EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013063844
Authors
Pahwa A.K. Arbab-Zadeh A. Brotman D.J. Feldman L.S.
Institution
(Pahwa, Brotman, Feldman) Department of Medicine, The Johns Hopkins
University, Baltimore, United States
(Arbab-Zadeh) Division of Cardiology, Department of Medicine, The Johns
Hopkins University, Baltimore, United States
Title
Potential role of coronary computed tomography-angiography for guiding
perioperative cardiac management for non-cardiac surgery.
Source
Heart International. 8 (1) (pp 1-3), 2013. Date of Publication: 2013.
Publisher
Page Press Publication (via Giuseppe Belli, Pavia 7, 27100, Italy)
Abstract
Perioperative cardiac events can be a major consequence of surgery. The
American College of Cardiology Foundation/American Heart Association has
set out guidelines to aid physicians in identifying patients at the
highest risk for these events. The guidelines do recommend for some
patients to undergo noninvasive cardiac stress testing for further risk
stratification, but their sensitivity and specificity for predicting
cardiac events is not optimal. With more data emerging of the superior
performance of computed coronary tomography angiography (CCTA) compared to
noninvasive stress testing, CCTA could be more useful in risk
stratification for these patients. A.K. Pahwa et al., 2013 Licensee
PAGEPress, Italy.

<2>
Accession Number
2013062014
Authors
Gandham R. Syamasundar A. Ravulapalli H. Karthekeyan R. Vakamudi M.
Kodalli R.B. Nandipati S.
Institution
(Gandham, Syamasundar, Ravulapalli, Karthekeyan, Vakamudi, Kodalli,
Nandipati) Department of Cardiac Anesthesiology, Sri Ramachandra Medical
College, Chennai, Tamil Nadu, India
Title
A comparison of hemodynamic effects of levosimendan and dobutamine in
patients undergoing mitral valve repair/replacement for severe mitral
stenosis.
Source
Annals of Cardiac Anaesthesia. 16 (1) (pp 11-15), 2013. Date of
Publication: January-March 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aims and Objectives: We aimed to compare the hemodynamic effects of
levosimendan and dobutamine in patients undergoing mitral valve surgery on
cardiopulmonary bypass (CPB). Materials and Methods: Sixty patients were
divided into 2 groups of 30 each. Group-L patients received levosimendan
0.1 mug/kg/min and Group-D patients received dobutamine 5 mug/kg/min while
weaning off CPB. Additional inotrope and/or vasoconstrictor were started
based on hemodynamic parameters. Hemodynamic data were collected at the
end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours
post-CPB. Mean arterial pressure (MAP), central venous pressure (CVP),
heart rate (HR), cardiac index (CI), systemic vascular resistance index
(SVRI), and lactate levels were measured. Results: Group-L showed
increased requirement of inotropes and vasoconstrictors. The SVRI, CVP,
and MAP were reduced more in Group-L. The CI was low in Group-L in the
initial period when compared to Group-D. Later Group-L patients showed a
statistically significant increase in CI even after 12 hrs of
discontinuation of levosimendan infusion. The HR was increased more in
Group-D. Lactate levels, intensive care unit stay, and duration of
ventilation were similar in both groups. Conclusions: Levosimendan 0.1
mug/kg/min compared to dobutamine 5 mug/kg/min showed more vasodilation
and lesser inotropic activity in patients undergoing mitral valve surgery
for mitral stenosis. Levosimendan compared to dobutamine showed a
statistically significant increase in CI even after 12 hrs of
discontinuation. The requirement of another inotrope or vasopressor was
frequent in levosimendan group.

<3>
Accession Number
2013062012
Authors
Suryaprakash S. Chakravarthy M. Muniraju G. Pandey S. Mitra S.
Shivalingappa B. Chittiappa S. Krishnamoorthy J.
Institution
(Suryaprakash, Chakravarthy, Muniraju, Pandey, Krishnamoorthy) Department
of Anesthesiology, Fortis Hospital, Bannerghatta Road, Bangalore,
Karnataka - 560 052, India
(Mitra, Shivalingappa, Chittiappa) Cardiac Surgical Intensive Care Unit,
Fortis Hospital, Bannerghatta Road, Bangalore, Karnataka, India
Title
Myocardial protection during off pump coronary artery bypass surgery: A
comparison of inhalational anesthesia with sevoflurane or desflurane and
total intravenous anesthesia.
Source
Annals of Cardiac Anaesthesia. 16 (1) (pp 4-8), 2013. Date of Publication:
January-March 2013.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Aims and Objectives: The objective of the study was to evaluate the
myocardial protective effect of volatile agents-sevoflurane and desflurane
versus total intravenous anesthesia (TIVA) with propofol in offpump
coronary artery bypass surgery (OPCAB) by measuring cardiac troponin-T
(cTnT) as a marker of myocardial cell death. Materials and Methods: The
study was conducted on 139 patients scheduled to undergo elective OPCAB
surgery. The patients were randomly allocated to receive anesthesia with
sevoflurane, desflurane or TIVA with propofol. The cTnT levels were
measured preoperatively, at arrival in postoperative intensive care unit,
at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels
at all time intervals were comparable in the three groups. Conclusion: The
study did not reveal any difference in myocardial protection after OPCAB
with either sevoflurane or desflurane or TIVA using propofol as assessed
by measuring serial cTnT values.

<4>
Accession Number
2013053853
Authors
Birgand G. Radu C. Alkhoder S. Al Attar N. Raffoul R. Dilly M.-P. Nataf P.
Lucet J.-C.
Institution
(Birgand, Lucet) Infection Control Unit, Bichat-Claude Bernard Hospital,
Assistance Publique-Hopitaux de Paris, Paris, France
(Birgand, Al Attar, Nataf, Lucet) Unite d'Hygiene et de Lutte Contre
l'Infection Nosocomiale, GH Bichat-Claude Bernard, 46 rue Henri Huchard,
75877 Paris Cedex 18, France
(Radu, Alkhoder, Al Attar, Raffoul, Nataf) Department of Cardiac Surgery,
Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris,
Paris, France
(Dilly) Department of Anesthesiology, Bichat-Claude Bernard Hospital,
Assistance Publique-Hopitaux de Paris, Paris, France
Title
Does a gentamicin-impregnated collagen sponge reduce sternal wound
infections in high-risk cardiac surgery patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 134-141),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives Sternal wound infections occurring after cardiac surgery have a
critical impact on morbidity, mortality and hospital costs. This study
evaluated the efficacy of a gentamicin-collagen sponge in decreasing deep
sternal-wound infections in high-risk cardiac surgery patients. Methods We
conducted a quasi-experimental single-centre prospective cohort study in
diabetic and/or overweight patients undergoing coronary-artery bypass
surgery with bilateral internal mammary artery grafts. The end-point was
the rate of reoperation for deep sternal wound infection. The period from
January 2006 to October 2008, before the introduction of the gentamicin
sponge, was compared with the period from November 2008 to December 2010.
Results Of 552 patients (median body mass index, 31.5; 37.7% with diabetes
requiring insulin), 68 (12.3%) had deep sternal wound infections.
Reoperation for deep sternal wound infections occurred in 40/289 (13.8%)
preintervention patients and 22/175 (12.6%) patients managed with the
sponge. Independent risk factors were female sex and longer time on
mechanical ventilation, but not use of the sponge (adjusted odds ratio,
0.95; 95% confidence interval, 0.52-1.73; P = 0.88). The group managed
with the sponge had a higher proportion of gentamicin-resistant
micro-organisms (21/27, 77.8%) compared with the other patients (23/56,
41.1%; P < 0.01). The median time to reoperation for wound infection was
higher with the sponge (21 vs 17 days, P < 0.01). Conclusions A
gentamicin-collagen sponge was not effective in preventing deep sternal
wound infections in high-risk patients. Our Results suggest that a
substantial proportion of wound contaminations occur after bypass surgery
with bilateral internal mammary artery grafts. 2012 The Author.

<5>
Accession Number
2013053852
Authors
Sepehripour A.H. Athanasiou T.
Institution
(Sepehripour, Athanasiou) Department of Cardiothoracic Surgery, Imperial
College Healthcare, London, United Kingdom
(Sepehripour, Athanasiou) Division of Surgery, Imperial College London St.
Mary's Hospital, QEQM Building, South Wharf Road, London W2 1NY, United
Kingdom
Title
Is there a surgeon or hospital volume-outcome relationship in off-pump
coronary artery bypass surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 202-207),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether there is a surgeon or hospital
volume-outcome relationship in patients undergoing off-pump coronary
artery bypass surgery. A total of 281 papers were found using the reported
searches, of which six represented the best evidence to answer the
clinical question. The authors, date, journal, study type, population,
main outcome measures and Results are tabulated. The studies found
analysed the outcomes of off-pump coronary artery bypass surgery in
relation to surgeon or hospital volume and evaluated the presence of a
volume-outcome relationship. Reported measures included mortality and
major adverse cardiovascular and cerebrovascular events. The
methodological quality and strength of each study for exploring
volume-outcome relationships were quantitatively assessed using a
predefined scoring system. Three studies analysed surgeon volume and three
studies analysed hospital volume. The two largest and most recent studies
presented a significant volume-outcome relationship in mortality and
postoperative complications. Perhaps owing to the smaller sample size,
this significant relationship in mortality was not observed in the four
smaller studies; however, one of these studies demonstrated a
significantly positive relationship for postoperative complications and
another study demonstrated a similar significant relationship for the
number of grafts and the degree of completeness of revascularization.
While the volume-outcome relationship in coronary artery bypass graft
surgery is very well-documented, the technically challenging nature of
off-pump surgery, the length of the learning curve associated with the
operation and the higher risk profile of patients undergoing off-pump
surgery in comparison with routine on-pump surgery render these Results
difficult to interpret. Although our review does support the idea of a
volume-outcome relationship in off-pump coronary artery bypass surgery,
this relationship may not be so clearly defined and requires further
analysis by higher-quality studies. 2012 The Author.

<6>
Accession Number
2013053849
Authors
Papalexopoulou N. Young C.P. Attia R.Q.
Institution
(Papalexopoulou, Young, Attia) Department of Cardiothoracic Surgery, Guy's
and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Road,
London SE1 7EH, United Kingdom
Title
What is the best timing of surgery in patients with post-infarct
ventricular septal rupture?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (2) (pp 193-196),
2013. Date of Publication: February 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'in which patients with a
post-infarct ventricular septal rupture (PIVSR) might immediate surgery
give better Results than delayed surgery in terms of mortality'?
Altogether, 88 papers were found using the reported search criteria, of
which 6 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and Results of these papers are tabulated.
The recommendations are based on outcomes from 3238 patients undergoing
surgery for PIVSR. Mean age was 67.5 +/- 8.8 (40-88 years). Left
ventricular function was compromised in most patients with mean ejection
fraction of 40%. All papers carried out univariate and/or multivariate
analyses of variables that contributed to different in-hospital
mortalities. Early surgery, i.e. from >3 days to within 4 weeks after MI,
had an overall in-hospital mortality of 52.4%; delayed surgery, typically
from 1 week to after 4 weeks post-myocardial infarction, had an overall
operative in-hospital mortality of 7.56%. Most authors observe that a
shorter time between rupture and surgery is an unfavourable predictor of
outcome independent of haemodynamic status. The consensus was that nearly
all patients with PIVSR, particularly if >15 mm diameter with a
significant shunt and resultant haemodynamic deterioration, should undergo
early surgical repair. The precise timing of surgery depends on patients'
haemodynamic status. Exclusion from surgery should be considered if life
expectancy or quality is severely limited by another limiting underlying
pathology. If the patient is in cardiogenic shock, due to pulmonary to
systemic blood flow ratio shunt rather than infarct size, immediate
surgery should follow resuscitation measures and cardiac support. If the
patient is haemodynamically stable, surgery could be performed after 3-4
weeks of medical optimization with inotropic and mechanical cardiac
support. If there is clinical deterioration, immediate surgery is
indicated. 2012 The Author.

<7>
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Accession Number
2013055419
Authors
Van Der Bom T. Winter M.M. Bouma B.J. Groenink M. Vliegen H.W. Pieper P.G.
Van Dijk A.P.J. Sieswerda G.T. Roos-Hesselink J.W. Zwinderman A.H. Mulder
B.J.M.
Institution
(Van Der Bom, Winter, Bouma, Groenink, Mulder) Department of Cardiology,
Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
(Groenink) Department of Radiology, Academic Medical Center, Amsterdam,
Netherlands
(Zwinderman) Department of Clinical Epidemiology and Biostatistics,
Academic Medical Center, Amsterdam, Netherlands
(Van Der Bom, Winter, Mulder) Netherlands Heart Institute, Utrecht,
Netherlands
(Vliegen) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Pieper) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
(Van Dijk) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
(Sieswerda) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
Title
Effect of valsartan on systemic right ventricular function: A
double-blind, randomized, placebo-controlled pilot trial.
Source
Circulation. 127 (3) (pp 322-330), 2013. Date of Publication: 22 Jan 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND - The role of angiotensin II receptor blockers in patients with
a systemic right ventricle has not been elucidated. METHODS AND RESULTS -
We conducted a multicenter, double-blind, parallel, randomized controlled
trial of angiotensin II receptor blocker valsartan 160 mg twice daily
compared with placebo in patients with a systemic right ventricle caused
by congenitally or surgically corrected transposition of the great
arteries. The primary end point was change in right ventricular ejection
fraction during 3-year follow-up, determined by cardiovascular magnetic
resonance imaging or, in patients with contraindication for magnetic
resonance imaging, multirow detector computed tomography. Secondary end
points were change in right ventricular volumes and mass, (Equation is
included in full-text article.)peak, and quality of life. Primary analyses
were performed on an intention-to-treat basis. A total of 88 patients
(valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious
adverse effects occurred in either group. There was no significant effect
of 3-year valsartan therapy on systemic right ventricular ejection
fraction (treatment effect, 1.3%; 95% confidence interval, -1.3% to 3.9%;
P=0.34), maximum exercise capacity, or quality of life. There was a larger
increase in right ventricular end-diastolic volume (15 mL; 95% confidence
interval, 3-28 mL; P<0.01) and mass (8 g; 95% confidence interval, 2-14 g;
P=0.01) in the placebo group than in the valsartan group. CONCLUSIONS -
There was no significant treatment effect of valsartan on right
ventricular ejection fraction, exercise capacity, or quality of life.
Valsartan was associated with a similar frequency of significant clinical
events as placebo. Small but significant differences between valsartan and
placebo were present for change in right ventricular volumes and mass.
2012 American Heart Association, Inc.

<8>
Accession Number
2013055353
Authors
Yokoyama J. Ito S. Ohba S. Fujimaki M. Ikeda K. Hanaguri M.
Institution
(Yokoyama, Ito, Ohba, Fujimaki, Ikeda) Department of Otolaryngology, Head
and Neck Surgery, Juntendo University School of Medicine, 113-8421, 2-1-1,
Hongo, Bunkyo-ku, Tokyo, Japan
(Hanaguri) Department of Otolaryngology, Kyushu Rosai Hospital,
Kitakyushu, Japan
Title
A safe and cosmetic method of removing the sternum by bone forceps for
mediastinal dissection of recurrent thyroid cancer.
Source
Head and Neck Oncology. 4 (2) , 2012. Article Number: 58. Date of
Publication: 09 Sep 2012.
Publisher
OA Publishing London (Second Floor, 10-12 Maclise Road, London, England
W140PR, United States)
Abstract
Introduction Thyroid cancer frequently recurs in the superior or anterior
mediastinum. Midline sternotomy is usually performed in order to dissect
recurrent mediastinal cancers, but there is a high risk of haemorrhage
that can result from unintentionally cutting the brachiocephalic veins
adhering to the sternum. A safe and minimally invasive method is thus
required for the treatment of recurrent thyroid cancer in the mediastinum.
The objective of this study was to evaluate a novel method of removing the
sternum by bone forceps for mediastinal dissection to determine its
safety, aesthetic outcome and duration of hospitalisation, as compared
with conventional reversed T-shaped sternotomy. Materials and methods A
collar skin incision was made followed by the removal of the sternum by
bone forceps. As a result, soft tissues, including the sternothyroid
muscle, behind the sternum were exposed and cut, allowing the surgeon a
clear area in which to observe great vessels in the mediastinum.
Mediastinal dissection could then be performed safely because of the clear
view afforded when retracting the brachiocephalic veins. After dissection,
many pieces of the sternal bone were grafted back to the sternum and were
subsequently covered with vascularised muscle tissue. Twenty-one patients
with recurrent thyroid carcinoma underwent this procedure between 2005 and
2010. The control group consisted of 12 patients treated by conventional
methods between 2002 and 2004. The difference between the two groups was
tested using Student's t-test and Mann-Whitney test; p values <0.05 were
considered to indicate significance. Results and Discussion The mean time
for removal of the sternum was 11 min (9-15 min). After the sternum was
removed, brachiocephalic veins could be clearly observed in the soft
tissue. Mediastinal dissection could be performed safely because of the
clear view provided, and it did not result in any complications. The mean
blood loss for the new method group and that for the control group was 185
ml (35-530) and 278 ml (55-687), respectively. The mean surgical time for
the new method group and the control group was 3 h 5 min and 3 h 58 min,
respectively. The mean duration of hospitalisation for the new method
group and the control group was 8.5 days (7-19) and 12.9 days (8-23),
respectively. These three key areas of comparison were significantly
different between the two groups. Patients were highly satisfied with the
post-operative aesthetic results. This method is effective for the
dissection of the central compartment rather than the lateral compartment.
Conclusion This novel method of removing the sternum by bone forceps is
more effective than the conventional method for mediastinal dissection of
recurrent thyroid cancer in terms of safety, aesthetic outcome and
duration of hospitalisation. Copyright 2012 OA Publishing London.

