Total documents retrieved: 29
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<1>
Accession Number
23917675
Authors
Zhang J. Chen C.Q. Lei X.Z. Feng Z.Y. Zhu S.M.
Institution
(Zhang, Chen, Lei, Feng, Zhu) Zhejiang University, First Affiliated
Hospital College of Medicine, Department of Anesthesiology, Hangzhou,
Zhejiang, China
Title
Goal-directed fluid optimization based on stroke volume variation and
cardiac index during one-lung ventilation in patients undergoing
thoracoscopy lobectomy operations: A pilot study.
Source
Clinics. 68 (7) (pp 1065-1070), 2013. Date of Publication: July 2013.
Abstract
Objectives: This pilot study was designed to utilize stroke volume
variation and cardiac index to ensure fluid optimization during one-lung
ventilation in patients undergoing thoracoscopic lobectomies. Methods:
Eighty patients undergoing thoracoscopic lobectomy were randomized into
either a goal-directed therapy group or a control group. In the
goal-directed therapy group, the stroke volume variation was controlled at
10%+1%, and the cardiac index was controlled at a minimum of 2.5
L.min<sup>-1</sup>.m<sup>-2</sup>. In the control group, the MAP was
maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at
between 60 BPM and 100 BPM, and urinary output was greater than 0.5
mL/kg<sup>-1</sup>/h<sup>-1</sup>. The hemodynamic variables, arterial
blood gas analyses, total administered fluid volume and side effects were
recorded. Results: The PaO<sub>2</sub>/FiO<sub>2</sub>-ratio before the
end of one-lung ventilation in the goal-directed therapy group was
significantly higher than that of the control group, but there were no
differences between the goal-directed therapy group and the control group
for the PaO<sub>2</sub>/FiO<sub>2</sub>-ratio or other arterial blood gas
analysis indices prior to anesthesia. The extubation time was
significantly earlier in the goal-directed therapy group, but there was no
difference in the length of hospital stay. Patients in the control group
had greater urine volumes, and they were given greater colloid and overall
fluid volumes. Nausea and vomiting were significantly reduced in the
goal-directed therapy group. Conclusion: The results of this study
demonstrated that an optimization protocol, based on stroke volume
variation and cardiac index obtained with a FloTrac/Vigileo device,
increased the PaO<sub>2</sub>/FiO<sub>2</sub>-ratio and reduced the
overall fluid volume, intubation time and postoperative complications
(nausea and vomiting) in thoracic surgery patients requiring one-lung
ventilation. 2013 CLINICS.
<2>
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Accession Number
2014234913
Authors
Couturier R. Rubatti M. Credico C. Louvain-Quintard V. Anerkian V. Doubine
S. Vasse M. Grassin-Delyle S.
Institution
(Couturier, Rubatti, Credico, Anerkian) Departement d'Anesthesie, Centre
Chirurgical Marie Lannelongue, 133 avenue de la Resistance, 92350 Le
Plessis Robinson, France
(Louvain-Quintard, Doubine) Laboratoire d'Hemostase, Centre Chirurgical
Marie Lannelongue, Le Plessis Robinson, France
(Vasse) Service de Biologie Clinique, Hopital Foch, Suresnes, France
(Grassin-Delyle) Laboratoire de Pharmacologie, UPRES EA220, Hopital Foch,
Suresnes, France
(Grassin-Delyle) Laboratoire de Pharmacologie - Toxicologie, Hopital
Raymond Poincare, AP-HP, Garches, France
Title
Continuous or discontinuous tranexamic acid effectively inhibits
fibrinolysis in children undergoing cardiac surgery with cardiopulmonary
bypass.
Source
Blood Coagulation and Fibrinolysis. 25 (3) (pp 259-265), 2014. Date of
Publication: April 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Tranexamic acid is given continuously or discontinuously as an
anti-fibrinolytic therapy during cardiac surgery, but the effects on
fibrinolysis parameters remain poorly investigated. We sought to assess
the effects of continuous and discontinuous tranexamic acid on
fibrinolysis parameters in children undergoing cardiac surgery with
cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat
surgery by sternotomy with CPB for congenital heart disease were
randomized to receive either continuous or discontinuous tranexamic acid.
Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA),
tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and
fibrin monomers were measured and compared to values obtained from
children who did not receive tranexamic acid. Tranexamic acid inhibited
the CPB-induced increase in D-dimers, with a similar potency between
continuous and discontinuous regimens. Time courses for tPA, fibrin
monomers, and fibrinogen were also similar for both regimen, and there was
a significant difference in tPA-PAI1 complex concentrations at the end of
surgery, which may be related to a significantly higher tranexamic acid
concentration. Continuous and discontinuous regimen are suitable for an
effective inhibition of fibrinolysis in children undergoing cardiac
surgery with CPB, but the continuous regimen was previously shown to be
more effective to maintain stable tranexamic acid concentrations. 2014
Wolters Kluwer Health Lippincott Williams & Wilkins.
<3>
Accession Number
2014227434
Authors
Paparella D. Rotunno C. De Palo M. Finamore S. Guida P. Rubino G. De Luca
Tupputi Schinosa L. Fiore T.
Institution
(Paparella, Rotunno, De Palo, Guida, De Luca Tupputi Schinosa) Division of
Cardiac Surgery, Department of Emergency and Organ Transplant, University
of Bari Aldo Moro, Piazza Giulio Cesare 11, 70100 Bari, Italy
(Finamore, Rubino, Fiore) Division of Anesthesia, Department of Emergency
and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
Title
Antithrombin administration in patients with low antithrombin values after
cardiac surgery: A randomized controlled trial.
Source
Annals of Thoracic Surgery. 97 (4) (pp 1207-1213), 2014. Date of
Publication: April 2014.
Publisher
Elsevier USA
Abstract
Background Antithrombin (AT) concentrations are reduced after cardiac
surgery with cardiopulmonary bypass compared with the preoperative levels.
Low postoperative AT is associated with worse short- and mid-term clinical
outcomes. The aim of the study is to evaluate the effects of AT
administration on activation of the coagulation and fibrinolytic systems,
platelet function, and the inflammatory response in patients with low
postoperative AT levels. Methods Sixty patients with postoperative AT
levels of less than 65% were randomly assigned to receive purified AT
(5000 IU in three administrations) or placebo in the postoperative
intensive care unit. Thirty patients with postoperative AT levels greater
than 65% were observed as controls. Interleukin 6 (a marker of
inflammation), prothrombin fragment 1-2 (a marker of thrombin generation),
plasmin-antiplasmin complex (a marker of fibrinolysis), and platelet
factor 4 (a marker of platelet activation) were measured at six different
times. Results Compared with the no AT group and control patients,
patients receiving AT showed significantly higher AT values until 48 hours
after the last administration. Analysis of variance for repeated measures
showed a significant effect of study treatment in reducing prothrombin
fragment 1-2 (p = 0.009; interaction with time sample, p = 0.006) and
plasmin-antiplasmin complex (p < 0.001; interaction with time sample, p <
0.001) values but not interleukin 6 (p = 0.877; interaction with time
sample, p = 0.521) and platelet factor 4 (p = 0.913; interaction with time
sample, p = 0.543). No difference in chest tube drainage, reopening for
bleeding, and blood transfusion was observed. Conclusions Antithrombin
administration in patients with low AT activity after surgery with
cardiopulmonary bypass reduces postoperative thrombin generation and
fibrinolysis with no effects on platelet activation and inflammatory
response. 2014 by The Society of Thoracic Surgeons.
<4>
Accession Number
2014227413
Authors
Zhang B. Zhou J. Li H. Liu Z. Chen A. Zhao Q.
Institution
(Zhang, Zhou, Li, Liu, Chen, Zhao) Department of Cardiac Surgery, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er
Rd, Shanghai 200025, China
Title
Comparison of graft patency between off-pump and on-pump coronary artery
bypass grafting: An updated meta-analysis.
Source
Annals of Thoracic Surgery. 97 (4) (pp 1335-1341), 2014. Date of
Publication: April 2014.
Publisher
Elsevier USA
Abstract
Background Currently, off-pump coronary artery bypass grafting (OPCAB) and
on-pump coronary artery bypass grafting (ONCAB) are 2 well-established
therapeutic strategies for patients with coronary artery disease, and
debate regarding which strategy provides superior graft patency is
ongoing. The current study is a meta-analysis of randomized controlled
trials that compared the graft patency between OPCAB and ONCAB. Methods
Data sources were PubMed, the Cochrane Library, Google Scholar, and ISI
Web of Knowledge (1966-2013). We identified studies comparing graft
patency after the 2 procedures as the primary intervention for patients
with multivessel coronary artery disease and conducted a meta-analysis of
randomized controlled trials on graft patency. Results A literature search
yielded 12 randomized controlled trials, for a total of 3,894 and 4,137
grafts performed during OPCAB and ONCAB procedures, respectively.
