EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
25172965
Authors
Imazio M. Brucato A. Ferrazzi P. Pullara A. Adler Y. Barosi A. Caforio
A.L. Cemin R. Chirillo F. Comoglio C. Cugola D. Cumetti D. Dyrda O. Ferrua
S. Finkelstein Y. Flocco R. Gandino A. Hoit B. Innocente F. Maestroni S.
Musumeci F. Oh J. Pergolini A. Polizzi V. Ristic A. Simon C. Spodick D.H.
Tarzia V. Trimboli S. Valenti A. Belli R. Gaita F. COPPS-2 Investigators
Institution
(Imazio) Cardiology Department, Maria Vittoria Hospital, Torino,
Italy2University of Torino, Torino, Italy.
(Brucato, Ferrazzi, Cugola, Cumetti, Innocente, Maestroni, Simon, Valenti)
Ospedale Papa Giovanni XXIII, Bergamo, Italy.
(Pullara, Gaita) University of Torino, Torino, Italy4AOU Citta della
Salute e della Scienza di Torino, Torino, Italy.
(Adler) Chaim Sheba Medical Center, Tel Hashomer and Sacker University,
Tel Aviv, Israel.
(Barosi, Gandino) Department of Internal Medicine and Cardiac Surgery,
Ospedale Niguarda, Milano, Italy.
(Caforio, Tarzia) Department of Cardiological Thoracic and Vascular
Sciences, University of Padova, Padova, Italy.
(Cemin) Cardiology Department, Ospedale Regionale San Maurizio, Bolzano,
Italy.
(Chirillo) Department of Cardiology and Cardiac Surgery, Ca Foncello
Hospital, Treviso, Italy.
(Comoglio, Dyrda, Trimboli) Department of Cardiac Surgery and
Rehabilitation, Villa Maria Pia Hospital, Torino, Italy.
(Ferrua) Department of Cardiology, Ospedale degli Infermi, Rivoli, Italy.
(Finkelstein) Department of Pediatrics, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada.
(Flocco) Cardiac Surgery, Ospedale Mauriziano, Torino, Italy.
(Hoit) Case Western Reserve University, Cleveland, Ohio15University
Hospitals Case Medical Center, Cleveland, Ohio.
(Musumeci, Pergolini, Polizzi) Department of Cardiac Surgery, Ospedale San
Camillo, Roma, Italy.
(Oh) Division of Cardiovascular Disease, Mayo Clinic, Rochester,
Minnesota.
(Ristic) Department of Cardiology, Belgrade University School of Medicine
and Clinical Centre of Serbia, Belgrade, Serbia.
(Spodick) St Vincent Hospital, Worcester, Massachusetts.
(Belli) Cardiology Department, Maria Vittoria Hospital, Torino, Italy.
Title
Colchicine for prevention of postpericardiotomy syndrome and postoperative
atrial fibrillation: the COPPS-2 randomized clinical trial.
Source
JAMA. 312 (10) (pp 1016-1023), 2014. Date of Publication: 10 Sep 2014.
Abstract
Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and
postoperative effusions may be responsible for increased morbidity and
health care costs after cardiac surgery. Postoperative use of colchicine
prevented these complications in a single trial. To determine the efficacy
and safety of perioperative use of oral colchicine in reducing
postpericardiotomy syndrome, postoperative AF, and postoperative
pericardial or pleural effusions. Investigator-initiated, double-blind,
placebo-controlled, randomized clinical trial among 360 consecutive
candidates for cardiac surgery enrolled in 11 Italian centers between
March 2012 and March 2014. At enrollment, mean age of the trial
participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had
planned valvular surgery. Main exclusion criteria were absence of sinus
rhythm at enrollment, cardiac transplantation, and contraindications to
colchicine. Patients were randomized to receive placebo (n=180) or
colchicine (0.5 mg twice daily in patients >70 kg or 0.5 mg once daily in
patients <70 kg; n=180) starting between 48 and 72 hours before surgery
and continued for 1 month after surgery. Occurrence of postpericardiotomy
syndrome within 3 months; main secondary study end points were
postoperative AF and pericardial or pleural effusion. The primary end
point of postpericardiotomy syndrome occurred in 35 patients (19.4%)
assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute
difference, 10.0%; 95% CI, 1.1%-18.7%; number needed to treat = 10). There
were no significant differences between the colchicine and placebo groups
for the secondary end points of postoperative AF (colchicine, 61 patients
[33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% CI,
-2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine,
103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference,
1.7%; 95% CI, -8.5% to 11.7%), although there was a reduction in
postoperative AF in the prespecified on-treatment analysis (placebo,
61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute
difference, 14.2%; 95% CI, 3.3%-24.7%). Adverse events occurred in 21
patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine
group (absolute difference, 8.3%; 95% CI; 0.76%-15.9%; number needed to
harm = 12), but discontinuation rates were similar. No serious adverse
events were observed. Among patients undergoing cardiac surgery,
perioperative use of colchicine compared with placebo reduced the
incidence of postpericardiotomy syndrome but not of postoperative AF or
postoperative pericardial/pleural effusion. The increased risk of
gastrointestinal adverse effects reduced the potential benefits of
colchicine in this setting. clinicaltrials.gov Identifier: NCT01552187.

<2>
Accession Number
24482012
Authors
Moller C.H. Steinbruchel D.A.
Institution
(Moller) Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark,
Title
Off-pump versus on-pump coronary artery bypass grafting.
Source
Current cardiology reports. 16 (3) (pp 455), 2014. Date of Publication:
Mar 2014.
Abstract
Coronary artery bypass grafting (CABG) remains the preferred treatment in
patients with complex coronary artery disease. However, whether the
procedure should be performed with or without the use of cardiopulmonary
bypass, referred to as off-pump and on-pump CABG, is still up for debate.
Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the
systemic inflammatory response from extracorporeal circulation is omitted,
but no single randomized trial has been able to prove off-pump CABG
superior to on-pump CABG as regards the hard outcomes death, stroke or
myocardial infarction. In contrast, off-pump CABG is technically more
challenging and may be associated with increased risk of incomplete
revascularization. The purpose of the review is to summarize the current
literature comparing outcomes of off-pump versus on-pump coronary artery
bypass surgery.

<3>
Accession Number
2014586659
Authors
Colquitt J.L. Mendes D. Clegg A.J. Harris P. Cooper K. Picot J. Bryant J.
Institution
(Colquitt, Mendes, Clegg, Harris, Cooper, Picot, Bryant) Southampton
Health Technology Assessments Centre (SHTAC), University of Southampton,
Southampton, United Kingdom
Title
Implantable cardioverter defibrillators for the treatment of arrhythmias
and cardiac resynchronisation therapy for the treatment of heart failure:
Systematic review and economic evaluation.
Source
Health Technology Assessment. 18 (56) (pp 1-559), 2014. Date of
Publication: 2014.
Publisher
NIHR Journals Library
Abstract
Background: This assessment updates and expands on two previous technology
assessments that evaluated implantable cardioverter defibrillators (ICDs)
for arrhythmias and cardiac resynchronisation therapy (CRT) for heart
failure (HF). Objectives: To assess the clinical effectiveness and
cost-effectiveness of ICDs in addition to optimal pharmacological therapy
(OPT) for people at increased risk of sudden cardiac death (SCD) as a
result of ventricular arrhythmias despite receiving OPT; to assess CRT
with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for
people with HF as a result of left ventricular systolic dysfunction (LVSD)
and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in
addition to OPT for people with both conditions. Data sources: Electronic
resources including MEDLINE, EMBASE and The Cochrane Library were searched
from inception to November 2012. Additional studies were sought from
reference lists, clinical experts and manufacturers' submissions to the
National Institute for Health and Care Excellence. Review methods:
Inclusion criteria were applied by two reviewers independently. Data
extraction and quality assessment were undertaken by one reviewer and
checked by a second. Data were synthesised through narrative review and
meta-analyses. For the three populations above, randomised controlled
trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D
with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were
eligible. Outcomes included mortality, adverse events and quality of life.
A previously developed Markov model was adapted to estimate the
cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations
by simulating disease progression calculated at 4-weekly cycles over a
lifetime horizon. Results: A total of 4556 references were identified, of
which 26 RCTs were included in the review: 13 compared ICD with medical
therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with
ICD. ICDs reduced all-cause mortality in people at increased risk of SCD,
defined in trials as those with previous ventricular arrhythmias/cardiac
arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic
cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF
and left ventricular ejection fraction < 35%. There was no benefit in
people scheduled for coronary artery bypass graft. A reduction in SCD but
not all-cause mortality was found in people with recent MI. Incremental
cost-effectiveness ratios (ICERs) ranged from 14,231 per quality-adjusted
life-year (QALY) to 29,756 per QALY for the scenarios modelled. CRT-P and
CRT-D reduced mortality and HF hospitalisations, and improved other
outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony
when compared with OPT. The rate of SCD was lower with CRT-D than with
CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT
produced ICERs of 27,584 per QALY and 27,899 per QALY respectively. The
ICER for CRT-D compared with CRT-P was 28,420 per QALY. In people with
both conditions, CRT-D reduced the risk of all-cause mortality and HF
hospitalisation, and improved other outcomes, compared with ICDs.
Complications were more common with CRT-D. Initial management with OPT
alone was most cost-effective (ICER 2824 per QALY compared with ICD) when
health-related quality of life was kept constant over time. Costs and
QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with
ICD was 27,195 per QALY and that for CRT-D compared with OPT was 35,193
per QALY. Limitations: Limitations of the model include the structural
assumptions made about disease progression and treatment provision, the
extrapolation of trial survival estimates over time and the assumptions
made around parameter values when evidence was not available for specific
patient groups. Conclusions: In people at risk of SCD as a result of
ventricular arrhythmias and in those with HF as a result of LVSD and
cardiac dyssynchrony, the interventions modelled produced ICERs of <
30,000 per QALY gained. In people with both conditions, the ICER for CRT-D
compared with ICD, but not CRT-D compared with OPT, was < 30,000 per QALY,
and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing
CRT-D and CRT-P in people with HF as a result of LVSD and cardiac
dyssynchrony is required, for both those with and those without an ICD
indication. A RCT is also needed into the benefits of ICD in non-ischaemic
cardiomyopathy in the absence of dyssynchrony. Study registration: This
study is registered as PROSPERO number CRD42012002062. Funding: The
National Institute for Health Research Health Technology Assessment
programme. Queen's Printer and Controller of HMSO 2014.

