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<1>
Accession Number
2015906298
Authors
Erne P. Radovanovic D. Seifert B. Bertel O. Urban P.
Institution
(Erne, Radovanovic) AMIS Plus Data Center, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Zurich, Switzerland
(Erne) Department of Cardiology, Clinic St. Anna, Lucerne, Switzerland
(Erne) University Hospital Zurich, Zurich, Switzerland
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Zurich, Switzerland
(Bertel) Cardiology Centre, Klinik Im Park, Zurich, Switzerland
(Urban) Cardiovascular Department, Hopital de la Tour, Geneva, Switzerland
Title
Outcome of patients admitted with acute coronary syndrome on palliative
treatment: Insights from the nationwide AMIS Plus registry 1997-2014.
Source
BMJ Open. 5 (3) , 2015. Article Number: e006218. Date of Publication: 02
Mar 2015.
Publisher
BMJ Publishing Group
Abstract
Objective: Compliance with guidelines is increasingly used to benchmark
the quality of hospital care, however, very little is known on patients
admitted with acute coronary syndromes (ACS) and treated palliatively.
This study aimed to evaluate the baseline characteristics and outcomes of
these patients. Design: Prospective cohort study. Setting: Eighty-two
Swiss hospitals enrolled patients from 1997 to 2014. Participants: All
patients with ACS enrolled in the AMIS Plus registry (n=45 091) were
analysed according to three treatment groups: palliative treatment,
defined as use of aspirin and analgesics only and no reperfusion;
conservative treatment, defined as any treatment including antithrombotics
or anticoagulants, heparins, P2Y<inf>12</inf> inhibitors, GPIIb/IIIa but
no pharmacological or mechanical reperfusion; and reperfusion treatment
(thrombolysis and/or percutaneous coronary intervention during initial
hospitalisation). The primary outcome measure was in-hospital mortality
and the secondary measure was 1-year mortality. Results: Of the patients,
1485 (3.3%) were palliatively treated, 11 119 (24.7%) were conservatively
treated and 32 487 (72.0%) underwent reperfusion therapy. In 1997, 6% of
all patients were treated palliatively and this continuously decreased to
2% in 2013. Baseline characteristics of palliative patients differed in
comparison with conservatively treated and reperfusion patients in age,
gender and comorbidities (all p<0.001). These patients had more
in-hospital complications such as postadmission onset of cardiogenic shock
(15.6% vs 5.2%; p<0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher
in-hospital mortality (25.8% vs 5.6%; p<0.001). The subgroup of patients
followed 1 year after discharge (n=8316) had a higher rate of reinfarction
(9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p<0.001).
Conclusions: Patients with ACS treated palliatively were older, sicker,
with more heart failure at admission and very high in-hospital mortality.
While refraining from more active therapy may often constitute the most
humane and appropriate approach, we think it is important to also evaluate
these patients and include them in registries and outcome evaluations.
Clinical trial number: ClinicalTrials.gov Identifier: NCT01 305 785.

<2>
Accession Number
2015893327
Authors
Zheng C. Liu S. Geng P. Zhang H. Tang A. Xie X.
Institution
(Zheng, Zhang, Tang, Xie) First Department of Comprehensive Surgery, South
Building, Chinese PLA General Hospital, Beijing 100853, China
(Liu) Department of Chinese PLA General Logistics, No. 2 Clinic,
Management Support Bureau, Beijing 100071, China
(Geng) Cancer Center, Chinese PLA General Hospital and Chinese PLA Medical
School, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
(Zheng, Zhang) No. 2 Clinic, Management Support Bureau, Chinese PLA
General Logistics Department, Beijing 100071, China
Title
Efficacy of edaravone on coronary artery bypass patients with myocardial
damage after ischemia and reperfusion: A meta analysis.
Source
International Journal of Clinical and Experimental Medicine. 8 (2) (pp
2205-2211), 2015. Date of Publication: 28 Feb 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objectives: To assess the efficacy and safety of edaravone for myocardial
damage during myocardial ischemia and reperfusion (I/R). Methods: We
included randomized controlled trials that compared edaravone with placebo
or no intervention in patients with acute myocardial infarction or
undergoing coronary artery bypass. Two authors selected eligible trials,
assessed trial quality and independently extracted the data. Results:
Seven clinical trials were eventually included and analyzed in this study,
involving 148 participants. Four trials were defined as waiting
assessment. All of the three remaining trials compared edaravone and
another treatment combined with other treatment alone, used the same dose
of edaravone injections (60 mg per day) and course of treatment (14 days),
evaluated the effect of edaravone at different times, applied different
methods, reported adverse events, and showed no differences between the
treatment group and the control group. When pooling all of the trials in
one dataset, edaravone appeared to decrease the proportion of participant
with marked myocardial damage during I/R as compared with the control
group. The meta-analysis also revealed decreased CK-MB, cTnI and MDA, and
increased content of SOD. Conclusions: Due to the moderate risk of bias
and small sample, our observation of an effective treatment trend of
edaravone for I/R requires future larger, high-quality trials to confirm.

<3>
Accession Number
2015902689
Authors
Ad N. Tran H.A. Halpin L. Speir A.M. Rongione A.J. Pritchard G. Holmes
S.D.
Institution
(Ad, Tran, Halpin, Speir, Rongione, Pritchard, Holmes) Cardiac Surgery
Research, Inova Heart and Vascular Institute, Falls Church, VA, United
States
Title
Practice changes in blood glucose management following open heart surgery:
From a prospective randomized study to everyday practice.
Source
European Journal of Cardio-thoracic Surgery. 47 (4) (pp 733-739), 2015.
Article Number: ezu205. Date of Publication: 01 Apr 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Targeted blood glucose (BG) levels following cardiac surgery
continues to be debated. According to the Society of Thoracic Surgeons
(STS) guidelines, BG should be kept <180 mg/dl following cardiac surgery.
However, our practice and others shifted to a stricter BG control (90-110
mg/dl) based on data suggesting an association with improved outcome.
Recently, we conducted a randomized control study that demonstrated no
added value to stricter control over liberal control (120-180 mg/dl). As a
result, we shifted our management accordingly. The purpose of this study
was to evaluate the impact that this change to a more liberal BG
management (BGM) had on patient outcomes at our centre. METHODS: BGM was
changed in June 2011 from strict (90-110 mg/dl) to liberal (120-180
mg/dl). Insulin drips, managed through a computerized algorithm,
controlled BG for the first 72 h post surgery. Consecutive cardiac surgery
patients operated on throughout 1 year prior to BGM change (n = 934) were
propensity score matched to patients operated on throughout 1 year after
the change (n = 927). RESULTS: After matching, there were 846 patient
pairs. There was no difference between cohorts for length of stay and
perioperative complications, and both cohorts achieved acceptable
outcomes. Incidence of perioperative renal failure (P = 0.02) and renal
failure requiring dialysis (P = 0.004) were better for the cohort with
liberal BGM. One-year cumulative survival did not differ between cohorts
(log-rank = 0.70, P = 0.40). CONCLUSIONS: Implementation of glycaemic
control of 120-180 mg/dl into clinical practice was not associated with
increased morbidity. The present results confirm our prior findings that a
more liberal glycaemic control strategy to maintain BG is equal to a
stricter target range. These findings are important for patient care and
demonstrate the safety and efficacy of practice change for all patients
following a successful randomized controlled trial.

<4>
Accession Number
2015924332
Authors
Obadia J.-F. Armoiry X. Iung B. Lefevre T. Mewton N. Messika-Zeitoun D.
Cormier B. Berthiller J. Maucort-Boulch D. Boutitie F. Vaz B. Trochu J.-N.
Vahanian A.
Institution
(Obadia) Service de Chirurgie Cardiothoracique et Transplantation, Hopital
Cardiothoracique Louis Pradel, 28, avenue du Doyen Lepine, Lyon-Bron
69677, France
(Obadia) INSERM, U 886 Cardioprotection, Laboratoire de Physiologie Lyon
Nord, UCBL1, Lyon, France
(Armoiry, Berthiller) Hospices Civils de Lyon, DRCI, Cellule Innovation,
Lyon, France
(Armoiry) Universite Claude Bernard Lyon 1, UMR-CNRS 5510/MATEIS, Lyon,
France
(Iung, Messika-Zeitoun, Vahanian) Departement de Cardiologie, Hopital
Xavier Bichat, DHU FIRE, Paris, France
(Lefevre, Cormier) Institut Cardiovasculaire Paris Sud, Hopital Prive
Jacques Cartier, Massy, France
(Mewton, Vaz) Hopital Cardiovasculaire Louis Pradel, Clinical
Investigation Center, Hospices Civils de Lyon, Bron, France
(Maucort-Boulch, Boutitie) Hospices Civils de Lyon, Service de
Biostatistique, Lyon, France
(Maucort-Boulch, Boutitie) Universite Lyon i, Villeurbanne, France
(Maucort-Boulch, Boutitie) CNRS, UMR 5558, Laboratoire Biostatistique
Sante, Pierre-Benite, France
(Trochu) L'Institut du Thorax, Clinique Cardiologique, Hopital Guillaume
et Rene Laennec, Nantes, France
Title
The MITRA-FR study: Design and rationale of a randomised study of
percutaneous mitral valve repair compared with optimal medical management
alone for severe secondary mitral regurgitation.
Source
EuroIntervention. 10 (11) (pp 1354-1360), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Percutaneous mitral valve repair (pMVR) is a new therapeutic option
for mitral valve regurgitation. Positive preliminary results in
non-randomised studies have been published supporting the use of the
MitraClip system in patients with secondary mitral regurgitation (MR) and
poor left ventricular (LV) function contraindicated to surgery. The aim of
the MITRA-FR study is to provide a higher level of evidence for the
efficacy of the MitraClip device in this setting. Methods and results: The
MITRA-FR study is a national, multicentre, investigator-initiated,
open-label, randomised trial to evaluate the benefits and safety of pMVR
using the MitraClip system plus optimal medical therapy (OMT) compared
with OMT alone (control) in patients with severe symptomatic secondary MR
contraindicated to surgical repair. The trial aims to enrol 144
MitraClip-treated subjects and 144 control (OMT alone) patients. The
primary endpoint is a composite of all-cause mortality and unplanned
hospitalisations for heart failure at 12 months after randomisation.
Conclusions: MITRA-FR is a randomised controlled national trial designed
to evaluate the performance of pMVR in comparison to OMT in patients with
severe symptomatic secondary MR contraindicated to cardiac surgery.

<5>
Accession Number
2015924317
Authors
Pilgrim T. Raber L. Limacher A. Wenaweser P. Cook S. Stauffer J.-C.
Garachemani A. Moschovitis A. Meier B. Juni P. Windecker S.
Institution
(Pilgrim, Raber, Wenaweser, Moschovitis, Meier, Windecker) Department of
Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern
3010, Switzerland
(Limacher, Juni, Windecker) Clinical Trials Unit Bern, Department of
Clinical Research, University of Bern, Bern, Switzerland
(Cook, Stauffer) Cardiology, University of Fribourg, Fribourg, Switzerland
(Garachemani) Lindenhof Hospital, Bern, Switzerland
(Juni) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
Title
Five-year results of a randomised comparison of
titaniumnitride-oxide-coated stents with zotarolimus-eluting stents for
coronary revascularisation.
Source
EuroIntervention. 10 (11) (pp 1284-1287), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Stents with a passive coating of titanium-nitride-oxide (TiNO) have
been compared with Endeavor zotarolimus-eluting stents (E-ZES) with regard
to the primary endpoint of in-stent late lumen loss at six to eight
months. The objective of the present analysis was to compare the long-term
outcomes of TiNO stents with E-ZES up to five years of clinical follow-up.
Methods and results: A total of 302 patients had been randomly allocated
to treatment with TiNO or E-ZES. Up to five years of follow-up, major
adverse cardiac events (MACE), the composite of cardiac death, myocardial
infarction, or clinically indicated target vessel revascularisation (TLR),
were observed in 27.6% of patients treated with TiNO stents and 25.3% of
patients treated with E-ZES (RR 1.13, 95% CI: 0.72-1.75, p=0.60), with the
majority of events related to clinically indicated TVR (TiNO 21.7% versus
E-ZES 20.7%, RR 1.10, 95% CI: 0.67-1.81). There were no differences with
respect to individual events including cardiac death, myocardial
infarction or stent thrombosis between the two treatment arms up to five
years of followup. A majority of patients remained free from angina
throughout the entire study duration (TiNO 77.3% versus E-ZES 76.1%,
p=0.92). Conclusions: Final five-year outcomes of the TIDE trial comparing
TiNO stents with E-ZES revealed increased rates of MACE driven primarily
by clinically indicated TVR. The TIDE trial is registered at
ClinicalTrials.gov: NCT00492908.

