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<1>
Accession Number
23238507
Authors
Maaroos M. Halonen J. Kiviniemi V. Hartikainen J. Hakala T.
Institution
(Maaroos, Halonen, Kiviniemi, Hartikainen, Hakala) Heart Center of Kuopio
University Hospital, Kuopio, Finland. martin.maaroos@kuh.fi
Title
Intravenous metoprolol versus biatrial pacing in the prevention of atrial
fibrillation after coronary artery bypass surgery: a prospective
randomized open trial.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 101 (4) (pp
292-296), 2012. Date of Publication: 2012.
Abstract
BACKGROUND AND AIMS: Atrial fibrillation (AF) is the most common
arrhythmia after coronary artery bypass surgery (CABG). Intravenous
metoprolol and biatrial pacing have been reported to be effective in AF
prophylaxis after cardiac surgery. The purpose of this trial was to
compare the efficacy of intravenous metoprolol versus biatrial pacing
combined with oral metoprolol in the prevention of AF after CABG.
METHODS: A single-centre prospective randomized open trial of 165
consecutive patients undergoing their first CABG. Patients were randomized
to receive either intravenous metoprolol infusion 1-3 mg per hour or
biatrial overdrive pacing and oral metoprolol (50-150 mg) daily for 72
hours after CABG starting immediately after the surgery. AAI pacing with a
pacing rate of 10 beats/minute above the baseline heart rate was used.
Patients had continuous ECG-monitoring. The primary end point was the
first episode of AF.
RESULTS: The incidence of postoperative AF in the intravenous metoprolol
and biatrial pacing groups did not differ from each other (14% vs. 18%
respectively, p=0.66). There was no difference in the time of AF onset
between the groups (28.2 +/- 16.2 h vs. 30.1 +/- 21.2 h respectively, p =
0.8). Intravenous metoprolol infusion had to be temporarily interrupted
for one hour in eleven patients because of hypotension or bradycardia. One
case of bleeding from the left atria related to the pacemaker electrode
wire was found.
CONCLUSION: We found no difference in the incidence of AF between patients
treated with intravenous metoprolol or the combination of biatrial pacing
and oral metoprolol.

<2>
Accession Number
2014621889
Authors
Kupelian V. Araujo A.B. Wittert G.A. McKinlay J.B.
Institution
(Kupelian, Araujo, McKinlay) New England Research Institutes, Inc., 480
Pleasant St., Watertown, MA 02472, United States
(Wittert) Department of Medicine, University of Adelaide, Royal Adelaide
Hospital, Adelaide, SA, Australia
(Araujo) Eli Lilly and Co., Indianapolis, IN, United States
Title
Association of moderate to severe lower urinary tract symptoms with
incident type 2 diabetes and heart disease.
Source
Journal of Urology. 193 (2) (pp 581-586), 2015. Date of Publication: 01
Feb 2015.
Publisher
Elsevier Inc.
Abstract
Purpose Increasing evidence suggests a possible link between lower urinary
tract symptoms and chronic illnesses. We determined whether lower urinary
tract symptoms are associated with incident type 2 diabetes and heart
disease in a population based study. Materials and Methods BACH is a
population based epidemiological survey of urological symptoms. A
multistage, stratified, cluster sample design was used to obtain a random
sample of 4,144 men and women 30 to 79 years old at baseline. Median
followup was 4.8 years between baseline (2002 to 2005) and followup (2006
to 2010). Type 2 diabetes and heart disease were assessed by self-report.
Lower urinary tract symptoms were assessed by the AUA-SI, and voiding and
storage subscores. Logistic regression was used to estimate the OR and 95%
CI, and adjust for potential confounders. Results In participants with a
body mass index of 30 kg/m² or greater the adjusted ORs for
incident heart disease were 1.89 (95% CI 1.05, 3.39) for AUA-SI 8 or
greater and 2.32 (95% CI 1.33, 4.05) for a storage score of 4 or greater.
In participants with abdominal obesity the adjusted ORs for incident type
2 diabetes were 2.06 (95% CI 1.19, 3.55) for AUA-SI 8 or greater and 1.81
(95% CI 1.04, 3.15) for a storage score of 4 or greater. Lower urinary
tract symptoms (AUA-SI 8 or greater) were also predictive of type 2
diabetes in men and women younger than 50 years (adjusted OR 2.37, 95% CI
1.18, 4.80). Conclusions Longitudinal results of BACH suggest that lower
urinary tract symptoms are a marker of increased risk for type 2 diabetes
and heart disease in obese men and women. The increased risk in younger
men and women suggests that lower urinary tract symptoms may be an
indicator of impending disease.

