EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015413199
Authors
Fukui T. Nishida H. Takanashi S.
Institution
(Fukui, Nishida, Takanashi) Department of Cardiovascular Surgery,
Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
Title
Biocompatibility of cardiopulmonary bypass circuit with new polymer Senko
E-Ternal Coating^TM.
Source
Perfusion (United Kingdom). 30 (7) (pp 572-579), 2015. Date of
Publication: 30 Oct 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective: The aim of this study was to compare the biocompatibility of a
new Senko E-Ternal coating (SEC) for cardiopulmonary bypass (CPB) circuits
with the well-established poly-2-methoxyethyl acrylate (PMEA) coating.
Methods: Forty patients undergoing aortic valve replacement were randomly
assigned to either an SEC-coated group (n = 20) or a PMEA-coated group (n
= 20). Clinical data and the following markers were analyzed: platelet
count, platelet factor (PF) 4, fibrinogen, fibrinogen degradation products
(FDPs), antithrombin III (AT III), thrombin-antithrombin complex (TAT),
plasminogen, complement hemolytic activity (CH50), complement 3 (C3) and
interleukin-6 (IL-6). Blood samples were obtained at five time points in
both groups. Results: CPB time, aortic cross-clamp time and blood loss and
transfusion were similar in both groups. There were no significant
differences between the groups in terms of platelet count, PF4 and all
coagulation and fibrinolytic parameters (FDP, AT III, TAT, and
plasminogen) at any time points. Inflammatory markers (CH50, C3 and IL-6)
were also similar in both groups at all time points. Conclusions: The
SEC-coated circuit demonstrated equivalent biocompatibility to the
PMEA-coated circuit. SEC-coated circuits are, therefore, favorably
comparable to PMEA-coated circuits for clinical use in CPB.

<2>
Accession Number
2015413192
Authors
Fang Y. Long C. Lou S. Guan Y. Fu Z.
Institution
(Fang, Long, Lou, Guan, Fu) Department of Extracorporeal Circulation,
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing 100037, China
Title
Blood versus crystalloid cardioplegia for pediatric cardiac surgery: A
meta-analysis.
Source
Perfusion (United Kingdom). 30 (7) (pp 529-536), 2015. Date of
Publication: 30 Oct 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective: Blood and crystalloid cardioplegia are the main myocardial
protective solutions used in pediatric cardiac surgery. However, the
effectiveness of these two solutions on myocardial metabolism, reperfusion
injury and clinical outcomes in pediatric patients is still under debate.
The purpose of this meta-analysis was to compare the efficacy of these two
cardioplegia solutions in pediatric cardiac surgery. Methods: Keyword
searches were performed on PUBMED, EMBASE and The Cochrane Library for
randomized, controlled, clinical studies which were primarily comparing
blood and crystalloid cardioplegia in pediatric cardiac surgery and
provided data of postoperative cardiac troponin I (cTnI), lactate,
mechanical ventilation time, length of intensive care unit (ICU) stay and
inotropic support. Databases were searched from 1966 to June 2013 and were
restricted to peer-reviewed English language publications of human
subjects. We summarized the combined results of the data as mean
difference (MD, when outcome measurements were made on the same scale) or
standard mean difference (SMD, when the studies assess the same outcome
with different scales), with 95% confidence intervals. Results: Five
studies were identified, with a total of 323 patients. Lactate level after
cardiopulmonary bypass (CPB) was significantly lower after blood
cardioplegia compared with crystalloid cardioplegia (SMD 1.09, 95%CI 0.12
to 2.06, p=0.03); cTnI release postoperatively at 4-6 h (MD 0.92 ng/ml,
95%CI -0.13 to 1.97, p=0.09), 12 h (MD 0.2 ng/ml, 95% CI -0.43 to 0.84,
p=0.53) and 24 h (MD 0.98 ng/ml, 95%CI -0.26 to 2.22, p=0.12) was not
significantly different between the groups; ventilation duration (MD 5.15
hours, 95%CI -7.51 to 17.81, p=0.42) and length of ICU stay (SMD -0.3,
95%CI -0.80 to 0.21, p=0.25) were not significantly different between the
groups either. Conclusion: Myocardial metabolism was better in the blood
cardioplegia group compared with the crystalloid cardioplegia group.
However, there was no evidence of improvement in myocardial damage or
clinical outcome for either cardioplegia solution.

<3>
Accession Number
2015413189
Authors
Mlejnsky F. Klein A.A. Lindner J. Maruna P. Kvasnicka J. Kvasnicka T. Zima
T. Pecha O. Lips M. Rulisek J. Porizka M. Kopecky P. Kunstyr J.
Institution
(Mlejnsky, Lindner) Department of Cardiovascular Surgery, First Faculty of
Medicine, Charles University in Prague, General University Hospital in
Prague, Czech Republic
(Klein) Department of Anaesthesia, Papworth Hospital, Cambridge, United
Kingdom
(Maruna) Department of Pathological Physiology, First Faculty of Medicine,
Charles University in Prague, Czech Republic
(Kvasnicka, Kvasnicka) Institute for Medical Biochemistry and Laboratory
Diagnostics, Centre for Thrombosis and Haemostasis, First Faculty of
Medicine, Charles University in Prague, General University Hospital in
Prague, Czech Republic
(Zima) Institute for Medical Biochemistry and Laboratory Diagnostics,
First Faculty of Medicine, Charles University in Prague, General
University Hospital in Prague, Czech Republic
(Pecha) Technology Centre ASCR, Prague, Czech Republic
(Lips, Rulisek, Porizka, Kopecky, Kunstyr) Department of Anesthesiology
and Intensive Care, First Faculty of Medicine, Charles University in
Prague, General University Hospital in Prague, Czech Republic
(Kunstyr) Department of Anesthesiology and Intensive Care, General
University Hospital in Prague, U Nemocnice 2, Prague 2 12808, Czech
Republic
Title
A randomised controlled trial of roller versus centrifugal cardiopulmonary
bypass pumps in patients undergoing pulmonary endarterectomy.
Source
Perfusion (United Kingdom). 30 (7) (pp 520-528), 2015. Date of
Publication: 30 Oct 2015.
Publisher
SAGE Publications Ltd
Abstract
Objectives: There is some controversy as to whether there is a benefit
from the use of a centrifugal pump compared with a roller pump during
cardiopulmonary bypass to facilitate cardiac surgery. We compared the two
pumps, with the primary aim of determining any difference in the effects
on inflammation after pulmonary endarterectomy surgery which required
prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest.
Methods: Between September 2010 and July 2013, 58 elective patients
undergoing pulmonary endarterectomy were included in this prospective,
randomised, controlled study; 30 patients were randomly allocated to the
control group, which used a roller pump, and 28 patients to the treatment
group, which used a centrifugal pump. Interleukin-6, procalcitonin,
C-reactive protein, thromboelastographic parameters, P-selectin,
international normalised ratio, activated prothrombin time, free
haemoglobin, haematocrit, red blood cell count, white blood cell count,
platelet count and protein S100beta were recorded during and after the
procedure. We also recorded the length of intensive care unit stay, blood
loss and transfusion, neurological outcomes and respiratory and renal
failure. Results: There was a significant difference in the primary
outcome measure: Interleukin-6 was significantly higher in the roller pump
group (587+/-38 ngl^-1 vs. 327+/-37 ngl^-1; p<0.001)
24 hours after surgery, which we interpreted as an increased inflammatory
response. This was confirmed by a significant rise in the procalcitonin
level in the roller pump group 48 hours following surgery (0.79
(0.08-25.25) ngml^-1 vs. 0.36 (0.02-5.83) ngml^-1;
p<0.05). There were, however, no significant differences in clinical
outcome data. Conclusions: We have shown that the use of a centrifugal
pump during prolonged cardiopulmonary bypass and deep hypothermic
circulatory arrest is associated with a reduced inflammatory response
compared to the standard roller pump. Larger multi-centre trials in this
area of practice are required.

<4>
Accession Number
2015413184
Authors
Sirvinskas E. Kinderyte A. Trumbeckaite S. Lenkutis T. Raliene L.
Giedraitis S. Macas A. Borutaite V.
Institution
(Sirvinskas, Lenkutis, Raliene, Giedraitis) Department of Cardiac,
Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health
Sciences, Sukileliu str 17, Kaunas LT - 50009, Lithuania
(Sirvinskas, Raliene) Institute of Cardiology, Lithuanian University of
Health Sciences, Kaunas, Lithuania
(Kinderyte, Macas) Department of Anesthesiology, Hospital of Lithuanian
University of Health Sciences, Kaunas, Lithuania
(Trumbeckaite, Borutaite) Biochemical Laboratory, Institute of
Neurosciences, Lithuanian University of Health Sciences, Kaunas, Lithuania
Title
Effects of sevoflurane vs. propofol on mitochondrial functional activity
after ischemia-reperfusion injury and the influence on clinical parameters
in patients undergoing CABG surgery with cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 30 (7) (pp 590-595), 2015. Date of
Publication: 30 Oct 2015.
Publisher
SAGE Publications Ltd
Abstract
The aim of the study was to evaluate the effects of sevoflurane and
propofol on the activity of mitochondrial function related to
ischemia-reperfusion injury, myocardial damage biomarkers release and
clinical parameters in the postoperative period. Seventy-two patients
scheduled for elective coronary artery bypass graft surgery with
cardiopulmonary bypass were randomized into two groups: 36 patients
received sevoflurane during anesthesia (Group S) and 36 patients received
propofol (Group P). To investigate the functional activity of
mitochondria, we used skinned fibers prepared from biopsies of right
atrial tissue before cardioplegia and after the aorta cross-clamp removal
(within 10-15 minutes after reperfusion). Patients clinical data (length
of stay in ICU, hemodynamic parameters, duration of mechanical ventilation
(MV) and the amount of lactate and troponin I in the blood serum) were
evaluated postoperatively. The results showed that, before cardioplegia
and after reperfusion, there was no significant difference in the
mitochondrial routine and State 3 respiration rates between the groups.
The effect of cytochrome c was higher in Group P. Troponin I concentration
at the 12^th hour after the surgery was 2.2 +/- 0.8 ng/mL in
Group S and 3.5 +/- 1.1 ng/mL in Group P (p<0.001). There were no
significant differences in the duration of mechanical ventilation,
hemodynamic parameters and length of stay in the ICU between the groups.
We conclude that sevoflurane slightly protects the mitochondrial outer
membrane from ischemia-reperfusion injury and the loss of cytochrome c,
yet has the similar effect on clinical parameters in the postoperative
period when compared to propofol.

