Saturday, March 28, 2015

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 19

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<1>
Accession Number
2014727661
Authors
Besic K.M. Strozzi M. Margetic E. Bulum J. Kolaric B.
Institution
(Besic, Strozzi, Margetic, Bulum) Department of Cardiovascular Medicine,
University Hospital Centre Zagreb, Zagreb, Croatia
(Kolaric) Department for Social Medicine and Epidemiology, Medical School,
University of Rijeka, Rijeka, Croatia
Title
Drug-eluting balloons in patients with non-ST elevation acute coronary
syndrome.
Source
Journal of Cardiology. 65 (3) (pp 203-207), 2015. Date of Publication: 01
Mar 2015.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We compared efficacy of bare-metal stent (BMS) and
drug-eluting balloon (DEB) combination vs BMS alone, in patients with
non-ST elevation acute coronary syndrome treated with percutaneous
coronary intervention (PCI). Methods: Patients with non-ST elevation
myocardial infarction (NSTEMI) or unstable angina (UA) were randomized to
BMS only or BMS. +. DEB group. Angiographic follow-up was performed after
6 months. The primary endpoints were binary in-stent restenosis (ISR) and
late lumen loss (LLL) and the secondary endpoints were target lesion
revascularization (TLR), stent thrombosis (ST), and new acute coronary
syndrome (ACS). Results: A total of 85 patients were enrolled, 44 (BMS)
and 41 (BMS. +. DEB). The median age was 67 (36-84) years and 68 (80%)
were male. Fifty-two patients (61.2%) had NSTEMI and 33 patients (38.8%)
UA. There was no difference in patient demographics, risk factors, and
clinical characteristics, except for more smokers in the BMS. +. DEB group
18/41 (43.9%) vs 9/44 (20.5%). At follow-up, no significant difference in
binary ISR was found; p=. 0.593, but LLL was significantly lower in the
BMS. +. DEB group 0.68 (0.00-2.15) mm vs 0.22 (0.00-2.35) mm; p=. 0.002.
The difference in major adverse cardiac events (MACE) rate combining TLR,
ST, and ACS, between the groups was also non-significant, 29.5% (BMS) vs
24.4% (BMS. +. DEB); p=. 0.835. One patient had a subacute ST (BMS. +.
DEB) due to clopidogrel resistance. Conclusion: Patients treated with BMS.
+. DEB combination for non-ST elevation acute coronary syndrome had
significantly less LLL in comparison to patients treated with BMS alone
but without an impact on patient clinical outcomes.

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

<3>
Accession Number
2015830629
Authors
Linni K. Aspalter M. Butturini E. Dabernig W. Guggenbichler S. Hitzl W.
Holzenbein T.
Institution
(Linni, Aspalter, Butturini, Dabernig, Guggenbichler, Holzenbein)
Department of Vascular and Endovascular Surgery, PMU Salzburg, Mullner
Hauptstrasse 48, Salzburg A-5020, Austria
(Hitzl) Department of Biostatistics, PMU, Salzburg, Austria
Title
Arm veins versus contralateral greater saphenous veins for lower extremity
bypass reconstruction: Preliminary data of a randomized study.
Source
Annals of Vascular Surgery. 29 (3) (pp 551-559), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Inc.
Abstract
Background The aim of this randomized study was to determine whether arm
vein (AV) or contralateral greater saphenous vein (CGSV) is the better
alternative vein source for lower extremity bypass reconstruction. Methods
Consecutive patients with absent ipsilateral greater saphenous vein
undergoing lower extremity revascularization were allocated to group A (AV
bypass) or B (CGSV bypass). Results From 6, 2010, to 11, 2013, 64 patients
(32 each group) were randomized. In all, 29 of 93 patients had to be
excluded for various reasons. Median age was 76 years vs. 71 years (P =
0.01) for group A and B patients. There were no statistically significant
differences regarding gender, cardiovascular risk factors, redo bypass
procedures (P = 0.77), below-knee bypass procedures (P = 0.61), median
bypass length (P = 0.6), and median length of incision on ipsilateral leg
to perform anastomoses (P = 0.2) between group A and B patients,
respectively. Incisions for vein harvest were longer in group A (P =
0.003). Overall surgical site infections (SSIs, P = 1.0) and SSI from vein
harvest (P = 1.0) were equally distributed. No patient was lost to
follow-up (17 vs. 18 months, P = 0.74). There was no statistically
significant difference regarding primary (P = 0.77) and secondary (P =
0.25) patency rates at 1 year (group A: 52% vs. group B: 54% and group A:
72% vs. group B: 61%) and at 2 years (52% vs. 48% and 64% vs. 61%),
respectively. There were 4 vs. 6 major amputations (P = 0.23) and 5 vs. 2
deaths (P = 0.1) in groups A and B during follow-up. Conclusions
Preliminary results suggest that both AV and CGSV may serve as a secondary
vein bypass graft equally well.

<4>
Accession Number
2015833633
Authors
Miao X. Liu J. Zhao M. Cui Y. Feng Z. Zhao J. Long C. Li S. Yan F. Wang X.
Hu S.
Institution
(Miao, Liu, Zhao, Cui, Feng, Zhao, Long) Department of Cardiopulmonary
Bypass, Cardiovascular Institute, Fuwai Hospital, No 167, Bei Li Shi Road
Xi Cheng, Beijing 100037, China
(Li, Wang, Hu) Department of Cardiac Surgery, Fuwai Hospital, Chinese
Academy of Medical Science, Beijing, China
(Yan) Department of Anesthesiology, Fuwai Hospital, Chinese Academy of
Medical Science, Beijing, China
Title
Evidence-based use of FFP: The influence of a priming strategy without FFP
during CPB on postoperative coagulation and recovery in pediatric
patients.
Source
Perfusion (United Kingdom). 30 (2) (pp 140-147), 2015. Date of
Publication: 16 Mar 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective: Although fresh frozen plasma (FFP) is one of the most commonly
used hemostatic agents in clinical specialties today, there is little
evidence available supporting its administration. Our present study
observed the effects of a priming strategy without FFP during
cardiopulmonary bypass (CPB) on postoperative coagulation and clinical
recovery in pediatric patients, aiming to supply new evidence for
evidence-based use of FFP. Method: Eighty pediatric patients with
congenital heart disease undergoing cardiac surgery with CPB were
randomized to receive either 10-20 ml/kg 4% succinylated gelatin
(Gelofusine, GEL group, n = 40) or 1-2 units FFP (FFP group, n = 40) in
the pump prime. Rapid-thromboelastography (r-TEG) and functional
fibrinogen level were measured before skin incision and 15 minutes after
heparin reversal. We recorded the volume of chest tube drainage,
transfusion requirements and the dosage of pharmacological agents. The
ventilation time, ICU length of stay and hospitalization time after
surgery were also collected. Results: After heparin neutralization, there
were significantly elevated levels of fibrinogen in the FFP group, which
were manifested by r-TEG parameters MAf and FLEV. No significant
differences were observed between the two groups in postoperative
bleeding, transfusion requirements and the usage of pharmacological
agents. Recovery time was also comparable between the two groups.
Conclusion: In conclusion, prophylactic use of FFP in the priming solution
does not provide clinical benefits as presumed. Artificial colloids, such
as Gelofusine, can be used safely and effectively as a substitute for FFP
in the pump prime. TEG is an effective assessment tool to evaluate
postoperative coagulation function in pediatric patients.

<5>
Accession Number
2015834339
Authors
Hu X.-Q. Cheng J. Tang B. Zhang Z.-H. Huang K. Yang Y.-P. Mao Y.-Y. Zhong
M. Fu S.-W.
Institution
(Hu, Cheng, Tang, Huang, Yang, Mao, Zhong, Fu) Department of
Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000,
China
(Zhang) Department of Critical Care Medicine, Jinhua Municipal Central
Hospital, Jinhua 321000, China
Title
Clinical effect of postconditioning in ST-elevation myocardial infarction
patients treated with primary percutaneous coronary intervention: a
meta-analysis of randomized controlled trials.
Source
Journal of Zhejiang University: Science B. 16 (3) (pp 198-207), 2015. Date
of Publication: 2015.
Publisher
Zhejiang University Press (Hangzhou Post Bureau, Hangzhou 310000, China)
Abstract
Objective: To evaluate the clinical effect of postconditioning on patients
with ST-elevation myocardial infarction (STEMI) treated with primary
percutaneous coronary intervention (PCI).
Methods: Randomized controlled trials were identified by searching
relevant databases published up to April 2nd, 2014. A meta-analysis of
eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a
fixed-effect model.
Results: Ten studies providing adverse cardiac events in a total of 1346
STEMI patients treated with primary PCI were identified. The occurrence of
heart failure was significantly reduced in patients treated with
postconditioning compared with usual care (risk ratio (RR) 0.533; 95%
confidence intervals (CI) 0.368-0.770), whereas non-fatal reinfarction
slightly increased in the postconditioning group (RR 2.746; 95% CI
1.007-7.488). No significant difference in total major adverse cardiac
events (MACEs) was observed between the two groups (RR 0.876; 95% CI
0.671-1.144).
Conclusions: Postconditioning in STEMI patients undergoing primary PCI
significantly reduces the risk of heart failure, but fails to decrease the
incidence of total MACEs and the risk of non-fatal reinfarction.

<6>
Accession Number
2015824932
Authors
Kim S.H. Sung J.-H. Shin J. Lee H.J. Lee H.S. Cho D.K. Lim S.W.
Institution
(Kim, Sung, Lim) Department of Cardiology, CHA University, CHA Bundang
Medical Center, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do
463-712, South Korea
(Shin) Department of Cardiology, Hanyang University Medical Center, Seoul,
South Korea
(Lee) Department of Cardiology, Sejong General Hospital, Bucheon, South
Korea
(Lee) Department of Cardiology, CHA Gumi Medical Center, CHA University,
Gumi, South Korea
(Cho) Department of Cardiology, Myongji Hospital, Goyang, South Korea
Title
Assessment of the efficacy and tolerability of clopidogrel napadisilate in
Korean patients with coronary stenting: A multicenter, prospective,
open-label, randomized trial.
Source
Current Medical Research and Opinion. 31 (3) (pp 449-457), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Informa Healthcare
Abstract
Objective: Clopidogrel is indicated for the treatment and prevention of
peripheral vascular, cerebrovascular, and coronary artery diseases. This
clinical trial was designed to demonstrate that clopidogrel napadisilate
(CN) is not inferior to clopidogrel bisulfate (CB) with respect to its
effectiveness in inhibiting platelet aggregation. Methods: This 4 week
multi-center, prospective, open-label, randomized trial was conducted at
five clinical centers in South Korea. Patients were randomized into the
75mg CN group or the 75mg CB group. Platelet aggregation was assessed by
the VerifyNow assay. The primary outcome was the difference of the
percentage P2Y12 inhibition and the secondary outcome was the baseline and
change in P2Y12 reaction units (PRU). Results: There was no significant
difference in the percentage P2Y12 inhibition (CN vs. CB, 34.92+/-21.33%
vs. 30.43+/-17.90%, p=0.203). The mean difference of the percentage P2Y12
inhibition between groups was 4.49%, their two-sided 95% confidence
interval was-2.45% to 11.44%, and the lower bound (-2.45%) was greater
than the acceptable non-inferiority margin of-9.0%. The baseline PRU was
96.67+/-76.76 in the CN group and 216.95+/-68.86 in the CB group
(p=0.121), and the change in the PRU was-3.32+/-51.71 in the CN group and
10.52+/-43.31 in the CB group (p=0.106). Four subjects experienced AEs
(6.3%, 5 events) in the CN group and 7 subjects (11.11%, 13 events) in the
CB group without statistical significance (p=0.364). With respect to
serious adverse events, 2 events were reported in 2 subjects, 1 in each
group. Conclusion: Clopidogrel napadisilate was not inferior to
clopidogrel bisulfate in terms of antiplatelet efficacy and tolerability,
and there were no clinically significant adverse events.

<7>
Accession Number
2015830842
Authors
Tamborini Permunian E. Riva N. Guasti L. Squizzato A.
Institution
(Tamborini Permunian, Riva, Guasti, Squizzato) University of Insubria,
Research Center on Thromboembolic Disorders and Antithrombotic Therapies,
Department of Clinical and Experimental Medicine, Viale Borri 57, Varese
21100, Italy
Title
Cangrelor for the treatment of arterial thrombosis:
Pharmacokinetics/pharmacodynamics and clinical data.
Source
Expert Opinion on Drug Metabolism and Toxicology. 11 (4) (pp 625-637),
2015. Date of Publication: 01 Apr 2015.
Publisher
Informa Healthcare
Abstract
Introduction: Dual antiplatelet therapy is the standard of care for
patients with acute coronary syndromes or with recent coronary stents
implantation. P2Y12 receptor antagonists have shown to reduce the risk of
recurrent ischemic events among these patients, at the expense of an
increased risk of bleeding. Cangrelor is a novel, intravenous,
short-acting, reversible platelet P2Y12 inhibitor, which has been
evaluated for the treatment of arterial thrombosis.Areas covered: Studies
on the pharmacological characteristics of cangrelor and clinical trials
were retrieved by a PubMed literature search.Expert opinion: Cangrelor has
been tested in patients with coronary artery diseases undergoing
percutaneous coronary intervention and as bridging therapy for patients
undergoing coronary artery bypass graft. The rapid peak of action allows a
fast and complete inhibition of platelet aggregation; the rapid offset is
advantageous in case of bleeding complications; and finally, the
intravenous administration also makes this drug suitable for patients
unable to consume oral medications. Unfortunately, the large clinical
trials evaluating cangrelor in percutaneous coronary intervention did not
show superiority to the standard antiplatelet therapy, and its future use
in this setting still needs to be better assessed. Conversely, when used
as bridging therapy to coronary artery bypass graft, cangrelor showed
promising results.

