EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
24297433
Authors
Penninga L. Moller C.H. Gustafsson F. Gluud C. Steinbruchel D.A.
Institution
(Penninga) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Rigshospitalet, Copenhagen University Hospital,
Blegdamsvej 9, Copenhagen, Denmark, DK-2100.
Title
Immunosuppressive T-cell antibody induction for heart transplant
recipients.
Source
The Cochrane database of systematic reviews. 12 (pp CD008842), 2013. Date
of Publication: 2013.
Abstract
Heart transplantation has become a valuable and well-accepted treatment
option for end-stage heart failure. Rejection of the transplanted heart by
the recipient's body is a risk to the success of the procedure, and
life-long immunosuppression is necessary to avoid this. Clear evidence is
required to identify the best, safest and most effective immunosuppressive
treatment strategy for heart transplant recipients. To date, there is no
consensus on the use of immunosuppressive antibodies against T-cells for
induction after heart transplantation. To review the benefits, harms,
feasibility and tolerability of immunosuppressive T-cell antibody
induction versus placebo, or no antibody induction, or another kind of
antibody induction for heart transplant recipients. We searched the
Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2012),
MEDLINE (Ovid) (1946 to November Week 1 2012), EMBASE (Ovid) (1946 to 2012
Week 45), ISI Web of Science (14 November 2012); we also searched two
clinical trial registers and checked reference lists in November 2012. We
included all randomised clinical trials (RCTs) (24/90 (27%) versus 10/95
(11%); RR 2.43; 95% CI 1.01 to 5.86; I(2) 28%). For all of these
differences in acute rejection, trial sequential alpha-spending boundaries
were not crossed and the required information sizes were not reached when
trial sequential analysis was performed, at a high risk of bias. Hence,
more RCTs are needed to assess the benefits and harms of T-cell antibody
induction for heart-transplant recipients. Such trials ought to be
conducted with low risks of systematic and random error.

<2>
Accession Number
24374731
Authors
Bradt J. Dileo C. Potvin N.
Institution
(Bradt) Department of Creative Arts Therapies, College of Nursing and
Health Professions, Drexel University, 1505 Race Street, rm 1041,
Philadelphia, PA, USA, 19102.
Title
Music for stress and anxiety reduction in coronary heart disease patients.
Source
The Cochrane database of systematic reviews. 12 (pp CD006577), 2013. Date
of Publication: 2013.
Abstract
Individuals with coronary heart disease (CHD) often suffer from severe
distress due to diagnosis, hospitalization, surgical procedures,
uncertainty of outcome, fear of dying, doubts about progress in recovery,
helplessness and loss of control. Such adverse effects put the cardiac
patient at greater risk for complications, including sudden cardiac death.
It is therefore of crucial importance that the care of people with CHD
focuses on psychological as well as physiological needs.Music
interventions have been used to reduce anxiety and distress and improve
physiological functioning in medical patients; however its efficacy for
people with CHD needs to be evaluated. To update the previously published
review that examined the effects of music interventions with standard care
versus standard care alone on psychological and physiological responses in
persons with CHD. We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) on The Cochrane Library (2012, Issue 10), MEDLINE
(OvidSP, 1950 to October week 4 2012), EMBASE (OvidSP, 1974 to October
week 5 2012), CINAHL (EBSCOhost, 1982 to 9 November 2012), PsycINFO
(OvidSP, 1806 to October week 5 2012), LILACS (Virtual Health Library,
1982 to 15 November 2012), Social Science Citation Index (ISI, 1974 to 9
November 2012), a number of other databases, and clinical trial registers.
We also conducted handsearching of journals and reference lists. We
applied no language restrictions. We included all randomized controlled
trials and quasi-randomized trials that compared music interventions and
standard care with standard care alone for persons with confirmed CHD. Two
review authors independently extracted data and assessed methodological
quality, seeking additional information from the trial researchers when
necessary. We present results using weighted mean differences for outcomes
measured by the same scale, and standardized mean differences for outcomes
measured by different scales. We used post-intervention scores. In cases
of significant baseline difference, we used change scores (changes from
baseline). We identified four new trials for this update. In total, the
evidence for this review rests on 26 trials (1369 participants). Listening
to music was the main intervention used, and 23 of the studies did not
include a trained music therapist.Results indicate that music
interventions have a small beneficial effect on psychological distress in
people with CHD and this effect is consistent across studies (MD = -1.26,
95% CI -2.30 to -0.22, P = 0.02, I² = 0%). Listening to music
has a moderate effect on anxiety in people with CHD; however results were
inconsistent across studies (SMD = -0.70, 95% CI -1.17 to -0.22, P =
0.004, I² = 77%). Studies that used music interventions in
people with myocardial infarction found more consistent anxiety-reducing
effects of music, with an average anxiety reduction of 5.87 units on a 20
to 80 point score range (95% CI -7.99 to -3.75, P < 0.00001, I²
= 53%). Furthermore, studies that used patient-selected music resulted in
greater anxiety-reducing effects that were consistent across studies (SMD
= -0.89, 95% CI -1.42 to -0.36, P = 0.001, I² = 48%). Findings
indicate that listening to music reduces heart rate (MD = -3.40, 95% CI
-6.12 to -0.69, P = 0.01), respiratory rate (MD = -2.50, 95% CI -3.61 to
-1.39, P < 0.00001) and systolic blood pressure (MD = -5.52 mmHg, 95% CI -
7.43 to -3.60, P < 0.00001). Studies that included two or more music
sessions led to a small and consistent pain-reducing effect (SMD = -0.27,
95% CI -0.55 to -0.00, P = 0.05). The results also suggest that listening
to music may improve patients' quality of sleep following a cardiac
procedure or surgery (SMD = 0.91, 95% CI 0.03 to 1.79, P = 0.04).We found
no strong evidence for heart rate variability and depression. Only one
study considered hormone levels and quality of life as an outcome
variable. A small number of studies pointed to a possible beneficial
effect of music on opioid intake after cardiac procedures or surgery, but
more research is needed to strengthen this evidence. This systematic
review indicates that listening to music may have a beneficial effect on
anxiety in persons with CHD, especially those with a myocardial
infarction. Anxiety-reducing effects appear to be greatest when people are
given a choice of which music to listen to.Furthermore, listening to music
may have a beneficial effect on systolic blood pressure, heart rate,
respiratory rate, quality of sleep and pain in persons with CHD. However,
the clinical significance of these findings is unclear. Since many of the
studies are at high risk of bias, these findings need to be interpreted
with caution. More research is needed into the effects of music
interventions offered by a trained music therapist.

<3>
Accession Number
23720096
Authors
Fredericks S. Yau T.
Institution
(Fredericks) Ryerson University, Toronto, ON, Canada
(Yau) University of Toronto, ON, Canada
Title
Educational Intervention Reduces Complications and Rehospitalizations
After Heart Surgery.
Source
Western Journal of Nursing Research. 35 (10) (pp 1251-1265), 2013. Date of
Publication: November 2013.
Abstract
The effectiveness of in-hospital self-care patient education, delivered to
patients following heart surgery, is questionable, as evidence indicates
individuals are not able to absorb and/or retain information at this time.
In the absence of adequate instruction, individuals will not have the
relevant information to engage in specific self-care behaviors, resulting
in the onset of complications and/or hospital readmissions. The purpose of
this pilot study was to collect preliminary evidence to demonstrate the
impact of an individualized education intervention given above and beyond
usual care, delivered, at two points in time, following hospital
discharge. A randomized controlled trial was used in which 34 patients
were randomly assigned to one of two groups. Chi-square analyses to
examine differences between groups on complications and hospital
readmission rates were conducted. Findings point to the impact of the
intervention in reducing the number of hospital readmissions and
complications at 3 months following hospital discharge. The Author(s)
2013.

<4>
Accession Number
2014214754
Authors
Mrozinski P. Lango R. Biedrzycka A. Kowalik M.M. Pawlaczyk R. Rogowski J.
Institution
(Mrozinski, Lango, Biedrzycka, Kowalik) Department of Cardiac
Anaesthesiology, Medical University of Gdansk, ul. Debinki 7, 80-211
Gdansk, Poland
(Pawlaczyk, Rogowski) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Poland
Title
Comparison of haemodynamics and myocardial injury markers under desflurane
vs propofol anaesthesia for off-pump coronary surgery. A prospective
randomised trial.
Source
Anaesthesiology Intensive Therapy. 46 (1) (pp 4-13), 2014. Date of
Publication: January-March 2014.
Publisher
Via Medica
Abstract
Background: Several studies have highlighted that volatile anaesthetics
improve myocardial protection in cardiopulmonary bypass coronary surgery.
However, the haemodynamic effect of desflurane in off-pump coronary
surgery has not been clarified yet. Our study hypothesis was that
desflurane-fentanyl anaesthesia could decrease myocardial injury markers
and improve haemodynamics compared to propofol-fentanyl in patients
undergoing off-pump coronary surgery. Methods: Design: Prospective
randomised open-label study. Sixty elective patients with left ventricular
ejection fraction above 30% received either desflurane (group D, n = 32)
or propofol (group P, n = 28), in addition to fentanyl and vecuronium
bromide anaesthesia for off-pump coronary surgery. Assessment of
haemodynamic function included thermodilution continuous cardiac output
and right ventricular end diastolic volume. Results: No significant
differences in cardiac output, stroke volume and mean arterial pressure
were noted between groups. The only observed difference in haemodynamic
profile was that group D demonstrated improved stability, expressed as
left ventricular stroke work index (LVSWI). Decrease in LVSWI after
performing distal anastomoses was smaller in D compared to P (median
value: -14.3 and -19.8 [g m m ^-2 beat^-1]),
respectively (P = 0.029). Oxygen uptake index (VO₂I) and oxygen
extraction ratio (OER) after skin incision were lower in D, while blood
lactate concentration was slightly higher after surgery in D compared to
P. The groups did not differ with respect to CK-MB and troponin I
concentration. Conclusions: This study demonstrated no difference between
desflurane and propofol anaesthesia for off-pump coronary surgery in major
haemodynamic parameters, as well as in myocardial injury markers and the
long-term outcome. However, the study indicated that desflurane might
accelerate recovery of myocardial contractility, as assessed by LVSWI.
Lower oxygen uptake and elevated lactate under desflurane anaesthesia
indicated a discrete shift towards anaerobic metabolism. Clinical trial
registration information: NCT00528515 (http://www.clinicaltrials.gov/
ct2/show/NCT00528515?term= NCT00528515&rank = 1).