<4>
Accession Number
2014576450
Authors
Suresh S. Schaldenbrand K. Wallis B. De Oliveira G.S.
Institution
(Suresh, Schaldenbrand) Department of Anesthesiology, Ann and Robert H.
Lurie Children's Hospital of Chicago, Chicago, IL, United States
(Wallis, De Oliveira) Department of Anesthesiology, Northwestern
University, 241 East Huron St., F5-704, Chicago, IL, United States
Title
Regional anaesthesia to improve pain outcomes in paediatric surgical
patients: A qualitative systematic review of randomized controlled trials.
Source
British Journal of Anaesthesia. 113 (3) (pp 375-390), 2014. Date of
Publication: September 2014.
Publisher
Oxford University Press
Abstract
The development of analgesic interventions in paediatric surgical patients
is often limited by the inherent difficulties of conducting large
randomized clinical trials to test interventions in those patients.
Regional anaesthesia is a valid strategy to improve postoperative pain in
the adult surgical population, but the effects of regional anaesthesia on
postoperative pain outcomes in paediatric patients are currently not well
defined. The main objective of the current review was to systematically
evaluate the use of regional anaesthesia techniques to minimize
postoperative pain in paediatric patients. A systematic search was
performed to identify randomized controlled trials that evaluated the
effects of the regional anaesthesia techniques on postoperative pain
outcomes in paediatric surgical patients' procedures. Seventy-three
studies on 5125 paediatric patients were evaluated. Only few surgical
procedures had more than one small randomized controlled trial favouring
the use of regional anaesthesia to minimize postoperative pain
(ophthalmological surgery, cleft lip repair, inguinal hernia, and
urological procedures). Additional evidence is required to support the use
of specific regional anaesthesia techniques to improve postoperative pain
for several surgical procedures (craniectomy, adenotonsillectomy,
appendectomy, cardiac surgery, umbilical hernia repair, upper and lower
extremity) in paediatric patients. Currently, only a very limited number
of regional anaesthesia techniques have demonstrated significant
improvement on postoperative pain outcomes for a restricted number of
surgical procedures. More studies are needed in order to establish
regional anaesthesia as a valid strategy to improve analgesia in the
paediatric surgical population. The Author 2014.

<5>
Accession Number
2014562477
Authors
Johnson J. Manouras A. Bergholm F. Brodin L.A. Agewall S. Henareh L.
Institution
(Johnson, Manouras, Bergholm, Brodin) School for Technology and Health,
Royal Institute of Technology, Stockholm, Sweden
(Manouras, Henareh) Department of Cardiology, Karolinska University
Hospital, Karolinska Institute, Huddinge, Stockholm, Sweden
(Agewall) Department of Cardiology, Oslo University Hospital Ullevaal,
Ulleval and Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
Title
The early diastolic myocardial velocity: A marker of increased risk in
patients with coronary heart disease.
Source
Clinical Physiology and Functional Imaging. 34 (5) (pp 389-396), 2014.
Date of Publication: September 2014.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Tissue Doppler imaging (TDI) is a promising echocardiographic
modality allowing quantification of myocardial performance. However, the
prognostic potential of TDI in patients with acute myocardial infarction
(AMI) is not yet investigated. We sought to explore the ability of TDI in
identifying patients at risk for new cardiovascular events after AMI.
Methods: One hundred and nineteen patients with AMI were recruited
prospectively (mean age 61 years; range 32-81 years of age). Patients with
diabetes mellitus (DM) were excluded. Echocardiography was performed 3-12
months after AMI. Two-dimensional (2-D) and TDI variables were recorded.
The patients were followed during a mean period of 46 years (range 1-8
years). The primary end-point was defined as any of the following: death
from any cause, non-fatal reinfarction or stroke, unstable angina
pectoris, congestive heart failure requiring hospitalization and coronary
revascularization procedure. Results: Thirty patients had some form of
cardiovascular events during follow-up. Seven patients had cardiovascular
death, 13 patients had reinfarction and four patients had a stroke. New
angina or unstable angina was recorded in 21 patients. Of these patients,
13 underwent percutaneous coronary angioplasty (PCI) or coronary artery
bypass grafting (CABG). The early diastolic myocardial velocity
(E_m) emerged as the only echocardiographic variable that
offered a clear differentiation between patients that presented with new
cardiovascular (CV) events as compared to the corresponding group without
any CV events at follow-up (P<005). In multivariate statistical analysis
and after adjustment for age, sex, total cholesterol, body mass index
(BMI) and other baseline characteristics, Em remained as independent
predictors of CV events (HR, 118, 95% CI, 102-136; P<005). However, none
of the investigated variables evolved as an independent predictor of
cardiovascular morbidity and mortality. Conclusion: E_m appears
to be a sensitive echocardiographic index in identifying non-diabetic
patients with AMI at risk of new cardiovascular events. 2013 Scandinavian
Society of Clinical Physiology and Nuclear Medicine.

<6>
Accession Number
2014505693
Authors
Fleischer S. Berg A. Behrens J. Kuss O. Becker R. Horbach A. Neubert T.R.
Institution
(Fleischer, Berg, Behrens) Institute of Health and Nursing Science,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Kuss) Institute of Medical Epidemiology, Biostatistics and Informatics,
Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
(Becker) Stadtisches Klinikum Munchen GmbH Akademie, Munich, Germany
(Horbach) Sana Herzchirurgische Klinik Stuttgart, Stuttgart, Germany
(Horbach) Department 4: Health and Social Work, University of Applied
Sciences, Frankfurt/Main, Germany
(Horbach) Hessian Institute of Nursing Research (HessIP), Franfurt/Main,
Germany
(Neubert) Department of Nursing Research, University Hospital Giessen and
Marburg, Location Marburg, Germany
(Neubert) Institute for Theoretical Surgery/Department of Visceral,
Thoracic and Vascular Surgery, University Hospital Giessen and Marburg,
Location Marburg, Germany
Title
Does an additional structured information program during the intensive
care unit stay reduce anxiety in ICU patients?: A multicenter randomized
controlled trial.
Source
BMC Anesthesiology. 14 , 2014. Article Number: 48. Date of Publication:
28 Jun 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Communication and information in order to reduce anxiety in
the intensive care unit (ICU) has been described as area needing
improvement. Therefore, the aim of this trial was to evaluate whether a
structured information program that intensifies information given in
standard care process reduces anxiety in ICU patients.Methods:
Multicenter, two-armed, non-blinded, parallel-group randomized controlled
trial in hospitals in the cities of Marburg, Halle, and Stuttgart
(Germany). The trial was performed in cardiac surgery, general surgery,
and internal medicine ICUs. Two-hundred and eleven elective and
non-elective ICU patients were enrolled in the study (intervention group,
n = 104; control group, n = 107). The experimental intervention comprised
a single episode of structured oral information that was given in addition
to standard care and covered two main parts: (1) A more standardized part
about predefined ICU specific aspects - mainly procedural, sensory and
coping information, and (2) an individualized part about fears and
questions of the patient. The control group received a non-specific
episodic conversation of similar length additional to standard care. Both
conversations took place at the beginning of the ICU stay and lasted 10-15
minutes. Study nurses administered both interventions. The primary outcome
ICU-related anxiety (CINT-Score, 0-100 pts., higher scores indicate higher
anxiety) was assessed after admission to a regular ward.Results: The
primary outcome could be measured in 82 intervention group participants
and 90 control group participants resulting in mean values of 20.4 (SD
14.4) compared to 20.8 (SD 14.7) and a mean difference of -0.2 (CI 95%
-4.5 to 4.1).Conclusions: A structured information intervention additional
to standard care during ICU stay had no demonstrated additional benefit
compared to an unspecific communication of similar duration. Reduction of
anxiety in ICU patients will probably require more continuous approaches
to information giving and communication.Trial registration:
ClinicalTrials.gov NCT00764933. 2014 Fleischer et al.; licensee BioMed
Central Ltd.