<8>
Accession Number
2015820577
Authors
Sibilitz K.L. Berg S.K. Hansen T.B. Risom S.S. Rasmussen T.B. Hassager C.
Kober L. Gluud C. Thygesen L.C. Lindschou J. Schmid J.P. Taylor R.S.
Zwisler A.-D.
Institution
(Sibilitz, Berg, Risom, Rasmussen, Hassager, Kober, Zwisler) The Heart
Centre, Department of Cardiology, Rigshospitalet, Copenhagen, University
Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Berg, Rasmussen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Sibilitz, Berg, Thygesen, Taylor, Zwisler) National Institute of Public
Health, University of Southern Denmark, Copenhagen, Denmark
(Hansen) Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
(Gluud, Lindschou) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Schmid) Cardiology Clinic, Tiefenau Hospital and University of Bern,
Bern, Switzerland
(Taylor) University of Exeter Medical School, Health Services Research,
University of Exeter, Exeter, Devon, United Kingdom
(Zwisler) Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark
Title
Update to the study protocol, including statistical analysis plan for a
randomized clinical trial comparing comprehensive cardiac rehabilitation
after heart valve surgery with control: The CopenHeartVR trial.
Source
Trials. 16 (1) , 2015. Article Number: 38. Date of Publication: February
05, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Heart valve diseases are common with an estimated prevalence
of 2.5% in the Western world. The number is rising because of an ageing
population. Once symptomatic, heart valve diseases are potentially lethal,
and heavily influence daily living and quality of life. Surgical
treatment, either valve replacement or repair, remains the treatment of
choice. However, post-surgery, the transition to daily living may become a
physical, mental and social challenge. We hypothesize that a comprehensive
cardiac rehabilitation program can improve physical capacity and
self-assessed mental health and reduce hospitalization and healthcare
costs after heart valve surgery. Methods: This randomized clinical trial,
CopenHeart<sub>VR</sub>, aims to investigate whether cardiac
rehabilitation in addition to usual care is superior to treatment as usual
after heart valve surgery. The trial will randomly allocate 210 patients
1:1 to an intervention or a control group, using central randomization,
and blinded outcome assessment and statistical analyses. The intervention
consists of 12 weeks of physical exercise and a psycho-educational
intervention comprising five consultations. The primary outcome is peak
oxygen uptake (VO<sub>2</sub> peak) measured by cardiopulmonary exercise
testing with ventilatory gas analysis. The secondary outcome is
self-assessed mental health measured by the standardized questionnaire
Short Form-36. Long-term healthcare utilization and mortality as well as
biochemistry, echocardiography and cost-benefit will be assessed. A
mixed-method design will be used to evaluate qualitative and quantitative
findings, encompassing a survey-based study before the trial and a
qualitative pre-and post-intervention study. Conclusion: This randomized
clinical trial will contribute with evidence of whether cardiac
rehabilitation should be provided after heart valve surgery. The study is
approved by the local regional Research Ethics Committee (H-1-2011-157),
and the Danish Data Protection Agency (j.nr. 2007-58-0015).

<9>
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)

<10>
Accession Number
2015826567
Authors
Murphy G.J. Pike K. Rogers C.A. Wordsworth S. Stokes E.A. Angelini G.D.
Reeves B.C.
Institution
(Murphy) Department of Cardiovascular Sciences, University of Leicester,
Glenfield General Hospital, Leicester, United Kingdom
(Pike, Rogers, Angelini, Reeves) Bristol Heart Institute, School of
Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol
BS2 8HW, United Kingdom
(Wordsworth, Stokes) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Oxford, United Kingdom
Title
Liberal or restrictive transfusion after cardiac surgery.
Source
New England Journal of Medicine. 372 (11) (pp 997-1008), 2015. Date of
Publication: 12 Mar 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Whether a restrictive threshold for hemoglobin level in
red-cell transfusions, as compared with a liberal threshold, reduces
postoperative morbidity and health care costs after cardiac surgery is
uncertain. METHODS: We conducted a multicenter, parallel-group trial in
which patients older than 16 years of age who were undergoing nonemergency
cardiac surgery were recruited from 17 centers in the United Kingdom.
Patients with a postoperative hemoglobin level of less than 9 g per
deciliter were randomly assigned to a restrictive transfusion threshold
(hemoglobin level <7.5 g per deciliter) or a liberal transfusion threshold
(hemoglobin level <9 g per deciliter). The primary outcome was a serious
infection (sepsis or wound infection) or an ischemic event (permanent
stroke [confirmation on brain imaging and deficit in motor, sensory, or
coordination functions], myocardial infarction, infarction of the gut, or
acute kidney injury) within 3 months after randomization. Health care
costs, excluding the index surgery, were estimated from the day of surgery
to 3 months after surgery. RESULTS: A total of 2007 patients underwent
randomization; 4 participants withdrew, leaving 1000 in the
restrictive-threshold group and 1003 in the liberal-threshold group.
Transfusion rates after randomization were 53.4% and 92.2% in the two
groups, respectively. The primary outcome occurred in 35.1% of the
patients in the restrictivethreshold group and 33.0% of the patients in
the liberal-threshold group (odds ratio, 1.11; 95% confidence interval
[CI], 0.91 to 1.34; P = 0.30); there was no indication of heterogeneity
according to subgroup. There were more deaths in the restrictivethreshold
group than in the liberal-threshold group (4.2% vs. 2.6%; hazard ratio,
1.64; 95% CI, 1.00 to 2.67; P = 0.045). Serious postoperative
complications, excluding primary-outcome events, occurred in 35.7% of
participants in the restrictivethreshold group and 34.2% of participants
in the liberal-threshold group. Total costs did not differ significantly
between the groups. CONCLUSIONS: A restrictive transfusion threshold after
cardiac surgery was not superior to a liberal threshold with respect to
morbidity or health care costs. (Funded by the National Institute for
Health Research Health Technology Assessment program; Current Controlled
Trials number, ISRCTN70923932.)

<11>
Accession Number
2015821453
Authors
Vercueil A.
Institution
(Vercueil) King's College Hospital, NHS Foundation Trust King's Health
Partners, London, United Kingdom
Title
Ischaemic conditioning: Intervening to protect; Before, after, and at a
distance.
Source
Anaesthesia. 70 (4) (pp 379-383), 2015. Date of Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Ltd

<12>
Accession Number
2015747552
Authors
Kajimoto K. Yamamoto T. Amano A.
Institution
(Kajimoto, Yamamoto, Amano) Department of Cardiovascular Surgery, Juntendo
University School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421,
Japan
Title
Coronary artery bypass revascularization using bilateral internal thoracic
arteries in diabetic patients: A systematic review and meta-analysis.
Source
Annals of Thoracic Surgery. 99 (3) (pp 1097-1104), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier USA
Abstract
This study examined the effect of coronary artery bypass graft surgery
with bilateral internal thoracic artery grafting in diabetic patients.
Coronary artery bypass graft surgery using skeletonized bilateral internal
thoracic artery grafts was not associated with an increased risk of deep
sternal wound infection or early death. Moreover, patients who underwent
coronary artery bypass graft surgery using bilateral internal thoracic
artery grafting had lower remote mortality and cardiac mortality. We
conclude that coronary artery bypass surgery using bilateral internal
thoracic artery grafts is an excellent strategy, even for diabetic
patients.

<13>
Accession Number
2015723737
Authors
Lam C.S.P. McEntegart M. Claggett B. Liu J. Skali H. Lewis E. Kober L.
Rouleau J. Velazquez E. Califf R. McMurray J.J. Pfeffer M. Solomon S.
Institution
(Lam) National University Health System, Tower Block, 1E Kent Ridge Road
119228, Singapore
(McEntegart, McMurray) Department of Cardiology, Western Infirmary
Scotland, Glasgow, United Kingdom
(Claggett, Liu, Skali, Lewis, Pfeffer, Solomon) Brigham and Women's
Hospital, Boston, MA, United States
(Kober) Rigshospitalet, Copenhagen, Denmark
(Rouleau) Montreal Heart Institute, QC, Canada
(Velazquez, Califf) Duke University Medical Center, Durham, NC, United
States
Title
Sex differences in clinical characteristics and outcomes after myocardial
infarction: Insights from the Valsartan in Acute Myocardial Infarction
Trial (VALIANT).
Source
European Journal of Heart Failure. 17 (3) (pp 301-312), 2015. Date of
Publication: 01 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background We examined the association of sex with clinical
characteristics and outcomes in patients following myocardial infarction
(MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
Methods and Results A total of 4570 women and 10 133 men with heart
failure (HF), left ventricular systolic dysfunction or both were enrolled
0.5-10 days after myocardial infarction (MI) and followed for a median of
24.7 months. Compared with men, women were older, had more comorbidities,
and were more likely to present in Killip Class III/IV and experience
post-infarction angina or HF. After adjusting for baseline differences,
both short-term and longer-term mortality were similar in men and women.
However, women were more likely than men to experience the composite
outcome of cardiovascular death, MI, HF, stroke, and resuscitation from
cardiac arrest [adjusted hazard ratio (HR) 1.15; 95% confidence interval
(CI); 1.06-1.24, P = 0.001], mainly owing to an increased risk of
hospitalization for HF (adjusted HR 1.36; 95% CI 1.22-1.52; P < 0.001). In
a subset of patients who underwent echocardiographic study (n = 603),
women had smaller left ventricular volumes indexed by body size than men
but similar ejection fractions and similar changes in ventricular volumes
from baseline to 1 month and 20 months. Conclusions In VALIANT, the risk
of HF following MI was higher in women than men after adjusting for age
and comorbidities, although the risk of other fatal and non-fatal outcomes
were similar. The higher long-term risk of HF in women appears to be
independent of the extent of left ventricular systolic dysfunction or
remodelling compared with men.

<14>
Accession Number
2015812729
Authors
Opfermann P. Derhaschnig U. Felli A. Wenisch J. Santer D. Zuckermann A.
Dworschak M. Jilma B. Steinlechner B.
Institution
(Opfermann, Felli, Dworschak, Steinlechner) Division of Cardiothoracic and
Vascular Anesthesia and Intensive Care, Medical University of Vienna,
Vienna, Austria
(Derhaschnig, Jilma) Department of Clinical Pharmacology, Medical
University of Vienna, Vienna, Austria
(Wenisch) Department of Internal Medicine I, Department of Clinical
Pharmacology, Medical University of Vienna, Vienna, Austria
(Zuckermann) Division of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Santer) Division of Cardiovascular Surgery, Hietzing Hospital, Vienna,
Austria
Title
A pilot study on reparixin, a CXCR1/2 antagonist, to assess safety and
efficacy in attenuating ischaemia-reperfusion injury and inflammation
after on-pump coronary artery bypass graft surgery.
Source
Clinical and Experimental Immunology. 180 (1) (pp 131-142), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Summary: Reparixin, a CXCR 1/2 antagonist, has been shown to mitigate
ischaemia-reperfusion injury (IRI) in various organ systems in animals,
but data in humans are scarce. The aim of this double-blinded,
placebo-controlled pilot study was to evaluate the safety and efficacy of
reparixin to suppress IRI and inflammation in patients undergoing on-pump
coronary artery bypass grafting (CABG). Patients received either reparixin
or placebo (n=16 in each group) after induction of anaesthesia until 8h
after cardiopulmonary bypass (CPB). We compared markers of systemic and
pulmonary inflammation, surrogates of myocardial IRI and clinical outcomes
using Mann-Whitney U- and Fisher's exact tests. Thirty- and 90-day
mortality was 0% in both groups. No side effects were observed in the
treatment group. Surgical revision, pleural and pericardial effusion,
infection and atrial fibrillation rates were not different between groups.
Reparixin significantly reduced the proportion of neutrophil granulocytes
in blood at the beginning [49%, interquartile range (IQR)=45-57 versus
58%, IQR=53-66, P=0035], end (71%, IQR=67-76 versus 79%, IQR=71-83,
P=0023) and 1h after CPB (73%, IQR=71-75 versus 77%, IQR=72-80, P=0035).
Reparixin patients required a lesser positive fluid balance during surgery
(2575ml, IQR=2027-3080 versus 3200ml, IQR=2928-3778, P=0029) and during
ICU stay (2603ml, IQR=1023-4288 versus 4200ml, IQR=2313-8160, P=0021).
Numerically, more control patients required noradrenaline > 011mug/kg/min
(50 versus 19%, P=0063) and dobutamine (50 versus 25%, P=014). Therefore,
administration of reparixin in CABG patients appears to be feasible and
safe. It concurrently attenuated postoperative granulocytosis in
peripheral blood.

