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<1>
Accession Number
2012042481
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J.
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, FL, United States
(Firstenberg) Division of Cardiothoracic Surgery, Ohio State University
Medical Center, Columbus, OH, United States
(Price, Topol) Division of Cardiovascular Diseases, Scripps Clinic and
Scripps Translational Science Institute, San Diego, CA, United States
(Tummala) Department of Cardiology, Northeast Georgia Heart Center,
Gainesville, GA, United States
(Hutyra) First Internal Clinic, Faculty Hospital Olomouc, Olomouc, Czech
Republic
(Welsby) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Voeltz) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Chandna) Department of Cardiology, Detar Hospital, Victoria, TX, United
States
(Ramaiah) Deptartment of Surgery, University of Kentucky, Lexington, KY,
United States
(Brtko) Deptartment of Cardiac Surgery, University Hospital, Hradec
Kralove, Czech Republic
(Cannon) Cardiac and Vascular Research Center of Northern Michigan,
Northern Michigan Regional Hospital, Petoskey, MI, United States
(Dyke) SouthEast Texas Cardiovascular Surgery Associates, Humble, TX,
United States
(Liu, Prats) Medicines Company, Parsippany, NJ, United States
(Montalescot) Groupe Hospitalier Pitie-Salpetriere, Universite Paris 6,
INSERM CMR 937, Paris, France
(Manoukian) Sarah Cannon Research Institute, Hospital Corporation of
America, Nashville, TN, United States
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: A randomized controlled trial.
Source
JAMA - Journal of the American Medical Association. 307 (3) (pp 265-274),
2012. Date of Publication: 18 Jan 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Context: Thienopyridines are among the most widely prescribed medications,
but their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding.
Objective: To evaluate the use of cangrelor, an intravenous, reversible
P2Y₁₂ platelet inhibitor for bridging thienopyridine-treated
patients to coronary artery bypass grafting (CABG) surgery. Design,
Setting, and Patients: Prospective, randomized, double-blind,
placebocontrolled, multicenter trial, involving 210 patients with an acute
coronary syndrome (ACS) or treated with a coronary stent and receiving a
thienopyridine awaiting CABG surgery to receive either cangrelor or
placebo after an initial open-label, dose-finding phase (n=11) conducted
between January 2009 and April 2011. Interventions Thienopyridines were
stopped and patients were administered cangrelor or placebo for at least
48 hours, which was discontinued 1 to 6 hours before CABG surgery. Main
Outcome Measures: The primary efficacy end point was platelet reactivity
(measured in P2Y₁₂ reaction units [PRUs]), assessed daily. The
main safety end point was excessive CABG surgery-related bleeding. Results
The dose of cangrelor determined in 10 patients in the open-label stage
was 0.75 mug/kg per minute. In the randomized phase, a greater proportion
of patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P<.001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P=.763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Conclusions: Among patients who discontinue thienopyridine therapy prior
to cardiac surgery, the use of cangrelor compared with placebo resulted in
a higher rate of maintenance of platelet inhibition. Trial Registration:
clinicaltrials.gov Identifier: NCT00767507. 2012 American Medical
Association. All rights reserved.

<2>
Accession Number
2012048144
Authors
Bortolotti U. Milano A.D. Frater R.W.M.
Institution
(Bortolotti) Cardio Thoracic and Vascular Department, University of Pisa
Medical School, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Verona Medical School,
Verona, Italy
(Frater) Department of Cardiothoracic Surgery and Pediatrics, Albert
Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United
States
Title
Mitral valve repair with artificial chordae: A review of its history,
technical details, long-term results, and pathology.
Source
Annals of Thoracic Surgery. 93 (2) (pp 684-691), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Mitral valve repair is considered the procedure of choice for correcting
mitral regurgitation in myxomatous disease, providing long-term results
that are superior to those with valve replacement. The use of artificial
chordae to replace elongated or ruptured chordae responsible for mitral
valve prolapse and severe mitral regurgitation has been the subject of
extensive experimental work to define feasibility, reproducibility, and
effectiveness of this procedure. Artificial chordae made of autologous or
xenograft pericardium have been replaced by chordae made of expanded
polytetrafluoroethylene (PTFE), a material with the unique property of
becoming covered by host fibrosa and endothelium. The use of artificial
chordae made of PTFE has been validated clinically over the past 2 decades
and has been an increasing component of the surgical armamentarium for
mitral valve repair. This article reviews the history, details of the
relevant surgical techniques, long-term results, and fate of artificial
chordae in mitral reconstructive surgery. 2012 The Society of Thoracic
Surgeons.

<3>
Accession Number
2012048143
Authors
Yu L. Gu T. Song L. Shi E. Fang Q. Wang C. Zhao J.
Institution
(Yu, Gu, Shi, Fang, Wang) Department of Cardiac Surgery, First Affiliated
Hospital, China Medical University, Nanjingbei St 155, Shenyang 110001,
China
(Song) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan,
China
(Zhao) Molecular Cardiology Research Institute, Tufts Medical Center,
Boston, MA, United States
Title
Fibrin sealant provides superior hemostasis for sternotomy compared with
bone wax.
Source
Annals of Thoracic Surgery. 93 (2) (pp 641-644), 2012. Date of
Publication: February 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Purpose: The purpose of this study was to evaluate the hemostatic efficacy
and feasibility of direct injection of fibrin sealant into the sternal
marrow cavity in senior patients undergoing on-pump coronary artery bypass
grafting (CABG). Description: A total of 82 senior patients undergoing
on-pump CABG were randomized to the bone wax group (n = 40) or the fibrin
sealant group (n = 42) for the period July 2010 to January 2011.
Evaluation: The fibrin sealanttreated group had less chest drainage in the
first 24 hours (186.67 +/- 49.53 versus 333.75 +/- 60.49 mL), less total
chest drainage (326.19 +/- 67.24 versus 516 +/- 88.46 mL), less packed red
blood cell (PRBC) administration (3.6 +/- 1.25 versus 7.4 +/- 2.13 U),
less fresh frozen plasma (FFP) administration (5.52 +/- 1.64 versus 8.95
+/- 1.77 U), shorter intubation time (40.36 +/- 8.62 versus 46.25 +/-
10.46 hours), and shorter hospital stay (10.45 +/- 1.17 versus 11.03 +/-
1.37 days) compared with the bone wax group. No significant difference in
the incidence of postoperative complications was found. Conclusions:
Direct injection of fibrin sealant into the sternal marrow cavity
significantly reduces the amount of postoperative blood loss and offers an
attractive new treatment alternative for senior patients undergoing
on-pump CABG. 2012 The Society of Thoracic Surgeons.

<4>
Accession Number
2011663572
Authors
Chan Y.-K. Stewart S. Calderone A. Scuffham P. Goldstein S. Carrington
M.J.
Institution
(Chan, Stewart, Calderone, Carrington) Preventative Health, Baker IDI
Heart and Diabetes Institute, St Kilda Rd Central, Melbourne, VIC 8008,
Australia
(Scuffham) School of Medicine, Griffith University, Brisbane, Australia
(Goldstein) School of Public Health and Community Medicine, University of
New South Wales, Sydney, Australia
Title
Exploring the potential to remain "young @ Heart": Initial findings of a
multi-centre, randomised study of nurse-led, home-based intervention in a
hybrid health care system.
Source
International Journal of Cardiology. 154 (1) (pp 52-58), 2012. Date of
Publication: 12 Jan 2012.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Disease management programs have been shown to improve health
outcomes in high risk individuals in many but not all health care systems.
Methods: Young @ Heart is a multi-centre, randomised controlled study of a
nurse-led, home-based intervention (HBI) program vs. usual care (UC) in
privately insured patients in Australia aged >= 45 years following an
acute cardiac admission. Intensity of HBI is tailored to an individual's
clinical stability, management and risk profile. The primary endpoint is
the rate of all-cause stay during a mean of 2.5 years follow-up. Results:
A target of 602 adults (72% men) were randomised to HBI (n = 306) or UC (n
= 296); their initial profiles being well matched. At baseline, 71% were
overweight (body mass index 29.7 +/- 3.9 kg/m²) and 66% had an
elevated blood pressure (153 +/- 18/89 +/- 7 mm Hg). Over half had a
history of smoking and 39% had a sub-optimal total cholesterol level > 4
mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease
(27% with multi-vessel disease and 39% underwent cardiac
revascularisation). A further 20% (120 cases) were treated for a cardiac
arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes
mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a
home visit triggering urgent clinical review and/or enhanced clinical
management in many patients. Conclusions: The Young @ Heart intervention
is a well accepted and potentially effective intervention to reduce
recurrent hospital stay in privately insured cardiac patients in
Australia.

<5>
Accession Number
2012011828
Authors
Yusuf A.M. Warkentin T.E. Arsenault K.A. Whitlock R. Eikelboom J.W.
Institution
(Yusuf, Arsenault, Whitlock, Eikelboom) Population Health Research
Institute, Hamilton, ON, Canada
(Warkentin, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Warkentin) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
Title
Prognostic importance of preoperative anti-PF4/heparin antibodies in
patients undergoing cardiac surgery: A systematic review.
Source
Thrombosis and Haemostasis. 107 (1) (pp 8-14), 2012. Date of
Publication: January 2012.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
It was the objective of this study to obtain best estimates of the
prevalence of anti-PF4/heparin antibodies in patients not suspected to
have clinical heparin-induced thrombocytopenia (HIT) prior to undergoing
cardiac surgery and to determine whether preoperative antibody status and
antibody class is predictive of postoperative thromboembolic outcomes,
non-thromboembolic outcomes, length of stay, and mortality. PubMed and
EMBASE online databases were searched up to July 2011, and we included
studies involving adults undergoing cardiac surgery examining the
relationship between preoperative anti-PF4/heparin antibodies (ELISA) and
postoperative clinical outcomes. Five studies involving a combined total
of 2,332 patients met our inclusion criteria. Preoperative
anti-PF4/heparin antibodies were detected in 5-22% of patients. No study
demonstrated an association between preoperative anti-PF4/heparin
antibodies and postoperative thromboembolic outcomes or mortality. Three
studies demonstrated a statistically significant association between
preoperative anti-PF4/heparin antibodies and length of stay while two
showed an association with non-thromboembolic complications. In the one
study that examined outcomes by anti-PF4/heparin antibody class, IgM
antibodies predicted non-thromboembolic complications and length-of-stay.
None of the studies reported prior heparin exposure, and most studies did
not examine the relationship of the absolute value of antibody titres
(ELISA OD) and risk, nor the incidence of true/clinical HIT in
preoperative positive or negative patients. In conclusion, pre-formed
anti-PF4/heparin antibodies are common in patients undergoing cardiac
surgery, but the available literature does not support that they predict
postoperative thromboembolic complications or death. There does appear to
be an association between anti-PF4/heparin antibodies and
non-thromboembolic adverse events, but a causal relationship is unlikely.
Schattauer 2012.