<7>
Accession Number
2014563752
Authors
Liu Y. Li S. Zeng Z. Wang J. Xie L. Li T. He Y. Qin X. Zhao J.
Institution
(Liu, Li, Wang, Xie, Li, He, Qin) Department of Clinical Laboratory, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang
Autonomous Region, China
(Zeng) Department of Cardiology, First Affiliated Hospital of Guangxi
Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
(Zhao) Department of Orthopaedics Trauma and Hand Surgery, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang
Autonomous Region, China
Title
Kidney stones and cardiovascular risk: A meta-analysis of cohort studies.
Source
American Journal of Kidney Diseases. 64 (3) (pp 402-410), 2014. Date of
Publication: September 2014.
Publisher
W.B. Saunders
Abstract
Background Recent epidemiologic evidence suggests an association between
kidney stones and incident cardiovascular disease after adjusting for
other cardiovascular risk factors, but results are inconsistent. Study
Design Meta-analysis of cohort studies. Setting & Population Patients with
kidney stones. Selection Criteria for Studies Cohort studies with data for
kidney stones and cardiovascular morbidity identified in PubMed, EMBASE,
Cochrane Central Register of Controlled Trials, and conference proceedings
through February 27, 2014. Predictor Kidney stones as determined by
physician diagnosis, clinical coding, or self-reported scales. Outcomes
Cardiovascular disease, coronary heart disease (CHD), and stroke. Results
6 cohort studies that contained 49,597 patients with kidney stones and
3,558,053 controls, with 133,589 cardiovascular events, were included.
Pooled results suggested that kidney stones were associated with an
increased adjusted risk estimate for CHD (HR, 1.19; 95% CI, 1.05-1.35; P =
0.05; n = 6 cohorts) and stroke (HR, 1.40; 95% CI, 1.20-1.64; P < 0.001; n
= 3 cohorts). In particular, kidney stones conferred HRs of 1.29 (95% CI,
1.10-1.52; n = 6 cohorts) and 1.31 (95% CI, 1.05-1.65; n = 4 cohorts) for
myocardial infarction and coronary revascularization, respectively.
Moreover, the pooled female cohorts showed a statistically significant
association (HR, 1.49; 95% CI, 1.21-1.82; n = 4 cohorts), whereas the male
cohorts showed no association (HR, 1.15; 95% CI, 0.89-1.50; n = 2
cohorts). Limitations Results may be limited by substantial heterogeneity,
likelihood of residual confounding, and paucity of studies that separately
evaluated for effect modification by sex. Conclusions Kidney stones were
associated with increased cardiovascular risk, including the risk for
incident CHD or stroke. There is some suggestion that the risk may be
higher in women than men. Further prospective studies are needed to
determine whether the association is sex specific. 2014 by the National
Kidney Foundation, Inc.

<8>
Accession Number
2014461086
Authors
Haycock P.C. Heydon E.E. Kaptoge S. Butterworth A.S. Thompson A. Willeit
P.
Institution
(Haycock, Heydon, Kaptoge, Butterworth, Thompson, Willeit) Strangeways
Research Laboratory, Institute of Public Health, University of Cambridge,
Cambridge, United Kingdom
(Haycock) Medical Research Council Integrative Epidemiology Unit, School
of Social and Community Medicine, University of Bristol, Bristol, United
Kingdom
(Thompson) Roche, Welwyn Garden City, United Kingdom
(Willeit) Department of Neurology, Innsbruck Medical University, Austria
Title
Leucocyte telomere length and risk of cardiovascular disease: Systematic
review and meta- Analysis.
Source
BMJ (Online). 349 , 2014. Article Number: g4227. Date of Publication: 08
Jul 2014.
Publisher
BMJ Publishing Group
Abstract
Objective To assess the association between leucocyte telomere length and
risk of cardiovascular disease. Design Systematic review and meta-
Analysis. Data sources Studies published up to March 2014 identified
through searches of Medline, Web of Science, and Embase. Eligibility
criteria Prospective and retrospective studies that reported on
associations between leucocyte telomere length and coronary heart disease
(defined as non-fatal myocardial infarction, coronary heart disease death,
or coronary revascularisation) or cerebrovascular disease (defined as
non-fatal stroke or death from cerebrovascular disease) and were broadly
representative of general populations- That is, they did not select cohort
or control participants on the basis of pre-existing cardiovascular
disease or diabetes. Results Twenty four studies involving 43 725
participants and 8400 patients with cardiovascular disease (5566 with
coronary heart disease and 2834 with cerebrovascular disease) were found
to be eligible. In a comparison of the shortest versus longest third of
leucocyte telomere length, the pooled relative risk for coronary heart
disease was 1.54 (95% confidence interval 1.30 to 1.83) in all studies,
1.40 (1.15 to 1.70) in prospective studies, and 1.80 (1.32 to 2.44) in
retrospective studies. Heterogeneity between studies was moderate
(I²=64%, 41% to 77%, P_het<0.001) and was not
significantly explained by mean age of participants (P=0.23), the
proportion of male participants (P=0.45), or distinction between
retrospective versus prospective studies (P=0.32). Findings for coronary
heart disease were similar in meta- Analyses restricted to studies that
adjusted for conventional vascular risk factors (relative risk 1.42, 95%
confidence interval 1.17 to 1.73); studies with >200 cases (1.44, 1.20 to
1.74); studies with a high quality score (1.53, 1.22 to 1.92); and in
analyses that corrected for publication bias (1.34, 1.12 to 1.60). The
pooled relative risk for cerebrovascular disease was 1.42 (1.11 to 1.81),
with no significant heterogeneity between studies (I²=41%, 0%
to 72%, P _het=0.08). Shorter telomeres were not significantly
associated with cerebrovascular disease risk in prospective studies (1.14,
0.85 to 1.54) or in studies with a high quality score (1.21, 0.83 to
1.76). Conclusion Available observational data show an inverse association
between leucocyte telomere length and risk of coronary heart disease
independent of conventional vascular risk factors. The association with
cerebrovascular disease is less certain.

<9>
Accession Number
2014432608
Authors
Windecker S. Stortecky S. Stefanini G.G. DaCosta B.R. Rutjes A.W. Di Nisio
M. Siletta M.G. Maione A. Alfonso F. Clemmensen P.M. Collet J.-P. Cremer
J. Falk V. Filippatos G. Hamm C. Head S. Kappetein A.P. Kastrati A. Knuuti
J. Landmesser U. Laufer G. Neumann F.-J. Richter D. Schauerte P. Uva M.S.
Taggart D.P. Torracca L. Valgimigli M. Wijns W. Witkowski A. Kolh P. Juni
P.
Institution
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Department of Cardiology, University Hospital Bern, Bern
University Hospital, 3010 Bern, Switzerland
(Windecker, Stortecky, Stefanini, DaCosta, Rutjes, Di Nisio, Siletta,
Maione, Juni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Title
Revascularisation versus medical treatment in patients with stable
coronary artery disease: Network meta-analysis.
Source
BMJ (Online). 348 , 2014. Article Number: g3859. Date of Publication: 23
Jun 2014.
Publisher
BMJ Publishing Group
Abstract
Objective: To investigate whether revascularisation improves prognosis
compared with medical treatment among patients with stable coronary artery
disease. Design: Bayesian network meta-analyses to combine direct within
trial comparisons between treatments with indirect evidence from other
trials while maintaining randomisation. Eligibility criteria for selecting
studies: A strategy of initial medical treatment compared with
revascularisation by coronary artery bypass grafting or Food and Drug
Administration approved techniques for percutaneous revascularization:
balloon angioplasty, bare metal stent, early generation paclitaxel eluting
stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent,
and new generation everolimus eluting stent, and zotarolimus eluting
(Resolute) stent among patients with stable coronary artery disease. Data
sources: Medline and Embase from 1980 to 2013 for randomised trials
comparing medical treatment with revascularisation. Main outcome measure:
All cause mortality. Results: 100 trials in 93 553 patients with 262 090
patient years of follow-up were included. Coronary artery bypass grafting
was associated with a survival benefit (rate ratio 0.80, 95% credibility
interval 0.70 to 0.91) compared with medical treatment. New generation
drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus
(Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to
1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug
eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to
1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with
improved survival compared with medical treatment. Coronary artery bypass
grafting reduced the risk of myocardial infarction compared with medical
treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a
trend towards a reduced risk of myocardial infarction (0.75, 0.55 to
1.01). The risk of subsequent revascularisation was noticeably reduced by
coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new
generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to
0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting
stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24
to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69,
0.59 to 0.81) compared with medical treatment. Conclusion: Among patients
with stable coronary artery disease, coronary artery bypass grafting
reduces the risk of death, myocardial infarction, and subsequent
revascularisation compared with medical treatment. All stent based
coronary revascularisation technologies reduce the need for
revascularisation to a variable degree. Our results provide evidence for
improved survival with new generation drug eluting stents but no other
percutaneous revascularisation technology compared with medical treatment.

