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<1>
Accession Number
2015682932
Authors
Ma W. Liang Y. Zhu J. Wang Y. Wang X.
Institution
(Ma, Liang, Zhu, Wang) State Key Laboratory of Cardiovascular Disease,
Chinese Academy of Medical Science, Peking Union Medical College, Beijing,
China
(Wang) Fuwai Hospital, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
Title
Meta-analysis appraising high maintenance dose clopidogrel in patients who
underwent percutaneous coronary intervention with and without high
on-clopidogrel platelet reactivity.
Source
American Journal of Cardiology. 115 (5) (pp 592-601), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Inc.
Abstract
The CURRENT-OASIS 7 (Clopidogrel and Aspirin Optimal Dose Usage to Reduce
Recurrent Events-Seventh Organization to Assess Strategies in Ischemic
Symptoms) trial showed that a 7-day 150-mg maintenance dose (MD)
clopidogrel could reduce cardiovascular events in subgroup patients who
underwent percutaneous coronary intervention (PCI) compared with the 75
mg/day regimen, although whether prolonging the high MD clopidogrel (>150
mg) treatment period to at least 4 weeks can reduce major adverse cardiac
events in the patients who underwent PCI with and without high
on-clopidogrel platelet reactivity (HPR) is still controversial. We
searched Pubmed, Embase, and Cochrane Library from inception until
September 2014 for randomized controlled trials that compared high versus
standard MD clopidogrel in patients who underwent PCI. Seventeen trials
involving 4,822 patients who underwent PCI included 2,879 patients who
were allocated to the "HPR patients" subgroup and 1,943 to the "native
patients" subgroup without paying attention to the clopidogrel reactivity
before randomization. Compared with the standard therapy, the high MD
clopidogrel was associated with a significant reduction in the risk of
major adverse cardiac events (odds ratio [OR] 0.52, 95% confidence
interval [CI] 0.39 to 0.71, p <0.0001) in patients who underwent PCI. The
HPR patients subgroup was also benefited from such high MD treatment (OR
0.54, 95% CI 0.38 to 0.77, p = 0.0007). The observed benefits were mainly
attributed to treatment-associated reduction in stent thrombosis (OR 0.43,
95% CI 0.23 to 0.78, p = 0.006) and target vessel revascularization (OR
0.38, 95% CI 0.20 to 0.74, p = 0.004). There was no difference in the rate
of major/minor bleeding event between the high and standard MD group (OR
0.80, 95% CI 0.56 to 1.13, p = 0.21). In conclusion, the efficacy and
safety of at least 4 weeks' high MD clopidogrel is greater than that of
standard therapy for patients who underwent PCI with and without HPR.

<2>
Accession Number
2015666712
Authors
Vriesendorp P.A. Schinkel A.F.L. Soliman O.I.I. Kofflard M.J.M. De Jong
P.L. Van Herwerden L.A. Ten Cate F.J. Michels M.
Institution
(Vriesendorp, Schinkel, Soliman, Ten Cate, Michels) Department of
Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(De Jong) Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Kofflard) Department of Cardiology, Albert Schweitzer Hospital,
Dordrecht, Netherlands
(Van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
Title
Long-term benefit of myectomy and anterior mitral leaflet extension in
obstructive hypertrophic cardiomyopathy.
Source
American Journal of Cardiology. 115 (5) (pp 670-675), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Inc.
Abstract
Severely symptomatic patients with obstructive hypertrophic cardiomyopathy
(HC) may benefit from surgical myectomy. In patients with enlarged mitral
leaflets and mitral regurgitation, myectomy can be combined with anterior
mitral leaflet extension (AMLE) to stiffen the midsegment of the leaflet.
The aim of this study was to evaluate the long-term results of myectomy
combined with AMLE in patients with obstructive HC. This prospective,
observational, single-center cohort study included 98 patients (49 +/- 14
years, 37% female) who underwent myectomy combined with AMLE from 1991 to
2012. End points included all-cause mortality and change in clinical and
echocardiographic characteristics. Mortality was compared with age- and
gender-matched patients with nonobstructive HC and subjects from the
general population. Long-term follow-up was 8.3 +/- 6.1 years. There was
no operative mortality, and New York Heart Association class was reduced
from 2.8 +/- 0.5 to 1.3 +/- 0.5 (p <0.001), left ventricular outflow tract
gradient from 93 +/- 25 to 9 +/- 8 mm Hg (p <0.001), mitral valve
regurgitation from grade 2.0 +/- 0.9 to 0.5 +/- 0.8 (p <0.001), and
systolic anterior motion of the mitral valve from grade 2.4 +/- 0.9 to 0.1
+/- 0.3 (p <0.001). The 1-, 5-, 10-, and 15-year cumulative survival rates
were 98%, 92%, 86%, and 83%, respectively, and did not differ from the
general population (99%, 97%, 92%, and 85%, respectively, p = 0.3) or
patients with nonobstructive HC (98%, 97%, 88%, and 83%, respectively, p =
0.8). In conclusion, in selected patients with obstructive HC, myectomy
combined with AMLE is a low-risk surgical procedure. It results in
long-term symptom relief and survival similar to the general population.

<3>
Accession Number
2015757827
Authors
Taniwaki M. Stefanini G.G. Silber S. Richardt G. Vranckx P. Serruys P.W.
Buszman P.E. Kelbaek H. Windecker S.
Institution
(Taniwaki, Stefanini, Windecker) Department of Cardiology, Swiss
Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse,
Bern 3010, Switzerland
(Silber) Kardiologische Praxis und Praxisklinik, Munich, Germany
(Richardt) Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Hasselt, Belgium
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Kelbaek) Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen,
Denmark
Title
4-Year clinical outcomes and predictors of repeat revascularization in
patients treated with new-generation drug-eluting stents: A report from
the RESOLUTE All-Comers trial (A Randomized Comparison of a
Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention).
Source
Journal of the American College of Cardiology. 63 (16) (pp 1617-1625),
2014. Date of Publication: 29 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives: The aim of the study was to investigate 4-year outcomes and
predictors of repeat revascularization in patients treated with the
Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Minneapolis,
Minnesota) and XIENCE V everolimus-eluting stent (EES) (Abbott Vascular,
Abbott Park, Illinois) in the RESOLUTE (A Randomized Comparison of a
Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention) All-Comers trial. Background: Data on
long-term outcomes of new-generation drug-eluting stents are limited, and
predictors of repeat revascularization due to restenosis and/or
progression of disease are largely unknown. Methods: Patients were
randomly assigned to treatment with the R-ZES (n = 1,140) or the EES (n =
1,152). We assessed prespecified safety and efficacy outcomes at 4 years
including target lesion failure and stent thrombosis. Predictors of
revascularization at 4 years were identified by Cox regression analysis.
Results: At 4 years, the rates of target lesion failure (15.2% vs. 14.6%,
p = 0.68), cardiac death (5.4% vs. 4.7%, p = 0.44), and target vessel
myocardial infarction (5.3% vs. 5.4%, p = 1.00), clinically-indicated
target lesion revascularization (TLR) (7.0% vs. 6.5%, p = 0.62), and
definite/probable stent thrombosis (2.3% vs. 1.6%, p = 0.23) were similar
with the R-ZES and EES. Independent predictors of TLR were age,
insulin-treated diabetes, SYNTAX (Synergy between PCI with Taxus and
Cardiac Surgery) score, treatment of saphenous vein grafts, ostial
lesions, and in-stent restenosis. Independent predictors of any
revascularization were age, diabetes, previous percutaneous coronary
intervention, absence of ST-segment elevation myocardial infarction,
smaller reference vessel diameter, SYNTAX score, and treatment of left
anterior descending, right coronary artery, saphenous vein grafts, ostial
lesions, or in-stent restenosis. Conclusions: R-ZES and EES demonstrated
similar safety and efficacy throughout 4 years. TLR represented less than
one-half of all repeat revascularization procedures. Patient- and
lesion-related factors predicting the risk of TLR and any
revascularization showed considerable overlap. (A Randomized Comparison of
a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for
Percutaneous Coronary Intervention [RESOLUTE-AC]; NCT00617084).

