EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 26

Results Generated From:
Embase <1980 to 2014 Week 18>
Embase (updates since 2014-04-24)

<1>
Accession Number
2014167796
Authors
Attar A.S. Tabari M. Rahnamazadeh M. Salehi M.
Institution
(Attar, Tabari, Rahnamazadeh) Department of Anesthesiology, Ghaem
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Salehi) Department of Community Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Title
A comparison of effects of propofol and isoflurane on arterial oxygenation
pressure, mean arterial pressure and heart rate variations following
one-lung ventilation in thoracic surgeries.
Source
Iranian Red Crescent Medical Journal. 16 (2) , 2014. Article Number:
e15809. Date of Publication: February 2014.
Publisher
Iranian Red Crescent Society
Abstract
Background: Hypoxia occurs during one-lung ventilation (OLV) due to the
arteriovenous shunt of unsaturated pulmonary venous blood. Hypoxic
pulmonary vasoconstriction (HPV) acts as a defense mechanism against
shunting. In thoracic surgery, anesthetics with minimal inhibitory effect
on HPV and minimal hemodynamic changes are preferred. Objectives: The
present study aimed to evaluate the Effects of propofol and isoflurane on
patients' arterial oxygen pressure following one-lung ventilation during
thoracic surgeries. Materials and Methods: In this randomized clinical
trial study which was conducted in Iran, sixty patients with ASA (The
American Society of Anesthesiologists) class I & II who were candidates
for right elective thoracotomy were divided in two groups. Induction of
anesthesia in the two groups was conducted using the same method, and left
double-lumen endotracheal tube was inserted. In the first group propofol
was used for the maintenance of anesthesia, and isoflurane for the second
group. During two-lung ventilation and at minutes 5 and 10 after OLV, ABG
(arterial blood gas) (for detecting the mean pressure of arterial oxygen),
mean arterial pressure and heart rate were recorded. Results: Sixty
patients (mean age = 4124.18 + 18.63 years) were divided into two groups.
The age and gender of the subjects were not statistically different
between the two groups. In the propofol group, the arterial oxygen
pressure during two-lung ventilation and at 5th and 10th minutes after OLV
was 263.14 + 136.19, 217.40 + 133.99 and 182.34 + 122.39; in the
isoflurane group, it was reported as 206.29 + 135.59, 164.78 + 118.90 and
155.35 + 109.21 mmHg, respectively. In the propofol group, mean arterial
pressure during two-lung ventilation, and 5th and 10th minutes after OLV,
was 84.01 + 20.67, 88.15 + 20.23 and 86.10 + 19.13, respectively;
regarding the isoflurane group, it was reported as 79.66 + 17.04, 84.78 +
20.19 and 86.50 + 17.07 mmHg, respectively. In the propofol group, heart
rate during two-lung ventilation, and 5th and 10th minutes after OLV was
92.77 + 17.20, 94.0 + 18.34 and 94.33 + 21.03, respectively; In the
isoflurane group, it was reported as 92.87 + 16.96, 91.8 + 18.75 and 91.05
+ 17.20 min, respectively. These values were statistically similar in the
two study groups. Conclusions: The Effects of propofol on hemodynamics and
arterial oxygen pressure during one- or two-lung ventilation were not
different from those of isoflurane. 2014, Iranian Red Crescent Medical
Journal; Published by Kowsar Corp.

<2>
Accession Number
2013657082
Authors
Soltani G. Abbasi Tashnizi M. Moeinipour A.A. Ganjifard M. Esfahanizadeh
J. Sepehri Shamloo A. Purafzali Firuzabadi S.J. Zirak N.
Institution
(Soltani, Ganjifard) Department of Anesthesiology, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Abbasi Tashnizi, Moeinipour, Esfahanizadeh, Sepehri Shamloo, Purafzali
Firuzabadi, Zirak) Department of Cardiac Surgery, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Comparing the effect of preoperative administration of methylprednisolone
and its administration before and during surgery on the clinical outcome
in pediatric open heart surgeries.
Source
Iranian Red Crescent Medical Journal. 15 (6) (pp 483-487), 2013. Date of
Publication: June 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: Cardiac surgery under Cardiopulmonary bypass causes a systemic
inflammatory response with a multifactorial etiology including direct
tissue damage, ischemia and stimulation of immune system induced by
cardiopulmonary bypass. This study was designed due to the high prevalence
and complications of this stimulated immune system in mortality,
morbidity, length of ICU stay, and mechanical ventilation. Objectives:
This study was aimed to compare preoperative and intraoperative
methylprednisolone (MP) to intraoperative MP alone with respect to
postbypass inflammation and clinical outcome. Patients and Methods: Sixty
pediatric patients (age < 5years) undergoing cardiopulmonary bypass
surgery between September 2011-2012 at Imam Reza hospital-Mashhad were
randomly assigned to receive preoperative and intraoperative MP (group 1:
30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or
intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative
temperature (peak temperature and average temperature during the first 24
hours), amount of inotropic, duration of mechanical ventilation, ICU stay,
WBC, BUN, creatinine, and CRP were recorded and compared in both groups.
Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if
necessary, and Chi-squared distribution. Results: Patient characteristics
including age, weight, gender, and duration of bypass were almost similar
in both groups (P > 0.05). No significant difference in amount of
inotropic medications used for hemodynamic supports, duration of
mechanical ventilation, peak and average temperature and length of ICU
stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP)
only WBC counts raised more in group 2 when compared to group 1(P < 0.05).
Conclusions: There was no difference in clinical outcome after cardiac
surgery when we administered an additional dose of methylprednisolone
compared to a single dose of methylprednisolone. 2013, Iranian Red
Crescent Medical Journal.

<3>
Accession Number
2013657066
Authors
Taghipour H. Shafiei H. Assar O. Ghiasi M.S.
Institution
(Taghipour) Trauma research center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Shafiei) Cardiac Surgery Ward, Baqiyatallah Hospital, Tehran, Iran,
Islamic Republic of
(Assar) Cardiovascular Research Center, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Ghiasi) Jamaran Heart Hospitals, Tehran, Iran, Islamic Republic of
Title
The effect of systemic arterial-line leukocyte filtration on the outcome
of adult patients undergoing cardiac surgery.
Source
Iranian Red Crescent Medical Journal. 15 (5) (pp 414-417), 2013. Date of
Publication: May 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: It is known that cardiopulmonary bypass causes an inflammatory
reaction with associated morbidity and mortality. Several
anti-inflammatory strategies have been implemented to reduce this
response, including leukocyte removal from the circulation using
specialized filters. Objectives: The aim of this randomized clinical study
was to assess the impact of arterial-line systemic leukocyte filtration on
the postoperative outcome of adult patients undergoing elective cardiac
surgery. Patients and Methods: 114 patients undergoing CABG or valve
replacement in Baqiyatallah hospital, Tehran, Iran from May to August 2011
were randomly assigned to two groups: with and without leukocyte
filtration and their outcomes were compared. Results: The postoperative
intubation time was significantly shorter in patients with leukocyte
filters (0.014). There was no significant difference between two groups
regarding other outcome relatedvariables. Conclusions: Systemic arterial
leukocyte filtration reduces the intubation time but has no other
beneficial effect on the outcome of patients undergoing CABG or valve
surgery. 2013, Iranian Red Crescent Medical Journal.

<4>
Accession Number
2013656960
Authors
Tabari M. Alipour M. Esalati H.
Institution
(Tabari, Alipour, Esalati) Department of Anesthesiology, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Title
Evaluation of oral tiazinidine effects on [intraoperative] hemodynamic
responses during direct laryngoscopy under general anesthesia.
Source
Iranian Red Crescent Medical Journal. 15 (7) (pp 541-546), 2013. Date of
Publication: July 2013.
Publisher
Iranian Red Crescent Society
Abstract
Background: Direct laryngoscopy and tracheal intubation can result in
blood pressure and heart rate increase which in turn may lead to
myocardial ischemia, cerebral hemorrhage, and even death in susceptible
patients. Tizanidine is alpha2-receptor agonists that suppresses central
sympathetic system. Objectives: This study evaluates the effects of oral
Tizanidine on hemodynamic responses during operations and aims to
determine the appropriate Propofol dosage to maintain anesthesia under BIS
monitoring. Materials and Methods: A double-blind clinical trial has been
performed on 70 candidates for elective abdominal surgery undergoing
general anesthesia in Educational Hospital of Ghaem, Mashhad, Iran. 35
randomly selected patients (the case group) were given 4 mg of oral
Tizanidine 90 minutes before the induction of anesthesia whereas the
remaining subjects (the control group) were given placebo. Blood pressure
and heart rate before and after induction of anesthesia, and after
intubation and extubation, existence of postoperative shivering, and the
needed Propofol dosage were measured and recorded. Data analysis was done
with T-test and Chi-squared test, using SPSS software version 16. Results:
Variations of blood pressure and heart rate after anesthesia induction,
intubation and extubation were less in Tizanidine group generally.
Postoperative shivering was reported in 28.6% and 11.4% of patients in
control and case group respectively. Average propofol needed dose for
anesthesia maintenance in case group was 25% less than the needed amount
in the control group. Conclusions: Using oral Tizanidine as a
premedication, yielded stability in blood pressure and heart rate during
surgery and decreased required Propofol. Considering its short duration of
action, Tizanidine use as a premedication is recommended for sedation and
stabilization of hemodynamic responses during the operations. 2013,
Iranian Red Crescent Medical Journal.

