EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014725595
Authors
Caceres M. Esmailian F. Moriguchi J.D. Arabia F.A. Czer L.S.
Institution
(Caceres) Division of Cardiothoracic Surgery, Veterans Affairs Medical
Center, 1030 Jefferson Avenue, Memphis, TN 38104, United States
(Esmailian, Moriguchi, Arabia, Czer) Division of Cardiothoracic Surgery
and Cardiology, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center,
Los Angeles, CA, United States
Title
Mechanical circulatory support in cardiogenic shock following an acute
myocardial infarction: A systematic review.
Source
Journal of Cardiac Surgery. 29 (5) (pp 743-751), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Blackwell Publishing Inc.
Abstract
The significance of the utilization of mechanical circulatory support
following a myocardial infarction is not well defined. We present a
systematic review of this treatment alternative and suggest guidelines to
be considered in the treatment of these patients.

<2>
Accession Number
2014717877
Authors
Thomson R. Meeran H. Valencia O. Al-Subaie N.
Institution
(Thomson, Meeran, Al-Subaie) Cardiothoracic Intensive Care Unit, St
Georges NHS Hospital Trust, London, United Kingdom
(Valencia) Department of Cardiac Surgery, St Georges NHS Hospital Trust,
London, United Kingdom
Title
Goal-directed therapy after cardiac surgery and the incidence of acute
kidney injury.
Source
Journal of Critical Care. 29 (6) (pp 997-1000), 2014. Date of Publication:
01 Dec 2014.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to assess the effect of
goal-directed therapy (GDT), after cardiac surgery, on the incidence of
acute kidney injury (AKI). Design: This is a prospective observational
study designed to achieve and maintain maximum stroke volume for 8 hours,
in patients after cardiac surgery. Setting: This is a single-center study
in a 15-bedded cardiothoracic intensive care unit (ICU). Participants:
Participants are patients after coronary artery bypass grafting and/or
aortic valve surgery. Interventions: Patients in the GDT group received
cardiac output monitoring and fluid challenges targeting an increase in
stroke volume by at least 10%. Stroke volume maximization was maintained
for a period of 8 hours from admission to the ICU. All other aspects of
care were dictated by the clinical team. Patients in the standard therapy
(ST) group had intravenous fluids in accordance with the routine practice
of the unit. Patients were divided into the GDT and ST group dependant on
availability of cardiac output monitors and allocation of nursing staff
with training in GDT. Patients' data were collected prospectively in both
groups. Measurements and main results: One hundred twenty-three patients
received GDT compared with 141 patients in the ST group. Both groups
received similar volumes of fluid (GDT, 2905 [1367] mL vs 2704 [1393] mL;
P = .09). Incidence of AKI was reduced in the GDT group (n = 8 [6.5%] vs n
= 28 [19.9%]; P = .002). The median duration of hospital stay was 6 (4)
days in the GDT group vs 7 (8) days in the ST, P = .004. Conclusion:
Postoperative GDT in patients after cardiac surgery was associated with
reduction in the incidence of AKI and a reduction in ICU and hospital
duration of stay.

<3>
Accession Number
2014742556
Authors
Yang Y. Lang X.-B. Zhang P. Lv R. Wang Y.-F. Chen J.-H.
Institution
(Yang, Lang, Zhang, Lv, Chen) Kidney Disease Center, First Affiliated
Hospital, Zhejiang University, 79 Qingchun Road, Hangzhou, Hangzhou
310003, China
(Wang) Department of Paediatrics and Adolescent Medicine, Li Ka Shing
Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
Title
Remote ischemic preconditioning for prevention of acute kidney injury: A
meta-analysis of randomized controlled trials.
Source
American Journal of Kidney Diseases. 64 (4) (pp 574-583), 2014. Date of
Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Conclusions RIPC might be beneficial for the prevention of AKI following
cardiac and vascular interventions, but the current evidence is not robust
enough to make a recommendation. Adequately powered trials are needed to
provide more evidence in the future.

<4>
Accession Number
2014741834
Authors
Suhler E.B. Lim L.L. Beardsley R.M. Giles T.R. Pasadhika S. Lee S.T. De
Saint Sardos A. Butler N.J. Smith J.R. Rosenbaum J.T.
Institution
(Suhler) Portland Veterans Administration Medical Center, Portland, OR,
United States
(Suhler, Lim, Beardsley, Giles, Pasadhika, Lee, De Saint Sardos, Butler,
Smith, Rosenbaum) Oregon Health and Science University, Department of
Ophthalmology, Casey Eye Institute, Portland, OR, United States
(Suhler) Department of Public Health and Preventive Medicine, Oregon
Health and Science University, Portland, OR, United States
(Rosenbaum) Department of Medicine, and Cell and Developmental Biology,
Oregon Health and Science University, Portland, OR, United States
(Smith, Rosenbaum) Department of Developmental Biology, Oregon Health and
Science University, Portland, OR, United States
(Lim) Centre for Eye Research Australia, University of Melbourne, Royal
Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
(Smith) Clinical and Molecular Medicine, Flinders University, Adelaide,
SA, Australia
(Rosenbaum) Devers Eye Institute, Portland, OR, United States
Title
Rituximab therapy for refractory scleritis: Results of a phase I/II
dose-ranging, randomized, clinical trial.
Source
Ophthalmology. 121 (10) (pp 1885-1891), 2014. Date of Publication: 01 Oct
2014.
Publisher
Elsevier Inc.
Abstract
Conclusions: Rituximab was effective treatment for 9 of 12 enrolled
patients with refractory, noninfectious scleritis at 24 weeks, although 7
required reinfusion with rituximab to maintain inflammatory control. The
treatment was well-tolerated, and peri-infusional inflammatory
exacerbations were managed successfully with oral corticosteroids. Further
long-term studies are warranted to determine the safety and efficacy of
rituximab in treating noninfectious scleritis and other ocular
inflammatory diseases.

<5>
Accession Number
2014730023
Authors
Lunde J. Stensballe J. Wikkelso A. Johansen M. Afshari A.
Institution
(Lunde, Johansen, Afshari) Juliane Marie Centre, Department of Anesthesia,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Stensballe) Section for Transfusion Medicine, Capital Region Blood Bank,
Copenhagen University Hospital, Copenhagen, Denmark
(Stensballe) Department of Anaesthesia, Centre of Head and Orthopedics,
Copenhagen University Hospital, Copenhagen, Denmark
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine, Herlev
Hospital, Copenhagen University Hospital, Copenhagen, Denmark
(Johansen) Department of Anaesthesiology, Department of Neuroanaesthesia
and Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
Title
Fibrinogen concentrate for bleeding - A systematic review.
Source
Acta Anaesthesiologica Scandinavica. 58 (9) (pp 1061-1074), 2014. Date of
Publication: 2014.
Publisher
Blackwell Munksgaard
Abstract
Fibrinogen concentrate as part of treatment protocols increasingly draws
attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the
potential to reduce bleeding, transfusion requirement and subsequently
reduce morbidity and mortality. A systematic search for randomised
controlled trials (RCTs) and non-randomised studies investigating
fibrinogen concentrate in bleeding patients was conducted up to November
2013. We included 30 studies of 3480 identified (7 RCTs and 23
non-randomised). Seven RCTs included a total of 268 patients (165 adults
and 103 paediatric), and all were determined to be of high risk of bias
and none reported a significant effect on mortality. Two RCTs found a
significant reduction in bleeding and five RCTs found a significant
reduction intransfusion requirements. The 23 non-randomised studies
included a total of 2825 patients, but only 11 of 23 studies included a
control group. Three out of 11 found a reduction in transfusion
requirements while mortality was reduced in two and bleeding in one. In
the available RCTs, which all have substantial shortcomings, we found a
significant reduction in bleeding and transfusions requirements. However,
data on mortality were lacking. Weak evidence from RCTs supports the use
of fibrinogen concentrate in bleeding patients, primarily in elective
cardiac surgery, but a general use of fibrinogen across all settings is
only supported bynon-randomised studies with serious methodological
shortcomings. It seems pre-mature to conclude whether fibrinogen
concentrate has a routine role in the management of bleeding and
coagulopathic patients. More RCTs are urgently warranted.

<6>
Accession Number
2014729426
Authors
Lomivorotov V.V. Efremov S.M. Pokushalov E.A. Romanov A.B. Ponomarev D.N.
Cherniavsky A.M. Shilova A.N. Karaskov A.M. Lomivorotov V.N.
Institution
(Lomivorotov, Efremov, Ponomarev, Lomivorotov) Department of
Anaesthesiology and Intensive Care, Research Institute of Circulation
Pathology, Rechkunovskaya 15 street, Novosibirsk 630055, Russian
Federation
(Pokushalov, Romanov, Karaskov) Department of Arrhythmia, Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
(Cherniavsky) Department of Cardiac Surgery, Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Shilova) Laboratory of Biochemistry, Research Institute of Circulation
Pathology, Novosibirsk, Russian Federation
Title
Randomized trial of fish oil infusion to prevent atrial fibrillation after
cardiac surgery: Data from an implantable continuous cardiac monitor.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1278-1284),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Conclusions Infusion of OMEGA-3 polyunsaturated fatty acids failed to
prevent the occurrence of atrial fibrillation in 2 years after coronary
artery bypass grafting surgery. The cumulative atrial fibrillation
duration registered by the continuous cardiac monitor at the 2-year
follow-up was a significant predictor of an adverse outcome.

<7>
Accession Number
2014767852
Authors
Du Y. Xu J. Wang G. Shi J. Yang L. Shi S. Lu H. Wang Y. Ji B. Zheng Z.
Institution
(Du, Wang, Shi, Yang, Shi, Lu, Wang) Department of Anesthesiology, Fuwai
Hospital, Peking Union Medical College, 167 Beilishi Road, Xicheng
District, Beijing 100037, China
(Ji) Department of Cardiopulmonary Bypass, Fuwai Hospital, Peking Union
Medical College, Beijing, China
(Zheng) Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
(Xu) Department of Anesthesiology, Chinese Academy of Medical Sciences,
Peking Union Medical College Hospital, Beijing, China
Title
Comparison of two tranexamic acid dose regimens in patients undergoing
cardiac valve surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1233-1237),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Interventions All patients were divided randomly into 2 groups. The
lower-dose TA group received a loading dose of 10 mg/kg, maintenance dose
of 2 mg/kg/h, and a cardiopulmonary bypass pump prime dose of 40 mg; the
higher-dose TA group received a loading dose of 30 mg/kg, maintenance dose
of 16 mg/kg/h, and a pump prime dose of 2 mg/kg.

<8>
Accession Number
2014754418
Authors
Biancari F. Martin M. Bordin G. Vettore E. Vinco G. Anttila V. Airaksinen
J. Vasques F.
Institution
(Biancari, Martin, Bordin, Vettore, Vinco, Anttila, Vasques) Department of
Surgery, Oulu University Hospital, Kajaanintie 50, Oulu PL 21, 90029,
Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
Title
Basic data from 176 studies on the immediate outcome after aortic valve
replacement with or without coronary artery bypass surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1251-1256),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Conclusions Isolated AVR is associated with low mortality and morbidity.
Coronary artery disease requiring concomitant CABG increases the operative
mortality. Patients requiring AVR and CABG should be the main target of
less-invasive treatment strategies.

<9>
Accession Number
2014853081
Authors
Andree Punke M. Goepfert M.S. Kluge S. Reichenspurner H. Goetz A.E. Reuter
D.A.
Institution
(Andree Punke, Goepfert, Goetz, Reuter) Department of Anesthesiologyy,
Center of Anesthesiology and Intensive Care Medicine, University Medical
Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany
(Kluge) Department of Intensive Care Medicine, University Medical Center
Hamburg-Eppendorf, Martinistrasse, Hamburg, Germany
(Reichenspurner) Department of Cardiovascular Surgery, University Medical
Center Hamburg-Eppendorf, Martinistrasse, Hamburg, Germany
Title
Perioperative glycemic control with a computerized algorithm versus
conventional glycemic control in cardiac surgical patients undergoing
cardiopulmonary bypass with blood cardioplegia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1273-1277),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Conclusions Early computer-based insulin therapy allows practitioners to
better achieve normoglycemia in patients undergoing major cardiac surgery
with the use of blood cardioplegia.

<10>
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
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.

<11>
Accession Number
2014850162
Authors
Sahebally S.M. Healy D. Coffey J.C. Walsh S.R.
Institution
(Sahebally, Healy, Coffey, Walsh) Department of Surgery, University
Hospital Limerick, Ireland
Title
Should patients taking aspirin for secondary prevention continue or
discontinue the medication prior to elective, abdominal surgery? Best
evidence topic (BET).
Source
International Journal of Surgery. 12 (1) (pp 16-21), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ltd
Abstract
This best evidence topic was investigated according to a described
protocol. The question asked was: should patients on acetylsalicylic acid
(ASA) for secondary prevention stop or continue the medication prior to
elective, abdominal surgery. Using the reported search 826 papers were
found of which five represented the best evidence to answer the clinical
question. The strongest evidence was from a randomized controlled trial
(RCT) specifically looking at elective abdominal surgery, which showed no
statistically significant difference between ASA continuation and
discontinuation in terms of haemorrhagic or thrombotic events. Two other
RCT's examined elective non-cardiac surgery but only a minor proportion
(20.6% and 23.6%) of patients underwent abdominal surgery and data were
unavailable regarding adverse events in these patients. However, one of
these trials did show a 7.2% absolute risk reduction in postoperative
cardiac adverse events when ASA was continued. One prospective cohort
study found no difference between ASA maintenance and cessation except for
longer duration of surgery in the ASA continuation group. Finally one
recent retrospective cohort study revealed similar bleeding rates between
ASA-treated and non-ASA-treated patients but increased cardiac
complication rates in the ASA group.Only two studies compared continuation
versus discontinuation of ASA, while the remaining three looked at
patients on ASA versus those not on ASA. This heterogeneity in methodology
makes it difficult to draw justifiable conclusions from the data. However,
it appears that continuing ASA isn't associated with excessive bleeding.
Further adequately powered trials with well-defined end points are needed
to answer this important clinical question.

<12>
Accession Number
2014856746
Authors
Yang Q. Qi X. Li Y.
Institution
(Yang, Qi, Li) Department of Cardiology, Hebei General Hospital,
Shijiazhuang, Hebei, China
Title
The preventive effect of atorvastatin on atrial fibrillation: A
meta-analysis of randomized controlled trials.
Source
BMC Cardiovascular Disorders. 14 (1) , 2014. Article Number: 99. Date of
Publication: August 13, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: A number of clinical and experimental studies have
investigated the effect of atorvastatin on atrial fibrillation (AF), but
the results are equivocal. This meta-analysis was performed to evaluate
whether atorvastatin can reduce the risk of AF in different
populations.Methods: We searched PubMed, EMBASE and the Cochrane Database
for all published studies that examined the effect of atorvastatin therapy
on AF up to April 2014. A random effects model was used when there was
substantial heterogeneity and a fixed effects model when there was
negligible heterogeneity.Results: Eighteen published studies including
9952 patients with sinus rhythm were identified for inclusion in the
analysis. Ten studies investigated primary prevention of AF by
atorvastatin in patients without AF, seven studies investigated secondary
prevention of atorvastatin in patients with AF, and one study investigated
mixed populations of patients. Overall, atorvastatin was associated with a
decreased risk of AF (odds ratio (OR) 0.51, 95% confidence interval (CI)
0.36-0.70, P < 0.0001). However, subgroup analyses showed that in the
primary prevention subgroup (OR 0.55, 95% CI 0.38-0.81, P = 0.002),
atorvastatin reduced the risk of new-onset AF in patients after coronary
surgery (OR 0.44, 95% CI 0.29-0.68, P = 0.0002), but had no beneficial
effect in patients without coronary surgery (OR 0.97, 95% CI 0.59-1.58, P
= 0.89); in the secondary prevention subgroup, atorvastatin had no
beneficial effect on AF recurrence in patients with electrical
cardioversion (EC) (OR 0.57, 95% CI 0.25-1.32, P = 0.19) or without EC (OR
0.38, 95% CI 0.14-1.06, P = 0.06).Conclusions: This meta-analysis suggests
that atorvastatin has an overall protective effect against AF. However,
this preventive effect was not seen in all types of AF. Atorvastatin was
significantly associated with a decreased risk of new-onset AF in patients
after coronary surgery. Moreover, atorvastatin did not prove to exert a
significant protective effect against the AF recurrences in both patients
who had experienced sinus rhythm restoration by means of EC and those who
had obtained cardioversion by means of drug therapy. Thus, further
prospective studies are warranted.

<13>
Accession Number
2014747485
Authors
Osnabrugge R.L. Speir A.M. Head S.J. Jones P.G. Ailawadi G. Fonner C.E.
Fonner E. Kappetein A.P. Rich J.B.
Institution
(Osnabrugge, Head, Kappetein) Department of Cardio-Thoracic Surgery,
Erasmus University Medical Center, Rotterdam, Netherlands
(Speir) Inova Heart and Vascular Institute, Fairfax, VA, United States
(Jones) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Ailawadi) Department of Thoracic and Cardiovascular Surgery, University
of Virginia Health System, Charlottesville, VA, United States
(Fonner) ARMUS Corporation, San Mateo, CA, United States
(Fonner, Fonner) Virginia Cardiac Surgery Quality Initiative, Falls
Church, VA, United States
(Rich) Sentara Heart Hospital, 600 Gresham Dr, Ste 8600, Norfolk, VA
23507, United States
Title
Prediction of costs and length of stay in coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 98 (4) (pp 1286-1293), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Elsevier USA
Abstract
Conclusions. The STS-PROM and preoperative regressionmodels are useful for
preoperative prediction of costsand length of stay for groups of patients,
case-mixadjustment in hospital benchmarking, and pay for
performancemeasures. The combined preoperative andpostoperative models
identify incremental costs andlength of stay associated with adverse
events and are moresuitable for prioritizing quality improvement efforts.

<14>
Accession Number
2014733582
Authors
Phan K. Xie A. Di Eusanio M. Yan T.D.
Institution
(Phan, Xie, Di Eusanio, Yan) Collaborative Research (CORE) Group,
Macquarie University, 2 Technology Pl, Sydney, NSW 2109, Australia
(Di Eusanio) Cardiovascular Surgery Department, Sant'Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW, Australia
Title
A meta-analysis of minimally invasive versus conventional sternotomy for
aortic valve replacement.
Source
Annals of Thoracic Surgery. 98 (4) (pp 1499-1511), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Elsevier USA
Abstract
Minimally invasive aortic valve replacement (AVR) is increasingly used as
an alternative to conventional AVR, despite limited randomized evidence
available. To assess the evidence base, a systematic search identified 50
comparative studies with a total of 12,786 patients. A meta-analysis
demonstrated that minimally invasive AVR is associated with reduced
transfusion incidence, intensive care stay, hospitalization, and renal
failure, and has a mortality rate that is comparable to conventional AVR.
The evidence quality was mostly very low. Given the inadequate statistical
power and heterogeneity of available studies, prospective randomized
trials are needed to assess the benefits and risks of minimally invasive
AVR approaches.

<15>
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
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.