<4>
Accession Number
2015751898
Authors
Stoekenbroek R.M. Boekholdt S.M. Fayyad R. Laskey R. Tikkanen M.J.
Pedersen T.R. Hovingh G.K.
Institution
(Stoekenbroek, Hovingh) Department of Vascular Medicine, Academic Medical
Center, Amsterdam, Netherlands
(Boekholdt) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Fayyad, Laskey) Pfizer Inc., New York, NY, United States
(Tikkanen) Department of Medicine, Helsinki University Central Hospital,
Helsinki and the Folkhalsan Research Center, Helsinki, Finland
(Pedersen) University of Oslo and Centre of Preventive Medicine, Oslo
University Hospital, Ulleval, Oslo, Norway
(Stoekenbroek) Department of Vascular Medicine, Academic Medical Center,
Meibergdreef 9, 1100 DD, Amsterdam 1105 AZ, Netherlands
Title
High-dose atorvastatin is superior to moderate-dose simvastatin in
preventing peripheral arterial disease.
Source
Heart. 101 (5) (pp 356-362), 2015. Date of Publication: 01 Mar 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives To study whether high-dose versus usualdose statin treatment
reduces the incidence of peripheral artery disease (PAD) and what is the
effect of high-dose statin treatment on cardiovascular disease (CVD)
outcome in patients with PAD. Methods and results In the Incremental
Decrease in End Points Through Aggressive Lipid Lowering trial, 8888
post-myocardial infarction patients were randomised to high-dose or
usual-dose statin therapy (atorvastatin 80 mg/day vs simvastatin 20-40
mg/day). We investigated the effect of high-dose versus usualdose statins
on the pre-specifi ed outcome PAD incidence, and additionally performed a
posthoc analysis of the efficacy of high-dose statins in reducing CVD risk
among patients with PAD. During a median follow-up of 4.8 years, 94
patients (2.2%) receiving atorvastatin and 135 patients (3.2%) receiving
simvastatin developed PAD (HR=0.70, 95% CI 0.53 to 0.91; p=0.007). The
risk of major coronary events was almost twofold higher in patients with
PAD at baseline, but was no longer significant after adjusting for the
adverse cardiovascular risk profile. In PAD patients, major coronary
events occurred in fewer patients in the atorvastatin group (14.4%) than
in the simvastatin group (20.1%), but the difference did not reach
statistical significance. (HR=0.68, 95% CI 0.41 to 1.11; p=0.13).
Atorvastatin treatment significantly reduced overall cardiovascular
(p=0.046) and coronary events ( p=0.004), and coronary revascularisation
(p=0.007) in these patients. Conclusions High-dose statin therapy with
atorvastatin significantly reduced the incidence of PAD compared with
usual-dose statin therapy with simvastatin. Patients with a history of PAD
at baseline were at higher risk of future coronary events and this risk
was reduced by high-dose atorvastatin treatment. Trial registration number
NCT00159835 (URL: http://clinicaltrials.gov/show/NCT00159835).

<5>
Accession Number
2015747210
Authors
Kaufman R.M. Djulbegovic B. Gernsheimer T. Kleinman S. Tinmouth A.T.
Capocelli K.E. Cipolle M.D. Cohn C.S. Fung M.K. Grossman B.J. Mintz P.D.
O'Malley B.A. Sesok-Pizzini D.A. Shander A. Stack G.E. Webert K.E.
Weinstein R. Welch B.G. Whitman G.J. Wong E.C. Tobian A.A.R.
Institution
(Kaufman) Department of Pathology, Brigham and Women's Hospital, Blood
Bank, Amory 260, 75 Francis Street, Boston, MA 02115, United States
(Djulbegovic) University of South Florida, Health/Therapy 1201,
Health/College of Medicine 27, 3515 East Fletcher Avenue, Tampa, FL 33612,
United States
(Gernsheimer) University of Washington, 1959 NE Pacific Street, Box
356330, Seattle, WA 98195, United States
(Kleinman) University of British Columbia, 1281 Rockcrest Avenue,
Victoria, BC V9A 4W4, Canada
(Tinmouth) Clinical Epidemiology Research Unit, Ottawa Hospital Research
Institute, General Campus, Box 201, Room 1812-C, 501 Smyth Road, Ottawa,
ON K1H 8L6, Canada
(Capocelli) Department of Pathology, Children's Hospital Colorado, B120,
Aurora, CO 80045, United States
(Cipolle) Christiana Care Health System, Surgical and Critical Care
Associates, 4755 Ogletown-Stanton Road, Suite 1320, Newark, DE 19713,
United States
(Cohn) Department of Laboratory Medicine and Pathology, University of
Minnesota, Mayo Mail Code 609, 420 Delaware Street Southeast, Minneapolis,
MN 55455, United States
(Fung) Department of Pathology, University of Vermont, Fletcher Allen
Health Care, 111 Colchester Avenue, Burlington, VT 05401, United States
(Grossman) Department of Pathology and Immunology, Washington University
School of Medicine, 660 South Euclid Avenue, Campus Box 8118, St. Louis,
MO 63110, United States
(Mintz) Division of Hematology Clinical Review, Center for Biologics
Evaluation and Research, U.S. Food and Drug Administration, 10903 New
Hampshire Avenue, Silver Spring, MD 20993, United States
(O'Malley) Department of Pathology, Wayne State University School of
Medicine, Harper University Hospital, 3990 John R. Road, Detroit, MI
48202, United States
(Sesok-Pizzini) Children's Hospital of Philadelphia, 5136 Main Hospital,
34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399,
United States
(Shander) Department of Anesthesiology and Critical Care Medicine,
Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ
07631, United States
(Stack) Yale School of Medicine, Pathology and Laboratory Medicine
Service/113, 950 Campbell Avenue, West Haven, CT 06516-2770, United States
(Webert) Canadian Blood Services, 35 Stone Church Road, Suite 200,
Ancaster, ON L9K 1S5, Canada
(Weinstein) University of Massachusetts Medical School, 55 Lake Avenue
North, LA-113, Worcester, MA 01655, United States
(Welch) University of Texas Southwestern Medical Center, 5161 Harry Hines
Boulevard, CS5.112, Dallas, TX 75390-8855, United States
(Whitman) Division of Cardiac Surgery, Johns Hopkins University, Zayed
Tower, Suite 7107/1800 Orleans Street, Baltimore, MD 21287, United States
(Wong) Division of Laboratory Medicine, Children's National Medical
Center, 111 Michigan Avenue NW, Washington, DC 20010, United States
(Tobian) Department of Pathology, Division of Transfusion Medicine, Johns
Hopkins University, Carnegie 437, 600 North Wolfe Street, Baltimore, MD
21287, United States
Title
Platelet transfusion: A clinical practice guideline from the AABB.
Source
Annals of Internal Medicine. 162 (3) (pp 205-213), 2015. Date of
Publication: 03 Feb 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The AABB (formerly, the American Association of Blood Banks)
developed this guideline on appropriate use of platelet transfusion in
adult patients. Methods: These guidelines are based on a systematic review
of randomized, clinical trials and observational studies (1900 to
September 2014) that reported clinical outcomes on patients receiving
prophylactic or therapeutic platelet transfusions. An expert panel
reviewed the data and developed recommendations using the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) framework.
Recommendation 1: The AABB recommends that platelets should be transfused
prophylactically to reduce the risk for spontaneous bleeding in
hospitalized adult patients with therapyinduced hypoproliferative
thrombocytopenia. The AABB recommends transfusing hospitalized adult
patients with a platelet count of 10 x 10⁹ cells/L or less to
reduce the risk for spontaneous bleeding. The AABB recommends transfusing
up to a single apheresis unit or equivalent. Greater doses are not more
effective, and lower doses equal to one half of a standard apheresis unit
are equally effective. (Grade: strong recommendation; moderate-quality
evidence) Recommendation 2: The AABB suggests prophylactic platelet
transfusion for patients having elective central venous catheter placement
with a platelet count less than 20 x 10⁹ cells/L. (Grade: weak
recommendation; low-quality evidence) Recommendation 3: The AABB suggests
prophylactic platelet transfusion for patients having elective diagnostic
lumbar puncture with a platelet count less than 50 x 10⁹
cells/L. (Grade: weak recommendation; very-low-quality evidence)
Recommendation 4: The AABB suggests prophylactic platelet transfusion for
patients having major elective nonneuraxial surgery with a platelet count
less than 50 x 10⁹ cells/L. (Grade: weak recommendation;
very-low-quality evidence) Recommendation 5: The AABB recommends against
routine prophylactic platelet transfusion for patients who are
nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass.
The AABB suggests platelet transfusion for patients having bypass who
exhibit perioperative bleeding with thrombocytopenia and/or evidence of
platelet dysfunction. (Grade: weak recommendation; very-low-quality
evidence) Recommendation 6: The AABB cannot recommend for or against
platelet transfusion for patients receiving antiplatelet therapy who have
intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain
recommendation; very-low-quality evidence).

<6>
Accession Number
2015747208
Authors
Sundstrom J. Arima H. Jackson R. Turnbull F. Rahimi K. Chalmers J.
Woodward M. Neal B.
Institution
(Sundstrom) Department of Medical Sciences, Uppsala Clinical Research
Center, Uppsala University, Uppsala SE-75185, Sweden
(Arima, Turnbull, Chalmers, Woodward, Neal) George Institute for Global
Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia
(Jackson) Section of Epidemiology and Biostatistics, School of Population
Health, University of Auckland, Private Bag 92019, Auckland 1142, New
Zealand
(Rahimi) George Institute for Global Health, Oxford Martin School,
University of Oxford, 34 Broad Street, Oxford OX1 3BD, United Kingdom
Title
Effects of blood pressure reduction in mild hypertension: A systematic
review and meta-analysis.
Source
Annals of Internal Medicine. 162 (3) (pp 184-191), 2015. Date of
Publication: 03 Feb 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Effects of blood pressure reduction in persons with grade 1
hypertension are unclear. Purpose: To investigate whether pharmacologic
blood pressure reduction prevents cardiovascular events and deaths in
persons with grade 1 hypertension. Data Sources: Trials included in the
BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and
trials identified from a previous review and electronic database searches.
Study Selection: Patients without cardiovascular disease with blood
pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg)
who were randomly assigned to an active (antihypertensive drug or more
intensive regimen) or control (placebo or less intensive regimen) blood
pressure-lowering regimen. Data Extraction: Individual-patient data from
BPLTTC trials and aggregate data from other trials were extracted. Risk of
bias was assessed for all trials. Data Synthesis: Individual-patient data
involved 10 comparisons from trials where most patients had diabetes, and
aggregate data involved 3 comparisons from trials of patients without
diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg.
Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total
cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74
to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure,
0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to
0.92) for total deaths. Results were similar in secondary analyses.
Withdrawal from treatment due to adverse effects was more common in the
active groups. Limitation: Blood pressure reductions and numbers of events
were small. Conclusion: Blood pressure-lowering therapy is likely to
prevent stroke and death in patients with uncomplicated grade 1
hypertension.

