EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012524975
Authors
Cho J.S. Song J.W. Na S. Moon J.-H. Kwak Y.L.
Institution
(Cho, Song, Na, Moon, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul, South Korea
(Song, Kwak) Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of a single bolus of methylene blue prophylaxis on vasopressor and
transfusion requirement in infective endocarditis patients undergoing
cardiac surgery.
Source
Korean Journal of Anesthesiology. 63 (2) (pp 142-148), 2012. Date of
Publication: August 2012.
Publisher
Korean Society of Anesthesiologists
Abstract
Background: The accentuated nitric oxide (NO) release that is induced by
the systemic inflammatory response associated with infective endocarditis
(IE) and cardiopulmonary bypass (CPB) may result in catecholamine
refractory hypotension (vasoplegia) and increased transfusion requirement
due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of
inducible NO. We aimed to evaluate the effect of prophylactic MB
administration before CPB on vasopressor and transfusion requirements in
patients with IE undergoing valvular heart surgery (VHS). Methods:
Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB
(MB group, n = 21) or saline (control group, n = 21) for 20 min before the
initiation of CPB. The primary end points were comparisons of vasopressor
requirements serially assessed after weaning from CPB and hemodynamic
parameters serially recorded before and after CPB. The secondary endpoint
was the comparison of transfusion requirements. Results: Two patients in
the control group received MB after weaning from CPB due to norepinephrine
and vasopressin refractory vasoplegia and were thus excluded. There were
no significant differences in vasopressor requirements and hemodynamic
parameters between the two groups. The mean number of units of packed
erythrocytes transfused per transfused patient was significantly less in
the MB group. The numbers of patients transfused with fresh frozen plasma
and platelet concentrates were less in the MB group. Conclusions: In IE
patients undergoing VHS, prophylactic MB administration before CPB did not
confer significant benefits in terms of vasopressor requirements and
hemodynamic parameters, but it was associated with a significant reduction
in transfusion requirement. &#xa9; the Korean Society of
Anesthesiologists, 2012.

<2>
Accession Number
2015853770
Authors
Ottens T.H. Hendrikse J. Slooter A.J.C. Van Herwerden L.A. Dieleman J.M.
Van Dijk D.
Institution
(Ottens, Dieleman) Department of Anesthesiology, University Medical Centre
Utrecht, Mail Stop Q. 042313, Utrecht 3508 GA, Netherlands
(Hendrikse) Department of Radiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine, University
Medical Centre Utrecht, Utrecht, Netherlands
(Van Herwerden) Department of Cardiothoracic Surgery, University Medical
Centre Utrecht, Utrecht, Netherlands
Title
Low incidence of early postoperative cerebral edema after coronary artery
bypass grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (3) (pp 632-636),
2015. Date of Publication: 01 Jun 2015.
Publisher
W.B. Saunders
Abstract
Objective Using magnetic resonance imaging, the authors studied the
influence of a single high dose of intraoperative dexamethasone on the
severity of cerebral edema that can occur early after coronary artery
bypass grafting (CABG). It was hypothesized that high-dose intraoperative
dexamethasone reduces cerebral edema after CABG. Design Secondary analysis
in a subset of participants of the Dexamethasone for Cardiac Surgery
(DECS) trial. The DECS trial was a multicenter, randomized, double-blind,
placebo-controlled trial in 4,494 cardiac surgery patients, which studied
the effect of high-dose dexamethasone on mortality and major complications
after cardiac surgery. Setting A large university hospital in The
Netherlands. Participants Twenty adult patients who underwent CABG with
cardiopulmonary bypass (CPB) between March and November 2011.
Interventions Participants received a single intravenous dose of
dexamethasone, 1 mg/kg, or placebo, at induction of anesthesia.
Measurements and Main Results Patients underwent magnetic resonance
imaging scanning immediately after surgery. The primary outcome was the
severity of cerebral edema. Data from 18 patients (9 in each group, median
age 69 years in both groups) could be analyzed. Patients in the
dexamethasone group were (median, interquartile range 66 (53-99) minutes
on cardiopulmonary bypass v 95 (81-105) minutes in the placebo group (p =
0.11). Only 1 patient in the dexamethasone group had slight cerebral edema
(0% v 11%, p = 1.00), and edema severity did not differ between groups (p
= 1.00). Conclusions Relevant degrees of early postoperative cerebral
edema were not observed. The present study findings strongly contrasted
with older studies showing cerebral edema early after CABG in most
patients.

<3>
Accession Number
2015853075
Authors
Odling Davidsson F. Johagen D. Appelblad M. Svenmarker S.
Institution
(Odling Davidsson, Johagen, Appelblad, Svenmarker) Department of Surgical
and Perioperative Science, Heart Centre Umea University, Umea 901 85,
Sweden
Title
Reversal of heparin after cardiac surgery: Protamine titration using a
statistical model.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (3) (pp 710-714),
2015. Date of Publication: 01 Jun 2015.
Publisher
W.B. Saunders
Abstract
Objective To establish a statistical model for determination of protamine
dose in conjunction with cardiopulmonary bypass. Design Prospective.
Setting University hospital. Participants Ninety consecutive cardiac
surgical patients. Interventions None. Measurements and Main Results A
series of clinically oriented variables were introduced into a statistical
model for projection of the protamine dose after cardiopulmonary bypass.
The following significant predictors were identified using multivariable
regression analysis: The patient's body surface area, the administered
dose of heparin, heparin clearance, and the preoperative platelet count.
The statistical model projected the protamine dose within 3+/-23 mg of the
point-of-care test used as reference. Conclusion Protamine dosing based on
statistical modeling represents an alternative to point-of-care tests.

<4>
Accession Number
2015068451
Authors
Cavallari I. Mega S. Goffredo C. Patti G. Chello M. Di Sciascio G.
Institution
(Cavallari, Mega, Goffredo, Patti, Chello, Di Sciascio) Department of
Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del
Portillo, Rome 200 - 00128, Italy
Title
Hand-held echocardiography in the setting of pre-operative cardiac
evaluation of patients undergoing non-cardiac surgery: results from a
randomized pilot study.
Source
International Journal of Cardiovascular Imaging. 31 (5) (pp 995-1000),
2015. Date of Publication: 29 Jun 2015.
Publisher
Kluwer Academic Publishers
Abstract
Transthoracic echocardiography is not a routine test in the pre-operative
cardiac evaluation of patients undergoing non-cardiac surgery but may be
considered in those with known heart failure and valvular heart disease or
complaining cardiac symptoms. In this setting, hand-held echocardiography
(HHE) could find a potential application as an alternative to standard
echocardiography in selected patients; however, its utility in this
context has not been investigated. The aim of this pilot study was to
evaluate the conclusiveness of HHE compared to standard echocardiography
in this subset of patients. 100 patients scheduled for non-cardiac surgery
were randomized to receive a standard exam with a Philips Ie33 or a
bedside evaluation with a pocket-size imaging device (Opti-Go, Philips
Medical System). The primary endpoint was the percentage of satisfactory
diagnosis at the end of the examination referred as conclusiveness.
Secondary endpoints were the mean duration time and the mean waiting time
to perform the exams. No significant difference in terms of conclusiveness
between HHE and standard echo was found (86 vs 96 %; P = 0.08). Mean
duration time of the examinations was 6.1 +/- 1.2 min with HHE and 13.1
+/- 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a
consistent save of waiting time because it was performed the same day of
clinical evaluation whereas patients waited 10.1 +/- 6.1 days for a
standard echocardiography (P < 0.001). This study suggests the potential
role of HHE for pre-operative evaluation of selected patients undergoing
non-cardiac surgery, since it provided similar information but it was
faster and earlier performed compared to standard echocardiography.

