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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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