<16>
Accession Number
2014848991
Authors
Souza R.W.A. Piedade W.P. Soares L.C. Souza P.A.T. Aguiar A.F.
Vechetti-Junior I.J. Campos D.H.S. Fernandes A.A.H. Okoshi K. Carvalho
R.F. Cicogna A.C. Dal-Pai-Silva M.
Institution
(Souza, Piedade, Soares, Souza, Vechetti-Junior, Carvalho, Dal-Pai-Silva)
Department of Morphology, Sao Paulo State University, Botucatu, Sao Paulo,
Brazil
(Campos, Okoshi) Department of Internal Medicine, Sao Paulo State
University, Botucatu, Sao Paulo, Brazil
(Fernandes, Cicogna) Department of Biochemistry, Sao Paulo State
University, Botucatu, Sao Paulo, Brazil
(Aguiar) Centre of Biological and Health Sciences, North University of
Parana, Londrina, Parana, Brazil
Title
Aerobic exercise training prevents heart failure-induced skeletal muscle
atrophy by anti-catabolic, but not anabolic actions.
Source
PLoS ONE. 9 (10) , 2014. Article Number: e110020. Date of Publication: 17
Oct 2014.
Publisher
Public Library of Science
Abstract
Background: Heart failure (HF) is associated with cachexia and consequent
exercise intolerance. Given the beneficial effects of aerobic exercise
training (ET) in HF, the aim of this study was to determine if the ET
performed during the transition from cardiac dysfunction to HF would alter
the expression of anabolic and catabolic factors, thus preventing skeletal
muscle wasting. Methods and Results: We employed ascending aortic stenosis
(AS) inducing HF in Wistar male rats. Controls were shamoperated animals.
At 18 weeks after surgery, rats with cardiac dysfunction were randomized
to 10 weeks of aerobic ET (AS-ET) or to an untrained group (AS-UN). At 28
weeks, the AS-UN group presented HF signs in conjunction with high
TNF-alpha serum levels; soleus and plantaris muscle atrophy; and an
increase in the expression of TNF-alpha, NFB (p65), MAFbx, MuRF1, FoxO1,
and myostatin catabolic factors. However, in the AS-ET group, the
deterioration of cardiac function was prevented, as well as muscle
wasting, and the atrophy promoters were decreased. Interestingly, changes
in anabolic factor expression (IGF-I, AKT, and mTOR) were not observed.
Nevertheless, in the plantaris muscle, ET maintained high PGC1alpha
levels. Conclusions: Thus, the ET capability to attenuate cardiac function
during the transition from cardiac dysfunction to HF was accompanied by a
prevention of skeletal muscle atrophy that did not occur via an increase
in anabolic factors, but through anti-catabolic activity, presumably
caused by PGC1alpha action. These findings indicate the therapeutic
potential of aerobic ET to block HF-induced muscle atrophy by
counteracting the increased catabolic state.

<17>
Accession Number
2014847850
Authors
Stoppe C. McDonald B. Rex S. Manzanares W. Whitlock R. Fremes S. Fowler R.
Lamarche Y. Meybohm P. Haberthur C. Rossaint R. Goetzenich A. Elke G. Day
A. Heyland D.K.
Institution
(Stoppe, Rossaint) Department of Anesthesiology, University Hospital of
the RWTH Aachen, Pauwelsstrase 30, Aachen 52074, Germany
(McDonald) Division of Cardiac Anesthesiology and Critical Care Medicine,
University of Ottawa Heart Institute Ottawa, 40 Ruskin Street, Ottawa, ON
K1Y 4W7, Canada
(Rex) Department of Anesthesiology and Department of Cardiovascular
Sciences, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
(Manzanares) Department of Critical Care Medicine, Universidad de la
Republica, UDELAR, Avda Italia s/n esq. Las Heras. CP, Montevideo 11600,
Uruguay
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook
Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
(Fowler) Department of Medicine and Department of Critical Care Medicine,
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5,
Canada
(Lamarche) Department of Surgery and Critical Care, Montreal Heart Inst.
and Hopital du Sacre-Coeur de Montreal, Institut de cardiologie de
Montreal, 5000 Belanger E, Montreal, QC H1T 1C8, Canada
(Meybohm) Department of Anaesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am
Main 60590, Germany
(Haberthur) Department of Anaesthesiology and Intensive Care Medicine,
Hirslanden Clinic, Witellikerstrasse 40, Zurich 8032, Switzerland
(Goetzenich) Department of Thoracic, Cardiac and Vascular Surgery,
University Hospital, RWTH Aachen, Pauwelsstrase 30, Aachen 52074, Germany
(Elke) Department of Anaesthesiology and Intensive Care Medicine,
University Medical Center Schleswig-Holstein, Campus Kiel,
Arnold-Heller-Str. 3, Kiel 24105, Germany
(Day, Heyland) Clinical Evaluation Research Unit, Kingston General
Hospital, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
Title
SodiUm SeleniTe Adminstration IN Cardiac Surgery (SUSTAIN CSX-trial):
Study design of an international multicenter randomized double-blinded
controlled trial of high dose sodium-selenite administration in high-risk
cardiac surgical patients.
Source
Trials. 15 (1) (pp 1-10), 2014. Article Number: 339. Date of Publication:
August 28, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Cardiac surgery has been shown to result in a significant
decrease of the antioxidant selenium, which is associated with the
development of multiorgan dysfunction and increased mortality. Thus, a
large-scale study is needed to investigate the effect of perioperative
selenium supplementation on the occurrence of postoperative organ
dysfunction.Methods/Design: We plan a prospective, randomized
double-blind, multicenter controlled trial, which will be conducted in
North and South America and in Europe. In this trial we will include 1,400
high-risk patients, who are most likely to benefit from selenium
supplementation. This includes patients scheduled for non-emergent
combined and/or complex procedures, or with a predicted operative
mortality of >5% according to the EuroSCORE II. Eligible patients will be
randomly assigned to either the treatment group (bolus infusion of 2,000
mug sodium selenite immediately prior to surgery, followed by an
additional dosage of 2,000 mug at ICU admission, and a further daily
supplementation of 1,000 mug up to 10 days or ICU discharge) or to the
control group (placebo administration at the same time points).The primary
endpoint of this study is a composite of 'persistent organ dysfunction'
(POD) and/or death within 30 days from surgery (POD + death). POD is
defined as any need for life-sustaining therapies (mechanical ventilation,
vasopressor therapy, mechanical circulatory support, continuous renal
replacement therapy, or new intermittent hemodialysis) at any time within
30 days from surgery.Discussion: The SUSTAIN-CSX study is a multicenter
trial to investigate the effect of a perioperative high dosage sodium
selenite supplementation in high-risk cardiac surgical patients.

<18>
Accession Number
2014845812
Authors
Stacy S.R. Suarez-Cuervo C. Berger Z. Wilson L.M. Yeh H.-C. Bass E.B.
Michos E.D.
Institution
(Stacy, Berger) Johns Hopkins Bloomberg School of Public Health, 615 North
Wolfe Street, Baltimore, MD 21205, United States
(Suarez-Cuervo) Johns Hopkins University, Evidence-based Practice Center,
624 North Broadway, Baltimore, MD 21205, United States
(Wilson) Johns Hopkins Outpatient Center, 601 North Caroline Street,
Baltimore, MD 21287, United States
(Yeh) Johns Hopkins University, 2024 East Monument Street, Baltimore, MD
21287, United States
(Bass) Johns Hopkins University School of Medicine, 624 North Broadway,
Baltimore, MD 21205, United States
(Michos) Division of Cardiology, Johns Hopkins University School of
Medicine, 600 North Wolfe Street, Baltimore, MD 21287, United States
Title
Role of troponin in patients with chronic kidney disease and suspected
acute coronary syndrome: A systematic review.
Source
Annals of Internal Medicine. 161 (7) (pp 502-512), 2014. Date of
Publication: 07 Oct 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Primary Funding Source: Agency for Healthcare Research and Quality.

<19>
Accession Number
2014844807
Authors
Suzuki S. Woinarski N.C.Z. Lipcsey M. Candal C.L. Schneider A.G. Glassford
N.J. Eastwood G.M. Bellomo R.
Institution
(Suzuki, Glassford, Eastwood, Bellomo) Department of Intensive Care,
Austin Hospital, Heidelberg, VIC, Australia
(Woinarski) Monash University, Faculty of Medicine, Nursing and Health
Sciences, Melbourne, VIC, Australia
(Lipcsey) Department of Surgical Sciences, Anaesthesiology and Intensive
Care, Uppsala University, Uppsala, Sweden
(Candal) Department of Intensive Care, Hospital Universitari Mutua
Terrassa, Barcelona, Spain
(Schneider) Intensive Care Medicine, Universite de Lausanne, Lausanne,
Switzerland
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventative Medicine, Monash University,
Melbourne, VIC, Australia
Title
Pulse pressure variation-guided fluid therapy after cardiac surgery: A
pilot before-and-after trial.
Source
Journal of Critical Care. 29 (6) (pp 992-996), 2014. Date of Publication:
01 Dec 2014.
Publisher
W.B. Saunders
Abstract
Purpose: The aim of this study is to study the feasibility, safety, and
physiological effects of pulse pressure variation (PPV)-guided fluid
therapy in patients after cardiac surgery. Materials and methods: We
conducted a pilot prospective before-and-after study during mandatory
ventilation after cardiac surgery in a tertiary intensive care unit. We
introduced a protocol to deliver a fluid bolus for a PPV > 13% for at
least > 10 minutes during the intervention period. Results: We studied 45
control patients and 53 intervention patients. During the intervention
period, clinicians administered a fluid bolus on 79% of the defined PPV
trigger episodes. Median total fluid intake was similar between 2 groups
during mandatory ventilation (1297 mL [interquartile range 549-1968] vs
1481 mL [807-2563]; P = .17) and the first 24 hours (3046 mL
[interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After
adjusting for several baseline factors, PPV-guided fluid management
significantly increased fluid intake during mandatory ventilation (P =
.004) but not during the first 24 hours (P = .47). Pulse pressure
variation-guided fluid therapy, however, did not significantly affect
hemodynamic, renal, and metabolic variables. No serious adverse events
were noted. Conclusions: Pulse pressure variation-guided fluid management
was feasible and safe during mandatory ventilation after cardiac surgery.
However, its advantages may be clinically small.

<20>
Accession Number
2014844806
Authors
Shim J.-K. Song J.-W. Song Y. Kim J.-H. Kang H.-M. Kwak Y.-L.
Institution
(Shim, Song, Song, Kang, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University Health System, Seoul 120-752, South Korea
(Shim, Song, Song, Kwak) Anesthesia and Pain Research Institute, Yonsei
University Health System, Seoul 120-752, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, National Health
Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do 410-719, South
Korea
Title
Pulse pressure variation is not a valid predictor of fluid responsiveness
in patients with elevated left ventricular filling pressure.
Source
Journal of Critical Care. 29 (6) (pp 987-991), 2014. Date of Publication:
01 Dec 2014.
Publisher
W.B. Saunders
Abstract
Purpose: The purpose of this study was to test the hypothesis that the
predictive ability of pulse pressure variation (PPV) for fluid
responsiveness would be altered in patients with elevated left ventricular
(LV) filling pressure. Materials and methods: According to the
preoperative echocardiographic assessment of the ratio of early
transmitral flow velocity to early diastolic velocity of the mitral
annulus (E/E'), patients undergoing surgical coronary revascularization
were classified into normal (n = 34, E/E' <. 8) and high (n = 34, E/E' >
15) LV filling pressure group. After anesthetic induction, PPV and
hemodynamic data were measured before and after 6 mL/kg of colloid
administration. Fluid responsiveness was defined as 12% or more increase
in stroke volume index assessed by pulmonary artery catheter and tested by
the area under the receiver operating characteristic curve (AUROC).
Results: The AUROCs of PPV in the normal and high filling pressure group
were 0.829 (95% confidence interval [CI], 0.661-0.963; P < .001) and 0.583
(95% CI, 0.402-0.749; P = .110), respectively. The AUROCs of cardiac
filling pressures and right ventricular end-diastolic volume index did not
show statistical significance in both groups. Conclusions: None of the
assessed preload indices including PPV were able to predict fluid
responsiveness in patients with elevated LV filling pressure.

<21>
Accession Number
2014842899
Authors
Madhavan M.V. Genereux P. Kirtane A.J. Xu K. Witzenbichler B. Mehran R.
Stone G.W.
Institution
(Madhavan, Genereux, Kirtane, Stone) Department of Medicine, Columbia
University Medical Center, New York-Presbyterian Hospital, New York, NY,
United States
(Genereux, Kirtane, Xu, Mehran, Stone) Cardiovascular Research Foundation,
New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Title
Postprocedural anticoagulation for specific therapeutic indications after
revascularization for ST-segment elevation myocardial infarction (from the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction Trial).
Source
American Journal of Cardiology. 114 (9) (pp 1322-1328), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Elsevier Inc.
Abstract
Postprocedural anticoagulation (AC) after primary percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
may be administered for a number of specific therapeutic indications (e.g.
atrial fibrillation or left ventricular thrombus). However, the safety and
effectiveness of such post-PCI AC for specific indications are not well
defined. Thus, we sought to study outcomes after postprocedural AC for
specific indications in patients undergoing primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial. Patients who underwent primary PCI for STEMI in the
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial
Infarction trial were grouped according to whether they received specific
indication AC. Adverse outcomes were assessed using propensity-adjusted
multivariate analyses. After excluding patients who received post-PCI AC
solely for routine prophylaxis, 410 patients (16.6%) received
postprocedural AC for specific indications and 2,063 patients (83.4%)
received no post-PCI AC. After propensity adjustment, use of
postprocedural AC for specific indications was associated with higher
rates of cardiac mortality, reinfarction, stent thrombosis, and major
bleeding at 30 days compared with patients who received no AC post-PCI. In
conclusion, in this large prospective study, use of postprocedural AC for
specific indications after primary PCI for STEMI was independently
associated with early rates of adverse ischemic and hemorrhagic outcomes.
Post-PCI AC for specific indications was also associated with worse
outcomes from 30 days to 3 years. Further studies are warranted to
determine the optimal use of postprocedural AC after primary PCI in STEMI.

<22>
Accession Number
2014842889
Authors
Giordana F. D'Ascenzo F. Nijhoff F. Moretti C. D'Amico M. Biondi Zoccai G.
Sinning J.M. Nickenig G. Van Mieghem N.M. Chieffo A. Dumonteil N. Tchetche
D. Barbash I.M. Waksman R. D'Onofrio A. Lefevre T. Pilgrim T. Amabile N.
Codner P. Kornowski R. Yong Z.Y. Baan J. Colombo A. Latib A. Salizzoni S.
Omede P. Conrotto F. La Torre M. Marra S. Rinaldi M. Gaita F.
Institution
(Giordana, D'Ascenzo, Moretti, D'Amico, Omede, Conrotto, Marra, Gaita)
Division of Cardiology, Department of Internal Medicine, University of
Turin, Turin, Italy
(Salizzoni, La Torre, Rinaldi) Division of Cardio-Surgery, Cardiovascular
and Thoracic Department, University of Turin, Turin, Italy
(Nijhoff) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Sinning, Nickenig) Medizinische Klinik und Poliklinik II, Innere Medizin,
Universitatsklinikum, Bonn, Germany
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
(Chieffo) Division of Metabolic and Cardiovascular Sciences, San Raffaele
Scientific Institute, Milan, Italy
(Dumonteil) Pole Cardiovasculaire et Metabolique, Hopital Rangueil,
Toulouse, France
(Tchetche) Department of General and Interventional Cardiology, Clinique
Pasteur, Toulouse, France
(Barbash, Waksman) Interventional Cardiology, Division of Cardiology,
Washington Hospital Center, Washington, DC, United States
(D'Onofrio) Division of Cardiac Surgery, University of Padova, Padova,
Italy
(Lefevre) Institut Cardiovasculaire Paris Sud, Institut Hospitalier
Jacques Cartier, Massy, France
(Pilgrim) Department of Cardiology, Swiss Cardiovascular Center, Bern
University Hospital, Bern, Switzerland
(Amabile) Department of Cardiology, Centre Marie Lannelongue, Le
Plessis-Robinson, France
(Codner, Kornowski) Division of Cardiology, Beilinson Hospital, Rabin
Medical Center, Petach-Tikva, Israel
(Codner, Kornowski) Tel-Aviv University, Sackler Faculty of Medicine,
Tel-Aviv, Israel
(Yong, Baan) Department of Cardiology and Cardio-Thoracic Surgery,
Academic Medical Center-University of Amsterdam, Amsterdam, Netherlands
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Meta-analysis of predictors of all-cause mortality after transcatheter
aortic valve implantation.
Source
American Journal of Cardiology. 114 (9) (pp 1447-1455), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Elsevier Inc.
Abstract
The aim of this study was to identify predictors of 30-day and midterm
mortality after transcatheter aortic valve implantation (TAVI) by means of
a systemic review. TAVI was demonstrated to be safe and efficacious in
patients with severe aortic stenosis. An accurate estimation of procedural
risk of these patients represents an actual challenge. The PubMed and
Cochrane Collaboration databases were systematically searched for studies
reporting on the incidence and independent predictors of 30-day and
midterm mortality. Adverse events were pooled with random effect, whereas
independent predictors are reported as odds ratios (ORs) with 95%
confidence intervals (CIs). A total of 25 studies with 8,874 patients were
included (median age 82.5 + 1.5 years, 54.6% women). At 30 days, 7.5% of
patients (n = 663) died. At midterm follow-up (median 365 days,
interquartile range 267 to 365 days), the cumulative mortality rate was
21.6% (n = 1,917). Acute kidney injury (AKI) stage >2 (OR 18.0, 95% CI 6.3
to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI
2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6
to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR
5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of
30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI
stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction
<30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial
infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of
midterm mortality. In conclusion, in this large meta-analysis of patients
undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI
were the strongest independent predictors of both 30-day and 1-year
mortality. These findings may contribute to a better understanding of the
risk assessment process of patients undergoing TAVI.

<23>
Accession Number
2014834328
Authors
Morshed A.A.M. Munn Z. Lockwood C.
Institution
(Morshed, Munn, Lockwood) School of Translational Health Science, Joanna
Briggs Institute, University of Adelaide, SA, Australia
Title
Effectiveness of tight glycemic control on mortality and morbidity of
patients undergoing cardiac surgery in hospital: A systematic review
protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 12 (9) (pp
132-145), 2014. Date of Publication: 2014.
Publisher
Joanna Briggs Institute
Abstract
The effectiveness of tight glycemic control on mortality and morbidity
among diabetic patients during the intra and post-operative period after
cardiac surgery in hospital.

<24>
Accession Number
2014844351
Authors
Hsu H.-T. Chou S.-H. Chou C.-Y. Tseng K.-Y. Kuo Y.-W. Chen M.-C. Cheng
K.-I.
Institution
(Hsu, Chou, Tseng, Kuo, Chen, Cheng) Department of Anesthesiology,
Kaohsiung Medical University Hospital, No.100 Ziyou 1st Rd., Sanmin
District, Kaohsiung 807, Taiwan (Republic of China)
(Hsu, Tseng) Graduate Institute of Medicine, College of Medicine,
Kaohsiung Medical University, Kaohsiung 807, Taiwan (Republic of China)
(Cheng) Faculty of Anesthesiology, College of Medicine, Kaohsiung Medical
University, Kaohsiung 807, Taiwan (Republic of China)
(Chou) Department of Chest Surgery, Kaohsiung Medical University Hospital,
Kaohsiung 807, Taiwan (Republic of China)
(Chou) School of Medicine, College of Medicine, Kaohsiung Medical
University, Kaohsiung 807, Taiwan (Republic of China)
Title
A modified technique to improve the outcome of intubation with a
left-sided double-lumen endobronchial tube.
Source
BMC Anesthesiology. 14 (1) , 2014. Article Number: 72. Date of
Publication: 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: The use of a video-assisted laryngoscope (VL) has been shown
to reduce the time to achieve intubation with a double-lumen endobronchial
tube (DLT). As the blade of the VL is curved differently to a standard
laryngoscope, the DLT must be angled into a hockey stick shape to fit
properly. We conducted a study to establish which direction of angulation
was best to facilitate correct positioning of the DLT when using a VL.
Methods: We enrolled patients scheduled for thoracic surgery who required
intubation with a DLT. They were prospectively randomized into one of two
groups: those intubated with a DLT angled to conceal the tracheal orifice
(the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed
(TOE) group. The composite primary outcome measures were time taken to
intubate and the frequency of first-time success. The time taken to
intubate was divided into: T1, the time from mouth opening to
visualization of the vocal cords with the VL; and T2, the time taken to
advance the DLT through the cords until its tip lay within the trachea and
three carbon dioxide waveforms had been detected by capnography. The
hemodynamic responses to intubation and intubation-related adverse events
were also recorded. Results: Sixty-six patients completed the study, with
33 in each group. Total intubation time was significantly shorter in the
TOC group (mean 30.6 + standard deviation 2.7 seconds versus 38.7 + 3.3
seconds, p <0.0001). T2 was also significantly shorter in the TOC group
than the TOE group (27.2 + 2.5 seconds versus 34.9 + 3.0 seconds, p
<0.0001). The severity of hoarseness on the first postoperative day and
sore throat on the fourth postoperative day were significantly lower in
the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The
hemodynamic responses to intubation were broadly similar between the
groups. Conclusion: When placing a left-sided DLT using a VL, angling the
bronchial lumen to a hockey stick shape that conceals the tracheal lumen
saves time and ameliorates the severity of post-intubation complications.