<10>
Accession Number
2014808709
Authors
Tie H.-T. Luo M.-Z. Luo M.-J. Zhang M. Wu Q.-C. Wan J.-Y.
Institution
(Tie, Zhang, Wu) Department of Cardiothoracic Surgery, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Luo, Wan) Chongqing Key Laboratory of Biochemistry and Molecular
Pharmacology, Chongqing Medical University, Chongqing 400016, China
(Luo) The Children's Hospital of Chongqing Medical University, Chongqing
400016, China
Title
Sodium bicarbonate in the prevention of cardiac surgery-associated acute
kidney injury: A systematic review and meta-analysis.
Source
Critical Care. 18 (5) , 2014. Article Number: 517. Date of Publication:
September 12, 2014.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Sodium bicarbonate (SBIC) was reported to be a promising
approach to prevent cardiac surgery-associated acute kidney injury
(CSA-AKI). However, the results remain controversial. We conducted a
systematic review and meta-analysis to evaluate the efficacy and safety of
SBIC on the prevention of CSA-AKI in adult patients undergoing cardiac
surgery.Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane
library databases were systematically searched. Randomized controlled
trials (RCTs) assessing the effect of SBIC versus placebo on the
prevention of CSA-AKI in adult patients undergoing cardiac surgery were
included. Two investigators independently searched articles, extracted
data, and assessed the quality of included studies. The primary outcome
was the incidence of CSA-AKI. Meta-analysis was performed using
random-effects models.Results: Five RCTs involving 1079 patients were
included in the meta-analysis. Overall, compared with placebo, SBIC was
not associated with a reduced risk of CSA-AKI (relative risk [RR] 0.99;
95% confidence interval [CI] 0.78 to 1.24; P = 0.911). SBIC failed to
alter the clinical outcomes of hospital length of stay (weighted mean
difference [WMD] 0.23 days; 95%CI -0.88 to 1.33 days; P = 0.688), renal
replacement therapy (RR 0.94; 95%CI 0.49 to 1.82; P = 0.861), hospital
mortality (RR 1.37; 95%CI 0.46 to 4.13; P = 0.572), postoperative atrial
fibrillation (RR 1.02; 95%CI 0.65 to 1.61; P = 0.915). However, SBIC was
associated with significant increased risks in longer duration of
ventilation (WMD 0.64 hours; 95%CI 0.16 to 1.11 hours; P = 0.008), longer
ICU length of stay (WMD 2.06 days; 95%CI 0.54 to 3.58 days; P = 0.008),
and increased incidence of alkalemia (RR 2.21; 95%CI 1.42 to 3.42; P
<0.001).Conclusions: SBIC could not reduce the incidence of CSA-AKI.
Contrarily, SBIC prolongs the duration of ventilation and ICU length of
stay, and increases the risk of alkalemia. Thus, SBIC should not be
recommended for the prevention of CSA-AKI and perioperative SBIC infusion
should be administrated with caution.

<11>
Accession Number
71633720
Authors
Garcia D. Ansari M.M. Martinez C.A. Ferreira A. De Marchena E.
Institution
(Garcia, Ferreira) University of Miami, Miami, FL, United States
(Ansari) University of Miami, Jackson Memorial Hospital, Miami, FL, United
States
(Martinez, De Marchena) University of Miami, Miller School of Medicine,
Miami, FL, United States
Title
Comparison between of mitral balloon valvuloplasty and surgical
commissurotomy for mitral valve stenosis: Meta-analysis of the randomized
clinical trials.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B238-B239),
2014. Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Percutaneous mitral valvuloplasty (PMB) has been described as
a feasible alternative option for surgical commissurotomy among patients
with mitral valve stenosis. We aimed to evaluate the post procedures
outcomes and its clinical significance on long term follow up between
these two treatment modalities. Methods: Pub Med, Cochrane and Scopus were
systematically searched up to May 2014. Subjects of analysis were post
procedure hemodynamic analysis of mitral valve area by Gorlin formula and
transmitral gradient. Post procedure long term follow-up outcomes were
analyzed by MVA, mitral valve re-stenosis, new or increase of mitral
regurgitation, and poor clinical status as NYHA class III/IV. We used
Fixed or Random Effect analysis using the Cochrane Handbook of Systematic
Reviews. Results: A total of 9 RCTs were selected and provided a total of
1200 patients on the PBM group and 1020 patients on the surgical group.
The PMB presented with a trend towards higher MVA with significant
decrease of the transmitral gradient (Figure 1). Clinical follow up
disclosed no difference among groups (Figure 2). (Figure Presented)
Conclusions: Our analysis could suggest that PMB might be non-inferior to
surgical commissurotomy presenting with good post procedural outcomes and
similar clinical results. Therefore further larger clinical randomized
studies are warranted.

<12>
Accession Number
71633689
Authors
Cardoso R.N. Ghatak A. Bavishi C. Macon C. O'Neill B. Singh V. Alfonso C.
Ferreira A. Heldman A.W. O'Neill W.W. De Marchena E. Cohen M.G.
Institution
(Cardoso, Ghatak, Macon, Singh, Alfonso, Ferreira, Heldman, De Marchena,
Cohen) University of Miami Miller, School of Medicine, Miami, FL, United
States
(Bavishi) St. Luke Roosevelt Hospital Center, New York, NY, United States
(O'Neill) Temple University, Philadelphia, PA, United States
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
Title
Comparison of 30-day major vascular complications between transfemoral and
transapical accesses in transcatheter aortic valve replacement: An updated
meta-analysis using standardized definitions.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B229), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Direct comparison of transfemoral (TF) and transapical (TA)
accesses for Transcatheter Aortic Valve Replacement (TAVR) is troublesome
due to heterogeneity in outcome definitions between studies. We used
applied standardized Valve Academic Research Consortium (VARC) definition
of vascular complications to perform an updated meta-analysis for patients
receiving Edwards SAPIEN TAVR via TF and TA approaches. Methods: Pubmed
and Scopus databases were searched for studies that compared the incidence
of major vascular complications in TF and TA accesses in Edwards SAPIEN
TAVR procedures. Random-effects model was used to calculate the relative
risk. Heterogeneity was assessed with Higgins and Thompson I2 statistic.
All analyses were performed using STATA 11.2 (Texas, USA). Results:
Fourteen studies met all inclusion criteria. A total of 2,526 patients
were included, of which 1,337 (52.9%) had TF TAVR. As illustrated in
figure 1, the pooled risk of major vascular complications with the TF
access was significantly higher than the TA approach (17.2% x 5.2%,
respectively; RR 2.94, 95% CI 2.08-4.14). This difference was consistent
among studies that predated VARC criteria (RR 3.18, 95% CI 1.86-5.45) and
those that adopted VARC standardized outcome definitions (RR 2.48; 95% CI
1.68-3.64). (Table Presented) Conclusions: In this updated meta-analysis,
TF access was associated with a significantly higher incidence of 30-day
major vascular complications when compared to the TA technique. This
difference persisted in studies that used standardized VARC definitions.