<15>
Accession Number
2015824155
Authors
Shakouri S.K. Salekzamani Y. Taghizadieh A. Sabbagh-Jadid H. Soleymani J.
Sahebi L. Sahebi R.
Institution
(Shakouri, Salekzamani, Sabbagh-Jadid, Soleymani) Physical Medicine and
Rehabilitation Research Center, Tabriz University of Medical Sciences,
Tabriz, Iran, Islamic Republic of
(Taghizadieh) Tuberculosis and Lung Disease Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Sahebi, Sahebi) Tabriz Health Service Management Research Center,
National public health management center (NPMC), Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
Effect of respiratory rehabilitation before open cardiac surgery on
respiratory function: A randomized clinical trial.
Source
Journal of Cardiovascular and Thoracic Research. 7 (1) (pp 13-17), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Prevention of pulmonary complications after coronary artery
bypass graft is attended as a very important issue. The aim of this study
was to evaluate the role of pulmonary rehabilitation before surgery for
reducing the risk of pulmonary complications after surgery. Methods: In a
randomized clinical trial, 60 patients undergoing heart surgery were
randomly divided into two groups A and B. Chest physiotherapy was
performed before and after surgery on group A patients however it was done
on group B's, only after surgery. Effects of preoperative pulmonary
rehabilitation were compared between two groups, using spirometry and
arterial blood gas (ABG). Results: Thirty nine males (65%) and 21 females
(35%) with mean age of 8.10 +/- 9.56 were analyzed. The mean differences
were statistically significant for predicted forced vital capacity (FVC)
(CI 95%:1.3 to 8.7) and Predicted Peak Flow indices (PEF) (CI 95%: 1.9 to
9.4) of spirometry indicator, PCO2 index (of ABG parameter) (CI 95%: 1.4
to 8.9) and mean oxygen saturation (mean Spo2) (CI 95%: 0.6 to 1.7) of ABG
index in two groups. Conclusion: The performance of pulmonary
rehabilitation program before surgery is recommended, as it may result in
the reduction of complications of heart surgery.

<16>
Accession Number
2015811458
Authors
Lai K.S.P. Herrmann N. Saleem M. Lanctot K.L.
Institution
(Lai, Herrmann, Saleem, Lanctot) Neuropsychopharmacology Research Group,
Sunnybrook Health Sciences Centre, Toronto, ON M4N3M5, Canada
(Lai) Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8,
Canada
(Herrmann, Lanctot) Department of Psychiatry, University of Toronto,
Toronto, ON M5T1R8, Canada
(Saleem, Lanctot) Department of Pharmacology and Toxicology, University of
Toronto, Toronto, ON M5S1A8, Canada
Title
Cognitive outcomes following transcatheter aortic valve implantation: A
systematic review.
Source
Cardiovascular Psychiatry and Neurology. 2015 , 2015. Article Number:
209569. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Severe aortic stenosis is the most common valvular heart disease in the
elderly in the Western world and contributes to a large proportion of all
deaths over the age of 70. Severe aortic stenosis is conventionally
treated with surgical aortic valve replacement; however, the less invasive
transcatheter aortic valve implantation (TAVI) is suggested for those at
high surgical risk. While TAVI has been associated with improved survival
and favourable outcomes, there is a higher incidence of cerebral
microembolisms in TAVI patients. This finding is of concern given
mechanistic links with cognitive decline, a symptom highly prevalent in
those with cardiovascular disease. This paper reviews the literature
assessing the possible link between TAVI and cognitive changes. Studies to
date have shown that global cognition improves or remains unchanged over 3
months following TAVI while individual cognitive domains remain preserved
over time. However, the association between TAVI and cognition remains
unclear due to methodological limitations. Furthermore, while these
studies have largely focused on memory, cognitive impairment in this
population may be predominantly of vascular origin. Therefore, cognitive
assessment focusing on domains important in vascular cognitive impairment,
such as executive dysfunction, may be more helpful in elucidating the
association between TAVI and cognition in the long term.

<17>
Accession Number
2015821403
Authors
Maurice-Szamburski A. Auquier P. Viarre-Oreal V. Cuvillon P. Carles M.
Ripart J. Honore S. Triglia T. Loundou A. Leone M. Bruder N.
Institution
(Maurice-Szamburski, Viarre-Oreal, Triglia, Bruder) Service d'Anesthesie
Reanimation, Hopital de la Timone Adulte, 264 Rue Saint Pierre, Marseille
CEDEX 05 13385, France
(Auquier) Laboratoire Universitaire EA 3279, Sante Publique et Maladies
Chroniques, Universite Aix-Marseille, Marseille, France
(Cuvillon) Service d'Anesthesie, Institut du Cancer, Universite
Montpellier 1, Montpellier, France
(Carles) Service d'Anesthesie Reanimation, Hopital Archet, Universite Nice
Sophia-Antipolis, Nice, France
(Ripart) Service d'Anesthesie, Pole ARDU, Hopital Universitaire Caremeau,
Nimes, Montpellier, France
(Honore) Expertise Pharmaceutique, Hopital de la Timone Adulte, Universite
Aix, Marseille, France
(Loundou) Unite d'Aide Methodologique, Direction de la Recherche Clinique,
AP-HM, Marseille, France
(Leone) Service d'Anesthesie Reanimation, Hopital Nord, Universite
Aix-Marseille, Marseille, France
Title
Effect of sedative premedication on patient experience after general
anesthesia: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 313 (9) (pp 916-925),
2015. Date of Publication: 03 Mar 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE Sedative premedication is widely administered before surgery,
but little clinical evidence supports its use. OBJECTIVE To assess the
efficacy of sedative premedication on perioperative patient experience.
DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial, the PremedX
study, enrolled 1062 adult patients who were younger than 70 years and had
been scheduled for various elective surgeries under general anesthesia at
5 French teaching hospitals (in Marseille, Montpellier, Nimes, and Nice)
between January 2013 and June 2014. Neurosurgery, obstetrical, cardiac,
and outpatient surgery were excluded. INTERVENTIONS Patients were
randomized to 3 groups of 354 participants each to receive 2.5mg of
lorazepam, no premedication, or placebo. MAIN OUTCOMES AND MEASURES The
primary outcomewas perioperative patient experience assessed 24 hours
after surgery with a validated questionnaire (Evaluation du Vecu de
l'Anesthesie Generale; EVAN-G) describing 6 domains of satisfaction and a
global index (score range, 0-100; high scores represent high
satisfaction); secondary outcomes included time to extubation and early
cognitive recovery. A subgroup analysis was planned a priori in patients
with a high level of preoperative anxiety. RESULTS Premedication with
lorazepam did not improve the EVAN-G mean global index for overall level
of patient satisfaction (72 [95%CI, 70-73]; n = 330) compared with no
premedication (73 [95%CI, 71-74]; n = 319) or placebo (71 [95%CI, 70-73];
n = 322) (P = .38). Among patients with heightened preoperative anxiety,
there were no significant differences found in the EVAN-G mean global
index between the lorazepam group (68 [95%CI, 65-72]; n = 87) and the no
premedication group (73 [95%CI, 69-77]; n = 57) or the placebo group (70
[95%CI, 67-72]; n = 87) (P = .18). Time to extubation was 17 minutes
(95%CI, 14-20 minutes) in the lorazepam group, 12 minutes (95%CI, 11-13
minutes) for the no premedication group, and 13 minutes (95%CI, 12-14
minutes) for the placebo group (P < .001) and the rate of early cognitive
recovery was 51% (95%CI, 45%-56%), 71%(95%CI, 66%-76%), and 64% (95%CI,
59%-69%), respectively (P < .001). CONCLUSIONS AND RELEVANCE Among
patients undergoing elective surgery under general anesthesia, sedative
premedication with lorazepam compared with placebo or no premedication did
not improve the self-reported patient experience the day after surgery,
but was associated with modestly prolonged time to extubation and a lower
rate of early cognitive recovery. The findings suggest a lack of benefit
with routine use of lorazepam as sedative premedication in patients
undergoing general anesthesia.

<18>
Accession Number
2015815007
Authors
Prijic S. Buchhorn R. Kosutic J. Vukomanovic V. Prijic A. Bjelakovic B.
Zdravkovic M.
Institution
(Prijic, Kosutic, Vukomanovic) Mother and Child Health Institute of Serbia
- Cardiology Department, R. Dakica St. 6-8, Belgrade 11070, Serbia
(Prijic, Kosutic, Vukomanovic, Zdravkovic) School of Medicine - University
of Belgrade, D r. Subotica St. 8, Belgrade 11000, Serbia
(Buchhorn) Klinik Kinder- und Jugend-medizin, Caritas-Krankenhaus,
Uhlandstr. 7, Bad Mergentheim 97980, Germany
(Prijic) Medical Center "Dr. D. Misovic - Dedinje", Heroja Milana Tepica
St. 1, Belgrade 11000, Serbia
(Bjelakovic) Clinical Center Nis - Pediatric Cardiology Department, D r.
Z. Djindjica Boulevard 48, Nis 18000, Serbia
(Bjelakovic) School of Medicine, University of Nis, Dr Z. Djindjica
Boulevard 81, Nis 18000, Serbia
(Zdravkovic) University Medical Center Bezanijska Kosa - Cardiology
Department, Bezanijska Kosa bb, Belgrade 11000, Serbia
Title
Beta-blockers (carvedilol) in children with systemic ventricle systolic
dysfunction - systematic review and meta-analysis.
Source
Reviews on Recent Clinical Trials. 9 (2) (pp 68-75), 2014. Date of
Publication: 01 Jan 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Numerous prospective randomized clinical trials demonstrated
favorable effect of beta-blockers in adults with chronic heart failure.
However, effectiveness of beta blockers in pediatric patients with
systemic ventricle systolic dysfunction was not recognized sufficiently.
Limited number of pediatric patients might be the course of unrecognized
carvediolol treatment benefit. Currently, no meta-analysis has examined
the impact of carvedilol and conventional therapy on the clinical outcome
in children with chronic heart failure due to impaired systemic ventricle
systolic function. Materials and Methods: We have systematically searched
the Medline/PubMed and Cochrane Library for the controlled clinical trials
that examine carvedilol and standard treatment efficacy in pediatric
patients with systemic ventricle systolic dysfunction. Mean differences
for continuous variables, odds ratios for dichotomous outcomes,
heterogeneity between studies and publication bias were calculated using
Cochrane Review Manager (Rev Man 5.2). Results: Total of 8
prospective/observational studies met established criteria. Odds ratio for
chronic heart failure related mortality/heart transplantation secondary to
carvedilol was 0.52 (95% CI: 0.28-0.97, I<sup>2</sup> = 0%). Our analysis
showed that carvedilol could prevent 1 death/ heart transplantation by
treating 14 pediatric patients with impaired systemic ventricle systolic
function. Conclusion: Meta-analysis demonstrated clinical outcome benefit
of carvedilol in children with chronic heart failure.

<19>
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.

Saturday, March 21, 2015

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 15

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<1>
Accession Number
2014727661
Authors
Besic K.M. Strozzi M. Margetic E. Bulum J. Kolaric B.
Institution
(Besic, Strozzi, Margetic, Bulum) Department of Cardiovascular Medicine,
University Hospital Centre Zagreb, Zagreb, Croatia
(Kolaric) Department for Social Medicine and Epidemiology, Medical School,
University of Rijeka, Rijeka, Croatia
Title
Drug-eluting balloons in patients with non-ST elevation acute coronary
syndrome.
Source
Journal of Cardiology. 65 (3) (pp 203-207), 2015. Date of Publication: 01
Mar 2015.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We compared efficacy of bare-metal stent (BMS) and
drug-eluting balloon (DEB) combination vs BMS alone, in patients with
non-ST elevation acute coronary syndrome treated with percutaneous
coronary intervention (PCI). Methods: Patients with non-ST elevation
myocardial infarction (NSTEMI) or unstable angina (UA) were randomized to
BMS only or BMS. +. DEB group. Angiographic follow-up was performed after
6 months. The primary endpoints were binary in-stent restenosis (ISR) and
late lumen loss (LLL) and the secondary endpoints were target lesion
revascularization (TLR), stent thrombosis (ST), and new acute coronary
syndrome (ACS). Results: A total of 85 patients were enrolled, 44 (BMS)
and 41 (BMS. +. DEB). The median age was 67 (36-84) years and 68 (80%)
were male. Fifty-two patients (61.2%) had NSTEMI and 33 patients (38.8%)
UA. There was no difference in patient demographics, risk factors, and
clinical characteristics, except for more smokers in the BMS. +. DEB group
18/41 (43.9%) vs 9/44 (20.5%). At follow-up, no significant difference in
binary ISR was found; p=. 0.593, but LLL was significantly lower in the
BMS. +. DEB group 0.68 (0.00-2.15) mm vs 0.22 (0.00-2.35) mm; p=. 0.002.
The difference in major adverse cardiac events (MACE) rate combining TLR,
ST, and ACS, between the groups was also non-significant, 29.5% (BMS) vs
24.4% (BMS. +. DEB); p=. 0.835. One patient had a subacute ST (BMS. +.
DEB) due to clopidogrel resistance. Conclusion: Patients treated with BMS.
+. DEB combination for non-ST elevation acute coronary syndrome had
significantly less LLL in comparison to patients treated with BMS alone
but without an impact on patient clinical outcomes.

