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<1>
Accession Number
24197403
Authors
Hayn D. Kollmann A. Perl S. Kos C. Rotman B. Lercher P. Tscheliessnigg
K.-H. Schreier G.
Institution
(Hayn, Kollmann, Schreier) Safety and Security Department, AIT Austrian
Institute of Technology GmbH, Graz, Austria
(Perl, Kos, Rotman, Lercher) Division of Cardiology, Department Internal
Medicine, Medical University of Graz, Austria
(Tscheliessnigg) Division of Cardiac Surgery, Department of Surgery,
Medical University of Graz, Austria
Title
A randomized controlled clinical trial of pacemaker follow-up in clinic
and by telemedical interpretation of the pacemakers' magnet mode.
Source
Journal of Telemedicine and Telecare. 19 (8) (pp 456-465), 2013. Date of
Publication: December 2013.
Abstract
We assessed a two-stage follow-up procedure for cardiac pacemakers, where
in-clinic follow-ups were partly replaced by telemedical follow-ups. This
was compared with the standard follow-up regime (in-clinic follow-up
only). The new procedure required an electronic patient record, a
telemedical follow-up unit for recording ECGs while the pacemaker was
temporarily set to magnet mode, an ECG processing unit, and a reviewing
and reporting unit. A total of 177 (86 female) patients were randomized to
the control group and 182 (98 female) patients to the telemedicine group.
In the telemedicine group, 234 telemedical follow-ups were performed. Out
of these, 68 required an additional in-clinic follow-up, while 166 were
sufficient for assessing the pacemakers' working status. During the study,
there were 19 deaths in the telemedicine group and 20 in the control
group. There was no significant difference between the two groups(P =
0.40). The probability that an individual patient's pacemaker would not to
be replaced over time was analysed in a similar way to the Kaplan-Meier
survival function. Fewer pacemakers were replaced in the telemedicine
group (14) than in the control group (18), but the difference was not
significant (P = 0.26). We conclude that alternating telemedical and
in-clinic follow-ups brings no additional risks for patients. The
follow-up procedure is feasible and interpretation of the pacemakers'
magnet effect provides an easy-to-use, manufacturer-independent method of
assessing the pacemakers' working status. This should reduce the patient
load on pacemaker centres and decrease the overall costs of pacemaker
therapy. The Author(s) 2013.

<2>
Accession Number
2014496983
Authors
Sarikaya S. Onk A. Boztosun B. Kocabay G. Sahin M. Fedakar A. Koksal C.
Institution
(Sarikaya, Onk, Fedakar, Koksal) Department of Cardiovascular Surgery,
Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital,
Kartal, Istanbul, Turkey
(Boztosun, Kocabay, Sahin) Department of Cardiology, Kartal Kosuyolu
Yuksek Ihtisas Heart Education and Research Hospital, Kartal, Istanbul,
34846, Turkey
Title
The effect of nebivolol on internal mammary artery blood flow during
coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). 29 (4) (pp 315-320), 2014. Date of
Publication: July 2014.
Publisher
SAGE Publications Ltd
Abstract
Background: During coronary artery bypass grafting (CABG), one of the most
important complications related to the internal mammary artery (IMA) is
perioperative spasm. Nebivolol causes endothelium-dependent vascular
relaxation by increasing nitric oxide (NO) release and prevents
endothelial dysfunction in long-term use. In our study, we measured the
effect of a third generation beta blocker, nebivolol, on the flow dynamics
of IMA grafts. Methods: We recruited 90 hypertensive patients undergoing
isolated CABG operation, who were divided into three groups and each group
included 30 patients: Group 1 patients were under antihypertensive
treatment other than betablockers (angiontensin-converting enzyme [ACE]
inhibitors, calcium channel blockers or diuretics; monotherapy or
combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3
received nebivolol (5 mg/day). These antihypertensive therapies were given
for at least one week before the operation and continued thereafter. IMA
blood flow volume was measured for one minute just before cardiopulmonary
bypass (measurement A) and before left internal mammary artery (LIMA)-left
anterior descending (LAD) artery anastomosis (measurement B) in the three
groups. Cardiac output measurements were also achieved simultaneously.
Results: The measurement A results were 56.3 + 36.2, 54.6 + 28.1 and 66.8
+ 34.2 mL/min in Groups 1, 2 and 3, respectively (p<0.05). The measurement
B results were 78.3 + 29.6, 80 + 28.8 and 91.1 + 40.8 mL/min in Groups 1,
2 and 3 (p<0.05), respectively. There were no differences in cardiac
outputs among the groups; 5.2 + 1.4, 5.0 + 1.6 and 5.3 + 1.1 L/min
(p>0.05). While the cardiac outputs were similar within the three groups,
the IMA free flow volume was higher in the nebivolol group after local
papaverine use. Conclusion: Nebivolol might represent a good choice in
hypertensive patients undergoing cardiac surgery by preventing
perioperative myocardial hypoperfusion which increases early morbidity and
mortality. The Author(s) 2014.

<3>
Accession Number
2014502135
Authors
Lim J.Y. Deo S.V. Kim W.S. Altarabsheh S.E. Erwin P.J. Park S.J.
Institution
(Lim, Deo, Kim) Division of Cardiovascular Surgery, Mayo Clinic,
Rochester, United States
(Kim) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Altarabsheh) Department of Cardiac Surgery, Queen Alia Heart Institute,
Amman, Jordan
(Deo) Department of Cardiac Surgery, Adventist Wockhardt Heart Hospital,
Surat Gujarat, India
(Erwin) Mayo Clinic Libraries, Rochester MN, United States
(Park) Division of Cardiovascular Surgery, Case Medical Center, Case
Western Reserve University, Cleveland OH, United States
Title
Drug-eluting stents versus coronary artery bypass grafting in diabetic
patients with multi-vessel disease: A meta-analysis.
Source
Heart Lung and Circulation. 23 (8) (pp 717-725), 2014. Date of
Publication: August 2014.
Publisher
Elsevier Ltd
Abstract
Background: Data comparing long-term results after percutaneous
intervention with drug-eluting stents (DES/PCI) and coronary artery
grafting (CABG) in diabetic patients (pts) with multi-vessel disease is
conflicting. We have conducted a systematic review and meta-analysis to
help answer this issue. Methods: MEDLINE, WoS, and Scopus were
systematically analysed to yield observational studies (OBS) or randomised
controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for
studied end-points were obtained with inverse variance random effects
analysis. Results are presented with 95% confidence intervals with
significance at p<0.05. Results: A total of 14 studies (5 RCT; 9 OBS)
including more than 5000 pts were selected for review. Early/30-day was
lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02;
I²=0%]. Post-procedural stroke was higher in the CABG (1.8%)
cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT
demonstrated that stroke rate was similar in both cohorts at the end of
one year [OR 0.84(0.19, 3.74); p=0.82; I² =67%].During a
follow-up of three to five years, repeat intervention was much higher in
the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an
adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times
higher in the DES/PCI cohort compared to CABG. Conclusion: In diabetic
patients with multivessel disease, early mortality is lower in the DES/PCI
cohort. While peri-procedural stroke rates are lower with PCI, they are,
however, comparable at the end of one year. Use of drug-eluting stents
leads to a higher rate of re-intervention and major
cardiovascular/cerebrovascular events at three to five years. 2014
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

