EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014868444
Authors
Otsuka M. Yokoi H. Matsuyama Y. Hayashi Y. Shiode N. Masaoka Y. Okimoto T.
Tamekiyo H. Kawase T. Yamane K. Kagawa Y. Nakamura M. Muramatsu T. Nanto
S.
Institution
(Otsuka, Hayashi, Shiode, Masaoka, Okimoto, Tamekiyo, Kawase, Yamane,
Kagawa) Division of Cardiology, Cardiovascular Center, Akane Foundation
Tsuchiya General Hospital, Hiroshima, Japan
(Yokoi) Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka,
Japan
(Matsuyama) Department of Biostatistics, School of Public Health, The
University of Tokyo, Tokyo, Japan
(Nakamura) Department of Cardiovascular Medicine, Toho University School
of Medicine, Ohashi Medical Center, Tokyo, Japan
(Muramatsu) Division of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Nanto) Nishinomiya Hospital Affairs, Nishinomiya Municipal Central
Hospital, Nishinomiya, Japan
Title
Comparison of sirolimus- and paclitaxel-eluting stents in patients with
moderate renal insufficiency: Results from the J-DESsERT trial.
Source
Cardiovascular Revascularization Medicine. 15 (6-7) (pp 323-328), 2014.
Date of Publication: 01 Sep 2014.
Publisher
Elsevier Inc.
Abstract
Background: It is unclear whether there are differences in clinical
outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting
stents (PES) in patients with moderate renal insufficiency (RI). Methods:
The Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT)
was a prospective, randomized multicenter trial which compared 1:1
coronary stenting between SES and PES patients. Patient with serious RI
(serum creatinine value 2mg/dL or higher) were excluded. Patients were
classified into 2 arms according to renal function: a non-RI arm of 2220
patients (SES 1094 and PES 1126 patients with estimated glomerular
filtration rate (eGFR) >60mLmin^-1 1.73m^-2) and an RI
arm of 1206 patients (SES 613, PES 593 with 30<eGFR <60mLmin^-1
1.73m^-2). Results: At 12. months, the primary endpoint of
target vessel failure in the non-RI arm occurred in 6.0% in the SES group
and 8.7% in the PES group (p. =. 0.02). In the RI arm, this occurred in
5.7% and 8.1% (p. =. 0.10). Mortality rates were 0.8% vs 0.7% (p. =. 0.78)
in the non-RI arm, and 2.2% vs 2.1% (p. =. 0.90) in the RI arm. Cardiac
death was 0.4% vs 0.1% (p. =. 0.17) in the non-RI arm, and 1.0% vs 1.0%
(p. =. 0.96) in the RI arm. Mortality was higher in patients with RI than
those without RI (2.1% vs 0.8%; p. <. 0.01). Cardiac death rates increased
in the RI arm compared with those in the non-RI arm (1.0% vs 0.2%; p. <.
0.01). Conclusions: Regardless of the presence or absence of moderate RI,
differences in outcomes between SES and PES change little except mortality
and cardiac death.

<2>
Accession Number
2014862280
Authors
Pibarot P. Weissman N.J. Stewart W.J. Hahn R.T. Lindman B.R. McAndrew T.
Kodali S.K. Mack M.J. Thourani V.H. Miller D.C. Svensson L.G. Herrmann
H.C. Smith C.R. Rodes-Cabau J. Webb J. Lim S. Xu K. Hueter I. Douglas P.S.
Leon M.B.
Institution
(Pibarot, Rodes-Cabau) Quebec Heart and Lung Institute, Institut
Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, 2725 Chemin Ste-Foy, Quebec, QC G1V-4G5, Canada
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Stewart) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Hahn, Kodali, Smith, Hueter, Leon) Columbia University Medical Center,
New York-Presbyterian Hospital, New York, NY, United States
(Hahn, McAndrew, Kodali, Smith, Xu, Leon) Cardiovascular Research
Foundation, New York, NY, United States
(Lindman) Washington University School of Medicine, St. Louis, MI, United
States
(Mack) Baylor Healthcare System, Dallas, TX, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Miller) Stanford University School of Medicine, Stanford, CA, United
States
(Svensson) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Webb) University of British Columbia, St. Paul's Hospital, Vancouver,
Canada
(Lim) University of Virginia Medical Center, Charlottesville, VA, United
States
(Douglas) Duke University Medical Center, Duke Clinical Research
Institute, Durham, NC, United States
Title
Incidence and sequelae of prosthesis-patient mismatch in transcatheter
versus surgical valve replacement in high-risk patients with severe aortic
stenosis: A PARTNER trial cohort-a analysis.
Source
Journal of the American College of Cardiology. 64 (13) (pp 1323-1334),
2014. Date of Publication: 30 Sep 2014.
Publisher
Elsevier USA
Abstract
Background Little is known about the incidence of prosthesis-patient
mismatch (PPM) and its impact on outcomes after transcatheter aortic valve
replacement (TAVR).
Methods The PARTNER Trial cohort A randomized patients 1:1 to TAVR or
bioprosthetic SAVR. Postoperative PPM was defined as absent if the indexed
effective orifice area (EOA) was >0.85 cm²/m²,
moderate if the indexed EOA was >0.65 but <0.85 cm;bsupesupbsupesup, or
severe if the indexed EOA was ;lt0.65 cm;bsupesupbsupesup. LV mass
regression and mortality were analyzed using the SAVR-RCT (n = 270),
TAVR-RCT (n = 304), and TAVR-NRCA (n = 1,637) cohorts.
Objectives The objectives of this study were: 1) to compare the incidence
of PPM in the TAVR and surgical aortic valve replacement (SAVR) randomized
control trial (RCT) arms of the PARTNER (Placement of AoRTic TraNscathetER
Valves) I Trial cohort A; and 2) to assess the impact of PPM on regression
of left ventricular (LV) hypertrophy and mortality in these 2 arms and in
the TAVR nonrandomized continued access (NRCA) registry cohort.
Results The incidence of PPM was 60.0% (severe: 28.1%) in the SAVR-RCT
cohort versus 46.4% (severe: 19.7%) in the TAVR-RCT cohort (p < 0.001) and
43.8% (severe: 13.6%) in the TAVR-NRCA cohort. In patients with an aortic
annulus diameter <20 mm, severe PPM developed in 33.7% undergoing SAVR
compared with 19.0% undergoing TAVR (p = 0.002). PPM was an independent
predictor of less LV mass regression at 1 year in the SAVR-RCT (p = 0.017)
and TAVR-NRCA (p = 0.012) cohorts but not in the TAVR-RCT cohort (p =
0.35). Severe PPM was an independent predictor of 2-year mortality in the
SAVR-RCT cohort (hazard ratio [HR]: 1.78; p = 0.041) but not in the
TAVR-RCT cohort (HR: 0.58; p = 0.11). In the TAVR-NRCA cohort, severe PPM
was not a predictor of 1-year mortality in all patients (HR: 1.05; p =
0.60) but did independently predict mortality in the subset of patients
with no post-procedural aortic regurgitation (HR: 1.88; p = 0.02).
Conclusions In patients with severe aortic stenosis and high surgical
risk, PPM is more frequent and more often severe after SAVR than TAVR.
Patients with PPM after SAVR have worse survival and less LV mass
regression than those without PPM. Severe PPM also has a significant
impact on survival after TAVR in the subset of patients with no
post-procedural aortic regurgitation. TAVR may be preferable to SAVR in
patients with a small aortic annulus who are susceptible to PPM to avoid
its adverse impact on LV mass regression and survival. (The PARTNER Trial:
Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).

<3>
Accession Number
2014860719
Authors
Carrie D. Delarche N. Piot C. Berland J. Menneveau N. Bonello L. Py A.
Teiger E. Leborgne L. Bayet G. Wittenberg O. Schiele F.
Institution
(Carrie) Cardiology B, Cardiovascular and Metabolic Pole, Rangueil
Hospital, Toulouse, France
(Delarche) Cardiology Department, Hospital Centre, Pau, France
(Piot) Cardiology Department, Arnaud de Villeneuve Hospital, Montpellier,
France
(Berland) Cardiology Department, St. Hilaire Clinic, Rouen, France
(Menneveau, Schiele) Cardiology Department, Jean Minjoz Hospital,
Besancon, France
(Bonello) Cardiology Department, North Hospital, Marseille, France
(Py) Cardiology Department, Alexandre Dumas Medical Centre, Amiens, France
(Teiger) Cardiology Department, Henri Mondor Hospital, Creteil, France
(Leborgne) Cardiology Department, North Hospital, Amiens, France
(Bayet) Cardiology Department, Rhone Durance Clinic, Avignon, France
(Wittenberg) Cardiology Department, Beauregard Polyclinic, Marseille,
France
Title
Everolimus-eluting stent for the treatment of bare metal in-stent
restenosis: Clinical and angiographic outcomes at nine-month follow-up of
XERES (Xience Evaluation in bare metal stent REStenosis) trial.
Source
EuroIntervention. 10 (6) , 2014. Date of Publication: 01 Oct 2014.
Publisher
EuroPCR
Abstract
Aims: Restenosis is a frequent complication of coronary stent
implantation, especially bare metal stent (BMS) implantation. The
everolimus-eluting stent (EES) has previously been shown to be efficacious
in the treatment of de novo lesions. We performed this study to evaluate
clinical, angiographic and IVUS results after EES implantation for the
treatment of BMS ISR.
Methods and results: XERES was a prospective, multicentre, nationwide
study, enrolling 97 consecutive patients with in-stent restenosis (ISR)
after BMS implantation across 20 centres in France. Suitable lesions had a
reference vessel diameter between 2.5 mm and 4 mm, a length <22 mm and a
diameter stenosis between 50 and 100-. The primary endpoint was
angiographic in-stent late loss (LL) as determined by quantitative
coronary angiography (QCA) at nine-month follow-up. QCA was required to be
performed in each included patient and IVUS was performed in a subgroup of
27 patients. At nine-month follow-up, the in-stent late loss was 0.35+0.63
mm. The rate of in-stent binary restenosis was 12.22-, including two
complete occlusions. The average volume of neointimal hyperplasia was
15.6+9.9 mm3. The in-stent percent volume obstruction was 8.5+5.2-. The
in-segment percent area and diameter obstruction were 32+17- and 27+11-,
respectively. Two initial malappositions were persistent and two other
patients had late acquired stent malapposition. The cumulative incidence
of major adverse cardiac events (MACE) was 10.1-.
Conclusions: EES for the treatment of bare metal in-stent restenosis
seemed safe and efficacious.