<3>
Accession Number
2015659120
Authors
Vermeijden W.J. Van Klarenbosch J. Gu Y.J. Mariani M.A. Buhre W.F.
Scheeren T.W.L. Hagenaars J.A.M. Tan M.E.S.H. Haenen J.S.E. Bras L. Van
Oeveren W. Van Den Heuvel E.R. De Vries A.J.
Institution
(Vermeijden) Department of Intensive Care, Thorax Centre Twente, Medisch
Spectrum Twente Enschede, Enschede, Netherlands
(Van Klarenbosch) Division of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
(Gu, Mariani, Van Oeveren) Department of Cardiothoracic Surgery,
University Medical Centre Groningen, Groningen, Netherlands
(Scheeren, Hagenaars, De Vries) Department of Anesthesiology, University
Medical Centre Groningen, Groningen, Netherlands
(Van Den Heuvel) Department of Epidemiology, University Medical Centre
Groningen, Groningen, Netherlands
(Buhre) Department of Anesthesiology and Pain Therapy, Maastricht
University Medical Centre, Maastricht, Netherlands
(Tan) Department of Cardiothoracic Surgery, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Haenen) Department of Cardiac Anesthesia, Medisch Centrum Leeuwarden,
Leeuwarden, Netherlands
(Bras) Department of Anesthesia, St. Antonius Ziekenhuis, Nieuwegein,
Netherlands
Title
Effects of cell-saving devices and filters on transfusion in cardiac
surgery: A multicenter randomized study.
Source
Annals of Thoracic Surgery. 99 (1) (pp 26-32), 2015. Date of Publication:
01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background Cell-saving devices (CS) are frequently used in cardiac surgery
to reduce transfusion requirements, but convincing evidence from
randomized clinical trials is missing. Filtration of salvaged blood in
combination with the CS is widely used to improve the quality of
retransfused blood, but there are no data to justify this approach.
Methods To determine the contribution of CS and filters on transfusion
requirements, we performed a multicenter factorial randomized clinical
trial in two academic and four nonacademic hospitals. Patients undergoing
elective coronary, valve, or combined surgical procedures were included.
The primary end point was the number of allogeneic blood products
transfused in each group during hospital admission. Results From 738
included patients, 716 patients completed the study (CS+filter, 175; CS,
189; filter, 175; neither CS nor filter, 177). There was no significant
effect of CS or filter on the total number of blood products (fraction
[95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96,
1.43]). Use of a CS significantly reduced red blood cell transfusions
within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86
[0.71, 1.05]). Use of a CS was significantly associated with increased
transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with
platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the
percentage of patients who received any transfusion (odds ratio [95%
confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92
[0.68, 1.25]). Conclusions Use of a CS, with or without a filter, does not
reduce the total number of allogeneic blood products, but reduces the
percentage of patients who need blood products during cardiac surgery.

<4>
Accession Number
2015658955
Authors
Almassi G.H. Wagner T.H. Carr B. Hattler B. Collins J.F. Quin J.A.
Ebrahimi R. Grover F.L. Bishawi M. Shroyer A.L.W.
Institution
(Almassi) Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United
States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
(Wagner) Veterans Affairs Palo Alto Health Economics Resource Center,
Menlo Park, CA, United States
(Wagner) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
(Carr, Bishawi, Shroyer) Northport Veterans Affair Medical Center,
Northport, NY, United States
(Hattler, Grover, Shroyer) Eastern Colorado Health Care System, Department
of Veterans Affairs, Denver, CO, United States
(Hattler, Grover) University of Colorado School of Medicine, Anschutz
Medical Campus, Aurora, CO, United States
(Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Ebrahimi) Greater Los Angeles VA Medical Center, Los Angeles, CA, United
States
Title
Postoperative atrial fibrillation impacts on costs and one-year clinical
outcomes: The veterans affairs randomized on/off bypass trial.
