EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012688636
Authors
Romeo S. Maglio C. Burza M.A. Pirazzi C. Sjoholm K. Peltonen M. Svensson
P.-A. Sjostrom Lars Carlsson L.M.S.
Institution
(Romeo, Maglio, Burza, Pirazzi, Sjoholm, Jacobson, Svensson, Sjostrom,
Carlsson) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Peltonen) Chronic Disease Epidemiology and Prevention Unit, Department of
Chronic Disease Prevention, National Institute for Health and Welfare,
Helsinki, Finland
Title
Cardiovascular events after bariatric surgery in obese subjects with type
2 diabetes.
Source
Diabetes Care. 35 (12) (pp 2613-2617), 2012. Date of Publication: 01 Dec
2012.
Publisher
American Diabetes Association Inc.
Abstract
OBJECTIVE - Obese individuals with type 2 diabetes have an increased risk
of cardiovascular disease. The effect of bariatric surgery on
cardiovascular events in obese individuals with type 2 diabetes remains to
be determined. The Swedish Obese Subjects (SOS) study is a prospective,
controlled intervention study that examines the effects of bariatric
surgery on hard end points. The aim of the present study was to examine
the effect of bariatric surgery on cardiovascular events in the SOS study
participants with type 2 diabetes. RESEARCH DESIGN AND METHODS - All SOS
study participants with type 2 diabetes at baseline were included in the
analyses (n = 345 in the surgery group and n = 262 in the control group).
Mean follow-up was 13.3 years (interquartile range 10.2-16.4) for all
cardiovascular events. RESULTS - Bariatric surgery was associated with a
reduced myocardial infarction incidence (38 events among the 345 subjects
in the surgery group vs. 43 events among the 262 subjects in the control
group; log-rank P = 0.017; adjusted hazard ratio [HR] 0.56 [95% CI
0.34-0.93]; P = 0.025). No effect of bariatric surgery was observed on
stroke incidence (34 events among the 345 subjects in the surgery group
vs. 24 events among the 262 subjects in the control group; log-rank P =
0.852; adjusted HR 0.73 [0.41-1.30]; P = 0.29). The effect of surgery in
reducing myocardial infarction incidence was stronger in individuals with
higher serum total cholesterol and triglycerides at baseline (interaction
P value = 0.02 for both traits). BMI (interaction P value = 0.12) was not
related to the surgery outcome. CONCLUSIONS - Bariatric surgery reduces
the incidence of myocardial infarction in obese individuals with type 2
diabetes. Preoperative BMI should be integrated with metabolic parameters
to maximize the benefits of bariatric surgery. &#xa9; 2012 by the American
Diabetes Association.

<2>
Accession Number
2015130973
Authors
Lee S. Lee S.H. Chang B.-C. Shim J.-K.
Institution
(Lee, Lee, Chang) Department of Thoracic and Cardiovascular Surgery,
Cardiovascular Research Institute, Yonsei University College of Medicine,
Seoul, South Korea
(Shim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, Seoul, South
Korea
Title
Efficacy of goal-directed therapy using bioreactance cardiac output
monitoring after valvular heart surgery.
Source
Yonsei Medical Journal. 56 (4) (pp 913-920), 2015. Date of Publication: 01
Jul 2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: We compared the efficacy of postoperative hemodynamic
goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and
bioreactance-based noninvasive cardiac output monitoring (NICOM) in
patients with atrial fibrillation undergoing valvular heart surgery.
Materials and Methods: Fifty eight patients were randomized into two
groups of GDT with common goals to maintain a mean arterial pressure of
60-80 mm Hg and cardiac index >2 L/min/m²: the PAC group
(n=29), based on pulmonary capillary wedge pressure, and the NICOM group
(n=29), based on changes in stroke volume index after passive leg raising.
The primary efficacy variable was length of hospital stay. Secondary
efficacy variables included resource utilization including vasopressor and
inotropic requirement, fluid balance, and major morbidity endpoints.
Results: Patient characteristics and operative data were similar between
the groups, except that significantly more patients underwent double valve
replacement in the NICOM group. The lengths of hospital stay were not
different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days,
p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and
ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the
PAC group. The PAC group also required significantly larger amounts of
colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004). Conclusion:
NICOM-based postoperative hemodynamic GDT showed promising results in
patients with atrial fibrillation undergoing valvular heart surgery in
terms of resource utilization.

<3>
Accession Number
2015125365
Authors
Aydin U. Yilmaz M. Duzyol C. Ata Y. Turk T. Orhan A.L. Kocogullari C.U.
Institution
(Aydin, Ata, Turk) Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
(Yilmaz, Orhan) Departments of Anesthesiology, Kocaeli Derince Education
and Research Hospital, Kocaeli, Turkey
(Duzyol, Kocogullari) Departments of Cardiovascular Surgery, Kocaeli
Derince Education and Research Hospital, Kocaeli, Turkey
Title
Efficiency of postoperative statin treatment for preventing new-onset
postoperative atrial fibrillation in patients undergoing isolated coronary
artery bypass grafting: A prospective randomized study.
Source
Anadolu Kardiyoloji Dergisi. 15 (6) (pp 491-495), 2015. Date of
Publication: 01 Jun 2015.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey. E-mail: info@avesyayincilik.com)
Abstract
Objective: Recent studies have demonstrated that preoperative statin
therapy reduces the incidence of postoperative atrial fibrillation (AF).
The objective of this study was to assess the efficacy of statin therapy
started in the early postoperative period for the prevention from
new-onset AF after isolated coronary artery bypass grafting (CABG).
Methods: This prospective and randomized study consisted of 60 consecutive
patients who underwent elective isolated CABG. Patients were divided into
two groups to examine the influence of statins: those with postoperative
statin therapy (statin group, n=30) and those without it (non-statin
group, n=30). Patient data were collected and analyzed prospectively. In
the statin group, each extubated patient was given 40 mg of atorvastatin
per day, starting from an average of 6 hours after the operation. Results:
The overall incidence of postoperative AF was 30%. Postoperative AF
occurred in 5 patients (16.7%) in the statin group. This was significantly
lower compared with 13 patients (43.3%) in the non-statin group (p=0.049).
According to the multivariate analysis, postoperative atorvastatin reduced
the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence
interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent
predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001).
Conclusion: Postoperative statin therapy seems to reduce new-onset AF
after isolated CABG in our study.

<4>
Accession Number
2015129773
Authors
Yanartas M. Baysal A. Aydin C. Ay Y. Kara I. Aydin E. Cevirme D. Koksal C.
Sunar H.
Institution
(Yanartas, Aydin, Cevirme, Koksal, Sunar) Cardiovascular Surgery Clinic,
Kartal Kosuyolu High, Speciality Training and Research Hospital, Istanbul,
Turkey
(Baysal) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High,
Speciality Training and Research Hospital, Istanbul, Turkey
(Aydin, Ay) Cardiovascular Surgery Clinic, Istanbul, Turkey
(Kara) Cardiovascular Surgery Clinic, Sakarya, Turkey
Title
The effects of tranexamic acid and 6% hydroxyethyl starch (HES) solution
(130/0.4) on postoperative bleeding in coronary artery bypass graft (CABG)
surgery.
Source
International Journal of Clinical and Experimental Medicine. 8 (4) (pp
5959-5971), 2015. Date of Publication: 30 Apr 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: The addition of 6% hydroxyethyl starch (HES) into Ringer
lactate priming solution may have adverse effects on hemostasis in
patients undergoing coronary artery bypass grafting (CABG) with
cardiopulmonary bypass (CPB) with or without the use of tranexamic acid.
Methods: In a prospective, randomized clinical trial, 132 patients were
assigned to receive 20 ml/kg of Ringer priming solution with or without
tranexamic acid (TA) (Group RS-TA, n=34 and Group RS-noTA, n=32) or 10
ml/kg of 6% HES plus 10 ml/kg of RS priming solution with or without
intravenous tranexamic acid (Group HES-TA, n=35 and Group HES-noTA, n=31).
Estimated blood loss, chest tube drainage, amount of blood products,
hemoglobin, hematocrit, platelet and coagulation parameters were examined
before and 24 hour after surgery. Results: For Group HES with tranexamic
acid, when compared to other groups, estimated blood loss, postoperative
24 hour drainage loss and blood product transfusions were less (P=0.023;
P=0.003; P=0.001; respectively) and hemoglobin, hematocrit values at 12
and 24 hours after surgery increased in comparison to other groups
(P=0.041, P=0.034, P=0.004, P=0.001; respectively). Platelet
concentrations were similar between groups (P>0.05). Conclusions: In CABG,
the administration of tranexamic acid in HES 130/0.4 prime solution study
group decreased estimated blood loss and chest tube drainage in comparison
to patients receving Ringer prime solution with or without tranexamic acid
postoperatively however, no effects on renal functions or postoperative
complications were shown.

<5>
Accession Number
2015920718
Authors
Taggart D.P. Ben Gal Y. Lees B. Patel N. Webb C. Rehman S.M. Desouza A.
Yadav R. De Robertis F. Dalby M. Banning A. Channon K.M. Di Mario C. Orion
E.
Institution
(Taggart, Rehman) Nuffield Department of Surgery, University of Oxford,
John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
(Ben Gal) Department of Cardiothoracic Surgery, Tal Aviv Sourasky Medical
Center, Tel Aviv University, Tel Aviv, Israel
(Lees) Clinical Trials and Evaluation Unit, Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Patel, Banning, Channon) Department of Cardiovascular Medicine,
University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Webb, Di Mario) Department of Cardiology, Royal Brompton Hospital,
London, United Kingdom
(Desouza, Yadav) Department of Cardiothoracic Surgery, Royal Brompton
Hospital, London, United Kingdom
(De Robertis) Department of Cardiothoracic Surgery, Harefield Hospital,
Middlesex, London, United Kingdom
(Dalby) Department of Cardiology, Harefield Hospital, Middlesex, London,
United Kingdom
(Orion) Vascular Graft Solutions Ltd, Tel Aviv, Israel
Title
A randomized trial of external stenting for saphenous vein grafts in
coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 99 (6) (pp 2039-2045), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier USA
Abstract
Background External stents inhibit saphenous vein graft (SVG) intimal
hyperplasia in animal studies. We investigated whether external stenting
inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery
bypass graft surgery. Methods Thirty patients with multivessel disease
undergoing coronary artery bypass graft surgery were enrolled. In addition
to an internal mammary artery graft, each patient received one external
stent to a single SVG randomly allocated to either the right or left
coronary territories; and one or more nonstented SVG served as the
control. Graft patency was confirmed at the end of surgery in all
patients. The primary endpoint was SVG intimal hyperplasia (mean area)
assessed by intravascular ultrasonography at 1 year. Secondary endpoints
were SVG failure, ectasia (>50% initial diameter), and overall uniformity
as judged by Fitzgibbon classification. Results One-year follow-up
angiography was completed in 29 patients (96.6%). All internal mammary
artery grafts were patent. Overall SVG failure rates did not differ
significantly between the two groups (30% stented versus 28.2% nonstented
SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43
SVGs, was significantly reduced in the stented group (4.37 +/- 1.40
mm²) versus nonstented group (5.12 +/- 1.35 mm², p =
0.04). In addition, stented SVGs demonstrated marginally significant
improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus
28.2%, p = 0.05). There was some evidence that ligation of side branches
with metallic clips increased SVG failure in the stented group.
Conclusions External stenting has the potential to improve SVG lumen
uniformity and reduce diffuse intimal hyperplasia 1 year after coronary
artery bypass graft surgery.

<6>
Accession Number
2015902000
Authors
Altarabsheh S.E. Deo S.V. Hang D. Haddad O.K. Cho Y.H. Markowitz A.H. Park
S.J.
Institution
(Altarabsheh, Deo, Haddad) Department of Cardiovascular Surgery, Queen
Alia Heart Institute, Amman, Jordan
(Markowitz, Park) Division of Cardiovascular Surgery, Case Western Reserve
University, Cleveland, OH, United States
(Hang) School of Medicine, Case Western Reserve University, Cleveland, OH,
United States
(Cho) Division of Cardiovascular Surgery, Samsung Hospital, Sungkyunkwang
School of Medicine, Seoul, South Korea
Title
Coronary artery bypass grafting after percutaneous intervention has higher
early mortality: A meta-analysis.
Source
Annals of Thoracic Surgery. 99 (6) (pp 2046-2052), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier USA
Abstract
Background We compared early adverse events and midterm survival between
primary coronary artery bypass grafting (pCABG) and CABG in patients with
percutaneous intervention (secondary CABG, sCABG) because data on this
topic are very limited. Methods A systematic review of published
literature was done to obtain original studies fulfilling the search
criteria. The end points studied were early mortality, stroke, renal
failure, myocardial infarction, and the need for an intra-aortic balloon
pump. A random-effect inverse variance weighted analysis was performed.
The results are presented as risk ratios (RR) (95% confidence interval); p
< 0.05 was considered statistically significant. Results Fourteen studies
(84,983 pCABG patients and 14,775 sCABG patients) were included in the
systematic review. Early mortality was lower with primary CABG (RR 1.54
[1.19-2]; p = 0.007). The incidence of myocardial infarction was also less
with pCABG than with sCABG. (RR 1.46 [1.04-2.06]; p = 0.06). Patients
undergoing pCABG were 14% (0% to 55%; p = 0.04). Less likely to need an
intra-aortic balloon pump. Although renal failure was lower with pCABG (RR
1.254 [1.047-1.502]; p = 0.014), the stroke rates were comparable in both
cohorts (p = 0.95). Renal failure was favorable in the primary CABG
cohort. Early stroke was comparable between the two cohorts (p = 0.95).
The pooled hazard ratios demonstrated comparable survival at the end of 3
years (p = 0.36). Conclusions Patients undergoing CABG after prior
percutaneous therapy have a higher incidence of myocardial infarction and
mortality in the postoperative period. However, midterm survival is
comparable in both cohorts.

<7>
Accession Number
2015726639
Authors
Fitzgerald D.C. Holmes S.D. St. Onge J.R. Ioanou C. Martin L.M. Ad N.
Institution
(Fitzgerald, Holmes, St. Onge, Ioanou, Martin, Ad) Division of
Cardiothoracic Surgery, Department of Cardiovascular Perfusion, Inova
Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA 22042, United States
Title
Systemic inflammatory response during cardiac surgery: A pilot study.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (2) (pp 125-132), 2015. Date of Publication: 04 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: There is a growing body of evidence indicating that
perioperative fluid management during cardiac surgery influences patient
care and outcome. The choice of fluid therapy and the degree of systemic
inflammatory response triggered during surgery control the effects of
tissue edema formation and end-organ function. As such, "goal-directed"
fluid resuscitation protocols that measure colloid osmotic pressure (COP)
may promote improvements in patient morbidity and mortality. Methods:
Thirty patients scheduled for primary coronary artery bypass grafting were
prospectively randomized for perioperative fluid treatment under COP
guidance [albumin (ALB), n = 17] or conventional fluid protocols without
COP support (control, n = 13). Wholeblood samples were drawn at four
different time intervals including (A) anesthesia induction, (B) 10
minutes after the initiation of cardiopulmonary bypass, (C) at the
completion of sternal skin approximation, and (D) 3 hours after admission
to the cardiac intensive care unit. Interleukin 6 (IL-6) and IL-8 were
measured by immunometric, enzyme-linked immunosorbent assays as well as
C-reactive protein. Colloid osmotic pressure values were measured using a
colloid osmometer. Results: As compared with conventional fluid protocols,
the patients treated in the intervention (ALB) group received
significantly less total perioperative fluid [7893.6 (1874.5) vs 10,754.8
(2403.9), P = 0.001], and this relationship remained after controlling for
age, sex, and The Society of Thoracic Surgeons risk score (beta = -0.5, t
= -3.1, P =0.005). Colloid osmotic pressure values were significantly
higher in the ALB group at time point D after surgery (P = 0.03). There
were no significant differences in IL-6, IL-8, and C-reactive protein
values between the groups at any of the time blood draw intervals.
Perioperative outcomes were evaluated by treatment group. For both groups,
the incidence of perioperative morbidity was low and did not differ by
treatment group. Conclusions: The use of COP-guided fluid resuscitation
was associated with a significant reduction in perioperative fluid demand.
However, patients prescribed toCOP-guided fluid therapy did not experience
a reduction in whole-body inflammation or improved surgical outcome as
compared with conventional fluid management techniques.

<8>
Accession Number
2015129792
Authors
Faritus S.Z. Khazaee-Koohpar M. Ziyaeifard M. Mehrabanian M.J.
Institution
(Faritus, Khazaee-Koohpar, Ziyaeifard, Mehrabanian) Rajaie Cardiovascular,
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Oral dexmedetomidine versus midazolam as anesthetic premedication in
children undergoing congenital heart surgery.
Source
Anesthesiology and Pain Medicine. 5 (3) , 2015. Article Number: e25032.
Date of Publication: 01 Jun 2015.
Publisher
Kowsar Medical Publishing Company
Abstract
Background: Premedication is required for reducing anxiety and child's
struggling against mask acceptance on anesthesia in pediatric surgery for
congenital heart disease. Midazolam has been widely used for this purpose,
but because of its side effects, finding an effective replacement with
less complication is necessary. Objectives: In the present study, we
compared the efficacy of oral midazolam versus dexmedetomidine in terms of
anxiolysis and mask acceptance behavior. Patients and Methods: Sixty
children aged between 2 and 12 years, and scheduled for on-pump surgery
due to a congenital heart disease were randomly assigned into two groups.
Oral midazolam (0.5 mg/kg up to 15 mg per patient) and dexmedetomidine (2
mug/kg) were administered 45 minutes pre-anesthesia. Children's anxiety,
mask acceptance behavior, hemodynamic measures, and cardiopulmonary
outcomes were recorded and compared. Results: The mean age of patients was
3.96 +/- 2.04 years. Twenty-eight (46.7%) patients were females. Two drugs
have similar effects on cardiopulmonary outcomes and hemodynamic measures
(P > 0.05). They equally relieved the children's anxiety (mean sedation
score 1.93 +/- 0.63 and 2.0 +/- 0.63 for midazolam and dexmedetomidine
groups, respectively; P > 0.05), while dexmedetomidine showed a better
effect on improving the mask acceptance behavior (mean mask acceptance
score 2.58 +/- 0.6 and 1.6 +/- 0.67 for midazolam and dexmedetomidine,
respectively; P < 0.05). Conclusions: It appears reasonable to apply oral
premedication with dexmedetomidine 45 minutes before transferring the
patient to the operating room when he or she is more prone to resist
inhalation anesthesia induction.