<5>
Accession Number
2014261756
Authors
Zhang D. Song X. Lv S. Yuan F. Xu F. Zhang M. Li W. Yan S.
Institution
(Zhang, Song, Lv, Yuan, Xu, Zhang, Li, Yan) Department of Cardiology,
Capital Medical University, Beijing Institute of Heart, Lung and Blood
Vessel Disease, Beijing, China
Title
Culprit vessel only versus multivessel percutaneous coronary intervention
in patients presenting with ST-segment elevation myocardial infarction and
multivessel disease.
Source
PLoS ONE. 9 (3) , 2014. Article Number: e92316. Date of Publication: 20
Mar 2014.
Publisher
Public Library of Science
Abstract
Background: The best strategy for ST-segment elevation myocardial
infarction (STEMI) patients with multivessel disease (MVD), who underwent
primary percutaneous coronary intervention (PCI) in the acute phase, is
not well established. Objectives: Our goal was to conduct a meta-analysis
comparing culprit vessel only percutaneous coronary intervention (culprit
PCI) with multivessel percutaneous coronary intervention (MV-PCI) for
treatment of patients with STEMI and MVD. Methods: Pubmed, Elsevier,
Embase, and China National Knowledge Infrastructure (CNKI) databases were
systematically searched for randomized and nonrandomized studies comparing
culprit PCI and MV-PCI strategies during the index procedure. A
meta-analysis was performed using Review Manager 5.1 (Cochrane Center,
Denmark). Results: Four randomized and fourteen nonrandomized studies
involving 39,390 patients were included. MV-PCI strategy is associated
with an increased short-term mortality (OR: 0.50, 95% CI: 0.32 to 0.77, p
= 0.002), long-term mortality (OR: 0.52, 95% CI: 0.36 to 0.74, p<0.001),
and risk of renal dysfunction (OR: 0.77, 95% CI: 0.61 to 0.97, p = 0.03)
compared with culprit PCI strategy, while it reduced the incidence of
revascularization (OR: 2.65, 95% CI: 1.80 to 3.90, p<0.001). Conclusions:
This meta-analysis supports current guidelines which indicate that the
non-culprit vessel should not be treated during the index procedure. 2014
Zhang et al.

<6>
Accession Number
2014263790
Authors
Eaton J. Mealing S. Thompson J. Moat N. Kappetein P. Piazza N. Busca R.
Osnabrugge R.
Institution
(Eaton, Mealing, Thompson) Oxford Outcomes Ltd, ICON Plc. Company,
Seacourt Tower, West Way, Oxford OX2 0JJ, United Kingdom
(Moat) Royal Brompton Hospital, London, United Kingdom
(Kappetein, Osnabrugge) Erasmus Medical Center, Rotterdam, Netherlands
(Piazza) Munich Heart Centre, Munich, Germany
(Piazza) McGill University Health Center, Montreal, QC, Canada
(Busca) Medtronic International Trading Sarl, Tolochenaz, Switzerland
Title
Is transcatheter aortic valve implantation (TAVI) a cost-effective
treatment in patients who are ineligible for surgical aortic valve
replacement? A systematic review of economic evaluations.
Source
Journal of Medical Economics. 17 (5) (pp 365-375), 2014. Date of
Publication: May 2014.
Publisher
Informa Healthcare
Abstract
Objectives: Health Technology Assessment (HTA) agencies often undertake a
review of economic evaluations of an intervention during an appraisal in
order to identify published estimates of cost-effectiveness, to elicit
comparisons with the results of their own model, and to support local
reimbursement decision-making. The aim of this research is to determine
whether Transcatheter Aortic Valve Implantation (TAVI) compared to medical
management (MM) is cost-effective in patients ineligible for surgical
aortic valve replacement (SAVR), across different jurisdictions and
country-specific evaluations. Methods: A systematic review of the
literature from 2007-2012 was performed in the MEDLINE, MEDLINE
in-process, EMBASE, and UK NHS EED databases according to standard
methods, supplemented by a search of published HTA models. All identified
publications were reviewed independently by two health economists. The
British Medical Journal (BMJ) 35-point checklist for economic evaluations
was used to assess study reporting. To compare results, incremental cost
effectiveness ratios (ICERs) were converted to 2012 dollars using
purchasing power parity (PPP) techniques. Results: Six studies were
identified representing five reimbursement jurisdictions (England/Wales,
Scotland, the US, Canada, and Belgium) and different modeling techniques.
The identified economic evaluations represent different willingness-to-pay
thresholds, discount rates, medical costs, and healthcare systems. In
addition, the model structures, time horizons, and cycle lengths varied.
When adjusting for differences in currencies, the ICERs ranged from
$27K-$65K per QALY gained. Conclusions: Despite notable differences in
modeling approach, under the thresholds defined by using either the local
threshold value or that recommended by the World Health Organization (WHO)
threshold value, each study showed that TAVI was likely to be a
cost-effective intervention for patients ineligible for SAVR. 2014
Informa UK Ltd.

<7>
Accession Number
2014262206
Authors
Huber C.
Institution
(Huber) Department of Cardiovascular Surgery, Swiss Cardiovascular
Centre,, University Hospital of Bern, Bern, Switzerland
Title
Re: Is valve choice a significant determinant of paravalvular leak
post-transcatheter aortic valve implantation? A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 45 (5) (pp 834-835), 2014.
Article Number: ezt558. Date of Publication: May 2014.
Publisher
Elsevier

