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<1>
Accession Number
2015727339
Authors
Bolotin G. Huber C.H. Shani L. Mohr F.W. Carrel T.P. Borger M.A. Falk V.
Taggart D. Nir R.-R. Englberger L. Seeburger J. Caliskan E. Starck C.T.
Institution
(Bolotin, Shani, Nir) Department of Cardiac Surgery, Rambam Health Care
Campus, and Faculty of Medicine, Technion-Israel Institute of Technology,
Haifa, Israel
(Huber, Carrel, Englberger) University Clinic for Cardiovascular Surgery
Inselspital, Bern, Switzerland
(Mohr, Borger, Seeburger) Heart Center Leipzig, University of Leipzig,
Leipzig, Germany
(Falk, Caliskan, Starck) University Hospital Zurich, Zurich, Switzerland
(Taggart) University of Oxford, Oxford, United Kingdom
Title
Novel emboli protection system during cardiac surgery: A multi-center,
randomized, clinical trial.
Source
Annals of Thoracic Surgery. 98 (5) (pp 1627-1633), 2014. Date of
Publication: 2014.
Publisher
Elsevier USA
Abstract
Background. Stroke is a major cause of morbidity and mortality during
open-heart surgery. Up to 60% of intraoperative cerebral events are emboli
induced. This randomized, controlled, multicenter trial is the first human
study evaluating the safety and efficacy of a novel aortic cannula
producing simultaneous forward flow and backward suction for extracting
solid and gaseous emboli from the ascending aorta and aortic arch upon
their intraoperative release. Methods. Sixty-six patients (25 females; 68
+/- 10 years) undergoing elective aortic valve replacement surgery, with
or without coronary artery bypass graft surgery, were randomized to the
use of the CardioGard (CardioGard Medical, Or-Yehuda, Israel) Emboli
Protection cannula ("treatment") or a standard ("control") aortic cannula.
The primary endpoint was the volume of new brain lesions measured by
diffusion-weighted magnetic resonance imaging (DW-MRI), performed
preoperatively and postoperatively. Device safety was investigated by
comparisons of complications rate, namely neurologic events, stroke, renal
insufficiency and death. Results. Of 66 patients (34 in the treatment
group), 51 completed the presurgery and postsurgery MRI (27 in the
treatment group). The volume of new brain lesion for the treatment group
was (mean +/- standard error of the mean) 44.00 +/- 64.00 versus 126.56
+/- 28.74 mm³in the control group ( p = 0.004). Of the
treatment group, 41% demonstrated new postoperative lesions versus 66% in
the control group ( p = 0.03). The complication rate was comparable in
both groups. Conclusions. The CardioGard cannula is safe and efficient in
use during open-heart surgery. Efficacy was demonstrated by the removal of
a substantial amount of emboli, a significant reduction in the volume of
new brain lesions, and the percentage of patients experiencing new brain
lesions.

<2>
Accession Number
2015859877
Authors
Naguib A.N. Winch P.D. Tobias J.D. Yeates K.O. Miao Y. Galantowicz M.
Hoffman T.M.
Institution
(Naguib, Winch, Tobias) Department of Anesthesiology, Section of Critical
Care Medicine, Ohio State University, 700 Children's Drive, Columbus, OH
43205, United States
(Naguib, Winch, Tobias, Miao, Galantowicz, Hoffman) Heart Center, Section
of Critical Care Medicine, Ohio State University, Columbus, OH, United
States
(Yeates) Department of Pediatrics, Section of Critical Care Medicine, Ohio
State University, Columbus, OH, United States
Title
Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary
bypass in children.
Source
Saudi Journal of Anaesthesia. 9 (1) (pp 12-18), 2015. Date of Publication:
01 Jan 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Modulating the stress response and perioperative factors can
have a paramount impact on the neurodevelopmental outcome of infants who
undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and
Methods: In this single center prospective follow-up study, we evaluated
the impact of three different anesthetic techniques on the
neurodevelopmental outcomes of 19 children who previously underwent
congenital cardiac surgery within their 1 ^st year of life.
Cases were done from May 2011 to December 2013. Children were assessed
using the Stanford-Binet Intelligence Scales (5 ^th edition).
Multiple regression analysis was used to test different parental and
perioperative factors that could significantly predict the different
neurodevelopmental outcomes in the entire cohort of patients. Results:
When comparing the three groups regarding the major cognitive scores, a
high-dose fentanyl (HDF) patients scored significantly higher than the
low-dose fentanyl (LDF) + dexmedetomidine (DEX) (LDF + DEX) group in the
quantitative reasoning scores (106 +/- 22 vs. 82 +/- 15 P = 0.046). The
bispectral index (BIS) value at the end of surgery for the -LDF group was
significantly higher than that in LDF + DEX group (P = 0.011). For the
entire cohort, a strong correlation was seen between the standard verbal
intelligence quotient (IQ) score and the baseline adrenocorticotropic
hormone level, the interleukin-6 level at the end of surgery and the BIS
value at the end of the procedure with an R ² value of 0.67 and
P < 0.04. There was an inverse correlation between the cardiac Intensive
Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P
0.027). Conclusions: Patients in the HDF group demonstrated overall higher
neurodevelopmental scores, although it did not reach statistical
significance except in fluid reasoning scores. Our results may point to a
possible correlation between blunting the stress response and improvement
of the neurodevelopmental outcome.

<3>
Accession Number
2015850848
Authors
Layland J. Oldroyd K.G. Curzen N. Sood A. Balachandran K. Das R. Junejo S.
Ahmed N. Lee M.M.Y. Shaukat A. O'Donnell A. Nam J. Briggs A. Henderson R.
McConnachie A. Berry C.
Institution
(Layland, Oldroyd, Ahmed, Lee, Shaukat, O'Donnell, Berry) West of Scotland
Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United
Kingdom
(Layland, Berry) BHF Glasgow Cardiovascular Research Centre, Institute of
Cardiovascular and Medical Sciences, University of Glasgow, 126 University
Place, Glasgow G12 8TA, United Kingdom
(Curzen) University Hospital Southampton Foundation Trust, Southampton,
United Kingdom
(Sood) Hairmyres Hospital, East Kilbride, United Kingdom
(Balachandran) Royal Blackburn Hospital, Blackburn, United Kingdom
(Das) Freeman Hospital, Newcastle, United Kingdom
(Junejo) City Hospitals Sunderland Foundation Trust, Sunderland, United
Kingdom
(Nam, Briggs) Health Economics and Health Technology Assessment Unit,
University of Glasgow, Glasgow, United Kingdom
(Henderson) Trent Cardiac Centre, Nottingham University Hospitals,
Nottingham, United Kingdom
(McConnachie) Robertson Centre for Biostatistics, University of Glasgow,
United Kingdom
Title
Fractional flow reserve vs. Angiography in guiding management to optimize
outcomes in non-ST-segment elevation myocardial infarction: The British
Heart Foundation FAMOUS-NSTEMI randomized trial.
Source
European Heart Journal. 36 (2) (pp 100-111), 2015. Date of Publication: 07
Jan 2015.
Publisher
Oxford University Press
Abstract
Aim We assessed the management and outcomes of non-ST segment elevation
myocardial infarction (NSTEMI) patients randomly assigned to fractional
flow reserve (FFR)-guided management or angiography-guided standard care.
Methods and results We conducted a prospective, multicentre, parallel
group, 1: 1 randomized, controlled trial in 350 NSTEMI patients with >1
coronary stenosis >30% of the lumen diameter assessed visually (threshold
for FFR measurement) (NCT01764334). Enrolment took place in six UK
hospitals from October 2011 to May 2013. Fractional flow reserve was
disclosed to the operator in the FFR-guided group (n = 176). Fractional
flow reserve was measured but not disclosed in the angiography-guided
group (n = 174). Fractional flow reserve <0.80 was an indication for
revascularization by percutaneous coronary intervention (PCI) or coronary
artery bypass surgery (CABG). The median (IQR) time from the index episode
of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary
outcome, the proportion of patients treated initially by medical therapy
was higher in the FFR-guided group than in the angiography-guided group
[40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P =
0.022]. Fractional flow reserve disclosure resulted in a change in
treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At
12 months, revascularization remained lower in the FFR-guided group [79.0
vs. 86.8%, difference 7.8% (-0.2%, 15.8%), P = 0.054]. There were no
statistically significant differences in health outcomes and quality of
life between the groups. Conclusion In NSTEMI patients, angiography-guided
management was associated with higher rates of coronary revascularization
compared with FFR-guided management. A larger trial is necessary to assess
health outcomes and cost-effectiveness.

