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<1>
Accession Number
2012261633
Authors
Ryan L. Rodseth R.N. Biccard B.M.
Institution
(Ryan, Rodseth, Biccard) Perioperative Research Unit, Department of
Anaesthetics, Nelson R Mandela School of Medicine, University of
KwaZulu-Natal, South Africa
(Rodseth, Biccard) Inkosi Albert Luthuli Central Hospital, Mayville,
United States
Title
The treatment of perioperative myocardial infarctions following noncardiac
surgery.
Source
Southern African Journal of Anaesthesia and Analgesia. 18 (2) (pp 86-93),
2012. Date of Publication: 2012.
Publisher
Medpharm Publications (Pty) Ltd (PO Box 14804, Lyttelton, Gauteng 0157,
South Africa)
Abstract
Background: Perioperative myocardial infarction (PMI) is a common
complication following noncardiac surgery, with a 30-day mortality of
10-20%. Effective therapeutic interventions are of public health
importance. Method: This is a systematic review, aimed to determine the
evidence for therapies following PMI. Results: A PubMed Central search up
to May 2011 identified 20 case series and reports (89 patients). We
extracted data on the type and timing of treatment and short-term
mortality. Short-term mortality differed significantly between
haemodynamically stable and unstable patients (0% and 32.2% respectively,
p-value = 0.015). Significantly more haemodynamically unstable patients
received acute coronary interventions (75.8% vs. 23.1%, p-value = 0.0006).
Acute coronary intervention in haemodynamically unstable patients was not
associated with improved short-term survival (p-value = 0.53). The high
proportion of symptomatic and haemodynamically unstable patients suggests
publication bias (chi² = 16.29, p-value = 0 < 0001 and
chi² = 154.41, p-value < 0.0001, respectively). Conclusion:
This systematic review highlights the paucity of evidence for PMI
management, and the need for future prospective trials. SASA.

<2>
Accession Number
2012248284
Authors
Elgebaly A.S. Sabry M.
Institution
(Elgebaly) Department of Anesthesia and SICU, Faculty of Medicine, Tanta
University, 43 IBN Elfard Street, Elgharbia, Tanta, Egypt
(Sabry) Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta
University, Egypt
Title
Infusion of low-dose vasopressin improves left ventricular function during
separation from cardiopulmonary bypass: A double-blind randomized study.
Source
Annals of Cardiac Anaesthesia. 15 (2) (pp 128-133), 2012. Date of
Publication: April-June 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
We aimed to investigate whether low-dose vasopressin administered to
patients undergoing coronary artery bypass grafting (CABG) surgery with
preexisting mild to moderate systolic dysfunction can produce sustained
improvement in cardiac function. This double-blind randomized study was
conducted in a hospital where a single anesthetic and surgical team
performed elective CABG. Twenty patients aged 32-61 years who underwent
elective CABG between January 2007 and December 2007 were enrolled in this
study. The patients randomly received either vasopressin 0.03 IU/min
(Group A) or normal saline (Group B) in equal volume for 60 min after
cardiopulmonary bypass (CPB). The cardiac output, cardiac index, stroke
volume index, fractional area of contraction and systemic vascular
resistance index were significantly higher in Group A than in Group B.
Adrenaline (mean dose: 0.06 mug/kgmin-1) was required in seven patients
from Group B but in none of the Group A patients on initial separation
from CPB (P< 0.05). Of the 10 patients in Group B, five required
phenylepherine to maintain the mean arterial pressure (MAP) >65 mmHg,
whereas none of the Group A patients required phenylephrine for MAP
regulation (P< 0.05). We conclude that Infusion of low-dose vasopressin
for patients with mild to moderate left ventricular systolic dysfunction
during separation from CPB is beneficial for the postoperative hemodynamic
profile, reduces the catecholamine doses required and improves left
ventricular systolic function.

<3>
Accession Number
2012248283
Authors
Mukherjee C. Koch E. Banusch J. Scholz M. Kaisers U.X. Ender J.
Institution
(Mukherjee, Koch, Banusch, Ender) Department of Anesthesiology and
Intensive Care Medicine II, Heart Center Leipzig, University of Leipzig,
Strumpelstrasse 39, 04289 Leipzig, Germany
(Scholz) Institute of Medical Informatics, Statistics and Epidemiology,
University of Leipzig, Germany
(Kaisers) Department of Anesthesiology, Intensive Care Medicine Medical
Faculty, University of Leipzig, Germany
Title
Intrathecal morphine is superior to intravenous PCA in patients undergoing
minimally invasive cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 15 (2) (pp 122-127), 2012. Date of
Publication: April-June 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aim of our study was to evaluate the beneficial effect of low dose
intrathecal morphine on postoperative analgesia, over the use of
intravenous patient controlled anesthesia (PCA), in patients undergoing
fast track anesthesia during minimally invasive cardiac surgical
procedures. A randomized controlled trial was undertaken after approval
from local ethical committee. Written informed consent was obtained from
61 patients receiving mitral or tricuspid or both surgical valve repair in
minimal invasive technique. Patients were assigned randomly to 2 groups.
Group 1 received general anesthesia and intravenous patient controlled
analgesia (PCA) pump with Piritramide (GA group). Group 2 received a
single shot of intrathecal morphine (1.5 g/kg body weight) prior to the
administration of general anesthesia (ITM group). Site of puncture was
confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of
intravenous piritramide used in post anesthesia care unit (PACU) and the
first postoperative day was defined as primary end point. Secondary end
points included: time for tracheal extubation, pain and sedation scores in
PACU upto third postoperative day. For statistical analysis Mann-Whitney-U
Test and Fishers exact test (SPSS) were used. We found that the demand for
intravenous opioids in PACU was significantly reduced in ITM group (P
<0.001). Pain scores were significantly decreased in ITM group until
second postoperative day (P <0.01). There was no time delay for tracheal
extubation in ITM group, and sedation scores did not differ in either
group. We conclude that low dose single shot intrathecal morphine provides
adequate postoperative analgesia, reduces the intravenous opioid
consumption during the early postoperative period and does not defer early
extubation.

<4>
Accession Number
2012248280
Authors
Chakravarthy M. Muniraj G. Patil S. Suryaprakash S. Mitra S. Shivalingappa
B.
Institution
(Chakravarthy, Muniraj, Patil, Suryaprakash, Mitra, Shivalingappa)
Department of Anesthesia, Critical Care and Pain Management, Fortis
Hospitals, Bannerghatta Road, Bangalore, India
Title
A randomized prospective analysis of alteration of hemostatic function in
patients receiving tranexamic acid and hydroxyethyl starch (130/0.4)
undergoing off pump coronary artery bypass surgery.
Source
Annals of Cardiac Anaesthesia. 15 (2) (pp 105-110), 2012. Date of
Publication: April-June 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Postoperative hemorrhagic complications is still one of the major problems
in cardiac surgeries. It may be caused by surgical issues, coagulopathy
caused by the side effects of the intravenous fluids administered to
produce plasma volume expansion such as hydroxyl ethyl starch (HES). In
order to thwart this hemorrhagic issue, few agents are available.
Fibrinolytic inhibitors like tranexamic acid (TA) may be effective modes
to promote blood conservation; but the possible complications of
thrombosis of coronary artery graft, precludes their generous use in
coronary artery bypass graft surgery. The issue is a balance between
agents that promote coagulation and those which oppose it. Therefore, in
this study we have assessed the effects of concomitant use of HES and TA.
Thromboelastogram (TEG) was used to assess the effect of the combination
of HES and TA. With ethical committee approval and patient's consent, 100
consecutive patients were recruited for the study. Surgical and anesthetic
techniques were standardized. Patients fulfilling our inclusion criteria
were randomly allocated into 4 groups of 25 each. The patients in group A
received 20 ml/kg of HES (130/0.4), 10 mg/kg of T.A over 30 minutes
followed by infusion of 1 mg/kg/hr over the next 12 hrs. The patients in
group B received Ringer's lactate + TA at same dose. The patients in the
Group C received 20 ml/kg of HES. Group D patients received RL. Fluid
therapy was goal directed. Total blood loss was assessed. Reaction time
(r), alpha angle, maximum amplitude (MA) values of TEG were assessed at
baseline, 12, 36 hrs. The possible perioperative myocardial infraction
(MI) was assessed by electrocardiogram (ECG) and troponin T values at the
baseline, postoperative day 1. Duration on ventilator, length of stay
(LOS) in the intensive care unit (ICU) were also assessed. The
demographical profile was similar among the groups. Use of HES increased
blood loss significantly (P < 0.05). Concomitant use of TA reduced blood
loss when used along with HES. r value was prolonged at 12 hours in all
the groups and angle was reduced at 12 hours in all the groups, where as
MA value was reduced at 12 ^th hour in the HES group compared to
the baseline and increased in TA + HES group. These findings were
statistically significant. No significant change in Troponin T values/
ECG, duration of ventilation and LOS ICU was observed. No adverse events
was noticed in any of the four groups. HES (130/0.4) used at a dose of 20
ml/kg seems to produce coagulopathy causing increased blood loss
perioperatively. Hemodilution produced by fluid therapy seems to produce
Coagulopathy as observed by TEG parameters. Concomitant use of TA with HES
appears to reverse these changes without causing any adverse effects in
patients undergoing OPCAB surgery.

<5>
Accession Number
2012247757
Authors
Gilard M. Eltchaninoff H. Iung B. Donzeau-Gouge P. Chevreul K. Fajadet J.
Leprince P. Leguerrier A. Lievre M. Prat A. Teiger E. Lefevre T. Himbert
D. Tchetche D. Carrie D. Albat B. Cribier A. Rioufol G. Sudre A. Blanchard
D. Collet F. Dos Santos P. Meneveau N. Tirouvanziam A. Caussin C. Guyon P.
Boschat J. Le Breton H. Collart F. Houel R. Delpine S. Souteyrand G.
Favereau X. Ohlmann P. Doisy V. Grollier G. Gommeaux A. Claudel J.-P.
Bourlon F. Bertrand B. Van Belle E. Laskar M.
Institution
(Gilard, Boschat) Centre Hospitalier Universitaire (CHU) Brest, Brest,
France
(Eltchaninoff, Cribier) Hopital Charles Nicolle, University of Rouen,
INSERM Unite 1096, Rouen, France
(Iung, Himbert) Bichat Hospital, Paris, France
(Chevreul, Teiger) CHU Henri Mondor, Paris, France
(Leprince) Pitie-Salpetriere Hospital, Paris, France
(Donzeau-Gouge, Lefevre) Institut Jacques Cartier, Massy, France
(Fajadet, Tchetche) Clinique Pasteur, Toulouse, France
(Carrie) CHU Toulouse, Toulouse, France
(Leguerrier, Le Breton) CHU Rennes, Rennes, France
(Lievre) University Lyon 1, Lyon, France
(Doisy) Clinique Tonkin, Lyon, France
(Claudel) Infirmerie Protestante, Lyon, France
(Prat, Sudre, Van Belle) CHU Lille, Lille, France
(Albat) CHU Montpellier, Montpellier, France
(Blanchard) Clinique St. Gatien, Tours, France
(Rioufol) CHU Lyon, Bron, France
(Collet, Collart) Hopital Clairval, Marseille, France
(Houel) Hopital St. Joseph, Marseille, France
(Collet, Collart) Hopital La Timone, Marseille, France
(Caussin) Hopital Marie Lannelongue, Le Plessis-Robinson, France
(Meneveau) CHU Besancon, Besancon, France
(Guyon) Centre Cardiologique du Nord, Saint-Denis, France
(Dos Santos) CHU Bordeaux, Bordeaux, France
(Tirouvanziam) CHU Nantes, Nantes, France
(Delpine) CHU Angers, Angers, France
(Souteyrand) CHU Clermont-Ferrand, Clermont-Ferrand, France
(Favereau) Parly 2, Le Chesnay, France
(Ohlmann) CHU Strasbourg, Strasbourg, France
(Grollier) CHU Caen, Caen, France
(Gommeaux) Polyclinique Bois-Bernard, Bois-Bernard, France
(Bertrand) CHU Grenoble, Grenoble, France
(Laskar) CHU Dupuytren, Limoges, France
(Bourlon) Centre Cardiothoracique, Monte Carlo, Monaco
Title
Registry of transcatheter aortic-valve implantation in high-risk patients.
Source
New England Journal of Medicine. 366 (18) (pp 1705-1715), 2012. Date of
Publication: 03 May 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
Background: Transcatheter aortic-valve implantation (TAVI) is an emerging
intervention for the treatment of high-risk patients with severe aortic
stenosis and coexisting illnesses. We report the results of a prospective
multicenter study of the French national transcatheter aortic-valve
implantation registry, FRANCE 2. Methods: All TAVIs performed in France,
as listed in the FRANCE 2 registry, were prospectively included in the
study. The primary end point was death from any cause. Results: A total of
3195 patients were enrolled between January 2010 and October 2011 at 34
centers. The mean (+/-SD) age was 82.7+/-7.2 years; 49% of the patients
were women. All patients were highly symptomatic and were at high surgical
risk for aortic-valve replacement. Edwards SAPIEN and Medtronic CoreValve
devices were implanted in 66.9% and 33.1% of patients, respectively.
Approaches were either transarterial (transfemoral, 74.6%; subclavian,
5.8%; and other, 1.8%) or transapical (17.8%). The procedural success rate
was 96.9%. Rates of death at 30 days and 1 year were 9.7% and 24.0%,
respectively. At 1 year, the incidence of stroke was 4.1%, and the
incidence of periprosthetic aortic regurgitation was 64.5%. In a
multivariate model, a higher logistic risk score on the European System
for Cardiac Operative Risk Evaluation (EuroSCORE), New York Heart
Association functional class III or IV symptoms, the use of a transapical
TAVI approach, and a higher amount of periprosthetic regurgitation were
significantly associated with reduced survival. Conclusions: This
prospective registry study reflected real-life TAVI experience in
high-risk elderly patients with aortic stenosis, in whom TAVI appeared to
be a reasonable option. (Funded by Edwards Lifesciences and Medtronic.)
Copyright 2012 Massachusetts Medical Society.

<6>
Accession Number
2012247756
Authors
Makkar R.R. Fontana G.P. Jilaihawi H. Kapadia S. Pichard A.D. Douglas P.S.
Thourani V.H. Babaliaros V.C. Webb J.G. Herrmann H.C. Bavaria J.E. Kodali
S. Brown D.L. Bowers B. Dewey T.M. Svensson L.G. Tuzcu M. Moses J.W.
Williams M.R. Siegel R.J. Akin J.J. Anderson W.N. Pocock S. Smith C.R.
Leon M.B.
Institution
(Makkar, Jilaihawi, Siegel) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
(Fontana) Lenox Hill Heart, Vascular Institute, New York, NY, United
States
(Kodali, Moses, Williams, Smith, Leon) Columbia University Medical Center,
New York Presbyterian Hospital, New York, NY, United States
(Kapadia, Svensson, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Pichard) Washington Hospital Center, Washington, DC, United States
(Douglas) Duke University School of Medicine, Durham, NC, United States
(Thourani, Babaliaros) Emory University School of Medicine, Atlanta, GA,
United States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
(Herrmann, Bavaria) Hospital of the University of Pennsylvania,
Philadelphia, PA, United States
(Brown) Baylor Healthcare System, Dallas, TX, United States
(Bowers) Medical City Dallas, Dallas, TX, United States
(Dewey, Anderson) Edwards Lifesciences, Irvine, CA, United States
(Akin, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
Title
Transcatheter aortic-valve replacement for inoperable severe aortic
stenosis.
Source
New England Journal of Medicine. 366 (18) (pp 1696-1704), 2012. Date of
Publication: 03 May 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Transcatheter aortic-valve replacement (TAVR) is the
recommended therapy for patients with severe aortic stenosis who are not
suitable candidates for surgery. The outcomes beyond 1 year in such
patients are not known. METHODS: We randomly assigned patients to
transfemoral TAVR or to standard therapy (which often included balloon
aortic valvuloplasty). Data on 2-year outcomes were analyzed. RESULTS: A
total of 358 patients underwent randomization at 21 centers. The rates of
death at 2 years were 43.3% in the TAVR group and 68.0% in the
standard-therapy group (P<0.001), and the corresponding rates of cardiac
death were 31.0% and 62.4% (P<0.001). The survival advantage associated
with TAVR that was seen at 1 year remained significant among patients who
survived beyond the first year (hazard ratio, 0.58; 95% confidence
interval [CI], 0.36 to 0.92; P = 0.02 with the use of the log-rank test).
The rate of stroke was higher after TAVR than with standard therapy (13.8%
vs. 5.5%, P = 0.01), owing, in the first 30 days, to the occurrence of
more ischemic events in the TAVR group (6.7% vs. 1.7%, P = 0.02) and,
beyond 30 days, to the occurrence of more hemorrhagic strokes in the TAVR
group (2.2% vs. 0.6%, P = 0.16). At 2 years, the rate of rehospitalization
was 35.0% in the TAVR group and 72.5% in the standard-therapy group
(P<0.001). TAVR, as compared with standard therapy, was also associated
with improved functional status (P<0.001). The data suggest that the
mortality benefit after TAVR may be limited to patients who do not have
extensive coexisting conditions. Echocardiographic analysis showed a
sustained increase in aortic-valve area and a decrease in aortic-valve
gradient, with no worsening of paravalvular aortic regurgitation.
CONCLUSIONS: Among appropriately selected patients with severe aortic
stenosis who were not suitable candidates for surgery, TAVR reduced the
rates of death and hospitalization, with a decrease in symptoms and an
improvement in valve hemodynamics that were sustained at 2 years of
follow-up. The presence of extensive coexisting conditions may attenuate
the survival benefit of TAVR. Copyright 2012 Massachusetts Medical
Society.