<8>
Accession Number
2014262205
Authors
O'sullivan K.E. Gough A. Segurado R. Barry M. Sugrue D. Hurley J.
Institution
(O'sullivan, Gough, Barry, Sugrue, Hurley) Mater University Hospital and
Mater Private Hospital, Dublin, Ireland
(Segurado) Centre for Support and Training in Analysis and Research
(CSTAR), University College Dublin, Dublin, Ireland
Title
Is valve choice a significant determinant of paravalular leak
post-transcatheter aortic valve implantation? A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 45 (5) (pp 826-833), 2014.
Article Number: ezt515. Date of Publication: May 2014.
Publisher
Elsevier
Abstract
OBJECTIVES: Paravalvular regurgitation (PVR) following transcatheter
aortic valve implantation (TAVI) is associated with poor survival. The two
main valve delivery systems used to date differ significantly in both
structure and deployment technique. The primary objective of this study
was to perform a systematic review and meta-analysis of studies
identifying PVR in patients post-TAVI using Medtronic CoreValve (MCV) and
Edward Sapien (ES) valves in order to identify whether a significant
difference exists between valve types. The secondary objective was to
identify additional factors predisposing to PVR to provide an overview of
the other associated considerations. METHODS: A systematic review and
meta-analysis of the current literature to identify PVR rate in patients
with MCV and ES valves was performed. We also sought to examine other
factors predisposing to PVR. RESULTS: A total of 5910 patients were
identified from 9 studies. PVR rates for MCV and ES were analysed. MCV was
associated with a higher PVR rate of 15.75% [95% confidence interval (CI)
12.48-19.32] compared with ES 3.93% [95% CI 1.05-8.38]. We separately
reviewed predisposing factors associated with PVR. A formal comparison of
the MCV and ES valve leakage rates by mixed-effects meta-regression with a
fixed-effect moderator variable for valve type (MCV or ES) suggested a
statistically significant difference in leakage rate between the two valve
types (P = 0.0002). CONCLUSIONS: Unfavourable anatomical and pathological
factors as well as valve choice have an impact on rates of PVR.
Additionally, certain anatomical features dictate valve choice. A direct
comparison of all the predisposing factors at this time is not possible
and will require prospective multivariate analysis. There is, however, a
significant difference in the PVR rates between valves based on the
published observational data available to date. The ES valve associated
with a lower incidence of PVR overall; therefore, we conclude that valve
choice is indeed a significant determinant of PVR post-TAVI. The Author
2013. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<9>
Accession Number
2014257363
Authors
Devereaux P.J. Sessler D.I. Leslie K. Kurz A. Mrkobrada M. Alonso-Coello
P. Villar J.C. Sigamani A. Biccard B.M. Meyhoff C.S. Parlow J.L. Guyatt G.
Robinson A. Garg A.X. Rodseth R.N. Botto F. Lurati Buse G. Xavier D. Chan
M.T.V. Tiboni M. Cook D. Kumar P.A. Forget P. Malaga G. Fleischmann E.
Amir M. Eikelboom J. Mizera R. Torres D. Wang C.Y. VanHelder T. Paniagua
P. Berwanger O. Srinathan S. Graham M. Pasin L. Le Manach Y. Gao P. Pogue
J. Whitlock R. Lamy A. Kearon C. Chow C. Pettit S. Chrolavicius S. Yusuf
S.
Institution
(Devereaux, Mrkobrada, Robinson, Botto, Lurati Buse, Eikelboom, Le Manach,
Gao, Pogue, Whitlock, Lamy, Pettit, Chrolavicius, Yusuf) Population Health
Research Institute, Hamilton Health Sciences and McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Cook, Eikelboom, Le Manach, Pogue, Kearon, Yusuf)
Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Devereaux, Guyatt, Tiboni, Cook, Eikelboom, Mizera, Le Manach, Pogue,
Kearon, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Devereaux, Guyatt, Cook, Eikelboom, VanHelder, Le Manach, Kearon, Yusuf)
Department of Anesthesia, McMaster University, Hamilton, ON, Canada
(Whitlock, Lamy) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock) Department of Critical Care, McMaster University, Hamilton, ON,
Canada
(Mrkobrada) Department of Medicine, London Health Sciences Centre, London,
ON, Canada
(Parlow) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Queen's University, Kingston, ON, Canada
(Garg) Department of Medicine, Division of Nephrology, University of
Western Ontario, London, ON, Canada
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Graham) Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Sessler, Kurz) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, United States
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Alonso-Coello) Iberoamerican Cochrane Center, Biomedical Research
Institute (IIB-Sant Pau), Barcelona, Spain
(Paniagua) Anesthesiology Department, Biomedical Research Institute
(IIB-Sant Pau), Barcelona, Spain
(Villar) Universidad Autonoma de Bucaramanga, Fundacion Cardioinfantil,
Bogota, Colombia
(Sigamani, Xavier) Department of Pharmacology, Division of Clinical
Research and Training, St. John's National Academy of Health Sciences,
Bangalore, India
(Biccard, Rodseth) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, Durban, South Africa
(Meyhoff) Department of Anesthesiology, Herlev Hospital, University of
Copenhagen, Herlev, Denmark
(Botto) Estudios Clinicos Latino America (ECLA), Instituto Cardiovascular
de Buenos Aires (ICBA), Buenos Aires, Argentina
(Lurati Buse) Department of Anesthesia, University Hospital Basel, Basel,
Switzerland
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong, Hong Kong
(Kumar) Department of Anesthesiology, University of North Carolina, Chapel
Hill, NC, United States
(Forget) Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels,
Belgium
(Malaga) Universidad Peruana Cayetano Heredia, Lima, Peru
(Fleischmann) Department of Anesthesia and Intensive Care, Medical
University Vienna, Vienna, Australia
(Amir) Department of Surgery, Shifa International Hospital, Islamabad,
Pakistan
(Torres) Department of Anesthesiology, Clinica Santa Maria, Santiago,
Chile
(Wang) Department of Anesthesiology, University of Malaya, Kuala Lumpur,
Malaysia
(Berwanger) Research Institute HCor (Hospital do Coracao), Sao Paulo,
Brazil
(Pasin) Anesthesia and Intensive Care, San Raffaele Scientific Institute,
Milan, Italy
(Chow) George Institute for Global Health, University of Sydney, Sydney,
Australia
Title
Clonidine in patients undergoing noncardiac surgery.
Source
New England Journal of Medicine. 370 (16) (pp 1504-1513), 2014. Date of
Publication: 2014.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Marked activation of the sympathetic nervous system occurs
during and after non-cardiac surgery. Low-dose clonidine, which blunts
central sympathetic outflow, may prevent perioperative myocardial
infarction and death without inducing hemodynamic instability. METHODS: We
performed a blinded, randomized trial with a 2-by-2 factorial design to
allow separate evaluation of low-dose clonidine versus placebo and
low-dose aspirin versus placebo in patients with, or at risk for,
atherosclerotic disease who were undergoing noncardiac surgery. A total of
10,010 patients at 135 centers in 23 countries were enrolled. For the
comparison of clonidine with placebo, patients were randomly assigned to
receive clonidine (0.2 mg per day) or placebo just before surgery, with
the study drug continued until 72 hours after surgery. The primary outcome
was a composite of death or nonfatal myocardial infarction at 30 days.
RESULTS: Clonidine, as compared with placebo, did not reduce the number of
primary-outcome events (367 and 339, respectively; hazard ratio with
clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29).
Myocardial infarction occurred in 329 patients (6.6%) assigned to
clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio,
1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the
clonidine group than in the placebo group had clinically important
hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio
1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo,
was associated with an increased rate of nonfatal cardiac arrest (0.3% [16
patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73;
P=0.02). CONCLUSIONS: Administration of low-dose clonidine in patients
undergoing noncardiac surgery did not reduce the rate of the composite
outcome of death or nonfatal myocardial infarction; it did, however,
increase the risk of clinically important hypotension and nonfatal cardiac
arrest. Copyright 2014 Massachusetts Medical Society.

<10>
Accession Number
2014245931
Authors
Pandit A. Aryal M.R. Pandit A.A. Jalota L. Hakim F.A. Mookadam F. Lee H.R.
Tleyjeh I.M.
Institution
(Pandit, Pandit, Hakim, Mookadam, Lee) Division of Cardiovascular
Diseases, Mayo Clinic, Scottsdale, AZ, United States
(Aryal, Jalota) Department of Internal Medicine, Reading Hospital, West
Reading, PA, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, King Fahad Medical City, Riyadh, Saudi
Arabia
(Tleyjeh) College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
Title
Cangrelor versus clopidogrel in percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
EuroIntervention. 9 (11) (pp 1350-1358), 2014. Date of Publication: March
2014.
Publisher
EuroPCR
Abstract
Aims: Cangrelor is a new antiplatelet agent that has been used in
percutaneous coronary intervention (PCI) with mixed results. We aimed to
review the evidence on the efficacy of cangrelor in comparison to
clopidogrel in reducing ischaemic endpoints at 48 hours in patients
undergoing PCI in large randomised trials. Methods and results: In three
large clinical trials involving 25,107 participants, the risk of the
primary composite efficacy endpoint of death, MI and ischaemia-driven
revascularisation at 48 hours, (pooled OR 0.94; 95% CI: 0.77-1.14, p=0.51,
I²=68%), death from all cause (pooled OR 0.72, 95% CI:
0.36-1.43, p=0.34, I²=52%), myocardial infarction (pooled OR
0.94, 95% CI: 0.77-1.14, p=0.51, I²=68%) was not significantly
different between cangrelor and clopidogrel. Likewise, severe or
life-threatening bleeding was similar between cangrelor and clopidogrel
(pooled OR 1.21, 95% CI: 0.70-2.12, p=0.50, I²=0%). The risk of
stent thrombosis (pooled OR 0.59, 95% CI: 0.43-0.81, p=0.001,
I²=0%), Q-wave myocardial infarction (pooled OR 0.53, 95% CI:
0.30-0.92, p=0.02, I ²=0%) and ischaemia-driven
revascularisation (pooled OR 0.71, 95% CI: 0.52-0.98, p=0.04,
I²=0%) was lower in the cangrelor group. Conclusions: Based on
this meta-analysis, we did not find any difference in the risk of the
primary composite efficacy endpoint of all-cause death, ischaemia-driven
revascularisation, and myocardial infarction at 48 hours between cangrelor
and clopidogrel use. Given that cangrelor was associated with a lower risk
of stent thrombosis, ischaemia-driven revascularisation and Q-wave
myocardial infarction compared to clopidogrel, cangrelor can be considered
as a suitable alternative during PCI. Europa Digital & Publishing 2014.
All rights reserved.