<5>
Accession Number
2015097158
Authors
Tian L. Zhang J. Xiao S. Huang J. Zhang Y. Shen J.
Institution
(Zhang) Department of Pharmacy, Fujian Medical University Union Hospital,
Fuzhou 350001, China
(Tian, Xiao, Huang, Zhang, Shen) Fujian Insitute of Hematology, Fujian
Provincial Key Laboratory on Hematology, Fujian Medical University Union
Hospital, Fuzhou 350001, China
Title
Impact of polymorphisms of the GGCX gene on maintenance warfarin dose in
Chinese populations: Systematic review and meta-analysis.
Source
Meta Gene. 5 (pp 43-54), 2015. Date of Publication: September 01, 2015.
Publisher
Elsevier
Abstract
The meta-analysis was conducted to investigate the impact of
gamma-glutamyl carboxylase (GGCX) on maintenance warfarin dose. 8 studies
were included, focusing on the impact of GGCX single nucleotide
polymorphisms (SNPs) on mean daily warfarin dose (MDWD). GGCX (rs699664;
AA versus GG, GA versus GG, A versus GG) and GGCX (rs12714145; GA versus
GG, AA versus GG, A versus GG) showed no significant differences on mean
daily warfarin dose (MDWD). This meta-analysis was the first to report the
relationship between GGCX SNPs and MDWD in Chinese populations. No
evidence could be found in the relationship between SNPs of GGCX (rs699664
and rs12714145) and maintenance warfarin dose.

<6>
Accession Number
2015077586
Authors
Campos C.M. Van Klaveren D. Farooq V. Simonton C.A. Kappetein A.-P. Sabik
J.F. Steyerberg E.W. Stone G.W. Serruys P.W.
Institution
(Campos, Van Klaveren, Kappetein, Steyerberg, Serruys) Erasmus University
Medical Center, s-Gravendijkwal 230, Rotterdam 3015, Netherlands
(Campos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Farooq) Manchester Heart Centre, Manchester Royal Infirmary, Central
Manchester University Hospitals NHS Trust, Manchester, United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Sabik) Department of Cardiothoracic Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, United States
(Stone) Columbia University Medical Center, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Long-term forecasting and comparison of mortality in the Evaluation of the
Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization (EXCEL) trial: Prospective
validation of the SYNTAX Score II.
Source
European Heart Journal. 36 (20) (pp 1231-1241), 2015. Date of Publication:
21 May 2015.
Publisher
Oxford University Press
Abstract
Aims To prospectively validate the SYNTAX Score II and forecast the
outcomes of the randomized Evaluation of the Xience Everolimus-Eluting
Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization (EXCEL) Trial. Methods and results Evaluation of the
Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization is a prospective, randomized
multicenter trial designed to establish the efficacy and safety of
percutaneous coronary intervention (PCI) with the everolimus-eluting stent
compared with coronary artery bypass graft (CABG) surgery in subjects with
unprotected left-main coronary artery (ULMCA) disease and low-intermediate
anatomical SYNTAX scores (<33). After completion of patient recruitment in
EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year
mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for
mortality were computed using simulation with bootstrap resampling (10 000
times). For the entire study cohort, the 4-year predicted mortalities were
8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR)
0.79; 95% PI 0.43-1.50). In subjects with low (a 22) anatomical SYNTAX
scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate
anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI
0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical
characteristics shifted long-term mortality predictions either in favour
of PCI (older age, male gender and COPD) or CABG (younger age, lower
creatinine clearance, female gender, reduced left ventricular ejection
fraction). Conclusion The SYNTAX Score II indicates at least an equipoise
for long-term mortality between CABG and PCI in subjects with ULMCA
disease up to an intermediate anatomical complexity. Both anatomical and
clinical characteristics had a clear impact on long-term mortality
predictions and decision making between CABG and PCI.

<7>
Accession Number
2015082613
Authors
Tu B. Rich B. Labos C. Brophy J.M.
Institution
(Tu) Medical Services, Executive Suites, Greenslopes Private Hospital,
Newdegate Street, Greenslopes, QLD 4120, Australia
(Rich, Labos, Brophy) McGill University Health Center, Royal Victoria
Hospital, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada
Title
Coronary revascularization in diabetic patients: A systematic review and
bayesian network meta-analysis.
Source
Annals of Internal Medicine. 161 (10) (pp 724-732), 2014. Date of
Publication: 18 Nov 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The optimal revascularization technique in diabetic patients
is an important unresolved question.
Purpose: To compare long-term outcomes between the revascularization
techniques of percutaneous coronary intervention (PCI) and coronary artery
bypass grafting (CABG).
Data Sources: English-language publications in PubMed, the Cochrane
Central Register of Controlled Trials, Ovid, and EMBASE between 1 January
1990 and 1 June 2014.
Study Selection: Two investigators independently reviewed randomized,
controlled trials comparing PCI (with drug-eluting or baremetal stents)
with CABG in adults with diabetes with multivessel or left main coronary
artery disease.
Data Extraction: Study design, quality, patient characteristics, length of
follow-up, and outcomes were extracted. For duplicate publications,
outcomes were obtained from the publication with the longest follow-up.
Data Synthesis: 40 studies were combined using a Bayesian network
meta-analysis that accounted for the variation in stent choice. The
primary outcome, a composite of all-cause mortality, nonfatal myocardial
infarction, and stroke, increased with PCI (odds ratio [OR], 1.33 [95%
credible interval {CrI}, 1.01 to 1.65]). Percutaneous coronary
intervention resulted in increased mortality (OR, 1.44 [CrI, 1.05 to
1.91]), no change in the number of myocardial infarctions (OR, 1.33 [CrI,
0.86 to 1.95]), and fewer strokes (OR, 0.56 [CrI, 0.36 to 0.88]).
Limitations: Study design and length of follow-up were heterogeneous, and
results were driven primarily by a single study. Costs and nonvascular
complications of the interventions were not examined.
Conclusion: Coronary artery bypass grafting seems to be the preferred
revascularization technique in diabetics, especially if longterm survival
is anticipated. However, because of residual uncertainties and increased
risk for stroke with CABG, clinical judgment is required when choosing a
revascularization technique in patients with diabetes.

<8>
Accession Number
2015071659
Authors
Duggal A. Ganapathy A. Ratnapalan M. Adhikari N.K.J.
Institution
(Duggal) Medical Intensive Care Unit, Respiratory Institute, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Ganapathy) Critical Care Unit, Guelph General Hospital and Division of
Internal Medicine, William Osler Brampton Civic Hospital, Brampton, Canada
(Ratnapalan) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
(Adhikari) Interdepartmental Division of Critical Care, University of
Toronto, Toronto, Canada
Title
Pharmacological treatments for acute respiratory distress syndrome:
Systematic review.
Source
Minerva Anestesiologica. 81 (5) (pp 567-588), 2015. Date of Publication:
01 May 2015.
Publisher
Edizioni Minerva Medica
Abstract
Background. Our objective was to systematically review the effect of
pharmacological therapies on mortality in patients with acute respiratory
distress syndrome (ARDS), focusing on randomized controlled trials (RCTs)
published since a previous review in 2004. Methods. We updated previous
searches and searched OVID versions of MEDLINE, EMBASE and CENTRAL (to
January 2013) and proceedings from conferences and bibliographies of
included studies. We included RCTs of pharmacologic therapies compared
with placebo or no therapy for adult patients with ARDS, using authors'
definitions, which reported on mortality (<3 months after randomization).
We excluded subgroups of patients with ARDS reported in RCTs enrolling
other populations and RCTs of therapies to prevent ARDS, nutritional or
fluid interventions, inhaled nitric oxide, therapies coupled to a
mechanical ventilation strategy, or oxygen. Two reviewers independently
screened citations, selected articles for inclusion, and abstracted
clinical and methodological data from included studies with disagreements
resolved by a third reviewer. Mortality data were pooled using
random-effects models. Results. From 13461 citations, 58 trials (6635
patients) of 21 classes of medications met selection criteria; 26 trials
(3880 patients) were published after 2003. Meta-analyses showed reduced
28-day mortality with a 48-hour infusion of cis-atracurium in early ARDS
(relative risk 0.66, 95% confidence interval 0.50 to 0.87; 431 patients,
138 deaths). There was no effect on mortality with granulocyte-macrophage
colony stimulating factor, late low-dose methylprednisolone, neutrophil
elastase inhibitors, intravenous salbutamol, surfactant, or
N-acetylcysteine; each meta-analysis included >1 trial published after
2003. Seven single trials of other treatments published after 2003 showed
no effect. Meta-analysis of older trials of prostaglandin E1 also showed
no effect. Conclusion. Effective pharmacotherapy for ARDS remains
extremely limited. Cis-atracurium is a promising treatment for early
moderate-severe ARDS (using Berlin definition nomenclature) and merits
further investigation in a large RCT.