<25>
Accession Number
71658781
Authors
Farag G. Boyce E. Jones P.M. Skanes A.
Institution
(Farag, Boyce, Jones, Skanes) LondonONCanada
Title
The utility of NT-proBNP to predict post-cardiac surgery risk of
developing atrial fibrillation: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S292), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Brain natriuretic peptide (BNP) may have the ability to
predict postoperative atrial fibrillation. Our objective was to evaluate
the usefulness of postoperative N-Terminal-proBNP (NT-proBNP) as an
independent factor to predict post-cardiac surgery atrial fibrillation
(POAF). METHODS: We developed a comprehensive search strategy including
Medline, Embase, and Cochrane databases. Studies were eligible if they met
the following inclusion criteria: adult patients (< 18 years old), cardiac
surgery, measured post-operative NT-proBNP, and atrial fibrillation was
one of the measured endpoints. We excluded studies that assessed only
preoperative BNP, non-cardiac surgeries, case reports, guidelines,
comments, e-comments, and abstracts. Four studies were identified as
eligible the systematic review with a total of 613 patients and two had
sufficient data to be included in the meta-analysis with total of 339
patients. RESULT: A random effects model was used for the metaanalysis.
Patients developing POAF had a statistically significant increase in
NT-proBNP levels compared to the cohort of patients who did not develop
POAF (weighted mean difference 1770 pg/mL [95% CI 568 to 2971], P =
0.004). Insufficient data was available for meta-analysis of the
sensitivity and specificity of various cut-offs of NTproBNP levels.
CONCLUSION: Although the data available is limited and originating from
observational studies with the potential for bias, NT-proBNP has been
shown to predict POAF. Future studies should further assess the
sensitivity and specificity of various cut-offs of post-operative
NT-proBNP for prediction of POAF.

<26>
Accession Number
71658703
Authors
Raval J. Nagaraja V. Eslick G. Siega A.D. Nadra I. Robinson S.
Institution
(Raval, Nagaraja, Eslick, Siega, Nadra, Robinson) SydneyWAAustralia
Title
Where do we stand with anticoagulation in primary PCI? A meta-analysis of
randomized trials comparing unfractionated heparin with bivalirudin.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S249-S250), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The randomised studies HORIZONS AMI, EUROMAX and recent HEAT
PPCI trial have compared clinical outcomes in patients undergoing primary
percutaneous coronary intervention (PCI) with unfractionated heparin (UFH)
to Bivalirudin with or without Glycoprotein 2b/3a inhibitors (GPIs). We
performed a meta-analysis to reappraise the benefits and risks of
Bivalirudin compared to UFH with or without GPIs in patients with ST
segment elevation myocardial infarction undergoing primary PCI. METHODS:
We followed the Preferred Reporting Items for Systematic reviews and
Meta-Analyses PRISMA guidelines where possible in performing our
systematic review. We performed a systematic search through MEDLINE,
PubMed, EMBASE, Current Contents Connect, Cochrane library, Google
scholar, Science Direct, and Web of Science to May 2014. The search terms
included "Unfractionated Heparin," "UFH," "Bivalirudin," "Glycoprotein
2b/3a inhibitors," "Primary percutaneous coronary intervention," and "ST
segment elevation myocardial infarction." Only abstract data was available
for the recently presented HEAT-PPCI study. RESULTS: Major non-coronary
artery bypass graft (CABG) bleeding was higher with UFH + GPI (Odds ratio
1.92 [95% CI 1.45 to 2.52]). Both Thrombolysis in Myocardial Infarction
(TIMI) major and TIMI minor bleeding were also higher with UFH + GPI (OR
1.77 [95% CI: 1.46-2.1] and 1.74 [95% CI: 1.43-2.11] respectively). In
contrast, both definite stent thrombosis (OR 0.37 [95% CI: 0.18-0.78]) and
target vessel revascularisation (TVR) were lower with UFH + GPI (OR 0.55
[95%CI: 0.31-0.96]). No significant difference was observed in mortality
from cardiac or non-cardiac causes or stroke. CONCLUSION: In patients
undergoing primary PCI, those treated with unfractionated heparin + GPI
had higher rates of bleeding in comparison to those treated with
bivalirudin. However rates of definite stent thrombosis and TVR were
significantly lower with heparin + GPI therapy though there was no
difference in stroke or overall mortality. This meta-analysis continues to
support the use of bilvalirudin during primary PCI in patients at high
risk of bleeding.

<27>
Accession Number
71658674
Authors
Chua D. Amadio A. San C.
Institution
(Chua, Amadio, San) VancouverBCCanada
Title
Epoetin dosing for blood conservation in Jehovah's witness patients
undergoing cardiac surgery-a systematic review.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S234), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Jehovah's Witness (JW) patients undergoing cardiac surgery
carry a high morbidity given their refusal of blood transfusions. The use
of epoetin pre-operatively to minimize anemia secondary to blood loss
during cardiac surgery is recommended, however the optimal dosing is
unclear. This systematic review will evaluate the appropiate dosing of
epoetin for JW patients undergoing cardiac surgery. METHODS: We searched
the Cochrane Register of Controlled trials, MEDLINE and EMBASE using the
keywords: "erythropoietin", "recombinant human erythropoietin", "epoetin"
and "Jehovah's witness" and "cardiac surgery", "open heart surgery".
Studies that reported epoetin use with a control/ comparator group
undergoing cardiac surgery and clearly stated epoetin dosages were
included. RESULTS: (Table presented) Five studies met our inclusion
criteria. All studies were retrospective or observational in nature and
thus, are confounded by patient selection, differences in operative
techniques and blood conservation protocols and baseline patient
characteristics. There is no established epoetin dose adopted for blood
conservation in JW patients, but epoetin doses studied are significantly
higher than those used for chronic kidney disease patients with anemia.
CONCLUSION: High dose epoetin as part of a blood conservation protocol has
been reported in the literature. The most common dose of epoetin reported
is 500 U/kg sc every 1-2 days until surgery or target Hct/Hg achieved.

<28>
Accession Number
71658669
Authors
Spaziano M. Barile D. Sia Y.T.
Institution
(Spaziano, Barile, Sia) MontrealQCCanada
Title
Safety of preoperative use of angiotensinconverting enzyme inhibitors and
angiotensin receptor blockers in patients undergoing cardiac surgery: A
systematic review and meta-analysis of the literature.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S232), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Although the long-term benefits of angiotensin- converting
enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in
myocardial infarction and heart failure have been repeatedly proven,
reports concerning their continuation in patients scheduled for cardiac
surgery have produced conflicting results. The purpose of this
meta-analysis was to assess the impact of preoperative ACEI/ARB on short
term outcomes following cardiac surgery. METHODS: We performed a
meta-analysis of articles comparing preoperative ACEI/ARB with no ACEI/ARB
in patients undergoing cardiac surgery. The EMBASE, MEDLINE and CENTRAL
databases were searched until the first week of October 2013. Two
reviewers performed independent article review and study quality
assessment. Data on atrial fibrillation, vasopressor requirements, acute
kidney injury and mortality all occurring in the first month following
surgery were collected. Since most included studies were retrospective,
the generic inverse variance method was used to analyse adjusted odds
ratios, calculating pooled odds ratios (ORs) and associated 95% confidence
intervals (CIs) using a random effects model. RESULTS: We retrieved 24
studies (2 randomized trials, 20 cohort studies and 2 case-control
studies) enrolling a total of 52 378 patients. Preoperative administration
of ACEI/ARB significantly increased postoperative atrial fibrillation (OR:
1.15; 95% CI: 1.01 - 1.31) and vasopressor requirements (OR: 1.65; 95% CI:
1.25 - 2.22). However, no differences in mortality (OR: 0.96; 95% CI: 0.8
- 1.16) or acute kidney injury (OR: 1.05; 95% CI: 0.86 - 1.26) were
observed. CONCLUSION: Preoperative use of ACEI or ARB is potentially
associated with an increased risk of adverse events following heart
surgery, including atrial fibrillation and greater vasopressor
requirements. Large randomized trials are required to confirm these
findings. (Figure presented) .

<29>
Accession Number
71658549
Authors
Spooner A. Clement F. Al-Qoofi F.
Institution
(Spooner, Clement, Al-Qoofi) CalgaryABCanada
Title
Cost-analysis of Tavi: A systematic review.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S169), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Aortic Stenosis is a disease that requires surgical
intervention in its later stages in order to prevent mortality.
Traditionally this has been done through a surgical aortic valve
replacement (AVR) approach. New and innovative technologies allow for the
insertion of prosthetic aortic valves through a transcatheter approach.
While the clinical utility of this procedure has been demonstrated, the
cost and cost-effectiveness of transcatheter aortic valve insertion (TAVI)
has not been established. Our objective in this study is to synthesize the
current estimates of cost and cost-effectiveness of TAVI compared to AVR
or medical management (MM). METHODS: A systematic review was completed.
Six databases (EBMReviews - Cochrane Central Register of Controlled
Trials, Ovid MEDLINE, Embase, NHS Economic Evaluation Database, EBM
Reviews - Health Technology Assessment, and Scopus) were searched from
1950 to Jan 2013 using broad search terms for TAVI and economic outcomes.
Articles were accepted if they included patients undergoing TAVI, reported
the cost of procedure and hospital stay or follow-up costs or reported the
findings of a cost-effectiveness study. RESULTS: Of the 198 citations
identified, 74 abstracts were included. Of those, 63 were excluded during
full-text review. The remaining 11 were included in the final analysis. 4
reported costs while 7 reported cost-effectiveness. Only 1 reported in a
Canadian healthcare context. These 11 journal articles were critically
appraised independently from three sources using the Drummond checklist.
The cost per QALY gained with TAVI compared to AVR ranges from $52,733 to
750,000. The cost per QALY gained with TAVI compared to MM ranges from
16,100 to $61 889. CONCLUSION: There is substantial literature reporting
the cost and cost-effectiveness of TAVI. However, there is limited data
reporting the Canadian context. This analysis is limited by the relatively
short follow up of these patients and heterogeneous data accumulation
among the primary literature. Centers need to understand the financial
implications of starting and sustaining TAVI programs. Our research
reveals the strengths of what has been published in the literature and
areas for improvement for future research focuses. (Table Presented).

<30>
Accession Number
71658532
Authors
Verma S. Goodman S.G. Latter D. Ruel M. Ahsan M.R. Gupta M. Gupta N. Teoh
H. Friedrich J.O.
Institution
(Verma, Goodman, Latter, Ruel, Ahsan, Gupta, Gupta, Teoh, Friedrich)
TorontoONCanada
Title
Should dual antiplatelet therapy be used after coronary artery bypass
surgery? A meta-analysis of 4662 patients from randomized controlled
trials.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S160), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Guidelines recommend the use of dual antiplatelet therapy
(DAPT) for patients with ACS who are managed either medically or with
revascularization. However, DAPT utilization in ACS patients following
CABG remains low, in part, due to limited data, and perceived risk of
bleeding. This meta-analysis specifically addresses the issue of DAPT use
post-CABG, and compares efficacy and bleeding between the newer vs. older
generation P2Y12 antagonists. METHODS: We systematically searched MEDLINE,
EMBASE, and the Cochrane Registry from inception to early 2014 to identify
randomized controlled trials (RCTs) in adult patients undergoing CABG
comparing either dual vs. single antiplatelet therapy, or higher- vs.
lower-intensity DAPT. No language restrictions were applied. Results were
pooled using random effects models. RESULTS: 8 RCTs (4662 patients) met
inclusion criteria. 4 single- or two-centre RCTs enrolled 762 patients
postelective CABG, and 2 multi-centre RCTs reported on post-randomization
subsets of 2155 ACS patients who subsequently underwent CABG. These 6 RCTs
compared clopidogrel plus aspirin to aspirin alone. 2 other multi-centre
RCTs reported on post-randomization subsets of ACS patients who
subsequently underwent CABG and compared higher intensity DAPT with either
ticagrelor (1261 patients) or prasugrel (484 patients) plus aspirin vs.
clopidogrel plus aspirin. Study quality was relatively high. Follow-up
ranged from 30 days to 1 year for the elective CABG RCTs, and 7.5-14.5
months for the ACS RCTs. There were no differences in all-cause mortality
in clopidogrel plus aspirin vs. aspirin RCTs; in contrast, allcause
mortality was significantly lower in the ticagrelor and prasugrel vs.
clopidogrel RCTs (risk ratio [RR] 0.49, 95% confidence interval [CI]
0.33-0.71, p=0.0002, 2 RCTs, 1695 patients) with no heterogeneity (I2=0%),
and interaction p<0.01 compared to clopidogrel plus aspirin RCT pooled
results. There were no differences in myocardial infarctions, strokes, or
composite outcomes overall or in any subgroup. Overall, major bleeding was
not significantly increased (RR 1.24, 95% CI 0.77-2.01, p=0.37, 6 RCTs,
4281 patients). However, there was some heterogeneity (I2=44%) that was
due almost entirely to the significantly higher bleeding reported for the
prasugrel RCT which included mainly CABGrelated major bleeding (RR 3.15,
95% CI 1.45-6.87, p=0.004, 1 RCT, 437 patients). CONCLUSION: Higher
intensity (prasugrel or ticagrelor with ASA) but not lower intensity
(clopidogrel and ASA) DAPT was associated with an approximate 50% lower
risk for all-cause mortality in ACS patients who underwent CABG based on
post-randomization subsets from single RCTs. Large prospective RCTs
evaluating the use of DAPT post CABG are warranted.

<31>
Accession Number
71658482
Authors
Tsoukas G.O. Blais C. Gagnon R. Hamel D. Garfield N. Sherman M. Essebag V.
Huynh T.
Institution
(Tsoukas, Blais, Gagnon, Hamel, Garfield, Sherman, Essebag, Huynh)
MontrealQCCanada
Title
The impact of pharmacotherapy on long-term survival and risk of
re-hospitalization for stroke after hospitalization for atrial
fibrillation.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S132-S133), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: While several drugs have shown survival benefits in coronary
artery disease (CAD), their impacts onmortality and hospitalization for
adverse cardiac outcomes have been less well evaluated in patients with
atrial fibrillation (AF). The objectives of this study were to evaluate
the impact of several drugs on longterm all-cause mortality and risk of
hospitalization for stroke or transient ischemic attack (TIA), in patients
hospitalized for AF. METHODS: UsingQuebec provincial linked health
administrative databases, we conducted a retrospective cohort study of all
patients aged >65 years hospitalized in Quebec for a primary diagnosis of
AF between 1998-2002 who were also subscribed to the provincial
prescription drug insurance plan. We excluded patients who died during the
index hospitalization, and patients who had undergone cardiothoracic
surgery 30 days before AF diagnosis. The primary endpoint was all-cause
mortality; the secondary endpoint was hospitalization for stroke/TIA.We
used multivariate regression Cox proportional hazards to determine the
independent risks associated with the use of beta-blockers, calciumchannel
blockers (CCB), diuretics, statins,ACE-I/ARBs, warfarin, digoxin, and
antiarrhythmic drugs for both endpoints. RESULTS: A total of 10,158
patients (mean age of 76.5 years, 59% females) were included in the
analysis. For the primary endpoint, the median follow-up period was 6.5
years (IQR 2.8, 10.4). At baseline, 65.6% of patients were hypertensive
and 19.8% of patients had diabetes mellitus. There was a history of prior
stroke or TIA in 10.1% of patients. A history of CAD was present in 53.5%
of patients hospitalized for AF, of which 29.3% had prior MI. The use of
beta-blockers, statins, warfarin and antiarrythmics were all associated
with lower all-cause mortality (Table 1), while diuretics and digoxin were
associated with increased mortality. Warfarin was the only drug associated
with decreased risk of hospitalization for stroke/TIA. CONCLUSION: Our
data suggests that in patients >65 years hospitalized for AF,
beta-blockers, statins, antiarrythmics and warfarin were associated with
long-term survival benefit while the opposite association was shown for
diuretics and digoxin. As expected, warfarin use was associated with
decreased risk of hospitalization for stroke/TIA. Future randomized
controlled studies are needed to elucidate the effects of these drug
classes on cardiovascular outcomes in patients with AF. (Table Presented).

<32>
Accession Number
71658414
Authors
Yousef A. Simard T. Pourdjabbar A. Hibbert B. Webb J. Le May M. Glover C.
Labinaz M. Chong A. So D.
Institution
(Yousef, Simard, Pourdjabbar, Hibbert, Webb, Le May, Glover, Labinaz,
Chong, So) OttawaONCanada
Title
Performance of transcatheter aortic valve implantation in patients with
bicuspid aortic valve: Systematic review.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S97), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
OBJECTIVE: To systematically review the current experience and outcomes of
TAVI performance in patients with stenotic bicuspid aortic valves.
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is the current
standard of care for managing patients with severely stenotic aortic valve
that are considered to be of high operative risk. However, major clinical
trials thus far have excluded patients with bicuspid aortic valve (BAV),
resulting in current guidelines listing BAV as a contraindication for
TAVI. We conducted a systematic review to describe the outcomes of TAVI in
patients with BAV. METHODOLOGY: We performed a computerized literature
search of SCOPUS until February 2014 for all English language studies
using following search terms: TAVI, TAVR and bicuspid or congenital aortic
valve. Additional studies were identified using references and citations
of identified studies. Inclusion criteria are patients with documented
bicuspid aortic valve undergoing TAVI and who reported a primary endpoint
of 30-day mortality. RESULTS: We identified 292 studies of which, only 10
case series and case reports met criteria for inclusion in the review.
This encompassed a total of 92 patients who underwent TAVI for BAV up
until February 2014. The primary endpoint of 30 day mortality (8.6% vs.
5.0%) and 1-year mortality rate (15% vs. 3.7%) were similar to those
reported in tricuspid Aortic valve patients undergoing TAVI in Partner-B
trial. Secondary endpoints were variable, with lower stroke events (0% vs.
6.7%) and higher rates of pacemaker insertion (21% vs. 3.4%) and major
vascular complications (23% vs. 16%). CONCLUSION: In this systematic
review, TAVI performance in patients with bicuspid aortic valves appears
to have comparable outcomes to that of tricuspid aortic valve. However,
the paucity of available data precludes further conclusions, with larger
dedicated studies being required to definitively elucidate the role of
TAVI for BAV patients. (Table Presented).

