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<1>
Accession Number
2012149621
Authors
Minkowitz H.S. Onel E. Patronella C.K. Smoot J.D.
Institution
(Minkowitz) Department of Anesthesiology, Memorial Hermann Memorial City
Medical Center, 921 Gessner Road, Houston, TX 77024, United States
(Onel) Pacira Pharmaceuticals, Inc., Parsippany, NJ, United States
Title
A two-year observational study assessing the safety of DepoFoam
bupivacaine after augmentation mammaplasty.
Source
Aesthetic Surgery Journal. 32 (2) (pp 186-193), 2012. Date of Publication:
February 2012.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background: Two-year safety outcomes in patients who received DepoFoam
bupivacaine during two prior breast augmentation studies were evaluated.
Objectives: The authors assess the clinical sequelae observed during
follow-up examination with respect to the integrity of the breast
implants. Methods: In Study 1, patients received bupivacaine HCl (75 mg)
in one breast pocket and DepoFoam bupivacaine (133 or 266 mg) in the
other. In Study 2, patients received either bupivacaine HCl (200 mg) or
DepoFoam bupivacaine (532 mg), divided equally into each breast pocket.
Investigators and patients remained blinded to the treatment administered.
Patients completed a questionnaire regarding breast pain, tenderness,
tingling, numbness, burning, changes in sensation, and any relevant life
events potentially affecting the implants. Patients were also assessed for
postoperative healing and implant integrity. Results: Ninety-four women
were evaluated. Most patients in all groups had no change in breast size
or shape and no changes in the skin or nipple. There were no reports of
palpable hard knots or swelling. There was one report of
irritation/implant leakage (in a patient who received bupivacaine HCl [75
mg] in the relevant breast). Most patients reported no breast pain,
tenderness, tingling, numbness, burning, other changes in sensation, chest
wall surgery or trauma, or life events affecting the implant. Conclusions:
At a two-year follow-up assessment, DepoFoam bupivacaine was not
associated with any complications that would compromise the integrity of
the breast implants. There was no indication of an association between
DepoFoam bupivacaine or bupivacaine HCl and changes in sensation or other
abnormal findings in these patients. 2012 The American Society for
Aesthetic Plastic Surgery, Inc.

<2>
Accession Number
2012127696
Authors
Lindqvist P. Holmgren A. Zhao Y. Henein M.Y.
Institution
(Lindqvist, Holmgren, Henein) Heart Centre, Umea University, S-90185 Umea,
Sweden
(Lindqvist, Zhao, Henein) Department of Public Health and Clinical
Medicine, Umea University, Sweden
(Holmgren) Department of Surgery and Peri-operative Sciences, Umea
University, Sweden
(Zhao) Ultrasound Department, Beijing AnZhen Hospital, Capital Medical
University, Beijing, China
Title
Effect of pericardial repair after aortic valve replacement on septal and
right ventricular function.
Source
International Journal of Cardiology. 155 (3) (pp 388-393), 2012. Date of
Publication: 22 Mar 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Aortic valve replacement (AVR) is associated with reversed
septal motion and right ventricular (RV) dysfunction but the cause remains
uncertain. The aim of this study was to investigate the role of
pericardial repair after AVR on septal and RV function. Methods: Thirty
patients (62 +/- 11 years, 18 males) with severe aortic stenosis were
studied before and after AVR surgery using echocardiography. Patients were
randomly allocated to pericardial repair vs. open pericardium. RV long
axis displacement and outflow tract fractional shortening (fs) were
measured. RV and right atrial (RA) tissue Doppler and strain rate (SR)
were measured as well as RA area. Systolic interventricular septal motion
towards and away from the RV was also determined. Stroke volume (SV) was
measured by conventional Doppler method. Pre-operative data were compared
with those from 30 normal gender and age matched controls. Results:
Post-operatively, global RV ejection function was preserved as shown by
SV. However, RV outflow tract fs and long axis displacement both fell (p <
0.01) but not SR. RA area remained unchanged but RA SR fell (p < 0.01). RV
displacement correlated with the extent of reversed septal motion (r =
0.60, p < 0.001) as well as RA SR (r = 0.54, p < 0.001). None of the RV or
septal measurements was affected by the pericardial repair procedure.
Conclusion: After AVR, septal motion is reversed and correlated directly
with RV long axis function. The latter is not affected by pericardial
repair but likely related to right atrial surgery injury. 2010 Elsevier
Ireland Ltd. All rights reserved.

<3>
Accession Number
2012147443
Authors
Momeni M. Liistro G. Baele P. Matta A. Kahn D. Van Dyck M. De Kock M. De
Kerchove L. Glineur D. Thiry D. Gregoire A. Jacquet L.-M. Laarbui F.
Watremez C.
Institution
(Momeni, Baele, Matta, Kahn, Van Dyck, De Kock, Watremez) Department of
Anesthesiology, Universit Catholique de Louvain, Cliniques Universitaires
Saint Luc, Avenue Hippocrate 10/1821, 1200 Brussels, Belgium
(Liistro) Department of Pneumology, Universit Catholique de Louvain,
Cliniques Universitaires Saint Luc, Brussels, Belgium
(De Kerchove, Glineur) Department of Cardiac Surgery, Universit Catholique
de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
(Thiry, Gregoire) Department of Perfusion Services, Universit Catholique
de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
(Jacquet, Laarbui) Department of Cardiac Intensive Care Unit, Universit
Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels,
Belgium
Title
An increase in endogenous erythropoietin concentrations has no
cardioprotective effects in patients undergoing coronary artery bypass
graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (2) (pp 251-257),
2012. Date of Publication: April 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: Preliminary data showed an increase in endogenous
erythropoietin (EPO) concentrations after acute normovolemic hemodilution
(ANH) in patients undergoing coronary artery bypass graft (CABG) surgery.
Numerous studies have shown the organ protective properties of EPO. The
aim of this study was to investigate the cardioprotective effects of these
increased EPO concentrations that resulted from ANH during cardiac
surgery. Design: A prospective, randomized, blind study. Setting: A
university hospital. Participants: A total of 93 patients undergoing
isolated CABG surgery with or without cardiopulmonary bypass (CPB).
Interventions: Subjects with CPB were randomized into the control (C) or
ANH group. Those in the off-pump coronary artery bypass group underwent no
treatment. In the ANH group, a precalculated amount of blood was withdrawn
and replaced by colloids after the induction of anesthesia. Measurements
and Main Results: Hemodynamic parameters were recorded intra- and
postoperatively. Troponin concentrations were measured as a routine
parameter postoperatively. Upon intensive care unit arrival, the EPO
levels were higher in the ANH group than in the C group. There was no
significant difference between the troponin values of the C and the ANH
groups at 4 hours postoperatively. Conclusions: In patients undergoing
CABG surgery on CPB, an increase in endogenous EPO concentrations in the
physiologic range has no cardioprotective effects. 2012 Elsevier Inc.

<4>
Accession Number
2012147434
Authors
Greiff G. Stenseth R. Wahba A. Videm V. Lydersen S. Irgens W. Bjella L.
Pleym H.
Institution
(Greiff, Stenseth, Bjella, Pleym) Department of Cardiothoracic Anesthesia
and Intensive Care, St Olav University Hospital, Prinsesse Kristinas Gate
3, N-7006 Trondheim, Norway
(Wahba) Department of Cardiothoracic Surgery, St Olav University Hospital,
Trondheim, Norway
(Videm) Department of Immunology and Transfusion Medicine, St Olav
University Hospital, Trondheim, Norway
(Irgens) Department of Medical Biochemistry, St Olav University Hospital,
Trondheim, Norway
(Greiff, Stenseth, Wahba, Pleym) Department of Circulation and Medical
Imaging, Norwegian University of Science and Technology, Trondheim, Norway
(Videm) Department of Laboratory Medicine, Children's and Women's Health,
Norwegian University of Science and Technology, Trondheim, Norway
(Lydersen) Department of Neuroscience, Norwegian University of Science and
Technology, Trondheim, Norway
Title
Tranexamic acid reduces blood transfusions in elderly patients undergoing
combined aortic valve and coronary artery bypass graft surgery: A
randomized controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (2) (pp 232-238),
2012. Date of Publication: April 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To evaluate the effects of tranexamic acid on postoperative
blood loss and transfusion requirements in elderly patients undergoing
combined aortic valve replacement and coronary artery bypass graft surgery
(CABG). Design: A prospective, randomized, double-blinded,
placebo-controlled, parallel-group trial. Setting: A university hospital
(single institution). Participants: Sixty-four patients 70 years or older
undergoing combined aortic valve replacement and CABG surgery were
included. One patient was withdrawn from the study after randomization by
the attending surgeon because of a change in the surgical procedure. The
remaining 63 patients were analyzed as intention to treat. Interventions:
The included patients were randomized to treatment with either tranexamic
acid, 10 mg/kg, as a bolus injection before surgery followed by 1 mg/kg/h
as an infusion during surgery, or a corresponding volume of 0.9% sodium
chloride. Measurements and Main Results: Postoperative blood loss was
recorded for 16 hours. The transfusion of blood products was recorded
during the entire hospital stay. The number of packed red cell
transfusions given to the patients was significantly lower in the
tranexamic acid group compared with the placebo group (median, 3.0
[interquartile range, 2-5] v 5.0 [3-7], p = 0.049). Conclusion: Tranexamic
acid reduced the number of packed red cell transfusions given to patients
70 years or older undergoing combined aortic valve replacement and CABG
surgery. 2012 Elsevier Inc.

<5>
Accession Number
2012134412
Authors
Pushparajah K. Miller O.I. Rawlins D. Barlow A. Nugent K. Simpson J.M.
Institution
(Pushparajah, Miller, Rawlins, Barlow, Nugent, Simpson) Department of
Congenital Heart Disease, Evelina Children's Hospital, Guy's and St
Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH,
United Kingdom
Title
Clinical application of a micro multiplane transoesophageal probe in
congenital cardiac disease.
Source
Cardiology in the Young. 22 (2) (pp 170-177), 2012. Date of Publication:
April 2012.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Aim To assess the quality of imaging modalities of a new micro multiplane
transoesophageal echocardiogram probe.Method This is a prospective study
of micro transoesophageal echocardiogram S8-3t probe used at a single
institution between 15 December, 2009 and 15 March, 2010. The images were
compared with standard paediatric or adult probes where possible.
Assessors prospectively rated imaging quality - two dimensional, colour
flow imaging, pulse wave, and continuous wave Doppler - with a subjective
4-point scale (1 = poor to 4 = excellent).Results A total of 24 studies
were performed on 23 patients, with a median weight = 11.7 kilograms
(2.6-72 kilograms) and a median age of 3 years (0.16-60 years). Of the 23
patients, one neonate (2.8 kilograms) had transient bradycardia on probe
insertion. Imaging in patients less than 10 kilograms was of full
diagnostic value and new information was obtained in eight out of ten
patients. Pulse wave and continuous wave Doppler was consistently good
across all weight groups. There were high frame rates and good imaging
quality to a depth of 4-6 centimetres in all studies. A comparison with a
larger alternative probe was available for 12 studies (weight 11.9-72
kilograms). The median micro transoesophageal two-dimensional image
quality score was 3 (2-4) and 4 (3-4) with the comparative probe. For the
10- to 30-kilogram group, image quality with the micro transoesophageal
echocardiogram probe was judged as inferior to larger standard probes.
Adult sized patients had good imaging of near the field, allowing guidance
for percutaneous device closure of the atrial septum.Conclusion The micro
multiplane transoesophageal echocardiogram probe provides imaging of
diagnostic quality in neonates. In larger patients, it offers good imaging
of near field structures. In the intermediate-sized child (10-30
kilograms), standard paediatric probes provide better imaging. 2011
Cambridge University Press.

<6>
Accession Number
2012123903
Authors
Kataoka Y. Yasuda S. Miyamoto Y. Sase K. Kosuge M. Kimura K. Yoshimasa Y.
Miyazaki S.
Institution
(Kataoka) Department of Internal Medicine, National Cerebral and
Cardiovascular Center, Suita, Japan
(Yasuda) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine, Sendai, Japan
(Miyamoto) Department of Preventive Cardiology, National Cerebral and
Cardiovascular Center, Suita, Japan
(Sase) Department of Clinical Pharmacology, Juntendo University School of
Medicine, Tokyo, Japan
(Kosuge, Kimura) Division of Cardiology, Yokohama City University Medical
Center, Yokohama, Japan
(Yoshimasa) Department of Atherosclerosis and Diabetes, National Cerebral
and Cardiovascular Center, Suita, Japan
(Miyazaki) Division of Cardiology, Department of Internal Medicine, Kinki
University School of Medicine, Osakasayama, Japan
Title
Effects of voglibose and nateglinide on glycemic status and coronary
atherosclerosis in early-stage diabetic patients.
Source
Circulation Journal. 76 (3) (pp 712-720), 2012. Date of Publication: 2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Postprandial hyperglycemia and hyperinsulinemia have been
considered as important determinants for the development of
atherosclerosis. However, it remains to be elucidated whether correction
of the postprandial glycemic status prevents atherosclerotic changes.
Methods and Results: The DIANA (DIAbetes and diffuse coronary NArrowing)
study is a prospective randomized open-label multicenter trial. The 302
patients with coronary artery disease (CAD), impaired glucose
tolerance/diabetes mellitus (DM) pattern according to 75-g oral glucose
tolerance test and HbA_1c <6.9% were randomly assigned to
life-style intervention (n=101), voglibose (0.9 mg/day, n=100) or
nateglinide treatment (180 mg/day, n=101). We compared 1-year coronary
atherosclerotic changes evaluated by quantitative coronary arteriography.
Although voglibose significantly increased the number of patients with
normal glucose tolerance at 1 year, there were no significant differences
in coronary atherosclerotic changes at 1 year. However, overall, less
atheroma progression was observed in patients in whom glycemic status was
improved at 1 year (%change in total lesion length: 3.5% vs. 26.2%,
P<0.01, %change in averaged lesion length: 0.7% vs. 18.6%, P=0.02).
Conclusions: Although coronary atherosclerotic changes were similar for
voglibose and nateglinide, an improvement in glycemic status at 1 year was
associated with less atheroma progression regardless of the treatment. Our
findings underscore the management of glycemic abnormality to prevent
coronary atherosclerotic changes in Japanese early-stage DM patients with
CAD.