<9>
Accession Number
2014896726
Authors
Ozturk T. Onur E. Cerrahoglu M. Calgan M. Nizamoglu F. Civi M.
Institution
(Ozturk, Nizamoglu, Civi) Department of Anaesthesiology and Reanimation,
Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey
(Onur, Calgan) Department of Biochemistry, Celal Bayar University, Faculty
of Medicine, Manisa 45020, Turkey
(Cerrahoglu) Department of Cardiovascular Surgery, Celal Bayar University,
Faculty of Medicine, Manisa 45020, Turkey
Title
Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid
gelatin in patients undergoing coronary surgery.
Source
Cytokine. 74 (1) (pp 69-75), 2015. Date of Publication: July 01, 2015.
Publisher
Academic Press
Abstract
Objectives: Compare the effects on inflammatory (TNF-alpha, IL-6, IL-8 and
IL-10) and immunologic (CD3⁺, CD4⁺, CD8⁺,
CD11b⁺, CD16⁺/56⁺ T cells and total
lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4%
modified fluid gelatin, or crystalloid when used as volume replacement
fluids for acute normovolemic hemodilution (a blood conservation
technique) in coronary artery bypass graft patients. Methods: Thirty
patients undergoing coronary artery bypass graft surgery were randomized
to receive Isolyte S (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group
HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic
hemodilution. Blood samples were taken immediately after induction of
anaesthesia (T0), and 2h (T1), 12h (T2), 24h (T3), and 48h (T4) after
separation from cardiopulmonary bypass. TNF-alpha, IL-6, IL-8 and IL-10
levels were determined with commercially available ELISA kits.
CD3⁺ (mature T cells), CD4⁺ (T helper cells),
CD8⁺ (suppressor cytotoxic T cells),
CD16⁺/56⁺ (natural killer lymphocytes), and
CD11b⁺ (Mac-1, adhesion receptor) levels were measured using
flow-cytometry reagents. The CD4⁺:CD8⁺ ratio was
calculated. Results: Between-group comparisons showed significantly higher
levels of TNF-alpha at T1 (2h after weaning from cardiopulmonary bypass)
in Group HES compared to Group ISO (p=0.003). IL-8 was significantly lower
in Group HES than Group GEL at T1 (p=0.0005). IL-10 was significantly
higher in Group HES than in Group GEL at T1 (p=0.0001). The
CD4⁺:CD8⁺ ratio in Group ISO was significantly lower
than that in Group HES at T2 (p=0.003). CD11b⁺ levels in Group
HES were also higher than those in Group GEL and group ISO at T2, but not
significantly. CD16/56⁺ levels in Group HES were higher than
those in Group GEL at T2 (p<0.003). No excessive hemorrhage occurred in
any patient. Mediastinal drainage during the first 24h after surgery in
Group HES (347+/-207mL) was not significantly different from that of Group
GEL (272+/-177mL) or Group ISO (247+/-109) (p>0.05). Conclusion:
Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and
increased anti-inflammatory responses to a greater degree than gelatin
solution and isolyte S. The use of hydroxyethyl starch, compared to
gelatin solution and isolyte S, resulted in less decrease in the
CD4⁺:CD8⁺ ratio, suggesting less immunosuppression.

<10>
Accession Number
2014829844
Authors
Buehler A.M. Ferri C. Flato U.A.P. Fernandes J.G.
Institution
(Buehler, Ferri, Flato, Fernandes) Hospital Alemao Oswaldo Cruz, Institute
of Health Education and Research, Brazil
Title
Robotically assisted coronary artery bypass grafting: A systematic review
and meta-analysis.
Source
International Journal of Medical Robotics and Computer Assisted Surgery.
11 (2) (pp 150-158), 2015. Date of Publication: 01 Jun 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: It remains uncertain as to whether robotically assisted
coronary bypass surgery (RACBS) is superior to non-robotic procedures.
Methods: Literature searches were conducted using MEDLINE, EMBASE and
LILACS. Two review authors independently screened citations, assessed
trial quality and performed data extraction. Results: Three trials met the
inclusion criteria. None was randomized. Compared with non-robotic
approaches, RACBS was associated with longer surgical times, shorter
intensive care unit and hospital stays, higher extubation rates and lower
odds for atrial fibrillation as well as myocardial infarction. There were
no differences for the odds of stroke and mortality between the
interventions. Conclusions: Although robotic-assisted coronary bypass
appears to be promising, the study designs were not adequate and may have
a high risk of selection bias. There is a need for randomized trials to
corroborate the findings and to determine the long-term benefits of RACBS
compared with traditional surgical approaches.

<11>
Accession Number
2015091115
Authors
Uebing A. Rigby M.L.
Institution
(Uebing) Adult Congenital Heart Centre, National Centre for Pulmonary
Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP,
United Kingdom
(Uebing, Rigby) National Heart and Lung Institute, Imperial College School
of Medicine, London, United Kingdom
(Rigby) Department of Paediatric Cardiology, Royal Brompton Hospital,
London, United Kingdom
Title
The problem of infective endocarditis after transcatheter pulmonary valve
implantation.
Source
Heart. 101 (10) (pp 749-751), 2015. Date of Publication: 01 May 2015.
Publisher
BMJ Publishing Group

<12>
Accession Number
2015961236
Authors
Wang Z.J. Gao F. Cheng W.J. Yang Q. Zhou Y.J.
Institution
(Wang, Gao, Cheng, Yang, Zhou) Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart Lung and Blood Vessel Disease,
Beijing, China
Title
Body Mass Index and Repeat Revascularization After Percutaneous Coronary
Intervention: A Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (6) (pp 800-808), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: The effect of obesity on restenosis in patients who undergo
percutaneous coronary intervention (PCI) has not been fully understood. We
undertook a meta-analysis for the effects of body mass index (BMI) on
repeat revascularization in these patients. Methods: A systematic search
was conducted for published studies in OVID/MEDLINE, EMBASE, and the
Cochrane library databases from 1980 to October, 2014. We identified
studies that provided estimates for repeat revascularization on the basis
of BMI in patients who underwent PCI. Summary estimates of risk ratios
(RRs) were obtained for 5 prespecified BMI groups: underweight, normal
weight, overweight, obese, and severely obese. Results: A total of 13
studies with 49,002 patients were included in the final analyses. In
contrast to a J-shaped association for mortality, a linear association was
observed across BMI categories for repeat revascularization. Using normal
weight as the reference, underweight was associated with a similar risk of
repeat revascularization (RR,0.93; 95% confidence interval [CI],
0.67-1.31), overweight, obesity, and severe obesity were all associated
with incrementally greater risk of repeat revascularization (overweight:
RR, 1.08; 95% CI,1.02-1.14; obesity: RR, 1.10; 95% CI, 1.03-1.18; severe
obesity: RR, 1.24; 95% CI, 1.04-1.48). The effect of overweight and
obesity vs normal weight was consistent across stent types (drug-eluting
stent and bare-metal stent) and definitions of repeat revascularization
(target lesion revascularization, target vessel revascularization, and all
revascularization). Conclusions: Our data revealed a linear relationship
between BMI categories and repeat revascularization for patients who
underwent PCI. The risk was lowest among underweight or normal weight
patients, and highest among severely obese patients. Introduction: Nous ne
comprenons pas entierement les consequences de l'obesite sur la restenose
des patients qui subissent l'intervention coronarienne percutanee (ICP).
Nous avons entrepris une meta-analyse des consequences de l'indice de
masse corporelle (IMC)sur la revascularisation repetee chez ces patients.
Methodes: Nous avons mene une recherche systematique d'etudes publiees
dans les banques de donnees d'Ovid MEDLINE, d'Embase et de la Bibliotheque
Cochrane de 1980 a octobre 2014. Nous avons trouve des etudes qui
fournissaient des estimations sur la revascularisation repetee qui
s'appuyaient sur l'IMC des patients ayant subi l'ICP. Les estimations
sommaires des risques relatifs (RR) ont eteobtenues pour 5 groupes dont
l'IMC etait prespecifie: poids insuffisant, poids normal, exces de poids,
obesite et obesite serieuse. Resultats: Dans les analyses finales, nous
avons inclus un total de 13etudes regroupant 49 002 patients.
Contrairement a l'association en forme de J pour la mortalite, nous avons
observe une association lineaire dans toutes les categories d'IMC pour la
revascularisation repetee. En utilisant le poids normal comme reference,
le poids insuffisant a ete associe a un risque similaire de
revascularisation repetee (RR, 0,93; intervalle de confiance [IC] a 95 %,
0,67-1,31), puis l'exces de poids, l'obesite et l'obesite serieuse ont
tous ete associes, et ce, de maniere croissante, a un risque plus eleve de
revascularisation repetee (exces de poids: RR, 1,08; IC a 95 %, 1,02-1,14;
obesite: RR, 1,10; IC a 95 %, 1,03-1,18; obesite serieuse: RR, 1,24; IC a
95 %, 1,04-1,48). Les consequences de l'exces de poids et de l'obesite vs
le poids normal ont ete constantes dans tous les types d'endoprotheses
(endoprothese medicamentee et endoprothese non medicamentee) et toutes les
definitions de la revascularisation repetee (revascularisation de la
lesion cible, revascularisation du vaisseau cible et toutes
revascularisations). Conclusions: Nos donnees ont revele une relation
lineaire entre les categories d'IMC et la revascularisation repetee des
patients qui subissaientl'ICP. Le risque est apparu plus faible chez les
patients ayant un poids insuffisant ou un poids normal, et plus eleve chez
les patients dont l'obesite etait serieuse.