<7>
Accession Number
2012247755
Authors
Kodali S.K. Williams M.R. Smith C.R. Svensson L.G. Webb J.G. Makkar R.R.
Fontana G.P. Dewey T.M. Thourani V.H. Pichard A.D. Fischbein M. Szeto W.Y.
Lim S. Greason K.L. Teirstein P.S. Malaisrie S.C. Douglas P.S. Hahn R.T.
Whisenant B. Zajarias A. Wang D. Akin J.J. Anderson W.N. Leon M.B.
Institution
(Kodali, Williams, Smith, Hahn, Leon) Columbia University Medical Center,
New York Presbyterian Hospital, 161 Fort Washington Ave., New York, NY
10032, United States
(Fontana) Lenox Hill Hospital, New York, NY, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver, BC,
Canada
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Dewey) Medical City Dallas, Dallas, TX, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Pichard) Washington Hospital Center, Washington, DC, United States
(Fischbein) Stanford University Medical School, Palo Alto, CA, United
States
(Teirstein) Scripps Clinic, San Diego, CA, United States
(Akin, Anderson) Edwards Lifesciences, Irvine, CA, United States
(Szeto) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Greason) Mayo Clinic, Rochester, MN, United States
(Malaisrie) Northwestern University, Chicago, IL, United States
(Douglas) Duke University Medical Center, Durham, NC, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Zajarias) Washington University Medical School, Barnes-Jewish Hospital,
St. Louis, WA, United States
(Wang) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Title
Two-year outcomes after transcatheter or surgical aortic-valve
replacement.
Source
New England Journal of Medicine. 366 (18) (pp 1686-1695), 2012. Date of
Publication: 03 May 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial
showed that among high-risk patients with aortic stenosis, the 1-year
survival rates are similar with transcatheter aortic-valve replacement
(TAVR) and surgical replacement. However, longerterm follow-up is
necessary to determine whether TAVR has prolonged benefits. METHODS: At 25
centers, we randomly assigned 699 high-risk patients with severe aortic
stenosis to undergo either surgical aortic-valve replacement or TAVR. All
patients were followed for at least 2 years, with assessment of clinical
outcomes and echocardiographic evaluation. RESULTS: The rates of death
from any cause were similar in the TAVR and surgery groups (hazard ratio
with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P = 0.41) and
at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0%
in the surgery group (P = 0.78). The frequency of all strokes during
follow-up did not differ significantly between the two groups (hazard
ratio, 1.22; 95% CI, 0.67 to 2.23; P = 0.52). At 30 days, strokes were
more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P =
0.12); subsequently, there were 8 additional strokes in the TAVR group and
12 in the surgery group. Improvement in valve areas was similar with TAVR
and surgical replacement and was maintained for 2 years. Paravalvular
regurgitation was more frequent after TAVR (P<0.001), and even mild
paravalvular regurgitation was associated with increased late mortality
(P<0.001). CONCLUSIONS: A 2-year follow-up of patients in the PARTNER
trial supports TAVR as an alternative to surgery in high-risk patients.
The two treatments were similar with respect to mortality, reduction in
symptoms, and improved valve hemodynamics, but paravalvular regurgitation
was more frequent after TAVR and was associated with increased late
mortality. Copyright 2012 Massachusetts Medical Society.

<8>
Accession Number
2012248447
Authors
Campbell J. Holland C. Richens D. Skinner H.
Institution
(Campbell) Clinical Perfusion, Nottingham University Hospitals NHS Trust,
United Kingdom
(Holland) Haematology, Nottingham University Hospitals NHS Trust, United
Kingdom
(Richens) Cardiac Surgery, Nottingham University Hospitals NHS Trust,
United Kingdom
(Skinner) Department of Anaesthesia, Nottingham University Hospitals NHS
Trust, Nottingham NG5 1PB, United Kingdom
Title
Impact of cell salvage during cardiac surgery on the thrombelastomeric
coagulation profile: A pilot study.
Source
Perfusion. 27 (3) (pp 221-224), 2012. Date of Publication: May 2012.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Intraoperative cell salvage of the cardiopulmonary bypass residual volume
can dilute platelets and coagulation factors. This is a report of a
randomised control trial of 20 patients undergoing coronary bypass
surgery. Residual cardiopulmonary bypass volume was processed and
transfused after surgery in the cell salvage group and the residual volume
was transfused unprocessed in the control group. The coagulation profile
was measured using the Rotem thrombelastometry system. Mean (SD) maximum
clot firmness after surgery was 52.8 (5.4) mm in the cell salvage group
compared to 57.2 (5.0) mm in the control group (p=0.04). Clot formation
time was prolonged after surgery by 39 (27) s in the cell saver group
compared to 19 (17) s in the control group (p=0.045). Platelet count was
reduced after surgery by 96 (32) x 109.L-1 in the cell saver group and 70
(19) x 109.L-1 in the control group (p=0.03). Blood volume in the chest
drains 4 hours after surgery was similar in both groups. There was a
strong association between clot formation time after surgery and blood
loss (R = 0.68, p=0.001). The increase in blood loss was 4.1 ml for every
one-second increase in clot formation time (95% CI 1.9-6.4, p=0.001). Cell
salvage of the residual cardiopulmonary bypass volume reduced platelet
numbers and prolonged clot formation time and maximum clot firmness was
less in this group. The Author(s) 2011.

<9>
Accession Number
2012246794
Authors
Ang L.B. Veloria E.N. Evanina E.Y. Smaldone A.
Institution
(Ang, Veloria, Evanina) Doctor of Nursing Practice Program, Columbia
University School of Nursing, New York, NY, United States
(Ang) Intensive Care Unit, Straub Clinic and Hospital, Honolulu, HI,
United States
(Veloria) Cardiothoracic Intensive Care Unit, Surgical Intensive Care Unit
New York Presbyterian, Columbia Univ. Medical Center, New York, NY, United
States
(Evanina) Program in Nurse Anesthesia, Columbia University School of
Nursing, New York, NY, United States
(Smaldone) Doctor of Nursing Practice Program, Columbia University School
of Nursing, New York, NY, United States
Title
Mediastinitis and blood transfusion in cardiac surgery: A systematic
review.
Source
Heart and Lung: Journal of Acute and Critical Care. 41 (3) (pp 255-263),
2012. Date of Publication: May 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Mediastinitis, a serious complication after cardiac surgery,
increases morbidity, mortality, and cost of care. Accumulating evidence
implicates blood transfusions in the development of mediastinitis.
Objectives: We conducted a systematic review to evaluate the association
between allogeneic blood transfusion and mediastinitis in adult cardiac
surgery patients. Results: After a search of Medline, PubMed, Cochrane
Library, the Cumulative Index to Nursing and Allied Health Literature, and
the Institute for Scientific Information's Web of Knowledge (1990-2010)
for relevant studies, 7 (3 prospective cohort and 4 retrospective reviews)
met our inclusion/exclusion criteria. Between 20% and 80.2% of patients
received blood transfusions, with an incidence of mediastinitis ranging
from 0.1% to 2.3%. Five studies demonstrated an independent association
between red blood cell transfusion and mediastinitis. Two studies
identified a dose-response relationship. Conclusion: The findings of this
systematic review suggest that allogeneic red blood cell transfusions are
associated with an increased risk of mediastinitis in patients undergoing
cardiac surgery. Individual risks and benefits should be assessed in each
patient before a red blood cell transfusion. 2012 Elsevier Inc.

<10>
Accession Number
2012253484
Authors
Hopp E. Lunde K. Solheim S. Aakhus S. Arnesen H. Forfang K. Edvardsen T.
Smith H.-J.
Institution
(Hopp, Smith) Department of Radiology, Oslo University Hospital,
Rikshospitalet, Postbox 4950, Nydalen, 0424 Oslo, Norway
(Lunde, Aakhus, Forfang, Edvardsen) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Norway
(Solheim, Arnesen) Department of Cardiology, Oslo University Hospital,
Ulleval, Norway
(Arnesen) Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Regional myocardial function after intracoronary bone marrow cell
injection in reperfused anterior wall infarction - A cardiovascular
magnetic resonance tagging study.
Source
Journal of Cardiovascular Magnetic Resonance. 13 (1) , 2011. Article
Number: 22. Date of Publication: 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Trials have brought diverse results of bone marrow stem cell
treatment in necrotic myocardium. This substudy from the Autologous Stem
Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI)
explored global and regional myocardial function after intracoronary
injection of autologous mononuclear bone marrow cells (mBMC) in acute
anterior wall myocardial infarction treated with percutaneous coronary
intervention. Methods. Cardiovascular magnetic resonance (CMR) tagging was
performed 2-3 weeks and 6 months after revascularization in 15 patients
treated with intracoronary stem cell injection (mBMC group) and in 13
controls without sham injection. Global and regional left ventricular (LV)
strain and LV twist were correlated to cine CMR and late gadolinium
enhancement (LGE). Results: In the control group myocardial function as
measured by strain improved for the global LV (6 months: -13.1 2.4 versus
2-3 weeks: -11.9 3.4%, p = 0.014) and for the infarct zone (-11.8 3.0
versus -9.3 4.1%, p = 0.001), and significantly more than in the mBMC
group (inter-group p = 0.027 for global strain, respectively p = 0.009 for
infarct zone strain). LV infarct mass decreased (35.7 20.4 versus 45.7
29.5 g, p = 0.024), also significantly more pronounced than the mBMC group
(inter-group p = 0.034). LV twist was initially low and remained unchanged
irrespective of therapy. Conclusions: LGE and strain findings quite
similarly demonstrate subtle differences between the mBMC and control
groups. Intracoronary injection of autologous mBMC did not strengthen
regional or global myocardial function in this substudy. Trial
registration. ClinicalTrials.gov: NCT00199823. 2011 Hopp et al; licensee
BioMed Central Ltd.

<11>
Accession Number
70738283
Authors
Bashir J.G. Karim S. Danter M. Cowan S. Tyers G.
Institution
(Bashir, Karim, Danter, Cowan, Tyers) St. Paul's Hospital, Vancouver, BC,
Canada
(Bashir, Karim, Danter, Cowan, Tyers) University of British Columbia,
Vancouver, BC, Canada
Title
Canadian lead extraction risk score (clear score): A proposal for a novel
risk scoring system for lead extraction.
Source
Heart Rhythm. Conference: 33rd Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2012 Boston, MA United States. Conference
Start: 20120509 Conference End: 20120512. Conference Publication:
(var.pagings). 9 (5 SUPPL. 1) (pp S69), 2012. Date of Publication: May
2012.
Publisher
Elsevier
Abstract
Introduction: Laser lead extraction is a proven effective treatment for
the removal of retained lead hardware. It is, however, associated with a
small but significant risk to the patient. While large multi-centre
studies have pursued variables associated with this risk, no objective way
of scoring this risk has previously been proposed. As such we created a
novel risk scoring system for laser lead extraction and validated it based
on our experience. Methods: Risk scoring systems such as the STS score and
Euroscore are well validated tools for the pre-operative evaluation of
surgical patients. No equivalent system is available for pacemaker or ICD
lead extraction. We undertook a systematic review of the literature to
determine the variables associated with major complication and used these
to establish a risk score. The score delineates the risk of a Life
Threatening Complication (LTC) (such as need for thoracotomy). Points are
added for each of the following clinical characteristics as follows:
female sex (+2), low BMI <26 (+1), operator experience 100 cases (+0),
lead implant duration >8 yrs (+2), lead implant duration <8 yrs (+0), no
previous cardiac surgery (+1), previous cardiac surgery (-2). Add 2 to
total. Max score 10. Min score 0. Results: To validate the score we
performed a retrospective analysis of the over 1000 patients in our
centers lead extraction experience. We then scored each of the patients
who had a major complication in the form of a perforation requiring
thoracotomy since 2001. These life threatening complications were
identified in 12 patients. The mean score for LTC was 7.67 and the median
score was 7.5. The minimum score was 5 in one patient while 3 patients
scored a 10and 3 patients scored an 8. Conclusions: We present a novel
risk scoring system for lead extraction. This was well validated by our
own experience as all patients who had a life threatening complication
scored 5 or more and most patients scored over 7. Further validation of
the score is required. We believe that utilization of this scoring system
will be effective at mitigating risk primarily by ensuring that high risk
patients are identified. The presence of a high risk score could also
mandate that surgical back-up be immediately available or allow the
operator to explore other options.

<12>
Accession Number
70735290
Authors
Haase M. Mertens P. Plas M. Bellomo R. Haase-Fielitz A.
Institution
(Haase, Mertens, Haase-Fielitz) Otto-von-Guericke University, Magdeburg,
Germany
(Plas) German Heart Center, Berlin, Germany
(Bellomo) Austin Health, Melbourne, Australia
Title
Neutrophil gelatinase-associated lipocalin predicts postoperative fluid
overload, a potentially modifiable risk factor for mortality after cardiac
surgery.
Source
Critical Care. Conference: 32nd International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20120320
Conference End: 20120323. Conference Publication: (var.pagings). 16 (pp
S126), 2012. Date of Publication: 20 Mar 2012.
Publisher
BioMed Central Ltd.
Abstract
Introduction: In most previous studies, neutrophil gelatinaseassociated
lipocalin (NGAL), measured immediately following cardiac surgery, has been
demonstrated to predict postoperative increases in serum creatinine and
decline in urine output. In patients undergoing cardiac surgery,
postoperative fluid overload is a typical complication. In this study, we
investigated the early postoperative value of NGAL to predict subsequent
fluid overload, a potentially modifiable risk factor in these patients.
Methods We studied 100 adult cardiac surgery patients assigned to the
control arm of a randomized controlled trial. Urine and serum were sampled
immediately after admission to the ICU. Urine NGAL was measured on the
ARCHITECT laboratory platform (Abbott Diagnostics) and serum creatinine
using an enzymatic assay. Postoperative fluid overload was defined as
positive fluid balance with >10% excess of preoperative body weight within
48 hours. An area under the curve of the receiver-operating
characteristics (AUC-ROC) of 0.5 indicates the predictive ability equaling
the toss of a coin and >0.7 of a useful biomarker. Results Postoperative
fluid overload was present in 15% of patients with a mean positive fluid
balance of 12 +/- 9 kg. Patients who survived the hospital stay had a
lower positive fluid balance of 2.8 l (25th to 75th percentiles: 1.5 to
5.5) compared to patients who died (23.0 l (25th to 75th percentiles: 14.5
to 24.0)); P = 0.010. A positive fluid balance predicted in-hospital
mortality with AUC 0.94 (95% CI 0.83 to 0.99), sensitivity 100% and
specificity 80% at a cut-off >6 l. Urine NGAL predicted fluid overload
(AUC-ROC 0.80 (95% CI 0.64 to 0.93)) and mortality (AUC-ROC 0.88 (95% CI
0.78 to 0.97)). Serum creatinine did not predict fluid overload (AUC-ROC
0.51 (95% CI 0.24 to 0.78)) or mortality (AUC-ROC 0.61 (95% CI 0.16 to
0.99)). Conclusion Fluid overload frequently occurs during the first 48
hours after cardiac surgery and is strongly correlated with postoperative
mortality. Early postoperatively measured urine NGAL is a good predictor
of fluid overload and mortality whereas measurement of serum creatinine at
the same time equals the toss of a coin. Early NGALguided adjustments of
fluid management might reduce organ edema and potentially improve patient
outcomes after cardiac surgery. Our findings should be validated in larger
patient cohorts.

<13>
Accession Number
70735282
Authors
Hammond N. Bass F. Shehabi Y.
Institution
(Hammond, Bass, Shehabi) Prince of Wales Hospital, Randwick, Australia
Title
Memories and post-traumatic stress-related symptoms in older, post-cardiac
surgery patients: Substudy of an RCT.
Source
Critical Care. Conference: 32nd International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20120320
Conference End: 20120323. Conference Publication: (var.pagings). 16 (pp
S123), 2012. Date of Publication: 20 Mar 2012.
Publisher
BioMed Central Ltd.
Abstract
Introduction: The majority of ICU survivors display little evidence of
severe psychological sequelae. However, there is evidence of posttraumatic
stress disorder (PTSD)-related symptoms such as anxiety, depression, panic
attacks, distressing memories and flashbacks within the first 3 months
post ICU discharge [1,2]. This substudy of the DEXCOM trial 3 (randomised
controlled trial of neurobehavioural effects of dexmedetomidine or
morphine for sedation and analgesia in patients 60 years or older,
undergoing coronary artery bypass grafting and/or valve replacement) aims
to explore any negative memories of the ICU and development of
PTSD-related symptoms between treatment groups of patients at high risk of
developing delirium. Methods At 8 weeks post ICU discharge, patients
completed three assessment tools, by mail or telephone. Tools used were
Depression Anxiety Stress Scale, ICU memory assessment tool and impact of
events scale. Results A total of 153 patients completed the substudy; 72
patients in the [M]orphine group and 81 in the [D]exmedetomidine group.
The mean age (years) in the M group was 72 (SD 5) and in the D group 69
(SD 6), with 71% (n = 51) males in the M group and 84% (n = 68) in the D
group. The mean ICU hours for M and D were 58 (SD 40) and 48 (SD 32)
respectively. No significant differences of memories or PTSDrelated
symptoms between the two treatment groups, for each of the three
assessment tools, were found. From the ICU memory tool, 21% (n = 15/70) of
M group patients and 15% (n = 12/81) of the D patients remember being in
the ICU. Just over one-half of the patients in both groups did not
remember all of their ICU stay with clarity (M group: 54%, n = 39/72; D
group: 51%, n = 40/78). Furthermore, 23% (n = 15/64) of M patients and 14%
(n = 10/73) of D patients had intrusive memories whilst in the ICU.
Conclusion Patients undergoing cardiac surgery with ICU stay do not have
clear memories of this episode. A small number had intrusive memories,
which are more common in M patients. The study used a convenience sample
so was not powered to detect a significant difference. No differences in
factual or delusional memories or PTSDrelated symptoms between the
treatment groups were found. These data could be the basis of a sample
size calculation for a larger study.

<14>
Accession Number
70735137
Authors
Osawa E. Rhodes A. Fukushima J. Almeida J. Jatene F. Nakamura R. Sundin M.
Auler J. Kalil Filho R. Galas F. Hajjar L.
Institution
(Osawa, Fukushima, Almeida, Jatene, Nakamura, Sundin, Auler, Kalil Filho,
Galas, Hajjar) Heart Institute, Sao Paulo, Brazil
(Rhodes) Charing Cross Hospital, Imperial College NHS Trust, London,
United Kingdom
Title
Goal-directed hemodynamic resuscitation in high-risk patients undergoing
cardiac surgery: A randomized controlled trial - Preliminary data (GRICCS
STUDY).
Source
Critical Care. Conference: 32nd International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20120320
Conference End: 20120323. Conference Publication: (var.pagings). 16 (pp
S71), 2012. Date of Publication: 20 Mar 2012.
Publisher
BioMed Central Ltd.
Abstract
Introduction Low cardiac output is a frequent clinical circumstance after
cardiac surgery and results in higher morbidity and mortality rates.
Goal-directed therapy (GDT) is a validated design that has been proved to
reduce the number of perioperative outcomes. We investigated the results
of a cardiac index optimization protocol through the use of the LiDCO
rapid device. Methods A prospective study that randomized 34 high-risk
patients (EuroSCORE higher than 6 or LVEF lower than 45%) to a GDT
protocol or a conventional hemodynamic therapy. Patients from the GDT
group were resuscitated to a cardiac index higher than 3 l/minute/m2
through the implementation of a three-step approach: (1) fluid challenge
of 250 ml aliquots, (2) dobutamine infusion up to a dose of 20
mug/kg/minute, and (3) blood transfusion to reach a hematocrit higher than
28%. The control group was managed according to institutional protocol.
Categorical variables were compared using Fisher's exact test and
categorical variables were compared using the Mann-Whitney U test. Results
Sixteen patients from the GDT group were compared with 18 patients from
the control group. There was a tendency towards reduction in ICU stay in
patients from GDT group in relation to the control group (7 days vs. 6
days, P = 0.18). Comparison of the primary endpoint variable (composite of
death or major postoperative complications within 30 days after surgery or
before discharge) between groups showed a reduced complication rate in the
GDT group (52.2% vs. 45.6%, P = 0.12), mainly attributed to worse acute
renal failure RIFLE criteria in the control group. Conclusion
Goal-directed hemodynamic resuscitation with the use of a minimally
invasive device seems to be a promising perioperative strategy aimed at
reducing the rates of worse outcomes and the ICU stay after cardiac
surgery.

