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<1>
Accession Number
24650125
Authors
Rafiq S. Steinbruchel D.A. Wanscher M.J. Andersen L.W. Navne A. Lilleoer
N.B. Olsen P.S.
Institution
(Rafiq, Steinbruchel, Wanscher, Andersen, Navne, Lilleoer, Olsen)
Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet,
Blegdamsvej 9, Copenhagen O 2100, Denmark. sulman_raf@hotmail.com
Title
Multimodal analgesia versus traditional opiate based analgesia after
cardiac surgery, a randomized controlled trial.
Source
Journal of cardiothoracic surgery. 9 (pp 52), 2014. Date of Publication:
2014.
Abstract
RESULTS: Patients in the multimodal group demonstrated significantly lower
average pain scores from the day of surgery throughout the third
postoperative day. Extensive nausea and vomiting, was found in no patient
in the multimodal group but in 13 patients in the morphine group, p<0.001.
Postoperative rise in individual creatinine levels demonstrated a
non-significant rise in the multimodal group, 33.0+/-53.4 vs. 19.9+/-48.5,
p=0.133. Patients in the multimodal group suffered less major in-hospital
events in crude numbers: myocardial infarction (MI) (1 vs. 2, p=0.54),
stroke (0 vs. 3, p=0.075), dialysis (1 vs. 2, p=0.54), and
gastrointestinal (GI) bleeding (0 vs. 1, p=0.31). 30-day mortality was 1
vs. 2, p=0.54.
CONCLUSIONS: In patients undergoing cardiac surgery, a multimodal regimen
offered significantly better analgesia than a traditional opiate regimen.
Nausea and vomiting complaints were significantly reduced. No safety
issues were observed with the multimodal regimen.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01966172.
BACKGROUND: To evaluate if an opiate sparing multimodal regimen of
dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic
effect, less side effects and was safe compared to a traditional morphine
and paracetamol regimen after cardiac surgery.
METHODS: Open-label, prospective randomized controlled trial. 180 patients
undergoing cardiac procedures through median sternotomy, were included in
the period march 2007-August 2009. 151 patients were available for
analysis. Pain was assessed with the 11-numeric rating scale (11-NRS).

<2>
Accession Number
24705913
Authors
Yin Z.-T.
Institution
(Wang) Department of Cardiovascular Surgery, Shenyang Northern Hospital,
Shenyang, Liaoning Province, China
(Wang) Department of Cardiovascular Surgery, Shenyang Northern Hospital,
Shenyang, Liaoning Province, China
(Yin) Department of Cardiovascular Surgery, Shenyang Northern Hospital,
Shenyang, Liaoning Province, China
Title
Carvedilol for prevention of atrial fibrillation after cardiac surgery: a
meta-analysis.
Source
PloS one. 9 (4) (pp e94005), 2014. Date of Publication: 2014.
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) remains the most
common complication after cardiac surgery. Current guidelines recommend
beta-blockers to prevent POAF. Carvedilol is a non-selective
beta-adrenergic blocker with anti-inflammatory, antioxidant, and multiple
cationic channel blocking properties. These unique properties of
carvedilol have generated interest in its use as a prophylaxis for POAF.
OBJECTIVE: To investigate the efficacy of carvedilol in preventing POAF.
METHODS: PubMed from the inception to September 2013 was searched for
studies assessing the effect of carvedilol on POAF occurrence. Pooled
relative risk (RR) with 95% confidence interval (CI) was calculated using
random- or fixed-effect models when appropriate. Six comparative trials
(three randomized controlled trials and three nonrandomized controlled
trials) including 765 participants met the inclusion criteria.
RESULTS: Carvedilol was associated with a significant reduction in POAF
(relative risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64,
p<0.001). Subgroup analyses yielded similar results. In a subgroup
analysis, carvedilol appeared to be superior to metoprolol for the
prevention of POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001). No evidence of
heterogeneity was observed.
CONCLUSIONS: In conclusion, carvedilol may effectively reduce the
incidence of POAF in patients undergoing cardiac surgery. It appeared to
be superior to metoprolol. A large-scale, well-designed randomized
controlled trial is needed to conclusively answer the question regarding
the utility of carvedilol in the prevention of POAF.

<3>
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Accession Number
25225746
Authors
Dardashti A. Ederoth P. Algotsson L. Bronden B. Grins E. Larsson M.
Nozohoor S. Zinko G. Bjursten H.
Institution
(Dardashti, Ederoth, Algotsson, Bronden, Grins, Larsson, Nozohoor, Zinko,
Bjursten) From the Department of Cardiothoracic Surgery, Anesthesiology,
and Intensive Care, Lund University and Skane University Hospital, Lund,
Sweden
Title
Erythropoietin and protection of renal function in cardiac surgery (the
EPRICS Trial).
Source
Anesthesiology. 121 (3) (pp 582-590), 2014. Date of Publication: 01 Sep
2014.
Abstract
BACKGROUND: To date, there are no known methods for preventing acute
kidney injury after cardiac surgery. Increasing evidence suggests that
erythropoietin has renal antiapoptotic and tissue protective effects.
However, recent human studies have shown conflicting results. The authors
aimed to study the effect of a single high-dose erythropoietin
preoperatively on renal function after coronary artery bypass grafting in
patients with preoperative impaired renal function.
METHODS: This single-center, randomized, double-blind, placebo-controlled
study included 75 patients scheduled for coronary artery bypass grafting
with preexisting renal impairment estimated glomerular filtration rate
based on p-cystatin C (<60 and >15 ml/min). The patients either received a
single high-dose erythropoietin (400 IU/kg) or placebo preoperatively. The
primary endpoint was renal protection evaluated by p-cystatin C at the
third postoperative day compared to the preoperative values. Incidence of
acute kidney injury and other renal biomarker changes were among secondary
endpoints.
RESULTS: There was no statistically significant difference on the third
postoperative day for relative p-cystatin C level changes from baseline
between the groups, 131 +/- 31% (mean +/- SD) for the study group and 125
+/- 24% for the control group (P = 0.31; 95% CI, -0.6 to 20% for the
difference). There were no statistically significant differences in other
renal biomarkers or measures between the groups (p-neutrophil
gelatinase-associated lipocalin, p-creatinine, p-urea, and estimated
glomerular filtration rate). There were no other differences in outcome
variables between the groups.
CONCLUSION: Intravenous administration of a single high-dose (400 IU/kg)
erythropoietin did not have a renal protective effect on patients with
reduced kidney function undergoing coronary artery bypass surgery.

<4>
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Accession Number
25225745
Authors
Ottens T.H. Dieleman J.M. Sauer A.-M.C. Peelen L.M. Nierich A.P. de Groot
W.J. Nathoe H.M. Buijsrogge M.P. Kalkman C.J. van Dijk D.
Institution
(Ottens, Dieleman, Sauer, Peelen, Nierich, de Groot, Nathoe, Buijsrogge,
Kalkman, van Dijk) From the Department of Anesthesiology (T.H.O., J.M.D.,
A.-M.C.S., C.J.K.), Department of Epidemiology, Julius Center for
Epidemiology and Primary Care (L.M.P.), Department of Cardiothoracic
Surgery (M.P.B.), and Intensive Care Medicine (D.v.D.), University Medical
Center, Utrecht, The Netherlands; Department of Anesthesiology, Isala
Clinics, Zwolle, The Netherlands (A.P.N.); Department of Anesthesiology,
Erasmus University Medical Center, Rotterdam, The Netherlands (W.J.d.G.);
and Department of Cardiology, University Medical, Utrecht, The Netherlands
(H.M.N.)
Title
Effects of dexamethasone on cognitive decline after cardiac surgery: a
randomized clinical trial.
Source
Anesthesiology. 121 (3) (pp 492-500), 2014. Date of Publication: 01 Sep
2014.
Abstract
BACKGROUND: Cardiac surgery can be complicated by postoperative cognitive
decline (POCD), which is characterized by impaired memory function and
intellectual ability. The systemic inflammatory response that is induced
by major surgery and cardiopulmonary bypass may play an important role in
the etiology of POCD. Prophylactic corticosteroids to attenuate the
inflammatory response may therefore reduce the risk of POCD. The authors
investigated the effect of intraoperative high-dose dexamethasone on the
incidence of POCD at 1 month and 12 months after cardiac surgery.
METHODS: This multicenter, randomized, double-blind, placebo-controlled
trial is a preplanned substudy of the DExamethasone for Cardiac Surgery
trial. A total of 291 adult patients undergoing cardiac surgery with
cardiopulmonary bypass were recruited in three hospitals and randomized to
receive dexamethasone 1 mg/kg (n = 145) or placebo (n = 146). The main
outcome measures were incidence of POCD at 1- and 12-month follow-up,
defined as a decline in neuropsychological test performance beyond natural
variability, as measured in a control group.
RESULTS: At 1-month follow-up, 19 of 140 patients in the dexamethasone
group (13.6%) and 10 of 138 patients in the placebo group (7.2%) fulfilled
the diagnostic criteria for POCD (relative risk, 1.87; 95% CI, 0.90 to
3.88; P = 0.09). At 12-month follow-up, 8 of 115 patients in the
dexamethasone group (7.0%) and 4 of 114 patients (3.5%) in the placebo
group had POCD (relative risk, 1.98; 95% CI, 0.61 to 6.40; P = 0.24).
CONCLUSION: Intraoperative high-dose dexamethasone did not reduce the risk
of POCD after cardiac surgery.

