EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015010832
Authors
Dalili M. Vesal A. Tabib A. Khani-Tafti L. Hosseini S. Totonchi Z.
Institution
(Dalili, Vesal, Tabib, Hosseini, Totonchi) Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Khani-Tafti) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Single dose corticosteroid therapy after surgical repair of fallot's
tetralogy; A randomized controlled clinical trial.
Source
Research in Cardiovascular Medicine. 4 (1) , 2015. Article Number: e25500.
Date of Publication: 2015.
Publisher
KOWSAR Medical Publishing Company
Abstract
Background: Infammatory reaction can produce several complications after
cardiac surgery. Many attempts have been made to reduce these
complications; perioperative corticosteroid therapy is one of the simplest
methods. Objectives: We conducted a randomized study to evaluate the
efcacy of single dose methylprednisolone, prescribed after surgery, for
reducing the complications. Repair of Tetralogy of Fallot was chosen as a
homogenous large group for the study. Patients and Methods: One hundred
children who underwent total repair of Tetralogy of Fallot were enrolled
in this study. After the surgery, all patients were transferred to
pediatric ICU and were randomized (in a double-blind fashion) in 2 groups
(A and B); a single dose of methylprednisolone (30 mg/kg of body weight)
was injected to participants of group "A" just at the time of ICU
entrance. Group "B" received no drug. Then, clinical outcomes and
laboratory data were compared between the two groups. Results: The only
significant differences were lower incidence of bacteremia and higher
incidence of hyperglycemia in the group who were used methylprednisolone.
Conclusions: Using a single postsurgical dose of methylprednisolone does
not signifcantly alter the clinical outcome after repairing Tetralogy of
Fallot.

<2>
Accession Number
2015009843
Authors
Tan Q. Wang Q. Liu D. Zhang S. Zhang Y. Li Y.
Institution
(Tan, Wang, Liu, Zhang, Zhang, Li) Department of Cardiology, Qinhuangdao
First Hospital, Hebei Medical University, Qinhuangdao, Hebei, China
Title
Intravascular ultrasound-guided unprotected left main coronary artery
stenting in the elderly.
Source
Saudi Medical Journal. 36 (5) (pp 549-553), 2015. Date of Publication:
2015.
Publisher
Saudi Arabian Armed Forces Hospital
Abstract
Objectives: To investigate whether intravascular ultrasound (IVUS) guided
percutaneous coronary intervention (PCI) could improve clinical outcomes
compared with angiography-guided PCI in the treatment of unprotected left
main coronary artery stenosis (ULMCA) in the elderly. Methods: This
controlled study was carried out between October 2009 and September 2012,
in Qinhuangdao First Hospital, Hebei Province, China. One hundred and
twenty-three consecutive patients with ULMCA, aged 70 or older, were
randomized to an IVUS-guided group and a control group. The occurrence of
major adverse cardiac events (MACE): death, non-fatal myocardial
infarction, or target lesion revascularizations) were recorded after 2
years of follow-up. Results: The IVUS-guided group had a lower rate of
2-year MACE than the control group (13.1% versus 29.3%, p=0.031). The
incidence of target lesion revascularization was lower in the IVUS-guided
group than in the control group (9.1% versus 24%, p=0.045). However, there
were no differences in death and myocardial infarction in the 2 groups. On
Cox proportional hazard analysis, distal lesion was the independent
predictor of MACE (hazard ratio [HR]: 1.99, confidence interval [CI]:
1.129-2.367; p=0.043); IVUS guidance was independent factor of survival
free of MACE (HR: 0.414, CI: 0.129-0.867; p=0.033). Conclusion: The use of
IVUS could reduce MACE in elderly patients undergoing ULMCA intervention.

<3>
Accession Number
2015964772
Authors
Cheng J.W.M. Colucci V. Howard P.A. Nappi J.M. Spinler S.A.
Institution
(Cheng) MCPHS University, Boston, MA, United States
(Cheng) Brigham and Women's Hospital, Boston, MA, United States
(Colucci) The University of Montana, Missoula, MT, United States
(Colucci) Providence/St Patrick Hospital and Health Sciences, Missoula,
MT, United States
(Howard) University of Kansas Medical Center, Kansas City, KS, United
States
(Nappi) South Carolina College of Pharmacy-MUSC Campus, Charleston, SC,
United States
(Nappi) Medical University of South Carolina, Charleston, SC, United
States
(Spinler) University of the Sciences, Philadelphia, PA, United States
Title
Vorapaxar in Atherosclerotic Disease Management.
Source
Annals of Pharmacotherapy. 49 (5) (pp 599-606), 2015. Date of Publication:
22 May 2015.
Publisher
SAGE Publications Inc.
Abstract
Objective: To review the pharmacology, efficacy, and safety of vorapaxar,
a protease activator receptor-1 (PAR-1) antagonist, in the management of
atherosclerotic diseases. Data Sources: Peer-reviewed clinical trials and
review articles were identified from MEDLINE and Current Content database
(both 1966 to December 31, 2014) using the search terms vorapaxar and
protease activator receptor antagonist. Study Selection and Data
Extraction: A total of 30 clinical studies were identified (16 clinical
trials, including subanalyses, 14 related to pharmacology,
pharmacokinetics, and pharmacodynamics and drug interactions). Data
Synthesis: Two phase III clinical trials with vorapaxar have been
published. In patients with non-ST segment elevation myocardial infarction
(MI), vorapaxar failed to significantly reduce the primary efficacy end
point (composite of cardiovascular death, MI, stroke, recurrent ischemia
with hospitalization, and urgent coronary revascularization). Conversely,
in a study of secondary prevention for patients with cardiovascular
disease, the composite end point of cardiovascular death, MI, or stroke
was significantly reduced. In both trials, the safety end points of
major/minor bleeding were increased compared with placebo. In the
secondary prevention trial, an increased incidence of intracranial
hemorrhage led to the exclusion of patients with a prior history of
stroke. Conclusion: Vorapaxar is approved for use with aspirin and/or
clopidogrel in the secondary prevention of cardiovascular events in stable
patients with peripheral arterial disease or a history of MI. However, the
addition of vorapaxar to other antiplatelets can significantly increase
the risk of bleeding. It is, therefore, essential to balance the need for
further reduction of risk of thrombotic event with patient's individual
bleeding risk.

<4>
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Accession Number
2015963784
Authors
Li Q.-H. Qi Z. Yu Z. Li X.-L. Ji H.-G. Yin J.-F. Yi S.
Institution
(Li, Qi, Yu, Li, Ji, Yin, Yi) Department of Cardiology, Changzhou TCM
Hospital, No. 25 Heping Road, Tianning District, Changzhou, China
Title
Long-term effect of second-generation drug-eluting stents for coronary
artery disease, everolimus-eluting versus zotarolimus-eluting stents: A
meta- A nalysis.
Source
Coronary Artery Disease. 26 (3) (pp 259-265), 2015. Date of Publication:
22 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background Compared with the zotarolimus-eluting stent (ZES), the
everolimus-eluting stent (EES) has reduced the risk of stent restenosis
and thrombosis as found in a number of randomized-controlled trials
(RCTs). However, the benefits have been variable. Materials and methods We
evaluate the long-term effect of EES and ZES on the risk of stent
thrombosis and target lesion revascularization in patients receiving PCI.
We identified RCTs by a systematic search of MEDLINE, EMBASE, and Cochrane
Database. Results Five RCTs (9853 patients) were included. Overall, EES
significantly reduced the risk of target lesion revascularization [odds
ratio (OR), 0.77; 95% confidence interval (CI), 0.62-0.95; P=0.01]
compared with ZES therapy. However, there was no difference in the risk of
target vessel revascularization (OR, 0.93; 95% CI, 0.78-1.10; P=0.38) and
definite/probable stent thrombosis (OR, 0.83; 95% CI, 0.56-1.25; P=0.37)
between the two groups. Furthermore, the risk of mortality (OR, 1.04; 95%
CI, 0.84-1.27; P=0.73), myocardial infarction (OR, 0.95; 95% CI,
0.74-1.23; P=0.70), and major adverse cardiac event (OR, 0.96; 95% CI,
0.84-1.10; P=0.53) was similar between the two groups. Conclusion The
new-generation Resolute-ZES and EES have a similar long-term safety and
efficacy profile.

<5>
Accession Number
2015015245
Authors
Paudel S. Zacharioudakis I.M. Zervou F.N. Ziakas P.D. Mylonakis E.
Institution
(Paudel, Zacharioudakis, Zervou, Ziakas, Mylonakis) Infectious Diseases
Division, Warren Alpert Medical School of Brown University, Rhode Island
Hospital, Providence, RI, United States
Title
Prevalence of clostridium difficile infection among solid organ transplant
recipients: A meta-analysis of published studies.
Source
PLoS ONE. 10 (4) , 2015. Article Number: e0124483. Date of Publication: 17
Apr 2015.
Publisher
Public Library of Science
Abstract
Several factors including antibiotic use, immunosuppression and frequent
hospitalizations make solid organ transplant (SOT) recipients vulnerable
to Clostridium difficile infection (CDI). We conducted a meta-analysis of
published studies from 1991-2014 to estimate the prevalence of CDI in this
patient population. We searched PubMed, EMBASE and Google Scholar
databases. Among the 75,940 retrieved citations, we found 30 studies coded
from 35 articles that were relevant to our study. Based on these studies,
we estimated the prevalence of CDI among 21,683 patients who underwent
transplantation of kidney, liver, lungs, heart, pancreas, intestine or
more than one organ and stratified each study based on the type of
transplanted organ, place of the study conduction, and size of patient
population. The overall estimated prevalence in SOT recipients was 7.4%
[95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant.
The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who
underwent transplantation for more than one organ. The prevalence among
other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1%
[95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2%
[95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas
3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data,
the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and
the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary,
CDI is a significant complication after SOT and preventive strategies are
important in order to reduce the CDI related morbidity and mortality.

<6>
Accession Number
2015012379
Authors
Navarese E.P. Andreotti F. Schulze V. Kolodziejczak M. Bufon A. Brouwer M.
Costa F. Kowalewski M. Parati G. Lip G.Y.H. Kelm M. Valgimigli M.
Institution
(Navarese, Schulze, Kolodziejczak, Kelm) Department of Internal Medicine,
Division of Cardiology, Pulmonology and Vascular Medicine,
Heinrich-Heine-University, Dusseldorf 40225, Germany
(Navarese, Andreotti, Schulze, Kolodziejczak, Bufon, Brouwer, Kowalewski,
Lip, Kelm) Systematic Investigation and Research on Interventions and
Outcomes (SIRIO), MEDICINE Research Network, Dusseldorf, Germany
(Andreotti, Bufon) Department of Cardiovascular Science, Catholic
University, Rome, Italy
(Kolodziejczak) Collegium Medicum in Bydgoszcz, University of Nicolaus
Copernicus, Torun, Poland
(Brouwer) Department of Cardiology, University Medical Centre St Radboud,
Nijmegen, Netherlands
(Costa, Valgimigli) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Kowalewski) Department of Cardiology, 10th Military Research Hospital and
Polyclinic, Bydgoszcz, Poland
(Parati) Department of Cardiovascular, Neural and Metabolic Sciences, San
Luca Hospital, University of Milan-Bicocca, Milan, Italy
(Lip) Department of Cardiology, University of Birmingham, Centre for
Cardiovascular Sciences, Birmingham, United Kingdom
Title
Optimal duration of dual antiplatelet therapy after percutaneous coronary
intervention with drug eluting stents: Meta-analysis of randomised
controlled trials.
Source
BMJ (Online). 350 , 2015. Article Number: h1618. Date of Publication: 16
Apr 2015.
Publisher
BMJ Publishing Group
Abstract
OBJECTIVE: To assess the benefits and risks of short term (<12 months) or
extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12
month therapy, following percutaneous coronary intervention with drug
eluting stents. DESIGN: Meta-analysis of randomised controlled trials.
Data SOURCES: PubMed, Embase, Cumulative Index to Nursing and Allied
Health Literature, Scopus, Web of Science, Cochrane Library, and major
congress proceedings, searched from 1 January 2002 to 16 February 2015.
review METHODS: Trials comparing short term (<12 months) or extended (>12
months) DAPT regimens with standard 12 month duration of therapy. Primary
outcomes were cardiovascular mortality, myocardial infarction, stent
thrombosis, major bleeding, and all cause mortality. RESULTS: 10
randomised controlled trials (n=32 287) were included. Compared to 12
month DAPT, a short term course of therapy was associated with a
significant reduction in major bleeding (odds ratio 0.58 (95% confidence
interval 0.36 to 0.92); P=0.02) with no significant differences in
ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a
significant reduction in the odds of myocardial infarction (0.53 (0.42 to
0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but
more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not
cardiovascular death was also significantly increased (1.30 (1.02 to
1.66); P=0.03). CONCLUSIONS: Compared with a standard 12 month duration,
short term DAPT (<12 months) after drug eluting stent implementation
yields reduced bleeding with no apparent increase in ischaemic
complications, and could be considered for most patients. In selected
patients with low bleeding risk and very high ischaemic risk, extended
DAPT (>12 months) could be considered. The increase in all cause but not
cardiovascular death with extended DAPT requires further investigation.