<11>
Accession Number
2014258710
Authors
Campo G. Punzetti S. Malagu M. Ferrari R. Valgimigli M.
Institution
(Campo, Punzetti, Malagu, Ferrari) Cardiovascular Institute, Azienda
Ospedaliero-Universitaria S. Anna, Ferrara, Italy
(Campo, Ferrari) LTTA Center, Ferrara, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care and Research, E.S. Health
Science Foundation, Cotignola, Italy
(Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Two-year outcomes after first- or second-generation drug-eluting stent
implantation in patients with in-stent restenosis. A PRODIGY trial
substudy.
Source
International Journal of Cardiology. 173 (2) (pp 343-345), 2014. Date of
Publication: 01 May 2014.
Publisher
Elsevier Ireland Ltd

<12>
Accession Number
2014260506
Authors
Rogge B.P. Gerdts E. Cramariuc D. Bahlmann E. Jander N. Gohlke-Barwolf C.
Pedersen T.R. Lonnebakken M.T.
Institution
(Rogge, Gerdts, Cramariuc) Department of Heart Disease, Haukeland
University Hospital, Bergen, Norway
(Gerdts, Lonnebakken) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Bahlmann) Department of Cardiology, Asklepios Clinic St. Georg, Hamburg,
Germany
(Jander, Gohlke-Barwolf) Herz-Zentrum Bad Krozingen, Bad Krozingen,
Germany
(Pedersen) Division of Medicine, Center of Preventive Medicine, Oslo
University Hospital, Ulleval, Oslo, Norway
Title
Impact of obesity and nonobesity on grading the severity of aortic valve
stenosis.
Source
American Journal of Cardiology. 113 (9) (pp 1532-1535), 2014. Date of
Publication: 01 May 2014.
Publisher
Elsevier Inc.
Abstract
We tested the hypothesis that the disproportionate increase of body
surface area in obesity may lead to the overestimation of aortic stenosis
(AS) severity when the aortic valve area (AVA) is indexed (AVAI) for body
surface area in 1,524 patients enrolled in the Simvastatin and Ezetimibe
in AS study. Obesity was defined as a body mass index of >30
kg/m². Peak aortic jet velocity, mean aortic gradient, AVA, and
energy loss (EL) did not differ, although AVAI and EL indexed (ELI) for
body surface area were significantly smaller in the obese group (n = 321)
compared with the nonobese (n = 1,203) group (both p <0.05). Severe AS by
AVAI (<0.6 cm²/m ²) but nonsevere by AVA (>1.0
cm²; AVAI/AVA discordance) was found in 15% of the patients,
whereas severe AS by ELI (<0.6 cm²/m²) but nonsevere
by EL (>1.0 cm²; ELI/EL discordance) was found in 9% of the
patients. Obesity was associated with a 2.4-fold higher prevalence of
AVAI/AVA discordance and a 1.6-fold higher prevalence of ELI/EL
discordance. Discordant grading was also associated with male gender,
larger body size, higher mean aortic gradient, and stroke volume (all p
<0.05). During a median follow-up of 4.3 years, 419 patients were referred
for aortic valve replacement and 177 patients died or were hospitalized
because of heart failure. In the Cox regression analyses, AVAI/AVA
discordance was associated with a 28% higher rate of aortic valve
replacement (p <0.05) but did not predict the rate of combined death and
hospitalization for heart failure. In conclusion, using AVAI and ELI for
the grading of stenosis in patients with obesity may lead to
overestimation of true AS severity. 2014 Elsevier Inc. All rights
reserved.

<13>
[Use Link to view the full text]
Accession Number
2014256035
Authors
Verdoia M. Schaffer A. Barbieri L. Cassetti E. Piccolo R. Galasso G.
Marino P. Sinigaglia F. De Luca G.
Institution
(Verdoia, Schaffer, Barbieri, Cassetti, Marino, De Luca) Division of
Cardiology, Azienda Ospedaliera-Universitaria maggiore della Carita,
Eastern Piedmont University, C.so Mazzini 18, Novara 28100, Italy
(Piccolo, Galasso) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(Sinigaglia) Department of Translational Medicine, Centro di Biotecnologie
per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University,
Novara, Italy
Title
Benefits from new ADP antagonists as compared with clopidogrel in patients
with stable angina or acute coronary syndrome undergoing invasive
management: A meta-analysis of randomized trials.
Source
Journal of Cardiovascular Pharmacology. 63 (4) (pp 339-350), 2014. Date of
Publication: April 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Aims: New P2Y12 receptor inhibitors have provided new and more potent
antiplatelet strategies, although raising several concerns on possible
increase of bleedings. The aim of current meta-analysis was to evaluate
the efficacy and safety of new adenosine diphosphate (ADP) receptor
antagonists as compared with clopidogrel in elective or ACS patients
managed invasively. Methods and Results: Literature archives (Pubmed,
EMBASE, Cochrane) and main scientific sessions abstracts were scanned for
randomized trials comparing new ADP antagonists with clopidogrel in
patients with acute coronary syndromes or stable angina. Primary endpoint
was mortality. Secondary endpoints were: (1) nonfatal myocardial
infarction (MI), (2) recurrent ischemia symptoms or ischemia-driven
revascularization (RI/IDR), (3) stent thrombosis (ST), and (4) safety
endpoints, defined as for TIMI major bleeding criteria. A total of 8
randomized clinical trials were finally included, for a total population
of 67,851 patients. Mean follow-up was 7.6 months, ranging from 48 hours
to 30 months. New ADP antagonists significantly reduced mortality {3.1%
vs. 3.6%, odds ratio [OR] [95% confidence interval (CI)], 0.86
[0.79-0.94], P = 0.0008, Phet = 0.18}, with greater impact of oral drugs.
Similar benefits were found for MI [6.1% vs. 7%; OR (95% CI)
(random-effect model) = 0.88 (0.79-0.98), P = 0.01, Phet = 0.02], RI [2.7%
vs. 3.1%; OR (95% CI) = 0.85 (0.77-0.93), P = 0.0005, Phet = 0.09], or ST
[1.1% vs. 1.7%; OR (95% CI) = 0.60 (0.51-0.71), P < 0.00001, Phet = 0.13].
By meta-regression analysis, no relationship was observed between benefits
in mortality, new MI, RI, and ST with new ADP antagonists and patients'
risk profile [beta (95% CI) =-0.01 [-0.30 to 0.27], P = 0.94; beta (95%
CI) =-0.05 [-1.49 to 1.43], P = 0.96); beta (95% CI) = 0.19 (-0.18 to
0.57), P = 0.31, and beta (95% CI) =-0.08 (-0.86 to 0.70), P = 0.84,
respectively]. CONCLUSIONS: Present meta-analysis shows that the new ADP
antagonists prasugrel, ticagrelor, and cangrelor are associated to
significant reduction of mortality, reinfarction, RI, and ST respect to
clopidogrel alone, without significant increase in bleeding complications.
2013 by Lippincott Williams & Wilkins.

<14>
Accession Number
2014253091
Authors
Hosbond S.E. Diederichsen A.C.P. Pedersen L. Rasmussen L.M. Munkholm H.
Gerke O. Poulsen T.S. Mickley H.
Institution
(Hosbond, Diederichsen, Poulsen, Mickley) Department of Cardiology, Odense
University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
(Hosbond, Diederichsen, Mickley) OPEN (Odense Patient Data Explorative
Network), Odense University Hospital, Odense, Denmark
(Pedersen, Rasmussen) Department of Biochemistry and Pharmacology, Odense
University Hospital, Odense, Denmark
(Diederichsen, Rasmussen) Centre for Individualized Medicine of Arterial
Diseases, Odense University Hospital, Odense, Denmark
(Munkholm) Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
(Gerke) Department of Nuclear Medicine, University of Southern Denmark,
Odense University Hospital, Denmark
Title
Lipocalin-type prostaglandin D synthase is not a biomarker of
atherosclerotic manifestations.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. 74 (3) (pp
219-227), 2014. Date of Publication: April 2014.
Publisher
Informa Healthcare
Abstract
Objective. Over the last decades Lipocalin-type prostaglandin D synthase
(L-PGDS), Osteoprotegerin (OPG), Osteopontin (OPN) and Pregnancy
associated plasma protein A (PAPP-A) have been reported to be associated
with coronary artery disease, and L-PGDS has been proposed as a potential
new diagnostic tool in the setting of stable coronary artery disease. We
set out to investigate if measurement of concentrations of these
biomarkers could be used to differentiate between four groups of
individuals with different atherosclerotic manifestations. Methods. A
total of 120 individuals from four equal gender- and age-matched groups
were studied: (i) no previous cardiovascular disease (CVD) and no coronary
calcifications [CAC-negative group], (ii) no previous CVD but evidence of
severe coronary calcifications [CAC-positive group], (iii) acute coronary
syndrome [ACS-group], and (iv) clinical stable patients with CVD, who were
referred for cardiovascular surgery [CVD-group]. Concentrations of L-PGDS,
OPG, OPN and PAPP-A were analyzed and compared between the four groups.
Results. We did not find any significant differences in L-PGDS
concentrations between the four groups (p = 0.32). OPG concentrations
differed significantly (p = 0.003), with the highest concentration
observed in ACS patients. Considering OPN (p = 0.12) and PAPP-A (p = 0.53)
their concentrations between groups did not differ significantly.
Conclusion. The main message from this study is the observation that
L-PGDS based on a single blood test appears to be less valuable than
previously proposed in identification of patients with coronary artery
disease. However, ACS patients have higher OPG concentrations than
patients with different manifestations of stable atherosclerosis. Neither
OPN nor PAPP-A concentrations differed between groups. 2014 Informa
Healthcare.