<33>
Accession Number
71658413
Authors
Gandhi S. Schwalm J.D. Pericak D. Farkouh M.E. Rodes-Cabau J. Velianou
J.L. Natarajan M.K.
Institution
(Gandhi, Schwalm, Pericak, Farkouh, Rodes-Cabau, Velianou, Natarajan)
HamiltonONCanada
Title
Dual versus mono-antiplatelet therapy posttranscatheter aortic valve
implantation: A metaanalysis of 30-day outcomes.
Source
Canadian Journal of Cardiology. Conference: 67th Annual Meeting of the
Canadian Cardiovascular Society Vancouver, BC Canada. Conference Start:
20141025 Conference End: 20141028. Conference Publication: (var.pagings).
30 (10 SUPPL. 1) (pp S96-S97), 2014. Date of Publication: October 2014.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as
an alternative to surgical aortic valve replacement in patients considered
at very high surgical risk. Despite high success rates, ischemic
complications such as myocardial infarction (MI) and stroke are not
uncommon. Post-procedure dual antiplatelet therapy (DAPT) with ASA and
clopidogrel is commonly used to reduce these complications despite the
lack of clinical trial evidence demonstrating superiority over
mono-antiplatelet therapy alone. METHODS: We conducted a systematic review
and performed a meta-analysis of studies comparing DAPT vs.
mono-antiplatelet therapy in patients who underwent TAVI. Metaanalysis was
conducted by combining odds ratios of individual studies into a pooled
odds ratio (OR) using a random-effects model. 95% confidence intervals for
both individual and composite outcomes were calculated. Hypotheses of a
difference in DAPT vs. mono-antiplatelet therapy were evaluated at an
alpha level of 0.05. RESULTS: Our search strategy yielded 91 studies of
which 3 studies met inclusion: 1 randomized controlled trial and 2
prospective cohort studies. In total, 520 patients were included (466
trans-femoral approach, 54 trans-apical approach), with 226 in the DAPT
group (combined ASA and clopidogrel) and 294 patients in the
mono-antiplatelet therapy group (2 studies ASA alone, 1 study ASA or
clopidogrel alone). In comparison of DAPT versus mono-antiplatelet
therapy, there was no difference in 30-day spontaneous MI (OR 0.59, [95%
CI 0.09 - 4.07], p=0.59, I²= 0%), 30-day major stroke (OR 1.61,
[95% CI 0.36 - 7.15], p=0.53, I²= 14%), 30-day cardiovascular
death (OR 1.28, [95% CI 0.67 - 2.45], p=0.45, I²= 0%), and
combined 30-day MI and/or stroke (OR 1.31, [95% CI 0.43 - 3.97], p=0.64,
I²= 0%). Patients in the DAPT group experienced increased major
bleeding (OR 3.46, [95% CI 1.71 - 6.99], p=0.0006, I²= 0%), and
increased combined 30-day MI/stroke/cardiovascular death/major bleeding
(OR 2.13, [95% CI 1.30 - 3.48], p=0.003, I²= 12%). CONCLUSION:
The results of this meta-analysis show that DAPT post-TAVI compared to
mono-antiplatelet therapy alone increases the risk of major bleeding, with
no clear benefit in reduction of 30-day MI, stroke, and/or cardiovascular
death. Given the limitations of the pooled analysis (such as small sample
size and observational studies), the optimal antiplatelet regimen
post-TAVI should be explored in a large randomized controlled trial.
(Table Presented).

<34>
Accession Number
71661026
Authors
Piven A.V. Gavrilenko A.V. Kuklin A.V. Abugov S.A. Vanov V.A. Antonov G.I.
Miklashevich E.R. Trunin I.V.
Institution
(Piven, Gavrilenko, Kuklin, Abugov) Federal Facility Russian Scientific
Centre of Surgery Named After Academician B.V. Petrovskii Under, Russian
Academy of Medical Sciences, Moscow, Russian Federation
(Vanov, Antonov, Miklashevich, Trunin) Federal Government Facility, 3rd
Central Military Clinical Hospital Named After A.A. Vishnevskii, Russia's
Defense Ministry, Krasnogorsk, Russian Federation
Title
Carotid endarterectomy and carotid stenting: Long-term results and choice
of the optimal treatment method.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 60th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2011 Moscow Russian Federation. Conference Start: 20110520
Conference End: 20110522. Conference Publication: (var.pagings). 12 (pp
S166), 2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Objective: The purpose of this analysis was to reveal the predictors of
stroke and myocardial infarction in periprocedural period, within 30 days
and one year after carotid endarterectomy and carotid artery stenting and
choice of optimal treatment for patients with carotid stenosis. Methods:
We performed retrospective controlled clinical trial for 167 patients with
symptomatic carotid stenosis. Patients were divided into two groups: 85
patients in carotid endarterectomy (CEA) group and 82 patients in
carotid-artery stenting (CAS) group. The primary composite end points were
stroke, myocardial infarction, or death from any cause during the
periprocedural period or any ipsilateral stroke within one years after
treatment. Results: For 167 patients periprocedural rates of individual
components of the end points were not differed between the stenting group
and the endarterectomy group. For stroke: 3.29% in CEA group vs. 4.59% in
CAS group (P=0.20), for myocardial infarction 3.29 vs. 0%, P=0.20,
respectively. There were no perioperative death in both groups. There was
no significant difference in the estimated one-year rates of the primary
end point between the endarterectomy group and the stenting group (6.12
and 6.84%, respectively; odds ratio, 1.58; 95% confidence interval,
0.251-9.7492; P=0.87). However, analysis by regression model showed
different between these groups: the stroke and myocardial infarction in
the CEA group were associated with contralateral occlusion (P=0.045) and
angina class III (P=0.024), respectively. In the stenting group the stroke
was associated with type II plaque (0.048) and plaque ulceration
(P=0.004). Conclusion: Need to consider the risk factors for carotid
endarterectomy (contralateral occlusion, and angina class III), and risks
for carotid artery stenting (type II plaque and its ulceration) to get the
proper optimal treatment method for the patient with carotid stenosis.
Observance of the optimal conditions for both methods can get better
results of carotid artery stenting and carotid endarterectomy.

<35>
Accession Number
71660920
Authors
Desai M. Gurusamy K. Ghanbari H. Hamilton G. Seifalian A.M.
Institution
(Desai, Gurusamy, Hamilton) Royal Free Hampstead NHS Trust, London, United
Kingdom
(Ghanbari, Seifalian) University College London, London, United Kingdom
Title
Remote ischaemic preconditioning does not improve morbidity or mortality
following open or endovascular aneurysm repair: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 60th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2011 Moscow Russian Federation. Conference Start: 20110520
Conference End: 20110522. Conference Publication: (var.pagings). 12 (pp
S139), 2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Objective: Remote ischaemic preconditioning (RIPC) has a protective effect
in patients undergoing major liver surgery or cardiac surgery. The main
aim of this study is to review effects of RIPC on outcomes from open and
endovascular abdominal aortic aneurysm (AAA) repair. Methods: An
electronic database search of Cochrane Specialised Register, PubMed,
Medline, Embase, CINAHL and AMED was performed to identify randomised
controlled trials evaluating role of RIPC in AAA repair. The outcomes
assessed were mortality, myocardial infarction, renal failure, hospital
and critical care stay, congestive cardiac failure, arrhythmias and
pneumonia. Results: Based on specified criteria, total of 1248 results
were obtained. Only three trials qualified for inclusion in this
meta-analysis encompassing 162 patients (95% males). Eighty-one patients
were randomised to undergo AAA repair with RIPC and 81 patients randomised
to have the procedure without RIPC. All trials were at high risk of bias
and random and systematic errors. There was no difference in mortality
between the two groups (RR 1.70, 95% CI 0.51-5.72; P=0.39). Similarly,
there was no statistically significant difference between two groups for
all other outcomes except reduced risk of myocardial infarction (MI) in
RIPC group (RR 0.31, 95% CI 0.10-0.90) which was significant by
fixed-effects model (P=0.03) but not by random-effects model (RR 0.34, 95%
CI 0.11-1.08; P=0.07). There was a trend of high incidence of unplanned
critical care admission in RIPC group, although not statistically
significant (RR 2.15, 95% CI 0.87-5.33; P=0.1). Conclusions: Based on this
meta-analysis, RIPC does not have any significant impact on reducing
mortality and morbidity from open and endovascular AAA repair, with
possible exception of MI. Because the positive effect of RIPC in other
areas of surgery is compelling and because of current low level of
evidence, the value of this technique needs to be confirmed in adequately
powered trials.

<36>
Accession Number
71660658
Authors
Kakuchaya T. Golukhova E. Eremeeva M. Chigogidze N. Aslanidi I. Nikitina
T. Shurupova I. Bockeria L.
Institution
(Kakuchaya, Golukhova, Eremeeva, Chigogidze, Aslanidi, Nikitina,
Shurupova, Bockeria) Bakoulev Center, Moscow, Russian Federation
Title
Bone-marrow progenitor stem cells for the treatment of patients with
congestive heart failure of different etiology in a placebo controlled
clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 60th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2011 Moscow Russian Federation. Conference Start: 20110520
Conference End: 20110522. Conference Publication: (var.pagings). 12 (pp
S68), 2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Objective: To evaluate effects of autologous bone-marrow (BM) derived
CD133+ progenitors on cardiac remodeling in patients with congestive heart
failure (CHF). Methods: Fifty CHF patients in NYHA class III-IV [24
patients with ischemic dilative cardiomyopathy (ICMP) and 26 patients with
idiopathic dilative cardiomyopathy (IDCMP)] were divided into groups by
CD133+/placebo transcatheter delivery technique: selectively intracoronary
or transendocardially. Patients with acute heart failure were excluded
from the trial. We used all the contemporary. Methods: Of investigation in
the study protocol along with lab tests. CD133+ were obtained by clinimacs
technology of magnetic separation, which allowed to extract pure cell
populations with high survival rate. Results: According to the single
photon emission computed tomography single isolated transendocardial
injection of CD133+ progenitors at average dosage 2 ml was more effective
in patients with ICMP than in patients with IDCMP compared to placebo in
the regions with profoundly reduced perfusion but viable myocardium in six
months after the procedure. This was associated with significantly reduced
left ventricular (LV) volumes and increased ejection fraction in ICMP
patients in that period of time, however there were no significant changes
in such LV remodeling indices as LV mass, left atrial volume, myocardial
performance index and mitral insufficiency. Mentioned positive changes
were offset in one year following the procedure. There were no significant
changes in IDCMP group. In order to evaluate stem cells paracrine effects
we performed enzyme-linked immunoelectrodiffusion assay of patients plasma
samples for 11 biological markers before and after elective CD133+
treatment. Paracrine effects manifested transiently in ischemic scarred
viable myocardium and did not exhibit in non-ischemic dilated myocardium.
Conclusions: CD133+ progenitors were more efficient, though temporarily,
in ICMP patients than in IDCMP patients. This phenomenon was due to the
significant expression and up-regulation of stem cell homing factors in a
scarred ischemic myocardium. Thus, isolated percutaneous transendocardial
delivery of CD133+ progenitors at average dosage 2 ml may have some
positive effects in patients with CHF secondary to coronary artery disease
and can be repeated in six months following the first procedure.

<37>
Accession Number
71660654
Authors
Glushko L.A. Bockeria L.A. Bockeria O.L.
Institution
(Glushko, Bockeria, Bockeria) Bakoulev Scientific Centre, Cardiovascular
Surgery, Moscow, Russian Federation
Title
Cardiac resynchronization therapy: The meta-analysis of modern clinical
trials and follow-up results of its application.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 60th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2011 Moscow Russian Federation. Conference Start: 20110520
Conference End: 20110522. Conference Publication: (var.pagings). 12 (pp
S67), 2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Objective: To determine the follow-up results of cardiac resynchronization
therapy (CRT) alone and with implantable cardioverter defibrillators (ICD)
in patients with left ventricular systolic dysfunction (LVSD). A
systematic and comprehensive literature research was conducted to identify
randomized controlled trials (RCTs) evaluating efficacy and observational
studies evaluating effectiveness or safety of CRT alone and with ICD in
patients with LVSD. Methods: Study selection, quality assessment, and data
extraction were completed from several randomized clinical trials and
observational studies. Statistical software was comprehensive
meta-analysis. Results: From 11,345 citations, were identified 14 RCTs
(4420 patients) for the CRT efficacy review, 106 studies (9209 patients)
for the CRT effectiveness review, 89 studies (9677 patients) for the CRT
safety review, 12 RCTs (8516 patients) for the ICD efficacy review, 48
studies (15,097 patients) for the ICD effectiveness review, and 49 studies
(12,592 patients) for the ICD safety review - all studies enrolled only
patients with LVSD. All patients in the CRT studies had LVSD (mean LVEF
from 21 to 30%) and prolonged QRS duration (mean from 155 to 209 ms), and
91% had III or IV class (NYHA) symptoms. In patients with LVSD and heart
failure symptoms, CRT improved ejection fraction [weighted mean difference
3.0% (95% CI, 0.9-5.1)], quality of life [weighted mean reduction in MLHFQ
8.0 points (95% CI, 5.6-10.4 points)], and function (59% of CRT recipients
vs. 37% of controls improved by at least one NYHA class in the RCTs and
between 63% and 82% of CRT recipients improved by at least one NYHA class
in observational studies. The proportion of patients hospitalized for HF
was reduced by 37% (95% CI, 7-57%) and all-cause mortality was reduced by
22% (95% CI, 9-33%; NNT=29 over six months). Implant success rate was 93%,
0.3% of patients with LVSD died during implantation. Over a median
11-month followup, 6.6% of CRT devices exhibited lead problems and 5%
malfunctioned. Conclusions: CRT reduce all-cause mortality in patients
with LVSD meeting RCT entry criteria. The incremental benefit of CRT plus
ICD over CRT alone in patients with LVSD remains uncertain. Examination of
individual patient trial data is urgently needed to define which clinical
subgroups are most likely to benefit from these devices.

<38>
Accession Number
71660647
Authors
Mordvinova A.S. Bockeria L.A. Bockeria O.L. Zavarina A.Y.
Institution
(Mordvinova, Bockeria, Bockeria, Zavarina) Bakoulev Scientific Center,
Cardiovascular Surgery, Moscow, Russian Federation
Title
Meta-analysis and evaluation of maze-III procedure in patients with lone
atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 60th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2011 Moscow Russian Federation. Conference Start: 20110520
Conference End: 20110522. Conference Publication: (var.pagings). 12 (pp
S65-S66), 2011. Date of Publication: May 2011.
Publisher
Oxford University Press
Abstract
Objective: To evaluate the results of maze III procedure in patients with
lone atrial fibrillation (AF) on the basis of meta-analysis according to
reported data. Methods: Nine studies (seven international) which included
624 patients have been analysed. The procedure considered to be effective
in case of restoration of stable sinus or atrial rhythm within 12 months
after it. The analysed parameters were: age, type of AF, AF duration, left
ventricular ejection fraction (LVEF), left atrium (LA) size, mortality
after surgery, analysis of postoperative complications, sick sinus
syndrome and necessity of the permanent pacemaker implantation, the % age
of sinus rhythm restoration. Meta-analysis has been performed by the
program 'Comprehensive meta-analysis'. Results: The evaluated parameters
were homogeneous in all studies. Mean age was 54+6.5 years (27-63).
Chronic AF was in 57% of cases. Mean duration of AF was 8.0+0.9 years.
Mean size of the LA was 60.4+5.6 mm. Mean LVEF was 58+9.8%. Restoration of
a stable sinus or atrial rhythm has been observed in 87.3% of all cases.
Hospital mortality was 0.2%. Mortality in longterm period (five years) was
4.2% and has not been presented by cardiac events. The frequency of
thromboembolic complications was in 0.6%, the rate of postoperative
bleeding has reached 4.5%. In 13.8% permanent pacemaker was implanted in
patients with concomitant sick sinus syndrome. Conclusions: The data of
Meta-analysis confirm the high efficacy of 'Maze III' procedure in
patients with long time existing lone atrial fibrillation and minimal
hospital and annual mortality. Chronic AF is usually associated with sick
sinus syndrome which requires permanent pacemaker implantation to maintain
physiological rhythm.

<39>
Accession Number
71661594
Authors
Bockeria L.A. Bockeria O.L. Zavarina A.Y. Mordvinova A.S.
Institution
(Bockeria, Bockeria, Zavarina, Mordvinova) Bakoulev Center for
Cardiovascular Surgery, Moscow, Russian Federation
Title
Results meta-analysis and long-term outcomes of maze surgery in patients
with atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 59th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2010 Izmir Turkey. Conference Start: 20140415 Conference End:
20140418. Conference Publication: (var.pagings). 10 (pp S140), 2010. Date
of Publication: April 2010.
Publisher
Oxford University Press
Abstract
Objective: Patients with atrial fibrillation (AF) often are resistant to
pharmacologic and direct current cardioversion. Surgical methods may be
particularly suitable for patients with AF. The purpose of this report to
determine results of the MAZE III procedure for patients with AF and the
data of metaanalysis. Methods: Between 1993 and 2003, 14 (100%) patients
(8 males, 6 females) with medically refractory AF underwent the surgical
Cox maze III procedure, in which had 10 (71%) concomitant procedures. Mean
age was 51.07+7.83 years with refractory permanent AF 6 (42.9%) patients,
other 8 (57.1%) - paroxysmal AF were included in present study. Cox-maze
III procedure performed in 10 (71%) patients whereas it was combined with
mitral valve replacement in 9 (90%) patients or with coronary artery
bypass grafting in 1 (10%) patient. A meta-analysis performed and include
all trials with lone AF involving 647 patients, randomized to receive MAZE
III procedure (MEDLINE, Cochrane library, EMBASE, were searched up to
September 2009). Results: After open heart surgery, normal sinus rhythm
was restored in 11 (78.6%) patients, AF was present in 2 (14.3%) patients,
1 (7%) patient required a permanent pacemaker. Postoperative sinus rhythm
conversion rates at 1, 3, and 5 years were 13 (92.6%) patients, 11 (78.6%)
patients, and 9 (71%) patients. All patients have class I-II congestive
heart failure NYHA in long-term follow-up. There were no thromboembolic
events reported. This data agree with meta-analysis were normal sinus
rhythm was restored in 92% with the need of pacemaker insertion in 5.3%
and no thromboembolic events. Conclusions: The Cox maze procedure remains
the gold standard for the treatment of atrial fibrillation and has
excellent long-term efficacy.

<40>
Accession Number
71661235
Authors
Mazari F.A. Khan J.A. Abdul Rahman M.N. Mockford K. Mccollum P.T. Chetter
I.C.
Institution
(Mazari, Khan, Abdul Rahman, Mockford, Mccollum, Chetter) Academic
Vascular Surgical Unit, University of Hull, Hull, United Kingdom
Title
Intermittent claudication due to femoro-popliteal disease: Is angioplasty
alone cost effective compared to supervised exercise or combined
treatment? Economic evaluation of a randomised controlled trial.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 59th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2010 Izmir Turkey. Conference Start: 20140415 Conference End:
20140418. Conference Publication: (var.pagings). 10 (pp S45), 2010. Date
of Publication: April 2010.
Publisher
Oxford University Press
Abstract
Objective: To compare costs and utilities of percutaneous transluminal
angioplasty (PTA), supervised exercise programme (SEP) and combined
treatment (PTA+SEP) in patients with intermittent claudication (IC) due to
femoro-popliteal disease to establish the most cost effective treatment.
Methods: Patients with femoro-popliteal IC were randomised to receive PTA,
SEP or PTA+SEP. Patients with critical limb ischaemia were excluded.
Assessments were performed prior to and at 1, 3, 6 and 12 months post
intervention. Clinical and quality of life indicators were recorded at
each visit. SF-6D health utility index was calculated from SF-36 and
plotted for all time points. Quality adjusted life years (QALYs) were
generated by calculating area under the curve. Costs were calculated using
National Health Service 2009-2010 payment by results tariffs (NHS-PBR),
National Institute of Health Research - Clinical Research Network
investigation pricing index and BUPA Healthcare pricelists. Adjustments to
treatment costs were made for re-interventions. Cost per QALY and
incremental costs were calculated for each procedure. Multiple sensitivity
analyses were performed for variation in utility and cost calculations to
check robustness of results. Results: One hundred and seventy-eight
patients were recruited and randomised to the three treatment arms (PTA
60, SEP 60, PTA+SEP 58). All treatments resulted in statistically
significant improvement in SF-6D index score (Friedman test, P<0.05).
INTER-GROUP ANALYSIS: QALYs: There was no significant difference
(Kruskal-Wallis test, P>0.05) between treatments in mean QALYs gained PTA
0.620 (95% CI 0.588-0.652), SEP 0.629 (95% CI 0.597-0.660) PTA+SEP 0.649
(95% CI 0.622-0.675). COSTS: Primary unadjusted cost per procedure was
5492.75 for PTA, 2832.74 for SEP and 5830.74 for PTA+SEP. After adjustment
for re-interventions (PTA 8, SEP 5, PTA+SEP 0), mean cost per procedure
was significantly higher (Kruskal-Wallis test, P>0.05) for PTA (6049.23)
compared to SEP (3198.13) and PTA+SEP (5830.74). Consequently, cost per
QALY was significantly higher for PTA (9756.82) compared to SEP (5084.47)
and PTA+SEP (8984.19). This resulted in an incremental cost of 26,642.41
if PTA was used alone compared to PTA+SEP; and 519,150.00 if PTA was used
instead of SEP to equate the QALY gain achieved by these treatments. These
results were robust and valid in all sensitivity analyses. Conclusions:
Supervised Exercise Programme is the most cost effective first line
treatment for intermittent claudication due to femoro-popliteal
atherosclerosis. SEP combined with PTA is more cost effective than PTA
alone and should be provided as standard treatment. Provision of SEP in
community can result in further reduction of costs and improve patient
compliance and satisfaction.