<7>
Accession Number
2015961347
Authors
Drury N.E. Howell N.J. Calvert M.J. Weber R.J.M. Senanayake E.L. Lewis
M.E. Hyde J.A.J. Green D.H. Mascaro J.G. Wilson I.C. Graham T.R. Rooney
S.J. Viant M.R. Freemantle N. Frenneaux M.P. Pagano D.
Institution
(Drury, Howell, Senanayake, Mascaro, Wilson, Graham, Rooney, Pagano)
Department of Cardiothoracic Surgery, Queen Elizabeth Hospital Birmingham,
Birmingham, United Kingdom
(Drury, Howell, Senanayake, Pagano) School of Clinical and Experimental
Medicine, University of Birmingham, Birmingham, United Kingdom
(Calvert) School of Health and Population Sciences, University of
Birmingham, Birmingham, United Kingdom
(Weber, Viant) Centre for Systems Biology, School of Biosciences,
University of Birmingham, Birmingham, United Kingdom
(Lewis, Hyde) Department of Cardiothoracic Surgery, Royal Sussex County
Hospital, Brighton, United Kingdom
(Green) Department of Cardiac Anesthesia, Queen Elizabeth Hospital
Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Frenneaux) School of Medicine, University of Aberdeen, Aberdeen, United
Kingdom
Title
The effect of perhexiline on myocardial protection during coronary artery
surgery: A two-centre, randomized, double-blind, placebo-controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 47 (3) (pp 464-472), 2015.
Article Number: ezu238. Date of Publication: 01 Mar 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Perhexiline is thought to modulate metabolism by inhibiting
mitochondrial carnitine palmitoyltransferase-1, reducing fatty acid uptake
and increasing carbohydrate utilization. This study assessed whether
preoperative perhexiline improves markers of myocardial protection in
patients undergoing coronary artery bypass graft surgery and analysed its
effect on the myocardial metabolome. METHODS: In a prospective,
randomized, double-blind, placebo-controlled trial, patients at two
centres were randomized to receive either oral perhexiline or placebo for
at least 5 days prior to surgery. The primary outcome was a low cardiac
output episode in the first 6 h. All pre-specified analyses were conducted
according to the intention-to-treat principle with a statistical power of
90% to detect a relative risk of 0.5 and a conventional one-sided
alpha-value of 0.025. A subset of pre-ischaemic left ventricular biopsies
was analysed using mass spectrometrybased metabolomics. RESULTS: Over a
3-year period, 286 patients were randomized, received the intervention and
were included in the analysis. The incidence rate of a low cardiac output
episode in the perhexiline arm was 36.7% (51/139) vs 34.7% (51/147) in the
control arm [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.56-1.50,
P = 0.74]. Perhexiline was associated with a reduction in the cardiac
index at 6 h [difference in means 0.19, 95% CI 0.07-0.31, P = 0.001] and
an increase in inotropic support in the first 12 h (OR 0.55, 95% CI
0.34-0.89, P = 0.015). There were no significant differences in myocardial
injury with troponin-T or electrocardiogram, reoperation, renal
dysfunction or length of stay. No difference in the preischaemic left
ventricular metabolism was identified between groups onmetabolomics
analysis. CONCLUSIONS: Preoperative perhexiline does not improve
myocardial protection in patients undergoing coronary surgery and in fact
reduced perioperative cardiac output, increasing the need for inotropic
support. Perhexiline has no significant effect on the mass spectrometry-
visible polar myocardial metabolome in vivo in humans, supporting the
suggestion that it acts via a pathway that is independent of myocardial
carnitine palmitoyltransferase inhibition and may explain the lack of
clinical benefit observed following surgery.

<8>
Accession Number
2015961344
Authors
Colak Z. Borojevic M. Bogovic A. Ivancan V. Biocina B. Majeric-Kogler V.
Institution
(Colak, Ivancan, Majeric-Kogler) Department of Anesthesiology,
Reanimatology and Intensive Care Medicine, University Hospital Center
Zagreb, Zagreb, Croatia
(Borojevic, Biocina) Department of Cardiac Surgery, University Hospital
Center Zagreb, Zagreb, Croatia
(Bogovic) Psychiatric Hospital Sv. Ivan, Zagreb, Croatia
Title
Influence of intraoperative cerebral oximetry monitoring on neurocognitive
function after coronary artery bypass surgery: A randomized, prospective
study.
Source
European Journal of Cardio-thoracic Surgery. 47 (3) (pp 447-454), 2015.
Article Number: ezu193. Date of Publication: 01 Mar 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Postoperative cognitive decline is common after cardiac
surgery, but it is often unrecognized at the time of hospital discharge.
However, it has a great impact on patient's quality of life. Cerebral
oximetry with the INVOS (IN Vivo Optical Spectroscopy) system provides the
possibility of non-invasive, continuous measurement of regional cerebral
oxygen saturation (rSO<inf>2</inf>), which can improve patients' outcome.
The aim of this study was to examine whether cerebral oximetry can
decrease the incidence of cognitive decline after coronary artery bypass
grafting. METHODS: We have performed a prospective, randomized study with
200 patients enrolled. Patients were divided into INVOS interventional
group and CONTROL group without monitoring of cerebral oximetry. A
standardized interventional protocol was performed in the INVOS group to
maintain rSO<inf>2</inf> above 80% of the patient's baseline value or
above 50% of the absolute value. Cognitive evaluation was performed in all
patients before and 7 days after surgery. Logistic regression was used to
reveal predictors of cognitive decline. RESULTS: The incidence of
cognitive decline 7 days after surgery was significantly lower (P = 0.002)
in the INVOS interventional group (28%) than in the CONTROL group (52%).
Intraoperative use of INVOS monitoring was associated with lower incidence
of cognitive decline (odds ratio 0.21). In addition, predictors of
cognitive decline revealed by multivariate logistic regression were older
age, higher EuroSCORE and SAPS II (Simplified Acute Physiology Score)
values, lower educational level and persistence of preoperative atrial
fibrillation. Patients with prolonged rSO<inf>2</inf> desaturation,
defined as rSO<inf>2</inf> area under the curve (AUC) of more than 150
min% for desaturation below 20% of baseline or AUC of more than 50 min%
for desaturation below 50% absolute value, had an increased risk of
cognitive decline. CONCLUSION: Postoperative cognitive outcome was
significantly better in patients with intraoperative cerebral oximetry
monitoring. Prolonged rSO<inf>2</inf> desaturation is a predictor of
cognitive decline and has to be avoided.

<9>
Accession Number
2015961338
Authors
Deppe A.-C. Liakopoulos O.J. Kuhn E.W. Slottosch I. Scherner M. Choi Y.-H.
Rahmanian P.B. Wahlers T
Institution
(Deppe, Kuhn, Slottosch, Scherner, Choi, Rahmanian, Wahlers) Department of
Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne,
Germany
(Liakopoulos) Department of Cardiothoracic Surgery, Heart Center,
University of Essen, Essen, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Minimally invasive direct coronary bypass grafting versus percutaneous
coronary intervention for single-vessel disease: A meta-analysis of 2885
patients.
Source
European Journal of Cardio-thoracic Surgery. 47 (3) (pp 397-406), 2015.
Article Number: ezu285. Date of Publication: 01 Mar 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Percutaneous coronary intervention (PCI) and minimally invasive direct
coronary artery bypass (MIDCAB) grafting are both established therapeutic
options for single-vessel disease of the left anterior descending artery
(LAD). The present systematic review with meta-analysis aims to determine
the current strength of evidence for or against PCI and MIDCAB for
revascularization of the LAD. Therefore, we performed a meta-analysis of
randomized, controlled trials (RCTs) and observational trials (OTs) that
reported clinical outcome after isolated LAD revascularization. Analysed
postoperative outcomes included major adverse cardiac and cerebrovascular
events (MACCEs), all-cause mortality, myocardial infarction and stroke.
Pooled treatment effects [odds ratio (OR) or weighted mean difference
(WMD), 95% confidence intervals (95% CI)] were assessed using a fixed- or
random-effects model. A total of 2885 patients from 12 studies (6 RCTs, 6
OTs) were identified after a literature search of major databases using a
predefined list of keywords. PCI of the LAD was performed in 60.7% (n =
1751) and MIDCAB in 39.3% of patients (n = 1126). Pooled-effect estimates
revealed an increased incidence for MACCEs after PCI (OR 1.98; 95% CI
1.45-2.69; P < 0.0001) 6 months after the procedure. Especially, PCI was
particularly associated with an increased odds for target vessel
revascularization (OR 2.11; 95% CI 1.00-4.47; P = 0.0295). No differences
with regard to stroke, myocardial infarction and allcause mortality were
observed between both revascularization strategies. Patients after PCI had
a shorter length of hospital stay (WMD -3.37 days; 95% CI (-)4.92 to
(-)1.81; P < 0.0001). In conclusion, the present systematic review
underscores the superiority of MIDCAB over PCI for treatment of
single-vessel disease of the LAD.

<10>
Accession Number
2015961377
Authors
Gopal S. Luckraz H. Giri R. Nevill A. Muhammed I. Reid M. Bickerton S.
Jenkins D.
Institution
(Gopal, Bickerton, Jenkins) Department of Intensive Care, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Luckraz, Muhammed) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Giri) Department of Cardiothoracic Anaesthesiology, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Nevill) University of Wolverhampton, Wolverhampton, United Kingdom
(Reid) Department of Infection Control, Heart and Lung Centre,
Wolverhampton, United Kingdom
Title
Significant reduction in ventilator-associated pneumonia with the
venner-pneux system in high-risk patients undergoing cardiac surgery: The
low ventilator-associated-pneumonia study.
Source
European Journal of Cardio-thoracic Surgery. 47 (3) (pp e92-e96), 2015.
Article Number: ezu483. Date of Publication: 01 Mar 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: This study assessed whether the Venner-PneuX endotracheal tube
(ET) system, which has sub-glottic suction as well as irrigation ports and
continuous cuff-pressure monitoring, is associated with a reduction in
ventilator-associated pneumonia (VAP) when compared with the standard ET
in high-risk patients undergoing cardiac surgery. METHODS: This was a
single-institution, prospective, randomized control trial. Patients were
categorized as either Group A (Venner- PneuX ET tube, n = 120) or Group B
(Standard ET tube, n = 120). Inclusion criteria included patients over the
age of 70 years and/or impaired left ventricular function (LVEF <50%)
undergoing cardiac surgery. Patients were monitored for VAP for up to 48 h
post extubation and the diagnosis of VAP was according to the centres for
disease control definition. RESULTS: There were no significant differences
in the patients' demographics. The mean (SD) ages for the two groups were
72.4 (8.2) and 72.1 (7.4) years (P = 0.6), respectively. The mean
EuroSCORE was 6.39 (2.2) for Group A and 6.48 (2.6) for Group B (P = 0.9).
The median intubation times were 14.7 (7.3, 2927.2) h and 13 (2.5, 528.7)
h, respectively. VAP incidence was significantly lower in the Venner-PneuX
ET group, being 10.8% when compared with 21% in the standard ET group (P =
0.03). There was no significant difference between the two groups in terms
of intensive care unit stay (P = 0.2) and in-hospital mortality (P = 0.2).
A binary logistic regression analysis (type of ET tube, age, LVEF, history
of lung disease, smoking history, surgical procedure, EuroSCORE,
cardiopulmonary bypass time, blood transfusion, intubation duration among
others) confirmed that the Venner-PneuX ET tube was associated with
significant VAP reduction (Odds ratio 0.45, P = 0.03). CONCLUSIONS: The
Venner-PneuX VAP prevention system is associated with a significant
reduction in VAP. This can potentially lead to significant cost reductions
and should be implemented as part of the VAP reduction bundle.

<11>
Accession Number
2015957884
Authors
Jelkmann I. Jelkmann W.
Institution
(Jelkmann) Department of Surgery, University of Lubeck, Germany
(Jelkmann) Institute of Physiology, University of Lubeck, Ratzeburger
Allee 160, Lubeck 23562, Germany
Title
Impact of erythropoietin on intensive care unit patients.
Source
Transfusion Medicine and Hemotherapy. 40 (5) (pp 310-318), 2013. Date of
Publication: 2013.
Publisher
S. Karger AG
Abstract
Anemia is common in intensive care unit (ICU) patients. Red blood cell
(RBC) transfusions are mainstays of their treatment and can be
life-saving. Allogeneic blood components inherently bear risks of
infection and immune reactions. Although these risks are rare in developed
countries, recombinant human erythropoietin (rhEpo) and other
erythropoiesis-stimulating agents (ESAs) have been considered alternative
anti-anemia treatment options. As summarized herein, however, most of the
clinical studies suggest that ESAs are not usually advisable in ICU
patients unless approved indications exist (e.g., renal disease). First,
ESAs act in a delayed way, inducing an increase in reticulocytes only
after a lag of 3-4 days. Second, many critically ill patients present with
ESA resistance as inflammatory mediators impair erythropoietic cell
proliferation and iron availability. Third, the ESA doses used for
treatment of ICU patients are very high. Fourth, ESAs are not legally
approved for general use in ICU patients. Solely in distinct cases, such
as Jehovah's Witnesses who refuse allogeneic blood transfusions due to
religious beliefs, ESAs may be considered an exceptional therapy.

<12>
Accession Number
2015006435
Authors
Lee J.M. Park K.W. Koo B.-K. Kim H.-S.
Institution
(Lee, Park, Koo, Kim) Department of Internal Medicine, Cardiovascular
Center, Seoul National University Hospital, 101 DaeHak-Ro, JongRo-Gu,
Seoul 110-744, South Korea
(Koo) Institute of Aging, Seoul National University, Seoul, South Korea
Title
Stenting of Coronary Bifurcation Lesions: a Literature and Technical
Review.
Source
Current Cardiology Reports. 17 (6) , 2015. Date of Publication: 01 Jun
2015.
Publisher
Current Medicine Group LLC 1
Abstract
Newer generation drug-eluting stents have improved outcomes in various
subsets of coronary lesions including bifurcation lesions. This article
reviews the current literature on various issues in bifurcation
percutaneous coronary intervention (PCI). Generally, the provisional
approach of placing one stent in the main vessel is the preferred
first-line treatment for most bifurcation lesions. However, some lesions
require 2-stenting. It is unknown whether 2nd-generation DES have improved
outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the
assessment of functional significance of the jailed side branch can help
avoid unnecessary stenting in complex lesions. Skilled techniques in every
step of the 2-stenting process and meticulous use of imaging techniques
including IVUS or OCT are warranted to obtain optimal angiographic and
clinical results. Dedicated bifurcation stents are feasible treatment
options and may change future concepts in bifurcation PCI, although larger
trials with control groups are required in order to widely apply these
techniques into daily routine practice.