<9>
Accession Number
2015131144
Authors
Siegrist P.T. Sumitsuji S.
Institution
(Siegrist, Sumitsuji) Department of Advanced Cardiovascular Therapeutics,
Osaka University Graduate School of Medicine, Osaka, Japan
Title
Chronic total occlusion: Current methods of revascularisation.
Source
Kardiovaskulare Medizin. 17 (12) (pp 347-356), 2014. Date of Publication:
2014.
Publisher
EMH Swiss Medical Publishers Ltd.
Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusions
(CTO) has been referred to as the "last frontier" in interventional
cardiology. In recent years novel devices, refined imaging modalities and
innovative techniques have increased success rate and safety of PCI for
treatment of CTO remarkably. Favourable long-term outcome data and
excellent performance of drug-eluting stents further support the choice of
PCI for CTO recanalisation. As strategies for treating complex lesions are
continuously evolving, we provide here a systematic review of current
methods for CTO revascularisation. Detailed knowledge about the
histopathological characteristics of CTO is crucial to understand the
basic principles of advanced interventional techniques. The concept of
imaging-guid ed PCI further enhances efficacy and safety of this complex
intervention. Finally, understanding the principle of antegrade and
retrograde approaches are completing the armamentarium essential for
interventional cardiologists dealing with this challenging lesion subset.

<10>
Accession Number
2015115236
Authors
Scherr D. Derval N. Sohal M. Pascale P. Wright M. Jadidi A. Komatsu Y.
Roten L. Wilton S.B. Pedersen M. Ramoul K. Miyazaki S. Shah A. Linton N.
Manninger M. Denis A. Hocini M. Sacher F. Haissaguerre M. Jais P. Knecht
S.
Institution
(Scherr, Derval, Pascale, Wright, Jadidi, Komatsu, Roten, Wilton,
Pedersen, Ramoul, Miyazaki, Shah, Linton, Denis, Hocini, Sacher,
Haissaguerre, Jais, Knecht) Hopital Cardiologique du Haut Leveque,
Universite Victor-Segalen Bordeaux, Pessac, France
(Scherr, Manninger) Division of Cardiology, Department of Medicine,
Medical University of Graz, Austria
(Sohal, Wright) Kings College London BHF Centre, Cardiovascular Division,
. Thomas Hospital, Lambeth Wing, St, London SE1 7EH, United Kingdom
Title
Length of the mitral isthmus but not anatomical location of ablation line
predicts bidirectional mitral isthmus block in patients undergoing
catheter ablation of persistent atrial fibrillation: A randomized
controlled trial.
Source
Journal of Cardiovascular Electrophysiology. 26 (6) (pp 629-634), 2015.
Date of Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Importance of Line and Length for Mitral Isthmus Introduction Mitral
isthmus (MI) ablation is an effective option in patients undergoing
ablation for persistent atrial fibrillation (AF). Achieving bidirectional
conduction block across the MI is challenging, and predictors of MI
ablation success remain incompletely understood. We sought to determine
the impact of anatomical location of the ablation line on the efficacy of
MI ablation. Methods and Results A total of 40 consecutive patients (87%
male; 54 +/- 10 years) undergoing stepwise AF ablation were included. MI
ablation was performed in sinus rhythm. MI ablation was performed from the
left inferior PV to either the posterior (group 1) or the anterolateral
(group 2) mitral annulus depending on randomization. The length of the MI
line (measured with the 3D mapping system) and the amplitude of the EGMs
at 3 positions on the MI were measured in each patient. MI block was
achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in
group 2 (P = NS). Total MI radiofrequency time (18 +/- 7 min vs. 17 +/- 8
min; P = NS) was similar between groups. Patients with incomplete MI block
had a longer MI length (34 +/- 6 mm vs. 24 +/- 5 mm; P < 0.001), a higher
bipolar voltage along the MI (1.75 +/- 0.74 mV vs. 1.05 +/- 0.69 mV; P <
0.01), and a longer history of continuous AF (19 +/- 17 months vs. 10 +/-
10 months; P < 0.05). In multivariate analysis, decreased length of the MI
was an independent predictor of successful MI block (OR 1.5; 95% CI
1.1-2.1; P < 0.05). Conclusions Increased length but not anatomical
location of the MI predicts failure to achieve bidirectional MI block
during ablation of persistent AF.

<11>
Accession Number
2015118330
Authors
Yamaji K. Natsuaki M. Morimoto T. Ono K. Furukawa Y. Nakagawa Y. Kadota K.
Ando K. Shirai S. Watanabe H. Shiomi H. Kimura T.
Institution
(Yamaji, Ando, Shirai) Division of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Natsuaki) Division of Cardiology, Saiseikai Fukuoka General Hospital,
Fukuoka, Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Nishinomiya, Japan
(Ono, Watanabe, Shiomi, Kimura) Department of Cardiovascular Medicine,
Kyoto University, Graduate School of Medicine, Kyoto, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical
Center, General Hospital, Kobe, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Tenri, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
Title
Long-term outcomes after coronary stent implantation in patients
presenting with versus without acute myocardial infarction (an observation
from Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry
Cohort-2).
Source
American Journal of Cardiology. 116 (1) (pp 15-23), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
It has not been adequately addressed yet how long the excess
cardiovascular event risk persists after acute myocardial infarction (AMI)
compared with stable coronary artery disease. Of 10,470 consecutive
patients who underwent percutaneous coronary intervention either with
sirolimus-eluting stent (SES) only or with bare-metal stent (BMS) only in
the Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry
Cohort-2, 3,710 (SES: n = 820 and BMS: n = 2,890) and 6,760 patients (SES:
n = 4,258 and BMS: n = 2,502) presented with AMI (AMI group) and without
AMI (non-AMI group), respectively. During the median 5-year follow-up, the
excess adjusted risk of the AMI group relative to the non-AMI group for
the primary outcome measure (cardiac death or myocardial infarction) was
significant (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.30 to
1.80, p <0.001). However, the excess event risk was limited to the early
period within 3 months. Late adjusted risk beyond 3 months was similar
between the AMI and non-AMI groups (HR 1.16, 95% CI 0.95 to 1.41, p =
0.15). The higher risk of the AMI group relative to the non-AMI group for
stent thrombosis (ST) was significant within 3 months (HR 3.38, 95% CI
2.04 to 5.60, p <0.001), whereas the risk for ST was not different between
the 2 groups beyond 3 months (HR 1.11, 95% CI 0.65 to 1.90, p = 0.70).
There were no interactions between the types of stents implanted and the
risk of the AMI group relative to the non-AMI groups for all the outcome
measures including ST. In conclusion, patients with AMI compared with
those without AMI were associated with similar late cardiovascular event
risk beyond 3 months after percutaneous coronary intervention despite
their higher early risk within 3 months.

<12>
Accession Number
2015072084
Authors
Agren S. Stromberg A. Jaarsma T. Luttik M.L.A.
Institution
(Agren) Department of Medical and Health Sciences, Linkoping University,
Department of Cardiothoracic Surgery, Linkoping, Sweden
(Agren, Stromberg, Luttik) Department of Medical and Health Sciences,
Linkoping University, Division of Nursing Sciences, Department of
Cardiology, Linkoping, Sweden
(Jaarsma) Department of Social and Welfare Studies, Linkoping University,
Linkoping, Sweden
(Luttik) Research Group Nursing Diagnostics, Hanze University of Applied
Sciences, Groningen, Netherlands
Title
Caregiving tasks and caregiver burden; effects of an psycho-educational
intervention in partners of patients withpost-operative heart failure.
Source
Heart and Lung: Journal of Acute and Critical Care. 44 (4) (pp 270-275),
2015. Date of Publication: 01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Objective: To evaluate the effects of a psycho-educational intervention on
caregiver burden in partners of patients with postoperative heart failure.
Background: Since partners of cardiac surgery patients play a significant
role in the patient's recovery, it is important to address their needs
during hospitalization and after discharge. Methods: Forty-two patients
with postoperative heart failure and their partners participated in a
randomized controlled pilot study. Dyads in the intervention group
received psycho-educational support from a multidisciplinary team. Dyads
in the control group received usual care. Results: No significant
differences were found in the performance of caregiving tasks and
perceived caregiver burden in the control versus the intervention group.
Conclusion: A pilot study exploring the effects of a psycho-educational
intervention in patients and their partners did not reveal significant
effects with regard to reduced feelings of burden in partners. Alleviating
caregiver burden in partners may need a more intense or specific approach.

<13>
Accession Number
2015000375
Authors
Sucha D. Daans C.G. Symersky P. Planken R.N. Mali W.P.T.M. Van Herwerden
L.A. Budde R.P.J.
Institution
(Sucha, Daans, Mali, Budde) Department of Radiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Symersky) Department of Cardiothoracic Surgery, VU University Medical
Center, Amsterdam, Netherlands
(Planken) Department of Radiology, Academic Medical Center, Amsterdam,
Netherlands
(Budde) Department of Radiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Title
Reliability, agreement, and presentation of a reference standard for
assessing implanted heart valve sizes by multidetector-row computed
tomography.
Source
American Journal of Cardiology. 116 (1) (pp 112-120), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
The implanted prosthetic heart valve (PHV) size is vital for the
evaluation of suspected PHV dysfunction and in case of reoperation or
valve-in-valve transcatheter approaches. The labeled size is not always
known, and discrepancies exist between manufacturers' labeled sizes and
true sizes. Reproducible methods for noninvasive PHV size assessment are
lacking. We determined the reliability and agreement of PHV size
measurements using multidetector-row computed tomography (MDCT) and
provide reference values of MDCT measurements compared with manufacturer
specifications. In vitro, 15 different PHV types in available sizes (total
n = 63) were imaged. In vivo, available MDCT acquisitions of patients with
PHVs were retrospectively gathered in 2 centers, and 230 patients with 249
PHVs were included. Inner valve area and area-derived diameter were
measured in all PHVs. For mechanical PHVs, the inner diameter was also
measured. Data were analyzed using the intraclass correlation coefficient
and Bland-Altman plots and related to manufacturer specifications.
Measurements could be obtained for all PHV types, except the Bjork-Shiley
(n = 7) because of severe valve-related artifacts hampering the image
quality. Intrarater and interrater reliability was excellent for
biological and mechanical PHVs (intraclass correlation coefficients
>0.903). Agreement was good for all measurements with an overall maximal
mean difference (95% confidence interval) of -2.61 mm² (-37.9
to 32.7), -0.1 mm (-1.1 to 1.0), and 0 mm (-0.4 to 0.3) for valve area,
area-derived diameter, and inner diameter, respectively. MDCT reliably
discriminated consecutive PHV sizes as labeled by the manufacturer because
the absolute ranges for the measurements never overlapped. In conclusion,
MDCT allows assessment of the implanted PHV size with excellent
reliability and agreement and can discriminate between PHV sizes for
contemporary prostheses. MDCT can be used to noninvasively identify the
manufacturer-labeled PHV size.

<14>
Accession Number
2015621109
Authors
Kidambi S. Mohamedali B. Bhat G.
Institution
(Kidambi, Bhat) Division of Advanced Heart Failure and Clinical
Transplantation, Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Mohamedali) Rush University, Chicago, IL, United States
Title
Clinical outcomes in sensitized heart transplant patients bridged with
ventricular assist devices.
Source
Clinical Transplantation. 29 (6) (pp 499-505), 2015. Date of Publication:
01 Jun 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Left ventricular assist devices (LVADs) as a bridge to
transplant (BTT) have been known to cause allosensitization, as measured
by panel-reactive antibody (PRA) levels. The goal of this study was to
measure the impact of this allosensitization on outcomes. Methods:
Panel-reactive antibodies were analyzed in BTT patients, with
sensitization defined as peak PRAs > 10%. Baseline characteristics and
outcomes in the two patient groups were evaluated using descriptive
statistics, Kaplan-Meier, and regression analysis. Results: Thirty-eight
patients were included in the study (17 sensitized vs. 21 non-sensitized).
There were more women in the sensitized group (47% vs. 10%, p = 0.023).
There was no difference in mean times to high-grade acute cellular
rejection (ACR; 18.3 months in sensitized vs. 36.9 months in
non-sensitized). Five patients in the sensitized groups developed
antibody-mediated rejection (AMR) vs. 0 in the non-sensitized, and all
five patients died (Kaplan-Meier log-rank p = 0.024). There was also a
significant difference in the incidence of infection at the one- to
six-month stage (52.9% vs. 19.0%, p = 0.03). Conclusion: Sensitization
appears to have a negative effect on mortality. This mortality appears to
be concentrated in patients with AMR, and we postulate that the
development of AMR in a sensitized patient may be a predictor of
mortality.

<15>
Accession Number
2015887611
Authors
Luo T. Ni Y.
Institution
(Luo, Ni) Department of Cardiovascular Surgery, First Affiliated Hospital
College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou,
Zhejiang 310003, China
Title
Short-term and long-term postoperative safety of off-pump versus on-pump
coronary artery bypass grafting for coronary heart disease: A
meta-analysis for randomized controlled trials.
Source
Thoracic and Cardiovascular Surgeon. 63 (4) (pp 319-327), 2015. Date of
Publication: 24 Mar 2015.
Publisher
Georg Thieme Verlag
Abstract
Objective The aim was to compare the short-term (30 days after surgery)
and long-term (over 6 months' follow-up) postoperative safety of off-pump
and on-pump coronary artery bypass grafting (CABG) for patients with
coronary heart disease (CHD). Methods Relevant randomized controlled
trials (RCTs) were obtained from PubMed, Embase, Springer, Ovid, and
Cochrane library up to July 2013. Odds ratios (ORs) with their 95%
confidence intervals (CIs) were used to access effect sizes. Results Seven
RCTs involving 9,128 patients were included. Results suggested no
significant difference in all the short-term outcomes (mortality, OR =
0.90, 95% CI: 0.69 to 1.16, p = 0.41; myocardial infarction, OR = 0.95,
95% CI: 0.79 to 1.15, p = 0.61; stroke, OR = 0.78, 95% CI: 0.56 to 1.07, p
= 0.12; renal failure, OR = 0.84, 95% CI: 0.60 to 1.18, p = 0.43;
revascularization: OR = 1.95, 95% CI: 0.79 to 4.85, p = 0.15) and some
long-term outcomes (mortality, OR = 1.02, 95% CI: 0.86 to 1.22, p = 0.81;
myocardial infarction, OR = 0.86, 95% CI: 0.70 to 1.04, p = 0.12; stroke,
OR = 0.89, 95% CI: 0.67 to 1.19, p = 0.44) between off-pump and on-pump
CABG. However, off-pump CABG had a significantly higher revascularization
rate (OR = 1.45; 95% CI: 1.02 to 2.06; p = 0.04) than on-pump CABG in
long-term follow-up. Conclusion Short-term postoperative safety was
similar between off-pump and on-pump CABG. A high revascularization rate
was the drawback of off-pump CABG for CHD patients in long-term follow-up.

<16>
Accession Number
2015128641
Authors
Silvetti S. Silvani P. Azzolini M.L. Dossi R. Landoni G. Zangrillo A.
Institution
(Silvetti, Silvani, Azzolini, Dossi, Landoni, Zangrillo) Department of
Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan,
Italy
Title
A systematic review on levosimendan in paediatric patients.
Source
Current Vascular Pharmacology. 13 (1) (pp 128-133), 2015. Date of
Publication: 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Levosimendan is a calcium-sensitizing agent that improves cardiac
function, hemodynamic performance, and survival in critically ill adult
patient. Few data exist on its off-label use in paediatric patients. We
therefore performed a systematic review updated in September 2013 of all
the published articles describing the use of levosimendan in paediatric
patients. We identified 24 studies published in the period 2004-2013 that
included a total of 623 patients, the largest one being a case series of
293 patients. Most of the patients underwent cardiac surgery, other
settings consisting of chronic heart failure, primary congenital heart
diseases and sepsis and cancer-associated cardiac dysfunction. Most
studies reported improvement in ventricular function, central venous
oxygen saturation, serum lactate levels or cardiac index. The 5 randomized
studies published so far have all been performed in cardiac surgery and
suggest a beneficial effect on hemodynamic data with no effect on
intensive care unit stay, hospital stay or survival. Side effects (e.g.
hypotension) were reported. This inodilator merits to be investigated with
further randomized trials focusing on clinically relevant outcomes.

<17>
Accession Number
2015070979
Authors
Ghatak A. Bavishi C. Cardoso R.N. MacOn C. Singh V. Badheka A.O. Padala S.
Cohen M.G. Mitrani R. O'Neill W. De Marchena E.
Institution
(Ghatak, Cardoso, MacOn, Singh, Cohen, Mitrani, De Marchena) University of
Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th
Street, Miami, FL 33136, United States
(Bavishi) Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, United
States
(Badheka) Wayne State University, Detroit, MI, United States
(Padala) Albany Medical Center, Albany, NY, United States
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
Title
Complications and mortality in patients undergoing transcatheter aortic
valve replacement with edwards SAPIEN & SAPIEN XT valves: A meta-analysis
of world-wide studies and registries comparing the transapical and
transfemoral accesses.
Source
Journal of Interventional Cardiology. 28 (3) (pp 266-278), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction Both transfemoral (TF) and transapical (TA) routes are
utilized for Transcatheter Aortic Valve Replacement (TAVR) using Edwards
SAPIEN & SAPIEN XT valves. We intended to perform a meta-analysis
comparing the complication rates between these two approaches in studies
published before and after the standardized Valve Academic Research
Consortium (VARC) definitions. Methods We performed a comprehensive
electronic database search for studies published until January 2014
comparing TF and TA approaches using the Edwards SAPIEN/SAPIEN XT aortic
valve. Studies were analyzed based on the following endpoints: 1-year
mortality, 30-day mortality, stroke, new pacemaker implantation, bleeding,
and acute kidney injury. Results Seventeen studies were included in the
meta-analysis. Patients undergoing TA TAVR had a significantly higher
logistic EuroSCORE (24.6 +/- 12.9 vs. 21.3 +/- 12.0; P < 0.001). The
cumulative risks for 30-day mortality (RR 0.61; 95%CI 0.46-0.81; P =
0.001), 1-year mortality (RR 0.68; 95%CI 0.55-0.84; P < 0.001), and acute
kidney injury (RR 0.53; 95%CI 0.38-0.73; P < 0.001) were significantly
lower for patients undergoing TF as compared to TA approach. Both
approaches had a similar incidence of 30-day stroke, pacemaker
implantation, and major or life-threatening bleeding. Studies utilizing
the VARC definitions and those pre-dating VARC yielded similar results.
Conclusion This meta-analysis demonstrates a decreased 30-day and 1-year
mortality in TF TAVR as compared to TA TAVR. Post-procedure acute kidney
injury and the need for renal replacement therapy are also significantly
lower in the TF group. These differences hold true even after utilizing
the standardized Valve Academic Research Consortium criteria.