<13>
Accession Number
71633683
Authors
Ghatak A. Bavishi C. Cardoso R.N. Macon C. Singh V. Badheka A. O'Neill B.
Padala S. Alfonso C. Cohen M.G. Heldman A.W. Ferreira A. Mitrani R.
Carrillo R.G. Williams D. O'Neill W.W. De Marchena E.
Institution
(Ghatak, Cardoso, Macon, Singh, Alfonso, Cohen, Heldman, Ferreira,
Mitrani, Carrillo, Williams, De Marchena) University of Miami Miller,
School of Medicine, Miami, FL, United States
(Bavishi) St. Luke Roosevelt Hospital Center, New York, NY, United States
(Badheka) Wayne State University, Detroit, MI, United States
(O'Neill) Temple University, Philadelphia, PA, United States
(Padala) Albany Medical Center, Albany, NY, United States
(O'Neill) Henry Ford Hospital, Detroit, United States
Title
A comparison of the complications and mortality between the transapical
and transfemoral accesses for transcatheter aortic valve replacement with
Edwards SAPIEN valve: PARTNER trial vs worldwide studies and registries.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B227), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: The Placement of Aortic Transcatheter Valves (PARTNER) study
was the first randomized controlled study involving the Edwards SAPIEN
valve. We intended to compare outcomes of transfemoral(TF) vs
transapical(TA) access for Transcutaneous Aortic Valve Replacement (TAVR)
between the rigorous PARTNER trial environment and real-world patient
registries. Methods: We searched databases for Edwards SAPIEN TAVR studies
comparing the TF and TA approaches regarding the following outcomes:
30-day and 1-year mortality; 30-day stroke; 30-day permanent pacemaker
implantation; and 30-day vascular complications. The outcomes were then
compared between the PARTNER trial and the pooled data from remaining
studies. Results: The PARTNER trial had 244 TF and 104 TA patients. In the
pooled data from 17 studies, TA patients had a significantly higher
EuroSCORE as compared to TF patients (24.6+12.9 vs 21.3+12.0; p< 0.001).
In the intention-to-treat analysis of the PARTNER study the EuroSCORE was
not significantly different between the TA and TF groups (29.8+15.9 vs
29.1+ 16.1; p=0.61). As shown in Table 1, 30-day and 1-year mortality were
similar between the two approaches in the PARTNER trial; conversely,
pooled results showed a significantly decreased risk with the TF approach.
The PARTNER trial and remaining studies showed an increased incidence of
30-day vascular complications in the TF arm and a similar risk of 30-day
stroke incidence and new pacemaker insertion between accesses. (Table
Presented) Conclusions: The observed difference in mortality is likely
secondary to the effect of randomization in thePARTNERtrial with
comparable pre-proceduremortality risk scores between the TA and TF arms.A
reduction in the relative risk of vascular complications in the TF arm in
the pooled data vs PARTNER trial is likely due to improvement in overall
screening, valves with smaller delivery sheath, and increasing operator
expertise.

<14>
Accession Number
71633675
Authors
Kanmanthareddy A.K. Buddam A.R. Sharma S. Vallakati A. Afzal M.R. Dacha S.
Devidi M. Koripalli V.S. Adabala N.P. Reddy M. Lakkireddy D.
Institution
(Kanmanthareddy, Koripalli, Reddy, Lakkireddy) University of Kansas
Hospital, Kansas City, KS, United States
(Buddam, Sharma) University of Kansas Medical Center, Kansas City, KS,
United States
(Vallakati) Case Western Reserve University Metro Health Medical Center,
Cleveland, OH, United States
(Afzal) University of Kansas, Kansas City, KS, United States
(Dacha, Devidi) Emory University Hospital, Atlanta, GA, United States
(Adabala) University of Kanas Medical Center, Kansas City, KS, United
States
Title
Complete heart block after transcatheter aortic valve implantation: A
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B224-B225),
2014. Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a minimally
invasive alternative to surgical aortic valve replacement (SAVR) in high
risk surgical patients. Pooled meta-analysis was attempted to analyze the
risk of developing permanent heart block following TAVI. Methods: All
electronic databases were queried for published studies on TAVI and SAVR.
Studies reporting the outcomes of TAVI procedure were included. Exclusion
criteria applied was: studies lacking SAVR as controls, studies comparing
trans-apical versus trans-femoral TAVI procedures and studies not
reporting on the outcome of heart block or pacemaker implantation.
Results: A total of 21 studies with a total of 5061 patients were included
in the study and 2692 of these had TAVI. The risk of permanent heart block
necessitating pacemaker implantation was very high in the patients
undergoing TAVI compared to SAVR (OR 3.5, 95% CI 2.4 - 5.1). Majority of
the pacemaker implantations were done immediately after the TAVI
procedure. Trans-femoral TAVI's were associated with higher risk (OR 8.6,
95% CI 3.1 - 28.3) of developing permanent heart block compared to
transapical route (OR 2.4, 95% CI, 1.3 - 4.3). Core Valve use was
associated with a higher risk of developing permanent heart block (OR 2.4,
95% CI 1.6 - 3.6) than Edward Sapiens Valve (OR 1.9, 95% CI 1.2 - 2.8)
compared to SAVR. Conclusions: Patients undergoing minimally invasive TAVI
procedure have a four times higher risk of developing heart block needing
pacemaker implantation compared to patients undergoing SAVR procedure.

<15>
Accession Number
71633656
Authors
Goel S.S. Aksoy O. Houghtaling P. Tuzcu E.M. Mihaljevic T. Svensson L.
Blackstone E. Griffin B.P. Stewart W. Kapadia S.
Institution
(Goel, Houghtaling, Svensson, Blackstone, Griffin, Stewart, Kapadia)
Cleveland Clinic, Cleveland, OH, United States
(Aksoy, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH, United States
(Mihaljevic) ClevelandOHUnited States
Title
Role of renin-angiotensin system blockade therapy following aortic valve
replacement for severe aortic stenosis.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B219), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Renin angiotensin system (RAS) blockade with
angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor
blockers (ARB) have survival benefit in heart failure. Persistent heart
failure after surgical aortic valve replacement (SAVR) for severe aortic
stenosis (AS) is associated with poor outcome. Data are lacking on the
impact of RAS blockade after SAVR for severe AS.We sought to investigate
the impact ofassociation between RAS blockade therapy on and outcomes
following SAVR for severe AS. Methods: Patients prescribed ACEI/ARB after
SAVR for severe AS between 1991 and 2010, with at least 2 refills 90 days
apart and at least 6 month follow up in our health system constituted the
RAS blockade group (n=741) and those not prescribed ACEI/ARB were the
untreatedcontrol group (n=1,011). Unadjusted and propensity matched
analyses (treatedcase: control untreated ratio of 1:1 yielding 594 matched
pairs) were performed. Primary outcome was survival after SAVR. Secondary
end points were changes in left ventricular mass index (LVMI), left
ventricular ejection fraction (LVEF) and left atrial (LA) size after SAVR.
Results: A total of 562 deaths occurred over a mean follow up of 6.3 + 4.1
years. Overall unadjusted estimated survival at 1, 5 and 10 years was 99%,
90% and 69% in the RAS group compared to 99%, 81% and 53% respectively in
the non-RAS group (p< 0.0001). Among propensity matched patients,
estimated survival at 1, 5 and 10 years remained significantly higher in
the RAS group compared to non-RAS group (99%, 90% and 71% vs. 96%, 78% and
49%, respectively p< 0.0001). When stratified by concomitant CABG,
survival remained significantly higher in the RAS group (unadjusted and
propensity matched, p< 0.0001). For the matched cohorts, on
echocardiographic analysis there were no significant group differences
between the RAS and non RAS groups with respect to change in LVMI
(p=0.37),LVEF(p=0.67) and LA size (p=0.43) after SAVR Conclusions: RAS
blockade is associated with an improved survival in patients following AVR
for severe AS. Therapy with ACEI/ARB should be considered in patients
after AVR for AS if proven beneficial in a randomized controlled trial.

<16>
Accession Number
71633639
Authors
Dorfmeister M. Mylotte D. Andalib A. Theriault-Lauzier P. Alharbi W.
Girgis M. Chetrit M. Kappetein A.P. Lange R.
Institution
(Dorfmeister, Lange) German Heart Center Munich, Munich, Germany
(Mylotte) University Hospital Galway, Galway, Ireland
(Andalib, Alharbi, Girgis, Chetrit) Mcgill University Health Centre,
Montreal, QC, Canada
(Theriault-Lauzier) McGill University, Montreal, QC, Canada
(Kappetein) Erasmus MC, Rotterdam, Netherlands
Title
VARC endpoint definition compliance rates in contemporary TAVI studies.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B215), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: The Aortic Valve Academic Research Consortium (VARC) endpoint
definitions were established to standardize the evaluation of clinical
outcomes following transcatheter aortic valve implantation (TAVI). It
remains unclear, however, to what extent and in which manner these
definitions are used in publications. Methods: We performed a systematic
review of the literature to identify TAVI-related manuscripts published
between Feb. 2011 and Feb. 2014. Two physicians independently reviewed
these manuscripts and categorized them into 3 groups: a 'compliant' group
comprised of VARC-defined endpoints only, a 'non-compliant' group
comprised of non-VARC-defined endpoints only, and a 'mixed compliant'
group comprising VARC- and non-VARC-defined endpoints. Results: The search
yielded a total of 5023 manuscripts and 514 were included in the analysis.
At least one VARC definition was used in 275 (54%) manuscripts while 223
(43%) did not use any VARC definitions. We excluded from the analysis 16
(3%) manuscripts which dealt with outcomes not defined in VARC. Of the
manuscripts using VARC, 49 (10%) were classified as compliant and 226
(46%) as mixed compliant. The following endpoints were more often defined
using VARC vs. non- VARC: MI (64% vs 36%), stroke (56% vs. 44%), bleeding
and (79% vs 21%) vascular complications (70% vs. 30%), AKI (63% vs. 37%),
reintervention (67% vs. 33%) and composite endpoints (52% vs. 48%). The
following endpoints were less often defined using VARC vs. non-VARC:
mortality (59% vs 41%), valve-dysfunction (82% vs. 18%), TAVI-related
complications (59% vs. 41%), NYHA (73% vs. 27%) and QOL (91% vs. 9%).
After publication of the first VARC manuscript, VARC usage in TAVI
publications increased from 29% at 6 months to 59% at 30 months. After
publication of the revised VARC definitions VARC-2 usage increased from 3%
at 6 months to 27% at 18 months, while VARC usage in general remained at
54%. Conclusions: Although VARC definitions are well accepted within the
"community", usage in peer-reviewed manuscripts remains suboptimal.
Further studies are warranted to better understand how to improve
compliance and adapt these findings in future VARC iterations.