<13>
Accession Number
2015976404
Authors
Watkins S. Oldroyd K.G. Preda I. Holmes D.R. Colombo A. Morice M.-C.
Leadley K. Dawkins K.D. Mohr F.W. Serruys P.W. Feldman T.E. Kornowski R.
Institution
(Watkins, Oldroyd) Golden Jubilee National Hospital, Department of
Cardiology, Agamemnon Street, Clydebank, Glasgow G81 4DY, United Kingdom
(Preda) National Health Service Centre, Budapest, Hungary
(Holmes) Mayo Clinic, Rochester, MN, United States
(Colombo) San Rafffaele Scientific Institute, Milan, Italy
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Leadley, Dawkins) Boston Scientific, Marlborough, MA, United States
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
(Serruys) Erasmus University Medical Centre, Rotterdam, Netherlands
(Feldman) Evanston Hospital, Evanston, IL, United States
(Kornowski) Department of Cardiology, Rabin Medical Center, Petach Tikva,
Israel
Title
Five-year outcomes of staged percutaneous coronary intervention in the
SYNTAX study.
Source
EuroIntervention. 10 (12) (pp 1402-1408), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: The SYNTAX study compared PCI with TAXUS Express stents to CABG for
the treatment of de novo 3-vessel and/or left main coronary disease. This
study aimed to determine patient characteristics and five-year outcomes
after a staged PCI strategy compared to single-session PCI. Methods and
results: In the SYNTAX trial, staged procedures were discouraged but were
allowed within 72 hours or, if renal insufficiency or contrast-induced
nephropathy occurred, within 14 days (mean 9.8+/-18.1 days post initial
procedure). A total of 125 (14%) patients underwent staged PCI. These
patients had greater disease severity and/or required a more complex
procedure. MACCE was significantly increased in staged patients (48.1% vs.
35.5%, p=0.004), as was the composite of death/stroke/MI (32.2% vs. 19%,
p=0.0007). Individually, cardiac death and stroke occurred more frequently
in the staged PCI group (p=0.03). Repeat revascularisation was
significantly higher in staged patients (32.8% vs 24.8%, p=0.035), as was
stent thrombosis (10.9% vs. 4.7%, p=0.005). Conclusions: There is a higher
incidence of MACCE in patients undergoing staged compared to
single-session PCI for 3-vessel and/or left main disease over the first
five years of follow-up. However, these patients had more comorbidities
and more diffuse disease.

<14>
Accession Number
2015958498
Authors
Sousa-Uva M.
Institution
(Sousa-Uva) Membro do Corpo Redatorial da Revista Portuguesade
Cardiologia, Portugal
Title
Comment on "Surgical treatment of moderate ischemic mitral regurgitation".
Source
Revista Portuguesa de Cardiologia. 34 (4) (pp 305-307), 2015. Article
Number: 621. Date of Publication: 01 Apr 2015.
Publisher
Sociedade Portuguesa de Cardiologia

<15>
[Use Link to view the full text]
Accession Number
2015938004
Authors
Wang A. Sangli C. Lim S. Ailawadi G. Kar S. Herrmann H.C. Grayburn P.
Foster E. Weissman N.J. Glower D. Feldman T.
Institution
(Wang) Department of Medicine, Duke University Medical Center, Durham, NC
27710, United States
(Glower) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Sangli) Abbott Vascular Structural Heart, Menlo Park, CA, United States
(Lim) Department of Medicine, University of Virginia, Charlottesville, VA,
United States
(Ailawadi) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Kar) Department of Medicine, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Grayburn) Department of Cardiology, Baylor University Medical Center,
Baylor Heart and Vascular Institute, Dallas, TX, United States
(Foster) Department of Medicine, University of California, San Francisco,
CA, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Feldman) Department of Medicine, Evanston Hospital, NorthShore University
Health System, Evanston, IL, United States
Title
Evaluation of renal function before and after percutaneous mitral valve
repair.
Source
Circulation: Cardiovascular Interventions. 8 (1) , 2015. Article Number:
e001349. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Chronic kidney disease (CKD) is strongly related to outcome in
cardiovascular diseases. The relationship between treatment of mitral
regurgitation (MR) and renal function is not well described. We sought to
evaluate renal function before and after mitral valve repair by the
MitraClip device. Methods and Results-Patients with moderate-to-severe or
severe (3+ or 4+, respectively) MR by core laboratory determination who
underwent transcatheter mitral valve repair with the MitraClip device in
multicenter, investigational trials were included in this study. Estimated
glomerular filtration rate (eGFR) was evaluated before and at hospital
discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight
hundred fifty-four patients with baseline mean eGFR 61.5+/-23.1
mL/min/1.73 m<inf>2</inf> were studied, including 438 (51.3%) with eGFR
>60 mL/min/1.73 m<inf>2</inf> (CKD stage 1 or 2), 371 (42.6%) with eGFR 30
to 59 mL/min/1.73 m<inf>2</inf> (CKD stage 3), and 52 (6.1%) with eGFR <30
mL/min/1.73 m<inf>2</inf> (CKD stage 4 or 5). Baseline renal dysfunction
was more prevalent in older patients with a history of heart failure,
coronary artery disease, cerebrovascular disease, diabetes mellitus,
hypertension, and atrial fibrillation. Baseline eGFR was associated with
1-year survival (P<0.001) after MitraClip repair. At 1-year follow-up, the
mean change in eGFR for the overall cohort was -1.0+/-15.1 mL/min/1.73
m<inf>2</inf>; for patients with CKD stage 1 or 2, stage 3, or stage 4 or
5, mean change was -4.1+/-16.6, +2.6+/-12.4, and +4.8+/-9.5 mL/min/1.73
m<inf>2</inf>, respectively. Linear mixed effect modeling demonstrated a
strong association between MR and eGFR, and a statistically significant
improvement in eGFR in patients with CKD stage 4 or 5 associated with MR
reduction to <2+ (P=0.007). Conclusions-Renal dysfunction is associated
with lower survival in patients with severe MR even after percutaneous
mitral valve repair. Reduction in MR severity by the MitraClip device is
associated with improvement in renal function at 1 year in patients with
baseline renal dysfunction.

<16>
Accession Number
2015878308
Authors
Ruiz-Garcia J. Teles R. Rumoroso J.-R. Cyrne Carvalho H. Goicolea F.J.
Moreu J. Mauri J. Mainar V. Garcia E. Moreno R.
Institution
(Ruiz-Garcia, Moreno) Seccion de Hemodinamica y Cardiologia
Intervencionista, Servicio de Cardiologia, Hospital Universitario La Paz,
Madrid, Spain
(Ruiz-Garcia) Servicio de Cardiologia, Hospital Universitario Quiron,
Madrid, Spain
(Ruiz-Garcia) Servicio de Cardiologia, Hospital Universitario de Torrejon,
Madrid, Spain
(Teles) Servicio de Cardiologia, Hospital de Santa Cruz, Lisboa, Portugal
(Rumoroso) Servicio de Cardiologia, Hospital de Galdakao, Bilbao, Spain
(Cyrne Carvalho) Servicio de Cardiologia, Hospital de Santo Antonio,
Porto, Portugal
(Goicolea) Servicio de Cardiologia, Hospital Puerta de Hierro,
Majadahonda, Spain
(Moreu) Servicio de Cardiologia, Hospital Virgen de la Salud, Toledo,
Spain
(Mauri) Servicio de Cardiologia, Hospital German Trias i Pujol, Badalona,
Spain
(Mainar) Servicio de Cardiologia, Hospital General, Alicante, Spain
(Garcia) Servicio de Cardiologia, Hospital Clinico San Carlos, Madrid,
Spain
Title
Comparison between diabetic and non-diabetic patients after successful
percutaneous coronary intervention for chronic total occlusions in the
drug-eluting stent era.
Source
Revista Portuguesa de Cardiologia. 34 (4) (pp 263-270), 2015. Article
Number: 619. Date of Publication: 01 Apr 2015.
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Abstract Objective Diabetes mellitus and chronic total occlusions are
associated with unfavorable outcome after percutaneous coronary
intervention. We sought to assess the clinical and angiographic outcomes
of diabetic and non-diabetic patients who underwent successful
percutaneous revascularization of chronic total occlusions with
drug-eluting stents. Methods Baseline clinical and angiographic
characteristics, procedural details, nine-month angiographic follow-up and
clinical events at 12 months were compared between 75 diabetic and 132
non-diabetic patients included in a clinical trial that randomized
successful recanalization of chronic total occlusions to receive
sirolimus- or everolimus-eluting stents. Results In both diabetic and
non-diabetic groups there was a favorable non-significantly different
angiographic result at nine months, with low in-stent late loss
(0.14+/-0.60 mm vs. 0.25+/-0.68 mm, p=0.305) and rates of binary
restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%,
p=0.334). During follow-up similar survival from death (97.3+/-1.9% vs.
99.2+/-0.8%, log-rank p=0.273), acute myocardial infarction (100.0+/-0.0%
vs. 97.7+/-1.3%, log-rank p=0.192), target vessel revascularization
(88.7+/-3.8% vs. 88.2+/-2.9%, log-rank p=0.899) and stent thrombosis
(100.0+/-0.0% vs. 97.7+/-1.3%, log-rank p=0.192) was observed.
Furthermore, the presence of more diffuse peripheral and coronary artery
disease and higher frequency of calcified lesions in diabetic patients did
not lead to significant differences in the approach (20.0% vs. 25.0%
radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy,
p=0.353), total stent length (48.1+/-24.6 mm vs. 49.2+/-23.9 mm, p=0758)
or contrast volume (261.3+/-116.4 ml vs. 297.4+/-135.9 ml, p=0.109)
required for revascularization. Conclusions In the drug-eluting stent era,
diabetic and non-diabetic patients have comparable favorable clinical and
angiographic outcomes after successful percutaneous revascularization of
chronic total occlusions.

<17>
Accession Number
2015781567
Authors
Hogan M. Needham A. Ortmann E. Bottrill F. Collier T.J. Besser M.W. Klein
A.A.
Institution
(Hogan, Bottrill, Klein) Department of Anaesthesia and Intensive Care,
Papworth Hospital, Cambridge, United Kingdom
(Needham) Department of Research and Development, Papworth Hospital,
Cambridge, United Kingdom
(Ortmann) Department of Anaesthesia and Intensive Care, Kerckhoff -Klinik,
Bad Nauheim, Germany
(Collier) Department of Statistics, London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Besser) Cambridge University Hospitals Cambridge Biomedical Campus,
Cambridge, United Kingdom
Title
Haemoconcentration of residual cardiopulmonary bypass blood using
Hemosep: A randomised controlled trial.
Source
Anaesthesia. 70 (5) (pp 563-570), 2015. Date of Publication: 01 May 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac surgery and cardiopulmonary bypass are associated with
haemodilution, activation of haemostasis and blood transfusion. We
undertook a randomised controlled trial that included 53 patients in order
to compare autotransfusion of residual cardiopulmonary bypass blood with
residual blood concentrated using the novel Hemosep device.
There was no difference in patients' mean (SD) haemoglobin concentration
after autotransfusion of unprocessed blood compared with Hemosep; 103.5
(10.2) g.l^-1 vs 106.2 (12.4) g.l^-1, respectively, p
= 0.40. The mean (SD) change in haemoglobin concentration after
autotransfusion was 5.9 (5.3) g.l^-1 in the control group
compared with 4.9 (6.3) g.l^-1 in the Hemosep group, p = 0.545.
Adjusted for baseline haemoglobin concentrations, the estimated mean (95%
CI) difference in change in haemoglobin concentration (control vs Hemosep)
was 0.57 (-2.65 to 3.79) g.l^-1, p = 0.72. This was despite
Hemosep's reducing the weight of the blood from a mean (SD) of 778.7
(243.0) g to 607.3 (248.2) g, p < 0.001. The haemoglobin concentration in
the processed blood increased from a mean (SD) of 87.0 (15.1)
g.l^-1 to 103.7 (17.4) g.l^-1, p < 0.001. We conclude
that Hemosep is capable of haemoconcentration when employed to process
residual cardiopulmonary bypass blood, but that this is insufficient to
increase patient haemoglobin.

<18>
Accession Number
2015765002
Authors
White H.D. Bhatt D.L. Gibson C.M. Hamm C.W. Mahaffey K.W. Price M.J. Steg
P.G. Stone G.W. Cortese B. Wilensky M. Deliargyris E.N. Liu T. Prats J.
Harrington R.A.
Institution
(White) Green Lane Cardiovascular Service, Auckland City Hospital, Private
Bag 92024, Victoria Street West, Auckland 1142, New Zealand
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Gibson) Beth Israel Hospital, Boston, MA, United States
(Hamm) University of Giessen, Kerckhoff Heart Center, Bad Nauheim, Germany
(Mahaffey, Harrington) Department of Medicine, Stanford University, School
of Medicine, Stanford, CA, United States
(Price) Scripps Clinic and Scripps Translational Science Institute, San
Diego, CA, United States
(Steg) Institut National de la Sante, Recherche Medicale-Unite 114, Paris,
France
(Steg) Assistance Publique-Hopitaux de Paris, Hopital Bichat, Paris,
France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
(Steg) Royal Brompton Hospital, London, United Kingdom
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
(Cortese) Interventional Cardiology, A.O. Fatebenefratelli, Bastioni di
Porta Nuova, Milan, Italy
(Wilensky) Cardiology PC, Birmingham, AL, United States
(Deliargyris, Liu, Prats) Medicines Company, Parsippany, United States
Title
Outcomes with cangrelor versus clopidogrel on a background of bivalirudin:
Insights from the CHAMPION PHOENIX (A clinical trial comparing cangrelor
to clopidogrel standard therapy in subjects who require percutaneous
coronary intervention [PCI]).
Source
JACC: Cardiovascular Interventions. 8 (3) (pp 424-433), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this study was to examine the efficacy and bleeding
outcomes of cangrelor in patients in the CHAMPION PHOENIX (A Clinical
Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who
Require Percutaneous Coronary Intervention [PCI]) who underwent
percutaneous coronary intervention with bivalirudin. Background Cangrelor
is a potent intravenous P2Y<inf>12</inf> inhibitor with rapid onset and
offset. In the CHAMPION PHOENIX, cangrelor compared with clopidogrel
significantly reduced 48-h ischemic events including stent thrombosis,
without increasing major bleeding. Bivalirudin has demonstrated ischemic
outcomes similar to those with heparin plus glycoprotein IIb/IIIa
inhibition, with reduced bleeding but increased early stent thrombosis.
Methods In the modified intent-to-treat population, 2,059 patients (18.8%)
received bivalirudin, with 1,014 patients in the cangrelor treatment arm
and 1,045 in the clopidogrel treatment arm. Results At 48 h, the primary
endpoint of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis was lower with cangrelor versus
clopidogrel (48 [4.7%] vs. 70 [6.7%]; odds ratio [OR]: 0.68, p = 0.047).
Death was similar in both arms (2 [0.2%] vs. 2 [0.2%]). Myocardial
infarction was reduced by cangrelor (37 [3.6%] vs. 59 [5.6%]; OR: 0.63, p
= 0.03), as was death/myocardial infarction (39 [3.8%] vs. 61 [5.8%]; OR:
0.65, p = 0.04). Cangrelor was associated with a nonsignificant trend
toward less stent thrombosis (7 [0.7%] vs. 15 [1.4%]; OR: 0.48, p = 0.10),
which was evident within 2 h after percutaneous coronary intervention (p =
0.057). GUSTO (Global Use of Strategies to Open Occluded Arteries) severe
bleeding was similar in both arms (2 of 1,021 [0.2%] vs. 2 of 1,055
[0.2%]) as were other bleeding definitions and transfusions. Efficacy and
safety results were consistent in patients with stable angina,
non-ST-segment elevation acute coronary syndrome, and ST-segment elevation
myocardial infarction (p for interaction: 0.62 and 0.29). Conclusions
Cangrelor may offer an attractive benefit risk profile when used in
combination with bivalirudin.