Source
Annals of Thoracic Surgery. 99 (1) (pp 109-114), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background New-onset postoperative atrial fibrillation (POAF) after
coronary artery bypass graft surgery (CABG) is associated with worse
in-hospital morbidity and mortality, extended hospital stays, and higher
costs. Beyond the initial hospital discharge, the cost and outcomes of
POAF have not been well studied. Methods For CABG patients with and
without new-onset POAF, a retrospective propensity-matched, multivariable
regression analysis was performed to compare 1-year outcomes (including
health-related quality of life [HRQoL] scores and mortality rates) and
costs (standardized to 2010 dollars). Regression models controlled for
site and patient factors, with propensity matching used to adjust for
differences in POAF versus no-POAF patients' risk profiles. Results Using
the existing CABG trial database, 2,096 patient records were analyzed,
including POAF patients (n = 549) versus no-POAF patients (n = 1,547). For
the index CABG hospitalization, POAF patients had longer postoperative
length of stay (+3.9 days) and higher discharge costs (+$13,993) than
no-POAF patients. At 1 year, POAF patients had more than twice the
adjusted odds of dying (p < 0.01), with higher 1-year total cumulative
costs. This 1-year cost difference (+$15,593) was largely attributable to
hospital-based costs during the index surgery hospitalization. There was
no difference in 1-year HRQoL scores (or HRQoL score changes) between POAF
patients and no-POAF patients. Conclusions Compared with no-POAF patients,
POAF patients had higher discharge and 1-year costs along with higher
1-year mortality rates, but no differences were observed in 1-year HRQoL
scores. Additional research appears warranted to improve the longer-term
survival rates for POAF CABG patients, targeting future POAF-specific
postdischarge interventions.

<5>
Accession Number
2014949261
Authors
Borger M.A. Moustafine V. Conradi L. Knosalla C. Richter M. Merk D.R.
Doenst T. Hammerschmidt R. Treede H. Dohmen P. Strauch J.T.
Institution
(Borger, Merk, Dohmen) University of Leipzig, Leipzig, Germany
(Moustafine, Strauch) University Hospital of the Ruhr University of
Bochum, North-Rhine-Westphalia, Germany
(Conradi, Treede) University Heart Center Hamburg, Hamburg, Germany
(Knosalla, Hammerschmidt) German Heart Institute Berlin, Berlin, Germany
(Richter, Doenst) Jena University Hospital, Jena, Germany
Title
A randomized multicenter trial of minimally invasive rapid deployment
versus conventional full sternotomy aortic valve replacement.
Source
Annals of Thoracic Surgery. 99 (1) (pp 17-24), 2015. Date of Publication:
01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background Minimally invasive surgical procedures (MIS) may offer several
advantages over conventional full sternotomy (FS) aortic valve replacement
(AVR). A novel class of aortic valve prostheses has been developed for
rapid-deployment AVR (RDAVR). We report a randomized, multicenter trial
comparing the outcomes for MIS-RDAVR with those of conventional FS-AVR.
Methods A total of 100 patients with aortic stenosis were enrolled in a
prospective, multicenter, randomized comparison trial (CADENCE-MIS).
Exclusion criteria included ejection fraction below 25%, AVR requiring
concomitant procedures, and recent myocardial infarction or stroke.
Patients were randomized to undergo MIS-RDAVR through an upper
hemisternotomy (n = 51) or AVR by FS with a conventional stented
bioprosthesis (n = 49). Three patients were excluded before the procedure,
and 3 more patients who were randomized to undergo RDAVR were excluded
because of their anatomy. Procedural, early clinical outcomes, and
functional outcomes were assessed for the remaining 94 patients.
Hemodynamic performance was assessed by an echocardiography core
laboratory. Results Implanted valve sizes were similar between groups
(22.9 +/- 2.1 vs 23.0 +/- 2.1 mm, p = 0.9). MIS-RDAVR was associated with
significantly reduced aortic cross-clamp times compared with FS-AVR (41.3
+/- 20.3 vs 54.0 +/- 20.3 minutes, p < 0.001), although cardiopulmonary
bypass times were similar (68.8 +/- 29.0 vs 74.4 +/- 28.4 minutes, p =
0.21). Early clinical outcomes were similar between the two groups,
including quality of life measures. The RDAVR patients had a significantly
lower mean transvalvular gradient (8.5 vs 10.3 mm Hg, p = 0.044) and a
lower prevalence of patient-prosthesis mismatch (0% vs 15.0%, p = 0.013) 3
months postoperatively compared with the FS-AVR patients. Conclusions
RDAVR by the MIS approach is associated with significantly reduced
myocardial ischemic time and better valvular hemodynamic function than
FS-AVR with a conventional stented bioprosthesis. Rapid deployment valves
may facilitate the performance of MIS-AVR.

<6>
Accession Number
2014917014
Authors
Keski-Nisula J. Suominen P.K. Olkkola K.T. Peltola K. Neuvonen P.J.
Tynkkynen P. Salminen J.T. Andersson S. Pesonen E.
Institution
(Keski-Nisula, Suominen, Peltola, Tynkkynen) Department of Anesthesia and
Intensive Care, Children's Hospital, Helsinki University Central Hospital,
Helsinki, Finland
(Olkkola) Department of Anesthesiology, Intensive Care, Emergency Care and
Pain Medicine, University of Helsinki, Helsinki University Central
Hospital, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
(Salminen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Central Hospital, Helsinki, Finland
(Andersson) Department of Neonatal Intensive Care, Children's Hospital,
Helsinki University Central Hospital, Helsinki, Finland
(Pesonen) Department of Anaesthesiology, Intensive Care, Emergency Care
and Pain Medicine, Meilahti Hospital, Helsinki University Central
Hospital, Helsinki, Finland
Title
Effect of timing and route of methylprednisolone administration during
pediatric cardiac surgical procedures.