<4>
Accession Number
2015846617
Authors
Beer L. Szerafin T. Mitterbauer A. Debreceni T. Maros T. Dworschak M. Roth
G.A. Ankersmit H.J.
Institution
(Beer, Mitterbauer, Ankersmit) Department of Thoracic Surgery, Medical
University of Vienna, Wahringer Gurtel 18-20, Vienna A-1090, Austria
(Beer, Mitterbauer, Ankersmit) Christian Doppler Laboratory for Cardiac
and Thoracic Diagnosis and Regeneration, Vienna, Austria
(Szerafin, Debreceni, Maros) Department of Cardiac Surgery, Institute of
Cardiology, Medical and Health Science Centre, University of Debrecen,
Hungary
(Dworschak, Roth) Department of Anesthesiology, General Intensive Care and
Pain Medicine, Medical University of Vienna, Vienna, Austria
Title
Low tidal volume ventilation during cardiopulmonary bypass reduces
postoperative chemokine serum concentrations.
Source
Thoracic and Cardiovascular Surgeon. 62 (8) (pp 677-682), 2015. Date of
Publication: 2015.
Publisher
Georg Thieme Verlag
Abstract
Background Open-heart surgery with cardiopulmonary bypass (CPB) is
associated with a generalized immune response and postoperative lung
dysfunction. Chemokines are involved in the pathogenesis of postoperative
lung dysfunction. We investigated whether continued mechanical ventilation
during CPB has an impact on chemokine serum concentrations. Methods A
total of 30 patients undergoing coronary artery bypass graft operation
were randomized to either continuous ventilated group (n = 15) or
nonventilated group (n = 15). Blood samples were drawn at the beginning
and at the end of surgery and on the 5 consecutive days. Serum CCL2, CCL4,
and CCL20 concentrations were measured and given as mean +/- standard
deviation. Results Chemokine concentrations were elevated at the end of
surgery in both groups. CCL2 and CCL4 levels returned to baseline on
postoperative day (POD)-1 in the ventilation group and stayed elevated in
the nonventilation group. CCL4 serum levels were significantly lower in
ventilated-group patients on POD-1 (10.9 [39.0] vs. 153.2 [168.1]; p =
0.005), POD-2 (16.8 [36.8] vs. 147.9 [165.4]; p = 0.019), POD-3 (14.2
[24.0] vs. 97.9 [87.1]; p = 0.005), and POD-5 (6.5 [25.0] vs. 33.6 [38.4];
p = 0.045). Conclusion Continued mechanical ventilation during CPB results
in reduced CCL4 concentrations on POD-1 to -5.

<5>
Accession Number
2015763061
Authors
Illuminati G. Schneider F. Greco C. Mangieri E. Schiariti M. Tanzilli G.
Barilla F. Paravati V. Pizzardi G. Calio' F. Miraldi F. MacRina F. Totaro
M. Greco E. Mazzesi G. Tritapepe L. Toscano M. Vietri F. Meyer N. Ricco
J.-B.
Institution
(Illuminati, Pizzardi, Calio', Vietri) F. Durante Department of Surgical
Sciences, University la Sapienza, Rome, Italy
(Schneider, Ricco) Department of Vascular Surgery, University of Poitiers,
Hospital Jean Bernard, Poitiers 86021, France
(Greco, Mangieri, Schiariti, Tanzilli, Barilla, Paravati, Miraldi,
MacRina, Totaro, Greco, Mazzesi, Tritapepe, Toscano) Department of
Cardiology and Cardiac Surgery, University la Sapienza, Rome, Italy
(Meyer) Department of Public Health - GMRC, FMTS, University Hospital of
Strasbourg, France
Title
Long-term results of a randomized controlled trial analyzing the role of
systematic pre-operative coronary angiography before elective carotid
endarterectomy in patients with asymptomatic coronary artery disease.
Source
European Journal of Vascular and Endovascular Surgery. 49 (4) (pp
366-374), 2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders Ltd
Abstract
Objectives To evaluate the potential benefit of systematic preoperative
coronary-artery angiography followed by selective coronary-artery
revascularization on the incidence of myocardial infarction (MI) in
patients undergoing carotid endarterectomy (CEA) without a previous
history of coronary artery disease (CAD). Methods We randomised 426
patients who were candidates for CEA, with no history of CAD, a normal
electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n =
216) all patients underwent coronary angiography before CEA. In group B (n
= 210) CEA was performed without coronary angiography. Patients were not
blinded for relevant assessments during follow-up. Primary end-point was
the occurrence of MI at 3.5 years. The secondary end-point was the overall
survival rate. Median length of follow-up was 6.2 years. Results In group
A, coronary angiography revealed significant coronary artery stenosis in
68 patients (31.5%). Among them, 66 underwent percutaneous Intervention
(PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass
grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6
MI occurred in group B, one of which was fatal (p =.01). During the study
period, 3 MI occurred in group A (1.4%) and 33 were observed in group B
(15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk
of MI for patients in group A receiving coronary angiography (HR,.078; 95%
CI, 0.024-0.256; p <.001). In addition, patients with diabetes and
patients <70 years presented with an increased risk of MI. Survival
analysis at 6 years by Kaplan-Meier estimates was 95.6 +/- 3.2% in Group A
and 89.7 +/- 3.7% in group B (Log Rank = 6.54, p =.01). Conclusions In
asymptomatic coronary-artery patients, systematic coronary angiography
prior to CEA followed by selective PCI or CABG significantly reduces the
incidence of late MI and increases long-term survival. (ClinicalTrials.gov
number, NCT02260453).