<5>
Accession Number
2015408246
Authors
Mylotte D. Andalib A. Theriault-Lauzier P. Dorfmeister M. Girgis M.
Alharbi W. Chetrit M. Galatas C. Mamane S. Sebag I. Buithieu J. Bilodeau
L. De Varennes B. Lachapelle K. Lange R. Martucci G. Virmani R. Piazza N.
Institution
(Mylotte, Andalib, Theriault-Lauzier, Girgis, Alharbi, Chetrit, Galatas,
Mamane, Buithieu, Bilodeau, Martucci, Piazza) Department of Interventional
Cardiology, McGill University Health Centre, Montreal, QC, Canada
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
(Dorfmeister, Lange, Piazza) Department of Cardiac Surgery, German Heart
Center, Munich, Germany
(Sebag) Department of Cardiology, Mortimer Davis, Jewish General Hospital,
Montreal, QC, Canada
(De Varennes, Lachapelle) Department of Cardiovascular Surgery, McGill
University Health Centre, Montreal, QC, Canada
(Virmani) CVPath Institute, Gaithersburg, MD, United States
Title
Transcatheter heart valve failure: A systematic review.
Source
European Heart Journal. 36 (21) (pp 1306-1327), 2015. Date of Publication:
2015.
Publisher
Oxford University Press
Abstract
Aims A comprehensive description of transcatheter heart valve (THV)
failure has not been performed. We undertook a systematic review to
investigate the aetiology, diagnosis, management, and outcomes of THV
failure. Methods and results The systematic review was performed in
accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus.
Between December 2002 and March 2014, 70 publications reported 87
individual cases of transcatheter aortic valve implantation (TAVI)
failure. Similar to surgical bioprosthetic heart valve failure, we
observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural
valve failure (n = 13), and THV thrombosis (n = 15). The microbiological
profile of THV PVE was similar to surgical PVE, though one-quarter had
satellite mitral valve endocarditis, and surgical intervention was
required in 40% (75% survival). Structural valve failure occurred most
frequently due to leaflet calcification and was predominantly treated by
redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean
9+7 months post-implantation and was successfully treated by prolonged
anticoagulation in three-quarters of cases. Twonovel causes of THV
failurewere identified: lateTHVembolization (n = 18); and THV compression
(n = 7) following cardiopulmonary resuscitation (CPR). These failure modes
have not been reported in the surgical literature. Potential risk factors
for late THV embolization include low prosthesis implantation, THV
undersizing/underexpansion, bicuspid, and non-calcified anatomy.
Transcatheter heart valve embolization mandated surgery in 80% of
patients. Transcatheter heart valve compression was noted at post-mortem
in most cases. Conclusion Transcatheter heart valves are susceptible to
failure modes typical to those of surgical bioprostheses and unique to
their specific design. Transcatheter heart valve compression and late
embolization represent complications previously unreported in the surgical
literature.

<6>
Accession Number
2015408245
Authors
Koertke H. Zittermann A. Wagner O. Secer S. Huth C. Sciangula A. Saggau W.
Sack F.-U. Ennker J. Cremer J. Musumeci F. Gummert J.F.
Institution
(Koertke, Zittermann, Secer, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia,
Ruhr University Bochum, Bad Oeynhausen, Germany
(Koertke, Wagner, Secer) Institute of Applied Telemedicine, Heart and
Diabetes Center North Rhine-Westphalia, Ruhr University Bochum,
Georgstr.11, Bad Oeynhausen 32545, Germany
(Huth) Clinic for Thoracic and Cardiovascular Surgery, Otto von Guericke
University Magdeburg, Magdeburg, Germany
(Sciangula) Hospital Santa Anna, Catanzaro, Italy
(Saggau, Sack) Academic City Hospital, Ludwigshafen, Germany
(Ennker) Mediclin Heart Institute Lahr/Baden, University Witten-Herdecke,
Faculty of Health, School of Medicine, Lahr, Germany
(Cremer) Clinic for Cardiac and Vascular Surgery,
Christain-Albrechts-University Kiel, Kiel, Germany
(Musumeci) Azienda Ospedaliera S. Camillo Forlani, Roma, Italy
Title
Telemedicine-guided, very low-dose international normalized ratio
self-control in patients with mechanical heart valve implants.
Source
European Heart Journal. 36 (21) (pp 1297-1305), 2015. Date of Publication:
2015.
Publisher
Oxford University Press
Abstract
Aim To study in patients performing international normalized ratio (INR)
self-control the efficacy and safety of an INR target range of 1.6-2.1 for
aortic valve replacement (AVR) and 2.0-2.5 for mitral valve replacement
(MVR) or double valve replacement (DVR). Methods and results In total,
1304 patients undergoing AVR, 189 undergoing MVR and 78 undergoing DVR
were randomly assigned to low-dose INR self-control (LOW group) (INR
target range, AVR: 1.8-2.8; MVR/DVR: 2.5-3.5) or very low-dose INR
self-control once a week (VLO group) and twice a week (VLT group) (INR
target range, AVR: 1.6-2.1; MVR/DVR: 2.0-2.5), with electronically guided
transfer of INR values.We compared grade III complications (major bleeding
and thrombotic events; primary end-points) and overall mortality
(secondary end-point) across the three treatment groups. Findings Two-year
freedom frombleedings in the LOW, VLO, and VLTgroupswas 96.3, 98.6, and
99.1%, respectively (P = 0.008). The corresponding values for thrombotic
eventswere 99.0, 99.8, and 98.9%, respectively (P = 0.258). The
risk-adjusted composite of grade III complicationswas in the per-protocol
population (reference: LOW-dose group) as follows: hazard ratio = 0.307
(95% CI: 0.102-0.926; P = 0.036) for the VLO group and = 0.241 (95% CI:
0.070-0.836; P = 0.025) for the VLT group. The corresponding values of
2-year mortality were = 1.685 (95% CI: 0.473-5.996; P = 0.421) for the VLO
group and = 4.70 (95% CI: 1.62-13.60; P = 0.004) for the VLT group.
Conclusion Telemedicine-guided very low-dose INR self-control is
comparable with low-dose INR in thrombotic risk, and is superior in
bleeding risk.Weekly testing is sufficient. Given the small number of MVR
and DVR patients, results are only valid for AVR patients.

<7>
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Accession Number
2015407787
Authors
Duncan A.E. Kashy B.K. Sarwar S. Singh A. Stenina-Adognravi O.
Christoffersen S. Alfirevic A. Sale S. Yang D. Thomas J.D. Gillinov M.
Sessler D.I.
Institution
(Duncan, Alfirevic, Sale) Department of Cardiothoracic Anesthesia,
Cleveland Clinic, 9500 Euclid Avenue/J4, Cleveland, OH 44195, United
States
(Duncan, Kashy, Sarwar, Singh, Yang, Sessler) Department of Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Stenina-Adognravi, Christoffersen) Department of Molecular Cardiology,
Cleveland Clinic, Cleveland, OH, United States
(Yang) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Thomas) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Gillinov) Department of Cardiac Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Kashy) Department of Anesthesiology, Northwestern University, Chicago,
IL, United States
(Sarwar) Department of Family Medicine, Case Medical Center, University
Hospitals of Cleveland, Cleveland, OH, United States
(Singh) Hepatobiliary Anesthesia, Toronto General Hospital, University of
Toronto, Toronto, ON, Canada
(Christoffersen) Case Western Reserve University, Cleveland, OH, United
States
(Thomas) Bluhm Cardiovascular Institute, Northwestern Memorial Hospital,
Chicago, IL, United States
Title
Hyperinsulinemic normoglycemia does not meaningfully improve myocardial
performance during cardiac surgery: A randomized trial.
Source
Anesthesiology. 123 (2) (pp 272-287), 2015. Date of Publication: 01 Aug
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Glucose-insulin-potassium (GIK) administration during cardiac
surgery inconsistently improves myocardial function, perhaps because
hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic
normoglycemic clamp (HNC) technique may better enhance the myocardial
benefits of GIK. The authors extended previous GIK investigations by (1)
targeting normoglycemia while administering a GIK infusion (HNC); (2)
using improved echocardiographic measures of myocardial deformation,
specifically myocardial longitudinal strain and strain rate; and (3)
assessing the activation of glucose metabolic pathways. Methods: A total
of 100 patients having aortic valve replacement for aortic stenosis were
randomly assigned to HNC (highdose insulin with concomitant glucose
infusion titrated to normoglycemia) versus standard therapy (insulin
treatment if glucose >150 mg/dl). The primary outcomes were left
ventricular longitudinal strain and strain rate, assessed using
speckle-tracking echocardiography. Right atrial tissue was analyzed for
activation of glycolysis/pyruvate oxidation and alternative metabolic
pathways. Results: Time-weighted mean glucose concentrations were lower
with HNC (127 +/- 19 mg/dl) than standard care (177 +/- 41 mg/dl; P <
0.001). Echocardiographic data were adequate in 72 patients for strain
analysis and 67 patients for strain rate analysis. HNC did not improve
myocardial strain, with an HNC minus standard therapy difference of -1.2%
(97.5% CI, -2.9 to 0.5%; P = 0.11). Strain rate was significantly better,
but by a clinically unimportant amount: -0.16 s^-1 (-0.30 to
-0.03 s^-1; P = 0.007). There was no evidence of increased
glycolytic, pyruvate oxidation, or hexosamine biosynthetic pathway
activation in right atrial samples (HNC, n = 20; standard therapy, 22).
Conclusion: Administration of glucose and insulin while targeting
normoglycemia during aortic valve replacement did not meaningfully improve
myocardial function.

<8>
Accession Number
2015408366
Authors
Kitagawa T. Yamamoto H. Sentani K. Takahashi S. Tsushima H. Senoo A. Yasui
W. Sueda T. Kihara Y.
Institution
(Kitagawa, Yamamoto, Tsushima, Senoo, Kihara) Department of Cardiovascular
Medicine, Hiroshima University Graduate School of Biomedical and Health
Sciences, Hiroshima, Japan
(Sentani, Yasui) Department of Molecular Pathology, Hiroshima University
Institute of Biomedical and Health Sciences, Hiroshima, Japan
(Takahashi, Sueda) Department of Cardiovascular Surgery, Hiroshima
University Hospital, Hiroshima, Japan
Title
The relationship between inflammation and neoangiogenesis of epicardial
adipose tissue and coronary atherosclerosis based on computed tomography
analysis.
Source
Atherosclerosis. 243 (1) (pp 293-299), 2015. Date of Publication: November
01, 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Previous studies indicate that epicardial adipose tissue (EAT)
biologically contributes to the progression of coronary atherosclerosis.
We evaluated the relationship between EAT pathology, represented by
inflammation and neoangiogenesis, and coronary atherosclerosis on computed
tomography (CT) images. Methods: We performed CT examination in 45
patients scheduled for cardiac surgery (coronary artery bypass graft
[CABG], n = 21; non-CABG, n = 24) to assess visceral adipose tissue (VAT)
area, EAT volume, coronary calcium score (CCS), and presence of
non-calcified coronary plaque (NCP) on CT angiography. Each patient was
assessed with the numbers of CD68⁺ individual macrophages and
CD31⁺ neovessels in six random high-power fields (400x) of EAT
samples subsequently obtained during cardiac surgery. Results: In three
groups based on CCS (mild, 0-100; moderate, 101-400; severe, >400), the
moderate group had the most extensive macrophage infiltration (p = 0.0025)
and neoangiogenesis (p = 0.0036) in EAT. The patients with NCP had more
extensive macrophage infiltration (p = 0.010) and neoangiogenesis (p =
0.0043) in EAT than those without. On multivariate analysis adjusted for
age, sex, CABG versus. non-CABG, VAT area, and EAT volume, moderate CCS
and the presence of NCP showed significant correlations with increased
macrophage infiltration (beta = 0.65; p < 0.0001, and beta = 0.49; p =
0.0089, respectively) and neoangiogenesis (beta = 0.55; p = 0.0011, and
beta = 0.53; p = 0.012, respectively) in EAT. Conclusion: Inflammation and
neoangiogenesis in EAT independently correlate with moderate coronary
calcification and presence of NCP, suggesting that these two factors may
have a role in promoting coronary atherosclerosis.

