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<1>
Accession Number
70383457
Authors
Arora S. Erikstad I. Wennerblom B. Sigurdardottir V. Eiskjaer H. Botker H.
Mortensen S.-A. Saunameki K. Ekmehag B. Jansson K. Simonsen S. Gude E.
Ragnarsson A. Solbu D. Gullestad L.
Institution
(Arora, Erikstad, Simonsen, Gude, Ragnarsson, Gullestad) Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Wennerblom, Sigurdardottir) Sahlgrenska University Hospital, Gothenburg,
Sweden
(Eiskjaer, Botker) Skeiby University Hospital, Aarhus, Denmark
(Mortensen, Saunameki) Rigshospitalet, Copenhagen, Denmark
(Ekmehag) Lund Hospital, Lund, Sweden
(Jansson) Heart Center University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge, Oslo, Norway
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S33-S34), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Immunosuppressant regimes centered on everolimus have been
demonstrated to provide a quantitative reduction in cardiac allograft
vasculopathy (CAV) amongst de-novo heart transplant (HTx) recipients.
However, the effect of such therapy on CAV assessed by the qualitative
method of Virtual Histology (VH) is unknown and was investigated in this
prospective randomized-controlled trial. Methods and Materials: In this
12-month multicenter Scandinavian study 190 maintenance HTx recipients
were randomized to everolimus with reduced calcineurin inhibitor (CNI)
exposure or continue standard CNI-therapy. Both groups continued their
prior usage of azathioprine (AZA) or mycophenolate mofetil (MMF). 78
patients had evaluable VH examinations at baseline and 12 months and
matched analysis was performed to measure change in fibrotic, fibrofatty,
calcified and necrotic tissue component. Results: When considering all 78
patients, mean age 57.4+/- 10.3 years and mean time post-HTx 5.4+/-4.1
yrs, a similar rate of quantitative CAV progression was observed in the
everolimus (n=30) versus standard CNI therapy group (n=48) (plaque index
1.9+/-3.9% and 1.6+/-3.7%, respectively; p=0.65). Virtual Histology
analysis revealed a significant increase in calcified (2.4+/-4.0 versus
0.3+/-3.1%; p=0.02) and necrotic component (6.4+/-8.5 versus 1.0+/-8.6%;
p<0.01) amongst everolimus patients as compared to standard CNI therapy,
respectively. Increase in calcified and necrotic component was
significantly greater (p<0.05) in everolimus patients as compared to
controls irrespective of background immunosuppression (AZA or MMF). Change
in fibrotic and fibrofatty tissue was not significantly different in the
everolimus and control group (p>0.05). Conclusions: Conversion to
everolimus and reduced CNI does not significantly influence quantitative
progression of CAV but is associated with a significant increase in
calcified and necrotic tissue component. The prognostic implication of
these qualitative changes in HTx recipients is unclear and warrants
further investigation.

<2>
Accession Number
70383545
Authors
Wray J. Orrells C. Latch H. Burch M.
Institution
(Wray, Orrells, Latch, Burch) Cardiorespiratory, Great Ormond Street
Hospital for Children, NHS Trust, London, United Kingdom
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S61), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Despite improvements in survival, heart transplantation (HTx) is
still associated with significant morbidity, particularly coronary artery
vasculopathy (CAV). Diet, exercise and psychological factors are known to
influence the progression of CAV but no studies have been conducted to
determine whether an information based diet and exercise intervention has
an impact on physical and psychological well-being in paediatric heart
recipients. Methods and Materials: Seventy children (median age: 8.7
years) with no significant co-morbidities who had undergone HTx at least
12 months previously were randomized to either an intervention (IG) or
control (CG) group using minimization to stratify for age, gender,
pre-transplant diagnosis and body-mass index. Questionnaires assessing
quality of life (QoL), self-concept, knowledge about diet and exercise and
physical activity levels were completed by parents and older children at
baseline and 12 months later. Children in the IG and their parents
received individually tailored information about diet and exercise
delivered during 4 separate sessions over a 12 month period, using an
approach based on the Theory of Planned Behaviour. Those in the CG
received usual care. Results: The groups did not differ at baseline on any
medical or demographic parameters. All children in the IG completed the
intervention satisfactorily. At follow-up the change in each of the QoL
domains (physical, emotional, social and school) was more positive in the
IG compared to the CG and the difference was significant on the child
ratings of school QoL (t=2.177; p=.036). There were also improvements in
reported exercise and healthy eating behaviours in the IG relative to the
CG. Conclusions: The diet and exercise intervention had a positive impact
on QoL and on reported levels of physical activity and healthy eating
behaviours in the short term. Lack of knowledge of both parents and
children about the benefits and importance of a healthy life-style after
transplant needs to be addressed routinely.

<3>
Accession Number
70383738
Authors
Alba A.C. McDonald M. Rao V. Ross H.J. Delgado D.H.
Institution
(Alba, McDonald, Ross, Delgado) Division of Cardiology and Heart
Transplantation, Toronto General Hospital, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, ON, Canada
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S124), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: VAD therapy is widely used as a bridge to cardiac transplant.
Studies addressing the effect of VADs on post-transplant outcomes showed
conflicting results. Our aim was to systematically evaluate the effect of
ventricular assist device (VAD) therapy on long-term post-transplant
outcomes in heart transplant recipients. Methods and Materials: We
searched online databases (Medline, Pubmed, Embase and CINAHL) and
unpublished data identified through reference of included articles.
Comparative studies evaluating the effect of VAD on post-transplant
outcomes in adults were included and study results were meta-analyzed
using random-effects models. We conducted sub-group analyses to assess the
effect estimate of extra-vs. intra-corporeal VADs and to evaluate the
impact of transplant era and listing status. Results: Overall, we
identified 31 observational studies. One-year posttransplant mortality in
recipients bridged with an extra-corporeal VAD was significantly higher
than in non-bridged recipients (RR 1.8, 95%CI 1.53-2.13,
I²=1%), while patients supported with an intra-corporeal VAD
had similar mortality to non-bridged recipients (RR 1.08, 95%CI 0.95-1.22,
I²=0%). (Table presented) The risks of rejection within the
first post-transplant year and coronary allograft vasculopathy were not
significantly different between patients with or without VAD support prior
to transplant. Publication bias was low; however, the risk of bias across
studies was moderate to high. Conclusions: Intra-corporeal VAD support
does not have a deleterious impact on post-transplant outcomes. However,
post-transplant survival may be poorer in the subgroup of patients
supported with extracorporeal devices. Studies with greater methodologic
rigour are warranted.

<4>
Accession Number
70383958
Authors
Nelson M.J. Liao K. John R. Shumway S. Tetteh H.A.
Institution
(Nelson, Liao, John, Shumway) Department of Cardiothoracic Surgery,
University of Minnesota, Minneapolis, MN, United States
(Tetteh) Department of Cardiothoracic Surgery, National Naval Medical
Center, Bethesda, MD, United States
Source
Journal of Heart and Lung Transplantation. Conference: 31st Annual
Meeting and Scientific Sessions of the International Society for Heart and
Lung Transplantation, ISHLT San Diego, CA United States. Conference Start:
20110413 Conference End: 20110416. Conference Publication: (var.pagings).
30 (4 SUPPL. 1) (pp S195-S196), 2011. Date of Publication: April 2011.
Publisher
Elsevier USA
Abstract
Purpose: Bi-atrial and bi-caval anastomotic techniques have been compared
in heart transplant populations and their respective rates of
postoperative permanent pacemaker (PPM) placement described. Previous
studies suggest that the rate of PPM placement is higher with the
bi-atrial technique because of postoperative atrial distortion. The aim of
this study is to confirm this finding among our patient population - now
just over 700 since the program's inception - and, further, to analyze the
cost impact of these two techniques in relation to their rates of PPM
placement. Methods and Materials: A prospective systematic review of 283
orthotopic heart transplants was performed at our institution from January
1, 2001 to December 31, 2009. 165 of these patients had bi-atrial
anastomoses (Group I), and 118 had bi-caval anastomoses (Group II). PPM
placement rates were compared and resultant excess cost was determined
using average Medicare reimbursement rates for DRG242 (PPM implant with
major complication and co-morbidities). Results: Group I had a PPM
placement rate of 11% (18/164) compared to Group II's 5.1% (6/118) (p =
0.057). Approximately 95% (23/24) of PPM's were placed within 30 days of
transplant. During the study period, Group I incurred an excess cost of
$336,162 attributable to PPM placement compared to Group II's excess cost
of $112,054. (Table presented) Conclusions: The higher rate of PPM
placement in Group I resulted in an initial cost difference from Group II
of $224,108. This difference warrants consideration, particularly at large
institutions where the marginal costs of PPM placement could have a
significant economic impact. Further analysis is also indicated to
determine the cost difference over the life expectancy of the transplant
recipient and the potential impact on patient survival.

<5>
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Accession Number
2011176042
Authors
Dadure C. Sauter M. Bringuier S. Bigorre M. Raux O. Rochette A. Canaud N.
Capdevila X.
Institution
(Dadure, Sauter, Raux, Rochette, Canaud) Department of Anesthesia and
Critical Care Medicine, Lapeyronie University Hospital, Montpellier,
France
(Bringuier) Departments of Anesthesia and Critical Care Medicine and
Biostatistics, Lapeyronie University Hospital, France
(Bigorre) Department of Pediatric Plastic Surgery, Lapeyronie University
Hospital, France
(Capdevila) Head of Department, Lapeyronie University Hospital, France
(Dadure) Departement d'Anesthesie Reanimation Lapeyronie, Hopital
Lapeyronie, 371 Ave du Doyen G. Giraud, 34295 Montpellier, France
Title
Intraoperative tranexamic acid reduces blood transfusion in children
undergoing craniosynostosis surgery: A randomized double-blind study.
Source
Anesthesiology. 114 (4) (pp 856-861), 2011. Date of Publication: April
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background: Surgical correction of craniosynostosis in children is
associated with substantial intraoperative bleeding. Tranexamic acid (TXA)
decreases intraoperative blood loss during cardiac or orthopedic surgery
in children. We hypothesized that intraoperative TXA would reduce blood
transfusion relative to placebo in patients pretreated with
erythropoietin. Methods: Forty consecutive children, American Society of
Anesthesiologists status 1 or 2, scheduled to undergo surgical correction
of craniosynostosis were randomly assigned to receive either intravenous
TXA or saline, 0.9%, intraoperatively. All children received preoperative
erythropoietin (600 U/kg once a week for 3 weeks before surgery).
Perioperative blood loss, number and volume of transfusions, percentage of
children who underwent transfusion, and side effects were noted after
surgery and at the end of the study. Surgeon satisfaction and cost of
treatment were also recorded. Results: There was no significant difference
between groups in demographic or surgical data. In the TXA group, the
volume of packed erythrocytes transfused was significantly reduced by 85%
(from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2
ml/kg) throughout the study period (P < 0.05). Compared with the placebo
group, the percentage of children requiring blood transfusion was lower in
the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P
< 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of
19; P < 0.05). Preoperative and postoperative hematologic parameters were
comparable in both groups. There were no adverse events. Conclusion: In
children undergoing surgical correction of craniosynostosis and pretreated
with erythropoietin, intraoperative TXA reduces the transfusion
requirement. 2011, the American Society of Anesthesiologists, Inc.
Lippincott Williams & Wilkins.

<6>
Accession Number
2011178517
Authors
Rossig L. Genth-Zotz S. Rau M. Heyndrickx G.R. Schneider T. Gulba D.C.L.
Desaga M. Buerke M. Harder S. Zeiher A.M.
Institution
(Rossig, Zeiher) Department of Medicine III, J.W. Goethe University of
Frankfurt, Theodor Stern-Kai 7, 60590 Frankfurt, Germany
(Genth-Zotz) Johannes Gutenberg-University, Mainz, Germany
(Rau) Kerckhoff Klinik, Bad Nauheim, Germany
(Heyndrickx) Cardiovascular Center, Aalst, Belgium
(Schneider) Klinik III fur Innere Med, Universitat zu Koln, Germany
(Gulba) Abteilung Innere Med i, Krankenhaus Duren GmbH, Duren, Germany
(Desaga) AmperKliniken AG, Dachau, Germany
(Buerke) Klinik und Poliklinik fur Innere Med III,
Martin-Luther-University, Halle/Saale, Germany
(Harder) Clinical Pharmacology, University of Frankfurt, Germany
Title
Argatroban for elective percutaneous coronary intervention: The ARG-E04
multi-center study.
Source
International Journal of Cardiology. 148 (2) (pp 214-219), 2011. Date of
Publication: 14 Apr 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
The synthetic arginine-derived direct thrombin inhibitor argatroban is an
attractive anticoagulant for percutaneous coronary intervention (PCI),
because of its rapid onset and offset, and its hepatic elimination.
Argatroban was approved for PCI in patients with heparin-induced
thrombocytopenia (HIT). However, there are limited data about argatroban
in non-HIT patients. The objective of this open-label, multiple-dose,
controlled study was to examine the safety and efficacy of argatroban in
patients undergoing elective PCI. Methods and results: Of 140 patients
randomized to three argatroban dose groups (ARG250, ARG300, and ARG350
with 250, 300, or 350 mug/kg bolus, followed by 15, 20, or 25 mug/kg/min
infusion) and one unfractionated heparin (UFH) group (70-100 IU/kg bolus),
138 patients were analyzed. Argatroban dose-dependently prolonged
activated clotting time (ACT) with more patients reaching the minimum
target ACT after the initial bolus injection (ARG250: 86.1%, ARG300:
89.5%, and ARG350: 96.8%) compared to 45.5% in UFH (p < 0.001). The
patient proportion who did not require additional bolus injections to
start PCI was significantly higher in argatroban than in UFH (p <= 0.002).
Consequently, the time to start of PCI was shortened in argatroban groups.
Composite incidences of death, myocardial infarction, and urgent
revascularization until day 30 were not significantly different between
the groups (ARG250: 2.8%, ARG300: 0.0%, ARG350: 3.2% vs. UFH: 3.0%). Major
bleeding was observed only in UFH (3.0%), while minor bleeding occurred in
ARG350 (3.2%) and UFH (6.1%, n.s.). Conclusion: Argatroban
dose-dependently increases coagulation parameters and, compared to UFH,
demonstrates a superior predictable anticoagulant effect in patients
undergoing elective PCI. 2009 Elsevier Ireland Ltd.