<5>
Accession Number
2014210202
Authors
Arulkumaran N. Corredor C. Hamilton M.A. Ball J. Grounds R.M. Rhodes A.
Cecconi M. Mahajan R.P.
Institution
(Arulkumaran, Corredor, Hamilton, Ball, Grounds, Rhodes, Cecconi, Mahajan)
Department of Intensive Care Medicine, St George's Hospital, London SW17
0QT, United Kingdom
Title
Cardiac complications associated with goal-directed therapy in high-risk
surgical patients: A meta-analysis.
Source
British Journal of Anaesthesia. 112 (4) (pp 648-659), 2014. Date of
Publication: April 2014.
Publisher
Oxford University Press
Abstract
SummaryPatients with limited cardiopulmonary reserve are at risk of
mortality and morbidity after major surgery. Augmentation of oxygen
delivery index (DO₂I) with i.v. fluids and inotropes
(goal-directed therapy, GDT) has been shown to reduce postoperative
mortality and morbidity in high-risk patients. Concerns regarding cardiac
complications associated with fluid challenges and inotropes may prevent
clinicians from performing GDT in patients who need it most. We
hypothesized that GDT is not associated with an increased risk of cardiac
complications in high-risk, non-cardiac surgical patients. We performed a
systematic search of Medline, Embase, and CENTRAL databases for randomized
controlled trials (RCTs) of GDT in high-risk surgical patients. Studies
including cardiac surgery, trauma, and paediatric surgery were excluded.
We reviewed the rates of all cardiac complications, arrhythmias,
myocardial ischaemia, and acute pulmonary oedema. Meta-analyses were
performed using RevMan software. Data are presented as odds ratios (ORs),
[95% confidence intervals (CIs)], and P-values. Twenty-two RCTs including
2129 patients reported cardiac complications. GDT was associated with a
reduction in total cardiovascular (CVS) complications [OR=0.54,
(0.38-0.76), P=0.0005] and arrhythmias [OR=0.54, (0.35-0.85), P=0.007].
GDT was not associated with an increase in acute pulmonary oedema
[OR=0.69, (0.43-1.10), P=0.12] or myocardial ischaemia [OR=0.70,
(0.38-1.28), P=0.25]. Subgroup analysis revealed the benefit is most
pronounced in patients receiving fluid and inotrope therapy to achieve a
supranormal DO₂I, with the use of minimally invasive cardiac
output monitors. Treatment of high-risk surgical patients GDT is not
associated with an increased risk of cardiac complications; GDT with
fluids and inotropes to optimize DO₂I during early GDT reduces
postoperative CVS complications. The Author [2013].

<6>
Accession Number
2014210125
Authors
Kristeller J.L. Jankowski A. Reinaker T.
Institution
(Kristeller) Department of Pharmacy Practice, Wilkes University, 84 W.
South Street, Wilkes-Barre, PA 18766, United States
(Jankowski) Geisinger Medical Center, Danville, PA, United States
(Reinaker) Department of Pharmacy, York Hospital, York, PA, United States
Title
Role of corticosteroids during cardiopulmonary bypass.
Source
Hospital Pharmacy. 49 (3) (pp 232-236), 2014. Date of Publication: 01 Mar
2014.
Publisher
Facts and Comparisons
Abstract
Corticosteroids are commonly used in the peri-operative setting for
patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The
inflammatory response to CPB is associated with organ dysfunction and
increased mortality. Corticosteroids reduce biochemical inflammatory
markers associated with CPB, however the impact on clinical outcomes is
mixed. The purpose of this article is to evaluate the evidence of changes
in clinical outcomes associated with the peri-operative administration of
corticosteroids in patients undergoing cardiac surgery with CPB.
Randomized, placebo-controlled trials and meta-analyses were reviewed for
evidence evaluating the impact of corticosteroids on clinical outcomes
including mortality, myocardial infarction, atrial fibrillation (AF),
duration of intubation, length of intensive care unit (ICU) or hospital
stay, hyperglycemia, and gastrointestinal complications. Most of the
relevant studies are underpowered to assess major clinical outcomes.
Although corticosteroids likely reduce the risk of AF, this needs to be
evaluated when used in addition to or in lieu of other anti-arrhythmic
agents. Evidence does not equivocally support the use of corticosteroids
to improve clinical outcomes in cardiac surgery patients. 2014 Thomas
Land Publishers, Inc.

<7>
Accession Number
2014210156
Authors
Hutcheson J.D. Aikawa E. Merryman W.D.
Institution
(Hutcheson) Center for Interdisciplinary Cardiovascular Sciences, Brigham
and Women's Hospital, Harvard Medical School, 3 Blackfan Circle, Boston,
MA 02115, United States
(Aikawa) Center for Excellence in Vascular Biology, Brigham and Women's
Hospital, Harvard Medical School, 3 Blackfan Circle, Boston, MA 02115,
United States
(Merryman) Department of Biomedical Engineering, Vanderbilt University,
2213 Garland Avenue, Nashville, TN 37212, United States
Title
Potential drug targets for calcific aortic valve disease.
Source
Nature Reviews Cardiology. 11 (4) (pp 218-231), 2014. Date of Publication:
April 2014.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Calcific aortic valve disease (CAVD) is a major contributor to
cardiovascular morbidity and mortality and, given its association with
age, the prevalence of CAVD is expected to continue to rise as global life
expectancy increases. No drug strategies currently exist to prevent or
treat CAVD. Given that valve replacement is the only available clinical
option, patients often cope with a deteriorating quality of life until
diminished valve function demands intervention. The recognition that CAVD
results from active cellular mechanisms suggests that the underlying
pathways might be targeted to treat the condition. However, no such
therapeutic strategy has been successfully developed to date. One hope was
that drugs already used to treat vascular complications might also improve
CAVD outcomes, but the mechanisms of CAVD progression and the desired
therapeutic outcomes are often different from those of vascular diseases.
Therefore, we discuss the benchmarks that must be met by a CAVD treatment
approach, and highlight advances in the understanding of CAVD mechanisms
to identify potential novel therapeutic targets. 2014 Macmillan
Publishers Limited.

<8>
Accession Number
2014208873
Authors
Fernando D.K. McIntosh A.M. Bladin P.F. Wilson S.J.
Institution
(Fernando, Wilson) Melbourne School of Psychological Sciences, The
University of Melbourne, Parkville 3010, Australia
(McIntosh) Melbourne Brain Centre, Department of Medicine, The Royal
Melbourne Hospital, The University of Melbourne, Melbourne, Australia
(McIntosh, Wilson) Epilepsy Research Centre, Department of Medicine,
Austin Health, The University of Melbourne, Australia
(McIntosh) Department of Neurology, The Royal Melbourne Hospital,
Melbourne, Australia
(McIntosh) Department of Neurology, Austin Health, Melbourne, Australia
(Bladin, Wilson) Comprehensive Epilepsy Program, Austin Health, Melbourne,
Australia
Title
Common experiences of patients following suboptimal treatment outcomes:
Implications for epilepsy surgery.
Source
Epilepsy and Behavior. 33 (pp 144-151), 2014. Date of Publication: April
2014.
Publisher
Academic Press Inc.
Abstract
Few studies have investigated the patient experience of unsuccessful
medical interventions, particularly in the epilepsy surgery field. The
present review aimed to gain insight into the patient experience of
seizure recurrence after epilepsy surgery by examining the broader
literature dealing with suboptimal results after medical interventions
(including epilepsy surgery). To capture the patient experience, the
literature search focused on qualitative research of patients who had
undergone medically unsuccessful interventions, published in English in
scholarly journals. Twenty-two studies were found of patients experiencing
a range of suboptimal outcomes, including seizure recurrence, cancer
recurrence and progression, unsuccessful joint replacement, unsuccessful
infertility treatment, organ transplant rejection, coronary bypass graft
surgery, and unsuccessful weight-loss surgery. In order of frequency, the
most common patient experiences included the following: altered social
dynamics and stigma, unmet expectations, negative emotions, use of coping
strategies, hope and optimism, perceived failure of the treating team,
psychiatric symptoms, and control issues. There is support in the epilepsy
surgery literature that unmet expectations and psychiatric symptoms are
key issues for patients with seizure recurrence, while other common
patient experiences have been implied but not systematically examined.
Several epilepsy surgery specific factors influence patient perceptions of
seizure recurrence, including the nature of postoperative seizures, the
presence of postoperative complications, and the need for increased
postoperative medications. Knowledge of common patient experiences can
assist in the delivery of patient follow-up and rehabilitation services
tailored to differing outcomes after epilepsy surgery. 2014 Elsevier Inc.

<9>
Accession Number
2014210292
Authors
Takagi H. Watanabe T. Mizuno Y. Kawai N. Umemoto T.
Institution
(Takagi, Watanabe, Mizuno, Kawai, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
A meta-analysis of large randomized trials for mid-term major cardio- and
cerebrovascular events following off-pump versus on-pump coronary artery
bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 522-524),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
To determine whether off-pump coronary artery bypass grafting (CABG)
increases mid-term major adverse cardiovascular (and cerebrovascular)
events MACCE over on-pump CABG, we performed a meta-analysis of exclusive
large randomized controlled trials (RCTs). Databases including MEDLINE,
EMBASE and the Cochrane Central Register of Controlled Trials were
searched through October 2013 using Web-based search engines (PubMed and
OVID). Eligible studies were RCTs of off-pump vs on-pump CABG enrolling
>100 patients in each procedure and reporting MACCE at the time of >1 year
follow-up. Mixed-effects meta-regression analyses were performed to
determine whether the effects of off-pump CABG on MACCE were modulated by
the prespecified factors. Eight RCTs enrolling 10 954 patients were
identified and included. A pooled analysis demonstrated no statistically
significant difference in off-pump and on-pump CABG (hazard ratio, 1.10;
95% confidence interval, 0.93-1.29; P = 0.27). In general, exclusion of
any single study from the analysis did not substantially alter the overall
result of our analysis. There was no evidence of significant publication
bias. Meta-regression coefficients were not statistically significant for
mean age, proportion of men and that of diabetes. In conclusion, off-pump
CABG appears not to increase mid-term MACCE over on-pump CABG. The Author
2013.