<41>
Accession Number
71661184
Authors
Ionel D. Iancu M. Gabriel C. Florina P. Stefan D. Vasile M.
Institution
(Ionel, Iancu, Gabriel, Florina, Stefan, Vasile) Army's Center for
Cardiovascular Diseases, Bucharest, Romania
Title
Combined coronary and carotid disease: Actual therapeutic strategy.
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 59th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2010 Izmir Turkey. Conference Start: 20140415 Conference End:
20140418. Conference Publication: (var.pagings). 10 (pp S30), 2010. Date
of Publication: April 2010.
Publisher
Oxford University Press
Abstract
Objective: Lacking randomised trials, a major controversy remains the
optimal management of patients who presents concomitant carotid and
coronary artery disease. The main question is whether staged or
simultaneous endarterectomy (CEA) will reduce perioperative morbidity and
mortality after cardiac surgery. The reported results were encouraging
using either of the two strategies, but there is no consensus as to which
is preferable. Recently carotid artery angioplasty with stenting (CAS)
represents a potential alternative to CEA mostly in high-risk CEA
patients. CAS offers a less invasive, safer therapeutic option for cardiac
patients who underwent or will undergo CABG. In some particular situations
CAS+CABG, such a strategy might be harmful. In particular, the need for
dual antiplatelet therapy after CAS can be balanced with avoiding
unnecessary bleeding complications after cardiac surgery. Methods: During
an 1-year period, between 1 January 2008 and 31 December 2008, at the
Army's Center of Cardiovascular Diseases 375 consecutive patients were
referred for coronary surgery. Forty-nine patients (13.3%) were found to
have combined carotid and coronary disease. Thirty-seven patients (10%)
underwent staged carotid endarterectomy (CEA) and coronary artery bypass
grafting (CABG), with a mean of 30+6 days between the interventions, and
12 patients (3.3%) underwent CABG and CEA simultaneously. Results: The
mean age was 62.8+4.7 years and 32 patients (65%) were males. The majority
of the cases (82%) presented triple vessel disease and 16.7% had left main
disease. The carotid disease was unilateral in 43 patients (87.7%) and
bilateral in 2 (4%), and 36 (74.0%) were neurologically asymptomatic. The
overall morbidity and mortality after the two procedures is 19.2% (Randall
2006) and after simultaneous procedure is 17.4% (Rutherford 2005).
Conclusions: In conclusion the presence of carotid stenosis is per se a
marker of risk. There is a need for a randomized controlled trial focusing
on combined or staged surgical approach or endovascular therapy.

<42>
Accession Number
71661130
Authors
Hassouna A. Allam H.
Institution
(Hassouna) Department of Cardiovascular and Thoracic Surgery, Ain-Shams
University, Cairo, Egypt
(Allam) National Research Center, Cairo, Egypt
Title
Anticoagulation of pregnant women with mechanical heart valve prosthesis:
A systematic review of the literature (2000-2009).
Source
Interactive Cardiovascular and Thoracic Surgery. Conference: 59th
International Congress of the European Society for CardioVascular Surgery,
ESCVS 2010 Izmir Turkey. Conference Start: 20140415 Conference End:
20140418. Conference Publication: (var.pagings). 10 (pp S16), 2010. Date
of Publication: April 2010.
Publisher
Oxford University Press
Abstract
Objective: Managing anticoagulation of pregnant women with mechanical
heart valve prosthesis (MPHV) is now mainly limited to three alternatives:
oral anticoagulants (OA) throughout pregnancy; oral anticoagulants
substituted by heparin between the 6th and 12th week of gestation then
resumed thereafter (OA/H); and heparin - either unfractionated or low
molecular weight - throughout pregnancy. Methods: A Medline search was
conducted for English-language articles published between January 2000 and
September 2009 using MESH headings 'prosthetic heart valves', 'pregnancy',
and 'anticoagulants'. Our inclusion criteria were: reports of five
patients or more defining the anticoagulation regimen used during
pregnancy, as well as the adverse fetal and maternal outcomes. Pooled
estimates (95% confidence interval) of those outcomes were calculated for
the three regimens, as well as for a fourth group of concomitantly
reported patients who stopped all anticoagulation, against medical advice.
Events were expressed as proportions of total pregnancies, except
embryopathy and maternal death, which were related to the numbers of live
births and number of patients, respectively. Results: There were 1343
eligible pregnancies, 62% of which followed the OA regimen. The low-dose
warfarin adopted by most authors may be responsible for the low rate of
fetal malformations: 3.7% (95% CI 1.9-4.8%). In OA/H patients, embryopathy
became negligible: 0.4% (95% CI 0.2-2.7%), and the rates of spontaneous
abortions and total fetal wastage dropped by around 40% from 23.3% (95% CI
13.8-31.6%) and 32.9% (95% CI 25.7-49.2%) in OA patients to 13% (95% CI
7-21.6%) and 19.9% (95% CI 15.9-31.4%), respectively. Such positive
effects disappeared with the continuation of heparin until parturition.
The pooled proportions calculated for prosthetic valve thrombosis, all
thromboembolic complications, and maternal mortality in OA patients, 1.2%
(95% CI 0.7-2.2%), 2.9% (95% CI 1.4-4.9%), and 1.1% (95% CI 0.5-2.2%),
were doubled in OA/H patients, 5.3% (95% CI 3-10.8%), 7.1% (95% CI
4.7-10.3%), and 1.7% (95% CI 0.8-4.5%) and almost quadrupled in heparin-
treated patients, 10.2% (95% CI 6.9-16.9%), 13.4% (95% CI 9.7-20.5%), and
4.7% (95% CI 2.2-10.7%), respectively. Conclusions: This study shows that
OA and OA/H are still competing alternatives for pregnant women with MPHV,
especially with an apparently decreasing rate of fetal embryopathy.
Heparin does not ensure better fetal outcomes and is still associated with
the worst adverse maternal outcomes, including mortality. Still, the three
regimens need more detailed reporting on anticoagulation levels and
adjustments. We do not have enough data to evaluate the effect of adjuvant
antiplatelet therapy.

<43>
Accession Number
71652607
Authors
Wu H.
Institution
(Wu) Affiliated Hospital of Nantong University, China
Title
Superiority of 5% NaHCO3 for preoperative hair removal in patients
undergoing coronary artery bypass graft surgery with a limb vein: A
randomized controlled trial.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 134), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective A wet, alkaline environment with the NaHCO3 solution is better
than a dry one with talcum powder, which can soften and expand the hair,
decrease the friction and shear forces on the skin, then making hair
removal easier and more efficient. The purpose of this study was to
compare the effects of a preoperative skin preparation of 5% NaHCO3 to
talcum powder for softening hair in patients undergoing coronary artery
bypass graft (CABG) surgery with the saphenous vein. Methods A prospective
randomized, single-blinded, controlled study was established. Between
March 2012 and June 2013, 120 patients who met the inclusion and exclusion
criteria underwent elective CABG surgery with the saphenous vein in our
hospital. The same doctor obtained the saphenous vein of each patient by a
uniform method. CABG surgery was performed through an open or endoscopic
technique, according to each patient's condition. Patients were divided
into two groups of 60 patients each, according to whether the preoperative
skin preparation procedure was performed with a 5% solution of NaHCO3 at
45 to 50 'C (Experimental group) or with talcum powder (Control group).
Main outcome measures were the incision inflammation rate, skin
preparation time, presence of shaving-induced macroscopic hemorrhagic
spots, verbal rating scale (VRS) pain score, and satisfaction. Result
Neither group had any evidence of incision inflammation. The average (mean
+ standard deviation) skin preparation time of the experimental group was
shorter than that of the control group [(5.58 + 1.52) min vs (9.74 + 1.23)
min, P < 0.001]. Three patients in the experimental group and 17 patients
in the control group had shavinginduced macroscopic hemorrhagic spots
after skin preparation (P = 0.001). The VRS pain scores were different
between the two groups (P < 0.001). In the control group, 40% of patients
and 37% of nurses were satisfied with the skin preparation procedure,
compared to 95% and 90%, respectively, in the experimental group (both P <
0.001). Conclusion Hair softening with a 5% NaHCO3 solution protected the
skin integrity, alleviated pain, and improved patient satisfaction to a
greater extent than talcum powder. Nurses found the 5% NaHCO3 solution to
be more convenient and less time-consuming to use.

<44>
Accession Number
71652576
Authors
Liu T. Shao Q. Li G.
Institution
(Liu, Shao, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardioolgy, China
Title
Red blood cell distribution width predicts adverse outcomes in patients
with heart failure: A systematic review meta-analysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 120-121), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective We aimed to perform a comprehensive meta-analysis to evaluate
the potential association between red blood cell distribution width (RDW)
and adverse outcomes in the patients with heart failure (HF). Methods We
conducted a systematic literature published August 2013 or earlier using
electronic database (PubMed, Ovid, Embase and Web of Science) to identify
the studies reporting on the association between RDW and adverse outcomes
of the patients with HF. Prespecified adverse outcomes of interest
included all-cause mortality, HF hospitalization, and combined adverse
events included combined allcause mortality and HF hospitalization,
all-cause mortality and heart transplantation, and cardiovascular death
and HF hospitalization. Cardiovascular Imaging and Laboratory Medicine 121
Result We retrieved 17 studies (18 data sets), involving a total of 41 311
participants. The results showed that high RDW level was associated with
increased risk of all-cause mortality, HF hospitalization, and combined
adverse events in the patients with HF. For every 1% increment in RDW, the
risk of all-cause mortality, HF hospitalization, and combined adverse
events increased by 12% (HR = 1.12, 95% CI: 1.08-1.16), 9.1% (HR = 1.091,
95% CI: 1.025-1.162), and 18.9% (HR = 1.189, 95% CI: 1.084-1.303)
respectively. Subgroup analyses showed a significant association between
RDW and all-cause mortality in the patients with acute HF (HR = 1.093, 95%
CI: 1.040-1.150), but the association was even stronger in the patients
with chronic HF (HR = 1.126, 95% CI: 1.075-1.179). Conclusion Our
meta-analysis suggests that the high level of RDW increases the risk of
adverse outcomes in the HF patients, especially in chronic HF subjects.

<45>
Accession Number
71652562
Authors
Xu F. Ao H. Chen S.
Institution
(Xu, Ao, Chen) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, China
Title
Impact of the pulmonary artery catheter in CABG patients.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 115), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Background Over the past 30 years the pulmonary artery catheter (PAC) has
become a widely used for monitoring of hemodynamic in patients undergoing
coronary bypass graft (CABG) surgery though recent studies have raised
concerns regarding both effectiveness and safety. Our aim was, therefore,
to determine the impact of PAC use on short- and long-term outcomes in
patients undergoing CABG. Methods 861 Chinese who consecutively underwent
isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital
from June 1, 2012 to September 31, 2012 were included in this study.
Propensity score matched-pair analysis was used to adjust for differences
in likelihood of PAC insertion, from which propensity paring yielded 228
matched pairs, for a total of 456 patients with comparable risk factors.
Short (in-hospital) and long-term (1-year) major post-operative
complications and mortalities were compared between PAC and non- PAC
groups after initialrevascularization Result Patients managed with PAC
received intraoperative vasoactive drugs more frequently: Adrenaline
(7.89% vs 3.07%, P = 0.027) and noradrenaline (8.77% vs 3.95% P = 0.043).
In addition, PAC patients were also associated with prolonged
postoperative stay (11.57 + 5.325 vs 8.97 + 6.793, P < 0.01). We noted no
difference for in-hospital plus 1-year mortality and other morbidity.
Conclusion Our findings indicate no clear evidence of benefit or harm by
managing CABG patients with PAC. A randomized controlled trial would be
ideal to either confirm or refute our findings. 116 Cardiovascular Drug
Therapy Cardiovascular Drug Therapy.

<46>
Accession Number
71652495
Authors
Wang S. Liu D. Pan L. Gao B. Wang W.
Institution
(Wang, Liu, Wang, Pan, Gao, Wang) Department of Cardiac Surgery of the
Second Hospital Lanzhou University, China
Title
Comparison of the cardioprotection between blood cardioplegia and STH
cardioplegia in infant cardiac surgery: A Meta-analysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 89-90), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective To compare the cardioprotection effect between blood and STH
cardioplegia during cardiacsurgery in infant patients, and 90 Pediatric
Cardiology provide a theoretical basis for optimal myocardial protection
strategies. Methods A Meta-analysis of randomized controlled trials (RCTs)
studies about comparing blood and STH cardioplegia in infant patients
undergoing cardiac surgery were performed. Cochrane library (Issue 4,
2014), MEDLINE, EMBase, PubMed, Springer Link, Science Direct, CBM, CNKI
and Wan fang were searched from increation to April 2014. Studies were
assessed according to the Cochrane Handbook for systematic reviews. Data
were extracted from these trials and analyzed by RevMan 5.1 software.
Result Fourteen trials were included, Meta-analysis indicated that, There
were significant differences between blood cardioplegia and STH
cardioplegia in the incidence of postoperative arrhythmias (OR = 0.24, 95%
CI: 0.08-0.76; P = 0.02), days in hospital (OR = -1.09, 95% CI:
-2.03-0.15; P = 0.02), resuscitation time (OR = -73.20, 95% CI: -111.65 -
-34.75; P = 0.0002), but there were no significant differences in the
incidence of postoperative auto-beating (OR = 2.55, 95% CI: 0.57-11.40; P
= 0.22), the incidence of postoperative low cardiac output (OR = 0.24, 95%
CI: 0.01-7.60; P = 0.41) and the hours of ventilation (OR = -0.975, 95%
CI: -24.00-4.51; P = 0.18). Conclusion The current evidence shows that The
protective effects of blood cardioplegia on immature myocardium in infants
cardiac surgery are obviously better than STH cardioplegia. However, given
the low methodological quality and the limited sample size of most
included studies, this conclusion still needs to be further proved by
conducting more strictly-designed, high-quality and large-scale RCTs. The
long-term effectiveness of those two treatment modalities also needs to be
observed in a longer follow-up duration.

<47>
Accession Number
71652490
Authors
Wang S. Liu D. Pan L. Wang W. Gao B.
Institution
(Wang, Liu, Wang, Pan, Wang, Gao) Department of Cardiac Surgery, Second
Hospital Lanzhou University, China
Title
Perioperative period of efficacy in high risk patients undergoing off-pump
versus onpump coronary artery bypass grafting: A Metaanalysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 87-88), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective To assess differences in perioperative efficacy and safety of
high-risk patients undergoing OPCABG versus CCABG. Methods Relevant
clinical trials, published in English and Chinese before March 2014, were
searched in PubMed, EMbase, China National Knowledge Infrastructure
(CNKI), China Biomedicine Literature Database (CBM), VIP Wan fang database
and CochraneLibrary (Issue 3 2014). Manual searches of bibliographies were
also performed. Two reviewers independently selected eligibletrials,
performed quality assessment, abstracted relevant data, and cross-checked
each other finally. The meta-analysis was performed with software RevMan
5.1. Result A total of 16 studies, including 2 randomized controlled
trials and 14 retrospective studies were identified. A total of 6441
highrisk patients, involving 2948 in the OPCABG group and 3493 in the
CCABG group were included. The results of meta-analyses showed: The
difference of stroke, the IABP using, recurrent myocardial infarction,
respiratory dysfunction and mortality incidence in the perioperative
period, the ventilation time, the time in ICU, hospitalization time,
postoperative drainage and blood transfusion were significant differences
between OPCABG and CCABG patients were significant, and the OR/ MD (95%
CI) value was 0.53 (0.38-0.74), 0.57 (0.41-0.79), 0.62 (0.41- 0.86), 0.54
(0.40-0.71), 0.62 (0.48-0.80), -6.65 (-9.24 - -4.12), -12.66 (-18.03 -
-7.92), -1.88 (-3.62 - -0.14), -338.28 (-552.08 - -124.48), -254.86
(-265.40 - -244.31) respectively.While there was no statistical 88 Cardiac
Surgery in the Adult difference in atrial fibrillation, acute renal
injury, wound infection and reoperation rate. Conclusion Compared with
CCABG in the perioperative period, using OPCABG for high-risk patients is
safe and effective and with less trauma, lower operative mortality,
rapider postoperative recovery, fewer complications advantages, but
because of the number of included studies limited and most is the Non-RCT,
OPCABG can not replace CCABG, However, the results and long-term efficacy
still need to be confirmed by higher-quality, more multi-center,
large-sample and randomized doubleblind controlled trials in the future.

<48>
Accession Number
71652468
Authors
Li J. Peng M. Yang X.
Institution
(Li, Peng, Yang) State Key Laboratory of Cardiovascular Disease, Peking
Union Medical College, Fuwai Hospital, China
Title
The comparison of short and long term prognosis about the aortic
dissection between open surgery and endografting or hybrid procedure.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 78-79), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective To compare the short and long term prognosis about the aortic
dissection between open surgery and endografting or hybrid procedure.
Methods We searched Medline and Embase for published studies reporting on
the comparison between open surgery and endografting or hybrid procedure.
We defined the "hybrid procedure" as the endovascular procedures were
performed either concomitantly or in a delayed fashion, less than 30 days
after the open surgery. The primary end point of this meta-analysis was
the mortality of all cause death (ACD) in hospital or in 30 days
discharged, and the long term mortality. The secondary end point was the
morbidity of neurologic complications in hospital. Result We had found
1230 articles on the internet, and enrolled 14 citations with 2141
patients for the Meta-analysis at last. There could be found that the
endografting or hybrid procedure has the significant benefit about the
prognosis of ACD, compared with the conventional open surgery in hospital
and 30 days discharged (13.95% vs 21.25%; RR = 0.61, 95% CI: 0.49-0.77; P
< 0.001), however, we could not conduct Cardiac Surgery in the Adult 79
the same result in the long term mortality (22.44% vs 27.47%, RR = 0.75,
95% CI: 0.54-1.03; P = 0.08). We could find that there is a significant
difference about the morbidity of neurologic complications in hospital,
which shows a lower occurrence of the endografting or hybrid procedure
(10.09% vs 11.12%, RR = 0.73, 95% CI: 0.54-0.98; P = 0.04). Conclusion The
endografting or hybrid procedure could conduct to a better result in
hospital, compared with conventional open surgery. And the long term
prognosis shows the same trend; however, we need more clinical trial to
confirm it.

