EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 28

Results Generated From:
Embase <1980 to 2013 Week 48>
Embase (updates since 2013-11-21)

<1>
Accession Number
2013672664
Authors
Lin G.-M. Li Y.-H. Lin C.-L. Wang J.-H. Han C.-L.
Institution
(Lin, Li) Department of Public Health, Tzu-Chi University, No. 701,
Zhongyang Rd., Hualien 97004, Taiwan (Republic of China)
(Lin) Department of Medicine, Hualien Armed Forces General Hospital,
Hualien, Taiwan (Republic of China)
(Lin, Wang) Division of Cardiology, Buddhist Tzu-Chi General Hospital,
Hualien, Taiwan (Republic of China)
(Han) Department of Medicine, Taipei Veterans General Hospital, Taipei,
Taiwan (Republic of China)
Title
Relation of body mass index to mortality among patients with percutaneous
coronary intervention in the drug-eluting stent era: A systematic review
and meta-analysis.
Source
International Journal of Cardiology. 168 (4) (pp 4315-4318), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<2>
Accession Number
2013672711
Authors
Cheng X. Chen S. Hu Q. Yin Y. Liu Z.
Institution
(Cheng, Chen, Yin, Liu) Department of Cardiology, Second Affiliated
Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmias
Service Center, Chongqing 400010, China
(Hu) Key Laboratory of Biochemistry and Molecular Biology, Chongqing
Medical University, Chongqing 400016, China
Title
Fish oil increase the risk of recurrent atrial fibrillation: Result from a
meta-analysis.
Source
International Journal of Cardiology. 168 (4) (pp 4538-4541), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<3>
Accession Number
2013672794
Authors
Zhao Y. Owen A. Henein M.
Institution
(Zhao, Owen, Henein) Heart Centre, Department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Owen) Canterbury Christ Church University, China
(Zhao) Cardiology Heart Centre, Department of Public Health and Clinical
Medicine, Umea University, Umea, Sweden
Title
Early valve replacement for aortic stenosis irrespective of symptoms
results in better clinical survival: A meta-analysis of the current
evidence.
Source
International Journal of Cardiology. 168 (4) (pp 3560-3563), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Objectives Patients with severe, but asymptomatic aortic stenosis (AS)
present a difficult clinical challenge. The conventional strategy is 'wait
for symptoms' approach. However, some observational studies have suggested
early aortic valve replacement (AVR) results in better outcome compared to
late surgery. There are no randomised controlled trials comparing clinical
outcome of early and late AVR. This meta-analysis is to examine the effect
of the two approaches on clinical outcome in such patients. Methods We
searched the PubMed for published studies on asymptomatic AS and
treatment. Four observational studies (N = 976 patients) were suitable for
inclusion in the analysis. Results All four studies provided sufficient
details. Using the subgroup of asymptomatic patients who underwent early
surgery together or separately from the subgroup who had surgery after
developing symptoms resulted in ORs of 0.17 and 0.16 respectively (p <
0.00001) in favour of early AVR compared with conservational or late
surgery. Conclusion Meta-analysis of the available observational studies
has demonstrated highly significant clinical outcome in favour of early
AVR compared with late surgery, suggesting that early surgical approach
offers substantial survival benefit for severe asymptomatic AS patients.
2013 Elsevier Ireland Ltd.

<4>
Accession Number
2013724171
Authors
Bouma W. Wijdh-den Hamer I.J. Klinkenberg T.J. Kuijpers M. Bijleveld A.
Van der Horst I.C. Erasmus M.E. Gorman J.H. Gorman R.C. Mariani M.A.
Institution
(Bouma, Wijdh-den Hamer, Klinkenberg, Kuijpers, Bijleveld, Van der Horst,
Erasmus, Mariani) Department of Cardiothoracic Surgery, University Medical
Center Groningen, Groningen, Netherlands
(Bouma, Wijdh-den Hamer, Klinkenberg, Kuijpers, Bijleveld, Van der Horst,
Erasmus, Mariani) Department of Cardiology, University Medical Center
Groningen, Groningen, Netherlands
(Bouma, Gorman, Gorman) Gorman Cardiovascular Research Group, Hospital of
the University of Pennsylvania, Philadelphia, PA, United States
Title
Mitral valve repair for post-myocardial infarction papillary muscle
rupture.
Source
European Journal of Cardio-thoracic Surgery. 44 (6) (pp 1063-1069), 2013.
Article Number: ezt150. Date of Publication: December 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
OBJECTIVES: Papillary muscle rupture (PMR) is a rare, but serious
mechanical complication of myocardial infarction (MI). Although mitral
valve replacement is usually the preferred treatment for this condition,
mitral valve repair may offer an improved outcome. In this study, we
sought to determine the outcome of mitral valve repair for post-MI PMR and
to provide a systematic review of the literature on this topic. METHODS:
Between January 1990 and December 2010, 9 consecutive patients (mean age
63.5 +/- 14.2 years) underwent mitral valve repair for partial post-MI
PMR. Clinical data, echocardiographic data, catheterization data and
surgical reports were reviewed. Follow-up was obtained in December of 2012
and it was complete; the mean follow-up was 8.7 +/- 6.1 (range 0.2-18.8
years). RESULTS: Intraoperative and in-hospital mortality were 0%.
Intraoperative repair failure rate was 11.1% (n = 1). Freedom from Grade
3+ or 4+ mitral regurgitation and from reoperation at 1, 5, 10 and 15
years was 87.5 +/- 11.7%. Estimated 1-, 5-, 10- and 15-year survival rates
were 100, 83.3 +/- 15.2, 66.7 +/- 19.2 and 44.4 +/- 22.2%, respectively.
There were 3 late deaths, and 2 were cardiac-related. All late survivors
were in New York Heart Association Class I or II. No predictors of
long-term survival could be identified. CONCLUSIONS: Mitral valve repair
for partial or incomplete post-MI PMR is reliable and provides good short-
and long-term results, provided established repair techniques are used and
adjacent tissue is not friable. PMR type and adjacent tissue quality
ultimately determine the feasibility and durability of repair. The Author
2013. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<5>
Accession Number
2013724158
Authors
Sastry P. Rivinius R. Harvey R. Parker R.A. Rahm A.-K. Thomas D. Nair S.
Large S.R.
Institution
(Sastry, Nair, Large) Department of Cardiothoracic Surgery, Papworth
Hospital, Cambridge, United Kingdom
(Rivinius, Rahm, Thomas) Department of Cardiology, Heidelberg University
Hospital, Heidelberg, Germany
(Harvey, Parker) Department of Public Health and Primary Care, Centre for
Applied Medical Statistics, University of Cambridge, Cambridge, United
Kingdom
Title
The influence of endoscopic vein harvesting on outcomes after coronary
bypass grafting: A meta-analysis of 267 525 patients.
Source
European Journal of Cardio-thoracic Surgery. 44 (6) (pp 980-989), 2013.
Article Number: ezt121. Date of Publication: December 2013.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
In recent times, practice in cardiac surgery has shifted towards using
endoscopic techniques to harvest the saphenous vein from the leg for use
as a bypass graft. A paper published in the New England Journal of
Medicine (NEJM) in 2009 raised concerns over increased graft occlusion
rates in veins harvested endoscopically. This NEJM paper has been
criticized, but has nonetheless been influential in guiding practice. We
have undertaken this meta-analysis to provide evidence on the clinical
outcomes of endoscopic vein harvesting (EVH), so that clinicians can make
an informed judgement about whether this technique, popular as it is with
patients, should still be offered. We systematically reviewed the global
literature and performed a meta-analysis of clinical outcomes after
endoscopic and open vein harvesting. In all outcomes, endoscopic
harvesting appears to be equal, if not superior, to open harvesting. The
suspicion of higher rates of vein graft occlusion was not borne out by
randomized studies. When considering evidence from only randomized
studies, there is no statistical difference in vein graft stenosis or
occlusion between open and endoscopically harvested veins. In conclusion,
EVH reduces pain and leg wound complications. At a median follow-up of 2.6
years, we found no significant difference in mortality, myocardial
infarction, repeat revascularization, angina recurrence, vein graft
stenosis or occlusion. Therefore, the authors support the ongoing use of
endoscopic harvesting techniques. Crown copyright 2013.

