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<1>
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Accession Number
2012683986
Authors
Menkis A.H. Martin J. Cheng D.C.H. Fitzgerald D.C. Freedman J.J. Gao C.
Koster A. MacKenzie G.S. Murphy G.J. Spiess B. Ad N.
Institution
(Menkis) WRHA Cardiac Sciences Program, Department of Surgery, University
of Manitoba, Winnipeg, MB, Canada
(Martin, Cheng) Evidence-Based Perioperative Clinical Outcomes Research
(EPiCOR), Department of Anesthesia and Perioperative Medicine, Western
University, 339 Windermere Rd, London, ON N6A 5A5, Canada
(Fitzgerald) Inova Heart and Vascular Institute, Falls Church, VA, United
States
(Freedman) Division of Hematology, Department of Medicine, St. Michael
Hospital, Toronto, ON, Canada
(Gao) Department of Cardiovascular Surgery, Minimally Invasive and Robotic
Cardiac Surgery Center, PLA General Hospital, Beijing, China
(Koster) Heart and Diabetes Center NRW, Bad Oeynhausen, Germany,
Ruhr-University, Bochum, Germany
(MacKenzie) Cardiac Anesthesia, WRHA/SBGH Cardiac Sciences Program,
Winnipeg, MB, Canada
(Murphy) Glenfield Hospital, University of Leicester, Leicester, United
Kingdom
(Spiess) Department of Anesthesiology, Virginia Commonwealth University,
Medical College of Virginia, Richmond VA, United States
(Ad) Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church,
VA, United States
Title
Drug, devices, technologies, and techniques for blood management in
minimally invasive and conventional cardiothoracic surgery: A Consensus
Statement from the International Society for Minimally Invasive
Cardiothoracic Surgery (ISMICS) 2011.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 7 (4) (pp 229-241), 2012. Date of Publication: July-August 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
OBJECTIVE: The objectives of this consensus conference were to evaluate
the evidence for the efficacy and safety of perioperative drugs,
technologies, and techniques in reducing allogeneic blood transfusion for
adults undergoing cardiac surgery and to develop evidence-based
recommendations for comprehensive perioperative blood management in
cardiac surgery, with emphasis on minimally invasive cardiac surgery.
METHODS: The consensus panel short-listed the potential topics for review
from a comprehensive list of potential drugs, devices, technologies, and
techniques. The process of short-listing was based on the need to
prioritize and focus on the areas of highest importance to surgeons,
anesthesiologists, perfusionists, hematologists, and allied health care
involved in the management of patients who undergo cardiac surgery whether
through the conventional or minimally invasive approach. MEDLINE, Cochrane
Library, and Embase databases were searched from their date of inception
to May 2011, and supplemental hand searches were also performed. Detailed
methodology and search strategies are outlined in each of the subsequently
published systematic reviews. In general, all relevant synonyms for drugs
(antifibrinolytic, aprotinin, [Latin Small Letter Open E]-aminocaproic
acid, tranexamic acid [TA], desmopressin, anticoagulants, heparin,
antiplatelets, anti-Xa agents, adenosine diphosphate inhibitors,
acetylsalicylic acid [ASA], factor VIIa [FVIIa]), technologies (cell
salvage, miniaturized cardiopulmonary bypass (CPB) circuits, biocompatible
circuits, ultrafiltration), and techniques (transfusion thresholds,
minimally invasive cardiac or aortic surgery) were searched and combined
with terms for blood, red blood cells, fresh-frozen plasma, platelets,
transfusion, and allogeneic exposure. The American Heart
Association/American College of Cardiology system was used to label the
level of evidence and class of each recommendation. RESULTS AND
RECOMMENDATIONS: Database search identified more than 6900 articles, with
4423 full-text randomized controlled trials assessed for eligibility, and
the final 125 systematic reviews and meta-analyses were used in the
consensus conference. The results of the consensus conference, including
the evidence-based statements and the recommendations, are outlined in the
text, with references given for the relevant evidence that formed the
basis for the statements and recommendations. 2012 by the International
Society for Minimally Invasive Cardiothoracic Surgery.

<2>
Accession Number
2012521459
Authors
Gao G. Zheng Z. Pi Y. Lu B. Lu J. Hu S.
Institution
(Gao, Zheng, Pi, Hu) Department of Surgery, Cardiovascular Institute and
Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, 167A Beilishilu, Beijing 100037, China
(Lu, Lu) Center of Imageology, Cardiovascular Institute and Fu Wai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
Title
Aspirin plus clopidogrel therapy increases early venous graft patency
after coronary artery bypass surgery: A single-center, randomized,
controlled trial.
Source
Journal of the American College of Cardiology. 56 (20) (pp 1639-1643),
2010. Date of Publication: 09 Nov 2010.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: We sought to evaluate the effect of aspirin plus clopidogrel
versus aspirin alone on saphenous vein graft occlusion at 3 months after
coronary artery bypass grafting (CABG). Background: Prevalence of graft
occlusion is high after CABG. Aggressive antiplatelet therapy is expected
to improve early post-operative graft patency. Methods: From December 2007
through December 2008, 249 consecutive patients undergoing elective CABG
at Fuwai Hospital were randomly assigned to 2 groups: 124 received aspirin
(100 mg) plus clopidogrel (75 mg) daily (AC group), and 125 received
aspirin (100 mg) alone daily (A group). Antiplatelet therapies were
initiated when postoperative chest tube drainage was <=30 cc/h for 2 h.
All participants were invited for clinical follow-up and 64- slice
multislice computed tomography angiography (MSCTA) analysis at 3 months
post-operatively. Generalized estimating equations analysis was used to
determine predictors of graft patency. Results: One participant, from
group A, died before 3-month follow-up. Of the remaining 248 patients, 224
(90.3%) underwent MSCTA. Participants had similar pre-operative and
intraoperative characteristics at baseline. No significant differences
were observed in intraoperative transit-time flow measurement findings or
major adverse cardiac-related events. Three-month MSCTA follow-up revealed
that saphenous vein graft patency was 91.6% (219 of 239) in the AC group
versus 85.7% (198 of 231) in the A group (p = 0.043). In multivariate
analysis, combined antiplatelet therapy independently increased venous
graft patency (p = 0.045). Conclusions: Aspirin plus clopidogrel is more
effective in venous graft patency than aspirin alone in the short term
after CABG, but further, long-term study is needed. (The Clopidogrel and
Aspirin After Surgery for Coronary Artery Disease; NCT00776477). 2010 by
the American College of Cardiology Foundation.

<3>
Accession Number
2012690080
Authors
Steurer M.P. Steurer M.A. Baulig W. Piegeler T. Schlapfer M. Spahn D.R.
Falk V. Dreessen P. Theusinger O.M. Schmid E.R. Schwartz D. Neff T.A.
Beck-Schimmer B.
Institution
(Steurer, Steurer, Baulig, Piegeler, Schlapfer, Spahn, Dreessen,
Theusinger, Beck-Schimmer) Institute of Anaesthesiology, University
Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
(Steurer, Steurer, Piegeler, Schlapfer, Beck-Schimmer) Institute of
Physiology, Zurich Center for Integrative Human Physiology, University of
Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
(Steurer) Department of Anesthesiology and Perioperative Care, University
of California at San Francisco, San Francisco General Hospital, 1001
Potrero Ave, San Francisco, CA 94110, United States
(Steurer) Pediatric Critical Care, Department of Pediatrics, University of
California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94143,
United States
(Falk) Department of Cardiac Surgery, University Hospital Zurich,
Raemistrasse 100, CH-8091 Zurich, Switzerland
(Schmid) Division of Cardiac Anaesthesia, Institute of Anaesthesiology,
University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
(Piegeler, Schwartz) Department of Anesthesiology, University of Illinois
at Chicago, 1740 West Taylor Street, Suite 3200W, MC 515, Chicago, IL
60612, United States
(Neff) Department of Anaesthesiology, Intensive Care and Emergency
Medicine, Cantonal Hospital, Postfach, CH-8596 Muensterlingen, Switzerland
Title
Late pharmacologic conditioning with volatile anesthetics after cardiac
surgery.
Source
Critical Care. 16 (5) , 2012. Article Number: R191. Date of Publication:
14 Oct 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: The aim of this randomized controlled trial was to
investigate whether volatile anesthetics used for postoperative sedation
have any beneficial effects on myocardial injury in cardiac surgery
patients after on-pump valve replacement.Methods: Anesthesia was performed
with propofol. After arrival in the intensive care unit (ICU), 117
patients were randomized to be sedated for at least 4 hours with either
propofol or sevoflurane. Sevoflurane was administered by using the
anesthetic-conserving device. Troponin T, creatine kinase, creatine kinase
from heart muscle tissue, myoglobin, and oxygenation index were determined
on arrival at the ICU, 4 hours after sedation, and in the morning of the
first postoperative day (POD1). Primary end points were cardiac injury
markers on POD1. As secondary end points oxygenation, postoperative
pulmonary complications, and ICU and hospital stay were
documented.Results: Fifty-six patients were analyzed in the propofol arm,
and 46 patients in the sevoflurane arm. Treatment groups were comparable
with regard to patient demographics and intraoperative characteristics.
Concentration of troponin T as the most sensitive marker for myocardial
injury at POD1 was significantly lower in the sevoflurane group compared
with the propofol group (unadjusted difference, -0.4; 95% CI, -0.7 to
-0.1; P < 0.01; adjusted difference, -0.2; 95% CI, -0.4 to -0.02; P =
0.03, respectively).Conclusions: The data presented in this investigation
indicate that late postconditioning with the volatile anesthetic
sevoflurane might mediate cardiac protection, even with a late, brief, and
low-dose application.Trial registration: ClinicalTrials.gov: NCT00924222.
2012 Steurer et al.; licensee BioMed Central Ltd.

<4>
Accession Number
2012683533
Authors
Treasure T. Fiorentino F. Scarci M. Moller H. Utley M.
Institution
(Treasure, Utley) Clinical Operational Research Unit, Department of
Mathematics, UCL, London, United Kingdom
(Fiorentino) National Heart and Lung Institute, Cardiothoracic Surgery,
Imperial College London, London, United Kingdom
(Scarci) Department of Thoracic Surgery, Papworth Hospital, NHS Foundation
Trust, Cambridge, United Kingdom
(Moller) Thames Cancer Registry, King's College London, London, United
Kingdom
Title
Pulmonary metastasectomy for sarcoma: A systematic review of reported
outcomes in the context of Thames Cancer Registry data.
Source
BMJ Open. 2 (5) , 2012. Article Number: e001736. Date of Publication:
2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objectives: Sarcoma has a predilection to metastasis to the lungs.
Surgical excision of these metastases (pulmonary metastasectomy) when
possible has become standard practice. We reviewed the published selection
and outcome data. Design: Systematic review of published reports that
include survival rates or any other outcome data. Survival data were put
in the context of those in a cancer registry. Setting: Specialist thoracic
surgical centres reporting the selection and outcome for pulmonary
metastasectomy in 18 follow-up studies published 1991-2010. Participants:
Patients having one or more of 1357 pulmonary metastasectomy operations
performed between 1980 and 2006. Interventions: All patients had surgical
pulmonary metastasectomy. A first operation was reported in 1196 patients.
Of 1357 patients, 43% had subsequent metastasectomy, some having 10 or
more thoracotomies. Three studies were confined to patients having
repeated pulmonary metastasectomy. Primary and secondary outcome measures:
Survival data to various time points usually 5 years and sometimes 3 or 10
years. No symptomatic or quality of life data were reported. Results:
About 34% and 25% of patients were alive 5 years after a first
metastasectomy operation for bone or soft tissues sarcoma respectively.
Better survival was reported with fewer metastases and longer intervals
between diagnosis and the appearance of metastases. In the Thames Cancer
Registry for 1985-1994 and 1995-2004 5 year survival rates for all
patients with metastatic sarcoma were 20% and 25% for bone, and for soft
tissue sarcoma 13% and 15%. Conclusions: The 5 year survival rate among
sarcoma patients who are selected to have pulmonary metastasectomy is
higher than that observed among unselected registry data for patients with
any metastatic disease at diagnosis. There is no evidence that survival
difference is attributable to metastasectomy. No data were found on
respiratory or any other symptomatic benefit. Given the certain harm
associated with thoracotomy, often repeated, better evidence is required.

<5>
Accession Number
2012679769
Authors
Eisen A. Shapira Y. Sagie A. Kornowski R.
Institution
(Eisen, Shapira, Sagie, Kornowski) Department of Cardiology, Rabin Medical
Center, 39 Jabotinsky Street, 49100, Petah Tikva, Israel
Title
Infective endocarditis in the transcatheter aortic valve replacement era:
Comprehensive review of a rare complication.
Source
Clinical Cardiology. 35 (11) (pp E1-E5), 2012. Date of Publication:
November 2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has emerged
as a revolutionary alternative for surgical aortic valve replacement
(SAVR) for the treatment of severe symptomatic aortic stenosis in patients
at high risk for surgery. Prosthetic aortic valve endocarditis is a
serious complication after SAVR with high morbidity and mortality.
Although numerous TAVR procedures have been performed worldwide, infective
endocarditis (IE) after TAVR was reported in the literature in few cases
only and in 0% to 2.3% of patients enrolled in large TAVR cohorts. Our aim
was to review the literature for IE following TAVR and to discuss the
diagnostic and management strategies of this rare complication. Ten case
reports of IE after TAVR were identified, 8 of which were published as
case reports and 2 of which were presented in congresses. Infective
endocarditis occurred in a mean time period of 186 days (median, 90 days)
after TAVR. Most cases were characterized by fever and elevated
inflammatory markers. Infective endocarditis after TAVR shared some common
characteristics with IE after SAVR, yet it has some unique features.
Echocardiographic findings included leaflet vegetations, severe mitral
regurgitation with rupture of the anterior leaflet, and left ventricle
outflow tract to left atrium fistula. Bacteriologic findings included
several atypical bacteria or fungi. Cases of IE were managed either
conservatively by antibiotics and/or using surgery, and the overall
prognosis was poor. Infective endocarditis after TAVR deserves prompt
diagnosis and treatment. Until further evidence is present, IE after TAVR
should be managed according to SAVR guidelines with modifications as
needed on a case-by-case basis. The authors have no funding, financial
relationships, or conflicts of interest to disclose. 2012 Wiley
Periodicals, Inc.

<6>
Accession Number
2012681118
Authors
Guiraud T. Granger R. Gremeaux V. Bousquet M. Richard L. Soukarie L. Babin
T. Labrunee M. Sanguignol F. Bosquet L. Golay A. Pathak A.
Institution
(Guiraud, Granger, Bousquet, Richard, Soukarie, Babin) Clinic of
Saint-Orens, Cardiovascular and Pulmonary Rehabilitation Centre, 12,
avenue de Revel, 31650 Saint-Orens-de-Gameville, France
(Guiraud, Labrunee, Pathak) National Institute of Health and Medical
Research (INSERM), UMR-1048, Institut des Maladies Metaboliques et
Cardiovasculaires, Toulouse, France
(Gremeaux) Rehabilitation Centre, CHU Dijon, France
(Gremeaux) INSERM U887, Dijon, France
(Golay) University Hospital of Geneva, Geneva, Switzerland
(Sanguignol) Clinic of Chateau de Vernhes, Bondigoux, France
(Bosquet) MOVE Laboratory (EA6314), University of Poitiers, Poitiers,
France
Title
Telephone support oriented by accelerometric measurements enhances
adherence to physical activity recommendations in noncompliant patients
after a cardiac rehabilitation program.
Source
Archives of Physical Medicine and Rehabilitation. 93 (12) (pp 2141-2147),
2012. Date of Publication: December 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Guiraud T, Granger R, Gremeaux V, Bousquet M, Richard L, Soukarie L, Babin
T, Labrunee M, Sanguignol F, Bosquet L, Golay A, Pathak A. Telephone
support oriented by accelerometric measurements enhances adherence to
physical activity recommendations in noncompliant patients after a cardiac
rehabilitation program. Objective: To assess the efficacy of a strategy,
based on telephone support oriented by accelerometer measurements, on the
adherence to physical activity (PA) recommendations in cardiac patients
not achieving PA recommendations. Design: Prospective and randomized
study. Setting: A cardiac rehabilitation program (CRP) at a clinic.
Participants: Stable, noncompliant cardiac (coronary artery disease, heart
failure, post-cardiovascular surgery) patients (weekly moderate-intensity
PA <150min) were randomly assigned to an intervention group (n=19) or a
control group (n=10). Interventions: The intervention group wore an
accelerometer for 8 weeks. Every 15 days, feedback and support were
provided by telephone. The control group wore the accelerometer during the
8th week of the intervention only. Main Outcome Measures: Active energy
expenditure (EE) (in kilocalories) and the time spent doing light,
moderate, or intense PA (minutes per week). Results: In the intervention
group, the time spent at moderate-intensity PA increased from 95.6+/-80.7
to 137.2+/-87.5min/wk between the 1st and 8th week (P=.002), with 36.8% of
the sample achieving the target amount of moderate-intensity PA. During
the 8th week, the EE averaged 543.7+/-144.1kcal and 266.7+/-107.4kcal in
the intervention group and control group, respectively (P=.004).
Conclusions: Telephone support based on accelerometer recordings appeared
to be an effective strategy to improve adherence to PA in noncompliant
patients. This intervention could be implemented after a CRP as an
inexpensive, modern, and easy-to-use strategy. 2012 American Congress of
Rehabilitation Medicine.