<6>
Accession Number
2015847413
Authors
Singh I. Achuthan S. Chakrabarti A. Rajagopalan S. Srinivasan A. Hota D.
Institution
(Singh, Achuthan, Chakrabarti, Rajagopalan, Srinivasan) Department of
Pharmacology, Post Graduate Institute of Medical Education and Research
(PGIMER), Chandigarh, India
(Hota) Department of Pharmacology, All India Institute of Medical Sciences
(AIIMS), Bhubaneshwar, Odisha, India
Title
Influence of pre-operative use of serotonergic antidepressants (SADs) on
the risk of bleeding in patients undergoing different surgical
interventions: A meta-analysis.
Source
Pharmacoepidemiology and Drug Safety. 24 (3) (pp 237-245), 2015. Date of
Publication: 01 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Serotonergic antidepressants (SADs) are one of the most widely prescribed
group of drugs. Of late, the use of SADs is being associated with an
increased risk of perioperative bleeding. However, the results are
inconsistent. The present analysis was planned to evaluate the association
between preoperative SADs use and the risk of bleeding/mortality in
patients undergoing surgery. Methods: Studies that had reported the
effects of preoperative SADs use on the perioperative bleeding outcomes
and/or mortality in adult patients undergoing surgical interventions were
identified and evaluated for inclusion in the analysis. Outcomes evaluated
were reoperation for bleeding event, requirement of blood/RBC transfusion
and mortality. A meta-analysis was conducted, and a pooled estimate of
odds ratio (OR) was calculated using the inverse variance method. Results:
Eight cohort studies, comprising a total of 79 976 SADs users and 485 336
non-antidepressant users were included in the final analysis. SADs use was
not associated with increased risk of requirement of reoperation for
bleeding event [OR = 1.48 (0.84-2.62)]. However, there was an increased
requirement of transfusion [OR = 1.19(1.09-1.30)], which was not observed
in the subgroup of patients undergoing coronary artery bypass graft (CABG)
[OR = 1.06(0.90-1.24)]. SADs use was associated with a substantial
increase in mortality [OR = 1.53 (1.15-2.04)] in patients undergoing CABG
but not in the overall population [OR = 1.1 (0.99-1.22)]. Conclusions:
Preoperative SADs use is associated with increased bleeding risk with
respect to requirement of transfusion; nevertheless, the results should
not be generalized to all surgical groups. The divergence between bleeding
risk and mortality in CABG surgery patients needs further evaluation.

<7>
Accession Number
2014612570
Authors
Khan M.F. Brilakis E.S. Wendel C.S. Thai H.
Institution
(Khan, Wendel) Department of Medicine, Southern Arizona VA Health Care
System, Tucson, AZ, United States
(Khan) Department of Medicine, University of Arizona, Tucson, AZ, United
States
(Brilakis) Division of Cardiology, VA North Texas Health Care System,
Dallas, TX, United States
(Brilakis) Division of Cardiology, University of Texas, Southwestern
Medical School, Dallas, TX, United States
(Thai) Division of Cardiology, Southern Arizona VA Health Care System,
Tucson, AZ, United States
(Thai) Division of Cardiology, University of Arizona, Tucson, AZ, United
States
Title
Comparison of procedural complications and in-hospital clinical outcomes
between patients with successful and failed percutaneous intervention of
coronary chronic total occlusions: A Meta-Analysis of Observational
Studies.
Source
Catheterization and Cardiovascular Interventions. 85 (5) (pp 781-794),
2015. Date of Publication: 01 Apr 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Multiple attempts to pass guidewires and balloons across
totally occluded segments may result in significant mechanical trauma and
higher rates of coronary complications in patients undergoing PCI
(percutaneous coronary intervention) for CTOs (chronic total occlusion).
It is unknown whether these procedural complications affect short-term
survival and in-hospital clinical outcomes after the PCI. The goal of this
analysis was to clarify this issue by comparing the rates of adverse
in-hospital clinical outcomes between successful and failed CTO-PCI
groups. Methods We performed a meta-analysis of 25 studies (16,490
patients) to determine the rates of in-hospital death, myocardial
infarction (MI), major adverse cardiovascular events (MACE), and urgent
CABG (coronary artery bypass grafting) for the successful and failed
CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI
procedures were associated with higher in-hospital mortality (1.44% versus
0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI]
(1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus
3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of
in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03]
and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI
(4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary
perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade
[RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful
PCI arm. Conclusions As compared to successful interventions, failed PCI
attempts for CTOs appear to be associated with higher risk of adverse
short-term clinical outcomes.

<8>
Accession Number
2015851238
Authors
Kiaii B. Fox S. Chase L. Fernandes M. Stitt L.W. Guo R. Quantz M. Chu M.W.
Koka P. McClure R.S. McKenzie F.N. Klein G.J. Novick R.J. Skanes A.C.
Institution
(Kiaii, Fox, Chase, Fernandes, Guo, Quantz, Chu, Koka, McClure, McKenzie,
Novick) Departments of Surgery, United States
(Stitt) Biostatistics, United States
(Klein, Skanes) Medicine, Western University, London Health Sciences
Centre, University Hospital, London, ON, Canada
Title
Postoperative atrial fibrillation is not pulmonary vein dependent: Results
from a randomized trial.
Source
Heart Rhythm. 12 (4) (pp 699-705), 2015. Date of Publication: 01 Apr 2015.
Publisher
Elsevier
Abstract
Background Although often short-lived and self-limiting, postoperative
atrial fibrillation (POAF) is a well-recognized postoperative complication
of cardiac surgery and is associated with a 2-fold increase in
cardiovascular mortality and morbidity. Objective Our aim was to determine
whether intraoperative bilateral pulmonary vein radiofrequency ablation
decreases the incidence of POAF in patients undergoing coronary artery
bypass grafting (CABG). Methods A total of 175 patients undergoing CABG
was prospectively randomized to undergo adjuvant bilateral radiofrequency
pulmonary vein ablation in addition to CABG (group A; n = 89) or CABG
alone (group B; n = 86). Intraoperative pulmonary vein isolation was
confirmed by the inability to pace the heart via the pulmonary veins after
ablation. All patients received postoperative beta-blocker. Results There
was no difference in the incidence of POAF in the treatment group who
underwent adjuvant pulmonary vein ablation (group A; 37.1%) compared with
the control group who did not (group B; 36.1%) (P =.887). There were no
differences in postoperative inotropic support, antiarrhythmic drug use,
need for oral anticoagulation, and complication rates. The mean length of
postoperative hospital stay was 8.2 +/- 6.5 days in the ablation group and
6.7 +/- 4.6 days in the control group (P <.001). Conclusion Adjuvant
pulmonary vein isolation does not decrease the incidence of POAF or its
clinical impact but increases the mean length of stay in the hospital. The
mechanism of POAF does not appear to depend on the pulmonary veins.

<9>
Accession Number
2015850746
Authors
Rassaf T. Balzer J. Rammos C. Zeus T. Hellhammer K. Hall S.V. Wagstaff R.
Kelm M.
Institution
(Rassaf, Balzer, Rammos, Zeus, Hellhammer, Hall, Wagstaff, Kelm)
Department of Medicine, University Hospital Dusseldorf, Medical Faculty,
Moorenstrasse 5, Dusseldorf 40225, Germany
Title
Influence of percutaneous mitral valve repair using the MitraClip system
on renal function in patients with severe mitral regurgitation.
Source
Catheterization and Cardiovascular Interventions. 85 (5) (pp 899-903),
2015. Date of Publication: 01 Apr 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In patients with mitral regurgitation (MR), changes in cardiac
stroke volume, and thus renal preload and afterload may affect kidney
function. Percutaneous mitral valve repair (PMVR) with the MitraClip
system can be a therapeutic alternative to surgical valve repair. The
influence of MitraClip therapy on renal function and clinical outcome
parameters is unknown. Methods and Results: Sixty patients with severe MR
underwent PMVR using the MitraClip system in an open-label observational
study. Patients were stratified according to their renal function. All
clips have been implanted successfully. Effective reduction of MR by 2-3
grades acutely improved KDOQI class. Lesser MR reduction (MR reduction of
0-1 grades) led to worsening of renal function in patients with
pre-existing normal or mild (KDOQI 1-2) compared to severe (KDOQI 3-4)
renal dysfunction. Reduction of MR was associated with improvement in
Minnesota Living with Heart Failure Questionnaire (MLHFQ), NYHA-stadium,
and 6-minute walk test. Conclusion: Successful PMVR was associated with an
improvement in renal function. The improvement in renal function was
associated with the extent of MR reduction and pre-existing kidney
dysfunction. Our data emphasize the relevance of PVMR to stabilize the
cardiorenal axis in patients with severe MR.