<13>
Accession Number
2015959029
Authors
Gandhi S. Schwalm J.-D.R. Velianou J.L. Natarajan M.K. Farkouh M.E.
Institution
(Gandhi) Department of Medicine, Division of Cardiology, McMaster
University, Hamilton, ON, Canada
(Schwalm, Velianou, Natarajan) Department of Medicine, Division of
Cardiology and Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Farkouh) Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar
Centre of Excellence, University of Toronto, Toronto, ON, Canada
Title
Comparison of Dual-antiplatelet Therapy to Mono-antiplatelet Therapy After
Transcatheter Aortic Valve Implantation: Systematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (6) (pp 775-784), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: Post-transcatheter aortic valve implantation (TAVI)
dual-antiplatelet therapy (DAPT) with acetylsalicylic acid and clopidogrel
is common practice to reduce ischemic complications despite the lack of
clinical trial evidence demonstrating superiority over mono-antiplatelet
therapy (MAPT). Methods: A systematic search was conducted to retrieve
studies that investigated DAPT vs MAPT in patients who have undergone
TAVI. Outcomes of interest included both ischemic and bleeding events at
30 days and 6 months. Results: Four studies met inclusion criteria-2
randomized control trials and 2 observational studies, with 286 patients
in the DAPT group and 354 patients in the MAPT group. For the primary
outcome of a combined end point of 30-day major stroke, spontaneous
myocardial infarction (MI), all-cause mortality, and combined lethal and
major bleeding, there was a trend toward increased harm in the DAPT group
(29%) compared with the MAPT group (16%), with an odds ratio (OR) of 1.88
(. P= 0.05). Secondary outcome analysis revealed that there was no
significant difference between groups regarding 30-day stroke, 30-day
spontaneous MI, and 30-day all-cause mortality. Patients who received DAPT
had a significant increase in combined 30-day lethal and major bleeding
(OR, 2.62; P= 0.008). Further analysis revealed that increased adverse
events were driven by observational studies, with no difference in
outcomes between groups in randomized controlled trials. Conclusions: DAPT
in patients who have undergone TAVI demonstrated no benefit over MAPT in
reduction of ischemic events, with a trend toward increased harm because
of bleeding. Future considerations should be given to MAPT with
clopidogrel alone, as well as the omission of clopidogrel loading before
the procedure. Introduction: La bitherapie antiplaquettaire (BTAP) par
l'acide acetylsalicylique et le clopidogrel apres l'implantation
valvulaire aortique par catheter (IVAC) est une pratique frequente pour
reduire les complications d'origine ischemique en depit du manque de
donnees provenant d'essais cliniques demontrant sa superiorite par rapport
a la monotherapie antiplaquettaire (MTAP). Methodes: Nous avons mene une
recherche systematique pour extraire les etudes qui avaient examine la
BTAP vs la MTAP chez les patients ayant subi l'IVAC. Les resultats
d'interet ont inclus les evenements ischemiques et les evenements
hemorragiques a 30 jours et a 6 mois. Resultats: Quatre etudes ont repondu
aux criteres d'inclusion (2essais cliniques aleatoires et 2 etudes
observationnelles totalisant 286 patients dans le groupe BTAP et 354
patients dans le groupe MTAP). Pour ce qui est du critere d'evaluation
principal d'un critere de jugement combine de l'accident vasculaire
cerebral a 30 jours, de l'infarctus du myocarde (IM) spontane, de la
mortalite toutes causes confondues, et de l'incidence combinee
d'hemorragie mortelle et d'hemorragie majeure, nous avons observe une
tendance a l'augmentation du risque dans le groupe BTAP (29 %) par rapport
au groupe MTAP (16 %), et un ratio d'incidence approche (RIA) de 1,88 (.
P= 0,05). L'analyse du critere d'evaluation secondaire a revele qu'il
n'existait aucune difference significative entre les groupes concernant
l'accident vasculaire cerebral a 30 jours, l'IM spontane a 30 jours et la
mortalite toutes causes confondues a 30 jours. Les patients qui recevaient
la BTAP ont montre une augmentation significative de l'incidence combinee
de l'hemorragie mortelle et de l'hemorragie majeure a 30 jours (RIA, 2,62;
P= 0,008). D'autres analyses ont revele que l'augmentation des evenements
indesirables avait ete soulevee par des etudes observationnelles, qui
n'ont montre aucune difference dans les resultats entre les groupes des
essais cliniques aleatoires. Conclusions: La BTAP chez les patients ayant
subi l'IVAC n'a demontre aucun avantage par rapport a la MTAP sur la
reduction des evenements d'origine ischemique, mais a plutOt montre une
tendance a l'augmentation des dommages causes par l'hemorragie. Nous
devrons nous pencher sur la MTAP par le clopidogrel seul, ainsi que sur
l'omission de la dose de charge du clopidogrel avant l'intervention.

<14>
Accession Number
2015091806
Authors
Talwar S. Muthukkumaran S. Choudhary S.K. Airan B.
Institution
(Talwar, Muthukkumaran, Choudhary, Airan) Department of Cardiothoracic &
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
Title
The Expanding Indications for the Lecompte Maneuver.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 5 (2) (pp
291-296), 2014. Date of Publication: 2014.
Publisher
SAGE Publications Inc.
Abstract
Since the anterior translocation of the pulmonary arteries in relation to
the aorta (Lecompte maneuver) was first described in 1981, its indications
have continued to expand. In this review, we discuss the physiological
basis and the expanding indications for this maneuver.