<2>
Accession Number
2015814787
Authors
Gershlick A.H. Khan J.N. Kelly D.J. Greenwood J.P. Sasikaran T. Curzen N.
Blackman D.J. Dalby M. Fairbrother K.L. Banya W. Wang D. Flather M.
Hetherington S.L. Kelion A.D. Talwar S. Gunning M. Hall R. Swanton H.
McCann G.P.
Institution
(Gershlick, Khan, McCann) Department of Cardiovascular Sciences,
University of Leicester, Glenfield Hospital, Groby Road Site, Leicester
LE3 9QP, United Kingdom
(Kelly) Department of Cardiology, Royal Derby Hospital, Derby, United
Kingdom
(Greenwood) Division of Cardiovascular and Diabetes Research, Leeds
Institute of Cardiovascular and Metabolic Medicine, University of Leeds,
Leeds, United Kingdom
(Greenwood, Blackman) Department of Cardiology, Leeds Teaching Hospitals
NHS Trust, Leeds, United Kingdom
(Sasikaran) Clinical Trials and Evaluation Unit, Royal Brompton and
Harefield NHS Foundation Trust, Imperial College London, London, United
Kingdom
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, Southampton, United Kingdom
(Dalby) Royal Brompton and Harefield NHS Trust, London, United Kingdom
(Fairbrother) University Hospitals of Leicester NHS Trust, Leicester,
United Kingdom
(Banya) National Institute for Health Research Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Trust, London, United
Kingdom
(Wang) Department of Clinical Sciences, Liverpool School of Tropical
Medicine, Liverpool, United Kingdom
(Flather, Hall) Norfolk and Norwich University Hospitals NHS Foundation
Trust, Norwich Medical School, University of East Anglia, Norwich, United
Kingdom
(Hetherington) Kettering General Hospital, Kettering, United Kingdom
(Kelion) Oxford Heart Centre, John Radcliffe Hospital, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
(Talwar) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Gunning) Royal Stoke University Hospital, University Hospitals of North
Midlands NHS Trust, Stoke-on-Trent, Staffordshire, United Kingdom
(Swanton) Heart Hospital, University College London Hospitals, London,
United Kingdom
Title
Randomized trial of complete versus lesion-only revascularization in
patients undergoing primary percutaneous coronary intervention for stemi
and multivessel disease: The CvLPRIT trial.
Source
Journal of the American College of Cardiology. 65 (10) (pp 963-972), 2015.
Date of Publication: 17 Mar 2015.
Publisher
Elsevier USA
Abstract
Background The optimal management of patients found to have multivessel
disease while undergoing primary percutaneous coronary intervention
(P-PCI) for ST-segment elevation myocardial infarction is uncertain.
Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a
U.K. open-label randomized study comparing complete revascularization at
index admission with treatment of the infarct-related artery (IRA) only.
Methods After they provided verbal assent and underwent coronary
angiography, 296 patients in 7 U.K. centers were randomized through an
interactive voice-response program to either in-hospital complete
revascularization (n = 150) or IRA-only revascularization (n = 146).
Complete revascularization was performed either at the time of P-PCI or
before hospital discharge. Randomization was stratified by infarct
location (anterior/nonanterior) and symptom onset (< 3 h or >3 h). The
primary endpoint was a composite of all-cause death, recurrent myocardial
infarction (MI), heart failure, and ischemia-driven revascularization
within 12 months. Results Patient groups were well matched for baseline
clinical characteristics. The primary endpoint occurred in 10.0% of the
complete revascularization group versus 21.2% in the IRA-only
revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24
to 0.84; p = 0.009). A trend toward benefit was seen early after complete
revascularization (p = 0.055 at 30 days). Although there was no
significant reduction in death or MI, a nonsignificant reduction in all
primary endpoint components was seen. There was no reduction in ischemic
burden on myocardial perfusion scintigraphy or in the safety endpoints of
major bleeding, contrast-induced nephropathy, or stroke between the
groups. Conclusions In patients presenting for P-PCI with multivessel
disease, index admission complete revascularization significantly lowered
the rate of the composite primary endpoint at 12 months compared with
treating only the IRA. In such patients, inpatient total revascularization
may be considered, but larger clinical trials are required to confirm this
result and specifically address whether this strategy is associated with
improved survival.

<3>
Accession Number
2015814778
Authors
Murphy T.P. Cutlip D.E. Regensteiner J.G. Mohler E.R. Cohen D.J. Reynolds
M.R. Massaro J.M. Lewis B.A. Cerezo J. Oldenburg N.C. Thum C.C. Jaff M.R.
Comerota A.J. Steffes M.W. Abrahamsen I.H. Goldberg S. Hirsch A.T.
Institution
(Murphy, Cerezo) Department of Diagnostic Imaging, Vascular Disease
Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy Street,
Providence, RI 02903, United States
(Cutlip) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Cutlip, Reynolds, Massaro, Thum, Abrahamsen) Harvard Clinical Research
Institute, Boston, MA, United States
(Regensteiner) University of Colorado School of Medicine-Aurora, Center
for Women's Health Research, Aurora, CO, United States
(Mohler) Section of Vascular Medicine, Cardiovascular Division at Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Cohen) Division of Cardiology, University of Missouri-Kansas City, Kansas
City, MO, United States
(Massaro) Department of Biostatistics, Boston University, Boston, MA,
United States
(Lewis) School of Kinesiology, University of Minnesota, Minneapolis, MN,
United States
(Oldenburg, Steffes, Hirsch) Lillehei Heart Institute, Cardiovascular
Division, University of Minnesota Medical School, Minneapolis, MN, United
States
(Jaff) Division of Cardiology, Massachusetts General Hospital, Boston, MA,
United States
(Comerota) Jobst Vascular Institute, Toledo Hospital, Toledo, OH, United
States
(Goldberg) National Heart Lung and Blood Institute, Bethesda, MD, United
States
Title
Supervised exercise, stent revascularization, or medical therapy for
claudication due to aortoiliac peripheral artery disease: The CLEVER
study.
Source
Journal of the American College of Cardiology. 65 (10) (pp 999-1009),
2015. Date of Publication: 17 Mar 2015.
Publisher
Elsevier USA
Abstract
Background Treatment for claudication that is due to aortoiliac peripheral
artery disease (PAD) often relies on stent revascularization (ST).
However, supervised exercise (SE) is known to provide comparable
short-term (6-month) improvements in functional status and quality of
life. Longer-term outcomes are not known. Objectives The goal of this
study was to report the longer-term (18-month) efficacy of SE compared
with ST and optimal medical care (OMC). Methods Of 111 patients with
aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus
ST, 79 completed the 18-month clinical and treadmill follow-up assessment.
SE consisted of 6 months of SE and an additional year of telephone-based
exercise counseling. Primary clinical outcomes included objective
treadmill-based walking performance and subjective quality of life.
Results Peak walking time improved from baseline to 18 months for both SE
(5.0 +/- 5.4 min) and ST (3.2 +/- 4.7 min) significantly more than for OMC
(0.2 +/- 2.1 min; p < 0.001 and p = 0.04, respectively). The difference
between SE and ST was not significant (p = 0.16). Improvement in
claudication onset time was greater for SE compared with OMC, but not for
ST compared with OMC. Many disease-specific quality-of-life scales
demonstrated durable improvements that were greater for ST compared with
SE or OMC. Conclusions Both SE and ST had better 18-month outcomes than
OMC. SE and ST provided comparable durable improvement in functional
status and in quality of life up to 18 months. The durability of
claudication exercise interventions merits its consideration as a primary
PAD claudication treatment.

<4>
Accession Number
2015810689
Authors
Saner F.H.
Institution
(Saner) Medical Center University of Essen/Germany, Department of General,
Visceral and Transplant Surgery, Hufelandstr. 55, Essen 45147, Germany
Title
Rotational thrombelastometry: A step forward to safer patient care?.
Source
Critical Care. 18 (1) , 2014. Article Number: 706. Date of Publication:
December 26, 2014.
Publisher
BioMed Central Ltd.
Abstract
The study by Hincker and colleagues indicated that the perioperative use
of rotational thrombelastometry (ROTEM) could predict thromboembolic
events in 90% of the cases in non-cardiac surgery. Viscoelastic tests
(VETs) - ROTEM and thrombelastography (TEG) - are used mainly to predict
bleeding complications. Most conventional coagulation tests, like
prothrombin time and activated partial thromboplastin time, can identify a
disturbance in plasmatic hemostasis. However, the relevance of these
assays is limited to the initiation phase of coagulation, whereas VETs are
designed to assess the whole clotting kinetics and strength of the whole
blood clot and reflect more the interaction between procoagulants,
anticoagulants, and platelets. The first reports about VET and
hypercoagulable state were published more than 25 years ago. Since then,
several studies with different quality and sample size have been
published, sometimes with conflicting results. A systematic review about
hypercoagulable state and TEG indicated that further studies are needed to
recommend VETs as a screening tool to predict postoperative thrombosis.

<5>
Accession Number
2015810429
Authors
Greenberg J.H. Coca S. Parikh C.R.
Institution
(Greenberg) Department of Pediatrics, Section of Nephrology, Yale
University School of Medicine, New Haven, CT, United States
(Coca, Parikh) Department of Internal Medicine, Section of Nephrology, New
Haven, CT, United States
(Coca, Parikh) VA Medical Center, Yale University School of Medicine, West
Haven, CT, United States
(Greenberg, Coca, Parikh) Yale Program of Applied Translational Research,
Yale University School of Medicine, 60 Temple Street, 6th Floor, Suite 6C,
New Haven, CT 06510, United States
Title
Long-term risk of chronic kidney disease and mortality in children after
acute kidney injury: A systematic review.
Source
BMC Nephrology. 15 (1) , 2014. Article Number: 184. Date of Publication:
21 Nov 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Acute kidney injury (AKI) is associated with significant
short-term morbidity and mortality in children. However, the risk for
long-term outcomes after AKI is largely unknown. Methods: We performed a
systematic review and meta-analysis to determine the cumulative incidence
rate of proteinuria, hypertension, decline in glomerular filtration rate
(GFR), and mortality after an episode of AKI. After screening 1934
published articles from 1985-2013, we included 10 cohort studies that
reported long-term outcomes after AKI in children. Results: A total of 346
patients were included in these studies with a mean follow-up of 6.5 years
(range 2-16) after AKI. The studies were of variable quality and had
differing definitions of AKI with five studies only including patients who
required dialysis during an AKI episode. There was a substantial
discrepancy in the outcomes across these studies, most likely due to study
size, disparate outcome definitions, and methodological differences. In
addition, there was no non-AKI comparator group in any of the published
studies. The cumulative incidence rates for proteinuria, hypertension,
abnormal GFR (<90 ml/min/1.73 m<sup>2</sup>), GFR < 60 ml/min/1.73
m<sup>2</sup>, end stage renal disease, and mortality per 100
patient-years were 3.1 (95% CI 2.1-4.1), 1.4 (0.9-2.1), 6.3 (5.1-7.5), 0.8
(0.4-1.4), 0.9 (0.6-1.4), and 3.7 (2.8-4.5) respectively. Conclusions: AKI
appears to be associated with a high risk of long-term renal outcomes in
children. These findings may have implications for care after an episode
of AKI in children. Future prospective studies with appropriate non-AKI
comparator groups will be required to confirm these results.

<6>
Accession Number
2015808751
Authors
Ozcan O.U. Tutar E. Candemir B. Ustun E.E. Erol C.
Institution
(Ozcan, Tutar, Candemir, Ustun, Erol) Department of Cardiology, Ankara
University, School of Medicine, Ankara 06230, Turkey
Title
Overcoming aspirin resistance with loading clopidogrel earlier in elective
percutaneous coronary intervention.
Source
International Journal of Angiology. 24 (1) (pp 19-24), 2015. Date of
Publication: 17 Feb 2014.
Publisher
Thieme Medical Publishers, Inc.
Abstract
We aimed to analyze the clinical effect of clopidogrel loading time on
adverse cardiovascular events among patients with aspirin resistance.
Recurrent adverse events may still occur despite dual antiplatelet therapy
after coronary stenting. Aspirin resistance is one of the possible reasons
of this trouble. Optimal antiplatelet strategy for coronary stenting is
unknown among patients with aspirin resistance. A total of 980 patients
scheduled for elective coronary stenting were enrolled and allocated into
two groups according to the loading time of clopidogrel more or less than
6 hours before coronary intervention (early- or late-loaded groups,
respectively). Aspirin resistance was determined according to the urinary
levels of 11-dehydrothromboxane B2. Overall 240 patients who were
allocated to early- and late-loaded groups were identified as aspirin
resistant according to the urinary levels of 11-dehydrothromboxane B2.
After a follow-up period of 12 months major adverse cardiac events were
observed among 16 patients (13.9%) in the early-loaded group and 30
patients (25.8%) in the late-loaded group (p = 0.02). Early loading of
clopidogrel was an independent predictor of lower rate of cardiac events
(hazard ratio = 0.46 [0.32-0.76, 95% confidence interval], p = 0.001). The
rates of bleeding events and periprocedural myocardial infarction were
similar in early- and late-loaded groups. The current study demonstrated
that loading of clopidogrel earlier than 6 hours before elective coronary
stenting among aspirin-resistant patients was associated with increased
benefits for ischemic events with similar bleeding rates.

<7>
Accession Number
2015812637
Authors
Imazio M.
Institution
(Imazio) Cardiology Department, Maria Vittoria Hospital and University of
Torino, Via Luigi Cibrario 72, Torino 10141, Italy
Title
New Clinical Trials in Acute and Recurrent Pericarditis.
Source
Current Cardiology Reports. 17 (4) (pp 1-7), 2015. Date of Publication:
2015.
Publisher
Current Medicine Group LLC 1
Abstract
Clinical trials in the last decade have improved the quality of evidence
to support preventive medical strategies to reduce the risk of recurrences
after pericarditis. There are essentially three main strategies: (1) to
use full anti-inflammatory doses for the treatment of each attack of
pericarditis till symptoms resolution and normalization of markers of
inflammation (i.e., C-reactive protein); (2) to limit the use of
corticosteroids and, if used, to use low to moderate doses (i.e.,
prednisone 0.2 to 0.5 mg/kg/day or equivalent) followed by slow tapering;
and (3) to add colchicine to improve the response to conventional
anti-inflammatory therapies and reduce the risk of recurrences.
Recommended regimens include weight-adjusted doses (i.e., 0.5-0.6 mg twice
daily for patients weighing >70 kg or 0.5-0.6 mg once daily for patients
weighing <70 kg for 3 months for acute pericarditis and 6 months for
recurrences) without a loading dose to improve patients' compliance. Using
these doses and appropriate selection of patients (e.g. to avoid severe
renal impairment or adjust doses according to comorbid conditions and
concomitant therapies), the drug is well tolerated, may cause reversible
gastrointestinal intolerance (mainly diarrhea) in about 8 to 10 % of cases
but has no severe side effects.