<6>
Accession Number
2012052746
Authors
Mazza A. Rigatelli G. Piva M. Rampin L. Cardaioli P. Giordan M. Roncon L.
Zattoni L. Zuin M. Al-Nahhas A. Rubello D. Ramazzina E. Ravenni R.
Casiglia E.
Institution
(Mazza, Zuin, Ramazzina) Department of Internal Medicine, Santa Maria
Della Misericordia Hospital, Rovigo, Italy
(Rigatelli, Cardaioli, Giordan) Interventional Cardiology Unit, Division
of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
(Piva) Unit of Nephrology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Rampin, Rubello) Service of Nuclear Medicine and PET/CT Centre,
Department of Imaging, Santa Maria Della Misericordia Hospital, Rovigo,
Italy
(Roncon) Division of Cardiology, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Zattoni) Department of Imaging, Santa Maria Della Misericordia Hospital,
Rovigo, Italy
(Al-Nahhas) Department of Nuclear Medicine, Hammersmith Hospital, London,
United Kingdom
(Casiglia) Department of Clinical and Experimental Medicine, University of
Padua, Padua, Italy
(Ravenni) Department of Neuroscience, Santa Maria Della Misericordia
Hospital, Rovigo, Italy
Title
In high risk hypertensive subjects with incidental and unilateral renal
artery stenosis percutaneous revascularization with stent improves blood
pressure control but not glomerular filtration rate.
Source
Minerva Cardioangiologica. 59 (6) (pp 533-542), 2011. Date of
Publication: December 2011.
Publisher
Edizioni Minerva Medica S.p.A. (Corso Bramante 83-85, Torino 10126, Italy)
Abstract
Aim. In high-risk hypertensive subjects (HTs) with incidental unilateral
renal artery stenosis (RAS), the effectiveness of percutaneous
revascularization with stent (PR-STENT) on blood pressure (BP) and
glomerular filtration rate (GFR) is not established. Methods. Eighteen HTs
aged 65.7+/-9.2 years with angiographically diagnosed unilateral RAS
(260%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP
(mercury sphygmomanometer) and GFR (^99mTc-DTPA clearances
during renal scintigraphy) were evaluated yearly for three years.
Echo-Doppler of renal arteries was performed to verify the anatomic
patency and flow velocities of the reperfused artery. Analysis of variance
compared BP and GFR values changes from baseline to the follow-up;
differences for continuous variables were evaluated between groups with
the Tukey's post hoc test after adjustment for age, change of BP between
baseline and at the follow-up, GFR and body mass index (BMI). Results.
Baseline systolic BP and GFR values were not different between groups. The
significantly greater GFR increase observed in PR-STENT than in NO-STENT
at univariate analysis at the end of follow-up (62.5+/-19.2 vs.
42.24+/-17.6, P<0.02) disappeared after adjustment for confounding
factors. However, systolic BP remained significantly lower in PR-STENT
than in NO-STENT (140.1+/-4.6 vs. 170.0+/-8.3, P<0.0001) also after
adjustment for age, GFR and BMI. Conclusion. PR-STENT reduces systolic BP
without improving GFR. Due to the strong association between high BP and
renal dam-age, this study raises the question on whether PR-STENT should
be performed in all HTs with unilateral and incidental RAS.

<7>
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Accession Number
2012050182
Authors
Voeks J.H. Howard G. Roubin G.S. Malas M.B. Cohen D.J. Sternbergh III W.C.
Aronow H.D. Eskandari M.K. Sheffet A.J. Lal B.K. Meschia J.F. Brott T.G.
Institution
(Voeks) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Howard) Department of Biostatistics, University of Alabama at Birmingham,
Birmingham, AL, United States
(Roubin) Department of Cardiovascular Medicine, Lenox Hill Hospital, New
York, NY, United States
(Malas) Department of Vascular and Endovascular Surgery, Johns Hopkins
Bayview Medical Center, Johns Hopkins Hospital, Baltimore, MD, United
States
(Cohen) Saint Luke's Mid America Heart and Vascular Institute, Kansas
City, MO, United States
(Sternbergh III) Vascular and Endovascular Surgery, Ochsner Health
Systems, New Orleans, LA, United States
(Aronow) Michigan Heart and Vascular Institute, Ypsilanti, MI, United
States
(Eskandari) Division of Vascular Surgery, Northwestern Memorial Hospital,
Chicago, IL, United States
(Sheffet) Department of Surgery, UMDNJ-New Jersey, Medical School, Newark,
NJ, United States
(Lal) Vascular Surgery, University of Maryland, Medical Center, Baltimore,
MD, United States
(Meschia, Brott) Department of Neurology, Mayo Clinic, 4500 San Pablo Rd.,
Griffin Bldg., Jacksonville, FL 32224, United States
Title
Age and outcomes after carotid stenting and endarterectomy: The Carotid
Revascularization Endarterectomy Versus Stenting Trial.
Source
Stroke. 42 (12) (pp 3484-3490), 2011. Date of Publication: December
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose: High stroke event rates among carotid artery
stenting (CAS)-treated patients in the Carotid Revascularization
Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an
a priori hypothesis that age may modify the relative efficacy of CAS
versus carotid endarterectomy (CEA). In the primary CREST report, we
previously noted significant effect modification by age. Here we extend
this investigation by examining the relative efficacy of the components of
the primary end point, the treatment-specific impact of age, and
contributors to the increasing risk in CAS-treated patients at older ages.
Methods: Among 2502 CREST patients with high-grade carotid stenosis,
proportional hazards models were used to examine the impact of age on the
CAS-to-CEA relative efficacy, and the impact of age on risk within
CAS-treated and CEA-treated patients. Results: Age acted as a treatment
effect modifier for the primary end point (P interaction=0.02), with the
efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk
for the primary end point increased with age (P<0.0001) by 1.77-times (95%
confidence interval, 1.38-2.28) per 10-year increment; however, there was
no evidence of increased risk for CEA-treated patients (P=0.27). Stroke
events were the primary contributor to the overall effect modification (P
interaction=0.033), with equal risk at 64 years. The treatment-by-age
interaction for CAS and CEA was not altered by symptomatic status (P=0.96)
or by sex (P=0.45). Conclusions:Outcomes after CAS versus CEA were related
to patient age, attributable to increasing risk for stroke after CAS at
older ages. Patient age should be an important consideration when choosing
between the 2 procedures for treating carotid stenosis. Clinical Trial
Registration: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00004732. 2011 American Heart Association, Inc.

<8>
Accession Number
2012040438
Authors
Udelsmann A. Maciel F.G. Servian D.C.M. Reis E. de Azevedo T.M. Melo
M.D.S.
Institution
(Udelsmann) Anesthesiology Dept. of the Faculdade de Ciencias Medicas
(FCM) of Univ. de Campinas (Unicamp), Brazil
(Maciel) R3, Unicamp, Brazil
(Servian, Reis, de Azevedo) Anesthesiology Sector of the Hospital das
Clinicas da Unicamp, Brazil
(Melo) Student in Surgical Sciences at FCM/Unicamp, Physician of the
Anesthesiology Sector of Hospital das Clinicas da Unicamp, Brazil
Title
Methadone and Morphine during Anesthesia Induction for Cardiac Surgery.
Repercussion in Postoperative Analgesia and Prevalence of Nausea and
Vomiting.
Source
Revista Brasileira de Anestesiologia. 61 (6) (pp 695-701), 2011. Date of
Publication: November 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background and objectives: Pain is an aggravating factor in postoperative
morbidity and mortality especially in large size surgeries. Methods to
effectively fend pain collide with elevated costs and for this reason they
are not accessible in every service. The option would be the use of an
opioid with long half-life, such as methadone. The objective of the
present study was to compare the requirements of postoperative analgesia
in patients who received methadone, morphine, or placebo during anesthetic
induction, besides the prevalence of postoperative nausea and vomiting.
Methods: Fifty-five patients scheduled for cardiac surgery were divided
into three groups and they received during anesthetic induction 20. mg of
methadone, 20. mg of morphine, or placebo. At the end of surgery, patients
were transferred to the ICU where the following parameters were evaluated:
duration of anesthesia, time until extubation, time until the need of the
first analgesic, number of doses required in 24 hours, assessment of
analgesia by the patient, and prevalence of nausea/vomiting. Results:
Differences in the duration of anesthesia and time until extubation were
not observed. The first dose of analgesic in patients who received
methadone was administered later than in patients in the other two groups.
The need of analgesics in the methadone group was lower, quality of
analgesia was better, and prevalence of nausea and vomiting was also
lower. Conclusions: Methadone during anesthetic induction was effective
for analgesia in large size surgeries. Lower incidence of nausea and
vomiting was observed in the methadone group and therefore it is a low
cost option available among us that should be stimulated. 2011 Elsevier
Editora Ltda.

<9>
Accession Number
2012044343
Authors
Campanella A. Bergamasco L. Macri L. Asioli S. Devotini R. Scipioni S.
Barbaro S. Rispoli P. Rinaldi M.
Institution
(Campanella, Devotini, Rinaldi) Thoracic and Cardiovascular Department,
Division of Cardiac Surgery, San Giovanni Battista of Turin Hospital,
University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Bergamasco) Physics Department, University of Turin, Corso Bramante 84,
10126 Turin, Italy
(Macri, Asioli) Biomedical Sciences and Human Oncology Department,
Division of Third Pathological Anatomy, San Giovanni Battista of Turin
Hospital, University of Turin, Corso Bramante 84, 10126 Turin, Italy
(Scipioni, Barbaro) Sanitary Direction Department, Division of Hospital
Hygiene and Management of Sanitary Technologies, San Giovanni Battista of
Turin, Corso Bramante 84, 10126 Turin, Italy
(Rispoli) Thoracic and Cardiovascular Department, Division of Vascular
Surgery, San Giovanni Battista of Turin Hospital, University of Turin,
Corso Bramante 84, 10126 Turin, Italy
Title
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for
coronary artery bypass grafting surgery: study protocol for a randomized
controlled trial.
Source
Trials. 12 , 2011. Article Number: 243. Date of Publication: 18 Nov
2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: In coronary artery bypass grafting surgery, arterial conduits
are preferred because of more favourable long-term patency and outcome.
Anyway the greater saphenous vein continues to be the most commonly used
bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is
increasingly being investigated in order to reduce the morbidity
associated with conventional open vein harvesting, includes postoperative
leg wound complications, pain and patient satisfaction. However, to date
the short and the long-term benefits of the endoscopic technique remain
controversial. This study provides an interesting opportunity to address
this gap in the literature.Methods/Design: Endoscopic Saphenous harvesting
with an Open CO₂System trial includes two parallel vein
harvesting arms in coronary artery bypass grafting surgery. It is an
interventional, single centre, prospective, randomized, safety/efficacy,
cost/effectiveness study, in adult patients with elective planned and
first isolated coronary artery disease. A simple size of 100 patients for
each arm will be required to achieve 80% statistical power, with a
significant level of 0.05, for detecting most of the formulated
hypotheses. A six-weeks leg wound complications rate was assumed to be 20%
in the conventional arm and less of 4% in the endoscopic arm. Previously
quoted studies suggest a first-year vein-graft failure rate of about 20%
with an annual occlusion rate of 1% to 2% in the first six years, with
practically no difference between the endoscopic and conventional
approaches. Similarly, the results on event-free survival rates for the
two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5%
cross-over rate, the goal is to enrol 230 patients from a single Italian
cardiac surgery centre.Discussion: The goal of this prospective randomized
trial is to compare and to test improvement in wound healing, quality of
life, safety/efficacy, cost-effectiveness, short and long-term outcomes
and vein-graft patency after endoscopic open CO₂harvesting
system versus conventional vein harvesting.The expected results are of
high clinical relevance and will show the safety/efficacy or
non-inferiority of one treatment approach in terms of vein harvesting for
coronary artery bypass grafting surgery.Trial registration:
www.clinicalTrials.gov NCT01121341. 2011 Campanella et al; licensee
BioMed Central Ltd.