<7>
Accession Number
2012673219
Authors
Mozaffarian D. Marchioli R. Macchia A. Silletta M.G. Ferrazzi P. Gardner
T.J. Latini R. Libby P. Lombardi F. O'Gara P.T. Page R.L. Tavazzi L.
Tognoni G.
Institution
(Mozaffarian, Libby, O'Gara) Division of Cardiovascular Medicine,
Department of Medicine, Brigham and Women's Hospital, Boston, MA, United
States
(Mozaffarian) Channing Division of Network Medicine, Department of
Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Mozaffarian) Departments of Epidemiology and Nutrition, Harvard School of
Public Health, Boston, MA, United States
(Marchioli, Silletta, Tognoni) Department of Clinical Pharmacology and
Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
(Macchia) GESICA Foundation, Buenos Aires, Argentina
(Ferrazzi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Gardner) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
(Latini) Department of Cardiovascular Research, Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy
(Lombardi) Department of Health Sciences, University of Milan, Milan,
Italy
(Page) Department of Medicine, University of Wisconsin, School of Medicine
and Public Health, Madison, WI, United States
(Tavazzi) GVM Hospitals of Care and Research, Villa Maria Cecilia
Hospital, Cotignola, Italy
(Marchioli) Consorzio Mario Negri Sud, Laboratory of Clinical Epidemiology
of Cardiovascular Disease, Via Nazionale 8, Santa Maria Imbaro, CH 66030,
Italy
Title
Fish oil and postoperative atrial fibrillation: The omega-3 fatty acids
for prevention of post-operative atrial fibrillation (OPERA) randomized
trial.
Source
JAMA - Journal of the American Medical Association. 308 (19) (pp
2001-2011), 2012. Date of Publication: 21 Nov 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Postoperative atrial fibrillation or flutter (AF) is one of the
most common complications of cardiac surgery and significantly increases
morbidity and health care utilization. A few small trials have evaluated
whether long-chain n-3-polyunsaturated fatty acids (PUFAs) reduce
postoperative AF, with mixed results. Objective: To determine whether
perioperative n-3-PUFA supplementation reduces postoperative AF. Design,
Setting, and Patients: The Omega-3 Fatty Acids for Prevention of
Postoperative Atrial Fibrillation (OPERA) double-blind,
placebo-controlled, randomized clinical trial. A total of 1516 patients
scheduled for cardiac surgery in 28 centers in the United States, Italy,
and Argentina were enrolled between August 2010 and June 2012. Inclusion
criteria were broad; the main exclusions were regular use of fish oil or
absence of sinus rhythm at enrollment. Intervention: Patients were
randomized to receive fish oil (1-g capsules containing >=840 mg n-3-PUFAs
as ethyl esters) or placebo, with preoperative loading of 10 g over 3 to 5
days (or 8 g over 2 days) followed postoperatively by 2 g/d until hospital
discharge or postoperative day 10, whichever came first. Main Outcome
Measure: Occurrence of postoperative AF lasting longer than 30 seconds.
Secondary end points were postoperative AF lasting longer than 1 hour,
resulting in symptoms, or treated with cardioversion; postoperative AF
excluding atrial flutter; time to first postoperative AF; number of AF
episodes per patient; hospital utilization; and major adverse
cardiovascular events, 30-day mortality, bleeding, and other adverse
events. Results: At enrollment, mean age was 64 (SD, 13) years; 72.2% of
patients were men, and 51.8% had planned valvular surgery. The primary end
point occurred in 233 (30.7%) patients assigned to placebo and 227 (30.0%)
assigned to n-3-PUFAs (odds ratio, 0.96 [95% CI, 0.77-1.20]; P=.74). None
of the secondary end points were significantly different between the
placebo and fish oil groups, including postoperative AF that was
sustained, symptomatic, or treated (231 [30.5%] vs 224 [29.6%], P=.70) or
number of postoperative AF episodes per patient (1 episode: 156 [20.6%] vs
157 [20.7%]; 2 episodes: 59 [7.8%] vs 49 [6.5%]; >=3 episodes: 18 [2.4%]
vs 21 [2.8%]) (P=.73). Supplementation with n-3-PUFAs was generally well
tolerated, with no evidence for increased risk of bleeding or serious
adverse events. Conclusion: In this large multinational trial among
patients undergoing cardiac surgery, perioperative supplementation with
n-3-PUFAs, compared with placebo, did not reduce the risk of postoperative
AF. Trial Registration: clinicaltrials.gov Identifier: NCT00970489. 2012
American Medical Association. All rights reserved.

<8>
Accession Number
2012684851
Authors
Abbasi M. Hoseinikhah H. Moinipoor A. Soltany G. Zirak N. Amozeshy A.
Institution
(Hoseinikhah) Department of Cardiac surgery, Imam Reza Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Use of a continuous local anesthetic infusion for pain management after
median sternotomy.
Source
Iranian Heart Journal. 13 (1) (pp 29-33), 2012. Date of Publication: 2012.
Publisher
Iranian Heart Association (P.O. Box 15745-1341, Tehran, Iran, Islamic
Republic of)
Abstract
Background-The use of large doses of opioid analgesics to treat pain after
cardiac surgery can prolong the time to tracheal extubation and interfere
with the recovery of the bowel and bladder function in the postoperative
period. Therefore, we sought to investigate the efficacy of a continuous
infusion of Bupivacaine 0.5%, at the median sternotomy site, for 48 hours
after cardiac surgery in reducing the opioid analgesic requirement and
improving the recovery process. Methods-In this prospective, randomized,
placebo-controlled, double-blind clinical trial, 36 consenting patients
undergoing open heart surgery with a standardized general anesthetic
technique had two indwelling infusion catheters placed at the median
sternotomy incision site at the end of surgery. The patients were randomly
assigned to receive normal saline (control), Bupivacaine 0.5% via an
elastomeric infusion pump at a constant rate of 4 ml/h for 48 hours. In
addition, the postoperative opioid analgesic requirements and
opioid-related adverse effects were recorded. The patients" satisfaction
with their pain management was assessed at specific intervals during the
postoperative period. Duration of mechanical ventilation and time of
ventilation were assessed in the two groups. Results-Compared with the
control group, there was a statistically significant reduction in
ambulatory time 13.7+/-2.5 vs. 16.5+/-4.6 hours (P=0.03). Hospital stay
was also shorter in the case group (5+/-0.6 vs. 6.1+/-0.9 with P= 0.01).
Extubation time and ICU stay were not statistically significant (P= 0.93
for extubation time and P=0.70 for duration of ICU stay), and also patient
satisfaction in the two groups was not statistically significant. Opioid
dose, used in the case group, was 1.1+/-0.8 and in the control group was
3.7+/-1.3, with the difference being statistically important (P = 0.02).
Conclusion-A continuous infusion of Bupivacaine 0.5% at 4 ml/h is
effective for decreasing pain and the need for opioid analgesic medication
as well as for improving patient satisfaction with pain management after
cardiac surgery. Patients in the Bupivacaine-0.5% group were able to
ambulate earlier, leading to a reduced length of hospital stay.

<9>
Accession Number
2012684840
Authors
Aghdaii N. Kabiri M. Yazdanian F. Ghaffarinejad M.H.
Institution
(Aghdaii, Yazdanian) Department of Anesthesiology, Shaheed Rajaei
Cardiovascular, Medical and Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Kabiri) Department of Anesthesiology, Kashani General Hospital,
Shahrekord University of Medical Sciences, Shahrekord, Iran, Islamic
Republic of
(Ghaffarinejad) Department of Cardiac Surgery, Shaheed Rajaei
Cardiovascular, Medical and Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of retransfusion of heparin remaining in the salvaged blood on
postoperative blood loss in coronary artery bypass grafting: Comparison
with homologous blood transfusion (running title: Postoperative blood loss
in CABG).
Source
Iranian Heart Journal. 13 (2) (pp 24-34), 2012. Date of Publication: 2012.
Publisher
Iranian Heart Association (P.O. Box 15745-1341, Tehran, Iran, Islamic
Republic of)
Abstract
Background: One of the typical problems of cell savers is the
retransfusion of the heparin added to the system. The aim of this study
was to determine whether or not heparin, remaining in the prepared sample
of retransfusion blood, might be responsible for disturbance in
coagulation and increase in blood loss. Methods: Fifty patients undergoing
coronary artery bypass grafting surgery (CABG) were randomly divided into
two groups: group C (n=25) received cell-saver blood and group H (n=25)
received homologous blood. Volumes of the intraoperative autologous and
homologous transfusion, activated clotting time (ACT) of the transfused
bloods, and ACT and amount of blood loss in the patients were measured
intra and postoperatively. Results: There was no statistical difference
between the groups in terms of demographics, preoperative characteristics,
or operative details. Cell saver was used in 25 cases, and the average
volume of blood autotransfused was 504+/- 158 mL. A significant
statistical difference was observed in the mean volumes (460+/-200 vs.
80+/-160 mL; P = 0.0001) of perioperative allogeneic blood transfusions
between groups H and C. Despite significant further cell-saver blood
transfusion (504+/- 158 cc vs. 338+/-123 cc; P=0.001) and a significantly
longer ACT of cell-saver blood than homologous blood (959+/-85 sec vs.
478+/-58 sec; P =0.0001) intraoperatively, there was no significant
difference between the two groups in terms of postoperative blood loss
(510 +/- 270 cc in group H vs. 454 +/- 150 cc in group C; P =0.362).
Conclusion: Utilization of a cell saver was safe, with no increased risk
of bleeding despite heparin added to the system.

<10>
Accession Number
2012682963
Authors
Gasparovic H. Petricevic M. Kopjar T. Djuric Z. Svetina L. Biocina B.
Institution
(Gasparovic, Petricevic, Kopjar, Djuric, Svetina, Biocina) Department of
Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb,
Kispaticeva 12, 10 000 Zagreb, Croatia
Title
Dual antiplatelet therapy in patients with aspirin resistance following
coronary artery bypass grafting: study protocol for a randomized
controlled trial [NCT01159639].
Source
Trials. 13 , 2012. Article Number: 148. Date of Publication: 25 Aug 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Coronary artery disease remains the dominant cause of
mortality in developed countries. While platelets have been recognized to
play a pivotal role in atherothrombosis, the ideal antiplatelet regime
after coronary artery surgery remains elusive.The evolution of CABG has
presently moved beyond technical improvements to involve modulation of
pharmacologic management designed to improve patient outcomes. The aim of
this trial will be to test the hypothesis that the addition of clopidogrel
to patients with documented postoperative aspirin resistance will reduce
the incidence of major cardiovascular events.Methods: Patients scheduled
for isolated coronary artery surgery will be eligible for the study.
Patients in whom postoperative multiple electrode aggregometry documents
aspirin resistance will be randomized into two groups. The control group
will receive 300 mg of aspirin. The dual antiplatelet group will receive
75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be
followed for 6 months. Major adverse cardiac and cerebrovascular events
(death from any cause, myocardial infarction, stroke, hospitalization due
to cardiovascular pathology) as well as bleeding events will be
recorded.Discussion: This will be the first trial that will specifically
address the issue of dual antiplatelet therapy in patients undergoing
coronary artery surgery who have been found to be aspirin resistant. In
the event that the addition of clopidogrel proves to be beneficial in this
subset of surgical patients, this study could significantly impact their
future antiplatelet management.This randomized controlled trial has been
registered at the ClinicalTrials.gov website (Identifier NCT01159639).
2012 Gasparovic et al.; licensee BioMed Central Ltd.

<11>
Accession Number
2012681888
Authors
Denollet J.
Institution
(Denollet) CoRPS, Center of Research on Psychology in Somatic diseases,
Tilburg University, Tilburg, Netherlands
Title
Depression and distressed (Type D) personality: What is their impact on
cardiovascular outcomes?.
Source
Dialogues in Cardiovascular Medicine. 17 (2) (pp 115-125), 2012. Date of
Publication: 2012.
Publisher
Les Laboratoires Seriver (50 Rue Carnot, F-92284, Suresnes Cedex, France)
Abstract
Depression and distressed (Type D) personality represent complementary
perspectives on behavioral risk factors in cardiovascular patients. Type D
refers to the combination of the negative affectivity and social
inhibition personality traits, and highlights the chronic nature of
emotional distress in some patients. Evidence from studies that compared
Type D personality and depression indicates that both constructs are
related, yet distinct prognostic risk factors for clinical events and poor
patient-reported outcomes in cardiac patients. The increase in risk
associated with Type D personality withstands adjustment for depression,
and the evidence that Type D personality is associated with a higher
prevalence of depressive symptoms in cardiac patients is robust.
Assessment of Type D personality may enhance our understanding of the role
of behavioral factors in cardiovascular patients. 2012 LLS SAS.

<12>
Accession Number
2012680545
Authors
Song Y.B. Hahn J.-Y. Song P.-S. Yang J.H. Choi J.-H. Choi S.-H. Lee S.H.
Gwon H.-C.
Institution
(Song, Hahn, Song, Yang, Choi, Choi, Lee, Gwon) Cardiac and Vascular
Center, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Gangnam-gu, Seoul, 135-710, South Korea
Title
Randomized comparison of conservative versus aggressive strategy for
provisional side branch intervention in coronary bifurcation lesions:
Results from the SMART-STRATEGY (SMart Angioplasty Research Team-Optimal
STRATEGY for Side Branch Intervention in Coronary Bifurcation Lesions)
Randomized trial.
Source
JACC: Cardiovascular Interventions. 5 (11) (pp 1133-1140), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: The authors sought to compare conservative and aggressive
strategies for provisional side branch (SB) intervention in coronary
bifurcation lesions. Background: The optimal provisional approach for
coronary bifurcation lesions has not been established. Methods: In this
prospective randomized trial, 258 patients with a coronary bifurcation
lesion treated with drug-eluting stents were randomized to a conservative
(n = 128) or aggressive (n = 130) SB intervention strategy. The criteria
for SB intervention after main vessel stenting differed between the
conservative and aggressive groups; Thrombolysis In Myocardial Infarction
flow grade <3 versus diameter stenosis >75% for non-left main bifurcations
and diameter stenosis >75% versus diameter stenosis >50% for left main
bifurcations. The primary endpoint was target vessel failure (cardiac
death, myocardial infarction, or target vessel revascularization) at 12
months. Results: Left main bifurcation lesions were noted in 114 patients
(44%) and true bifurcation lesions in 171 patients (66%). SB ballooning
after main vessel stenting and SB stenting after SB ballooning were
performed less frequently in the conservative group than in the aggressive
group (25.8% vs. 68.5%, p < 0.001; and 7.0% vs. 30.0%, p < 0.001,
respectively). The conservative strategy was associated with a lower
incidence of procedure-related myocardial necrosis compared with the
aggressive strategy (5.5% vs. 17.7%, p = 0.002). At 12 months, the
incidence of target vessel failure was similar in both groups (9.4% in the
conservative group vs. 9.2% in the aggressive group, p = 0.97).
Conclusions: Compared with the aggressive strategy, the conservative
strategy for provisional SB intervention was associated with similar
long-term clinical outcomes and a lower incidence of procedure-related
myocardial necrosis. (Optimal Strategy for Side Branch Stenting in
Coronary Bifurcation Lesions [SMART-STRATEGY]; NCT00794014) 2012 American
College of Cardiology Foundation.