<49>
Accession Number
71652467
Authors
Li J. Hua K. Yang X.
Institution
(Li, Hua, Yang) State Key Laboratory of Cardiovascular Disease, Peking
Union Medical College, Fuwai Hospital, China
Title
The meta-analysis of the comparison of conventional coronary artery bypass
grafting and hybrid coronary revascularization.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 78), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective To compare the prognosis of hybrid coronary revascularization
(HCR) and conventional coronary artery bypass grafting (CABG). Methods We
performed the electronic search of the PubMed. We defined the "hybrid
coronary revascularization" as the operation based on combining the
excellent long term patency of LIMA-LAD graft by surgical procedure and
minimal invasiveness of interventional procedures to achieve complete
revascularization. The primary end point of this meta-analysis was the
mortality of all cause death (ACD) in the follow-up after two ways of
revascularization (HCR, CABG), the rate of "repeat revascularization" and
"major adverse cardiac events" (MACE) or "major adverse cardiac and
cerebral events (MACCE) ". The secondary end point was the number of
bridge vessels used in operation. Result We found 965 articles from the
internet, of which, we considered and retrieved 6 citations with 5572
patients for possible inclusion in the meta-analysis. The mean age of
participants in individual trials varied from 60 to 65 years, and the
length of follow-up ranged from 1 to 60 months. It had been found that the
HCR therapy has no significant benefit of the prognosis ofA CD compared
with CABG (0.58% vs 1.68%; RR = 0.434, 95% CI: 0.144-1.31; P = 0.14). The
comparison of MI also conducted to the same result, which could not find
the significant difference between HCR and CABG (0.27%vs0.67%; RR = 0.39,
95% CI: 0.04-3.89; P = 0.43). We finally found that patients treated with
HCR definitely had a higher probability than conventional coronary artery
bypass grafting of repeat revascularization (5.23% vs 0.77%; RR = 2.52,
95% CI: 1.47-4.32; P < 0.001). And we found that patients treated with HCR
therapy had a better result of MACE, compared with CABG (3.52% vs 3.67%;
RR = 0.32, 95% CI: 0.17-0.61; P < 0.001). There was no doubt that patients
treated with HCR had a lower number bridge vessels used in operation than
CABG (1.08 vs 2.98; RR = 0.711, 95% CI: 0.663-0.762, P < 0.001). However,
though operations of HCR may use fewer saphenous veins, they also used
stents of bare metal and drug eluting, which consequently led to a longer
length of stay in operation room and higher cost because of the hybrid
medical process and supplies. Conclusion It could be concluded that HCR
therapy has a significant benefit of MACE and usage of bridge vessels,
compared with conventional CABG.

<50>
Accession Number
71652466
Authors
Cao F. Zhang H. Feng X.
Institution
(Cao, Zhang, Feng) State Key Laboratory of Cardiovascular Disease, Peking
Union Medical College, Fuwai Hospital, China
Title
Effects of dexmedetomidine on perioperative sedation in coronary artery
bypass grafting surgery patients: A meta-analysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 78), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective To assess the effect of dexmedetomidineon perioperative sedation
in coronary artery bypass grafting surgery patients. Method Electronic
databases including Cochrane library, Pubmed, EMBase, Highwire, MEDLINE,
CBM, CNKI and CSJD were searched. A meta-analysis of all randomized
controlled trials (RCTs) comparing dexmedetomidine with control in
perioperative coronary artery bypass grafting surgery was performed.Study
selection and meta-analysis were conducted which according to the Cochrane
Handbook for systematic reviews. Data were extracted from these trials by
3 reviewers independently and analyzed by RevMan 5.0 software. Result A
total of 10 RCTs including 562 patients were assessed in this study.
Compared with control group, dexmedetomidinegroup decreased ventilation
time significantly (RR = -2.26, 95% CI: -4.44 - -0.07; P = 0.04),
ventricular tachyarrhythmias (RR = 0.21, 95% CI: 0.09-0.53; P = 0.0009),
and incidence of delirium (RR = 0.53, 95% CI: 0.29-0.98; P = 0.04). No
difference was existed in intensive care unit time (RR = -0.27, 95% CI:
-0.56-0.02; P = 0.06), mortality (RR = 0.77, 95% CI: 0.20-3.05; P = 0.71),
bradycardia (RR = 1.46, 95% CI: 0.88-2.44; P = 0.14), hypotension (RR =
1.55, 95% CI: 0.98-2.46, P = 0.06), application of vasoactive agents (RR =
0.99, 95% CI: 0.56-1.76; P = 0.98), atrial-fibrillation (RR = 0.82, 95%
CI: 0.58-1.17; P = 0.27). Conclusion Dexmedetomidine applied in
perioperative coronary artery bypass grafting surgery patients could
decreased ventilation time, incidence of ventricular tachyarrhythmias and
delirium and no increase in complications, thereby improved the prognosis
of patients.

<51>
Accession Number
71652459
Authors
Xu B.
Institution
(Xu) Department of Cardiology, Peking Union Medical College, Fuwai
Hospital, China
Title
Resolute China randomized controlled trial: Two-year results of resolute
zotarolimus eluting stent versustaxusliberte paclitaxel eluting stent.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 74-75), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective We sought to compare the 2-year clinical outcomes with
theResolute?otarolimus-eluting stent (R-ZES) vsthe
Taxus?Liberte?paclitaxel-eluting stent (PES) in a Chinese population.
Methods The RESOLUTE China multicenter trial randomized patients to R-ZES
or PES. Inclusion criteria included de novo coronary artery lesions in
native coronary arteries with a reference vessel diameter of 2.25 mm to
4.0 mm. Clinical outcomes included target lesion failure (TLF), a
composite of death from cardiac causes (CD), target vessel myocardial
infarction (TV-MI), and clinically-driven target lesion revascularization
(TLR); target vessel failure (TVF), a composite of target vessel
revascularization (TVR), CD, and TV-MI; and Major Adverse Cardiac Events
(MACE), a composite of death, MI, emergent coronary bypass surgery, or
TLR. Between 26 September 2011 and 30 November 2011, 400 patients (198
R-ZES vs 202 PES) were enrolled at 16 study sites in China. Baseline
characteristics were similar in patients treated with R-ZES vs PES: mean
age was (59.7 + 9.9) vs (59.6 + 10.6) years (P = 0.986), and men comprised
77.8% vs 80.7% (P = 0.538) of the study group, respectively; however,
acute MI within 72 hours at baseline was 8.9% with R-ZES vs 3.2% with PES
(P = 0.029). The primary endpoint, 9-month late lumen loss, was
significant lower for R-ZES vsPES [(0.16 + 0.38) mm vs (0.33 + 0.52) mm, P
< 0.001), and 1-year clinically-driven TLR was significantly lower for
R-ZES vs PES (1.5% vs 7.0%, P = 0.011). Result Follow-up at 2 years is
available for 194 R-ZES patients Interventional Cardiology 75 and 194 PES
patients. R-ZES as compared with PES continued to have a significantly
lower rate of clinically-driven TLR (2.6% vs 7.7%, P = 0.036),
clinically-driven TVR (3.1% vs 9.7%, P = 0.012), TVF (7.2% vs 14.3%, P =
0.033) and MACE (6.7% vs 13.3%, P = 0.042), and a numerically lower TLF
(6.7% vs 12.2%, P = 0.083), respectively. There was no significant
difference between R-ZES and PES in the incidence of cardiac death (1.0%
vs 1.0%), TV-MI (4.1% vs 3.6%, P = 0.799), or ARC definite/probable ST
(1.0% vs 1.0%), respectively. Conclusion Use of R-ZES as compared with PES
in a Chinese population was associated with a significantly lower rate of
TLR, TVR, TVF, and MACE that was sustained to two years post enrollment,
and TLF continued to trend lower with R-ZES as compared to PES. These
results confirm the excellent and sustained clinical safety and efficacy
of R-ZES also in a Chinese population.

<52>
Accession Number
71652442
Authors
Bai Y. Qin Y.
Institution
(Bai, Qin) Changhai Hospital, Second Military Medical University, China
Title
Ispercutaneous closure superior to surgical repair in terms of heart
blocks after closureof perimembranous ventricular septal defect? evidence
from a meta-analysis.
Source
Cardiology (Switzerland). Conference: China Heart Congress 2014 Beijing
China. Conference Start: 20140807 Conference End: 20140810. Conference
Publication: (var.pagings). 129 (pp 68), 2014. Date of Publication:
August 2014.
Publisher
S. Karger AG
Abstract
Objective Traditional surgical repair, as a standard treatment for
perimembranous ventricular septal defect (VSD), has yielded great results
in the past decades. Percutaneous device closure for VSD is also
associated with excellent rates of closure and low morbidity. However,
Compared with surgical repair in which atrio-ventricular block usually
appears early after the operation, atrio-ventricular block can occur
immediately or late after transcatheteroccluder closure. The aim of this
study was to compare the incidence of atrio-ventricular block after VSD
closure of percutaneous procedure and surgical repair, and to find whether
percutaneous procedure yields better outcomes than surgical repair.
Methods We searched PubMed, the Cochrane Library, the Web of Science and
Chinese Biomedical Literature databases, Chinese National Knowledge
Infrastructure, the Chinese Science and Technology Journal Full-Text
database, and Wangfang database. The latest data was accessed in March
2014. Review Manager 5.1 software was used for comprehensive
quantification data analysis. Result Sixteen studies were included in the
Meta-analysis, composed of 4669 participants and reporting heart block
complications. The Meta-analysis indicated no statistically significant
difference in right bundle branch block and third degree atrio-ventricular
block between the two approaches, except for left bundle branch block (OR
= 3.19; 95% CI: 1.42-7.15; P = 0.005; I2 = 33%). Conclusion Current
evidence suggests that percutaneous approach may be a good alternative to
the surgery technique for closure of perimembranous ventricular septal
defect in terms of heart blocks after procedure.

<53>
Accession Number
71650390
Authors
Shin D.-H. Kim J.S. Kim B.K. Ko Y.G. Choi D.H. Hong M.K. Jang Y.S.
Institution
(Shin, Kim, Kim, Ko, Choi, Hong, Jang) Yonsei Cardiovascular Center,
Division of Cardiology, Seoul, South Korea
Title
Indirect comparison of coronary artery bypass grafting vs percutaneous
coronary intervention using new generation drug-eluting stents, a bayesian
network meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 974), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Background: As the technology advances, new generation drug-eluting stents
(DES) are reported to have better clinical outcomes than bare metal stents
(BMS) or 1st generation DES. However, there has been no trial using new
generation DES in comparing coronary artery bypass grafting (CABG) vs
percutaneous coronary intervention (PCI). We performed indirect
comparisons between CABG vs PCI with new generation DES. Methods: For the
indirect comparison, we used Bayesian network meta-analysis. During
systematic literature search, randomized trials comparing one
intracoronary stents another were included as well as studies of CABG vs.
PCI for treating left main or multivessel disease. (80,375 patients from
100 trials and 9,736 from 11 trials respectively). Comparisons were made
for all-cause mortality, myocardial infarction (MI), repeat
revascularization and stroke. Results: With respect to mortality and MI,
superiority of CABG was not significant, especially compared to new
generation DES (figure). Regarding repeat revascularization, CABG was
better than PCI, regardless of stent types. However, the benefit decreased
from odds ratio (OR) 6.7 with BMS to OR 1.9 with biolimus eluting stent
(BES, figure). In the direct comparison using trials of CABG vs. PCI,
stroke was fewer in PCI group than in CABG group (OR 0.47, 95% credible
interval 0.19~0.88). Conclusion: Benefit of CABG over PCI in morality and
MI reduction seems uncertain. Although CABG was superior to PCI regarding
repeat revascularization, the advance of stent technology has narrowed the
gap. Randomized trials comparing CABG vs. PCI with new generation DES is
required. (Figure Presented).

<54>
Accession Number
71650378
Authors
Saldarriaga C.I. Mejia J. Mcewen O. Donado J.H.
Institution
(Saldarriaga, Mejia) University of Antioquia, Cardiology Department,
Medellin, Colombia
(Mcewen) Universidad Pontificia Bolivariana, Medellin, Colombia
(Donado) Hospital Pablo Tobon Uribe, Cardiovascular Clinic Santa Maria,
Medellin, Colombia
Title
PCI vs CABG for multivessel disease in DES era, systematic review and
metanalysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 971), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
The strategies of percutaneous coronary intervention (PCI) and coronary
artery bypass grafting (CABG) for revascularization have been compared in
randomized clinical trials, however questions persist concerning the
comparative effectiveness of both interventions. Objective: To compare the
safety and efficacy of PCI with DES vs CABG in the population of patients
with multivessel disease. Methodology: A systematic review and
meta-analysis of randomized clinical trials (RCTs) was conducted, RCT
comparing PCI using DES vs CABG with at least 12 months of follow up were
included. The search was performed in Medline, Cochrane, EMBASE, CINAHL,
OVID, LILACS,SCIELO.Two investigators extracted data independently on
trial design, baseline characteristics, outcomes, and safety events from
published manuscripts and unpublished supplemental data. The primary end
point was a composite of all-cause mortality, myocardial infarction (AMI),
stroke or the need of repeated revascularization after 12 months of follow
up. The secondary end point was all-cause mortality and other individual
cardiovascular events after 12 months and also the need of repeated
revascularization after 3 and 5 years of follow up.Summary RRs and 95% CIs
were calculated using a fixed and random model for combining results.The
heterogeneity between studies were using Forest Plot and also by Cochrane
Q considering heterogeneity as a p value lesser than or equal to 0.1 and
I2 equal or higher than 50%. The risk of bias was evaluated by funnel
plot. Results: 1935 studies were screened for eligibility and 55 were
identified for review, after excluding 51 studies, a total of 4 RCT with
4417 patients met r inclusion criteria for final meta-analysis (FREEDOM,
CARDIA, SYNTAX, VA CARDS) All the trials analyzed in the study showed a
low risk of bias (kappa=0.82). There was a significant difference in
primary outcome in favor of CABG (RR 1.51 I C 95% 1.3-1.76) (I2: 0). A
significant difference in myocardial infarction at 12 months (RR 1,51 CI
1.15 - 2.0) I2: 0) and repeated revascularization (RR 2,48 CI 2,0 - 3,01)
(I2: 66.9) was also found in the CABG group, with non-significant
reduction in mortality (RR 1,07 CI 0.79 - 1.44) (I2: 0). Stroke was less
frequent in PCI group ((RR 0,35 CI 0.19 - 0.64) (I2: 0). A subgroup
analysis was performed in diabetic population showing better outcomes in
the CABG group. Conclusion: CABG remains the standard of care for patients
with multi vessel coronary disease, since the use of CABG, as compared
with PCI, resulted in lower rates of the combined end point of major
adverse cardiac at 1 year.

<55>
Accession Number
71650140
Authors
Al-Shualah R.
Institution
(Al-Shualah) Royal Comission Hospital in Jubail, Training and Education
Department, Jubail, Saudi Arabia
Title
Groin dressing post cardiac catheterization: Traditional pressure vs
transparent film.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 909-910), 2014.
Date of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose of the study: To determine the efficacy of using a small
transparent non pressure dressing compared with the traditional controlled
pressure dressing applied to the femoral artery puncture wound site to
maintain haemostasis following cardiac catheterization procedures.
Methods: Design: An experimental design, Randomized Controlled Trial
(RCT). Patients: 80 post cardiac catheterization patients were randomized
to have their groins dressed either with pressure dressing (N=40) or
Transparent Film Dressing (N=40). Patients ambulated 8 hours after the
procedures. Outcome variables were hematoma formation or bleeding, patient
discomfort, and nurse-reported ease of observation of the groin puncture
site after the procedure. Five instruments were used for data collection:
1)Demographic and medical data sheet, 2)Hematoma Formation and Bleeding
Scale, 3)Skin Integrity Scale, 4)Patient Discomfort and Pain Scale &
5)Nurses Ease of Assessment Scale. Results: There were no significant
differences in base line characteristics and medical data between the two
groups. 100% in Transparent Film Dressing (TFD) group vs 55% in pressure
dressing group reported feeling very comfortable (p value of 0.003).
Hematoma formation was equal in the two dressing groups with no incidence
of bleeding complications. Nurses rated the ease of assessing the groin
significantly higher for TFD than for pressure dressing (p value of
0.000). Conclusion: Dressing of the puncture site after cardiac
catheterization with TFD was more comfortable than the conventional
pressure dressing without any difference in hematoma or bleeding
complications. So TFD can be used safely and comfortably after achieving
hemostasis.

<56>
Accession Number
71650003
Authors
Hassell M.E.C.J. Wiegerinck E.M.A. Vis M.M. Koch K.T. Baan Jr. J. Piek
J.J. Delewi R.
Institution
(Hassell, Wiegerinck, Vis, Koch, Baan Jr., Piek, Delewi) Academic Medical
Center of Amsterdam, Cardiology department, Amsterdam, Netherlands
Title
Bleeding vs. ischemia: Finding a balance in antithrombotic therapy
following transcatheter aortic valve implantation-a meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 873), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: Despite the clinical benefits of transcatheter aortic valve
implantation (TAVI), the reported risk of stroke and bleeding events is
exceedingly higher compared to other cardiac interventions. Dual
antiplatelet therapy (DAPT) with clopidogrel and aspirin is recommended by
the guidelines, but limited evidence is available to support decision
making in antiplatelet therapy. Methods: Pubmed, MEDLINE, EMBASE and
Central (2002-2014) were searched for English studies that compared DAPT
with single antiplatelet treatment (SAPT) following TAVI. Primary endpoint
was the combined endpoint of major adverse cardiac and ischemic
cerebrovascular events (MACE) at one month, including both ischemic as
bleeding events. Secondary endpoints were stroke and major bleeding.
Results: In total 4 studies were eligible (Figure 1). Overall MACE
occurred significantly less in patients treated with SAPT than with DAPT
(OR 0.56, 95% CI 0.36 to 0.86; P=0.008). No clear benefit of DAPT in
comparison to SAPT was observed in preventing stroke occurrence 30 days
post-TAVI (OR 0.95, 95% CI 0.32-2.84, P=0.89). DAPT was associated with an
increased occurrence of major bleeding (OR 0.32, 95% CI 0.17-0.60,
P=0.38). (Figure Presented) Conclusion: Treatment with SAPT one month
following TAVI was associated with a decreased occurrence of MACE and
major bleeding without increasing the risk of future stroke, indicating a
better risk/benefit ratio in comparison to DAPT.

<57>
Accession Number
71649924
Authors
Gargiulo G. Sannino A. Schiattarella G.G. Brevetti L. Perrino C. Stabile
E. Losi M.-A. Toscano E. Trimarco B. Esposito G.
Institution
(Gargiulo, Sannino, Schiattarella, Brevetti, Perrino, Stabile, Losi,
Toscano, Trimarco, Esposito) University Hospital Federico II, Naples,
Italy
Title
Increased mortality after transcatheter aortic valve implantation (TAVI)
in patients with severe aortic stenosis and low ejection fraction: A
meta-analysis of 6,898 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 852), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: There is conflicting evidence regarding safety and efficacy of
transcatheter aortic valve implantation (TAVI) procedures in patients with
severe aortic stenosis and low left ventricular ejection fraction (EF).
The primary aim of this study was to determine the impact of TAVI on
short- and long-term mortality in patients with low EF (EF <50%); the
secondary aim was to analyse the impact of TAVI procedure on EF recovery
in the same setting of patients. Methods and results: Twenty-six studies
enrolling 6,898 patients with severe aortic stenosis undergoing TAVI
procedure were included in the meta-analysis and analyzed for 30-day,
6-month and 1-year all-cause and cardiovascular mortality; a further
meta-analysis was also performed in patients with low EF to assess EF
changes post TAVI. In low EF patients, both all-cause and cardiovascular
short- and long-term mortality were significantly higher when compared to
patients with normal EF (30-dayall- cause mortality: 0.13; 95% confidence
interval [CI]: 0.01 to 0.25, I2 = 49.65, Q = 21.85; 1-year-all-cause
mortality: 0.25; 95% [CI]: 0.16 to 0.34, I2 = 25.57, Q = 16.12;
30-day-cardiovascular mortality: 0.03; 95% [CI]: -0.31 to 0.36, I2 =
66.84, Q = 6.03; 1-year-cardiovascular mortality: 0.29; 95% [CI]: 0.12 to
0.45, I2 = 0.00, Q = 1.88). Nevertheless, in low EF patients TAVI was
associated with a significant recovery of EF, which started at discharge
and proceeded up to 1-year-follow-up. Conclusions: Patients with low EF
severe aortic stenosis have higher mortality following TAVI compared to
normal EF patients, despite a significant and sustained improvement in EF.

