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<1>
Accession Number
2014558067
Authors
Jensen L.O. Thayssen P. Maeng M. Christiansen E.Ho. Ravkilde J. Hansen
K.No. Kaltoft A. Tilsted H.H. Madsen M. Lassen J.F.
Institution
(Jensen, Thayssen, Hansen) Department of Cardiology, Odense University
Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
(Maeng, Christiansen, Kaltoft, Lassen) Department of Cardiology, Aarhus
University Hospital, Skejby Hospital, Aarhus, Denmark
(Ravkilde, Tilsted) Department of Cardiology, Aalborg University Hospital,
Aalborg, Aalborg, Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
Title
Three-year outcomes after revascularization with everolimus- and
sirolimus-eluting stents from the SORT OUT IV trial.
Source
JACC: Cardiovascular Interventions. 7 (8) (pp 840-848), 2014. Date of
Publication: August 2014.
Publisher
Elsevier Inc.
Abstract
Objectives The study sought to compare the risk of late outcome with a
focus on very late definite stent thrombosis of the everolimus-eluting
stent (EES) with that of the sirolimus-eluting stent (SES) at 3-year
follow-up. Background In the SORT OUT IV (SORT OUT IV Trial), comparing
the EES with the SES in patients with coronary artery disease, the EES was
noninferior to the SES at 9 months. The SORT OUT IV trial provides
long-term head-to-head randomized comparison of the EES with the SES.
Methods We prospectively randomized 2,774 patients in the SORT OUT IV
trial. Follow-up through 3 years was complete in 2,771 patients (99.9%).
The 3-year pre-specified endpoints were composites of safety and efficacy
(major adverse cardiac events [MACE]: cardiac death, myocardial
infarction, target vessel revascularization, and definite stent
thrombosis). Results At 3 years, the composite endpoint MACE occurred in
9.8% of the EES group and in 11.1% of the SES group (hazard ratio [HR]:
0.89, 95% confidence interval [CI]: 0.70 to 1.12). Overall rate of
definite stent thrombosis was lower in the EES group (0.2% vs. 1.4%; HR:
0.15, 95% CI: 0.04 to 0.50), which was largely attributable to a lower
risk of very late definite stent thrombosis: 0.1% versus 0.8% (HR: 0.09,
95% CI: 0.01 to 0.70). Conclusions At 3-year follow-up, the MACE rate did
not differ significantly between EES- and SES-treated patients. A
significant reduction of overall and very late definite stent thrombosis
was found in the EES group. (The SORT OUT IV TRIAL [SORT OUT IV];
NCT00552877). 2014 by the American College of Cardiology Foundation.

<2>
Accession Number
2014556772
Authors
Nakamura M. Nanto S. Hirayama A. Takayama T. Nishikawa M. Kimura K. Morita
S. Aizawa T. Asano R. Matsumaru Y. Hamada C. Isshiki T.
Institution
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan
(Nanto) Department of Advanced Cardiovascular Therapeutics, Osaka
University Graduate School of Medicine, Osaka, Japan
(Hirayama, Takayama) Division of Cardiology, Department of Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Nishikawa) Institute of Human Research Promotion and Drug Development,
Mie University Faculty of Medicine, Tsu, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, Yokohama, Japan
(Morita) Department of Epidemiology and Healthcare Research, Kyoto
University School of Public Health, Kyoto, Japan
(Aizawa) Department of Cardiology, Cardiovascular Institute Hospital,
Tokyo, Japan
(Asano) Department of Cardiology, Sakakibara Memorial Hospital, Tokyo,
Japan
(Matsumaru) Department of Endovascular Neurosurgery, Toranomon Hospital,
Tokyo, Japan
(Hamada) Department of Management Science, Faculty of Engineering, Tokyo
University of Science, Tokyo, Japan
(Isshiki) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
Title
Optimal duration of dual antiplatelet therapy following treatment with the
endeavor zotarolimus-eluting stent in real-world Japanese patients with
coronary artery disease (OPERA): Study design and rationale.
Source
Catheterization and Cardiovascular Interventions. 84 (3) (pp 368-374),
2014. Date of Publication: 01 Sep 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In patients with coronary artery disease (CAD), there is an
increasing therapeutic need among interventional cardiologists to conduct
dual antiplatelet therapy (DAPT) whose duration is shorter than current
guideline-recommended 6-12 months after the implantation of drug-eluting
stents. However, no clinical grounds sufficient to rationalize the need
are available. Objectives: To define the optimal duration of DAPT and to
examine the safety and efficacy of the Endeavor zotarolimus-eluting stent
(E-ZES) in real-world Japanese patients with CAD. Study design: The
present prospective, nonrandomized, multicenter, controlled study is
uniquely designed to examine the analysis set to be formulated after
integrating two different databases consisting of the following two study
arms: the 3-month DAPT arm, in which 1,210 patients were consecutively
enrolled at 106 medical institutions; and the 12-month DAPT arm, in which
1,210 patients will be consecutively extracted from the Endeavor Japan
post-marketing surveillance at 60 medical institutions. The primary
endpoint is "net adverse cardiac and cerebrovascular events - death,
myocardial infarction, cerebrovascular accident, and major bleeding)" at
12 months after implantation. The secondary endpoints are as follows:
major adverse cardiac events at 1, 3, 6, 9, and 12 months after
implantation; target vessel revascularization and target lesion
revascularization at 9 and 12 months after implantation; and stent
thrombosis, DAPT compliance, and bleeding events at 12 months after
implantation. Noninferiority in the E-ZES's profiles between the study
arms will be investigated. Conclusions: The present study will provide
insight into the optimal duration of DAPT after the E-ZES implantation in
individual, real-world patients with CAD. 2013 Wiley Periodicals, Inc.

<3>
Accession Number
2014560051
Authors
Sehatzadeh S. Doble B. Xie F. Blackhouse G. Campbell K. Kaulback K.
Chandra K. Goeree R.
Title
Transcatheter aortic valve implantation (TAVI) for treatment of aortic
valve stenosis: An evidence update.
Source
Ontario Health Technology Assessment Series. 13 (1) , 2013. Date of
Publication: 2013.
Abstract
Background: One-year mortality outcomes in the PARTNER trial showed that
transcatheter aortic valve implantation (TAVI) was noninferior to surgical
aortic valve replacement (sAVR) in patients who were eligible for sAVR
(cohort A), and superior to standard treatment in patients who were
ineligible for sAVR (cohort B). Objective: To update a previous report on
the safety, effectiveness, and cost-effectiveness of TAVI, published in
2012. Data Sources: A literature search was performed on September 11,
2012, using OVID MEDLINE, OVID MEDLINE InProcess and Other Non-Indexed
Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing and Allied
Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for
Reviews and Dissemination database, for studies published from January 1,
2011, until September 11, 2012. Review Methods: Randomized controlled
trials investigating TAVI in comparison to sAVR or standard treatment were
included for analysis. Results were summarized descriptively. Results: At
2-year follow-up, mortality in cohort A was similar between the TAVI and
sAVR groups. Rates of stroke/transient ischemic attack, major vascular
complications, and moderate/severe paravalvular aortic regurgitation were
significantly higher in the TAVI group, but rate of major bleeding was
significantly higher in the sAVR group. Mortality in cohort B was
significantly lower with transfemoral (TF) TAVI than with standard
treatment, but rate of stroke was significantly higher with TF TAVI. TF
TAVI resulted in a more rapid improvement in quality of life scores than
sAVR, but this difference was not sustained at 6 and 12 months. Patients
who underwent transapical TAVI did not have a greater early improvement in
quality of life compared to sAVR patients. Compared to standard treatment,
TF TAVI resulted in a greater improvement in quality of life scores at all
time points.Incremental cost-effectiveness ratios were in favour of TAVI
for inoperable patients in the base-case analysis, but varied widely for
operable patients. Conclusions: The findings of the 2-year follow-up with
respect to mortality and adverse events were consistent with those of the
1-year follow-up. TAVI was also associated with improvement in quality of
life, although results varied by cohort. Consistent with the 2012 report,
TAVI may be cost-effective for patients who are not candidates for
surgery. Queen's Printer for Ontario, 2013.

<4>
Accession Number
2014556815
Authors
Bangalore S. Gong Y. Cooper-Dehoff R.M. Pepine C.J. Messerli F.H.
Institution
(Bangalore) Leon H. Charney Division of Cardiology, Cardiovascular
Outcomes Group, New York University School of Medicine, 550 First Avenue,
New York, NY 10016, United States
(Gong, Cooper-Dehoff) Department of Pharmacotherapy and Translational
Research, University of Florida, College of Pharmacy, Gainesville, FL,
United States
(Cooper-Dehoff, Pepine) Division of Cardiology, University of Florida,
College of Medicine, Gainesville, FL, United States
(Messerli) Division of Cardiology, Mt. Sinai School of Medicine, St.
Luke's Roosevelt Hospital, New York, NY, United States
Title
2014 eighth joint national committee panel recommendation for blood
pressure targets revisited: Results from the invest study.
Source
Journal of the American College of Cardiology. 64 (8) (pp 784-793), 2014.
Date of Publication: 26 Aug 2014.
Abstract
BACKGROUND: The 2014 Eighth Joint National Committee panel recommendations
for management of high blood pressure (BP) recommend a systolic BP
threshold for initiation of drug therapy and a therapeutic target of <150
mm Hg in those >60 years of age, a departure from prior recommendations of
<140 mm Hg. However, it is not known whether this is an optimal choice,
especially for the large population with coronary artery disease (CAD).
OBJECTIVES: This study sought to evaluate optimal BP in patients >60 years
of age. METHODS: Patients 60 years of age or older with CAD and baseline
systolic BP >150 mm Hg randomized to a treatment strategy on the basis of
either atenolol/ hydrochlorothiazide or verapamil-SR (sustained
release)/trandolapril in INVEST (INternational VErapamil SR Trandolapril
STudy) were categorized into 3 groups on the basis of achieved
on-treatment systolic BP: group 1, <140 mm Hg; group 2, 140 to <150 mm Hg;
and group 3, >150 mm Hg. Primary outcome was first occurrence of all-cause
death, nonfatal myocardial infarction (MI), or nonfatal stroke. Secondary
outcomes were all-cause mortality, cardiovascular mortality, total MI,
nonfatal MI, total stroke, nonfatal stroke, heart failure, or
revascularization, tabulated separately. Outcomes for each group were
compared in unadjusted and multiple propensity score-adjusted models.
RESULTS: Among 8,354 patients included in this analysis with an
accumulated 22,308 patient-years of follow-up, 4,787 (57%) achieved
systolic BP of <140 mm Hg (group 1), 1,747 (21%) achieved systolic BP of
140 to <150 mm Hg (group 2), and 1,820 (22%) achieved systolic BP of >150
mm Hg (group 3). In unadjusted models, group 1 had the lowest rates of the
primary outcome (9.36% vs. 12.71% vs. 21.32%; p < 0.0001), all-cause
mortality (7.92% vs. 10.07% vs. 16.81%; p < 0.0001), cardiovascular
mortality (3.26% vs. 4.58% vs. 7.80%; p < 0.0001), MI (1.07% vs. 1.03% vs.
2.91%; p < 0.0001), total stroke (1.19% vs. 2.63% vs. 3.85%; p <0.0001),
and nonfatal stroke (0.86% vs 1.89% vs 2.86%; p<0.0001) compared with
groups 2 and 3, respectively. In multiple propensity score-adjusted
models, compared with the reference group of <140 mm Hg (group 1), the
risk of cardiovascular mortality (adjusted hazard ratio [HR]: 1.34; 95%
confidence interval [CI]: 1.01 to 1.77; p = 0.04), total stroke (adjusted
HR: 1.89; 95% CI: 1.26 to 2.82; p = 0.002) and nonfatal stroke (adjusted
HR: 1.70; 95% CI: 1.06 to 2.72; p = 0.03) was increased in the group with
BP of 140 to <150 mm Hg, whereas the risk of primary outcome, all-cause
mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke,
and nonfatal stroke was increased in the group with BP >150 mm Hg.
CONCLUSIONS: In hypertensive patients with CAD who are >60 years of age,
achieving a BP target of 140 to <150 mm Hg as recommended by the JNC-8
panel was associated with less benefit than the previously recommended
target of <140 mm Hg. 2014 by the American College of Cardiology
Foundation.

<5>
Accession Number
2014553458
Authors
Gukop P. Gutman N. Bilkhu R. Karapanagiotidis G.T.
Institution
(Gukop, Gutman, Bilkhu, Karapanagiotidis) Department of Cardiothoracic
Surgery, St George's Hospital NHS Trust, London SW17 0QT, United Kingdom
Title
Who might benefit from early aspirin after coronary artery surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 505-511),
2014. Date of Publication: September 2014.
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether early
administration of aspirin might optimize vein graft patency. More than 250
papers were found using the reported search, of which 4 new papers in
addition to the previous 7 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Early postoperative aspirin administered within 6 h
following coronary artery bypass grafting (CABG) has been shown to be
optimal for prevention of vein graft occlusion. Early aspirin has
significant benefit in reducing vein graft occlusion, mortality,
myocardial infarction, stroke, renal failure and bowel infarction. The
efficacy of early postoperative aspirin on vein graft patency diminishes
the later it is administered. It has optimal benefit at 6 h, some benefit
at 24 h and no benefit after 48 h post CABG. ACC/AHA, EACTS and ACCP have
issued guidelines recommending administration of early aspirin or an
alternative (clopidogrel, ticlopidine and indobufen) at 6 h or soon after
bleeding has settled as the standard of care for optimization of vein
graft patency. The ACCP guideline has also suggested that optimal
prevention of cardiovascular complication should have higher value than
prevention of postoperative bleeding. Several randomized, controlled
studies, including a meta-analysis, have shown that early administration
of aspirin following CABG is not associated with increased blood loss or
transfusion requirement. Postoperative bleeding has been identified as a
significant reason for non administration of early aspirin in a
prospective study. It is essential to define/quantify the postoperative
blood loss that precludes administration of early aspirin. This will
enhance prompt administration in some cases and guide judgement,
especially in patients with high-risk factors for vein graft thrombosis.
Administration at 6 h is the optimal time to give aspirin as long as
bleeding has settled. The Author 2014. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<6>
Accession Number
2014553453
Authors
Plumereau F. Pinaud F. Roch A. Baufreton C.
Institution
(Plumereau, Pinaud, Roch, Baufreton) Department of Cardiac Surgery,
University Hospital, Angers Cedex, France
(Pinaud) CNRS UMR 6214, INSERM 1083, University of Angers, Angers Cedex,
France
Title
Do patients with haematological malignancy who need cardiopulmonary bypass
have a short-term higher mortality or a higher chance of disease
progression?.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 474-478),
2014. Date of Publication: September 2014.
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether patients with
haematological malignancy (HM) who need cardiopulmonary bypass (CPB) have
a higher short-term mortality or a higher chance of disease progression
secondary to CPB. Altogether, 107 papers were found using the reported
search terms, but ultimately only eight were relevant to our subject. We
found four case series and four case-control series. Most of the found
papers were only short series. The largest series included 56 patients
with HM and requiring CPB, suggesting that HM patients rarely require CPB
surgery and/or are not operated on. Most of these studies showed that the
overall postoperative morbidity rate was increased, reaching 50-60% of the
patients. These comorbidities were mainly related to postoperative
infections, bleeding and blood transfusions, which were highly
significant. However, in most papers, the postoperative hospital stay was
not different and the in-hospital mortality rate of HM patients was
similar to that of healthy patients. One paper demonstrated that the time
taken before initiating chemotherapy was longer in patients who underwent
CPB surgery. No paper reported an acute change in blood disorders.
Long-term mortality rates were not mentioned in some papers, but when it
was stated, the HM patients' long-term mortality seemed not increased by
using CPB surgery, with more than 80% survival at 3 years and 20-25%
progression of the disease at 3 years. Although these study limitations
are linked to the low-evidence levels in some of the papers used,
haematological malignancies should not be considered a contraindication
for cardiac CPB surgery. The Author 2014. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<7>
Accession Number
2014553452
Authors
Soylu E. Harling L. Ashrafian H. Casula R. Kokotsakis J. Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Casula, Kokotsakis, Athanasiou) Department of
Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed
Street, London W2 1NY, United Kingdom
Title
Adjunct coronary endarterectomy increases myocardial infarction and early
mortality after coronary artery bypass grafting: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 462-473),
2014. Date of Publication: September 2014.
Abstract
Coronary endarterectomy (CE) may provide a useful adjunct to coronary
artery bypass grafting (CABG) in patients with extensive, diffuse coronary
atheroma. However, concerns regarding its morbidity and mortality have
created uncertainty as to the role of CE in the current era. The aim of
this study was therefore to quantitatively summarize the short- and
long-term outcomes of CE. Twenty observational studies were identified by
systematic literature search, incorporating 54 440 patients (7366 CABG +
CE; 47 074 CABG only), which were analysed using random-effects modelling.
Heterogeneity, subgroup analysis, quality scoring and risk of bias were
assessed. Primary end-points were 30-day mortality and perioperative and
postoperative myocardial infarction (MI). Secondary end-points were
postoperative morbidity, intensive care unit (ITU) stay, hospital stay and
long-term graft patency. Adjunctive CE significantly increased 30-day
mortality [odds ratios (OR) = 1.69, 95% confidence interval (CI)
[1.49-1.92], P <0.00001], perioperative (OR = 2.10, 95% CI [1.82-2.43], P
<0.00001) and postoperative MI (OR = 3.34, 95% CI [1.74-6.41], P = 0.0003)
when compared with CABG alone. Furthermore, postoperative ventricular
arrhythmias, pulmonary complications, renal failure and inotrope use were
significantly greater in patients undergoing adjunct CE. CE also increased
ITU and hospital stay and reduced angiographic patency at the last
follow-up (OR = 0.57, 95% CI [0.36-0.88]). Increased 30-day morbidity and
mortality continues to raise concerns over the safety of adjunct CE.
Furthermore, the procedure can be associated with worse long-term graft
patency. To better determine whether CE should remain a viable adjunct to
CABG, novel studies must focus on collecting prospective data with
homogeneous inclusion criteria for CE as well as isolating outcomes for
different coronary vessels and standardizing postoperative
anticoagulation. The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<8>
Accession Number
2014553451
Authors
Testa G. Iodice F. Ricci Z. Vitale V. De Razza F. Haiberger R. Iacoella C.
Conti G. Cogo P.
Institution
(Testa, Iodice, Ricci, Vitale, De Razza, Haiberger, Iacoella, Cogo)
Department of Pediatric Cardiac Anesthesia and Intensive, Children's
Hospital Bambino Gesu', Piazza San Onofrio 4, 00165 Rome, Italy
(Conti) Pediatric Intensive Care Unit, Policlinico A. Gemelli, Catholic
University of Rome Italy, Rome, Italy
Title
Comparative evaluation of high-flow nasal cannula and conventional oxygen
therapy in paediatric cardiac surgical patients: A randomized controlled
trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 456-461),
2014. Date of Publication: September 2014.
Abstract
OBJECTIVES: The aim of this study was to compare high-flow nasal cannula
(HFNC) and conventional O₂ therapy (OT) in paediatric cardiac
surgical patients; the primary objective of the study was to evaluate
whether HFNC was able to improve PaCO₂ elimination in the first
48 h after extubation postoperatively. METHODS: We conducted a randomized,
controlled trial in pediatric cardiac surgical patients under 18 months of
age. At the beginning of the weaning of ventilation, patients were
randomly assigned to either of the following groups: OT or HFNC. Arterial
blood samples were collected before and after extubation at the following
time points: 1, 6, 12, 24 and 48 h. The primary outcome was comparison of
arterial PaCO₂ postextubation; secondary outcomes were
PaO₂ and PaO₂/fractional inspired oxygen
(FiO₂) ratio, rate of treatment failure and need of respiratory
support, rate of extubation failure, rate of atelectasis, simply to
complications and the length of paediatric cardiac intensive care unit
stay. RESULTS: Demographic and clinical variables were comparable in the
two groups. Analysis of variance for repeated measures showed that
PaCO₂ was not significantly different between the HFNC and OT
groups (P = 0.5), whereas PaO₂ and
PaO₂/FiO₂ were significantly improved in the HFNC
group (P = 0.01 and P = 0.001). The rate of reintubation was not different
in the two groups (P = 1.0), whereas the need for noninvasive respiratory
support was 15% in the OT group and none in the HFNC group (P = 0.008).
CONCLUSIONS: HFNC had no impact on PaCO₂ values. The use of
HFNC appeared to be safe and improved PaO₂ in paediatric
cardiac surgical patients. The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<9>
Accession Number
2014553450
Authors
Toishi M. Yoshida K. Agatsuma H. Sakaizawa T. Eguchi T. Saito G. Hashizume
M. Hamanaka K. Shiina T.
Institution
(Toishi, Yoshida, Agatsuma, Sakaizawa, Eguchi, Saito, Hashizume, Hamanaka,
Shiina) Department of Thoracic Surgery, Shinshu University School of
Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Title
Usefulness of vessel-sealing devices for <7 mm diameter vessels: A
randomized controlled trial for human thoracoscopic lobectomy in primary
lung cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 448-455),
2014. Date of Publication: September 2014.
Abstract
OBJECTIVES: Vessel-sealing devices (VSDs) are widely used for various
surgical procedures, including thoracoscopic surgery, but very few reports
have compared their safety and usefulness with human thoracoscopic
lobectomy procedures not employing VSDs. METHODS: Primary lung cancer
patients for whom a thoracoscopic lobectomy involving mediastinal lymph
node dissection was planned in our department from April 2011 to March
2013 were recruited for the study. Patients were randomly allocated to a
control group (n = 14) or a VSD group (n = 44), which comprised three
sub-groups, namely EnSeal (n = 17), LigaSure (n = 15) and Harmonic (n =
12). The control group comprised patients undergoing surgery solely with
ligation and conventional electrocautery. EnSeal, LigaSure and Harmonic
were chosen because they are the three most popular disposable VSDs used
in Japan. In the VSD groups, the proximal side of pulmonary artery stumps
(<7 mm diameter) were ligated and then treated with respective devices.
Primary end-points were burst pressure of the pulmonary artery stump
(measured using resected specimens), operative time, intraoperative blood
loss, instances of endostapler use, intraoperative surgeon stress
(assessed by visual analogue scale) and postoperative drainage volume and
duration. As a secondary objective, the individual VSD groups were also
compared with each other. RESULTS: The burst pressure of ligation-treated
pulmonary artery stumps was higher than that of VSD-treated stumps (P
<0.0001). The burst pressure of <5-mm-wide VSD-treated stumps was higher
than that of >5-mm-wide stumps (P = 0.0421). However, the burst pressure
for all groups and all vessel diameters was sufficient to withstand the
physiological pulmonary artery pressure. The VSD group demonstrated
reduced intraoperative blood loss (P = 0.0241), surgeon stress (P =
0.0002), postoperative drainage volume (P = 0.0358) and shortened
postoperative drainage duration (P = 0.0449). Operative time and the
instances of endostapler use did not significantly differ. Comparison
between each of the VSD groups revealed no significant differences. None
of the patients experienced serious perioperative complications or died
because of surgery. CONCLUSION: VSD is simple and safe to use in
thoracoscopic lobectomy involving mediastinal lymph node dissection for
primary lung cancer. Furthermore, none of the VSDs used in this study
presented any observable differences in quality that could lead to
clinical problems. The Author 2014. Published by Oxford University Press
on behalf of the European Association for Cardio-Thoracic Surgery. All
rights reserved.