<13>
Accession Number
2012682957
Authors
Rafiq S. Johansson P.I. Zacho M. Stissing T. Kofoed K. Lilleor N.B.
Steinbruchel D.A.
Institution
(Rafiq, Lilleor, Steinbruchel) Department of Cardiothoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Johansson, Stissing) Capital Region Blood Bank, Section for Transfusion
Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Zacho) Department of Radiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Kofoed) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Thrombelastographic haemostatic status and antiplatelet therapy after
coronary artery bypass surgery (TEG-CABG trial): assessing and monitoring
the antithrombotic effect of clopidogrel and aspirin versus aspirin alone
in hypercoagulable patients: study protocol for a randomized controlled
trial.
Source
Trials. 13 , 2012. Article Number: 48. Date of Publication: 27 Apr 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Hypercoagulability, assessed by the thrombelastography (TEG)
assay, has in several observational studies been associated with an
increased risk of post-procedural thromboembolic complications. We
hypothesize that intensified antiplatelet therapy with clopidogrel and
aspirin, as compared to aspirin alone, will improve saphenous vein graft
patency in preoperatively TEG-Hypercoagulable coronary artery bypass
surgery (CABG) patients and reduce their risk for thromboembolic
complications and death postoperatively.Methods/Design: This is a
prospective randomized clinical trial, with an open-label design with
blinded evaluation of graft patency. TEG-Hypercoagulability is defined as
a TEG maximum amplitude above 69 mm. Two hundred and fifty
TEG-Hypercoagulable patients will be randomized to either an
interventional group receiving clopidogrel 75 mg daily for three months
(after initial oral bolus of 300 mg) together with aspirin 75 mg or a
control group receiving aspirin 75 mg daily alone. Monitoring of
antiplatelet efficacy and on-treatment platelet reactivity to clopidogrel
and aspirin will be conducted with Multiplate aggregometry. Graft patency
will be assessed with Multislice computed tomography (MSCT) at three
months after surgery.Conclusions: The present trial is the first
randomized clinical trial to evaluate whether TEG-Hypercoagulable CABG
patients will benefit from intensified antiplatelet therapy after surgery.
Monitoring of platelet inhibition from instituted antithrombotic therapy
will elucidate platelet resistance patterns after CABG surgery. The
results could be helpful in redefining how clinicians can evaluate
patients preoperatively for their postoperative thromboembolic risk and
tailor individualized postoperative antiplatelet therapy.Trial
registration: Clinicaltrials.gov Identifier NCT01046942. 2012 Rafiq et
al.; licensee BioMed Central Ltd.

<14>
Accession Number
2012678284
Authors
Hauer D. Weis F. Campolongo P. Schopp M. Beiras-Fernandez A. Strewe C.
Giehl M. Toth R. Kilger E. Schelling G.
Institution
(Hauer, Weis, Schopp, Strewe, Giehl, Toth, Kilger, Schelling) Department
of Anaesthesiology, Ludwig Maximilians University, D-81377 Munich, Germany
(Campolongo) Department of Physiology and Pharmacology, La Sapienza
University of Rome, 00185 Rome, Italy
(Beiras-Fernandez) Department of Cardiac Surgery, Ludwig Maximilians
University, D-81377 Munich, Germany
(Beiras-Fernandez) Department of Cardiac Surgery, Johann Wolfgang
Goethe-University, Frankfurt/Main, Germany
(Toth) School of PhD Studies, Semmelweis University, Budapest, Hungary
Title
Glucocorticoid-endocannabinoid interaction in cardiac surgical patients:
Relationship to early cognitive dysfunction and late depression.
Source
Reviews in the Neurosciences. 23 (5-6) (pp 681-690), 2012. Date of
Publication: November 2012.
Publisher
Walter de Gruyter GmbH and Co. KG (Genthiner Strasse 13, Berlin D-10785,
Germany)
Abstract
Background: Endocannabinoids (ECs) are rapidly acting immune-modulatory
lipid-signaling molecules that are important for adaptation to stressful
and aversive situations. They are known to interact with glucocorticoids
and other stress-responsive systems. Maladaptation to acute or chronic
stress represents a major risk factor for the development of psychiatric
disorders. In the present study, we administered stress doses of
hydrocortisone in a prospective, randomized, placebo-controlled
doubleblind study in patients undergoing cardiac surgery (CS) to examine
the relationship between the use of glucocorticoids, plasma EC levels, and
the occurrence of early postoperative cognitive dysfunction (delirium) and
of later development of depression. Methods: We determined plasma levels
of the ECs anandamide and 2-arachidonoylglycerol (2-AG) in CS patients of
the hydrocortisone (n=56) and the placebo group (n=55) preoperatively, at
postoperative day (POD) 1, at intensive care unit discharge, and at 6
months after CS (n=68). Postoperative delirium was diagnosed according to
Diagnostic and Statistical Manual of the American Psychiatric Association
IVth Edition (DSM-IV) criteria, and depression was determined by validated
questionnaires and a standardized psychological interview (Structured
Clinical Interview for DSM-IV). Results: Stress doses of hydrocortisone
did not affect plasma EC levels and the occurrence of delirium or
depression. However, patients who developed delirium on POD 1 had
significantly lower preoperative 2-AG levels of the neuroprotective EC
2-AG (median values, 3.8 vs. 11.3 ng/ml; p=0.03). Preoperative 2-AG
concentrations were predictive of postoperative delirium
(sensitivity=0.70; specificity=0.69; cutoff value=4.9 ng/ml; receiver
operating characteristic curve area=0.70; 95% confidence interval=0.54 -
0.85). Patients with depression at 6 months after CS (n=16) had
significantly lower anandamide and 2-AG levels during the perioperative
period. Conclusions: A low perioperative EC response may indicate an
increased risk for early cognitive dysfunction and long-term depression in
patients after CS. Glucocorticoids do not seem to influence this
relationship.

<15>
Accession Number
2012677053
Authors
Seim B.E. Tonnessen T. Woldbaek P.R.
Institution
(Seim, Tonnessen, Woldbaek) Department of Cardiothoracic Surgery, Oslo
University Hospital, Ullevaal, Box 4956, Nydalen, 0424 Oslo, Norway
(Tonnessen) Department of Cardiothoracic Surgery, Oslo University
Hospital, University of Oslo, Norway
Title
Triclosan-coated sutures do not reduce leg wound infections after coronary
artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (3) (pp 411-415),
2012. Date of Publication: September 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVESLeg wound infection is a common complication after coronary
artery bypass grafting (CABG). Suture contamination has been suggested as
a mechanism of surgical site infections. Vicryl Plus is a
polyglacitin suture coated with the antiseptic chemical substance
Triclosan, which has been shown to inhibit the growth of Staphylococcus
aureus in vitro. The first aim of the present study was to compare Vicryl
Plus with conventional Vicryl sutures with regard to leg wound
infections following CABG. The second aim was to examine patient-and
operative characteristics, which are assumed to predict leg wound
infections.METHODSAfter statistical calculations a priori, 328 CABG
patients were prospectively randomized to leg wound closure with Vicryl
Plus (164 patients) or conventional Vicryl sutures (164 patients).
Incidences of leg wound infection and predictors of infection related to
patient-and operative characteristics were examined.RESULTSThe incidence
of leg wound infections was 10.4% (17/163) in the Vicryl group, and 10.0%
(16/160) in the Vicryl Plus group (P = 1.00). Patients with leg wound
infections had increased body mass index and prolonged extracorporeal
circulation and aortic clamping time compared with patients without
infections.CONCLUSIONSIn the present study, we report for the first time
that Vicryl Plus did not reduce the incidence of leg wound infections in
patients undergoing CABG. Obesity and prolonged time of extracorporeal
circulation were both associated with the increased risk of infections.
Currently, the clinical role and indication for the use of Vicryl Plus
have yet to be defined. 2012 The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<16>
Accession Number
2012676888
Authors
Krishnamoorthy B. Critchley W.R. Glover A.T. Nair J. Jones M.T. Waterworth
P.D. Fildes J.E. Yonan N.
Institution
(Krishnamoorthy, Nair, Jones, Waterworth, Yonan) Department of
Cardiothoracic Surgery, University Hospital of South Manchester NHS
Foundation Trust, Manchester, United Kingdom
(Critchley, Glover, Fildes, Yonan) Transplant Centre, University Hospital
of South Manchester NHS Foundation Trust, Manchester M23 9LT, United
Kingdom
(Fildes) School of Translational Medicine, Faculty of Medical and Human
Sciences, University of Manchester, Manchester, United Kingdom
Title
A randomized study comparing three groups of vein harvesting methods for
coronary artery bypass grafting: Endoscopic harvest versus standard
bridging and open techniques.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (2) (pp 224-228),
2012. Date of Publication: August 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: The use of an open vein harvesting (OVH) technique for
saphenous vein harvesting (SVH) is associated with wound complications and
delayed patient mobilization. This has led to the development of minimally
invasive vein harvesting (MIVH) techniques, such as standard bridging and
endoscopic SVH (EVH). This randomized trial was established to assess
immediate clinical outcome and patient satisfaction in our centre.METHODS:
A total of 150 consecutive patients were prospectively randomized into
three groups. Group 1 consisted of 50 patients who underwent OVH, Group 2
consisted of 50 patients who underwent a standard bridging technique (SBT)
and Group 3 consisted of 50 patients who underwent EVH. Each group was
assessed for the incidence of wound infection, postoperative pain and
satisfaction and the number of vein repairs using previously validated
scoring systems.RESULTS: The MIVH techniques reduced the pain at hospital
(P < 0.001) and at 6 weeks (P < 0.001), and improved cosmesis (P < 0.001),
compared with the OVH group. Patient satisfaction was greatest in the EVH
group followed by the SBT and then the OVH group. The clinical markers of
inflammation were reduced with an MIVHt. There were more vein repairs in
the EVH compared with the OVH (P < 0.001) and the SBT (P = 0.04)
groups.CONCLUSIONS: This study demonstrates that MIVH reduces wound
morbidity. We believe that each technique has advantages and
disadvantages, which should be considered during the selection of a
harvesting procedure by both the patient and the surgeon. 2012 The Author
2012. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2012676884
Authors
Rodrigo R. Gutierrez R. Fernandez R. Guzman P.
Institution
(Rodrigo, Gutierrez, Fernandez, Guzman) Molecular and Clinical
Pharmacology Program, Institute of Biomedical Sciences, University of
Chile, Independencia 1027, Casilla 70058, Santiago 7, Chile
Title
Ageing improves the antioxidant response against postoperative atrial
fibrillation: A randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (2) (pp 209-214),
2012. Date of Publication: August 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Extracorporeal circulation is associated with
ischaemia-reperfusion-induced oxidative stress and atrial fibrillation
(AF). Ageing is the major risk factor for this arrhythmia. Reinforcing the
antioxidant defence system would be expected to protect the myocardium
against ischaemia-reperfusion damage. We studied the effect of antioxidant
reinforcement and ageing on the occurrence of postoperative AF.METHODS: A
randomized, double-blind, placebo-controlled trial was performed in
patients scheduled for cardiac surgery with extracorporeal circulation.
Supplementation with omega-3 polyunsaturated fatty acid (PUFA) and
vitamins C and E, or placebo was administered to 152 patients divided by
age: young patients (30-59 years) and old patients (60-80 years). For the
detection of AF, we used 12-lead and Holter EKGs. Antioxidant enzyme
activity was determined in atrial tissue. Oxidative stress was assessed
through plasma malondialdehyde levels.RESULTS: Supplemented patients over
60 years old showed higher glutathione peroxidase activity than control
patients in the same age range. There was no difference between the
supplemented and placebo groups in patients under 60 years old. The
decrease in the incidence of postoperative AF in supplemented patients was
more marked in the older patients than in the younger ones.CONCLUSIONS:
Since the antioxidant supplementation with n-3 PUFAs and vitamins C and E
resulted in a more marked reduction of postoperative AF in older patients,
it could be suggested that the efficacy of this therapy improves with
ageing. 2012 The Author 2012. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<18>
Accession Number
2012673311
Authors
Atasever B. Van Der Kuil M. Boer C. Vonk A. Schwarte L. Girbes A.R.J. Ince
C. Beishuizen A. Groeneveld A.B.J.
Institution
(Atasever, Van Der Kuil, Boer, Vonk, Schwarte, Girbes, Ince, Beishuizen,
Groeneveld) Departments of Intensive Care, Anesthesiology, and
Cardiothoracic Surgery, Free University Medical Center, The Netherlands
and the Department of Translational Physiology, Academic Medical Center,
Amsterdam, The Netherlands
Title
Red blood cell transfusion compared with gelatin solution and no infusion
after cardiac surgery: Effect on microvascular perfusion, vascular
density, hemoglobin, and oxygen saturation.
Source
Transfusion. 52 (11) (pp 2452-2458), 2012. Date of Publication: November
2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: After cardiac surgery, red blood cell (RBC) transfusion may
improve systemic hemodynamics and thereby microvascular blood flow and O
₂ delivery (DO₂). Study design and methods: In a
nonrandomized prospective observational study on post-cardiac surgery
patients, systemic hemodynamics and microvascular blood flow, vascular
density (sidestream dark-field imaging), hemoglobin (Hb) content, and
saturation (reflectance spectrophotometry) were measured before and 1 hour
after start of transfusion of 1 to 2 units of leukoreduced RBCs (270 +/-
203 mL), 500 mL of gelatin solution, or control (no infusion), when
patients were considered clinically hypovolemic with (RBC group, n = 12)
or without (gelatin group, n = 14) anemia (Hb < 10 g/dL) or not (n = 13),
respectively. Results: Systemic Hb was lower and increased in the RBC
transfusion but not in gelatin and control groups. There were no
differences in changes in systemic DO₂, O₂ uptake,
and extraction between groups. RBC transfusion, compared with gelatin or
control, increased medium-sized vascular density, Hb content, and
saturation in the microcirculation, while blood flow remained unchanged.
Changes of microvascular Hb and saturation paralleled changes in systemic
Hb. Conclusion: The data argue in favor of efficacy of RBC transfusion
after cardiac surgery. RBC transfusion increases systemic Hb and this in
turn increases medium-sized vascular density and DO₂ in the
sublingual microcirculation, independently of systemic hemodynamics and
volume status. 2012 American Association of Blood Banks.

<19>
Accession Number
2012675744
Authors
Pilcher J.M. Young P. Weatherall M. Rahman I. Bonser R.S. Beasley W.R.
Institution
(Pilcher, Young, Beasley) Medical Research Institute of New Zealand,
Wellington 6242, New Zealand
(Young, Weatherall, Beasley) Capital and Coast District Health Board,
Wellington 6242, New Zealand
(Weatherall) University of Otago Wellington, Wellington 6242, New Zealand
(Rahman, Bonser) University Hospital, Birmingham NHS Trust, Birmingham B15
2PR, United Kingdom
(Bonser) University of Birmingham, Edgbaston, Birmingham B15 2TT, United
Kingdom
Title
A systematic review and meta-analysis of the cardioprotective effects of
remote ischaemic preconditioning in open cardiacsurgery.
Source
Journal of the Royal Society of Medicine. 105 (10) (pp 436-445), 2012.
Date of Publication: October 2012.
Publisher
Royal Society of Medicine Press Ltd (P.O. Box 9002, London W1A 0ZA, United
Kingdom)
Abstract
Objective: To investigate the cardioprotective efficacy of remote
ischaemic preconditioning (RIPC) in cardiac surgery. Design: We have
performed a systematic search of MEDLINE, EMBASE and Cochrane Central
Register of Controlled Trials to identify randomized controlled trials
involving RIPC. Setting: Randomized controlled trials of RIPC in open
cardiac surgery patients. Main outcome measures: Meta-analysis was
performed with the primary outcome the standardized mean difference
between intervention and control groups in 12 hour postoperative troponin
concentration. Heterogeneity was examined by fixed effects
meta-regression. Results: Ten studies with a total of 693 participants
were included in the meta-analysis. RIPC reduced troponin levels 12 hours
after surgery compared with control. The fixed and random effects
differences were 0.35 (95% CI 0.19 to 0.51) and 0.53 (95% CI 0.18-0.88)
respectively. However, important heterogeneity was present. Fixed effects
metaregression partially accounted for heterogeneity based on whether
studies had full blinding, comprising blinding of patients, surgeons,
anaesthetists and investigators. Studies with incomplete or no blinding
demonstrated a larger estimate of effect, 0.74 (95% CI 0.47 to 1.00)
compared to those with full blinding, 0.13 (95% CI - 0.07 to 0.33).
Conclusions: Although our analysis suggests RIPC may result in cardiac
protection during cardiac surgery, the effect was most marked in studies
without full blinding, with a smaller and statistically nonsignificant
effect in fully blinded studies. We propose that further double blind
randomized controlled trials investigating the cardioprotective effects of
RIPC in cardiac surgery are required to resolve the current clinical
uncertainty.