<7>
Accession Number
2012141617
Authors
Kinney M.A.O. Mantilla C.B. Carns P.E. Passe M.A. Brown M.J. Michael
Hooten W. Curry T.B. Long T.R. Thomas Wass C. Wilson P.R. Weingarten T.N.
Huntoon M.A. Rho R.H. Mauck W.D. Pulido J.N. Allen M.S. Cassivi S.D.
Deschamps C. Nichols F.C. Robert Shen K. Wigle D.A. Hoehn S.L. Alexander
S.L. Hanson A.C. Schroeder D.R.
Institution
(Kinney, Mantilla, Carns, Michael Hooten, Curry, Long, Thomas Wass,
Wilson, Weingarten, Huntoon, Mauck, Pulido, Hoehn, Alexander) Department
of Anesthesiology, College of Medicine Mayo Clinic, Rochester, MN, United
States
(Mantilla) Department of Physiology, College of Medicine Mayo Clinic,
Rochester, MN, United States
(Passe) Anesthesia Clinical Research Unit, College of Medicine Mayo
Clinic, Rochester, MN, United States
(Brown) SMH Anesthesiology Division, College of Medicine Mayo Clinic,
Rochester, MN, United States
(Rho, Mauck) Division of Pain Management, College of Medicine Mayo Clinic,
Rochester, MN, United States
(Allen, Cassivi, Deschamps, Nichols, Robert Shen, Wigle) Department of
Surgery, College of Medicine Mayo Clinic, Rochester, MN, United States
(Hanson, Schroeder) Division of Biostatistics, Department of Health
Sciences Research, College of Medicine Mayo Clinic, Rochester, MN, United
States
Title
Preoperative Gabapentin for Acute Post-thoracotomy Analgesia: A
Randomized, Double-Blinded, Active Placebo-Controlled Study.
Source
Pain Practice. 12 (3) (pp 175-183), 2012. Date of Publication: March 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: The role of preoperative gabapentin in postoperative pain
management is not clear, particularly in patients receiving regional
blockade. Patients undergoing thoracotomy benefit from epidural analgesia
but still may experience significant postoperative pain. We examined the
effect of preoperative gabapentin in thoracotomy patients. Methods: Adults
undergoing elective thoracotomy were enrolled in this prospective,
randomized, double-blinded, placebo-controlled study, and randomly
assigned to receive 600mg gabapentin or active placebo (12.5mg
diphenhydramine) orally within 2hours preoperatively. Standardized
management included thoracic epidural infusion, intravenous
patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain
scores, opioid use and side effects were recorded for 48hours. Pain was
also assessed at 3months. Results: One hundred twenty patients (63 placebo
and 57 gabapentin) were studied. Pain scores did not significantly differ
at any time point (P=0.53). Parenteral and oral opioid consumption was not
significantly different between groups on postoperative day 1 or 2 (P>0.05
in both cases). The frequency of side effects such as nausea and vomiting
or respiratory depression was not significantly different between groups,
but gabapentin was associated with decreased frequency of pruritus
requiring nalbuphine (14% gabapentin vs. 43% control group, P<0.001). The
frequency of patients experiencing pain at 3months post-thoracotomy was
also comparable between groups (70% gabapentin vs. 66% placebo group,
P=0.72). Conclusions: A single preoperative oral dose of gabapentin
(600mg) did not reduce pain scores or opioid consumption following
elective thoracotomy, and did not confer any analgesic benefit in the
setting of effective multimodal analgesia that included thoracic epidural
infusion. 2011 The Authors. Pain Practice 2011 World Institute of Pain.

<8>
Accession Number
2012143878
Authors
Isik I. Selimen D. Senay S. Alhan C.
Institution
(Isik, Selimen) Surgical Nursing Department, Health Sciences Faculty,
Marmara University, Istanbul, Turkey
(Senay, Alhan) Department of Cardiovascular Surgery, School of Medicine,
Acibadem University, Istanbul, Turkey
Title
Efficiency of antibacterial suture material in cardiac surgery: A
double-blind randomized prospective study.
Source
Heart Surgery Forum. 15 (1) (pp E40-E45), 2012. Date of Publication:
February 2012.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objective: Postoperative surgical site infections (SSI) still greatly
affect mortality and morbidity in cardiovascular surgery. SSI may be
related to the suture material. In this prospective, randomized,
controlled, and double-blinded study, the effect of antibacterial suture
material on SSI in cardiac surgical patients was investigated. Methods: We
randomly allocated 510 patients into 2 groups. Antibacterial suture
materials were used for wound closure in 170 patients (triclosan-coated
suture group), and routine suture materials were used in 340 patients
(noncoated suture group). All patients were evaluated for SSI on days 10,
20, and 30 following cardiac surgery. Results: Preoperative risk factors
and laboratory findings were comparable for the 2 groups. Sternal
infection occurred in 4 (2.4%) of the patients in the triclosan-coated
suture group and in 3.5% of the noncoated suture group (P > .05). Leg
wound infection occurred in 5 (3.5%) of the patients in the
triclosan-coated suture group and in 3.8% of the noncoated suture group (P
> .05). Only diabetes mellitus was an independent predictor of SSI.
Conclusion: Both noncoated and triclosan-coated suture materials are safe.
Larger studies may be needed to show the benefit and cost-effectiveness,
if any, of triclosan-coated materials over noncoated materials. 2012
Forum Multimedia Publishing, LLC.

<9>
Accession Number
2012145583
Authors
Sultan P. Hamilton M.A. Ackland G.L.
Institution
(Sultan) Department of Anesthesia, Stanford University Medical Center,
Stanford, CA 94305, United States
(Hamilton) Anaesthesia and Critical Care, St Georges Hospital NHS Trust,
London, United Kingdom
(Ackland) Centre for Anaesthesia, Critical Care and Pain Management,
University College London, London, United Kingdom
(Ackland) Department of Medicine, University College London, London,
United Kingdom
Title
Preoperative muscle weakness as defined by handgrip strength and
postoperative outcomes: A systematic review.
Source
BMC Anesthesiology. 12 , 2012. Article Number: 1. Date of Publication: 17
Jan 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Reduced muscle strength- commonly characterized by decreased
handgrip strength compared to population norms- is associated with
numerous untoward outcomes. Preoperative handgrip strength is a
potentially attractive real-time, non-invasive, cheap and easy-to-perform
"bedside" assessment tool. Using systematic review procedure, we
investigated whether preoperative handgrip strength was associated with
postoperative outcomes in adults undergoing surgery.Methods: PRISMA and
MOOSE consensus guidelines for reporting systematic reviews were followed.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical
Trials (1980-2010) were systematically searched by two independent
reviewers. The selection criteria were limited to include studies of
preoperative handgrip strength in human adults undergoing non-emergency,
cardiac and non-cardiac surgery. Study procedural quality was analysed
using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed
were postoperative morbidity, mortality and hospital stay.Results:
Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising
2194 patients were identified between1980-2010. Impaired handgrip strength
and postoperative morbidity were defined inconsistently between studies.
Only 2 studies explicitly ensured investigators collecting postoperative
outcomes data were blinded to preoperative handgrip strength test results.
The heterogeneity of study design used and the diversity of surgical
procedures precluded formal meta-analysis. Despite the moderate quality of
these observational studies, lower handgrip strength was associated with
increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and
length of hospital stay (n = 3/7 studies).Conclusions: Impaired
preoperative handgrip strength may be associated with poorer postoperative
outcomes, but further work exploring its predictive power is warranted
using prospectively acquired, objectively defined measures of
postoperative morbidity. 2012 Sultan et al; licensee BioMed Central Ltd.

<10>
Accession Number
22099130
Authors
Shahzamani M. Ghanavati A. Froutagheh A.N. Foroughi M. Rahimian H.
Shahsanaei A. Hasantash S.A. Dabbagh A.
Institution
(Shahzamani, Ghanavati, Foroughi, Hasantash) Department of Cardiac
Surgery, Shahid Beheshti University of Medicine, Tehran, Iran, Islamic
Republic of
(Froutagheh) Research Development Department, Modarres Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Rahimian) Cardiac Surgery, Department of Cardiac Surgery, Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Shahsanaei) Research Deputy, Shahrekord University of Medical Sciences,
Shahrekord, Iran, Islamic Republic of
(Dabbagh) Anesthesiology Research Center and Anesthesiology Department,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Carvedilol Compared With Metoprolol on Left Ventricular Ejection Fraction
After Coronary Artery Bypass Graft.
Source
Journal of Perianesthesia Nursing. 26 (6) (pp 384-387), 2011. Date of
Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
A NUMBER OF elective coronary artery bypass graft (CABG) surgery patients
have impaired underlying left ventricular function (poor ejection
fraction). This study was performed to compare the effect of postoperative
oral carvedilol versus metoprolol on left ventricular ejection fraction
(LVEF) after CABG compared with metoprolol. In a double-blind clinical
trial, 60 patients with coronary artery disease, aged 35 to 65 years, who
had an ejection fraction of 15% to 35% were included. Either carvedilol or
metoprolol was administered the day after CABG. The patients were
evaluated by the same cardiologist 14 days before and 2 and 6 months after
elective CABG. The results demonstrated better improvements in LVEF in the
carvedilol group. No difference regarding postoperative arrhythmias or
mortality was detected. The results suggest that carvedilol may exert more
of an improved myocardial effect than metoprolol for the low ejection
fraction patients undergoing CABG in the early postoperative months. 2011
American Society of PeriAnesthesia Nurses.

<11>
[Use Link to view the full text]
Accession Number
2012133911
Authors
Bennett-Guerrero E. Phillips-Bute B. Waweru P.M. Gaca J.G. Spann J.C.
Milano C.A.
Institution
(Bennett-Guerrero) Perioperative Clinical Research, Duke Clinical Research
Institute, Duke University, Durham, NC 27710, United States
(Phillips-Bute, Waweru) Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Gaca, Milano) Division of Cardiothoracic Surgery, Duke University Medical
Center, Durham, NC, United States
(Spann) Oklahoma Heart Institute, Hillcrest Medical Center, Tulsa, OK,
United States
Title
Pilot study of sternal plating for primary closure of the sternum in
cardiac surgical patients.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 6 (6) (pp 382-388), 2011. Date of Publication: November-December
2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objective: Postoperative sternal wound complications are a significant
problem in high-risk patients. In addition to closure with conventional
wires, several systems involving rigid fixation with metal plates are
currently available. The Rapid Sternal Closure System (Talon) is approved
for stabilization and fixation of the anterior chest wall. Anecdotal
evidence suggests that use of the Talon may result in improved
postoperative recovery. Methods: Fifty-one cardiac surgical patients at
higher risk for sternal wound complications were enrolled at two sites.
Subjects were randomized to insertion of Talons (n = 28) or wires only
(control, n = 23) for sternal closure. The primary endpoint was a
comparison between study groups of the percent of baseline incentive
spirometry volume through postoperative day 7. Secondary endpoints
included other measures of quality of recovery, sternal wound infection,
and nonunion. Results: The percentage of preoperative incentive spirometry
volume achieved was higher in the Talon arm (67% +/- 32%) versus control
(58% +/- 24%); however, this was not statistically significant (P = 0.41).
Use of the Talon was associated with decreased use of opiates (21.3 +/-
11.8 vs 25.4 +/- 21.6 mg, P = 0.44), increased ability to ambulate 1000 ft
on postoperative day 5 (25% vs 13%, P = 0.28), and decreased duration of
mechanical ventilation (median 0.5 vs 1.0 days, P = 0.24) and hospital
length of stay (4.5 +/- 3.2 vs 5.3 +/- 4.0 days, P = 0.40). One
superficial sternal wound infection was observed in each study arm. There
were no cases of nonunion. Conclusions: In this pilot study, the primary
endpoint was not statistically different between the treatment groups. Use
of the Talon was associated with trends toward benefit in endpoints
consistent with enhanced postoperative recovery, highlighting a need for
additional data from larger randomized trials. Copyright 2012 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<12>
Accession Number
70685995
Authors
Kuah D.
Institution
(Kuah) NSW Institute of Sport, Australia
Title
Platelet rich plasma-Current evidence and use in musculoskeletal medicine.
Source
Journal of Science and Medicine in Sport. Conference: 2011 Australian
Conference of Science and Medicine in Sport "Optimising Health and
Fitness-Participation, Prevention and Performance" Perth, WA Australia.
Conference Start: 20111019 Conference End: 20111022. Conference
Publication: (var.pagings). 14 (pp e66), 2011. Date of Publication:
December 2011.
Publisher
Elsevier
Abstract
The author will present a literature review on current evidence and use of
platelet rich plasma (PRP) in musculoskeletal (MSK) medicine. Reports of
PRP use was first made in 1987 by Ferrari et al. in open heart surgery.
Since then, there has been extensive use in a wide range of medical fields
including, orthopaedics, sports medicine, dentistry, ENT, neurosurgery,
cosmetic/aesthetic medicine, wound healing, cardiothoracic and
maxillofacial surgery. Much of the evidence on the use in musculoskeletal
(MSK) medicine has been in animal studies, anecdotal or case series. It is
only in recent years that randomized controlled trials in PRP use have
been published. Whilst much of the research and use of PRP in MSK medicine
has been in treating tendon pathologies (particularly chronic
tendinopathies), PRP is also used in bone, joint, muscle and ligament
injuries. This has included augmentation for acute orthopaedic procedures
such as joint replacement, internal fixation of fractures (particularly
for non unions), arthrodesis and tendon repairs. These uses and any
evidence will be presented by the author. It is generally accepted that
growth factors play a central role in tissue healing and regeneration. In
blood, platelets have a role in clotting, but also contain alpha granules
which contain various growth factors including TGF-beta, PDGF (platelet
derived growth factor), EGF (endothelial growth factor), VEGF (vascular
endothelial growth factor), FGF (fibroblast growth factor) and IGF
(insulin growth factor). It is understood that these growth factors
perform a variety of tasks including regulation of cellular migration and
proliferation, stimulation of cell replication, stimulation of
angiogenesis, and acceleration of mesenchymal stem cell replication and
osteoid production. The author was an invited presenter at a landmark
invitation only international seminar on use of growth factors in sports
medicine held in Qatar in February 2009 where the medical directors of
both IOC and WADA were present. At this seminar, a randomized controlled
trial on use of PRP in hamstring muscle tears was designed, targeted at
the national football competition, which were a captive audience.
Following this, WADA released its 2010 guidelines which included
recommendations specifically on PRP, allowing use in MSK conditions apart
fro into muscle. The 2011 WADA guidelines now allow the use of PRP for all
MSK areas.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 14