<17>
Accession Number
71633613
Authors
Chakravarty T. Van Belle E. Jilaihawi H. Noheria A. Testa L. Bedogni F.
Ruck A. Barbanti M. Toggweiler S. Thomas M. Khawaja M.Z. Hutter A.
Abramowitz Y. Cheng W. John W. Leon M. Makkar R.
Institution
(Chakravarty, Cheng) Cedars Sinai Medical Center, Los Angeles, CA, United
States
(Van Belle) Hopital cardiologique CHRU Lille, Lille, France
(Jilaihawi) Cedars-Sinai Heart Institute, Los Angeles, United States
(Noheria) Mayo Clinic, Rochester, MN, United States
(Testa, Bedogni) Istituto Clinico S. Ambrogio, Milan, Italy
(Ruck) Karolinska University Hospital, Stockholm, Sweden
(Barbanti) Ferrarotto Hospital, University of Catania, Catania, Italy
(Toggweiler, John) St Pauls Hospital, Vancouver, BC, Canada
(Thomas) St Thomas' Hospital, London, United Kingdom
(Khawaja) King's College London, London, United Kingdom
(Hutter) Klinikum Bogenhausen, Munich, Bavaria, Germany
(Abramowitz) Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
(Leon) Columbia University Medical Center, New York, NY, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
Title
A collaborative meta-analysis of the impact of mitral regurgitation on
outcomes after transcatheter aortic valve replacement: 8 studies involving
8919 patients.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B207), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Significant mitral regurgitation (MR) is present in 20-30% of
patients undergoing transcatheter aortic valve replacement (TAVR) and
constitutes a significant co-existing valvular heart disease burden. We
perform a meta-analysis and systematic review of literature to evaluate
the impact of significant MR on outcomes after TAVR. Methods: Eight
studies comprising 8919 patients reporting TAVR outcomes based on the
presence or absence of moderate-severe MR were included. Risk ratios (RR)
were calculated using the inverse variance random effects model. Results:
None-mild MR was present in 77.8% and moderate-severe MR in 22.2% of the
patients. The presence of baseline moderate-severe MR, compared to
none-mild MR, was associated with increased mortality at 30-days (RR 1.24,
95% CI 1.13-1.37, p < 0.00001) and 1 year (RR 1.21, 95% CI 1.10-1.34, p =
0.0001; Figure 1A). The increased mortality associated with
moderate-severe MR was not influenced by the etiology of MR (functional or
degenerative MR) (RR 0.90, 95% CI 0.62-1.30, p = 0.56). The severity of MR
improved in 61% + 6.0% of patients after TAVR. Moderate-severe residual
MR, compared to none-mild residual MR post-TAVR, was associated with
significantly increased 1-year mortality (RR 1.48, 95% CI 1.31-1.68, p <
0.00001; Figure 1B). Conclusions: Baseline moderate-severe MR results in
increased mortality after TAVR. The severity of moderate-severe MR
improves in the majority of patients undergoing TAVR. Significant residual
MR post-TAVR is strongly associated with mortality; this may represent an
important group to target with transcatheter therapies in future. (Table
Presented).

<18>
Accession Number
71633604
Authors
Rodes-Cabau J. Pibarot P. Suri R.M. Thourani V. Svensson L. Dumont E. Xu
K. Leon M.
Institution
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec, Canada
(Pibarot) N/A, Quebec City, Canada
(Suri) Mayo Clinic, Rochester, MN, United States
(Thourani) Emory University, Atlanta, United States
(Svensson) Cleveland Clinic, Cleveland, United States
(Dumont) Quebec Heart and Lung Institute, Laval University, Quebec, QC,
Canada
(Xu, Leon) Cardiovascular Research Foundation, New York, NY, United States
Title
Is transcatheter aortic valve replacement the best option for patients
with severe aortic stenosis and small aortic annulus? Insights from the
PARTNER trial.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B205), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: We sought to evaluate the effects of aortic annulus size on
valve hemodynamics and clinical outcomes in those patients included in the
PARTNER randomized controlled trial (RCT) cohort A and the PARTNER
non-randomized continued access (NRCA) cohort. Methods: Patients included
the RCT (n=574) and NRCA (n=1358) cohorts were divided in tertiles
according to aortic annulus diameter (small, medium, large aortic annulus;
SAA, MAA and LAA, respectively) as measured by transthoracic
echocardiography. Moderate-to-severe prosthesis-patient mismatch (PPM) was
defined as an effective aortic orifice area of <0.85 cm2/m2. Results: In
the RCT cohort, patients in the SAA tertile who underwent TAVR had a lower
incidence of PPM (39% vs. 63%, P=0.01), and only a trend toward a higher
incidence of moderate-to-severe paravalvular leak (PVL) compared to SAVR
(5.7% vs. 0%, P=0.06). In the LAA tertile, there were no differences in
the rate of PPM between groups and a significant increase in
moderate-to-severe PVL was associated with TAVR (9% vs. 0%, P=0.01). In
the NRCA cohort, there were no differences in PPM between the SAA and LAA
tertiles, but a higher rate of moderate-to-severe PVL was observed in the
LAA tertile (5.9% vs. 11.5%, P=0.004). Patients in the LAA tertile had a
higher mortality rate at 1-year follow-up compared to the SAA and MAA
tertiles (24.8%, 18.3% and 18.7%, respectively, P=0.02), and differences
persisted in multivariable analysis (P=0.048 for LAA vs. MAA, P=0.035 for
LAA vs. SAA). Conclusions: Aortic annulus size had amajorimpact on valve
hemodynamics and clinical outcomes following AVR. This study highlights
the importance of considering aortic annulus size in the evaluation of
high-risk patients who are candidates for AVR, and suggests that TAVR may
be the preferred strategy for those with smaller aortic annulus.

<19>
Accession Number
71633602
Authors
Nombela-Franco L. Eltchaninoff H. Testa L. Leon M. Trillo R. D'Onofrio A.
Webb J. Bleiziffer S. Gilard M. Tamburino C. Bedogni F. Barbanti M.
Salizzoni S. Del Blanco B.G. Sabate M. Moreo A. Ribeiro H.B. Amat-Santos
I.J. Urena M. Allende R. Garcia E.J. Macaya C. Pibarot P. Rodes-Cabau J.
Institution
(Nombela-Franco) Cardiovascular Institute, Hospital Clinico San Carlos,
Madrid, Spain
(Eltchaninoff) N/A, Rouen, France
(Testa) Istituto Clinico S. Ambrogio, Milan, Italy
(Leon) Cardiovascular Research Foundation, New York, United States
(Trillo) Hospital Clinico Universitario de Santiago de Compostela,
Santiago de Compostela, Spain
(D'Onofrio) University of Padova, Padova, Italy
(Webb) University of British Columbia, Vancouver, Canada
(Bleiziffer) German Heart Center Munich, Munich, Germany
(Gilard) FESC, Brest, France
(Tamburino) University of Catania, Catania, Italy
(Bedogni) Istituto Clinico S . Ambrogio, Milan, Italy
(Barbanti) Univeristy of Catania, Catania, Italy
(Salizzoni) University of Torino, Citta della Salute e della Scienza
Hospital, Torino, Italy
(Del Blanco) Vall d'Hebron University Hospital, Barcelona, Spain
(Sabate) University of Barcelona, Barcelona, Spain
(Moreo) Niguarda Ca' Granda Hospital, Milan, Italy
(Ribeiro) Quebec Heart and Lung Institute, Laval University, Quebec City,
Canada
(Amat-Santos) Institute of Heart Sciences (ICICOR), University Clinic,
Hospital of Valladolid, Valladolid, Valladolid, Spain
(Urena) Quebec Lung and Heart Institute, Laval University, Quebec, Canada
(Allende) Quebec Heart and Lung Institute, Quebec City, Canada
(Garcia) Hospital Clinico San Carlos, Madrid, Spain
(Macaya) Clinico San Carlos Hospital, Madrid, Spain
(Pibarot) N/A, Quebec City, Canada
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec, Canada
Title
Clinical impact and evolution of mitral regurgitation following
transcatheter aortic valve replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B204), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Mitral regurgitation (MR) is a common entity in patients with
aortic stenosis undergoing transcatheter aortic valve replacement (TAVR),
but its influence on outcomes remains controversial. The purpose of this
meta-analysis was to assess the clinical impact of and changes in
significant (moderate-severe) MR in patients undergoing TAVR, overall and
according to valve design (self-expandable [SEV] vs. balloon-expandable
[BEV]). Methods: All national registries and randomized trials published
between 2002 and 2013 were identified and pooled using meta-analytical
guidelines to establish the impact of moderate or severe MR on mortality
after TAVR. Studies reporting changes in MR after TAVR on an individual
level were electronically searched and used for the analysis. Results:
Eight studies including 8015 patients (SEV: 3474 patients; BEV: 4492
patients) were included in the analysis. The overall 30-day and 1-year
mortality was increased in patients with significant MR (OR: 1.49, 95% CI:
1.16-1.92; HR: 1.32, 95% CI: 1.12-1.55, respectively), but a significant
heterogeneity across studies was observed (P< 0.05). The negative effect
of MR on 1-year mortality was more evident in patients who had received a
SEV (HR: 1.62, 95% CI 1.23-2.14) than those who had received a BEV (HR:
1.22, 95% CI 0.98 to 1.51). Changes in MR over time were evaluated in 9
studies including 1278 patients. Moderate-severe MR (SEV: 326 patients;
BEV: 192 patients) improved in 50.5% of the patients at a median follow-up
of 180 (30-360) days after TAVR, and the degree of improvement was greater
in patients who had received a BEV (66.7% vs. 40.8% in the SEV group,
P=0.001). Conclusions: Concomitant moderate-severe MR was associated with
increased early and late mortality following TAVR. A significant
improvement in MR severity was detected in half of the patients following
TAVR, and the degree of improvement was greater in those patients who had
received a BEV. The results of the present metaanalysis provide further
insight into the effects of and changes in MR in patients undergoing TAVR,
and this may be of help in the clinical decision-making process and
procedural planning for such a challenging group of patients.

