European Heart Journal

Mller, Christian H.; Penninga, Luit; Wetterslev, Jrn; Steinbrchel, Daniel A.; Gluud, Christian

doi: 10.1093/eurheartj/ehn335pmid: 18628261

AimsTo assess the clinical outcomes of off- vs. on-pump coronary artery bypass surgery in randomized trials.Methods and resultsWe searched electronic databases and bibliographies until June 2007. Trials were assessed for risk of bias. Outcome measures were all-cause mortality, myocardial infarction, stroke, atrial fibrillation, and renewed coronary revascularization at maximum follow-up. We applied trial sequential analysis to estimate the strength of evidence. We found 66 randomized trials. There was no statistically significant differences regarding mortality [relative risk (RR) 0.98; 95 confidence interval (CI) 0.661.44], myocardial infarction (RR 0.95; 95 CI 0.651.37), or renewed coronary revascularization (RR 1.34; 95 CI 0.832.18). We found a significant reduced risk of atrial fibrillation (RR 0.69; 95 CI 0.570.83) and stroke (RR 0.53; 95 CI 0.310.91) in off-pump patients. However, when continuity correction for zero-event trials was included, the reduction in stroke became insignificant (RR 0.62; 95 CI 0.321.19). Trial sequential analysis demonstrated overwhelming evidence supporting that off-pump bypass surgery reduces atrial fibrillation.ConclusionOff-pump surgery reduces the risks of postoperative atrial fibrillation compared with on-pump surgery. For death, myocardial infarction, stroke, and renewed coronary revascularization, the evidence is still weak and more low-bias risk trials are needed.

Eitel, Ingo; Behrendt, Florian; Schindler, Kathrin; Kivelitz, Dietmar; Gutberlet, Matthias; Schuler, Gerhard; Thiele, Holger

doi: 10.1093/eurheartj/ehn433pmid: 18820322

AimsThe apical ballooning syndrome (ABS) is a new diagnostic entity which is increasingly recognized. Precise magnetic resonance imaging (MRI) data are not yet available and there is little evidence for the differential diagnosis of ABS assessed by MRI.Methods and resultsBetween January 2005 and January 2008, 6100 consecutive patients with diagnosis of acute coronary syndrome underwent left heart catheterization. In 59 patients (1.0), coronary angiography revealed normal coronary arteries, but left ventriculography showed left ventricular dysfunction with apical ballooning. These 59 patients underwent cardiac MRI using a 1.5 T MRI scanner. In 13 patients (22.0), MRI revealed diagnosis of myocardial infarction, in eight patients (13.6) diagnosis of myocarditis. In all other 38 (64.4) patients (36 female, age 73 10 years) with suspected ABS, no delayed enhancement or signs of inflammation were detected. Follow-up MRI after 3 months showed a completely normalized left ventricular ejection in all patients with suspected ABS. Similarly, the end-diastolic volume and end-systolic volume improved at follow-up.ConclusionCardiac MRI allows differentiating ABS from other rare causes with unobstructed coronary vessels such as myocarditis and coronary emboli with spontaneous lysis. Therefore, cardiac MRI can add valuable information in all patients with suspected ABS for further differential diagnosis.

Turnbull, Fiona; Woodward, Mark; Neal, Bruce; Barzi, Federica; Ninomiya, Toshiharu; Chalmers, John; Perkovic, Vlado; Li, Nicole; MacMahon, S.; ,

doi: 10.1093/eurheartj/ehn427pmid: 18852183

van der Rijken, Rachel; Hulstijn-Dirkmaat, Gerdine; Kraaimaat, Floris; Nabuurs-Kohrman, Lida; Nijveld, Aagje; Maassen, Ben; Danils, Otto

doi: 10.1093/eurheartj/ehn432pmid: 18820321

AimsAlthough neurocognitive problems after open-heart surgery for congenital heart disease are frequent, due to a shortage of prospective studies assessing neurocognitive functioning both before and after the procedure, the exact nature of the deficits usually remains unknown. The present study aims at assessing the neurocognitive effects of, in particular, cardiopulmonary bypass at school age. In addition, surgery-related risk factors for reduced neurocognitive outcome are explored.Methods and resultsParticipants were aged between 6 and 16 years. Forty-three children indicated for open-heart surgery and a comparison group of 19 children scheduled for interventional cardiac catheterization completed a neurocognitive assessment battery before and 1 year after their procedures. Forty healthy matched controls did so at a 1 year interval. The baseline-to-follow-up outcomes were similar in all three groups. The observed improvements most likely resulted from increased age and the repeated neurocognitive assessment. No risk factors for postsurgical neurocognitive deficits were identified.ConclusionThe present study demonstrates that at school age cardiac surgery using full-flow cardiopulmonary bypass does not affect neurocognitive functioning.