<10>
Accession Number
2012033331
Authors
Wang K.-Y. Wang H.-W. Xin L.-F. Wang Y.-W. Xue Y.-L.
Institution
(Wang, Wang, Xin, Wang, Xue) Department of Anesthesiology, TEDA
International Cardiovascular Hospital, Tianjin 300457, China
Title
Evaluation of high-concentration sevoflurane for induction and
nasotracheal intubation without muscle relaxant for infants with different
pulmonary blood flow undergoing surgery for congenital heart diseases.
Source
Chinese Medical Journal. 124 (24) (pp 4144-4148), 2011. Date of
Publication: 20111220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Inhalational anesthesia with sevoflurane for endotracheal
intubation without muscle relaxant is now used widely for pediatric
patients. This study assessed the efficacy and safety of induction with
high concentration sevoflurane and of nasotracheal intubation without
muscle relaxant in infants with increased or decreased pulmonary blood
flow (PBF) and undergoing surgery for congenital heart diseases. Methods
Fifty-five infants aged 2-12 months, weighing 4.7-10.0 kg, and scheduled
for congenital cardiac surgery were enrolled. Subjects were divided into
those with increased (IPBF group, n=29) and decreased (DPBF group, n=26)
pulmonary blood flow. All infants received inhalational induction with 8%
sevoflurane in 100.0% oxygen at a gas flow rate of 6 L/min. Nasotracheal
intubation was performed 4 minutes after induction. Sevoflurane
vaporization was decreased to 4.0% for placement of a peripheral
intravenous line and invasive hemodynamic monitors. Five minutes later,
sedatives and muscle relaxant were administered and the vaporizer was
adjusted to 2% for maintenance of anesthesia. Bispectral index (BIS)
scores, circulatory parameters, satisfactory and successful intubation
ratios, adverse reactions, and complications of intubation were recorded.
Results Times to loss of lash and pain reflexes were longer for the DPBF
group (P <0.01). Satisfactory intubation ratios were 93.1% and 61.5% for
the IPBF and DPBF groups, respectively (P=0.008). Successful intubation
ratios were 96.6% and 76.9% for the IPBF and DPBF groups, respectively
(P=0.044). Following sevoflurane inhalation, blood pressures decreased
significantly in the IPBF group but remained stable in the DPBF group. BIS
scores declined to similar stable values, and a "nadir BIS" was recorded
for both groups. No obvious adverse reactions or complications of
intubation were noted perioperatively. Conclusions Induction with high
concentration sevoflurane, although faster for infants with IPBF, is safe
for infants with IPBF or DPBF. However, nasotracheal intubation without
muscle relaxant after induction with high concentration sevoflurane is
less successful and less satisfactory for infants with DPBF and should be
used with caution in this patient group.

<11>
Accession Number
70647913
Authors
Berger J.S. Sallum R.H. Katona B.G. Maya J. Ranganathan G. Mwamburi M.
Institution
(Berger) New York University Medical Center, New York, NY, United States
(Sallum, Ranganathan) United BioSource Corporation, Lexington, MA, United
States
(Katona, Maya) Astra Zeneca LP, Wilmington, DE, United States
(Mwamburi) Tufts University, School of Medicine, Boston, MA, United States
Title
Meta-analysis of the relationship between aspirin dosing and efficacy and
bleeding outcomes in medically managed patients with acute coronary
syndromes (ACS).
Source
Pharmacotherapy. Conference: 2011 Annual Meeting of the American College
of Clinical Pharmacy Pittsburgh, PA United States. Conference Start:
20111016 Conference End: 20111019. Conference Publication: (var.pagings).
31 (10) (pp 320e-321e), 2011. Date of Publication: October 2011.
Publisher
Pharmacotherapy Publications Inc.
Abstract
PURPOSE: Acetylsalicylic acid (ASA) dosing guidelines for ACS treatment
are inconsistent and lack supporting data. This analysis evaluated the
relationship between ASA maintenance dosing and clinical outcomes in
patients with ACS who did not undergo revascularization and are managed
medically. METHODS: A meta-analysis was conducted with random-effects
modeling to estimate the frequency of clinical outcomes for low (75-149
mg) and high (150-325 mg) doses of ASA, using data from worldwide clinical
and observational trials published from Jan 1995 to Feb 2010, available
from PubMed, EMBASE and Current Contents. Clinical outcomes measured were:
revascularization rate (overall rate, percutaneous coronary intervention
[PCI] or coronary artery bypass graft [CABG]), cardiovascular (CV) death,
all-cause death, myocardial infarction (MI), stroke, and bleeding at 1, 3,
6 and 12 months. RESULTS: Sixty-eight studies including 207,523 patients
were accepted and appraised for quality using Oxford Centre for Evidence-
Based Medicine scoring. Significant heterogeneity was seen in the results
(quantified using the Cochran's Q statistics and the I²
measures), due to differences in enrolment procedures, medical management
regimens and timing of administration, study designs and some
inconsistencies in the definitions of bleeding and MACE. At one month, the
incidence of clinical outcomes with high- and low-dose ASA groups were
4.9% and 5.0% for MI; 6.3% and 3.7% for revascularization; 1.4% and 1.3%
for stroke; 5.5% and 3.4% for CV death; 5.7% and 4.3% for all cause death;
and 4.0% and 1.7% for major bleeding, respectively. Meta regression
demonstrated a significant association between aspirin dose and major
bleeding (p=0.037). Further data will be presented at the meeting.
CONCLUSIONS: This analysis suggests that in patients receiving medical
management for ACS, major bleeding occurred more frequently in patients
who received higher doses of ASA. ASA dose does not have a statistically
significant impact on the other outcomes analyzed.

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<1>
Accession Number
2012013528
Authors
Whitlow P.L. Feldman T. Pedersen W.R. Lim D.S. Kipperman R. Smalling R.
Bajwa T. Herrmann H.C. Lasala J. Maddux J.T. Tuzcu M. Kapadia S. Trento A.
Siegel R.J. Foster E. Glower D. Mauri L. Kar S.
Institution
(Whitlow, Tuzcu, Kapadia) Department of Cardiovascular Medicine, J2-3,
Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
(Feldman) Northshore University Health System, Chicago, IL, United States
(Pedersen) Minneapolis Heart Institute and Foundation, Minneapolis, MN,
United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Kipperman) Oklahoma Heart Hospital, Oklahoma City, OK, United States
(Smalling) Memorial Hermann Heart and Vascular Institute, Houston, TX,
United States
(Bajwa) Aurora Health Center, West Bend, WI, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Lasala) Washington University, St. Louis, MO, United States
(Maddux) International Heart Institute of Montana, Missoula, MT, United
States
(Trento, Siegel, Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Foster) University of California, San Francisco, San Francisco, CA,
United States
(Glower) Duke University Medical Center, Durham, NC, United States
(Mauri) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
Title
Acute and 12-month results with catheter-based mitral valve leaflet
repair: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk
Study.
Source
Journal of the American College of Cardiology. 59 (2) (pp 130-139), 2012.
Date of Publication: 10 Jan 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High
Risk Study (HRS) assessed the safety and effectiveness of the MitraClip
device (Abbott Vascular, Santa Clara, California) in patients with
significant mitral regurgitation (MR) at high risk of surgical mortality
rate. Background: Patients with severe MR (3 to 4+) at high risk of
surgery may benefit from percutaneous mitral leaflet repair, a potentially
safer approach to reduce MR. Methods: Patients with severe symptomatic MR
and an estimated surgical mortality rate of >=12% were enrolled. A
comparator group of patients screened concurrently but not enrolled were
identified retrospectively and consented to compare survival in patients
treated by standard care. Results: Seventy-eight patients underwent the
MitraClip procedure. Their mean age was 77 years, >50% had previous
cardiac surgery, and 46 had functional MR and 32 degenerative MR.
MitraClip devices were successfully placed in 96% of patients.
Protocol-predicted surgical mortality rate in the HRS and concurrent
comparator group was 18.2% and 17.4%, respectively, and Society of
Thoracic Surgeons calculator estimated mortality rate was 14.2% and 14.9%,
respectively. The 30-day procedure-related mortality rate was 7.7% in the
HRS and 8.3% in the comparator group (p = NS). The 12-month survival rate
was 76% in the HRS and 55% in the concurrent comparator group (p = 0.047).
In surviving patients with matched baseline and 12-month data, 78% had an
MR grade of <=2+. Left ventricular end-diastolic volume improved from 172
ml to 140 ml and end-systolic volume improved from 82 ml to 73 ml (both p
= 0.001). New York Heart Association functional class improved from III/IV
at baseline in 89% to class I/II in 74% (p < 0.0001). Quality of life was
improved (Short Form-36 physical component score increased from 32.1 to
36.1 [p = 0.014] and the mental component score from 45.5 to 48.7 [p =
0.065]) at 12 months. The annual rate of hospitalization for congestive
heart failure in surviving patients with matched data decreased from 0.59
to 0.32 (p = 0.034). Conclusions: The MitraClip device reduced MR in a
majority of patients deemed at high risk of surgery, resulting in
improvement in clinical symptoms and significant left ventricular reverse
remodeling over 12 months. (Pivotal Study of a Percutaneous Mitral Valve
Repair System [EVEREST II]; NCT00209274). 2012 by the American College of
Cardiology Foundation.