<7>
Accession Number
2011179238
Authors
Hempenius L. Van Leeuwen B.L. Van Asselt D.Z.B. Hoekstra H.J. Wiggers T.
Slaets J.P.J. De Bock G.H.
Institution
(Hempenius, Slaets) University Center for the Elderly, University Medical
Center Groningen, Groningen, Netherlands
(Van Leeuwen, Hoekstra, Wiggers) Department of Surgery, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
(Van Asselt) Department of Geriatric Medicine, Medical Center Leeuwarden,
Leeuwarden, Netherlands
(De Bock) Department of Epidemiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Title
Structured analyses of interventions to prevent delirium.
Source
International Journal of Geriatric Psychiatry. 26 (5) (pp 441-450), 2011.
Date of Publication: May 2011.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Delirium is one of the most serious complications in
hospitalized elderly, with incidences ranging from 3-56%. The objective of
this meta-analysis was two-fold, first to investigate if interventions to
prevent delirium are effective and second to explore which factors
increase the effectiveness of these interventions. Methods: An electronic
search was carried out on articles published between January 1979 and July
2009. Abstracts were reviewed, data were extracted and methodologic
quality was assessed by two independent reviewers. Effect sizes of the
interventions were expressed as ORs (odds ratios) and 95%CIs (confidence
intervals). A random effect model was used to provide pooled ORs. To
explore which factors increase the effectiveness of the interventions, ORs
were stratified for several factors. Results: Sixteen relevant studies
were found. Overall the included studies showed a positive result of any
intervention to prevent delirium (pooled OR: 0.64; 95%CI: 0.46-0.88). The
largest effect was seen in studies on populations with an incidence of
delirium above 30% in the control group (pooled OR: 0.34; 95%CI: 0.16-0.71
versus 0.76; 95%CI: 0.60-0.97). Conclusions: Interventions to prevent
delirium are effective. Interventions seem to be more effective when the
incidence of delirium in the population under study is above 30%. To
maximize the options for a cost-effective strategy of delirium prevention
it might be useful to offer an intervention to a selected population.
Copyright 2010 John Wiley & Sons, Ltd.

<8>
Accession Number
2011161669
Authors
Wang D.Y. Richmond M.E. Quinn T.A. Mirani A.J. Rusanov A. Yalamanchi V.
Weinberg A.D. Cabreriza S.E. Spotnitz H.M.
Institution
(Wang) Department of Medicine, Columbia University, New York, NY, United
States
(Richmond, Mirani) Department of Pediatrics, Columbia University, New
York, NY, United States
(Rusanov, Yalamanchi, Cabreriza, Spotnitz) Department of Surgery, Columbia
University, New York, NY, United States
(Quinn) Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
(Weinberg) Department of Health Evidence and Policy, Mount Sinai School of
Medicine, New York, NY, United States
(Spotnitz) Department of Surgery, Columbia University Medical Center,
Vanderbilt Clinic, 622 West 168th St, New York, NY 10032, United States
Title
Optimized temporary biventricular pacing acutely improves intraoperative
cardiac output after weaning from cardiopulmonary bypass: A substudy of a
randomized clinical trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp
1002-1008.e1), 2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Permanent biventricular pacing benefits patients with heart
failure and interventricular conduction delay, but the importance of
pacing with and without optimization in patients at risk of low cardiac
output after cardiac surgery is unknown. We hypothesized that pacing
parameters independently affect cardiac output. Accordingly, we analyzed
aortic flow measured with an electromagnetic flowmeter in patients at risk
of low cardiac output during an ongoing randomized clinical trial of
biventricular pacing (n = 11) versus standard of care (n = 9). Methods: A
substudy was conducted in all 20 patients in both groups with stable
pacing after coronary artery bypass grafting, valve surgery, or both.
Ejection fraction averaged 33% +/- 15%, and QRS duration was 116 +/- 19
ms. Effects were measured within 1 hour of the conclusion of
cardiopulmonary bypass. Atrioventricular delay (7 settings) and
interventricular delay (9 settings) were optimized in random sequence.
Results: Optimization of atrioventricular delay (171 +/- 8 ms) at an
interventricular delay of 0 ms increased flow by 14% versus the worst
setting (111 +/- 11 ms, P < .001) and 7% versus nominal atrioventricular
delay (120 ms, P < .001). Interventricular delay optimization increased
flow 10% versus the worst setting (P < .001) and 5% versus nominal
interventricular delay (0 ms, P < .001). Optimized pacing increased
cardiac output 13% versus atrial pacing at matched heart rate (5.5 +/- 0.5
vs 4.9 +/- 0.6 L/min, P = .003) and 10% versus sinus rhythm (5.0 +/- 0.6
L/min, P = .019). Conclusions: Temporary biventricular pacing increases
intraoperative cardiac output in patients with left ventricular
dysfunction undergoing cardiac surgery. Atrioventricular and
interventricular delay optimization maximizes this benefit. 2011 by The
American Association for Thoracic Surgery.

<9>
Accession Number
2011161670
Authors
Braathen B. Jeppsson A. Schersten H. Hagen O.M. Vengen O. Rexius H. Lepore
V. Tonnessen T.
Institution
(Braathen, Hagen, Vengen, Tonnessen) Department of Cardiothoracic Surgery,
Faculty of Hospital Medicine, Oslo University Hospital Ullevl, Oslo,
Norway
(Jeppsson, Schersten, Rexius, Lepore) Department of Cardiovascular Surgery
and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
(Jeppsson, Schersten, Rexius, Lepore) Department of Molecular and Clinical
Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg,
Sweden
(Tonnessen) University of Oslo, Faculty of Hospital Medicine, Center for
Heart Failure Research, Oslo, Norway
Title
One single dose of histidine-tryptophan-ketoglutarate solution gives
equally good myocardial protection in elective mitral valve surgery as
repetitive cold blood cardioplegia: A prospective randomized study.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp 995-1001),
2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Histidine-tryptophan-ketoglutarate (HTK-Custodiol)
cardioplegic solution is administered as one single dose for more than 2
hours of ischemia. No prospective randomized clinical study has compared
the effects of HTK and cold blood cardioplegia on myocardial damage in
elective mitral valve surgery. Thus, the main aim of the present study was
to examine whether one single dose of cold antegrade HTK gives as good
myocardial protection as repetitive antegrade cold blood cardioplegia in
mitral valve surgery. Methods: Eighty consecutive patients undergoing
elective isolated mitral valve surgery for mitral regurgitation, with or
without ablation for atrial fibrillation, were included in the study and
randomized to HTK or blood cardioplegia. Markers of myocardial injury
(troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours,
1 day, 2 days, and 3 days after surgery. Results: No significant
difference in creatine kinase MB and troponin-T between HTK and blood
cardioplegia groups was found at any time point. There was a significant
correlation between ischemic time and markers of myocardial injury in the
HTK group only and significantly more spontaneous ventricular fibrillation
after release of crossclamping in the HTK group. Conclusions: One single
dose of antegrade cold HTK cardioplegic solution in elective mitral valve
surgery protects the myocardium equally well as repetitive antegrade cold
blood cardioplegia. 2011 by The American Association for Thoracic
Surgery.

<10>
Accession Number
2011161675
Authors
Kukucka M. Potapov E. Stepanenko A. Weller K. Mladenow A. Kuppe H.
Habazettl H.
Institution
(Kukucka, Weller, Mladenow, Kuppe) Department of Anaesthesiology,
Deutsches Herzzentrum, Berlin, Germany
(Potapov, Stepanenko) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum, Berlin, Germany
(Habazettl) Institute of Physiology, Charite Campus Benjamin Franklin,
Berlin, Germany
(Kukucka) Deutsches Herzzentrum, Berlin, Department of Anesthesiology,
Augustenburger Platz 1, 13353 Berlin, Germany
Title
Acute impact of left ventricular unloading by left ventricular assist
device on the right ventricle geometry and function: Effect of nitric
oxide inhalation.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp 1009-1014),
2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Left ventricular assist device (LVAD) implantation is an
established option for treatment of patients with end-stage heart failure,
but outcome may be worsened by right ventricular failure. The aim of this
study was to evaluate the acute effect of LVAD on right ventricular
geometry and function and the pulmonary circulation. The effect of inhaled
nitric oxide (iNO) was assessed. Methods: We evaluated pre- and
postoperatively obtained transesophageal echocardiography images and
hemodynamics of patients participating in a randomized trial on the effect
of inhaled nitric oxide during LVAD implantation. Twenty-four patients
were randomized to the iNO group and 23 to the placebo group. Results:
After LVAD implantation marked decreases in pulmonary capillary wedge
pressure (P < .01) and mean pulmonary artery pressure (P < .01) were
observed in both groups. Pulmonary vascular resistance decreased only in
the iNO group (311 +/- 35 to 225 +/- 17, P < .01). Transesophageal
echocardiography measurements show significant improvement of right
ventricular geometry (right ventricular end-diastolic diameter: 50 +/- 2
to 45 +/- 2, P < .01 and 48 +/- 2 to 44 +/- 2 mm, P < .05 in iNO and
placebo groups) and function (right ventricular fractional area change:
24% +/- 2% to 31% +/- 2%, P < .05 and 23% +/- 2% to 29% +/- 2%, P < .05 in
iNO and placebo groups) without any difference between the iNO and placebo
groups. The overall incidence of postoperative right ventricular failure
was 4 of 47 (8.5%). Conclusions: LVAD implantation markedly improved right
ventricular geometry and function in most of the patients, probably by
resolving left ventricular congestion and thus reducing right ventricular
afterload. Beneficial effects of iNO may have been masked by more
pronounced consequences of left ventricular unloading on right ventricular
function. 2011 by The American Association for Thoracic Surgery.

<11>
Accession Number
2011168034
Authors
Sudhakaran N. Davenport M.
Institution
(Sudhakaran, Davenport) Department of Paediatric Surgery, King's College
Hospital, Denmark Hill, London SE5 9RS, United Kingdom
Title
Congenital parenchymal lesions of the lung.
Source
Current Respiratory Medicine Reviews. 7 (2) (pp 130-137), 2011. Date of
Publication: 2011.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Increasing use of ultrasonography during pregnancy has uncovered a range
of parenchymal lesions within the lung, some of which will, if left, be a
cause of morbidity and occasional mortality. These include congenital
cystic adenomatoid malformations (CCAM), bronchopulmonary sequestration
(BPS), congenital lobar & segmental emphysema and bronchogenic cysts.
Adverse antenatal features include mediastinal shift, caval obstruction,
and (rarely) hydrops. This review aims to define current thoughts on these
lesions and suggest appropriate management. 2011 Bentham Science
Publishers Ltd.

<12>
Accession Number
2011177100
Authors
Pellegrino V.A. Mudaliar Y. Gopalakrishnan M. Horton M.D. Killick C.J.
Parkin W.G. Playford H.R. Raper R.F.
Institution
(Pellegrino) Intensive Care Unit, Alfred Hospital, Commercial Rd,
Melbourne, VIC 3004, Australia
(Mudaliar, Playford) Intensive Care Unit, Westmead Hospital, Sydney, NSW,
Australia
(Gopalakrishnan) Intensive Care Unit, St. Vincent's Hospital, Sydney, NSW,
Australia
(Horton) Cardiothoracic Unit, St. George Hospital, Sydney, NSW, Australia
(Killick, Parkin) Intensive Care Unit, Monash Medical Centre, Melbourne,
VIC, Australia
(Raper) Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW,
Australia
Title
Computer based haemodynamic guidance system is effective and safe in
management of postoperative cardiac surgery patients.
Source
Anaesthesia and Intensive Care. 39 (2) (pp 191-201), 2011. Date of
Publication: March 2011.
Publisher
Australian Society of Anaesthetists (P.O. Box 600, Edgecliff NSW 2027,
Australia)
Abstract
A circulatory guidance system, Navigator, was evaluated in a prospective,
randomised control trial at six Australian university teaching hospitals
involving 112 scheduled postoperative cardiac surgical patients with
pulmonary artery catheters placed and receiving 1:1 nursing care. The
guidance system was used to achieve and maintain physician-designated
cardiac output and mean arterial pressure targets and compared these with
standard post open-heart surgery care. The primary efficacy endpoint was
the standardised unsigned error between the targeted and the actual values
for cardiac output and mean arterial pressure, time averaged over the
duration of cardiac output monitoring - the average standardised distance.
This was 1.71 (SD=0.65) for the guidance group and 1.92 (SD=0.65) in the
control group (P=0.202). Rates of postoperative atrial fibrillation,
adverse events, intensive care unit and hospital length-of-stay were
similar in both groups. There were no device-related adverse events.
Guided haemodynamic therapy with the Navigator device was non-inferior to
standard intensive care unit therapy. The study was registered with
ClinicalTrials.gov Identifier NCT00468247.