<6>
Accession Number
2013722357
Authors
Russell T. Slinger P. Roscoe A. McRae K. Van Rensburg A.
Institution
(Russell) Sir Charles Gairdner Hospital, Nedlands, WA, Australia
(Slinger, Roscoe, McRae, Van Rensburg) Department of Anaesthesia, Toronto
General Hospital, Toronto, ON, Canada
Title
A randomised controlled trial comparing the GlideScope and the Macintosh
laryngoscope for double-lumen endobronchial intubation.
Source
Anaesthesia. 68 (12) (pp 1253-1258), 2013. Date of Publication: December
2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Summary Double-lumen endobronchial tubes are the most common method of
achieving lung isolation and one-lung ventilation during thoracic
anaesthesia and surgery. We compared the clinical performance of the
Macintosh laryngoscope and the GlideScope during endobronchial
intubation with a double-lumen tube. Seventy patients with no predictors
for difficult laryngoscopy were allocated randomly to the Macintosh
laryngoscope or GlideScope. The time taken for endobronchial intubation
with the Macintosh laryngoscope was significantly shorter compared with
that taken for the GlideScope, median (IQR [range]) 33 (22-52 [11-438]) s
vs 70 (39-129 [21-242]) s, respectively, p = 0.0013. There was no
statistical difference in the rate of success at the first attempt (91% vs
83%, respectively). On a numerical rating scale (scored from 0 to 10), the
30 anaesthetists who took part in the study rated endobronchial intubation
overall as easier using the Macintosh compared with the GlideScope, 2 (1-3
[0-8]) vs 3 (2-6 [0-10]), respectively, p = 0.003. Postoperative voice
changes were also less common in the Macintosh group (8 (22%) vs 17 (58%),
p = 0.045). Anaesthetists found the GlideScope more difficult to use than
the Macintosh laryngoscope and endobronchial intubation took longer;
therefore, we cannot recommend its routine use with double-lumen tubes in
patients who are predicted to have a normal airway. 2013 The Association
of Anaesthetists of Great Britain and Ireland.

<7>
Accession Number
2013722243
Authors
Tsai Y.-F. Liu F.-C. Yu H.-P.
Institution
(Tsai, Liu, Yu) Department of Anesthesiology, Chang Gung Memorial
Hospital, Taoyuan, Taiwan (Republic of China)
(Tsai, Liu, Yu) College of Medicine, Chang Gung University, Taoyuan,
Taiwan (Republic of China)
(Tsai) Graduate Institute of Clinical Medical Sciences, Chang Gung
University, Taoyuan, Taiwan (Republic of China)
Title
FloTrac/Vigileo system monitoring in acute-care surgery: Current and
future trends.
Source
Expert Review of Medical Devices. 10 (6) (pp 717-728), 2013. Date of
Publication: November 2013.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
As acute critical-care surgery evolves, it is imperative to introduce
reliable devices that can intraoperatively assess a patient's
cardiovascular functions. Owing to the fact that traditional methods are
usually invasive, non- or less-invasive innovations have attracted the
attention of clinicians in recent decades. The FloTrac system monitors
cardiovascular performance by analyzing peripheral arterial waveforms and
a preset database, and it decreases the invasiveness by using a pulmonary
arterial catheter. The reliability of cardiac output measurements was
confirmed in many critically ill subjects in cardiac surgeries and
intensive care units. Moreover, the FloTrac system is easy to set up, and
interpreting the information is simple. The FloTrac system also provides a
useful preload predictor, that is, stroke volume variation (SVV), for
fluid management, which has been proven to enhance surgical safety in the
treatment of critically ill patients. Goal-directed therapy guided by SVV
and other hemodynamic variables was advocated for peri-operative fluid
optimization. Although the evolution of each updated algorithm of the
FloTrac system has demonstrated improved accuracy and limited
shortcomings, the latest third-generation algorithm is still not equal to
the gold standard reference. The accuracy of the latest third-generation
algorithm is controversial in septic conditions, and its use is still
unacceptable in liver transplantation. Due to vasoactive challenges,
especially in the administration of norepinephrine, a conclusion could not
be reached. Clinicians should recognize the appropriate uses and
limitations when using the algorithm during acute critical surgeries.
2013 Informa UK, Ltd.

<8>
Accession Number
2013709723
Authors
Wei G. Xuan Y. Zheng H. Wang J.
Institution
(Wei, Xuan, Zheng, Wang) Department of Anesthesiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
Title
Effectiveness and safety of thoracic epidural analgesia for postoperative
complications after cardiac surgery: A systematic review.
Source
Chinese Journal of Evidence-Based Medicine. 13 (10) (pp 1229-1235), 2013.
Date of Publication: 2013.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To systematically review the effectiveness and safety of
thoracic epidural analesis (TEA) for postoperative complications after
cardiac surgery. Methods Such databases as PubMed, Science Citation Index,
EMbase, The Cochrane Library, CNKI and CBM were electronically searched
from inception to October 2012 for collecting the randomized controlled
trials on the effectiveness and safety of thoracic epidural analgesisa for
postoperative complications after cardiac surgery. Two reviewers
independently screened literature according to inclusion and exclusion
criteria, extracted data, and assessed the methodological quality of the
included studies. Then, meta-analysis was performed using RevMan 5.1
software. Results Totally 14 studies were eligible, involving 1 942
patients. The results of meta-analysis showed that, TEA combined with
general anesthesia (GA) was superior to GA alone in reducing the
incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96,
P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000
1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005),
and duration of mechanical ventilation (MD= -2.15, 95%CI -3.72 to -0.58,
P=0.007), with significant differences. Conclusions Current evidence shows
that, TEA after surgery is effective in reducing the incidences of
myocardial ischemia/infarction, respiratory complications,
supraventricular arrhythmias, and duration of mechanical ventilation.
There is the lack of data on the adverse events of TEA (mainly referring
to epidural hematoma). Due to limited quality and quantity of the included
studies, patients' conditions should be fully considered before applying
TEA in clinical practice. 2013 Editorial Board of Chin J Evid-based Med.

<9>
Accession Number
2013720352
Authors
Efthymiou C.A. Mills R.J. O'Regan D.J.
Institution
(Efthymiou, Mills, O'Regan) Department of Cardiothoracic Surgery, Leeds
General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
Title
Early postoperative thrombosis of an aortic bioprosthetic valve: Should
anticoagulation be patient specific?.
Source
Journal of Cardiac Surgery. 28 (6) (pp 723-729), 2013. Date of
Publication: November 2013.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Optimal antithrombotic recommendations for patients following
bioprosthetic aortic valve replacement have yet to be decided. Current
guidelines present conflicting opinions and are based on historical
studies, which are limited by their design. We review comparative studies
investigating differing thromboprophylactic regimes and outcomes for
bioprosthetic aortic valve replacement. 2013 Wiley Periodicals, Inc.

<10>
Accession Number
2013672714
Authors
Li Y.-H. Lin G.-M. Lai C.-P. Lin C.-L. Wang J.-H.
Institution
(Li, Lin) Department of Public Health, Tzu-Chi University, No.701,
Zhongyang Rd., Hualien 97004, Taiwan (Republic of China)
(Lin) Department of Medicine, Hualien Armed Forces General Hospital,
Hualien, Taiwan (Republic of China)
(Lai, Lin, Wang) Division of Cardiology, Buddhist Tzu-Chi General
Hospital, Hualien, Taiwan (Republic of China)
Title
The "smoker's paradox" in Asian versus non-Asian patients with
percutaneous coronary intervention longer than 6 months follow-up: A
collaborative meta-analysis with the ET-CHD registry.
Source
International Journal of Cardiology. 168 (4) (pp 4544-4548), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<11>
Accession Number
2013672762
Authors
Jensen M.T. Kaiser C. Sandsten K.E. Alber H. Wanitschek M. Iversen A.
Jensen J.S. Pedersen S. Soerensen R. Rickli H. Zurek M. Fahrni G. Bertel
O. De Servi S. Erne P. Pfisterer M. Galatius S.
Institution
(Jensen, Sandsten, Iversen, Jensen, Pedersen, Soerensen, Galatius)
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels
Andersens Vej 65, 2900 Copenhagen, Denmark
(Kaiser, Fahrni, Pfisterer) University Hospital, Basel, Switzerland
(Rickli, Zurek) Kantonsspital, St. Gallen, Switzerland
(Bertel) Klinik im Park, Zurich, Switzerland
(De Servi) Ospedale Civile di Legnano, Milan, Italy
(Erne) Kantonsspital, Lucerne, Switzerland
(Alber, Wanitschek) University Hospital Innsbruck, Austria
Title
Heart rate at discharge and long-term prognosis following percutaneous
coronary intervention in stable and acute coronary syndromes - Results
from the BASKET PROVE trial.
Source
International Journal of Cardiology. 168 (4) (pp 3802-3806), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Elevated heart rate (HR) is associated with mortality in a
number of heart diseases. We examined the long-term prognostic
significance of HR at discharge in a contemporary population of patients
with stable angina (SAP), non-ST-segment elevation acute coronary
syndromes (NSTE-ACS), and ST-segment elevation myocardial infarction
(STEMI) revascularized with percutaneous coronary intervention (PCI).
Methods Patients from the BASKET-PROVE trial, an 11-center randomized
all-comers trial comparing bare-metal and drug-eluting stenting in large
coronary vessels, were included. Discharge HR was determined from a
resting ECG. Long-term outcomes (7 days to 2 years) were evaluated for
all-cause mortality and cardiovascular death and non-fatal myocardial
infarction. Results A total of 2029 patients with sinus rhythm were
included, 722 (35.6%) SAP, 647 (31.9%) NSTE-ACS, and 660 (32.5%) STEMI.
Elevated discharge HR was associated significantly with all-cause
mortality: when compared to a reference of < 60 beats per minute (bpm),
the adjusted hazard ratios were (95% CI) 4.5 (1.5-13.5, p = 0.006) for
60-69 bpm, 3.8 (1.2-11.9, p = 0.022) for 70-79 bpm, 4.3 (1.2-15.6, p =
0.025) for 80-89 bpm, and 16.9 (5.2-55.0, p < 0.001) for > 90 bpm. For
cardiovascular death/myocardial infarction, a discharge HR > 90 bpm was
associated with a hazard ratio of 6.2 (2.5-15.5, p < 0.001) compared to a
HR < 60 bpm. No interaction was found for disease presentation, diabetes
or betablocker use. Conclusion In patients revascularized with PCI for
stable angina or acute coronary syndromes an elevated discharge HR was
independently associated with poor prognosis. Conversely, a HR < 60 bpm at
discharge was associated with a good long-term prognosis irrespective of
indication for PCI. 2013 Elsevier Ireland Ltd.