<15>
Accession Number
70734578
Authors
Shah K.B. Flattery M.P. Doolin K.
Institution
(Shah, Flattery, Doolin) Pauley Heart Center, Virginia Commonwealth
University Health System, Richmond, VA, United States
Title
Women in a predominantly african american population exhibit lower gene
expression scores early after heart transplant.
Source
Journal of Heart and Lung Transplantation. Conference: 32nd Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation Prague Czech Republic. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 31 (4
SUPPL. 1) (pp S167-S168), 2012. Date of Publication: April 2012.
Publisher
Elsevier USA
Abstract
Purpose: Gene expression profiling (GEP) (Allomap, XDx, Brisbane, CA), an
alternative to endomyocardial biopsy for surveillance of cellular
rejection was validated in a randomized controlled trial for patients
(pts) >6 mo. post heart transplant (HT). We evaluated the impact of immune
therapies (rx) and demographic variables on GEP >6 months after HT.
Methods and Materials: We abstracted data for patients with GEP performed
2-6 mo. post HT. Continuous variables were compared with t-tests and
categorical variables with chi². Results: We evaluated 93 GEP
scores in 44 pts (51yrs, 59% AA, 33% women). Mean scores=19+/-7 at 84+/-14
days after HT and increased to 24+/-6 by 180+/-8 days (P=0.02). Scores had
inverse relationships with tacrolimus (TAC) dose (beta [95%CI] =
beta0.18[beta0.57,beta0.12]), prednisone dose (beta [95%CI]=
beta0.42[beta0.67,beta0.43]) and TAC level (beta [95%CI] =
beta0.16[beta0.64,beta0.09]). Women had lower scores at initial
measurement (15+/-8 vs 21+/-7, P=0.048). Age, induction and maintenance rx
were similar for both genders. At the 3 mo. GEP, mean TAC dose (8.1+/-1.2
mg vs 8.5+/-3.9 mg, P=NS), TAC level (7.3+/-2.2 vs 8.6+/-3.1, P=NS) and
prednisone dose (14.4+/-5.0 mg vs 13.6+/-3.1 mg, P=NS) did not differ by
gender. Nearly the entire female cohort were AA (88% vs 50% of the men;
P=0.07) and men had higher serum creatinine (0.8+/-0.2 mg/dL vs 1.3+/-0.4
mg/dL, P=0.002). (Figure presented) Conclusions: In this single center
study, a predominantly AA cohort of women had lower GEP scores than men
early after HT despite similar immune modulating rx. Gender specific
sensitivity of the GEP to clinical events and immune rx early post HT may
exist. Further studies examining the interaction of race, gender and
components of the GEP are needed.

<16>
Accession Number
70734458
Authors
Guglin M. Mehra S. Mason T.
Institution
(Guglin) Cardiology, University of South Florida, Tampa, FL, United States
(Mehra, Mason) College of Public Health, University of South Florida,
Tampa, FL, United States
Title
Comparative effects of the drugs used for pulmonary hypertension
reversibility testing: A meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 32nd Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation Prague Czech Republic. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 31 (4
SUPPL. 1) (pp S127), 2012. Date of Publication: April 2012.
Publisher
Elsevier USA
Abstract
Purpose: Testing for reversibility of pulmonary hypertension (PH) is
important for evaluation of candidates for heart transplant. Hemodynamic
effects of multiple drugs used for this purpose were never systematically
analyzed. Our goal is to compare effects of pulmonary vasodilators.
(Figure Presented) Methods and Materials: We identified 20 prospective
studies with documentation of hemodynamic data before and after the
pharmacologic testing for PH reversibility in advanced heart failure.
Effects on pulmonary vascular resistance (PVR) and pulmonary capillary
wedge pressure (PCWP) were analyzed. The data from the studies were pooled
by the drug and weighted on the sample size. Individual drugs were
compared with oxygen as a reference with mixed models using inverse
variance and testing for heterogeneity with random effects. Results: We
had sufficient data for comparison of sodium nitroprusside, milrinone,
nitroglycerine, dobutamine, inhaled nitric oxide, prostaglandin E1,
inhaled prostacyclin, intravenous prostacyclin, and sildenafil. Effects of
different drugs on PVR are shown on Figure 1. Prostaglandins
(prostaglandin E1, and prostacycline, inhaled or intravenous) had the most
potent effect on PVR decreasing it by 2.3, 2.6 and 2.5 Wood units,
respectively. Sildenafil decreased PVR by 1.7 Wood units. In regards to
PCWP, nitroprusside was the most potent drug decreasing it by 14 mm Hg,
followed by nitroglycerin, while prostaglandins did not provide any
significant effect. Conclusions: Because reversibility of pulmonary
hypertension in pretransplant cardiac patients is mostly determined by
vasoconstriction, prostaglandins, especially prostacyclin, appear to be
the drugs of choice in acute reversibility testing.

<17>
Accession Number
70734323
Authors
Hayes K. Leet A.S. Bradley S.J. Holland A.E.
Institution
(Hayes, Leet, Bradley, Holland) Alfred Health, Melbourne, VIC, Australia
(Leet) Baker Heart Institute, Melbourne, Australia
(Holland) La Trobe University, Melbourne, Australia
Title
Effects of exercise training on exercise capacity and quality of life in
patients with a left ventricular assist device (LVAD): A randomised
controlled trial.
Source
Journal of Heart and Lung Transplantation. Conference: 32nd Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation Prague Czech Republic. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 31 (4
SUPPL. 1) (pp S82), 2012. Date of Publication: April 2012.
Publisher
Elsevier USA
Abstract
Purpose: There is a paucity of studies examining the effect of exercise
training after left ventricular assist device (LVAD) implantation.
Previous research has demonstrated that insertion of the mechanical pump
alone improves exercise capacity and quality of life (QOL). Methods and
Materials: The purpose of this study was to determine whether supervised
exercise training results in a further improvement in exercise capacity
and QOL. Results: A prospective, randomised controlled trial with
concealed allocation, assessor blinding and intention-to-treat analysis
was conducted to investigate the effect of exercise training on exercise
capacity and QOL in 14 patients that underwent LVAD insertion as a bridge
to heart transplantation. Exercise training consisted of eight weeks of
gym-based aerobic and strengthening exercises, in addition to a daily,
progressive mobilisation program, compared to the control group that
completed mobilisation alone. Exercise capacity was measured before and
after intervention using maximal cardiopulmonary exercise testing and six
minute walk distance (6MWD), while QOL was measured using the SF-36.
Conclusions: No adverse events were reported during the trial. There was a
trend towards greater improvement in peak VO&2&, 6MWD and QOL in the
exercise group compared to the control group, however, no significant
between-group difference was detected for improvements in peak VO&2& [Mean
difference (exercise - control) 2.96 ml.kg-1.min-1, 95% CI -1.04 to 6.97],
6MWD [54 m, -51 to 159] and QOL scores over time (p > 0.05). Exercise
training is feasible and safe in patients with a LVAD. Trends toward
greater improvement in exercise capacity and QOL after exercise training
warrant further investigation in a larger trial.

<18>
Accession Number
70734304
Authors
Kaczmarek I. Zaruba M.-M. Sadoni S. Bigdeli A. Schramm R. Meiser B.
Institution
(Kaczmarek, Schramm, Meiser) Transplantation Center,
Ludwig-Maximilians-University, Munich, Germany
(Zaruba) Cardiology, Ludwig-Maximilians-University, Munich, Germany
(Sadoni, Bigdeli) Cardiac Surgery, Ludwig-Maximilians-University, Munich,
Germany
Title
Prospective randomized 3-ARM trial comparing tacrolimus with mycophenolate
mofetil (MMF) or sirolimus with calcineurininhibitor-free
immunosuppression (sirolimus/MMF) after heart transplantation: 5-year
results.
Source
Journal of Heart and Lung Transplantation. Conference: 32nd Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation Prague Czech Republic. Conference Start: 20120418
Conference End: 20120421. Conference Publication: (var.pagings). 31 (4
SUPPL. 1) (pp S76), 2012. Date of Publication: April 2012.
Publisher
Elsevier USA
Abstract
Purpose: Despite improvements in immunosuppression the most advantageous
combination for heart transplant recipients is not established. We
performed a randomized controlled trial to evaluate the efficacy and
safety of three immunosuppressive protocols. Methods and Materials: From
2003 to 2005, 78 cardiac transplant recipients were randomized on a 2:2:1
basis to receive either tacrolimus (TAC) and MMF (n=32), TAC and sirolimus
(SRL) (n=31), or SRL and MMF (n=15). ATG-induction was given in the
SRL/MMF group. Steroids were withdrawn after 6 months. Results: In the
intention to treat analysis 5-year-survival was: 86.1% (TAC/MMF), 93.1%
(TAC/SRL) and 86.7% (SRL/MMF) (p=ns). Freedom from biopsy proven rejection
or hemodynamic compromise rejection at 5 years was 82.4% (TAC/MMF), 85.2%
(TAC/SRL) and 73.3% (SRL/ MMF) (p=ns). Freedom from cardiac allograft
vasculopathy (CAV) was: TAC/MMF 72.2%, TAC/SRL 80.8%, and SRL/MMF 93.3%
revealling superior CAV prevention for SIR/MMF (p=0.01) and TAC/SRL
(p=0.02) when compared to TAC/MMF. Freedom from CMV was: TAC/MMF 72.2%,
TAC/SRL 89.7%, and SRL/MMF 86.7%. There was a superior freedom from CMV
for SRL/ MMF (p=0.01) and TAC/SRL (p=0.01) compared to TAC/MMF. Serum
creatinine at 5 years was TAC/MMF 1.44+/-0.5 mg/dL, TAC/SRL 1.65+/-0.9
mg/dL and SRL/MMF 1.25+/-0.3 mg/dL, revealing a trend towards superior
renal function for SRL/MMF. Cholesterol at 5 years was TAC/MMF 167+/-42
mg/dL, TAC/SRL 179+/-34 mg/dL, and SRL/MMF 183+/-33 mg/dL (p=ns). In the
SRL/MMF group 10 patients temporarily discontinued SRL because of adverse
events or rejection episodes. Conclusions: Both tacrolimus groups proved
to be efficacious for the prevention of acute rejection. The side effect
profile for the SRL/MMF group is inferior to the TAC groups resulting in a
high discontinuation rate. Both sirolimus groups revealed a lower
incidence of CMV infections and cardiac allograft vasculopathy in the
long-term analysis.

<19>
Accession Number
70735525
Authors
Scott N.B.
Title
Future directions for regional anesthesia in fast-track surgery-enhanced
recovery.
Source
Regional Anesthesia and Pain Medicine. Conference: 30th Annual European
Society of Regional Anaesthesia, ESRA Congress 2011 Dresden Germany.
Conference Start: 20110907 Conference End: 20110910. Conference
Publication: (var.pagings). 36 (5 SUPPL. 2) (pp E76-E78), 2011. Date of
Publication: September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Due to growing economic pressure, the need to reduce hospital lengths of
stay is gaining increasing importance and the transition from fast track
to enhanced recovery programmes embraces this need. Traditional fast track
surgery programmes 'cherry-picked' patients who were young fit and healthy
and by allowing them to deviate from the established routine unit
protocols shorter lengths of stay could be achieved. Enhanced recovery
after surgery (ERAS) is a process that shortens postoperative recovery by
minimising the physical and physiological trauma of the surgery, by
removing non evidencebased traditions and by encouraging early
mobilisation and feeding. ERAS differs from previous 'fast track' and
'accelerated recovery' programmes in that it is not exclusive to the
young, fit and healthy and is not dependent on a patient's suitability for
inclusion. Programmes, if conducted properly, should benefit every
patient. Successful implementation requires the formation of a
multidisciplinary team that focuses on all aspects of the perioperative
period and meets regularly to audit and redesign patient pathways for its
own hospital. This team approach requires leadership that ensures best
practice is achieved by each and every clinical department, similar to the
role of the conductor of an orchestra. Success also depends on the level
of expertise and engagement of the staff involved. Consequently, patients
recover more quickly spend less time in hospital and develop fewer
hospital-associated infections. They are therefore able to return to their
own activities of daily living (ADL) including work, more swiftly. Thus
for the anaesthetist ERAS affords the unique opportunity to convert from
the 'come, stun and run' perception of our 'inferior'specialty to that of
a valued and important member of the perioperative team who can influence
many aspects of the recovery process. Since the mid-1970's, recognition of
'other' benefits of RA on postoperative pathophysiology led to attempts to
define the advantages in comparative 'outcome' studies, but these have
produced less than definitive results, primarily because of the
difficulties associated with such studies even when they are combined by
meta-analysis. Thus there has been some questioning of the place of
regional techniques, especially for the provision of analgesia after major
surgery, driven also by concerns about major complications. However, the
recent Royal College of Anaesthetists UK-wide audit of adverse outcome
after central nerve block has defined such risks more clearly. The
fundamental consideration to achieving the benefits of regional methods
after major surgery is the physiological ('stress') response to surgery.
The changes comprising the response evolved as mechanisms for the repair
of relatively simple injuries, but the scale and range of the responses
after major surgery are anything but beneficial. Convential anaesthetic
and analgesic techniques have minimal effect on these changes, yet
managing (and minimising) their impact is a major component of
peri-operative care, particularly those aspects delivered by
anaesthetists. Regional techniques have much to offer in this area, but
they must be delivered both safely and effectively if the patient is to
benefit. This requires knowledge of the adverse physiological consequences
of surgery, the moderating effects which regional methods can provide, and
an understanding of the ways in which the features of different techniques
may (or may not) contribute to patient safety and comfort. Pain and
analgesia: The pain pathway was long thought to be be a simple conduit to
provide a warning of, and withdrawal from, harmful stimuli, but it is now
recognised that it also has many complex components and functions. General
anaesthesia overcomes what would otherwise be the immediate 'behavioural'
response to surgery, and opioid analgesics provide some relief from the
psychological effects of post-operative pain, but neither has any
significant impact on the physiological processes that the pain pathway
activates. The most immediate of these responses is a reflex increase in
muscle tone ('splinting') to decrease movement and minimise subsequent
pain, but this limits mobilisation after limb surgery and has significant
respiratory impact after abdominal and thoracic procedures. Postoperative
pain reduces both static and dynamic lung parameters, most notably
functional residual capacity and peak flow rate. Basal atelectasis occurs
rapidly, and both deep breathing and effective coughing are impaired.
Secretion retention, airway collapse and venous admixture predispose to
hypoxia, hypercapnia and sepsis, each of which can amplify other aspects
of the stress response. Subsequent changes within the pain pathway itself
can amplify and prolong the pain experienced by the patient, even
resulting in chronic pain states developing. Stimulation of the pain
pathway is also the key to the activation of all other components of the
physiological stress response. The primary aims of analgesia are to
provide/ensure low morbidity and near-immediate mobilization. Thus the
anaesthetic regime should aim to provide a good balance between analgesia
and the patient's ability to mobilise. The growing recognition that the
significant side-effects of all opioids limit the potential for rapid
mobilisation. The concept of 'multimodal analgesia' was designed to
substitute opioids with analgesics that have less troublesome
side-effects, but provide good quality pain relief. The most outstanding
feature of even a single-shot regional technique is the excellent
analgesia (without central depression) that is produced. Pain will develop
on block regression, but administration of supplementary oral or
parenteral analgesics should be timed so that they become effective before
the block wears off. This results in a gradual, rather than a sudden,
awareness of pain and reduces the requirement for (and complications of)
subsequent analgesic therapy. Where needed, catheter techniques allow the
period of profound analgesia to be prolonged well into the postoperative
period. Thus there is Level 1 evidence that the long held and widespread
belief that opioids are the 'gold standard' for postoperative pain is no
longer true. Opioids by whatever route, are inferior to both PNB and CNB
and therefore regional anaesthesia -in all its forms - should remain
central to any ERAS analgesia programme. Sympathetic activation and
sympatholysis: The increased sympathetic activity that follows peripheral
surgery is stimulated mainly by somatic afferent pathways, and is both
minimal and localised, even after lengthy procedures. However, breaching
of the thoracic or abdominal cavities (particularly with handling of the
viscera) produces widespread stimulation of sympathetic afferent pathways,
triggering a multitude of inhibitory reflexes that impair major organ
function as well as releasing adrenal catecholamines and further
interacting with the other cascades. Because the effects are widespread,
block of one or two spinal cord segments is insufficient to prevent these
effects which may persist for several days or even weeks. Regional
techniques produce sympathetic block in the relevant area for the duration
of the block. In peripheral surgery (i.e. of the head, neck and limbs),
afferent somatic and sympathetic block are usually complete, but with the
effects on the circulation being minimal when peripheral blocks are used.
The haemodynamic effects of central blocks used for peripheral surgery are
usually easy to control, with the cause of any significant hypotension
being readily apparent. In body cavity surgery, the consequences of
central techniques are more variable, but there is now considerable
evidence that sympathetic block is effective in reducing the duration and
severity of postoperative systemic organ dysfunction, particularly after
major procedures. However, full knowledge of these effects is needed so
that the patient can be managed appropriately and the benefits gained.
Inflammation and immunosuppression: Current understanding of the
mechanisms that initiate postoperative immunosuppression is poor, but the
magnitude of the stress response correlates directly with both serum
cortisol and the degree of immunosuppression. Triggers include transient
episodes of ischaemia or malperfusion of vulnerable organs or surgical
handling of major vessels and organs. Concomitant complement activation
has been associated with exacerbation of ischaemic brain, kidney and
myocardial injury through increased capillary permeability, neutrophil
activation and protease-activated receptor upregulation. IL-6 produces
negative inotropic effects and myocardial stunning, its concentration
correlating with left ventricular dysfunction and poor clinical outcome,
while IL-8 exacerbates cardiac injury, correlating with cardiac troponin-I
concentrations. In addition, IL-1, IL-6 & IL-8 also promoting the
discharge of A- and C-fibres, further increasing the severity of
postoperative pain. After major surgery both helper and suppressor cells
are suppressed, and the numbers of circulating Natural Killer cells, which
have a wide range of cytotoxic activity particularly against tumour cells,
are reduced also. Thus, cellular immunity is disturbed for up to seven
days postoperatively. Regional compared to general anaesthesia for
transurethral resection of the prostate reduces the postoperative
depression of lymphocyte transformation. Combined spinal and general
anaesthesia was shown to attenuate liver metastasis formation by
preserving Th1/Th2 cytokine balance. These findings suggest that use of
central blocks may result in less immunosuppression, although there is
still relatively little objective evidence to indicate whether such
effects influence outcome.

