EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 24

Results Generated From:
Embase <1980 to 2015 Week 23>
Embase (updates since 2015-05-28)
Embase <1980 to 2015 Week 23>
Embase (updates since 2015-05-28)

<1>
Accession Number
2015075580
Authors
Bavry A.A. Elgendy I.Y. Mahmoud A. Jadhav M.P. Huo T.
Institution
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
(Bavry, Elgendy, Mahmoud, Jadhav, Huo) Department of Medicine, University
of Florida, Gainesville, FL, United States
Title
Critical appraisal of bivalirudin versus heparin for percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
PLoS ONE. 10 (5) , 2015. Article Number: e0127832. Date of Publication: 26
May 2015.
Publisher
Public Library of Science
Abstract
Percutaneous coronary intervention with bivalirudin plus bail-out
glycoprotein IIb/IIIa inhibitors has been shown to be as effective as
unfractionated heparin plus routine glycoprotein IIb/IIIa inhibitors in
preventing cardiac ischemic events, but with a lower bleeding risk. It is
unknown whether bivalirudin would have the same beneficial effects if
compared with heparin when the use of glycoprotein IIb/IIIa inhibitors was
similar between treatment arms. We searched the MEDLINE, Web of Science,
and Cochrane databases from inception until March 2015 for randomized
trials that compared bivalirudin to heparin in patients undergoing
percutaneous coronary intervention. We required that the intended use of
glycoprotein IIb/IIIa inhibitors was similar between the study groups.
Summary estimates were principally constructed by the Peto method. Fifteen
trials met our inclusion criteria, which yielded 25,824 patients.
Bivalirudin versus heparin was associated with an increased hazard of
stent thrombosis (odds ratio [OR] 1.49, 95% confidence interval [CI]
1.15-1.92, P = .002, I² = 16.9%), with a similar hazard of
myocardial infarction (OR 1.09, 95% CI 0.98-1.22, P = .11, I² =
35.8%), all-cause mortality (OR 0.88, 95% CI 0.72-1.08, P = .21,
I² = 31.5%) and major adverse cardiac events (OR 1.04, 95% CI
0.94-1.14, P = .46, I² = 53.9%). Bivalirudin was associated
with a reduced hazard of major bleeding (OR 0.80, 95% CI 0.70-0.92, P =
.001, I² = 63.5%). The dose of heparin in the control arm
modified this association; when the dose of unfractionated heparin in the
control arm was > 100 units/kg, bivalirudin was associated with a
reduction in major bleeding (OR 0.55, 95% CI 0.45-0.68, P < .0001), but
when the dose of unfractionated heparin was < 75 units/kg, bivalirudin was
not associated with reduction in bleeding (OR 1.09, 95% CI 0.91-1.31, P =
.36). Among patients undergoing PCI, bivalirudin was associated with an
increased hazard of stent thrombosis. Bivalirudin may be associated with a
reduced hazard of major bleeding; however, this benefit was no longer
apparent when compared with a dose of unfractionated heparin < 75
units/kg.

<2>
Accession Number
2015051648
Authors
Krogstad L.E.B. Slagsvold K.H. Wahba A.
Institution
(Krogstad, Slagsvold, Wahba) Faculty of Medicine, Norwegian University of
Science and Technology, Aseboen 5, Alesund 6017, Norway
(Slagsvold, Wahba) Department of Cardiothoracic Surgery, St. Olav's
Hospital, Trondheim University Hospital, Norway
Title
Remote ischemic preconditioning and incidence of postoperative atrial
fibrillation.
Source
Scandinavian Cardiovascular Journal. 49 (3) (pp 117-122), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Informa Healthcare
Abstract
Objectives. Although remote ischemic preconditioning (RIPC) has shown
favorable effects on ischemia-reperfusion injury, much remains unknown of
its mechanisms and clinical significance. We hypothesized that RIPC would
reduce the incidence of postoperative atrial fibrillation (POAF) following
coronary artery bypass graft (CABG) surgery. In addition, we investigated
whether RIPC could induce alterations of circulating microRNA in blood
plasma. Design. This is a single-center, double-blind, randomized
controlled trial. 92 adult patients referred for first-time isolated CABG
surgery were randomly assigned to either RIPC (n = 45) or control (n =
47). The RIPC-stimulus comprised three 5-min cycles of upper arm ischemia,
induced by inflating a blood pressure cuff to 200 mmHg, with an
intervening 5 min reperfusion. Heart rhythm was assessed by telemetry.
MicroRNA expression was assessed in plasma by real-time polymerase chain
reaction. Results. Of the 92 patients included in the study, 27 patients
developed POAF (29%). 17 of these patients belonged to the RIPC group
(38%), and 10 to the control group (21%). There were no significant
alterations of microRNA expression. Conclusions. We did not observe a
reduced incidence of POAF by RIPC before CABG surgery. Larger multi-center
studies may be necessary to further clarify this issue.

<3>
Accession Number
2015070332
Authors
Campos C.M. Christiansen E.H. Stone G.W. Serruys P.W.
Institution
(Campos, Serruys) Erasmus University Medical Center, Rotterdam,
Netherlands
(Campos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Christiansen) Department of Cardiology, B Aarhus University Hospital,
Skejby, Denmark
(Stone) Columbia University Medical Center, New York, NY, United States
(Serruys) International Centre for Circulatory Health, NHLI, South
Kensington Campus, London SW7 2AZ, United Kingdom
Title
The EXCEL and NOBLE trials: Similarities, contrasts and future
perspectives for left main revascularisation.
Source
EuroIntervention. 11 (pp V115-V119), 2015. Date of Publication: 01 May
2015.
Publisher
EuroPCR
Abstract
Unprotected left main coronary artery (ULMCA) stenosis has relatively high
prevalence and exposes patients to a high risk for adverse cardiovascular
events. The optimal revascularisation strategy (coronary artery bypass
surgery [CABG] or percutaneous coronary intervention [PCI]) for patients
with complex coronary artery disease is a topic of continuing debate. The
introduction of the newer-generation drug-eluting stents (DES) -with
documented improvements in both safety and efficacy -has prompted the
interventional community to design two new dedicated randomised trials
comparing CABG and PCI: the NOBLE (Coronary Artery Bypass Grafting Vs Drug
Eluting Stent Percutaneous Coronary Angioplasty in the Treatment of
Unprotected Left Main Stenosis) and EXCEL (Evaluation of XIENCE Everolimus
Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of
Left Main Revascularization) trials. The aims of the present review are to
describe the similarities and contrasts between these two trials as well
to explore their future implications in ULMCA treatment.