<12>
Accession Number
2013672858
Authors
Conraads V.M. Van Craenenbroeck E.M. Pattyn N. Cornelissen V.A. Beckers
P.J. Coeckelberghs E. De Maeyer C. Denollet J. Frederix G. Goetschalckx K.
Hoymans V.Y. Possemiers N. Schepers D. Shivalkar B. Vanhees L.
Institution
(Conraads, Van Craenenbroeck, Beckers, De Maeyer, Denollet, Frederix,
Hoymans, Possemiers, Shivalkar) Department of Cardiology, Antwerp
University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
(Conraads, Van Craenenbroeck, Beckers, De Maeyer, Hoymans, Shivalkar)
University of Antwerp, Antwerp, Belgium
(Pattyn, Cornelissen, Coeckelberghs, Goetschalckx, Schepers, Vanhees)
University Hospitals of Leuven, Leuven, Belgium
(Pattyn, Cornelissen, Coeckelberghs, Goetschalckx, Schepers, Vanhees)
Department of Rehabilitation Sciences, Research Centre for Cardiovascular
and Respiratory Rehabilitation, Katholieke Universiteit Leuven, Heverlee,
Belgium
(Denollet) CoRPS-Centre of Research on Psychology in Somatic Diseases,
Tilburg University, Tilburg, Netherlands
Title
Rationale and design of a randomized trial on the effectiveness of aerobic
interval training in patients with coronary artery disease: The
SAINTEX-CAD study.
Source
International Journal of Cardiology. 168 (4) (pp 3532-3536), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background Exercise-based cardiac rehabilitation is considered an
important adjunct treatment and secondary prevention measure in patients
with coronary artery disease (CAD). However, the issues of training
modality and exercise intensity for CAD patients remain controversial.
Objective Main aim of the present study is to test the hypothesis that
aerobic interval training (AIT) yields a larger gain in peak aerobic
capacity (peakVO₂) compared to a similar training programme of
moderate continuous training (MCT) in CAD patients. Study design In this
multicentre study stable CAD patients with left ventricular ejection
fraction > 40% will be randomized after recent myocardial infarction or
revascularization (PCI or CABG) to a supervised 12-week programme of three
weekly sessions of either AIT (85-90% of peak oxygen uptake
[peakVO₂], 90-95% of peak heart rate) or MCT (60-70% of peakVO
_2, 65-75% of peak heart rate). The primary endpoint of the
study is the change of peakVO₂ after 12 weeks training.
Secondary endpoints include safety, changes in peripheral endothelial
vascular function, the evolution of traditional cardiovascular risk
factors, quality of life and the number and function of circulating
endothelial progenitor cells as well as endothelial microparticles.
Possible differences in terms of long-term adherence to prescribed
exercise regimens will be assessed by regular physical activity
questionnaires, accelerometry and reassessment of peakVO₂ 12
months after randomization. A total number of 200 patients will be
randomized in a 1:1 manner (significance level of 0.05 and statistical
power of 0.90). Enrolment started December 2010; last enrolment is
expected for February 2013.

<13>
Accession Number
2013719574
Authors
Thiele H. Zeymer U. Neumann F.-J. Ferenc M. Olbrich H.-G. Hausleiter J. De
Waha A. Richardt G. Hennersdorf M. Empen K. Fuernau G. Desch S. Eitel I.
Hambrecht R. Lauer B. Bohm M. Ebelt H. Schneider S. Werdan K. Schuler G.
Institution
(Thiele, Fuernau, Desch, Eitel, Schuler) University of Leipzig, Heart
Centre, Department of Internal Medicine/Cardiology, 04289 Leipzig, Germany
(Zeymer, Schneider) Klinikum Ludwigshafen, Institut fur
Herzinfarktforschung, Ludwigshafen, Germany
(Neumann) University of Freiburg, Heart Centre Bad Krozingen, Bad
Krozingen, Germany
(Ferenc, Olbrich) Asklepios Clinic Langen-Seligenstadt, Langen, Germany
(Hausleiter) Klinikum der Ludwig-Maximilians, Universitat Munchen, Munich,
Germany
(De Waha) German Heart Centre Munich, Munich, Germany
(Richardt) Heart Centre-Segeberger Kliniken, Bad Segeberg, Germany
(Hennersdorf) SLK Kliniken Heilbronn, Heilbronn, Germany
(Empen) Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
(Hambrecht) Klinikum Links der Weser, Bremen, Germany
(Lauer) Zentralklinik Bad Berka, Bad Berka, Germany
(Bohm) University Clinic of Saarland, Homburg/Saar, Germany
(Ebelt, Werdan) Martin-Luther University Halle-Wittenberg, Halle (Saale),
Germany
Title
Intra-aortic balloon counterpulsation in acute myocardial infarction
complicated by cardiogenic shock (IABP-SHOCK II): Fi nal 12 month results
of a randomised, open-label trial.
Source
The Lancet. 382 (9905) (pp 1638-1645), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background In current international guidelines the recommendation for
intra-aortic balloon pump (IABP) use has been downgraded in cardiogenic
shock complicating acute myocardial infarction on the basis of registry
data. In the largest randomised trial (IABP-SHOCK II), IABP support did
not reduce 30 day mortality compared with control. However, previous
trials in cardiogenic shock showed a mortality benefi t only at extended
follow-up. The present analysis therefore reports 6 and 12 month results.
Methods The IABP-SHOCK II trial was a randomised, open-label, multicentre
trial. Patients with cardiogenic shock complicating acute myocardial
infarction who were undergoing early revascularisation and optimum medical
therapy were randomly assigned (1:1) to IABP versus control via a central
web-based system. The primary effi cacy endpoint was 30 day all-cause
mortality, but 6 and 12 month follow-up was done in addition to
quality-of-life assessment for all survivors with the Euroqol-5D
questionnaire. A masked central committee adjudicated clinical outcomes.
Patients and investigators were not masked to treatment allocation.
Analysis was by intention to treat. This trial is registered at
ClinicalTrials.gov, NCT00491036. Findings Between June 16, 2009, and March
3, 2012, 600 patients were assigned to IABP (n=301) or control (n=299). Of
595 patients completing 12 month follow-up, 155 (52%) of 299 patients in
the IABP group and 152 (51%) of 296 patients in the control group had died
(relative risk [RR] 101, 95% CI 086-118, p=091). There were no signifi
cant diff erences in reinfarction (RR 260, 95% CI 095-710, p=005),
recurrent revascularisation (091, 058- 141, p=077), or stroke (150,
025-884, p=100). For survivors, quality-of-life measures including
mobility, self-care, usual activities, pain or discomfort, and anxiety or
depression did not diff er signifi cantly between study groups.
Interpretation In patients undergoing early revas cularisation for
myocardial infarction complicated by cardiogenic shock, IABP did not
reduce 12 month all-cause mortality. Funding German Research Foundation;
German Heart Research Foundation; German Cardiac Society;
Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte; University
of Leipzig-Heart Centre; Maquet Cardiopulmonary; Teleflex Medical.