<20>
Accession Number
70735523
Authors
Moka E. Argyra E. Siafaka I.
Institution
(Moka, Argyra, Siafaka) Greece
Title
Safety of epidural anaesthesia.
Source
Regional Anesthesia and Pain Medicine. Conference: 30th Annual European
Society of Regional Anaesthesia, ESRA Congress 2011 Dresden Germany.
Conference Start: 20110907 Conference End: 20110910. Conference
Publication: (var.pagings). 36 (5 SUPPL. 2) (pp E69-E72), 2011. Date of
Publication: September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Every patient wishes to receive anaesthesia care that is
safe, in other words, free from risk, not involving danger or mishap and
guaranteed against failure. Anaesthesiologists usually present a more
realistic view to the patient. The personal view of the hoped-for care
will be one in which the clinical outcome is satisfactory and achieved
without complications, since performance has not deviated from the ideal.
By this standard, most deviations are trivial or easily corrected by a
perfect process, whereas patient outcome and a reasonably stress-free life
for the clinician are objectives for all anaesthesiologists [1]. Safety of
an anaesthetic technique is characterized by avoidance of complications,
minimal percentages of associated risks and numerous primary and secondary
beneficial endpoints, balanced against the inevitable consequences of
method-related dangers. Consequently, prior to any conclusion regarding
safety, reliable evidence must be established for both sides of the
anaesthetic technique benefit-and-risk equation [2, 3]. Epidural
anaesthesia-analgesia (EAA) has a long and distinguished history. For many
clinicians, it remains an attractive option and a leading anaesthetic-
analgesic modality applied in the perioperative environment [4, 5]. In
regard to the benefit side, there is widespread conviction among
anaesthesiologists that EAA offers significant advantages in certain
settings, especially those involving abdominal and thoracic operative
procedures [4, 6]. EAA is highly effective for controlling acute pain
after surgery or trauma to the chest, abdomen, pelvis or lower limbs, with
its salutary effects providing an added therapeutic benefit
postoperatively. It has been instituted in various subpopulations,
including cardiothoracic, vascular, paediatric and obstetric patients,
with optimistic and promising results. Usually, the combination of
excellent pain relief, associated with minimal side-effects, results in
high patient satisfaction, when compared with other methods of analgesia
[4, 6-8]. However, the controversy around EAA still continues,
particularly with regard to its true impact on postoperative morbidity and
mortality, as well as its safety, mostly due to the fear of rare, but
potentially life-threatening or catastrophic complications [3, 6, 9].
Controversies represent the debate and dialogue that ensue when clinicians
examine the issue of best practice. Taking into account the other
("darker?") side of the benefit-and-risk equation, unfortunately, the fear
of complications is still held with almost equal intensity, compared to
the enthusiasm which initially escorts EAA beneficial effects. Since there
is always risk attached to all anaesthesia methods, contemporary EAA
practice in certain situations has been controversial. In addition, the
main factor which in the past turned our specialty away from EAA has been
the difficulty in making a reasonable risk/benefit analysis about the
technique, resulting in clinicians constantly asking whether epidurals are
effective and whether the technique can finally be safe [2-4, 6, 9-12].
Nowadays, EAA is widely used again and since it is an invasive method, its
benefit/risk ratio deserves to be appraised, in order to help physicians
estimate technique safety, make appropriate choice among other
opportunities (general anaesthesia, peripheral nerve blocks, wound
infiltration) and provide objective information to patients, prior to
their written informed consent acquisition [5, 6, 13]. In this context,
the "ultimate tool" of evidencebased medicine, the Level 1 evidence of
meta-analysis, has shown over the previous years that EAA decreases
postoperative morbidity and mortality [6, 15], as well as pulmonary
complications [16], improves bowel recovery [17] and reduces incidence of
myocardial infarctions [18]. However, evidence to support improved outcome
from surgery remains elusive [19, 20], with the exception of aortic
surgery, where mortality and major complications were significantly
reduced [21]. Therefore, it is not surprising that research and more or
less scientific and emotive debates in this area continue, even more so in
view of reports of safety, complications and the current medicolegal
environment in many countries [5, 6]. EAA complications have been
described by many authors, although our understanding of the numerous risk
factors is limited [2, 10-14]. Despite their relatively infrequent
occurrence, the fear of EAA complications exceeds their actual incidence
[2, 3, 9, 13, 22]. Incidence knowledge could be an essential component of
the clinical decision-making, objective safety judging and consent
processes, although there are few good and detailed data, which can be
quoted to support such discussions, leaving both patient and clinicians in
quandary. Figures (ranging from 1:1.000 to 1:100.000 in general) are
quoted, but their doubtful validity questions the ability to obtain
genuinely informed consent from patients offered these procedures [13].
Although it is impossible to prevent all EAA complications, it may be
possible to reduce their occurrence, by avoiding well-defined risk factors
and by using a meticulous epidural technique at all times. Further studies
on clarification of risks, complications' early recognition and on EAA
technique improvement may reduce adverse effects occurrence and improve
EAA safety [13, 14, 22]. In the following paragraphs, the general
objective is to focus on the clinical aspects of EAA risks in terms of
their incidence, recognition, prevention and management, in an effort to
provide information that will help clinicians to avoid or minimize
complications, incurred during technique application. In this context, EAA
provision can be safe, as well as effective, if described risks and
benefits are carefully considered and the Hippocratic axiom "primum non
nocere" is kept in mind. Complications and Safety of EAA: Aetiology -
Evaluation of Evidence EAA complications represent the unexpected or
untoward events following the application of the technique itself or the
exposure to anaesthetic agents. They can be classified as simple adverse
events and common or uncommon/rare complications. Some of them are
considered minor side effects, easy to prevent and to manage, that usually
do not raise safety concerns. However, others, resulting from EAA as
unexpected outcomes, are of major concern, due to their potential to cause
neurological damage, leading to long-term or permanent disability. Both
major and minor EAA complications are well-known to clinicians and are
also well-annotated. They can occur immediately, or can be delayed. They
can be clinically insignificant, or, in rare situations, life-threatening.
Knowledge and attention to the technique can reduce the likelihood for
major complications. The impact of EAA complications in anaesthesia
practice is significant because anaesthesia care is rarely therapeutic and
known to carry risks. Furthermore, there is compelling evidence that
adverse outcomes trigger malpractice claims. As a group,
anaesthesiologists seem to accept the blame of complications that may or
may not have been caused by EAA itself. Furthermore, even when the
standard of care has been met, juries tend to assign blame more readily in
EAA complicated cases [2, 9-14, 22]. EAA complications [2, 6, 9-12, 22],
may happen in the whole perioperative period, including the postoperative
one and can be the direct or indirect result of the following: - the
technique itself: usually related to direct or indirect trauma by needle/
catheter insertion and/or catheter presence in the epidural space - the
untoward effects of local anaesthetics/adjuvant drugs instilled - local
and systemic toxicity results of drugs infused - fatal drug errors -
untoward effects resulting from the anticipated or unanticipated
physiologic consequences of local anaesthetic blockade - poor/late/no
management of physiologic responses and/or adverse effects (arterial
hypotension-fatal cardiovascular collapse) - intraoperative technical
problems/equipment failure - ignorance regarding complications'
anticipation/recognition of precipitating factors - delayed complications'
diagnosis - non-application/delayed application of complications'
preventive measures - lack of experience/education/audit/monitoring -
human/behavioural/operator/patient factors EAA complications have been
recognized over 100 years ago and the database concerning such risks is
large but confusing. Studies are scarce, and their results difficult to
compare. Due to their rarity, definite studies on EAA risks remain
problematic and the quoted ranges of complications for severe adverse
events still vary widely, because the study methodologies vary, much of
the data are retrospective, and the distinction between permanent and
temporary disability is not always clear. Many complications are known
through case reports, and these rare events might not be evenly
distributed within the patient population. Retrospective observational
studies/surveys and case reports are important sources for evaluation,
providing valuable information on incidence and possible associations with
confounding factors. Observational data are often clinically relevant, can
have a profound influence on clinical practice when a consensus of
opinions is formulated, but, unlike randomized controlled trials, lack a
control group, making it difficult to calculate an accurate incidence of
risk. Because the enormous number of patients needed to perform
prospective studies exceeds feasibility, it is important that
retrospective studies try to minimize the inherent weakness of such study
designs. Underreporting is common in retrospective studies, causing
underestimation of risk [2, 3, 6, 9, 10, 14, 22].

<21>
Accession Number
70735517
Authors
Gottschalk A.
Institution
(Gottschalk) Germany
Title
Regional anaesthesia and organ protection.
Source
Regional Anesthesia and Pain Medicine. Conference: 30th Annual European
Society of Regional Anaesthesia, ESRA Congress 2011 Dresden Germany.
Conference Start: 20110907 Conference End: 20110910. Conference
Publication: (var.pagings). 36 (5 SUPPL. 2) (pp E63-E64), 2011. Date of
Publication: September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Regional anaesthesia - epidural anaesthesia as well as peripheral nerve
blocks - has been shown to provide superior analgesia compared to other
analgesic regimes [2, 6]. Additionally now the question arises which
effects regional anaesthesia has with respect to organ protection and long
term outcome of patients after surgery. However, whereas several studies
have been published evaluating the effects of epidural anaesthesia on
organ protection no sufficient evidence exists concerning organ protective
effects of peripheral nerve blocks. Studies concerning organ protective
effects have been performed with respect to the cardiac, pulmonary and
gastrointestinal system. Experimental studies were able to show that
thoracic epidural anaesthesia is able to reduce the activation of the
sympathetic nerve system [8]. This effect may reduce the postoperative
stress response as well as the activation of the coagulation system.
Thoracic epidural analgesia has been shown to reduce the incidence of
myocardial infarction in patients undergoing vascular surgery [1]. Singh
et al were able to show that epidural analgesia in patients undergoing
infrainguinal vascular surgery is able to reduce the incidence of
cardiovascular, respiratory and gastrointestinal complications and
myocardial infarction [9]. Results after coronary bypass surgery are
inconsistent. Thoracic and abdominal surgery results in a relevant
impairment of pulmonary function [10. Several studies were able to show
that thoracic epidural analgesia is able to reduce postoperative pulmonary
complications like atelectasis and pneumonia, and is able to improve lung
function and oxygenation. Protective effects of epidural anaesthesia with
respect to the development of pneumonia have been shown recently [5].
Additionally duration of postoperative ventilation and need of
reintubation were reduced, lung function and oxygenation could be
improved. Concerning the gastrointestinal system use of epidural
anaesthesia results in a reduced duration of postoperative ileus and
gastrointestinal dysfunction especially after abdominal surgery and
improves oral intake [3]. These positive effects of epidural anaesthesia
are a milestone in the development of "fast-track-surgery" concepts. No
effects of regional anaesthesia on postoperative cognitive dysfunction has
been detected by now [4]. Due to methological problems the evaluation of
the influence of regional anaesthesia on mortality rates after surgery is
difficult to perform as a huge number of patients is necessary to include.
Until today meta-analyses and retrospective analyses have been published
demonstrating a slight reduction in mortality rate [7, 11, 12]. These
results should be interpreted with extreme caution as the differences are
quite small and prospective randomised studies are still missing. Thoracic
epidural anaesthesia has been shown to improve cardiac, pulmonary and
gastrointestinal function. These effects should be used intensively in
multimodal concepts to improve patients' outcome. Results concerning
influences of epidural anaesthesia on mortality rates remain inconsistent.

<22>
Accession Number
70735488
Authors
Missant C.
Institution
(Missant) Belgium
Title
Regional anesthesia for awake cardiac surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 30th Annual European
Society of Regional Anaesthesia, ESRA Congress 2011 Dresden Germany.
Conference Start: 20110907 Conference End: 20110910. Conference
Publication: (var.pagings). 36 (5 SUPPL. 2) (pp E27-E28), 2011. Date of
Publication: September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Regional anesthesia for cardiac surgery: Escalating costs and changing
profiles of cardiac surgery patients requires continuous modification of
perioperative management strategies. Regional anesthesia plays a role in
many fast track anesthesia protocols, including anesthesia for cardiac
surgery. Regional anesthesia techniques for cardiac surgery include
continuous local anesthetic infiltration, intrapleural local anesthetics,
intercostal and paravertebral nerve blocks and intrathecal/epidural
techniques. Although appropriate studies are lacking, it is assumed that,
compared to intravenous opioids, only intrathecal and epidural anesthesia
provide equipotent analgesia. In addition to excellent analgesia and a
reduction in respiratory complications, thoracic epidural anesthesia (TEA)
induced sympathicolysis improves the endogenous stress response, and
reduces the myocardial oxygen demand and infarct size. The use of TEA in
cardiac surgery, however, remains controversial because the insertion of
an epidural catheter in patients requiring full heparinization may lead to
an epidural hematoma and permanent neurological injury if not detected and
evacuated promptly. In addition, TEA induced sympathicolysis has recently
been shown to decrease left ventricular contractility and to abolish the
positive inotropic response of the right ventricle to an acute increase in
afterload(1-2). The use of TEA in cardiac surgery has regained new
interest in the last two years. A number of randomized controlled trials
and meta-analyses have been published recently. Last year, Bignami et al.
published a meta-analysis including 2366 patients. They concluded that
epidural analgesia improved outcome after cardiac surgery, indicated by
reduced incidence of acute renal failure, time on mechanical ventilation
and a reduction in the composite endpoint mortality/infarction(3). In
2011, Svircevic et al. subsequently have reported a randomized controlled
trial in 654 elective cardiac surgical patients who were randomized to
combined general anesthesia (GA) and TEA versus GA. Thirty day and 1-year
survival free from myocardial infarction, pulmonary complications, renal
failure and stroke were not different in both regimens (4). A metaanalysis
investigating the effects of adding a TEA to general anesthesia for
cardiac surgery, including a total of 28 randomized controlled trials with
a total of 2700 patients concluded that the addition of a TEA reduced the
incidence of supraventricular arrhythmias and respiratory complications
but had no effect on mortality, myocardial infarction or stroke(5).
Specifically in patients undergoing OPCAB surgery, Caputo et al showed
that the addition of TEA to GA reduces the incidence of postoperative
arrhythmias and improves pain control and overall quality of recovery,
allowing earlier extubation and hospital discharge(6). In conclusion, the
addition of TEA to GA for cardiac surgery enhances postoperative analgesia
and reduces postoperative ventilation times but is labour intensive and
has a high clinical risk and failure rate without a clear effect on
clinical outcome. The actual and potential risks and benefits of a TEA
during cardiac surgery should be taken into account for every individual
patient. Awake cardiac surgery: Awake cardiac surgery with the use of only
TEA has been suggested as an alternative to GA for both low and high risk
on- and off pump procedures via lower or full median sternotomy or minimal
invasive approaches using a small thoracotomy. Several manuscripts have
already reported awake cardiac surgery to be safe and feasible if all
preventive measures and international guidelines are taken into account to
avoid epidural hematoma. Conversion rates to GA have been reported between
0 and 10% due to inadequate analgesia or respiratory difficulties. Besides
a growing number of case reports, few studies have compared anesthesia
techniques including sole TEA for cardiac surgery (mainly due to ethical
and medical considerations). In addition, few data are available on
postoperative outcomes after awake cardiac surgery. In 2005, Kessler et al
have compared GA with combined GA and TEA and sole TEA for OPCAB surgery.
They reported all anesthetic techniques to be equally safe, but the
combination GA + TEA appeared to be most comprehensive (7). A comparable
study by Porizak et al in 2011 found all three anesthetic methods
equivalent in terms of early and late postoperative outcome (including
3-year mortality) except for a lower incidence of atrial fibrillation in
the awake TEA group (8). Very recently, Watanabe et al reported a
favourable surgical outcome and postoperative recovery after day case
awake off-pump cardiac surgery in 72 patients with severe pre-operative
comorbidities, including cerebrovascular impairment or severe pulmonary
disease (9). Conclusion: A final ranking of available anesthesia
techniques for cardiac surgery remains difficult. General anesthesia
without TEA is the established technique and should be used whenever
contraindications for epidural catheters apply. The decision which
technique is used in an individual patient should be made on an individual
basis regarding both the patient and the anesthesiologist's personal
preference. Although it is the author's opinion that systemic
anticoagulation hampers the use of epidural techniques, it is not
unimaginable that for few patients, GA+TEA and even sole TEA may be
preferred.

<23>
Accession Number
70733402
Authors
Glantz H. Thunstrom E. Herlitz J. Cederin B. Kallryd A. Ejdeback J. Peker
Y.
Institution
(Glantz) Dept. of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Glantz, Thunstrom, Peker) Dept. of Emergency and Cardiovascular Medicine,
Sahlgrenska Academy, University of Gothenburg, Sweden
(Herlitz) Dept. of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Cederin) Dept. of Internal Medicine, Skaraborg Hospital, Skovde, Sweden
(Kallryd, Ejdeback) Dept. of Cardiology, Skaraborg Hospital, Skovde,
Sweden
(Peker) Dept. Neurology, Rehabilitation and Sleep Medicine, Skaraborg
Hospital, Skovde, Sweden
Title
Occurence of obstructive sleep apnea in revascularized patients with
coronary artery disease: Baseline clinical characteristics of the RICCADSA
trial.
Source
Scandinavian Cardiovascular Journal. Conference: 14th Svenska
Kardiovaskulara Varmotet Stockholm Sweden. Conference Start: 20120425
Conference End: 20120427. Conference Publication: (var.pagings). 46 (pp
26), 2012. Date of Publication: June 2012.
Publisher
Informa Healthcare
Abstract
Background: The RICCADSA study is an on-going, randomized, controlled
trial in Skaraborg County, Western Sweden, addressing the impact of
continuous positive airway pressure (CPAP) on cardiovascular outcomes in
patients with coronary artery disease (CAD) and obstructive sleep apnea
(OSA). In this cross-sectional analysis, we describe the occurrence of OSA
and clinical characteristics of the cohort. Material and methods: All
patients undergoing Percutaneous Coronary Intervention or Coronary Artery
Bypass Grafting between September 2005 and November 2010 (n = 1291) were
invited to participate. Anthropometrics, medical history and sleep data
were recorded and all subjects completed Epworth Sleepiness Scale (ESS)
questionnaire. In total, 662 patients agreed and underwent an ambulatory
polygraphic sleep recording. OSA was defined as an Apnea-Hypopnea-Index
(AHI) > 15/h. Results: OSA was found among 422 (63.8%) patients. The
prevalence of hypertension was 55.9%, obesity (Body-Mass-Index > 30 kg/m2)
25.2%, diabetes mellitus 22.1% and current smoking 18.9%. The majority
(62.1%) of the OSA patients were non-sleepy (ESS score < 10). Age, male
gender and obesity were associated with OSA independently of the other
comorbidities. Within the OSA group, there were no significant clinical
differences among the non-sleepy subjects, except for less obesity.
Conclusions: Among revascularized CAD patients, OSA was more prevalent
than other traditional risk indicators, suggesting that OSA should be
considered as a confounding factor in the current secondary prevention
protocols. Whether or not all CAD patients with OSA should be treated by
CPAP, regardless of daytime sleepiness, needs to be further clarified.

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<1>
Accession Number
22486138
Authors
Heidari S.M. Saghaei M. Shafiee Z.
Institution
(Heidari) Department of Anesthesiology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran.
Title
Effect of preoperative volume loading on the intraoperative variability of
blood pressure and postoperative nausea and vomiting.
Source
Medicinski arhiv. 66 (2) (pp 94-96), 2012. Date of Publication: 2012.
Abstract
Preoperative volume loading (PVL) in addition to counteract the decreases
in blood pressure during intraoperative period, also may decrease
postoperative nausea and vomiting (PONV). This study was designed to
investigate the effect of preoperative volume loading on the
intraoperative blood pressure variability and postoperative nausea and
vomiting. Thirty subjects scheduled for elective orthopedic procedures
randomly divided into case and control groups. The patients in the case
group received lactated Ringer 10 ml/kg before induction of general
anesthesia. Mean arterial blood pressure (MAP) and heart rate were
recorded in two groups every 3 minutes from induction of anesthesia until
five minutes after extubation. Variability of mean arterial blood pressure
and heart rate were defined as the standard deviation (SD) of the measured
values for each patient. Means of these individual SD values were compared
between two groups using Mann-Whitney U test. The mean variability of mean
arterial blood pressure and heart rate ware significantly lower in case
group (8.3 +/- 3 mmHg and 8.4 +/- 2.5 bpm vs. 13 +/- 6 mmHg and 11 +/- 2.6
bpm in control group; p < 0.5). The severity of nausea (measured as a
ten-point visual analog scale) was significantly lower in case group (1.2
+/- 0.9 vs. 3.9 +/- 1.8 in control group; p < 0.05). No patients in case
group developed postoperative vomiting (compared to 5 patients in control
group). The results of this study shows that preoperative volume loading
is associated with lower variability of blood pressure and heart rate
during operative period and also reduces the severity and incidence of
postoperative nausea and vomiting.