<19>
Accession Number
2015952654
Authors
Jiang B. Wang J. Lv X. Cai W.
Institution
(Jiang, Wang) Departments of Radiology, BenQ Medical Center, Nanjing
Medical University, 71 Hexi Street, Nanjing, Jiangsu 210019, China
(Lv) Departments of Interventional Radiology, BenQ Medical Center, Nanjing
Medical University, Nanjing, China
(Cai) Departments of Cardiology, BenQ Medical Center, Nanjing Medical
University, Nanjing, China
Title
Prognostic value of cardiac computed tomography angiography in patients
with suspected coronary artery disease: A meta-analysis.
Source
Cardiology (Switzerland). 128 (4) (pp 304-312), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Objectives: The diagnostic accuracy of cardiac computed tomography
angiography (CCTA) is well reported. The prognostic value of CCTA has been
described in several studies, but many of these were underpowered and an
update of the meta-analysis is necessary to increase the power to predict
rare events. The purpose of this study was to perform a meta-analysis of
the ability of CCTA to predict future cardiovascular events. Methods: We
searched multiple databases for longitudinal studies of CCTA with a
follow-up of at least 12 months of symptomatic patients with suspected
coronary artery disease (CAD) reporting major adverse cardiovascular
events (MACE), death, myocardial infarction and revascularization. Summary
test parameters and receiver-operating characteristic curves were
calculated. Results: Eighteen studies evaluated 29,243 patients with a
median follow-up of 25 months. For MACE in patients with negative findings
on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95%
confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI
1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of
0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI
22.20-1,139.80). The weighted average annualized MACE rate for positive
versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no
CAD, nonobstructive CAD or obstructive CAD, there were incrementally
increasing adverse events. Conclusions: Adverse cardiovascular events
among patients with normal findings on CCTA are rare. There are
incrementally increasing future MACE with increasing CAD by CCTA.

<20>
Accession Number
2015933038
Authors
Xia J. Qu Y. Shen H. Liu X.
Institution
(Xia) Medical School of Chinese People's Liberation Army, Xuanwu Hospital,
Beijing 100853, China
(Xia) Department of Cardiology, Xuanwu Hospital, Beijing 100853, China
(Qu) Department of Pathology, Beijing Chest Hospital, Capital Medical
University, Beijing 100853, China
(Shen) Department of Emergency, Chinese PLA General Hospital, Beijing
100853, China
(Liu) Department of Pathophysiology, Chinese PLA General Hospital,
Beijing, China
Title
Patients with stable coronary artery disease receiving chronic statin
treatment who are undergoing noncardiac emergency surgery benefit from
acute atorvastatin reload.
Source
Cardiology (Switzerland). 128 (3) (pp 285-292), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Objective: This study was designed to investigate whether patients with
stable coronary artery disease (CAD) receiving chronic statin treatment
who are undergoing noncardiac emergency surgery benefit from acute
atorvastatin reload. Methods: A total of 500 patients with stable CAD and
regular administration of statin before noncardiac emergency surgery were
randomized to atorvastatin reload (n = 250) or placebo (n = 250). All
patients received atorvastatin treatment thereafter. The primary end point
was a 30-day incidence of major adverse cardiac events (MACE). Secondary
end points were the incidence of atrial fibrillation (AF) during
hospitalization and length of hospital stay. Results: The primary end
point occurred in 2.4% of patients treated with atorvastatin reload and in
8% in the placebo arm (p = 0.0088). The incidence of AF during
hospitalization was 6.8% in patients treated with atorvastatin reload and
17% in the placebo arm (p = 0.0003). Compared with the placebo arm, the
atorvastatin reload arm shortened the length of stay (9.8 +/- 3.3 vs. 10.6
+/- 3.5 days, p = 0.009). Multivariable analysis suggested that
atorvastatin reload conferred a 65% risk reduction of 30-day MACE (odds
ratio 0.35, 95% confidence interval 0.18-0.86; p = 0.005). Conclusion: The
trial suggests that atorvastatin reload may improve the clinical outcome
of patients with stable CAD receiving chronic statin treatment who are
undergoing noncardiac emergency surgery.

<21>
Accession Number
2015931002
Authors
Wiebe J. Franke J. Lubos E. Boekstegers P. Schillinger W. Ouarrak T. May
A.E. Eggebrecht H. Kuck K.-H. Baldus S. Senges J. Sievert H.
Institution
(Wiebe, Franke, Sievert) CardioVascular Center Frankfurt, Seckbacher
Landstrasse 65, Frankfurt 60389, Germany
(Lubos) Universitares Herzzentrum, Hamburg, Germany
(Boekstegers) Department of Cardiology, Klinikum Siegburg, Germany
(Schillinger) Heart Center, Universitatsmedizin Gottingen, Germany
(Ouarrak, Senges) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(May) Department of Cardiology, Universitatsklinikum Tubingen, Germany
(Eggebrecht) Cardioangiologisches Centrum Bethanien - CCB, Frankfurt,
Germany
(Kuck) Department of Cardiology, Asklepios Klinik St. Georg, Hamburg,
Germany
(Baldus) Heart Center, Universitatsklinikum Koln, Germany
Title
Percutaneous mitral valve repair with the mitraclip system according to
the predicted risk by the logistic EuroSCORE: Preliminary results from the
German Transcatheter Mitral Valve Interventions (TRAMI) registry.
Source
Catheterization and Cardiovascular Interventions. 84 (4) (pp 591-598),
2014. Date of Publication: 01 Oct 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective To evaluate in-hospital and short-term outcomes of percutaneous
mitral valve repair according to patients' logistic EuroSCORE
(logEuroSCORE) in a multicenter registry Background The logEuroSCORE is an
established tool to predict the risk of mortality during cardiac surgery.
In high-risk patients percutaneous mitral valve repair with the MitraClip
system represents a less-invasive alternative Methods Data from 1002
patients, who underwent percutaneous mitral valve repair with the
MitraClip system, were analyzed in the German Transcatheter Mitral Valve
Interventions (TRAMI) Registry. A logEuroSCORE (mortality risk in %) > 20
was considered high risk Results Of all patients, 557 (55.6%) had a
logEuroSCORE > 20. Implantation of the MitraClip was successful in 95.5 %
(942/986) patients. Moderate residual mitral valve regurgitation was more
often detected in patients with a logEuroSCORE > 20 (23.8% vs. 17.1%,
respectively, P < 0.05). In patients with a logEuroSCORE > 20 the
procedural complication rate was 8.9% (vs. 6.4, n.s.) and the in-hospital
MACCE rate 4.9% (vs. 1.4% P < 0.01). The in-hospital mortality rate in
patients with a logEuroSCORE > 20 and logEuroSCORE < 20 was 4.3 and 1.1%,
respectively (P < 0.01) Conclusion Percutaneous mitral valve repair with
the MitraClip system is feasible in patients with a logEuroSCORE > 20 with
similar procedural results compared to patients with lower predicted risk.
Although mortality was four times higher than in patients with
logEuroSCORE < 20, mortality in high risk patients was lower than
predicted. In those with a logEuroSCORE > 20, moderate residual mitral
valve regurgitation was more frequent.

<22>
Accession Number
2015952576
Authors
Shan L. Saxena A. McMahon R.
Institution
(Shan) Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Melbourne, VIC, Australia
(Saxena, McMahon) Cardiology Unit, South Eastern Sydney and Illawarra
Health Network, Wollongong, NSW 2500, Australia
Title
A systematic review on the quality of life benefits after percutaneous
coronary intervention in the elderly.
Source
Cardiology (Switzerland). 129 (1) (pp 46-54), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Aims: Percutaneous coronary intervention (PCI) is being increasingly
performed on elderly patients with acceptable peri-procedural outcomes and
long-term survival. We aim to systematically review the health-related
quality of life (HRQOL) following PCI in the elderly which is an important
measure of procedural success. Methods: A systematic review of clinical
studies before September 2012 was performed to identify HRQOL in the
elderly after PCI. Strict inclusion and exclusion criteria were applied.
Quality appraisal of each study was also performed using pre-defined
criteria. HRQOL results were synthesised through a narrative review with
full tabulation of results of all included studies. Results: Elderly
patients have significant improvements in cardiovascular well-being. Early
HRQOL appears improved from baseline, but recovery in physical health may
be slower than in younger patients. HRQOL is comparable to an age-matched
general population and younger patients undergoing PCI. Conservative
management is not able to offer the same HRQOL benefits. Coronary artery
bypass graft surgery may be superior to PCI in the very elderly.
Significant heterogeneity and bias exists. Lack of appropriate data
precluded meta-analysis. Conclusion: HRQOL after PCI in the elderly can
improve for at least 1 year across a broad range of health domains, and is
comparable to an age-matched general population and younger patients
undergoing PCI. Given a limited number of articles and patients included,
more prospective studies are needed to better identify the benefits for
elderly patients.

<23>
Accession Number
2014968024
Authors
Iannaccone A. Marwick T.H.
Institution
(Iannaccone, Marwick) Menzies Research Institute Tasmania, 17 Liverpool
St, Hobart, TAS 7000, Australia
Title
Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with
Medical Management or Surgery for Patients with Aortic Stenosis.
Source
Applied Health Economics and Health Policy. 13 (1) (pp 29-45), 2014. Date
of Publication: 2014.
Publisher
Springer International Publishing
Abstract
Background: In the symptomatic patient, severe aortic stenosis (AS) has an
extremely adverse prognosis in the absence of valve replacement,
inevitably leading to deterioration of heart function, heart failure, and
death. However, many patients with severe AS, advanced age, and comorbid
disease may die with AS rather than from AS. While the results of surgical
aortic valve replacement (SAVR) are extremely favorable, this technique is
not always possible because of either local- or patient-level
contraindications. Over the last decade, transcatheter aortic valve
replacement (TAVR) has emerged as a new treatment strategy for selected
patients with AS. It has now become the standard of care for extremely
high-risk (inoperable) patients with AS, and is an appropriate alternative
to surgery in high-risk but operable patients. However, whether this
intervention is a cost-effective use of resources is open to question.
Aim: The aim of this review was to assess the results and quality of the
economic evaluations in the current literature and to identify the drivers
of cost effectiveness.
Methods: We performed an electronic data search using four different
electronic databases, selecting all studies that included
cost-effectiveness data for TAVR compared with either medical management
or surgery. Sixteen studies were evaluated for a qualitative and
quantitative assessment.
Results: The quality of the cost-effectiveness analyses (CEAs) were
generally sufficient. In contrast, we found an extreme heterogeneity of
input assumptions with consequent difficulties to generalize the
conclusions. However, in the population of patients with severe
symptomatic AS and a prohibitive surgical risk, TAVR generally represents
a good choice, with incremental costs that are well balanced by the great
benefit in terms of quality of life and survival. Nevertheless, the cost
effectiveness of this procedure in the real world, particularly in
patients with high healthcare costs from other comorbid conditions, may be
less favorable. In AS patients with high (but not prohibitive) surgical
risk, the choice between TAVR and SAVR is still debatable. Both procedures
are comparable in terms of efficacy and safety but the evidence is
inconclusive from an economic point of view.
Conclusions: On the basis of this review, it was ascertained that the
details of risk evaluation and patient selection will be critical in
understanding how improvements in survival can be used to target the use
of TAVR to ensure the cost-effective and sustainable use of resources.

<24>
[Use Link to view the full text]
Accession Number
2014705078
Authors
Peral S.C. Burkharte H.M. Nelsona T.J.
Institution
(Peral, Nelsona) Division of General Internal Medicine, Rochester, MN,
United States
(Peral, Nelsona) Department of Molecular Pharmacology and Experimental
Therapeutics, Rochester, MN, United States
(Nelsona) Transplant Center, Rochester, MN, United States
(Nelsona) Department of Medicine, Mayo Clinic, 200 First Street SW,
Rochester, MN 55905, United States
(Burkharte) Pediatric Cardiothoracic Surgery, University of Oklahoma,
Norman, OK, United States
Title
Utilization of stem cells to treat congenital heart disease: Hype and
hope.
Source
Current Opinion in Pediatrics. 26 (5) (pp 553-560), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Surgical advances over the past few decades have
transformed the clinical management of congenital heart disease, such as
hypoplastic left heart syndrome. Congenital heart disease affects more
than 1% of liveborn infants and accounts for more than 2.5 million
affected children per year worldwide. The cost and availability of complex
medical management for these children becomes bluntly realized when heart
failure progresses and only palliative options remain. Cell-based cardiac
regeneration has been the focus of intensive efforts in adult heart
disease for more than a decade and now has promise for pediatrics. Recent
findings Innate cardiac regeneration in the pediatric setting is
measurable and potentially modifiable in the early stages of development.
Repurposing cell-based manufactured products to promote cardiac
regeneration in congenital heart disease has demonstrated significant
improvement in cases of dilated cardiomyopathy and structural heart
disease in infants. Summary A focus on preemptive cardiac regeneration in
the pediatric setting may offer new insights into the timing of surgery,
location of cell-based delivery, and type of cell-based regeneration that
could further inform acquired cardiac disease applications. The concept of
cell-based pediatric cardiac regenerative surgery could transform the
management of congenital heart disease when cost-effective strategies
produce a valuable adjunctive solution to improve outcomes of cardiac
surgery.

