EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2010241144
Authors
Jokinen J.J. Hippelainen M.J. Turpeinen A.K. Pitkanen O. Hartikainen
J.E.K.
Institution
(Jokinen) Department of Cardiothoracic Surgery, Helsinki University
Hospital, PO Box 340, FI-00029 Helsinki, Finland.
(Hippelainen) Department of Surgery, Kuopio University Hospital,
Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
(Turpeinen, Hartikainen) Department of Medicine, Kuopio University
Hospital, Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
(Pitkanen) Department of Anesthesiology, Kuopio University Hospital,
Puijonlaaksonkatu 2, FI-70211 Kuopio, Finland.
Title
Health-related quality of life after coronary artery bypass grafting: A
review of randomized controlled trials.
Source
Journal of Cardiac Surgery. 25(3)(pp 309-317), 2010. Date of Publication:
May 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Objective outcome measures (i.e., survival, mortality, morbidity,
complication rate, symptom recurrence, and need for re-interventions) have
long been used as benchmarks for successful cardiac surgery, including
coronary artery bypass grafting (CABG). Along with these objectively
measurable outcome indicators, acquired improvement by cardiac surgery in
subjectively experienced health-related quality of life (HRQoL) has gained
importance during the last decade in cardiac surgical research. If an
increasing proportion of adult patients referred for CABG are elderly,
octogenarians or even nonagenarians, the acquired HRQoL benefit from
bypass surgery should be considered to be at least as important an outcome
measure as potentially marginal improvement in life expectancy or
longevity alone. To achieve the maximal HRQoL benefit and to optimize
patient selection, a comprehensive analysis and understanding of
contributors that affect pre- and postoperative self-perceived HRQoL is
essential. These include patient-related characteristics (e.g.,
demographics and underlying comorbidities), surgical technique-related
factors, and healthcare-related attributes. In this paper we review the
randomized controlled trials published during the last ten years to
analyze the effect of CABG on HRQoL. Specifically, we focus on the
differences between the on-pump and off-pump (OPCAB) bypass techniques,
investigate the factors that contribute to post-CABG HRQoL, and study
post-CABG HRQoL in elderly patients. copyright 2010 Wiley Periodicals,
Inc.

<2>
Accession Number
2010235023
Authors
Van Breugel H.N.A.M. Nieman F.H.M. Accord R.E. Van Mastrigt G.A.P.G. Nijs
J.F.M.A. Severens J.L. Vrakking R. Maessen J.G.
Institution
(Van Breugel, Accord, Nijs, Maessen) Department of Cardiothoracic Surgery,
University Hospital Maastricht, P. Debeyelaan 25, 6202 AZ Maastricht,
Netherlands.
(Nieman, Van Mastrigt) Clinical Epidemiology and Medical Technology
Assessment, University Hospital Maastricht, Maastricht, Netherlands.
(Severens) Department of Health Organisation, Policy and Economics, Public
Health and Primary Care (CAPHRI) Research Institute, Maastricht
University, Maastricht, Netherlands.
(Vrakking) Department of Cardiothoracic Surgery, Amphia Hospital Breda,
Breda, Netherlands.
Title
A prospective randomized multicenter comparison on health-related quality
of life: The value of add-on arrhythmia surgery in patients with
paroxysmal, permanent or persistent atrial fibrillation undergoing
valvular and/or coronary bypass surgery.
Source
Journal of Cardiovascular Electrophysiology. 21(5)(pp 511-520), 2010.
Date of Publication: May 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: This is a multicenter, prospective, randomized controlled
trial to determine the effect of add-on arrhythmia surgery on
health-related quality of life during 1-year follow-up of cardiac surgery
patients with atrial fibrillation. Methods: 150 patients with documented
atrial fibrillation were randomly assigned to undergo cardiac surgery with
or without add-on surgery. Patients completed quality of life
questionnaires, comprising the RAND 36-item Health Survey 1.0 (SF-36),
Multidimensional Fatigue Inventory-20 (MFI-20) and EuroQoL (EQ-5D and VAS)
at baseline and 3, 6, and 12 months following operation. Results: 132
patients completed the questionnaires at a minimum of one time-point
during follow-up. At baseline patient characteristics, operative data and
health-related quality of life were comparable. At 12-month follow-up 62
patients were free of atrial fibrillation without significant differences
between groups (P = 0.28). Conversion to SR occurred in 69.8% (37/53) of
patients with paroxysmal AF, in 28.2% (11/39) of patients with permanent
AF and in 44.4% (12/27) of patients in persistent AF. Cardiac surgery in
general resulted in an overall improvement of the RAND SF-36 and the
MFI-20. However, the EQ-5D showed a significant deterioration in the
subscale Pain/Discomfort for both groups (P < 0.001), with a significant
worse outcome for the control group (P = 0.006). Conclusions:
Health-related quality of life in patients with paroxysmal, permanent and
persistent atrial fibrillation improves after cardiac surgery regardless
of giving add-on surgery or not, but this improvement is presumably more
affected by treating the underlying heart disease than by restoring sinus
rhythm. copyright 2009 Wiley Periodicals, Inc.

<3>
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Accession Number
2010229279
Authors
Breukers R.-M.B.G.E. De Wilde R.B.P. Van den Berg P.C.M. Jansen J.R.C.
Faes T.J.C. Twisk J.W.R. Groeneveld A.B.J.
Institution
(Breukers, Groeneveld) Department of Intensive Care, Institute for
Cardiovascular Research, Amsterdam, Netherlands.
(De Wilde, Van den Berg, Jansen) VU University Medical Center, Amsterdam,
Netherlands.
(De Wilde, Van den Berg, Jansen) Department of Intensive Care, Leiden
University Medical Center, Leiden, Netherlands.
(Faes) Department of Physics and Medical Technology, Leiden University
Medical Center, Leiden, Netherlands.
(Twisk) Department of Clinical Epidemiology and Biostatistics, Leiden
University Medical Center, Leiden, Netherlands.
Title
Assessing fluid responses after coronary surgery: Role of mathematical
coupling of global end-diastolic volume to cardiac output measured by
transpulmonary thermodilution.
Source
European Journal of Anaesthesiology. 26(11)(pp 954-960), 2009. Date of
Publication: November 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background Mathematical coupling may explain in part why cardiac filling
volumes obtained by transpulmonary thermodilution may better predict and
monitor responses of cardiac output to fluid loading than pressures
obtained by pulmonary artery catheters (PACs). Methods Eleven consecutive
patients with hypovolaemia after coronary surgery and a PAC, allowing
central venous pressure (CVP) and continuous cardiac index (CCIp)
measurements, received a femoral artery catheter for transpulmonary
thermodilution measurements of global end-diastolic blood volume index
(GEDVI) and cardiac index (CItp). One to five colloid fluid-loading steps
of 250 ml were done in each patient (n=48 total). Results Fluid responses
were predicted and monitored similarly by CItp and CCIp, whereas CItp and
CCIp correlated at r=0.70 (P<0.001) with a biasof 0.40 l min-1m-2.Changes
in volumes(and not inCVP) related to changes in CItp and not in CCIp.
Changes in CVP and GEDVI similarly related to changes in CItp, after
exclusion of two patients with greatest CItp outliers (as compared to
CCIp). Changes in GEDVI correlated better to changes in CItp when derived
from the same thermodilution curve than to changes in CItp of unrelated
curves and changes in CCIp. Conclusions After coronary surgery, fluid
responses can be similarly assessed by intermittent transpulmonary and
continuous pulmonary thermodilution methods, in spite of overestimation of
CCIp by CItp. Filling pressures are poor monitors of fluid responses and
superiority of GEDVI can be caused, at least in part, by mathematical
coupling when cardiac volume and output are derived from the same
thermodilution curve. Eur J Anaesthesiol 26:954-960 copyright2009 European
Society of Anaesthesiology.

<4>
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Accession Number
2010229259
Authors
Ayouba C.M. Sfeirb P.M. Pierre B.-K. Azara M. Haddadind A.S. Harfoucha D.
Nasra V.G. El-Khatiba M.F.
Institution
(Ayouba, Azara, Harfoucha, Nasra, El-Khatiba) Department of
Anaesthesiology, American University, Beirut Medical Center, Hamra Street,
Beirut 1107-2020, Lebanon.
(Sfeirb) Department of Surgery, American University, Beirut Medical
Center, Beirut, Lebanon.
(Pierre) Department of Internal Medicine, American University, Beirut
Medical Center, Beirut, Lebanon.
(Haddadind) Department of Anaesthesiology, Yale University School of
Medicine, New Haven, CT, United States.
Title
Prophylactic amiodarone versus lidocaine for prevention of reperfusion
ventricular fibrillation after release of aortic cross-clamp.
Source
European Journal of Anaesthesiology. 26(12)(pp 1056-1060), 2009. Date of
Publication: December 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and objective Ventricular fibrillation is common after aortic
cross-clamp release in patients undergoing open-heart surgeries. The aim
of the study was to evaluate the efficacy of the prophylactic
administration of 150mg amiodarone by way of the pump 2 min before release
of aortic cross-clamp in preventing ventricular fibrillation. Methods The
present study is a prospective, randomized, controlled and blinded study
performed at a teaching university hospital where 120 patients undergoing
coronary bypass graft surgery were randomly assigned to three groups. Each
group received either 150mg of amiodarone or 100mg lidocaine or isotonic
saline by way of pump 2 min before release of the aortic cross-clamp. The
frequency of occurrence of ventricular fibrillation and the subsequent
required defibrillation counter shocks were determined in all groups.
Results The frequency of occurrence of ventricular fibrillation was
significantly higher in both the amiodarone (48%) and the control group
(45%) as compared with the lidocaine group (20%) with no statistically
significant difference between the amiodarone and the control groups.
Furthermore, when ventricular fibrillation occurred, the percentage of
patients requiring defibrillation counter shocks was significantly higher
in both the amiodarone (58%) and control (61%) groups as compared with the
lidocaine group (13%) with no difference between the amiodarone and the
control groups, despite a significant decrease in the defibrillation
counter shocks energy requirements in the amiodarone group. Conclusion The
present study showed no difference between amiodarone (150 mg) and placebo
in preventing ventricular fibrillation after release of aortic
cross-clamp. In addition, the use of lidocaine was able to reduce the
incidence of ventricular fibrillation as compared with both amiodarone and
placebo. Eur J Anaesthesiol 261056-1060 copyright 2009 European Society of
Anaesthesiology.

<5>
Accession Number
2010224514
Authors
Sezai A. Hata M. Niino T. Yoshitake I. Unosawa S. Wakui S. Fujita K.
Takayama T. Kasamaki Y. Hirayama A. Minami K.
Institution
(Sezai, Hata, Niino, Yoshitake, Unosawa, Wakui, Fujita, Minami) Department
of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo,
Japan.
(Takayama, Kasamaki, Hirayama) Department of Cardiology, Nihon University
School of Medicine, Tokyo, Japan.
Title
Continuous Low-Dose Infusion of Human Atrial Natriuretic Peptide in
Patients With Left Ventricular Dysfunction Undergoing Coronary Artery
Bypass Grafting. The NU-HIT (Nihon University working group study of
low-dose Human ANP Infusion Therapy during cardiac surgery) for Left
Ventricular Dysfunction.
Source
Journal of the American College of Cardiology. 55(17)(pp 1844-1851),
2010. Date of Publication: 27 Apr 2010.
Publisher
Elsevier USA
Abstract
Objectives: Continuous low-dose infusion of human atrial natriuretic
peptide (hANP) in patients undergoing cardiac surgery on cardiopulmonary
bypass (CPB) inhibits the renin-angiotensin-aldosterone system and
compensates for the adverse effects of CPB. Background: We examined the
influence of hANP infusion on cardiac and renal function in patients with
left ventricular dysfunction undergoing coronary artery bypass grafting
(CABG). Methods: The subjects were 133 patients who underwent CABG and had
a pre-operative ejection fraction [less-than or equal to]35%. They were
randomized to receive 0.02 mug/kg/min of hANP from the initiation of CPB
(hANP group) or placebo (saline) infusion. Results: Early post-operative
mortality did not show a significant difference between the 2 groups, but
perioperative complications were significantly less frequent in the hANP
group (p = 0.015). Long-term all-cause mortality showed no difference, but
the cardiac death-free rate at 5 or 8 years post-operatively was 98.5% in
the hANP group and 85.5% in the placebo group (p = 0.0285). Post-operative
ejection fraction was significantly larger and the post-operative brain
natriuretic peptide level was significantly lower in the hANP group. Serum
creatinine was significantly lower in the hANP group than the placebo
group at 1 month, 6 months, and 1 year post-operatively, whereas the
estimated glomerular filtration rate was significantly higher in the hANP
group at these times. Conclusions: In patients with left ventricular
dysfunction undergoing CABG, hANP showed renal- and cardio-protective
effects and reduced post-operative complications. It also improved the
long-term prognosis. We suggest that hANP should be considered as part of
perioperative management of patients with cardiac dysfunction undergoing
cardiac surgery. (NU-HIT trial for LVD; UMIN000001652). copyright 2010
American College of Cardiology Foundation.

