EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014820001
Authors
Gao X.-F. Zhang Y.-J. Tian N.-L. Wu W. Li M.-H. Bourantas C.V. Jiang X.-M.
Wang Z.-M. Li B. Mao W.-X. Zhang J.-J. Chen S.-L.
Institution
(Gao, Zhang, Tian, Wu, Li, Jiang, Wang, Li, Mao, Zhang, Chen) Department
of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68
Changle Road, Nanjing 210006, China
(Zhang, Bourantas) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Tian, Chen) Department of Cardiology, Nanjing Heart Center, Nanjing,
China
Title
Stenting strategy for coronary artery bifurcation with drug-eluting
stents: A meta-analysis of nine randomised trials and systematic review.
Source
EuroIntervention. 10 (5) (pp 561-569), 2014. Date of Publication: 01 Sep
2014.
Publisher
EuroPCR
Abstract
Aims: The present study sought to compare angiographic and clinical
outcomes of a simple strategy versus a complex strategy in patients with
coronary bifurcation lesions undergoing drug-eluting stent implantation.
Methods and results: Medline, the Cochrane Library, and other internet
sources were searched for randomised trials comparing simple strategy
versus complex strategy for treating patients with bifurcation lesions.
Nine eligible randomised trials including 2,569 patients were identified.
The meta-analysis showed that cardiac death (odds ratio [OR]: 0.99, 95%
confidence interval [CI]: 0.40-2.41, p=0.98) and stent thrombosis (OR:
0.64, 95% CI: 0.31-1.34, p=0.24) were similar in the simple and the
complex strategy. Compared with the complex strategy, the simple strategy
was associated with a reduced risk of either early or follow-up myocardial
infarction (OR: 0.53, 95% CI: 0.36-0.79, p=0.002; OR: 0.60, 95% CI:
0.43-0.86, p=0.01, respectively). The overall risks of side branch
restenosis (OR: 1.44, 95% CI: 0.73-2.87, p=0.30), target lesion (OR: 1.72,
95% CI: 0.95-3.12, p=0.07) and target vessel revascularisation (OR: 1.59,
95% CI: 0.94-2.69, p=0.09) were comparable between the two groups. In the
true bifurcation, with large side branches, and DK-crush subgroups, there
were higher rates of reintervention seen in the simple strategy than in
the complex strategy.
Conclusions: A complex strategy remains an optional treatment for patients
with coronary bifurcation lesions without severe safety concerns. A
complex strategy may be an optimal treatment for true bifurcation lesions
with large side branches. &#xa9; Europa Digital & Publishing 2014. All
rights reserved.

<2>
Accession Number
2015029377
Authors
Corredor C. Wasowicz M. Karkouti K. Sharma V.
Institution
(Corredor, Sharma) Department of Anaesthesia, St. George's Hospital,
London, United Kingdom
(Wasowicz, Karkouti) Department of Anesthesia and Pain Management, Toronto
General Hospital, Toronto, ON, Canada
Title
The role of point-of-care platelet function testing in predicting
postoperative bleeding following cardiac surgery: A systematic review and
meta-analysis.
Source
Anaesthesia. 70 (6) (pp 715-731), 2015. Date of Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Ltd
Abstract
This systematic review and meta-analysis appraises the utility of
point-of-care platelet function tests for predicting blood loss and
transfusion requirements in cardiac surgical patients, and analyses
whether their use within a transfusion management algorithm is associated
with improved patient outcomes. We included 30 observational studies
incorporating 3044 patients in the qualitative assessment, and nine
randomised controlled trials including 1057 patients in the meta-analysis.
Platelet function tests demonstrated significant variability in their
ability to predict blood loss and transfusion requirements. Their use
within a blood transfusion algorithm demonstrated a reduction in blood
loss at longest follow-up (mean difference -102.9 ml (95% CI -149.9 to
-56.1 ml), p < 0.001), and transfusion of packed red cells (RR 0.86 (95%
CI 0.78-0.94), p = 0.001) and fresh frozen plasma (RR 0.42 (95% CI
0.30-0.59), p < 0.001). Viscoelastic methods used in combination with
other platelet function tests achieved greater reduction in blood loss
(mean difference -111.8 ml (95% CI -174.9 to -49.1 ml), p = 0.0005)
compared with their use alone (mean difference -90.6 ml (95% CI 166.1-15.0
ml), p = 0.02). We conclude that incorporation of point-of-care platelet
function tests into transfusion management algorithms is associated with a
reduction in blood loss and transfusion requirements in cardiac surgery
patients.

<3>
Accession Number
2015031422
Authors
Fiorentino F. Angelini G.D. Suleiman M.-S. Rahman A. Anderson J. Bryan
A.J. Culliford L.A. Moscarelli M. Punjabi P.P. Reeves B.C.
Institution
(Fiorentino, Angelini, Rahman, Anderson, Moscarelli, Punjabi) Imperial
College London, National Heart and Lung Institute, Cardiothoracic Surgery
Department, Du Cane Road, London W12 0NN, United Kingdom
(Angelini, Suleiman, Bryan, Culliford, Reeves) Bristol Heart Institute,
University of Bristol, Bristol Royal Infirmary, Marlborough Street,
Bristol BS2 8HW, United Kingdom
Title
Investigating the effect of remote ischaemic preconditioning on biomarkers
of stress and injury-related signalling in patients having isolated
coronary artery bypass grafting or aortic valve replacement using
cardiopulmonary bypass: Study protocol for a randomized controlled trial.
Source
Trials. 16 (1) , 2015. Article Number: 181. Date of Publication: April 23,
2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Ischaemia-reperfusion injury occurs during heart surgery that
uses cardiopulmonary bypass (CPB) and cardioplegic arrest. It is
hypothesised that remote ischaemic preconditioning (RIPC) protects the
heart against such injury. Despite the numerous studies investigating the
protective effects of RIPC, there is still uncertainty about the
interpretation of the findings as well as conflicting results between
studies. The objective of this trial is to investigate the
cardioprotective effect of RIPC in patients having coronary artery bypass
grafting (CABG) or aortic valve replacement surgery. This will be achieved
by estimating the effect of the intervention in the two groups of
pathologies and by investigating the signalling mechanisms that may
underpin the cardioprotective effect. Methods/Design: A two-centre
randomised controlled trial will be used to investigate the effects of
RIPC in two pathologies: patients having isolated CABG and those having
aortic valve replacement surgery (AVR) with CPB. Participants will be
randomised to RIPC or control (sham RIPC), stratified by surgical stratum.
The intervention will be delivered by a research nurse. Data will be
collected by a research nurse blinded to the intervention. The patient and
the theatre staff are also blinded to the allocation. Markers of
myocardial injury and inflammation will be measured in myocardial biopsies
and in blood samples at different times. Discussion: This trial is
designed to investigate whether RIPC will reduce myocardial injury and
inflammation following heart surgery and whether there is a difference in
effect between participants having CABG or AVR. This trial is a unique
opportunity to study the mechanisms associated with RIPC using human
myocardial tissue and blood, and to relate these to the extent of
myocardial injury/protection.

<4>
Accession Number
2015871464
Authors
Gil R.J. Bil J. Dzavik V. Vassilev D. Kern A. Formuszewicz R.
Zalewska-Adamiec M. Dobrzycki S.
Institution
(Gil, Bil) Department of Invasive Cardiology, Central Clinical Hospital of
the Ministry of Interior, Warsaw, Poland
(Gil) Institute of Experimental and Clinical Medicine, Polish Academy of
Science, Warsaw, Poland
(Dzavik) Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
(Vassilev) Alexandrovska University Hospital, Sofia, Bulgaria
(Kern) Faculty of Medical Sciences, University of Varmia and Masuria,
Olsztyn, Poland
(Formuszewicz) 10th Clinical Military Hospital, Bydgoszcz, Poland
(Zalewska-Adamiec, Dobrzycki) Department of Invasive Cardiology, Medical
University of Bialystok, Bialystok, Poland
Title
Regular drug-eluting stent vs dedicated coronary bifurcation BiOSS expert
stent: multicenter open-label randomized controlled POLBOS I trial.
Source
Canadian Journal of Cardiology. 31 (5) (pp 671-678), 2015. Date of
Publication: 01 May 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: Results of regular drug-eluting stents (rDESs) in bifurcation
treatment are not optimal. The aim of the Polish Bifurcation Optimal
Stenting I (POLBOS I) trial was to compare bifurcation treatment with any
rDES vs the dedicated bifurcation paclitaxel-eluting stent BiOSS Expert
(Balton, Poland). The second aim was to study the effect of final kissing
balloon (FKB) inflation on clinical outcomes. Methods: Between October
2010 and January 2013 patients with stable coronary artery disease or
non-ST-elevation acute coronary syndrome were assigned 1:1 to 1 of 2
treatment strategies: BiOSS Expert stent or rDES implantation. Coronary
angiography was performed at 12 months. The primary end point was a
composite of cardiac-related death, myocardial infarction (MI), and target
lesion revascularization (TLR) at 12 months. Results: The BiOSS Expert was
implanted in 120 patients (49.4%),and an rDES was implanted in 123
patients. The target vessel was the left anterior descending (LAD) artery
(52% vs 70%) followed by the left main stem (LMS) coronary artery (22% vs
15%). In the rDES group, 38.2% received paclitaxel-eluting stents. There
were 3 stent implantation failures (2 in the rDES group and 1 in the BiOSS
Expert group). Side branch treatment with an rDES was required in 10% of
cases in both groups. At 12 months, the incidence of cumulative major
adverse cardiovascular events (MACE) was similar in both groups: 13.3% vs
12.2% (P= 0.7). The TLR rate was significantly higher in the BiOSS Expert
group compared with the rDES group (11.5% vs 7.3%; P= 0.02). Significantly
lower rates of restenosis were observed in FKB subgroups of both the BiOSS
Expert (8.1% vs 13.2%; P < 0.05) and rDES groups (4.9% vs 9.5%; P < 0.05).
Conclusions: MACE rates were comparable between the 2 groups; however, the
TLR rate was higher in the BiOSS Expert group. A more aggressive protocol
yielded better angiographic and clinical outcomes.

<5>
Accession Number
2015814904
Authors
O'Sullivan K.E. Hurley E.T. Segurado R. Sugrue D. Hurley J.P.
Institution
(O'Sullivan, Hurley, Sugrue, Hurley) Heart Team, Mater Private Hospital,
Dublin, Ireland
(Segurado) CSTAR Centre for Statistical Training and Research, University
College Dublin, Ireland
Title
Transaortic TAVI is a valid alternative to transapical approach.
Source
Journal of Cardiac Surgery. 30 (5) (pp 381-390), 2015. Date of
Publication: 01 May 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background and Aim Transcatheter aortic valve implantation (TAVI) can be
performed via a number of different anatomical approaches based on patient
characteristics and operator choice. The aim of this study was to compare
procedural outcomes between transaortic (TAo) and transapical (TA)
approaches in an effort to establish whether any differences exist.
Methods A systematic review and meta-analysis of the current literature
reporting outcomes for patients undergoing TAo and TA TAVI was performed
to compare outcomes using each vascular approach to valve deployment.
Results A total of 10 studies and 1736 patients were included. A total of
193 patients underwent TAo and 1543 TA TAVI. No significant difference in
30-day mortality was identified (TAo 9.4, TA 10.4 p = 0.7). There were no
significant differences identified between TAo and TA TAVI in procedural
success rate (96.3% vs. 93.7% p = 0.3), stroke and transient ischemic
attack (TIA) incidence (1.8% vs. 2.3% p = 0.7), major bleed (5.8% vs. 5.5%
p = 0.97) or pacemaker insertion rates (6.1% vs. 7.4% p = 0.56). In
addition, the incidence of clinically significant paravalvular
regurgitation (PVR) was the same between groups (6.7% vs. 11% p = 0.43).
Conclusion Comparison of TAo and TA approaches revealed equivalent
outcomes in 30-day mortality, procedural success, major bleeding,
stroke/TIA incidence, pacemaker insertion rates and paravalvular leak.
Heart teams should be familiar with the use of both TA and TAo access and
tailor their selection on a case-to-case basis.

<6>
Accession Number
2015052375
Authors
Briasoulis A. Palla M. Mostafa A. Afonso L. Grines C.
Institution
(Briasoulis, Palla, Mostafa, Afonso, Grines) Wayne State University,
Detroit Medical Center, Department of Cardiology, Detroit, IL 48226,
United States
Title
Fractional flow-guided management in patients with acute coronary
syndromes: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 187 (1) (pp 334-337), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Ireland Ltd

<7>
Accession Number
2015049530
Authors
Pearce A. Lockwood C. Van Den Heuvel C.
Institution
(Pearce, Lockwood) Joanna Briggs Institute, The University of Adelaide,
SA, Australia
(Van Den Heuvel) School of Medical Sciences, The University of Adelaide,
SA, Australia
Title
The use of therapeutic magnesium for neuroprotection during global
cerebral ischemia associated with cardiac arrest and cardiac bypass
surgery in adults: A systematic review protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 13 (4) (pp
3-13), 2015. Date of Publication: 2015.
Publisher
Joanna Briggs Institute
Abstract
Review objective The objective of this review is to present the best
currently available evidence in relation to the neuroprotective
effectiveness of magnesium during a period of global cerebral ischemia in
adults with cardiac arrest or undergoing cardiac bypass surgery. Inclusion
criteria Types of participants This review will consider adults above 18
years of age. Studies of patients with existing neurological deficits or
under the age of 18 will be excluded from the review. Types of
intervention(s) The intervention of interest is magnesium in doses of at
least two grams compared to placebo administered to adult patients within
24 hours of cardiac arrest or coronary bypass surgery. Types of outcomes
The outcome of interest is neurological recovery post-cardiac arrest or
coronary bypass surgery as measured by objective scales, such as, but not
limited to: cerebral performance category, brain stem reflex, Glasgow Coma
Score and independent living or dependent living status.