<4>
Accession Number
2015785313
Authors
Hofsten D.E. Kelbaek H. Helqvist S. Klovgaard L. Holmvang L. Clemmensen P.
Torp-Pedersen C. Tilsted H.-H. Botker H.E. Jensen L.O. Kober L. Engstrom
T.
Institution
(Hofsten, Kelbaek, Helqvist, Klovgaard, Holmvang, Clemmensen, Kober,
Engstrom) Department of Cardiology, Heart Center, Copenhagen University
Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
(Torp-Pedersen, Tilsted) Department of Cardiology, Aalborg University
Hospital, Aalborg, Denmark
(Botker) Department of Cardiology, Aarhus University Hospital, Skejby
Hospital, Aarhus, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
Title
The Third DANish Study of Optimal Acute Treatment of Patients with
ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or
deferred stent implantation versus conventional primary angioplasty and
complete revascularization versus treatment of culprit lesion only:
Rationale and design of the DANAMI 3 trial program.
Source
American Heart Journal. 169 (5) (pp 613-621), 2015. Date of Publication:
01 May 2015.
Publisher
Mosby Inc.
Abstract
Background In patients undergoing primary percutaneous coronary
intervention for ST-segment elevation myocardial infarction, ischemic
postconditioning has been shown to reduce infarct size, but the effect on
clinical outcome has not been tested in a large randomized trial. In
addition, deferring stent implantation in the infarct-related lesion 1 to
3 days after acute opening of the infarct-related artery could have
protective effects, by reducing the risk of injury caused by distal
embolization and microvascular obstruction. Finally, a considerable
fraction of patients present with lesions in other coronary artery
branches than the infarct-related artery. Whether a strategy of complete
or partial revascularization of these patients should be preferred remains
uncertain. Study design The DANAMI 3 trial program was designed to
investigate 3 different randomized treatment strategies in patients with
ST-segment elevation myocardial infarction: (1) ischemic postconditioning
versus conventional treatment with a primary end point of death and
hospitalization for heart failure; (2) deferring stent implantation in the
infarct-related lesion versus conventional treatment with a primary end
point of death, hospitalization for heart failure, reinfarction, and
repeat revascularization; and (3) treatment of the culprit lesion only
versus fractional flow reserve-guided complete revascularization in
patients with multivessel disease, with a primary end point of death,
reinfarction, and repeat revascularization. Summary The DANAMI 3 trial
program will determine whether either of 2 approaches to reduce
reperfusion injury and distal microvascular obstruction with
postconditioning or deferred stent implantation will translate into
improved clinical outcome and whether patients with multivessel disease
undergoing primary percutaneous coronary intervention will benefit from a
strategy of complete or partial revascularization.

<5>
Accession Number
2015041550
Authors
Kumar A. Mhaskar R. Grossman B.J. Kaufman R.M. Tobian A.A.R. Kleinman S.
Gernsheimer T. Tinmouth A.T. Djulbegovic B.
Institution
(Kumar, Mhaskar, Djulbegovic) Division of Evidence-Based Medicine,
Department of Internal Medicine, University of South Florida, 3515 East
Fletcher Avenue, Tampa, FL 33612, United States
(Kumar, Djulbegovic) Moffitt Cancer Center, Tampa, FL, United States
(Grossman) Washington University, School of Medicine, St Louis, MO, United
States
(Kaufman) Brigham and Women's Hospital, Boston, MA, United States
(Tobian) Johns Hopkins Hospital, Baltimore, MD, United States
(Kleinman) Center for Blood Research, University of British Columbia,
Vancouver, BC, Canada
(Gernsheimer) University of Washington, Medical Center and Seattle Cancer
Care Alliance, Seattle, WA, United States
(Tinmouth) Ottawa Hospital and Research Institute, Ottawa, ON, Canada
Title
Platelet transfusion: A systematic review of the clinical evidence.
Source
Transfusion. 55 (5) (pp 1116-1127), 2015. Date of Publication: 01 May
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Platelet (PLT) transfusion is indicated either
prophylactically or therapeutically to reduce the risk of bleeding or to
control active bleeding. Significant uncertainty exists regarding the
appropriate use of PLT transfusion and the optimal threshold for
transfusion in various settings. We formulated 12 key questions to assess
the role of PLT transfusion. Study Design and Methods: We performed a
systematic review (SR) of randomized controlled trials (RCTs) and
observational studies. A comprehensive search of PubMed, Web of Science,
and Cochrane registry of controlled trials was performed. Methodologic
quality of included studies was assessed and a meta-analysis was performed
if more than two studies with similar designs were identified for a
specific question. Results: Seventeen RCTs and 55 observational studies
were included in the final SR. Results: from RCTs showed a beneficial
effect of prophylactic compared with therapeutic transfusion for the
prevention of significant bleeding in patients with hematologic disorders
undergoing chemotherapy or stem cell transplantation. We found no
difference in significant bleeding events related to the PLT count
threshold for transfusion or the dose of PLTs transfused. Overall
methodologic quality of RCTs was moderate. Results: from observational
studies showed no evidence that PLT transfusion prevented significant
bleeding in patients undergoing central venous catheter insertions, lumbar
puncture, or other surgical procedures. The methodologic quality of
observational studies was very low. Conclusion: We provide a comprehensive
assessment of evidence on the use of PLT transfusions in a variety of
clinical settings. Our report summarizes current knowledge and identifies
gaps to be addressed in future research.

<6>
[Use Link to view the full text]
Accession Number
2015037470
Authors
Biccard B.
Institution
(Biccard) Perioperative Research Group, Department of Anaesthesiology and
Critical Care, University of Kwazulu-Natal, Private Bag 7, Congella,
Kwazulu-Natal 4013, South Africa
Title
Proposed research plan for the derivation of a new cardiac risk index.
Source
Anesthesia and Analgesia. 120 (3) (pp 543-553), 2015. Date of Publication:
04 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The Revised Cardiac Risk Index (RCRI) was incorporated into the American
College of Cardiology/American Heart Association (ACC/AHA) recommendations
for the preoperative evaluation of the cardiac patient for noncardiac
surgery. The purpose of this review was to analyze studies on
cardiovascular clinical risk prediction that had used the previous
"standard best" model, the RCRI, as a comparator. This review aims to
determine whether modification of the current risk factors or adoption of
other risk factors or other risk indices would improve upon the
discrimination of cardiac risk prediction when compared with the RCRI.
This is necessary because recent risk prediction models have shown better
discrimination for major adverse cardiac events, and the pre-eminence of
the RCRI is now in question. There is now a need for a new "best
standard"cardiovascular risk prediction model to supersede the RCRI. This
is desirable because it would: (1) allow for a global standard of
cardiovascular risk assessment; (2) provide a standard comparator in all
risk prediction research; (3) result in comparable data collection; and
(4) allow for individual patient data meta-analyses. This should lead to
continued progress in cardiovascular clinical risk prediction. A review of
the current evidence suggests that to improve the preoperative clinical
risk stratification for adverse cardiac events, a new risk stratification
model be built that maintains the clinical risk factors identified in the
RCRI, with the following modifications: (1) additional glomerular
filtration rate cut points (as opposed to a single creatinine cut point);
(2) age; (3) a history of peripheral vascular disease; (4) functional
capacity; and (5) a specific surgical procedural category. One would
expect a substantial improvement in the discrimination of the RCRI with
this approach. Although most noncardiac surgeries will benefit from a
standard "generic" cardiovascular risk prediction model, there are data to
suggest that patients with human immunodeficiency virus disease who are
undergoing vascular surgery may benefit from specific cardiovascular risk
prediction models.

