EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015779260
Authors
Puricel S. Arroyo D. Corpataux N. Baeriswyl G. Lehmann S. Kallinikou Z.
Muller O. Allard L. Stauffer J.-C. Togni M. Goy J.-J. Cook S.
Institution
(Puricel, Arroyo, Corpataux, Baeriswyl, Lehmann, Kallinikou, Muller,
Allard, Stauffer, Togni, Goy, Cook) Department of Cardiology, Fribourg
University and Hospital, Fribourg CH-1708, Switzerland
Title
Comparison of everolimus- and biolimus-eluting coronary stents with
everolimus-eluting bioresorbable vascular scaffolds.
Source
Journal of the American College of Cardiology. 65 (8) (pp 791-801), 2015.
Date of Publication: 03 Mar 2015.
Publisher
Elsevier USA
Abstract
Background The first CE-approved bioresorbable vascular scaffold (BVS) is
effective at treating simple lesions and stable coronary artery disease,
but it has yet to be assessed versus the best-in-class drug-eluting stents
(DES). Objectives This study sought to compare the performance of a BVS
with that of everolimus-eluting stents (EES) and biolimus-eluting stents
(BES) in all-comer patients. Methods The EVERBIO II (Comparison of
Everolimus- and Biolimus-Eluting Stents With Everolimus-Eluting
Bioresorbable Vascular Scaffold Stents II) trial was a single-center,
assessor-blinded study of 240 patients randomly assigned in a 1:1:1 ratio
to EES, BES, or BVS. The only exclusion criterion was a reference vessel
diameter >4.0 mm, which precluded treatment with BVS. The primary endpoint
was angiographic late lumen loss (LLL) at 9 months. Secondary endpoints
included patient-oriented major acute coronary events (MACE) (death,
myocardial infarction [MI], and any revascularization), device-oriented
MACE (cardiac death, MI, and target lesion revascularization), and stent
thrombosis at the 9-month clinical follow-up. Results Follow-up
angiography was performed in 216 patients (90.7%) at 9 months. In-stent
LLL was similar between patients treated with BVS (0.28 +/- 0.39 mm) and
those treated with EES/BES (0.25 +/- 0.36 mm; p = 0.30). Clinical outcomes
were similar at 9 months: the patient-oriented MACE rate was 27% in BVS
and 26% in the EES/BES group (p = 0.83) and the device-oriented MACE rate
was 12% in BVS and 9% in the EES/BES group (p = 0.6). Conclusions
New-generation metallic DES (EES/BES) were not superior to BVS in terms of
angiographic LLL and clinical outcomes. (Comparison of Everolimus- and
Biolimus-Eluting Stents With Everolimus-Eluting Bioresorbable Vascular
Scaffold Stents [EVERBIO II]; NCT01711931)

<2>
Accession Number
2015779250
Authors
Gilard M. Barragan P. Noryani A.A.L. Noor H.A. Majwal T. Hovasse T.
Castellant P. Schneeberger M. Maillard L. Bressolette E. Wojcik J.
Delarche N. Blanchard D. Jouve B. Ormezzano O. Paganelli F. Levy G.
Sainsous J. Carrie D. Furber A. Berland J. Darremont O. Le Breton H.
Lyuycx-Bore A. Gommeaux A. Cassat C. Kermarrec A. Cazaux P. Druelles P.
Dauphin R. Armengaud J. Dupouy P. Champagnac D. Ohlmann P. Endresen K.
Benamer H. Kiss R.G. Ungi I. Boschat J. Morice M.-C.
Institution
(Gilard, Castellant, Boschat) Department of Cardiology, Brest University,
Brest, France
(Barragan) Polyclinique les Fleurs, Ollioules, France
(Noryani) Al Qassimi Hospital, Sharjah, United Arab Emirates
(Noor) Bahrain Defence Force West, Riffa, Bahrain
(Majwal) Dubai Hospital, Dubai, United Arab Emirates
(Hovasse, Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud,
Massy, France
(Schneeberger) Hopital Albert Schweitzer, Colmar, France
(Maillard) Clinique Axium, Aix en Provence, France
(Bressolette) Nouvelles Cliniques Nantaises, Nantes, France
(Wojcik) Klinika Kardiologii SPSK4, Lublin, Poland
(Delarche) Centre Hospitalier Mitterrand, Pau, France
(Blanchard) Clinique Saint Gatien, Tours, France
(Jouve) Centre Hospitalier, Aix en Provence, France
(Ormezzano) Centre Hospitalier Universitaire de Grenoble, Grenoble, France
(Paganelli) Centre Hospitalier Universitaire, Hopital Nord, Marseille,
France
(Levy) Clinique du Millenaire, Montpellier, France
(Sainsous) Clinique Rhone Durance, Avignon, France
(Carrie) Centre Hospitalier Universitaire, Toulouse, France
(Furber) Centre Hospitalier Universitaire, Angers, France
(Berland) Clinique Saint Hilaire, Rouen, France
(Darremont) Clinique Saint Augustin, Bordeaux, France
(Le Breton) Centre Hospitalier Universitaire, Rennes, France
(Lyuycx-Bore) Centre Hospitalier, Compiegne, France
(Gommeaux) Polyclinique de Bois, Bernard, France
(Cassat) Centre Hospitalier Universitaire, Limoges, France
(Kermarrec) Centre Hospitalier, Vannes, France
(Cazaux) Centre Hospitalier, Lorient, France
(Druelles) Poly de Saint Laurent, Rennes, France
(Dauphin) Hopital de la Croix Rousse, Lyon, France
(Armengaud) Clinique Esquirol, Agen, France
(Dupouy) Hopital Prive, Antony, France
(Champagnac) Clinique Tonkin, Villeurbanne, France
(Ohlmann) Centre Hospitalier Universitaire, Strasbourg, France
(Endresen) Oslo Universitetssykehus, Oslo, Norway
(Benamer) Hopital la Roseraie, Aubervilliers, France
(Kiss) MH Egrszsegugyi Kozpont, Budapest, Hungary
(Ungi) Honved Korhaz, Budapest, Hungary
(Ungi) University of Szeged, Szent-Gyorgyi Albert, Szeged, Hungary
Title
6-versus 24-month dual antiplatelet therapy after implantation of
drug-eluting stents in patients nonresistant to aspirin: The randomized,
multicenter ITALIC trial.
Source
Journal of the American College of Cardiology. 65 (8) (pp 777-786), 2015.
Date of Publication: 03 Mar 2015.
Publisher
Elsevier USA
Abstract
Background The currently recommended duration of dual antiplatelet therapy
(DAPT) in drug-eluting stent (DES) recipients is 12 months to reduce the
risk of late stent thrombosis, particularly in those with acute coronary
syndrome (ACS). Objectives This study hypothesized that antiplatelet
treatment with DAPT for 6 months may be noninferior to 24-month DAPT in
aspirin-sensitive patients. Methods A multicenter, randomized study
assigned patients undergoing implantation of everolimus-eluting stents
with confirmed nonresistance to aspirin to receive 6- or 24-month DAPT.
The primary endpoint was a composite of death, myocardial infarction,
urgent target vessel revascularization, stroke, and major bleeding at 12
months post-stenting. Results A total of 2,031 patients were enrolled in
70 European and Middle Eastern centers. The trial was prematurely
terminated due to recruitment problems, leaving 941 patients randomized to
24-month DAPT and 953 to 6-month DAPT. The 2 treatment groups had similar
baseline and procedural characteristics. There was no significant
difference in the primary endpoint (24-month: 1.5% vs. 6-month: 1.6%; p =
0.85). Noninferiority was demonstrated for 6- versus 24-month DAPT, with
an absolute risk difference of 0.11% (95% confidence interval: -1.04% to
1.26%; p for noninferiority = 0.0002). There were no significant
differences in stent thrombosis or bleeding complications. In the 792
(44%) high-risk patients with ACS, primary and secondary endpoints did not
significantly differ (hazard ratio: 1.7 [95% confidence interval: 0.519 to
6.057; p = 0.361]). Conclusions Rates of bleeding and thrombotic events
were not significantly different according to 6- versus 24-month DAPT
after PCI with new-generation DES in good aspirin responders. (Is There A
LIfe for DES After Discontinuation of Clopidogrel [ITALICplus];
NCT01476020)