<8>
Accession Number
2015022059
Authors
Yi J. Gong Y. Quan X. Huang Y.
Institution
(Yi, Gong, Quan, Huang) Peking Union Medical College Hospital, Department
of Anesthesiology, Chinese Academy of Medical Science, No.1 Shuaifuyuan
Wangfujing Street, Beijing 100730, China
Title
Comparison of the Airtraq laryngoscope and the GlideScope for double-lumen
tube intubation in patients with predicted normal airways: A prospective
randomized trial.
Source
BMC Anesthesiology. 15 (1) , 2015. Article Number: 58. Date of
Publication: April 28, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: The Airtraq laryngoscope and the GlideScope are commonly used
in many airway scenarios. However, their features have not been fully
described for double-lumen tube intubation. A prospective randomized study
was designed to compare their intubation performances in thoracic surgery
patients. Methods: Seventy ASA physical status I and II patients with
predicted normal airway were scheduled for thoracic surgeries with
double-lumen tube intubation. They were randomly assigned to one of two
groups and intubated with either the Airtraq laryngoscope (group A, n =
35) or the GlideScope (group G, n = 35). Airway assessments were performed
prior to anesthesia, and all patients were induced with a standard
anesthetic regimen. The Cormack-Lehane grades were initially evaluated
with a Macintosh laryngoscope and subsequently with the group-specific
laryngoscope before intubation. Intubation time was recorded as the
primary outcome. The Cormack-Lehane grade, the success of the first
intubation attempt, the intubation difficulty scales and ease of tube
advancement were noted. Hemodynamic variables during intubation and
incidence of post-operative sore throat were documented as well. Results:
The intubation time of group A was shorter than that of group G (36.6 +/-
20.2 s vs. 54.6 +/- 25.7 s, p = 0.002). The Cormack-Lehane grade
(I/II/III/IV) was significantly better in group A (33/2/0/0 vs. 28/7/0/0,
p = 0.042). The mean arterial pressure and heart rate rose to higher
levels during intubation with the GlideScope than with the Airtraq
laryngoscope. The success of the first intubation attempt and the
intubation difficulty scales were comparable between the two groups. The
numbers of patients who experienced postoperative sore throat were similar
(6 vs. 8) in the two groups. Conclusions: Compared with the GlideScope,
the specially designed Airtraq laryngoscope might be more suitable for
double-lumen tube intubations in patients with predicted normal airway.
Trial registration: www.chictr.org Identifier: ChiCTR-TRC-11001628.

<9>
Accession Number
2015047689
Authors
Virk S.A. Tian D.H. Liou K. Pathan F. Villanueva C. Akhunji Z. Cao C.
Institution
(Virk, Tian, Cao) Systematic Review Unit, Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
(Villanueva) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
(Akhunji, Cao) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Villanueva, Cao) University of New South Wales, Sydney, Australia
Title
Systematic review of percutaneous coronary intervention and transcatheter
aortic valve implantation for concomitant aortic stenosis and coronary
artery disease.
Source
International Journal of Cardiology. 187 (1) (pp 453-455), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Ireland Ltd

<10>
Accession Number
2015048104
Authors
Nishikido T. Oyama J.-I. Ohira H. Node K.
Institution
(Nishikido, Oyama, Node) Department of Cardiovascular of Medicine, Saga
University Hospital, Saga, Japan
(Ohira) Department of Cardiovascular Medicine, Edogawa Hospital, Tokyo,
Japan
Title
The effects and safety of vildagliptin on cardiac function after acute
myocardial infarction.
Source
International Journal of Cardiology. 188 (1) (pp 13-15), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Ireland Ltd

<11>
Accession Number
2015043781
Authors
Sivanna U. Joshi S. Babu B. Jagadeesh A.M.
Institution
(Sivanna, Joshi, Babu, Jagadeesh) Department of Cardiac Anaesthesiology,
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru,
Karnataka, India
Title
A comparative study of pharmacological myocardial protection between
sevoflurane and desflurane at anaesthestic doses in patients undergoing
off pump coronary artery bypass grafting surgery.
Source
Indian Journal of Anaesthesia. 59 (5) (pp 282-286), 2015. Date of
Publication: 01 May 2015.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Perioperative myocardial ischaemia (PMI) is one of
the known complications during off pump coronary artery bypass (OPCAB)
surgeries. The length of hospital stay is considerably prolonged in
patients with PMI. Myocardial protection is an area which is being widely
researched currently to prevent or reduce the incidence of PMI. Over the
last decade it has become clear that volatile anaesthetic agents are
protective in the setting of PMI and reperfusion. Hence, we planned to
study the effect of two different volatile anaesthetics as myocardial
protective agents in OPCAB surgery. Methods: A total of 40 patients were
enrolled for the study; Group A (sevoflurane, n = 20) and Group B
(desflurane, n = 20). All patients had a baseline measurement of Trop-T,
creatine phosphokinase-MB (CPKMB) and myocardial performance index (MPI)
pre-operatively, which was repeated 4 h after the surgery.
Chi-square/Fisher test was used to find the significance of the
differences between the two agents. Results: Patients were comparable in
demographic, baseline, biochemical and echo criteria. Post-operative CPKMB
levels (desflurane - 30.85 +/- 2.69 u/L; sevoflurane - 29.05 +/- 5.26 u/L,
P = 0.7) and number of Trop-T positive patients (Sevoflurane - 9;
desflurane - 6, P > 0.05) were comparable. Post-operative MPI indicated
decreased left ventricular function in sevoflurane group as compared to
desflurane group (P < 0.03). Conclusion: Desflurane exerts better
cardioprotective effect than sevoflurane as indicated by better MPI in
OPCAB surgeries.

