) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, UK
(Elbourne) Medical Statistics Department, London School of Hygiene and
Tropical Medicine, London, UK
Title
A clinical and economic evaluation of Control of Hyperglycaemia in
Paediatric intensive care (CHiP): a randomised controlled trial.
Source
Health technology assessment (Winchester, England). 18 (26) (pp 1-210),
2014. Date of Publication: 01 Apr 2014.
Abstract
BACKGROUND: Early research in adults admitted to intensive care suggested
that tight control of blood glucose during acute illness can be associated
with reductions in mortality, length of hospital stay and complications
such as infection and renal failure. Prior to our study, it was unclear
whether or not children could also benefit from tight control of blood
glucose during critical illness.
OBJECTIVES: This study aimed to determine if controlling blood glucose
using insulin in paediatric intensive care units (PICUs) reduces mortality
and morbidity and is cost-effective, whether or not admission follows
cardiac surgery.
DESIGN: Randomised open two-arm parallel group superiority design with
central randomisation with minimisation. Analysis was on an
intention-to-treat basis. Following random allocation, care givers and
outcome assessors were no longer blind to allocation.
SETTING: The setting was 13 English PICUs.
PARTICIPANTS: Patients who met the following criteria were eligible for
inclusion: >36 weeks corrected gestational age; <16 years; in the PICU
following injury, following major surgery or with critical illness;
anticipated treatment >12 hours; arterial line; mechanical ventilation;
and vasoactive drugs. Exclusion criteria were as follows: diabetes
mellitus; inborn error of metabolism; treatment withdrawal considered; in
the PICU >5 consecutive days; and already in CHiP (Control of
Hyperglycaemia in Paediatric intensive care).
INTERVENTION: The intervention was tight glycaemic control (TGC): insulin
by intravenous infusion titrated to maintain blood glucose between 4.0 and
7.0mmol/l.
CONVENTIONAL MANAGEMENT (CM): This consisted of insulin by intravenous
infusion only if blood glucose exceeded 12.0mmol/l on two samples at least
30 minutes apart; insulin was stopped when blood glucose fell below
10.0mmol/l.
MAIN OUTCOME MEASURES: The primary outcome was the number of days alive
and free from mechanical ventilation within 30 days of trial entry
(VFD-30). The secondary outcomes comprised clinical and economic outcomes
at 30 days and 12 months and lifetime cost-effectiveness, which included
costs per quality-adjusted life-year.
RESULTS: CHiP recruited from May 2008 to September 2011. In total, 19,924
children were screened and 1369 eligible patients were randomised (TGC,
694; CM, 675), 60% of whom were in the cardiac surgery stratum. The
randomised groups were comparable at trial entry. More children in the TGC
than in the CM arm received insulin (66% vs. 16%). The mean VFD-30 was 23
[mean difference 0.36; 95% confidence interval (CI) -0.42 to 1.14]. The
effect did not differ among prespecified subgroups. Hypoglycaemia occurred
significantly more often in the TGC than in the CM arm (moderate, 12.5%
vs. 3.1%; severe, 7.3% vs. 1.5%). Mean 30-day costs were similar between
arms, but mean 12-month costs were lower in the TGC than in CM arm
(incremental costs -3620, 95% CI -7743 to 502). For the non-cardiac
surgery stratum, mean costs were lower in the TGC than in the CM arm
(incremental cost -9865, 95% CI -18,558 to -1172), but, in the cardiac
surgery stratum, the costs were similar between the arms (incremental cost
133, 95% CI -3568 to 3833). Lifetime incremental net benefits were
positive overall (3346, 95% CI -11,203 to 17,894), but close to zero for
the cardiac surgery stratum (-919, 95% CI -16,661 to 14,823). For the
non-cardiac surgery stratum, the incremental net benefits were high
(11,322, 95% CI -15,791 to 38,615). The probability that TGC is
cost-effective is relatively high for the non-cardiac surgery stratum,
but, for the cardiac surgery subgroup, the probability that TGC is
cost-effective is around 0.5. Sensitivity analyses showed that the results
were robust to a range of alternative assumptions.
CONCLUSIONS: CHiP found no differences in the clinical or
cost-effectiveness of TGC compared with CM overall, or for prespecified
subgroups. A higher proportion of the TGC arm had hypoglycaemia. This
study did not provide any evidence to suggest that PICUs should stop
providing CM for children admitted to PICUs following cardiac surgery. For
the subgroup not admitted for cardiac surgery, TGC reduced average costs
at 12 months and is likely to be cost-effective. Further research is
required to refine the TGC protocol to minimise the risk of hypoglycaemic
episodes and assess the long-term health benefits of TGC.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN61735247.
FUNDING: This project was funded by the NIHR Health Technology Assessment
programme and will be published in full in Health Technology Assessment;
Vol. 18, No. 26. See the NIHR Journals Library website for further project
information.

<10>
Accession Number
24527444
Authors
Mentese A.
Institution
(Erturk) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Topaloglu) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Dohman) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Kutanis) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Besir) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Demirci) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Kayir) Department of Anesthesiology and Intensive Care, Faculty of
Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
(Mentese) Department of Biochemistry, Faculty of Medicine, Karadeniz
Technical University, 61080 Trabzon, Turkey
Title
The comparison of the effects of sevoflurane inhalation anesthesia and
intravenous propofol anesthesia on oxidative stress in one lung
ventilation.
Source
BioMed research international. 2014 (pp 360936), 2014. Date of
Publication: 2014.
Abstract
BACKGROUND: The aim of this study is to compare the effects of sevoflurane
and propofol on one lung ventilation (OLV) induced ischemia-reperfusion
injury (IRI) by determining the blood gas, ischemia-modified albumin
(IMA), and malonyldialdehyde (MDA).
MATERIAL AND METHODS: Forty-four patients undergoing thoracic surgery with
OLV were randomized in two groups (sevoflurane Group S, propofol Group P).
Anesthesia was inducted with thiopental and was maintained with 1-2.5% of
sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P
anesthesia was inducted with propofol and was maintained with infusion of
propofol and remifentanil. Hemodynamic records and blood samples were
obtained before anesthesia induction (t 1), 1 min before two lung
ventilation (t 2), 30 min after two lung ventilation (t 3), and
postoperative sixth hours (t 4).
RESULTS: Heart rate at t 2 and t 3 in Group P was significantly lower than
that in Group S. While there were no significant differences in terms of
pH and pCO2, pO2 at t 2 and t 3 in Group S was significantly lower than
that in Group P. IMA levels at t 4 in Group S were significantly lower
than those in Group P.
CONCLUSION: Sevoflurane may offer protection against IRI after OLV in
thoracic surgery.