<5>
Accession Number
2015691805
Authors
Sondergaard E.S. Fonnes S. Gogenur I.
Institution
(Sondergaard) Department of Anesthesiology, Roskilde Hospital, Kogevej
7-13, Roskilde 4000, Denmark
(Fonnes) Department of Gastroenterology, Herlev Hospital, University of
Copenhagen, Herlev, Denmark
(Gogenur) Department of Surgery, Koge Hospital, University of Copenhagen,
Koge, Denmark
Title
Endothelial dysfunction after non-cardiac surgery: A systematic review.
Source
Acta Anaesthesiologica Scandinavica. 59 (2) (pp 140-146), 2014. Date of
Publication: 01 Feb 2015.
Publisher
Blackwell Munksgaard
Abstract
Background More than 50% of patients with increased troponin levels after
non-cardiac surgery have an impaired endothelial function pre-operatively.
Non-invasive markers of endothelial function have been developed for the
assessment of endothelial dysfunction. The aim of this paper was to
systematically review the literature to evaluate the association between
non-cardiac surgery and non-invasive markers of endothelial function.
Methods A systematic search was conducted in MEDLINE, EMBASE and Cochrane
Library Database according to the PRISMA guidelines. Endothelial
dysfunction was described only with non-invasive measurements done both
pre- and post-operatively and published in English. All types of
non-cardiac surgery and both men and women of all ages were included.
Results We found 1722 eligible studies in our search, and of these, five
studies fulfilled our inclusion and exclusion criteria. Endothelial
function was disturbed in patients after non-cardiac surgery. Three
studies found a significant decrease in the endothelial function
immediately after surgery (2 and 24 h post-operatively). Two studies found
that patients with previous endothelial dysfunction and scheduled for
surgery (renal transplantation and vascular surgery respectively) had an
improvement in endothelial dysfunction 1 month after surgery. Conclusion
Endothelial function changes in relation to surgery. Assessment of
endothelial function by non-invasive measures has the potential to guide
clinicians in the prevention or treatment of post-operative myocardial
damage.

<6>
Accession Number
2015636070
Authors
Giaquinta S. Michaels M.G. McCullers J.A. Wang L. Fonnesbeck C. O'Shea A.
Green M. Halasa N.B.
Institution
(Giaquinta, O'Shea, Halasa) Pediatrics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Michaels, Green) Pediatrics, Children's Hospital of Pittsburgh,
Pittsburgh, PA, United States
(McCullers) Pediatrics, St. Jude Children's Research Hospital, Memphis,
TN, United States
(McCullers) Pediatrics, University of Tennessee, Health Sciences Center,
Memphis, TN, United States
(Wang, Fonnesbeck) Biostatistics, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
Randomized, double-blind comparison of standard-dose vs. high-dose
trivalent inactivated influenza vaccine in pediatric solid organ
transplant patients.
Source
Pediatric Transplantation. 19 (2) (pp 219-228), 2014. Date of Publication:
01 Mar 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Children who have undergone SOT mount a lower immune response after
vaccination with TIV compared to healthy controls. HD or SD TIV in
pediatric SOT was given to subjects 3-17 yr and at least six months
post-transplant. Subjects were randomized 2:1 to receive either the HD (60
mug) or the SD (15 mug) TIV. Local and systemic reactions were solicited
after each vaccination, and immune responses were measured before and
after each vaccination. Thirty-eight subjects were enrolled. Mean age was
11.25 yr; 68% male, 45% renal, 26% heart, 21% liver, 5% lung, and 5%
intestinal. Twenty-three subjects were given HD and 15 SD TIV. The median
time since transplant receipt was 2.2 yr. No severe AEs or rejection was
attributed to vaccination. The HD group reported more tenderness and local
reactions, fatigue, and body ache when compared to the SD cohort, but
these were considered mild and resolved within three days. Subjects in the
HD group demonstrated a higher percentage of four-fold titer rise to H3N2
compared to the SD group. HD influenza vaccine was well tolerated and may
have increased immunogenicity. A phase 2 trial is needed to confirm.

<7>
Accession Number
2014910238
Authors
Hung W.
Title
Self-monitoring and self-titration of antihypertensive medications result
in better systolic blood pressure control.
Source
Journal of Clinical Outcomes Management. 21 (10) (pp 444-448), 2014. Date
of Publication: 01 Oct 2014.
Publisher
Turner White Communications Inc.
Abstract
Objective. To examine the effect of self-monitoring of blood pressure and
self-titration of antihypertensive medications among hypertensive patients
with cardiovascular disease, diabetes, or chronic kidney disease. Design.
Unblinded randomized controlled trial. Setting and participants. The study
was conducted in central and east England. Patients with poorly controlled
blood pressure with a last recorded systolic blood pressure of at least
145 mm Hg at 59 UK primary care practices were invited to participate.
Patients had to be at least 35 years old and have at least 1 of the
following comorbidities: transient ischemic attack or stroke, stage 3
chronic kidney disease, or history of coronary artery bypass graft
surgery, myocardial infarction, or angina. Patients were excluded if they
could not self-monitor blood pressure, had dementia or failed a cognitive
screen using the short-orientation memory concentration test, had postural
hypotension, took more than 3 antihypertensive medications, had an acute
cardiovascular event within the previous 3 months, were receiving care
from a specialist for their hypertension, were pregnant, or had a terminal
disease. Participants were randomized to the self-management intervention
or usual care. Intervention. Patients in the self-management group were
asked to monitor their blood pressure using an automated blood pressure
monitor and to titrate their blood pressure medications using an
individualized 3-step plan devised by the patient with their family
physician. They were trained to do these tasks in 2- or 3-hour sessions.
Patients were instructed to take their blood pressure twice each morning
for the first week of each month; if 4 or more blood pressure readings
during the measurement week for 2 consecutive months were higher than the
target blood pressure, patients were to follow their individualized plan
to change their medications. The target blood pressure was 120/75 mm Hg,
following British guidelines for patients with stroke, diabetes, chronic
kidney disease, or coronary heart disease. If patients exhausted all 3
steps for medication titration, they were to return to their family
physician for additional instructions. Patients in the usual care group
had a routine blood pressure check and medication review appointment with
their family physician, which was followed by follow-up care at the
discretion of the family physician for blood pressure measurement, blood
pressure targets, or adjustment of medication. Main outcome measure. The
primary outcome was systolic blood pressure at 12 months. The difference
in outcomes between the intervention and usual care groups was examined
while accounting for baseline blood pressure and other clinical factors. 6
blood pressures were taken at 1-minute intervals after an initial 5
minutes of rest. Blood pressure was taken by an electronic automated blood
pressure machine. The mean of the second and third readings were used as
primary outcome. Outcome assessor was not blinded to group assignment. The
primary analysis included all cases with complete data, and a sensitivity
analysis with multiple imputations was also performed. Preplanned subgroup
analyses included older vs. younger age-groups, men vs. women, and other
risk groups. Main results. Among 10,764 patients assessed for eligibility,
3353 were excluded as they were considered by their family physician to be
housebound, have a terminal illness, or not be a suitable candidate. Among
the 7411 invited to participate, 4207 did not respond to the invitation
and 2003 declined participation (with a third who did not want to alter
their own medications, and a third who did not want to measure their own
blood pressure). Among the 1201 who attended the baseline clinic, 138
withdrew their consent and 508 were deemed ineligible. A total of 555 were
randomized, and 220 in the intervention group and 230 in the control group
completed the study and provided outcome data (81%). Patients in the
self-management group had a 9.2 mm Hg-lower systolic blood pressure at 12
months (95% CI, 5.7-12.7) compared with the usual care group. The
self-management group also had a larger increase in the intake of
antihypertensive drugs compared with controls, with an increase in both
doses and number of medications. Although adverse symptoms were common in
both groups, there were no significant differences in adverse symptoms
between groups. Conclusions. Self-management of hypertension among
patients with stroke, cardiovascular disease, and other high-risk
conditions is safe and effective in achieving better blood pressure
control.

<8>
Accession Number
2015691948
Authors
Douglas P.S. Hahn R.T. Pibarot P. Weissman N.J. Stewart W.J. Xu K. Wang Z.
Lerakis S. Siegel R. Thompson C. Gopal D. Keane M.G. Svensson L.G. Tuzcu
E.M. Smith C.R. Leon M.B.
Institution
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Hahn, Smith, Leon) Columbia University Medical Center, New York
Presbyterian Hospital, New York, NY, United States
(Pibarot) Department of Medicine, Laval University, Quebec, QC, Canada
(Weissman) Medstar Health Research Institute, Georgetown University School
of Medicine, Washington, DC, United States
(Stewart, Svensson, Tuzcu) Cleveland Clinic Foundation, Cleveland, OH,
United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
(Wang) Medstar Washington Hospital Center, Washington, DC, United States
(Lerakis) Emory University School of Medicine, Atlanta, GA, United States
(Siegel) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thompson) St Paul's Hospital, Vancouver, BC, Canada
(Gopal) Heart Hospital Baylor, Scott and White Health, Plano, TX, United
States
(Keane) Temple Heart and Vascular Center, Philadelphia, PA, United States
(Douglas) Duke Clinical Research Institute, 7022 North Pavilion DUMC, PO
Box 17969, Durham, NC 27715, United States
Title
Hemodynamic outcomes of transcatheter aortic valve replacement and medical
management in severe, inoperable aortic stenosis: A longitudinal
echocardiographic study of cohort B of the PARTNER trial.
Source
Journal of the American Society of Echocardiography. 28 (2) (pp
210-217.e9), 2015. Date of Publication: 01 Feb 2015.
Publisher
Mosby Inc.
Abstract
Background: Inoperable aortic stenosis may be treated with either
transcatheter aortic valve replacement (TAVR) or medical management (MM)
with or without balloon aortic valvuloplasty (BAV). The aim of this study
was to compare the long-term echocardiographic findings among TAVR, MM,
and BAV in patients with severe, inoperable aortic stenosis. Methods: A
total of 358 inoperable patients in the Placement of Aortic Transcatheter
Valves trial were randomized to MM or TAVR. Echocardiograms obtained at
baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core
laboratory. Results: At baseline, TAVR and MM were similar, with more
frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P =.03)
and larger end-systolic volumes (54.5 +/- 29.3 vs 69.1 +/- 48.0 mL, P
=.03) in MM. By 30 days after TAVR, mean aortic valve gradient had
decreased (from 43.8 +/- 14.7 to 10.0 +/- 4.3 mm Hg, P <.001), ejection
fraction had increased (from 53.2 +/- 12.4% to 56.7 +/- 10.0%, P <.001),
and left ventricular (LV) mass index had decreased (from 144.7 +/- 36.1 to
140.0 +/- 37.9 gm/m², P <.05). After 1 year, aortic valve
gradients and area were unchanged, while LV mass index had decreased by
another 16 gm/m² (to 124 gm/m²). By 30 days after
BAV, mean aortic valve gradient had decreased from 43.4 +/- 15.0 to 31.9
+/- 11.1 mm Hg, while ejection fraction and LV mass index were unchanged;
gradient reverted to baseline at 1 year. No changes in gradients or mass
were seen in MM patients. Conclusions: TAVR results in immediate and
sustained relief in pressure overload and improved LV systolic function,
with continued regression of hypertrophy over 3 years. Poor clinical
results with BAV are explained by the modest and transient reductions in
pressure overload with BAV, which were not accompanied by improved LV
function or remodeling. TAVR is the preferred treatment in eligible
inoperable patients.