<9>
Accession Number
2015168707
Authors
Lawley C.M. Lain S.J. Algert C.S. Ford J.B. Figtree G.A. Roberts C.L.
Institution
(Lawley, Lain, Algert, Ford, Roberts) Clinical Population Perinatal Health
Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
(Lawley, Figtree) Department of Cardiology, Clinical Population Perinatal
Health Research, University of Sydney, Royal North Shore Hospital, St
Leonards, NSW, Australia
Title
Prosthetic heart valves in pregnancy, outcomes for women and their babies:
A systematic review and meta-analysis.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. 122 (11) (pp
1446-1455), 2015. Date of Publication: 01 Oct 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background Historically, pregnancies among women with prosthetic heart
valves have been associated with an increased incidence of adverse
outcomes. Objectives Systematic review to assess risk of adverse pregnancy
outcomes among women with a prosthetic heart valve(s) over the last 20
years. Search strategy Electronic literature search of Medline, The
Cochrane Library, Cumulative Index to Nursing and Allied Health Literature
and Embase to find recent studies. Selection criteria Studies of pregnant
women with heart valve prostheses including trials, cohort studies and
unselected case series. Data collection and analysis Primary analysis
calculated absolute risks and 95% confidence intervals (CI) for pregnancy
outcomes using a random effects model. The Freeman-Tukey transformation
was utilised in secondary analysis due to the large number of individual
study outcomes with zero events. Main results Eleven studies capturing 499
pregnancies among women with heart valve prostheses, including 256
mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled
estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2),
for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic
subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100
pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI
1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5).
Conclusions Women with heart valve prostheses experienced higher rates of
adverse outcomes than expected in a general obstetric population; however,
lower than previously reported. Women with bioprostheses had significantly
fewer thromboembolic events compared to women with mechanical valves.
Women should be counselled pre-pregnancy about risk of maternal death and
pregnancy loss. Vigilant surveillance by a multidisciplinary team
throughout the perinatal period remains warranted for these women and
their infants. Tweetable abstract Metaanalysis suggests improvement in
#pregnancy outcomes among women with #heartvalveprostheses.

<10>
Accession Number
2015406523
Authors
Mittnacht J. Choukair D. Kneppo C. Brunner R. Parzer P. Gorenflo M.
Bettendorf M.
Institution
(Mittnacht, Choukair, Kneppo, Bettendorf) Division of Paediatric
Endocrinology and Diabetes, Department of Paediatrics, University Hospital
Heidelberg, Im Neuenheimer Feld 430, Heidelberg DE-69120, Germany
(Brunner, Parzer) Department of Child and Adolescent Psychiatry, Centre of
Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
(Gorenflo) Department of Paediatric and Congenital Cardiology, University
Hospital Heidelberg, Heidelberg, Germany
Title
Long-term neurodevelopmental outcome of children treated with
tri-iodothyronine after cardiac surgery: Follow-up of a double-blind,
randomized, placebo-controlled study.
Source
Hormone Research in Paediatrics. 84 (2) (pp 130-136), 2015. Date of
Publication: 27 Aug 2015.
Publisher
S. Karger AG
Abstract
Background: Transient thyroid dysfunction occurs in children after
cardiopulmonary bypass (CPB). We demonstrated significant benefits of
acute postoperative tri-iodothyronine (T3) treatment for recovery and
myocardial function. Now we report the long-term neurodevelopment of these
children. Methods: Twenty-eight children (70% of the original study
population) could be recruited for a follow-up examination (median age
10.7 years, range 10-19.6 years) retaining the double-blind, randomized,
placebo-controlled protocol. Cognitive function and motor development were
tested, as were growth and thyroid and cardiac functions. Results: The
median full-scale intelligence quotient of all children was within the
reference range and similar in the placebo and T3 groups. Tests for motor
and cognitive functions, growth, and thyroid and cardiac functions
revealed concurrent results. Conclusions: Overall intellectual development
is preserved in adolescents treated with CPB in infancy irrespectively of
low postoperative thyroid hormone concentrations. While acute
postoperative T3 treatment in children after CPB improves recovery, no
significant long-term effects on neurodevelopment could be detected. We
therefore speculate that transient postoperative thyroid dysfunction by
means of nonthyroidal illness syndrome is predominantly mediated by
extranuclear, nongenomic mechanisms and thus acutely affects the
cardiovascular system but not the development of the central nervous
system mediated by genomic mechanisms.

<11>
Accession Number
2015409564
Authors
Girdauskas E. Rouman M. Disha K. Espinoza A. Misfeld M. Borger M.A. Kuntze
T.
Institution
(Girdauskas, Rouman, Disha, Espinoza, Misfeld, Borger, Kuntze) Department
of Cardiac Surgery, Central Clinic Bad Berka, Robert-Koch-Allee 9, Bad
Berka 99437, Germany
Title
Aortic Dissection after Previous Aortic Valve Replacement for Bicuspid
Aortic Valve Disease.
Source
Journal of the American College of Cardiology. 66 (12) (pp 1409-1411),
2015. Date of Publication: 22 Sep 2015.
Publisher
Elsevier USA

<12>
[Use Link to view the full text]
Accession Number
2015407524
Authors
Ren C. Chi M. Zhang Y. Zhang Z. Qi F. Liu Z. Xu L.
Institution
(Qi) Department of Anesthesiology (FQ), Qilu Hospital of Shandong
University, Jinan, China
(Ren, Chi, Zhang, Zhang, Liu) Department of Anesthesiology, Liaocheng
People's Hospital, NO. 67 Dongchang West Road, Liaocheng City, Shandong
Province 252000, China
Title
Dexmedetomidine in postoperative analgesia in patients undergoing
hysterectomy: A CONSORT-prospective, randomized, controlled trial.
Source
Medicine (United States). 94 (32) , 2015. Article Number: e1348. Date of
Publication: 01 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Both dexmedetomidine and sufentanil modulate spinal analgesia by different
mechanisms, and yet no human studies are available on their combination
for analgesia during the first 72 hours after abdominal hysterectomy. This
CONSORT-prospective, randomized, double-blinded, controlled trial sought
to evaluate the safety and efficacy of the combination of dexmedetomidine
and sufentanil in intravenous patient-controlled analgesia (PCA) for 72
hours after abdominal hysterectomy. Ninety women undergoing total
abdominal hysterectomy were divided into 3 equal groups that received
sufentanil (Group C; 0.02 mug/kg/h), sufentanil plus dexmedetomidine
(Group D1; 0.02 mug/kg/h, each), or sufentanil (0.02 mug/kg/h) plus
dexmedetomidine (0.05 mug/kg/h) (Group D2) for 72 hours after surgery in
this double-blinded, randomized study. The primary outcome measure was the
postoperative sufentanil consumption, whereas the secondary outcome
measures were pain intensity (visual analogue scale), requirement of
narcotic drugs during the operation, level of sedation, Bruggrmann comfort
scale, and concerning adverse effects. The postoperative sufentanil
consumption was significantly lower in Groups D1 and D2 than in Group C
during the observation period (P<0.05), but lower in Group D2 than in
Group D1 at 24, 48, and 72 hours after surgery (P<0.05). The heart rate
after intubation and incision was lower in Groups D1 and D2 than in Group
C (P<0.05). On arrival at the recovery room, Groups D1 and D2 had lower
mean blood pressure than Group C (P<0.05). The intraoperative requirement
of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The
sedation levels were greater in Groups D1 and D2 during the first hour
(P<0.05). Compared with Groups C and D1, Group D2 showed lower levels of
the overall incidence of nausea and vomiting (P<0.05). Among the tested
PCA options, the addition of dexmedetomidine (0.05 mug/kg/h) and
sufentanil (0.02 mug/kg/h) showed better analgesic effect and greater
patient satisfaction without other clinically relevant side effects for
patients undergoing hysterectomy during thefirst 72 hours after abdominal
hysterectomy.

<13>
[Use Link to view the full text]
Accession Number
2015407514
Authors
Ren C. Zhang X. Liu Z. Li C. Zhang Z. Qi F. Hanaoka K.
Institution
(Ren, Qi) Department of Anaesthesiology, Qilu Hospital of Shandong
University, No. 107, Wenhua West Road, Jinan, Shandong Province 250012,
China
(Ren, Zhang, Liu, Li, Zhang) Department of Anaesthesiology, Liaocheng
People's Hospital, Liaocheng, China
Title
Effect of intraoperative and postoperative infusion of dexmedetomidine on
the quality of postoperative analgesia in highly nicotine-dependent
patients after thoracic surgery: A CONSORT-prospective, randomized,
controlled trial.
Source
Medicine (United States). 94 (32) , 2015. Article Number: e1329. Date of
Publication: 01 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Smoking is one of the most common addictions in the world. Nicotine
inhalation could increase the risk of cardiorespiratory diseases. However,
the solution that improved postoperative analgesia for highly
nicotine-dependent patients undergoing thoracic surgery has not been
specifically addressed. This CONSORT-prospective, randomized,
double-blinded, controlled trial investigated the efficacy of combination
of dexmedetomidine and sufentanil for highly nicotine (Fagerstrom test of
nicotine dependence >6)-dependent patients after thoracic surgery. One
hundred seventy-four male patients who underwent thoracic surgery were
screened between February 2014 and November 2014, and a total of
forty-nine were excluded. One hundred thirty-two highly nicotine-dependent
male patients who underwent thoracic surgery and received postoperative
patient-controlled intravenous analgesia were divided into 3 groups after
surgery in this double-blind, randomized study: sufentanil (0.02 mug/kg/h,
Group S), sufentanil plus dexmedetomidine (0.02 mug/kg/h each, Group D1),
or sufentanil (0.02 mug/kg/h) plus dexmedetomidine (0.04 mug/kg/h) (Group
D2). The patient-controlled analgesia (PCA) program was programmed to
deliver a bolus dose of 2 ml, with background infusion of 2 ml/h and a
lockout of 5 min, 4-hour limit of 40 ml, as our retrospective study. The
primary outcome measure was the cumulative amount of self-administered
sufentanil; the secondary outcome measures were pain intensity (numerical
rating scale, NRS), level of sedation (LOS), Bruggrmann comfort scale
(BCS), functional activity score (FAS), and concerning adverse effects.
The amount of self-administered sufentanil were lower in group D2 compared
with S and D1 groups during the 72 hours after surgery (P< 0.05), whereas
the total dosage and dosage per body weight of sufentanil were
significantly lower in D1 group than that of S group only at 4, 8, and 16
hours after surgery (P <0.05). Compared with S group, the NRS scores at
restat 1,4, and 8 hours after surgery and with coughingat4, 8, 16, and 24
hours after surgery were significantly lower in D2 group (P< 0.05).
However, compared with D1 group, the NRS scores both at rest and with
coughing at 4 and 8 hours after surgery were significantly lower in D2
group (P<0.05). The NRS scores both at rest and with coughing show that
there were no significant differences between D1 group and S group at each
time point after surgery (P>0.05). LOS of group D2 was higher than S and
D1 groups at 1 hour after surgery (P < 0.05), BCS of group D2 was higher
than S and D1 groups at 4, 8, and 16 hours after surgery (P <0.05), and
FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after
surgery (P< 0.05). The number of rescue analgesia during72 hours after
surgery in D2 group was lower than S and D1 groups (P<0.05). There were no
significant differences among the 3 groups in terms of baseline clinical
characteristics and postoperative adverse effects except for itching
(P>0.05). Among the tested patient-controlled analgesia options, the
addition of dexmedetomidine (0.04 mug/kg/h) and sufentanil (0.02 mug/kg/h)
showed better analgesic effect and greater patient satisfaction without
other clinically relevant side effects for highly nicotine-dependent
patients during the initial 72 hours after thoracic surgery.