<7>
Accession Number
2015750143
Authors
Benedetto U. Ng C. Frati G. Biondi-Zoccai G. Vitulli P. Zeinah M. Raja
S.G.
Institution
(Benedetto, Ng, Raja) Department of Cardiac Surgery, Harefield Hospital,
London, United Kingdom
(Frati, Biondi-Zoccai, Vitulli) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati) Department of AngioCardio Neurology, IRCCS NeuroMed, Pozzilli,
Italy
(Zeinah) Ain Shams University, Cairo, Egypt
Title
Miniaturized extracorporeal circulation versus off-pump coronary artery
bypass grafting: A meta-analysis of randomized controlled trials.
Source
International Journal of Surgery. 14 (pp 96-104), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Ltd
Abstract
Background: Controversies exist whether off-pump coronary artery bypass
(OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in
reducing deleterious effects of cardiopulmonary bypass as only a number of
smaller randomized controlled trials (RCT) currently provide a limited
evidence base. The main purpose of conducting the present meta-analysis
was to overcome the expected low power in RCTs in an attempt to establish
whether MECC is comparable to OPCAB. Methods: A MEDLINE/PubMed search was
conducted to identify eligible RCTs. A pooled summary effect estimate was
calculated by means of Mantel-Haenszel method. Results: The search yielded
7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB
group and 279 in the MECC group. The OPCAB and MECC groups were comparable
in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01;
95%CI -0.02, 0.03; P=0.55; I²=0%), stroke (RD -0.01; 95%CI
-0.05, 0.04; P=0.69; I²=0%), need for renal replacement therapy
(RD 0.00; -0.06, 0.06; P=1; I²=0%), postoperative atrial
fibrillation (RD -0.03; -0.17, 0.10; P=0.64; I²=0%),
re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P=0.65;
I²=0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P=0.65;
I²=0%) and the amount of blood loss (weighted mean difference
-25mL; 95%CI -71, 21; P=0.28; I²=0%). Conclusions: Using a
meta-analytic approach, MECC achieves clinical results comparable to OPCAB
including postoperative blood loss and blood transfusion requirement. On
the basis of our findings, MECC should be considered as a valid
alternative to OPCAB in order to reduce surgical morbidity of conventional
cardiopulmonary bypass.

<8>
Accession Number
2015756632
Authors
Garg A. Parashar A. Agarwal S. Aksoy O. Hammadah M. Poddar K.L. Puri R.
Svensson L.G. Krishnaswamy A. Tuzcu E.M. Kapadia S.R.
Institution
(Garg, Parashar, Hammadah) Department of Internal Medicine, Cleveland
Clinic, Cleveland, OH 44195, United States
(Agarwal, Aksoy, Poddar, Puri, Krishnaswamy, Tuzcu, Kapadia) Department of
Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, United
States
(Svensson) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH 44195, United States
Title
Comparison of acute elastic recoil between the SAPIEN-XT and SAPIEN valves
in transfemoral-transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. 85 (3) (pp 490-496),
2015. Date of Publication: 01 Feb 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The SAPIEN-XT is a newer generation balloon-expandable valve
created of cobalt chromium frame, as opposed to the stainless steel frame
used in the older generation SAPIEN valve. We sought to determine if there
was difference in acute recoil between the two valves. Methods: All
patients who underwent transfemoral- transcatheter aortic valve
replacement using the SAPIEN-XT valve at the Cleveland Clinic were
included. Recoil was measured using biplane cine-angiographic image
analysis of valve deployment. Acute recoil was defined as [(valve diameter
at maximal balloon inflation) 2 (valve diameter after deflation)]/valve
diameter at maximal balloon inflation (reported as percentage). Patients
undergoing SAPIEN valve implantation were used as the comparison group.
Results: Among the 23 mm valves, the mean (standard deviation-SD) acute
recoil was 2.77% (1.14) for the SAPIEN valve as compared to 3.75% (1.52)
for the SAPIEN XT valve (P = 0.04). Among the 26 mm valves, the mean (SD)
acute recoil was 2.85% (1.4) for the SAPIEN valve as compared to 4.32%
(1.63) for the SAPIEN XT valve (P = 0.01). Multivariable linear regression
analysis demonstrated significantly greater adjusted recoil in the SAPIEN
XT valves as compared to the SAPIEN valves by 1.43% [(95% CI: 0.69-2.17),
P < 0.001]. However, the residual peak gradient was less for SAPIEN XT
compared to SAPIEN valves [18.86 mm Hg versus 23.53 mm Hg (P = 0.01)].
Additionally, no difference in paravalvular leak was noted between the two
valve types (P = 0.78). Conclusions: The SAPIEN XT valves had
significantly greater acute recoil after deployment compared to the SAPIEN
valves. Implications of this difference in acute recoil on valve
performance need to be investigated in future studies.

<9>
Accession Number
2015756631
Authors
Van Houwelingen K.G. Sen H. Lam M.K. Tandjung K. Lowik M.M. De Man
F.H.A.F. Louwerenburg J.W. Stoel M.G. Hartmann M. Linssen G.C.M. Doggen
C.J. Von Birgelen C.
Institution
(Van Houwelingen, Sen, Lam, Tandjung, Lowik, De Man, Louwerenburg, Stoel,
Hartmann, Von Birgelen) Department of Cardiology, Thoraxcentrum Twente,
Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede 7513 ER,
Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo and
Hengelo, Netherlands
(Doggen, Von Birgelen) Health Technology and Services Research,
MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Three-year clinical outcome after treatment of chronic total occlusions
with second-generation drug-eluting stents in the TWENTE trial.
Source
Catheterization and Cardiovascular Interventions. 85 (3) (pp E76-E82),
2015. Date of Publication: 01 Feb 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To compare long-term outcome of patients treated for chronic
total occlusion (CTO) lesions versus patients treated for non-CTO lesions
only. Background: Percutaneous coronary interventions (PCI) for CTO
lesions generally have a higher adverse event risk than PCI for non-CTO
lesions. However, long-term outcome data from prospective studies with
second-generation drug-eluting stent (DES) use in CTO lesions is scarce.
Methods: We analyzed in this substudy of the TWENTE trial the data of 674
patients, who had stable angina and were electively treated with
second-generation DES (Resolute zotarolimus-eluting or Xience V
everolimus-eluting stents). Main outcome parameter was target lesion
failure (TLF), a composite of cardiac death, target vessel-related
myocardial infarction (MI), or target lesion revascularization (TLR).
Results: Patients with CTO lesions (n = 59, 8.8%) were more often treated
for lesions in small vessels (94.9% vs. 63.1%, P < 0.001), long lesions
(52.5% vs. 17.7%, P < 0.001) and multiple vessels (42.4% vs. 22.4%, P <
0.001), and were less often males (62.7% vs. 74.6%, P < 0.05) than
patients with non-CTO lesions (n = 615, 91.2%). J-CTO scores >2 were
present in 56% of CTO lesions. Despite significant differences in
characteristics of patients, lesions, and interventional procedures, the
TLF rate at 3-year follow-up was similar for both groups (13.6% vs. 12.9%,
P = 0.89). In addition, a patient-oriented composite endpoint (any death,
MI or revascularization) did not differ between groups (18.6% vs. 18.8%, P
= 0.97). Conclusion: Patients treated with second-generation DES for CTO
lesions showed at 3-year follow-up an incidence of adverse clinical events
that was low and similar to patients with non-CTO lesions only.

<10>
Accession Number
2015756624
Authors
Sanborn T.A. Tomey M.I. Mehran R. Genereux P. Witzenbichler B. Brener S.J.
Kirtane A.J. McAndrew T.C. Kornowski R. Dudek D. Nikolsky E. Stone G.W.
Institution
(Sanborn) Cardiology Division, NorthShore University HealthSystem, 2650
Ridge Ave., Walgreen Building, Third Floor, Evanston, IL 60201, United
States
(Tomey, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Mehran, Genereux, Brener, Kirtane, McAndrew, Stone) Cardiovascular
Research Foundation, New York, NY, United States
(Genereux, Kirtane, Stone) Columbia University Medical Center, New York,
NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Kornowski) Rabin Medical Center, Petach-Tikva, Israel
(Dudek) Department of Interventional Cardiology, Jagiellonian University
Medical College, Krakow, Poland
(Nikolsky) Rambam Health Care Campus, Technion - Israel Institute of
Technology, Haifa, Israel
Title
Femoral vascular closure device use, bivalirudin anticoagulation, and
bleeding after primary angioplasty for STEMI: Results from the
HORIZONS-AMI trial.
Source
Catheterization and Cardiovascular Interventions. 85 (3) (pp 371-379),
2015. Date of Publication: 01 Feb 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To assess the relationship of femoral vascular closure device
(VCD) use to bleeding and ischemic events in patients undergoing primary
percutaneous coronary intervention (PCI) for ST-segment elevation
myocardial infarction (STEMI) via different anticoagulation strategies.
Background: It is unknown whether femoral VCD reduce major bleeding after
primary PCI for STEMI using bivalirudin anticoagulation. Methods: We
compared VCD-treated patients with propensity-matched controls in the
HORIZONS-AMI trial with respect to net adverse clinical events (NACE),
defined as the composite of major bleeding unrelated to coronary artery
bypass graft surgery (CABG) and major adverse cardiac events (comprised of
death, reinfarction, ischemia-driven target vessel revascularization, and
stroke), at 30 days and 1 year. Results: Among 3,602 patients enrolled in
HORIZONS-AMI, 2,948 underwent primary PCI via femoral arterial access and
896 (30%) received VCDs, of whom 642 were included in our model along with
642 propensity-matched controls. At 30 days, VCD-treated patients had
significantly less NACE (6.7% vs. 10.8%, HR: 0.61, 95% CI: 0.42-0.89, P =
0.009), driven by a lower rate of non-CABG related major bleeding (5.0%
vs. 8.1%, HR: 0.61, 95% CI: 0.39-0.94, P = 0.02). Bleeding reduction was
maintained at one year and consistent in magnitude regardless of
randomization to bivalirudin or unfractionated heparin plus a glycoprotein
IIb/IIIa inhibitor (P for interaction = 0.84). Conclusion: In patients
undergoing transfemoral primary PCI for STEMI, VCD use was associated with
significantly lower non-CABG major bleeding irrespective of
anticoagulation strategy.