<2>
Accession Number
2012035869
Authors
Fernandez-Sabe N. Cervera C. Farinas M.C. Bodro M. Munoz P. Gurgui M.
Torre-Cisneros J. Martin-Davila P. Noblejas A. Len O. Garcia-Reyne A. Del
Pozo J.L. Carratala J.
Institution
(Fernandez-Sabe, Bodro, Carratala) Infectious Disease Service, Institut
d'Investigacio Biomedica de Bellvitge (IDIBELL), Hospital Universitari de
Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
(Cervera) Infectious Disease Service, Hospital Clinic, University of
Barcelona, Spain
(Farinas) Infectious Disease Unit, Hospital Universitario Marques de
Valdecilla, University of Cantabria, Santander, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
Hospital General Universitario Gregorio Maranon, Universidad Complutense
de Madrid, Spain
(Gurgui) Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau,
Universitat Autonoma de Barcelona, Spain
(Torre-Cisneros) Unidad Clinica de Enfermedades Infecciosas, Hospital
Universitario Reina Sofia-IMIBIC, Universidad de Cordoba, Spain
(Martin-Davila) Department of Infectious Diseases, Hospital Universitario
Ramon y Cajal, Spain
(Noblejas) Transplant Department, Hospital Universitario Puerta de Hierro,
Madrid, Spain
(Len) Infectious Disease Service, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Garcia-Reyne) Infectious Disease Unit, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Del Pozo) Infectious Diseases Division, Clinica Universidad de Navarra,
Spain
Title
Risk factors, clinical features, and outcomes of toxoplasmosis in
solid-organ transplant recipients: A matched case-control study.
Source
Clinical Infectious Diseases. 54 (3) (pp 355-361), 2012. Date of
Publication: 01 Feb 2012.
Publisher
Oxford University Press (2001 Evans Road, Cary NC 27513, United States)
Abstract
Background. Solid-organ transplant (SOT) recipients are considered to be
at increased risk for toxoplasmosis. However, risk factors for this
infection have not been assessed. The aim of this study was to determine
the risk factors, clinical features, and outcomes of toxoplasmosis in SOT
recipients. Methods. A multicenter, matched case-control study (1:2 ratio)
was conducted between 2000 and 2009. Control subjects were matched for
center, transplant type, and timing. Cases were identified from the
hospitals' microbiology and transplantation program databases. Logistic
regression was performed to identify independent risk factors. Results.
Twenty-two cases (0.14%) of toxoplasmosis were identified among 15 800
SOTs performed in 11 Spanish hospitals, including 12 heart, 6 kidney, and
4 liver recipients. Diagnosis was made by seroconversion (n = 17),
histopathologic examination (n = 5), polymerase chain reaction (n = 2),
and autopsy (n = 2). In a comparison of case patients with 44 matched
control subjects, a negative serostatus prior to transplantation was the
only independent risk factor for toxoplasmosis (odds ratio, 15.12 [95%
confidence interval, 2.37-96.31]; P =. 004). The median time to diagnosis
following transplantation was 92 days. Primary infection occurred in 18
(81.8%) cases. Manifestations included pneumonitis (n = 7), myocarditis (n
= 5), brain abscesses (n = 5), chorioretinitis (n = 3), lymph node
enlargement (n = 2), hepatosplenomegaly (n = 2), and meningitis (n =1).
Five patients (22.7%) had disseminated disease. Crude mortality rate was
13.6% (3 of 22 patients). Conclusions. Although uncommon, toxoplasmosis in
SOT patients causes substantial morbidity and mortality. Seronegative
recipients are at high risk for developing toxoplasmosis and should be
given prophylaxis and receive careful follow-up. The Author 2011.
Published by Oxford University Press on behalf of the Infectious.

<3>
Accession Number
2012033138
Authors
Nojiri T. Yamamoto K. Maeda H. Takeuchi Y. Funakoshi Y. Inoue M. Okumura
M.
Institution
(Nojiri, Maeda, Takeuchi, Funakoshi) Department of General Thoracic
Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka City
560-8552, Osaka, Japan
(Nojiri, Inoue, Okumura) Department of General Thoracic Surgery, Osaka
University, Graduate School of Medicine, Suita-City, Japan
(Yamamoto) Department of Cardiology, Osaka University, Graduate School of
Medicine, Suita-City, Japan
Title
Effect of low-dose human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer: A double-blind, placebo-controlled study.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 488-494),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We previously reported that patients with preoperative B-type
natriuretic peptide levels of 30 pg/mL or more have increased risk of
postoperative atrial fibrillation after pulmonary resection. This study
evaluated the effects of human atrial natriuretic peptide on postoperative
atrial fibrillation in patients undergoing pulmonary resection for lung
cancer. Methods: A prospective, randomized study was conducted with 40
patients who had preoperative elevated B-type natriuretic peptide (>=30
pg/mL) and underwent a scheduled pulmonary resection for lung cancer.
Results were compared between patients who received low-dose human atrial
natriuretic peptide and those who received a placebo. The primary end
point was the incidence of postoperative atrial fibrillation during the
first 4 days after surgery. Results: The incidence of postoperative atrial
fibrillation was significantly lower in the human atrial natriuretic
peptide group than in the placebo group (10% vs 60%; P < .001). Patients
in the human atrial natriuretic peptide group also showed significantly
lower white blood cell counts and C-reactive protein levels after surgery.
Conclusions: Continuous infusion of low-dose human atrial natriuretic
peptide during lung cancer surgery had a prophylactic effect against
postoperative atrial fibrillation after pulmonary resection in patients
with preoperative elevation of B-type natriuretic peptide levels. A larger
sample size is needed to establish the safety and efficacy of this
intervention. 2012 by The American Association for Thoracic Surgery.

<4>
Accession Number
2012033160
Authors
Desai S.P. Henry L.L. Holmes S.D. Hunt S.L. Martin C.T. Hebsur S. Ad N.
Institution
(Desai, Henry, Holmes, Hunt, Martin, Hebsur, Ad) Inova Heart and Vascular
Institute, 3300 Gallows Road, Falls Church, VA 22042, United States
Title
Strict versus liberal target range for perioperative glucose in patients
undergoing coronary artery bypass grafting: A prospective randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 318-325),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: The purpose of this study was to test the hypothesis that a
liberal blood glucose strategy (121-180 mg/dL) is not inferior to a strict
blood glucose strategy (90-120 mg/dL) for outcomes in patients after
first-time isolated coronary artery bypass grafting and is superior for
glucose control and target blood glucose management. Methods: A total of
189 patients undergoing coronary artery bypass grafting were investigated
in this prospective randomized study to compare 2 glucose control
strategies on patient perioperative outcomes. Three methods of analyses
(intention to treat, completer, and per protocol) were conducted. Observed
power was robust (>80%) for significant results. Results: The groups were
similar on preoperative hemoglobin A _1c and number of diabetic
patients. The liberal group was found to be noninferior to the strict
group for perioperative complications and superior on glucose control and
target range management. The liberal group had significantly fewer
patients with hypoglycemic events (<60 mg/dL; P < .001), but severe
hypoglycemic events (<40 mg/dL) were rare and no group differences were
found (P = .23). These results were found with all 3 methods of analysis
except for blood glucose variability, maximum blood glucose, and
perioperative atrial fibrillation. Conclusions: This study demonstrated
that maintenance of blood glucose in a liberal range after coronary artery
bypass grafting led to similar outcomes compared with a strict target
range and was superior in glucose control and target range management. On
the basis of the results of this study, a target blood glucose range of
121 to 180 mg/dL is recommended for patients after coronary artery bypass
grafting as advocated by the Society of Thoracic Surgeons. 2012 by The
American Association for Thoracic Surgery.

<5>
Accession Number
2012033153
Authors
Lee H.J. Kim Y.T. Park P.J. Shin Y.S. Kang K.N. Kim Y. Kim C.W.
Institution
(Lee, Kim) Department of Molecular Oncology, Cancer Research Institute,
Seoul National University, Seoul, South Korea
(Lee) National Evidence-Based Healthcare Collaborating Agency, Seoul,
South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Clinical Research
Institute, Seoul National University Hospital, Seoul, South Korea
(Park, Shin, Kang) Bioinfra Inc, Cancer Research Institute, Seoul National
University, Seoul, South Korea
(Kim) Department of Statistics, Seoul National University, Seoul, South
Korea
(Kim) Department of Pathology, Cancer Research Institute, Seoul National
University, Seoul, South Korea
Title
A novel detection method of non-small cell lung cancer using multiplexed
bead-based serum biomarker profiling.
Source
Journal of Thoracic and Cardiovascular Surgery. 143 (2) (pp 421-427),
2012. Date of Publication: February 2012.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: Non-small cell lung cancer (NSCLC) is the leading cause of
cancer-related mortality. Development of an early diagnosis method may
improve survivals. We aimed to develop a new diagnostic model for NSCLC
using serum biomarkers. Methods: We set up a patient group diagnosed with
NSCLC (n = 122) and a healthy control group (n = 225). Thirty serum
analytes were selected on the basis of previous studies and a literature
search. An antibody-bead array of 30 markers was constructed using the
Luminex bead array platform (Luminex Inc, Austin, Tex) and was analyzed.
Each marker was ranked by importance using the random forest method and
then selected. Using selected markers, multivariate classification
algorithms were constructed and were validated by application to
independent validation cohort of 21 NSCLC and 28 control subjects.
Results: There was no difference in demographics between patients and the
control population except for age (64.8 +/- 10.0 for patients vs 53.0 +/-
7.6 years for the control group). Among the 30 serum proteins, 23 showed a
difference between the 2 groups (12 increased and 11 decreased in the
patient group). We found the highest accuracy of multivariate
classification algorithms when using the 5 highest-ranked biomarkers
(A1AT, CYFRA 21-1, IGF-1, RANTES, AFP). When we applied the algorithms on
a validation cohort, each method recognized the patients from the controls
with high accuracy (89.8% with random forest, 91.8% with support vector
machine, 88.2% with linear discriminant analysis, and 90.5% with logistic
regression). Conclusions: We confirmed that a new diagnostic method using
5 serum biomarkers profiling constructed by multivariate classification
algorithms could distinguish NSCLC from healthy controls with high
accuracy. 2012 by The American Association for Thoracic Surgery.

<6>
Accession Number
2012041563
Authors
van Loon R.B. Veen G. Baur L.H.B. Kamp O. Bronzwaer J.G.F. Twisk J.W.R.
Verheugt F.W.A. van Rossum A.C.
Institution
(van Loon, Veen, Kamp, Bronzwaer, van Rossum) Department of Cardiology, VU
University Medical Center, Amsterdam, Netherlands
(Baur) Department of Cardiology, Atrium Medical Center Parkstad, Heerlen
and Faculty of Health, Medicine and Life Sciences, University Maastricht,
Netherlands
(Twisk) Department of Clinical Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, Netherlands
(Verheugt) Heartcenter, University Medical Center, St Radboud, Nijmegen,
Netherlands
Title
Improved clinical outcome after invasive management of patients with
recent myocardial infarction and proven myocardial viability: Primary
results of a randomized controlled trial (VIAMI-trial).
Source
Trials. 13 , 2012. Article Number: 1. Date of Publication: 03 Jan
2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) not
treated with primary or rescue percutaneous coronary intervention (PCI)
are at risk for recurrent ischemia, especially when viability in the
infarct-area is present. Therefore, an invasive strategy with PCI of the
infarct-related coronary artery in patients with viability would reduce
the occurrence of a composite end point of death, reinfarction, or
unstable angina (UA).Methods: Patients admitted with an (sub)acute
myocardial infarction, who were not treated by primary or rescue PCI, and
who were stable during the first 48 hours after the acute event, were
screened for the study. Eventually, we randomly assigned 216 patients with
viability (demonstrated with low-dose dobutamine echocardiography) to an
invasive or a conservative strategy. In the invasive strategy stenting of
the infarct-related coronary artery was intended with abciximab as adjunct
treatment. Seventy-five (75) patients without viability served as registry
group. The primary endpoint was the composite of death from any cause,
recurrent myocardial infarction (MI) and unstable angina at one year. As
secondary endpoint the need for (repeat) revascularization procedures and
anginal status were recorded.Results: The primary combined endpoint of
death, recurrent MI and unstable angina was 7.5% (8/106) in the invasive
group and 17.3% (19/110) in the conservative group (Hazard ratio 0.42; 95%
confidence interval [CI] 0.18-0.96; p = 0.032). During follow up
revascularization-procedures were performed in 6.6% (7/106) in the
invasive group and 31.8% (35/110) in the conservative group (Hazard ratio
0.18; 95% CI 0.13-0.43; p < 0.0001). A low rate of recurrent ischemia was
found in the non-viable group (5.4%) in comparison to the
viable-conservative group (14.5%). (Hazard-ratio 0.35; 95% CI 0.17-1.00; p
= 0.051).Conclusion: We demonstrated that after acute MI (treated with
thrombolysis or without reperfusion therapy) patients with viability in
the infarct-area benefit from a strategy of early in-hospital stenting of
the infarct-related coronary artery. This treatment results in a long-term
uneventful clinical course. The study confirmed the low risk of recurrent
ischemia in patients without viability. Trial registration:
ClinicalTrials.gov: NCT00149591. 2012 van Loon et al; licensee BioMed
Central Ltd.