<2>
Accession Number
2012241039
Authors
Rognoni A. Lupi A. Sansa M. Secco G.G. Santagostino M. Bongo A.S.
Institution
(Rognoni, Lupi, Sansa, Secco, Santagostino, Bongo) Cardiologia 2, A.O.U.
Maggiore della Carita, Corso Mazzini 18, 28100 Novara, Italy
Title
Radial approach for percutaneous coronary intervention.
Source
Reviews on Recent Clinical Trials. 7 (2) (pp 127-132), 2012. Date of
Publication: May 2012.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The transradial approach for percutaneous coronary intervention (both
diagnostic and therapeutic procedures) has gained progressive acceptance
in the last years. Transradial access has been shown, also, to have
several advantages over transfemoral approach; the radial artery is easily
compressible, thus bleeding is controllable and hemorrhagic complications
are significantly reduced. Furthermore, pe-riprocedural bleeding and
vascular complications after percutaneous coronary intervention are
associated with worse clinical outcomes and increased short and long -
mortality. With increasing experience and availability of dedicated
equipment this technique is now being increasingly used for complex
catheter intervention. The main purpose of this review is to highlight the
benefits, complications and problems with transradial approach compared
with conventional transfemoral approach. 2012 Bentham Science Publishers.

<3>
Accession Number
2012248554
Authors
Friedland S.N. Eisenberg M.J. Shimony A.
Institution
(Friedland, Eisenberg, Shimony) Divisions of Cardiology and Clinical
Epidemiology, McGill University, Jewish General Hospital, Montreal, ON,
Canada
(Shimony) Department of Cardiology, Soroka University Medical Center,
Ben-Gurion University, Beersheva, Israel
Title
Meta-analysis of randomized controlled trials on effect of cilostazol on
restenosis rates and outcomes after percutaneous coronary intervention.
Source
American Journal of Cardiology. 109 (10) (pp 1397-1404), 2012. Date of
Publication: 15 May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cilostazol is a generic drug with antiplatelet and antiproliferative
effects. It is unclear whether adding cilostazol to standard dual
antiplatelet therapy (aspirin and clopidogrel) after percutaneous coronary
intervention reduces restenosis and improves the outcomes. We, therefore,
conducted a systematic review and meta-analysis. We systematically
searched the Cochrane Library, EMBASE, and MEDLINE databases for
randomized controlled trials comparing dual antiplatelet therapy with and
without cilostazol after percutaneous coronary intervention. The data were
pooled using random-effects models and stratified into short-term
(1-month), midterm (1- to 12-month), and long-term (<12-month) follow-up
durations. Twelve randomized controlled trials involving 5,655 patients
met our inclusion criteria. The addition of cilostazol to dual
antiplatelet therapy was not associated with a significant change in
target lesion revascularization (TLR) and target vessel revascularization
(TVR) at short-term follow-up. However, TLR and TVR were significantly
reduced at midterm follow-up (relative risk 0.57, 95% confidence interval
0.39 to 0.84, and relative risk 0.62, 95% confidence interval 0.47 to
0.83, respectively). Data regarding TLR and TVR at long-term follow-up
were limited and inconclusive. We did not find a difference in myocardial
infarction, mortality, or major bleeding at any follow-up duration. In
conclusion, the addition of cilostazol to dual antiplatelet therapy after
percutaneous coronary intervention has favorable effects on TLR and TVR at
1 to 12 months, with no differences in adverse outcomes at any follow-up
duration. 2012 Elsevier Inc.

<4>
Accession Number
22416600
Authors
Nuszkowski M.M. Deutsch N. Jonas R.A. Zurakowski D. Montague E. Holt D.W.
Institution
(Nuszkowski) Children's National Medical Center, Washington, DC
20010-2970, USA.
Title
Randomized trial of the Terumo Capiox FX05 oxygenator with integral
arterial filter versus Terumo Capiox Baby RX05 and Terumo Capiox AF02
arterial filter in infants undergoing cardiopulmonary bypass.
Source
The Journal of extra-corporeal technology. 43 (4) (pp 207-214), 2011. Date
of Publication: Dec 2011.
Abstract
The purpose of this clinical trial was to evaluate the effect of the
Terumo Capiox FX05 oxygenator with integrated arterial filter during
cardiopulmonary bypass (CPB) compared with the Terumo Capiox RX05 Baby RX
and arterial filter on inflammatory mediators and blood product
utilization. Forty patients weighing less than 10 kg who underwent
congenital heart surgery utilizing cardiopulmonary bypass were randomized
into either oxygenator group. The endpoints included measuring
inflammatory markers at six different time points (preoperative baseline,
CPB circuit being primed, 15 minutes after CPB initiation, status post
protamine administration, prior to transport to intensive care unit, and
within 12 to 24 hours post surgery), blood product utilization, extubation
time, and days until discharge. The inflammatory mediators showed no
significant differences between oxygenators at any time points. However,
looking at the inflammatory mediators of both the FX and RX groups
combined, a statistically significant difference was seen in interleukin
(IL)-6 at 12/24 hour post surgery (p < .001) versus baseline and all other
time points. IL-8 at status post protamine (p < .001) and 12/24 hours post
surgery (p < .001) demonstrated significant differences versus all other
time points, and IL-10 at status post protamine (p < .001) and prior to
leaving the operating room (p < .001) were statistically different
compared to all other time points. Cardiopulmonary bypass stimulates the
systemic inflammatory response through various components of the
extracorporeal system. This investigation did not find significant
differences in cytokines interferon-gamma, IL-1beta, IL-2, IL-4, IL-5,
IL-6, IL-8, IL-10, IL-12 p70, tumor necrosis factor (TNF)-alpha, and
TNF-beta when comparing these two oxygenators. It is well known that
various mechanisms contribute to the levels of cytokines circulating in a
patient's blood volume and many manipulations throughout cardiac surgery
have the ability to demonstrate anti-inflammatory interventions. Further
investigation is needed as to how modification of the extracorporeal
circuit may minimize increases in inflammatory mediators. Keywords:
infant, bypass, cytokines, blood, infant perfusion strategy.

<5>
Accession Number
2012235686
Authors
Serraino G.F. Marsico R. Musolino G. Ventura V. Gulletta E. Sante P.
Renzulli A.
Institution
(Serraino, Marsico, Musolino, Renzulli) Department of Clinical and
Experimental Medicine, Cardiac Surgery Unit, University of Magna Graecia,
Campus 'S.Venuta', Viale Europa, 88100 Catanzaro, Italy
(Ventura, Gulletta) Department of Clinical and Experimental Medicine,
Clinical Pathology Unit, Italy
(Sante) University of Magna Graecia, Catanzaro, Department of
Cardiothoracic and Respiratory Sciences, AON Monaldi Second University of
Naples, Naples, Italy
Title
Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves
organ function and reduces endothelial activation.
Source
Circulation Journal. 76 (5) (pp 1121-1129), 2012. Date of Publication:
2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: We aimed to evaluate if the use of an intra-aortic balloon
pump (IABP) during cardioplegic arrest improves organ function and reduces
endothelial activation in patients undergoing coronary artery bypass graft
(CABG). Methods and Results: Five-hundred and one CABG patients were
randomized into 2 groups: (Group A n=270) linear cardiopulmonary bypass
(CPB); and (Group B n=231) automatic 80 beats/min IABP-induced pulsatile
CPB. We evaluated hemodynamic response, coagulation and fibrinolysis,
transaminase, bilirubin, amylase, lactate, renal function (estimated
glomerular filtration rate [eGFR], creatinine and any possibility of renal
insufficiency or failure), respiratory function and endothelial markers
(vascular endothelial growth factor [VEGF] and monocyte chemotactic
protein-1 [MCP-1]). IABP, which induced surplus hemodynamic energy, was
21,387+/-4,262 ergs/cm³. Group B showed lower chest drainage,
transfusions, international normalized ratio, and antithrombin III,
together with higher platelets, activated partial thromboplastin time,
fibrinogen and D-dimer. Transaminases, bilirubin, amylase, lactate were
lower in Group B; there were better results for eGFR in Group B from
ICU-arrival to 48 h, resulting in lower creatinine from ICU-arrival to 48
h. The necessity for renal replacement therapy was lower in Group B
Stage-3. Group B P_aO₂/F_iO₂ and
lung compliance improved with aortic de-clamping on the first day with
shorter intubation time. Group B showed lower VEGF and MCP-1. Conclusions:
Pulsatile flow by IABP improves whole-body perfusion and reduces
endothelial activation during CPB.

<6>
Accession Number
2012235685
Authors
Yamauchi T. Miyata H. Sakaguchi T. Miyagawa S. Yoshikawa Y. Takeda K.
Motomura N. Tsukihara H. Sawa Y.
Institution
(Yamauchi, Sakaguchi, Miyagawa, Yoshikawa, Takeda, Sawa) Department of
Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2
Yamadaoka, Suita 565-0871, Japan
(Motomura, Tsukihara) Department of Cardiac Surgery, Faculty of Medicine,
Graduate School of Medicine, University of Tokyo, Tokyo, Japan
(Miyata) Department of Healthcare Quality Assessment, Graduate School of
Medicine, University of Tokyo, Tokyo, Japan
Title
Coronary artery bypass grafting in hemodialysis-dependent patients:
Analysis of Japan Adult Cardiovascular Surgery Database.
Source
Circulation Journal. 76 (5) (pp 1115-1120), 2012. Date of Publication:
2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Perioperative risk during coronary artery bypass grafting
(CABG) is reportedly high in patients with chronic renal disease. We aimed
to determine postoperative mortality and morbidity and identify the
perioperative risk factors of mortality during CABG in hemodialysis
(HD)-dependent patients. Methods and Results: From the Japan Adult
Cardiovascular Surgery Database, we compared 1,300 HD-dependent chronic
renal failure patients with 18,387 non-HD patients who all underwent
isolated CABG between January 2005 and December 2008. The operative
mortality and mortality, including major morbidity, was 4.8% vs. 1.4% and
23.1% vs. 13.7% in the HD and non-HD groups, respectively. Preoperative
predictors of operative mortality included age, chronic obstructive
pulmonary disease, peripheral arterial disease, congestive heart failure,
arrhythmia, preoperative inotropic agent requirement, New York Heart
Association class IV, urgent or emergency operation, poor left ventricular
function, aortic valve regurgitation (>2), and mitral valve regurgitation
(>3). Postoperative predictors of operative mortality included stroke,
infection, prolonged ventilation, pneumonia, heart block, and
gastrointestinal complications. Conclusions: Compared with non-HD
patients, CABG in HD patients was associated with high mortality and
morbidity rates. An appropriate surgical strategy and careful
perioperative assessment and management for prevention of respiratory and
gastrointestinal complications might contribute to improved clinical
outcomes after CABG in these patients.

<7>
Accession Number
2012237080
Authors
Wei G. Fang Y. Yaqi R. Lin C. Ningfu W.
Institution
(Wei, Fang, Yaqi, Lin, Ningfu) Department of Cardiology, Nanjing Medical
University, Hangzhou First People's Hospital, #261 Huansha Road, Hangzhou,
310006, China
Title
Clinical outcomes of zotarolimus-eluting stents versus the first
generation sirolimus-eluting stents and paclitaxel-eluting stents: A
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 157 (1) (pp 152-156), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<8>
Accession Number
2012237063
Authors
Gray W.A. Yeung A.C. Cutlip D.E. Popma J.J. Fitzgerald P.J. Williams D.O.
Heuer H. O'Shaughnessy C.D. Overlie P.A. Mann J.T. Cannon L.A. Hermiller
J.B. Henry T.D. Whitbourn R. Stuckey T.D. Midei M.G. Coe J. Schwartz L.B.
Institution
(Gray) Columbia University Medical Center, New York, NY, United States
(Yeung, Fitzgerald) Stanford University Medical Center, Palo Alto, CA,
United States
(Cutlip) Harvard Clinical Research Institute, Boston, MA, United States
(Popma) Brigham and Women's Hospital, Boston, MA, United States
(Williams) Rhode Island Hospital, Providence, RI, United States
(Heuer) St. Johannes Hospital, Dortmund, Germany
(O'Shaughnessy) Eyria Memorial Hospital (EMH), Regional Medical Center,
Elyria, OH, United States
(Overlie) Lubbock Heart Hospital, Lubbock, TX, United States
(Mann) Wake Medical Hospital, Raleigh, NC, United States
(Cannon) Northern Michigan Hospital, Petosky, MI, United States
(Hermiller) Heart Center of Indianapolis, Indianapolis, IN, United States
(Henry) Abbott Northwestern Hospital, Minneapolis, MN, United States
(Whitbourn) St. Vincent's Hospital, Melbourne, Australia
(Stuckey) Moses H. Cone Memorial Hospital, Greensboro, NC, United States
(Midei) St. Joseph Medical Center, Towson, MD, United States
(Coe, Schwartz) Abbott Laboratories, 200 Abbott Park Road, AP52-2, Abbott
Park, IL 60064-6215, United States
Title
A randomized, controlled, multi-center trial comparing the safety and
efficacy of zotarolimus-eluting and paclitaxel-eluting stents in de novo
lesions in coronary arteries: Final results of the ZoMaxx II trial.
Source
International Journal of Cardiology. 157 (1) (pp 96-101), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background/Objectives: The purpose of this prospective, randomized,
single-blind controlled clinical trial was to compare the effectiveness of
a zotarolimus-eluting stent (ZoMaxx) with a paclitaxel-eluting coronary
stent (Taxus Express²) in patients with angina pectoris and a
single native coronary artery lesion between 10-28 mm in length and
2.5-3.75 mm in diameter. Methods: Patients were enrolled at 75
international institutions between June 2005 and November 2006. Results:
1099 (1672 originally planned) patients received 557 ZoMaxx and 542 Taxus
stents: cohorts were well-matched for diabetes (27% vs. 27%), reference
vessel diameter (2.73 +/- 0.46 mm vs. 2.74 +/- 0.45 mm) and lesion length
(14.8 +/- 6.7 mm vs. 14.3 +/- 6.4 mm). Nine month clinical and
angiographic follow-up was available in 1052/1099 (96%) and 649/836 (78%)
patients, respectively. The safety profiles for the two stents (myocardial
infarction (MI), cardiac death and/or target vessel revascularization
(TVR)) were similar (ZoMaxx 8.7% vs. Taxus 6.9%, p = NS). The primary
endpoint of 9-month TVR occurred more frequently after treatment with
ZoMaxx (6.8%) as compared with Taxus (4.2%), therefore the primary
clinical endpoint was not met. However, the 9-month in-segment late lumen
loss for ZoMaxx (0.29 +/- 0.47 mm) and Taxus (0.22 +/- 0.41 mm, p = NS)
were similar, thus satisfying the primary angiographic endpoint. Secondary
endpoints of the rates of in-segment and in-stent binary restenosis were
also similar (5.9% vs. 5.8%, 7.8% vs. 7.9%, respectively). Conclusions: At
9 months, the ZoMaxx stent failed to achieve the primary endpoint of
non-inferiority in TVR to the Taxus stent, but safety endpoints were equal
between the two stent systems. 2011 Elsevier Ireland Ltd. All rights
reserved.

<9>
Accession Number
2012237059
Authors
Hermanides R.S. Ottervanger J.P. Dambrink J.-H.E. Dill T. Van Houwelingen
G. Ten Berg J.M. Kolkman E. Hamm C. Van't Hof A.W.J.
Institution
(Hermanides, Ottervanger, Dambrink, Van't Hof) Isala Klinieken, Department
of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, Netherlands
(Dill, Hamm) Kerckhoff-Klinik, Bad Nauheim, Germany
(Van Houwelingen) Medisch Spectrum Twente, Enschede, Netherlands
(Ten Berg) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Kolkman) Diagram BV, Zwolle, Netherlands
Title
Risk of bleeding after prehospital administration of high dose tirofiban
for ST Elevation Myocardial Infarction.
Source
International Journal of Cardiology. 157 (1) (pp 86-90), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: In most patients with ST-elevation myocardial infarction
(STEMI), antiplatelet drugs are already administrated in the ambulance,
before hospital admission. We investigated the safety of prehospital
initiation of a high dose of the glycoprotein IIb/IIIa inhibitor tirofiban
on top of aspirin, clopidogrel and heparin. Methods: It concerns a
sub-analysis of the On-TIME 2 trial. 1398 patients were enrolled and 1275
patients (91.2%) had clinical follow up. Non CABG-related bleeding was
defined according to the TIMI criteria. Logistic regression was used to
determine predictors of 30-day bleeding. The independent association
between bleeding and mortality (30-day and 1-year) was evaluated using Cox
proportional Hazard models. Results: Bleeding (major or minor) was
observed in 47 patients (3.7%), with only 13 patients (1%) with major
bleeding. The strongest independent determinants of bleeding were age (OR
1.05, 95% CI 1.01-1.08, p = 0.011), Killip class > 1 at admission (OR 2.5,
95% CI 1.2-5.3, p = 0.020) and intra aortic balloon pump (IABP) use (OR
4.2, 95% CI 1.6-11.1, p = 0.003). High dose tirofiban was not an
independent predictor of bleeding (OR 1.7, 95% CI 0.9-3.2, p = 0.116).
Bleeding was associated with an increased risk of 30-day mortality (HR
5.5, 95% CI 1.6-7.8, p < 0.001) and one-year mortality (HR 3.2, 95% CI
1.4-7.2, p = 0.005). Conclusion: Prehospital use of high dose tirofiban is
safe and associated with a low risk of bleeding. Age, Killip class > 1,
IABP use, but not high dose tirofiban are independent determinants of
bleeding in STEMI patients. Bleeding is independently associated with
30-day and 1-year mortality. 2010 Elsevier Ireland Ltd. All rights
reserved.