<6>
Accession Number
2010224503
Authors
Colmenarez H.J. Escaned J. Fernandez C. Lobo L. Cano S. del Angel J.G.
Alfonso F. Jimenez P. Banuelos C. Gonzalo N. Garcia E. Hernandez R. Macaya
C.
Institution
(Colmenarez, Escaned, Lobo, del Angel, Alfonso, Jimenez, Banuelos,
Gonzalo, Garcia, Hernandez, Macaya) Cardiovascular Institute, Hospital
Clinico San Carlos, Madrid, Spain.
(Fernandez, Cano) Preventive Medicine Unit, Hospital Clinico San Carlos,
Madrid, Spain.
Title
Efficacy and Safety of Drug-Eluting Stents in Chronic Total Coronary
Occlusion Recanalization. A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. 55(17)(pp 1854-1866),
2010. Date of Publication: 27 Apr 2010.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to compare the efficacy and safety
of drug-eluting stent (DES) and bare-metal stent (BMS) use in chronic
total occlusion (CTO) recanalization. Background: The long-term
effectiveness and safety of DES use in CTO recanalization are unclear, and
performance of randomized clinical trials in the field is complex.
Methods: Major electronic information sources were explored for articles
comparing outcomes with DES and BMS use among patients with CTO. Assessed
clinical outcomes were death, myocardial infarction, target vessel
revascularization, major adverse cardiac events, and stent thrombosis;
angiographic outcomes were stent restenosis and stent reocclusion.
Results: Fourteen comparative studies were identified (a total of 4,394
patients). When compared with BMS, DES significantly reduced risk of major
adverse cardiac events (relative risk [RR]: 0.45, 95% confidence interval
[CI]: 0.34 to 0.60, p < 0.001) and TVR (RR: 0.40, 95% CI: 0.28 to 0.58, p
< 0.001) without increasing death (RR: 0.87, 95% CI: 0.66 to 1.16, p =
0.88) or myocardial infarction (RR: 0.89, 95% CI: 0.54 to 1.46, p = 0.80).
This benefit was sustained at [greater-than or equal to]3 years of
follow-up. Lower RRs for restenosis (RR: 0.25, 95% CI: 0.16 to 0.41, p <
0.001) and stent reocclusion (RR: 0.30, 95% CI: 0.18 to 0.49, p < 0.001)
were also observed in the DES group. A strong trend toward a higher rate
of stent thrombosis was documented in DES-treated patients (RR: 2.79, 95%
CI: 0.98 to 7.97, p = 0.06). Conclusions: DES use in CTO recanalization is
associated with significantly fewer major adverse cardiac events and fewer
occurrences of target vessel revascularization, restenosis, and stent
reocclusion than with BMS. Although a statistical trend toward a higher
risk of stent thrombosis was observed, the use of DES in this context
seems to be safe, with an overall benefit sustained in the long term.
copyright 2010 American College of Cardiology Foundation.

<7>
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Accession Number
2010225950
Authors
Gullestad L. Iversen M. Mortensen S.-A. Eiskjaer H. Riise G.C. Mared L.
Bjortuft O. Ekmehag B. Jansson K. Simonsen S. Gude E. Rundqvist B.
Fagertun H.E. Solbu D. Bergh C.-H.
Institution
(Gullestad) Department of Cardiology, Oslo University Hospital, University
of Oslo, Oslo, Norway.
(Iversen) Division of Lung Transplantation, Department of Cardiology,
Rigshospitalet, Copenhagen, Denmark.
(Mortensen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
(Eiskjaer) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus, Denmark.
(Riise) Department of Respiratory Medicine, Sahlgrenska University
Hospital, Goteborg, Sweden.
(Mared) Department of Respiratory Medicine, Lund University Hospital,
Lund, Sweden.
(Bjortuft) Department of Respiratory Medicine, Oslo University Hospital,
Rikshospitalet, Oslo, Norway.
(Ekmehag) Department of Cardiology, Lund University Hospital, Lund,
Sweden.
(Jansson) Department of Cardiology, Heart Center, University Hospital,
Linkoping, Sweden.
(Simonsen, Gude) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway.
(Rundqvist, Bergh) Department of Cardiology, Sahlgrenska University
Hospital, University of Goteborg, Goteborg, Sweden.
(Fagertun) Capturo AS (Statistics) Kjeller, Norway.
(Solbu) Novartis Norge AS, Oslo, Norway.
Title
Everolimus with reduced calcineurin inhibitor in thoracic transplant
recipients with renal dysfunction: A multicenter, randomized trial.
Source
Transplantation. 89(7)(pp 864-872), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND.: The proliferation signal inhibitor everolimus offers the
potential to reduce calcineurin inhibitor (CNI) exposure and alleviate
CNI-related nephrotoxicity. Randomized trials in maintenance thoracic
transplant patients are lacking. METHODS.: In a 12-month, open-labeled,
multicenter study, maintenance thoracic transplant patients (glomerular
filtration rate [greater-than or equal to]20 mL/min/1.73m2 and <90
mL/min/1.73 m2) >1 year posttransplant were randomized to continue their
current CNI-based immunosuppression or start everolimus with predefined
CNI exposure reduction. RESULTS.: Two hundred eighty-two patients were
randomized (140 everolimus, 142 controls; 190 heart, 92 lung transplants).
From baseline to month 12, mean cyclosporine and tacrolimus trough levels
in the everolimus cohort decreased by 57% and 56%, respectively. The
primary endpoint, mean change in measured glomerular filtration rate from
baseline to month 12, was 4.6 mL/min with everolimus and-0.5 mL/min in
controls (P<0.0001). Everolimus-treated heart and lung transplant patients
in the lowest tertile for time posttransplant exhibited mean increases of
7.8 mL/min and 4.9 mL/min, respectively. Biopsy-proven treated acute
rejection occurred in six everolimus and four control heart transplant
patients (P=0.54). In total, 138 everolimus patients (98.6%) and 127
control patients (89.4%) experienced one or more adverse event (P=0.002).
Serious adverse events occurred in 66 everolimus patients (46.8%) and 44
controls (31.0%) (P=0.02). CONCLUSION.: Introduction of everolimus with
CNI reduction offers a significant improvement in renal function in
maintenance heart and lung transplant recipients. The greatest benefit is
observed in patients with a shorter time since transplantation. copyright
2010 by Lippincott Williams & Wilkins.

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Accession Number
2010225938
Authors
Tong A. Howard K. Jan S. Cass A. Rose J. Chadban S. Allen R.D. Craig J.C.
Institution
(Tong, Craig) Centre for Kidney Research, Children's Hospital at Westmead,
Sydney, NSW 2145, Australia.
(Tong, Howard, Craig) School of Public Health, Sydney Medical School,
University of Sydney, Sydney, NSW, Australia.
(Jan, Cass) Renal Division, George Institute for International Health,
Camperdown, Sydney NSW, Australia.
(Cass) Poche Centre for Indigenous Health, University of Sydney, Sydney,
NSW, Australia.
(Rose) Faculty of Economics and Business, Institute of Transport and
Logistics Studies, University of Sydney, Sydney, NSW, Australia.
(Chadban, Allen) Central Clinical School, Bosch Institute, University of
Sydney, Sydney, NSW, Australia.
(Chadban) Department of Renal Medicine, Royal Prince Alfred Hospital,
Camperdown, Sydney NSW, Australia.
Title
Community preferences for the allocation of solid organs for
transplantation: A systematic review.
Source
Transplantation. 89(7)(pp 796-805), 2010. Date of Publication: April
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND.: Organs for transplantation are a scarce community resource
but community preferences and how they are incorporated into allocation
policies are unclear. This systematic review aimed to ascertain community
preferences for organ allocation and the principles underpinning these
preferences. METHODS.: Medline, Embase, PsycINFO, EconLit, and gray
literature databases were searched. Quantitative data were extracted, and
a qualitative textual synthesis of the results and conclusions reported in
each included study was performed. RESULTS.: Fifteen studies involving
more than 5563 respondents were included. Seven themes describing
community preferences for organ allocation were identified: (1) maximum
benefit, to achieve maximum health gain in recipient survival and quality
of life; (2) social valuation, to base preferences on societal gain; (3)
moral deservingness, to consider the "worthiness" of recipients based on
their social standing and lifestyle decisions; (4) prejudice, to make a
judgement based on personal ideologic viewpoints; (5) "fair innings," to
provide an organ preferentially to the younger recipient giving
opportunity for a "normal" life span and to those waiting for a first
organ rather than a retransplant; (6) "first come, first served," to
allocate the organ to recipients wait-listed the longest; and (7) medical
urgency, to allocate based on illness severity and saving life.
CONCLUSIONS.: Community preferences for organ allocation hinge on a
complex balance of efficiency, social valuation, morality, fairness, and
equity principles. Being a community-held resource, effective ways to
identify and incorporate community preferences into allocation algorithms
for solid organ transplantation are warranted. copyright 2010 by
Lippincott Williams & Wilkins.

<9>
Accession Number
2010209518
Authors
Ussia G.P. Capodanno D. Barbanti M. Scarabelli M. Imme S. Cammalleri V.
Mule M. Pistritto A. Aruta P. Tamburino C.
Institution
(Ussia, Capodanno, Barbanti, Scarabelli, Imme, Cammalleri, Mule,
Pistritto, Aruta, Tamburino) Department of Cardiology, Ferrarotto
Hospital, University of Catania, via Citelli 6, 95124 Catania, Italy.
(Capodanno, Tamburino) ETNA Foundation, Catania, Italy.
Title
Balloon aortic valvuloplasty for severe aortic stenosis as a bridge to
high-risk transcatheter aortic valve implantation.
Source
Journal of Invasive Cardiology. 22(4)(pp 161-166), 2010. Date of
Publication: April 2010.
Publisher
HMP Communications
Abstract
OBJECTIVES: To provide data on feasibility, safety and efficacy of balloon
aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve
implantation (TAVI). Background. There are no data on BAV use as a bridge
to TAVI in patients at high risk of periprocedural complications. Methods:
Between June 2007 to May 2009, 83 consecutive patients with symptomatic
severe aortic stenosis (48 female, 35 male) aged from 65 to 88 years (mean
age 81 +/- 5 years) were treated with TAVI. Early hemodynamic and clinical
outcomes of patients undergoing palliative BAV before TAVI (BAV Group, n =
43) were compared with those of patients who directly underwent TAVI
(no-BAV Group, n = 40). Results: Patients in the BAV group had worse
baseline clinical characteristics than those in the no-BAV group, with
higher rates of congestive heart failure, New York Heart Association
(NYHA) functional class III or IV and a higher EuroSCORE. In the BAV
group, significant changes were found after valvuloplasty with regard to
NYHA functional class, mean pressure gradient and aortic valve area.
Peak-to-peak transvalvular pressure gradient and left ventricular systolic
pressure also decreased immediately after BAV. Before TAVI, no differences
in either clinical status or hemodynamic data were observed between
patients who underwent BAV and those who did not. Conclusions: Bridging to
TAVI with BAV is a feasible and reasonably safe approach to offer
temporary relief in selected high-risk patients with symptomatic severe
aortic stenosis and a high chance of periprocedural complications.