<13>
Accession Number
70379809
Authors
Podoll A. Kurian D. Finkel K.
Institution
(Podoll, Kurian, Finkel) University of Texas Health Science Center,
Houston, TX, United States
Source
American Journal of Kidney Diseases. Conference: National Kidney
Foundation 2011 Spring Clinical Meetings, SCM 11 Las Vegas, NV United
States. Conference Start: 20110426 Conference End: 20110430. Conference
Publication: (var.pagings). 57 (4) (pp A79), 2011. Date of Publication:
April 2011.
Publisher
W.B. Saunders
Abstract
Mortality after cardiac surgery is often due to complications such as
peri-operative myocardial infarction, impaired myocardial function,
arrhythmias, and acute renal failure. Based on the hypothesis that oxidant
injury is a consequence of cardiac surgery, the beneficial effects of
administration of xanthine oxidase inhibitors were studied in a series of
patients in the 1990's. Although the results of these studies were
variable, a 2003 review article recommended that allopurinol be considered
in all patients undergoing standard coronary artery bypass surgery unless
contraindicated. This study was not a systematic review and did not
include five studies available at the time. Adoption of the recommendation
was poor. With a recent renewed focus on the importance of oxidative
stress and the role of uric acid and its metabolites, we conducted a
systematic review of the use of xanthine oxidase inhibitors and the
complications of cardiac surgery. A systematic review and meta-analysis
was conducted on the use of allopurinol in cardiac surgery. A search
strategy using PubMed, Embase, and the Cochrane Library identified
randomized controlled and prospective cohort studies. Study quality was
assessed by the U.S. Preventive Task Force guidelines. A meta-analysis was
conducted on mortality and pooled cardiac complications of cardiac
function, arrhythmias and ischemic events. Two level I randomized
controlled trials with 219 patients demonstrated a decreased risk of
hospital mortality (RR 0.85, <0.001) and decreased cardiac complications
(RR 0.78, p<0.004). An additional 8 studies of Level II and III quality
(n=454) analyzed separately were associated with decreased cardiac
complications (RR 0.87, p<0.04), although mortality was not consistently
reported. In patients undergoing cardiac surgery, the use of allopurinol
may reduce mortality and cardiac complications but the evidence to support
its routine use is not robust. Our findings indicate that a large
randomized control trial using xanthine oxidase inhibitors to reduce the
post-operative complications of cardiac surgery is warranted.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 22

Results Generated From:
EMBASE <1980 to 2011 Week 14>
EMBASE (updates since 2011-03-31)

<1>
Accession Number
2011160489
Authors
Yan H.-B. Song L. Liu R. Zhao H.-J. Wang S.-P. Chi Y.-P. Zheng B. Li W.-Z.
Liu C. Zhou P.
Institution
(Yan) Cardiovascular Institute and Fuwai Hospital, Peking Union Medical
College and Chinese Academy of Medical Sciences, Beijing 100029, China
(Song, Liu, Zhao, Wang, Chi, Zheng, Li, Liu, Zhou) Beijing Anzhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Comparison of safety and efficacy between fondaparinux and nadroparin in
non-ST elevation acute coronary syndromes.
Source
Chinese Medical Journal. 124 (6) (pp 879-886), 2011. Date of
Publication: March 2011.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background American College of Cardiology/American Heart
Association/European Society of Cardiology (ACC/AHA/ESC) guidelines gave
fondaparinux a class I recommendation for use in patients with non-ST
elevation acute coronary syndromes (NSTE-ACS) undergoing invasive or
conservative strategy. Nadroparin is one of the common anticoagulants used
in NSTE-ACS in China. Accordingly, this study compared the safety and
efficacy between fondaparinux and nadroparin in patients with NSTE-ACS.
Methods In this prospective, randomized, open-label, and single center
study, a total of 300 patients with NSTE-ACS were randomized to receive
either fondaparinux (group F, n=150, 2.5 mg/d) or nadroparin (group N,
n=150, 0.1 ml/10 kg q12 h) for a mean of 4 days. The primary safety
endpoint was the incidence of major or minor bleeding at 9 days that was
not related to coronary artery bypass grafting (CABG). The primary
efficacy endpoints included death, myocardial infarction, or recurrent
ischemia at 9 days. All patients underwent a 180-day follow-up. Results
Baseline characteristics were well matched between the two groups. There
was a non-significant 28% relative risk reduction in the primary safety
endpoint in group F compared with group N (4.7% vs. 6.7%, HR 0.72, 95% CI
0.42-1.65, P=0.38). The primary efficacy endpoint was 8.0% in group F and
10.0% in group N (HR, 0.82, 95% CI 0.54-1.71, P=0.49). The composite of
the safety and efficacy endpoints at 9 days (10.0% vs. 16.0%, HR 0.61, 95%
CI 0.31-1.10, P=0.10), 30 days (14.0% vs. 17.9%, HR 0.72, 95% CI
0.47-1.16, P=0.21), or 180 days (18.7% vs. 27.3%, HR 0.65, 95% CI
0.38-1.11, P=0.11) showed a non-significant trend toward a lower value in
group F. Conclusion Fondaparinux resulted in a nonsignificant risk
reduction in patients with NSTE-ACS in both bleeding and ischaemic events
during short- and long-term follow-up compared with nadroparin.

<2>
Accession Number
2011165623
Authors
Tangcharoen T. Bell A. Hegde S. Hussain T. Beerbaum P. Schaeffter T.
Razavi R. Botnar R.M. Greil G.F.
Institution
(Tangcharoen, Bell, Hegde, Hussain, Beerbaum, Schaeffter, Razavi, Botnar,
Greil) Division of Imaging Sciences, Guy's and St. Thomas' Hospital,
King's College London, London SE1 7EH, United Kingdom
(Tangcharoen) Department of Internal Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
Title
Detection of coronary artery anomalies in infants and young children with
congenital heart disease by using MR imaging.
Source
Radiology. 259 (1) (pp 240-247), 2011. Date of Publication: April 2011.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To evaluate the feasibility and accuracy of magnetic resonance
(MR) coronary angiography for the detection of coronary artery anomalies
in infants and children by using surgical findings as a reference.
Materials and Methods: The data analysis was approved by the institutional
review board. One hundred children with congenital heart disease underwent
MR coronary angiography while under general anesthesia (mean age +/-
standard deviation, 3.9 years +/- 3; age range, 0.2-11 years). A
navigator-gated, T2-prepared, three-dimensional steady-state free
precession whole-heart protocol (isotropic voxel size, 1.0-1.3
mm³; mean imaging time, 4.6 minutes +/- 1.2; mean navigator
efficiency, 70%; 3-mm gating window) was used after injection of
gadopentetate dimeglumine. The cardiac rest period (end systole or
middiastole) and acquisition window were prospectively assessed for each
patient. Coronary artery image quality (score of 0 [nondiagnostic] to 4
[excellent]), vessel sharpness, and coronary artery anomalies were
assessed by two observers. Surgery was performed in 58 patients, and those
findings were used to define accuracy. Variables were assessed between age
groups by using either analysis of variance or Kruskal-Wallis tests.
Results: Diagnostic image quality (score, >=1 for all coronary artery
segments) was obtained in 46 of the 58 patients (79%) who underwent
surgery. The origin and course of the coronary artery anatomy depicted
with MR imaging was confirmed at surgery in all 46 patients - including
the four (9%) with substantial coronary artery anomalies.
Diagnostic-quality images were obtained in 84 of the 100 patients. The
rate of success improved significantly when patients were older than 4
months (88% for patients >4 months vs 17% for patients <=4 months, P <
.001). Conclusion: Improved whole-heart MR coronary angiography enables
accurate detection of abnormal origin and course of the coronary artery
system even in very young patients with congenital heart disease. RSNA,
2011.

<3>
Accession Number
2011174780
Authors
Vrtovec B. Poglajen G. Sever M. Lezaic L. Domanovic D. Cernelc P. Haddad
F. Torre-Amione G.
Institution
(Vrtovec, Poglajen) Department of Cardiology, Advanced Heart Failure and
Transplantation Center, Ljubljana University Medical Center, Zaloska 7,
Ljubljana SI-1000, Slovenia
(Sever, Cernelc) Department of Hematology, Ljubljana, Slovenia
(Lezaic) Center for Nuclear Medicine, Ljubljana, Slovenia
(Domanovic) Blood Transfusion Center of the Republic of Slovenia,
Ljubljana, Slovenia
(Haddad) Division of Cardiovascular Medicine, Stanford University School
of Medicine, Stanford, CA, United States
(Torre-Amione) Hospital San Jose TEC de Monterrey, Monterrey, Mexico
(Torre-Amione) Weill Medical College of Cornell University, New York, NY,
United States
(Torre-Amione) Methodist DeBakey Heart Center, Methodist Hospital,
Houston, TX, United States
Title
Effects of intracoronary stem cell transplantation in patients with
dilated cardiomyopathy.
Source
Journal of Cardiac Failure. 17 (4) (pp 272-281), 2011. Date of
Publication: April 2011.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Background: We investigated clinical effects of intracoronary
transplantation of CD34+ cells in patients with dilated cardiomyopathy
(DCM). Methods: Of 55 patients with DCM, 28 were randomized to CD34+
transplantation (SC group), and 27 patients did not receive stem cell
therapy (controls). In the SC group, peripheral blood CD34+ cells were
mobilized by granulocyte-colony stimulating factor and collected via
apheresis. Patients underwent myocardial scintigraphy and CD34+ cells were
injected in the coronary artery supplying the segments with reduced
viability. Results: At baseline, the 2 groups did not differ in age,
gender, left ventricular ejection fraction (LVEF), or NT-proBNP levels. At
1 year, stem cell therapy was associated with an increase in LVEF (from
25.5 +/- 7.5% to 30.1 +/- 6.7%; P = .03), an increase in 6-minute walk
distance (from 359 +/- 104 m to 485 +/- 127 m; P = .001), and a decrease
in NT-proBNP (from 2069 +/- 1996 pg/mL to 1037 +/- 950 pg/mL; P = .01).
The secondary endpoint of 1-year mortality or heart transplantation was
lower in patients receiving SC therapy (2/28, 7%) than in controls (8/27,
30%) (P = .03), and SC therapy was the only independent predictor of
outcome on multivariable analysis (P = .04). Conclusions: Intracoronary
stem cell transplantation could lead to improved ventricular remodeling,
better exercise tolerance and potentially improved survival in patients
with DCM. 2011 Elsevier Inc. All rights reserved.

<4>
Accession Number
21412876
Authors
Henry D.A. Carless P.A. Moxey A.J. O'Connell D. Stokes B.J. Fergusson D.A.
Ker K.
Institution
(Henry) Institute of Clinical Evaluative Sciences, 2075 Bayview Avenue, G1
06, Toronto, Ontario, Canada, M4N 3M5.
Title
Anti-fibrinolytic use for minimising perioperative allogeneic blood
transfusion.
Source
Cochrane database of systematic reviews (Online). 3 (pp CD001886), 2011.
Date of Publication: 2011.
Abstract
Concerns regarding the safety of transfused blood have led to the
development of a range of interventions to minimise blood loss during
major surgery. Anti-fibrinolytic drugs are widely used, particularly in
cardiac surgery, and previous reviews have found them to be effective in
reducing blood loss, the need for transfusion, and the need for
re-operation due to continued or recurrent bleeding. In the last few years
questions have been raised regarding the comparative performance of the
drugs. The safety of the most popular agent, aprotinin, has been
challenged, and it was withdrawn from world markets in May 2008 because of
concerns that it increased the risk of cardiovascular complications and
death. To assess the comparative effects of the anti-fibrinolytic drugs
aprotinin, tranexamic acid (TXA), and epsilon aminocaproic acid (EACA) on
blood loss during surgery, the need for red blood cell (RBC) transfusion,
and adverse events, particularly vascular occlusion, renal dysfunction,
and death. We searched: the Cochrane Injuries Group's Specialised Register
(July 2010), Cochrane Central Register of Controlled Trials (The Cochrane
Library 2010, Issue 3), MEDLINE (Ovid SP) 1950 to July 2010, EMBASE (Ovid
SP) 1980 to July 2010. References in identified trials and review articles
were checked and trial authors were contacted to identify any additional
studies. The searches were last updated in July 2010. Randomised
controlled trials (RCTs) of anti-fibrinolytic drugs in adults scheduled
for non-urgent surgery. Eligible trials compared anti-fibrinolytic drugs
with placebo (or no treatment), or with each other. Two authors
independently assessed trial quality and extracted data. This version of
the review includes a sensitivity analysis excluding trials authored by
Prof. Joachim Boldt. This review summarises data from 252 RCTs that
recruited over 25,000 participants. Data from the head-to-head trials
suggest an advantage of aprotinin over the lysine analogues TXA and EACA
in terms of reducing perioperative blood loss, but the differences were
small. Compared to control, aprotinin reduced the probability of requiring
RBC transfusion by a relative 34% (relative risk [RR] 0.66, 95% confidence
interval [CI] 0.60 to 0.72). The RR for RBC transfusion with TXA was 0.61
(95% CI 0.53 to 0.70) and was 0.81 (95% CI 0.67 to 0.99) with EACA. When
the pooled estimates from the head-to-head trials of the two lysine
analogues were combined and compared to aprotinin alone, aprotinin
appeared more effective in reducing the need for RBC transfusion (RR 0.90;
95% CI 0.81 to 0.99).Aprotinin reduced the need for re-operation due to
bleeding by a relative 54% (RR 0.46, 95% CI 0.34 to 0.62). This translates
into an absolute risk reduction of 2% and a number needed-to-treat (NNT)
of 50 (95% CI 33 to 100). A similar trend was seen with EACA (RR 0.32, 95%
CI 0.11 to 0.99) but not TXA (RR 0.80, 95% CI 0.55 to 1.17). The blood
transfusion data were heterogeneous and funnel plots indicate that trials
of aprotinin and the lysine analogues may be subject to publication
bias.When compared with no treatment aprotinin did not increase the risk
of myocardial infarction (RR 0.87, 95% CI 0.69 to 1.11), stroke (RR 0.82,
95% CI 0.44 to 1.52), renal dysfunction (RR 1.10, 95% CI 0.79 to 1.54) or
overall mortality (RR 0.81, 95% CI 0.63 to 1.06). Similar trends were seen
with the lysine analogues, but data were sparse. These data conflict with
the results of recently published non-randomised studies, which found
increased risk of cardiovascular complications and death with aprotinin.
There are concerns about the adequacy of reporting of uncommon events in
the small clinical trials included in this review.When aprotinin was
compared directly with either, or both, of the two lysine analogues it
resulted in a significant increase in the risk of death (RR 1.39, 95% CI
1.02, 1.89), and a non-significant increase in the risk of myocardial
infarction (RR 1.11 95% CI 0.82, 1.50). Most of the data contributing to
this added risk came from a single study - the BART trial (2008).
Anti-fibrinolytic drugs provide worthwhile reductions in blood loss and
the receipt of allogeneic red cell transfusion. Aprotinin appears to be
slightly more effective than the lysine analogues in reducing blood loss
and the receipt of blood transfusion. However, head to head comparisons
show a lower risk of death with lysine analogues when compared with
aprotinin. The lysine analogues are effective in reducing blood loss
during and after surgery, and appear to be free of serious adverse
effects.