<10>
Accession Number
2014210289
Authors
Sastry P. Tocock A. Coonar A.S.
Institution
(Sastry, Tocock, Coonar) Department of Cardiothoracic Surgery, Papworth
Hospital, Papworth Everard, Cambridge CB23 3RE, United Kingdom
Title
Adrenalectomy for isolated metastasis from operable non-small-cell lung
cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 495-497),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'in [patients with
isolated adrenal metastasis from operable/operated non-small cell lung
cancer] is [adrenalectomy] superior [to chemo/radiotherapy alone for
achieving long-term survival]?' Altogether >160 papers were found using
the reported search, of which 3 represented the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. We conclude that the body of
evidence is small, retrospective and not formally controlled. As such
interpretation is limited by selection bias in assignment of patients.
These limitations notwithstanding, surgical resection is associated with
prolonged survival for patients with isolated adrenal metastasis from
non-small cell lung cancer (NSCLC). Patient selection is probably
critical. Factors that are important are: otherwise early tumour, node
(TN) status of the lung primary and R0 resection, long disease-free
interval and confidence that there are no other sites of metastasis.
Patients with ipsilateral adrenal metastasis may derive the greatest
survival benefit from adrenalectomy, since spread to the ipsilateral gland
may occur via direct lymphatic channels in the retroperitoneum.
Involvement of the contralateral adrenal may signify haematogenous spread
and therefore, a more aggressive process. Adrenalectomy must be
accompanied by regional lymph node clearance to reduce the chance of
further spread from the adrenal itself. The Author 2013.

<11>
Accession Number
2014210288
Authors
Ogutu P. Werner R. Oertel F. Beyer M.
Institution
(Ogutu, Oertel, Beyer) Department of Cardiothoracic Surgery, Klinikum
Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
(Werner) Department of Cardiovascular Surgery, Herz-Neuro-Zentrum
Bodensee, Kreuzlingen, Switzerland
Title
Should patients with asymptomatic significant carotid stenosis undergo
simultaneous carotid and cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 511-518),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiovascular surgery was written according to a
structured protocol. The question addressed was whether patients with
severe asymptomatic carotid and coronary artery diseases should undergo
simultaneous carotid endarterectomy (CEA) and coronary artery bypass
grafting (CABG). A total of 624 papers were found using the reported
search, of which 20 represent the best evidence to answer the clinical
question. The author, journal, date and country of publication, patient
group studied, study type, relevant outcomes, results and study results of
these papers are tabulated. Previous cohort studies showed mixed results,
while advocating for the necessity of a randomized controlled trial (RCT).
A recent RCT showed that patients undergoing prophylactic or simultaneous
CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1-3
months after CABG (7.7%), without significant perioperative mortality
difference. This study included patients with unilateral severe (>70%)
asymptomatic carotid stenosis requiring CABG. An earlier partly randomized
trial also showed better outcomes for patients undergoing simultaneous
procedures (P = 0.045). Interestingly, systematic reviews previously
failed to show compelling evidence supporting prophylactic CEA. This could
be partly due to the fact that these reviews collectively analyse
different cohort qualities. Neurological studies have, however, shown
reduced cognitive and phonetic quality and function in patients with
unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one
RCTs comparing lone carotid artery stenting (CAS) and CEA informed the
American Heart Association guidelines, which declared CAS comparable with
CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the
risk of death/stroke for CAS alone is double that for CEA alone in the
acute phase following onset of symptoms, while CEA alone is associated
with a doubled risk of myocardial infarction. There is, however, no
significant difference for combined 30-day risk of death/stroke/myocardial
infarction. Outcomes of hybrid or simultaneous CAS/CABG procedures show
comparable results, albeit from rather small cohorts. While current
evidence leans towards simultaneous CEA/CABG, the emergence of hybrid
operating theatres in various institutions may allow larger cohorts with
subsequent significant data on simultaneous CAS/CABG. A randomized
controlled trial comparing both approaches would be crucial in informing
future updates of existing guidelines. The Author 2013.

<12>
Accession Number
2014210286
Authors
Zakkar M. Kanagasabay R. Hunt I.
Institution
(Zakkar, Kanagasabay, Hunt) Department of Cardiothoracic, St. George's
Hospital, Blackshaw Road, SW17 0QT London, United Kingdom
Title
No evidence that manual closure of the bronchial stump has a lower failure
rate than mechanical stapler closure following anatomical lung resection.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (4) (pp 488-493),
2014. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether manual closure of
the bronchial stump is safer with lower failure rates than mechanical
closure using a stapling device following anatomical lung resection. One
hundred and twenty-nine papers were identified using the search below.
Eight papers presented the best evidence to answer the clinical question
as they included sufficient number of patients to reach conclusions
regarding the issues of interest for this review. Complications,
complication rates and operation time were included in the assessment. The
author, journal, date and country of publication, patient group studied,
study type, relevant outcomes, results and study weaknesses of the papers
are tabulated. When looking at manual vs mechanical staples, it was noted
that stapler failure can occur in around 4% of cases. The rate of
bronchopleural fistula (BPF) development varied more in patients who
underwent manual closure (1.5-12.5%) than in patients who underwent
mechanical closure (1-5.7%). Although most of the studies reviewed showed
no statistical differences between manual and mechanical closure in terms
of BPF development, one study, however, showed that manual closure was
significantly associated with lower numbers of postoperative BPF, while
another study showed that mechanical closure is significantly associated
with lower incidence of BPF. When looking at the role of the learning
curve and training opportunities, it seems that the surgeon's inexperience
when using mechanical staples can contribute to BPF development. A
surgeon's experience can play a major role in the prevention of BPF
development in patients having manual closure. Manual closure can provide
a cheap and reliable technique when compared with costs incurred from
using staplers, it is applicable in all situations and can be taught to
surgeons in training with an acceptable risk. However, there is a lack of
evidence to suggest that manual closure is better than mechanical stapler
closure following anatomical lung resection. The Author 2013.

<13>
Accession Number
2014215569
Authors
Choquet S. Varnous S. Deback C. Golmard J.L. Leblond V.
Institution
(Choquet, Leblond) Clinical Hematology Unit, CHU la Pitie Salpetriere
Hospital, APHP, Paris, France
(Varnous) Department of Heart Surgery, CHU la Pitie Salpetriere Hospital,
APHP, Paris, France
(Deback) Virology Laboratory, CHU la Pitie Salpetriere Hospital, APHP,
Paris, France
(Golmard) Department of Biostatistics, CHU la Pitie Salpetriere Hospital,
APHP, Paris, France
Title
Adapted treatment of epstein-barr virus infection to prevent
posttransplant lymphoproliferative disorder after heart transplantation.
Source
American Journal of Transplantation. 14 (4) (pp 857-866), 2014. Date of
Publication: April 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Up to 35% of posttransplant lymphoproliferative disorder (PTLD) cases
occur within 1 year of transplantation, and over 50% are associated with
Epstein-Barr virus (EBV). EBV primary infection and reactivation are PTLD
predictive factors, but there is no consensus for their treatment. We
conducted a prospective single-center study on 299 consecutive
heart-transplant patients treated with the same immunosuppressive regimen
and monitored by repetitive EBV viral-load measurements and endomyocardial
biopsies to detect graft rejection. Immunosuppression was tapered on EBV
reactivation with EBV viral loads >10⁵copies/mL or primary
infection. In the absence of response at 1 month or a viral load
>10⁶copies/mL, patients received one rituximab infusion
(375mg/m²). All patients responded to treatment without
increased graft rejection. One primary infection case developed a possible
PTLD, which completely responded to diminution of immunosuppression, and
one patient, whose EBV load was unevaluable, died of respiratory
complications secondary to PTLD. Compared with a historical cohort of 820
patients, PTLD incidence was decreased (p=0.033) by a per-protocol
analysis. This is the largest study on EBV primary infection/reactivation
treatment, the first using rituximab following solid organ transplantation
to prevent PTLD and the first to demonstrate an acceptable tolerability
profile in this setting. Copyright 2014 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<14>
Accession Number
2014209147
Authors
Pandit A. Aryal M.R. Pandit A.A. Jalota L. Kantharajpur S. Hakim F.A. Lee
H.R.
Institution
(Pandit, Pandit, Hakim, Lee) Division of Cardiovascular Diseases, Mayo
Clinic, Scottsdale Arizona, United States
(Aryal, Jalota) Department of Internal Medicine, Reading Health System,
West Reading, PA, United States
(Kantharajpur) Department of Medicine, Huntsville Hospital, Alabama,
United States
Title
Amplatzer PFO Occluder Device may Prevent Recurrent Stroke in Patients
with Patent Foramen Ovale and Cryptogenic Stroke: A Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. 23 (4) (pp 303-308), 2014. Date of
Publication: April 2014.
Publisher
Elsevier BV
Abstract
Objective: To review efficacy of percutaneous closure of patent foramen
ovale compared with medical therapy in prevention of recurrent strokes in
patients with cryptogenic stroke. Methods and Results: Electronic
databases; PUBMED, EMBASE, Cochrane registry and web of knowledge were
searched for relevant studies. In three randomised clinical trials
involving 2303 participants, risk of the recurrent strokes (pooled HR
0.62, 95% CI=0.36-1.07, P=0.09, I² =10%) did not show benefit
with device closure when compared with medical therapy group on
meta-analysis of all three trials. However, on sensitivity analysis in
trials using Amplatzer PFO occluder device, the closure of PFO was
associated with significantly lower recurrent strokes (pooled HR=0.44, 95%
CI=0.21-0.94, P=0.03, I²=0%) compared with medical therapy.
Conclusion: The closure of PFO with Amplatzer PFO occluder device was
associated with significant reduction in recurrent strokes in patients
with cryptogenic stroke and patent foramen ovale. The better outcome in
prevention of secondary stroke in patients with cryptogenic stroke and PFO
may be associated with type of closure device used. 2013 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<15>
Accession Number
2014209108
Authors
De Luca G. Schaffer A. Verdoia M. Suryapranata H.
Institution
(De Luca, Schaffer, Verdoia) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, Novara, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting
stents in diabetic patients with multivessel coronary artery disease.
Source
Nutrition, Metabolism and Cardiovascular Diseases. 24 (4) (pp 344-354),
2014. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
Background and aim: Clinical trials have reported lower mortality and
repeated revascularization rate in diabetic patients treated with coronary
artery bypass grafting (CABG) as compared to percutaneous
revascularization. However, these studies were conducted in the era of
bare-metal stents. Therefore, we performed a meta-analysis to compare CABG
to PCI with drug-eluting stents (DES) in diabetic patients with
multivessel and/or left main disease. Methods and results: The literature
was scanned by formal search of electronic databases (Medline, EMBASE, and
Cochrane databases), and major international scientific session abstracts
from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4
randomized and 10 non-randomized) trials were finally included, with a
total of 7072 patients. Up to 5 years follow-up, CABG was associated with
a reduction in mortality (7.3% vs 10.4%, OR[95%CI]=0.65[0.55-0.77],
p<0.0001; phet=0.00001), with similar results in both RCTs
(OR[95%CI]=0.64[0.50-0.82], p=0.0005) and NRCTs
(OR[95%CI]=0.75[0.6-0.94)], p=0.01) (p int=0.93). A significant
relationship was observed between risk profile and benefits in mortality
with CABG (p<0.001). CABG reduced target vessel revascularization (TVR;
5.2% vs 15.7%, OR[95%CI]=0.30[0.25-0.36], p<0.00001, p het=0.02), with a
relationship between risk profile and the benefits from CABG as compared
to DES (p<0.0001). CABG was associated with a lower rate of MACCE (14.9%
vs 22.9%, OR[95%CI]=0.59[0.51-0.67], p<0.00001, p het<0.00001) but higher
risk of CVA (3.6% vs 1.4%, OR[95%CI]=2.34[1.63-3.35], p<0.00001, p
het=0.71). Conclusions: The present meta-analysis demonstrates that among
diabetic patients with multivessel disease and/or left main disease, CABG
provides benefits in mortality and TVR, especially in high-risk patients
but it is counterbalanced by a higher risk of stroke. Future trials are
certainly needed in the era of new DES and improved antiplatelet
therapies. 2013 Elsevier B.V.