<15>
Accession Number
2014250697
Authors
Cooper Jr. L.T. Keren A. Sliwa K. Matsumori A. Mensah G.A.
Institution
(Cooper Jr.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Keren) Center for Heart Failure and Heart Muscle Diseases, Hadassah -
Hebrew University Hospital, Jerusalem, Israel
(Sliwa) Hatter Institute for Cardiovascular Research University of Cape
Town, Cape Town, South Africa
(Matsumori) Non-Profit Organization Asian Pacific Society of Cardiology,
Kyoto, Japan
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
Title
The global burden of myocarditis: Part 1: A systematic literature review
for the global burden of diseases, injuries, and risk factors 2010 study.
Source
Global Heart. 9 (1) (pp 121-129), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Myocarditis contributes to the global burden of cardiovascular disease
primarily through sudden death and dilated cardiomyopathy. A systematic
approach to identify the cardiovascular mortality and major morbidity
attributable to myocarditis has not been performed. A writing group
convened by the GBD 2010 (Global Burden of Diseases, Injuries and Risk
Factors) Study systematically reviewed the world's literature by a manual
review of all titles since 1966 on myocarditis identified using Ovid
Medline, development of a disease model, and provision of estimates when
possible of the incidence, prevalence, risk of death, and major morbidity
for the world regions. Accurate population-based estimates of myocarditis
incidence and prevalence are not directly available in any world region.
However, a model that quantitates the risk of acute death and chronic
heart failure following myocarditis was derived from the published data.
Using hospital dismissal data, the burden of myocarditis as a percentage
of prevalent heart failure varied by age and region from approximately
0.5% to 4.0%. The novel combination of multiple data sources may provide
an estimate of the years of life lost and years of life disabled from
myocarditis. Pending the integration of these data sources, the burden of
dilated cardiomyopathy and myocarditis were reported together in the 2010
GBD report. The 2013 GBD project may refine these estimates with the
inclusion of more comprehensive payor databases and more precise case
definitions. 2014 World Heart Federation (Geneva). Published by Elsevier
Ltd. All rights reserved.

<16>
Accession Number
2014250694
Authors
Bin Abdulhak A.A. Baddour L.M. Erwin P.J. Hoen B. Chu V.H. Mensah G.A.
Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, School of Medicine, University of
Missouri - Kansas City, Kansas City, MO, United States
(Baddour, Tleyjeh) Division of Infectious Diseases, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Medical Library, Mayo Clinic, Rochester, MN, United States
(Hoen) Department of Infectious Diseases, Dermatology and Internal
Medicine, University Medical Center of Guadeloupe, cedex, France
(Chu) Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Mensah) Center for Translation Research and Implementation Science
(CTRIS), National Heart, Lung, and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King-Fahad
Medical City, Riyadh, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Global and regional burden of infective endocarditis, 1990-2010: A
systematic review of the literature.
Source
Global Heart. 9 (1) (pp 131-143), 2014. Date of Publication: March 2014.
Publisher
Elsevier
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with
serious complications. The GBD 2010 (Global Burden of Disease, Injuries,
and Risk Factors) study IE expert group conducted a systematic review of
IE epidemiology literature to inform estimates of the burden on IE in 21
world regions in 1990 and 2010. The disease model of IE for the GBD 2010
study included IE death and 2 sequelae: stroke and valve surgery. Several
medical and science databases were searched for IE epidemiology studies in
GBD high-, low-, and middle-income regions published between 1980 and
2008. The epidemiologic parameters of interest were IE incidence,
proportions of IE patients who developed stroke or underwent valve
surgery, and case fatality. Literature searches yielded 1,975 unique
papers, of which 115 published in 10 languages were included in the
systematic review. Eligible studies were population-based (17%),
multicenter hospital-based (11%), and single-center hospital-based studies
(71%). Population-based studies were reported from only 6 world regions.
Data were missing or sparse in many low- and middle-income regions. The
crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people
and was reported from 10 countries. The overall mean proportion of IE
patients that developed stroke was 0.158 + 0.091, and the mean proportion
of patients that underwent valve surgery was 0.324 + 0.188. The mean case
fatality risk was 0.211 + 0.104. A systematic review for the GBD 2010
study provided IE epidemiology estimates for many world regions, but
highlighted the lack of information about IE in low- and middle-income
regions. More complete knowledge of the global burden of IE will require
improved IE surveillance in all world regions. 2014 World Heart
Federation (Geneva). Published by Elsevier Ltd. All rights reserved.

<17>
Accession Number
2014257340
Authors
Abdel-Wahab M. Mehilli J. Frerker C. Neumann F.-J. Kurz T. Tolg R. Zachow
D. Guerra E. Massberg S. Schafer U. El-Mawardy M. Richardt G.
Institution
(Abdel-Wahab, Tolg, El-Mawardy, Richardt) Heart Center, Segeberger
Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel and
Hamburg, Am Kurpark 1, 23795 Bad Segeberg, Germany
(Mehilli, Massberg) Munich University Clinic, Munich, Germany
(Frerker, Schafer) Cardiology Department, Asklepios Clinic St. Georg,
Hamburg, Germany
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Kurz) Cardiology Department, Lubeck University Hospital, Lubeck, Germany
(Zachow) Radiology Department, Segeberger Kliniken, Bad Segeberg, Germany
(Guerra) Intracoronary Stenting and Antithrombosis Research Center,
Munich, Germany
(Schafer) Cardiology Department, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
Title
Comparison of balloon-expandable vs self-expandable valves in patients
undergoing transcatheter aortic valve replacement: The CHOICE randomized
clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (15) (pp
1503-1514), 2014. Date of Publication: 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: Transcatheter aortic valve replacement (TAVR) is an effective
treatment option for high-risk patients with severe aortic stenosis.
Different from surgery, transcatheter deployment of valves requires either
a balloon-expandable or self-expandable system. A randomized comparison of
these 2 systems has not been performed. OBJECTIVE: To determine whether
the balloon-expandable device is associated with a better success rate
than the self-expandable device. DESIGN, SETTING, AND PATIENTS: The CHOICE
studywas an investigator-initiated trial in high-risk patients with severe
aortic stenosis and an anatomy suitable for the transfemoral TAVR
procedure. One hundred twenty-one patients were randomly assigned to
receive a balloon-expandable valve (Edwards Sapien XT) and 120 were
assigned to receive a self-expandable valve (Medtronic CoreValve).
Patients were enrolled between March 2012 and December 2013 at 5 centers
in Germany. INTERVENTIONS: Transfemoral TAVR with a balloon-expandable or
self-expandable device. MAIN OUTCOMES AND MEASURES: The primary end
pointwas device success, which is a composite end point including
successful vascular access and deployment of the device and retrieval of
the delivery system, correct position of the device, intended performance
of the heart valve without moderate or severe regurgitation, and only 1
valve implanted in the proper anatomical location. Secondary end points
included cardiovascular mortality, bleeding and vascular complications,
postprocedural pacemaker placement, and a combined safety end point at 30
days, including all-cause mortality, major stroke, and other serious
complications. RESULTS: Device success occurred in 116 of 121 patients
(95.9%) in the balloon-expandable valve group and 93 of 120 patients
(77.5%) in the self-expandable valve group (relative risk [RR], 1.24,
95%CI, 1.12-1.37, P < .001). This was attributed to a significantly lower
frequency of residual more-than-mild aortic regurgitation (4.1%vs 18.3%;
RR, 0.23; 95%CI, 0.09-0.58; P < .001) and the less frequent need for
implanting more than 1 valve (0.8%vs 5.8%, P = .03) in the
balloon-expandable valve group. Cardiovascular mortality at 30 days was
4.1% in the balloon-expandable valve group and 4.3%in the self-expandable
valve group (RR, 0.97; 95% CI, 0.29-3.25; P = .99). Bleeding and vascular
complications were not significantly different, and the combined safety
end point occurred in 18.2%of those in the balloon-expandable valve group
and 23.1%of the self-expandable valve group (RR, 0.79; 95%CI, 0.48-1.30; P
= .42). Placement of a new permanent pacemaker was less frequent in the
balloon-expandable valve group (17.3%vs 37.6%, P = .001). CONCLUSIONS AND
RELEVANCE: Among patients with high-risk aortic stenosis undergoing TAVR,
the use of a balloon-expandable valve resulted in a greater rate of device
success than use of a self-expandable valve. TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT01645202. Copyright 2014 American
Medical Association. All rights reserved.