Meta-analysis of these studies showed an increased risk of occlusion of
all grafts (risk ratio [RR], 1.35; 95% confidence interval [CI],
1.16-1.57) and saphenous vein grafts (SVGs) (RR, 1.41; 95% CI, 1.24-1.60)
in the OPCAB group, whereas there was no significant difference in graft
occlusion of left internal mammary artery (LIMA) (RR, 1.15; 95% CI,
0.83-1.59) and radial artery (RR, 1.37; 95% CI, 0.76-2.47) grafts between
OPCAB and ONCAB. Conclusions Meta-analysis of currently available
randomized controlled trials on graft patency shows that ONCAB reduces the
incidence of SVG graft occlusion significantly but does not affect LIMA
and radial artery graft patency compared with OPCAB. 2014 by The Society
of Thoracic Surgeons.
<5>
Accession Number
2014226341
Authors
Ngai K.M.G.
Title
Can influenza vaccination prevent adverse cardiovascular events?.
Source
Journal of Clinical Outcomes Management. 20 (12) (pp 540-541), 2013. Date
of Publication: December 2013.
Publisher
Turner White Communications Inc.
<6>
Accession Number
2014225127
Authors
Yu X.-Y. Dai Q. Cheng S.-Q. Xia Y.-Y.
Institution
(Yu, Dai, Cheng, Xia) School of Public Health and Management, Chongqing
Medical University, Chongqing 400016, China
Title
Efficacy of early use of heparin for thrombolytic therapy on patients with
acute myocardial infarction: A systematic review.
Source
Chinese Journal of Evidence-Based Medicine. 14 (3) (pp 277-286), 2014.
Date of Publication: 2014.
Publisher
West China University of Medical Science
Abstract
Objective To systematically review the efficacy of early use of heparin
for thrombolytic therapy in patients with acute myocardial infarction
(AMI). Methods The Chinese databases involving VIP, CNKI, WanFang Data,
CBM and foreign language databases including PubMed and The Cochrane
Library (Issue 1, 2013) were electronically searched from inception to
January 2013. Randomized controlled trials (RCTs) on early use of heparin
in the treatment of AMI were included. Two reviewers assessed the quality
of each trial and extracted data independently according to the Cochrane
Handbook. RevMan5.2 software was used for statistical analysis. Results A
total of 23 RCTs involving 2 697 patients were included. The results of
meta-analysis showed that the heparin group was superior to the control
group in increasing of the rate of coronary artery recanalization,
decreasing the time of recanalization, reducing the rate of re-infarction
and the death rate, and decreasing the time of ST-T fell for 50%, the time
of enzyme peak showed and the time of chest pain relief. There had no
significant difference observed in the incidence of adverse reaction
between the two groups. Conclusion It is effective to use heparin before
thrombolytic therapy in AMI. 2014 Editorial Board of Chin J Evid-based
Med.
<7>
Accession Number
2014225110
Authors
Jin X. Ma H.-P. Wang J. Zheng H.
Institution
(Jin, Ma, Wang, Zheng) Department of Anesthesia, The First Hospital of
Xinjiang Medical University, Urumqi 830054, China
Title
Transfusion of red blood cells with different duration for patients'
prognosis: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 14 (3) (pp 299-305), 2014.
Date of Publication: 2014.
Publisher
West China University of Medical Science
Abstract
Objective To systematically review transfusion of red blood cells with
different duration for patients' prognosis so as to provide evidence for
the reasonable blood use in clinic. Methods Databases including The
Cochrane Library (Issue 3, 2013), PubMed, Ovid, EMbase, WanFang Data and
CNKI were electrically searched to collect studies published from 2002 to
2013, and relevant periodicals and references of the included studies were
also manually retrieved. According to the inclusion and exclusion
criteria, related studies were screened, data were extracted, and the
quality of included studies was evaluated by two reviewers independently.
Then meta-analysis was conducted using RevMan 5.0 software. Results A
total of 10 studies (including 4 case-control studies and 6 cohort
studies) were included, involving 15 187 patients. The results of
meta-analysis revealed that, transfusion of fresh red cells (< 10-18 days)
was superior to that of old ones (>14-28 days) in decreasing the
short-term mortality (OR=0.69, 95%CI 0.58 to 0.82, P<0.000 1) and the
incidence of hospital infection (OR=0.67, 95%CI 0.55 to 0.81, P<0.000 1),
and in decreasing the incidences of post-operation kidney failure (OR=0.52
95%CI 0.37 to 0.73, P=0.000 2) and prolonged ventilatory support (>72 h)
(OR=0.54 95%CI 0.45 to 0.66, P<0.000 01) for patients with cardiac
surgery, all with significant differences. Conclusion Transfusion of fresh
red cells (< 10-18 days) is superior to that of old ones (>14-28 days) in
decreasing the short-term mortality and the incidence of hospital
infection, and in decreasing the incidences of post-operation kidney
failure and prolonged ventilatory support (>72 h) for patients with
cardiac surgery, which improve prognosis. Due to the limited quality and
quantity of the included studies, the aforementioned conclusion needs to
be verified by conducting more high quality studies. 2014 Editorial Board
of Chin J Evid-based Med.
<8>
Accession Number
2014223236
Authors
Ugurlucan M. Basaran M. Erdim F. Selimoglu O. Caglar I.M. Zencirci E.
Filizcan U. Ogus N.T. Yildiz Y. Tireli E. Isik O. Dayioglu E.
Institution
(Ugurlucan, Basaran, Tireli, Dayioglu) Department of Cardiovascular
Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
(Erdim, Selimoglu) Cardiovascular Surgery Clinic, Istanbul Cerrahi
Hospital, Istanbul, Turkey
(Caglar) Cardiology Clinic, Bakirkoy Dr. Sadi Konuk Education and Research
Hospital, Istanbul, Turkey
(Zencirci) Cardiology Clinic, Maslak Acibadem Hospital, Istanbul, Turkey
(Filizcan) Department of Cardiovascular Surgery, Maltepe University
Medical Faculty, Istanbul, Turkey
(Ogus) Cardiovascular Surgery Clinic, Medistate Hospital, Istanbul, Turkey
(Yildiz, Isik) Cardiovascular Surgery Clinic, Pendik Bolge Hospital,
Istanbul, Turkey
Title
Pressure-controlled mechanical ventilation is more advantageous in the
follow-up of patients with chronic obstructive pulmonary disease after
open heart surgery.
Source
Heart Surgery Forum. 17 (1) (pp E1-E6), 2014. Date of Publication:
February 2014.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Objective: Cardiopulmonary bypass deteriorates pulmonary functions to a
certain extent. Patients with chronic obstructive pulmonary disease (COPD)
are associated with increased mortality and morbidity risks in the
postoperative period of open-heart surgery. In this study we compared 2
different mechanical ventilation modes, pressure-controlled ventilation
(PCV) and volume-controlled ventilation (VCV), in this particular patient
population. Patients and Methods: Forty patients with severe COPD were
assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the
postoperative period. Arterial blood gases, respiratory parameters, and
intensive care unit and hospital stays were compared between the 2 groups.
Results: Maximum airway pressure was higher in the VCV group. Pulmonary
compliance was lower in the VCV group and minute ventilation was
significantly lower in the group ventilated with PCV mode. The respiratory
index was increased in the PCV group compared with the VCV group and with
preoperative findings. Duration of mechanical ventilation was
significantly shorter with PCV; however, intensive care unit and hospital
stays did not differ. Conclusion: There is not a single widely accepted
and established mode of ventilation for patients with COPD undergoing
open-heart surgery. Our modest experience indicated promising results with
PCV mode; however, further studies are warranted. 2014 Forum Multimedia
Publishing, LLC.
<9>
[Use Link to view the full text]
Accession Number
2014219732
Authors
Dagres N. Iliodromitis E.K. Lekakis J.P. Simitsis P. Karatzas D. Rallidis
L.S. Simeonidou E. Anastasiou-Nana M.
Institution
(Dagres, Iliodromitis, Lekakis, Simitsis, Karatzas, Rallidis, Simeonidou,
Anastasiou-Nana) Second Cardiology Department, Attikon University
Hospital, University of Athens, Athens, Greece
Title
Ranolazine for the prevention or treatment of atrial fibrillation: A
systematic review.