<18>
Accession Number
2015940819
Authors
Teismann I.K. Oelschlager C. Werstler N. Korsukewitz C. Minnerup J.
Ringelstein E.B. Dziewas R.
Institution
(Teismann) Department of Sleep Medicine and Neuromuscular Disorders,
Albert-Schweitzer-Campus 1, Building A1, Munster DE-48149, Germany
(Oelschlager) Department of Neurology, Evangelisches Krankenhaus
Bielefeld, Bielefeld, Germany
(Werstler, Korsukewitz, Minnerup, Ringelstein, Dziewas) Department of
Neurology, Munster, Germany
Title
Discontinuous versus continuous weaning in stroke patients.
Source
Cerebrovascular Diseases. 39 (5-6) (pp 269-277), 2015. Date of
Publication: 09 Jun 2015.
Publisher
S. Karger AG
Abstract
Background: An increasing number of stroke patients have to be supported
by mechanical ventilation in intensive care units (ICU), with a relevant
proportion of them requiring gradual withdrawal from a respirator. To
date, weaning studies have focused merely on mixed patient groups, COPD
patients or patients after cardiac surgery. Therefore, the best weaning
strategy for stroke patients remains to be determined. Methods: Here, we
designed a prospective randomized controlled study comparing adaptive
support ventilation (ASV), a continuous weaning strategy, with biphasic
positive airway pressure (BIPAP) in combination with spontaneous breathing
trials, a discontinuous technique, in the treatment of stroke patients.
The primary endpoint was the duration of the weaning process. Results:
Only the 40 (out of 54) patients failing in an initial spontaneous
breathing trial (T-piece test) were included into the study; the failure
proportion is considerably larger compared to previous studies. Eligible
patients were pseudo-randomly assigned to one of the two weaning groups.
Both groups did not differ regarding age, gender, and severity of stroke.
The results showed that the median weaning duration was 10.7 days (+/-SD
7.0) in the discontinuous weaning group, and 8 days (+/-SD 4.5) in the
continuous weaning group (p < 0.05). Conclusions: To the best of our
knowledge, this is the first clinical study to show that continuous
weaning is significantly more effective compared to discontinuous weaning
in mechanically ventilated stroke patients. We suppose that the reason for
the superiority of continuous weaning using ASV as well as the bad
performance of our patients in the 2 h T-piece test is caused by the
patients' compliance. Compared to patients on surgical and medical ICUs,
neurological patients more often suffer from reduced vigilance, lack of
adverse-effects reflexes, dysphagia, and cerebral dysfunction. Therefore,
stroke patients may profit from a more gradual withdrawal of weaning.

<19>
Accession Number
2015864562
Authors
Phan K. Wong S. Phan S. Ha H. Qian P. Yan T.D.
Institution
(Phan, Yan) The Collaborative Research (CORE) Group, Macquarie University
Hospital Clinic, Macquarie University, Suite 302, 2 Technology Place,
Sydney, NSW 2109, Australia
(Wong) Gosford Hospital, Gosford, Australia
(Phan, Phan) Sydney Medical School, University of Sydney, Sydney,
Australia
(Phan, Ha) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Phan, Qian) Department of Cardiology, Westmead Hospital, Sydney,
Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Title
Transcatheter Aortic Valve Implantation (TAVI) in Patients With Bicuspid
Aortic Valve Stenosis - Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 24 (7) (pp 649-659), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a feasible
interventional technique for severe aortic stenosis in patients who are
deemed inoperable or at high surgical risk. There is limited evidence for
the safety and efficacy of TAVI in patients with bicuspid aortic valves
(BAV), the most common congenital valve abnormality. In many TAVI trials,
patients with BAV have been contraindicated due to concerns surrounding
abnormal valve geometry, leading to malfunction or malpositioning. A
systematic review and meta-analysis was conducted in order to assess the
current evidence and relative merits of TAVI in aortic stenosis patients
with BAV. Method: From six electronic databases, seven articles including
149 BAV and 2096 non-BAV patients undergoing TAVI were analysed. Results:
Between the BAV and no-BAV cohorts, there was no difference in 30-day
mortality (8.3% vs 9.0%; P=0.68), post-TAVI mean peak gradients (weighted
mean difference, 0.36. mmHg; P=0.55), moderate or severe paravalvular leak
(25.7% vs 19.9%; P=0.29), pacemaker implantations (18.5% vs 27.9%;
P=0.52), life-threatening bleeding (8.2% vs 13.9%; P=0.33), major bleeding
(20% vs 16.8%; P=0.88), conversion to conventional surgery (1.9% vs 1.2%;
P=0.18) and vascular complications (8.6% vs 10.1%; P=0.32). Conclusions:
Preliminary short and mid-term pooled data from observation studies
suggest that TAVI is feasible and safe in older patients with BAV. While
future randomised trials are not likely, larger adequately-powered
multi-institutional studies are warranted to assess the long-term
durability and complications associated with TAVI in older BAV patients
with severe aortic stenosis.

<20>
Accession Number
2015696025
Authors
Wynne D.G. Rampat R. Trivedi U. De Belder A. Hill A. Hutchinson N.
Hildick-Smith D.
Institution
(Wynne, Rampat, Trivedi, De Belder, Hill, Hutchinson, Hildick-Smith)
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern
Road Brighton, East Sussex BN2 5BE, United Kingdom
Title
Transradial secondary arterial access for transcatheter aortic valve
implantation: Experience and limitations.
Source
Heart Lung and Circulation. 24 (7) (pp 682-685), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Objectives: The transradial approach limits vascular complications in
coronary interventions. The same may be true for transcatheter aortic
valve implantation (TAVI). We present our experience using secondary
transradial arterial access. Methods: Secondary transradial arterial
access has been our default strategy for TAVI since 2007. Procedural data
is collected prospectively. We assessed procedural success and
complications. Results: Data from 282 patients aged 81. +/-. 5.2yrs was
examined. Secondary arterial access was transradial (74%), femoral (24%)
and none (2%). Secondary femoral access was reserved for failed radial
access (3%), anatomical anomalies (4%), operator preference (7%), trial
requirements (6%) or proctor preference (4%). The principal pathology was
aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination
(2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were
delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian
(3.9%) or transapical approaches (1.8%). Significant vascular
complications occurred in 25 cases (9.4%), including surgical repair of a
failed percutaneous closure device (n=16), ilio-femoral dissection (n=3),
iliac perforations (n=3), plaque disruption (n=1) and false aneurysm
(n=2), one of which was from the secondary femoral access site. There was
no local vascular complication from the secondary radial site.
Conclusions: The transradial secondary access route for TAVI is safe and
effective. The transradial route may limit vascular access complications
from secondary transfemoral access.

<21>
Accession Number
2015123462
Authors
Safaie N. Montazerghaem H. Jodati A. Maghamipour N.
Institution
(Safaie, Jodati) Cardiovascular Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Montazerghaem) Cardiovascular Research Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Maghamipour) Department of Cardiac Surgery, Behsat Hospital, School of
Medical Science, Tehran, Iran, Islamic Republic of
Title
In-hospital complications of coronary artery bypass graft surgery in
patients older than 70 years.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 60-62), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Cardiovascular diseases contribute to mortality and
morbidity in aged individuals. It is crucial to have a clear perception of
coronary artery bypass graft (CABG) risks and benefits to make logical
decision in aged patients. Unfortunately, cardiovascular disease
researches have focused very little on the aged patients. The aim of the
present study is to evaluate in-hospital complications in patients older
than 70 years old following CABG operation to determine if CABG is
preferred or not considering present complications. Methods: In a cross
sectional study, 500 patients older than 70 years old were randomly
selected (70-75 patients for each year) from March 2004 to March 2011.
Descriptive statistical methods were used for evaluating the obtained
data. Results: Overall, 70.6% of patients (353 individuals) were male and
29.4% were female (147 individuals). Totally, 107 patients (21.4%) had
complications during hospitalization; these complications were
statistically significant in male individuals. Complications included
Stroke 1.6%, deep vein thrombosis 0.8%, MI 2.4%, repeat surgery 2.80%,
bleeding 2.40%, and more than 48 hours mechanical ventilation in 13.4%.
Conclusion: Need for more than 48 hours mechanical ventilation and
bleeding after surgery were the most occurred complications in these
patients.

<22>
Accession Number
2015123460
Authors
Sabzi F. Faraji R.
Institution
(Sabzi) Preventive Cardiovascular Research Center Kermanshah, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Faraji) Yazd Cardiovascular Research Center, Shahid Sadoughi University
of Medical Sciences, Yazd, Iran, Islamic Republic of
Title
Liver function tests following open cardiac surgery.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 49-54), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: The cardiopulmonary bypass may have multiple systemic
effects on the body organs as liver. This prospective study was planned to
explore further the incidence and significance of this change. Methods:
Two hundred patients with coronary artery bypass grafting (CABG), were
randomly selected for the study. Total and indirect bilirubin, aspartate
aminotransferase, alanine aminotransferase, alkaline phosphatase were
measured preoperatively and at 24, 48 and 72 hours, following coronary
artery bypass grafting. Postoperative value of the liver function tests
with respect to hypothermia or hypotension were compared by one way
analysis of variance for repeated measure and compared with t test.
Patient's characteristics with bilirubin value (=1.5 mg or > 1.5 mg) were
compared with t test. Results: A significant increase of total bilirubin,
aspartate aminotransferase, and alkaline phosphatase were noted in the
third postoperative day. Significant relation was seen between hypotension
and alkaline phosphatase, and aspartate aminotransferase change but
hypothermia had not affected alanine aminotransferase, total bilirubin and
indirect bilirubin change. Pump time, alanine aminotransferase in third
postoperative day and direct bilirubin in first and second day of
postoperative period had significant relation with pre and post-operative
bilirubin change. Conclusion: Transient but not permanent alterations of
hepatic enzymes after coronary artery bypass grafting presumably
attributed to the decreased hepatic flow, hypoxia, or pump-induced
inflammation.

<23>
Accession Number
2015123459
Authors
Porhomayon J. Joude P. Adlparvar G. El-Solh A.A. Nader N.D.
Institution
(Porhomayon) VA Western New York Healthcare System, Division of Critical
Care Medicine, Department of Anesthesiology, State University of New York
at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United
States
(Joude, El-Solh) VA Western New York Healthcare System, Division of
Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine,
State University of New York at Buffalo School of Medicine and Biomedical
Sciences, Buffalo, NY, United States
(Adlparvar) Monroe College, State University of New York, Buffalo School
of Medicine and Biomedical Sciences, Rochester, NY, United States
(Nader) VA Western New York Healthcare System, Division of Cardiothoracic
Anesthesia and Pain Medicine, Department of Anesthesiology, State
University of New York at Buffalo School of Medicine and Biomedical
Sciences, Buffalo, NY, United States
Title
The impact of high versus low sedation dosing strategy on cognitive
dysfunction in survivors of intensive care units: A systematic review and
meta-analysis.
Source
Journal of Cardiovascular and Thoracic Research. 7 (2) (pp 43-48), 2015.
Date of Publication: 2015.
Publisher
Tabriz University of Medical Sciences
Abstract
Background: The practice of low vs. high sedation dosing strategy may
impact the cognitive and mental health function in the intensive care unit
(ICU). We aim to demonstrate that high sedation strategy will result in
change of mental health function in ICU patients. Methods: We performed a
systemic search and meta-analysis of medical databases in MEDLINE (from
1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the
Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental
Health, for assessing the impact of sedation on posttraumatic stress
disorder (PTSD) or anxiety/depression and delirium in the mix ICU setting
including cardiac surgery patients. A total of 1216 patients were included
in the final analysis. Results: We included 11 studies in the final
analysis and concluded that high dose sedation strategy resulted in higher
incidence of cognitive dysfunction with P value of 0.009. The result for
subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P =
0.001, Heterogeneity I² was 64%. Overall analysis was
statistically significant with a P value of 0.002. Conclusion: High
sedation dosing strategy will negatively affect cognitive function in
critically ill patients. Large randomized trials are needed to address
cognitive dysfunction in subgroup of patients with delirium.

<24>
Accession Number
2015120021
Authors
Alizadeh Ghavidel A. Totonchi Z. Chitsazan M. Dehaki M.G. Jalili F. Farsad
F. Hejrati M.
Institution
(Alizadeh Ghavidel, Chitsazan, Dehaki) Heart Valve Disease Research
Center, Rajaei Cardiovascular Medical and Research Center, Iran University
of Medical Science, Tehran, Iran, Islamic Republic of
(Totonchi, Jalili, Farsad) Rajaei Cardiovascular Medical and Research
Center, Iran University of Medical Science, Tehran, Iran, Islamic Republic
of
(Hejrati) Rasoul-e-Akram General Hospital, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Safety and efficacy of caproamin fides and tranexamic acid versus placebo
in patients undergoing coronary artery revascularization.
Source
Journal of Cardiovascular and Thoracic Research. 6 (3) (pp 197-202), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Excessive fibrinolysis contributes to post-cardiopulmonary
bypass bleeding. Tranexamic Acid (TXA) and Caproamin Fides are synthetic
lysine analogues that inhibit plasminogen-fibrin binding. The present
study aimed to compare TXA and Caproamin Fides versus placebo in patients
undergoing elective coronary artery revascularization. Methods: We
analyzed perioperative data of 300 adult patients undergoing coronary
artery revascularization. Patients were randomly allocated to receive TXA
(n=100), Caproamin Fides (n=100) or placebo (n=100) during perioperative
time. Mediastinal bleeding during the first 24 hours post-operation,
transfusion requirement and post-surgical complications were assessed.
Results: Most descriptive and intra-operative parameters were well
comparable between the 3 study groups. Except for mean number of packed
red blood cell (PRBC) units transfused during ICU stay (P=0.01), patients
in the Caproamin Fides and TXA groups did not show any statistically
significant differences regarding transfusion of blood products during
peri-operative period. There was no evidence of a significant difference
in mediastinal blood loss during the first 24 hours post-operation between
the patients receiving TXA or placebo, while patients in the Caproamin
Fides group had significantly lower mediastinal bleeding than the other 2
groups (Caproamin Fides vs. placebo, P=0.002, <0.001 and <0.001 at 6, 12
and 24 hours post-operation; Caproamin Fides vs. TXA, P=0.009, 0.003,
<0.001 at 6, 12 and 24 hours post-operation). The incidence of
postoperative complications were comparable between Caproamin Fides and
TXA groups (P>0.05). Conclusion: In conclusion, Caproamin Fides seems to
be superior to TXA regarding the blood saving effects in patients
undergoing coronary artery revascularization.

<25>
Accession Number
2015120013
Authors
Tarbiat M. Manafi B. Davoudi M. Totonchi Z.
Institution
(Tarbiat, Manafi, Davoudi) Ekbatan Cardiovascular Surgery Center,
Department of Anesthesiology, Hamedan University of Medical Sciences,
Hamedan, Iran, Islamic Republic of
(Totonchi) Department of Anesthesiology, Rajaei Heart Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Comparison of the complications between left side and right side
subclavian vein catheter placement in patients undergoing coronary artery
bypass graft surgery.
Source
Journal of Cardiovascular and Thoracic Research. 6 (3) (pp 147-151), 2014.
Date of Publication: 2014.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Percutaneous subclavian vein catheterization is one of the
most common invasive procedures performed in cardiac surgery. The aim of
this study was to compare left and right subclavian vein catheter
placement via the infraclavicular approach in patients who undergo
coronary artery bypass graft (CABG) surgery. Methods: This prospective,
randomized clinical trial was performed in193 patients. The technique
applied for cannulation was infraclavicular approach for both the right
and the left sides. Subclavian vein of other side was attempted only when
catheterization at initial side was unsuccessful at two attempts. The
success and complication rates were compared for the two sides. Results:
On193 patients, catheterization attempts were performed. Overall 177
catheterizations (91.7%) were successful during the first attempt, 105
(92.1%) on the right side and 72 (91.1%) on the left side. There was no
significant difference between success rate and side of catheterization.
Malposition of the catheter tip on the right side (9.6%) was significantly
more than the left side (0%) (P= 0.003). The differences in other
complications on two sides were statistically insignificant. Conclusion:
Compared with the right side, insertion of the cannula on the left side
resulted in fewer catheter tip misplacements. Incidence of cannulation
failure and other complications were similar on both sides.

<26>
Accession Number
2015913265
Authors
Naraghi L. Mejaddam A.Y. Birkhan O.A. Chang Y. Cropano C.M. Mesar T.
Larentzakis A. Peev M. Sideris A.C. Van der Wilden G.M. Imam A.M.
Hwabejire J.O. Velmahos G.C. Fagenholz P.J. Yeh D. de Moya M.A. King D.R.
Institution
(Naraghi, Mejaddam, Birkhan, Chang, Cropano, Mesar, Larentzakis, Peev,
Sideris, Van der Wilden, Imam, Hwabejire, Velmahos, Fagenholz, Yeh, de
Moya, King) Division of Trauma, Emergency Surgery and Surgical Critical
Care, Massachusetts General Hospital and Harvard Medical School, Boston,
MA, United States
Title
Sample entropy predicts lifesaving interventions in trauma patients with
normal vital signs.
Source
Journal of Critical Care. 30 (4) (pp 705-710), 2015. Date of Publication:
01 Aug 2015.
Publisher
W.B. Saunders
Abstract
Introduction: Heart rate complexity, commonly described as a "new vital
sign," has shown promise in predicting injury severity, but its use in
clinical practice is not yet widely adopted. We previously demonstrated
the ability of this noninvasive technology to predict lifesaving
interventions (LSIs) in trauma patients. This study was conducted to
prospectively evaluate the utility of real-time, automated, noninvasive,
instantaneous sample entropy (SampEn) analysis to predict the need for an
LSI in a trauma alert population presenting with normal vital signs.
Methods: Prospective enrollment of patients who met criteria for trauma
team activation and presented with normal vital signs was conducted at a
level I trauma center. High-fidelity electrocardiogram recording was used
to calculate SampEn and SD of the normal-to-normal R-R interval (SDNN)
continuously in real time for 2 hours with a portable, handheld device.
Patients who received an LSI were compared to patients without any
intervention (non-LSI). Multivariable analysis was performed to control
for differences between the groups. Treating clinicians were blinded to
results. Results: Of 129 patients enrolled, 38 (29%) received 136 LSIs
within 24 hours of hospital arrival. Initial systolic blood pressure was
similar in both groups. Lifesaving intervention patients had a lower
Glasgow Coma Scale. The mean SampEn on presentation was 0.7 (0.4-1.2) in
the LSI group compared to 1.5 (1.1-2.0) in the non-LSI group (. P <
.0001). The area under the curve with initial SampEn alone was 0.73 (95%
confidence interval [CI], 0.64-0.81) and increased to 0.93 (95% CI,
0.89-0.98) after adding sedation to the model. Sample entropy of less than
0.8 yields sensitivity, specificity, negative predictive value, and
positive predictive value of 58%, 86%, 82%, and 65%, respectively, with an
overall accuracy of 76% for predicting an LSI. SD of the normal-to-normal
R-R interval had no predictive value. Conclusions: In trauma patients with
normal presenting vital signs, decreased SampEn is an independent
predictor of the need for LSI. Real-time SampEn analysis may be a useful
adjunct to standard vital signs monitoring. Adoption of real-time,
instantaneous SampEn monitoring for trauma patients, especially in
resource-constrained environments, should be considered.