<3>
Accession Number
2015779248
Authors
Valgimigli M. Patialiakas A. Thury A. McFadden E. Colangelo S. Campo G.
Tebaldi M. Ungi I. Tondi S. Roffi M. Menozzi A. De Cesare N. Garbo R.
Meliga E. Testa L. Gabriel H.M. Airoldi F. Ferlini M. Liistro F.
Dellavalle A. Vranckx P. Briguori C.
Institution
(Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Patialiakas, Campo, Tebaldi) Interventional Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
(Patialiakas) Cardiology Department, Crete Naval Hospital, Crete, Greece
(Thury, Ungi) Cardiology Center, University of Szeged, Szeged, Hungary
(McFadden) Division of Cardiology, Cork University Hospital, Cork, Ireland
(Colangelo, Garbo) Interventional Cardiology, San Giovanni Bosco Hospital,
Torino, Italy
(Tondi) Azienda Unita Sanitaria Locale di Modena-Ospedale, Baggiovara,
Italy
(Roffi) Division of Cardiology, University Hospital, Geneva, Switzerland
(Menozzi) Interventional Cardiology Unit, Azienda
Ospedaliero-Universitaria di Parma, Parma, Italy
(De Cesare) Policlinico S. Marco Zingonia, Bergamo, Italy
(Meliga) Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
(Testa) Interventional Cardiology, Ist. Clinico S. Ambrogio, IRCCS San
Donato, Milan, Italy
(Gabriel) Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
(Airoldi) IRCCS Multimedica Sesto San Giovanni, Milan, Italy
(Ferlini) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Liistro) Cardiovascular Departments of San Donato Hospital, Arezzo, Italy
(Dellavalle) Ospedali Riuniti, Savigliano, Italy
(Vranckx) Virga Jesse Ziekenhuis, Hasselt, Belgium
(Briguori) Clinica Mediterranea, Napoli, Italy
Title
Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting
stent candidates.
Source
Journal of the American College of Cardiology. 65 (8) (pp 805-815), 2015.
Date of Publication: 03 Mar 2015.
Publisher
Elsevier USA
Abstract
Background The use of drug-eluting stents (DES) in patients at high risk
of bleeding or thrombosis has not been prospectively studied; limited data
are available in patients who have a low restenosis risk. Objectives This
study sought to compare a hydrophilic polymer-based, second-generation
zotarolimus-eluting stent (ZES) with a unique drug fast-release profile
versus bare-metal stents (BMS) under similar durations of
dual-antiplatelet therapy (DAPT). Methods We randomly assigned 1,606
patients with stable or unstable symptoms, and who on the basis of
thrombotic bleeding or restenosis risk criteria, qualified as uncertain
candidates for DES, to receive ZES or BMS. DAPT duration was on the basis
of patient characteristics, rather than stent characteristics, and allowed
for a personalized 1-month dual antiplatelet regimen. The primary endpoint
was the risk of 1-year major adverse cardiovascular events (MACE), which
included death, myocardial infarction (MI), or target vessel
revascularization (TVR). Results Median DAPT duration was 32 days
(interquartile range [IQR]: 30 to 180 days) and did not differ between the
groups. In the ZES group, 140 patients (17.5%) reached the primary
endpoint, compared with 178 patients (22.1%) in the BMS group (hazard
ratio: 0.76; 95% confidence interval: 0.61 to 0.95; p = 0.011) as a result
of lower MI (2.9% vs. 8.1%; p < 0.001) and TVR rates (5.9% vs.10.7%; p =
0.001) in the ZES group. Definite or probable stent thrombosis was also
significantly reduced in ZES recipients (2.0% vs. 4.1%; p = 0.019).
Conclusions Compared with BMS, DES implantation using a stent with a
biocompatible polymer and fast drug-eluting characteristics, combined with
an abbreviated, tailored DAPT regimen, resulted in a lower risk of 1-year
MACE in uncertain candidates for DES implantation. (Zotarolimus-eluting
Endeavor Sprint Stent in Uncertain DES Candidates [ZEUS] Study;
NCT01385319)

<4>
Accession Number
2015776766
Authors
Jin L. Ji H.-W.
Institution
(Jin, Ji) Department of Anesthesiology, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing 100037, China
Title
Effect of desmopressin on platelet aggregation and blood loss in patients
undergoing valvular heart surgery.
Source
Chinese Medical Journal. 128 (5) (pp 644-647), 2015. Date of Publication:
2015.
Publisher
Chinese Medical Association
Abstract
Background: Blood loss after cardiac surgery can be caused by impaired
platelet (PLT) function after cardiopulmonary bypass. Desmopressin or
1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of
vasopressin. DDAVP can increase the level of von Willebrand factor and
coagulation factor VIII, thus it may enhance PLT function and improve
coagulation. In this study, we assessed the effects of DDAVP on PLT
aggregation and blood loss in patients undergoing cardiac surgery.
Methods: A total of 102 patients undergoing valvular heart surgery (from
October 2010 to June 2011) were divided into DDAVP group (n = 52) and
control group (n = 50). A dose of DDAVP (0.3 mug/kg) was administered to
the patients intravenously when they were being re-warmed. At the same
time, an equal volume of saline was given to the patients in the control
group. PLT aggregation rate was measured with the AggRAM four-way PLT
aggregation measurement instrument. The blood loss and transfusion,
hemoglobin levels, PLT counts, and urine outputs at different time were
recorded and compared. Results: The postoperative blood loss in the first
6 h was significantly reduced in DDAVP group (202 +/- 119 ml vs. 258 +/-
143 ml, P = 0.023). The incidence of fresh frozen plasma (FFP) transfusion
was decreased postoperatively in DDAVP group (3.8% vs. 12%, P = 0.015).
There was no significant difference in the PLT aggregation, urine volumes,
red blood cell transfusions and blood loss after 24 h between two groups.
Conclusions: A single dose of DDAVP can reduce the first 6 h blood loss
and FFP transfusion postoperatively in patients undergoing valvular heart
surgery, but has no effect on PLT aggregation.

<5>
Accession Number
2015759720
Authors
Young P.P. Schafer R.
Institution
(Young) Department of Pathology, Microbiology and Immunology, Vanderbilt
University Medical Center, Nashville, TN, United States
(Young) Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN, United States
(Young) Department of Veterans Affairs, Nashville, TN, United States
(Schafer) Institute for Transfusion Medicine and Immunohematology, German
Red Cross Blood Donor Service Baden-Wurttemberg-Hessen GGmbH,
Johann-Wolfgang-Goethe-University Hospital, Frankfurt am Main, Germany
Title
Cell-based therapies for cardiac disease: A cellular therapist's
perspective.
Source
Transfusion. 55 (2) (pp 441-451), 2015. Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Cell-based therapy is an exciting, promising, and a developing new
treatment for cardiac diseases. Stem cell-based therapies have the
potential to fundamentally transform the treatment of ischemic cardiac
injury and heart failure by achieving what would have been unthinkable
only a few years ago - the Holy Grail of myocardial regeneration. Recent
therapeutic approaches involve bone marrow (BM)-derived mononuclear cells
and their subsets such as mesenchymal stem/stromal cells (MSCs),
endothelial progenitor cells as well as adipose tissue-derived MSCs,
cardiac tissue-derived stem cells, and cell combinations. Clinical trials
employing these cells have demonstrated that cellular therapy is feasible
and safe. Regarding delivery methods, the safety of catheter-based,
transendocardial and -epicardial stem cell injection has been established.
However, the results, while variable, suggest rather modest clinical
efficacy overall in both heart failure and ischemic heart disease, such as
in acute myocardial infarction. Future studies will focus on determining
the most efficacious cell type(s) and/or cell combinations and the most
reasonable indications and optimal timing of transplantation, as well as
the mechanisms underlying their therapeutic effects. We will review and
summarize the clinical trial results to date. In addition, we discuss
challenges and operational issues in cell processing for cardiac
applications.

<6>
Accession Number
2015767915
Authors
Warshauer J. Patel V.G. Christopoulos G. Kotsia A.P. Banerjee S. Brilakis
E.S.
Institution
(Warshauer, Patel, Christopoulos, Kotsia, Banerjee, Brilakis) VA North
Texas Healthcare System, University of Texas Southwestern Medical Center,
Dallas, TX, United States
Title
Outcomes of preoperative bridging therapy for patients undergoing surgery
after coronary stent implantation: A weighted meta-analysis of 280
patients from eight studies.
Source
Catheterization and Cardiovascular Interventions. 85 (1) (pp 25-31), 2015.
Date of Publication: 01 Jan 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Preoperative bridging with a glycoprotein IIb/IIIa inhibitor
is often performed in patients with prior coronary stents undergoing
surgery who require antiplatelet therapy discontinuation, but its safety
and efficacy have received limited study. We performed a weighted
meta-analysis of the outcomes in patients with coronary stents undergoing
bridging with glycoprotein IIb/IIIa inhibitors prior to surgery. Methods:
We conducted a weighted meta-analysis of preoperative bridging studies
published between 2002 and 2013 in patients with coronary stents
undergoing surgery. Data on in-hospital mortality, stent thrombosis,
bleeding, hemoglobin decrease, blood transfusion, time to hospital
discharge and myocardial infarction were collected. Results: A total of
eight studies with 280 patients were included. Pooled estimates of
outcomes were as follows: in-hospital mortality 3.5% (95% confidence
interval [CI] 1.7-5.9%);stent thrombosis 1.3% (95% CI 0.3-3.0%); major
bleeding 7.4% (95% CI 2.8-14.1%);any bleeding 20.6% (95% CI 4.8-43.2%);
mean decrease in hemoglobin 2.8 g/dL(95% CI 2.5-3.0 g/dL); mean blood loss
271 mL (95% CI 211-311 mL); blood transfusion 13.9% (95% CI 1.0-38.2%);
time to hospital discharge 5.9 days (95% CI 4.4-7.3 days); and myocardial
infarction 1.6% (95% CI 0.3-3.6%). Conclusions: Preoperative bridging with
a glycoprotein IIb/IIIa inhibitor in patients undergoing surgery after
coronary stenting does not abolish the risk of perioperative stent
thrombosis and may carry increased risk for bleeding.