<14>
Accession Number
2013672823
Authors
Villani A.M. Crotty M. Cleland L.G. James M.J. Fraser R.J. Cobiac L.
Miller M.D.
Institution
(Villani, Cobiac, Miller) Department of Nutrition and Dietetics, School of
Medicine, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
(Crotty) Department of Rehabilitation and Aged Care, School of Medicine,
Flinders University, Adelaide, SA, Australia
(Cleland, James) Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA,
Australia
(Fraser) Flinders Clinical Effectiveness, School of Medicine, Flinders
University, Adelaide, SA, Australia
Title
Fish oil administration in older adults with cardiovascular disease or
cardiovascular risk factors: Is there potential for adverse events? A
systematic review of the literature.
Source
International Journal of Cardiology. 168 (4) (pp 4371-4375), 2013. Date of
Publication: 09 Oct 2013.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)

<15>
Accession Number
71235362
Authors
Miller J.D. Shargall Y. Finley C. Alabdulmohsin M. Ostrander C.
Institution
(Miller, Shargall, Finley, Alabdulmohsin, Ostrander) Thoracic Surgwery,
Mcmaster University, Canada
Title
Limited resection of early staged lung cancer: A retrospective review of
our database comparing lobar resection and segmental and wedge resection.
Pilot.
Source
Journal of Thoracic Oncology. Conference: 14th World Conference on Lung
Cancer Amsterdam Netherlands. Conference Start: 20110703 Conference End:
20110707. Conference Publication: (var.pagings). 6 (6 SUPPL. 2) (pp
S435-S436), 2011. Date of Publication: June 2011.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: The Canadian Lung Cancer Study Group (LCSG) published their
findings comparing lobectomy and segmental resection of early stage lung
cancer in 1997. Despite the fact that little or no clear survival
advantage was demonstrated by the larger resection (lobectomy) the
thoracic community has not embraced limited resection. Lobectomy remains
the basic standard operation for patients with resectable lung cancer.
NCIC-BR5 in association with international intergroup study has begun a
new randomized controlled trial to evaluate segmental and lobar resections
for lung tumours 2cms or less in diameter. This report is a retrospective
review of our experience with limited resection over the past several
years. Methods: a:Objective: This pilot assessment of long term outcomes
will help develop our role and understanding as we prepare to evaluate
limited resection in a multinational RCT (NCIC-BR5). Disease recurrence
and disease free and overall survival are our primary outcomes. Methods:
b:Source and Statistics:Using the Division of Thoracic Surgery Data base
and office and hospital charts, consecutive patients who have undergone
either a lobectomy or lesser resection for early staged lung cancer is
shown in Table 1. Survival appears equivalent between groups but lesser
resections are associated with more local recurrences. A Kaplan-Meier
survival analysis was performed comparing the time survived since surgery
between the two treatment groups. Results: The overall survival appeared
better in the lobectomy group, sample size limits statistically
significant. (Table Presented) Conclusion: These results show a trend
toward increased survival in the lobectomy treated group. Although safer,
as more early deaths occured in the lobectomy group, segmental resection
did not confer any long term survival benefit over lobectomy even in the
smaller tumours (<2cms). Lessor resections must be saved only for those
severely disabled patients who cannot tolerate a bigger operation. The
results of this study encourage us to more fully study the possible
advantage of a sub-lobar resection and the long term outcomes.

<16>
Accession Number
71235030
Authors
Lam S. Tammemagi M. Miller A. Mayo J. Johnston M. Dickinson J. Yang H. Mai
V. Evans W.K.
Institution
(Lam) Integrative Oncology, BC Cancer Research Centre, Canada
(Tammemagi) Department of Community Health Sciences, Brock University,
Canada
(Miller) Dalla Lana School of Public Health, University of Toronto, Canada
(Mayo) Department of Advanced Cardiac Imaging, Vancouver General Hospital,
Canada
(Johnston) Department of Surgery, Queen Elizabeth II Health Sciences Ctr.,
Canada
(Dickinson) Faculty of Medicine, University of Calgary, Canada
(Yang) Populationa Dn Public Health, Alberta Health Services, Canada
(Mai) Prevention and Cancer Control, Cancer Care Ontario, Canada
(Evans) Juravinski Hospital and Cancer Centre, Cancer Care Ontario, Canada
Title
Lung cancer screening by low dose ct (discussant).
Source
Journal of Thoracic Oncology. Conference: 14th World Conference on Lung
Cancer Amsterdam Netherlands. Conference Start: 20110703 Conference End:
20110707. Conference Publication: (var.pagings). 6 (6 SUPPL. 2) (pp
S132-S134), 2011. Date of Publication: June 2011.
Publisher
International Association for the Study of Lung Cancer
Abstract
Lung cancer is the most common cause of cancer death world-wide. Despite
advances in therapies, the outcome of patients with lung cancer remains
poor. In the last decade, the 5-year survival rate changed from 13.9% to
17.7% with a slightly better improvement in the one-year survival from 36%
to 43% (Lancet 2011;377:127-138). Roughly 85-90% of lung cancers are
attributable to smoking. Currently more than half the lung cancers
diagnosed in North America are diagnosed in former-smokers, and for this
reason lung cancer is expected to remain a major public health concern for
many years to come. The recent finding by the National Lung Screening
Trial (NLST) in the United States that screening of high-risk smokers with
low dose computed tomography (LDCT) reduces lung cancer mortality by 20%
compared to screening with chest x-ray may represent a potential strategy
that can significantly improve the outcome of patients with lung cancer
NLST, NELSON-Danish and the ITALUNG are the first randomized trials using
superior study designs to evaluate the efficacy of CT screening to reduce
lung cancer mortality. Simple case detection and demonstration of
improvement of survival in single arm studies are not equivalent to
efficacy as some cancers may not be curable, nor have their natural
history modified by available treatment. Some cancers may never have
become life-threatening in the patient's lifetime (over-diagnosis bias).
The randomized controlled trial design with lung cancer mortality as the
outcome avoids length, lead-time and overdiagnosis biases that invalidate
study designs dependent upon survival. Selection or participation bias -
i.e., the healthy volunteer effect, is still present in randomized
controlled trials, so they may have better outcomes than can be achieved
in the general population. Screening is a process, not a single event. It
requires the use of tests to detect unrecognized health risks or diseases
in order to permit timely intervention. For a screening program to
demonstrate effectiveness at a population level, the screening tests must
be applied systematically on a large scale. They are used to distinguish
apparently unaffected (undiagnosed) people from those who may have a
disease. A screening test is not intended to be diagnostic. The test
results require confirmation through definitive diagnostic tests, followed
by treatment of confirmed cases. Screening can only be effective if
effective treatment is available for the disease revealed by screening.
The potential benefits of screening must be balanced against possible
harms of screening tests, downstream investigations or therapeutic
intervention for suspicious lesions that turn out to be non-malignant, and
these may be several times more frequent than the true cancers.
Implementation of lung cancer screening at the population level requires
coordinated and specialized professional expertise to ensure benefits of
screening are maximized while the potential risks are minimized. For
example, population penetration strategies for large scale screening will
have to be developed; pulmonologists and thoracic surgeons experienced in
management of lung nodules, interventional pulmonologists skilled in
diagnosis of peripheral lung lesions and staging of lung cancer using
endoscopic ultrasound; radiologists skilled in interpretation of lung
cancer screening low dose CT scans, biopsy and localization of small lung
nodules, thoracic surgeons knowledgeable in staging, resection techniques
and treatment methods and pathologists experienced with interpretation of
small biopsy specimen need to be made available. The development of
screening programs will need to be accompanied by a parallel process of
quality assurance including medical technologists, picture archiving and
communications (PACS) specialists, radiologists, external evaluators and
medical physicists. Further developments in computer aided diagnosis (CAD)
technology should reduce radiologist's interpretive errors. Screening can
be useful for those who are in the defined target group, but carry a risk
of causing net harm if performed on low risk individuals. More accurate
lung cancer risk prediction tools to identify individuals at risk of lung
cancer beyond age and smoking history alone have been developed using data
from the Prostate Lung Colon and Ovarian Cancer Screening Trial (Tammemagi
M. et al. J Natl Cancer Inst. Under review). The PLCO lung cancer
prediction tool was applied to recruit high risk current and former
smokers between 50 to 74 years of age in the Pan-Canadian Early Detection
of Lung Cancer Study. Preliminary results suggest this prediction tool
performs well allowing identification of subjects harboring a 3-year lung
cancer risk of >= 2%. The incremental value of biomarkers such as lung
function to the prediction tool has also been evaluated. Data from the
British Columbia Lung Health Study and the Pan-Canadian Early Detection of
Lung Cancer Study suggest lung function (FEV1) adds significantly to lung
cancer risk prediction and that there is a gender difference in lung
cancer risk and decline in lung function (Tammemagi M, Lam S, McWilliams
A, et al. Incremental value of pulmonary function and sputum DNA image
cytometry in lung cancer risk prediction. Cancer Prediction Research
2011;4(4);1-11.). Further research is required in a number of areas in
lung cancer screening including: features that best define the screened
population, discrimination of benign versus malignant lung nodules, most
efficient follow-up diagnostic and treatment pathways and the optimal
frequency and duration of screening. Evidence based guidelines for
treatment of small lung cancers using sub-anatomic resection or
stereotactic body radiation versus conventional anatomic resection need to
be established. Widespread lung cancer screening programs might be best
introduced in stages to ensure that adequate infrastructures are available
and that quality assurance and program performance can be evaluated at
least at a local level, before national implementation of a program is
instituted. This will allow efficient troubleshooting of problems before
they become widely implemented. The data collected can then be used to
model the effect of potential strategies, to facilitate the development of
guidelines for the most effective program. A well designed screening
program can also provide the opportunity for research such as on tobacco
addiction and smoking cessation modifiers as well as lung cancer risk
reduction through the use of chemoprevention drug therapy or
immunotherapy.