<11>
Accession Number
2015740620
Authors
Migliore M. Criscione A. Calvo D. Privitera G. Spatola C. Parra E.S.
Palmucci S. Ciancio N. Cajozzo M. Maria G.D.
Institution
(Migliore, Criscione, Calvo) Academic Thoracic Surgery Unit, A.O.U.
Policlinico-Vittorio Emanuele, Catania, Italy
(Migliore, Criscione, Calvo) Department of Surgery, University of Catania,
Catania, Italy
(Privitera, Spatola) Radiotherapy Unit, A.O.U. Policlinico-Vittorio
Emanuele, University of Catania, Catania, Italy
(Parra) Oncology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania,
Italy
(Palmucci) Radiology Unit, A.O.U. Policlinico-Vittorio Emanuele,
University of Catania, Catania, Italy
(Ciancio, Maria) Pneumology Unit, A.O.U. Policlinico-Vittorio Emanuele,
Catania, Italy
(Cajozzo) Thoracic Surgery Unit, University of Palermo, Palermo, Italy
(Maria) Department of Clinical and Molecular Bio-Medicine, University of
Catania, Catania, Italy
Title
Wider implications of video-assisted thoracic surgery versus open approach
for lung metastasectomy.
Source
Future Oncology. 11 (2s) (pp 25-29), 2015. Date of Publication: 01 Jan
2015.
Publisher
Future Medicine Ltd.
Abstract
Lung metastasectomy is considered a safe and potentially curative
procedure despite there is not a strong evidence that metastasectomy
prolongs long-term survival in patients with lung metastases. Moreover,
the debate is open regarding the best approach for lung metastasectomy,
video-assisted thoracic surgery versus open approach. A systematic review
of literature to clarify what is the best approach to prolong survival in
patients with lung metastases was performed. Our study confirms that
overall survival is equivalent for video-assisted thoracic surgery and
thoracotomy, therefore the 'gold standard' surgical treatment for lung
metastases remains a point of debate. The choice of the surgical approach
still depends more on the single center or surgeon practice than on strong
scientific evidence. A prospective randomized trial could clarify the
question.

<12>
Accession Number
2015737604
Authors
Fearon W.F. Kodali S. Doshi D. Fischbein M.P. Yeung A.C. Murat Tuzcu E.
Rihal C.S. Babaliaros V. Zajarias A. Herrmann H.C. Brown D.L. Mack M.
Teirstein P.S. Whisenant B.K. Makkar R. Kapadia S. Leon M.B.
Institution
(Fearon, Fischbein, Yeung, Leon) Stanford University School of Medicine,
300 Pasteur Drive, Stanford, CA 94305, United States
(Kodali, Doshi) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
(Murat Tuzcu, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Rihal) Mayo Clinic, Rochester, MN, United States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Zajarias) Washington University School of Medicine, St. Louis, MO, United
States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Brown) Baylor Healthcare System, Plano, TX, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Teirstein) Scripps Clinic, Sna Diego, CA, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
Title
Outcomes after transfemoral transcatheter aortic valve replacement a
comparison of the randomized PARTNER (placement of aortic transcatheter
valves) trial with the NRCA (nonrandomized continued access) registry.
Source
JACC: Cardiovascular Interventions. 7 (11) (pp 1245-1251), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
OBJECTIVES This study sought to determine whether outcomes for
transfemoral (TF) transcatheter aortic valve replacement (TAVR) differ
between the randomized controlled trial (RCT) and the subsequent NRCA
(Nonrandomized Continued Access) registry of the PARTNER (Placement of
AoRTic TraNscathetER Valves) trial. BACKGROUND The PARTNER RCT
demonstrated that TAVR with the Edwards Sapien valve (Edwards
Lifesciences, Irvine, California) is noninferior to surgery in high-risk
patients and superior to standard therapy for inoperable patients. METHODS
The inclusion and exclusion criteria, data collection, monitoring, and
core laboratories were the same for the RCT and NRCA registry. Baseline
characteristics, procedural results, and 1-year outcomes were compared
between patients undergoing TF-TAVR as part of the RCT and as part of the
NRCA registry. RESULTS In the RCT, 415 patients underwent TF-TAVR, whereas
in the NRCA, 1,023 patients did. At 30 days, death, cardiac death, stroke,
and transient ischemic attacks were not different in the NRCA registry
than in the RCT. Major vascular complications (8.0% vs. 15.7%, p < 0.0001)
and major bleeding (6.8% vs. 15.3%, p < 0.0001) were signifi- cantly lower
in the NRCA registry. At 1 year, death rates were significantly lower in
the NRCA cohort (19.0% vs. 25.3%, p = 0.009) and cardiac death tended to
be lower (8.4% vs. 11.1%, p = 0.12). Stroke or transient ischemic attack
(6.2% vs. 8.7%, p = 0.10) and stroke alone (5.0% vs. 7.1%, p = 0.13) also
tended to be lower. CONCLUSIONS The large NRCA registry demonstrates
further improvement in procedural and longer-term outcomes after TF-TAVR
when compared with the favorable results from the PARTNER RCT.

<13>
Accession Number
2015737588
Authors
Gasior M. Zembala M.O. Tajstra M. Filipiak K. Gierlotka M. Hrapkowicz T.
Hawranek M. Polonski L. Zembala M.
Institution
(Gasior, Tajstra, Gierlotka, Hawranek, Polonski) Third Department of
Cardiology, Silesian Center for Heart Diseases, Medical University of
Silesia, Ul. Szpitalna 2, Zabrze 41-800, Poland
(Zembala, Filipiak, Hrapkowicz, Zembala) Department of Cardiac Surgery and
Transplantology, Silesian Center for Heart Diseases, Medical University of
Silesia, Zabrze, Poland
Title
Hybrid revascularization for multivessel coronary artery disease.
Source
JACC: Cardiovascular Interventions. 7 (11) (pp 1277-1283), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
OBJECTIVES The aim of this study was to assess the feasibility of hybrid
coronary revascularization (HCR) in patients with multivessel coronary
artery disease (MVCAD) referred for standard coronary artery bypass
grafting (CABG). BACKGROUND Conventional CABG is still the treatment of
choice in patients with MVCAD. However, the limitations of standard CABG
and the unsatisfactory long-term patency of saphenous grafts are commonly
known. METHODS A total of 200 patients with MVCAD involving the left
anterior descending artery (LAD) and a critical (>70%) lesion in at least
1 major epicardial vessel (except the LAD) amenable to both PCI and CABG
and referred for conventional surgical revascularization were randomly
assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was
the evaluation of the safety of HCR. The feasibility was defined by the
percent of patients with a complete HCR procedure and the percent of
patients with conversions to standard CABG. The occurrence of major
adverse cardiac events such as death, myocardial infarction, stroke,
repeated revascularization, and major bleeding within the 12-month period
after randomization was also assessed. RESULTS Most of the pre-procedural
characteristics were similar in the 2 groups. Of the patients in the
hybrid group, 93.9% had complete HCR and 6.1% patients were converted to
standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS),
myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%,
p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in
the 2 groups. In both groups, no cerebrovascular incidents were observed.
CONCLUSIONS HCR is feasible in select patients with MVCAD referred for
conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization
in Multivessel Coronary Artery Disease.