<10>
Accession Number
2014553439
Authors
Guizilini S. Alves D.F. Bolzan D.W. Cancio A.S.A. Regenga M.M. Moreira
R.S.L. Trimer R. Gomes W.J.
Institution
(Guizilini, Alves, Bolzan, Cancio, Regenga, Moreira, Gomes) Cardiology and
Cardiovascular Surgery Discipline, Federal University of Sao Paulo, Rua
Napoleao de Barros, 715-CEP, SP 04023-900, Brazil
(Guizilini) Department of Human Motion Sciences, Physical Therapy School,
Federal University of Sao Paulo, Sao Paulo, Brazil
(Trimer) Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in
Physical Exercise, Federal University of Sao Carlos, Sao Paulo, Brazil
Title
Sub-xyphoid pleural drain as a determinant of functional capacity and
clinical results after off-pump coronary artery bypass surgery: A
randomized clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 19 (3) (pp 382-387),
2014. Date of Publication: September 2014.
Abstract
OBJECTIVES: The aim of this trial was to compare functional capacity,
pulmonary shunt fraction and clinical outcomes between patients undergoing
pleurotomy with a pleural drain inserted in the sub-xyphoid position and
patients with a pleural drain placed in the intercostal position after
off-pump coronary artery bypass surgery. METHODS: Patients were randomized
into two groups according to the pleural drain site: Group II (n = 33
intercostal pleural drain); and Group SI (n = 35 sub-xyphoid pleural
drain). Functional capacity was assessed by the distance covered on the
6-min walking test performed preoperatively and on postoperative day (POD)
5; in addition, pulmonary function test was determined preoperatively and
on POD 1 and 5. Pulmonary shunt fraction was evaluated preoperatively and
on POD 1, and clinical outcomes were recorded throughout the study.
RESULTS: Group SI had better preservation of lung volumes and capacities
in POD compared with Group II (P <0.05). Pulmonary shunt fraction
increased in both groups postoperatively; however, Group SI showed a
smaller pulmonary shunt fraction (0.26 + 0.04 vs 0.21 + 0.04%; P =
0.0014). Functional capacity was significantly reduced in both groups on
POD 5; however, Group SI showed better preservation of functional capacity
(P = 0.0001). Group SI had better postoperative clinical results, with
lower incidence of atelectasis and pleural effusion (P <0.05), lower pain
scores (P <0.0001), and shorter orotracheal intubation and hospitalization
lengths (P <0.001). CONCLUSIONS: Sub-xyphoid pleural drain determined
better functional capacity and exercise tolerance with a smaller pulmonary
shunt fraction and improved clinical outcomes compared with intercostal
pleural drainage after off-pump coronary artery bypass surgery. The
Author 2014. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<11>
Accession Number
2014558002
Authors
Lemkes J. Nijveldt R. Beek A.M. Knaapen P. Hirsch A. Meijers J. Allaart
C.P. Van Rossum A. Van Royen N.
Institution
(Lemkes, Nijveldt, Beek, Knaapen, Allaart, Van Rossum, Van Royen)
Department of Cardiology, VU University Medical Center, De Boelelaan 1117,
1081 HV Amsterdam, Netherlands
(Lemkes, Nijveldt, Beek, Knaapen, Allaart, Van Rossum, Van Royen)
Institute for Cardiovascular Research ICaR-VU, VU University Medical
Center, Amsterdam, Netherlands
(Hirsch) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Meijers) Department of Experimental Vascular Medicine, Academic Medical
Center, Amsterdam, Netherlands
Title
Evaluating the optimal timing of revascularisation in patients with
transient ST-segment elevation myocardial infarction: Rationale and design
of the TRANSIENT trial.
Source
Journal of Cardiovascular Translational Research. 7 (6) (pp 590-596),
2014. Date of Publication: August 2014.
Publisher
Springer New York LLC
Abstract
Patients with chest pain and a prehospital ST-segment elevation myocardial
infarction (STEMI) are preferably treated with immediate percutaneous
coronary intervention (PCI). However, patients with normalization of
symptoms and ST-segment elevation upon hospital arrival (transient STEMI)
received inconsistent therapy due to logistic reasons and the absence of
evidence or explicit guidelines. In this trial, the optimal timing of
coronary angiography and subsequent revascularisation is investigated in
patients presenting with transient STEMI. In this prospective,
multicentre, randomized controlled clinical trial, 142 consecutive
patients with initially acute chest pain and STEMI, whose symptoms and
ST-segment elevation resolve upon admission, are randomized to immediate
intervention or a delayed intervention. Primary outcome is infarct size
measured at 4 days determined by cardiovascular magnetic resonance.
Secondary outcomes are left ventricular function and volumes, myocardial
salvage and microvascular injury at baseline; the change in left
ventricular function, volumes and infarct size at 4 months; and major
adverse cardiac events at 4 and 12 months. The TRANSIENT Trial evaluates
whether a delayed invasive strategy (according to NSTEMI-guidelines) is
superior to an immediate invasive strategy (according to STEMI-guidelines)
in patients with a transient STEMI. 2014 Springer Science+Business Media.

<12>
Accession Number
2014553755
Authors
Huang Y.-L. Hu Z.-D. Liu S.-J. Sun Y. Qin Q. Qin B.-D. Zhang W.-W. Zhang
J.-R. Zhong R.-Q. Deng A.-M.
Institution
(Huang) Department of Laboratory Medicine, NO. 455 Hospital of People's
Liberation Army, Shanghai, China
(Huang, Sun, Qin, Zhang, Zhang, Deng) Department of Laboratory Diagnosis,
Changhai Hospital, Second Military Medical University, Shanghai, China
(Huang, Hu, Qin, Zhong) Department of Laboratory Diagnosis, Changzheng
Hospital, Second Military Medical University, Shanghai, China
(Hu) Department of Laboratory Medicine, General Hospital of ji'Nan
Military Region of People's Liberation Army, Ji'nan, Shandong Province,
China
(Liu) Department of Biobank and Biostatistics, Pediatric Translational
Institute, Shanghai Jiaotong University, Shanghai, China
Title
Prognostic value of red blood cell distribution width for patients with
heart failure: A systematic review and meta-analysis of cohort studies.
Source
PLoS ONE. 9 (8) , 2014. Article Number: e104861. Date of Publication: 18
Aug 2014.
Abstract
Aims: Multiple studies have investigated the prognostic role of red blood
cell distribution width (RDW) for patients with heart failure (HF), but
the results have been inconsistent. The aim of the present study was to
estimate the impact of RDW on the prognosis of HF by performing a
systematic review and meta-analysis. Methods and Results: The Embase,
PubMed, and Web of Science databases were searched up to November 16, 2013
to identify eligible cohort studies. The quality of each study was
assessed using the Newcastle-Ottawa Scale (NOS). The association between
RDW, either on admission or at discharge, and HF outcomes (all-cause
mortality [ACM], heart transplantation, cardiovascular mortality, and
rehospitalization, etc.) were reviewed. The overall hazard ratio (HR) for
the effect of RDW on ACM was pooled using a random-effects model, and the
publication bias was evaluated using funnel plots and Eggers' tests.
Seventeen studies, with a total of 18288 HF patients, were included for
systematic review. All eligible studies indicated that RDW on admission
and RDW at discharge, as well as its change during treatment, were of
prognostic significance for HF patients. The HR for the effect of a 1%
increase in baseline RDW on ACM was 1.10 (95% confidence interval:
1.07-1.13), based on pooling of nine studies that provided related data.
However, publication bias was observed among these studies. Conclusions:
HF patients with higher RDW may have poorer prognosis than those with
lower RDW. Further studies are needed to explore the potential mechanisms
underlying this association. 2014 Huang et al.

<13>
Accession Number
2014548406
Authors
Azeka E. Jatene M. Galas F.R.B. Tanamati C. Penha J. Benvenuti L. Miura N.
Junior J.O.C.
Institution
(Azeka, Jatene, Galas, Tanamati, Penha, Benvenuti, Miura, Junior) Heart
Institute (InCor), University of Sao Paulo Medical School, Sao Paulo,
Brazil
Title
Heart transplantation in pediatric population and in adults with
congenital heart disease: Long-term follow-up, critical clinical analysis,
and perspective for the future.
Source
Transplantation Proceedings. 46 (6) (pp 1842-1844), 2014. Date of
Publication: July-August 2014.
Publisher
Elsevier USA
Abstract
Background. Heart transplantation is a treatment option for children as
well as for adults with congenital heart disease. Objective. To report the
experience of a tertiary center with heart transplant program in pediatric
population and in adults with congenital heart disease. Patients and
Methods. The study consisted of the evaluation of pediatric as well as
adult patients undergoing heart transplantation for congenital heart
disease. We evaluated the following indication and complications such as
renal dialysis, graft vascular disease, tumors and survival. Results. From
October 1992 to November 2013, 134 patients had transplantation, and there
were 139 transplantations and 5 retransplantations. The immunosuppression
regimen is based on calcineurin inhibitors and cytostatic drugs. The type
of heart disease indicated for transplantation was cardiomyopathies in 70%
and congenital heart disease in 30%. Of these 134 patients, 85 patients
were alive. Actuarial survival is 77.4%, 69.6%, 59.3% at 1, 5, and 10
years after transplantation. Three patients underwent renal
transplantation, 1 patient is in renal dialysis, and 8.2% of patients had
post-transplant lymphoproliferative disease. Two patients had
retransplantation for graft vascular disease; 1 of them required a
simultaneous kidney transplant and died 30 days after the procedure and 1
patient is clinically well 2 years after retransplantation. Conclusion.
Heart transplantation in children and in adults with congenital heart
disease is a promising therapeutic option and enables long-term survival
for these patients. 2014 by Elsevier Inc. All rights reserved.

<14>
Accession Number
2014548149
Authors
Feng X.D. Wang X.N. Yuan X.H. Wang W.
Institution
(Feng) Shanghai Eastern Hospital, Shanghai, China
(Wang) ShanXi Cardiovascular Hospital, TaiYuan, Shanxi, China
(Yuan) Changzhi Peace Hospital, Changzhi, ShanXi, China
(Wang) Scripps Memorial Hospital, 9850 Genesee Ave, San Diego, CA 92037,
United States
Title
Effectiveness of biatrial epicardial application of amiodarone-releasing
adhesive hydrogel to prevent postoperative atrial fibrillation.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (3) (pp 939-943),
2014. Date of Publication: September 2014.
Abstract
Objective Postoperative atrial fibrillation (POAF) is the most frequent
complication arising after cardiac surgery, occurring in 30% of cases.
Amiodarone is the most effective drug for prophylaxis and treatment.
However, because of significant extracardiac side effects, only high-risk
patients are eligible for prophylactic amiodarone therapy. We performed a
randomized prospective study of 100 patients undergoing cardiac surgery
with epicardial application of amiodarone-releasing hydrogel to determine
the effectiveness of preventing POAF. Methods After institutional review
board approval, 100 patients, from January 2012 to July 2013, who had
undergone cardiac surgery, were randomized to 2 equal groups. The study
group received poly-based hydrogel with amiodarone sprayed diffusely over
the epicardium. The control group underwent the procedure without the
spray. Continuous telemetry monitored for POAF, and amiodarone levels in
the atria, plasma, and tissue were measured postoperatively. Daily
electrocardiographic parameters were measured until postoperative day 14.
Results The incidence of POAF was significantly less in the study group,
with 4 of 50 patients (8%) incurring atrial fibrillation compared with 13
of 50 patients (26%) in the control group (P <.01). The mean amiodarone
concentrations in the atria (12.06 + 3.1) were significantly greater than
those in the extracardiac tissues (1.32 + 0.9; P <.01). The plasma
amiodarone levels remained below the detection limit (<8 mug/mL) during
the 14 days of follow-up. Bradycardia was observed less in the study group
(76 + 29) than in the control group (93 + 18; P <.01). Conclusions
Epicardial application of amiodarone-releasing adhesive hydrogel is a less
invasive, well-tolerated, quick, and effective therapeutic option for
preventing POAF at minimal risk of extracardiac adverse side effects.
2014 by The American Association for Thoracic Surgery.

<15>
Accession Number
2014548143
Authors
Kim K.-B. Hwang H.Y. Hahn S. Kim J.S. Oh S.J.
Institution
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744,
South Korea
(Hahn) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Seoul National
University Bundang Hospital, Seongnam, South Korea
(Oh) Department of Thoracic and Cardiovascular Surgery, Seoul National
University Boramae Hospital, Seoul, South Korea
Title
A randomized comparison of the Saphenous Vein Versus Right Internal
Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial: One-year
angiographic results and mid-term clinical outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 148 (3) (pp 901-908),
2014. Date of Publication: September 2014.
Abstract
Objective The Saphenous Vein Versus Right Internal Thoracic Artery as a
Y-Composite Graft (SAVE RITA) trial was designed to evaluate the
noninferiority of the saphenous vein (SV) compared with the right internal
thoracic artery ([R]ITA) used as a Y-composite graft. Methods A total of
224 patients who had undergone off-pump revascularization for multivessel
coronary artery disease using the SV or RITA as a Y-composite graft based
on the in situ left ITA were assigned randomly to the SV Y-composite graft
(SV group, n = 112) or free RITA Y-composite graft (RITA group, n = 112).
The primary endpoint was the 1-year angiographic patency rate of the
second limb conduits (SV or RITA). Postoperative 1-year coronary
angiograms were performed in 215 patients (SV group, 108; RITA group,
107). Results The overall graft patency rate was 97.4% (745 of 765) at 1
year (97.9% in the SV group vs 96.9% in the RITA group, P =.362). The
primary endpoint of the study, the 1-year patency rate of the SV composite
grafts, was 97.1% (238 of 245) and was noninferior to that of the RITA
composite grafts (97.1% [198 of 204]) with a 95% lower confidence limit of
-2.6% (P <.001 for noninferiority). The graft qualities, evaluated using
the FitzGibbon patency grades, were also similar between the 2 groups (P
=.948). No statistically significant differences were found in the overall
survival rates between the 2 groups at 1 and 4 years (P =.998). Also, no
statistically significant differences were found between the 2 groups in
the freedom from major adverse cardiac and cerebrovascular event rates at
1 and 4 years (P =.597). Conclusions The SV composite grafts were
noninferior to the RITA composite grafts in terms of the 1-year
angiographic patency rates. 2014 by The American Association for Thoracic
Surgery.

<16>
Accession Number
2014550622
Authors
Nguyen B.A.V. Suleiman M.-S. Anderson J.R. Evans P.C. Fiorentino F. Reeves
B.C. Angelini G.D.
Institution
(Nguyen, Anderson, Evans, Fiorentino, Reeves, Angelini) Department of
Cardiothoracic Surgery, Hammersmith Hospital, Imperial College, London,
United Kingdom
(Suleiman) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
(Evans) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
Metabolic derangement and cardiac injury early after reperfusion following
intermittent cross-clamp fibrillation in patients undergoing coronary
artery bypass graft surgery using conventional or miniaturized
cardiopulmonary bypass.
Source
Molecular and Cellular Biochemistry. 395 (1-2) (pp 167-175), 2014. Date of
Publication: October 2014.
Publisher
Kluwer Academic Publishers
Abstract
Myocardial ischemic stress and early reperfusion injury in patients
undergoing coronary artery bypass grafting (CABG) operated on using
intermittent cross-clamp fibrillation (ICCF) are not presently known. The
role of mini-cardiopulmonary bypass (mCPB) versus conventional CPB (cCPB)
during ICCF has not been investigated. These issues have been addressed as
secondary objective of randomised controlled trial (ISRCTN30610605)
comparing cCPB and mCPB. Twenty-six patients undergoing primary elective
CABG using ICCF were randomised to either cCPB or mCPB. Paired left
ventricular biopsies collected from 21 patients at the beginning and at
the end of CPB were used to measure intracellular substrates (ATP and
related compounds). Cardiac troponin T (cTnT) and CK-MB levels were
measured in plasma collected from all patients preoperatively and after 1,
30, 60, 120, and 300 min after institution of CPB. ICCF was associated
with significant ischemic stress as seen by fall in energy-rich phosphates
early after reperfusion. There was also a fall in nicotinamide adenine
dinucleotide (NAD⁺) indicating cardiomyocyte death which was
confirmed by early release of cTnT and CK-MB during CPB. Ischemic stress
and early myocardial injury were similar for cCPB and mCPB. However, the
overall cardiac injury was significantly lower in the mCPB group as
measured by cTnT (mean + SEM: 96 + 14 vs. 59 + 8 mug/l, p = 0.02), but not
with CK-MB. ICCF is associated with significant metabolic derangement and
early myocardial injury. This early outcome was not affected by the CPB
technique. However, the overall cardiac injury was lower for mCPB only
when measured using cTnT. 2014 Springer Science+Business Media.