<9>
Accession Number
2015687728
Authors
Panthee N. Ono M.
Institution
(Panthee, Ono) Department of Cardiac Surgery, University of Tokyo, 7-3-1
Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Title
Spinal cord injury following thoracic and thoracoabdominal aortic repairs.
Source
Asian Cardiovascular and Thoracic Annals. 23 (2) (pp 235-246), 2013. Date
of Publication: 23 Feb 2015.
Publisher
SAGE Publications Inc.
Abstract
Objective: To discuss the currently available approaches to prevent spinal
cord injury during thoracic and thoracoabdominal aortic repairs. Methods:
We carried out a PubMed search up to 2013 using the Medical Subject
Headings: "aortic aneurysm/surgery" and "spinal cord ischemia"; "aortic
aneurysm, thoracic/surgery" and "spinal cord ischemia"; "aneurysm/surgery"
and "spinal cord ischemia/cerebrospinal fluid"; "aortic aneurysm/surgery"
and "paraplegia". All 190 original articles satisfying our inclusion
criteria were analyzed for incidence, predictors, and other pertinent
variables related to spinal cord injury, and we compared the results in
recent publications with those in earlier reports. Results: The mean age
of the 38,491 patients was 65.3 +/- 4.9 years. The overall incidence of
paraplegia and/or paraparesis was 7.1% +/- 6.1% (range 0%-32%). The
incidence of spinal cord injury before 2000, from 2001 to 2007, and
2008-2013 was 9.0% +/- 6.7%, 7.0% +/- 6.1%, and 5.9% +/- 5.2%,
respectively (p = 0.019). Various predictors of spinal cord injury were
identified, extent of disease being the most common. Modification of
surgical techniques, use of adjuncts, and better understanding of spinal
cord perfusion physiology were attributed to the decrease in postoperative
spinal cord injury in recent years. Conclusions: Spinal cord injury after
thoracic and thoracoabdominal aortic repair poses a real challenge to
cardiovascular surgeons. However, with evolving surgical strategies,
identification of predictors, and use of various adjuncts over the years,
the incidence of spinal cord injury after thoracic/thoracoabdominal aortic
repair has declined. Embracing a multimodality approach offers a good
insight into combating this grave complication.

<10>
Accession Number
2015682207
Authors
Navarese E.P. Schulze V. Andreotti F. Kowalewski M. Kolodziejczak M.
Kandzari D.E. Rassaf T. Gorny B. Brockmeyer M. Meyer C. Berti S. Kubica J.
Kelm M. Valgimigli M.
Institution
(Navarese, Berti) National Research Council of Clinical Physiology,
Invasive Cardiology, Moruzzi 1, Pisa 56124, Italy
(Navarese, Schulze, Rassaf, Brockmeyer, Meyer, Kelm) Department of
Internal Medicine, Division of Cardiology, Pulmonology and Vascular
Medicine, Heinrich-Heine-University, Dusseldorf, Germany
(Navarese, Schulze, Andreotti, Kowalewski, Kolodziejczak, Rassaf, Gorny,
Brockmeyer, Meyer, Kubica, Kelm) Syst. Investigation and Research on
Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland
(Navarese, Schulze, Andreotti, Kowalewski, Kolodziejczak, Rassaf, Gorny,
Brockmeyer, Meyer, Kubica, Kelm) Syst. Investigation and Research on
Interventions and Outcomes (SIRIO) MEDICINE Research Network, Germany
(Andreotti, Gorny) Department of Cardiovascular Science, Catholic
University, Rome, Italy
(Kowalewski) Department of Cardiology, 10Th Military Research Hospital and
Polyclinic, Bydgoszcz, Poland
(Kolodziejczak, Kubica) Department OfCardiologyand Internal Medicine,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Berti) Cardiothoracic Department, Heart Hospital, Fondazione Toscana
Gabriele Monasterio, Massa, Italy
(Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Comprehensive meta-analysis of safety and efficacy of bivalirudin versus
heparin with or without routine glycoprotein IIb/IIIa inhibitors in
patients with acute coronary syndrome.
Source
JACC: Cardiovascular Interventions. 8 (1) (pp 201-213), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier Inc.
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety
and efficacy of bivalirudin with those of heparin with or without routine
administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with
acute coronary syndrome (ACS). BACKGROUND: Bivalirudin has been a mainstay
of anticoagulation in patients with ACS compared with heparin. The extent
to which trial results have been affected by the coadministration of
heparin with a GPI, however, remains unclear. METHODS: A total of 13
randomized, controlled trials involving 24,605 patients were included.
RESULTS: There was no significant difference in 30-day mortality or
myocardial infarction rate with bivalirudin compared with heparin with or
without routine GPI administration. A reduction of 30-day major bleeding
was observed with bivalirudin compared with heparin that was significant
when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence
interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally
administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The
occurrence of stent thrombosis (ST) at 30 days was significantly increased
with bivalirudin compared with heparin plus routinely administered GPI
(OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin
plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p =
0.42). The rate of acute ST (<24 h), however, was almost 4.5-fold higher
with bivalirudin compared with heparin with or without GPI, whereas the
rate of subacute ST (24 h to 30 days) did not differ significantly.
CONCLUSIONS: Overall, bivalirudin in ACS patients is associated with a
significant reduction of major bleeding compared with heparin plus
routinely administered GPI, but with a marked increase in ST rates
compared with heparin with or without GPI.

<11>
Accession Number
2015682206
Authors
Pollack A. Mohanty B.D. Handa R. Looser P.M. Fuster V. King S.B. Sharma
S.K.
Institution
(Pollack, Fuster, Sharma) Zena and Michael A. Wiener Cardiovascular
Institute, Mount Sinai Heart, New York, NY, United States
(Mohanty) Division of Cardiology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
(Handa) Department of Medicine, Morristown Medical Center, Morristown, NJ,
United States
(Looser) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(King) St. Joseph's Health System, Atlanta, GA 07960, United States
Title
Preventive stenting in acute myocardial infarction.
Source
JACC: Cardiovascular Interventions. 8 (1) (pp 131-138), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier Inc.
Abstract
Current practice guidelines advocate culprit vessel intervention alone in
patients with ST-segment elevation myocardial infarction (STEMI) found to
have multivessel coronary disease during primary percutaneous coronary
intervention (PCI). The debate on the timing of noninfarct artery
intervention has recently been reinvigorated by the PRAMI (Preventive
Angioplasty in Acute Myocardial Infarction) trial, in which patients
undergoing preventive PCI of significant nonculprit lesions at the time
primary PCI for STEMI had reduced rates of cardiac death, nonfatal
myocardial infarction, and refractory angina. Given that previous
literature has cautioned against multivessel PCI during STEMI, this raises
the question of whether technical and pharmacological advances in PCI may
have opened the door to safely revisit this issue with additional clinical
rigor. The impact of STEMI pathophysiology on nonculprit vessel plaque,
how treatment of nonculprit lesions alters the natural history of coronary
disease after STEMI, and whether this results in a clinical benefit remain
unclear, and much of the existing data are retrospective. Additionally,
the PRAMI trial did not include a staged PCI, leaving questions as to how
this approach might fare compared with simultaneous preventive PCI. In
this review, we discuss the pathophysiology of nonculprit vessel plaque in
STEMI, provide a summary of the existing literature on the topic, and
discuss the PRAMI trial in the face of previous data and possible future
directions for further study.

<12>
Accession Number
2015692758
Authors
Sipahi I.
Institution
(Sipahi) Department of Cardiology, Acibadem University Medical School,
Acibadem Maslak Hospital, Buyukdere Cad 40, Istanbul 34457, Turkey
(Sipahi) Harrington Heart and Vascular Institute, University Hospitals
Case Medical Center, Case Western Reserve University School of Medicine,
Cleveland, OH, United States
Title
Bypass Grafting Versus Percutaneous Intervention in Multivessel Coronary
Disease: the Current State.
Source
Current Cardiology Reports. 17 (2) (pp 1-8), 2015. Date of Publication:
2015.
Publisher
Current Medicine Group LLC 1
Abstract
Whether stenting or coronary artery bypass grafting (CABG) is the best
revascularization strategy in patients with multivessel disease has been a
heavily debated controversy. The trials comparing the two methods were
unfortunately underpowered for mortality. Moreover, results of clinical
trials appeared to contradict with each other. Because CABG is
unequivocally a more cumbersome method, stenting became commonly preferred
in the absence of evidence for mortality difference. Meta-analysis is a
powerful tool, especially when several high-quality randomized trials are
available on the same issue. In these instances, meta-analyses can
overcome the power limitation of the individual trials. Our recent
meta-analysis reveals that, as compared to stenting, CABG leads to
unequivocal reductions in mortality and myocardial infarctions in patients
with multivessel disease. These benefits are seen regardless of whether
patients are diabetic or not and also do not depend on whether bare-metal
or drug-eluting stents are used.