Results Generated From:
Embase <1980 to 2012 Week 11>
Embase (updates since 2012-03-08)

<1>
Accession Number
2012131977
Authors
Stergiopoulos K. Brown D.L.
Institution
(Stergiopoulos, Brown) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, Stony Brook, NY, United
States
Title
Initial coronary stent implantation with medical therapy vs medical
therapy alone for stable coronary artery disease: Meta-analysis of
randomized controlled trials.
Source
Archives of Internal Medicine. 172 (4) (pp 312-319), 2012. Date of
Publication: 27 Feb 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Background: Prior meta-analyses have yielded conflicting results regarding
the outcomes of treatment of stable coronary artery disease (CAD) with
initial percutaneous coronary intervention (PCI) vs medical therapy.
However, most of the studies in prior systematic reviews used balloon
angioplasty as well as medical therapies that do not reflect current
interventional or medical practices. We therefore performed a
meta-analysis of all randomized clinical trials comparing initial coronary
stent implantation with medical therapy to determine the effect on death,
nonfatal myocardial infarction (MI), unplanned revascularization, and
persistent angina. Methods: Prospective randomized trials were identified
by searches of the MEDLINE database from 1970 to September 2011. Trials in
which stents were used in less than 50% of PCI procedures were excluded.
Data were extracted from each study, and summary odds ratios (ORs) were
obtained using a random effects model. Results: Eight trials enrolling
7229 patients were identified. Three trials enrolled stable patients after
MI, whereas 5 studies enrolled patients with stable angina and/or ischemia
on stress testing. Mean weighted follow-up was 4.3 years. The respective
event rates for death with stent implantation and medical therapy were
8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and
8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4%
and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29%
and 33% (OR, 0.80; 95% CI, 0.60-1.05). Conclusion: Initial stent
implantation for stable CAD shows no evidence of benefit compared with
initial medical therapy for prevention of death, nonfatal MI, unplanned
revascularization, or angina. 2012 American Medical Association. All
rights reserved.

<2>
Accession Number
2012122459
Authors
Mannacio V. Di Tommaso L. De Amicis V. Stassano P. Musumeci F. Vosa C.
Institution
(Mannacio, Di Tommaso, De Amicis, Stassano, Vosa) Department of Cardiac
Surgery, University of Naples Federico II, Via S. Domenico 62, 80127
Naples, Italy
(Musumeci) Department of Cardiac Surgery, Azienda Ospedaliera S. Camillo
Forlanini, Rome, Italy
Title
Preoperative intraaortic balloon pump for off-pump coronary arterial
revascularization.
Source
Annals of Thoracic Surgery. 93 (3) (pp 804-809), 2012. Date of
Publication: March 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Prophylactic intraaortic balloon pump (IABP) support showed
better outcomes in critical patients undergoing coronary revascularization
compared with intraoperative or postoperative insertion. We conducted a
prospective, randomized study to determine the optimal timing for
preoperative IABP insertion in high-risk patients undergoing off-pump
coronary artery revascularization. Methods: The study enrolled 230
consecutive high-risk patients (having a logistic European System for
Cardiac Operative Risk Evaluation score of <10) undergoing off-pump
coronary artery revascularization. They were randomized for preoperative
IABP starting at 2 hours (2T, n = 115) or 12 hours (12T, n = 115).
Clinical, biochemical, and hemodynamic results, and the need for inotropic
drug support, were markers of outcome and compared between groups.
Results: Hospital mortality in group 12T was reduced by 60%, but the
difference between groups was not statistically significant (hazard ratio,
0.4; 95% confidence interval, 0.1 to 1.5; p = 0.1). Twelve hours of
preoperative IABP therapy reduced postoperative low output syndrome
(hazard ratio, 0.4; 95% confidence interval, 0.1 to 0.9; p = 0.03) and
biomarker leakage upper normal limit (hazard ratio, 0.3; 95% confidence
interval, 0.1 to 0.7; p = 0.001). Postoperative left ventricular function
was similar between the groups. Group 2T patients required higher
inotropic support for a longer average duration and prolonged
postoperative intensive care unit and hospital length of stay.
Conclusions: Twelve hours preoperative IABP therapy improved treatment
efficacy. Postoperative morbidity was reduced, but hospital mortality rate
was not affected. The IABP-related complication rate was low and not
related to the length of treatment. 2012 The Society of Thoracic
Surgeons.

<3>
Accession Number
2012122458
Authors
Heying R. Wehage E. Schumacher K. Tassani P. Haas F. Lange R. Hess J.
Seghaye M.-C.
Institution
(Heying, Wehage) Department of Pediatric Cardiology, University Hospital
Aachen, Aachen, Germany
(Heying) Department of Pediatric Cardiology, UZ Leuven, Herestraat 49,
3000 Leuven, Belgium
(Schumacher, Seghaye) Department of Pediatrics, University Hospital Lige,
Lige, Belgium
(Tassani) Department of Anesthesiology, German Heart Centre, Technical
University, Munich, Germany
(Haas, Lange) Department of Cardiac Surgery, German Heart Centre,
Technical University, Munich, Germany
(Hess) Department of Pediatric Cardiology, German Heart Centre, Technical
University, Munich, Germany
Title
Dexamethasone pretreatment provides antiinflammatory and myocardial
protection in neonatal arterial switch operation.
Source
Annals of Thoracic Surgery. 93 (3) (pp 869-876), 2012. Date of
Publication: March 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: This prospective double-blinded randomized study tested the
hypothesis that preoperative treatment with dexamethasone would attenuate
inflammatory priming of the myocardium, reduce the systemic inflammatory
reaction upon cardiac operation, and provide organ protection in neonates.
Methods: Twenty neonates (age, 8 to 21 days) with transposition of the
great arteries scheduled for arterial switch operation were included. Nine
received dexamethasone (1 mg/kg body weight) 4 hours before
cardiopulmonary bypass, and 11 received natrium chloride. We studied
intramyocardial messenger RNA expression of interleukin (IL)-6, IL-8,
IL-1beta, and tumor necrosis factor-alpha (TNF-alpha), as well as IL-10
and expression of TNF-alpha on protein level in right atrial tissue taken
before institution of CPB. We measured plasma levels of IL-6, IL-10,
lipopolysaccharide binding protein, and cardiac troponin T. Cytokine
expression was related to postoperative outcome. Results: Pretreatment
with dexamethasone led to a significant decrease in myocardial expression
of IL-6, IL-8, IL-1beta, and TNF-alpha messenger RNA and to a decrease in
protein synthesis of TNF-alpha. Plasma concentrations of IL-6 were
significantly lower and those of IL-10 significantly higher in pretreated
patients. This was associated with lower cardiac troponin T values and
lower dobutamine requirement. Levels of lipopolysaccharide binding protein
were significantly higher postoperatively in pretreated neonates.
Conclusions: Dexamethasone administration before arterial switch operation
leads to a shift in the myocardial and systemic cytokine expression
profile in neonates with transposition of the great arteries, with
downregulation of proinflammatory and upregulation of antiinflammatory
cytokines. Lower myocardial cell damage and lower catecholamine
requirement suggest myocardial protection in treated patients. 2012 The
Society of Thoracic Surgeons.

<4>
Accession Number
2012128632
Authors
Mehta R.H. Yu J. Piccini J.P. Tcheng J.E. Farkouh M.E. Reiffel J. Fahy M.
Mehran R. Stone G.W.
Institution
(Mehta, Piccini, Tcheng) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Yu, Farkouh, Mehran) Cardiovascular Research Foundation, Mount Sinai
Medical Center, New York, NY, United States
(Reiffel, Fahy, Stone) Cardiovascular Research Foundation, Columbia
University, Medical Center, New York, NY, United States
Title
Prognostic significance of postprocedural sustained ventricular
tachycardia or fibrillation in patients undergoing primary percutaneous
coronary intervention (from the HORIZONS-AMI trial).
Source
American Journal of Cardiology. 109 (6) (pp 805-812), 2012. Date of
Publication: 15 Mar 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The prognostic significance of postprocedure sustained ventricular
tachycardia or ventricular fibrillation (VT/VF) in patients undergoing
primary percutaneous coronary intervention (PPCI) for ST-segment elevation
myocardial infarction (STEMI) has rarely been studied, although a previous
study has suggested that its occurrence portends decreased survival. We
examined outcomes from the prospective large-scale multicenter randomized
HORIZONS-AMI trial to evaluate the incidence, clinical correlates, and
outcomes of in-hospital sustained VT/VF after PPCI. Of 3,485 patients
undergoing PPCI in whom VT/VF did not occur before or during the
procedure, 181 patients (5.2%) developed VT/VF after PPCI. Most
postprocedural VT/VF episodes (85%) occurred in the first 48 hours.
Patients with postprocedural VT/VF were more likely men with Killip class
>I on presentation but had a lower prevalence of hypertension and
diabetes. Patients with postprocedural VT/VF were also less frequently
taking beta blockers and angiotensin-converting enzyme
inhibitors/angiotensin receptor blockers at admission. Mean
door-to-balloon time was shorter and Thrombolysis In Myocardial Infarction
grade 0 flow before PPCI was more common in patients with VT/VF, although
Thrombolysis In Myocardial Infarction grade 3 flow rates after PPCI did
not vary. There were no significant differences in adjusted 3-year rates
of mortality (hazard ratio 0.73, 95% confidence interval 0.30 to 1.79) or
composite major adverse clinical events (death, myocardial infarction,
target vessel revascularization, or stroke; hazard ratio 0.71, 95%
confidence interval 0.44 to 1.15) in patients with versus without
postprocedural sustained VT/VF. In conclusion, sustained VT/VF after PPCI
in the HORIZONS-AMI trial was not significantly associated with 3-year
mortality or major adverse clinical events. Further studies are required
to address the prognostic significance of VT/VF in patients with STEMI
undergoing PPCI. 2012 Elsevier Inc. All rights reserved.

<5>
Accession Number
2012121115
Authors
Dixon E.
Title
Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis.
Source
Journal of the American College of Surgeons. 214 (3) (pp 374-376), 2012.
Date of Publication: March 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)

<6>
Accession Number
2012120691
Authors
Baidya D.K. Pawar D.K. Dehran M. Gupta A.K.
Institution
(Baidya, Pawar, Dehran) Department of Anaesthesia and Intensive Care, All
India Institute of Medical Sciences, New Delhi - 110 029, India
(Gupta) Department of Radiology, All India Institute of Medical Sciences,
New Delhi, India
Title
Advancement of epidural catheter from lumbar to thoracic space in
children: Comparison between 18G and 23G catheters.
Source
Journal of Anaesthesiology Clinical Pharmacology. 28 (1) (pp 21-27),
2012. Date of Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Backgrounds and Objectives: Lumbar-to-thoracic advancement of epidural
catheter is a safe alternative to direct thoracic placement in children.
In this prospective randomized study, success rate of advancement of two
different types and gauges of catheter from lumbar-to-thoracic space were
studied. Materials and Methods: Forty ASA I and II children (up to 6
years) undergoing thoracic or upper-abdominal surgery were allocated to
either Group I (18G catheter) or Group II (23G catheter). After induction
of general anesthesia a pre-determined length of catheter was inserted.
Successful catheter placement was defined as the catheter tip within two
segment of surgical incision in radio-contrast study. Intra-operative
analgesia was provided by epidural bupivacaine and intravenous morphine.
Post-operative analgesia was provided with epidural infusion of 0.1%
bupivacaine+1mcg/ml fentanyl. Observations and Results: Catheter
advancement was successful in 3 cases in Group I and 2 cases in Group II.
Five different types of catheter positions were found on X-ray. Negative
correlation was found between age and catheter advancement [significance
(2-tailed) =0.03]. However, satisfactory post-operative analgesia was
obtained in 35 cases. Positive correlation was found between infusion
rate, the number of segment of gap between desired level and the level
reached [significance (2-tailed) =0.00]. 23G catheter use was associated
with more technical complications. Conclusion: Advancement of epidural
catheter from lumbar to thoracic level was successful in only 10-15% cases
but satisfactory analgesia could be provided by increasing the infusion
rates.