<17>
[Use Link to view the full text]
Accession Number
2014545155
Authors
Cao C. Tian D.H. Ang S.C. Peeceeyen S. Allan J. Fu B. Yan T.D.
Institution
(Cao, Tian, Ang, Allan, Fu, Yan) Collaborative Research (CORE) Group,
Macquarie University, St. George Hospital, 2 Technology Place, Sydney, NSW
2109, Australia
(Cao) Baird Institute for Applied Heart and Lung Surgical Research, St.
George Hospital, Sydney, Australia
(Cao, Ang, Peeceeyen) Department of Cardiothoracic Surgery, St. George
Hospital, Sydney, Australia
Title
A meta-analysis of endoscopic versus conventional open radial artery
harvesting for coronary artery bypass graft surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 9 (4) (pp 269-275), 2014. Date of Publication: July-August 2014.
Abstract
OBJECTIVE: The radial artery has been demonstrated to provide superior
long-term patency outcomes compared with saphenous veins for selected
patients who undergo coronary artery bypass graft surgery. Recently,
endoscopic radial artery harvesting has been popularized to improve
cosmetic and perioperative outcomes. However, concerns have been raised
regarding the effects on long-term survival and graft patency of this
relatively novel technique. The present meta-analysis aimed to assess the
safety and the efficacy of endoscopic radial artery harvesting versus the
conventional open approach. METHODS: A systematic review of the current
literature was performed on five electronic databases. All comparative
studies on endoscopic versus open radial artery harvesting were included
for analysis. Primary endpoints included mortality and recurrent
myocardial infarction. Secondary endpoints included graft patency, wound
infection, hematoma formation, and paresthesia. RESULTS: Twelve studies
involving 3314 patients were included for meta-analysis according to
predefined selection criteria. There were no statistically significant
differences in overall mortality, recurrent myocardial infarction, or
graft patency between the two surgical techniques. However, patients who
underwent endoscopic harvesting were found to have significantly lower
incidences of wound infection, hematoma formation, and paresthesia.
CONCLUSIONS: Current literature on endoscopic harvesting of the radial
artery for coronary artery bypass graft surgery is limited by relatively
short follow-up periods as well as differences in patient selection and
surgical techniques. In addition, there are currently no randomized
controlled trials to provide robust clinical data. However, the available
evidence suggests that the endoscopic approach is associated with superior
perioperative outcomes without clear evidence demonstrating compromised
patency or survival outcomes. Copyright 2014 by the International Society
for Minimally Invasive Cardiothoracic Surgery.

<18>
Accession Number
2014547974
Authors
Matro R. Daskalakis C. Negoianu D. Katz L. Henry C. Share M. Kastenberg D.
Institution
(Matro, Katz, Kastenberg) Division of Gastroenterology and Hepatology,
Thomas Jefferson University Hospital, Philadelphia, PA, United States
(Daskalakis) Division of Biostatistics, Thomas Jefferson University,
Philadelphia, PA, United States
(Negoianu) Renal, Electrolyte and Hypertension Division, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
(Henry) Department of Internal Medicine, Thomas Jefferson University
Hospital, Philadelphia, PA, United States
(Share) Department of Internal Medicine, Ronald Reagan UCLA Medical
Center, Los Angeles, CA, United States
(Share) Jefferson Medical College, Philadelphia, PA, United States
Title
Randomised clinical trial: Polyethylene glycol 3350 with sports drink vs.
polyethylene glycol with electrolyte solution as purgatives for
colonoscopy - The incidence of hyponatraemia.
Source
Alimentary Pharmacology and Therapeutics. 40 (6) (pp 610-619), 2014. Date
of Publication: September 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Background Polyethylene glycol 3350 plus sports drink (PEG-SD) is a
hypo-osmotic purgative commonly used for colonoscopy, though little safety
data are available. Aim To evaluate the effect of PEG-SD on serum sodium
(Na) and other electrolytes compared with PEG-electrolyte solution
(PEG-ELS). Methods We performed a single center, prospective, randomised,
investigator-blind comparison of PEG-ELS to PEG-SD in out-patients
undergoing colonoscopy. Laboratories were obtained at baseline and
immediately before and after colonoscopy. The primary endpoint was
development of hyponatraemia (Na <135 mmol/L) the day of colonoscopy.
Changes in electrolyte levels were computed as the difference between the
lowest value on the day of colonoscopy and baseline. Purgative tolerance
and efficacy were assessed. Results A total of 389 patients were
randomised; 364 took purgative and had baseline and day of colonoscopy
labs (180 PEG-SD, 184 PEG-ELS). The groups were well matched except for a
higher fraction of women and Blacks in PEG-ELS. Seven patients (3.9%) in
PEG-SD and four patients (2.2%) in PEG-ELS developed hyponatraemia (OR =
1.82, 95% CI: 0.45-8.62, P = 0.376). Changes in electrolytes from baseline
were small but significantly worse with PEG-SD for sodium, potassium and
chloride (P = 0.001, 0.012, 0.001, respectively). Preparation completion,
adverse events, and overall colon cleansing were similar between the
groups, but PEG-ELS had more excellent preparations (52% vs. 30%; P =
0.001). Conclusions Greater, but very modest, electrolyte changes occur
with PEG-SD. Hyponatraemia is infrequent with both purgatives. A
significant increase in hyponatraemia was not identified for PEG-SD vs.
PEG-ELS, but the sample size may have been inadequate to identify a small,
but clinically important difference. 2014 John Wiley & Sons Ltd.

<19>
Accession Number
2014551683
Authors
Sannino A. Gargiulo G. Schiattarella G.G. Brevetti L. Perrino C. Stabile
E. Losi M.A. Toscano E. Giugliano G. Scudiero F. Chiacchio E. Trimarco B.
Esposito G.
Institution
(Sannino, Gargiulo, Schiattarella, Brevetti, Perrino, Stabile, Losi,
Toscano, Giugliano, Scudiero, Chiacchio, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University of Naples, Via Pansini 5, 80131 Naples, Italy
Title
Increased mortality after transcatheter aortic valve implantation (TAVI)
in patients with severe aortic stenosis and low ejection fraction: A
meta-analysis of 6898 patients.
Source
International Journal of Cardiology. 176 (1) (pp 32-39), 2014. Date of
Publication: September 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background There is conflicting evidence regarding the safety and efficacy
of transcatheter aortic valve implantation (TAVI) procedures in patients
with severe aortic stenosis and low left ventricular ejection fraction
(EF). The primary aim of this study was to determine the impact of TAVI on
short- and long-term mortality in patients with low EF (EF < 50%); the
secondary aim was to analyze the impact of TAVI procedure on EF recovery
in the same setting of patients. Methods and results Twenty-six studies
enrolling 6898 patients with severe aortic stenosis undergoing TAVI
procedure were included in the meta-analysis and analyzed for 30-day,
6-month and 1-year all-cause and cardiovascular mortality; a further
meta-analysis was also performed in patients with low EF to assess EF
changes post TAVI. In low EF patients, both all-cause and cardiovascular
short- and long-term mortality were significantly higher when compared to
patients with normal EF (30-day-all-cause mortality: 0.13; 95% confidence
interval [CI]: 0.01 to 0.25, I² = 49.65, Q = 21.85;
1-year-all-cause mortality: 0.25; 95% [CI]: 0.16 to 0.34, I² =
25.57, Q = 16.12; 30-day-cardiovascular mortality: 0.03; 95% [CI]: - 0.31
to 0.36, I² = 66.84, Q = 6.03; 1-year-cardiovascular mortality:
0.29; 95% [CI]: 0.12 to 0.45, I² = 0.00, Q = 1.88).
Nevertheless, in low EF patients TAVI was associated with a significant
recovery of EF, which started at discharge and proceeded up to
1-year-follow-up. Conclusions Patients with low EF severe aortic stenosis
have higher mortality following TAVI compared to normal EF patients,
despite a significant and sustained improvement in EF. 2014 Elsevier
Ireland Ltd. All rights reserved.

<20>
Accession Number
2014551684
Authors
Healy D.A. Khan W.A. Wong C.S. Moloney M.C. Grace P.A. Coffey J.C. Dunne
C. Walsh S.R. Sadat U. Gaunt M.E. Chen S. Tehrani S. Hausenloy D.J. Yellon
D.M. Kramer R.S. Zimmerman R.F. Lomivorotov V.V. Shmyrev V.A. Ponomarev
D.N. Rahman I.A. Mascaro J.G. Bonser R.S. Jeon Y. Hong D.M. Wagner R.
Thielmann M. Heusch G. Zacharowski K. Meybohm P. Bein B. Tang T.Y.
Institution
(Healy, Khan, Wong, Moloney, Grace, Coffey, Dunne) Department of Surgery,
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
(Walsh) National University of Ireland Galway, Ireland
(Sadat, Gaunt) Addenbrooke's Hospital, Cambridge, United Kingdom
(Chen) Central South University, Hunan, China
(Tehrani, Hausenloy, Yellon) Hatter Cardiovascular Institute, University
College London, United Kingdom
(Kramer, Zimmerman) Maine Medical Centre, ME, United States
(Lomivorotov, Shmyrev, Ponomarev) Novosibirsk State Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Rahman, Mascaro, Bonser) Queen Elizabeth Medical Centre, Birmingham,
United Kingdom
(Jeon, Hong) Seoul National University Hospital, Seoul, South Korea
(Wagner) St. Anne's University Hospital, Brno, Czech Republic
(Thielmann, Heusch) University Hospital Essen, Essen, Germany
(Zacharowski, Meybohm) University Hospital Frankfurt, Germany
(Meybohm, Bein) University Hospital Schleswig-Holstein, Kiel, Germany
(Tang) Changi General Hospital, Singapore, Singapore
Title
Remote preconditioning and major clinical complications following adult
cardiovascular surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 176 (1) (pp 20-31), 2014. Date of
Publication: September 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background A number of 'proof-of-concept' trials suggest that remote
ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ
injury in patients undergoing major cardiovascular surgery. To date, few
studies have involved hard clinical outcomes as primary end-points.
Methods Randomised clinical trials of RIPC in major adult cardiovascular
surgery were identified by a systematic review of electronic abstract
databases, conference proceedings and article reference lists. Clinical
end-points were extracted from trial reports. In addition, trial principal
investigators provided unpublished clinical outcome data. Results In
total, 23 trials of RIPC in 2200 patients undergoing major adult
cardiovascular surgery were identified. RIPC did not have a significant
effect on clinical end-points (death, peri-operative myocardial infarction
(MI), renal failure, stroke, mesenteric ischaemia, hospital or critical
care length of stay). Conclusion Pooled data from pilot trials cannot
confirm that RIPC has any significant effect on clinically relevant
end-points. Heterogeneity in study inclusion and exclusion criteria and in
the type of preconditioning stimulus limits the potential for
extrapolation at present. An effort must be made to clarify the optimal
preconditioning stimulus. Following this, large-scale trials in a range of
patient populations are required to ascertain the role of this simple,
cost-effective intervention in routine practice. 2014 Elsevier Ireland
Ltd. All rights reserved.

<21>
[Use Link to view the full text]
Accession Number
2014545088
Authors
Yi G. Shine B. Rehman S.M. Altman D.G. Taggart D.P.
Institution
(Yi, Rehman, Taggart) Oxford Heart Centre, John Radcliffe Hospital,
Oxford, United Kingdom
(Yi) Department of Thoracic and Cardiovascular Surgery, Yonsei University
College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
(Shine) Nuffield Department of Clinical Medicine, University of Oxford,
John Radcliffe Hospital, Oxford, United Kingdom
(Altman) Centre for Statistics in Medicine, University of Oxford, Oxford,
United Kingdom
Title
Effect of bilateral internal mammary artery grafts on long-term survival:
A meta-analysis approach.
Source
Circulation. 130 (7) (pp 539-545), 2014. Date of Publication: 12 Aug 2014.
Abstract
Background-Although the potential survival benefit of bilateral internal
mammary artery (BIMA) grafting in comparison with single internal mammary
artery (SIMA) grafting has been emphasized by many investigators, the use
of BIMA is still low in clinical practice in the absence of randomized
trials and long-term results. In the current study, we aimed to assess if
there is a long-term survival benefit of BIMA up to 10 years after
coronary bypass surgery. Methods and Results-We selected published
articles comparing survival between SIMA and BIMA patients with follow-up
duration of more than a mean of 9 years. We evaluated the log hazard ratio
with 95% confidence interval for included studies by using a
random-effects meta-analysis. Nine eligible observational studies provided
15 583 patients (8270 SIMA and 7313 BIMA) for meta-analysis. Five studies
used propensity score methods for statistical adjustment, 2 with a
propensity score-based patient-matching method and 3 with quintile-based
stratification. A significant reduction in mortality by using BIMA was
observed (hazard ratio, 0.79; 95% confidence interval, 0.75-0.84); no
study showed any significantly harmful effect of BIMA on survival.
Subgroups of studies using different statistical approaches-unmatched,
quintile-based propensity score analysis, and propensity score-based exact
patient matching-all showed the survival benefit of BIMA grafting.
Conclusions-BIMA grafting appears to have better survival with up to 10
years follow-up in comparison with SIMA grafting. Long-term survival
benefit of BIMA seems to continue in the second decade after surgery. An
ongoing randomized trial comparing SIMA and BIMA groups will add evidence
on this issue. 2014 American Heart Association, Inc.

<22>
Accession Number
75007456
Authors
Isella F. Paternoster G. Taddeo D. Martino E. A. Ponschab M. Saleh O.
Lembo R. Ascari R. Gianni S. Belletti A. Zangrillo A.
Institution
(Paternoster) Cardiovascular Anaestesia and Intensive Care San Carlo
Hospital, Potenza, Italy
(Isella, Taddeo, Martino, Saleh, Lembo, Ascari, Gianni, Belletti,
Zangrillo) Irccs San Raffaele Scientific Institute, Milano, Italy
(Ponschab) Ludwig Boltzmann Institute for experimental and clinical
traumatology, Auva Research Centre, Vienna, Austria
Title
Levosimendan in non-cardiac surgery: a systematic review.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
122-123), 2014. Date of Publication: 2014.
Abstract
Introduction. Levosimendan reduces mor-tality in the critically ill [1]
and increases car-diac output with no increase in myocardial oxygen
consumption. It is mostly used in car-diac surgery and heart failure
patients. Even if more than 200 million major non-cardiac surgical
interventions are performed per year worldwide, the use of this drug has
been sel-dom reported in this context. We performed a systematic review to
identify all the manuscripts ever published reporting levosimen- dan
administration in patients undergoing non-cardiac surgery. Methods. An
extensive research of the literature (PubMed, BioMedCentral and Sco-pus)
was performed by trained investigators. Data on surgical setting, dose of
levosimen-dan, postoperative course, and outcome were extracted. Results.
Nine studies (published in 2008-2013) reported the use of levosimendan in
non-cardiac surgery, four of them in vascular surgery. A total of only 46
patients received levosimendan and 10 patients placebo (only one small
randomized trial has been pub-lished so far). Four manuscripts described
emergency procedures. Bolus dose was reported by five authors and
continuous infu-sion (0.1-0.2 g/kg/min) was continued for 12-48 hr. A
significant improvement in the main cardiac function parameters (e.g.
car-diac index) and no 30-day mortality were achieved in the five
manuscripts reporting these data. No haemodynamic complica-tions (e.g.
hypotension) nor major arrhyth-mias were described, with the exception of
a single case of atrial fibrillation with spontaneous reversal.
Discussion. Levosimendan may be a feasible option for the peri-operative
man-agement of high-risk patients undergoing non-cardiac surgery. The
topic merits further attention since only few and small studies previously
investigated the role of levosimen-dan in this setting.

<23>
Accession Number
75007441
Authors
Cassisi C. Chiarenza F. Sanfilippo F. Santonocito C. Astuto M. George S.
Taggart D. Keiralla A.
Institution
(Cassisi, Chiarenza, Sanfilippo, Santonocito, George, Keiralla)
Cardiothoracic Critical Care Unit, Oxford Heart Centre, John Radcliffe
Hospital, Oxford, United Kingdom
(Astuto) School of Anaesthesia and Intensive Care, University of Catania,
Catania, Italy
(Taggart) Cardiothoracic Surgery, Oxford Heart Cen-tre, John Radcliffe
Hospital, Oxford, United Kingdom
Title
Pre-operative fasting and postoperative metabolic response after coronary
artery bypass grafting.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
111-112), 2014. Date of Publication: 2014.
Abstract
Introduction. A prolonged period of preop-erative fasting may worsen the
postopera-tive metabolic response [1]. A meta-analysis showed that it is
safe to shorten pre-operative fasting before elective surgery [2]. We
studied the impact of pre-operative fasting on postoperative levels of
arterial lactate (AL), pH and base excess (BE) since ICU admis sion in
patients undergoing coronary artery bypass grafting (CABG). Methods. This
was a single centre ret-rospective study with one year data collec-tion
(Aug 2012 to Jul 2013) from electronic medical records. Two groups were
analysed: M = morning (1^st case); A = afternoon (2^nd
case). Patients were nil-by-mouth from the midnight before surgery,
regardless the list order. Demographics, comorbidities, logistic
EuroSCORE, ndegree of grafts performed and pre-operative AL, pH and BE
were screened. Data on AL, pH and BE at ICU admission and at 1, 3, 6, 12,
18, 24 h after ICU admission were collected. Patients with pre-operative
haemodynamic support and/or dialysis were excluded. Normal distribution of
data was assessed. Continuous variables are presented as mean + standard
deviation and compared with student's t test for independent samples.
Categorical variables are presented as percentage (%) and analysed with
chi-squared test with Yates's correction. Results. We found 339 patients
(M = 173, 52%; A = 163, 48%). There were no differ-ence in rate of on- vs
off-pump CABG (M = 64.8%, A = 62.0%, p = 0.67). Demographics,
comorbidities and logistic EuroSCORE were not different. Number of grafts
performed was higher in the M group (2.9 + 0.7 vs 2.7 + 0.8; p = 0.03).
There were no differences in the values of pH and BE between the groups at
any time. We found a trend towards higher AL in the M group until the 12th
postopera-tive h: differences were significant at admission (M = 1.75 +
0.9 vs A = 1.43 + 0.6; p < 0.001) and at 3 h (M = 1.70 + 1.1 vs A = 1.46 +
0.8; p = 0.02). Discussion. The length of pre-operative fasting before
cardiac surgery did not affect the level of pH and BE. Lactate level
seemed worse in the CABG patients scheduled 1st on the list. These results
still await confirmation by multi-regression analysis.

<24>
Accession Number
75007401
Authors
Pasin L. Baio S. Tornaghi A. Matsuno J. Redaelli M. B. Maffini A. Putzu A.
Winterton D. Greco T. Bellandi M. Zangrillo A.
Institution
(Pasin, Baio, Tornaghi, Matsuno, Redaelli, Maffini, Putzu, Winterton,
Greco, Bellandi, Zangrillo) IRCCS San Raffaele Scientific Institute,
Milano, Italy
Title
Propofol and survival: a meta-analysis of randomized clinical trials.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
79-80), 2014. Date of Publication: 2014.
Abstract
Introduction. One of the most commonly used hypnotics is propofol, which
is well known to non-anaesthesiologists because of its white colour and to
the large public be-cause of Michael Jackson's death. Propofol is widely
used in different settings because of its characteristics: fast induction,
rapid elimination, short duration of action, smooth recovery from
anaesthesia, few adverse effects, and no teratogenic effects,
charac-teristics that undoubtedly contributed to its popularity. However,
its effect on survival is unknown, with meta-analyses reporting an
increased mortality in cardiac surgical patients receiving a
propofol-based total in- travenous anaesthesia. Furthermore, the
pos-sibility of infections and the "propofol syn-drome" have suggested
that this drug might be dangerous. We decided to carry out a meta-analysis
of all randomized controlled studies ever performed on propofol versus any
comparator in any clinical setting. Methods. Pertinent studies were
independently searched in BioMedCentral, PubMed, Embase, and the Cochrane
Central Register of clinical trials by expert investigators. The following
inclusion criteria were used: random allocation to treatment and
comparison between propofol and any comparator in any clinical setting.
Computations were performed with Stata (release 11, College Station, TX)
and SAS 2002-08 pro-gram (release 9.2, SAS Institute, Inc, Cary, NC).
Outcomes from individual studies were analysed to compute individual and
pooled risk ratio (RR) with pertinent 95% confidence interval (CI), by
means of inverse variance method and with a fixed-effect model. Results.
One hundred and thirty-three studies randomizing 16,026 patients were
included. No difference in mortality be-tween patients receiving propofol
(335/7,758 [4.30%]) versus any comparator (324/8,268 [4.0%]) were observed
in the overall population (RR 1.04, [95% CI 0.92 to 1.18], p = 0.5) and in
several subanalyses. Discussion. In spite of theoretical concerns,
propofol has no detrimental effect on survival according to the largest
meta-analysis of randomized controlled trials ever per-formed on this
hypnotic drug.