Source
Annals of Thoracic Surgery. 99 (1) (pp 180-185), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier USA
Abstract
Background We compared the antiinflammatory and cardioprotective effects
of the two most common regimens of corticosteroid administration in
pediatric cardiac surgical procedures: a single dose delivered either at
anesthesia induction or by cardiopulmonary bypass (CPB) prime. Methods
Forty-five children, aged between 1 and 18 months and undergoing
ventricular septal or atrioventricular septal defect correction, were
randomized in double-blind fashion into three groups. The anesthesia
induction group received 30 mg/kg methylprednisolone intravenously after
anesthesia induction, and the CPB-prime group received 30 mg/kg
methylprednisolone by CPB circuit. The placebo group received saline
solution. Plasma concentrations of methylprednisolone, interleukin (IL)-6,
IL-8 and IL-10, and troponin were measured at anesthesia induction before
the study drug, 30 minutes on CPB, after patients were weaned from CPB,
and 6 hours after cessation of CPB. Results Equally high
methylprednisolone concentrations were detected in both methylprednisolone
groups, but the measured peak concentration occurred earlier in the
induction group. Significantly lower IL-8 concentrations were observed
just after patients were weaned from and 6 hours after CPB in the
anesthesia induction group compared with the placebo (p = 0.002, p =
0.001) and prime groups (p = 0.003, p = 0.006). Significant reductions of
troponin were detected in both methylprednisolone groups compared with
placebo (induction, p = 0.001; prime, p = 0.002) 6 hours after patients
were weaned from CPB. Conclusions Methylprednisolone administration at
anesthesia induction was superior in terms of antiinflammatory action.
Methylprednisolone administration in CPB-prime only a few minutes before
aortic cross-clamping and cardioplegia resulted in mean troponin
reductions similar to those of administration at anesthesia induction.
Corticosteroids may have direct cardioprotective properties, as reported
in experimental studies.

<7>
Accession Number
2015659723
Authors
Abbate A. Kontos M.C. Abouzaki N.A. Melchior R.D. Thomas C. Van Tassell
B.W. Oddi C. Carbone S. Trankle C.R. Roberts C.S. Mueller G.H. Gambill
M.L. Christopher S. Markley R. Vetrovec G.W. Dinarello C.A. Biondi-Zoccai
G.
Institution
(Abbate, Kontos, Abouzaki, Melchior, Thomas, Van Tassell, Oddi, Carbone,
Trankle, Roberts, Mueller, Gambill, Christopher, Markley, Vetrovec) VCU
Pauley Heart Center, Victoria Johnson Research Laboratories, Virginia
Commonwealth University, Richmond, VA, United States
(Dinarello) Department of Medicine, University of Colorado, Aurora, CO,
United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Italy
Title
Comparative safety of interleukin-1 blockade with anakinra in patients
with ST-segment elevation acute myocardial infarction (from the VCU-ART
and VCU-ART2 pilot studies).
Source
American Journal of Cardiology. 115 (3) (pp 288-292), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Inc.
Abstract
Two pilot studies of interleukin-1 (IL-1) blockade in ST-segment elevation
myocardial infarction (STEMI) showed blunted acute inflammatory response
and overall favorable outcomes at 3 months follow-up. We hereby present a
patient-level pooled analysis with extended follow-up of 40 patients with
clinically stable STEMI randomized to anakinra, a recombinant IL-1
receptor antagonist, 100 mg/day for 14 days or placebo in a double-blinded
fashion. End points included death, cardiac death, recurrent acute
myocardial infarction (AMI), stroke, unstable angina, and symptomatic
heart failure. Median follow-up was 28 (interquartile range 3 to 38)
months. Sixteen patients (40%) had a total of 22 adverse cardiovascular
events: 1 cardiac death, 4 recurrent AMI, 5 episodes of unstable angina
pectoris requiring hospitalization and/or urgent revascularization, and 11
new diagnoses of heart failure. Treatment with anakinra was associated
with a hazard ratio of 1.08 (95% confidence interval 0.31 to 3.74, p =
0.90) for the combined end point of death, recurrent AMI, unstable angina
pectoris, or stroke and a hazard ratio of 0.16 (95% confidence interval
0.03 to 0.76, p = 0.008) for death or heart failure. In conclusion, IL-1
blockade with anakinra for 2 weeks appears, therefore, to have a neutral
effect on recurrent ischemic events, whereas it may prevent new-onset
heart failure long term after STEMI.