<9>
Accession Number
2013044614
Authors
Chen X. Zhang N. Cai Y. Shi J.
Institution
(Chen, Zhang, Cai, Shi) Department of Clinical Epidemiology, Institute of
Cardiovascular Diseases and Center of Evidence Based Medicine, First
Affiliated Hospital, China Medical University, Shenyang, China
Title
Evaluation of left ventricular diastolic function using tissue Doppler
echocardiography and conventional doppler echocardiography in patients
with subclinical hypothyroidism aged <60 years: A meta-analysis.
Source
Journal of Cardiology. 61 (1) (pp 8-15), 2013. Date of Publication:
January 2013.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) (Hongo 4-9-22,
Bunkyo-ku, Tokyo 113, Japan)
Abstract
Studies have suggested that subclinical hypothyroidism (SCH) may have
detrimental effects on left ventricular (LV) diastolic function. Whether
SCH is a risk factor for LV diastolic dysfunction is controversial.
Databases (MEDLINE, PubMed, EMBASE) were searched for cross-sectional
studies evaluating LV diastolic function in SCH patients aged <60 years
using tissue Doppler echocardiography (TDE) and conventional
two-dimensional Doppler echocardiography (2D-DECG) published in the past
12 years. The weighted mean difference (WMD) and 95% confidence interval
(CI) were calculated using fixed or random-effects models. We summarized
the results of 14 cross-sectional studies with 675 participants. SCH
patients had a significantly lower LV mitral annular E_a peak
velocity (WMD=-1.71cm/s; 95%CI: -3.02 to -0.40; p<0.05),
E_a/A_a ratio (WMD=-0.22; 95%CI: -0.40 to -0.05;
p<0.05), and significantly higher mitral annular A_a peak
velocity (WMD=0.47cm/s; 95%CI: 0.10-0.85; p<0.05) than euthyroid subjects
using TDE. Subgroup analyses showed that statistical significance existed
only in E_a and E_a/A_a parameters when data
from " women>=90%" were used, and in the A_a parameter when data
from " women<90%" were used. No matter which subgroup of females was used,
there were significant differences in LV peak transmitral A velocity
(WMD=7.64cm/s; 95%CI: 4.55-10.73; p<0.05), and E/A ratio (WMD=-0.22;
95%CI: -0.31 to -0.21; p<0.05) but no significant difference in peak
transmitral E velocity (p>0.05) between SCH patients and euthyroid
controls using 2D-DECG. Therefore, for those aged <60 years, SCH patients
had significantly worse parameters of LV diastolic function than euthyroid
controls. 2012 Japanese College of Cardiology.

<10>
Accession Number
2013037706
Authors
Chrysant S.G. Chrysant G.S.
Institution
(Chrysant) Oklahoma Cardiovascular and Hypertension Center, University of
Oklahoma, 5850 W Wilshire Blvd, Oklahoma City, OK 73132, United States
(Chrysant) INTEGRIS Baptist Medical Center, Oklahoma City, OK, United
States
Title
New insights into the true nature of the obesity paradox and the lower
cardiovascular risk.
Source
Journal of the American Society of Hypertension. 7 (1) (pp 85-94), 2013.
Date of Publication: January-February 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Obesity is considered a major risk factor for cardiovascular disease,
hypertension, and diabetes by National and International Committees. For
this reason, they advocate weight loss and prevention of obesity. However,
several studies in patients with established coronary artery disease
(CAD), congestive heart failure, and hypertension have shown an inverse
relationship between obesity and mortality, the so called "obesity
paradox," whereas other studies have not shown such a relationship. In
studies showing the obesity paradox (OP), body mass index (BMI) was used,
almost exclusively as an index of obesity, although is a poor
discriminator of total body fatness. Recent studies using better indices
of obesity such as waist circumference (WC) and waist to hip ratio (WHR)
have shown that high WC and WHR were directly and positively associated
with higher event rate and total mortality in these patients. Because the
OP could convey the wrong message in obese patients, the validity and true
nature of the OP will be examined in this concise review. A Medline search
of the English literature was performed between 2000 and September 2012,
and 46 pertinent articles were selected for this review. The majority of
these studies do not support an OP and those that do have used almost
exclusively BMI as an index of obesity. Therefore, based on recent studies
using other indices of body fat distribution, such as WC and WHR, besides
BMI, the true existence of OP has been questioned and needs to be
confirmed by future studies. 2013 American Society of Hypertension. All
rights reserved.

<11>
Accession Number
2013044134
Authors
Teeuwen K. Adriaenssens T. Van den Branden B.J.L. Henriques J.P.S. Van der
Schaaf R.J. Koolen J.J. Vermeersch P.H.M.J. Bosschaert M.A.R. Tijssen
J.G.P. Suttorp M.J.
Institution
(Teeuwen, Bosschaert, Suttorp) Department of Cardiology, St. Antonius
Hospital, Koekoekslaan1, 3435 CM, Nieuwegein, Netherlands
(Adriaenssens) Department of Cardiology, University Hospitals Leuven,
Herestraat 49, 3000, Leuven, Belgium
(Van den Branden, Tijssen) Department of Cardiology, Amphia Hospital,
Molengracht 21, 4818 CK, Breda, Netherlands
(Henriques) Department of Cardiology, Academic Medical Center, University
of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
(Van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, 1091 AC, Amsterdam, Netherlands
(Koolen) Department of Cardiology, Catharina Hospital, Michalangelolaan 2,
6523 EJ, Eindhoven, Netherlands
(Vermeersch) Department of Cardiology, Middelheim Hospital, Lindendreef 1,
2020, Antwerpen, Belgium
Title
A randomized multicenter comparison of hybrid sirolimus-eluting stents
with bioresorbable polymer versus everolimus-eluting stents with durable
polymer in total coronary occlusion: Rationale and design of the Primary
Stenting of Occluded Native Coronary Arteries IV study.
Source
Trials. 13 , 2012. Article Number: 240. Date of Publication: 15 Dec 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Percutaneous recanalization of total coronary occlusion (TCO)
was historically hampered by high rates of restenosis and reocclusions.
The PRISON II trial demonstrated a significant restenosis reduction in
patients treated with sirolimus-eluting stents compared with bare metal
stents for TCO. Similar reductions in restenosis were observed with the
second-generation zotarolimus-eluting stent and everolimus-eluting stent.
Despite favorable anti-restenotic efficacy, safety concerns evolved after
identifying an increased rate of very late stent thrombosis (VLST) with
drug-eluting stents (DES) for the treatment of TCO. Late malapposition
caused by hypersensitivity reactions and chronic inflammation was
suggested as a probable cause of these VLST. New DES with bioresorbable
polymer coatings were developed to address these safety concerns. No
randomized trials have evaluated the efficacy and safety of the
new-generation DES with bioresorbable polymers in patients treated for
TCO.Methods/Design: The prospective, randomized, single-blinded,
multicenter, non-inferiority PRISON IV trial was designed to evaluate the
safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting
stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany)
compared with everolimus-eluting stents with durable polymers (Xience
Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA) in patients with
successfully recanalized TCOs. In total, 330 patients have been randomly
allocated to each treatment arm. Patients are eligible with estimated
duration of TCO >=4 weeks with evidence of ischemia in the supply area of
the TCO. The primary endpoint is in-segment late luminal loss at 9-month
follow-up angiography. Secondary angiographic endpoints include in-stent
late luminal loss, minimal luminal diameter, percentage of diameter
stenosis, in-stent and in-segment binary restenosis and reocclusions at
9-month follow-up. Additionally, optical coherence tomography is performed
in the first 60 randomized patients at 9 months to assess neointima
thickness, percentage of neointima coverage, and stent strut malapposition
and coverage. Personnel blinded to the allocated treatment will review all
angiographic and optical coherence assessments. Secondary clinical
endpoints include major adverse cardiac events, clinically driven target
vessel revascularization, target vessel failure and stent thrombosis to
5-year clinical follow-up. An independent clinical event committee blinded
to the allocated treatment will review all clinical events.Trial
registration: Clinical Trials.gov: NCT01516723. Patient recruitment
started in February 2012. 2012 Teeuwen et al.; licensee BioMed Central
Ltd.

<12>
Accession Number
2012685171
Authors
Qaseem A. Fihn S.D. Williams S. Dallas P. Owens D.K. Shekelle P.
Institution
(Qaseem) American College of Physicians, 190 N. Independence Mall West,
Philadelphia, PA 19106, United States
(Fihn) 1100 Olive Way, Seattle, WA 98101, United States
(Williams) 423 Guardian Drive, Philadelphia, PA 19104, United States
(Dallas) 1906 Bellview Avenue, Roanoke, VA 24014, United States
(Owens) 117 Encina Commons, Stanford, CA 94305, United States
(Shekelle) 11301 Wiltshire Boulevard, Los Angeles, CA 90073, United States
Title
Management of stable ischemic heart disease: Summary of a clinical
practice guideline from the American College of Physicians/American
College of Cardiology Foundation/ American Heart Association/American
Association for Thoracic Surgery/Preventive Cardiovascular Nurses
Association/Society of Thoracic Surgeons.
Source
Annals of Internal Medicine. 157 (10) (pp 735-743), 2012. Date of
Publication: 20 Nov 2012.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Description: The American College of Physicians (ACP) developed this
guideline with the American College of Cardiology Foundation (ACCF),
American Heart Association (AHA), American Association for Thoracic
Surgery, Preventive Cardiovascular Nurses Association, and Society of
Thoracic Surgeons to present the available evidence on the management of
stable known or suspected ischemic heart disease. Methods: Literature on
this topic published before November 2011 was identified by using MEDLINE,
Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were
limited to human studies published in English. This guideline grades the
evidence and recommendations according to a translation of the ACCF/AHA
grading system into ACP's clinical practice guidelines grading system.
Recommendations: The guideline includes 48 specific recommendations that
address the following issues: patient education, management of proven risk
factors (dyslipidemia, hypertension, diabetes, physical activity body
weight, and smoking), risk factor reduction strategies of unproven
benefit, medical therapy to prevent myocardial infarction and death and to
relieve symptoms, alternative therapy, revascularization to improve
survival and symptoms, and patient follow-up. 2012 American College of
Physicians.

<13>
Accession Number
70977183
Authors
Verberne H.J. Verschure D.O. Veltman C.E. Manrique A. Somsen G. Koutelou
M. Katsikis A. Agostini D. Gerson M.C. Van Eck-Smit B.L.F. Scholte
A.J.H.A. Jacobson A.F.
Institution
(Verberne, Verschure, Van Eck-Smit) Academic Medical Center, Amsterdam,
Netherlands
(Veltman, Scholte) Leiden University Medical Center, Leiden, Netherlands
(Manrique) Service Commun Investigations chez l'Homme, GIP Cyceron, Caen,
France
(Somsen) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Koutelou, Katsikis) Onassis Cardiac Surgery Center, Athens, Greece
(Agostini) CHU Cote de Nacre, Caen, France
(Gerson) University of Cincinnati, College of Medicine, Cincinnati, OH,
United States
(Jacobson) GE Healthcare, Princeton, NJ, United States
Title
For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest
prognostic value in patients with heart failure? Results of a pooled
individual patient data metaanalysis.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
25th Annual Congress of the European Association of Nuclear Medicine, EANM
2012 Milan Italy. Conference Start: 20121027 Conference End: 20121031.
Conference Publication: (var.pagings). 39 (pp S192), 2012. Date of
Publication: October 2012.
Publisher
Springer Verlag
Abstract
Aim: Despite the numerous single studies demonstrating the prognostic
value of myocardial ¹²³I-metaiodobenzylguanidine (MIBG) in
heart failure (HF) patients, clinical use of this procedure remains
limited. The purpose of this study was to determine the most appropriate
prognostic endpoint for use of MIBG imaging based upon aggregate results
from multiple studies published in the past decade. Materials and Methods:
Published studies from Europe and the United States were identified for
which original individual patient data for heart/mediastinum ratio (H/M)
from late (3-5 hour) planar MIBG imaging were available. Data submitted by
the participating investigators were pooled and Cox proportional hazards
analyses were performed. Endpoints of all-cause mortality, cardiac
mortality, arrhythmic events, and heart transplantation were investigated
to determine which provided the strongest prognostic significance for the
MIBG imaging data. Results: Data from 6 studies with a total of 636 HF
patients were retrieved. The majority of patients was male (78%), had a
decreased left ventricular ejection fraction (LVEF) (31.1% +/- 12.5%) and
a mean late H/M of 1.67 +/- 0.47 (1st quintile <=1.32 2nd to 4th quintile
1.33-1.97, 5th quintile >=1.98). During follow-up (mean 42.1 +/- 26.5
months) there were 95 deaths, 79 cardiac deaths, 38 arrhythmic events, and
57 heart transplants. In univariate Cox analyses, late H/M was a
significant predictor of all event categories, but the highest chi-squares
and lowest hazard ratios (HR) were for allcause (chi²=17.68,
HR=0.37, 95%CI: 0.22-0.61) and cardiac mortality (chi²=14.57,
HR=0.37, 95%CI: 0.21-0.65). In multivariate analysis for the composite of
any event, H/M was a significant predictor (HR=0.53, 95%CI: 0.36-0.78),
with LVEF, gender, and NYHA class also included in the model. In similar
analyses for the individual event categories in subjects with reduced LVEF
(<50%, n=580), H/M was a significant predictor of all-cause (HR=0.49,
95%CI: 0.27-0.89) and cardiac mortality (HR=0.45, 95%CI: 0.23-0.87), with
LVEF, age, and HF aetiology also included in the model. The same 4
variables were significant in models using a dichotomous H/M split at 1.20
(1 SD below the mean) (patients with late H/M <1.2 having the highest
mortality (median survival 71 months)), with an H/M HR for cardiac death
and allcause mortality of 0.39 (95%CI: 0.22-0.71) and 0.49 (95%CI:
0.28-0.86) respectively. Conclusions: Late H/M is strongest as a
univariate predictor of all-cause and cardiac mortality in HF patients. In
multivariate analyses, MIBG imaging tends to be strongest as a predictor
of cardiac death.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 17

Results Generated From:
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Embase (updates since 2013-01-24)

<1>
Accession Number
2013043232
Authors
Alkan-Bozkaya T. Akcevin A. Turkoglu H. Undar A.
Institution
(Alkan-Bozkaya, Akcevin, Turkoglu) Department of Cardiovascular Surgery,
Istanbul Medipol University, Istanbul, Turkey
(Undar) Departments of Pediatrics, Surgery and Bioengineering, Penn State
Hershey College of Medicine, Pediatric Cardiovascular Research Center,
Hershey, PA, United States
Title
Impact of Pulsatile Perfusion on Clinical Outcomes of Neonates and Infants
With Complex Pathologies Undergoing Cardiopulmonary Bypass Procedures.
Source
Artificial Organs. 37 (1) (pp 82-86), 2013. Date of Publication: January
2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
The aim of this clinical trial was to evaluate the pulsatile perfusion
mode in pediatric patients who had complex cardiac pathologies according
to Jenkins stratifications (category 4) undergoing cardiopulmonary bypass
procedures (CPB). Patients with transposition of great arteries (TGA) and
ventricular septal defect (VSD) were included in this clinical study.
Eighty-nine consecutive pediatric patients undergoing open heart surgery
for repair of TGA-VSD were prospectively entered into the study and were
randomly assigned to either the pulsatile perfusion group (Group P, n=58)
or the nonpulsatile perfusion group (Group NP, n=31). There were no
differences between groups in terms of demographical and intraoperative
parameters. The pulsatile group needed significantly less inotropic
support (P<0.05) and had lower lactate levels (P<0.001), higher urine
output (P<0.01), and higher albumin levels (P<0.05). In addition, the
pulsatile group had less ICU (P<0.01) and hospital stays (P<0.001). We
conclude that the use of pulsatile flow is a better option and should be
considered for repair of the complex congenital heart defects. 2013, The
Authors. Artificial Organs 2013, International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<2>
Accession Number
2013037937
Authors
Farooq V. Serruys P.W. Garcia-Garcia H.M. Zhang Y. Bourantas C.V. Holmes
D.R. MacK M. Feldman T. Morice M.-C. Stahle E. James S. Colombo A. Diletti
R. Papafaklis M.I. De Vries T. Morel M.-A. Van Es G.A. Mohr F.W. Dawkins
K.D. Kappetein A.-P. Sianos G. Boersma E.
Institution
(Farooq, Serruys, Garcia-Garcia, Zhang, Bourantas, Diletti, Papafaklis,
Boersma) Department of Interventional Cardiology, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(MacK) Medical City Dallas Hospital, Dallas, TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Morice) Institut Jacques Cartier, Massy, France
(Stahle, James, Sianos) University Hospital Uppsala, Uppsala, Sweden
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(De Vries, Morel, Van Es) Cardialysis BV, Rotterdam, Netherlands
(Mohr) Herzzentrum, Leipzig, Germany
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
Title
The negative impact of incomplete angiographic revascularization on
clinical outcomes and its association with total occlusions: The SYNTAX
(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac
Surgery) trial.
Source
Journal of the American College of Cardiology. 61 (3) (pp 282-294), 2013.
Date of Publication: 22 Jan 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The study sought to evaluate the clinical impact of
angiographic complete (CR) and incomplete (ICR) revascularization and its
association with the presence of total occlusions (TO), after percutaneous
coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery
in the "all-comers" SYNTAX (Synergy Between Percutaneous Coronary
Intervention with Taxus and Cardiac Surgery) trial. Background: In
patients with complex coronary artery disease undergoing PCI or CABG, the
long-term prognostic implications of CR versus ICR is unsettled. Methods:
In this post hoc study, consisting of randomized (n = 1,800) and nested
PCI (n = 198) and CABG (n = 649) registries, 4-year clinical outcomes were
compared in groups, with and without angiographic CR, in the PCI and CABG
arms. Clinical outcomes were analyzed with Kaplan-Meier estimates,
log-rank comparisons, and Cox regression analyses. Multivariate predictors
of ICR were determined. Similar analyses were undertaken in the TO and
non-TO treated groups of both study arms. Results: Angiographic CR was
achieved in 52.8% of the PCI arm and 66.9% of the CABG arm. Within the PCI
and CABG arms, ICR (compared with CR) seemed to be a surrogate marker of a
greater burden of anatomical coronary complexity and clinical comorbidity
and was associated with significantly higher frequencies of 4-year
mortality, all-cause revascularization, stent thrombosis (PCI arm), and
major adverse cardiac and cerebrovascular events. The presence of a TO was
the strongest independent predictor of ICR after PCI (hazard ratio: 2.70,
95% confidence interval: 1.98 to 3.67, p < 0.001). Eight hundred and forty
patients (PCI: 26.3%, CABG: 36.4%, p < 0.001) were identified to have
1,007 TOs, with 68.1% of TOs located in the proximal-mid coronary
vasculature. The findings associating ICR (compared with CR) with higher
frequencies of 4-year mortality and major adverse cardiac and
cerebrovascular events remained consistent in the TO-treated groups in the
PCI and CABG arms. Conclusions: Within the PCI and CABG arms of the
all-comers SYNTAX trial, angiographically determined ICR has a detrimental
impact on long-term clinical outcomes, including mortality. This effect
remained consistent in patients with and without TOs. 2013 American
College of Cardiology Foundation.