<58>
Accession Number
71649923
Authors
Sannino A. Losi M.-A. Schiattarella G.G. Gargiulo G. Perrino C. Stabile E.
Cirillo P. Imbriaco M. Trimarco B. Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Cirillo,
Imbriaco, Trimarco, Esposito) University Hospital Federico II, Naples,
Italy
Title
Moderate to severe mitral regurgitation in patients undergoing
trancatheter aortic valve replacement: A meta-analysis of mortality
outcomes and mitral regurgitation evolution in 4,933 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 852), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: Transcatheter aortic valve replacement (TAVR) is an effective
alternative therapy in selected patients with severe aortic stenosis. We
sought to investigate the role and effects of coexistent moderate to
severe mitral regurgitation (sMR) in patients undergoing TAVR, which, to
date, remain still unclear. Methods and results: Sixteen studies enrolling
4,933 patients undergoing TAVR, including patients with sMR, were
considered in the meta-analysis and analyzed for all-cause-mortality; a
further meta-analysis was performed to assess MR evolution post TAVR. In
patients with sMR, all-cause-mortality post TAVR was significantly
increased, at 30-day (ES: -0.18; 95% confidence interval CI: -0.31 to
-0.04, I2 = 46.51, Q = 7.48), 1-year (ES: -0.22; 95% CI: -0.36 to -0.08,
I2 = 56.20, Q = 11.41) and 2-year-follow-up (ES: -0.15; 95% CI: -0.27 to
-0.02, I2 = 0.00, Q = 2.64) compared to patients with absent or mild MR,
independently from baseline left ventricular ejection fraction.
Interestingly, sMR impact on outcome was statistically stronger when the
CoreValve System was used. TAVR was associated with an improvement in MR
entity, at 3/6-month (overall ES: -0.25, 95% CI: -0.41 to -0.09, I2 =
62.37, Q = 15.95) and at 1-year-follow-up (overall ES: -0.15, 95% CI:
-0.28 to -0.01, I2 = 74.05, Q = 11.56), however this improvement reached
significance only in patients undergoing TAVR with Edwards SAPIEN valve.
Conclusions: In patients undergoing TAVR, the presence of sMR increases
postprocedural mortality. After TAVR, only the implantation of devices at
higher positions significantly improved MR severity. Whether such recovery
in MR severity impacts on mortality after TAVR remains to be defined.

<59>
Accession Number
71648694
Authors
Kannan A. Poongkunran C. Balamuthusamy S.
Institution
(Kannan, Poongkunran, Balamuthusamy) University of Arizona, Tucson, United
States
Title
Coronary revascularization in chronic renal disease and end stage renal
disease-a systematic review and meta analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 525), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Introduction: Patients with Chronic Kidney Disease (CKD) and End Stage
Renal Disease (ESRD) on dialysis have an increased risk for cardiovascular
events secondary to occlusive coronary artery disease. Optimal
revascularization strategy is unclear in this high-risk population.
Objective: We performed a meta- analysis to compare Coronary Artery Bypass
Graft (CABG) versus Percutaneous Coronary Intervention (PCI) in patients
with ESRD and CKD. Methods: Clinical trials comparing patients with ESRD
and CKD undergoing CABG and PCI were considered. We searched PubMed, Ovid,
MEDLINE, CINAHL and EMBASE (1980-2013). The relative risk across all study
groups was computed using Mantel-Hanszel random effects model. Results
were calculated with 95% CI and was considered statistically significant
if 2-sided alpha error was <0.05. Results: 17 trials (N=33,584) in End
Stage Renal Disease arm and six studies (n=15,493) in the CKD arm were
included in the trial. The mean age in the ESRD group was 62.45 years and
in the CKD group was 65.16 years. The weighted average follow up period
was 26.7 months in the ESRD group and 34.2 months in the CKD group. In the
ESRD and CKD group, we found significantly reduced early mortality with
the PCI group with the odds ratio of (2.08 [1.90, 2.26; p<0.00001]) and
(2.55 [1.45, 4.51; p=0.001]) respectively. Contrary to the early mortality
results, we found decreased late mortality with the CABG group when
compared to PCI group (0.86 [0.83, 0.89; p<0.000001]) and (0.82 [0.76,
0.88; p<0.00001]) in the ESRD and CKD arm respectively. When compared to
PCI, there was decreased cardiovascular mortality with an odds ratio of
(0.61 [0.40, 0.92; p=0.02]) in patients who underwent CABG in ESRD
population and a similar trend, albeit insignificant, is observed in CKD
population (1.13 [0.34, 3.81; p<0.84]). We also observed decreased
incidence of myocardial infarction ((ESRD (0.34 [0.32, 0.36;
p<0.00001]))); (CKD (0.89 [0.56, 1.43]; p=0.64))) and repeat
revascularization ((ESRD (0.12 [0.08, 0.18]; p<0.00001)); (CKD (0.26
[0.18, 0.39]; p<0.00001))) in patients undergoing CABG compared to PCI.
There is a strong trend for decreased risk of stroke with PCI when
compared to CABG in ESRD (3.46 [1.02, 11.78] with p=0.05) and CKD
population (0.78 [0.43, 1.41] with p=0.41). Conclusion: In patients with
CKD and ESRD, CABG offers overall mortality benefit compared to PCI.
Similar trends are observed in incidence of myocardial infarction and
repeat revascularization. We observed decreased risk of stroke with PCI
when compared to CABG in ESRD and CKD but more studies are needed to
validate this observation.

<60>
Accession Number
71648469
Authors
Khand A. Palmer N. Patel B. Jones J. Andron M. Perry R. Mehrotra S.
Mitsudo K.
Institution
(Khand, Palmer, Patel, Andron, Perry) Liverpool Heart and Chest Hospital,
Cardiology, Liverpool, United Kingdom
(Jones) Aintree University Hospital, Liverpool, United Kingdom
(Mehrotra) Narayana Hrudayalaya Institute of Medical Sciences, Bangalore,
India
(Mitsudo) Kurashiki Central Hospital, Kurashiki, Japan
Title
Retrograde wiring of collateral channels of the heart in chronic total
occlusions: A systematic review and meta-analysis of safety, feasibility
and incremental value in achieving revascularisation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 463-464), 2014.
Date of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Aims: To conduct a systematic review and meta-analysis on retrograde
wiring of chronic total occlusions (CTO). Methods and results: We searched
publications from 1966 to June 2013 in medline and embase databases with
inclusion of studies detailing success rates of retrograde wiring (n>10)
and complications.We analysed individual data on successful retrograde
wiring and collateral vessel used. 17 case series (n range 17-378) with a
total of 1818 CTO revascularisation attempts fulfilled criteria for
inclusion. The majority of cases were undertaken by CTO dedicated
operators. Procedural CTO revascularisation success rates ranged from
67-90.6% with a large proportion having previously failed an "antegrade"
approach. The septal perforator collaterals and epicardial channels were
used in 75% (n=1356) and 21% (n=384) of cases respectively. Septal
perforating wiring (80%) was significantly more likely to be successful
compared to epicardial coronary artery wiring (68.8%) when chosen by the
operator as a route of retrograde access to the CTO body. RR 1.16 (95% CI:
1.04, 1.30; p=0.010).(figure) Although collateral/coronary perforation was
not infrequent (n=90, 5%) serious acute complications were uncommon; in
the combined population 12 cases of cardiac tamponade (0.7%) requiring
pericardiocentesis, and 2 deaths (0.1%). (Figure presented) Conclusions:
Septal perforator channels are significantly more likely to be
successfully retrogradely wired compared to epicardial vessels when either
is selected, by reference to their anatomical suitability, as a route of
access. Successful retrograde wiring of collateral channels in selected
patients undertaken by "CTO dedicated" operators can significantly enhance
the chances of revascularisation of complex CTOs with a low risk of acute
serious complications.

<61>
Accession Number
71648278
Authors
Mylotte D. Andalib A. Theriault-Lauzier P. Dorfmeister M.C. De Varennes B.
Lachapelle K. Lange R. Martucci G. Virmani R. Piazza N.
Institution
(Mylotte) Galway University Hospital, Galway, Ireland
(Andalib, Theriault-Lauzier, De Varennes, Lachapelle, Martucci, Piazza)
McGill Health University Hospital, Montreal, Canada
(Dorfmeister, Lange) German Heart Center of Munich, Munich, Germany
(Virmani) CVPath Institute, Gaithersburg, United States
Title
TAVI failure: Systematic appraisal of published data.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 414), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: Bioprosthetic surgical valve failure is well described, however
no study has described transcatheter heart valve (THV) failure in a large
series. We performed a systematic review of published literature to
investigate the causes, diagnosis, management and outcomes of THV failure.
Methods: Between January 2002 and October 2013, all published studies
reporting patient level data on THV failure were identified by systematic
electronic search. Outcomes were defined according to the VARC criteria.
Results: Among 56 publications and 69 individual cases of THV failure,
prosthetic valve endocarditis (PVE) (n=29), structural valve failure
(n=8), and THV thrombosis (n=12) were identified. The microbiological
profile of THV PVE was similar to that of surgical PVE, though up to 1/3
of patients underwent surgical intervention. THV thrombosis occurred at a
mean 8+7 months post implantation and was successfully treated with
anticoagulation in 2/3 of patients. Two novel causes of THV failure were
identified: 13 cases of late THV embolization and 7 cases of THV
compression following cardiopulmonary resuscitation. These failure modes
have not been reported in surgical aortic valve replacement, and all
involved balloon expandable THV systems. Potential risk factors for late
THV embolization include THV undersizing/underexpansion; bicuspid and
noncalcified aortic valve; and asymmetric root calcification. Conclusions:
THVs are susceptible to failure modes typical of surgical bioprostheses
and unique to the design of THVs. THV compression and late embolization
represent complications previously unreported in the surgical literature.
Management of THV PVE, valve thrombosis, and structural valve failure
differed considerably from surgical bioprosthetic failure.

<62>
Accession Number
71648270
Authors
Escarcega R. Lipinski M. Magalhaes M. Baker N. Torguson R. Waksman R.
Institution
(Escarcega, Lipinski, Magalhaes, Baker, Torguson, Waksman) Washington
Hospital Center, Washington, United States
Title
Mortality in patients requiring pacemaker implantation following
transcatheter aortic valve replacement: Insights from a systematic review
and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 412), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: While the incidence of permanent pacemaker (PPM) implantation
following transcatheter aortic valve replacement (TAVR) has been
established, the effect of PPM implantation on mortality is less well
described. Thus, we performed a meta-analysis to determine the impact of
PPM following TAVR on all-cause mortality. Methods: PubMed and Cochrane
CENTRAL were searched for studies reporting data on patients that
underwent PPM implantation following TAVR. Primary end-point was all-cause
mortality. Summary effect estimates were generated with random-effects
modeling to compare all-cause mortality between patients requiring PPM and
patients not requiring PPM. Results: We identified 39 studies pertinent to
PPM implantation after TAVR were assessed at the full-text level. We
abstracted data from 7 published studies. Among the 7 included studies,
all-cause mortality data during follow-up was available on 534 patients
that received PPM implantation following TAVR compared with 2012 patients
that did not receive PPM implantation. As seen in the figure, requirement
of PPM implantation following TAVR did not increase all-cause mortality
during follow-up compared with patients that did not require PPM
implantation following TAVR (pooled odds-ratio: 1.00 [95% CI 0.78-1.27],
p=1.00). Heterogeneity was extremely low with an I2 of 0% and visual
inspection of the funnel plot along with Peters' test (p=0.43) did not
suggest small study bias. Conclusions: Our current meta-analysis suggests
that the need for PPM following TAVR does not increase the risk of
all-cause mortality. Further studies directed towards changes in left
ventricular function, cost, length of stay, valve type and post-pacemaker
complications should shed light on the overall effect of PPM implantation
in patients following TAVR.

<63>
Accession Number
71648258
Authors
Stangl V. Baldenhofer G. Laule M. Baumann G. Stangl K.
Institution
(Stangl, Baldenhofer, Laule, Baumann, Stangl) Charite - University
Medicine Berlin, Campus Mitte, Department of Cardiology and Angiology,
Berlin, Germany
Title
Influence of gender on outcome following Transcatheter Aortic Valve
Implantation (TAVI): Meta-Analysis of the Literature.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 409), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Objectives: This study sought to undertake a comprehensive meta-analysis
of studies investigating differences in outcome after Transcatheter Aortic
Valve Implantation (TAVI) in women compared to men. Background: Sex
differences exist in pathogenesis, clinical presentation and outcome in
aortic stenosis (AS). Still limited information is available concerning
sex differences in periprocedural complications and outcome after TAVI.
Methods: PUBMED, MEDLINE, EMBASE and the Cochrane Central Register of
Controlled Trials were screened. Inclusion criteria were: AS treated with
all forms of TAVI; studies targeting specifically on sex/gender
differences; and at least two of the following outcome data: 30-day
all-cause mortality, all-cause mortality during follow-up (>3 months),
major vascular complications, and major bleeding. Exclusion criteria were
studies in which gender was merely considered in subgroup analysis.
Results: 11 observational studies with a total of 5867 patients (3087
women, 2780 men) were included. At 30 days (10 studies, 2716 women, 2438
men), female sex was associated with a significant, 25% lower mortality
rate [odds ratio (95% confidence interval) = 0.75 (0.60-0.94)]. Nine
studies with 4985 patients (2578 women, 2407 men) providing data on
mortality during follow-up reported a significant survival advantage for
women [0.67 (0.53-0.83)]. Whereas major vascular complication rate was
greater in women (9 studies, 2757 women, 2536 men) [1.72 (1.39 to 2.14)],
major bleedings (7 studies, 1977 women, 1899 men) were not significantly
different between genders [1.12 (0.91, 1.37)]. Conclusions: There is
evidence for a significant overall survival benefit in women over men
treated with TAVI.

<64>
Accession Number
71647864
Authors
Spaziano M. Barile D. Sia Y.T.
Institution
(Spaziano, Barile, Sia) Montreal Heart Institute, Montreal, Canada
Title
Safety of preoperative use of angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers in patients undergoing cardiac surgery: A
systematic review and meta-analysis of the literature.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 303), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Background: Although the long-term benefits of angiotensin-converting
enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in
myocardial infarction and heart failure have been repeatedly proven,
reports concerning their continuation in patients scheduled for cardiac
surgery have produced conflicting results. The purpose of this
meta-analysis was to assess the impact of preoperative ACEI/ARB on short
term outcomes following cardiac surgery. Methods: We performed a
meta-analysis of articles comparing preoperative ACEI/ARB with no ACEI/ARB
in patients undergoing cardiac surgery. The EMBASE, MEDLINE and CENTRAL
databases were searched until the first week of October 2013. Two
reviewers performed independent article review and study quality
assessment. Data on atrial fibrillation, vasopressor requirements, acute
kidney injury and mortality all occurring in the first month following
surgery were collected. Since most included studies were retrospective,
the generic inverse variance method was used to analyse adjusted odds
ratios, calculating pooled odds ratios (ORs) and associated 95% confidence
intervals (CIs) using a random effects model. Results: We retrieved 24
studies (2 randomized trial, 20 cohort studies and 2 case-control studies)
enrolling a total of 52378 patients. Preoperative administration of
ACEI/ARB significantly increased postoperative atrial fibrillation (OR:
1.15; 95% CI: 1.01 - 1.31) and vasopressor requirements (OR: 1.65; 95% CI:
1.25 - 2.22). However no difference was observed in acute kidney injury
(OR: 1.05; 95% CI: 0.86 - 1.26) or in mortality (OR: 0.96; 95% CI: 0.8 -
1.16). Conclusion: Preoperative use of ACEI or ARB is potentially
associated with an increased risk of atrial fibrillation and vasopressor
requirements following heart surgery. (Figure Presented).

<65>
Accession Number
71647656
Authors
Conrotto F. D'Ascenzo F. Giordana F. Colaci C. Scacciatella P. Pennone M.
Moretti C. D'amico M. Gaita F. Marra S.
Institution
(Conrotto, Scacciatella, Pennone, D'amico, Marra) Citta della Salute e
della Scienza Hospital, Turin, Italy
(D'Ascenzo, Giordana, Colaci, Moretti, Gaita) University of Turin,
Department of Internal Medicine, Division of Cardiology, Turin, Italy
Title
Impact of access on TAVI procedural and midterm term follow up: A
meta-analysis of 13 studies and 10468 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 248), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: In most of the patients, Transcatheter Aortic Valve Implantation
(TAVI) may be performed using transfemoral (TF) or transapical (TA)
approach: however impact of access choice on periprocedural and mid-term
results remains to be defined. Aim of our study was to evaluate the impact
of access choice on short and mid-term follow-up after TAVI Methods:
Medline and Cochrane Library were searched for articles describing
differences in baseline, peri-procedural and mid-term outcomes among
patients undergoing TF or TA TAVI. The primary end point was all-cause
mortality at midterm follow-up, while secondary ones were 30 days
mortality and in hospital complications (bleeding and cerebrovascular
events). The independent impact of access choice was evaluated with pooled
analysis using a random-effect model. Results: 13 studies with 10468
patients were included. TF was the most exploited strategy (69.5% vs.
30.5%). After adjusting for confounding variables, 30 days and follow-up
mortality (median 365 days, range 222-400) were lower in TF patients with
a pooled adjusted odds ratio of 0.81 [0.68-0.99 I2 99%] and 0.85
[0.80-0.90 I2 96%], respectively. Regarding periprocedural outcomes, TF
reduced risk of bleedings and strokes (OR respectively of 0.74 [0.66-0.82
I2 95] and 0.91 [0.83- 0.99) I2 86% respectively. Conclusions: TF approach
reduces mortality in TAVI patients, due to lower rates of periprocedural
bleedings and strokes.

<66>
Accession Number
71647441
Authors
Luni F.K. Riaz H. Riaz I.B. Riaz T. Husnain M. Khan S. Cooper C.
Institution
(Luni, Cooper) University of Toledo, Medical Center, Internal Medicine,
Toledo, United States
(Riaz, Riaz, Khan) Dow University of Health Sciences, Karachi, Pakistan
(Riaz, Husnain) University of Arizona, Tuscon, United States
Title
A meta-analysis of non-compliance or planned discontinuation of aspirin
and the risk of mortality and non-fatal myocardial infarction in patients
with established or at risk of coronary artery disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2014 Barcelona Spain. Conference Start: 20140830 Conference End:
20140903. Conference Publication: (var.pagings). 35 (pp 190), 2014. Date
of Publication: 01 Sep 2014.
Publisher
Oxford University Press
Abstract
Purpose: Aspirin for prolonged duration is commonly prescribed to patients
with a history of or at increased risk of occlusive vascular events
(secondary prevention) due to its proven role in reducing mortality and
non-fatal myocardial infarction (MI). Non-adherence due to poor
compliance; adverse effects or discontinuation due to medical reasons may
deteriorate outcomes among such patients. Methods: PubMed and Embase were
searched to identify the studies that report discontinuation or
non-adherence of aspirin. Studies reporting the hazardous outcomes
(all-cause mortality and non-fatal myocardial infarction) were included in
the review. Two reviewers independently performed the literature search
and data abstraction using a structured template. Effect size in terms of
odds ratios were pooled by random effects method. Quality assessment was
done as per Cochrane Collaboration's tool for ascertainment of bias and a
funnel plot was constructed to determine the publication bias. Results: A
total of 856 titles were screened, after which 11 observational studies
met the inclusion criteria (103,759 patients). 3 studies evaluated aspirin
adherence in acute coronary syndrome (ACS), 3 on the discontinuation in
perioperative period (coronary artery bypass graft (CABG) and valvular
replacement, 3 in aspirin adherence in drug eluting stents (DES) and 2 on
aspirin non-compliance in coronary artery disease (CAD). Pooled overall
estimates suggest that aspirin discontinuation/non-adherence is associated
with significantly increased risk of death and MI (Hazard Ratio=1.64, 95%
CI= 1.19-2.25). The risk was highest with DES (HR=3.33, CI=2.41-4.66)
followed by ACS (HR=2.00, CI=1.47-2.65) and CABG (HR=1.73, CI=1.3-2.3).
Graphical representation delineating temporal trends showed that the risk
is present regardless of the duration of therapy. Conclusion: Asprin
non-adherence is strongly linked with increased mortality and risk of MI
among patients with a history of ACS, CAD, DES implantation and
peri-operative patients. Efforts should be undertaken to improve the
compliance of aspirin in patients at risk of cardiovascular events and
controlled clinical trials should be conducted to identify evidence based
strategies of improving outcomes in non-complaint patients. Our findings
are limited by variable duration of follow up and significant
heterogeneity among the included studies.

