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<1>
Accession Number
2013815486
Authors
Ma X. Ma C. Yun Y. Zhang Q. Zheng X.
Institution
(Ma, Ma, Yun) Shandong University School of Medicine, Jinan, Shandong,
China
(Zhang, Zheng) Provincial Hospital, Shandong University, No. 324 Jingwu
Road, Jinan, Shandong 250021, China
Title
Safety and efficacy outcomes of preoperative aspirin in patients
undergoing coronary artery bypass grafting: A systematic review and
meta-analysis.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 19 (1) (pp
97-113), 2014. Date of Publication: January 2014.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: The administration of aspirin is traditionally discontinued
prior to coronary artery bypass grafting (CABG), given a potential risk of
excessive postoperative bleeding. Few studies have previously suggested
the benefits of continuing aspirin until the time of surgery. The primary
aim of this review is to evaluate the effects of preoperative aspirin
therapy on several clinically important outcomes in patients undergoing
CABG. Methods: A meta-analysis of eligible studies of patients undergoing
CABG, reporting preoperative aspirin in comparison with no aspirin/placebo
and our outcomes, was carried out. The safety outcomes included
postoperative bleeding, packed red blood cell (PRBC) transfusion
requirements, and reoperation for bleeding. The efficacy outcomes included
perioperative myocardial infarction (MI), cerebrovascular accidents
(CVAs), and mortality. Results: In 8 randomized controlled trials (RCTs; n
= 1538), preoperative aspirin increased postoperative bleeding (difference
in means = 132.30 mL; 95 % confidence interval [CI] 47.10-217.51; P =
.002), PRBC transfusion requirements (difference in means = 0.67 units;
95% CI 0.10-1.24; P = .02), and reoperation for bleeding (odds ratio [OR]
= 1.76; 95% CI 1.05-2.93; P = .03). In 19 observational studies (n =
19551), preoperative aspirin increased postoperative bleeding (difference
in means = 132.74 mL; 95% CI 45.77-219.72; P = .003) and PRBC transfusion
requirements (difference in means = 0.19 units; 95% CI 0.02-0.35; P = .02)
but not reoperation for bleeding (OR = 1.13; 95% CI 0.91-1.42; P = .27).
Subgroup analyses for RCTs demonstrated that aspirin given at doses <= 100
mg/d might not increase the postoperative bleeding, and the dose of 325
mg/d might not be a cutoff value that has clinical and statistical
significance. No statistically significant differences in the rate of
perioperative MI, CVAs, or mortality were seen between the 2 groups.
Conclusions: Preoperative aspirin therapy is associated with increased
postoperative bleeding, PRBC transfusion requirements, and reoperation for
bleeding in patients undergoing CABG. Doses lower than 100 mg/d may
minimize the risk of bleeding. Additional RCTs are needed to assess the
effects of preoperative aspirin on the safety and efficacy outcomes in
patients undergoing CABG.

<2>
Accession Number
2013807117
Authors
Athappan G. Patvardhan E. Tuzcu M.E. Ellis S. Whitlow P. Kapadia S.R.
Institution
(Athappan) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Case Western Reserve University, Cleveland, OH, United States
(Patvardhan) Department of Cardiovascular Medicine, Tufts University
School of Medicine, Boston, MA, United States
(Tuzcu, Ellis, Whitlow, Kapadia) Department of Cardiovascular Medicine,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
Title
Left main coronary artery stenosis: A meta-analysis of drug-eluting stents
versus coronary artery bypass grafting.
Source
JACC: Cardiovascular Interventions. 6 (12) (pp 1219-1230), 2013. Date of
Publication: December 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The goal of this study was to provide a systematic review
comparing the long-term outcomes of percutaneous coronary intervention
(PCI) with drug-eluting stents (DES) versus coronary artery bypass graft
surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.
Background One-year outcomes from randomized controlled trials,
observational studies, and pooled analyses have demonstrated the safety
and efficacy of PCI of the UPLM when compared with CABG. However, there
remain concerns over the sustainability of PCI with DES at longer
follow-up. Methods Studies published between January 2000 and December
2012 of PCI versus CABG for UPLM stenosis were identified using an
electronic search and reviewed using meta-analytical techniques. Results
Twenty-four studies comprising 14,203 patients were included in the
analysis. There was no significant difference for all-cause mortality
between PCI or CABG at 1 year (odds ratio [OR]: 0.792, 95% confidence
interval [CI]: 0.53 to 1.19), 2 years (OR: 0.920, 95% CI: 0.67 to 1.26), 3
years (OR: 0.94, 95% CI: 0.60 to 1.48), 4 years (OR: 0.84, 95% CI: 0.53 to
1.33), and 5 years (OR: 0.79, 95% CI: 0.57 to 1.08). The need for target
vessel revascularization (TVR) was significantly higher in patients
undergoing PCI at all time points. The occurrence of stroke, however, was
significantly less frequent in patients treated with PCI. The occurrence
of nonfatal myocardial infarction showed a statistically significant trend
towards a lower incidence in CABG patients at 1 year (OR: 1.62, 95% CI:
1.05 to 2.50), 2 years (OR: 1.60, 95% CI: 1.09 to 2.35), and 3 years (OR:
2.06, 95% CI: 1.36 to 3.1). There was no significant difference in
combined major adverse cardiovascular and cerebrovascular events between
the 2 groups. Conclusions Our findings suggest that PCI with DES is a safe
and durable alternative to CABG for the revascularization of UPLM stenosis
in select patients at long-term follow-up. 2013 BY THE AMERICAN COLLEGE
OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.