Source
Journal of Cardiovascular Medicine. 15 (3) (pp 254-259), 2014. Date of
Publication: March 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
The use of currently available antiarrhythmic drugs for atrial
fibrillation is limited by their moderate efficacy and the considerable
proarrhythmic risk. Ranolazine, an antianginal agent, has been reported to
possess antiarrhythmic properties, resulting in a reduction of
supraventricular and ventricular arrhythmias. We performed a systematic
review of the clinical studies reporting the outcome of patients treated
with ranolazine for the prevention or treatment of atrial fibrillation in
various clinical settings. We searched PubMed and abstracts of major
conferences for clinical studies using ranolazine, either alone or in
combination with other antiarrhythmic agents for the prevention or
treatment of atrial fibrillation. Ten relevant records were identified.
These included both randomized trials and retrospective cohort studies
concerning the use of ranolazine in different clinical settings;
prevention of atrial fibrillation in patients with acute coronary
syndrome, prevention as well as conversion of postoperative atrial
fibrillation after coronary artery bypass grafting, conversion of
recent-onset atrial fibrillation, sinus rhythm maintenance in
drug-resistant recurrent atrial fibrillation and facilitation of
electrical cardioversion in cardioversion-resistant patients. A
beneficial, mostly modest effect of ranolazine was homogeneously reported
in all clinical settings. There were no substantial proarrhythmic effects.
No meta-analysis could be performed because for most of the clinical
scenarios, there was only one study investigating the effect of
ranolazine. Except for one large randomized trial, all the other studies
were either relatively small randomized studies or retrospective cohort
analyses, which in several cases lacked a control group. This systematic
review indicates a modest beneficial effect of ranolazine administered for
the prevention or treatment of atrial fibrillation across several clinical
settings without substantial proarrhythmic risk. 2014 Italian Federation
of Cardiology.
<10>
Accession Number
2014217489
Authors
Kufner S. Byrne R.A. de Waha A. Schulz S. Joner M. Laugwitz K.-L. Kastrati
A.
Institution
(Kufner, Byrne, de Waha, Schulz, Joner, Kastrati) Deutsches Herzzentrum,
Technische Universitat, Munich, Germany
(Laugwitz) Medizinische Klinik, Klinikum rechts der Isar, Technische
Universitat, Munich, Germany
(Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular Research),
Partner site Munich Heart Alliance, Munich, Germany
Title
Sirolimus-eluting versus paclitaxel-eluting stents in diabetic and
non-diabetic patients within sirolimus-eluting stent restenosis: Results
from the ISAR-DESIRE 2 trial.
Source
Cardiovascular Revascularization Medicine. 15 (2) (pp 69-75), 2014. Date
of Publication: March 2014.
Publisher
Elsevier Inc.
Abstract
Background: Concern exists relating to potential attenuated efficacy of
limus-eluting stents in patients with diabetes mellitus. In this respect
diabetic patients with sirolimus-eluting stent (SES) failure requiring
reintervention may be expected to derive particular benefit from a
treatment-switch to paclitaxel-eluting stent (PES) implantation.
Objective: The aim of the current report was to investigate outcomes of
patients with SES restenosis randomized to treatment with SES (same stent
strategy) or PES (switch stent strategy) in the pre-specified subgroups of
patients with and without diabetes mellitus. Methods: In the setting of
ISAR-DESIRE 2 trial, 450 patients with clinically significant SES
restenosis were randomly assigned to receive either SES or PES. The
primary end point was in-stent late loss at 6-8. month follow-up
angiography. Secondary endpoints were binary angiographic restenosis
(diameter stenosis >. 50%) and target lesion revascularization (TLR), the
composite of death or myocardial infarction (MI) and definite stent
thrombosis at 12. months. Results: Of 450 patients enrolled, 162 (36.0%)
had a diagnosis of diabetes mellitus. In patients with diabetes 86
patients were randomly assigned to SES versus 76 to PES. In patients
without diabetes 139 were assigned to SES versus 149 to PES. Late loss was
comparable between SES and PES both in patients with diabetes (0.38+0.59mm
vs. 0.37+0.59mm; p=0.97) and without (0.41+0.67mm vs. 0.38+0.6mm; p=0.98;
p<sub>interaction</sub>=0.89). Similarly binary restenosis was comparable
between SES and PES in patients with diabetes (19.0% vs. 26.0%; p=0.32) or
without (18.9% vs. 17.8%; p=0.98; p<sub>interaction</sub>=0.36). TLR,
death or MI and definite stent thrombosis were also similar in SES versus
PES treatment groups regardless of diabetes status. Conclusions: In cases
of SES-restenosis, treatment with either repeat SES or switch to PES was
associated with a comparable degree of efficacy, regardless of diabetic
status. 2014 Elsevier Inc.
<11>
Accession Number
2014221546
Authors
Tait A.R. Voepel-Lewis T. Chetcuti S.J. Brennan-Martinez C. Levine R.
Institution
(Tait, Voepel-Lewis) Department of Anesthesiology, University of Michigan
Health System, Ann Arbor, MI, United States
(Chetcuti, Brennan-Martinez) Department of Cardiology, University of
Michigan Health System, Ann Arbor, MI, United States
(Tait) Center for Bioethics and Social Sciences in Medicine, University of
Michigan, United States
(Levine) Emergency Care Center, Jackson Memorial Hospital, Miami, FL,
United States
(Levine) ArchieMD, Inc., Boca Raton, FL, United States
Title
Enhancing patient understanding of medical procedures: Evaluation of an
interactive multimedia program with in-line exercises.
Source
International Journal of Medical Informatics. 83 (5) (pp 376-384), 2014.
Date of Publication: May 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Standard print and verbal information provided to patients
undergoing treatments are often difficult to understand and may impair
their ability to be truly informed.This study examined the effect of an
interactive multimedia informational program with in-line exercises and
corrected feedback on patients' real-time understanding of their cardiac
catheterization procedure. Methods: 151 adult patients scheduled for
diagnostic cardiac catheterization were randomized to receive information
about their procedure using either the standard institutional verbal and
written information (SI) or an interactive iPad-based informational
program (IPI). Subject understanding was evaluated using semi-structured
interviews at baseline, immediately following catheterization, and 2 weeks
after the procedure. In addition, for those randomized to the IPI, the
ability to respond correctly to several in-line exercises was recorded.
Subjects' perceptions of, and preferences for the information delivery
were also elicited. Results: Subjects randomized to the IPI program had
significantly better understanding following the intervention compared
with those randomized to the SI group (8.3. +. 2.4 vs 7.4. +. 2.5,
respectively, 0-12 scale where 12. = complete understanding, P<. 0.05).
First-time correct responses to the in-line exercises ranged from 24.3% to
100%. Subjects reported that the in-line exercises were very helpful (9.1.
+. 1.7, 0-10 scale, where 10. = extremely helpful) and the iPad program
very easy to use (9.0. +. 1.6, 0-10 scale, where 10. = extremely easy)
suggesting good clinical utility. Discussion: Results demonstrated the
ability of an interactive multimedia program to enhance patients'
understanding of their medical procedure. Importantly, the incorporation
of in-line exercises permitted identification of knowledge deficits,
provided corrected feedback, and confirmed the patients' understanding of
treatment information in real-time when consent was sought. 2014 Elsevier
Ireland Ltd.
<12>
Accession Number
2014215736
Authors
Yang J. Yang L. Yu S. Liu J. Zuo J. Chen W. Duan W. Zheng Q. Xu X. Li J.
Zhang J. Xu J. Sun L. Yang X. Xiong L. Yi D. Wang L. Liu Q. Ge S. Ren J.
Institution
(Yang, Yang, Yu, Liu, Zuo, Chen, Duan, Zheng, Xu, Li, Zhang, Xu, Sun,
Yang, Xiong, Yi, Ge, Ren) Department of Cardiovascular Surgery, Xijing
Hospital, Fourth Military Medical University, Xi'an, China
(Wang) Department of Cardiology, Xi'An Children Hospital, Xi'an, China
(Liu) Department of Cardiovascular Surgery, Hanzhong Central Hospital,
Hanzhong, China
(Ge) Heart Center at St. Christopher's Hospital for Children, Drexel
University College of Medicine, Philadelphia, PA, United States
(Ren) College of Health Sciences, University of Wyoming, Laramie, WY,
United States
Title
Transcatheter versus surgical closure of perimembranous ventricular septal
defects in children: A randomized controlled trial.