<3>
Accession Number
2013049771
Authors
Vasques F. Rainio A. Heikkinen J. Mikkola R. Lahtinen J. Kettunen U.
Juvonen T. Biancari F.
Institution
(Vasques, Rainio, Heikkinen, Mikkola, Lahtinen, Kettunen, Juvonen,
Biancari) Division of Cardio-thoracic and Vascular Surgery, Department of
Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland
Title
Off-pump versus on-pump coronary artery bypass surgery in patients aged 80
years and older: Institutional results and meta-analysis.
Source
Heart and Vessels. 28 (1) (pp 46-56), 2013. Date of Publication: January
2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Patients aged >=80 years are at high risk of adverse events after coronary
artery bypass grafting. This study was performed to evaluate whether
off-pump coronary artery bypass surgery (OPCAB) is superior to
conventional surgery (CCAB) in these high-risk patients. The outcome of
185 patients aged >=80 years who underwent OPCAB or CCAB at our
institution was reviewed and a meta-analysis on this issue was performed.
Similar immediate postoperative results were observed after OPCAB and CCAB
at our institution, despite significantly different operative risk (mean
logistic EuroSCORE, OPCAB 20.3% vs CCAB 13.4%, P = 0.003). Among 56
propensity score matched pairs a trend toward lower postoperative stroke
(0%, 95% CI 0-0 vs 3.6%, 95% CI 0-10.0, P = 0.50) was observed after
OPCAB. No significant differences were observed in the other outcome end
points. Five-year survival was 81.0% after OPCAB and 78.1% after CCAB (P =
0.239). Pooled analysis of eight studies including 3416 patients showed a
significantly higher risk of postoperative stroke after CCAB (pooled
rates: 4.2%, 95% confidence interval (95% CI) 2.4-7.1 vs 1.5%, 95% CI
0.9-2.5, risk ratio (RR) 2.15, 95% CI 1.17-3.96, P = 0.01). A trend toward
higher immediate postoperative mortality was observed after CCAB (15
studies including 4409 patients, pooled rates: 6.5%, 95% CI 5.2-8.0 vs
5.6%, 95% CI 4.2-7.4, RR 1.29, 95% CI 0.86-1.93, P = 0.21). Generic
inverse variance analysis showed similar intermediate survival after CCAB
and OPCAB (RR 1.31, 95% CI 0.85-2.01, P = 0.22). At 2 years, survival was
82.8% (95% CI 76.4-89.2) after CCAB and 88.3% (95% CI 82.9-93.7) after
OPCAB. Current results indicate that OPCAB compared with CCAB in patients
aged >=80 years is associated with significantly lower postoperative
stroke and with a trend toward better early survival. However, suboptimal
quality of the available studies, particularly the lack of comparability
of the study groups, prevents conclusive results on this controversial
issue. 2011 Springer.

<4>
Accession Number
2013043798
Authors
Lomivorotov V.V. Efremov S.M. Kalinichenko A.P. Kornilov I.A. Knazkova
L.G. Chernyavskiy A.M. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Efremov, Kalinichenko, Kornilov, Knazkova, Chernyavskiy,
Lomivorotov, Karaskov) Research Institute of Circulation Pathology,
Rechkunovskaya Street 15, Novosibirsk 630055, Russian Federation
Title
Methylprednisolone Use is Associated with Endothelial Cell Activation
Following Cardiac Surgery.
Source
Heart Lung and Circulation. 22 (1) (pp 25-30), 2013. Date of Publication:
January 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Background: The objective of this study was to investigate the effect of
the perioperative use of methylprednisolone in medium doses on markers of
endothelial cell activation in patients with coronary artery disease
undergoing cardiopulmonary bypass. Methods: In this prospective,
double-blinded, placebo-controlled, randomised study, 44 patients,
undergoing a coronary artery bypass graft surgery received either
methylprednisolone 20mg/kg or a placebo intraoperatively after anaesthesia
induction. The primary endpoint was endothelin-1, and secondary endpoints
were E-selectin, interleukin (IL)-6 and IL-10,
PaO₂/FiO₂ coefficient, and microalbuminuria.
Results: Endothelin-1 was higher in the study group postoperatively at
10min (p=0.0008), 2h (p=0.02), 4h (p=0.005), and 24h (p=0.004). IL-6 was
lower in the study group postoperatively at 2h (p=0.03), 4h (p=0.04), and
24h (p<0.0001). IL-10 was higher in the study group postoperatively at
10min (p<0.0001), 2h (p=0.009), and 4h (p=0.001).
PaO₂/FiO₂ was lower in the study group at 24h after
surgery (p=0.03). Microalbuminuria was similar in both groups. Conclusion:
Despite an obvious anti-inflammatory effect, methylprednisolone causes
endothelial cell activation in patients undergoing cardiopulmonary bypass.
2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

<5>
Accession Number
2013044601
Authors
Park J.-B. Koo B.-K. Choi W.-G. Kim S.-Y. Park J. Kwan J. Park C.G. Kim
H.-S.
Institution
(Park, Koo, Kim) Division of Cardiology, Department of Internal
Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul,
South Korea
(Choi) Division of Cardiology, Department of Internal Medicine, Konkuk
University Chungju Hospital, Chungju, South Korea
(Kim) Department of Cardiology, Seoul Medical Center, Seoul, South Korea
(Park) Division of Cardiology, Department of Internal Medicine, Sejong
General Hospital, Bucheon, South Korea
(Kwan) Division of Cardiology, Department of Internal Medicine, Inha
University Hospital, Incheon, South Korea
(Park) Division of Cardiology, Cardiovascular Center, Korea University
Guro Hospital, Seoul, South Korea
Title
Comparison of Antiplatelet Efficacy and Tolerability of Clopidogrel
Napadisilate With Clopidogrel Bisulfate in Coronary Artery Disease
Patients After Percutaneous Coronary Intervention: A Prospective,
Multicenter, Randomized, Open-Label, Phase IV, Noninferiority Trial.
Source
Clinical Therapeutics. 35 (1) (pp 28-37.e4), 2013. Date of Publication:
January 2013.
Publisher
Excerpta Medica Inc. (105 Raider Blvd, Suite 101, Hillsborough NJ 08844,
United States)
Abstract
Background: Clopidogrel bisulfate, a potent antiplatelet agent, has a
pivotal role in the prevention and treatment of atherothrombotic disease.
Clopidogrel napadisilate, a different salt preparation of clopidogrel, has
been developed and approved in Korea and several European countries.
Recent studies have suggested that clopidogrel napadisilate might have
improved stability and comparable bioequivalence to clopidogrel bisulfate.
However, these 2 clopidogrel preparations have not been compared in terms
of efficacy and tolerability in patients with coronary artery disease
(CAD) who underwent percutaneous coronary intervention (PCI). Objective:
We sought to investigate the antiplatelet efficacy and safety profile of
clopidogrel napadisilate compared with clopidogrel bisulfate in CAD
patients. Methods:This was a randomized, multicenter, open-label, Phase
IV, noninferiority clinical trial. We prospectively recruited CAD patient
in 6 institutions in Korea between October 2010 and November 2011.
Patients who underwent PCI were randomly assigned to the test group
(clopidogrel napadisilate plus aspirin) or control group (clopidogrel
bisulfate plus aspirin). Antiplatelet efficacy and safety profile were
assessed after 4 weeks of maintenance treatment. The primary end point was
noninferiority of the percentage of P2Y₁₂ inhibition, measured
by point-of-care assay. The rate of major adverse cardiovascular events
(MACE), as a secondary end point, was compared between the 2 clopidogrel
preparations. To assess tolerability, we evaluated the incidence,
severity, and causal relation of adverse events (AEs) of 2 groups. Results
A total of 169 patients were screened, and 127 patients completed the
study (64 in the test group and 63 in the control group; P = 0.296). The
baseline characteristics of patients did not differ significantly between
the treatment groups. The between-group difference in percentage of
P2Y₁₂ inhibition did not exceed the prespecified limit for
noninferiority P for noninferiority = 0.032; 95% CI, -8.33 to 5.53). With
respect to the risk of MACE, no significant difference was found in the
incidence of myocardial infarction or stroke between the groups (1 in the
test group and 2 in the control group; P > 0.99); no mortality was
reported in either group. The tolerability of clopidogrel napadisilate was
comparable with that of clopidogrel bisulfate in terms of all AEs,
drug-related AEs, and serious AEs (all AEs: test group, 33.3%; control
group, 32.9% [P > 0.99]; drug-related AEs: test group, 4.17%; control
group, 0% [P = 0.113]; serious AEs: test group, 1.39%; control group,
5.26% [P=0.367]). Conclusions: In this study of CAD Korean patients who
have undergone PCI, the antiplatelet efficacy of clopidogrel napadisilate
was noninferior to that of clopidogrel bisulfate after 4 weeks of
maintenance treatment. No statistically significant difference was found
in tolerability between the 2 treatment groups. ClinicalTrials.gov
identifier: NCT01584791. 2013 Elsevier HS Journals, Inc.

<6>
Accession Number
2013038487
Authors
Alvarez V. Rossetti A.O. Papavasileiou V. Michel P.
Institution
(Alvarez, Rossetti, Papavasileiou, Michel) Department of Clinical
Neurosciences, Centre Hospitalier Universitaire Vaudois, University of
Lausanne, 1011 Lausanne, Switzerland
Title
Acute seizures in acute ischemic stroke: Does thrombolysis have a role to
play?.
Source
Journal of Neurology. 260 (1) (pp 55-61), 2013. Date of Publication:
January 2013.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Seizures appear at stroke presentation, during the acute phase or as a
late complication of stroke. Thrombolysis has not been investigated as a
risk factor despite its potential neurotoxic effect. We try to identify
risk factors for seizures during the acute phase of ischemic stroke in a
cohort including thrombolysed patients. We undertook a case-control study
at a single stroke center using data from Acute Stroke Registry and
Analyse of Lausanne (ASTRAL). Patients with seizure occurring during the
first 7 days following stroke were retrospectively identified. Bi-variable
and multivariable statistical analyses were applied to compare cases and
randomly selected controls. We identified 28 patients experiencing from
seizures in 2,327 acute ischemic strokes (1.2 %). All seizures occurred
during the first 72 h. Cortical involvement, thrombolysis with rt-PA,
arterial recanalization, and higher initial NIHSS were statistically
associated with seizures in univariated analysis. Backward linear
regression identified cortical involvement (OR 7.53, 95 % CI 1.6-35.2, p <
0.01) and thrombolysis (OR 4.6, 95 % CI 1.6-13.4, p = 0.01) as being
independently associated with seizure occurrence. Overall, 3-month outcome
measured by the modified Rankin scale (mRS) was comparable in both groups.
In the subgroup of thrombolysed patients, outcome was significantly worse
at 3 months in the seizure group with 9/12 (75 %) patients with mRS >=3,
compared to 6/18 (33.3 %) in the seizure-free group (p = 0.03). Acute
seizures in acute ischemic stroke were relatively infrequent. Cortical
involvement and thrombolysis with rt-PA are the principal risk factors.
Seizures have a potential negative influence on clinical outcome in
thrombolysed patients. 2012 Springer-Verlag.

<7>
Accession Number
2013034057
Authors
Lomivorotov V.V. Efremov S.M. Boboshko V.A. Nikolaev D.A. Vedernikov P.E.
Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Efremov, Boboshko, Nikolaev, Vedernikov, Lomivorotov,
Karaskov) Department of Anesthesiology and Intensive Care, Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
Title
Evaluation of nutritional screening tools for patients scheduled for
cardiac surgery.
Source
Nutrition. 29 (2) (pp 436-442), 2013. Date of Publication: February 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objective: The aim of this study was to assess the prognostic value of
different nutritional screening tools in patients undergoing
cardiopulmonary bypass with regard to an adverse clinical course. Methods:
This prospective cohort study analyzed 894 adult patients who underwent
cardiopulmonary bypass. Patients were screened using four nutritional
screening tools: Nutritional Risk Screening 2002 (NRS-2002), the
Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional
Assessment (MNA), and the Short Nutritional Assessment Questionnaire
(SNAQ). Nutritional status was assessed using the Subjective Global
Assessment. In-hospital mortality, postoperative complications, length of
stay in the intensive care unit, and length of hospitalization were
analyzed. Results: The sensitivities of the SNAQ, MUST, and NRS-2002 to
detect the malnutrition confirmed by the Subjective Global Assessment were
91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of
81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and
NRS-2002 was associated with postoperative complications (odds ratios
[ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care
unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected
by the SNAQ and MUST was also associated with prolonged hospitalization
(ORs 1.49 and 1.59). According to multivariate logistic regression
analysis, postoperative complications were independently predicted by the
European System for Cardiac Operative Risk Evaluation (OR 1.1, P <
0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and
malnutrition identified by the MUST (OR 1.2, P = 0.01). Conclusion: The
MUST independently predicts postoperative complications. The SNAQ and MUST
have comparable accuracy in detecting malnutrition. Whether preoperative
nutritional therapy would improve the outcome in malnourished patients
needs to be studied. 2013 Elsevier Inc.

<8>
Accession Number
2013035819
Authors
Kassaian S.E. Abbasi K. Hakki Kazazi E. Soltanzadeh A. Alidoosti M. Karimi
A. Shirani S. Salarifar M. Ahmadi S.H. Hajizeinali A.M. Razmjoo K.
Institution
(Kassaian, Alidoosti, Salarifar, Hajizeinali) Department of Interventional
Cardiology, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Abbasi, Karimi, Ahmadi) Department of Cardiothoracic Surgery, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Hakki Kazazi) Department of Research, Tehran Heart Center, Tehran
University of Medical Sciences, North Kargar Street, 1411713138 Tehran,
Iran, Islamic Republic of
(Soltanzadeh, Razmjoo) Department of Neurology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shirani) Department of Radiology, Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Staged carotid artery stenting and coronary artery bypass surgery versus
isolated coronary artery bypass surgery in concomitant coronary and
carotid disease.
Source
Journal of Invasive Cardiology. 25 (1) (pp 8-12), 2013. Date of
Publication: January 2013.
Publisher
HMP Communications (83 General Warren Blvd. Suite 100, Malven PA 19355,
United States)
Abstract
BACKGROUND: We aimed to compare the outcomes of patients who underwent
carotid artery stenting (CAS) followed by coronary artery bypass grafting
(CABG) with the outcomes of those who underwent isolated CABG without
carotid intervention. METHODS: In this prospective cohort study, conducted
between March 2007 and February 2010, all patients who had significant
carotid artery stenosis (>70%) and were candidates for CABG were included.
The outcome measures, including 30-day post-stenting complications,
cardiac surgery neurological complications, myocardial infarction (MI),
and mortality rates, were assessed. RESULTS: A total of 112 patients
underwent CABG without carotid artery intervention and 62 patients were
scheduled for CAS + CABG. The death and MI or stroke rates in the CAS +
CABG patients and isolated CABG group were 9.7% and 6.3%, respectively
(P=.18). In the CAS + CABG group, 4 patients (6.4%) were complicated by
ipsilateral stroke, 2 (3.2%) by MI, and 3 (4.8%) by death; 2 deaths had
neurological causes and 1 death had a cardiac cause. In the isolated CABG
group, 4 stroke cases (3.6%) were diagnosed in the postoperative period, 2
of them (1.8%) being ipsilateral. Also, 1 MI case (0.9%) and 4 deaths
(3.6%) occurred after cardiac surgery; 2 deaths had neurological causes
and the remaining 2 deaths resulted from other postoperative complications
(mediastinitis and arrhythmia). CONCLUSION: The risk of ipsilateral stroke
in the isolated CABG approach in patients with concomitant coronary and
carotid stenosis is small, and there is no evidence that this risk is
lessened by prophylactic CAS. Staged CAS + CABG may become the preferred
option in patients with symptomatic bilateral carotid stenosis with stable
cardiac status if it is conducted in a high-volume center by experienced
operators.