<25>
Accession Number
75007399
Authors
Dossi R. Paternoster G. Isella F. Martino E. A. Greco T. Moretti R. Taddeo
D. Winterton D. Barletta A. Pappalardo F. Landoni G.
Institution
(Paternoster) Cardiovascular Anaestesia And Intensive Care San Carlo
Hospital, Potenza, Italy
(Dossi, Isella, Martino, Greco, Moretti, Taddeo, Winterton, Barletta,
Pappalardo, Landoni) IRCCS San Raffaele Scientific Institute, Milano,
Italy
Title
Pre-operative IABP to reduce mortality in CABG surgery: a meta-analysis of
randomized controlled trials.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
78-79), 2014. Date of Publication: 2014.
Abstract
Introduction. Intra-aortic balloon pump (IABP) is routinely used in heart
failure pa-tients undergoing cardiac surgery. However its impact on
clinical outcome is yet a mat-ter of debate. We performed a meta-analysis
of all the randomized controlled trials (RCTs) that investigated the use
of pre-operative IABP in adult high-risk patients undergoing coronary
artery bypass grafting (CABG). Methods. Eligible trials were identified by
searching Medline, Embase, Scopus, ISI Web of Knowledge and the Cochrane
Library. Analysis was performed using STATA 11.0 Software (StataCorp LP,
College Station, TX, USA). The primary endpoint was mortal-ity at the
longest follow-up available and the secondary endpoint was 30-days
mortality. Results. Eight pertinent RCTs were identi-fied and included in
the meta-analysis, for a total of 625 enrolled patients (312 assigned to
receive IABP and 313 controls). Pre-op-erative IABP implantation was found
to be associated with a significant reduction in mortality risk (11 of 312
[3.5%] in the IABP group versus 33 of 313 [11%] in the control group, RR
0.38 [95% CI 0.20-0.73], p for effect = 0.004, p for heterogeneity = 0.7,
I² = 0). The benefit on mortality reduction was confirmed when
restricting the analysis to tri-als with low risk of bias, to those
reporting 30-days follow up and to patients undergo-ing on-pump CABG
surgery. Discussion. Prophylactic intra-aortic bal-loon pump can reduce
peri-operative and 30-days mortality in high-risk patients under-going
coronary artery bypass grafting.

<26>
Accession Number
75007398
Authors
Lightfoot N. J. Hastings S. L. Jerath A. Wasowicz M. Beattie W. S.
Institution
(Lightfoot, Hastings, Jerath, Wasowicz, Beattie) Department of
Anaesthesia; University of Toronto, Toronto, ON, Canada
Title
Does volatile anaesthetic exposure lead to an improvement in patient
outcome after cardiac surgery: a meta-analysis.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
77-78), 2014. Date of Publication: 2014.
Abstract
Introduction. Cardiac surgery is associated with myocardial ischaemia and
the release of cardiac enzymes. The use of volatile anaesthetics may
reduce myocardial damage but randomized studies have shown conflict-ing
Results. We have conducted an updated review to determine if volatile
anaesthetic exposure leads to an alteration in troponin levels and
optimization of cardiac outcomes compared with an intravenous anaesthetic
control. Methods. Institutional approval was ob-tained prior for the
conduct of this analysis. The full protocol conformed to the PRISMA
guidelines for meta-analysis design. PubMed, clinicaltrials.gov and the
Cochrane Library databases were searched with limita-tion to prospective
randomized trials. There were no restrictions in the language or date of
publication. Trial quality was assessed using Eggers methodology. The
outcome variables were blood troponin, cardiac in-dex and mortality at 30
days. Analyses were completed with REVMAN5 software on an intention to
treat basis. Heterogeneity was assessed with the I2 statistic with a value
of > 75% regarded as high. Publication bias was assessed through the use
of the funnel plot. Results. A literature search identified 59 studies
enrolling 5687 patients. Overall volatile anaesthetic exposure was
associated with a reduction in troponin values (Table 1). A sub-group
analysis for troponin T did not meet criteria for statistical significance
(p = 0.23). Cardiac indices in the volatile exposed group were elevated
after the ischaemic insult until 12 h postoperatively compared to
intravenous controls. There was no differ-ence in 30 day mortality (Odds
Ratio 0.75 [0.44-1.29]). The I² values were elevated indicating
heterogeneity between studies. Funnel plot review revealed significant
publications bias with a lack of negative studies. Discussion. Our data
revealed that vola-tile anaesthetic exposure corresponds to lower troponin
values and an increase in postoperative cardiac indices. This was not
associated with any significant change in postoperative mortality. There
were signifi-cant differences between studies which cannot be explained by
random chance alone. Publication bias also exists with a distinct lack of
negative publications.

<27>
Accession Number
75007366
Authors
Hogan M. Needham A. Ortmann E. Bottrill F. Besser M. Klein A.
Institution
(Hogan, Needham, Bottrill, Besser, Klein) Papworth Hospital, Cambridge,
United Kingdom
(Ortmann) Kerckhoff Klinic, Bad Nauheim, Germany
Title
A randomized controlled trial of the effect of concentrating residual
cardiopulmonary bypass blood using Hemosep on patient haematocrit after
cardiac surgery.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
51-52), 2014. Date of Publication: 2014.
Abstract
Introduction. Re-transfusion of residual pump blood at the end of
cardiopulmonary bypass (CPB) is currently recommended as a blood
conservation strategy after cardiac surgery [1]. Hemosep is a cell salvage
device, designed to ultra-filter residual CPB blood. The blood is
introduced into the device, concentrated using the membrane controlled
superabsorber process, and transfused back to the patient. The aim of this
study was to determine if concentration of residual CPB blood using
Hemosep was associated with raised patient haematocrit compared with
standard re-transfusion of CPB blood. Methods. After formal ethical
approval and written consent, 47 adult patients under-going primary
coronary bypass graft, valve, or combined graft and valve surgery using
CPB were randomized to have residual CPB blood treated with Hemosep or
not, before it was re-transfused. Data are reported as mean (standard
deviation), and analysed for significance using student's t-test. Results.
The quantity of residual CPB blood collected was not different between
groups (768 [189] ml and 797 [245] ml, p = 0.66). Treatment with Hemosep
for a fixed 20 minute period significantly reduced the volume of blood
from 797 (245) ml to 624 (257) ml (p = 0.04), and effectively raised the
haematocrit of the residual CPB blood (26 [4]% to 31 [5]%, p = 0.002), n =
20. Patient haematocrit after re-transfusion was however not significantly
different between either standard (30 [3]%, n = 27), or Hemosep (31 [4]%,
n = 20), treated groups. Discussion. Hemosep reduced the volume of
residual CPB blood, leading to a concentration effect of around 20%.
However this was not associated with increased patient haematocrit
compared with current standard practice of simply re-transfusing the
residual blood. The concentration effect is insufficient to result in
raised patient haematocrit after cardiac surgery with CPB.

<28>
Accession Number
75007346
Authors
Mouton R. Pollock J. Soar J. Mitchell D. Rogers C.
Institution
(Mouton, Soar, Mitchell) North Bristol NHS Trust, Bristol, United Kingdom
(Pollock) University of the West of England, Bristol, United Kingdom
(Rogers) University of Bristol, Bristol, United Kingdom
Title
Remote ischaemic preconditioning for elective abdominal aortic aneurysm
(AAA) repair: a randomized controlled trial to assess feasibility.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
35), 2014. Date of Publication: 2014.
Abstract
Introduction. Remote ischaemic preconditioning (RIC) is a brief episode of
ischaemia-reperfusion with a limb tourniquet that protects against a
subsequent longer ischaemic insult. Small clinical trials demonstrated it
can protect organs during cardiovascular surgery. This study investigated
the feasibility of RIC in elective AAA surgery, a specialty that is
undergoing significant organizational change, to inform the design of a
large RCT. Methods. Consecutive patients presenting for elective AAA
repair (using the open or EVAR approach) were assessed for eligibility.
Consented patients were randomized to receive either RIC (three cycles of
5 min ischaemia and 5 min reperfusion in the upper arm immediately before
surgery) or a sham procedure. Blood samples to measure serum creatinine
and troponin levels were taken after surgery and on the first 2
post-operative days. Patients were followed-up for 6 months. We assessed
the practicability and acceptability of the intervention, and success of
blinding through interviews with patients and staff. A study in 60
participants (30 Open and 30 EVAR procedures), was considered sufficient
to provide recruitment estimates with adequate precision to inform a
larger definitive trial; e.g. 50% eligible patients recruited (worse-case
scenario) would be estimated with a 95% confidence interval of + 13%. The
study was not powered to compare outcomes between the RIC and sham groups.
Results. Ninety-eight patients underwent surgery during the study period,
93 were screened for the trial, and 84 were eligible to take part. Of
these 70 were approached and 69 patients consented to participate.
Thirty-four participants were randomized to RIC and 35 to a sham
procedure. By chance, the complexity of EVAR surgery was higher in the RIC
group. Overall, 28/69 participants (41%) had acute kidney injury (AKI)
following surgery. In the majority of cases the injury was graded as AKIN
1 (16 participants, 23%). AKI occurred more frequently in the RIC group
(47% vs. 34%). Cardiac events were also more common in the RIC group (MI
15% vs.6%; new arrhythmias 21% vs. 14%; Troponin T > 14 ng/l 47% vs. 29%).
There were 3 deaths, one in the RIC group and 2 in the sham group. Post
procedure interviews indicated that patients and staff remained blinded to
the allocation and that the procedure was acceptable. There were no
adverse events secondary to the intervention. Discussion. This study
provides essential information for the planning and design of a
multi-centre RCT to assess the effectiveness of RIC for improving clinical
outcomes for patients having elective AAA surgery. Consent was high and
the RIC intervention can be carried out with minimal disruption to
clinical care and the time taken for anaesthetic or surgical procedures.

<29>
Accession Number
75007343
Authors
Pota V. Schiavone V. Pescatore G. Allocca S. Cantiello A. Bonis C. D. Maio
S. D. Lorenzo A. D. Ferrone O. Giordano S. Passannanti T. Pepino P.
Sferragatta V. Ventriglia V. Vosa P. Schiavone S.
Institution
(Pota, Schiavone, Pescatore, Allocca, Cantiello, Bonis, Maio, Lorenzo,
Ferrone, Giordano, Passannanti, Pepino, Sferragatta, Ventriglia, Vosa,
Schiavone) Pinetagrande Private Hospital, Castelvolturno, Italy
Title
Double-lumen tube vs. video-assisted Cohen blocker for mini-invasive
mitral valve surgery.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
32-33), 2014. Date of Publication: 2014.
Abstract
Introduction. Mini-invasive mitral valve surgery is one of heart surgical
procedures requiring single lung ventilation. The most commonly used
devices are the doublelumen tube (DLT) and different models of
endobronchial blockers. The aim of this randomized controlled study was to
compare the efficacy and the safety of Cohen endobronchial Blocker (CB)
placed with Et-view vs. DLT in mini-invasive mitral valve surgery.
Methods. After Ethics Committee approval and informed written consent 30
patients undergoing elective mini-invasive mitral valve surgery via right
mini-thoracotomy were included. Exclusion criteria were age < 18, ASA IV
or patients with a suspected difficult airway. The patients were randomly
allocated into two groups: DLT and CB. The DLT group were intubated with a
left-side DLT using conventional laryngoscopy. The CB group were intubated
with an Et-view tube and then the Cohen endobronchial blocker was placed
into the right bronchus under continuous bronchial vision. Efficacy
parameters were: time to initial tube placement (TIP); the incidence of
displacement; the time to correct replacement; the grade of satisfaction
of surgeons on lung collapse and the grade of difficulty in using the
devices. Results. The placement of DLTs was faster than CBs (TIP: 85 sec +
35 vs. 130 + 95 sec). After posturing patients into the correct surgical
position there were 2 cases of dis- placement of the DLT with the
necessity of fibreoptic broncoscopy (mean time 185 sec) vs. 1 in the CB
group which was immediately resolved with the Et-view (mean time 40 sec).
There was no difference in the grade of satisfation of surgeons. The
degree of difficulty (DLT vs. CB) for anaesthesiologists was very easy in
50% vs. 66%; easy 15% vs. 33%; medium 2% vs 10%; worse 13% vs 5%. All the
patients were then trasferred to UTI but in the DLT group patients it was
necessary to change to a single tracheal tube for the DLT to facilitate
respiratory weaning. Discussion. Although time for intubation was longer
in the CB group, there was a minor incidence of displacement and more
rapid replacement of CB, thanks to Et-view. The efficacy of single lung
ventilation was the same. There were also advantages of Et-view CB in
cases of unsuspected difficult airway. Moreover after heart surgery with
the necessity of progressive awakening and weaning in the UTI, the DLT has
to be changed to a normal single lumen tube. So Et-view CB can be
considered a valid alternative devices for mini-invasive mitral valve
surgery.

<30>
Accession Number
75007335
Authors
Elmi-Sarabi M. Deschamps A. Delisle S. Lamarche Y. Ased H. Perrault L. P.
Lambert J. Denault A. Y.
Institution
(Elmi-Sarabi, Deschamps, Lamarche, Ased, Perrault, Lambert, Denault)
Montreal Heart Institute, Montreal, QC, Canada
(Delisle) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
Title
Inhalation agents for the treatment of pulmonary hypertension in patients
undergoing cardiac surgery: a systematic review and meta-analysis.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
26), 2014. Date of Publication: 2014.
Abstract
Introduction. In the context of cardiac surgery, pulmonary hypertension
(PH) is an important prognostic factor associated with increased morbidity
and mortality, with an impact on survival mainly through its effects on
right ventricular function. Optimal perioperative management is therefore
essential to ensure the best postoperative Results. Intravenous
vasodilators play an important role in the management of PH, but their
lack of specificity for the pulmonary circulation often limits their use
because of their systemic hypotensive effects. The introduction of inhaled
nitric oxide (iNO) as a selective pulmonary vasodilator has been a major
advance in the treatment of PH, but treatment with iNO is expensive.
Consequently, other inhaled pulmonary vasodilators, such as prostacyclin
and milrinone, have been investigated as alternatives. In this study, we
performed a meta-analysis to determine the effectiveness of inhaled agents
compared to intravenously administered agents or a placebo in the
treatment of PH during cardiac surgery. Additionally, using subgroup
analysis, we explored the efficacy among inhaled agents, divided between
iNO and non-iNO alternatives. Methods. We performed a systematic review
and meta-analysis of randomized controlled trials. Studies were identified
in MEDLINE, CENTRAL, EMBASE, The Web of Knowledge and ClinicalTrials.gov.
databases from inception to February 02, 2013. From 629 studies retrieved,
9 articles comprising a total of 323 patients were included in the
meta-analysis. Primary outcome was haemodynamic stability and secondary
outcomes were length of stay in-hospital, length of stay in the intensive
care unit, and mean dose of inotropes and vasopressor agents. Results.
Overall, inhaled agents were associated with a significant decrease in
pulmonary vascular resistance (p = 0.02), central venous pressure (p =
0.04) and transpulmonary gradient (p = 0.002) and a significant increase
in cardiac index (p = 0.03) and mean arterial pressure (p = 0.005). No
statistically significant difference was observed regarding other outcomes
evaluated. The use of iNO was associated with a significant increase in
mean arterial pressure compared with non-iNO inhaled agents (p = 0.0003).
No other differences were observed between the groups. Discussion. The
administration of inhaled agents for the treatment of PH during cardiac
surgery is associated with a greater decrease in pulmonary vascular
resistance and fewer systemic haemodynamic side effects compared to
intravenously administered agents. Additionally, although non-iNO inhaled
vasodilators seem as promising cost effective alternatives, their efficacy
compared to iNO requires further study based on randomized controlled
clinical trials.

<31>
Accession Number
75007334
Authors
Fonteyne I. Herck I. Lierde F. V. Cruyenaere J. D.
Institution
(Fonteyne, Herck, Lierde, Cruyenaere) Ghent University Hospital, Ghent,
Belgium
Title
Analgesia for chest drain removal in children after cardiac surgery:
sevoflurane vs. ketamine.
Source
Applied Cardiopulmonary Pathophysiology. Conference: 29th Annual Meeting
of the European Association of Cardiothoracic Anaesthesiologists, EACTA
2014 and 14th International Congress on Cardiovascular Anesthesia, ICCVA
2014 (29)Italy. Conference Start: 20140917 Conference End: 20140919
Sponsor: Abbott Vascular, abbvie, CSL Behring, Edwards Lifesciences, GE
Healthcare, Philips Healthcare, MEDICA-Gruppe, Quartier ad fontes musica.
Conference Publication: Rameshkumar B.S., Manners J. (146 pages). 18 (pp
25), 2014. Date of Publication: 2014.
Abstract
Introduction. Standard postoperative analgesia in the paediatric cardiac
intensive care unit comprises paracetamol, ibuprofen and morphine. During
painful procedures this may be supplemented with sevoflurane or ketamine
(not routinely). This prospective, randomized controlled trial aimed to
determine whether standard analgesia is adequate for chest drain removal
in awake, non-ventilated children and whether the addition of sevoflurane
or ketamine can enhance comfort and pain relief. Methods. Following ethics
committee approval and informed consent 51 children under the age of 14
were randomized into 3 groups. Group 1 received the standard analgesia
alone, group 2 received standard and sevoflurane (6% start) and group 3
standard and ketamine (1 mg/kg). The primary endpoints were pain and
comfort measured by the Comfort B Score and VAS observation scale.
Secondary endpoints were changes in blood pressure and heart rate, and
potential side effects. Results. There were no significant differences in
the number of drains, consumption of standard analgesics or baseline
comfort B score across all groups. In the standard group there was a
significant rise of the Comfort B to a mean of 22 indicating severe
discomfort. In the sevoflurane group it decreased to a mean of 8
indicating oversedation (p < 0.05). Comfort B in the ketamine group
remained within the limits of comfort. The mean blood pressure rose
significantly in the standard and ketamine groups (30 and 11% resp; p <
0.001), and dropped significantly by 18.9% in the sevoflurane group. The
heart rate increased significantly in the standard and ketamine groups
(17.8 and 6.3% resp; p < 0.05); in the sevoflurane group there was a
non-significant drop (4%). Discussion. This study suggests that standard
postoperative pain relief using a combination of paracetamol, ibuprofen
and morphine is inadequate during painful procedures. The use of
sevoflurane appears to cause oversedation and haemodynamic instability,
whereas the addition of ketamine to the standard pain medication provides
sufficient comfort whilst maintaining cardiorespiratory stability.

<32>
Accession Number
71598084
Authors
Rao S. Thompson K. Thomas R. Rath N. Choong C.
Institution
(Rao, Thompson, Thomas) Department of neonatology, Princess Margaret
Hospital for Children, Perth, WA, Australia
(Rath, Choong) Department of endocrinology, Princess Margaret Hospital for
Children, Perth, WA, Australia
(Rao, Thompson, Thomas) Department of neonatology, King Edward Memorial
Hospital for Women, Perth, WA, Australia
Title
Evaluating and managing relative adrenal insufficiency in neonates:
Evidence based guidelines.
Source
Journal of Paediatrics and Child Health. Conference: 18th Congress of the
Perinatal Society of Australia and New Zealand, PSANZ 2014 Perth, WA
Australia. Conference Start: 20140406 Conference End: 20140409. Conference
Publication: (var.pagings). 50 (pp 62), 2014. Date of Publication: April
2014.
Publisher
Blackwell Publishing
Abstract
Background: To establish guidelines for evaluating relative adrenal
insufficiency (RAI) in neonates. Methods: A systematic review of the
neonatal literature. GRADE guidelines were used to rate the quality of
evidence and to grade the strength of recommendations. Results: 50 studies
were included; majority were observational yielding conflicting results.
On GRADE system, the quality of evidence was low to moderate and hence the
strength of recommendations weak. The following guidelines appear
reasonable a) RAI can occur in sick neonates with vasopressor resistant
hypotension, severe HMD, meconium aspiration syndrome, congenital
diaphragmatic hernia, sepsis and post-cardiac surgery b) Low dose (1 mcg,
IV) ACTH test appears to be useful in diagnosing RAI c. Cortisol levels
are to be estimated at baseline, 30 and 60 minutes after ACTH; d. Basal
levels of <15 mcg/dL (414 nmol/L) and/or cortisol (peak minus baseline)
after ACTH of <9 mcg/dL (250 nmol/L) could be considered evidence of RAI.
e) The treatment of RAI is with hydrocortisone 1 mg/kg, 6 to 8 hourly for
the least possible duration. f. Once, patients recover and are off
hydrocortisone, it is important to rule out permanent pituitary or adrenal
diseases; for this the standard dose of ACTH (250 mcg/1.73 m²
IM) is preferable because low dose has the potential to spuriously
overdiagnose adrenal insufficiency in healthy patients. Cortisol< 550
nmol/L (20 mcg/dl) at 30 or 60 minutes of age can be considered as
suboptimal response. Conclusions: Guidelines for diagnosis and management
of RIA in critically ill neonates have been provided.