<18>
Accession Number
2014253978
Authors
Phan K. Xie A. La Meir M. Black D. Yan T.D.
Institution
(Phan, Xie, Yan) Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan, Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, University of Sydney, 2 Technology Place, Sydney, Australia
(La Meir) Department of Cardiothoracic Surgery and Cardiology, Academic
Hospital Maastricht and Cardiovascular Research, Institute Maastricht,
Maastricht, Netherlands
(La Meir) University Hospital Brussels, Brussels, Belgium
(Black) Faculty of Health Sciences, University of Sydney, Sydney,
Australia
Title
Surgical ablation for treatment of atrial fibrillation in cardiac surgery:
A cumulative meta-analysis of randomised controlled trials.
Source
Heart. 100 (9) (pp 722-730), 2014. Article Number: 305351. Date of
Publication: May 2014.
Publisher
BMJ Publishing Group
Abstract
Introduction: Concomitant surgical ablation is a treatment modality for
patients with atrial fibrillation (AF) undergoing cardiac surgery,
however, its efficacy and clinical outcomes are not well established. The
present study is the first cumulative meta-analysis of randomised
controlled trials (RCT) on clinical outcomes of surgical ablation versus
no ablative treatment in all patients with cardiac surgery. Methods:
Electronic searches were performed using six databases from their
inception to October 2013, identifying all relevant RCTs comparing
surgical ablation versus no ablation in patients with AF undertaking
cardiac surgery. Data were extracted and analysed according to predefined
clinical endpoints. Results: Sixteen relevant RCTs were identified for the
present study. Higher prevalence of sinus rhythm in the surgical ablation
group was evident at all >12 month follow-up (OR, 6.72; 95% CI 4.88 to
9.25; p<0.00001). There were no significant differences between surgical
ablation versus no ablation in terms of mortality (OR, 1.05; 95% CI 0.66
to 1.68; p=0.83), pacemaker implantations (OR, 0.88; 95% CI 0.51 to 1.51;
p=0.64), and neurological events (OR, 0.86; 95% CI 0.37 to 2.04; p=0.74).
Cumulative meta-analysis demonstrated that these trends have remained
consistent over the years, with recent studies narrowing the CIs of the
summary estimates. Conclusions: The evaluation of the current randomised
trials demonstrates that concomitant surgical ablation and cardiac surgery
is safe and effective at restoring sinus rhythm.

<19>
Accession Number
2014261959
Authors
Mardani M. Farshidpour M. Nekoonam M. Varahram F. Najafizadeh K. Mohammadi
N. Sharifkashani B. Gachkar L. Farokhzad B. Droudinia A. Javanmard P.
Tabarsi P.
Institution
(Mardani, Nekoonam, Gachkar) Iranian Infectious Disease Research Center,
NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Farshidpour, Mohammadi, Farokhzad, Droudinia, Javanmard, Tabarsi)
Clinical TB and Epidemiology Research Center, NRITLD, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Varahram, Najafizadeh, Sharifkashani) Transplantation Research Center,
NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
Performance of QuantiFERON TB Gold test compared with the tuberculin skin
test for detecting latent tuberculosis infection in lung and heart
transplant candidates.
Source
Experimental and Clinical Transplantation. 12 (2) (pp 129-132), 2014. Date
of Publication: April 2014.
Publisher
Baskent University (26 Austin Avenue,Baglica Kampusu, P.O. Box 337,Ankara
06530, Turkey)
Abstract
Objectives: Evaluation for latent tuberculosis infection is advised before
organ transplant. The interferon-gamma release assay has been shown to be
more specific than the tuberculin skin test for screening for latent
tuberculosis infection. We compared the tuberculin skin test and
QuantiFERON-TB Gold In-Tube test for screening for latent tuberculosis
infection and agreement between the tests in heart and lung transplant
recipients before transplant. Materials and Methods: Fifty-five adult
patients who had been evaluated for heart and lung transplant between
September 2011 and September 2012 at Masih Daneshvari Hospital in Iran
were prospectively enrolled. We performed the tuberculin skin test and
QuantiFERON-TB Gold In-Tube test. Results: Of the 55 patients, 3 (5%) had
positive tuberculin skin test results, and 11 (20%) had positive
QuantiFERON-TB Gold In-Tube test results. Agreement between the tuberculin
skin test and QuantiFERON-TB Gold In-Tube test was fair (Kappa=0.061; 95%
CI: - 0.185-0.307) (P =.56). Conclusions: The positivity for
QuantiFERON-TB Gold In-Tube test was greater than the positivity for the
tuberculin skin test, and QuantiFERON-TB Gold In-Tube test more accurately
determined the risk for latent tuberculosis infection. However, a further
longitudinal study is necessary to verify that the QFT-G test would
predict developing tuberculosis after heart and lung transplant. Baskent
University 2014 Printed in Turkey. All Rights Reserved.

<20>
[Use Link to view the full text]
Accession Number
2014245030
Authors
Hlatky M.A. Ray R.M. Burwen D.R. Margolis K.L. Johnson K.C.
Kucharska-Newton A. Manson J.E. Robinson J.G. Safford M.M. Allison M.
Assimes T.L. Bavry A.A. Berger J. Cooper-DeHoff R.M. Heckbert S.R. Li W.
Liu S. Martin L.W. Perez M.V. Tindle H.A. Winkelmayer W.C. Stefanick M.L.
Institution
(Hlatky, Assimes, Perez, Winkelmayer, Stefanick) Stanford University
School of Medicine, HRP Redwood Bldg, Room T150, 259 Campus Dr, Stanford,
CA 94305-5405, United States
(Ray) Fred Hutchinson Cancer Research Center, Seattle, WA, United States
(Burwen) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Margolis) HealthPartners Institute for Education and Research Foundation,
Minneapolis, MN, United States
(Johnson) University of Tennessee Health Science Center, Memphis, United
States
(Kucharska-Newton) University of North Carolina School of Public Health,
Chapel Hill, United States
(Manson) Harvard Medical School, Boston, MA, United States
(Robinson) University of Iowa College of Public Health, Iowa City, United
States
(Safford) University of Alabama, Birmingham, United States
(Allison) University of California, San Diego, United States
(Bavry, Cooper-DeHoff) University of Florida, Gainesville, United States
(Berger) New York University Medical Center, NY, United States
(Heckbert) University of Washington School of Public Health, Seattle,
United States
(Li) University of Massachusetts Medical School, Worcester, United States
(Liu) University of California, Los Angeles, United States
(Martin) George Washington University, Washington, DC, United States
(Tindle) University of Pittsburgh, Pittsburgh, PA, United States
Title
Use of medicare data to identify coronary heart disease outcomes in the
women's health initiative.
Source
Circulation: Cardiovascular Quality and Outcomes. 7 (1) (pp 157-162),
2014. Date of Publication: January 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Data collected as part of routine clinical practice could be
used to detect cardiovascular outcomes in pragmatic clinical trials or
clinical registry studies. The reliability of claims data for documenting
outcomes is unknown. Methods and Results-We linked records of Women's
Health Initiative (WHI) participants aged >65 years to Medicare claims
data and compared hospitalizations that had diagnosis codes for acute
myocardial infarction or coronary revascularization with WHI outcomes
adjudicated by study physicians. We then compared the hazard ratios for
active versus placebo hormone therapy based solely on WHI-adjudicated
events with corresponding hazard ratios based solely on claims data for
the same hormone trial participants. Agreement between WHI-adjudicated
outcomes and Medicare claims was good for the diagnosis of myocardial
infarction (, 0.71-0.74) and excellent for coronary revascularization (,
0.88-0.91). The hormone:placebo hazard ratio for clinical myocardial
infarction was 1.31 (95% confidence interval, 1.03-1.67) based on WHI
outcomes and 1.29 (95% confidence interval, 1.00-1.68) based on Medicare
data. The hazard ratio for coronary revascularization was 1.09 (95%
confidence interval, 0.88-1.35) based on WHI outcomes and 1.10 (95%
confidence interval, 0.89-1.35) based on Medicare data. The differences
between hazard ratios derived from WHI and Medicare data were not
significant in 1000 bootstrap replications. Conclusions-Medicare claims
may provide useful data on coronary heart disease outcomes among patients
aged =65 years in clinical research studies. 2014 American Heart
Association, Inc.

<21>
[Use Link to view the full text]
Accession Number
2014245014
Authors
Escolar E. Lamas G.A. Mark D.B. Boineau R. Goertz C. Rosenberg Y. Nahin
R.L. Ouyang P. Rozema T. Magaziner A. Nahas R. Lewis E.F. Lindblad L. Lee
K.L.
Institution
(Escolar, Lamas) Columbia University, Division of Cardiology, Mount Sinai
Medical Center, 4300 Alton Rd, Suite 2070A, Miami Beach, FL 33140, United
States
(Boineau, Rosenberg) National Heart, Lung, and Blood Institute, Bethesda,
MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Nahin) National Center for Complementary and Alternative Medicine,
Bethesda, MD, United States
(Ouyang) Johns Hopkins University, Baltimore, MD, United States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Magaziner) Magaziner Center for Wellness, Cherry Hill, NJ, United States
(Nahas) Seekers Centre for Integrative Medicine, Ottawa, ON, United States
(Lewis) Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Mark, Lindblad, Lee) Duke Clinical Research Institute, Durham, NC, United
States
Title
The Effect of an EDTA-based Chelation Regimen on Patients with Diabetes
Mellitus and Prior Myocardial Infarction in the Trial to Assess Chelation
Therapy (TACT).
Source
Circulation: Cardiovascular Quality and Outcomes. 7 (1) (pp 15-24), 2014.
Date of Publication: January 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The Trial to Assess Chelation Therapy (TACT) showed clinical
benefit of an EDTA-based infusion regimen in patients aged =50 years with
prior myocardial infarction. Diabetes mellitus before enrollment was a
prespecified subgroup., Methods and Results-Patients received 40 infusions
of EDTA chelation or placebo. A total of 633 (37%) patients had diabetes
mellitus (322 EDTA and 311 placebo). EDTA reduced the primary end point
(death, reinfarction, stroke, coronary revascularization, or
hospitalization for angina; 25% versus 38%; hazard ratio, 0.59; 95%
confidence interval [CI], 0.44- 0.79; P<0.001) over 5 years. The result
remained significant after Bonferroni adjustment for multiple subgroups
(99.4% CI, 0.39-0.88; adjusted P=0.002). All-cause mortality was reduced
by EDTA chelation (10% versus 16%; hazard ratio, 0.57; 95% CI, 0.36-0.88;
P=0.011), as was the secondary end point (cardiovascular death,
reinfarction, or stroke; 11% versus 17%; hazard ratio, 0.60; 95% CI,
0.39-0.91; P=0.017). However, after adjusting for multiple subgroups,
those results were no longer significant. The number needed to treat to
reduce 1 primary end point over 5 years was 6.5 (95% CI, 4.4-12.7). There
was no reduction in events in non-diabetes mellitus (n=1075; P=0.877),
resulting in a treatment by diabetes mellitus interaction (P=0.004).,
Conclusions-Post-myocardial infarction patients with diabetes mellitus
aged =50 demonstrated a marked reduction in cardiovascular events with
EDTA chelation. These findings support efforts to replicate these findings
and define the mechanisms of benefit. However, they do not constitute
sufficient evidence to indicate the routine use of chelation therapy for
all post-myocardial infarction patients with diabetes mellitus. 2013
American Heart Association, Inc.