<6>
Accession Number
2015924315
Authors
Lowik M.M. Lam M.K. Sen H. Tandjung K. Houwelingen K.G. De Man F.H.A.F.
Stoel M.G. Louwerenburg J.W. Linssen G.C.M. Doggen C.J.M. Von Birgelen C.
Institution
(Lowik, Lam, Sen, Tandjung, Houwelingen, De Man, Stoel, Louwerenburg, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Haaksbergerstraat 55, Enschede 7513 ER, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Hengelo,
Netherlands
(Doggen, Von Birgelen) Health Technology and Services Research,
MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Safety of second-generation drug-eluting stents three years after
randomised use in the TWENTE trial.
Source
EuroIntervention. 10 (11) (pp 1276-1279), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: To assess three-year clinical outcome following randomised use of
the second-generation Resolute zotarolimus-eluting stent (ZES) and the
XIENCE V everolimus-eluting stent (EES). For Resolute ZES and randomised
use, outcome data >3 years are relatively scarce. Methods and results: The
TWENTE trial examined 1,391 patients with stable angina or
non-ST-elevation acute coronary syndromes, of whom 21.6% were diabetics,
70.1% had complex B2 or C lesions and 77.4% had "off-label" indications
for DES use. Three-year follow-up data were obtained in 1,381 patients
(99.3%; 10 withdrawals). Adverse clinical events were independently
adjudicated. The primary endpoint target vessel failure (TVF), a composite
of cardiac death, target vessel-related myocardial infarction and
clinically indicated target vessel revascularisation, was 12.1% for
Resolute ZES and 13.4% for XIENCE V EES (p=0.50). Cardiac death rates were
1.9% vs. 3.5% (p=0.06); the other individual components of TVF also showed
no significant between-group differences. The rates of
definite-or-probable stent thrombosis (1.4% vs. 1.6%, p=0.82) and very
late stent thrombosis (0.6% vs. 0.4%, p=1.0) did not differ between the
groups. Conclusions: Three-year follow-up data of patients included in the
randomised TWENTE trial demonstrated similar and sustained safety and
efficacy of Resolute ZES and XIENCE V EES.

<7>
Accession Number
2015924314
Authors
Teeuwen K. Van Den Branden B.J.L. Koolen J.J. Van Der Schaaf R.J.
Henriques J.P.S. Tijssen J.G.P. Kelder J.C. Vermeersch P.H.M.J. Rensing
B.J.W.M. Suttorp M.J.
Institution
(Teeuwen, Rensing, Suttorp) Department of Interventional Cardiology, St.
Antonius Hospital, Koekoekslaan 1, Nieuwegein 3435 CM, Netherlands
(Van Den Branden) Department of Interventional Cardiology, Amphia
Hospital, Breda, Netherlands
(Koolen) Department of Interventional Cardiology, Catharina Hospital,
Eindhoven, Netherlands
(Van Der Schaaf) Department of Interventional Cardiology, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Henriques) Department of Interventional Cardiology, Academic Medical
Center, Amsterdam, Netherlands
(Tijssen) Research and Statistics, Academic Medical Center, Amsterdam,
Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
(Vermeersch) Department of Interventional Cardiology, Middelheim Hospital,
Antwerp, Belgium
Title
Three-year clinical outcome in the primary stenting of totally occluded
native coronary arteries III (PRISON III) trial: A randomised comparison
between sirolimus-eluting stent implantation and zotarolimus-eluting stent
implantation for the treatment of total coronary occlusions.
Source
EuroIntervention. 10 (11) (pp 1272-1275), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Sirolimus-eluting stents (SES) have been shown to be superior to
Endeavor zotarolimus-eluting stents (ZES) and comparable to Resolute ZES
at eight-month angiography in patients treated for total coronary
occlusions (TCO). This study investigated clinical outcome at three-year
follow-up. Methods and results: The PRISON III trial investigated the
efficacy and safety of SES against ZES (Endeavor and Resolute) in two
study phases. In the first phase, 51 patients were randomised to receive
SES and 46 to Endeavor ZES. In the second phase, 103 and 104 patients were
randomised to SES or Resolute ZES, respectively. Between one and three
years there were only a few additional clinical events in all groups. As a
result, the rates of target lesion revascularisation 12.2% vs. 19.6%,
p=0.49, target vessel failure 14.3% vs. 19.6%, p=0.68, and definite or
probable stent thrombosis 4.1% vs. 2.2% were comparable between SES and
Endeavor ZES at three years. In the second study phase, the rates of
target lesion revascularisation 10% vs. 5.9%, p=0.42, target vessel
failure 10% vs. 7.9%, p=0.79 and definite or probable stent thrombosis
1.0% vs. 0% were similar between SES and Resolute ZES. Conclusions: The
present study demonstrated a low incidence of clinical events between
one-and threeyear follow-up with either SES compared to Endeavor ZES or
SES versus Resolute ZES in patients treated for total coronary occlusions.

<8>
Accession Number
2015924312
Authors
Tamburino C. Capodanno D. Erglis A. Menown I.B.A. Horvath I.G. Moreno R.
Gilbert T.J. Crowley J.J. Calabria P. Allocco D.J. Dawkins K.D.
Institution
(Tamburino, Capodanno) Ferrarotto Hospital, University of Catania,
Catania, Italy
(Erglis) Pauls Stradins Clinical University Hospital, University of
Latvia, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(Horvath) Heart Institute, University of Pecs, Pecs, Hungary
(Moreno) University Hospital la Paz, Madrid, Spain
(Gilbert) Norfolk and Norwich University Hospital NHS Trust, Norwich,
United Kingdom
(Crowley) Galway University Hospital, Galway, Ireland
(Calabria) Ospedale della Misericordia, Grosseto, Italy
(Allocco, Dawkins) Boston Scientific Corporation, Marlborough, MA, United
States
Title
One-year outcomes in unselected patients treated with a thinstrut,
platinum-chromium, paclitaxel-eluting stent: Primary endpoint results from
the TAXUS Element European postapproval surveillance study (TE-PROVE).
Source
EuroIntervention. 10 (11) (pp 1261-1266), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: To evaluate clinical outcomes in patients receiving the
next-generation, paclitaxel-eluting, platinumchromium TAXUS Element stent
in a real-world setting. The PERSEUS Workhorse and Small Vessel studies
showed positive results with the TAXUS Element stent in a clinical trial
setting. Methods and results: TE-PROVE was a prospective, open-label,
multicentre, "all-comers" study which enrolled 1,014 patients at 37
European sites. Follow-up was at 30 days, six months and one year, and
will continue annually up to five years. The primary endpoint was overall
and stent-related target vessel failure (TVF), defined as cardiac death,
target vessel-related myocardial infarction (MI) and target vessel
revascularisation (TVR) at one year post implantation. Secondary endpoints
included the components of TVF, allcause mortality, and ARC
definite/probable stent thrombosis. Follow-up was available in 97.3%
(987/1,014) of patients. Patients were 75.0% male (760/1,014), mean age
was 65.1+/-10.8 years, 25.5% had medically treated diabetes (259/1,014),
and 10.7% (109/1,014) were treated for STEMI. At baseline, mean lesion
length among 1,299 treated lesions was 19.8+/-12.0 mm and mean reference
vessel diameter was 3.1+/-0.5 mm. At one year, the rate of TVF (primary
endpoint) was 6.0% (59/987) overall; 3.7% (37/987) of TVF events were
stent-related. Cardiac death was 0.7% (7/987), target vessel-related MI
was 1.1% (11/987), and TVR was 4.7% (46/987). All-cause death occurred in
1.2% (12/987) of patients and ARC definite/probable ST was 0.5% (5/987).
Conclusions: The primary endpoint results from the TE-PROVE registry
demonstrate good performance and safety for the TAXUS Element
paclitaxel-eluting stent at one year in everyday clinical practice.
Clinical Trial Registration Information: NCT01242696.

<9>
Accession Number
2015927223
Authors
Passeri J.J. Elmariah S. Xu K. Inglessis I. Baker J.N. Alu M. Kodali S.
Leon M.B. Svensson L.G. Pibarot P. Fearon W.F. Kirtane A.J. Vlahakes G.J.
Palacios I.F. Douglas P.S.
Institution
(Passeri, Elmariah, Inglessis, Palacios) Cardiology Division, Department
of Medicine, Massachusetts General Hospital, 5 Fruit Street, GRB 800,
Boston, MA, United States
(Elmariah) Harvard Clinical Research Institute, Boston, MA, United States
(Xu, Alu, Kodali, Leon, Kirtane) Columbia University Medical Center/New
York-Presbyterian Hospital, Cardiovascular Research Foundation, NY, United
States
(Baker, Vlahakes) Department of Cardiac Surgery, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Svensson) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec,
Canada
(Fearon) Stanford University School of Medicine, Stanford, CA, United
States
(Douglas) Duke Clinical Research Institute/Duke University Medical Center,
Durham, NC, United States
(Douglas) Massachusetts General Hospital, 55 Fruit Street, YAW 5700,
Boston, MA 02114, United States
Title
Transcatheter aortic valve replacement and standard therapy in inoperable
patients with aortic stenosis and low EF.
Source
Heart. 101 (6) (pp 463-471), 2015. Date of Publication: 01 Mar 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives The aims of this study were to evaluate the effect of left
ventricular (LV) dysfunction on clinical outcomes after transcatheter
aortic valve replacement (TAVR) and standard therapy for severe aortic
stenosis (AS) and to assess LV ejection fraction (LVEF) recovery and its
impact on subsequent clinical outcomes. Methods Cohort B of the Placement
of AoRtic TraNscathetER Valves trial randomised 342 inoperable patients
with severe AS to TAVR or standard therapy. We defi ned LV dysfunction as
an LVEF <50% and LVEF improvement as an absolute increase in LVEF >10% at
30 days. Results Baseline LV dysfunction did not affect survival after
TAVR but was associated with increased cardiac mortality at 1 year with
standard therapy (59.3% vs 45.8% with normal LVEF; HR=1.71 (95% CI 1.08 to
2.71); p=0.02). In those with LV dysfunction, LVEF improvement occurred in
48.7% and 30.4% of TAVR and standard therapy patients, respectively (
p=0.08), and was independently predicted by relative wall thickness and
receipt of TAVR. LVEF improvement with standard therapy portended reduced
all-cause mortality at 1 year (28.6% vs 65.6% without LVEF improvement;
HR=0.32 (95% CI 0.11 to 0.93); p=0.03) but not at 2 years. Conclusions In
inoperable patients with severe AS, mild-to-moderate LV dysfunction is
associated with higher cardiac mortality with standard therapy but not
TAVR. A subset of patients undergoing standard therapy with LV dysfunction
demonstrates LVEF improvement and favourable 1-year but not 2-year
survival. TAVR improves survival and should be considered the standard of
care for inoperable patients with AS and LVEF >20%. The PARTNER Trial was
supported by Edwards Lifesciences, and the protocol was designed
collaboratively by the Steering Committee and Sponsor. This work was, in
part, supported by the American Heart Association (14 FTF20440012 to SE).