<5>
Accession Number
2011155131
Authors
Tamis-Holland J.E. Lu J. Bittner V. Magee M.F. Lopes N. Adler D.S. Kip
K.E. Schwartz L. Groenewoud Y.A. Jacobs A.K.
Institution
(Tamis-Holland) St. Luke's-Roosevelt Hospital Center, New York, NY, United
States
(Lu) University of Pittsburgh, Pittsburgh, PA, United States
(Bittner) University of Alabama, Birmingham, AL, United States
(Magee) Medstar Diabetes Institute, Georgetown University, School of
Medicine and Healthcare Sciences, Washington, DC, United States
(Lopes) University of Sao Paulo, Heart Institute, So Paulo, Brazil
(Adler) Brigham and Women's Hospital, Boston, MA, United States
(Kip) University of South Florida, Tampa, FL, United States
(Schwartz, Groenewoud) Toronto General Hospital, University Health
Network, Toronto, ON, Canada
(Jacobs) Boston University, School of Medicine, Boston Medical Center,
Boston, MA, United States
Title
Sex, clinical symptoms, and angiographic findings in patients with
diabetes mellitus and coronary artery disease (from the Bypass Angioplasty
Revascularization Investigation [BARI] 2 Diabetes Trial).
Source
American Journal of Cardiology. 107 (7) (pp 980-985), 2011. Date of
Publication: 01 Apr 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Previous studies have reported differences in presenting symptoms and
angiographic characteristics between women and men undergoing evaluation
for suspected coronary artery disease (CAD). We examined the relation
between symptoms and extent of CAD in patients with type 2 diabetes
mellitus and known CAD enrolled in the Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial. Of 1,775
patients (533 women, 30%, and 1,242 men, 70%), women were more likely than
men to have angina (65% vs 56%, p <0.001) or an atypical angina/anginal
equivalent (71% vs 58%, p <0.001). More women reported unstable angina
(17% vs 13%, p = 0.047) or were in a higher Canadian Cardiology Society
class compared to men (Canadian Cardiology Society classes II to IV 78% vs
68%, p = 0.002). Fewer women than men had no symptoms (14% vs 22%, p
<0.001). Women had a lower mean myocardial jeopardy index (42.5 +/- 24.3
vs 47.9 +/- 24.3, p <0.001), smaller number of total significant lesions
(2.3 +/- 1.7 vs 2.7 +/- 1.8, p <0.001), and fewer jeopardized left
ventricular regions (p <0.001 for distribution) or long-term occlusions
(29% vs 42%, p <0.001). After adjustment for relevant covariates, the odds
of having CAD symptoms were still higher in women than men (odds ratio for
angina 1.31, 95% confidence interval 1.02 to 1.69; odds ratio for atypical
angina 1.52, 95% confidence interval 1.17 to 1.96). In conclusion, in a
high-risk group of patients with known CAD and diabetes mellitus, women
were more symptomatic than men but had less obstructive CAD. These data
suggest that factors other than epicardial CAD severity influence symptom
presentation in women in this population. 2011 Elsevier Inc. All rights
reserved.

<6>
Accession Number
2011155141
Authors
Fernandes J.L. Sampaio R.O. Brando C.M. Accorsi T.A.D. Cardoso L.F. Spina
G.S. Tarasoutchi F. Pomerantzeff P. Auler Jr. J.O. Grinberg M.
Institution
(Fernandes, Sampaio, Brando, Accorsi, Cardoso, Spina, Tarasoutchi,
Pomerantzeff, Auler Jr., Grinberg) Heart Institute (InCor), University of
Sao Paulo Medical School, Sao Paulo, Brazil
Title
Comparison of inhaled nitric oxide versus oxygen on hemodynamics in
patients with mitral stenosis and severe pulmonary hypertension after
mitral valve surgery.
Source
American Journal of Cardiology. 107 (7) (pp 1040-1045), 2011. Date of
Publication: 01 Apr 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Pulmonary hypertension represents an important cause of morbidity and
mortality in patients with mitral stenosis who undergo cardiac surgery,
especially in the postoperative period. The aim of this study was to test
the hypothesis that inhaled nitric oxide (iNO) would improve the
hemodynamic effects and short-term clinical outcomes of patients with
mitral stenosis and severe pulmonary hypertension who undergo cardiac
surgery in a randomized, controlled study. Twenty-nine patients (4 men, 25
women; mean age 46 +/- 2 years) were randomly allocated to receive iNO (n
= 14) or oxygen (n = 15) for 48 hours immediately after surgery.
Hemodynamic data, the use of vasoactive drugs, duration of stay, and
short-term complications were assessed. No differences in baseline
characteristics were observed between the groups. After 24 and 48 hours,
patients receiving iNO had a significantly greater increase in cardiac
index compared to patients receiving oxygen (p <0.0001). Pulmonary
vascular resistance was also more significantly reduced in patients
receiving iNO versus oxygen (-117 dyne/s/cm⁵, 95% confidence
interval -34 to -200, vs 40 dyne/s/cm⁵, 95% confidence interval
-34 to 100, p = 0.005) at 48 hours. Patients in the iNO group used fewer
systemic vasoactive drugs (mean 2.1 +/- 0.14 vs 2.6 +/- 0.16, p = 0.046)
and had a shorter intensive care unit stay (median 2 days, interquartile
range 0.25, vs median 3 days, interquartile range 7, p = 0.02). In
conclusion, iNO immediately after surgery in patients with mitral stenosis
and severe pulmonary hypertension improves hemodynamics and may have
short-term clinical benefits. 2011 Elsevier Inc. All rights reserved.

<7>
Accession Number
2011155142
Authors
Ben-Dor I. Goldstein S.A. Pichard A.D. Satler L.F. Maluenda G. Li Y. Syed
A.I. Gonzalez M.A. Gaglia Jr. M.A. Wakabayashi K. Delhaye C. Belle L. Wang
Z. Collins S.D. Torguson R. Okubagzi P. Aderotoye A. Xue Z. Suddath W.O.
Kent K.M. Epstein S.E. Lindsay J. Waksman R.
Institution
(Ben-Dor, Goldstein, Pichard, Satler, Maluenda, Li, Syed, Gonzalez, Gaglia
Jr., Wakabayashi, Delhaye, Belle, Wang, Collins, Torguson, Okubagzi,
Aderotoye, Xue, Suddath, Kent, Epstein, Lindsay, Waksman) Division of
Cardiology, Washington Hospital Center, Washington, DC, United States
Title
Clinical profile, prognostic implication, and response to treatment of
pulmonary hypertension in patients with severe aortic stenosis.
Source
American Journal of Cardiology. 107 (7) (pp 1046-1051), 2011. Date of
Publication: 01 Apr 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The incidence, correlates, and prognostic implications of pulmonary
hypertension (PH) are unclear in patients with severe aortic stenosis
(AS). We studied 509 patients with severe AS evaluated for transcatheter
aortic valve implantation (TAVI). Patients were divided into groups based
on pulmonary artery systolic pressure (PASP): group I, 161 (31.6%) with
PASP <40 mm Hg; group II, 175 (34.3%) with PASP 40 to 59 mm Hg; and group
III, 173 (33.9%) with PASP <60 mm Hg. Group III patients were more
symptomatic and had higher creatinine levels and higher left ventricular
end-diastolic pressure. Transpulmonary gradient was >12 mm Hg in 17
patients (10.5%), 31 patients (17.7%), and 80 patients (46.2%) in groups I
through III, respectively. In a median follow-up of 202 days (73 to 446)
mortality rates were 35 (21.7%), 69 (39.3%), and 85 (49.1%) in groups I
through III, respectively (p <0.001). Immediately after TAVI, in patients
with PASP >40 mm Hg there was significant decrease in PASP (63.1 +/- 16.2
to 48.8 +/- 12.4 mm Hg, p <0.0001), which remained at 1 year (50.1 +/-
13.1 mm Hg, p = 0.04). After surgical aortic valve replacement there was a
significant immediate decrease in PASP (66.1 +/- 16.3 to 44.7 +/- 14.2 mm
Hg, p <0.0001), which persisted at 3 to 12 months (44.8 +/- 20.1 mm Hg, p
<0.001). In patients who underwent balloon aortic valvuloplasty, PASP
decreased immediately after the procedure (63.2 +/- 14.8 to 51.8 +/- 17.1
mm Hg, p <0.0001), yet at 3 to 12 months pressure returned to baseline
levels (57.4 +/- 17.0 mm Hg, p = 0.29). In conclusion, patients with
severe AS have a high prevalence of PH, and in patients with severe AS
increased PASP is associated with increased mortality. Surgical aortic
valve replacement and TAVI are effective treatments for these patients and
result in a significant PASP decrease. 2011 Elsevier Inc. All rights
reserved.

<8>
[Use Link to view the full text]
Accession Number
2011165345
Authors
Singh P.P. Singh M. Bedi U.S. Adigopula S. Singh S. Kodumuri V. Molnar J.
Ahmed A. Arora R. Khosla S.
Institution
(Singh, Singh, Bedi, Adigopula, Singh, Kodumuri, Molnar, Ahmed, Arora,
Khosla) Department of Cardiology, Chicago Medical School, Rosalind
Franklin University of Medicine and Science, North Chicago, IL 60064,
United States
Title
Outcomes of nonemergent percutaneous coronary intervention with and
without on-site surgical backup: A meta-analysis.
Source
American Journal of Therapeutics. 18 (2) (pp e22-e28), 2011. Date of
Publication: March-April 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Despite major advances in percutaneous coronary intervention (PCI)
techniques, the current guidelines recommend against elective PCI at
hospitals without on-site cardiac surgery backup. Nonetheless, an
increasing number of hospitals without on-site cardiac surgery in the
United States have developed programs for elective PCI. Studies evaluating
outcome in this setting have yielded mixed results, leaving the question
unanswered. Hence, a meta-analysis comparing outcomes of nonemergent PCI
in hospitals with and without on-site surgical backup was performed. A
systematic review of literature identified four studies involving 6817
patients. Three clinical end points were extracted from each study and
included in-hospital death, myocardial infarction, and the need for
emergency coronary artery bypass grafting. The studies were homogenous for
each outcome studied. Therefore, the combined relative risks (RRs) across
all the studies and the 95% confidence intervals (CIs) were computed using
the Mantel-Haenszel fixed-effect model. A two-sided alpha error less than
0.05 was considered to be statistically significant. Compared with
facilities with on-site surgical backup, the risk of in-hospital death
(RR, 2.7; CI, 0.6-12.9; P = 0.18), nonfatal myocardial infarction (RR,
1.3; CI, 0.7-2.2; P = 0.29), and need of emergent coronary artery bypass
grafting (RR, 0.46; CI, 0.06-3.1; P = 0.43) was similar in those lacking
on-site surgical backup. The present meta-analysis suggests that there is
no difference in the outcome with regard to risk of nonfatal myocardial
infarction, need for emergency coronary artery bypass grafting, and the
risk of death in patients undergoing elective PCI in hospitals with and
without on-site cardiac surgery backup. 2011 Lippincott Williams
&Wilkins.

<9>
Accession Number
2011170324
Authors
Thiara A.S. Mollnes T.E. Videm V. Andersen V.Y. Svennevig K. Kolset S.O.
Fiane A.E.
Institution
(Thiara, Andersen, Fiane) Department of Thoracic and Cardiovascular
Surgery, Oslo University Hospital, 0027 Oslo, Norway
(Mollnes) Institute of Immunology, Oslo University Hospital, Oslo, Norway
(Mollnes) Nordland Hospital, Bodo, University of Tromso, Norway
(Mollnes, Fiane) Faculty Division Rikshospitalet, University of Oslo,
Oslo, Norway
(Videm) Department of Immunology and Transfusion Medicine, Norwegian
University of Science and Technology, Trondheim University Hospital,
Trondheim, Norway
(Svennevig, Kolset) Department of Nutrition, Institute of Basic Medical
Sciences, University of Oslo, Norway
Title
Biocompatibility and pathways of initial complement pathway activation
with Phisio- and PMEA-coated cardiopulmonary bypass circuits during
open-heart surgery.
Source
Perfusion. 26 (2) (pp 107-114), 2011. Date of Publication: March 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
A randomized open-heart surgery study comprising 30 patients was
undertaken to compare the biocompatibility of Phisio-(phosphorylcholine)
and PMEA-(poly-2-methoxyethyl acrylate) coated cardiopulmonary bypass
(CPB) circuits and to assess the initial complement pathway activation
during open-heart surgery. Blood samples were obtained at five time
points, from the start of surgery to 24 hours postoperatively. The
following analyses were performed: haemoglobin, lactate dehydrogenase,
leukocyte and platelet counts, myeloperoxidase and neutrophil-activating
peptide-2, thrombin-anti-thrombin complexes, syndecan-1 and the complement
activation products C1rs-C1-inhibitor complexes, C4bc, C3bc, C3bBbP and
the terminal complement complex (TCC). No significant inter-group
difference was found in any parameters, except for the concentration of
TCC which was moderately lower in the PMEA group at termination of CPB.
Complement activation during open-heart surgery was mainly mediated
through the alternative pathway. In conclusion, PMEA- and Phisio-coated
circuits displayed similar biocompatibility with respect to inflammatory
and haemostatic responses during and after open-heart surgery. The
Author(s) 2010.