<22>
Accession Number
2014248602
Authors
Alfonso F. Perez-Vizcayno M.J. Cardenas A. Garcia Del Blanco B.
Seidelberger B. Iniguez A. Gomez-Recio M. Masotti M. Velazquez M.T.
Sanchis J. Garcia-Touchard A. Zueco J. Bethencourt A. Melgares R. Cequier
A. Dominguez A. Mainar V. Lopez-Minguez J.R. Moreu J. Marti V. Moreno R.
Jimenez-Quevedo P. Gonzalo N. Fernandez C. Macaya C.
Institution
(Alfonso, Seidelberger) Departamento de Cardiologia, Hospital
Universitario de la Princesa, IIS-IP, Universidad Autonoma de Madrid,
c/Diego de Leon 62, Madrid 28006, Spain
(Alfonso, Perez-Vizcayno, Cardenas, Jimenez-Quevedo, Gonzalo, Fernandez,
Macaya) Hospital Universitario Clinico San Carlos, Madrid, Spain
(Garcia Del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Iniguez) Complejo Hospitalario, Universitario de Vigo, Pontevedra, Spain
(Gomez-Recio) Hospital Universitario de Torrecardenas, Almeria, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Velazquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Bethencourt) Hospital Universitario Son Espases, Palma de Mallorca, Spain
(Melgares) Hospital Universitario Virgen de Las Nieves, Granade, Spain
(Cequier) Hospital Universitario de Bellvitge, Barcelona, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Mainar) Hospital Universitario de Alicante, Alicante, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina Badajoz, Badajoz,
Spain
(Moreu) Hospital Universitario Virgen de la Salud Toledo, Toledo, Spain
(Marti) Hospital Universitario Sant Pau, Barcelona, Spain
(Moreno) Hospital Universitario la Paz, Madrid, Spain
Title
A randomized comparison of drug-eluting balloon versus everolimus-eluting
stent in patients with bare-metal stent-in-stent restenosis: The RIBS v
clinical trial (restenosis intra-stent of bare metal stents:
Paclitaxel-eluting balloon vs. everolimus-eluting stent).
Source
Journal of the American College of Cardiology. 63 (14) (pp 1378-1386),
2014. Date of Publication: 15 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives This study sought to compare the efficacy of drug-eluting
balloons (DEB) with that of everolimus-eluting stents (EES) in patients
with bare-metal stents (BMS) in-stent restenosis (ISR). Background
Treatment of patients with ISR remains a challenge. Methods This was a
prospective, multicenter, randomized trial comparing DEB with EES in
patients with bare-metal stents (BMS) in-stent restenosis (ISR). The
primary endpoint was the minimal lumen diameter at 9 months' follow-up.
Results A total of 189 patients with BMS-ISR from 25 Spanish sites were
included (95 were allocated to DEB and 94 to EES). Procedural success was
achieved in all patients. At late angiography (median 249 days; 92% of
eligible patients), patients in the EES arm had a significantly larger
minimal lumen diameter (2.36 + 0.6 mm vs. 2.01 + 0.6 mm, p < 0.001;
absolute mean difference: 0.35 mm; 95% confidence interval [CI]: 0.16 to
0.53) and a lower percent of diameter stenosis (13 + 17% vs. 25 + 20%, p <
0.001). However, late loss (0.04 + 0.5 mm vs. 0.14 + 0.5 mm, p = 0.14) and
binary restenosis rate (4.7% vs. 9.5%, p = 0.22) were very low and similar
in both groups. Clinical follow-up (median 365 days) was obtained in all
(100%) patients. Occurrences of the combined clinical outcome measure
(cardiac death, myocardial infarction, and target vessel
revascularization; 6% vs. 8%; hazard ratio [HR]: 0.76; 95% CI: 0.26 to
2.18, p = 0.6) and the need for target vessel revascularization (2% vs.
6%; HR: 0.32: 95% CI: 0.07 to 1.59, p = 0.17) were similar in the 2
groups. Conclusions In patients with BMS-ISR, both DEB and EES provided
excellent clinical results with a very low rate of clinical and
angiographic recurrences. However, compared with DEB, EES provide superior
late angiographic findings. (Restenosis Intra-stent of Bare Metal Stents:
Paclitaxel-eluting Balloon vs. Everolimus-eluting Stent [RIBS V];
NCT01239953).

<23>
Accession Number
2014248596
Authors
De Belder A. De La Torre Hernandez J.M. Lopez-Palop R. O'Kane P. Hernandez
Hernandez F. Strange J. Gimeno F. Cotton J. Diaz Fernandez J.F. Carrillo
Saez P. Thomas M. Pinar E. Curzen N. Baz J.A. Cooter N. Lozano I. Skipper
N. Robinson D. Hildick-Smith D.
Institution
(De Belder, Cooter, Skipper, Hildick-Smith) Department of Cardiology,
Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton
BN2 5BE, United Kingdom
(De La Torre Hernandez) Hospital Marques de Valdecilla, Santander, Spain
(Lopez-Palop, Carrillo Saez) Hospital San Juan de Alicante, Alicante,
Spain
(O'Kane) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Hernandez Hernandez) Hospital 12 de Octubre, Madrid, Spain
(Strange) Bristol Royal Infirmary, Bristol, United Kingdom
(Gimeno) Hospital Clinico de Valladolid, Valladolid, Spain
(Cotton) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom
(Diaz Fernandez) Hospital Juan Ramon Jimenez, Huelva, Spain
(Thomas) St Thomas' Hospital, London, United Kingdom
(Pinar) Hospital Virgen de la Arrixaca, Murcia, Spain
(Curzen) Southampton University Hospitals National Health Service Trust,
Southampton, United Kingdom
(Baz) Hospital Meixoeiro, Vigo, Spain
(Lozano) Hospital Central de Asturias, Oviedo, Spain
(Robinson) Department of Mathematics, University of Sussex, East-Sussex,
United Kingdom
Title
A prospective randomized trial of everolimus-eluting stents versus
bare-metal stents in octogenarians: The XIMA trial (xience or vision
stents for the management of angina in the elderly).
Source
Journal of the American College of Cardiology. 63 (14) (pp 1371-1375),
2014. Date of Publication: 15 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives The aim of this study was to determine whether drug-eluting
stents (DES) are superior to bare-metal stents (BMS) in octogenarian
patients with angina. Background Patients >80 years of age frequently have
complex coronary disease warranting DES but have a higher risk of bleeding
from prolonged dual antiplatelet therapy. Methods This multicenter
randomized trial was conducted in 22 centers in the United Kingdom and
Spain. Patients >80 years of age underwent stent placement for angina. The
primary endpoint was a 1-year composite of death, myocardial infarction,
cerebrovascular accident, target vessel revascularization, or major
hemorrhage. Results In total, 800 patients (83.5 + 3.2 years of age) were
randomized to BMS (n = 401) or DES (n = 399) for treatment of stable
angina (32%) or acute coronary syndrome (68%). Procedural success did not
differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07).
Thirty-eight percent of patients had >2-vessel percutaneous coronary
intervention, and 66% underwent complete revascularization. Patients who
received BMS had shorter stent implants (24.0 + 13.4 mm vs. 26.6 + 14.3
mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for
patients in the BMS group and 94.0% for patients in the DES group. The
primary endpoint occurred in 18.7% of patients in the BMS group versus
14.3% of patients in the DES group (p = 0.09). There was no difference in
death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p =
0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial
infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization
(7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS
group. Conclusions BMS and DES offer good clinical outcomes in this age
group. DES were associated with a lower incidence of myocardial infarction
and target vessel revascularization without increased incidence of major
hemorrhage. (Xience or Vision Stent-Management of Angina in the Elderly
[XIMA]; ISRCTN92243650).