<12>
Accession Number
2015041870
Authors
Parfrey P.S. Drueke T.B. Block G.A. Herzog C.A. London G.M. Mahaffey K.W.
Moe S.M. Wheeler D.C. Kubo Y. Dehmel B. Goodman W.G. Chertow G.M. Santos
J. Najun Zarazaga C. Marin I. Garrote N. Cusumano A. Penalba N. Del Valle
E. Juncos L. Martinez Saye J. Lef L. Altobelli V. Petraglia G. Rosa Diez
G. Douthat W. Lobo J. Gallart C. Lafalla A. Diez G. Linares B. Lopez N.
Ramirez N. Gonzalez R. Valtuille R. Beresan H. Hermida O. Rudolf G.
Marchetta N. Rano M. Ramirez M. Garcia N. Gillies A. Jones B. Pedagogos E.
Walker R. Talaulikar G. Bannister K. Suranyi M. Kark A. Roger S. Kerr P.
Disney A. Mount P. Fraenkel M. Mathew M. Fassett R. Jose M. Hawley C.
Lonergan M. Mackie J. Ferrari P. Menahem S. Sabto J. Hutchison B. Langham
R. Pollock C. Holzer H. Oberbauer R. Arias I. Graf H. Mayer G. Lhotta K.
Neyer U. Klauser R. Hoerl W. Horn S. Kovarik J. Kramar R. Eigner M. Dhaene
M. Billiouw J. De Meester J. Warling X. Cambier-Dwelschauwers P. Evenepoel
P. Daelemans R. Dratwa M. Maes B. Stolear J. Dejagere T. Vanwalleghem J.
Bouman K. Jadoul M. Peeters J. Vanholder R. Tielemans C. Donck J. Almeida
F. Picollo de Oliveira J. Burdmann E. Garcia V. Saldanha Thome F. Deboni
L. Bregman R. Lugon J. Araujo S. Ferreira Filho S. de Francesco Daher E.
Sperto Baptista M. Carvalho A. d'Avila D. Moyses Neto M. Yu L. Bastos M.
Sampaio Lacativa P. Jorgetti V. de Almeida Romao E. Cardeal da Costa J.
Pecoits Filho R. Gordan P. Salgado N. Teixeira Araujo M. Neiva Coelho S.
Oliveira I. Moyses R. Vasconcellos L. Batista P. Luiz Gross J. Pedrosa A.
Cournoyer S. LeBlanc M. Chow S. Karunakaran S. Wong G. Tobe S. Desmeules
S. Zimmerman D. Murphy S. Montambault P. Donnelly S. MacRae J. Culleton B.
Soroka S. Rabbat C. Jindal K. Vasilevsky M. Michaud M. Wijeyesinghe E.
Zacharias J. Lok C. Muirhead N. Verrelli M. Da Roza G. Sapir D. Olgaard K.
Daugaard H. Brandi L. Jensen P. Boulechfar H. Ang K. Simon P. Rieu P.
Brunet P. Touchard G. London G. Urena Torres P. Combe C. Durrbach A. Ortiz
J. Hannedouche T. Vela C. Lionet A. Ryckelynck P. Zaoui P. Choukroun G.
Fessi H. Lang P. Stroumza P. Joly D. Mousson C. Laville M. Dellanna F.
Erley C. Braun J. Rambausek M. Riegel W. Klingberg M. Schwertfeger E.
Wizemann V. Eckardt K. Reichel H. Floege J. Passauer J. Hubel E.
Frischmuth N. Liebl R. Fiedler R. Schwenger V. Vosskuhler A. Kunzendorf U.
Renders L. Rattensberger D. Rump L. Ketteler M. Neumayer H. Zantvoort F.
Stahl R. Ladanyi E. Kulcsar I. Mezei I. Csiky B. Rikker C. Arkossy O.
Berta K. Szegedi J. Major L. Ferenczi S. Fekete A. Szabo T. Zakar G.
Wagner G. Kazup Erdelyine S. Borbas B. Eustace J. Reddan D. Capasso G.
Locatelli F. Villa G. Cozzolino M. Brancaccio D. Messa P. Bolasco P.
Ricciardi B. Malberti F. Moriero E. Cannella G. Ortalda V. Stefoni S.
Frasca G. Cappelli G. Albertazzi A. Zoccali C. Farina M. Elli A. Avella F.
Ondei P. Mingardi G. Errico R. Losito A. Di Giulio S. Pertosa G. Schena F.
Grandaliano G. Gesualdo L. Auricchio M. Bochicchio-Ricardelli T.
Correa-Rotter R. Aranda Verastegui F. Pena J. Chew Wong A. Cruz-Valdez J.
Torres Zamora M. Solis M. Sebastian Diaz M. Vital Flores M. Alvarez
Sandoval E. van den Dorpel M. Brink H. Van Kuijk W. Vermeij C. Smak
Gregoor P. Hagen E. van der Sande F. Klinger M. Nowicki M. Muszytowski M.
Bidas K. Bentkowski W. Wiecek A. Ksiazek A. Marczewski K. Ostrowski M.
Switalski M. Sulowicz W. Matuszkiewicz-Rowinska J. Mysliwiec M. Durlik M.
Rutkowski B. Macario F. Carvalho B. Frazao J. Machado D. Weigert A.
Andrusev A. Khrustalev O. Zemtchenkov A. Gurevich K. Staroselsky K.
Khadikova N. Rozhinskaya L. Timokhovskaya G. Strokov A. Balkarova O.
Ermolenko V. Kolmakova E. Komandenko M. Timofeev M. Shilo V. Shostka G.
Smirnov A. Anashkin V. Volgina G. Domashenko O. Gurevich A. Perlin D.
Martinez Garcia J. Andres Ribes E. Coll Piera E. Fernandez Lucas M.
Galicia M. Prados M. Gonzalez M. Romero R. Martin de Francisco A.
Montenegro J. Santiago C. Garcia F. Alcazar de La Ossa J. Arrieta J. Pons
J. Martin-Malo A. Soler Amigo J. Cases A. Sterner G. Jensen G. Wikstrom B.
Jacobson S. Lund U. Weiss L. Stahl A. von Albertini B. Burnier M. Meier P.
Martin P. Uehlinger D. Dickenmann M. Yaqoob M. Zehnder D. Kalra P. Wheeler
D. Padmanabhan N. Roe S. Eadington D. Pritchard N. Hutchison A. Davies S.
Wilkie M. Davies M. Pai P. Swift P. Kwan J. Goldsmith D. Tomson C.
Stratton J. Dasgupta I. Sarkar S. Moustafa M. Gandhi K. Jamal A.
Galindo-Ramos E. Tuazon J. Batlle D. Tucker K. Schiller-Moran B. Assefi A.
Martinez C. Samuels L. Goldman J. Cangiano-Rivera J. Darwish R. Lee M.
Topf J. Kapatkin K. Baer H. Kopelman R. Acharya M. Tharpe D. Bernardo M.
Nader P. Guzman-Rivera J. Pergola P. Sekkarie M. Alas E. Zager P. Liss K.
Navarro J. Roppolo M. Denu-Ciocca C. Kshirsagar A. El Khatib M. Kant K.
Scott D. Murthyr B. Finkelstein F. Keightley G. McCrary R. Pitone J.
Cavalieri T. Tsang A. Pellegrino B. Schmidt R. Ahmad S. Brown C. Friedman
E. Mittman N. Fadem S. Shapiro W. Reddy M. Goldberger S. Woredekal Y.
Agarwal A. Anger M. Haque M. Chidester P. Kohli R. Rubinstein S. Newman G.
Gladish R. Ayodeji O. Soman S. Sprague S. Hunt N. Gehr T. Rizk D. Warnock
D. Polack D. Pahl M. Fischer D. Dreyer P. James G. Husserl F. Rogers T.
Raff A. Sedor J. Silver M. Smith M. Steinberg S. DelGiorno T. Jones E.
Cunha P.D. Cheng J. Pogue V. Block G. Blumenthal S. Brown E. Charytan C.
Buerkert J. Cook M. Felsenfeld A. Tareen N. Herman T. Diamond S. Hura C.
Laski M. MacLaurin J. Plumb T. Brosnahan G. Kumar J. Henriquez M. Poole C.
Osanloo E. Matalon A. Sholer C. Arfeen S. Azer M. Belledonne M. Gross M.
Dunnigan E. McConnell K. Becker B. Skinner F. Rigolosi R. Spiegel D.
Stegman M. Patak R. Streja D. Ranjit U. Youell T. Wooldridge T. Stafford
C. Cottiero R. Weinberg M. Schonefeld M. Shahmir E. Hazzan A. Ashfaq A.
Bhandari K. Cleveland W. Culpepper M. Golden J. Lai L. Lien Y. Lorica V.
Robertson J. Malireddi K. Morse S. Thakur V. Israelit A. Raguram P. Alfred
H. Weise W. Al-Saghir F. El Shahawy M. Rastogi A. Nissenson A. Kopyt N.
Lynn R. Lea J. McClellan W. Teredesai P. Ong S. Tolkan S. Sugihara J.
Minga T. Mehrotra R. Minasian R. Bhatia D. Specter R. Capelli J. Sidhu P.
Dalal S. Dykes P. Khan M. Rahim F. Saklayen M. Thomas A. Michael B. Torres
M. Al-Bander H. Murray B. Abukurah A. Gupta B. Nosrati S. Raja R. Zeig S.
Braun M. Amatya A. Endsley J. Sharon Z. Gupta A. Dolson G. Dumler F. Ntoso
K. Rosansky S. Kumar N. Gura V. Thompson N. Goldfarb D. Halligan R.
Middleton J. Widerhorn A. Arbeit L. Arruda J. Crouch T. Friedman L.
Khokhar S. Mittleman J. Light P. Taparia B. West C. Cotton J. Dhingra R.
Kleinman L. Arif F. Lew S. Nammour T. Sterrett J. Williams M. Ramirez J.
Rubin J. McCarthy J. Noble S. Chaffin M. Rekhi A. Evaluation of Cinacalcet
HCL Therapy to Lower Cardiovascular Events (EVOLVE) Trial Investigators
Institution
(Parfrey) Department of Medicine, Health Sciences Center, St. John's, NL,
Canada
(Drueke) French Institute of Health and Medical Research Unit 1088,
University of Picardie, Amiens, France
(Block) Denver Nephrology, Denver, CO, United States
(Correa-Rotter) Department of Nephrology and Mineral Metabolism, Salvador
Zubiran National Institute of Health Sciences and Nutrition, Mexico City,
Mexico
(Floege) Department of Nephrology, RWTH Aachen University Hospital,
Aachen, Germany
(Herzog) Department of Internal Medicine, University of Minnesota,
Minneapolis, MN, United States
(London) Service of Nephrology, Manhes Hospital, Paris, France
(Mahaffey, Chertow) Department of Medicine, Stanford University School of
Medicine, Palo Alto, CA, United States
(Moe) Department of Medicine, Indiana University School of Medicine,
Roudebush Veterans Administration Medical Center, Indianapolis, IN, United
States
(Wheeler) Centre for Nephrology, University College London, United Kingdom
(Kubo, Dehmel, Goodman) Amgen Inc, Thousand Oaks, CA, United States
(Santos, Najun Zarazaga, Marin, Garrote, Cusumano, Penalba, Del Valle,
Juncos, Martinez Saye, Lef, Altobelli, Petraglia, Rosa Diez, Douthat,
Lobo, Gallart, Lafalla, Diez, Linares, Lopez, Ramirez, Gonzalez,
Valtuille, Beresan, Hermida, Rudolf, Marchetta, Rano, Ramirez, Garcia)
Argentina
(Gillies, Jones, Pedagogos, Walker, Talaulikar, Bannister, Suranyi, Kark,
Roger, Kerr, Disney, Mount, Fraenkel, Mathew, Fassett, Jose, Hawley,
Lonergan, Mackie, Ferrari, Menahem, Sabto, Hutchison, Langham, Pollock)
Australia
(Holzer, Oberbauer, Arias, Graf, Mayer, Lhotta, Neyer, Klauser, Hoerl,
Horn, Kovarik, Kramar, Eigner) Austria
(Dhaene, Billiouw, De Meester, Warling, Cambier-Dwelschauwers, Evenepoel,
Daelemans, Dratwa, Maes, Stolear, Dejagere, Vanwalleghem, Bouman, Jadoul,
Peeters, Vanholder, Tielemans, Donck) Belgium
(Almeida, Picollo de Oliveira, Burdmann, Garcia, Saldanha Thome, Deboni,
Bregman, Lugon, Araujo, Ferreira Filho, de Francesco Daher, Sperto
Baptista, Carvalho, d'Avila, Moyses Neto, Yu, Bastos, Sampaio Lacativa,
Jorgetti, de Almeida Romao, Cardeal da Costa, Pecoits Filho, Gordan,
Salgado, Teixeira Araujo, Neiva Coelho, Oliveira, Moyses, Vasconcellos,
Batista, Luiz Gross, Pedrosa) Brazil
(Cournoyer, LeBlanc, Chow, Karunakaran, Wong, Tobe, Desmeules, Zimmerman,
Murphy, Montambault, Donnelly, MacRae, Culleton, Soroka, Rabbat, Jindal,
Vasilevsky, Michaud, Wijeyesinghe, Zacharias, Lok, Muirhead, Verrelli, Da
Roza, Sapir) Canada
(Olgaard, Daugaard, Brandi, Jensen) Denmark
(Boulechfar, Ang, Simon, Rieu, Brunet, Touchard, London, Urena Torres,
Combe, Durrbach, Ortiz, Hannedouche, Vela, Lionet, Ryckelynck, Zaoui,
Choukroun, Fessi, Lang, Stroumza, Joly, Mousson, Laville) France
(Dellanna, Erley, Braun, Rambausek, Riegel, Klingberg, Schwertfeger,
Wizemann, Eckardt, Reichel, Floege, Passauer, Hubel, Frischmuth, Liebl,
Fiedler, Schwenger, Voskuhler, Kunzendorf, Renders, Rattensberger, Rump,
Ketteler, Neumayer, Zantvoort, Stahl) Germany
(Ladanyi, Kulcsar, Mezei, Csiky, Rikker, Arkossy, Berta, Szegedi, Major,
Ferenczi, Fekete, Szabo, Zakar, Wagner, Kazup Erdelyine, Borbas) Hungary
(Eustace, Reddan) Ireland
(Capasso, Locatelli, Villa, Cozzolino, Brancaccio, Messa, Bolasco,
Ricciardi, Malberti, Moriero, Cannella, Ortalda, Stefoni, Frasca,
Cappelli, Albertazzi, Zoccali, Farina, Elli, Avella, Ondei, Mingardi,
Errico, Losito, Di Giulio, Pertosa, Schena, Grandaliano, Gesualdo,
Auricchio) Italy
(Bochicchio-Ricardelli, Correa-Rotter, Aranda Verastegui, Pena, Chew Wong,
Cruz-Valdez, Torres Zamora, Solis, Sebastian Diaz, Vital Flores, Alvarez
Sandoval) Mexico
(van den Dorpel, Brink, Van Kuijk, Vermeij, Smak Gregoor, Hagen, van der
Sande) Netherlands
(Klinger, Nowicki, Muszytowski, Bidas, Bentkowski, Wiecek, Ksiazek,
Marczewski, Ostrowski, Switalski, Sulowicz, Matuszkiewicz-Rowinska,
Mysliwiec, Durlik, Rutkowski) Poland
(Macario, Carvalho, Frazao, Machado, Weigert) Portugal
(Andrusev, Khrustalev, Zemtchenkov, Gurevich, Staroselsky, Khadikova,
Rozhinskaya, Timokhovskaya, Strokov, Balkarova, Ermolenko, Kolmakova,
Komandenko, Timofeev, Shilo, Shostka, Smirnov, Anashkin, Volgina,
Domashenko, Gurevich, Perlin) Russian Federation
(Martinez Garcia, Andres Ribes, Coll Piera, Fernandez Lucas, Galicia,
Prados, Gonzalez, Romero, Martin de Francisco, Montenegro, Santiago,
Garcia, Alcazar de La Ossa, Arrieta, Pons, Martin-Malo, Soler Amigo,
Cases) Spain
(Sterner, Jensen, Wikstrom, Jacobson, Lund, Weiss, Stahl) Sweden
(von Albertini, Burnier, Meier, Martin, Uehlinger, Dickenmann) Switzerland
(Yaqoob, Zehnder, Kalra, Wheeler, Padmanabhan, Roe, Eadington, Pritchard,
Hutchison, Davies, Wilkie, Davies, Pai, Swift, Kwan, Goldsmith, Tomson,
Stratton, Dasgupta) United Kingdom
(Sarkar, Moustafa, Gandhi, Jamal, Galindo-Ramos, Tuazon, Batlle, Tucker,
Schiller-Moran, Assefi, Martinez, Samuels, Goldman, Cangiano-Rivera,
Darwish, Lee, Topf, Kapatkin, Baer, Kopelman, Acharya, Tharpe, Bernardo,
Nader, Guzman-Rivera, Pergola, Sekkarie, Alas, Zager, Liss, Navarro,
Roppolo, Denu-Ciocca, Kshirsagar, El Khatib, Kant, Scott, Murthyr,
Finkelstein, Keightley, McCrary, Pitone, Cavalieri, Tsang, Pellegrino,
Schmidt, Ahmad, Brown, Friedman, Mittman, Fadem, Shapiro, Reddy,
Goldberger, Woredekal, Agarwal, Anger, Haque, Chidester, Kohli,
Rubinstein, Newman, Gladish, Ayodeji, Soman, Sprague, Hunt, Gehr, Rizk,
Warnock, Polack, Pahl, Fischer, Dreyer, James, Husserl, Rogers, Raff,
Sedor, Silver, Smith, Steinberg, DelGiorno, Jones, Cunha, Cheng, Pogue,
Block, Blumenthal, Brown, Charytan, Buerkert, Cook, Felsenfeld, Tareen,
Gupta, Herman, Diamond, Hura, Laski, MacLaurin, Plumb, Brosnahan, Kumar,
Henriquez, Poole, Osanloo, Matalon, Sholer, Arfeen, Azer, Belledonne,
Gross, Dunnigan, McConnell, Becker, Skinner, Rigolosi, Spiegel, Stegman,
Patak, Streja, Ranjit, Youell, Wooldridge, Stafford, Cottiero, Weinberg,
Schonefeld, Shahmir, Hazzan, Ashfaq, Bhandari, Cleveland, Culpepper,
Golden, Lai, Lien, Lorica, Robertson, Malireddi, Morse, Thakur, Israelit,
Raguram, Alfred, Weise, Al-Saghir, El Shahawy, Rastogi, Nissenson, Kopyt,
Lynn, Lea, McClellan, Teredesai, Ong, Tolkan, Sugihara, Minga, Mehrotra,
Minasian, Bhatia, Specter, Capelli, Sidhu, Dalal, Dykes, Khan, Rahim,
Saklayen, Thomas, Michael, Torres, Al-Bander, Murray, Abukurah, Gupta,
Nosrati, Raja, Zeig, Braun, Amatya, Endsley, Sharon, Gupta, Dolson,
Dumler, Ntoso, Rosansky, Kumar, Gura, Thompson, Goldfarb, Halligan,
Middleton, Widerhorn, Arbeit, Arruda, Crouch, Friedman, Khokhar,
Mittleman, Light, Taparia, West, Cotton, Dhingra, Kleinman, Arif, Lew,
Nammour, Sterrett, Williams, Ramirez, Rubin, McCarthy, Noble, Chaffin,
Rekhi) United States
Title
The effects of cinacalcet in older and younger patients on hemodialysis:
The evaluation of cinacalcet HCL therapy to lower cardiovascular events
(EVOLVE) trial.
Source
Clinical Journal of the American Society of Nephrology. 10 (5) (pp
791-799), 2015. Date of Publication: 01 Jan 2015.
Publisher
American Society of Nephrology
Abstract
Background and objectives The calcimimetic cinacalcet reduced the risk of
death or cardiovascular (CV) events in older, but not younger, patients
with moderate to severe secondary hyperparathyroidism (HPT) who were
receiving hemodialysis. To determine whether the lower risk in younger
patients might be due to lower baseline CV risk and more frequent use of
cointerventions that reduce parathyroid hormone (kidney transplantation,
parathyroidectomy, and commercial cinacalcet use), this study examined the
effects of cinacalcet in older (> 65 years, n=1005) and younger (<65
years, n=2878) patients. Design, setting, participants, & measurements
Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events
(EVOLVE) was a global, multicenter, randomized placebo-controlled trial in
3883 prevalent patients on hemodialysis, whose outcomes included death,
major CV events, and development of severe unremitting HPT. The age
subgroup analysis was prespecified. ResultsOlder patients had higher
baseline prevalence of diabetesmellitus and CV comorbidity. Annualized
rates of kidney transplantation and parathyroidectomy were > 3-fold higher
in younger relative to older patients and were more frequent in patients
randomized to placebo. In older patients, the adjusted relative hazard
(95% confidence interval) for the primary composite (CV) end point
(cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients,
the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted
relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to
1.13). Reduction in the risk of severe unremitting HPT was similar in both
groups. Conclusions In the EVOLVE trial, cinacalcet decreased the risk of
death and of major CV events in older, but not younger, patients with
moderate to severe HPT who were receiving hemodialysis. Effect
modification by age may be partly explained by differences in underlying
CV risk and differential application of cointerventions that reduce
parathyroid hormone.

<13>
Accession Number
2015034309
Authors
He W.-M. Li C.-L. Sun Y. Zhou Z. Mai Y.-F.
Institution
(He, Zhou, Mai) Department of Cardiovascular Disease, Affiliated Hospital
of Ningbo University, Ningbo, Zhejiang 315000, China
(Li, Sun) Department of Cardiovascular Disease, The Second Affiliated
Hospital of Zhejiang, University School of Medicine, Hangzhou, Zhejiang
310000, China
Title
Safety and efficacy of a novel technique in the use of fractional flow
reserve in complex coronary artery lesions.
Source
Chinese Medical Journal. 128 (6) (pp 822-825), 2015. Date of Publication:
20 Mar 2015.
Publisher
Chinese Medical Association
Abstract
Background: Fractional flow reserve (FFR) has become an increasingly
important index when making decisions with respect to revascularization of
coronary artery stenosis. However, the pressure guidewire used in
obtaining FFR measurements is difficult to control and manipulate in
certain complex coronary artery lesions, resulting in increased
fluoroscopy time and contrast dye usage. This study examined a novel (NOV)
technique for obtaining FFR measurements in hope of easing the
difficulties associated with evaluating and treating complex coronary
artery lesions. Methods: Fifty-six patients with complex coronary artery
lesions were assigned to a conventional (CON) FFR technique group or a NOV
FFR technique group. The NOV technique involved the use of a balloon and
wire exchange within the coronary artery. The fluoroscopy time, contrast
dye usage, and FFR-related complications were assessed after completing
the FFR measurement procedure for each patient. Results: The median time
required for fluoroscopy in the NOV technique group was significantly less
than that in the CON technique group; additionally, lesser amounts of
contrast dye were used in the NOV technique group (both P < 0.05). The NOV
technique was successfully performed in thirty patients, without any
FFR-related complications. However, the CON technique failed in three
patients, including two who experienced coronary artery spasms (P > 0.05).
Conclusions: Compared to the CON technique used for measuring FFR, the new
technique reduced the fluoroscopy time and amount of contrast dye used
when evaluating complex coronary artery lesions. The new technique did not
increase the risk of operation or decrease the success rate.