<7>
[Use Link to view the full text]
Accession Number
2015037468
Authors
Glance L.G. Kellermann A.L. Hannan E.L. Fleisher L.A. Eaton M.P. Dutton
R.P. Lustik S.J. Li Y. Dick A.W.
Institution
(Glance, Eaton, Lustik) Department of Anesthesiology, University of
Rochester School of Medicine, Rochester, NY, United States
(Li) Department of Public Health Sciences, University of Rochester School
of Medicine, Rochester, NY, United States
(Glance, Dick) RAND Health, RAND, Boston, MA, United States
(Kellermann) F. Edward Hebert School of Medicine, Uniformed Services
University of the Health Sciences, Bethesda, MD, United States
(Hannan) School of Public Health, University at Albany, State University
of New York, Albany, NY, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Dutton) Anesthesia Quality Institute, Park Ridge, IL, United States
Title
The impact of anesthesiologists on coronary artery bypass graft surgery
outcomes.
Source
Anesthesia and Analgesia. 120 (3) (pp 526-533), 2015. Date of Publication:
04 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: One of every 150 hospitalized patients experiences a lethal
adverse event; nearly half of these events involves surgical patients.
Although variations in surgeon performance and quality have been reported
in the literature, less is known about the influence of anesthesiologists
on outcomes after major surgery. Our goal of this study was to determine
whether there is significant variation in outcomes between
anesthesiologists after controlling for patient case mix and hospital
quality. METHODS: Using clinical data from the New York State Cardiac
Surgery Reporting System, we conducted a retrospective observational study
of 7920 patients undergoing isolated coronary artery bypass graft surgery.
Multivariable logistic regression modeling was used to examine the
variation in death or major complications (Q-wave myocardial infarction,
renal failure, stroke) across anesthesiologists, controlling for patient
demographics, severity of disease, comorbidities, and hospital quality.
RESULTS: Anesthesiologist performance was quantified using fixed-effects
modeling. The variability across anesthesiologists was highly significant
(P < 0.001). Patients managed by low-performance anesthesiologists
(corresponding to the 25th percentile of the distribution of
anesthesiologist risk-adjusted outcomes) experienced nearly twice the rate
of death or serious complications (adjusted rate 3.33%; 95% confidence
interval [CI], 3.09%-3.58%) as patients managed by high-performance
anesthesiologists (corresponding to the 75th percentile) (adjusted rate
1.82%; 95% CI, 1.58%-2.10%). This performance gap was observed across all
patient risk groups. CONCLUSIONS: The rate of death or major complications
among patients undergoing coronary artery bypass graft surgery varies
markedly across anesthesiologists. These findings suggest that there may
be opportunities to improve perioperative management to improve outcomes
among high-risk surgical patients.

<8>
Accession Number
2015900659
Authors
Huang B.-T. Huang F.-Y. Zuo Z.-L. Liao Y.-B. Heng Y. Wang P.-J. Gui Y.-Y.
Xia T.-L. Xin Z.-M. Liu W. Zhang C. Chen S.-J. Pu X.-B. Chen M. Huang
D.-J.
Institution
(Huang, Huang, Zuo, Liao, Wang, Gui, Xia, Xin, Liu, Zhang, Chen, Pu, Chen,
Huang) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
(Heng) Department of Family Medicine, West China Hospital, Sichuan
University, Chengdu, China
Title
Meta-analysis of relation between oral beta-blocker therapy and outcomes
in patients with acute myocardial infarction who underwent percutaneous
coronary intervention.
Source
American Journal of Cardiology. 115 (11) (pp 1529-1538), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier Inc.
Abstract
The aim of the present review was to investigate the association between
the use of oral beta-blockers and prognosis in patients with acute
myocardial infarction (AMI) who underwent percutaneous coronary
intervention (PCI) treatment. A systematic literature search was conducted
in Pubmed (from inception to September 27, 2014) and Embase (Ovid SP, from
1974 to September 29, 2014) to identify studies that compared the outcome
of patients with AMI taking oral beta-blockers with that of patients not
taking after PCI. Systematic review and meta-analysis were performed with
random-effects model or fixed-effects model. Ten observational studies
with a total of 40,873 patients were included. Use of beta-blockers was
associated with a reduced risk of all-cause death (unadjusted relative
risk 0.58, 95% confidential interval 0.48 to 0.71; adjusted hazard ratio
0.76, 95% confidential interval 0.62 to 0.94). The potential benefit of
beta-blockers in preventing all-cause death was not similar in all
population but was restricted to those with reduced ejection fraction,
with low use proportion of other secondary prevention drugs or with
non-ST-segment elevation myocardial infarction. The association between
the use of beta-blockers and improved survival rate was significant in
<1-year follow-up duration. Rates of cardiac death, myocardial infarction,
and heart failure readmission in patients using beta-blockers were not
significantly different from those in patients without beta-blocker
therapy. In conclusion, there is lack of evidence to support routine use
of beta-blockers in all patients with AMI who underwent PCI. Further
trials are urgently needed to address the issue.

<9>
Accession Number
2015886322
Authors
Elgendy I.Y. Mahmoud A. Huo T. Beaver T.M. Bavry A.A.
Institution
(Elgendy, Mahmoud, Huo, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Beaver) Department of Surgery, University of Florida, Gainesville, FL,
United States
(Bavry) North Florida/South Georgia Veterans Health Systems, Gainesville,
FL, United States
Title
Meta-analysis of 12 trials evaluating the effects of statins on decreasing
atrial fibrillation after coronary artery bypass grafting.
Source
American Journal of Cardiology. 115 (11) (pp 1523-1528), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier Inc.
Abstract
Atrial fibrillation (AF) is a common arrhythmia encountered after coronary
artery bypass graft surgery (CABG) and is associated with poor outcomes.
The purpose of this study was to examine whether initiation of statins
before CABG reduces the risk of postoperative AF. We searched for clinical
trials that randomized patients who underwent CABG to preoperative statin
therapy versus placebo. We required that the trial reported the incidence
of postoperative AF. Random-effects summary odds ratio (OR) were
constructed. Sensitivity analysis for the trials that reported AF as a
primary outcome along with subgroup analyses according to the different
statins used was also conducted. Twelve trials with 2,980 patients met our
inclusion criteria. Atorvastatin was tested in 8 trials, whereas
rosuvastatin was studied in 2 studies. Statins were associated with a
lower risk of postoperative AF (OR 0.42, 95% confidence interval [CI] 0.27
to 0.66, p <0.0001). There was benefit with atorvastatin (OR 0.35, 95% CI
0.25 to 0.50, p <0.0001) but not rosuvastatin (OR 0.69, 95% CI 0.28 to
1.71, p = 0.42). On sensitivity analysis limited to trials that reported
AF as a primary outcome, the risk of postoperative AF was still reduced
with statins (OR 0.40, 95% CI 0.25 to 0.90, p = 0.02). The mean duration
of the hospital stay was significantly lower in the statin group: 8.5 +/-
1.8 days versus 9.1 +/- 2.2 days (p <0.0001). Statin therapy, particularly
atorvastatin, before CABG was associated with a reduction in the risk of
postoperative AF.