<24>
Accession Number
71427417
Authors
Bansch D. Bonnemeier H. Brandt J. Bode F. Svendsen J.H. Felk A. Hauser T.
Taborsky M. Kuster S. Wegscheider K.
Institution
(Bansch, Bonnemeier, Brandt, Bode, Svendsen, Felk, Hauser, Taborsky,
Kuster, Wegscheider) Rostock Heart Center, Rostock, Germany, University
Hospital Schleswig-Holstein, campus Kiel, Kiel, Germany, Univesity
Hospital of Southern Sweden, LUND, Sweden, Universitaetsklinikum Luebeck,
Luebeck, Germany, Heart Center, Rigshospitalet Copenhagen University
Hospital, Copenhagen, Denmark, BIOTRONIK Vertriebs GmbH & Co. KG, Berlin,
Germany, Univesity Hospital Olomouc, Olomouc, Czech Republic, DRK Hospital
Molln- Ratzeburg, Ratzeburg, Germany, Department of Medical Biometry and
Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
Title
The rationale and design of the "no regular defibrillation testing in
cardioverter defibrillator implantation" (nordic ICD) trial: A randomized,
controlled trial of intraoperative defibrillation testing during de novo
defibrillator implantation.
Source
Heart Rhythm. Conference: 35th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2014 San Francisco, CA United States.
Conference Start: 20140507 Conference End: 20140510. Conference
Publication: (var.pagings). 11 (5 SUPPL. 1) (pp S109-S110), 2014. Date of
Publication: May 2014.
Publisher
Elsevier
Abstract
Introduction: Implantable cardioverter defibrillator (ICD) testing has
been an integral part of ICD implantations and of all trials, which have
demonstrated a survival benefit of ICD therapy. There is, however, little
evidence if intra-operative defibrillation (DF) testing improves outcome
per se. The aim of the present randomized trial is to prove
non-inferiority of ICD implantation without DF testing versus with DF
testing with respect to ICD shock efficacy for ventricular
tachyarrhythmias. Methods: The patient recruitment began in February 2011.
1080 patients with an indication for primary or secondary prevention of
sudden cardiac death were to be included. Meanwhile recruitment was
stopped. Patients were randomly assigned to an ICD implantation with or
without DF testing. The intra-operative DF testing was standardized, and
the study protocol required an initial ICD shock energy of 40 J. The
primary endpoint of the NORDIC ICD trial is the average efficacy of the
first ICD shock for all true ventricular tachyarrhythmias in each patient
during a minimum of 12 months follow-up. Secondary endpoints include the
frequency of system revisions at ICD implantation, the total fluoroscopy
and implantation time, blood parameters indicating myocardial injury
(optional), serious adverse events associated with the implantation
procedure, all-cause, cardiac, and arrhythmic mortality during follow-up.
Home Monitoring is used in all patients in order to continuously monitor
the system integrity, device programming and performance. Results: N/A
Conclusions: The NORDIC ICD trial is one of two trials assessing ICD
implantation without DF testing in a prospective randomized manner. The
implantation and serious adverse event data at thirty days will be
available in April 2014 and will be presented at the annual American Heart
Rhythm Society meeting.

<25>
Accession Number
71423309
Authors
Srimurugan B. Sridhar A. Farzana F. Arimuthuswamy Kalu N. Pradeep K.K.
Subramanyan R. Agarwal R. Cherian K.M.
Institution
(Srimurugan, Sridhar, Farzana, Arimuthuswamy, Kalu, Pradeep, Subramanyan,
Agarwal, Cherian) Department of Pediatric Cardiology and Cardiothoracic
Surgery, Frontier Life Line Dr. K.M. Cherian Heart Foundation, Chennai,
India
Title
Outcome of bioprosthetic valve implantation in pediatric patients.
Source
Annals of Pediatric Cardiology. Conference: 5th Congress of the
Asia-Pacific Pediatric Cardiac Society, APPCS 2014 New Delhi India.
Conference Start: 20140306 Conference End: 20140309. Conference
Publication: (var.pagings). 7 (pp S127), 2014. Date of Publication:
February 2014.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
Background: The choice between mechanical and tissue valves in the
Pediatric population is debated. There is limited data on the longevity of
bioprosthetic (BP) valves in children. Patients and method: A systematic
review of case records of 56 pediatric patients (< 18 years of age) who
underwent BP Valve implantation in our institution between June 2004 and
July 2012, was done. Results: A total of 56 children [mean age10.6 +
years; 32 males] underwent BPV: pulmonary (n = 30), mitral (16), aortic
(2), tricuspid (3), mitral and aortic (3), tricuspid and pulmonary (1),
mitral and tricuspid (n = 1). The diagnosis were: TOF (20), RHD (10),
Absent Pulmonary valve (6), Mitral valve prolapse (6,), HOCM (n = 1),
Shones Complex (2), Truncus Arteriosus (4), and others (6). The most
frequently used valve was a Carpentier Edward porcine valve. There were 7
early deaths overall (perioperative mortality 12.5%; 4/7 redo surgeries).
19 patients were lost to follow up including 15 foreign nationals. At a
mean follow up period of 62 + 2.6 months, 30 children were available for
follow up, 28 patients (93%) were in NYHA class I and 2 were in NYHA class
II with or without medical therapy. A total of 5 patients needed
replacement of Bioprosthetic valve at a mean postoperative period of 36 +
4.2 months. Actuarial freedom from reintervention at 1, 3 and 5 years for
patients surviving the operation are 97%, 90% and 80%. Conclusion:
Bioprosthetic valve replacement is a reasonable option in pediatric
patients. The early and mid term follow up results have been satisfactory
with reasonable mid term freedom from reintervention and with most
patients remaining in good functional class.

<26>
Accession Number
71423282
Authors
Banque M.N. Requiron-Sy M.D. De Leon M.N.A. Bautista M.S. Limpin M.E.B.
Institution
(Banque, Requiron-Sy, De Leon, Bautista, Limpin) Division of Pulmonary and
Critical Care Medicine, Philippines
Title
Rudhe syndrome-reversible shunt related lobar emphysema - A report of
cases and systematic review of literature.
Source
Annals of Pediatric Cardiology. Conference: 5th Congress of the
Asia-Pacific Pediatric Cardiac Society, APPCS 2014 New Delhi India.
Conference Start: 20140306 Conference End: 20140309. Conference
Publication: (var.pagings). 7 (pp S118-S119), 2014. Date of Publication:
February 2014.
Publisher
Medknow Publications and Media Pvt. Ltd
Abstract
Congenital large hyperlucent lobe or what was known as lobar emphysema
(LE) in earlier literature is not quite uncommon in children with
congenital heart diseases (CHD). In the year 2010, the name Rudhe syndrome
was used to refer to reversible shunt related lobar emphysema. This is in
honor of the Swedish radiologist, Ulf Rudhe who made his first observation
in 1971 that emphysema in children with congenital heart disease is
secondary to the shunt thus surgical intervention be directed to the
correction of the cardiac defect alone and not lobectomy. We reviewed the
cases of four patients with concomitant LE and CHD. The medical records
were evaluated with reference to age, type of CHD, pulmonary function,
radiographic findings, pulmonary artery pressure, clinical signs and
symptoms, surgical management and outcome after surgery. We also reviewed
21 literatures on LE with CHD. Among the four cases we had, 3 were left to
right shunts and 1 is a case of Tetralogy of Fallot (TOF) with an absent
pulmonary valve. The 3 underwent correction of the cardiac lesion and
repeat chest radiograph and CT scan showed almost complete resolution of
the lobar emphysema with complete resolution of clinical symptoms 6 months
post cardiac surgery. The other one underwent TOF correction with lung
tacking with radiographic resolution of the lobar emphysema however
patient succumbed to sepsis. The most commonly affected lobes were the
left upper and right middle lobes. The literature review consisted of 137
subjects with lobar emphysema with concomitant congenital heart disease.
The three most common cardiac lesions associated with lobar emphysema are
ventricular septal defect, patent ductus arterioles and TOF with absent
pulmonary valve. One hundred out of the 137 underwent correction of the
cardiac lesion without lobectomy. Resolution of airway obstruction as well
as radiographic resolution of the emphysematous lung were noted as early
as 3 months to 1 year post cardiac surgery. The coexistence of lobar
emphysema in children with congenital heart disease is not uncommon. The
findings of reversible airway obstruction and spontaneous resolution of
lobar emphysema post cardiac surgery without lobectomy made us believed
that the emphysema is secondary to the shunt. Extrinsic compression
brought about by enlarged and dilated pulmonary arteries as well as
chamber enlargements were attributed for this. Earlier correction of
cardiac lesion improves the prognosis in terms of reversibility of
symptoms and anatomic defects of the bronchus.