<14>
Accession Number
2015034299
Authors
Shen L. Yang W. Yin J.-S. Liu X.-B. Wu Y.-Z. Sun A.-J. Qian J.-Y. Ge J.-B.
Institution
(Shen, Yin, Wu, Sun, Qian, Ge) Department of Cardiology, Shanghai
Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan
University, Shanghai 200032, China
(Yang) Department of Cardiology, First Affiliated Hospital of Harbin
Medical University, Harbin, Heilongjiang 150001, China
(Liu) Department of Cardiology, East Hospital, Tongji University School of
Medicine, Shanghai 200120, China
Title
Nine-month angiographic and two-year clinical follow-up of novel
biodegradable-polymer arsenic trioxide-eluting stent versus
durable-polymer sirolimus-eluting stent for coronary artery disease.
Source
Chinese Medical Journal. 128 (6) (pp 768-773), 2015. Date of Publication:
20 Mar 2015.
Publisher
Chinese Medical Association
Abstract
Background: Despite great reduction of in-stent restenosis,
first-generation drug-eluting stents (DESs) have increased the risk of
late stent thrombosis due to delayed endothelialization. Arsenic trioxide,
a natural substance that could inhibit cell proliferation and induce cell
apoptosis, seems to be a promising surrogate of sirolimus to improve DES
performance. This randomized controlled trial was to evaluate the efficacy
and safety of a novel arsenic trioxide-eluting stent (AES), compared with
traditional sirolimus-eluting stent (SES). Methods: Patients with symptoms
of angina pectoris were enrolled and randomized to AES or SES group. The
primary endpoint was target vessel failure (TVF), and the second endpoint
includes rates of all-cause death, cardiac death or myocardial infarction,
target lesion revascularization (TLR) by telephone visit and late luminal
loss (LLL) at 9-month by angiographic follow-up. Results: From July 2007
to 2009, 212 patients were enrolled and randomized 1:1 to receive either
AES or SES. At 2 years of follow-up, TVF rate was similar between AES and
SES group (6.67% vs. 5.83%, P = 0.980). Frequency of all-cause death was
significantly lower in AES group (0 vs. 4.85%, P = 0.028). There was no
significant difference between AES and SES in frequency of TLR and
in-stent restenosis, but greater in-stent LLL was observed for AES group
(0.29 +/- 0.52 mm vs. 0.10 +/- 0.25 mm, P = 0.008). Conclusions: After 2
years of follow-up, AES demonstrated comparable efficacy and safety to SES
for the treatment of de novo coronary artery lesions.

<15>
Accession Number
2015034252
Authors
Wei L.-Y. Fu X.-H. Li W. Bi X.-L. Bai S.-R. Xing K. Wang Y.-B.
Institution
(Wei) Department of Cardiology, The First Hospital of Hebei Medical
University, Shijiazhuang, Hebei 050000, China
(Fu, Li, Bi, Bai, Xing, Wang) Department of Cardiology, The Second
Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
Title
Effect of intravenous administration of liposomal prostaglandin E1 on
microcirculation in patients with ST elevation myocardial infarction
undergoing primary percutaneous intervention.
Source
Chinese Medical Journal. 128 (9) (pp 1147-1150), 2015. Date of
Publication: 05 May 2015.
Publisher
Chinese Medical Association
Abstract
Background: Several studies have demonstrated that primary percutaneous
coronary intervention (PCI) can result in reperfusion injury. This study
aims to investigate the effectiveness of liposomal prostaglandin E1
(Lipo-PGE1, Alprostadil, Beijing Tide Pharmaceutical Co., Ltd.) for
enhancing microcirculation in reperfusion injury. In addition, this study
determined the optimal administration method for acute ST elevation
myocardial infarction (STEMI) patients undergoing primary PCI. Methods:
Totally, 68 patients with STEMI were randomly assigned to two groups:
intravenous administration of Lipo-PGE1 (Group A), and no Lipo-PGE1
administration (Group B). The corrected thrombolysis in myocardial
infarction (TIMI) frame count (cTFC) and myocardial blush grade (MBG) were
calculated. Patients were followed up for 6 months. Major adverse cardiac
events (MACE) were also measured. Results: There was no significant
difference in the baseline characteristics between the two groups. The
cTFC parameter in Group A was significantly lower than Group B (18.06 +/-
2.06 vs. 25.31 +/- 2.59, P < 0.01). The ratio of final MBG grade-3 was
significantly higher (P < 0.05) in Group A (87.9%) relative to Group B
(65.7%). There was no significant difference between the two groups in
final TIMI-3 flow and no-reflow. Patients were followed up for 6 months,
and the occurrence of MACE in Group A was significantly lower than that in
Group B (6.1% vs. 25.9% respectively, P < 0.05). Conclusions: Myocardial
microcirculation of reperfusion injury in patients with STEMI, after
primary PCI, can be improved by administering Lipo-PGE1.

<16>
Accession Number
2015044672
Authors
Xu X. Wang R. Wang Y. Cai S.
Institution
(Xu, Cai) Department of Cardiology, Affiliated Hospital of Qingdao
University, Qingdao 266003, China
(Wang, Wang) Department of Endocrinology, Affiliated Hospital of Qingdao
University, Qingdao 266003, China
Title
Glycosylated hemoglobin levels and clinical outcomes in diabetic patients
receiving percutaneous coronary interventions: A meta-analysis of cohort
studies.
Source
International Journal of Cardiology. 190 (1) (pp 143-147), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ireland Ltd

<17>
Accession Number
2015046272
Authors
Campos C.M. Garcia-Garcia H.M. Van Klaveren D. Ishibashi Y. Cho Y.-K.
Valgimigli M. Raber L. Jonker H. Onuma Y. Farooq V. Garg S. Windecker S.
Morel M.-A. Steyerberg E.W. Serruys P.W.
Institution
(Campos, Garcia-Garcia, Ishibashi, Cho, Valgimigli, Onuma, Farooq,
Serruys) Department of Interventional Cardiology, Erasmus University
Medical Centre, Thoraxcenter, Rotterdam, Netherlands
(Campos) Department of Interventional Cardiology Heart Institute (InCor),
University of Sao Paulo Medical School, Sao Paulo, Brazil
(Garcia-Garcia, Jonker, Morel) Cardialysis, Rotterdam, Netherlands
(Van Klaveren, Steyerberg) Department of Public Health, Erasmus MC -
University Medical Centre Rotterdam, Rotterdam, Netherlands
(Raber, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Garg) Department of Cardiology, East Lancashire Hospitals NHS Trust,
Blackburn, United Kingdom
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Validity of SYNTAX score II for risk stratification of percutaneous
coronary interventions:A patient-level pooled analysis of 5433 patients
enrolled in contemporary coronary stent trials.
Source
International Journal of Cardiology. 187 (1) (pp 111-115), 2015. Date of
Publication: 06 May 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: To assess the clinical profile and long-term mortality in
SYNTAX score II based strata of patients who received percutaneous
coronary interventions (PCI) in contemporary randomized trials.
Background: The SYNTAX score II was developed in the randomized,
all-comers' SYNTAX trial population and is composed by 2 anatomical and 6
clinical variables. The interaction of these variables with the treatment
provides individual long-term mortality predictions if a patient undergoes
coronary artery bypass grafting (CABG) or PCI. Methods: Patient-level (n =
5433) data from 7 contemporary coronary drug-eluting stent (DES) trials
were pooled. The mortality for CABG or PCI was estimated for every
patient. The difference in mortality estimates for these two
revascularization strategies was used to divide the patients into three
groups of theoretical treatment recommendations: PCI, CABG or PCI/CABG
(the latter means equipoise between CABG and PCI for long term mortality).
Results: The three groups had marked differences in their baseline
characteristics. According to the predicted risk differences, 5115
patients could be treated either by PCI or CABG, 271 should be treated
only by PCI and, rarely, CABG (n = 47) was recommended. At 3-year
follow-up, according to the SYNTAX score II recommendations, patients
recommended for CABG had higher mortality compared to the PCI and PCI/CABG
groups (17.4%; 6.1% and 5.3%, respectively; P < 0.01). Conclusions: The
SYNTAX score II demonstrated capability to help in stratifying PCI
procedures.

<18>
Accession Number
2015746990
Authors
Pericas J.M. Llopis J. Cervera C. Sacanella E. Falces C. Andrea R. Garcia
de la Maria C. Ninot S. Almela M. Pare J.C. Sabate M. Moreno A. Marco F.
Mestres C.A. Miro J.M. Miro J.M Pericas J.M Tellez A. Castaneda X. Gatell
J.M. de la Maria C.G. Armero Y. Vila J. Carlos Pare J. Azqueta M. Sitges
M. Vidal B. Quintana E. Cartana R. Pereda D. Pomar Castella M. Ramirez J.
Ribalta T. Brunet M. Soy D. Fuster D. Granados U.
Institution
(Pericas, Cervera, Garcia de la Maria, Moreno, Miro) Infectious Diseases
Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi
i Sunyer, University of Barcelona, Barcelona, Spain
(Llopis) Department of Statistics, Faculty of Biology, University of
Barcelona, Spain
(Sacanella) Internal Medicine Service, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona,
Barcelona, Spain
(Falces, Andrea, Vidal, Pare, Sabate) Cardiology Service, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Ninot, Mestres) Department of Cardiovascular Surgery, Hospital Clinic,
Institut d'Investigacions Biomediques August Pi i Sunyer, University of
Barcelona, Barcelona, Spain
(Almela) Microbiology Service, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
(Marco) ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology
Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
(Miro, Pericas, Tellez, Castaneda, Gatell, de la Maria, Armero, Vila,
Carlos Pare, Azqueta, Sitges, Vidal, Quintana, Cartana, Pereda, Pomar,
Castella, Ramirez, Ribalta, Brunet, Soy, Fuster, Granados) Hospital
Clinic-IDIBAPS, University of Barcelona School of Medicine, Barcelona,
Spain
Title
Infective endocarditis in patients with an implanted transcatheter aortic
valve: Clinical characteristics and outcome of a new entity.
Source
Journal of Infection. 70 (6) (pp 565-576), 2015. Date of Publication: 01
Jun 2015.
Publisher
W.B. Saunders Ltd
Abstract
Aims: This study reports one case and review the literature on
TAVI-associated endocarditis (TAVIE), to describe its clinical picture and
to perform an analysis on prognostic factors. Methods and results: A
MEDLINE search from January 2002 to October 2014 revealed 31 cases of
TAVIE, including 1 from our hospital. Median age was 81 years (IQR,
78-85), 53% of patients were males and the median age-adjusted Charlson
score was 7 (IQR, 5-8). Heart failure was recorded in 42%, embolic events
in 19%, and periannular complications in 45%. The most common causative
agent was Enterococcus spp (36%). Ten patients (32%) underwent surgery and
nine patients died (29%). The prognostic factors for 6-month mortality
were heart failure (HR, 9.97 [3.7-24.5]; p=0.001), periannular
complications (HR, 11.82 [3.3-41.3]; p=0.004), and
nonenterococcal/streptococcal etiology (HR, 4.76 [2.1-11.1]; p=0.03). In
patients with heart failure who did not undergo surgery, mortality was 89%
(8 out of 9); in those who did undergo surgery, mortality was 0%
(p<0.001). Conclusions: TAVIE is an emerging entity with high mortality.
Patients with heart failure who did not undergo surgery had a higher
probability of dying. Surgical treatment provided better outcomes even in
patients in whom surgery had previously been ruled out.

<19>
Accession Number
2015038183
Authors
Yang Z. Wang J. Wang W. Han L. Zhang Y. Nie X. Zhan S.
Institution
(Yang, Wang, Wang, Zhang, Zhang, Nie, Zhan) Department of Epidemiology and
Biostatistics, School of Public Health, Peking University, Beijing, China
(Yang) Shantou-Oxford Clinical Research Unit, Shantou University Medical
College, Shantou, Guangdong, China
(Han) Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Zhang) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
Title
Proportions of staphylococcus aureus and methicillin-resistant
staphylococcus aureus in patients with surgical site infections in
Mainland China: A systematic review and meta-analysis.
Source
PLoS ONE. 10 (1) , 2015. Article Number: e0116079. Date of Publication: 20
Jan 2015.
Publisher
Public Library of Science
Abstract
Background: Sufficient details have not been specified for the
epidemiological characteristics of Staphylococcus aureus (S. aureus) and
methicillin-resistant Staphylococcus aureus (MRSA) among surgical site
infections (SSIs) in mainland China. This systematicreview aimed to
estimate proportions of S. aureus and MRSA in SSIs through available
published studies. Methods: PubMed, Embase and four Chinese electronic
databases were searched to identify relevant primary studies published
between 2007 and 2012. Meta-analysis was conducted on the basis of
logit-transformed metric for proportions of S. aureus and MRSA, followed
by predefined subgroup meta-analysis. Random-effects meta-regression was
also conducted to explore the impact of possible factors on S. aureus
proportions. Results: 106 studies were included, of which 38 studies
involved MRSA. S. aureus accounted for 19.1% (95%CI 17.2-21.0%;
I<inf>2</inf> = 84.1%) of all isolates in SSIs, which was roughly parallel
to 18.5% in the United States (US) (P-value = 0.57) but significantly
exceeded those calculated through the surveillance system in China
(P-value<0.001). In subgroup analysis, S. aureus in patients with thoracic
surgery (41.1%, 95%CI 26.3-57.7%; I<inf>2</inf> = 74.4%) was more common
than in those with gynecologic surgery (20.1%, 95%CI 15.6-25.6%;
I<inf>2</inf> = 33.0%) or abdominal surgery (13.8%, 95%CI 10.3-18.4%;
I<inf>2</inf> = 70.0%). Similar results were found in metaregression. MRSA
accounted for 41.3% (95%CI 36.5-46.3%; I<inf>2</inf> = 64.6%) of S.
aureus, significantly lower than that in the US (P-value = 0.001). MRSA
was sensitive to vancomycin (522/522) and linezolid (93/94), while
79.9%(95%CI 67.4-88.4%; I<inf>2</inf>= 0%) and 92.0% (95%CI 80.2-97.0%;
I<inf>2</inf>= 0%) of MRSA was resistant to clindamycin and erythromycin
respectively. Conclusion: The overall proportion of S. aureus among SSIs
in China was similar to that in the US but seemed higher than those
reported through the Chinese national surveillance system. Proportions of
S. aureus SSIs may vary with different surgery types. Commonly seen in
SSIs, MRSA tended to be highly sensitive to vancomycin and linezolid but
mostly resistant to clindamycin and erythromycin.