<9>
Accession Number
2013035396
Authors
Straka Z. Budera P. Osmancik P. Vanek T. Hulman M. Smid M. Maly M.
Widimsky P.
Institution
(Straka, Budera, Osmancik, Vanek, Widimsky) Cardiocenter, Third Faculty of
Medicine, Charles University Prague, Czech Republic
(Hulman) National Institute of Cardiovascular Diseases, Bratislava,
Slovakia
(Smid) Cardiocenter, Faculty of Medicine, Charles University Prague,
Pilsen, Czech Republic
(Maly) National Institute of Public Health, Prague, Czech Republic
Title
Design and rationale of the PRAGUE-12 trial: A large, prospective,
randomized, multicenter trial that compares cardiac surgery with left
atrial surgical ablation with cardiac surgery without ablation in patients
with coronary and/or valvular heart disease plus atrial fibrillation.
Source
Clinical Cardiology. 36 (1) (pp 1-5), 2013. Date of Publication: January
2013.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Surgical ablation procedure can restore sinus rhythm (SR) in patients with
atrial fibrillation (AF) undergoing cardiac surgery. However, it is not
known whether it has any impact on clinical outcomes. There is a need for
a randomized trial with long-term follow-up to study the outcome of
surgical ablation in patients with coronary and/or valve disease and AF.
Patients are prospectively enrolled and randomized either to group A
(cardiac surgery with left atrial ablation) or group B (cardiac surgery
alone). The primary efficacy outcome is the SR presence (without any AF
episode) during a 24-hour electrocardiogram after 1 year. The primary
safety outcome is the combined end point of death, myocardial infarction,
stroke, and renal failure at 30 days. Long-term outcomes are a composite
of total mortality, stroke, bleeding, and heart failure at 1 and 5 years.
We finished the enrollment with a total of 224 patients from 3 centers in
2 countries in December 2011. Currently, the incomplete 1-year data are
available, and the patients who enrolled first will have their 5-year
visits shortly. PRAGUE-12 is the largest study to be conducted so far
comparing cardiac surgery with surgical ablation of AF to cardiac surgery
without ablation in an unselected population of patients who are operated
on for coronary and/or valve disease. Its long-term results will lead to a
better recognition of ablation's potential clinical benefits. The
PRAGUE-12 trial is partially funded by the Charles University Research
Projects MSM0021620817 and UNCE 204010/2012. The authors have no other
funding, financial relationships, or conflicts of interest to disclose.
2012 Wiley Periodicals, Inc.

<10>
Accession Number
2013033062
Authors
Farah P. Ahmad-Ali A. Hanane G. Abbas E.
Institution
(Farah, Hanane) Department of Pediatrics, Islamic Azad University, Kazerun
Branch, Kazerun, Iran, Islamic Republic of
(Ahmad-Ali) Department of Surgery, Division of Cardiovascular Surgery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Abbas) Department of Medicine, New York Medical College, Valhalla, NY,
United States
Title
Additive effect of phosphodiesterase inhibitors in control of pulmonary
hypertension after congenital cardiac surgery in children.
Source
Iranian Journal of Pediatrics. 23 (1) (pp 19-26), 2013. Date of
Publication: February 2013.
Publisher
Tehran University of Medical Sciences (TUMS) (No. 31, Poursina St. Ghods
Ave, Tehran, Iran, Islamic Republic of)
Abstract
Objective: Control of residual pulmonary arterial hypertension (PAH) after
closure of left to right shunts in children is still a challenging issue.
The purpose of this study was to compare the effect of two
phosphodiesterase inhibitors in pediatric cardiac surgical patients.
Methods: A total of 48 postoperative children were enrolled in the study
between 2008 and 2010. Patients were stratified based upon choice of
pulmonary vasodilator into three equal groups (n=16); Milrinone group
received intravenous milrinone (0.75 mu/kg/min), Sildenafil group received
oral sildenafil (0.3 mg/kg every 3 hours) and the Combination group
received both medications. Findings: Demographic variables and types of
congenital anomalies were not different among the 3 groups. Patients in
the Combination group had higher preoperative pulmonary artery to aortic
(PA/AO) pressure ratios compared to other two groups (P=0.001).
Postoperatively, patients in Milrinone group incurred lower systolic PA
and PA/AO pressures compared to Sildenafil group (P=0.014, 0.003), but it
was the same in Sildenafil and Combination group (P=0.2; 0.330
respectively). Pulmonary hypertensive crisis was noted in 6 patients in
Sildenafil group, and 3 patients in Combination group (P=0.02).
Significant rise in PA pressure was noticed after discontinuation of drug
in Milrinone group (P=0.001), which was not observed in the Combination
group (P= 0.6). No mortality was noticed in any of the groups. Conclusion:
Intravenous milrinone is more effective than oral sildenafil in control of
postoperative PAH and elimination of pulmonary hypertensive crisis.
Combination of two drugs reduces the risk of rebound pulmonary arterial
hypertension after discontinuation of milrinone. 2013 by Pediatrics
Center of Excellence, Children's Medical Center, Tehran University of
Medical Sciences, All rights reserved.

<11>
Accession Number
2013025672
Authors
Poon K.K. Crowhurst J. James C. Campbell D. Roper D. Chan J. Incani A.
Clarke A. Tesar P. Aroney C. Raffel O.C. Walters D.L.
Institution
(Poon, James, Roper, Chan, Incani, Clarke, Tesar, Aroney, Raffel, Walters)
Cardiology Program, Prince Charles Hospital, Rode Road, Brisbane, QLD
4032, Australia
(Crowhurst, Campbell) Department of Radiology, Prince Charles Hospital,
Brisbane, QLD, Australia
(Clarke, Tesar) Department of Cardiothoracic Surgery, Prince Charles
Hospital, Brisbane, QLD, Australia
Title
Impact of optimising fluoroscopic implant angles on paravalvular
regurgitation in transcatheter aortic valve replacements - Utility of
three-dimensional rotational angiography.
Source
EuroIntervention. 8 (5) (pp 538-545), 2012. Date of Publication: September
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The clinical value of optimising implant angles during transcatheter
aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide
(AVG) is a proprietary software that provides structured analysis of
three-dimensional images from rotational angiography (DynaCT). This study
compares AVG with preprocedural multislice computed tomography (MSCT) and
DynaCT in optimal implant angle prediction for TAVR, and evaluates if an
optimised implant angle is associated with reduced paravalvular
regurgitation (PVR). Methods and results: One hundred and six consecutive
patients were included, comprising three groups. Group 1 (n=19) underwent
no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent
periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG.
Implant angles yielded were graded as excellent, satisfactory or poor.
Group 3 were more likely than Groups 2 and 1 to have excellent implant
angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients
who had 30-day transthoracic echocardiogram follow-up, an excellent
implant angle was significantly more likely to be associated with no PVR
than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045),
independent of operator experience and THV used. Conclusions: Optimising
implant angles may be important in reducing PVR. This is significantly
more likely to be achieved with AVG rotational angiography. Europa
Digital & Publishing 2012. All rights reserved.

<12>
[Use Link to view the full text]
Accession Number
2013032256
Authors
Soro M. Gallego L. Silva V. Ballester M.T. Llorens J. Alvarino A.
Garcia-Perez M.L. Pastor E. Aguilar G. Marti F.J. Carratala A. Belda F.J.
Institution
(Soro, Gallego, Silva, Ballester, Llorens, Garcia-Perez, Pastor, Aguilar,
Marti, Belda) Department of Anaesthesia and Critical Care, Central
Laboratory, Hospital Clinico Universitario de Valencia, Avenida Blasco
Ibanez 17, 46010 Valencia, Spain
(Alvarino, Carratala) Department of Clinical Chemistry, Central
Laboratory, Hospital Clinico Universitario de Valencia, Valencia, Spain
(Marti) Department of Surgery, University of Valencia, Valencia, Spain
Title
Cardioprotective effect of sevoflurane and propofol during anaesthesia and
the postoperative period in coronary bypass graft surgery: A double-blind
randomised study.
Source
European Journal of Anaesthesiology. 29 (12) (pp 561-569), 2012. Date of
Publication: December 2012.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Context: Volatile anaesthetics may have direct cardioprotective properties
due to effects similar to ischaemic preconditioning and postconditioning.
Clinical results in cardiac surgery patients are controversial and may be
related to the timing of administration of anaesthetics intraoperatively.
Objective: We hypothesised that the cardioprotective effect of sevoflurane
in coronary bypass graft surgical patients would be greater if
administration during anaesthesia continued in the ICU for at least 4 h
postoperatively until weaning from mechanical ventilation. Design:
Double-blind, double-dummy, prospective, randomised and controlled
clinical trial. Setting: In a single centre between June 2006 and June
2007. Patients Seventy-five adult patients were assigned randomly to
receive anaesthesia and postoperative sedation either with propofol
(control, n=37) or sevoflurane (n=36). Intervention:s Myocardial
biomarkers were measured before surgery, at the time of admission to the
intensive care unit and at 6, 24, 48 and 72 h. The need for inotropic
support, and lengths of stay in the intensive care unit and hospital were
also recorded. Main outcome measures: Elevation of myocardial biomarkers
was the primary endpoint. The secondary endpoints were haemodynamic events
and lengths of stay in the intensive care unit and hospital. Results:
Necrosis biomarkers increased significantly in the postoperative period in
both groups with no significant differences at any time. Inotropic support
was needed in 72.7 and 54.3% of patients in the propofol and sevoflurane
groups, respectively (P=0.086). There were no significant differences in
haemodynamic variables, incidence of arrhythmias, myocardial ischaemia or
and lengths of stay in the ICU and hospital between the two groups.
Conclusion: In patients undergoing coronary bypass graft surgery,
continuous administration of sevoflurane as a sedative in the ICU for at
least 4 h postoperatively did not yield significant improvements in the
extent and time course of myocardial damage biomarkers compared to
propofol. 2012 Copyright European Society of Anaesthesiology.

<13>
Accession Number
2013034546
Authors
Samiei N. Kashfi F. Khamoushi A. Hosseini S. Ghavidel A.A. Taheripanah R.
Mirmesdagh Y.
Institution
(Samiei, Kashfi, Khamoushi, Hosseini, Ghavidel, Mirmesdagh) Heart Valve
Disease Research Center, Rajaei Cardiovascular Medical and Research
Center, Tehran University of Medical Sciences, Vali-Asr Avenue, Tehran,
Iran, Islamic Republic of
(Kashfi) Reproductive Epidemiology Research Center, Roy an Institute,
ACECR, Tehran, Iran, Islamic Republic of
(Taheripanah) Imam Hossein Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Pregnancy outcome after mechanical mitral valve replacement: A prospective
study.
Source
Journal of Tehran University Heart Center. 7 (3) (pp 117-120), 2012. Date
of Publication: Summer 2012.
Publisher
Tehran Heart Center (North Kargar Street, Tehran 1411713138, Iran, Islamic
Republic of)
Abstract
Background: Pregnant patients with mechanical heart valves require
anticoagulation. The risk of bleeding and embryopathy associated with oral
anticoagulants must be weighed against the risk of valve thrombosis.
Methods: In this prospective study, undertaken between 1999 and 2009, 53
pregnancies (47 women with mechanical mitral valves; 29.8 +/- 4.8 years
old) were studied. Patients were divided into two groups: group I (n = 43)
received Warfarin throughout the pregnancy, while group 11 (n = 10)
received Heparin in the first trimester and then Warfarin until the 36th
week. Results: Thirty-two (60.4%) pregnancies resulted in live births,
whereas 18 (34%) abortions, 2 (3.8%) stillbirths, and one (1.9%) maternal
death occurred. In group I, there were 26 (60.5%) live births, one (2.3%)
stillbirth, and 15 (34.9%) abortions. In group II, there were 6 (60%) live
births, one (10%) stillbirth, and 3 (30%) abortions. There were no
significant differences between the two groups in terms offetal outcome.
Thirty-nine (90.7%) of the pregnancies in group I and 50% of those in
group II (p value = 0.001) were without complications. There were no
congenital malformations in the two groups. Conclusion: Fetal outcome was
almost the same between the Warfarin and Heparin regimens. In maternal
outcome, the Warfarin regimen is safer than Heparin.

<14>
Accession Number
2013026922
Authors
El Tahan M.R. Khidr A.M.
Institution
(El Tahan, Khidr) Department of Anesthesiology, King Fahd Hospital,
University of Dammam, Al Aqrabiah Street, Al Khubar 31952, Saudi Arabia
(El Tahan) Cardiothoracic Anesthesia Unit, Mansoura University, Mansoura
City, Egypt
Title
Low target sufentanil effect-site concentrations allow early extubation
after valve surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 27 (1) (pp 63-70),
2013. Date of Publication: February 2013.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To test the ability of low sufentanil effect-site
concentrations (Ce) to shorten the time to tracheal extubation after valve
surgery. Design: A prospective, randomized, blinded, controlled study.
Setting: A single university hospital. Participants: Forty-eight patients
scheduled for valve surgery under target-controlled propofol infusion.
Interventions: After ethical committee approval, patients were allocated
randomly to receive sufentanil concentrations of 0.2, 0.3, or 0.4 ng/mL (n
= 16 per group) during target-controlled propofol infusion. Measurements
and Main Results: Times to spontaneous eye opening, return of spontaneous
breathing and extubation; number of changes and cumulative doses of
propofol and sufentanil; incidences of light anesthesia and myocardial
ischemia; intensive care unit and hospital stays; and costs of propofol,
sufentanil, and ventilation were recorded. Compared with the sufentanil
0.4-ng/mL group, 0.2- and 0.3-ng/mL groups had shorter times to eye
opening (24.8 min [SD 7.8] and 52.6 min [12.5] v 85.6 min [10.0],
respectively), spontaneous breathing (32.7 min [19.9] and 70.1 min [27.2]
v 137.5 min [20.8], respectively), and extubation (112.2 min [16.9] and
161.9 min [32.9] v 271.3 min [27.4], respectively; p < 0.001), more
frequent changes in propofol concentrations (p < 0.001), higher cumulative
propofol doses, lower cumulative sufentanil doses, and 33% to 44% lower
total cost (p < 0.001). Incidences of light anesthesia and myocardial
ischemia and intensive care unit and hospital stays were similar for all
groups. Conclusions: Compared with sufentanil Ce of 0.4 ng/mL, lower
concentrations (0.2 and 0.3 ng/mL) promoted faster recovery and shorter
times to extubation after valve surgery performed under target-controlled
propofol infusion. 2012 Elsevier Inc.

<15>
Accession Number
2013029888
Authors
Jones N.L. Edmonds L. Ghosh S. Klein A.A.
Institution
(Jones, Edmonds, Ghosh, Klein) Papworth Hospital, Cambridge, United
Kingdom
Title
A review of enhanced recovery for thoracic anaesthesia and surgery.
Source
Anaesthesia. 68 (2) (pp 179-189), 2013. Date of Publication: February
2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
During the past decade, there has been a dramatic increase in the number
of thoracic surgical procedures carried out in the UK. The current
financial climate dictates that more efficient use of resources is
necessary to meet escalating demands on healthcare. One potential means to
achieve this is through the introduction of enhanced recovery protocols,
designed to produce productivity savings by driving reduction in length of
stay. These have been promoted by government bodies in a number of
surgical specialties, including colorectal, gynaecological and orthopaedic
surgery. This review focuses on aspects of peri-operative care that might
be incorporated into such a programme for thoracic anaesthesia, for which
an enhanced recovery programme has not yet been introduced in the UK, and
a review of the literature specific to this area of practice has not been
published before. We performed a comprehensive search for published work
relating to the peri-operative management and optimisation of patients
undergoing thoracic surgery, and divided these into appropriate areas of
practice. We have reviewed the specific interventions that may be included
in an enhanced recovery programme, including: pre-optimisation; minimising
fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and
analgesic technique and surgical approach; postoperative rehabilitation;
and chest drain management. Using the currently available evidence, the
design and implementation of an enhanced recovery programme based on this
review in selected patients as a package of care may reduce morbidity and
length of hospital stay, thus maximising utilisation of available
resources. 2012 The Association of Anaesthetists of Great Britain and
Ireland.