<4>
Accession Number
2014501167
Authors
Wang W. Xu Z. Xiong X. Yin W. Xu X. Shao W. Chen H. He J.
Institution
(Wang, Xu, Xiong, Yin, Xu, Shao, Chen, He) Department of Cardiothoracic
Surgery, The First Affiliated Hospital of Guangzhou Medical University,
Guangzhou 510120, China
(Wang, Xu, Xiong, Yin, Xu, Shao, Chen, He) Guangzhou Institute of
Respiratory Disease, China State Key Laboratory of Respiratory Disease,
Guangzhou 510120, China
Title
Video-assisted thoracoscopic lobectomy for non-small cell lung cancer in
patients with severe chronic obstructive pulmonary disease.
Source
Journal of Thoracic Disease. 5 (SUPPL.3) (pp S253-S259), 2013. Date of
Publication: 2013.
Publisher
Pioneer Bioscience Publishing
Abstract
Objective: To assess the feasibility, safety and long-term outcomes of
video-assisted thoracic surgery (VATS) lobectomy for the treatment of
non-small cell lung cancer (NSCLC) in patients with severe chronic
obstructive pulmonary disease (COPD). Methods: The clinical data of
patients with NSCLC and severe COPD (preoperative FEV1% <50%) who
underwent VATS lobectomy from January 2000 to January 2011 were
retrospectively analyzed to identify their demographic parameters,
postoperative complications and outcomes. Results: The preoperative
FEV1/FVC was <70% and FEV1% <50% in all 61 patients in this study, with a
mean preoperative FEV1 of 0.99 L (0.54-1.58 L) and mean FEV1% of 38.4%
(22-49.82%). All of the 61 patients underwent the VATS lobectomy or sleeve
resection plus systemic lymph node dissection. The mean operative time was
218 minutes (120-355 minutes), with a mean intraoperative blood loss of
342 mL (50-1,600 mL). None of the patients converted to thoracotomy.
Multivariate statistical analysis revealed that age and TNM staging after
tumor resection were independent predictive factors for the 5-year
survival in those patients (P=0.014 and 0.013). Conclusions: With
preoperative imaging studies, pulmonary function assessment and target
positioning, VATS lobectomy can be safely and effectively performed for
patients with NSCLC and severe COPD to achieve a satisfying long-term
survival outcome. Pioneer Bioscience Publishing Company.

<5>
Accession Number
2014501863
Authors
Ding N. Ni B.-Q. Zhang X.-L. Zha W.-J. Hutchinson S.Z. Lin W. Huang M.
Zhang S.-J. Wang H.
Institution
(Ding, Zhang, Zha, Huang, Wang) Department of Respiratory Medicine, The
First Affiliated Hospital of Nanjing Medical University, Nanjing, China
(Ni, Zhang) Department of Cardiothoracic Surgery, The First Affiliated
Hospital of Nanjing Medical University, Nanjing, China
(Hutchinson) Morsani College of Medicine, Tampa, FL, United States
(Lin) Department of Geriatric Medicine, The First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
Title
Elimination of central sleep apnea by cardiac valve replacement: A
continuous follow-up study in patients with rheumatic valvular heart
disease.
Source
Sleep Medicine. 15 (8) (pp 880-886), 2014. Date of Publication: August
2014.
Publisher
Elsevier
Abstract
Background: Recent studies have suggested that cardiac surgery may affect
sleep-disordered breathing (SDB) in chronic heart failure patients.
However, the dynamic changes in sleep apnea and heart function after
cardiac surgery and the mechanisms responsible for these changes remain
unknown. Methods: Patients with rheumatic valvular heart disease (RVHD)
and SDB were enrolled and followed up at three, six and 12. months after
cardiac valve replacement (CVR). Baseline and follow-up clinical data
consisting of NYHA classification, 6. min walk distance (6-MWD),
medications, echocardiography, electrocardiography, chest X-ray, arterial
blood gas, lung-to-finger circulation time (LFCT), and sleep data were
collected and evaluated. Results: Twenty-four central sleep apnea (CSA)
patients and 15 obstructive sleep apnea (OSA) patients completed three
follow-up assessments. Comparison of the baseline parameters between OSA
patients and CSA patients showed that CSA patients had a worse baseline
cardiac function assessed by higher NYHA class, shorter 6-MWD, larger left
atrial diameter, longer LFCT, and enhanced chemosensitivity (higher pH and
lower arterial carbon dioxide tension (PaCO₂)). A continuous
significant elevation in 6-MWD and left ventricular ejection fraction and
decrease in NYHA class, plasma BNP, and left atrial diameter were found in
both CSA and OSA patients. When comparing CSA and OSA patients, the CSA
indices were remarkably reduced at month 3 post CVR and sustained
throughout the trial, whereas there were no significant decreases in OSA
index and hypopnea index. pH values and LFCT were markedly decreased and
PaCO₂ markedly increased in patients with CSA at the end of the
third months following CVR. These changes were sustained until the end of
the trial. Conclusions: CSA patients with RVHD had a worse baseline
cardiac function, enhanced chemosensitivity and disordered hemodynamic as
compared with OSA patients with RVHD. CSA were eliminated after CVR;
however, there were no changes in OSA. The elimination of CSA, post CVR,
is associated with the combined efficacies of improvement of cardiac
function, normalized chemosensitivity, and stabilized hemodynamic. 2014
Elsevier B.V.

<6>
Accession Number
2014501840
Authors
Santa Mina D. Clarke H. Ritvo P. Leung Y.W. Matthew A.G. Katz J.
Trachtenberg J. Alibhai S.M.H.
Institution
(Santa Mina, Matthew, Trachtenberg) Department of Surgical Oncology,
Princess Margaret Cancer Center, Toronto, ON, Canada
(Santa Mina, Ritvo) University of Guelph-Humber, Toronto, ON, Canada
(Santa Mina, Katz) School of Kinesiology and Health Science, York
University, Toronto, ON, Canada
(Clarke, Leung, Matthew, Katz, Trachtenberg, Alibhai) University of
Toronto, Toronto, ON, Canada
(Clarke, Leung, Katz, Alibhai) University Health Network, Toronto, ON,
Canada
(Ritvo) Cancer Care Ontario, Toronto, ON, Canada
Title
Effect of total-body prehabilitation on postoperative outcomes: A
systematic review and meta-analysis.
Source
Physiotherapy (United Kingdom). 100 (3) (pp 196-207), 2014. Date of
Publication: September 2014.
Publisher
Elsevier Ltd
Abstract
Objective: To systematically review the evidence of pre-operative
exercise, known as 'prehabilitation', on peri- and postoperative outcomes
in adult surgical populations. Design: Systematic review and
meta-analysis. Data sources: CENTRAL, Medline, EMBASE, CINAHL, PsycINFO
and PEDro were searched from 1950 to 2011. Methods: Two reviewers
independently examined relevant, English-language articles that examined
the effects of pre-operative total-body exercise with peri- and
postoperative outcome analysis. Given the nascence of this field,
controlled and uncontrolled trials were included. Risk of bias was
assessed using the Cochrane Risk of Bias Assessment tool. Only data on
length of stay were considered eligible for meta-analysis due to the
heterogeneity of measures and methodologies for assessing other outcomes.
Results: In total, 4597 citations were identified by the search strategy,
of which 21 studies were included. Trials were generally small (median. =
54 participants) and of moderate to poor methodological quality. Compared
with standard care, the majority of studies found that total-body
prehabilitation improved postoperative pain, length of stay and physical
function, but it was not consistently effective in improving
health-related quality of life or aerobic fitness in the studies that
examined these outcomes. The meta-analysis indicated that prehabilitation
reduced postoperative length of stay with a small to moderate effect size
(Hedges' g= -0.39, P= 0.033). Intervention-related adverse events were
reported in two of 669 exercising participants. Conclusion: The literature
provides early evidence that prehabilitation may reduce length of stay and
possibly provide postoperative physical benefits. Cautious interpretation
of these findings is warranted given modest methodological quality and
significant risk of bias. 2013 Chartered Society of Physiotherapy.