<8>
Accession Number
2015660288
Authors
Xiong Y. Sun Y. Ji B. Liu J. Wang G. Zheng Z.
Institution
(Xiong, Sun, Ji, Liu) Department of Cardiopulmonary Bypass, Cardiovascular
Institute, Fuwai Heart Hospital, Beijing, China
(Xiong) Department of Cardiopulmonary Bypass, Second XiangYa Hospital,
Central South University, ChangSha, China
(Wang) Department of Anesthesiology, Cardiovascular Institute, Fuwai Heart
Hospital, Beijing, China
(Zheng) Department of Cardiovascular Surgery, Cardiovascular Institute,
Fuwai Heart Hospital, Beijing, China
Title
Systematic Review and Meta-Analysis of benefits and risks between
normothermia and hypothermia during cardiopulmonary bypass in pediatric
cardiac surgery.
Source
Paediatric Anaesthesia. 25 (2) (pp 135-142), 2014. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background The controversy over the benefits between normothermic and
hypothermic cardiopulmonary bypass (CPB) for children is still uncertain.
The purpose of this systematic review and meta-analysis is to investigate
the benefits and risks of normothermia comparing with hypothermia in
pediatric cardiac surgery by randomized controlled trials. Methods Pubmed,
Embase, and the Cochrane Central Register of Controlled Trials were
searched for studies reported in English up to September 28, 2013.
Eligible studies were those in which investigators enrolled pediatric
patients, who had cardiac surgery, randomized them to normothermic or
hypothermic CPB. We prespecified the use of random-effects models to
calculate risk ratios and 95% CIs for binary variables, weighted mean
difference (WMD) or standard mean difference and 95% CIs for continuous
variables. We assessed heterogeneity using I². When
heterogeneity was absent (I² = 0%), we used fixed-effects
models. The endpoints were serum lactate, serum creatinine, duration of
clamp, and duration of CPB in pediatrics who had cardiac surgery in
normothermic CPB compared with those in hypothermic CPB. Results The
initial search strategy identified 3910 citations, of which 10 trials
compared pediatrics and seven trails were eligible. These seven trials
included 419 participants from seven countries. The serum lactate and the
serum creatinine had three time points. The outcomes had no different
between normothermic group and hypothermic group. Duration of clamp (WMD =
-10.793, 95% CI -28.89, 7.304; P = 0.242; I² = 86.6%; 204
patients, three trials) and duration of CPB (WMD = -41.780, 95% CI
-89.523, 5.963; P = 0.086; I² = 95.6%; 199 patients, three
trials) also had no significant differences between two groups. Conclusion
Normothermic CPB is as safe as hypothermic CPB in children requiring
correction of simple congenital cardiac defects.

<9>
Accession Number
2014740136
Authors
Afshani N. Schulein S. Biccard B.M. Thomas J.M.
Institution
(Afshani) Department of Anaesthetics, University of Cape Town, Groote
Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
(Schulein) Department of Anesthetics, Toronto General Hospital, University
of Toronto, Toronto, Canada
(Schulein) McMaster University, ON, Canada
(Biccard) Perioperative Research Group, Department of Anaesthetics,
University of Kwazulu-Natal, Durban, South Africa
(Thomas) Department of Anaesthetics, Red Cross War Memorial Children's
Hospital, Cape Town, South Africa
Title
Clinical utility of B-type natriuretic peptide (NP) in pediatric cardiac
surgery - A systematic review.
Source
Paediatric Anaesthesia. 25 (2) (pp 115-126), 2014. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background NP is a biomarker that has been used in the diagnosis,
management, and prognostication of a number of cardiovascular disorders in
the pediatric population. The physiological role of this hormone is to
allow the myocardium to adapt to stress or strain imposed by a volume
and/or pressure load. Objective The aim of this study was to determine the
utility of preoperative and postoperative NP to predict outcome in
pediatric patients undergoing cardiac surgery for structural congenital
heart disease. Method We conducted a systematic review by searching three
electronic databases using the search terms 'paediatric' or 'pediatric'
and 'B-type natriuretic peptide'. Twenty peer-reviewed papers were
included in the study. Results Preoperative NP levels were associated with
the severity of cardiac failure in several studies. Preoperative NPs also
correlated with early postoperative outcome measures such as duration of
cardiopulmonary bypass, duration of mechanical ventilation, presence of
low cardiac output syndrome, length of stay in the intensive care unit and
in one study, death. Early (within 24 h) postoperative NPs showed a
stronger correlation than preoperative NPs to early postoperative adverse
events. Conclusion NPs provide a simple, noninvasive and complementary
tool to echocardiography that can be used to assist clinicians in the
assessment and management of pediatric patients with congenital heart
disease in the perioperative period.