Source
Journal of the American College of Cardiology. 63 (12) (pp 1159-1168),
2014. Date of Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives The objective of this study was to evaluate the safety and
efficacy of the surgical versus transcatheter approach to correct
perimembranous ventricular septal defects (pmVSDs) in a prospective,
randomized, controlled clinical trial. Background pmVSD is a common
congenital heart disease in children. Surgical closure of pmVSD is a
well-established therapy but requires open-heart surgery with
cardiopulmonary bypass. Although the transcatheter approach is associated
with significant incidence of complete atrioventricular block, it may
provide a less invasive alternative. Critical comparison of the safety and
efficacy of the 2 interventions necessitates a prospective, randomized,
controlled trial. Methods Between January 2009 and July 2010, 229 children
with pmVSD were randomly assigned to surgical or transcatheter
intervention. Clinical, laboratory, procedural, and follow-up data over a
2-year period were compared. Results Neither group had mortality or major
complications. However, statistical analysis of the 2 groups demonstrated
significant differences (p < 0.001) in minor adverse events (32 vs. 7),
quantity of blood transfused, duration of the procedure, median hospital
stay, median intensive care unit stay, median hospitalization cost, and
median blood loss. During a median follow-up of 2 years, the left
ventricular end-diastolic dimension of both groups returned to normal and
there was no difference in closure rate, adverse events, and complications
between groups. Conclusions Transcatheter device closure and surgical
repair are effective interventions with excellent midterm results for
treating pmVSD in children. Transcatheter device closure has a lower
incidence of myocardial injury, less blood transfused, faster recovery,
shorter hospital stay, and lower medical expenses. (Transcatheter Closure
Versus Surgery of Perimembranous Ventricular Septal Defects; NCT00890799).
2014 by the American College of Cardiology Foundation.
<13>
Accession Number
71405384
Authors
Firmin R.K. Borisenko O. Payne J. Smith J. Bjessmo S. Yonan N. Wyllie G.
Institution
(Firmin) Cardiothoracic Surgery/ECMO, Glenfield Hospital, Leicester,
United Kingdom
(Borisenko, Bjessmo) Synergus AB, Danderyd, Sweden
(Payne) Scottish National Advanced Heart Failure Service, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Smith) Paediatric and Neonatal ECMO Service, Freeman Hospital, Newcastle,
United Kingdom
(Yonan) Department of Cardiothoracic Transplant, Wythenshawe Hospital,
Manchester, United Kingdom
(Wyllie) Yorkhill Children's Hospital, Glasgow, United Kingdom
Title
Thoratec centrimag for temporary treatment of refractory cardiogenic shock
or severe cardiopulmonary insufficiency in adult and pediatric patients: A
systematic literature review and meta-analysis of observational studies.
Source
Journal of Heart and Lung Transplantation. Conference: 34th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2014 San Diego, CA United States. Conference Start:
20140410 Conference End: 20140413. Conference Publication: (var.pagings).
33 (4 SUPPL. 1) (pp S249-S250), 2014. Date of Publication: April 2014.
Publisher
Elsevier USA
Abstract
Purpose: This study was a systematic evaluation of the CentriMag heart
pump (Thoratec Corp, USA) as a VAD and for ECMO on outcomes in patients
with cardio-respiratory failure. Methods: A search was conducted in 5
databases for the period 2003-2012. Additionally, authors provided
unpublished studies. Observational studies with multiple with
CentriMag/PediVAS were included. Survival, weaning from support, bridging
to transplant and long-term VAD, adverse events were analyzed. Results
were summarized qualitatively and quantitatively (meta-analysis).
Fixed-effect model using inverse-variance method was used in the
meta-analysis. Results: 53 publications on 999 patients were included.
CentriMag was used as a VAD in 72% and for ECMO in 25%. 94% of patients
had a cardiac indication for support: the remaining 6% a respiratory
indication. 68% of the cardiac group were post and 32% pre -cardiotomy.
Mean duration of VAD support (days) was 25.0 days in pre-cardiotomy group,
10.9 in post-cardiac surgery group, 8.8 in post-transplant group, and 16.0
in post-LVAD placement RV failure group. The mean duration of ECMO support
was 5.4 days post-heart transplant and 20 days for respiratory failure.
Survival was 82.2% (CI 69.8-91.8%) for VAD support in pre-cardiotomy
indications, 62.8% (CI 45.6-78.5%) in VAD support post-cardiac surgery,
61.6% (CI 46.2-75.9%) in VAD support in post-transplant group and 83.1%
(CI 72.5-91.5%) in VAD support in post-LVAD placement RV failure. The mean
occurrence of bleeding on support was 27.6% (CI 23.3-32.0%), thrombosis -
7.4% (CI 4.5-11.1%), haemolysis - 2.5% (CI 0.7-5.5%), neurologic
complications - 7.3% (CI 4.4-10.7%), infections - 24.4% (CI 19.1-29.6%),
renal complications - 28.4% (CI 21.8-35.5%) and device failure - 0.08% (CI
0.0-0.5%). Conclusion: Results of a literature review and meta-analysis
showed that CentriMag is an effective temporary support technology for
patients with cardiorespiratory failure. Mean survival on VAD support
varied from 61% in VAD support in the post-transplant group to 83% in
post-LVAD placement RV failure indication. Temporary heart pumps have
revolutionized care for critically ill patient with cardiac and
cardiorespiratory failure.
<14>
Accession Number
71405170
Authors
Bartfay S. Gullestad L. Sigurdardottir V. Andreassen A.K. Gude E.
Andersson B.
Institution
(Bartfay, Andersson) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gullestad, Andreassen, Gude) Department of Cardiology, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Sigurdardottir) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Maintained cardiac reserve in heart transplant patients during early
calcineurin inhibitor avoidance: A substudy of A randomised controlled
trial (schedule trial).
Source
Journal of Heart and Lung Transplantation. Conference: 34th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2014 San Diego, CA United States. Conference Start:
20140410 Conference End: 20140413. Conference Publication: (var.pagings).
33 (4 SUPPL. 1) (pp S173-S174), 2014. Date of Publication: April 2014.
Publisher
Elsevier USA
Abstract
Purpose: Calcineurin inhibitors have been the cornerstone of
immunosuppressive regime following heart transplantation. The transplanted
heart is prone to increased hypertrophy and risk of developing graft
vasculopathy. To what extent these negative effects are influenced by
different immunosuppressive drugs, is largely unknown. We conducted a
randomised, open-label, parallel group clinical trial to assess early
introduction of everolimus (EVE) followed by withdrawal of cyclosporine
(CYA) in de novo heart transplant recipients, compared to a standard
protocol of cyclosporine-based immunosuppression. In a substudy we
investigated cardiac reserve by invasive hemodynamics during rest and
exercise, early (7 weeks) and later (52 weeks) after heart
transplantation. in 37 (CYA) and 32 (EVE) patients. The aim was to compare
cardiac reserve in the two treatment arms. Methods: Patients had a right
heart catheterisation at rest and during submaximal supine bicycle
exercise 7 and 52 weeks after heart transplantation. Pressures and cardiac
output (CO) were measured. Results: Patients in the CYA group were
significantly heavier and had higher diastolic blood pressure (DBP) when
entering the study. The difference in weight, but not in DBP, remained
after 52 w. At baseline (7 w) PCWP and CO increased from rest to exercise.
After 52 w the hemodynamic pattern was similar, with a non-significant
trend towards higher CO during exercise. There were no significant
differences between treatment groups. Conclusion: Early withdrawal of
cyclosporine in a de-novo everolimusbased immunosuppressive therapy had no
negative effect on cardiac reserve as measured by invasive hemodynamics
compared to a cyclosporine-based regime. (Table Presented).
<15>
Accession Number
71405044
Authors
Relbo A. Grov I. Andersson B. Gustafsson F. Eiskjaer H. Radegran G. Gude
E. Jansson K. Solbu D. Sigurdardottir V. Arora S. Dellgren G. Andreassen
A.K. Gullestad L.
Institution
(Relbo, Grov, Gude, Arora, Andreassen, Gullestad) Department of
Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Skejby University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital, Lund University, Lund, Sweden
(Jansson) Dept of Cardiology County Hospital, Linkoping University,
Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Sigurdardottir, Dellgren) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Sweden
Title
Everolimus and cyclosporine equally improve QoL in de novo heart
transplanted patients: The results of a randomized controlled trial
(SCHEDULE trial).
Source
Journal of Heart and Lung Transplantation. Conference: 34th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2014 San Diego, CA United States. Conference Start:
20140410 Conference End: 20140413. Conference Publication: (var.pagings).
33 (4 SUPPL. 1) (pp S128), 2014. Date of Publication: April 2014.