<11>
Accession Number
23478196
Authors
Lu M. Liu S. Zheng Z. Yin G. Song L. Chen H. Chen X. Chen Q. Jiang S. Tian
L. He Z. Hu S. Zhao S.
Institution
(Lu, Liu, Zheng, Yin, Song, Chen, Chen, Chen, Jiang, Tian, He, Hu, Zhao)
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, 100037, People's Republic of
China
Title
A pilot trial of autologous bone marrow mononuclear cell transplantation
through grafting artery: a sub-study focused on segmental left ventricular
function recovery and scar reduction.
Source
International journal of cardiology. 168 (3) (pp 2221-2227), 2013. Date of
Publication: 03 Oct 2013.
Abstract
METHODS: A randomized, double-blinded, placebo-controlled study was
performed in 50 patients with chronic MI. The patients were randomly
allocated into CABG with stem cell transplantation (group A) and CABG only
(group B) groups. CMR assessments of global and segmental left ventricular
function and scar tissue were performed before surgery and repeated at 12
months after CABG and aBM-MNC transplantation.
RESULTS: The left ventricular ejection fraction (LVEF) improved by 13.5%
and 8.0% in group A and B respectively (P=0.04). Segmental analysis of
regional LV function recovery indicated that more improvement in
contractility was found in group A within the same degree of the infarct
transmurality (P=0.017) and showed a predominant interaction in the most
severely affected segments (76-100%, P=0.016). Decrease in infarct size
between the two groups did not reach statistical difference (9.4% vs.
6.0%, P=0.100).
CONCLUSIONS: CMR assessments revealed reversed ventricular remodeling and
improved systolic function and scar reduction in patients who underwent
aBM-MNC transplantation during CABG. And the conjunctional use of CABG and
stem cell therapy could improve the left ventricular function in patients
with chronic MI.
BACKGROUND: Our preliminary study suggested that patients with chronic
myocardial infarction (MI) and heart failure could potentially benefit
from CABG combined with aBM-MNC by improving global left ventricular (LV)
function. The purpose of this sub-study was to quantitatively evaluate the
effectiveness of aBM-MNC transplantation during CABG in patients with
chronic MI by intensively analyzing the global and segmental LV function,
the scar, and the relationships between the function recovery and the scar
transmural extent.

<12>
Accession Number
24880018
Authors
Lima R.C.
Institution
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br
(Ferraz) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil
(Escobar) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in
Health Sciences of Faculty of Medical Sciences and Biological Sciences
Institute (FCM/ICB), Recife, Brazil
(Nunes) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil
(Lustosa) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil
(Vasconcelos) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil
(Lima) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil
Title
Patency of skeletonized versus pedicled internal thoracic artery in
coronary bypass graft surgery: a systematic review, meta-analysis and
meta-regression.
Source
International journal of surgery (London, England). 12 (7) (pp 666-672),
2014. Date of Publication: 2014.
Abstract
BACKGROUND: It is suggested that the skeletonization harvesting technique
influences the patency rates of internal thoracic artery (ITA) after
coronary artery bypass graft (CABG) surgery in comparison to conventional
(pedicled) harvesting. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled ITA in terms
of patency after CABG.
METHODS: We performed a systematic-review using MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of
relevant articles to search for studies that performed angiographic
evaluation within the first two years after CABG between these two groups
until December 2013. The principal summary measures were odds ratio (OR)
with 95% Confidence Interval (CI) and P values (statistically significant
when <0.05). The OR's were combined across studies using weighted
DerSimonian-Laird random effects model and weighted Mantel-Haenszel fixed
effects. Meta-analysis, sensitivity analysis and meta-regression were
completed using the software Comprehensive Meta-Analysis version 2
(Biostat Inc., Englewood, New Jersey).
RESULTS: Five studies involving 1764 evaluated conduits (1145
skeletonized; 619 pedicled) met the eligibility criteria. There was no
evidence for important heterogeneity of effects among the studies. The
overall OR (95% CI) for graft occlusion showed no statistical significant
difference between groups (fixed effect model: OR 1.351, 95% CI 0.408 to
4.471, P = 0.801; random effect model: OR 1.351, 95% CI 0.408 to 4.471, P
= 0.801). In sensitivity analysis, no difference regarding to left or
right ITA was also observed. In meta-regression, we observed no
statistically significant coefficients for graft occlusion and proportion
of female, diabetics, renal failure, age, off-pump surgery or urgency,
which means that the effect is not modulated by these factors.
CONCLUSION: In terms of patency, skeletonized ITA appears to be
non-inferior in comparison to pedicled ITA after CABG.