<20>
Accession Number
2015006390
Authors
Berger C. Bochud P.-Y. Boggian K. Cusini A. Egli A. Garzoni C. Hirsch H.H.
Hoffmann M. Khanna N. Manuel O. Meylan P. Nadal D. van Delden C. Weisser
M. Mueller N.J.
Institution
(Berger, Nadal) Division of Infectious Diseases and Hospital Epidemiology
and Children's Research Center, University Children's Hospital of Zurich,
Zurich, Switzerland
(Bochud, Manuel, Meylan) Infectious Diseases Service, University Hospital
and University of Lausanne, Lausanne, Switzerland
(Boggian, Hoffmann) Division of Infectious Diseases and Hospital
Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
(Cusini, Garzoni) University Clinic for Infectious Diseases, University
Hospital Bern, Bern, Switzerland
(Egli) Clinical Microbiology, University Hospital Basel, Basel,
Switzerland
(Hirsch) Transplantation & Clinical Virology Division, Department
Biomedicine, Institute for Medical Microbiology, University of Basel,
Basel, Switzerland
(Hirsch, Khanna, Weisser) Division of Infectious Diseases and Hospital
Epidemiology, University Hospital Basel, Basel, Switzerland
(van Delden) Service of Transplantation, Department of Surgery, University
Hospitals Geneva, University of Geneva, Geneva, Switzerland
(Mueller) Division of Infectious Diseases and Hospital Epidemiology,
University Hospital Zurich, University of Zurich, Ramistrasse 100/ RAE U
70, Zurich 8091, Switzerland
(Garzoni) Department of Internal Medicine and Infectious Diseases, Clinica
Luganese, Lugano, Switzerland
Title
The Swiss Transplant Cohort Study: Lessons from the First 6 Years.
Source
Current Infectious Disease Reports. 17 (6) , 2015. Date of Publication: 01
Jun 2015.
Publisher
Current Medicine Group LLC 1
Abstract
Prospective cohort studies significantly contribute to answering specific
research questions in a defined population. Since 2008, the Swiss
Transplant Cohort Study (STCS) systematically enrolled >95 % of all
transplant recipients in Switzerland, collecting predefined data at
determined time points. Designed as an open cohort, the STCS has included
>3900 patients to date, with a median follow-up of 2.96 years (IQR
1.44-4.73). This review highlights some relevant findings in the field of
transplant-associated infections gained by the STCS so far. Three key
general aspects have crystallized: (i) Well-run cohort studies are a
powerful tool to conduct genetic studies, which are crucially dependent on
a meticulously described phenotype. (ii) Long-term real-life observations
are adding a distinct layer of information that cannot be obtained during
randomized studies. (iii) The systemic collection of data, close
interdisciplinary collaboration, and continuous analysis of some key
outcome data such as infectious diseases endpoints can improve patient
care.

<21>
Accession Number
2015051360
Authors
Cakar M.A. Aydin E.
Institution
(Cakar, Aydin) Department of Cardiology, Sakarya University, Sakarya,
Turkey
Title
Diagnosis and treatment of bicuspid aortic valve disease.
Source
Erciyes Tip Dergisi. 37 (1) (pp 1-5), 2015. Date of Publication: 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey. E-mail: info@avesyayincilik.com)
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac
anomaly. The prevalence in the general population is between 0.46% and
1.37%. There is significantly high cardiac morbidity associated with
bicuspid aortic valve disease, predominantly due to progressive valve
dysfunction (stenosis or regurgitation) that requires surgical
intervention for symptom relief or prevention of left ventricular
dysfunction, or less commonly, for complications of endocarditis. Bicuspid
aortic valve disease is clinically important not only because of valve
disease but also because of its association with many vascular
abnormalities, such as aortic dilatation and aortic coarctation.

<22>
Accession Number
2015041244
Authors
Van Loon R.B. Veen G. Baur L.H.B. Twisk J.W.R. Van Rossum A.C.
Institution
(Van Loon, Veen, Van Rossum) Department of Cardiology, VU University
Medical Center, De Boelelaan 1117, HV Amsterdam 1081, Netherlands
(Baur) Atrium Medical Center Parkstad, Heerlen and Faculty of Health,
Medicine and Life Sciences, University Maastricht, Netherlands
(Twisk) Department of Clinical Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, Netherlands
Title
Long-term follow-up of the viability guided angioplasty after acute
myocardial infarction (VIAMI) trial.
Source
International Journal of Cardiology. 186 (pp 111-116), 2015. Date of
Publication: 01 May 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background Patients with ST-elevation myocardial infarction (STEMI) not
treated with primary or rescue percutaneous coronary intervention (PCI)
are at risk for recurrent ischemia. In non-high risk patients, with proven
viability in the infarct-area, the VIAMI trial showed benefit of early
in-hospital stenting of the infarct-related coronary artery for the
composite of death, myocardial infarction (MI), or unstable angina (UA) at
1 year follow-up. In this study we evaluated the long-term outcome (median
8 years) of patients included in the VIAMI-trial. Methods After being
stable during the first 48 h of their acute MI, we randomly assigned 216
patients with viability to an invasive (PCI) or a conservative
(ischemia-guided) strategy. The primary outcome was the composite endpoint
of death from any cause, recurrent myocardial infarction, or unstable
angina. The secondary outcome of this study was the need for (repeat)
revascularization. Results The combined endpoint of death, recurrent MI
and UA was 20.8% in the invasive group and 32.7% in the conservative group
(hazard ratio 0.59; 95% CI 0.36-0.99, p = 0.049). No differences were seen
in death (8.5% vs. 8.2%, p = 0.80) or MI (7.5% vs. 10.9%, p = 0.48). Only
UA showed a significant difference (4.7% vs. 13.6%, p = 0.002). Repeated
revascularization was performed in 22.6% of the invasive group and 41.8%
of the conservative group (hazard ratio 0.43; 95% CI 0.29-0.74, p <
0.001).' Conclusion In patients with acute MI (treated with thrombolysis
or without reperfusion therapy) and proven viability in the infarct-area,
we demonstrated a long-term benefit of early in-hospital stenting of the
infarct-related coronary artery.

<23>
Accession Number
2015019198
Authors
Greco T. Calabro M.G. Covello R.D. Greco M. Pasin L. Morelli A. Landoni G.
Zangrillo A.
Institution
(Greco, Calabro, Covello, Greco, Pasin, Landoni, Zangrillo) Department of
Anaesthesiology and Intensive Care, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Morelli) Department of Anaesthesiology and Intensive Care, La Sapienza
University, Rome, Italy
Title
A Bayesian network meta-analysis on the effect of inodilatory agents on
mortality.
Source
British Journal of Anaesthesia. 114 (5) (pp 746-756), 2015. Date of
Publication: 01 May 2015.
Publisher
Oxford University Press
Abstract
Background: Inodilators are commonly used in critically ill patients, but
their effect on survival has not been properly studied to date. The
objective of this work was to conduct a network meta-analysis on the
effects of inodilators on survival in adult cardiac surgery patients, and
to compare and rank drugs that have not been adequately compared in
head-to-head trials. Methods: Relevant studies were independently searched
in BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Central
Register of clinical trials (updated on May 1, 2014). The criteria for
inclusion were: random allocation to treatment with at least one group
receiving dobutamine, enoximone, levosimendan, or milrinone and at least
another group receiving the above inodilators or placebo, performed in
cardiac surgical patients. The endpoint was to identify differences in
mortality at longest follow-up available. Results: The 46 included trials
were published between 1995 and 2014 and randomised 2647 patients. The
Bayesian network meta-analysis found that only the use of levosimendan was
associated with a decrease in mortality when compared with placebo
(posterior mean of OR=0.48, 95% CrI 0.28 to 0.80). The posterior
distribution of the probability for each inodilator to be the best and the
worst drug showed that levosimendan is the best agent to improve survival
after cardiac surgery. The sensitivity analyses performed did not produce
different interpretative result. Conclusion: Levosimendan seems to be the
most efficacious inodilator to improve survival in cardiac surgery.

<24>
Accession Number
2015022188
Authors
Dandel M. Englert A. Wallukat G. Riese A. Knosalla C. Stein J. Hetzer R.
Institution
(Dandel, Englert, Wallukat, Riese, Knosalla, Stein, Hetzer) Department of
Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany
Title
Immunoadsorption can improve cardiac function in transplant candidates
with non-ischemic dilated cardiomyopathy associated with diabetes
mellitus.
Source
Atherosclerosis Supplements. 18 (pp 124-133), 2015. Date of Publication:
01 May 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Diabetes mellitus (DM) is a risk factor for death from heart
failure (HF) in patients with dilated cardiomyopathy (DCM) but DM patients
are less eligible for heart transplantation (HTx) and DM is a risk factor
for death also after HTx. New therapies are therefore necessary to improve
survival of diabetic DCM patients. Immunoadsorption (IA) can improve heart
function in DCM but its usefulness for therapy of DM-associated DCM is
unknown. We assessed this aspect. Methods: Cardiac function and HTx-free
survival were evaluated in diabetic HTx-candidates with DCM who underwent
IA (Globaffin, a broadband-immunoadsorber containing synthetic
peptide-GAM) in 6/2003-6/2012 (follow-up 1-10yrs). Non-diabetic
HTx-candidates with DCM who received IA in the same time-period served as
controls. Before and after IA patients were tested for serum
beta<inf>1</inf>-autoantibodies (beta<inf>1</inf>-AABs). Results: We
evaluated 31 patients with and 31 without DM. Before IA there were no
differences between the 2 groups in LV size, LVEF and beta<inf>1</inf>-AAB
levels. However, DM patients were older, their HF duration was longer and
their peak oxygen-uptake was lower (p<0.005). During the 1st post-IA year
in both groups there was a decrease in LV size and improvement in both
LVEF and NYHA-class (p<0.05). Post-IA 3-year HTx-free survival and
prevalence of responders to IA in patients with and without DM was
81.3+/-8% and 78.4+/-8%, respectively and 73.3% and 67.7%, respectively.
Post-IA 3-year freedom from beta<inf>1</inf>-AAB reappearance in patients
with and without DM reached 72.1+/-9.0% and 71.1+/-8.6%, respectively.
Conclusions: IA improves heart function, exercise tolerance and Tx-free
survival in patients with DM-associated end-stage DCM. Our results also
suggest that IA can delay HTx-listing, improve survival on HTx lists and
even spare some diabetic patients from HTx, benefits of particular
importance for these patients who are at high risk for pre-HTx and
post-HTx mortality.

<25>
Accession Number
2015034373
Authors
Sundermann S.H. Czerny M. Falk V.
Institution
(Sundermann, Falk) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum Berlin (German Heart Institute Berlin),
Augustenburgr Platz 1, Berlin 13353, Germany
(Czerny) Department of Cardiovascular Surgery, University Heart Center
Freiburg-Bad Krozingen, Freiburg, Germany
Title
Open vs. Minimally Invasive Mitral Valve Surgery: Surgical Technique,
Indications and Results.
Source
Cardiovascular Engineering and Technology. 6 (2) (pp 160-166), 2015. Date
of Publication: 01 Jun 2015.
Publisher
Springer New York LLC
Abstract
Minimally invasive procedures are the standard approach in many centres
but are still under debate in regards of inferiority compared to
conventional mitral valve surgery through a median sternotomy. The aim of
this review was to summarize the current literature comparing minimally
invasive mitral valve surgery (MIVS) and conventional mitral valve
surgery. In this review of the current literature, we summarize our
findings from a recent meta-analysis and add information from papers that
were published afterwards. There were no differences between patients
treated minimally invasive or through a conventional sternotomy approach
in regards of perioperative stroke rate and mortality. Procedural time,
cardio-pulmonary-bypass time and cross-clamp time were longer in the MIVS
group. In contrast, length of intensive care unit (ICU) stay and length of
in hospital stay were significantly reduced in this group. Need for blood
transfusion was lower in the MIVS group. Other outcomes like i.e., the
rate of rethoracotomies or renal failure didn't differ between the groups.
Repair rates and long-term freedom from recurrence of mitral regurgitation
and reoperation are similar. Newer publications underline these findings.
The current literature shows that MIVS and conventional mitral valve
surgery show a similar perioperative outcome. Minimally invasive mitral
valve surgery is favourable with regards to ICU stay, in hospital stay as
well as need for blood transfusion.

<26>
Accession Number
2015008484
Authors
Hassouna A. Ammar A. Elnahas Y. Toema A. Allam H.
Institution
(Hassouna, Ammar, Elnahas, Toema) Department of Thoracic and
Cardiovascular Surgery, Ain Shams University Hospitals, Faculty Of
Medicine, Cairo, Egypt
(Allam) National Research Center, Giza, Egypt
Title
Limited dose warfarin throughout pregnancy in high-risk patients with
mechanical valves: A randomized clinical trial.
Source
Egyptian Heart Journal. 67 (2) (pp 115-122), 2015. Date of Publication: 01
Jun 2015.
Publisher
Egyptian Society of Cardiology
Abstract
Objectives: Limited dose warfarin (LDW) throughout pregnancy was suggested
to provide safe and effective anticoagulation in pregnant patients with
mechanical heart valve prosthesis (MHVP). Our aim was to study its rate of
failure in achieving the INR recommended for high-risk patients with
mitral (+/-aortic) MHVP. Methods: A clinical trial was designed to compare
failure rates of either LDW (<5. mg/day) or phenindione (<100. mg/day) to
achieve target INR (2.5-3.5) in pregnant (Group A) and non-pregnant
patients with MHVP (Group B). Eligibility criteria: young females (18-40.
years), mitral (+/-aortic) MHVP, NYHA class I-II and achieving INR during
the last three months. At Ain-Shams University, 100 patients were
randomized in each group to either receive LDW or phenindione in a 3:1
ratio. Primary outcome was failure to achieve target INR on two successive
controls. Results: Group A: follow-up was complete, twenty patients on LDW
(26.7%; CI at 95%: 16.7-36.7%) failed to achieve target but none on
phenindione (P= 0.003). Group B: follow-up was 97%, four LDW patients
failed to achieve target (5.3%; 0.2-10.4%) and none on phenindione (P=
0.5). Pregnant patients received larger doses of either OA (P< 0.0001),
achieved lower INR (P< 0.0001) and experienced more failures to maintain
INR (relative risk: 5; 1.8-13.9; P= 0.002), compared to controls. We had
no patient mortality or fetal embryopathy but 11 fetal losses that were
related to lower INR (P= 0.039). Conclusions: LDW may be insufficient to
achieve the INR target recommended for high-risk pregnant patients with
mitral (+/-aortic) MHVP. Phenindione can offer an effective and probably
safe alternative (NCT01758640).

