EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015035229
Authors
Liakopoulos O.J. Kuhn E.W. Hellmich M. Kuhr K. Krause P. Reuter H. Thurat
M. Choi Y.-H. Wahlers T.
Institution
(Liakopoulos, Kuhn, Krause, Choi, Wahlers) Department of Cardiothoracic
Surgery, Heart Center, University of Cologne, Kerpener Strasse 62, Cologne
50924, Germany
(Hellmich, Kuhr) Institute of Medical Statistics, Informatics and
Epidemiology, University of Cologne, Cologne, Germany
(Reuter) Department of Cardiology, Heart Center, University of Cologne,
Cologne, Germany
(Thurat) Clinical Trials Center Cologne (ZKS Koln), Cologne, Germany
Title
Statin Recapture Therapy before Coronary Artery Bypass Grafting Trial:
Rationale and study design of a multicenter, randomized, double-blinded
controlled clinical trial.
Source
American Heart Journal. 170 (1) (pp 46-54.e2), 2015. Date of Publication:
01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Introduction Patients undergoing coronary artery bypass grafting (CABG)
are still at significant risk for postoperative major adverse cardiac and
cerebrovascular events (MACCEs). Recent clinical evidence shows that
cardioprotection in patients receiving a chronic statin treatment can be
"recaptured" by a high-dose statin therapy given shortly before an
ischemia-reperfusion sequence. Evaluation of this novel therapeutic
approach in the setting of CABG seems promising because myocardial
ischemia-reperfusion injury plays a pivotal role in poor clinical outcomes
that may be improved by a simple preoperative statin recapture treatment.
Methods The investigator-initiated StaRT-CABG trial is a multicenter,
randomized, double-blinded, 2-parallel group controlled clinical study in
2,630 patients. The trial aims to evaluate whether a high-dose statin
recapture therapy given shortly before CABG reduces the incidence of MACCE
at 30 days after surgery (primary composite outcome: all-cause mortality,
nonfatal myocardial infarction, and cerebrovascular events). Consenting
patients who are on chronic statin therapy before surgery will be
randomized to receive either oral statin reloading therapy or matching
placebo 12 and 2 hours before CABG. Key secondary end points include
enzymatic myocardial injury; new-onset atrial fibrillation; length of stay
in the intensive care unit and hospital; need for repeat coronary
revascularization at 30 days; and, finally, all-cause mortality at 12
months after surgery. Implications The StaRT-CABG trial is expected to
provide highly relevant clinical data on the efficacy of this novel
therapeutic approach to optimize the care for patients with coronary
artery disease undergoing CABG.

<2>
Accession Number
2015030960
Authors
Hawkins N.M. Bennett M.T. Andrade J.G. Virani S.A. Krahn A.D. Ignaszewski
A. Toma M.
Institution
(Hawkins, Bennett, Andrade, Virani, Krahn, Ignaszewski, Toma) Division of
Cardiology, University of British Columbia, Vancouver, BC, Canada
Title
Review of Eligibility for Cardiac Resynchronization Therapy.
Source
American Journal of Cardiology. 116 (2) (pp 318-324), 2015. Article
Number: 21129. Date of Publication: 15 Jul 2015.
Publisher
Elsevier Inc.
Abstract
Cardiac resynchronization therapy (CRT) is underused. Recent guidelines
have expanded indications for CRT to include less severe symptoms but now
favor left bundle branch block morphology in patients with moderate QRS
prolongation. The prevalence of CRT eligibility according to historical
and current guidelines is uncertain. The aim of this review was to
identify and synthesize all existing published research reporting the
prevalence of CRT eligibility. A systematic review of electronic databases
including MEDLINE, Embase, and the Cochrane Library was performed. The
primary outcome was the proportion of patients eligible for CRT according
to historical and current criteria. Secondary outcomes included the
individual components of eligibility (the ejection fraction, symptoms, and
QRS duration and morphology). Eligibility estimates were pooled using
random-effects models because of marked heterogeneity in between-study
variance. Thirty studies were identified. No study used current guideline
criteria. On the basis of historical criteria, 11 +/- 3% of ambulatory and
9 +/- 3% of hospitalized patients are eligible for CRT. However, New York
Heart Association class II in current guidelines is at least as frequent
as New York Heart Association III or IV. Approximately 1/3 of patients
have QRS prolongation, 2/3 of whom have left bundle branch block. Only a
few patients have non-left bundle branch block with QRS duration <150 ms.
Medical contraindication or ineligibility was rarely assessed. In
conclusion, current estimates of need are outdated. Inclusion of milder
symptoms potentially doubles the eligible population. Studies in
unselected cohorts are needed to accurately define the individual
components of eligibility, together with the prevalence and reasons for
ineligibility.