<7>
Accession Number
2014497935
Authors
Turner K.R. Fisher E.C. Hade E.M. Houle T.T. Rocco M.V.
Institution
(Turner) Department of Anesthesiology, Wexner Medical Center, Ohio State
University, Columbus, OH, United States
(Fisher) Metrolina Nephrology Associates, Charlotte, NC, United States
(Hade) Center for Biostatistics, The Ohio State University, Columbus, OH,
United States
(Houle) Department of Anesthesia, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Rocco) Section on Nephrology, Department of Medicine, Wake Forest School
of Medicine, Winston-Salem, NC, United States
Title
The role of perioperative sodium bicarbonate infusion affecting renal
function after cardiothoracic surgery.
Source
Frontiers in Pharmacology. 5 JUN , 2014. Article Number: 127. Date of
Publication: 2014.
Publisher
Frontiers Research Foundation
Abstract
Cardiac surgery associated acute kidney injury (CSA-AKI) is associated
with poor outcomes including increased mortality, length of hospital stay
(LOS) and cost. The incidence of acute kidney injury (AKI) is reported to
be between 3 and 30% depending on the definition of AKI. We designed a
multicenter randomized controlled trial to test our hypothesis that a
perioperative infusion of sodium bicarbonate (SB) during cardiac surgery
will attenuate the post-operative rise in creatinine indicating renal
injury when compared to a perioperative infusion with normal saline. An
interim analysis was performed after data was available on the first 120
participants. A similar number of patients in the two treatment groups
developed AKI, defined as an increase in serum creatinine the first 48 h
after surgery of 0.3 mg/dl or more. Specifically 14 patients (24%) who
received sodium chloride (SC) and 17 patients (27%) who received SB were
observed to develop AKI post-surgery, resulting in a relative risk of AKI
of 1.1 (95% CI: 0.6-2.1, chi-square p-value = 0.68) for patients receiving
SB compared to those who received SC. The data safety monitoring board for
the trial recommended closing the study early as there was only a 12%
probability that the null hypothesis would be rejected. We therefore
concluded that a perioperative infusion of SB failed to attenuate the risk
of CSA-AKI. 2014 Turner, Fisher, Hade, Houle and Rocco.

<8>
Accession Number
2014486368
Authors
Jaksch P. Ankersmit J. Scheed A. Kocher A. Murakozy G. Klepetko W. Lang G.
Institution
(Jaksch, Ankersmit, Scheed, Murakozy, Klepetko, Lang) Department of
Thoracic Surgery, Medical University of Vienna, Wien, Austria
(Kocher) Department of Cardiac Surgery, Medical University of Vienna,
Wien, Austria
Title
Alemtuzumab in lung transplantation: An open-label, randomized,
prospective single center study.
Source
American Journal of Transplantation. 14 (8) (pp 1839-1845), 2014. Date of
Publication: August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Induction therapy with alemtuzumab followed by lower maintenance
immunosuppression (IS) has been associated with reduced morbidity and
mortality in abdominal and heart transplantation (TX). In the current
study, alemtuzumab, in combination with reduced levels of maintenance IS,
was compared to thymoglobulin in combination with standard IS. Sixty
consecutive patients who underwent lung transplantation (LUTX) at a single
center were prospectively randomized in two groups: group A received
alemtuzumab in conjunction with reduced doses of tacrolimus, steroids and
mycophenolate mofetil. Group B received thymoglobulin in association with
standard dose IS. Patient and graft survival, freedom from acute cellular
rejection (ACR), lymphocytic bronchiolitis, bronchiolitis obliterans
syndrome, kidney function, infectious complications and posttransplant
lymphoproliferative disorder were analyzed. Alemtuzumab induction therapy
resulted in complete the absence of ACR episodes > A2 within the first
year post-TX. The difference to thymoglobulin was significant (alemtuzumab
0 vs. ATG 0.33; p=0.019). All other factors studied did not show any
differences between the two groups. Alemtuzumab induction therapy after
LUTX in combination with reduced maintenance IS significantly reduces
higher-grade rejection rates. This novel therapeutic agent had no impact
on survival, infections rates, kidney function and incidence of
malignancies. Alemtuzumab induction therapy after lung transplantation in
combination with reduced maintenance immunosuppression significantly
reduces higher grade rejection rates, and shows comparable survival and
BOS rates to standard immunosuppressive therapy without increasing
incidence of infectious complications or malignancies. See editorial by
Todd and Palmer on page 1721. Copyright 2014 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<9>
Accession Number
2014486362
Authors
Andreassen A.K. Andersson B. Gustafsson F. Eiskjaer H. Gude E. Jansson K.
Solbu D. Sigurdardottir V. Arora S. Dellgren G. Gullestad L.
Institution
(Andreassen, Gude, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Gude) The Clinic for Heart Failure and Valvular Disease, Skane University
Hospital, Lund University, Lund, Sweden
(Jansson) Department of Cardiology, Heart and Medicine Center County
Council of Ostergotland, Linkoping University, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Sigurdardottir, Dellgren) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Center, Faculty of Medicine,
University of Oslo, Oslo, Norway
Title
Everolimus initiation and early calcineurin inhibitor withdrawal in heart
transplant recipients: A randomized trial.
Source
American Journal of Transplantation. 14 (8) (pp 1828-1838), 2014. Date of
Publication: August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
In a randomized, open-label trial, everolimus was compared to cyclosporine
in 115 de novo heart transplant recipients. Patients were assigned within
5 days posttransplant to low-exposure everolimus (3-6ng/mL) with
reduced-exposure cyclosporine (n=56), or standard-exposure cyclosporine
(n=59), with both mycophenolate mofetil and corticosteroids. In the
everolimus group, cyclosporine was withdrawn after 7-11 weeks and
everolimus exposure increased (6-10ng/mL). The primary efficacy end point,
measured GFR at 12 months posttransplant, was significantly higher with
everolimus versus cyclosporine (mean+SD: 79.8+17.7mL/min/1.73m²
vs. 61.5+19.6mL/min/1.73m ²; p<0.001). Coronary intravascular
ultrasound showed that the mean increase in maximal intimal thickness was
smaller (0.03mm [95% CI 0.01, 0.05mm] vs. 0.08mm [95% CI 0.05, 0.12mm],
p=0.03), and the incidence of cardiac allograft vasculopathy (CAV) was
lower (50.0% vs. 64.6%, p=0.003), with everolimus versus cyclosporine at
month 12. Biopsy-proven acute rejection after weeks 7-11 was more frequent
with everolimus (p=0.03). Left ventricular function was not inferior with
everolimus versus cyclosporine. Cytomegalovirus infection was less common
with everolimus (5.4% vs. 30.5%, p<0.001); the incidence of bacterial
infection was similar. In conclusion, everolimus-based immunosuppression
with early elimination of cyclosporine markedly improved renal function
after heart transplantation. Since postoperative safety was not
jeopardized and development of CAV was attenuated, this strategy may
benefit long-term outcome. This randomized, open-label trial in 115 de
novo heart transplant recipients shows that low-exposure everolimus (3-6
ng/mL) combined with reduced-exposure cyclosporine withdrawn at 7-11 weeks
results in significantly better renal function at 12 months versus
standard-exposure cyclosporine. See editorial by Kobashigawa and Zuckerman
on page 1719. Copyright 2014 The American Society of Transplantation and
the American Society of Transplant Surgeons.