<20>
Accession Number
71633463
Authors
Garcia D. Ansari M.M. Toussaint J.L. Cardoso R.N. Schob A. Alfonso C.
Institution
(Garcia, Cardoso) University of Miami, Miami, FL, United States
(Ansari) University of Miami, Jackson Memorial Hospital, Miami, FL, United
States
(Toussaint) Univeristy of Miami, Miami, FL, United States
(Schob) VA Hospital - Miami, Miami, FL, United States
(Alfonso) University of Miami, Miller School of Medicine, Miami, FL,
United States
Title
Could staged carotid stenting with CABG be non-inferior to combined
carotid endarterectomy and CABG for carotid and coronary
revascularization? A meta-analysis of prospective studies.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B161), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Carotid stenting (CS) is considered to be non-inferior to
carotid endarterectomy (CEA) for treatment of symptomatic carotid disease
with similar stoke and death rates. It is still to be determined if staged
CS followed by CABG could be also non-inferior to combined CEA and CABG
for the concomitant presence of coronary and carotid artery disease.
Therefore we aimed to evaluate the non-inferiority of staged CS compared
to combined CEA and CABG by using all the prospective available studies.
Methods: Pub Med, Chocrane and Scopus were systematically searched up to
April 2014. Subjects of analysis were 30 days post surgery incidence of
stroke and death for carotid and coronary revascularization using either
CS or CEA with CABG. We used Fixed or Random Effect analysis using the
Cochrane Handbook of Systematic Reviews. Results: Out of 350 articles,
three prospective studies were identified and disclosed a total of 94
patients on the CS and 140 in the CEA group respectively. There was a
trend towards lower stroke in the CAS group compared to the CEA (4.2% vs
9.2%, p=0.1; Figure 1.A) and no difference on mortality rate (5.3% vs.
7.8%, p=0.42; Figure 1.B). Conclusions: Our analysis suggests that staged
CS and CABG might not be inferior to combined CEA and CABG. Also the
overall mean incidence of 30 days stroke is below the average reported on
most observational studies. Therefore clinical randomized studies are
warranted. (Table Presented).

<21>
Accession Number
71633028
Authors
Saurav A. Kaja A.K. Kaushik M. Mooss A. DelCore M. White M.D. Woodruff M.
Institution
(Saurav, Kaushik, Mooss, DelCore, White, Woodruff) Cardiac Center,
Creighton University Medical Center, Omaha, NE, United States
(Kaja) Dept. of Internal Medicine, Creighton University Medical Center,
Omaha, NE, United States
Title
Drug eluting stents versus coronary artery bypass graft surgery for
isolated proximal left anterior descending artery stenosis: A
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 26th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2014 Washington,
DC United States. Conference Start: 20140913 Conference End: 20140917.
Conference Publication: (var.pagings). 64 (11 SUPPL. 1) (pp B32), 2014.
Date of Publication: 16 Sep 2014.
Publisher
Elsevier USA
Abstract
Background: Coronary Artery Bypass Graft surgery (CABG) involving Internal
Mammary Artery (IMA) graft is considered superior to stenting for
revascularization of Left Anterior Descending (LAD) artery. Current
generation Drug Eluting Stents (DES) are associated with extremely low
target vessel revascularization (TVR) rates. We sought to compare the
outcomes of DES versus CABG for treatment of isolated stenosis of proximal
LAD artery. Methods: PubMed, Cochrane and Web of Science databases were
searched for relevant articles in English language through April 30th 2014
comparing the outcomes of DES versus CABG for revascularization of
isolated proximal LAD stenosis. Outcomes assessed were all-cause
mortality, cardiovascular mortality, myocardial infarction (MI),
peri-procedure stroke and TVR. Study quality, publication bias and
heterogeneity were assessed. Analysis was done using DerSimonian and Laird
random effect model. Results: From 339 publications, we identified 4
studies (2 randomized & 2 observational) with 1182 patients (DES=634
CABG=548). Mean age was 62 years and 79% were males in both groups. Follow
up period varied from 6 months to 10 years with a mean follow up of 4730
patient-years. DES types used included Paclitaxel, Sirolimus and
Everolimus eluting stents. All CABG surgeries involved IMA graft while 78%
of the CABG were done off-pump using lateral thoracotomy approach. There
was no difference in all-cause mortality (RR: 1.20 95% CI: 0.51- 2.83,
p=0.67), cardiovascular mortality (RR: 0.43 95% CI: 0.11-1.64, p=0.21), MI
(RR: 0.56 95% CI: 0.20-1.52, p=0.25) & stroke (RR: 0.55 95% CI: 0.09-3.44,
p=0.51) rates between DES and CABG. TVR rate was also similar between two
groups (DES Vs CABG RR: 2.20 95% CI: 0.74-649, p=0.15). Subgroup analysis
of these outcomes both early (< 30days) and late (>30days) after the
procedure did not show any difference between both treatment strategies.
Hospital stay however was significantly lower in the DES group as expected
(SMD= -9.1 days 95% CI: 14.06-4.14, p< 0.001). Conclusions: DES in
comparison to CABG for revascularization of isolated proximal LAD stenosis
is associated with similar outcomes including the TVR rates while the
hospital stay is significantly lower.

<22>
Accession Number
71630622
Authors
Trujillo-Garcia E. Curiel-Balsera E. Munoz-Bono J. Molina-Diaz H.
Joya-Montosa C. Mora-Ordonez J.
Institution
(Trujillo-Garcia, Curiel-Balsera, Munoz-Bono, Molina-Diaz, Joya-Montosa,
Mora-Ordonez) H. R. U. Carlos Haya, Malaga, Spain
Title
Advantages in the use of pre-surgery intra-aortic ballon pump implantation
in cardiac surgery: Propensity score in the ariam cardiac surgery
register.
Source
Intensive Care Medicine. Conference: 27th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2014 Barcelona Spain. Conference
Start: 20140927 Conference End: 20141001. Conference Publication:
(var.pagings). 40 (1 SUPPL. 1) (pp S225), 2014. Date of Publication:
September 2014.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Preoperative use of intra-aortic balloon pump is frequently
discussed, and some published meta-analyses and research studies show
reduced mortality rate in high risk patients undergoing cardiac surgery.
However, these studies showed important variability in surgery type,
patient features, and time of implantation. Our objective is confirming
whether intra-aortic balloon pump is useful in all types of cardiac
surgery patients included in our cardiac surgery Register (ARIAM
database). METHODS. Observational, retrospective and multicentric study of
patients undergoing cardiac surgery and included in the ARIAM-Andalucia
Register of cardiac surgery from March 2008 to July 2012. Likelihood of
pre-surgery intra-aortic balloon pump implantation was calculated by means
of a propensity score so as to obtain two homogeneous groups of patients
treated either with or without balloon pump according to demographic
features, functional capacity, and surgery type. A total number of 77
balloon-pump patients were matched to 77 non-balloon-pump patients
according to the closest propensity score. Chi square and Student's
t-tests were used, as well as binary logit regression for multivariate
analysis so as to avoid confusing variables. RESULTS. A total number of
8026 patients underwent cardiac surgery in 5 years. Out of these patients,
4.5 % (358) needed intra-aortic balloon pump implantation (65.4 % were
males). A propensity score was calculated, matching 77 couples of patients
with and without intra-aortic balloon pump according to their (similar)
epidemiological features and surgery type, and surgery type, which are
shown in the table below: (Table presented) Mortality rate analysis by any
cause 30 days after surgery showed statistically significant differences,
since mortality reached 27 % among patients who had undergone pre-surgery
intra-aortic balloon pump implementation, relative to 13.1 % reached among
patients who had undergone no balloon pump implementation (p = 0.043).
Analysis of mortality causes (prolonged mechanical ventilation,
reintervention, mediastinitis, and stroke) 30 days after surgery showed
mortality differences between patients with and without balloon pump
implementation (58.3 vs. 41.7 %; p = 0.046). No differences between both
groups were found when Euroscore, mortality rate and mortality causes were
analyzed by multivariate and stratified analysis [p = 0.62, OR 0.75
(0.23-2.35)] and [p = 0.11, OR 0.47 (0.19-1.18)], respectively. Patients
who underwent balloon pump implantation showed higher ICU stay (7.7 + 10.6
vs. 4.6 + 6.7; p = 0.046), and no differences were observed in global
hospital stay (21.8 + 18.7 vs. 22.08 + 18.9, ns). CONCLUSIONS. The use of
intra-aortic balloon pump prior to cardiac surgery in high-risk patients
proves no improvement in terms of mortality and the effect of mortality
causes. Longer ICU stays were found among patients who undergone balloon
pump implantation, and no differences were observed in global hospital
stay.