<10>
Accession Number
2015850889
Authors
Yang J. Yang L. Yu S. Liu J. Zuo J. Chen W. Duan W. Zheng Q. Xu X. Li J.
Zhang J. Xu J. Sun L. Yang X. Xiong L. Yi D. Wang L. Liu Q. Ge S. Ren J.
Institution
(Yang, Yang, Yu, Liu, Zuo, Chen, Duan, Zheng, Xu, Li, Zhang, Xu, Sun,
Yang, Xiong, Yi, Ge, Ren) Department of Cardiovascular Surgery, Xijing
Hospital, Fourth Military Medical University, Xi'an, China
(Wang) Department of Cardiology, Xi'An Children Hospital, Xi'an, China
(Liu) Department of Cardiovascular Surgery, Hanzhong Central Hospital,
Hanzhong, China
(Ge) Heart Center at St. Christopher's Hospital for Children, Drexel
University College of Medicine, Philadelphia, PA, United States
(Ren) College of Health Sciences, University of Wyoming, Laramie, WY,
United States
Title
Transcatheter versus surgical closure of perimembranous ventricular septal
defects in children: A randomized controlled trial.
Source
Journal of the American College of Cardiology. 63 (12) (pp 1159-1168),
2014. Date of Publication: 01 Apr 2014.
Publisher
Elsevier USA
Abstract
Objectives The objective of this study was to evaluate the safety and
efficacy of the surgical versus transcatheter approach to correct
perimembranous ventricular septal defects (pmVSDs) in a prospective,
randomized, controlled clinical trial. Background pmVSD is a common
congenital heart disease in children. Surgical closure of pmVSD is a
well-established therapy but requires open-heart surgery with
cardiopulmonary bypass. Although the transcatheter approach is associated
with significant incidence of complete atrioventricular block, it may
provide a less invasive alternative. Critical comparison of the safety and
efficacy of the 2 interventions necessitates a prospective, randomized,
controlled trial. Methods Between January 2009 and July 2010, 229 children
with pmVSD were randomly assigned to surgical or transcatheter
intervention. Clinical, laboratory, procedural, and follow-up data over a
2-year period were compared. Results Neither group had mortality or major
complications. However, statistical analysis of the 2 groups demonstrated
significant differences (p < 0.001) in minor adverse events (32 vs. 7),
quantity of blood transfused, duration of the procedure, median hospital
stay, median intensive care unit stay, median hospitalization cost, and
median blood loss. During a median follow-up of 2 years, the left
ventricular end-diastolic dimension of both groups returned to normal and
there was no difference in closure rate, adverse events, and complications
between groups. Conclusions Transcatheter device closure and surgical
repair are effective interventions with excellent midterm results for
treating pmVSD in children. Transcatheter device closure has a lower
incidence of myocardial injury, less blood transfused, faster recovery,
shorter hospital stay, and lower medical expenses. (Transcatheter Closure
Versus Surgery of Perimembranous Ventricular Septal Defects; NCT00890799)

<11>
Accession Number
2015777326
Authors
Jilaihawi H. Wu Y. Yang Y. Xu L. Chen M. Wang J. Kong X. Zhang R. Wang M.
Lv B. Wang W. Xu B. Makkar R.R. Sievert H. Gao R.
Institution
(Jilaihawi, Makkar) Division of Cardiology, Cedars-Sinai Heart Institute,
Los Angeles, CA, United States
(Wu, Yang, Wang, Xu, Gao) Department of Cardiology, Fuwai Hospital,
Chinese Academy of Medical Sciences, Beijing, China
(Xu) Cardiac Catheterization Laboratory, Fuwai Hospital, National Center
for Cardiovascular Diseases, Beijing, China
(Chen) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
(Wang) Department of Cardiology, Second Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou, China
(Kong) Department of Cardiology, Jiangsu Provincial People's Hospital,
Nanjing Medical University, Nanjing, China
(Zhang) Department of Cardiology, Rui Jin Hospital, Jiao Tong University
School of Medicine, Shanghai, China
(Lv) Department of Radiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Wang) Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Disease, Beijing, China
(Sievert) Department of Cardiology, CardioVascular Center, Frankfurt,
Germany
Title
Morphological characteristics of severe aortic stenosis in China: Imaging
corelab observations from the first Chinese transcatheter aortic valve
trial.
Source
Catheterization and Cardiovascular Interventions. 85 (S1) (pp 752-761),
2015. Date of Publication: 01 Mar 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives We sought to describe the morphological characteristics of
aortic valve disease in a Chinese population presenting for transcatheter
aortic valve replacement (TAVR). Background Racial and regional
differences are known to exist in aortic stenosis (AS), but limited data
exist comparing the specific anatomical variations between populations.
Methods Patients were prospectively evaluated in a Chinese population
presenting for TAVR in the Venus A-Valve trial, the first trial evaluating
TAVR in China. A systematic anatomical assessment protocol employed
contrast-enhanced computed tomography (CT) in all the cases. Results A
total of 120 consecutive patients were studied. Of these, 61 (50.7%) were
patients with tricuspid, 57 (47.5%) bicuspid, and 2 (1.7%) unicuspid valve
morphologies. Of the 57 cases with bicuspid valve, 31 (54.4%) had no raphe
(Sievers classification, type 0) and 26 (45.6%) were of raphe type.
Although the incidence of bicuspid valve morphology was more than a third
in the northern Chinese population, this was lower than the eastern
Chinese population (P = 0.035), in whom the incidence was more than half.
A comparison of tricuspid morphologies in China versus a Western series of
229 consecutive patients undergoing TAVR assessed with CT showed a
threefold excess of leaflet calcium burden in China, with a leaflet
calcium volume of 421 mm³ (IQR, 188-688 mm³) versus
142 mm³ (IQR, 58-267 mm³). Conclusions Patients
presenting for TAVR in China have a very high frequency of bicuspid valve
morphology. Even in tricuspid disease, there are clear differences to
Western patients, with a high calcium burden, which presents challenges
for TAVR in this population (ClinicalTrials.gov NCT01683474).