<13>
Accession Number
24530783
Authors
Zhou X.
Institution
(Tian) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, No.
167, Beilishi Road, Beijing 100037, China
(Chen) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, No.
167, Beilishi Road, Beijing 100037, China
(Xiao) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, No.
167, Beilishi Road, Beijing 100037, China
(Yang) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, No.
167, Beilishi Road, Beijing 100037, China
(Zhou) Department of Cardiology, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical College, No.
167, Beilishi Road, Beijing 100037, China. Electronic address:
Title
Intramyocardial autologous bone marrow cell transplantation for ischemic
heart disease: a systematic review and meta-analysis of randomized
controlled trials.
Source
Atherosclerosis. 233 (2) (pp 485-492), 2014. Date of Publication: 01 Apr
2014.
Abstract
OBJECTIVE: This study was undertaken to evaluate the efficacy of
intramyocardial bone marrow cell (BMC) transplant therapy for ischemic
heart disease (IHD).
METHODS: The PubMed, Embase, and Cochrane Library databases through
October 2013 were searched for randomized clinical trials (RCTs) of
intramyocardial BMCs to treat IHD. The primary endpoint was change in left
ventricular ejection fraction (LVEF). Secondary endpoints were changes in
left ventricular end-systolic volume (LVESV) and left ventricular
end-diastolic volume (LVEDV). Weighted mean differences for the changes
were estimated with a random-effects model.
RESULTS: Eleven RCTs with 492 participants were included. Intramyocardial
BMC transplantation increased LVEF (4.91%; 95% confidence interval [CI]
2.84%-6.99%; P<0.00001), reduced LVESV (10.66 mL; 95% CI, -18.92 mL to
-2.41 mL; P=0.01), and showed a trend toward decreased LVEDV (-7.82 mL;
95% CI, -16.36 mL-0.71 mL; P=0.07). Patients suitable for
revascularization with coronary artery bypass grafting had greater
improvement in LVEF (7.60%; 95% CI, 4.74%-10.46%, P<0.00001) than those
unsuitable for revascularization (3.76%; 95% CI, 2.20%-5.32%; P<0.00001).
LVEDV reduction was also more significant in revascularizable IHD (-16.51
mL; 95% CI, -22.05 mL to -10.07 mL; P<0.00001) than non-revascularizable
IHD (-0.89 mL; 95% CI, -8.44 mL-6.66 mL; P=0.82).
CONCLUSION: Intramyocardial BMC injection contributes to improvement in
left ventricular dysfunction and reduction in left ventricular volume.
Patients with revascularizable IHD may benefit more from this therapy.

<14>
Accession Number
2015716898
Authors
Numasawa Y. Kohsaka S. Miyata H. Noma S. Suzuki M. Ishikawa S. Nakamura I.
Nishi Y. Ohki T. Negishi K. Takahashi T. Fukuda K.
Institution
(Numasawa, Takahashi) Department of Cardiology, Ashikaga Red Cross
Hospital, Tochigi, Japan
(Kohsaka, Fukuda) Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Miyata) University of Tokyo, Healthcare Quality Assessment, Tokyo, Japan
(Noma) Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi,
Japan
(Suzuki) Department of Cardiology, National Hospital Organization, Saitama
National Hospital, Saitama, Japan
(Ishikawa) Department of Cardiology, Saitama City Hospital, Saitama, Japan
(Nakamura) Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan
(Nishi) Department of Cardiology, St. Luke's International Hospital Heart
Center, Tokyo, Japan
(Ohki) Department of Cardiology, Tokyo Dental College Ichikawa General
Hospital, Chiba, Japan
(Negishi) Department of Cardiology, Yokohama Municipal Hospital, Kanagawa,
Japan
Title
Gender differences in in-hospital clinical outcomes after percutaneous
coronary interventions: An insight from a Japanese multicenter registry.
Source
PLoS ONE. 10 (1) , 2015. Article Number: e0116496. Date of Publication: 30
Jan 2015.
Publisher
Public Library of Science
Abstract
Background: Gender differences in clinical outcomes after percutaneous
coronary intervention (PCI) among different age groups are controversial
in the era of drug-eluting stents, especially among the Asian population
who are at higher risk for bleeding complications. Methods and Results: We
analyzed data from 10,220 patients who underwent PCI procedures performed
at 14 Japanese hospitals from September 2008 to April 2013. A total of
2,106 (20.6%) patients were women. Women were older (72.7+/-9.7 vs
66.6+/-10.8 years, p< 0.001), and had a lower body mass index (23.4+/-4.0
vs 24.3+/-3.5, p<0.001), with a higher prevalence of hypertension
(p<0.001), hyperlipidemia (p<0.001), insulin-dependent diabetes (p<0.001),
renal failure (p<0.001), and heart failure (p<0.001) compared with men.
Men tended to have more bifurcation lesions (p = 0.003) and chronic
totally occluded lesions (p<0.001) than women. Crude overall complications
(14.8% vs 9.5%, p<0.001) and the rate of bleeding complications (5.3% vs
2.8%, p<0.001) were significantly higher in women than in men. On
multivariate analysis in the total cohort, female sex was an independent
predictor of overall complications (OR, 1.47; 95% CI, 1.26 -1.71; p<0.001)
and bleeding complications (OR, 1.74; 95% CI, 1.36-2.24; p<0.001) after
adjustment for confounding variables. A similar trend was observed across
the middle-aged group (>55 and <75 years) and old age group (>75 years).
Conclusions: Women are at higher risk than men for post-procedural
complications after PCI, regardless of age.

<15>
Accession Number
2014788537
Authors
Gallagher S.M. Jones D.A. Kapur A. Wragg A. Harwood S.M. Mathur R.
Archbold R.A. Uppal R. Yaqoob M.M.
Institution
(Gallagher, Jones, Kapur, Wragg, Archbold) Department of Cardiology, Barts
Health NHS Trust, London, United Kingdom
(Gallagher, Jones, Kapur, Harwood, Mathur, Uppal, Yaqoob) William Harvey
Research Institute, Queen Mary University, London, United Kingdom
(Gallagher, Jones, Kapur, Wragg, Archbold, Uppal, Yaqoob) NIHR
Cardiovascular Biomedical Research Unit, London Chest Hospital, London,
United Kingdom
(Uppal) Department of Cardiothoracic Surgery, Barts Health NHS Trust,
London, United Kingdom
(Yaqoob) Department of Nephrology, Barts Health NHS Trust, London, United
Kingdom
Title
Remote ischemic preconditioning has a neutral effect on the incidence of
kidney injury after coronary artery bypass graft surgery.
Source
Kidney International. 87 (2) (pp 473-481), 2015. Date of Publication: 03
Feb 2015.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Acute kidney injury (AKI) is a frequent complication of cardiac surgery
and usually occurs in patients with preexisting chronic kidney disease
(CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal
ischemia-reperfusion injury associated with cardiac surgery and may be a
preventive strategy for postsurgical AKI. We undertook a randomized
controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated
glomerular filtration rate under 60 ml/min per 1.73 m 2) undergoing
coronary artery bypass graft (CABG) surgery. Forty-three patients each
were randomized to receive standard care with or without RIPC consisting
of three 5-minute cycles of forearm ischemia followed by reperfusion. The
primary end point was the development of AKI defined as an increase in
serum creatinine concentration over 0.3 mg/dl within 48 h of surgery.
Secondary end points included a comparison between the study and control
groups of several serum biomarkers of renal injury including cystatin-C,
neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18
(IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury
molecule-1 measured at 6, 12, and 24 h after CABG, and the 72-h serum
troponin T concentration area under the curve as a marker of myocardial
injury. Clinical and operative characteristics were similar between the
preconditioned and control groups. AKI developed in 12 patients in both
groups within 48 h of CABG. There were no significant differences between
the two groups in the concentrations of any of the serum or urinary
biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by
forearm ischemia-reperfusion had no effect on the frequency of AKI after
CABG in patients with CKD.