<10>
Accession Number
2015877909
Authors
El-Hayek G.E. Gershlick A.H. Hong M.K. Dominguez A.C. Banning A. Afshar
A.E. Herzog E. Tamis-Holland J.E.
Institution
(El-Hayek, Hong, Dominguez, Afshar, Herzog, Tamis-Holland) Department of
Cardiology, Mount Sinai Saint Luke's Hospital, New York, NY, United States
(Gershlick, Banning) NIHR Leicester Cardiovascular Biomedical Research
Unit, University of Leicester, Leicester, United Kingdom
Title
Meta-analysis of randomized controlled trials comparing multivessel versus
culprit-only revascularization for patients with ST-segment elevation
myocardial infarction and multivessel disease undergoing primary
percutaneous coronary intervention.
Source
American Journal of Cardiology. 115 (11) (pp 1481-1486), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Elsevier Inc.
Abstract
Current guidelines recommend against revascularization of the noninfarct
artery during the index percutaneous coronary intervention (PCI) in
hemodynamically stable patients with ST-segment elevation myocardial
infarction (STEMI). This was based largely on observational studies with
few data coming from randomized controlled trials (RCTs). Recently,
several small-to-moderate sized RCTs have provided data, suggesting that a
multivessel revascularization approach may be appropriate. We performed a
meta-analysis of RCTs comparing multivessel percutaneous coronary
intervention (MV PCI) versus culprit vessel-only revascularization (COR)
during primary PCI in patients with STEMI and multivessel coronary disease
(MVCD). We searched Medline, PubMed, and Scopus databases for RCTs
comparing MV PCI versus COR in patients with STEMI and MVCD. The incidence
of all-cause death, cardiac death, recurrent myocardial infarction, and
revascularization during follow-up were extracted. Four RCTs fit our
primary selection criteria. Among these, 566 patients underwent MV PCI
(either at the time of the primary PCI or as a staged procedure) and 478
patients underwent COR. During long-term follow-up (range 1 to 2.5 years),
combined data indicated a significant reduction in all-cause mortality
(relative risk [RR] 0.57, 95% confidence interval [CI] 0.36 to 0.92, p =
0.02) and in cardiac death (RR 0.38, 95% CI 0.20 to 0.73, p = 0.004) with
MV PCI. In addition, there was a significantly lower risk of recurrent
myocardial infarction (RR 0.41, 95% CI 0.23 to 0.75; p = 0.004) and future
revascularization (RR 0.37, 95% CI 0.27 to 0.52; p <0.00001). In
conclusion, from the RCT data, MV PCI appears to improve outcomes in
patients with STEMI and MVCD.

<11>
Accession Number
2015836356
Authors
Dunne B. Xiao A. Litton E. Andrews D.
Institution
(Dunne) Western Australian Cardiothoracic Research and Audit Group (WA
CRAG), Perth, WA, Australia
(Dunne, Xiao, Andrews) Department of Cardiothoracic Surgery, Royal Perth
Hospital, Perth, WA 6000, Australia
(Litton) Intensive Care Unit, Fiona Stanley Hospital, University of
Western Australia, Perth, Australia
Title
Mechanical prostheses for right ventricular outflow tract reconstruction:
A systematic review and meta-analysis.
Source
Annals of Thoracic Surgery. 99 (5) (pp 1841-1847), 2015. Date of
Publication: 01 May 2015.
Publisher
Elsevier USA
Abstract
It remains unclear as to whether mechanical valves have a role in
pulmonary valve replacement. A systematic review and meta-analysis was
performed to answer this question. Nineteen observational studies,
including 299 pediatric and adult patients with a mean follow-up of 73
months, were analyzed. Nonstructural valve deterioration and valve
thrombosis occurred in 1.5% and 2.2% of patients, respectively. Surgical
reintervention was required in 0.9% of cases and thrombolysis was required
in 0.5%. Mechanical valves in the pulmonary position are associated with a
low incidence of valve deterioration and thrombosis, as well as freedom
from reoperation and thrombolysis.

<12>
Accession Number
2015833200
Authors
Altarabsheh S.E. Deo S.V. Rababa'H A.M. Lim J.Y. Cho Y.H. Sharma V. Jung
S.H. Shin E. Markowitz A.H. Park S.J.
Institution
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Department of Cardiovascular Surgery, University
Hospitals, Case Western Reserve University, Cleveland, OH, United States
(Rababa'H) Department of Clinical Pharmacy, Jordan University of Science
and Technology, Irbid, Jordan
(Lim, Jung, Shin) Department of Cardiovascular Surgery, Asan Medical
Center, Seoul, South Korea
(Cho) Department of Cardiovascular Surgery, Samsung Hospital, Sungkyunkwan
University of Medical Sciences, Seoul, South Korea
(Sharma) Department of General Surgery, Wellspan York Hospital, York, PA,
United States
Title
Off-pump coronary artery bypass reduces early stroke in octogenarians: A
meta-analysis of 18,000 patients.
Source
Annals of Thoracic Surgery. 99 (5) (pp 1568-1575), 2015. Date of
Publication: 01 May 2015.
Publisher
Elsevier USA
Abstract
Background Data comparing results of off-pump and conventional operations
in octogenarians is very limited. Thus we chose to compare early adverse
events between off-pump coronary artery bypass grafting (OPCABG) and
on-pump CABG (ONCABG) in patients older than 80 years. Methods Systematic
review of multiple databases was performed to obtain original studies
fulfilling search criteria. End points - early mortality, stroke,
respiratory failure, atrial fibrillation, and myocardial infarction - were
compared between these cohorts. A random-effects weighted analysis was
performed using the trim-fill adjustment when necessary. Results are
presented as risk ratios (RRs) with 95% confidence intervals (CIs); p <
0.05 is considered statistically significant. Results Sixteen
retrospective studies (9,744 ONCABG and 8,566 OPCABG patients) were
included in the systematic review. OPCAGB patients received significantly
fewer grafts (2.54 +/- 0.16) compared with ONCABG patients (3.22 +/-
0.41). Early mortality was comparable at 4.6% and 5.2% in the OPCABG and
ONCABG cohorts, respectively (risk ratio [RR], 0.91; 95% CI, 0.64-1.28; p
= 0.598). Stroke rates were higher in the ONCABG cohort (RR, 0.65; 95% CI,
0.49- 0.87; p < 0.01). Respiratory failure was higher with ONCABG (RR,
0.74; 95% CI, 0.57-0.97; p = 0.03). New-onset renal failure (p = 0.99),
atrial fibrillation (p = 0.27), and myocardial infarction (p = 0.99) were
comparable. Conclusions Coronary artery bypass in octogenarians can be
performed safely with low early mortality. Although off-pump operations
reduce the risk of early stroke, all other adverse events are comparable
in on- and off-pump coronary artery bypass operations. Data regarding late
mortality is at present limited; however, both on- and off-pump procedures
appear to produce comparable survival.