<20>
Accession Number
70931086
Authors
Uzzaman M.M. Robb J.D. Mhandu P.C.E. Khan H. Whitaker D.C.
Institution
(Uzzaman, Robb, Mhandu, Khan, Whitaker) Department of Cardiothoracic
Surgery, King's College Hospital, London, United Kingdom
Title
A meta-analysis of studies comparing conventional posterolateral
thoracotomy and muscle-sparing thoracotomy: Significantly better outcomes
with the muscle-sparing approach.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S143), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: Posterolateral thoracotomy (PLT) causes considerable
postoperative pain and reduced lung and shoulder function. The alternative
muscle-sparing thoracotomy (MST) has the potential to reduce this
morbidity. We performed a meta-analysis of trials comparing outcomes of
PLT and MST. We measured primary outcome measures of FEV1, FVC and range
of shoulder movement at 30 days and secondary measures of duration of
surgery, linear pain score on days 1, 7 and 4 weeks after surgery,
hospital stay and overall complication rates. Methods: Seven studies
comparing PLT MST were selected according to specific inclusion criteria.
Using a random effect model, weighted mean difference (WMD) was determined
for continuous variables whilst pooled oddsratio (OR) was determined for
discrete variables. Results are displayed with forest plots. Results: MST
(344 patients) resulted in significantly improved shoulder flexion
(WMD+=21.636581 [95% CI=9.611869 to 33.661294] P=0.0004) and abduction
(WMD=13.320218 [95% CI=8.253044 to 18.387392] P<0.0001) compared to the
PLT (381 patients) group. There was also no difference in FEV1 and FVC.
MST patients had better pain scores on day 1 (WMD+=-0.767234 [95%
CI=-1.324582 to -0.209886] P=0.007) and 7 days (WMD+=-0.765948 [95%
CI=-1.549569 to 0.017674] P=0.05) but no difference at 30 days. No
differences in duration of surgery, hospital stay and overall complication
rates were found. Conclusions: MST results in significantly better
shoulder flexion and abduction and better early postoperative pain scores
compared to conventional PLT.

<21>
Accession Number
70931072
Authors
Yamamoto H. Takagi H. Iwata K. Goto S. Umemoto T.
Institution
(Yamamoto, Takagi, Iwata, Goto, Umemoto) Department of Cardiothoracic
Surgery, Shizuoka Medical Center, Shizuoka, Japan
Title
Bilateral internal thoracic artery grafting increases risk for
mediastinitis: A meta-analysis of randomized and risk-adjusted
observational studies.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S140), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: Mediastinitis (or deep sternal wound infection) is an
infrequent, yet potentially devastating complication after coronary artery
bypass grafting (CABG). Although a number of studies suggest that the use
of bilateral internal thoracic artery (BITA) grafts carries increased risk
for mediastinitis, no meta-analysis of them has been conducted to date. To
determine whether the use of BITA increases risk for mediastinitis, we
performed the first metaanalysis. Methods: MEDLINE, EMBASE, and the
Cochrane Central Register of Controlled Trials were searched through
February 2012. Search terms included bilateral or double, internal
thoracic/mammary artery, and mediastinitis or mediastinum/ mediastinal
infection or sternum/sternal infection. Eligible studies were randomized
controlled trials and risk-adjusted observational comparative studies of
BITA vs non-BITA grafting and reporting incidence of mediastinitis as an
outcome. Of 151 potentially relevant articles screened initially, one
randomized trial and 18 observational studies (reporting adjusted odds
ratio [OR]) enrolling a total of 69 946 patients undergoing CABG were
included. Included studies were reviewed to determine incidence of
mediastinitis of BITA and non-BITA cohorts. Results: Pooled analysis
suggested a significant increase in incidence of mediastinitis among
patients undergoing BITA vs non-BITA grafting (randomeffects OR, 3.19, 95%
confidence interval, 2.39-4.25, P<0.00001; P value for
heterogeneity=0.02). The increase in incidence of mediastinitis remained
significant even after exclusion of any single study from the analysis.
There was no evidence of significant publication bias. Conclusions: The
use of BITA grafts appears to significantly increase the risk for
mediastinitis more than three-fold in patients undergoing CABG.

<22>
Accession Number
70931071
Authors
Yamamoto T. Kajimoto K. Amano A.
Institution
(Yamamoto, Kajimoto, Amano) Department of Cardiovascular Surgery, Juntendo
University, Tokyo, Japan
Title
Remote outcomes in diabetic patients following coronary artery bypass
revascularization using bilateral internal thoracic arteries: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S140), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: In coronary artery bypass graft surgery (CABG), internal
thoracic artery grafts have excellent long-term prognosis and patency.
However, CABG using bilateral internal thoracic arteries (BITA) is not as
common as that with a single internal thoracic artery (SITA). We aimed to
assess the effects of BITA in diabetic patients following CABG. Methods: A
literature review of studies comparing SITA and BITA for diabetic patients
was conducted using the following electronic databases: MEDLINE via PubMed
(from 1995 to December 2011), EMBASE, and the Cochrane Library database
(Cochrane Central Register of Controlled Trials). Studies were included in
this meta-analysis if they satisfied the following criteria: (1) compared
SITA and BITA for diabetes patients, and (2) evaluated remote outcomes.
Results: The literature review identified six studies comprising 2817
patients. All-cause death occurred in 18% of patients with SITA and 10%
with BITA (odds ratio [OR], 0.48; 95% confidence interval [CI]=0.36 to
0.64; P<0.0001). Cardiac death occurred in 8.8% of patients with SITA and
3.9% with BITA (OR, 0.35; 95% CI=0.23 to 0.53, P<0.0001). Myocardial
infarction occurred in 4.6% of SITA and 1.6% of BITA (OR, 0.27; 95% CI
0.13 to 0.59, P<0.0001) patients. Target vessel revascularization occurred
in 9.7% of patients with SITA and 5.7% with BITA (OR, 0.49; 95% CI=0.31 to
0.78, P<0.0001). Conclusions: This study demonstrated better survival and
fewer incidences of myocardial infarction and revascularization after CABG
using BITA when compared to SITA among the patients with diabetes.

<23>
Accession Number
70931051
Authors
Head S.J. Osnabrugge R.L. Howell N.J. Freemantle N. Bridgewater B.
Kappetein A.P. Pagano D.
Institution
(Head, Osnabrugge, Kappetein) Department of Cardio-Thoracic Surgery,
Erasmus University Medical Center, Rotterdam, Netherlands
(Howell, Pagano) Department of Cardiothoracic Surgery, University Hospital
Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Biostatistics, University of Birmingham,
Birmingham, United Kingdom
(Bridgewater) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
Title
A systematic review of risk prediction in adult cardiac surgery: Which
variables should be collected for the forthcoming eacts model?.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S134-S135), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: Predicting procedural mortality in adult cardiac surgery is
critical for decision-making purposes. Risk models have been shown to be
inaccurate, particularly in high-risk patients, and prediction therefore
remains challenging. To improve accuracy in European patients, separate
procedurespecific algorithms should exist. Furthermore, it is crucial that
cardiac and also non-traditional risk factors are considered. This study
reports the first step in developing a novel European risk model initiated
by The European Association for Cardio-Thoracic Surgery (EACTS). A
systematic review was performed to identify variables that will be
prospectively collected in an EACTS database. Methods: The EACTS model
will be designed to predict mortality, stroke, renal failure, and length
of stay after specific procedures, e.g. valve replacement, coronary artery
bypass grafting (CABG), etc. The PubMed database was searched from January
1995 through December 2011 for publications that report risk models or
have identified independent predictors of one of the outcomes. In addition
to outcome keywords (mortality/ death, stroke/cerebrovascular event, renal
failure, length of stay/LOS), a combination of subject (cardiac/heart
surgery, heart valve surgery, valve replacement/AVR/MVR, valve repair/MVP,
coronary artery bypass grafting/ CABG) and design (risk
model/score/factor, independent, multi-variate/ variable,
c-index/c-statistic, area under the curve/AUC) entries complemented the
search. Results: The search yielded 6805 publications which are being
independently screened by two researchers. The identified variables and
further steps in developing the model will be presented at the meeting.
Conclusions: Risk prediction remains inaccurate, especially in high-risk
patients. The forthcoming EACTS model will prospectively collect the
identified variables to develop a procedure-specific model for estimating
mortality, stroke, renal failure, and length of stay in European patients
undergoing cardiac surgery.

<24>
Accession Number
70931049
Authors
Jeppsson A. Thimour-Bergstrom L. Gudbjartsson T. Aneman C. Friberg O.
Institution
(Jeppsson, Thimour-Bergstrom) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Gudbjartsson) Department of Cardiothoracic Surgery, Landspitali Hospital,
Reykjavik, Ireland
(Aneman) Department of Infectious Diseases, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Friberg) Department of Cardiothoracic Surgery, Orebro University
Hospital, Orebro, Sweden
Title
Triclosan-coated sutures reduce surgical site infections after open vein
harvesting in coronary artery bypass graft patients: A prospective
randomized controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S134), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: The incidence of surgical site infection (SSI) after open vein
harvesting in coronary artery bypass graft (CABG) patients ranges between
5% and 20% in different studies. Triclosan is an antibacterial substance
which mainly affects Staphylococcus. We hypothesized that wound closure
with sutures coated with triclosan reduces SSI after open vein harvesting.
Methods: An investigator-initiated prospective randomized double-blind
single centre study was performed. The patients (n=374) were randomized to
subcutaneous and intra-cutaneous leg wound closure with either triclosan-
coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Somerville, NJ,
USA) (n=184) or identical sutures without triclosan (n=190) from the same
manufacturer. All patients were followed up after 30 days (clinical visit)
and 60 days (telephone interview). The primary endpoint was SSI within 60
days after surgery according to the definition of the Center for Disease
Control. Predefined secondary endpoints included culture-proven and
antibiotictreated SSI. Results: The primary endpoint occurred in 23
patients (12.5%) with triclosancoated sutures and in 38 patients (20.0%)
in the group without triclosan (odds ratio 0.57, 95% confidence interval
0.32-1.00, P=0.05). Corresponding figures for culture-proven infections
were 7.6% vs 12.1% (OR 0.60, 0.30-1.20, P=0.15), and for
antibiotic-treated infections 10.9% vs 18.4%, (OR 0.57, 0.30-0.98,
P=0.041). Staphylococcus aureus and coagulase negative Staphylococcus were
the most common pathogens in both groups. Insulintreated diabetes and vein
harvesting time were independent predictors of SSI after vein harvesting.
Conclusions: Leg wound closure with triclosan-coated sutures in CABG
patients significantly reduces antibiotic-treated surgical site infections
after open vein harvesting.

<25>
Accession Number
70930966
Authors
Deppe A. Liakopoulos O.J. Choi Y. Slottosch I. Kuhn E.W. Stange S.
Scherner M. Wahlers T.
Institution
(Deppe, Liakopoulos, Choi, Slottosch, Kuhn, Stange, Scherner, Wahlers)
Department of Cardiothoracic Surgery, Heart Center, University of Cologne,
Cologne, Germany
Title
Endoscopic vein harvesting for coronary artery bypass grafting: A
systematic review with meta-analysis of 27 789 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S114), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: To determine the current strength of evidence for or against
endoscopic vein harvesting (EVH) in patients undergoing coronary artery
bypass grafting (CABG). Methods: A meta-analysis of randomized (RCT) and
observational trials (OT) was performed which reported the impact of EVH
on adverse clinical outcomes after coronary artery bypass grafting (CABG).
Analysed postoperative outcomes included wound infection, postoperative
pain, myocardial infarction, vein graft failure, length of hospital stay
and mortality. Pooled treatment effects (odds ratio [OR]) or weighted mean
difference (WMD), 95% confidence intervals (95% CI) were assessed using a
fixed or random effects model. Results: A total of 27 789 patients from 43
studies (16 RCT, 27 OT) were identified that underwent saphenectomy by
endoscopic (46%, n=12 822) or conventional technique (54%, n=14 967).
Pooled effect estimates revealed a reduced incidence (P<0.002) of wound
infections (OR 0.27; 95% CI 0.22- 0.32), pain (WMD -1.26, 95% CI -2.07 to
-0.44) and length of hospital stay (WMD -0.6 days, 95% CI -1.08 to -0.12).
EVH was associated with an increase of the odds for vein graft failure (OR
1.38; 95% CI 1.01-1.88, P=0.0433), a finding that lost statistical
difference after pooled analysis of RCTs and studies with high
methodological quality. Similarly, graft-related endpoints including
mortality and myocardial infarction did not differ between the harvesting
techniques. Conclusions: The present systematic review underscores the
safety of EVH in patients undergoing CABG. EVH reduces leg wound
infections without increasing the mid-term risk for vein graft failure,
myocardial infarction or mortality.

<26>
Accession Number
70930963
Authors
Faggian G. Gu Y.J. Dodonov M. Van Oeveren W. Tessari M. Menon T. Mazzucco
A. Milano A.
Institution
(Faggian, Dodonov, Tessari, Menon, Mazzucco, Milano) Department of Cardiac
Surgery, University of Verona, Verona, Italy
(Gu) Department of Biomedical Engineering, University of Groningen,
Groningen, Netherlands
(Van Oeveren) Haemoscan BV, Groningen, Netherlands
Title
Randomized controlled trial of pulsatile perfusion in elderly patients
undergoing aortic valve surgery: Clinically beneficial or detrimental?.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S113), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: Analysis of the haemodynamic effects, vascular reactivity, and
endothelial integrity in elderly patients undergoing aortic valve
replacement (AVR) with either pulsatile (PP) or non-pulsatile (NP)
cardiopulmonary bypass (CPB). Methods: Forty elderly patients (age 80+/-3
years, EuroSCORE 5.9+/-1.5) with aortic valve stenosis were prospectively
randomized for surgery with either PP or NP perfusion performed by
centrifugal pump. Pulsatility was evaluated in terms of energy equivalent
pressure (EEP) and surplus haemodynamic energy (SHE). Systemic (SVRi),
pulmonary (PVRi) vascular resistance and plasma levels of inter-cellular
adhesive molecules (ICAM-I), endothelin-I (ETI) and von Willebrand factor
(vWF) were collected during 24 hours of the perioperative period. Results:
Mean EEP and SHE were significantly higher in the PP group (P<0.001). Mean
perfusion pressure (55+/-9 mmHg in the PP group vs 60+/-13 mmHg in the NP
group) and flow (4.4+/-0.5 vs 4.3+/-0.4 l/min) showed no difference
between the groups. SVRi was significantly lower during the crossclamp
period in the PP group until the rewarming phase and just after crossclamp
removal (ANOVA Group-time interaction P=0.06). PVRi was significantly
lower in the PP group after protamine administration and during the first
hours of ICU stay (ANOVA Group-time interaction P=0.02). Lower vascular
resistance induced by PP required higher perioperative dosage of
vasopressor drugs (P=0.01). Plasma ICAM-1, vWF and ET-1 showed marked
variations at the early post-CPB period, without important differences
between the groups. PP and NP patients were comparable in perioperative
lactate levels, drainage blood loss, transfusion rates, ICU and hospital
stay periods, and early complications. Conclusions: In elderly patients
undergoing aortic valve surgery, pulsatile perfusion has some paradoxical
effects, providing lower systemic and pulmonary vascular resistance but
resulting in augmented perioperative vasopressor requirements.