<27>
Accession Number
2015758653
Authors
Habets J. Tanis W. Reitsma J.B. van den Brink R.B.A. Mali W.P.T.M.
Chamuleau S.A.J. Budde R.P.J.
Institution
(Habets, Mali) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht 3508 GA, Netherlands
(Tanis) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(Reitsma) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(van den Brink) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Chamuleau) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Are novel non-invasive imaging techniques needed in patients with
suspected prosthetic heart valve endocarditis? A systematic review and
meta-analysis.
Source
European Radiology. 25 (7) (pp 2125-2133), 2015. Date of Publication: 14
Feb 2015.
Publisher
Springer Verlag
Abstract
Objectives: Multimodal non-invasive imaging plays a key role in
establishing a diagnosis of PHV endocarditis. The objective of this study
was to provide a systematic review of the literature and meta-analysis of
the diagnostic accuracy of TTE, TEE, and MDCT in patients with (suspected)
PHV endocarditis. Methods: Studies published between 1985 and 2013 were
identified via search and cross-reference of PubMed/Embase databases.
Studies were included if (1) they reported on the non-invasive index tests
TTE, TEE, or MDCT; (2) data was provided on PHV endocarditis as the
condition of interest; and (3) imaging results were verified against
either surgical inspection/autopsy or clinical follow-up reference
standards, thereby enabling the extraction of 2-by-2 tables. Results:
Twenty articles (including 496 patients) met the inclusion criteria for
PHV endocarditis. TTE, TEE, and MDCT + TEE had a pooled
sensitivity/specificity for vegetations of 29/100 %; 82/95 %, and 88/94 %,
respectively. The pooled sensitivity/specificity of TTE, TEE, and MDCT +
TEE for periannular complications was 36/93 %, 86/98 %, and 100/94 %,
respectively. Conclusions: TEE showed good sensitivity and specificity for
establishing a diagnosis of PHV endocarditis. Although MDCT data are
limited, this review showed that MDCT in addition to TEE may improve
sensitivity in detecting life-threatening periannular complications. Key
Points: * Multimodal imaging is an important ingredient of diagnostic
workup for PHV endocarditis. * Transthoracic and transesophageal
echography may miss life-threatening periannular complications. * MDCT can
improve sensitivity for the detection of life-threatening periannular
complications.

<28>
Accession Number
2015118917
Authors
Bagan P. De Dominicis F. Hernigou J. Dakhil B. Zaimi R. Pricopi C. Le
Pimpec Barthes F. Berna P.
Institution
(Bagan, Hernigou, Dakhil, Zaimi) Department of Thoracic and Vascular
Surgery, Victor Dupouy Hospital, rue du lieut, Prudhon, Argenteuil 95100,
France
(Bagan, De Dominicis, Berna) Department of Thoracic Surgery, Amiens
Picardie University Hospital, Amiens, France
(Bagan, Pricopi, Le Pimpec Barthes) Department of Thoracic Surgery and
Lung Transplantation, Pompidou European Hospital, Paris V University,
Paris, France
Title
Complete thoracoscopic lobectomy for cancer: Comparative study of
three-dimensional high-definition with two-dimensional high-definition
video systems.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 820-824),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Common video systems for video-assisted thoracic surgery (VATS)
provide the surgeon a two-dimensional (2D) image. This study aimed to
evaluate performances of a new three-dimensional high definition (3D-HD)
system in comparison with a two-dimensional high definition (2D-HD) system
when conducting a complete thoracoscopic lobectomy (CTL). METHODS This
multi-institutional comparative study trialled two video systems: 2D-HD
and 3D-HD video systems used to conduct the same type of CTL. The
inclusion criteria were T1N0M0 non-small-cell lung carcinoma (NSCLC) in
the left lower lobe and suitable for thoracoscopic resection. The CTL was
performed by the same surgeon using either a 3D-HD or 2D-HD system.
Eighteen patients with NSCLC were included in the study between January
and December 2013: 14 males, 4 females, with a median age of 65.6 years
(range: 49-81). The patients were randomized before inclusion into two
groups: to undergo surgery with the use of a 2D-HD or 3D-HD system. We
compared operating time, the drainage duration, hospital stay and the N
upstaging rate from the definitive histology. RESULTS The use of the 3D-HD
system significantly reduced the surgical time (by 17%). However,
chest-tube drainage, hospital stay, the number of lymph-node stations and
upstaging were similar in both groups. CONCLUSIONS The main finding was
that 3D-HD system significantly reduced the surgical time needed to
complete the lobectomy. Thus, future integration of 3D-HD systems should
improve thoracoscopic surgery, and enable more complex resections to be
performed. It will also help advance the field of endoscopically assisted
surgery.

<29>
Accession Number
2015118915
Authors
Ali-Hassan-Sayegh S. Mirhosseini S.J. Haddad F. Karimi-Bondarabadi A.A.
Shahidzadeh A. Weymann A. Popov A.-F. Sabashnikov A.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Haddad, Karimi-Bondarabadi, Shahidzadeh)
Cardiovascular Research Center, Shahid Sadoughi University of Medical
Sciences, Arsalan Street, Yazd 8916936637, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Shahid Sadoughi
University of Medical Sciences, , Yazd, Iran, Islamic Republic of
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Protective effects of corticosteroids in coronary artery bypass graft
surgery alone or combined with valvular surgery: An updated and
comprehensive meta-analysis and systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 825-836),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press
Abstract
This systematic review with meta-analysis sought to determine the
protective effects of corticosteroids on clinical outcomes following
coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and
Sciences online database as well as Google scholar literature were used
for selecting appropriate studies with randomized controlled design. The
effect sizes measured were odds ratio (OR) for categorical variables and
weighted mean difference with 95% confidence interval (CI) for calculating
differences between mean values of duration of hospitalization in
intervention and control groups. Values of P < 0.1 for Q-test or
I² > 50% indicated significant heterogeneity between the
studies. The literature search of all major databases retrieved 3735
studies. After screening, a total of 45 trials were identified that
reported outcomes. Pooled analysis was performed on incidence of atrial
fibrillation (OR of 0.71; 95% CI: 0.59-0.86; P = 0.000), stroke (OR of
1.61; 95% CI: 0.63-4.1; P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5;
P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63; P = 0.6), length
of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI:
0.10-0.41; P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66
to -0.3; P = 0.000), amount of blood loss (WMD of -124.05; 95% CI: -147.72
to -100.38; P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35; P =
0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64; P = 0.6). Overall,
steroid prophylaxis in patients undergoing CABG could significantly reduce
complications such as atrial fibrillation and length of hospital stay, but
slightly increased the length of ventilation time. On the other hand, no
significant impact on the incidence of infection was observed compared
with the placebo.

<30>
Accession Number
2015123559
Authors
Ferguson Z.G. Yarborough D.E. Jarvis B.L. Sistino J.J.
Institution
(Ferguson, Yarborough, Jarvis, Sistino) Medical University of South
Carolina, Charleston, United States
Title
Evidence-based medicine and myocardial protection - where is the
evidence?.
Source
Perfusion (United Kingdom). 30 (5) (pp 415-422), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective: Myocardial protection with cardioplegia is an integral
component of most cardiac surgical procedures, providing protection of the
heart by limiting metabolic activity and increasing the myocardium's
capacity to withstand ischemia for prolonged periods of time. Cardioplegia
has greatly affected the landscape of cardiothoracic surgery since its
introduction in the 1960s, but, to this day, there continues to be a
debate over what the ideal cardioplegic solution should be. The goal of
this analysis is to describe current practices in cardioplegia and to
point out the lack of quality human research and subsequent publications
that prevent best practices from being utilized. Methods: This study is a
systematic review of journal publications pertaining to the composition of
commonly used cardioplegic solutions. Four main types of cardioplegia were
assessed to give a narrower field of examination; specifically,
microplegia, del Nido, Custodiol HTK, and 4:1 blood cardioplegia. Other
combinations of cardioplegia, including St. Thomas's Solution and the
University of Wisconsin (UW) Solution, were considered when applicable
according to the context of the publication being reviewed. Factors being
assessed consisted of scientific validity, nature of the test subject
(isolated organ vs. animal vs. human studies), experimental setup
(retrospective trials vs. randomized clinical trials) and patient
outcomes. Results: There are very few randomized clinical trials with
human subjects comparing commonly used cardioplegic solutions. Numerous
retrospective studies exist, but often show similar intraoperative and
postoperative outcomes between the solutions. Some solutions, del Nido
cardioplegia in particular, were found to have few or no significant human
trials to back the rigor required in such a highly specialized field as
cardiovascular surgery. A wide variation in the types of surgeries and
primary outcomes were included in the publications, so it is difficult to
perform an accurate systematic review of the topic. Conclusion: Uniform
variables among different studies would be preferable for analysis of this
topic; thus, it is the researchers' recommendation that the collection of
multicenter data be undertaken in order to more fully answer this research
question. Comparative effectiveness studies to associate commonly used
solutions are needed. Without this research, surgeon preference remains
the primary determining factor for deciding which cardioplegic solution to
use. Cardioplegia selection should rely more on higher scientific
research, using evidenced-based medicine and ranking of clinical studies.

<31>
Accession Number
2015123554
Authors
Chalegre S.T. Sa M.P.B.O. Goncalves De Rueda F. Salerno P.R. Vasconcelos
F.P. Lima R.C.
Institution
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) Division of
Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) University
of Pernambuco - UPE, Recife, Brazil
(Chalegre, Sa, Lima) Nucleus of Postgraduate and Research in Health
Sciences, Faculty of Medical Sciences FCM, Biological Sciences Institute
ICB, Recife, Brazil
(Chalegre) Universidade de Pernambuco, Faculdade de Ciencias Medicas,
Campus Universitario, Rua Arnobio Marques 310 Sto. Amaro, Recife, PE CEP
50.100-130, Brazil
Title
Central versus peripheral arterial cannulation and neurological outcomes
after thoracic aortic surgery: meta-analysis and meta-regression of 4459
patients.
Source
Perfusion (United Kingdom). 30 (5) (pp 383-388), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Thoracic aortic surgeries remain with high mortality rates,
often associated with postoperative neurological complications. The choice
of the right cannulation site is extremely important for suitable blood
supply and maintenance of vital functions, especially of the central
nervous system. Objectives: To compare the influence of central versus
peripheral arterial cannulation on neurological outcomes in patients
undergoing thoracic aortic surgery through systematic review and
meta-analysis. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS and
reference lists of relevant articles were searched for clinical studies
that reported in-hospital neurological outcomes after central or
peripheral arterial cannulation during thoracic aortic surgery procedures
until December 2013. The principal summary measures were Odds Ratio (OR)
for central compared to peripheral arterial cannulation with 95%
confidence interval (CI) and p-values considered statistically significant
when <0.05. The ORs were combined across studies, using the
DerSimonian-Laird random effects model and fixed effects model using the
Mantel-Haenszel model - both models were weighted. The meta-analysis was
completed using the software Comprehensive Meta-Analysis version 2
(Biostat Inc., Englewood, NJ). Results: Six studies were identified and
included a total of 4459 patients (1180 for central and 3279 for
peripheral cannulation). There was no significant difference between the
central and peripheral groups regarding neurological outcomes. The
meta-regression evidenced no relationship between neurological outcomes
and the variables age, sex, previous coronary event, previous neurological
event, urgency surgery, cardiopulmonary bypass time, activated clotting
time and esophageal temperature with p>0,05. Conclusion: When it comes to
neurological outcomes in patients undergoing thoracic aortic surgery,
there was no evidence that argues in favor of any choice of arterial
cannulation site, which makes us reject any superiority of one approach
over the other in this regard.

<32>
Accession Number
2015123553
Authors
Gong B. Ji B. Sun Y. Wang G. Liu J. Zheng Z.
Institution
(Gong, Ji, Sun, Wang, Liu, Zheng) State Key Laboratory of Cardiovascular
Medicine, Fuwai Hospital, Chinese Academy of Medical Science, Beijing,
China
(Gong, Zheng) Department of Cardiovascular Surgery, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji, Sun, Liu) Department of Cardiopulmonary Bypass, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Wang) Department of Anesthesia, Chinese Academy of Medical Science,
Peking Union Medical College, Beijing, China
Title
Is microplegia really superior to standard blood cardioplegia? The results
from a meta-analysis.
Source
Perfusion (United Kingdom). 30 (5) (pp 375-382), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd
Abstract
Background: Microplegia (whole blood cardioplegia with reduced volume)
retains all the advantages of blood cardioplegia (such as superior
oxygen-carrying capacity, better osmotic properties and antioxidant
capability, etc.) without the potential disadvantages of hemodilution
(such as myocardial edema). We sought to perform a systematic review and
meta-analysis to compare microplegia and standard blood cardioplegia on
the cardioprotective effects for patients undergoing coronary artery
bypass grafting (CABG). Methods: MEDLINE, EMBASE and the Cochrane Central
Register of Controlled Trials were searched for relevant controlled trials
published in English, from their inception up to May 15th, 2013. Data on
low output syndrome, spontaneous return to sinus rhythm, volume of
cardioplegia and perioperative myocardial infarction were analyzed.
Results: Five studies, totaling 296 patients, were included out of 77
retrieved citations. The microplegia group used less volume of
cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when
compared with the standard blood cardioplegia group. There were no
statistical differences in the incidence of low output syndrome (RR, 0.95,
95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI:
0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI:
0.19 to 2.08). Conclusions: Microplegia was associated with less volume of
cardioplegia, whereas the incidence of spontaneous return to sinus rhythm
and perioperative myocardial infarction were similar, but large controlled
randomized trials are still needed to confirm this.

<33>
Accession Number
2015119559
Authors
Goel S. Sharma A.D. Goyal R. Srivastava M.
Institution
(Goel, Sharma, Goyal, Srivastava) Department of Anaesthesia, Sarswathi
institute of Medical Sciences Hapur, Ghaziabad, Uttar Pradesh, India
Title
A randomized double blind comparative study of intravenous diltiazem and
lignocaine in attenuating haemodynamic stress during laryngoscopy and
endotracheal intubation in western Uttar Pradesh.
Source
Indian Journal of Public Health Research and Development. 5 (4) (pp
309-312), 2014. Date of Publication: 2014.
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India. E-mail: editor.ijphrd@gmail.com )
Abstract
The procedure of laryngoscopy and endotracheal intubation frequently
induces a cardiovascular stress response characterized by hypertension,
tachycardia, arrhythmias and increased serum concentration of
catecholamines. Our study was undertaken to evaluate and compare the
influence of lignocaine and diltiazem on the cardiovascular responses to
laryngoscopy and intubation. A total of sixty patients of ASA grade I or
II patients, between 18-60 years of age, of either sex, scheduled for
non-cardiac surgery, were selected for the study. Baseline parameters i.e.
heart rate, systolic blood pressure, diastolic blood pressure and mean
arterial pressure were recorded and same parameters were recorded at one
minute interval till the completion of study period. The percentage change
(increase or decrease) was calculated and was analyzed statistically.
There was minimal change in heart rate, systolic blood pressure, diastolic
blood pressure and mean arterial pressure after intubation in patients who
were given diltiazem as compared to lignocaine and was more stable drug.
We concluded that Diltiazem 0.3 mg/kg is able to attenuate the
haemodynamic response better as compared to lignocaine.

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Total documents retrieved: 28

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<1>
Accession Number
2015104790
Authors
Zarbock A. Schmidt C. Van Aken H. Wempe C. Martens S. Zahn P.K. Wolf B.
Goebel U. Schwer C.I. Rosenberger P. Haeberle H. Gorlich D. Kellum J.A.
Meersch M.
Institution
(Zarbock, Schmidt, Van Aken, Wempe, Meersch) Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Martens) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Zahn, Wolf) Department of Anaesthesiology, Intensive Care Medicine,
Palliative and Pain Medicine, University Hospital Bochum, Bochum, Germany
(Goebel, Schwer) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Freiburg, Freiburg, Germany
(Rosenberger, Haeberle) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Tubingen, Tubingen, Germany
(Gorlich) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Zarbock) Department of Anesthesiology, Critical Care Medicine and Pain
Therapy, University Hospital Munster, Albert-Schweitzer-Campus 1, Gebaude
A1, Munster 48149, Germany
Title
Effect of remote ischemic preconditioning on kidney injury among high-risk
patients undergoing cardiac surgery: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 313 (21) (pp
2133-2141), 2015. Date of Publication: 02 Jun 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE: No interventions have yet been identified to reduce the risk
of acute kidney injury in the setting of cardiac surgery. OBJECTIVE: To
determine whether remote ischemic preconditioning reduces the rate and
severity of acute kidney injury in patients undergoing cardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: In this multicenter trial, we enrolled
240 patients at high risk for acute kidney injury, as identified by a
Cleveland Clinic Foundation score of 6 or higher, between August 2013 and
June 2014 at 4 hospitals in Germany. We randomized them to receive remote
ischemic preconditioning or sham remote ischemic preconditioning
(control). All patients completed follow-up 30 days after surgery and were
analyzed according to the intention-to-treat principle. INTERVENTIONS:
Patients received either remote ischemic preconditioning (3 cycles of
5-minute ischemia and 5-minute reperfusion in one upper arm after
induction of anesthesia) or sham remote ischemic preconditioning
(control), both via blood pressure cuff inflation. MAIN OUTCOMES AND
MEASURES: The primary end point was the rate of acute kidney injury
defined by Kidney Disease: Improving Global Outcomes criteria within the
first 72 hours after cardiac surgery. Secondary end points included use of
renal replacement therapy, duration of intensive care unit stay,
occurrence of myocardial infarction and stroke, in-hospital and 30-day
mortality, and change in acute kidney injury biomarkers. RESULTS: Acute
kidney injury was significantly reduced with remote ischemic
preconditioning (45 of 120 patients [37.5%]) compared with control (63 of
120 patients [52.5%]; absolute risk reduction, 15%; 95% CI, 2.56%-27.44%;
P = .02). Fewer patients receiving remote ischemic preconditioning
received renal replacement therapy (7 [5.8%] vs 19 [15.8%]; absolute risk
reduction, 10%; 95% CI, 2.25%-17.75%; P = .01), and remote ischemic
preconditioning reduced intensive care unit stay (3 days [interquartile
range, 2-5]) vs 4 days (interquartile range, 2-7) (P = .04). There was no
significant effect of remote ischemic preconditioning on myocardial
infarction, stroke, or mortality. Remote ischemic preconditioning
significantly attenuated the release of urinary insulinlike growth
factor-binding protein 7 and tissue inhibitor of metalloproteinases 2
after surgery (remote ischemic preconditioning, 0.36 vs control, 0.97
ng/mL²/1000; difference, 0.61; 95% CI, 0.27-0.86; P < .001). No
adverse events were reported with remote ischemic preconditioning.
CONCLUSIONS AND RELEVANCE: Among high-risk patients undergoing cardiac
surgery, remote ischemic preconditioning compared with no ischemic
preconditioning significantly reduced the rate of acute kidney injury and
use of renal replacement therapy. The observed reduction in the rate of
acute kidney injury and the need for renal replacement warrants further
investigation. TRIAL REGISTRATION: German Clinical Trials Register
Identifier: DRKS00005333.