<27>
Accession Number
2015007604
Authors
Payne R.E. Aldwinckle J. Storrow J. Kong R.S. Lewis M.E.
Institution
(Payne) Department of Trauma and Orthopaedic Surgery, University Hospital
Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United
Kingdom
(Aldwinckle) Department of Cardiology, University Hospital Coventry and
Warwickshire, Coventry, United Kingdom
(Storrow) Department of Intensive Care, Heartlands Hospital, Birmingham,
United Kingdom
(Kong, Lewis) Department of Cardiac Surgery, Royal Sussex County Hospital,
Brighton, United Kingdom
Title
RIPC remains a promising technique for protection of the myocardium during
open cardiac surgery: A meta-analysis and systematic review.
Source
Heart Surgery Forum. 18 (2) , 2015. Date of Publication: 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Background: Remote ischemic preconditioning (RIPC) is the process of
inducing brief ischemia in a tissue to prevent ischemic damage in another.
This preconditioning can be induced simply by inflating a blood pressure
cuff on a limb. Previous randomized controlled trials (RCT) have suggested
that RIPC may infer myocardial protection during open cardiac surgery. One
method of assessing the degree of myocardial damage incurred in these
studies is to assay troponin concentration. Troponin is a cardiac enzyme
released by damaged myocardiocytes. With the recent publication of several
large RCTs in this area, a meta-analysis of the evidence was undertaken.
Methods: A systematic search of PubMed, EMBASE, and clinicaltrials.gov.uk
was conducted using MeSH terms "ischaemic preconditioning" and "cardiac
surgery." RCTs that examined post-surgery troponin concentrations were
included in this review. The primary outcome investigated was troponin
levels at six hours post-cardiac surgery. Secondary outcomes included six
to eight hour and twenty-four hour troponin release. Results: Thirteen
RCTs, comprising 1398 participants, were identified for inclusion in this
meta-analysis. Twelve hour postoperative troponin was significantly
reduced by RIPC, standardized mean difference 1.29 (95% CI 0.34-2.24). Six
to eight and twenty-four hour troponin were also significantly reduced,
standardized mean differences 1.23 (95% CI 0.62-1.84) and 1.25 (95% CI
0.31-2.19) respectively. Conclusion: The reduction in troponin
concentration suggests that RIPC reduces myocardial damage during open
cardiac surgery, however, the degree of bias in the studies assessed may
have had a significant impact on this result.

<28>
Accession Number
2015046346
Authors
Li Y. Guo W. Zhang T. Liu J. Jia S. Liu X. Jia X.
Institution
(Li, Guo, Zhang, Liu, Jia, Liu, Jia) Department of Vascular Surgery,
Clinical Division of Surgery, Chinese PLA General Hospital, 28 Fuxing
Road, Beijing 100853, China
(Zhang, Liu) Department of Vascular Surgery, Peking University People's
Hospital, Beijing, China
Title
Improvement in quality of life in old people with aortic stenosis after
transcatheter aortic valve implantation.
Source
Current Signal Transduction Therapy. 9 (3) (pp 164-171), 2014. Date of
Publication: 01 Mar 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: This study aimed to compare the improvement in the quality of
life (QoL) in the long-term follow-up of 12 to 24 months after
transcatheter aortic valve implantation (TAVI) therapy for old people with
severe aortic stenosis. Methods: According to the guidelines provided by
PRISMA, published studies till 15 June, 2014 were retrieved from Google
Scholar, Pubmed, Embase and CNKI. Health-related QoL was evaluated at
beginning and at 12 to 24 months with five kinds of instruments. Funnel
plots were used to test the potential publication bias, and analyze the
source of heterogeneity, such as meta-regression, subgroup and
sensitivity. Results: Our meta-analysis involved ten studies with 1359
patients. Preprocedural summary 12-item Short Form (SF-12) physical and
mental scores showed a significant improvement after one year after TAVI
[weighted mean difference (WMD): -10.61, 95% confidence interval (CI):
-15.06, -6.15; WMD: -6.39, 95%CI: -9.08, -3.70; respectively]. One year
follow-up visit after TAVI revealed significantly improved QoL compared to
baseline in Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol
(EQ-5D) (WMD: -29.44, 95%CI: -33.29, -26.58; WMD: -0.09, 95%CI: -0.12,
-0.06; respectively). At 12 to 24 months, weighted mean 36-item Short-Form
(SF-36) physical improved by 16.96 points (95%CI: -27.77, -6.16) and
SF-36-mental improved by 5.57 points (95%CI: -9.96, -1.19); weighted mean
Minnesota Living with Heart Failure Questionnaire (MLHFQ) decreased by
22.29 points (95%CI: 16.09, 28.48). Conclusion: This technique provides a
promising therapy approach for old patients with severe symptomatic aortic
stenosis in high-risk surgery, and there are significant improvements for
this group in health-related quality of life in the follow-up.

<29>
Accession Number
2015007918
Authors
Yilmaz M. Aydin U. Arslan Z.I. Balci C. Kocogullari C.U. Ata Y. Turk T.
Institution
(Yilmaz, Arslan, Balci) Departmentof Anesthesiology, Bursa Yuksek Ihtisas
Education and Research Hospital, Bursa, Turkey
(Aydin, Ata, Turk) Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
(Kocogullari) Cardiovascular Surgery, Kocaeli Derince Education and
Research Hospital, Kocaeli, Turkey
Title
The Effect of lidocaine and amiodarone on prevention of ventricular
fibrillation in patients undergoing coronary artery bypass grafting.
Source
Heart Surgery Forum. 17 (5) (pp E245-E249), 2014. Date of Publication: 01
Oct 2014.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Objective: Ventricular fibrillation is common after aortic declamping in
patients undergoing open heart surgery. This situation has a negative
impact on morbidity and mortality. The aim of this prospective study was
to compare the effect of administering lidocaine versus amiodarone before
aortic declamping during elective coronary bypass grafting, paying close
attention to when the initial effect of amiodarone sets in. Methods: In
this double blind, prospective, randomized, controlled study, 86 patients
who were candidates for elective coronary artery bypass grafting were
recruited into three groups: group lidocaine (group L, n = 29); group
amiodarone (group A, n = 27); and group placebo (group P, n = 30). Group L
patients received 1.5 mg/kg of lidocaine 2 minutes before aortic
declamping and group A patients received 300 mg of amiodarone
intravenously 15 minutes before release of the aortic cross clamp. The
primary endpoints were the incidence of ventricular fibrillation and the
number of shocks required to terminate ventricular fibrillation. Results:
The frequency of ventricular fibrillation occurrence was significantly
higher in group P (70%) when compared with group A (37%) and group L (38%)
(P = .017). There was no statistically significant difference between the
amiodarone and the lidocaine groups regarding ventricular fibrillation.
However, when ventricular fibrillation occurred, the percentage of
patients requiring electrical defibrillation was significantly higher in
both group L and group P when compared with group A (P = .023).
Conclusion: We suggest that during coronary arterial bypass surgery,
administration of an amiodarone regime before release of the aortic cross
clamp, paying particular attention to the start of the initial effect of
amiodarone, is no more effective than lidocaine for prevention from
arrhythmia; however, amiodarone reduces the need for electrical
defibrillation.

<30>
Accession Number
2015041699
Authors
Tartavoulle T. Manning J. Fowler L.H.
Institution
(Tartavoulle, Manning, Fowler) The Louisiana Center for Evidence Based
Nursing at LSUHSC School of Nursing, United States
Title
Effectiveness of bed position versus chair position on reliability and
validity of cardiac index in postoperative cardiothoracic surgery adult
patients: A systematic review protocol.
Source
JBI Library of Systematic Reviews. 11 (8) (pp 73-83), 2013. Date of
Publication: 2013.
Publisher
Joanna Briggs Institute
Abstract
Review question/objective: The objective is to systematically review the
best available evidence to determine the reliability and validity of
cardiac index (CI) in postoperative cardiothoracic surgery (CTS) adult
patients in bed position versus chair position. The research question used
for the systematic review will be: "What is the effect of bed position in
comparison with chair position on reliability and validity of cardiac
index in the adult patient post cardiothoracic surgery?" Inclusion
criteria: Types of participants: This review will consider studies that
include postoperative cardiothoracic surgery adult patients over the age
of 18 years of age including those that have undergone coronary artery
bypass graft surgery, valve replacement surgery, ascending thoracic aorta
repair, and/or ventricular septal defect repair. Exclusion criteria
include mechanical ventilation and unstable hemodynamic status (CI<2.0
L/min/²). Types of intervention(s): This review will consider
studies that evaluate bed position versus chair position in measuring
cardiac index. In bed position includes head of bed elevation between 0
and 45 degrees (CI index can be accurately measured and trended with head
of bed elevated to 45 degrees as long as zeroing stopcock is properly
leveled to the phlebostatic axis and patient is in supine position.) A
chair position includes a sitting position, and an out-of-bed position in
a non-reclining, straight-back chair in the upright position with knees
bent and feet on the floor, with patients allowed to rest for at least 10
minutes before CI is measured to allow for physiological equilibrium.
Types of outcomes: The primary outcome of interest for the review is the
reliability and validity of cardiac index in bed position versus chair
position. Secondary outcomes of interest include: cardiac output,
pulmonary artery occlusive pressure, stroke volume, heart rate, mean
arterial pressure, central venous pressure, mean pulmonary artery
pressure, pulmonary artery pressure systolic and pulmonary artery pressure
diastolic measurement.

<31>
Accession Number
2015041719
Authors
Mares M.A. McNally S.
Institution
(Mares, McNally) University of Western Sydney, The New South Wales Centre
for Evidence Based Health Care, Australia
Title
The effectiveness of nurse-led cardiac rehabilitation programs following
coronary artery bypass graft surgery: A systematic review protocol.
Source
JBI Library of Systematic Reviews. 11 (11) (pp 21-32), 2013. Date of
Publication: 2013.
Publisher
Joanna Briggs Institute
Abstract
Review question/objective Do nurse-led cardiac rehabilitation programs
following coronary artery bypass graft surgery improve patients'
health-related quality of life and reduce hospital readmissions?
Background Cardiovascular diseases (CVDs) are an emerging epidemic and the
primary cause of premature death, disability, hospitalization and
healthcare expenditure throughout the world.^1,2 CVDs include
vascular diseases of the brain and diseases of the blood vessels and
heart. More people die annually from CVDs - primarily from stroke and
heart attack - than from any other cause.² In 2008, of the 57
million deaths globally, 17.3 million (30%) were due to CVDs; a figure
that is projected to rise to 25 million by 2030.^2,3 The worst
affected populations are those from low and middle income countries
(LMICs), where over 80% of cardiovascular deaths occur, with approximately
equal prevalence among men and women.² There are 3.5 million
(17%) Australians living with chronic CVD; the main types are coronary
heart disease (CHD), cardiomyopathy or stroke and heart failure. In
2007-08, CHD was the principal diagnosis of 161,417 hospitalizations with
rates twice as high for males than females, 60% of which occurred among
those 65 years and over.⁴ In 2008, an estimated 48,453 deaths
were due to CVD, with death rates in males aged 45 to 64 years almost
three times higher than females of a similar age. However, a higher
percentage of the female population is living longer and 78% of CVD deaths
occur in females aged 75 years and over. The direct and indirect costs of
CVD places great strain on healthcare resources worldwide.⁵ In
2004-05, Australia spent $5,942 million worth (11%) of healthcare
expenditure on CVD; more than any other disease,⁵ and in excess
of $500 billion is spent on CVD annually in the USA.⁵ According
to Weerasinghe et al., 17,000 coronary artery bypass graft (CABG)
surgeries are performed in Australia annually with the CABG rate second
only to the US.⁶ The safety and efficiency of cardiac
operations and surgical procedures has improved over the last three
decades.⁶ In recent years, percutaneous coronary intervention
(PCI), a non-surgical procedure, has become the treatment of choice for
patients who may not survive CABG surgery.^7,8 However, while
PCI may be universally applicable, findings from meta-analysis have
consistently shown increased rates of repeat procedures.^8,9
Over the last decade, despite patients presenting with co-morbidities
including hypertension and obesity, CABG remains superior to PCI as an
excellent revascularization procedure for complex CHD, such as left
ventricular dysfunction and diabetes mellitus. CABG enhances blood flow to
the heart and offers long term survival, freedom from re-intervention due
to failure of the initial procedure and adverse cardiac events, notably
heart failure or stroke, as well as being a more cost-effective
procedure.^7,8 Data collected from the Australia and New Zealand
Global Registry of Acute Coronary Events (GRACE) - a large multinational
acute coronary syndrome registry - reported that between 1999 and 2007,
20% of the 1048 patients that were readmitted within 6 months of discharge
were from the CABG population.¹⁰ According to Sangu et al.,
revascularization by CABG surgery is associated with a lower risk of early
readmission within 30 days after discharge, suggesting that better
detection and appropriate revascularization treatment for patients with
recurrent coronary occlusion and ST segment elevation myocardial ischemia
may avoid early hospital readmission.¹⁰ Often preventable,
readmission is a costly and common outcome among patients who survive a
cardiac event.¹⁰ In a study by Price et al., CABG surgery
accounted for most of the frequent causes for hospital
readmission.¹¹ Due to the high cost of in-hospital care, the
introduction of guidelines and protocols has been successful in reducing
hospital length of stay from 11 to 8 days to contain healthcare costs for
patients following CABG surgery.¹² However, findings from a
number of studies have found that early discharge can lead to poorer
outcomes and higher costs as the patient's condition may be less stable
and is more likely to result in major complications such as bleeding,
wound infection and death.^11,12,10 Quality improvement
initiatives and cost containment should focus on the entire episode of
care from initial hospitalization and the care that is required
subsequently.¹² Over the past two decades, there has been a
dramatic decline in CVD mortality rates in developed countries through
individual healthcare approaches including screening of people in
different care settings for early detection. In addition, population-wide
primary prevention strategies, such as public awareness promotion about
the risk factors for CVD (e.g., smoking, alcohol use and unhealthy
eating), provides foundational knowledge for policy makers to deliver or
support prevention and treatment programs.²Current guidelines
highlight the importance of patients participating in cardiac
rehabilitation (CR) as is also recommended by cardiovascular experts for
the management of CVD.^1,13 CR has been defined as measures
designed to help patients minimize recovery time following a cardiac event
and maximize physical, social and psychological functioning by encouraging
positive behaviors.4 Intervention consists of medical evaluation, cardiac
risk factor modification, education, behavioral change and supervised
exercise training for two to three days a week over a number of weeks,
months or years to produce optimum improvements in patients'
health-related quality of life (HRQoL).^14,15,16 Patients'
perceptions of health are significant indicators of outcomes following a
cardiac event. HRQoL assessments after CABG surgery and acute myocardial
infarction (AMI) further provide extra measures of evaluating the
effectiveness of medical and surgical treatments.¹⁷
Furthermore, with the increasing health and social care costs, CR has
shown to be cost effective. There is consensus that the short-term and
long-term benefits of CR programs reduce hospital readmission rates,
improve health-related quality of life and lessen subsequent mortality and
myocardial infarct in patients with CVD, justifying the use of health
related budget.^11,16,18-26Comprehensive reviews have concluded
that a physician's recommendation to CR is a strong indicator of
participation, however as nurses spend more time with patients, patients
who received recommendations from nurses demonstrated significantly higher
CR attendance.¹³Nurses are essential to the delivery of CR
interventions as they encourage adherence and participation.²⁴
Nurse-led CR programs can be distinguished by certain structures or
features related to their purpose. These include emphasis on life
management rather than intervention and diagnosis and a focus on health
rather than illness.²⁷ In addition to providing autonomy,
nurse-led CR programs increase the opportunity for professional
development among nurse practitioners. Nurse-led CR programs are staffed
and managed solely by nurses with the ability to treat and consult,
evaluate and refer patients to other health professionals as
needed.²⁷ Nurse-led services can optimize quality of care in
managing patients with established CHD by diverting health consumers from
busy general practice and hospital settings.²⁷ This supports
the view expressed by Johnson et al., that CR endorsement from nurses
should be included in strategies to increase participation.¹³
Uptake for CR remains poor due to many reasons, such as lack of ease of
access and varies between individuals who have work commitments or
competing roles and responsibilities.^28,29 Usual care for
non-participation in CR provides mandatory patient education including
phone interaction or face-to-face contact with healthcare professionals,
written materials available as pamphlets, brochures or online and
audio-visual resources. Topics covered are related to pain and medication
management, signs and symptoms of complications, activity performance and
follow up procedures. Education included in usual care is provided free of
charge in the form of either a group discussion or one-on-one, for a
number of sessions and for a predetermined length of time.³⁰
Tailored approaches such as coordination of care supported by liaison
nurses, motivational communication and home visits may improve uptake and
adherence in CR.²⁸Optimum gains for patients participating in
nurse-led CR are clear. This systematic review aims to investigate the
effects of nurse-led CR programs on the HRQoL of patients and hospital
readmissions following coronary artery bypass graft surgery. The review
will add to the evidence base for nurse-led CR programs using the JBI
review methodology.