Publisher
Elsevier USA
Abstract
Purpose: Due to long term complications of calcineurin inhibitors (CNI),
there has been an increasing interest on CNI free regimes with
introduction of rapamycin inhibitor (mTORi). However, these agents have
been associated with a number of adverse effects which may reduce quality
of life (QoL). We examined QoL in The Scandinavian heart transplant
everolimus de novo study with early calcineurin inhibitors avoidance
(SCHEDULE) trial. Methods: A total of 115 patients were randomly assigned
within 5 days postoperatively to low dose EVR and reduced dose CsA
followed by CsA withdrawal in week 7-11 ( EVR group; n= 56) or standard
CsA dosage (CsA group; n= 59).The primary efficacy endpoint was renal
function assessed by measured glomerular filtration rate (mGFR) after 12
months. Secondary objectives were number of rejections, serious adverse
events (SAE) and QoL. QoL was assessed pre-HTx and 12 months by the Short
Form-36, the 21 -item Beck Depression Inventory (BDI), and Euroqual (EQ
5D). Results: Mean age was 51+13 years, 27 % women. At 12 months, the EVR
group demonstrated improved renal function, increased number of rejections
and similar rates of SAE compared with the CsA group. The mean SF-36
physical component scale increased significantly from 31+11 to 49+10 (P<
0.001) with EVR and from 33+8 to 49+9 (P< 0.001) with CsA, and the mental
health component from 46+12 to 52+12 (EVR;P= 0.02)and 42+13 to 53+10 (P<
0.001) Mean BDI decreased significantly from 12+11 to 7+7 ( EVR; P=
0.001)and 13+13 to 7+6 /CSA, P< 0.001).There was no statistical difference
in these parameters between the two treatment groups. QoL measured by
EQ-5D index or 100 mm visual analog score also improved following HTx
within each treatment group but there was statistical difference between
the groups. Conclusion: Early elimination of CsA and replacement with an
EVR-based immunosuppression resulted in a similar improvement in QoL as
treatment with a conventional CNI (CsA) regimen. We speculate that the
adverse impact of increased number of rejections on QoL with EVR may be
counter-balanced by improved renal function resulting in a similar
improvement of QoL scores in both treatment arms.
<16>
Accession Number
71404834
Authors
Alba A.C. Walter S. Guyatt G. Ross H.
Institution
(Alba, Ross) University Health Network, Toronto, ON, Canada
(Walter, Guyatt) McMaster University, Hamilton, ON, Canada
Title
Predicting survival in heart failure patients with an implantable
cardioverter defibrillator: The heart failure meta-score.
Source
Journal of Heart and Lung Transplantation. Conference: 34th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2014 San Diego, CA United States. Conference Start:
20140410 Conference End: 20140413. Conference Publication: (var.pagings).
33 (4 SUPPL. 1) (pp S52), 2014. Date of Publication: April 2014.
Publisher
Elsevier USA
Abstract
Purpose: Many heart failure (HF) patients are currently treated with an
implantable cardioverter defibrillator (ICD) for preventing sudden death.
Prognostic evaluation in HF is important to predict need for advanced
therapies such as heart transplantation or mechanical circulatory support.
. The aim of this study was to validate a prognostic score, derived from a
meta-analysis, to predict survival in HF patients with an ICD. Methods:
The HF Meta-Score includes 10 independent mortality predictors identified
in a meta-analysis, including age, diabetes, chronic obstructive pulmonary
disease, peripheral vascular disease, atrial fibrillation, NYHA, left
ventricular ejection fraction (LVEF), renal function, QRS duration, and
ICD shocks. The score was validated in 572 ambulatory ICD patients with
reduced LVEF seen at a single institution from 2000-1011. The HF
Meta-Score performance was evaluated in comparison to the SHOCKED
predictors. Results: During a median follow-up of 3 years, 139 patients
died. The HF Meta-Score showed excellent calibration with predicted versus
observed 1 and 3-year survival of 93% and 81.5% versus 92% and 81.5%
respectively. Model discrimination was adequate (c-statistic of 0.704).
The HF Meta-Score showed enhanced risk classification when compared to the
SHOCKED predictors, with improved discrimination and calibration. The net
reclassification improvement was 39%, 55% and 15% in patients categorized
as having a 3-year predicted survival of 90-80%, 80-70% and < 70%,
respectively. Conclusion: The HF Meta-Score provides an accurate
assessment of survival in ICD HF patients. The excellent calibration and
enhanced discriminatory capacity demonstrates the usefulness of the score
for clinical decision making.
<17>
Accession Number
71404728
Authors
Greig D. Alba C. Foroutan F. Lee D.S. Ross H.J.
Institution
(Greig) Cardiovascular Diseases, P. Universidad Catolica de Chile,
Santiago, Chile
(Alba, Lee, Ross) University Health Network, Toronto, ON, Canada
(Foroutan) University of Toronto, Toronto, ON, Canada
Title
Proliferation signal inhibitors for cardiac allograft vasculopathy in
heart transplant recipients: A systematic review and meta-analysis of
randomized clinical trials.
Source
Journal of Heart and Lung Transplantation. Conference: 34th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2014 San Diego, CA United States. Conference Start:
20140410 Conference End: 20140413. Conference Publication: (var.pagings).
33 (4 SUPPL. 1) (pp S16), 2014. Date of Publication: April 2014.
Publisher
Elsevier USA
Abstract
Purpose: Cardiac allograft vasculopathy (CAV) is the main cause of late
morbi-mortality in heart transplant (HT) recipients. The concomitant use
of proliferation signal inhibitors (PSI) with standard immunosuppressive
therapy have been show to be effective in the treatment of CAV. The
purpose of our study is to evaluate the efficacy and safety of PSI on the
prevention and treatment of CAV compared with standard treatment in adult
HT recipients. Methods: Randomized clinical trials (RCT) were identified
in MEDLINE and EMBASE (from their inception to October 2013) using a
sensitive strategy and without language restrictions. Two independent
reviewers evaluated eligibility, abstracted the data, and assessed the
risk of bias. Predefined primary outcomes where CV-related death, and
change in the maximal intimal thickness (MIT) determined by IVUS.
Secondary outcomes where incidence of de novo CAV (increase from baseline
in MIT> 0.5mm), and any adverse events requiring cessation of study drug.
Pooled effect estimate analyses were performed by using inverse variance
method and random effect modeling. Results: Five RCT were included in the
analysis. In the overall group analysis, there were no significant
difference in mortality at 1-year (RR: 1.12 [95%CI: 0.61, 2.07];
I<sup>2</sup>= 35%) or MIT changes between arm treatments (Mean
difference: -0.03mm [95%CI: -0.06, 0.01]; I<sup>2</sup>= 78%). Compared to
standard therapy, PSI prevented the progression of CAV in the subgroup of
patients receiving therapy immediately (de novo) after transplant (Mean
difference: -0.04mm. [95%CI: -0.06, -0.02mm]; I<sup>2</sup>= 0%).
Furthermore, the pooled analyses showed that the incidence of CAV was
lower in patients treated with PSIs compared to those treated with
standard therapy (Risk ratio: 0.6 [95%CI: 0.45, 0.81]; I<sup>2</sup>= 0%],
NNT: 6 [95%CI:4, 14]). Regarding safety issues, patients receiving PSI had
a 52% increased risk of present any adverse event that leads to
discontinuation of the drug, compared with the standard therapy (RR: 1.52
[95%CI: 1.19, 7.93]; I<sup>2</sup>= 0%], NNH:13 [95%CI: 8, 33]).
Conclusion: Compared with standard therapy, early treatment with PSI
delays and prevents the development of CAV in adult HT recipients.
However, this benefit does not confer a lower risk of mortality at 1-year,
and was associated with a higher incidence of adverse events.
<18>
Accession Number
71404278
Authors
Bayman E. Brennan T.
Institution
(Bayman, Brennan) University of Iowa, Iowa City, IA, United States
Title
No change on the incidence of chronic pain after thoracotomy for 3
decades.
Source
Journal of Pain. Conference: 33rd Annual Scientific Meeting of the
American Pain Society Tampa, FL United States. Conference Start: 20140430
Conference End: 20140503. Conference Publication: (var.pagings). 15 (4
SUPPL. 1) (pp S11), 2014. Date of Publication: April 2014.
Publisher
Churchill Livingstone Inc.
Abstract
Meta-analyses were conducted to find the incidence of chronic pain at 3
and 6 months after thoracotomy and to determine whether the incidence of
chronic post-thoracotomy pain syndrome has changed since the 1990s. A
MEDLINE search was performed for databases and references for English
articles assessing the incidence of chronic pain after thoracic surgery
from prospective studies on adults. 722 articles were reviewed.