<10>
Accession Number
2014487229
Authors
Krause U. Becker K. Hahn G. Dittmar J. Ruschewski W. Paul T.
Institution
(Krause, Becker, Paul) Department of Pediatric Cardiology and Intensive
Care Medicine, University Medical Center Gottingen,
Georg-August-University Gottingen, Robert-Koch-Str. 40, 37099 Gottingen,
Germany
(Hahn, Dittmar) Department of Anesthesiology, Emergency and Intensive Care
Medicine, University Medical Center Gottingen, Gottingen, Germany
(Ruschewski) Department of Thoracic and Cardiovascular Surgery, Congenital
Cardiac Surgery, University Medical Center Gottingen, Gottingen, Germany
Title
Monitoring of regional lung ventilation using electrical impedance
tomography after cardiac surgery in infants and children.
Source
Pediatric Cardiology. 35 (6) (pp 990-997), 2014. Date of Publication:
August 2014.
Publisher
Springer New York LLC
Abstract
Electrical impedance tomography (EIT) is a noninvasive method to monitor
regional lung ventilation in infants and children without using radiation.
The objective of this prospective study was to determine the value of EIT
as an additional monitoring tool to assess regional lung ventilation after
pediatric cardiac surgery for congenital heart disease in infants and
children. EIT monitoring was performed in a prospective study comprising
30 pediatric patients who were mechanically ventilated after cardiac
surgery. Data were analyzed off-line with respect to regional lung
ventilation in different clinical situations. EIT data were correlated
with respirator settings and arterial carbon dioxide (CO₂)
partial pressure in the blood. In 29 of 30 patients, regional ventilation
of the lung could sufficiently and reliably be monitored by means of EIT.
The effects of the transition from mechanical ventilation to spontaneous
breathing after extubation on regional lung ventilation were studied.
After extubation, a significant decrease of relative impedance changes was
evident. In addition, a negative correlation of arterial CO₂
partial pressure and relative impedance changes could be shown. EIT was
sufficient to discriminate differences of regional lung ventilation in
children and adolescents after cardiac surgery. EIT reliably provided
additional information on regional lung ventilation in children after
cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive
care unit environment interfered with the application of EIT. EIT
therefore may be used as an additional real-time monitoring tool in
pediatric cardiac intensive care because it is noninvasive. 2014 Springer
Science+Business Media.

<11>
Accession Number
2014489056
Authors
Holmberg F.E.O. Ottas K.A. Andreasen C. Perko M.J. Moller C.H. Engstrom T.
Steinbruchel D.A.
Institution
(Holmberg, Perko, Moller, Steinbruchel) Department of Cardiovascular and
Thoracic Surgery, Rigshospitalet, Sandbjerggade 48, 2th, DK-2200
Copenhagen N, Denmark
(Engstrom) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Ottas, Andreasen) Department of Cardiothoracic Anesthesiology,
Rigshospitalet, Copenhagen, Denmark
Title
Conditioning techniques and ischemic reperfusion injury in relation to
on-pump cardiac surgery.
Source
Scandinavian Cardiovascular Journal. 48 (4) (pp 241-248), 2014. Date of
Publication: August 2014.
Publisher
Informa Healthcare
Abstract
Objectives. The objective was to investigate the potential protective
effects of two conditioning methods, on myocardial ischemic and
reperfusion injury in relation to cardiac surgery. Design. Totally 68
patients were randomly assigned to either a control group (n = 23), a
remote ischemic preconditioning (RIPC) group (n = 23) or a glucagon-like
peptide-1 (GLP-1) analogue group (n = 22). The RIPC protocol consisted of
three cycles of upper limb ischemia. The GLP-1 analogue protocol consisted
of intravenous infusion with exenatide. The primary endpoint was
postoperative cardiac enzyme release. The other secondary endpoints were
metabolic parameters related to myocardial ischemia, measured using
microdialysis technique, as well as other operative-and postoperative
data. Results. Postoperative cardiac enzyme release indicated a possible
beneficial effect of the interventions, but the difference did not reach
statistical significance. RIPC showed a trend toward lower levels (p =
0.07). We managed to establish a functional myocardial microdialysis
model, but we were unable to demonstrate clear protective effects.
Conclusions. We were in this prospective randomized proof-of-concept
trial, unable to show distinct protective effects of the studied
conditioning methods. However, this trial can hopefully contribute to
generate a productive discussion concerning limitations and future use of
cardiac conditioning as well as microdialysis technique. 2014 Informa
Healthcare.

<12>
Accession Number
2014479265
Authors
Hanedan M.O. Unal E.U. Aksoyek A. Basar V. Tak S. Tutun U. Isik H.
Birincioglu C.L.
Institution
(Hanedan, Unal, Aksoyek, Basar, Tak, Tutun, Birincioglu) Cardiovascular
Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
(Isik) Microbiology Laboratory, Turkiye Yuksek Ihtisas Hospital, Ankara,
Turkey
Title
Comparison of two different skin preparation strategies for open cardiac
surgery.
Source
Journal of Infection in Developing Countries. 8 (7) (pp 885-890), 2014.
Date of Publication: July 2014.
Publisher
Journal of Infection in Developing Countries
Abstract
Introduction: Surgical site infection (SSI) is a serious complication
after cardiac surgery; skin preparation is an important step in the
prevention of wound contamination with skin flora. In this study, two
different skin preparation strategies (standard povidine iodine cleaning
plus plain adhesive drape and microbial sealant (InteguSeal,
Kimberly-Clark Health Care, Roswell, GA, USA) were compared in cardiac
surgery patients. Methodology: This prospective study included 96 cardiac
surgery patients randomized to either a standard plain adhesive drape (28
patients, control group) or a microbial sealant (68 patients, study
group). Bacterial isolates were obtained from the wounds in the operating
room before the skin incision and after the surgical procedure had ended.
Results: Microorganisms were isolated from 38 patients (39.6%) in the
study population. Twenty-seven of these patients were from the microbial
sealant group and 11 were from the plain adhesive drape group. No
postoperative wound infection was encountered in either group. No
statistically significant differences between the two groups regarding the
number of patients with microorganism isolation (p = 0.974) or
postoperative leukocyte counts and neutrophil granulocyte percentages were
observed. Conclusions: Regarding SSI after cardiac surgery, microbial
sealant is equivalent to the standard skin preparation strategy applied
with povidine iodine cleaning and a plain adhesive drape. 2014 Hanedan et
al.

<13>
Accession Number
2014484453
Authors
Kogoj P. Furlan T. Bunc M.
Institution
(Kogoj, Bunc) Department of Cardiology, Division of Internal Medicine,
University Medical Centre Ljubljana, Slovenia
(Furlan) Department of Internal Medicine, General Hospital Jesenice,
Slovenia
Title
Balloon aortic valvuloplasty for severe aortic stenosis: Acute and
long-term outcomes.
Source
Experimental and Clinical Cardiology. 20 (7) (pp 1961-1969), 2014. Date of
Publication: 2014.
Publisher
Cardiology Academic Press
Abstract
Introduction. The use of balloon aortic valvuloplasty (BAV) has risen with
the development of transcatheter aortic valve stenosis (TAVR). The role of
BAV should be reevaluated as a part of complex treatment of severe aortic
stenosis in high risk patients. Aim. We evaluated patient characteristics,
peri-procedural complications and long-term outcome after BAV. We also
present our results of the external beam radiation therapy (EBRT) impact
on restenosis after BAV. Methods. We retrospectively analyzed all patients
who underwent BAV between January 2009 and June 2013 and stratified our
cohort into 3 groups: BAV as a bridge to TAVR/SAVR, BAV as a final therapy
and consecutive BAV. Results. We analyzed 228 patients (mean age 82.5+6.3,
logistic EuroSCORE 17.0+11.4). After BAV aortic valve area increased
(0.60+0. 20cm² to 0.72+0.21 cm², p<0.001) and mean
aortic gradient decreased (48.8+15.7 mm Hg to 37.1+11.9 mm Hg, p<0.001).
Major intra-hospital complications occurred in 11.4% with three procedure
related deaths (1.3%). BAV bridged to TAVR had a better outcome than BAV
alone. EBRT showed no effect on long-term outcome.