<10>
Accession Number
2011170325
Authors
Baufreton C. Pinaud F. Corbeau J.J. Chevailler A. Jolivot D. Ter Minassian
A. Henrion D. De Brux J.L.
Institution
(Baufreton, Pinaud, Jolivot, De Brux) Department of Cardiac Surgery,
University Hospital, 4 rue Larrey, F-49933, Angers Cedex 09, France
(Corbeau, Ter Minassian) Department of Anaesthesiology, University
Hospital, Angers, France
(Chevailler) Laboratory of Immunology, University Hospital, Angers, France
(Pinaud, Henrion) UMR-CNRS 6214, INSERM 771, University of Angers, Angers,
France
Title
Increased cerebral blood flow velocities assessed by transcranial Doppler
examination is associated with complement activation after cardiopulmonary
bypass.
Source
Perfusion. 26 (2) (pp 91-98), 2011. Date of Publication: March 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
The role of complement activation on the cerebral vasculature after
cardiopulmonary bypass (CPB) is unclear. The goal of the study was to
assess whether heparin-coated CPB reduces complement activation, and
influences cerebral blood flow velocities (CBFV). Twenty-four patients
undergoing coronary surgery were randomly allocated to non-coated
(NC-group) or heparin-coated (HC-group) CPB. Complement activation was
assessed by measuring sC5b-9. Transcranial Doppler (TCD) was performed on
middle cerebral arteries before and after CPB. Systolic (SV), diastolic
(DV) and mean (MV) CBFV were measured. Significant increase of sC5b-9
(p=0.003) was observed in the NC-group and CBFV increased after CPB (SV by
27%, p=0.05; DV by 40%, p=0.06; MV by 33%, p=0.04) whereas no changes were
detected in the HC-group. TCD values were higher in the NC-group than in
the HC-group (SV, p=0.04; DV, p=0.03; MV, p=0.03) although cardiac index,
systemic vascular resistance, haematocrit and pCO₂ were
similar. Postoperative SV, DV and MV were significantly correlated with
sC5b-9 (r=0.583, p=0.009; r=0.581, p=0.009; r=0.598, p=0.007,
respectively). Increased CBFV after CPB are correlated to the level of
complement activation and may be controlled by heparin-coated circuits.
The Author(s) 2010.

<11>
Accession Number
2011156891
Authors
Moreno R. Martin-Reyes R. Jimenez-Valero S. Sanchez-Recalde A. Galeote G.
Calvo L. Plaza I. Lopez-Sendon J.-L.
Institution
(Moreno, Martin-Reyes, Jimenez-Valero, Sanchez-Recalde, Galeote, Calvo,
Plaza, Lopez-Sendon) University Hospital La Paz, Paseo La Castellana, 261,
28046 Madrid, Spain
Title
Determining clinical benefits of drug-eluting coronary stents according to
the population risk profile: A meta-regression from 31 randomized trials.
Source
International Journal of Cardiology. 148 (1) (pp 23-29), 2011. Date of
Publication: 01 Apr 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: The use of drug-eluting stents (DES) in unfavourable patients
has been associated with higher rates of clinical complications and stent
thrombosis, and because of that concerns about the use of DES in high-risk
settings have been raised. Objective: This study sought to demonstrate
that the clinical benefit of DES increases as the risk profile of the
patients increases. Methods: A meta-regression analysis from 31 randomized
trials that compared DES and bare-metal stents, including overall 12,035
patients, was performed. The relationship between the clinical benefit of
using DES (number of patients to treat [NNT] to prevent one episode of
target lesion revascularization [TLR]), and the risk profile of the
population (rate of TLR in patients allocated to bare-metal stents) in
each trial was evaluated. Results: The clinical benefit of DES increased
as the risk profile of each study population increased: NNT for TLR =
31.1-1.2 (TLR for bare-metal stents); p < 0.001. The use of DES was safe
regardless of the risk profile of each study population, since the effect
of DES in mortality, myocardial infarction, and stent thrombosis, was not
adversely affected by the risk profile of each study population (95%
confidence interval for beta value 0.09 to 0.11, - 0.12 to 0.19, and -
0.03 to-0.15 for mortality, myocardial infarction, and stent thrombosis,
respectively). Conclusions: The clinical benefit of DES increases as the
risk profile of the patients increases, without affecting safety. 2009
Elsevier Ireland Ltd.

<12>
Accession Number
2011160323
Authors
Wilinski J. Czarnecka D. Wojciechowska W. Kloch-Badelek M. Jastrzebski M.
Bacior B. Sondej T. Kusak P. Przybyla A. Kawecka-Jaszcz K.
Institution
(Wilinski, Czarnecka, Wojciechowska, Kloch-Badelek, Jastrzebski, Bacior,
Sondej, Kusak, Przybyla, Kawecka-Jaszcz) 1st Department of Cardiology and
Hypertension, Jagiellonian University Medical College, Krakow, Poland
Title
Clinical and classic echocardiographic features of patients with, and
without, left ventricle reverse remodeling following the introduction of
cardiac resynchronization therapy.
Source
Cardiology Journal. 18 (2) (pp 157-164), 2011. Date of Publication:
2011.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: The aim of the study was to assess clinical and classic
echocardiographic data in patients with different cardiac
resynchronization therapy (CRT) outcomes. Methods: Sixty consecutive
patients (aged 66.3 +/- 8.7 years, 57 men) with chronic heart failure
(CHF) in New York Heart Association (NYHA) classes III-IV despite
optimized pharmacotherapy, with left ventricular end-diastolic diameter
(LVEDD) > 55 mm, left ventricular ejection fraction <= 35% and wide QRS
complex (>= 120 ms), including individuals with permanent atrial
fibrillation (AF) and single- and dual-chamber pacing, were assessed
firstly before, and secondly three months after, biventricular heart
stimulator implantation (excluding three patients who died during the
follow-up). Patients developing >= 10% reduction of left ventricular
end-systolic volume (LVESV) were classified as responders to CRT. Results:
The group of responders (n = 34, 59.7%) and the group of non-responders (n
= 23, 40.3%) did not differ regarding baseline echocardiographic
parameters or in terms of clinical data of age, gender, concomitant
diseases, smoking or pharmacological treatment. The differences involved
higher rates of ischemic CHF background, prevalence of hypertension and
permanent AF, and a higher concentration of N-terminal pro-B-type
natriuretic peptide (NT- -proBNP) among the non-responders. In the
multivariate logistic regression analysis, NT-proBNP, body mass index
(BMI) and the presence of permanent AF correlated negatively with the
magnitude of LVESV reduction following CRT introduction. Conclusions:
Classic echocardiographic data did not predict left ventricle reverse
remodeling. Higher rates of ischemic CHF aetiology, hypertension,
permanent AF and higher NT-proBNP concentration were found in the group
without at least 10% LVESV reduction at the three month follow-up.
NT-proBNP, BMI and the presence of permanent AF had negative effects on
the magnitude of LVESV. 2011 Via Medica.

<13>
Accession Number
2011161682
Authors
De Leyn P. Muller M.-R. Oosterhuis J.W.A. Schmid T. Choong C.K.C. Weder W.
Sokolow Y.
Institution
(De Leyn) University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
(Muller) Otto Wagner Hospital, Vienna, Austria
(Oosterhuis) VU-Medisch Centrum, Amsterdam, Netherlands
(Schmid) Universitatsklinik-Landeskrankenhaus Innsbruck, Innsbruck,
Austria
(Choong) Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Weder) Universitaets Spital Zurich, Zurich, Switzerland
(Sokolow) Hopital Erasme, Brussels, Belgium
Title
Prospective European multicenter randomized trial of PleuraSeal for
control of air leaks after elective pulmonary resection.
Source
Journal of Thoracic and Cardiovascular Surgery. 141 (4) (pp 881-887),
2011. Date of Publication: April 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We sought to evaluate the efficacy and safety of a synthetic
bioresorbable pleural sealant (PleuraSeal; Covidien, Bedford, Mass) to
treat air leaks after pulmonary resection. Methods: Patients with air
leaks after lung resection were randomized to treatment with pleural
sealant on air leak sites after standard methods of lung closure or
standard lung closure only. The primary outcome variable was the
percentage of patients remaining air leak free until discharge. The
secondary outcome variables were the proportion of patients with
successful intraoperative air leak sealing, time to last air leak, and
durations of chest tube drainage and hospitalization. Results: The sealant
group comprised 62 subjects, and the control group comprised 59 subjects.
Most patients (98.3%) underwent open lobectomy for bronchogenic carcinoma.
The overall success rates for intraoperative air leak sealing were as
follows: sealant group, 71.0%; control group, 23.7% (P < .001). For grade
2 and 3 air leaks (n = 77), the intraoperative sealing rates were as
follows: sealant group, 71.7%; control group, 9.1% (P < .001). More
patients with grade 2 and 3 air leaks had their leaks remain sealed in the
sealant group (43.5% vs 15.2%, P = .013). The median time from skin
closure to last observable air leak was 6 hours (sealant group) versus 42
hours (control group, P = .718). No treatment-related complications were
reported. No differences in drainage or hospitalization were observed.
Conclusions: In this multicenter study the pleural sealant was safe and
effective treatment for intraoperative air leaks after lung resection.
Significantly fewer patients with surgically relevant intraoperative air
leaks had postoperative air leaks when the pleural sealant was applied.
2011 by The American Association for Thoracic Surgery.

<14>
Accession Number
2011165311
Authors
Onuma Y. Wykrzykowska J.J. Garg S. Vranckx P. Serruys P.W.
Institution
(Onuma, Wykrzykowska, Garg, Vranckx, Serruys) Thoraxcenter, Erasmus
Medical Center, Department of Interventional Cardiology, Dr
Molerwaterplein 40, Ba-583, 3015-GD, Rotterdam, Netherlands
Title
5-year follow-up of coronary revascularization in diabetic patients with
multivessel coronary artery disease: Insights from ARTS (Arterial
revascularization therapy study)-II and ARTS-I trials.
Source
JACC: Cardiovascular Interventions. 4 (3) (pp 317-323), 2011. Date of
Publication: March 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: We compared the 5-year outcomes of diabetic patients with
multivessel disease treated with sirolimus-eluting stents (SES),
bare-metal stents (BMS), and coronary artery bypass graft surgery (CABG)
enrolled in the ARTS (Arterial Revascularization Therapy Study) I and II
studies. Background: Diabetes is an established risk factor for major
adverse cardiac events after revascularization. Recent trials suggest that
revascularization with drug-eluting stents has equivalent safety to CABG
up to 2 years. Methods: The ARTS I and II studies included 367 diabetic
patients (SES: 159, CABG: 96, and BMS: 112) compared with respect to
5-year clinical outcomes. Results: The rate of major adverse
cardiovascular and cerebrovascular events was significantly higher in
patients treated with BMS (BMS 53.6% vs. CABG 23.4% vs. SES 40.5%;
log-rank, p < 0.01 for SES vs. BMS and SES vs. CABG). There was no
significant difference in mortality among all 3 groups. There was,
however, a statistically significant difference in the myocardial
infarction rate between BMS and CABG arms (BMS 11.0%, CABG 5.2%, SES 4.8%,
p = 0.04 for SES vs. BMS and p = 0.76 for SES vs. CABG). The rate of
repeat revascularization was significantly lower in patients treated with
CABG compared with SES (SES 33.2% vs. CABG 10.7%, p < 0.001).
Revascularization rate of patients treated with SES at 5 years approached
that of patients treated with BMS although remained significantly lower.
This "catch-up" phenomenon was not apparent in the nondiabetic population.
Conclusions: At 5-year follow-up, CABG has comparable safety and superior
efficacy compared with BMS and SES in the treatment of diabetic patients
with multivessel disease. 2011 American College of Cardiology Foundation.

<15>
Accession Number
2011165315
Authors
Burzotta F. Trani C. Todaro D. Mariani L. Talarico G.P. Tommasino A.
Giammarinaro M. Niccoli G. Porto I. Leone A.M. Mongiardo R. Mazzari M.A.
Schiavoni G. Crea F.
Institution
(Burzotta, Trani, Todaro, Mariani, Talarico, Tommasino, Giammarinaro,
Niccoli, Porto, Leone, Mongiardo, Mazzari, Schiavoni, Crea) Institute of
Cardiology, Catholic University of the Sacred Heart, Rome, Italy
(Burzotta) L.go Gemelli 1, 00168 Rome, Italy
Title
Prospective randomized comparison of sirolimus- or everolimus-eluting
stent to treat bifurcated lesions by provisional approach.
Source
JACC: Cardiovascular Interventions. 4 (3) (pp 327-335), 2011. Date of
Publication: March 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to compare the procedural performance and
the acute angiographic result on side-branch ostium obtained using 2
different drug-eluting stents (DES) to treat patients with bifurcated
coronary lesions. Background: Drug-eluting stents are routinely used in
percutaneous coronary interventions (PCI) of bifurcated coronary lesions.
Different DES types have major technical differences that may influence
the procedural and clinical performance in bifurcation PCI. Methods:
Consecutive patients with bifurcated lesions undergoing DES implantation
using a systematic provisional-stenting strategy were randomized to
sirolimus-eluting stent (SES) or everolimus-eluting stent (EES) before
intervention. The procedural details for PCI were prospectively recorded
to assess the occurrence of any trouble in the side-branch (SB) management
(primary end point). Post-PCI angiographic result (primary end point:
minimal lumen diameter at SB ostium) was evaluated offline by
3-dimensional reconstruction and quantitative coronary analysis. Clinical
outcome was prospectively recorded up to 18 months to assess the
occurrence of target bifurcation failure. Results: A total of 150 patients
were enrolled in the study (29% diabetics, 17% unprotected left main). The
stent was successfully implanted according to randomization in all cases.
Procedural performance was not significantly different between the 2 kinds
of DES. Three-dimensional reconstruction and quantitative coronary
analysis showed similar post-PCI results in the main vessel and better
results in the SB with EES than with SES (minimal lumen diameter at SB
ostium: 1.94 +/- 0.72 mm vs. 1.64 +/- 0.62 mm; p = 0.013). At 18 months,
target bifurcation failure occurred in 7 (9.0%) of SES-treated patients
versus 8 (10.7%) of EES patients (p = 0.57). Conclusions: In patients with
bifurcated lesions treated by provisional stenting technique, EES compared
with SES is associated with similar procedural performance and better
3-dimensional reconstruction and quantitative coronary analysis result in
the SB. Both DES are associated with low rates of major adverse events and
angiographic failure. (Sirolimus Versus Everolimus-Eluting Stent
Randomized Assessment in Bifurcated Lesions and Clinical Significance of
Residual Side-Branch Stenosis [SEA-SIDE]; NCT00697372) 2011 American
College of Cardiology Foundation.