<7>
Accession Number
22253393
Authors
Angiolillo D.J. Firstenberg M.S. Price M.J. Tummala P.E. Hutyra M. Welsby
I.J. Voeltz M.D. Chandna H. Ramaiah C. Brtko M. Cannon L. Dyke C. Liu T.
Montalescot G. Manoukian S.V. Prats J. Topol E.J. BRIDGE Investigators
Institution
(Angiolillo) Department of Cardiology, University of Florida,
Jacksonville, USA.
Title
Bridging antiplatelet therapy with cangrelor in patients undergoing
cardiac surgery: a randomized controlled trial.
Source
JAMA : the journal of the American Medical Association. 307 (3) (pp
265-274), 2012. Date of Publication: 18 Jan 2012.
Abstract
Thienopyridines are among the most widely prescribed medications, but
their use can be complicated by the unanticipated need for surgery.
Despite increased risk of thrombosis, guidelines recommend discontinuing
thienopyridines 5 to 7 days prior to surgery to minimize bleeding. To
evaluate the use of cangrelor, an intravenous, reversible P2Y(12) platelet
inhibitor for bridging thienopyridine-treated patients to coronary artery
bypass grafting (CABG) surgery. Prospective, randomized, double-blind,
placebo-controlled, multicenter trial, involving 210 patients with an
acute coronary syndrome (ACS) or treated with a coronary stent and
receiving a thienopyridine awaiting CABG surgery to receive either
cangrelor or placebo after an initial open-label, dose-finding phase (n =
11) conducted between January 2009 and April 2011. Interventions
Thienopyridines were stopped and patients were administered cangrelor or
placebo for at least 48 hours, which was discontinued 1 to 6 hours before
CABG surgery. The primary efficacy end point was platelet reactivity
(measured in P2Y(12) reaction units [PRUs]), assessed daily. The main
safety end point was excessive CABG surgery-related bleeding. The dose of
cangrelor determined in 10 patients in the open-label stage was 0.75
mug/kg per minute. In the randomized phase, a greater proportion of
patients treated with cangrelor had low levels of platelet reactivity
throughout the entire treatment period compared with placebo (primary end
point, PRU <240; 98.8% (83 of 84) vs 19.0% (16 of 84); relative risk [RR],
5.2 [95% CI, 3.3-8.1] P < .001). Excessive CABG surgery-related bleeding
occurred in 11.8% (12 of 102) vs 10.4% (10 of 96) in the cangrelor and
placebo groups, respectively (RR, 1.1 [95% CI, 0.5-2.5] P = .763). There
were no significant differences in major bleeding prior to CABG surgery,
although minor bleeding episodes were numerically higher with cangrelor.
Among patients who discontinue thienopyridine therapy prior to cardiac
surgery, the use of cangrelor compared with placebo resulted in a higher
rate of maintenance of platelet inhibition. clinicaltrials.gov Identifier:
NCT00767507.

<8>
Accession Number
2012028337
Authors
Yazici D. Tas S. Emir H. Sunar H.
Institution
(Yazici) Sub-department of Endocrinology and Metabolism, Department of
Internal Medicine, School of Medicine, Marmara University, Istanbul,
Turkey
(Tas, Sunar) Cardiac and Vascular Surgery Clinic, Kartal Kosuyolu
Education and Research Hospital, Istanbul, Turkey
(Emir) Diabetes Education Nurse, Kartal Education and Research Hospital,
Istanbul, Turkey
Title
A Comparison of preprandial mixed insulin given three times daily and
basal-bolus insulin therapy started postoperatively on patients having
coronary artery bypass graft surgery.
Source
Marmara Medical Journal. 25 (1) (pp 16-19), 2012. Date of Publication:
2012.
Publisher
Marmara University (Haydarpasa, Istanbul, Turkey)
Abstract
Objective: Insulin therapy initiated after coronary artery bypass graft
(CABG) surgery has decreased long-term mortality. The aim was to compare
the effectiveness of prandial premixed therapy (PPT) using insulin thrice
daily and basal-bolus therapy (BBT) on patients having CABG surgery.
Patients and Methods: Thirty-four patients having CABG surgery were
included. Fasting blood glucose (FBG), postprandial blood glucose (PPBG),
hemoglobin A1c (HbA1c) and hemoglobin levels were determined
preoperatively and at the first week postoperatively when the patients
were randomized to either PPT or BBT. Initial measurements were repeated
at the end of three months. Results: Seventeen patients (F/M:9/8;
61.5+/-8.5 years) were assigned on a random basis to the mixed insulin arm
and 17 patients (F/M:10/7; 57.4+/-9.2 years) to the basal-bolus arm. FBG,
PPBG and HbA1c levels of both groups (7.6+/-0.8 % vs 6.7+/-0.5 % in the
BBT and 7.3+/-0.7 % vs 7.3+/-1.0 % in the PPT group) at the end of the 3
months were not different than at the time of randomization. The
percentage of patients reaching HbA1c levels below 6.0%, 6.5% and 7.0%
were higher in the BBT group compared to the PPT group. Conclusion: For
patients who had undergone CABG surgery, BBT provided more patients with
HbA1c levels below the target than did PPT. Marmara Medical Journal,
Published by Galenos Publishing.

<9>
Accession Number
2012031984
Authors
De Luca G. Iorio S. Venegoni L. Marino P.
Institution
(De Luca, Iorio, Venegoni, Marino) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carit, Eastern Piedmont
University, Novara, Italy
Title
Evaluation of intracoronary adenosine to prevent periprocedural
myonecrosis in elective percutaneous coronary intervention (from the
PREVENT-ICARUS trial).
Source
American Journal of Cardiology. 109 (2) (pp 202-207), 2012. Date of
Publication: 15 Jan 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Great interest has focused on pharmacotherapy to prevent periprocedural
myocardial injury during elective percutaneous coronary intervention
(PCI). The aim of the present trial was to investigate the benefits of
preprocedural intracoronary administration of high-dose adenosine during
elective PCI. This was a single-center, double-blind, randomized trial of
patients undergoing elective PCI. The patients were randomized (1:1) by
sealed envelops to intracoronary adenosine (120 mug for the right coronary
artery and 180 mug for the left coronary artery) or placebo. The primary
study end point was a periprocedural increase in troponin I >3 times the
upper limit of normal. The secondary study end points were (1) the
corrected Thrombolysis In Myocardial Infarction frame count; (2) troponin
I release >10 times the upper limit of normal; (3) creatine kinase-MB mass
release <3 times the upper limit of normal; and (4) the combined
cumulative incidence of in-hospital death, periprocedural myocardial
infarction, and in-hospital urgent target vessel revascularization. The
safety end point was the occurrence of bradycardia and ventricular
arrhythmias during study drug administration. From November 2009 to
September 2010, we randomized 260 patients who were undergoing elective
PCI to intracoronary adenosine (n = 130) or placebo (n = 130). A greater
prevalence of calcified lesions was observed in the adenosine group (p =
0.002). In contrast, a greater prevalence of type C lesions (p = 0.091),
chronic occlusions (p = 0.015), worse preprocedural Thrombolysis In
Myocardial Infarction flow (p = 0.038), and more severely stenotic lesions
(p = 0.005) were observed in the placebo group. No difference was found in
the primary (67.7% vs 70%, p = 0.69) or secondary end points. No serious
side effects were observed with adenosine. In conclusion, our randomized
trial showed that preprocedural intracoronary administration of a single
high-dose bolus of adenosine does not provide any benefit in terms of
periprocedural myonecrosis in patients undergoing elective PCI. 2012
Elsevier Inc.

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<1>
[Use Link to view the full text]
Accession Number
2012014641
Authors
Heusch G. Musiolik J. Kottenberg E. Peters J. Jakob H. Thielmann M.
Institution
(Heusch, Musiolik) Institut fur Pathophysiologie, Universitatsklinikum
Essen, Hufelandstr 55, 45122 Essen, Germany
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Jakob, Thielmann) Klinik fur Thorax- und Kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Essen, Germany
Title
STAT5 activation and cardioprotection by remote ischemic preconditioning
in humans.
Source
Circulation Research. 110 (1) (pp 111-115), 2012. Date of Publication:
06 Jan 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Rationale: The heart can be protected from infarction by brief episodes of
ischemia/reperfusion of a remote organ. Remote ischemic preconditioning
(RIPC) by brief arm ischemia/reperfusion has been recruited in patients
undergoing coronary artery bypass surgery or percutaneous coronary
interventions and during transport to the hospital for acute myocardial
infarction. Cardioprotective signaling has been extensively characterized
in animal experiments. Objective: To identify cardioprotective signaling
by RIPC in humans. Methods and Results: RIPC was induced by 3 cycles of 5
minutes of arm ischemia/5 minutes of reperfusion in patients undergoing
coronary artery bypass surgery. Twelve patients each were randomly
assigned to undergo RIPC or a sham control procedure. Protection was
confirmed by reduced serum troponin I concentrations in patients with RIPC
versus control patients. In myocardial biopsies, an array of established
cardioprotective proteins was analyzed by Western immunoblotting. The
phosphorylation of signal transducer and activator of transcription 5
(STAT5) increased from baseline before ischemic cardioplegic arrest to 10
minutes of reperfusion with RIPC, and STAT5 phosphorylation during
reperfusion was greater in patients with RIPC than in control patients.
Conclusions: The identification of this unique signaling signature of RIPC
will facilitate the development of pharmacological cardioprotection. 2011
American Heart Association, Inc.