<3>
Accession Number
2015026425
Authors
Toyota T. Shiomi H. Morimoto T. Kimura T.
Institution
(Toyota, Shiomi, Kimura) Department of Cardiovascular Medicine, Graduate
School of Medicine, Kyoto University, Kyoto, Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Hyogo, Japan
Title
Meta-Analysis of Long-Term Clinical Outcomes of Everolimus-Eluting Stents.
Source
American Journal of Cardiology. 116 (2) (pp 187-194), 2015. Article
Number: 21109. Date of Publication: 15 Jul 2015.
Publisher
Elsevier Inc.
Abstract
The superiority of everolimus-eluting stents (EES) over sirolimus-eluting
stents (SES) for long-term clinical outcomes has not been yet firmly
established. We conducted a systematic review and a meta-analysis of
randomized controlled trials (RCTs) comparing EES directly with SES using
the longest available follow-up data. We searched PubMed, the Cochrane
database, and ClinicalTrials.gov for RCTs comparing outcomes between EES
and SES and identified 13,434 randomly assigned patients from 14 RCTs. EES
was associated with significantly lower risks than SES for definite stent
thrombosis (ST), definite/probable ST, target-lesion revascularization
(TLR), and major adverse cardiac events (MACE). The risks for all-cause
death and myocardial infarction were similar between EES and SES. By the
stratified analysis according to the timing after stent implantation, the
favorable trend of EES relative to SES for ST, TLR, and MACE was
consistently observed both within and beyond 1 year. The lower risk of EES
relative to SES for MACE beyond 1 year was statistically significant
(pooled odds ratio 0.77, 95% confidence interval 0.61 to 0.96, p = 0.02).
In conclusion, the current meta-analysis of 14 RCTs directly comparing EES
with SES suggested that EES provided improvement in both safety and
efficacy; EES compared with SES was associated with significantly lower
risk for definite ST, definite/probable ST, TLR, and MACE. The direction
and magnitude of the effect beyond 1 year were comparable with those
observed within 1 year.

<4>
Accession Number
2015020423
Authors
Bradley S.M. Chan P.S. Hartigan P.M. Nallamothu B.K. Weintraub W.S. Sedlis
S.P. Dada M. Maron D.J. Kostuk W.J. Berman D.S. Teo K.K. Mancini G.B.J.
Boden W.E. Spertus J.A.
Institution
(Bradley) Division of Cardiology, Department of Medicine, VA Eastern
Colorado Health Care System, Denver, CO, United States
(Bradley) Department of Medicine, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, United States
(Chan, Spertus) Department of Cardiovascular Research, Saint Luke's Mid
America Heart Institute, MO, United States
(Chan, Spertus) Department of Medicine, University of Missouri-Kansas
City, MO, United States
(Hartigan) Department of Medicine, Clinical Epidemiology Research Center,
VA Connecticut Healthcare Center, West Haven, CT, United States
(Nallamothu) Department of Medicine, University of Michigan Medical
School, Ann Arbor, MI, United States
(Weintraub) Department of Medicine, Christiana Care Health System, Newark,
DE, United States
(Sedlis) Division of Cardiology, Department of Medicine, VA New York
Harbor Health Care System, New York, NY, United States
(Sedlis) Department of Medicine, New York University School of Medicine,
New York, NY, United States
(Dada) Department of Medicine, Hartford Hospital, Hartford, CT, United
States
(Maron) Department of Medicine, Stanford University School of Medicine,
Stanford, CA, United States
(Kostuk) Department of Medicine, London Health Sciences Centre, University
of Western Ontario, London, ON, Canada
(Berman) Department of Medicine, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Teo) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Mancini) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Boden) Department of Medicine, Western New York VA Healthcare Network,
Buffalo, NY, United States
(Boden) Buffalo General Hospital, SUNY, Buffalo, NY, United States
Title
Validation of the Appropriate Use Criteria for Percutaneous Coronary
Intervention in Patients With Stable Coronary Artery Disease (from the
COURAGE Trial).
Source
American Journal of Cardiology. 116 (2) (pp 167-173), 2015. Article
Number: 21106. Date of Publication: 15 Jul 2015.
Publisher
Elsevier Inc.
Abstract
Establishing the validity of appropriate use criteria (AUC) for
percutaneous coronary intervention (PCI) in the setting of stable ischemic
heart disease can support their adoption for quality improvement. We
conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing
Revascularization and Aggressive Drug Evaluation trial patients with
stable ischemic heart disease randomized to PCI with optimal medical
therapy (OMT) or OMT alone. Within appropriateness categories, we compared
rates of death, myocardial infarction, revascularization subsequent to
initial therapy, and angina-specific health status as determined by the
Seattle Angina Questionnaire in patients randomized to PCI + OMT to those
randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to
the 2012 publication of the AUC, with 1,334 (67.1%) classified as
appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There
were no significant differences between PCI and OMT alone in the rate of
mortality and myocardial infarction by appropriateness classification.
Rates of revascularization were significantly lower in patients initially
receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65;
95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio
0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among
patients classified as appropriate by the AUC, Seattle Angina
Questionnaire scores at 1 month were better in the PCI-treated group
compared with the medical therapy group (80 +/- 23 vs 75 +/- 24 for angina
frequency, 73 +/- 24 vs 68 +/- 24 for physical limitations, and 68 +/- 23
vs 60 +/- 24 for quality of life; all p <0.01), with differences generally
persisting through 12 months. In contrast, health status scores were
similar throughout the first year of follow-up in PCI + OMT patients
compared with OMT alone in patients classified as uncertain or
inappropriate. In conclusion, these findings support the validity of the
AUC in efforts to improve health care quality through optimal use of PCI.