<15>
Accession Number
2015082397
Authors
Kumbhani D.J. Bavry A.A. Desai M.Y. Bangalore S. Byrne R.A. Jneid H. Bhatt
D.L.
Institution
(Kumbhani) Division of Cardiology, Southwestern Medical Center, University
of Texas, 5323 Harry Hines Blvd., Dallas, TX 75390-9047, United States
(Bavry) North Florida/South Georgia Veterans Health System, Division of
Cardiology, University of Florida, Gainesville, FL, United States
(Desai) Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH,
United States
(Bangalore) School of Medicine, New York University, New York, NY, United
States
(Byrne) Deutsches Herzzentrum, Technische Universitat, Munich, Germany
(Jneid) Division of Cardiology, Baylor College of Medicine, Houston, TX,
United States
(Bhatt) Heart and Vascular Center, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
Title
Aspiration thrombectomy in patients undergoing primary angioplasty:
Totality of data to 2013.
Source
Catheterization and Cardiovascular Interventions. 84 (6) (pp 973-977),
2014. Date of Publication: 15 Nov 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We sought to update our meta-analysis on clinical outcomes
with aspiration thrombectomy prior to primary percutaneous coronary
intervention (PPCI) compared with conventional PPCI alone due to the
availability of additional trial data. Background: The clinical efficacy
of adjunctive aspiration thrombectomy in STelevation myocardial infarction
(STEMI) patients undergoing PPCI remains controversial. A recent
large-scale randomized trial showed no benefit in terms of mortality at 30
days. Methods: Clinical trials that randomized STEMI patients to
aspiration thrombectomy prior to PPCI compared with conventional PPCI
alone were included. Results: A total of 11,321 patients from 20
randomized controlled trials were included. The composite major adverse
cardiac event (MACE) endpoint was lower in the aspiration thrombectomy arm
compared with conventional PPCI alone (risk ratio [RR]50.81, 95% CI
0.70-0.94; P50.006). Although all-cause mortality was similar between the
adjunctive aspiration thrombectomy arm and PPCI arms (RR50.83, 95% CI
0.67-1.01; P50.06), late mortality (6-12 months) was significantly reduced
(RR50.64; 95% CI 0.44-0.92; P50.016). Reinfarction (RR50.64, 95% CI
0.44-0.92; P50.017) and stent thrombosis (RR50.54; 95% CI 0.32-0.91;
P50.021) were similarly lower. Differences in target vessel
revascularization were of borderline significance (RR50.83, 95% CI 0.68-
1.01; P50.06). Conclusions: Our meta-analysis including all randomized
controlled trials on aspiration thrombectomy to date demonstrates a
significant reduction in adverse clinical outcomes including stent
thrombosis compared with conventional PCI alone.

<16>
Accession Number
2015078523
Authors
Zarrabi K. Dehghani P. Ardekani A.A. Zarrabi M.A. Zolghadrasli A.
Institution
(Zarrabi) Department of Cardiac Surgery, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Dehghani, Ardekani, Zolghadrasli) Department of Cardiology, School of
Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Zarrabi) Student Research Committee, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
The comparison between two surgical methods for left internal mammary
artery (LIMA) anastomosis on left anterior descending (LAD) artery in
patients with severe diffuse lesions: Short to mid-term results.
Source
Acta Medica Iranica. 53 (6) (pp 369-372), 2015. Date of Publication: 2015.
Publisher
Medical Sciences University of Teheran
Abstract
Coronary artery disease is the leading cause of death worldwide. In this
study, we compared two surgical methods of left internal mammary artery
(LIMA) anastomosis on left anterior descending (LAD) artery in patients
with severe diffuse lesions. A total of 40 patients were included in our
study and randomly assigned into two groups. In group A, after a long
arteriotomy on LAD, the posterior surface of left internal mammary artery
(LIMA) was opened by the same length and was anastomosed along the LAD
course through normal and diseased parts. In group B instead of complete
opening of LAD, a small arteriotomy was done only in areas where the wall
of the vessel was nearly normal (especially the anterolateral wall), and
LIMA was anastomosed to these areas in a sequential (Jump) method. The
patients were then followed for post-operation results. The two groups
showed equal results regarding early mortality, post-operation bleeding,
and infection, pleural and pericardial effusion. There were two cases of
myocardial infarction (MI) in group A with one mortality after 18 months,
while no MI was reported in group B. Group B demonstrated significantly
superior results regarding the rise in ejection fraction and the
improvement in functional class. In this study it was demonstrated that
diffuse coronary artery lesions of LAD should be preferably operated using
LIMA with the sequential-jump anastomoses method and the surgeon should
avoid long arteriotomy with single long anastomosis because of lower
chance of long-term patency.

<17>
Accession Number
2015060230
Authors
Abbasi S.H. Mohammadinejad P. Shahmansouri N. Salehiomran A. Beglar A.A.
Zeinoddini A. Forghani S. Akhondzadeh S.
Institution
(Abbasi, Shahmansouri, Salehiomran, Beglar) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Abbasi) Family Health Research Center, Iranian Petroleum Industry Health
Research Institute, Tehran, Iran, Islamic Republic of
(Mohammadinejad, Zeinoddini, Akhondzadeh) Psychiatric Research Center,
Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Forghani) Razi Vaccine and Serum Research Institute, Karaj, Iran, Islamic
Republic of
Title
Simvastatin versus atorvastatin for improving mild to moderate depression
in post-coronary artery bypass graft patients: A double-blind,
placebo-controlled, randomized trial.
Source
Journal of Affective Disorders. 183 (pp 149-155), 2015. Article Number:
7426. Date of Publication: 01 Sep 2015.
Publisher
Elsevier
Abstract
Abstract Background A decreased risk of developing depression has been
reported among statin users. Aside from their lipid-lowering effects,
statins are considered immunomodulatory agents and have protective effects
against oxidative stress and inflammation which are well known for their
association with depression. The aim of the present study was to compare
the probable antidepressant effects of simvastatin and atorvastatin among
post-coronary artery bypass graft (CABG) surgery patients with high and
low potentials for blood-brain-barrier penetration, respectively. Method
Forty-six outpatients who had undergone CABG in the last 6 months and
suffered from mild to moderate depression participated in a parallel,
double-blind, placebo-controlled trial, and were randomized to undergo 6
weeks of treatment with either simvastatin (20 mg/day) or atorvastatin (20
mg/day). Participants were evaluated using Hamilton depression rating
scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to
evaluate the efficacy of simvastatin in improving the depressive symptoms.
Result General linear model repeated measures demonstrated significant
effect for timextreatment interaction on the HDRS scores [F (1.62,
71.06)=3.41, P=0.048]. There was no significant difference between the
treatment groups regarding the adverse events. No one experienced serious
adverse event. Limitation The limitations of the present study were its
small sample size and the short-term follow-up period. Conclusion
Treatment with simvastatin seems to be well tolerated with superior
antidepressant effects compared to atorvastatin in post-CABG patients.
Long-term outcomes of this practice and its probable influence on other
psychological aspects are yet to be investigated in future studies. Trial
registration Iranian registry of clinical trials (http://www.irct.ir):
IRCT201410271556N68.

<18>
Accession Number
2015056846
Authors
Hermans M.P. Bouenizabila E. Amoussou-guenou D.K. Ahn S.A. Rousseau M.F.
Institution
(Hermans) Universite catholique de Louvain, Division of Endocrinology and
Nutrition, Cliniques universitaires St-Luc, Institut de Recherche
Experimentale et Clinique (IREC), Brussels, Belgium
(Bouenizabila) Centre Hospitalier et Universitaire de Brazzaville, Service
de Maladies Metaboliques et Endocriniennes, Brazzaville, Congo
(Amoussou-guenou) CNHU HKM Cotonou, Universite d'Abomey-Calavi, Service
d'Endocrinologie et Metabolisme, Abomey-Calavi, Benin
(Ahn, Rousseau) Cliniques universitaires St-Luc and Pole de Recherche
Cardiovasculaire, Institut de Recherche Experimentale et Clinique (IREC),
Universite catholique de Louvain, Division of Cardiology, Brussels,
Belgium
Title
Baseline diabetes as a way to predict CV outcomes in a lipid-modifying
trial: A meta-analysis of 330,376 patients from 47 landmark studies.
Source
Cardiovascular Diabetology. 14 (1) , 2015. Article Number: 60. Date of
Publication: May 21, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Diabetes is a major cardiovascular risk factor. However, its
influence on the rate of occurrence of cardiovascular (CV) events during a
clinical trial that included a diabetes subgroup has not yet been
quantified. Aims: To establish equations relating baseline diabetes
prevalence and incident CV events, based on comparator arms data of major
lipid-modifying trials. Methods: Meta-analysis of primary outcomes (PO)
rates of key prospective trials, for which the baseline proportion of
diabetics was reported, including studies having specifically reported CV
outcomes within their diabetic subgroups. Results: 47 studies,
representing 330,376 patients (among whom 124,115 diabetics), were
analyzed as regards the relationship between CV outcomes rates (including
CHD) and the number of diabetics enrolled. Altogether, a total of 18,445
and 16,156 events occurred in the comparator and treatment arms,
respectively. There were significant linear relationships between diabetes
prevalence and both PO and CHD rates (%/year): y = 0.0299*x + 3.12 [PO] (p
= 0.0128); and y = 0.0531*x + 1.54 [CHD] (p = 0.0094), baseline diabetes
predicting PO rates between 3.12 %/year (no diabetic included) and 6.11
%/year (all patients diabetic); and CHD rates between 1.54 %/year (no
diabetic) and 6.85 %/year (all patients diabetic). The slopes of the
equations did not differ according to whether they were derived from
primary or secondary prevention trials. Conclusions: Absolute and relative
CV risk associated with diabetes at inclusion can be readily predicted
using linear equations relating diabetes prevalence to primary outcomes or
CHD rates.