<10>
Accession Number
2012237054
Authors
Andreini D. Pontone G. Mushtaq S. Annoni A. Formenti A. Bertella E.
Parolari A. Agostoni P. Bartorelli A. Ballerini G. Fiorentini C. Pepi M.
Institution
(Andreini, Pontone, Mushtaq, Annoni, Formenti, Bertella, Parolari,
Agostoni, Bartorelli, Ballerini, Fiorentini, Pepi) Centro Cardiologico
Monzino IRCCS, Department of Cardiovascular Sciences, University of Milan,
Milan, Italy
Title
Diagnostic performance of two types of low radiation exposure protocol for
prospective ECG-triggering multidetector computed tomography angiography
in assessment of coronary artery bypass graft.
Source
International Journal of Cardiology. 157 (1) (pp 63-69), 2012. Date of
Publication: 17 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Multidetector computed tomography (MDCT) is useful in
evaluation of coronary artery bypass graft (CABG). However, radiation
exposure is a reason for concern. We compared diagnostic performance and
effective dose of a new dedicated post-processing reconstruction algorithm
with BMI-adapted scanning protocol (MDCT-XTe) vs. standard prospective
ECG-triggering protocol (MDCT-XT) and retrospective ECG-triggering
(MDCT-Helical), compared to invasive coronary angiography (ICA), in the
assessment of grafts and nongrafted or distal runoff coronary arteries.
Methods: One hundred and nineteen patients with 277 grafts were randomized
to Group 1 based on BMI-adapted scanning protocol with prospective
ECG-triggering (40 patients), Group 2 with prospective ECG-triggering (39
patients) and Group 3 (40 patients) with retrospective ECG-triggering.
Data were acquired using 64-slice MDCT. Results: MDCT correctly assessed
the patency of all CABG in 3 groups. After comparison with ICA, MDCT was
able to correctly detect the occlusion or stenosis of CABG in all groups,
with the exception of one case of Group 3. In Group 3 sensitivity,
specificity, positive predictive value, negative predictive value and
accuracy of CABG evaluation were 100%, 98.4%, 96.7%, 100% and 98.9%,
respectively. In Groups 1 and 2 the diagnostic accuracy of CABG evaluation
was 100%. Effective radiation dose was 3.5 +/- 1.4 mSv in Group 1 vs. 7.4
+/- 2.6 mSv in Group 2 vs. 27.8 +/- 9.4 mSv in Group 3. Conclusions: Our
results indicated that MDCT-XTe and MDCT-XT have a diagnostic performance
in the evaluation of CABG similar to MDCT-Helical, with a significant
reduction of radiation exposure, specially for MDCT-XTe. 2010 Elsevier
Ireland Ltd. All rights reserved.

<11>
Accession Number
2012236860
Authors
Balaban F. Yagar S. Ozgok A. Koc M. Gullapoglu H.
Institution
(Balaban, Yagar, Ozgok, Koc, Gullapoglu) Department of Anesthesiology and
Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital,
Sihhiye 06100, Ankara, Turkey
Title
A randomized, placebo-controlled study of pregabalin for postoperative
pain intensity after laparoscopic cholecystectomy.
Source
Journal of Clinical Anesthesia. 24 (3) (pp 175-178), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Study Objective: To determine the efficacy of two different doses (150 mg
and 300 mg) of preoperative pregabalin on pain relief and total opioid
consumption after laparoscopic cholecystectomy. Design: Prospective,
randomized, placebo-controlled, double-blinded study. Setting: Training
and research hospital. Patients: 90 adult, ASA physical status 1 and 2
patients. Interventions: Patients were randomly assigned to three groups
to receive orally one hour before surgery, a placebo (Group 1), pregabalin
150 mg (Group 2), or pregabalin 300 mg (Group 3). Patients were observed
for pregabalin side effects, somnolence via Ramsay Sedation Scale,
dizziness, confusion, and ataxia. Measurements: In the operating room,
heart rate and noninvasive systolic and diastolic blood pressures were
measured. Visual analog scale (VAS), Ramsay Sedation Scale, and Aldrete
scores were also recorded on arrival at the Postanesthesia Care Unit (time
0), 15, 30, 60, 120 minutes and 3, 4, 6, 8, 10, 12 and 24 hours after
surgery. Additional doses of drugs (fentanyl and/or metoclopramide) were
also recorded. Main Results: Preemptive pregabalin decreased pain scores
and postoperative fentanyl consumption in patients after laparoscopic
cholecystectomy in a dose-dependent manner. There were no differences
between the groups in side effects. Conclusion: Preoperative pregabalin
may be a useful analgesic for patients after laparoscopic cholecystectomy,
as it lowers pain intensity and opiod consumption, and does not increase
the frequency of side effects. 2012 Elsevier Inc.

<12>
Accession Number
2012241123
Authors
Kweon T.D. Jung C.-W. Park J.-W. Jeon Y.-S. Bahk J.-H.
Institution
(Kweon) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Seoul, South Korea
(Jung, Park, Jeon, Bahk) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
Title
Hemodynamic effect of full flexion of the hips and knees in the supine
position: A comparison with straight leg raising.
Source
Korean Journal of Anesthesiology. 62 (4) (pp 317-321), 2012. Date of
Publication: April 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Straight raising of the legs in the supine position or
Trendelenburg positioning has been used to treat hypotension or shock, but
the advantages of these positions are not clear and under debate. We
performed a crossover study to evaluate the circulatory effect of full
flexion of the hips and knees in the supine position (exaggerated
lithotomy), and compare it with straight leg raising. Methods: This study
was a prospective randomized crossover study from the tertiary care unit
at our university hospital. Twenty-two patients scheduled for off-pump
coronary artery bypass surgery were enrolled. Induction and maintenance of
anesthesia were standardized. Exaggerated lithotomy position or straight
leg raising were randomly selected in the supine position. Hemodynamic
variables were measured in the following sequence: 10 min after induction,
1, 5, and 10 min following the designated position, and 1 and 5 min after
returning to the supine position. Ten min later, the other position was
applied to measure the same hemodynamic variables. Results: During the
exaggerated lithotomy position, cerebral and coronary perfusion pressure
increased significantly (P < 0.01) without a change in cardiac output.
During straight leg raising, cardiac output increased at 5 min (P < 0.05)
and cerebral and coronary perfusion pressures did not increase except for
cerebral perfusion pressure at 1 min. However, the difference between the
two groups at each time point in terms of cerebral perfusion pressure was
clinically insignificant. Conclusions: Full flexion of the hips and knees
in the supine position did not increase cardiac output but may be more
beneficial than straight leg raising in terms of coronary perfusion
pressure. the Korean Society of Anesthesiologists, 2012.

<13>
Accession Number
2012231037
Authors
Perin E.C. Willerson J.T. Pepine C.J. Henry T.D. Ellis S.G. Zhao D.X.M.
Silva G.V. Lai D. Thomas J.D. Kronenberg M.W. Martin A.D. Anderson R.D.
Traverse J.H. Penn M.S. Anwaruddin S. Hatzopoulos A.K. Gee A.P. Taylor
D.A. Cogle C.R. Smith D. Westbrook L. Chen J. Handberg E. Olson R.E.
Geither C. Bowman S. Francescon J. Baraniuk S. Piller L.B. Simpson L.M.
Loghin C. Aguilar D. Richman S. Zierold C. Bettencourt J. Sayre S.L.
Vojvodic R.W. Skarlatos S.I. Gordon D.J. Ebert R.F. Kwak M. Moye L.A.
Simari R.D.
Institution
(Perin, Willerson, Silva, Smith, Westbrook, Chen) Texas Heart Institute,
St. Luke's Episcopal Hospital, Houston, TX, United States
(Pepine, Anderson, Cogle, Handberg) School of Medicine, University of
Florida, Gainesville, FL, United States
(Martin) College of Public Health and Health Professions, University of
Florida, Gainesville, FL, United States
(Henry, Traverse, Olson) Minneapolis Heart Institute, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Henry, Traverse, Taylor, Zierold) School of Medicine, University of
Minnesota, Minneapolis, MN, United States
(Ellis, Thomas, Geither) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Zhao, Kronenberg, Hatzopoulos, Bowman, Francescon) School of Medicine,
Vanderbilt University, Nashville, TN, United States
(Lai, Baraniuk, Piller, Simpson, Bettencourt, Sayre, Vojvodic, Moye)
School of Public Health, University of Texas, Houston, TX, United States
(Loghin) School of Medicine, University of Texas, Houston, TX, United
States
(Penn) Northeast Ohio Medical University, Akron, OH, United States
(Anwaruddin) Penn Heart and Vascular Hospital, University of Pennsylvania,
Philadelphia, PA, United States
(Gee, Aguilar, Richman) College of Medicine, Baylor University, Houston,
TX, United States
(Skarlatos, Gordon, Ebert, Kwak) National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Simari) Mayo Clinic, Rochester, MN, United States
Title
Effect of transendocardial delivery of autologous bone marrow mononuclear
cells on functional capacity, left ventricular function, and perfusion in
chronic heart failure: The FOCUS-CCTRN trial.
Source
JAMA - Journal of the American Medical Association. 307 (16) (pp
1717-1726), 2012. Date of Publication: 25 Apr 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Previous studies using autologous bone marrow mononuclear cells
(BMCs) in patients with ischemic cardiomyopathy have demonstrated safety
and suggested efficacy. Objective: To determine if administration of BMCs
through transendocardial injections improves myocardial perfusion, reduces
left ventricular end-systolic volume (LVESV), or enhances maximal oxygen
consumption in patients with coronary artery disease or LV dysfunction,
and limiting heart failure or angina. Design, Setting, and Patients:
Aphase 2 randomized double-blind, placebo-controlled trial of symptomatic
patients (New York Heart Association classification II-III or Canadian
Cardiovascular Society classification II-IV) with a left ventricular
ejection fraction of 45% or less, a perfusion defect by single-photon
emission tomography (SPECT), and coronary artery diseasenotam enable to
revascularization who were receiving maximal medical therapy at 5 National
Heart, Lung, and Blood Institute-sponsored Cardiovascular Cell Therapy
Research Network (CCTRN) sites between April 29, 2009, and April 18, 2011.
Intervention: Bone marrow aspiration (isolation of BMCs using a
standardized automated system performed locally) and transendocardial
injection of 100 million BMCs or placebo (ratio of 2 for BMC group to 1
for placebo group). Main Outcome Measures: Co-primary end points assessed
at 6 months: changes in LVESV assessed by echocardiography, maximal oxygen
consumption, and reversibility on SPECT. Phenotypic and functional
analyses of the cell product were performed by the CCTRN biorepository
core laboratory. Results: Of 153 patients who provided consent, a total of
92 (82 men; average age: 63 years) were randomized (n=61 in BMC group and
n=31 in placebo group). Changes in LVESV index (-0.9 mL/m2 [95% CI, -6.1
to 4.3]; P=.73), maximal oxygen consumption (1.0 [95% CI, -0.42 to 2.34];
P=.17), and reversible defect (-1.2 [95% CI, -12.50 to 10.12]; P=.84) were
not statistically significant. There were no differences found in any of
the secondary outcomes, including percent myocardial defect, total defect
size, fixed defect size, regional wall motion, and clinical improvement.
Conclusion: Among patients with chronic ischemic heart failure,
transendocardial injection of autologous BMCs compared with placebo did
not improve LVESV, maximal oxygen consumption, or reversibility on SPECT.
Trial Registration: clinicaltrials.gov Identifier: NCT00824005. 2012
American Medical Association. All rights reserved.

<14>
Accession Number
2012237670
Authors
Foltran F. Ballali S. Passali F.M. Kern E. Morra B. Passali G.C.
Berchialla P. Lauriello M. Gregori D.
Institution
(Foltran, Gregori) Laboratory of Epidemiological Methods and
Biostatistics, Department of Environmental Medicine and Public Health,
University of Padova, Padova, Italy
(Ballali) Prochild ONLUS, Trieste, Italy
(Passali) Ear, Nose, and Throat Clinic, University Tor Vergata, Rome,
Italy
(Kern) ENT Department Mayo Clinic, Rochester, NY, United States
(Morra) ENT Department, San Giovanni Battista Molinette Hospital, Turin,
Italy
(Passali) ENT Department, Catholic University The Sacred Heart, Rome,
Italy
(Berchialla) Department of Public Health and Microbiology, University of
Torino, Italy
(Lauriello) Department of Experimental Medicine, University of L'Aquila,
Italy
Title
Foreign bodies in the airways: A meta-analysis of published papers.
Source
International Journal of Pediatric Otorhinolaryngology. 76 (SUPPL. 1) (pp
S12-S19), 2012. Date of Publication: 14 May 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Very recently, some attempts have been made to start a
systematic collection of foreign bodies (FB) in view of using them to
characterize the risk of chocking in terms of size, shape and consistency
of the FB. However, most of the epidemiologic evidence on foreign bodies
in children comes from single-center retrospective studies, without any
systematic geographical and temporal coverage. This paper is aimed at
providing an estimate of the distribution of foreign body's injuries in
children according to gender, age, type of FB, site of obstruction,
clinical presentation, diagnostic/therapeutic procedures, complications,
as emerging from a meta-analytic review of published papers. Methods: A
free text search on PubMed database ((foreign bodies) OR (foreign body))
AND ((aspiration) OR (airways) OR (tracheobronchial) OR (nasal) OR
(inhalation) OR (obstruction) OR (choking) OR (inhaled) OR (aspirations)
OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child))
finalized to identify all English written articles referring to foreign
body inhalation over a 30. years period (1978-2008) was performed. The
target of the analysis has been defined as the proportion of injuries as
reported in the studies, stratified according to children demographic
characteristics, type of FB, site of obstruction. The pooled proportions
of FB were calculated using the DerSimonian and Laird approach. Results:
1699 papers were retrieved and 1063 were judged pertinent; 214 English
written case series were identified, among them 174 articles were
available and have been included in the analysis. Airway foreign body most
commonly occurs in young children, almost 20% of children who have inhaled
foreign bodies being between 0 and 3. years of age. Organic FB,
particularly nuts, are the most documented objects while, among inorganic
FBs, the greatest pooled proportion has been recorded for magnets, which
can be particularly destructive in each location. Non specific symptoms or
a complete absence of symptoms are not unusual, justifying mistaken or
delayed diagnosis. Acute and chronic complications seem to occur in almost
15% of patients. Conclusions: Even if an enormous heterogeneity among
primary studies seems to exist and even if the absence of variables
standardized definitions across case series, including class age
definition and symptoms and signs descriptions, seriously impairs studies
comparability, our results testify the relevant morbidity associated with
foreign body inhalation in children, stressing the importance of
preventive measures. 2012 Elsevier Ireland Ltd.

<15>
Accession Number
2012236258
Authors
Hao Z. Zhi-Wei W. Zhen Z. Xiao-Ping H. Hong-Bing W. Yi G.
Institution
(Hao, Zhi-Wei, Zhen, Xiao-Ping, Hong-Bing, Yi) Department of
Cardiothoracic Surgery, Renmin Hospital of Wuhan University, 99 Ziyang
Road, Wuhan, Hubei Province 430060, China
Title
Endovascular stent-graft placement or open surgery for the treatment of
acute type B aortic dissection: A meta-analysis.
Source
Annals of Vascular Surgery. 26 (4) (pp 454-461), 2012. Date of
Publication: May 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Acute type B aortic dissection (ATBAD) is a life-threatening
condition. Open chest surgical repair using a prosthetic graft has been a
conventional treatment for ATBAD. During the past decade, thoracic
endovascular aortic repair (TEVAR), which is considered as a less invasive
and potentially safer technique, has been increasingly used to treat this
condition. Evidence is needed to support the use of TEVAR for these
patients. The aim of this review was to assess the efficacy of TEVAR
versus conventional open surgery in patients with ATBAD. Methods: For this
review, we searched the Cochrane Central Register of Controlled Trials
(CENTRAL) in The Cochrane Library (last searched: 2010, issue 4), MEDLINE,
EMBASE, CINAHL, Web of Science, and the Chinese Biomedicine Database for
clinical trials until January 18, 2011. Controlled trials in which
patients with ATBAD were assigned to TEVAR or open surgical repair were
included. For each outcome, we evaluated the quality of the evidence with
reference to the Grading of Recommendations Assessments, Development, and
Evaluation criteria. At the end, we used RevMan 5.0 software to analyze
the datum. Results: Five trials (318 participants) are included in this
review. As determined by the Grading of Recommendations Assessments,
Development, and Evaluation approach, the result quality was low for
30-day mortality and very low for other variables. TEVAR can significantly
reduce the short-term mortality for ATBAD (Mantel-Haenszel fixed odds
ratio [95% confidence interval]: 0.19 [0.09-0.39], P < 0.001). TEVAR
cannot significantly improve postoperative complications or long-term
mortality. Conclusions: TEVAR can be weakly recommended as an alternative
for the selective treatment of ATBAD but cannot always be used in case of
surgery. Annals of Vascular Surgery Inc.

<16>
Accession Number
2012237799
Authors
Kawahara Y. Ninomiya I. Fujimura T. Funaki H. Nakagawara H. Takamura H.
Oyama K. Tajima H. Fushida S. Inaba H. Kayahara M.
Institution
(Kawahara, Ninomiya, Fujimura, Funaki, Nakagawara, Takamura, Oyama,
Tajima, Fushida, Kayahara) Gastroenterologic Surgery, Department of
Oncology, Division of Cancer Medicine, Graduate School of Medical Science,
Kanazawa University, Kanazawa, Japan
(Inaba) Department of Emergency and Critical Care Medicine, Kanazawa
University Hospital, Kanazawa, Japan
Title
Prospective randomized controlled study on the effects of perioperative
administration of a neutrophil elastase inhibitor to patients undergoing
video-assisted thoracoscopic surgery for thoracic esophageal cancer.
Source
Diseases of the Esophagus. 23 (4) (pp 329-339), 2010. Date of Publication:
May 2010.
Publisher
Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053,
Australia)
Abstract
Sivelestat sodium hydrate (Ono Pharmaceutical Co., Osaka, Japan) is a
selective inhibitor of neutrophil elastase (NE) and is effective in
reducing acute lung injury associated with systemic inflammatory response
syndrome (SIRS). We conducted a prospective randomized controlled study to
investigate the efficacy of perioperative administration of sivelestat
sodium hydrate to prevent postoperative acute lung injury in patients
undergoing thoracoscopic esophagectomy and radical lymphadenectomy.
Twenty-two patients with thoracic esophageal cancer underwent
video-assisted thoracoscopic esophagectomy with extended lymph node
dissection in our institution between April 2007 and November 2008. Using
a double-blinded method, these patients were randomly assigned to one of
two groups preoperatively. The active treatment group received sivelestat
sodium hydrate intravenously for 72 hours starting at the beginning of
surgery (sivelestat-treated group; n = 11), while the other group received
saline (control group; n = 11). All patients were given methylprednisolone
immediately before surgery. Postoperative clinical course was compared
between the two groups. Two patients (one in each group) were discontinued
from the study during the postoperative period because of surgery-related
complications. Of the remaining 20 patients, 2 patients who developed
pneumonia within a week after surgery were excluded from some laboratory
analyses, so data from 18 patients (9 patients in each group) were
analyzed based on the arterial oxygen pressure/fraction of inspired oxygen
ratio, white blood cell count, serum C-reactive protein level, plasma
cytokine levels, plasma NE level, and markers of alveolar type II
epithelial cells. In the current study, the incidence of postoperative
morbidity did not differ between the two groups. The median duration of
SIRS in the sivelestattreated group was significantly shorter than that in
the control group: 17 (range 9-36) hours versus 49 (15-60) hours,
respectively (P = 0.009). Concerning the parameters used for the diagnosis
of SIRS, the median heart rates on postoperative day (POD) 2 were
significantly lower in the sivelestat-treated group than in the control
group (P = 0.007). The median arterial oxygen pressure/fraction of
inspired oxygen ratio of the sivelestat-treated group were significantly
higher than those of the control group on POD 1 and POD 7 (POD 1: 372.0
[range 284.0-475.0] vs 322.5 [243.5-380.0], respectively, P = 0.040; POD
7: 377.2 [339.5-430.0] vs 357.6 [240.0-392.8], P = 0.031). Postoperative
white blood cell counts, serum C-reactive protein levels, plasma
interleukin-1beta, tumor necrosis factor-alpha levels, and plasma NE
levels did not differ significantly between the two groups at any point
during the postoperative course, nor did serum Krebs von den Lungen 6,
surfactant protein-A, or surfactant protein-D levels, which were used as
markers of alveolar type II epithelial cells to evaluate the severity of
lung injury. Plasma interleukin-8 levels were significantly lower in the
sivelestat-treated group than in the control group on POD 3 (P = 0.040).
In conclusion, perioperative administration of sivelestat sodium hydrate
(starting at the beginning of surgery) mitigated postoperative hypoxia,
partially suppressed postoperative hypercytokinemia, shortened the
duration of SIRS, and stabilized postoperative circulatory status after
thoracoscopic esophagectomy. 2009 Copyright the Authors Journal
compilation 2010, Wiley Periodicals, Inc.