<4>
Accession Number
2014853078
Authors
Hu Y. Craig S.J. Rowlingson J.C. Morton S.P. Thomas C.J. Persinger M.B.
Isbell J. Lau C.L. Kozower B.D.
Institution
(Hu, Isbell) Department of Surgery, University of Virginia, School of
Medicine, Charlottesville, VA, United States
(Craig, Thomas, Persinger, Isbell, Lau, Kozower) Department of Thoracic
and Cardiovascular Surgery, University of Virginia, School of Medicine, PO
Box 800709, Charlottesville, VA 22908-0679, United States
(Rowlingson, Morton) Department of Anesthesiology, University of Virginia,
School of Medicine, Charlottesville, VA, United States
Title
Early removal of urinary catheter after surgery requiring thoracic
epidural: A prospective trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1302-1306),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Objectives To prevent urinary retention, urinary catheters commonly are
removed only after thoracic epidural discontinuation after thoracotomy.
However, prolonged catheterization increases the risk of infection. The
purpose of this study was to determine the rates of urinary retention and
catheter-associated infection after early catheter removal.
Design This study described a prospective trial instituting an early
urinary catheter removal protocol compared with a historic control group
of patients.
Setting The protocol was instituted at a single, academic thoracic surgery
unit.
Participants The study group was comprised of patients undergoing surgery
requiring thoracotomy who received an intraoperative epidural for
postoperative pain control.
Interventions An early urinary catheter removal protocol was instituted
prospectively, with all catheters removed on or before postoperative day
2. Urinary retention was determined by bladder ultrasound and treated with
recatheterization.
Measurements and Main Results The primary outcomes were urinary retention
rate, defined as bladder volume>400 mL, and urinary tract infection rate.
Results were compared with a retrospective cohort of 210 consecutive
patients who underwent surgery before protocol initiation. Among the 101
prospectively enrolled patients, urinary retention rate was higher (26.7%
v 12.4%, p = 0.003), while urinary tract infection rate improved
moderately (1% v 3.8%, p = 0.280).
Conclusions Early removal of urinary catheters with thoracic epidurals in
place is associated with a high incidence of urinary retention. However,
an early catheter removal protocol may play a role in a multifaceted
approach to reducing the incidence of catheter-associated urinary tract
infections.

<5>
Accession Number
2014849279
Authors
Barbanti M. Petronio A.S. Capodanno D. Ettori F. Colombo A. Bedogni F. De
Marco F. De Carlo M. Fiorina C. Latib A. Testa L. Bruschi G. Poli A.
Giannini C. Curello S. Maffeo D. Sgroi C. Martina P. Gulino S. Patane M.
Ohno Y. Attizzani G.F. Imme S. Cannata S. Gentili A. Rossi A. Tamburino C.
Institution
(Barbanti, Capodanno, Sgroi, Gulino, Patane, Ohno, Attizzani, Imme,
Cannata, Tamburino) Ferrarotto Hospital, University of Catania, Division
of Cardiology, Via Citelli 1, Catania 95100, Italy
(Barbanti, Capodanno, Sgroi, Tamburino) ETNA Foundation, Catania, Italy
(Petronio, De Carlo, Giannini) AOU Pisana, Pisa, Italy
(Ettori, Fiorina, Curello, Maffeo) Spedali Civili, Brescia, Italy
(Colombo, Latib) Scientific Institute S. Raffaele, Milan, Italy
(Bedogni, Testa) Clinical Institute S. Ambrogio, Milan, Italy
(De Marco, Bruschi) Niguarda ca'Granda Hospital, Milan, Italy
(Poli, Martina) Ospedale Civile, Legnano, Italy
(Gentili) EMEA Regional Clinical Center, Medtronic Clinical Research
Institute, Rome, Italy
(Rossi) Medtronic Italy, Milan, Italy
Title
Impact of balloon post-dilation on clinical outcomes after transcatheter
aortic valve replacement with the self-expanding CoreValve prosthesis.
Source
JACC: Cardiovascular Interventions. 7 (9) (pp 1014-1021), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this study was to assess the incidence and clinical
impact of balloon post-dilation (BPD) after transcatheter aortic valve
replacement (TAVR) with the CoreValve prosthesis (Medtronic Inc.,
Minneapolis, Minnesota).
Background BPD is a widely adopted strategy to reduce the degree of
paraprosthetic regurgitation in case of transcatheter heart valve
underexpansion. However, controversies still remain regarding its real
effectiveness and safety.
Methods The ClinicalService (a nation-based data repository and medical
care project) dataset was analyzed. All patients were dichotomized
according to the need for BPD during the index procedure.
Results Among 1,376 patients, BPD of the transcatheter heart valve was
performed in 272 (19.8%). In 37% of cases, it was unsuccessful at reducing
the paravalvular regurgitation to mild or less. No case of valve
embolization, new intravalvular regurgitation, coronary occlusion, and
aortic root injury occurred during BPD. There were no statistically
significant differences between the 2 groups in the incidence of
in-hospital all-cause and cardiovascular mortality, neurological events,
myocardial infarction, bleeding, conversion to open-chest surgery, and the
need for a permanent pacemaker. The need for BPD did not emerge as an
independent risk factor for all-cause (adjusted hazard ratio [HR]: 1.33,
95% confidence interval [CI]: 0.81 to 2.19, p = 0.264) and cardiovascular
(adjusted HR: 1.48, 95% CI: 0.74 to 2.97, p = 0.265) mortality at 1 year
after the procedure. In addition, BPD did not predispose to higher odds of
neurological events during 12 months after TAVR (HR: 0.92, 95% CI: 0.45 to
1.88, p = 0.815).
Conclusions This large study showed that BPD after TAVR was safe and not
associated with increased rates of cerebrovascular events, mortality,
myocardial infarction, and aortic root injury.

<6>
Accession Number
2014864637
Authors
Chekan E. Whelan R.L.
Institution
(Chekan) Ethicon Inc, Cincinnati, OH, United States
(Whelan) St Luke's Roosevelt Hospital, New York, NY, United States
Title
Surgical stapling device-tissue interactions: What surgeons need to know
to improve patient outcomes.
Source
Medical Devices: Evidence and Research. 7 (pp 305-318), 2014. Date of
Publication: 12 Sep 2014.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
The introduction of both new surgical devices and reengineered existing
devices leads to modifications in the way traditional tasks are carried
out and allows for the development of new surgical techniques. Each new
device has benefits and limitations in regards to tissue interactions
that, if known, allow for optimal use. However, most surgeons are unaware
of these attributes and, therefore, new device introduction creates a
"knowledge gap" that is potentially dangerous. The goal of this review is
to present a framework for the study of device- tissue interactions and to
initiate the process of "filling in" the knowledge gap via the available
literature. Surgical staplers, which are continually being developed, are
the focus of this piece. The integrity of the staple line, which depends
on adequate tissue compression, is the primary factor in creating a stable
anastomosis. This review focuses on published studies that evaluated the
creation of stable anastomoses in bariatric, thoracic, and colorectal
procedures. Understanding how staplers interact with target tissues is key
to improving patient outcomes. It is clear from this review that each
tissue type presents unique challenges. The thickness of each tissue
varies as do the intrinsic biomechanical properties that determine the
ideal compressive force and prefiring compression time for each tissue
type. The correct staple height will vary depending on these
tissue-specific properties and the tissue pathology. These studies
reinforce the universal theme that compression, staple height, tissue
thickness, tissue compressibility, and tissue type must all be considered
by the surgeon prior to choosing a stapler and cartridge. The surgeon's
experience, therefore, is a critical factor. Educational programs need to
be established to inform and update surgeons on the characteristics of
each stapler. It is hoped that the framework presented in this review will
facilitate this process.

<7>
Accession Number
2014847697
Authors
Espinosa A. Stenseth R. Videm V. Pleym H.
Institution
(Espinosa, Videm) Department of Immunology and Transfusion Medicine, St.
Olav University Hospital, Trondheim, Norway
(Stenseth) Department of Cardiothoracic Anesthesia and Intensive Care
Medicine, St. Olav University Hospital, Trondheim, Norway
(Stenseth, Pleym) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
(Videm) Department of Laboratory Medicine, Children's and Women's Health,
Norwegian University of Science and Technology, Trondheim, Norway
(Pleym) Clinic of Anaesthesia and Intensive Care, St. Olav University
Hospital, Trondheim, Norway
Title
Comparison of three point-of-care testing devices to detect hemostatic
changes in adult elective cardiac surgery: A prospective observational
study.
Source
BMC Anesthesiology. 14 (1) , 2014. Article Number: 80. Date of
Publication: September 22, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Bleeding complications in cardiac surgery may lead to
increased morbidity and mortality. Traditional blood coagulation tests are
not always suitable to detect rapid changes in the patient's coagulation
status. Point-of-care instruments such as the TEG (thromboelastograph) and
RoTEM (thromboelastometer) have been shown to be useful as a guide for the
clinician in the choice of blood products and they may lead to a reduction
in the need for blood transfusion, contributing to better patient blood
management.Methods: The purpose of this study was to evaluate the ability
of the TEG, RoTEM and Sonoclot instruments to detect changes in hemostasis
in elective cardiac surgery with cardiopulmonary bypass and to investigate
possible correlations between variables from these three instruments and
routine hematological coagulation tests. Blood samples from thirty-five
adult patients were drawn before and after surgery and analyzed in TEG,
RoTEM, Sonoclot and routine coagulation tests. Data were compared using
repeated measures analysis of variance and Pearson's test for linear
correlation.Results: We found significant changes for all TEG variables
after surgery, for three of the RoTEM variables, and for one variable from
the Sonoclot. There were significant correlations postoperatively between
plasma fibrinogen levels and variables from the three
instruments.Conclusions: TEG and RoTEM may be used to detect changes in
hemostasis following cardiac surgery with CPB. Sonoclot seems to be less
suitable to detect such changes. Variables from the three instruments
correlated with plasma fibrinogen and could be used to monitor treatment
with fibrinogen concentrate.