<14>
[Use Link to view the full text]
Accession Number
2015407481
Authors
Li J. Yu S. Qian D. He Y. Jin J. Wilhelm M.
Institution
(Li, Yu, Qian, He, Jin) Institute of Cardiovascular Science, Xinqiao
Hospital, Third Military Medical University, Chongqing 400037, China
Title
Bivalirudin anticoagulant therapy with or without platelet glycoprotein
IIb/IIIa inhibitors during transcatheter coronary interventional
procedures: A meta-analysis.
Source
Medicine (United States). 94 (32) , 2015. Article Number: e1067. Date of
Publication: 01 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The safety and effectiveness of using the direct thrombin inhibitor
bivalirudin during transcatheter coronary interventional procedures
remains uncertain. This study aimed to systematically assess
anticoagulation with bivalirudin alone or bivalirudin plus glycoprotein
(GP) IIb/IIIa inhibitors (bivalirudin-based anticoagulant therapy) in
patients undergoing percutaneous coronary intervention (PCI) procedures by
a meta-analysis of randomized controlled trials (RCTs). Systematical
searches of the MEDLINE, EMBASE, and Cochrane databases were conducted.
RCTs comparing bivalirudin-based anticoagulant therapy with a comparable
heparin therapy in patients undergoing PCI were eligible. Risk ratios
(RRs) with 95% confidence intervals (CIs) served as summary statistics. A
total of 38,096 patients from 17 RCTs were randomized to the bivalirudin
group (n=18,878) or heparin group (n=19,218) in the meta-analysis. No
significant differences in death, myocardial infarction or reinfarction,
ischemia-driven revascularization, or in-stent thrombosis were observed
between the 2 groups (all P > 0.05). Notably, bivalirudin-based therapy
showed a highly significant 34% decrease in the incidence of major
bleeding (RR=0.66; 95% CI 0.54-0.81; P < 0.001) and a 28% reduction in the
need for blood transfusion (RR =0.72; 95% CI 0.56-0.91; P<0.01).
Meta-regression analyses demonstrated that additional administration of GP
IIb/IIIa receptor inhibitors (P=0.01), especially eptifibatide (P= 0.001)
and tirofiban (P= 0.002), was likely to increase the major bleeding risk
associated with bivalirudin. Bivalirudin, in comparison to heparin, is
associated with a markedly lower risk of major bleeding, and the
additional use of GP IIb/IIIa inhibitors may weaken this benefit.

<15>
Accession Number
2015249032
Authors
Tandogdu Z. Vale L. Fraser C. Ramsay C.
Institution
(Tandogdu) Northern Institute for Cancer Research, Newcastle University,
Newcastle Upon Tyne, United Kingdom
(Tandogdu, Vale) Health Economics Group, Institute of Health and Society,
Newcastle University, Newcastle Upon Tyne, United Kingdom
(Fraser, Ramsay) Health Services Research Unit, University of Aberdeen,
3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD,
United Kingdom
Title
A Systematic Review of Economic Evaluations of the Use of Robotic Assisted
Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery.
Source
Applied Health Economics and Health Policy. 13 (5) (pp 457-467), 2015.
Date of Publication: 04 Aug 2015.
Publisher
Springer International Publishing
Abstract
Background: Robot assisted laparoscopic (RAL) surgery developed to
overcome the limitations of laparoscopy to assist in surgical procedures,
has high capital and operating costs. Systematically assembled evidence
demonstrating its clinical and cost effectiveness would be helpful for its
adoption by decision makers. Objective: To summarise the evidence on the
cost-effectiveness of robot-assisted laparoscopic (RAL) surgery compared
with relevant alternatives. Methods and results of identified studies were
assessed to identify the deficiencies in evidence and areas for further
research. Methods: Studies reporting both costs and outcomes for
comparisons of RAL with laparoscopy and/or open surgery were
systematically identified. Searches were conducted in February 2015 on
MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed
against a standard checklist for economic analyses. Length of hospital
stay and operating time (determinants of cost), cost of intervention,
quality-adjusted life-years (QALYs) and incremental cost-effectiveness
ratio (ICER) were extracted. To aid comparison, costs were converted into
a common currency and price year (2014 US dollars). Results: Forty-seven
eligible studies were identified (full economic evaluation n = 6 and cost
analysis n = 41). Economic models were used in 11 (23 %) studies. Only
three studies used a model considered representative of the disease and
clinical pathway with a time-horizon allowing capture of relevant
differences in outcomes across strategies. The cost of RAL varied
substantially between uses, ranging from US$7011 for hysterectomy to over
US$30,000 for radical cystectomy. The majority of estimates were between
US$15,000 and US$25,000 per person. In part this difference is explained
by the difference between studies in which costs were included. It was
also identified to have higher costs than the alternatives it was compared
against. Incremental cost per QALY for RAL radical prostatectomy was
US$28,801-$31,763 over a 10-year period assuming 200 cases per annum.
Conclusion: The clinical evidence available for RAL overall and used
within included studies is limited. RAL surgery costs were consistently
higher than open and laparoscopic surgery. Therefore, in adopting the
robotic technology decision makers need to take into account the cost
effectiveness within their own systems. Economic models generated and
published for radical prostatectomy and hysterectomy may be adapted to
other health systems if the care pathway is similar to provide locally
relevant data.

<16>
Accession Number
2015405580
Authors
Lee S.-Y. Kim S.-J. Son J.S. Kim S.-H. Lee C.-H.
Institution
(Lee, Kim, Lee) Department of Pediatrics, Department of Thoracic and
Cardiovascular Surgery, Sejong Cardiovascular Institute, Bucheon, South
Korea
(Kim, Son) Division of Pediatric Cardiology, Department of Pediatrics,
Konkuk University Hospital, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030,
South Korea
Title
Stepwise approach using combined management in patients with congenital
heart disease and borderline pulmonary vascular disease.
Source
Korean Circulation Journal. 45 (5) (pp 408-415), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Korean Society of Circulation
Abstract
Background and Objectives: Despite remarkable advances in pediatric
cardiology, pulmonary arterial hypertension associated with congenital
heart disease remains a major problem. In the past decade new vasodilators
have been introduced and appear to be effective in reducing pulmonary
vascular resistance (PVR). Subjects and Methods: From 2000 to 2011, we
retrospectively reviewed the records of 22 patients who had congenital
septal defects and borderline pulmonary vascular disease (PVD). The PVR in
these patients was from 6 to 16 wood units m2, and/or the systolic
pulmonary arterial pressure was more than 2/3 of the systemic arterial
pressure. Results: The median age was 16 years (range, 9 months-46 years).
The median duration of follow-up was 7.4 years (range, 1.4-11.7 years).
According to hemodynamic data and clinical symptoms, the initial
management comprised targeted medical therapy in four (18%), complete
closure in four (18%), and partial closure in 14 patients (63.6%). In the
four patients who had a high PVR and negative vasoreactivity, the PVR
decreased and vasoreactivity increased after targeted medical therapy;
three of these patients underwent cardiac surgery later. Finally, 11 (50%)
received targeted medical therapy and 21 patients (95.4%) underwent
cardiac surgery. Complete closure resulted in six patients and partial
closure in 17 patients. Mortality was observed in two patients. The other
19 patients (91%) had New York Heart Association functional class I.
Conclusion: Targeted medical therapy may be effective in reducing PVR in
patients with congenital heart disease and borderline PVD. A stepwise
approach may help to achieve improved outcomes in these patients.

<17>
Accession Number
2015404585
Authors
Yildirim V. Doganci S. Cinar S. Eskin M.B. Ozkan G. Eksert S. Ince M.E.
Dogrul A.
Institution
(Yildirim, Cinar, Eskin, Ozkan, Eksert, Ince) Department of Anesthesiology
and Intensive Care, Gulhane Military Academy of Medicine, Ankara, Turkey
(Doganci) Department of Cardiovascular Surgery, Gulhane Military Academy
of Medicine, Ankara, Turkey
(Dogrul) Department of Pharmacology, Gulhane Military Academy of Medicine,
Ankara, Turkey
Title
Acute high dose-fentanyl exposure produces hyperalgesia and tactile
allodynia after coronary artery bypass surgery.
Source
European Review for Medical and Pharmacological Sciences. 18 (22) (pp
3425-3434), 2014. Date of Publication: 2014.
Publisher
Verduci Editore
Abstract
OBJECTIVE: Opioid-induced hyperalgesia is well known complication of acute
high dose and chronic opioid therapy. In this study, we evaluated
development of opioid-induced hyperalgesia following intraoperative
short-term use of i-opioid agonist fentanyl after coronary artery bypass
surgery. PATIENTS AND METHODS: 100 patients undergoing elective coronary
artery bypass graft surgery is divided into two groups. In group I (low
dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2
mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group
I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10
mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal
thresholds were measured before surgery and in 1st, 3rd and 7th
postoperative days by using Von Frey filaments and a thermal source,
respectively. RESULTS: Tactile thresholds were significantly decreased at
the first (6.08 +/- 0.21 and 3.76 +/- 0.13 g; p > 0.001) and third (6.76
+/- 0.24 and 4.96 +/- 0.16 g; p > 0.001) postoperative days compared to
baseline preoperative values (7.72 +/- 0.26, and 7.60 +/- 0.21 g; p = 816)
in two groups. Postoperative 1st(13.45 +/- 0.33 and 10.05 +/- 0.24 sec; p
> 0.001) and 3rd day (14.77 +/- 0.28 and 13.17 +/- 0.26 sec; p > 0.001)
assessments showed a statistically significant thermal hyperalgesia
compared to the preoperative baseline values (16.67 +/- 0.51 and 16.45 +/-
0.42 sec; p = 0.997) in two groups. This decrease in both tactile and
thermal thresholds returned to baseline control values at the 7th day of
measurement. CONCLUSIONS: Our results showed that patients undergoing
coronary artery bypass surgery receiving fentanyl anesthesia developed
postoperative tactile allodynia and thermal hyperalgesia and this was more
prominent in high dose group.