<10>
Accession Number
2015927702
Authors
Zhang D. Lv S. Song X. Yuan F. Xu F. Zhang M. Yan S. Cao X.
Institution
(Zhang, Lv, Song, Yuan, Xu, Zhang, Yan, Cao) Department of Cardiology,
Beijing An Zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel
Disease, Anzhenli Avenue, Beijing 100029, China
Title
Fractional flow reserve versus angiography for guiding percutaneous
coronary intervention:A meta-analysis.
Source
Heart. 101 (6) (pp 455-462), 2015. Date of Publication: 01 Mar 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives The purpose of this study was to investigate whether fractional
flow reserve (FFR) should be performed for patients with coronary artery
disease (CAD) to guide the percutaneous coronary intervention (PCI)
strategy. Background PCI is the most effective method to improve the
outcomes of CAD. However, the proper usage of PCI has not been achieved in
clinical practice. Methods A meta-analysis was performed on
angiography-guided PCI and FFR-guided PCI strategies. Prospective and
retrospective studies were included when research subjects were patients
with CAD undergoing PCI. The primary endpoint was the rate of major
adverse cardiac events (MACE) or major adverse cardiac and cerebrovascular
events (MACCE). Secondary endpoints included death, myocardial infarction
(MI), repeat revascularisation and death or MI. Results Four prospective
and three retrospective studies involving 49 517 patients were included.
Absolute risks of MACE/MACCE, death, MI, revascularisation and death or MI
for angiography-guided PCI and FFR-guided PCI were 34.8% vs 22.5%, 15.3%
vs 7.6%, 8.1% vs 4.2%, 20.4% vs 14.8%, and 21.9% vs 11.8%, respectively.
The meta-analysis demonstrated that FFRguided PCI was associated with
lower MACE/MACCE (OR: 1.71, 95% CI 1.31 to 2.23), death (OR: 1.64, 95% CI
1.37 to 1.96), MI (OR: 2.05, 95% CI 1.61 to 2.60), repeat
revascularisation (OR: 1.25, 95% CI 1.09 to 1.44), and death or MI (OR:
1.84, 95% CI 1.58 to 2.15) than angiography-guided PCI strategy.
Conclusions This meta-analysis supports current guidelines advising the
FFR-guided PCI strategy for CAD. PCI should only be performed when
haemodynamic significance is found.

<11>
Accession Number
2015794751
Authors
Guo S. Sun Y. Ji B. Liu J. Wang G. Zheng Z.
Institution
(Guo, Sun, Ji, Liu) Department of Cardiopulmonary Bypass, State Key
Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
(Wang) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
(Zheng) Department of Cardiovascular Surgery, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union
Medical College, Beijing, China
Title
Similar cerebral protective effectiveness of antegrade and retrograde
cerebral perfusion during deep hypothermic circulatory arrest in aortic
surgery: A meta-analysis of 7023 patients.
Source
Artificial Organs. 39 (4) (pp 300-308), 2015. Date of Publication: 01 Apr
2015.
Publisher
Blackwell Publishing Inc.
Abstract
In aortic arch surgery, deep hypothermic circulatory arrest (DHCA)
combined with cerebral perfusion is employed worldwide as a routine
practice. Even though antegrade cerebral perfusion (ACP) is more widely
used than retrograde cerebral perfusion (RCP), the difference in benefit
and risk between ACP and RCP during DHCA is uncertain. The purpose of this
meta-analysis is to compare neurologic outcomes and early mortality
between ACP and RCP in patients who underwent aortic surgery during DHCA.
PubMed, EMBASE, and the Cochrane Library were searched using the key words
"antegrade," "retrograde," "cerebral perfusion," "cardiopulmonary bypass,"
"extracorporeal circulation," and "cardiac surgery" for studies reporting
on clinical endpoints including early mortality, stroke, temporary
neurologic dysfunction (TND), and permanent neurologic dysfunction (PND)
in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was
analyzed with the Cochrane Q statistic and I² statistic.
Publication bias was tested with Begg's funnel plot and Egger's test.
Thirty-four studies were included in this meta-analysis, with 4262
patients undergoing DHCA+ACP and 2761 undergoing DHCA+RCP. The overall
pooled relative risk for TND was 0.722 (95% CI=[0.579, 0.900]), and the
z-score for overall effect was 2.9 (P=0.004). There was low heterogeneity
(I²=18.7%). The analysis showed that patients undergoing
DHCA+ACP had better outcomes than those undergoing DHCA+RCP in terms of
TND, while there were no significant differences between groups in terms
of PND, stroke, and early mortality. This meta-analysis indicates that
DHCA+ACP has an advantage over DHCA+RCP in terms of TND, while the two
methods show similar results in terms of PND, early mortality, and stroke.

<12>
Accession Number
2015907343
Authors
Unic D. Baric D. Brkic K. Planinc M. Jonjic D. Rudez I. Sutlic Z.
Institution
(Unic, Baric, Brkic, Planinc, Jonjic, Rudez, Sutlic) Department of Cardiac
and Transplant Surgery, Dubrava University Hospital, Av. G. Suska 6,
Zagreb HR-10 000, Croatia
Title
Off-pump myocardial revascularization attenuates endothelin-1 expression
in systemic, pulmonary, and coronary circulation.
Source
Wiener Klinische Wochenschrift. 126 (21) (pp 710-717), 2014. Date of
Publication: 2014.
Publisher
Springer-Verlag Wien
Abstract
Objective The objective of this study was to evaluate the influence of
cardiopulmonary bypass (CPB) on endothelin-1 (ET-1) expression in various
circulation compartments in patients undergoing myocardial
revascularization. Methods A total of 30 patients were randomized to
undergo myocardial revascularization with (CABG, n=15) or without (OPCAB,
n=15) CPB. Samples were taken preoperatively, after establishing CPB and
after CPB (CABG group), prior to and after revascularization (OPCAB
group), and 6 and 24 h postoperatively. Values of ET-1 were compared
between groups at all time points and correlated with postoperative
cardioselective enzyme values and clinical parameters. Results In OPCAB
group, ET-1 levels did not significantly vary between time points. In CABG
group, ET-1 levels were significantly elevated vs. baseline in arterial:
ART-T2 vs. ART-T0 (1.83 +/- 1.81 vs. 0.76 +/- 1.07 fmol/mL, p=0.05),
pulmonary: SG-T2 vs. SG-T0 (2.70 +/- 2.75 vs. 0.39 +/- 0.28 fmol/mL, p <
0.001) and SG-T3 vs. SG-T0 (1.56 +/- 0.28 vs. 0.39 +/- 0.28 fmol/mL,
p<0.001), and coronary circulation CS-T2 vs. CS-T1 (1.12 +/- 0.49 vs. 0.27
+/- 0.09 fmol/mL, p=0.01). ET-1 levels were significantly higher in CABG
group in all vascular compartments: ART-T2 (1.83 +/- 1.81 vs. 0.17 +/-
0.16 fmol/mL, p=0.02), ART-T4 (0.99 +/- 0.56 vs. 0.24 +/- 0.12 fmol/mL,
p=0.01), SG-T1 (0.59 +/- 0.15 vs. 0.25 +/- 0.13 fmol/mL, p=0.01), SG-T2
(2.70 +/- 2.75 vs. 0.30 +/- 0.24 fmol/mL, p=0.004), SG-T3 (1.56 +/- 0.28
vs. 0.35 +/- 0.31 fmol/mL, p<0.001), SG-T4 (1.34 +/- 0.11 vs. 0.34 +/-
0.16 fmol/mL, p < 0.001), and CS-T2 (1.12 +/- 0.49 vs. 0.12 +/- 0.12
fmol/mL, p=0.004). Coronary sinus ET-1 level after CPB (CS-T2) in CABG
group correlated positively with troponin-I level 24 h postoperatively
(r²=0.802, p=0.02)

<13>
Accession Number
2015908843
Authors
Denardo S.J. Gong Y. Cooper-Dehoff R.M. Farsang C. Keltai M. Szirmai L.
Messerli F.H. Bavry A.A. Handberg E.M. Mancia G. Pepine C.J.
Institution
(Denardo, Cooper-Dehoff, Bavry, Handberg, Pepine) Division of
Cardiovascular Medicine, College of Medicine, University of Florida,
Gainesville, FL, United States
(Gong) Center for Pharmacogenomics, College of Pharmacy, University of
Florida, Gainesville, FL, United States
(Cooper-Dehoff) Department of Pharmacotherapy and Translational Research,
College of Pharmacy, University of Florida, Gainesville, FL, United States
(Farsang) St Imre Teaching Hospital Cardiometabolic Centre, Budapest,
Hungary
(Keltai) Semmelweis University, Hungarian Institute of Cardiology,
Budapest, Hungary
(Szirmai) NandSz Study Master Medical Research Center Ltd., Szentendre,
Hungary
(Messerli) Division of Cardiology, St Luke's-Roosevelt Hospital Center,
Columbia University, New York, NY, United States
(Bavry) North Florida/South Georgia Veterans Affairs Health System,
Gainesville, FL, United States
(Mancia) Clinica Medica, Ospedale San Gerardodei Tintori Monza, University
of Milano-Bicocca, Milan, Italy
(Denardo) Division of Cardiovascular Medicine, Duke University Medical
Center, Durham, NC, United States
Title
Effects of verapamil SR and atenolol on 24-hour blood pressure and heart
rate in hypertension patients with coronary artery disease: An
international verapamil SR-trandolapril ambulatory monitoring substudy.
Source
PLoS ONE. 10 (4) , 2015. Article Number: e0122726. Date of Publication: 02
Apr 2015.
Publisher
Public Library of Science
Abstract
Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP
and HR variability, and altered diurnal variations of BP and HR (nighttime
dipping and morning surge) in patients with systemic hypertension are each
associated with increased adverse cardiovascular events. However, there
are no reports on the effect of hypertension treatment on these important
hemodynamic parameters in the growing population of hypertensive patients
with atherosclerotic coronary artery disease (CAD). This was a
pre-specified subgroup analysis of the INternational VErapamil
SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable
patients aged >50 years with hypertension and CAD randomized to either
verapamil SR-oratenolol-based hypertension treatment strategies. The
subgroup consisted of 117 patients undergoing 24-hour ambulatory
monitoring at baseline and after 1 year of treatment. Hourly systolic and
diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR-
and atenolol-based treatment strategies compared with baseline (P<0.0001).
Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies
decreased SBP variability (weighted standard deviation: P = 0.012 and
0.021, respectively). Compared with verapamil SR, atenolol also increased
the prevalence of BP and HR nighttime dipping among prior non-dippers (BP:
OR = 3.37; 95% CI: 1.26-8.97; P = 0.015; HR: OR = 4.06; 95% CI:
1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5
beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based
strategies resulted in favorable changes in ambulatory monitoring
parameters that have been previously associated with increased adverse
cardiovascular events.