<17>
Accession Number
71235000
Authors
Midthun D.
Institution
(Midthun) Pulmonary and Critical Care Medicine, Mayo Clinic, United States
Title
Guidelines for CT-detected nodules.
Source
Journal of Thoracic Oncology. Conference: 14th World Conference on Lung
Cancer Amsterdam Netherlands. Conference Start: 20110703 Conference End:
20110707. Conference Publication: (var.pagings). 6 (6 SUPPL. 2) (pp
S101-S102), 2011. Date of Publication: June 2011.
Publisher
International Association for the Study of Lung Cancer
Abstract
The finding of a solitary pulmonary nodule (SPN) or multiple nodules on CT
presents a decision point for the patient and physician. The vast majority
of such nodules are benign; however the detection of a nodule may be the
first and only point in time of a chance of cure in the patient with lung
cancer. In the absence of a completely sensitive and specific non-invasive
test for malignancy, the physician and patient must weigh the options for
management. Guidelines for nodule evaluation by the American college of
Chest physicians (ACCP) and the Fleischner Society can help guide the
decision making. The single arm, observational studies have shown that CT
screening leads to a high rate of detection of small parenchymal nodules.
The rate of nodule detection is, in part, a function of the CT slice
thickness (collimation) used. Screening with 10 mm collimation results in
detection of one or more nodules in approximately 20-25% of participants,
5 mm collimation increases this to 40-50% of participants, and 1.25 mm
collimation raises detection to as high as 60%. A review of the data from
8 CT studies in high risk patients (current or former smokers, age 50 or
above) reported that likelihood of malignancy was 0 to 1% for nodules < 5
mm, 6 to 28% for nodules 5 to 10 mm, 33 to 60% for nodules > 11-20 mm, and
64 to 82% for nodules > 20-30 mm. The finding of a nodule on CT should
first prompt review of any available old images that might include the
nodule for comparison. Review of old images may show that the nodule is
growing or establish that it has been stable for 2 or more years. The
finding of nodule stability in size over a two-year period has been
established as an excellent indicator of benignancy. If old images are not
available, nodules < 8 mm may be observed with follow-up CT at an interval
determined by the nodule size. Evidence for nodule growth is a hallmark of
malignancy and should lead to a staging PET-CT scan (in those who are
candidates for surgery) and consideration of prompt resection.
Calcification in a benign pattern is an excellent indicator that a nodule
is a granuloma and needs no further pursuit. Eccentric calcification
should maintain concern for malignancy. Ground-glass opacities (GGO) are
nodules of low density (attenuation) that are generally only visible by CT
scan. They deserve special mention as they may represent low-grade
adenocarcinomas (bronchioloalveolar cell carcinoma) which behave
differently than most malignancies presenting as solid nodules. Malignant
GGOs typically exhibit slow growth with doubling times on average over 400
days and, for this reason, the 2-year stability rule for solid nodules
doesn't apply and a longer period of follow-up is needed. PET scanning is
not helpful to distinguish malignancy due to the low density of the
lesions, and needle biopsy is often nondiagnostic. GGOs may show growth or
stay the same size yet change to becoming solid or part solid in the
process of progression. PET scanning uses the injection of the glucose
analog 18F-2-fluorodeoxyglucose (FDG) and identifies nodules with high
metabolic activity. Nodule enhancement is an indication that a nodule is
more likely malignant than benign, and absence of enhancement is a strong
predictor that a nodule is benign. In a multicenter prospective study
reported that FDG-PET had an overall sensitivity of 92% and a specificity
of 90% for detecting malignant nodules, yet the sensitivity fell to only
80% when nodules of 15 mm or smaller were analyzed. A metaanalysis of
pulmonary nodules showed that PET had a sensitivity of 94% and a
specificity of 86%. The lower limit of nodule size for PET applicability
using current techniques is about 8-10 mm. A growing nodule that is shows
no enhancement on PET should still be considered suspicious for malignancy
and prompt needle biopsy or resection. If multiple nodules are present,
then follow-up is dictated by the largest nodule. Observation may be
appropriate for patients with nodules that are larger than 8-10 mm and
have a low likelihood of malignancy. Whether or not an indeterminate
nodule > 8-10 should be biopsied is the subject of considerable debate and
practices vary. The two biopsy techniques for assessment of SPNs are
bronchoscopy and transthoracic needle aspiration (TTNA). A number of
series have shown that bronchoscopy with fluoroscopy has a yield is a
function of nodule size and may be as less than 20% in the setting of
malignant nodules less than 2 centimeters and in the range of 40-60% when
the nodule is 3 cm. Yield rises with increasing nodule size, however,
preoperative diagnosis is generally not needed for lesions greater than 3
centimeters due to the high likelihood of malignancy in nodules of this
size. Bronchoscopic yield increases if the CT shows that a bronchus is
present within the nodule. Studies using CT, endobronchial ultrasound, or
electromagnetic guidance have shown marked improvements in diagnostic
yield over standard fluoroscopic guidance. Studies using one or more of
these techniques in combination have shown yields of 60 to 80% of
peripheral nodules of a mean diameter of 2- to 25 mm. A meta-analysis of
47 studies evaluating small peripheral nodules with TTNA reported yields
of approximately over 90% for nodules < 2 cm and 95% for nodules > 2 cm
(figure 7). Likelihood of obtaining a specific diagnosis in the setting of
a benign lesion is greater than with bronchoscopy but is still
problematic. Pneumothorax is the most frequent complication of TTNA.
Resection is the ultimate management for many lesions that remain
indeterminate after imaging evaluation especially in a high risk
individual. Unfortunately there are currently too many benign nodules
removed surgically. Recent series of video assisted thoracic surgery
(VATS) have reported benign nodules representing 50-86% of nodules
resected. Reduction in benign nodule resections may be achieved by
observing smaller nodules, by utilizing PET-CT, and by performing biopsy
by TTNA or bronchoscopy when information is discordant.

<18>
Accession Number
71231985
Authors
Macedo R. Faria Neto J. Ortiz Costantini C. Olandoski M. Carvalho K.
Macedo A. Muller A. Roberto Costantini C. Amaral V. Guarita Souza L.
Institution
(Macedo, Faria Neto, Olandoski, Amaral, Guarita Souza) Post Graduation in
the Health Sciences, Pontifical Catholic University of Parana, Curitiba,
Brazil
(Ortiz Costantini, Roberto Costantini) Hemodynamics, Costantini Cardiac
Hospital, Curitiba, Brazil
(Carvalho) Post Graduation Department, Little Prince Institute, Curitiba,
Brazil
(Macedo) Rehabilitation, Costantini Cardiac Hospital, Curitiba, Brazil
(Macedo, Muller) Physical Therapy, Costantini Cardiac Hospital, Curitiba,
Brazil
Title
A periodized model for exercise improves the intra-hospital evolution of
patients after myocardial revascularization: A pilot randomized controlled
trial.
Source
Cardiology (Switzerland). Conference: 10th International Congress on
Coronary Artery Disease, ICCAD 2013 Florence Italy. Conference Start:
20131013 Conference End: 20131016. Conference Publication: (var.pagings).
126 (pp 430), 2013. Date of Publication: October 2013.
Publisher
S. Karger AG
Abstract
Objective: To compare models of the postoperative hospital treatment phase
after myocardial revascularization. Design: A pilot randomized controlled
trial. Setting: Hospital patients in a hospital setting. Subjects:
Thirty-two patients with indications for myocardial revascularization were
included between January 2008 and December 2009, with a left ventricular
ejection fraction (LVEF) >=50%, 1-second forced expiratory volume (FEV1)
>=60 and forced vital capacity (FVC) >= 60% of predicted value.
Interventions: Patients were randomly placed into two groups: one
performed prescribed exercises according to the model proposed by the
American College of Sports Medicine (ACSM) and the other according to a
periodized model. Main measures: Partial pressure of O2 (Po2) and arterial
O2 saturation (Sao2), percentage of predicted FVC and total distance on
the six-minute walking test (6MWT). Results: Twenty-seven patients were
re-evaluated upon release from the hospital . In the preoperative period
the variables Po2, Sao2, % FVC and 6MWT were similar. In the postoperative
period, a reduction was observed for all parameters in both groups. Upon
comparison of the groups, a difference was observed in Po2 (ACSM = 68.0
+/- 4.3 vs. PP = 75.9 +/- 4.8 mmHg; P < 0.001), Sao2 (ACSM = 93.5 +/- 1.4
vs. PP = 94.8 +/- 1.2%; P = 0.018) and 6MWT (ACSM = 339.3 +/- 41.7 vs. PP
= 393.8 +/- 25.7 m; P < 0.001). There was no difference in % FVC.
Conclusion:Patients after myocardial revascularization following a
periodized model of exercise presented a better intra-hospital evolution
when compared to those using the ACSM model.