<2>
Accession Number
2012022454
Authors
Robinson J.L. Doucette K.
Institution
(Robinson) Department of Pediatrics, University of Alberta, Edmonton,
Canada
(Doucette) Department of Medicine, University of Alberta, Edmonton, Canada
Title
The natural history of hepatitis C virus infection acquired during
childhood.
Source
Liver International. 32 (2) (pp 258-270), 2012. Date of Publication:
February 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: The outcome of patients with hepatitis C virus (HCV) infection
acquired during childhood in the absence of antiviral therapy is not
clear. Aims: The purpose of this study was to review the outcome of
untreated HCV acquired in childhood. Only population-based studies were
included, as referred cases would be predicted to have more severe
disease. Methods: A systematic review of the literature was completed up
to October 2010 to identify studies where a population was screened for
HCV infection that was presumably acquired during childhood. Demographical
and clinical data were collected on infected patients who had not been
treated with an antiviral. Primary outcome was development of a severe
adverse outcome (cirrhosis, hepatoma, need for a liver transplant or
liver-related death). Results: There were 25 studies reporting a total of
733 infected patients. Liver biopsy results were provided for 180 patients
(25%), revealing cirrhosis in eight (1.0% of the total and 4.0% of those
who had a biopsy). None of the other patients developed a severe adverse
outcome. As a result of the small number of patients with a severe adverse
outcome, risk factors for HCV progression could not be identified.
Conclusion: Although HCV can lead to liver transplantation and death
during childhood, the vast majority of patients with disease acquired
during childhood have slowly progressive disease. There is no clear
indication for antiviral therapy in the majority of children with HCV
infection. 2011 John Wiley & Sons A/S.

<3>
Accession Number
2012003354
Authors
Damman P. Clayton T. Wallentin L. Lagerqvist B. Fox K.A.A. Hirsch A.
Windhausen F. Swahn E. Pocock S.J. Tijssen J.G.P. De Winter R.J.
Institution
(Damman, Hirsch, Windhausen, Tijssen, De Winter) Department of Cardiology,
Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ
Amsterdam, Netherlands
(Clayton, Pocock) London School of Hygiene and Tropical Medicine, Keppel
Street, London, United Kingdom
(Wallentin, Lagerqvist) Department of Cardiology, Cardiothoracic Center,
University Hospital, Uppsala, Sweden
(Fox) Cardiovascular Research, Department of Medical and Radiological
Sciences, Royal Infirmary, Edinburgh, United Kingdom
(Swahn) Department of Cardiology, Heart Centre, University Hospital,
Linkoping, Sweden
Title
Effects of age on long-term outcomes after a routine invasive or selective
invasive strategy in patients presenting with non-ST segment elevation
acute coronary syndromes: A collaborative analysis of individual data from
the FRISC II - ICTUS - RITA-3 (FIR) trials.
Source
Heart. 98 (3) (pp 207-213), 2012. Date of Publication: February 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Objective: To perform a patient-pooled analysis of a routine invasive
versus a selective invasive strategy in elderly patients with non-ST
segment elevation acute coronary syndrome. Methods: A meta-analysis was
performed of patientpooled data from the FRISC IIeICTUSeRITA-3 (FIR)
studies. (Un)adjusted HRs were calculated by Cox regression, with
adjustments for variables associated with age and outcomes. The main
outcome was 5-year cardiovascular death or myocardial infarction (MI)
following routine invasive versus selective invasive management. Results:
Regarding the 5-year composite of cardiovascular death or MI, the routine
invasive strategy was associated with a lower hazard in patients aged
65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged >=75 years (HR
0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95%
CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and
age. The interaction was driven by an excess of early MIs in patients <65
years of age; there was no heterogeneity between age groups concerning
cardiovascular death. The benefits were smaller for women than for men
(p=0.009 for interaction). After adjustment for other clinical risk
factors the HRs remained similar. Conclusion: The current analysis of the
FIR dataset shows that the long-term benefit of the routine invasive
strategy over the selective invasive strategy is attenuated in younger
patients aged <65 years and in women by the increased risk of early events
which seem to have no consequences for long-term cardiovascular mortality.
No other clinical risk factors were able to identify patients with
differential responses to a routine invasive strategy. Trial registration:
http://www.controlled-trials.com/ISRCTN82153174 (ICTUS),
http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).

<4>
Accession Number
2012014182
Authors
Shehata N. Burns L.A. Nathan H. Hebert P. Hare G.M.T. Fergusson D. Mazer
C.D.
Institution
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Departments of
Medicine, Anesthesia and Physiology, University of Toronto, St. Michael's
Hospital, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Central Ontario
Region, Canadian Blood Services, Toronto, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, St Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Anesthesia, University of Ottawa, Ottawa, ON, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Critical Care, General Campus, Canada
(Shehata, Burns, Nathan, Hebert, Hare, Fergusson, Mazer) Department of
Clinical Epidemiology, Ottawa Hospital Research Institute, CMAJ, Ottawa,
ON, Canada
Title
A randomized controlled pilot study of adherence to transfusion strategies
in cardiac surgery.
Source
Transfusion. 52 (1) (pp 91-99), 2012. Date of Publication: January 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
BACKGROUND: It is important to determine the optimal hemoglobin (Hb)
concentration for red blood cell (RBC) transfusion for patients undergoing
cardiac surgery because increased mortality has been associated with the
severity of anemia and exposure to RBCs. Because a definitive trial will
require thousands of patients, and because there is variability in
transfusion practices, a pilot study was undertaken to determine adherence
to proposed strategies. STUDY DESIGN AND METHODS: A single-center parallel
randomized controlled pilot trial was conducted in high-risk cardiac
patients to assess adherence to two transfusion strategies. Fifty patients
were randomly assigned either to a "restrictive" transfusion strategy
(RBCs if their Hb concentration was 70 g/L or less intraoperatively during
cardiopulmonary bypass [CPB] and 75 g/L or less postoperatively) or a
"liberal" transfusion strategy (RBCs if their Hb concentration was 95 g/L
or less during CPB and less than 100 g/L postoperatively). RESULTS: The
percentage of adherence overall was 84% in the restrictive arm and 41% in
the liberal arm. Twenty-two (88%) patients were transfused 99 units of
RBCs in the liberal group compared to 13 patients who were transfused 50
units in the restrictive group (p < 0.01). There were no significant
differences in individual adverse outcomes; however, more adverse events
occurred in the restrictive group (38 vs. 15, p < 0.01). CONCLUSION:
Adherence to the evaluated interventions is vital to all randomized
controlled trials as it has the potential to affect outcomes. Further
pilot studies are required to optimize enrollment and transfusion
adherence before a definitive study is conducted. 2011 American
Association of Blood Banks.

<5>
Accession Number
22077816
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van de Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W. TRACER
Investigators
Institution
(Tricoci) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC 27705, USA.
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
The New England journal of medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 5 Jan 2012.
Abstract
Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist
that inhibits thrombin-induced platelet activation. In this multinational,
double-blind, randomized trial, we compared vorapaxar with placebo in
12,944 patients who had acute coronary syndromes without ST-segment
elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. Follow-up in
the trial was terminated early after a safety review. After a median
follow-up of 502 days (interquartile range, 349 to 667), the primary end
point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of
6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs.
19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01;
P=0.07). A composite of death from cardiovascular causes, myocardial
infarction, or stroke occurred in 822 patients in the vorapaxar group
versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard
ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe
bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group
(hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. In patients with acute coronary syndromes, the
addition of vorapaxar to standard therapy did not significantly reduce the
primary composite end point but significantly increased the risk of major
bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER
ClinicalTrials.gov number, NCT00527943.).

<6>
Accession Number
2012019313
Authors
Hassan Murad M. Coburn J.A. Coto-Yglesias F. Dzyubak S. Hazem A. Lane M.A.
Prokop L.J. Montori V.M.
Institution
(Hassan Murad, Coburn, Coto-Yglesias, Dzyubak, Hazem, Lane, Prokop,
Montori) Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First
Street SW, Rochester, MN 55905, United States
(Hassan Murad, Hazem) Division of Preventive Medicine, Mayo Clinic,
Rochester, MN 55905, United States
(Hazem) Department of Internal Medicine, University of North Dakota,
Fargo, ND 58103, United States
(Montori) Division of Endocrinology, Diabetes, Metabolism, and Nutrition,
Mayo Clinic, Rochester, MN 55905, United States
Title
Glycemic control in non-critically ill hospitalized patients: A systematic
review and meta-analysis.
Source
Journal of Clinical Endocrinology and Metabolism. 97 (1) (pp 49-58),
2012. Date of Publication: January 2012.
Publisher
Endocrine Society (8401 Connecticut Ave. Suite 900, Chevy Chase MD 20815,
United States)
Abstract
Background: The effect of intensive therapy to achieve tight glycemic
control in patients hospitalized in non-critical care settings is unclear.
Methods:Weconducted a systematic review and meta-analysis to determine the
effect of intensive glycemic control strategies on the outcomes of death,
stroke, myocardial infarction, incidence of infection, and hypoglycemia.
We included randomized and observational studies. Bibliographic databases
were searched through February 2010. Random effects model was used to pool
results across studies. Results: Nineteen studies (nine randomized and 10
observational studies) were included. The risk of bias across studies was
moderate. Meta-analysis demonstrates that intensive glycemic control was
not associated with significant effect on the risk of death, myocardial
infarction, or stroke. There was a trend for increased risk of
hypoglycemia (relative risk, 1.58; 95% confidence interval,0.97-2.57),
particularly in surgical studies and when the planned glycemic target was
achieved. Intensive glycemic control was associated with decreased risk of
infection (relative risk, 0.41; 95% confidence interval, 0.21-0.77) that
was mainly derived from studies in surgical settings. Conclusion:
Intensive control of hyperglycemia in patients hospitalized in
non-critical care settings may reduce the risk of infection. The quality
of evidence is low and mainly driven by studies in surgical settings.
Copyright 2012 by The Endocrine Society.

<7>
Accession Number
2012013932
Authors
Navarese E.P. Kubica J. Castriota F. Gibson C.M. De Luca G. Buffon A.
Bolognese L. Margheri M. Andreotti F. Di Mario C. De Servi S.
Institution
(Navarese, Kubica) Department of Cardiology and Internal Medicine, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University,
Sklodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland
(Castriota) GVM Care and Research, Interventional Cardio-Angiology Unit,
Cotignola, Italy
(Gibson) Cardiovascular Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
(De Luca) Department of Cardiology, Maggiore Della Carita Hospital,
Novara, Italy
(Buffon, Andreotti) Department of Cardiovascular Medicine, Catholic
University of the Sacred Heart, Rome, Italy
(Bolognese) Cardiovascular Department, San Donato Hospital, Arezzo, Italy
(Margheri) Division of Cardiology, Azienda Ospedaliera, Ravenna, Italy
(Di Mario) Royal Brompton Hospital, Imperial College, London, United
Kingdom
(De Servi) Department of Cardiovascular Diseases, Civic Hospital, Legnano,
Italy
Title
Safety and efficacy of biodegradable vs. durable polymer drug-eluting
stents: Evidence from a meta-analysis of randomised trials.
Source
EuroIntervention. 7 (8) (pp 985-994), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Drug-eluting stents (DES) are a major advance in interventional
cardiology; however concerns have been raised regarding their long-term
safety due to the permanent nature of the polymer. New generation stents
with biodegradable polymers (BDS) have recently been developed. The aim of
this study was to perform a meta-analysis of randomised controlled trials
(RCTs) comparing the safety and efficacy profile of BDS vs. durable
polymer DES. Methods and results: The MEDLINE/CENTRAL and Google Scholar
databases were searched for RCTs comparing safety and efficacy of BDS vs.
DES. Safety endpoints were mortality, myocardial infarction (MI), and
stent thrombosis (ST). Efficacy endpoints were target vessel
revascularisation (TVR), target lesion revascularisation (TLR) and
six-month in-stent late loss (ISLL). The meta-analysis included eight RCTs
(n=7,481). At a median follow-up of nine months, as compared to DES, BDS
use did not increase mortality (OR [95% CI] = 0.91 [0.69-1.22], p=0.53) or
MI (OR [95% CI] = 1.14 [0.90-1.44], p=0.29). Rate of late/very late ST was
significantly reduced in BDS patients (OR [95% CI] = 0.60 [0.39-0.91],
p=0.02), as was six-month ISLL (mean difference [95% CI] = -0.07 [-0.12;
-0.02] mm, p=0.004) in comparison with DES patients. Rates of TVR and TLR
were comparable between BDS and DES. Conclusions: BDS are at least as safe
as standard DES with regard to survival and MI, and more effective in
reducing late ST, as well as six-month ISLL. Further large RCTs with
long-term follow-up are warranted to definitively confirm the potential
benefits of BDS. Europa Edition 2011. All rights reserved.