<3>
Accession Number
2013807114
Authors
Gada H. Kirtane A.J. Newman W. Sanz M. Hermiller J.B. Mahaffey K.W. Cutlip
D.E. Sudhir K. Hou L. Koo K. Stone G.W.
Institution
(Gada, Kirtane, Stone) Columbia University Medical Center, New
York-Presbyterian Hospital, Cardiovascular Research Foundation, 111 East
59th Street, New York, NY 10022, United States
(Newman) Wake Medical Center, Raleigh, NC, United States
(Sanz) St. Patrick Hospital, Missoula, MT, United States
(Hermiller) Heart Center of Indiana, Indianapolis, IN, United States
(Mahaffey) Duke Clinical Research Institute, Durham, NC, United States
(Cutlip) Harvard Clinical Research Institute, Boston, MA, United States
(Sudhir, Hou, Koo) Abbott Vascular, Santa Clara, CA, United States
Title
5-year results of a randomized comparison of XIENCE v everolimus-eluting
and TAXUS paclitaxel-eluting stents: Final results from the SPIRIT III
trial (Clinical Evaluation of the XIENCE v Everolimus Eluting Coronary
Stent System in the Treatment of Patients with de Novo Native Coronary
Artery Lesions).
Source
JACC: Cardiovascular Interventions. 6 (12) (pp 1263-1266), 2013. Date of
Publication: December 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to evaluate the long-term safety and efficacy
of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in
patients with obstructive coronary artery disease. Background The use of
EES compared to PES has been shown to result in improved clinical outcomes
in patients undergoing PCI. However, there have been concerns regarding
the durability of these benefits over longer-term follow-up. Methods
SPIRIT III was a prospective, multicenter trial in which 1,002 patients
were randomized 2:1 to EES versus PES. Endpoints included ischemia-driven
target vessel failure (TVF) (death, myocardial infarction (MI), or
ischemia-driven target vessel revascularization [TVR]), the pre-specified
primary endpoint), target lesion failure (TLF) (cardiac death,
target-vessel MI, or ischemia-driven target lesion revascularization
[TLR]), major adverse cardiac events (MACE) (cardiac death, MI, or
ischemia-driven TLR), their individual components and stent thrombosis.
Results Five-year follow-up was available in 91.9% of patients. Treatment
with EES versus PES resulted in lower 5-year Kaplan-Meier rates of TVF
(19.3% vs. 24.5%, p = 0.05), TLF (12.7% vs. 19.0%, p = 0.008), and MACE
(13.2% vs. 20.7%, p = 0.007). EES also resulted in reduced rates of
all-cause death (5.9% vs. 10.1%, p = 0.02), with nonsignificantly
different rates of MI, stent thrombosis, and TLR, and no evidence of late
catch-up of TLR over time. Conclusions At 5 years after treatment, EES
compared to PES resulted in durable benefits in composite safety and
efficacy measures as well as all-cause mortality. Additionally, the
absolute difference in TLR between devices remained stable over time
without deterioration of effect during late follow-up. 2013 BY THE
AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.

<4>
Accession Number
2013807118
Authors
Chen S.-L. Han Y.-L. Zhang Y.-J. Ye F. Liu H.-W. Zhang J.-J. Xu B. Jiang
T.-M. Zhou Y.-J. Lv S.-Z.
Institution
(Chen, Ye, Zhang) Cardiology Department, Nanjing First Hospital, Nanjing
Medical University, Nanjing 21000, China
(Han, Liu) Cardiology Department, Shenyang Northern Hospital, Shenyang,
China
(Zhang) Cardiology Department, Nanjing Heart Center, Nanjing, China
(Xu) Cardiology Department, Beijing Fuwai Hospital, Beijing, China
(Jiang) Cardiology Department, Tianjin Armed Policemen Hospital, Tianjin,
China
(Zhou, Lv) Cardiology Department, Beijing Anzhen Hospital, Beijing, China
Title
The anatomic- and clinical-based NERS (New Risk Stratification) score II
to predict clinical outcomes after stenting unprotected left main coronary
artery disease: Results from a multicenter, prospective, registry study.