<16>
Accession Number
2013021494
Authors
Markar S.R. Sadat U. Edmonds L. Nair S.K.
Institution
(Markar, Edmonds, Nair) Department of Cardiothoracic Surgery, Papworth
Hospital, Papworth Everard, Cambridge, United Kingdom
(Sadat) Department of Vascular Surgery, Addenbrooke's Hospital, Cambridge,
United Kingdom
Title
Mitral valve repair versus replacement in the elderly population.
Source
Journal of Heart Valve Disease. 20 (3) (pp 265-271), 2011. Date of
Publication: May 2011.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The study aim was to evaluate the
available literature comparing mitral valve repair (MVRep) versus mitral
valve replacement (MVR) in the elderly population, and to provide a pooled
analysis regarding this issue. Methods: Medline, Embase, Cochrane, trial
registries, conference proceedings and reference lists were searched for
trials of MVRep versus MVR surgery in the elderly population. The primary
outcome was 30-day mortality, while secondary outcomes were postoperative
complications and length of hospital stay. Pooled odds ratios were
calculated for categorical outcomes and weighted mean differences for
continuous outcomes. Results: Four studies retrieved were deemed
appropriate for inclusion. The outcome measures used for the analysis
clearly showed a benefit of MVRep in the elderly population with reduced
mortality (pooled Odds Ratio (OR) = 3.97; p = 0.003) and reduced
postoperative complications (pooled OR = 2.35; p = 0.003). There was no
significant difference between the two groups with regards to duration of
hospital stay (weighted mean difference = 0.22; p = 0.18). Conclusion:
With the demonstration of clear advantages of MVRep over MVR in the
elderly population, a randomized trial between the two techniques is not
ethically justifiable. As there are clear advantages to MVRep, it is
recommended that this should be the primary treatment offered in mitral
valve pathology, irrespective of the patient's age. Copyright by ICR
Publishers 2011.

<17>
Accession Number
70975133
Title
British Cardiovascular Society Annual Conference 2012.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2012
Manchester United Kingdom. Conference Start: 20120528 Conference End:
20120530. Conference Publication: (var.pagings). 98 , 2012. Date of
Publication: May 2012.
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 156 papers. The topics discussed include: unbiased
assessment of symptomatic 'response rate' to cardiac resynchronization
therapy by systematic review of randomized controlled trials (reverse,
miracle, miracle ICD, miracle ICD II, CARE-HF, companion, CONTAK-CD, and
MUSTIC); a gene-based restoration of Akt activity in endothelial
progenitor cells from human subjects at high cardiovascular risk rescues
vascular reparative capacity; a randomized study of temporary epicardial
cardiac resynchronization vs conventional right ventricular pacing in
cardiac surgical patients; simultaneous invasive pressure and flow
measurements during atrioventricular delay improvement reveal a
compensatory peripheral vasodilator response which attenuates the initial
blood pressure increment: implications for the design of optimization
protocols; and cardiac MRI: understanding myocardial motion to predict
remodeling pre cardiac resynchronization therapy.

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<1>
Accession Number
2013017094
Authors
Van Der Linden P. James M. Mythen M. Weiskopf R.B.
Institution
(Van Der Linden) Service D'Anesthesiologie-Reanimation, CHU Brugmann,
Bruxelles, Belgium
(James, Mythen) University College London, University College London and
Royal Free London NHS Foundation Trust, Research Support Centre, London,
United Kingdom
(Mythen) University College London Hospitals NHS Foundation Trust,
University College London and Royal Free London NHS Foundation Trust,
Research Support Centre, London, United Kingdom
(Mythen) Department of Health, Enhanced Recovery Partnership, London,
United Kingdom
(Weiskopf) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, San Francisco, CA 94143, United States
Title
Safety of modern starches used during surgery.
Source
Anesthesia and Analgesia. 116 (1) (pp 35-48), 2013. Date of Publication:
January 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Various hydroxyethyl starch (HES) preparations have been used for decades
to augment blood volume. There has been concern recently regarding
possible adverse outcomes when using HES in the intensive care setting,
especially in patients with septic shock. However, the pharmacokinetic and
pharmacodynamic properties of HES preparations depend on their chemical
composition and source material. Thus, different clinical conditions could
result in differing effectiveness and safety for these preparations.
Consequently, we assessed the safety of tetrastarches when used during
surgery, using a formal search, that yielded 59 primary full publications
of studies that met a priori inclusion criteria and randomly allocated
4529 patients with 2139 patients treated with tetrastarch compared with
2390 patients treated with a comparator. There were no indications that
the use of tetrastarches during surgery induces adverse renal effects as
assessed by change or absolute concentrations of serum creatinine or need
for renal replacement therapy (39 trials, 3389 patients), increased blood
loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20
trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence
interval = 0.61-0.87], P = 0.0005), or increased mortality (odds ratio for
HES mortality = 0.51 [0.24-1.05], P = 0.079). Copyright 2012
International Anesthesia Research Society.

<2>
[Use Link to view the full text]
Accession Number
2013022873
Authors
Andrassy J. Hoffmann V.S. Rentsch M. Stangl M. Habicht A. Meiser B.
Fischereder M. Jauch K.-W. Guba M.
Institution
(Andrassy, Rentsch, Stangl, Jauch, Guba) Department of Surgery, University
Hospital Grosshadern, Ludwig Maximilian's University, Munich, Germany
(Hoffmann) Institute of Medical Information Sciences, Biometry and
Epidemiology (IBE), Ludwig-Maximilian's-University, Munich, Germany
(Habicht, Meiser) Transplant Center Munich, University Hospital
Grosshadern, Ludwig Maximilian's University, Munich, Germany
(Fischereder) Medizinische Klinik und Poliklinik IV, University Hospital
Grosshadern, Ludwig Maximilian's University, Munich, Germany
Title
Is cytomegalovirus prophylaxis dispensable in patients receiving an mtor
inhibitor-based immunosuppression? a systematic review and meta-analysis.
Source
Transplantation. 94 (12) (pp 1208-1217), 2012. Date of Publication: 27 Dec
2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Cytomegalovirus (CMV) is a common opportunistic infection
after solid organ transplantation. Cytomegalovirus causes increased
morbidity, mortality, and reduced allograft survival. Prophylaxis may help
control the virus but is associated with substantial side effects and does
not completely prevent virus reactivation; relapses after cessation of the
prophylaxis are frequent. Experimental and clinical data suggest that mTOR
inhibitors may have an anti-CMV effect. Here, we present a meta-analysis
of clinical trials after solid organ transplantation and describe
potential mechanisms involved in the anti-CMV effect of mTOR-inhibitors.
Methods: The current literature was reviewed for randomized controlled
trials in solid organ transplantation comparing an mTOR-I with a
non-mTOR-I (CNI based) treatment. The scientific quality of the trials was
assessed by the Jadad score, the use of an effective allocation
concealment (AC) and the existence of an intention-to-treat (ITT)
analysis. Cytomegalovirus incidence was assessed in studies comparing 1)
an mTOR-I-based with a CNI-based immunosuppression (10 trials, n=3,100
patients) and 2) an mTOR-I/CNI combination therapy with a CNI-based
immunosuppression (15 trials, n=7,100 patients). Results: In the first
meta-analysis, CMV events after solid organ transplantation occurred
significantly more often under CNIs (RR=2.27). The second meta-analysis
comparing the mTOR-I + CNI combination with a CNI treatment in 15 trials
of kidney, heart, and liver transplantation showed again a higher CMV
incidence when patients received an mTOR-I free immunosuppression
(RR=2.45). Conclusions: mTOR-inhibitor treatment either alone or in
combination with CNIs reduces significantly the CMV incidence after organ
transplantation. With the use of an mTOR-inhibitor, CMV prophylaxis may be
dispensible. 2012 Lippincott Williams & Wilkins.

<3>
Accession Number
2013025656
Authors
Sen H. Tandjung K. Basalus M.W.Z. Lowik M.M. Van Houwelingen G.K. Stoel
M.G. Louwerenburg H.W. De Man F.H.A.F. Linssen G.C.M. Nijhuis R. Nienhuis
M.B. Verhorst P.M.J. Van Der Palen J. Von Birgelen C.
Institution
(Sen, Tandjung, Basalus, Lowik, Van Houwelingen, Stoel, Louwerenburg, De
Man, Verhorst, Von Birgelen) Thoraxcentrum Twente, Department of
Cardiology, MST, Haaksbergerstraat 55, 7513ER Enschede, Netherlands
(Von Birgelen) MIRA, Institute for Biomedical Technology and Technical
Medicine, University of Twente, Enschede, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Netherlands
(Nijhuis) Department of Cardiology, Ziekenhuisgroep Twente, Hengelo,
Netherlands
(Nienhuis) Department of Cardiology, Streekziekenhuis Koningin Beatrix,
Winterswijk, Netherlands
(Van Der Palen) Department of Epidemiology, Medisch Spectrum Twente,
Enschede, Netherlands
(Van Der Palen) Department of Research Methodology, Measurement and Data
Analysis, University of Twente, Enschede, Netherlands
Title
Comparison of eligible non-enrolled patients and the randomised TWENTE
trial population treated with Resolute and XIENCE v drug-eluting stentsz.
Source
EuroIntervention. 8 (6) (pp 664-671), 2012. Date of Publication: October
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The TWENTE trial recently enrolled more than 80% of all eligible
patients, who were randomised to zotarolimus-eluting Resolute or
everolimus-eluting XIENCE V stents. In the present study, we investigated
whether eligible, non-enrolled patients differed from the randomised
TWENTE trial population in baseline characteristics and one-year outcome.
Methods and results: Characteristics of 1,709 eligible patients were
analysed. Independent external adjudication of clinical events was
likewise performed for non-enrolled (n=318) and randomised patients
(n=1,391). Non-enrolled and randomised patients did not differ in gender
distribution, diabetes mellitus, and clinical presentation, but differed
significantly in age and cardiovascular history. Nevertheless, clinical
outcome after one year did not differ in the primary composite endpoint
target-vessel failure (TVF; 9.8% vs. 8.1%; p=0.34), and its components
cardiac death (1.6% vs. 1.2%; p=0.61), target vessel-related myocardial
infarction (4.7% vs. 4.6%; p=0.92), and target-vessel revascularisation
(3.8% vs. 3.0%; p=0.48). Previous bypass surgery predicted TVF in
non-enrolled patients (p=0.001); removal of these patients resulted in
identical TVF rates for non-enrolled and randomised patients (7.3% vs.
7.3%; p=0.99). Conclusions: Despite some differences in baseline
characteristics, non-enrolled and randomised patients did not differ in
one-year outcome, which was favourable for both populations and may be
related to the drug-eluting stents used. Europa Digital & Publishing
2012. All rights reserved.

<4>
Accession Number
2013025649
Authors
Zhang Y. Farooq V. Garcia-Garcia H.M. Bourantas C.V. Tian N. Dong S. Li M.
Yang S. Serruys P.W. Chen S.-L.
Institution
(Zhang, Tian, Li, Yang, Chen) Division of Cardiovascular Diseases, Nanjing
First Hospital, Nanjing Medical University, Nanjing, China
(Zhang, Farooq, Garcia-Garcia, Bourantas, Serruys) Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Dong) Soochow University, Suzhou, China
Title
Comparison of intravascular ultrasound versus angiography-guided
drug-eluting stent implantation: A meta-analysis of one randomised trial
and ten observational studies involving 19,619 patients.
Source
EuroIntervention. 8 (7) (pp 855-865), 2012. Date of Publication: November
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The impact of intravascular ultrasound (IVUS) guided coronary
drug-eluting stent (DES) implantation on clinical outcomes remains
controversial. A meta-analysis of the currently available clinical trials
investi-gating IVUS-guided DES implantation was undertaken. Methods and
results: We searched Medline, the Cochrane Library and other internet
sources, without language or date restrictions, for published articles
comparing clinical outcomes between IVUS-guided and angiography-guided DES
implantation. Clinical studies with both adjusted and unadjusted data were
included. Eleven studies were identified (one randomised controlled trial
and 10 registries) and included in the meta-analysis with a weighted
follow-up time of 20.7+/-11.5 months. Compared with angiography guid-ance,
IVUS-guided DES implantation was associated with a reduced incidence of
death (hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.48-0.73,
p<0.001), major adverse cardiac events (HR: 0.87, 95% CI: 0.78-0.96,
p=0.008) and stent thrombosis (HR: 0.58, 95% CI: 0.44-0.77, p<0.001). The
incidence of myocar-dial infarction (HR: 0.82, 95% CI: 0.63-1.06,
p=0.126), target lesion (HR: 0.90, 95% CI: 0.73-1.11, p=0.316) and target
vessel (HR: 0.90, 95% CI: 0.77-1.05, p=0.195) revascularisation was
comparable between the angiography and IVUS-guided arms. A repeat
meta-analysis of propensity-matched studies only (six studies, n=5,300)
yielded broadly similar results in terms of clinical outcomes.
Conclusions: IVUS-guided coronary DES implantation is associated with a
significant reduction in death, MACE and stent thrombosis compared to
angiography guidance. Appropriately powered randomised trials are
necessary to confirm the findings from this meta-analysis. Europa Digital
& Publishing 2012. All rights reserved.

<5>
Accession Number
2013025642
Authors
Xu B. Dou K. Yang Y. Lv S. Wang H. Li Z. Wang L. Chen Y. Huo Y. Li W.
Kirtane A.J. Gao R.
Institution
(Xu, Dou, Yang, Li, Gao) Department of Cardiology, Fu Wai Hospital,
National Centre for Cardiovascular Diseases of China, No.167, Beilishi
Road, Xicheng District, Beijing, 100037, China
(Lv, Wang, Chen) Capital Medical University, Beijing, China
(Wang) 4th Military Medical University, Xi'an, China
(Li) Liaoning Provincial People's Hospital, Shenyang, China
(Wang) Chinese PLA Medical University, Beijing, China
(Huo) Peking University First Hospital, Beijing, China
(Kirtane) Columbia University Medical Center, New York, NY, United States
Title
Nine-month angiographic and 2-year clinical follow-up of the NOYA
biodegradable polymer sirolimus-eluting stent in the treatment of patients
with de novo native coronary artery lesions: The NOYA I trial.
Source
EuroIntervention. 8 (7) (pp 796-802), 2012. Date of Publication: November
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: This study sought to evaluate the safety and efficacy of the NOYA
stent which is a cobalt chromium-based sirolimus-eluting stent (SES) with
DL-polylactide biodegradable polymer (Medfavour Medical, Beijing, China)
in treating de novo coronary artery lesions. Methods and results: The NOYA
I trial was designed to compare the NOYA stent with the FIREBIRD2 stent, a
durable polymer SES widely used in China (MicroPort Medical, Shanghai,
China); the trial was a non-inferiority trial with a primary angiographic
endpoint of the in-stent late lumen loss (LLL) at nine-month follow-up.
The secondary endpoints were binary restenosis rates within nine months,
major adverse cardiac events (MACE) defined as the composite of cardiac
death, myocardial infarction (MI) or target lesion revascularisation
(TLR), and definite/probable stent thrombosis (ST) at 24-month follow-up.
A total of 300 patients (n=150 in each group) were enrolled in the study
from 16 Chinese centres. The LLL in the NOYA group at nine-month follow-up
was similar to the FIREBIRD2 group (0.11+/-0.18 mm vs. 0.14+/-0.23 mm,
p=0.16; non-inferiority p<0.001). The rates of MACE, death, MI and TLR at
24-month follow-up were comparable between these two devices (p>0.05,
respectively). Conclusions: The biodegradable polymer NOYA stent was
non-inferior to the FIREBIRD2 durable polymer stent with respect to the
primary non-inferiority endpoint of in-stent LLL at nine-month follow-up.
Clinical outcomes at 24-month follow-up were comparable between the two
stents. (ClinicalTrials.gov number, NCT01226355) Europa Digital &
Publishing 2012. All rights reserved.

<6>
Accession Number
2013008594
Authors
Diletti R. Farooq V. Girasis C. Bourantas C. Onuma Y. Heo J.H. Gogas B.D.
Van Geuns R.-J. Regar E. De Bruyne B. Dudek D. Thuesen L. Chevalier B.
McClean D. Windecker S. Whitbourn R.J. Smits P. Koolen J. Meredith I. Li
X. Miquel-Hebert K. Veldhof S. Garcia-Garcia H.M. Ormiston J.A. Serruys
P.W.
Institution
(Diletti, Farooq, Girasis, Bourantas, Onuma, Heo, Gogas, Van Geuns, Regar,
Serruys) Department of Interventional Cardiology, Thoraxcenter, Erasmus
MC, Rotterdam, Netherlands
(De Bruyne) Department of Interventional Cardiology, Cardiovascular Center
Aalst, Aalst, Belgium
(Dudek) Department of Cardiology, Jagiellonian University, Krakow, Poland
(Thuesen) Department of Cardiology, Skejby Sygehus, Aarhus University
Hospital, Skejby, Aarhus, Denmark
(Chevalier) Department of Cardiology, Institut Hospitalier Jacques
Cartier, Massy, France
(McClean) Department of Cardiology, Christchurch Hospital, Christchurch,
New Zealand
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Whitbourn) Department of Cardiology, St. Vincents Hospital, Fitzroy, VIC,
Australia
(Smits) Department of Interventional Cardiology, Maasstad Ziekenhuis
Rotterdam, Rotterdam, Netherlands
(Koolen) Department of Interventional Cardiology, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Meredith) Department of Interventional Cardiology, Monash Medical Centre,
VIC, Australia
(Li) Abbott Vascular, Santa Clara, CA, United States
(Miquel-Hebert, Veldhof) Abbott Vascular, Diegem, Belgium
(Garcia-Garcia) Cardialysis B.V., Rotterdam, Netherlands
(Ormiston) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
Title
Clinical and intravascular imaging outcomes at 1 and 2 years after
implantation of absorb everolimus eluting bioresorbable vascular scaffolds
in small vessels. Late lumen enlargement: Does bioresorption matter with
small vessel size? Insight from the ABSORB cohort B trial.
Source
Heart. 99 (2) (pp 98-105), 2013. Date of Publication: January 2013.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: The long-term results after second generation everolimus
eluting bioresorbable vascular scaffold (Absorb BVS) placement in small
vessels are unknown. Therefore, we investigated the impact of vessel size
on long-term outcomes, after Absorb BVS implantation. Methods: In ABSORB
Cohort B Trial, out of the total study population (101 patients), 45
patients were assigned to undergo 6-month and 2-year angiographic
follow-up (Cohort B1) and 56 patients to have angiographic follow-up at
1-year (Cohort B2). The prereference vessel diameter (RVD) was <2.5 mm
(small-vessel group) in 41 patients (41 lesions) and >=2.5 mm
(large-vessel group) in 60 patients (61 lesions). Outcomes were compared
according to pre-RVD. Results: At 2-year angiographic follow-up no
differences in late lumen loss (0.29+/-0.16 mm vs 0.25+/-0.22 mm,
p=0.4391), and in-segment binary restenosis (5.3% vs 5.3% p=1.0000) were
demonstrated between groups. In the small-vessel group, intravascular
ultrasound analysis showed a significant increase in vessel area
(12.25+/-3.47 mm² vs 13.09+/-3.38 mm² p=0.0015),
scaffold area (5.76+/-0.96 mm² vs 6.41+/-1.30 mm²
p=0.0008) and lumen area (5.71+/-0.98 mm² vs 6.20+/-1.27 mm
² p=0.0155) between 6-months and 2-year follow-up. No
differences in plaque composition were reported between groups at either
time point. At 2-year clinical follow-up, no differences in
ischaemia-driven major adverse cardiac events (7.3% vs 10.2%, p=0.7335),
myocardial infarction (4.9% vs 1.7%, p=0.5662) or ischaemia-driven target
lesion revascularisation (2.4% vs 8.5%, p=0.3962) were reported between
small and large vessels. No deaths or scaffold thrombosis were observed.
Conclusions: Similar clinical and angiographic outcomes at 2-year
follow-up were reported in small and large vessel groups. A significant
late lumen enlargement and positive vessel remodelling were observed in
small vessels.