<16>
Accession Number
2015708784
Authors
Larsen B.M.K. Field C.J. Leong A.Y. Goonewardene L.A. Van Aerde J.E. Joffe
A.R. Clandinin M.T.
Institution
(Larsen) Nutrition Service, Alberta Health Services, Edmonton, AB, Canada
(Field, Goonewardene, Clandinin) Alberta Institute for Human Nutrition,
University of Alberta, Edmonton, AB, Canada
(Van Aerde, Joffe) Department of Pediatrics, University of Alberta,
Stollery Children's Hospital, Edmonton, AB, Canada
(Larsen, Clandinin) Department of Medicine, University of Alberta,
Edmonton, AB, Canada
(Field, Leong) Department of Agricultural, Food and Nutritional Sciences,
University of Alberta, Edmonton, AB, Canada
Title
Pretreatment with an intravenous lipid emulsion increases plasma
eicosapentanoic acid and downregulates leukotriene B4, procalcitonin, and
lymphocyte concentrations after open heart surgery in infants.
Source
Journal of Parenteral and Enteral Nutrition. 39 (2) (pp 171-179), 2015.
Date of Publication: 02 Feb 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: The effect of providing a lipid emulsion containing
medium-chain triglyceride (MCT), soybean oil, and fish oil in critically
ill infants is not widely studied. This study investigated lipid emulsion
effects on plasma phospholipids and immune biomarkers. Materials and
Methods: Thirty-two infants undergoing cardiopulmonary bypass (CPB) and
dependent on parenteral nutrition (PN) were randomized to receive either
soybean oil (control, n = 16) or a 50:40:10 mixture of MCT, soybean oil,
and fish oil (treatment, n = 16). PN was administered for 3 days
preoperatively and 10 days postoperatively. Fatty acids, procalcitonin
(PCT), leukotriene B₄ (LTB₄), and lymphocytes were
quantified at baseline, before surgery, and days 1, 7 and 10 after
surgery. Results: PCT was significantly lower in the treatment vs control
group 1 day postoperatively (P =.01). The treatment group exhibited a
lower -6 to -3 ratio (P =.0001) and a higher -3 concentration at all
postoperative study periods (P =.001). Treatment resulted in higher (P
<.05) plasma phospholipid eicosapentaenoic acid (EPA) on days 7 and 10,
while alpha-linolenic acid, arachidonic acid, and docosahexaenoic acid
remained constant. An increase in plasma phospholipid EPA concentration
was associated with a decrease in plasma phospholipid LTB₄
concentration (P <.05). On postoperative day 10, treatment infants with
high Pediatric Risk of Mortality III scores exhibited a 45% lower
lymphocyte concentration (P <.05). Conclusion: These findings suggest that
treating infants undergoing CPB with a lipid emulsion containing -3
improves fatty acid status and results in a lower inflammatory response
after surgery. Overall, this alternative -3-enriched lipid emulsion may
benefit clinical outcomes of critically ill infants after cardiac surgery.

<17>
Accession Number
2015711725
Authors
Schiffl H.
Institution
(Schiffl) Department of Internal Medicine IV, University Hospital Munich,
Munich, Germany
(Schiffl) KfH Renal Centre Munich Laim, Munich, Germany
Title
Sodium bicarbonate infusion for prevention of acute kidney injury: No
evidence for superior benefit, but risk for harm?.
Source
International Urology and Nephrology. 47 (2) (pp 321-326), 2014. Date of
Publication: 2014.
Publisher
Kluwer Academic Publishers
Abstract
The best "treatment" of acute kidney injury (AKI) is prevention. Patients
who are at high risk of AKI should have an assessment of their volume
status and receive appropriate volume expansion. The most effective type
of intravenous fluid remains unclear. Innumerable studies have compared
sodium bicarbonate and isotonic saline and have combined fluid hydration
with pharmacological interventions, particularly N-acetyl-cysteine.
However, abundant systematic reviews and meta-analyses have provided
conflicting conclusions and have recognized a significant degree of
heterogeneity between studies and publication bias. Most studies comparing
intravenous sodium bicarbonate and saline were small. They often enrolled
patients with a low risk for AKI, yielding low serious events (renal
replacement therapy), and used different protocols for administration of
fluids. Based on current literature, intravenous sodium bicarbonate does
not seem to be more efficient than saline for the prevention of
contrast-media-induced AKI, cardiac surgery-associated AKI, pigment
nephropathy or septic AKI. However, some cohort studies or prospective
randomized trials did track and report serious adverse events, such as
higher rates of AKI or higher in-hospital mortality. At present, it should
be concluded that the use of intravenous sodium bicarbonate administration
to prevent AKI should be evaluated further in multicenter randomized
double-blind trials rather than adopted into routine clinical practice.