<12>
Accession Number
2015851720
Authors
Yeo J. Jeon Y.
Institution
(Yeo, Jeon) Kyungpook National University Hospital, Daegu, South Korea
(Yeo) Department of Anesthesiology and Pain Medicine, School of Medicine,
Kyungpook Natinoal University Medical Center, Kyungpook National
University, Daegu, South Korea
(Jeon) Department of Anesthesiology and Pain Medicine, School of
Dentistry, Kyungpook National University, Daegu, South Korea
Title
Effects of stellate ganglion block on sedation as assessed by bispectral
index in normal healthy volunteers.
Source
Pain Physician. 18 (2) (pp 173-178), 2015. Date of Publication: 2015.
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: The sympathetic nervous system plays an important role in the
arousal response. Recently, the stellate ganglion block (SGB) was found to
effectively treat anxiety and night awakening in humans and decrease
electroencephalogram (EEG) indices of arousal responses in rat. But, the
role of the sympathetic block in human arousal responses has not yet been
studied. Objective: We performed this prospective, double-blinded,
controlled volunteer study to investigate the sedative effects and
bispectral index (BIS) changes of SGB. Study Design: A randomized,
double-blind trial. Setting: Single academic medical center. Methods: This
study was approved by the Ethics Committee of Kyungpook National
University Hospital (ref: KNUH_10-1081) and registered with CRiS (Clinical
Research Information Service, http://cris.cdc.go.kr, ref: KCT0000036,
2010. 9.24). Twenty healthy volunteers were enrolled in this study. The
volunteers were randomly assigned to one of 2 groups: the SGB group (n =
10) and the sham group (n =10). Volunteers in SGB group received SGB and
volunteers in the sham group received a sham procedure. BIS value, heart
rate, and blood pressure were measured before and 5, 10, 20, and 30
minutes after the procedure. Observer's Assessment of Alertness/Sedation
(OAA/S) scores were assessed before and 10 and 30 minutes after the
intervention. Results: In the SGB group, BIS values and OAA/S scores
significantly decreased after the intervention as compared to baseline (P
< 0.05). The values were also significantly decreased in the SGB group
when compared to the values in sham group after the intervention (P <
0.05). There was a significant change of mean blood pressure 10 to 30
minutes after SGB (P < 0.05). There were no differences in heart rate
during study period between groups. Limitations: This study is limited by
a relatively small sample size. Conclusions: This study showed that SGB
has a sedative effect in normal healthy volunteers, as evidenced by
decreased OAA/S scores and BIS values.

<13>
Accession Number
2015845050
Authors
Zhang Q. Long Wang X. Lei Liao M. Hu J. Kun Yang Z. Hua Ding F. Sheng
Zhang J. Du R. Qi Zhu T. Feng Shen W. Yan Zhang R.
Institution
(Zhang, Hu, Kun Yang, Hua Ding, Sheng Zhang, Du, Qi Zhu, Feng Shen, Yan
Zhang) Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200025, China
(Long Wang) Department of Cardiology, Shuguang Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai 201203, China
(Lei Liao) Department of Cardiology, Wusong Hospital, Shanghai 200940,
China
Title
Periprocedural use of tirofiban in elective percutaneous coronary
intervention for long coronary lesions in stable patients with overlapping
drug-eluting stents - The PETITION study: A prospective, randomized,
multicenter study.
Source
Catheterization and Cardiovascular Interventions. 85 (S1) (pp 762-769),
2015. Date of Publication: 01 Mar 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background and purpose Patients are at risk of developing periprocedural
myonecrosis after percutaneous coronary intervention (PCI). We
investigated whether the use of the platelet glycoprotein (GP) IIb/IIIa
receptor inhibitor tirofiban could reduce periprocedural myocardial
infarction (PMI) in patients with stable coronary artery disease
undergoing elective PCI with overlapping stent implantation for long
lesions. Methods A total of 748 stable angina patients with long lesions
(> 40 mm in length) treated with overlapping stent implantation were
randomly assigned to receive tirofiban (tirofiban group; n = 373) or
conventional therapy (control group; n = 375). Intravenous tirofiban was
initiated before PCI and maintained for 12 hr after the procedure. The
primary endpoint was PMI, defined as an elevation in CK-MB > 3 times the
upper limit of normal 12 hr after the index procedure. The secondary
endpoint was major adverse cardiac events (MACE), including cardiac death,
target vessel revascularization, and recurrent MI (re-MI), at one-year of
clinical follow-up. The safety end-points included Thrombolysis in
Myocardial Infarction (TIMI) major bleeding and stent thrombosis. Results
Despite comparable angiographic and procedural characteristics, in the
intention-to-treatment analysis, the primary endpoint was significantly
reduced in the tirofiban group (4.0% vs. 11.5%, P < 0.001). Multivariate
analysis revealed that the adjunctive use of tirofiban was the only
negative predictor of PMI (OR 0.41, 95% CI 0.28-0.81, P < 0.01). At
one-year of clinical follow-up, the overall occurrence of MACE was
significantly lower in the tirofiban group (13.4% vs. 22.7%, P = 0.001).
The rate of TIMI major bleeding and stent thrombosis did not differ
significantly between the two groups. Conclusion Our results show that the
adjunctive use of tirofiban reduces the occurrence of PMI and MACE at one
year in stable coronary artery disease patients undergoing elective PCI
for long lesions with overlapping stent implantation.

<14>
Accession Number
2015859489
Authors
Kongmalai P. Karunasumetta C. Kuptarnond C. Prathanee S. Taksinachanekij
S. Intanoo W. Wongbuddha C. Senthong V.
Institution
(Kongmalai, Karunasumetta, Kuptarnond, Prathanee, Taksinachanekij,
Intanoo, Wongbuddha) Cardiothoracic Division, Department of Surgery, Khon
Kaen University, Khon Kaen, Thailand
(Senthong) Cardiology unit, Department of Medicine, Khon Kaen University,
Khon Kaen, Thailand
Title
The posterior pericardiotomy. Does it reduce the incidence of
postoperative atrial fibrillation after coronary artery bypass grafting?.
Source
Journal of the Medical Association of Thailand. 97 (pp S97-S104), 2014.
Date of Publication: 2014.
Publisher
Medical Association of Thailand
Abstract
Atrial fibrillation (AF) is the most common arrhythmia after coronary
artery bypass graft surgery (CABG). Posterior pericardiotomy (PP) has been
reported toreduce pericardial effusion, AF trigger, and reduce the length
of hospital stay and hospital costs without significant complications. A
total of 20 patients, diagnosed with coronary artery diseases to be
treated by an elective or urgent CABG between August and December 2013,
were randomly divided into two groups; 10 patients received PP (PP group)
and 10 patients did not receive PP (control group). The incidence of AF
was equal (40% in both groups). Early pericardial effusion was slightly
higher in the PP group (PP 70%, control 60%; p = 1.00). The incidence of
left pleural effusion and pneumonia were higher in the PP group than in
the control. Moreover, one patient in the PP group developed perioperative
myocardial infarction (MI) that required intensive care with medication.
The duration of ICU stay of the PP group was significantly longer than
that of the control group. In conclusion, PP did not reduce the incidence
of postoperative AF nor did early pericardial effusion.Rather, PP
increased post-operative complications such as perioperative MI, left
pleural effusion, and pneumonia resulting in the prolonged ICU stay.