<25>
Accession Number
2014732000
Authors
Rassaf T. Balzer J. Zeus T. Rammos C. Shayganfar S. Hall S.V. Wagstaff R.
Kelm M.
Institution
(Rassaf, Balzer, Zeus, Rammos, Shayganfar, Hall, Wagstaff, Kelm)
Department of Medicine, Division of Cardiology, Pulmonology, and Vascular
Medicine, University Hospital Dusseldorf, Moorenstrase 5, Dusseldorf
40225, Germany
Title
Safety and efficacy of deep sedation as compared to general anaesthesia in
percutaneous mitral valve repair using the MitraClip system.
Source
Catheterization and Cardiovascular Interventions. 84 (4) (pp E38-E42),
2014. Date of Publication: 01 Oct 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective To characterize the safety and efficacy of deep sedation (DS) as
compared to general anaesthesia (GA) in percutaneous mitral valve repair
(PMVR) using the MitraClip system. Background PMVR with the MitraClip
system has emerged as a therapeutic alternative to surgical valve repair
in high-risk patients. The PMVR procedure is typically performed under GA.
Due to their high surgical risk, avoidance of GA in many of those patients
would be desirable. Methods: In an open-label observational study 21
patients with severe mitral regurgitation were randomized to either GA or
DS using propofol. Primary endpoints of this comparison were related to
safety with rate of conversion from DS to GA, bleeding, aspiration, and
pneumonia. Secondary endpoints were related to efficacy with procedural,
in-hospital, and mid-term outcome at 1 month. Results All clips have been
implanted successfully in both groups. No conversion from DS to GA was
necessary. Four patients undergoing GA suffered from upper respiratory
tract infections and two from peripheral vascular complications during
placement of central venous catheter for GA. Short- and mid-term efficacy
were comparable in both groups with a reduced hospital stay in the DS
group. Conclusion PVMR in high-risk patients performed under DS is as safe
and effective as with GA, preventing complications related to GA and
shortening hospital stay.

<26>
Accession Number
2014748794
Authors
Philip F. Athappan G. Tuzcu E.M. Svensson L.G. Kapadia S.R.
Institution
(Philip, Athappan, Tuzcu, Svensson, Kapadia) Department of Cardiovascular
Medicine and Cardiothoracic Surgery, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
Title
MitraClip for severe symptomatic mitral regurgitation in patients at high
surgical risk: A comprehensive systematic review.
Source
Catheterization and Cardiovascular Interventions. 84 (4) (pp 581-590),
2014. Date of Publication: 01 Oct 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background The optimal treatment of patients with severe mitral
regurgitation (MR) at high surgical risk (HSR) is unknown. Recently, the
EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study
suggested MitraClip (MC) was a safe and effective treatment option.
Methods We performed a search strategy for MC or mitral valve surgery
(MVS) in patients at HSR for surgical mortality (logistic EuroSCORE >18 or
STS score > 10) using Medline databases, proceedings of international
meetings, and the STS database. We identified 21 studies utilizing MC (n =
3,198) and MVS (n = 3,265, >90% from the STS database) from 2003 to 2013.
Information about patient characteristics, surgical risk, and 30-day and
1-year outcomes were extracted. Results Patients who underwent MC or MVS
had a mean age of 74 +/- 10 years with no differences in surgical risk,
NYHA class, or MR grade (P = 0.46). Technical success was achieved in 96%
of patients undergoing MC versus 98% in the MVS group (P = 0.45). Patients
undergoing MC were treated with one or two MC in 90% (n = 2,878) with only
a few requiring repeat MC (0.4%, n = 13) or mitral surgery (0.3%, n = 52)
at 30 days. The pooled event rates for mortality was 3.2% (95% CI
[2.5-4.2]), stroke was 1.1% (95% CI [0.7-0.2]) at 30 days. At 31 days to 1
year, the pooled event rate for mortality was 13.0% [95% CI (9-18.3)],
stroke was 1.6% [95% CI (0.8-3.2)], and repeat MVS was 1.3% [95% CI
(0.7-2.6)] with the majority of patients in the mild/moderate MR grade and
NYHA class after MC. The 30-day event rates for mortality and stroke were
16.8% (95% CI [14-19]) and 4.5% (95% CI [3.9-5.3]) after MVS,
respectively. Conclusion Based on high risk MC studies and high risk MVS
data predominantly from STS database, patients with severe MR who are at
HSR can be effectively treated with MC or MVS. MC can be safely implanted
in high risk patients with relatively low mortality and stroke risk.

<27>
Accession Number
2014823165
Authors
Fengler K. Fuernau G. Desch S. Eitel I. Neumann F.-J. Olbrich H.-G. de
Waha A. de Waha S. Richardt G. Hennersdorf M. Empen K. Hambrecht R.
Fuhrmann J. Bohm M. Poess J. Strasser R. Schneider S. Schuler G. Werdan K.
Zeymer U. Thiele H.
Institution
(Fengler, Fuernau, Schuler) Department of Internal Medicine, Cardiology,
University of Leipzig, Heart Center, Strumpellstrase 39, Leipzig 04289,
Germany
(Desch, Eitel, Poess, Thiele) Department of Internal Medicine II,
University of Lubeck, Lubeck, Germany
(Neumann) Department of Cardiology, University of Freiburg, Bad Krozingen
Heart Center, Bad Krozingen, Germany
(Olbrich) Department of Internal Medicine I, Hospital Langen, Langen,
Germany
(de Waha) Department of Cardiology, German Heart Center Munich, Munich,
Germany
(de Waha, Richardt) Department of Cardiology, Angiology, Bad Segeberg
Heart Center, Bad Segeberg, Germany
(Hennersdorf) Department of Internal Medicine I, Klinikum am
Gesundbrunnen, Heilbronn, Germany
(Empen) Department of Internal Medicine B, University of Greifswald,
Greifswald, Germany
(Hambrecht) Department of Cardiology, Angiology, Klinikum links der Weser,
Bremen, Germany
(Fuhrmann) Department of Cardiology, Zentralklinik Bad Berka, Bad Berka,
Germany
(Bohm) Department of Internal Medicine III, University of Homburg,
Homburg, Saar, Germany
(Strasser) Department of Internal Medicine, Cardiology, University of
Dresden, Heart Center, Dresden, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Werdan) Department of Internal Medicine III, Martin-Luther-University
Halle-Wittenberg, Halle, Saale, Germany
Title
Gender differences in patients with cardiogenic shock complicating
myocardial infarction: a substudy of the IABP-SHOCK II-trial.
Source
Clinical Research in Cardiology. 104 (1) (pp 71-78), 2014. Date of
Publication: 2014.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Cardiogenic shock (CS) complicating acute myocardial
infarction (AMI) is associated with high mortality. Previous studies
regarding gender-specific differences in CS are conflicting and there are
insufficient data for the presence of gender-associated differences in the
contemporary percutaneous coronary intervention era. Aim of this study was
therefore to investigate gender-specific differences in a large cohort of
AMI patients with CS undergoing contemporary treatment.
Methods: In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock
II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI undergoing
early revascularization were assigned to therapy with or without
intra-aortic balloon pump. We compared sex-specific differences in these
patients with regard to baseline and procedural characteristics as well as
short- and long-term clinical outcome.
Results: Of 600 patients 187 (31 %) were female. Women were significantly
older than men and had a significantly lower systolic and diastolic blood
pressure at presentation (p < 0.05 for all). Diabetes mellitus and
hypertension were more frequent in women, whereas smoking was more
frequent in men (p < 0.05 for all). Women showed a higher mortality within
the first day after randomization (p = 0.004). However, after
multivariable adjustment this numerical difference was no longer
statistically significant. No gender-related differences in clinical
outcome were observed after 1, 6 and 12 months of follow-up.
Conclusion: In this large-scale multicenter study in patients with CS
complicating AMI, women had a worse-risk profile in comparison to men. No
significant gender-related differences in treatment as well as short- and
long-term outcome were observed.

<28>
Accession Number
2015897651
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) ACTION Study Group, Institut de Cardiologie Hopital
Pitie-Salpetriere (APHP), Universite Paris 6, INSERM, 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: 01 Nov
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 068-203]; p=058). STEEPLE major bleeding events occurred more often in
the continuation group (seven [1%] patients) compared with the
interruption group (one [<05%] patient; HR 015 [002-120]; p=0073). 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 026 [007-091]; p=004). 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.

<29>
[Use Link to view the full text]
Accession Number
2015928324
Authors
Nordanstig J. Taft C. Hensater M. Perlander A. Osterberg K. Jivegard L.
Institution
(Nordanstig, Hensater, Perlander, Osterberg, Jivegard) Department of
Vascular Surgery, Institute of Medicine, Sahlgrenska University Hospital
and Academy, Bla Straket 5, Gothenburg S-413 45, Sweden
(Taft) Health and Care Sciences, Gothenburg University Center for
Person-Centered Care, Gothenburg University, Gothenburg, Sweden
Title
Improved quality of life after 1 year with an invasive versus a
noninvasive treatment strategy in claudicants: One-year results of the
invasive revascularization or not in intermittent claudication (IRONIC)
trial.
Source
Circulation. 130 (12) (pp 939-947), 2014. Date of Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The quality of evidence for invasive revascularization in
intermittent claudication is low or very low. This prospective,
randomized, controlled study tested the hypothesis that an invasive
treatment strategy versus continued noninvasive treatment improves
health-related quality of life after 1 year in unselected patients with
intermittent claudication. Methods and Results-After clinical and duplex
ultrasound assessment, unselected patients with intermittent claudication
requesting treatment for claudication were randomly assigned to invasive
(n=79) or noninvasive (n=79) treatment groups. Primary end point was
health-related quality of life after 1 year, assessed with Medical
Outcomes Study Short Form 36 version 1 and Vascular Quality of Life
Questionnaire, and secondary end points included walking distances on a
graded treadmill. The Medical Outcomes Study Short Form 36 version 1
physical component summary (P<0.001) and 2 Medical Outcomes Study Short
Form 36 version 1 physical subscales improved significantly more in the
invasive versus the noninvasive treatment group. Overall, Vascular Quality
of Life Questionnaire score (P<0.01) and 3 of 5 domain scores improved
significantly more in the invasive versus the noninvasive treatment group.
Intermittent claudication distance improved significantly in the invasive
(+124 m) versus the noninvasive (+50 m) group (P=0.003), whereas the
change in maximum walking distance was not significantly different between
groups. Conclusions-An invasive treatment strategy improves health-related
quality of life and intermittent claudication distance after 1 year in
patients with stable lifestyle-limiting claudication receiving current
medical management. Long-term follow-up data and health-economic
assessments are warranted to further establish the role for
revascularization in intermittent claudication. Clinical Trial
Registration-URL: http://www.clinicaltrials.gov. Unique identifier:
NCT01219842.

<30>
Accession Number
2015926955
Authors
Li J. Xu J.-P. Zhao X.-Z. Sun X.-J. Xu Z.-W. Song S.-J.
Institution
(Li, Xu, Zhao, Sun, Xu, Song) Department of Cardiology, Affiliated
Hospital of Hebei University, Baoding, Hebei 071000, China
Title
Protective effect of metformin on myocardial injury in metabolic syndrome
patients following percutaneous coronary intervention.
Source
Cardiology (Switzerland). 127 (2) (pp 133-139), 2014. Date of Publication:
2014.
Publisher
S. Karger AG
Abstract
Objectives: The present study tested the hypothesis that pretreatment with
metformin decreases postprocedural myocardial injury and improves clinical
outcomes in metabolic syndrome patients following percutaneous coronary
intervention (PCI). Methods: We enrolled 152 metabolic syndrome patients
with no prior history of metformin treatment. Patients scheduled for
elective coronary intervention were randomized to the metformin or control
group 7 days before the procedure. Creatine kinase-MB (CK-MB) and troponin
I levels were measured at baseline and 8 and 24 h after the procedure, and
clinical outcomes were monitored for 1 year. Results: Post-PCI myocardial
injury as indicated by CK-MB elevation (14.5 vs. 32.9%, p = 0.008) and
troponin I elevation (14.5 vs. 34.2%, p = 0.005) was significantly lower
in the metformin group than in the control group. Postprocedural peak
values of CK-MB (2.70 +/- 4.30 vs. 6.29 +/- 8.03 ng/ml, p < 0.001) and
troponin I (0.02 +/- 0.05 vs. 0.07 +/- 0.10 ng/ml, p = 0.001) were also
significantly lower in the metformin group than in the control group. At 1
year, the composite endpoint of death from any cause, post-PCI myocardial
infarction (MI), MI after PCI hospitalization or ischemia-driven target
lesion revascularization occurred in 7.9% of metformin-treated patients
and 28.9% of controls (hazard ratio 0.25, 95% CI 0.10-0.62, log rank p =
0.001). Conclusions: A 7-day metformin pretreatment regimen (250 mg 3
times a day) significantly reduces postprocedural myocardial injury and
improves 1-year clinical outcomes in metabolic syndrome patients
undergoing PCI.

<31>
Accession Number
2015994841
Authors
Iglar P.J. Hogan K.J.
Institution
(Iglar) University of Wisconsin School of Medicine and Public Health,
Department of Population Health Sciences, 707 WARF Building, 610 North
Walnut Street, Madison, WI 53726, United States
(Hogan) University of Wisconsin School of Medicine and Public Health,
Department of Anesthesiology, 600 Highland Avenue, B/6 319 Clinical
Sciences Center, Madison, WI 53792-3272, United States
Title
Vitamin D status and surgical outcomes: A systematic review.
Source
Patient Safety in Surgery. 9 (1) , 2015. Article Number: 14. Date of
Publication: April 30, 2015.
Publisher
BioMed Central Ltd.
Abstract
The importance of vitamin D for musculoskeletal health has long been
recognized, and awareness of significant extra-skeletal effects in health
and disease is rapidly emerging. Although it has been possible for many
decades to quantify serum markers of vitamin D deficiency, and to correct
deficiency at low cost and with high safety, the influence of vitamin D
status on post-surgical outcomes has only recently been identified as a
research topic of interest. To the present, these data have not been the
subject matter of formal review. Accordingly, we conducted a systematic
review to assess the association between perioperative vitamin D status
and outcomes after surgery. The databases of PubMed, Ovid MEDLINE, EMBASE,
AMED, CINAHL (EBSCOHost), The Cochrane Databases of Systematic Review, and
PROSPERO were searched through December, 2014 for studies relating to
vitamin D and surgery. The initial search yielded 90 manuscripts. After
applying exclusion criteria, 31 studies were eligible for inclusion.
Fifteen studies employed prospective observational designs, 3 used
prospective randomized protocols, and 13 report retrospective database
interrogations. The main finding of the present review is that 26 of 31
studies (84%) report at least one statistically significant worse outcome
in patients with low vitamin D status. Five of 31 studies (16%) found no
association. In conclusion, this review supports the hypothesis that
hypovitaminosis D is associated with adverse outcomes after diverse
surgical procedures. Future studies should focus on additional surgeries
and outcomes, and on the role of vitamin D supplementation in the
improvement of patient safety in participants with low vitamin D status at
the time of surgery.