<7>
Accession Number
2012117131
Authors
Wang Y. Zhang H.-B. Xia B. Wang G.-M. Zhang M.-Y.
Institution
(Wang) Department of Cardiac Surgery, Provincial Hospital Affiliated to
Shandong University, Jinan, Shandong 250021, China
(Zhang, Xia, Wang, Zhang) Department of Anesthesiology, Provincial
Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
Title
Preemptive analgesic effects of flurbiprofen axetil in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach.
Source
Chinese Medical Journal. 125 (4) (pp 579-582), 2012. Date of
Publication: 20120220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Systemic non-steroidal anti-inflammatory drugs have been
evaluated for their possible preemptive analgesic effects. The efficacy of
flurbiprofen axetil for preemptive analgesia in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach
needs further investigation. The aim of this study was to research the
preemptive analgesic effects of flurbiprofen axetil in thoracic surgery,
and the influence of preoperative administration on postoperative
respiratory function. Methods This randomized, double-blind, controlled
trial enrolled 60 patients undergoing radical resection of esophageal
carcinoma via the left thoracic approach. Anesthesia management was
standardized. Each patient was randomly assigned to receive either 100 mg
flurbiprofen axetil intravenously 15 minutes before incision (PA group) or
intravenous normal saline as a control (C group). Postoperative analgesia
was with sufentanil delivered by patient-controlled analgesia pump.
Postoperative sufentanil consumption, visual analog scale pain scores,
plasma levels of interleukin-8, and oxygenation index were measured.
Results Compared with the preoperative baseline, postoperative patients in
the PA group had no obvious increase in pain scores (P >0.05), but
patients in the C group had significantly increased pain scores (P <0.05).
Pain scores in the C group were significantly higher at 24 hours
postoperatively than preoperatively. Intergroup comparisons showed lower
visual analog scale scores at 2-24 hours postoperatively in the PA group
than the C group (P <0.05). Sufentanil consumption and plasma
interleukin-8 levels at 2 and 12 hours postoperatively were significantly
lower in the PA group than the C group (P <0.05). The oxygenation index at
2 and 12 hours postoperatively was significantly higher in the PA group
than the C group (P <0.05). Conclusions Intravenous flurbiprofen axetil
appears to have a preemptive analgesic effect in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach,
and appears to contribute to recovery of respiratory function and to
reduction of the postoperative inflammatory reaction.

<8>
Accession Number
2012115754
Authors
Polito A. Ricci Z. Fragasso T. Cogo P.E.
Institution
(Polito, Ricci, Fragasso, Cogo) Department of Cardiology, Bambino Gesu
Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
Title
Balloon atrial septostomy and pre-operative brain injury in neonates with
transposition of the great arteries: A systematic review and a
meta-analysis.
Source
Cardiology in the Young. 22 (1) (pp 1-7), 2012. Date of Publication:
February 2012.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Objective: To perform a systematic review and a meta-analysis of the
effects of balloon atrial septostomy on peri-operative brain injury in
neonates with transposition of the great arteries. Data source: We conduct
a systematic review of the literature to identify all observational
studies that included neonates born with transposition of the great
arteries who had peri-operative evidence of brain injury. Study selection
and data extraction: The search strategy produced three prospective and
two retrospective cohort studies investigating the association between
balloon atrial septostomy and brain injury totalling 10,108 patients. In
two studies, the outcome was represented by the presence of a coded
diagnosis of a clinically evident stroke at discharge, whereas in three
studies the outcome was represented by the finding of pre-operative brain
injury identified by magnetic resonance scans. Data synthesis: The overall
brain injury rate for neonates who underwent balloon atrial septostomy
versus control patients was 60 of 2273 (2.6%) versus 45 of 7835 (0.5%;
pooled odds ratio, 1.90; 95% confidence intervals, 0.93-3.89; p = 0.08). A
subgroup analysis of the three studies that used pre-operative brain
injury as the primary outcome found no significant association between
balloon atrial septostomy and brain injury (pooled odds ratio, 2.70; 95%
confidence intervals, 0.64-11.33; p = 0.17). Balloon atrial septostomy
frequency was 22.4% (2273 of 10,108), with reported rates ranging from 20%
to 75%. Conclusion: Our analysis shows that balloon atrial septostomy is
not associated with increased odds for peri-operative brain injury.
Balloon atrial septostomy should still be used for those patients with
significant hypoxaemia, haemodynamic instability, or both. Copyright
Cambridge University Press 2011.

<9>
Accession Number
2012125534
Authors
Oh S.-Y. Kim J.C. Choi Y.S. Lee W.K. Lee Y.-K. Kwak Y.L.
Institution
(Oh, Kim, Lee, Lee, Kwak) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, Seoul, South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Kyungpook National
University Hospital, 250, Seongsanno, Seodaemun-gu, Seoul 120-752, South
Korea
Title
Effects of ulinastatin treatment on myocardial and renal injury in
patients undergoing aortic valve replacement with cardiopulmonary bypass.
Source
Korean Journal of Anesthesiology. 62 (2) (pp 148-153), 2012. Date of
Publication: February 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: We determined the protective effects of a high dose of
ulinastatin on myocardial and renal function in patients undergoing aortic
valve replacement with cardiopulmonary bypass (CPB). Methods: Sixty
patients were assigned randomly to either the ulinastatin group (n = 30)
or the control group (n = 30). In the ulinastatin group, ulinastatin
(300,000 U) was given after the induction of anesthesia, ulinastatin
(400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000
U) was administered after weaning from CPB. In the control group, the same
volume of saline was administered at the same time points. Creatine
kinase-MB levels were assessed 1 day before surgery, and on the first and
second postoperative day (POD 1 and 2). Serum creatinine and cystatin C
levels were assessed 1 day before surgery, upon intensive care unit
arrival, and on POD 1 and 2. The level of plasma neutrophil
gelatinase-associated lipocalin was assessed before induction of
anesthesia, upon ICU arrival, and on POD 1. Results: No significant
differences were observed in serum levels of creatine kinase-MB and
biomarkers of renal injury between the two groups at any point during the
study period. Conclusions: Ulinastatin showed no cardiac or renal
protective effects after CPB in patients undergoing aortic valve
replacement. the Korean Society of Anesthesiologists, 2012.

<10>
Accession Number
2012125533
Authors
Min T.J. Kim W.Y. Jeong W.J. Choi J.H. Lee Y.S. Kim J.H. Park Y.C.
Institution
(Min, Kim, Jeong, Choi, Lee, Kim, Park) Department of Anesthesiology and
Pain Medicine, Korea University Ansan Hospital, Ansan, South Korea
Title
Effect of ketamine on intravenous patient-controlled analgesia using
hydromorphone and ketorolac after the Nuss surgery in pediatric patients.
Source
Korean Journal of Anesthesiology. 62 (2) (pp 142-147), 2012. Date of
Publication: February 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Nuss surgery is preferred in pectus excavatum repair because
this procedure produces excellent cosmetic results and prevents
postoperative distressed pulmonary function. However, the procedure causes
severe pain due to thoracic expansion. This study was designed to
investigate the analgesic effect of small doses of ketamine on an
intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and
ketorolac for pain control after Nuss surgery. Methods: Forty-four
patients undergoing elective Nuss surgery were randomly assigned to
receive hydromorphone 3 mug/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron
0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 mug/kg/ hr, ketorolac
0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group
HK, n = 22) via an IVPCA pump after surgery. A blind observer evaluated
each patient using the Modified Children's Hospital of Eastern Ontario
Pain Scale (CHEOPS) for the assessment of pain control. The total
administered PCA volume, side effects and parents satisfaction with pain
control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours.
Results: There were no significant differences in Modified CHEOPS between
the groups during postoperative 48 hours. The total PCA volume in group HK
was significantly lower than that in group HO (P < 0.05). The side effects
in both groups did not significantly differ except for pruritus. The
levels of satisfaction from the parents were not significantly different
between the groups. Conclusions: A small dose of ketamine on IV-PCA
reduced the total administered dose of IV-PCA with hydromorphone and
ketorolac and reduced the incidence of pruritus after the Nuss procedure
in pediatric patients. the Korean Society of Anesthesiologists, 2012.

<11>
Accession Number
2012122711
Authors
Slany J. Nirnberger G. Pittrow L.A.
Institution
(Nirnberger) Bioconsult GmbH, Breitenfurt, Austria
(Pittrow) Takeda Pharma Ges.m.b.H., Seidengasse 33-35, 1070 Vienna,
Austria
Title
Cardiovascular risk stratification and antihypertensive therapy according
to guidelines in the outpatient setting.
Source
Wiener Medizinische Wochenschrift. 161 (23-24) (pp 557-564), 2011. Date
of Publication: December 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
Basic concepts and methodology: Acceptance of the ESH/ESC 2007
hypertension guidelines and their reappraisal 2009 are not known by
Austrian practitioners. Therefore, within the frame of a noninterventional
trial we investigated 3,488 ambulatory hypertensive patients. Primary goal
was the evaluation of the assignment to cardiovascular risk categories
according to the ESH/ESC charts by office-based physicians compared to an
independent risk adjudication using the same data and method. Further
goals were assessment of compliance with the recommendation to start
combination treatment in grade 2 and 3 hypertension and efficacy and
tolerability of treatment with candesartan. Results: The comparison
revealed incorrect physicians? risk assessment for approximately 60% of
the patients with a strong tendency for underestimation. Despite
guidelines recommending an initial combination therapy for hypertension
>=160/90 mmHg, 15.4% of these patients still received candesartan as a
monotherapy. Target blood pressure <=140/90mmHg could be well achieved (in
81.6%) with candesartan as monotherapy or combined with
hydrochlorothiazide (HCTZ) for hypertension grade 1-3. Conclusions:
Guidelines for assessment of individual risk and derived therapy
algorithms should be better communicated in the outpatient setting.
Candesartan alone or combined with HCTZ is an effective and well tolerated
therapeutic option to control blood pressure in the majority of patients.
Springer-Verlag 2011.

<12>
Accession Number
70682482
Authors
Ravven S. Bader C. Azar A.R. Rudolph J.L.
Institution
(Ravven) Cambridge Health Alliance, Harvard Medical School, Cambridge, MA,
United States
(Bader) Albert Einstein College of Medicine, Bronx, NY, United States
(Azar) Geriatrics and Extended Care, Povidence VA Medical Center,
Providence, RI, United States
(Rudolph) Geriatric Research, Education and Clinical Center, VA Boston
Healthcare System, Boston, MA, United States
Title
Depression after CABG surgery: A meta-analysis.
Source
American Journal of Geriatric Psychiatry. Conference: AAGP Annual Meeting
2012 Washington, DC United States. Conference Start: 20120316 Conference
End: 20120319. Conference Publication: (var.pagings). 20 (3 SUPPL. 1)
(pp S84), 2012. Date of Publication: March 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Coronary Artery Bypass Graft (CABG) surgery is a common
surgical procedure. Preoperative and postoperative depression can impair
the recovery process. The objective of this meta-analysis was to determine
the course of depressive symptoms after CABG surgery. Methods: Scientific
databases were searched for studies assessing depression before and after
CABG. Studies that reported depression and/or depressive symptoms before
and after CABG were included in meta-analyses Meta-analyses were performed
for early (1-2 weeks), recovery (>2 weeks - 2 months), mid (>2 months - 6
months), and late (>6 months) time points. Analysis of studies reporting
dichotomous outcomes were included. Heterogeneity and publication bias
were analyzed. Results: 21 studies reporting dichotomous outcomes were
included in the meta analysis. While there was a nonsignificant increased
risk of depression early after CABG (RR 95%CI), there was a significantly
decreased risk of depression at recovery (RR 0.78, 95% CI 0.67-0.90), mid
(RR 0.64, 95% CI 0.58-0.70) and late (RR 0.68, 95% CI 0.58- 0.79) time
points without heterogeneity. Conclusions: Risk of depression decreased
post-CABG. While depression improves overall after CABG, not all patients
will experience improvement and preoperative and postoperative depression
monitoring is important.

<13>
[Use Link to view the full text]
Accession Number
70681601
Authors
Blaudszun G. Lysakowski C. Elia N. Tramer M.R.
Institution
(Blaudszun, Lysakowski, Elia, Tramer) Uinversity Hospitals of Geneva,
Department of Anaesthesiology, Geneve, Switzerland
Title
Effect of perioperative systemic alpha2-agonists on postoperative morphine
consumption and pain intensity - Systematic review of randomized
controlled trials.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2011 Amsterdam Netherlands. Conference Start:
20110611 Conference End: 20110614. Conference Publication: (var.pagings).
28 (pp 196), 2011. Date of Publication: June 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Perioperative systemic alpha2-agonists are
expected to reduce postoperative opioid requirements and pain intensity.
Materials and Methods: We searched Medline, Embase, Central, and
bibliographies (to 4.2010), without language restriction, for randomized
trials testing any systemic alpha2-agonist (versus placebo or no
treatment), administrated before, during or after surgery, in adults
undergoing non-cardiac surgery under general anesthesia, and that reported
on postoperative cumulative opioid consumption or pain intensity. Opioid
doses were converted to morphine equivalents. We estimated weighted mean
differences (WMD) and numbers-needed-to-treat/harm (NNT/H) with 95%
confidence intervals (CI) when data from at least five studies or 100
patients could be combined. Results and Discussion: Thirty studies (1,792
patients, 933 received clonidine or dexmedetomidine) were included.
Alpha2-agonists regimens varied widely across trials. Their opioid-sparing
effect consistently increased over time: WMD at 2 h -0.4 mg, at 6 h -4.7
mg, at 12 h and 24h -8.5 mg, and at 36h -17.6 mg. Alpha2-agonists
significantly decreased pain intensity at 30 min (-1 cm on the 10 cm VAS)
and at 2 h (-0.7 cm), but not at 24 h. They also significantly decreased
nausea at 8 and 48 h (NNT 8.4 and 6.2, respectively), and vomiting at 48 h
(NNT 18), but increased the risk of postoperative bradycardia (NNH 12),
and of intraoperative and postoperative arterial hypotension (NNH 11 and
16, respectively). Recovery times were not prolonged. Conclusion(s):
Peri-operative systemic alpha2-agonists have only a weak postoperative
opioid-sparing effect and a short lasting effect on pain intensity. Their
impact on nausea and vomiting is clinically not relevant while hemodynamic
adverse effects may limit their routine usage.