<8>
Accession Number
2014822856
Authors
Silverberg S.J. Clarke B.L. Peacock M. Bandeira F. Boutroy S. Cusano N.E.
Dempster D. Lewiecki E.M. Liu J.-M. Minisola S. Rejnmark L. Silva B.C.
Walker M.D. Bilezikian J.P.
Institution
(Silverberg, Cusano, Dempster, Walker, Bilezikian) Columbia University,
College of Physicians and Surgeons, 630 West 168th Street, PH 8W-864, New
York, NY 10032, United States
(Clarke) Mayo Clinic, Rochester, MN 55902, United States
(Peacock) Indiana University, School of Medicine, Indianapolis, IN 46202,
United States
(Bandeira) University of Pernambuco, School of Medicine, Recife 52050-450,
Brazil
(Boutroy) INSERM UMR 1033, Universite de Lyon, Lyon 69437, France
(Lewiecki) New Mexico Clinical Research and Osteoporosis Center,
University of New Mexico, School of Medicine, Albuquerque, NM 87106,
United States
(Liu) Shanghai Jiao-tong University, School of Medicine, Shanghai 200025,
China
(Minisola) Sapienza University of Rome, Rome 00161, Italy
(Rejnmark) Aarhus University Hospital, Aarhus 8000, Denmark
(Silva) Federal University of Minas Gerais, Belo Horizonte 30.130-100,
Brazil
Title
Current issues in the presentation of asymptomatic primary
hyperparathyroidism: Proceedings of the fourth International Workshop.
Source
Journal of Clinical Endocrinology and Metabolism. 99 (10) (pp 3580-3594),
2014. Date of Publication: 01 Oct 2014.
Publisher
Endocrine Society
Abstract
Conclusions: 1) There are limited new data available on the natural
history of asymptomatic PHPT. Although recognition of normocalcemic PHPT
(normal serum calcium with elevated PTH concentrations; no secondary cause
for hyperparathyroidism) is increasing, data on the clinical presentation
and natural history of this phenotypeare limited. 2) Although there are
geographic differences in the predominant phenotypes of PHPT (symptomatic,
asymptomatic, normocalcemic), they do not justify geography-specific
management guidelines. 3) Recent data using newer, higher resolution
imaging and analytic methods have revealed that in asymptomatic PHPT, both
trabecular bone and cortical bone are affected. 4) Clinically silent
nephrolithiasis and nephrocalcinosis can be detected by renal imaging and
should be listed as a new criterion for surgery. 5) Current data do not
support a cardiovascular evaluation or surgery forthe purpose of improving
cardiovascular markers, anatomical orfunctional abnormalities. 6) Some
patients with mild PHPT have neuropsychological complaints and cognitive
abnormalities, and some of these patients may benefit from surgical
intervention. However, it is not possible at this time to predict which
patients with neuropsychological complaints or cognitive issues will
improve after successful parathyroid surgery.
Objective: This report summarizes data on traditional and nontraditional
manifestations of primary hyperparathyroidism (PHPT) that have been
published since the last International Workshop on PHPT.
Participants: This subgroup was constituted by the Steering Committee to
address key questions related to the presentation of PHPT. Consensus was
established at a closed meeting of the Expert Panel that followed.
Evidence: Data from the 5-year period between 2008 and 2013 were presented
and discussed to determine whether they support changes in recommendations
for surgery or nonsurgical follow-up.
Consensus Process: Questions were developed by the International Task
Force on PHPT. A comprehensive literature search for relevant studies was
undertaken. After extensive review and discussion, the subgroup came to
agreement on what changes in the recommendations for surgery or
nonsurgical follow-up of asymptomatic PHPT should be made to the Expert
Panel.

<9>
Accession Number
2014820001
Authors
Gao X.-F. Zhang Y.-J. Tian N.-L. Wu W. Li M.-H. Bourantas C.V. Jiang X.-M.
Wang Z.-M. Li B. Mao W.-X. Zhang J.-J. Chen S.-L.
Institution
(Gao, Zhang, Tian, Wu, Li, Jiang, Wang, Li, Mao, Zhang, Chen) Department
of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68
Changle Road, Nanjing 210006, China
(Zhang, Bourantas) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Tian, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing,
China
Title
Stenting strategy for coronary artery bifurcation with drug-eluting
stents: A meta-analysis of nine randomised trials and systematic review.
Source
EuroIntervention. 10 (5) (pp 561-569), 2014. Date of Publication: 01 Sep
2014.
Publisher
EuroPCR
Abstract
Aims: The present study sought to compare angiographic and clinical
outcomes of a simple strategy versus a complex strategy in patients with
coronary bifurcation lesions undergoing drug-eluting stent implantation.
Methods and results: Medline, the Cochrane Library, and other internet
sources were searched for randomised trials comparing simple strategy
versus complex strategy for treating patients with bifurcation lesions.
Nine eligible randomised trials including 2,569 patients were identified.
The meta-analysis showed that cardiac death (odds ratio [OR]: 0.99, 95%
confidence interval [CI]: 0.40-2.41, p=0.98) and stent thrombosis (OR:
0.64, 95% CI: 0.31-1.34, p=0.24) were similar in the simple and the
complex strategy. Compared with the complex strategy, the simple strategy
was associated with a reduced risk of either early or follow-up myocardial
infarction (OR: 0.53, 95% CI: 0.36-0.79, p=0.002; OR: 0.60, 95% CI:
0.43-0.86, p=0.01, respectively). The overall risks of side branch
restenosis (OR: 1.44, 95% CI: 0.73-2.87, p=0.30), target lesion (OR: 1.72,
95% CI: 0.95-3.12, p=0.07) and target vessel revascularisation (OR: 1.59,
95% CI: 0.94-2.69, p=0.09) were comparable between the two groups. In the
true bifurcation, with large side branches, and DK-crush subgroups, there
were higher rates of reintervention seen in the simple strategy than in
the complex strategy.
Conclusions: A complex strategy remains an optional treatment for patients
with coronary bifurcation lesions without severe safety concerns. A
complex strategy may be an optimal treatment for true bifurcation lesions
with large side branches. Europa Digital & Publishing 2014. All rights
reserved.

<10>
Accession Number
2014796031
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.
Institution
(Imazio, Belli) Department of Cardiology, Maria Vittoria Hospital,
University of Torino, Via Cibrario 72, Torino, Torino 10141, Italy
(Imazio, Pullara, Gaita) University of Torino, Torino, Italy
(Brucato, Ferrazzi, Cugola, Cumetti, Innocente, Maestroni, Simon, Valenti)
Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Pullara, Gaita) AOU 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, ON, Canada
(Flocco) Cardiac Surgery, Ospedale Mauriziano, Torino, Italy
(Hoit) Case Western Reserve University, Cleveland, OH, United States
(Hoit) University Hospitals Case Medical Center, Cleveland, OH, United
States
(Musumeci, Pergolini, Polizzi) Department of Cardiac Surgery, Ospedale San
Camillo, Roma, Italy
(Oh) Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN,
United States
(Ristic) Department of Cardiology, Belgrade University School of Medicine,
Clinical Centre of Serbia, Belgrade, Serbia
(Spodick) St Vincent Hospital, Worcester, MA, United States
Title
Colchicine for prevention of postpericardiotomy syndrome and postoperative
atrial fibrillation: The COPPS-2 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (10) (pp
1016-1023), 2014. Date of Publication: 10 Sep 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: 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. OBJECTIVE:
To determine the efficacy and safety of perioperative use of oral
colchicine in reducing postpericardiotomy syndrome, postoperative AF, and
postoperative pericardial or pleural effusions. DESIGN, SETTING, AND
PARTICIPANTS: 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. INTERVENTIONS:
Patients were randomized to receive placebo (n=180) or colchicine (0.5mg
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. MAIN OUTCOMES AND MEASURES: Occurrence of
postpericardiotomy syndrome within 3 months; main secondary study end
points were postoperative AF and pericardial or pleural effusion. RESULTS:
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. CONCLUSIONS AND
RELEVANCE: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01552187
Copyright 2014 American Medical Association. All rights reserved.

<11>
Accession Number
2014796030
Authors
O'Donoghue M.L. Braunwald E. White H.D. Steen D.P. Lukas M.A. Tarka E.
Steg P.G. Hochman J.S. Bode C. Maggioni A.P. Im K. Shannon J.B. Davies
R.Y. Murphy S.A. Crugnale S.E. Wiviott S.D. Bonaca M.P. Watson D.F. Weaver
W.D. Serruys P.W. Cannon C.P.
Institution
(O'Donoghue, Braunwald, Steen, Im, Murphy, Crugnale, Wiviott, Bonaca,
Cannon) TIMI Study Group, Cardiovascular Division, Brigham AndWomen's
Hospital, 350 Longwood Ave, Boston, MA 02115, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Lukas) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Philadelphia, PA, United States
(Tarka, Davies) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, King of Prussia, PA, United States
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Universite Paris-Diderot, Paris, France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital, United Kingdom
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Maggioni) ANMCO Research Center, Florence, Italy
(Shannon, Watson) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Research Triangle Park, NC, United States
(Weaver) Henry Ford Heart and Vascular Institute, Detroit, MI, United
States
(Serruys) Erasmus University, Thoraxcentrum, Rotterdam, Netherlands
(Serruys) International Center for Circulatory Health, Imperial College,
London, United Kingdom
Title
Effect of darapladib on major coronary events after an acute coronary
syndrome: The SOLID-TIMI 52 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 312 (10) (pp
1006-1015), 2014. Date of Publication: 10 Sep 2014.
Publisher
American Medical Association
Abstract
IMPORTANCE: Lipoprotein-associated phospholipase
A₂(Lp-PLA₂) has been hypothesized to be involved in
atherogenesis through pathways related to inflammation. Darapladib is an
oral, selective inhibitor of the Lp-PLA₂enzyme. OBJECTIVE: To
evaluate the efficacy and safety of darapladib in patients after an acute
coronary syndrome (ACS) event. DESIGN, SETTING, AND PARTICIPANTS:
SOLID-TIMI 52was a multinational, double-blind, placebo-controlled trial
that randomized 13 026 participants within 30 days of hospitalization with
an ACS (non-ST-elevation or ST-elevationmyocardial infarction [MI]) at 868
sites in 36 countries. INTERVENTIONS: Patients were randomized to either
once-daily darapladib (160mg) or placebo on a background of
guideline-recommended therapy. Patients were followed up for a median of
2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES
AND MEASURES: The primary end point (major coronary events)was the
composite of coronary heart disease (CHD) death, MI, or urgent coronary
revascularization formyocardial ischemia. Kaplan-Meier event rates are
reported at 3 years. RESULTS: During a median duration of 2.5 years, the
primary end point occurred in 903 patients in the darapladib group and 910
in the placebo group (16.3%vs 15.6%at 3 years; hazard ratio [HR], 1.00
[95%CI, 0.91-1.09]; P = .93). The composite of cardiovascular death, MI,
or stroke occurred in 824 in the darapladib group and 838 in the placebo
group (15.0%vs 15.0%at 3 years; HR, 0.99 [95%CI, 0.90-1.09]; P = .78).
There were no differences between the treatment groups for additional
secondary end points, for individual components of the primary end point,
or in all-cause mortality (371 events in the darapladib group and 395 in
the placebo group [7.3%vs 7.1%at 3 years; HR, 0.94 [95%CI, 0.82-1.08]; P =
.40). Patients were more likely to report an odor-related concern in the
darapladib group vs the placebo group (11.5%vs 2.5%) and also more likely
to report diarrhea (10.6%vs 5.6%). CONCLUSIONS AND RELEVANCE: In patients
who experienced an ACS event, direct inhibition of Lp-PLA₂with
darapladib added to optimal medical therapy and initiated within 30 days
of hospitalization did not reduce the risk of major coronary events. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01000727 Copyright 2014
American Medical Association. All rights reserved.