<14>
Accession Number
2015752486
Authors
Lenkin A.I. Zaharov V.I. Lenkin P.I. Smetkin A.A. Bjertnaes L.J. Kirov
M.Y.
Institution
(Lenkin) Department of Anesthesiology and Intensive Care Medicine, City
Hospital 1 of Arkhangelsk, Suvorov Street 1, Arkhangelsk 163001, Russian
Federation
(Zaharov, Lenkin, Smetkin, Kirov) Department of Anesthesiology and
Intensive Care Medicine, Northern State Medical University, Arkhangelsk,
Russian Federation
(Bjertnaes, Kirov) Department of Clinical Medicine (Anesthesiology),
Faculty of Health Sciences, University of Tromsoe, Tromsoe, Norway
Title
Monitoring of anesthetic depth during surgical correction of acquired
valvular disorders: Single center, randomized trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 301-307),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
Objective The authors' primary objective was to test the hypothesis that
Cerebral State Index (CSI)-guided control of anesthetic depth might reduce
the consumption of anesthetics and shorten the duration of ICU and
hospital stays after surgical correction of combined valve disorders.
Design Single center, randomized trial. Setting City Hospital Number 1 of
Arkhangelsk, Russian Federation. Participants Fifty adult patients with
combined valve disorders requiring surgical correction. Interventions The
patients were randomized into 2 groups. In the CSI group, anesthetic depth
was monitored, and the rate of infusion of propofol was titrated to
maintain the depth of anesthesia corresponding to a CSI of 40-60. In the
control group, the depth of anesthesia was monitored clinically, and the
dosage of propofol was administered according to the recommendations of
the manufacturer. Measurements and Main Results All patients received
standard perioperative monitoring. Consumption of anesthetics and length
of ICU and hospital stays were recorded. Preoperative patient
characteristics did not differ significantly between the groups. In the
CSI group, average intraoperative doses of midazolam and propofol were
reduced by 41% and 19%, respectively (p<0.01). Maintenance of anesthesia
guided by CSI shortened the time until fit for ICU discharge by 50% and
reduced the lengths of ICU and postoperative hospital stays by 35% and
25%, respectively (p< 0.05). Conclusions Monitoring of anesthetic depth
reduces the requirements for midazolam and propofol, resulting in a faster
recovery and a shorter postoperative ICU and hospital stay after surgical
correction of combined valve disorders.

<15>
Accession Number
2015752485
Authors
Lomivorotov V.V. Shmirev V.A. Efremov S.M. Ponomarev D.N. Moroz G.B.
Shahin D.G. Kornilov I.A. Shilova A.N. Lomivorotov V.N. Karaskov A.M.
Institution
(Lomivorotov, Shmirev, Efremov, Ponomarev, Moroz, Shahin, Kornilov,
Shilova, Lomivorotov, Karaskov) Department of Anesthesiology and Intensive
Care, Research Institute of Circulation Pathology, Novosibirsk, Russian
Federation
Title
Hypothermic versus normothermic cardiopulmonary bypass in patients with
valvular heart disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 295-300),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to test the hypothesis that
normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic
CPB in terms of cardiac protection (cTnI level) and outcome in patients
with valvular heart disease. Design Prospective randomized study. Setting
A tertiary cardiothoracic referral center. Participants 140 patients who
had valvular heart disease, with/without coronary artery disease,
surgically treated under CPB. Interventions The patients were allocated
randomly to undergo either hypothermic (temperature [T],
31degreeC-32degreeC) or normothermic CPB (T>36degreeC). Measurements and
Main Results The primary endpoint was the dynamics of troponin I. The
secondary endpoints were ventilation time, the need for inotropic support,
intensive care unit (ICU) and hospital stay durations, complications, and
mortality. There were no significant intergroup differences in dynamics of
troponin I. Ventilation time was significantly lower in the hypothermic
group (6 (5-9) and 8 (5-12); p = 0.01). Conclusions Normothermic CPB in
patients with valvular heart disease was as effective as hypothermic
perfusion in terms of myocardial protection after the surgery assessed by
cTnI release. The short ventilation duration in patients who underwent
hypothermic CPB needs to be confirmed in a future investigation.

<16>
Accession Number
2015752518
Authors
Levin A.I. Heine A.M. Coetzee J.F. Coetzee A.
Institution
(Levin, Heine, Coetzee, Coetzee) Department of Anesthesiology and Critical
Care, Faculty of Health Sciences, Stellenbosch University, Francie van Zyl
Avenue, Tygerberg 7505, South Africa
Title
Heparinase thromboelastography compared with activated coagulation time
for protamine titration after cardiopulmonary bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 224-229),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
Objective The present study is a comparison of two point-of-care (POC)
tests as endpoints of protamine titration after CPB. The authors
hypothesized that using the heparinase-kaolin thromboelastography (TEG-HK)
R-time difference would more readily identify residual heparin
necessitating additional protamine than when using activated coagulation
time (ACT). The primary endpoint was the between-group difference in
protamine dose. Whether this approach would lessen postoperative bleeding
and sequelae also was investigated. Design Single center, blinded,
prospective, randomized study. Setting University teaching hospital.
Participants Eighty-two adult patients for on-pump coronary artery bypass
and/or valve surgery. Interventions Patients were randomized. In the ACT
group, protamine was titrated until ACT did not exceed baseline by more
than 10%. In the TEG group, a TEG-HK R-time difference less than 20% was
targeted. Protamine was repeated to achieve the endpoints. Clinicians in
the ACT group were blinded to TEG data and vice versa. Measurements and
Main Results There was no between-group difference in total protamine dose
(3.9+/-0.6 and 4.2+/-0.7; 95% CI of the difference between means: -0.544
to 0.008 mg/kg; p = 0.057) or protamine:heparin ratios (1.3:1 and 1.4:1;
95% CI of the difference between means: -0.05 to 0.03 mg/mg; p = 0.653).
In the ACT group, 17% of patients required a second protamine dose, and in
the TEG group, 24% of patients required a second protamine dose. No
between-group differences in the postoperative transfusion requirements or
intensive care unit length of stay were demonstrated. Conclusion No
difference was identified in protamine dosing using either ACT or TEG-HK
R-time difference as endpoints. Heparinase TEG may be useful for
monitoring heparin reversal.

<17>
Accession Number
2015752513
Authors
Landoni G. Pasin L. Di Prima A.L. Dossi R. Taddeo D. Zangrillo A.
Institution
(Landoni, Pasin, Di Prima, Dossi, Taddeo, Zangrillo) Department of
Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan,
Italy
Title
Methylene blue: Between Scylla (Meta-analysis) and Charybdis (Propensity).
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp e12-e13),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders

<18>
Accession Number
2015752512
Authors
Vonk A.B.A. Veerhoek D. Van Den Brom C.E. Van Barneveld L.J.M. Boer C.
Institution
(Vonk, Veerhoek, Van Barneveld) Department of Cardio-thoracic Surgery,
Institute for Cardio-vascular Research, VU University Medical Center,
Amsterdam, Netherlands
(Van Den Brom, Boer) Department of Anesthesiology, Institute for
Cardio-vascular Research, VU University Medical Center, Amsterdam,
Netherlands
Title
Individualized heparin and protamine management improves rotational
thromboelastometric parameters and postoperative hemostasis in valve
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 235-241),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
Objectives This study investigated whether a tailored approach to heparin
and protamine management improved thromboelastometric parameters after
cardiopulmonary bypass and reduced postoperative blood loss compared with
activated coagulation time (ACT)-based fixed target heparin and protamine
management. Design Randomized controlled study. Setting Tertiary
university hospital. Participants Patients undergoing elective valve
surgery (n = 38). Interventions Heparin and protamine management were
based either on the ACT (n = 19) or hemostasis management system (HMS)
measurements (n = 19; HMS Plus; Medtronic, Minneapolis, MN). Measurements
and Main Results The target ACT for initiation of cardiopulmonary bypass
was 480 seconds. Study variables included rotational thromboelastometry
EXTEM (extrinsic coagulation), HEPTEM (intrinsic coagulation with
heparinase), and FIBTEM (fibrin part of clot formation) tests and 24-hour
blood loss. The use of HMS reduced the median protamine-to-heparin ratio
from 1.00 (1.00-1.00) to 0.62 (0.56-0.66; p<0.001). The ACT group showed a
prolonged postbypass clotting time for both EXTEM (86+/-13 seconds v
78+/-10 seconds; p = 0.05) and HEPTEM (217+/-58 seconds v 183+/-24
seconds; p = 0.03) tests. There was a moderate correlation between
protamine dosing with the EXTEM and HEPTEM clotting time (r = 0.42; p =
0.009 and r = 0.38; p = 0.02, respectively). The number of patients with
more than 450 mL/24 hours was higher in the ACT than in the HMS group (42%
v 12%; p = 0.04). Conclusions Individualized heparin and protamine
management decreased the protamine-to-heparin ratio, improved postbypass
thromboelastometric hemostatic parameters, and reduced the incidence of
severe blood loss compared with an ACT-based strategy, supporting the
added value of this approach for hemostatic optimization during cardiac
surgery.

<19>
Accession Number
2015752505
Authors
Guay J. Ochroch E.A.
Institution
(Guay) Department of Anesthesiology, University of Montreal, Montreal, QC,
Canada
(Ochroch) Department of Anesthesiology, University of Pennsylvania Health
System, Philadelphia, PA, United States
Title
Effects of adding statins before surgery on mortality and major morbidity:
A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (2) (pp 255-266),
2014. Date of Publication: 2014.
Publisher
W.B. Saunders
Abstract
Objective To re-evaluate the effects of adding a statin before surgery on
mortality at 30 days and at 1 year and on major morbidity at 0-30 days.
Design A meta-analysis of parallel, randomized, controlled trials
published in English. Setting A university-based electronic search.
Participants Adult patients undergoing any type of procedure. Intervention
Adding a statin before a procedure compared to a placebo or no
intervention. Measurements and Main Results A search for all randomized
controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the
Cochrane Central Register of Controlled Trials in November 2012. The
quality of each study was assessed with the Cochrane Collaboration Tools.
An I-square >25% was chosen as the cut-off point for heterogeneity
exploration. The search produced 29 trials. Statins reduced the 0-30 days'
risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61);
I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no
statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95),
acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10
(0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26
(0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was
slightly decreased with atorvastatin: standardized mean difference (SMD)
-0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p =
0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with
simvastatin SMD -0.04 (-0.41, 0.48). Conclusions Adding a statin before a
high risk cardiac procedure reduces the 0-30 days' risk of myocardial
infarction.