Source
JACC: Cardiovascular Interventions. 6 (12) (pp 1233-1241), 2013. Date of
Publication: December 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives The present study aimed to establish a risk score using a
simple calculation with an enhanced predictive value for major adverse
cardiac events (MACE) in patients with unprotected left main coronary
artery (UPLMCA) disease after the implantation of a drug-eluting stent
(DES). Background The anatomic-, clinical-, and procedure-based NERS (New
Risk Stratification) score was superior to the SYNTAX (Synergy Between
Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score
in predicting MACE after stenting UPLMCA. The complexity of the
calculation was its major limitation. Methods The NERS score II was
derived from our previous 2 studies and externally compared with the NERS
and SYNTAX scores in 1,463 patients with UPLMCA disease who underwent
implantation of a DES in a prospective, multicenter registry trial. The
primary endpoint was MACE at 1 year after the index procedure, including
myocardial infarction, cardiac death, and target vessel revascularization.
Results The NERS score II system consisted of 16 (7 clinical and 9
angiographic) variables. A NERS score II >=19 demonstrated enhanced MACE
sensitivity and specificity of 84.0% and 76.0% (MACE as the state
variable), respectively, which were similar to the NERS score but
significantly higher compared with the SYNTAX score. A NERS score II >=19
was the only independent predictor of cumulative MACE (hazard ratio: 3.27;
95% confidence interval [CI]: 1.86 to 5.23; p <= 0.001) and stent
thrombosis (odds ratio: 22.15; 95% CI: 12.47 to 57.92; p <= 0.001) at
follow-up. Conclusions The NERS score II, similar to the conventional NERS
score, is more predictive of MACE than the SYNTAX score in UPLMCA patients
after implantation of a DES. 2013 BY THE AMERICAN COLLEGE OF CARDIOLOGY
FOUNDATION PUBLISHED BY ELSEVIER INC.

<5>
Accession Number
2013804780
Authors
Riber L.P. Christensen T.D. Pilegaard H.K.
Institution
(Riber, Christensen, Pilegaard) Department of Cardiothoracic and Vascular
Surgery, Institute of Clinical Medicine, Aarhus University Hospital,
Aarhus, Denmark
(Riber) Department of Cardiothoracic and Vascular Surgery, Institute of
Clinical Medicine, Odense University Hospital, Odense, Denmark
Title
Amiodarone is a cost-neutral way of preventing atrial fibrillation after
surgery for lung cancer.
Source
European Journal of Cardio-thoracic Surgery. 45 (1) (pp 120-125), 2014.
Article Number: ezt169. Date of Publication: January 2014.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
Objectives: Our aim was to estimate the costs and health benefits of
routinely administered postoperative amiodarone as a prophylactic agent in
reducing the risk of atrial fibrillation in patients undergoing surgery
for lung cancer. Methods: This was a cost-effectiveness study, based on
the randomized, controlled, double-blinded PASCART study, using avoidance
of atrial fibrillation as the measure of benefit. Two hundred and
fifty-four eligible, consecutively enrolled patients, undergoing surgery
for lung cancer at the department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Denmark, were included and randomized to
receive either 300 mg of amiodarone or placebo (5% aqueous dextrose
solution), administered intravenously over 20 min immediately after
surgery, followed by 600 mg of amiodarone/placebo orally twice per day (8
a.m. and 6 p.m.) for the first five postoperative days. Results: In the
amiodarone group there were 11 cases of atrial fibrillation, compared with
38 in the control group (P < 0.001). There were no differences in the
length of hospital stay or resources used. The mean total costs per
patient were equal and amounted to 7288 per patient (P = 0.23). There were
no signs of adverse developments referable to amiodarone in this
prophylactic regime. Conclusions: For patients undergoing surgery for lung
cancer, routine use of postoperative prophylactic intravenous bolus and
five subsequent days of oral amiodarone therapy reduces the risk of atrial
fibrillation in a cost-neutral manner. The Author 2013. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<6>
Accession Number
2013804764
Authors
Kuhn E.W. Liakopoulos O.J. Stange S. Deppe A.-C. Slottosch I. Choi Y.-H.
Wahlers T.
Institution
(Kuhn, Liakopoulos, Stange, Deppe, Slottosch, Choi, Wahlers) Department of
Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne,
Germany
Title
Preoperative statin therapy in cardiac surgery: A meta-analysis of 90 000
patients.
Source
European Journal of Cardio-thoracic Surgery. 45 (1) (pp 17-26), 2014.
Article Number: ezt181. Date of Publication: January 2014.