<10>
Accession Number
2010188526
Authors
Tetik S. Ak K. Isbir S. Eksioglu-Demiralp E. Arsan S. Iqbal O. Yardimci T.
Institution
(Tetik, Yardimci) Department of Biochemistry, Faculty of Pharmacy, Marmara
University, Istanbul, Turkey.
(Ak, Isbir, Arsan) Department of Cardiovascular Surgery, School of
Medicine, Marmara University, Istanbul, Turkey.
(Eksioglu-Demiralp) Department of Haematology and Immunology, School of
Medicine, Marmara University, Istanbul, Turkey.
(Iqbal) Department of Pathology, Loyola University, Medical Center,
Maywood, IL, United States.
Title
Clopidogrel provides significantly greater inhibition of platelet activity
than aspirin when combined with atorvastatin after coronary artery bypass
grafting: A prospective randomized study.
Source
Clinical and Applied Thrombosis/Hemostasis. 16(2)(pp 189-198), 2010. Date
of Publication: April 2010.
Publisher
SAGE Publications Inc.
Abstract
Objective: We aimed to compare the effects of 2 different antiplatelet
agents on platelet activity in patients receiv- ing atorvastatin after
coronary artery bypass grafting (CABG). Methods: We prospectively
randomized 50 patients undergoing CABG into 2 groups; group 1 started to
receive atorvastatin (10 mg) plus clopidogrel (75 mg; C + A, n = 25) and
group 2 atorvastatin (10 mg) and acetylsalicylic acid (ASA; 300 mg, ASA +
A, n = 25) daily on postoperative day 1 and continued for 6 months after
operation. Adenosine diphosphate (ADP)-induced pla- telet aggregation and
the expressions of glycoprotein (Gp) IIb, GpIIIa, P-selectin, and
fibrinogen (Fg) and low-density lipoprotein (LDL) binding to platelets
were assessed preoperatively and at postoperative days 7, 90, and 180.
Results: The mean age of the patients was 59.6 +/- 7.6 years, and 82% of
the patients were males. The combination of C + A markedly inhibited
ADP-induced platelet aggregation compared with ASA + A at postoperative
days 90 and 180 (52% +/- 6.0% vs 56% +/- 7.25% and 19.6% +/- 3.2% vs 37%
+/- 4.1%, P =.039 and P =.0001, respectively). The therapy of C + A
significantly suppressed the expressions of GpIIIa at postoperative days
7, 90, and 180 (P =.0001, P =.0001, and P =.0001, respectively) and
P-selectin at postoperative days 90 and 180 (P =.035 and P =.002,
respectively) when compared to ASA + A. The expression of GpIIb was also
significantly depressed at postoperative day 180 in group 1 when compared
to group 2 (P =.0001). Low-density lipoprotein binding was significantly
increased at day 180 postoperatively in both the groups (basal: 42.9% +/-
5.6% vs 45.3% +/- 4.4% and day 180: 60.3% +/- 4.6% vs 61.8% +/- 5.7%, P
=.0001). Conclusions: Our results demonstrate that the combination of C +
A is more effective than that of ASA + A in inhibiting ADP-mediated
platelet aggregation and expression of major platelet receptors after
CABG.

<11>
Accession Number
2010069527
Authors
De Arenaza D.P. Pepper J. Lees B. Rubinstein F. Nugara F. Roughton M.
Jasinski M. Bazzino O. Flather M.
Institution
(De Arenaza, Bazzino) Cardiology Department, Hospital Italiano, Buenos
Aires, Argentina.
(Pepper, Roughton, Flather) Royal Brompton and Harefield NHS Trust,
London, United Kingdom.
(Pepper, Roughton, Flather) Imperial College, London, United Kingdom.
(Lees, Nugara) Clinical Trials and Evaluation Unit, Royal Brompton and
Harefield NHS Trust, London, United Kingdom.
(Rubinstein) Family Medicine Department, Hospital Italiano, Buenos Aires,
Argentina.
(Jasinski) Medical University of Silesia, Katowice, Poland.
Title
Preoperative 6-minute walk test adds prognostic information to Euroscore
in patients undergoing aortic valve replacement.
Source
Heart. 96(2)(pp 113-117), 2010. Date of Publication: January 2010.
Publisher
BMJ Publishing Group
Abstract
Aims: The authors investigated the additive prognostic value of the
6-minute walk test (6MWT) to Euroscore in patients with severe aortic
stenosis undergoing aortic valve replacement (AVR) Methods and results:
208 patients with severe AS underwent the 6MWT before AVR, as part of a
randomised trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The
rate of death, myocardial infarction (MI) or stroke (time to first event)
was 13% (n=14) in patients walking <300 metres compared to 4% (n=4) in
those who walked [greater-than or equal to]300 metres (p=0.017). When rate
of death, MI or stroke by Euroscore risk was stratified by 6-minute
walking distance, the 6MWT added prognostic information. In a Cox
regression analysis 6MWT distance was the only variable retained as an
independent predictor of the composite outcome of death, MI or stroke at
12 months (HR 0.28 95% CI 0.09 to 0.85, p=0.025). Conclusions: The 6MWT is
safe and feasible to carry out in patients with severe aortic stenosis
before AVR, and provides potentially important functional and prognostic
information to clinical assessment and the Euroscore risk score.

<12>
[Use Link to view the full text]
Accession Number
2010065694
Authors
Gajarski R.J. Stefanelli C.B. Graziano J.N. Kaciroti N. Charpie J.R.
Vazquez D.
Institution
(Gajarski, Stefanelli, Graziano, Charpie) Department of Pediatrics,
Divisions of Cardiology,
(Vazquez) Department of Endocrinology,
(Kaciroti, Vazquez) Center for Growth and Development, University of
Michigan Health Center, Ann Arbor, MI, United States.
Title
Adrenocortical response in infants undergoing cardiac surgery with
cardiopulmonary bypass and circulatory arrest*.
Source
Pediatric Critical Care Medicine. 11(1)(pp 44-51), 2010. Date of
Publication: 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To detail changes in adrenocorticotropic hormone (ACTH),
cortisol, and aldosterone levels following cardiac surgery and to test the
hypothesis that postcardiotomy infants requiring excessively high-dose
vasopressor support will demonstrate adrenal insufficiency which will be
proportional to cardiopulmonary bypass (CPB)/circulatory arrest times and
vasopressor requirements. Design: Prospective observational pilot study.
Setting: A tertiary care pediatric cardiac intensive care unit. Patients:
Prospectively enrolled infants were divided into three subgroups: CPB, CPB
with deep hypothermic circulatory arrest (DHCA), and control subjects.
Interventions: None. Measurements and Main Results: A representative
patient sample from each surgical group underwent preoperative synthetic
ACTH testing. Postoperative serum samples for cortisol, ACTH, and inotrope
score (IS) were collected at discrete intervals over 48 hrs along with
patient demographics, surgical procedure, and CPB/DHCA times. Fifty-eight
patients were classified by subgroup: 31 CPB, 22 DHCA, and 5 controls. Ten
patients with DHCA, analyzed separately, received intraoperative steroids.
Tested patients demonstrated preoperative adrenal competence. Cortisol
peaked within 2 hrs of surgery without differences among groups. ACTH
inversely correlated with bypass time in patients with DHCA (p = .03) but
not with circulatory arrest time. Peak cortisol level did not correlate
with simultaneous IS. Although not noted in any DHCA-steroid patients,
nine patients had increased ACTH/cortisol ratios in association with
elevated ISs suggesting inadequate adrenal responsiveness to endogenous
ACTH. Conclusions: The majority of infants with congenital heart disease
and intact hypothalamic-pituitary-adrenal axes demonstrated an appropriate
adrenocortical stress response to cardiac surgery. Peak serum cortisol was
unrelated to CPB/DHCA time and did not predict the level of inotrope
support. However, a subset of patients with elevated ACTH/cortisol ratios
seemed to have a clinical status consistent with adrenal insufficiency and
may be a target group for early postoperative steroid therapy. copyright
2010 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 10

Results Generated From:
EMBASE <1980 to 2010 Week 18>
EMBASE (updates since 2010-04-29)

<1>
Accession Number
2010235977
Authors
Sadoh W.E.
Institution
(Sadoh) Paediatric Cardiology Unit, Department of Child Health, University
of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Title
Natural history of ventricular septal defects in Nigerian children.
Source
SAJCH South African Journal of Child Health. 4(1)(pp 16-19), 2010. Date
of Publication: 2010.
Publisher
Health and Medical Publishing Group
Abstract
Introduction. Ventricular septal defect (VSD) is a common congenital heart
disease (CHD). Spontaneous closure of the VSD may occur, depending on the
type and size of defects. This study was conducted to determine the
natural history of VSD in a group of Nigerian children. Subjects and
methods. Sixty-one children diagnosed with VSD were prospectively studied
at a tertiary centre in Nigeria until they were 2 years old. They had
regular two-dimensional (2D) and Doppler echocardiography evaluations for
the VSD size and closure. Results. Most (35 - 57.4%) of the patients were
female, their mean age at presentation was 11.2+/-5.2 months, and the most
common type of VSD was the perimembranous (39 - 63.9%). Almost half (28 -
45.9%) of the patients had spontaneous closure. The spontaneous closure
rate was highest in muscular VSD (82.4%) and in small defects (95.0%).
Incidental presence of a murmur, absence of heart failure and
bronchopneumonia were good clinical predictors of closure. Only 3 (4.9%)
patients had surgery abroad. There were 2 (3.3%) deaths from
bronchopneumonia and bacterial endocarditis. Conclusion. Spontaneous
closure readily occurs in small-sized defects and muscular VSDs. However,
most patients with moderate to large VSDs are confined to long-term
medical management, highlighting the need for indigenous surgical capacity
in Nigeria.

<2>
Accession Number
0020231678
Authors
Pisters K.M. Vallieres E. Crowley J.J. Franklin W.A. Bunn Jr. P.A.
Ginsberg R.J. Putnam Jr. J.B. Chansky K. Gandara D.
Institution
(Pisters, Vallieres, Crowley, Franklin, Bunn Jr., Ginsberg, Putnam Jr.,
Chansky, Gandara) The University of Texas M. D. Anderson Cancer Center, PO
Box 301402, Unit 432, Houston, TX 77230-1402, USA.
Title
Surgery with or without preoperative paclitaxel and carboplatin in
early-stage non-small-cell lung cancer: Southwest Oncology Group Trial
S9900, an intergroup, randomized, phase III trial..
Source
Journal of clinical oncology : official journal of the American Society of
Clinical Oncology. 28(11)(pp 1843-1849), 2010. Date of Publication: 10
Apr 2010.
Abstract
PURPOSE Patients with early-stage non-small-cell lung cancer (NSCLC) have
a poor prognosis even after complete resection. Earlier studies of
preoperative (induction) chemotherapy in resectable NSCLC demonstrated
feasibility and encouraging survival data. This randomized phase III trial
compared overall survival (OS) for preoperative paclitaxel and carboplatin
followed by surgery with surgery alone in patients with early-stage NSCLC.
PATIENTS AND METHODS Patients with clinical stage IB-IIIA NSCLC (excluding
superior sulcus tumors and N2 disease) were eligible. Patients were
randomly assigned to surgery alone or to three cycles of paclitaxel (225
mg/m(2)) and carboplatin (area under curve, 6) followed by surgical
resection. The primary end point was OS; secondary end points were
progression-free survival (PFS), chemotherapy response, and toxicity.
RESULTS The trial closed early with 354 patients after reports of a
survival benefit for postoperative chemotherapy in other studies. The
median OS was 41 months in the surgery-only arm and 62 months in the
preoperative chemotherapy arm (hazard ratio, 0.79; 95% CI, 0.60 to 1.06; P
= .11.) The median PFS was 20 months for surgery alone and 33 months for
preoperative chemotherapy (hazard ratio, 0.80; 95% CI, 0.61 to 1.04; P =
.10.) Major response to chemotherapy was seen in 41% of patients; no
unexpected toxicity was observed. CONCLUSION This trial closed prematurely
after compelling evidence supporting postoperative chemotherapy emerged.
Although OS and PFS were higher with preoperative chemotherapy, the
differences did not reach statistical significance. At present, stronger
evidence exists for postoperative chemotherapy in early-stage NSCLC.

<3>
Accession Number
0020387748
Authors
Akbarzadeh F. Kazemi-Arbat B. Golmohammadi A. Pourafkari L.
Institution
(Akbarzadeh, Kazemi-Arbat, Golmohammadi, Pourafkari) Department of
Cardiology, Shahid Madani Cardiovascular Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of.
Title
Biatrial pacing vs. intravenous amiodarone in prevention of atrial
fibrillation after coronary artery bypass surgery.
Source
Pakistan Journal of Biological Sciences. 12(19)(pp 1325-1329), 2009. Date
of Publication: 2009.
Publisher
Asian Network for Scientific Information
Abstract
This study was aimed to compare the results of post operative biatrial
pacing and IV amiodarone in prevention of AF. In a single blind randomized
clinical trial, 210 patients scheduled for elective CABG surgery were
randomized either to receive overdrive biatrial pacing, IV amiodarone or
no intervention. Incidence of AF postoperatively evaluated. Pacing was
successful in 83% of patients and 80% of patients in amiodarone group
could receive their drug. Twenty and one patients developed AF. Incidence
of AF in pace, amiodarone and control group was 10.7, 5.3 and 17.9%,
respectively (p = 0.08). Comparing incidence of AF between pacing and
control group, the difference was not significant (p = 0.2), but the
difference between amiodarone and control groups was significant
statistically (p = 0.03). Patients who developed AF were older but their
left ventricular ejection fraction was not different with patients without
AF. The ICU stay was higher in patients with AF. Use of IV amiodarone was
more effective than biatrial pacing in prevention of post operative AF and
we recommend use of this drug in high risk patients. copyright 2009 Asian
Network for Scientific Information.