<16>
Accession Number
2014209481
Authors
Hakim F.A. Aryal M.R. Pandit A. Pandit A.A. Alegria J.R. Kendall C.B.
Click R.L.
Institution
(Hakim, Pandit, Pandit, Alegria, Kendall) Division of Cardiovascular
Diseases, Department of Medicine, Mayo Clinic College of Medicine, 13400 E
Shea Blvd, Scottsdale, AZ 85259, United States
(Aryal) Department of Internal Medicine, Reading Health System, West
Reading, PA, United States
(Click) Division of Cardiovascular Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
Title
Papillary fibroelastoma of the pulmonary valve - A systematic review.
Source
Echocardiography. 31 (2) (pp 234-240), 2014. Date of Publication: February
2014.
Publisher
Blackwell Publishing Inc.
Abstract
The pulmonary valve is the least affected site for valvular papillary
fibroelastoma. With increasing use of routine echocardiography and other
modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE)
are being recognized more frequently. PVPFE is more often an incidental
diagnosis and symptomatic patients usually present with shortness of
breath. Embolic phenomena and right ventricular outflow tract obstruction
are the most serious complications of PVPFE. Since PVPFE is rare, the
purpose of this systematic review is to address demographic
characteristics, the clinical presentation, management, and outcome of
this benign tumor of the pulmonary valve. 2013, Wiley Periodicals, Inc.

<17>
Accession Number
2014212718
Authors
Stefanelli F. Meoli I. Cobuccio R. Curcio C. Amore D. Casazza D. Tracey M.
Rocco G.
Institution
(Stefanelli, Meoli, Cobuccio) Division of Pneumology, AORN Dei Colli
'Monaldi Hospital', Naples, Italy
(Curcio, Amore, Casazza) Division of Thoracic Surgery, AORN Dei Colli
'Monaldi Hospital', Naples, Italy
(Tracey, Rocco) Division of Thoracic Surgery, Istituto Nazionale dei
Tumori 'Pascale Foundation', Naples, Italy
Title
High-intensity training and cardiopulmonary exercise testing in patients
with chronic obstructive pulmonary disease and non-small-cell lung cancer
undergoing lobectomy.
Source
European Journal of Cardio-thoracic Surgery. 44 (4) (pp e260-e265), 2013.
Article Number: ezt375. Date of Publication: October 2013.
Publisher
Elsevier
Abstract
OBJECTIVES: Peak VO₂, as measure of physical performance is
central to a correct preoperative evaluation in patients with both
nonsmall- cell lung cancer (NSCLC) and chronic obstructive pulmonary
disease (COPD) because it is closely related both to operability criteria
and the rate of postoperative complications. Strategies to improve peak
VO₂, as a preoperative pulmonary rehabilitation programme
(PRP), should be considered favourably in these patients. In order to
clarify the role of pulmonary rehabilitation, we have evaluated the
effects of 3-week preoperative high-intensity training on physical
performance and respiratory function in a group of patients with both
NSCLC and COPD who underwent lobectomy. METHODS: We studied 40 patients
with both NSCLC and COPD, age < 75 years, TNM stages I-II, who underwent
lobectomy. Patients were randomly divided into two groups (R and S): Group
R underwent an intensive preoperative PRP, while Group S underwent only
lobectomy. We evaluated peak VO₂ in all patients at Time 0
(T0), after PRP/before surgery in Group R/S (T1) and 60 days after
surgery, respectively, in both groups (T2). RESULTS: There was no
difference between groups in peak VO₂ at T0, while a
significant difference was observed both at T1 and T2. In Group R, peak
VO₂ improves significantly from T0 to T1: 14.9 + 2.3-17.8 + 2.1
ml/kg/min + standard deviation (SD), P < 0.001 (64.5 + 16.5- 76.1 + 14.9%
predicted + SD, P < 0.05) and deteriorates from T1 to T2: 17.8 + 2.1-15.1
+ 2.4, P < 0.001 (76.1 + 14.9-64.6 + 15.5, P < 0.05), reverting to a
similar value to that at T0, while in Group S peak VO₂ did not
change from T0 to T1 and significantly deteriorates from T1 to T2: 14.5 +
1.2-11.4 + 1.2 ml/kg/min + SD, P < 0.00001 (60.6 + 8.4-47.4 + 6.9%
predicted + SD, P < 0.00001). CONCLUSIONS: PRP was a valid preoperative
strategy to improve physical performance in patients with both NSCLC and
COPD and this advantage was also maintained after surgery. The Author
2013.The Author 2013. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
2014212679
Authors
Taioli E. Leea D.-S. Lesserc M. Floresa R.
Institution
(Taioli, Leea, Floresa) Division of Thoracic Surgery, Mount Sinai Medical
Center, 1190 Fifth Avenue, Box 1028, New York, NY 10029, United States
(Taioli) Epidemiology Program, North Shore LIJ-Hofstra School of Medicine,
New York, NY, United States
(Lesserc) Center for Biostatistics, North Shore LIJ-Hofstra School of
Medicine, New York, NY, United States
Title
Long-term survival in video-assisted thoracoscopic lobectomy vs open
lobectomy in lung-cancer patients: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 44 (4) (pp 591-597), 2013.
Article Number: ezt051. Date of Publication: October 2013.
Publisher
Elsevier
Abstract
Video-assistedthoracicsurgery (VATS) lobectomy is an appealing alternative
to open lobectomy via thoracotomy for non-small-cell lung cancer. However,
there is no clear consensus in regard to the superior approach for
long-term outcomes. The data are limited to small series, which precludes
further clarification. Meta-analysis of these studies was performed in
order to obtain a more objective determination of the oncological
feasibility of VATS lobectomy. A systematic review of the PubMed and
Embase databases was performed. Twenty observational studies reporting
long-term outcomes were included, involving 2106 VATS and 2661 thoracotomy
patients. There was an advantage in long-term mortality for patients who
underwent VATS vs patients who underwent thoracotomy (meta difference in
survival: 5%; 95% CI: 3-6%) with large heterogeneity among studies (Q =
42.6; P-value: 0.001; I² = 55.7%). There was no evidence of
publication bias. Compared with open lobectomy, VATS lobectomy appears to
have improved long-term outcomes. The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<19>
Accession Number
2014206305
Authors
Forcillo J. Perrault L.P.
Institution
(Forcillo, Perrault) Cardiac Surgery Department, Montreal Heart Institute,
Universite de Montreal, Canada
Title
Armentarium of topical hemostatic products in cardiovascular surgery: An
update.
Source
Transfusion and Apheresis Science. 50 (1) (pp 26-31), 2014. Date of
Publication: February 2014.
Publisher
Elsevier Ltd
Abstract
Within Canada, 2.6. million in-hospital surgical procedures are completed
annually. Significant bleeding following is the most common surgical
complication, occurring in up to 25% of all surgeries. Bleeding causes
increased mortality and morbidity, by increasing the number of
transfusions required, secondary to increased cumulative blood loss, and
by causing hemodynamic instability. A solution to this issue encountered
during surgery is the use of hemostatic products. The objectives of this
manuscript are (1) to review the spectrum of hemostatic products available
in cardiovascular surgery and (2) to provide an update on new topical
products soon available, or in development, for optimizing hemostasis
during surgical procedures. 2014 Elsevier Ltd.

<20>
Accession Number
2014209306
Authors
Stanger O. Aigner I. Schimetta W. Wonisch W.
Institution
(Stanger, Aigner) Department of Cardiac Surgery, Research, Amino Acid
Metabolism, Paracelsus Medical University Salzburg, Salzburg, Austria
(Schimetta) Institute of Systems Sciences, University of Linz, Linz, Upper
Austria, Austria
(Wonisch) Clinical Institute of Medical and Chemical Laboratory
Diagnostics, Medical University of Graz, Graz, Styria, Austria
(Wonisch) Institute of Physiological Chemistry, Center for Physiological
Medicine, Medical University of Graz, Graz, Styria, Austria
(Stanger) Clinical Research and Development INSELSPITAL, Department of
Caldiovascular Surgery, Bern University Hospital, Bern, Bern, Switzerland
Title
Antioxidant supplementation attenuates oxidative stress in patients
undergoing coronary artery bypass graft surgery.
Source
Tohoku Journal of Experimental Medicine. 232 (2) (pp 145-154), 2014. Date
of Publication: February 2014.
Publisher
Tohoku University Medical Press
Abstract
Ischemia-reperfusion has been reported to be associated with augmented
oxidative stress in the course of surgery, which might be causally
involved in the onset of atrial fibrillation (AF), the most common
arrhythmia after cardiac surgery. We hypothesized that supplementation of
antioxidants and n-3 polyunsaturated fatty acids (n-3 PUFAs) might lower
the incidence of AF following coronary artery bypass graft (CABG) surgery.
In the present study, by monitoring oxidative stress in the course of CABG
surgery, we analyzed the efficacy of vitamins (ascorbic acid and alpha
-tocopherol) and/or n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic
acid). Subjects (n = 75) were divided into 4 subgroups: control, vitamins,
n-3 PUFAs, and a combination of vitamins and n-3 PUFAs. Fluorescent
techniques were used to measure the antioxidative capacity, i.e. ability
to inhibit oxidation. Total peroxides, endogenous peroxidase activity, and
antibodies against oxidized LDL (oLAb) were used as serum oxidative stress
biomarkers. Post-operative increase in oxidative stress was associated
with the consumption of antioxidants and a simultaneous onset of AF. This
was confirmed through an increased peroxide level and a decreased oLAb
titer in control and n-3 PUFAs groups, indicating the binding of
antibodies to oxidative modified epitopes. In both subgroups that were
supplemented with vitamins, total peroxides decreased, and the maintenance
of a constant IgG antibody titer was facilitated. However, treatment with
vitamins or n-3 PUFAs was inefficient with respect to AF onset and its
duration. We conclude that the administration of vitamins attenuates
post-operative oxidative stress in the course of CABG surgery. 2014
Tohoku University Medical Press.