Publisher
European Association for Cardio-Thoracis Surgery (3 Park Street, Windsor,
Berkshire SL4 1LU, United Kingdom)
Abstract
The objective of this systematic literature review with meta-analysis was
to determine the strength of evidence for a preoperative statin on the
reduction of adverse postoperative outcomes in patients undergoing cardiac
surgery. Randomized controlled (RCT) and observational trials were
searched in online databases that reported about the effects of
preoperative statin therapy on major adverse clinical outcomes after
cardiac surgery. Analysed outcomes included early all-cause mortality,
myocardial infarction, atrial fibrillation (AF), stroke and renal failure
using a priori-defined criteria. Effect estimates were calculated and are
given as odds ratio (OR) with 95% confidence intervals (95% CI) using
fixed- or random-effect models. Literature search of all major databases
retrieved 2371 studies. After screening, a total of 54 trials were
identified (12 RCT, 42 observational) that reported outcomes of 91 491
cardiac surgery patients with (n = 46 614; 51%) or without (n = 44 877;
49%) preoperative statin therapy. Preoperative statin use resulted in a
0.9% absolute risk (2.6 vs 3.5%) and a 31% odds reduction for early
all-cause mortality (OR 0.69; 95% CI 0.59-0.81; P < 0.0001). In addition,
statin treatment before surgery was associated with a substantial
reduction (P < 0.01) in the postoperative end-points AF (OR 0.71; 95% CI
0.61-0.82), new-onset AF (OR 0.68; 95% CI 0.54-0.85), stroke (OR 0.83; 95%
CI 0.74-0.93), stay on intensive care unit (weighted mean difference [WMD]
-0.14; 95% CI -0.23 to -0.03; P < 0.01) and in-hospital stay (WMD -0.57;
95% CI -0.76 to -0.38; P < 0.01). No statistical differences were found
between groups with regard to myocardial infarction or renal failure. In
conclusion, the current systematic review strengthens the evidence that
preoperative statin therapy extends substantial clinical benefit to early
postoperative outcomes in cardiac surgery patients. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<7>
Accession Number
2013798052
Authors
Le Guen M. Nicolas-Robin A. Lebard C. Arnulf I. Langeron O.
Institution
(Le Guen) Department of Anesthesiology and Critical Care, Universite
Versailles Saint-Quentin, Ho Pital Foch, 40 rueWorth, 92150 Suresnes,
France
(Nicolas-Robin, Lebard, Langeron) Department of Anesthesiology and
Critical Care, France
(Arnulf) Sleep Disorder Unit, Universite Pierre et Marie Curie, Groupe
Hospitalier Pitie-Salpe Triere, Assistance Publique-Hopitaux de Paris,
Paris, France
Title
Earplugs and eye masks vs routine care prevent sleep impairment in
post-anaesthesia care unit: A randomized study.
Source
British Journal of Anaesthesia. 112 (1) (pp 89-95), 2014. Date of
Publication: January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundPost-anaesthesia care units (PACUs) with 24/7 activity and
consequently artificial light and noise may disturb the sleep of patients
who require prolonged medical supervision. After one postoperative night,
we compared sleep quality in patients with and without noise (earplug) and
light (eye mask) protection.MethodsAfter ethical board approval, 46
patients without any neurological or respiratory failure undergoing major
non-cardiac surgery were prospectively included. They were randomized to
sleep with or without protective devices during the first postoperative
night in the PACU. Sleep quality was simultaneously measured by
sleep-quality scales (Spiegel score and Medical Outcomes Study Sleep),
nurses' assessment, and through a wrist actigraph (Actiwatch^O).
Secondary outcomes such as pain control and nocturnal activity were
recorded. Comparisons between groups were made by Student's t-test or
non-parametric test for repeated measures as appropriate (SPSS 10.0). A
P-value <0.05 was considered significant.ResultsData from 41 patients were
analysed. Protective devices during the first postoperative night
prevented a decrease in sleep quality compared with standard care, as
evaluated by the Spiegel scale: 20 (4) vs 15 (5), P=0.006. These devices
significantly decreased the need for a nap [50% 95% confidence interval
(CI) (20-80) vs 95% 95% CI (85-100), P<0.001], but had no effect on sleep
length evaluated by Actiwatch^O. The total consumption of
morphine was significantly reduced in the first 24 h [respectively, 15(12)
mg and 27(17) mg, P=0.02].ConclusionsEarplugs and eye masks applied in the
PACU during the first postoperative night significantly preserve sleep
quality. Such non-invasive and cheap devices may be generalized in the
PACU or in intensive care units. 2014 The Author.

<8>
Accession Number
2013798051
Authors
Gillies M.A. Habicher M. Jhanji S. Sander M. Mythen M. Hamilton M. Pearse
R.M.