<14>
[Use Link to view the full text]
Accession Number
70681222
Authors
Candela-Toha A.M. Elias-Martin E. Martinez-Perez A. Prada P. Parise-Roux
D.
Institution
(Candela-Toha, Elias-Martin, Martinez-Perez, Prada, Parise-Roux) Hospital
Universitario Ramon y Cajal, Department of Anaesthesiology, Madrid, Spain
Title
Efficacy and safety of intraoperative cell saver use in cardiac surgery
with cardiopulmonary bypass: A propensity score analysis.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2011 Amsterdam Netherlands. Conference Start:
20110611 Conference End: 20110614. Conference Publication: (var.pagings).
28 (pp 80), 2011. Date of Publication: June 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Controversy exists about the effect of
intraoperative cell saver (ICS) use during cardiac surgery. While earlier
trials showed a reduction in blood components utilization, recent studies
show no effect or an increase in fresh frozen plasma use. A recent
meta-analysis of 31 randomized clinical trials (RCT) found a decrease in
exposure to allogenic blood products (OR 0.63) without increase in
morbidity or mortality (1). Because RCTs rarely reflect clinical practice,
the aim of our study was to determine the efficacy and safety of ICS in
routine clinical practice. Materials and Methods: Retrospective analysis
of prospectively collected data recorded in our Cardiac Anaesthesia
database. For the purpose of the present study patients operated of mayor
cardiac surgery with cardiopulmonary bypass (CPB) between September 1st
2004 and December 31^st 2007 were included. We excluded patients
with ICS contraindication (i.e. endocardits) and early (< 24 h) deaths. We
first developed a propensity score (PS) model with ICS use as the
dependent variable. Baseline variables included were demographic: age,
sex, weight, height, body surface; analytical: preoperative hemoglobin,
hematocrit, platelet count, INR, aPTT, serum creatinine, preoperative
antiplatelet medication, and surgical variables: type, priority,
complexity, previous cardiac surgery and intraoperative use of
antifibrinolytics. We then performed matching without replacement based on
the PS model. Efficacy variables considered were: intraoperative
transfusion (IT), postoperative ICU transfusion (PT) and transfusion
during the first 48h (T48). Safety evaluation was assessed wtih
postoperative bleeding (PB) at 6h, 12h and 24h and bleeding needing
reintervention (BNR). Results and Discussion: During this period 986
surgeries were performed. ICS was used in 270 cases (27.4%) and 238 of
them could be matched by PS. ICS use decreased IT (OR, 95% confidence
interval [CI]) (0.57 [0.40-0.81]), PT 0.52 [0.35-0.77) and T48 0.38
[0.25-0.56]. PB at 6 and 12h, but not at 24h, was significantly higher in
patients with ICS use (mean difference in mL [CI]) at 6h: 76 [3-149], at
12h: 105 [10 - 200] and at 24h 101 [-14 - 215]. BNR was nonsignificantly
more frequent in the ICS group (OR [CI]) 1.9 [0.9 - 4.1]. Conclusion(s):
ICS use in cardiac surgery with CPB decreases intraoperative and
postoperative transfusion despite small non relevant increases in PB.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 23

Results Generated From:
Embase <1980 to 2012 Week 10>
Embase (updates since 2012-03-02)

<1>
Accession Number
2012110646
Authors
Yalcin S. Ozgencil E. Serdaroglu H. Oba S. Enon S. Demiralp S.
Institution
(Yalcin, Ozgencil, Serdaroglu, Oba, Demiralp) Department of Anesthesiology
and ICU, Faculty of Medicine, Ankara University, Ankara, Turkey
(Yalcin) Department of Anesthesiology and ICU, Faculty of Medicine, Harran
University, Sanliurfa, Turkey
(Enon) Department of Thoracic Surgery, Faculty of Medicine, Ankara
University, Ankara, Turkey
Title
Anesthetics modulate oxidative stress during one-lung ventilation in lung
cancer patients: Comparison of target-controlled propofol infusion and
desflurane.
Source
African Journal of Pharmacy and Pharmacology. 6 (6) (pp 407-411), 2012.
Date of Publication: February 2012.
Publisher
Academic Journals (P.O. Box 5170-00200, Nairobi,Victoria Island 73023,
Nigeria)
Abstract
Lung injury following thoracic surgery is a relatively uncommon disease,
but has a major complication with high mortality. Many factors, including;
ischemia reperfusion injury and the use of one-lung ventilation (OLV) are
involved in this process. This study was conducted to compare the results
of target-controlled infusion (TCI) of propofol versus desflurane in the
aspect of oxidative stress in lung cancer patients operated with OLV.
Thirty patients with non-small cell lung cancer whom were operated with
OLV were studied. In propofol group (n = 15), anesthesia was based on
propofol and remifentanil, both simultaneously administered via
target-control infusion and in desflurane group (n = 15), anesthesia was
maintained with desflurane. Serum malondialdehyde (MDA) levels were
measured during operation and postoperatively. In each group, cases showed
a statistically significant increase in serum malondialdehyde levels
during operation as compared to baseline levels (P < 0.05 for both). The
mean baseline levels of MDA were not significantly different among groups,
although mean serum MDA levels were statistically significantly decreased
at 30 min OLV, at 5 min of reoxygenation and at postoperative 6 h
measurements in propofol group as compared to desflurane group (P < 0.01
for all). TCI of propofol maintained hemodynamic stability similar with
desflurane in lung cancer patients which underwent lobectomy with OLV.
Findings of the present study suggested that the oxidative stress during
OLV might be modified with anesthetic approach and that the favorable
results with propofol in view of oxidative stress might lead to the
preferred use of this drug as compared to desflurane for general
anesthesia with OLV. 2012 Academic Journals.

<2>
Accession Number
2012099489
Authors
Xie J.-J. Liao X.-L. Chen W.-G. Huang D.-D. Chang F.-J. Chen W. Luo Z.-L.
Wang Z.-P. Ou J.-S.
Institution
(Xie, Chen, Huang, Luo) Guangzhou First Municipal People's Hospital,
Guangzhou Institute of Clinical Medicine, Guangzhou Medical College,
Guangzhou, China
(Liao, Chang, Wang, Ou) Division of Cardiac Surgery, First Affiliated
Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou 510080,
China
(Chen) Department of Medical Statistics and Epidemiology, School of Public
Health, Sun Yat-sen University, Guangzhou, China
Title
Remote ischaemic preconditioning reduces myocardial injury in patients
undergoing heart valve surgery: Randomised controlled trial.
Source
Heart. 98 (5) (pp 384-388), 2012. Date of Publication: March 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To determine whether remote ischaemic preconditioning (RIPC) is
cardioprotective in patients undergoing heart valve replacement. Design:
Single-blinded, randomised controlled trial. Setting :Tertiary referral
hospital in China. Patients: Adult patients (31-72 years) undergoing
mitral valve, aortic valve or tricuspid valve surgery. Interventions:
Patients were randomised to either the RIPC (n=38) or control (n=35)
group. After induction of anaesthesia, patients in the RIPC group
underwent three 5 min cycles of right upper limb ischaemia, induced by an
automated cuff-inflator placed on the upper arm and inflated to 200 mm Hg.
Each cycle was interrupted by a 5 min period of reperfusion during which
time the cuff was deflated. The control group had only a deflated cuff
placed on the upper arm for 30 min. Main outcome measures: Serum troponin
I concentration was measured before surgery and at 6, 12, 24, 48, and 72 h
postoperatively. The cardiac function of all patients was followed
postoperatively. Results: Troponin I concentration was reduced in the RIPC
group (398.7+/-179.3 mug/l) compared with the control group (708.4+/-242.5
mug/l). Mean difference was 309.7+/-50.8 (95% CI 210.1 to 409.3,
p<0.0001). A greater improvement in postsurgical cardiac function was
noted in the RIPC group than in the control group. Conclusions: These data
indicate that RIPC reduces myocardial injury and improves cardiac function
in patients undergoing heart valve surgery. Trial registration number:
NCT01175681.

<3>
Accession Number
2012122857
Authors
Fakin R. Zimpfer D. Sodeck G.H. Rajek A. Mora B. Dumfarth J. Grimm M.
Czerny M.
Institution
(Fakin) Division of General Thoracic Surgery, University Hospital Bern,
University of Bern, Bern, Switzerland
(Zimpfer, Dumfarth, Grimm) Department of Cardiac Surgery, Medical
University of Vienna, Vienna, Austria
(Sodeck) Department of Emergency Medicine, Medical University of Vienna,
Vienna, Austria
(Rajek, Mora) Department of Cardiothoracic and Vascular Anesthesiology,
Medical University of Vienna, Vienna, Austria
(Czerny) Swiss Cardiovascular Center, University Hospital Bern, University
of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
Title
Influence of temperature management on neurocognitive function in
biological aortic valve replacement. A prospective randomized trial.
Source
Journal of Cardiovascular Surgery. 53 (1) (pp 107-112), 2012. Date of
Publication: February 2012.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. Aim of this study was to elucidate if postoperative neurocognitive
function after biological aortic valve replacement (AVR) can be influenced
by temperature management during cardiopulmonary bypass (CPB). Methods. In
this prospective randomized study, we measured the effect of mild
hypothermic (32degreeC, N.=30) vs. normothermic (37degreeC, N.=30) CPB on
neurocognitive function. All patients underwent elective isolated
biological AVR (mean age 67+/-8 years, mean additional EuroSCORE
5.6+/-2.4). Neurocognitive function was objectively measured by means of
objective P300 auditory-evoked potentials before surgery, one week and
four months after surgery. Clinical data and outcome were monitored.
Results. P300 evoked potentials were comparable between patients operated
with mild hypothermic (370+/-30 ms) and normothermic CPB (373+/-32 ms)
before surgery (P=0.85). P300 peak latencies were prolonged (=impaired) in
patients operated with normothermic (402+/-29, P<0.0001) as well as with
mild hypothermic CPB (405+/-30 ms, P<0.0001) one week after surgery. Even
four months after surgery, still impairment of P300 peak latencies could
be documented in either patients operated with normothermic (394+/-28 ms)
and mild hypothermic CPB (400+/-33 ms,) in repeated measures analysis of
variance (P=0.042). Group comparison revealed no difference between
patients operated with normothermic and mild hypothermic CPB at one week
(P=0.54) and four months (P=0.67) after surgery. Clinical data as well as
postoperative adverse events were comparable between the two groups.
Conclusion. Normothermic temperature management during CPB is non-inferior
to hypothermic in means of neuroprotection. Since patients after
biological aortic valve replacement show a subclinical but measurable
cognitive deficit up to four months after surgery, other factors have to
be addressed to add further benefit to the extremely good results of open
biological AVR.

<4>
Accession Number
2012122280
Authors
Prowle J.R. Calzavacca P. Licari E. Ligabo E.V. Echeverri J.E. Haase M.
Haase-Fielitz A. Bagshaw S.M. Devarajan P. Bellomo R.
Institution
(Prowle, Calzavacca, Licari, Ligabo, Echeverri, Bellomo) Department of
Intensive Care, Austin Health, Austin Hospital, Studley Road, Heidelberg,
VIC 3084, Australia
(Prowle) Intensive Care Unit, Royal London Hospital, Barts and the London
NHS Trust, London, United Kingdom
(Haase, Haase-Fielitz) Department of Nephrology and Hypertension and
Endocrinology and Metabolic Diseases, Otto-von-Guericke-University,
Magdeburg, Germany
(Bagshaw) Division of Critical Care Medicine, University of Alberta
Hospital, University of Alberta, Edmonton, AB, Canada
(Devarajan) Center for Acute Care Nephrology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
Title
Pilot double-blind, randomized controlled trial of short-term atorvastatin
for prevention of acute kidney injury after cardiac surgery.
Source
Nephrology. 17 (3) (pp 215-224), 2012. Date of Publication: March 2012.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Aim: To test whether short-term perioperative administration of oral
atorvastatin could reduce incidence of postoperative acute kidney injury
(AKI) in cardiac surgical patients. Methods: We conducted a double-blind,
randomized controlled trial in 100 cardiac surgical patients at increased
risk of postoperative AKI. Patients were randomized to atorvastatin (40 mg
once daily for 4 days starting preoperatively) or identical placebo
capsule. Primary outcome was to detect a smaller absolute rise in
postoperative creatinine with statin therapy. Secondary outcomes included
AKI defined by the creatinine criteria of RIFLE consensus classification
(RIFLE R, I or F), change in urinary neutrophil gelatinase-associated
lipocalin (NGAL) concentration, requirement for renal replacement therapy,
length of stay in intensive care, length of stay in hospital and hospital
mortality. Results: Study groups were well matched. For each patient
maximal increase in creatinine during the 5 days after surgery was
assessed; median maximal increase was 28 mumol/L in the atorvastatin group
and 29.5 mumol/L in the placebo group (P = 0.62). RIFLE R or greater
occurred in 26% of patients with atorvastatin and 32% with placebo (P =
0.65). Postoperatively urine NGAL changes were similar (median NGAL:
creatinine ratio at intensive care unit admission: Atorvastatin group 1503
ng/mg, placebo group 1101 ng/mg; P = 0.22). Treatment was well tolerated
and adverse events were similar between groups. Conclusion: Short-term
perioperative atorvastatin use was not associated with a reduced incidence
of postoperative AKI or smaller increases in urinary NGAL.
(ClinicalTrials.gov NCT00910221). In this randomized, double-blind
clinical trial in 100 cardiac surgical patients at increased risk of
postoperative acute kidney injury, atorvastatin 40 mg/day given for 4 days
did not change the likelihood of elevation in serum creatinine or urinary
neutrophil gelatinase-associated lipocalin. 2011 Asian Pacific Society of
Nephrology.