<7>
Accession Number
2015768326
Authors
Boning A. Diegeler A. Hilker M. Zacher M. Reents W. Faerber G. Doenst T.
Institution
(Boning) Department of Cardiovascular Surgery, University Hospital
Giessen, Rudolf-Buchheim-Str. 7, Giessen 38385, Germany
(Diegeler, Zacher, Reents) Department of Cardiac Surgery, Herz- und
Gefasklinik, Bad Neustadt, Germany
(Hilker) Department of Cardiac Surgery, University Hospital Regensburg,
Regensburg, Germany
(Faerber, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich Schiller University of Jena, Jena, Germany
Title
Preoperative atrial fibrillation and outcome in patients undergoing
on-pump or off-pump coronary bypass surgery: Lessons learned from the
GOPCABE trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (1) (pp 74-78), 2015.
Date of Publication: 01 Jan 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Patients undergoing coronary bypass grafting (CABG) are at
higher risk if they suffer from atrial fibrillation (AF). It was suggested
that performing CABG without the use of cardiopulmonary bypass (off-pump)
would reduce perioperative risk. We assessed the influence of preoperative
AF on outcome in a randomized cohort of patients above the age of 75
undergoing either on-pump or off-pump CABG. METHODS The German Off-Pump
Coronary Artery Bypass grafting in the Elderly trial, a randomized,
controlled multicentre trial conducted at 12 German institutions, enrolled
2303 patients between 2008 and 2011. The presence of AF was recorded at
admission and discharge. There was no record on the rhythm status during
hospital stay. RESULTS AF at admission was present in 5% in the on-pump
(121/1158) and 5% in the off-pump (112/1145) group. The number of patients
with AF at discharge was not different between these two groups (10% on
pump, 10% off pump). As expected, AF patients had worse preoperative
conditions, which had a negative impact on outcome: The combined end-point
of death, infarction, stroke, dialysis and revascularization occurred more
often (13 vs 8%, P = 0.008) and 30-day mortality was significantly higher
(6 vs 2%, P = 0.003) in AF patients. However, the operative technique used
for CABG did not affect these outcome parameters. CONCLUSIONS AF at
admission is a significant risk factor for elderly patients undergoing
coronary bypass grafting. However, this risk is not altered by performing
bypass grafting off pump.

<8>
Accession Number
2015768983
Authors
Kapadia S. Stewart W.J. Anderson W.N. Babaliaros V. Feldman T. Cohen D.J.
Douglas P.S. Makkar R.R. Svensson L.G. Webb J.G. Wong S.C. Brown D.L.
Miller D.C. Moses J.W. Smith C.R. Leon M.B. Tuzcu E.M.
Institution
(Kapadia, Stewart, Svensson, Tuzcu) Cleveland Clinic Foundation,
Cleveland, OH, United States
(Anderson) IrvineCAUnited States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Feldman) NorthShore University Health System, Evanston, IL, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Douglas) Duke Clinical Research Institute, Durham, NC, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Wong) New York-Presbyterian Hospital, Weill Cornell Medical Center, New
York, NY, United States
(Brown) Medical City Dallas Hospital, Dallas, TX, United States
(Miller) Stanford University, Stanford, CA, United States
(Moses, Smith, Leon) New York-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
Title
Outcomes of inoperable symptomatic aortic stenosis patients not undergoing
aortic valve replacement: Insight into the impact of balloon aortic
valvuloplasty from the PARTNER trial (Placement of AoRtic TraNscathetER
Valve Trial).
Source
JACC: Cardiovascular Interventions. 8 (2) (pp 324-333), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this report is to characterize the impact of balloon
aortic valvuloplasty (BAV) in patients not undergoing aortic valve
replacement in the PARTNER (Placement of AoRtic TraNscathetER Valves)
trial. Background The PARTNER trial is the only randomized trial with
independently adjudicated data of inoperable severe symptomatic aortic
stenosis patients, allowing outcome analysis of unoperated-on patients.
Methods The design and initial results of the PARTNER trial (Cohort B)
were reported previously. After excluding patients with pre-randomization
BAV, we compared patients undergoing BAV within 30 days of randomization
(BAV group) with those not having BAV within 30 days of randomization (no
BAV group) to characterize the use and impact of BAV. Results In the
PARTNER Cohort B study, 179 inoperable patients were randomized to
standard treatment including 39 patients (21.8%) who had undergone a BAV
before randomization (previous BAV group). Of the 140 patients who did not
have BAV before enrollment in the study, 102 patients (73%) had BAV within
30 days of study randomization (BAV group). Survival at 3 months was
greater in the BAV group compared with the no BAV group (88.2%; 95%
confidence interval [CI]: 82.0% to 94.5% vs. 73.0%; 95% CI: 58.8% to
87.4%). However, survival was similar at 6-month follow-up (74.5%; 95% CI:
66.1% to 83.0% vs. 73.1%; 58.8% to 87.4%). There was improvement in
quality of life parameters when paired comparisons were made between
baseline and 30 days and 6 months between the BAV and no BAV groups, but
this effect was lost at 12-month follow-up. Conclusions BAV improves
functional status and survival in the short term, but these benefits are
not sustained. BAV for aortic stenosis patients who cannot undergo aortic
valve replacement is a useful palliative therapy. (THE PARTNER TRIAL:
Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)

<9>
Accession Number
2015768976
Authors
Amat-Santos I.J. Ribeiro H.B. Urena M. Allende R. Houde C. Bedard E.
Perron J. Delarochelliere R. Paradis J.-M. Dumont E. Doyle D. Mohammadi S.
Cote M. San Roman J.A. Rodes-Cabau J.
Institution
(Amat-Santos, Ribeiro, Urena, Allende, Bedard, Perron, Delarochelliere,
Paradis, Dumont, Doyle, Mohammadi, Cote, Rodes-Cabau) Department of
Cardiology, Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Amat-Santos, San Roman) Department of Cardiology, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Houde) Department of Pediatric Cardiology, Centre Mere-Enfant, Quebec
City, QC, Canada
Title
Prosthetic valve endocarditis after transcatheter valve replacement: A
systematic review.
Source
JACC: Cardiovascular Interventions. 8 (2) (pp 334-346), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this review is to describe the incidence, features,
predisposing factors, and outcomes of prosthetic valve endocarditis (PVE)
after transcatheter valve replacement (TVR). Background Very few data
exist on PVE after TVR. Methods Studies published between 2000 and 2013
regarding PVE in patients with transcatheter aortic valve replacement
(TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified
through a systematic electronic search. Results A total of 28 publications
describing 60 patients (32 TAVRs, 28 TPVRs) were identified. Most TAVR
patients (66% male, 80 +/- 7 years of age) had a very high-risk profile
(mean logistic EuroSCORE: 30.4 +/- 14.0%). In TPVR patients (90% male, 19
+/- 6 years of age), PVE was more frequent in the stenotic conduit/valve
(61%). The median time between TVR and infective endocarditis was 5 months
(interquartile range: 2 to 9 months). Typical microorganisms were mostly
found with a higher incidence of enterococci after TAVR (34.4%), and
Staphylococcus aureus after TPVR (29.4%). As many as 60% of the TAVR-PVE
patients were managed medically despite related complications such as
local extension, embolism, and heart failure in more than 50% of patients.
The valve explantation rate was 57% and 23% in balloon- and
self-expandable valves, respectively. In-hospital mortality for TAVR-PVE
was 34.4%. Most TPVR-PVE patients (75%) were managed surgically, and
in-hospital mortality was 7.1%. Conclusions Most cases of PVE post-TVR
involved male patients, with a very high-risk profile (TAVR) or underlying
stenotic conduit/valve (TPVR). Typical, but different, microorganisms of
PVE were involved in one-half of the TAVR and TPVR cases. Most TPVR-PVE
patients were managed surgically as opposed to TAVR patients, and the
mortality rate was high, especially in the TAVR cohort.

<10>
Accession Number
2014710948
Authors
Yadav M. Genereux P. Palmerini T. Caixeta A. Madhavan M.V. Xu K. Brener
S.J. Mehran R. Stone G.W.
Institution
(Yadav, Genereux, Xu, Stone) Cardiovascular Research Foundation, New York,
NY, United States
(Yadav, Genereux, Madhavan, Stone) New York-Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Palmerini) Istituto di Cardiologia, University of Bologna, Italy
(Caixeta) HospitalIsraelita Albert Einstein and Escola Paulista de
Medicina, Universidade Federal de Sao Paulo, Brazil
(Brener) New York Methodist Hospital, New York, NY, United States
(Mehran) Mount Sinai Medical Center, New York, NY, United States
Title
SYNTAX score and the risk of stent thrombosis after percutaneous coronary
intervention in patients with non-ST-segment elevation acute coronary
syndromes: An ACUITY trial substudy.
Source
Catheterization and Cardiovascular Interventions. 85 (1) (pp 1-10), 2015.
Date of Publication: 01 Jan 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: We sought to investigate the relationship between the SYNTAX
score (SS) and stent thrombosis (ST) in patients with non-ST-segment
elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous
coronary intervention (PCI). Background: The relationship between the SS
and ST is undetermined. Methods: We stratified 2,627 patients undergoing
PCI in the ACUITY trial by SS tertile according to the current population
(true tertiles, SS <7, SS = 7-12, and SS >12) and by the SYNTAX trial
(original SYNTAX tertiles, SS <23, SS = 23-32, and SS >32). Thirty-day and
1-year rates of definite/probable ST were determined for each tertile.
Results: A total 30 (1.1%) and 41 (1.6%) definite/probable STevents
occurred by 30 days and 1 year, respectively. When stratified by true
tertiles, 30-day and 1-year rates of definite/probable STwere
significantly greater in the highest tertile (SS >12; 2.0% and 2.8%)
compared with the intermediate (SS = 7-12; 0.7% and 1.1%) and lowest
tertiles (SS <7; 0.6% and 0.7%), P = 0.007 and P = 0.0009, respectively.
When stratified by original SYNTAX tertiles, 30-day and 1-year rates of
definite/probable ST were significantly greater in the highest (SS >32;
6.3% and 8.8%) and intermediate tertiles (SS = 23-32; 2.8% and 3.7%)
compared with the lowest tertile (SS < 22; 0.8% and 1.2%), P <0.0001 for
both. By multivariable analysis, the SS was an independent predictor for
both 30-day and 1-year definite/probable ST. Conclusions: In patients with
NSTE-ACS undergoing PCI, the extent and severity of CAD, as assessed by
the SS before revascularization, was strongly associated with the
occurrence of ST both at 30 days and 1 year.