<32>
Accession Number
2015864314
Authors
Chen S.-L. Ye F. Zhang J.-J. Xu T. Tian N.-L. Liu Z.-Z. Lin S. Shan S.-J.
Ge Z. You W. Liu Y.-Q. Qian X.-S. Li F. Yang S. Kwan T.W. Xu B. Stone G.W.
Institution
(Chen, Ye, Zhang, Shan, Ge) Nanjing First Hospital, Nanjing Medical
University, Cardiology Department, 68 Changle Road, Nanjing 210006, China
(Chen) Collaborative Innovation Center for Cardiovascular Disease
Translational Medicine, Clinical Medical Research Center of Jiangsu
Province, China
(Xu, Tian, Liu, You) Nanjing Heart Center, Nanjing, China
(Lin, Liu) Jintan Municipal People's Hospital, Jintan, China
(Qian) Zhangjiagang People's Hospital, Zhangjiagang, China
(Li) Huainan Oriental General Hospital, Huainan, China
(Yang) Yixin People's Hospital, Yixin, China
(Kwan) Beth Israel Hospital, New York, NY, United States
(Xu) Beijing Fuwai Cardiovascular Hospital, Beijing, China
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, 111 East 59th Street, New York, NY 10022, United States
Title
Randomized comparison of FFR-guided and angiography-guided provisional
stenting of true coronary bifurcation lesions: The DKCRUSH-VI trial
(double kissing crush versus provisional stenting technique for treatment
of coronary bifurcation lesions VI).
Source
JACC: Cardiovascular Interventions. 8 (4) (pp 536-546), 2015. Date of
Publication: 20 Apr 2015.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to compare the outcomes of fractional flow
reserve (FFR)-guided and angiography (Angio)-guided provisional
side-branch (SB) stenting for true coronary bifurcation lesions.
Background Angio-guided provisional SB stenting after stenting of the main
vessel provides favorable outcomes for the majority of coronary
bifurcation lesions. Whether an FFR-guided provisional stenting approach
is superior has not been studied. Methods A total of 320 patients with
single Medina 1,1,1 and 0,1,1 coronary bifurcation lesions undergoing
stenting with a provisional SB approach were randomly assigned 1:1 to
Angio-guided and FFR-guided groups. SB stenting was performed for
Thrombolysis In Myocardial Infarction flow grade <3, ostial SB stenosis
>70%, or greater than type A dissection after main vessel stenting in the
Angio-guided group and for SB-FFR <0.80 in the FFR-guided group. The
primary endpoint was the 1-year composite rate of major adverse cardiac
events (cardiac death, myocardial infarction, and clinically driven target
vessel revascularization). Results Comparing the Angio-guided and
FFR-guided groups, treatment of the SB (balloon or stenting) was performed
in 63.1% and 56.3% of lesions respectively (p = 0.07); stenting of the SB
was attempted in 38.1% and 25.9%, respectively (p = 0.01); and, when
attempted, stenting was successful in 83.6% and 73.3% of SBs, respectively
(p = 0.01). The 1-year composite major adverse cardiac event rate was
18.1% in both groups (hazard ratio: 0.91, 95% confidence interval: 0.48 to
1.88; p = 1.00). The 1-year target vessel revascularization and stent
thrombosis rates were 6.9% and 5.6% (p = 0.82) and 1.3% and 0.6% (p =
0.56) in the Angio-guided and FFR-guided groups, respectively. Conclusions
In this multicenter, randomized trial, angiographic and FFR guidance of
provisional SB stenting of true coronary bifurcation lesions provided
similar 1-year clinical outcomes.

<33>
Accession Number
2015951270
Authors
Billings F.T. Yu C. Byrne J.G. Petracek M.R. Pretorius M.
Institution
(Billings, Pretorius) Department of Anesthesiology, Vanderbilt University,
School of Medicine, 1215 21st Avenue S., Nashville, TN 37232, United
States
(Yu) Departments of Biostatistics, Vanderbilt University School of
Medicine, Nashville, TN, United States
(Byrne, Petracek) Departments of Cardiac Surgery, Vanderbilt University
School of Medicine, Nashville, TN, United States
(Pretorius) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University School of Medicine, Nashville, TN, United States
Title
Heme oxygenase-1 and acute kidney injury following cardiac surgery.
Source
CardioRenal Medicine. 4 (1) (pp 12-21), 2014. Date of Publication: 2014.
Publisher
S. Karger AG
Abstract
Background: Intraoperative hemolysis and inflammation are associated with
acute kidney injury (AKI) following cardiac surgery. Plasma-free
hemoglobin induces heme oxygenase-1 (HO-1) expression. HO-1 degrades heme
but increases in experimental models of AKI. This study tested the
hypothesis that plasma HO-1 concentrations are associated with
intraoperative hemolysis and are increased in patients that develop AKI
following cardiac surgery. Methods: We measured plasma HO-1, free
hemoglobin, and inflammatory markers in 74 patients undergoing
cardiopulmonary bypass (CPB). AKI was defined as an increase in serum
creatinine concentration of 50% or 0.3 mg/dl within 72 h of surgery.
Results: Twenty-eight percent of patients developed AKI. HO-1
concentrations increased from 4.2 +/- 0.2 ng/ml at baseline to 6.6 +/- 0.5
ng/ml on postoperative day (POD) 1 (p < 0.001). POD1 HO-1 concentrations
were 3.1 ng/ml higher (95% CI 1.1-5.1) in AKI patients, as was the change
in HO-1 from baseline to POD1 (4.4 +/- 1.3 ng/ml in AKI patients vs. 1.5
+/- 0.3 ng/ml in no-AKI patients, p = 0.006). HO-1 concentrations remained
elevated in AKI patients even after controlling for AKI risk factors and
preoperative drug therapy. Peak-free hemoglobin concentrations correlated
with peak HO-1 concentrations on POD1 in patients that developed AKI (p =
0.02). Duration of CPB and post-CPB IL-6 and IL-10 concentrations were
also associated with increased HO-1 on POD1. Conclusion: Plasma HO-1 is
increased in patients that develop AKI, and CPB duration, hemolysis, and
inflammation are associated with increased HO-1 concentrations following
cardiac surgery. Strategies that alter hemolysis and HO-1 expression
during cardiac surgery may affect risk for AKI.

<34>
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Accession Number
2015945640
Authors
Faraoni D. Cacheux C. Van Aelbrouck C. Ickx B.E. Barvais L. Levy J.H.
Institution
(Faraoni) Department of Anaesthesiology, Queen Fabiola Children's
University Hospital, Free University of Brussels, 15 JJ Crocq Avenue,
Brussels B-1020, Belgium
(Cacheux, Van Aelbrouck, Ickx, Barvais) Department of Anaesthesiology,
Erasme University Hospital, Free University of Brussels, Brussels, Belgium
(Levy) Department of Anaesthesiology and Intensive Care, Duke University
School of Medicine, Durham, NC, United States
Title
Effect of two doses of tranexamic acid on fibrinolysis evaluated by
thromboelastography during cardiac surgery: A randomised, controlled
study.
Source
European Journal of Anaesthesiology. 31 (9) (pp 491-498), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Tranexamic acid is used to decrease bleeding and transfusions
during cardiac surgery. However, dosing based on pharmacokinetic data to
optimally inhibit fibrinolysis is unknown. With increasing concerns
regarding seizures associated with higher doses, lower dosing schemes may
be important. OBJECTIVE To determine the effect of two dosing schemes
compared with placebo on fibrinolysis and clinical outcomes. DESIGN: A
double-blind, randomised, controlled, pilot trial. SETTING: Single
tertiary centre. PATIENTS: Cardiac surgery patients requiring
cardiopulmonary bypass. INTERVENTION: Patients were randomised to receive
a 30mg kg^-1 bolus and continuous infusion of 16mg
kg^-1 h^-1 (Group HIGH), a 5mg kg^-1 bolus
followed by 5mg kg^-1 h^-1 (Group LOW) or Sodium
chloride (Placebo). MAIN OUTCOME MEASURE Fibrinolysis was evaluated by
thromboelastography and D-dimers. Secondary endpoints were blood loss,
transfusion requirement and side effects. RESULTS: Thirty-three patients
were included. Significant fibrinolysis was defined by LY30 more than 7.5%
based on thromboelastography and was not observed after cardiopulmonary
bypass in any groups. After protamine administration, LY30 differences
between groups were 0.7 [95% confidence interval (95% CI)-0.04 to 1.4]
between Groups HIGH and Placebo,-0.08 (95% CI-0.82 to 0.66) between Groups
HIGH and LOW, and 0.78 (95% CI 0.02 to 1.5) between Groups LOW and
Placebo. A significant increase in D-dimers was observed in the Group
Placebo compared with the two treatment groups. There were no differences
in bleeding or transfusion requirement. CONCLUSION: In this dose-finding
study, there were no differences in fibrinolysis or clinical outcomes
among the two tranexamic acid schemes and placebo. Any difference in
fibrinolytic inhibition requires a larger adequately powered study.

<35>
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Accession Number
2015945639
Authors
Nitzschke R. Wilgusch J. Kersten J.F. Trepte C.J. Haas S.A. Reuter D.A.
Goepfert M.S.
Institution
(Nitzschke, Wilgusch, Trepte, Haas, Reuter, Goepfert) Department of
Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine,
University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg
20246, Germany
(Kersten) Department of Medical Biometry and Epidemiology, University
Medical Centre Hamburg-Eppendorf, Hamburg, Germany
Title
Bispectral index guided titration of sevoflurane in on-pump cardiac
surgery reduces plasma sevoflurane concentration and vasopressor
requirements: A prospective, controlled, sequential two-arm clinical
study.
Source
European Journal of Anaesthesiology. 31 (9) (pp 482-490), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Electroencephalographic-based monitoring systems such as the
bispectral index (BIS) may reduce anaesthetic overdose rates. OBJECTIVE We
hypothesised that goal-directed sevoflurane administration (guided by BIS
monitoring) could reduce the sevoflurane plasma concentration (SPC) and
intraoperative vasopressor doses during on-pump cardiac surgery. DESIGN: A
prospective, controlled, sequential two-arm clinical study. SETTING:
German university medical centre with more than 2500 cardiac surgery
interventions per year. PATIENTS: Sixty elective on-pump cardiac surgery
patients. INTERVENTION: In group Sevo<inf>1.8%</inf> (n=29), the sedation
depth was maintained with a sustained inspired concentration of
sevoflurane 1.8% before and during cardiopulmonary bypass (CPB). In group
Sevo<inf>BIS</inf> (n=31), the inspired sevoflurane concentration was
titrated to maintain a BIS target between 40 and 60. OUTCOME MEASURES SPC
during CPB and the intraoperative administration of noradrenaline.
Additional analyses were performed on intraoperative awareness,
postoperative blood lactate concentration, duration of mechanical
ventilation, intensive care unit length of stay and kidney injury.
RESULTS: Mean inspired sevoflurane concentration was 0.8% in group
Sevo<inf>BIS</inf>, representing a 57.1% reduction (P<0.001) compared with
group Sevo<inf>1.8%</inf>. The mean SPC was 42.3mugml^-1 [95%
confidence interval (CI) 40.0 to 44.6] in group Sevo1.8% and
21.0mugml^-1 (95% CI 18.8 to 23.3) in group Sevo<inf>BIS</inf>,
representing a 50.2% reduction (P<0.001). During CPB, the mean cumulative
dose of noradrenaline administered was 13.48mugkg^-1 (95% CI
10.52 to 17.19) in group Sevo<inf>1.8%</inf> and 4.06mugkg^-1
(95% CI 2.67 to 5.97) in group SevoBIS (P<0.001). Pearson's correlation
coefficient (between the cumulative applied dosage of sevoflurane
calculated from the area under the curve of the SPC over time and the
administered cumulative noradrenaline dose) was 0.607 (P<0.001). No
intraoperative awareness signs were detected. CONCLUSION: BIS-guided
titration of sevoflurane reduces the SPC and decreases noradrenaline
administration compared with routine care during on-pump cardiac surgery.

<36>
[Use Link to view the full text]
Accession Number
2015945637
Authors
Qutub H. El-Tahan M.R. Mowafi H.A. El Ghoneimy Y.F. Regal M.A. Al Saflan
A.A.
Institution
(Qutub) Department of Critical Care and Pulmonary Medicine, King Fahd
Hospital, University of Dammam, Al Khubar, Saudi Arabia
(El-Tahan, Mowafi, Al Saflan) Department of Anaesthesia and Surgical ICU,
King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia
(El Ghoneimy, Regal) Department of Cardiothoracic Surgery, King Fahd
Hospital, University of Dammam, Al Khubar, Saudi Arabia
Title
Effect of tidal volume on extravascular lung water content during one-lung
ventilation for video-assisted thoracoscopic surgery: A randomised,
controlled trial.
Source
European Journal of Anaesthesiology. 31 (9) (pp 466-473), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The use of low tidal volume during one-lung ventilation (OLV)
has been shown to attenuate the incidence of acute lung injury after
thoracic surgery. OBJECTIVE To test the effect of tidal volume during OLV
for video-assisted thoracoscopic surgery on the extravascular lung water
content index (EVLWI). DESIGN: A randomised, double-blind, controlled
study. SETTING: Single university hospital. PARTICIPANTS Thirty-nine
patients scheduled for elective video-assisted thoracoscopic surgery.
INTERVENTIONS Patients were randomly assigned to one of three groups (n=13
per group) to ventilate the dependent lung with a tidal volume of 4, 6 or
8 ml kg^-1 predicted body weight with I:E ratio of 1:2.5 and
PEEP of 5cmH<inf>2</inf>O. MAIN OUTCOME MEASURES: The primary outcomes
were perioperative changes in EVLWI and EVLWI to intrathoracic blood
volume index (ITBVI) ratio. Secondary outcomes included haemodynamics,
oxygenation indices, incidences of postoperative acute lung injury,
atelectasis, pneumonia, morbidity and 30-day mortality. RESULTS: A tidal
volume of 4 compared with 6 and 8 ml kg^-1 after 45 min of OLV
resulted in an EVLWI of 4.1 [95% confidence interval (CI) 3.5 to 4.7]
compared with 7.7 (95% CI 6.7 to 8.6) and 8.6 (95% CI 7.5 to 9.7) ml
kg^-1, respectively (P<0.003). EVLWI/ITBVI ratios were 0.57 (95%
CI 0.46 to 0.68) compared with 0.90 (95% CI 0.75 to 1.05) and 1.00 (95% CI
0.80 to 1.21), respectively (P<0.05). The incidences of postoperative
acute lung injury, atelectasis, pneumonia, morbidity, hospitalisation and
30-day mortality were similar in the three groups. CONCLUSION: The use of
a tidal volume of 4 ml kg^-1 during OLV was associated with less
lung water content than with larger tidal volumes of 6 to 8 ml
kg^-1, although no patient developed acute lung injury. Further
studies are required to address the usefulness of EVLWI as a marker for
the development of postoperative acute lung injury after the use of a low
tidal volume during OLV in patients undergoing pulmonary resection.