<12>
Accession Number
25124184
Authors
Marui A. Kimura T. Nishiwaki N. Mitsudo K. Komiya T. Hanyu M. Shiomi H.
Tanaka S. Sakata R.
Institution
(Marui) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan. Electronic address:
(Kimura, Shiomi) Department of Cardiovascular Medicine, Kyoto University
Graduate School of Medicine, Kyoto, Japan.
(Nishiwaki) Department of Cardiovascular Surgery, Nara Hospital, Kinki
University Faculty of Medicine, Ikoma, Japan.
(Mitsudo) Department of Cardiovascular Medicine, Kurashiki Central
Hospital, Kurashiki, Japan.
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Japan.
(Hanyu) Department of Cardiovascular Surgery, Kokura Memorial Hospital,
Kitakyushu, Japan.
(Tanaka) Department of Pharmacoepidemiology, Kyoto University Graduate
School of Medicine, Kyoto, Japan.
(Sakata) Department of Cardiovascular Surgery, Kyoto University Graduate
School of Medicine, Kyoto, Japan.
Title
Comparison of five-year outcomes of coronary artery bypass grafting versus
percutaneous coronary intervention in patients with left ventricular
ejection fractions<50% versus >50% (from the CREDO-Kyoto PCI/CABG Registry
Cohort-2).
Source
The American journal of cardiology. 114 (7) (pp 988-996), 2014. Date of
Publication: 1 Oct 2014.
Abstract
Coronary heart disease is a major risk factor for left ventricular (LV)
systolic dysfunction. However, limited data are available regarding
long-term benefits of percutaneous coronary intervention (PCI) in the era
of drug-eluting stent or coronary artery bypass grafting (CABG) in
patients with LV systolic dysfunction with severe coronary artery disease.
We identified 3,584 patients with 3-vessel and/or left main disease of
15,939 patients undergoing first myocardial revascularization enrolled in
the CREDO-Kyoto PCI/CABG Registry Cohort-2. Of them, 2,676 patients had
preserved LV systolic function, defined as an LV ejection fraction (LVEF)
of >50% and 908 had impaired LV systolic function (LVEF<50%). In patients
with preserved LV function, 5-year outcomes were not different between PCI
and CABG regarding propensity score-adjusted risk of all-cause and cardiac
deaths. In contrast, in patients with impaired LV systolic function, the
risks of all-cause and cardiac deaths after PCI were significantly greater
than those after CABG (hazard ratio 1.49, 95% confidence interval 1.04 to
2.14, p=0.03 and hazard ratio 2.39, 95% confidence interval 1.43 to 3.98,
p<0.01). In both patients with moderate (35%<LVEF<50%) and severe
(LVEF<35%) LV systolic dysfunction, the risk of cardiac death after PCI
was significantly greater than that after CABG (hazard ratio 2.25, 95%
confidence interval 1.15 to 4.40, p=0.02 and hazard ratio 4.42, 95%
confidence interval 1.48 to 13.24, p=0.01). Similarly, the risk of
all-cause death tended to be greater after PCI than after CABG in both
patients with moderate and severe LV systolic dysfunction without
significant interaction (hazard ratio 1.57, 95% confidence interval 0.96
to 2.56, p=0.07 and hazard ratio 1.42, 95% confidence interval 0.71 to
2.82, p=0.32; interaction p=0.91). CABG was associated with better 5-year
survival outcomes than PCI in patients with impaired LV systolic function
(LVEF<50%) with complex coronary disease in the era of drug-eluting
stents. In both patients with moderate (35%<LVEF<50%) and severe
(LVEF<35%) LV systolic dysfunction, CABG tended to have better survival
outcomes than PCI. Copyright 2014 Elsevier Inc. All rights reserved.

<13>
Accession Number
25257633
Authors
Pibarot P. Weissman N.J. Stewart W.J. Hahn R.T. Lindman B.R. McAndrew T.
Kodali S.K. Mack M.J. Thourani V.H. Miller D.C. Svensson L.G. Herrmann
H.C. Smith C.R. Rodes-Cabau J. Webb J. Lim S. Xu K. Hueter I. Douglas P.S.
Leon M.B.
Institution
(Pibarot) Quebec Heart and Lung Institute/Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Laval University, Quebec, Canada.
Electronic address:
(Weissman) Medstar Health Research Institute, Washington, DC.
(Stewart) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio.
(Hahn, Kodali, Smith, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, New York, New York; The Cardiovascular
Research Foundation, New York, New York.
(Lindman) Washington University School of Medicine, St. Louis, Missouri.
(McAndrew, Xu) The Cardiovascular Research Foundation, New York, New York.
(Mack) Baylor Healthcare System, Dallas, Texas.
(Thourani) Emory University School of Medicine, Atlanta, Georgia.
(Miller) Stanford University School of Medicine, Stanford, California.
(Svensson) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio.
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia,
Pennsylvania.
(Rodes-Cabau) Quebec Heart and Lung Institute/Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Laval University, Quebec, Canada.
(Webb) University of British Columbia and St. Paul's Hospital, Vancouver,
Canada.
(Lim) University of Virginia Medical Center, Charlottesville, Virginia.
(Hueter) Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York.
(Douglas) Duke University Medical Center and Duke Clinical Research
Institute, Durham, North Carolina.
Title
Incidence and sequelae of prosthesis-patient mismatch in transcatheter
versus surgical valve replacement in high-risk patients with severe aortic
stenosis: a PARTNER trial cohort--a analysis.
Source
Journal of the American College of Cardiology. 64 (13) (pp 1323-1334),
2014. Date of Publication: 30 Sep 2014.
Abstract
Little is known about the incidence of prosthesis-patient mismatch (PPM)
and its impact on outcomes after transcatheter aortic valve replacement
(TAVR). The objectives of this study were: 1) to compare the incidence of
PPM in the TAVR and surgical aortic valve replacement (SAVR) randomized
control trial (RCT) arms of the PARTNER (Placement of AoRTic TraNscathetER
Valves) I Trial cohort A; and 2) to assess the impact of PPM on regression
of left ventricular (LV) hypertrophy and mortality in these 2 arms and in
the TAVR nonrandomized continued access (NRCA) registry cohort. The
PARTNER Trial cohort A randomized patients 1:1 to TAVR or bioprosthetic
SAVR. Postoperative PPM was defined as absent if the indexed effective
orifice area (EOA) was >0.85 cm(2)/m(2), moderate if the indexed EOA was
>0.65 but <0.85 cm(2)/m(2), or severe if the indexed EOA was <0.65
cm(2)/m(2). LV mass regression and mortality were analyzed using the
SAVR-RCT (n = 270), TAVR-RCT (n = 304), and TAVR-NRCA (n = 1,637) cohorts.
The incidence of PPM was 60.0% (severe: 28.1%) in the SAVR-RCT cohort
versus 46.4% (severe: 19.7%) in the TAVR-RCT cohort (p < 0.001) and 43.8%
(severe: 13.6%) in the TAVR-NRCA cohort. In patients with an aortic
annulus diameter <20 mm, severe PPM developed in 33.7% undergoing SAVR
compared with 19.0% undergoing TAVR (p = 0.002). PPM was an independent
predictor of less LV mass regression at 1 year in the SAVR-RCT (p = 0.017)
and TAVR-NRCA (p = 0.012) cohorts but not in the TAVR-RCT cohort (p =
0.35). Severe PPM was an independent predictor of 2-year mortality in the
SAVR-RCT cohort (hazard ratio [HR]: 1.78; p = 0.041) but not in the
TAVR-RCT cohort (HR: 0.58; p = 0.11). In the TAVR-NRCA cohort, severe PPM
was not a predictor of 1-year mortality in all patients (HR: 1.05; p =
0.60) but did independently predict mortality in the subset of patients
with no post-procedural aortic regurgitation (HR: 1.88; p = 0.02). In
patients with severe aortic stenosis and high surgical risk, PPM is more
frequent and more often severe after SAVR than TAVR. Patients with PPM
after SAVR have worse survival and less LV mass regression than those
without PPM. Severe PPM also has a significant impact on survival after
TAVR in the subset of patients with no post-procedural aortic
regurgitation. TAVR may be preferable to SAVR in patients with a small
aortic annulus who are susceptible to PPM to avoid its adverse impact on
LV mass regression and survival. (The PARTNER Trial: Placement of AoRTic
TraNscathetER Valve Trial; NCT00530894). Copyright 2014 American College
of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<14>
Accession Number
24831401
Authors
Marchetti-Filho M.A. Leao L.E.V. Costa-Junior A.S.
Institution
(Marchetti-Filho, Leao, Costa-Junior) Department of Thoracic Surgery,
Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo,
Brazil
Title
The role of intercostal nerve preservation in acute pain control after
thoracotomy.
Source
Jornal Brasileiro de Pneumologia. 40 (2) (pp 164-170), 2014. Date of
Publication: 2014.
Abstract
Objective: To evaluate whether the acute pain experienced during
in-hospital recovery from thoracotomy can be effectively reduced by the
use of intraoperative measures (dissection of the neurovascular bundle
prior to the positioning of the Finochietto retractor and preservation of
the intercostal nerve during closure). Methods: We selected 40 patients
who were candidates for elective thoracotomy in the Thoracic Surgery
Department of the Federal University of Sao Paulo/Paulista School of
Medicine, in the city of Sao Paulo, Brazil. The patients were randomized
into two groups: conventional thoracotomy (CT, n = 20) and neurovascular
bundle preservation (NBP, n = 20). All of the patients underwent thoracic
epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was
assessed with a visual analog scale on postoperative days 1, 3, and 5, as
well as by monitoring patient requests for/consumption of analgesics.
Results: On postoperative day 5, the self-reported pain intensity was
significantly lower in the NBP group than in the CT group (visual analog
scale score, 1.50 vs. 3.29; p = 0.04). No significant differences were
found between the groups regarding the number of requests for/ consumption
of analgesics. Conclusions: In patients undergoing thoracotomy, protecting
the neurovascular bundle prior to positioning the retractor and preserving
the intercostal nerve during closure can minimize pain during in-hospital
recovery.