<11>
Accession Number
2015764080
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Lotfaliani M.-R. Dehghan H.R.
Sedaghat-Hamedani F. Kayvanpour E. Rezaeisadrabadi M. Ghaffari N.
Vahabzadeh V. Jebran A.F. Sabashnikov A. Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Lotfaliani, Dehghan, Rezaeisadrabadi)
Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi
University of Medical Sciences, Arsalan Street, Hassan-beigi Blvd, Yazd
8916936637, Iran, Islamic Republic of
(Sedaghat-Hamedani, Kayvanpour) Department of Medicine III, University of
Heidelberg, Heidelberg, Germany
(Ghaffari, Vahabzadeh) Department of Cardiovascular Surgery, Herzchirurgie
Klinikum, Karlsruhe, Germany
(Jebran) Department of Thoracic and Cardiovascular Surgery, University
Hospital Goettingen, Goettingen, Germany
(Sabashnikov, Popov) Department of Cardiothoracic Transplantation and
Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Transplantation of bone marrow stem cells during cardiac surgery.
Source
Asian Cardiovascular and Thoracic Annals. 23 (3) (pp 363-374), 2015. Date
of Publication: 17 Mar 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: This systematic review with meta-analysis sought to determine
the efficacy and safety of intramyocardial transplantation of bone marrow
stem cells during coronary artery bypass graft surgery on postoperative
cardiac functional parameters such as left ventricular ejection fraction
and left ventricular end-diastolic volume. Methods: Medline/PubMed,
Embase, Elsevier, Sciences online database, and Google Scholar literature
search were searched. The effect sizes measured were risk ratio for
categorical variables and weighted mean difference with 95% confidence
interval for calculating differences between mean values of baseline and
follow-up cardiac functional parameters. A value of p<0.1 for Q test, or
I²>50%, indicated significant heterogeneity among studies. The
literature search retrieved 2900 studies from screened databases, of which
2866 (98.6%) were excluded and 34 (619 patients) were included for scoping
review. The final analysis included 9 studies (335 patients). Results:
Pooled effects estimates of left ventricular ejection fraction and left
ventricular end-diastolic volume showed that bone marrow stem cell
transplantation had a weighted mean difference of 4.06 (95% confidence
interval: 0.41-7.72; p=0.02) and 7.06 (95% confidence interval:
-8.58-22.7; p=0.3), respectively. Conclusions: Intramyocardial
transplantation of bone marrow stem cells improves cardiac functional
parameters, significantly increasing left ventricular ejection fraction
with a nonsignificant reduction in left ventricular end-diastolic volume.
Also, this therapeutic method has no life-threatening complications and
was therefore found to be an effective and safe method.

<12>
Accession Number
2015764070
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Liakopoulos O. Sabashnikov A.
Dehghan H.R. Sedaghat-Hamedani F. Kayvanpour E. Ghaffari N. Vahabzadeh V.
Aghabagheri M. Mozayan M.R. Popov A.-F.
Institution
(Ali-Hassan-Sayegh) Cardiovascular Research Center, Afshar Hospital,
Shahid Sadoughi University of Medical Sciences, Jomhouri Blvd, Yazd, Iran,
Islamic Republic of
(Mirhosseini, Dehghan, Aghabagheri, Mozayan) Yazd Cardiovascular Research
Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences,
Yazd, Iran, Islamic Republic of
(Liakopoulos) Department of Thoracic and Cardiovascular Surgery, West
German Heart Center, Essen University Hospital, Essen, Germany
(Sabashnikov, Popov) Department of Cardiothoracic Transplantation and
Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Sedaghat-Hamedani, Kayvanpour) Department of Medicine III, University of
Heidelberg, Heidelberg, Germany
(Ghaffari, Vahabzadeh) Department of Cardiovascular Surgery, Herzchirurgie
Klinikum, Karlsruhe, Germany
Title
Posterior pericardiotomy in cardiac surgery: Systematic review and
meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. 23 (3) (pp 354-362), 2015. Date
of Publication: 17 Mar 2015.
Publisher
SAGE Publications Inc.
Abstract
This systematic review with meta-analysis sought to determine the impact
of posterior pericardiotomy on incidences of atrial fibrillation and
supraventricular arrhythmias, pericardial effusion, pleural effusion,
tamponade, and the length of hospital stay after cardiac surgery. We
searched for randomized controlled trials, using Medline, Embase, Elsevier
and Sciences online databases as well as Google Scholar literature. The
effect sizes measured were odds ratio for categorical variables and
standard mean difference with 95% confidence interval for calculating
differences between mean values of hospital stay in intervention and
control groups. A value of p < 0.1 for Q test or I2 > 50% indicated
significant heterogeneity between the studies. The literature search of
all major databases retrieved 20 studies. After screening, 12 suitable
trials were identified, which reported outcomes of 2052 patients
undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of
0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial
fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular
arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early pericardial
effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial
effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for pleural effusion, odds
ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean
difference = 0.01 [a 0.12 to 0.14] p = 0.8 for hospital stay. Posterior
pericardiotomy is a simple intraoperative technique that can improve
postoperative clinical outcomes. However, the incidence of pleural
effusion associated with posterior pericardiotomy might be higher.

<13>
Accession Number
2015767727
Authors
Athappan G. Gajulapalli R.D. Sengodan P. Bhardwaj A. Ellis S.G. Svensson
L. Tuzcu E.M. Kapadia S.R.
Institution
(Athappan, Sengodan, Bhardwaj) Department of Cardiovascular Medicine,
Heart and Vascular Institute, Case Western Reserve University, Cleveland,
OH, United States
(Gajulapalli, Ellis, Svensson, Tuzcu, Kapadia) Department of
Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH, United States
Title
Influence of transcatheter aortic valve replacement strategy and valve
design on stroke after transcatheter aortic valve replacement: A
meta-analysis and systematic review of literature.
Source
Journal of the American College of Cardiology. 63 (20) (pp 2101-2110),
2014. Date of Publication: 27 May 2014.
Publisher
Elsevier USA
Abstract
Objectives: The study undertook a systematic review to establish and
compare the risk of stroke between the 2 widely used approaches
(transfemoral [TF] vs. transapical [TA]) and valve designs (CoreValve,
Medtronic, Minneapolis, Minnesota vs. Edwards Valve, Edwards Lifesciences,
Irvine, California) for transcatheter aortic valve replacement (TAVR).
Background: There has been a rapid adoption and expansion in the use of
TAVR. The technique is however far from perfect and requires further
refinement to alleviate safety concerns that include stroke. Methods: All
studies reporting on the risk of stroke after TAVR were identified using
an electronic search and pooled using established meta-analytical
guidelines. Results: 25 multicenter registries and 33 single-center
studies were included in the analysis. There was no difference in pooled
30-day stroke post-TAVR between the TF and TA approach in multicenter
(2.8% [95% confidence interval (CI): 2.4 to 3.4] vs. 2.8% [95% CI: 2.0 to
3.9]) and single-center studies (3.8% [95% CI: 3.1 to 4.6] vs. 3.4% [95%
CI: 2.5 to 4.5]). Similarly, there was no difference in pooled 30-day
stroke post TAVR between the CoreValve and Edwards Valve in multicenter
(2.4% [95% CI: 1.9 to 3.2] vs. 3.0% [95% CI: 2.4 to 3.7]) and
single-center studies (3.8% [95% CI: 2.8 to 4.9] vs. 3.2% [95% CI: 2.4 to
4.3]). There was a decline in stroke risk with experience and
technological advancement. There was no difference in the outcome of
30-day stroke between TAVR and surgical aortic valve replacement.
Conclusions: Our findings suggest that the risk of 30-day stroke after
TAVR is similar between the approaches and valve types. There has been a
decline in stroke risk after TAVR with improvements in valve technology,
patient selection, and operator experience.

<14>
Accession Number
2015726414
Authors
Tai C. Sun Y. Dai N. Xu D. Chen W. Wang J. Protogerou A. van Sloten T.T.
Blacher J. Safar M.E. Zhang Y. Xu Y.
Institution
(Tai, Sun, Dai, Xu, Chen, Zhang, Xu) Department of Cardiology, Shanghai
Tenth Peoples Hospital, Tongji University School of Medicine, Shanghai,
China
(Wang) Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
(Protogerou) Hypertension Center, 1st Department of Propaedeutic Medicine,
Laiko Hospital, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
(van Sloten) Department of Medicine, Cardiovascular Research Institute
Maastricht, and School for Nutrition, Toxicology and Metabolism,
Maastricht University Medical Centre, Maastricht, Netherlands
(Blacher, Safar) Diagnosis and Therapeutic Center, Hotel-Dieu Hospital,
AP-HP, Paris Descartes University, Paris, France
Title
Prognostic Significance of Visit-to-Visit Systolic Blood Pressure
Variability: A Meta-Analysis of 77,299 Patients.
Source
Journal of Clinical Hypertension. 17 (2) (pp 107-115), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
In recent clinical investigations, visit-to-visit systolic blood pressure
(SBP) variability was proven as a predictor of cardiovascular events and
all-cause mortality. However, inconsistent results exist in this
association. A meta-analysis of 13 prospective studies was conducted to
evaluate the prognostic value of visit-to-visit SBP variability by
different parameters in 77,299 patients with a mean follow-up of 6.3
years. The pooled age- and mean SBP-adjusted hazard ratios (HRs) for
all-cause mortality were 1.03 (95% confidence interval [CI], 1.02-1.04;
P<.001) per 1-mm Hg increase in SBP standard deviation (SD) and 1.04
(1.02-1.06, P<.001) per 1% in SBP coefficient of variation, and the
corresponding values of cardiovascular mortality were 1.10 (1.02-1.17,
P<.001) and 1.01 (0.99-1.03, P=.32), respectively. Moreover, a 1-mm Hg
increase in SD was significantly associated with stroke, with an HR of
1.02 (1.01-1.03, P<.001). Visit-to-visit SBP variability, independent of
age and mean SBP, is a predictor of cardiovascular and all-cause mortality
and stroke.