<21>
Accession Number
2014205552
Authors
Ziabakhsh-Tabary S. Jalalian R. Mokhtari-Esbuie F. Habibi M.R.
Institution
(Ziabakhsh-Tabary) Department of Cardiac Surgery, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Jalalian) Department of Cardiovascular, Fatemeh Zahra Hospital,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Mokhtari-Esbuie) Fatemeh Zahra Hospital, Mazandaran University of Medical
Science, Sari, Iran, Islamic Republic of
(Habibi) Department of Anesthesiology, Fatemeh Zahra Hospital, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Echocardiographic evaluation of the effects of a single bolus of
erythropoietin on reducing ischemia-reperfusion injuries during coronary
artery bypass graft surgery; a randomized, double-blind, placebo-control
study.
Source
Iranian Journal of Medical Sciences. 39 (2) (pp 94-101), 2014. Date of
Publication: 2014.
Publisher
Shiraz University of Medical Sciences
Abstract
Background: Erythropoietin (EPO) is known as a regulating hormone for the
production of red blood cells, called erythropoiesis. Some studies have
shown that EPO exerts some non-hematopoietic protective effects on
ischemia-reperfusion injuries in myocytes. Using echocardiography, we
evaluated the effect of EPO infusion on reducing ischemia-reperfusion
injuries and improvement of the cardiac function shortly after coronary
artery bypass graft surgery (CABG). Methods: Forty-three patients were
recruited in this study and randomly divided into two groups: the EPO
group, receiving standard medication and CABG surgery plus EPO (700 IU/
kg), and the control group, receiving standard medication and CABG surgery
plus normal saline (10 cc) as placebo. The cardiac function was assessed
through echocardiography before as well as at 4 and 30 days after CABG.
Results: Echocardiography indicated that the ejection fraction had no
differences between the EPO and control groups at 4 days (47.05+6.29 vs.
45.90+4.97; P=0.334) and 30 days after surgery (47.27+28 vs. 46.62+5.7;
P=0.69). There were no differences between the EPO and control groups in
the wall motion score index at 4 (P=0.83) and 30 days after surgery
(P=0.902). In the EPO group, there was a reduction in left ventricular
end-systolic and end-diastolic diameters (LVESD and LVEDD, respectively),
as compared to the control group. Conclusion: Our results indicated that
perioperative exogenous EPO infusion could not improve the ventricular
function and wall motion index in the immediate post-CABG weeks.
Nevertheless, a reduction in LVEDD and LVESD at 4 days and 30 days after
CABG in the EPO group, by comparison with the control group, suggested
that EPO correlated with a reduction in the remodeling of myocytes and
reperfusion injuries early after CABG.

<22>
Accession Number
2014200995
Authors
Lupi A. Rognoni A. Secco G.G. Lazzero M. Nardi F. Fattori R. Bongo A.S.
Agostoni P. Sheiban I.
Institution
(Lupi, Rognoni, Lazzero, Nardi, Bongo) Hospital Cardiology, Maggiore della
Carita Hospital, Novara, Italy
(Secco) Department of Clinical and Experimental Medicine, University of
Eastern Piedmont, Maggiore della Carita Hospital, Novara, Italy
(Secco, Fattori) Division of Interventional Cardiology, Ospedali Riuniti
Marche Nord, Pesaro, Italy
(Agostoni) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Sheiban) Interventional Cardiology, Division of Cardiology, University of
Turin, Turin, Italy
Title
Biodegradable versus durable polymer drug eluting stents in coronary
artery disease: Insights from a meta-analysis of 5834 patients.
Source
European Journal of Preventive Cardiology. 21 (4) (pp 411-424), 2014. Date
of Publication: April 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: Biodegradable polymer drug eluting stents (BP-DES) have been
developed to overcome the limitations of first generation durable polymer
DES (DP-DES) but the clinical results of different BP-DES are not
consistent. We performed a meta-analysis to compare the outcomes of BP-DES
and DP-DES in the treatment of coronary artery disease (CAD). Methods and
results: Online databases including MEDLINE were searched for studies
comparing BP-DES and DP-DES for obstructive CAD that reported rates for
overall mortality, myocardial infarction (MI), late stent thrombosis
(LST), target lesion revascularization (TLR) and late lumen loss (LLL)
with a follow-up of >6 months. Ten studies (5834 patients) with a 1-year
median follow-up were included in the meta-analysis. When comparing
patients treated with DP-DES and BP-DES those treated with BP-DES had
lower LLL (in-stent: weighted mean difference (WMD) -0.10 mm, 95% CI=-0.17
to -0.03 mm, 0.004; in-segment: WMD >0.06 mm, 95% CI=-0.10 to -0.01 mm,
0.01) with lower TLR rates (OR 0.67, 95% CI=-0.47 to 0.98, 0.04). However,
BP-DES did not improve mortality (OR 0.97, 95% CI=-0.73 to 1.29, 0.83), MI
(OR 1.13, 95% CI=-0.87 to 1.46, 0.36) or LST rates (OR 0.64, 95% CI=-0.36
to 1.16, 0.14). A pre-specified subgroup analysis of Biolimus BP-DES
confirmed significant LLL reduction without differences in other clinical
endpoints. Meta-regression analysis demonstrated a strong significant
inverse correlation between LLL and reference coronary diameter (p
<0.001). Conclusions: Our present meta-analysis showed that BP-DES when
compared with DP-DES significantly reduced LLL and TVR but without clear
benefits on mortality, MI and LST rates. (Clinicaltrials.gov identifier:
NCT01466634). The European Society of Cardiology 2012.