<23>
Accession Number
71630598
Authors
Tam P. Gomersall C.D. Tian Q. Ng S.K. Buckley T.A. Underwood M.J.
Institution
(Tam, Gomersall, Tian, Ng) Chinese University of Hong Kong, Dept of
Anaesthesia and Intensive Care, Shatin, Hong Kong
(Buckley) Princess Margaret Hospital, Intensive Care Unit, Lai Chi Kok,
Hong Kong, Hong Kong
(Underwood) Chinese University of Hong Kong, Dept of Surgery, Shatin, Hong
Kong
Title
A randomized controlled trial of two algorithms for weaning cardiac
surgical patients receiving adaptive support ventilation.
Source
Intensive Care Medicine. Conference: 27th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2014 Barcelona Spain. Conference
Start: 20140927 Conference End: 20141001. Conference Publication:
(var.pagings). 40 (1 SUPPL. 1) (pp S219), 2014. Date of Publication:
September 2014.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Adaptive support ventilation (ASV) is an effective mode to
wean fasttrack cardiac surgical patients [1, 2]. Trials comparing ASV
(using different algorithms) with Synchronised Intermittent Mandatory
Ventilation (SIMV) suggest that an ASV algorithm that incorporates a
progressive decrease in target minute ventilation might result in more
rapid weaning [2, 3]. OBJECTIVES. To determine whether an algorithm
incorporating a decremental target minute ventilation results in more
rapid weaning of patients ventilated in Adaptive Support Ventilation mode
following cardiac surgery compared to an algorithm incorporating a
constant target minute ventilation. METHODS. Randomized controlled
unblinded study of 54 adults ventilated in Adaptive Support Ventilation
mode following elective coronary artery bypass grafting. The anaesthetic
and surgical technique was standardized. Patients were randomized to one
of two algorithms for mechanical ventilation with ASV: an algorithm
incorporating a decremental target minute ventilation or an algorithm in
which target minute ventilation was constant. The target minute
ventilation was reduced to 50 % and then 25 % of predicted target minute
ventilation (based on height and sex) in the decremental group if the
patient was making spontaneous breathing efforts and there were no signs
of weaning intolerance. Reductions were made by bedside nurses. Target
minute ventilation was maintained at 100 % of predicted in the constant
target minute ventilation group. Patients were considered to have failed
the weaning protocols if they were still ventilated at 8 h. Sedation was
stopped on arrival in the ICU in both groups. All other management,
including analgesia, followed standard unit guidelines. RESULTS. Median
duration of mechanical ventilation was significantly shorter in the
decremental target minute ventilation group (145 vs 309 min) as was the
duration of intubation (225 vs 423 min). The incidence of adverse effects
(42 vs 46 %) and mortality (0 vs 0 %) and the duration of ICU stay (21 vs
22 h) were not significantly different between the two groups. Patients in
the decremental target minute ventilation group required more manual
ventilator changes (2.5 vs 0.6) but fewer patients in this group required
assessment by a physician as a result of weaning protocol failure (0 vs
5). CONCLUSIONS. Adaptive support ventilation has previously been
demonstrated to be an effective method of weaning patients following
fast-track cardiac surgery. Data from this study indicate that the speed
of liberation from the ventilator can be further enhanced by progressive
reduction in the target minute ventilation without an increase in adverse
effects. However, this does require an average of two additional
ventilator changes per patient.

<24>
Accession Number
71630306
Authors
Osawa E. Rhodes A. Vincent J.-L. Galas F. Fukushima J. Pileggi B. Lima M.
Piccioni M. Chan R. Almeida J. Jatene F. Hajjar L.
Institution
(Osawa, Galas, Fukushima, Pileggi, Lima, Piccioni, Chan, Almeida, Jatene,
Hajjar) University of Sao Paulo, Heart Institute, Sao Paulo, Brazil
(Rhodes) St George's University of London, London, United Kingdom
(Vincent) Universite Libre de Bruxelles, Brussels, Belgium
Title
Goal-directed resuscitation in high-risk patients undergoing cardiac
surgery (grics)-a randomised controlled trial.
Source
Intensive Care Medicine. Conference: 27th Annual Congress of the European
Society of Intensive Care Medicine, ESICM 2014 Barcelona Spain. Conference
Start: 20140927 Conference End: 20141001. Conference Publication:
(var.pagings). 40 (1 SUPPL. 1) (pp S135), 2014. Date of Publication:
September 2014.
Publisher
Springer Verlag
Abstract
INTRODUCTION. Perioperative mortality after cardiac surgery has decreased
due to advances in surgical techniques and perioperative care. However,
morbidity is still high and results in significant clinical complications
and longer intensive care unit (ICU) and hospital stays. In non-cardiac
surgeries, there is evidence showing that goal-directed therapy (GDT) may
improve outcomes in high-risk patients, but there are few data in cardiac
surgery. OBJECTIVES. We investigated whether the implementation of a GDT
protocol guided by LiDCOrapid in high-risk patients reduces complications
after cardiac surgery. The study was conducted in the Surgical ICU of the
Heart Institute, University of Sao Paulo, from December 2011 to January
2014. METHODS. We performed a prospective study comparing a GDT protocol
with standard care in patients fulfilling one of these high-risk criteria:
EuroSCORE>5, left ventricular ejection fraction (LVEF)<50 %, redo,
combined CABG and valve surgery, and recent myocardial infarction). GDT
protocol involved a hemodynamic resuscitation strategy aimed to reach a
cardiac index higher than 3 l/min/m² in the first 8 h after
surgery. A 3 step approach was implemented: fluid therapy with bolus of
250 ml lactated Ringer's solution, dobutamine infusion up to a dose of
20mcg/kg/min and red blood cell transfusion (RBC). Complications were
defined by the development of one of the following: delirium, stroke,
seizure, low cardiac output syndrome, myocardial ischemia,
tachyarrhythmia, infection, acute kidney injury and venous
thromboembolism. RESULTS. A total of 126 patients were included.
Seventy-three percent were male and groups did not differ regarding age
(66 + 9 vs. 69 + 9 years, p = 0.103), EuroSCORE (4 [3-6] vs. 4 [3-5], p =
0.402), LVEF (p = 0.430), Charlson comorbidity index (4 [3-5] vs. 4 [3-5],
p = 0.402) and SAPS 3 score (18 [13-25] vs. 19 [15-23]). Analysis of
hemodynamic interventions in the first 8 h showed that the amount of fluid
administration was higher in the GDT group (1000 ml [625-1500] vs. 500 ml
[500-1000], p<0.0001), but similar doses of dobutamine (4 [3-5] vs. 4
[3-6] mcg/kg, p = 0.218) and rates of RBC transfusion (0 vs. 1.6 %, p =
0.323) were prescribed. Patients from GDT group had a shorter ICU stay (3
days [3-4] vs. 5 [4-7], p<0.001) and hospital stay (9 days [8-16] vs. 12
(9-22), p = 0.049) and a lower duration of inotropic (2 days [2-3] vs. 3
[2-4], p = 0.001) and vasopressor therapy (0 day [0-3] vs. 3 [0-5]) as
compared to standard group. GDT patients had a lower complication rate (25
[40.3 %] vs. 41 [64.1 %], p = 0.008), due to a reduced incidence of low
cardiac output syndrome (4.8 % vs. 21.9 %, p = 0.005) and infection (19.3
% vs. 43.8 %, p = 0.009). Hospital mortality was similar between groups (3
(5.2 %) vs. 5 (8.8 %) deaths, p = 0.448). CONCLUSION. A GDT strategy in
high-risk patients undergoing cardiac surgery reduced complications and
ICU and hospital stay.