<5>
Accession Number
2015644357
Authors
Tregay J. Wray J. Bull C. Franklin R.C. Daubeney P. Barron D.J. Brown K.
Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2014.
Publisher
Cambridge University Press
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway.

<6>
Accession Number
2015149081
Authors
Pike K. Nash R.L. Murphy G.J. Reeves B.C. Rogers C.A.
Institution
(Pike, Nash, Reeves, Rogers) University of Bristol, Clinical Trials and
Evaluation Unit, School of Clinical Sciences, Bristol, United Kingdom
(Murphy) University of Leicester, Department of Cardiovascular Sciences,
Leicester, United Kingdom
Title
Transfusion Indication Threshold Reduction (TITRe2) randomized controlled
trial in cardiac surgery: Statistical analysis plan.
Source
Trials. 16 (1) , 2015. Article Number: 54. Date of Publication: February
22, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: The Transfusion Indication Threshold Reduction (TITRe2) trial
is the largest randomized controlled trial to date to compare red blood
cell transfusion strategies following cardiac surgery. This update
presents the statistical analysis plan, detailing how the study will be
analyzed and presented. The statistical analysis plan has been written
following recommendations from the International Conference on
Harmonisation of Technical Requirements for Registration of
Pharmaceuticals for Human Use, prior to database lock and the final
analysis of trial data. Outlined analyses are in line with the
Consolidated Standards of Reporting Trials (CONSORT). Methods and design:
The study aims to randomize 2000 patients from 17 UK centres. Patients are
randomized to either a restrictive (transfuse if haemoglobin concentration
<7.5 g/dl) or liberal (transfuse if haemoglobin concentration <9 g/dl)
transfusion strategy. The primary outcome is a binary composite outcome of
any serious infectious or ischaemic event in the first 3 months following
randomization. Trial registration: ISRCTN70923932.

<7>
Accession Number
2015151817
Authors
Ling Z.-G. Wu Y.-B. Ming M.-Y. Cai S.-Q. Chen Y.-Q.
Institution
(Ling, Wu, Cai, Chen) Institute of Respiratory Diseases, Guangxi Medical
University, Nanning, Guangxi, China
(Ming) Department of Respiratory Diseases, Guangxi Medical University,
Liuzhou, Guangxi, China
Title
The effect of pleural abrasion on the treatment of primary spontaneous
pneumothorax: A systematic review of randomized controlled trials.
Source
PLoS ONE. 10 (6) , 2015. Article Number: e0127857. Date of Publication: 04
Jun 2015.
Publisher
Public Library of Science
Abstract
Background: Pleural abrasion has been widely used to control the
recurrence of primary spontaneous pneumothorax (PSP). However, controversy
still exists regarding the advantages and disadvantages of pleural
abrasion compared with other interventions in preventing the recurrence of
PSP. Methods: The PubMed, Embase, and Cochrane Central Register of
Controlled Trials databases were searched up to December 15, 2014 to
identify randomized controlled trials (RCTs) that compared the effects of
pleural abrasion with those of other interventions in the treatment of
PSP. The study outcomes included the PSP recurrence rate and the
occurrence rate of adverse effects. Results: Mechanical pleural abrasion
and apical pleurectomy after thoracoscopic stapled bullectomy exhibited
similarly persistent postoperative air leak occurrence rates (p = 0.978)
and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led
to reduced residual chest pain and discomfort (p = 0.001) and a smaller
rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the
addition of minocycline pleurodesis to pleural abrasion did not reduce the
pneumothorax recurrence rate compared with apical pleurectomy (3.8% for
both procedures) but was associated with fewer complications. There was no
statistical difference in the pneumothorax recurrence rate between
mechanical pleural abrasion and chemical pleurodesis with minocycline on
either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12;
Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24;
Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did
not reduce the pneumothorax recurrence rate compared with pleural abrasion
alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis
was associated with more intense acute chest pain. The postoperative
overall recurrence rate in patients who underwent staple line coverage
with absorbable cellulose mesh and fibrin glue was similar to that with
mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%,
respectively; p = 0.555), but staple line coverage resulted in less
postoperative residual pain than mechanical abrasion (0.4% vs.3.2%;
p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not
decrease the recurrence of pneumothorax compared with wedge resection
alone (p = 0.791), but the intraoperative bleeding and postoperative
pleural drainage rates were higher when pleural abrasion was performed.
Conclusions: In addition to resulting in the same pneumothorax recurrence
rate, thoracoscopic pleural abrasion with or without minocycline
pleurodesis is safer than apical pleurectomy in the treatment of PSP.
However, minocycline pleurodesis with or without pleural abrasion is not
any more effective than pleural abrasion alone. Moreover, additional
mechanical abrasion is not safer than additional staple line coverage with
absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy
because of increased postoperative pain. Additionally, pleural abrasion
after thoracoscopic wedge resection should not be recommended for routine
application due to the greater incidence of adverse effects than wedge
resection alone. However, further large-scale, well-designed RCTs are
needed to confirm the best procedure.