<20>
Accession Number
2015746015
Authors
Yang J. Zhang J. Cui W. Liu F. Xie R. Gu G. Zheng H. Lu J. Yang X. Zhang
G. Wang Q. Geng X.
Institution
(Yang, Zhang, Cui, Liu, Xie, Yang, Gu, Zheng, Lu, Yang, Zhang, Wang, Geng)
Department of Cardiology, Second Hospital of Hebei Medical University,
Shijiazhuang City, China
Title
Cardioprotective effects of single oral dose of nicorandil before
selective percutaneous coronary intervention.
Source
Anadolu Kardiyoloji Dergisi. 15 (2) (pp 125-131), 2015. Date of
Publication: 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey. E-mail: info@avesyayincilik.com)
Abstract
Objective: Nicorandil, an opener of ATP-sensitive K+ channels, was used to
treat angina in patients with coronary artery disease. In this study, we
aim to investigate the cardioprotective effects of single oral dose of
nicorandil in patients undergoing selective percutaneous coronary
intervention (PCI). Methods: One hundred and thirty-eight patients with
acute coronary syndrome undergoing PCI from July 2011 to October 2012 were
randomly divided into control group (group 1, n=47), 10 mg oral nicorandil
group (group 2, n=45), and 20 mg oral nicorandil group (group 3, n=46)
about 2 hours before procedure, respectively. Cardiac troponin I (cTnI)
levels were determined at 20 ~ 24 hours after PCI. Results: There was a
significant difference in the rate of any cTnI elevation among the three
groups (group 1: 36.17%, group 2: 20.00%, group 3: 15.22%, p=0.0176). With
respect to the frequency of cTnI elevation >3 and 5x the upper limit of
normal (ULN), there also had statistical difference among the three groups
(17.02% in group 1, 8.89% in group 2, and 4.35% in group 3, respectively
for cTnI elevation >3x ULN, p=0.0428; 12.77% in group 1, 6.67% in group 2,
and 2.17% in group 3, respectively, for cTnI elevation >5x ULN, p=0.0487).
Logistic regression analysis showed that LVEF (OR=0.915, 95%
CI=0.853-0.981) and the use of nicorandil (OR=0.516, 95% CI=0.267-0.996)
before PCI were independent protective factors of myocardial injury.
Conclusion: Single oral dose of nicorandil (10 mg, 20 mg) 2 hours before
the PCI procedure could decrease the incidence of peri-procedure
myocardial injury and PCI-related myocardial infarction.

<21>
Accession Number
2015751519
Authors
Hassani S. Alipour A. Darvishi Khezri H. Firouzian A. Emami Zeydi A.
Gholipour Baradari A. Ghafari R. Habibi W.-A. Tahmasebi H. Alipour F.
Ebrahim Zadeh P.
Institution
(Hassani, Darvishi Khezri, Tahmasebi) Department of Nursing, Faculty of
Medicine, Islamic Azad University, 7th km of Sea Road (Farah Abaad),
Firoozkande, Sari, Iran, Islamic Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Firouzian, Gholipour Baradari) Department of Anesthesiology, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Emami Zeydi) Department of Nursing, Faculty of Nursing and Midwifery,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Emami Zeydi) School of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Ghafari, Habibi) Department of Cardiac Surgery, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Alipour, Ebrahim Zadeh) ICU, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
Title
Can Valeriana officinalis root extract prevent early postoperative
cognitive dysfunction after CABG surgery? A randomized, double-blind,
placebo-controlled trial.
Source
Psychopharmacology. 232 (5) (pp 843-850), 2015. Date of Publication: March
2015.
Publisher
Springer Verlag
Abstract
Rationale: We hypothesized that valerian root might prevent cognitive
dysfunction in coronary artery bypass graft (CABG) surgery patients
through stimulating serotonin receptors and anti-inflammatory activity.
Objectives: The aim of this study was to evaluate the effect of Valeriana
officinalis root extract on prevention of early postoperative cognitive
dysfunction after on-pump CABG surgery. Methods: In a randomized,
double-blind, placebo-controlled trial, 61 patients, aged between 30 and
70 years, scheduled for elective CABG surgery using cardiopulmonary bypass
(CPB), were recruited into the study. Patients were randomly divided into
two groups who received either one valerian capsule containing 530 mg of
valerian root extract (1,060 mg/daily) or placebo capsule each 12 h for 8
weeks, respectively. For all patients, cognitive brain function was
evaluated before the surgery and at 10-day and 2-month follow-up by Mini
Mental State Examination (MMSE) test. Results: Mean MMSE score decreased
from 27.03+/-2.02 in the preoperative period to 26.52+/-1.82 at the 10th
day and then increased to 27.45+/-1.36 at the 60th day in the valerian
group. Conversely, its variation was reduced significantly after 60 days
in the placebo group, 27.37+/-1.87 at the baseline to 24+/-1.91 at the
10th day, and consequently slightly increased to 24.83+/-1.66 at the 60th
day. Valerian prophylaxis reduced odds of cognitive dysfunction compared
to placebo group (OR=0.108, 95 % CI 0.022-0.545). Conclusion: We concluded
that, based on this study, the cognitive state of patients in the valerian
group was better than that in the placebo group after CABG; therefore, it
seems that the use of V. officinalis root extract may prevent early
postoperative cognitive dysfunction after on-pump CABG surgery.

<22>
Accession Number
2015742015
Authors
Lim C.-H. Nam M.-J. Lee J.-S. Kim H.-J. Kim J.-Y. Shin H.-W. Lee H.-W. Sun
K.
Institution
(Lim, Shin, Lee) Department of Anesthesiology and Pain Medicine, Korea
University Medical Center, Seoul, South Korea
(Nam) College of Medicine, Korea University, Seoul, South Korea
(Lee) Biostatistical Consulting Unit, Soonchunhyang University Medical
Center, Seoul, South Korea
(Kim) Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital,
Inje University, Seoul, South Korea
(Sun) Department of Thoracic and Cardiovascular Surgery, Korea University
Medical Center, Seoul, South Korea
Title
A Meta-Analysis of Pulmonary Function With Pulsatile Perfusion in Cardiac
Surgery.
Source
Artificial Organs. 39 (2) (pp 110-117), 2015. Date of Publication: 01 Feb
2015.
Publisher
Blackwell Publishing Inc.
Abstract
The aim of this study was to determine whether pulsatile or nonpulsatile
perfusion had a greater effect on pulmonary dysfunction in randomized
controlled trials. MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were used to identify available articles published
before April 13, 2013. A meta-analysis was conducted on the effects of
pulsatile perfusion on postoperative pulmonary function, intubation time,
and the lengths of intensive care unit (ICU) and hospital stays. Eight
studies involving 474 patients who received pulsatile perfusion and 496
patients who received nonpulsatile perfusion during cardiopulmonary bypass
(CPB) were considered in the meta-analysis. Patients receiving pulsatile
perfusion had a significantly greater PaO₂/FiO₂
ratio 24h and 48h post-operation (P<0.00001, both) and significantly lower
chest radiograph scores at 24h and 48h post-operation (P<0.00001 and
P=0.001, respectively) compared with patients receiving nonpulsatile
perfusion. The incidence of noninvasive ventilation for acute respiratory
insufficiency was significantly lower (P<0.00001), and intubation time and
ICU and hospital stays were shorter (P=0.004, P<0.00001, and P<0.00001,
respectively) in patients receiving pulsatile perfusion during CPB
compared with patients receiving nonpulsatile perfusion. In conclusion,
our meta-analysis suggests that the use of pulsatile flow during CPB
results in better postoperative pulmonary function and shorter ICU and
hospital stays.