<15>
Accession Number
25132330
Authors
Amat-Santos I.J. Dahou A. Webb J. Dvir D. Dumesnil J.G. Allende R. Ribeiro
H.B. Urena M. Paradis J.M. DeLarochelliere R. Dumont E. Bergeron S.
Thompson C.R. Pasian S. Bilodeau S. Leipsic J. Larose E. Pibarot P.
Rodes-Cabau J.
Institution
(Amat-Santos, Dahou, Dumesnil, Allende, Ribeiro, Urena, Paradis,
DeLarochelliere, Dumont, Bergeron, Pasian, Bilodeau, Larose, Pibarot)
Department of Cardiology, Quebec Heart and Lung Institute, Laval
University, Quebec City, Quebec, Canada.
(Webb, Dvir, Thompson, Leipsic) Department of Cardiology, St. Paul's
Hospital, University of British Columbia, Vancouver, British Columbia,
Canada.
(Rodes-Cabau) Department of Cardiology, Quebec Heart and Lung Institute,
Laval University, Quebec City, Quebec, Canada. Electronic address:
Title
Comparison of hemodynamic performance of the balloon-expandable SAPIEN 3
versus SAPIEN XT transcatheter valve.
Source
The American journal of cardiology. 114 (7) (pp 1075-1082), 2014. Date of
Publication: 1 Oct 2014.
Abstract
The SAPIEN 3 valve (S3V) is a new-generation transcatheter valve with
enhanced anti-paravalvular leak properties, but no data comparing with
earlier transcatheter valve systems are available. We aimed to compare the
hemodynamic performance of the S3V and the SAPIEN XT valve (SXTV) in a
case-matched study with echo core laboratory analysis. A total of 27
patients who underwent transcatheter aortic valve replacement (TAVR) with
the S3V were matched for prosthesis size (26 mm), aortic annulus area, and
mean diameter measured by computed tomography, left ventricular ejection
fraction, body surface area, and body mass index with 50 patients treated
with the SXTV. The prosthesis size was determined by oversizing of 1% to
15% of annulus area. Doppler echocardiographic images collected at
baseline and 1-month follow-up were analyzed in a central echocardiography
core laboratory. The need for postdilation was higher in the SXTV group
(20% vs 4%, p=0.047), and mean residual gradient and effective orifice
area were similar in both groups (p>0.05). The incidence of paravalvular
aortic regurgitation was greater with the SXTV (>mild: 42%, moderate: 8%)
than with the S3V (>mild: 7%, moderate: 0%; p=0.002 for >mild vs SXTV).
The implantation of an S3V was the only factor associated with trace or no
paravalvular leak after TAVR (p=0.007). In conclusion, TAVR with the S3V
was associated with a very low rate of paravalvular leaks and need for
balloon postdilation, much lower than that observed with the earlier
generation of balloon-expandable valve (SXTV). The confirmation of these
results in a larger cohort of patients will represent a major step forward
in using transcatheter valves for the treatment of aortic stenosis.
Copyright 2014 Elsevier Inc. All rights reserved.

<16>
Accession Number
25124186
Authors
Buszman P.E. Buszman P.P. Bochenek A. Gierlotka M. Gasior M. Milewski K.
Orlik B. Janas A. Wojakowski W. Kiesz R.S. Zembala M. Polonski L.
Institution
(Buszman, Bochenek, Milewski, Orlik, Janas) American Heart of Poland,
Center for Cardiovascular Research and Development, Katowice, Poland.
(Buszman) American Heart of Poland, Center for Cardiovascular Research and
Development, Katowice, Poland; III Clinical Department of Cardiology,
Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze,
Poland. Electronic address:
(Gierlotka, Gasior) III Clinical Department of Cardiology, Medical
University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
(Wojakowski) American Heart of Poland, Center for Cardiovascular Research
and Development, Katowice, Poland; IIIrd Clinical Division of Cardiology,
Medical University of Silesia in Katowice, Katowice, Poland.
(Kiesz) American Heart of Poland, Center for Cardiovascular Research and
Development, Katowice, Poland; University of Texas Health Sciences, San
Antonio, Texas.
(Zembala) Department of Cardiac Surgery and Transplantology, Silesian
Center for Heart Diseases, Zabrze, Poland.
(Polonski) III Clinical Department of Cardiology, Medical University of
Silesia, Silesian Center for Heart Diseases, Zabrze, Poland; Department of
Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases,
Zabrze, Poland.
Title
Comparison of stenting and surgical revascularization strategy in non-ST
elevation acute coronary syndromes and complex coronary artery disease
(from the Milestone Registry).
Source
The American journal of cardiology. 114 (7) (pp 979-987), 2014. Date of
Publication: 1 Oct 2014.
Abstract
The optimal revascularization strategy in patients with complex coronary
artery disease and non-ST-segment elevation acute coronary syndromes is
undetermined. In this multicenter, prospective registry, 4,566 patients
with non-ST-segment elevation myocardial infarctions, unstable angina, and
multivessel coronary disease, including left main disease, were enrolled.
After angiography, 3,033 patients were selected for stenting (10.3%
received drug-eluting stents) and 1,533 for coronary artery bypass
grafting. Propensity scores were used for baseline characteristic matching
and result adjustment. Patients selected for percutaneous coronary
intervention (PCI) were younger (mean age 64.4+10 vs 65.2+9 years, p=0.03)
and more frequently presented with non-ST-segment elevation myocardial
infarctions (32.0% vs 14.5%, p=0.01), cardiogenic shock (1.5% vs 0.7%,
p<0.01), and history of PCI (13.1% vs 5.5%, p<0.01) or coronary artery
bypass grafting (10.6% vs 4.6%, p<0.01). European System for Cardiac
Operative Risk Evaluation scores were higher in PCI patients (5.4+2 vs
5.2+2, p<0.01). Patients referred for coronary artery bypass grafting more
often presented with triple-vessel disease and left main disease (82.2% vs
33.8% and 13.7% vs 2.4%, respectively, p<0.01). After adjustment, 929
well-matched pairs were chosen. Early mortality was lower after PCI before
matching (2.1% vs 3.1%, p<0.01), whereas after balancing, there was no
difference (2.5% vs 2.8%, p=0.62). Three-year survival was in favor of PCI
compared with surgery before (87.5% vs 82.8%, hazard ratio 1.44, 95%
confidence interval 1.2 to 1.7, p<0.01) and after (86.4% vs 82.3%, hazard
ratio 1.33, 95% confidence interval 1.05 to 1.7, p=0.01). Stenting was
associated with improved outcomes in the following subgroups: patients
aged >65 years, women, patients with unstable angina, those with European
System for Cardiac Operative Risk Evaluation scores>5, those with
Thrombolysis In Myocardial Infarction (TIMI) risk scores >4, those
receiving drug-eluting stents, and those with 2-vessel disease. In
conclusion, in patients presenting with non-ST-segment elevation acute
coronary syndromes and complex coronary artery disease, immediate stenting
was associated with lower mortality risk in the long term compared with
surgical revascularization, especially in subgroups at high clinical risk.
Copyright 2014 Elsevier Inc. All rights reserved.

<17>
Accession Number
25092192
Authors
Sannino A. Losi M.A. Schiattarella G.G. Gargiulo G. Perrino C. Stabile E.
Toscano E. Giugliano G. Brevetti L. Franzone A. Cirillo P. Imbriaco M.
Trimarco B. Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Toscano,
Giugliano, Brevetti, Franzone, Cirillo, Imbriaco, Trimarco) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy.
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy. Electronic address:
Title
Meta-analysis of mortality outcomes and mitral regurgitation evolution in
4,839 patients having transcatheter aortic valve implantation for severe
aortic stenosis.
Source
The American journal of cardiology. 114 (6) (pp 875-882), 2014. Date of
Publication: 15 Sep 2014.
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative
therapy in selected patients with severe aortic stenosis. The role and
effects of coexistent moderate to severe mitral regurgitation (msMR) in
patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839
patients who underwent TAVI, including patients with msMR, were considered
in a meta-analysis and analyzed for all-cause-mortality; a further
meta-analysis was performed to assess mitral regurgitation (MR) evolution
after TAVI. In patients with msMR, all-cause-mortality after TAVI was
significantly increased at 30-day (effect size [ES] -0.18, 95% confidence
interval [CI] -0.31 to -0.04, I(2) = 46.51, Q = 7.48), 1-year (ES -0.22,
95% CI -0.36 to -0.08, I(2) = 56.20, Q = 11.41), and 2-year (ES -0.15, 95%
CI -0.27 to -0.02, I(2) = 0.00, Q = 2.64) follow-up compared with patients
with absent or mild MR, independent of baseline left ventricular ejection
fraction. Interestingly, the impact of msMR on outcomes was statistically
stronger when the CoreValve system was used. TAVI was also associated with
an improvement in MR entity at 3- and 6-month follow-up (overall ES -0.19,
95% CI -0.37 to -0.01, I(2) = 61.52, Q = 10.39). In conclusion, the
presence of preoperative msMR in patients with severe, symptomatic aortic
stenosis who undergo TAVI negatively affects outcomes after TAVI. In
addition, in the same group of patients, a trend toward a reduction in MR
severity was observed. Whether the decrease in MR severity affects
mortality after TAVI remains to be defined. Copyright 2014 Elsevier Inc.
All rights reserved.