<17>
Accession Number
70728079
Authors
Lee J.K. Pearce-Smith B. Wei L. Chelly J.
Institution
(Lee, Pearce-Smith, Chelly) University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Wei) University of Pittsburgh, Pittsburgh, PA, United States
Title
Continuous paravertebral catheters in patients who underwent minimally
invasive cardiac surgery: A case series.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual Regional
Anesthesia Meeting and Workshops, ASRA 2011 Las Vegas, NV United States.
Conference Start: 20110505 Conference End: 20110508. Conference
Publication: (var.pagings). 36 (5) , 2011. Date of Publication:
September-October 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Minimally invasive surgery is a relatively new approach to
cardiac procedures done through several small thoractomy incisions. This
is done in an effort to reduce the morbidity associated with cardiac
procedures approached with a full sternotomy. In combination with the
physiolgical benefits of regional anesthesia techniques during recovery,
fast tracking surgical strategies may provide a benefit on surgical
outcome (Carli, 2011). Paravertebral nerve block techniques have gained a
recent resurgence in popularity as an effective mode of analgesia post
thoracotomy. Paravertebrals may be just as effective as thoracic epidural
analgesia and associated with fewer side effects and less incidence of
devastating neurological complications (Davies, 2006). Recent
meta-analyses demonstrated that thoracic paravertebrals may decrease
pulmonary complications and facilitate earlier extubation (Joshi, 2008),
(Lynch, 2010). We aim to describe a novel modality of postoperative pain
control after minimally invasive cardiac surgery. Methods: Following IRB
approval, we performed a retrospective review of 11 patients who received
continuous paravertebral catheters for postoperative analgesia undergoing
minimally invasive maze, mitral valve replacement, or LIMA to LAD CABG
procedures. All surgeries were performed by a single surgeon. Depending on
the type of surgery, patients received preoperative bilateral or
unilateral paravertebral continuous catheters at levels T3 or T4. Patients
were given ropivacaine 0.5% bolus during the initial placement of the
block. Infusate consisted of either lidocaine 0.25% or bupivacaine
0.0625%. Inclusion criteria include age greater than 18 - 85 years old,
ASA physical status I-IV, who underwent a minimally invasive cardiac
surgery (coronary artery bypass, mitroplasty, mitral valve repair, or maze
procedure) under the care a single cardiothoracic surgeon, from the dates
9/1/2008 to 12/15/2010. Exclusion criteria included patients who have
psychological disease, history of narcotic or substance abuse, on chronic
anticoagulation, antiplatelet therapy within one week of the procedure, or
had a contraindication to the surgery, paravertebral block, allergy or
intolerance to local anesthetic, or women who were pregnant or post
partum. Results: Eleven patients were retrospectively studied (2 F/9 M).
Median postoperative pain scores at 6, 12, 24, and 48 hrs were 3 (range
0-8, n= 9), 2.25 (0-6, n = 10), 2.5 (0-4, n = 8), and 2 (0-6, n=5),
respectively. 5 of 9 patients were extubated in the OR. Median length of
ICU stay was 1 day (1-7, n= 9). Conclusions: Continuous paravertebral
nerve blocks may be an effective and beneficial modality of postoperative
pain control for minimally invasive cardiac surgery.

<18>
Accession Number
2012230784
Authors
Gu W.-J. Wu Z.-J. Wang P.-F. Htet Aung L.H. Yin R.-X.
Institution
(Gu, Htet Aung, Yin) Department of Cardiology, Institute of Cardiovascular
Diseases, The First Affiliated Hospital, Guangxi Medical University, 22
Shuangyong Road, Nanning 530021, Guangxi, China
(Wu) Department of Colorectal and Anal Surgery, The First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi, China
(Wang) Department of Orthopaedics, China-Japan Union Hospital, Jilin
University, Changchun, Jilin, China
Title
N-acetylcysteine supplementation for the prevention of atrial fibrillation
after cardiac surgery: A meta-analysis of eight randomized controlled
trials.
Source
BMC Cardiovascular Disorders. 12 , 2012. Article Number: 10. Date of
Publication: 24 Feb 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Atrial fibrillation is the most common type of arrhythmia
after cardiac surgery. An increasing body of evidence demonstrates that
oxidative stress plays a pivotal role in the pathophysiology of atrial
fibrillation. N-acetylcysteine (NAC) is a free radical scavenger, and may
attenuate this pathophysiologic response and reduce the incidence of
postoperative AF (POAF). However, it is unclear whether NAC could
effectively prevent POAF. Therefore, this meta-analysis aims to assess the
efficacy of NAC supplementation on the prevention of POAF.Methods: Medline
and Embase were systematically reviewed for studies published up to
November 2011, in which NAC was compared with controls for adult patients
undergoing cardiac surgery. Outcome measures comprised the incidence of
POAF and hospital length of stay (LOS). The meta-analysis was performed
with the fixed-effect model or random-effect model according to the
heterogeneity.Results: Eight randomized trials incorporating 578 patients
provided the best evidence and were included in this meta-analysis. NAC
supplementation significantly reduced the incidence of POAF (OR 0.62, 95%
CI 0.41 to 0.93; P = 0.021) compared with controls, but had no effect on
LOS (WMD -0.07, 95% CI -0.42 to 0.28; P = 0.703).Conclusions: The
prophylactic NAC supplementation may effectively reduce the incidence of
POAF. However, the overall quality of current studies is poor and further
research should focus on adequately powered randomized controlled trials
with POAF incidence as a primary outcome measure. 2012 Gu et al; licensee
BioMed Central Ltd.

<19>
Accession Number
21684171
Authors
Mukherjee D. Ashrafian H. Kourliouros A. Ahmed K. Darzi A. Athanasiou T.
Institution
(Mukherjee) Department of Surgery and Cancer, Imperial College London,
London, UK.
Title
Intra-operative conversion is a cause of masked mortality in off-pump
coronary artery bypass: a meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (2) (pp 291-299),
2012. Date of Publication: Feb 2012.
Abstract
Coronary artery bypass surgery can offer excellent results when performed
with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass
(off pump). The debate as to which technique is superior remains
unanswered. Intra-operative conversion from off- to on-pump coronary
surgery is a relatively unexplored phenomenon, which cannot be assessed
within randomised controlled trial design. We aimed to assess the effect
of off-pump conversion on patient mortality. Medline, Embase, Cochrane and
Google Scholar databases were systematically reviewed for studies
published between 1980 and 2010 that compared the incidence of mortality
between converted and non-converted off-pump patients. Publication bias
and heterogeneity were assessed and data were extracted independently by
multiple observers. We undertook a meta-analysis of these studies using
random effects modelling. A total of 17 studies fulfilled our inclusion
criteria, containing data for 18,870 off-pump coronary artery bypass
operations spanning a decade (1998-2008), involving 920 cases of
conversion. Overall, conversion increased mortality by an odds ratio of
6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion
further raised the odds ratio of mortality to 6.99 (95% confidence
interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery
may significantly increase the chance of an adverse outcome, whereas
emergency conversion confers a significant rise in mortality. The risk of
conversion should be discussed when obtaining the patient's informed
consent and its prevention warrants serious consideration by cardiac
surgeons and cardiac surgical training programmes.

<20>
Accession Number
21640602
Authors
Biancari F. Mikkola R. Heikkinen J. Lahtinen J. Airaksinen K.E. Juvonen T.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland.
Title
Estimating the risk of complications related to re-exploration for
bleeding after adult cardiac surgery: a systematic review and
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 41 (1) (pp 50-55), 2012.
Date of Publication: Jan 2012.
Abstract
The aim of this study was to evaluate the impact of re-exploration for
bleeding after cardiac surgery on the immediate postoperative outcome.
Systematic review of the literature and meta-analysis of data on
re-exploration for bleeding after adult cardiac surgery were performed.
The literature search yielded eight observational studies reporting on
557,923 patients and were included in the present analysis. Patients
requiring re-exploration were significantly older, more frequently males,
had a higher prevalence of peripheral vascular disease and preoperative
exposure to aspirin, and more frequently underwent urgent/emergency
surgery. Re-exploration was associated with significantly increased risk
ratio (RR) of immediate postoperative mortality (RR 3.27, 95% confidence
interval (CI) 2.44-4.37), stroke, need of intra-aortic balloon pump, acute
renal failure, sternal wound infection, and prolonged mechanical
ventilation. The pooled analysis of four studies (two being propensity
score-matched pairs analysis) reporting adjusted risk for mortality led to
an RR of 2.56 (95%CI 1.46-4.50). Studies published during the last decade
tended to report a higher risk of re-exploration-related mortality (RR
4.30, 95%CI 3.09-5.97) than those published in the 1990s (RR 2.75, 95%CI
2.06-3.66). This study suggests that re-exploration for bleeding after
cardiac surgery carries a significantly increased risk of postoperative
mortality and morbidity.

<21>
Accession Number
22314630
Authors
Cutshall S.A. Anderson P.G. Prinsen S.K. Wentworth L.J. Olney T.J. Messner
P.K. Brekke K.M. Li Z. Sundt 3rd. T.M. Kelly R.F. Bauer B.A.
Institution
(Bauer) Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Title
Effect of the combination of music and nature sounds on pain and anxiety
in cardiac surgical patients: a randomized study.
Source
Alternative therapies in health and medicine. 17 (4) (pp 16-23), 2011.
Date of Publication: 2011 Jul-Aug.
Abstract
Postoperative pain and anxiety are common in cardiac surgery patients.
Studies have suggested that music can decrease anxiety in hospitalized
patients. Primary Study Objective This study focused on the efficacy and
feasibility of special music, which included nature sounds, for pain and
anxiety. In this randomized controlled trial, postoperative cardiovascular
surgery patients were randomly assigned to a music group to receive 20
minutes of standard postoperative care and music twice daily on
postoperative days 2 through 4 or to a control group to receive 20 minutes
of standard care with a quiet resting period twice daily on postoperative
days 2 through 4. Cardiovascular surgical unit of Saint Marys Hospital,
Rochester, Minnesota. One hundred patients completed the study (music
group, n = 49; control group, n = 51). Intervention The music was
delivered through CD players in the patients' rooms. Pain, anxiety,
satisfaction, and relaxation were evaluated from visual analog scales.
Data showed a significant decrease in mean (SD) pain scores after the
second session of day 2 for the music group (change, ?1.4 [1.4]) compared
with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation
scores improved more at the first session of day 2 for the music group
(change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P
= .03). The music group also showed lower anxiety and increased
satisfaction overall, but these differences were not statistically
significant. No major barriers to using the therapy were identified.
Recorded music and nature sounds can be integrated into the postoperative
care of cardiovascular surgery patients. The recordings may provide an
additional means for addressing common symptoms of pain and anxiety while
providing a means of relaxation for these patients.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 11

Results Generated From:
Embase <1980 to 2012 Week 18>
Embase (updates since 2012-04-26)

<1>
Accession Number
2012221030
Authors
Nejad M.H.G. Baharestani B. Esfandiari R. Hashemi J. Panahipoor A.
Institution
(Nejad, Baharestani, Esfandiari, Hashemi, Panahipoor) Shaheed Rajaiee
Cardiovascular Research Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Evaluation and comparison of using low-dose aprotinin and tranexamic acid
in CABG: A double blind randomized clinical trial.
Source
Journal of Tehran University Heart Center. 7 (1) (pp 15-18), 2012. Date of
Publication: 2012.
Publisher
Tehran University of Medical Sciences (North Kargar Street, Tehran
1411713138, Iran, Islamic Republic of)
Abstract
Background: Cardiovascular operations are associated with an inherent
bleeding tendency that sometimes leads to severe bleeding and transfusion
requirement. Pharmacological intervention to minimize post-bypass bleeding
and blood product transfusions has received increasing attention from both
medical and economic viewpoints. Methods: This double-blind, randomized,
placebo-controlled clinical trial recruited three groups of patients (each
group consisting of 50 patients) undergoing on-pump coronary artery bypass
graft surgery (CABG) and blindly randomized them to receive either low
aprotinin, tranexamic acid, or placebo. The results were, subsequently,
evaluated and compared between the groups. All the patients were operated
on by one surgeon and the same surgery team. Results: The following
variables were similar between the groups, and there was no statistically
significant difference between the groups in terms of these variables: age
(p value = 0.308), sex (p value = 0.973), hyperlipidemia (p value =
0.720), hypertension (p value = 0.786), smoking (p value = 0.72), and
diabetes (p value = 0.960). The amounts of drainage from chest tubes were
less in the aprotinin and tranexamic acid groups than the amount in the
placebo group; the difference was statistically important (p value <
0.001). There was no statistically significant difference with respect to
need for reoperation for bleeding between the three groups (p value =
0.998). Complications following surgery in the three groups were
statistically the same and not significantly different. All the
complications (myocardial infarction, pericardial effusion, neurological
complication and renal complication) had a good course, and all the
patients were discharged from the hospital uneventfully. There was no
mortality in any group. Conclusion: Low-dose aprotinin and tranexamic acid
can significantly reduce blood loss and transfusion requirement in CABG
without importantly increasing mortality and morbidity.

<2>
Accession Number
2012231401
Authors
Levy J.H. Sniecinski R.M.
Institution
(Levy, Sniecinski) Department of Anesthesiology, School of Medicine, Emory
University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, United
States
Title
Prohemostatic treatment in cardiac surgery.
Source
Seminars in Thrombosis and Hemostasis. 38 (3) (pp 237-243), 2012. Date of
Publication: 2012.
Publisher
Thieme Medical Publishers, Inc. (333 7th Avenue, New York NY 10001-5004,
United States)
Abstract
Cardiac surgical patients represent a unique group of patients where
coagulopathy occurs due to multiple causes besides simple hemorrhagic
blood loss. Hemodilution, inflammation, and hemostatic activation while on
cardiopulmonary bypass all contribute to this problem and provide targets
for therapeutic intervention. Current pharmacological strategies to reduce
the need for allogeneic transfusions include both preemptive agents to
decrease the potential for bleeding as well as prohemostatic agents to
promote the coagulation process. This article will discuss pharmacological
agents including antifibrinolytics, protamine, desmopressin, fibrinogen,
purified protein concentrates, recombinant factor VIIa, factor XIII, and
topical agents used in cardiac surgery. Copyright 2012 by Thieme Medical
Publishers, Inc.

<3>
Accession Number
2012231964
Authors
Zamani P. Ganz P. Libby P. Sutradhar S.C. Rifai N. Nicholls S.J. Nissen
S.E. Kinlay S.
Institution
(Kinlay) Cardiovascular Division, Veterans Affairs Boston Healthcare
System, 1400 VFW Parkway, West Roxbury, MA 02132, United States
(Libby, Kinlay) Cardiovascular Division, Brigham and Women's Hospital,
Boston, MA, United States
(Libby, Kinlay) Harvard Medical School, Boston, MA, United States
(Zamani) Cardiovascular Division, University of California, San Diego, San
Diego CA, United States
(Ganz) Cardiovascular Division, University of California San Francisco,
San Francisco, CA, United States
(Sutradhar) Pfizer Inc, New York, NY, United States
(Rifai) Children's Hospital Boston, Harvard Medical School, Boston, MA,
United States
(Nicholls, Nissen) Cleveland Clinic Foundation, Cleveland Clinic Lerner
School of Medicine, Case Western Reserve University, Cleveland, OH, United
States
Title
Relationship of antihypertensive treatment to plasma markers of vascular
inflammation and remodeling in the Comparison of Amlodipine versus
Enalapril to Limit Occurrences of Thrombosis study.
Source
American Heart Journal. 163 (4) (pp 735-740), 2012. Date of Publication:
April 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Antihypertensive agents lower the risk of cardiovascular
events, but whether they affect pathways important in inflammation and
plaque remodeling in atherosclerosis is uncertain. We assessed whether 2
commonly used antihypertensive agents affected plasma biomarkers
reflecting specific inflammatory and remodeling processes over 2 years in
the Comparison of Amlodipine versus Enalapril to Limit Occurrences of
Thrombosis (CAMELOT) study. Methods: The study was a randomized controlled
trial of 2 antihypertensives (amlodipine and enalapril) compared with
placebo in patients with coronary artery disease and diastolic blood
pressure less than 100 mm Hg. In 196 subjects who had baseline and 2-year
intravascular coronary ultrasound examinations, we measured plasma
interleukin 18, interleukin 1 receptor antagonist, matrix
metalloproteinase 9, neopterin, and C-reactive protein. Results for both
treatment groups were pooled and compared with placebo. Results:
Antihypertensive treatment with either agent significantly lowered
diastolic blood pressure (-4.7 vs placebo 1.3 mm Hg, P =.002) and
progression of coronary atheroma ( percent atheroma volume 0.6 vs placebo
2.1, P =.031). Antihypertensive therapy did not affect plasma biomarkers
of inflammation or plaque remodeling in the 135 subjects with baseline and
2-year biomarker samples. Progression in percent atheroma volume was
significantly less in subjects taking statins at baseline (-2.5%, P
=.0008). Conclusions: In patients with coronary artery disease and
well-controlled risk factors, antihypertensive therapy lowered blood
pressure and progression of coronary atherosclerosis but did not affect
plasma biomarkers of inflammation and remodeling. Antihypertensives may
decrease atheroma progression by mechanisms other than those reflected by
these plasma biomarkers. 2012 Mosby, Inc.