<7>
Accession Number
2013024807
Authors
Greisen J. Nielsen D.V. Sloth E. Jakobsen C.-J.
Institution
(Greisen, Nielsen, Sloth, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital Skejby, DK-8200 Aarhus N,
Denmark
Title
High thoracic epidural analgesia decreases stress hyperglycemia and
insulin need in cardiac surgery patients.
Source
Acta Anaesthesiologica Scandinavica. 57 (2) (pp 171-177), 2013. Date of
Publication: February 2013.
Publisher
Blackwell Munksgaard (1 Rosenorns Alle, P.O. Box 227, Copenhagen V
DK-1502, Denmark)
Abstract
Objective Assuming that high thoracic epidural analgesia (HTEA) with the
sympathetic block might decrease postoperative blood glucose (BG) level
and reduce the need of insulin, the aim was to evaluate the effect of HTEA
on the BG level and insulin requirement in patients undergoing cardiac
surgery. Materials and methods Forty-two low-risk patients age 65-79 years
scheduled for elective coronary artery bypass grafting with or without
aortic valve replacement were randomised to receive HTEA as supplement for
general anaesthesia. BG and lactate were measured before and after
cardiopulmonary bypass and postoperatively at least every 3 h together
with administration of insulin. Postoperative pain was evaluated 30 min,
2, 4 and 6 h after extubation, and before discharge from the intensive
care unit. Results Overall BG levels showed great variation over time (P <
0.001). No statistically significant difference was found in perioperative
BG, but postoperative lower BG levels were found in HTEA patients (P =
0.042). The number of patients not receiving insulin in postoperative
period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No
differences were seen in lactate levels. Patients in the HTEA group had
significant lower pain scores (P < 0.001). Conclusion HTEA preserves
glucose metabolism better and leads to a lesser degree of 'stress
hyperglycaemia' in cardiac surgery patients. 2012 The Authors. Acta
Anaesthesiologica Scandinavica 2012 The Acta Anaesthesiologica
Scandinavica Foundation.

<8>
Accession Number
2013025626
Authors
Wykrzykowska J.J. Diletti R. Gutierrez-Chico J.L. Van Geuns R.J. Van Der
Giessen W.J. Ramcharitar S. Duckers H.E. Schultz C. De Feyter P. Van Der
Ent M. Regar E. De Jaegere P. Garcia-Garcia H.M. Pawar R. Gonzalo N.
Ligthart J. De Schepper J. Van Den Berg N. Milewski K. Granada J.F.
Serruys P.W.
Institution
(Wykrzykowska, Diletti, Gutierrez-Chico, Van Geuns, Van Der Giessen,
Ramcharitar, Duckers, Schultz, De Feyter, Van Der Ent, Regar, De Jaegere,
Garcia-Garcia, Pawar, Gonzalo, Ligthart, Van Den Berg, Serruys) Department
of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam,
Netherlands
(Milewski, Granada) Skirball Center for Cardiovascular Research,
Cardiovascular Research Foundation, Columbia University Medical Center,
New York, NY, United States
(Wykrzykowska) Academic Medical Center, Amsterdam, Netherlands
(De Schepper) Svelte Medical Systems, New Providence, NJ, United States
Title
Plaque sealing and passivation with a mechanical self-expanding low
outward force nitinol vShield device for the treatment of IVUS and
OCT-derived thin cap fibroatheromas (TCFAs) in native coronary arteries:
Report of the pilot study vShield Evaluated at Cardiac hospital in
Rotterdam for Investigation and Treatment of TCFA (SECRITT).
Source
EuroIntervention. 8 (8) (pp 945-954), 2012. Date of Publication: December
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: The aim of the pilot SECRITT trial was to evaluate the safety and
feasibility of sealing the high risk IVUS and optical coherence
tomography-derived thin cap fibroatheroma (TCFA), with a dedicated nitinol
self-expanding vShield device. Methods and results: After screening with
angiography, fractional flow reserve (FFR), intravascular ultrasound
virtual histology (IVUS-VH) and optical coherence tomography (OCT), 23
patients met enrolment criteria (presence of non-obstructive VH-derived
TCFA lesion with thin cap on OCT) and were randomised to vShield (n=13)
versus medical therapy (n=10). In the shielded group, baseline percent
diameter stenosis was 33.2+/-13.5%, FFR was 0.93+/-0.06. At six-month
follow-up in shielded patients percent diameter stenosis further decreased
to 18.7+/-16.9% and FFR remained the same 0.93+/-0.05. Average late loss
was 0.24+/-0.13 mm. Average baseline fibrous cap thickness was 48+/-12
mum. After shield placement at six-month follow-up neo-cap formation was
observed with average cap thickness of 201+/-168 mum. There were no
dissections after shield placement and no plaque ruptures. In addition,
mean stent area of 8.76+/-2.16 mm² increased to 9.45+/-2.30
mm², that is by 9% at six-month follow-up. The number of
malapposed struts decreased from 10.7% to 7.6% and the number of uncovered
struts at six months was 8.1%. There were no device-related major adverse
cardiovascular events (MACE) events at six-month follow-up. Conclusions:
High risk plaque passivation and sealing with a vShield self-expanding
nitinol device appears feasible and safe. A long-term larger randomised
study with streamlined screening criteria is needed to evaluate the
efficacy of this approach over medical therapy. Europa Digital &
Publishing 2012. All rights reserved.

<9>
Accession Number
2013022246
Authors
Nielsen H.H.M. Klaaborg K.E. Nissen H. Terp K. Mortensen P.E. Kjeldsen
B.J. Jakobsen C.-J. Andersen H.R. Egeblad H. Krusell L.R. Thuesen L.
Hjortdal V.E.
Institution
(Nielsen, Klaaborg, Terp, Hjortdal) Department of Cardiothoracic Surgery,
Aarhus University Hospital, Skejby, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Mortensen, Kjeldsen) Department of Thoracic Surgery, Odense University
Hospital, Odense, Denmark
(Jakobsen) Department of Anesthesiology, Aarhus University Hospital,
Skejby, Denmark
(Andersen, Egeblad, Krusell, Thuesen) Department of Cardiology, Aarhus
University Hospital, Skejby, Denmark
Title
A prospective, randomised trial of transapical transcatheter aortic valve
implantation vs. surgical aortic valve replacement in operable elderly
patients with aortic stenosis: The STACCATO trial.
Source
EuroIntervention. 8 (3) (pp 383-389), 2012. Date of Publication: July
2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: In a prospective randomised trial we aimed to compare transapical
transcatheter aortic valve implantation (a-TAVI) with surgical aortic
valve replacement (SAVR) in operable elderly patients. Methods and
results: The study was designed as a randomised controlled trial of a-TAVI
(Edwards SAPIEN heart valve system; Edwards Lifesciences, Irvine, CA, USA)
vs. SAVR. Operable patients with isolated aortic valve stenosis and an age
>=75 years were included. The primary endpoint was the composite of
all-cause mortality, cerebral stroke and/or renal failure requiring
haemodialysis at 30 days. After advice from the Data Safety Monitoring
Board, the study was prematurely terminated after the inclusion of 70
patients because of an excess of events in the a-TAVI group. The primary
endpoint was met in five a-TAVI patients (two deaths, two strokes, and one
case of renal failure requiring dialysis) vs. one stroke in the SAVR group
(p=0.07). In the a-TAVI group, one patient was converted to SAVR because
of an abnormally positioned heart, and four patients were re-operated with
open heart surgery because of annulus rupture (n=1), severe paravalvular
leakage (n=2), and blockage of the left coronary artery (n=1). In the SAVR
group, one patient was converted to TAVI because of a large intra-thoracic
goitre. Conclusions: Given the limitations of a small prematurely
terminated study, our results suggest that a-TAVI in its present form may
be associated with complications and device success rates in low-risk
patients similar or even inferior to those found in high-risk patients
with aortic valve stenosis. This will probably change in the near future
with improved catheter based devices and better pre-procedural assessment.
Europa Edition 2012. All rights reserved.

<10>
Accession Number
2013022177
Authors
Mookadam F. Raslan S.F. Jiamsripong P. Jalal U. Murad M.H.
Institution
(Mookadam, Raslan, Jiamsripong, Jalal) Division of Cardiovascular
Diseases, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ 85259,
United States
(Murad) Mayo Clinic, Rochester, MN, United States
Title
Percutaneous closure of mitral paravalvular leaks: A systematic review and
meta-analysis.
Source
Journal of Heart Valve Disease. 21 (2) (pp 208-217), 2012. Date of
Publication: March 2012.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The percutaneous closure of mitral
paravalvular leak (PVL) is emerging as an alternative treatment for
high-risk surgical candidates. Several cases have been reported, and a few
small studies have been conducted to investigate the outcome of the
technique. A meta-analysis of the combined data would be considered
helpful in deriving more powerful data; hence, the study aim was to
conduct a meta-analysis of the percutaneous closure of mitral PVLs, as
reported in the medical literature. Methods: Searches were conducted of
the PubMed, Embase, and CINAHL databases for reports of mitral PVL
percutaneous closure. The data were extracted by two reviewers, who
aggregated the information by using a random-effects model. Results: Eight
studies were included in the meta-analysis, with a total of 100 patients.
The percutaneous closure of mitral PVLs was associated with a 15%
cardiovascular mortality during the first year of follow up. Clinical
success was noted in 48% of patients, while 52% failed to show any
clinical improvement. Failures were mainly attributed either to deployment
failure (18%), to the presence of a persistent leak, to hemolysis, or both
(31%). Procedure-related complications (e.g., bleeding, stroke,
endocarditis) were observed in 16% of patients. Conclusion: The
percutaneous closure of mitral PVLs carries a 15% risk of cardiovascular
mortality. The reported mortality rates for surgically treated patients
ranged from 12% to 37%, but most patients who underwent percutaneous
closure were considered high-risk surgical candidates with multiple
comorbidities. While percutaneous closure appears promising, the
development of lesion-specific occluders, standardized imaging techniques
and parameters, and the design of randomized clinical trials to compare
the outcome of surgical versus percutaneous intervention, are required
before any final judgment may be made. Copyright by ICR Publishers 2012.

<11>
Accession Number
2013022098
Authors
Von Oppell U.O. Segadal L. Busund R. Johnston G.G. Dimitrakakis G. Masani
N. Lung T.-H.
Institution
(Von Oppell, Dimitrakakis, Masani) Department of Cardiothoracic Surgery,
University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United
Kingdom
(Segadal) Haukeland University Hospital, Bergen, Norway
(Busund) University Hospital of North Norway HF, Tromso, Norway
(Johnston) St. Joseph Hospital, Tacoma, WA, United States
(Lung) Medtronic, Inc., MN, United States
Title
Aortic annulus diameter and valve design each determine the valve size
implanted.
Source
Journal of Heart Valve Disease. 21 (5) (pp 591-598), 2012. Date of
Publication: September 2012.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: The study aim was to compare the sizing
characteristics and hemodynamics of the Medtronic Mosaic Ultra porcine and
Carpentier-Edwards PERIMOUNT Magna bovine pericardial bioprosthetic
stented aortic valves in relation to the patient's true aortic annulus
size. Methods: In this prospective multicenter randomized study, data
acquired perioperatively and at six months postoperatively were collected.
Following aortic valve excision and debridement, the annulus was measured
by blinded sizers prior to the randomization of 141 patients (Ultra, n =
72; Magna, n = 69). Results: The median patient age was 75 years, and 89%
of the patients had aortic stenosis. A good left ventricular function was
present in 75% of patients, and the EuroSCORE-predicted mortality was 9%.
Concomitant procedures (coronary artery bypass grafting, mitral/tricuspid
repair, septal myectomy, modified Maze) were performed in 61% of patients.
The in-hospital mortality was 3%, and at six months postoperatively 96% of
the patients were NYHA class I or II, with no intergroup differences. The
mean 'true aortic annulus' size was 23.0 +/- 1.4 mm for the Ultra valve,
and 22.6 +/- 1.8 mm for the Magna valve (p = NS). The implanted labeled
valve size was >=23 mm for 83% of Ultra valves, and for 52% of Magna
valves (p <0.01), and smaller than the measured true aortic diameter (44%
Magna versus 33% Ultra). The mean echo gradients were lower with Magna
valves (11 +/- 6 mmHg) than with Ultra (17 +/- 6 mmHg; p <0.01), while the
effective orifice area (EOA) was higher with Magna than with Ultra (1.6
+/- 0.4 versus 1.4 +/- 0.4 cm²; p <0.01). Both groups showed a
similar left ventricular mass regression (Ultra -48 +/- 83 g; Magna - 42
+/- 70 g). Trivial to moderate regurgitation was noted in 24% of Ultra
valves compared to 48% of Magna valves (p <0.01). Conclusion: Selection of
the Ultra bioprosthetic valve allowed the implantation of larger valve
sizes. However, when compared to the 'true aortic annulus', the Magna was
associated with lower transprosthetic gradients and larger EOAs. The
longer term significance of these observations remains inconclusive in
terms of bioprosthesis selection, however. Copyright by ICR Publishers
2012.

<12>
Accession Number
2013021602
Authors
Mahesh B. Navaratnarajah M. Mensah K. Ilsley C. Amrani M.
Institution
(Mahesh, Navaratnarajah, Mensah, Ilsley, Amrani) Center for Cardiothoracic
Surgery and Transplantation, Harefield Hospital, Harefield, United Kingdom
Title
Mini-sternotomy aortic valve replacement: Is it safe and effective?
Comparison with standard techniques.
Source
Journal of Heart Valve Disease. 20 (6) (pp 650-656), 2011. Date of
Publication: November 2011.
Publisher
ICR Publishers Ltd (12/A South Approach, Moor Park, Northwood HA6 2ET,
United Kingdom)
Abstract
Background and aim of the study: Mini-sternotomy aortic valve replacement
(MSAVR) has been increasingly performed at the authors' institution since
October 2003. The study aim was to compare results obtained with MSAVR to
those following AVR with conventional sternotomy (SAVR). Methods: Between
1998 and 2008, a total of 143 consecutive patients (mean age: 67 +/- 12.5
years) underwent AVR at the authors' institution. Of these patients, 82
underwent SAVR, and 61 underwent MSAVR performed through a
reversed-L-shaped median sternotomy with a transverse limb at the right
fourth intercostal space. Ascending aortic and right atrial cannulation
through the mini-sternotomy were employed for cardiopulmonary bypass
(CPB). Results: Typically, the MSAVR patients were slightly younger than
SAVR patients (mean age: 67 +/- 16 years and 70 +/- 15 years,
respectively; p = 0.037), had a lower incidence of diabetes (3% versus
18%, p = 0.008), and a slightly higher left ventricular ejection fraction
(74.5 +/- 12% versus 71 +/- 12%, p = 0.019). There were no other
inter-group preoperative differences. As expected, MSAVR required a
slightly longer aortic cross-clamp time (49 +/- 19 min) compared to SAVR
(44.5 +/- 16 min; p = 0.019), and longer CPB times (77 +/- 31 min versus
60 +/- 26 min; p <0.0001), though the overall operating times were similar
(p = 0.38). Postoperatively, MSAVR patients were extubated at 3 +/- 5 h,
similar to SAVR patients (4 +/- 5 h) (p = 0.13). The median intensive
therapy unit stay was 1 +/- 1 days in both groups. The median hospital
stay was comparable between groups (MSAVR, 7 +/- 5 days; SAVR, 8 +/- 4
days; p = 0.48). The MSAVR patients had a higher incidence of delayed
pericardial effusions requiring pericardiocentesis (n = 4; p = 0.031), but
this did not affect survival. The 30-day mortality was similar in both
groups (MSAVR group, n = 1 (1.6%); SAVR group, n = 3 (3.7%); p = 0.64). At
five years after surgery, freedom from cardiac-related death was 96 +/-
2.6% in MSAVR patients, and 89 +/- 4.9% in SAVR patients (p = 0.32).
Conclusion: Mini-sternotomy AVR is technically challenging with longer CPB
and aortic cross-clamp times. However, with increasing surgical
experience, it offers results comparable to those achieved with
conventional AVR, and with acceptable cosmetic results. Copyright by ICR
Publishers 2011.