<33>
Accession Number
71600009
Authors
Moza A.K. Stoppe C. Stevanovic A. Hatam N. Menon A. Rex S. Goetzenich A.
Autschbach R.
Institution
(Moza, Hatam, Menon, Goetzenich, Autschbach) Uniklinik RWTH Aachen, Klinik
fur Thorax-, Herz- und Gefas-Chirurgie, Aachen, Germany
(Stoppe) Uniklinik RWTH Aachen, Institut fur Biochemie und molekulare
Zellbiologie, Aachen, Germany
(Stoppe, Stevanovic) Uniklinik RWTH Aachen, Klinik fur Anasthesiologie,
Aachen, Germany
(Rex) University Hospitals Leuven, KU Leuven, Department of
Anesthesiology, Leuven, Belgium
Title
Perioperative whole blood levels of selenium in patients undergoing
off-pump cardiac surgery: A randomized controlled study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 43. Jahrestagung der
Deutschen Gesellschaft fur Thorax-, Herz- und Gefachirurgie Freiburg
Germany. Conference Start: 20140209 Conference End: 20140212. Conference
Publication: (var.pagings). 62 , 2014. Date of Publication: January 2014.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Cardiac surgery is frequently accompanied by an increase of
oxidative stress, resulting in a significant reduced antioxidant (AOX)
capacity, which is associated with postoperative inflammation, development
of organ dysfunction and increased mortality. Given the pivotal role of
selenium (Se) as an essential co-factor of various antioxidant enzymes and
the previously shown decrease of selenium during cardiac surgery, we
evaluated the time course of selenium levels in patients undergoing
off-pump surgery. Methods: In this prospective, randomized, observational
study, 40 patients (67+10 yrs) scheduled for elective coronary artery
bypass grafting (CABG) were randomly assigned to undergo either on-pump or
off-pump surgery. Clinical relevant data and circulating whole blood
levels of selenium, oxidative stress and perioperative inflammation were
measured at predefined perioperative time points. Results: When compared
to baseline, intraoperative Se decrease was most pronounced in the on-pump
group (on-pump: 31.23+13.60% vs. OPCAB: 20.23+16.34%; p=0.026), whereas
the inflammatory response was comparable in both groups. In all patients,
circulating Se-levels showed a negative correlation to perioperative
inflammation (interleukin-6: r=-0.628; p=0.000), which was comparable
between the two study groups. Moreover, whole blood levels of Se
correlated with the measured markers for antioxidant capacity
(glutathionperoxidase: r=0.720; p=0.000) and oxidative stress (asymmetric
dimethylarginine levels: r=0.244; p=0.011), whereas the latter was
significantly higher in the on-pump group. Se levels showed a negative
correlation to the extent of myocardial damage (CK-MB: r=-0.571; p=0.000).
Furthermore, low postoperative selenium levels in patients undergoing
off-pump surgery were predictive for the development of postoperative
complications (area under the curve (AUC)=0.711;p=0.037). Conclusions:
Patients undergoing off-pump cardiac surgery exhibited a less pronounced
decrease of selenium in comparison to on-pump procedure. Postoperative
selenium levels were predictive for the development of postoperative organ
dysfunctions.

<34>
Accession Number
71599888
Authors
Emontzpohl C. Stoppe C. Goetzenich A. Kraemer S. Bernhagen J. Autschbach
R.
Institution
(Emontzpohl, Stoppe, Kraemer, Bernhagen) Uniklinik RWTH Aachen, Institut
fur Biochemie und Molekulare Zellbiologie, Aachen, Germany
(Stoppe) Uniklinik RWTH Aachen, Klinik fur Anasthesiologie, Aachen,
Germany
(Goetzenich, Kraemer, Autschbach) Uniklinik RWTH Aachen, Klinik fur
Thorax-, Herz- und Gefas-Chirurgie, Aachen, Germany
Title
The effects of xenon and sevoflurane anesthesia on perioperative release
of macrophage migration inhibitory factor (MIF), stromal cell-derived
factor 1alpha (SDF-1alpha) and recruitment of immune cells in cardiac
surgical patients in a randomized controlled trial.
Source
Thoracic and Cardiovascular Surgeon. Conference: 43. Jahrestagung der
Deutschen Gesellschaft fur Thorax-, Herz- und Gefachirurgie Freiburg
Germany. Conference Start: 20140209 Conference End: 20140212. Conference
Publication: (var.pagings). 62 , 2014. Date of Publication: January 2014.
Publisher
Georg Thieme Verlag
Abstract
Introduction: An increasing body of evidence suggests inhalative
anesthetics like sevoflurane to trigger a cytokine release with influence
on the immune reaction. Only little is known about the anesthetic xenon
and its influence on cytokine release of macrophage migration inhibitory
factor (MIF) and stromal cell-derived factor 1alpha (SDF-1alpha), which
are known to mediate the migration of immune- and endothelial progenitor
cells (EPC). Our aim was to compare the influence of two anesthetics
(xenon vs. sevoflurane) on the secretion of the cytokines macrophage
migration inhibitory factor (MIF) and stromal cell-derived factor 1alpha
(SDF-1alpha) in patients that underwent cardiac surgery. Methods: Twenty
patients undergoing elective coronary artery bypass grafting were enrolled
in this randomized, single blind controlled trial. Patients were
randomized to receive balanced general anesthesia with either xenon (45-50
vol%) or sevoflurane (1-1.4 vol%). Subsequently, sandwich-ELISAs were
performed to measure the serum levels of the cytokines MIF and SDF-1alpha
at three different time points: pre-operative (baseline value),
intra-operative (2 min after opening of cross-clamp=onset of reperfusion)
and post-operative (24 h after admission to ICU). The migration of immune
cells (peripheral blood mononuclear cells) was measured by a chemotaxis
assay with the sera as chemoattractant. Results: We found an
intra-operative increase for both cytokines in both groups. There was no
difference in the intra-operative MIF secretion between xenon and the
sevoflurane group. Patients in the xenon group showed a significant higher
SDF-1alpha concentration compared to sevoflurane (851 pg/ml vs 475 pg/ml,
p<0.05). Accordingly the migration of PBMCs indicated a higher migration
towards sera in the xenon group (p=0.112). This difference decreased
post-operatively, but still showed a strong trend (938 pg/ml vs 662 pg/ml,
p=0.054). Discussion: Xenon anesthesia leads to a moderately inflammatory
response in cardiac surgical patients that is comparable to the
well-established anesthetic sevoflurane. Present results showed
significantly elevated SDF-1alpha levels in the xenon group, which was
associated with an enhanced migration of PBMCs. Given the role of
SDF-1alpha as potent chemokine, further studies are needed to investigate
the influence of xenon (and other anesthetics) on the migration of other
immune cells and the resulting effects on outcome of patients.

<35>
Accession Number
71599736
Authors
Heilmann C. Fritzsche K. Beyersdorf F. Leonhart R. Imbery C. Starke S.
Bigot G. Feuchtinger J. Siepe M.
Institution
(Heilmann, Beyersdorf, Starke, Bigot, Siepe) Universitats-Herzzentrum
Freiburg - Bad Krozingen, Klinik fur Herz- und Gefaschirurgie, Freiburg,
Germany
(Fritzsche) Universitatsklinikum Freiburg, Abt. fur Psychosomatische
Medizin und Psychotherapie, Freiburg, Germany
(Leonhart) Albert-Ludwigs-Universitat Freiburg, Institut fur Psychologie,
Freiburg, Germany
(Imbery) Universitats-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen,
Germany
(Feuchtinger) Universitatsklinikum Freiburg, Stabsstelle Qualitat und
Entwicklung in der Pflege, Freiburg, Germany
Title
Short-term intervention to reduce anxiety before artery coronary bypass
surgery-A randomised controlled study.
Source
Thoracic and Cardiovascular Surgeon. Conference: 43. Jahrestagung der
Deutschen Gesellschaft fur Thorax-, Herz- und Gefachirurgie Freiburg
Germany. Conference Start: 20140209 Conference End: 20140212. Conference
Publication: (var.pagings). 62 , 2014. Date of Publication: January 2014.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Anxiety is experienced by most patients who face CABG.
Patients with high preoperative anxiety suffer more often postoperative
adverse events. According to a recent survey, 62% of cardiosurgical
patients would appreciate preoperative psychosocial support. Therefore, we
tested an anxiety-reducing intervention that is applicable to CABG
patients even in the evening before surgery. Methods: We included 253
adult patients (208 male, 45 female) who were admitted for planned CABG.
Following the preoperative information by surgeon and anaesthetist and
after giving informed consent, patients were randomized to intervention
(n=139) or control (n=114). They completed the STOA questionnaire
(State-Trait Operation Anxiety) and a visual analog scale for current
anxiety (T0). State anxiety (STOA-S, 10 items) describes cognitive and
affective components of situational anxiety, trait anxiety depends on the
personality. The intervention consisted of a 30 minute dialog with a
trained nurse containing information on surgery and postoperative care and
emotional support with respect to the specific anxieties of the patient.
Control patients received usual information only. The primary endpoint was
state anxiety (STOA-S, anxiety scale) after the intervention at the
evening before surgery (T1). Secondary end points were time on intensive
care unit (ICU), in-hospital mortality and postoperative need for
analgetics and antiphlogistics on day 5 postop (T2). Results: There were
no differences between intervention and control group with regard to
anxiety or clinical and demographic data at T0. The intervention resulted
in significantly different changes between the groups at T1. Values for
cognitive anxiety fell from 10.4 at T0 to 9.1 at T1 in the intervention
group and from 11.1 to 10.5 in the control group (p=0.008 between groups
for difference T0-T1). Affective anxiety changed from 10.0 at T0 to 8.4
after intervention and from 10.0 to 10.1 in control patients (p=0.004).
Anxiety scale values sank from 3.5 to 2.8 in the intervention group and
from 3.7 to 3.4 in the control group (p=0.004 between groups T0-T1). A
strong influence of trait anxiety was found. The groups did not differ in
time on ICU, in-hospital mortality and postoperative need for medication
at T2. Conclusion: Medical information and professional emotional support,
both focussing on the patients' specific concerns, can help to reduce
preoperative situational fear even at the evening before CABG.

<36>
Accession Number
71599558
Authors
Holland B.J. Myers J.A. Woods Jr. C.R.
Institution
(Holland, Myers, Woods Jr.) University of Louisville, School of Medicine,
Louisville, KY, United States
Title
Prenatal diagnosis of complex congenital heart disease results in
decreased risk of death from cardiovascular compromise prior to planned
cardiac surgery: A meta-analysis.
Source
Journal of the American Society of Echocardiography. Conference: 25th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2014 Portland, OR United States. Conference Start: 20140620 Conference
End: 20140624. Conference Publication: (var.pagings). 27 (6) (pp B73),
2014. Date of Publication: June 2014.
Publisher
Mosby Inc.
Abstract
Background: Most studies looking at surgical and hospital outcomes have
not shown improved survival following prenatal diagnosis of congenital
heart disease made by fetal echocardiography. However, these studies have
been limited by selection bias, small numbers of preoperative deaths, and
heterogeneous patient populations. A meta-analysis was performed in an
attempt to overcome the limitations of individual studies and to determine
if prenatal diagnosis improves the chance that a patient will survive to
undergo planned cardiac surgery. Methods: A review of the medical
literature identified five studies which met the following criteria: 1.
Compared outcomes between groups of newborns with prenatal and postnatal
diagnosis of complex congenital heart disease, 2. Contained the same
anatomic diagnosis in each group, 3. Provided detailed information on
cardiac anatomy, and 4. Included detailed information on the pre-operative
cause of death. A meta-analysis was performed to assess differences in
preoperative mortality rates between newborns with a prenatal diagnosis
versus postnatal diagnosis. Patients with established risk factors for
increased mortality and those whose families chose comfort care were
excluded. Results: In patients with comparable anatomy, standard risk, and
a parental desire to treat, newborns with a prenatal diagnosis of complex
congenital heart disease made by fetal echocardiography were significantly
less likely to die prior to planned cardiac surgery compared to newborns
with a postnatal diagnosis (n = 0, 0.0% vs. n = 30, 3.5%; p = 0.013). All
of the deaths in standard risk patients prior to planned cardiac surgery
were due to cardiovascular compromise. Conclusions: When focusing on the
newborns most likely to benefit from treatment for their complex
congenital heart disease, those whose families want to pursue treatment
and who do not have additional high risk factors, there is evidence of
improved preoperative survival in patients with a prenatal diagnosis made
by fetal echocardiography. Further study and efforts to improve prenatal
screening and diagnosis of congenital heart disease should be considered.

<37>
Accession Number
71596855
Authors
Esposito E. Hollander J.E. Ryan R.J. Schreiber D. O'Neil B.J. Jackson R.E.
Christenson R. Gibler W.B. Lindsell C.
Institution
(Esposito, Hollander, Ryan, Schreiber, O'Neil, Jackson, Christenson,
Gibler, Lindsell) University of Pennsylvania School of Medicine,
University of Cincinatti College of Medicine, Stanford University
Hospital/Kaiser Permanente Medical Center, Wayne State University/Detroit
Medical Center, University of Maryland
Title
Predictors of 30-day cardiovascular events in patients with prior
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG).
Source
Academic Emergency Medicine. Conference: 2010 Annual Meeting of the
Society for Academic Emergency Medicine, SAEM 2010 Phoenix, AZ United
States. Conference Start: 20100603 Conference End: 20100606. Conference
Publication: (var.pagings). 17 (pp S161), 2010. Date of Publication: May
2010.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Risk stratification of patients with potential acute coronary
syndrome (ACS) is difficult. Patients with prior revascularization with
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) are considered higher risk, but they can also have
symptoms from noncardiac causes. We evaluated whether presenting clinical
characteristics were predictive of an increased risk of 30-day
cardiovascular (CV) events in patients with prior revascularization
presenting to the emergency department (ED) with symptoms of potential
ACS. Methods: We conducted a secondary analysis of the Disposition
Impacted by Serial Point of Care Markers in Acute Coronary Syndromes
(DISPO-ACS) study, a 2000 patient, four-site, randomized controlled trial
that evaluated point-of-care cardiac markers. Data included demographics,
history, presenting symptoms, lab and ECG results, hospital course, and
30-day CV events (death, AMI, revascularization). The association between
presenting characteristics and 30-day CV events was assessed using
univariable and multivariable logistic regression; odds ratios (OR) with
95% confidence intervals are given. Results: Of the 2000 pts enrolled, 611
had prior revascularization (538 PCI, 232 CABG, 159 both). They had mean
age of 66+/-14 years; 44% female; 22% black. By 30-days, 101 pts (17%) had
CV events (81 during index visit, 20 during follow up). There were 13
deaths, 34 AMIs, and 74 revascularizations within 30 days; 20 had multiple
endpoints. Being male (OR, 1.67; 1.07-2.62), being nonblack (1.95;
1.07-3.56), having a family history of CAD (2.09; 1.32- 3.3), elevated
lipids (1.71; 1.04-2.82), prior AMI (1.79; 1.16-2.76), abnormal ECG on
arrival (2.1; 1.33-3.34), and a positive initial troponin (13.3; 5.9-29.6)
were predictive of events. The multivariable model found that family
history of CAD (2.06; 1.26-3.36), abnormal initial ECG (1.89; 1.16-3.09),
and positive initial troponin (13.3; 5.9- 29.6) remained predictive of 30
day CV events. Conclusions: In patients with prior PCI or CABG, the
initial ECG and early cardiac marker elevations, but not clinical
presentation, predict likelihood of 30 day death, AMI, or
revascularization.

<38>
Accession Number
71594764
Authors
Smiley D. Cardona S. Pasquel F. Farrokhi F. Jacobs S. Peng L. Halkos M.
Puskas J.D. Guyton R.A. Thourani V. Umpierrez G.E.
Institution
(Smiley, Cardona, Pasquel, Farrokhi, Jacobs, Halkos, Puskas, Guyton,
Thourani, Umpierrez) Medicine-Division of Endocrinology, Emory University,
Atlanta, United States
(Peng) Biostatistics, Rollins School of Public Health, Atlanta, United
States
Title
Intensive versus conservative glucose control in patients undergoing
coronary artery bypass graft surgery (GLUCO-CABG Trial).
Source
Diabetologia. Conference: 50th Annual Meeting of the European Association
for the Study of Diabetes, EASD 2014 Vienna Austria. Conference Start:
20140915 Conference End: 20140919. Conference Publication: (var.pagings).
57 (1 SUPPL. 1) (pp S55), 2014. Date of Publication: September 2014.
Publisher
Springer Verlag
Abstract
Background and aims: This randomized controlled trial aimed to determine
whether intensive glucose control (intensive, BG target: 5.6-7.8 mmol/L)
reduces perioperative complications compared to conservative glucose
control (conservative, BG target: 7.8-10 mmol/L) in hyperglycaemic
patients undergoing CABG. Materials and methods: After ICU care, subjects
were transitioned to the same treatment regimen targeting BG<7.8 mmol/L
before meals during the hospital stay and 90 days post discharge. The
primary outcome was differences in a composite score of hospital
complications including mortality, wound infection, pneumonia, bacteremia,
respiratory failure, acute renal failure, and major cardiovascular events.
Results: A total of 302 patients were randomized to intensive (n=151) or
conservative (n=151) glucose control following a computerized insulin
infusion algorithm. The groups were well balanced. The mean ICU daily BG
was 7.3+0.78 mmol/L (IQR 6.9-7.7) in the intensive group and 8.6+1.1
mmol/L (IQR 7.9-9.1) in the conservative group (p=0.99), and the hospital
length of stay was 11.4+11 vs. 9.5+6 days (p=0.13), respectively. In the
ICU, a BG <3.9 mmol/L occurred in 8% and 2% of the intensive and
conservative groups (p=0.03), with no BG <2.2 mmol/L. After ICU care,
there were no differences between intensive and conservative groups in
mean daily BG (7.9+1.6 mmol/L vs. 7.8 +1.6 mmol/L), patients with
hypoglycaemia (<2.2 mmol/L: 1% vs. 3%, p=0.68), or hospital readmissions
(18% vs. 20%, p=0.62). Conclusion: In summary, intensive control targeting
a BG of 5.6 -7.8 mmol/L in the ICU did not reduce perioperative
complications, mortality or hospital length of stay compared to a less
strict glucose target of 7.8-10 mmol/L in hyperglycaemic patients
undergoing CABG surgery.