<4>
Accession Number
2010069638
Authors
Brown J.R. Toler A.W.J. Kramer R.S. Clive Landis R.
Institution
(Brown, Toler) Dartmouth Institute for Health Policy and Clinical
Practice, Dartmouth Medical School, Lebanon, NH, United States.
(Kramer) Division of Cardiothoracic Surgery, Maine Medical Center,
Portland, ME, United States.
(Clive Landis) Edmund Cohen Laboratory for Vascular Research, University
of the West Indies, Barbados.
Title
Anti-inflammatory effect of aprotinin: A meta-analysis.
Source
Journal of Extra-Corporeal Technology. 41(2)(pp 79-86), 2009. Date of
Publication: June 2009.
Publisher
American Society of Extra-Corporeal Technology
Abstract
It is important to define the extent, and any limitations, of potential
anti-inflammatory regimens used in cardiac surgery to guide the rational
combination of drugs to suppress the systemic inflammatory response.
Aprotinin (Trasylol) is an anti-fibrinolytic agent with reported
anti-inflammatory properties. In this study, we investigated the published
data on aprotinin's effect on acute phase protein and cytokine levels in
cardiac surgery patients. Randomized placebo-controlled trials of
aprotinin published between 1985 and 2007, in adult cardiac surgery using
cardiopulmonary bypass, reporting tumor necrosis factor-alpha (TNF-alpha),
interleukin-6 (IL-6), IL-8, and IL-10 levels were included for review. Two
independent reviewers graded each paper and collected information on
inflammatory markers. RevMan 4.3 statistical software was used to
calculate and plot the weighted mean difference between placebo and
aprotinin groups. Thirteen studies met the review criteria. None of the
inflammatory markers were reduced by high-dose aprotinin treatment.
Low-dose aprotinin significantly reduced IL-10 levels after protamine
administration (?41.3 pg/ mL; 95% CI: ?59.5, ?23.1), but this result was
gone by the first post-operative day. These meta-analyses showed no
significant effect of aprotinin on acute phase proteins or systemic
cytokine markers of inflammation during clinical adult cardiac surgery
using cardiopulmonary bypass. While recognizing that other host defense
systems, such as coagulation and complement, contribute to the overall
systemic inflammatory response, the evidence presented here does not
support the clinical use of aprotinin as an anti-inflammatory agent on its
own.

<5>
Accession Number
2010065040
Authors
Neyt M. Vinck I. Gewillig M. Van Brabandt H.
Institution
(Neyt, Vinck, Van Brabandt) BelgianHealth Care Knowledge Centre,
Kruidtuinlaan 55, 1000 Brussels, Belgium.
(Gewillig) Department of Paediatric Cardiology, University Hospital
Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Title
Percutaneous pulmonary and aortic valve insertion in Belgium: Going for
conditional reimbursement or waiting for further evidence?.
Source
International Journal of Technology Assessment in Health Care. 25(3)(pp
281-289), 2009. Date of Publication: July 2009.
Publisher
Cambridge University Press
Abstract
Objectives: The aim of this study was to assess current evidence
supporting the use of percutaneous heart valves (PHV) in degenerative
aortic valve and congenital pulmonary outflow tract disease, as compared
to conservative medical therapy or traditional surgical valve replacement.
Methods: A systematic review of the literature on PHV was performed.
Results: No randomized controlled trials (RCT) on PHV have been published
so far. Only observational data from series and data presented at
cardiology meetings are available. Both percutaneous aortic valve (PAV)
and percutaneous pulmonary valve (PPV) seem feasible in the hands of an
experienced team. Safety, however, seems to be a problem in PAV, as shown
by the high 30-day and 6-month mortality rates. Conclusions: Due to safety
concerns, PAV reimbursement is not recommended and patients should only be
subjected to PAV insertion within the boundaries of an RCT. In contrast,
PPV implantation seems to be a safe and promising technology for which
reimbursement under strict conditions may be recommended. copyright 2009
Cambridge University Press.

<6>
Accession Number
2010191781
Authors
Axelsson B. Arbeus M. Magnuson A. Hultman J.
Institution
(Axelsson, Arbeus) Department of Cardiothoracic Surgery and
Anesthesiology, Orebro University Hospital, Orebro, Sweden.
(Magnuson) Statistical and Epidemiological Unit, Orebro University
Hospital, Orebro, Sweden.
(Hultman) Thoracic Clinic, Karolinska University Hospital, Stockholm,
Sweden.
Title
Milrinone Improves Diastolic Function in Coronary Artery Bypass Surgery as
Assessed by Acoustic Quantification and Peak Filling Rate: A Prospective
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 244-249),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of a bolus dose of milrinone, 50 mug/kg,
to placebo on diastolic function (active relaxation) in patients
undergoing on-pump coronary artery bypass grafting (CABG). Design:
Prospective, randomized, double-blind, placebo-controlled study. Setting:
University hospital. Participants: Twenty-four patients with stable angina
and left ventricular ejection fraction >30%, scheduled for elective CABG
using cardiopulmonary bypass (CPB), were included. Intervention: Patients
were randomized to receive either 50 mug/kg of milrinone (n = 12) or
placebo (n = 12) after aortic declamping. Measurements and Main Results:
The diastolic function of the left ventricle (LV) was measured as peak
filling rate (dA/dt [maximal diastolic area change over time]) with
transesophageal echocardiography (TEE) using acoustic quantification (AQ)
before CPB and 10 minutes after termination of CPB. The normalized peak
filling rate (dA/dt)/EDA was also calculated. Active relaxation was
statistically significantly increased in the milrinone group compared with
the placebo group after CPB. Conclusion: Patients undergoing CABG surgery
and treated with milrinone after aortic declamping had better diastolic
function following cardiopulmonary bypass. copyright 2010 Elsevier Inc.
All rights reserved.

<7>
Accession Number
2010191777
Authors
Hasija S. Makhija N. Choudhury M. Hote M. Chauhan S. Kiran U.
Institution
(Hasija, Makhija, Choudhury, Chauhan, Kiran) Department of Cardiac
Anaesthesia, Cardiothoracic Centre, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India.
(Hote) Department of Cardiothoracic and Vascular Surgery, Cardiothoracic
Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi,
India.
Title
Prophylactic Vasopressin in Patients Receiving the Angiotensin-Converting
Enzyme Inhibitor Ramipril Undergoing Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 230-238),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to compare the effects of
continuation versus discontinuation of the angiotensin-converting enzyme
(ACE) inhibitor ramipril and assess the efficacy of prophylactic
vasopressin infusion on hemodynamic stability and vasoactive drug
requirements in patients undergoing coronary artery bypass graft (CABG)
surgery. Design: A prospective, randomized, double-blinded, single-center
clinical study. Setting: Tertiary care hospital. Participants: Forty-seven
patients on the ACE inhibitor ramipril for 6 weeks before undergoing
elective primary CABG surgery on cardiopulmonary bypass (CPB).
Interventions: Patients were randomly divided into 3 groups: group A (n =
16), patients discontinued ramipril 24 hours before surgery; group B (n =
16), patients continued ramipril until the morning of surgery; and group C
(n = 15), patients continued ramipril until the morning of surgery and
received vasopressin infusion (0.03 U/min) from the onset of rewarming
until the hemodynamics were stable without vasopressor agents. The
anesthetic technique and conduct of CPB were standardized for all the
groups. Hemodynamic parameters and vasoactive drug requirements were
recorded for 3 days postoperatively. Measurements and Main Results:
Patients in group A maintained stable mean arterial pressure (MAP) and
systemic vascular resistance (SVR). In group B, MAP and SVR decreased
after the induction of anesthesia and remained so throughout surgery (p <
0.05). In group C, MAP and SVR decreased upon the induction of anesthesia
(p < 0.05) but normalized after CPB. Conclusions: Preoperative ACE
inhibitor continuation predisposed to hypotension upon the induction of
anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin
infusion prevented post-CPB hypotension. Low-dose vasopressin can be
considered as potential therapy in these patients. copyright 2010 Elsevier
Inc. All rights reserved.

<8>
Accession Number
2010065029
Authors
Quenneville S.P. Xie X. Brophy J.M.
Institution
(Quenneville, Xie, Brophy) Technology Assessment Unit, Royal Victoria
Hospital, McGill University, 687 Pine Avenue West, R4.14, Montreal, QC H3A
1A1, Canada.
(Brophy) Department of Medicine and Epidemiology (McGill), McGill
University, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.12,
Montreal, QC H3A 1A1, Canada.
Title
The cost-effectiveness of Maze procedures using ablation techniques at the
time of mitral valve surgery.
Source
International Journal of Technology Assessment in Health Care. 25(4)(pp
485-496), 2009. Date of Publication: October 2009.
Publisher
Cambridge University Press
Abstract
Background: The classic cut and sew surgical Maze procedure has been shown
to reduce atrial fibrillation (AF), and recently newer surgical ablation
techniques with reduced technical complexity have been introduced. This
study sought to systematically review the efficacy and safety of these
newer techniques and to evaluate their long-term cost-effectiveness at the
time of scheduled mitral valve (MV) surgery. Methods: A systematic
literature search and meta-analysis was performed to generate the most
reliable efficacy and safety parameter estimates for a Markov decision
analysis model comparing MV surgery alone to MV surgery plus an ablation
Maze procedure. Both basic and probabilistic sensitivity analyses were
conducted. Results: Based on the six randomized controlled trials (RCTs)
identified, the pooled 1-year estimate of AF after surgery alone was 71
percent (95 percent confidence interval [CI], 64 percent to 78 percent).
The pooled risk ratio of AF after surgical ablation treatment at the time
of mitral valve surgery relative to valve surgery alone was 0.33 (95
percent CI, 0.19 to 0.55). The pooled analyses showed that no statistical
significant increases in operative mortality, permanent pacemaker
implantation, and postoperative bleeding with the ablative Maze
procedures. An ablation-based Maze procedure at the time of mitral valve
surgery had an incremental cost-effectiveness ratio (ICER) of $4,446CAD
($3,850US) per quality-adjusted life-year (QALY) compared with valve
surgery alone. Specifically costs were an extra $900CAD but with improved
clinical outcomes (0.20 QALYs), including a prolonged life expectancy of
0.10 life-years. In one-way sensitivity analyses, survival time after MV
surgery had the largest impact on ICER. Other variables influencing the
ICER included the risk ratio of AF, utility, and cost estimates.
Probabilistic sensitivity analysis suggests that 58.1 percent, 73.9
percent, and 89.3 percent of the simulations of the Maze strategy are
cost-effective at willingness to pay thresholds of $20,000, $50,000, and
$100,000CAD per QALY gained, respectively. Conclusions: Our meta-analysis
suggests that a Maze surgical ablation procedure at the time of MV surgery
is associated with a reduced postoperative AF risk. Our economic model
further suggests that the surgical ablation strategy at the time of mitral
valve surgery is likely a cost-effective intervention, provided patients
have a good long-term postsurgical prognosis. copyright 2009 Cambridge
University Press.