<23>
Accession Number
2015740491
Authors
Wang J.-G. Han J. Jiang T. Li Y.-J.
Institution
(Wang, Li) Department of Pathology, Affiliated Hospital of Qingdao
University, 16 Jiangsu Road, Qingdao 266003, China
(Han) Department of Pathology, Zhongshan Hospital, Fudan University,
Shanghai, China
(Jiang) Department of Oncology, Affiliated Hospital of Qingdao University,
Qingdao, China
Title
Cardiac paragangliomas.
Source
Journal of Cardiac Surgery. 30 (1) (pp 55-60), 2015. Date of Publication:
01 Jan 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Cardiac paraganglioma is a rare entity. We review the clinical data from
158 patients reported in 132 isolated papers, and discuss clinical
presentations, imaging findings, pathology, location, therapy, and
outcomes. doi: 10.1111/jocs.12455 (J Card Surg 2015;30:55-60)

<24>
Accession Number
2015740729
Authors
Ruiz Ortiz M. Pena M.L. Mesa D. Delgado M. Romo E. Santisteban M. Puentes
M. Lopez Granados A. Castillo J.C. Arizon J.M. De Lezo J.S.
Institution
(Ruiz Ortiz, Pena, Mesa, Delgado, Romo, Santisteban, Puentes, Lopez
Granados, Castillo, Arizon, De Lezo) Cardiology Department, Reina Sofia
University Hospital, Cordoba, Spain
Title
Impact of asymptomatic acute cellular rejection on left ventricle
myocardial function evaluated by means of two-dimensional speckle tracking
echocardiography in heart transplant recipients.
Source
Echocardiography. 32 (2) (pp 229-237), 2014. Date of Publication: 01 Feb
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Our objective was to evaluate the impact of asymptomatic acute
cellular rejection (ACR) in left ventricular myocardial strain in heart
transplant (HT) recipients by means of two-dimensional speckle tracking
echocardiography (2DSTE). Methods From September 1, 2009 to December 15,
2010 a conventional echocardiography and 2DSTE exam was performed on all
consecutive HT recipients in their first year posttransplantation within 3
hours of the surveillance endomyocardial biopsies, as well as on 14
healthy controls. The association of strain echocardiographic variables
with different grades of ACR was investigated. Results Of the 78 studies
performed 4 +/- 3 months after HT in 20 patients, 32 studies were
coincident with grade 0R rejection, 41 with grade 1R, and 5 with grade 2R.
Significantly lower values of average radial strain were found with higher
grades of ACR (29.1 +/- 7.7%, 23.2 +/- 8.5%, and 14.3 +/- 8.8% for grades
0R, 1R, and 2R of ACR, P = 0.001). Average deformation was similar for
controls versus transplanted patients, in the absence of acute rejection:
radial 29.1 +/- 10.0% versus 29.1 +/- 7.7%, P = 0.98; circumferential
-19.3 +/- 3.2% versus -20.2 +/- 5.9%, P = 0.62; and longitudinal -20.7 +/-
4.1% versus -18.5 +/- 5.4%, P = 0.19. An average radial strain <25%
presented 100% sensitivity, 48% specificity, 6% positive predictive value,
and 100% negative predictive value for the presence of 2R rejection (area
under the curve 0.80, IC 95% 0.60-0.99, P = 0.048). Conclusion In this
study, HT recipients showed significantly lower values of average radial
left ventricle strain, evaluated by means of 2DSTE, with the presence of
ACR.

<25>
Accession Number
2015737881
Authors
Han Y. Xu B. Jing Q. Lu S. Yang L. Xu K. Li Y. Li J. Guan C. Kirtane A.J.
Yang Y.
Institution
(Han, Jing, Xu, Li, Li) Department of Cardiology, General Hospital of
Shenyang Military Region, 83 Wenhua Road, Shenhe District, Shenyang
110016, China
(Xu, Guan, Yang) Fu Wai Hospital, National Center for Cardiovascular
Diseases, Beijing, China
(Lu) Affiliated Anzhen Hospital of Capital Medical University, Beijing,
China
(Yang) Kunming General Hospital of Chengdu Military Region, Kunming, China
(Kirtane) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
Title
A randomized comparison of novel biodegradable polymer-and durable
polymer-coated cobalt-chromium sirolimus-eluting stents.
Source
JACC: Cardiovascular Interventions. 7 (12) (pp 1352-1360), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to investigate the hypothesis that a
novel biodegradable polymer-coated, cobalt-chromium (CoCr),
sirolimus-eluting stent (BP-SES) is noninferior in safety and efficacy
outcomes compared with a durable polymer (DP)-SES. Background: No
randomized trials have the compared safety and efficacy of BP-SES versus
DP-SES on similar CoCr platforms, thereby isolating the effect of the
polymer type. Methods: In this prospective, single-blind, randomized trial
conducted at 32 Chinese sites, 2,737 patients eligible for coronary
stenting were treated with BP- or DP-SES in a 2:1 ratio. The primary
endpoint was 12-month target lesion failure (TLF), a composite of cardiac
death, target vessel myocardial infarction, or clinically indicated target
lesion revascularization. Secondary endpoints included TLF components, and
definite/probable stent thrombosis. Results: At 12 months, the difference
in the primary endpoint of TLF between BP-SES (6.3%) and DP-SES (6.1%)
groups was 0.25% (95% confidence interval: -1.67% to 2.17%, p for
noninferiority = 0.0002), demonstrating noninferiority of BP-SES to
DP-SES. Individual TLF components of cardiac death (0.7% vs. 0.6%, p =
0.62), target vessel myocardial infarction (3.6% vs. 4.3%, p = 0.39), and
clinically indicated target lesion revascularization (2.6% vs. 2.2%, p =
0.50) were similar, as were low definite/probable stent thrombosis rates
(0.4% vs. 0.6%, p = 0.55). Conclusions: In this large-scale real-world
trial, BP-SES was noninferior to DP-SES for 1-year TLF. (Evaluate Safety
and Effectiveness of the Tivoli DES and the Firebird DES for Treatment
of Coronary Revascularization;. NCT01681381).

<26>
Accession Number
2015730454
Authors
Phan K. Xie A. Tsai Y.-C. Kumar N. La Meir M. Yan T.D.
Institution
(Phan, Xie, Yan) Collaborative Research (CORE) Group, Macquarie University
Hospital, Macquarie University, 2 Technology Place, Sydney, Australia
(Phan) Sydney Medical School, University of Sydney, Sydney, Australia
(Tsai) Prince Charles Hospital, Chermside, Australia
(Kumar, La Meir) Department of Cardiothoracic Surgery and Cardiology,
Academic Hospital Maastricht, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(La Meir) University Hospital Brussels, Brussels, Belgium
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Biatrial ablation vs. left atrial concomitant surgical ablation for
treatment of atrial fibrillation: A meta-analysis.
Source
Europace. 17 (1) (pp 38-47), 2015. Date of Publication: 25 Nov 2014.
Publisher
Oxford University Press
Abstract
Aims Surgical ablation performed concomitantly with cardiac surgery has
emerged as an effective curative strategy for atrial fibrillation (AF).
Left atrial (LA) lesion sets for ablation have been suggested to reduce
procedural times and post-surgical bradycardia compared with biatrial (BA)
lesions. Given the inconclusive literature regarding BA vs. LA ablation,
the present meta-analysis sought to assess the current evidence. Methods
and results Electronic searches were performed using six databases from
their inception to December 2013, identifying all relevant randomized
trials and observational studies comparing BA vs. LA surgical ablation AF
patients undertaking cardiac surgery. In 10 included studies, 2225 patient
results were available for analysis to compare BA (n = 888) vs. LA (n =
1337) ablation. Sinus rhythm prevalence was higher in the BA cohort
compared with the LA cohort at 6-month and 12-month follow-up, but similar
beyond 1 year. Permanent pacemaker implantations were higher in the BA
cohort, but 30-day and late mortality, neurological events, and
reoperation for bleeding were similar between BA and LA groups.
Conclusions Biatrial and LA ablations produced comparable 30-day and late
mortality but LA was associated with significantly reduced permanent
pacemaker implantation rates. Biatrial ablation appeared to be more
efficacious than LA ablation in achieving SR at 1 year, but this
difference was not maintained beyond 1 year. Trends appear to be driven by
the preferential selection of long-standing and persistent AF patients for
the BA approach. Future randomized studies of adequate follow-up are
required to validate risks and benefits of BA vs. LA surgical ablation.

<27>
Accession Number
2015739868
Authors
Gkegkes I.D. Mourtarakos S. Gakidis I.
Institution
(Gkegkes, Gakidis) Department of Thoracic Surgery, General Hospital of
Attica 'KAT', Athens, Greece
(Mourtarakos) Department of Surgery, Korinthos General Hospital, Corinth,
Greece
Title
Endobronchial valves in treatment of persistent air leaks: A systematic
review of clinical evidence.
Source
Medical Science Monitor. 21 (pp 432-438), 2015. Date of Publication: 09
Feb 2015.
Publisher
International Scientific Literature Inc.
Abstract
Background: Persistent air leak is one of the most common complications of
lung diseases and pulmonary resections. Prolonged hospitalization,
increased morbidity, and increased overall treatment costs arise from
persistent air leaks. The use of endobronchial valves (EBVs) in the
management of air leaks is an important alternative, especially for
patients who are not candidates for surgical treatment. Material/Methods:
We retrieved the included studies by performing a systematic search in
PubMed and Scopus databases. The references of the included studies were
also hand-searched. Results: We retrieved 25 case reports and 3 case
series from our literature search. The most common cause of persisting air
leaks was spontaneous secondary pneumothorax (12/39, 31%). The left upper
lobe (13/39, 33%) and right upper lobe (14/39, 36%) were the most frequent
locations of air leaks. Most air leaks treated with EBVs ceased in less
than 24 h. Three recurrences of air leak were reported and 2 cases of EBV
migration were described. No deaths were reported in correlation with
EBVs. Conclusions: EBVs are a minimally invasive therapeutical option that
may be suitable for the treatment of persistent air leaks regardless of
the initial cause, especially in high-risk patients. Nevertheless, studies
with better methodological quality are essential to standardize this
technique and to provide more evidence on EBV safety issues.