<8>
Accession Number
2014833753
Authors
Wu Y.-C. Su T.-W. Zhang J.-F. Shen W.-F. Ning G. Kong Y.
Institution
(Wu, Zhang, Kong) Department of Cardiovascular Surgery, Shanghai Chest
Hospital, Shanghai Jiao Tong University, Shanghai, China
(Su, Ning) Shanghai Institute of Endocrine and Metabolic Diseases,
Shanghai, China
(Su, Ning) Department of Endocrinology and Metabolism, Shanghai Jiao Tong
University, Shanghai, China
(Shen) Department of Cardiology, Rui Jin Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
Title
Coronary artery bypass grafting versus drug-eluting stents in patients
with severe coronary artery disease and diabetes mellitus: Systematic
review and meta-analysis.
Source
Journal of Diabetes. 7 (2) (pp 192-201), 2015. Date of Publication: 01 Mar
2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: A comprehensive meta-analysis was performed to evaluate the
comparative benefits of coronary artery bypass grafting (CABG) versus
drug-eluting stents (DES) in patients with diabetes mellitus and severe
coronary artery disease (CAD). Methods: A comprehensive literature search
of PubMed, Embase, and ScienceDirect was undertaken. References cited with
the papers were also checked to identify relevant articles. Results: In
all, four randomized controlled trials, two prospective registries, and 11
retrospective studies were identified for review. Pooled analysis
demonstrated that DES was associated with lower all-cause mortality at Day
30. However, there was no significant difference between CABG and DES in
mortality at 12 months and at maximum follow-up. Furthermore, DES was
associated with lower overall and major adverse cardiac and
cerebrovascular events (MACCE)-free survival, as well as a higher
incidence of myocardial infarction and repeat revascularization. In
contrast, CABG was associated with an increased risk of stroke.
Conclusions: For patients with diabetes mellitus and severe CAD, CABG is
superior to DES in that it significantly improves overall and MACCE-free
survival and reduces the incidence of myocardial infarction and repeat
revascularization in the long term, although it is associated with greater
perioperative risk and a higher incidence of stroke. Therefore, CABG
should remain the gold standard for these patients.

<9>
Accession Number
2015801783
Authors
Mohanty S. Di Biase L. Mohanty P. Trivedi C. Santangeli P. Bai R.
Burkhardt J.D. Gallinghouse J.G. Horton R. Sanchez J.E. Hranitzky P.M.
Zagrodzky J. Al-Ahmad A. Pelargonio G. Lakkireddy D. Reddy M. Forleo G.
Rossillo A. Themistoclakis S. Hongo R. Beheiry S. Casella M. Dello Russo
A. Tondo C. Natale A.
Institution
(Mohanty, Di Biase, Mohanty, Trivedi, Santangeli, Bai, Burkhardt,
Gallinghouse, Horton, Sanchez, Hranitzky, Zagrodzky, Al-Ahmad, Natale)
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N.,
Austin, TX 78705, United States
(Di Biase, Horton, Natale) Department of Biomedical Engineering,
University of Texas at Austin, Austin, TX, United States
(Di Biase) Albert Einstein College of Medicine, Montefiore Hospital,
Bronx, NY, United States
(Di Biase, Santangeli) University of Foggia, Foggia, Italy
(Santangeli) University of Pennsylvania, Philadelphia, PA, United States
(Bai) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Pelargonio) Catholic University, Rome, Italy
(Lakkireddy, Reddy) University of Kansas, Kansas City, KS, United States
(Forleo) University Tor Vergata, Rome, Italy
(Rossillo, Themistoclakis) Ospedale dell'Angelo, Mestre/Venice, United
States
(Hongo, Beheiry, Natale) California Pacific Medical Center, San Francisco,
CA, United States
(Casella, Dello Russo, Tondo) RCCS Monzino Hospital, Milan, Italy
(Natale) Division of Cardiology, Stanford University, Palo Alto, CA,
United States
(Natale) Interventional Electrophysiology, Scripps Clinic, San Diego, CA,
United States
(Natale) Department of Internal Medicine, Dell Medical School, Austin, TX,
United States
Title
Effect of periprocedural amiodarone on procedure outcome in patients with
longstanding persistent atrial fibrillation undergoing extended pulmonary
vein antrum isolation: Results from a randomized study (SPECULATE).
Source
Heart Rhythm. 12 (3) (pp 477-483), 2015. Date of Publication: 01 Mar 2015.
Publisher
Elsevier
Abstract
Background The impact of amiodarone on ablation outcome in longstanding
persistent atrial fibrillation (LSPAF) patients is not known yet.
Objective The purpose of this study was to assess the effect of amiodarone
on procedural-outcomes in LSPAF patients undergoing catheter ablation.
Methods We enrolled 112 LSPAF patients on amiodarone and scheduled to
undergo atrial fibrillation (AF) ablation. Patients were randomized to
amiodarone discontinuation 4 months before ablation (group 1, n = 56) and
a control group (group 2, n = 56) in which ablation was performed without
amiodarone discontinuation. All patients underwent pulmonary vein (PV)
antrum and posterior wall isolation, defragmentation and extra PV triggers
ablation. Patients were followed up for recurrence for 32 +/- 8 months
post-ablation. Repeat procedures in all recurrent patients were performed
off amiodarone. Results During ablation, AF termination was more frequent
in group 2 compared to group 1 [44 (79%) vs 32 (57%), P =.015]. After
high-dosage isoproterenol, more non-PV triggers were disclosed in group 1
compared to group 2 (42 [75%] vs 24 [43%] respectively, P <.001). Group 2
had lower procedure, radiofrequency and fluoroscopy times compared to
group 1 (2.7 +/- 1 vs 3.1 +/- 1 h, 69 +/- 13 min vs 87 +/- 11 min and 64
+/- 14 min vs 85 +/- 18 min respectively, p <.05). At 32 +/- 8 month
follow-up, on or off antiarrhythmic drug success rate was 37 (66%) in
group 1 and 27 (48%) in group 2 (P =.04). During redo, new non-PV trigger
sites were identified in group 2 patients. Conclusion Periprocedural
continuous amiodarone was associated with higher organization rate and
lower radiofrequency ablation rate. However, masking non-PV triggers
increased the late recurrence rate.

<10>
[Use Link to view the full text]
Accession Number
2015800435
Authors
Gosain P. Yamani N. Santana O. Mihos C.G. Lamelas J.
Institution
(Gosain, Santana, Mihos) Division of Cardiology, Columbia University,
Mount Sinai Heart Institute, Miami Beach, FL, United States
(Yamani) Department of Internal Medicine, John H. Stroger Hospital of Cook
County, Chicago, IL, United States
(Lamelas) Division of Cardiac Surgery, Mount Sinai Medical Center, Miami
Beach, FL, United States
(Santana) Echocardiography Laboratory, Columbia University Division of
Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, FL
33140, United States
Title
Hybrid coronary revascularization: A systematic review.
Source
Cardiology in Review. 23 (2 Supplement 3) (pp 87-93), 2015. Date of
Publication: 04 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The hybrid approach to coronary revascularization is an evolving technique
that is being used as an alternative to the traditional median sternotomy
coronary artery bypass graft surgery. It combines a minimally invasive
approach to bypass the left anterior descending coronary artery with a
percutaneous approach to revascularize the other coronary arteries. A
systematic review of the available literature was conducted to evaluate
the benefits, and the short-and long-term outcomes of this procedure.

<11>
Accession Number
2015796339
Authors
Millan X. Skaf S. Joseph L. Ruiz C. Garcia E. Smolka G. Noble S.
Cruz-Gonzalez I. Arzamendi D. Serra A. Kliger C. Sia Y.T. Asgar A. Ibrahim
R. Jolicoeur E.M.
Institution
(Millan, Skaf, Asgar, Ibrahim, Jolicoeur) Department of Medicine, Montreal
Heart Institute, Universite de Montreal, Montreal, QC, Canada
(Joseph) Division of Clinical Epidemiology, McGill University Health
Centre, Montreal, QC, Canada
(Ruiz, Kliger) Division of Structural and Congenital Heart Disease, Lenox
Hill Heart and Vascular Institute-North Shore LIJ Health System, New York,
NY, United States
(Garcia) Division of Interventional Cardiology, Hospital Universitario
Clinico San Carlos, Madrid, Spain
(Smolka) Division of Cardiology, Medical University of Silesia, Katowice,
Poland
(Noble) Department of Medical Specialties, Cardiology Division, Universite
de Geneve, Geneva, Switzerland
(Cruz-Gonzalez) Division of Interventional Cardiology, Hospital
Universitario de Salamanca, Salamanca, Spain
(Arzamendi, Serra) Division of Interventional Cardiology, Hospital de la
Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
(Sia) Centre Hospitalier Universitaire de Montreal, Universite de
Montreal, Montreal, QC, Canada
Title
Transcatheter Reduction of Paravalvular Leaks: ASystematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (3) (pp 260-269), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: Significant paravalvular leak (PVL) after surgical valve
replacement can result in intractable congestive heart failure and
hemolytic anemia. Because repeat surgery is performed in only few
patients, transcatheter reduction of PVL is emerging as an alternative
option, but its safety and efficacy remain uncertain. In this study we
sought to assess whether a successful transcatheter PVL reduction is
associated with an improvement in clinical outcomes. Methods: We
identified 12 clinical studies that compared successful and failed
transcatheter PVL reductions in a total of 362 patients. A Bayesian
hierarchical meta-analysis was performed using cardiac mortality as a
primary end point. The combined occurrence of improvement in New York
Heart Association functional class or hemolytic anemia and the need for
repeat surgery, were used as secondary end points. Results: A successful
transcatheter PVL reduction was associated with a lower cardiac mortality
rate (odds ratio [OR], 0.08; 95% credible interval [CrI], 0.01-0.90) and
with a superior improvement in functional class or hemolytic anemia,
compared with a failed intervention (OR, 9.95; 95% CrI, 2.10-66.73). Fewer
repeat surgeries were also observed after successful procedures (OR, 0.08;
95% CrI, 0.01-0.40). Conclusions: A successful transcatheter PVL reduction
is associated with reduced all-cause mortality and improved functional
class in patients deemed unsuitable for surgical correction.

<12>
Accession Number
71810035
Authors
Khan I.Y. Johnson S.R. Singer L.G. De Perrot M. Granton J.T. Keshavjee S.
Chau C. Kron A.T.
Institution
(Johnson) Division of Rheumatology, Toronto Western Hospital, University
Health Network Pulmonary Hypertension Programme, Toronto, Canada
(Khan) Pulmonary Hypertension Programme, University Health Network,
University of Toronto, Toronto, Canada
(Singer) Division of Respirology, University of Toronto, Canada
(Singer) Toronto Lung Transplant Program, University Health Network,
Toronto, Canada
(De Perrot, Keshavjee) Division of Thoracic Surgery, University Health
Network, University of Toronto, Toronto, Canada
(Granton) Toronto Pulmonary Hypertension Programme, Toronto General
Hospital, University of Toronto, Toronto, Canada
(Chau, Kron) Toronto Scleroderma Research Program, Toronto Western
Hospital, University of Toronto, Toronto, Canada
Title
Survival after lung transplantation in systemic sclerosis. A systematic
review.
Source
Clinical and Experimental Rheumatology. Conference: 3rd Systemic Sclerosis
World Congress Rome Italy. Conference Start: 20140206 Conference End:
20140208. Conference Publication: (var.pagings). 32 (2 SUPPL. 81) (pp
S18), 2014. Date of Publication: 2014.
Publisher
Clinical and Experimental Rheumatology S.A.S.
Abstract
Background/Purpose. Lung transplantation is a life-saving option for
systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH)
and interstitial lung disease (SSc-ILD) patients. Yet, there is risk of
post-transplantation mortality. The objective of this study was to
evaluate survival of SSc patients post-lung transplantation. We
secondarily evaluated SSc lung transplant recipient characteristics, and
compared post-lung transplantation survival of SSc patients to non- SSc
patients (idiopathic PAH, and ILD). Methods. A systematic review of
MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials and CINAHL
(all inception to 2012) was performed to identify studies evaluating
post-lung transplant survival in SSc compared to non-SSc patients. Two
reviewers independently abstracted study and survival data using a
standardized form. Results. 226 citations were screened to identify 7
observational studies reporting SSc patients who underwent single lung,
double lung, or heart-lung transplantation. Mean age at transplantations
ranged 46-53 years. SSc post-transplantation survival ranged 69%-91% at
30-days, 69%-85% at 6-months, 59%-93% at 1-year, 49%-80% at 2-years, and
46%-79% at 3-years. ILD post-transplant survival was 80% at 30-days,
80%-90% at 6-months, 59%-83% at 2-years, and 69% at 3-years. IPAH post
transplant survival was 79% at 30-days, 79%-90% at 6-months, and 74%-90%
at 1-year. The reporting of overlapping cohorts potentially including the
same patients precluded meta-analysis. Causes of death in SSc patients,
when reported, included graft failure (n=6), infection (n=8), cardiac
events (n=3), hemorrhagic stroke (n=1), respiratory failure (n=3),
malignancy (n=2), pulmonary hypertension (n=1), complications of
bronchiolitis obliterans syndrome (BOS) (n=1), anesthetic complication
(n=1), and scleroderma renal crisis (n=1). There were no reports of
recurrence of SSc in the lung allograft. Conclusion. SSc survival
post-lung transplantation is very good, and improving with time. The
short-term and intermediate-term survival post-lung transplantation are
similar to IPAH and ILD patients requiring lung transplantation. Future
researchers should delineate the access process for lung transplantation
and report the occurrence of acute rejection, infection, bronchiolitis
obliterans syndrome, renal dysfunction and dialysis, gastroparesis, and
need for tube feeding.