Meta-analyses are performed for the incidence of pain at 3 and 6 months
after thoracotomy and for articles published in 1990 - 1999, 2000 - 2009
and after 2009 for the incidence at 3 and 6 months separately. Event rates
and confidence intervals with random effect models and Freeman-Tukey
double arcsine variance-stabilizing transformation were obtained
separately for the incidence of chronic pain from 16 studies and 1373
patients at 3 months and 14 studies and 1294 patients at 6 months. The
incidences of chronic pain at 3 and 6 month after thoracotomy were 55% and
50%, respectively. For the incidence of chronic pain at 3 months after
thoracotomy, 3 studies from 1990's, 7 studies from 2000's and 6 studies
after 2009 were included. For the pain at 6 months, 2, 7 and 5 studies
from those periods were included. Reported chronic pain rates at 3 months
were 66%, 54%, and 52% in 1990 - 1999, 2000 - 2009 and after 2009,
respectively. Incidences at 6 months were similar for each decade (63%,
48% and 46%). Even if a trend for decreased pain both at 3 and 6 months
from the 1990s to the present is observed, chronic pain rates did not
change significantly since 1990's (p = 0.43 and 0.52). Chronic pain after
thoracotomy continues to be a high impact problem despite advances in
perioperative care.
<19>
Accession Number
71408053
Authors
Ladia V. Panchal H. Ramu V. Patel R. Paul T.
Institution
(Ladia, Panchal, Ramu, Patel, Paul) East Tennessee State University,
Johnson City, TN, United States
Title
Incidence of renal failure requiring hemodialysis following transcatheter
aoritc valve implantation using edwards valve for severe aortic stenosis:
A meta-analysis of transfemoral versus transapical approach.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A2029), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: Studies have shown that transfemoral approach for
transcatheter aortic valve implantation (TF-TAVI) requires more contrast
compared to transapical (TA-TAVI) approach during the procedure. The
purpose of this meta-analysis is to compare the amount of contrast used
and incidence of renal failure requiring hemodialysis between TF-TAVI and
TA-TAVI performed using Edwards valve. Methods: PubMed database was
searched through May 2013. Ten studies (n=2459) comparing TF-TAVI (n=1268)
and TA-TAVI (n=1191) procedures using Edwards valve were included. End
points were baseline logistic EuroSCORE (LES), amount of contrast and
incidence of renal failure requiring hemodialysis. The odds ratio (OR) and
95% confidence interval (CI) was computed and p<0.05 was considered as a
level of significance. Results: LES was significantly higher in TA-TAVI
compared to TF-TAVI (p=0.001). The amount of contrast (ml) used was
significantly higher in TFTAVI group compared to TA-TAVI (MD: 36.9, CI:
25.7-48.1, p<0.00001). The incidence of hemodialysis was significantly
higher in the TA-TAVI group compared to TF-TAVI (OR: 4.3, CI: 2.4-7.8,
p<0.00001). Conclusion: Our meta-analysis of 2459 patients suggest that
despite lower amount of contrast used in TA-TAVI, the incidence of renal
failure requiring hemodialysis was higher compared to TF-TAVI using
Edwards valve. This suggests that the incidence of renal failure requiring
hemodialysis is associated with baseline risk factors other than amount of
contrast used. (Table Presented).
<20>
Accession Number
71407988
Authors
Chakravarty T. Jilaihawi H. Noheria A. Doctor N. Patel J. Pokhrel H. Cheng
W. Makkar R.
Institution
(Chakravarty, Jilaihawi, Noheria, Doctor, Patel, Pokhrel, Cheng, Makkar)
Cedars-Sinai Medical Center, Los Angeles, CA, United States
Title
Impact of moderate-severe mitral regurgitation on outcomes after
transcatheter aortic valve replacement: Meta-analysis of 8 studies
comprising 6166 patients.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1964), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: There are conflicting reports on the impact of moderate-severe
mitral regurgitation (MR) on outcomes after transcatheter aortic valve
replacement (TAVR). We perform a meta-analysis of available studies to
evaluate the impact of moderate-severe MR on outcomes after TAVR. Methods:
Mantel-Haenszel random effects model was used to calculate the risk ratio.
Statistical analysis was performed using Review Manager 5.1 statistics
software. Results: Eight studies with a total of 6166 patients were
identified. Moderate-severe MR was present in 24.2% (1491/6166) and
none-mild MR was present in 75.8% (4684/6166) of patients undergoing TAVR.
Moderate-severe MR was associated with a trend towards increased 30-day
mortality (Risk ratio 1.35; 95% Confidence interval 0.95-1.93, p=0.10;
Figure 1A). At 1 year post-TAVR, moderate-severe MR was associated with a
statistically significant increase in mortality (Risk ratio 1.22; 95%
Confidence interval 1.02-1.47, p=0.03; Figure 1B). Conclusion: Moderate or
severe MR at baseline is common in patients undergoing TAVR and is
associated with increased 1-year mortality. (Table Presented).
<21>
Accession Number
71407947
Authors
Andalib A. Chetrit M. Filion K. Gatalas C. Mylotte D. Theriault-Lauzier P.
Alharbi W. Mamane S. Dorfmeister M. Girgis M. De Varennes B. Lachapelle K.
Cecere R. Lange R. Martucci J. Eisenberg M. Piazza N.
Institution
(Andalib, Chetrit, Filion, Gatalas, Mylotte, Theriault-Lauzier, Alharbi,
Mamane, Dorfmeister, Girgis, De Varennes, Lachapelle, Cecere, Lange,
Martucci, Eisenberg, Piazza) McGill University Health Centre, Montreal,
Canada, Jewish General Hospital, Montreal, Canada
Title
A systematic review and meta-analysis of surgical outcomes following
mitral valve surgery in patients with functional mitral regurgitation and
severe left ventricular dysfunction.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1923), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: Clinical guidelines for surgical management of significant
functional mitral regurgitation (MR) associated with severe left
ventricular (LV) dysfunction are not well established. Objective: The goal
of this systematic review and meta-analysis is to evaluate the outcomes of
mitral valve surgery in patients with significant functional MR and severe
LV dysfunction. This information may help with clinical decision-making
and potentially shed light on the future role of the rapidly developing
field of transcatheter mitral valve interventions. Methods: We performed a
systematic review and meta-analysis of published studies on patients with
severe LV dysfunction and significant functional MR who underwent mitral
valve repair (MVRpr) or mitral valve replacement (MVR). Bayesian
hierarchical models were used to estimate the pooled proportion of 30-day
operative mortality, cerebrovascular accidents, and renal failure.
Results: Our search yielded 24 observational studies. Pooled proportion of
operative mortality was 5% following MVRpr (23 studies, 1,608 patients,
95% credible interval (CrI) 4-7%) and 10% following MVR (8 studies, 343
patients, 95% CrI 5-20%). Furthermore, for patients undergoing MVRpr,
pooled proportions of post-operative cerebrovascular accidents and renal
failure were 2% (5 studies, 338 patients, 95% CrI 1-6%) and 14% (6
studies, 389 patients, 95% CrI 6-30%), respectively. In addition,
long-term survivals and pre-operative characteristics of individual
studies identified in our systematic review are presented. Conclusion:
Surgical treatment of significant functional MR in patients with severe LV
dysfunction is a challenging task that could potentially be performed with
an acceptable surgical risk. An individualized pre-operative screening
approach should be adopted to select cases for the appropriate surgical
technique and to potentially refer patients for transcatheter mitral valve
procedures.
<22>
Accession Number
71407914
Authors
Khan M.F. Wendel C. Thai H.
Institution
(Khan, Wendel, Thai) Southern Arizona VA Health Care System, Tucson, AZ,
United States
Title
Effect of procedural complications on in-hospital clinical outcomes after
percutaneous coronary chronic total occlusion interventions.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1890), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: Failed PCI (percutaneous coronary intervention) attempts for
CTOs (chronic total occlusions) mostly result from premature termination
of the procedure due to unwanted vascular complications. But the actual
effect of these complications on in-hospital survival after CTOPCI is
unknown. We presumed higher rates of procedural complications in patients
with failed CTO-PCI attempts and compared in-hospital outcomes between
successful and failed CTO-PCI groups to indirectly quantify the effect of
procedural complications on short-term clinical outcomes. Methods: We
performed a meta-analysis of 25 studies (16,490 patients) to analyze the
rates of in-hospital death, myocardial infarctions (MI), major adverse
cardiovascular events (MACE), urgent CABG (coronary artery bypass
grafting), coronary perforations and cardiac tamponades for the successful
and failed CTO-PCI groups. Results: Failed PCI attempts for CTOs were
associated with higher in-hospital mortality (RR of 2.88, p-value <
0.001), a higher risk of in-hospital MACE (RR of 2.25, p-value < 0.001),
and increased need for urgent CABG (RR of 6.67), p-value < 0.001).