Institution
(Gillies) Department of Critical Care, Royal Infirmary of Edinburgh,
Little France Crescent, Edinburgh EH16 4SA, United Kingdom
(Habicher, Sander) Charite-Universitatsmedizin Berlin, Campus Charite
Mitte, Chariteplatz 1, Berlin D-10117, Germany
(Jhanji) Royal Marsden Hospital, London SW3 6JJ, United Kingdom
(Mythen) University College Hospital, London NW1 2BU, United Kingdom
(Hamilton) St George's Healthcare, NHS Trust, London SW17 0QT, United
Kingdom
(Pearse) Barts and the London School of Medicine and Dentistry, Queen
Mary's University of London, London EC1M 6BQ, United Kingdom
Title
Incidence of postoperative death and acute kidney injury associated with
i.v. 6% hydroxyethyl starch use: Systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 112 (1) (pp 25-34), 2014. Date of
Publication: January 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundTrials suggest that the use of i.v. hydroxyethyl starch (HES)
solutions is associ-ated with increased risk of death and acute kidney
injury (AKI) in critically ill patients. It is uncertain whether similar
adverse effects occur in surgical patients.MethodsSystematic review and
meta-analysis of trials in which patients were randomly allocated to 6%
HES solutions or alternative i.v. fluids in patients undergoing surgery.
Ovid Medline, Embase, Cinhal, and Cochrane Database of Systematic Reviews
were searched for trials comparing 6% HES with clinically relevant
non-starch comparator. The primary end-point was hospital mortality.
Secondary endpoints were requirement for renal replacement therapy (RRT)
and author-defined AKI. Pre-defined subgroups were cardiac and non-cardiac
surgery.ResultsFour hundred and fifty-six papers were identified; of which
19 met the inclusion criteria. In total, 1567 patients were included in
the analysis. Dichotomous outcomes were expressed as a difference of
proportions [risk difference (RD)]. There was no difference in hospital
mortality [RD 0.00, 95% confidence interval (CI)-0.02, 0.02], requirement
for RRT (RD-0.01, 95% CI-0.04, 0.02), or AKI (RD 0.02, 95% CI-0.02 to
0.06) between compared arms overall or in predefined
subgroups.ConclusionsWe did not identify any differences in the incidence
of death or AKI in surgical patients receiving 6% HES. Included studies
were small with low event rates and low risk of heterogeneity. Narrow CIs
suggest that these findings are valid. Given the absence of demonstrable
benefit, we are unable to recommend the use of 6% HES solution in surgical
patients. 2014 The Author.

<9>
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Accession Number
2013815080
Authors
Barbanti M. Webb J.G. Hahn R.T. Feldman T. Boone R.H. Smith C.R. Kodali S.
Zajarias A. Thompson C.R. Green P. Babaliaros V. Makkar R.R. Szeto W.Y.
Douglas P.S. McAndrew T. Hueter I. Miller D.C. Leon M.B.
Institution
(Barbanti, Webb, Boone, Thompson) St. Paul's Hospital, 1081 Burrard St,
Vancouver, BC, Canada
(Hahn, Smith, Kodali, Green, McAndrew, Hueter, Leon) Columbia University
Medical Center, New York-Presbyterian Hospital, New York, United States
(Feldman) NorthShore University Health System, Evanston, IL, United States
(Zajarias) Washington University, St. Louis, MO, United States
(Babaliaros) Emory University Hospital, Atlanta, GA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Szeto) University of Pennsylvania, Philadelphia, United States
(Douglas) Duke University Medical Center, Durham, NC, United States
(Miller) Stanford University, Stanford, CA, United States
Title
Impact of preoperative moderate/severe mitral regurgitation on 2-year
outcome after transcatheter and surgical aortic valve replacement insight
from the placement of aortic transcatheter valve (PARTNER) trial cohort a.
Source
Circulation. 128 (25) (pp 2776-2784), 2013. Date of Publication: December
24-31, 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-The effect of preoperative mitral regurgitation (MR) on
clinical outcomes of patients undergoing transcatheter aortic valve
replacement (TAVR) is controversial. This study sought to examine the
impact of moderate and severe MR on outcomes after TAVR and surgical
aortic valve replacement (SAVR). Methods and Results-Data were drawn from
the randomized Placement of Aortic Transcatheter Valve (PARTNER) Trial
cohort A patients with severe, symptomatic aortic stenosis undergoing
either TAVR (n=331) or SAVR (n=299). Both TAVR and SAVR patients were
dichotomized according to the degree of preoperative MR (moderate/severe
versus none/mild). At baseline, moderate or severe MR was reported in 65
TAVR patients (19.6%) and 63 SAVR patients (21.2%). At 30 days, among
survivors who had isolated SAVR/TAVR, moderate/severe MR had improved in
25 SAVR patients (69.4%) and 30 TAVR patients (57.7%), was unchanged in 10
SAVR patients (27.8%) and 19 TAVR patients (36.5%), and worsened in 1 SAVR
patient (2.8%) and 4 TAVR patients (5.8%; all P=NS). Mortality at 2 years
was higher in SAVR patients with moderate or severe MR than in those with
mild or less MR (49.8% versus 28.1%; adjusted hazard ratio, 1.73; 95%
confidence interval, 1.01-2.96; P=0.04). In contrast, MR severity at
baseline did not affect mortality in TAVR patients (37.0% versus 32.7%,
moderate/severe versus none/mild; hazard ratio, 1.14; 95% confidence
interval, 0.72-1.78; P=0.58; P for interaction=0.05). Conclusions-Both
TAVR and SAVR were associated with a significant early improvement in MR
in survivors. However, moderate or severe MR at baseline was associated
with increased 2-year mortality after SAVR but not after TAVR. TAVR may be
a reasonable option in selected patients with combined aortic and mitral
valve disease. 2013 American Heart Association, Inc.