<2>
Accession Number
2015104397
Authors
Taggart D.P. Altman D.G. Gray A.M. Lees B. Nugara F. Yu L.-M. Flather M.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Altman, Yu) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Altman, Yu) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Botnar Research Centre, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Headington, Oxford, United Kingdom
(Lees, Nugara, Flather) Clinical Trials and Evaluation Unit, Royal
Brompton and Harefield NHS Trust, London, United Kingdom
(Lees, Flather) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
Title
Effects of on-pump and off-pump surgery in the arterial revascularization
trial.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 1059-1065), 2014.
Article Number: ezu349. Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The Arterial Revascularization Trial (ART) is a randomized
comparison of bilateral internal mammary artery (BIMA) versus single
internal mammary artery (SIMA) grafting in coronary artery bypass graft
(CABG) surgery and is one of the largest randomized trials of surgery ever
conducted. ART is also one of the largest studies of contemporary CABG
with a high proportion of off-pump surgeries (41%). The objective of this
post hoc analysis was to evaluate the surgical process and 1-year outcomes
for surgery performed on-pump compared with off-pump. METHODS: ART
randomized 3102 patients with multivessel coronary artery disease (CAD) to
SIMA or BIMA grafts to determine if BIMA grafts have an additional
survival advantage at 10 years. The 1-year interim analysis showed an
overall very low mortality and major morbidity rate irrespective of
whether the procedure was with an SIMA or BIMA. The surgical process and
1-year outcomes were analysed according to whether surgery was performed
on-pump or off-pump. RESULTS: Baseline variables were not statistically
significantly different between on- and off-pump surgery within each
treatment group after taking account of the effects of clustering by
individual surgeons. At both 30 days and 1 year, there was a low incidence
of death (1.2%, 2.3%), stroke (1.1%, 1.7%), myocardial infarction (MI)
(1.4%, 1.9%), repeat revascularization (0.5%, 1.5%) and wound
reconstruction (1.2%). A similar average number of grafts were performed
with on- and off-pump surgery (median = 3), but the duration of surgery
was 20-30 min and ventilation time ~2 h shorter with off-pump surgery.
Blood loss and platelet transfusions were lower in the off-pump group,
with no difference in the need for balloon pump or renal support. Sternal
wound reconstruction was similar with off-pump surgery in the SIMA group
(0.5 vs 0.6%) and lower with off-pump surgery in the BIMA group (1.4 vs
2.2%). Repeat revascularization was marginally higher in off-pump patients
at 30 days (0.8 vs 0.3%) and at 1 year (1.7 vs 1.3%). CONCLUSIONS: The
outcomes of contemporary CABG are excellent with low mortality, stroke,
myocardial infarction and need for wound reconstruction and repeat
revascularization whether performed on-pump or off-pump. CLINICAL TRIAL
REGISTRATION: Controlled-trials.com (ISRCTN46552265).

<3>
Accession Number
2015104381
Authors
Cheng X. Tong J. Hu Q. Chen S. Yin Y. Liu Z.
Institution
(Cheng, Tong, Chen, Yin, Liu) Department of Cardiology, The Second
Affiliated Hospital, The Second Clinical Institute, Chongqing Medical
University, Chongqing, China
(Tong) Department of Respirology, The Second Affiliated Hospital, The
Second Clinical Institute, Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, The Third People's Hospital of
Chongqing, Chongqing, China
(Chen) Shanghai First People's Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
Title
Meta-analysis of the effects of preoperative renin-angiotensin system
inhibitor therapy on major adverse cardiac events in patients undergoing
cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 958-966), 2014.
Article Number: ezu330. Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The purpose of this meta-analysis was to assess the role of preoperative
renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac
events (MACE) in patients undergoing cardiac surgery. The Medline,
Cochrane Library and Embase databases were searched for clinical studies
published up to May 2014. Studies that evaluated the effects of
preoperative RASI therapy in cardiac surgery were included. Odds ratio
(OR) estimates were generated under a random-effects model. After a
literature search in the major databases, 18 studies were identified
[three randomized prospective clinical trials (RCTs) and 15 observational
trials] that reported outcomes of 54 528 cardiac surgery patients with (n
= 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy.
Pool analysis indicated that preoperative RASI therapy was not associated
with a significant reduction of early all-cause mortality [OR: 1.01; 95%
confidence interval (CI) 0.88-1.15, P = 0.93; I² = 25%],
myocardial infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I²
= 16%), or stroke (OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I² =
38%). Meta-regression analysis confirmed that there was a strong negative
correlation between the percentage of diabetics and early all-cause
mortality (P = 0.03). Furthermore, preoperative RASI therapy significantly
reduced mortality in studies containing a high proportion of diabetic
patients (OR: 0.84; 95% CI 0.71-0.99, P = 0.04; I² = 0%). In
conclusion, our meta-analysis indicated that although preoperative RASI
therapy was not associated with a lower risk of MACE in cardiac surgery
patients, it might provide benefits for diabetic patients.

<4>
Accession Number
2015065499
Authors
Ahn J.-M. Roh J.-H. Kim Y.-H. Park D.-W. Yun S.-C. Lee P.H. Chang M. Park
H.W. Lee S.-W. Lee C.W. Park S.-W. Choo S.J. Chung C. Lee J. Lim D.-S. Rha
S.-W. Lee S.-G. Gwon H.-C. Kim H.-S. Chae I.-H. Jang Y. Jeong M.-H. Tahk
S.-J. Seung K.B. Park S.-J.
Institution
(Ahn, Roh, Kim, Park, Lee, Chang, Park, Lee, Lee, Park, Choo, Chung, Lee,
Park) Heart Institute, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, South Korea
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Seoul, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Rha) Korea University Kuro Hospital, Seoul, South Korea
(Lee) Ulsan University Hospital, Ulsan, South Korea
(Gwon) Samsung Medical Center, Seoul, South Korea
(Kim) Seoul National University Hospital, Seoul, South Korea
(Chae) Seoul National University Hospital, Bundang, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Tahk) Ajou University Medical Center, Suwon, South Korea
(Seung) Catholic University of Korea, St. Mary's Hospital, Seoul, South
Korea
Title
Randomized trial of stents versus bypass surgery for left main coronary
artery disease: 5-year outcomes of the PRECOMBAT study.
Source
Journal of the American College of Cardiology. 65 (20) (pp 2198-2206),
2015. Date of Publication: 26 May 2015.
Publisher
Elsevier USA
Abstract
Background In a previous randomized trial, we found that percutaneous
coronary intervention (PCI) was not inferior to coronary artery bypass
grafting (CABG) for the treatment of unprotected left main coronary artery
stenosis at 1 year. Objectives This study sought to determine the 5-year
outcomes of PCI compared with CABG for the treatment of unprotected left
main coronary artery stenosis. Methods We randomly assigned 600 patients
with unprotected left main coronary artery stenosis to undergo PCI with a
sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint
was a major adverse cardiac or cerebrovascular event (MACCE: a composite
of death from any cause, myocardial infarction, stroke, or ischemia-driven
target vessel revascularization) and compared on an intention-to-treat
basis. Results At 5 years, MACCE occurred in 52 patients in the PCI group
and 42 patients in the CABG group (cumulative event rates of 17.5% and
14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval
[CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly
in terms of death from any cause, myocardial infarction, or stroke as well
as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p =
0.66). Ischemia-driven target vessel revascularization occurred more
frequently in the PCI group than in the CABG group (11.4% and 5.5%,
respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012). Conclusions
During 5 years of follow-up, our study did not show significant difference
regarding the rate of MACCE between patients who underwent PCI with a
sirolimus-eluting stent and those who underwent CABG. However, considering
the limited power of our study, our results should be interpreted with
caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent
in Patients With Left Main Coronary Artery Disease [PRECOMBAT];
NCT00422968)

<5>
Accession Number
2015065490
Authors
Thyregod H.G.H. Steinbruchel D.A. Ihlemann N. Nissen H. Kjeldsen B.J.
Petursson P. Chang Y. Franzen O.W. Engstrom T. Clemmensen P. Hansen P.B.
Andersen L.W. Olsen P.S. Sondergaard L.
Institution
(Thyregod, Steinbruchel, Olsen) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen
DK-2100, Denmark
(Ihlemann, Franzen, Engstrom, Clemmensen, Sondergaard) Department of
Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Petursson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chang) Department of Statistics, Medtronic Inc., Mounds View, MN, United
States
(Hansen, Andersen) Department of Cardiac Anesthesia, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Transcatheter versus surgical aortic valve replacement in patients with
severe aortic valve stenosis: 1-year results from the all-comers NOTION
randomized clinical trial.
Source
Journal of the American College of Cardiology. 65 (20) (pp 2184-2194),
2015. Date of Publication: 26 May 2015.
Publisher
Elsevier USA
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an option in
certain high-risk surgical patients with severe aortic valve stenosis. It
is unknown whether TAVR can be safely introduced to lower-risk patients.
Objectives The NOTION (Nordic Aortic Valve Intervention Trial) randomized
clinical trial compared TAVR with surgical aortic valve replacement (SAVR)
in an all-comers patient cohort. Methods Patients >70 years old with
severe aortic valve stenosis and no significant coronary artery disease
were randomized 1:1 to TAVR using a self-expanding bioprosthesis versus
SAVR. The primary outcome was the composite rate of death from any cause,
stroke, or myocardial infarction (MI) at 1 year. Results A total of 280
patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and
81.8% were considered low-risk patients. In the intention-to-treat
population, no significant difference in the primary endpoint was found
(13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in
the as-treated population. No difference in the rate of cardiovascular
death or prosthesis reintervention was found. Compared with SAVR-treated
patients, TAVR-treated patients had more conduction abnormalities
requiring pacemaker implantation, larger improvement in effective orifice
area, more total aortic valve regurgitation, and higher New York Heart
Association functional class at 1 year. SAVR-treated patients had more
major or life-threatening bleeding, cardiogenic shock, acute kidney injury
(stage II or III), and new-onset or worsening atrial fibrillation at 30
days than did TAVR-treated patients. Conclusions In the NOTION trial, no
significant difference between TAVR and SAVR was found for the composite
rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic
Valve Intervention Trial [NOTION]; NCT01057173)

<6>
Accession Number
2015065479
Authors
Yeh R.W. Kereiakes D.J. Steg P.G. Windecker S. Rinaldi M.J. Gershlick A.H.
Cutlip D.E. Cohen D.J. Tanguay J.-F. Jacobs A. Wiviott S.D. Massaro J.M.
Iancu A.C. Mauri L.
Institution
(Yeh) Massachusetts General Hospital, Boston, MA, United States
(Yeh, Cutlip, Massaro, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Yeh, Cutlip, Wiviott, Mauri) Harvard Medical School, Boston, MA, United
States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Steg) Universite Paris-Diderot, Paris, France, INSERM U-1148, Paris,
France
(Steg) Hopital Bichat, Departement Hospitalo-Universitaire FIRE,
Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Windecker) Bern University Hospital, Bern, Switzerland
(Rinaldi) Sanger Heart and Vascular Institute, Carolinas HealthCare
System, Charlotte, NC, United States
(Gershlick) Department of Cardiovascular Sciences, University of
Leicester, University Hospitals of Leicester, Leicester, United Kingdom
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Cohen) Saint Luke's Mid-America Heart Institute, University of
Missouri-Kansas City School of Medicine, Kansas City, MO, United States
(Tanguay) Montreal Heart Institute, Universite de Montreal, Montreal,
Canada
(Jacobs) Boston Medical Center, Boston University School of Medicine,
Boston, MA, United States
(Wiviott, Mauri) Brigham and Women's Hospital, Boston, MA, United States
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Iancu) Heart Institute, University of Medicine Iuliu Hatieganu, Cluj
Napoca, Romania
Title
Benefits and risks of extended duration dual antiplatelet therapy after
PCI in patients with and without acute myocardial infarction.
Source
Journal of the American College of Cardiology. 65 (20) (pp 2211-2221),
2015. Date of Publication: 26 May 2015.
Publisher
Elsevier USA
Abstract
Background The benefits and risks of prolonged dual antiplatelet therapy
may be different for patients with acute myocardial infarction (MI)
compared with more stable presentations. Objectives This study sought to
assess the benefits and risks of 30 versus 12 months of dual antiplatelet
therapy among patients undergoing coronary stent implantation with and
without MI. Methods The Dual Antiplatelet Therapy Study, a randomized
double-blind, placebo-controlled trial, compared 30 versus 12 months of
dual antiplatelet therapy after coronary stenting. The effect of continued
thienopyridine on ischemic and bleeding events among patients initially
presenting with versus without MI was assessed. The coprimary endpoints
were definite or probable stent thrombosis and major adverse
cardiovascular and cerebrovascular events (MACCE). The primary safety
endpoint was GUSTO (Global Utilization of Streptokinase and Tissue
Plasminogen Activator for Occluded Arteries) moderate or severe bleeding.
Results Of 11,648 randomized patients (9,961 treated with drug-eluting
stents, 1,687 with bare-metal stents), 30.7% presented with MI. Between 12
and 30 months, continued thienopyridine reduced stent thrombosis compared
with placebo in patients with and without MI at presentation (MI group,
0.5% vs. 1.9%, p < 0.001; no MI group, 0.4% vs. 1.1%, p < 0.001;
interaction p = 0.69). The reduction in MACCE for continued thienopyridine
was greater for patients with MI (3.9% vs. 6.8%; p < 0.001) compared with
those with no MI (4.4% vs. 5.3%; p = 0.08; interaction p = 0.03). In both
groups, continued thienopyridine reduced MI (2.2% vs. 5.2%, p < 0.001 for
MI; 2.1% vs. 3.5%, p < 0.001 for no MI; interaction p = 0.15) but
increased bleeding (1.9% vs. 0.8%, p = 0.005 for MI; 2.6% vs. 1.7%, p =
0.007 for no MI; interaction p = 0.21). Conclusions Compared with 12
months of therapy, 30 months of dual antiplatelet therapy reduced the risk
of stent thrombosis and MI in patients with and without MI, and increased
bleeding. (The Dual Antiplatelet Therapy Study [The DAPT Study];
NCT00977938)

<7>
Accession Number
2015098250
Authors
Kereiakes D.J. Yeh R.W. Massaro J.M. Driscoll-Shempp P. Cutlip D.E. Steg
P.G. Gershlick A.H. Darius H. Meredith I.T. Ormiston J. Tanguay J.F.
Windecker S. Garratt K.N. Kandzari D.E. Lee D.P. Simon D.I. Iancu A.C.
Trebacz J. Mauri L.
Institution
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kereiakes) Lindner Research Center, Cincinnati, OH, United States
(Yeh, Massaro, Driscoll-Shempp, Cutlip, Mauri) Harvard Clinical Research
Institute, Boston, MA, United States
(Yeh) Massachusetts General Hospital, Boston, United States
(Massaro) Boston University, Boston, MA, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Steg) Universite Paris-Diderot, Paris, France
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat, Paris,
France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Gershlick) University Hospitals of Leicester, Leicester, United Kingdom
(Darius) Vivantes Neukoelln Medical Center, Berlin, Germany
(Meredith) Monash Heart, VIC, Australia
(Ormiston) Mercy Hospital, Auckland, New Zealand
(Tanguay) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Windecker) Bern University Hospital, Bern, Switzerland
(Garratt) Lenox Hill Hospital, New York, NY, United States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Lee) Stanford University, Stanford, CA, United States
(Simon) University Hospitals Case Medical Center, Cleveland, OH, United
States
(Iancu) Heart Institute, Cluj-Napoca, Romania
(Trebacz) Jan Pawel II Hospital Krakow, Krakow, Poland
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
Title
Antiplatelet therapy duration following bare metal or drug-eluting
coronary stents.
Source
JAMA - Journal of the American Medical Association. 313 (11) (pp
1113-1121), 2015. Date of Publication: 17 Mar 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE Despite antirestenotic efficacy of coronary drug-eluting stents
(DES) compared with bare metal stents (BMS), the relative risk of stent
thrombosis and adverse cardiovascular events is unclear. Although dual
antiplatelet therapy (DAPT) beyond 1 year provides ischemic event
protection after DES, ischemic event risk is perceived to be less after
BMS, and the appropriate duration of DAPT after BMS is unknown. OBJECTIVE
To compare (1) rates of stent thrombosis and major adverse cardiac and
cerebrovascular events (MACCE; composite of death,myocardial infarction,
or stroke) after 30 vs 12 months of thienopyridine in patients treated
with BMS taking aspirin and (2) treatment duration effect within the
combined cohorts of randomized patients treated with DES or BMS as
prespecified secondary analyses. DESIGN, SETTING, AND PARTICIPANTS
International, multicenter, randomized, double-blinded, placebo-controlled
trial comparing extended (30-months) thienopyridine vs placebo in patients
taking aspirin who completed 12 months of DAPT without bleeding or
ischemic events after receiving stents. The study was initiated in August
2009 with the last follow-up visit in May 2014. INTERVENTIONS Continued
thienopyridine or placebo at months 12 through 30 after stent placement,
in 11 648 randomized patients treated with aspirin, of whom 1687 received
BMS and 9961 DES. MAIN OUTCOMES AND MEASURES Stent thrombosis, MACCE, and
moderate or severe bleeding. RESULTS Among 1687 patients treated with BMS
whowere randomized to continued thienopyridine vs placebo, rates of stent
thrombosiswere 0.5%vs 1.11% (n = 4 vs 9; hazard ratio [HR], 0.49; 95%CI,
0.15-1.64; P = .24), rates of MACCE were 4.04%vs 4.69%(n = 33 vs 38; HR,
0.92; 95%CI, 0.57-1.47; P = .72), and rates of moderate/severe bleeding
were 2.03%vs 0.90% (n = 16vs 7; P = .07), respectively. Among all 11 648
randomized patients (both BMS and DES), stent thrombosis rateswere 0.41%
vs 1.32%(n = 23 vs 74; HR, 0.31; 95%CI, 0.19-0.50; P < .001), rates of
MACCE were 4.29% vs 5.74%(n = 244 vs 323; HR, 0.73; 95%CI, 0.62-0.87; P <
.001), and rates of moderate/severe bleedingwere 2.45%vs 1.47%(n = 135 vs
80; P < .001). CONCLUSIONS AND RELEVANCE Among patients undergoing
coronary stent placement with BMS and who tolerated 12 months of
thienopyridine, continuing thienopyridine for an additional 18 months
compared with placebo did not result in statistically significant
differences in rates of stent thrombosis, MACCE, or moderate or severe
bleeding. However, the BMS subsetmay have been underpowered to identify
such differences, and further trials are suggested.