<27>
Accession Number
70930928
Authors
Yang H.C. Song I. Lee J. Choi W. Cho S. Kim K. Jheon S.
Institution
(Yang, Lee, Song, Lee, Choi, Cho, Kim, Jheon) Department of Thoracic and
Cardiovascular Surgery, Seoul National University, Bundang Hospital,
Seongnam, South Korea
Title
Pain control of thoracoscopic major pulmonary resection: Is pre-emptive
local bupivacaine injection able to replace intravenous patient-controlled
analgesia?.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S104-S105), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: Pain is an important problem even in video-assisted
thoracoscopic surgery (VATS). Intravenous patient-controlled analgesia (IV
PCA) is generally applied after VATS. However, this may have accompanying
sideeffects including nausea/vomiting, drowsiness, urinary retention, and
respiratory depression. A randomized controlled study was performed to
evaluate whether pre-emptive local bupivacaine injection (PLBI) may be
able to replace IV PCA in patients undergoing VATS major pulmonary
resection. Methods: Between August 2010 and July 2011, we randomly
assigned 56 patients into two groups (PLBI vs IV PCA), who were scheduled
for VATS segmentectomy or lobectomy. Avisual analogue pain scale (range
0-10) was utilized. Results: The PLBI group and IV PCA groups showed no
difference in terms of age, sex, disease entity, operation time, chest
tube indwelling time, and hospital stay. Serial pain scores demonstrated
no statistical differences between the PLBI and IV PCA groups (day of
surgery, 5.6+/-1.4 vs 5.8+/-1.4; day 1, 3.4+/-1.5 vs 3.3+/-1.2; day 2,
2.7+/-1.3 vs 2.5+/-1.3; day 3, 2.3+/-1.4 vs 2.1+/-1.3; one week after
discharge, 3.4+/-1.8 vs 2.7+/-1.6; one month, 2.3+/-1.3 vs 2.2+/-1.4 and 2
months, 1.5+/-1.3 vs 1.3+/-1.1; P>0.05). A mean one more usage of
additional IV analgesics was needed in the PLBI group (3.3+/-2.1 vs
2.3+/-1.3, P=0.03). The occurrence of nausea/vomiting was higher in the IV
PCA group (11% vs 36%, P=0.04) and 54% of IV PCA patients experienced
drug-induced side effects that required removal of IV PCAwithin
postoperative day 1. Conclusions: PLBI is a simple, safe, effective, and
economical method. PLBI is able to replace IV PCA in VATS major pulmonary
resection.

<28>
Accession Number
70930848
Authors
Liakopoulos O.J. Stange S. Kuhn E.W. Deppe A. Slottosch I. Choi Y. Wahlers
T.
Institution
(Liakopoulos, Stange, Kuhn, Deppe, Slottosch, Choi, Wahlers) Department of
Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne,
Germany
Title
Impact of statin use on clinical outcomes after cardiac surgery: A
systematic review of studies, with meta-analysis of over 90 000 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S85), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: To determine the strength of evidence for the use of
preoperative statins in reducing adverse postoperative outcomes in
patients undergoing cardiac surgery. Methods: We performed a systematic
review with meta-analysis of randomized controlled (RCT) and observational
trials reporting the effects of preoperative statin therapy on major
adverse clinical outcomes after cardiac surgery. Analysed outcomes
included early all-cause mortality, myocardial infarction, atrial
fibrillation, stroke and renal failure using a priori defined criteria.
Effect estimates were calculated and are given as odds ratio (OR) with 95%
confidence intervals (95% CI) using fixed or random effect models.
Results: A literature search of all major databases retrieved 2371
studies. After screening, a total of 54 trials were identified (12 RCT, 42
observational) that reported outcomes of 91 491 cardiac surgery patients
with (n=46 614; 51%) or without (n=44 877; 49%) preoperative statin
therapy. Preoperative statin use resulted in a 0.9% absolute risk (2.6% vs
3.5%; P<0.0001) and a 31% odds reduction for early all-cause mortality (OR
0.69; 95% CI 0.59-0.81; P<0.01). In addition, statin treatment before
surgery was associated with a substantial reduction (P<0.01) in the
postoperative endpoints atrial fibrillation (OR 0.69; 95% CI 0.59-0.80),
new onset atrial fibrillation (OR 0.68; 95% CI 0.54-0.85), and stroke (OR
0.83; 95% CI 0.74-0.93). No statistical differences were found between
treatment groups (P=NS) with regard to myocardial infarction (OR 1.05; 95%
CI 0.91-1.21) or renal failure (OR 1.03; 95% CI 0.89-1.19). Conclusions:
The current systematic review strenghtens the evidence that preoperative
statin therapy exerts substantial clinical benefit on early postoperative
adverse outcomes in cardiac surgery patients and underlines the need for
large RCTs.

<29>
Accession Number
70930808
Authors
Verberkmoes N.J. Wolters S.L. Post J.C. Soliman-Hamad M.A. Ter Woorst F.J.
Berreklouw E.
Institution
(Verberkmoes, Soliman-Hamad, Ter Woorst, Berreklouw) Department of
Cardiothoracic Surgery, Eindhoven, Netherlands
(Wolters) Department of Radiology, Eindhoven, Netherlands
(Post) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
Title
Distal anastomosis patency of the cardica c-port system versus the
hand-sewn technique: A prospective randomized controlled study in patients
undergoing coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 26th Annual
Meeting of the European Association for Cardio-Thoracic Surgery, EACTS
2012 Barcelona Spain. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 15 (pp S75), 2012. Date of
Publication: October 2012.
Publisher
Oxford University Press
Abstract
Objectives: The C-Port Distal Anastomosis Systems (Cardica Inc, Redwood
City, CA) demonstrated favourable results in feasibility trials. However,
distal vein anastomoses created with the C-port system have never been
compared to hand-sewn distal vein anastomoses. In this regard, the
objective of this study was to compare distal anastomoses facilitated with
The C-Port System to the traditional hand-sewn method. Methods: This
single-centre prospective randomized controlled study compromised 71
patients (C-Port group n=35, control group n=36) who underwent elective
coronary artery bypass grafting (CABG) between June 2008 and April 2011.
The primary study end-point was twelve-month distal anastomosis patency,
which was assessed with prospective ECG-gated 256-multislice computed
tomographic (CT) coronary angiography using a step-andshoot scanning
protocol. Results: Technical failure of the C-Port System occurred in four
patients (11.4%). There was no hospital mortality in either group. During
12-month follow-up, a single death occurred in the C-Port group and was
unrelated to the device. Twenty-nine patients in the C-Port group (mean
age 66.6 years, male 86.2%) and 30 patients in the control group (mean age
65.8 years, male 90.0%) completed 12-month CT coronary angiography on
April 1, 2012. The overall patency of 156 studied distal vein graft
anastomoses was 92.9%. Comparison of the end-to-side target anastomosis
showed 12-month patency of 86.2% and 86.7% (P=0.96) in the C-Port group
and the control group, respectively. Conclusions: The use of C-Port System
is safe in performing distal vein graft anastomosis. Twelve-month patency
is comparable to that of the traditional hand-sewn technique. These
results are promising as they may further enhance the use of anastomotic
devices.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 24

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<1>
Accession Number
2012671362
Authors
Mannacio V.A. Di Tommaso L. Antignan A. De Amicis V. Vosa C.
Institution
(Mannacio, Di Tommaso, De Amicis, Vosa) Department of Cardiac Surgery,
University of Naples Federico II, Naples, Italy
(Antignan) Department of Cardiology, Azienda Ospedaliera
Santobono-Pausillipon, Naples, Italy
Title
Aspirin plus clopidogrel for optimal platelet inhibition following
off-pump coronary artery bypass surgery: Results from the CRYSSA
(prevention of Coronary arteRY bypaSS occlusion after off-pump procedures)
randomised study.
Source
Heart. 98 (23) (pp 1710-1715), 2012. Date of Publication: December 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To determine the individual variability in the response to
aspirin and/or clopidogrel and its impact on graft patency after off-pump
coronary artery bypass grafting. Design: A single-centre prospective
randomised controlled study designed according to the Consolidated
Standards of Reporting Trials statement. Randomisation was obtained by a
computer-generated algorithm. Setting: University medical school in Italy.
Patients: 300 patients who underwent off-pump coronary artery bypass
grafting were randomised to receive aspirin (n=150) or aspirin plus
clopidogrel (n=150). Intervention: Aspirin 100 mg or aspirin 100 mg plus
clopidogrel 75 mg daily was initiated when postoperative chest tube
drainage was <=50 ml/h for 2 h and patients were followed up for 12
months. Main outcome measures: Qualitative and quantitative assessment of
platelet function, angiographic evaluation of coronary revascularisation
by 64-slice CT and clinical outcome. Results: In the aspirin group, 49
patients (32.6%) were aspirin resistant and, in the aspirin-clopidogrel
group, 19 patients (12.6%) were aspirin and clopidogrel resistant. The
platelet response to aspirin was similar in all aspirin responders despite
the study arm (Aspirin Reaction Units 313.2644.8 vs 323.6653.6; p=0.07).
The platelet response to clopidogrel was enhanced by aspirin in patients
responsive to both aspirin and clopidogrel (synergistic effect) compared
with responders to clopidogrel only (P2Y12 Reaction Units 139.9+/-15.5 vs
179.4+/-18.5; p<0.001). Combined therapy was associated with a reduced
vein graft occlusion rate (7.4% vs 13.1%; p=0.04). Antiplatelet resistance
was a predictor of graft occlusion (RR 3.6, 95% CI 2.5 to 6.9; p<0.001).
Synergistic aspirin and clopidogrel activity was a strong predictor of
vein graft patency (RR 5.1, 95% CI 1.4 to 16.3; p<0.01). Conclusions:
Combined clopidogrel and aspirin overcome single drug resistances, are
safe for bleeding and improve venous graft patency.

<2>
Accession Number
2012676428
Authors
Mirhosseini S.J. Sayegh S.A.H.
Institution
(Mirhosseini) Department of Cardiovascular Surgery, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic
Republic of
(Sayegh) Medical Student and Researcher of Cardiac Surgery, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Effect of preoperative anemia on short term clinical outcomes in diabetic
patients after elective off-pump CABG surgery.
Source
Acta Medica Iranica. 50 (9) (pp 615-618), 2012. Date of Publication: 2012.
Publisher
Medical Sciences University of Teheran (Poursina St, Teheran 14-174, Iran,
Islamic Republic of)
Abstract
Diabetic mellitus (DM) is a major risk factor of morbidity, mortality and
economic cost to society. Diabetic patients are at risk of having
microvascular or macrovascular disorders of diabetes. Postoperative anemia
have wide spectrum of some early complications that require more care in
hospitalization stays. Therefore, this study was designed to evaluate
effect of preoperative anemia on shortterm clinical outcomes in diabetic
patients undergoing elective off-pump CABG. This study conducted on 86
diabetic patients underwent elective off-pump CABG surgery from August to
October 2011, in Afshar Cardiovascular Center, Yazd, Iran. The patients
had hemoglobin concentration between 10-12 mg/dl, patients with
preoperative atrial fibrillation and renal and respiratory dysfunction
were excluded from this study. Participants were randomly assigned into
two groups; the normal group (n=42) that had hemoglobin concentration ~
12-15 g/dl and the anemic group (n=44) had hemoglobin concentration~7-10
g/dl. We evaluated post-CABG variables including incidence of atrial
fibrillation and early morbidity such as infection, vomiting, renal and
respiratory dysfunctions, ICU or hospital stay and early mortality. Data
were analyzed by ANOVA, Chi-square and Fisher's exact test for
quantitative and qualitative variables. The mean age of the patients was
52.51+/-6.9 years, from all of patients 64 cases (74.4%) were male and 22
cases (445.6%) were female. Postoperative atrial fibrillation was observed
in 17 cases (19.8%), 7 cases (16.7%) of whom were in normal group and 10
cases (22.7%) of whom were in anemia group. anemia could significantly
increase hospital stay (P=0.0001) but no ICU stay. Preoperative anemia did
not affect the incidence of atrial fibrillation and early complications
and mortality in patients undergoing off-pump CABG. However, anemia could
increase postoperative hospital stay and renal dysfunction significantly.
2012 Tehran University of Medical Sciences. All rights reserved.

<3>
Accession Number
2012673763
Authors
Nilsson J. Scicluna S. Malmkvist G. Pierre L. Algotsson L. Paulsson P.
Bjursten H. Johnsson P.
Institution
(Nilsson, Scicluna, Malmkvist, Pierre, Algotsson, Paulsson, Bjursten,
Johnsson) Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia
and Intensive Care, Skane University Hospital, Lund University, SE 221 85
Lund, Sweden
Title
A randomized study of coronary artery bypass surgery performed with the
Resting Heart System utilizing a low vs a standard dosage of heparin.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (5) (pp 834-839),
2012. Date of Publication: November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
OBJECTIVES: Allogeneic blood transfusion and reoperation for postoperative
bleeding after the coronary artery bypass grafting have a negative impact
on the patient outcome. This study aimed at evaluating the effects of
reduced doses of heparin and protamine on the patient outcome, using a
heparin-coated mini-cardiopulmonary bypass (CPB) system.METHODS: Sixty
patients undergoing elective first-time CPB were prospectively randomized
either to have a reduced systemic heparinization [activated clotting time
(ACT) = 250 s] or to a control group perfused with a full heparin dose
(ACT = 420 s). Blood transfusions, ventilation time, early postoperative
bleeding, ICU stay, reoperations for bleeding, postoperative cognitive
status and the level of mobilization were registered.RESULTS: Twenty-nine
patients were randomized to the control group, 27 patients to the low-dose
group and 4 patients were excluded because of protocol violations. Four
patients in the control group received a total of 10 units of packed red
blood cells, and in the low-dose group, no transfusions were given, P =
0.046. No patient was reoperated because of bleeding. The ICU stay was
significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020),
less dependent on oxygen on the first postoperative day (78 vs 97%, P =
0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual
analogue scale 2.0 vs 3.5, P = 0.019) compared with the control
group.CONCLUSIONS: The use of a mini-CPB system combined with a low dose
of heparin reduced the need for blood transfusions and may facilitate the
faster mobilization of the patients. 2012 The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<4>
Accession Number
2012673749
Authors
Giglio M. Dalfino L. Puntillo F. Rubino G. Marucci M. Brienza N.
Institution
(Giglio, Dalfino, Puntillo, Rubino, Marucci, Brienza) Anesthesia and
Critical Care Division, Department of Emergency and Organ Transplantation,
University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Title
Haemodynamic goal-directed therapy in cardiac and vascular surgery. A
systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 15 (5) (pp 878-887),
2012. Date of Publication: November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
In cardiovascular surgery, reduced organ perfusion and oxygen delivery
contribute to increased postoperative morbidity and prolonged intensive
care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic
strategy aiming to increase cardiac output, is helpful in preventing
postoperative complications, but studies in the context of cardiovascular
surgery have produced conflicting results. The purpose of the present
meta-analysis is to determine the effects of perioperative haemodynamic
goal-directed therapy on mortality and morbidity in cardiac and vascular
surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were
searched until July 2011. Randomized controlled trials reporting on adult
cardiac or vascular surgical patients managed with perioperative GDT or
according to routine haemodynamic practice were included. Primary outcome
measures were mortality and morbidity. Data synthesis was obtained by
using odds ratio (OR) with 95% confidence interval (CI) by a random
effects model. An OR <1 favoured GDT. Statistical heterogeneity was
assessed by Q and I² statistics. Eleven articles (five cardiac
surgery and six vascular procedures), enrolling a total sample of 1179
patients, were included in the analysis. As compared with routine
haemodynamic practice, perioperative GDT did not reduce mortality in
either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02;
statistical power 64%). GDT significantly reduced the number of cardiac
patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but
no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P
= 0.58). Perioperative GDT prevents postoperative complications in cardiac
surgery patients, while it has no effect in vascular surgery. The
different characteristics and comorbidities of the population enrolled
could explain these conflicting results. More trials conforming to the
characteristics of low-risk-of-bias studies and enrolling a larger and
well-defined population of patients are needed to better clarify the
effect of GDT in the specific setting of cardiovascular surgery. 2012 The
Author 2012. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2012648130
Authors
Han Y.-L. Zhang Q.-Y. Li Y. Guan S.-Y. Jing Q.-M. Wang Z.-L. Zhao X. Wang
X.-Z. Ma Y.-Y. Wang B. Deng J. Wang G. Kim Y.-H.
Institution
(Han, Zhang, Li, Guan, Jing, Wang, Zhao, Wang, Ma, Wang, Deng, Wang)
Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning,
China
(Kim) Cardiology Department, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Title
Clinical Presentations, Antiplatelet Strategies and Prognosis of Patients
with Stent Thrombosis: An Observational Study of 140 Patients.
Source
PLoS ONE. 7 (10) , 2012. Article Number: e48520. Date of Publication: 31
Oct 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Background: Until now there has been scarce evidence regarding an optimal
antiplatelet strategy and clinical outcomes for patients who had suffered
from stent thrombosis (ST). Methods and Results: 140 patients who suffered
from stent thrombosis were prospectively registered. Patients received
dual (aspirin and 150 mg clopidogrel, N = 66) or triple (additional
cilostazol, N = 74) antiplatelet therapy at the physician's discretion.
Thereafter platelet reactivity and one year clinical outcomes were
analyzed. The primary outcome included the composite of cardiac death,
non-fatal myocardial infarction (MI) or stroke at one year,which developed
in 41 (29.3%) patients, consisting of 31 (22.1%) cardiac death, 9 (6.4%)
non-fatal MI and 1 (1.4%) stroke. Recurrent definite and probable ST
according to ARC definition was observed in 8 (5.7%) and 14 (10.0%)
patients, respectively. Triple therapy was associated with significantly
lower platelet reactivities (50.2+/-17.8, % vs. 59.6+/-17.2, %, P = 0.002)
compared to high dose dual antiplatelet therapy. However, the incidence of
primary events (24.3% vs. 34.8%, P = 0.172) did not differ between triple
and dual antiplatelet therapies. High on-treatment platelet reactivity
(HR: 8.35, 95% CI: 2.234~30.867, P = 0.002) and diabetes (HR: 3.732, 95%
CI: 1.353~10.298, P = 0.011) were independent predictors of primary
events. Conclusions: Patients who suffered from stent thrombosis have a
poor prognosis even after revascularization with intensive antiplatelet
therapy. Triple antiplatelet therapy was more effective in reducing
on-treatment platelet reactivity, compared to high dose dual antiplatelet
therapy. 2012 Han et al.