<9>
Accession Number
2010192128
Authors
Landoni G. Turi S. Biondi-Zoccai G. Bignami E. Testa V. Belloni I. Cornero
G. Zangrillo A.
Institution
(Landoni, Turi, Bignami, Testa, Belloni, Cornero, Zangrillo) Department of
Anesthesia and Intensive Care, Universita Vita-Salute San Raffaele, Milan,
Italy.
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy.
Title
Esmolol Reduces Perioperative Ischemia in Noncardiac Surgery: A
Meta-analysis of Randomized Controlled Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 219-229),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: Literature increasingly has suggested how beta-blockers could
be associated with reductions of mortality and morbidity in noncardiac
surgery. Recently, the POISE trial showed that beta-blockers could be
harmful in the perioperative period. The authors performed a meta-analysis
to evaluate the clinical effects of esmolol in noncardiac surgery. Design:
Meta-analysis. Setting: Hospitals. Participants: A total of 1765 patients
from 32 randomized trials. Interventions: None. Measurements and Main
Results: Three investigators independently searched BioMedCentral and
PubMed. Inclusion criteria were random allocation to treatment and
comparison of esmolol versus placebo, other drugs, or standard of care in
noncardiac surgery. Exclusion criteria were duplicate publications,
nonhuman experimental studies, and no data on clinical outcomes. The use
of esmolol was associated with a significant reduction of myocardial
ischemia episodes (5/283 [1.76%] in the esmolol group v 16/265 [6.03%] in
the control arm, odds ratio [OR] = 0.16 [0.05-0.54], p = 0.003). The
authors did not observe significant differences regarding episodes of
arrhythmias (8/236 [3.38%] v 22/309 [7.11%], OR = 0.52 [0.23-1.18], p =
0.12) and in the incidence of myocardial infarction (0/148 [0%] v 1/169
[0.59%], OR = 0.23 [0.01-6.09], p = 0.38). Esmolol-treated patients did
not experience more episodes of hypotension (17/384 [4.42%] v 38/439
[8.65%], OR = 0.41 [0.22-0.79], p = 0.17) and bradycardia (25/342 [7.30%]
v 17/406 [4.18%], OR = 1.42 [0.74-2.74], p = 0.42). Conclusions: Esmolol
seemed to reduce the incidence of myocardial ischemia in noncardiac
surgery without increasing the episodes of hypotension and bradycardia.
Large randomized trials are necessary to confirm these promising results.
copyright 2010 Elsevier Inc. All rights reserved.

<10>
Accession Number
2010166060
Authors
Rutter M.K. Nesto R.W.
Institution
(Rutter) Cardiovascular Research Group, School of Clinical and Laboratory
Sciences, University of Manchester, Manchester, United Kingdom.
(Rutter) Manchester Diabetes Centre, Manchester Academic Health Science
Centre, Manchester NIHR Biomedical Research Centre, Manchester, United
Kingdom.
(Nesto) Lahey Clinic, Burlington, United States.
(Nesto) Tufts Medical School, MA, United States.
(Rutter) Cardiovascular Research Group, Core Technology Facility, 46
Grafton Street, Manchester M13 9NT, United Kingdom.
Title
The BARI 2D study: A randomised trial of therapies for type 2 diabetes and
coronary artery disease.
Source
Diabetes and Vascular Disease Research. 7(1)(pp 69-72), 2010. Date of
Publication: 2010.
Publisher
SAGE Publications Ltd
Abstract
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI
2D) trial randomized 2368 patients with type 2 diabetes (T2DM) and
coronary artery disease to either prompt revascularization or intensive
medical therapy alone; and to either insulin-sensitization or
insulin-provision diabetes therapy. Randomization was stratified by
proposed revascularization method. Five-year survival and major
cardiovascular events (MACE) were similar in study subgroups except in the
coronary bypass surgery (CABG) stratum where there were fewer MACE after
revascularization. There was less hypoglycaemia and weight gain, and
greater apparent benefit from CABG in the insulin sensitization group.
BARI 2D has provided important data for clinicians. copyright The
Author(s) 2010.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 21

Results Generated From:
EMBASE <1980 to 2010 Week 17>
EMBASE (updates since 2010-04-22)

<1>
Accession Number
0020238333
Authors
Hoenig M.R. Aroney C.N. Scott I.A.
Institution
(Hoenig, Aroney, Scott) Royal Brisbane and Women's Hospital, Herston,
Brisbane, Australia, 4029.
Title
Early invasive versus conservative strategies for unstable angina and
non-ST elevation myocardial infarction in the stent era..
Source
Cochrane database of systematic reviews (Online). 3(pp CD004815), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: In patients with unstable angina and non-ST elevation
myocardial infarction (UA/NSTEMI) two strategies are possible, either a
routine invasive strategy where all patients undergo coronary angiography
shortly after admission and, if indicated, coronary revascularization; or
a conservative strategy where medical therapy alone is used initially,
with selection of patients for angiography based on clinical symptoms or
investigational evidence of persistent myocardial ischemia. OBJECTIVES: To
determine the benefits of an invasive compared to conservative strategy
for treating UA/NSTEMI in the stent era. SEARCH STRATEGY: The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library
2008, Issue 1), MEDLINE and EMBASE were searched (1996 to February 2008)
with no language restrictions. SELECTION CRITERIA: Included studies were
prospective trials comparing invasive with conservative strategies in
UA/NSTEMI. DATA COLLECTION AND ANALYSIS: We identified five studies (7818
participants). Using intention-to-treat analysis with random-effects
models, summary estimates of relative risk (RR) with 95% confidence
interval (CI) were determined for primary end-points of all-cause death,
fatal and non-fatal myocardial infarction, all-cause death or non-fatal
myocardial infarction, and refractory angina. Further analysis of included
studies was undertaken based on whether glycoprotein IIb/IIIa receptor
antagonists were used routinely. Heterogeneity was assessed using Chi(2)
and variance (I(2) statistic) methods. MAIN RESULTS: In the all-study
analysis, mortality during initial hospitalization showed a trend to
hazard with an invasive strategy (RR 1.59, 95% CI 0.96 to 2.64). The
invasive strategy did not reduce death on longer-term follow up.
Myocardial infarction rates assessed at 6 to 12 months (5 trials) and 3 to
5 years (3 trials) were significantly decreased by an invasive strategy
(RR 0.73, 95% CI 0.62 to 0.86; and RR 0.78, 95% CI 0.67 to 0.92
respectively). The incidence of early (< 4 month) and intermediate (6 to
12 month) refractory angina were both significantly decreased by an
invasive strategy (RR 0.47, 95% CI 0.32 to 0.68; and RR 0.67, 95% CI 0.55
to 0.83 respectively), as were early and intermediate rehospitalization
rates (RR 0.60, 95% CI 0.41to 0.88; and RR 0.67, 95% CI 0.61 to 0.74
respectively). The invasive strategy was associated with a two-fold
increase in the RR of peri-procedural myocardial infarction (as variably
defined) and a 1.7-fold increase in the RR of (minor) bleeding with no
hazard of stroke. AUTHORS' CONCLUSIONS: Compared to a conservative
strategy for UA/NSTEMI, an invasive strategy is associated with reduced
rates of refractory angina and rehospitalization in the shorter term and
myocardial infarction in the longer term. However, the invasive strategy
is associated with a doubled risk of procedure-related heart attack and
increased risk of bleeding and procedural biomarker leaks. Available data
suggest that an invasive strategy may be particularly useful in those at
high risk for recurrent events.

<2>
Accession Number
0020238316
Authors
Carless P.A. Henry D.A. Moxey A.J. O'Connell D. Brown T. Fergusson D.A.
Institution
(Carless, Henry, Moxey, O'Connell, Brown, Fergusson) Discipline of
Clinical Pharmacology, Faculty of Health, University of Newcastle, Level
5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street,
Waratah, Newcastle, New South Wales, Australia, 2298.
Title
Cell salvage for minimising perioperative allogeneic blood transfusion..
Source
Cochrane database of systematic reviews (Online). 3(pp CD001888), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Concerns regarding the safety of transfused blood, have
prompted reconsideration of the use of allogeneic (blood from an unrelated
donor) red blood cell (RBC) transfusion, and a range of techniques to
minimise transfusion requirements. OBJECTIVES: To examine the evidence for
the efficacy of cell salvage in reducing allogeneic blood transfusion and
the evidence for any effect on clinical outcomes. SEARCH STRATEGY: We
identified studies by searching CENTRAL (The Cochrane Library 2009, Issue
2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the Internet
(to August 2009) and bibliographies of published articles. SELECTION
CRITERIA: Randomised controlled trials with a concurrent control group in
which adult patients, scheduled for non-urgent surgery, were randomised to
cell salvage (autotransfusion), or to a control group, who did not receive
the intervention. DATA COLLECTION AND ANALYSIS: Data were independently
extracted and the risk of bias assessed. Relative risks (RR) and weighted
mean differences (WMD) with 95% confidence intervals (CIs) were
calculated. Data were pooled using a random effects model. The primary
outcomes were the number of patients exposed to allogeneic red cell
transfusion, and the amount of blood transfused. Other clinical outcomes
are detailed in the review. MAIN RESULTS: A total of 75 trials were
included. Overall, the use of cell salvage reduced the rate of exposure to
allogeneic RBC transfusion by a relative 38% (RR=0.62: 95% CI 0.55 to
0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC
transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR
of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to
0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage
resulted in an average saving of 0.68 units of allogeneic RBC per patient
(WMD=-0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact
adversely on clinical outcomes. AUTHORS' CONCLUSIONS: The results suggest
cell salvage is efficacious in reducing the need for allogeneic red cell
transfusion in adult elective cardiac and orthopaedic surgery. The use of
cell salvage did not appear to impact adversely on clinical outcomes.
However, the methodological quality of trials was poor. As the trials were
unblinded and lacked adequate concealment of treatment allocation,
transfusion practices may have been influenced by knowledge of the
patients' treatment status potentially biasing the results in favour of
cell salvage.

<3>
Accession Number
2010207022
Authors
Serebruany V.L. Atar D.
Institution
(Serebruany) HeartDrugTM Research Laboratories, Johns Hopkins University,
Towson, MD 21204, United States.
(Atar) Division of Cardiology, Oslo University Hospital Aker, Faculty of
Medicine, Norway.
Title
The PLATO trial: Do you believe in magic?.
Source
European Heart Journal. 31(7)(pp 764-767), 2010. Date of Publication:
April 2010.
Publisher
Oxford University Press
Abstract
The recently published and presented PLATelet Inhibition and Clinical
Outcomes (PLATO) trial was a pivotal Phase III, randomized, double-blind,
parallel-group, multinational, clinical study.1 The trial compared
head-to-head the efficacy of the experimental antiplatelet agent
ticagrelor (formerly known as AZD6140, to be marketed as Brilintaw) vs.
standard care with clopidogrel. Patients (n = 18 624) with moderate to
high risk acute coronary syndromes undergoing coronary intervention were
randomized to ticagrelor 180 mg loading dose followed by 90 mg twice daily
thereafter, or clopidogrel 300-600 mg loading dose followed by 75 mg once
daily for 6-12 months. The primary endpoint was the time of the first
event of death from vascular causes, myocardial infarction (MI), or
stroke, and occurred in 11.7% of patients treated with clopidogrel vs.
9.8% of patients randomized to ticagrelor, representing a highly
significant benefit [hazard ratio (HR)=0.84; confidence interval (CI)
=0.77-0.92; P<0.001] of the experimental drug.1 Triaging these three
components of the combined endpoint suggests that the difference in favour
of ticagrelor was driven by the reduction of vascular death (P<0.001) and
MI (P<0.005), but not stroke (P=0.22). There were significantly more fatal
intracranial bleedings (11 vs. 1, P=0.02), but numerically less overall
fatal bleeding (20 vs. 23) after ticagrelor. Among side effects associated
with ticagrelor, dyspnoea (already recognized in the earlier studies with
AZD6140, and probably caused by transitory bronchoconstriction) was the
most prominent one (HR=1.84; CI=1.68-2.02; P<0.001), followed by
ventricular pauses (P,0.01), and laboratory findings of increased uric
acid as well as elevated creatinine (P<0.001 for both). Obviously the
PLATO data will undergo detailed scrutiny and verification during the
assessment by regulatory authorities; however, some considerations already
seem appropriate.

<4>
Accession Number
2010207978
Authors
Conte J.
Institution
(Conte) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, MD, United States.
Title
An indictment of the STICH trial: "True, true, and unrelated".
Source
Journal of Heart and Lung Transplantation. 29(5)(pp 491-496), 2010. Date
of Publication: May 2010.
Publisher
Elsevier USA

<5>
Accession Number
2010222827
Authors
Weir R.A.P. Murphy C.A. Petrie C.J. Martin T.N. Clements S. Steedman T.
Wagner G.S. McMurray J.J.V. Dargie H.J.
Institution
(Weir, Murphy, Petrie, Martin, Clements, Steedman, McMurray, Dargie)
Cardiology Department, Western Infirmary, Glasgow G11 6NT, Scotland,
United Kingdom.
(Wagner) Duke University Medical Center, Durham, NC, United States.
Title
Monocyte chemoattractant protein-1: A dichotomous role in cardiac
remodeling following acute myocardial infarction in man?.
Source
Cytokine. 50(2)(pp 158-162), 2010. Date of Publication: May 2010.
Publisher
Academic Press
Abstract
Introduction: Monocyte chemoattractant protein-1 (MCP-1) is elevated after
acute myocardial infarction (AMI), and potentiates left ventricular (LV)
remodeling in murine models of AMI. We examined the relationships between
serum MCP-1, change in LV function and biomarkers related to remodeling in
a cohort of AMI patients. Methods: Serum MCP-1 concentrations were
measured in 100 patients (age 58.9 +/- 12.0. years, 77% male) admitted
with AMI and LV dysfunction, at baseline (mean 46. h), 12 and 24. weeks;
cardiac magnetic resonance imaging and measurement of matrix
metalloproteinase-2 (MMP-2), MMP-3 and MMP-9 occurred at each time-point.
Results: MCP-1 increased significantly from 697 [483, 997]. pg/mL at
baseline to 878 [678, 1130]. pg/mL at 24. weeks (p<0.001). MMP-3
concentration increased while MMP-9 decreased significantly over time;
MMP-2 concentration did not change significantly. Baseline MCP-1
correlated with change in (Delta) LV end-systolic volume index
(DeltaLVESVI; r=-0.48, p=0.01) and with DeltaLV ejection fraction
(DeltaLVEF; r=0.50, p=0.02). However, DeltaMCP-1 correlated positively
with DeltaLVESVI (r=0.40, p=0.006) and negatively with DeltaLVEF (r=-0.36,
p=0.004). MCP-1 had no relationship with any MMP. Conclusions: MCP-1 may
have a dichotomous role following AMI, aiding early infarct healing but
potentiating later remodeling, which merits further study before any
therapeutic trials of MCP-1 modulation in humans. copyright 2010 Elsevier
Ltd.