<14>
Accession Number
2015909948
Authors
Benstoem C. Moza A. Autschbach R. Stoppe C. Goetzenich A.
Institution
(Benstoem, Moza, Autschbach, Stoppe, Goetzenich) Department of Thoracic
and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen,
Germany
(Stoppe) Department of Anaesthesiology, University Hospital RWTH Aachen,
Aachen, Germany
Title
Evaluating outcomes used in cardiothoracic surgery interventional
research: A systematic review of reviews to develop a core outcome set.
Source
PLoS ONE. 10 (4) , 2015. Article Number: e0122204. Date of Publication: 01
Apr 2015.
Publisher
Public Library of Science
Abstract
Background: When planning clinical trials, it is a key element to choose
appropriate outcomes that ensure the comparability of effects of
interventions in ways that minimise bias. We hypothesise that outcome
measures in cardiothoracic surgical trials are inconsistent and without
standard. Therefore, comparing the relative effectiveness of interventions
across studies is problematic. We surmise that cardiothoracic research has
focused habitually on the identification of risk factors and on the
reduction of adverse outcomes with less consideration of factors that
contribute to well being and positive health outcomes (salutogenesis).
Methods and Findings: We conducted a systematic review of reviews to
determine both the type and number of outcomes reported in current
cardiothoracic surgery interventional research, in order to identify a
list of potential outcomes for a minimum core outcome set (COS). Special
focus was placed on outcomes that emphasise salutogenesis. We interpreted
salutogenic outcomes as those relating to optimum and/or positive health
and well being. We searched Issue 7 (July 2014) of the Cochrane Database
of Systematic Reviews. Systematic reviews of randomised trials on
non-minimal-invasive off- or on-pump cardiothoracic surgery (elective and
emergency, excluding transplants) investigating pre-, intra- or
postsurgical interventions related to the outcome of the procedure were
eligible for inclusion. We excluded protocols and withdrawn systematic
reviews. Two review authors extracted outcome data independently. Unique
lists of salutogenically and non-salutogenically focused outcomes were
established. 15 systematic reviews involving 371 randomized trials and
58,253 patients were included in this review. Applied definitions of
single and composite endpoints varied significantly, and patient-centred,
salutogenically focused outcomes were seldom reported. One third of
included reviews did not assess patient-centred outcomes at all; all other
reviews were unable to perform meta-analyses due to an absence of data or
heterogeneity in outcome measures. This compares to 36 non-salutogenically
focused outcome domains representing 121 individual non-salutogenically
focused outcomes, whereof 50% were assessed only once. Measures of
mortality, cerebrovascular complications and hospitalisation were reported
most frequently. Two reviews chose a composite endpoint as primary
outcome. Pooled analysis of composite endpoints was not possible, as the
required data was not reported per patient in all components. Conclusion:
In cardiothoracic surgical trials, choice and definition of
non-salutogenically focused single and composite outcomes are
inconsistent. There is an absence of patient centred, salutogenically
focused outcome parameters in cardiac trials. We recommend the development
of a core outcome set of salutogenically focused and non-salutogenically
focused outcomes for cardiothoracic surgical research.

<15>
Accession Number
2015906347
Authors
Jacob K.A. Hjortnaes J. Kranenburg G. De Heer F. Kluin J.
Institution
(Jacob, Hjortnaes, De Heer, Kluin) Department of Cardiothoracic Surgery,
University Medical Centre Utrecht, Mail Stop E03.511, PO Box 85500,
Utrecht 3508 GA, Netherlands
(Kranenburg) Julius Center for Health Sciences and Primary Care,
University Medical Centre Utrecht, Utrecht, Netherlands
Title
Mortality after cardiac surgery in patients with liver cirrhosis
classified by the Child-Pugh score.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (4) (pp 520-530),
2015. Date of Publication: 01 Apr 2015.
Publisher
Oxford University Press
Abstract
Liver cirrhosis is a known risk factor for postoperative mortality in
patients undergoing cardiac surgery. Clinical assessment of liver
cirrhosis using the widely accepted Child-Pugh (CP) score is thus vital
for evaluation of surgical options and perioperative care. However,
detailed mortality rates as a consequence of liver cirrhosis are unclear.
This review aimed to stratify the risk of short-term (<30 days) and
overall (up to 10 years) mortality after cardiac surgery in patients with
liver cirrhosis, classified by the CP score. Thus, PubMed, Embase, CINAHL
and the Cochrane Library were systematically reviewed by two independent
investigators for studies published up to February 2014, in which
mortality in cirrhotic patients, classified by the CP classification,
undergoing cardiac surgery was evaluated postoperatively. A total of 993
articles were identified. After critical appraisal of 21 articles, 19 were
selected for final analysis. Weighted short-term mortality of cirrhotic
patients undergoing cardiac surgery was 19.3% [95% confidence interval
(CI): 16.4-22.5%]. Across the different CP groups, short-term mortality
appeared to be 9.0% (95% CI: 6.6-12.2%), 37.7% (95% CI: 30.8-44.3%) and
52.0% (95% CI: 33.5-70.0%) in Groups A, B and C, respectively. Weighted
overall mortality within 1 year was 42.0% (95% CI: 36.0-48.3%) in all
cirrhotic patients. Subdivided in groups, overall mortality within that 1
year was 27.2% (95% CI: 20.9-34.7%), 66.2% (95% CI: 54.3-76.3%) and 78.9%
(95% CI: 56.1-92.1%) in Groups A, B and C, respectively. In conclusion,
short-term mortality is considerably increased in patients with liver
cirrhosis CP class B and C. Overall mortality is significantly high in all
classes of liver cirrhosis.

<16>
Accession Number
2015906346
Authors
Akter F. Routledge T. Toufektzian L. Attia R.
Institution
(Akter, Routledge, Toufektzian, Attia) Department of Cardiothoracic
Surgery, Guy's Hospital, 6th Floor Tower Wing, London SE1 9RT, United
Kingdom
Title
In minor and major thoracic procedures is uniport superior to multiport
video-assisted thoracoscopic surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (4) (pp 550-555),
2015. Date of Publication: 01 Apr 2015.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Are there differences in
outcomes in uniport compared with multiport video-assisted thoracoscopic
surgery? Altogether, 45 papers were found using the reported search, of
which 8 papers represent the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type and level of evidence of publication, relevant
outcomes and results of these papers are tabulated. Two studies (272
patients) compared outcomes for lobectomy. One study found pain control
was significantly better in uniportal (P < 0.01) with earlier mobilization
(P < 0.05), and decreased hospital stay by half a day (P < 0.05). The
chest drain volume was less, and consequently the number of days the chest
drain remained in situ decreased by 1 day (P < 0.05). The second study
looking at lobectomies failed to find any differences between the two
techniques. For minor thoracic procedures (pneumothorax, peripheral lung
nodules, thymic tumours, lung biopsies, sympathectomies and mediastinal
cystectomies), 3 papers (117 patients) showed a statistically significant
reduction in pain score during inpatient stay, and 1 paper showed a
reduction in pain score day 0 postoperatively, however, no difference in
pain score days 1 and 3 postoperatively. Two papers (n = 91) showed no
difference in the reported pain scores; however, the patients in the
uniportal group experienced less paraesthesia postoperatively. Patients in
the uniportal group in this study also had reduced in-hospital stay (P =
0.03), and this led to a reduction in inpatient costs (P = 0.03). Four
other studies, however, did not find any significant difference in
duration of hospital stay. Pain scores are lower in uniportal VATS, most
studies however do not demonstrate differences in other outcomes including
analgesic use, duration of chest tube drainage, length of hospital stay or
other thoracic complications. We conclude that, although uniport access
may offer improved pain scores, the current evidence reveals no
differences in most postoperative outcomes between uniport and multiport
approaches to VATS in either minor or major thoracic procedures.

<17>
Accession Number
2015906344
Authors
Ueki C. Sakaguchi G. Akimoto T. Shintani T. Ohashi Y. Sato H.
Institution
(Ueki, Sakaguchi, Akimoto, Shintani, Ohashi, Sato) Department of
Cardiovascular Surgery, Shizuoka General Hospital, 4-27-1 Kita Ando,
Aoi-ku, Shizuoka 420-8527, Japan
Title
Influence of previous percutaneous coronary intervention on clinical
outcome of coronary artery bypass grafting: A meta-analysis of comparative
studies.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (4) (pp 531-537),
2015. Date of Publication: 01 Apr 2015.
Publisher
Oxford University Press
Abstract
The prognostic significance of previous percutaneous coronary intervention
(PCI) in patients undergoing coronary artery bypass grafting (CABG) is
still unclear. Although many studies have reported adverse effects of
previous PCI on postoperative mortality in CABG, as yet no meta-analysis
has been carried out. We conducted this first meta-analysis to assess
whether previous PCI increases postoperative mortality in CABG. MEDLINE
and EMBASE were searched for relevant articles up to and including April
2014. Studies published in English satisfying the following criteria were
included in the meta-analysis: (i) comparing CABG patients with previous
PCI versus without previous PCI; and (ii) reporting hospital mortality.
Our search identified 23 comparative studies, including 174 777 patients:
19 179 with previous PCI and 155 598 without previous PCI. Pooled analysis
demonstrated that previous PCI had an adverse effect on hospital
mortality: odds ratio (OR) 1.187, 95% confidence interval (CI)
1.075-1.312. Furthermore, subgroup analysis stratified by the proportion
of multiple previous PCI (i.e. number of patients with multiple previous
PCI/number of patients with single or multiple previous PCI) was
performed. In the subgroup of studies with the proportion <40%, the
adverse effect was not significant: OR 0.897 (95% CI 0.723-1.113);
however, in the subgroup of studies with the proportion a 40%, the adverse
effect of previous PCI was significant: OR 1.987 (95% CI 1.563-2.526). A
meta-regression coefficient was significantly positive for the proportion
of patients with a history of multiple PCI (coefficient 0.841; 95% CI
0.457-1.226; P < 0.001). This meta-analysis would argue that as the
proportion of patients with multiple previous PCI in the CABG cohort
increases, postoperative mortality also increases. This result
re-emphasizes the importance of the heart team approach to coronary
revascularization.

<18>
Accession Number
2015799954
Authors
Simmers D. Potgieter D. Ryan L. Fahrner R. Rodseth R.N.
Institution
(Simmers, Potgieter) Department of Anaesthetics, Nelson R. Mandela School
of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013,
South Africa
(Ryan, Rodseth) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
(Fahrner) Division of General, Visceral and Vascular Surgery, University
Hospital Jena, Germany
(Rodseth) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
Title
The use of preoperative B-type natriuretic peptide as a predictor of
atrial fibrillation after thoracic surgery: Systematic review and
meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 389-395),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective To determine whether elevated preoperative B-type natriuretic
peptide (NP) measurements are an independent predictor of atrial
fibrillation (AF) in patients having thoracic surgery. Design Systematic
review and meta-analysis. Setting In-hospital and 30 days after thoracic
surgery. Participants The 742 patients who participated in the 5
observational studies. Interventions None. Measurements and Main Results
EMBASE, OVID Health Star, Ovid Medline, Cochrane Central Register of
Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest
Dissertations and Theses A&I databases were searched for all studies of
noncardiac thoracic surgery patients in whom a preoperative NP was
measured up to 1 month before surgery, and that measured the incidence of
postoperative AF. Studies were included regardless of their language,
sample size, publication status, or study design. Study quality was
evaluated using the Newcastle Ottowa Scale. The combined incidence of
postoperative AF was 14.5% (n = 108/742), and the NP thresholds used to
predict AF varied among studies. An elevated preoperative NP measurement
was associated with an OR of 3.13 (95% CI 1.38-7.12; I2 = 87%) for
postoperative AF, with the sensitivity analysis reporting an OR of 9.51
(95% CI 4.66-19.40; I2 = 0). Conclusion Patients with an elevated
preoperative NP measurement are at an increased risk of postoperative AF.
There may be value in incorporating NP measurement into existing AF risk
prediction models.