<8>
Accession Number
2015084453
Authors
Mewton N. Cung T.T. Morel O. Cayla G. Bonnefoy-Cudraz E. Rioufol G.
Angoulvant D. Guerin P. Elbaz M. Delarche N. Coste P. Vanzetto G. Metge M.
Aupetit J.-F. Jouve B. Motreff P. Tron C. Labeque J.-N. Steg P.G. Cottin
Y. Range G. Clerc J. Coussement P. Prunier F. Moulin F. Roth O. Belle L.
Dubois P. Barragan P. Gilard M. Piot C. Colin P. Morice M.-C. Monassier
J.-P. Ider O. Dubois-Rande J.L.P. Unterseeh T. Lebreton H. Beard T.
Blanchard D. Grollier G. Malquarti V. Staat P. Sudre A. Hansson M.J. Elmer
E. Boussaha I. Jossan C. Torner A. Claeys M. Garcia-Dorado D. Ovize M.
Institution
(Mewton, Boussaha, Jossan, Ovize) Hopital Cadiovasculaire Louis Pradel,
Clinical Investigation Center, Hospices Civils de Lyon, 28, Avenue Doyen
Lepine, BRON Cedex 69677, France
(Cung) Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier,
France
(Morel) Hopitaux Universitaires de Strasbourg, NHC, Strasbourg, France
(Cayla) Centre Hospitalier Universitaire de Nimes, Nimes, France
(Bonnefoy-Cudraz, Rioufol) Centre Hospitalier Universitaire, Hopital
Cardiovasculaire Louis Pradel, Lyon, France
(Angoulvant) Centre Hospitalier Universitaire de Tours, Tours, France
(Guerin) Hopital Guillaume et Rene Laennec, Nantes, France
(Elbaz) Centre Hospitalier Universitaire de Rangueil, Toulouse, France
(Delarche) Centre Hospitalier de Pau, Pau, France
(Coste) Hopital Haut Leveque, Bordeaux, France
(Vanzetto) Hopital A. Michallon, Centre Hospitalier Universitaire,
Grenoble, France
(Metge) Hopital Henri Duffau, Avignon, France
(Aupetit) Centre Hospitalier St Luc St Joseph, Lyon, France
(Jouve) Centre Hospitalier du Pays d'Aix, Aix en provence, France
(Motreff) Centre Hospitalier Universitaire, Hopital Gabriel Montpied,
Clermont Ferrand, France
(Tron) Hopital Charles Nicolle, Rouen, France
(Labeque) Clinique de la Fourcade, Bayonne, France
(Steg) APHP, Hopital Bichat, Paris, France
(Cottin) Hopital du Bocage, Dijon, France
(Range) Centre Hospitalier General, Chartres, France
(Clerc) Centre Hospitalier de Compiegne, Compiegne, France
(Coussement) Algemeen Ziekenhuis Sint Jan, Brugge, Belgium
(Prunier) Centre Hospitalier Universitaire, Angers, France
(Moulin) Centre Hospitalier Universitaire de Nancy Brabois, Nancy, France
(Roth) Centre Hospitalier Universitaire de Mulhouse, Mulhouse, France
(Belle) Centre Hospitalier d'Annecy, Annecy, France
(Dubois) Centre Hospitalier Henri Mondor, Creteil, France
(Barragan) Polyclinique des Fleurs, Ollioules, France
(Gilard) Hopital de la Cavale Blanche, Brest, France
(Piot) Clinique du Millenaire, Montpellier, France
(Colin) Clinique Esquirol, Agen, France
(Morice) Institut Jacques Cartier, Massy, France
(Monassier, Ider) Clinique du Diaconat, Mulhouse, France
(Dubois-Rande) Centre Hospitalier Universitaire Charleroi, Charleroi,
Belgium
(Unterseeh) Hopital Claude Galien, Quincy sous senat, France
(Lebreton) Hopital Pontchaillou, Rennes, France
(Beard) Clinique de l'Ormeau - CCV des Pyrenees, Tarbes, France
(Blanchard) Clinique Saint-Gatien, Tours, France
(Grollier) Centre Hospitalier Regional et Universitaire, Hopital de la
Cote de Nacre, Caen, France
(Malquarti) Clinique de la Sauvegarde, Lyon, France
(Staat) Clinique du Tonkin, Lyon, France
(Sudre) Centre Hospitalier Regional et Universitaire, Hopital
Cardiologique Calmette, Lille, France
(Hansson, Elmer) Department of Physiology, Lund University, Lund, Sweden
(Torner) Scandinavian Development Services, Danderyd, Sweden
(Claeys) University Hospital Antwerp, Edegem, Belgium
(Garcia-Dorado) Hospital Universitari Vall D 'Hebron, Barcelona, Spain
Title
Rationale and design of the Cyclosporine to ImpRove Clinical oUtcome in
ST-elevation myocardial infarction patients (the CIRCUS trial).
Source
American Heart Journal. 169 (6) (pp 758-766), 2015. Date of Publication:
01 Jun 2015.
Publisher
Mosby Inc.
Abstract
Background Both acute myocardial ischemia and reperfusion contribute to
cardiomyocyte death in ST-elevation myocardial infarction (STEMI). The
final infarct size is the principal determinant of subsequent clinical
outcome in STEMI patients. In a proof-of-concept phase II trial, the
administration of cyclosporine prior to primary percutaneous coronary
intervention (PPCI) has been associated with a reduction of infarct size
in STEMI patients. Methods CIRCUS is an international, prospective,
multicenter, randomized, double-blinded, placebo-controlled trial. The
study is designed to compare the efficacy and safety of cyclosporine
versus placebo, in addition to revascularization by PPCI, in patients
presenting with acute anterior myocardial infarction within 12 hours of
symptoms onset and initial TIMI flow <1 in the culprit left anterior
descending coronary artery. Patients are randomized in a 1:1 fashion to
2.5 mg/kg intravenous infusion of cyclosporine or matching placebo
performed in the minutes preceding PCI. The primary efficacy end point of
CIRCUS is a composite of 1-year all-cause mortality, rehospitalization for
heart failure or heart failure worsening during initial hospitalization,
and left ventricular adverse remodeling as determined by sequential
transthoracic echochardiography. Secondary outcomes will be tested using a
hierarchical sequence of left ventricular (LV) ejection fraction and
absolute measurements of LV volumes. The composite of death and
rehospitalization for heart failure or heart failure worsening during
initial hospitalization will be further assessed at three years after the
initial infarction. Results Recruitment lasted from April 2011 to February
2014. The CIRCUS trial has recruited 975 patients with acute anterior
myocardial infarction. The 12-months results are expected to be available
in 2015. Conclusions The CIRCUS trial is testing the hypothesis that
cyclosporine in addition to early revascularization with PPCI compared to
placebo in patients with acute anterior myocardial infarction reduces the
incidence of death, heart failure and adverse LV remodeling at one-year
follow-up.

<9>
Accession Number
2015099991
Authors
Elmahdy M.F. ElGuindy A.M. Antoniucci D.
Institution
(Elmahdy, ElGuindy) Aswan Heart Center, Division of Cardiology, Aswan,
Egypt
(Antoniucci) Head of Cardiology Department, Careggi Hospital, Florence,
Italy
Title
TASTE: One-year follow-up results.
Source
Global Cardiology Science and Practice. 2015 (2) , 2015. Article Number:
18. Date of Publication: 01 Apr 2015.
Publisher
Bloomsbury Qatar Foundation Journals

<10>
Accession Number
2014707807
Authors
Wang A.S. Kleinerman R. Armstrong A.W. Fitzmaurice S. Pascucci A. Awasthi
S. Ratnarathorn M. Sivamani R. King T.H. Eisen D.B.
Institution
(Wang, Fitzmaurice, Pascucci, Awasthi, Ratnarathorn, Sivamani, King,
Eisen) Department of Dermatology, University of CaliforniaeDavis Health
System, 3301 C St, Sacramento, CA 95816, United States
(Wang, King) Department of Dermatology, Department of Veterans Affairs,
Northern California Healthcare System, Mather, CA, United States
(Kleinerman) Schweiger Dermatology, New York, NY, United States
(Armstrong) Department of Dermatology, University of Colorado-Denver,
Aurora, CO, United States
Title
Set-back versus buried vertical mattress suturing: Results of a randomized
blinded trial.
Source
Journal of the American Academy of Dermatology. 72 (4) (pp 674-680), 2015.
Date of Publication: 01 Apr 2015.
Publisher
Mosby Inc.
Abstract
Background The set-back suture, an absorbable dermal suturing technique,
purportedly improves wound eversion and cosmetic outcomes. Objective We
sought to conduct a split-wound, prospective, randomized study to compare
the cosmetic outcome and wound eversion achieved with the set-back suture
and the buried vertical mattress suture (BVMS). Methods A total of 46
surgical elliptical wounds were randomized to subcuticular closure with
the set-back suture on half and the BVMS on the other. Maximum eversion
height and width were measured immediately postoperatively. At 3 months, 2
blinded observers evaluated each scar using a 7-point Likert physician
global scar assessment scale. Subjects and observers also completed the
validated Patient and Observer Scar Assessment Scale, where a score of 6
represents normal-appearing skin and 60 represents worst imaginable scar.
Results In all, 42 subjects completed the study. The set-back suture
provided statistically significant wound eversion. On the Likert scale,
observers rated the set-back suture side 1 point better than the BVMS
side. Both patient and observer total Patient and Observer Scar Assessment
Scale scores were significantly lower for the set-back suture side
(subject mean 13.0 +/- 8.7 vs 16.2 +/- 12.0 [P =.039]; observer mean 24.5
+/- 10.4 vs 27.7 +/- 13.6 [P =.028], respectively). Limitations Single
institution experience and relatively short follow-up are limitations.
Conclusion The set-back suture provides superior wound eversion and better
cosmetic outcomes than the BVMS.

<11>
[Use Link to view the full text]
Accession Number
2014705090
Authors
Saleh A. Khanna A. Chagin K.M. Klika A.K. Johnston D. Barsoum W.K.
Institution
(Saleh, Klika, Barsoum) Department of Orthopaedic Surgery, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Khanna) Anesthesiology Institute and Department of Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Chagin) Department of Quantitative Health Sciences (QHS), Cleveland
Clinic, Cleveland, OH, United States
(Johnston) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
Title
Glycopeptides versus beta-lactams for the prevention of surgical site
infections in cardiovascular and orthopedic surgery.
Source
Annals of Surgery. 261 (1) (pp 72-80), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To compare the efficacy of glycopeptides and beta-lactams in
preventing surgical site infections (SSIs) in cardiac, vascular, and
orthopedic surgery. Background: The cost-effectiveness of switching from
beta-lactams to glycopeptides for preoperative antibiotic prophylaxis has
been controversial. beta-Lactams are generally recommended in clean
surgical procedures, but they are ineffective against resistant
gram-positive bacteria. Methods: PubMed, International Pharmaceuticals
Abstracts, Scopus, and Cochrane were searched for randomized clinical
trials comparing glycopeptides and beta-lactams for prophylaxis in adults
undergoing cardiac, vascular, or orthopedic surgery. Abstracts and
conference proceedings were included. Two independent reviewers performed
study selection, data extraction, and assessment of risk of bias. Results:
Fourteen studies with a total of 8952 patients were analyzed. No
difference was detected in overall SSIs between antibiotic types. However,
compared with beta-lactams, glycopeptides reduced the risk of resistant
staphylococcal SSIs by 48% (relative risk, 0.52; 95% confidence interval,
0.29-0.93; P = 0.03) and enterococcal SSIs by 64% (relative risk, 0.36;
95% confidence interval, 0.16-0.80; P = 0.01), but increased respiratory
tract infections by 54% (relative risk, 1.54; 95% confidence interval,
1.19-2.01; P < 0.01). Subgroup analysis of cardiac procedures showed
superiority of beta-lactams in preventing superficial and deep chest SSIs,
susceptible staphylococcal SSIs, and respiratory tract infections.
Conclusions: Glycopeptides reduce the risk of resistant staphylococcal
SSIs and enterococcal SSIs, but increase the risk of respiratory tract
infections. Additional high-quality randomized clinical trials are needed
as these results are limited by high risk of bias.

<12>
Accession Number
2015916071
Authors
Armstrong P.W. Zheng Y. Westerhout C.M. Rosell-Ortiz F. Sinnaeve P.
Lambert Y. Lopes R.D. Bluhmki E. Danays T. Van De Werf F.
Institution
(Armstrong, Zheng, Westerhout) Canadian VIGOUR Centre, University of
Alberta, 2-132 Li Ka Shing Centre for Health Research Innovation,
Edmonton, AB T6G 2E1, Canada
(Rosell-Ortiz) Empresa Publica de Emergencias Sanitarias, Almeria, Spain
(Sinnaeve, Van De Werf) Department of Cardiology, University Hospital
Gasthuisberg, Leuven, Belgium
(Lambert) Centre Hospitalier de Versailles, SAMU 78 and Mobile Intensive
Care Unit, Versailles, France
(Lopes) Duke University Medical Centre, Duke Clinical Research Institute,
Durham, NC, United States
(Bluhmki) Boehringer Ingelheim, Berkshire, United Kingdom
(Danays) Boehringer Ingelheim France, Reims, France
Title
Reduced dose tenecteplase and outcomes in elderly ST-segment elevation
myocardial infarction patients: Insights from the STrategic Reperfusion
Early after Myocardial infarction trial.
Source
American Heart Journal. 169 (6) (pp 890-898), 2015. Date of Publication:
01 Jun 2015.
Publisher
Mosby Inc.
Abstract
Background Elderly patients with ST-segment elevation myocardial
infarction (STEMI) have worse outcomes and a greater risk of intracranial
bleeding than nonelderly patients. Baseline characteristics, clinical
outcomes, and the relationship of the tenecteplase (TNK) dose reduction to
the efficacy, safety, and electrocardiographic indicators of reperfusion
efficacy were evaluated in STEMI patients >75 years. Methods The STREAM
trial evaluated early presenting STEMI patients who could not undergo
primary percutaneous coronary intervention within 1 hour of first medical
contact. Because of excess intracranial hemorrhage (ICH) in patients >75
years, the dose of TNK was reduced by 50%. Results Before dose amendment,
there were 3 (7.1%) of 42 elderly patients with ICH; 2 of these were
fatal, whereas no ICH occurred in the 93 elderly patients who received
half-dose TNK postamendment. The median extent of ST-segment elevation
resolution (>50%) and proportion of patients with >2 mm in the
electrocardiogram lead with greatest ST-segment elevation was comparable
in elderly patients preamendment and postamendment (63.2% vs 56.0% and
43.6% vs 40.0%, respectively). Patients requiring rescue coronary
intervention after TNK was also similar (42.9% vs 44.1%). The primary
composite end point (30-day all-cause death, cardiogenic shock, congestive
heart failure, and reinfarction) was 31.0% before versus 24.7%
postamendment. onclusions Our data, from a modest-sized population of
elderly STEMI patients, indicate that half-dose TNK reduces the likelihood
of ICH without compromising reperfusion efficacy. These observations are
hypothesis generating and warrant further confirmation in randomized
clinical trials in the elderly.

<13>
Accession Number
2015112491
Authors
Van Der Baan A. Kortekaas K.A. Van Es E. Meier S. Klautz R.J.M. Engbers
F.H.M.
Institution
(Van Der Baan, Kortekaas, Van Es, Klautz) Department of Cardiothoracic
Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden RC 2300,
Netherlands
(Meier, Engbers) Department of Anesthesiology, Leiden University Medical
Center, Leiden, Netherlands
Title
Sevoflurane-enriched blood cardioplegia: The intramyocardial delivery of a
volatile anesthetic.
Source
Perfusion (United Kingdom). 30 (4) (pp 295-301), 2015. Date of
Publication: 09 May 2015.
Publisher
SAGE Publications Ltd
Abstract
Myocardial ischemia/reperfusion injury is a major problem in cardiac
surgery, characterized by an enhanced inflammatory response
postoperatively. Sevoflurane has anti-inflammatory effects and may
attenuate this injury. This study describes a novel approach to using
sevoflurane as a local anti-inflammatory drug and not as an anesthetic.
Therefore, a pediatric oxygenator with a sevoflurane vaporizer was
integrated into the blood cardioplegia system of an adult bypass system.
In addition, a gas blender was implemented to regulate pO<inf>2</inf> and
pCO<inf>2</inf> concentrations in the cardioplegia. This
proof-of-principle study was tested in vivo and shows that it is feasible
to deliver sevoflurane locally while regulating O<inf>2</inf> and
CO<inf>2</inf> concentrations. Moreover, this set-up enables one to use
only the specific cardioprotective features of sevoflurane. Inflammatory
responses were attenuated, both locally (i.e. the heart) as well as
systemically through intramyocardial delivery of sevoflurane.