<16>
Accession Number
2011165320
Authors
Stone G.W. Goldberg S. O'Shaughnessy C. Midei M. Siegel R.M. Cristea E.
Dangas G. Lansky A.J. Mehran R.
Institution
(Stone, Cristea, Dangas, Lansky, Mehran) Department of Medicine, Columbia
University, New York-Presbyterian Hospital, New York, NY, United States
(Goldberg) Hahnemann University Hospital, Philadelphia, PA, United States
(O'Shaughnessy) EMH Regional Medical Center, Elyria, OH, United States
(Midei) St. Joseph's Medical Center, Towson, MD, United States
(Siegel) Phoenix Memorial Hospital, Phoenix, AZ, United States
(Stone) Columbia University Medical Center, New York Presbyterian
Hospital, Cardiovascular Research Foundation, 111 East 59th Street, New
York, NY 10022, United States
Title
5-year follow-up of polytetrafluoroethylene-covered stents compared with
bare-metal stents in aortocoronary saphenous vein grafts: The randomized
BARRICADE (Barrier Approach to Restenosis: Restrict Intima to Curtail
Adverse Events) trial.
Source
JACC: Cardiovascular Interventions. 4 (3) (pp 300-309), 2011. Date of
Publication: March 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: We sought to evaluate the utility of the JOSTENT
polytetrafluoroethylene (PTFE) stent-graft (Jomed GmbH, Rangendingen,
Germany) in patients with diseased saphenous vein grafts (SVGs) undergoing
percutaneous coronary intervention (PCI). Background: Prior trials of the
JOSTENT stent-graft did not mandate high-pressure implantation or
prolonged dual antiplatelet therapy, and were limited by short-term
follow-up. Methods: A total of 243 patients at 47 centers with 1 to 2
discrete lesions in SVGs were prospectively randomized to JOSTENT
implantation (<18 atm.) versus bare-metal stents (BMS). The JOSTENT
patients were treated with aspirin indefinitely and clopidogrel for <8
months. Routine angiographic follow-up was performed at 8 months, and all
patients were followed for 5 years. Results: The primary end point of
in-lesion binary restenosis occurred in 31.8% of lesions treated with the
JOSTENT versus 28.4% of lesions treated with BMS (relative risk: 1.12, 95%
confidence interval [CI]: 0.72 to 1.75, p = 0.63). At 9 months, the major
secondary end point of target vessel failure (death, myocardial
infarction, or clinically driven target vessel revascularization) occurred
in 32.2% of patients treated with the JOSTENT versus 22.1% of patients
treated with BMS (hazard ratio: 1.54, 95% CI: 0.94 to 2.53, p = 0.08).
During long-term follow-up, significantly more events accrued in the
JOSTENT arm such that by 5 years target vessel failure had occurred in
68.3% of JOSTENT patients versus 51.8% of BMS patients (hazard ratio:
1.59, 95% CI: 1.13 to 2.23, p = 0.007). Conclusions: The long-term
prognosis for diseased SVGs requiring PCI is dismal. The JOSTENT PTFE
stent-graft results in inferior outcomes compared with BMS, despite
high-pressure implantation and prolonged dual antiplatelet therapy, a
finding that becomes more evident with longer-term follow-up. 2011
American College of Cardiology Foundation.

<17>
Accession Number
2011166525
Authors
Rosenfeldt F. Braun L. Spitzer O. Bradley S. Shepherd J. Bailey M. van der
Merwe J. Leong J.-Y. Esmore D.
Institution
(Rosenfeldt, Braun, Spitzer, van der Merwe, Leong, Esmore) Cardiac
Surgical Research Unit, Alfred Hospital, Department of Surgery, Monash
University, Baker IDI Institute Melbourne, Australia
(Bailey) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bradley) Department of Physiotherapy, Alfred Hospital, Melbourne,
Australia
(Shepherd) Occupational Therapy Services, Alfred Hospital, Melbourne,
Australia
Title
Physical conditioning and mental stress reduction - a randomised trial in
patients undergoing cardiac surgery.
Source
BMC Complementary and Alternative Medicine. 11 , 2011. Article Number:
20. Date of Publication: 09 Mar 2011.
Publisher
BioMed Central Ltd. (34 - 42 Cleveland Street, London W1T 4LB, United
Kingdom)
Abstract
Background: Preoperative anxiety and physical unfitness have been shown to
have adverse effects on recovery from cardiac surgery. This study
involving cardiac surgery patients was primarily aimed at assessing the
feasibility of delivering physical conditioning and stress reduction
programs within the public hospital setting. Secondary aims were to
evaluate the effect of these programs on quality of life (QOL), rates of
postoperative atrial fibrillation (AF) and length of stay (LOS) in
hospital.Methods: Elective patients scheduled for coronary artery bypass
graft and/or valve surgery at a public hospital in Melbourne, Australia
were enrolled. Patients were randomized to receive either holistic therapy
(HT) or usual care (UC). HT consisted of a series of light physical
exercise sessions together with a mental stress reduction program
administered in an outpatient setting for the first two weeks after
placement on the waiting list for surgery. A self-administered SF-36
questionnaire was used to measure QOL and hospital records to collect data
on LOS and rate of postoperative AF.Results: The study population
comprised 117 patients of whom 60 received HT and 57 received UC. Both
programs were able to be delivered within the hospital setting but ongoing
therapy beyond the two week duration of the program was not carried out
due to long waiting periods and insufficient resources. HT, as delivered
in this study, compared to UC did not result in significant changes in
QOL, LOS or AF incidence.Conclusions: Preoperative holistic therapy can be
delivered in the hospital setting, although two weeks is insufficient to
provide benefits beyond usual care on QOL, LOS or postoperative AF.
Further research is now required to determine whether a similar program of
longer duration, or targeted to high risk patients can provide measurable
benefits.Trial registration: This trial was conducted as part of a larger
study and according to the principles contained in the CONSORT statement
2001. 2011 Rosenfeldt et al; licensee BioMed Central Ltd.

<18>
[Use Link to view the full text]
Accession Number
2011167497
Authors
Goldberg D.J. French B. McBride M.G. Marino B.S. Mirarchi N. Hanna B.D.
Wernovsky G. Paridon S.M. Rychik J.
Institution
(Goldberg, McBride, Mirarchi, Hanna, Wernovsky, Paridon, Rychik) Division
of Cardiology, Children's Hospital of Philadelphia, 34th and Civic Center
Blvd, Philadelphia, PA 19104, United States
(Goldberg, Hanna, Wernovsky, Paridon, Rychik) Departments of Pediatrics,
United States
(French) Departments of Biostatistics and Epidemiology, University of
Pennsylvania School of Medicine, Philadelphia, United States
(Marino) Divisions of Cardiology and Critical Care Medicine, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
Title
Impact of oral sildenafil on exercise performance in children and young
adults after the fontan operation: A randomized, double-blind,
placebo-controlled, crossover trial.
Source
Circulation. 123 (11) (pp 1185-1193), 2011. Date of Publication: 22 Mar
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street, Philadelphia PA
19106-3621, United States)
Abstract
Background-: Children and young adults with single-ventricle physiology
have abnormal exercise capacity after the Fontan operation. A medication
capable of decreasing pulmonary vascular resistance should allow improved
cardiac filling and improved exercise capacity. Methods and results-: This
study was a double-blind, placebo-controlled, crossover trial conducted in
children and young adults after Fontan. Subjects were randomized to
receive placebo or sildenafil (20 mg three times daily) for 6 weeks. After
a 6-week washout, subjects crossed over for an additional 6 weeks. Each
subject underwent an exercise stress test at the start and finish of each
phase. After taking sildenafil, subjects had a significantly decreased
respiratory rate and decreased minute ventilation at peak exercise. At the
anaerobic threshold, subjects had significantly decreased ventilatory
equivalents of carbon dioxide. There was no change in oxygen consumption
during peak exercise, although there was a suggestion of improved oxygen
consumption at the anaerobic threshold. Improvement at the anaerobic
threshold was limited to the subgroup with single left or mixed
ventricular morphology and to the subgroup with baseline serum brain
natriuretic peptide levels 100 pg/mL. Conclusions-: In this cohort,
sildenafil significantly improved ventilatory efficiency during peak and
submaximal exercise. There was also a suggestion of improved oxygen
consumption at the anaerobic threshold in 2 subgroups. These findings
suggest that sildenafil may be an important agent for improving exercise
performance in children and young adults with single-ventricle physiology
after the Fontan operation. 2011 American Heart Association, Inc.

<19>
Accession Number
2011168349
Authors
Georgiadis A.L. Memon M.Z. Shah Q.A. Vazquez G. Suri M.F.K. Lakshminarayan
K. Qureshi A.I.
Institution
(Georgiadis, Memon, Shah, Vazquez, Suri, Lakshminarayan, Qureshi) Zeenat
Qureshi Stroke Research Center, Department of Neurology, University of
Minnesota, Minneapolis, MN, United States
Title
Comparison of Partial (6 mg/kg) versus Full-Dose (9 mg/kg) Intravenous
Recombinant Tissue Plasminogen Activator Followed by Endovascular
Treatment for Acute Ischemic Stroke: A Meta-Analysis.
Source
Journal of Neuroimaging. 21 (2) (pp 113-120), 2011. Date of Publication:
April 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
In the treatment of acute ischemic stroke, intravenous (IV) recombinant
tissue plasminogen (rt-PA) and intraarterial (IA) interventions are often
combined. However, the optimal dose of IV rt-PA preceding endovascular
treatment has not been established. METHODS: Studies that used combined IV
and IA thrombolysis were identified from a search of the MEDLINE, PubMed,
and Cochrane databases. We compared the rates of angiographic
recanalization, symptomatic intracerebral hemorrhage (sICH), and favorable
functional outcome between patients who had been treated with .6 mg/kg IV
rt-PA and those who had received .9 mg/kg rt-PA. RESULTS: Eleven studies
met our criteria. In 7 studies, .6 mg/kg IV rt-PA had been administered to
317 patients, whereas 140 patients in 4 studies had received .9 mg/kg of
IV rt-PA. The weighted mean of median National Institutes of Health Stroke
Scale score at presentation was 18.3 in the .6 mg/kg group (median range
9-34), and 17.3 in the .9 mg/kg group (median range 4-39). Patients in the
.9 mg/kg group had higher rates of favorable outcome [odds ratio (OR) =
1.60, 95% confidence interval (CI) = (1.07-2.40), P=.022] and similar
rates of sICH [OR=.86 (95% CI .41-1.83), P=.70]. Depending on the
statistics used, the higher angiographic recanalization rate among
patients treated with .9 mg/kg was significant (P=.03, events/trial syntax
logistic regression) or borderline significant (P=.07, random effects
model). CONCLUSION: Our analysis suggests that using .9 mg/kg IV rt-PA
prior to IA thrombolysis is safe and may be associated with higher
recanalization rates and better functional outcome at 3 months. 2009 by
the American Society of Neuroimaging.

<20>
Accession Number
70371678
Authors
Haase M. Bellomo R. Devarajan P. Haase-Fielitz A.
Institution
(Haase, Haase-Fielitz) Department of Nephrology and Intensive Care
Medicine, Charite-University Medicine Berlin, Germany
(Bellomo) Department of Intensive Care, Austin Health, Melbourne,
Australia
(Devarajan) Department of Pediatrics and Developmental Biology, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
Source
Infection. Conference: 4th International Congress "Sepsis and Multiorgan
Dysfunction" Weimar Germany. Conference Start: 20090909 Conference End:
20090912. Conference Publication: (var.pagings). 37 (pp 33), 2009.
Date of Publication: November 2009.
Publisher
Urban und Vogel
Abstract
Introduction: Neutrophil Gelatinase-Associated Lipocalin (NGAL) appears to
be a promising biomarker for the early diagnosis of acute kidney injury
(AKI), however a wide range in its predicitve accuracy has been reported.
Objectives: To estimate the accuracy of NGAL for the early diagnosis of
AKI. Methods: Study design: Meta-analysis of observational cohort studies
contacting each author to complete and return custom-made datasheets using
standardized AKI definition and timing of NGAL measurement. Setting and
population: Different clinical settings of AKI. Selection criteria for
studies: MEDLINE, EMBASE, CENTRAL databases and congress abstracts were
searched for studies that reported the value of NGAL to predict AKI.
Outcomes: The primary outcome was AKI defined as an increase in serum
creatinine > 50% from baseline within 7 days or as contrast-induced
nephropathy (creatinine > 25% or 0.5 mg/dL in adults or > 50% in children
within 48 hours). Secondary outcomes included renal replacement therapy
initiation and in-hospital mortality. Results: Using a hierarchical
bivariate generalized linear model, we analyzed data from 19 studies and 8
countries involving 2538 patients, out of whom 461 (18.2%) developed AKI.
Overall, the diagnostic odds ratio (DOR [95%CI]) of NGAL to predict AKI
was 18.6 (9.038.1). The DOR when standardized platforms were used was 25.5
(8.972.8) with cut-off of > 150 ng/mL for AKI compared to 16.7 (7.1-39.7)
for research-based NGAL assays. In cardiac surgery patients, the DOR of
NGAL was 13.1 (5.7-34.8), in critically ill patients 10.0 (3.033.1) and
after contrast infusion 92.0 (10.7-794.1). The diagnostic accuracy of
plasma/serum NGAL (17.9 [6.0-53.7]) was similar to that of urine NGAL
(18.6 [7.2-48.4]). We identified age to be an effective modifier of NGAL
value with better predictive ability in children (25.4 [8.9-72.2])
compared to adults (10.6 [4.8-23.4]). NGAL was a useful prognostic tool
predicting renal replacement therapy initiation (12.9 [4.9-33.9]) and
in-hospital mortality (8.8 [1.9-40.8]). Conclusions: NGAL appears to be of
diagnostic and prognostic value in patients developing AKI.