<6>
Accession Number
2010217444
Authors
van de Gevel D.F.D. Soliman Hamad M.A. Elenbaas T.W.O. Ostertag J.U.
Schonberger J.P.A.M.
Institution
(van de Gevel, Soliman Hamad, Elenbaas, Schonberger) Department of
Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, Michelangelolaan
2, 5623 EJ Eindhoven, Netherlands.
(Ostertag) Department of Dermatology, Catharina Hospital, Eindhoven,
Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands.
Title
Is the use of Steri-Strip[trademark] S for wound closure after coronary
artery bypass grafting better than intracuticular suture?.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 561-564), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Several methods have been used in wound closure after coronary artery
bypass grafting (CABG). In this study, the safety and efficacy of one of
these methods, Steri-Strip[trademark] S is compared with the traditional
intracuticular suture method. Eighty-one patients undergoing CABG were
prospectively randomized into two groups according to the method of skin
closure: Steri-Strip[trademark] S group and traditional suture group.
Comparison between the two methods was done with regards to the length of
the wound and the time needed to close it. The median closure time with
Steri-Strip[trademark] S was 5.45+/-3.35 min vs. 7.53+/-3.41 min in the
suture group. A pain score of [greater-than or equal to]6 at the first
postoperative day was found in 30% of the patients in the suture group vs.
14% of the patients in the Steri-Strip[trademark] S group (P=0.07).
Cosmetic evaluation showed a non-significant difference in the linear
visual analogue score in favor of Steri-Strip[trademark] S group compared
to the intracuticular suture group (73.1 vs. 70.1) (P=0.07).
Steri-Strip[trademark] S is a fast, safe alternative for wound closure of
the sternotomy incision and graft harvesting site. A larger study is
needed to establish the potential beneficial effect of
Steri-Strip[trademark] S on wound infection prevention. copyright 2010
Published by European Association for Cardio-thoracic Surgery.

<7>
Accession Number
2010217433
Authors
Hoffmann M. Bruch H.-P. Kujath P. Limmer S.
Institution
(Hoffmann, Bruch, Kujath, Limmer) Surgical Clinic, University Clinic
Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck,
Germany.
Title
Cold-plasma coagulation in the treatment of malignant pleural
mesothelioma: Results of a combined approach.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 502-505), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Malignant pleural mesothelioma is on a continuous rise throughout the
Western countries. It is associated with asbestos fibre exposition in the
past. Surgical approaches include extrapleural pneumonectomy and
pleurectomy/decortication (PyD). We investigated the feasability of the
implementation of cold-plasma coagulation (CPC) on the pleura, pericardium
and diaphragm into an established therapeutic algorithm consisting of PyD
and hyperthermic intrathoracal chemoperfusion (HITHOC) therapy. The
underlying rationale was the prevention of cardiotoxic effects during
HITHOC as well as accidental translocation of malignant cells to the
abdomen. CPC was done as part of a multimodal therapy in stage III
mesothelioma patients. Histologic examinations of pleural excisates after
CPC were done. The patients were followed up in three-month intervals.
Neither parenchymal fistulas, nor cardiotoxic effects were observed. The
histologic examination of the pleural excisates showed complete
predictable necrosis. Moreover, until now (median time after operation 1
year) no relapse of the disease was observed. CPC proved to be a safe
technique when used on the pleura, pericardium and diaphragm. We consider
our trial as a pilot-study. To evaluate potential survival benefits using
this technique larger trials are mandatory. copyright 2010 Published by
European Association for Cardio-Thoracic Surgery.

<8>
Accession Number
2010217102
Authors
Crowe E. Lovibond K. Gray H. Henderson R. Krause T. Camm J.
Institution
(Crowe, Lovibond, Krause) National Clinical Guideline Centre, Royal
College of Physicians of London, London NW1 4LE, United Kingdom.
(Gray) Southampton University Hospital, Southampton SO16 6YD, United
Kingdom.
(Henderson) Nottingham University Hospitals, Nottingham NG5 1PB, United
Kingdom.
(Camm) St. George's, University of London, London SW17 0RE, United
Kingdom.
Title
Early management of unstable angina and non-ST segment elevation
myocardial infarction: Summary of NICE guidance.
Source
BMJ. 340(7750)(pp 805-807), 2010. Date of Publication: 10 Apr 2010.
Publisher
BMJ Publishing Group

<9>
Accession Number
2010211230
Authors
Chong E. Poh K.K. Liang S. Lee R.C.-H. Low A. Teo S.-G. Tan H.C.
Institution
(Chong) Cardiac Department, Alexandra Hospital, National University,
Singapore.
(Poh, Lee, Low, Teo, Tan) National University, Heart Center, National
University Hospital, Singapore.
(Poh, Lee, Low, Teo, Tan) Yong Loo Lin School of Medicine, National
University of Singapore, Singapore.
(Liang) Biostatistics Unit, National University of Singapore, Yong Loo Lin
School of Medicine, Singapore.
Title
Two-year clinical registry follow-up of endothelial progenitor cell
capture stent versus sirolimus-eluting bioabsorbable polymer-coated stent
versus bare metal stents in patients undergoing primary percutaneous
coronary intervention for ST elevation myocardial infarction: ACUTE
CORONARY SYNDROME.
Source
Journal of Interventional Cardiology. 23(2)(pp 101-108), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Endothelial progenitor cell (EPC) capture stent is designed to
promote rapid endothelization and healing and is potentially useful in
patients undergoing primary percutaneous coronary intervention (PCI) for
acute myocardial infarction (AMI). We studied the intermediate-term
efficacy and safety of EPC stent and compared that with sirolimus-eluting
bioabsorbable polymer stent (CURA) and bare metal stent (BMS) in AMI
patients. Methodology: Patients presenting with AMI who underwent primary
PCI with the respective stents between January 2004 and June 2006 were
enrolled in the single-center clinical registry. The study end-points were
major adverse cardiac events (MACE) and stent thrombosis. Results: A total
of 366 patients (EPC = 95, CURA = 53, BMS 218) were enrolled. Baseline
demographics including age, gender, diabetes, renal impairment,
predischarge left ventricular ejection fraction, and creatinine kinase
level were comparable among the groups. Procedural success rate was 99.5%.
Post-procedural thrombolysis in myocardial infarction (TIMI) 3 flow was
achieved in EPC 91.6%, CURA 96.2%, and BMS 88.5% (P = 0.209). At 2 years,
the MACE rate was EPC 13.7%, CURA 15.1%, and BMS 19.7% (P = 0.383). Target
vessel revascularizations (TVR) were EPC 4.2%, CURA 9.4%, and BMS 6.0% (P
= 0.439). Nonfatal myocardial infarctions were EPC 1.1%, CURA 3.8%, and
BMS 4.1% (P = 0.364). One patient in the EPC group had acute stent
thrombosis. There was no late stent thrombosis in the EPC group.
Conclusion: EPC stent appeared to be safe and had comparable clinical
efficacy with a BMS when used in the AMI setting. At 2-year follow-up, the
EPC group showed favorable, single-digit TVR rate and stent thrombosis
remained a low-event occurrence. copyright 2010, Wiley Periodicals, Inc.

<10>
Accession Number
2010211223
Authors
Galassi A.R. Tomasello S.D. Costanzo L. Campisano M.B. MarzA F. Tamburino
C.
Institution
(Galassi, Tomasello, Costanzo, Campisano, MarzA, Tamburino) Department of
Internal Medicine and Systemic Disease, Ferrarotto Hospital, University of
Catania, Catania, Italy.
Title
Recanalization of complex coronary chronic total occlusions using
high-frequency vibrational energy CROSSER catheter as first-line therapy:
A single center experience.
Source
Journal of Interventional Cardiology. 23(2)(pp 130-138), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Several studies have illustrated the safety and the procedural
outcome of high-frequency vibrational energy in guidewire refractory
chronic total occlusions (CTOs). Aim: To evaluate the advantage of
high-frequency vibrational energy device (CROSSER Catheter) use in
coronary complex CTO revascularization as primary strategy. Methods:
CROSSER was used as a primary approach if four or more unfavorable
angiographic features were observed in the CTO lesions. Results: From May
2007 to February 2009, a CTO percutaneous intervention attempt was
performed in 178 lesions of 171 patients (60.1 +/- 8.9 age with 49.4 +/-
7.2% in ejection fraction). Among these, the CROSSER was used in 46
complex CTO lesions of 45 patients (25.8% of cases) and in the remaining
cases, typical CTO percutaneous coronary intervention techniques were
employed. Clinical success was 84.8% in CROSSER group. Moreover, in the
CROSSER group, no periprocedural myocardial infarction, perforation, or 30
days MACE was observed. In addition, the use of CROSSER was associated
with lower time of procedure, time of fluoroscopy, and contrast load
administration as compared with conventional techniques [88 +/- 27 minutes
vs 109 +/- 38 minutes (P = 0.045), 39 +/- 12 minutes vs 50 +/- 27 minutes
(P = 0.032), and 334 +/- 122cc vs 408 +/- 198cc (P = 0.05), respectively].
Conclusion: In the present study, the CROSSER System was safe and obtained
a high rate of success in complex CTO similar to conventional dedicated
guidewire techniques for noncomplex CTO; however, the CROSSER Catheter
obtained CTO recanalization with lower contrast load administration, less
time of procedure, and lower fluoroscopy exposure. copyright 2010, Wiley
Periodicals, Inc.

<11>
Accession Number
2010211219
Authors
Fernandez-Guerrero J.C. Herrador-Fuentes J. Sanchez-Gila J. Guzman-Herrera
M. Lozano C.
Institution
(Fernandez-Guerrero, Herrador-Fuentes, Sanchez-Gila, Guzman-Herrera,
Lozano) Unidad de Hemodinamica, Servicio de Cardiologia, Complejo
Hospitalario de Jaen, C/Avenida Ejercito Espanol, 10, 23007 Jaen, Spain.
Title
In-hospital and 12-month postprocedural clinical outcome of coronary
bifurcational lesion treatment with the endeavor stent.
Source
Journal of Interventional Cardiology. 23(2)(pp 188-194), 2010. Date of
Publication: April 2010.
Publisher
Blackwell Publishing Inc.
Abstract
Background: The zotarolimus-eluting stent (ZES) has been documented as
significantly reducing restenosis and target lesion revascularization
(TLR) requirement compared to bare metal stents (BMS). Methods: In this
single-centered, prospective study we sought to evaluate the short- and
medium-term outcomes of ZES placement in bifurcated coronary artery
lesions. Between August 2006 and December 2007, 107 consecutive patients
(110 bifurcations) were recruited to have ZES placement in the lesion. The
provisional T stenting (PTS) technique was used in 96.3%. Angiographic
success was 100% in main vessel (MV) cases and 97.2% in that of side
branch (SB). Results: With a mean follow-up of 12.4 +/- 1.77 (mean +/- SD)
months there were four deaths, three from cardiac cause (2.85%). There
were 18 patients (19 bifurcations) requiring TLR (17.59%) for clinical
reasons. The only predictor of TLR was the use diameter of ZES [less-than
or equal to]3 mm. Conclusion: ZES can be used for bifurcation lesions
using the PTS technique with a high rate of intraprocedural success;
however, frequency of TLR is high, especially for stents with a diameter
[less-than or equal to]3 mm. copyright 2010, Wiley Periodicals, Inc.