<37>
Accession Number
2015977975
Authors
Ozaydin M. Erdogan D. Yucel H. Peker O. Icli A. Akcay S. Etli M. Ceyhan
B.M. Sutcu R. Varol E. Dogan A. Yavuz T.
Institution
(Ozaydin, Erdogan, Yucel, Icli, Akcay, Varol, Dogan) Department of
Cardiology, Suleyman Demirel University, Isparta, Turkey
(Peker, Etli, Yavuz) Department of Cardiovascular Surgery, Suleyman
Demirel University, Isparta, Turkey
(Ceyhan, Sutcu) Department of Biochemistry, Suleyman Demirel University,
Isparta, Turkey
Title
N-acetyl cysteine for the conversion of atrial fibrillation into sinus
rhythm after cardiac surgery: A prospective, randomized, double-blind,
placebo-controlled pilot study.
Source
International Journal of Cardiology. 165 (3) (pp 580-583), 2013. Date of
Publication: 25 May 2013.
Publisher
Elsevier Ireland Ltd

<38>
Accession Number
71873744
Authors
Manda Y. Aradhya M. Vefali H. Agrawal S. Singh A. Sinha A. Sarnoski C.
Puleo P. Durkin R. Shirani J.
Institution
(Manda, Aradhya, Vefali, Agrawal, Singh, Sinha, Sarnoski, Puleo, Durkin,
Shirani) St Luke's University Health Network, United States
Title
Comparison of transradial and transfemoral approach for coronary artery
bypass graft angiography and intervention: Systemic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S171-S172), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transradial (TR) approach for coronary artery angiography and
intervention is gaining popularity and is associated with reduced
morbidity and mortality in comparison to transfemoral (TF) approach.
However, safety and effectiveness of TR approach in this setting is not
well studied. Methods: We performed a systemic review of the literature
and identified one randomized controlled trial and six observational
studies (n = 1370) that specifically addressed this issue. Meta-analysis
was performed to compare the characteristics and outcomes of each approach
including vascular access site complications, major adverse cardiovascular
events (MACE), access site crossover rates, fluoroscopy time, procedure
time and contrast volume use. Results: Baseline patient characteristics
were similar in both groups. Compared with TF approach, TR approach was
associated with decreased risk of vascular access site complications (1.4%
vs. 3.8%; OR: 0.34, 95% CI: 0.16 to 0.75; p = 0.008) and a tendency
towards lower MACE (2.39% vs. 4.7%; OR 0.57, 95% CI: 0.25 to 1.3; p =
0.18). There was no difference in rates of major bleeding (0.17% vs.
0.57%; OR 0.65, p = 0.58) or in-hospital death (0.29% vs. 0.7%, OR 0.58, p
= 0.54). The risk of vascular access site cross over rate was high in TR
approach (5.16% vs. 0.4%; OR: 6.31, p = 0.0003). TR approach was
associated with comparable fluoroscopy time, procedure time and contrast
volume usage to TF approach (p = 0.22, p = 0.13, and p = 0.84,
respectively). Conclusion: Transradial approach for bypass graft
angiography and intervention reduces vascular access site complications
and has comparable fluoroscopy time and contrast volume usage.

<39>
Accession Number
71873739
Authors
Dahal K. Rijal J. Giri S. Lee J. Azrin M.
Institution
(Dahal) LRGHealthcare, United States
(Rijal) Miriam Hospital, Memphis, TN, United States
(Giri) University of Tennessee, Health Science Center, Memphis, TN, United
States
(Lee, Azrin) University of Connecticut, School of Medicine, United States
Title
Transulnar versus transradial access for coronary angiography or
percutaneous coronary intervention: A metaanalysis of randomized
controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S169), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transradial access (TRA) is preferred for patients undergoing
coronary angiography (CA) or percutaneous coronary intervention (PCI). In
patients with difficult or failed radial access, transulnar access (TUA)
has been proposed as an alternative. Ulnar artery can be used as an access
in repeated catheterizations, or if radial artery is required for future
coronary artery bypass grafting. To evaluate the safety and efficacy of
TUA versus TRA in patients undergoing CA or PCI, we performed a
meta-analysis of randomized controlled trials (RCT). Methods: We searched
PubMed, EMBASE and CENTRAL for RCTs since inception through December 2014.
Meta-analysis was performed using random effects model. Major adverse
cardiac events (MACE), vascular complications, arterial access and
fluoroscopy times, number of punctures, contrast volume and access
cross-over were the main outcomes. Results: We identified a total of 5
RCTs involving 2744 total patients. TUA compared to TRA had similar risks
of MACE [Relative risk (RR): 0.87, 95% confidence interval (CI):
0.56-1.36, p = 0.54] and vascular complications [RR: 0.93 (0.68-1.27), p =
0.64]. Higher rates of access cross-over [RR: 2.31 (1.07-5.0), p = 0.03]
and number of punctures [mean difference (MD): 0.17, 95% CI: 0.08-0.26, p
= 0.0002] were noted with TUA. There was no difference in arterial access
time [MD: 1.86 (-1.35-5.7), p = 0.26)], fluoroscopy time [MD: 0.37
(-0.39-1.1.3), p = 0.34] and contrast volume [MD: -2.74 (-17.21-11.73), p
= 0.71]. Conclusion: The current meta-analysis demonstrates that TUA is
safe and effective with higher access cross-over and puncture rates
compared to TRA.

<40>
Accession Number
71873717
Authors
Rai M. Rustagi T.
Institution
(Rai) Hartford Hospital, United States
(Rustagi) Yale - New Haven Hospital, United States
Title
A meta-analysis of safety and efficacy of percutaneous mitral valve repair
in real world setting.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S157), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Percutaneous mitral valve repair has emerged as a viable
option for repair of mitral valve in high surgical risk candidates with
severe functional and/or degenerative mitral regurgitation (MR). We sought
to study the safety and efficacy of this procedure using a metaanalytic
approach. Methods: PubMed and EMBASE database were searched for original
studies reporting safety and efficacy of percutaneous mitral valve repair
with at least 30 day follow up. Two independent reviewers extracted
tabulated data. Baseline demographics, co-morbidities, improvement in MR,
NYHA functional class, 30-day mortality, operative and postoperative
complications were recorded. Results: Twenty one studies with total 2065
patients (mean age: 73.2+/-3.2 years, males: 66.3%) were included. Five
studies evaluated only patients with functional MR. The acute procedural
success ranged from 72-100%. Postoperative decrease in MR<grade 2 was seen
in 81.7% patients (95% CI, 79.7%-83.6%). Improvement in NYHA functional
class was 42.7% (95% CI, 37.9%-47.6%) in the pooled dataset. 30-day
mortality ranged between 0-7.8% (mean: 2.98%, 95%CI: 2.3%-3.9%). Weighted
mean of successful clip implantation was 97.5% with >2clips implanted in
30.1% patients. 2.3% patients needed emergent surgery whereas 4.6%
patients had significant bleeding requiring transfusion. Partial clip
detachment was seen in 3.6% while chordal rupture was seen in 1.7%
patients. All the safety and efficacy endpoints are depicted in Figure 1.
Conclusion: Percutaneous mitral valve repair with MitraClip has good
success and is safe at short term follow up. (Figure Presented).

<41>
Accession Number
71873701
Authors
Garcia D. Ansari M.M. Cardoso R. Mendoza C.
Institution
(Garcia, Cardoso) University of Miami, Miller School of Medicine, Jackson
Memorial Hospital, United States
(Ansari) Lenox Hill Heart and Vascular Institute of New York, United
States
(Mendoza) Jackson Memorial Hospital, United States
Title
Should mitral valve replacement be considered for ischemic mitral
disease?: A meta-analysis of RCTs.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S149), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Ischemic mitral regurgitation is associated with increased
mortality in patients with underlying coronary artery disease. The benefit
of mitral valve repair (MVR) upon performing coronary artery bypasses
grafting (CABG) is yet to be determined. We aimed to perform a
meta-analysis of randomized clinical trials (RCT) comparing CABG and MVR
to CABG only in patients with ischemic moderate mitral regurgitation.
Methods: We searched Pub Med and Cochrane trough up to 2014 for all RCTs
that directly compared CABG+MVR to CABG only. Primary outcome was 30 day
mortality. Secondary outcomes were longterm (12 months) mortality,
moderate mitral regurgitation and mean NYHA class upon follow-up. We used
Fixed or Random Effect analysis using the Cochrane Handbook of Systematic
Reviews and RevMan 5.2 for statistical analysis. Results: Out of 216
articles, four randomized trial studies were included. The pooled data
provided 570 patients; 285 treated with CABG+MVR only and 285 with CABG
only. Mean follow up was 12 months. There was a trend towards lower 30
days mortality rate in CABG+MVR compared to CABG only group (2.1% vs.
4.2%, p = 0.14). There was a significant trend towards less long-term
death in the CABG+MVR group (12.2% vs. 16.4%, p = 0.04), moderate MR (7.2%
vs. 38.6%, p<0.03) and smaller mean NYHA (p<0.001). (Figure 1) Conclusion:
Our analysis suggests that ischemic mitral regurgitation treated with
concomitant CABG and MVR can lead to decreased mortality and better
clinical outcomes. In addition, our study is limited by small sample size
and further randomized trials should be pursued to confirm those findings.

<42>
Accession Number
71873687
Authors
Aminian A. Lalmand J. Dolatabadi D. Lefebvre P. Devuyst E. Dubois P.
Institution
(Aminian, Lalmand, Dolatabadi, Lefebvre, Devuyst, Dubois) Centre
Hospitalier, Universitaire De Charleroi, Belgium
Title
Embolization of left atrial appendage closure devices: A systematic review
of cases reported with the watchman device and the amplatzer cardiac plug.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S142), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Device embolization is a known complication of LAA closure
procedures. The goal of this study is to provide a systematic review of
reported cases of LAA closure device embolization by focusing on the the 2
most commonly implanted devices: the Watchman (WM) (Boston Scientific,
Plymouth, Minnesota), and the Amplatzer Cardiac Plug (ACP) (St. Jude
Medical, Minneapolis, Minnesota). Methods: A comprehensive search of
Pubmed database from inception through October 1, 2014, was conducted
using pre-defined criteria. Studies were included if they described at
least 1 case of embolization of the WM and/or the ACP. Results: A total of
20 studies reporting 31 cases of device embolization was identified
including 12 cases with WM and 19 cases with ACP. The timing of
embolization was described in 29 cases and was categorized as acute (i.e
during hospital stay) in 20 cases (65%, 12 out of 20 cases were
intraprocedural) and late (i.e following hospital discharge) in 9 cases
(30%). The anatomical location of embolized devices was reported in 21
cases: into the aorta in 9 cases (30%; WM 7/9, ACP 2/9), into the left
ventricle (LV) in 9 cases (30%; WM 3/9, ACP 6/9) and into the left atrial
cavity in 3 cases (10%; ACP 3/3). The device was retrieved by percutaneous
methods in 17 patients (55%, WM 8/17, ACP 9/17) while 10 patients
underwent surgical retrieval (32%, WM 4/10, ACP 6/10). As compared to
embolization into the Ao or the LA cavity, device embolization into the LV
was associated with a higher rate of surgical retrieval (8/9 vs 2/12; 88%
vs 17%, p = 0.0019). Major adverse events related to device embolization
occurred in 3 patients: 1 case of internal bleeding during percutaneous
retrieval, 1 case of Ao cusps damage requiring Ao valve replacement and 1
case of death due to cardiogenic shock. Conclusion: Device embolization is
a rare but serious complication of percutaneous LAA closure and occurs
mainly in the periprocedural period. Although embolization into the Ao or
the LA can be successfully managed by percutaneous techniques in most
cases, device embolization into the LV is associated with a high rate of
surgical retrieval, increasing thereby procedure-related morbidity.

<43>
Accession Number
71873685
Authors
Agarwal S. Parashar A. Kumbhani D. Svensson L. Krishnaswamy A. Tuzcu E.
Kapadia S.
Institution
(Agarwal, Parashar, Svensson, Krishnaswamy, Tuzcu, Kapadia) Cleveland
Clinic, Southwestern, United States
(Kumbhani) University of Texas, Southwestern, United States
Title
Comparative meta-analysis of balloon-expandable and self-expandable valves
for transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S140-S141), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Balloon-expandable valves (BEV) and self-expandable valves
(SEV) are two major types of valves utilized for transcatheter aortic
valve replacement (TAVR). We conducted a meta-analysis of available
studies to compare the safety and efficacy of these two valve types.
Methods: Medline search was conducted to determine eligible studies.
Primary outcomes of the study were death and stroke at 30 days and 1 year.
Pooled estimates of procedural outcomes were also compared between the
groups. Analysis was performed for entire cohort and separately for
patients undergoing transfemoral TAVR (TF TAVR). Results: A total of 33
studies with 35347 patients were included. Analysis of entire cohort
revealed similar 30-day and 1-year mortality and stroke in the SEV and BEV
cohorts. We observed a significantly higher incidence of new pacemaker
implantation, aortic regurgitation> 2+ at 30 days, valve embolization, and
need for >1 valve following SEV compared with BEV implantation. Analysis
of TF TAVR cohort showed higher 30 day [IRR (95% CI): 1.34 (1.19-1.52)]
(Figure) but a similar 1-year mortality [IRR (95% CI): 1.07 (0.96-1.19)]
for SEV compared to BEV implantation. Conclusion: Compared to BEV
implantation, SEV implantation was associated with a similar risk of
mortality and stroke at 30-day and 1 year follow up. Analysis of the TF
TAVR cohort showed a significantly higher mortality at 30 days among
patients undergoing SEV, compared with BEV implantation; although 1 year
mortality was similar between the two groups. In addition, there was a
significantly higher incidence of other adverse events noted above, after
SEV vs. BEV implantation. (Figure Presented).