<13>
Accession Number
2015692432
Authors
Song J.W. Shim J.K. Soh S. Jang J. Kwak Y.L.
Institution
(Song, Shim, Soh, Jang, Kwak) Department of Anaesthesiology and Pain
Medicine, Anaesthesia and Pain Research Institute, Yonsei University
College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South
Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Cardiovascular
Research Institute, Yonsei University College of Medicine, Seoul, South
Korea
Title
Double-blinded, randomized controlled trial of N-acetylcysteine for
prevention of acute kidney injury in high risk patients undergoing
off-pump coronary artery bypass.
Source
Nephrology. 20 (2) (pp 96-102), 2015. Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing
Abstract
Aim The aim of this study was to investigate the influence of
perioperative N-acetylcysteine (NAC) administration, a known antioxidant,
on the incidence of acute kidney injury (AKI) after off-pump coronary
bypass surgery (OPCAB) in patients with known risk factors of AKI. Methods
One hundred and seventeen patients with >1 of the following risk factors
of AKI were randomized into either the control (n = 57) or the NAC (n =
60) group; (i) preoperative serum creatinine >1.4 mg/dL; (ii) left
ventricular ejection fraction <35% or congestive heart failure (iii) age
>70 years (iv) diabetes or (v) re-operation. Patients in the NAC group
received 150 mg/kg of NAC IV bolus at anaesthetic induction followed by a
continuous infusion at 150 mg/kg per day for 24 h. AKI was diagnosed based
on Acute Kidney Injury Network criteria during 48 h postoperatively.
Results The incidence of AKI was 32% (19/60) and 35% (20/57) in the
control and the NAC group, respectively (P = 0.695). The serum
concentrations of creatinine and cystatin C were similar between the
groups throughout the study period. Fluid balance including the amount of
blood loss and transfusion requirement were similar between the groups
except the amount of postoperative urine output, which was higher in the
control group compared with the NAC group (5528 +/- 1247 mL vs. 4982 +/-
1185 mL, control vs. NAC, P = 0.017). Conclusion Perioperative
administration of NAC did not prevent the development of postoperative AKI
after OPCAB in highly susceptible patients to AKI.

<14>
Accession Number
2014983446
Authors
Blazek S. Rossbach C. Borger M.A. Fuernau G. Desch S. Eitel I. Stiermaier
T. Lurz P. Holzhey D. Schuler G. Mohr F.-W. Thiele H.
Institution
(Blazek, Rossbach, Fuernau, Desch, Eitel, Stiermaier, Lurz, Schuler,
Thiele) Department of Internal Medicine/Cardiology, University of
Leipzig-Heart Center, Leipzig, Germany
(Borger, Holzhey, Mohr) Department of Cardiac Surgery, University of
Leipzig-Heart Center, Leipzig, Germany
(Desch, Eitel, Thiele) University of Lubeck, University Hospital
Schleswig-Holstein-Campus Lubeck, Medical Clinic II, Ratzeburger Allee
160, Lubeck 23538, Germany
Title
Comparison of sirolimus-eluting stenting with minimally invasive bypass
surgery for stenosis of the left anterior descending coronary artery:
7-year follow-up of a randomized trial.
Source
JACC: Cardiovascular Interventions. 8 (1) (pp 30-38), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Elsevier Inc.
Abstract
OBJECTIVES: The aim of this analysis was to assess the 7-year long-term
safety and effectiveness of a randomized comparison of percutaneous
coronary intervention (PCI) with sirolimus-eluting stents (SES) versus
minimally invasive direct coronary artery bypass (MIDCAB) surgery for the
treatment of isolated proximal left anterior descending lesions.
BACKGROUND: Long-term follow-up data comparing PCI by SES and MIDCAB
surgery for isolated proximal left anterior descending lesions are sparse.
METHODS: Patients were randomized either to PCI with SES (n = 65) or
MIDCAB (n = 65). Follow-up data were obtained after 7 years with respect
to the primary composite endpoint of death, myocardial infarction, and
target vessel revascularization. Angina was assessed by the Canadian
Cardiovascular Society classification and quality of life with Short Form
36 and MacNew quality of life questionnaires. RESULTS: Follow-up was
conducted in 129 patients at a median time of 7.3 years (interquartile
range: 5.7, 8.3). There were no significant differences in the incidence
of the primary composite endpoint between groups (22% PCI vs. 12% MIDCAB;
p = 0.17) or the endpoints death (14% vs. 17%; p = 0.81) and myocardial
infarction (6% vs. 9%, p = 0.74). However, the target vessel
revascularization rate was higher in the PCI group (20% vs. 1.5%; p <
0.001). Clinical symptoms and quality of life improved significantly from
baseline with both interventions and were similar in magnitude between
groups. CONCLUSIONS: At 7-year follow-up, PCI by SES and MIDCAB in
isolated proximal left anterior descending lesions yielded similar
long-term outcomes regarding the primary composite clinical endpoint and
quality of life. Target vessel revascularization was more frequent in the
PCI group.

<15>
Accession Number
2015689028
Authors
Cheng X. Hu Q. Liu Z. Tang X.
Institution
(Cheng, Tang) Department of Cardiology, Banan People's Hospital of
Chongqing, Chongqing, 2 Xinnong Street, Banan District, Chongqing 401320,
China
(Hu) Department of Clinical Laboratory, Third Peoples Hospital of
Chongqing, United States
(Liu) Department of Cardiology, Second Affiliated Hospital, Chongqing
Medical University, Chongqing, China
Title
Preoperative statin therapy decreases early mortality in patients
undergoing isolated valve surgery: Result from a meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (1) (pp 107-114),
2015. Date of Publication: 01 Feb 2015.
Publisher
W.B. Saunders
Abstract
Objective The purpose of this meta-analysis was to assess the role of
preoperative statin therapy on adverse cardiovascular events in patients
undergoing valve surgery. Design Meta-analysis of 10 observational
studies. Setting Hospital. Participants 22,158 patients. Interventions
None. Measurements and Main Results The Medline, Cochrane, and Embase
databases were searched for clinical studies published up to June 2014.
Studies that evaluated the effects of preoperative statin therapy on valve
surgery were included. After a literature search in the major databases,
10 observational studies with 22,518 patients were identified. Pool
analysis indicated that preoperative statin therapy was associated with a
significantly lower risk of early all-cause mortality (Odds ratio [OR]:
0.69; 95% confidence interval [CI] 0.50-0.95, p = 0.03). The benefits of
preoperative statin therapy were more obvious in studies with isolated
valve surgery, resulting in a 1.9% absolute risk and a 38% odds reduction
of early mortality (2.4 v 4.3%; OR: 0.62; 95% CI 0.49-0.77, p<0.0001). A
significant reduction by statin therapy also was observed for atrial
fibrillation (OR 0.88, 95% CI: 0.80-0.98, p = 0.02). However, statin
therapy was not associated with a lower risk of postoperative stroke (OR:
0.74; 95% CI 0.46-1.19, p = 0.21), myocardial infarction (OR: 1.02; 95% CI
0.78-1.34, p = 0.87), and renal failure (OR: 0.91; 95% CI 0.57-1.44, p =
0.68). Conclusions Preoperative statin therapy was associated with a
significantly lower risk of early mortality in patients undergoing
isolated valve surgery. A prospective, randomized, controlled trial is
warranted.

<16>
Accession Number
2015689009
Authors
Okamoto Y. Nohmi T. Higa Y. Seki K. Yamashita A.
Institution
(Okamoto, Nohmi, Higa, Seki, Yamashita) Department of Anesthesia, IMS
Katusika Heart Center, 3-30-1 Horikiri, Katusikaku, Tokyo, Japan
Title
Vasopressin does not raise cardiac enzymes following cardiac surgery: A
randomized double-blind clinical trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (1) (pp 46-51),
2015. Date of Publication: 01 Feb 2015.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to investigate the relationship
between intraoperative vasopressin infusion and postoperative cardiac
enzymes. Design A prospective, double-blind, randomized, controlled study.
Setting A single tertiary cardiac center. Participants One hundred
consecutive patients undergoing cardiac surgery with or without
cardiopulmonary bypass. Interventions The study was approved by the
Institutional Review Board, and patients provided informed consent to
participate. Patients were randomized by computer into 2 equal groups:
Vasopressin or control. The blinded study included vasopressin
administered at a dose of 1.8 U/h or 1.8 mL/h of normal saline, along with
catecholamines. The drug was administered continually during surgery while
patients needed catecholamines. The intervention was discontinued upon
admission to the intensive care unit when information regarding the true
character of the drug was reported to the doctor in charge of patients in
the intensive care unit by one of the investigators. Primary outcomes were
CK-MB and troponin T levels measured at 0, 6, and 12 hours
postoperatively. Measurements and Main Results Of the 100 patients, 8 were
excluded; the remaining 92 were randomized to either the vasopressin (n =
47) or control (n = 45) group. There were no significant differences in
demographic data between the groups. Postoperatively at 0, 6, and 12
hours, there were no differences in CK-MB (U/l) (37.5 +/- 57.9 v 32.0 +/-
21.5, 29.4 +/- 41.1 v 24.4 +/- 23.1, and 21.4 +/- 21.3 v. 21.8 +/- 32.4,
respectively) and troponin T (752.4 +/- 638.2 v 762.7 +/- 557.1, 753.8 +/-
507.3 v 777.6 +/- 515.0, and 774.6 +/- 572.6 v 698.7 +/- 540.2,
respectively) values. Conclusions Vasopressin infusion has been used to
treat catecholamine-unresponsive shock. In this study, intraoperative
vasopressin was used safely as a possible first-line drug for treating
hypotension; however, it did not increase the levels of cardiac enzymes
after cardiac surgery.