<4>
Accession Number
2012231706
Authors
Kalesan B. Pilgrim T. Heinimann K. Raber L. Stefanini G.G. Valgimigli M.
Da Costa B.R. MacH F. Luscher T.F. Meier B. Windecker S. Juni P.
Institution
(Kalesan, Pilgrim, Raber, Stefanini, Meier, Windecker) Department of
Cardiology, Bern University Hospital, Bern, Switzerland
(Kalesan, Meier, Windecker, Juni) Clinical Trials Unit, University of
Bern, Bern, Switzerland
(Kalesan, Heinimann, Da Costa, Juni) Institute of Social and Preventive
Medicine, University of Bern, Switzerland
(Raber) Department of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Valgimigli) Department of Cardiology, University Hospital of Ferrara,
Italy
(MacH) Department of Cardiology, University Hospital of Geneva,
Switzerland
(Luscher) Department of Cardiology, University Hospital of Zurich,
Switzerland
Title
Comparison of drug-eluting stents with bare metal stents in patients with
ST-segment elevation myocardial infarction.
Source
European Heart Journal. 33 (8) (pp 977-987), 2012. Date of Publication:
April 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims To evaluate safety and effectiveness of early generation drug-eluting
stents (DES) compared with bare-metal stents (BMS) in patients with
ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (PCI), and to determine whether
benefits and risks vary over time.Methods and resultsWe performed a
meta-analysis of 15 randomized controlled trials enrolling a total of 7867
patients comparing first-generation FDA-approved DES with BMS in patients
with STEMI. Random effect models were used to assess differences in
outcomes between DES and BMS among different time periods with regard to
the pre-specified primary outcomes stent thrombosis (ST) and target vessel
revascularization (TVR). The overall risk of definite ST was similar for
DES and BMS [risk ratio (RR) 1.08, 95 CI 0.821.43]. However, there were
time-dependent effects, with a RR of 0.80 during the first year (95 CI
0.581.12) and 2.10 during subsequent years (95 CI 1.203.69), with a
positive test for interaction between RR of ST and time (P for interaction
0.009). Results were similar for definite or probable ST (P for
interaction 0.015). In the overall analysis, TVR was performed less
frequently in patients with DES when compared with BMS (RR 0.51, 95 CI
0.430.61), with a greater benefit in the first year (RR 0.46, 95 CI
0.380.55) when compared with subsequent years (RR 0.75, 95 CI 0.590.94; P
for interaction 0.007).ConclusionAn early benefit of early generation DES
in primary PCI for STEMI with a reduction in TVR and a trend towards less
definite ST is offset in subsequent years by an increased risk of very
late ST. 2011 The Author.

<5>
Accession Number
2012232375
Authors
Yin X.-R. Pei L.
Institution
(Yin, Pei) Department of Anesthesiology, The First Affiliated Hospital,
China Medical University, Shenyang 110001, China
Title
Effects of magnesium sulfate on postoperative pain and complications after
general anesthesia: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (3) (pp 334-340), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically evaluate the effects of magnesium sulfate on
postoperative pain and complications after general anesthesia. Methods A
literature search was conducted in following databases as The Cochrane
Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date
of establishment to September 2011 to identify randomized controlled
trials (RCTs) about intravenous infusion of magnesium sulfate during
general anesthesia. All included RCTs were assessed and the data were
extracted according to the standard of Cochrane systematic review. The
homogenous studies were pooled using RevMan 5.1 software. Results A total
of 11 RCTs involving 905 patients were included. The results of
meta-analyses showed that compared with the control group, intravenous
infusion of magnesium sulfate during general anesthesia significantly
reduced the visual analog scale (VAS) scores at the time-points of 2, 4,
6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24
hours morphine requirements, and the incidents of postoperative nausea and
vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29,
95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia
(RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse
events or significant differences in the incidents of hypotension and
serum concentration changes of magnesium. Conclusion Intravenous infusion
of magnesium sulfate during general anesthesia may obviously decrease the
pain intensity, and the incidents of nausea and vomiting and chilling
after surgery, without increasing cardiovascular adverse events and risk
of hypermagnesemia. The results still need to be confirmed by more
high-quality and large-sample RCTs.

<6>
[Use Link to view the full text]
Accession Number
2012231947
Authors
Mora S. Wenger N.K. Demicco D.A. Breazna A. Boekholdt S.M. Arsenault B.J.
Deedwania P. Kastelein J.J.P. Waters D.D.
Institution
(Mora) Brigham and Women's Hospital, Harvard Medical School, 900
Commonwealth Ave E, Boston, MA 02215, United States
(Wenger) Emory University School of Medicine, Atlanta, GA, United States
(Demicco, Breazna) Pfizer, New York, NY, United States
(Boekholdt, Arsenault, Kastelein) University of Amsterdam, Amsterdam,
Netherlands
(Deedwania) University of California San Francisco, Fresno, United States
(Waters) University of California San Francisco, San Francisco, United
States
Title
Determinants of residual risk in secondary prevention patients treated
with high-versus low-dose statin therapy: The treating to new targets
(TNT) study.
Source
Circulation. 125 (16) (pp 1979-1987), 2012. Date of Publication: 24 Apr
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Cardiovascular events occur among statin-treated patients,
albeit at lower rates. Risk factors for this "residual risk" have not been
studied comprehensively. We aimed to identify determinants of this risk
above and beyond lipid-related risk factors. Methods and Results-A total
of 9251 coronary patients with low-density lipoprotein cholesterol <130
mg/dL randomized to double-blind atorvastatin 10 or 80 mg/d in the
Treating to New Targets (TNT) study had complete on-treatment 1-year lipid
data. Median follow-up was 4.9 years. The primary end point was major
cardiovascular events (n=729): coronary death, nonfatal myocardial
infarction, resuscitation after cardiac arrest, or fatal or nonfatal
stroke. Multivariable determinants of increased risk were older age
(adjusted hazard ratio [aHR], 1.13 per 1 SD [8.8 years]; 95% confidence
interval [CI], 1.04-1.23), increased body mass index (aHR, 1.09; 95% CI,
1.02-1.17 per 4.5 kg/m), male sex (aHR, 1.33; 95% CI, 1.07-1.65),
hypertension (aHR, 1.38; 95% CI, 1.17-1.63), diabetes mellitus (aHR, 1.33;
95% CI, 1.11-1.60), baseline apolipoprotein B (aHR, 1.19; 95% CI,
1.11-1.28 per 19 mg/dL), and blood urea nitrogen (aHR, 1.10; 95% CI,
1.03-1.17 per 4.9 mg/dL), in addition to current smoking, prior
cardiovascular disease, and calcium channel blocker use. Determinants of
decreased risk were high-dose statin (aHR, 0.82; 95% CI, 0.70-0.94),
aspirin use (aHR, 0.67; 95% CI, 0.56-0.81), and baseline apolipoprotein
A-I (aHR, 0.91; 95% CI, 0.84-0.99 per 25 mg/dL). On-treatment 1-year
lipids or apolipoproteins were not additionally associated with risk in
multivariable models. Known baseline variables performed moderately well
in discriminating future cases from noncases (Harrell c index=0.679).
Conclusions-Determinants of residual risk in statin-treated secondary
prevention patients included lipid-related and nonlipid factors such as
baseline apolipoproteins, increased body mass index, smoking,
hypertension, and diabetes mellitus. A multifaceted prevention approach
should be underscored to address this risk. 2012 American Heart
Association, Inc.

<7>
Accession Number
2012229304
Authors
Tang Y. Tang X.-W.
Institution
(Tang, Tang) Department of Cardiology, People's Hospital of Banan District
of Chongqing, Chongqing 401320, China
Title
Sirolimus-eluting stents versus bare-metal stents for patients with
ST-segment elevation myocardial infarction: A meta-analysis of randomized
controlled trials.
Source
Chinese Journal of Evidence-Based Medicine. 12 (2) (pp 188-193), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically evaluate the efficacy and safety of
sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in treating
patients with ST-segment elevation myocardial infarction. Methods The
databases such as PubMed (1960 to Mar. 2011), EMbase (1980 to Mar. 2011),
the Cochrane Central Register of Controlled Trials (1989 to Mar. 2011),
CBM (1979 to Mar. 2011), VIP (1989 to Mar. 2011) and CNKI (1979 to Mar.
2011) were searched to collect all the randomized controlled trials (RCTs)
on SES versus BMS in patients with ST-segment elevation myocardial
infarction. After the data extraction and methodological quality
evaluation, meta-analysis was conducted with RevMan 4.2 software. Results
A total of 7 RCTs were included. Among 2 555 patients involved, 1 282 were
in the SES group, while the other 1273 were in the BMS group. The results
of meta-analyses showed that SES was superior to BMS in the target-lesion
revascularization (OR=0.27, 95%CI 0.16 to 0.45, P<0.000 01) and
target-vessel revascularization (OR=0.33, 95%CI 0.24 to 0.46, P<0.000 01).
In contrast, there were no differences between SES and BMS in death, stent
thrombosis and recurrence of myocardial infarction. Conclusion With the
one-year clinical outcomes, SES is more effective than BMS in reducing the
rate of target-vessel revascularization and target-lesion
revascularization.

<8>
Accession Number
2012231846
Authors
Erkapic D. De Rosa S. Kelava A. Lehmann R. Fichtlscherer S. Hohnloser S.H.
Institution
(Erkapic, Hohnloser) Division of Clinical Electrophysiology, Department of
Cardiology, J.W. Goethe University, Theodor Stern Kai 7, D-60590
Frankfurt, Germany
(De Rosa, Lehmann, Fichtlscherer) Department of Cardiology, J.W. Goethe
University, Frankfurt, Germany
(Kelava) Faculty of Human Sciences, Institute of Psychology, Technical
University of Darmstadt, Darmstadt, Germany
Title
Risk for permanent pacemaker after transcatheter aortic valve
implantation: A comprehensive analysis of the literature.
Source
Journal of Cardiovascular Electrophysiology. 23 (4) (pp 391-397), 2012.
Date of Publication: April 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Risk for Permanent Pacemaker After Transcatheter Aortic Valve
Implantation. Background: Permanent pacemaker (PM) requirement is a known
complication after transcatheter aortic valve implantation (TAVI). There
are, however, no systematic data concerning this complication. Objective:
To determine the incidence and potential predictors of permanent PM
requirement after TAVI based on published literature. Methods: We
conducted a MEDLINE search to identify potentially relevant literature
dealing with PM requirement after TAVI. Data were collected on paper
extraction forms by 2 independent investigators. Results: There were 32
relevant published studies comprising data of 5,258 patients without an
implanted PM before TAVI. An Edwards-Sapiens prosthesis (ESP) was
implanted in 2,887 patients, whereas 2,371 patients received a CoreValve
prosthesis (CVP). The crude incidence of PM implantation after TAVI was
15%. Six hundred and fourteen of 2,371 (25.8%) CVP patients and 189 of the
2,887 (6.5%) ESP patients had to receive a permanent PM (odds ratio [OR]
4.91, 95% confidence interval [CI] 4.12-5.86, P < 0.001). Presence of
right bundle branch block (RBBB) before TAVI was a significant predictor
for development of complete atrioventricular (AV) block and subsequent PM
need (OR 1.358, 95% CI 1.001-1.841, P = 0.02). More than 90% of all
AV-block requiring PM implantation occurred immediately or within 7 days
after TAVI. Conclusion: Patients undergoing TAVI with implantation of CVP
are at significantly higher risk for development of AV block and
subsequent need for permanent PM, particularly if RBBB preexists. Since AV
block occurs in >90% within the first week after the procedure, careful
monitoring should be performed for at least 7 days after TAVI. 2012 Wiley
Periodicals, Inc.

<9>
Accession Number
2012219009
Authors
Jovic M. Stancic A. Nenadic D. Cekic O. Nezic D. Milojevic P. Micovic S.
Buzadzic B. Korac A. Otasevic V. Jankovic A. Vucetic M. Velickovic K.
Golic I. Korac B.
Institution
(Jovic, Nenadic, Cekic, Nezic, Milojevic, Micovic) University of Belgrade,
Medical School, Dedinje Cardiovascular Institute, Serbia
(Stancic, Buzadzic, Otasevic, Jankovic, Vucetic, Korac) University of
Belgrade, Institute for Biological Research Sinisa Stankovic, Department
of Physiology, Bulevar despota Stefana 142, 11060 Belgrade, Serbia
(Korac, Velickovic, Golic) Faculty of Biology, Institute of Zoology,
University of Belgrade, Serbia
Title
Mitochondrial molecular basis of sevoflurane and propofol cardioprotection
in patients undergoing aortic valve replacement with cardiopulmonary
bypass.
Source
Cellular Physiology and Biochemistry. 29 (1-2) (pp 131-142), 2012. Date of
Publication: 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Background/Aims: Study elucidates and compares the mitochondrial
bioenergetic-related molecular basis of sevoflurane and propofol
cardioprotection during aortic valve replacement surgery due to aortic
valve stenosis. Methods: Twenty-two patients were prospectively randomized
in two groups regarding the anesthetic regime: sevoflurane and propofol.
Hemodynamic parameters, biomarkers of cardiac injury and brain natriuretic
peptide (BNP) were measured preoperatively and postoperatively. In tissue
samples, taken from the interventricular septum, key mitochondrial
molecules were determined by Western blot, real time PCR, as well as
confocal microscopy and immunohisto-and immunocyto-chemical analysis.
Results: The protein levels of cytochrome c oxidase and ATP synthase were
higher in sevoflurane than in propofol group. Nevertheless, cytochrome c
protein content was higher in propofol than sevoflurane receiving
patients. Propofol group also showed higher protein level of connexin 43
(Cx43) than sevoflurane group. Besides, immunogold analysis showed its
mitochondrial localization. The mRNA level of mtDNA and uncoupling protein
(UCP2) were higher in propofol than sevoflurane patients, as well. On the
other hand, there were no significant differences between groups in
hemodynamic assessment, intensive care unit length of stay, troponin I and
BNP level. Conclusions: Our data indicate that sevoflurane and propofol
lead to cardiac protection via different mitochondrially related molecular
mechanisms. It appears that sevoflurane acts regulating cytochrome c
oxidase and ATP synthase, while the effects of propofol occur through
regulation of cytochrome c, Cx43, mtDNA transcription and UCP2. 2012 S.
Karger AG, Basel.

<10>
Accession Number
2012222376
Authors
Braga J.R. Santos I.S.O. Mcdonald M. Shah P.S. Ross H.J.
Institution
(Braga, Mcdonald, Ross) Division of Cardiology, Peter Munk Cardiac Centre,
University Health Network, Toronto General Hospital, Toronto, ON, Canada
(Santos) Department of Heart Transplantation, Hospital de Messejana,
Fortaleza, Brazil
(Shah) Department of Paediatrics, Department of Health Policy, Evaluation
and Management, University of Toronto, ON, Canada
Title
Factors associated with the development of cardiac allograft vasculopathy
- a systematic review of observational studies.
Source
Clinical Transplantation. 26 (2) (pp E111-E124), 2012. Date of
Publication: March/April 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Cardiac allograft vasculopathy (CAV) is a significant factor impacting
outcomes after heart transplant. We performed a systematic review of risk
factors for the development of CAV. A search of electronic databases was
performed. The eligibility criteria included cohort and case-control
studies with more than 50 adult patients submitted to a heart transplant.
The outcome should be CAV diagnosed by angiography and/or intravascular
ultrasound (IVUS). Two reviewers performed study selection, data
abstraction, and quality assessment. Of 2514 citations, 66 articles were
included - 46 had 200 participants or less; 61 were single-center; and 44
were retrospective cohorts. The most used definition of CAV using
angiography was the detection of any degree of abnormality (21 studies of
58). In studies using IVUS, an intimal thickness >=0.5mm was the most used
definition (five of eight studies). Quality assessment revealed an
inadequate description of patient selection, attrition, and accounting of
potential confounders. Donor age, recipient age, recipient gender,
etiology of heart failure, ischemic time, human leukocyte antigen
matching, cytomegalovirus, lipid profile, and rejection episodes were the
most studied factors. Our review indicates that the current evidence is
not consistent across different studies. The definite contribution of risk
factors for the development of CAV is still to be determined. 2011 John
Wiley & Sons A/S.

<11>
Accession Number
2012219290
Authors
Lamy A. Devereaux P.J. Prabhakaran D. Taggart D.P. Hu S. Paolasso E.
Straka Z. Piegas L.S. Akar A.R. Jain A.R. Noiseux N. Padmanabhan C.
Bahamondes J.-C. Novick R.J. Vaijyanath P. Reddy S. Tao L.
Olavegogeascoechea P.A. Airan B. Sulling T.-A. Whitlock R.P. Ou Y. Ng J.
Chrolavicius S. Yusuf S.
Institution
(Lamy, Devereaux, Whitlock, Ou, Ng, Chrolavicius, Yusuf) Population Health
Research Institute, Hamilton Health Sciences, McMaster University,
Hamilton, ON L8L 2X2, Canada
(Novick) London Health Sciences Center, London, ON, Canada
(Prabhakaran) Centre for Chronic Disease Control, New Delhi, India
(Airan) All India Institute of Medical Sciences, New Delhi, India
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Padmanabhan) G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
(Vaijyanath) Dr. K.M. Cherian Heart Foundation, Chennai, India
(Reddy) Mediciti Hospitals, Hyderabad, India
(Taggart) University of Oxford, Oxford, United Kingdom
(Hu) Fu Wai Cardiovascular Hospital, Xicheng District, Beijing, China
(Paolasso) Instituto de Investigaciones Clinicas de Rosario, Rosario,
Argentina
(Straka) Third Faculty of Medicine, Charles University, Prague, Czech
Republic
(Piegas) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Akar) Ankara University School of Medicine, Ankara, Turkey
(Noiseux) Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
(Bahamondes) Hospital Regional Temuco, Temuco, Chile
(Tao) Frontier Lifeline, Wuhan Asia Heart Hospital, Wuhan, China
(Olavegogeascoechea) Fundacion Medica de Rio Negro Y Neuguen, Rio Negro,
Argentina
(Sulling) North Estonia Medical Center, Tallinn, Estonia
Title
Off-pump or on-pump coronary-artery bypass grafting at 30 days.
Source
New England Journal of Medicine. 366 (16) (pp 1489-1497), 2012. Date of
Publication: 19 Apr 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND:The relative benefits and risks of performing coronary-artery
bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as
compared with cardiopulmonary bypass (on-pump CABG), are not clearly
established. METHODS:At 79 centers in 19 countries, we randomly assigned
4752 patients in whom CABG was planned to undergo the procedure off-pump
or on-pump. The first coprimary outcome was a composite of death, nonfatal
stroke, nonfatal myocardial infarction, or new renal failure requiring
dialysis at 30 days after randomization. RESULTS:There was no significant
difference in the rate of the primary composite outcome between off-pump
and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group,
0.95; 95% confidence interval [CI], 0.79 to 1.14; P = 0.59) or in any of
its individual components. The use of off-pump CABG, as compared with
on-pump CABG, significantly reduced the rates of blood-product transfusion
(50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001),
reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk,
0.61; 95% CI, 0.40 to 0.93; P = 0.02), acute kidney injury (28.0% vs.
32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P = 0.01), and
respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI,
0.63 to 0.98; P = 0.03) but increased the rate of early repeat
revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to
12.0; P = 0.01). CONCLUSIONS:There was no significant difference between
off-pump and on-pump CABG with respect to the 30-day rate of death,
myocardial infarction, stroke, or renal failure requiring dialysis. The
use of off-pump CABG resulted in reduced rates of transfusion, reoperation
for perioperative bleeding, respiratory complications, and acute kidney
injury but also resulted in an increased risk of early revascularization.
(Funded by the Canadian Institutes of Health Research; CORONARY
ClinicalTrials.gov number, NCT00463294.). Copyright 2012 Massachusetts
Medical Society.