<13>
Accession Number
2015827277
Authors
O'Donoghue M.L. Glaser R. Aylward P.E. Cavender M.A. Crisp A. Fox K.A.A.
Laws I. Lopez-Sendon J.L. Steg P.G. Theroux P. Sabatine M.S. Morrow D.A.
Institution
(O'Donoghue, Cavender, Sabatine, Morrow) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, MA 02115, United States
(Glaser, Crisp, Laws) GlaxoSmithKline Pharmaceuticals, King of Prussia,
PA, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University, Medical Centre, Adelaide, SA, Australia
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Lopez-Sendon) Cardiovascular Division, University Hospital La Paz,
Madrid, Spain
(Steg) FACT, DHU FIRE, Universite Paris-Diderot, Sorbonne Paris-Cite,
France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Theroux) Montreal Heart Institute, University of Montreal, Montreal, QC,
Canada
Title
Rationale and design of the LosmApimod To Inhibit p38 MAP kinase as a
TherapeUtic target and moDify outcomes after an acute coronary syndromE
trial.
Source
American Heart Journal. 169 (5) (pp 622-630.e6), 2015. Date of
Publication: 01 May 2015.
Publisher
Mosby Inc.
Abstract
Background p38 mitogen-activated protein kinase (MAPK) mediates cytokine
production and amplification of the inflammatory cascade. Through
inhibition of p38 MAPK, losmapimod appears to attenuate the inflammatory
response in the vascular wall and thus may help stabilize plaques. Study
design The LATITUDE-TIMI 60 trial is a randomized, double-blind,
placebo-controlled, parallel-group, multicenter study planned to be
conducted in a 3-stage design. Overall, the trial is designed to include
25,500 patients hospitalized with non-ST-elevation or ST-elevation
myocardial infarction (MI) randomized to oral losmapimod (7.5 mg twice
daily) versus matching placebo. Part A consists of a leading cohort (n =
3,500) that will provide an initial assessment of safety and exploratory
efficacy before progressing to part B. Part B (n = ~22,000) of the study
is event driven and will provide the primary assessment of efficacy. An
independent safety review will be conducted after 3,500 patients in part
B1 to determine whether a more focused schedule of clinic visits and
laboratory assessments can be implemented (part B2). All patients are to
be treated with study drug until week 12 and followed up until week 24.
The primary end point is the composite of cardiovascular death, MI, or
severe recurrent ischemia requiring urgent coronary revascularization. The
key secondary end point is the composite of cardiovascular death or MI.
The trial is designed to provide >90% power for the primary end point.
Conclusions The LATITUDE-TIMI 60 trial will determine the efficacy and
safety of short-term p38 MAPK inhibition with losmapimod in acute MI. The
trial design adopts a stepwise approach to decision making and collection
of data.

<14>
[Use Link to view the full text]
Accession Number
2015044489
Authors
Doyle F. McGee H. Conroy R. Conradi H.J. Meijer A. Steeds R. Sato H.
Stewart D.E. Parakh K. Carney R. Freedland K. Anselmino M. Pelletier R.
Bos E.H. De Jonge P.
Institution
(Doyle) Division of Population Health Sciences (Psychology), Epidemiology
and Public Health Medicine, Royal College of Surg. in Ireland, 123 St
Stephen's Green, Dublin 2, Ireland
(Conroy) Population Health Sciences, Epidemiology and Public Health
Medicine, Royal College of Surg. in Ireland, Ireland
(McGee) Faculty of Medicine and Health Sciences, Royal College of Surg. in
Ireland, Ireland
(Conradi) Department of Clinical Psychology, University of Amsterdam,
Amsterdam, Netherlands
(Meijer, Bos, De Jonge) Interdisciplinary Center Psychopathology and
Emotion Regulation, University Medical Center Groningen, Groningen,
Netherlands
(Steeds) Department of Cardiology, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Sato) School of Human Welfare Studies, Kwansei Gakuin University,
Nishinomiya, Japan
(Stewart) University Health Network, University of Toronto, Toronto, ON,
Canada
(Parakh) Department of Medicine, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Carney, Freedland) Department of Psychiatry, Washington University, St
Louis, MI, United States
(Anselmino) Division of Cardiology, Department of Medical Sciences,
University of Turin, Turin, Italy
(Pelletier) McGill University Health Centre, Montreal, Canada
Title
Systematic review and individual patient data meta-analysis of sex
differences in depression and prognosis in persons with myocardial
infarction: A MINDMAPS study.
Source
Psychosomatic Medicine. 77 (4) (pp 419-428), 2015. Date of Publication: 15
May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Using combined individual patient data from prospective
studies, we explored sex differences in depression and prognosis
post-myocardial infarction (MI) and determined whether disease indices
could account for found differences. Methods: Individual patient data
analysis of 10,175 MI patients who completed diagnostic interviews or
depression questionnaires from 16 prospective studies from the MINDMAPS
study was conducted. Multilevel logistic and Cox regression models were
used to determine sex differences in prevalence of depression and
sex-specific effects of depression on subsequent outcomes. Results:
Combined interview and questionnaire data from observational studies
showed that 36% (635/1760) of women and 29% (1575/5526) of men reported
elevated levels of depression (age-adjusted odds ratio = 0.68, 95%
confidence interval [CI] = 0.60-0.77). The risk for all-cause mortality
associated with depression was higher in men (hazard ratio = 1.38, 95% CI
= 1.30-1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14-1.31; sex
by depression interaction: p <.001). Low left ventricular ejection
fraction (LVEF) was associated with higher depression scores in men only
(sex by LVEF interaction: B = 0.294, 95% CI = 0.090-0.498), which
attenuated the sex difference in the association between depression and
prognosis. Conclusions: The prevalence of depression post-MI was higher in
women than in men, but the association between depression and cardiac
prognosis was worse for men. LVEF was associated with depression in men
only and accounted for the increased risk of all-cause mortality in
depressed men versus women, suggesting that depression in men post-MI may,
in part, reflect cardiovascular disease severity.

<15>
Accession Number
2015048861
Authors
Javaid I. Yao-Jun Z. Holmes D.R. Morice M.-C. Mack M.J. Kappetein A.P. Ted
F. Elizabeth S. Javier E. Banning A.P. Gunn J.P. Colombo A. Steyerberg
E.W. Mohr F.W. Serruys P.W.
Institution
(Javaid, Yao-Jun, Kappetein, Serruys) Thoraxcenter, Erasmus Medical
Centre, Rotterdam, Netherlands
(Steyerberg) Department of Public Health, Erasmus Medical Centre,
Rotterdam, Netherlands
(Javaid, Gunn) University of Sheffield, United Kingdom
(Holmes) Mayo Clinic, Rochester, MN, United States
(Morice) ICPS, Hopital Prive Jacques Cartier, Generale de Sante Massy,
France
(Mack) Heart Hospital, Dallas, TX, United States
(Ted) Evanston Hospital, IL, United States
(Elizabeth) University Hospital Uppsala, Sweden
(Javier) Hospital Clinico San Carlos, Madrid, Spain
(Banning) Oxford University Hospitals, United Kingdom
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Mohr) Herzzentrum Universitat, Leipzig, Germany
(Serruys) International Centre for Circulatory Health, Imperial College,
London, United Kingdom
Title
Optimal medical therapy improves clinical outcomes in patients undergoing
revascularization with percutaneous coronary intervention or coronary
artery bypass grafting: Insights from the Synergy between Percutaneous
Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the
5-year follow-up.
Source
Circulation. 131 (14) (pp 1269-1277), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - There is a paucity of data on the use of optimal medical
therapy (OMT) in patients with complex coronary artery disease undergoing
revascularization with percutaneous coronary intervention or coronary
artery bypass grafting (CABG) and its long-term prognostic significance.
Methods and Results - The Synergy Between Percutaneous Coronary
Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a
multicenter, randomized, clinical trial of patients (n=1800) with complex
coronary disease randomized to revascularization with percutaneous
coronary intervention or CABG. Detailed drug history was collected for all
patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and
5-year follow-ups. OMT was defined as the combination of at least 1
antiplatelet drug, statin, beta-blocker, and angiotensin-converting enzyme
inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were
stratified by OMT and non-OMT. OMT was underused in patients treated with
coronary revascularization, especially CABG. OMT was an independent
predictor of survival. OMT was associated with a significant reduction in
mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85;
P=0.002) and composite end point of death/myocardial infarction/stroke
(hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the
5-year follow-up. The treatment effect with OMT (36% relative reduction in
mortality over 5 years) was greater than the treatment effect of
revascularization strategy (26% relative reduction in mortality with CABG
versus percutaneous coronary intervention over 5 years). On stratified
analysis, all the components of OMT were important for reducing adverse
outcomes regardless of revascularization strategy. Conclusions - The use
of OMT remains low in patients with complex coronary disease requiring
coronary intervention with percutaneous coronary intervention and even
lower in patients treated with CABG. Lack of OMT is associated with
adverse clinical outcomes. Targeted strategies to improve OMT use in
postrevascularization patients are warranted. Clinical Trial Registration
- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