<32>
Accession Number
71888638
Authors
Beattie S. Wijeysundera D. Tait G. Ragoonanan T. Hu T. El Beheiry M. Tsui
A.K.Y. Carroll J. Karkouti K. Mazer C.D. Hare G.M.T.
Institution
(Beattie, Wijeysundera, Tait, Ragoonanan, Carroll, Karkouti) Anesthesia
and Pain Management, Toronto General Hospital, University Health Network,
Toronto, ON, Canada
(Hu, El Beheiry, Tsui, Mazer, Hare) Anesthesia, St. Michael's Hospital,
Toronto, ON, Canada
Title
Mechanisms of postoperative stroke: A multi-disciplinary translational
research program.
Source
Canadian Journal of Anesthesia. Conference: 2012 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS Quebec City, QC Canada.
Conference Start: 20120615 Conference End: 20120618. Conference
Publication: (var.pagings). 59 , 2012. Date of Publication: June 2012.
Publisher
Springer New York LLC
Abstract
Introduction: Metoprolol, a relatively poor beta1 specific drug increases
the risk of postoperative stroke. Animal studies demonstrate that possible
mechanisms include the impairment of compensatory mechanisms which
maintain cerebral oxygen delivery by antagonism of: 1) beta1-mediated
increases in cardiac output and 2) beta2- mediated cerebral
vasodilatation. Published clinical meta-analyses suggest that drugs with
increased beta1 selectivity may not increase stroke risk. This clinical
evaluation hypothesized that a more highly beta1 specific beta- blocker
(bisoprolol) would not increase stroke rates compared to a relatively
nonspecific beta-blocker (metoprolol). Methods: This is a single center,
having 3 sites, retrospective cohort study. After Institutional Ethics
approval and linking the operative booking, discharge, pharmacy,
laboratory, blood bank, and diagnostic imaging databases we identified
71,000 consecutive inpatient surgeries between Jan 2003 and Dec 2009. We
excluded all patients having cardiac, transplant and neurosurgery.
Postoperative stroke was defined as a patient with a discharge ICD10 code
for cerebral ischemia, independently confirmed by either MRI and/or CT
findings of stroke within 7 days of index surgery. Logistic regression
with backward elimination was used to identify the independent
associations with postoperative stroke. Results: 11,595 beta-blocked
patients were identified: 6439 (55%) patient received metoprolol and 1327
(13%) received bisoprolol. Stroke was identified in 103 patients within 7
days of surgery (0.1%). The peak incidence was the first and second
postoperative day. A history of cerebral vascular disease, age, nadir
hemoglobin, transfusion, and high risk surgery, (vascular and thoracic Sx)
were found to be independently associated with stroke. The model was
accurate ROC=.803 and well calibrated. (Homser-Lemenshow p= .478) This
analysis found that 49 patients receiving non specific Beta blockers
experienced stroke (OR 2.6; 95% CI 1.7-4.1) Five (5) patients taking
highly selective beta1 drugs experienced a stroke (OR1.2; 95%CI 0.4-3.4).
Discussion: Our data demonstrate that metoprolol, but not bisporolol, was
found to be associated with more than a doubling of the peri-operative
stroke rate. Importantly, stroke is also influenced by acute reductions in
Hb and a history of CVD. In this common peri-operative scenario
cardio-protective drugs with higher beta1 selectivity are not associated
with increased stroke incidence.

<33>
Accession Number
71888617
Authors
Rochon A. Belisle S. Deschamps A. Ayoub C. Blain R. Cogan J. Couture P.
Denault A.Y. Lebon J.-S. Perrault L. Qizilbash B. Taillefer J. Toledano K.
Institution
(Rochon, Belisle, Deschamps, Ayoub, Blain, Cogan, Couture, Denault, Lebon,
Perrault, Qizilbash, Taillefer, Toledano) Anesthesiology, Montreal Heart
Institute, Montreal, QC, Canada
Title
In vivo protamine titration in cardiac surgery: Proof of concept.
Source
Canadian Journal of Anesthesia. Conference: 2012 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS Quebec City, QC Canada.
Conference Start: 20120615 Conference End: 20120618. Conference
Publication: (var.pagings). 59 , 2012. Date of Publication: June 2012.
Publisher
Springer New York LLC
Abstract
Introduction: Protamine sulfate is used to neutralize unfractionated
heparin after cardiopulmonary bypass (CPB). The optimal protamine:heparin
ratio (P:H) is difficult to individualize. Indeed, when in excess,
protamine can induce hemodynamic instability, complement activation and
platelet dysfunction.1 Using in vivo titration curves, our objective was
to determine the optimal P:H, hoping it would translate into a safe and
effective heparin neutralization. Methods: With our Research Ethics Board
approval, 118 patients admitted for elective primary cardiac surgery
requiring CPB consented to participate in this prospective randomized
controlled study. After weaning from CPB, protamine infusion was initiated
and celite activated clotting time (ACT) values were measured every 3
minutes. The control group was given a standard protamine infusion of 1.3
mg:1 mg (100 U) of heparin. The test group was given an infusion of
protamine until two consecutive celite ACT values were lower than 160 and
had reached a plateau. Anti-Xa activity was determined pre-protamine, 15
minutes and 3 hours post-protamine. The P:H, blood losses and transfusion
exposure were recorded. Results are presented as mean +/- standard
deviation. Student T-test, Chi2 or Wilcoxon rank sum tests were used for
analysis. Statistical significance was assumed for a P value lower than
0.05. Results: Demographic data between the two groups were similar. At
the end of the protamine infusion, the ACT was significantly lower in the
test group (136 +/- 28 sec vs. 151 +/- 23 sec) . Mean P:H was 1.31 +/-
0.10 in the control group and 0.82 +/- 0.22 in the test group (P <
0.0001). Residual heparin concentrations were higher in the test group 15
minutes (0.12 +/- 0.12 U/ml vs. 0.04 +/- 0.06 U/ml, P = 0.0002) and 3
hours (0.07 +/- 0.12 U/ml vs. 0.01 +/- 0.03 U/ml, P = 0.0005)
post-protamine. Mean total blood losses in the control group were
comparable to blood losses in the test group (1335 +/- 1420 cc vs. 1275
+/- 960 cc, P = 0.99). Discussion: The lower ACT at the end of infusion in
the test group suggests that excess protamine causes an elevation of ACT.
The optimal P:H was 0.82 mg of protamine to 100 U of total heparin,
consistent with the existing literature.2 Residual circulating heparin did
not qualify for heparin rebound (i.e. > 0.3 U/ml). Optimized protamine
dosing did not translate into increased blood losses and/or transfusion of
allogenic blood products. The in vivo protamine titration method
eliminates the need for estimating the blood volume and measuring the
heparin concentration at the end of CPB. It individualizes the optimal
protamine:heparin ratio and is safe and efficient in this low-risk
population.

<34>
Accession Number
71888616
Authors
Noyahr L.-A. Le Zhou T. Wijeysundera D.
Institution
(Noyahr, Le Zhou) Postgraduate Department of Anesthesia, University of
Toronto, Toronto, ON, Canada
(Wijeysundera) Department of Anesthesia, Toronto General Hospital,
Toronto, ON, Canada
Title
Does preoperative CRP predict postoperative outcomes?.
Source
Canadian Journal of Anesthesia. Conference: 2012 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS Quebec City, QC Canada.
Conference Start: 20120615 Conference End: 20120618. Conference
Publication: (var.pagings). 59 , 2012. Date of Publication: June 2012.
Publisher
Springer New York LLC
Abstract
Introduction: Postoperative complications can result in significant
mortality and morbidity, thus necessitating accurate screening tests to
identify high-risk surgical patients. C-reactive protein (CRP) is an
inflammatory marker associated with cardiac, cerebrovascular and infective
events. We conducted a quantitative systematic review to determine whether
preoperative CRP levels can predict cardiac events, atrial fibrillation,
infections and mortality after major surgery. Methods: This study required
no REB approval. Sensitive search strategies were created for Medline
(1950- June 2011) and EMBASE (1980-June 2011). These databases were
searched independently by two authors for cohort studies that measured the
association of preoperative CRP levels with cardiac events, infections,
and allcause mortality within 30 days of major surgery (cardiac and
non-cardiac). No language restrictions were applied. The pooled predictive
accuracy of CRP was calculated using a hierarchical summary
receiveroperating- curve (hsROC) meta-analysis method. This random-effects
model accounted for both within-study and between-study variability.
Pooled measures of prognostic accuracy [area-under-the curve (AUC) of
receiver-operating-characteristic (ROC) curve, sensitivity, specificity,
positive likelihood ratio, negative likelihood ratio] were then
calculated. Results: From 7142 unique citations identified in the
electronic databases, 52 eligible studies (18,977 patients) were included
in the systematic review. Postoperative atrial fibrillation was reported
in 22 studies; cardiac events in 15 studies; infections in 16 studies; and
mortality in 15 studies. In a pooled hsROC analysis of all surgeries,
preoperative CRP poorly predicted postoperative cardiac events (AUC 0.57,
95% CI 0.53 to 0.62), with positive likelihood ratio (PLR) of 1.20 (CI
0.99 to 2.29) and negative likelihood ratio (NLR) of 0.80 (CI 0.64 to
1.00). Its performance was somewhat better in non-cardiac surgeries (AUC
0.68, CI 0.64 to 0.72), with PLR of 1.26 (CI 0.97 to 1.64) and NLR of 0.66
(CI 0.47 to 0.94). CRP also poorly predicted atrial fibrillation after
cardiac surgery (AUC 0.53, CI 0.48 to 0.57]) with PLR of 0.96 (CI 0.71 to
1.29) and NLR of 1.02 (CI 0.90 to 1.16). Preoperative CRP demonstrated
reasonable predictive accuracy (AUC 0.73, CI 0.69 to 0.76) with regard to
postoperative infections in all surgeries, with PLR 2.23 (CI 1.28 to 3.89)
and NLR 0.51 (CI 0.31 to 0.86). CRP also had fair predictive value (AUC
0.67, CI 0.63 to 0.71) with respect to postoperative mortality after all
surgeries, with PLR 1.72 (CI 1.28 to 2.30) and NLR 0.58 (CI 0.48 to 0.69).
Discussion: Preoperative CRP generally performs poorly as a single
predictor of postoperative mortality and major complications. Further
research is needed to determine whether the addition of preoperative CRP
to other preoperative screening tools can improve the prediction of
postoperative infections (all surgeries), mortality (all surgeries) and
cardiac events (non-cardiac surgeries). Such prognostic studies should use
newer analytic approaches, such as reclassification measures.