<13>
Accession Number
71808902
Authors
Chandraprakasam S. Pandya J. Reddy A.K. Alla V.M.B.
Institution
(Chandraprakasam, Pandya, Reddy, Alla) Creighton University, Omaha, NE,
United States
Title
A meta-analysis of clinical outcomes between edwards valve versus
corevalve after transcatheter aortic valve replacement.
Source
JACC: Cardiovascular Interventions. Conference: Cardiovascular Research
Technologies, CRT 2015 Washington, DC United States. Conference Start:
20150221 Conference End: 20150224. Conference Publication: (var.pagings).
8 (2 SUPPL. 1) (pp S52-S53), 2015. Date of Publication: 01 Feb 2015.
Publisher
Elsevier Inc.
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has been approved
by US FDA for high surgical risk and inoperable patients with severe
aortic stenosis. However, there is no single large study comparing the
performance of valves with respect to mortality or stroke. OBJECTIVE To
compare the 30-day mortality and stroke outcomes in TAVR patients treated
with balloon expandable valve (BEV, Edwards Lifesciences Corporation,
Irvine, Ca) and self-expanding valve (SEV, Medtronic CV, Luxembourg
S.a.r.l.). METHODS We performed an electronic search for studies published
between 2009 and 2014 reporting clinical outcomes for BEV and SEV. Pooled
odd's ratio with 95% confidence intervals was calculated using Mantel
Haenszel random effects model. RESULTS A total of 165 studies were
initially selected of which 10 studies were included in the final
analysis, yielding a total of 5204 patients (2779 with Edwards Valve and
2425 with CoreValve). Pooled estimate of 30-day mortality was 9.4% (493/
5204) and of stroke was 1.3% (71/5204). There was no difference in the
30-day mortality between the valves (OR 1.03, 95% CI 0.76 to 1.39). There
was no statistically significant difference in stroke risk (OR 1.75, 95%
CI 0.96 to 3.21). Figure 1 CONCLUSION Post-operative mortality and stroke
risk appear to be similar with both valves. Large randomized controlled
trials assessing clinical outcomes are warranted as these analyses may be
confounded by heterogeneity in study population, baseline risk
characteristics and TAVR approaches. (Table Presented).

<14>
Accession Number
71808602
Authors
Modi R. Patted S.V. Halkati P.C. Porwal S.C.
Institution
(Modi, Patted, Halkati, Porwal) KLES University and MRC, Belgaum, India
Title
Left main stenting registry.
Source
Indian Heart Journal. Conference: 66th Annual Conference of Cardiological
Society of India, CSI 2014 Hyderabad India. Conference Start: 20141204
Conference End: 20141207. Conference Publication: (var.pagings). 66 (pp
S94), 2014. Date of Publication: November 2014.
Publisher
Elsevier
Abstract
Background: Several studies have compared the treatment effects for left
main disease between coronary stenting and coronaryartery bypass grafting
(CABG). Various metaanalysis and present guidelines have revealed the
significance of syntax scores and anatomical location in left main artery
stenosis for determination of Major adverse cardiac events (MACE)
.However, debate still persists over the best treatment regarding
long-term outcomes of these two interventions for patients with left main
coronary artery disease. The aim of the study was to examine the
demographic parameters, presentation, immediate and long term outcomes of
stenting of left main coronary artery stenosis at out centre. Methods: Our
ongoing study has presently evaluated 100 patients in our centre with left
main coronary artery disease who underwent stent implantation between June
2011 and to date. We compared demographic parameters, SYNTAX scores,
anatomic conditions associated with left main artery stenosis and adverse
outcomes (death, Q-wave myocardial infarction, or stroke; and
target-vessel revascularization) in patients with left main artery
stenting. Results: Our results of demographic analysis revealed majority
of the patients with left main artery stenting to be males with age group
between 51-60 years. Among the risk factors, hypertension, diabetes and
dyslipidemia were found to be significant. Out of 100, stenting of
unprotected left main was performed in 90 patients. Syntax scores were low
in 70 intermediate in 19 and high in 11 patients. Anatomical location of
left main stenosis was ostial in 27, mid in 7 and distal in 66 with medina
classification of 1,1,1 in 49 patients . The most common technique used in
was crossover (72%) patients. In the study no patients reported of any
MACEE or adverse outcomes at regular follow up. Conclusions: In the study
of patients with left main artery disease, we found no significant MACEE
after stenting with drug eluting stents with respect to the syntax scores
and anatomical location of the left main artery stenosis.

<15>
Accession Number
71801378
Authors
Yuncu G. Ozturk G.
Institution
(Yuncu) Thoracic Surgery, Turkey
(Ozturk) PAU, Denizli, Turkey
Title
Peroperative enteral nutrition with arginine-omega-3 fatty acids and
ribonucleic acid and glutamin supplemented diet could improve
postoperative recovery in lung cancer patients.
Source
Clinical Nutrition. Conference: 36th European Society for Clinical
Nutrition and Metabolism, ESPEN Congress Geneva Switzerland. Conference
Start: 20140906 Conference End: 20140909. Conference Publication:
(var.pagings). 33 (pp S60), 2014. Date of Publication: September 2014.
Publisher
Churchill Livingstone
Abstract
Rationale: The purpose of this study was to evaluate the effect of
peroperative immunonutrition pharmaceutics diet versus standard enteral
nutrition on postoperative recovery of patients with lung cancer. Methods:
A retrospective, controlled clinical study was conducted from January 2012
to March 2014 in the Department of Thoracic Surgery, Pamukkale University,
School of Medicine. Patients with lung cancer undergoing elective surgery
were divided into an immunonutrition group (n=32) and a control group
(n=30). Patients in the immunonutrition group received oral
supplementation containing arginine, omega-3 fatty acids, RNA and glutamin
for 7 days prior to surgery and for 15 days after surgery. Patients in the
control group received no artificial nutrition and were allowed to consume
regular food before surgery. Postoperative complications, surgical site
infections, and the days of postoperative hospitalization were measured.
Results: No significant differences between the 2 groups were noted for
the body mass index, total protein, albumin, hemoglobin, surgical methods,
operation time, or volume of intraoperative bleeding. The incidence of
postoperative complications was significantly lower and the days of
postoperative hospitalization were significantly decreased in the
immunonutrition group (P<0.05). Conclusion: Peroperative enteral
immunonutrition improves postoperative recovery in lung cancer patients.

Saturday, March 14, 2015

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Total documents retrieved: 22

Results Generated From:
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<1>
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), 2015. 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.

<2>
Accession Number
2014962397
Authors
Jashari H. Rydberg A. Ibrahimi P. Bajraktari G. Henein M.Y.
Institution
(Jashari, Ibrahimi, Bajraktari, Henein) Department of Public Health and
Clinical Medicine, Umea University, Sweden
(Rydberg) Department of Clinical Sciences, Umea University, Sweden
Title
Left ventricular response to pressure afterload in children: Aortic
stenosis and coarctation: A systematic review of the current evidence.
Source
International Journal of Cardiology. 178 (pp 203-209), 2015. Date of
Publication: 15 Jan 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent
two forms of pressure afterload that affect the left ventricle (LV), hence
require regular echocardiographic monitoring. Subclinical dysfunction of
the LV exists even in asymptomatic patients with preserved left
ventricular ejection fraction (EF), implying low sensitivity of EF in
predicting optimum time for intervention. In this article we review
patterns of LV myocardial deformation before and after correction of CAS
and CoA in infants, children and adolescents, showing their important role
in monitoring the course of LV dysfunction. A systematic search using
PubMed was performed and suitable studies are presented on a narrative
form. Normal EF and/or fractional shortening (FS), with subclinical
myocardial dysfunction are reported in all studies before intervention.
The short-term results, after intervention, were related to the type of
procedure, with no improvement or further deterioration related to surgery
but immediate improvement after balloon intervention. Long term follow-up
showed further improvement but still subnormal function. Thus correction
of CAS and CoA before irreversible LV dysfunction is vital, and requires
longitudinal studies in order to identify the most accurate parameter for
function prognostication. Until then, conventional echocardiographic
parameters together with myocardial velocities and deformation parameters
should continue to provide follow-up reproducible measures of ventricular
function.

<3>
Accession Number
2014962375
Authors
Briasoulis A. Afonso L. Palla M. Sharma S. Panaich S. Papageorgiou N.
Tousoulis D.
Institution
(Briasoulis, Afonso, Palla, Sharma, Panaich) Wayne State
University/DetroitMedical Center, Department of Cardiology, Detroit, IL
48226, United States
(Papageorgiou, Tousoulis) University of Athens Medical School, 1st
Department of Cardiology, Greece
Title
Culprit-vessel versus complete revascularization during primary
angioplasty in ST-elevation myocardial infarction: An updated
meta-analysis.
Source
International Journal of Cardiology. 178 (pp 171-174), 2015. Date of
Publication: 15 Jan 2015.
Publisher
Elsevier Ireland Ltd

<4>
Accession Number
2014962079
Authors
Shao Y. Fan Y. Li J. Cao H. Liu B. Wang J. Yang J. Zhang Q. Hu X.
Institution
(Shao, Fan, Li, Cao, Liu, Wang, Yang, Zhang, Hu) Department of Surgery,
First Affiliated Hospital of China Medical University, Shenyang 110001,
China
Title
Does elevated asymmetrical dimethylarginine predict major adverse cardiac
events and mortality in patients after percutaneous coronary
intervention?.
Source
International Journal of Cardiology. 178 (pp 188-190), 2015. Date of
Publication: 15 Jan 2015.
Publisher
Elsevier Ireland Ltd

<5>
Accession Number
2014960958
Authors
Pezawas T. Grimm M. Ristl R. Kivaranovic D. Moser F.T. Laufer G.
Schmidinger H.
Institution
(Pezawas, Moser, Schmidinger) Department of Internal Medicine II, Devision
of Cardiology, Medical University of Vienna, Wahringer Gurtel 18-20,
Vienna 1090, Austria
(Grimm, Laufer) Department of Cardiothoracic Surgery, Medical University
of Vienna, Vienna, Austria
(Ristl, Kivaranovic) Center for Medical Statistics Informatics and
Intelligent Systems, Medical University of Vienna, Vienna, Austria
Title
Primary preventive cardioverter-defibrillator implantation (Pro-ICD) in
patients awaiting heart transplantation. A prospective, randomized,
controlled 12-year follow-up study.
Source
Transplant International. 28 (1) (pp 34-41), 2015. Date of Publication: 01
Jan 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Summary The aim of this study was to evaluate whether short-term primary
preventive cardioverter-defibrillator (ICD) implantation as bridge to
heart transplantation (HTX) provides any survival benefit. Thirty-three
patients awaiting HTX were randomized to either conventional therapy
(control group) or primary preventive ICD implantation (ICD group).
Fourteen patients had ischemic cardiomyopathy (ICM) and 19 patients had
dilated cardiomyopathy (DCM). Sixteen patients were randomized to the ICD
group and 17 patients were randomized to the control group. Twenty
patients (61%) were transplanted after a waiting time of 10 +/- 9 months.
The remaining 13 patients (39%) were not transplanted because of clinical
improvement (n = 5), cerebral hemorrhage (n = 3), or death (n = 5). On the
waiting list, 3 ICD patients with DCM developed slow VTs without ICD
intervention, two patients with ICM (6%) had fast VT terminated by the
ICD, and no arrhythmic death was observed. After 11.9 years (median), 13
of 20 HTX patients (65%) and 5 of 13 non-HTX patients (38%) were alive.
Survivors had a higher LVEF (22 +/- 6 vs. 17 +/- 4%, P = 0.0092) and a
better exercise capacity (75 +/- 29 vs. 57 +/- 24 Watt, P = 0.0566) at
baseline as compared to nonsurvivors. This study may not support the
general use of primary preventive ICDs as a short-term bridge to heart
transplantation.

<6>
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), 2015. 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.

<7>
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), 2015. 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.

<8>
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), 2015. 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.

<9>
[Use Link to view the full text]
Accession Number
2014771741
Authors
Veerasamy M. Edwards R. Ford G. Kirkwood T. Newton J. Jones D. Kunadian V.
Institution
(Veerasamy, Ford, Newton, Jones, Kunadian) Institute of Cellular Medicine,
Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE2
4HH, United Kingdom
(Veerasamy, Edwards, Kunadian) Cardiothoracic Centre, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Kirkwood, Newton) Institute for Ageing and Health, Newcastle University,
Newcastle upon Tyne, United Kingdom
Title
Acute coronary syndrome among older patients: A review.
Source
Cardiology in Review. 23 (1) (pp 26-32), 2015. Date of Publication: 14 Dec
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Ischemic heart disease is the leading cause of mortality worldwide. Due to
advances in medicine in the past few decades, life expectancy has
increased resulting in an aging population in developed and developing
countries. Acute coronary syndrome causes greater morbidity and mortality
in this group of older patients, which appears to be due to age-related
comorbidities. This review examines the incidence and prevalence of acute
coronary syndrome among older patients, examines current treatment
strategies, and evaluates the predictors of adverse outcomes. In
particular, the impact of frailty on outcomes and the need for frailty
assessment in developing future research and management strategies among
older patients are discussed.