<12>
Accession Number
2010207451
Authors
Angeli F. Verdecchia P. Karthikeyan G. Mazzotta G. Repaci S. Del Pinto M.
Gentile G. Cavallini C. Reboldi G.
Institution
(Angeli, Verdecchia, Mazzotta, Repaci, Del Pinto, Cavallini) Department of
Cardiology, Hospital 'Santa Maria della Misericordia', Perugia, Italy.
(Angeli, Verdecchia) Fondazione Umbra Cuore e Ipertensione, AUCI-ONLUS,
06126 Perugia, Italy.
(Karthikeyan) Departement of Cardiology, All India Institute of Medical
Sciences, New Delhi, India.
(Gentile, Reboldi) Department of Internal Medicine, University of Perugia,
Perugia, Italy.
Title
beta-blockers and risk of all-cause mortality in non-cardiac surgery.
Source
Therapeutic Advances in Cardiovascular Disease. 4(2)(pp 109-118), 2010.
Date of Publication: April 2010.
Publisher
SAGE Publications Ltd
Abstract
Myocardial ischemia is a frequent complication in patients undergoing
non-cardiac surgery and beta-blockers may exert a protective effect. The
main benefit of beta-blockers in perioperative cardiovascular morbidity
and mortality is believed to be linked to specific effects on myocardial
oxygen supply and demand. beta-blockers may exert anti-inflammatory and
anti-arrhythmic effects. Randomized clinical trials which evaluated the
effects of beta-blockers on all-cause mortality in patients undergoing
non-cardiac surgery have yielded conflicting results. In 9 trials, 10,544
patients with non-cardiac surgery were randomized to beta-blockers (n =
5274) or placebo (n = 5270) and there were a total of 304 deaths. Patients
randomized to beta-blockers group showed a 19% increased risk of all-cause
mortality (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.95-1.50; p
= 0.135). However, trials included in the meta-analysis differed in
several aspects, and a significant degree of heterogeneity (I2 = 46.5%)
was noted. A recent analysis showed that the surgical risk category had a
substantial influence on the overall estimate of the effect of
beta-blockers. Compared with patients in the
intermediate-high-surgical-risk category, those in the high-risk category
showed a 73% reduction in the risk of total mortality with beta-blockers
compared with placebo (OR 0.27, 95% CI 0.10-0.71, p = 0.016). These data
suggest that perioperative beta-blockers confer a benefit which is mostly
limited to patients undergoing high-risk surgery. copyright The Author(s),
2010.

<13>
Accession Number
2010173773
Authors
Onorati F. Rubino A.S. Nucera S. Foti D. Sica V. Santini F. Gulletta E.
Renzulli A.
Institution
(Onorati, Rubino, Nucera, Renzulli) Cardiac Surgery Unit, Magna Graecia
University of Catanzaro, Catanzaro, Italy.
(Foti, Gulletta) Pathology Unit, Magna Graecia University of Catanzaro,
Catanzaro, Italy.
(Santini) Cardiac Surgery Unit, University of Verona, Verona, Italy.
(Sica) Institute of Pathology, Second University of Naples, Naples, Italy.

Title
Off-pump coronary artery bypass surgery versus standard linear or
pulsatile cardiopulmonary bypass: endothelial activation and inflammatory
response.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 897-904), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objective: Poor outcomes after coronary artery bypass grafting (CABG) have
been linked to perioperative endothelial activation and systemic
inflammatory responses. The use of pulsatile cardiopulmonary bypass (PCPB)
or off-pump CABG (OPCABG) may minimise these phenomena. We compared
biochemical and clinical outcomes among patients who underwent CABG with
PCPB, CABG with linear CPB (LCPB) or OPCABG. Methods: Sixty consecutive
patients undergoing isolated elective CABG were prospectively randomised
trial to receive pulsatile CPB (group A, 20 patients), linear CPB (group
B, 20 patients) or OPCABG (group C, 20 patients). Levels of
proinflammatory cytokines (interleukins-2, -6, and -8), anti-inflammatory
cytokines (interleukin-10) and endothelial markers (vascular endothelial
growth factor (VEGF), monocyte chemo-attractant protein (MCP)-1) were
measured before, during and after surgery. Results: VEGF and MCP-1 levels
increased significantly during surgery in all groups, but they increased
the least and were the lowest overall with OPCABG. They rose most and
peaked overall with LCPB. Interleukin-2 levels remained stable during
OPCABG but decreased equally during PCPB and LCPB. Interleukin-6 and -8
levels rose significantly during both types of CPB versus OPCABG.
Interleukin-10 levels increased significantly in all groups during
surgery, but they rose least and were the lowest overall with OPCABG and
rose most and were the highest overall with PCPB. Intubation times,
intensive care unit (ICU) stay and hospital stay were significantly longer
in the LCPB group than the other two groups. Conclusions: LCPB appears to
promote endothelial activation and cytokine secretion, which may delay
recovery. OPCABG was associated with slight endothelial activation and
cytokine response. PCPB significantly attenuates endothelial/cytokine
leakage, resulting in hospital outcomes comparable with those after
OPCABG. copyright 2009 European Association for Cardio-Thoracic Surgery.

<14>
Accession Number
2010177833
Authors
Wu N. Yan S. Wang X. Lv C. Wang J. Zheng Q. Feng Y. Yang Y.
Institution
(Wu, Yan, Wang, Lv, Wang, Zheng, Feng, Yang) Key laboratory of
Carcinogenesis and Translational Research (Ministry of Education),
Department of Thoracic Surgery II, Peking University School of Oncology,
No. 52, Fucheng Avenue, Haidian District, Beijing 100142, China.
Title
A prospective, single-blind randomised study on the effect of intercostal
nerve protection on early post-thoracotomy pain relief.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 840-845), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objectives: Intracostal suture or intercostal muscle flap can reduce
post-thoracotomy pain through the preservation of intercostal nerves below
or above the incision. This study aims to test whether combining
intracostal suture with intercostal muscle flap might achieve better pain
relief than intracostal suture alone. Methods: This study included 144
consecutive patients who underwent pulmonary resection. Eighty patients
entered the trial but eight were excluded. Seventy-two patients were
randomly assigned to a muscle flap group, in which the fifth intercostal
muscle and neurovascular bundle were raised and intracostal suture on the
sixth rib was applied. For the control group, only intracostal suturing on
the sixth rib was done. All patients had a functional epidural placed,
which were removed 24 h after surgery. Differences on average numeric
rating scale (aNRS) scores were assessed in an early post-operative period
from day 1 to day 7 and a later period from week 2 to week 12, when
patients were resting or coughing. The doses of oxycodone demand and
hyperalgesia-related intercostal dermatomes (HIDs) were recorded for
analysis. Results: No differences were noted between the two groups in
terms of length and width of the incision, or duration of rib retraction.
Neither in different time periods (early or late) nor the activity status
(while resting or coughing) yielded a statistical difference on aNRS
scores between the muscle flap group and the control group (muscle flap
group vs control group: mean (95% confidence intervals) from d ay 1 to day
7, 4.42 (1.56-7.28) vs 4.79 (2.03-7.55) on coughing (p = 0.282); median
(inter-quartile range, IQR) from day 1 to day 7, 1.71 (0.86-3) vs 2.50
(1.16-3.12) while resting (p = 0.279); median (IQR) from week 2 to week
12, 0.43 (0-0.86) vs 0.48 (0.06-1.20) on coughing (p = 0.595); median
(IQR) from week 2 to week 12, 0 (0-0.14) vs 0.05 (0-0.14) while resting (p
= 0.856)). No differences were found in total oxycodone consumption from
day 1 to day 7 between the two groups (Z = -1.821, p = 0.069). The rate of
HIDs in each intercostal space and median number of HIDs were similar
between the two groups on day 1 (p > 0.05) and day 7 (p > 0.05).
Conclusions: The combination of intracostal suture with intercostal muscle
flap may not necessarily achieve better post-thoracotomy pain control than
using intracostal suture alone. copyright 2009 European Association for
Cardio-Thoracic Surgery.

<15>
Accession Number
2010177832
Authors
Cardillo G. Carleo F. Giunti R. Lopergolo M.G. Salvadori L. De Massimi
A.R. Petrella L. Martelli M.
Institution
(Cardillo, Carleo, Giunti, Lopergolo, Salvadori, De Massimi, Martelli)
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera
San Camillo-Forlanini, Via Portuense 332, 00149 Rome, Italy.
(Petrella) Department of Studi Geoeconomici, Linguistici, Statistici,
Storici per l'Analisi Regionale, Sapienza University of Rome, Rome, Italy.

Title
Predictors of survival in patients with locally advanced thymoma and
thymic carcinoma (Masaoka stages III and IVa).
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 819-823), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Objective: We sought to evaluate factors influencing long-term survival of
patients with locally advanced thymoma/thymic carcinoma (Masaoka stages
III and IVa) treated by immediate surgery or induction therapy plus
surgery. Methods: From January 1991 to April 2007, we surgically treated
61 patients with locally advanced thymoma/thymic carcinoma (Masaoka stages
III and IVa). Staging included total body computed tomography (CT) scan in
all patients, and chest magnetic resonance imaging (MRI) in 27 selected
patients. All patients had histological confirmation before surgery.
Thirty-one patients (group A) underwent induction chemotherapy followed by
surgery. Thirty patients (group B) underwent immediate surgery.
Thirty-four patients (group A: 13; group B: 17) received postoperative
radiation therapy. Results: No intra-operative mortality was reported.
World Health Organization (WHO) histological classification included 19
AB, four B1, seven B2 and 13 B3 thymomas and 18 thymic carcinomas.
Thirty-four patients were Masaoka stage III (group A: 18; group B: 16) and
27 patients were stage IVa (group A: 13; group B: 14). After a median
follow-up of 77 months, six patients of group A and seven patients of
group B died of disease. The overall 10-year survival rate was 50.6%. The
10-year survival rate was 57.9% in group A and 38.1% in group B (p =
0.03). Multivariate analysis showed complete resection (p = 0.02), Masaoka
stage (III vs IVa) (p = 0.02), induction chemotherapy (group A vs group B)
(p = 0.003) and histological WHO subtype (AB vs B1, B2 and B3) (p = 0.01)
to be statistically significant independent predictors of survival. Sex,
age and adjuvant radiation therapy showed no statistically significant
difference. Conclusions: Complete resection, Masaoka stage, induction
chemotherapy and histological WHO classification showed to be independent
predictors of survival in locally advanced thymoma/thymic carcinoma.
copyright 2009 European Association for Cardio-Thoracic Surgery.

<16>
Accession Number
2010173724
Authors
Fan Y. Zhang A.-M. Xiao Y.-B. Weng Y.-G. Hetzer R.
Institution
(Fan, Xiao) Department of Cardiothoracic and Vascular Surgery, Chongqing
Xinqiao Hospital, Third Military Medical University, Chongqing, China.
(Zhang) Department of Oncology, Chongqing Xinqiao Hospital, Third Military
Medical University, Chongqing, China.
(Weng, Hetzer) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum Berlin, Berlin, Germany.
Title
Warm versus cold cardioplegia for heart surgery: a meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 37(4)(pp 912-919), 2010.
Date of Publication: April 2010.
Publisher
Elsevier
Abstract
Much controversy persists regarding the optimal techniques for myocardial
protection during heart surgery. Numerous studies have compared warm
cardioplegia with cold cardioplegia for myocardial preservation, but the
outcomes were inconclusive. The aim of this meta-analysis of randomised
controlled trials (RCTs) was to compare the beneficial and harmful effects
of warm and cold cardioplegia during heart surgery. Electronic databases
and manual bibliographical searches were conducted. A meta-analysis of all
RCTs comparing warm cardioplegia to cold cardioplegia perfusion during
cardiac surgery was performed. Data for clinical events (in-hospital
death, myocardial infarction (MI), low output syndrome, postoperative use
of intra-aortic balloon pump, stroke and atrial fibrillation),
postoperative cardiac index, postoperative creatine kinase-MB (CK-MB) and
cardiac troponin release were extracted, and we summarised the combined
results of the data of the RCTs as relative risk (RR), with 95% confidence
intervals. A total of 41 RCTs including 5879 patients were assessed in
this study. We found that there was no statistical difference between
patients receiving warm cardioplegia and cold cardioplegia in the
incidences of clinical events. Warm cardioplegia was associated with
improved postoperative cardiac index. CK-MB and cardiac troponin
concentrations after surgery were significantly lower in the warm group as
compared with the cold group. Using warm cardioplegia for myocardial
protection during heart surgery resulted in similar incidences of clinical
events, significant improvement in postoperative cardiac index and
reduction in postoperative enzyme release as compared with cold
cardioplegia. copyright 2009 European Association for Cardio-Thoracic
Surgery.