<18>
[Use Link to view the full text]
Accession Number
2014970691
Authors
Bailey M. McGuinness S. Haase M. Haase-Fielitz A. Parke R. Hodgson C.L.
Forbes A. Bagshaw S.M. Bellomo R.
Institution
(Bailey, Hodgson, Forbes, Bellomo) Department of Epidemiology and
Preventive Medicine, Australian and New Zealand Intensive Care Research
Center, Monash University, 99 Commercial Road, Melbourne 3181, Australia
(McGuinness, Parke) Cardiothoracic and Vascular Intensive Care Unit,
Auckland City Hospital, Auckland, New Zealand
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension,
Diabetes, and Endocrinology, Otto-von-Guericke-University Magdeburg,
Magdeburg, Germany
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AB, Canada
Title
Sodium bicarbonate and renal function after cardiac surgery: A
prospectively planned individual patient meta-analysis.
Source
Anesthesiology. 122 (2) (pp 294-306), 2015. Date of Publication: 02 Feb
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND:: The effect of urinary alkalinization in cardiac surgery
patients at risk of acute kidney injury (AKI) is controversial and trial
findings conflicting. Accordingly, the authors performed a prospectively
planned individual patient data meta-analysis of the double-blind
randomized trials in this field. METHODS:: The authors studied 877
patients from three double-blind, randomized controlled trials enrolled to
receive either 24 h of intravenous infusion of sodium bicarbonate or
sodium chloride. The primary outcome measure was a postoperative increase
in serum creatinine concentration of greater than 25% or 0.5 mg/dl (> 44
muM/L) within the first five postoperative days. Secondary outcomes
included the raw change in serum creatinine, greater than 50% and greater
than 100% rises in serum creatinine, developing AKI (Acute Kidney Injury
Network criteria), initiation of renal replacement therapy, morbidity, and
mortality. RESULTS:: Patients were similar in demographics, comorbidities,
and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P
< 0.001) and urine pH (P < 0.001). There were no differences in the
development of the primary outcome (Bicarbonate 45% [39-51%] vs. Saline
42% [36-48%], P = 0.29). This result remained unchanged when controlling
for study and covariates (odds ratio [OR], 99% confidence interval [CI]:
Bicarbonate vs. Control, 1.11 [0.77-1.60], P = 0.45). There was, however,
a significant study-adjusted benefit in elective coronary artery bypass
surgery patients in terms of renal replacement therapy (Bicarbonate vs.
Control, OR: 0.38 [99% CI: 0.25-0.58], P < 0.0001) and the development of
an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR:
0.45 [99% CI: 0.43-0.48], P < 0.0001). CONCLUSIONS:: Urinary
alkalinization using sodium bicarbonate infusion is not associated with an
overall lower incidence of AKI; however, it reduces severe AKI and need
for renal replacement therapy in elective coronary artery bypass patients.

<19>
Accession Number
2015711141
Authors
Sgueglia G.A. Belloni F. Summaria F. Conte M. Cortese B. Silva P.L. Ricci
R. Lioy E. Pucci E. Gaspardone A.
Institution
(Sgueglia, Gaspardone) Division of Cardiology, Sant'Eugenio Hospital,
Rome, Italy
(Belloni, Ricci) Division of Cardiology, Santo Spirito Hospital, Rome,
Italy
(Summaria, Lioy) Interventional Cardiology, Policlinico Casilino, Rome,
Italy
(Conte, Pucci) Interventional Cardiology, Santa Maria Goretti Hospital,
Latina, Italy
(Cortese, Silva) Interventional Cardiology, Fatebenefratelli Hospital,
Milan, Italy
Title
One-year follow-up of patients treated with new-generation polymer-based
38 mm everolimus-eluting stent: The p38 study.
Source
Catheterization and Cardiovascular Interventions. 85 (2) (pp 218-224),
2015. Date of Publication: 01 Feb 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To assess the clinical outcome at 1-year follow-up of
real-world patients with long coronary lesions treated with the 38 mm
Xience Prime (Abbott Vascular) everolimus-eluting stent (EES). Background:
Long-lesions present special challenges to the interventional
cardiologists, including increased risk of restenosis, periprocedural
injury, geographical miss, and stent deliverability. Indeed, results
obtained with shorter stent in the treatment of simpler lesions are of
limited applicability to longer stents. Methods: Consecutive patients
presenting with a long coronary lesion treated by percutaneous coronary
intervention with at least one implanted 38 mm EES were enrolled in the
study. Their clinical data were prospectively registered. Major adverse
cardiac events (MACE) were defined as a composite of cardiac death,
nonfatal myocardial infarction (according to the Universal Definition) and
target vessel revascularization. Stent thrombosis was defined according to
the Academic Research Consortium criteria. Results: Overall, 203
real-world patients (152 men, 68 +/- 9 years) were enrolled in the P38
Study. At 1-year follow-up, 6 (3.0%) patients had died from cardiac
causes, 7 (3.4%) had a nonfatal myocardial infarction and 8 (3.9%)
underwent target vessel revascularization, yielding a 10.3% cumulative
rate of MACE. Two patients had a stent thrombosis (one definite and one
probable). No significant differences in event rates were found between
patients with and without an additional stent implanted overlapping the 38
mm one. Conclusions: The use of a new-generation polymer-based 38 mm EES
in a real-world population with unselected long lesions is associated with
excellent procedural results and good clinical outcomes at 12-month
follow-up.

<20>
Accession Number
2015709931
Authors
Noro T. Takehara N. Sumitomo K. Takeuchi T. Ishii Y. Kato J.-I. Kawabe
J.-I. Hasebe N.
Institution
(Noro, Sumitomo, Takeuchi, Hasebe) Department of Cardiology, Asahikawa
Medical University, Japan
(Takehara, Kawabe) Department of Cardiovascular Regeneration and
Innovation, Asahikawa Medical University, Japan
(Ishii) Department of Cardiology, Asahikawa City Hospital, Japan
(Kato) Department of Cardiology, Asahikawa Kosei General Hospital, Japan
Title
Initial reduction of oxidative stress by angiotensin receptor blocker
contributes long term outcomes after percutaneous coronary intervention.
Source
American Journal of Cardiovascular Disease. 4 (4) (pp 159-167), 2014. Date
of Publication: 2014.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: It remains unclear whether administration of ARB with reactive
oxygen species (ROS) scavenging effects improves the prognosis of patients
undergoing PCI. Objectives: This study investigated whether the
pre-intervention antioxidant effect of angiotensin receptor blocker (ARB)
affects long-term outcomes in patients after successful percutaneous
coronary intervention (PCI) without early adverse events. Methods:
Fifty-two patients who underwent elective PCI were randomly assigned for
treatment with or without ARB, which was administered within 48 hours
before PCI. ROS levels in mononuclear cells (MNCs) and serum superoxide
dismutase (SOD) activity were measured pre-PCI and 6 months post-PCI.
After exclusion of unexpected early adverse events during angiographic
follow-up period, the long-term outcome (major adverse
cerebro-cardiovascular event; MACCE) was assessed in eligible patients.
Results: Forty-three patients (non-ARB n = 22, ARB n = 21) were followed
up in this