<28>
Accession Number
71788319
Authors
Logvin M.R. Murawski T. Dorotta I. Brauer S. Lauer R. Razzouk A.
Institution
(Logvin) Anesthesiology, Loma Linda University Medical Center, Highland,
CA, United States
(Murawski, Dorotta, Brauer, Lauer, Razzouk) Anesthesiology, Loma Linda
University Medical Center, Loma Linda, CA, United States
Title
Effects of protective lung strategies on clinical outcome after
cardiopulmonary bypass in patients without pre-existing lung injury.
Source
Anesthesia and Analgesia. Conference: 2010 Annual Meeting of the
International Anesthesia Research Society, IARS 2010 Honolulu, HI United
States. Conference Start: 20100320 Conference End: 20100323. Conference
Publication: (var.pagings). 110 (3 SUPPL. 1) (pp S95), 2010. Date of
Publication: March 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : A systemic inflammatory response occurs in patients
following cardiac surgery(1). Multiple factors such as surgical trauma,
cardiopulmonary bypass, general anesthesia with mechanical ventilation,
rapid cooling and warming and blood administration contribute to that
response(2). Previous studies show that ventilating the lungs with lower
tidal volumes (Tv) and utilizing open lung ventilation (use of PEEP and
CPAP during CPB) may attenuate this increase in inflammatory
mediators(2,3,4). We hypothesize that protective lung ventilatory strategy
will decrease lung inflammation and that this decrease will improve
clinical outcome after CPB in patients without preexisting lung injury.
Methods : We designed a prospective, randomized, controlled study to
ascertain if implementing a 'protective lung strategy' would decrease
inflammation and if this, in turn, would translate into more favorable
clinical outcomes. All patients who were scheduled for cardiac surgery
with cardiopulmonary bypass were randomized into one of two groups. Those
in the experimental arm (Ve), once intubated were ventilated using tidal
volume of 6mL/kg of ideal body weight, PEEP of 5cm H2O both before and
after CPB, and CPAP during CPB. Those patients randomized to the control
arm (Vc), were ventilated with a tidal volume of 10mL/kg of ideal body
weight, no PEEP and no CPAP was used during CPB. The protocol was
discontinued once the patient reached the ICU and ventilator management
was transferred to the ICU team. Post-operative data was analyzed for
clinical outcomes. Results : Interim analysis of 51 consented subjects, 47
underwent protocol dictated ventilator settings. 10 were excluded from
analysis due to baseline lung injury (P/F <200), surgeon insistence, case
cancellation, re-operation, and failed attempt to extubate. 18 subjects
were randomized to experimental arm (Ve) and 19 randomized to control arm
(Vc). Time to extubation for Ve arm vs Vc arm was 481 minutes vs. 325
minutes respectively (p=.091). Time to discharge for Ve arm vs Vc arm was
140 hours vs. 123 hours respectively (p=.217). Total CT output and
presence of dysrhythmia for Ve vs Vc were 1185 mL vs. 1194 mL (p=.969) and
56% vs 42% (p=.869), respectively. Interim analysis did not capture any
incidence of ALI, ARDS, Sepsis or Septic shock. Discussion : Interim
analysis shows no difference thus far in clinical outcomes. Both arms had
similar hospital length of stay; similar total chest tube output; similar
rates of dysrhythmias and incidence of acute renal failure. We cannot
comment on trends as the sample size is small and only includes about 20%
of planned subjects to be randomized. We are still tabulating data and
enrolling subjects.

<29>
Accession Number
71788315
Authors
Abdelmalak J.B. Abdelmalak B. You J. Kurz A. Daniel S.
Institution
(Abdelmalak, Abdelmalak, You) General Anesthesia, Anesthiology Institute,
Cleveland, OH, United States
(Kurz, Daniel) Department of Outcomes Research Anesthesia, Anesthiology
Institute, Cleveland, OH, United States
Title
Association of statins and beta blockers with pre-operative CRP levels in
non cardiac surgery patients.
Source
Anesthesia and Analgesia. Conference: 2010 Annual Meeting of the
International Anesthesia Research Society, IARS 2010 Honolulu, HI United
States. Conference Start: 20100320 Conference End: 20100323. Conference
Publication: (var.pagings). 110 (3 SUPPL. 1) (pp S90), 2010. Date of
Publication: March 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Mounting evidence is indicating the usefulness of elevated
pre-operative CRP levels in predicting post-operative morbidity and
mortality. Statins have been shown to improve postoperative morbidity and
mortality presumably through anti-inflammatory effects. beta blockers have
been shown to improve postoperative outcomes in certain populations, a
proposed mechanism is its anti-inflammatory property We hypothesized that
the pre-operative CRP level is indirectly related to the administration of
statins, beta blockers and that their effects are additive. Methods :
After IRB approval, patients scheduled for major non cardiac surgery under
general anesthesia were enrolled in the DeLiT Trial. The Dexamethasone,
Light Anesthesia and Tight Glucose control (GC) Randomized Controlled
Trial (DeLiT Trial) is conducted to study the effects of these three
interventions on outcomes. CRP levels were collected pre-operatively. We
report on pre-operative CRP levels in patients with and without statins /
beta blockers treatment. The interaction between statin use and beta
blocker use and the main effects of each were assessed univariably and
also multivariably by adjusting for other demographic and baseline
variables using analysis of covariance (ANCOVA). Results were considered
statistically significant when P < 0.05. Results : Data from 193 patients
with completed records of preoperative CRP level, statins and Beta Blocker
treatment were analyzed. In our sample, the median [Q1, Q3] of the
pre-operative CRP levels of the patients with (N=85) and without statins
treatment (N=108) were 3.65 [1.51, 9.15] mg/L, and 4.33 [2.02, 9.45]
respectively. For patients with (N=88) and without (N=105) beta blockers
treatment the pre-operative CRP were 4.03 [1.96, 9.23], and 4.00 [1.69,
9.60] mg/L respectively. (Fig 1) Neither statin use nor beta-blocker use
was related to CRP levels, either univariably or after adjusting for
baseline variables (Table 1). Further, no interaction between statin use
and beta-blocker use was found. Discussion : Our data indicates that there
is no apparent association between statins or beta-blockers on
pre-operative CRP levels in this population. This is contrary to the
common belief that the perioperative protective effects of statin and to a
lesser extent, beta blockers is through an anti-inflammatory effect.
However, as we investigate other plausible mechanisms, this theory should
not be excluded all together. Yet to be determined is whether statins and/
or beta blockers treated patients experience less rise in their CRP
post-operatively i.e. they modulate the perioperative inflammatory
response, rather than improving the base-line state which they don't
according to our findings, and whether that indeed correlates with better
outcomes. (Figure Presented).

<30>
Accession Number
71788257
Authors
Raghunathan K. Kanter G.J. Connelly N.R.
Institution
(Raghunathan, Kanter, Connelly) Department of Anesthesiology, Tufts
University, School of Medicine, Springfield, MA, United States
Title
Clinical value in cardiac anesthesia : More lessons from the BART study.
Source
Anesthesia and Analgesia. Conference: 2010 Annual Meeting of the
International Anesthesia Research Society, IARS 2010 Honolulu, HI United
States. Conference Start: 20100320 Conference End: 20100323. Conference
Publication: (var.pagings). 110 (3 SUPPL. 1) (pp S30), 2010. Date of
Publication: March 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : The 'Blood Conservation Using Antifibrinolytics in a
Randomized Trial' (BART)1 is the largest head-to-head study comparing the
three commonly used antifibrinolytics during high-risk cardiac surgery:
aprotinin with epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA).
These investigators concluded that despite a modest reduction in the risk
of massive bleeding, aprotinin was associated with a significant negative
mortality trend. Later, Henry et al2 in their recent meta-analysis
(including BART data) also concluded that the mortality risk was higher
with aprotinin. The FDA suspended marketing and distribution of aprotinin
in November 2007. Current guidelines3 do support the use of EACA and TXA
to reduce blood loss during certain cardiac surgeries. We used the BART
data to compare EACA with TXA: a pair-wise comparison that has not been
reported previously. We also introduce the concept of 'clinical value' as
it applies to the choice of lysine analogue. Methods : After obtaining
appropriate permission, we used data from tables in the BART supplementary
appendix to perform relative risk calculations for several outcomes. We
present the third pair-wise comparison (EACA versus TXA) not reported in
the BART publication. The Bonferroni correction was used (corrected alpha
= 0.05/3 = 0.0167) with the corresponding confidence interval of 98.33%.
The Newcombe-Wilson method without continuity correction4 was used to
calculate confidence intervals. Results : Tranexamic Acid (TXA, n=770)
versus Epsilon- Aminocaproic Acid (EACA, n=780). Discussion : When
appraising different therapies, one should evaluate several outcomes
including clinical measures, functional and cost measures, and, perceived
benefit. This type of 'clinical value' analysis represents a new paradigm
5, especially in this era of Comparative Effectiveness Research. The
clinical value equation can be viewed as: Clinical Value = Function of
{(Quality / Costs) * Volume}. In other words, clinical value may be
improved by decreasing costs while holding quality constant5. At our
institution the direct pharmacy costs for equivalent amounts of EACA and
TXA, used as per the BART protocol, are $2.40 versus $540.00. Based on our
table, these therapies appear largely equivalent, despite the slight
reduction in FFP use with TXA (use of other blood products did not
differ). Applied to 200 such operations per year, estimated annual savings
may be over $100,000. Admittedly indirect costs along with the various
risks and benefits of blood product utilization need to be accounted for.
Also, Medicare makes reimbursements per the Diagnosis-Related Group where
charge is not as important as cost. In conclusion , the clinical value of
EACA for high-risk cardiac surgery appears credible. (Table Presented).