<13>
Accession Number
2013023362
Authors
Pellicer A. Riera J. Lopez-Ortego P. Bravo M.C. Madero R. Perez-Rodriguez
J. Labrandero C. Quero J. Buno A. Castro L. Lubomirov R. Cabanas F.
Institution
(Pellicer, Riera, Lopez-Ortego, Bravo, Perez-Rodriguez, Quero, Cabanas)
Department of Neonatology, La Paz University Hospital, Madrid, Spain
(Riera) Centre for Biomedical Technology, Technical University of Madrid,
Madrid, Spain
(Madero) Division of Biostatistics, La Paz University Hospital, Madrid,
Spain
(Labrandero) Department of Pediatric Cardiology, La Paz University
Hospital, Madrid, Spain
(Buno) Clinical Pathology Service, La Paz University Hospital, Madrid,
Spain
(Castro) Department of Pediatric Anaesthesiology, La Paz University
Hospital, Madrid, Spain
(Lubomirov) Clinical Pharmacology Centre, Pharmacology and Therapeutics
Department, School of Medicine, Madrid, Spain
Title
Phase 1 study of two inodilators in neonates undergoing cardiovascular
surgery.
Source
Pediatric Research. 73 (1) (pp 95-103), 2013. Date of Publication: January
2013.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Inodilators are routinely used in cardiovascular surgery with
cardiopulmonary bypass (CPB). Information regarding safety and
tolerability of the novel molecule, levosimendan (LEVO), in newborns is
anecdotal; no pharmacokinetic data in this population are
available.Methods:This was a phase I, randomized, and blinded study.
Neonates undergoing surgical repair for congenital heart defects received
stepwise dose increases of milrinone (MR; 0.5-1 mug/kg/min, n = 9) or LEVO
(0.1-0.2 mug/kg/min, n = 11) as an i.v. continuous infusion, starting
before CPB. Infants had continuous, time-locked, physiological, and
near-infrared spectroscopy (NIRS) (cerebral and peripheral) recordings
during the first 24 h, and at 48 and 96 h postsurgery. Serial biochemistry
and pharmacokinetic studies were performed.Results:During the first 24 h
postsurgery, patients showed time-related, group-independent increased
cerebral tissue oxygenation and decreased diastolic blood pressure; in
addition, group-dependent differences in heart rate and peripheral
perfusion were found. Early postsurgery, MR-treated infants showed lower
pH, higher glycemia, and higher inotrope score. The groups differed in
cerebral NIRS-derived variables from 24 to 96 h. Study drug withdrawal at
96 h was more frequent with LEVO. LEVO intermediate metabolites were
detected in plasma at day 14 after surgery.Conclusion:LEVO is well
tolerated in critically ill neonates. LEVO may have advantages over MR in
terms of the dosing regimen. 2013 International Pediatric Research
Foundation, Inc.

<14>
Accession Number
2013022257
Authors
Ceelie I. De Wildt S.N. Van Dijk M. Van Den Berg M.M.J. Van Den Bosch G.E.
Duivenvoorden H.J. De Leeuw T.G. Mathot R. Knibbe C.A.J. Tibboel D.
Institution
(Ceelie, De Wildt, Van Dijk, Van Den Berg, Van Den Bosch, Knibbe, Tibboel)
Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital,
Rotterdam, Netherlands
(De Leeuw) Department of Anesthesiology, Erasmus MC, Sophia Children's
Hospital, Rotterdam, Netherlands
(Duivenvoorden) Departments of Medical Psychology and Psychotherapy,
Erasmus MC, Rotterdam, Netherlands
(Mathot) Clinical Pharmacology Unit, Department Hospital Pharmacy,
Academic Medical Centre, Amsterdam, Netherlands
(Knibbe) Leiden/Amsterdam Center for Drug Research, Division of
Pharmacology, Leiden University, Leiden, Netherlands
(Knibbe) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Effect of intravenous paracetamol on postoperative morphine requirements
in neonates and infants undergoing major noncardiac surgery: A randomized
controlled trial.
Source
JAMA - Journal of the American Medical Association. 309 (2) (pp 149-154),
2013. Date of Publication: 09 Jan 2013.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Importance: Continuous morphine infusion as standard postoperative
analgesic therapy inyounginfants is associated withunwantedadverse effects
such as respiratory depression. Objective: To determine whether
intravenous paracetamol (acetaminophen) would significantly (>30%) reduce
morphine requirements in neonates and infants after major surgery. Design,
Setting, and Patients: Single-center, randomized, double-blind study
conducted in a level3 pediatric intensive care unit in Rotterdam, the
Netherlands. Patients were 71 neonates or infants younger than 1 year
undergoing major thoracic (noncardiac) or abdominal surgery between March
2008 and July 2010, with follow-up of 48 hours. Interventions: All
patients received a loading dose of morphine 30 minutes before the end of
surgery, followed by continuous morphine or intermittent intravenous
paracetamol up to 48 hours postsurgery. Infants in both study groups
received morphine (boluses and/or continuous infusion) as rescue
medication on the guidance of the validated pain assessment instruments.
Main Outcome Measures: Primary outcome was cumulative morphine dose (study
and rescue dose). Secondary outcomes were pain scores and morphine-related
adverse effects. Results: The cumulative median morphine dose in the first
48 hours postoperatively was 121 (interquartile range, 99-264) mug/kg in
the paracetamol group (n=33) and 357 (interquartile range, 220-605)
mug/kgin the morphine group (n=38), P<.001, with a between group
difference that was 66% (95% CI, 34%-109%) lower in the paracetamol group.
Pain scores and adverse effects were not significantly different between
groups. Conclusion and Relevance: Among infants undergoing major surgery,
postoperative use of intermittent intravenous paracetamol compared with
continuous morphine resulted in a lower cumulative morphine dose over 48
hours. Trial Registration: trialregister.nl Identifier: NTR1438. 2013
American Medical Association. All rights reserved.

<15>
Accession Number
2013027260
Authors
Sameenakousar Mahesh Srinivasan K.V.
Institution
(Sameenakousar, Mahesh) Department of Anaesthesia, P.E.S.I.M.S.R Kuppam,
AP, India
(Srinivasan) Department of Anaesthesia, P.E.S Medical College Kuppam,
Andhra Pradesh, India
Title
Comparison of fentanyl and clonidine for attenuation of the haemodynamic
response to laryngocopy and endotracheal intubation.
Source
Journal of Clinical and Diagnostic Research. 7 (1) (pp 106-111), 2013.
Date of Publication: 01 Jan 2013.
Publisher
Journal of Clinical and Diagnostic Research (71 Veer Nagar,G.T. Road,
Delhi 110007, India)
Abstract
Introduction: Laryngoscopy and tracheal intubation after the induction of
anaesthesia, are nearly always associated with a sympathetic
hyperactivity. To 'blunt' this pressor response, various methods have been
tried, but very few studies have been done to assess the effects of
fentanyl orI.V. clonidine on the haemodynamic response during laryngoscopy
and tracheal intubation. The purpose of this study was to compare these
agents, to find the drug which was best suited for this purpose and the
most favourable time for its administration. Methods: This was a
prospective study which involved 3 groups of patients. The patients in
group-1 (control) were given normal saline and the groups 2 and 3 were
given i.v. fentanyl and clonidine respectively. Each group had 50 patients
who presented for elective, non-cardiovascular surgeries. All the patients
were ASA-1 or ASA-II and were operated in PESIMSR, Kuppam. Results: The
heart rate rise was 48.07% in the control group, whereas it was
significantly lower in the fentanyl (II) 27.75% and the clonidine groups
(III) 12.57% (p<0.001). In the control group, the systolic blood pressure
increased maximally after 5 minutes (42.62%) i.e., immediately after the
laryngoscopy and the intubation. It decreased gradually over 10 minutes
(17.39%). With the administration of fentanyl, the maximum increase as
compared to the preinduction value was 9.91%, but it was only 7.38% in the
clonidine group. Both, when they were compared with the control, showed a
significant suppression (P<.001), with clonidine showing better results.
The maximum increase in the diastolic blood pressure was 30.12% in the
control group (P<.001) at 5 min and it was 18.22%, and 6.15% in the
fentanyl and the clonidine groups respectively, with clonidine faring
better again (P<.001). Interpretation and Conclusion: Clonidine showed
better attenuation of the sympathetic response, which is statistically
highly significant and it remained so till the end of 10 minutes.
Intravenous clonidine 2mug/kg which is administered 5 minutes before the
laryngoscopy can be recommended to attenuate the sympathetic response to
the laryngoscopy and the intubation.

<16>
Accession Number
2013018344
Authors
Scheeren T.W.L. van Harten A.E. Kok W.F. Absalom A.R.
Institution
(Scheeren, van Harten, Kok, Absalom) Universitair Medisch Centrum
Groningen, Rijksuniversiteit Groningen, Netherlands
Title
Intraoperative cerebral tissue oxygenation and postoperative cognitive
dysfunction after onand off-pump coronary artery bypass surgery - a
randomized study.
Source
Applied Cardiopulmonary Pathophysiology. 16 (4) (pp 347-349), 2012. Date
of Publication: 2012.
Publisher
Pabst Science Publishers (Eichengrund 28, Lengerich D-49525, Croatia)

<17>
Accession Number
2013018334
Authors
Habicher M. Treskatsch S. Spies C. von Heymann C. Sander M.
Institution
(Habicher, Treskatsch, Spies, von Heymann, Sander) Klinik fur
Anasthesiologie mit S. op. Intensivmedizin, Charite Universitatsmedizin
Berlin, CVK/CCM, Germany
Title
Active patient warming can reduce postoperative complications after
interventional aortic valve replacement.
Source
Applied Cardiopulmonary Pathophysiology. 16 (4) (pp 329-332), 2012. Date
of Publication: 2012.
Publisher
Pabst Science Publishers (Eichengrund 28, Lengerich D-49525, Croatia)

<18>
Accession Number
2013022825
Authors
Patel R.D. Saver J.L.
Institution
(Patel, Saver) David Geffen School of Medicine, University of California,
UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA 90095, United
States
Title
Evolution of reperfusion therapies for acute brain and acute myocardial
ischemia: A systematic, comparative analysis.
Source
Stroke. 44 (1) (pp 94-98), 2013. Date of Publication: January 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background and Purpose-: Early reperfusion is the most effective therapy
for both acute brain and cardiac ischemia. However, the cervicocephalic
circulatory bed offers more challenges to recanalization interventions.
The historical development of reperfusion interventions has not previously
been systematically compared. Methods-: Medline search identified all
multi-arm, controlled trials of coronary revascularization for acute
myocardial infarction and multicenter trials of cerebral revascularization
for acute ischemic stroke reporting angiographic reperfusion rates.
Results-: Thirty-seven trials of coronary reperfusion enrolled 10 908
patients from 1983 to 2009, and 10 trials of cerebral reperfusion enrolled
1064 patients from 1992 to 2009. Coronary reperfusion trials included 10
of intravenous fibrinolysis alone, 8 combined intravenous fibrinolysis and
percutaneous transluminal coronary angioplasty with or without stenting, 3
intra-arterial fibrinolysis, and 16 percutaneous transluminal coronary
angioplasty with or without stenting. Cerebral reperfusion trials included
1 of intravenous fibrinolysis alone, 3 intra-arterial fibrinolysis, 3
endovascular device alone, and 3 of endovascular treatment +/- intravenous
fibrinolysis. In both circulatory beds, endovascular treatments were more
efficacious at achieving reperfusion than peripherally administered
fibrinolytics. In the coronary bed, rates of achieved reperfusion began at
high levels in the 1980s and improved modestly over the subsequent 3
decades. In the cerebral bed, reperfusion rates began at modest levels in
the early 1990s and increased more slowly. Most recently, in 2005 to 2009,
cardiac reperfusion rates substantially exceeded cerebral, partial
reperfusion 86.1% versus 61.1%, complete reperfusion 78.6% versus 23.4%.
Conclusions-: Reperfusion therapies developed more slowly and remain less
effective for cerebral than cardiac ischemia. Further, cerebral
circulation-specific technical advances are required for physicians to
become as capable at safely restoring blood flow to the ischemic brain as
the ischemic heart. 2012 American Heart Association, Inc.

<19>
Accession Number
2013006508
Authors
Pugliese M. Minardi G. Vitali A. Natale E. de Girolamo P. Zampi G. Leggio
M. Chiarelli A. Pappalardo A. Avella A. Laurenzi F. Fera M.S.
Institution
(Pugliese, Minardi, Vitali, Natale, Zampi, Chiarelli, Fera) Cardiovascular
Department, Intensive Cardiac Unit, San Camillo Hospital, Circ.ne
Gianicolense 87, 00152 Rome, Italy
(de Girolamo, Pappalardo, Avella, Laurenzi) Cardiovascular Arrhythmology
Unit, San Camillo Hospital, Rome, Italy
(Leggio) Cardiovascular Department, Cardiac Rehabilitation Unit, San
Filippo Neri Hospital, Rome, Italy
Title
Influence of myocardial viability on responsiveness to cardiac
resynchronization in ischemic dilated cardiomyopathy: A prospective
observational cohort study.
Source
Anadolu Kardiyoloji Dergisi. 12 (2) (pp 132-141), 2012. Date of
Publication: March 2012.
Publisher
AVES Publishing Co. (Kizilelma CAD. 5/3, Findikzade- Istanbul 34096,
Turkey)
Abstract
Objective: To understand whether patients with post-ischemic dilated
cardiomyopathy and myocardial viability (MV) could benefit from cardiac
resynchronization therapy (CRT) in terms of clinical, echocardiographic
and neuro- hormonal parameters compared to patients without MV. Methods:
One hundred and four consecutive patients were enrolled in a prospective
observational cohort study. Using dobutamine stress echocardiography, 2
groups were identified: group A of 51 patients with MV and group B of 53
patients without MV. All patients were implanted with biventricular pacing
devices combined with an internal cardioverter-defibrillator. Clinical,
echocardiographic and neuro-hormonal parameters were evaluated at baseline
and at six month follow-up. Analysis of variance for repeated measures on
each variable suggestive of remodeling was performed. We considered
responder every patient with: decrease of > 15% in left ventricular
volumes and/or improvement in left ventricular ejection fraction of > 5%
in addition to NYHA class improvement. Results: All the variables improved
in both groups (time effect). Comparing the two groups (group effect), the
following variables were significantly better in group A: N-terminal
pro-B-type natriuretic peptide (p=0.02), NYHA class (p=0.003), reverse
remodeling (RR) (p=0.007), dP/dt (p=0.005), left ventricular ejection
fraction (p=0.009), 3rd sound (p=0.01), and left ventricular end-systolic
volume after the first week (p=0.035). RR occurred at the first week after
CRT only in Group A and was maintained for all the time of this study. The
maximum difference of the decrease of left ventricular volumes between the
two groups occurred after the first week (p<0.001). Conclusion: Patients
with MV responded better than patients without MV with a significant
improvement after the first week from CRT. 2012 by AVES
Yayi{dotless}nci{dotless}li{dotless}k Ltd.

<20>
Accession Number
2013007429
Authors
Broughton J.D. Asopa S. Goodwin A.T. Gildersleeve S.
Institution
(Broughton, Asopa, Goodwin) Department of Cardiothoracic Surgery, James
Cook University Hospital, Middlesbrough, United Kingdom
(Gildersleeve) School of Health and Social Care, Teesside University,
Middlesbrough, United Kingdom
Title
Could routine saphenous vein ultrasound mapping reduce leg wound
complications in patients undergoing coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 16 (1) (pp 75-78), 2013.
Date of Publication: January 2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic was written in cardiothoracic surgery based on a
structured protocol. The question addressed was whether ultrasound mapping
of the long saphenous vein (LSV) might reduce leg wound complications by
reducing unnecessary leg incisions due to poor quality veins. Altogether,
32 abstracts were identified from the search, from which 5 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Surgical site
infections can be extremely distressing for patients, and it is estimated
that treating a surgical wound can cost up to 1554 each. Ultrasound
mapping of the LSV has been reported to be an accurate way of assessing
vein quality preoperatively, reducing unnecessary surgical dissection,
theatre time and cost to both the patient and the health service. We
identified four studies that showed that ultrasound scanning
preoperatively could accurately predict the anatomy and quality of the LSV
(correlation coefficient 0.87). One paper showed that ultrasound scanning
reduced length of incision (P = 0.005), harvest time (P = 0.04) and
hospital stay and reduced morbidity (although not statistically
significant). However, one study found that it could not accurately
predict vein wall changes. Evidence from the papers supports the use of
preoperative ultrasound assessment of the saphenous vein. Benefits to the
patient include a smaller scar, reduced harvest time and minimizing
unnecessary incisions. 2012 The Author.