<15>
Accession Number
2015838711
Authors
Shah M.U.A. Asghar M.I. Siddiqi R. Chaudhri M.S. Janjua A.M. Iqbal A.
Institution
(Shah) Department of Cardiac Surgery, Rawalpindi Institute of Cardiology,
Rawalpindi, Pakistan
(Asghar, Chaudhri, Janjua, Iqbal) Department of Cardiac Surgeon, Armed
Forces Institute of Cardiology (AFIC-NIHD), Rawalpindi, Pakistan
(Siddiqi) Department of Cardiac Anesthesia, Armed Forces Institute of
Cardiology (AFIC-NIHD), Rawalpindi, Pakistan
Title
Topical application of tranexamic acid reduces postoperative bleeding in
open-heart surgery: Myth or fact?.
Source
Journal of the College of Physicians and Surgeons Pakistan. 25 (3) (pp
161-165), 2015. Date of Publication: 2015.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan. E-mail: admin@cpsp.edu.pk)
Abstract
Objective: To determine the efficacy of topical application of Tranexamic
acid in controlling postoperative bleeding in open-heart surgery. Study
Design: Double blind randomized control trial. Place and Duration of
Study: Departments of Cardiac Surgery and Intensive Care of Armed Forces
Institute of Cardiology and National Institute of Heart Diseases
(AFIC-NIHD), Rawalpindi, Pakistan, from May to October 2011. Methodology:
A total of 100 consecutive adult patients fulfilling the inclusion
criteria undergoing elective on-pump cardiac surgeries were randomly
divided in groups 'A' and 'B'. A study solution that contained 2.5 g of
Tranexamic acid in 250 ml normal saline in group-A and equal amount of
normal saline (placebo) in group-B was poured in the pericardial cavity
over the mediastinal tissues before sternal closure. Postoperative
bleeding was measured in both groups for 24 hours in the cardiac surgical
ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms
of mean postoperative bleeding in ml. Kindly again include these lines
which seem to have been omitted in the final proof. Results: There was
significant difference in the mean postoperative bleeding within 24 hours
among the two groups 340.1 +/- 112.4 ml in Tranexamic acid group vs. 665
+/- 187.28 ml in placebo group (p < 0.001). Conclusion: Patients who did
not have topical Tranexamic acid before chest closure had a significantly
higher postoperative bleeding. Topical Tranexamic acid application is an
effective and economical way for controlling non-surgical bleeding in
patients undergoing cardiac surgery with cardiopulmonary bypass.

<16>
Accession Number
2015733917
Authors
Sun Y. Wu Z. Li S. Qin X. Li T. Xie L. Deng Y. Chen J.
Institution
(Sun) Department of Clinical Laboratory, Liuzhou Hospital of Traditional
Chinese Medicine, 32 Jiefang North Road, Liuzhou, Guangxi 545001, China
(Wu) Department of Clinical Laboratory, Guigang City People's Hospital, 1
Zhongshan Middle Road, Guigang, Guangxi 537100, China
(Li, Qin, Li, Xie, Deng) Department of Clinical Laboratory, First
Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road,
Nanning, Guangxi 530021, China
(Chen) Department of Gastrointestinal Surgery, First Affiliated Hospital,
Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi 530021,
China
Title
Impact of gamma-glutamyl carboxylase gene polymorphisms on warfarin dose
requirement: A systematic review and meta-analysis.
Source
Thrombosis Research. 135 (4) (pp 739-747), 2015. Date of Publication: 01
Apr 2015.
Publisher
Elsevier Ltd
Abstract
Background The Gamma-glutamyl carboxylase (GGCX) gene, as with Vitamin K
Epoxide Reductase Complex Subunit 1(VKORC1), CytochromeP450 Complex
Subunit 14 F2 (CYP4F2) and CytochromeP450 Complex Subunit2C9 (CYP2C9), is
a candidate predictor for appropriate maintenance warfarin dose. However,
the association between GGCX gene polymorphisms and warfarin dose
requirement is still controversial. To quantify the influence of GGCX
polymorphisms on warfarin dose requirements, we performed a systematic
review and meta-analysis. Methods According to PRISRM statement (Preferred
reporting items for systematic reviews and meta-analyses), a comprehensive
literature search was undertaken through August 2014 looking for eligible
studies in Embase, Pubmed,Web of Science and the Cochrane Library. The
impact of GGCX polymorphisms on mean daily warfarin dose (MDWD) was
counted by means of Z test. RevMan 5.2.7 software (developed by the
Cochrane Collaboration) was applied to analyze the relationship between
GGCX gene polymorphisms and warfarin dose requirements. Results Nineteen
articles including 21 studies with a total of 6957 patients were included
in the meta-analysis. Among three investigated single nucleotide
polymorphisms (SNPs), rs11676382 showed higher CC genotype frequencies in
Asian than those in Caucasian(97.7% vs. 86.9%); patients who were "G
carriers" (that is, carried the GGCX rs11676382 CG or GG genotypes)
required 27% lower warfarin dose than CC genotype[95%Confidence
Interval(CI) = 17%-37%, P = 0.000, I²% = 82.0 and P_Q
= 0.000], moreover, stratified analysis by ethnicity showed similar
results in Caucasian(23% lower, 95%CI = 12%-33%), but not in Asian. With
respect to genetic variation of rs699664 and rs121714145 SNPs, no
significant impact on warfarin dose requirements were demonstrated.
Conclusions This meta-analysis suggested that GGCX rs11676382 polymorphism
may be one of factors affecting the dose of warfarin requirement, and the
effects are different in different ethnicities. Further studies about this
topic in different ethnicities with larger samples are expected to be
conducted to validate our results.

<17>
Accession Number
2015667017
Authors
Herbeck Belnap B. Schulberg H.C. He F. Mazumdar S. Reynolds III Rollman
B.L.
Institution
(Herbeck Belnap, Rollman) Division of General Internal Medicine, Center
for Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, United States
(He, Mazumdar) Department of Biostatistics, University of Pittsburgh
Graduate School of Public Health, Pittsburgh, PA, United States
(Reynolds) Department of Psychiatry, University of Pittsburgh School of
Medicine, Pittsburgh, PA, United States
Title
Electronic protocol for suicide risk management in research participants.
Source
Journal of Psychosomatic Research. 78 (4) (pp 340-345), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Inc.
Abstract
Objective: To describe an electronic, telephone-delivered, suicide risk
management protocol (SRMP) that is designed to guide research staff and
safely triage study participants who are at risk for self-harm. Methods:
We tested the SRMP in the context of the NIH-funded randomized clinical
trial "Bypassing the Blues" in which 302 patients who had undergone
coronary artery bypass graft surgery (CABG) were screened for depression
and assessed by telephone 2-weeks following hospital discharge and at 2-,
4-, and 8-month follow-up. We programmed the SRMP to assign different risk
levels based on patients' answers from none to imminent with action items
for research staff keyed to each of them. We describe frequency of
suicidal thinking, SRMP use, and completion of specific steps in the SRMP
management process over the 8-month follow-up period. Results: Suicidal
ideation was expressed by 74 (25%) of the 302 study participants in 139
(13%) of the 1069 blinded telephone assessments performed by research
staff. The SRMP was launched in 103 (10%) of assessments, and the suicidal
risk level was classified as moderate or high in 10 (1%) of these
assessments, thereby necessitating an immediate evaluation by a study
psychiatrist. However, no hospitalizations, emergency room visits, or
deaths ascribed to suicidal ideation were discovered during the study
period. Conclusion: The SRMP was successful in systematically and safely
guiding research staff lacking specialty mental health training through
the standardized risk assessment and triaging research participants at
risk for self-harm.