<10>
Accession Number
2015661414
Authors
Clive A.O. Wilson P. Taylor H. Morley A.J. De Winton E. Panakis N. Rahman
N. Pepperell J. Howell T. Batchelor T.J.P. Jordan N. Lee Y.C.G. Dobson L.
Maskell N.A.
Institution
(Clive, Morley, Jordan, Maskell) Respiratory Research Unit, North Bristol
NHS Trust, Southmead Hospital, Bristol, United Kingdom
(Clive, Maskell) Academic Respiratory Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Wilson) University Hospitals Bristol NHS Trust, Bristol, United Kingdom
(Taylor) Research Design Service South West, Bristol, United Kingdom
(De Winton) Royal United Hospital, Bath, United Kingdom
(Panakis, Rahman) Oxford University Hospitals NHS Trust, Oxford, United
Kingdom
(Pepperell) Musgrove Park Hospital, Taunton, United Kingdom
(Howell) Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
(Batchelor) University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Lee) Allergy and Respiratory Research, School of Medicine and
Pharmacology, University of Western Australia, Perth, Australia
(Dobson) South Devon Healthcare NHS Foundation Trust, Torbay, United
Kingdom
Title
Protocol for the surgical and large bore procedures in malignant pleural
mesothelioma and radiotherapy trial (Smart Trial): An RCT evaluating
whether prophylactic radiotherapy reduces the incidence of procedure tract
metastases.
Source
BMJ Open. 5 (1) , 2015. Article Number: e006673. Date of Publication: 01
Jan 2015.
Publisher
BMJ Publishing Group
Abstract
Patients with malignant pleural mesothelioma (MPM) may develop painful
'procedure tract metastasis' (PTM) at the site of previous pleural
interventions. Prophylactic radiotherapy has been used to minimise this
complication; however, three small randomised trials have shown
conflicting results regarding its effectiveness. The surgical and large
bore procedures in malignant pleural mesothelioma and radiotherapy trial
(SMART Trial) is a suitably powered, multicentre, randomised controlled
trial, designed to evaluate the efficacy of prophylactic radiotherapy
within 2 days of pleural instrumentation in preventing the development of
PTM in MPM. Methods and analysis: 203 patients with a histocytologically
proven diagnosis of MPM, who have undergone a large bore pleural
intervention (thoracic surgery, large bore chest drain, indwelling pleural
catheter or local anaesthetic thoracoscopy) in the previous 35 days, will
be recruited from UK hospitals. Patients will be randomised (1:1) to
receive immediate radiotherapy (21 Gy in 3 fractions over 3 working days
within 42 days of the pleural intervention) or deferred radiotherapy (21
Gy in 3 fractions over 3 working days given if a PTM develops). Patients
will be followed up for 12 months. The primary outcome measure is the rate
of PTM until death or 12 months (whichever is sooner), as defined by the
presence of a clinically palpable nodule of at least 1 cm diameter felt
within cm of the margins of the procedure site as confirmed by two
assessors. Secondary outcome measures include chest pain, quality of life,
analgaesic requirements, healthcare utilisation and safety (including
radiotherapy toxicity). Ethics and dissemination: The trial has received
ethical approval from the Southampton B Research Ethics Committee
(11/SC/0408). There is a Trial Steering Committee, including independent
members and a patient and public representative. The trial results will be
published in a peer-reviewed journal and presented at international
conferences. Trial registration number: ISRCTN72767336.

<11>
Accession Number
2015657396
Authors
Goto T. Kadota Y. Mori T. Yamashita S.-I. Horio H. Nagayasu T. Iwasaki A.
Institution
(Goto, Kadota, Mori, Yamashita, Horio, Nagayasu, Iwasaki) Guidelines
Committees of Japanese Association for Chest Surgery, Kyoto, Japan
(Goto) Division of General Thoracic Surgery, Department of Surgery, School
of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan
(Kadota) Department of General Thoracic Surgery, Osaka Prefectural Medical
Center for Respiratory and Allergic Diseases, Osaka, Japan
(Mori) Department of Thoracic Surgery, Kumamoto University Hospital,
Kumamoto, Japan
(Yamashita, Iwasaki) Department of General Thoracic, Breast, and Pediatric
Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
(Horio) Department of General Thoracic Surgery, Tokyo Metropolitan Cancer
and Infectious Diseases Center, Tokyo, Japan
(Nagayasu) Division of Surgical Oncology, Department of Surgery, Nagasaki
University Graduate School of Biomedical Sciences, Nagasaki, Japan
Title
Video-assisted thoracic surgery for pneumothorax: republication of a
systematic review and a proposal by the guideline committee of the
Japanese Association for Chest Surgery 2014.