<19>
Accession Number
71231976
Authors
Alves D. Bolzan D.W. Cancio A. Moreira R.S.L. Faresin S. Carvalho A.C.C.
Gomes W.J. Guizilini S.
Institution
(Alves, Bolzan, Cancio, Moreira, Faresin, Carvalho, Gomes, Guizilini)
Cardiology, Federal University of Sao Paulo, Sao Paulo, Brazil
Title
Subxyphoid pleural drain as a determinant of functional capacity after
off-pump coronary artery bypass graft: A randomized controlled trial.
Source
Cardiology (Switzerland). Conference: 10th International Congress on
Coronary Artery Disease, ICCAD 2013 Florence Italy. Conference Start:
20131013 Conference End: 20131016. Conference Publication: (var.pagings).
126 (pp 422), 2013. Date of Publication: October 2013.
Publisher
S. Karger AG
Abstract
Background: Previous reports showed that changing the pleural drain
insertion site to the subxyphoid region promoted better preservation of
lung volumes and capacities after CABG with the LITA graft. The aim of
this trial was to compare functional capacity, pulmonary shunt fraction,
and clinical outcomes between patients undergoing pleurotomy with pleural
drain inserted in the subxyphoid position and patients with a pleural
drain placed in the intercostal position after off-pump CABG (OPCAB).
Methods: Sixty-eight patients were randomized into two groups according to
the pleural drain site: Group IC (n=33 interscostal pleural drain); Group
SS (n=35 subxyphoid pleural drain). Functional capacity was assessed by
the distance walked in the six-minute walking test (6MWT) which was
performed preoperatively and on 5th postoperative day (POD), pulmonary
function was assessed preoperatively and on POD1 and POD5, pulmonary shunt
fraction was assessed preoperatively and on POD1, clinical outcomes were
recorded throughout the study. Results: Functional capacity was
significantly reduced in both groups after surgery, group SS showed better
preservation of functional capacity (343,6+/-35,81 vs. 389,5+/-45,84;
p=0.0001). Pulmonary shunt fraction was significantly higher in both
groups postoperatively, however group SS showed a smaller pulmonary shunt
fraction (0.26 +/- 0.04 vs. 0.21 +/- 0.04; p=0.0014). Group SS had better
postoperative clinical results, with lower incidence of atelectasis and
pleural effusion (p=0.03; p=0.02), lower pain scores (p<0.0001) and
shorter intubation and hospitalization lengths (p=0.0003; p<0.0001).
Conclusion: Subxyphoid pleural drain position determined better functional
capacity and exercise tolerance with improved clinical outcomes when
compared with intercostal pleural drainage.

<20>
Accession Number
71229126
Authors
Gullu A.U. Senay S. Toraman F. Karabulut H. Kocyigit M. Okten E.M. Ariturk
C. Degirmencioglu A. Celik S.E. Dagdelen S. Alhan C.
Institution
(Gullu, Senay, Toraman, Karabulut, Degirmencioglu, Celik, Dagdelen, Alhan)
Acibadem University, School of Medicine, Istanbul, Turkey
(Kocyigit) Acibadem Maslak Hospital, Istanbul, Turkey
(Okten, Ariturk) Acibadem Kadikoy Hospital, Istanbul, Turkey
Title
Preoperative prophylactic use of levosimendan in patients with severely
depressed left ventricle.
Source
Journal of the American College of Cardiology. Conference: 29th Turkish
Cardiology Congress of the Turkish Society of Cardiology, TSC 2013 Antalya
Turkey. Conference Start: 20131026 Conference End: 20131029. Conference
Publication: (var.pagings). 62 (18 SUPPL. 2) (pp C100), 2013. Date of
Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: The beneficial effects of the calcium sensitizer levosimendan
have previously been demonstrated in patients undergoing coronary surgery
(CABG) with left ventricular dysfunction however there are still questions
regarding optimal dosing and timing of therapy. The goal of this study was
to investigate the clinical outcomes of preoperative initiation of
levosimendan in patients with left ventricular ejection fraction (LVEF)
30% or less during cardiac surgery. Methods: Eighty one patients with an
EF less than or equal 30% underwent CABGother cardiac procedures in our
center between 2005 and 2013. Myocardial viability was documented
pre-operatively with thallium scintigraphy and/or PET scan. All patients
received a 24 hour continuous levosimendan infusion of 0.1 mcg/kg/min
starting 4 hours before the surgical procedure in the ICU. No loading dose
was given. The infusion was prepared using 500 cc Dextrose and 12, 5 mg
levosimendan and was administered through a central venous catheter.
Results: Forty six patients underwent concomitant surgery (56.8%). The
30-day mortality rate was 0%. In 5 patients (6.2%) IABP was used and in
one patient (1.2%) ventricular assist device was inserted following
surgery. The intubation time was 9.7+/-8.1 hours, intensive care unit stay
50.7+/-82.7 hours, total chest tube output 772+/-463 cc, red blood cell
transfusion 1.7+/-4.4 units, postoperative atrial fibrillation 21.0%,
renal failure requiring dialysis 0%, and hospital stay was 10.4+/-9.0
days. Discussion: Preoperative, prophylactic levosimendan use is safe and
seems to improve the outcomes of cardiac surgery in patients with severely
depressed left ventricle function. Further randomized controlled studies
are needed to show the benefit and cost effectivity of this drug.

<21>
Accession Number
71228894
Authors
Rajpurohit N. Farritor C. Khan M. Stys T.P. Petrasko M. Stys A.
Institution
(Rajpurohit, Farritor, Stys, Petrasko, Stys) University of South Dakota,
Sanford Heart Hospital, Sioux Falls, SD, United States
(Khan) University of South Dakota, Sanford Heart hospital, Sioux Falls,
SD, United States
Title
Early versus delayed percutaneous coronary intervention for high risk
patients with non ST elevation-acute coronary syndrome: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B255), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: Studies indicate no clear benefit of early percutaneous
coronary intervention (PCI) (<24 hours) in non ST elevation acute coronary
syndrome (NSTEACS) patients as compared to delayed PCI (>24 hours).
However, high risk NSTEACS patients may benefit from early PCI. We pooled
existing data and performed a meta-analysis. Methods: Medline, PubMed and
abstracts from major cardiology conferences were searched. Randomized
control trials (RCTs) comparing the composite of death and/or myocardial
infarctions (MI) and/or repeat revascularization within 6 months of early
or delayed PCI for high risk patients with NSTE-ACS were included. High
risk was defined as TIMI score >5 or GRACE score >140. The effects of both
methods were analyzed by calculating pooled estimates for death, MI and
repeat revascularization. Analyses were performed for the outcome by using
odds ratio (OR) by random effects model. Heterogeneity among studies was
assessed by calculating I00 measure of inconsistency. Results: Three
studies (ACUITY, ELISA-3 and TIMACS) with a total of 3090 patients met our
inclusion criteria. The incidence of the composite of death and/or MI
and/or repeat revascularization was not different between early PCI
[207/1422 (14.5%)] as compared to delayed PCI [310/1668(18.6%)], (OR 0.72,
95% CI 0.51- 1.01, P=0.06). Conclusions: Coronary artery revascularization
within 24 hours of presentation does not reduce composite of death and/or
MI and/or repeat revascularization at 6 months in high risk NSTE-ACS as
compared to intervention after 24 hours. More studies are needed on this
subgroup of NSTE-ACS patients. (Table Presented).

<22>
Accession Number
71228887
Authors
Garcia D. Benjo A.M. Nasi G. Macedo F.Y. Aziz E.
Institution
(Garcia, Nasi) University of Miami, Miami, FL, United States
(Benjo) Columbia University Division of Cardiology, St.Lukes-Roosevelt
Hospital Center, New York, NY, United States
(Macedo) Baylor College of Medicine, Houston, TX, United States
(Aziz) Columbia College of Physicians, St Luke's Hospital, New York, NY,
United States
Title
Subclavian access safety for TAVR: A two steps meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B253), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: Trans-aortic valve replacement (TAVR) has been proven a safe
alternative for surgery and medical therapy in high risk and;or inoperable
patients with aortic stenosis. Transfemoral and transapical accesses were
the initially evaluated but the subclavian has emerged as an alternative.
As the data regarding the subclavian access safety is still scarce we
aimed to compare it to the prior alternatives in a metaanalysis. Methods:
We searched PubMed, EMBASE, and Cochrane databases from 1966 through May
2013 for studies comparing subclavian (SC) vs. transfemoral (TF) and or
transapical accesses (TA). We evaluated 30 days mortality, stroke,
vascular complications, pacemaker need, and dialysis requirement rates. We
analyzed the data with RevMan 5.2 with fixed effect if P>0.1 and I2<40%,
and random effect otherwise. Results: Out of 204 articles, 5 articles
presented the studied data and were included in the analysis. The pooled
data provided a total of 3855 patients being 3201 TF, 654 TA and 630 SC.
As demonstrate in figure 1 SC had 30 days mortality comparable to TF (A),
TA (B) and their grouping (C). Similar results were found in stroke (CI
0.42- 4.43), vascular complications (CI 0.62-7.25) and pacemaker
requirement (CI 0.43- 1.36). When compared only to TF the procedure
failure and dialysis requirement were again similar (CI) and (CI).
Conclusions: The subclavian access seems to be a safe alternative in TAVR.
Larger studies are needed to validate this our findings. (Table
Presented).