<14>
Accession Number
2015103817
Authors
Dvir D. Waksman R. Barbash I.M. Kodali S.K. Svensson L.G. Tuzcu E.M. Xu K.
Minha S. Alu M.C. Szeto W.Y. Thourani V.H. Makkar R. Kapadia S. Satler
L.F. Webb J.G. Leon M.B. Pichard A.D.
Institution
(Dvir, Waksman, Barbash, Minha, Satler, Pichard) Department of
Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving
Street, NW, Suite 4B-1, Washington, D.C. 20010, United States
(Kodali, Xu, Alu, Leon) Center for Interventional Vascular Therapy,
Columbia University Medical Center, Cardiovascular Research Foundation,
New York, NY, United States
(Svensson, Tuzcu, Kapadia) Sones Cardiac Catheterization Laboratory,
Cleveland Clinic Foundation, Cleveland, OH, United States
(Szeto) Division of Cardiovascular Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Thourani) Cardiac Surgery, Emory University School of Medicine, Atlanta,
GA, United States
(Makkar) Cardiovascular Interventional Center, Cedars-Sinai Heart
Institute, Los Angeles, CA, United States
(Webb) Interventional Cardiology and Cardiac Catheterization Laboratories
Martin B. Leon, Center for Interventional Vascular Therapy, St. Paul's
Hospital, Vancouver, BC, Canada
Title
Outcomes of patients with chronic lung disease and severe aortic stenosis
treated with transcatheter versus surgical aortic valve replacement or
standard therapy: Insights from the PARTNER trial (Placement of AoRTic
TraNscathetER Valve).
Source
Journal of the American College of Cardiology. 63 (3) (pp 269-279), 2014.
Date of Publication: 28 Jan 2014.
Publisher
Elsevier USA
Abstract
Objectives The study aimed to evaluate the impact of chronic lung disease
(CLD) on outcomes of severe aortic stenosis patients across all treatment
modalities. Background Outcomes of patients with CLD undergoing
transcatheter aortic valve replacement (TAVR) have not been systematically
examined. Methods All patients who underwent TAVR in the PARTNER
(Placement of AoRTic TraNscathetER Valve) trial, including the continued
access registry (n = 2,553; 1,108 with CLD), were evaluated according to
CLD clinical severity. Additionally, outcomes of CLD patients included in
the randomization arms of the PARTNER trial were compared: Cohort A
patients (high-risk operable) treated by either TAVR (n = 149) or surgical
aortic valve replacement (SAVR); (n = 138); and Cohort B patients
(inoperable) treated by either TAVR (n = 72) or standard therapy only (n =
95). Results Among all TAVR-treated patients, at 1-year follow-up,
patients with CLD had higher mortality than those without it (23.4% vs.
19.6%, p = 0.02). Baseline characteristics of CLD patients who underwent
TAVR were similar to respective controls. In Cohort A, 2-year all-cause
death rates were similar (TAVR 35.2% and SAVR 33.6%, p = 0.92), whereas in
Cohort B, the death rate was lower after TAVR (52.0% vs. 69.6% after
standard therapy only, p = 0.04). Independent predictors for mortality in
CLD patients undergoing TAVR included poor mobility (6-min walk test <50
m; hazard ratio: 1.67, p = 0.0009) and oxygen-dependency (hazard ratio:
1.44, p = 0.02). Although CLD patients undergoing TAVR have worse outcomes
than patients without CLD, TAVR is better in these patients than standard
therapy and is similar to SAVR. Conclusions Although patients with CLD
undergoing TAVR had worse outcomes than patients without CLD, TAVR
performed better in these patients than standard therapy and was similar
to SAVR. However, CLD patients who were either poorly mobile or
oxygen-dependent had poor outcomes. (THE PARTNER TRIAL: Placement of
AoRTic TraNscathetER Valve Trial; NCT00530894)

<15>
Accession Number
2015869811
Authors
Mulkey S.B. Yap V.L. Bai S. Ramakrishnaiah R.H. Glasier C.M. Bornemeier
R.A. Schmitz M.L. Bhutta A.T.
Institution
(Mulkey) Department of Pediatrics, Section of Pediatric Neurology,
University of Arkansas for Medical Sciences, 1 Childrens Way, Slot 512-15,
Little Rock, AR 72202, United States
(Yap) Department of Pediatrics, Section of Neonatology, Arkansas
Children's Hospital, Little Rock, AR, United States
(Bai) Department of Pediatrics, Section of Biostatistics, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Ramakrishnaiah, Glasier) Department of Radiology, Section of Pediatric
Neuroradiology, Arkansas Children's Hospital, Little Rock, AR, United
States
(Bornemeier) Department of Pediatrics, Section of Cardiology, Arkansas
Children's Hospital, Little Rock, AR, United States
(Schmitz) Department of Anesthesiology, Section of Pediatric
Cardiothoracic Anesthesia, Arkansas Children's Hospital, Little Rock, AR,
United States
(Bhutta) Department of Pediatrics, Section of Critical Care, Arkansas
Children's Hospital, Little Rock, AR, United States
(Yap) New York Presbyterian Weill Cornell Medical College, New York, NY,
United States
(Bhutta) University of Maryland, Baltimore, MD, United States
Title
Amplitude-integrated EEG in newborns with critical congenital heart
disease predicts preoperative brain magnetic resonance imaging findings.
Source
Pediatric Neurology. 52 (6) (pp 599-605), 2015. Date of Publication: 01
Jun 2015.
Publisher
Elsevier Inc.
Abstract
Objective The study aims are to evaluate cerebral background patterns
using amplitude-integrated electroencephalography in newborns with
critical congenital heart disease, determine if amplitude-integrated
electroencephalography is predictive of preoperative brain injury, and
assess the incidence of preoperative seizures. We hypothesize that
amplitude-integrated electroencephalography will show abnormal background
patterns in the early preoperative period in infants with congenital heart
disease that have preoperative brain injury on magnetic resonance imaging.
Methods Twenty-four newborns with congenital heart disease requiring
surgery at younger than 30 days of age were prospectively enrolled within
the first 3 days of age at a tertiary care pediatric hospital. Infants had
amplitude-integrated electroencephalography for 24 hours beginning close
to birth and preoperative brain magnetic resonance imaging. The
amplitude-integrated electroencephalographies were read to determine if
the background pattern was normal, mildly abnormal, or severely abnormal.
The presence of seizures and sleep-wake cycling were noted. The
preoperative brain magnetic resonance imaging scans were used for brain
injury and brain atrophy assessment. Results Fifteen of 24 infants had
abnormal amplitude-integrated electroencephalography at 0.71 (0-2) (mean
[range]) days of age. In five infants, the background pattern was severely
abnormal. (burst suppression and/or continuous low voltage). Of the 15
infants with abnormal amplitude-integrated electroencephalography, 9 (60%)
had brain injury. One infant with brain injury had a seizure on
amplitude-integrated electroencephalography. A severely abnormal
background pattern on amplitude-integrated electroencephalography was
associated with brain atrophy (P = 0.03) and absent sleep-wake cycling (P
= 0.022). Conclusion Background cerebral activity is abnormal on
amplitude-integrated electroencephalography following birth in newborns
with congenital heart disease who have findings of brain injury and/or
brain atrophy on preoperative brain magnetic resonance imaging.

<16>
Accession Number
2015819487
Authors
Zannad F. Cannon C.P. Cushman W.C. Bakris G.L. Menon V. Perez A.T. Fleck
P.R. Mehta C.R. Kupfer S. Wilson C. Lam H. White W.B.
Institution
(Zannad) Institut Lorrain du Coeur et des Vaisseaux, Universite de
Lorraine and CHU, Centre d'Investigation Clinique Inserm,
Vandoeuvre-Les-Nancy, France
(Cannon) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Cushman) University of Tennessee, College of Medicine, Memphis Veterans
Affairs Medical Center, Memphis, TN, United States
(Bakris) University of Chicago Pritzker School of Medicine, Chicago, IL,
United States
(Menon) Cleveland Clinic Foundation, Cleveland, OH, United States
(Perez, Fleck, Kupfer, Wilson, Lam) Takeda Development Center Americas,
Deerfield, IL, United States
(Mehta) Harvard School of Public Health, Boston, MA, United States
(White) Calhoun Cardiology Center, University of Connecticut School of
Medicine, Farmington, CT, United States
Title
Heart failure and mortality outcomes in patients with type 2 diabetes
taking alogliptin versus placebo in EXAMINE: A multicentre, randomised,
double-blind trial.
Source
The Lancet. 385 (9982) (pp 2067-2076), 2015. Date of Publication: 23 May
2015.
Publisher
Lancet Publishing Group
Abstract
Background The EXAMINE trial showed non-inferiority of the DPP-4 inhibitor
alogliptin to placebo on major adverse cardiac event (MACE) rates in
patients with type 2 diabetes and recent acute coronary syndromes.
Concerns about excessive rates of in-hospital heart failure in another
DPP-4 inhibitor trial have been reported. We therefore assessed hospital
admission for heart failure in the EXAMINE trial. Methods Patients with
type 2 diabetes and an acute coronary syndrome event in the previous 15-90
days were randomly assigned alogliptin or placebo plus standard treatment
for diabetes and cardiovascular disease prevention. The prespecified
exploratory extended MACE endpoint was all-cause mortality, non-fatal
myocardial infarction, non-fatal stroke, urgent revascularisation due to
unstable angina, and hospital admission for heart failure. The post-hoc
analyses were of cardiovascular death and hospital admission for heart
failure, assessed by history of heart failure and brain natriuretic
peptide (BNP) concentration at baseline. We also assessed changes in
N-terminal pro-BNP (NT-pro-BNP) from baseline to 6 months. This study is
registered with ClinicalTrials.gov, number NCT00968708. Findings 5380
patients were assigned to alogliptin (n=2701) or placebo (n=2679) and
followed up for a median of 533 days (IQR 280-751). The exploratory
extended MACE endpoint was seen in 433 (160%) patients assigned to
alogliptin and in 441 (165%) assigned to placebo (hazard ratio [HR] 098,
95% CI 086-112). Hospital admission for heart failure was the first event
in 85 (31%) patients taking alogliptin compared with 79 (29%) taking
placebo (HR 107, 95% CI 079-146). Alogliptin had no effect on composite
events of cardiovascular death and hospital admission for heart failure in
the post hoc analysis (HR 100, 95% CI 082-121) and results did not differ
by baseline BNP concentration. NT-pro-BNP concentrations decreased
significantly and similarly in the two groups. Interpretation In patients
with type 2 diabetes and recent acute coronary syndromes, alogliptin did
not increase the risk of heart failure outcomes. Funding Takeda
Development Center Americas.

<17>
Accession Number
2015794735
Authors
Rojas S.V. Avsar M. Hanke J.S. Khalpey Z. Maltais S. Haverich A. Schmitto
J.D.
Institution
(Rojas, Avsar, Hanke, Haverich, Schmitto) Department of Cardiothoracic,
Transplantation, and Vascular Surgery, Hannover Medical School, Hannover,
Germany
(Khalpey) Division of Cardiothoracic Surgery, College of Medicine,
University of Arizona, Tucson, AZ, United States
(Maltais) Heart and Vascular Institute, Vanderbilt University, Nashville,
TN, United States
Title
Minimally Invasive Ventricular Assist Device Surgery.
Source
Artificial Organs. 39 (6) (pp 473-479), 2015. Date of Publication: 01 Jun
2015.
Publisher
Blackwell Publishing Inc.
Abstract
The use of mechanical circulatory support to treat patients with
congestive heart failure has grown enormously, recently surpassing the
number of annual heart transplants worldwide. The current generation of
left ventricular assist devices (LVADs), as compared with older devices,
is characterized by improved technologies and reduced size. The result is
that minimally invasive surgery is now possible for the implantation,
explantation, and exchange of LVADs. Minimally invasive procedures improve
surgical outcome; for example, they lower the rates of operative
complications (such as bleeding or wound infection). The miniaturization
of LVADs will continue, so that minimally invasive techniques will be used
for most implantations in the future. In this article, we summarize and
describe minimally invasive state-of-the-art implantation techniques, with
a focus on the most common LVAD systems in adults.

<18>
Accession Number
2015764899
Authors
Lindholm E.E. Aune E. Seljeflot I. Otterstad J.E. KirkebOen K.A.
Institution
(Lindholm) Department of Anaesthesiology, Vestfold Hospital Trust, P.O.
Box 2168, Tonsberg, Norway
(Aune, Otterstad) Department of Cardiology, Vestfold Hospital Trust,
Tonsberg, Norway
(Seljeflot) Center for Clinical Heart Research, Department of Cardiology,
Oslo University Hospital, Oslo, Norway
(KirkebOen) Department of Anaesthesiology, Oslo University Hospital, Oslo,
Norway
(Seljeflot, KirkebOen) Faculty of Medicine, University of Oslo, Oslo,
Norway
Title
Biomarkers of inflammation in major vascular surgery: A prospective
randomised trial.
Source
Acta Anaesthesiologica Scandinavica. 59 (6) (pp 773-787), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Blackwell Munksgaard
Abstract
Background Surgery induces inflammation and pro-inflammatory cytokines are
associated with post-operative complications. In cardiac surgery, it has
been shown that volatile anaesthetics have cardioprotective properties. We
explored whether sevoflurane affects the pro-inflammatory response
favourably compared with total intravenous anaesthesia (TIVA) after
surgery. Methods We measured monocyte chemotactic protein 1 (MCP-1),
matrix metalloproteinase 9 (MMP-9), C-reactive protein (CRP), vascular
cell adhesion molecule 1 (VCAM-1), interleukin (IL)-6 and IL-8
perioperatively and evaluated if the anaesthetic regimen affected these
mediators. Our hypothesis was that sevoflurane-based anaesthesia is
associated with a reduced release of biomarkers of inflammation compared
with TIVA with propofol/remifentanil. Results In the total population,
MCP-1, MMP-9, IL-6 and IL-8 increased 30min after arrival intensive care
unit, compared with before surgery (P<0.001), whereas CRP and VCAM-1
transiently declined (P<0.001). From 30min after arrival intensive care
unit to 1st post-operative day, MCP-1 and IL-6 levels declined (P<0.001),
CRP and VCAM-1 increased (P<0.001), whereas MMP-9 and IL-8 were not
significantly altered. Pre-operatively there were no significant
differences in any variables between the two anaesthetic groups. Lower
levels of MCP-1 and IL-8 (P<0.001) and higher levels of IL-6 and MMP-9
(P=0.003) were found in the sevoflurane group, compared with the TIVA
group 30min post-operatively. CRP and VCAM-1 levels did not differ. There
were no significant differences between the two anaesthetic groups before
surgery or at 1st post-operative day. Conclusion We found an inflammatory
response during the observation period, which was modified by the
anaesthetic regimen in the early phase. This short-lasting difference is
probably too short to support a cardioprotective effect of sevoflurane
compared with TIVA in open abdominal aortic surgery.

<19>
Accession Number
2015098826
Authors
Malik A. Asghar M. Farman T. Laiq N. Shah S.M.A. Khan R.A.
Institution
(Malik, Asghar, Farman, Laiq, Shah, Khan) Department of Cardiovascular
Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar,
Pakistan
Title
Standard median sternotomy versus right anterolateral thoracotomy for
mitral valve replacement.
Source
Journal of Medical Sciences (Peshawar). 23 (1) (pp 42-45), 2015. Date of
Publication: 2015.
Publisher
Khyber Medical College
Abstract
Objective: To compare the morbidity and mortality of standard median
sternotomy with right anterolateral thoracotomy for procedure of mitral
valve replacement. Materials and Methods: All patients who were selected
for mitral valve replacement in the department of Cardiovascular Surgery
Lady Reading Hospital were included in the study. They were randomly
assigned to one of the group. Group I patients of SMS and Group II
Patients of RALT. Patients of both groups were operated as per standard
protocols of the procedures for mitral valve replacement. All patients had
a similar pre and post operative care. The groups were compared for aortic
cross clamp time, procedure time, mortality, hospital stay etc. Results:
Total of 281 cases was included in the study. There were 204 cases in
group I of SMS and 77 in group II of RALT. Female were 73% in group I and
76% in group II. Mean age of patients in group I was 28 +/- 11 years and
in group II was 26+/- 12 years. Almost all patients were having rheumatic
mitral valve disease. Mean CPB time was 92+/-12 mints in group I while
100+/-14 in group II with a p value of <0.0001 Aortic cross clamp time was
61+/- 15 mints in group I and 69+/-12 mints in group II which was
statistically significant. Ventilation time in group I was 8.9+/-0.8 hours
and 6.75+/-1 hour in group II with significant p valve of <0.0001. 6.86%
of patients died in group I compared to 5.2% of group II which is not
statistically significant. None of the patients with RALT were reopened
compared to 10(4.875%) of the patients with SMS which was highly
significant with a p value of 0.001. Similarly infection did not occur in
any patient in RALT group compared to 6(2.92%) patients of SMS group.
Conclusion: Right anterolateral thoracotomy for mitral valve replacement
in a selected group of patients was safe with fewer per and postoperative
morbidity and mortality compared standard median sternotomy.

<20>
Accession Number
2015098821
Authors
Laiq N. Khan S. Ahmed H. Aslam S. Khan R.A.
Institution
(Laiq, Khan, Ahmed, Aslam, Khan) Department of Cardiothoracic Anaesthesia,
Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
Title
The effects of glycaemic control in cardiac patients undergoing CABG
surgery.
Source
Journal of Medical Sciences (Peshawar). 23 (1) (pp 21-25), 2015. Date of
Publication: 2015.
Publisher
Khyber Medical College
Abstract
Objective: To see the effect of glycemic control during and after cardiac
surgery in the two groups. Material and Methods: This randomized clinical
control study was conducted in the department of Cardiothoracic Anesthesia
PGMI/LRH from April 2012 to December 2014. A totol number of 100 patients
were randomly assigned in one of the two groups,i-e 50 in Glucose,
Insulin, Potassium (GIK) and 50 patients in control group. Patients's
demographic data,and the effect of glycemic control during and after
cardiac surgery on clinical outcome was recorded and compared in the two
groups. Calculations were done using the SPSS,software pakage,version17.
Results: Glycaemic control reduced the incidence of post-surgical atrial
fibrillation in 10 (20%) of GIK group versus 20 (40%) of contol group, P <
0.05 (Significat).The duration of mechanical ventilation (6.3 +/- 1.03
hours GIK versus 8.1 +/- 20.9 hours contol group, P < 0.05 and length of
stay in the ICU (intensive care unit) 48 +/- 4.5 hours GIK versus control
group 60.7+/-2.89 hours, P < 0.05 (Significat). Conclusion: There may be
some benefit to tight glycaemic control during and after cardiac surgery
in terms of atrial fibrillation, mechanical ventilation, and length of
stay in ICU.