<21>
Accession Number
2013020079
Authors
Fiocca L. Guagliumi G. Rossini R. Parise H. Musumeci G. Sirbu V.
Lortkipanidze N. Yu J. Mihalcsik L. Vassileva A. Valsecchi O. Gavazzi A.
Mehran R. Stone G.W.
Institution
(Fiocca, Guagliumi, Rossini, Musumeci, Sirbu, Lortkipanidze, Mihalcsik,
Vassileva, Valsecchi, Gavazzi) Cardiovascular Department, Ospedali Riuniti
di Bergamo, Bergamo, Italy
(Parise, Mehran, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Yu, Mehran) Mount Sinai Medical Center, New York, NY, United States
Title
Characteristics and outcomes of patients with ST-segment elevation
myocardial infarction excluded from the harmonizing outcomes with
revascularization and stents in acute myocardial infarction (horizons-ami)
trial.
Source
American Journal of Cardiology. 111 (2) (pp 196-201), 2013. Date of
Publication: 15 Jan 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Randomized controlled trials assessing new drugs and devices tend to
exclude subjects who are at greatest risk. The Harmonizing Outcomes With
Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
trial incorporated broader inclusion criteria in an attempt to include a
more representative spectrum of patients presenting with ST-segment
elevation myocardial infarction (STEMI). To identify the differences
between this modern trial and the real world, we analyzed the
characteristics and outcomes of patients with STEMI who were screened but
not enrolled at a high-volume recruiting center. Of 318 consecutive
patients with STEMI who were screened, 200 (62.9%) were randomized, and
118 (37.1%) were excluded. The baseline characteristics and 30-day and
1-year clinical outcomes were compared in the 2 groups. The excluded
patients had numerous high-risk features compared to those randomized,
including being older (67.0 +/- 12.8 vs 63.0 +/- 11.4 years, p = 0.004),
more often had had a previous MI (34.7% vs 8.0%, p <0.001), Killip class
III-IV (27.4% vs 4.0%, p <0.001), and lower hemoglobin (13.4 +/- 2.3 vs
14.8 +/- 1.5 g/dl, p <0.001). The excluded patients had markedly greater
30-day and 1-year rates of all-cause mortality (17.4% vs 2.0%, p <0.001,
and 27.6% vs 2.5%, p <0.001, respectively), major adverse cardiovascular
events (death, MI, ischemia-driven target vessel revascularization, and
stroke), major bleeding, and net adverse clinical events (major adverse
cardiovascular events or major bleeding). On multivariate analysis, Killip
class III-IV at presentation, age, left ventricular ejection fraction, and
final Thrombolysis In Myocardial Infarction flow grade 3 were independent
predictors of outcome. In conclusion, despite the broadened entry criteria
of the HORIZONS-AMI trial, 37.1% of all patients presenting with STEMI at
a center with a high rate of enrollment were judged to be ineligible and
were excluded. The excluded patients had a significantly greater risk
profile and markedly increased mortality and adverse events compared to
the trial-eligible group. 2013 Elsevier Inc. All rights reserved.

<22>
Accession Number
2013011300
Authors
Boissonnat P. Gaillard S. Mercier C. Redonnet M. Lelong B. Mattei M.-F.
Mouly-Bandini A. Pattier S. Sirinelli A. Epailly E. Varnous S. Billes
M.-A. Sebbag L. Ecochard R. Cornu C. Gueyffier F.
Institution
(Boissonnat, Sebbag) Hospices Civils de Lyon, Hopital Louis Pradel, Pole
Medico-Chirurgical de Transplantation Cardiaque Adulte, 28, avenue du
Doyen Lepine, F-69677, Bron Cedex, France
(Gaillard, Cornu, Gueyffier) INSERM, CIC 201, Lyon, Hospices Civils de
Lyon, Service de Pharmacologie Clinique et Essais Therapeutiques,
Universite Lyon 1, 7 Rue Guillaume Paradin, F-69000, Lyon, France
(Mercier, Ecochard) Hospices Civils de Lyon, Service de Biostatistique,
162, avenue Lacassagne, F-69003, Lyon, France
(Redonnet) Departement de Chirurgie Cardiaque, Hopital Charles Nicolle,
Universite de Rouen, 1, rue de Germont, F-76000, Rouen, France
(Lelong) Service de Cardiologie, Centre Hospitalier et Universitaire de
Rennes, 2 rue Henri le Guilloux, F-35033, Rennes, France
(Mattei) Departement de Cardiologie et Transplantation, Hopital Brabois,
rue du Morvan, F-54511, Nancy, France
(Mouly-Bandini) Service de Chirurgie Cardiaque Adultes, Hopital Timone,
264 rue Saint-Pierre, F-13385, Marseille, France
(Pattier) Departement de Cardiologie et Transplantation, Hopital Guillaume
et Rene Laennec, boulevard Jacques Monod, F-44093, Nantes, France
(Sirinelli) Service de Chirurgie Cardiaque, Centre Hospitalier
Universitaire de Tours, 41, boulevard Beranger, F-37044, Tours, France
(Epailly) Service de Chirurgie Cardiaque, Les Hopitaux Universitaires de
Strasbourg, 3, rue Koeberle, F-67000, Strasbourg, France
(Varnous) Departement de Chirurgie Thoracique et Cardiovasculaire, Groupe
Hospitalier la Pitie-Salpetriere, 47-83 boulevard de l'hopital, F-75013,
Paris, France
(Billes) Departement de Cardiologie et Transplantation, Centre Hospitalier
du Haut Leveque, avenue de Magellan, 33604, Pessac, France
(Mercier, Ecochard) CNRS and Universite Lyon 1, UMR5558, Laboratoire de
Biometrie et Biologie Evolutive, Equipe Biotatistique-Sante, 162, avenue
Lacassagne, F-69003, Lyon, France
(Cornu, Gueyffier) CNRS and Universite Lyon 1, UMR5558, Laboratoire de
Biometrie et Biologie Evolutive, Equipe Modelisation et Evaluation des
Therapeutiques, 7 Rue Guillaume Paradin, F-69000, Lyon, France
Title
Impact of the early reduction of cyclosporine on renal function in heart
transplant patients: A French randomised controlled trial.
Source
Trials. 13 , 2012. Article Number: 231. Date of Publication: 03 Dec 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: Using reduced doses of Cyclosporine A immediately after heart
transplantation in clinical trials may suggest benefits for renal function
by reducing serum creatinine levels without a significant change in
clinical endpoints. However, these trials were not sufficiently powered to
prove clinical outcomes.Methods: In a prospective, multicentre,
open-label, parallel-group controlled trial, 95 patients aged 18 to 65
years old, undergoing de novo heart transplantation were centrally
randomised to receive either a low (130 < trough CsA concentrations <200
mug/L, n = 47) or a standard dose of Cyclosporine A (200 < trough CsA
concentrations <300 mug/L, n = 48) for the three first post-transplant
months along with mycophenolate mofetil and corticosteroids. Participants
had a stable haemodynamic status, a serum creatinine level <250 mumol/L
and the donors' cold ischemia time was under six hours; multiorgan
transplants were excluded. The change in serum creatinine level over 12
months was used as the main criterion for renal function.
Intention-to-treat analysis was performed on the 95 randomised patients
and a mixed generalised linear model of covariance was applied.Results: At
12 months, the mean (+/- SD) creatinine value was 120.7 mumol/L (+/- 35.8)
in the low-dose group and 132.3 mumol/L (+/- 49.1) in the standard-dose
group (P = 0.162). Post hoc analyses suggested that patients with higher
creatinine levels at baseline benefited significantly from the lower
Cyclosporine A target. The number of patients with at least one rejection
episode was not significantly different but one patient in the low-dose
group and six in the standard-dose group required dialysis.Conclusions: In
patients with de novo cardiac transplantation, early Cyclosporine A dose
reduction was not associated with renal benefit at 12 months. However, the
strategy may benefit patients with high creatinine levels before
transplantation.Trial registration: ClinicalTrials.gov NCT00159159. 2012
Boissonnat et al.; licensee BioMed Central Ltd.

<23>
Accession Number
2013013989
Authors
Al-Mutairi F.H. Fallows S.J. Abukhudair W.A. Islam B.B. Morris M.M.
Institution
(Al-Mutairi, Fallows, Morris) Department of Clinical Sciences, University
of Chester, Chester, United Kingdom
(Abukhudair) Department of Cardiac Surgery, King Fahd Armed Forces
Hospital, Jeddah, Saudi Arabia
(Islam) Department of Pulmonary Care, King Fahd Armed Forces Hospital,
Jeddah, Saudi Arabia
Title
Difference between continuous positive airway pressure via mask therapy
and incentive spirometry to treat or prevent post-surgical atelectasis.
Source
Saudi Medical Journal. 33 (11) (pp 1190-1195), 2012. Date of Publication:
2012.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To assess the effect of early use of continuous positive
airway pressure (CPAP) therapy to treat or prevent acute atelectasis in
post-operative cardiac patients particularly smokers and elderly patients.
Methods: A pilot study suggested enrolling at least 32 participants in
each group to be significant. One hundred and eight patients from King
Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia who met the
inclusion criteria participated in this study conducted between March 2010
and March 2011. The participants were divided randomly into 3 groups,
incentive spirometry (IS) therapy, and CPAP therapy every 2 (CPAP2hrs), or
4 hours (CPAP4hrs). Inspiratory capacity (IC) was used to compare the 3
therapy regimes. Simultaneously, respiratory rate (RR), heart rate (HR)
and oxygen saturation (SpO₂) were measured for all groups.
Failure was defined as requiring intubation, bi-level positive airway
pressure, or added chest physiotherapy. Results: Thirty-six patients
participated in each group (98 male and 10 female, with a mean age of
62+/-9.3 years). The IC increased significantly in the CPAP2hrs group when
compared with the control group or the CPAP4hrs group. The SpO₂
decreased significantly in the control group and the CPAP4hrs groups when
compared with the CPAP2hrs group. Also, there were no significant
differences in RR and HR between all groups. Conclusion: Early use of CPAP
via mask therapy for half an hour every 2 hours had better outcomes to
reopen collapsed alveoli after cardiac surgery.

<24>
Accession Number
70969997
Authors
Shihong W.
Institution
(Shihong) PLA, Military General Hospital of Beijing, China
Title
Intracoronary autologous CD34+ stem cell therapy for intractable angina.
Source
Heart. Conference: 23rd Great Wall International Congress of Cardiology,
Asia Pacific Heart Congress 2012 Beijing China. Conference Start: 20121011
Conference End: 20121014. Conference Publication: (var.pagings). 98 (pp
E42-E43), 2012. Date of Publication: October 2012.
Publisher
BMJ Publishing Group
Abstract
Objectives: A large number of patients with coronary artery disease
experience angina that is not suitable for revascularisation and is
refractory to conventional medical therapy. Laboratory and preclinical
studies have provided evidence for the safety and potential efficacy of
autologous CD34+ stem cell therapies as treatment for angina. Clinical
studies investigating intramyocardial transplantation of autologous CD34+
stem cells by catheter injection for patients with refractory angina show
that this is safe and feasible. It remains unclear whether intracoronary
infusion of CD34+ stem cells exerts beneficial effects in patients with
angina as well. We addressed this question with a controlled clinical
trial by enrolling 112 patients with refractory angina. Previous trials
have investigated the safety and beneficial effects of CD34+ cells
isolated from granulocyte colony-stimulating factor-mobilised peripheral
blood; in our trial, we isolated CD34+ cells directly from the patient's
bone marrow. Methods: One hundred and twelve patients with diffuse
triple-vessel disease and Canadian Cardiovascular Society class III or IV
angina were enrolled in a double-blind, randomised (1: 1),
placebo-controlled study. Patients received optimal medical treatment but
were not candidates for mechanical revascularisation (percutaneous
coronary intervention or coronary artery bypass grafting). Fifty-six
patients (27 women and 29 men aged 42-80 years) were enrolled in the
treatment group, and 56 patients (28 women and 28 men aged 43-80 years)
who received optimal medical treatment and intracoronary saline injections
were enrolled in the placebo control group. Bone marrow was collected from
all enrolled patients at a volume of 120-150 ml each in both groups.
Selections of CD34+ cells were performed by a CE-marked device approved by
the Security, Food and Drug Administration of China. Coronary angiography
had been performed before enrolment in this study. Results: No myocardial
infarction was observed during intracoronary infusion. The intracoronary
infusion of cells or saline did not result in cardiac enzyme elevation,
cardiac perforation or pericardial effusion. No arrhythmia, such as
ventricular tachycardia or ventricular fibrillation, was induced by
intracoronary infusion. No serious adverse events occurred in either
group. The reduction in the frequency of angina episodes per week 3 and 6
months after infusion was significantly higher in the treatment group
(-14.6 8 4.8 at 3 months and -15.6 8 4.0 at 6 months) than in the control
group (-4.5 8 0.3 and -3.0 8 1.2, respectively; p ! 0.01). Other efficacy
parameters such as nitroglycerine usage, exercise time and the Canadian
Cardiovascular Society class also showed an improvement in the treatment
group compared to the control group. A significant improvement in
myocardial perfusion was noted in the treatment group compared to the
control group, as measured by single-photon emission CT. Conclusions: This
randomised trial investigating intracoronary infusion of autologous CD34+
cells in patients with intractable angina shows the safety and feasibility
of this therapy and provides evidence for efficacy.

<25>
Accession Number
70967984
Authors
Prokopchuk-Gauk O. Rosin M. Mycyk T. Lim H. Brose K.
Institution
(Prokopchuk-Gauk) Hematology and Hematologic Malignancy, University of
Calgary, Calgary, AB, Canada
(Rosin) Clinical Perfusion, Royal University Hospital, Saskatoon, SK,
Canada
(Mycyk) Cardiac Surgery, University of Saskatchewan, Saskatoon, SK, Canada
(Lim) Community Health and Epidemiology, University of Saskatchewan,
Saskatoon, SK, Canada
(Brose) Hematology, University of Saskatchewan, Saskatoon, SK, Canada
Title
Topical application of tranexamic acid to reduce post-operative bleeding
in coronary artery bypass surgery.
Source
Blood. Conference: 54th Annual Meeting of the American Society of
Hematology, ASH 2012 Atlanta, GA United States. Conference Start: 20121208
Conference End: 20121211. Conference Publication: (var.pagings). 120 (21)
, 2012. Date of Publication: 16 Nov 2012.
Publisher
American Society of Hematology
Abstract
Patients who undergo on-pump coronary artery bypass graft surgery (CABG)
are at an increased risk of bleeding due physiologic, mechanical and
pharmacologic disruption of hemostasis. The use of topically applied
antifibrinolytic agents has been explored as a blood-conservation adjunct
to reduce post-operative bleeding in cardiac surgery. Analysis of pooled
results in a meta-analysis published by Abrishami et al. in 2009 showed
that a significant reduction in blood loss could be achieved utilizing
topical tranexamic acid in the absence of concurrent intravenous
antifibrinolytic agents. However, current blood conservation clinical
practice guidelines recommend the use of intravenous lysine analogues to
limit peri-operative blood loss. Presently, there is no published
prospective data evaluating blood loss in CABG patients who have received
intravenous tranexamic acid, plus topical tranexamic acid versus placebo.
Our study was designed to determine whether combined intravenous and
topical application of tranexamic acid would reduce post-CABG blood loss
in low-risk bypass surgery candidates. A sample calculation based on pilot
study data analysis concluded that a minimum total of 74 patients was
required, allowing 80% power to detect a 200mL difference in total blood
loss (Type I error = 0.05) between groups. In our prospective,
double-blind, randomized controlled trial, patients enrolled were randomly
assigned to receive an intra-operative cardiac bath of either normal
saline or tranexamic acid solution prior to sternotomy closure. All
participants received intravenous tranexamic acid prior to the initiation
of circulatory bypass. Research subject participation ended upon transfer
out of the intensive care unit. Primary outcomes included the total volume
of chest tube blood loss and number of transfusions administered following
CABG. Secondary outcomes included chest tube loss volumes at 6 hours and
12 hours. Between December 1, 2011 and April 30, 2012, a total of 41
patients who underwent randomization were included in final data analysis.
Baseline characteristics of patients enrolled in both groups were similar.
Post-CABG losses at chest tube removal were found to be significantly
reduced in the patients who received topical tranexamic acid. Mean chest
tube loss in the placebo group (n=18) was 789mL versus 632mL in the
topical tranexamic acid group (n=23), with a difference of 157mL (Figure
1, p value of student t-test 0.0493). A significantly greater proportion
of patients in the placebo group were found to bleed more than 700mL at
chest tube removal, in comparison with the topical tranexamic acid group
(72.2% versus 30.4%, p value of chi-squared test 0.0079). Chest tubes
remained in situ for a mean duration of 20 hours and 19 hours,
respectively. None of the patients received post-operative red cell
transfusions. One patient, randomized to the topical tranexamic acid
group, received a single dose each of platelets and cryoprecipitate
post-operatively. The application of topical tranexamic acid did not
significantly reduce blood loss at 6 hours and 12 hours, with a difference
of 76mL (p=0.1876) and 106mL (p=0.0930) respectively. The application of
topical tranexamic acid reduces post-operative blood loss in patients
undergoing on-pump CABG who have received intravenous tranexamic acid.
There was no difference in blood product use between groups. Further
studies must be carried out to investigate long-term outcomes of this
practice and its applicability in high-risk cardiac surgery patients.