<23>
Accession Number
2014203365
Authors
Bertolaccini L. Viti A. Cavallo A. Terzi A.
Institution
(Bertolaccini, Viti, Cavallo, Terzi) Division of Thoracic Surgery, S.
Croce e Carle Hospital, Cuneo, Italy
Title
Results of Li-Tho trial: A prospective randomized study on effectiveness
of ligasure in lung resections.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 693-698), 2014.
Article Number: ezt445. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
OBJECTIVE: The role of electro-thermal bipolar tissue sealing system
(LigaSure. (LS); Covidien, Inc., CO, USA) in thoracic surgery is still
undefined. Reports of its use are still limited. The objective of the
trial was to evaluate the cost and benefits of LS in major lung resection
surgery. METHODS: A randomized blinded study of a consecutive series of
100 patients undergoing lobectomy was undertaken. After muscle-sparing
thoracotomy and classification of lung fissures according to Craig-Walker,
patients with fissure Grade 2-4 were randomized to Stapler group or LS
group fissure completion. Recorded parameters were analysed for
differences in selected intraoperative and postoperative outcomes.
Statistical analysis was performed with the bootstrap method. Pearson's
chi² test and Fisher's exact test were used to calculate
probability value for dichotomous variables comparison. Cost-benefit
evaluation was performed using Pareto optimal analysis. RESULTS: There
were no significant differences between groups, regarding demographic and
baseline characteristics. No patient was withdrawn from the study; no
adverse effect was recorded. There was no mortality or major complications
in both groups. There were no statistically significant differences as to
operative time or morbidity between patients in the LS group compared with
the Stapler group. In the LS group, there was a not statistically
significant increase of postoperative air leaks in the first 24
postoperative hours, while a statistically significant increase of
drainage amount was observed in the LS group. No statistically significant
difference in hospital length of stay was observed. Overall, the LS group
had a favourable multi-criteria analysis of cost/benefit ratio with a good
'Pareto optimum'. CONCLUSIONS: LS is a safe device for thoracic surgery
and can be a valid alternative to Staplers. In this setting, LS allows
functional lung tissue preservation. As to costs, LS seems equivalent to
Staplers. The Author 2013. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<24>
Accession Number
2014203356
Authors
Bertholdt S. Latal B. Liamlahi R. Pretre R. Scheer I. Goetti R. Dave H.
Bernet V. Schmitz A. Von rhein M. Knirsch W. Sennhauser F.H. Plecko B.R.
Kretschmar O. Batinic K. Dimitropoulos A. Kellenberger C. Makki M. Hug
M.I. Burki C. Weiss M. Hagmann C.
Institution
(Bertholdt, Liamlahi, Knirsch) Pediatric Cardiology, University Children's
Hospital, Zurich, Switzerland
(Latal, Von rhein) Child Development Center, University Children's
Hospital, Zurich, Switzerland
(Pretre, Dave) Congenital Cardiovascular Surgery, University Children's
Hospital, Zurich, Switzerland
(Scheer, Goetti) Diagnostic Imaging, University Children's Hospital,
Zurich, Switzerland
(Bernet) Pediatric Intensive Care and Neonatology, University Children's
Hospital, Zurich, Switzerland
(Schmitz) Anaesthesia, University Children's Hospital, Zurich, Switzerland
(Sennhauser) University Children's Hospital, Pediatrics, Zurich,
Switzerland
(Hagmann) University Hospital Zurich, Neonatology, Switzerland
Title
Cerebral lesions on magnetic resonance imaging correlate with preoperative
neurological status in neonates undergoing cardiopulmonary bypass surgery.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 625-632), 2014.
Article Number: ezt422. Date of Publication: April 2014.
Publisher
Elsevier
Abstract
Objectives: To determine the prevalence, spectrum and course of cerebral
lesions in neonates with congenital heart disease (CHD) undergoing full
flow cardiopulmonary bypass (CPB) surgery using magnetic resonance imaging
(MRI) and to examine the correlation between cerebral lesions and clinical
neurological abnormalities. Methods: Prospective cohort study of neonates
with d-transposition of the great arteries (n = 22), univentricular heart
malformation with hypoplastic aortic arch (n = 6) and aortic arch
obstructions (n = 2) undergoing CPB. Neonates underwent cerebral MRI and
blinded standardized neurological examination before (median day 6) and
after surgery (day 13). The MRI findings were compared with those of 20
healthy controls. Results: Preoperative cerebral lesions were present in 7
of 30 patients (23%) with isolated mild or moderate white matter injury
(WMI) (n = 4), isolated small cerebral stroke (n = 1) and combined WMI and
stroke (n = 2). None of the healthy controls had cerebral lesions on MRI.
CHD neonates with preoperative cerebral lesions had more neurological
abnormalities (P = 0.01) than neonates without cerebral lesions. Low
arterial oxygen saturation (P = 0.03) was a risk factor for preoperative
cerebral lesions, while balloon atrioseptostomy (P = 0.19) was not. After
surgery, preoperative cerebral lesions persisted in 5 of 7 neonates, and 2
neonates (7%) showed signs of additional WMI in their postoperative MRI.
Conclusions: In neonates with severe CHD, WMI was the predominant
preoperative finding, while cerebral strokes were less frequent. New
postoperative lesions were rare. Preoperative neurological abnormalities
correlated with the presence of cerebral lesions on MRI. The Author 2013.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
71397588
Authors
Cao C. Manganas C. Ang S. Yan T.D.
Institution
(Cao, Ang, Yan) Systematic Reviews Unit, Collaborative Research Group,
Australia
(Manganas) Cardiothoracic Surgery, St. George Hospital, Australia
Title
A systematic review and meta-analysis on pulmonary resections by robotic
videoassisted thoracic surgery.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S1121), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: Pulmonary resection by robotic-video assisted thoracic surgery
(RVATS) has been performed for selected patients in specialized centers
over the past decade. Despite encouraging results from case-series
reports, there remains a lack of robust clinical evidence for this
relatively novel surgical technique. The present systematic review aimed
to assess the short- and longterm safety and efficacy of RVATS. Methods:
Nine relevant and updated studies were identified from 12 institutions
using five electronic databases. Endpoints included perioperative
morbidity and mortality, conversion rate, operative time, length of
hospitalization, intraoperative blood loss, duration of chest drainage,
recurrence rate and long-term survival. In addition, cost analyses and
quality of life assessments were also systematically evaluated.
Comparative outcomes were meta-analyzed when data were available. Results:
All institutions used the same master-slave robotic system (da Vinci,
Intuitive Surgical, Sunnyvale, California) and most patients underwent
lobectomies for early-stage non-small cell lung cancers. Perioperative
mortality rates for patients who underwent pulmonary resection by RVATS
ranged from 0 - 3.8%, whilst overall morbidity rates ranged from 10 - 39%.
Two propensity-score analyses compared patients with malignant disease who
underwent pulmonary resection by RVATS or thoracotomy, and a meta-analysis
was performed to identify a trend towards fewer complications after RVATS.
In addition, one cost analysis and one quality of life study reported
improved outcomes for RVATS when compared to open thoracotomy. Conclusion:
Results of the present systematic review suggest that RVATS is feasible
and can be performed safely for selected patients in specialized centers.
Perioperative outcomes including postoperative complications were similar
to historical accounts of conventional VATS. A steep learning curve for
RVATS was identified in a number of institutional reports, which was most
evident in the first 20 cases. Future studies should aim to present data
with longer follow-up, clearly defined surgical outcomes, and through an
intention-to-treat analysis. (Table presented) .

<26>
Accession Number
71397062
Authors
Cao C. Manganas C. Ang S. Peeceeyen S. Yan T.D.
Institution
(Cao, Ang, Yan) Systematic Reviews Unit, Collaborative Research Group,
Australia
(Manganas, Peeceeyen) Cardiothoracic Surgery, St. George Hospital,
Australia
Title
Video-assisted thoracic surgery versus open thoracotomy for non-small cell
lung cancer-a meta-analysis of propensity score matched patients.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S824), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: This meta-analysis aims to compare the perioperative outcomes
of video-assisted thoracic surgery (VATS) versus open thoracotomy for
propensity score-matched patients with early stage non-small cell lung
cancer (NSCLC). Methods: Four relevant studies with propensity
score-matched patients were identified from six electronic databases.
Endpoints included perioperative mortality and morbidity, individual
postoperative complications and duration of hospitalization. Results:
indicate that all-cause perioperative mortality was similar between VATS
and open thoracotomy. However, patients who underwent VATS were found to
have significantly fewer overall complications, and significantly lower
rates of prolonged air leak, pneumonia, atrial arrhythmias and renal
failure. In addition, patients who underwent VATS had a significantly
shorter length of hospitalization compared to patients who underwent open
thoracotomy. Conclusion: In view of a paucity of high level clinical
evidence in the form of large, well-designed randomized controlled trials,
propensity score matching may provide the highest level of evidence to
compare VATS with open thoracotomy for patients with NSCLC. The present
meta-analysis demonstrated superior perioperative outcomes for patients
who underwent VATS, including overall complication rates and duration of
hospitalization. (Table Presented).

<27>
Accession Number
71397034
Authors
Syrigos K.N. Boura P. Tsapas C. Nikolaou A. Kalavrouziotis G. Reveliotis
K. Charpidou A.
Institution
(Syrigos, Boura, Tsapas, Nikolaou, Kalavrouziotis, Reveliotis, Charpidou)
Oncology Unit Gpp, Sotiria General Hospital, Greece
Title
Wedge resection and segmentectomy in patients with stage I non-small cell
lung cancer.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S809), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: The use of resections lesser than lobectomy as definitive
management of a stage I non-small cell lung carcinoma (NSCLC) is a topic
that creates controversy in the global medical community. To describe the
current conclusions concerning the relative indications of each type of
resection in the surgical treatment of stage I NSCLC, as well as the
international results from their application concerning the local
recurrence, disease-free survival, and five-year survival rates. Methods:
Thirty four prospective and retrospective studies registered in PubMed and
Scopus electronic databases during the last twenty five years were
reviewed. Bibliographies and handsearching of journals were used to
identify trials. Studies' authors, citations, objectives, and results were
extracted. No meta-analysis was used. Validation of results was discussed.
Results: Segmentectomies were superior to wedge resections in terms of
local recurrence and cancer-related survival rates. Sublobar resections
were superior to lobectomy concerning preservation of pulmonary
parenchyma. It was recommended that high-risk patients undergo
segmentectomy. Lobectomies were superior to segmentectomies only for
tumors >2 cm (T2bN0M0) as regarding disease-free and overall 5-year
survival. There was no significant difference for tumors <2 cm in most
studies. Free surgical margins were crucial for local control rates.
Systematic lymphadenectomy was mandatory regardless of type of resection.
In cases of pure bronchoalveolar carcinoma, segmentectomy was recommended.
Shorter hospital stay was achieved with sublobar resections. Conclusion:
The choice of type of resection for T1aN0M0 tumors should rely on specific
patient and tumor characteristics. Patient age and tumor size are the most
important factors. Further prospective randomized trials are needed to
determine minimal resections in early lung cancer patients.

<28>
Accession Number
71395965
Authors
Darling G.E. Dickie J. Malthaner R. Mcknight L. Sallay Y. Hunter A. Li Y.
Mcleod R.
Institution
(Darling) Division of Thoracic Surgery, Toronto General Hospital,
University of Toronto, Canada
(Dickie) Surgery, Lakeridge Health Centre, Canada
(Malthaner) Surgery, London Health Sciences Centre, Canada
(Mcknight, Sallay, Hunter, Li, Mcleod) Surgical Oncology, Cancer Care
Ontario, Canada
Title
Quality indicators in thoracic surgery: The importance of process
indicators in lung cancer.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S166-S167), 2013.
Date of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
Background: Outcome after surgery is the result of many components of the
care pathway. The Thoracic Surgery Community of Practice of Cancer Care
Ontario developed quality indicators which reflected processes of care as
well as outcomes. Methods: A systematic review of the literature
identified potential indicators in the care of lung cancer patients which
were relevant to thoracic surgery. These were then evaluated using a
modified Delphi process. Seventeen indicators were chosen from seven
domains: pre-operative assessment, staging, surgery, pathology, adjuvant
therapy, surgical outcomes and miscellaneous based on actionability,
validity, usefulness, discriminability, and feasibility. Data obtained
from administrative databases is reported for 4 process indicators and 3
outcome indicators. Results: Of the 3242 patients diagnosed with Stage I
and Stage II non-small cell lung cancer in 2009 and 2010, 2172 (67%)
received a surgical consultation and 1524 (47%) underwent resection within
3 months of diagnosis. For the 1075 Stage I and Stage II patients over age
75 only 634 (59%) received a surgical consultation and 322 ( 32%)
underwent resection. Of the 2302 patients resected in total (all stages),
only 736 (32%) had invasive mediastinal staging(IMS) prior to
resection:15% for sublobar resections; 30% for stage I; and 42% for stage
II. Surprisingly only 42% of patients with stage III disease had IMS. IMS
was also performed in an additional 23% of patients for whom stage data
was unavailable. In a similar cohort of patients resected in 2011-2012,
only 28% had >10 lymph nodes removed at the time of resection but this did
not include nodes assessed by IMS. However, for 20% of patients lymph node
resection data was not available or could not be determined. Positive
resection margins were reported in 7% of patients, however in a further 7%
of patients margins could not be assessed. 30 day mortality for lobectomy
was 1.9%, reoperation rate was 2.8% (2.0% for same day as resection).
Conclusion: Initial results of 7 quality indicators in thoracic surgery
identified some quality gaps in processes of care as well as limitations
in databases. Evaluation of process indicators allowed feedback to
thoracic surgeons and pathologists who identified quality improvement
opportunities. Rate of surgical consultation and resection for stage I and
II disease was lower than expected as were rates of invasive mediastinal
staging especially for patients with stage III disease for whom cytologic
or histologic confirmation is recommended. To address variable
intraoperative lymph node assessment, systematic lymph node sampling or
complete mediastinal lymphadenectomy was recommended to standardize
intraoperative lymph node assessment. Quality improvement opportunities
for pathologists also included dissection of intralobar lymph nodes,
standardization of pathological processing and margin assessment. Feedback
of quality indicator data was important in stimulating quality improvement
initiatives by thoracic surgeons and pathologists.