<15>
Accession Number
2015756542
Authors
Bail D.H.L.
Institution
(Bail) Competence-Center Quality Assurance, Medical Service of Statutory
Healthcare Insurance, Tuebingen and Stuttgart, Bismarckstr. 96, Tuebingen
72072, Germany
Title
(Meta)-Analysis of Safety and Efficacy Following Edge-to-Edge Mitral Valve
Repair Using the MitraClip System.
Source
Journal of Interventional Cardiology. 28 (1) (pp 69-75), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: The authors investigated safety and efficacy of the
MitraClip-System (MC-S) using a systematic analysis. Background: The
safety and efficacy of the MC-S continues to be debated, and randomized
trials are still lacking. Method: A systematic literature search was
conducted using common medical and scientific databases. The following
kinds of data were obtained: at baseline, 30 days, 6 and 12 month
post-procedure. For safety and efficacy mortality-rate (survival), mitral
regurgitation <2+ (MR), adverse event rate (AE), NYHA class and
reoperationrate were documented. A meta-analysis with quantitative summary
was performed. Results: Twenty-six studies including 3821 patient's who
were treated with MC-S, were analyzed. Weighted mean age was 73.9 +/- 2.3
years and LogEuroScore was 25.2 +/- 6.0%. Post-procedural MR<2+ was
achieved in 86.4% and 66.3% of the patients were in NYHA class I/II within
30 days, AE-rate was 18.3%, mortality-rate was 2.8% and reoperation-rate
was 3.5%. Freedom from MR>3 + -4 was 80.2% (80.1%), from NYHA III/IV was
78.6% (66.1%) and freedom from death was 82.6% (87.8%) and from
reoperation 95.6% (88.6%) at 6 and 12 month. Conclusion: Based on the
analysis of the current literature treatment with MC-S is associated with
good short-term success and low mortality. MC-S is safe and effective for
patients with limited surgical options. The results are comparable with
open mitral valve repair (oMVR) but patients are markedly older and have a
higer risk profile than patients who undergo oMVR. Prospective randomized
controlled trials are warranted to determine potential AEs, device
durability and long-term follow-up.

<16>
Accession Number
2015756541
Authors
Song Y.-J. Shin H.O.-C. Yang J.-I.I. Ho-Young L.E.E. Han-Young J.I.N.
Jeong-Sook S.E.O. Yang T.-H. Dae-Kyeong K.I.M. Dong-Soo K.I.M. Jang J.-S.
Institution
(Song, Shin, Yang, Ho-Young, Han-Young, Jeong-Sook, Yang, Dae-Kyeong,
Dong-Soo, Jang) Department of Cardiology, Inje University Busan Paik
Hospital, Busan, South Korea
Title
Preventive versus culprit-only percutaneous coronary intervention in
ST-elevation myocardial infarction patients with multivessel disease: A
meta-analysis.
Source
Journal of Interventional Cardiology. 28 (1) (pp 1-13), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Although previous studies have suggested clinical benefits of
complete revascularization in patients with multivessel coronary artery
disease, it is still controversial whether preventive percutaneous
coronary intervention (PCI) leads to better clinical outcomes in the
clinical setting of ST-segment elevation myocardial infarction (STEMI).
Methods: Relevant studies through September 2014 were searched and
identified in the electronic databases. Primary endpoint was all-cause
mortality at the longest follow-up. Secondary endpoints included
myocardial infarction (MI), repeat revascularization, and major adverse
cardiac events (MACE). Results: From 836 initial citations, 7 randomized
trials, and 23 observational studies with 44,256 patients (8,087
preventive and 36,169 culprit-only) were included in this study.
Preventive PCI was associated with a significant reduction in repeat
revascularization (odds ratios [OR]: 0.71; 95% CI: 0.51-0.99) with no
differences in all-cause mortality (OR: 0.99; 95% CI: 0.76-1.29) or MI
(OR: 1.08; 95% CI: 0.62-1.87) as compared with culprit-only PCI.
Comparison of preventive PCI to the culprit-only PCI group revealed OR for
MACE of 0.80 (95% CI: 0.57-1.12). Stratified analysis according to
revascularization strategy demonstrated a significant survival benefit of
culprit-only PCI over multivessel PCI during the index procedure and a
significantly lower incidence of all-cause mortality with staged PCI as
compared with culprit-only or multivessel PCI during the index procedure.
Conclusions: Preventive PCI strategy appears to be effective in reducing
the risk of repeat revascularization without significant benefits for
mortality or MI when compared with culprit-only revascularization in STEMI
patients with multivessel disease.

<17>
[Use Link to view the full text]
Accession Number
2014933326
Authors
Gosain P. Yamani N. Santana O. Mihos C.G. Lamelas J.
Institution
(Gosain, Santana, Mihos) Echocardiography Laboratory, Columbia University
Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road,
Miami Beach, FL 33140, 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
Title
Hybrid coronary revascularization: A systematic review.
Source
Cardiology in Review. 23 (2) (pp 87-93), 2015. Date of Publication: 13 Feb
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.

<18>
[Use Link to view the full text]
Accession Number
2014933297
Authors
Qin S.-L. He C.-Y. Xu J.-S. Lai X.-Y. Liu S.-S. He W.-P.
Institution
(Qin) Endocrinology Department, Nanchang University, Nanchang, China
(He) Endocrinology Department, Nursing Vocational College of Jiangxi,
Nanchang 330029, China
(Xu, Lai, Liu, He) Experiment Center, Nanchang University, Nanchang, China
Title
Meta-analysis of coronary artery bypass graft surgery combined with stem
cell transplantation in the treatment of ischemic heart diseases.
Source
Coronary Artery Disease. 26 (2) (pp 170-175), 2015. Date of Publication:
13 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVE: The use of bone marrow cells (BMCs) to regenerate the
myocardium and vessels is a new treatment for ischemic heart diseases
(IHD) that has been receiving attention. In this study, a meta-analysis
was used to analyze the efficacy of combining coronary artery bypass graft
(CABG) surgery with BMC transplantation in the treatment of IHD. METHODS
AND RESULTS: MEDLINE, EMBASE, Cochrane, CNKI, WAN-FANG, and WEI-PU
databases were searched. The main inclusion criteria were as follows: (a)
studies that analyzed patients diagnosed with chronic IHD. (b) Studies
that had randomized-controlled trials. (c) Studies that included research
comparing the efficacy of CABG and CABG combined with bone BMC
transplantation in the treatment of IHD. (d) Studies with specific
enumeration data at the end of the follow-up with a follow-up time of at
least 3 months. Nine randomized trials were included. There were 158
patients in the group that received the treatment of CABG surgery as well
as stem cell transplantation, referred to as the 'cell transplantation
group.' A total of 147 patients were in the group that only received the
treatment of CABG surgery, referred to as the 'CABG group'. Our data show
that not only did stem cell transplantation significantly improve left
ventricular ejection fraction (odds ratio=11.7, 95% confidence interval:
4.04-19.36; P=0.003) but it also significantly reduced the left
ventricular end-diastolic volume and left ventricular end-systolic volume
(P<0.001). CONCLUSION: BMC transplantation is associated with a
significant improvement in left ventricular ejection fraction and the
attenuation of left ventricular remodeling.