<10>
Accession Number
2014740136
Authors
Afshani N. Schulein S. Biccard B.M. Thomas J.M.
Institution
(Afshani) Department of Anaesthetics, University of Cape Town, Groote
Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
(Schulein) Department of Anesthetics, Toronto General Hospital, University
of Toronto, Toronto, Canada
(Schulein) McMaster University, ON, Canada
(Biccard) Perioperative Research Group, Department of Anaesthetics,
University of Kwazulu-Natal, Durban, South Africa
(Thomas) Department of Anaesthetics, Red Cross War Memorial Children's
Hospital, Cape Town, South Africa
Title
Clinical utility of B-type natriuretic peptide (NP) in pediatric cardiac
surgery - A systematic review.
Source
Paediatric Anaesthesia. 25 (2) (pp 115-126), 2015. Date of Publication: 01
Feb 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background NP is a biomarker that has been used in the diagnosis,
management, and prognostication of a number of cardiovascular disorders in
the pediatric population. The physiological role of this hormone is to
allow the myocardium to adapt to stress or strain imposed by a volume
and/or pressure load. Objective The aim of this study was to determine the
utility of preoperative and postoperative NP to predict outcome in
pediatric patients undergoing cardiac surgery for structural congenital
heart disease. Method We conducted a systematic review by searching three
electronic databases using the search terms 'paediatric' or 'pediatric'
and 'B-type natriuretic peptide'. Twenty peer-reviewed papers were
included in the study. Results Preoperative NP levels were associated with
the severity of cardiac failure in several studies. Preoperative NPs also
correlated with early postoperative outcome measures such as duration of
cardiopulmonary bypass, duration of mechanical ventilation, presence of
low cardiac output syndrome, length of stay in the intensive care unit and
in one study, death. Early (within 24 h) postoperative NPs showed a
stronger correlation than preoperative NPs to early postoperative adverse
events. Conclusion NPs provide a simple, noninvasive and complementary
tool to echocardiography that can be used to assist clinicians in the
assessment and management of pediatric patients with congenital heart
disease in the perioperative period.

<11>
Accession Number
2015718648
Authors
Bhargava S. Tamaskar A. Chakravarty N. Shende S. Shidhaye R.V.
Institution
(Bhargava, Tamaskar, Chakravarty, Shende, Shidhaye) Department of
Anesthesiology and Critical Care, L.N. Medical College, J.K. Hospital,
Kolar Road, Bhopal 462042, India
Title
Comparative study of thoracic epidural fentanyl with sufentanil for
postoperative pain relief in thoracic surgery.
Source
Anaesthesia, Pain and Intensive Care. 18 (3) (pp 260-264), 2014. Date of
Publication: 01 Jul 2014.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Objectives: Both fentanyl and sufentanil have been used, either alone or
with local anesthetics, for thoracic epidural analgesia. This study was
undertaken to compare quality and safety of thoracic epidural fentanyl and
thoracic epidural sufentanil for providing postoperative analgesia for 48
hours after thoracic surgery. Methodology: In a prospective randomized,
controlled study, 70 patients age group between 20-60 years, of either
gender, scheduled for routine thoracic surgery were randomly distributed
into two groups of 35 patients each. Postoperatively, fentanyl 50 mug in
Group-F and sufentanil 20 mug in Group-S, diluted in 10 ml of normal
saline was injected in the thoracic epidural space (between T6 - T8)
through the catheter and then repeated 6 hourly. Pain intensity score,
onset of analgesia, number of top-ups required and overall patient
satisfaction score were recorded. Results: Mean onset of analgesia was
10.31 +/- 1.5 min with sufentanil group as against 14.23 +/- 1.2 min with
fentanyl group. Pain Intensity (PPI) score < 1 was observed in 78.21%
observations belonging to sufentanil group and in 50 % observations
belonging to fentanyl group. Twenty five patients (71.4%) from sufentanil
group and 30 patients (85.7%) from fentanyl group required rescue
analgesia. The patient's feedback on pain relief was graded as very good
or good by 78.5% of the patients in Group-S and 69% patients in Group-F.
Conclusion: Though both drugs are equally safe, sufentanil is faster
acting, more potent and efficient analgesic than fentanyl when used for
postoperative pain relief in thoracic surgeries via thoracic epidural
approach.

<12>
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), 2014. 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.

<13>
Accession Number
2015789289
Authors
Paikin J.S. Hirsh J. Ginsberg J.S. Weitz J.I. Chan N.C. Whitlock R.P. Pare
G. Johnston M. Eikelboom J.W.
Institution
(Paikin, Whitlock, Eikelboom) Hamilton General Hospital, McMaster
University, Hamilton, ON, Canada
(Paikin, Hirsh, Ginsberg, Weitz, Pare, Eikelboom) Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Hirsh, Chan, Whitlock, Pare, Johnston, Eikelboom) Population Health
Research Institute, McMaster University, Hamilton, ON, Canada
(Ginsberg, Weitz, Eikelboom) Thrombosis and Atherosclerosis Research
Institute, McMaster University, Hamilton, ON, Canada
Title
Multiple daily doses of acetyl-salicylic acid (ASA) overcome reduced
platelet response to once-daily ASA after coronary artery bypass graft
surgery: A pilot randomized controlled trial.
Source
Journal of Thrombosis and Haemostasis. 13 (3) (pp 448-456), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Summary: Background: The efficacy of ASA for prevention of graft failure
following CABG surgery may be limited by incomplete platelet inhibition
due to increased post-operative platelet turnover. Objectives: To
determine whether acetyl-salicylic acid (ASA) 325 mg once-daily or 81 mg
four-times daily overcomes the impaired response to ASA 81 mg once-daily
in post-operative coronary artery bypass graft (CABG) patients. Methods:
We randomized 110 patients undergoing CABG surgery to either ASA 81 mg
once-daily, 81 mg four times daily or 325 mg once-daily and compared their
effects on serum thromboxane B<sub>2</sub> (TXB<sub>2</sub>) suppression
and arachidonate-induced platelet aggregation. Results: One hundred
patients were included in the final analysis. Platelet counts fell after
surgery, reached a nadir on day 2, and then gradually increased. Although
there was near complete suppression of TXB<sub>2</sub> on the second or
third post-operative day, TXB<sub>2</sub> levels increased in parallel
with the rise in platelet count on subsequent days. This increase was most
marked in patients receiving ASA 81 mg once-daily and less evident in
those receiving ASA four times daily. On post-operative day 4, (i) median
TXB<sub>2</sub> levels were lower with four times daily ASA than with
either ASA 81 mg once-daily (1.1 ng/mL; Quartile(Q) Q1,Q3: 0.5, 2.4 and
13.3 ng/mL; Q1,Q3: 7.8, 30.8 ng/mL, respectively; P < 0.0001) or ASA 325
mg once-daily (3.4 ng/mL; Q1,Q3: 2.0, 8.2 ng/mL; P = 0.002), and (ii) ASA
given four times daily was more effective than ASA 81 mg once-daily and
325 mg once-daily at suppressing platelet aggregation. Conclusions: Four
times daily ASA is more effective than ASA 81 and 325 mg once-daily at
suppressing serum TXB<sub>2</sub> formation and platelet aggregation
immediately following CABG surgery.

<14>
Accession Number
2015684592
Authors
Feldman A.M. She L. McNamara D.M. Mann D.L. Bristow M.R. Maisel A.S.
Wagner D.R. Andersson B. Chiariello L. Hayward C.S. Hendry P. Parker J.D.
Racine N. Selzman C.H. Senni M. Stepinska J. Zembala M. Rouleau J.
Velazquez E.J. Lee K.L.
Institution
(Feldman) Department of Medicine, Temple University School of Medicine,
3500 N. Broad Street, Philadelphia, PA 19140, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(She, Lee) Duke Clinical Research Institute, Durham, NC, United States
(McNamara) Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Mann) Department of Medicine, Washington University in St. Louis School
of Medicine, St. Louis, MO, United States
(Bristow) Department of Medicine, University of Colorado at Denver,
Denver, CO, United States
(Maisel) Department of Medicine, University of California, San Diego, CA,
United States
(Selzman) Department of Surgery, University of Utah Hospital, Salt Lake
City, UT, United States
(Wagner) Laboratory of Cardiovascular Research, Luxembourg Heart
Institute, Luxembourg, Luxembourg
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chiariello) Department of Cardiac Surgery, Policlinico Tor Vergata of
Rome, Rome, Italy
(Senni) Department of Medicine, Ospedali Riuniti, Bergamo, Italy
(Hayward) Department of Cardiology, St. Vincent's Hospital, Sydney, NSW,
Australia
(Hendry) Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa,
ON, Canada
(Parker) Department of Medicine, Toronto General Hospital, Toronto, ON,
Canada
(Racine, Rouleau) Department of Medicine, Montreal Heart Institute,
Montreal, QC, Canada
(Stepinska) Valvular Heart Department, National Institute of Cardiology,
Warsaw, Poland
(Zembala) Department of Cardiac Surgery, Silesian Center for Heart
Diseases, Zabrze, Poland
Title
Genetic variants are not associated with outcome in patients with coronary
artery disease and left ventricular dysfunction: Results of the genetic
substudy of the Surgical Treatment for Ischemic Heart Failure (STICH)
trials.
Source
Cardiology (Switzerland). 130 (2) (pp 69-81), 2015. Date of Publication:
24 Feb 2015.
Publisher
S. Karger AG
Abstract
Objectives and Background: We evaluated the ability of 23 genetic variants
to provide prognostic information in patients enrolled in the Genetic
Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH)
trials. Methods: Patients assigned to STICH Hypothesis 1 were randomized
to medical therapy with or without coronary artery bypass grafting (CABG).
Those assigned to STICH Hypothesis 2 were randomized to CABG or CABG with
left ventricular reconstruction. Results: In patients assigned to STICH
Hypothesis 2 (n = 714), no genetic variant met the prespecified
Bonferroni-adjusted threshold for statistical significance (p < 0.002);
however, several variants met nominal prognostic significance: variants in
the beta<sub>2</sub>-adrenergic receptor gene (beta<sub>2</sub>-AR
Gln27Glu) and in the A<sub>1</sub>-adenosine receptor gene
(A<sub>1</sub>-717 T/G) were associated with an increased risk of a
subject dying or being hospitalized for a cardiac problem (p = 0.027 and
0.031, respectively). These relationships remained nominally significant
even after multivariable adjustment for prognostic clinical variables.
However, none of the 23 genetic variants influenced all-cause mortality or
the combination of death or cardiovascular hospitalization in the STICH
Hypothesis 1 population (n = 532) by either univariate or multivariable
analysis. Conclusion: We were unable to identify the predictive genotypes
in optimally treated patients in these two ischemic heart failure
populations.

<15>
Accession Number
2015791353
Authors
Gu W.-J. Wang F. Liu J.-C.
Institution
(Gu, Liu) Department of Anesthesiology, Hospital of Guangxi Medical
University, Nanning, China
(Wang) Department of Anesthesiology, General Hospital of Jinan Military
Command, Jinan, China
Title
Effect of lung-protective ventilation with lower tidal volumes on clinical
outcomes among patients undergoing surgery: A meta-analysis of randomized
controlled trials.
Source
CMAJ. 187 (3) (pp E101-E109), 2015. Date of Publication: 17 Feb 2015.
Publisher
Canadian Medical Association (1867 Alta Vista Drive, Ottawa KIG5W8,
Canada. E-mail: dahlia@car.ca)
Abstract
Background: In anesthetized patients undergoing surgery, the role of
lung-protective ventilation with lower tidal volumes is unclear. We
performed a meta-analysis of randomized controlled trials (RCTs) to
evaluate the effect of this ventilation strategy on postoperative
outcomes. Methods: We searched electronic databases from inception through
September 2014. We included RCTs that compared protective ventilation with
lower tidal volumes and conventional ventilation with higher tidal volumes
in anesthetized adults undergoing surgery. We pooled outcomes using a
random-effects model. The primary outcome measures were lung injury and
pulmonary infection. Results: We included 19 trials (n = 1348). Compared
with patients in the control group, those who received lung-protective
ventilation had a decreased risk of lung injury (risk ratio [RR] 0.36, 95%
confidence interval [CI] 0.17 to 0.78; I<sup>2</sup> = 0%) and pulmonary
infection (RR 0.46, 95% CI 0.26 to 0.83; I<sup>2</sup> = 8%), and higher
levels of arterial partial pressure of carbon dioxide (standardized mean
difference 0.47, 95% CI 0.18 to 0.75; I<sup>2</sup> = 65%). No significant
differences were observed between the patient groups in atelectasis,
mortality, length of hospital stay, length of stay in the intensive care
unit or the ratio of arterial partial pressure of oxygen to fraction of
inspired oxygen. Interpretation: Anesthetized patients who received
ventilation with lower tidal volumes during surgery had a lower risk of
lung injury and pulmonary infection than those given conventional
ventilation with higher tidal volumes. Implementation of a lung-protective
ventilation strategy with lower tidal volumes may lower the incidence of
these outcomes.