<19>
Accession Number
2015787027
Authors
Taniwaki M. Radu M.D. Garcia-Garcia H.M. Heg D. Kelbaek H. Holmvang L.
Moschovitis A. Noble S. Pedrazzini G. Saunamaki K. Dijkstra J. Landmesser
U. Wenaweser P. Meier B. Stefanini G.G. Roffi M. Luscher T.F. Windecker S.
Raber L.
Institution
(Taniwaki, Moschovitis, Wenaweser, Meier, Stefanini, Windecker, Raber)
Department of Cardiology, Swiss Cardiovascular Center Bern, Bern
University Hospital, Bern 3010, Switzerland
(Radu, Kelbaek, Holmvang, Saunamaki) Rigshospitalet, Copenhagen, Denmark
(Garcia-Garcia) Erasmus MC, Rotterdam, Netherlands
(Heg) Clinical Trial Unit, University of Bern, Bern, Switzerland
(Noble, Roffi) University Hospital, Geneva, Switzerland
(Pedrazzini) Cardiocentro, Lugano, Switzerland
(Dijkstra) Leiden University Medical Center, Leiden, Netherlands
(Landmesser, Luscher) University Heart Center, Cardiology, University
Hospital Zurich, Zurich, Switzerland
Title
Long-term safety and feasibility of three-vessel multimodality
intravascular imaging in patients with ST-elevation myocardial infarction:
the IBIS-4 (integrated biomarker and imaging study) substudy.
Source
International Journal of Cardiovascular Imaging. 31 (5) (pp 915-926),
2015. Date of Publication: 28 Feb 2015.
Publisher
Kluwer Academic Publishers
Abstract
We assessed the feasibility and the procedural and long-term safety of
intracoronary (i.c) imaging for documentary purposes with optical
coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients
with acute ST-elevation myocardial infarction (STEMI) undergoing primary
PCI in the setting of IBIS-4 study. IBIS4 (NCT00962416) is a prospective
cohort study conducted at five European centers including 103 STEMI
patients who underwent serial three-vessel coronary imaging during primary
PCI and at 13 months. The feasibility parameter was successful imaging,
defined as the number of pullbacks suitable for analysis. Safety
parameters included the frequency of peri-procedural complications, and
major adverse cardiac events (MACE), a composite of cardiac death,
myocardial infarction (MI) and any clinically-indicated revascularization
at 2 years. Clinical outcomes were compared with the results from a cohort
of 485 STEMI patients undergoing primary PCI without additional imaging.
Imaging of the infarct-related artery at baseline (and follow-up) was
successful in 92.2 % (96.6 %) of patients using OCT and in 93.2 % (95.5 %)
using IVUS. Imaging of the non-infarct-related vessels was successful in
88.7 % (95.6 %) using OCT and in 90.5 % (93.3 %) using IVUS.
Periprocedural complications occurred <2.0 % of OCT and none during IVUS.
There were no differences throughout 2 years between the imaging and
control group in terms of MACE (16.7 vs. 13.3 %, adjusted HR1.40, 95 % CI
0.77-2.52, p = 0.27). Multi-modality three-vessel i.c. imaging in STEMI
patients undergoing primary PCI is consistent a high degree of success and
can be performed safely without impact on cardiovascular events at
long-term follow-up.

<20>
Accession Number
2015057997
Authors
Villella M. Villella A.
Institution
(Villella) Cardiac Rehabilitation Unit, IRCCS 'Casa Sollievo della
Sofferenza', Head of Cardiac Rehabilitation Unit, Italy
(Villella) ASL FG Cardiology-CCU Department, 'Masselli Mascia' Hospital,
San Severo, Italy
Title
Exercise and cardiovascular diseases.
Source
Kidney and Blood Pressure Research. 39 (2-3) (pp 147-153), 2014. Date of
Publication: 22 May 2014.
Publisher
S. Karger AG
Abstract
Exercise is a physiologic stressor that has multiple beneficial effects on
cardiovascular system. Currently exercise training is a class I
intervention as part of a multifactorial long-term process that includes:
clinical assistance, assessment of global cardiovascular risk,
identification of specific objective for each cardiovascular risk factor,
formulation of an individual treatment plan with multiple intervention
aimed at reduction of the risk, educational programs, planning of long
term follow-up. This paper reviews the evidences of benefit of exercise in
the most common heart diseases and describes the role of exercise training
in the cardiac rehabilitation programs.

<21>
Accession Number
71903630
Authors
Burnos Z. Szalanski P. Suwalski G. Gryszko L. Golowicz J. Krawczyk K.
Tomaszewski D. Olszewski R.
Institution
(Burnos, Szalanski, Suwalski, Gryszko, Golowicz, Krawczyk) Institute of
Military Medicine, Cardiac Surgery Ward, Warsaw, Poland
(Tomaszewski) Institute of Military Medicine, Department of
Anaesthesiology and Intensive Therapy, Warsaw, Poland
(Olszewski) Institute of Military Medicine, Department of Cardiology and
Internal Medicine, Warsaw, Poland
Title
A comparison of different methods of heart muscle preconditioning. A
preliminary study of patients with heart failure, undergoing elective
off-pump coronary artery bypass graft surgery.
Source
European Journal of Heart Failure. Conference: Heart Failure 2015 and the
2nd World Congress on Acute Heart Failure Seville Spain. Conference Start:
20150523 Conference End: 20150526. Conference Publication: (var.pagings).
17 (pp 330-331), 2015. Date of Publication: May 2015.
Publisher
John Wiley and Sons Ltd
Abstract
Background: Cardiac damage after cardiac surgery can lead to prolonged
hospitalization for patients with heart failure (PwHF) as well as an
increased perioperative mortality rate. The concept of pharmacological
preconditioning by volatile anesthetics has recently gained widespread
interest. Aim: The aim of this study was to compare different methods of
heart muscle preconditioning in PwHF, undergoing elective off-pump
coronary artery bypass graft surgery (OPCAB). Methods: The randomized
controlled study was performed to compare cardiac troponin I release in
PwHF receiving different methods of anesthesia with a combination of
remote ischemic preconditioning (RIPC) during OPCAB. 31 pts, (51-79) mean
age 63 yrs (75% male), NYHA (II) were randomly assigned: 9 pts to combined
desflurane anaesthesia (CDa) and RIPC (group 1), 10 pts to desflurane
anaesthesia (Da) (group 2) and 12 pts to total intravenous anesthesia
(TIVA) (group 3). RIPC was performed during general anesthesia before
surgery in three 5 min cycles of transient upper limb
ischaemia/reperfusion. In addition, all patients were anesthetised with a
standardised protocol. Depth of anesthesia was evaluated by bispectral
index. Troponin I release was measured as a marker of myocardial necrosis
before surgery, 6, 12 and 24 hours after surgery. Results: In PwHF there
was a trend of reduction in postoperative median peak of troponin I in
patients' Da (group 2) and in patients receiving TIVA (group 3) compared
to patients anesthetised with CDa and received RIPC (group 1). Ryc 1.
Conclusions: Using two methods of heart preconditioning simultaneously
resulted in a higher peak troponin I release. (Table Presented).