<21>
Accession Number
2015706546
Authors
Zhang Y.-J. Iqbal J. Windecker S. Linke A. Antoni D. Sohn H.Y. Corti R.
Van Es G.-A. Copt S. Eerdmans P. Saitta R. Morice M.-C. Di Mario C. Juni
P. Wijns W. Buszman P. Serruys P.W.
Institution
(Zhang, Iqbal, Serruys) Thoraxcenter, Erasmus Medical Center, PO Box 2125,
Rotterdam 3000 CC, Netherlands
(Iqbal) Nanjing Medical University, Nanjing First Hospital, Nanjing, China
(Windecker) Department of Cardiology, University of Bern, Bern,
Switzerland
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Antoni) Department of Cardiology, Hospital Bogenhausen, Munich, Germany
(Sohn) Department of Cardiology, University Hospital Munich, Munich,
Germany
(Corti) HerzKlinik Hirslanden, Zurich, Switzerland
(Van Es) Cardialysis BV, Rotterdam, Netherlands
(Copt, Eerdmans, Saitta) Biosensors Europe SA, Morges, Switzerland
(Morice) Institut Cardiovasculaire Paris-Sud, Institut Hospitalier
Jacques-Cartier, Massy, France
(Di Mario) NIHR Cardiovascular Biomedical Research Unit, Royal Brompton
Hospital, London, United Kingdom
(Juni) CTU, University of Bern, Bern, Switzerland
(Wijns) Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst,
Belgium
(Buszman) American Heart of Poland, Ustron, Poland
Title
Biolimus-eluting stent with biodegradable polymer improves clinical
outcomes in patients with acute myocardial infarction.
Source
Heart. 101 (4) (pp 271-278), 2015. Date of Publication: 01 Feb 2015.
Publisher
BMJ Publishing Group
Abstract
Objective To investigate clinical outcomes of coronary intervention using
a biolimus-eluting stent (BES) compared with a sirolimus-eluting stent
(SES) in patients with acute myocardial infarction (AMI) in the Limus
Eluted from A Durable versus ERodable Stent (LEADERS) coating trial at the
final 5-year follow-up. Methods The LEADERS trial is a multicentre
all-comer study, where patients (n=1707) were randomised to percutaneous
intervention with either BES containing biodegradable polymer or SES
containing durable polymer. Out of 1707 patients enrolled in this trial,
573 patients had percutaneous coronary intervention for AMI (BES=280,
SES=293) and were included in the current analysis. Patient-oriented
composite endpoint (POCE, including all death, all myocardial infarction
(MI) and all revascularisations), major adverse cardiac events (MACE,
including cardiac death, MI and clinically indicated target vessel
revascularisation) and stent thrombosis were assessed at 5-year follow-up.
Results The baseline clinical, angiographic and procedural characteristics
were well matched between BES and SES groups. In all patients with AMI,
coronary intervention with a BES, compared with SES, significantly reduced
POCE (28.9% vs 42.3%; relative risk (RR) 0.61, 95% CI 0.47 to 0.82,
p=0.001) at 5-year follow-up. There was also a reduction in MACE rate in
the BES group (18.2% vs 25.9%; RR 0.67, 95% CI 0.47 to 0.95, p=0.025);
however, there was no difference in cardiac death and stent thrombosis. In
patients with ST-elevation MI (STEMI), coronary intervention with BES
significantly reduced POCE (24.4% vs 39.3%; RR 0.55, 95% CI 0.36 to 0.85,
p=0.006), MACE (12.6% vs 25.0%; RR 0.47, 95% CI 0.26 to 0.83, p=0.008) and
cardiac death (3.0% vs 11.4%; RR 0.25, 95% CI 0.08 to 0.75, p=0.007),
along with a trend towards reduction in definite stent thrombosis (3.7% vs
8.6%; RR 0.41, 95% CI 0.15 to 1.18, p=0.088), compared with SES.
Conclusions BES, compared with SES, significantly improved safety and
efficacy outcomes in patients with AMI, especially those with STEMI, at
5-year follow-up.

<22>
Accession Number
2015703110
Authors
Ji Q. Mei Y. Wang X. Feng J. Ding W.
Institution
(Ji, Mei, Wang, Feng) Department of Thoracic Cardiovascular Surgery of
Tongji Hospital of Tongji University, Shanghai, China
(Ding) Department of Cardiovascular Surgery of Zhongshan Hospital of Fudan
University, Shanghai, China
Title
Risk Factors for late right ventricular systolic dysfunction in pediatric
patients with repaired tetralogy of fallot.
Source
International Heart Journal. 56 (1) (pp 80-85), 2015. Date of Publication:
2015.
Publisher
International Heart Journal Association
Abstract
To evaluate independent risk factors for late right ventricular systolic
dysfunction after correction of Tetralogy of Fallot (TOF) in a
single-centre, retrospective and observational clinical trial. Patients
less than 3 years of age who underwent correction of TOF and subsequently
routine clinical follow-up of more than 36 months were included in this
study and were divided either into an experimental group (right
ventricular systolic dysfunction) or a control group (normal right
ventricular systolic function) according to the tricuspid annular peak
systolic velocity (TAPSV) value measured by pulsed wave-tissue Doppler
imaging (pulsed wave-TDI). The relevant data of all selected patients were
investigated and analyzed. From January 2012 to December 2012, a total of
113 consecutive eligible patients were enrolled in this study and were
divided either into an experimental group (n = 41) or control group (n =
72). Through univariate analysis and subsequent logistic regression, low
preoperative arterial oxygen saturation (OR = 1.66, 95%CI 1.22-4.58, P =
0.0163), age less than 6 months at the time of surgery (OR = 3.45, 95%CI
1.87-9.17, P = 0.0021), and transannular patch (OR = 2.15, 95%CI
1.31-5.38, P = 0.0015) were 3 independent risk factors for late right
ventricular systolic dysfunction after correction of TOF. This clinical
trial suggested low preoperative arterial oxygen saturation was associated
with late right ventricular systolic dysfunction after correction of TOF,
and appropriate age at the time of surgery and selection of a proper
surgical method to reconstruct the right ventricular outfow tract
contributed to improving late right ventricular systolic function in
pediatric patients with repaired TOF.