<39>
Accession Number
71591041
Authors
De Grooth H.S. Vos J. Scheeren T. Van Beest P.A.
Institution
(De Grooth, Vos, Scheeren, Van Beest) Anesthesiology, University Medical
Center Groningen, Groningen, Netherlands
Title
Minimally invasive prediction of SCVO2 in high-risk surgery: The
introduction of a model index of oxygenation.
Source
Anesthesia and Analgesia. Conference: 2014 Annual Meeting of the
International Anesthesia Research Society, IARS 2014 Montreal, QC Canada.
Conference Start: 20140517 Conference End: 20140520. Conference
Publication: (var.pagings). 118 (5 SUPPL. 1) (pp S305), 2014. Date of
Publication: May 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: The purpose of this study was to examine the trilateral
relationship between cardiac index (CI), tissue oxygen saturation
(StO₂) and central venous oxygen saturation (ScvO₂)
and subsequently develop a model to predict ScvO₂ on minimal
invasive manner in patients undergoing major elective surgery. METHODS:
The continuous data of thirty-three high-risk non-cardiac surgical
patients from a randomized controlled trial (NCT01342900) were analyzed on
a between- and within-patient basis using regression on group means,
random-effects Generalized Least Squares (GLS) regression. Trend
concordance was assessed using a four-quandrant plot. We developed a model
Index of Oxygenation (IO) to predict ScvO₂ based on CI,
StO₂, heart rate (HR), fraction of inspired oxygen
(FiO₂) and mean arterial pressure (MAP). The dataset was split
by randomizing each patient into an estimation or validation subsample.
Randomization was stratified by type of surgery. IO was validated using
random-effects GLS regression, a Bland-Altman analysis and four-quadrant
concordance. RESULTS: The patients were monitored for an average duration
on 227.5 minutes, giving 7509 observations in total. We could not
establish a positive significant association between StO₂ and
CI using regression analyses (slope of -1.08 (p = 0.15; 95%CI -2.54 to
0.377; within-R2 0.01; figure 1). Trending concordance is nonexistent (on
a 5-minute basis: 56%) or very weak (on a 60-minute basis: 73%; figure 2).
CI was found to be strongly associated with ScvO₂ on a
within-patient basis, but lacks predictive power in explaining
between-patient differences. StO₂, in contrast, was
significantly associated with between-patient ScvO₂
differences, but does not follow (short term) within-patient
ScvO₂ variability (figure 3). The mean difference or bias
between ScvO₂ and IO is 1.07% (95% limits of agreement -14.7%
to 16.9%). Concordance for 5-minute and 60-minute trends was 71% and 90%,
respectively. The IO model was translated into a linear prediction, which
was then scaled back to the mean (78.5) and SD (6.49) of ScvO₂
in the estimation sample, according to the following formula (the brackets
denote standardized variables): Figure 4 displays the complete
intraoperative ScvO₂ data and the IO prediction for two
patients in the validation sample. CONCLUSIONS: StO₂ cannot be
considered a flow dependent variable during high-risk surgery. We
hypothesize that StO₂ is a gauge of microcirculatory
functioning more than a measure of systemic oxygen balance. IO is a better
estimator is ScvO₂ than either CI or StO₂ alone and
could potentially be used for minimally invasive monitoring of systemic
oxygenation(Figure Presented).

<40>
Accession Number
71589636
Authors
Zhou C. Zhou S. Cheng G. Li H.
Institution
(Zhou, Zhou, Cheng, Li) State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing
100037, China
Title
Potential role of ischemic protocol, anesthesia, and diabetes in remote
preconditioning induced cardioprotection for adult cardiac surgery: A meta
analysis of randomized trials.
Source
Cardiology (Switzerland). Conference: International Heart Forum 2012
Beijing China. Conference Start: 20120809 Conference End: 20120812.
Conference Publication: (var.pagings). 123 , 2012. Date of Publication:
August 2012.
Publisher
S. Karger AG
Abstract
Objective This meta analysis comprehensively evaluated the cardiac effect
of remote ischemic preconditioning (RIPC) in adult cardiac surgery.
Methods Randomized controlled trials (RCTs) published in English were
selected from PubMed, EMBase, and Cochrane Library (up to Jan 2012) .
Heterogeneity was explored by using I2. Random-effect model was used for
analysis in case of significant heterogeneity among trials(I2>50%).
Further exploration for the potential sources of significant heterogeneity
was conducted by meta-regression analysis. P<0.05 (2-sided) was considered
to be statistically significant. All statistical analysis was performed in
Stata software (version 9.0; Stata Corporation, College Station, TX).
Results 11 Randomized controlled trials (RCTs) with 877 subjects were
identified. The cardiac effect of RIPC in adult patients undergoing
cardiac surgery was focused. Standardized mean difference (SMD) was used
for postoperative troponin or CK-MB levels. Compared with control group,
RIPC significantly reduced postoperative biomarkers of myocardial injury
(SMD=-0.64; 95% CI, -1.06 to -0.22; P= 0.003; heterogeneity test:
I2=88.8%, P<0.00001).Total ischemic duration and limb types were used for
ischemic protocol. Anesthesia was categorized as balanced anesthesia with
or without inhalational anesthetics. Further meta-regression analysis of
myocardial biomarkers suggested that the major sources of significant
heterogeneity were total ischemic duration (coefficient=-0.0854; 95% CI,
-0.1592 to -0.0115; P=0.028) and inhalational anesthetics
(coefficient=1.1849; 95% CI, 0.1744 to 2.1955; P=0.026), but not diabetes
proportion (%) (Coefficient =-0.5188; 95% CI, -3.3519 to 2.3142; P=0.684).
Conclusions Our first comprehensive meta analysis suggests that remote
ischemic preconditioning provides cardioprotection in adult cardiac
surgery by reducing postoperative troponin or CK-MB levels. This
protective potential may be more beneficial with prolonged ischemic
protocol, whereas less beneficial with inhalational anesthetics and seems
to remain effective in patients with diabetes status. Considerable efforts
should direct at the mortality in future high-quality, large-scale
clinical trials with long-term follow-up.

<41>
Accession Number
2014546780
Authors
Patricia T. Rosa R.F.M. Koshiyama D.B. Diehl Z.T. Paskulin G.A. Zen P.R.G.
Institution
(Patricia, Koshiyama, Diehl, Paskulin, Zen) Universidade Federal de
Ciencias da Saude de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
(Rosa) Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre,
RS, Brazil
Title
Congenital heart disease and chromossomopathies detected by the karyotype.
Source
Revista Paulista de Pediatria. 32 (2) (pp 262-271), 2014. Date of
Publication: June 2014.
Abstract
Objective: To review the relationship between congenital heart defects and
chromosomal abnormalities detected by the karyotype. Data sources:
Scientific articles were searched in MED- LINE database, using the
descriptors "karyotype" OR "chromosomal" OR "chromosome" AND "heart
defects, congenital". The research was limited to articles published in
English from 1980 on. Data synthesis: Congenital heart disease is
characterized by an etiologically heterogeneous and not well understood
group of lesions. Several researchers have evaluated the presence of
chromosomal abnormalities detected by the karyo-type in patients with
congenital heart disease. However, most of the articles were retrospective
studies developed in Europe and only some of the studied patients had a
karyo-type exam. In this review, only one study was conducted in Latin
America, in Brazil. It is known that chromosomal abnormalities are
frequent, being present in about one in every ten patients with congenital
heart disease. Among the karyotype alterations in these patients, the most
important is the trisomy 21 (Down syndrome). These patients often have
associated extra-cardiac malformations, with a higher risk of morbidity
and mortality, which makes heart surgery even more risky. Conclusions:
Despite all the progress made in recent decades in the field of
cytogenetic, the karyotype remains an essential tool in order to evaluate
patients with congenital heart disease. The detailed dysmorphological
physical examination is of great importance to indicate the need of a
karyotype.

<42>
Accession Number
2014544933
Authors
Gurian D.B. Meneghini A. De Abreu L.C. Murad N. De Matos L.L. Pires A.C.
Valenti V.E. Breda J.R.
Institution
(Gurian, Meneghini, Murad, De Matos) Disciplina de Cardiologia, Santo
Andre, Sao Paulo, Brazil
(De Abreu) Laboratorio de Escrita Cientifica, Santo-Andre, Sao Paulo,
Brazil
(Pires, Breda) Departamento de Cirurgia, Faculdade de Medicina Do ABC, Av
Principe de Gales, 821, 09060-650, Santo-Andre, Sao Paulo, Brazil
(Valenti) Programa de Pos-Graduacao em Fisioterapia, Faculdade de Ciencias
e Tecnologia, Universidade Estadual Paulista, Sao Paulo, Brazil
Title
A randomized trial of the topical effect of antifibrinolytic epsilon
aminocaproic acid on coronary artery bypass surgery without
cardiopulmonary bypass.
Source
Clinical and Applied Thrombosis/Hemostasis. 20 (6) (pp 615-620), 2014.
Date of Publication: September 2014.
Publisher
SAGE Publications Inc.
Abstract
We assessed the effect of the topical application of epsilon-aminocaproic
antifibrinolytic acid (EACA) on the pericardium of patients submitted to
coronary artery bypass graft (CABG) without the use of cardiopulmonary
bypass (CPB). This is a prospective, randomized, and double-blind study.
We evaluated 26 patients with chronic coronary heart disease indicated for
CABG without CPB (EACA and placebo groups). The analysis of the
postoperative hematological results showed no difference between groups in
hemoglobin and hematocrit. There was no difference between the groups
regarding the postoperative bleeding through the drains in the first 24
hours, 48 hours, and accumulated loss until removal of drains. The use of
EACA in patients undergoing CABG without CPB presented no difference in
the reduction of the amount of bleeding and the need for blood
transfusions. 2014 The Author(s).

<43>
Accession Number
2014543219
Authors
Stevanovic A. Coburn M. Menon A. Rossaint R. Heyland D. Schalte G. Werker
T. Wonisch W. Kiehntopf M. Goetzenich A. Rex S. Stoppe C.
Institution
(Stevanovic, Coburn, Rossaint, Schalte, Werker, Stoppe) Department of
Anaesthesiology, University Hospital, RWTH Aachen, Aachen, Germany
(Menon, Goetzenich, Stoppe) Department of Thoracic, Cardiac and Vascular
Surgery, University Hospital, RWTH Aachen, Aachen, Germany
(Heyland) Kingston General Hospital, Kingston, ON, Canada
(Wonisch) Institute of Physiological Chemistry, Centre for Physiological
Medicine, Medical University of Graz, Graz, Austria
(Wonisch) Clinical Institute of Medical and Chemical Laboratory
Diagnostics, Medical University of Graz, Graz, Austria
(Kiehntopf) Institute of Clinical Chemistry, Friedrich-Schiller
University, Jena, Germany
(Rex) Department of Anaesthesiology and Department of Cardiovascular
Sciences, University Hospitals Leuven, KU Leuven, Belgium
(Stoppe) Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen
University, Aachen, Germany
Title
The importance of intraoperative selenium blood levels on organ
dysfunction in patients undergoing off-pump cardiac surgery: A randomised
controlled trial.
Source
PLoS ONE. 9 (8) , 2014. Article Number: e104222. Date of Publication: 13
Aug 2014.
Abstract
Introduction: Cardiac surgery is accompanied by an increase of oxidative
stress, a significantly reduced antioxidant (AOX) capacity, postoperative
inflammation, all of which may promote the development of organ
dysfunction and an increase in mortality. Selenium is an essential
co-factor of various antioxidant enzymes. We hypothesized a less
pronounced decrease of circulating selenium levels in patients undergoing
off-pump coronary artery bypass (OPCAB) surgery due to less intraoperative
oxidative stress. Methods: In this prospective randomised, interventional
trial, 40 patients scheduled for elective coronary artery bypass grafting
were randomly assigned to undergo either on-pump or OPCAB-surgery, if both
techniques were feasible for the single patient. Clinical data, myocardial
damage assessed by myocard specific creatine kinase isoenzyme (CK-MB),
circulating whole blood levels of selenium, oxidative stress assessed by
asymmetric dimethylarginine (ADMA) levels, antioxidant capacity determined
by glutathionperoxidase (GPx) levels and perioperative inflammation
represented by interleukin-6 (IL-6) levels were measured at predefined
perioperative time points. Results: At end of surgery, both groups showed
a comparable decrease of circulating selenium concentrations. Likewise,
levels of oxidative stress and IL-6 were comparable in both groups.
Selenium levels correlated with antioxidant capacity (GPx: r = 0.720;
p<0.001) and showed a negative correlation to myocardial damage (CK-MB: r
= -0.571, p<0.001). Low postoperative selenium levels had a high
predictive value for the occurrence of any postoperative complication.
Conclusions: OPCAB surgery is not associated with less oxidative stress
and a better preservation of the circulating selenium pool than on-pump
surgery. Low postoperative selenium levels are predictive for the
development of complications. Trial registration: ClinicalTrials.gov
NCT01409057 2014 Stevanovic et al.

<44>
Accession Number
2014546354
Authors
Donohue J.M. Belnap B.H. Men A. He F. Roberts M.S. Schulberg H.C. Reynolds
C.F. Rollman B.L.
Institution
(Donohue, Men, Roberts) Department of Health Policy and Management,
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,
United States
(Belnap, Roberts, Rollman) Division of General Internal Medicine, Center
for Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(He, Reynolds) Department of Psychiatry, University of Pittsburgh School
of Medicine, Pittsburgh, PA, United States
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, United States
Title
Twelve-month cost-effectiveness of telephone-delivered collaborative care
for treating depression following CABG surgery: A randomized controlled
trial.
Source
General Hospital Psychiatry. 36 (5) (pp 453-459), 2014. Date of
Publication: September 2014.
Publisher
Elsevier Inc.
Abstract
Objective: To determine the 12-month cost-effectiveness of a collaborative
care (CC) program for treating depression following coronary artery bypass
graft (CABG) surgery versus physicians' usual care (UC). Methods: We
obtained 12 continuous months of Medicare and private medical insurance
claims data on 189 patients who screened positive for depression following
CABG surgery, met criteria for depression when reassessed by telephone 2
weeks following hospitalization (nine-item Patient Health Questionnaire >
10) and were randomized to either an 8-month centralized, nurse-provided
and telephone-delivered CC intervention for depression or to their
physicians' UC. Results: At 12 months following randomization, CC patients
had $2068 lower but statistically similar estimated median costs compared
to UC (P= .30) and a variety of sensitivity analyses produced no
significant changes. The incremental cost-effectiveness ratio of CC was
-$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year
(QALY), and there was 90% probability it would be cost-effective at the
willingness to pay threshold of $20,000 per additional QALY. A
bootstrapped cost-effectiveness plane also demonstrated a 68% probability
of CC "dominating" UC (more QALYs at lower cost). Conclusions:
Centralized, nurse-provided and telephone-delivered CC for post-CABG
depression is a quality-improving and cost-effective treatment that meets
generally accepted criteria for high-value care. 2014 Elsevier Inc.

<45>
Accession Number
2014541107
Authors
Futier E. Constantin J.-M. Jaber S.
Institution
(Futier, Jaber) Department of Anesthesiology and Critical Care B (DAR B),
Saint Eloi Teaching Hospital, Montpellier University Hospital,
Montpellier, France
(Futier, Constantin) University of Clermont-Ferrand, Clermont-Ferrand,
France
Title
Protective lung ventilation in operating room: A systematic review.
Source
Minerva Anestesiologica. 80 (6) (pp 726-735), 2014. Date of Publication:
June 2014.
Publisher
Edizioni Minerva Medica
Abstract
Postoperative pulmonary and extrapulmonary complications adversely affect
clinical outcomes and healthcare utilization, so that prevention has
become a measure of the quality of perioperative care. Mechanical
ventilation is an essential support therapy to maintain adequate gas
exchange during general anesthesia for surgery. Mechanical ventilation
using high tidal volume (VT) (between 10 and 15 mL/kg) has been
historically encouraged to prevent hypoxemia and atelectasis formation in
anesthetized patients undergoing abdominal and thoracic surgery. However,
there is accumulating evidence from both experimental and clinical studies
that mechanical ventilation, especially the use of high VT and plateau
pressure, may potentially aggravate or even initiate lung injury.
Ventilator-associated lung injury can result from cyclic alveolar
overdistension of non-dependent lung tissue, and repetitive opening and
closing of dependent lung tissue resulting in ultrastructural damage at
the junction of closed and open alveoli. Lung-protective ventilation,
which refers to the use of lower VT and limited plateau pressure to
minimize overdistension, and positive end-expiratory pressure to prevent
alveolar collapse at end-expiration, was shown to improve outcome in
critically ill patients with acute respiratory distress syndrome (ARDS).
It has been recently suggested that this approach might also be beneficial
in a broader population, especially in critically ill patients without
ARDS at the onset of mechanical ventilation. There is, however, little
evidence regarding a potential beneficial effect of lung protective
ventilation during surgery, especially in patients with healthy lungs.
Although surgical patients are frequently exposed to much shorter periods
of mechanical ventilation, this is an important gap in knowledge given the
number of patients receiving mechanical ventilation in the operating room.
This review developed the benefits of lung protective ventilation during
surgery and general anesthesia and offers some recommendations for
mechanical ventilation in the surgical context.

<46>
Accession Number
2014537831
Authors
Balducci S. Vulpiani M.C. Pugliese L. D'Errico V. Menini S. Salerno G.
Gargiulo L. Ferretti A. Pugliese G.
Institution
(Balducci, Menini, Salerno, Pugliese) Department of Clinical and Molecular
Medicine, La Sapienza University, Rome, Italy
(Balducci, D'Errico, Pugliese) Diabetes Unit, Sant'Andrea Hospital, Rome,
Italy
(Balducci, D'Errico) Metabolic Fitness Association, Via Nomentana, 27,
00015 Monterotondo, Rome, Italy
(Vulpiani, Gargiulo, Ferretti) Department of Medical and Surgical Sciences
and Translational Medicine, La Sapienza University, Rome, Italy
(Vulpiani, Gargiulo) Physical Medicine and Rehabilitation Unit,
Sant'Andrea Hospital, Rome, Italy
(Pugliese) Radiology Unit, Sant'Andrea Hospital, Rome, Italy
(Ferretti) Orthopedic Unit, Kirk Kilgour Sports Injury Center, Sant'Andrea
Hospital, Rome, Italy
Title
Effect of supervised exercise training on musculoskeletal symptoms and
function in patients with type 2 diabetes: The Italian Diabetes Exercise
Study (IDES).
Source
Acta Diabetologica. 51 (4) (pp 647-654), 2014. Date of Publication: August
2014.
Abstract
Musculoskeletal disorders are common in subjects with type 2 diabetes
mellitus (T2DM) and may represent a barrier to physical activity (PA). In
the Italian Diabetes and Exercise Study, we assessed whether a strategy
aimed at minimizing the risk of injury and worsening of musculoskeletal
symptoms favors participation in exercise training and results in
improvements in joint-specific functional scores, along with amelioration
of metabolic profile. Sedentary patients with T2DM (n = 606) from 22
outpatient diabetes clinics were randomized to twice-a-week supervised
aerobic and resistance training plus exercise counseling (EXE) versus
counseling alone (CON) for 12 months. Musculoskeletal symptoms were
evaluated at baseline in the entire cohort by the use of a self-reported
questionnaire in order to design tailored exercise programs with exclusion
of painful segments, and validated joint-specific scores were calculated
at the end of study in a subgroup of CON (n = 65) and EXE subjects (n =
62). Musculoskeletal symptoms were present in more than 3/4 of EXE and CON
subjects. Yet, volumes of non-supervised PA were high, whereas dropout
rates and adverse events were low in both groups. Moreover, in the EXE
group, no difference was observed between patients with and without
symptoms in session attendance and PA/exercise volume. Scores for symptoms
and functional status of limbs and spine were significantly better in EXE
than in CON subjects and correlated with PA/exercise volume and
improvements in fitness parameters. Preliminary evaluation of
musculoskeletal symptoms is useful in favoring compliance with supervised
training programs and obtaining significant benefits to the functional
status of the involved joints. 2014 Springer-Verlag.