<19>
Accession Number
2015763434
Authors
Alfonso F. Perez-Vizcayno M.J. Cardenas A. Del Blanco B.G. Seidelberger B.
Iniguez A. Gomez-Recio M. Masotti M. Velazquez M.T. Sanchis J.
Garcia-Touchard A. Zueco J. Bethencourt A. Melgares R. Cequier A.
Dominguez A. Mainar V. Lopez-Minguez J.R. Moreu J. Marti V. Moreno R.
Spanish Society of Cardiology Gonzalo N. Fernandez C. Macaya C.
Institution
(Alfonso, Seidelberger) Departamento de Cardiologia, Hospital
Universitario de la Princesa, Universidad Autonoma de Madrid, c/Diego de
Leon 62, Madrid 28006, Spain
(Alfonso, Perez-Vizcayno, Cardenas, Jimenez-Quevedo, Gonzalo, Fernandez,
Macaya) Hospital Universitario Clinico San Carlos, Madrid, Spain
(Del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Iniguez) Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
(Gomez-Recio) Hospital Universitario de Torrecardenas, Almeria, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Velazquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Bethencourt) Hospital Universitario Son Espases, Palma de Mallorca, Spain
(Melgares) Hospital Universitario Virgen de Las Nieves, Granada, Spain
(Cequier) Hospital Universitario de Bellvitge, Barcelona, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Mainar) Hospital Universitario de Alicante, Alicante, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina Badajoz, Badajoz,
Spain
(Moreu) Hospital Universitario Virgen de la Salud Toledo, Toledo, Spain
(Marti) Hospital Universitario Sant Pau, Barcelona, Spain
(Moreno) Hospital Universitario la Paz, Madrid, Spain
Title
A randomized comparison of drug-eluting balloon versus everolimus-eluting
stent in patients with bare-metal stent-in-stent restenosis: The RIBS V
clinical trial (Restenosis Intra-stent of Bare Metal Stents:
Paclitaxel-eluting balloon vs. everolimus-eluting stent).
Source
Journal of the American College of Cardiology. 63 (14) (pp 1378-1386),
2014. Date of Publication: 15 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives: This study sought to compare the efficacy of drug-eluting
balloons (DEB) with that of everolimus-eluting stents (EES) in patients
with bare-metal stents (BMS) in-stent restenosis (ISR). Background:
Treatment of patients with ISR remains a challenge. Methods: This was a
prospective, multicenter, randomized trial comparing DEB with EES in
patients with bare-metal stents (BMS) in-stent restenosis (ISR). The
primary endpoint was the minimal lumen diameter at 9 months' follow-up.
Results: A total of 189 patients with BMS-ISR from 25 Spanish sites were
included (95 were allocated to DEB and 94 to EES). Procedural success was
achieved in all patients. At late angiography (median 249 days; 92% of
eligible patients), patients in the EES arm had a significantly larger
minimal lumen diameter (2.36 +/- 0.6 mm vs. 2.01 +/- 0.6 mm, p < 0.001;
absolute mean difference: 0.35 mm; 95% confidence interval [CI]: 0.16 to
0.53) and a lower percent of diameter stenosis (13 +/- 17% vs. 25 +/- 20%,
p < 0.001). However, late loss (0.04 +/- 0.5 mm vs. 0.14 +/- 0.5 mm, p =
0.14) and binary restenosis rate (4.7% vs. 9.5%, p = 0.22) were very low
and similar in both groups. Clinical follow-up (median 365 days) was
obtained in all (100%) patients. Occurrences of the combined clinical
outcome measure (cardiac death, myocardial infarction, and target vessel
revascularization; 6% vs. 8%; hazard ratio [HR]: 0.76; 95% CI: 0.26 to
2.18, p = 0.6) and the need for target vessel revascularization (2% vs.
6%; HR: 0.32: 95% CI: 0.07 to 1.59, p = 0.17) were similar in the 2
groups. Conclusions: In patients with BMS-ISR, both DEB and EES provided
excellent clinical results with a very low rate of clinical and
angiographic recurrences. However, compared with DEB, EES provide superior
late angiographic findings.

<20>
Accession Number
2015763428
Authors
De Belder A. De La Torre Hernandez J.M. Lopez-Palop R. O'Kane P. Hernandez
F.H. Strange J. Gimeno F. Cotton J. Diaz Fernandez J.F. Carrillo Saez P.
Thomas M. Pinar E. Curzen N. Baz J.A. Cooter N. Lozano I. Skipper N.
Robinson D. Hildick-Smith D.
Institution
(De Belder, Cooter, Skipper, Hildick-Smith) Department of Cardiology,
Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton
BN2 5BE, United Kingdom
(De La Torre Hernandez) Hospital Marques de Valdecilla, Santander, Spain
(Lopez-Palop, Carrillo Saez) Hospital San Juan de Alicante, Alicante,
Spain
(O'Kane) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Hernandez) Hospital 12 de Octubre, Madrid, Spain
(Strange) Bristol Royal Infirmary, Bristol, United Kingdom
(Gimeno) Hospital Clinico de Valladolid, Valladolid, Spain
(Cotton) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom
(Diaz Fernandez) Hospital Juan Ramon Jimenez, Huelva, Spain
(Thomas) St Thomas' Hospital, London, United Kingdom
(Pinar) Hospital Virgen de la Arrixaca, Murcia, Spain
(Curzen) Southampton University Hospitals National Health Service Trust,
Southampton, United Kingdom
(Baz) Hospital Meixoeiro, Vigo, Spain
(Lozano) Hospital Central de Asturias, Oviedo, Spain
(Robinson) Department of Mathematics, University of Sussex, East Sussex,
United Kingdom
Title
A prospective randomized trial of everolimus-eluting stents versus
bare-metal stents in octogenarians: The XIMA trial (Xience or vision
stents for the management of angina in the elderly).
Source
Journal of the American College of Cardiology. 63 (14) (pp 1371-1375),
2014. Date of Publication: 15 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives: The aim of this study was to determine whether drug-eluting
stents (DES) are superior to bare-metal stents (BMS) in octogenarian
patients with angina. Background: Patients >80 years of age frequently
have complex coronary disease warranting DES but have a higher risk of
bleeding from prolonged dual antiplatelet therapy. Methods: This
multicenter randomized trial was conducted in 22 centers in the United
Kingdom and Spain. Patients >80 years of age underwent stent placement for
angina. The primary endpoint was a 1-year composite of death, myocardial
infarction, cerebrovascular accident, target vessel revascularization, or
major hemorrhage. Results: In total, 800 patients (83.5 +/- 3.2 years of
age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of
stable angina (32%) or acute coronary syndrome (68%). Procedural success
did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07).
Thirty-eight percent of patients had >2-vessel percutaneous coronary
intervention, and 66% underwent complete revascularization. Patients who
received BMS had shorter stent implants (24.0 +/- 13.4 mm vs. 26.6 +/-
14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were
32.2% for patients in the BMS group and 94.0% for patients in the DES
group. The primary endpoint occurred in 18.7% of patients in the BMS group
versus 14.3% of patients in the DES group (p = 0.09). There was no
difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs.
2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77).
Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel
revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in
patients in the BMS group. Conclusions: BMS and DES offer good clinical
outcomes in this age group. DES were associated with a lower incidence of
myocardial infarction and target vessel revascularization without
increased incidence of major hemorrhage.

<21>
Accession Number
71795041
Authors
Eifer D.A. Torres F.S. Foppa M.
Institution
(Eifer, Torres) Radiology, Hospital De Clinicas De Porto Alegre, Porto
Alegre, Brazil
(Foppa) Internal Medicine, Cardiology, Hospital De Clinicas De Porto
Alegre, Porto Alegre, Brazil
Title
Role of gadolinium enhanced cardiac magnetic resonance in recent onset
non-ischemic cardiomyopathy: A systematic review and metanalysis.
Source
Journal of Cardiovascular Magnetic Resonance. Conference: 18th Annual SCMR
Scientific Sessions Nice France. Conference Start: 20150204 Conference
End: 20150207. Conference Publication: (var.pagings). 17 , 2015. Date of
Publication: 03 Feb 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Cardiac magnetic resonance (CMR) late gadolinium enhancement
(LGE) and early gadolinium enhancement (EGE) are powerful diagnostic tools
for acute cardiomyopathies. LGE is associated with impaired prognosis in
ischemic and in chronic non-ischemic cardiomyopathy (NICM), but the impact
of gadolinium enhanced CMR on prognosis in recent onset NICM is less well
established. We performed a systematic review with metanalysis to
investigate the prognostic role of an abnormal contrast enhanced CMR in
patients presenting with recent onset NICM. Methods: From January 1994 to
July 2014, Pubmed, EMBASE and additional bibliographic sources were
searched for publications using contrast enhanced CMR (EGE and LGE) in
patients with recent onset NICM, defined as symptoms onset within 6 months
of presentation, including myocarditis, acute chest pain syndromes with
normal coronaries, and idiopathic acute cardiomyopathy. We included
articles that assessed total mortality and/or composite cardiovascular
events (mortality plus any combination of cardioverter defibrillator
implantation, cardiac transplantation, hospitalization or worsening heart
failure) with a follow-up of least 3 months after the initial
presentation. Data were independently extracted by 2 authors and pooled
risk ratios (RR) were calculated using the DerSimonian and Laird
random-effects method. Results: Eleven publications (1249 patients) were
identified for the mortality endpoint and 8 (1151 patients) for the
composite endpoint, with an average follow-up varying from 3 to 56 months.
Five studies had myocarditis as the primary diagnostic hypothesis and
seven had non-ischemic cardiomyopathy. Prevalence of abnormal CMR varied
from 28 to 64%, which was defined by LGE in 9 studies and by EGE or a
combination of both in the remaining studies. Abnormal CMR had a pooled RR
of 2.53 (95%CI: 0.87-7.4) for total mortality (figure 1), and a pooled RR
of 2.65 (95%CI: 1.57-4.47) for composite endpoints (figure 2), with
significant heterogeneity, I2=65.5%;P=0.005, and I2=67.6%;P=0.003,
respectively. Conclusions: In patients presenting with recent onset NICM,
the presence of an abnormal contrasted enhanced CMR is associated with a
statistically significant increased risk ratio for composite endpoints.
These findings may help identify those patients with a worse prognosis and
increased use of medical resources. (Figure presented) .