<5>
[Use Link to view the full text]
Accession Number
2012122961
Authors
Van Haren F.M.P. Sleigh J. Boerma E.C. La Pine M. Bahr M. Pickkers P. Van
Der Hoeven J.G.
Institution
(Van Haren) Australian National University Medical School, Intensive Care
Department, Canberra Hospital, PO Box 11, Canberra Woden, ACT 2606,
Australia
(Sleigh, La Pine, Bahr) Intensive Care Department, Waikato Hospital,
Hamilton, New Zealand
(Boerma) Intensive Care Department, Medical Centre Leeuwarden, Leeuwarden,
Netherlands
(Pickkers, Van Der Hoeven) Intensive Care Department, Radboud University
Nijmegen Medical Centre, Nijmegen, Netherlands
Title
Hypertonic fluid administration in patients with septic shock: A
prospective randomized controlled pilot study.
Source
Shock. 37 (3) (pp 268-275), 2012. Date of Publication: March 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
We assessed the short-term effects of hypertonic fluid versus isotonic
fluid administration in patients with septic shock. This was a
double-blind, prospective randomized controlled trial in a 15-bed
intensive care unit. Twenty-four patients with septic shock were
randomized to receive 250 mL 7.2% NaCl/6% hydroxyethyl starch (HT group)
or 500 mL 6% hydroxyethyl starch (IT group). Hemodynamic measurements
included mean arterial blood pressure (MAP), central venous pressure,
stroke volume index, stroke volume variation, intrathoracic blood volume
index, gastric tonometry, and sublingual microcirculatory flow as assessed
by sidestream dark field imaging. Systolic tissue Doppler imaging
velocities of the medial mitral annulus were measured using
echocardiography to assess left ventricular contractility. Log
transformation of the ratio MAP divided by the norepinephrine infusion
rate (log MAP/NE) quantified the combined effect on both parameters.
Compared with the IT group, hypertonic solution treatment resulted in an
improvement in log MAP/NE (P = 0.008), as well as an increase in systolic
tissue Doppler imaging velocities (P = 0.03) and stroke volume index (P =
0.017). No differences between the groups were found for preload
parameters (central venous pressure, stroke volume variation,
intrathoracic blood volume index) or for afterload parameters (systemic
vascular resistance index, MAP). Hypertonic solution treatment decreased
the need for ongoing fluid resuscitation (P = 0.046). No differences
between groups were observed regarding tonometry or the sublingual
microvascular variables. In patients with septic shock, hypertonic fluid
administration did not promote gastrointestinal mucosal perfusion or
sublingual microcirculatory blood flow in comparison to isotonic fluid.
Independent of changes in preload or afterload, hypertonic fluid
administration improved the cardiac contractility and vascular tone
compared with isotonic fluid. The need for ongoing fluid resuscitation was
also reduced. 2012 by the Shock Society.

<6>
Accession Number
2012121023
Authors
Oraby M. Youssef A.
Institution
(Oraby, Youssef) Cardiology Department, Suez Canal University Hospital,
Ismailia, Egypt
Title
Immediate and 18-month outcome of balloon mitral valvuloplasty: Comparison
of inoue and multi-track system.
Source
Journal of Interventional Cardiology. 25 (1) (pp 47-52), 2012. Date of
Publication: February 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Aims: To compare the immediate and 18-month clinical and echocardiographic
outcome of Inoue and multi-track system for balloon mitral valvuloplasty
(BMV). Methods: We included 78 consecutive patients with moderate to
severe rheumatic mitral stenosis (MS) [mitral valve area (MVA) < 1.5
cm²] and clinically indicated BMV. The first 42 consecutive
patients were assigned to Inoue BMV (group I), and the following 36
consecutive patients were assigned to multi-track system (group M).
Clinical and echocardiographic assessment was performed before,
immediately after, 3 months after, and 18 months after the procedure.
Results: The successful immediate result [MVA > 1.5 cm² and
mitral regurgitation (MR) < II/IV] was achieved in 40 (95.23%) patients of
group I and 34 (94.44%) patients of group M (P = 0.12). Immediately after
BMV, MVA increased from 0.9 +/- 0.4 to 1.7 +/- 0.5 cm² in group
I and from 0.8 +/- 0.2 to 1.9 +/- 0.3 cm² in group M (P <
0.01). Bilateral commissural splitting was significantly higher in group M
(P < 0.01). This was associated with higher incidence of mild commissural
mitral regurgitation. There were no significant differences of moderate to
severe MR. Both procedure and fluoroscopy time were significantly shorter
in group I (P < 0.001). Eighteen-month clinical and echocardiographic
evaluation was available for 66 (84.64%) patients with sustained immediate
clinical and echocardiographic improvements. Conclusions: Both Inoue and
the multi-track balloon systems achieved successful immediate and 18-month
results. The multi-track double balloon system produced significantly
larger MVA, with better bilateral commissurotomy, yet with longer
procedure and fluoroscopy times. 2011, Wiley Periodicals, Inc.

<7>
[Use Link to view the full text]
Accession Number
2012119866
Authors
Muramatsu T. Matsushita K. Yamashita K. Kondo T. Maeda K. Shintani S.
Ichimiya S. Ohno M. Sone T. Ikeda N. Watarai M. Murohara T.
Institution
(Muramatsu, Matsushita, Yamashita, Kondo, Maeda, Shintani, Murohara)
Department of Cardiology, Nagoya University Graduate, School of Medicine,
65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
(Ichimiya, Ohno) Yokkaichi Municipal Hospital, Yokkaichi, Japan
(Shintani) Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
(Sone) Ogaki Municipal Hospital, Ogaki, Japan
(Ikeda) Chunichi Hospital, Nagoya, Japan
(Watarai) Anjo Kosei Hospital, Anjo, Japan
Title
Comparison between valsartan and amlodipine regarding cardiovascular
morbidity and mortality in hypertensive patients with glucose intolerance:
NAGOYA HEART study.
Source
Hypertension. 59 (3) (pp 580-586), 2012. Date of Publication: March
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
It has not been fully examined whether angiotensin II receptor blocker is
superior to calcium channel blocker to reduce cardiovascular events in
hypertensive patients with glucose intolerance. A prospective,
open-labeled, randomized, controlled trial was conducted for Japanese
hypertensive patients with type 2 diabetes mellitus or impaired glucose
tolerance. A total of 1150 patients (women: 34%; mean age: 63 years;
diabetes mellitus: 82%) were randomly assigned to receive either
valsartan- or amlodipine-based antihypertensive treatment. Primary outcome
was a composite of acute myocardial infarction, stroke, coronary
revascularization, admission attributed to heart failure, or sudden
cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and
glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan
group and the amlodipine group, respectively. Both of them were equally
controlled between the 2 groups during the study. The median follow-up
period was 3.2 years, and primary outcome had occurred in 54 patients in
the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97
[95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a
significantly lower incidence of heart failure than in the amlodipine
group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components
and all-cause mortality were not significantly different between the 2
groups. Composite cardiovascular outcomes were comparable between the
valsartan- and amlodipine-based treatments in Japanese hypertensive
patients with glucose intolerance. Admission because of heart failure was
significantly less in the valsartan group. 2012 American Heart
Association, Inc.

<8>
Accession Number
2012093716
Authors
Foroulis C.N. Anastasiadis K. Charokopos N. Antonitisis P. Halvatzoulis
H.V. Karapanagiotidis G.T. Grosomanidis V. Papakonstantinou C.
Institution
(Foroulis, Anastasiadis, Charokopos, Antonitisis, Halvatzoulis,
Karapanagiotidis, Papakonstantinou) Department of Thoracic and
Cardiovascular Surgery, Aristotle University Medical School, AHEPA
University Hospital, Stilponos Kiriakidi Street, Thessaloniki 54636,
Greece
(Grosomanidis) Department of Anaesthesiology and Intensive Care, Aristotle
University Medical School, AHEPA University Hospital, Thessaloniki, Greece
Title
A modified two-port thoracoscopic technique versus axillary
minithoracotomy for the treatment of recurrent spontaneous pneumothorax: A
prospective randomized study.
Source
Surgical Endoscopy and Other Interventional Techniques. 26 (3) (pp
607-614), 2012. Date of Publication: March 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
Background: Currently, most thoracic surgeons perform surgical pleurodesis
for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic
surgery (VATS). However, the superiority of VATS over axillary
minithoracotomy is not been established in prospective studies to date. A
modified two-port VATS technique and axillary minithoracotomy were
prospectively evaluated for possible differences in the short- and
long-term outcome for patients. Methods: In this study, 66 consecutive
patients underwent surgical pleurodesis for RSP through either a modified
two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy
(group B, 33 patients). According to the study design (NCT01192217), the
patients were randomly assigned to the two groups, which were similar in
terms of age and body mass index. One-lung ventilation time, histology of
the available lung parenchyma specimens, early postoperative
complications, length of chest tube drainage and hospital stay, recurrence
rate, and a score for patient satisfaction with treatment based on the sum
of postoperative pain, dependent-arm mobilization, and return to full
activity subscores were evaluated. The follow-up period varied from 3 to
53 months (median, 30 months). Results: The one-lung ventilation and
operating times were significantly longer (p < 0.001) in group A than in
group B. The overall detection of blebs, bulla, or both was 51.5% in group
A and 63.8% in group B. The recurrence rate, complication rate,
postoperative chest tube drainage duration, postoperative hospital stay,
and incidence of chronic pain did not differ between the two groups. The
score for patient satisfaction with treatment was significantly higher in
group A than in group B (p < 0.001) according the subscores for better
dependent-arm mobilization and return to full activity. Conclusions:
Axillary minithoracotomy and VATS are equally effective for the treatment
of RSP, although the rate for resection of blebs, bulla, or both is higher
with the axillary minithoracotomy procedure. Although VATS is more time
consuming, it offers to the patient more satisfaction with treatment.
2011 Springer Science+Business Media, LLC.

<9>
Accession Number
2012113251
Authors
Santangeli P. Di Biase L. Burkhardt J.D. Bai R. Mohanty P. Pump A. Natale
A.
Institution
(Santangeli, Di Biase, Burkhardt, Bai, Mohanty, Pump, Natale) St. David's
Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States
Title
Examining the safety of amiodarone.
Source
Expert Opinion on Drug Safety. 11 (2) (pp 191-214), 2012. Date of
Publication: March 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Introduction: Amiodarone is the most widely used antiarrhythmic agent,
with demonstrated effectiveness against all the spectrum of cardiac
tachyarrhythmias. The risk of adverse effects acts as a limiting factor to
its utilization especially in the long term. This article systematically
reviews the published evidence on amiodarone versus placebo to examine its
safety as an antiarrhythmic drug. Areas covered: Authors collected data on
adverse effects reported in 49 randomized placebo-controlled trials with
amiodarone. Adverse effects were classified according to the organ/system
involved. Pooled estimates of the number needed to treat (NNT) and to harm
(NNH) versus placebo were calculated. Expert opinion: Amiodarone is
effective for both the acute conversion of atrial fibrillation (AF) (11
trials, NNT = 4 at 24 h; p = 0.003) and the prevention of postoperative AF
(18 trials, NNT = 8; p < 0.001), although with an increased risk of
bradycardia, hypotension, nausea or phlebitis (pooled NNH = 4; p < 0.001).
Amiodarone administration for the maintenance of sinus rhythm has a
favorable net clinical benefit (pooled NNT = 3; p < 0.001 versus pooled
NNH for either thyroid toxicity, gastrointestinal discomfort, skin
toxicity or eye toxicity = 11; p < 0.001). Treatment with amiodarone for
the prophylaxis of sudden cardiac death has less favorable net clinical
benefit (15 trials, NNT = 38; p < 0.001 versus NNH for either thyroid
toxicity, hepatic toxicity, pulmonary toxicity or bradycardia = 14; p <
0.001). Amiodarone treatment in this setting should be used in only
selected cases. 2012 Informa UK, Ltd.