<17>
Accession Number
2014950829
Authors
Bainbridge D.T. Chu M.W.A. Kiaii B. Cleland A. Murkin J.
Institution
(Bainbridge, Murkin) Department of Anesthesiology and Perioperative
Medicine, University of Western Ontario, C3-106 339 Windermere Road,
London, ON, Canada
(Chu, Cleland) Division of Cardiac Surgery, Department of Surgery,
University of Western Ontario, London, ON, Canada
(Kiaii) Department of Perfusion Services, London Health Sciences Centre,
London, ON, Canada
Title
Percutaneous superior vena cava drainage during minimally invasive mitral
valve surgery: A randomized, crossover study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (1) (pp 101-106),
2015. Date of Publication: 01 Feb 2015.
Publisher
W.B. Saunders
Abstract
Objective Minimally invasive techniques commonly are applied to mitral
valve surgery; however, there has been little research investigating the
optimal methods of cardiopulmonary bypass for the right minithoracotomy
approach. Controversy exists as to whether a percutaneous superior vena
cava drainage cannula (PSVC) is necessary during these operations. The
authors, therefore, sought to determine the effect of using a percutaneous
superior vena cava catheter on brain near-infrared spectroscopy, blood
lactate levels, hemodynamics and surgical parameters. Design Randomized,
blinded, crossover trial. Setting Tertiary care university hospital.
Participants Patients undergoing minimally invasive mitral valve surgery
via a right minithoracotomy. Interventions Twenty minutes of either
clamped or unclamped percutaneous superior vena cava neck catheter
drainage, during mitral valve repair. Measurement and Main Results For the
primary outcome of brain near-infrared spectroscopy, there were no
differences between the two groups (percutaneous superior vena cava
clamped 55.0%+/-11.6% versus unclamped 56.1%+/-10.2%) (p = 0.283). For the
secondary outcomes pH (clamped 7.35+/-0.05 versus unclamped 7.37+/-0.05 p
= 0.015), surgical score (clamped 1.96+/-1.14 versus unclamped 1.22+/-0.51
p = 0.002) and CVP (clamped 11.6 mmHg+/-4.8 mmHg versus unclamped 6.1
mmHg+/-6.1 mmHg p<0.001) were significantly different. Conclusions The use
of a percutaneous superior vena cava drainage improved surgical
visualization and lowered CVP, but had no effect on brain near infrared
spectroscopy during minimally invasive mitral valve surgery.
(ClinicalTrials.gov Identifier: NCT01166841)

<18>
Accession Number
2015683726
Authors
Watt D.G. Horgan P.G. McMillan D.C.
Institution
(Watt, Horgan, McMillan) Academic Unit of Colorectal Surgery, School of
Medicine-University of Glasgow, New Lister Building, 10-16 Alexandra
Parade, Glasgow G31 2ER, United Kingdom
Title
Routine clinical markers of the magnitude of the systemic inflammatory
response after elective operation: A systematic review.
Source
Surgery (United States). 157 (2) (pp 362-380), 2015. Date of Publication:
01 Feb 2015.
Publisher
Mosby Inc.
Abstract
Background Operative injury to the body from all procedures causes a
stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute
phase responses. This response has been examined commonly by the use of
cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein
(CRP). We aimed to determine which markers of the systemic inflammatory
response were useful in determining the magnitude of injury after elective
operations. Methods A systematic review of the literature was performed
using surgery, endocrine response, systemic inflammatory response,
cortisol, IL-6, white cell count, and CRP. For each analyte the studies
were grouped according to whether the operative injury was considered to
be minor, moderate, or major and then by the operative procedure. Results
A total of 164 studies were included involving 14,362 patients. The IL-6
and CRP responses clearly were associated with the magnitude of operative
injury and the invasiveness of the operative procedure. For example, the
peak CRP response increased from 52 mg/L with cholecystectomy to 123 mg/L
with colorectal cancer resection, 145 mg/L with hip replacement, 163 mg/L
after abdominal aortic aneurysm repair, and 189 mg/L after open cardiac
surgery. There also appeared to be a difference between minimally
invasive/laparoscopic and open procedures such as cholecystectomy (27 vs
80 mg/L), colorectal cancer resection (97 vs 133 mg/L), and aortic
aneurysm repair (132 vs 180 mg/L). Conclusion Peak IL-6 and CRP
concentrations consistently were associated with the magnitude of
operative injury and operative procedure. These markers may be useful in
the objective assessment of which components of Enhanced Recovery after
Surgery are likely to improve patient outcome and to assess the possible
impact of operative injury on immune function.

<19>
Accession Number
2014925423
Authors
Xu L. Hu Z. Shen J. Mcquillan P.M.
Institution
(Xu) Department of Anesthesiology, The Second Affiliated Hospital of
Zhejiang Chinese Medical University, Hangzhou, China
(Hu) Department of Anesthesiology, The Children's Hospital, School of
Medicine, Zhejiang University, Hangzhou, China
(Shen) Department of Anesthesiology, The Second Affiliated Hospital,
School of Medicine, Zhejiang University, Hangzhou, China
(Mcquillan) Penn State Hershey Medical Center, Penn State College of
Medicine, Hershey, PA, United States
Title
Does dexmedetomidine have a cardiac protective effect during non-cardiac
surgery? A randomised controlled trial.
Source
Clinical and Experimental Pharmacology and Physiology. 41 (11) (pp
879-883), 2014. Date of Publication: 01 Nov 2014.
Publisher
Blackwell Publishing
Abstract
Summary: This study was designed to determine the effects of
dexmedetomidine on perioperative myocardial injury by observing peripheral
circulatory changes in response to tracheal intubation and extubation,
myocardial enzyme levels, myocardial ischaemia improvements,
cardiovascular adverse events and cytokines in patients with coronary
heart disease (CHD) undergoing non-cardiac surgery. This study was a
prospective, randomized, double-blind trial. Eighty patients having CHD
were scheduled for elective hip-replacement surgery and randomly allocated
to receive a loading dose of 1 mug/kg dexmedetomidine followed by a 0.2
mug/kg per h infusion (Dex group; n = 40) or normal saline (control group;
n = 40). Systolic blood pressure, diastolic blood pressure, mean arterial
pressure, heart rate, rate-pressure product and changes in ST-T segment on
the electrocardiogram were recorded every 5 min during surgery. Serum
creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), glycogen
phosphorylase BB (GP-BB), interleukin (IL)-6 and tumour necrosis factor
(TNF)-alpha protein levels were determined preoperatively, at the end of
surgery and 12 and 24 h after surgery. The improvement rate of myocardial
ischaemia was higher in the Dex than control group (87.5% vs 32.5%,
respectively; P < 0.05). In addition, the Dex group had lower serum CK-MB,
IL-6, cTnI and GP-BB concentrations than the control group (P < 0.05).
There was no significance difference in TNF-alpha between the two groups
(P > 0.05). Dexmedetomidine can reduce myocardial injury and cytokine
levels in patients with CHD undergoing non-cardiac surgery.

<20>
Accession Number
2015688671
Authors
Aryal M.R. Karmacharya P. Pandit A. Hakim F. Pathak R. Mainali N.R.
Ukaigwe A. Mahmood M. Badal M. Fortuin F.D.
Institution
(Aryal, Karmacharya, Pathak, Mainali, Ukaigwe, Mahmood, Badal) Department
of Internal Medicine, Reading Health System, West Reading, Pennsylvania
19611, United States
(Pandit, Hakim, Fortuin) Division of Cardiovascular Disease, Mayo Clinic
College of Medicine, Phoenix, AZ 85054, United States
Title
Dual Versus Single Antiplatelet Therapy in Patients Undergoing
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
Heart Lung and Circulation. 24 (2) (pp 185-192), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Ltd
Abstract
Background: Although dual antiplatelet therapy (DAPT) with clopidogrel and
aspirin is a widely accepted strategy in patients undergoing transcatheter
aortic valve replacement (TAVR), this approach is not evidence based. We
therefore sought to systematically review the current evidence for this
practice in terms of 30-day outcome looking at stroke, MI, bleeding, and
death. Methods: Relevant studies were identified through electronic
literature search. Studies involving single antiplatelet therapy (SAPT)
and DAPT in patients undergoing TAVR were included. Study specific risk
ratios were calculated and combined using random-effects model
meta-analysis. Results: Analysis of data from 410 patients, stroke
occurred in seven (3.16%) of SAPT and six (3.17%) of DAPT RR. =. 1.03 (95%
CI, 0.36-2.96, P. =. 0.96). In analysis of 530 patients, MI occurred in
three (1.07%) of SAPT and one (0.40%) of DAPT RR. =. 1.97 (95% CI,
0.29-13.29, P. =. 0.49), significant bleeding (major, life threatening and
bleeding requiring transfusion) occurred in 20 (7.11%) of SAPT and 43
(17.27%) of DAPT RR. =. 0.41 (95% CI, 0.25-0.69, P. =. 0.0006). Number
needed to harm for major or life threatening bleeding was 10. Death
occurred in 15 (6.78%) of SAPT and 15 (7.94%) of DAPT (RR 0.91; 95% CI
0.46-1.79, P. =. 0.78). Conclusion: Our meta-analysis suggests that at 30
days following TAVR there is no difference between post-procedural SAPT
versus DAPT for the risk of stroke or MI and DAPT may have a higher
bleeding risk. Adequately powered RCTs are warranted to clarify the
optimal antiplatelet treatment strategy following TAVR.

<21>
Accession Number
2015685646
Authors
Pickering J.W. James M.T. Palmer S.C.
Institution
(Pickering, Palmer) Department of Medicine, University of Otago
Christchurch, PO Box 4345, Christchurch 8140, New Zealand
(James) Department of Medicine, University of Calgary, Calgary, AB, Canada
Title
Acute kidney injury and prognosis after cardiopulmonary bypass: A
meta-analysis of cohort studies.
Source
American Journal of Kidney Diseases. 65 (2) (pp 283-293), 2015. Date of
Publication: 01 Feb 2015.
Publisher
W.B. Saunders
Abstract
Background Robust estimates and sources of variation in risks of clinical
outcomes for cardiopulmonary bypass (CPB)-associated acute kidney injury
(AKI) are needed to inform clinical practice and policy. We aimed to
assess whether the methods for defining acute kidney disease modify the
estimated association of AKI with CPB. Study Design Systematic review and
meta-analysis. Setting & Population Adults undergoing CPB. Selection
Criteria for Studies Cohort studies reporting adjusted associations
between CPB-associated AKI and early mortality, later mortality, stroke,
myocardial infarction, congestive heart failure, all-cause
hospitalization, chronic kidney disease, end-stage kidney disease,
bleeding complications, or perioperative infection. Predictors
CPB-associated AKI and renal replacement therapy. Outcomes The primary
outcome was early mortality (in-hospital or within 90 days of surgery) in
studies reporting adjusted associations and secondary outcomes including
total and cardiovascular mortality, major adverse cardiovascular events,
rehospitalization, end-stage kidney disease, bleeding, and perioperative
infection. Results 46 studies with 47 unique cohorts comprising 242,388
participants were included. The pooled rate of CPB-associated AKI was
18.2%, and of renal replacement therapy, 2.1%. CPB-associated AKI was
associated with early mortality (risk ratio [RR], 4.0; 95% CI, 3.1-5.2;
crude mortality with CPB-associated AKI, 4.6%; without CPB-AKI, 1.5%) with
considerable heterogeneity between studies (I² = 87%). The AKI
definition did not modify prognostic estimates (P for subgroup analysis =
0.9). When heterogeneity was fully accounted for using credibility
ceilings, risks of early mortality were attenuated (RR, 2.2; 95% CI,
1.8-2.8) but remained high. Renal replacement therapy also was associated
with early mortality (RR, 5.3; 95% CI, 3.4-8.1). CPB-associated AKI also
was associated with long-term mortality (RR, 2.0; 95% CI, 1.7-2.3) and
stroke (RR, 2.2; 95% CI, 1.1-4.5). No other outcomes were reported in more
than 3 studies. Limitations Unclear attrition from follow-up in most
studies and variable adjustment for confounders across studies.
Conclusions CPB-associated AKI is associated with a more than 2-fold
increase in early mortality regardless of AKI definition.