<8>
Accession Number
2012013931
Authors
Sabate M. Cequier A. Iniguez A. Serra A. Hernandez-Antolin R. Mainar V.
Valgimigli M. Tespili M. Den Heijer P. Bethencourt A. Vazquez N.
Brugaletta S. Backx B. Serruys P.W.
Institution
(Sabate, Brugaletta) University Hospital Clinic, Barcelona, Spain
(Cequier) University Hospital of Bellvitge, Barcelona, Spain
(Iniguez) Hospital do Meixoeiro, Vigo, Spain
(Serra) University Hospital of Sant Pau, Barcelona, Spain
(Hernandez-Antolin) University Hospital San Carlos, Madrid, Spain
(Mainar) Hospital General of Alicante, Alicante, Spain
(Valgimigli) University Hospital Ferrara, Ferrara, Italy
(Tespili) University Hospital Bolognini Seriate, Bergamo, Italy
(Den Heijer) Amphia Ziekenhuis, Breda, Netherlands
(Bethencourt) Hospital Son Dureta, Palma de Mallorca, Spain
(Vazquez) Hospital Juan Canalejo, A Coruna, Spain
(Backx) Cardialysis, Rotterdam, Netherlands
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
Title
Rationale and design of the EXAMINATION trial: A randomised comparison
between everolimus-eluting stents and cobalt-chromium bare-metal stents in
ST-elevation myocardial infarction.
Source
EuroIntervention. 7 (8) (pp 977-984), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To assess the performance of the everolimus-eluting stent (EES)
versus cobalt chromium bare-metal stent (BMS) in the setting of primary
percutaneous coronary intervention for treatment of patients presenting
with ST-segment elevation myocardial infarction (STEMI). The implantation
of a drug-eluting stent in the setting of an acute myocardial infarction
is still controversial. In several registries this clinical scenario has
been associated with the development of stent thrombosis. The EES has
demonstrated to reduce the stent thrombosis rate as compared to
paclitaxel-eluting stent in randomised controlled trials, mainly performed
in patients in stable clinical conditions. There are however few data
regarding the effectiveness of EES in the context of STEMI. Methods and
results: This is an investigator-driven, prospective, multicentre,
multinational, randomised, single blind, two-arm, controlled trial
(ClinicalTrials.gov number: NCT00828087). This trial, with an all comer
design, randomises approximately 1,500 patients 1:1 to EES or BMS.
Overall, any patient presenting with STEMI up to 48 hours who requires
emergent percutaneous coronary intervention can be included. The primary
endpoint is the patient-oriented combined endpoint of all-cause death, any
myocardial infarction and any revascularisation at 1-year according to the
Academic Research Consortium. Clinical follow-up will be scheduled at 30
days, six months, one year and yearly up to five years. No angiographic
follow-up is mandated per protocol. Conclusions: This trial with broad
inclusion and few exclusion criteria will shed light on the performance of
the second generation EES in the complex scenario of STEMI. Europa
Edition 2011. All rights reserved.

<9>
Accession Number
2012013925
Authors
Kang W.C. Ahn T. Lee K. Han S.H. Shin E.K. Jeong M.H. Yoon J.H. Park J.-S.
Bae J.H. Hur S.H. Rha S.W. Oh S.K. Kim D.I. Jang Y. Choi J.W. Kim B.O.
Institution
(Kang, Ahn, Lee, Han, Shin) Cardiology, Gil Hospital, Gachon University of
Medicine and Science, 1198 Kuwol-dong, Namdong-gu, Incheon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Yoon) Wonju Christian Hospital, Wonju, South Korea
(Park) Yeungnam University Hospital, Daegu, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Oh) Wonkwang University Hospital, Iksan, South Korea
(Kim) Inje University Busan Paik Hospital, Busan, South Korea
(Jang) Severance Hospital, Seoul, South Korea
(Choi) Eulji Hospital, Seoul, South Korea
(Kim) Inje University Sanggye Paik Hospital, Seoul, South Korea
Title
Comparison of zotarolimus-eluting stents versus sirolimus-eluting stents
versus paclitaxel-eluting stents for primary percutaneous coronary
intervention in patients with ST-elevation myocardial infarction: Results
from the Korean Multicentre Endeavor (KOMER) acute myocardial infarction
(AMI) trial.
Source
EuroIntervention. 7 (8) (pp 936-943), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The aim of this study was to compare the efficacy and safety of
zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES) and
paclitaxel-eluting stents (PES) in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI).Methods and results: This study was a prospective,
single-blind, multicentre, randomised trial. The primary endpoint was
major adverse cardiac events (MACE) at 12 months post-procedure, defined
as cardiac death, recurrent myocardial infarction (MI), or
ischaemia-driven target lesion revascularisation (TLR). An angiographic
substudy was performed at nine months among 348 patients. From October
2006 to April 2008, 611 patients with STEMI undergoing primary PCI were
randomly assigned to treatment with ZES (n=205), SES (n=204), or PES
(n=202). The cumulative incidence of MACE was 5.9% in the ZES group, 3.4%
in the SES group and 5.7% in the PES group at 12-month follow-up
(p=0.457). There was a trend towards a lower rate of ischaemia-driven TLR
at 12- (p=0.092) and 18-month (p=0.080) follow-up in the SES group
compared to the ZES and PES groups. No difference was observed in rates of
cardiac death, recurrent MI and combined death and/or recurrent MI among
three groups at 12- and 18-month follow-up. The rate of stent thrombosis
was similar among the three groups (2.0% in each group,
p=1.000).Conclusions: As compared with SES and PES, the use of ZES in
patients with STEMI undergoing primary PCI, showed similar rates of MACE,
cardiac death and recurrent MI at 12 and 18 months. There was a trend
towards a higher rate of TLR with ZES or PES compared to SES. Europa
Edition 2011. All rights reserved.

<10>
Accession Number
2012013921
Authors
Genereux P. Mehran R. Palmerini T. Caixeta A. Kirtane A.J. Lansky A.J.
Brodie B.R. Witzenbichler B. Mockel M. Guagliumi G. Peruga J.Z. Dudek D.
Fahy M.P. Dangas G. Stone G.W.
Institution
(Genereux, Mehran, Palmerini, Caixeta, Kirtane, Lansky, Fahy, Dangas,
Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 E. 59th St., New York, NY 10022, United States
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Hospital,
Greensboro, NC, United States
(Witzenbichler, Mockel) Charite-Universitatsmediz in Berlin, Campus
Benjamin Franklin, Campus Virchow-Klinikum, Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Department of Cardiology Medical University, Lodz Bieganski
Hospital, Lodz, Poland
(Dudek) Jagiellonian University, Krakow, Poland
Title
Radial access in patients with ST-segment elevation myocardial infarction
undergoing primary angioplasty in acute myocardial infarction: The
HORIZONS-AMI trial.
Source
EuroIntervention. 7 (8) (pp 905-916), 2011. Date of Publication:
December 2011.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We sought to determine whether a transradial (TR) approach compared
with a transfemoral (TF) approach was associated with improved clinical
outcomes in patients with ST-segment elevation myocardial infarction
(STEMI) undergoing primary percutaneous coronary intervention (PCI) in a
post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data
comparing the TR approach with the TF approach in patients with STEMI
treated with primary PCI and contemporary anticoagulant regimens. Methods
and results: In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340
patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints
included the 30-day and one-year rates of major adverse cardiovascular
events (MACE: death, reinfarction, stroke or target vessel
revascularisation), non CABG-related major bleeding, and net adverse
clinical events (NACE: MACE or major bleeding). TR compared to TF access
was associated with significantly lower 30-day rates of composite death or
reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non
CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95],
p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and
NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year,
the TR group still had significantly reduced rates of death or
reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non
CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89],
p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and
NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By
multivariable analysis, TR access was an independent predictor of freedom
from MACE and NACE at 30 days and one year. Conclusions: In patients with
STEMI undergoing primary PCI with contemporary anticoagulation regimens in
the HORIZONS-AMI trial, a TR compared with a TF approach was associated
with reduced major bleeding and improved event-free survival. Europa
Edition 2011. All rights reserved.

<11>
Accession Number
2012022817
Authors
Santangeli P. Di Biase L. Pelargonio G. Dello Russo A. Casella M.
Bartoletti S. David Burkhardt J. Mohanty P. Santarelli P. Natale A.
Institution
(Santangeli, Di Biase, David Burkhardt, Mohanty, Natale) Texas Cardiac
Arrhythmia Institute, St. David's Medical Center, 1015 East 32nd Street,
Austin, TX, United States
(Pelargonio, Santarelli) Institute of Cardiology, Catholic University of
the Sacred Heart, Rome, Italy
(Dello Russo, Casella, Bartoletti) Arrhythmia Department, Institute of
Cardiology, IRCCS-Centro Cardiologico Monzino, Milan, Italy
(Di Biase, Natale) Department of Biomedical Engineering, University of
Texas, Austin, TX, United States
(Di Biase) Department of Cardiology, University of Foggia, Foggia, Italy
Title
Cardiac resynchronization therapy in patients with mild heart failure: A
systematic review and meta-analysis.
Source
Journal of Interventional Cardiac Electrophysiology. 32 (2) (pp 125-135),
2011. Date of Publication: November 2011.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
Purpose: Cardiac resynchronization therapy (CRT) reduces symptoms and
improves survival in patients with advanced heart failure (New York Heart
Association (NYHA) functional class III-IV), reduced ejection fraction,
and wide QRS complex. Whether CRT has the same benefit also in
asymptomatic or mildly symptomatic heart failure patients is
controversial. Our objective is to summarize the available evidence on the
effects of CRT in asymptomatic or mildly symptomatic (NYHA I-II) heart
failure patients. Methods: We searched major web databases for randomized
controlled trials of CRT in patients with mild heart failure (NYHA
functional class I-II). Data regarding all-cause mortality, heart failure
events, left ventricular (LV) volumes and ejection fraction, and worsening
of NYHA functional class were extracted. Results: We identified five
trials (CONTAK-CD, MIRACLE ICD-II, REVERSE, MADIT-CRT, and RAFT) that
enrolled 4,213 patients (91% with NYHA II functional class). Primary
analysis excluded the CONTAK-CD, which was not specifically conducted on
patients with mild heart failure. At pooled analysis, CRT decreased
mortality (odds ratio (OR), 0.78 [95% confidence interval (CI)], 0.63 to
0.97; p=0.024) and heart failure events (OR, 0.63 [95% CI, 0.52 to 0.76],
p<0.001), induced a significant LV reverse remodeling (weighted mean
difference (WMD) of LV ejection fraction =+4.8%[95% CI, + 0.9 to+ 8.7%],
p=0.015 and WMD of LV end-systolic volume index =
-19.4mL/m²[95%CI, - 18.2 to - 20.7mL/m²], p<0.001)
and prevented the progression of heart failure symptoms (OR for worsening
of NYHA functional class= 0.54 [95% CI, 0.31 to 0.93], p=0.026). Inclusion
of the CONTAK-CD did not change the results. Conclusions: Among patients
with mild (NYHA II) heart failure, CRT reduces mortality and the risk of
heart failure events, induces a favorable LV reverse remodeling and slows
the progression of heart failure symptoms. Springer Science+Business
Media, LLC 2011.