<6>
Accession Number
2012646696
Authors
Dieleman J.M. Nierich A.P. Rosseel P.M. Van Der Maaten J.M. Hofland J.
Diephuis J.C. Schepp R.M. Boer C. Moons K.G. Van Herwerden L.A. Tijssen
J.G. Numan S.C. Kalkman C.J. Van Dijk D.
Institution
(Dieleman, Moons, Van Herwerden, Numan, Kalkman, Van Dijk) Division of
Anesthesiology, Intensive Care, and Emergency Medicine, University Medical
Center Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands
(Nierich) Isala Klinieken, Zwolle, Netherlands
(Rosseel) Amphia Ziekenhuis, Breda, Netherlands
(Van Der Maaten) University Medical Center, Groningen, Netherlands
(Hofland) Erasmus Medical Center, Rotterdam, Netherlands
(Diephuis) Medisch Spectrum Twente, Enschede, Netherlands
(Schepp) Medical Center, Leeuwarden, Netherlands
(Boer) Vrije Universiteit Medical Center, Amsterdam, Netherlands
(Tijssen) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Intraoperative high-dose dexamethasone for cardiac surgery: A randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 308 (17) (pp
1761-1767), 2012. Date of Publication: 07 Nov 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Prophylactic corticosteroids are often administered during
cardiac surgery to attenuate the inflammatory response to cardiopulmonary
bypass and surgical trauma; however, evidence that routine corticosteroid
use can prevent major adverse events is lacking. Objective: To quantify
the effect of intraoperative high-dose dexamethasone on the incidence of
major adverse events in patients undergoing cardiac surgery. Design,
Setting, and Participants: A multicenter, randomized, double-blind,
placebocontrolled trial of 4494 patients aged 18 years or older undergoing
cardiac surgery with cardiopulmonary bypass at 8 cardiac surgical centers
in the Netherlands enrolled between April 13, 2006, and November 23, 2011.
Intervention: Patients were randomly assigned to receive a single
intraoperative dose of 1 mg/kg dexamethasone (n=2239) or placebo (n=2255).
Main Outcome Measures: A composite of death, myocardial infarction,
stroke, renal failure, or respiratory failure, within 30 days of
randomization. Results: Of the 4494 patients who underwent randomization,
4482 (99.7%) could be evaluated for the primary outcome. A total of 157
patients (7.0%) in the dexamethasone group and 191 patients (8.5%) in the
placebo group reached the primary study end point (relative risk, 0.83;
95% CI, 0.67-1.01; absolute risk reduction, -1.5%; 95% CI, -3.0% to 0.1%;
P=.07). Dexamethasone was associated with reductions in postoperative
infection, duration of postoperative mechanical ventilation, and lengths
of intensive care unit and hospital stays. In contrast, dexamethasone was
associated with higher postoperative glucose levels. Conclusion: In our
trial of adults undergoing cardiac surgery, the use of intraoperative
dexamethasone did not reduce the 30-day incidence of major adverse events
compared with placebo. Trial Registration: clinicaltrials.gov Identifier:
NCT00293592 2012 American Medical Association. All rights reserved.

<7>
Accession Number
2012646695
Authors
Sesso H.D. Christen W.G. Bubes V. Smith J.P. MacFadyen J. Schvartz M.
Manson J.E. Glynn R.J. Buring J.E. Gaziano J.M.
Institution
(Sesso, Christen, Bubes, Smith, MacFadyen, Schvartz, Manson, Glynn,
Buring, Gaziano) Division of Preventive Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Sesso, Buring, Gaziano) Division of Aging, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Gaziano) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Sesso, Manson, Buring) Department of Epidemiology, Harvard School of
Public Health, Boston, MA, United States
(Glynn) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Buring) Department of Ambulatory Care and Prevention, Harvard Medical
School, Boston, MA, United States
(Gaziano) Harvard Medical School, VA Boston Healthcare Center, Boston, MA,
United States
Title
Multivitamins in the prevention of cardiovascular disease in men: The
physicians' health study II randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 308 (17) (pp
1751-1760), 2012. Date of Publication: 07 Nov 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Although multivitamins are used to prevent vitamin and mineral
deficiency, there is a perception that multivitamins may prevent
cardiovascular disease (CVD). Observational studies have shown
inconsistent associations between regular multivitamin use and CVD, with
no long-term clinical trials of multivitamin use. Objective: To determine
whether long-term multivitamin supplementation decreases the risk of major
cardiovascular events among men. Design, Setting, and Participants: The
Physicians' Health Study II, a randomized, double-blind,
placebo-controlled trial of a common daily multivitamin, began in 1997
with continued treatment and follow-up through June 1, 2011. A total of 14
641 male US physicians initially aged 50 years or older (mean, 64.3 [SD,
9.2] years), including 754 men with a history of CVD at randomization,
were enrolled. Intervention: Daily multivitamin or placebo. Main Outcome
Measures: Composite end point of major cardiovascular events, including
nonfatal myocardial infarction (MI), nonfatal stroke, and CVD mortality.
Secondary outcomes included MI and stroke individually. Results: During a
median follow-up of 11.2 (interquartile range, 10.7-13.3) years, there
were 1732 confirmed major cardiovascular events. Compared with placebo,
there was no significant effect of a daily multivitamin on major
cardiovascular events (11.0 and 10.8 events per 1000 person-years for
multivitamin vs placebo, respectively; hazard ratio [HR], 1.01; 95% CI,
0.91-1.10; P=.91). Further, a daily multivitamin had no effect on total MI
(3.9 and 4.2 events per 1000 person-years; HR, 0.93; 95% CI, 0.80-1.09;
P=.39), total stroke (4.1 and 3.9 events per 1000 person-years; HR, 1.06;
95% CI, 0.91-1.23; P=.48), or CVD mortality (5.0 and 5.1 events per 1000
person-years; HR, 0.95; 95% CI, 0.83-1.09; P=.47). A daily multivitamin
was also not significantly associated with total mortality (HR, 0.94; 95%
CI, 0.88-1.02; P=.13). The effect of a daily multivitamin on major
cardiovascular events did not differ between men with or without a
baseline history of CVD (P=.62 for interaction). Conclusion: Among this
population of US male physicians, taking a daily multivitamin did not
reduce major cardiovascular events, MI, stroke, and CVD mortality after
more than a decade of treatment and follow-up. Trial Registration:
clinicaltrials.gov Identifier: NCT00270647 2012 American Medical
Association. All rights reserved.

<8>
Accession Number
2012672151
Authors
Wiesner G. Braun S.L. Gruber M. Gertler R. Lange R. Tassani P. Martin K.
Institution
(Wiesner, Gertler, Tassani, Martin) Institute of Anaesthesiology, German
Heart Centre Munich, Lazarettstr.36, D-80636 Munich, Germany
(Braun) Institute of Laboratory Medicine, German Heart Centre Munich,
Lazarettstr. 36, D-80636 Munich, Germany
(Gruber) Department of Anaesthesiology, University of Regensburg,
Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
(Lange) Department of Cardiovascular Surgery, German Heart Centre Munich,
Lazarettstr 36, D-80636 Munich, Germany
Title
Neither moxifloxacin nor cefuroxime produces significant attenuation of
inflammatory mediator release in patients exposed to cardiopulmonary
bypass: A randomized controlled trial.
Source
Journal of Antimicrobial Chemotherapy. 67 (1) (pp 230-233), 2012. Date of
Publication: 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: In vitro and experimental studies in animals have established
the anti-inflammatory effects of moxifloxacin. Cardiopulmonary bypass
(CPB) leads to an inflammatory response. The aim of this study was to
assess whether the inflammatory cytokine response to CPB is reduced with a
perioperative antibiotic prophylaxis, either moxifloxacin or cefuroxime
(the standard prophylaxis). Patients and methods: Twenty-eight patients
scheduled for elective coronary artery bypass grafting with CPB were
randomly assigned to receive either moxifloxacin or cefuroxime as the
perioperative antibiotic prophylaxis. Interleukin (IL)-6, -8, -10 and
tumour necrosis factor-alpha (TNF-alpha) serum concentrations were
determined at eight time points before and after CPB. Results: In both
groups, all cytokine concentrations significantly increased after the
start of CPB. There were no statistically significant differences between
the moxifloxacin and cefuroxime groups at any point; IL-6 concentrations
[median (interquartile range)] 240 min after CPB, the primary endpoint,
were 364 (192-598) and 465 (325-906) pg/mL (P=0.323), respectively.
Conclusions: Neither moxifloxacin nor cefuroxime produced significant
attenuation of the inflammatory cytokine response to CPB. The reasons why
moxifloxacin did not have significant anti-inflammatory effects in this
unique clinical situation may be: (i) the inflammatory response to CPB may
be different from that of infectious disease states that were used to
establish the immunomodulatory effects of moxifloxacin; and (ii) a single
intravenous dose, which was used in this investigation, may not lead to
high enough plasma and intracellular concentrations. The Author 2011.
Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved.

<9>
Accession Number
2012668237
Authors
Piccolo R. Cassese S. Galasso G. Niglio T. De Rosa R. De Biase C. Piscione
F.
Institution
(Piccolo, Cassese, Galasso, Niglio, De Rosa, De Biase, Piscione)
Department of Clinical Medicine, Cardiovascular Sciences and Immunology,
Federico II University, Via S. Pansini 5, 80131 Naples, Italy
Title
Long-term clinical outcomes following sirolimus-eluting stent implantation
in patients with acute myocardial infarction. A meta-analysis of
randomized trials.
Source
Clinical Research in Cardiology. 101 (11) (pp 885-893), 2012. Date of
Publication: November 2012.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Objectives The aim of this study was to perform a metaanalysis of
randomized trials, evaluating the long-term outcomes of sirolimus-eluting
stents (SES) versus baremetal stents (BMS) in patients with ST-segment
elevation myocardial infarction (STEMI). Background Despite short-term
outcomes of patients with STEMI undergoing primary percutaneous coronary
intervention indicate a benefit of SES in terms of reintervention, several
concerns remain on the long-term safety and efficacy of SES. Methods A
systematic literature search of electronic resources, through October
2011, was performed using specific search terms. Included trials were
randomized studies comparing SES to BMS in STEMI patients, with a
follow-up C3 years. Results Seven trials were included, with a total of
2,364 patients. At a median follow-up of 3 years, SES significantly
reduced the risk of target-vessel revascularization when compared with BMS
[odds ratio (OR), 0.44; 95 % confidence interval (CI), 0.34-0.57;
p<0.0001], without increasing the risk of mortality (OR 0.78; 95 % CI,
0.57-1.08; p = 0.14), reinfarction (OR 0.91; 95 % CI, 0.61-1.35, p = 0.64)
and early to late stent thrombosis (OR 0.77; 95 % CI, 0.49-1.20; p =
0.25). However after the first year, SES did not further reduce
target-vessel revascularization (OR 1.06; 95 % CI, 0.64-1.74; p = 0.83)
and increased the risk of very late stent thrombosis (OR 2.81; 95 % CI,
1.33-5.92; p = 0.007). Conclusions At long-term follow-up, SES compared to
BMS use in STEMI patients reduces the risk of targetvessel
revascularization, without increasing the risk of death and reinfarction.
However, the strong SES efficacy is counterbalanced by a significant risk
of very late stent thrombosis. Springer-Verlag 2012.

<10>
Accession Number
2012670746
Authors
Lin Y.Y. He B. Chen J. Wang Z.N.
Institution
(Lin, Chen, Wang) Department of Cardiothoracic Surgery, Changzheng
Hospital, The Second Military Medical University, Fengyang road 415#,
Shanghai, 200003, China
(He) Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai
Jiaotong University School of Medicine, Kongjiang road 1665#, Shanghai,
200092, China
Title
Can dexmedetomidine be a safe and efficacious sedative agent in
post-cardiac surgery patients? A meta-analysis.
Source
Critical Care. 16 (5) , 2012. Article Number: R169. Date of Publication:
27 Sep 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: The aim of this study was to explore the use of
dexmedetomidine as a safe and efficacious sedative agent in post-cardiac
surgery patients.Methods: A systematic literature search of MEDLINE,
EMBASE, the Cochrane Library and Science Citation Index until January 2012
and review of studies was conducted. Eligible studies were of randomized
controlled trials or cohort studies, comparing dexmedetomidine with a
placebo or an alternative sedative agent in elective cardiac surgery,
using dexmedetomidine for postoperative sedation and available in full
text. Two reviewers independently performed study selection, quality
assessment, and data extraction.Results: The search identified 530
potentially relevant publications; 11 met selection criteria in this
meta-analysis. Our results revealed that dexmedetomidine was associated
with a shorter length of mechanical ventilation (mean difference -2.70
[-5.05, -0.35]), a lower risk of delirium (risk ratio 0.36 [0.21, 0.64]),
ventricular tachycardia (risk ratio 0.27 [0.08, 0.97]) and hyperglycemia
(risk ratio 0.78 [0.61, 0.99]), but may increase the risk of bradycardia
(risk ratio 2.08 [1.16, 3.74]). But there was no significant difference in
ICU stay, hospital stay, and morphine equivalents between the included
studies. Dexmedetomidine may not increase the risk of hypotension, atrial
fibrillation, postoperative nausea and vomiting, reintubation within 5
days, cardiovascular complications, postoperative infection or hospital
mortality.Conclusions: Dexmedetomidine was associated with shorter length
of mechanical ventilation and lower risk of delirium following cardiac
surgery. Although the risk of bradycardia was significantly higher
compared with traditional sedatives, it may not increase length of
hospital stay and hospital mortality. Moreover, dexmedetomidine may
decrease the risk of ventricular tachycardia and hyperglycemia. Thus,
dexmedetomidine could be a safe and efficacious sedative agent in cardiac
surgical patients. 2012 Lin et al.; licensee BioMed Central Ltd.