<22>
Accession Number
71767593
Authors
Byun H. Abboud C.S. Diep J. Yu B. Rao G.G. Jacobs D.M.
Institution
(Byun, Diep, Yu, Rao, Jacobs) University at Buffalo, School of Pharmacy
and Pharmaceutical Sciences, Buffalo, NY, United States
(Abboud) Infection Control Department, Instituto Dante Pazzanese De
Cardiologia, Sao Paulo, Brazil
Title
Antibiotic polytherapy against multidrug-resistant, Klebsiella pneumoniae
carbapenemase (KPC)-producing Enterobacteriaceae infections: Case series
and systematic review.
Source
Pharmacotherapy. Conference: 2014 Annual Meeting of the American College
of Clinical Pharmacy, ACCP 2014 Austin, TX United States. Conference
Start: 20141012 Conference End: 20141015. Conference Publication:
(var.pagings). 34 (10) (pp e280), 2014. Date of Publication: October 2014.
Publisher
Pharmacotherapy Publications Inc.
Abstract
PURPOSE: Multidrug resistant Gram-negative (MRGN) bacteria, especially
KPC-producing, are becoming increasingly prevalent. Our objective was to
review the clinical outcomes of patients with KPC infections and perform a
systematic review to assess polytherapy (>3 antibiotics) against resistant
bacteria. METHODS: The clinical course of twelve patients from a hospital
in Brazil on polytherapy for KPC-producing infections were reviewed and
compared with published literature. A comprehensive literature search was
conducted using PubMed. Search terms included "triple antibiotic
combination", "K. pneumoniae carbapenemase", "multidrug resistant
Gram-negative", and "polymyxin- resistant." Article reference lists were
reviewed. Review articles, studies with <3 concurrent antibiotics, in
vitro studies, and literature omitting outcomes were excluded. Descriptive
analysis was performed to assess the outcomes of antibiotic polytherapy.
RESULTS: All 12 patients were admitted for cardiac surgery and developed
post-operative infections including mediastinitis (6/12) and deep sternal
wounds (5/12). Enterobacter spp. was isolated from all patients, which
tested positive for bla_KPC-2. Ten (83%) patients were infected
by polymyxin resistant (MIC, >4 mug/mL) strains and all strains were
resistant to meropenem (MIC, >16 mug/mL). For targeted therapy, 5 (42%)
patients were treated with triple coverage and 7 (58%) were prescribed
four or more antibiotics. The average length of treatment was 27 +/- 15
days with a 60 day mortality of 33%. The search methodology identified 63
articles; following all exclusions, 12 articles were included (75
patients). KPC-producing K. pneumoniae was the most common offending
pathogen. Seventy (93%) patients were treated with 3-drug and 5 (7%) with
4-drug therapy, and polymyxin was the backbone of all combinations.
Overall, 77% of patients achieved clinical success with a mortality rate
of 19%. CONCLUSION: The recent upsurge in clinically challenging MRGN
infections has led to the increased utilization of polytherapy. Hence,
future studies investigating the optimization of combination therapy with
multiple antibiotics is necessary for ensuring clinical success.

<23>
Accession Number
71760526
Authors
Ostro J. Kopolovic I. Lin Y. Dzik W.H. Cserti C. Tsubota H. Keir A.
Messner H.A. DenHollander N. Callum J.
Institution
(Ostro, Kopolovic) University of Toronto, Toronto, Canada
(Lin, Tsubota, Callum) Sunnybrook Health Sciences Centre, Toronto, Canada
(Dzik) Massachusetts General Hospital, Boston, MA, United States
(Cserti, DenHollander) University Health Network, Toronto, Canada
(Keir) Hospital for Sick Children, Toronto, Canada
(Messner) Princess Margaret Cancer Centre, Toronto, Canada
Title
Systematic review of cases of transfusion associated
graft-versus-host-disease (TA-GVHD): analysis of patient characteristics
and outcomes.
Source
Blood. Conference: 56th Annual Meeting of the American Society of
Hematology, ASH 2014 San Francisco, CA United States. Conference Start:
20141206 Conference End: 20141209. Conference Publication: (var.pagings).
124 (21) , 2014. Date of Publication: 06 Dec 2014.
Publisher
American Society of Hematology
Abstract
Introduction: TA-GVHD is a rare, usually fatal complication from blood
transfusions wherein donor lymphocytes engraft and mount an immune
response against recipient tissues. Immunocompromised hosts who are unable
to recognize and destroy foreign lymphocytes are at theoretical risk of
TA-GVHD, and a variety of immune incompetencies thus form the indications
for cellular blood component irradiation. Much of our understanding on who
is at risk of TA-GVHD as well as policies regarding who should receive
irradiated components derive from case reports and small case series. We
performed a systematic review of cases of TA-GVHD to refine evidence-based
guidelines for the use of gamma-irradiated blood components, assess the
usefulness of the Centers for Disease Control (CDC) criteria in making the
diagnosis of TA-GVHD and to define the minimum details of a case of
TA-GVHD that should be reported. Methods: Our systematic review, which was
registered with PROSPERO, included all reported cases of TA-GVHD from 1947
until September 2013 with no restrictions on language or date. Titles and
abstracts were reviewed by two independent reviewers. References were
assessed for additional cases. Data collected included patient
demographics, details regarding the transfusion(s), clinicolaboratory
features outlined in the CDC criteria (rash, diarrhea, fever,
hepatomegaly, liver dysfunction, marrow aplasia and pancytopenia), patient
outcomes and results of HLA and chimerism studies. Results: After
duplicates were removed, 2130 publications were available for review, with
348 cases of TA-GVHD included in the analysis. The median age was 58 years
(IQR 18, 68) with 61.6% males. The most frequent underlying diagnoses were
non-cardiac surgery (n=81, 23.3%), cardiac surgery (n=71, 20.4%) and
hematologic malignancy (n=66, 19.0%). According to our institutional
guidelines for irradiation of blood components (Massachusetts General
Hospital, Sunnybrook Health Sciences Centre, The Hospital for Sick
Children and University Health Network), 121 cases (34.5%) met the
criteria for requiring irradiation of blood components. Among the 245
patients in whom time of symptom onset was reported, the first symptom of
TA-GVHD occurred a median of 11 (IQR 8, 14) days from the implicated
transfusion. Patients had an average of 3.6 symptoms and/or signs of
TA-GVHD using the CDC definition, with rash being the most common finding
in 80.2% of cases (Figure 1). A biopsy was performed in 67.5% of cases,
with skin as the most common site in 97.0% of cases. Chimerism studies
were done in 103 cases (29.7%) to confirm the diagnosis. According to the
CDC case definition, 215 (62.0%) had definitive and 73 (21.0%) had
probable TA-GVHD. The case imputability based on the CDC definition was
definite, probable, possible and doubtful in 28.5, 2.3, 50.0 and 2.0% of
cases, respectively. The implicated blood component was red blood cells in
132 cases (37.9%), whole blood in 92 cases (26.4%), and platelets in 20
cases (5.7%). The treatment for TA-GVHD was immunosuppression therapy
(IST) in 48.9%, bone marrow transplant (BMT) in 2.3%, and no intervention
in 46.7%. Of those treated with IST or BMT, 10.7% survived, whereas 5.6%
of the untreated survived, p = 0.063. Overall, 29 patients (8.4%)
survived; of these, 3 (10.3%) received BMT, 16 (55.2%) IST and 10 (31.0%)
no therapy. Conclusions: To our knowledge this is the largest systematic
review of reported cases of TA-GVHD. This review describes the diversity
of patient characteristics and presentations of TA-GVHD. Firstly, patients
at risk for TA-GVHD encompass all levels of immune integrity, and reliance
on the patient's underlying diagnosis to dictate the need for irradiated
blood components limits mitigation, as blood component or donor-recipient
factors may be more important considerations. Secondly, the analysis of
cases revealed limitations and inconsistencies in reported details,
underscoring the need for consensus on reporting criteria, without which
TA-GVHD case confirmation is challenging.

<24>
Accession Number
71754893
Title
Common Congress of the Swiss Society of Anaesthesiology and Resuscitation,
SGAR-SSAR and the Swiss Society for the Study of Pain, SGSS-SSED 2014.
Source
Swiss Medical Weekly. Conference: Common Congress of the Swiss Society of
Anaesthesiology and Resuscitation, SGAR-SSAR and the Swiss Society for the
Study of Pain, SGSS-SSED 2014 Interlaken Switzerland. Conference Start:
20141106 Conference End: 20141108. Conference Publication: (var.pagings).
144 , 2014. Date of Publication: 23 Oct 2014.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
The proceedings contain 52 papers. The topics discussed include:
endotracheal tube displacement during head mobilization; intubation with
vivasight or conventional left-sided double lumen tubes: a randomized
trial; randomized, double-blind comparison of liquorice versus sugar-water
gargle for prevention of postoperative sore throat and post-extubation
coughing; effects of a single anesthetic induction dose of etomidate on
hemodynamics and adrenocortical function in cardiac surgery: a
prospective, parallel group, triple-blinded, randomized controlled trial;
troponin T and brain natriuretic peptide after on-pump cardiac surgery:
impact on 12-month mortality and major cardiac events after adjustment for
postoperative complications; and the association between intraoperative
electroencephalographic suppression and postoperative mortality.