<14>
Accession Number
2014483211
Authors
Makara-Studzinska M. Partyka I. Ziemecki P. Ziemecka A.
Institution
(Makara-Studzinska) Department of Applied Psychology, Medical University
of Lublin, Poland
(Partyka) Neuropsychiatric Hospital in Lublin, Poland
(Ziemecki, Ziemecka) Individual Medical Practice, Poland
Title
The occurrence of emotional problems in somatic diseases based on
psychodermatology.
Source
Archives of Psychiatry and Psychotherapy. 16 (2) (pp 23-28), 2014. Date of
Publication: June 2014.
Publisher
Polish Psychiatric Association
Abstract
Aim of the study. The aim of this study is to present selected aspects of
psychosocial problems in chronic somatic diseases based on the example of
dermatology with an impact on psoriasis as a model type of
psychodermatological disease. This review does not include the theoretical
basis for somatization as the issue exceeds the size of this article.
Material and methods. The analysis of present literature related to the
subject. Results. Confirmed the connection between emotional problems and
the course of an illness and proved the usefulness of psychodermatology in
improving the quality of life of patients with chronic skin diseases.
Discussion. Comparison of demographically and culturally varied groups.
The use of different research methods evokes the need of unification.
Conclusions. Relation between emotional factors and the course of
psychosomatic disease is unquestionable and mutual. Promising trends
include social support, multidisciplinary care and creating adequate tools
for assessment of emotional problems in psychosomatic problems and
practical use. Developing research tendencies compare impairment in
dermatological problems with other somatic disease.

<15>
Accession Number
2014481013
Authors
Gogenur I. Kucukakin B. Panduro Jensen L. Reiter R.J. Rosenberg J.
Institution
(Gogenur, Kucukakin, Rosenberg) Department of Surgery, University of
Copenhagen, Herlev Hospital, Herlev, Denmark
(Panduro Jensen) Department of Vascular Surgery, University of Copenhagen,
Rigshospitalet, Denmark
(Reiter) Department of Cellular and Structural Biology, University of
Texas, Health Science Center, San Antonio, TX, United States
Title
Melatonin reduces cardiac morbidity and markers of myocardial ischemia
after elective abdominal aortic aneurism repair: A randomized,
placebo-controlled, clinical trial.
Source
Journal of Pineal Research. 57 (1) (pp 10-15), 2014. Date of Publication:
August 2014.
Publisher
Blackwell Publishing Ltd
Abstract
The aim was to examine the effect of perioperative melatonin treatment on
clinical cardiac morbidity and markers of myocardial ischemia in patients
undergoing elective surgery for abdominal aortic aneurism. Reperfusion
injury results in increased cardiac morbidity in patients undergoing
surgery for abdominal aortic aneurisms (AAA). A randomized,
placebo-controlled, clinical trial including patients undergoing surgery
for AAA was performed. The patients received by infusion over a 2-hr
period either, 50 mg melatonin or placebo intra-operatively, and 10 mg
melatonin or placebo orally, the first three nights after surgery.
Postoperative cardiac morbidity was registered, and blood samples for
analysis of troponin-I (TpI) were collected preoperatively, and at 5 min,
6, 24, 48, 72, and 96 hr after clamp removal/recirculation of the first
leg. Continuous measurement of ST-segment depression was performed by
Holter monitoring. A total of 26 patients received melatonin, while 24
received placebo. A significant reduction in cardiac morbidity was seen in
the melatonin-treated patients compared with those given placebo [4%
versus 29% (P = 0.02)]. Five patients (19%) who received melatonin had
increased TpI levels in the postoperative period compared with 12 patients
(50%) who were given placebo (P = 0.036). The median number of ST-segment
deviations was less in the melatonin-treated patients compared with the
placebo group [median 1 (range 0-4) versus 6 (range 0-13) (P = 0.01)], but
no differences were found in the duration of ST-segment deviations.
Melatonin treatment in the perioperative period decreased clinical cardiac
morbidity as well as the occurrence of myocardial ischemia after abdominal
aortic aneurism repair. 2014 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd.

<16>
[Use Link to view the full text]
Accession Number
2014486086
Authors
Jongman R.M. Zijlstra J.G. Kok W.F. Van Harten A.E. Mariani M.A. Moser J.
Struys M.M.R.F. Absalom A.R. Molema G. Scheeren T.W.L. Van Meurs M.
Institution
(Jongman, Kok, Van Harten, Struys, Absalom, Scheeren) Departments of
Anaesthesiology, Groningen, Netherlands
(Jongman, Moser, Molema, Van Meurs) Department of Critical Care,
University Medical Center Groningen, University of Groningen, P.O. Box
30.001, 9700 RB Groningen, Netherlands
(Zijlstra, Moser, Van Meurs) Critical Care, Groningen, Netherlands
(Mariani) Cardiothoracic Surgery, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Title
Off-Pump CABG surgery reduces systemic inflammation compared with on-pump
surgery but does not change systemic endothelial responses: A prospective
randomized study.
Source
Shock. 42 (2) (pp 121-128), 2014. Date of Publication: August 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Coronary artery bypass graft (CABG) surgery can result in severe
postoperative organ failure. During CABG surgery, cardiopulmonary bypass
(CPB) with cardiac arrest is often used (on-pump CABG), which often
results in a systemic inflammatory response. To reduce this inflammatory
response, off-pump CABG was reintroduced, thereby avoiding CPB. There is
increasing evidence that the endothelium plays an important role in the
pathophysiology of organ failure after CABG surgery. In this study, 60
patients who were scheduled for elective CABG surgery were randomized to
have surgery for on-pump or off-pump CABG. Blood was collected at four
time points: start, end, 6 h, and 24 h postoperatively. Levels of
inflammatory cytokines, soluble adhesion molecules, and angiogenic factors
and their receptors were measured in the plasma. No differences were found
in preoperative characteristics between the patient groups. The levels of
tumor necrosis factor-alpha, interleukin 10, and myeloperoxidase, but not
interleukin 6, were increased to a greater extent in the on-pump CABG
compared with off-pump CABG after sternum closure. The soluble endothelial
adhesion molecules E-selectin, vascular cell adhesion molecule 1, and
intracellular adhesion molecule 1 were not elevated in the plasma during
and after CABG surgery in both on-pump and off-pump CABG. Angiopoietin 2
was only increased 24 h after surgery in both on-pump and off-pump CABG.
Higher levels of sFlt-1 were found after sternum closure in off-pump CABG
compared with on-pump CABG. Avoiding CPB and aortic cross clamping in CABG
surgery reduces the systemic inflammatory response. On-pump CABG does not
lead to an increased release of soluble endothelial adhesion molecules in
the circulation compared with off-pump CABG. Copyright 2014 by the Shock
Society.

<17>
Accession Number
2014486494
Authors
Hu Z. Wang Z. Ren Z. Wu H. Zhang M. Zhang H. Hu X.
Institution
(Hu, Wang, Ren, Wu, Zhang, Zhang, Hu) Department of Cardiothoracic
Surgery, Renmin Hospital of Wuhan University, 99 Ziyang Rd, Wuhan, Hubei
Province 430060, China
Title
Similar cerebral protective effectiveness of antegrade and retrograde
cerebral perfusion combined with deep hypothermia circulatory arrest in
aortic arch surgery: A meta-analysis and systematic review of 5060
patients.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (2) (pp 544-560),
2014. Date of Publication: August 2014.
Publisher
Mosby Inc.
Abstract
Objective Our objective was to determine if antegrade cerebral perfusion
(ACP) and retrograde cerebral perfusion (RCP) combined with deep
hypothermia circulatory arrest in aortic arch surgery results in different
mortality and neurologic outcomes. Methods The Cochrane Library, Medline,
EMBASE, CINAHL, Web of Science, and the Chinese Biomedical Database were
searched for studies reporting on postoperative strokes, permanent
neurologic dysfunction, temporary neurologic dysfunction, and all causes
mortality within 30 days postoperation in aortic arch surgery.
Meta-analysis for effect size, t test, and I² for detecting
heterogeneity and sensitivity analysis for assessing the relative
influence of each study was performed. Results Fifteen included studies
encompassed a total of 5060 patients of whom 2855 were treated with deep
hypothermic circulatory arrest plus ACP and 1897 were treated with deep
hypothermic circulatory arrest plus RCP. Pooled analysis showed no
significant statistical difference (P >.01) of 30-day mortality, permanent
neurologic dysfunction, and transient neurologic dysfunction in the 2
groups. Before sensitivity analysis, postoperative stroke incidence in the
ACP group was higher than in the RCP group (7.2% vs 4.7%; P <.01). After a
study that included a different percentage of patients with a history of
central neurologic events in the 2 groups was ruled out, postoperative
stroke incidence in the 2 groups also showed no significant statistical
difference (P >.01). Conclusions ACP and RCP provide similar cerebral
protective effectiveness combined with deep hypothermia circulatory arrest
and could be selected according to the actual condition in aortic arch
surgery. A high-quality randomized controlled trial is urgently needed to
confirm this conclusion, especially for stroke morbidity following ACP or
RCP. Copyright 2014 by The American Association for Thoracic Surgery.