<23>
Accession Number
2015702608
Authors
Warren J. Mehran R. Yu J. Xu K. Bertrand M.E. Cox D.A. Lincoff A.M.
Manoukian S.V. Ohman E.M. Pocock S.J. White H.D. Stone G.W.
Institution
(Warren, Mehran, Yu) Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Mehran, Xu, Stone) Cardiovascular Research Foundation, New York, NY,
United States
(Bertrand) Hopital Cardiologique, Lille, France
(Cox) Lehigh Valley Health Network, Allentown, PA, United States
(Lincoff) Cleveland Clinic Lerner College of Medicine, Case Western
Reserve University, Cleveland, OH, United States
(Manoukian) Sarah Cannon Research Institute, Nashville, TN, United States
(Ohman) Duke University Medical Center, Durham, NC, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(White) Department of Medicine, University of Auckland, Auckland, New
Zealand
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Stone) NewYork-Presbyterian/Columbia University Medical Center, New York,
NY, United States
Title
Incidence and impact of totally occluded culprit coronary arteries in
patients presenting with non-ST-segment elevation myocardial infarction.
Source
American Journal of Cardiology. 115 (4) (pp 428-433), 2015. Date of
Publication: 15 Feb 2015.
Publisher
Elsevier Inc.
Abstract
The accuracy of the 12-lead electrocardiogram in detecting coronary artery
occlusion is limited. We sought to determine the incidence, distribution,
and outcomes of patients who have total occlusion of the culprit artery
but present with non-ST-segment elevation myocardial infarction (NSTEMI).
The randomized Acute Catheterization and Urgent Intervention Triage
Strategy trial enrolled 13,819 patients presenting with non-ST-segment
elevation acute coronary syndromes who underwent an early invasive
strategy. The present study includes 1,319 patients with baseline
biomarker elevation (NSTEMI) and no history of coronary artery bypass
graft who underwent percutaneous coronary intervention of a single culprit
vessel. We compared the baseline characteristics and outcomes according to
whether the culprit vessel was occluded (baseline Thrombolysis In
Myocardial Infarction [TIMI] 0 to 1) or patent (TIMI 2 to 3 flow) by
angiographic core laboratory assessment. TIMI 0 to 1 flow in the culprit
artery was present in 262 of 1,319 (19.9%) patients. The incidence of
coronary occlusion was 28.4%, 19.3%, and 12.6% in patients with NSTEMI
because of right coronary, left circumflex, and left anterior descending
artery disease, respectively. Patients with an occluded culprit artery
were more commonly men and had ST-segment deviation >1 mm. One-year
outcomes, including death (3.5% vs 3.0%, p = 0.68) and myocardial
infarction (8.4% vs 9.6%, p = 0.47), did not differ significantly between
patients with versus without occluded culprit arteries, respectively. In
conclusion, the present study demonstrates that the culprit artery is
totally occluded in approximately 1 in 5 patients presenting with NSTEMI
and single-vessel disease; however, the presence of total occlusion in
NSTEMI was not associated with an incremental hazard of death or
reinfarction at 1 year.

<24>
Accession Number
2014843334
Authors
Gibson M.C. Krucoff M. Fischell D. Fischell T.A. Keenan D. Abueg C. Patel
C. Holmes D.
Institution
(Gibson, Abueg, Patel) Cardiovascular Division, Department of Medicine,
Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215,
United States
(Krucoff) Duke Clinical Research Institute, Durham, NC, United States
(Fischell, Keenan) Angel Medical Systems, Shrewsbury Township, NJ, United
States
(Fischell) Heart Institute at Borgess, Kalamazoo, MI, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
Title
Rationale and design of the angelmed for early recognition and treatment
of STEMI trial: A randomized, prospective clinical investigation.
Source
American Heart Journal. 168 (2) (pp 168-174), 2014. Date of Publication:
2014.
Publisher
Mosby Inc.
Abstract
Significant improvements in door-to-balloon times have led to a reduction
in mortality in ST-segment elevation myocardial infarction; however, mean
symptom-to-door times remain at 2 to 3 hours. An intracardiac electrogram
monitoring device may be beneficial in high-risk patients by alerting them
to rapidly progressive ST-segment changes indicative of acute coronary
occlusion. The Cardiosaver and DETECT phase I clinical studies
demonstrated the safety, feasibility, and potential benefit of using an
intracardiac electrogram monitoring device to alert the patient to seek
medical attention. The goal of the randomized, prospective ALERTS Trial
(Clinicaltrials.gov no. NCT00781118) is to evaluate the efficacy of an
implantable monitoring device (IMD) in reducing the composite of either
cardiac or unexplained death, new Q-wave myocardial infarction, or
symptom-to-door time of >2 hours for confirmed thrombotic events. The IMD
alerts the patient in real time when ST-segment deviation from a
personalized baseline exceeds the trigger threshold. The trial is designed
to enroll high-risk post a coronary syndrome patients or patients with
previous multivessel coronary artery bypass surgery. All patients have the
IMD implanted, with 1:1 unblinded randomization to the alerting feature
being either turned on versus turned off for the first 6 months.
Randomization occurs at the first follow-up visit, 7 to 14 days after the
implantation of the IMD. Subjects then return for follow-up visits at
months 1, 3, and 6 and thereafter every 6 months until closure of the
investigational device exemption. Subjects who cannot be implanted
successfully or who have the device explanted are removed from the study
and followed up for a minimum of 30 days post aprocedure. If a subject
experiences a device-related complication and/or adverse experience, the
subject is followed up until resolution or until the condition becomes
stable and no further change is anticipated.