<25>
Accession Number
71754846
Authors
Basciani R.M. Rindlisbacher A. Begert E. Brander L. Jakob S.M. Etter R.
Carrel T. Eberle B.
Institution
(Basciani, Rindlisbacher, Begert, Brander, Jakob, Etter, Carrel, Eberle)
University Hospital Bern, Inselspital, Departments of Anesthesiology and
Pain Medicine1, and Intensive Care Medicine2
Title
Effects of a single anesthetic induction dose of etomidate on hemodynamics
and adrenocortical function in cardiac surgery: A prospective, parallel
group, triple-blinded, randomized controlled trial.
Source
Swiss Medical Weekly. Conference: Common Congress of the Swiss Society of
Anaesthesiology and Resuscitation, SGAR-SSAR and the Swiss Society for the
Study of Pain, SGSS-SSED 2014 Interlaken Switzerland. Conference Start:
20141106 Conference End: 20141108. Conference Publication: (var.pagings).
144 (pp 3S), 2014. Date of Publication: 23 Oct 2014.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Background: To evaluate the effect of a single anesthetic induction dose
of etomidate on hemodynamics and adrenocortical function in patients
undergoing cardiac surgery. Methods: This prospective, randomized
controlled trial was conducted between December 2006 and December 2009 at
the University Hospital of Bern, Switzerland, in 130 patients aged 18-80.
Two subgroups, coronary artery bypass graft surgery (CABG, n = 90) and
mitral valve surgery (MVS, n = 40), were randomized separately to receive
either etomidate 0.15 mg/kg, propofol 1.5 mg/kg, or etomidate 0.15 mg/kg &
hydrocortisone 100 mg in CAGB (each n = 30), or etomidate 0.15 mg/kg or
propofol 1.5 mg/kg in MVS (each n = 20). A 250 mug corticotropin test was
performed the day before surgery, at 7 and 24 hours, and on day 4.
Relative adrenal insufficiency (RAI) was defined as increase of serum
cortisol <248 nmol/L. Main outcome measure was cumulative vasopressor use
(normalized to body weight) at postoperative day 1 (POD1), and overall
incidence of relative adrenal insufficiency (RAI). Randomization was
computer-generated, and allocation concealment by opaque sealed envelopes.
Patients, investigators, and assessors were blinded. Results: Ninety
patients were randomized to CABG and forty to MVS. All 130 patients were
analyzed in their allocated treatment group (intention-to-treat). For
cumulative vasopressor use, no significant differences between treatments
were found in CABG (norepinephrine: F 0.05, P = 0.95; epinephrine F 1.17,
P = 0.32) and MVS (norepinephrine: F 2.18, P = 0.15; epinephrine F 0.86, P
= 0.36). For effect sizes see table. Overall RAI incidence was 87%, 43%,
and 80% in CABG (P <0.000), and 95% and 45% in MVS (P = 0.001).
Conclusion: In elective cardiac surgery, a single induction dose of
etomidate significantly increases incidence of adrenal insufficiency for
24 hours. However, compared to propofol and etomidate & hydrocortisone,
there is no relevant difference in cumulative vasopressor use during the
first 24 hours after anesthetic induction. (Table Presented).

<26>
Accession Number
71755413
Title
Annual Meeting of the Swiss Society of Anesthesiology and Resuscitation,
SGAR/SSAR 2013.
Source
Swiss Medical Weekly. Conference: Annual Meeting of the Swiss Society of
Anesthesiology and Resuscitation, SGAR/SSAR 2013 Lausanne Switzerland.
Conference Start: 20131107 Conference End: 20131109. Conference
Publication: (var.pagings). 143 , 2013. Date of Publication: 24 Oct 2013.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
The proceedings contain 35 papers. The topics discussed include: hip
fracture accelerated surgical treatment and care track (HIP ATTACK)
trial-feasibility pilot; a restrictive fluid regimen combined with
norepinephrine during open radical cystectomy decreases the postoperative
complication rate and accelerates recovery; anesthetic conditioning in
liver transplantation: a multicenter randomized controlled trial; effect
of different deployment techniques in transapical aortic valve
implantation on transcranial doppler microembolic signals; selective
antegrade cerebral perfusion: effect of increasing flow rate on cerebral
oxygen saturation and transcranial doppler flow velocity; automated
assessment of difficult ventilation with facial recognition techniques;
and the maximum effective needle-to-nerve distance for ultrasound-guided
interscalene block.

<27>
Accession Number
71752116
Authors
Saffi M. Furtado M.V. Montenegro M.M. Ribeiro I.W.J. Kampits C.
Rabelo-Silva E.R. Polanczyk C.A. Rosing C.K. Haas A.N.
Institution
(Saffi, Rabelo-Silva, Polanczyk) School of Medicine, Federal University of
Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre,
Brazil
(Furtado) School of Medicine, Federal University of Rio Grande do Sul,
Institute for Health Technology Assessment (IATS-CNPq), Porto Alegre,
Brazil
(Montenegro, Ribeiro, Kampits, Rosing, Haas) Faculty of Dentistry
Periodontology, Federal University of Rio Grande do Sul, Porto Alegre,
Brazil
Title
The effect of periodontal therapy on endothelial function and
proinflammatory biomarkers in patients with stable coronary disease:
Protocol for a RCT.
Source
Atherosclerosis. Conference: 82nd European Atherosclerosis Society
Congress, EAS 2014 Madrid Spain. Conference Start: 20140531 Conference
End: 20140603. Conference Publication: (var.pagings). 235 (2) (pp
e227-e228), 2014. Date of Publication: August 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Scarce information exists regarding the preventive effect of
periodontal treatment in the recurrence of cardiovascular events.
Prevention may be achieved by targeting risk factors for recurrent
coronary artery disease (CAD) in patients with previous history of
cardiovascular events. The aim of this trial is to compare the effect of
two periodontal treatment approaches on levels of C-reactive protein,
lipids, flow-mediated dilation and serum concentrations of proinflammatory
and endothelial markers in stable CAD patients with periodontitis over a
period of 12 months. Methods: This is a randomized, parallel design,
examiner blinded, controlled clinical trial. Individuals from both
genders, 35 years of age and older, with concomitant diagnosis of CAD and
periodontitis will be included. CAD will be defined as the occurrence of
at least one of the following events: history of myocardial infarction;
myocardial revascularization; angina and positive testing of ischemia.
Periodontitis will be defined using the definition (>2 interproximal sites
with clinical attachment loss >6 mm and >1 interproximal site with probing
depth >5 mm). Individuals will have to present at least ten teeth present
to be included. One hundred individuals will be allocated to test
(intensive periodontal treatment comprised by scaling and root planing) or
control (community periodontal treatment consisting of one session of
supragingival plaque removal) treatment groups. Full-mouth six sites per
tooth periodontal examinations and subgingival biofilm samples will be
conducted at baseline, 3, 6 and 12 months after treatment. Results:
Primary outcome will be C-reactive protein changes over time. Secondary
outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides,
IL-1beta, IL-6, TNFalpha, fibrinogen, ICAM-1, VCAM-1 and E-selectin.
Flow-mediated dilation will be assessed at baseline,1, 3 and 6 months
after periodontal therapy. Conclusion: This trial will provide new
evidence regarding the effect of periodontal treatment on risk markers for
recurrence of cardiovascular events in stable coronary artery disease
patients.

<28>
Accession Number
71750444
Authors
Jinjuvadia R. Walia S. Bhalla S. Siddiqui Y.
Institution
(Jinjuvadia, Walia, Bhalla, Siddiqui) Internal Medicine, Henry Ford
Hospital, Detroit, MI, United States
Title
Interesting case of retained wireless capsule despite successful passage
of patency capsule in a patient with crohn's disease.
Source
American Journal of Gastroenterology. Conference: 79th Annual Scientific
Meeting of the American College of Gastroenterology Philadelphia, PA
United States. Conference Start: 20141017 Conference End: 20141022.
Conference Publication: (var.pagings). 109 (pp S455), 2014. Date of
Publication: October 2014.
Publisher
Nature Publishing Group
Abstract
Introduction: There are case reports and case series that have described
retention of wireless capsule endoscopy and complications related to it,
mainly small bowel perforation. Use of a patency capsule before wireless
capsule endoscopy has been suggested to avoid such complications. A recent
meta-analysis by Zhang et al. suggested a sensitivity of 97% and a
specificity of 83% with the use of a patency capsule in confirming GI
tract patency. We have identified only one case report by Sciaudone et al.
describing the retention of a wireless capsule following successful
confirmation of GI tract patency with a patency capsule. Case Report: The
patient is a 71-year-old male with a history of seizures, aortic valve
replacement and atrial fibrillation on Coumadin, who presented to the
gastroenterology clinic in follow-up after a recent hospitalization for
severe abdominal pain. A CT abdomen obtained during the hospitalization
revealed multifocal enteritis with moderate mural edema involving the
terminal ileum and low grade partial small bowel obstruction. Of note, he
had a normal colonoscopy 3 years prior to presentation, but the terminal
ileum was not intubated. The decision was made to proceed with a wireless
capsule endoscopy for further evaluation of the small bowel inflammation
seen on the recent CT abdomen as described above. To ensure patency of the
GI tract, the patient was scheduled for a patency capsule study prior to
pursuing the wireless capsule endoscopy. Following ingestion of the
patency capsule, an abdominal x-ray confirmed the presence of the patency
capsule in the distal colon. Shortly after, the patient underwent the
wireless capsule endoscopy study per protocol. The capsule endoscopy
suggested several discrete areas of inflammation and ulceration that may
represent small bowel Crohn's disease. However, the wireless capsule did
not pass into the colon. Due to an absence of symptoms/signs of
obstruction, the patient was followed as an outpatient for 1 week with a
trial of corticosteroids and serial abdominal x-rays, which suggested the
capsule was retained in the right lower quadrant. Subsequently, the
patient underwent an elective exploratory laparotomy for removal of the
retained wireless capsule. During the surgery, the wireless capsule was
identified in the ileum with successful retrieval following enterotomy.
Conclusion: This case report demonstrates that despite the patency capsule
having good sensitivity and specificity in confirming GI tract patency,
rare complications such as retained wireless capsule requiring surgery,
small bowel obstruction, and perforation cannot be avoided completely.