<12>
Accession Number
70639618
Authors
Haase-Fielitz A. Mertens P.R. Plas M. Kuppe H. Hetzer R. Westerman M.
Ostland V. Prowle J.R. Bellomo R. Haase M.
Institution
(Haase-Fielitz, Mertens, Haase) Otto von Guericke University, Nephrology,
Magdeburg, Germany
(Plas, Kuppe) German Heart Center Berlin, Institute of Anesthesiology,
Berlin, Germany
(Hetzer) German Heart Center Berlin, Department of Cardiothoracic Surgery,
Berlin, Germany
(Westerman, Ostland) Intrinsic LifeSciences LLC, San Diego, United States
(Prowle, Bellomo) Austin Health, Melbourne, Australia
Title
Urine hepcidin is an early predictor of protection from cardiopulmonary
bypass-associated acute kidney injury-an observational cohort study.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S208), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Conventional markers of acute kidney injury (AKI) lack
diagnosticaccuracy and are expressed only late after cardiac surgery with
cardiopulmonary bypass(CPB). Recently, interest has focused on hepcidin, a
regulator of iron homeostasis, as a uniquerenal biomarker.OBJECTIVES. We
aimed to (1) assess the predictive value of early postoperative
urinehepcidin and plasma hepcidin for protection from AKI (2) investigate
the role of chronickidney disease on the predictive value of hepcidin and
(3) explore whether changes in urinehepcidin reflect changes in plasma
hepcidin.METHODS. We studied 100 adult patients in the control arm of a
randomized controlled trial(clinicaltrials.gov NCT00672334) that were
identified to be at increased risk of AKI aftercardiac surgery with CPB.
AKI was defined according to the RIFLE classification. Samples ofplasma
and urine were obtained simultaneously (1) before CPB (2) 6 h after the
start of CPBand (3) at 24 h after CPB. Plasma and urine hepcidin
25-isoforms were quantified by competitiveenzyme-linked
immunoassay.RESULTS. At 6 and 24 h after CPB, AKI-free patients (N = 91)
had largely increased andwere 3-7 times higher urine hepcidin
concentrations compared to patients with subsequentAKI (N = 9) in whom
postoperative urine hepcidin remained at preoperative levels(P = 0.004, P
= 0.002). Furthermore, higher urine hepcidin and, even more so, urine
hepcidinadjusted to urine creatinine at 6 h after CPB discriminated
patients who did not developAKI [AUC-ROC 0.80 (95% CI 0.71-0.87); 0.88
(95% CI 0.78-0.97)] or did not need renalreplacement therapy initiation
[AUC 0.81 (95% CI 0.72-0.88); 0.88 (95% CI 0.70-0.99)] fromthose who did.
At 6 h, urine hepcidin adjusted to urine creatinine was an independent
predictorof protection from AKI (P = 0.011). Plasma hepcidin did not
predict protection from AKI.The study findings remained essentially
unchanged after excluding patients with preoperativechronic kidney
disease.CONCLUSIONS. Our findings suggest that urine hepcidin is an early
predictive biomarker ofprotection from AKI after CPB thereby contributing
to early patients risk stratification.

<13>
Accession Number
70639315
Authors
Goepfert M.S. Richter H.P. Kubitz J.C. Von Sandersleben A. Gruetzmacher J.
Rafflenbeul E. Roeher K. Zu Eulenburg C. Reichenspurner H. Goetz A.E.
Reuter D.A.
Institution
(Goepfert, Richter, Kubitz, Von Sandersleben, Gruetzmacher, Rafflenbeul,
Roeher, Goetz, Reuter) University Medical Center Hamburg-Eppendorf,
Anaesthesiolgy and Intensive Care Medicine, Hamburg, Germany
(Zu Eulenburg) University Medical Center Hamburg-Eppendorf, Department of
Medical Biometry and Epidemiology, Hamburg, Germany
(Reichenspurner) University Heart Center Hamburg, Department of
Cardiovascular Surgery, Hamburg, Germany
Title
Does early perioperative goal directed therapy using functional and
volumetric hemodynamic parameters improve therapy in cardiac surgery? A
prospective, Randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S132), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. There is growing evidence that an early and algorithm guided
hemodynamic therapy primarily increasing cardiac output by preload
optimization improves outcome in high risk surgical patients. Preload
optimization was so far guided either by the filling pressures CVP or
PAOP, cardiac output (CO), or functional parameters based on heart lung
interactions, i.e. stroke volume variations (SVV). In particular the
latter one, having shown to be useful intraoperatively under
controlledmechanical ventilation, but becomes invalid in patients under
assisted mechanical ventilation or during spontaneous breathing.
Volumetric parameters of cardiac preload, such as global end-diastolic
volume index (GEDI) differ significantly inter-individually in critically
ill patients, but have been proven to be highly accurate to allow tracking
changes in cardiac preload in both, mechanically ventilated patients, and
during spontaneous breathing. OBJECTIVES. We implemented a hemodynamic
treatment algorithmbased on measurements of CO, SVV, and a
patient-individual GEDI for optimizing therapy during and after elective
cardiac surgery.We compared a study group (SG) guided by this
algorithmwith a control group (CG) guided by an algorithm based on CVP and
mean arterial blood pressure (MAP). METHODS.After approval of the ethic
committee and written informed consent one-hundred patients scheduled for
elective coronary artery bypass (CAB) surgery or CAB surgery in
combination with aortic valve replacement (AVR) were randomized either to
the SG (n = 50), or to the CG (n = 50). Algorithm driven hemodynamic
therapy started immediately after induction of anesthesia and was
commenced until discharge from the intensive care unit (ICU). RESULTS. 92
Patients could finally be analyzed. There was no difference in
perioperative mortality. All over complications were less in the SG (42
vs. 63). Time to reach ICU discharge criteria (SG: 15 +/- 6 h vs. CG: 24
+/- 29 (p<0.001), length of stay on the ICU (SG: 42 +/- 19 h vs.CG: 61 +/-
58 (p<0.05), and time to reach criteria for hospital discharge (SG: 5d +/-
3 vs.CG: 6 +/- 3 (p<0.001) were significantly shorter in the SG. The
cumulative use of catecholamines and vasopressors was significantly less
in the SG (1,196 +/- 1,002 mug) compared to the CG (2,523 +/- 2,205mulg;
p<0.001).Areas under the curve for postoperative (36 h) creatinine kinase,
AST, ALT, and gGT all were smaller in the study group, however without
reaching statistical significance. There were no differences in pulmonary
or renal function within the study period. CONCLUSIONS. Goal-directed
hemodynamic therapy based on an algorithm using measurements of CO, SVV
and a patient-individual GEDI minimizes organ damage and reduces length of
ICU stay after elective cardiac surgery. If long-term outcome can be
improved by these treatment strategies needs to be clarified in the
future.

<14>
Accession Number
70639219
Authors
Paulus F. Veelo D.P. De Nijs S.B. Beenen L.F. Bresser P. De Mol B.A.
Binnekade J.M. Schultz M.J.
Institution
(Paulus, Veelo, Binnekade, Schultz) Academic Medical Center, Department of
Intensive Care, Amsterdam, Netherlands
(De Nijs) Academic Medical Center, Department of Respiratory Medicine,
Amsterdam, Netherlands
(Beenen) Academic Medical Center, Department of Radiology, Amsterdam,
Netherlands
(Bresser) Academic Medical Center, Respiratory Medicine, Amsterdam,
Netherlands
(De Mol) Academic Medical Center, Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
Title
Manual hyperinflation partly prevents reductions of functional residual
capacity in cardiac surgical patients: A randomized controlled trial.
Source
Intensive Care Medicine. Conference: 24th Annual Congress of the European
Society of Intensive Care Medicine, ESICM LIVES 2011 Berlin Germany.
Conference Start: 20111001 Conference End: 20111005. Conference
Publication: (var.pagings). 37 (pp S108), 2011. Date of Publication:
September 2011.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Cardiac surgical patients are kept in an iatrogenic state of
physical and pharmacologic immobilization for several hours after surgery,
to facilitate intubation and weaning from mechanically ventilation.
Immobilization reduces mucociliary transport, which can lead to retention
of sputum at atelectasis. Manual hyperinflation (MH) aims at preventing
airway plugging by mobilization of airway secretions in mechanical
ventilated patients, and as such could improve functional residual
capacity (FRC) and oxygenation after surgery. OBJECTIVES. We performed a
randomized controlled trial in patients after cardiac surgery with the aim
to compare a strategy using routineMHmaneuvers with a strategy only
usingMH if clinically indicated. METHODS. Patients after elective cardiac
surgery and admitted to the ICU of a university hospital were randomly
allocated to "routine" (MH within 1/2 h after arrival in the ICU and every
6 h until tracheal extubation) or "on demand" MH (MH only in case of
failed endotracheal suctioning while sputum is obviously present, or in
case of oxygen de-saturation not responding to 3 min hyper-oxygenation)
during mechanical ventilation. FRC was measured pre-operatively and 1, 3,
and 5 days after extubation. Chest radiographs were obtained, both
pre-operative and on the third post-operative day. Peripheral hemoglobin
saturation (Spo2) was measured at day 1, 3, and 5 after extubation while
the patient was breathing room air. RESULTS. Hundred patients were
enrolled. Patients in the "routine" group received median [IOR] 2
[2-3]MHprocedures compared to 0 [0-0]MHprocedures in the "on demand"
group. In the "routine" group FRC decreased to 72% of the pre-operative
measurement compared to 57% in the "on demand" (P = 0.002). Post-operative
chest radiographs showed more patients without signs of atelectasis in the
routineMHgroup (17%) compared to patients in the control group (0%) (P =
0.002). There were, however, no differences in oxygenation. CONCLUSIONS.
"Routine" MH attenuates reduction of FRC in the early post-operative days
after cardiac surgery. In accordance, occurrence of atelectasis on
post-operative chest radiographs was significant lower in patients who
received MH.