<18>
Accession Number
2015401238
Authors
Wesselink E.M. Kappen T.H. Van Klei W.A. Dieleman J.M. Van Dijk D. Slooter
A.J.C.
Institution
(Wesselink, Kappen, Van Klei, Dieleman) Department of Anesthesiology,
University Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508,
Netherlands
(Van Dijk, Slooter) Department of Intensive Care Medicine, University
Medical Center Utrecht, P.O. Box 85500, Utrecht, GA 3508, Netherlands
Title
Intraoperative hypotension and delirium after on-pump cardiac surgery.
Source
British Journal of Anaesthesia. 115 (3) (pp 427-433), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Oxford University Press
Abstract
Background Delirium is a common complication after cardiac surgery and may
be as a result of inadequate cerebral perfusion. We studied delirium after
cardiac surgery in relation to intraoperative hypotension (IOH). Methods
This observational single-centre, cohort study was nested in a randomized
trial, on a single intraoperative dose of dexamethasone vs placebo during
cardiac surgery. During the first four postoperative days, patients were
screened for delirium based on the Confusion Assessment Method (CAM) for
Intensive Care Unit on the intensive care unit, CAM on the ward, and by
inspection of medical records. To combine depth and duration of IOH, we
computed the area under the curve for four blood pressure thresholds.
Logistic regression analyses were performed to investigate the association
between IOH and the occurrence of postoperative delirium, adjusting for
confounding and using a 99% confidence interval to correct for multiple
testing. Results Of the 734 included patients, 99 patients (13%) developed
postoperative delirium. The adjusted Odds Ratio for the Mean Arterial
Pressure <60 mm Hg threshold was 1.04 (99% confidence interval: 0.99-1.10)
for each 1000 mm Hg2 min2 AUC² increase. IOH, as defined
according to the other three definitions, was not associated with
postoperative delirium either. Deep and prolonged IOH seemed to increase
the risk of delirium, but this was not statistically significant.
Conclusions Independent of the applied definition, IOH was not associated
with the occurrence of delirium after cardiac surgery.

<19>
Accession Number
2015401230
Authors
Hastings S. Myles P. McIlroy D.
Institution
(Hastings, Myles, McIlroy) Department of Anaesthesia and Perioperative
Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004,
Australia
(Myles, McIlroy) Department of Anaesthesia and Perioperative Medicine,
Monash University, Melbourne, VIC, Australia
Title
Aspirin and coronary artery surgery: A systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 115 (3) (pp 376-385), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Oxford University Press
Abstract
Background Aspirin administration before cardiac surgery represents a
balance between preventing perioperative thrombotic events and promoting
surgical bleeding. Clear evidence to guide the preoperative use of aspirin
in patients undergoing cardiac surgery is lacking. This systematic review
and meta-analysis was performed to evaluate the efficacy and safety of
preoperative aspirin, in patients undergoing coronary artery surgery.
Methods We conducted a systematic review and meta-analysis of randomized
trials involving patients undergoing coronary artery surgery assigned to
preoperative aspirin therapy or no aspirin/placebo. The MEDLINE and EMBASE
databases and Cochrane Central Register of Controlled Trials were searched
up to March 2014 without language restrictions. Two reviewers performed
independent quality review and data extraction. Efficacy outcomes of
myocardial infarction (MI) and mortality, and safety outcomes of blood
loss, red cell transfusion, and surgical re-exploration were compared.
Results In 13 trials (n=2399), preoperative aspirin therapy reduced the
risk of MI (OR, 0.56; 95% CI, 0.33-0.96; P=0.03), without a reduction in
mortality (OR, 1.16; 95% CI, 0.42-3.22; P=0.77). Preoperative aspirin
increased postoperative chest tube drainage (mean difference 168 ml; 95%
CI, 39-297 ml; P=0.01), red cell transfusion (mean difference 141 ml; 95%
CI, 55-226; P=0.001) and need for surgical re-exploration (OR, 1.85, 95%
CI, 1.15-2.96; P=0.01). Studies were of low methodological quality, with
significant heterogeneity identified. Conclusions In patients undergoing
coronary artery surgery, preoperative aspirin reduces perioperative MI,
but at a cost of increased bleeding, blood transfusion, and surgical
re-exploration.

<20>
Accession Number
2015397138
Authors
Li F. Yuan Y.
Institution
(Li) First People's Hospital, Department of Anesthesia, Yancheng, Jiangsu
Province 224000, China
(Yuan) First People's Hospital, Department of Otolaryngology,
Yancheng,Jiangsu Province 224000, China
Title
Meta-analysis of the cardioprotective effect of sevoflurane versus
propofol during cardiac surgery.
Source
BMC Anesthesiology. 15 (1) , 2015. Article Number: 128. Date of
Publication: September 24, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: To evaluate the cardioprotective effects of sevoflurane versus
propofol anesthesia in patients undergoing cardiac surgery. Methods:
Studies were retrieved through searching several databases. Study quality
was evaluated by Jadad scale. Meta-analysis was performed with RevMan5.0
software. Publication bias was tested by funnel plot. Results: As a
result, 15 studies were included. Compared with propofol, sevoflurane
anesthesia significantly improved postoperative (WMD (weighted mean
difference) = 0.62, 95% CI: 0.33 to 0.92; P < 0.0001) and postoperative 12
hour cardiac index (WMD = 0.18, 95% CI: 0.03 to 0.33; P = 0.02),
postoperative cardiac output (WMD = 1.14, 95% CI: 0.74 to 1.54; P <
0.00001), and reduced postoperative 24 hour cardiac troponin I
concentration (WMD = -0.86, 95% CI:-1.49 to -0.22; P = 0.008),
postoperative inotropic drug usage (OR (odds ratio) = 0.31, 95% CI: 0.22
to 0.44; P < 0.00001), vasoconstrictor drug usage (OR = 0.30, 95% CI:0.21
to 0.43; P < 0.00001), ICU stay (WMD = -15.53, 95% CI: -24.29 to -6.58; P
= 0.0007) and a trial fibrillation incidence (OR = 0.25, 95% CI: 0.07 to
0.85; P = 0.03). However, no significant differences were found in other
indexes. Subgroup analysis indicated the similar results. Discussion: The
sevoflurane-induced cTnI reduction is associated with lower incidence of
late adverse cardiac events, accounting for its roles in cardiac
protection. Several limitations existed such as the small sample size and
the lack use of blind design. Conclusions: Sevoflurane may exhibit a more
favorable cardioprotective effect during cardiac surgery than propofol.

<21>
Accession Number
2015398117
Authors
Jhund P.S. McMurray J.J.V. Chaturvedi N. Brunel P. Desai A.S. Finn P.V.
Haffner S.M. Solomon S.D. Weinrauch L.A. Claggett B.L. Pfeffer M.A.
Institution
(Jhund, Desai, Finn, Solomon, Weinrauch, Claggett, Pfeffer) Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA, United States
(Jhund, McMurray) BHF Glasgow Cardiovascular Research Centre, Institute of
Cardiovascular and Medical Sciences, University of Glasgow, Glasgow,
United Kingdom
(Chaturvedi) Institute of Cardiovascular Sciences, University College
London, London, United Kingdom
(Brunel) Novartis Pharma, Basel, Switzerland
(Haffner) Department of Medicine and Clinical Epidemiology, University of
Texas Health Science Center, San Antonio, TX, United States
Title
Mortality following a cardiovascular or renal event in patients with type
2 diabetes in the ALTITUDE trial.
Source
European Heart Journal. 36 (36) (pp 2463-2469), 2015. Date of Publication:
21 Sep 2015.
Publisher
Oxford University Press
Abstract
Aims Patients with type 2 diabetes mellitus (T2DM) are at high risk of
developing cardiovascular (CV) and renal disease. We examined the burden
of, and risk of death following, CV and renal events in the Aliskiren
Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), a
randomized trial of alikiren vs. placebo. Methods and results We followed
8561 patients with T2DM and evidence of chronic kidney disease, CV
disease, or both in ALTITUDE until the first non-fatal CV or renal event
of myocardial infarction (MI), stroke, heart failure (HF), and end-stage
renal disease (ESRD; initiation of dialysis, renal transplantation, or a
serum creatinine concentration above 6.0 mg/dL) and then to death or
censoring. Time-updated multivariable Cox models were used to estimate the
relative risk of death following each event. In total 1008 patients (12%)
experienced at least one first non-fatal CV or renal event (4.1% HF, 2.8%
MI, 2.8% stroke, and 2.2% ESRD). Death occurred subsequently in 26.4% of
those experiencing a first HF event, 29.7% of those experiencing an MI
event, 23.7% of those experiencing a stroke, and 14.7% of those
experiencing ESRD, and in 6.5% (488) of the 7553 patients (88%) who did
not experience a non-fatal CV or renal event. Compared with patients who
did not experience a non-fatal event, the adjusted hazard ratio for death
was 5.9 (95% confidence interval 4.6-7.6) after HF, 9.7 (7.5-12.6) after
MI, 7.1 (5.3-9.5) after stroke, and 5.8 (3.7-9.0) after ESRD. Conclusion
The majority of deaths occurred in patients who did not experience a
non-fatal CV or renal event, although the risk of death was higher
following an event. Our findings illustrate continuing opportunities to
reduce morbidity and mortality in patients with type 2 diabetes.