<22>
Accession Number
71795008
Authors
Cole B. Douglas H. Soong C.M. Horan P. Dixon L. Johnston N. Harbinson M.
Institution
(Cole, Douglas, Dixon, Johnston) Cardiology, Royal Victoria Hospital,
Belfast, United Kingdom
(Soong, Harbinson) Queens University, Belfast, United Kingdom
(Horan) Antrim Area Hospital, Antrim, United Kingdom
Title
The impact of cardiac magnetic resonance viability assessment on the
management of patients with ischaemic heart disease and left ventricular
dysfunction.
Source
Journal of Cardiovascular Magnetic Resonance. Conference: 18th Annual SCMR
Scientific Sessions Nice France. Conference Start: 20150204 Conference
End: 20150207. Conference Publication: (var.pagings). 17 , 2015. Date of
Publication: 03 Feb 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Identifying patients with ischaemic left ventricular
dysfunction that would benefit from revascularisation as opposed to
medical therapy alone is challenging. Viability assessment has in many
centres become a gatekeeper to revascularisation, however its use remains
controversial with several prospective randomised trials showing no
mortality benefit with this strategy. The aim of this study was to
investigate the role of cardiovascular magnetic resonance (CMR) imaging in
the decision making process in patients being considered for
revascularisation at our institution. Methods: All patients referred for
CMR viability assessment at a single regional centre were identified
retrospectively between January 2011 and March 2013 inclusive. CMR scans
were reviewed and segmental viability was determined using the AHA
segmental model with viability defined as less than 50% delayed contrast
enhancement. Patient records were reviewed to determine the ultimate
revascularisation strategy as well as patient outcomes. Results: 324
consecutive patients were identified, of which 256 were being considered
for revascularisation. The remainder were undergoing viability assessment
for other reasons, for example valvular heart disease. Of the patients
being considered for revascularisation, 38 (14.4%) had preserved left
ventricular (LV) systolic function, 33 (17.3%) mild LV dysfunction, 77
(28.4%) moderate LV dysfunction and 108 (39.9%) severe LV dysfunction. Of
the patients with severe LV dysfunction 22 subsequently underwent coronary
artery bypass grafting (CABG), 30 had percutaneous coronary intervention
(PCI) and the remaining 56 patients were managed medically. The patient
characteristics are detailed in table 1. All patients undergoing CABG had
at least partial viability in the left anterior descending artery
territory. In those who underwent PCI, the results of viability testing
changed the proposed management strategy in 30%. By the end of the follow
period (median, 28 months), death from any cause occurred in 3 patients
(14%) in the CABG group, 4 (13%) in the PCI group and 14 (25%) in the
medical-therapy group (p=0.32). Hospitalisation for cardiac causes
occurred in 1 patient (5%) in the CABG group, 1 (3%) in the PCI group and
28 (50%) in the medical-therapy group (p <0.001). Hospitalisation in the
medical therapy group was primarily related to admissions with heart
failure (73%). Conclusions: Patients undergoing surgical revascularisation
had significantly less adverse remodelling than those managed with PCI or
medical therapy. Patients undergoing CABG with viability prior to
revascularisation demonstrated good outcomes, similar to those undergoing
PCI. The medical therapy group had a significantly higher number of
non-viable segments and outcome was poor. Further randomised controlled
trials using CMR assessment of viability may provide evidence that
viability assessment is still beneficial prior to revascularisation in
patients with ischaemic cardiomyopathy. (Table presented) .

<23>
Accession Number
71794740
Authors
McElnay P.J. Choong A. Jordan E. Song F. Lim E.
Institution
(McElnay) Department of Cardiothoracic Surgery, Freeman Hospital,
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne,
United Kingdom
(Choong) Department of Vascular Surgery, Imperial College Healthcare NHS
Trust, London, United Kingdom
(Jordan) Library Services, University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
(Song) Faculty of Health, University of East Anglia, Norwich, United
Kingdom
(Lim) Academic Division of Thoracic Surgery, Royal Brompton Hospital and
Imperial College London, London, United Kingdom
Title
Outcome of surgery versus radiotherapy after induction treatment in
patients with N2 disease: Systematic review and meta-analysis of
randomised trials.
Source
Lung Cancer. Conference: 13th Annual British Thoracic Oncology Group
Conference, BTOG 2015 Dublin Ireland. Conference Start: 20150128
Conference End: 20150130. Conference Publication: (var.pagings). 87 (pp
S65), 2015. Date of Publication: January 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Chemo-radiotherapy is often considered to be the "standard
of care" in the management of patients with N2 disease. The aim of this
study is to evaluate survival outcomes of patients with N2 disease in
multi-modality trials of chemotherapy, radiotherapy, and surgery. Methods:
A systematic literature search of Medline (1980-2013) and Embase
(1980-2013) was conducted. Abstracts from recent major thoracic surgery
scientific meetings were searched. Reference lists of all relevant studies
were reviewed. All studies of patients with N2 disease who received
induction chemotherapy or chemoradiotherapy and randomised to surgery or
radiotherapy were included. No restrictions were placed on language in any
of the searches. Both random and fixed effects meta-analysis were
performed. The main outcome was overall survival. Results: 805
publications were identified. 519 and 281 were excluded because they were
not primary results from randomised clinical trials (or did not include N2
disease) or did not compare surgery against radiotherapy respectively. The
final 6 trials consisted of 868 patients and were comparable for age and
gender of participants. In four trials, patients received induction
chemotherapy and in two trials patients received induction
chemo-radiotherapy. The hazard ratio (HR) comparing patients randomised to
surgery after chemotherapy was 1.01 (95% CI 0.82- 1.23; P = 0.954) whereas
for patients randomised to surgery after chemo-radiotherapy HR was 0.87
(0.75-1.01; P = 0.068). The overall hazard ratio of all pooled trials was
0.92 (0.81-1.03; P = 0.157). Conclusion: Surgery should be considered as
part of multi-modality treatment for patients with resectable lung cancer
and ipsilateral mediastinal lymph node disease. Although the overall
survival of patients randomised to surgery in bimodality treatment was the
same as medical treatment, in trials where patients who received surgery
as part of trimodality treatment, the overall survival was better than
chemo-radiotherapy alone.

<24>
Accession Number
71793738
Authors
Lurati Buse G.A. Schumacher P. Schumann R. Fassl J. Bolliger D. Seeberger
M.
Institution
(Lurati Buse, Schumann, Fassl, Bolliger, Seeberger) Anesthesiology,
University Hospital, Basel, Switzerland
(Schumacher) Anesthesiology, Burgerspital Soothurn, Solothurn, Switzerland
Title
Impact of sevoflurane vs. propofol on ntprobnp release after noncardiac
surgery-a randomized controlled trial.
Source
Anesthesia and Analgesia. Conference: 2012 Annual Meeting of the
International Anesthesia Research Society, IARS 2012 Boston, MA United
States. Conference Start: 20120518 Conference End: 20120521. Conference
Publication: (var.pagings). 114 (5 SUPPL. 1) (pp S463), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Animal studies suggest cardioprotection by sevoflurane.
There is evidence supporting this cardioprotective effect in patients
undergoing cardiac surgery1,2. Our objective was to evaluate if
sevoflurane compared to propofol reduces postoperative NT-proBNP release
in patients undergoing noncardiac surgery. Methods : This is a secondary
analysis of a randomized controlled trial of sevoflurane vs. propofol to
reduce perioperative ischemia. Postoperative NT-proBNP concentrations were
prespecified secondary endpoints. We enrolled patients at cardiovascular
risk in 3 centres between February 2006 and October 2010. Patients were
randomized to maintenance with sevoflurane or propofol. We measured
NT-proBNP on postoperative day 1 and 2. Patients and laboratory staff were
blinded. The distributions of NT-proBNP concentration on both
postoperative days were skewed; as such, we tested for differences in the
distribution of postoperative NTproBNP concentrations (day 1 and day 2) of
patients allocated to sevoflurane and to propofol by Mann-Whitney-test.
Results : We enrolled 385 patients. Five patients dropped out (3 patients
in the sevoflurane group); as such 181 patients received sevoflurane and
199 patients propofol. The NT-proBNP concentration was missing in 5.8%
(22/380) on day 1 and in 4.2% (16/380) on day 2. The median NT-proBNP
concentration on postoperative day 1 was 545.5 pg/mL (interquartile range
[IQR] 260-545.5) after sevoflurane and 558.5 pg/mL (IQR 238.25- 1,247.25)
after propofol (p=0.844). On postoperative day 2, the median NT-proBNP
concentrations was 937.0 pg/mL (IQR 483.0- 937.0) and 931 pg/mL (IQR
422.5-2074.0) after sevoflurane and after propofol (p=0.858),
respectively. Discussion : Compared to propofol, sevoflurane did not
affect postoperative NT-proBNP release in patients undergoing major
noncardiac surgery.