<18>
Accession Number
25222386
Authors
Mark D.B. Knight J.D. Velazquez E.J. Wasilewski J. Howlett J.G. Smith P.K.
Spertus J.A. Rajda M. Yadav R. Hamman B.L. Malinowski M. Naik A. Rankin G.
Harding T.M. Drew L.A. Desvigne-Nickens P. Anstrom K.J.
Title
Quality-of-life outcomes with coronary artery bypass graft surgery in
ischemic left ventricular dysfunction: a randomized trial.
Source
Annals of internal medicine. 161 (6) (pp 392-399), 2014. Date of
Publication: 16 Sep 2014.
Abstract
The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a
strategy of routine coronary artery bypass grafting (CABG) with
guideline-based medical therapy for patients with ischemic left
ventricular dysfunction. To describe treatment-related quality-of-life
(QOL) outcomes, a major prespecified secondary end point in the STICH
trial. Randomized trial. (ClinicalTrials.gov: NCT00023595). 99 clinical
sites in 22 countries. 1212 patients with a left ventricular ejection
fraction of 0.35 or less and coronary artery disease. Random assignment to
medical therapy alone (602 patients) or medical therapy plus CABG (610
patients). A battery of QOL instruments at baseline (98.9% complete) and
4, 12, 24, and 36 months after randomization (collection rates were 80% to
89% of those eligible). The principal prespecified QOL measure was the
Kansas City Cardiomyopathy Questionnaire, which assesses the effect of
heart failure on patients' symptoms, physical function, social
limitations, and QOL. The Kansas City Cardiomyopathy Questionnaire overall
summary score was consistently higher (more favorable) in the CABG group
than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0
points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1
points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to
6.3 points) at 36 months. Sensitivity analyses to account for the effect
of mortality on follow-up QOL measurement were consistent with the primary
findings. Therapy was not masked. In this cohort of symptomatic high-risk
patients with ischemic left ventricular dysfunction and multivessel
coronary artery disease, CABG plus medical therapy produced clinically
important improvements in quality of life compared with medical therapy
alone over 36 months. National Heart, Lung, and Blood Institute.

<19>
Accession Number
25001621
Authors
Saari T.I. Ihmsen H. Mell J. Frohlich K. Fechner J. Schuttler J. Jeleazcov
C.
Institution
(Saari) Anasthesiologische Klinik, Universitatsklinikum Erlangen,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Krankenhausstrasse 12,
D-91054 Erlangen, Germany Department of Anaesthesiology, Intensive Care,
Emergency Care and Pain Medicine, University of Turku and Turku University
Hospital, PO Box 52 (Kiinamyllynkatu 4-8), 20521 Turku, Finland
(Ihmsen, Frohlich, Fechner, Schuttler, Jeleazcov) Anasthesiologische
Klinik, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat
Erlangen-Nurnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
(Mell) Anasthesiologische Klinik, Universitatsklinikum Erlangen,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Krankenhausstrasse 12,
D-91054 Erlangen, Germany Department of Anaesthesiology, Intensive Care,
Emergency Care and Pain Medicine, University of Turku and Turku University
Hospital, PO Box 52 (Kiinamyllynkatu 4-8), 20521 Turku, Finland.
Title
Influence of intensive care treatment on the protein binding of sufentanil
and hydromorphone during pain therapy in postoperative cardiac surgery
patients.
Source
British journal of anaesthesia. 113 (4) (pp 677-687), 2014. Date of
Publication: Oct 2014.
Abstract
Our objective was to evaluate the effect of intensive care treatment on
the protein binding of sufentanil and hydromorphone in cardiac surgery
patients during postoperative analgesia using a target-controlled infusion
(TCI) and patient-controlled analgesia (PCA). Fifty adult patients were
enrolled in this prospective randomized study; of which, 49 completed the
study (age range 40-81 yr). Sufentanil was administered as an analgesic
intraoperatively, and hydromorphone was dosed after operation with TCI and
PCA until 8 a.m. on the first postoperative day. Arterial plasma samples
were collected for drug and protein concentration measurements up to 24 h
after cardiac surgery. Corresponding patient data were collected from the
electronic patient data system. After explorative data analysis with
principal component analysis, multivariate regression analysis and
non-linear mixed effects modelling was used to study the effect of
treatment on protein binding. Data of 35 patients were analysed. The
median protein binding of sufentanil and hydromorphone was 88.4% (IQ range
85.7-90.5%) and 11.6% (IQ range 9.5-14.3%), respectively. Free fraction of
sufentanil increased towards the end of the study period, whereas
hydromorphone free fraction remained nearly constant. The total sufentanil
concentration and volume balance were identified as significant covariates
for the protein binding of sufentanil. For the protein binding of
hydromorphone, no significant covariate effects were found. Sufentanil
protein binding was significantly dependent on changes in the total drug
concentration and volume balance addressing the importance of adequate
dosing and fluid-guided therapy. Hydromorphone protein binding was nearly
constant throughout the study period. EudraCT 2011-003648-31 and
ClinicalTrials.gov: NCT01490268. The Author 2014. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<20>
Accession Number
2014886562
Authors
Wilcox R. Iqbal K. Costigan T. Lopez-Sendon J. Ramos Y. Widimsky P.
Institution
(Wilcox) Faculty of Medicine and Health Sciences, Cardiovascular Medicine,
Queens Medical Centre, Nottingham NG7 2UH, United Kingdom
(Iqbal) Daiichi Sankyo UK Ltd, Gerrards Cross, Buckinghamshire, United
Kingdom
(Costigan) Lilly Research Laboratories, Indianapolis, IN, United States
(Lopez-Sendon) Hospital Universitario La Paz, IdiPaz, Universidad Autonoma
de Madrid, Madrid, Spain
(Ramos) Daiichi Sankyo Europe GmbH, Munich, Germany
(Widimsky) Charles University Prague, University Hospital Kralovske
Vinohrady, Prague, Czech Republic
Title
An analysis of TRITON-TIMI 38, based on the 12 month recommended length of
therapy in the European label for prasugrel.
Source
Current Medical Research and Opinion. 30 (11) (pp 2193-2205), 2014. Date
of Publication: 01 Nov 2014.
Publisher
Informa Healthcare
Abstract
Background: In TRITON-TIMI 38, patients with acute coronary syndromes were
treated with prasugrel or clopidogrel, with aspirin, for a median of 14.5
(maximum of 15) months. Based on this trial, the EU label for prasugrel
recommends treatment for up to 12 months and excludes patients with prior
stroke/transient ischemic attack (TIA). Furthermore, the EU label
recommends the 10mg maintenance dose (MD) for patients with body weight
>60kg and age <75 years. A lower MD of 5mg is recommended for those with
body weight <60kg; although generally not recommended, 5mg can be
prescribed to patients >75 years after individual risk-benefit evaluation.
This paper presents the one-year outcome data for this '10mg indicated
cohort'. Methods and results: From the overall cohort of 13,608 patients
in TRITON-TIMI 38, 10,804 fulfilled inclusion criteria for the 10mg
indicated cohort, of whom 22% had a history of diabetes, 73% an index
diagnosis of unstable angina/non-ST-segment-elevation myocardial
infarction (UA/NSTEMI), and 27% an index diagnosis of ST-segment-elevation
myocardial infarction (STEMI). In this cohort at 12 months, those given
prasugrel experienced significantly fewer ischemic events (cardiovascular
death, non-fatal myocardial infarction, or non-fatal stroke, 7.8% vs
10.5%, hazard ratio (HR)=0.73, p<0.001, than those given clopidogrel, with
a non-significant increase in non-coronary artery bypass graft (CABG) TIMI
major bleeding, 1.7% vs 1.5%, HR=1.15, p=0.40; similarly, in the overall
cohort these frequencies were 9.4% vs 11.4%, HR=0.81, p<0.001, for
cardiovascular death, non-fatal myocardial infarction, or non-fatal
stroke, and 2.2% vs 1.8%, HR=1.24, p=0.10, for non-CABG TIMI major
bleeding. There was a significant reduction in stent thrombosis in the
prasugrel group, with similar mortality rates and no excess of strokes.
Conclusions: Treatment with prasugrel according to EU label
recommendations results in a significant 27% and 57% relative risk
reduction (absolute risk reductions of 2.7% and 1.2%) in ischemic events
and stent thromboses respectively compared with clopidogrel, with a 15%
relative risk increase (absolute risk increase of 0.2%) for major bleeds
(p=0.40), and no excess of strokes. Limitations: Although restricted to
365 days of follow-up, this analysis encapsulates 1366 of 1424 (95.9%) of
all primary endpoint events and 244 of 257 (94.9%) of all first non-CABG
TIMI major bleeds reported in the pivotal manuscript. Furthermore, the
10mg indicated cohort was not a pre-specified subgroup in the study
protocol, but due to European labeling restrictions, results for all
outcomes in this cohort are presented through 12 months.

<21>
Accession Number
2014876557
Authors
Ji Q. Ding W. Mei Y. Wang X. Feng J. Cai J.
Institution
(Ji, Mei, Wang, Feng, Cai) Department of Thoracic Cardiovascular Surgery
of Tongji Hospital of Tongji University, Shanghai, China
(Ding) Department of Cardiovascular Surgery of Zhongshan Hospital of Fudan
University, Shanghai, China
Title
Protective Effects of Tight Glucose Control During Cardiopulmonary Bypass
on Myocardium in Adult Nondiabetic Patients Undergoing Valve Replacement.
Source
Canadian Journal of Cardiology. 30 (11) (pp 1429-1435), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Pulsus Group Inc.
Abstract
Background: In this study, we aimed to evaluate the protective effect of
tight glucose control during cardiopulmonary bypass on myocardium in adult
nondiabetic patients undergoing isolated aortic valve replacement in a
prospective and randomized trial. Methods: Sixty-five adult nondiabetic
patients undergoing selective isolated aortic valve replacement were
enrolled and randomly assigned to an insulin group (patients received a
continuous insulin infusion during surgery; n= 33) or a control group
(patients were not administered insulin unless their blood glucose level
exceeded 200 mg/dL; n= 32). Cardiac troponin I was assayed preoperatively,
and then at 2, 6, 12, 24, and 48 hours after aortic cross-declamping. The
pre-, intra-, and postoperative relevant data of all selected patients
were analyzed. Results: Tight glucose control reduced postoperative peak
release by 48% for cardiac troponin I compared with the control group
(0.48 + 0.12 vs 0.71 + 0.17 ng/mL; P < 0.0001). Patients with continuous
insulin infusion had lower peak inotropic score during the first
postoperative 24 hours and peak level of blood glucose (5.8 + 2.2 vs 8.2 +
3.1 mug/kg/min; P < 0.0001; 131.9 + 23.8 vs 191.1 + 38.5 mg/dL; P < 0.001,
respectively), shorter duration of mechanical ventilation and intensive
care unit stay and hospital stay compared with the control group (11.6 +
2.9 hours vs 14.8 + 3.5 hours; P= 0.0002; 28.4 + 7.2 hours vs 36.5 + 7.8
hours; P < 0.0001; 9.4 + 3.3 days vs 11.5 + 4.2 days; P= 0.0283,
respectively). Conclusions: Tight glucose control during cardiopulmonary
bypass might provide myocardial protection in adult nondiabetic patients
undergoing isolated aortic valve replacement.