<10>
Accession Number
2013778083
Authors
Ferraz Cavalcanti P.E. Sa M.P.B.O. Santos C.A. Esmeraldo I.M. Escobar
R.R.D. Menezes A.M.D. Azevedo Jr. O.M.D. Vasconcelos Silva F.P.D. Lins
R.F.D.A. Lima R.D.C.
Institution
(Ferraz Cavalcanti, Sa, Escobar, Menezes, Azevedo Jr., Vasconcelos Silva,
Lins, Lima) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco, PROCAPE, Rua dos Palmares, S/N, Recife,
Pernambuco, Brazil
(Ferraz Cavalcanti, Sa, Santos, Esmeraldo, Escobar, Menezes, Azevedo Jr.,
Vasconcelos Silva, Lins, Lima) Department of Cardiothoracic Surgery,
University of Pernambuco, UPE, Recife, Pernambuco, Brazil
(Ferraz Cavalcanti, Sa, Lima) Nucleus of Postgraduate and Research in
Health Sciences, Faculty of Medical Sciences and Biological Sciences
Institute, FCM/ICB, Recife, Pernambuco, Brazil
Title
Pulmonary valve replacement after operative repair of Tetralogy of Fallot:
Meta-analysis and meta-regression of 3,118 patients from 48 studies.
Source
Journal of the American College of Cardiology. 62 (23) (pp 2227-2243),
2013. Date of Publication: 10 Dec 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Because the real benefit of pulmonary valve replacement (PVR) in patients
with repaired tetralogy of Fallot who develop pulmonary insufficiency
remains unclear, it is necessary to analyze the evidence published around
the world. We performed a systematic review of studies that reported data
about the effect of PVR in patients with repaired tetralogy of Fallot that
developed pulmonary insufficiency, until December 2012. The variables
chosen to represent the benefit were both right ventricular (RV) and left
ventricular measures, QRS duration, and functional class. The principal
summary measures were difference in means with 95% confidence interval and
p values (considered statistically significant when p < 0.05). The
differences in means were combined across studies with the weighted
DerSimonian-Laird random effects model. Meta-analysis, sensitivity
analysis, and meta-regression were completed with the software
Comprehensive Meta-Analysis (version 2, Biostat, Inc., Englewood, New
Jersey). Forty-eight studies involving 3,118 patients met the eligibility
criteria. The pooled 30-day mortality was 0.87% (47 studies; 27 of 3,100
patients); the pooled 5-year mortality was 2.2% (24 studies; 49 of 2,231
patients); the pooled 5-year re-PVR was 4.9% (15 studies; 88 of 1,798
patients). The results of this meta-analysis demonstrate that after PVR:
1) the RV experiences improvement of its volumes and function; 2) the left
ventricle experiences improvement of its function; 3) QRS duration
decreases; 4) symptoms improve; 5) pre-operative RV geometry modulates the
effect of PVR; and 6) there is important heterogeneity of the effects
among the studies, and few publication biases. In conclusion, PVR seems to
be a positive approach in the analyzed scenario. 2013 by the American
College of Cardiology Foundation Published by Elsevier Inc.