<11>
Accession Number
2012667277
Authors
Uhlemann M. Adams V. Lenk K. Linke A. Erbs S. Adam J. Thiele H. Hilberg T.
Gutberlet M. Grunze M. Schuler G.C. Mobius-Winkler S.
Institution
(Hilberg) Sports medicine, University Wuppertal, Wuppertal, Germany
(Gutberlet) Department for Radiology, Heart Centre, University of Leipzig,
Leipzig, Germany
(Grunze) MediClin-Klinikum Trassenheide, Trassenheide, Germany
(Uhlemann, Adams, Lenk, Linke, Erbs, Adam, Thiele, Schuler,
Mobius-Winkler) Department of Internal Medicine/Cardiology, Heart Centre,
University of Leipzig, Strumpellstrasse 39, Leipzig, 04289, Germany
Title
Impact of different exercise training modalities on the coronary
collateral circulation and plaque composition in patients with significant
coronary artery disease (EXCITE trial): study protocol for a randomized
controlled trial.
Source
Trials. 13 , 2012. Article Number: 167. Date of Publication: 14 Sep 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Exercise training (ET) in addition to optimal medical therapy
(OMT) in patients with stable coronary artery disease (CAD) has been
demonstrated to be superior to percutaneous coronary interventions (PCI)
with respect to the composite endpoint of death, myocardial infarction,
stroke, revascularization and hospitalization due to worsening of angina.
One mechanism leading to this superiority discussed in the literature is
the increase in coronary collateral blood flow due to ET. Until now, data
demonstrating the positive effect of ET on the collateral blood flow and
the functional capacity of the coronary collateral circulation are still
lacking.Methods/design: The EXCITE trial is a three-armed randomized,
prospective, single-center, open-label, controlled study enrolling 60
patients with stable CAD and at least one significant coronary stenosis
(fractional flow reserve <=0.75). The study is designed to compare the
influence and efficacy of two different 4-week ET programs [high-intensity
interval trainings (IT) versus moderate-intensity exercise training (MT)
in addition to OMT] versus OMT only on collateral blood flow (CBF). The
primary efficacy endpoint is the change of the CBF of the target vessel
after 4 weeks as assessed by coronary catheterization with a pressure wire
during interruption of the antegrade flow of the target vessel by balloon
occlusion. Secondary endpoints include the change in plaque composition as
assessed by intravascular ultrasound (IVUS) after 4 weeks, myocardial
perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen
uptake (V02 peak), change in endothelial function and biomarkers after 4
weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse
cardiovascular events (death from cardiovascular cause, myocardial
infarction, stroke, TIA, target vessel revascularization or
hospitalization) after 12 months.Discussion: The trial investigates
whether ET for 4 weeks increases the CBF in patients with significant CAD
compared to a sedentary control group. It also examines the impact of two
intensities of ET on the CBF as well as the histological plaque
composition. The trial started recruitment in June 2009 and will complete
recruitment until June 2012. First results are expected in December 2012
(4-week follow-up), final results (12-month long-term secondary endpoint)
in December 2013.Trial registration: Clinical trial registration
information-URL: http://www.clinicaltrials.gov.Unique identifier:
NCT01209637. 2012 Uhlemann et al.; licensee BioMed Central Ltd.

<12>
Accession Number
2012661383
Authors
Hammoudeh A. Saleh A. Hamam I. Alhaddad I. Bakri M. Nammas A. Alnaquib A.
Izraiq M. Tarawneh H. Harassis A. Tabbalat R. Khader Y. Al-Mousa E.
Institution
(Hammoudeh, Izraiq, Al-Mousa) Cardiology Department, Istishari Hospital,
Amman, Jordan
(Saleh, Hamam) Cardiology Division, Internal Medicine Department, Jordan
University Hospital, Amman, Jordan
(Alhaddad, Bakri) Cardiology Department, Jordan Hospital Medical Center,
Amman, Jordan
(Nammas, Alnaquib) Cardiology Division, Internal Medicine Department,
Islamic Hospital, Amman, Jordan
(Tarawneh, Harassis, Tabbalat) Cardiology Department, Khalidi Hospital
Medical Center, Amman, Jordan
(Khader) Department of Community Medicine, Public Health and Family
Medicine, School of Medicine Jordan University of Science and Technology,
Irbid, Jordan
Title
The prognostic implications of TIMI risk scores in Jordanian patients with
acute coronary syndrome. Results from the glucometabolic abnormalities in
acute coronary syndrome in Jordan (GLORY) study.
Source
Jordan Medical Journal. 46 (3) (pp 237-245), 2012. Date of Publication:
September 2012.
Publisher
Jordan Medical Association (P.O. Box 915, Amman, Jordan)
Abstract
Background and Aims: Western studies have shown that TIMI (Thrombolysis In
Myocardial Infarction) risk scores predict adverse events in patients with
non ST-elevation acute coronary syndrome (NSTEACS) and ST-elevation
myocardial infarction (STEMI). Whether this also applies to Jordanian
patients is largely unknown. Materials and Methods: We prospectively
followed up 656 patients with ACS for total mortality, combined events of
death, nonfatal MI or urgent coronary revascularization up to one year
after admission. Results: Of the whole group, 472 patients (72%) had
NSTEACS, and 184 patients (28%) had STEMI. Among NSTEACS patients, 31.0%
had a low risk score (total points 0-2 of 7), 43.5% had an intermediate
risk score (total points 3-4), and 25.5% had a high risk score (total
points 5-7). In-hospital mortality was not different in the respective
risk score groups (1.4%, 0.5%, and 3.4%, p = 0.123). At 1 year, mortality
was significantly higher in the high risk score group (12.8%) compared
with the intermediate (4%) and low (1.4%) risk groups (p = 0.001). Among
STEMI patients, 58.6% had a low risk score (total points 0-3 of 13-14),
31.0% had a low intermediate risk score (total points 4-6), 8.0% had a
high intermediate score (total points 7-9), and 2.4% had a high risk score
(total points > 10). In-hospital mortality rate was significantly higher
in the two intermediate risk score groups (7.4%, 14.3%, respectively) and
the high risk score group (50%) compared with the low risk score group
(1.0%, p = 0.001). The high risk and the two intermediate risk groups also
had higher one-year mortality (75%, 28.6% and 16.7%, respectively) than
the low risk group (3.9%, p = 0.001). Similarly, composite events occurred
at a significantly higher rate in patients with high risk scores than
intermediate or low risk scores among NSTEACS and STEMI patients.
Conclusions: In Jordanian ACS patients, high TIMI risk scores were
associated with a high risk of cardiovascular events. Such patients are
candidates for early aggressive therapeutic strategies. 2012 DAR
Publishers/University of Jordan. All Rights Reserved.

<13>
Accession Number
2012663794
Authors
Jensen L.O. Thayssen P. Junker A. Maeng M. Tilsted H.-H. Kaltoft A. Hansen
K.N. Christiansen E.H. Kristensen S.D. Ravkilde J. Madsen M. Sorensen H.T.
Thuesen L. Lassen J.F.
Institution
(Jensen, Thayssen, Junker, Hansen) Department of Cardiology, Odense
University Hospital, Odense, Denmark
(Maeng, Kaltoft, Christiansen, Kristensen, Thuesen, Lassen) Department of
Cardiology, Aarhus University Hospital, Skejby, Denmark
(Tilsted, Ravkilde) Department of Cardiology, Aarhus University Hospital,
Aalborg, Denmark
(Madsen, Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
Title
Comparison of outcomes in patients with versus without diabetes mellitus
after revascularization with everolimus- and sirolimus-eluting stents
(from the SORT OUT IV Trial).
Source
American Journal of Cardiology. 110 (11) (pp 1585-1591), 2012. Date of
Publication: 01 Dec 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Diabetes is associated with increased risk of major adverse cardiac events
(MACEs) after percutaneous coronary intervention. The purpose of this
substudy of the SORT OUT IV trial was to compare clinical outcomes in
patients with and without diabetes mellitus treated with
everolimus-eluting stents (EESs) or sirolimus-eluting stents (SESs). In
total 2,774 patients (390 with diabetes, 14.1%) were randomized to stent
implantation with EESs (n = 1,390, diabetes in 14.0%) or SESs (n = 1,384,
diabetes in 14.2%). Randomization was stratified by presence/absence of
diabetes. The primary end point was MACEs, a composite of cardiac death,
myocardial infarction, definite stent thrombosis, or target vessel
revascularization within 18 months. MACEs were higher in diabetic than in
nondiabetic patients (13.1% vs 6.4%, hazard ratio [HR] 2.08, 95%
confidence interval [CI] 1.51 to 2.86). In diabetic patients, MACEs were
seen in 10.3% of those treated with EESs and in 15.8% of those treated
with SESs (HR 0.63, 95% CI 0.36 to 1.11). In nondiabetic patients, MACEs
occurred in 6.6% of EES-treated and in 6.3% SES-treated patients (HR 1.06,
95% CI 0.77 to 1.46). In diabetics, cardiac death occurred in 3.1% of
EES-treated and in 4.6% of SES-treated patients (HR 0.67, 95% CI 0.24 to
1.89), myocardial infarction occurred in 0.5% of EES-treated and in 3.6%
of SES-treated patients (HR 0.14, 95% CI 0.02 to 1.16), and clinically
driven target lesion revascularization was needed in 3.1% of EES-treated
and in 7.7% of SES-treated patients (HR 0.40, 95% CI 0.15 to 1.02). No
interaction between diabetes status and type of drug-eluting stent was
found for the end points. In conclusion, patients with diabetes have
higher MACE rates than nondiabetics. No significant differences in safety
or efficacy outcomes after EES or SES implantation were present in
nondiabetic or diabetic patients. 2012 Elsevier Inc. All rights reserved.

<14>
Accession Number
2012657623
Authors
Szczeklik W. Devereaux P.J.
Institution
(Szczeklik) 2nd Department of Medicine, Jagiellonian University Medical
College, Krakow, Poland
(Devereaux) Departments of Clinical Epidemiology and Biostatistics and
Medicine, McMaster University, Hamilton, ON, Canada
Title
Troponin T level and mortality risk after noncardiac surgery: Practical
implications of the VISION study.
Source
Polskie Archiwum Medycyny Wewnetrznej. 122 (10) (pp 499-503), 2012. Date
of Publication: 2012.
Publisher
Medycyna Praktyczna (31-066 Krakow31-066Poland)
Abstract
This review article presents the current state of knowledge about major
perioperative cardiovascular complications in noncardiac surgery patients
and the role of the currently available stratification models and
biomarkers in risk prediction. The authors discuss a recent paper
presented by the VISION Investigators in the June edition of the Journal
of the American Medical Association and its practical implications in
day-to-day perioperative practice. According to this study, the authors
conclude that troponin (Tn) measurement up to 3 days after noncardiac
surgery substantially improves perioperative risk estimation, and peak Tn
values (even the levels previously considered as normal) strongly predict
30-day mortality. One in 25 patients with a peak fourth generation
troponin T (TnT) measurement of 0.02 mug/l, 1 in 11 patients with a peak
TnT measurement of 0.03 to 0.29 mug/l, and 1 in 6 patients with a peak TnT
measurement of 0.30 mug/l or higher will die within 30 days of surgery.
Postoperative monitoring of TnT measurements substantially improves risk
stratification after noncardiac surgery and may help identify patients
requiring further therapeutic interventions. Copyright by Medycyna
Praktyczna, 2012.

<15>
Accession Number
2012660565
Authors
Ye Z. Zhang B.-L. Zhao X.-X. Qin Y.-W. Wu H. Cao J. Zhang J.-L. Hu J.-Q.
Zheng X. Xu R.-L.
Institution
(Ye, Zhang, Zhao, Qin, Wu, Cao, Zhang, Hu, Zheng, Xu) Department of
Cardiovascular Diseases, Changhai Hospital, Second Military Medical
University, 168 Changhai Road, Shanghai 200433, China
Title
Intracoronary infusion of bone marrow-derived mononuclear cells
contributes to longstanding improvements of left ventricular performance
and remodelling after acute myocardial infarction: A meta-analysis.
Source
Heart Lung and Circulation. 21 (11) (pp 725-733), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: Conflicting results exist now on the sustained effects of
intracoronary bone marrow-derived mononuclear cells (BMMNCs) infusion in
patients with acute myocardial infarction (AMI). Methods: Systematical
literature search of PubMed, ISI Web of Science, and Cochrane databases
was conducted. We included the randomised controlled trials with at least
12-month follow-up data for AMI patients receiving primary percutaneous
coronary intervention in addition to intracoronary BMMNCs transfer or not
(the control). Summary statistics were calculated using random-effects
models. Results: A total of 10 trials with 757 patients were available for
analysis. The pooled statistics showed intracoronary administration of
BMMNCs significantly improved post-infarction left ventricular ejection
fraction (weight mean differences [WMD]=4.04%, 95% confidence intervals
[CI], 3.01-5.07%; p< 0.01), and attenuated the enlargement of left
ventricular end-diastolic volume (WMD=-6.13. ml, 95%CI, -10.56. ml to
-1.69. ml; p=0.007) as well as infarct size (WMD=-2.47%, 95%CI, -3.79% to
-1.15%; p=0.0002). However, for the major adverse clinical events (MACEs),
there appeared to be neutral results (between-group differences of p>
0.10). Conclusions: Intracoronary BMMNCs infusion leads to longstanding
and moderate improvements of post-infarction left ventricular performance
as well as remodelling. Meanwhile, the procedure did not increase the risk
of MACEs. 2012 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ).

<16>
Accession Number
2012660562
Authors
Dell'Amore A. Caroli G. Nizar A. Cassanelli N. Luciano G. Greco D. Dolci
G. Bini A. Stella F.
Institution
(Dell'Amore, Caroli, Nizar, Cassanelli, Luciano, Greco, Dolci, Bini,
Stella) Thoracic Surgery Operative Unit, S.Orsola Malpighi University
Hospital, Bologna, Italy
Title
Can Topical Application of Tranexamic Acid Reduce Blood Loss in Thoracic
Surgery? A Prospective Randomised Double Blind Investigation.
Source
Heart Lung and Circulation. 21 (11) (pp 706-710), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: The systemic or topical use of antifibrinolytic agents is
effective in reducing postoperative bleeding and blood product transfusion
in cardiac surgery. We sought to study the effect of the topical
application of tranexamic acid into the pleural space to reduce
postoperative bleeding after lung surgery. Methods: This was a prospective
randomised double blind placebo controlled investigation. From May-2010 to
February-2012, 89-patients, scheduled for pulmonary resection, were
randomly allocated to one of the two study groups. Group-A received 5. g
of tranexamic-acid in 100. ml of saline solution. Group-B received 100. ml
of saline solution as placebo. Results: The blood loss in the first 12-h
was significantly less in group-A. The same trend was observed in the
first 24-h but without reaching a true statistical significance. The mean
volume of blood transfusion was statistically lower in group-A. The
analysis between post-operative haemoglobin concentration, haematocrit,
platelet-count, international-normalised-ratio, fibrinogen and
partial-thromboplastin-time of both groups was not statistically
significant. Conclusion: In our experience, the topical use of
tranexamic-acid after lung surgery reduces postoperative bleeding and
blood transfusion volume. The topical administration of tranexamic-acid is
safe without increasing the risk of post-operative complications related
to pharmacological side-effects. 2012 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ).

<17>
Accession Number
2012660557
Authors
Dong M.-F. Ma Z.-S. Wang J.-T. Chai S.-D. Tang P.-Z. Wang L.-X.
Institution
(Dong, Ma, Wang, Chai, Tang, Wang) Department of Cardiac Surgery,
Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical
University, Liaocheng, Shandong 252000, China
(Ma, Wang) School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2650, Australia
Title
Effect of Preoperational Mechanical Ventilation on Short-Term
Postoperative Outcomes in Patients with Severe Tetralogy of Fallot.
Source
Heart Lung and Circulation. 21 (11) (pp 679-683), 2012. Date of
Publication: November 2012.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: This study is designed to investigate the effect of
preoperational mechanical ventilation on the short-term postoperative
outcomes following corrective surgery for severe tetralogy of Fallot
(TOF). Methods: Ninety-two patients (58 males, mean age 20.5 +/- 8.5
months) with severe TOF were randomised into study and control groups. In
the study group, mechanical ventilation was performed in PEEP/PRVC mode in
the intensive care unit to correct blood gas imbalances for the corrective
surgery. In the control group, preoperative oxygen supply was provided via
face mask or nasal tubes. Results: The postoperative mechanical
ventilation time (14.3 +/- 1.9 vs 22.5 +/- 2.2. h, p=0.02), intensive care
stay (2.3 +/- 1.2 vs 4.7 +/- 1.1 d, p= 0.03) and duration for positive
inotropic drug administration (2.5 +/- 1.1 vs 4.8 +/- 1.2. d, p=0.04) in
the study group were shorter than those in the control group. The
postoperative capillary leak syndrome in the study group was lower than
that in the control group (4.3% vs 23.9%, p=0.006). There was no
statistically significant difference in the postoperative mortality
between the study and control groups (2.1% vs 6.5%, p=0.606). Conclusions:
Preoperational mechanical ventilation in patients with severe forms of TOF
was associated with improved short-term outcomes following the corrective
surgery. The effect of the preoperational ventilation on postoperative
mortality requires further investigation. 2012.