<16>
Accession Number
2014721843
Authors
McMaster K. Sanchez-Ramos L. Kaunitz A.M.
Institution
(McMaster, Sanchez-Ramos, Kaunitz) Department of Obstetrics and
Gynecology, University of Florida, College of Medicine - Jacksonville,
Jacksonville, FL, United States
Title
Balancing the efficacy and safety of misoprostol: A meta-analysis
comparing 25 versus 50 micrograms of intravaginal misoprostol for the
induction of labour.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. 122 (4) (pp
468-476), 2014. Date of Publication: 01 Mar 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background The optimal dose of misoprostol for the induction of labour
remains uncertain. Objectives To compare the efficacy and safety of 25
versus 50 micrograms of intravaginal misoprostol tablets for the induction
of labour and cervical ripening. Search strategy We performed electronic
and manual searches to identify relevant randomised trials. Selection
criteria The efficacy outcomes assessed were rates of vaginal delivery
within 24 hours, delivery within one dose, and oxytocin augmentation, and
interval to delivery. The safety outcomes assessed were incidences of
tachysystole, hyperstimulation, caesarean delivery, cesarean delivery for
non-reassuring fetal heart rate (FHR), operative vaginal delivery,
abnormal 5-minute Apgar score, abnormal cord gas values, admission to a
neonatal intensive care unit (NICU), and meconium passage. Data collection
and analysis Thirteen studies (1945 women) were included. Relative risk
(RR) and 95% confidence intervals (CI) were calculated using fixed-effects
and random-effects models. Main results We found that 25 micrograms was
less efficacious, with lower rates of delivery after one dose (RR 0.59;
95% CI 0.39-0.88) and vaginal delivery within 24 hours (RR 0.88; 95% CI
0.79-0.96), and with increased rates of oxytocin augmentation (RR 1.54,
95% CI 1.36-1.75). We noted an improved safety profile with 25 micrograms,
however, with decreased rates of tachysystole (RR 0.46; 95% CI 0.35-0.61),
hyperstimulation (RR 0.5; 95% CI 0.31-0.78), caesarean deliveries for
non-reassuring FHR (RR 0.67; 95% CI 0.52-0.87), NICU admissions (RR 0.63;
95% CI 0.4-0.98), and meconium passage (RR 0.65; 95% CI 0.45-0.96).
Conclusions Although 50 micrograms of intravaginal misoprostol may be more
efficacious, safety concerns make the 25-microgram dose preferable.

<17>
Accession Number
2015694930
Authors
Siegmund-Schultze N.
Title
Preconditioning for bypass surgery: Heart-distant, short ischemic phases
are cardioproctive.
Source
Deutsches Arzteblatt International. 110 (40) (pp A1860), 2013. Date of
Publication: 04 Oct 2013.
Publisher
Deutscher Arzte-Verlag GmbH (Dieselstrasse 2 (Postfach 0254), Cologne
50859, Germany. E-mail: verlag@aerzteblatt.de)

<18>
Accession Number
2015791165
Authors
Billings F.T. Petracek M.R. Roberts L.J. Pretorius M.
Institution
(Roberts, Pretorius) Division of Clinical Pharmacology, Department of
Medicine, Vanderbilt University Medical School, Nashville, TN, United
States
(Petracek) Department of Cardiac Surgery, Vanderbilt University Medical
School, Nashville, TN, United States
(Roberts) Department of Pharmacology, Vanderbilt University Medical
School, Nashville, TN, United States
(Billings, Pretorius) Department of Anesthesiology, Vanderbilt University
Medical School, Nashville, TN, United States
Title
Perioperative intravenous acetaminophen attenuates lipid peroxidation in
adults undergoing cardiopulmonary bypass: A randomized clinical trial.
Source
PLoS ONE. 10 (2) , 2015. Article Number: e0117625. Date of Publication: 23
Feb 2015.
Publisher
Public Library of Science
Abstract
Background: Cardiopulmonary bypass (CPB) lyses erythrocytes and induces
lipid peroxidation, indicated by increasing plasma concentrations of free
hemoglobin, F<sub>2</sub>-isoprostanes, and isofurans. Acetaminophen
attenuates hemeprotein-mediated lipid peroxidation, reduces plasma and
urine concentrations of F<sub>2</sub>-isoprostanes, and preserves kidney
function in an animal model of rhabdomyolysis. Acetaminophen also
attenuates plasma concentrations of isofurans in children undergoing CPB.
The effect of acetaminophen on lipid peroxidation in adults has not been
studied. This was a pilot study designed to test the hypothesis that
acetaminophen attenuates lipid peroxidation in adults undergoing CPB and
to generate data for a clinical trial aimed to reduce acute kidney injury
following cardiac surgery. Methods and Results: In a prospective
double-blind placebo-controlled clinical trial, sixty adult patients were
randomized to receive intravenous acetaminophen or placebo starting prior
to initiation of CPB and for every 6 hours for 4 doses. Acetaminophen
concentrations measured 30 min into CPB and post-CPB were 11.9+/- 0.6
mug/mL (78.9+/-3.9 muM) and 8.7+/- 0.3 mug/mL (57.6+/-2.0 muM),
respectively. Plasma free hemoglobin increased more than 15-fold during
CPB, and haptoglobin decreased 73%, indicating hemolysis. Plasma and
urinary markers of lipid peroxidation also increased during CPB but
returned to baseline by the first postoperative day. Acetaminophen reduced
plasma isofuran concentrations over the duration of the study (P = 0.05),
and the intraoperative plasma isofuran concentrations that corresponded to
peak hemolysis were attenuated in those subjects randomized to
acetaminophen (P = 0.03). Perioperative acetaminophen did not affect
plasma concentrations of F<sub>2</sub>-isoprostanes or urinary markers of
lipid peroxidation. Conclusions: Intravenous acetaminophen attenuates the
increase in intraoperative plasma isofuran concentrations that occurs
during CPB, while urinary markers were unaffected. Trial Registration:
ClinicalTrials.gov NCT01366976.

<19>
Accession Number
2014722173
Authors
Matzelle S.J. Murphy M.J. Weightman W.M. Gibbs N.M. Edelman J.J.B. Passage
J.
Institution
(Matzelle, Murphy, Weightman, Gibbs) Department of Anaesthesia, Sir
Charles Gairdner Hospital, Nedlands, WA, Australia
(Edelman, Passage) Department of Cardiothoracic Surgery, Sir Charles
Gairdner Hospital, Nedlands, WA, Australia
(Passage) School of Medicine, Fremantle, University of Notre Dame, WA,
Australia
Title
Minimally invasive mitral valve surgery using single dose antegrade
custodiol cardioplegia.
Source
Heart Lung and Circulation. 23 (9) (pp 863-868), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Elsevier Ltd
Abstract
Objective: Our unit began a minimally invasive mitral surgery (MIMS)
program utilising antegrade Custodiol solution as the sole cardioplegia.
The aim of this paper is to report our results of this program.
Patients/Methods: Early clinical outcomes were identified and assessed for
the first consecutive 100 MIMS patients with comparisons made to a
historical group operated via a sternotomy (n. =. 113). The efficacy of
myocardial protection was assessed using surrogate outcomes of myocardial
protection with serial sodium concentrations also analysed. Results: Six
hours postoperatively 12 patients required inotropic support. Peak
troponin-I in the first 24. hours was 5.1 (0.8-40. mug/L [median(range)].
Sodium levels decreased following administration of Custodiol but by six
hours postoperatively the sodium had returned to greater than 130mmol/L in
all but five patients. Blood transfusion was smaller in the MIMS versus
historical group (RBC 17% vs. 65%). MIMS patients had a shorter duration
of ventilation, hospital stay and one-year mortality rate (0%).
Conclusions: In this series of patients undergoing MIMS, single dose
antegrade Custodiol offers satisfactory and safe myocardial protection.
Early clinical outcomes were also satisfactory. Whilst our findings are
observational, they nevertheless support the use of this less invasive
approach to mitral surgery using single dose Custodiol for myocardial
protection.

<20>
Accession Number
2014740233
Authors
Jarral O.A. Saso S. Harling L. Ashrafian H. Naase H. Casula R. Athanasiou
T.
Institution
(Jarral, Saso, Harling, Ashrafian, Naase, Casula, Athanasiou) Department
of Surgery and Cancer, Imperial College, London, United Kingdom
Title
Organ dysfunction in patients with left ventricular impairment: What is
the effect of cardiopulmonary bypass?.
Source
Heart Lung and Circulation. 23 (9) (pp 852-862), 2014. Date of
Publication: 01 Sep 2014.
Publisher
Elsevier Ltd
Abstract
Objective: We have previously demonstrated that avoidance of
cardiopulmonary bypass may reduce early mortality and cardiac related
complications in patients with left ventricular dysfunction. This study
examines the impact of cardiopulmonary bypass in the same subgroup in
terms of organ dysfunction and non-cardiac related complications. Methods:
A systematic literature review identified 24 studies including 7,976
patients. Data was extracted for the following outcomes of interest:
stroke, renal failure, ventilation time, pulmonary complications and
sternal wound infection. Random effects meta-analysis was used to
aggregate the data. Sensitivity and heterogeneity were assessed. Results:
Meta-analysis through subgroup analysis of the highest quality studies
revealed that the off-pump technique is associated with significantly
lower incidence of stroke, renal failure, ventilation time and sternal
wound infection. Conclusion: These results highlight an important link
between cardiopulmonary bypass and the incidence of multi-organ
dysfunction in patients with left ventricular dysfunction. The results add
to the growing body of evidence that off-pump surgery is more beneficial
in high-risk patients. Even in the light of mixed reports on graft patency
and completeness of revascularisation, the technique may be justified in
selected patients in attempt to reduce organ dysfunction.

<21>
Accession Number
2015785990
Authors
Ghiasi A. Shafiee A. Omran A.S. Ghaffari-Marandi N. Shirzad M. Barkhordari
K.
Institution
(Ghiasi) Department of Anesthaesiology and Critical Care, Tehran Heart
Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Shafiee, Ghaffari-Marandi, Barkhordari) Department of Cardiovascular
Research, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Omran, Shirzad) Department of Cardiac Surgery, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
The effect of continuous low dose methylprednisolone infusion on
inflammatory parameters in patients undergoing coronary artery bypass
graft surgery: A randomized-controlled clinical trial.
Source
Acta Medica Iranica. 53 (2) (pp 104-111), 2015. Date of Publication: 2015.
Publisher
Medical Sciences University of Teheran
Abstract
This trial was performed to determine if a continuous low-dose infusion of
methylprednisolone is as effective as its bolus of high-dose in reducing
inflammatory response. The study was single-center, doubleblinded
randomized clinical trial and performed in a surgical intensive care unit
of an academic hospital. In this study, 72 consecutive patients undergoing
elective coronary artery bypass grafting (CABG) were assigned to receive
either a methylprednisolone loading dose (1mg/kg) followed by continuous
infusion (2mg/Kg/24 hours for 1 day) (low-dose regime) or a single dose of
methylprednisolone (15 mg/kg) before cardiopulmonary bypass (high dose
regime). Serum concentrations of IL-6 and C-reactive protein (CRP) were
measured preoperatively and 6, 24 and 48 hours after surgery, and serum
creatinine was measured before the operation and 24, 48 and 72 hours
postoperatively. The measurements were then compared between the groups to
evaluate the efficacy of each regimen. The basic characteristics and
measurements were not different between the study groups. There was no
significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46,
respectively). Early outcomes such as the length of stay in the intensive
care unit, intubation time, changes in serum creatinine and blood glucose
levels, inotropic support, insulin requirements, and rate of infection
were also similar in both groups. A continuous low dose infusion of
methylprednisolone was as effective as a single high dose
methylprednisolone in reducing the inflammatory response after CABG with
extracorporeal circulation with no significant difference in the
postoperative measurements and outcomes.

<22>
Accession Number
71797486
Authors
Visser M. De Mol B.A. Van Leeuwen P.A.
Institution
(Visser, Van Leeuwen) Surgery, VU University, Medical Center, Amsterdam,
Netherlands
(Visser, De Mol) Cardiothoracic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Nutrition during surgery increases myocardial arginine/adma ratio and
essential amino acids in patients undergoing off-pump coronary artery
bypass grafting: A randomized controlled trial.
Source
Clinical Nutrition. Conference: 35th European Society for Clinical
Nutrition and Metabolism, ESPEN Congress Leipzig Germany. Conference
Start: 20130831 Conference End: 20130903. Conference Publication:
(var.pagings). 32 (pp S27), 2013. Date of Publication: September 2013.
Publisher
Churchill Livingstone
Abstract
Rationale: Nitric oxide (NO) is essential for proper cardiovascular
functioning but might be low in the surgical patient as its precursor
arginine decreases and the NO synthase inhibitor asymmetric
dimethylarginine (ADMA) increases in these patients resulting in a low
arginine/ADMA ratio. Besides arginine, several amino acids are essential
for proper cardiovascular metabolism. We investigated whether
supplementation of (par) enteral nutrition during surgery can increase
myocardial arginine/ADMA ratio and amino acids. Methods: In 33 patients
undergoing off-pump coronary artery bypass grafting, enteral, parenteral
or no nutrition (control) was supplemented from two days before, during,
until two days after surgery. A myocardial tissue sample was taken before
and after revascularization, and analysed for arginine/ADMA ratio, and
amino acids concentrations. Results: During surgery the increases in
myocardial arginine/ ADMA ratio, branched chain amino acids (BCAA) and
essential amino acids (EAA) concentrations were significantly higher in
the enteral and parenteral group compared to the control group
(arginine/ADMA ratio: 47.7 (30.7-74.9), 49.6 (33.0-68.0), and 26.0
(15.4-32.5), p = 0.012; BCAA (nmol/g tissue): 12.6 (7.1-27.1), 14.9
(6.6-23.6), and 1.0 (-1.8-9.2), p = 0.029; EAA (nmol/g tissue): 15.2
(7.4-39.2), 26.8 (3.4-48.2), and 4.1 (-11.9-11.7) p = 0.040). Conclusion:
Enteral or parenteral nutrition during surgery can increase the
arginine/ADMA ratio, and BCAA and EAA concentrations in the human heart.