<25>
Accession Number
71793736
Authors
Lurati Buse G.A. Schumacher P. Studer W. Seeberger E. Bolliger D.
Seeberger M.
Institution
(Lurati Buse, Seeberger, Bolliger, Seeberger) Anesthesiology, University
Hospital Basel, Basel, Switzerland
(Schumacher) Anesthesiology, Burgerspital Solothurn, Solothurn,
Switzerland
(Studer) Anesthesiology, Kantonsspital Liestal, Liestal, Switzerland
Title
Randomized controlled trial of sevoflurane vs. propofol to prevent
myocardial ischemia in noncardiac surgery patients.
Source
Anesthesia and Analgesia. Conference: 2012 Annual Meeting of the
International Anesthesia Research Society, IARS 2012 Boston, MA United
States. Conference Start: 20120518 Conference End: 20120521. Conference
Publication: (var.pagings). 114 (5 SUPPL. 1) (pp S461), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Animal studies suggest cardioprotection by sevoflurane.
There is evidence supporting this cardioprotective effect in patients
undergoing cardiac surgery1,2. Our objective was to evaluate if
sevoflurane compared to propofol reduces myocardial ischemia in patients
undergoing major noncardiac surgery. Methods : We enrolled patients at
cardiovascular risk in 3 centers between February 2006 and October 2010.
Patients were randomized to maintenance of anesthesia with sevoflurane or
propofol. We recorded continuous ECG (cECG) for 48 hours perioperatively
and measured troponin T on postoperative day 1 and 2, and 12-lead ECG at 7
days. The predefined primary endpoint was a composite of myocardial
ischemia in cECG and troponin elevation. Secondary endpoints were the
single items of the primary endpoint and a composite of cECG ischemia,
troponin elevation and Q-wave development. Patients and outcome assessors
were blinded. We tested dichotomous endpoints by chi-squared on
intention-totreat basis. Results : We enrolled 385 patients. Five patients
dropped out (3 patients in the sevoflurane group); as such 181 patients
received sevoflurane and 199 patients propofol. cECG was missing in 2
(1.1%) patients in the sevoflurane and 6 (3%) in the propofol group.
Troponin data on both postoperative day 1 and 2 were missing in 3 (1.7%)
patients after sevoflurane and 3 (1.5%) after propofol. Simultaneous
missing of troponin and cECG did not occur. The primary composite endpoint
occurred in 75 (41.4%) patients after sevoflurane and 81 (40.7%) after
propofol (relative risk 0.98, 95%confidence interval 0.76-1.27). None of
the secondary endpoints differed between treatments. Discussion : Compared
to propofol, sevoflurane did not reduce the occurrence of perioperative
ischemia in patients undergoing major noncardiac surgery.

<26>
Accession Number
71793735
Authors
Lurati Buse G.A. Seeberger E. Filipovic M. Bolliger D. Seeberger M.
Institution
(Lurati Buse, Seeberger, Filipovic, Bolliger, Seeberger) Anesthesiology,
University Hospital Basel, Basel, Switzerland
(Filipovic) Anesthesiology, Kantonsspital St. Gallen, St. Gallen,
Switzerland
Title
Impact of sevoflurane vs. propofol on incident delirium after noncardiac
surgery-a randomized controlled trial.
Source
Anesthesia and Analgesia. Conference: 2012 Annual Meeting of the
International Anesthesia Research Society, IARS 2012 Boston, MA United
States. Conference Start: 20120518 Conference End: 20120521. Conference
Publication: (var.pagings). 114 (5 SUPPL. 1) (pp S460), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Animal studies suggest neuroprotection by sevoflurane.
There is some evidence supporting this neuroprotective effect in patients
undergoing cardiac surgery1. Our objective was to evaluate if sevoflurane
compared to propofol reduced the incidence of postoperative delirium in
patients undergoing major noncardiac surgery. Methods : This is a
secondary analysis of a randomized controlled trial of sevoflurane vs.
propofol to reduce perioperative ischemia. The occurrence of delirium was
a prespecified secondary endpoint. We enrolled patients at cardiovascular
risk in 3 centres between February 2006 and October 2010. Patients were
randomized to maintenance of anesthesia with sevoflurane or propofol.
Research staff previously trained by a neuropsychologist assessed the
occurrence of delirium by the Confusion Assessment Method (CAM) at
baseline, on postoperative day 1, 2 and day 7 or discharge day whatever
occurred first. Postoperative delirium was defined as a CAM suggestive of
delirium on postoperative day 1 or 2 or 7. Results : We enrolled 385
patients. Five patients dropped out (3 patients in the sevoflurane group);
as such 181 patients received sevoflurane and 199 patients propofol. The
CAM was missing in 1 patient (0.3%) on postoperative day 1, in 5 (1.3%) on
day 2, and in 42 (11.1%) on postoperative day 7. Delirium was diagnosed in
50 (13.2%) patients, 21 (11.6%) after sevoflurane and 29 (14.6%) after
propofol (p=0.392). Delirium decreased over time: 8.4% on day 1, 6.6% on
day 2, and 2.1% on day 7. Discussion : Compared to propofol, sevoflurane
did not reduce the occurrence of postoperative delirium in patients
undergoing major noncardiac surgery.

<27>
Accession Number
71793673
Authors
Zhao H. Feng Y. Jiang Y.
Institution
(Zhao, Feng, Jiang) Anesthesiology, Peking University People's Hosptial,
Beijing, China
Title
Application of tramadol analgesia after offpump coronary artery bypass
graft surgery.
Source
Anesthesia and Analgesia. Conference: 2012 Annual Meeting of the
International Anesthesia Research Society, IARS 2012 Boston, MA United
States. Conference Start: 20120518 Conference End: 20120521. Conference
Publication: (var.pagings). 114 (5 SUPPL. 1) (pp S362), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : The analgesic action of tramadol is based on a multimodal
mechanism of action. Potential advantages of administering tramadol for
postoperative pain relief include earlier recovery and less sedation than
opiates. This prospective randomized controlled study aimed to investigate
the analgesic efficacy and safety of tramadol used after off-pump coronary
bypass graft surgery (OPCAB). Methods : Sixty-two consecutive patients
undergoing OPCAB under standard sufentanil-based general anesthesia in
Peking University People's Hospital were randomly allocated to receive
tramadol 1 mg/kg or sufentanil 0.1 ug/kg at the end of sternal closure,
followed by patient-controlled analgesia (bolus tramadol 0.2mg/kg, or
sufentanil 0.02ug/kg, lockout time being 10min) with background infusions
(tramadol 0.15mg/kg/h or sufentanil 0.015ug/ kg/h). Patients were
transferred to cardiac surgery intensive care unit (CSICU) directly after
surgery. Pain intensity was rated by the patients with visual analogue
scale (VAS) at 12, 24 and 48 hours after surgery. The level of sedation
was assessed by using a 5-point score (1=fully awake, 5 =asleep, not
arousable) at the same time interval. Results : Demographic and surgical
data were comparable between two groups. Patients in Tramadol group were
less painful and sedated compared with patients in Sufentanil group.
Patients in Tramadol group tended to have an earlier awakening from
general anesthesia and an earlier tracheal extubation than patients in
Sufentanil group, but the difference was not statistically significant.
Patients were more satisfied with pain management in Tramadol group.
Discussion : Postoperative cardiac surgical patients need good pain relief
for hemodynamic stability, early extubation, cooperation for chest
physiotherapy and prevention of pulmonary dysfunction. Patients in
Tramadol group were less painful and sedated compared with patients in
Sufentanil group. Patients in Tramadol group tended to have an earlier
awakening from general anesthesia and an earlier tracheal extubation than
patients in Sufentanil group. This could be explained by discontinuing use
of sufentanil after large amount of sufentanil during surgery and
providing equally effective analgesics. In summary, tramadol could
attenuate postoperative pain after OPCAB effectively and has a tendency to
accelerate patients awakening and weaning from mechanical ventilation.
(Figure Presented).

<28>
Accession Number
71793523
Authors
Lurati Buse G.A. Seeberger E. Werner C. Filipovic M. Bolliger D. Seeberger
M.
Institution
(Lurati Buse, Seeberger, Werner, Filipovic, Bolliger, Seeberger)
Anesthesiology, University Hospital Basel, Basel, Switzerland
(Filipovic) Anesthesiology, Kantonsspital St. Gallen, St.Gallen,
Switzerland
Title
Value of combined pre-and postoperative NT-proBNP measurement to predict
death and major cardiovascular events at 1 year after noncardiac surgery.
Source
Anesthesia and Analgesia. Conference: 2012 Annual Meeting of the
International Anesthesia Research Society, IARS 2012 Boston, MA United
States. Conference Start: 20120518 Conference End: 20120521. Conference
Publication: (var.pagings). 114 (5 SUPPL. 1) (pp S69), 2012. Date of
Publication: May 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction : Several studies addressed the prognostic value of
perioperative natriuretic peptides' measurement1,2. It is not established
if combined pre- and postoperative measurements add to the prognostic
accuracy. Our objective was to evaluate the incremental prognostic value
of combined pre- and postoperative NT-proBNP measurement in patients
undergoing noncardiac surgery. Methods : This is a predefined cohort
analysis nested in a randomized controlled trial. The prespecified
endpoint was a composite of all-cause mortality, acute coronary syndrome,
coronary revascularisation, and congestive heart failure requiring
hospitalization within 1 year after surgery. We measured NTproBNP prior to
induction, on postoperative day 1 and 2. Patients and outcome adjudicators
were blinded. We calculated the area under the receiver operating
characteristics curve (AUC) for NTproBNP at each timepoint. We conducted a
multivariate logistic regression with the composite endpoint as dependent
and NTproBNP( preoperative and day 2), postoperative troponin T elevation
and treatment allocation as independent variables. Results : We assessed
380 patients. Information on major adverse cardiac event at 1 year was
missing in 2 (0.5%) patients; survival data were complete. Seventy (18.4%)
patients suffered an event at 1 year. The AUC of NT-proBNP for 1-year
outcome was 0.666 (95%confidence interval 0.59-0.84), 0.659 (0.59-0.73)
and 0.656 (0.58-0.73) prior to induction, on day 1, and day 2,
respectively. After multivariate adjustment, preoperative NT-proBNP was no
longer significantly associated with 1-year outcome, whereas the
association for NT-proBNP on day 2 persisted (OR 1.012 per 100 pg/mL
increase, 95%CI 1.001-1.023). Discussion : After multivariate adjustment,
including by postoperative NT-proBNP, preoperative NT-proBNP waqs no
longer associated with 1-year all-cause mortality and major cardiovascular
events after major noncardiac surgery. In contrast, the predictive value
of postoperative NT-proBNP concentrations persisted after adjustment by
the preoperative values. This findings need confirmation in a larger
cohort.