<22>
Accession Number
2014859820
Authors
Dehghani M.R. Madjidi N. Rahmani A. Asgari B. Rezaei Y.
Institution
(Dehghani) Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia
University of Medical Sciences, Urmia, Iran, Islamic Republic of
(Madjidi, Rahmani) Department of Medical Surgical Nursing, School of
Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Asgari) Department of Cardiovascular Surgery, Seyyed-al-Shohada Heart
Center, Urmia University of Medical Sciences, Urmia, Iran, Islamic
Republic of
(Rezaei) Seyyed-al-Shohada Heart Center, Urmia University of Medical
Sciences, Urmia, Iran, Islamic Republic of
Title
Effect of oral vitamin C on atrial fibrillation development after isolated
coronary artery bypass grafting surgery: A prospective randomized clinical
trial.
Source
Cardiology Journal. 21 (5) (pp 492-499), 2014. Date of Publication: 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
viamedica@viamedica.com.pl)
Abstract
Background: Some evidences have shown the role of antioxidant vitamins in
preventing atrial fibrillation (AF) after coronary artery bypass grafting
(CABG) surgery. We sought to determine the effect of oral vitamin C on the
incidence of postoperative AF in patients undergoing elective isolated
on-pump CABG surgery.
Methods: One-hundred patients who underwent isolated CABG surgery were
prospectively assigned into two groups: Group 1 - 50 patients received 2 g
of oral vitamin C before and 500 mg twice daily lasting for 5 days after
surgery; Group 2 - 50 patients as the control group did not receive any.
All patients were continuously monitored after surgery in the intensive
care unit (ICU), and then Holter monitoring was implemented for 72 h.
Results: The mean of patients' age was 61.31 + 6.42 years. Postoperative
AF occurred in 16 and 4 patients in control and treatment groups,
respectively (32% vs. 8%, p = 0.003). The ICU stay was 1.79 + 0.313 and
2.10 + 0.61 days for vitamin C and control groups, respectively (p =
0.002). The hospital stay was significantly lower in vitamin C group
compared with that of the control group (5.32 + 0.59 vs. 5.74 + 1.30 days,
respectively, p = 0.041). Baseline erythrocyte sedimentation rate (OR
1.030, 95% CI 1.003-1.058, p = 0.030) and taking vitamin C (OR 8.068, 95%
CI 1.783-36.517, p = 0.007) were the independent predictors of
postoperative AF.
Conclusions: Oral vitamin C can be safely used to decrease the incidence
of postoperative AF in patients undergoing elective isolated on-pump CABG
surgery.

<23>
Accession Number
2014830555
Authors
Habibi M.R. Baradari A.G. Soleimani A. Zeydi A.E. Nia H.S. Onagh N.
Institution
(Habibi, Baradari) Department of Anesthesiology, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Soleimani) Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Zeydi) Department of Medical-Surgical Nursing, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Nia, Onagh) Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
Title
Hemodynamic responses to etomidate versus ketamine-thiopental sodium
combination for anesthetic induction in coronary artery bypass graft
surgery patients with low ejection fraction: A double-blind, Randomized,
Clinical trial.
Source
Journal of Clinical and Diagnostic Research. 8 (10) (pp GC01-GC05), 2014.
Date of Publication: October 2014.
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar, G T
Road, Delhi 110007, India. E-mail: editor-in-chief@jcdr.net )
Abstract
Background: During induction of anesthesia and intubation, hemodynamic
changes are very important; especially in patients with coronary artery
disease (CAD) and left ventricular dysfunction. A little information is
available on the hemodynamic effects of a combination of
ketamine-thiopental for induction of anesthesia in patients undergoing
coronary artery bypass graft (CABG) surgery, with impaired ventricular
function.
Aim: The aim of this study was to compare the hemodynamic responses to
etomidate versus ketamine-thiopental sodium combination for anesthetic
induction in CABG surgery patients with low ejection fraction (EF<45%).
Materials and Methods: In a double blind randomized clinical trial, a
total of 100 patients, scheduled for elective CABG surgery were randomly
assigned into two groups. These patients received either etomidate or
ketamine-thiopental sodium combination at induction of anesthesia.
Hemodynamics variable were measured and recorded at baseline, immediately
before and after laryngoscopy and intubation, one, two and three minutes
after intubation. Also, muscle twitching incidence among patients in two
groups was evaluated.
Results: No significant differences between the two groups regarding the
changes of hemodynamic variables including systolic and diastolic arterial
blood pressure, mean arterial pressure and heart rate, were notice
(p>0.05). Muscle twitching was not observed in the two groups.
Conclusion: Hemodynamic stability after administration of
ketamine-thiopental sodium combination for induction of anesthesia in
patients undergoing CABG surgery, with impaired ventricular function,
supports the clinical impression that this combination is safe in CABG
surgery patients with low EF.

<24>
Accession Number
2014848047
Authors
Tona F. Fedrigo M. Famoso G. Previato M. Tellatin S. Vecchiati A. Bellu R.
Marra M.P. Feltrin G. Gerosa G. Thiene G. Iliceto S. Angelini A.
Institution
(Tona, Fedrigo, Famoso, Previato, Tellatin, Vecchiati, Bellu, Marra,
Feltrin, Gerosa, Thiene, Iliceto, Angelini) Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua, Padua, Italy
Title
Everolimus prevents coronary microvasculopathy in heart transplant
recipients with normal coronary angiograms: An anatomo-functional study.
Source
Transplantation Proceedings. 46 (7) (pp 2339-2344), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Elsevier USA
Abstract
Background Coronary allograft vasculopathy (CAV) involves both epicardial
vessels and coronary microcirculation. Little is known about the effect of
everolimus on coronary microvasculopathy in heart transplantation (HT).
The aim of our study was to assess the pathological substrate of coronary
flow reserve (CFR) impairment in HT patients and the effect of everolimus
on microvascular remodeling and CFR.
Methods We studied 28 HT patients with normal coronary angiograms (25
male, age at HT 54 + 10 years). Immunosuppressive regimen consisted of
cyclosporine and everolimus (10 patients) or mycophenolate mophetil (18
patients). They were evaluated with digital microscopy for morphometric
analysis of fibrosis and microvascular remodeling. Coronary flow velocity
in the left anterior descending coronary artery was detected using
transthoracic Doppler echocardiography at rest and during adenosine
infusion. CFR was the ratio of hyperaemic diastolic flow velocity (DFV) to
resting DFV. A CFR <2.5 was considered abnormal and sign of coronary
microvascular dysfunction.
Results In patients with CFR <2.5 the thickness of the tunica media of
intramyocardial arterioles was greater than in patients with CFR >2.5 (39
+ 2 vs 17 + 3 mum; P =.02). Microvascular remodeling was significantly
higher in patients with CFR <2.5 (72.7 + 2.4 vs 50.4 + 8.4%; P <.007).
Capillary density and fibrosis were comparable between groups (157.2 +
42.4 vs 175.7 + 42.4 capillaries/mm² P =.3; and 6.8 + 5 vs 8.3
+ 4.9%; P =.4, respectively). The thickness of the tunica media of
intramyocardial arterioles was lower in patients whose therapy included
everolimus (15 + 2 vs 32 + 4 mum, P =.03) and CFR was higher (3.2 + 0.5 vs
2.8 + 0.9; P =.03).
Conclusion The pathological substrate of reduced CFR in HT patients seems
to be a hypertrophic remodeling of coronary arterioles. Everolimus appears
to prevent such microvascular remodeling and preserve coronary flow
reserve.

<25>
Accession Number
2014847243
Authors
Onan B. Yeniterzi M. Onan I.S. Ersoy B. Gonca S. Gelenli E. Solakoglu S.
Bakir I.
Institution
(Onan, Yeniterzi, Onan, Ersoy, Bakir) Departments of Cardiovascular
Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular, Surgery
Training Hospital, Istanbul 34303, Turkey
(Gonca, Gelenli) Histology and Embryology, Kocaeli University, Kocaeli
41380, Turkey
(Solakoglu) Istanbul University, Istanbul 34093, Turkey
Title
Effect of electrocautery on endothelial integrity of the internal thoracic
artery: Ultrastructural analysis with transmission electron microscopy.
Source
Texas Heart Institute Journal. 41 (5) (pp 484-490), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Texas Heart Institute
Abstract
The internal thoracic artery (ITA) is typically harvested from the chest
wall by means of conventional electrocautery. We investigated the effects
of electrocautery on endothelial-cell and vessel-wall morphology at the
ultrastructural level during ITA harvesting. Internal thoracic artery
specimens from 20 patients who underwent elective coronary artery bypass
grafting were investigated in 2 groups. The ITA grafts were sharply
dissected with use of a scalpel and clips in the control group (n=10) and
were harvested by means of electrocautery in the study group (n=10). Each
sample was evaluated for intimal, elastictissue, muscular-layer, and
adventitial changes. Free flow was measured intraoperatively. Light
microscopic examinations were performed after hematoxylin-eosin and
Masson's trichrome staining. Transmission electron microscopy was used to
evaluate ultrastructural changes in the endothelial cells and vessel walls
of each ITA. In the sharp-dissection group, the endothelial surfaces were
lined with normal amounts of original endothelium, endothelial cells were
distinctly attached to the basal lamina, cytoplasmic organelles were
evident, and intercellular junctional complexes were intact. Conversely,
in the electrocautery group, the morphologic integrity of endothelial
cells was distorted, with some cell separations and splits, contracted
cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic
organelles. The subendothelial layer exhibited disintegration. Free ITA
flow was higher in the sharp-dissection group (P=0.04). The integrity of
endothelial cells can be better preserved when the ITA is mobilized by
means of sharp dissection, rather than solely by electrocautery; we
recommend a combined approach.