<67>
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Accession Number
71638435
Authors
Pasin L. Belletti A. De Lurdes Castro M. Isella F. Taddeo D. Martino E.A.
Institution
(Pasin, Belletti, De Lurdes Castro, Isella, Taddeo, Martino) San Raffaele
Scientific Institute, Dept of Anaesthesiology and Intensive Care, Milan,
Italy
Title
Inotropes and mortality in adults. A meta-analysis of ranfomizad trials.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 201), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Inotropes and vasopressors are frequently used in the
critically ill patient to improve cardiovascular function and to correct
hemodynamic derangements. However, some studies have suggested a possible
association between administration of inotropes and increased mortality.
We therefore performed a meta-analysis of all the randomized clinical
trials performed in the last 20 years to investigate the effect of
inotropes and vasopressors on mortality. Materials and methods:
BioMedCentral, PubMed, Embase and the Cochrane Central Register were
independently searched (range 1993-2013) by independent investigators.
Inclusion criteria were: adult patients, random allocation to treatment
with at least one group receiving an inotrope or vasopressor and one group
receiving placebo or a non-inotropic/vasopressor control or standard
treatment. The primary endpoint was mortality at the longest follow-up
available. Results and discussion: A total of 31,134 patients from 172
trials were included in the analysis. Overall, pooled estimates showed no
difference in mortality between the group receiving inotropes or
vasopressors and the control group (4,895/16,134 [30%] versus 4,546/15,000
[30%] risk ratio [RR], 1.00; 95% confidence interval [CI], 0.97 to 1.02;
P=0.7). A trend towards increased survival associated with
inotropes/vasopressors administration was seen in the clinical setting of
sepsis (64/138 [46%] versus 57/96 [59%] RR, 0.82; 95% CI, 0.66 to 1.01;
P=0.07, with 7 studies included). No difference was found in the settings
of cardiac surgery (46/1,634 [2.8%] versus 54/1,638 [3.3%] RR, 0.9; 95%
CI, 0.63 to 1.28; P=0.55, with 66 studies included), acute heart failure
(308/1,978 [16%] versus 227/1,538 [15%] RR, 0.93; 95% CI, 0.80 to 1.09;
P=0.39, with 18 studies included), and chronic heart failure (2,062/8,219
[25%] versus 1773/6846 [26%] RR, 1.00; 95% CI 0.89 to 1.12; P=0.97,with 27
studies included). Conclusions: Administration of inotropes and
vasopressors according to published randomized evidence is not associated
to an improved survival nor to an increased mortality in the overall adult
population and in the majority of subsettings. The only exception seems to
be sepsis, with a trend toward a beneficial effect of
vasoconstrictors/inotropic agents on survival.

<68>
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Accession Number
71638112
Authors
Chkhaidze M. Metreveli I. Tsintsadze A.
Institution
(Chkhaidze) Jo Ann Medical Center, Dept of Intensive Care, Tbilisi,
Georgia
(Metreveli, Tsintsadze) Jo Ann Medical Center, Dept of Surgery, Tbilisi,
Georgia
Title
Comparison of two RBC transfusion strategies in pediatric cardiac surgery
patients.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 92), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Despite numerous publications regarding safe
thresholds of blood transfusion, there are still insufficient data of
optimal blood transfusion strategy in pediatric population. The aim of
this study was to compare outcomes of two transfusion strategies, in
pediatric cardiac surgery patients, "restrictive" (R.B.C. transfusion
threshold hemoglobin level < 8 g/dl ) and "liberal" (Hb < 10 g /dl).
Materials and methods: From March 2013 to May 2013, in a randomized
controlled trial, we studied 43 patients with non-cyanotic congenital
heart defects, age from 1 to 7 years, underwent elective cardiac surgery,
in stable postoperative condition. Af ter written informed consent and
approval by the institutional Ethics Committee, we randomly divided
patients in two groups: "restrictive" group (n =23) and "liberal" group
(n=20). The outcome measures analyzed were: volume of RBC transfused
perioperatively, in-hospital length of stay (LOS), LOS in the PICU,
duration of mechanical ventilation, in-hospital morbidity. Continuous
variables are described as mean with (SD) and were tested with the
Mann-Whitney U test or Student's t test. Categorical variables are
described as numbers or percentages and were examined using a chi-square
test or Fisher's exact test. A Kaplan-Meier curve was used to assess LOS
(in-hospital and PICU) and duration of mechanical ventilation. Differences
between groups were considered significant when p value was <0.05. Results
and discussion: Transfused RBC volume was: 264 (59) RBC ml/kg in "liberal"
vs. 164(71) in "restrictive" group (p< 0.05). The duration of M.V. - 13.8
(3.1) hours in "liberal" vs. 12.2 (3.1) in "restrictive". The length of
PICU stay was similar in both groups -3.7 (2.2) vs. 3.8 (1.9) days.
In-hospital LOS was 10 (3,5) vs. 10.3 (1.2). Morbidity rate was 5.8% in
"liberal" group "vs. 6.1% in "restrictive". In this pilot study, with the
small number of patients, we couldn't find any difference in outcome
measures between "liberal" and "restrictive" groups. Only difference was
observed, is the amount of transfused RBC, that was significantly higher
in the "liberal" group. Conclusion(s): We can conclude:"restrictive" RBC
transfusion strategy in pediatric cardiac surgery is at least as safe as
"liberal" strategy. If the amount of transfused RBC will be taken in to
consideration, "liberal" strategy is more expensive in comparison to
"restrictive" strategy.

<69>
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Accession Number
71638079
Authors
Puig J. Ferrando C. Leon I. Romero E. Mugarra A. Belda F.J.
Institution
(Puig, Ferrando, Leon, Romero, Mugarra, Belda) Hospital Clinico
Universitario de Valencia, Dept of Anaesthesiology and Intensive Care,
Valencia, Spain
Title
Lung protective ventilation during general anesthesia in
non-cardiothoracic surgery: A preliminary study.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 80), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Mechanical ventilation (MV) has the
potential to cause so-called ventilator-associated lung injury (VALI) from
overdistention of lung tissue. Recent meta-analysis suggest that MV with
lower tidal volumes (VT) prevents VALI in short-lasting MV. Except for
cardiothoracic surgery, differences in alveolar overdistension when
comparing different VT< 10mlKg^-1 are not known. A novel
ventilatory parameter, the stress index (SI) has been shown to detect
alveolar overdistension when calculated values are >1,1. The primary
endpoint was to describe the incidence of alveolar overdistension
evaluating the SI with different VT (6,8,10mlKg^-1of PBW) during
general anesthesia. Materials and Methods: 15 patients scheduled for
general anesthesia were included. Exclusion criteria: cardiothoracic
surgery. Af ter induction, randomized 6, 8 ,10 VT,during 7 min each one
were administered in volume control ventilation. Af ter that, a
recruitment maneouver (RM) with maximal Paw of 40cmH₂O was
realized and the randomized VT were administered again. in all procedures:
50%FiO₂, PEEP 5cmH₂O and RR 12. Peak airway (Paw),
mean airway pressure (PAM), compliance (Crs) and SI were continuously
monitored. The Kolmogorov-Smirnov test was performer. T student test for
paired samples was used. Results and Discussion: Paw significantly
increased with higher VT but none of the VT studied pre and postRM showed
overdistension. Ventilation with 6 vs 10mlKg^-1 pre or postRM
did not showed differences in SI and Crs. RM significantly decreased Paw
and increased Crs with 8 and 10mlKg^-1 nevertheless the SI was
not affected. Conclusions: In patients with healthy lungs during
short-lasting mechanical ventilation, VT<10mlKg^-1 do not
produces alveolar overdistension. VT<10mlKg^-1 could be consider
lung-protective ventilation in non-cardiothoracic surgery. (Table
Presented).

<70>
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Accession Number
71638066
Authors
Ramirez M. Guerrero-Orriach J. Galan M. Iglesias P. Rubio M. Bellido I.
Cruz J.
Institution
(Ramirez, Guerrero-Orriach, Galan, Iglesias, Rubio, Cruz) Virgen de la
Victoria University Hospital, Dept of Anaesthesiology, Malaga, Spain
(Bellido) School of Medicine, University of Malaga, Dept of
Anaesthesiology, Malaga, Spain
Title
Cardioprotective effect of sevoflurane vs. propofol during anaesthesia and
postoperative period in off-pump coronary artery bypass graft surgery.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 75-76), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Experimental and clinical studies have shown
that sevoflurane (SEV) protect against myocardial ischemia and reperfusion
injury compared with propofol (PRO) in cardiovascular surgery. Nterminal
pro-brain natriuretic peptide (NT-proBNP) is a myocardial damage
biomarker. We evaluated the perioperative cardio protective effect of
sevoflurane vs. propofol using the NT-proBNP quantification in patients
undergoing off-pump coronary artery bypass graft surgery. Materials and
methods: A prospective, longitudinal, double-blind, randomised and
controlled clinical trial was done in ASA class II-IV patients undergoing
elective off-pump coronary artery bypass graft (CAGB) surgery and general
anaesthesia. Exclusion criteria were Euroscore scale value >7, combined
surgery, hemodynamic instability, heart failure and need for vasoactive
drugs before surgery. Patients were randomized to receive anaesthesia and
sedation during intensive care unit (ICU) hospitalization in three groups:
SEV intraoperative+postoperative (SEV), SEV intraoperative+PRO
postoperative (SP), or PRO intraoperative+postoperative (PRO). Clinical
and surgical parameters, cardiopulmonary function were checked
perioperatively and during the ICU hospitalization follow-up. Cardiac
troponin 1 and NT-proBNP (by electroluminescence immunoassay) and
inotropic drugs use were determined preanesthesia induction and 12 h, 24 h
and 48 h after surgery. Results and discussion: 60 Patients, 48.3% male,
aged 61-74 years old, were enrolled and randomized into the three groups
(n=20/group). The groups were comparables at the initial evaluation. At 24
h of following the troponin 1 ranking order was: i): SEV 0.5+0.4 ng/mL* <
< SP 1.61+1.30 ng/mL < PRO 2.27+1.5 ng/mL (p< 0.05). At 24 h of following
the NT-proBNP ranking order was: SEV 501+280 pg/mL*< < SP 1270+498 pg/mL
=PRO 1775+527 pg/ mL (p< 0.05). The patients (in percentage) under at
least one inotropic drug treatment were: i) At 24 h SEV 10%* =SP 19% < <
PRO 51%; and ii) At 48 h: SEV 5%* < < SP 34% < PRO 47% (p< 0.05). Lower
postoperative troponin 1 and NT-proBNP release plus lesser inotropic drug
requirements associated to SEV as unic or combined treatment with respect
to PRO demonstrated the higher cardioprotective effect of sevoflurane
anaesthesia. Conclusion: Sevoflurane exert higher cardioprotective effect
than propofol in patients undergoing off-pump coronary artery bypass
graft, in the operating room and the intensive care unit.

<71>
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Accession Number
71638063
Authors
Cavalcanti I.L. Salgado Filho M.F. Barrucand L. Tinoco De Siqueira H.C.
Germano Filho P.A. Vercosa N.
Institution
(Cavalcanti, Tinoco De Siqueira) Universidade Federal Fluminense UFF, Dept
of Anaesthesiology and Pain Medicine, Niteroi, Brazil
(Salgado Filho) Instituto Nacional de Cardiologia, Dept of
Anaesthesiology, Rio de Janeiro, Brazil
(Barrucand, Vercosa) Universidade Federal do Rio de Janeiro UFRJ, Dept of
Anaesthesiology, Rio de Janeiro, Brazil
(Germano Filho) Hospital Federal de Bonsucesso, Dept of Anaesthesiology,
Rio de Janeiro, Brazil
Title
Impact of adrenaline and levosimendan guided by the left ventricle
myocardial performance index measure on outcome of patients undergoing
on-pump coronary artery bypass: A randomized controlled clinical trial.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 74), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: The myocardial performance index (MPI) or
the TEI index can guide the use of inotropic drugs and volemic
repositioning during the removal of CPB. The objective was to compare the
impact of adrenaline and levosimendan guided by the lef t ventricle
myocardial performance index (LVMPI) measure on outcome of patients
undergoing on-pump coronary artery bypass (CABG). Materials and methods:
81 patients were randomly divided into 2 groups: Epinephrine Group (EG)
and Levosimendan Group (LG). General anaesthesia with etomidate,
cisatracurium, fentanyl, and sevoflurane, and tracheal intubation was
performed. A 8MHz multiplane transesophageal echocardiogram probe was
introduced and the echocardiographic study began. The LVMPI was performed
evaluated 30 minutes after tracheal intubation (T0) and 10 minutes after
the end of protamine infusion (T1). All drugs were prepared in 0.9% saline
solution with a final volume of 100 ml (epinephrine 0.06
mcg.kg^-1. min^-1 or levosimendan 0.2
mcg.kg^-1.min^-1). The data were analyzed by Student's
test or the inter-group proportion test (p< 0.05 was considered
significant). The outcomes studied are shown in table 1. Results and
discussion: After exclusions, 73 patients (37 in the EG and 36 in the LG)
were analyzed. The LVMPI in the EG at T1 (0.26 + 0.1) was significantly
lower than that of the LG (0.39 + 0.1) (p=0,0013). There were no
differences between the groups in terms of postoperative complications and
mortality within 30 days, except the need for norepinephrine (p=0,005),
time use of drugs in ICU (p=0,03) and use of recovery drugs (p=0,001)
(Table 1). Conclusion(s): The necessity to use of rescue medication was
higher in the levosimendan group and duration of use of inotropic agent
was higher in the epinephrine group. (Table Presented).

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Accession Number
71638056
Authors
Al Tmimi L. Sergeant P. Van De Velde M. Meyns B. Coburn M. Rex S.
Institution
(Al Tmimi, Van De Velde, Rex) KU Leuven, University of Leuven, Dept of
Anaesthesiology, Leuven, Belgium
(Sergeant, Meyns) KU Leuven, University of Leuven, Cardiac Surgery,
Leuven, Belgium
(Coburn) University Hospital of the RWTH Aachen, Dept of Anaesthesiology,
Aachen, Germany
Title
Xenon anaesthesia in patients undergoing off-pump coronary artery bypass
graft surgery: A prospective, randomized controlled clinical trial
(EudraCT 2012-002316-12).
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 71), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Xenon anaesthesia has been repeatedly shown
to exhibit a favourable and unique haemodynamic profile. Moreover, xenon
conveys remarkable cardio- and neuroprotective effects in animal
experiments. These properties could render xenon an attractive anaesthetic
agent in off pump coronary artery bypass surgery (OPCAB). We hypothesized
that xenon anaesthesia is non-inferior to sevoflurane anaesthesia with
regard to haemodynamic stability during OPCAB surgery. Materials and
Methods: After obtainment of ethical committee approval and written
informed consent, 42 patients undergoing elective OPCAB surgery were
enrolled. Patients were randomized to receive balanced anaesthesia with
either xenon (50-60 vol.-%) or sevoflurane (1.1-1.4 vol.-%). Anaesthesia
was titrated to maintain a bispectral index value between 40-60. Primary
outcome parameter was the intraoperative use of vasopressors that were
required to achieve pre-defined haemodynamic goals. Secondary outcomes
included feasibility and safety criteria, including the incidence of
postoperative delirium (POD). Haemodynamics were continuously monitored
using a pulmonary artery catheter. While it was technically impossible to
blind the attending anaesthesiologist, research staffs blinded to
treatment allocation performed pre- and postoperative visits. Results and
Discussion: Groups did not differ with respect to baseline characteristics
and surgical parameters. In addition, intraoperative fluid balance,
respiratory profile, depth of anaesthesia and heart rate were similar in
both groups. However, in order to maintain a mean arterial blood pressure
of >65mmHg, patients in the sevoflurane group required significantly
higher norepinephrine doses (median (IQR): 0.07(0.06) vs. 0.02(0.01) mug
kg^-1min^-1, p<0.0001). Area under the curves for
intraoperative cardiac index (2.9(0.9) vs. 2.4(0.8) L
min^-1m^-2, p<0.033) and stroke volume index
(45.4(14.4) vs. 40.2(12.2) mL m^-2, p<0.014) were significantly
higher in the xenon- than in the sevoflurane group. Patients in the
sevoflurane group had a significantly higher incidence of POD (38% vs.
9.5%, p<0.044). No differences were noticed with respect to intraoperative
safety parameters. Conclusion(s): Xenon-anaesthesia is safe and feasible
in patients undergoing OPCAB-surgery. In addition, xenon anaesthesia was
associated with a superior haemodynamic profile in these high-risk
patients and with a lower incidence of POD.

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Accession Number
71637980
Authors
Brossier D. Dechanet F. Fischer M.-O. Hanouz J.-L. Fellahi J.-L.
Institution
(Brossier, Dechanet, Fischer, Hanouz, Fellahi) CHU de Caen, Universite de
Caen Basse-Normandie, Dept of Anaesthesiology and Intensive Care, Caen,
France
Title
Early goal-directed therapy based on endotracheal bioimpedance
cardiography: A prospective, randomized controlled study in coronary
surgery.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2014 Stockholm Sweden. Conference Start:
20140531 Conference End: 20140603. Conference Publication: (var.pagings).
31 (pp 43), 2014. Date of Publication: June 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: New mini-invasive cardiac output devices
have been developed over the last decade. Easy to use, they could help the
practitioners in promoting early goal-directed therapy in high-risk
patients, in an attempt to improve postoperative outcome. This pragmatic
study compared the impact of an early goal-directed hemodynamic therapy
based on Endotracheal Cardiac Output Monitor (ECOM) with a standard of
care on postoperative outcome following coronary surgery. Materials and
methods: This prospective, controlled, parallel-arm trial randomized 100
elective primary coronary artery bypass graf ting patients to a study
group (ECOM; n=50) or a control group (control; n=50). In the ECOM group,
hemodynamic therapy was guided by respiratory stroke volume variation and
cardiac index given by the ECOM system. A standard of care was used in the
control. Goal-directed therapy was started immediately after induction of
anesthesia and continued until arrival in the intensive care unit. The
primary endpoint was the time when patients fulfilled discharge criteria
from hospital (possible hospital discharge). Secondary endpoints were the
true hospital discharge, the time to reach extubation, the length of stay
in intensive care unit, the number of major adverse cardiac events, and
in-hospital mortality. An intention-to-treat analysis was performed on all
randomized patients. Results: Patients in the ECOM group received more of
ten fluid loading and dobutamine. No significant differences were found
between both groups for possible hospital discharge (Hazard Ratio=0.96
[95% CI: 0.64-1.45]) and true hospital discharge (Hazard Ratio=1.20 [95%
CI: 0.79-1.81]). The time to reach extubation was significantly reduced in
the ECOM group: 510 min [extremes: 360-1110] vs. 570 min [extremes:
320-1520], P=0.005. No significant difference was found between the two
groups in the total number of major adverse cardiac events and noncardiac
complications, the length of stay in ICU and in-hospital mortality.
Conclusions: A simple and mini-invasive early goal-directed hemodynamic
therapy based on ECOM can reduce the time to reach extubation but fails to
significantly reduce the length of stay in hospital and the rate of major
cardiac morbidity following coronary surgery.