Source
General Thoracic and Cardiovascular Surgery. 63 (1) (pp 8-13), 2014. Date
of Publication: 2014.
Publisher
Springer-Verlag Tokyo
Abstract
Objective: The purpose of this consensus conference was to determine
whether video-assisted thoracic surgery (VATS) improves clinical outcomes
compared with conventional thoracotomy in patients undergoing surgery for
pneumothorax, and to outline evidence-based recommendations for the use of
VATS. Methods: Before the consensus conference, the best available
evidence was reviewed, with systematic reviews, randomized trials, and
nonrandomized trials all taken into consideration in descending order of
validity and importance. At the consensus conference, evidence-based
interpretative statements were created, and consensus processes were used
to determine the ensuing recommendations. The Medical Information Network
Distribution Service in Japan (Minds) system was used to label the levels
of evidence for the references and the classes of recommendations. Results
and recommendations: The consensus panel agreed upon the following
statements and recommendations for patients with pneumothorax undergoing
surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS
is judged to be less invasive, as it results in minimal postoperative
pain, the periods of chest tube placement and hospitalization are short,
and it shows a trend toward early realization of social integration. 3.
There is no difference in terms of safety and complications between VATS
and open thoracotomy. 4. As it is anticipated that VATS will result in a
higher recurrence rate than open thoracotomy, it may be desirable to add a
supplemental procedure during surgery. In summary, VATS can be recommended
as pneumothorax surgery (Recommendation grade: Level B).

<12>
Accession Number
2015650157
Authors
Serruys P.W. Chevalier B. Dudek D. Cequier A. Carrie D. Iniguez A.
Dominici M. Van Der Schaaf R.J. Haude M. Wasungu L. Veldhof S. Peng L.
Staehr P. Grundeken M.J. Ishibashi Y. Garcia-Garcia H.M. Onuma Y.
Institution
(Serruys) International Centre for Cardiovascular Health, Imperial
College, London, United Kingdom
(Chevalier) Institut Jacques Cartier, Massy, France
(Dudek) Jagiellonian University, Department of Cardiology and Cardio
Vascular Interventions, University Hospital, Krakow, Poland
(Cequier) Bellvitge University Hospital, Barcelona, Spain
(Carrie) Hopital de Rangueil, Toulouse, France
(Iniguez) Hospital de Meixoeiro, Vigo, Spain
(Dominici) S Maria University Hospital, Terni, Italy
(Van Der Schaaf) OLVG, Amsterdam, Netherlands
(Haude) Stadtisches Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Germany
(Wasungu, Veldhof) Abbott Vascular, Diegem, Belgium
(Peng, Staehr) Abbott Vascular, Santa Clara, CA, United States
(Grundeken) Academic Medical Centre, Amsterdam, Netherlands
(Ishibashi, Garcia-Garcia, Onuma) Erasmus MC, Rotterdam, Netherlands
(Garcia-Garcia, Onuma) Cardialysis BV, Rotterdam, Netherlands
Title
A bioresorbable everolimus-eluting scaffold versus a metallic
everolimus-eluting stent for ischaemic heart disease caused by de-novo
native coronary artery lesions (ABSORB II): An interim 1-year analysis of
clinical and procedural secondary outcomes from a randomised controlled
trial.
Source
The Lancet. 385 (9962) (pp 43-54), 2015. Date of Publication: 03 Jan 2015.
Publisher
Lancet Publishing Group
Abstract
Background Despite rapid dissemination of an everolimus-eluting
bioresorbable scaffold for treatment for coronary artery disease, no data
from comparisons with its metallic stent counterpart are available. In a
randomised controlled trial we aimed to compare an everolimus-eluting
bioresorbable scaffold with an everolimus-eluting metallic stent. Here we
report secondary clinical and procedural outcomes after 1 year of
follow-up. Methods In a single-blind, multicentre, randomised trial, we
enrolled eligible patients aged 18-85 years with evidence of myocardial
ischaemia and one or two de-novo native lesions in different epicardial
vessels. We randomly assigned patients in a 2:1 ratio to receive treatment
with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott
Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting
metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA).