<25>
Accession Number
2014843331
Authors
Kim S.-J. Samad Z. Bloomfield G.S. Douglas P.S.
Institution
(Kim, Bloomfield, Douglas) Duke Clinical Research Institute, Durham, NC,
United States
(Samad, Bloomfield, Douglas) Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Kim) Division of Cardiology, Ulsan University Hospital, University of
Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan,
South Korea
Title
A critical review of hemodynamic changes and left ventricular remodeling
after surgical aortic valve replacement and percutaneous aortic valve
replacement.
Source
American Heart Journal. 168 (2) (pp 150-159.e7), 2014. Date of
Publication: 2014.
Publisher
Mosby Inc.
Abstract
Background The introduction of transcatheter aortic valve replacement
(TAVR) in clinical practice has widened options for symptomatic patients
at high surgical risk; however, it is not known whether TAVR has
equivalent or prolonged benefits in terms of left ventricular (LV)
remodeling.
Methods To explore the relative hemodynamic benefits and postoperative LV
remodeling associated with TAVR and surgical aortic valve replacement
(SAVR), we performed a critical review of the available literature. A
total of 67 studies were included in this systematic review.
Results There is at least equivalent if not slightly superior hemodynamic
performance of TAVR over SAVR, and TAVR showed lower prosthesis-patient
mismatch compared with SAVR. However, LV mass appears to regress to a
greater degree after SAVR compared with TAVR. Aortic regurgitation,
paravalvular in particular, is more common after TAVR than SAVR, although
it is rarely more than moderate in severity. Improvements in diastolic
function and mitral regurgitation are reported in only a handful of
studies each and could not be compared across prosthesis types.
Conclusions The published data support the hemodynamic comparability of
SAVR and TAVR, with the higher incidence of prosthesis-patient mismatch in
SAVR offset by higher incidence of paravalvular leak in TAVR. These
results highlight the need for further studies focusing on hemodynamic
changes after valve therapy.

<26>
Accession Number
2015639867
Authors
Lim J.Y. Deo S.V. Altarabsheh S.E. Jung S.H. Erwin P.J. Markowitz A.H.
Park S.J.
Institution
(Lim, Jung) Asan Medical Center, Seoul, South Korea
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, Case Medical
Center, Case Western Reserve University, Cleveland, OH 44106, United
States
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Erwin) Mayo Clinic Libraries, Rochester, MN, United States
Title
Conventional versus minimally invasive aortic valve replacement: Pooled
analysis of propensity-matched data.
Source
Journal of Cardiac Surgery. 30 (2) (pp 125-134), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Minimally invasive aortic valve replacement (mAVR) is
increasingly preferred over conventional AVR (cAVR). However, data
comparing these procedures present conflicting results. Hence, we
conducted a systematic review and meta-analysis comparing clinical results
in these cohorts. Method Only randomized controlled trials (RCT) and
propensity-matched observational studies (POS) (1998-2013) comparing
clinical outcome of patients subjected to mAVR or cAVR were pooled.
Continuous data was compared using mean/standardized mean difference
(MD/SMD) while categorical results were pooled to obtain an odds ratio
(OR) with a 95% confidence interval. Results A total of 18 studies (6 RCT
and 12 POS) (1973 mAVR patients; 2697 cAVR patients) were analyzed. The
mean ischemic time was significantly longer with mAVR (MD 9.42 minutes
[4.25-14.59]; p-<-0.01). However, early mortality (mAVR [1.8%] and cAVR
[3%]) was comparable (OR 0.70 [0.46-1.06]; p-=-0.09). Postoperative
ventilation time was slightly shorter after mAVR (7.5 vs 11.1 hours;
p-=-0.07), and hospital discharge was earlier after mAVR (MD -1.05 [-1.64
to -0.46]; p-<-0.01). However, mAVR failed to reduce transfusion
requirement (OR 0.77 [0.51-1.14]; p-=-0.19) or pain scores (SMD -0.25
[-0.65 to 0.13]; p-=-0.20). Postoperative atrial fibrillation (p-=-0.67)
and stroke (p-=-0.79) rates were comparable. Pooled rate of conversion to
full sternotomy was 2.5%. Cosmetic satisfaction could not be pooled due to
reporting heterogeneity. Conclusion Minimally invasive aortic valve
replacement can be performed safely despite the longer ischemic time.
While minimally invasive surgery does demonstrate some advantages in
postoperative recovery, we failed to find any other substantial
improvement in outcome over conventional aortic valve replacement. doi:
10.1111/jocs.12493 (J Card Surg 2015;30:125-134)

<27>
Accession Number
2015696433
Authors
Potocnik I. Jankovic V.N. Sostaric M. Jerin A. Stupnik T. Skitek M.
Markovic-Bozic J. Klokocovnik T.
Institution
(Potocnik, Jankovic, Sostaric, Markovic-Bozic) Clinical Department of
Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Jerin, Skitek) Institute for Clinical Chemistry and Biochemistry,
University Medical Centre Ljubljana, Ljubljana, Slovenia
(Stupnik) Clinical Department of Thoracic Surgery, University Medical
Centre Ljubljana, Ljubljana, Slovenia
(Klokocovnik) Clinical Department of Cardiovascular Surgery, University
Medical Centre Ljubljana, Ljubljana, Slovenia
Title
Antiinflammatory effect of sevoflurane in open lung surgery with one-lung
ventilation.
Source
Croatian Medical Journal. 55 (6) (pp 628-637), 2014. Date of Publication:
2014.
Publisher
Medicinska Naklada Zagreb
Abstract
Aim To prospectively assess the antiinflammatory effect of volatile
anesthetic sevoflurane in patients undergoing open lung surgery with one
lung ventilation (OLV). Methods This prospective, randomized study
included 40 patients undergoing thoracic surgery with OLV (NCT02188407).
The patients were randomly allocated into two equal groups that received
either propofol or sevoflurane. Four patients were excluded from the study
because after surgery they received blood transfusion or non-steroid
antiinflammatory drugs. Inflammatory mediators (interleukins 6, 8, and 10,
C-reactive protein [CRP], and procalcitonin) were measured
perioperatively. The infiltration of the nonoperated lung was assessed on
chest x-rays and the oxygenation index was calculated. The major
postoperative complications were counted. Results Interleukin 6 levels
were significantly higher in propofol than in sevoflurane group (P =
0.014). Preoperative CRP levels did not differ between the groups (P =
0.351) and in all patients they were lower than 20 mg/L, but postoperative
CRP was significantly higher in propofol group (31 +/- 6 vs 15 +/- 7 ng/L;
P = 0.035); Pre- and postoperative procalcitonin was within the reference
range (< 0.04 mug/L) in both groups. The oxygenation index was
significantly lower in propofol group (339 +/- 139 vs 465 +/- 140; P =
0.021). There was no significant difference between the groups in lung
infiltrates (P = 0.5849). The number of postoperative adverse events was
higher in propofol group, but the difference was not-significant (5 vs 1;
P = 0.115). Conclusion The study suggests an antiinflammatory effect of
sevoflurane in patients undergoing thoracotomy with OLV.