Furthermore, higher rates of coronary perforations (RR of 5.09, p-value of
< 0.001) and cardiac tamponades (RR of 5.00, p-value of < 0.001) were
observed in the unsuccessful PCI arm. Conclusions: Higher rates of
procedural complications in patients with failed PCI attempts for CTO
appear to be associated with adverse inhospital outcomes. (Table
Presented).
<23>
Accession Number
71407888
Authors
Kannan A. Medina R. Ramanujam V. Poongkunran M. Balamuthusamy S.
Institution
(Kannan, Medina, Ramanujam, Poongkunran, Balamuthusamy) University of
Arizona, Tucson, AZ, United States
Title
Stroke risk in renal failure patients undergoing CABG vs PCI-meta
analysis.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1864), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Introduction: The presence of cardiovascular disease (CVD) is an important
predictor of mortality in patients with renal disease. A paucity of data
exists concerning the optimal method of coronary revascularization in
patients with renal disease. Objective: We performed a meta- analysis to
compare the risk of stroke in End Stage Renal Disease (ESRD) and Chronic
Kidney Disease (CKD) patients with CVD undergoing Coronary Artery Bypass
Graft (CABG) or Percutaneous Coronary Intervention (PCI). Methods:
Clinical trials evaluating the mortality in patients with ESRD and CKD
undergoing CABG and PCI were considered. Studies were obtained using
search words in Medline, Pubmed, EMBASE, CINAHL and Cochrane databases.
The relative risk across all study groups was computed using Mantel-
Hanszel random effects model. Results were calculated with 95% CI and was
considered statistically significant if 2-sided alpha error was <.05.
Results: Clinical outcomes in ESRD and CKD patients were analyzed
separately. Fifteen trials (n= 53,579) were included for analysis in the
ESRD group with average follow-up duration of 25 months. Five trials
(n=14,768) were included in CKD arm. Mean age and follow-up duration were
65.5 years and 36 months respectively. The relative risk for stroke in
ESRD patients undergoing CABG when compared to PCI was 3.46 (1.02, 11.78);
p=0.05)) and in CKD cohort was 0.78 (0.43, 1.41); p=0.41)). Conclusions:
There is a strong trend for decreased risk of stroke with PCI when
compared to CABG in the ESRD group. Though PCI seems to be associated with
a decreased risk for stroke in ESRD patients the results did not reach
statistical significance. The risk for stroke with PCI and CABG is
comparable in CKD patients. Prospective randomized studies that include
cardio-metabolic markers in ESRD and CKD patients would be required to
elucidate the pathophysiological mechanisms and risk for stroke in
patients with different stages of renal failure.
<24>
Accession Number
71407770
Authors
Kumar A. Paniagua D. Kar B. Deswal A. Alam M. Omer S. Bakaeen F. Rosengart
T. Blaustein A. Bozkurt B. Jneid H. De Bakey M.E.
Institution
(Kumar, Paniagua, Kar, Deswal, Alam, Omer, Bakaeen, Rosengart, Blaustein,
Bozkurt, Jneid, De Bakey) VA Medical Center, Houston, TX, United States
Title
Safety and effectiveness of balloon aortic valvuloplasty for severe aortic
stenosis in the contemporary era.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1746), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: The introduction of transcatheter aortic valve replacement
(TAVR) has renewed interest in balloon aortic valvuloplasty (BAV) for
severe aortic stenosis (AS). It is unclear whether technical advances and
increased experience associated with TAVR development have resulted in
improved BAV outcomes. We performed meta-analyses of all BAV studies and
examined the indications, hemodynamic outcomes, and procedural
complications of BAV in the contemporary era. Method: A literature search
from February 1987 through June 2013 was conducted for all studies
reporting BAV outcomes. Studies with < 50 BAV procedures were excluded.
BAV outcomes were compared in studies enrolling patients in the
early/pre-TAVR and contemporary/post-TAVR periods (before vs. after 2005).
Results: 27 studies representing 4,123 patients were included (Table). In
the contemporary era, BAV was performed as a bridge to TAVR in 23.4% of
patients. There were significant improvements in trans-aortic valvular
gradients, aortic valve area, and cardiac output following BAV in all time
periods. There was also a significant reduction in procedural death,
in-hospital mortality, and major vascular complications in contemporary
compared to early studies, with similar rates of myocardial infarction,
stroke, severe aortic insufficiency, and tamponade. Conclusion: BAV is
increasingly used as a bridge to TAVR, continues to impart significant
hemodynamic improvement, and has an improved safety profile in the
contemporary era. (Table presented).
<25>
Accession Number
71407751
Authors
Mylotte D. Andalib A. Theriault-Lauzier P. Dorfmeister M. Girgis M.
Mohtashami S. Alharbi W. Chetrit M. Galatas C. Mamane S. Sebag I. Buithieu
J. De Varennes B. Lachapelle K. Martucci J. Lange R. Piazza N.
Institution
(Mylotte, Andalib, Theriault-Lauzier, Dorfmeister, Girgis, Mohtashami,
Alharbi, Chetrit, Galatas, Mamane, Sebag, Buithieu, De Varennes,
Lachapelle, Martucci, Lange, Piazza) McGill University Health Centre,
Montreal, Canada
Title
Transcatheter heart valve failure: A systematic review.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1727), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: No study has addressed the failure modes of transcatheter
heart valves (THV). We performed a systematic review to investigate the
causes of THV failure, and to describe the clinical characteristics,
diagnosis, management, and outcomes of these patients. Methods: Between
January 2002 and October 2013, all studies reporting patient level data on
THV failure were identified. Reports describing only an incidence of THV
failure were excluded. Prosthetic valve endocarditis (PVE) was defined
according to the modified Duke criteria and the other outcomes were
defined according to VARC. Results: Among 56 separate publications (69
cases) of THV failure, 5 THV failure modes were identified: PVE (n=29),
structural valve failure (SVF) (n=8), thrombosis (n=12), late embolization
(n=13), and compression (n=7). Most (66%) PVE cases had risk factors
predisposing to IE: diabetes, immunosuppression etc. The microbiological
profile of THV PVE was similar to that of surgical PVE. Surgery was
performed in 1/3 of cases and 1/3 ultimately died. THV thrombosis with the
Edwards Sapien (n=11) and CoreValve (n=1) occurred at a mean 8+7 months
post implantation. Most patients (73%) were taking dual antiplatelet
agents and 2/3's were successfully treated with anticoagulation. SVF was
attributed to leaflet calcification (n=3), cusp rupture (n=1), and THV
underexpansion (n=1) or tissue ingrowth (n=1). The failure mode was
unclear in 2 cases. Management included surgical valve replacement (n=3)
or redo THV (n=5). All cases of late THV embolization occurred with the
Edwards Sapien THV. The time to presentation was 35+41 days and most
(n=11) THVs embolized to the left ventricle. Surgical intervention was
performed in 92% and 33% ultimately died. All 7 cases of valve compression
occurred with the Edwards Sapien THV in the setting of cardiac arrest. All
patients died. Conclusions: Although many THV failure modes are similar to
those of surgical bioprostheses, the management of these complications in
high-risk THV recipients differs substantially from surgical valve
patients. THV compression and late embolization represent unique THV
failure modes not described in the surgical literature.