<29>
Accession Number
71395910
Authors
Rami-Porta R.
Institution
(Rami-Porta) Thoracic Surgery, Hospital Universitari Mutua Terrassa, Spain
Title
Feedback and closing remarks.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S127), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
The Cochrane Collaboration celebrates its 20th anniversary this year. (1,
2) With around 28,000 people involved in 53 Cochrane Review Groups in
about 100 countries and more than 5,000 systematic reviews, the Cochrane
Collaboration has assisted clinicians, patients, researchers, policy
makers and other health professionals to make decisions on a large number
of healthrelated topics. Around 400 systematic reviews are on screening,
prevention or treatment of different cancers, and they collectively
analyse nearly 5,000 studies. (2) Forty-one systematic reviews are on lung
cancer and mesothelioma: 21 of them deal with non-small cell lung cancer
and 8, on small cell lung cancer; 7 are related to general aspects of
treatment; 3 are about prevention and early detection; and 2 are about
mesothelioma. (3) A Cochrane systematic review is the final product of a
highly elaborated process. Today's Workshop has gone through all this
process starting with the definition of a question that needs to be
answered with the highest certainty. The question is reflected in the
TITLE of the review, the first submission to the review group editors that
the potential authors do. Once the title has been approved, potential
authors have to write and submit a PROTOCOL, a larger document that
includes the background of the topic, the methodology to be used, with
inclusion and exclusion criteria of studies and patients, the therapeutic
interventions that will be included, the search strategy, and relevant
references. After approval of this second phase of the process by the
review group editors, the authors have to write the final document, the
SYSTEMATIC REVIEW, which is internally and externally reviewed. Most
systematic reviews analyse randomised clinical trials only, because this
is the best research instrument we have in clinical practice. The
conclusions derived from these reviews have a high level of evidence -
that can even be increased if meta-analyses can be done combining data
from the different studies. (4) The meticulous search of published and
unpublished data, the careful identification of biases and the sound
methodology provide reliable information on the effectiveness of a certain
therapeutic intervention, that can be recommended to patients with similar
characteristics to those of the patients included in the reviewed studies.
(5) Many questions need to be answer in lung cancer therapy. However,
randomized clinical trials are relatively few, especially in my specific
field: thoracic surgery. We all should feel the responsibility to
participate and include patients in clinical trials. No doubt,
participation demands an extra effort from us: selecting patients, taking
the time to explain the trial to the patients, abiding by randomization
rules, sticking to the protocol and so on. But the effort pays off,
because the conclusions we draw from randomized clinical trials are the
most reliable and solid we can now have on therapeutic interventions. I
would like to encourage the audience to participate in clinical trials.
The more randomized clinical trials we complete, the more systematic
reviews and greater the level of evidence on specific issues of lung
cancer and other health-related problems.

<30>
Accession Number
71395889
Authors
Midthun D. Milne D.
Institution
(Midthun) Pulmonary Medicine Mayo Clinic, United States
(Milne) Auckland Dhb Radiology, New Zealand
Title
A practical approach to the incidental pulmonary nodule.
Source
Journal of Thoracic Oncology. Conference: 15th World Conference on Lung
Cancer Sydney, NSW Australia. Conference Start: 20131027 Conference End:
20131030. Conference Publication: (var.pagings). 8 (pp S106), 2013. Date
of Publication: November 2013.
Publisher
International Association for the Study of Lung Cancer
Abstract
A Practical Approach to the Incidental Pulmonary Nodule David Midthun,
M.D. David Milne, M.D. The finding of a pulmonary nodule (or multiple
nodules) on an imaging study presents a decision point for the patient and
physician. In the absence of a completely sensitive and specific
non-invasive test for malignancy, the physician and patient must weigh the
options for management. The vast majority of such nodules are benign;
however the detection of a nodule may be the first and only point in time
of a chance of cure in the patient with lung cancer. Guidelines for nodule
evaluation by the American college of Chest physicians (ACCP) and the
Fleischner Society may help guide the decision making. Studies of lung
cancer screening have shown high rates of nodule detection and that the
rate is related to the CT slice thickness (collimation) used. Screening
with 10 mm collimation results in detection of one or more nodules in
approximately 20-25% of participants, 5 mm collimation increases this to
40-50% of participants, and 1.25 mm collimation raises detection to as
high as 60%. A review of the data from 8 CT studies in high risk patients
(current or former smokers, age 50 or above) reported that likelihood of
malignancy was 0 to 1% for nodules < 5 mm, 6 to 28% for nodules 5 to 10
mm, 33 to 60% for nodules > 11-20 mm, and 64 to 82% for nodules > 20-30
mm. The finding of a nodule on CT should first prompt review of any
available old images that might include the nodule for comparison. Review
of old images may show that the nodule is growing or, alternatively,
establish that it has been stable for 2 or more years. Stability in size
over a two-year period has been established as an excellent indicator of
benignancy for a solid nodule. If old images are not available, nodules <
8 mm may be observed with follow-up CT at an interval determined by the
nodule size. Evidence for nodule growth is a hallmark of malignancy and
should lead to a staging PET-CT scan (in those who are candidates for
surgery) and consideration of prompt resection. Calcification in a benign
pattern is an excellent indicator that a nodule is a granuloma and needs
no further pursuit. Eccentric calcification should maintain concern for
malignancy. Ground-glass nodules (GGN) are nodules of low density
(attenuation) that are generally only visible by CT scan. They deserve
special mention as they may represent low-grade adenocarcinomas which
behave differently than most malignancies presenting as solid nodules.
Malignant GGNs typically exhibit slow growth with doubling times on
average over 400 days and, for this reason, the 2-year stability rule for
solid nodules doesn't apply and a longer period of follow-up is needed.
PET scanning is not helpful to distinguish malignancy due to the low
density of the lesions, and needle biopsy is often nondiagnostic. GGNs may
show growth or stay the same size yet develop a solid component in the
process of progression. PET scanning uses the injection of the glucose
analog 18F-2-fluorodeoxyglucose (FDG) and identifies elevated metabolic
activity. Nodule enhancement is an indication that a nodule is more likely
malignant than benign, and absence of enhancement is a strong predictor
that a nodule is benign. In a multicenter prospective study reported that
FDGPET had an overall sensitivity of 92% and a specificity of 90% for
detecting malignant nodules, yet the sensitivity fell to only 80% when
nodules of 15 mm or smaller were analyzed. A meta-analysis of pulmonary
nodules showed that PET had a sensitivity of 94% and a specificity of 86%.
The lower limit of solid nodule size for PET applicability using current
techniques is about 8-10 mm. A growing nodule that shows no enhancement on
PET should still be considered suspicious for malignancy and prompt needle
biopsy or resection. If multiple nodules are present, then evaluation is
dictated by the largest nodule. Observation may be appropriate for
patients with nodules that are larger than 8-10 mm and have a low
likelihood of malignancy based lack of enhancement. Whether or not an
indeterminate nodule > 8-10 mm should be biopsied is the subject of
considerable debate and practices vary. The two biopsy techniques for
assessment of nodules are bronchoscopy and transthoracic needle aspiration
(TTNA). Bronchoscopy with fluoroscopy alone has a yield of less than 20%
in the setting of malignant nodules less than 2 centimeters and in the
range of 40- 60% when the nodule is 3-4 cm. Studies of guided bronchoscopy
using endobronchial ultrasound and/or electromagnetic guidance have shown
marked improvements in diagnostic yield over standard fluoroscopic
guidance. Studies using one or more of these techniques have shown yields
of 60 to 80% of peripheral nodules of a mean diameter of 2- to 25 mm.
Yields remain highest with TTNA; multiple studies report yields of 90% and
above for nodules < 2 cm and 95% for nodules > 2 cm. Pneumothorax is the
most frequent complication of TTNA. Likelihood of obtaining a specific
diagnosis in the setting of a benign lesion is problematic for both
bronchoscopy and TTNA. Decision as to the method of biopsy involves lesion
size, location, presence of a bronchus leading to the lesion, and
comorbidities. Preoperative diagnosis may not be needed for lesions that
show growth or are nearing 3cm and are PET avid due to the high likelihood
of malignancy and low likelihood a biopsy is going to provide a specific
benign diagnosis. An exception would be in countries where there is a high
prevalence of tuberculosis where sampling may remain appropriate.
Resection is the ultimate management for many lesions that remain
indeterminate after imaging evaluation especially in a high risk
individual. There are currently too many benign nodules removed
surgically. Series of video assisted thoracic surgery (VATS) have reported
benign nodules representing as high as 50-86% of nodules resected.
Reduction in benign nodule resections may be achieved by observing smaller
nodules, by utilizing PET-CT, and by performing biopsy by TTNA or
bronchoscopy when information is discordant.

<31>
Accession Number
71391087
Authors
Surer S. Toktas F. Yavuz S. Turk T. Ata Y. Vural A.H. Goncu M.T. Yasar
N.G. Yalcinkaya U.
Institution
(Surer, Toktas, Yavuz, Turk, Ata, Vural, Goncu) Department of
Cardiovasculer Surgery, Bursa Yuksek Ihtisas Training and Research
Hospital, Bursa, Turkey
(Yasar) Faculty of Veterinary Medicine, Uludat University, Bursa, Turkey
(Yalcinkaya) Department of Pathology, Faculty of Medicine, Uludat
University, Bursa, Turkey
Title
The effect of transforming growth factor EB on regulation of intimal
hyperplasia in a rabbit carotid anastomosis model.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S79), 2014. Date of Publication: 01
Apr 2014.
Publisher
Elsevier Inc.
Abstract
Objective: The aim of the study was to investigate the effect of
transforming growth factor- b (TGF- beta) on regulation of intimal
hyperplasia in rabbit carotid anastomosis model. Methods: This
experimental, prospective, randomized controlled study was performed on
total of 20, six-month-old,New Zealand white young female rabbits
(2300+300g body weight) were used in this study. After anaesthesia,the
right carotid artery of each rabbits were transected and both ends
anastomosed.Rabbits were divided into four groups of five animal search:
T1 (tikagrelor: 5 mg/kg, po, daily), T2 (tikagrelor: 10 mg/kg, po, daily),
T3(tikagrelor: 20 mg/kg, po, daily), and C (control) group received
sterile PBS (phosphate buffered saline 2 ml/kg/day/p.o) for 3 weeks
postoperatively. After the sacrification, firstly anastomosis segment on
the right carotid artery and secondly a part of the left carotid artery of
each rabbit were isolated. Arterial sections were evaluated
histomorphologically and immunohistochemically with staining using
antibodies against transforming growth factor-beta. Results: In the
control group, the intima/media ratio was significantly higher than the
controlateral normal artery and TGF- beta scores increased maximum. In the
tikagrelol groups(T2,T3) (p<0.05), this ratio had significantly decreased
when compared with the control group (p< 0.05) and TGF- beta scores
decreased when the dose of ticagrelor that blocks ADP-induced platelet
aggregation increased. Conclusion: TGF- beta can plays an major role in
the development of intimal hyperplasia after vascular injury.