<10>
Accession Number
2012114421
Authors
Chopra V. Wesorick D.H. Sussman J.B. Greene T. Rogers M. Froehlich J.B.
Eagle K.A. Saint S.
Institution
(Chopra, Wesorick, Sussman, Greene, Rogers, Froehlich, Eagle, Saint)
Division of General Internal Medicine, University of Michigan Health
System, Ann Arbor, MI, United States
(Chopra, Wesorick, Sussman, Greene, Rogers, Saint) Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, MI, United
States
(Froehlich, Eagle) Department of Cardiovascular Medicine, University of
Michigan Health System, Ann Arbor, MI, United States
(Saint) Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, United
States
Title
Effect of perioperative statins on death, myocardial infarction, atrial
fibrillation, and length of stay: A systematic review and meta-analysis.
Source
Archives of Surgery. 147 (2) (pp 181-189), 2012. Date of Publication:
February 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objective: To assess the influence of perioperative statin treatment on
the risk of death, myocardial infarction, atrial fibrillation, and
hospital and intensive care unit length of stay in statin-naive patients
undergoing cardiac or non-cardiac surgery. Data Sources: MEDLINE via
PubMed, EMBASE, Biosis, and the Cochrane Central Register of Controlled
Trials via Ovid. Additional studies were identified through hand searches
of bibliographies, trial Web sites, and clinical experts. Randomized
controlled trials reporting the effect of perioperative statins in
statin-naive patients undergoing cardiac and noncardiac surgery were
included. Study Selection: Two investigators independently selected
eligible studies from original research published in any language studying
the effects of statin use on perioperative outcomes of interest. Data
Extraction: Two investigators performed independent article abstraction
and quality assessment. Data Synthesis: Fifteen randomized controlled
studies involving 2292 patients met the eligibility criteria.
Random-effects meta-analyses of unadjusted and adjusted data were
performed according to the method described by DerSimonian and Laird.
Perioperative statin treatment decreased the risk of atrial fibrillation
in patients undergoing cardiac surgery (relative risk [RR], 0.56; 95% CI,
0.45 to 0.69; number needed to treat [NNT], 6). In cardiac and noncardiac
surgery, perioperative statin treatment reduced the risk of myocardial
infarction (RR, 0.53; 95% CI, 0.38 to 0.74; NNT, 23) but not the risk of
death (RR, 0.62; 95% CI, 0.34 to 1.14). Statin treatment reduced mean
length of hospital stay (standardized mean difference, -0.32; 95% CI,
-0.53 to -0.11) but had no effect on length of intensive care unit stay
(standardized mean difference, -0.08; 95% CI, -0.25 to 0.10). Conclusions:
Perioperative statin treatment in statin-naive patients reduces atrial
fibrillation, myocardial infarction, and duration of hospital stay. Wider
use of statins to improve cardiac outcomes in patients undergoing
high-risk procedures seems warranted. 2012 American Medical Association.
All rights reserved.

<11>
Accession Number
2012111589
Authors
Biancari F. Airaksinen K.E.J. Lip G.Y.H.
Institution
(Biancari) Division of Cardiothoracic and Vascular Surgery, Department of
Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu, Finland
(Airaksinen) Division of Cardiology, Department of Internal Medicine,
Turku University Hospital, Turku, Finland
(Lip) University of Birmingham Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
Title
Benefits and risks of using clopidogrel before coronary artery bypass
surgery: Systematic review and meta-analysis of randomized trials and
observational studies.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (3) (pp 665-675.e4),
2012. Date of Publication: March 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The benefits and risks associated with the use of clopidogrel
before coronary artery bypass grafting are controversial, and these were
investigated in the present meta-analysis. Methods: A systematic
literature search was performed to identify studies on the use of
clopidogrel before coronary artery bypass grafting. Meta-analysis was
performed according to the Cochrane Handbook for Systematic Reviews.
Results: The literature search yielded 3 prospective randomized studies
and 17 observational studies with valid data. Randomized studies were post
hoc analyses of the Clopidogrel as Adjunctive Reperfusion Therapy
(CLARITY), Clopidogrel for the Reduction of Events During Observation
(CREDO), and Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic
Events trials. Meta-analysis based on these data showed a nonsignificant
reduced risk of immediate postoperative composite end point (death,
myocardial infarction, or stroke) in the clopidogrel group (risk ratio
[RR], 0.77; 95% confidence interval [CI], 0.58-1.04). Data from the CREDO
and CLARITY trials showed a similar risk of death (RR, 0.81; 95% CI,
0.20-3.37), myocardial infarction (RR, 0.58; 95% CI, 0.25-1.33), and major
bleeding according to Thrombolysis in Myocardial Infarction criteria (RR,
1.48; 95% CI, 0.72-3.04). Meta-analysis of observational studies showed
that preoperative exposure to clopidogrel was associated with an increased
risk of death (RR, 1.30; 95% CI, 1.02-1.67), reoperation for bleeding (RR,
1.88; 95% CI, 1.37-2.58), blood loss (mean difference, 157.8 mL; 95% CI,
61.9-253.6), need of packed red blood cell transfusion (RR, 1.23; 95% CI,
1.10-1.37), and increased use of blood products. A significantly reduced
risk of postoperative myocardial infarction was observed among patients
taking clopidogrel (RR, 0.63; 95% CI, 0.48-0.82). Conclusions: Contrary to
the findings of post hoc analyses of randomized trials, observational
studies showed that recent exposure to clopidogrel before coronary artery
bypass grafting is associated with increased risk of postoperative death,
reoperations for bleeding, blood loss, and need of blood transfusions.
Copyright 2012 by The American Association for Thoracic Surgery.

<12>
Accession Number
2012093370
Authors
Aggarwal V. Kapoor P.M. Choudhury M. Kiran U. Chowdhury U.
Institution
(Aggarwal, Kapoor, Choudhury, Kiran) Department of Cardiac Anaesthesia,
All India Institute of Medical Sciences, C.N. Centre, New Delhi-110 029,
India
(Chowdhury) Department of Cardiac Surgery, All India Institute of Medical
Sciences, New Delhi, India
Title
Utility of Sonoclot analysis and tranexamic acid in tetralogy of Fallot
patients undergoing intracardiac repair.
Source
Annals of Cardiac Anaesthesia. 15 (1) (pp 26-31), 2012. Date of
Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Sonoclot analysis is a point of care test to monitor the coagulation
process, presenting a comprehensive evaluation of the clot formation and
retraction as well as platelet function. This randomized double-blinded
study was designed to investigate the utility of Sonoclot analysis in
monitoring the coagulation profile as also the antifibrinolytic effects of
tranexamic acid administered in patients with tetralogy of Fallot
undergoing intracardiac repair. Eighty of a total 94 patients were
randomly divided into two groups of 40 each. In the study group, TA was
administered thrice at a dosage of 10 mg/kg, i.e. before CPB, on CPB and
after CPB, whereas in the control group, placebo was administered at the
same time intervals. Sonoclot analysis and D-dimer measurement were
performed at baseline and following heparin neutralisation. An additional
variable, DR ₁₅ (diminishing rate of clot strength at 15 min
postmaximal clot strength), was calculated from the Sonoclot graph and was
compared with d-dimer levels as a measure of fibrinolysis. The three
Sonoclot variables, i.e. activated clotting time, clot rate and platelet
function, were deranged at baseline in all the patients. Post-CPB, the
change in these variables was not significant. ACT, clot rate and platelet
function showed no significant (P > 0.05) difference in both the groups at
both the time intervals. DR ₁₅ and d-dimer values were
comparable at baseline in both the groups. However, a significant (P <
0.05) difference was seen in these variables in the control group as
compared with the TA group following heparin neutralisation. To conclude,
Sonoclot analysis is a useful, point of care method for the monitoring of
coagulation and fibrinolysis in patients with tetralogy of Fallot
undergoing intracardiac repair.

<13>
Accession Number
2012093366
Authors
Sundar A.S. Kodali R. Sulaiman S. Ravullapalli H. Karthekeyan R. Vakamudi
M.
Institution
(Sundar, Kodali, Sulaiman, Ravullapalli, Karthekeyan) Department of
Cardiac Anaesthesiology, Sri Ramachandra Medical College and Research
Institute, No. 1, Ramachandra Nagar, Porur, Chennai-116, India
(Vakamudi) Department of Anaesthesiology and Critical Care, Sri
Ramachandra Medical College and Research Institute, Porur, Chennai, India
Title
The effects of preemptive pregabalin on attenuation of stress response to
endotracheal intubation and opioid-sparing effect in patients undergoing
off-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 15 (1) (pp 18-25), 2012. Date of
Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
The clinical study was designed to evaluate and compare single
preoperative dose of pregabalin to a placebo regarding hemodynamic
responses to laryngoscopy and endotracheal intubation, to assess
perioperative fentanyl requirement and any side-effects. It was a
randomized, double-blind, placebo-controlled, parallel assignment,
efficacy study. The study was done at a tertiary university hospital. This
study was a comparison between two groups of 30 adult patients scheduled
for elective off pump coronary artery bypass surgery. In the control
group, the patients were given placebo capsules, and in the pregabalin
group, the patients were given pregabalin 150 mg capsule orally 1 h before
surgery. The patients were compared for hemodynamic changes before the
start of the surgery, after induction, 1, 3, and 5 min after intubation.
Additionally, fentanyl requirement during surgery and the first
postoperative day was also compared. The present study shows that a single
oral dose of 150 mg pregabalin given 1 h before surgery attenuated the
pressor response to tracheal intubation in adults, but the drug did not
show any effect on perioperative opioid consumption and was devoid of
side-effects in the given dose.

<14>
Accession Number
2012110227
Authors
Zellweger M.J. Kaiser C. Jeger R. Brunner-La Rocca H.-P. Buser P. Bader F.
Mueller-Brand J. Pfisterer M.
Institution
(Zellweger, Kaiser, Jeger, Brunner-La Rocca, Buser, Bader, Pfisterer)
Division of Cardiology, University Hospital, Petersgraben 4, 4031 Basel,
Switzerland
(Mueller-Brand) Division of Nuclear Medicine, University Hospital, Basel,
Switzerland
(Brunner-La Rocca) Department of Cardiology, University Hospital,
Maastricht, Netherlands
Title
Coronary artery disease progression late after successful stent
implantation.
Source
Journal of the American College of Cardiology. 59 (9) (pp 793-799), 2012.
Date of Publication: 28 Feb 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to define the importance of 5-year coronary
artery disease (CAD) progression after successful stenting. Background:
Safety concerns regarding first-generation drug-eluting stents mandate
5-year follow-up studies. However, only limited data exist on the
long-term importance of CAD progression relative to late stentrelated
problems. Methods: This study followed for 5 years, 428 consecutive
patients randomized to drug-eluting versus bare-metal stents with
successful stenting documented by freedom from symptoms/events and no
ischemic perfusion defects (PDs) after 6 months. Rest/stress scintigraphic
scans were repeated after 60 months. Late events and new PDs in areas
remote from stented vessels indicated CAD progression. Results: During
follow-up, 110 of 428 (25.7%) patients had 150 clinical events: 43
patients (10%) died, 36 (8.4%) suffered a myocardial infarction, and 71
(16.6%) needed repeat revascularization. Event rates were lower in remote
versus target-vessel areas (9.8% vs. 14.3%, p = 0.019). Remote myocardial
infarction and repeat revascularization accounted for 46 of 124 (37.1%)
nonfatal events and were similar for both stent types. Five-year
scintigraphic studies in patients without follow-up events showed 23.3%
new PDs, 71% of which were asymptomatic. Remote defects accounted for
37.5% PDs and were similar for both stent types. Conclusions: Even 5 years
after stenting, target-vessel events and/or new PDs remained more frequent
than CAD progression assessed by remote events and/or new PDs. Still,
remote events accounted for almost 40% of all events with a similar rate
of additional new PDs, often silent, and independent of stent type. This
documents the importance of CAD progression and stresses the need to
differentiate remote from target-vessel events/PDs in long-term stent
safety studies. (Basel Stent Kosten-Effektivitts Trial [BASKET];
ISRCTN75663024) 2012 American College of Cardiology Foundation.

<15>
Accession Number
2012119941
Authors
Ko Y.-G. Kim J.-S. Kim B.-K. Choi D. Hong M.-K. Jeon D.W. Yang J.-Y. Ahn
Y.K. Jeong M.H. Yu C.W. Yun K.-H. Lim D.-S. Jang Y.
Institution
(Ko, Kim, Kim, Choi, Hong, Jang) Severance Cardiovascular Hospital, Yonsei
University Health System, Seoul, South Korea
(Jeon, Yang) National Health Insurance Corporation, Ilsan Hospital,
Goyang, South Korea
(Ahn, Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Yu) Sejong General Hospital, Bucheon, South Korea
(Yun) Wonkwang University Hospital, Iksan, South Korea
(Lim) Korea University, Anam Hospital, Seoul, South Korea
Title
Efficacy of drug-eluting stents for treating in-stent restenosis of
drug-eluting stents (from the Korean des ISR multicenter registry study
[KISS]).
Source
American Journal of Cardiology. 109 (5) (pp 607-613), 2012. Date of
Publication: 01 Mar 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
There is currently no established standard treatment for in-stent
restenosis (ISR) after the implantation of a drug-eluting stent (DES). The
aim of this study was to investigate the efficacy of DES versus balloon
angioplasty (BA) for the treatment of DES ISR in a multicenter registry
cohort. After matching propensity scores of 805 patients with DES ISR
treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were
selected and analyzed for major adverse cardiac events, a composite of
death, myocardial infarction, and target-vessel revascularization, as the
primary end point. Baseline clinical and lesion characteristics of the
matched pairs were similar. Survival free of major adverse cardiac events
at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p <0.001),
mainly because of higher TVR-free survival (92.4% vs 81.0%, p <0.001).
Among various baseline variables, BA (hazard ratio 2.546, 95% confidence
interval 1.412 to 4.593, p = 0.002) was the most important independent
risk factor for recurrent target vessel revascularization, followed by
acute coronary syndromes as the clinical presentation of DES ISR, and
previous implantation of a sirolimus-eluting stent. Survival free of
death, myocardial infarction, or stent thrombosis did not differ between
the 2 groups. Whereas there was no significant difference in survival free
of target vessel revascularization between DES and BA for focal ISR
lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at
2 years, p <0.001). In conclusion, compared to BA, the implantation of DES
was safe and more effective in the treatment of DES ISR. 2012 Elsevier
Inc.