<16>
Accession Number
2015048425
Authors
Lei Y. Gu T. Shi E. Wang C. Qin F.
Institution
(Lei, Gu, Shi, Wang, Qin) Department of Cardiac Surgery, China Medical
University, First Affiliated Hospital, Shenyang, China
Title
Myocardial protection and early outcome of different coronary surgical
techniques for diabetic patients with triple vessels.
Source
Annals of Saudi Medicine. 34 (5) (pp 375-382), 2014. Date of Publication:
01 Sep 2014.
Publisher
King Faisal Specialist Hospital and Research Centre
Abstract
BACKGROUND AND OBJECTIVES: For patients with diabetes and triple-vessel
disease, coronary artery bypass grafting (CABG) surgery is a
well-established procedure, but cardiopulmonary bypass support may also
lead to severe complications to these patients. The aim of this study was
to compare myocardial protection and early outcomes in patients with
diabetes and triple-vessel disease following different coronary surgical
techniques. DESIGN AND SETTINGS: Prospective randomized trial of patients
treated at the First Affiliated Hospital of China Medical University over
a 3-year period (2011- 2013). METHODS: In a single-center randomized
trial, 668 patients with diabetes and triple-vessel disease were randomly
assigned to off-pump (OPCAB) (number [n]=222), on-pump beating heart
(OnP-BH) (n=223), and conventional CABG (OnP) (n=223) between January 2011
and October 2013. Myocardial injury was assessed by measuring the serial
release of cardiac troponin I (cTnI) preoperatively, 1 hour, 12 hours, 24
hours, and 72 hours postoperatively. The early outcomes were compared
among these 3 groups. RESULTS: Preoperative characteristics of the
patients in all 3 groups were similar. No significant difference was found
regarding the number of anastomoses, the use of the internal thoracic
artery, postoperative new-onset atrial fibrillation, hemodialysis, stroke,
reoperation for bleeding, and infective complications in the 3 groups
(P>05). The complete revascularization, postoperative drainage loss,
intra-aortic balloon pump support, blood requirements, postoperative
myocardial infarction, pulmonary complications, gastrointestinal
complications, inotropic requirements >24 hours, ventilation >24 hours,
intensive care unit stay >24 hours, and in-hospital stay >7 days were
significantly lower in the OPCAB group than in the other 2 groups (P<.05).
In-hospital mortality was lower in the OPCAB group than in the other 2
groups, but no statistical difference was observed (P>05). Preoperative
cTnI in the 3 groups was similar (P>05); however, the lowest cTnI value
was noted in the OPCAB group, followed by the OnP group, and it was
highest in the OnP-BH group 1 hour, 12 hours, 24 hours, and 72 hours
postoperatively (P<.05). CONCLUSION: OPCAB is superior to the OnP-BH and
OnP techniques in terms of postoperative complications and myocardial
protection in patients with diabetes and triple-vessel disease. Myocardial
injury in the OnP-BH group was significantly higher than that in the OnP
group.

<17>
Accession Number
2015046119
Authors
Haas T. Gorlinger K. Grassetto A. Agostini V. Simioni P. Nardi G. Ranucci
M.
Institution
(Haas) Department of Paediatric Anaesthesia, University Children's
Hospital Zurich, Steinwiesstrasse 75, Zurich CH-8032, Switzerland
(Gorlinger) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Essen, Essen, Germany
(Grassetto) UOC Anestesia e Rianimazione, Dipartimento di Emergenza
Urgenza, Ospedale dell'Angelo di Mestre, Venice, Italy
(Agostini) Struttura Dipartimentale di Medicina Trasfusionale Ospedale
Bufalini USL Cesena, Italy
(Simioni) Department of Cardiologic, Thoracic, and Vascular Sciences,
University of Padua, Medical School, Padova, Italy
(Nardi) UOC Shock e Trauma, Azienda Ospedaliera S. Camillo-Forlanini,
Rome, Italy
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
Title
Thromboelastometry for guiding bleeding management of the critically ill
patient: A systematic review of the literature.
Source
Minerva Anestesiologica. 80 (12) (pp 1320-1335), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Edizioni Minerva Medica
Abstract
A systematic review of the published literature clearly demonstrates the
usefulness of thromboelastometry (ROTEM) in detecting
coagulation disorders in severe trauma, cardiac and aortic surgery, liver
transplantation, and postpartum haemorrhage reliably and within a
clinically acceptable turn-around time. In all of the above-mentioned
scenarios, the transfusion of any allogeneic blood products could be
reduced significantly using ROTEM-guided bleeding management,
thereby minimising or avoiding transfusion-related side effects. Based on
the current body of evidence as assessed by the GRADE system, the use of
ROTEM may be recommended in particular for management of severe
bleeding after trauma and during cardiac and aortic surgery. However, as
laboratory testing contributes only one part of severe bleeding
management, the implementation of safe and effective treatment algorithms
must be ensured at the same time.

<18>
Accession Number
2015845796
Authors
Ambrosini V. Sorropago G. Laurenzano E. Golino L. Casafina A. Schiano V.
Gabrielli G. Ettori F. Chizzola G. Bernardi G. Spedicato L. Armigliato P.
Spampanato C. Furegato M.
Institution
(Ambrosini, Sorropago, Laurenzano, Golino, Casafina, Schiano) Montevergine
Clinic, Mercogliano, Italy
(Gabrielli) University Hospital Ospedali Riuniti, Ancona, Italy
(Ettori, Chizzola) Spedali Civili University Hospital, Brescia, Italy
(Bernardi, Spedicato) University Hospital S. Maria Misericordia, Udine,
Italy
(Armigliato, Furegato) Istituto Italiano Ricerche Mediche, Verona, Italy
(Spampanato) Telethon Institute of Genetics and Medicine (TIGEM), Naples,
Italy
(Golino) Moriggia-Pelascini Hospital, Gravedona, Como, Italy
Title
Early outcome of high energy Laser (Excimer) facilitated coronary
angioplasty ON hARD and complex calcified and balloOn-resistant coronary
lesions: LEONARDO Study.
Source
Cardiovascular Revascularization Medicine. 16 (3) (pp 141-146), 2015. Date
of Publication: 01 Apr 2015.
Publisher
Elsevier Inc.
Abstract
Aim: An innovative xenon-chlorine (excimer) pulsed laser catheter (ELCA
X80) has been recently used for the treatment of complex coronary lesions,
as calcified stenosis, chronic total occlusions and non-compliant plaques.
Such complex lesions are difficult to adequately treat with balloon
angioplasty and/or intracoronary stenting. The aim of this study was to
examine the acute outcome of this approach on a cohort of patients with
coronary lesions. Methods and Results: Eighty patients with 100 lesions
were enrolled through four centers, and excimer laser coronary angioplasty
was performed on 96 lesions (96%). Safety and effectiveness data were
compared between patients treated with standard laser therapy and those
treated with increased laser therapy. Laser success was obtained in 90
lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and
clinical success in was obtained in 87 lesions (90.6%). There was no
perforation, major side branch occlusion, spasm, no-reflow phenomenon,
dissection nor acute vessel closure. Increased laser parameters were used
successfully for 49 resistant lesions without complications. Conclusions:
This study suggests that laser-facilitated coronary angioplasty is a
simple, safe and effective device for the management of complex coronary
lesions. Furthermore, higher laser energy levels delivered by this
catheter improved the device performance without increasing complications.