<19>
Accession Number
2015796424
Authors
Agarwal S. Johnson R.I. Shaw M.
Institution
(Agarwal, Shaw) Department of Anaesthesia and Critical Care, Liverpool
Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
(Johnson) Department of Perfusion, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
Title
Preoperative point-of-care platelet function testing in cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 333-341),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective To investigate if the use of preoperative platelet function
testing (PFT) as part of a transfusion algorithm reduced blood product
usage in coronary artery bypass surgery (CABG). Design Prospective,
randomized, controlled trial. Setting A cardiothoracic hospital.
Participants 249 patients having CABG surgery. Interventions The patients
were allocated randomly to PFT preoperatively with Multiple Electrode
Aggregometry (MEA, Group A), TEG PlateletMapping (PM, Group B) or none
(control, Group C). Post-bypass bleeding management was determined by a
transfusion algorithm. Measurements and Main Results The primary outcome
measure was blood product transfusion in the first 48 hours post-surgery.
There was a significant reduction in all blood product transfusion between
Groups A (MEA) and B (PM) and Group C (control) (median number of units
transfused, 2 (A)/2 (B)/ 4(C), p = 0.02). Those in A and B received fewer
units of red cells (median number of units, 0 (A)/1 (B) /2 (C), p = 0.006)
and fresh frozen plasma than the control Group C (median number of units,
0 (A)/0 (B)/2 (C), p<0.001), without receiving significantly more units of
platelets (median number of units, 1 (A)/1 (B)/0 (C), p = 0.11). In those
who had taken an adenosine disphosphate (ADP)-receptor antagonist within 5
days (n = 173), these results were amplified, and additionally, there was
a significant cost saving (median cost, A = 1738.53, B = 1736.96, C=
3191.80 p = 0.006). Conclusion Preoperative PFT as part of a point-of-care
testing-based transfusion algorithm led to a reduction in blood
transfusion. There is a potential cost saving in those who have taken an
ADP-receptor antagonist within 5 days.

<20>
Accession Number
2015792712
Authors
Hudetz J.A. Patterson K.M. Iqbal Z. Gandhi S.D. Pagel P.S.
Institution
(Hudetz, Patterson, Iqbal, Gandhi, Pagel) Anesthesia Service, Clement J.
Zablocki Veterans Affairs Medical Center, 5000 W. National Avenue,
Milwaukee, WI 53295, United States
Title
Remote ischemic preconditioning prevents deterioration of short-term
postoperative cognitive function after cardiac surgery using
cardiopulmonary bypass: Results of a pilot investigation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 382-388),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective Remote ischemic preconditioning (RIPC) exerts neuroprotective
effects in models of cerebral ischemia-reperfusion injury. The authors
tested the hypothesis that RIPC decreases the incidence of postoperative
delirium and prevents deterioration of short-term postoperative cognitive
function in isoflurane-fentanyl-anesthetized patients undergoing cardiac
surgery using cardiopulmonary bypass (CPB). Design Randomized, blinded,
single-center pilot investigation. Setting Veterans Affairs Medical
Center. Participants Thirty age- and education-matched men>55 years of age
undergoing elective coronary artery or valve surgery using CPB. Fifteen
nonsurgical patients also were enrolled. Interventions RIPC was produced
after induction of anesthesia using 4 cycles of brief (5 minutes) upper
extremity ischemia (tourniquet inflation to 200 mmHg) interspersed with
5-minute periods of reperfusion (tourniquet deflation). Measurements and
Main Results The Intensive Care Delirium Screening Checklist was used to
assess delirium before and each day after surgery for as many as 5
consecutive days. Recent verbal and nonverbal memory and executive
functions were assessed before and 1 week after surgery using a standard
neuropsychometric test battery or at 1-week intervals in nonsurgical
controls. The Geriatric Depression and the Hachinski Ischemia scales were
used to identify the presence of clinical depression and vascular
dementia, respectively. No differences in delirium scores were observed
between RIPC and control groups (p = 0.54). Baseline neurocognitive scores
were similar in patients with versus without RIPC in all 3 cognitive
domains. Significant declines in performance on 2 nonverbal memory tests
(figure reconstruction and delayed figure reproduction; p = 0.001 and p =
0.003, respectively) and 1 verbal memory test (delayed story recall; p =
0.0004) were observed 1 week after surgery in patients who were not
treated with RIPC. There were no changes in performance of measures of
executive function in this group. In contrast, performance on all
cognitive tests was unchanged after compared with before surgery in
patients receiving RIPC. At least a 1-standard deviation decline from
baseline in cognitive performance was detected in figure reconstruction,
delayed figure reproduction, immediate story recall, and delayed story
recall in patients who were not exposed to RIPC. The incidence of at least
a 1-standard deviation decline in neuropsychometric tests was observed in
significantly fewer (1 v 9; p<0.0001) patients with versus without RIPC
treatment based on composite Z-scores. Overall cognitive performance after
surgery was better in patients treated with versus without RIPC (p =
0.002). Clinical depression and vascular dementia were not detected in
either group. Conclusion The results of this pilot investigation indicated
that RIPC prevented deterioration of short-term postoperative cognitive
function but were unable to detect any difference in delirium in
isoflurane-fentanyl-anesthetized patients undergoing cardiac surgery using
CPB.

<21>
Accession Number
2015764724
Authors
Briguori C. Visconti G. Focaccio A. Donahue M. Golia B. Selvetella L.
Ricciardelli B.
Institution
(Briguori, Visconti, Focaccio, Donahue, Golia, Ricciardelli) Department of
Cardiology, Clinica Mediterranea, Naples, Italy
(Selvetella) Vascular Surgery Unit, Clinica Mediterranea, Naples, Italy
Title
Novel approaches for preventing or limiting events (Naples) III trial:
Randomized comparison of bivalirudin versus unfractionated heparin in
patients at increased risk of bleeding undergoing transfemoral elective
coronary stenting.
Source
JACC: Cardiovascular Interventions. 8 (3) (pp 414-423), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to assess the safety and the efficacy of
bivalirudin compared with unfractionated heparin (UFH) alone in the subset
of patients at increased risk of bleeding undergoing transfemoral elective
percutaneous coronary intervention (PCI). Background Bivalirudin, a
synthetic direct thrombin inhibitor, determines a significant decrease of
in-hospital bleeding following PCI. Methods This is a single-center,
investigator-initiated, randomized, double-blind, controlled trial.
Consecutive biomarker-negative patients at increased bleeding risk
undergoing PCI through the femoral approach were randomized to UFH (UFH
group; n = 419) or bivalirudin (bivalirudin group; n = 418). The primary
endpoint was the rate of in-hospital major bleeding. Results The primary
endpoint occurred in 11 patients (2.6%) in the UFH group versus 14
patients (3.3%) in the bivalirudin group (odds ratio: 0.78; 95% confidence
interval: 0.35 to 1.72; p = 0.54). Distribution of access-site and
non-access-site bleeding was 18% and 82% in the UFH group versus 50% and
50% in the bivalirudin group (p = 0.10). Conclusions The results of this
randomized study, carried out at a single institution, suggest that there
is no difference in major bleeding rate between bivalirudin and UFH in
increased-risk patients undergoing transfemoral PCI. (Novel Approaches in
Preventing and Limiting Events III Trial: Bivalirudin in High-Risk
Bleeding Patients [NAPLES III]; NCT01465503)

<22>
Accession Number
2015738916
Authors
Niclauss L. Colombier S. Pretre R.
Institution
(Niclauss, Colombier, Pretre) Department of Cardiovascular Surgery,
University Hospital of Lausanne (CHUV), 46, rue du Bugnon, Lausanne
CH-1011, Switzerland
Title
Percutaneous coronary interventions prior to coronary artery bypass
surgery.
Source
Journal of Cardiac Surgery. 30 (4) (pp 313-318), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background and aim of the study Percutaneous coronary interventions (PCI)
are frequently performed before coronary artery bypass graft (CABG)
surgery. This study sought to evaluate postoperative outcomes, and
incidence of recurrent target ischemia in vessels with prior PCI in
patients who had PCI prior to CABG compared to only CABG patients. Methods
A review included CABG patients operated from 2000 to 2012. PCI prior to
CABG patients were compared with patients having had CABG on native
coronary arteries. Demographic and risk factors, including hospital
morbidity, mortality, and recurrent target vessel ischemia at follow-up
(FU), were compared. Major end-points were statistical differences of
postoperative morbidity and reintervention rates due to symptomatic graft
failure or target vessel ischemia during FU. Results Twenty-four percent
of 1669 isolated CABG patients had PCI prior to CABG, with an increasing
percentage during recent years. Demographics, risk factors, comorbidities
and mortality rates were similar. Incidence of postoperative hemorrhage
(OR 1.9; 95% CI 1.1-3.2; p=0.02), perioperative myocardial infarction rate
(p=0.02), neurological deficits (OR 3.5; 95% CI 1.2-9.7; p=0.02) and
re-intervention rate for symptomatic graft or target vessel occlusion were
higher in pretreated patients (OR 1.8; 95% CI 1.1-3.0; p=0.01).
Conclusions PCI prior to CABG increases the risk for postoperative
morbidity. Increased postoperative hemorrhage could be attributed to
ongoing double anti-platelet therapy. doi: 10.1111/jocs.12514 (J Card Surg
2015;30:313-318)

<23>
Accession Number
2015731321
Authors
Duan L. Zhang C.-F. Luo W.-J. Gao Y. Chen R. Hu G.-H.
Institution
(Duan, Zhang, Luo, Gao, Chen) Department of Cardiothoracic Surgery,
Xiangya Hospital, Central South University, Changsha, China
(Hu) Department of Surgery, Fourth Hospital of Changsha, Hunan Normal
University, Changsha 410006, China
Title
Does magnesium-supplemented cardioplegia reduce cardiac injury? A
meta-analysis of randomized controlled trials.
Source
Journal of Cardiac Surgery. 30 (4) (pp 338-345), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Magnesium is often used to supplement cardioplegic solutions
during cardiopulmonary bypass due to its cardioprotective effect during
ischemia and reperfusion. The aim of this meta-analysis was to evaluate
the effects of magnesium-supplemented cardioplegia versus an inactive
(placebo) control cardioplegia on reducing cardiac injury after cardiac
arrest surgery, as found by randomized, controlled trials. Methods The
Medline, Cochrane Library, and Chinese literature databases (CJFD, CBM,
CSJD, Wanfang) were comprehensively searched for reports of randomized,
controlled trials (RCTs) evaluating magnesium-supplemented cardioplegic
solutions. The clinical parameters and outcomes of interest were the
incidence of postoperative low cardiac output, auto-rebeating rate, ICU
stay length, new onset postoperative atrial fibrillation, peak value of
CK-MB (and/or cTnI), incidence of myocardial infarction, and in-hospital
mortality. Results Ten trials, with a total of 1214 patients, were
included. The frequency of low cardiac output, inotropic utilization, and
myocardial infarction, as well as auto-rebeating rate, length of ICU stay
and in-hospital mortality, were similar between the two groups. There was
a marginal reduction in the incidence of new-onset postoperative atrial
fibrillation in the magnesium-supplemented cardioplegia group. Conclusions
The advantage of magnesium-supplemented cardioplegia, compared with
cardioplegia without magnesium, remains unconvincing based on the current
evidence. The decision to add magnesium to the cardioplegic solution to a
patient undergoing cardiac arrest surgery should be carefully considered.
doi: 10.1111/jocs.12518 (J Card Surg 2015;30:338-345)

<24>
Accession Number
2015681905
Authors
Goicoechea M. Garcia De Vinuesa S. Verdalles U. Verde E. Macias N. Santos
A. Perez De Jose A. Cedeno S. Linares T. Luno J.
Institution
(Goicoechea, Garcia De Vinuesa, Verdalles, Verde, Macias, Santos, Perez De
Jose, Cedeno, Linares, Luno) Department of Nephrology, Hospital General
Universitario Gregorio Maranon, C/Dr Esquerdo 46, Madrid 28007, Spain
Title
Allopurinol and progression of CKD and cardiovascular events: Long-term
follow-up of a randomized clinical trial.
Source
American Journal of Kidney Diseases. 65 (4) (pp 543-549), 2015. Date of
Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Background Asymptomatic hyperuricemia increases renal and cardiovascular
(CV) risk. We previously conducted a 2-year, single-blind, randomized,
controlled trial of allopurinol treatment that showed improved estimated
glomerular filtration rate and reduced CV risk. Study Design Post hoc
analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants 113 participants (57 in the allopurinol group and
56 in the control group) initially followed up for 2 years and 107
participants followed up to 5 additional years. Intervention Continuation
of allopurinol treatment, 100 mg/d, or standard treatment. Outcome Renal
event (defined as starting dialysis therapy and/or doubling serum
creatinine and/or >50% decrease in estimated estimated glomerular
filtration rate) and CV events (defined as myocardial infarction, coronary
revascularization or angina pectoris, congestive heart failure,
cerebrovascular disease, and peripheral vascular disease). Results During
initial follow-up, there were 2 renal and 7 CV events in the allopurinol
group compared with 6 renal and 15 CV events in the control group. In the
long-term follow-up period, 12 of 56 participants taking allopurinol
stopped treatment and 10 of 51 control participants received allopurinol.
During long-term follow-up, an additional 7 and 9 participants in the
allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal
or CV event, respectively. Thus, during the initial and long-term
follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95%
CI, 0.15-0.69; P = 0.004; adjusted for age, sex, baseline kidney function,
uric acid level, and renin-angiotensin-aldosterone system blockers).
Overall, 16 patients treated with allopurinol experienced CV events
compared with 23 in the control group (HR, 0.43; 95% CI, 0.21-0.88; P =
0.02; adjusted for age, sex, and baseline kidney function). Limitations
Small sample size, single center, not double blind, post hoc follow-up and
analysis. Conclusions Long-term treatment with allopurinol may slow the
rate of progression of kidney disease and reduce CV risk.