<18>
Accession Number
2012663902
Authors
Cao P. De Rango P. Czerny M. Evangelista A. Fattori R. Nienaber C.
Rousseau H. Schepens M.
Institution
(Cao) Vascular Surgery, Ospedale San Camillo, Rome, Italy
(De Rango) Vascular Surgery, Ospedale S. Maria della Misericordia,
Perugia, Italy
(Czerny) Cardiovascular Surgery, Basel, Switzerland
(Evangelista) Cardiology, Hospital Val d'Hebron Barcelona, Barcelona,
Spain
(Fattori) Cardiovascular Radiology, San Salvatore Hospital, Pesaro, Italy
(Nienaber) Interventional Cardiology, University of Rostock, Rostock,
Germany
(Rousseau) Radiology, Toulouse, France
(Schepens) Cardiovascular Surgery, Brugge, Belgium
Title
Systematic review of clinical outcomes in hybrid procedures for aortic
arch dissections and other arch diseases.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (6) (pp 1286-1300.e2),
2012. Date of Publication: December 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Available data on clinical outcomes of hybrid aortic arch
repair are limited, especially for patients with aortic dissection. The
objective of this review was to provide pooled analysis of periprocedural
mortality and neurologic outcomes in hybrid procedures involving the
aortic arch for dissection and other aortic diseases. Methods: Studies
involving hybrid aortic arch procedures (2002-2011) were systematically
searched and reviewed. End points were periprocedural mortality, stroke,
and spinal cord ischemia. Results: A total of 50 studies including 1886
patients were included. Perioperative mortality ranged from 1.6% to 25.0%
with a pooled event ratio of 10.8% (95% confidence intervals [CI],
9.3-12.5). Perioperative stroke, regardless of severity, ranged from 0.8%
to 25.0% (pooled ratio 6.9%; 95% CI, 5.7%-8.4), and spinal cord ischemia,
including permanent and transitory events, ranged from 1.0% to 25.0%
(pooled ratio, 6.8%; 95% CI, 5.6-8.2). Neurologic but no mortality risk
was affected by timing and center volume with decreased rates in more
recent and higher volume studies. In dissected aorta, perioperative
mortality rate was 9.8% (95% CI, 7.7-12.4), stroke 4.3% (95% CI, 3.0-6.3),
and spinal cord ischemia 5.8% (95% CI, 4.2-7.9). Perioperative mortality
was higher in diseases that extended to the ascending aorta (15.1% vs
7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P =.021), whereas there were no
significant differences in the neurologic risks of stroke or spinal cord
ischemia. Conclusions: Hybrid repair of the aortic arch carries not
negligible risks of perioperative mortality and neurologic morbidity. Risk
of neurologic complications has decreased with timing and center volume
and may be limited in dissection repairs. However, contemporary
information on aortic hybrid arch procedures is mainly provided by small
case series or retrospective studies with wide range of results. Copyright
2012 by The American Association for Thoracic Surgery.

<19>
Accession Number
2012663937
Authors
Suri R.M. Michelena H.I. Burkhart H.M. Greason K.L. Daly R.C. Dearani J.A.
Park S.J. Joyce L.D. Stulak J.M. Sundt III T.M. Li Z. Schaff H.V.
Institution
(Suri, Burkhart, Greason, Daly, Dearani, Park, Joyce, Stulak, Schaff)
Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905, United States
(Michelena) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Li) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Sundt III) Division of Cardiac Surgery, Massachusetts General Hospital,
Boston, MA, United States
Title
A prospective, randomized comparison of 3 contemporary bioprosthetic
aortic valves: Should hemodynamic performance influence device selection?.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (6) (pp 1387-1398),
2012. Date of Publication: December 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Latest generation biologic aortic valve prostheses were
designed to improve hemodynamic performance. We sought to determine
whether there are clinically important early differences among these
devices. Methods: Three hundred adults with severe aortic valve stenosis
undergoing aortic valve replacement were randomized to receive the Edwards
Magna, Sorin Mitroflow, or St. Jude Epic bioprostheses (n = 100, n = 101,
n = 99, respectively). Early hemodynamic performance was studied by
echocardiography. Results: Mean patient age was 76 +/- 8 years and there
were 203 men (68%). There were no significant differences in baseline
characteristics among implant groups. Early mortality was 1.7%, and there
were no differences in early adverse events. Postoperative
echocardiography showed small but statistically significant differences
overall between the Magna, Mitroflow, and Epic valves in mean gradient
(14.2 mm Hg, 16.3 mm Hg, 16.5 mm Hg, respectively; P = .011), aortic valve
area (2.05 cm², 1.88 cm², 1.86 cm²,
respectively; P = .012), and indexed aortic valve area (1.05 cm
²/m², 0.97 cm²/m², 0.95 cm
²/m², respectively; P = .012). Prosthetic
performance was similar among all with a small (<=21 mm) aortic annulus.
Patients who received the Magna device with a 23-mm annulus had slightly
greater indexed aortic valve area; those with >23 mm had a slightly lower
transprosthetic gradient. Analogous trends were found when data were
stratified by either commercial implant size or
echocardiography-determined aortic annulus size. Severe patient-prosthesis
mismatch was infrequent overall and was similarly low among devices (P
value not significant). Conclusions: This prospective, randomized
comparison reveals that there are small but consistent early postoperative
hemodynamic differences among current third-generation porcine and
pericardial aortic valve prostheses. The 3 valves studied performed
equally well in patients with a small (<=21 mm) aortic annulus. The Magna
valve had a slightly lower mean gradient in those with larger annular size
(>23 mm). Longitudinal follow-up of these randomized cohorts is essential
to determine late clinical implications of these early postoperative
findings. Copyright 2012 by The American Association for Thoracic
Surgery.

<20>
Accession Number
2012655569
Authors
Li J.-H. Aikebaer Inamdar K.Y. Mula-Ti
Institution
(Li, Aikebaer, Inamdar, Mula-Ti) Department of Cardiac Surgery Division
One, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
830054, China
Title
Effectiveness and safety of coronary artery bypass grafting versus
percutaneous coronary intervention for coronary heart disease combined
with diabetic mellitus: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 12 (9) (pp 1116-1121), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate the effectiveness and security through meta-analysis
of a comprehensive study of efficacy of coronary artery bypass grafting
(CABG) versus drug-eluting stent percutaneous coronary intervention
(DESPCI), for diabetes mellitus with multi-vessel coronary disease.
Methods Databases including The Cochrane Library, PubMed, MEDLINE, EMbase,
CBM, CNKI, WanFang Data and VIP were searched from their establishment
dates to 2010. Published information and conference papers including
references were handsearched. Relevant randomized controlled trials (RCTs)
on diabetic patients with coronary multi-vessel disease treated with
revascularization were collected and screened by two reviewers
independently. After data extraction and quality assessment of the
included studies, metaanalysis was performed using RevMan 5.0. Results A
total of eight studies involving a total of 3 689 cases (CABG group: 1 814
cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses
showed that: compared with the DESPCI group, the CABG group could
significantly reduce postoperative repeat revascularization rate (OR=0.27,
95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events
(OR=0.49, 95% CI 0.38 to 0.62, P<0.000 01). But in reducing mortality rate
(OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00,
95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate
(OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant
differences between the two groups. Conclusion CABG is superior to DES-PCI
in the treatment of diabetic patients with multi-vessel disease. However,
due to the limitation of the quality and quantity of the included studies,
the above conclusion should be tested by conducting more large-scale,
multi-center and prospective RCTs in future. 2012 Editorial Board of Chin
J Evid-based Med.

<21>
Accession Number
2012655567
Authors
Wang S.-L. Shi D.-Z. Wang C.-L.
Institution
(Wang, Shi, Wang) Cardiovascular Center, Xiyuan Hospital, China Academy of
Chinese Medical Sciences, Beijing, China
Title
Prognostic effects of obstructive sleep apnea treated with continuous
positive airway pressure or upper airway surgery on coronary heart
disease: A systematic review.
Source
Chinese Journal of Evidence-Based Medicine. 12 (9) (pp 1105-1109), 2012.
Date of Publication: 2012.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate prognostic impact of treatment with Continuous
Positive Airway Pressure (CPAP) or upper airway surgery on the patients
with obstructive sleep apnea (OSA) and coronary heart disease (CHD).
Methods Database search in The Cochrane Library, PubMed, OVID and CBM
(from establishment dates to October 2009) were conducted. Cohort studies
and randomized controlled trials of OSA with CPAP or upper airway surgery
in CHD patients were identified. We assessed the quality of the included
trials and extracted the relevant data. Statistical analysis was performed
using RevMan 4.3.2 software. Results A total of 4 cohort studies involving
945 participants were included. The results of meta-analysis were as
follows: a) there were no significant differences in the rate of late
lumen loss and 10-year mortality between CHD patients with OSA treated by
CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80,
95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in
the treatment of OSA on CHD patients after PCI had a significant decrease
in the rate of 5-year cardiac death when compared with those untreated OSA
patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no
differences in the rate of 5-year allcause mortality, major adverse
cardiac events (MACE) between the two groups respectively (RR=0.66, 95%CI
0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or
upper airway surgery in treating OSA significantly reduced the risk of
MACE occurrence during the 86.5+/-39 months follow-up period (RR=0.22,
95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that
treating OSA with CPAP or upper airway surgery in CHD patients might be
associ ated with a decrease in the risk of cardiac death. But more studies
are necessary to evaluate prognostic impact of treatment with CPAP or
upper airway surgery on the patients with OSA and CHD. However, due to the
limited quantity and quality of the included studies, more high-quality
studies are need. 2012.

<22>
Accession Number
2012653008
Authors
Budera P. Straka Z. Osmancik P. Vanek T. Jelinek S. Hlavicka J. Fojt R.
Cervinka P. Hulman M. Smid M. Mal M. Widimsk P.
Institution
(Budera, Straka, Osmancik, Vanek, Jelinek, Hlavicka, Fojt, Widimsk)
Cardiocenter, Third Faculty of Medicine, Charles University Prague, Czech
Republic
(Cervinka) Cardiology Department, Masaryk Hospital, Usti nad Labem, Czech
Republic
(Hulman) National Institute of Cardiovascular Diseases, Bratislava,
Slovakia
(Smid) Cardiocenter, Faculty of Medicine in Pilsen, Charles University
Prague, Czech Republic
(Mal) National Institute of Public Health, Prague, Czech Republic
Title
Comparison of cardiac surgery with left atrial surgical ablation vs.
cardiac surgery without atrial ablation in patients with coronary and/or
valvular heart disease plus atrial fibrillation: Final results of the
PRAGUE-12 randomized multicentre study.
Source
European Heart Journal. 33 (21) (pp 2644-2652), 2012. Date of Publication:
November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsSurgical ablation procedure can restore sinus rhythm (SR) in patients
with atrial fibrillation (AF) undergoing cardiac surgery. However, it is
not known whether it has any impact on long-term clinical outcomes.Methods
and resultsThis multicentre study randomized 224 patients with AF
scheduled for valve and/or coronary surgery: group A (left atrial surgical
ablation, n 117) vs. group B (no ablation, n 107). The primary efficacy
outcome was the SR presence (without any AF episode) during a 24 h
electrocardiogram (ECG) after 1 year. The primary safety outcome was the
combined endpoint of death/myocardial infarction/stroke/renal failure at
30 days. A Holter-ECG after 1 year revealed SR in 60.2 of group A patients
vs. 35.5 in group B (P = 0.002). The combined safety endpoint at 30 days
occurred in 10.3 (group A) vs. 14.7 (group B, P = 0.411). All-cause 1-year
mortality was 16.2 (A) vs. 17.4 (B, P = 0.800). Stroke occurred in 2.7 (A)
vs. 4.3 (B) patients (P = 0.319). No difference (A vs. B) in SR was found
among patients with paroxysmal (61.9 vs. 58.3) or persistent (72 vs. 50)
AF, but ablation significantly increased SR prevalence in patients with
longstanding persistent AF (53.2 vs. 13.9, P < 0.001).ConclusionSurgical
ablation improves the likelihood of SR presence post-operatively without
increasing peri-operative complications. However, the higher prevalence of
SR did not translate to improved clinical outcomes at 1 year. Further
follow-ups (e.g. 5-year) are warranted to show any potential clinical
benefit which might occur later. 2012 The Author.

<23>
Accession Number
2012653001
Authors
Hara H. Oyenuga O.A. Tanaka H. Adelstein E.C. Onishi T. McNamara D.M.
Schwartzman D. Saba S. Gorcsan J.
Institution
(Hara, Oyenuga, Tanaka, Adelstein, Onishi, McNamara, Schwartzman, Saba,
Gorcsan) Cardiovascular Institute, University of Pittsburgh, Scaife 564,
200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
Title
The relationship of QRS morphology and mechanical dyssynchrony to
long-term outcome following cardiac resynchronization therapy.
Source
European Heart Journal. 33 (21) (pp 2680-2691), 2012. Date of Publication:
November 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsBecause benefits of cardiac resynchronization therapy (CRT) appear to
be less favourable in non-left bundle branch block (LBBB) patients, this
prospective longitudinal study tested the hypothesis that QRS morphology
and echocardiographic mechanical dyssynchrony were associated with
long-term outcome after CRT.Methods and resultsTwo-hundred and
seventy-eight consecutive New York Heart Association class III and IV CRT
patients with QRS <120 ms and ejection fraction <=35 were studied. The
pre-specified primary endpoint was death, heart transplant, or left
ventricular assist device over 4 years. Dyssynchrony assessed before CRT
included interventricular mechanical delay (IVMD) and speckle-tracking
radial strain using pre-specified cut-offs for each. Of 254 with baseline
quantitative echocardiographic data available, 128 had LBBB, 81 had
intraventricular conduction delay (IVCD), and 45 had right bundle branch
block (RBBB). Radial dyssynchrony was observed in 85 of the patients with
LBBB, 59 with IVCD (*), and 40 with RBBB (*) ( (*)P < 0.01 vs. LBBB). Of
248 (98) with follow-up, LBBB patients had a significantly more favourable
long-term survival than non-LBBB patients. However, non-LBBB patients with
dyssynchrony had a more favourable event-free survival than those without
dyssynchrony: radial dyssynchrony hazard ratio 2.6, 95 confidence interval
(CI) 1.47-4.53 (P = 0.0008) and IVMD hazard ratio 4.9, 95 CI 2.60-9.16 (P
= 0.0007). Right bundle branch block patients who lacked dyssynchrony had
the least favourable outcome.ConclusionNon-LBBB patients with dyssynchrony
had a more favourable long-term survival than non-LBBB patients who lacked
dyssynchrony. Mechanical dyssynchrony and QRS morphology are associated
with outcome following CRT. 2012 The Author.

<24>
Accession Number
70925380
Authors
Moraca R.J. Wanamaker K. Nitzberg D. Bailey S.H. Benckart D. McGregor W.
Maher T. Magovern G.
Institution
(Moraca, Wanamaker, Nitzberg, Bailey, Benckart, McGregor, Maher, Magovern)
Allegheny General Hosp, Pittsburgh, PA, United States
Title
The role of routine carotid artery duplex in patients referred for
coronary artery bypass grafting.
Source
Stroke. Conference: 2012 International Stroke Conference and Nursing
Symposium New Orleans, LA United States. Conference Start: 20120201
Conference End: 20120203. Conference Publication: (var.pagings). 43 (2
Meeting Abstracts) , 2012. Date of Publication: February, 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction In the past decade, there has been an increase in the amount
of patients with medical co-morbidities referred for coronary artery
bypass surgery (CABG). Cerebrovascular accident (CVA) after CABG is a
devastating and multi-factorial problem. Carotid artery disease in
patients undergoing cardiopulmonary bypass procedures may increase the
risk of significant neurological complication. We review the results of
carotid screening, management and outcome of carotid disease in patients
referred for CABG. Methods Between 2008 through 2010, 673 patients were
referred for isolated coronary artery bypass surgery at a single
institution. Patients were identified through a systematic review of The
Department of Cardiothoracic Surgery Society of Thoracic Surgery Outcomes
Database. A retrospective analysis of prospectively collected demographic,
clinical data and outcomes were preformed. All patients with screening
preoperative carotid duplex were reviewed. We defined the degree of
carotid disease as: none to mild stenosis (<50%), moderate stenosis
(50-69%), severe stenosis (70-99%). Results 559 (83%) patients underwent
screening preoperative carotid ultrasonography prior to surgery. Patient
demographics and clinical variable are listed in Table 1. Severity of
carotid disease on preoperative imaging was none/mild (68%), unilateral
moderate disease (17%), bilateral moderate (7%) and severe (8%). 12 (2.1
%) of patients underwent a preoperative carotid endarterectomy and
subsequent CABG, with no peri-operative cardiac events or CVAs. Only 4
(0.7%) patients in the entire series had a peri-operative CVA. Conclusions
Routine use of carotid ultrasound in patients referred for CABG with
aggressive management may reduce the incidence of peri-operative CVA.