<22>
Accession Number
71899744
Title
2014 Annual Meeting of the Canadian Anesthesiologists' Society, CAS.
Source
Canadian Journal of Anesthesia. Conference: 2014 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS St John's, NL Canada. Conference
Start: 20140613 Conference End: 20140616. Conference Publication:
(var.pagings). 61 , 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
The proceedings contain 107 papers. The topics discussed include:
individualized blood management in cardiac surgery using a point-of-care
based transfusion algorithm; simulation and the maintenance of competence
in the anesthesiology - a systematic review; validation of a preoperative
self-report comorbidity questionnaire; perioperative outcomes of high
spinal anesthesia for cardiac surgery; evaluation of retromolar space size
for intubation feasibility; quantifying competency - the development and
validation of a hand motion analysis program to discriminate experts and
non-experts during central venous line cannulation; impact of
trendelenburg position on respiratory mechanics in pediatric laparoscopic
surgery; effect of opioids replacement by beta-blockers on post mastectomy
pain; professional, health advocate and scholar simulation assessment;
power and conflict: residents' ability to challenge authority; and
interspecialty crisis resource management team training program.

<23>
Accession Number
71899690
Authors
Bock E.R. Amadeo R. Mutch W.A.C.
Institution
(Bock, Amadeo, Mutch) Department of Anesthesiology and Perioperative
Medicine, University of Manitoba, Canada
Title
The effect of altering end-tidal carbon dioxide on cerebral oxygenation
during one-lung ventilation.
Source
Canadian Journal of Anesthesia. Conference: 2014 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS St John's, NL Canada. Conference
Start: 20140613 Conference End: 20140616. Conference Publication:
(var.pagings). 61 (pp S85-S86), 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
Introduction: The non-invasive measurement of cerebral oxygen saturation
(SctO2) has been previously described[1,2], and is increasingly used
clinically to guide anesthetic management - especially in patients with
potential risk of cerebral injury.Decreases in cerebral oxygen saturation
have been shown to be predictive of increased post-operative neurologic
and non-neurologic morbidity in different surgical populations. [2,3] The
goal of the study was to compare a ventilation strategy utilizing two
distinct levels of end-tidal CO2 (ETCO2) to determine its effecton
cerebral saturation in patients undergoing thoracic surgery. This study
was undertaken because of previous evidence showed cerebral desaturation
during one-lung ventilation (OLV) (1,2, 4). We hypothesized that
ventilation to permissive hypercapnia would result in fewer episodes of
cerebral desaturation. Methods: In a randomized controlled trial, patients
were assigned to two minute-ventilation strategies, both consistent with
the current standard of care. One targeted a low normal ETCO2 (Group 1),
defined as 32 mmHg, and the other allowed for an increased ETCO2 (Group
2), defined as 42 mmHg. Continuous measurement of cerebral oximetry and
pulse oximetry were undertaken in both groups. Results: Approval from the
institutional Research Ethics Board was obtained and patients provided
consent for participation in thist study. A total of 34 patients were
enrolled in this study, with 17 patients in each group. All patients were
included in the final analysis. Thirty-five percent of patients ventilated
to an ETCO2 of 32 mmHg had an episode of cerebral desaturation, defined as
a cerebral saturation <65%, whereas no patients ventilated to an ETCO2 of
42 mmHg had a cerebral desaturation (p< 0.003, Fisher exact test). The
lowest average cerebral saturation recorded in Group 1 patients averaged
68(5)%, whereas in Group 2 this value was 73(4)%. Within each group,
patients reached the ETCO2 target and stayed at the target value range
during the duration of OLV , as did the measured PaCO2. No patients
required an increase in FiO2 during OLV in either group. Conclusions: The
management of one-lung ventilation with a permissive increase in ETCO2
decreased the incidence of cerebral oxygen desaturation, when compared to
maintaining ETCO2in the low normal range. Thus, permissive hypercapnia may
be an easy and presumably safe method to treat intra-operative cerebral
desaturations during thoracic surgery. A lung protective strategy allowing
permissive hypercapnia can therefore be employed without concern for the
effects on brain saturation. No cerebral desaturations occurred when
hypercapnia was permitted even using an FiO2 of 0.6 , which allows for
further protection against hyperoxia. Further work needs to be performed
to confirm our findings and to determine if our ventilation strategy
results in less postoperative neurologic and non-neurologic morbidity.f.

<24>
Accession Number
71899678
Authors
Denault A.Y. Bussieres J.S. Arellano R. Finegan B. Haddad F. Nguyen A.Q.N.
Varin F. Fortier A. Levesque S. Shi Y. Tardif J.-C. Perrault L.P. Lambert
J.
Institution
(Denault) Department of Anesthesiology, Montreal Heart Institute,
Universite De Montreal, Canada
(Bussieres) Department of Anesthesiology, Institut Universitaire De
Cardiologie et De Pneumologie De Quebec, Canada
(Arellano) Department of Anesthesiology, Kingston Hospital, Queens
University, Canada
(Finegan) Department of Anesthesiology, Edmonton Heart Institute,
University of Alberta, Canada
(Haddad) Department of Cardiology, Stanford University, United States
(Nguyen, Varin) Department of Pharmacology, Universite De Montreal, Canada
(Fortier, Levesque) Department of Public Health, Montreal Health
Coordinating Centre, Canada
(Shi, Tardif) Department of Medicine, Montreal Heart Institute, Universite
De Montreal, Canada
(Perrault) Department of Cardiac Surgery, Montreal Heart Institute,
Universite De Montreal, Canada
(Lambert) Department of Social and Preventive Medicine, School of Public
Health, Universite De Montreal, Canada
Title
Multicentered randomized controlled trial of inhaled milrinone.
Source
Canadian Journal of Anesthesia. Conference: 2014 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS St John's, NL Canada. Conference
Start: 20140613 Conference End: 20140616. Conference Publication:
(var.pagings). 61 (pp S67), 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
Introduction: Pulmonary hypertension is a major cause of mortality and
morbidity in patients undergoing valvular and complex heart surgery as it
can lead to right ventricular (RV) failure. Inhaled milrinone (iMil) has
been used for the treatment of pulmonary hypertension (1-2) but its safety
and pre-emptive effects in facilitating separation from cardiopulmonary
bypass (CPB) and preventing right ventricular dysfunction have not been
studied in patients undergoing high-risk valvular surgery. Methods: This
study has been approved by the institutional Ethics Committee and patient
informed consent was obtained. High-risk cardiac surgical patients with
preoperative pulmonary hypertension were randomized in a double-blind
fashion to receive iMil or placebo. The inhalation occurred after the
induction of anesthesia and before surgical incision and CPB. The
hemodynamic effects on ventricular function were evaluated by means of
pulmonary artery catheterization and transesophageal echocardiography. The
primary outcome was the level of difficulty in weaning from CPB. Results:
A total of 124 patients were randomized. There was no baseline difference
between the two groups except for more women and consequently a lower
weight mean in the iMil group. The mean EuroSCORE II was 8.0+/-2.6 and the
baseline average systolic pulmonary artery pressure (PAP) was 59+/-9 mmHg.
The use of iMil was associated with lower diastolic PAP (p=0.0339) and
higher mean systemic to pulmonary arterial pressure ratio (p=0.0113) with
no systemic hypotension. However, no advantage in terms of separation from
CPB (easy in 72% in control vs 70% in the iMil group; p=0.240) and RV
failure (15% vs 14%; p=0.941) was observed. Patients in both study groups
showed an increase in mortality with RV failure (22%), compared with those
without RV failure (1.9%) (p=0.0002). Predictors of RV failure were the
EuroSCORE II (OR 0.64, 95%CI 0.48-0.86) and RV systolic area (OR: 0.81,
95% CI 0.70-0.94). Conclusion: In this high-risk cardiac surgery cohort,
the pre-emptive use of inhaled milrinone is associated with favorable
hemodynamic effects which do not translate in improvement of clinically
relevant end-points.