<18>
Accession Number
2015637807
Authors
Sarathy K. Nagaraja V. Kapur A. Szirt R. Raval J. Eslick G.D. Burgess D.
Denniss A.R.
Institution
(Sarathy, Nagaraja, Kapur, Szirt) Prince of Wales Hospital, University of
New South Wales, Sydney, Australia
(Raval, Burgess, Denniss) Department of Cardiology, Blacktown Hospital,
Sydney, Australia
(Nagaraja, Eslick) The Whiteley-Martin Research Centre, University of
Sydney, Nepean Hospital, Sydney, Australia
Title
Target-vessel versus multivessel revascularisation in st-elevation
myocardial infarction: A meta-analysis of randomised trials.
Source
Heart Lung and Circulation. 24 (4) (pp 327-334), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: In acute ST-segment elevation myocardial infarction (STEMI),
coronary reperfusion with percutaneous coronary intervention (PCI) to
treat the culprit lesion responsible for infarction improves clinical
outcomes in nearly all patients. The concurrent treatment of non-infarct
vessels with significant stenoses during initial angiography remains an
area of controversy. Methods: A systematic search was conducted using
MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library,
Google Scholar, Science Direct, and Web of Science. Original data were
abstracted from each study and used to calculate a pooled odds ratio (OR)
and 95% confidence interval (95% CI). Results: Only four randomised trials
comprising 775 patients met full criteria for analysis. The incidence of
non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory
angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat
revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was
lower in the multivessel revascularisation cohort. Death from cardiac
causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336,
95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26%
vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the
multivessel revascularisation cohort. The Median Contrast Volume and
Procedure Length were similar in both cohorts. Conclusions: In patients
with acute STEMI who undergo primary PCI, a strategy of treatment of
significant non-infarct stenosis (preventive PCI) in addition to the
culprit lesion responsible for infarction may result in improved
cardiovascular outcomes and reduced overall mortality; however there is
insufficient data to fully validate this from currently published
literature.

<19>
Accession Number
2014744836
Authors
Collet J.-P. Silvain J. Barthelemy O. Range G. Cayla G. Van Belle E.
Cuisset T. Elhadad S. Schiele F. Lhoest N. Ohlmann P. Carrie D. Rousseau
H. Aubry P. Monsegu J. Sabouret P. O'connor S.A. Abtan J. Kerneis M.
Saint-Etienne C. Beygui F. Vicaut E. Montalescot G.
Institution
(Collet, Silvain, Barthelemy, Sabouret, O'connor, Abtan, Kerneis,
Montalescot) Institut de Cardiologie, Bureau 2-236, Centre Hospitalier
Universitaire Pitie-Salpetriere, 47 Boulevard de l'Hopital, Paris 75013,
France
(Range) Les Hopitaux de Chartres, Le Coudray, France
(Cayla) ACTION Study Group, Cardiologie, CHU Caremeau, Nimes, France
(Van Belle, Rousseau) CHRU de Lille, Lille, France
(Cuisset) Departement de Cardiologie, CHU La Timone, Marseille, France
(Elhadad) Cardiologie, CH de Lagny-Marne-la-Vallee, Lagny-sur-Marne,
France
(Schiele) CHU Jean Minjoz, Besancon, France
(Lhoest) GH du Centre Alsace, France
(Ohlmann) CHR, Strasbourg, France
(Carrie) CHU Rangueil, Toulouse, France
(Rousseau, Vicaut) ACTION Study Group, Unite de Recherche Clinique-Hopital
Lariboisiere (APHP), Universite Denis Diderot, Paris, France
(Aubry) Centre Hospitalier Bichat, APHP, Paris, France
(Monsegu) Institut Mutualiste Montsouris, Paris, France
(Saint-Etienne) CHU Trousseau, Tours, France
(Beygui) ACTION Study Group, CHU, Caen, France
Title
Dual-antiplatelet treatment beyond 1 year after drug-eluting stent
implantation (ARCTIC-interruption): A randomised trial.
Source
The Lancet. 384 (9954) (pp 1577-1585), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group
Abstract
Background: Optimum duration of dual antiplatelet treatment (DAPT) after
coronary stenting remains uncertain, with an unknown efficacy to safety
ratio of extended treatment leading to discrepancies between international
guidelines and clinical practice. We assessed whether DAPT continuation
beyond 1 year after coronary stenting is beneficial. Methods: This
analysis was a planned extension of the previously published
ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a
strategy of platelet function testing with antiplatelet treatment
adjustment or a conventional strategy after coronary stenting with
drug-eluting stent (DES). We recruited patients (aged 18 years or older)
scheduled for planned DES implantation at 38 centres in France. After 1
year of follow-up, patients without contraindication to interruption of
DAPT were eligible for a second randomisation to this second phase of the
study (ARCTIC-Interruption). Using a computer-generated randomisation
sequence (1:1; stratified by centre), we allocated patients to a strategy
of interruption of DAPT where the thienopyridine was interrupted and
single aspirin antiplatelet treatment was maintained (interruption group)
or a strategy of DAPT continuation for 6-18 months (continuation group).
The primary endpoint was the composite of death, myocardial infarction,
stent thrombosis, stroke, or urgent revascularisation, analysed by
intention to treat. This trial is registered with ClinicalTrials.gov,
number NCT00827411. Findings: Between Jan 4, 2011, and March 3, 2012, 1259
eligible patients were randomly allocated to treatment in
ARCTIC-Interruption: 624 to the interruption group and 635 to the
continuation group. After a median follow-up of 17 months (IQR 15-18), the
primary endpoint occurred in 27 (4%) patients in the interruption group
and 24 (4%) patients in the continuation group (hazard ratio [HR] 117 [95%
CI 0.68-2.03]; p=0.58). STEEPLE major bleeding events occurred more often
in the continuation group (seven [1%] patients) compared with the
interruption group (one [<0.5%] patient; HR 0.15 [0.02-1.20]; p=0.073).
Major or minor bleedings were also more common in the continuation group
compared with the interruption group (12 [2%] patients vs three [1%]
patients; HR 0.26 [0.07-0.91]; p=0.04). Interpretation: Our finding
suggests no apparent benefit but instead harm with extension of DAPT
beyond 1 year after stenting with DES when no event has occurred within
the first year after stenting. No conclusion can be drawn for high-risk
patients who could not be randomised. The consistency between findings
from all trials of such interruption suggests the need for a reappraisal
of guidelines for DAPT after coronary stenting towards shorter duration of
treatment. Funding: Allies in Cardiovascular Trials Initiatives and
Organized Networks (ACTION Study Group), Fondation de France,
Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM.