<22>
Accession Number
2015397853
Authors
Patti G. Bennett R. Seshasai S.R.K. Cannon C.P. Cavallari I. Chello M.
Nusca A. Mega S. Caorsi C. Spadaccio C. Keun On Y. Mannacio V. Berkan O.
Yilmaz M.B. Katrancioglu N. Ji Q. Kourliouros A. Baran C. Pasceri V. Akar
A.R. Kaski J.C. Di Sciascio G. Ray K.K.
Institution
(Patti, Cavallari, Chello, Nusca, Mega, Di Sciascio) Department of
Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
(Bennett, Seshasai, Kaski, Ray) Cardiovascular Sciences Research Centre,
St George's University of London, Cranmer Terrace, London SW170RE, United
Kingdom
(Cannon) Cardiovascular Division, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Caorsi) Cardiovascular Department, Clinica Las Condes, Hospital Clinico
de la Fuerza Aerea de Chile, Las Condes, Chile
(Spadaccio) Cardiovascular Diseases and Cardiac Surgery Departments,
University Hospital UZ Leuven, Leuven, Belgium
(Spadaccio) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
(Keun On) Department of Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Mannacio) Department of Cardiac Surgery, University of Naples Federico
II, Naples, Italy
(Berkan) Department of Cardiovascular Surgery, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Yilmaz, Katrancioglu) Department of Cardiology, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Ji) Department of Thoracic Cardiovascular Surgery, Tongji University,
Tongji Hospital, Shanghai, China
(Kourliouros) Department of Cardiothoracic Surgery, King's College
Hospital, London, United Kingdom
(Baran, Akar) Department of Cardiovascular Surgery, Heart Center, Ankara
University School of Medicine, Dikimevi, Turkey
(Pasceri) Interventional Cardiology, San Filippo Neri Hospital of Rome,
Rome, Italy
Title
Statin pretreatment and risk of in-hospital atrial fibrillation among
patients undergoing cardiac surgery: A collaborative meta-analysis of 11
randomized controlled trials.
Source
Europace. 17 (6) (pp 855-863), 2015. Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
Aims Statin pretreatment in patients undergoing cardiac surgery is
understood to prevent postoperative atrial fibrillation (AF). However,
this is based on observational and limited randomized trial evidence,
resulting in uncertainty about any genuine anti-arrhythmic benefits of
these agents in this setting.We therefore aimed to quantify precisely the
association between statin pretreatment and postoperative AF among
patients undergoing cardiac surgery. Methods and results A detailed search
of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012)was
conducted, followed by a review of the reference lists of published
studies and correspondence with trial investigators to obtain
individual-participant data for meta-analysis. Evidence was combined
across prospective, randomized clinical trials that compared the risk of
postoperative AF among individuals randomized to statin pretreatment or
placebo/control medication before elective cardiac surgery. Postoperative
AF was defined as episodes of AF lasting >5 min. Overall, 1105
participants from 11 trials were included; of them, 552 received statin
therapy preoperatively. Postoperative AF occurred in 19% of these
participants when compared with 36% of those not treated with statins
(odds ratio 0.41, 95% confidence interval 0.31-0.54, P < 0.00001, using a
random-effects model). Atrial fibrillation prevention by statin
pretreatmentwas consistent across different subgroups. Conclusion
Short-term statin pretreatment may reduce the risk of postoperative AF
among patients undergoing cardiac surgery.

<23>
Accession Number
25499302
Authors
Blazek S. Rossbach C. Borger M.A. Fuernau G. Desch S. Eitel I. Stiermaier
T. Lurz P. Holzhey D. Schuler G. Mohr F.-W. Thiele H.
Institution
(Blazek) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Rossbach) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Borger) Department of Cardiac Surgery, University of Leipzig-Heart
Center, Leipzig, Germany
(Fuernau) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Desch) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of
Lubeck, Lubeck, Germany
(Eitel) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of
Lubeck, Lubeck, Germany
(Stiermaier) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Lurz) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Holzhey) Department of Cardiac Surgery, University of Leipzig-Heart
Center, Leipzig, Germany
(Schuler) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Mohr) Department of Cardiac Surgery, University of Leipzig-Heart Center,
Leipzig, Germany
(Thiele) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany; Medical Clinic II, University of
Lubeck, Lubeck, Germany. Electronic address:
Title
Comparison of sirolimus-eluting stenting with minimally invasive bypass
surgery for stenosis of the left anterior descending coronary artery:
7-year follow-up of a randomized trial.
Source
JACC. Cardiovascular interventions. 8 (1 Pt A) (pp 30-38), 2015. Date of
Publication: 01 Jan 2015.
Abstract
OBJECTIVES: The aim of this analysis was to assess the 7-year long-term
safety and effectiveness of a randomized comparison of percutaneous
coronary intervention (PCI) with sirolimus-eluting stents (SES) versus
minimally invasive direct coronary artery bypass (MIDCAB) surgery for the
treatment of isolated proximal left anterior descending lesions.
BACKGROUND: Long-term follow-up data comparing PCI by SES and MIDCAB
surgery for isolated proximal left anterior descending lesions are sparse.
METHODS: Patients were randomized either to PCI with SES (n = 65) or
MIDCAB (n = 65). Follow-up data were obtained after 7 years with respect
to the primary composite endpoint of death, myocardial infarction, and
target vessel revascularization. Angina was assessed by the Canadian
Cardiovascular Society classification and quality of life with Short Form
36 and MacNew quality of life questionnaires.
RESULTS: Follow-up was conducted in 129 patients at a median time of 7.3
years (interquartile range: 5.7, 8.3). There were no significant
differences in the incidence of the primary composite endpoint between
groups (22% PCI vs. 12% MIDCAB; p = 0.17) or the endpoints death (14% vs.
17%; p = 0.81) and myocardial infarction (6% vs. 9%, p = 0.74). However,
the target vessel revascularization rate was higher in the PCI group (20%
vs. 1.5%; p < 0.001). Clinical symptoms and quality of life improved
significantly from baseline with both interventions and were similar in
magnitude between groups.
CONCLUSIONS: At 7-year follow-up, PCI by SES and MIDCAB in isolated
proximal left anterior descending lesions yielded similar long-term
outcomes regarding the primary composite clinical endpoint and quality of
life. Target vessel revascularization was more frequent in the PCI group.
(MIDCAB Versus DES in Proximal LAD Lesions; NCT00299429).

<24>
Accession Number
25806562
Authors
Burkhardt B.E. Rucker G. Stiller B.
Institution
(Burkhardt, Rucker, Stiller) Department of Cardiology, Kinderspital
Zurich, Steinwiesstrasse 75, Zurich, Switzerland, 8032
Title
Prophylactic milrinone for the prevention of low cardiac output syndrome
and mortality in children undergoing surgery for congenital heart disease.
Source
The Cochrane database of systematic reviews. 3 (pp CD009515), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Children with congenital heart disease often undergo heart
surgery at a young age. They are at risk for postoperative low cardiac
output syndrome (LCOS) or death. Milrinone may be used to provide
inotropic and vasodilatory support during the immediate postoperative
period.
OBJECTIVES: This review examines the effectiveness of prophylactic
postoperative use of milrinone to prevent LCOS or death in children having
undergone surgery for congenital heart disease.
SEARCH METHODS: Electronic and manual literature searches were performed
to identify randomised controlled trials. We searched CENTRAL, MEDLINE,
EMBASE and Web of Science in February 2014 and conducted a top-up search
in September 2014 as well as clinical trial registries and reference lists
of published studies. We did not apply any language restrictions.
SELECTION CRITERIA: Only randomised controlled trials were selected for
analysis. We considered studies with newborn infants, infants, toddlers,
and children up to 12 years of age.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
data according to a pre-defined protocol. We obtained additional
information from all study authors.
MAIN RESULTS: Three of the five included studies compared milrinone versus
levosimendan, one study compared milrinone with placebo, and one compared
milrinone verus dobutamine, with 101, 242, and 50 participants,
respectively. Three trials were at low risk of bias while two were at
higher risk of bias. The number and definitions of outcomes were
non-uniform as well. In one study comparing two doses of milrinone and
placebo, there was some evidence in an overall comparison of milrinone
versus placebo that milrinone lowered risk for LCOS (risk ratio (RR) 0.52,
95% confidence interval (CI) 0.28 to 0.96; 227 participants). The results
from two small studies do not provide enough information to determine
whether milrinone increases the risk of LCOS when compared to levosimendan
(RR 1.22, 95% CI 0.32 to 4.65; 59 participants). Mortality rates in the
studies were low, and there was insufficient evidence to draw conclusions
on the effect of milrinone compared to placebo or levosimendan or
dobutamine regarding mortality, the duration of intensive care stay,
hospital stay, mechanical ventilation, or maximum inotrope score (where
available). Numbers of patients requiring mechanical cardiac support were
also low and did not allow a comparison between studies, and none of the
participants of any study received a heart transplantation up to the end
of the respective follow-up period. Time to death within three months was
not reported in any of the included studies. A number of adverse events
was examined, but differences between the treatment groups could not be
proven for hypotension, intraventricular haemorrhage, hypokalaemia,
bronchospasm, elevated serum levels of liver enzymes, or a reduced left
ventricular ejection fraction < 50% or reduced left ventricular fraction
of shortening < 28%. Our analysis did not prove an increased risk of
arrhythmias in patients treated prophylactically with milrinone compared
with placebo (RR 3.59, 95% CI 0.83 to 15.42; 238 participants), a
decreased risk of pleural effusions (RR 1.78, 95% CI 0.92 to 3.42; 231
participants), or a difference in risk of thrombocytopenia on milrinone
compared with placebo (RR 0.86, 95% CI 0.39 to 1.88; 238 participants).
Comparisons of milrinone with levosimendan or with dobutamine,
respectively, did not clarify the risk of arrhythmia and were not possible
for pleural effusions or thrombocytopenia.
AUTHORS' CONCLUSIONS: There is insufficient evidence of the effectiveness
of prophylactic milrinone in preventing death or low cardiac output
syndrome in children undergoing surgery for congenital heart disease,
compared to placebo. So far, no differences have been shown between
milrinone and other inodilators, such as levosimendan or dobutamine, in
the immediate postoperative period, in reducing the risk of LCOS or death.
The existing data on the prophylactic use of milrinone has to be viewed
cautiously due to the small number of small trials and their risk of bias.