<25>
Accession Number
71899664
Authors
Jasudavisius A. Bainbridge D. Arellano R.
Institution
(Jasudavisius, Bainbridge, Arellano) Anesthesia and Perioperative
Medicine, London Health Sciences Centre, United Kingdom
Title
A systematic review of TTE and tee in non-cardiac surgery.
Source
Canadian Journal of Anesthesia. Conference: 2014 Annual Meeting of the
Canadian Anesthesiologists' Society, CAS St John's, NL Canada. Conference
Start: 20140613 Conference End: 20140616. Conference Publication:
(var.pagings). 61 (pp S46), 2014. Date of Publication: June 2014.
Publisher
Springer New York LLC
Abstract
Background: It is well known that ultrasound is essential in cardiac
surgery however the body of evidence supporting its use in non-cardiac
surgery is lacking. Nevertheless, point of care ultrasound (POC) is an
evolving field in anesthesia. While several narrative reviews exist there
have been no systematic reviews to examine the literature and thus guide
the development of an evidence based curriculum for anesthesia training
purposes1, 2. Therefore, we undertook a systematic review to ascertain
common diagnoses made by POC during non-cardiac surgery. Methods: A
systematic review of case series was conducted to evaluate the use of TTE
and TEE in the intraoperative setting for high risk patients or during
periods of hemodynamic instability. With the assistance of a librarian,
studies were identified using PubMed, Cochrane, Cinahl, Embase and
reference lists of relevant articles. The search terms included TTE, TEE,
perioperative and ultrasound. The outcome variables analyzed were
segmental wall motion abnormalities (SWMAs), low left ventricular ejection
fraction (LVEF), hypovolemia, air embolism, cardiac and aortic thrombus,
pulmonary embolus (PE), aortic valve disease, mitral valve disease,
tricuspid valve disease, right ventricular (RV) failure, pericardial
disease and patent foramen ovale. No ethics approval was required for this
study. Results: Our search found seven studies that met our inclusion
criteria. The studies included 279 patients with either Group A: high risk
comorbidities (n = 176) or Group B: hemodynamic compromise/cardiac arrest
(n = 103). The most common diagnoses in Group A were low LVEF (40%),
mitral valve disease (22%), RV failure (14%) and SWMAs (12%). In Group B,
the most common diagnoses were low LVEF (24%), RV failure (21%), SWMAs
(18%), PE (15%) and hypovolemia (14%). Other diagnoses occurred less than
5% of the time. Discussion: Currently there is a limited body of
literature that examines the use of POC in noncardiac surgery. Regardless,
this systematic review suggests that a curriculum designed to teach
intraoperative POC should include common diagnoses such as low LVEF, RV
failure, mitral valve disease, SWMAs, PE and hypovolemia which is based on
evidence and not anecdote.

<26>
Accession Number
71894480
Authors
Varzaly J. Lau D.H. Chapman D.G. Viana F. Edwards J. Stuklis R.
Worthington M. Sanders P.
Institution
(Varzaly, Lau, Chapman, Viana, Edwards, Stuklis, Worthington, Sanders)
Centre for Heart Rhythm Disorders and South Australian Health and Medical
Research Institute (SAHMRI), University of Adelaide and Department of
Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia,
Centre for Heart Rhythm Disorders and South Australian Health and Medical
Research Institute (SAHMRI), University of Adelaide and Department of
Cardiology, Royal Adelaide Hospital, Adelaide, Australia, Centre for Heart
Rhythm Disorders and South Australian Health and Medical Research
Institute (SAHMRI), University of Adelaide, Adelaide, Australia
Title
Surgical ablation of isolated atrial fibrillation-a systematic review of
the literature.
Source
Heart Rhythm. Conference: 36th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2015 Boston, MA United States. Conference
Start: 20150513 Conference End: 20150516. Conference Publication:
(var.pagings). 12 (5 SUPPL. 1) (pp S430-S431), 2015. Date of Publication:
May 2015.
Publisher
Elsevier
Abstract
Introduction: Surgical atrial fibrillation (AF) ablation is used in
patients undergoing concurrent surgery. However, acceptance for "isolated"
surgical AF ablative procedures is limited. Here we undertook a systematic
literature review to evaluate the efficacy and safety of "isolated" AF
surgical procedures. Methods: A systematic literature review was conducted
to August 2014 using PUBMED/EMBASE. Broad search terms included "Cox-Maze,
Mini-Maze, ablation methods (including RF, cryoablation, cryomaze) and
surgery". This yielded 3626 results and all abstracts were reviewed to
remove studies with <100 patients, concomitant cardiac surgery and without
outcome data. 88 full articles were retrieved with 8 included in this
review. Results: Eight studies supplied a total 853 patients undergoing
isolated AF surgery (46% paroxysmal, 32% persistent and 22% long-standing
persistent). Mean follow-up duration was 22.2+/-12 months utilising
minimum of ECG and Holter monitor at variable time points. Lesion sets
were created using "cut and sew", radiofrequency (RF), cryothermy,
microwave (MW) or a combination. Average sinus rhythm maintenance (SRM)
was 80.9+/-20% with anti-arrhythmic drugs (AAD) and 68.5+/-18.3% without
AAD. The success rates differ according to procedural type with the
Cox-Maze lesion sets achieving higher SRM than PVI or Box lesion sets
(93.2% vs. 74.7%). Significantly lower SRM was achieved with MW than other
modalities. Mortality rate was 0.6%, CVA 0.8%, re-exploration for bleeding
0.6% and PPM requirement 3.3%. Further analysis of sternotomy vs minimally
invasive approaches found notable increases in mortality (1.4% vs. 0.3%),
re-exploration (1.4% vs. 0.3%) and PPM (7.5% vs. 1.9%) in the sternotomy
group. No atrioesophageal fistulas were described. Conclusions: This
review confirms good medium-term outcome and low complication rates for
isolated surgical AF ablation. Of note, minimally invasive approach
yielded greater safety profile than the sternotomy approach. Longer-term
data is needed to determine the role of such approach in relation to more
established catheter based ablation procedures.

<27>
Accession Number
71894166
Authors
Abraham W.T. Aggarwal S. Georgakopoulos D. Kao A.
Institution
(Abraham, Aggarwal, Georgakopoulos, Kao) The Ohio State University,
Columbus, OH, Mid America Heart and Vascular Institute, Kansas City, MO,
Sunshine Heart, Columbus, MN, Cardiovascular Consultants, Kansas City, MO
Title
Clinical experience with the C-pulse extraaortic counterpulsation system
in patients previously treated with optimal medical therapy and CRT.
Source
Heart Rhythm. Conference: 36th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2015 Boston, MA United States. Conference
Start: 20150513 Conference End: 20150516. Conference Publication:
(var.pagings). 12 (5 SUPPL. 1) (pp S306), 2015. Date of Publication: May
2015.
Publisher
Elsevier
Abstract
Introduction: Despite optimal medical therapy (OMT), including cardiac
resynchronization therapy (CRT), patients with NYHA Class III/ambulatory
IV HF with reduced ejection fraction (HFrEF) experience high rates of
morbidity and mortality. Due to the progressive nature of the disease,
patients remain symptomatic requiring hospitalization, transplantation or
mechanical circulatory support (VAD) thereby placing a significant burden
on hospital resource utilization. The C-Pulse System (Sunshine Heart,
Inc.) is a non-blood contacting, non-obligatory mechanical assist device
implanted on the ascending aorta. This technology is based on the
principle of counterpulsation. The purpose of this study is to evaluate
symptomatic patients with CRT therapy who receive C-Pulse System therapy
over a six month period. Methods: Twenty patients implanted with C-Pulse
system in the US feasibility IDE study (12 male, age 56.7+/-7 years) have
been previously reported. Ten patients had previous CRT (2.5+/-1.3 yrs).
Of the ten, seven had baseline and six month data collected including
6MHW, NYHA Class, CO, and LVEF. Three did not contribute six month data
(non-device related death, device related death, heart transplant)
Results: Parameters demonstrating improvement (p<.0001) from baseline to
six months are NYHA (3.1 +/- 0.4/2.0+/-0.6), MLWHF
(65.4+/-28.3/39.9+/-21.3) and KCCQ (44.2+/-25.3/65.3+/-19.2). 6MHW
(295.2+/-53.4/346.8+/-30.9), LVEF (29.1+/-7.3/34.1+/-4.7), and CO
(4.6+/-0.8/5.5+/-1.8) indicated directionally positive changes from
baseline to six months (NS). Conclusions: Published data has demonstrated
preliminary indications of safety and efficacy of extra aortic
counterpulsation therapy for the management of chronic heart failure. In
this small subset of patients the C-pulse System was implanted into
symptomatic patients previously treated with OMT+CRT therapy. The addition
of C-Pulse resulted in significant improvement in QOL and NYHA
classification at six months. A prospective, multicenter, randomized
controlled trial COUNTER HFTM is currently enrolling patients to further
evaluate the C-Pulse System.