<47>
Accession Number
2014537729
Authors
Ruetzler K. Blome C.J. Nabecker S. Makarova N. Fischer H. Rinoesl H.
Goliasch G. Sessler D.I. Koinig H.
Institution
(Ruetzler, Blome, Nabecker, Fischer, Rinoesl, Koinig) Division of
Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine,
Medical University of Vienna, Vienna, Austria
(Ruetzler) Institute of Anaesthesiology, University Hospital Zurich,
Zurich, Switzerland
(Makarova) Departments of Quantitative Health Sciences and Outcomes
Research, Cleveland Clinic, Cleveland, United States
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
United States
(Goliasch) Department of Internal Medicine II, Medical University of
Vienna, Vienna, Austria
(Koinig) Department of Anaesthesia, Hospital Krems, Krems, Austria
Title
A randomised trial of oral versus intravenous opioids for treatment of
pain after cardiac surgery.
Source
Journal of Anesthesia. 28 (4) (pp 580-586), 2014. Date of Publication:
August 2014.
Abstract
Background: Cardiac surgery and sternotomy are procedures accompanied by
substantial postoperative pain which is challenging to treat. In general,
intravenous (IV) opioids are used in the immediate postoperative phase,
followed by oral opioids. Oral opioids are easier to use and generally
less expensive. Our goal was thus to determine whether a new opioid
preparation provides adequate analgesia after sternotomy. In particular,
we tested the primary hypothesis that total opioid use (in morphine
equivalents) is not greater with oral opioid compared with
patient-controlled IV morphine. Our secondary hypothesis was that
analgesic efficacy is similar with oral and IV opioids. Methods: A total
of 51 patients having elective cardiac surgery were enrolled in this
study. After rapid postoperative respiratory weaning, the patients were
randomised into one of two groups receiving different types of analgesia:
oral Targin (a combination of oxycodone-hydrochloride and the opioid
antagonist naloxone hydrochloride-dihydrate) or patient-controlled IV
morphine. Pain score (visual analogue scale), sedation (Ramsey score),
respiratory rate and side effects were assessed at 3, 5, 7, 9 and 11 h
after surgery, and every 6 h throughout the third postoperative evening.
Results: The total opioid dose in morphine equivalent doses was
significantly lower with oral opioid than with IV morphine (adjusted
geometric means [95 % confidence interval]: 34 [29; 38] vs. 69 [61; 78]
mg, respectively). Pain scores were similar in each group. Conclusions:
Analgesic quality was comparable with oral and IV opioids, suggesting that
postoperative pain even after very painful procedures can be sufficiently
managed with oral opioids. 2013 Japanese Society of Anesthesiologists.

<48>
Accession Number
2014538513
Authors
Yao H.-M. Wan Y.-D. Zhang X.-J. Shen D.-L. Zhang J.-Y. Li L. Zhao L.-S.
Sun T.-W.
Institution
(Yao, Shen, Zhang, Li, Zhao) Department of Cardiology, Zhengzhou
University, Zhengzhou, China
(Wan, Zhang, Sun) Department of Integrated Intensive Care Unit, First
Affiliated Hospital, Zhengzhou University, 1 Jianshe East Road, Zhengzhou
450052, China
Title
Long-term follow-up results in patients undergoing percutaneous coronary
intervention (PCI) with drug-eluting stents: Results from a single
high-volume PCI centre.
Source
BMJ Open. 4 (8) , 2014. Article Number: e004892. Date of Publication:
2014.
Abstract
Objective: To assess both short-term and long-term prognosis in
consecutive patients with coronary heart disease treated with drug-eluting
stents in a high-volume percutaneous coronary intervention (PCI) centre.
Design: Observational cohort study. Setting: A hospital in the Henan
province, China, between 2009 and 2011. Participants: A total of 2533
patients were enrolled. Patients with ST-elevation myocardial infarction
(STEMI) treated with urgent PCI accounted for 3.9% of cases; patients with
STEMI treated with delayed PCI accounted for 20.5% of cases; patients with
stable angina accounted for 16.5% of cases; and patients with non-ST
elevation acute coronary syndrome (NSTE-ACS) accounted for 58.6% of cases.
Primary outcomes: Death, major adverse cardiac and cerebrovascular events
(MACCE: death/myocardial infarction/stroke), and target vessel
revascularisation. Results: Follow-up after a median of 29.8 months was
obtained for 2533 patients (92.6%). The mortality rate during
hospitalisation was highest in the urgent PCI group (p<0.001). During
follow-up, although the incidences of death and MACCE were highest in the
urgent PCI group, no significant differences were observed among the
different groups. The incidences of cardiac death and myocardial
infarction were significantly higher in the paclitaxel-eluting stent (PES)
group than in the sirolimus-eluting stent (SES) group. Independent
predictors of death during follow-up were age, left ventricular ejection
function <40%, diabetes mellitus, prior coronary artery bypass graft and
chronic total occlusion. Conclusions: PCI patients with STEMI had the
worst hospital and long-term prognosis. The mortality rate after hospital
increased markedly in patients with NSTE-ACS. SESs seem to be more
effective than PESs.

<49>
[Use Link to view the full text]
Accession Number
2014537415
Authors
Shiomi H. Kozuma K. Morimoto T. Igarashi K. Kadota K. Tanabe K. Morino Y.
Akasaka T. Abe M. Suwa S. Muramatsu T. Kobayashi M. Dai K. Nakao K.
Uematsu M. Tarutani Y. Fujii K. Simonton C.A. Kimura T.
Institution
(Shiomi, Kimura) Department of Cardiovascular Medicine, Kyoto University
Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto
606-8507, Japan
(Kozuma) Department of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Nishinomiya, Japan
(Igarashi) Department of Cardiology, Hokkaido Social Insurance Hospital,
Sapporo, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Tanabe) Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Morino) Department of Cardiology, Iwate University Hospital, Morioka,
Japan
(Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University Hospital, Wakayama, Japan
(Abe) Department of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Suwa) Department of Cardiology, Juntendo University Shizuoka Hospital,
Nagaoka, Japan
(Muramatsu) Department of Cardiology, Saiseikai Yokohama-City Eastern
Hospital, Yokohama, Japan
(Kobayashi) Department of Cardiology, Hamamatsu Medical Center, Hamamatsu,
Japan
(Dai) Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
(Nakao) Department of Cardiology, Saiseikai Kumamoto Hospital,
Cardiovascular Center, Kumamoto, Japan
(Uematsu) Department of Cardiology, Kansai Rosai Hospital, Cardiovascular
Center, Hyogo, Japan
(Tarutani) Department of Cardiology, Okamura Memorial Hospital, Shizuoka,
Japan
(Fujii) Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka,
Japan
(Simonton) Abbott Vascular, Abbott Park, IL, United States
Title
Long-term clinical outcomes after everolimus- and sirolimus-eluting
coronary stent implantation: Final 3-year follow-up of the randomized
evaluation of sirolimus-eluting versus everolimus-eluting stent trial.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 343-354), 2014. Date
of Publication: June 2014.
Abstract
Background-Long-term clinical outcomes of everolimus-eluting stent (EES)
compared with sirolimus-eluting stent (SES) have not been evaluated fully
yet, especially whether EES implantation could positively affect late
adverse events reported after SES implantation occurring >1 year. Methods
and Results-In this all-comer prospective multicenter randomized
open-label trial, 3196 patients were assigned randomly to implant either
EES (n=1596) or SES (n=1600). At 3 years, EES was noninferior to SES on
the primary safety end point (all-cause death or myocardial infarction;
10.1% versus 11.5%; noninferiority P <0.001; and superiority P=0.19).
Cumulative incidence of defnite stent thrombosis was low and was not
signifcantly different between the 2 groups (0.5% versus 0.6%; P=0.81).
There was no signifcant difference in the effcacy end point of
target-lesion revascularization between the EES and SES groups (6.6%
versus 7.9%; P=0.16). However, the cumulative incidence of target-lesion
failure (cardiac death/target-vessel myocardial infarction/ischemia-driven
target-lesion revascularization) was signifcantly lower in the EES group
than in the SES group (8.8% versus 11.4%; P=0.01). By a landmark analysis
at 1 year, the cumulative incidence of very late stent thrombosis and late
target-lesion revascularization was not signifcantly different between the
2 groups (0.2% versus 0.2%; P=0.99 and 2.2% versus 2.9%; P=0.21,
respectively). Conclusions-The effcacy and safety outcomes for this trial
after EES implantation remained comparable with those after SES
implantation through 3-year follow-up. However, improvement of clinical
outcome after EES implantation compared with SES implantation was
suggested by the signifcantly lower cumulative incidences of target-lesion
failure, which has been the most widely used primary end point in the
stent-versus-stent trials. 2014 American Heart Association, Inc.

<50>
[Use Link to view the full text]
Accession Number
2014537413
Authors
Lee J.-Y. Park D.-W. Kim Y.-H. Ahn J.-M. Kim W.-J. Kang S.-J. Lee S.-W.
Lee C.W. Park S.-W. Yun S.-C. Yang T.-H. Lee B.-K. Lee N.-H. Yang J.-Y.
Shin W.-Y. Park H.S. Kim K.-S. Hur S.H. Lee S.Y. Park J.-S. Choi Y.S. Lee
S.U. Her S.-H. Park S.-J.
Institution
(Lee, Park, Kim, Ahn, Kim, Kang, Lee, Lee, Park, Park) Department of
Cardiology, University of Ulsan College of Medicine, Asan Medical Center,
388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Seoul, South Korea
(Yang) Department of Internal Medicine, Inje University Pusan Paik
Hospital, Pusan, South Korea
(Lee) Department of Internal Medicine, Kangwon National University
Hospital, Chuncheon, South Korea
(Lee) Department of Internal Medicine, Soonchunhyang University Bucheon
Hospital, Bucheon, South Korea
(Yang) Department of Internal Medicine, National Health Insurance
Corporation, Ilsan Hospital, Goyang, South Korea
(Shin) Department of Internal Medicine, Soonchunhyang University Hospital,
Cheonan, South Korea
(Park) Department of Internal Medicine, Kyungpook National University
Hospital, Daegu, South Korea
(Kim) Department of Internal Medicine, Daegu Catholic University Medical
Center, Daegu, South Korea
(Hur) Department of Internal Medicine, Keimyung University Dongsan Medical
Center, Daegu, South Korea
(Lee) Department of Internal Medicine, Inje University Ilsan Paik
Hospital, Goyang, South Korea
(Park) Department of Internal Medicine, Yeungnam University Medical
Center, Daegu, South Korea
(Choi) Department of Internal Medicine, Catholic University of Korea,
Yeouido St. Mary's Hospital, Seoul, South Korea
(Lee) Department of Internal Medicine, Kwangju Christian Hospital,
Kwangju, South Korea
(Her) Department of Internal Medicine, Catholic University of Korea,
Daejeon St. Mary's Hospital, Daejeon, South Korea
Title
Comparison of biolimus A9-eluting (Nobori) and everolimus-eluting (Promus
Element) stents in patients with de novo native long coronary artery
lesions: A randomized long drug-eluting stent v trial.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 322-329), 2014. Date
of Publication: June 2014.
Abstract
Background-Procedural and clinical outcomes still remain unfavorable for
patients with long coronary lesions who undergo percutaneous coronary
intervention. The current study, therefore, evaluated 2 innovative
drug-eluting stents for the management of long-lesion coronary artery
disease. Methods and Results-This randomized, multicenter, prospective
trial, called the Long Drug-Eluting Stent (LONG-DES) V trial, compared the
biodegradable polymer-based biolimus A9-eluting stent (BES) and the
durable polymer-based platinum chromium everolimus-eluting stent
(PtCr-EES) in 500 patients with long (>25 mm) coronary lesions. The
primary end point of the trial was in-segment late luminal loss at the
9-month angiographic follow-up. The BES and PtCr-EES groups had similar
baseline characteristics, with a slightly shorter lesion length in the BES
group versus the PtCr-EES group (29.24+12.17 versus 32.27+13.84 mm;
P=0.016). In-segment late luminal loss was comparable between the 2 groups
at the 9-month angiographic follow-up (BES, 0.14+0.38 versus PtCr-EES,
0.11+0.37 mm; difference, 0.031; 95% confdence interval, -0.053 to 0.091;
P=0.03 for a noninferiority margin of 0.11, P=0.45 for superiority), as
was in-stent late luminal loss (0.20+0.41 versus 0.24+0.38 mm; P=0.29).
The incidence of in-segment (6.1% versus 4.9%; P=0.63) and in-stent (3.7%
versus 4.9%; P=0.59) binary restenosis was also similar between the
groups. There was no signifcant between-group difference in the rate of
composite outcome of death, myocardial infarction, and target vessel
revascularization (41, 16.7% in BES versus 42, 16.5% in PtCr-EES; P=0.94).
Conclusions-BES and PtCr-EES implantation showed analogous angiographic
and clinical outcomes for patients with de novo long coronary lesions.
2014 American Heart Association, Inc.

<51>
[Use Link to view the full text]
Accession Number
2014537412
Authors
Shiratori Y. Cola C. Brugaletta S. Alvarez-Contreras L. Martin-Yuste V.
Del Blanco B.G. Ruiz-Salmeron R. Diaz J. Pinar E. Marti V. Garcia-Picart
J. Sabate M.
Institution
(Shiratori, Brugaletta, Sabate) Department of Cardiology, Hospital Clinic,
University of Barcelona, C/Villaroel 170, 08036 Barcelona, Spain
(Cola, Alvarez-Contreras, Martin-Yuste, Marti, Garcia-Picart) Cardiology
Department, Interventional Cardiology Unit, Sant Pau Hospital, Barcelona,
Spain
(Del Blanco) Cardiology Department, Interventional Cardiology Unit, Vall
d'Hebron Hospital, Barcelona, Spain
(Ruiz-Salmeron) Cardiology Department, Interventional Cardiology Unit,
Virgen de Macarena Hospital, Sevilla, Spain
(Diaz) Cardiology Department, Interventional Cardiology Unit, Juan Ramon
Jimenez Hospital, Huelva, Spain
(Pinar) Cardiology Department, Interventional Cardiology Unit, Virgen de
la Arrixaca Hospital, Murcia, Spain
Title
Randomized comparison between polymer-free versus polymer-based
paclitaxel-eluting stent two-year final clinical results.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 312-321), 2014. Date
of Publication: June 2014.
Abstract
Background-Most drug-eluting stents currently in use are coated with a
polymer carrying the drug that is released for several weeks. However, a
durable polymer may provoke hypersensitive reaction, delayed artery
healing, and eventually stent thrombosis. The aim of this study was to
investigate the safety and effcacy of a polymer-free paclitaxel-eluting
stent (PF-PES) versus a polymer-based PES (PB-PES). Methods and
Results-Eligible patients undergoing percutaneous coronary intervention
were randomized 1:1 to receive either PF-PES or PB-PES. The primary end
point was late loss at 9 months. Intravascular ultrasound analysis at 9
months and fnal 2-year clinical follow-up were also performed. From
October 2007 to April 2009, 164 patients were enrolled and randomized into
2 groups (PF-PES: n=84; PB-PES: n=80). Mean in-stent lumen loss was
0.90+0.59 mm for PF-PES and 0.49+0.52 mm for PB-PES (P<0.001). Mean
neointimal area by intravascular ultrasound was higher in PF-PES than in
PB-PES (1.42+1.09 versus 0.51+0.61 mm²; P<0.001). At 2 years, a
composite end point of all-cause death, any myocardial infarction, and
target vessel revascularization occurred in 36.9% for PF-PES and 16.3% for
PB-PES (P=0.004), mainly driven by a higher rate of target vessel
revascularization (PF-PES: 35.7%; PB-PES: 13.8%; P=0.001). One late stent
thrombosis was observed in PF-PES. Conclusions-Compared with PB-PES,
PF-PES was associated with increased neointimal proliferation and
subsequent clinical restenosis. Polymer plays an essential role in the
performance of drug-eluting stents. 2014 American Heart Association, Inc.

<52>
[Use Link to view the full text]
Accession Number
2014537410
Authors
Fernandez-Rodriguez D. Regueiro A. Brugaletta S. Martin-Yuste V. Masotti
M. Cequier A. Iniguez A. Serra A. Hernandez-Antolin R. Mainar V.
Valgimigli M. Tespili M. Den Heijer P. Bethencourt A. Vazquez N. Serruys
P.W. Sabate M.
Institution
(Fernandez-Rodriguez, Regueiro, Brugaletta, Martin-Yuste, Masotti, Sabate)
University Hospital Clinic, Institut d'Investigacions Biomediques August
Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
(Cequier) Cardiology Department, University Hospital of Bellvitge,
Barcelona, Spain
(Iniguez) Cardiology Department, Hospital Do Meixoeiro, Vigo, Spain
(Serra) Cardiology Department, University Hospital of Sant Pau, Barcelona,
Spain
(Hernandez-Antolin) Cardiology Department, University Hospital San Carlos,
Madrid, Spain
(Mainar) Cardiology Department, Hospital General of Alicante, Alicante,
Spain
(Valgimigli, Serruys) Cardiology Department, Erasmus MC, Thoraxcenter,
Rotterdam, Netherlands
(Tespili) Cardiology Department, University Hospital Bolognini Seriate,
Bergamo, Italy
(Den Heijer) Cardiology Department, Amphia Ziekenhuis, Breda, Netherlands
(Bethencourt) Cardiology Department, Hospital Son Dureta, Palma de
Mallorca, Spain
(Vazquez) Cardiology Department, Hospital Juan Canalejo, A Coruna, Spain
Title
Optimization in stent implantation by manual thrombus aspiration in
ST-segment-elevation myocardial infarction: Findings from the EXAMINATION
trial.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 294-300), 2014. Date
of Publication: June 2014.
Abstract
Background-Manual thrombus aspiration (TA) is effective to reduce the
thrombus burden during primary percutaneous coronary intervention for
ST-elevation myocardial infarction. The objective of this study is to
assess the impact of manual TA on stent implantation during primary
percutaneous coronary intervention. Methods and Results-Population of the
EXAMINATION trial (n=1498) was divided into 2 groups according to the use
of TA. Immediate angiographic results, primary patient-oriented end point
(combination of all-cause death, myocardial infarction, and any
revascularization) and secondary device-oriented end point (combination of
cardiac death, target vessel myocardial infarction, and clinically driven
target lesion revascularization), defnite/probable stent thrombosis, and
major/minor bleeding were evaluated at 2 years. A total of 976 (65.2%)
patients were classifed into TA group and 522 (34.8%) patients into
nonthrombus aspiration group. Manual TA was most frequently used in
patients with worse initial thrombolysis in myocardial infarction fow. The
TA group received less number of stents implanted (1.35+0.62 versus
1.45+0.71, P=0.005) with bigger size (3.25+0.44 versus 3.11+0.46 mm,
P<0.001) compared with the nonthrombus aspiration group. A higher rate of
direct stenting (69.2% versus 43.3%, P<0.001) with lower rate of
postdilatation (13.0% versus 18.0%, P<0.009) was also present in the TA
group compared with the nonthrombus aspiration group. At 2-year follow-up,
no differences in clinical end point were observed between groups.
Conclusions-Manual TA during primary percutaneous coronary intervention is
associated with a higher rate of direct stenting, a lower rate of
postdilatation, and larger and less stents in comparison with conventional
primary percutaneous coronary intervention. Conversely, manual TA had no
apparent impact on clinical outcomes at long-term follow-up. Clinical
Trial Registration-http://www.clinicaltrials.gov. Unique identifer:
NCT00828087. 2014 American Heart Association, Inc.

<53>
[Use Link to view the full text]
Accession Number
2014537409
Authors
Planer D. Mehran R. Ohman E.M. White H.D. Newman J.D. Xu K. Stone G.W.
Institution
(Planer) Hadassah-Hebrew University Medical Center, Jerusalem, Israel
(Mehran) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Mehran, Xu, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, 111 E 59th St, New York, NY 10022, United States
(Ohman) Duke University Medical Center, Durham, NC, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Newman, Stone) Columbia University Medical Center, New York, NY, United
States
Title
Prognosis of patients with non-ST-segment-elevation myocardial infarction
and nonobstructive coronary artery disease: Propensity-matched analysis
from the acute catheterization and urgent intervention triage strategy
trial.
Source
Circulation: Cardiovascular Interventions. 7 (3) (pp 285-293), 2014. Date
of Publication: June 2014.
Abstract
Background-Troponin elevation is a risk factor for mortality in patients
with non-ST-segment-elevation acute coronary syndromes. However, the
prognosis of patients with troponin elevation and nonobstructive coronary
artery disease (CAD) is unknown. Our objective was therefore to evaluate
the impact of nonobstructive CAD in patients with non-ST-segment-elevation
acute coronary syndromes and troponin elevation enrolled in the Acute
Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.
Methods and Results-In the ACUITY trial, 3-vessel quantitative coronary
angiography was performed in a formal substudy of 6921 patients presenting
with non-ST-segment-elevation acute coronary syndromes. Patients with
elevated admission troponin levels were stratifed by the presence or
absence of obstructive CAD (any lesion with quantitative diameter stenosis
>50%). Propensity score matching was performed to adjust for baseline
characteristics. Of 2442 patients with elevated troponin, 197 (8.8%) had
nonobstructive CAD. Maximum diameter stenosis was 87.4 (73.2, 100.0)
versus 22.6 (19.2, 25.7; P<0.0001) in patients with versus without
obstructive CAD, respectively. Propensity matching yielded 117 patients
with nonobstructive CAD and 331 patients with obstructive CAD, with no
signifcant baseline differences between groups. In the matched cohort,
overall 1-year mortality was signifcantly higher in patients with
nonobstructive CAD (5.2% versus 1.6%; hazard ratio [95% confdence
interval]=3.44 [1.05, 11.28]; P=0.04), driven by greater noncardiac
mortality. Conversely, recurrent myocardial infarction and unplanned
revascularization rates were signifcantly higher in patients with
obstructive CAD. Conclusions-Patients with non-ST-segment-elevation acute
coronary syndromes and elevated troponin levels but without obstructive
CAD, while having low rates of subsequent myocardial infarction and
unplanned revascularization, are still at considerable risk for 1-year
mortality from noncardiac causes. 2014 American Heart Association, Inc.