<25>
Accession Number
2015915579
Authors
Steiner M.E. Ness P.M. Assmann S.F. Triulzi D.J. Sloan S.R. Delaney M.
Granger S. Bennett-Guerrero E. Blajchman M.A. Scavo V. Carson J.L. Levy
J.H. Whitman G. D'Andrea P. Pulkrabek S. Ortel T.L. Bornikova L. Raife T.
Puca K.E. Kaufman R.M. Nuttall G.A. Young P.P. Youssef S. Engelman R.
Greilich P.E. Miles R. Josephson C.D. Bracey A. Cooke R. McCullough J.
Hunsaker R. Uhl L. McFarland J.G. Park Y. Cushing M.M. Klodell C.T.
Karanam R. Roberts P.R. Dyke C. Hod E.A. Stowell C.P.
Institution
(Steiner, Pulkrabek, McCullough) Fairview-University Medical Center,
Minneapolis, MN 55454, United States
(Nuttall) Mayo Clinic, Rochester, MN, United States
(Ness, Whitman) Johns Hopkins University, Baltimore, MD, United States
(Cooke) University of Maryland, Baltimore, MD, United States
(Assmann, Granger) New England Research Institutes, Data Coordinating
Center, Watertown, MA, United States
(Sloan) Boston Children's Hospital, Boston, MA, United States
(Bornikova, Stowell) Massachusetts General Hospital, Boston, MA, United
States
(Kaufman) Brigham and Women's Hospital, Boston, MA, United States
(Engelman) Tufts University, Boston, MA, United States
(Hunsaker) St. Elizabeth's Medical Center, Boston, MA, United States
(Uhl) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Engelman) Baystate Medical Center, Springfield, MA, United States
(Triulzi, D'Andrea) University of Pittsburgh, University of
Pittsburgh-Mercy Hospital, Pittsburgh, PA, United States
(Delaney) Puget Sound Blood Center, University of Washington, Seattle, WA,
United States
(Youssef) Swedish Medical Center, Seattle, WA, United States
(Bennett-Guerrero, Levy, Ortel) Duke University, Durham, NC, United States
(Park) University of North Carolina, Chapel Hill, NC, United States
(Blajchman) McMaster University, Hamilton, ON, Canada
(Scavo) Indiana-Ohio Heart, St. Joseph Hospital, Fort Wayne, IN, United
States
(Carson) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Karanam) Newark Beth Israel Medical Center, Newark, NJ, United States
(Raife) University of Iowa, Iowa City, IA, United States
(Puca) Aurora St. Luke's Medical Center, Milwaukee, WI, United States
(McFarland) Froedert Memorial Lutheran Hospital, Milwaukee, WI, United
States
(Miles) Aspirus Heart and Vascular Institute, Wausau, WI, United States
(Young) Vanderbilt University, Nashville, TN, United States
(Greilich) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Josephson) Children's Healthcare of Atlanta, Emory University, Emory
University Hospital, Atlanta, GA, United States
(Bracey) St. Luke's-Texas Heart Institute, Houston, TX, United States
(Cushing) Weill Cornell Medical College, New York, NY, United States
(Hod) Columbia University Medical Center, New York, NY, United States
(Klodell) University of Florida, Gainesville, FL, United States
(Roberts) University of Oklahoma, Oklahoma City, OK, United States
(Dyke) University of North Dakota School of Medicine and Health Sciences,
Fargo, ND, United States
Title
Effects of red-cell storage duration on patients undergoing cardiac
surgery.
Source
New England Journal of Medicine. 372 (15) (pp 1419-1429), 2015. Date of
Publication: 09 Apr 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Some observational studies have reported that transfusion of
red-cell units that have been stored for more than 2 to 3 weeks is
associated with serious, even fatal, adverse events. Patients
undergoingcardiac surgery may be especially vulnerable to the adverse
effects of transfusion. METHODS: We conducted a randomized trial at
multiple sites from 2010 to 2014. Participants 12 years of age or older
who were undergoing complex cardiac surgery and were likely to undergo
transfusion of red cells were randomly assigned to receive
leukocyte-reduced red cells stored for 10 days or less (shorter-term
storage group) or for 21 days or more (longer-term storage group) for all
intraoperative and postoperative transfusions. The primary outcome was the
change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with
higher scores indicating more severe organ dysfunction) from the
preoperative score to the highest composite score through day 7 or the
time of death or discharge. RESULTS: The median storage time of red-cell
units provided to the 1098 participants who received red-cell transfusion
was 7 days in the shorter-term storage group and 28 days in the
longer-term storage group. The mean change in MODS was an increase of 8.5
and 8.7 points, respectively (95% confidence interval for the difference,
-0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term
storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day
mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did
not differ significantly between groups except that hyperbilirubinemia was
more common in the longer-term storage group. CONCLUSIONS: The duration of
red-cell storage was not associated with significant differences in the
change in MODS. We did not find that the transfusion of red cells stored
for 10 days or less was superior to the transfusion of red cells stored
for 21 days or more among patients 12 years of age or older who were
undergoing complex cardiac surgery.

<26>
Accession Number
2015915576
Authors
Jolly S.S. Cairns J.A. Yusuf S. Meeks B. Pogue J. Rokoss M.J. Kedev S.
Thabane L. Stankovic G. Moreno R. Gershlick A. Chowdhary S. Lavi S.
Niemela K. Steg P.G. Bernat I. Xu Y. Cantor W.J. Overgaard C.B. Naber C.K.
Cheema A.N. Welsh R.C. Bertrand O.F. Avezum A. Bhindi R. Pancholy S. Rao
S.V. Natarajan M.K. Ten Berg J.M. Shestakovska O. Gao P. Widimsky P.
Dzavik V.
Institution
(Jolly, Yusuf, Meeks, Pogue, Rokoss, Thabane, Natarajan, Shestakovska,
Gao) Population Health Research Institute and Department of Medicine,
McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
(Cairns) University of British Columbia, Vancouver, Canada
(Lavi) London Health Sciences Centre, Department of Medicine, London, ON,
Canada
(Cantor) Southlake Regional Health Centre, Newmarket, ON, Canada
(Overgaard, Dzavik) Peter Munk Cardiac Centre, University Health Network,
Canada
(Cheema) St. Michael's Hospital, Toronto, Canada
(Welsh) Mazankowski Alberta Heart Institute, Department of Medicine,
Edmonton, Canada
(Bertrand) Quebec Heart-Lung Institute, Laval University, Quebec, QC,
Canada
(Kedev) University Clinic of Cardiology, Sts. Cyril and Methodius
University, Skopje, Macedonia
(Stankovic) Clinical Center of Serbia and Department of Cardiology,
Medical Faculty, University of Belgrade, Belgrade, Serbia
(Moreno) University Hospital la Paz, Madrid, Spain
(Gershlick) University Hospitals of Leicester, Department of
Cardiovascular Sciences, Leicester, United Kingdom
(Chowdhary) University Hospitals South Manchester, Manchester Academic
Health Science Centre, Manchester, United Kingdom
(Niemela) Heart Center, Tampere University Hospital, Tampere, Finland
(Steg) Universite Paris-Diderot, Sorbonne Paris-Cite, INSERM Unite 1148,
Paris, France
(Bernat) University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech
Republic
(Widimsky) Third Faculty of Medicine, Charles University Prague,
University Hospital Kralovske Vinohrady, Prague, Czech Republic
(Xu) Tenth People's Hospital, Tongji University, Shanghai, China
(Naber) Department of Cardiology and Angiology, Contilla Heart and
Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
(Bhindi) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Avezum) Royal North Shore Hospital, Sydney, Australia
(Pancholy) Northeast Clinical Trials Group, Scranton, PA, United States
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Ten Berg) Department of Cardiology, Saint-Antonius Hospital, Nieuwegein,
Netherlands
Title
Randomized trial of primary PCI with or without routine manual
thrombectomy.
Source
New England Journal of Medicine. 372 (15) (pp 1389-1398), 2015. Date of
Publication: 09 Apr 2015.
Publisher
Massachussetts Medical Society
Abstract
Background: During primary percutaneous coronary intervention (PCI),
manual thrombectomy may reduce distal embolization and thus improve
microvascular perfusion. Small trials have suggested that thrombectomy
improves surrogate and clinical outcomes, but a larger trial has reported
conflicting results. Methods: We randomly assigned 10,732 patients with
ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI
to a strategy of routine upfront manual thrombectomy versus PCI alone. The
primary outcome was a composite of death from cardiovascular causes,
recurrent myocardial infarction, cardiogenic shock, or New York Heart
Association (NYHA) class IV heart failure within 180 days. The key safety
outcome was stroke within 30 days. Results: The primary outcome occurred
in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of
5030 patients (7.0%) in the PCI-alone group (hazard ratio in the
thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P =
0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5%
with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.34) and
the primary outcome plus stent thrombosis or target-vessel
revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to
1.14; P = 0.95) were also similar. Stroke within 30 days occurred in 33
patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the
PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P = 0.02).
Conclusions: In patients with STEMI who were undergoing primary PCI,
routine manual thrombectomy, as compared with PCI alone, did not reduce
the risk of cardiovascular death, recurrent myocardial infarction,
cardiogenic shock, or NYHA class IV heart failure within 180 days but was
associated with an increased rate of stroke within 30 days.