<11>
Accession Number
2013770634
Authors
Steg P.G. Van't Hof A. Hamm C.W. Clemmensen P. Lapostolle F. Coste P. Ten
Berg J. Van Grunsven P. Eggink G.J. Nibbe L. Zeymer U. Dell'Orto M.C. Nef
H. Steinmetz J. Soulat L. Huber K. Deliargyris E.N. Bernstein D. Schuette
D. Prats J. Clayton T. Pocock S. Hamon M. Goldstein P.
Institution
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Assistance Publique-Hopitaux de Paris, 46 rue Henri Huchard, 75018 Paris,
France
(Lapostolle) SAMU 93-Unite Fonctionnelle Recherche-Enseignement-Qualite,
Universite Paris 13, Hopital Avicenne, France
(Coste) Hopital Cardiologique-Centre Hospitalier Universitaire Bordeaux,
Universite de Bordeaux, Pessac, France
(Soulat) Services d'Aide Medicale Urgente, Service Mobile d'Urgence et de
Reanimation Urgences, Centre Hospitalier, Chateauroux, France
(Hamon) Clinical Research Department, University of Caen, Caen, France
(Goldstein) Emergency Department, SAMU, Lille University Hospital, Lille,
France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, London, United Kingdom
(Clayton, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Van't Hof) Isala Klinieken, Department of Cardiology, Netherlands
(Eggink) Regionale Ambulancevoorziening IJsselvecht, Zwolle, Netherlands
(Ten Berg) St. Antonius Hospital, Nieuwegein, Netherlands
(Van Grunsven) RAV Gelderland Zuid, Nijmegen, Netherlands
(Hamm, Dell'Orto) Kerckhoff Clinic and Thoraxcenter, Department of
Cardiology, Bad Nauheim, Germany
(Nibbe) Department of Nephrology and Medical Intensive Care, Campus
Virchow-Klinikum, Universitatsmedizin Berlin, Berlin, Germany
(Zeymer) Klinikum Ludwigshafen, Ludwigshafen, Germany
(Nef) University of Giessen, Medizinische Klinik I, Cardiology and
Angiology, Giessen, Germany
(Clemmensen) Department of Cardiology, Institute for Clinical Medicine,
University of Copenhagen, Copenhagen, Denmark
(Steinmetz) Dept. of Anesthesia (Hd. and Orthopedics Center) and Emergency
Medical Service of the Capital Region, Capital Region Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Huber) 3rd Department of Medicine, Cardiology, Wilhelminenhospital,
Vienna, Austria
(Deliargyris, Bernstein, Schuette, Prats) Medicines Company, Parsippany,
NJ, United States
Title
Bivalirudin started during emergency transport for primary PCI.
Source
New England Journal of Medicine. 369 (23) (pp 2207-2217), 2013. Date of
Publication: 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Bivalirudin, as compared with heparin and glycoprotein
IIb/IIIa inhibitors, has been shown to reduce rates of bleeding and death
in patients undergoing primary percutaneous coronary intervention (PCI).
Whether these benefits persist in contemporary practice characterized by
prehospital initiation of treatment, optional use of glycoprotein IIb/IIIa
inhibitors and novel P2Y₁₂ inhibitors, and radial-artery PCI
access use is unknown. METHODS: We randomly assigned 2218 patients with
ST-segment elevation myocardial infarction (STEMI) who were being
transported for primary PCI to receive either bivalirudin or
unfractionated or low-molecular-weight heparin with optional glycoprotein
IIb/IIIa inhibitors (control group). The primary outcome at 30 days was a
composite of death or major bleeding not associated with coronary-artery
bypass grafting (CABG), and the principal secondary outcome was a
composite of death, reinfarction, or non-CABG major bleeding. RESULTS:
Bivalirudin, as compared with the control intervention, reduced the risk
of the primary outcome (5.1% vs. 8.5%; relative risk, 0.60; 95% confidence
interval [CI], 0.43 to 0.82; P=0.001) and the principal secondary outcome
(6.6% vs. 9.2%; relative risk, 0.72; 95% CI, 0.54 to 0.96; P=0.02).
Bivalirudin also reduced the risk of major bleeding (2.6% vs. 6.0%;
relative risk, 0.43; 95% CI, 0.28 to 0.66; P<0.001). The risk of acute
stent thrombosis was higher with bivalirudin (1.1% vs. 0.2%; relative
risk, 6.11; 95% CI, 1.37 to 27.24; P=0.007). There was no significant
difference in rates of death (2.9% vs. 3.1%) or reinfarction (1.7% vs.
0.9%). Results were consistent across subgroups of patients. CONCLUSIONS:
Bivalirudin, started during transport for primary PCI, improved 30-day
clinical outcomes with a reduction in major bleeding but with an increase
in acute stent thrombosis. Copyright 2013 Massachusetts Medical Society.

<12>
Accession Number
2013808454
Authors
Duffett M. Choong K. Hartling L. Menon K. Thabane L. Cook D.J.
Institution
(Duffett, Choong) Departments of Pediatrics and Clinical Epidemiology and
Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON
L8S 4L8, Canada
(Hartling) Department of Pediatrics and Alberta Research Centre for Health
Evidence, University of Alberta, 116 Street and 85 Avenue, Edmonton, AB
T6G 2R3, Canada
(Menon) Departments of Pediatrics and Epidemiology and Community Medicine,
University of Ottawa, 75 Laurier Avenue East, Ottawa, ON K1N 6N5, Canada
(Thabane) Departments of Clinical Epidemiology and Biostatistics and
Pediatrics, Biostatistics Unit, St Joseph's Healthcare-Hamilton, McMaster
University, Hamilton1280 Main Street West, ON L8S 4L8, Canada
(Cook) Departments of Medicine and Clinical Epidemiology and
Biostatistics, 462 McMaster University, 1280 Main Street West, Hamilton,
ON L8S 4L8, Canada
Title
Randomized controlled trials in pediatric critical care: A scoping review.