<21>
Accession Number
2011142681
Authors
Zhou Z.-J. Zheng Y.-L. Hu Y.-H.
Institution
(Zhou, Hu) School of Public Health, Peking University, Beijing 100191,
China
(Zheng) Department of Pharmacy, Beijing Fuwai Cardiovascular Hospital,
Beijing 100037, China
Title
Effect and cost of perioperative use of antibiotics in coronary artery
bypass grafting: A randomized controlled study.
Source
Chinese Medical Journal. 124 (5) (pp 699-703), 2011. Date of
Publication: March 2011.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Bacterial infections remain a serious complication following
coronary artery bypass grafting (CABG). The objective of the study was to
determine the effectiveness of a guideline for the appropriate use of
antibiotics in CABG during the perioperative period. Methods Six hundred
and fourteen hospitalized patients who had undergone CABG from January to
June 2006 were randomly allocated to an intervention group and a control
group. The data on the hospital stay, days of antibiotic used, types of
prophylactic antibiotics used, surgical wound infection and pulmonary
infection and antibiotic costs for the patients were compared. Results The
postoperative hospitalization days of the intervention group were
significantly fewer than that for the control group (P <0.05). The time of
antibiotic use and post-infection treatment time were also significantly
less in the intervention group than in the control group (P <0.05). The
average hospital daily cost and total cost of antibiotics were less in the
intervention group than in the control group (P <0.05). Compared with the
control group, prophylactic antibiotic use in the intervention group was
more reasonable. Conclusions The guideline for the appropriate use of
antibiotics in CABG during the perioperative period is effective
strategies for reducing antibiotic costs, the time of antibiotic use and
post-infection treatment time without compromising the patients' clinical
outcome.

<22>
Accession Number
2011158879
Authors
Xia W. Liu Y. Zhou Q.-S. Tang Q.-Z. Zou H.
Institution
(Xia, Zhou, Zou) Department of Critic Care Medicine, Renmin Hospital of
Wuhan University, 238 Jiefang Road, Wuhan 430060, China
(Xia, Liu, Tang) Department of Cardiology, Renmin Hospital of Wuhan
University, 238 Jiefang Road, Wuhan 430060, China
(Tang) Cardiovascular Research Institute, Wuhan University, Wuhan, China
Title
Comparison of the effects of propofol and midazolam on inflammation and
oxidase stress in children with congenital heart disease undergoing
cardiac surgery.
Source
Yonsei Medical Journal. 52 (2) (pp 326-332), 2011. Date of Publication:
March 2011.
Publisher
Yonsei University College of Medicine (Shinchon dong 134, Seodaemoon ku,
Seoul 120-752, South Korea)
Abstract
Purpose: To investigate and compare the effects of propofol and midazolam
on inflammation and oxidase stress in children with congenital heart
disease undergoing cardiac surgery. Materials and Methods: Thirty-two ASA
class I-II children with congenital heart disease undergoing cardiac
surgery were randomly divided into two groups: propofol combined with low
dose fentanyl (PF group, n = 16) and midazolam combined with low dose
fentanyl (MF group, n = 16). Tracheal extubation time and length of
Intensive Care Unit (ICU) stay were recorded. Blood samples were taken
before operation (T₀), at 2 h after release of the aorta
cross-clamp (T₃) and at 24 h after operation (T₄) to
measure interleukin 6 (IL-6), IL-8, superoxide dismutase (SOD) and
malondialdehyde (MDA) levels. Myocardium samples were collected at 10-20
min after aorta cross-clamp (T₁) and at 10-20 min after the
release of the aorta cross-clamp (T₂) to detect heme
oxygenase-1 (HO-1) expression. Results: Tracheal extubation time and
length of ICU stay in PF group were significantly shorter than those of
the MF group (p < 0.05, respectively). After cardiopulmonary bypass, IL-6,
IL-8 and MDA levels were significantly increased, and the SOD level was
significantly reduced in both two groups, but PF group exhibited lower
IL-6, IL-8 and MDA levels and higher SOD levels than the MF group (p <
0.05, respectively). The HO-1 expression in the PF group was significantly
higher than that in MF group at the corresponding time points (p < 0.05,
respectively). Conclusion: Propofol is superior to midazolam in reducing
inflammation and oxidase stress and in improving post-operation recovery
in children with congenital heart disease undergoing cardiac surgery.
Yonsei University College of Medicine 2011.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 14

Results Generated From:
EMBASE <1980 to 2011 Week 13>
EMBASE (updates since 2011-03-24)

<1>
Accession Number
2011158421
Authors
McHugh S.M. Collins C.J. Corrigan M.A. Hill A.D.K. Humphreys H.
Institution
(McHugh, Corrigan, Hill) Department of Surgery, Royal College of Surgeons
in Ireland, Dublin 2, Ireland
(McHugh, Corrigan, Hill) Department of Surgery, Beaumont Hospital, Dublin
9, Ireland
(Collins, Humphreys) Department of Microbiology, Beaumont Hospital, Dublin
9, Ireland
(Humphreys) Department of Clinical Microbiology, Royal College of Surgeons
in Ireland, Dublin 2, Ireland
Title
The role of topical antibiotics used as prophylaxis in surgical site
infection prevention.
Source
Journal of Antimicrobial Chemotherapy. 66 (4) (pp 693-701), 2011.
Article Number: dkr009. Date of Publication: April 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Compared with systemic antibiotic therapy, the topical or local delivery
of an antibiotic has many potential advantages. However, local antibiotics
at the surgical site have received very limited approval in any of the
surgical prophylaxis consensus guidelines that we are aware of. A review
of the literature was carried out through searches of peer-reviewed
publications in PubMed in the English language over a 30 year period
between January 1980 and May 2010. Both retrospective and prospective
studies were included, as well as meta-analyses. With regard to defining
'topical' or 'local' antibiotic application, the application of an
antibiotic solution to the surgical site intraoperatively or immediately
post-operatively was included. A number of surgical procedures have been
shown to significantly benefit from perioperative topical prophylaxis,
e.g. joint arthroplasty, cataract surgery and, possibly, breast
augmentation. In obese patients undergoing abdominal surgery, topical
surgical prophylaxis is also proven to be beneficial. The selective use of
topical antibiotics as surgical prophylaxis is justified for specific
procedures, such as joint arthroplasty, cataract surgery and, possibly,
breast augmentation. In selective cases, such as obese patients undergoing
abdominal surgery, topical surgical prophylaxis is also proven to be
beneficial. Apart from these specific indications, the evidence for use of
topical antibiotics in surgery is lacking in conclusive randomized
controlled trials. The Author 2011. Published by Oxford University Press
on behalf of the British Society for Antimicrobial Chemotherapy. All
rights reserved.

<2>
Accession Number
2011159799
Authors
Schramko A.A. Suojaranta-Ylinen R.T. Kuitunen A.H. Raivio P.M. Kukkonen
S.I. Niemi T.T.
Institution
(Schramko, Suojaranta-Ylinen, Kuitunen, Kukkonen, Niemi) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Meilahti Hospital, PO Box 340, Helsinki, FI-00029 Hus, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University Central
Hospital, Meilahti Hospital, Helsinki, Finland
Title
Comparison of the effect of 6% hydroxyethyl starch and gelatine on cardiac
and stroke volume index: A randomized, controlled trial after cardiac.
Source
Perfusion. 25 (5) (pp 283-291), 2010. Date of Publication: September
2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background and aims: The objective of this study was to find out the
effect of various doses of hydroxyethyl starch (HES), gelatine or Ringer's
acetate on cardiac and stroke volume index after cardiac surgery. Material
and methods: Three consecutive boluses (each 7 mL.kg-1) of either 6% HES
130/0.4, 4% gelatine, or Ringer's acetate solutions were administered to
45 patients postoperatively. The rate of infusions was adjusted according
to haemodynamic measurements. Thereafter, infusion of the study solution
(7 mL.kg-1) was continued for the following 12 hours. The total dose of
study solution was 28 mL. kg-1. Results and conclusion: Mean (SD) cardiac
and stroke volume indices were greater in the HES group [2.8 L.min-1.m-2
(0.7), 34.1 (6.7) ml.m-2] than in the gelatine group [2.2 L. min-1.m-2
(0.6), 25.8 (7.2) ml.m-2] after completion of 7 mL. kg-1 of study
solution. At this stage, the effect of gelatine did not differ from
Ringer's acetate. After completion of 14 mL.kg-1 and 21 mL.kg-1 of
colloids, similar cardiac and stroke volume indices were observed and the
haemodynamic response was better in both colloid groups than in the
Ringer's acetate group. No differences between groups were detected on the
first postoperative morning. In the early postoperative phase after
cardiac surgery, the effect of a single dose of HES solution on the
haemodynamics was superior to the effect of gelatine or Ringer's acetate.
However, after repeated administration of the study solutions, the
haemodynamics in the two colloid groups appeared to be similar, but
superior to the Ringer's acetate group.

<3>
Accession Number
2011159801
Authors
Lund P.E. Wassback G. Thomas O. Carlsson T. Schott U.
Institution
(Lund, Wassback, Carlsson) Orebro University Hospital, Department of
Cardiothoracic Anaesthesiology and Intensive Care, Orebro, Sweden
(Thomas) Lund University Medical Faculty, Lund, Sweden
(Schott) Department of Anaesthesiology and Intensive Care, Lund University
Skane University Hospital, Lund, Sweden
Title
Comparison of two infusion rates of antithrombin concentrate in
cardiopulmonary bypass surgery.
Source
Perfusion. 25 (5) (pp 305-312), 2010. Date of Publication: September
2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Antithrombin concentrate (AT) is used to treat heparin
resistance (HR) in cardiac surgery. It is usually given slowly due to the
fear of anaphylaxis. This may delay cardiac catheterisation and the start
of cardiopulmonary bypass (CPB). HR is often defined as the failure to
reach or maintain a target activated clotting time (ACT) despite a
standard dose of heparin. It is not generally possible to predict which
patients will display HR, although there are known risk factors. Routine
early administration of AT before heparinisation is probably not
cost-effective. Infusing AT relatively quickly after demonstrating HR may
be more cost-effective, while not delaying surgery. The aim of this study
is to investigate the safety and side effects of a faster infusion of AT.
Methods: Forty patients undergoing elective heart surgery were included
and randomised to two groups in a double-blind fashion. Each group
received 1000 IU of AT intravenously (IV). One group received a slow
infusion (100 IU/min) before full-dose heparinisation. The other group
received a fast infusion (250 IU/min). Haemodynamic and respiratory data
were recorded. Any adverse effects were noted. Thrombin-antithrombin,
anti-Xa and antithrombin levels in plasma were measured. Results: No
anaphylaxis occurred in either group. No differences were found regarding
haemodynamics, respiration or laboratory results. Two patients experienced
major haemorrhage and recovered; there were two deaths, thought to be
unrelated to the study drugs. Conclusion: AT can be infused at a rate of
250 IU/min. This is faster than the current recommendation of 100 IU/min.
This rate of infusion allows restricting AT infusion to those patients who
display HR, without delaying surgery. Optimal anticoagulant therapy for
CPB probably includes point-of-care measurement of ACT and plasma AT and
small, but rapid, infusions of AT in heparin-resistant patients. 2010 The
Author(s).

<4>
Accession Number
2011158368
Authors
Castillo R. Rodrigo R. Perez F. Cereceda M. Asenjo R. Zamorano J.
Navarrete R. Villalabeitia E. Sanz J. Baeza C. Aguayo R.
Institution
(Castillo, Rodrigo, Perez, Navarrete) Institute of Biomedical Sciences,
Faculty of Medicine, University of Chile, Santiago, Chile
(Cereceda, Asenjo, Zamorano) Cardiovascular Department, University of
Chile Clinical Hospital, Santiago, Chile
(Villalabeitia, Sanz, Baeza) Cardiothoracic Surgery Unit, San Juan de Dios
Hospital, Santiago, Chile
(Aguayo) Coronary Intensive Unit, San Juan de Dios Hospital, Santiago,
Chile
Title
Antioxidant Therapy Reduces Oxidative and Inflammatory Tissue Damage in
Patients Subjected to Cardiac Surgery with Extracorporeal Circulation.
Source
Basic and Clinical Pharmacology and Toxicology. 108 (4) (pp 256-262),
2011. Date of Publication: April 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Ischaemia reperfusion injury is a pathophysiological event that occurs
after cardiac surgery with extracorporeal circulation. This clinical event
has been associated with the induction of oxidative and inflammatory
damage in atrial tissue. Here, we tested whether combined omega 3
polyunsaturated fatty acids (n-3 PUFA)-antioxidant vitamin protocol
therapy reduces oxidative and inflammatory cardiac tissue damage. This
trial assigned 95 either-sex patients to supplementation with n-3 PUFA
(2g/day), or matching placebo groups, 7days before on-pump surgery.
Antioxidant vitamins C (1g/day) and E (400IU/day) or placebo were added
from 2days before surgery until discharge. Blood and atrial tissue samples
were obtained during the intervention. Reduced/oxidized glutathione
(GSH/GSSG) ratio, malondialdehyde (MDA) and protein carbonylation were
determined in atrial tissue. Leucocyte count and high-sensitivity
C-reactive protein (hs-CRP) in blood plus nuclear factor (NF)-appaB
activation in atrial tissue served for inflammation assessment. Lipid
peroxidation and protein carbonylation were 27.5 and 24% lower in
supplemented patients (p<0.01). GSH/GSSG ratio was 38.1% higher in
supplemented patients compared with placebo (p<0.01). Leucocyte count and
serum hs-CRP levels were markedly lower throughout the protocol in
supplemented patients (p<0.01). Atrial tissue NF-B DNA activation in
supplemented patients was 22.5% lower than that in placebo patients
(p<0.05). The combined n-3 PUFA-antioxidant vitamin protocol therapy here
proposed reduced the oxidative stress and inflammation biomarkers, in
patients undergoing on-pump cardiac surgery. 2010 The Authors. Basic &
Clinical Pharmacology & Toxicology 2010 Nordic Pharmacological Society.