<26>
Accession Number
71683288
Title
EuroHeartCare 2013.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2013
Glasgow United Kingdom. Conference Start: 20130322 Conference End:
20130323. Conference Publication: (var.pagings). 12 , 2013. Date of
Publication: April 2013.
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 156 papers. The topics discussed include:
deactivation of the implantable cardioverter defibrillator: the patient
perspective; cost-effectiveness of a nurse-led integrated chronic care
program for patients with atiral fibrillation; psychometric testing of the
self-care of chronic angina Index (SCCAI); a nurse led pre admission
education program for elective adult cardiac surgical patients- a pilot
study using an interdiscplinary approach; the natural history of coronary
calcification: a meta-analysis from St Francis and EBEAT trials; the
burden of caregiving in chronic heart failure: a qualitative study; impact
of acute hyperglycemia after angioplasty for acute myocardial infarction;
effects of medical yoga in quality of life, blood pressure and heart rate
in patients with paroxysmal atrial fibrillation; region-wide automatic
referral to cardiac rehabilitation is associated with improved referral
rates; and evidence of persisting Yentl syndrome in Romania.

<27>
Accession Number
71679711
Authors
Giordana F. D'Ascenzo F. Omede P. Moretti C. Conrotto F. D'Amico M.
Salizzoni S. La Torre M. Rinaldi M. Marra S. Gaita F.
Institution
(Giordana, D'Ascenzo, Omede, Moretti, Conrotto, D'Amico, Marra, Gaita)
Division of Cardiology, Citta della Salute e della Scienza, University of
Turin, Torino, Italy
(Salizzoni, La Torre, Rinaldi) Division of Cardiac Surgery, Citta della
Salute e della Scienza, University of Turin, Torino, Italy
Title
Comparison between 957 self-expandable and 947 balloonexpandable valves
for patients undergoing transcatheter aortic valve implantation: A
meta-analysis of randomized controlled trials and adjusted observational
results.
Source
Giornale Italiano di Cardiologia. Conference: 35 Congresso Nazionale della
Societa Italiana di Cardiologia Invasiva - SICI-GISE 2014 Porto Antico di
Genova Italy. Conference Start: 20141014 Conference End: 20141017.
Conference Publication: (var.pagings). 15 (pp e63), 2014. Date of
Publication: 2014.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Two different devices, self- and balloon- expandable, have
been developed for patients undergoing transcatheter aortic valve
implantation (TAVI), although contrasting data are reported about their
efficacy and safety. Methods. PubMed, Medline and Google Scholar were
systematically searched for studies comparing balloon expandable and
self-expandable TAVI devices, with data derived from randomized controlled
trial or multivariate analysis. All cause death at 30-days and at follow
up were the primary end points, while post procedural moderate or severe
aortic regurgitation, stroke, major vascular complications, bleeding and
pacemaker implantation the secondary ones. Results. Six studies with 957
self-expandable and 947 balloon-expandable valves were included, one
randomized controlled trial and five observational study. Median age was
82 (81-83) years, with a logistic EuroSCORE of 22% (21-22%); 50% (44-51%)
of them were implanted with a 26 mm prosthesis. At 30-days, the rate of
death (OR 1.02 [0.94, 1.11]) and stroke (OR 1.23 [0.89, 1.69]) did not
significantly differ between the two valves. The self-expandable
prosthesis has a lower rate of major or life threatening bleeding (OR 0.86
[0.81, 0.91]) and major vascular complications (OR 0.88 [0.82, 0.94]),
while the rate of PM implantation (OR 1.74 [1.45, 2.09]) and of moderate
or severe aortic regurgitation (OR 1.35 [1.18, 1.55]) was higher. After a
follow up of 360 days (300-390), the rate of all cause death did not
significantly differ between the two groups (OR 1.00 [0.93, 1.08]). At the
meta-regression analysis, the benefit of balloon expandable valves has
increased with annulus diameter (beta 0.15, p<0.001). Conclusions. The
risk of moderate or severe aortic regurgitation and pace maker
implantation was lower in the balloon expandable devices, although with a
more frequent rates of vascular and bleeding complications. The between
groups all cause of death at 30 and 360 days did not significantly differ.

<28>
Accession Number
71679653
Authors
Verdoia M. Barbieri L. Schaffer A. Marino P. De Luca G.
Institution
(Verdoia, Barbieri, Schaffer, Marino, De Luca) SCDU Cardiologia,
Universita Del Piemonte Orientale, Novara, Italy
Title
Bivalirudin as compared to unfractionated heparin in patients undergoing
percutaneous coronary revascularization: A metaanalysis of 16 randomized
trials.
Source
Giornale Italiano di Cardiologia. Conference: 35 Congresso Nazionale della
Societa Italiana di Cardiologia Invasiva - SICI-GISE 2014 Porto Antico di
Genova Italy. Conference Start: 20141014 Conference End: 20141017.
Conference Publication: (var.pagings). 15 (pp e27-e28), 2014. Date of
Publication: 2014.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Bivalirudin is nowadays a largely used anticoagulation
strategy for percutaneous coronary revascularization procedures (PCI), due
to a reported better safety profile as compared with unfractionated
heparin (UFH). However, is still questioned whether bivalirudin may
provide advantages in clinical outcome beyond the known benefits in major
bleeding complications. In current study we performed a comprehensive
meta-analysis of randomized trials evaluating efficacy and safety of
bivalirudin as compared with UFH in patients undergoing PCI. Methods and
study outcomes. Literature archives and main scientific sessions abstracts
were scanned for randomized trials comparing bivalirudin with UFH in
patients undergoing PCI. Primary efficacy endpoint was overall mortality.
Secondary endpoints were: 1) mortality within 30 days; 2) overall non
fatal myocardial infarction and non fatal myocardial infarction within 30
days. Safety endpoint were the rate of major bleedings according to a per
protocol definition or TIMI classification. A prespecified analysis was
conducted according to clinical presentation (elective, ACS, STEMI).
Results. A total of 16 randomized clinical trials, 36303 patients, were
finally included, 54% randomized to bivalirudin and 46% to heparin. Death
occurred in 1042 (2.9%) of patients, with no difference in mortality
between bivalirudin and UFH (2.9%, vs 3% OR [95%CI] 0.94 [0.83-1.07],
p=0.37, phet=0.23). The results did not change according to clinical
presentation (elective, ACS, STEMI). By meta-regression analysis no
significant relationship was observed between benefits in mortality with
bivalirudin as compared to UFH and risk profile (r=-0.44 [-0.97, 0.08],
p=0.10) or reduction in major bleeding complications (r=-0.06 [-0.98,
0.87], p=0.9). No difference was observed for death within 30 days (OR
[95%C] 0.98 [0.81-1.20], p=0.88, phet=0.27), myocardial infarction within
30 days (OR [95%CI] 1.08 [0.96-1.20], p=0.21, phet= 0.12) and overall
myocardial infarction (OR [95%C] 1.06 [0.97-1.15], p=0.20, phet=0.03).
However, bivalirudin was associated with a significant reduction in
bleedings according to both study protocol definition (OR [95%CI] 0.63
[0.57-0.70], p<0.00001; phet<0.0001) or TIMI major criteria (OR [95%CI]
0.65 [0.53-0.79], p<0.00001; phet= 0.95). Conclusions. Present
meta-analysis shows that in patients undergoing PCI, bivalirudin, as
compared with UFH, is associated with a significant reduction in major
bleeding complications that, however, did not translate into mortality
benefits, independently from the type of presentation. Among STEMI
patients bivalirudin is associated with higher 30-day recurrent MI.
(Figure Presented).

<29>
Accession Number
71677541
Authors
Donohoe K. Mouawad P. Levine R.L.
Institution
(Donohoe, Levine) Hematology and Oncology, Lenox Hill Hospital, New York,
NY, United States
(Mouawad, Levine) Blood Bank, Lenox Hill Hospital, New York, NY, United
States
Title
Fresh-frozen plasma use across a range of clinical specialties in an urban
hospital.
Source
Transfusion. Conference: AABB Annual Meeting 2014 Philadelphia, PA United
States. Conference Start: 20141025 Conference End: 20141028. Conference
Publication: (var.pagings). 54 (pp 226A), 2014. Date of Publication:
September 2014.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: There is a dearth of randomized controlled trial
evidence to guide appropriate fresh-frozen plasma (FFP) use, particularly
in the prophylactic setting. Published guidelines based on expert opinion
provide the best source of information. Given the associated risks of
transfusion and the lack of evidence to support plasma transfusion in many
settings, we embarked on an evaluation of our institution's plasma
transfusion practice. A hospital-wide audit of FFP transfusion was
undertaken. Study Design/Methods: We collected data from September 1,
2013, through March 31, 2014, to assess FFP transfusion practice patterns
and to compare these ordering practices among the medical specialties. We
followed our hospital's guidelines for what constituted appropriate use.
Our criteria for FFP transfusion are: coagulation test prolonged more than
1.5 times the midpoint of normal range or specific coagulation factor
deficiency with bleeding or preoperative status, warfarin reversal for
bleeding or emergency surgery, abnormal intraoperative bleeding and
suspected coagulopathy, massive transfusion protocol, use as replacement
fluid when performing plasma exchange therapy, and treatment of heparin
resistance or antithrombin III deficiency. Results/Findings: A total of
1144 units of FFP transfusions given to 251 patients were analyzed. The
majority of patients receiving FFP were admitted to the medicine service
(594 units/109 patients, 51.92% of total FFP transfused). Cardiothoracic
(CT) surgery and general surgery patients received 246 units/63 patients
(21.50%) and 113 units/34 patients (9.88%), respectively. The most
frequent diagnosis associated with FFP transfusion outside hospital
guidelines was postoperative bleeding without a documented coagulopathy in
patients on the general surgery service. Thirteen percent of FFP ordered
by general surgery physicians was for the above indication. CT surgery and
medicine FFP use was outside of the guidelines 2.4% and 1.9% of the time,
respectively. Fifty-four units of FFP (4.7%) were ordered prophylactically
to prevent bleeding in patients with mild coagulopathy (INR <1.86) who
were scheduled for invasive procedures. Conclusion: Approximately 5% of
the FFP ordered at our institution was used to normalize a mildly elevated
INR (<1.86) in the prophylactic setting. However, the literature does not
support this practice, and the clinical efficacy of prophylactic FFP in
this setting remains in question. This audit provides data that we will
use to educate our physicians regarding FFP transfusions. We plan to
expand our audit to include postransfusion laboratory data to assess
efficacy.

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