<44>
Accession Number
71873658
Authors
Rasania S. Rasania S.P. Suryadevara R. Berger P.B. Green S.M. Scott T.
Skelding K.A. Feng W. Blankenship J.C.
Institution
(Rasania, Rasania, Berger, Green, Scott, Skelding, Blankenship) Geisinger
Health System, United States
(Suryadevara) Vidant Medical Center, East Carolina University, United
States
(Feng) Geisinger Center for Health Research, United States
Title
A randomized controlled trial to assess operator radiation exposure from
cardiac catheterization procedures using a rad BOARD with standard pelvic
shielding versus standard pelvic shielding alone.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S126), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The use of radial access for catheterization in the United
States has increased from 1% in 2007 to 25% in 2014 and is likely to
increase further. A RAD BOARD radio-dense radial access arm board was
marketed as reducing radiation to operators by 21-40%. We studied operator
radiation exposure using this radio-dense radial arm board along with
standard radiation pelvic drape versus pelvic drape alone for cardiac
catheterizations. Methods: We randomized 215 patients aged 18-89
undergoing catheterization via right radial access to standard shielding
using a pelvic drape on the patient (non-board group) vs. RAD BOARD in
addition to pelvic drape (board group). We excluded patients with bypass
grafts & those with known anomalous coronaries. Operator radiation
exposure was measured using Lindauer Microstar nanodot badges worn by the
operator. Data analysis was performed with all 215 patients, and then
repeated excluding 21 "complex" patients who required conversion of access
site or more than 4 coronary catheters. Results: Board & non-board groups
were similar with respect to age, gender, history of prior myocardial
infarction, heart failure, peripheral vascular disease & various
procedural variables. The mean dose per case was higher in the board group
(68.95 +/- 21.7 mrad) than in the nonboard group (56.65 +/- 13.4 mrad,
p<0.0001). Analysis excluding the 21 "complex" patients provided similar
results. In sub-group analyses, radiation doses were higher in the board
group compared to the non-board group in patients with left
ventriculography & in those without left ventriculography (p<0.05 for
both), as well as across all BMI groups (<25 kg/m², 25-30
kg/m² and >30 kg/m², p<0.03 for all). Post-hoc
analysis of the table set-up with RAD BOARD revealed that use of RAD BOARD
prevented placement of a shield normally inserted into the top of the
standard below-table shield. Conclusion: RAD BOARD with the pelvic shield
was associated with higher radiation exposure to the operator compared
with pelvic shield alone. This might be explained by inability to use
standard radiation shielding along with the RAD BOARD . Operators should
be wary of innovations in radiation shielding that prevent use of standard
shielding.

<45>
Accession Number
71873550
Authors
Kanmanthareddy A. Buddam A. Alla V. Hunter C. White M. Del Core M.
Woodruff M. Mooss A. Lilly S.
Institution
(Kanmanthareddy, Alla, Hunter, White, Del Core, Woodruff, Mooss) Creighton
University, School of Medicine, United States
(Buddam) University of Kansas Medical Center, United States
(Lilly) Ohio State University, Department of Cardiovascular Medicine,
United States
Title
Long term outcomes of percutaneous coronary intervention vs coronary
artery bypass grafting in unprotected left main disease.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S69-S70), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Percutaneous coronary intervention (PCI) is increasingly being
used in lieu of coronary artery bypass grafting (CABG) in patients with
favorable coronary anatomy and high surgical risk. We compared outcomes
(early and late) with follow up duration >3 years in patients undergoing
PCI and CABG for left main disease in this meta-analysis. Methods: PubMed,
EBSCO and Google Scholar databases were queried for studies on left main
interventions. Studies comparing PCI and CABG for left main intervention
were included. Data on endpoints of major adverse cardiovascular events
(MACE), mortality, myocardial infarction (MI), target vessel
revascularization (TVR) and stroke were extracted from the included
studies. Meta-analysis was performed using random effects model. Results:
A total of 12 studies (1 RCT) with 9888 patients were included in this
analysis. Compared to CABG (or PCI? Which is reference group?) the risk of
MACE was similar (OR: 0.85, 95% CI 0.65 - 1.11). Similarly, the risk of
mortality (OR: 91; 95% CI 0.69 - 1.12) and MI (OR: 1.44; 95% CI 0.99 -
2.10) were similar in both the groups. The risk of TVR was higher in the
PCI group (OR: 3.68; 95% CI 3.16 - 4.27), although stroke risk was lower
in the PCI group compared to the CABG group (OR: 0.60; 95% CI: 0.44 -
0.83). Conclusion: Unprotected left main interventions using PCI or CABG
have comparable long term MACE, mortality and MI outcomes. However, the
risk of TVR is increased and stroke risk is decreased with the use of PCI.
(Table Presented).

<46>
Accession Number
71873488
Authors
Patel T. Suppogu N. Pancholy S.
Institution
(Patel, Suppogu, Pancholy) Wright Center for Graduate Medical Education,
Scranton, PA, United States
Title
PCI vs CABG in ESRD patients on hemodialysis: An updated systematic review
and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S32-S33), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Coronary artery disease (CAD) is one of the major causes of
increased mortality in end stage renal disease (ESRD) patients on
hemodialysis (HD). The data for optimal revascularization strategy in ESRD
patients is still controversial and is based on small retrospective
studies. With recent advances in both percutaneous coronary intervention
(PCI) and coronary artery bypass grafting (CABG) techniques, the
comparison between these strategies based on old data is difficult. We
performed an updated and detailed systematic review and meta-analysis of
existing literature to evaluate the early and late outcomes of PCI vs CABG
in ESRD patients on HD. Methods: A systematic review of major indexed
databases was done to identify studies evaluating PCI vs CABG in ESRD
patients. We performed a search with keywords "coronary artery bypass
grafting" "percutaneous coronary intervention" "coronary artery disease"
and "end stage renal disease". Search revealed 526 studies, out of which
24 studies (43,760 PCI patients and 36,474 CABG patients) met inclusion
criteria. The primary outcome measure studied was all-cause mortality, at
early (30-day) and late (>1 year) follow-up. Results: In ESRD patients on
HD, PCI has favorable outcomes in early follow up period [Odds Ratio (OR)
0.47, 95% Confidence Interval (CI) 0.38-0.58] as compared to CABG. However
CABG is associated with lower risk of late mortality (OR 1.16, 95% CI
1.03-2.47) as compared to PCI (Fig 1). Conclusion: In comparison to PCI,
CABG is associated has superior long term outcomes despite higher short
term mortality in ESRD patients on HD. (Table Presented).

<47>
Accession Number
71873483
Authors
Gao J. Chen T. Liu Z.
Institution
(Gao, Chen, Liu) Central Hospital of Shanghai Putuo District, China
Title
Effect of completeness of revascularization with elective percutaneous
coronary intervention on long-term outcomes of multivessel coronary artery
disease: A meta-analysis of 12 prospective studies.
Source
Catheterization and Cardiovascular Interventions. Conference: 38th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2015 San Diego, CA United States. Conference Start:
20150506 Conference End: 20150509. Conference Publication: (var.pagings).
85 (pp S29-S30), 2015. Date of Publication: 01 May 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background: There have been conflicting results on the clinical benefit of
revascularization strategy with percutaneous coronary intervention (PCI)
in patients with multivessel coronary artery disease. This study aimed to
elucidate the long-term outcomes of these subjects completely versus
incompletely revascularized with PCI by a meta-analysis of prospective
studies. Methods: PubMed, EMBASE, and Cochrane databases were
systematically searched. Prospective studies with available data on
complete or incomplete revascularization (CR or IR) during elective PCI,
clinical outcomes, and follow-up of at least 12 months were eligible. Risk
ratios (RRs) with 95% confidence intervals (CIs) calculated by
random-effect models were used to present combined results. Results:
Twelve studies involving 54,116 patients were included in the analysis.
Compared to IR procedure, CR with PCI was associated with lower all-cause
mortality (RR = 0.61, 95% CI 0.50-0.75, p<0.0001) and cardiovascular
mortality (RR = 0.54, 95% CI 0.38-0.77, p = 0.0006). The difference in
all-cause mortality between the two interventional strategies became
significant at 24 months post PCI (p<0.001) and sustained to at least 60
months (p = 0.01). Moreover, CR procedure significantly decreased the
incidence of nonfatal myocardial infarction (RR = 0.60, p<0.0001), repeat
PCI (RR = 0.65, p = 0.0009), and subsequent coronary artery bypass graft
(RR = 0.72, p = 0.007). Additionally, meta-regression analyses
demonstrated that relevant clinical factors did not have substantial
influence on the overall results. Conclusion: Based on the available data
from prospective studies, CR procedure with elective PCI significantly
improved long-term prognosis in patients with multivessel coronary
disease.

<48>
Accession Number
71871492
Authors
Abdelrahman A.M. Yu D. Lowndes B. Hallbeck S. Juliane B.
Institution
(Abdelrahman, Yu) Division of Health Care Policy and Research, Department
of Health Sciences Research, Mayo Clinic, United States
(Lowndes) Robert D. and Patricia E. Kern Center for the Science of Health
Care Delivery, Mayo Clinic, United States
(Hallbeck) Department of surgery, United States
(Juliane) Division of Subspecialty General Surgery, Department of Surgery,
Mayo Clinic, United States
Title
Impact of the single incision laparoscopic cholecystectomy (SILC) versus
4-port laparoscopic cholecystectomy on surgeon stress and workload: A
randomized controlled trial.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: Annual
Scientific Meeting of the Association of Laparoscopic Surgeons of Great
Britain and Ireland, ALSGBI 2014 Aberdeen United Kingdom. Conference
Start: 20141127 Conference End: 20141128. Conference Publication:
(var.pagings). 29 (pp S316), 2015. Date of Publication: April 2015.
Publisher
Springer New York LLC
Abstract
Introduction: The goal of this study was to compare surgeon stress and
workload between single incision laparoscopic cholecystectomy (SILC) and
4-port laparoscopic cholecystectomy during an ongoing randomized trial.
Despite patient satisfaction and preference, SILC may expose surgeons to
an excessively high workload and stress that may impact surgeon health and
performance. Methods and Procedures: During a double-blind randomized
controlled trial comparing patient outcomes for single port versus 4-port
cholecystectomy (NCT0148943), heart rate monitoring and salivary cortisol
levels were used to measure surgeon stress and workload. Continuous heart
rate data was collected using a portable heart rate monitor attached to
the surgeon's chest with wireless data capture. Heart rate was sampled at
three points in the operation: prior to the start (baseline), after
clipping the cystic duct, and immediately after the procedure. Average
heart rate, maximum heart rate, and mean change between the three distinct
points within each procedure were analyzed. Salivary cortisol levels were
sampled from the surgeon before the random assignment of the surgical
procedure, during the surgery after the cystic duct was clipped, and after
the procedure ended. The salivary specimens were placed on dry ice, stored
at -80degreeF and assayed using ELISA (Salimetrics Inc.). To account for
cortisol diurnal rhythm changes, only-first cases of the day were included
in the cortisol analysis. After each procedure, the surgeon completed the
SURG-TLX questionnaire, which is a validated workload assessment adapted
from the National Aeronautics and Space Administration-Task load index
(NASA-TLX). Student t-tests, Wilcoxon rank sum test, and Kruskal-wallis
non-parametric ANOVAS on the dependent variables by the technique
(singleport vs 4-port) were performed in intention to treat analysis with
alpha = 0.05. Results: Twenty three SILC and twenty five 4-port
laparoscopic cholecystectomies were included in the study. No significant
differences were observed in the patient demographics and procedure time
(Table 1). SILC had significantly higher post-surgery maximum heart rates
than 4-port (p<0.01). SILC also had significantly higher mean change in
the maximum heart rate during and before each procedure (p<0.05), and
after and before each procedure (p<0.01). Furthermore, inter-quartile
range of the average heart rates ranged between the 85 and 99
beats/minute, and mean change in the average heart rate during and before
each procedure was significantly higher in SILC than 4-port (p<0.01).
Salivary cortisol level was significantly higher during SILC than 4-port
(0.23 mug/dl SILC, 0.16 mug/dl 4-port, p<0.01), and the significance
remained consistent for first cases only analysis. Using a 20 points
visual analogue scales in SURG-TLX, higher physical demands were reported
for SILC than 4-port (8.05/20 SILC, 7.50/20 4-port, p<0.05). Conclusions:
Objective stress measures of heart rate and salivary cortisol, and
subjective physical workload on SURG-TLX were higher during SILC,
indicating that SILC may be more stressful and physically demanding to the
surgeon than the 4-port. Surgeon stress and workload may impact patients'
outcomes, thus ergonomic improvement on SILC is necessary. (Table
Presented).

<49>
Accession Number
71870222
Title
IPTA 8th Congress on Pediatric Transplantation.
Source
Pediatric Transplantation. Conference: 8th Congress on Pediatric
Transplantation, IPTA 2015 San Francisco, CA United States. Conference
Start: 20150328 Conference End: 20150331. Conference Publication:
(var.pagings). 19 , 2015. Date of Publication: May 2015.
Publisher
Blackwell Publishing Inc.
Abstract
The proceedings contain 288 papers. The topics discussed include: does
donor-recipient weight mismatch adversely affect the outcomes in
pediatricorthotopic heart transplantation?; an exploratory study examining
psychosocial outcomes in adolescents with a heart transplant; conversion
to everolimus in pediatric heart transplant patients; changes in renal
function over time in pediatric heart transplant recipients; a case of
heart valve replacement leading to extensive sensitization;
corticosteroid-free kidney transplantation improves growth: long-term
follow-up of the twist randomized controlled trial; and pubertal
development after pediatric kidney transplantation: comparison between
everolimus-based and conventional immunosuppression.