<25>
Accession Number
25758322
Authors
Lewicki M. Ng I. Schneider A.G.
Institution
(Lewicki, Ng, Schneider) Department of Nephrology, Monash Medical Centre,
246 Clayton Road, Clayton, VIC, Australia, 3168
Title
HMG CoA reductase inhibitors (statins) for preventing acute kidney injury
after surgical procedures requiring cardiac bypass.
Source
The Cochrane database of systematic reviews. 3 (pp CD010480), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common in patients undergoing
cardiac surgery among whom it is associated with poor outcomes, prolonged
hospital stays and increased mortality. Statin drugs can produce more than
one effect independent of their lipid lowering effect, and may improve
kidney injury through inhibition of postoperative inflammatory responses.
OBJECTIVES: This review aimed to look at the evidence supporting the
benefits of perioperative statins for AKI prevention in hospitalised
adults after surgery who require cardiac bypass. The main objectives were
to 1) determine whether use of statins was associated with preventing AKI
development; 2) determine whether use of statins was associated with
reductions in in-hospital mortality; 3) determine whether use of statins
was associated with reduced need for RRT; and 4) determine any adverse
effects associated with the use of statins.
SEARCH METHODS: We searched the Cochrane Renal Group's Specialised
Register to 13 January 2015 through contact with the Trials' Search
Co-ordinator using search terms relevant to this review.
SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared
administration of statin therapy with placebo or standard clinical care in
adult patients undergoing surgery requiring cardiopulmonary bypass and
reporting AKI, serum creatinine (SCr) or need for renal replacement
therapy (RRT) as an outcome were eligible for inclusion. All forms and
dosages of statins in conjunction with any duration of pre-operative
therapy were considered for inclusion in this review.
DATA COLLECTION AND ANALYSIS: All authors extracted data independently and
assessments were cross-checked by a second author. Likewise, assessment of
study risk of bias was initially conducted by one author and then by a
second author to ensure accuracy. Disagreements were arbitrated among
authors until consensus was reached. Authors from two of the included
studies provided additional data surrounding post-operative SCr as well as
need for RRT. Meta-analyses were used to assess the outcomes of AKI, SCr
and mortality rate. Data for the outcomes of RRT and adverse effects were
not pooled. Adverse effects taken into account were those reported by the
authors of included studies.
MAIN RESULTS: We included seven studies (662 participants) in this review.
All except one study was assessed as being at high risk of bias. Three
studies assessed atorvastatin, three assessed simvastatin and one
investigated rosuvastatin. All studies collected data during the immediate
perioperative period only; data collection to hospital discharge and
postoperative biochemical data collection ranged from 24 hours to 7 days.
Overall, pre-operative statin treatment was not associated with a
reduction in postoperative AKI, need for RRT, or mortality. Only two
studies (195 participants) reported postoperative SCr level. In those
studies, patients allocated to receive statins had lower postoperative SCr
concentrations compared with those allocated to no drug treatment/placebo
(MD 21.2 micro&#32;mol/L, 95% CI -31.1 to -11.1). Adverse effects were
adequately reported in only one study; no difference was found between the
statin group compared to placebo.
AUTHORS' CONCLUSIONS: Analysis of currently available data did not suggest
that preoperative statin use is associated with decreased incidence of AKI
in adults after surgery who required cardiac bypass. Although a
significant reduction in SCr was seen postoperatively in people treated
with statins, this result was driven by results from a single study, where
SCr was considered as a secondary outcome. The results of the
meta-analysis should be interpreted with caution; few studies were
included in subgroup analyses, and significant differences in methodology
exist among the included studies. Large high quality RCTs are required to
establish the safety and efficacy of statins to prevent AKI after cardiac
surgery.

<26>
Accession Number
24861376
Authors
Koranyi S. Barth J. Trelle S. Strauss B.M. Rosendahl J.
Institution
(Koranyi, Barth, Trelle, Strauss, Rosendahl) Institute of Psychosocial
Medicine and Psychotherapy, University Hospital of Jena, Stoystrasse 3,
Jena, Thuringia, Germany, 07743
Title
Psychological interventions for acute pain after open heart surgery.
Source
The Cochrane database of systematic reviews. 5 (pp CD009984), 2014. Date
of Publication: 2014.
Abstract
BACKGROUND: Acute postoperative pain is one of the most disturbing
complaints in open heart surgery, and is associated with a risk of
negative consequences. Several trials investigated the effects of
psychological interventions to reduce acute postoperative pain and improve
the course of physical and psychological recovery of participants
undergoing open heart surgery.
OBJECTIVES: To compare the efficacy of psychological interventions as an
adjunct to standard care versus standard care alone or standard care plus
attention in adults undergoing open heart surgery on pain, pain
medication, mental distress, mobility, and time to extubation.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1946 to
September 2013), EMBASE (1980 to September 2013), Web of Science (all
years to September 2013), and PsycINFO (all years to September 2013) for
eligible studies. We used the 'related articles' and 'cited by' options of
eligible studies to identify additional relevant studies. We also checked
lists of references of relevant articles and previous reviews. We also
searched the ProQuest Dissertations and Theses Full Text Database (all
years to September 2013) and contacted the authors of primary studies to
identify any unpublished material.
SELECTION CRITERIA: Randomised controlled trials comparing psychological
interventions as an adjunct to standard care versus standard care alone or
standard care plus attention in adults undergoing open heart surgery.
DATA COLLECTION AND ANALYSIS: Two review authors (SK and JR) independently
assessed trials for eligibility, estimated the risk of bias and extracted
all data. We calculated effect sizes for each comparison (Hedges' g) and
meta-analysed data using a random-effects model.
MAIN RESULTS: Nineteen trials were included (2164 participants).No study
reported data on the number of participants with pain intensity reduction
of at least 50% from baseline. Only one study reported data on the number
of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain
intensity. Psychological interventions have no beneficial effects in
reducing pain intensity measured with continuous scales in the medium-term
interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants,
moderate quality evidence) nor in the long-term interval (g 0.12, 95% CI
-0.09 to 0.33, 3 studies, 280 participants, low quality evidence).No study
reported data on median time to remedication or on number of participants
remedicated. Only one study provided data on postoperative analgesic use.
Studies reporting data on mental distress in the medium-term interval
revealed a small beneficial effect of psychological interventions (g 0.36,
95% CI 0.10 to 0.62, 12 studies, 1144 participants, low quality evidence).
Likewise, a small beneficial effect of psychological interventions on
mental distress was obtained in the long-term interval (g 0.28, 95% CI
0.05 to 0.51, 11 studies, 1320 participants, low quality evidence). There
were no beneficial effects of psychological interventions on mobility in
the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444
participants, low quality evidence) nor in the long-term interval (g 0.29,
95% CI -0.14 to 0.71, 4 studies, 423 participants, low quality evidence).
Only one study reported data on time to extubation.
AUTHORS' CONCLUSIONS: For the majority of outcomes (two-thirds) we could
not perform a meta-analysis since outcomes were not measured, or data were
provided by one trial only. Psychological interventions have no beneficial
effects on reducing postoperative pain intensity or enhancing mobility.
There is low quality evidence that psychological interventions reduce
postoperative mental distress. Due to limitations in methodological
quality, a small number of studies, and large heterogeneity, we rated the
quality of the body of evidence as low. Future trials should measure
crucial outcomes (e.g. number of participants with pain intensity
reduction of at least 50% from baseline) and should focus to enhance the
quality of the body of evidence in general. Altogether, the current
evidence does not clearly support the use of psychological interventions
to reduce pain in participants undergoing open heart surgery.

<27>
Accession Number
25178118
Authors
Vale N. Nordmann A.J. Schwartz G.G. de Lemos J. Colivicchi F. den Hartog
F. Ostadal P. Macin S.M. Liem A.H. Mills E.J. Bhatnagar N. Bucher H.C.
Briel M.
Institution
(Vale, Nordmann, Schwartz, de Lemos, Colivicchi, den Hartog, Ostadal,
Macin, Liem, Mills, Bhatnagar, Bucher, Briel) Family Medicine, St Mary's
Hospital, McGill University, 377 Rue Jean Brilliant, Montreal, QC, Canada,
H3T 1M5
Title
Statins for acute coronary syndrome.
Source
The Cochrane database of systematic reviews. 9 (pp CD006870), 2014. Date
of Publication: 2014.
Abstract
BACKGROUND: The early period following the onset of acute coronary
syndrome (ACS) represents a critical stage of coronary heart disease, with
a high risk of recurrent events and deaths. The short-term effects of
early treatment with statins on patient-relevant outcomes in patients
suffering from ACS are unclear. This is an update of a review previously
published in 2011.
OBJECTIVES: To assess the effects, both harms and benefits, of early
administered statins in patients with ACS, in terms of mortality and
cardiovascular events.
SEARCH METHODS: We updated the searches of CENTRAL (2013, Issue 3),
MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013
Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied
no language restrictions. We supplemented the search by contacting experts
in the field, by reviewing the reference lists of reviews and editorials
on the topic, and by searching trial registries.
SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing statins
with placebo or usual care, with initiation of statin therapy within 14
days following the onset of ACS, follow-up of at least 30 days, and
reporting at least one clinical outcome.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of
bias and extracted data. We calculated risk ratios (RRs) for all outcomes
in the treatment and control groups and pooled data using random-effects
models.
MAIN RESULTS: Eighteen studies (14,303 patients) compared early statin
treatment versus placebo or no treatment in patients with ACS. The new
search did not identify any new studies for inclusion. There were some
concerns about risk of bias and imprecision of summary estimates. Based on
moderate quality evidence, early statin therapy did not decrease the
combined primary outcome of death, non-fatal myocardial infarction, and
stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI)
0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up
when compared to placebo or no treatment. There were no statistically
significant risk reductions from statins for total death, total myocardial
infarction, total stroke, cardiovascular death, revascularization
procedures, and acute heart failure at one month or at four months,
although there were favorable trends related to statin use for each of
these endpoints. Moderate quality evidence suggests that the incidence of
unstable angina was significantly reduced at four months following ACS (RR
0.76, 95% CI 0.59 to 0.96). There were nine individuals with myopathy
(elevated creatinine kinase levels more than 10 times the upper limit of
normal) in statin-treated patients (0.13%) versus one (0.015%) in the
control groups. Serious muscle toxicity was mostly limited to patients
treated with simvastatin 80 mg.
AUTHORS' CONCLUSIONS: Based on moderate quality evidence, due to concerns
about risk of bias and imprecision, initiation of statin therapy within 14
days following ACS does not reduce death, myocardial infarction, or stroke
up to four months, but reduces the occurrence of unstable angina at four
months following ACS. Serious side effects were rare.