<19>
Accession Number
2015062307
Authors
Colli A. Manzan E. Rucinskas K. Janusauskas V. Zucchetta F. Zakarkaite D.
Aidietis A. Gerosa G.
Institution
(Colli, Manzan, Zucchetta, Gerosa) Department of Cardiac, Thoracic and
Vascular Sciences, University of Padua, Via Giustiniani, 2, Padova 35128,
Italy
(Rucinskas, Janusauskas, Zakarkaite, Aidietis) Department of Cardiac
Surgery, University of Vilnius, Vilnius, Lithuania
Title
Acute safety and efficacy of the NeoChord procedure.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 575-581),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES Transapical off-pump mitral valve repair using the NeoChord
device has been proposed to treat degenerative mitral valve regurgitation.
This prospective study sought to evaluate acute safety and efficacy of
this innovative, minimally invasive, transcatheter mitral valve repair
approach. METHODS Symptomatic patients with severe mitral regurgitation
(MR) were selected if they presented a favourable valve anatomy (the
presence of leaflet flail/prolapse with consistent overlap of tissue).
Early device success was defined as placement of at least two neochordae
with residual mitral regurgitation <2+ after the procedure. The primary
acute safety and efficacy end points were evaluated at 30 days. RESULTS
Between February 2013 and June 2014, in Padua and Vilnius University
Hospitals, a total of 62 patients were treated, with a median age of 66
years (IQR 52-76) and a median EuroSCORE I of 1.9% (IQR 0.9-6). Fifty-six
patients (88.9%) presented with a posterior leaflet prolapse, 4 (6%) with
an anterior leaflet prolapse and 3 (5%) with a combined disease. Early
procedural success was achieved in all patients. Two neochordae were
implanted in 2 patients (3%), 3 in 20 (32%), 4 in 28 (44%), 5 in 10 (16%),
6 in 2 (3%) and 7 in 1 (2%). At 30 days, major adverse events included
only 1 acute myocardial infarction (2%) successfully treated
percutaneously and 2 cases of sepsis (3%). Mitral regurgitation at 30 days
was absent in 29 patients (46%), Grade 1+ in 16 (25%), Grade 2+ in 10
(16%), Grade 3+ in 7 (11%) and Grade 4+ in 1 (2%). All 8 patients with MR
>2+ were successfully reoperated with conventional surgery or NeoChord
reintervention. CONCLUSIONS Initial results with the NeoChord procedure in
a small number of patients indicate that transapical off-pump mitral valve
repair is feasible and safe. Efficacy is maintained up to the 30-day
follow-up with significant clinical benefit for patients.

<20>
Accession Number
2015062303
Authors
Toufektzian L. Zisis C. Balaka C. Roussakis A.
Institution
(Toufektzian) Department of Thoracic Surgery, Guy's Hospital, Great Maze
Pond, London SE1 9RT, United Kingdom
(Zisis, Balaka, Roussakis) Department of Cardiothoracic Surgery,
Evangelismos General Hospital, Athens, Greece
Title
Effectiveness of brain natriuretic peptide in predicting postoperative
atrial fibrillation in patients undergoing non-cardiac thoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 654-657),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether plasma brain natriuretic peptide (BNP)
levels could effectively predict the occurrence of postoperative atrial
fibrillation (AF) in patients undergoing non-cardiac thoracic surgery. A
total of 14 papers were identified using the reported search, of which 5
represented the best evidence to answer the clinical question. The
authors, date, journal, country, study type, population, outcomes and key
results are tabulated. All studies were prospective observational, and all
reported a significant association between BNP and N-terminal (NT)-proBNP
plasma levels measured in the immediate preoperative period and the
incidence of postoperative AF in patients undergoing either anatomical
lung resections or oesophagectomy. One study reported a cut-off value of
30 pg/ml above which significantly more patients suffered from
postoperative AF (P < 0.0001), while another one reported that this value
could predict postoperative AF with a sensitivity of 77% and a specificity
of 93%. Another study reported that patients with NT-proBNP levels of 113
pg/ml or above had an 8-fold increased risk of developing postoperative
AF. These findings support that BNP or NT-proBNP levels, especially when
determined during the preoperative period, if increased, are able to
identify patients at risk for the development of postoperative AF after
anatomical major lung resection or oesophagectomy. The same does not seem
to be true for lesser lung resections. These high-risk patients might have
a particular benefit from the administration of prophylactic
antiarrhythmic therapy.

<21>
Accession Number
2015062287
Authors
Arrigoni S.C. Mecozzi G. Grandjean J.G. Hillege J.L. Kappetein A.P.
Mariani M.A.
Institution
(Arrigoni, Mariani) Thoraxcenter, University Medical Center, Hanzeplein 1,
Groningen 9700 RB, Netherlands
(Mecozzi, Grandjean) Thoraxcenter Twente, Enschede, Netherlands
(Hillege) Department of Epidemiology, University Medical Center,
Groningen, Netherlands
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Off-pump no-touch technique: 3-year results compared with the SYNTAX
trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 601-604),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press
Abstract
OBJECTIVES A 3-year follow-up of a retrospective, single-centre clinical
study of OPCAB (off-pump coronary artery bypass) no-touch technique with
arterial composite grafts and an indirect comparison with clinical
outcomes of the 3-year follow-up of the SYNTAX trial. METHODS A total of
400 consecutive patients ('all-comers') who underwent OPCAB no-touch
coronary surgery. Primary endpoint was 3-year MACCE (major adverse
cardiovascular and cerebrovascular events). These results were compared
with the randomized arms of the SYNTAX trial. RESULTS The observed 3-year
survival was 82.2%. The cumulative 3-year freedom from MACCE was 89.7%.
The percentage of MACCE was significantly lower (P < 0.001) in the OPCAB
no-touch group (10.3%) compared with both arms of the SYNTAX trial (20.2
and 28.0%, respectively). Repeat revascularization in the OPCAB no-touch
group (4.3%) was significantly lower (P < 0.001) compared with both arms
of the SYNTAX trial (10.7 and 19.7%, respectively). The percentage of
stroke was significantly lower (P = 0.032) in the OPCAB no-touch group
compared with the CABG arm in the SYNTAX trial (1.3 vs 3.4%). There was no
significant difference of stroke rate between the OPCAB no-touch group and
the PCI arm of the SYNTAX trial (1.3 vs 2%, P = 0.347). CONCLUSIONS The
results at the 3-year follow-up showed the safety and efficacy of OPCAB
no-touch technique. The OPCAB no-touch technique may improve patients'
outcome by minimizing the morbidity and the neurological complications.
Prospective controlled trials are needed to confirm these results.