<27>
Accession Number
2015888890
Authors
Deng Q.-W. Xia Z.-Q. Qiu Y.-X. Wu Y. Liu J.-X. Li C. Liu K.-X.
Institution
(Deng, Xia, Qiu, Wu, Liu, Li, Liu) Department of Anesthesiology, First
Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan 2nd Road,
Guangzhou 510080, China
Title
Clinical benefits of aortic cross-clamping versus limb remote ischemic
preconditioning in coronary artery bypass grafting with cardiopulmonary
bypass: A meta-analysis of randomized controlled trials.
Source
Journal of Surgical Research. 193 (1) (pp 52-68), 2015. Date of
Publication: 2015.
Publisher
Academic Press Inc.
Abstract
Background: We assessed whether aortic cross-clamping or limb remote
ischemic preconditioning improved postoperative outcomes, reduced
myocardial injury and incidences of postoperative complications in
patients undergoing on-pump coronary artery bypass grafting (CABG).
Materials and methods: PubMed, EMBASE, the Cochrane Library, and
ClinicalTrials databases were searched for studies comparing the effects
of ischemic preconditioning with no preconditioning in adult patients
undergoing on-pump CABG. The primary end points were mechanical
ventilation time, the length of stay in intensive care unit and hospital,
whereas the secondary end points were peak values of myocardial biomarkers
and postoperative complications. Mean differences were estimated for the
primary end points, as well as standard mean differences and odds ratios
for the secondary end points. Results: A total of 29 randomized controlled
trials with 1791 patients were included. Compared with control group,
aortic cross-clamping preconditioning reduced mechanical ventilation time
(mean difference [95% confidence interval {CI}]) (-5.59 h [-9.21 to
-1.96]), whereas limb remote ischemic preconditioning was not associated
with improvement of postoperative outcomes. For myocardial biomarkers,
both aortic cross-clamping and limb remote ischemic preconditioning
reduced peak values of myocardial biomarkers (standard mean difference
[95% CI]) (-0.48 [-0.81 to -0.14]; -0.19 [-0.36 to -0.02], respectively).
Subgroup analysis showed that aortic cross-clamping preconditioning
protocols with ischemia episodes <5 min did reduce the release of
biomarkers (-0.69 [-1.04 to -0.34]) but those with 5 min ischemia episodes
elevated them (0.40 [0.04-0.75]). Cardiovascular, cerebrovascular, renal,
and intestinal complications were reported, and aortic crossclamping
preconditioning seemed to reduce the incidences of cardiac arrhythmia
(odds ratio [95% CI]) (0.46 [0.27-0.80], P = 0.006). Conclusions: Cardiac
surgeons could consider aortic cross-clamping or limb remote ischemic
preconditioning to reduce myocardial injury during CABG. Moreover, aortic
crossclamping preconditioning is associated with a decreased risk of
postoperative respiratory failure and cardiac arrhythmia.

<28>
Accession Number
2015903177
Authors
Hepponstall M. Ignjatovic V. Binos S. Attard C. Karlaftis V. D'Udekem Y.
Monagle P. Konstantinov I.E.
Institution
(Hepponstall, Ignjatovic, Attard, Karlaftis, D'Udekem, Monagle,
Konstantinov) Murdoch Childrens Research Institute, Melbourne, Australia
(Hepponstall, D'Udekem, Konstantinov) Cardiac Surgery Unit and Cardiology,
Royal Children's Hospital, Melbourne, Australia
(Hepponstall, Ignjatovic, Monagle, Konstantinov) Department of
Paediatrics, University of Melbourne, Melbourne, Australia
(Hepponstall, Binos) Department of Environment and Primary Industries,
Bioscience Research Division, Melbourne, Australia
Title
Remote Ischemic Preconditioning (RIPC) modifies the plasma proteome in
children undergoing repair of tetralogy of fallot: A randomized controlled
trial.
Source
PLoS ONE. 10 (3) , 2015. Article Number: e0122778. Date of Publication: 31
Mar 2015.
Publisher
Public Library of Science
Abstract
Background: Remote ischemic preconditioning (RIPC) has been applied in
paediatric cardiac surgery. We have demonstrated that RIPC induces a
proteomic response in plasma of healthy volunteers. We tested the
hypothesis that RIPC modifies the proteomic response in children
undergoing Tetralogy of Fallot (TOF) repair. Methods and Results: Children
(n=40) were randomized to RIPC and control groups. Blood was sampled at
baseline, after cardiopulmonary bypass (CPB) and 6, 12 and 24h post-CPB.
Plasma was analysed by liquid chromatography mass spectrometry (LC-MS) in
an untargeted approach. Peptides demonstrating differential expression (p
<0.01) were subjected to tandem LC-MS/MS and protein identification.
Corresponding proteins were identified using the NCBI protein database.
There was no difference in age (7.3+/- 3.5vs6.8+/-3.6 months)(p=0.89),
weight (7.7 +/-1.8vs7.5+/-1.9 kg)(p=0.71), CPB time (104+/-7vs94+/-7
min)(p=0.98) or aortic cross-clamp time (83+/-22vs75+/-20 min)(p=0.36). No
peptides were differentially expressed at baseline or immediately after
CPB. There were 48 peptides with higher expression in the RIPC group 6h
post-CPB. This was no longer evident at 12 or 24h, with one peptide
down-regulated in the RIPC group. The proteins identified were:
inter-alpha globulin inhibitor (42.0+/-11.8 vs 820.8 +/-181.1, p=0.006),
fibrinogen preproprotein (59.3+/-11.2 vs 1192.6+/-278.3, p=0.007),
complement-C3 precursor (391.2 +/-160.9 vs 5385.1 +/-689.4, p=0.0005),
complement C4B (151.5+/-17.8 vs 4587.8 +/-799.2, p=0.003), apolipoprotein
B100 (53.4 +/-8.3 vs 1364.5+/-278.2, p=0.005) and urinary proteinase
inhibitor (358.6+/- 74.9 vs 5758.1+/- 1343.1, p=0.009). These proteins are
involved in metabolism, haemostasis, immunity and inflammation.
Conclusions: We provided the first comprehensive analysis of RIPC-induced
proteomic changes in children undergoing surgery. The proteomic changes
peak 6h post-CPB and return to baseline within 24h of surgery. Trial
Registration: ACTR.org.au ACTRN12610000496011

<29>
Accession Number
2015885267
Authors
Wressnegger A. Kinstner C. Funovics M.
Institution
(Wressnegger, Kinstner, Funovics) Cardiovascular and Interventional
Radiology, Department of Biomedical Imaging and Imageguided Therapy,
Medical University of Vienna, Wahringer Gurtel 18-20, Vienna 1090, Austria
Title
Treatment of the aorto-iliac segment in complex lower extremity arterial
occlusive disease.
Source
Journal of Cardiovascular Surgery. 56 (1) (pp 73-79), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Edizioni Minerva Medica
Abstract
Endovascular treatment of the aortoiliac segment in occlusive disease has
an established role especially in TASC A and B lesions. Recent studies
with modern stent technology have shown excellent results with one-year
primary patency above 95%. Regarding different endovascular approaches,
there is level Ib evidence supporting provisional stenting in stenosed
arteries, and primary stenting in occlusion. While open surgery shows
higher patency rates in direct comparison to endovascular techniques, the
latter show significantly lower complication rates and lower mortality.
The recommendations reserving TASC C and D lesions exclusively to surgery
are currently challenged, especially in poor surgical candidates.

<30>
Accession Number
2015895663
Authors
Kim J.B. Yang D.H. Kang J.-W. Jung S.-H. Choo S.J. Chung C.H. Song J.-K.
Lee J.W.
Institution
(Kim, Jung, Choo, Chung, Lee) Department of Thoracic and Cardiovascular
Surgery, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
(Yang, Kang) Department of Radiology, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, South Korea
(Song) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Title
Left atrial function following surgical ablation of atrial fibrillation:
Prospective evaluation using dual-source cardiac computed tomography.
Source
Yonsei Medical Journal. 56 (3) (pp 608-616), 2015. Date of Publication:
2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: The Maze procedure has shown excellent efficacy in the
elimination of atrial fibrillation (AF); however, little is known about
the quality of functional recovery in the left atrium (LA) following
successful sinus rhythm conversion by the Maze procedure. Materials and
Methods: We prospectively enrolled 12 patients (aged 52.5+/-10.1 years, 1
female) with valvular AF undergoing mitral valve surgery combined with the
Maze procedure. Parameters of LA function in three anatomic compartments
[anterior, posterior, and LA appendage (LAA)] were evaluated using
electrocardiography-gated dual-source cardiac CT at one month and at six
months after surgery. Twelve subjects matched by age, gender, and body
surface area served as controls. Results: At one month after surgery,
ejection fraction (EF) and emptying volume (EV) of the LA were 14.9+/-7.4%
and 21.3+/-9.7 mL, respectively, and they were significantly lower than
those of the control group (EF, 47.9+/-11.2%; EV, 46.0+/-10.7%; p<0001).
These values did not significantly change throughout late periods (p=0.22
and 0.21, respectively). Functional contributions of the anterior,
posterior, and appendage compartments (EV of each compartment/overall EV)
were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA
preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection
(n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects
(p<0.001). Conclusion: Contractile functions of the LA significantly
decreased after the Maze procedure. Functional contributions of three
compartments of the LA were also altered. The influence of LAA
preservation on postoperative LA functions needs to be evaluated through
studies of larger populations.

<31>
Accession Number
2015895143
Authors
Zhang Y.-J. Iqbal J. Van Klaveren D. Campos C.M. Holmes D.R. Kappetein
A.P. Morice M.-C. Banning A.P. Grech E.D. Bourantas C.V. Onuma Y.
Garcia-Garcia H.M. MacK M.J. Colombo A. Mohr F.W. Steyerberg E.W. Serruys
P.W.
Institution
(Zhang, Campos, Kappetein, Bourantas, Onuma, Garcia-Garcia, Serruys)
Department of Interventional Cardiology, Erasmus University Medical
Centre, Thoraxcenter, s-Gravendijkwal 230, CC Rotterdam 3000, Netherlands
(Zhang) Department of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Iqbal, Grech) Sheffield Teaching Hospitals, University of Sheffield,
Sheffield, United Kingdom
(Van Klaveren, Steyerberg) Department of Public Health, Erasmus Medical
Centre, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Morice) Institut Jacques Cartier, Massy, France
(Banning) Oxford University Hospitals, Oxford, United Kingdom
(MacK) Heart Hospital, Plano, TX, United States
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
(Serruys) International Centre for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Smoking is associated with adverse clinical outcomes in patients
undergoing revascularization with PCI or CABG: The SYNTAX trial at 5-year
follow-up.
Source
Journal of the American College of Cardiology. 65 (11) (pp 1107-1115),
2015. Date of Publication: 24 Mar 2015.
Publisher
Elsevier USA
Abstract
Background Cigarette smoking is a well-known risk factor for development
of coronary artery disease (CAD). However, some studies have suggested a
"smoker's paradox," meaning neutral or favorable outcomes in smokers who
have developed CAD, especially myocardial infarction (MI). Objectives The
study aimed to examine the association of smoking status with clinical
outcomes in the randomized controlled SYNTAX (SYNergy Between PCI With
TAXUS and Cardiac Surgery) trial at 5-year follow-up. Methods Detailed
smoking history was collected at baseline, 6-month, 1-year, 3-year, and
5-year follow-up. The composite endpoints included death/MI/stroke
(primary endpoint) plus major adverse cardiac and cerebrovascular events
(MACCE) (combination of death/MI/stroke and target lesion
revascularization) according to patient smoking status. The comparison of
5-year clinical outcomes between the groups according to smoking status
was performed with Cox regression using smoking status at baseline or
smoking as a time-dependent covariate. Results A sizeable proportion (n =
322, 17.9%) of patients had changing smoking status during 5-year
follow-up. One in 5 patients with complex CAD was smoking at baseline.
However, 60% stopped after revascularization while others continued to
smoke. Smokers had worse clinical outcomes due to a higher incidence of
recurrent MI in both revascularization arms. Smoking was an independent
predictor of the composite endpoint of death/MI/stroke (hazard ratio [HR]:
1.8; 95% confidence interval [CI]: 1.3 to 2.5; p = 0.001) and MACCE (HR:
1.4; 95% CI: 1.1 to 1.7; p = 0.02). Conclusions Smoking is associated with
poor clinical outcomes after revascularization in patients with complex
CAD. This places further emphasis on efforts at smoking cessation to
improve revascularization benefits. (SYNTAX Study: TAXUS Drug-Eluting
Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed
Arteries; NCT00114972)