<5>
Accession Number
2011144484
Authors
Dodd K.S. Saczynski J.S. Zhao Y. Goldberg R.J. Gurwitz J.H.
Institution
(Dodd, Saczynski, Gurwitz) Department of Medicine, University of
Massachusetts, Medical School, Worcester, MA, United States
(Dodd, Saczynski, Gurwitz) Meyers Primary Care Institute, University of
Massachusetts, Medical School, Worcester, MA, United States
(Goldberg) Department of Quantitative Health Sciences, University of
Massachusetts, Medical School, Worcester, MA, United States
(Zhao) Duke Translational Nursing Institute, Duke University, Durham, NC,
United States
Title
Exclusion of older adults and women from recent trials of acute coronary
syndromes.
Source
Journal of the American Geriatrics Society. 59 (3) (pp 506-511), 2011.
Date of Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
OBJECTIVES: To determine whether the participation of older adults and
women in published clinical trials has increased during recent years.
DESIGN: Systematic review to identify clinical trials of acute coronary
syndromes (ACSs) published from May 2007 to May 2009. Trials were excluded
if they enrolled fewer than 50 participants, were substudies of previously
published trials, or initiated treatment more than 3 weeks after the acute
cardiac event. SETTING: A search of MEDLINE and the Cochrane Central
Register of Controlled Trials. PARTICIPANTS: Sixty-eight thousand sixteen
participants of 80 trials. MEASUREMENTS: Information on the age of trial
participants, percentage of participants who were female, and whether
there were specific exclusions based on age were abstracted from all
included trials. RESULTS: Twenty-three trials (29.7%) had explicit
exclusion criteria based on age. Only 13.8% of study participants were
aged 75 and older, and 27.7% were women. These percentages are below the
representation of all U.S. adults experiencing an ACS in recent years who
were aged 75 and older (41.9%) or female (41.5%). The average age of all
study participants was 61.6 +/- 3.8. There was a significant association
between the mean age of a study population and the proportion of women
enrolled in the trial. CONCLUSION: Older adults and women remain
under-represented in recent clinical trials of people hospitalized with an
ACS. These exclusions may hinder efforts to inform evidence-based clinical
decision-making in these high-risk populations. 2011, Copyright the
Authors Journal compilation 2011, The American Geriatrics Society.

<6>
Accession Number
2011152357
Authors
Protopapas A.D. Baig K. Mukherjee D. Athanasiou T.
Institution
(Protopapas, Mukherjee, Athanasiou) Department of Surgery and Cancer,
Imperial College London, United Kingdom
(Baig) Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
Title
Pulmonary embolism following coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 26 (2) (pp 181-188), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Pulmonary embolism (PE) is a life-threatening complication,
with a deceptive clinical presentation following coronary artery bypass
grafting (CABG). Methods: We identified 13 studies on PE in post-CABG
patients, spanning a period of 34 years. Results: The overall cumulative
incidence of PE following CABG was 1.3% (111 PEs in 8553 CABGs).
Conclusion: We suggest further prospective randomized studies to examine
the effect of saphenous system vein grafting, and choice of low molecular
weight heparin prophylaxis on the incidence of post-CABG PE. 2011 Wiley
Periodicals, Inc.

<7>
Accession Number
2011152371
Authors
Moraca R.J. Wanamaker K.M. Bailey S.H. McGregor W.E. Benckart D.H. Maher
T.D. Magovern Jr. G.J.
Institution
(Moraca, Wanamaker, Bailey, McGregor, Benckart, Maher, Magovern Jr.)
Department of Cardiovascular and Thoracic Surgery, Allegheny General
Hospital, 320 East North Avenue, Pittsburgh, PA 15212, United States
Title
Strategies and outcomes of cardiac surgery in Jehovah's witnesses.
Source
Journal of Cardiac Surgery. 26 (2) (pp 135-143), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Jehovah's Witnesses (JW) are a Christian faith, with an
estimated 1.1 million members in the United States, well recognized for
their refusal of blood and blood products. JW may not be considered for
cardiac surgery due to perceived higher risks of morbidity and mortality.
This study reviews our contemporary strategies and experience with JW
undergoing routine and complex cardiac surgery. Methods: From November
2001 to April 2010, 40 JW were referred for cardiac surgery at a single
quaternary referral institution. A retrospective analysis of demographic
data, perioperative management, and clinical outcomes was examined.
Published validated clinical risk calculator and model for prediction of
transfusion were used to identify high-risk patients (risk of mortality
>6% or probability of transfusion >0.80). Results: The mean age was 70
(+/- 9.5) years with 21 men and 19 women. Patients were classified as high
risk (45%, n = 18) and low risk (55%, n = 22) with demographics and
comorbidities listed in Table 2. Operative procedures included: isolated
coronary artery bypass grafting (CABG) (n = 19), isolated valve
replacement/repair (n = 7), valve/CABG (n = 7), reoperative valve
replacement (n = 4), reoperative CABG (n = 2), valve/ascending aorta
replacement (n = 1), and CABG /ascending aorta replacement (n = 1). All JW
were evaluated by The Department of Bloodless Medicine to individually
define acceptable blood management strategies. The mean preoperative
hemoglobin was 14.1 g/dL (+/-1.6). Overall mortality was 5% (n = 2) all of
which were in the high-risk group. Discussion: Using a multidisciplinary
approach to blood management, JW can safely undergo routine and complex
cardiac surgery with minimal morbidity and mortality. 2011 Wiley
Periodicals, Inc.

<8>
Accession Number
2011152373
Authors
Chaudhuri K. Marasco S.F.
Institution
(Chaudhuri) Department of Cardiothoracic Surgery, Alfred Hospital,
Australia
(Marasco) Department of Surgery, Monash University, Australia
Title
The effect of carbon dioxide insufflation on cognitive function during
cardiac surgery.
Source
Journal of Cardiac Surgery. 26 (2) (pp 189-196), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
The use of carbon dioxide (CO₂) insufflation into the
pericardial well has become widespread, and in some units routine. The
rationale behind this practice is the fact that CO₂ is more
soluble than air leading to fewer gaseous microemboli entering the
bloodstream and being transferred to the brain or heart. However, the
evidence that this reduces postoperative neurocognitive decline is scant.
Although CO₂ insufflation is generally a safe procedure there
are case reports of significant complications. The aim of this systematic
review is to analyze the current evidence for this practice. 2011 Wiley
Periodicals, Inc.

<9>
Accession Number
2011155390
Authors
Cleeland C.S. Wang X.S. Shi Q. Mendoza T.R. Wright S.L. Berry M.D.
Malveaux D. Shah P.K. Gning I. Hofstetter W.L. Putnam Jr. J.B. Vaporciyan
A.A.
Institution
(Cleeland, Wang, Shi, Mendoza, Wright, Berry, Malveaux, Shah, Gning,
Hofstetter, Putnam Jr., Vaporciyan) University of Texas, MD Anderson
Cancer Center, Department of Symptom Research, 1515 Holcombe Blvd, Box
1450, Houston, TX 77030, United States
Title
Automated symptom alerts reduce postoperative symptom severity after
cancer surgery: A randomized controlled clinical trial.
Source
Journal of Clinical Oncology. 29 (8) (pp 994-1000), 2011. Date of
Publication: 10 Mar 2011.
Publisher
American Society of Clinical Oncology (330 John Carlyle Street, Suite 300,
Alexandria VA 22314, United States)
Abstract
Purpose: Patients receiving cancer-related thoracotomy are highly
symptomatic in the first weeks after surgery. This study examined whether
at-home symptom monitoring plus feedback to clinicians about severe
symptoms contributes to more effective postoperative symptom control.
Patients and Methods: We enrolled 100 patients receiving thoracotomy for
lung cancer or lung metastasis in a two-arm randomized controlled trial;
79 patients completed the study. After hospital discharge, patients rated
symptoms twice weekly for 4 weeks via automated telephone calls. For
intervention group patients, an e-mail alert was forwarded to the
patient's clinical team for response if any of a subset of symptoms (pain,
disturbed sleep, distress, shortness of breath, or constipation) reached a
predetermined severity threshold. No alerts were generated for controls.
Group differences in symptom threshold events were examined by generalized
estimating equation modeling. Results: The intervention group experienced
greater reduction in symptom threshold events than did controls (19% v 8%,
respectively) and a more rapid decline in symptom threshold events. The
difference in average reduction in symptom interference between groups was
-0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts.
Both groups reported equally high satisfaction with the automated system
and with postoperative symptom control. Conclusion: Frequent symptom
monitoring with alerts to clinicians when symptoms became moderate or
severe reduced symptom severity during the 4 weeks after thoracic surgery.
Methods of automated symptom monitoring and triage may improve symptom
control after major cancer surgery. These results should be confirmed in a
larger study. 2011 by American Society of Clinical Oncology.

<10>
Accession Number
2011156729
Authors
Mariscalco G. Banach M. Bruno V.D. Borsani P. Sala A.
Institution
(Mariscalco, Bruno, Borsani, Sala) Department of Surgical Sciences,
Cardiac Surgery Unit, Varese University Hospital, Viale Guicciardini, 7,
I-21100, Varese, Italy
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
Title
Reply to preoperative n-3 polyunsatured fatty acids do not reduce
postoperative atrial fibrillation in cardiac surgery, by takagi i. and
umemoto t.
Source
Angiology. 62 (3) (pp 278-279), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)

<11>
Accession Number
2011156733
Authors
Takagi H. Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Preoperative n-3 polyunsatured fatty acids do not reduce postoperative
atrial fibrillation in cardiac surgery.
Source
Angiology. 62 (3) (pp 276-277), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)

<12>
Accession Number
2011140534
Authors
Chittoodan S. Breen D. O'Donnell B.D. Iohom G.
Institution
(Chittoodan, Breen, O'Donnell, Iohom) Department of Anaesthesia, Cork
University Hospital, University College Cork, Cork, Ireland
Title
Long versus short axis ultrasound guided approach for internal jugular
vein cannulation: A prospective randomised controlled trial.
Source
Medical Ultrasonography. 13 (1) (pp 21-25), 2011. Date of Publication:
March 2011.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (Str. Iosif
Bulbuca nr.10, Timisoara 300736, Romania)
Abstract
Aim: The aim of this study was to compare the short and long axis
approaches to ultrasound guided right internal jugular vein cannulation
with respect to indicators of success. Methods: Patients undergoing
cardiac surgery requiring central venous cannulation (99 patients) were
randomised to undergo either long or short axis ultrasound guided
cannulation of the right internal jugular vein by a skilled anaesthetist.
First pass success, number of needle passes, procedural taken and
complications were documented for each procedure. Results: The right
internal jugular vein was successfully cannulated in all 99 patients. The
first pass success rate was significantly higher in the short axis 98%
group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p
<0.006]. Procedural time was comparable in both the groups [39.6 (18.4)
versus 46.9 (42.4)]. Fewer needle redirections were required in the short
axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery
puncture only occurred in the long axis group. Conclusions: We conclude
that anaesthetists with experience in ultrasound guided internal jugular
vein cannulation, have higher first pass success rate and less carotid
artery puncture when a short axis, rather than a long axis, approach is
employed.

<13>
Accession Number
2011145128
Authors
Hoole S.P. Hamburger J.N.
Institution
(Hoole, Hamburger) Vancouver General Hospital, Vancouver BC, Canada
(Hoole, Hamburger) University of British Columbia, 2775, Laurel Street,
V5Z 1M9 Vancouver BC, Canada
Title
Calculators of revascularization risk: Peering into the crystal ball.
Source
Interventional Cardiology. 3 (1) (pp 49-53), 2011. Date of Publication:
February 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Revascularization risk-assessment tools guide optimal management of
patients with coronary disease. However, until recently, percutaneous
coronary intervention risk-prediction models had lagged behind surgical
risk-prediction tools. Validated percutaneous coronary intervention risk
calculators are now available, which allow the comparison of predicted
30-day mortality with coronary artery bypass graft surgical data,
facilitating optimal treatment selection by both physicians and patients,
insuring valid, informed consent to potentially high-risk procedures.
2011 Future Medicine Ltd.

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Accession Number
2011145132
Authors
Ahmed I. Gertner E. Nelson W.B. House C.M. Zhu D.W.
Institution
(Ahmed, Gertner, Nelson, House, Zhu) Regions Hospital and the University
of Minnesota Medical School, MN, United States
(Nelson, Zhu) Section of Cardiology 11102H, Department of Medicine,
Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101, United States
Title
Safety of coronary angiography and percutaneous coronary intervention in
patients on uninterrupted warfarin therapy: A meta-analysis.
Source
Interventional Cardiology. 3 (1) (pp 101-109), 2011. Date of
Publication: February 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Objective: A systematic review of the literature was conducted relating to
the continuation of warfarin therapy at the time of coronary angiography,
with or without percutaneous coronary intervention, to determine the
bleeding risk of these patients. Methods: A search of a major electronic
database was independently conducted by two reviewers from 1960 to
December 2009. Studies were included if they met the following criteria:
were original; included patients who were undergoing coronary
angiography/catheterization with or without angioplasty/stent placement
and were receiving uninterrupted warfarin therapy throughout the
periprocedural period; and reported the number of bleeding events and
procedure related complications. Based on the inclusion and exclusion
criteria, a total of eight studies (one randomized, four cohort and three
case series) were included for analysis. Results: The pooled odds ratio
(95% CI) for procedure-related complications in continued warfarin versus
nonanticoagulated patients, in those studies that had comparison groups,
was 0.53 (0.29-0.94) and for combined major bleeding and procedure-related
complication was 1.01 (0.29-3.51). However, there was significant
heterogeneity (p = 0.001; I² = 81%) in retrospective studies
and no heterogeneity in prospective studies (I² = 25%). The
pooled incidence (95% CI) of major bleeding and periprocedural
complications for all studies, including case series, was 0.037
(0.024-0.057). There was no significant heterogeneity (p = 0.32;
I² = 14.1%). Discussion: Continuing warfarin therapy during
coronary angiography and percutaneous intervention appears to be safe,
with no increased incidence of major bleeding and periprocedural
complications. However, the quality of evidence is low due to several
limitations of a number of the studies included in our article. A
multicenter randomized trial is necessary to determine the optimal
periprocedral strategy for patients receiving uninterrupted warfarin
therapy undergoing coronary angiography and percutaneous coronary
intervention. 2011 Future Medicine Ltd.