<20>
Accession Number
2014706825
Authors
Shahzad A. Kemp I. Mars C. Wilson K. Roome C. Cooper R. Andron M. Appleby
C. Fisher M. Khand A. Kunadian B. Mills J.D. Morris J.L. Morrison W.L.
Munir S. Palmer N.D. Perry R.A. Ramsdale D.R. Velavan P. Stables R.H.
Institution
(Shahzad, Kemp, Mars, Wilson, Roome, Cooper, Andron, Appleby, Fisher,
Khand, Kunadian, Mills, Morris, Morrison, Munir, Palmer, Perry, Ramsdale,
Velavan, Stables) Institute of Cardiovascular Medicine and Science,
Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool L14
3PE, United Kingdom
Title
Unfractionated heparin versus Bivalirudin in primary percutaneous coronary
intervention (HEAT-PPCI): An open-label, single centre, randomised
controlled trial.
Source
The Lancet. 384 (9957) (pp 1849-1858), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group
Abstract
Background: Bivalirudin, with selective use of glycoprotein (GP) IIb/IIIa
inhibitor agents, is an accepted standard of care in primary percutaneous
coronary intervention (PPCI). We aimed to compare antithrombotic therapy
with bivalirudin or unfractionated heparin during this procedure. Methods:
In our open-label, randomised controlled trial, we enrolled consecutive
adults scheduled for angiography in the context of a PPCI presentation at
Liverpool Heart and Chest Hospital (Liverpool, UK) with a strategy of
delayed consent. Before angiography, we randomly allocated patients (1:1;
stratified by age [<75 years vs >75 years] and presence of cardiogenic
shock [yes vs no]) to heparin (70 U/kg) or bivalirudin (bolus 075 mg/kg;
infusion 175 mg/kg per h). Patients were followed up for 28 days. The
primary efficacy outcome was a composite of all-cause mortality,
cerebrovascular accident, reinfarction, or unplanned target lesion
revascularisation. The primary safety outcome was incidence of major
bleeding (type 3-5 as per Bleeding Academic Research Consortium
definitions). This study is registered with ClinicalTrials.gov, number
NCT01519518. Findings: Between Feb 7, 2012, and Nov 20, 2013, 1829 of 1917
patients undergoing emergency angiography at our centre (representing 97%
of trial-naive presentations) were randomly allocated treatment, with 1812
included in the final analyses. 751 (83%) of 905 patients in the
bivalirudin group and 740 (82%) of 907 patients in the heparin group had a
percutaneous coronary intervention. The rate of GP IIb/IIIa inhibitor use
was much the same between groups (122 patients [13%] in the bivalirudin
group and 140 patients [15%] in the heparin group). The primary efficacy
outcome occurred in 79 (87%) of 905 patients in the bivalirudin group and
52 (57%) of 907 patients in the heparin group (absolute risk difference
30%; relative risk [RR] 152, 95% CI 109-213, p=001). The primary safety
outcome occurred in 32 (35%) of 905 patients in the bivalirudin group and
28 (31%) of 907 patients in the heparin group (04%; 115, 070-189, p=059).
Interpretation: Compared with bivalirudin, heparin reduces the incidence
of major adverse ischaemic events in the setting of PPCI, with no increase
in bleeding complications. Systematic use of heparin rather than
bivalirudin would reduce drug costs substantially. Funding: Liverpool
Heart and Chest Hospital, UK National Institute of Health Research, The
Medicines Company, AstraZeneca, The Bentley Drivers Club (UK).

<21>
Accession Number
2015839199
Authors
Schramko A. Suojaranta-Ylinen R. Niemi T. Pesonen E. Kuitunen A. Raivio P.
Salmenpera M.
Institution
(Schramko, Suojaranta-Ylinen, Niemi, Pesonen, Salmenpera) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Melahti Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
(Kuitunen) Department of Intensive Care, Tampere University Hospital,
Tampere, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University
Hospital, Meilahti Hospital, Helsinki, Finland
Title
The use of balanced HES 130/0.42 during complex cardiac surgery; Effect on
blood coagulation and fluid balance: A randomized controlled trial.
Source
Perfusion (United Kingdom). 30 (3) (pp 224-232), 2014. Date of
Publication: 19 Apr 2015.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Colloids and crystalloid are used during cardiac surgery for
priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease
postoperative fluid balance because of their high oncotic pressure and low
risk of fluid extravasation. On the other hand, colloids have been shown
to impair blood coagulation. Materials and methods: In a prospective,
randomized, double-blinded study, 50 patients scheduled for coronary
artery bypass grafting or a valve procedure were planned to be randomized
to receive either balanced 6% HES130/0.42 or Ringer-acetate solution for
CPB priming. Randomization was stopped prematurely after 35 randomized
patients (19 in the HES and 16 in the Ringer groups) because of the
published report where HES130/0.42 was associated with impaired renal
function. Effects on haemostasis and fluid balance were investigated.
Results: The rotational thromboelastometry (ROTEM) parameters and chest
tube drainage on the first postoperative morning (1POM) were comparable
between the groups (p>0.05). However, patients in the HES group needed
more blood and blood product transfusions. The total volume administered
into the CPB circuit was lower in the HES than in the Ringer (RIN) group,
2905+/-1049 mL versus 3973+/-1207 mL (p=0.011), but there was no
statistically significant difference in total fluid balance on the 1POM
(5086+/-1660 mL in the HES group versus 5850+/-1514 mL in the RIN group,
respectively). Conclusions: After complex cardiac surgery, the use of
balanced 6% HES130/0.42 solution for CPB circuit priming did not impair
haemostasis measured by ROTEM, but it increased the need for transfusions.
Fluid balance after CPB was less positive in the HES group, but, on the
1POM, it was comparable between the groups.

<22>
Accession Number
71818466
Authors
Herial N.A. Mohammad N.S. Chughtai M. Qureshi A.I.
Institution
(Herial, Mohammad, Chughtai, Qureshi) Neurology, CentraCare Health, St.
Cloud, MN, United States
Title
Cerebral ischemic events associated with transcatheter aortic valve
replacement (TAVR): A systematic review.
Source
Stroke. Conference: American Heart Association/American Stroke Association
2015 International Stroke Conference and State-of-the-Science Stroke
Nursing Symposium Nashville, TN United States. Conference Start: 20150211
Conference End: 20150213. Conference Publication: (var.pagings). 46 ,
2015. Date of Publication: February 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has recently
emerged as a treatment option in patients with symptomatic severe aortic
stenosis. Cerebral ischemic events are recognized events associated with
TAVR, however, a detailed analysis of such events is not performed.
Methods: We performed a literature search to identify studies reporting
outcome data at different time intervals following TAVR
(peri-procedural/30-days, 1, 2, and 3 yrs). Data on the incidence of
stroke/TIA was extracted from studies that used the Valve Academic
Research Consortium criteria and a comparison of stroke/TIA incidence
between TAVR vs. surgical AVR, transfemoral (TF) vs. transapical (TA)
approach, and self-expanding vs. balloon expanding valves is reported.
Results: Peri-procedural stroke/TIA incidence after TAVR ranged from 1.6%
to 5.5%. Incidence rates from the registries and meta-analyses were lower
(2.3 - 2.8%) than those reported in the randomized clinical trials (RCTs)
(4.6 - 5.5%). At 1-yr, pooled incidence rates from meta-analyses and RCTs
ranged from 3.8 - 4.5% and 7.6 - 8.8%, respectively. Incidence at 2 and 3
yrs was 11.2% and 8.2% as reported in the RCT. Meta-analyses revealed no
difference in incidence rates between TAVR and SAVR at 30-d or 1 yr, but
one RCT suggested a higher incidence of stroke/TIA with TAVR at both these
intervals. At 3 yrs, the stroke/TIA incidence incidence rates were similar
between TAVR and SAVR. No difference in stroke incidence between the
TF-TAVR and TA-TAVR approaches or the valve type was noted. Conclusions:
In comparison to SAVR, existing data indicates a marginally higher
incidence of stroke with TAVR during the peri-procedural period.
Inconsistencies were noted in long term clinical outcomes including
stroke/TIA incidence with TAVR. Future research should focus on patient
selection, improvement in valve technology and procedural techniques to
minimize the observed risk.