<32>
Accession Number
2015885392
Authors
Beer L. Szerafin T. Mitterbauer A. Kasiri M.M. Debreceni T. Palotas L.
Dworschak M. Roth G.A. Ankersmit H.J.
Institution
(Beer, Mitterbauer, Kasiri, Ankersmit) Department of Thoracic Surgery,
Medical University Vienna, Vienna, Austria
(Beer, Mitterbauer, Kasiri, Ankersmit) Christian Doppler Laboratory for
Cardiac and Thoracic Diagnosis, Department of Thoracic Surgery, Medical
University of Vienna, Wahringer Gurtel 18-20, Vienna A-1090, Austria
(Szerafin, Debreceni, Palotas) Department of Cardiac Surgery, Institute of
Cardiology, Medical and Health Science Centre, University of Debrecen,
Debrecen, Hungary
(Dworschak, Roth) Department of Anesthesiology, General Intensive Care and
Pain Medicine, Medical University of Vienna, Vienna, Austria
Title
Ventilation during Cardiopulmonary bypass: Impact on heat shock protein
release.
Source
Journal of Cardiovascular Surgery. 55 (6) (pp 849-856), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Edizioni Minerva Medica
Abstract
Aim: Cardiopulmonary bypass (CPB), utilized in on-pump coronary artery
bypass graft procedures (CABG) induces generalized immune suppression,
release of heat shock proteins (HSP), inflammatory markers and
apoptosis-specific proteins. We hypothesized that continued mechanical
ventilation during cardiopulmonary bypass attenuates immune response and
HSP liberation. Methods: Thirty patients undergoing conventional coronary
artery bypass graft (CABG) operation were randomized into a ventilated on
CPB (VG; N.=15) and a non-ventilated CPB group (NVG; N.=15). Blood samples
were drawn at the beginning and end of surgery, as well as on the five
consecutive postoperative days (POD). Molecular markers were measured by
ELISA. Data are given as mean +/- (SD). Mann-Whitney-U-test was used for
statistical analysis. Results: Serum concentrations of HSP70 were
significantly lower in VG compared to NVG on POD-1 (VG: 1629+/-608 vs.
NVG: 5203+/-2128.6 pg/mL, P<0.001). HSP27 and HSP60 depicted a minor
increase in both study groups at the end of surgery without any intergroup
differences (HSP27: VG 6207.9+/-1252.5 vs. NVG 7424.1+/-2632.5; HSP60: VG
1046.2+/-478.8 vs. NVG 1223.5+/-510.1). IL-8 and CK-18 M30 evidenced the
highest serum concentrations at the end of surgery (IL-8: VG 119.5+/-77.9
vs. NVG 148.0+/-184.55; CK-18 M30: VG 62.1+39.2 vs. NVG 67.5+/-33.9) with
no differences between groups. Decreased ICAM-1 serum concentrations were
detected postoperatively, however ICAM-1 concentrations on POD-1 to POD-5
showed slightly elevated concentrations in both study groups with no
intergroup differences. Conclusion: Significantly less HSP70 was
detectable in patients receiving uninterrupted mechanical lung ventilation
on CPB, indicating either different inflammatory response, cellular stress
or cell damage between the ventilated and non-ventilated group. These data
suggest that continued mechanical ventilation has a modulatory effect on
the immune response in patients after CABG surgery.

<33>
Accession Number
2014772307
Authors
Zhang Y.-J. Zhu L.-L. Bourantas C.V. Iqbal J. Dong S.-J. Campos C.M. Li
M.-H. Ye F. Tian N.-L. Garcia-Garcia H.M. Serruys P.W. Chen S.-L.
Institution
(Zhang, Zhu, Li, Ye, Tian, Chen) Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Zhang, Bourantas, Iqbal, Campos, Garcia-Garcia, Serruys) Erasmus Medical
Center, Rotterdam, Netherlands
(Iqbal) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Dong) Soochow University, Suzhou, China
(Campos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
Title
The impact of everolimus versus other rapamycin derivative-eluting stents
on clinical outcomes in patients with coronary artery disease: A
meta-analysis of 16 randomized trials.
Source
Journal of Cardiology. 64 (3) (pp 185-193), 2014. Date of Publication:
2014.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Everolimus-eluting stent (EES) are considered to have better
clinical outcomes than other rapamycin derivative-eluting stents; however,
the individual trials may not have sufficient power to prove it. This
meta-analysis aimed to compare clinical outcomes of EES against other
rapamycin derivative-eluting stents. Methods: We searched Medline, the
Cochrane Library, and other internet sources, without language or date
restrictions for articles comparing clinical outcomes between EES and
other rapamycin derivative-eluting stents. Safety endpoints were stent
thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI).
Efficacy endpoints were major adverse cardiac events (MACE), target lesion
revascularization (TLR), and target vessel revascularization (TVR).
Results: We identified 16 randomized controlled trials with 23,481
patients and a weighted mean follow-up of 18 months. Compared with other
rapamycin derivative-eluting stents, EES were associated with a
significant reduction in definite ST [relative risk (RR): 0.45; 95%
confidence interval (CI): 0.30-0.69; p < 0.001] and TLR (RR: 0.87; 95% CI:
0.77-0.99; p = 0.03). EES also showed a non-significant trend toward
reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p = 0.06).
However, both groups had similar rates of mortality (RR: 0.95; 95% CI:
0.82-1.09; p = 0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p = 0.43), and MACE
(RR: 0.94; 95% CI: 0.87-1.02; p = 0.35). The stratified analysis of the
included trials showed that EES was associated with significantly lower
rate of definite ST compared with either zotarolimus-eluting stent (p =
0.012) or sirolimus-eluting stent (p = 0.006), but not biolimus-eluting
stent (p = 0.16). In longer follow-up (>1 year) stratification, EES was
associated with a significant reduction in risk of definite ST (p <
0.001). Conclusions: EES is associated with a significant reduction in
definite ST and TLR for treating patients with coronary artery disease,
compared with a pooled group of other rapamycin derivative-eluting stents.
Biolimus-eluting stent had similar safety and efficacy for treating
patients with coronary artery disease, compared with the EES.

<34>
Accession Number
71843476
Authors
Westerdahl E. Urell C. Jonsson M. Bryngelsson I.-L. Hedenstrom H. Emtner
M.
Institution
(Westerdahl) School of Health and Medical Sciences, Orebro University,
Orebro, Sweden
(Urell) Department of Neuroscience, Physiotherapy, Uppsala University,
Orebro, Sweden
(Jonsson) Department of Physiotherapy and Cardiothoracic Surgery, Orebro
University Hospital, Orebro, Sweden
(Bryngelsson) Department of Occupational and Environmental Medicine,
Orebro University Hospital, Orebro, Sweden
(Hedenstrom, Emtner) Department of Medical Sciences, Uppsala University,
Uppsala, Sweden
Title
Home-based deep breathing exercises after cardiac surgery-A randomized
controlled trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2013 Barcelona Spain. Conference Start: 20130907
Conference End: 20130911. Conference Publication: (var.pagings). 42 ,
2013. Date of Publication: 01 Sep 2013.
Publisher
European Respiratory Society
Abstract
Breathing exercises are recommended to cardiac surgery patients.
Instructions concerning how long patients should continue exercises after
discharge vary, and the significance of treatment needs to be determined.
Our aim was to assess the effects of home-based deep breathing exercises
performed with a positive expiratory pressure device for two months
following cardiac surgery. The study design was a prospective,
single-blinded, parallel-group, randomized trial. Patients performing
breathing exercises two months after cardiac surgery (n=159) were compared
to a control group (n=154) performing no breathing exercises after
discharge. The intervention consisted of 30 slow deep breaths performed
with a positive expiratory pressure device (10-15 cmH20) five times a day
during the first two months after surgery. The outcomes were lung function
measurements, oxygen saturation, thoracic excursion mobility, subjective
experiences of breathing and pain, patient-perceived quality of recovery,
health-related quality of life and self-reported respiratory tract
infection/pneumonia and antibiotic treatment. Two months postoperatively,
the patients had significantly reduced lung function, with a mean decrease
in FEV1 to 93 +/- 12 % (p <0.001) of preoperative values. Oxygenation had
returned to preoperative values, and health-related quality of life was
improved compared to preoperative values (p<0.01). There were no
significant differences between the groups in any of the measured
outcomes. No significant differences in lung function, subjective
experiences, or quality of life were found between patients performing
home-based deep breathing exercises and control patients two months after
cardiac surgery.

<35>
Accession Number
71843304
Authors
Bayram S. Tezel C. Cesur E. Kanbur S. Kiral H. Urek S.
Institution
(Bayram, Tezel, Cesur, Kanbur, Kiral, Urek) Thoracic Surgery, Sureyyapasa
Education and Research Hospital, Istanbul 34840, Turkey
Title
The feasibility of awake thoracic epidural anesthesia in patients
requiring VATS wedge resection.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2013 Barcelona Spain. Conference Start: 20130907
Conference End: 20130911. Conference Publication: (var.pagings). 42 ,
2013. Date of Publication: 01 Sep 2013.
Publisher
European Respiratory Society
Abstract
Background: Video-assisted thoracic surgery (VATS) is usually performed
with general anesthesia and single lung ventilation. However, performing
thoracic surgery under awake anesthesia has several potential advantages
including avoidance of airway trauma associated with endotracheal
intubation and single lung ventilation. Objectives: The study was aimed to
analyze the feasibility, safety, and early results of awake thoracic
surgery in patients who underwent videothoracoscopic pulmonary resection.
Methods: In 2012, four patients underwent VATS wedge resection via
thoracic epidural anesthesia for both diagnostic and therapeutic
indications. Results: listed Conclusions: In our study, awake pulmonary
videothoracoscopic wedge resection was easily accepted and well tolerated
by patients resulted in shorter ICU stay. Large scale randomized
controlled studies are needed in order to refine our findings. (Table
Presented).

<36>
Accession Number
71843292
Authors
Banque M.N. Requiron-Sy D.
Institution
(Banque, Requiron-Sy) Pulmonary and Critical Care Medicine- Section of
Pediatric Pulmonology, Philippine Heart Center, National Capitol Region,
Quezon City 1100, Philippines
Title
Reliving Rudhe syndrome: The reversible shunt related lobar
emphysema-Report of cases and systematic review of literature.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2013 Barcelona Spain. Conference Start: 20130907
Conference End: 20130911. Conference Publication: (var.pagings). 42 ,
2013. Date of Publication: 01 Sep 2013.
Publisher
European Respiratory Society
Abstract
Lobar emphysema (LE) is not quite uncommon in children with congenital
heart diseases (CHD). In the year 2010, the name Rudhe syndrome was used
to refer to reversible shunt related lobar emphysema, Rudhe proposed that
the emphysema is secondary to the shunt thus surgical intervention be
directed to the correction of the cardiac defect alone and not lobectomy.
We reviewed 4 cases of patients with concomitant LE and CHD. The medical
records were evaluated with reference to age, type of CHD, pulmonary
function, radiographic findings, pulmonary artery pressure, clinical signs
and symptoms, surgical management and outcome after surgery. We also
reviewed 21 literatures on LE with CHD. Among the 4 cases we had, 3 were
left to right shunts and 1 is a case of Tetralogy of Fallot (TOF) with an
absent pulmonary valve. The 3 underwent correction of the cardiac lesion
and repeat chest radiograph and CT scan showed almost complete resolution
of the lobar emphysema with complete resolution of clinical symptoms
6months post cardiac surgery. The other one underwent TOF correction with
lung tacking with radiographic resolution of the lobar emphysema however
patient died of sepsis. The literature review consisted of 137 subjects.
The three most common cardiac lesions associated with lobar emphysema are
ventricular septal defect, patent ductus arterioles and TOF with absent
pulmonary valve. One hundred out of the 137 underwent correction of the
cardiac lesion without lobectomy. Resolution of airway obstruction as well
as radiographic resolution of the emphysematous lung were noted as early
as 3months to 1 year post cardiac surgery.