<23>
Accession Number
71228879
Authors
Kang S.-H. Park K.W. Kang D.-Y. Lim W.-H. Park K.T. Han J.-K. Kang H.-J.
Koo B.-K. Oh B.-H. Park Y.-B. Kandzari D. Cohen D. Hwang S.-S. Kim H.-S.
Institution
(Kang, Park, Kang, Oh, Park) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
(Kang, Lim, Park) Seoul National University Hospital, Seoul, South Korea
(Han) Cardiovascular Center, Seoul National University Hospital, Seoul,
South Korea
(Koo) Seoul National University, Seoul, South Korea
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, United
States
(Hwang) Inha University School of Medicine, Incheon, South Korea
(Kim) Seoul National University, College of Medicine, Seoul, South Korea
Title
Biodegradable-polymer drug-eluting stents versus bare metal stents versus
durable-polymer drug-eluting stents : A systematic review and bayesian
approach network meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B251), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: To compare the safety and efficacy of biodegradable-polymer
(BP) drug-eluting stents (DES), bare metal stents (BMS), and
durable-polymer DES in patients undergoing coronary revascularization, we
performed a systematic review of randomized controlled trials, and a
multiple-treatments network meta-analysis using a Bayesian framework.
Methods: PubMed, Embase, Cochrane Controlled Trials Register databases,
and relevant websites from the inception of each database to March 2013.
Study stents included BMS, paclitaxel-eluting (PES), sirolimus-eluting
(SES), Endeavor zotarolimus- eluting (ZES-E), cobalt-chromium
everolimus-eluting (CoCr-EES), platiniumchromium everolimus-eluting
(PtCr-EES), Resolute zotarolimus-eluting stents (ZES-R), and BP
biolimus-eluting stents (BP-BES). Among 1,649 potentially relevant
studies, 112 trials comprising 90,084 patients were finally selected. The
principal safety endpoints were definite or probable stent thrombosis (ST)
and definite ST defined according to the Academic Research Consortium
within 1 year. Results: BP-BES (OR, 0 .56; 95% credible interval [CrI],
0.33-0.90), SES (OR, 0 .53; 95% CrI, 0 .38-0.73), CoCr-EES (OR, 0 .34; 95%
CrI, 0 .23-0.52), and PtCr-EES (OR, 0.31; 95% CrI, 0 .10-0.90) were
superior to BMS in terms of definite or probable ST within 1 year.
CoCr-EES demonstrated the lowest risk of ST of all stents and tended to
reduce the risk of ST, at all times after stent implantation. CoCr-EES was
associated with lower risk of definite ST within 1 year than BP-BES (OR, 0
.41; 95% CrI, 0 .21- 0.76). SES was superior within 1 year but inferior
after 1 year to BMS (OR, 1 .82; 95% CrI, 1 .05-3.13) regarding the risk of
definite or probable ST. All DES reduced the need for repeat
revascularization, and all but PES reduced the risk of myocardial
infarction compared to BMS. For any comparison between study stents
regarding allcause death and cardiac death, there were no statistical
differences. Conclusions: Our study suggests that the optimal combination
of stent alloy, geometry, strut thickness, polymer, and drug plays a more
important role than the biodegradability of the polymer itself in
determining the safety of DES.

<24>
Accession Number
71228878
Authors
Sabbagh A.E. Patel V.G. Jeroudi O.M. Michael T.T. Alomar M.E. Mogabgab O.
Fuh E. Roesle M. Rangan B. Abdullah S. Hastings J.L. Grodin J. Kumbhani
D.J. Alexopoulos D. Fasseas P. Banerjee S. Brilakis E.
Institution
(Sabbagh, Patel, Jeroudi, Michael, Alomar, Mogabgab, Fuh, Abdullah,
Hastings, Grodin, Kumbhani, Banerjee, Brilakis) University of Texas
Southwestern Medical Center, VA North Texas Healthcare System, Dallas, TX,
United States
(Roesle, Rangan) VA North Texas Healthcare System, Dallas, TX, United
States
(Alexopoulos) Patras University Hospital, Patras, Greece
(Fasseas) Medical College of Wisconsin, Milwaukee, WI, United States
Title
Angiographic success and procedural complications in patients undergoing
retrograde percutaneous coronary chronic total occlusion interventions: A
weighted meta-analysis of 3,482 patients from 26 studies.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B250-B251), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: The efficacy and safety profile of retrograde chronic total
occlusion (CTO) percutaneous coronary intervention (PCI) has received
limited study. We sought to perform a weighted meta-analysis of the
complication risk during retrograde CTO PCI. Methods: We conducted a
meta-analysis of 26 studies published between 2006 and April 2013
reporting in-hospital outcomes of retrograde CTO PCI. Data on procedural
success, frequency of death, emergent coronary artery bypass graft surgery
(CABG), stroke, myocardial infarction (MI), perforation, tamponade, stent
thrombosis, major vascular or bleeding events, contrast nephropathy, and
radiation skin injury were collected. Results: A total of 26 studies with
3,482 patients and 3,493 target CTO lesions were included. Primary
retrograde CTO PCI was attempted in 52.4% and 42% of the patients had a
prior failed antegrade attempt. The CTO target vessel was the right
coronary artery (62%), left anterior descending artery (25%), circumflex
(11.4%), or other vessel (1.6%). Pooled estimates of outcomes are shown in
the Table. Conclusions: Retrograde CTO PCI is associated with high
procedural success rate and acceptable risk for procedural complications.
(Table Presented).

<25>
Accession Number
71228810
Authors
Alam M. Bandeali S. Basra S. Virani S.S. Jneid H. Paniagua D. Kar B.
Bakaeen F.G. Coselli J.S. Rosengart T.K. Kleiman N. Ballantyne C.M. Lakkis
N.M.
Institution
(Alam, Bandeali, Basra, Bakaeen, Coselli, Rosengart, Ballantyne, Lakkis)
Baylor College of Medicine, Houston, TX, United States
(Virani, Jneid) Michael E DeBakey VAMC and Baylor College of Medicine,
Houston, TX, United States
(Paniagua) Michael E DeBakey VAMC and Texas Heart Institute, Houston, TX,
United States
(Kar) UTHealth Medical School, Houston, TX, United States
(Kleiman) Weill-Cornell Medical College, Methodist DeBakey Heart Center,
Houston, TX, United States
Title
All-cause mortality after surgical or trans-catheter aortic valve
replacement in patients with low-flow low-gradient aortic stenosis.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B231-B232), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: Low-Flow Low-Gradient (LF-LG) or "Paradoxical Aortic Stenosis"
is a rarely encountered clinical entity with limited data on clinical
outcomes after surgical (SAVR) or trans-catheter aortic valve (TAVI)
replacement. We conducted a meta-analysis of all the studies comparing
all-cause mortality after aortic valve replacement in LF-LG AS in
comparison to medical therapy alone. Methods: A thorough PubMed
(time-unlimited till 06/01/2013) search revealed 5 studies comparing
TAVI/SAVR outcomes in LF-LG aortic stenosis (mean gradient <40mmHg; stroke
volume index <35ml/m2). Primary clinical endpoint was all-cause mortality
at 2 year follow-up. Odds ratio (OR) and confidence interval (CI) were
estimated using the random effects model. Results: A total of 607 patients
(SAVR/TAVI 263; medical therapy 344) were included in the analysis.
Baseline characteristics of these patients in valve replacement and
medical therapy arms were comparable. At 2-year follow-up, SAVR/TAVI was
associated with lower all-cause mortality (24.3% vs. 55.8%; OR 0.23; 95%
CI 0.15 - 0.36). This corresponds to an absolute risk reduction of 31.5%
and a Number Needed to Treat 3.55 to save one life. (Table Presented)
Conclusions: Patients with LF-LG aortic stenosis experience very high
2-year mortality in the absence of valve replacement. Valve replacement
with surgical or trans-catheter approach results in improved 2-year
survival and saves 1 life for every 3.6 patients treated with SAVR/TAVI.
Data on outcomes of TAVI in these complex patients continues to evolve and
mandates heart team approach in clinical decision making.