<21>
Accession Number
2015097696
Authors
Qi Z. Duan F. Liu S. Lv X. Wang H. Gao Y. Wang J.
Institution
(Qi, Duan, Lv, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, Beijing, China
Title
Effects of bone marrow mononuclear cells delivered through a graft vessel
for patients with previous myocardial infarction and chronic heart
failure: An echocardiographic study of left ventricular function.
Source
Echocardiography. 32 (6) (pp 937-946), 2014. Date of Publication: 01 Jun
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives The graft of stem cells to treat ischemic cardiomyopathy is
popular in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through graft vessels to
improve left ventricular function of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Methods
Forty-two patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: CABG only (18 in
CABG group), or CABG with BMMNC transplantation (24 in CABG + BMMNC
group). Echocardiographic parameters of systolic function were measured on
B-mode imaging, tissue Doppler imaging (TDI), two-dimensional (2D) strain
imaging, and 8 parameters were measured totally. Echocardiographic
parameters of diastolic function were measured on pulsed-wave Doppler
imaging, TDI, and 2D strain rate imaging; 17 parameters were measured
totally. Results Postoperative left ventricular ejection fraction (LVEF)
versus preoperative LVEF were 49.083 +/- 1.914% versus 36.042 +/- 1.185%
(P < 0.05) in CABG + BMMMNC group and 41.389 +/- 2.210% versus 34.667 +/-
1.369% (P < 0.05) in CABG group, global longitudinal strain were -12.542
+/- 0.512% versus -7.083 +/- 0.583% (P < 0.05) in CABG + BMMMNC group and
-9.278 +/- 0.591% versus -7.000 +/- 0.673% (P < 0.05) in CABG group, mLsr1
were -0.108 +/- 0.018/sec versus -0.039 +/- 0.017/sec (P < 0.05) in
CABG+BMMMNC group and -0.048 +/- 0.021/sec versus 0.004 +/- 0.020/sec (P <
0.05) in CABG group, mLsr2 were -0.055 +/- 0.013/sec versus -0.009 +/-
0.015/sec (P < 0.05) in CABG + BMMMNC group and 0.004 +/- 0.015/sec versus
0.024 +/- 0.017/sec (P < 0.05) in CABG group, and Aa1 were 7.303 +/- 0.479
cm/sec versus 5.131 +/- 0.381 cm/sec (P < 0.05) in CABG + BMMMNC group and
7.908 +/- 0.553 cm/sec versus 6.764 +/- 0.440 cm/sec (P < 0.05) in CABG
group. Parameters above were significantly improved postoperatively in
both groups. The degree of the improvement was significantly different
between the two groups with the CABG + BMMNC group improved more versus
the group of CABG only (P < 0.05). Conclusions The improvement of left
ventricular function in CABG + BMMNC group is better than CABG group. 2D
strain and strain rate imaging is a more sensitive tool to evaluate left
ventricular function.

<22>
Accession Number
2014914951
Authors
Wang H.-X. Dong P.-S. Li Z.-J. Wang H.-L. Wang K. Liu X.-Y.
Institution
(Wang, Dong, Li, Wang, Wang, Liu) Department of Cardiology, First
Affiliated Hospital of Henan Science and Technology University, No. 24
Jinghua Road, Jianxi District, Luoyang 471003, China
Title
Application of intravascular ultrasound in the emergency diagnosis and
treatment of patients with ST-segment elevation myocardial infarction.
Source
Echocardiography. 32 (6) (pp 1003-1008), 2014. Date of Publication: 01 Jun
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Purpose This study aimed to examine the application of intravascular
ultrasound (IVUS) in ST-segment elevation myocardial infarction (STEMI)
patients with high thrombus burden (thrombus grade >3) undergoing
emergency diagnosis and primary percutaneous coronary intervention.
Methods Eighty STEMI patients were enrolled and randomly assigned to the
IVUS-guided group (38 patients) or non-IVUS group (42 patients). Stent
implantation was performed in non-IVUS group patients. IVUS group patients
were further divided into low-risk and high-risk patients on the basis of
IVUS evaluation for determining whether stenting should be performed.
Major adverse cardiac event (MACE) rates, changes in the left ventricular
end-diastolic diameter (LVEDD) and ejection fraction (EF) values, and
stent numbers were examined during hospitalization, and follow-up was
performed at 1, 3, 6, and 12 months postoperatively. Results During
hospitalization, there were no significant differences in the MACE rates,
LVEDD, and EF values and in the follow-up outcomes at 1, 3, 6, and 12
months postoperatively among the patients in the 2 groups (P > 0.05). A
significantly lower number of stents were implanted in the IVUS group than
in the non-IVUS group patients (P < 0.05). Conclusion During the
IVUS-guided emergency intervention, enhanced antithrombotic therapy and
best medical care for low-risk STEMI patients may be feasible.

<23>
Accession Number
2014945575
Authors
Dunlay S.M. Deo S.V. Park S.J.
Institution
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, 200 First St
SW, Rochester, MN 55905, United States
(Dunlay) Division of Health Care Policy and Research, Mayo Clinic,
Rochester, MN, United States
(Deo, Park) Division of Cardiovascular Surgery, Case Western Reserve
University, Cleveland, OH, United States
Title
Impact of tricuspid valve surgery at the time of left ventricular assist
device insertion on postoperative outcomes.
Source
ASAIO Journal. 61 (1) (pp 15-20), 2015. Date of Publication: 13 Jan 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Tricuspid regurgitation (TR) is common in patients with heart failure
undergoing left ventricular assist device (LVAD) implantation. Whether the
TR should be surgically managed at the time of LVAD surgery is
controversial. We searched SCOPUS, Web of Science, Ovid EMBASE, and Ovid
MEDLINE (through May 10, 2014) for randomized controlled trials and
observational studies comparing postoperative outcomes in patients treated
with LVAD with concomitant tricuspid valve surgery (TVS) compared with
LVAD alone. Six observational studies including 3,249 patients compared
outcomes following LVAD + TVS versus LVAD. Four studies were single-center
and most did not adjust for potential confounders. Addition of TVS
prolonged cardiopulmonary bypass times by an average of 31 minutes (three
studies, 95% CI 20-42). There was no difference in need for right
ventricular assist device (six studies, HR 1.42, 95% CI 0.54-3.76), acute
renal failure (four studies, HR 1.07, 95% CI 0.55-2.10), or early
mortality (six studies, HR 1.28, 95% CI 0.78-2.08) in patients treated
with LVAD + TVS versus LVAD alone. TVS prolongs cardiopulmonary bypass
times, but available data demonstrate no significant association with
early postoperative outcomes. However, differences in baseline risk of
patients treated with TVS versus not limit our ability to draw
conclusions.

<24>
Accession Number
2015940486
Authors
Zhang N. Lei J. Liu Q. Huang W. Xiao H. Lei H.
Institution
(Zhang, Huang, Xiao, Lei) Department of Cardiology, First Affiliated
Hospital, Chongqing Medical University, 1 Youyi Road, Yuzhong, Chongqing
400016, China
(Liu) Center for Clinical Research, First Affiliated Hospital, Chongqing
Medical University, China
(Lei) First Affiliated Hospital, Chongqing Medical University, Chongqing,
China
Title
The effectiveness of preoperative trimetazidine on myocardial preservation
in coronary artery bypass graft patients: A systematic review and
meta-Analysis.
Source
Cardiology (Switzerland). 131 (2) (pp 86-96), 2015. Date of Publication:
01 Jun 2015.
Publisher
S. Karger AG
Abstract
Coronary artery bypass grafting (CABG) is a key and effective surgical
treatment modality for coronary artery disease. Unfortunately,
ischemia-reperfusion injury during and after CABG can lead to reversible
and irreversible myocardial damage. Trimetazidine
[1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic
anti-ischemic agent with demonstrated cardioprotective effects; however,
its effects with respect to myocardial preservation in CABG patients
remain unclear. Methods: We conducted a systematic review and
meta-Analysis of randomized controlled trials (RCTs) to investigate the
effectiveness of myocardial preservation of preoperative trimetazidine
therapy in CABG patients by assessing the postoperative levels of several
blood-based biochemical markers of myocardial injury, including creatine
kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine
phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were
classified into two subgroup analyses by the timing of sample collection
(either <12 or >12 h after CABG). Results: Six RCTs were finally included
in the meta-Analysis. The pooled effect sizes showed significantly lower
postoperative levels of CK, CK-MB, TnT and TnI in the
trimetazidine-treated CABG patients relative to control CABG patients.
However, there were no significant differences in the postoperative CPK
levels between trimetazidine-treated CABG patients relative to control
CABG patients. In both the <12 and >12 h post-CABG subgroup analyses,
significant differences in CK, CK-MB, TnT and TnI were detected between
the trimetazidine-treated CABG patients relative to control CABG patients.
Conclusions: Preoperative trimetazidine therapy appears to have a positive
effect on myocardial preservation in CABG patients.

<25>
Accession Number
2015924585
Authors
Moretti C. D'Ascenzo F. Mennuni M. Taha S. Brambilla N. Nijhoff F.
Fraccaro C. Barbanti M. Tamburino C. Tarantini G. Rossi M.L. Presbitero P.
Napodanno M. Stella P. Bedogni F. Omede P. Conrotto F. Montefusco A.
Giordana F. Biondi Zoccai G. Agostoni P. D'Amico M. Rinaldi M. Marra S.
Gaita F.
Institution
(Moretti, D'Ascenzo, Taha, Omede, Montefusco, Giordana, Gaita) Division of
Cardiology 1, Citta della Salute e della Scienza Hospital, University of
Turin, Turin, Italy
(Conrotto, D'Amico, Marra) Division of Cardiology 2, Citta della Salute e
della Scienza Hospital, University of Turin, Turin, Italy
(Rinaldi) Division of Cardiac Surgery, Citta della Salute e della Scienza
Hospital, University of Turin, Turin, Italy
(Mennuni, Rossi, Presbitero) Division of Cardiology, Istituto Humanitas,
Milan, Italy
(Taha) Department of Cardiology, Assuit University Hospital, Assuit, Egypt
(Brambilla, Bedogni) Department of Interventional Cardiology, Istituto
Clinico S. Ambrogio, Milan, Italy
(Nijhoff, Stella, Agostoni) Cardiology Department, University Medical
Center Utrecht, Utrecht, Netherlands
(Fraccaro, Tarantini, Napodanno) Division of Cardiology, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova,
Italy
(Barbanti, Tamburino) Cardiology Department, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
Title
Meta-Analysis of Comparison Between Self-Expandable and Balloon-Expandable
Valves for Patients Having Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 115 (12) (pp 1720-1725), 2015. Article
Number: 21053. Date of Publication: 15 Jun 2015.
Publisher
Elsevier Inc.
Abstract
Two different devices, 1 self-expanding and 1 balloon-expandable, have
been developed for patients who underwent transcatheter aortic valve
implantation with contrasting data about efficacy and safety. Pubmed,
Medline, and Google Scholar were systematically searched for studies of
these different devices, with data derived from randomized controlled
trial or registries with multivariate analysis. All-cause death at 30 days
and at follow-up were the primary end points, whereas postprocedural
moderate or severe aortic regurgitation (AR), stroke, major vascular
complications, bleedings, and pacemaker implantation the secondary ones.
Six studies with 957 self-expanding and 947 balloon-expandable valves were
included: 1 randomized controlled trial and 5 observational studies. At 30
days follow-up, rates of death did not differ between self-expanding and
balloon-expandable valves (odds ratio [OR] 0.74, 95% confidence interval
[CI] 0.47 to 1.17), whereas balloon expandable reduced rates of moderate
or severe AR (OR 0.51, 95% CI 0.27 to 0.99) and of pacemaker implantation
(OR 0.28, 95% CI 0.17 to 0.47). After a follow-up of 360 days (300 to
390), rates of all-cause death did not differ between the 2 groups. In
conclusion, risks of moderate or severe AR and pacemaker implantation were
lower with the balloon-expandable devices without an impact on 30 days and
midterm mortality.

<26>
Accession Number
2015733733
Authors
Schuepbach R. Grande B. Camen G. Schmidt A.R. Fischer H. Sessler D.I.
Seifert B. Spahn D.R. Ruetzler K.
Institution
(Schuepbach, Grande, Schmidt, Spahn, Ruetzler) Institute of
Anesthesiology, University and University Hospital Zurich, Raemistrasse
100, Zurich 8091, Switzerland
(Camen) Department of Internal Medicine, Cantonal Hospital of Glarus,
Glarus, Switzerland
(Fischer) Medical Department, Federal Ministry of the Interior, Vienna,
Austria
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Zurich, Switzerland
(Ruetzler) Division of Cardiothoracic and Vascular Anesthesia and
Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
Title
Intubation with VivaSight or conventional left-sided double-lumen tubes: a
randomized trial.
Source
Canadian Journal of Anesthesia. 62 (7) (pp 762-769), 2015. Date of
Publication: 06 Jul 2015.
Publisher
Springer New York LLC
Abstract
Introduction: Double-lumen endotracheal tubes (DLTs), which are commonly
used for single-lung ventilation during surgery, are difficult to insert.
In addition, they often move during surgical lung manipulation which can
cause life-threatening complications. Flexible bronchoscopy is used
routinely to establish and confirm proper DLT placement. The newly
designed VivaSight DLT has an integrated camera, allowing continuous
visualization of its position in the trachea. We hypothesized that the
time to intubation using the VivaSight DLT would be faster than with a
conventional DLT. Methods: We enrolled 40 adults scheduled for thoracic
surgery. Patients were randomized to conventional DLT (n = 20) or
VivaSight DLT (n = 20). Time to intubation was our primary outcome.
Secondary outcomes were insertion success without flexible bronchoscopy,
frequency of tube displacement, ease of insertion, quality of lung
collapse, postoperative complaints, and airway injuries. Results: Time
[mean (SD)] to successful intubation was significantly faster with the
VivaSight DLT [63 (58) sec] compared with the conventional DLT [97 (84)
sec; P = 0.03]. The VivaSight DLTs were correctly inserted during all
attempts. When malpositioning of the VivaSight DLT occurred, it was easily
remedied, even in the lateral position. The devices were comparable with
respect to postoperative coughing, hoarseness, and sore throat. Airway
injuries tended to be more common with the VivaSight DLT, although this
study was underpowered for airway injuries. Conclusion: The VivaSight DLT
camera allowed faster insertion and facilitated initial positioning. It
also confirmed proper tube positioning intraoperatively and facilitated
repositioning when necessary. This trial was registered at
clinicaltrials.gov: NCT01807676.

<27>
Accession Number
2015079471
Authors
Park S.-J. Ahn J.-M.
Institution
(Park, Ahn) Division of Cardiology, Asan Medical Center, University of
Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736,
South Korea
Title
Intravascular Ultrasound for the Assessment of Coronary Lesion Severity
and Optimization of Percutaneous Coronary Interventions.
Source
Interventional Cardiology Clinics. 4 (3) (pp 383-395), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.

<28>
[Use Link to view the full text]
Accession Number
2015069850
Authors
Gaies M.G. Langer M. Alexander J. Steil G.M. Ware J. Wypij D. Laussen P.C.
Newburger J.W. Goldberg C.S. Pigula F.A. Shukla A.C. Duggan C.P. Agus
M.S.D. Costello J.M. Curley M.A. Del Nido P.J. Jaksic T. Sadhwani A.
Institution
(Gaies, Goldberg) Department of Pediatrics and Communicable Diseases, C.S.
Mott Children's Hospital, University of Michigan Medical School, Ann
Arbor, MI, United States
(Langer) Department of Surgery, Maine Medical Center, Portland, ME, United
States
(Alexander, Steil, Duggan, Agus) Department of Medicine, Children's
Hospital Boston, Harvard Medical School, Boston, MA, United States
(Ware, Sadhwani) Department of Psychology, Children's Hospital Boston,
Harvard Medical School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard University, School of Public
Health, Boston, MA, United States
(Laussen, Newburger) Department of Cardiology, Children's Hospital Boston,
Harvard Medical School, Boston, MA, United States
(Pigula, Del Nido) Department of Cardiac Surgery, Children's Hospital
Boston, Harvard Medical School, Boston, MA, United States
(Shukla) Department of Anesthesia, Children's Hospital Boston, Harvard
Medical School, Boston, MA, United States
(Costello) Northwestern University, Feinberg School of Medicine,
Children's Memorial Hospital, Chicago, IL, United States
(Curley) Department of Nursing, Children's Hospital Boston, Harvard
Medical School, Boston, MA, United States
(Jaksic) Department of Surgery, Children's Hospital Boston, Harvard
Medical School, Boston, MA, United States
Title
Design and rationale of safe pediatric euglycemia After cardiac surgery: A
randomized controlled trial of tight glycemic control After pediatric
cardiac surgery.
Source
Pediatric Critical Care Medicine. 14 (2) (pp 148-156), 2013. Date of
Publication: 01 Feb 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: To describe the design of a clinical trial testing the
hypothesis that children randomized to tight glycemic control with
intensive insulin therapy after cardiac surgery will have improved
clinical outcomes compared to children randomized to conventional blood
glucose management. Design: Two-center, randomized controlled trial.
Setting: Cardiac ICUs at two large academic pediatric centers. Patients:
Children from birth to those aged 36 months recovering in the cardiac ICU
after surgery with cardiopulmonary bypass. Interventions: Subjects in the
tight glycemic control (intervention) group receive an intravenous insulin
infusion titrated to achieve normoglycemia (target blood glucose range of
80-110 mg/dL; 4.4-6.1 mmol/L). The intervention begins at admission to the
cardiac ICU from the operating room and terminates when the patient is
ready for discharge from the ICU. Continuous glucose monitoring is
performed during insulin infusion to minimize the risks of hypoglycemia.
The standard care group has no target blood glucose range. Measurements
and Main Results: The primary outcome is the development of any nosocomial
infection (bloodstream, urinary tract, and surgical site infection or
nosocomial pneumonia). Secondary outcomes include mortality, measures of
cardiorespiratory function and recovery, laboratory indices of nutritional
balance, immunologic, endocrinologic, and neurologic function, cardiac ICU
and hospital length of stay, and neurodevelopmental outcome at 1 and 3 yrs
of age. A total of 980 subjects will be enrolled (490 in each treatment
arm) for sufficient power to show a 50% reduction in the prevalence of the
primary outcome.