<18>
Accession Number
2014486491
Authors
Indraratna P. Ang S.C. Gada H. Yan T.D. Manganas C. Bannon P. Cao C.
Institution
(Indraratna, Ang, Gada, Yan, Bannon, Cao) Systematic Review Unit,
Department of Cardiothoracic Surgery, St George Hospital, Sydney,
Australia
(Indraratna, Ang, Manganas, Cao) Department of Cardiothoracic Surgery, St
George Hospital, Sydney, Australia
(Yan, Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, University of Sydney, Sydney, Australia
Title
Systematic review of the cost-effectiveness of transcatheter aortic valve
implantation.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (2) (pp 509-514),
2014. Date of Publication: August 2014.
Publisher
Mosby Inc.
Abstract
Objective Transcatheter aortic valve implantation (TAVI) has emerged as an
alternative treatment to aortic valve replacement (AVR) for selected
patients with severe aortic stenosis. The present systematic review was
conducted to analyze the cost-effectiveness of this novel technique within
reimbursed healthcare systems. Methods Two reviewers used 7 electronic
databases from January 2000 to November 2012 to identify relevant
cost-effectiveness studies of TAVI versus AVR or medical therapy. The
primary endpoints were the incremental cost-effectiveness ratio (ICER) and
the probability of cost-effectiveness. The eligible studies for the
present systematic review included those in which the cost-effectiveness
data were measured or projected for TAVI and either medical therapy or
AVR. All forms of TAVI were included, and all retrieved publications were
limited to the English language. Results Eight studies were included for
quantitative assessment. The ICER for TAVI compared with medical therapy
for surgically inoperable patients ranged from US$26,302 to US$61,889 per
quality-adjusted life year gained. The probability of TAVI being
cost-effective compared with medical therapy ranged from 0.03 to 1.00. The
ICER values for TAVI compared with AVR for high-risk surgical candidates
ranged from US$32,000 to US$975,697 per quality-adjusted life year gained.
The probability of TAVI being cost-effective in this cohort ranged from
0.116 to 0.709. Conclusions Depending on the ICER threshold selected, TAVI
is potentially justified on both medical and economic grounds compared
with medical therapy for patients deemed to be surgically inoperable.
However, in the high-risk surgical patient cohort, the evidence is
currently insufficient to economically justify the use of TAVI in
preference to AVR. Copyright 2014 by The American Association for
Thoracic Surgery.

<19>
Accession Number
71546374
Authors
Guo Z. Yuan X. Ju W. Wang D. He X.
Institution
(Guo, Yuan, Ju, Wang, He) First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
Title
Changes in patient/graft survival and causes of death in liver, kidney,
and heart transplantation over time, according to age, sex, and geographic
region: A meta-analysis.
Source
Transplantation. Conference: 2014 World Transplantation Congress, WTC 2014
San Francisco, CA United States. Conference Start: 20140726 Conference
End: 20140731. Conference Publication: (var.pagings). 98 (pp 832), 2014.
Date of Publication: 15 Jul 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background The efficacy of solid organ transplantation (SOT) has been
improved over time. We aimed to assess the patient/graft survivals and
causes of death in SOT recipients in relation to age, sex, geographic
region, and time period. Methods A search of PubMed and Embase with
predefined inclusion criteria identified eligible prospective studies.
Trends in patient/graft survivals and causes of death over time and the
effect of age, sex, and geographic region on these trends were assessed
with weighted linear regression analysis. Findings 66 studies with 12589
liver transplant recipients, 35 studies with 10296 renal transplant
recipients, and 39 studies with 14831 cardiac transplant recipients were
included. Patient/graft survivals in all three SOTs had increasing trends
per year. The annual increase of long-term patient survivals were with
yearly increases by 0.5%, 1.2%, and 2.3%, respectively, at 1, 3, and 5
years after liver transplantation; by 0.5% and 0.6% at 3 and 5 years after
kidney transplantation; and by 0.2%, 0.8%, and 0.8% at 1, 3, and 5 years
after heart transplantation. The 5-year kidney transplant recipient
survival rates (94%, 89-98) were higher in Asia than Europe (82%, 75-88).
No regional survival disparities were found in both liver and heart
transplantation. While the incidences of infection/sepsis and
cardiovascular factors as causes of death have decreased yearly, the
incidence of malignancy as a cause of death has been on the rise.
Furthermore, the role of graft rejection as a cause of death has been
decreasing overtime in liver and heart transplantation. Interpretation
Post-transplant patient/graft survivals have shown improving trends in the
past three decades, and these trends are not affected by patient age, sex,
or geographic region. (Figure Presented).

<20>
Accession Number
71543546
Authors
Sigurdardottir V. Andreassen A. Gustafsson F. Eiskjaer H. Radegran G. Gude
E. Larsson K. Solbu D. Andersson B. Dellgren G. Gullestad. L.
Institution
(Sigurdardottir, Dellgren) Transplant Institute, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Andreassen, Gude, Gullestad.) Department of Cardiology, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Skejby University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital and Lund University, Lund, Sweden
(Larsson) Heart Center University Hospital, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Early calcineurin inhibitors elimination improves renal function in de
novo heart transplant recipients: The results of a randomized controlled
trial (schedule trial).
Source
Transplantation. Conference: 2014 World Transplantation Congress, WTC 2014
San Francisco, CA United States. Conference Start: 20140726 Conference
End: 20140731. Conference Publication: (var.pagings). 98 (pp 3), 2014.
Date of Publication: 15 Jul 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: Calcineurin inhibitors remain the mainstay of immunosuppression
following heart transplantation, but are associated with significant long
term complications. We conducted a randomized, open-label, parallel group
clinical trial to assess whether early introduction of everolimus followed
by withdrawal of cyclosporine would lead to superior renal function in de
novo heart transplant (HTx) recipients, compared to a standard
cyclosporine-based immunosuppression. Methods: 115 patients were randomly
assigned within 5 days postoperatively to everolimus and reduced dose
cyclosporine (CsA) followed by CsA withdrawal after 7-11 weeks (n=56) or
standard cyclosporine dosage (n=59). All received mycophenolate mofetil
and corticosteroids. The primary efficacy endpoint was renal function
assessed by measured glomerular filtration rate (mGFR) after 12 months.
Secondary objectives included progression of cardiac-allograft
vasculopathy (by intravascular ultrasound (IVUS)), left ventricular
function and rejections. Results: At 12 months, mGFR was significantly
higher in the everolimus group compared to those receiving standard
cyclosporine-based immunosuppression (80 mL/minvs.62 mL/min; p<0.0001;
Intention To Treat population). A significantly higher incidence of acute
cellular rejection was observed in the everolimus group, while left
ventricular function and NT-proBNP were similar between the two groups.
there were similar rates of bacterial infection but less cytomegalovirus
infection in everolimus treated patients (5.4% vs 30.5%; p<0.001). IVUS
data, not yet ready, will be presented. Conclusions: Early introduction of
everolimus followed by withdrawal of cyclosporine was associated with
significant and clinically relevant improvement in renal function in HTx
patients.