<26>
Accession Number
71228801
Authors
Osnabrugge R.L.J. Mylotte D. Head S.J. Van Mieghem N.M. Nkomo V.T. Le Reun
C. Bogers A.J. Piazza N. Kappetein A.P.
Institution
(Osnabrugge, Head, Bogers) Erasmus University Medical Center, Rotterdam,
Netherlands
(Mylotte) McGill University Health Center, Royal Victoria Hospital,
Montreal, QC, Canada
(Van Mieghem, Kappetein) Erasmus MC, Rotterdam, Netherlands
(Nkomo) Mayo Clinic, Rochester, MN, United States
(Le Reun) Biostatistician, Carrigaline, Ireland
(Piazza) McGill University Health Center, Royal Victoria Hospital,
Montreal, Canada
Title
Aortic stenosis in the elderly: Number of tavr candidates.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B228-B229), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: Severe AS is a leading cause of morbidity and mortality in
elderly.A proportion of patients is now considered for transcatheter
aortic valve replacement (TAVR).We i) performed a meta-analysis on the
prevalence of AS in the elderly and ii) systematically estimated the
number of candidates for TAVR. Methods: A systematic search was conducted
in multiple databases and prevalence rates of patients (>75 years) were
pooled.A model was based on a second systematic literature search of
studies on decision making in AS.Monte Carlo simulations were performed to
estimate the number of TAVR candidates in 19 European countries and North
America. Results: Data from 7 studies (n=9,723 subjects) were used.The
prevalence of all AS in the elderly was 12.4%(95%CI:6.6-18.2%),and the
prevalence of severe AS was 3.4% (95%CI:1.1-5.7%).Among elderly with
severe AS,75.6% (95%CI:65.8-85.4%) were symptomatic,and 40.5%
(95%CI:35.8-45.1%) of these patients were not treated surgically.Of
those,40.3% (95%CI:33.8-46.7%) received TAVR.Of the high-risk
patients,5.2% were candidates.Projections showed that there are approx.
189,836 (95%CI:80,281-347,372) TAVR candidates in the European countries
and 102,558 (95%CI:43,612-187,002)in North America. Annually, there are
17,712 (95%CI:7,590- 32,691) new candidates in the EU and 9,189
(95%CI:3,898-16,682) in North America. (Figure Presented) Conclusions:
With a pooled prevalence of 3.4%, the burden of disease among the elderly
due to severe AS is substantial.Under current indications,approx 290,000
elderly patients with severe AS are TAVR candidates.Nearly 27,000 patients
become eligible for TAVR annually.

<27>
Accession Number
71228171
Authors
Kirtane A.J. Brown D. Williams M. George I. Lei Y. Magnuson E. Reynolds
M.R. Arnold S.V. Leon M. Smith C. Thourani V. Svensson L. Tuzcu E.M. Szeto
W.Y. Dewey T. Cohen D.
Institution
(Kirtane) Columbia University/Cardiovascular Research Foundation, New
York, NY, United States
(Brown) N/A, Plano, TX, United States
(Williams, Smith) Columbia University, New York, United States
(George) Cardiothoracic Surgery, New York, NY, United States
(Lei) Saint Luke's MidAmerica Heart Institute, Kansas City, MO, United
States
(Magnuson) Saint Luke's MidAmerica Heart Institute, Saint Louis, MO,
United States
(Reynolds) Harvard Clinical Research Institute, Boston, MA, United States
(Arnold) Saint Lukes Mid America Heart Institute, Kansas City, KS, United
States
(Leon) Cardiovascular Research Foundation, New York, NY, United States
(Thourani) Emory University, Atlanta, GA, United States
(Svensson) Cleveland Clinic, Cleveland, United States
(Tuzcu) Cleveland Clinic Foundation, Cleveland, OH, United States
(Szeto) University of Pennsylvania Medical Center, Philadelphia, PA,
United States
(Dewey) Medical City Dallas Hospital, Dallas, TX, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, United
States
Title
Quality of life outcomes among high-risk patients undergoing tavr via the
transapical approach: A partner continued access substudy.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B38), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: In the randomized PARTNER trial of transcatheter aortic valve
replacement (TAVR) for high-risk aortic stenosis, TAVR via the transapical
(TA) approach was associated with worse health-related quality of life
(HRQOL) in the short-term compared with surgical aortic valve replacement
(SAVR). Since PARTNER A represented the first TA-TAVR procedures for many
study sites, it is possible that results have improved with greater
experience. We therefore examined HRQOL after TA-TAVR in the
non-randomized continued access registry (NRCA) of the Edwards-Sapien
valve and compared these outcomes with patients from the randomized
controlled trial (RCT). Methods: Patients undergoing TA-TAVR in the NRCA
of the Edwards Sapien valve underwent standardized health status
assessments using the Kansas City Cardiomyopathy Questionnaire (KCCQ), the
Short Form-12 (SF-12), and the Euro- Qol-5D (EQ-5D) at baseline, 1 month
(m), 6 m, and 12 m after TAVR. Post-procedure health status outcomes were
compared with those of the TA cohort of the PARTNER RCT who were treated
with either TA-TAVR or SAVR. Results: Among NRCA TA-TAVR patients with
evaluable data, the overall KCCQ summary score increased by 12.6 points at
1 m (n=704), 25.8 at 6 m (n=608), and 25.1 at 12 m (n=504) (p<0.001 for
all compared with baseline). Compared with RCT-TA patients, there were no
significant differences in HRQOL at 12 m, but there were trends toward
greater improvements at 1 and 6 m. Compared with RCT-SAVR patients, there
were no significant differences in health status outcomes at any follow-up
timepoints (mean difference in KCCQ Overall Summary Score adjusted for
baseline: -1.8 at 1 m, -3.8 at 6 m, 1.8 at 12 m; all p=NS). Similar
results were seen for the SF-12 physical (0.9 at 1 m; -1.1 at 6 m; 0.2 at
12 m; all P=NS) and mental (-1.4 at 1 m; -0.3 at 6 m; -0.9 at 12 m; all
P=NS) component summary scores. Conclusions: Improvements in both disease
specific and generic health status among patients in the NRCA cohort
undergoing minimally invasive TA-TAVR with the Sapien valve were similar
to (but not better than) those of SAVR as performed within the randomized
PARTNER trial.

<28>
Accession Number
71228139
Authors
Qasim A. Mauri L. Apruzzese P. Crosson L. Ellis J. Fail P.S. Wang A. Gray
W.A. Feldman T. Foster E.
Institution
(Qasim, Foster) University of California, San Francisco, CA, United States
(Mauri) Harvard Medical School, Boston, MA, United States
(Apruzzese) Harvard Clinical Research Institute, Boston, MA, United States
(Crosson) Abbott, Menlo Park, CA, United States
(Ellis) Abbott Vascular, Menlo Park, CA, United States
(Fail) Cardiovascular Institute of the South, Houma, LA, United States
(Wang) Duke University Medical Center, Durham, NC, United States
(Gray) Columbia University Medical Center, New York, United States
(Feldman) Evanston Hospital, Evanston, United States
Title
Ventricular and atrial remodeling after the percutaneous mitraclip: 4 year
follow-up data from the everest II randomized controlled trial.
Source
Journal of the American College of Cardiology. Conference: 25th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2013 San
Francisco, CA United States. Conference Start: 20131027 Conference End:
20131101. Conference Publication: (var.pagings). 62 (18 SUPPL. 1) (pp
B27-B28), 2013. Date of Publication: 29 Oct 2013.
Publisher
Elsevier USA
Abstract
Background: Reverse remodeling of the left ventricle (LV) and left atrium
(LA) is a desirable outcome after mitral valve repair (MVR) for
significant mitral regurgitation (MR). Using data from the EVEREST II
randomized trial, we compared the extent of left-sided chamber reverse
remodeling between the percutaneous and surgical mitral repair cohorts.
Methods: The EVEREST II trial is a prospective, multicenter, randomized,
nonblinded evaluation of the percutaneous MitraClip system compared in 2:1
fashion to surgical MVR in the setting of moderate to severe MR. Four year
follow up echocardiographic data was available for 85 individuals with
percutaneous repair (PR) and 42 with surgical repair (SR). Successful
repair was defined as <=2+ residual MR. Results: Baseline characteristics
and LV and LA dimensions were similar in PR and SR groups except for a
greater proportion of history of heart failure in the PR group. At 4
years, 73% (62/85) of the PR group and 93% (39/42) of the SR group had <=
2+ MR. LV systolic and diastolic dimensions were significantly reduced in
both groups at 4 years, although the SR group had significantly more
reverse remodeling (Table 1, p = <0.001). Reduction in LV volumes was seen
in both functional and degenerative MR subtypes. LA volumes decreased an
average of 29 ml (p =0.009) after successful SR, but LA volumes were only
reduced significantly in the PR group when residual MR severity was <= 1+
(reduction of 14 ml, p=0.0016). (Table 1). Conclusions: Favorable LV
remodeling occurred after successful PR, however improvements were less
robust compared to SR at 4 years. LA volumes improved significantly after
successful SR, but only after PR when residual MR was <=1+. Further study
should inform whether the degree of reverse remodeling impacts longterm
clinical outcomes and MitraClip durability. (Table Presented).