Randomisation was stratified by diabetes status and number of planned
target lesions. The co-primary endpoints of this study are vasomotion
(change in mean lumen diameter before and after nitrate administration at
3 years) and difference between minimum lumen diameter (after nitrate
administration) after the index procedure and at 3 years. Secondary
endpoints were procedural performance assessed by quantitative angiography
and intravascular ultrasound; composite clinical endpoints based on death,
myocardial infarction, and coronary revascularisation; device and
procedural success; and angina status assessed by the Seattle Angina
Questionnaire and exercise testing at 6 and 12 months. Cumulative angina
rate based on adverse event reporting was analysed post hoc. This trial is
registered at ClinicalTrials.gov, number NCT01425281. Findings Between Nov
28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned
them to the bioresorbable scaffold group (335 patients, 364 lesions) or
the metallic stent group (166 patients, 182 lesions). Dilatation pressure
and balloon diameter at the highest pressure during implantation or
postdilatation were higher and larger in the metallic stent group, whereas
the acute recoil post implantation was similar (019 mm for both, p=085).
Acute lumen gain was lower for the bioresorbable scaffold by quantitative
coronary angiography (115 mm vs 146 mm, p<00001) and quantitative
intravascular ultrasound (285 mm² vs 360 mm²,
p<00001), resulting in a smaller lumen diameter or area post procedure. At
1 year, however, cumulative rates of first new or worsening angina from
adverse event reporting were lower (72 patients [22%] in the bioresorbable
scaffold group vs 50 [30%] in the metallic stent group, p=004), whereas
performance during maximum exercise and angina status by SAQ were similar.
The 1-year composite device orientated endpoint was similar between the
bioresorbable scaffold and metallic stent groups (16 patients [5%] vs five
patients [3%], p=035). Three patients in the bioresorbable scaffold group
had definite or probable scaffold thromboses (one definite acute, one
definite sub-acute, and one probable late), compared with no patients in
the metallic stent group. There were 17 (5%) major cardiac adverse events
in the bioresorbable scaffold group compared with five (3%) events in the
metallic stent group, with the most common adverse events being myocardial
infarction (15 cases [4%] vs two cases [1%], respectively) and clinically
indicated target-lesion revascularisation (four cases [1%] vs three cases
[2%], respectively). Interpretation The everolimus-eluting bioresorbable
scaffold showed similar 1-year composite secondary clinical outcomes to
the everolimus-eluting metallic stent. Funding Abbott Vascular.

<13>
Accession Number
2015643239
Authors
Kim H.-J. Kim W.H. Kim G. Kim E. Park M.-H. Shin B.S. Sim W.S. Kim C.S.
Lee Y.T. Cho H.S.
Institution
(Kim, Kim) Department of Anesthesiology and Pain Medicine, Samsung
Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
South Korea
(Kim, Kim, Kim, Park, Shin, Sim, Kim, Cho) Department of Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School
of Medicine, Seoul, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Title
A comparison among infusion of lidocaine and dexmedetomidine alone and in
combination in subjects undergoing coronary artery bypass graft: A
randomized trial.
Source
Contemporary Clinical Trials. 39 (2) (pp 303-309), 2014. Date of
Publication: November 01, 2014.
Publisher
Elsevier Inc.
Abstract
Background: Previous studies have reported the cardioprotective effect of
dexmedetomidine and lidocaine. We compared the effect of lidocaine and
dexmedetomidine infusion during off-pump coronary artery bypass graft
(OPCAB). Methods: 153 patients undergoing OPCAB were enrolled. The
lidocaine group (n = 36, Group LIDO) received an infusion of lidocaine 2.
mg/kg/h after bolus 1.5. mg/kg; the dexmedetomidine group (n = 40, Group
DEX) received dexmedetomidine 0.3-0.7. mug/kg/h; the combined group (n =
39, Group Combined) received infusion of both drugs; and the control group
(n = 38) received nothing. We measured serum creatinine kinase-myocardial
band (CK-MB) and cardiac troponin I (cTnI) concentration before and
immediately after the surgery, postoperative day (POD)#1 and #2. The
complication rate and clinical outcomes were compared. Results: The
concentration of cTnI was significantly lower in the Group LIDO and Group
Combined than the control group on POD#2. The concentration of CK-MB was
significantly lower in the Group LIDO and Group Combined compared to the
control group on POD#1 and #2 [CK-MB on POD#1: 7.67 (5.78-11.92) vs. 7.18
(5.01-11.72) vs. 13.19 (6.85-23.87) in the Group LIDO, combined and
control, respectively, Group LIDO vs. control: p = 0.003, Group Combined
vs. control: p = 0.015]. The AUC of CK-MB was significantly lower in the
Group LIDO and Group Combined than the control group. However, clinical
variables including complication rate, ICU stay and one-year mortality
were not different. Conclusions: Lidocaine infused at 2. mg/kg/h, but not
dexmedetomidine infused at 0.3-0.7. mug/kg/h reduced postoperative
myocardial injury marker levels compared with the control group. However,
no other clinical benefits were observed.