<32>
Accession Number
71391018
Authors
Dotan O.F.
Institution
(Dotan) Adana Numune Education and Training Hospital, Turkey
Title
Levosimendan use decreases atrial fibrillation in patients after coronary
artery bypass grafting: A pilot study.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S48-S49), 2014. Date of Publication:
01 Apr 2014.
Publisher
Elsevier Inc.
Abstract
Atrial fibrillation (AF) often occurs after coronary artery bypass
grafting (CABG) and can result in increased morbidity and mortality due to
complications. In the present study, our goal was to investigate whether
the use of levosimendan can reduce the frequency of AF after coronary
artery bypass grafting in patients with poor left ventricle function. To
investigate the effectiveness of levosimendan in the prophylaxis of AF, we
conducted a prospective, randomized, placebo-controlled clinical study on
200 consecutive patients in whom we performed elective CABG operations.
Baseline characteristics were similar in both groups. A control group of
100 patients were treated with placebo (500 mL saline solution), whereas
the levosimendan group (n = 100 patients) was treated with levosimendan.
High-sensitivity C-reactive protein, cardiac troponin, and creatine
kinase-MB levels were measured before surgery and 5 days postoperatively.
AF occurred in 12% of the levosimendan group and 36% of the control group.
The occurrence of AF was significantly lower in the levosimendan group (P
< 0.05). The duration of AF in the levosimendan group was significantly
shorter than that in the control group (4.83 + 1.12 and 6.50 + 1.55 hours,
respectively; P = 0.028). Our research showed that C-reactive protein was
higher postoperatively in the control group than in the levosimendan group
(P < 0.05). The incidence of postoperative AF in the levosimendan group
was reduced significantly in patients with poor left ventricle function
after CABG operations. (Figure Presented).

<33>
Accession Number
71390922
Authors
Cay S. Topaloglu S. Aras D. Ozeke O. Canpolat U. Aydogdu S.
Institution
(Cay, Topaloglu, Aras, Ozeke, Canpolat, Aydogdu) Department of Cardiology,
Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
Title
Meta-analysis of trials comparing cryothermal energy and radio frequency
energy for ablation of isthmus dependent atrial flutter.
Source
American Journal of Cardiology. Conference: 10th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20140313 Conference End: 20140316. Conference Publication:
(var.pagings). 113 (7 SUPPL. 1) (pp S10), 2014. Date of Publication: 01
Apr 2014.
Publisher
Elsevier Inc.
Abstract
Background: Catheter ablation of isthmus dependent atrial flutter is
highly effective to maintain sinus rhythm. Cryothermal or radiofrequency
energy can be used for ablation. Aim: The aim was to perform a
meta-analysis of clinical studies comparing cryothermal and radiofrequency
energies for isthmus dependent atrial flutter ablation. Methods: Medline,
EMBASE and Cochrane were searched for the topic. Data from 6 randomized
clinical trials were included in the analysis. Acute and follow-up
procedure related clinical outcomes were defined as percent of patients
with bidirectional conduction block, pain perception at procedure,
procedural time, and freedom from arrhythmia during a minimum 3-month
follow-up. Results: The percent of patients with bidirectional conduction
block was significantly higher in radiofrequency ablation compared to
cryoablation (OR 0.432, 95% CI 0.235 - 0.793, p = 0.0067). Pain perception
at procedure was lower with cryoablation than radiofrequency ablation
(p<0.001). However, procedural time was not different between cryothermal
and radiofrequency energies (p>0.05). Lastly, higher proportions of
patients without arrhythmia during follow-up in radiofrequency group
compared to cryoablation group were detected (OR 2.497, 95% CI 1.007 -
6.190, p = 0.0483) (Figure). Conclusion: Although total procedural time
was not different between 2 energy types, the prevalence of bidirectional
conduction block, pain perception and proportion of symptom-free patients
were higher with radiofrequency energy (Figure Presented).

<34>
Accession Number
71393523
Authors
Khalil A. Suff N. Grande A. Carvalho J. Cooper D. Thilaganathan B.
Institution
(Khalil, Carvalho, Thilaganathan) St. George's University Hospital,
London, United Kingdom
(Suff, Grande) University College London, London, United Kingdom
(Carvalho) Royal Brompton Hospital, London, United Kingdom
(Cooper) King's College London, London, United Kingdom
Title
Brain abnormalities and neurodevelopmental delay in congenital heart
disease: Systematic review and meta-analysis.
Source
Archives of Disease in Childhood: Fetal and Neonatal Edition. Conference:
16th Annual Conference of the British Maternal and Fetal Medicine Society
Dublin Ireland. Conference Start: 20130425 Conference End: 20130426.
Conference Publication: (var.pagings). 98 , 2013. Date of Publication:
April 2013.
Publisher
BMJ Publishing Group
Abstract
Objectives Studies have demonstrated an association between congenital
heart disease (CHD) and neurodevelopmental delay, partly attributed to the
risk of brain injury during cardiac surgery. However, neuroimaging studies
have demonstrated a high incidence of preoperative brain abnormalities.
The aim of this study was to perform a systematic review in order to
quantify the non-surgical risk of brain abnormalities and
neurodevelopmental delay in fetuses/newborns with CHD. Methods MEDLINE,
EMBASE and The Cochrane Library, without language restrictions were
searched electronically, utilising combinations of the terms congenital
heart, cardiac, neurologic, neurodevelopment, MRI, ultrasound,
neuroimaging, autopsy, preoperative and outcome. Reference lists of
relevant articles and reviews were hand searched for additional reports.
Cohort and case-control studies were included. Case reports and editorials
were excluded. Between-study heterogeneity was assessed using the I2
statistic. Results The search yielded 9,129 citations. Full manuscripts
were retrieved for 119, and 30 were included in the review and
meta-analysis. 21 studies (n = 953) have reported brain abnormalities in
fetuses, newborn or infants with CHD, either preoperatively or in those
who did not undergo congenital cardiac surgery. The remaining 9 studies (n
= 512) have reported preoperative data on neurodevelopmental assessment in
newborn or infants with CHD. The prevalence of brain abnormalities was 36%
(95% CI, 26%, 47%; I² = 90.5%) and of the neurodevelopmental
delay 42% (95% CI, 34%, 51%; I² = 68.9%), though with
heterogeneity between studies. Conclusions In the absence of chromosomal
or genetic abnormalities, fetuses with CHD are at increased risk of brain
abnormalities and neurodevelopmental delay, which are independent of the
surgical risk.

<35>
Accession Number
71387024
Authors
Jiang X. Clark M. Juhn A. Singh R.K. Schnatz P.F.
Institution
(Jiang, Clark, Juhn, Singh, Schnatz) ObGyn, Reading Hospital, West
Reading, PA, United States
(Jiang, Schnatz) ObGyn, Jefferson Medical College, Thomas Jefferson
University, Philadelphia, PA, United States
Title
Mammographically detected breast arterial calcifications and coronary
artery disease: A meta-analysis.
Source
Menopause. Conference: 24th Annual Meeting of the North American Menopause
Society, NAMS 2013 Dallas, TX United States. Conference Start: 20131009
Conference End: 20131012. Conference Publication: (var.pagings). 20 (12)
(pp 1323), 2013. Date of Publication: December 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Coronary artery disease (CAD) and strokes continue to be the
leading causes of morbidity and mortality among women in the United
States. Regular screening mammograms are recommended for women after age
40 due to their ability to assist in the early detection of breast cancer.
The investigators of many recent studies have analyzed the relationship
between breast arterial calcifications (BACs), seen on mammography, with
both CAD and strokes. We conducted a meta-analysis of the current
literature to deduce the strength of this association. Design: Using the
search terms "breast arterial calcification", "breast artery calcium",
"breast vascular calcification", "coronary artery disease", "coronary
heart disease", "cardiovascular disease", "myocardial infarction", "angina
pectoris", "abnormal coronary angiography", "coronary artery bypass
graft", "stroke" and "peripheral vascular disease", our literature search
revealed 75 articles. Limiting our search to articles that analyzed only
CAD and/or stroke, 35 full manuscripts were reviewed. Of these articles,
16 were included in the final analysis. Results: Two cohort studies were
analyzed, one prospective and one retrospective where n=14,215. The odds
ratio (OR) for developing CAD in those with BAC, vs. those without BAC, is
1.61, 95% CI: 1-33-1.95, and p<0.0001. For stroke, the OR=1.79, 95% CI:
1.55-2.23 and p<0.0001. There were 10 cross-sectional studies analyzed
with CAD as the primary outcome, diagnosed by coronary angiography, where
n=3,952. The OR of CAD in those with BAC, vs. those without BAC, is 3.86,
95% CI: 3.25-4.59 and p<0.0001. For stroke, 7 cross-sectional studies were
analyzed where n=19,011. The OR of stroke in those with BAC, vs. those
without BAC, is 1.77, 95% CI: 1.45-2.16 and p<0.0001. Conclusion: These
results suggest that BAC is significantly associated with both CAD and
stroke. Although previous studies have been criticized regarding sample
sizes and study designs, a recent prospective study along with this robust
data set and meta-analysis adds to our knowledge. While more prospective
studies are warranted to clarify whether BACs are truly a predictor of the
future development of CAD and stroke, there clearly appears to be an
association. In light of this, it may be beneficial to routinely report
BACs on mammograms to alert providers to the increased risk for the
presence of, vs. development of, CAD and / or stroke.