<54>
Accession Number
2014700790
Authors
Pieper D. Mathes T. Asfour B.
Institution
(Pieper, Mathes) Institute for Research in Operative Medicine,
Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, Cologne D-
51109, Germany
(Asfour) German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin,
Sankt Augustin, Germany
Title
A systematic review of the impact of volume of surgery and specialization
in Norwood procedure.
Source
BMC Pediatrics. 14 (1) , 2014. Article Number: 198. Date of Publication:
August 06, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: The volume-outcome relationship is supposed to be stronger in
high risk, low volume procedures. The aim of this systematic review is to
examine the available literature on the effects of hospital and surgeon
volume, specialization and regionalization on the outcomes of the Norwood
procedure.Methods: A systematic literature search was performed in
Medline, Embase, and the Cochrane Library. On the basis of titles and
abstracts, articles of comparative studies were obtained in full-text in
case of potential relevance and assessed for eligibility according to
predefined inclusion criteria. All relevant data on study design, patient
characteristics, hospital volume, surgeon volume and other institutional
characteristics, as well as results were extracted in standardized tables.
Study selection, data extraction and critical appraisal were carried out
independently by two reviewers.Results: We included 10 studies. All but
one study had an observational design. The number of analyzed patients
varied from 75 to 2555. Overall, the study quality was moderate with a
huge number of items with an unclear risk of bias. All studies
investigating hospital volume indicated a hospital volume-outcome
relationship, most of them even having significant results. The results
were very heterogeneous for surgeon volume.Conclusions: The volume-outcome
relationship in the Norwood procedure can be supported. However, the
magnitude of the volume effect is difficult to assess.

<55>
Accession Number
2014700848
Authors
Khawaja M.Z. Wang D. Pocock S. Redwood S.R. Thomas M.R.
Institution
(Khawaja, Redwood) Rayne Institute, Cardiovascular Division, King's
College London, BHF Centre of Excellence, St Thomas' Hospital, Westminster
Bridge Road, London_apop SE1 7EH, United Kingdom
(Khawaja, Redwood, Thomas) Department of Cardiology, Guy's and St Thomas'
NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United
Kingdom
(Wang) Department of Clinical Sciences, Liverpool School of Tropical
Medicine, Pembroke Pl, Liverpool, Merseyside L3 5QA, United Kingdom
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
Title
The percutaneous coronary intervention prior to transcatheter aortic valve
implantation (ACTIVATION) trial: Study protocol for a randomized
controlled trial.
Source
Trials. 15 (1) , 2014. Article Number: 300. Date of Publication: July 24,
2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Current guidelines recommend treatment of significant coronary
artery disease by concomitant coronary artery bypass grafting (CABG) in
patients undergoing surgical aortic valve replacement. However there is no
consensus as to how best to treat coronary disease in high-risk patients
requiring transcatheter aortic valve implantation (TAVI).Methods/Design:
The percutaneous coronary intervention prior to transcatheter aortic valve
implantation (ACTIVATION) trial is a randomized, controlled open-label
trial of 310 patients randomized to treatment of significant coronary
artery disease by percutaneous coronary intervention (PCI - test arm) or
no PCI (control arm). Significant coronary disease is defined as >1 lesion
of >70% severity in a major epicardial vessel or 50% in a vein graft or
protected left main stem lesion. The trial tests the hypothesis that the
strategy of performing pre-TAVI PCI is non-inferior to not treating such
coronary stenoses with PCI prior to TAVI, with a composite primary outcome
of 12-month mortality and rehospitalization. Secondary outcomes include
efficacy end-points such as 30-day mortality, safety endpoints including
bleeding, burden of symptoms, and quality of life (assessed using the
Seattle Angina Questionnaire and the Kansas City Cardiomyopathy
Questionnaire).In conclusion, we hope that using a definition of coronary
artery disease severity closer to that used in everyday practice by
interventional cardiologists - rather than the 50% severity used in
surgical guidelines - will provide robust evidence to direct guidelines
regarding TAVI therapy and improve its safety and efficacy profile of this
developing technique. Trial registration: ISRCTN75836930,
http://www.controlled-trials.com/ISRCTN75836930 (registered 19 November
2011).

<56>
Accession Number
71584218
Authors
Garcia D. Ansari M. Nascimento R. Toussaint J. Martinez C. Alfonso C.
Heldman A.
Institution
(Garcia, Ansari, Nascimento, Toussaint) University of Miami, Jackson
Memorial Hospital, Miami, FL, United States
(Martinez, Heldman) University of Miami, Miami, FL, United States
(Alfonso) University of Miami, VA Medical Center, United States
Title
Do edward sapiens and corevalve transcatheter devices have different
procedure complications for aortic valve replacement? A meta-analysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 509), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Background: TAVR is a therapeutic alternative for high-surgical-risk
patients with severe symptomatic aortic stenosis. There are currently
available two different types of devices that can be clinically used in
the USA: Edward Sapiens (ES) and CoreValve (CV). We aimed to analyze the
difference in complications among those two devices. Methods: We searched
PubMed, EMBASE, and Cochrane databases up to January 2014. The studied
outcomes were pacemaker implantation, acute kidney injury (AKI), major
vascular complications, and conversion to open heart surgery and moderate
to severe perivalvular aortic regurgitation. We used Fixed or Random
Effect analysis using the Cochrane Handbook of Systematic Reviews.
Results: 5 studies provided a total of 5087 non-overlapping patients, 3170
received ES and 1917 CV device. As demonstrated in figure 1, ES valve
presented fewer complications as such as pacemaker implantation,
conversion to open heart surgery and significantly less major bleeding
complications (4.2% ES vs. 6.3% CV; p<0.05). There was no difference in
regards AKI or perivalvular leaking. Conclusion: Our analysis has
suggested that bleeding complications might be more common in the CV
whereas some other complications might not differ among TAVR devices.
Further randomized trials are warranted.

<57>
Accession Number
71584184
Authors
Fomaneg C.K. Samonte P.E.E. Sasondoncillo-Nadal M.M. Sim-Apura C.L.L.
Padua L.P.
Institution
(Fomaneg, Samonte, Sasondoncillo-Nadal, Sim-Apura, Padua) Philippine Heart
Center, Quezon City, Philippines
Title
Colchicine use for the primary prevention of postpericardiotomy syndrome
(CUPP): A meta-analysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 475), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Introduction: Postpericardiotomy syndrome (PPS) is a potential
inflammatory pleuropericardial complication after cardiac surgery.
Symptomatic treatment is similar to acute pericarditis using NSAIDs,
steroids and colchicine. Unfortunately, current recommendation for primary
prevention is not yet available. Objective: This study aims to determine
the efficacy and safety of colchicine for the primary prevention of PPS.
Methods Extensive search for RCTs focusing on the use of colchicine for
primary prevention of PPS was done using several databases. Free text
search for unpublished trials as well as search from the local research
registry was likewise facilitated. Each article was appraised
independently by two reviewers. The data were analyzed using Rev Man 5.
Results: Three RCTs were included with a total of 591 patients. Results
showed that colchicine decreased the incidence of PPS with a risk ratio of
0.43 (95% CI 0.27-0.67, p for effect 0.0002, p for heterogeneity 0.93,
I2=0%). There was no observable publication bias. Majority of the patients
complained of gastrointestinal symptoms and the reasons for drug
withdrawal are mostly related to side effects. Nevertheless, both outcomes
were statistically insignificant compared to placebo. No life threatening
side effect was documented in the study population. Conclusion: As an
anti-inflammatory agent, colchicine is highly effective and appears to be
safe in the primary prevention of PPS.

<58>
Accession Number
71584121
Authors
Khouzam R.N.
Institution
(Khouzam) Department of Medicine, Division of Cardiovascular Diseases,
University of Tennessee Health Science Center, Memphis, TN, United States
Title
Are airbags protective or detrimental to the heart post motor vehicle
accidents?.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 411), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Background: Airbags have been shown to decrease morbidity and mortality
associated with motor vehicle accidents (MVA) when used in conjunction
with seat belts. Airbag deployment alone however, has recently been
implicated as a cause of significant thoracic injuries to unrestrained
drivers. This includes major cardiovascular and pulmonary complications.
Airbags provide safety to occupants of cars and reduce mortality by
25-30%. When not used in accordance with international standards, however,
they can cause serious injury. Objectives: Physicians must maintain a high
index of suspicion for injury when evaluating drivers who were not wearing
seat belts when airbags deployed, regardless of the speed of the collision
given that increased thoracic injury with airbags has also been described
in the literature. Even new technology, specifically Side Air Bag (SAB),
has been associated with a higher rate of thoracic injury. Given that
regulations are a driving force for airbag technology, further research
and scrutiny by medical teams is needed to study the effects of airbag
technology advancements on morbidity and mortality rates of car accidents
to help in making improvements in the future and to guide the lawmakers in
implementing rules that can help protect the safety of occupants. The
major cardiovascular problems following airbag deployment described in the
literature are: aortic transection, tricuspid valve injury delayed cardiac
rupture (right atrial rupture), cardiac contusion (reversible cardiac
injury), acute coronary occlusion and myocardial infarction, aortic valve
avulsion, airbag trauma induced cutaneous fistulae in a heart transplant
patient, delayed cardiac tamponade complicating airbag deployment, and
hemopericardium. The first cases of airbag related cardiac traumas were
reported in 1993. Airbag deployment has been reported to be the cause of
the following thoracic injuries: rib fractures, chest wall burns, sternum
fractures, and bilateral pneumothorax. Airbags have also been implicated
in the following pulmonary conditions: exacerbation of asthma, reactive
airway diseases, new onset asthma, and inhalational chemical pneumonitis.
Methods: We searched online databases from 1970 to January 2013 and
included 17 retrospective studies, 12 systematic review articles, 18 case
reports, 5 prospective studies, 1 lab study, 3 cohort studies and 1
meta-analysis. Outcomes included clinical/functional response, left
ventricular (LV) remodeling, hospitalizations and mortality. Conclusion:
Airbags provide safety to occupants of cars and reduce mortality by
25-30%. Even new airbag technology, has been associated with a higher rate
of thoracic injury including cardiovascular and pulmonary complications.
Further investigation is needed to study the effects of airbag technology
advancements on morbidity and mortality rates of car accidents to aid
lawmakers in implementing rules that can help protect the safety of
occupants.

<59>
Accession Number
71583871
Authors
Martinez J.M. Vijayvargiya P. Tamariz L. Chaparro S.
Institution
(Martinez, Vijayvargiya) University of Miami Miller School of Medicine
Regional Campus, Atlantis, FL, United States
(Tamariz, Chaparro) University of Miami, Miami, FL, United States
Title
Comparison of iloprost and nitric oxide for treatment of pulmonary
hypertension in the setting of cardiovascular surgery-A meta-analysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 161), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Background: Patients undergoing a cardiac surgery (insertion of left
ventricular assist device (LVAD), mitral valve repair, cardiopulmonary
bypass, heart transplant) are at risk of developing right ventricular
failure from increased pulmonary vascular resistance. Pulmonary
hypertension is a risk factor for premature death after heart
transplantation. Iloprost (IL) and Nitric oxide (NO) have been used in
randomized control trials to decrease pulmonary hypertension. The aim of
this study was to identify any significant difference for treatment of
pulmonary hypertension in cardiovascular surgery using NO vs. IL. Methods:
We performed a meta-analysis of studies comparing IL and NO for treatment
of pulmonary hypertension after cardiac surgery. We calculated the
weighted standardized mean difference (SMD) in mean pulmonary artery
pressure after treatment with IL and NO using the DeSirmonian and Laird
method. Results: Seven clinical trials were selected from the databases
MEDLINE, PUBMED, Cochrane and EMBASE with a total of 201 subjects. Three
trials randomized the subjects into NO and IL group and in four studies,
subjects received both Nitric oxide and Iloprost and comparison of
efficacy was done over time. The median dosage of NO was 20 ppm (range
20-40) and the median dosage of IL was 17.5mcg (range 10-50). The median
pulmonary artery pressure for NO was 28 mmHg (range 25-55) and for IL was
35 mmHg (range 25-52). The SMD of mean pulmonary pressure was -0.52; 95%
CI (-1.2-0.1) p = 0.148. Conclusion: NO or IL are equally efficacious in
reducing the mean pulmonary artery pressure after a cardiac surgery. In
light of these findings, IL seems to be a cost effective, selective
pulmonary artery vasodilator, and can be an acceptable alternative to NO.

<60>
Accession Number
71583865
Authors
Agostinho N. Saxena A. Shan L. Vallely M.P. Yan T.D. Newcomb A.E. Bannon
P.G.
Institution
(Agostinho, Saxena, Vallely, Yan, Bannon) Royal Prince Alfred Hospital,
Sydney, NSW, Australia
(Shan, Newcomb) St Vincent's Hospital, Melbourne, VIC, Australia
Title
A systematic review on the quality of life benefits after aortic valve
replacement surgery in the elderly.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 155), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Background: Surgical aortic valve replacement (AVR) is being increasingly
performed on elderly patients with good peri-operative outcomes and
long-term survival. Evidence is limited on healthrelated quality of life
(HRQOL) following AVR which is an important measure of operative success
in the elderly. Methods: A systematic review of clinical studies after
January 2000 was performed to identify HRQOL in the elderly after AVR.
Strict inclusion and exclusion criteria were applied. Quality appraisal of
each study was also performed using pre-defined criteria. HRQOL results
were synthesised through a narrative review with full tabulation of
results of all included studies. Results: HRQOL improvements were shown
across most or all domains in different HRQOL instruments. Elderly
patients experienced marked symptomatic improvement. HRQOL was equivalent
or superior to both an age-matched population as well as younger patients
undergoing identical procedures. There were excellent functional gains
after surgery, but elderly patients remain susceptible to geriatric issues
and mood problems. Concomitant coronary artery bypass did not impact on
HRQOL. There was a diverse range of study designs, methods and follow-up
times which limited direct comparison between studies. Conclusion: AVR
results in significant HRQOL benefits across a broad range of health
domains in elderly patients. Age alone should not be a precluding factor
for surgery. Data is heterogeneous and mostly retrospective. We recommend
future studies based on consistent guidelines provided in this systematic
review.

<61>
Accession Number
71583801
Authors
Farkouh M.E. Udell J.A.
Institution
(Farkouh, Udell) Peter Munk Cardiac Centre, Women's College Hospital,
University of Toronto, Canada
Title
The influenza vaccine- preventing cardiovascular events in high-risk
patients.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
19th World Congress on Heart Disease Annual Scientific Sessions 2014
Boston, MA United States. Conference Start: 20140725 Conference End:
20140728. Conference Publication: (var.pagings). 128 (pp 91), 2014. Date
of Publication: July 2014.
Publisher
S. Karger AG
Abstract
Background: Recent influenza infection is associated with an increased
risk of cardiovascular events. We evaluated whether influenza vaccination
reduces the risk of major adverse cardiovascular events. Methods: We
performed a systematic review and meta-analysis of Medline, Embase, and
the Cochrane central registry (inception - August 2013) for randomized
trials comparing influenza vaccine to standard care/placebo in patients
with, or at high risk of, cardiovascular disease. A composite
cardiovascular endpoint, mortality, and individual cardiovascular events
were detected either as efficacy or safety events in trials with >50
patients. Analyses were stratified by subgroups of patients with and
without a recent acute coronary syndrome (ACS). Results: Six randomized
controlled trials of 6,735 patients (mean age 67 years, 51% women, 36%
with a cardiac history, mean duration of follow-up 8.9 months) were
included. Influenza vaccine reduced the risk of composite cardiovascular
events (2.7% vs. 4.6%; RR 0.64, 95% CI, 0.49-0.84; P=0.001) with a
directionally consistent trend for individual endpoints, including
cardiovascular mortality, all-cause mortality, myocardial infarction,
stroke, heart failure, unstable angina, and coronary revascularization. A
treatment interaction was detected between patients with (RR 0.46, 95% CI,
0.33-0.64) and without (RR 0.91, 95% CI, 0.54-1.54) a recent ACS
(P-interaction=0.03). Results remained significant when an additional 6
trials comprising 16,857 patients randomized to experimental versus
standard influenza vaccination were included. Conclusion: Influenza
vaccine reduced major adverse cardiovascular events and may reduce
cardiovascular mortality in patients with, or at risk of, cardiovascular
disease. A large multicenter trial is warranted to address these findings
and inform policy.

<62>
Accession Number
71587831
Authors
Lewicki M.C. Ng I. Schneider A.G.
Institution
(Lewicki) Department of Nephrology, Monash Medical Centre, Clayton, VIC,
Australia
(Lewicki) Department of Medicine, Monash University, Clayton, VIC,
Australia
(Lewicki, Ng, Schneider) Department of Epidemiology and Preventative
Medicine, Monash University, Clayton, VIC, Australia
(Ng) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Parkville, VIC, Australia
(Schneider) Intensive Care Unit, Centre Hospitalo, Universitaire Vaudois
(CHUV), Lausanne, Switzerland
Title
HMG COA reductase inhibitors (statins) for preventing acute kidney injury
after surgical procedures requiring cardiac bypass: A systematic review
and meta-analysis.
Source
Nephrology. Conference: 50th Annual Scientific Meeting of the Australian
and New Zealand Society of Nephrology Melbourne, VIC Australia. Conference
Start: 20140825 Conference End: 20140827. Conference Publication:
(var.pagings). 19 (pp 30), 2014. Date of Publication: August 2014.
Publisher
Blackwell Publishing
Abstract
Aim: To assess evidence supporting benefits of perioperative statins to
prevent acute kidney injury (AKI) after cardiac bypass surgery. Further,
to determine if use is associated with reduction in mortality, need for
renal replacement therapy (RRT) or if adverse effects are associated with
use. Background: AKI is common in patients undergoing cardiac surgery and
is associated with poor outcomes, prolonged hospital stays and increased
mortality. Statin drugs exert multiple pleiotropic effects independent of
lipid lowering effect, and may ameliorate AKI through inhibition of
postoperative inflammatory responses. Methods: Systematic review and
meta-analysis. Randomised controlled trials (RCT's) comparing statin
therapy to standard care in adult patients undergoing cardiac bypass
surgery and reporting one of AKI, mortality, serum creatinine or need for
RRT. All forms/dosages of statin and any duration of preoperative therapy
were considered for inclusion. Results: Seven trials (662 participants).
Six of the seven trials were rated as high risk of bias. Three trials
assessed atorvastatin, three simvastatin and one rosuvastatin. Overall,
statin treatment was not associated with a reduction in postoperative AKI,
need for RRT or mortality. Two studies (195 patients) reported
postoperative serum creatinine. Patients receiving statins had lower
postoperative serum creatinine compared placebo (mean difference 21.2
mumol/L, 95%CI -31.1, -11.1). Adverse effects were only adequately
reported in one trial, with no difference seen between groups.
Conclusions: The analysis does not suggest that preoperative statin use is
associated with decreased AKI in adults after cardiac bypass surgery.
Other results must be interpreted with caution as only a limited number of
studies were included in subgroup analyses. High quality RCT's are still
required to establish the utility of statins to prevent AKI after cardiac
surgery.