<21>
Accession Number
71538817
Authors
Siontis G. Juni P. Pilgrim T. Stortecky S. Buellesfeld L. Meier B.
Wenaweser P. Windecker S.
Institution
(Siontis, Juni, Pilgrim, Stortecky, Buellesfeld, Meier, Wenaweser,
Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland; 2. Department of Clinical Research, Clinical Trials Unit,
Bern, Switzerland
Title
Predictors of permanent pacemaker implantation after TAVI: A
meta-analysis.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: Several patient and procedure related characteristics have been
evaluated and proposed as potential predictors of permanent pacemaker
(PPM) implantation after transcatheter aortic valve implantation (TAVI);
however, the available evidence is sparse and inconsistent, mainly derived
from small studies. Therefore, we aimed to provide summary effect
estimates for clinically useful risk predictors. Methods and results: We
performed a systematic search for studies of original design reporting the
incidence of PPM implantation after TAVI. We deemed eligible any study
that provided quantitative raw data that enabled the calculation of crude
risk ratios for each predictor of interest. When overlapping populations
(according to participating institution(s) and recruitment period) were
documented in different reports, we included the one with the most recent
results and available data of interest. Patients with prior PPM were
excluded from the analysis. For our purpose, we focused on previously
proposed and clinically meaningful predictors, which could be plausibly
related to the intervention owing to direct injury to the aortic root.
Data on study design, patients, and procedural characteristics were
abstracted. Crude risk ratios (RR) and 95% confidence intervals (CI) were
obtained for each predictor and combined by using random effects models,
while stratified analyses by the type of valve was also performed.
Heterogeneity across the studies was quantified with I index. Data were
obtained from 41 studies including 11,210 TAVI patients of whom 1,917
(17%) required PPM implantation after intervention. Studies were mainly
performed in Europe (93%) and published between 2009-2013; while patients'
recruitment occurred between 2005-2011. The self-expandable Medtronic
CoreValve Revalving System (MCRS) and the Edwards Sapine Valve (ESV) were
equally used; and the valve implantation was performed via femoral (73%),
apical (23%), or other route (4%) (aortic or subclavian access). The rate
of PPM ranged from 2% to 51% in individual studies (with a median of 28%
for MCRS (interquartile range, 24% to 35%) and 6% for ESV (5% to 7%)).
Fourteen predictors of interest were identified, while two or more
non-overlapping datasets were available for 11 of them. The summary
estimate indicated increased risk of PPM after TAVI for men (RR 1.23, 95%
CI 1.10-1.38); for patients with first degree AV block (RR 1.52, 95% CI
1.15-2.01), left anterior hemiblock (RR 1.62, 95% CI 1.17-2.25), or RBBB
(RR 2.89, 95% CI 2.36-3.54) at baseline and for patients with
intraprocedural AV block (RR 3.49, 95% CI 2.49-4.89) (p-value<0.01 for all
estimates). There was no significant heterogeneity for any of the above
predictors and the I point estimate was 0% to 44%. The aforementioned
variables remained significant predictors when only patients treated with
the MCRS were considered; conversely, the data for ESV were limited.
Unadjusted estimate indicated a 2.5-fold higher risk of PPM for patients
who received MCRS compared to ESV. Conclusions: Conduction disturbances at
baseline and intraprocedural AV block emerged as predictors of PPM
implantation after TAVI in high-risk patients receiving one of the two
most widely used bioprostheses. Given the clinical and economic impact of
such interventions, clinicians should appropriately stratify patients.
This study provides useful tools to help clinicians to identify high-risk
patients and to guide clinical decision-making before and after TAVI.

<22>
Accession Number
71538636
Authors
Conrotto F. D'Ascenzo F. Giordana F. Colaci C. Scacciatella P. Pennone M.
Omede P. Moretti C. D'Amico M. Gaita F. Marra S.
Institution
(Conrotto, D'Ascenzo, Giordana, Colaci, Scacciatella, Pennone, Omede,
Moretti, D'Amico, Gaita, Marra) Department of Cardiology, Citta della
Salute e della Scienza Hospital, Turin, Italy; 2. Department of Internal
Medicine, Division of Cardiology, University of Turin, Turin, Italy
Title
Impact of access on TAVI procedural and mid-term follow-up: A
meta-analysis of 13 studies and 10,468 patients.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: In most of the patients, Transcatheter Aortic Valve Implantation
(TAVI) may be performed using transfemoral (TF) or transapical (TA)
approach: however impact of access choice on periprocedural and mid-term
results remains to be defined. Aim of our study was to evaluate the impact
of access choice on short and mid-term follow-up after TAVI. Methods and
results: Medline and Cochrane Library were searched for articles
describing differences in baseline, periprocedural and mid-term outcomes
among patients undergoing TF or TA TAVI. The primary end point was
all-cause mortality at mid-term follow-up, while secondary ones were 30
days mortality and in hospital complications (bleeding and cerebrovascular
events). The independent impact of access choice was evaluated with pooled
analysis using a random-effect model. 13 studies with 10,468 patients were
included. TF was the most exploited strategy (69.5% vs. 30.5%). After
adjusting for confounding variables, 30 days and follow-up mortality
(median 365 days, range 222-400) were lower in TF patients with a pooled
adjusted odds ratio of 0.81 [0.68-0.99 I: 99%] and 0.85 [0.80-0.90 I2
96%], respectively. Regarding periprocedural outcomes, TF reduced risk of
bleedings and strokes (OR respectively of 0.74 [0.66-0.82 I: 95] and 0.91
[0.83-0.99) I: 86% respectively. Conclusions: TF approach reduces
mortality in TAVI patients, due to lower rates of periprocedural bleedings
and strokes.

<23>
Accession Number
71538633
Authors
Millan X. Skaf S. Joseph L. Noble S. Sia Y. Tzikas A. Asgar A. Ibrahim R.
Jolicoeur M.
Institution
(Millan, Skaf, Joseph, Noble, Sia, Tzikas, Asgar, Ibrahim, Jolicoeur)
Montreal Heart Institute, Montreal, Canada; 2. McGill University Health
Centre, Montreal, Canada; 3. Department of Medical Specialties, Cardiology
Division, Universite de Geneve, Geneve, Switzerland; 4. Centre Hospitalier
Universitaire de Montreal, Montreal, Canada; 5. Interbalkan European
Medical Center, Thessaloniki, Greece
Title
Transcatheter reduction of paravalvular leaks: A systematic review and
meta-analysis.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: Significant paravalvular leak following prosthetic valve replacement
can result in intractable congestive heart failure and haemolytic anaemia.
Since repeat surgery is only possible in a minority of patients,
transcatheter reduction of paravalvular leaks is emerging as an
alternative option, but its safety and efficacy remain uncertain. This
study sought to assess whether a successful transcatheter paravalvular
leak reduction is associated with an improvement in congestive heart
failure functional class or haemolytic anaemia. Methods and results: We
identified 9 clinical studies totalling 269 patients comparing successful
and failed transcatheter paravalvular leak reductions. A Bayesian
hierarchical meta-analysis was performed using as primary endpoint the
combined occurrence of improvement in New York Heart Association
functional class or haemolytic anaemia. Mortality and the need for repeat
surgery were used as secondary endpoints. A successful transcatheter
paravalvular leak reduction is associated with a superior improvement in
functional class or haemolytic anaemia compared to a failed intervention
(OR=7.63, 95% credible interval [CrI] from 1.32 to 52.33). A trend toward
fewer repeat surgeries was also observed with successful paravalvular leak
reductions (OR=0.22, 95% CrI from 0.04 to 1.12). Due to small sample
sizes, the effect between paravalvular leak reduction and mortality could
not be accurately estimated (OR=0.58, 95% CrI from 0.06 to 4.27).
Conclusions: A successful transcatheter paravalvular leak reduction is
associated with favourable clinical outcomes, including an improvement in
functional class and haemolytic anaemia.