<26>
Accession Number
71407379
Authors
Sharma A. Vallakati A. Einstein A. Lavie C. Arbab-Zadeh A. Lopez-Jimenez
F. Mukherjee D. Lichstein E.
Institution
(Sharma, Vallakati, Einstein, Lavie, Arbab-Zadeh, Lopez-Jimenez,
Mukherjee, Lichstein) Maimonides Medical Center, Brooklyn, NY, United
States
Title
Relationship of body mass index with total mortality, cardiovascular
mortality and myocardial infa rction after coronary revascularization:
Evidence from a meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1355), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: We aim to investigate the relationship of body mass index
(BMI) with total mortality, cardiovascular (CV) mortality and myocardial
infarction (MI) after coronary revascularization procedures (coronary
artery bypass grafting [CABG] and percutaneous coronary intervention
[PCI]). Methods and Results: A systematic search of studies published
between 1966 to May 2013 was conducted using Pub Med, CINAHL, Cochrane
CENTRAL and the Web of Science databases We identified studies reporting
rate of myocardial infarction, cardiovascular mortality and total
mortality among CAD patients' postcoronary revascularization procedures in
various BMI categories [<20 (underweight); 20-24.9 (normal reference);
25-29.9 (overweight); 30-34.9 (obese); >=35 (severe obese)]. Event rates
were compared using a random effects model assuming inter-study
heterogeneity. 36 studies (12 CABG; 26 PCI) were selected for final
analyses. The risk of total mortality, CV mortality and MI was highest
among patients with low BMI (RR 2.59 [95% CI 2.09 - 3.21]; 2.67 [95% CI
1.63 - 4.39], 1.79 [95% CI 1.28 -2.50] respectively) at the end of mean
follow up period of 1.7 years. Risk of CV mortality was lowest among
overweight patients (RR 0.81 [95% CI 0.68 - 0.95]). Increasing degree of
adiposity as assessed by BMI had a neutral effect on risk MI (RR (0.92
[95% CI 0.84- 1.01]), (0.99 [95% CI 0.85 -1.15]), and (0.93 [95% CI 0.78 -
1.11]) for overweight, obese and severe obese, respectively]. Conclusion:
After a coronary revascularization procedure, the risk of total mortality,
CV mortality and MI was highest among underweight patients and CV
mortality was lowest among overweight patients.
<27>
Accession Number
71407187
Authors
Romero J. Wever-Pinzon O. Golive A. Kelesidis I. Manrique C. Drakos S.
Pina I. Kfoury A. Stehlik J. Garcia M.
Institution
(Romero, Wever-Pinzon, Golive, Kelesidis, Manrique, Drakos, Pina, Kfoury,
Stehlik, Garcia) Montefiore Medical Center, Bronx, NY, United States
Title
Coronary computed tomography angiography for the detection of cardiac
allograft vasculopathy: A meta-analysis of prospective trials.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1163), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: Cardiac Allograft Vasculopathy (CAV) limits long term survival
after heart transplantation. We evaluated the diagnostic accuracy of
Coronary Computed Tomography Angiography (CCTA) for detecting CAV compared
with Conventional Coronary Angiography (CCAG) alone or with Intravascular
Ultrasound (IVUS). Methods: A systematic review of Medline, Cochrane, and
Embase for all prospective trials was performed with standard
meta-analysis approach for diagnostic test and bivariate analysis.
Thirteen studies evaluating 615 patients (mean age 52 years, 83% males)
and 9,481 segments were included. Results: Patient-based analyses
comparing CCTA vs. CCAG for detection of any CAV (> luminal
irregularities) and significant CAV (stenosis > 50%), showed mean weighted
sensitivities of 97% and 94%, specificities of 81% and 92%, negative
predictive value (NPV) of 97% and 99%, positive predictive value (PPV) of
78% and 67%, and diagnostic accuracies of 88% and 94%, respectively. There
was a strong trend towards improved sensitivity (97% vs. 91%, p=0.06) and
NPV (99% vs. 97%, p=0.06) to detect significant CAV with 64-slice vs.
16-slice CCTA. Analysis of 64-slice CCTA vs. IVUS showed a mean weighted
sensitivity and specificity of 81% and 75% to detect CAV (intimal
thickening > 0.5 mm), whereas PPV and NPV were 93% and 50%, respectively.
Conclusion: CCTA is a reliable noninvasive modality with excellent
sensitivity, specificity and NPV. CCTA as a screening tool for CAV is
feasible for heart transplant recipients. (Table Presented).
<28>
Accession Number
71407173
Authors
Jorge R. Lupercio F. Goodman D. Liebelt J. Garcia M.
Institution
(Jorge, Lupercio, Goodman, Liebelt, Garcia) Montefiore Medical Center,
Bronx, NY, USA, Jacobi Medical Center, Bronx, NY, USA
Title
Microvascular obstruction and intramyocardial hemorrhage detected on CMR
as predictors for mace and left ventricle adverse remodelling. A
meta-analysis of prospective studies.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A1149), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Microvascular obstruction (MVO) is a complication of coronary reperfusion
therapy in acute myocardial infarction detected on cardiovascular magnetic
resonance (CMR). It has been suggested that MVO may be an independent
predictor for major adverse cardiac events (MACEs) and LV reverse
remodeling (LVRR) especially if complicated with intra-myocardial
hemorrhage (IMH). Objective: To determine the prognostic value of MVO and
IMH detected by CMR as a predictor for MACEs and LV reverse remodeling in
patients with AMI. Methods: A systemic review of major databases for
clinical trials using CMR to detect MVO and IMH and its association with
MACE and LVRR with increase in LVEDVi and LVESVi in patients with AMI.
Given the high heterogeneity (i.e. I2 > 25), random effect model was used.
Results: A total of 21 studies with 2745 patients fulfilled the inclusion
criteria. The incidence for MVO was 66% (n:1846). The Risk Ratio (RR) for
MACEs in the presence of MVO (RR 3.68, 95%CI 2-3), which showed that MVO
on CE-CMR increases the chance of developing MACE by 3.32 fold. Head to
head comparison of patients with and without MVO on initial CMR within 1
week for AMI showed a higher incidence of LVRR on the follow up CMR at a
mean time of 6 months (SD+/-1). Patients with MVO had significantly higher
volumes. The mean difference in LVEDVi and LVESVi between the initial and
follow up CMR was 8.67 (95% CI 5.83-11.52) and 8.31 (95% CI 5.92-10.71)
respectively. Conclusion: MVO and IMH detected by CE-CMR are strong
predictors for MACEs and LVRR. (Figure Presented).
<29>
Accession Number
71406341
Authors
Santangeli P. Epstein A. Hutchinson M. Zado E. Muser D. Callans D.J.
Marchlinski F.
Institution
(Santangeli, Epstein, Hutchinson, Zado, Muser, Callans, Marchlinski)
University of Pennsylvania, Philadelphia, PA, United States
Title
Comparative effectiveness of left ventricular versus biventricular pacing
for cardiac resynchronization therapy: A meta-analysis of randomized
controlled trials.
Source
Journal of the American College of Cardiology. Conference: 63rd Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.14 Washington, DC United States.
Conference Start: 20140329 Conference End: 20140331. Conference
Publication: (var.pagings). 63 (12 SUPPL. 1) (pp A317), 2014. Date of
Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Background: Cardiac resynchronization therapy (CRT) reduces symptoms and
improves survival in patients with severe left ventricular (LV)
dysfunction and a prolonged QRS duration. The extent to which such benefit
is due to biventricular (BV) versus LV pacing is unclear. This systematic
review and meta-analysis of randomized trials compares BV versus LV-only
pacing in patients undergoing CRT. Methods: We searched PubMed, CENTRAL,
BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of
Science for randomized controlled trials specifically designed to compare
BV with LV-only pacing in patients undergoing CRT. Data regarding
all-cause mortality or heart transplantation, hospitalization, LV ejection
fraction (LVEF), and exercise tolerance (i.e., 6-minute walk test, 6MWT)
were extracted. Odds ratios (OR) and weighted mean difference (WMD) with
their 95% confidence intervals (CI) were calculated and pooled using a
random-effect model. Results: We identified 8 trials that enrolled 786
patients (age 63.3 + 2.9 years, 73% males) with severe LV dysfunction
(LVEF 23.4 + 1.9%; 57% ischemic cardiomyopathy; average QRS duration 173 +
18 ms). 342 (43%) patients were randomized to LV-only pacing. The mean
follow-up duration was 6.5 + 4.1 mo. On pooled analysis, no difference was
found between LV-only and BV pacing for the endpoints of death or heart
transplantation (OR 1.12, 95% CI 0.53 to 2.39, P = 0.77), and
hospitalization (OR 0.46, 95% CI 0.09 to 2.26, P = 0.34). Compared to BV
pacing, LV-only pacing provided similar improvements in LVEF (mean
increase 5.3+1.1% vs. 6.4+2.9%, respectively; WMD -0.98, 95% CI -2.47 to
0.51, P = 0.19) and exercise tolerance at the 6MWT (mean increase
46.4+24.6 m vs. 51.9+20.4 m, respectively; WMD -4.43, 95% CI -15.46 to
6.59, P = 0.43). Conclusions: LV-only pacing provides similar benefits to
BV pacing in terms of all-cause mortality, need for transplantation,
hospitalization, improvement in LVEF and exercise tolerance. In patients
treated with CRT who are not pacemaker-dependent, LV-only pacing is an
alternative to increase battery longevity.