<17>
Accession Number
2010218092
Authors
Ovrum E. Tangen G. Tollofsrud S. Ringdal M.-A.L. Oystese R. Istad R.
Institution
(Ovrum, Tangen, Tollofsrud, Ringdal, Oystese, Istad) Division of
Cardiovascular and Respiratory Medicine and Surgery, Oslo Heart Center,
Oslo University Hospital, Rikshospitalet, Norway.
Title
Low postoperative dose of aprotinin reduces bleeding and is safe in
patients receiving clopidogrel before coronary artery bypass surgery. A
prospective randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 10(4)(pp 545-548), 2010.
Date of Publication: April 2010.
Publisher
European Association for Cardio-Thoracis Surgery
Abstract
Clopidogrel (Plavix) given before the operation increases bleeding
complications following coronary artery bypass grafting (CABG). High
perioperative doses of aprotinin (Trasylol) are known to reduce bleeding
and transfusions after cardiac surgery, but may increase the risk of
thrombosis, renal impairment, and mortality. The aim of the study was to
evaluate the clinical effects of aprotinin given in high doses intra- and
postoperatively vs. a low postoperative dose in patients on clopidogrel.
Patients admitted for first-time CABG and receiving clopidogrel with or
without aspirin, were prospectively randomized either to receive a total
of 75,000 kallikrein inhibitor unit (KIU)/kg aprotinin given intra- and
postoperatively or 25,000 KIU/kg aprotinin after the operation. Three
hundred and ninety-nine patients aged 32-87 years (median 67 years) were
included. Postoperative bleeding was slightly different, but moderate in
both groups. The transfusion rate was similar, as were the incidences of
postoperative neurological disturbances and myocardial infarction. Renal
impairment and need for inotropic drugs were more frequent in the high
dose group. Thirty-day mortality was similar (high dose 2%, low dose 0.5%,
P=0.22). A low postoperative dose of aprotinin in patients receiving
clopidogrel is safe and has comparable effects regarding postoperative
bleeding complications as a high dose. copyright 2010 Published by
European Association for Cardio-Thoracic Surgery.

<18>
Accession Number
2010210919
Authors
Piscione F. Piccolo R. Cassese S. Galasso G. D'Andrea C. De Rosa R.
Chiariello M.
Institution
(Piscione, Piccolo, Cassese, Galasso, D'Andrea, De Rosa, Chiariello)
Department of Clinical Medicine, Cardiovascular Sciences and Immunology,
Federico II University, Naples, Italy.
Title
Is direct stenting superior to stenting with predilation in patients
treated with percutaneous coronary intervention? Results from a
meta-analysis of 24 randomised controlled trials.
Source
Heart. 96(8)(pp 588-594), 2010. Date of Publication: April 2010.
Publisher
BMJ Publishing Group
Abstract
Background: In the last decade, direct stenting has been proposed as an
alternative strategy to conventional stenting with balloon predilation.
The aim of this study was to perform a meta-analysis of randomised trials
comparing a direct stenting strategy versus a conventional one. Methods: A
literature search was performed using Medline, EMBASE, the Cochrane
Central Register of Controlled Trials, scientific session abstracts and
relevant websites, from inception of each database to June 2009. Included
studies comprised randomised controlled trials evaluating direct versus
conventional stenting in patients undergoing percutaneous coronary
intervention. Primary endpoint was the composite of death or myocardial
infarction and secondary endpoints were myocardial infarction and
target-vessel revascularisation occurrence. Results: 24 trials met
inclusion criteria, with 6803 patients enrolled (3412 or 50.15% randomised
to direct stenting and 3391 or 49.85% randomised to conventional
stenting). Up to 6-month follow-up, the composite of death or myocardial
infarction was significantly reduced with direct stenting compared with
conventional stenting (3.95% versus 5.10% respectively, OR=0.76 (95% CI
0.60 to 0.96), p=0.02). This reduction was primarily driven by a lower
myocardial infarction occurrence (3.16% versus 4.04%, respectively,
OR=0.77 (0.59 to 0.99), p=0.04). Furthermore, direct stenting was not
associated with a reduction in target-vessel revascularisation (6.50%
versus 6.96%, respectively, OR=0.92 (0.76 to 1.12), p=0.42). Conclusion:
This meta-analysis demonstrates that, in selected coronary lesions, direct
stenting improves outcome in patients undergoing percutaneous coronary
intervention, primarily reducing myocardial infarction incidence.

<19>
Accession Number
2010210670
Authors
Flores G.
Title
Racial and ethnic disparities in the health and health care of children.
Source
Pediatrics. 125(4)(pp e979-e1020), 2010. Date of Publication: April 2010.
Publisher
American Academy of Pediatrics
Abstract
OBJECTIVE: This technical report reviews and synthesizes the published
literature on racial/ethnic disparities in children's health and health
care. METHODS: A systematic review of the literature was conducted for
articles published between 1950 and March 2007. Inclusion criteria were
peer-reviewed, original research articles in English on racial/ ethnic
disparities in the health and health care of US children. Search terms
used included "child," "disparities," and the Index Medicus terms for each
racial/ethnic minority group. RESULTS: Of 781 articles initially reviewed,
111 met inclusion criteria and constituted the final database. Review of
the literature revealed that racial/ethnic disparities in children's
health and health care are quite extensive, pervasive, and persistent.
Disparities were noted across the spectrum of health and health care,
including in mortality rates, access to care and use of services,
prevention and population health, health status, adolescent health,
chronic diseases, special health care needs, quality of care, and organ
transplantation. Mortality-rate disparities were noted for children in all
4 major US racial/ethnic minority groups, including substantially greater
risks than white children of all-cause mortality; death from drowning,
from acute lymphoblastic leukemia, and after congenital heart defect
surgery; and an earlier median age at death for those with Down syndrome
and congenital heart defects. Certain methodologic flaws were commonly
observed among excluded studies, including failure to evaluate children
separately from adults (22%), combining all nonwhite children into 1 group
(9%), and failure to provide a white comparison group (8%). Among studies
in the final database, 22% did not perform multivariable or stratified
analyses to ensure that disparities persisted after adjustment for
potential confounders. CONCLUSIONS: Racial/ethnic disparities in
children's health and health care are extensive, pervasive, and
persistent, and occur across the spectrum of health and health care.
Methodologie flaws were identified in how such disparities are sometimes
documented and analyzed. Optimal health and health care for all children
will require recognition of disparities as pervasive problems,
methodologically sound disparities studies, and rigorous evaluation of
disparities interventions.

<20>
Accession Number
2010210628
Authors
Snookes S.H. Gunn J.K. Eldridge B.J. Donath S.M. Hunt R.W. Galea M.P.
Shekerdemian L.
Institution
(Snookes, Eldridge) Physiotherapy Department, Melbourne, VIC, Australia.
(Gunn, Hunt) Department of Neonatal Medicine, Melbourne, VIC, Australia.
(Donath) Clinical Epidemiology and Biostatistics Unit, Melbourne, VIC,
Australia.
(Shekerdemian) Paediatric Intensive Care Unit, Royal Children's Hospital,
Melbourne, VIC, Australia.
(Snookes, Galea) School of Physiotherapy, Melbourne, VIC, Australia.
(Gunn, Donath, Hunt, Shekerdemian) Department of Paediatrics, University
of Melbourne, Melbourne, VIC, Australia.
(Gunn, Hunt, Shekerdemian) Critical Care and Neurosciences, Melbourne,
VIC, Australia.
(Donath) Clinical Epidemiology and Biostatistics Unit, Murdoch Children's
Research Institute, Melbourne, VIC, Australia.
Title
A systematic review of motor and cognitive outcomes after early surgery
for congenital heart disease.
Source
Pediatrics. 125(4)(pp e818-e827), 2010. Date of Publication: April 2010.
Publisher
American Academy of Pediatrics
Abstract
CONTEXT: Brain injury is the most common long-term complication of
congenital heart disease requiring surgery during infancy. It is clear
that the youngest patients undergoing cardiac surgery, primarily neo-nates
and young infants, are at the greatest risk for brain injury.
Develop-mental anomalies sustained early in life have lifelong
repercussions. OBJECTIVE: We conducted a systematic reviewto examine
longitudinal studies of cognitive and/or motor outcome after cardiac
surgery dur-ing early infancy. METHODS: Electronic searches were performed
in Medline, the Cumu-lative Index to Nursing and Allied Health Literature
(Cinahl), and Em-base (1998-2008). The search strategy yielded 327
articles, of which 65 were reviewed. Eight cohorts provided prospective
data regarding the cognitive and/or motor outcome of infants who had
undergone surgery for congenital heart disease before 6 months of age. Two
authors, Ms Snookes and Dr Gunn, independently extracted data and
presented results according to 3 subgroups for age of follow-up: early
develop-ment (1 to <3 years); preschool age (3-5 years); and school age
(>5 to 17 years). Weighted analysis was undertaken to pool the results of
studies when appropriate. RESULTS: All of the identified studies reported
results of the Bayley Scales of Infant Development for children younger
than the age of 3. Outcome data as reported by the Bayley Scales were
combined for infants assessed at 1 year of age, revealing a weighted mean
Mental Development Index of 90.3 (95% confidence interval: 88.9-91.6) and
Psychomotor Development Index of 78.1 (95% confidence interval:
76.4-79.7). Additional analysis was limited by a lack of data at
pre-school and school age. CONCLUSIONS: With this review we identified a
limited number of pro-spective studies that systematically addressed
outcome in patients at the highest risk. These studies consistently
revealed cognitive and mo-tor delay in children after cardiac surgery
during early infancy. Addi-tional investigation is required to ascertain
the consequences of such impairment during later childhood and into adult
life.

<21>
[Use Link to view the full text]
Accession Number
2010172125
Authors
Eder B. Hofmann P. Von Duvillard S.P. Brandt D. Schmid J.-P. Pokan R.
Wonisch M.
Institution
(Eder, Brandt, Wonisch) Center for Cardiac Rehabilitation, PVA SKA,
Quellenstr.1, Graz, A-8061 St Radegund, Austria.
(Hofmann) Institute of Sports Sciences, Human Performance Research,
Karl-Franzens University Graz, Austria.
(Von Duvillard) Department of Sport Science and Kinesiology, University of
Salzburg, Austria.
(Schmid) Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and
Rehabilitation, University Hospital, Switzerland.
(Pokan) Institute of Sports Science, University of Vienna, Austria.
Title
Early 4-week cardiac rehabilitation exercise training in elderly patients
after heart surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 30(2)(pp
85-92), 2010. Date of Publication: March-April 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: The aim of this study was to assess the effects on exercise
performance of supplementing a standard cardiac rehabilitation program
with additional exercise programming compared to the standard cardiac
rehabilitation program alone in elderly patients after heart surgery.
Methods: In this prospective, randomized controlled trial, 60 patients (32
men and 28 women, mean age 73.1 +/- 4.7 years) completed cardiac
rehabilitation (initiated 12.2 +/- 4.9 days postsurgery). Subjects were
assigned to either a control group (CG, standard cardiac rehabilitation
program [n = 19]), or an intervention group (IG, additional walking [n =
19], or cycle ergometry training [n = 22]). A symptom limited
cardiopulmonary exercise test and 6-minute walk test (6MWT) were performed
before and after 4 weeks of cardiac rehabilitation. The MacNew
questionnaire was used to assess quality of life (QOL). Results: At
baseline, no significant differences for peak oxygen uptake (V[dot]2),
maximal power output, or the 6MWT were detected between IG and CG. Global
QOL was significantly higher in IG. After 4 weeks of cardiac
rehabilitation, patients significantly improved in absolute values of the
cardiopulmonary exercise test, 6MWT, and QOL scores. Significant
differences between groups were found for peak V[dot]2 (IG: 18.2 +/- 3.1
mL*kg-1*min -1 vs. CG: 16.5 +/- 2.2 mL*kg*min, P < .05); maximal power
output (IG: 72.2 +/- 16 W vs. CG: 60.7 +/- 15 W, P < .05); 6MWT (IG: 454.8
+/- 76.3 m vs. CG: 400.5 +/- 75.5 m, P < .05); and QOL global (IG: 6.5 +/-
0.5 vs. CG: 6.3 +/- 0.6, P < .05). Conclusion: The supplementation of
additional walking or cycle exercise training to standard cardiac
rehabilitation programming compared to standard cardiac rehabilitation
alone in elderly patients after heart surgery leads to significantly
better exercise tolerance.