Source
Critical Care. 17 (5) , 2013. Article Number: R256. Date of Publication:
29 Oct 2013.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Evidence from randomized controlled trials (RCTs) is
required to guide treatment of critically ill children, but the number of
RCTs available is limited and the publications are often difficult to
find. The objectives of this review were to systematically identify RCTs
in pediatric critical care and describe their methods and
reporting.Methods: We searched MEDLINE, EMBASE, LILACS and CENTRAL (from
inception to April 16, 2013) and reference lists of included RCTs and
relevant systematic reviews. We included published RCTs administering any
intervention to children in a pediatric ICU. We excluded trials conducted
in neonatal ICUs, those enrolling exclusively preterm infants, and
individual patient crossover trials. Pairs of reviewers independently
screened studies for eligibility, assessed risk of bias, and abstracted
data. Discrepancies were resolved by consensus.Results: We included 248
RCTs: 45 (18%) were multicentered and 14 (6%) were multinational. Trials
most frequently enrolled both medical and surgical patients (43%) but
postoperative cardiac surgery was the single largest population studied
(19%). The most frequently evaluated types of intervention were
medications (63%), devices (11%) and nutrition (8%). Laboratory or
physiological measurements were the most frequent type of primary outcomes
(18%). Half of these trials (50%) reported blinding. Of the 107 (43%)
trials that reported an a priori sample size, 34 (32%) were stopped early.
The median number of children randomized per trial was 49 and ranged from
6 to 4,947. The frequency of RCT publications increased at a mean rate of
0.7 RCTs per year (P<0.001) from 1 to 20 trials per year.Conclusions: This
scoping review identified the available RCTs in pediatric critical care
and made them accessible to clinicians and researchers
(http://epicc.mcmaster.ca). Most focused on medications and intermediate
or surrogate outcomes, were single-centered and were conducted in North
America and Western Europe. The results of this review underscore the need
for trials with rigorous methodology, appropriate outcome measures, and
improved quality of reporting to ensure that high quality evidence exists
to support clinical decision-making in this vulnerable population. 2013
Duffett et al.; licensee BioMed Central Ltd.

<13>
Accession Number
2013768522
Authors
Ulus A.T. Poyraz N.Y. Arat N. Babaroglu S. Parlar A.T. Yavas S. Unlu M.
Institution
(Ulus, Babaroglu, Parlar, Yavas) Department of Cardiovascular Surgery,
Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
(Poyraz, Unlu) Department of Nuclear Medicine, Gazi University Medical
Faculty, Ankara, Turkey
(Arat) Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara,
Turkey
Title
Right ventricular and septal function in patients with pulmonary
hypertension.
Source
Heart Lung and Circulation. 22 (12) (pp 1003-1010), 2013. Date of
Publication: December 2013.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Objective: Pulmonary hypertension (PHT) exacerbates the functions of both
ventricles. This prospective, randomised study was planned to investigate
the effects of PHT on kinetics of both ventricles and the septum. Methods:
Twenty-five patients were randomly selected among the patients who had
been planned to undergo mitral valve replacement (MVR) because of isolated
mitral stenosis and divided into two groups according to their
preoperative pulmonary artery pressure (PAP) values. Blood pool gated
single photon emission tomography (BPGS) and transthoracic
echocardiography were performed. Ventricles' regional, global and
functional parameters were also assessed by using pulsed wave Doppler
tissue imaging (DTI). Results: Preoperative and postoperative PAP of the
group 1 (PAP. < 50. mmHg) were 40.0 +/- 2.8 and 30.0 +/- 2.6. mmHg (p =
0.03), group 2 (PAP >= 50. mmHg) were 71.9 +/- 4.7 and 50.6 +/- 3.5. mmHg
(p < 0.05). The global right and left ventricle scores were decreased
after the operation. The decrement was only significant in group 2.
Considering the septal kinetics, right ventricle septal score was
decreased from 7.6 to 3.3 (p < 0.05) in group 1, from 3.8 to 1.6 (p <
0.05) in group 2 postoperatively. Conclusion: Following MVR, a decrement
in PAP values, and an improvement in ventricular function, especially in
the right ventricular and septal kinetics were achieved. Furthermore, it
was found that both DTI and BPGS techniques are beneficial to investigate
the functional changes postoperatively and in the follow-up period of the
patients who undergo mitral valve surgery. 2013 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ).

<14>
Accession Number
2013772811
Authors
Fukuoka Y. Beatty A.L. Whooley M.A.
Institution
(Fukuoka) Institute for Health and Aging, Department of Social and
Behavioral Sciences, University of California, San Francisco, CA, United
States
(Beatty, Whooley) Department of Medicine, University of California, San
Francisco, CA, United States
(Whooley) Department of Epidemiology and Biostatistics, University of
California, San Francisco, CA, United States
(Whooley) Veterans Affairs Medical Center, San Francisco, CA, United
States
Title
Using mobile technology for cardiac rehabilitation: A review and framework
for development and evaluation.
Source
Journal of the American Heart Association. 2 (6) , 2013. Article Number:
e000568. Date of Publication: December 2013.
Publisher
American Heart Association Inc. (7272 Greenville Avenue, Dallas TX
75231-4596, United States)