<16>
Accession Number
2012113976
Authors
Adamkova V. Kacer P. Mraz J. Suchanek P. Pickova J. Kralova Lesna I.
Skibova J. Kozak P. Maratka V.
Institution
(Adamkova, Kacer, Suchanek, Kralova Lesna, Skibova) Department of
Preventive Cardiology, Institute for Clinical and Experimental Medicine,
Videnska 1958/19, 140 21 Prague 4-Krc, Czech Republic
(Mraz, Pickova, Kozak) University of South Bohemia, Faculty of Fisheries
and Protection of Waters, Ceske Budejovice, Czech Republic
(Maratka) Spa Podebrady, Czech Republic
Title
The consumption of the carp meat and plasma lipids in secondary prevention
in the heart ischemic disease patients.
Source
Neuroendocrinology Letters. 32 (SUPPL. 2) (pp 17-20), 2011. Date of
Publication: 2011.
Publisher
Maghira and Maas Publications (P.O. Box 26132, Stockholm S-100 41, Sweden)
Abstract
OBJECTIVES: Omega-3 fatty acids (FA) have been shown to be protective
against cardiovascular diseases (CVD). The effect of the consumption of
carp meat on CVD risk factors has not yet been examined in detail. We
ascertained the influence of a diet enriched with carp meat with an
elevated content of omega-3FA (200 g twice weekly for 4 weeks) in a group
of subjects after cardiac revascularization surgery for ischemic heart
disease with a follow-up spa treatment. DESIGN: After cardiac
revascularization surgery, the probands consumed either a standard spa
diet (56 individuals, 41 males, 15 females, age 41-80 years) or a diet
enriched with two portions of carp meat (87 individuals, 64 males, 23
females, age 50-82 years). The differences in body mass index
(kg/m²), blood pressure, plasma lipids and C-reactive protein
(CRP) of the groups were analyzed. RESULTS: In the group with a higher
consumption of carp meat, significantly greater improvements in lipid
parameters in comparison to the standard spa diet were detected (total
cholesterol p<0.001, triglycerides p<0.001, LDL-C p<0.001, CRP p<0.001,
HDL-C p<0.001). No differences between these groups in blood pressure and
body mass index were found. CONCLUSION: We conclude that the diet enriched
with carp meat significantly improved plasma lipid parameters in patients
after major cardiac revascularization surgery. 2011 Neuroendocrinology
Letters.

<17>
Accession Number
70675718
Authors
Kramer C.K. Rodrigues T.C. Canani L.H. Gross J.L. Azevedo M.J.
Institution
(Kramer, Rodrigues, Canani, Gross, Azevedo) Endocrinology Division,
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Title
Diabetic retinopathy predicts all-cause mortality and cardiovascular
events in both type 1 and 2 diabetes mellitus: A meta-analysis of
observational studies.
Source
Endocrine Reviews. Conference: 93rd Annual Meeting and Expo of the
Endocrine Society, ENDO 2011 Boston, MA United States. Conference Start:
20110604 Conference End: 20110607. Conference Publication: (var.pagings).
32 (3 Meeting Abstracts) , 2011. Date of Publication: June 2011.
Publisher
Endocrine Society
Abstract
The association of diabetic retinopathy (DR) with death and/or
cardiovascular events has been investigated, but its predictive role for
these outcomes is still debatable. Therefore, the aim of this study was to
investigate the association of DR with all-cause mortality and
cardiovascular events in patients with type 2 and type 1 diabetes by a
systematic review and meta-analysis. The electronic databases Medline and
Embase were searched up until April/2010 for cohort studies that evaluated
DR in type 2 or type 1 diabetic patients and reported total mortality
and/or fatal and non-fatal cardiovascular events (myocardial infarction,
angina pectoris, myocardial revascularization procedures, ischemic changes
on a conventional 12-lead electrocardiogram, transient ischemic attack,
nonfatal stroke, or lower leg amputation). Two independent reviewers
performed data extraction. Pooled effect estimates were obtained by using
random-effect meta-analysis. A total of 20 studies fulfilled inclusion
criteria and were included, providing data from 19,234 patients. In
patients with type 2 diabetes (n = 14,896) the presence of any degree of
DR increased the risk for all-cause mortality and/or cardiovascular events
by 2.34 (95%CI 1.96-2.80) as compared with patients without DR. The
positive likelihood ratio of any DR for all-cause mortality and/or
cardiovascular events was 1.78 (95%CI 1.57-2.00). In patients with type 1
diabetes (n = 4,438) the corresponding risk for all-cause mortality and/or
cardiovascular events was 4.10 (95%CI 1.50-11.18) and the positive
likelihood ratio was 1.80 (95%CI 1.20-2.70). In 15 included studies, the
risk determined by DR was also adjusted for possible confounders. The
results did not change when an additional meta-analysis including these
adjusted odds ratios was performed. DR was also predictive for all-cause
mortality in both type 2 (OR 2.41; 95%CI 1.87-3.10) and type 1 (OR 3.65;
95%CI 1.05-12.66) diabetes. Links between DR and studied outcomes were not
addressed by the current meta-analysis, but it demonstrated that the
presence of DR can help to identify patients with increased risk for
adverse outcomes. In conclusion, DR predicts all-cause mortality and
cardiovascular events in both type 2 and type 1 diabetes.

<18>
Accession Number
70674551
Authors
Quantz M.A.
Institution
(Quantz) LondonONCanada
Title
Does incisional vac therapy (IVAC) reduce wound complications in high risk
patients?.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 145D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Surgical site infections (SSI) remain prevalent in a
population of patients that are becoming older with more comorbidities.
Superficial sternal infections account for significant morbidity
(occasionally mortality) and resource utilization in patients undergoing
cardiac surgery. VAC therapy (KCI Canada) improves wound healing and
patient outcomes. The same processes that make VAC therapy on open wounds
may also provide enhanced healing to closed incisions (Incisional
VACIVAC). We examined the outcomes of IVAC therapy and Prevena, a new
self-contained incision management system (KCI Canada), on wound
infection, dehiscence and mediastinitis in a population at high risk for
wound complications. CONCLUSION: This initial experience with incisional
vacuum therapy in patients at high risk for wound complications is
positive. Prevena is particularly appealing as it facilitates patient
mobility and can be used in the outpatient setting. Future work should
include a randomized controlled trial to determine the efficacy and cost
effectiveness of this novel therapy.

<19>
Accession Number
70674550
Authors
Chan V. Mesana L. Mesana T.G. Ruel M.
Institution
(Chan, Mesana, Mesana, Ruel) OttawaONCanada
Title
Heart valve prosthesis selection in patients with end-stage renal failure
requiring dialysis: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 145D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Data describing heart valve prosthesis selection in patients
with end-stage renal disease (ESRD) on dialysis is scarce. A formal
summary of the available literature currently does not exist. The
objectives of this study were to perform a: 1) systematic review of
studies describing valve replacement in patients with ESRD on dialysis; 2)
quantitative meta-analysis comparing survival and valve-related outcomes
following valve replacement with bioprostheses versus mechanical
prostheses in this population. CONCLUSION: A meta-analysis of the
published literature suggests that there is no survival difference between
bioprostheses and mechanical prosthesis in patients with ESRD on dialysis.
Bioprostheses, however, were associated with fewer valve-related
complications. Bioprostheses are therefore recommended for patients with
ESRD on dialysis requiring heart valve replacement.

<20>
Accession Number
70674386
Authors
Sun J.C. Lamy A. Teoh K. Sheth T. Landry D. Jung H. Yusuf S. Eikelboom
J.W.
Institution
(Sun, Lamy, Teoh, Sheth, Landry, Jung, Yusuf, Eikelboom) HamiltonONCanada
Title
Randomized trial of fondaparinux versus heparin to prevent graft failure
after coronary artery bypass grafting: The fonda CABG pilot study.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 114D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Thrombotic occlusion is the major mechanism of early coronary
artery bypass graft (CABG) failure. Fondaparinux is effective for the
prevention of death, myocardial infarction (MI), and stroke in patients
with acute coronary syndrome (ACS) but has not been studied for the
prevention of graft failure and major cardiovascular (CV) events
post-CABG. We performed a pilot randomized controlled trial (RCT) to
assess the feasibility of comparing the efficacy and safety of
fondaparinux versus heparin for prevention of graft failure and major CV
events in patients undergoing CABG. CONCLUSION: One in 10 patients
undergoing CABG have at least one occluded graft at 30 days and one in 20
grafts is blocked at 30 days. Fondaparinux appears to be a safe
alternative to heparin after CABG and it seems feasible to conduct a
definitive RCT using CT angiography to evaluate the effect of fondaparinux
treatment on graft patency.

<21>
Accession Number
70674320
Authors
Afilalo J. Rasti M. Ohayon S. Eisenberg M.J.
Institution
(Afilalo, Rasti, Ohayon, Eisenberg) MontrealQCCanada
Title
Meta-regression of off-pump versus on-pump coronary artery bypass surgery.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 101D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The benefits of off-pump coronary artery bypass surgery
(OPCAB) continue to be debated, with prior meta-analyses suggesting a
reduction in atrial fibrillation and stroke, and a promising trend towards
reduction in myocardial infarction and death. These observed benefits may
be affected by a host of secondary factors such as age, comorbidities and
completeness of revascularization. There has yet to be a metaregression of
OPCAB (which can control for secondary factors), and prior meta-analyses
were published before five recent trials including the two largest trials
to date. Our objective was to perform a meta-regression of the
contemporary evidence for OPCAB. CONCLUSION: Contrary to previous trends,
our synthesis of the current body of evidence does not support
improvements in death, myocardial infarction, or stroke with OPCAB. The
benefit of OPCAB for reducing postoperative atrial fibrillation remains
significant. Moreover, our metaregression does not support the commonly
held hypothesis that OPCAB reduces stroke in elderly patients or those
with prior stroke, nor that OPCAB increases myocardial infarction in
trials with fewer number of grafts placed.

<22>
Accession Number
70674074
Authors
Fedak P.M. Kasatkin A. Kieser T.M. Maitland A. Borsato G. Frohlich D.C.
Narine K. King K.M.
Institution
(Fedak, Kasatkin, Kieser, Maitland, Borsato, Frohlich, Narine, King)
CalgaryABCanada
Title
A randomized controlled trial of adhesiveenhanced sternal closure to
improve postoperative functional recovery: Sternal innovative closure with
kryptonite (STICK) trial.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 54D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Unstable median sternotomy closure can lead to significant
morbidity such as sternal dehiscence and infection. Post-operative
functional recovery, incisional pain, and respiratory mechanics are also
influenced by early sternal stability. We previously established a
proof-ofconcept in human cadaveric sternum where conventional wire
cerclage was augmented with a novel biocompatible bone adhesive.
Mechanical strength was increased and pathologic sternal displacement
(>2mm) during physiologic distracting forces (i.e. coughing) was
prevented. We report herein the initial results of a randomized clinical
trial (STICK-RCT) examining the effects of adhesive-enhanced sternal
closure on functional post-operative recovery and early outcomes.
CONCLUSION: Adhesive-enhanced sternal closure is a novel cardiac surgery
innovation. These RCT data represent a worldwide first-in-man series.
Adhesive-enhanced closure is a safe and simple addition to conventional
wire closure with demonstrated benefits on functional recovery respiratory
capacity, incisional pain, and analgesic requirements. Longer follow-up is
necessary to further evaluate bony in-growth, osteosynthesis and potential
late complications. A larger multi-center RCT to examine the potential of
the adhesive to prevent major sternal complications is warranted.

<23>
Accession Number
70674050
Authors
Yamashita M.H. Cook R.C. Kearns M.J. Ramanathan K. Gin K. Humphries K.H.
Institution
(Yamashita, Cook, Kearns, Ramanathan, Gin, Humphries) VancouverBCCanada
Title
Prophylactic magnesium does not prevent atrial fibrillation after cardiac
surgery: A meta-analysis and comprehensive review of randomized trials.
Source
Canadian Journal of Cardiology. Conference: 2010 Canadian Council of
Cardiovascular Nurses Annual Scientific Sessions Montreal, QC Canada.
Conference Start: 20101023 Conference End: 20101026. Conference
Publication: (var.pagings). 26 (pp 49D), 2010. Date of Publication:
October 2010.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Atrial fibrillation (AF) after cardiac surgery is a common
complication that is associated with an increased risk of death, stroke
and longer hospital stays. Previous trials have shown widely divergent
results while meta-analyses have concluded that magnesium prevents
postoperative AF, although with a significant degree of heterogeneity.
Recently, the largest randomized controlled trial (RCT) published to date
concluded that magnesium sulphate is not protective against AF following
cardiac surgery. The objective of this study was to conduct a new
meta-analysis to include the results of this large RCT and to investigate
the heterogeneity in previous meta-analyses. CONCLUSIONS: When the
evidence is restricted to high quality RCTs prophylactic magnesium is not
effective in preventing AF following cardiac surgery. Although a pooled
effect estimate using all published studies suggests that magnesium may
prevent postoperative AF, there is a significant degree of heterogeneity
and evidence of publication bias which requires further investigation.
Limiting the meta-analysis to high quality RCTs decreases the
heterogeneity and is likely a better indicator of the real effect of
prophylactic magnesium on the incidence of AF post cardiac surgery. The
available evidence also suggests that magnesium has no effect on the
incidence of stroke, 30 day all-cause mortality or length of hospital
stay.