<24>
Accession Number
71538630
Authors
Mylotte D. Andalib A. Theriault-Lauzier P. Dorfmeister M. Girgis M.
Alharbi W. Chetrit M. Galatas C. Mamane S. Sebag I. Buithieu J. Bilodeau
L. De Varennes B. Lachapelle K. Lange R. Martucci G. Virmani R. Piazza N.
Institution
(Mylotte, Andalib, Theriault-Lauzier, Dorfmeister, Girgis, Alharbi,
Chetrit, Galatas, Mamane, Sebag, Buithieu, Bilodeau, De Varennes,
Lachapelle, Lange, Martucci, Virmani, Piazza) McGill University Heart
Centre, Montreal, Canada; 2. German Heart Centre, Munich, Germany; 3.
CVPath Institute, Gaithersburg, USA
Title
Transcatheter heart valve failure: A systematic review.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: Bioprosthetic surgical valve failure is well described, however no
study has described transcatheter heart valve failure (THV) in a large
series. We performed a systematic review of published literature to
investigate the causes, diagnosis, management and outcomes of THV failure.
Methods and results: Between January 2002 and October 2013, all published
studies reporting patient level data on THV failure were identified by
systematic electronic search. Outcomes were defined according to the VARC
criteria. Among 56 publications and 69 individual cases of THV failure,
prosthetic valve endocarditis (PVE) (n=29), structural valve failure
(n=8), and THV thrombosis (n=12) were identified. The microbiological
profile of THV PVE was similar to that of surgical PVE, though up to 1/3
of patients underwent surgical intervention. THV thrombosis occurred at a
mean 8+7 months post implantation and was successfully treated with
anticoagulation in 2/3 of patients. Two novel causes of THV failure were
identified: 13 cases of late THV embolisation and 7 cases of THV
compression following cardiopulmonary resuscitation. These failure modes
have not been reported in surgical aortic valve replacement, and all
involved balloon expandable THV systems. Potential risk factors for late
THV embolisation include THV undersizing/underexpansion; bicuspid and
non-calcified aortic valve; and asymmetric root calcification.
Conclusions: THVs are susceptible to failure modes typical of surgical
bioprostheses and unique to the design of THVs. THV compression and late
embolisation represent complications previously unreported in the surgical
literature. Management of THV PVE, valve thrombosis, and structural valve
failure differed considerably from surgical bioprosthetic failure.

<25>
Accession Number
71538608
Authors
Conrotto F. D'Ascenzo F. Giordana F. D'Amico M. Moretti C. Colaci C. Omede
P. Scacciatella P. Pennone M. Gaita F. Marra S.
Institution
(Conrotto, D'Ascenzo, Giordana, D'Amico, Moretti, Colaci, Omede,
Scacciatella, Pennone, Gaita, Marra) Department of Cardiology, Citta della
Salute e della Scienza Hospital, Turin, Italy; 2. Department of Internal
Medicine, Division of Cardiology, University of Turin, Turin, Italy
Title
Mid-term prognostic value of sex in patients undergoing TAVI: A
meta-analysis of adjusted observational studies.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: The impact of gender related pathophyisiological features of severe
aortic stenosis on the outcome of transcatheter aortic valve implantation
(TAVI) is still debated. Our meta-analysis aims to clarify the independent
prognostic role of gender on mid-term survival in patients undergoing
TAVI. Methods and results: Pubmed, Medline and Cochrane collaboration were
searched for studies reporting predictors of adverse outcomes of patients
undergoing TAVI. Midterm all-cause mortality was the primary endpoint. 30
Days mortality and in-hospital complications the secondary ones.
Multivariable-adjusted risk estimates for all cause death, evaluated as
odds ratios ([OR] 95% confidence intervals [CI]), were pooled after
logarithmic transformation according to random-effect models with
inverse-variance weighting. 945 citations were first screened and finally
5 studies and 5,213 patients were included. Among them 52% were females.
Females were older (83.4 vs. 82.2 years), had a better ejection fractions
(55.1% vs. 49.5%) and higher mean pressure gradient (52.6 vs. 47 mmHg).
Women suffered more major vascular complications (12% vs. 7.4%) and more
major/life-threatening bleeds (22.1% vs. 12.7%). 30 days mortality was 7%
in females and 10% in males. After a median follow-up of 441 days
(365-730) mortality was 23.6% in females and 33.6% in males. At pooled
analysis of multivariate approach, female gender was significantly related
to a lower risk of death (OR 0.84, 95% CI, confidence interval: 0.73-0.96
I=0%). Conclusions: Female sex is independently associated with better
mid-term survival after TAVI. This finding should be weighted to
accurately evaluate risk and strategies for patients with severe aortic
stenosis.

<26>
Accession Number
71538607
Authors
Giordana F. D'Ascenzo F. Omede P. Benedetto S. Colaci C. D'Amico M.
Moretti C. Marra S. Gaita F.
Institution
(Giordana, D'Ascenzo, Omede, Benedetto, Colaci, D'Amico, Moretti, Marra,
Gaita) Division of Cardiology, Citta della Salute e della Scienza
Hospital, University of Turin, Torino, Italy; 2. Division of Cardiology,
Citta della Salute e della Scienza Hospital, University of Turin, Torino,
Italy; 3. Division of Cardiology, Citta della Salute e della Scienza
Hospital, Torino, Italy
Title
Incidence and predictors of all-cause mortality after TAVI: A systematic
review.
Source
EuroIntervention. Conference: EuroPCR 2014 Paris France. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
, 2014. Date of Publication: May 2014.
Publisher
EuroPCR
Abstract
Aims: TAVI (Transcatheter aortic valve implantation) was demonstrated to
be safe and efficacious in patients with severe aortic stenosis, although
with important rates of complications and of death at follow-up, mainly
due to comorbidities of patients. An accurate estimation of risk of these
patients represents an actual challenge. Methods and results: The PubMed
and Cochrane Collaboration databases were systematically searched for
articles reporting on the incidence and independent predictors of 30-day
and mid-term (>1 year) mortality. Adverse events were pooled with random
effect, while independent predictors were reported as odds ratios with 95%
confidence intervals. A total of 25 studies with 8,874 patients were
included (median age 82.5+1.5, 54.6% females). At 30-days 7.5% (663) of
patients died. At mid-term follow-up (median 365 days [IQR 267-365]) the
cumulative mortality rate was 21.6% (1,917). Acute kidney injury (AKI)
stage >2 (OR 18.0; CI 6.3-52), preprocedural hospitalisation for heart
failure (OR 9.4; CI 2.6-35), periprocedural myocardial injury (OR 8.5; CI
2.6-33.5) and increased pro-BPN levels (OR 5.4; CI 1.7-16.5) were the most
important independent predictors of 30-day mortality. Increased pro-BNP
levels (OR 11; CI 1.5-81), AKI stage 3 (OR 6.8; CI 2.6-15.7), left
ventricle ejection fraction <30% (OR 6.7; CI 3.5-12.7) and periprocedural
myocardial infarction (OR 6.5; CI 2.3-18.1) represented the predictors of
mid-term mortality. Conclusions: In this large meta-analysis of TAVI
patients, we found that high pro-BNP levels and post-procedural AKI were
the strongest independent predictors of both 30-day and 1 year mortality.
These findings may contribute to a better understanding of the risk
assessment process of TAVI patients.