<29>
Accession Number
71744904
Authors
Jones B. Pepe S. Sheeran F. Donath S. Hardy P. Shekerdemian L. Penny D.
McKenzie I. Horton S. Brizard C. D'Udekem Y. Konstantinov I. Cheung M.
Institution
(Jones, Penny, Cheung) Department of Cardiology, Royal Children's
Hospital, Australia
(Jones, Pepe, Sheeran, Shekerdemian, Penny, Horton, Brizard, D'Udekem,
Konstantinov, Cheung) Heart Research Group, Murdoch Children's Research
Institute, Australia
(Jones, Pepe, Sheeran, Shekerdemian, Penny, McKenzie, Horton, Brizard,
D'Udekem, Konstantinov, Cheung) Department of Paediatrics, University of
Melbourne, Australia
(Donath, Hardy) Clinical Epidemiology and Biostatistics Unit, Murdoch
Children's Research Institute, Australia
(Shekerdemian) Pediatric Intensive Care Unit, Royal Children's Hospital,
Australia
(McKenzie, Horton) Department of Anesthesia, Royal Children's Hospital,
Australia
(Brizard, D'Udekem, Konstantinov) Cardiac Surgery Unit, Royal Children's
Hospital, Australia
Title
Remote ischaemic preconditioning fails to protect cyanosed neonates
undergoing cardiopulmonary bypass: A randomised controlled trial.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2012
Brisbane, QLD Australia. Conference Start: 20120816 Conference End:
20120819. Conference Publication: (var.pagings). 21 (pp S298), 2012. Date
of Publication: 2012.
Publisher
Elsevier Ltd
Abstract
Objectives: A randomised controlled trial was conducted to determine
whether remote ischaemic preconditioning (RIPC) in cyanosed neonates
undergoing cardiac surgery confers protection against cardiopulmonary
bypass (CPB). Background: The myocardial protective effect of RIPC has
been demonstrated in heterogeneous groups of patients undergoing cardiac
surgery. There is no data examining this technique in neonates. This study
was performed to examine RIPC efficacy in this high-risk patient group.
Methods: Two groups of neonates undergoing cardiac surgery were recruited
to the study: patients with transposition of the great arteries (TGA)
undergoing the arterial switch procedure and patients with hypoplastic
left heart syndrome (HLHS) undergoing the Norwood procedure. Subjects were
randomised to RIPC or sham control groups. RIPC was induced by four
5-minute cycles of lower limb ischaemia and reperfusion using a blood
pressure cuff. Pre- and postoperative measurements of troponin I and
biomarkers for renal and cerebral injury were made. Results: Thirty-nine
subjects were recruited - 20 with TGA and 19 with HLHS. Baseline
demographics were not significantly different between the groups. CPB and
x-clamp times were not significantly different. Levels of troponin I were
not significantly different at 6 h post CPB nor were post-operative
inotrope requirements. Markers of renal (NGAL) and cerebral injury (S100b,
NSE)were not significantly different between the two groups. Conclusions:
Our data suggests that RIPC in hypoxic neonates undergoing CPB surgery
does not provide myocardial, renal or neuronal protection. Further studies
are needed to examine the relationships between developmental age, hypoxia
and molecular mechanisms of ischaemic preconditioning.

<30>
Accession Number
71744881
Authors
Hosseini M. Davidson P. Salehi A. Khoshknab Fallahi M.
Institution
(Hosseini, Khoshknab Fallahi) University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) POSTDOC Staff of Nursing, Midwifery and Health Faculty of UTS,
NSW, Australia
(Davidson) Faculty of Nursing, Midwifery and Health, University of
Technology, Sydney, Australia
(Salehi) Master Science of Nursing, Tameen Egtemaee Organization, Tehran,
Iran, Islamic Republic of
Title
The effect of spiritual training on anxiety of CABG candidates in Iran.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2012
Brisbane, QLD Australia. Conference Start: 20120816 Conference End:
20120819. Conference Publication: (var.pagings). 21 (pp S289), 2012. Date
of Publication: 2012.
Publisher
Elsevier Ltd
Abstract
Introduction: Coronary artery bypass graft (CABG) impacts on the physical,
psychological and social dimensions of both patients and their families.
In particular anxiety is a common and burdensome condition. The aim of
this study was to evaluate the effect of spiritual training on anxiety in
individuals scheduled for CABG in a cardiac surgery centre in Iran 2011.
Methods: A randomised controlled trial of a five session's intervention of
45 minutes duration was undertaken. The intervention was based on
spiritual training principles and congruent with Islamic Zikr. A total of
66 participants were randomly allocated to a treatment and control groups.
The intervention was undertaken prior to CABGsurgery. Baseline levels of
anxiety and the impact of the intervention were assessed using the
Hamilton Anxiety Scale. Results: Baseline characteristics were comparable
between intervention and control groups. Following the intervention there
was a statistically significant difference in anxiety mean scores between
the intervention (19.48+/-2.03) and control groups (43.27+/-5.49) p <
0.000. Conclusions: The results of the study indicated that presurgery
spiritual training was useful for reducing anxiety for patients undergoing
CABG and well accepted by participants.

<31>
Accession Number
71730652
Authors
Healy D. Bashar K. Clarke Moloney M. Walsh S.
Institution
(Healy, Bashar, Clarke Moloney) Department of Vascular, University
Hospital Limerick, Limerick, Ireland
(Walsh) Department of Surgery, NUIG, Galway, Ireland
Title
Remote preconditioning and major clinical complications following adult
cardiovascular surgery: Systematic review and meta-analysis.
Source
Irish Journal of Medical Science. Conference: 39th Sir Peter Freyer
Memorial Lecture and Surgical Symposium Galway Ireland. Conference Start:
20140905 Conference End: 20140906. Conference Publication: (var.pagings).
183 (5 SUPPL. 1) (pp S251), 2014. Date of Publication: September 2014.
Publisher
Springer-Verlag London Ltd
Abstract
Introduction: A number of 'proof-of-concept' trials suggest that remote
ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ
injury in patients undergoing major cardiovascular surgery. There are
currently no studies with clinical outcomes as primary endpoints. Aim: To
evaluate the effect of RIPC on clinical outcomes following cardiovascular
surgery. Methods: Randomised clinical trials of RIPC in major adult
cardiovascular surgery were identified by a systematic review of
electronic abstract databases, conference proceedings and article
reference lists. Clinical end-points were extracted from trial reports. In
addition, trial principal investigators provided unpublished clinical
outcome data. Results: In total, 23 trials of RIPC in 2200 patients
undergoing major adult cardiovascular surgery were identified. RIPC did
not have a significant effect on clinical end-points (death,
peri-operative myocardial infarction (MI), renal failure, stroke,
mesenteric ischaemia, hospital or critical care length of stay).
Conclusion: Pooled data from pilot trials cannot confirm that RIPC has any
significant effect on clinically relevant end-points. Heterogeneity in
study inclusion and exclusion criteria and in the type of preconditioning
stimulus limits the potential for extrapolation at present. An effort must
be made to clarify the optimal preconditioning stimulus. Following this,
large-scale trials in a range of patient populations are required to
ascertain the role of this simple, cost-effective intervention in routine
practice.

<32>
Accession Number
71730511
Authors
O'Sullivan K.E. Segurado R. Sugrue D. Hurley J.
Institution
(O'Sullivan, Sugrue, Hurley) Mater Private Hospital, Dublin, Ireland
(Segurado) Centre for Support and Training in Analysis and Research, UCD,
Ireland
Title
Transaortic TAVI is a valid alternative to the transapical approach with
comparable procedural outcomes.
Source
Irish Journal of Medical Science. Conference: 65th Irish Cardiac Society
Annual Scientific Meeting Co. Westmeath Ireland. Conference Start:
20141016 Conference End: 20141018. Conference Publication: (var.pagings).
183 (8 SUPPL. 1) (pp S412-S413), 2014. Date of Publication: October 2014.
Publisher
Springer-Verlag London Ltd
Abstract
Introduction: Transapical access has dominated as the alternative to
transfemoral TAVI to date. Feasibility of the transaortic approach has
recently been demonstrated by a number of groups and may provide a
superior or at least equivalent alternative. The objective of this study
was to compare outcomes of transapical versus transaortic TAVI utilizing
meta-analysis of data published to date. Methods: Data was extracted from
eligible studies reporting post procedural outcomes from patients
undergoing transapical and transaortic TAVI. A random-effects
meta-analysis was performed using DerSimonian Laird between-study variance
estimation. Multilevel mixed effects meta-regression with fixed moderator
variable for access type was run using package meta (v3.2-0) and metafor
(v1.9- 2) in the R statistical software version 3.0.2 (cran.rproject.org),
and SAS (v 9.3). Results: A total of 10 studies and 1736 patients were
included. A total of 193 patients underwent transaortic and 1543
transapical TAVI. There was no difference identified in STS or EuroSCORE
between groups confirming comparability. No difference in 30-day mortality
was identified. There were no differences identified in procedural success
rate, stroke and transient ischaemic attack (TIA) incidence, major bleed
or pacemaker insertion rates. In addition, the incidence of clinically
significant paravalvular regurgitation (PVR) was the same between groups.
Conclusion: Provisional comparison of transapical and transaortic
approaches revealed equivalent outcomes in 30-day mortality, procedural
success, stroke and TIA incidence and pacemaker insertion rates. This
preliminary analysis suggests transaortic is a valid alternative to
transapical TAVI. Furthermore it is reasonable to suggest that centers
attain experience in both considering transaortic access may be more
suitable in certain patients such as those with a poor ejection fraction.
(Table Presented).