<28>
Accession Number
25233038
Authors
Blessberger H. Kammler J. Domanovits H. Schlager O. Wildner B. Azar D.
Schillinger M. Wiesbauer F. Steinwender C.
Institution
(Blessberger, Kammler, Domanovits, Schlager, Wildner, Azar, Schillinger,
Wiesbauer, Steinwender) Department of Internal Medicine I - Cardiology,
Linz General Hospital (Allgemeines Krankenhaus Linz) Johannes Kepler
University School of Medicine, Krankenhausstrase 9, Linz, Austria, 4020
Title
Perioperative beta-blockers for preventing surgery-related mortality and
morbidity.
Source
The Cochrane database of systematic reviews. 9 (pp CD004476), 2014. Date
of Publication: 2014.
Abstract
BACKGROUND: Randomized controlled trials have yielded conflicting results
regarding the ability of beta-blockers to influence perioperative
cardiovascular morbidity and mortality. Thus routine prescription of these
drugs in unselected patients remains a controversial issue.
OBJECTIVES: The objective of this review was to systematically analyse the
effects of perioperatively administered beta-blockers for prevention of
surgery-related mortality and morbidity in patients undergoing any type of
surgery while under general anaesthesia.
SEARCH METHODS: We identified trials by searching the following databases
from the date of their inception until June 2013: MEDLINE, EMBASE, the
Cochrane Central Register of Controlled Trials (CENTRAL), Biosis Previews,
CAB Abstracts, Cumulative Index to Nursing and Allied Health Literature
(CINAHL), Derwent Drug File, Science Citation Index Expanded, Life
Sciences Collection, Global Health and PASCAL. In addition, we searched
online resources to identify grey literature.
SELECTION CRITERIA: We included randomized controlled trials if
participants were randomly assigned to a beta-blocker group or a control
group (standard care or placebo). Surgery (any type) had to be performed
with all or at least a significant proportion of participants under
general anaesthesia.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
data from all studies. In cases of disagreement, we reassessed the
respective studies to reach consensus. We computed summary estimates in
the absence of significant clinical heterogeneity. Risk ratios (RRs) were
used for dichotomous outcomes, and mean differences (MDs) were used for
continuous outcomes. We performed subgroup analyses for various potential
effect modifiers.
MAIN RESULTS: We included 89 randomized controlled trials with 19,211
participants. Six studies (7%) met the highest methodological quality
criteria (studies with overall low risk of bias: adequate sequence
generation, adequate allocation concealment, double/triple-blinded design
with a placebo group, intention-to-treat analysis), whereas in the
remaining trials, some form of bias was present or could not be
definitively excluded (studies with overall unclear or high risk of bias).
Outcomes were evaluated separately for cardiac and non-cardiac surgery.
CARDIAC SURGERY (53 trials)We found no clear evidence of an effect of
beta-blockers on the following outcomes.* All-cause mortality: RR 0.73,
95% CI 0.35 to 1.52, 3783 participants, moderate quality of evidence.*
Acute myocardial infarction (AMI): RR 1.04, 95% CI 0.71 to 1.51, 3553
participants, moderate quality of evidence.* Myocardial ischaemia: RR
0.51, 95% CI 0.25 to 1.05, 166 participants, low quality of evidence.*
Cerebrovascular events: RR 1.52, 95% CI 0.58 to 4.02, 1400 participants,
low quality of evidence.* Hypotension: RR 1.54, 95% CI 0.67 to 3.51, 558
participants, low quality of evidence.* Bradycardia: RR 1.61, 95% CI 0.97
to 2.66, 660 participants, low quality of evidence.* Congestive heart
failure: RR 0.22, 95% CI 0.04 to 1.34, 311 participants, low quality of
evidence.Beta-blockers significantly reduced the occurrence of the
following endpoints.* Ventricular arrhythmias: RR 0.37, 95% CI 0.24 to
0.58, number needed to treat for an additional beneficial outcome (NNTB)
29, 2292 participants, moderate quality of evidence.* Supraventricular
arrhythmias: RR 0.44, 95% CI 0.36 to 0.53, NNTB six, 6420 participants,
high quality of evidence.* On average, beta-blockers reduced length of
hospital stay by 0.54 days (95% CI -0.90 to -0.19, 2450 participants, low
quality of evidence). NON-CARDIAC SURGERY (36 trials)We found a potential
increase in the occurrence of the following outcomes with the use of
beta-blockers.* All-cause mortality: RR 1.24, 95% CI 0.99 to 1.54, 11,463
participants, low quality of evidence.Whereas no clear evidence of an
effect was noted when all studies were analysed, restricting the
meta-analysis to low risk of bias studies revealed a significant increase
in all-cause mortality with the use of beta-blockers: RR 1.27, 95% CI 1.01
to 1.59, number needed to treat for an additional harmful outcome (NNTH)
189, 10,845 participants.* Cerebrovascular events: RR 1.59, 95% CI 0.93 to
2.71, 9150 participants, low quality of evidence.Whereas no clear evidence
of an effect was found when all studies were analysed, restricting the
meta-analysis to low risk of bias studies revealed a significant increase
in cerebrovascular events with the use of beta-blockers: RR 2.09, 95% CI
1.14 to 3.82, NNTH 255, 8648 participants.Beta-blockers significantly
reduced the occurrence of the following endpoints.* AMI: RR 0.73, 95% CI
0.61 to 0.87, NNTB 72, 10,958 participants, high quality of evidence.*
Myocardial ischaemia: RR 0.43, 95% CI 0.27 to 0.70, NNTB seven, 1028
participants, moderate quality of evidence.* Supraventricular arrhythmias:
RR 0.72, 95% CI 0.56 to 0.92, NNTB 111, 8794 participants, high quality of
evidence.Beta-blockers significantly increased the occurrence of the
following adverse events.* Hypotension: RR 1.50, 95% CI 1.38 to 1.64, NNTH
15, 10,947 participants, high quality of evidence.* Bradycardia: RR 2.24,
95% CI 1.49 to 3.35, NNTH 18, 11,083 participants, moderate quality of
evidence.We found no clear evidence of an effect of beta-blockers on the
following outcomes.* Ventricular arrhythmias: RR 0.64, 95% CI 0.30 to
1.33, 526 participants, moderate quality of evidence.* Congestive heart
failure: RR 1.17, 95% CI 0.93 to 1.47, 9223 participants, moderate quality
of evidence.* Length of hospital stay: mean difference -0.27 days, 95% CI
-1.29 to 0.75, 601 participants, low quality of evidence.
AUTHORS' CONCLUSIONS: According to our findings, perioperative application
of beta-blockers still plays a pivotal role in cardiac surgery , as they
can substantially reduce the high burden of supraventricular and
ventricular arrhythmias in the aftermath of surgery. Their influence on
mortality, AMI, stroke, congestive heart failure, hypotension and
bradycardia in this setting remains unclear.In non-cardiac surgery,
evidence from low risk of bias trials shows an increase in all-cause
mortality and stroke with the use of beta-blockers. As the quality of
evidence is still low to moderate, more evidence is needed before a
definitive conclusion can be drawn. The substantial reduction in
supraventricular arrhythmias and AMI in this setting seems to be offset by
the potential increase in mortality and stroke.

<29>
Accession Number
25240570
Authors
Aryal M.R. Karmacharya P. Pandit A. Hakim F. Pathak R. Mainali N.R.
Ukaigwe A. Mahmood M. Badal M. Fortuin F.D.
Institution
(Aryal) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Karmacharya) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Pandit) Division of Cardiovascular Disease, Mayo Clinic College of
Medicine, Phoenix, Arizona, USA 85054
(Hakim) Division of Cardiovascular Disease, Mayo Clinic College of
Medicine, Phoenix, Arizona, USA 85054
(Pathak) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611. Electronic address: ranjanrp@gmail.com
(Mainali) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Ukaigwe) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Mahmood) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Badal) Department of Internal Medicine, Reading Health System, West
Reading, Pennsylvania, USA 19611
(Fortuin) Division of Cardiovascular Disease, Mayo Clinic College of
Medicine, Phoenix, Arizona, USA 85054
Title
Dual versus single antiplatelet therapy in patients undergoing
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Heart, lung & circulation. 24 (2) (pp 185-192), 2015. Date of Publication:
01 Feb 2015.
Abstract
BACKGROUND: Although dual antiplatelet therapy (DAPT) with clopidogrel and
aspirin is a widely accepted strategy in patients undergoing transcatheter
aortic valve replacement (TAVR), this approach is not evidence based. We
therefore sought to systematically review the current evidence for this
practice in terms of 30-day outcome looking at stroke, MI, bleeding, and
death.
METHODS: Relevant studies were identified through electronic literature
search. Studies involving single antiplatelet therapy (SAPT) and DAPT in
patients undergoing TAVR were included. Study specific risk ratios were
calculated and combined using random-effects model meta-analysis.
RESULTS: Analysis of data from 410 patients, stroke occurred in seven
(3.16%) of SAPT and six (3.17%) of DAPT RR=1.03 (95% CI, 0.36-2.96,
P=0.96). In analysis of 530 patients, MI occurred in three (1.07%) of SAPT
and one (0.40%) of DAPT RR=1.97 (95% CI, 0.29-13.29, P=0.49), significant
bleeding (major, life threatening and bleeding requiring transfusion)
occurred in 20 (7.11%) of SAPT and 43 (17.27%) of DAPT RR=0.41 (95% CI,
0.25-0.69, P=0.0006). Number needed to harm for major or life threatening
bleeding was 10. Death occurred in 15 (6.78%) of SAPT and 15 (7.94%) of
DAPT (RR 0.91; 95% CI 0.46-1.79, P=0.78).
CONCLUSION: Our meta-analysis suggests that at 30 days following TAVR
there is no difference between post-procedural SAPT versus DAPT for the
risk of stroke or MI and DAPT may have a higher bleeding risk. Adequately
powered RCTs are warranted to clarify the optimal antiplatelet treatment
strategy following TAVR.

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Accession Number
26017188
Authors
Friedell M.L. Van Way C.W. Freyberg R.W. Almenoff P.L.
Institution
(Friedell) Department of Surgery, University of Missouri-Kansas City
School of Medicine, Kansas City
(Van Way) Department of Surgery, University of Missouri-Kansas City School
of Medicine, Kansas City
(Freyberg) Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio
(Almenoff) Veterans Affairs Medical Center-Kansas City, Kansas City,
Missouri
Title
beta-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or
Helpful?.
Source
JAMA surgery. 150 (7) (pp 658-663), 2015. Date of Publication: 01 Jul
2015.
Abstract
IMPORTANCE: The use of perioperative pharmacologic beta-blockade in
patients at low risk of myocardial ischemic events undergoing noncardiac
surgery (NCS) is controversial because of the risk of stroke and
hypotension. Published studies have not found a consistent benefit in this
cohort.
OBJECTIVE: To determine the effect of perioperative beta-blockade on
patients undergoing NCS, particularly those with no risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective observational
analysis of patients undergoing surgery in Veterans Affairs hospitals from
October 1, 2008, through September 31, 2013.
METHODS: beta-Blocker use was determined if a dose was ordered at any time
between 8 hours before surgery and 24 hours postoperatively. Data from the
Veterans Affairs electronic database included demographics, diagnosis and
procedural codes, medications, perioperative laboratory values, and date
of death. A 4-point cardiac risk score was calculated by assigning 1 point
each for renal failure, coronary artery disease, diabetes mellitus, and
surgery in a major body cavity. Previously validated linear regression
models for all hospitalized acute care medical or surgical patients were
used to calculate predicted mortality and then to calculate odds ratios
(ORs).
MAIN OUTCOMES AND MEASURES: The end point was 30-day surgical mortality.
RESULTS: There were 326,489 patients in this cohort: 314,114 underwent NCS
and 12,375 underwent cardiac surgery. beta-Blockade lowered the OR for
mortality significantly in patients with 3 to 4 cardiac risk factors
undergoing NCS (OR, 0.63; 95% CI, 0.43-0.93). It had no effect on patients
with 1 to 2 risk factors. However, beta-blockade resulted in a
significantly higher chance of death in patients (OR, 1.19; 95% CI,
1.06-1.35) with no risk factors undergoing NCS.
CONCLUSIONS AND RELEVANCE: In this large series, beta-blockade appears to
be beneficial perioperatively in patients with high cardiac risk
undergoing NCS. However, the use of beta-blockers in patients with no
cardiac risk factors undergoing NCS increased risk of death in this
patient cohort.