<22>
Accession Number
2015060755
Authors
Ansari M.T. Ahmadzai N. Coyle K. Coyle D. Moher D.
Institution
(Ansari, Ahmadzai, Moher) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
(Coyle) Brunel University London, Uxbridge, Middlesex, United Kingdom
(Coyle) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Mitral valve clip for treatment of mitral regurgitation: An evidence-based
analysis.
Source
Ontario Health Technology Assessment Series. 15 (12) (pp 1-104), 2015.
Date of Publication: 2015.
Publisher
Medical Advisory Secretariat
Abstract
Background: Many of the 500,000 North American patients with chronic
mitral regurgitation may be poor candidates for mitral valve surgery.
Objective: The objective of this study was to investigate the comparative
effectiveness, harms, and cost-effectiveness of percutaneous mitral valve
repair using mitral valve clips in candidates at prohibitive risk for
surgery. Data Sources: We searched articles in MEDLINE, Embase, and the
Cochrane Library published from 1994 to February 2014 for evidence of
effectiveness and harms; for economic literature we also searched NHS EED
and Tufts CEA registry. Grey literature was also searched. Review Methods:
Primary studies were sought from existing systematic reviews that had
employed reliable search and screening methods. Newer studies were sought
by searching the period subsequent to the last search date of the review.
Two reviewers screened records and assessed study validity. We used the
Cochrane risk of bias tool for randomized, generic assessment for
non-randomized studies, and the Phillips checklist for economic studies.
Results: Ten studies including 1 randomized trial were included. The
majority of the direct comparative evidence compared the mitral valve clip
repair with surgery in patients not particularly at prohibitive surgical
risk. Irrespective of degenerative or functional chronic mitral
regurgitation etiology, evidence of effectiveness and harms is
inconclusive and of very low quality. Very-low-quality evidence indicates
that percutaneous mitral valve clip repair may provide a survival
advantage, at least during the first 1 to 2 years, particularly in
medically managed chronic functional mitral regurgitation. Because of
limitations in the design of studies, the cost-effectiveness of mitral
valve clips in patients at prohibitive risk for surgery also could not be
established. Limitations: Because of serious concerns of risk of bias,
indirectness, and imprecision, evidence is of very low quality.
Conclusions: No meaningful conclusions can be drawn about the comparative
effectiveness, harms, and cost-effectiveness of mitral valve clips in the
population with chronic mitral regurgitation who are at prohibitive risk
for surgery.

<23>
Accession Number
2015039906
Authors
Tsai Y.-C. Phan K. Munkholm-larsen S. Tian D.H. La meir M. Yan T.D.
Institution
(Tsai) Department of Cardiothoracic Surgery, The Prince Charles Hospital,
Chermside, Australia
(Phan, Tian, Yan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan, Munkholm-larsen) Sydney Medical School, University of Sydney,
Sydney, Australia
(Munkholm-larsen) Department of Cardiology, Hvidovre University Hospital,
Copenhagen, Denmark
(La meir) Department of Cardiothoracic Surgery and Cardiology, Academic
Hospital Maastricht and Cardiovascular Research Institute Maastricht,
Maastricht, Netherlands
(La meir) University Hospital Brussels, Brussels, Belgium
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Surgical left atrial appendage occlusion during cardiac surgery for
patients with atrial fibrillation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 47 (5) (pp 847-854), 2014.
Article Number: ezu291. Date of Publication: 19 Nov 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during
surgical ablation has emerged as a potential treatment strategy to reduce
stroke and perioperative mortality in patients with atrial fibrillation
(AF). The present meta-analysis aims to assess current evidence on the
efficacy and safety between LAAO and LAA preservation cohorts for patients
undergoing cardiac surgery. METHODS: Electronic searches were performed
using six electronic databases from their inception to November 2013,
identifying all relevant comparative randomized and observational studies
comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery.
Data were extracted and analysed according to predefined endpoints
including mortality, stroke, postoperative AF and reoperation for
bleeding. RESULTS: Seven relevant studies identified for qualitative and
quantitative analyses, including 3653 patients undergoing LAAO (n = 1716)
versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in
the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio
(OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P =
0.01), compared with the non-LAAO group. Incidence of all-cause mortality
was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003),
while postoperative AF and reoperation for bleeding was comparable.
CONCLUSIONS: While acknowledging the limitations and inadequate
statistical power of the available evidence, this study suggests LAAO as a
promising strategy for stroke reduction perioperatively and at the
short-term follow-up without a significant increase in complications.
Larger randomized studies in the future are required, with clearer
surgical and anticoagulation protocols and adequate long-term follow-up,
to validate the clinical efficacy of LAAO versus non-LAAO groups.

<24>
Accession Number
2015039897
Authors
Zhang Y. Ma L.
Institution
(Zhang, Ma) Department of Cardiothoracic Surgery, First Affiliated
Hospital of Zhejiang University, Hangzhou, China
Title
Effect of preoperative angiotensin-converting enzyme inhibitor on the
outcome of coronary artery bypass graft surgery.
Source
European Journal of Cardio-thoracic Surgery. 47 (5) (pp 788-795), 2014.
Article Number: ezu298. Date of Publication: 19 Nov 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The safety of the preoperative administration of angiotensin-converting
enzyme inhibitors (ACEIs) in patients undergoing coronary artery bypass
grafting (CABG) surgery is still uncertain. This systematic review thus
evaluated the effect of preoperative ACEIs on the clinical outcomes in
patients undergoing CABG surgery. We searched PubMed, the Cochrane Library
and the Web of Science for randomized control trials or observational
studies that compared the use of ACEIs with that of placebos before
isolated CABG. Thirteen studies (3 randomized control trials and 10
observational studies) that included 31 390 patients met the eligibility
criteria. Preoperative ACEI treatment increased the risk of hypotension
[risk ratio (RR) = 2.36, 95% confidence interval (CI) 1.11-5.02, P =
0.03], postoperative myocardial infarction (RR = 1.14, 95% CI 1.02-1.27, P
= 0.02) and postoperative renal dysfunction (RR = 1.26, 95% CI 1.00-1.60,
P = 0.05) in patients undergoing on-pump CABG, but had no significant
impact on the risk of postoperative atrial fibrillation (RR = 0.79, 95% CI
0.37-1.71, P = 0.56) or postoperative stroke (RR = 1.17, 95% CI 0.74-1.85,
P = 0.50), and did not influence the early mortality (RR = 1.21, 95% CI
0.95-1.54, P = 0.12) in patients undergoing on-pump CABG. Preoperative use
of ACEIs increased the risk of several postoperative complications in
patients undergoing CABG. Further randomized studies are needed to more
clearly elucidate the risks and benefits of ACEI therapy before CABG.