<35>
Accession Number
71888929
Authors
Laskowski K. Stirling A. McKay W.P. Lim H. Thakore S.
Institution
(Laskowski, Stirling, McKay, Thakore) Anesthesia, University of
Saskatchewan, Saskatoon, SK, Canada
(Lim) Community Health and Epidemiology, University of Saskatchewan,
Saskatoon, SK, Canada
Title
Systematic review of IV ketamine for post-operative pain.
Source
Canadian Journal of Anesthesia. Conference: 2011 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS Toronto, ON Canada. Conference
Start: 20110624 Conference End: 20110628. Conference Publication:
(var.pagings). 58 (pp S153), 2011. Date of Publication: June 2011.
Publisher
Springer New York LLC
Abstract
Introduction: Perioperative low-dose intravenous ketamine may be a useful
addition in pain management regimens. Randomised Controlled Trials (RCTs)
of IV ketamine have produced remarkably variable efficacy results. It
would be useful to know the evidence for the correct role of ketamine in
postoperative pain control. Previous systematic reviews have included all
routes of ketamine administration and assumed a fixed-effects model.
Heterogeneity between studies is significant and this was addressed by
narrowing inclusion criteria, using a random effects model, and performing
subgroup analyses on groups designated prior to data collection.
Metaregression was used to analyse the effect of total dose of ketamine.
Methods: High-quality RCTs that were randomized, double-blinded and
placebo-controlled using intravenous ketamine as the treatment group were
included. Pubmed, Embase, and the Cochrane Library were searched, and
manufacturers contacted to find RCTs. Primary outcome was total dose of
narcotic consumed postoperatively. Studies were excluded if they used
regional anesthesia. No limitation was placed on patient age or language
of publication. P-values of subgroups were corrected for multiple
comparisons. Analysis was by standard differences in means. Results:
Sixty-three studies were analyzed, with 80 comparison arms. A clear
reduction in total narcotic consumed was observed across all studies
(p<0.0001). Calculations of publication bias were negative. Ketamine was
unhelpful for prostate, dental, head & neck, hernia,
laminectomy/discectomy, lower abdominal, or coronary artery bypass graft
surgery. It was helpful for orthopedic/limb, mid- or upper- abdominal, and
thoracic surgery. Efficacy was not different between adult and pediatric
studies. The dose of ketamine had little influence on outcome. Timing of
administration (pre- or post-incision) had no influence. In particular,
there was no preemptive effect. There was no difference from placebo for
psychic side-effects, postoperative nausea and vomiting measures, or
sedation. Discussion: Implications for clinicians: Perioperative low-dose
ketamine is especially useful when the anticipated postoperative pain is
severe, and it may be given at any point (preemptively, intraoperatively,
postoperatively) and in any method (bolus, infusion, PCA
co-administration). Intuitively, an increased postoperative VAS score
correlates with painful surgery such as upper abdominal and thoracic
incisions. Future research: There is little to be gained from more RCTs of
surgery known to produce mild pain. Further study should be directed
towards unanswered questions, and should concentrate on studying patients
at risk for severe postoperative pain, for respiratory depression, and
patients who continue to experience severe postoperative pain despite
routine treatment. There may be benefit in those patients for whom
narcotic sparing is important, such as patients that are intolerant to
narcotic side effects and those with significant histories of
postoperative nausea and vomiting.

<36>
Accession Number
71883648
Authors
Savci S. Arikan H. Saglam M. Inal-Ince D. Degirmenci B. Turan H.N.
Demircin M.
Institution
(Savci) Dokuz Eylul University, School of Physiotherapy and
Rehabilitation, Izmir, Turkey
(Arikan, Saglam, Inal-Ince, Degirmenci, Turan) Hacettepe University,
Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation, Ankara, Turkey
(Demircin) Hacettepe University, Faculty of Medicine, Department of
Cardiothoracic Surgery, Ankara, Turkey
Title
Effects of inspiratory muscle training compared with active cycle of
breathing techniques and usual care in coronary artery bypass surgery.
Source
Physiotherapy (United Kingdom). Conference: World Physical Therapy 2011
Amsterdam Netherlands. Conference Start: 20110620 Conference End:
20110623. Conference Publication: (var.pagings). 97 (pp eS1081-eS1082),
2011. Date of Publication: June 2011.
Publisher
Elsevier Ltd
Abstract
Purpose: The aim of the study was to determine the effects of inspiratory
muscle training (IMT) and compared with the active cycle of breathing
techniques (ACBT) and usual care on postoperative pulmonary function,
respiratory muscle strength, and functional capacity among patients with
coronary artery bypass graft (CABG) surgery. Relevance: Cardiopulmonary
dysfunction is common in patients with post-CABG surgery. Chest
physiotherapy and mobilization are frequently used treatment techniques by
physiotherapist to prevent post-operative pulmonary complications. The IMT
can be implemented in the perioperative care of CABG surgery.
Participants: Seventy-three patients undergoing CABG surgery were randomly
assigned to one of the three groups: IMT group (n = 23), ACTB group (n =
25), and usual care (control) group (n = 25). Methods: The study was a
single-blinded, randomized controlled trial. Pulmonary function testing,
respiratory muscle strength, and 6-minute walk test (6MWT) were assessed
preoperatively and the fifth day after the surgery. Subjects in all groups
received the same usual care once daily. The ACBT and IMT group trained
daily, 2 times per day for 10 days (5 days in preoperative period, 5 days
in postoperative period). The ACBT consisted of 1- breathing control
breaths, three thoracic expansion exercises followed by a 3-second breath
hold at the end of deep inspiration, and the forced expiration technique.
Each IMT session consisted of 30 minutes of inspiratory muscle training
under the supervision of a physiotherapist. The patients were trained to
use an inspiratory threshold-loading device. The patients started
breathing at a resistance equal to 15% of their maximal inspiratory
pressure. The resistance was increased incrementally between 15 and 45%
based on patients' tolerance in the following days. Analysis: Comparisons
between groups were performed with the one-way ANOVA followed by Tukey's b
post-hoc test. The statistical tests were 2-sided and p < 0.05 was
considered statistically significant. Results: There were no significant
differences in age, gender, and surgical procedures among the groups (p >
0.05). Inspiratory and expiratory muscle strength, and six-minute walk
distance were significantly higher in IMT group compared with the other
techniques (p < 0.05). Intensive care unit stay was significantly shorter
in IMT group compared with the other techniques (p < 0.05). Inspiratory
and expiratory muscle strengths were also significantly higher in the ACBT
group compared with the control group (p < 0.05). Conclusions: The IMT
results in a faster recovery of inspiratory muscle strength and functional
capacity compared with ACBT and usual care after CABG. Implications:
Improvements in functional capacity and respiratory muscle strength may
lead patients to participate activities of daily living. Further study is
needed to determine the effects of longer inspiratory muscle training on
postoperative pulmonary complications and disease specific quality of life
in patients undergoing CABG with a wider sample size.

<37>
Accession Number
71882862
Authors
Hsieh P.-L. Chao W.-J. Wu Y.-T.
Institution
(Hsieh, Chao, Wu) National Taiwan University, School and Graduate
Institute of Physical Therapy, Taipei, Taiwan (Republic of China)
(Wu) National Taiwan University Hospital, Division of Physical Therapy,
Department of Physical Medicine and Rehabilitation, Taipei, Taiwan
(Republic of China)
Title
Effects of exercise training in patients after heart transplantation: A
meta-analysis.
Source
Physiotherapy (United Kingdom). Conference: World Physical Therapy 2011
Amsterdam Netherlands. Conference Start: 20110620 Conference End:
20110623. Conference Publication: (var.pagings). 97 (pp eS506-eS507),
2011. Date of Publication: June 2011.
Publisher
Elsevier Ltd
Abstract
Purpose: To investigate the effects of exercise training (including
aerobic, resistance, and combined aerobic and resistance exercise) on
exercise capacity and upper/lower extremity muscle strength in heart
transplant patients by a meta-analysis. Relevance: Most of the studies on
exercise training effects in heart transplant patients were relatively
small in sample size. This meta-analysis was conducted to provide more
evidence for exercise intervention. Participants: Only randomized
controlled trials (RCTs) with exercise intervention versus control or
usual care were considered in this meta-analysis regardless of the type of
exercise training. Aerobic exercise, resistance exercise, or combined
exercises, or any form of exercises mentioned above as a part of a
multidisciplinary treatment were included and the language was limited to
English or Chinese. Outcome measures of this study were peak oxygen
consumption and muscle strength of upper and/or lower extremities. A total
of six studies from 1998 to 2009 were included, with 117 patients in the
part of peak oxygen consumption analysis (aged 55.3+/-9.4 years) and 67 in
the analysis of upper/lower muscle strength (aged 55.9+/-8.3 years); 85%
of them were males. Methods: A systematic searching strategy was adopted
from online electronic databases, including Ovid Medline, PubMed, CINAHL,
Web of Knowledge, PEDro, the Cochrane Library, and Chinese Electronic
Periodical Services (CEPS) and hand searching the reference lists of the
retrieved articles up to June 30, 2010. Searching keywords included heart
transplantation-related medical subject heading (MeSH) keywords and
exercise-related MeSH keywords. Study quality was rated by PEDro scale by
two independent reviewers; only those >4 were included. Analysis: Mean and
standard deviation for the variables of interest were retrieved from each
study. Data were pooled to obtain overall effect size, 95% confidence
interval (CI), and level of significance by using RevMan 5.0 (The Nordic
Cochrane Centre, Denmark). Post-intervention net difference between groups
was compared and a weighted mean difference (WMD) and 95% CI were
calculated. A test of heterogeneity (I2)was carried out to determine
whether a random or fixed effect model was applied; random effect model
was used when p value of I2 < 0.05. Results: Of six studies with RCT
design, two used aerobic exercise, two used resistance exercise, and the
other two studies used combined exercise in their training programs. Four
studies reported peak oxygen consumption, and three studies reported
upper/lower extremity muscle strength. The exercise training was
prescribed by intensity at 60-80% peak oxygen consumption, 11-14 of Borg
score, or >50% of 1 repetition maximum (1-RM). Peak oxygen consumption was
significantly increased by 2.30 ml/kg/minute (95% CI 0.58-4.02). The 1-RM
of chest-press and leg-press was significantly improved (WMD 23.28 kg, 95%
CI 0.64-45.91, and WMD 28.84 kg, 95% CI 5.70-51.98, respectively).
Conclusions: Exercise training has a significant favorable change on peak
oxygen consumption and upper/lower extremity muscle strength. Further high
quality, large scale, and randomized trials are needed for this patient
population. Implications: Exercise training, including aerobic and/or
resistance exercise, should be implemented in heart transplant patients to
improve their exercise capacity and muscle strength.

<38>
Accession Number
71882840
Authors
Hirschhorn A. Richards D. Mungovan S. Morris N. Adams L.
Institution
(Hirschhorn, Mungovan) Westmead Private Physiotherapy Services, Sydney,
Australia
(Hirschhorn, Morris, Adams) Griffith University, School of Physiotherapy
and Exercise Science, Gold Coast, Australia
(Richards) Westmead Private Cardiology, Sydney, Australia
Title
Stationary cycling is as effective as walking in phase I cardiac
rehabilitation: A randomized-controlled trial.
Source
Physiotherapy (United Kingdom). Conference: World Physical Therapy 2011
Amsterdam Netherlands. Conference Start: 20110620 Conference End:
20110623. Conference Publication: (var.pagings). 97 (pp eS490-eS491),
2011. Date of Publication: June 2011.
Publisher
Elsevier Ltd
Abstract
Purpose: The purpose of this study was to determine if cycling as
effective as walking in Phase I cardiac rehabilitation (CR) after coronary
artery bypass graft surgery (CABG). Relevance: Physiotherapists routinely
employ walking exercise in Phase I CR after CABG. While guidelines exist
for Phase I CR exercise prescription, there are limited data investigating
the optimal mode and dose of exercise to restore postoperative functional
capacity. Stationary cycling may provide an effective alternative to
IEtraditionalIE graded walking programs. Participants: Consecutive
patients (n = 64) awaiting firsttime, non-emergency CABG at Westmead
Private Hospital between August 2008 and July 2009 (mean age: 66+/-9
years, 57 men, 7women) participated in the study. Exclusion criteria were
concomitant surgery and musculoskeletal/neurological impairment precluding
exercise testing/training. Methods: Patients were randomly allocated to
receive Phase I CR comprising either physiotherapy-supervised, moderate
intensity stationary cycling or walking exercise. Ten-minute exercise
sessions were scheduled twice-daily from the third postoperative day until
hospital discharge. Primary outcomes, six-minute walk distance (6MWD) and
six-minute cycle work (6MCW), were measured preoperatively and at hospital
discharge by a physiotherapist blinded to group allocation. Secondary
outcomes were postoperative length of hospital stay (LOS) and compliance
with exercise training. For all completed training sessions the following
data were recorded: (i) cycle work or walk distance as applicable, and
(ii) exercise heart rate (HR) and blood pressure (BP). Analysis: Repeated
measures analysis of variance was used to compare stationary cycling and
walking exercise groups for 6MWD and 6MCW. Non-parametric analysis of
variance was used to test for differences in LOS. Generalised linear
effects models were used to assess the impact of (i) group, postoperative
day and time and their interaction on exercise training compliance, HR and
BP; and (ii) postoperative day and time on training cycle work and walk
distance. Results: Stationary cycling (n = 32) and walking (n = 32)
exercise groups were well matched at baseline for demo
graphic/anthropometric variables, 6MWD and 6MCW. At hospital discharge
there was no significant difference between 'cyclists' and 'walkers' for
6MWD (402+/-93 meter vs. 417+/-86 meter, p = 0.803) or 6MCW (15.0+/-6.4 kJ
vs. 14.0+/-6.3 kJ, p = 0.798). There was no significant difference between
groups for LOS (cyclists: median 7.0, IQR 7.0-8.5 days vs. walkers: median
7.0, IQR 7.0-8.0 days, p = 0.335). Training compliance was excellent and
similar between groups (cyclists: 185/246, 75% of scheduled sessions
attended vs. walkers: 199/242, 82%, p = 0.162). Training cycle work (1.2
kJ/session, p < 0.001) and walk distance (46 m/session, p < 0.001)
improved significantly and linearly with postoperative time. There were no
significant differences between groups, or across postoperative time, for
exercise HR and BP. Conclusions: Stationary cycling provides a clinically
effective alternative to walking exercise in Phase I CR after CABG.
Compliance with physiotherapy-supervised Phase I exercise programs is
excellent, regardless of exercise mode. The optimal frequency, intensity
and duration of exercise in Phase I CR requires further investigation.
Implications: As stationary cycling facilitates both: (i) measurement of
hemodynamic data, and (ii) titration and measurement of exercise
intensity, future investigations of exercise dose might preferentially
employ stationary cycling.