<8>
Accession Number
2015141409
Authors
Williams J.M. Young P. Pilcher J. Weatherall M. Miller J.H. Beasley R. La
Flamme A.C.
Institution
(Williams, Miller, La Flamme) School of Biological Sciences, Victoria
University of Wellington, PO Box 600, Wellington 6140, New Zealand
(Young, Weatherall, Beasley) Capital and Coast District Health Board,
Wellington, New Zealand
(Young, Pilcher, Weatherall, Beasley) Medical Research Institute of New
Zealand, Wellington, New Zealand
(Weatherall) Department of Medicine, Otago University, Wellington, New
Zealand
Title
Remote ischaemic preconditioning does not alter perioperative cytokine
production in high-risk cardiac surgery.
Source
Heart Asia. 4 (1) (pp 97-101), 2014. Date of Publication: 2014.
Publisher
BMJ Publishing Group
Abstract
Rationale Remote ischaemic preconditioning (RIPC) is a novel
cardioprotective strategy that uses brief intermittent limb ischaemia to
protect the myocardium and other organs from perioperative ischaemic
damage. The precise mechanism through which this protective effect occurs
is unknown, but potentially could be related to changes in blood-borne
mediators such as cytokines.
Objective To determine whether RIPC alters inflammatory cytokine
expression in a double-blind, randomised, controlled trial of patients
undergoing highrisk cardiac surgery.
Methods and results Serum interleukin (IL)-6, IL-8, and IL-10 levels from
95 patients randomised to RIPC (n=47) or control treatment (n=48) were
measured preoperatively, and 1, 2, 3, 6 and 12 h after cross-clamp
removal. Systemic concentrations of all cytokines were increased from
baseline following surgery, and, compared with simple procedures, complex
surgeries were associated with significantly higher release of IL-6 (ratio
of mean area under the curves 1.54 (95% CI 1.02 to 2.34), p=0.04) and
IL-10 (1.97 (1.16 to 3.35), p=0.012). No significant difference in mean
cytokine levels between the RIPC and control groups was detected at any
time point, irrespective of the type of surgery undergone.
Conclusions High levels of IL-6, IL-8 and IL-10 are produced during
high-risk cardiac surgery, and RIPC does not alter these elevated
perioperative cytokine concentrations. Identification of factors that
influence the ability to induce RIPC-mediated cardioprotection should be
the priority of future research.

<9>
Accession Number
2015034889
Authors
Sansone R. Stanske B. Keymel S. Schuler D. Horn P. Saeed D. Boeken U.
Westenfeld R. Lichtenberg A. Kelm M. Heiss C.
Institution
(Sansone, Stanske, Keymel, Schuler, Horn, Westenfeld, Kelm, Heiss)
Division of Cardiology, Pulmonology, and Vascular Medicine, University of
Dusseldorf, Medical Faculty, Moorenstrasse 5, Dusseldorf 40225, Germany
(Saeed, Boeken, Lichtenberg) Department of Cardiovascular Surgery,
University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
(Lichtenberg, Kelm) Cardiovascular Research Institute, Heinrich Heine
University, University of Dusseldorf, Dusseldorf, Germany
Title
Macrovascular and microvascular function after implantation of left
ventricular assist devices in end-stage heart failure: Role of
microparticles.
Source
Journal of Heart and Lung Transplantation. 34 (7) (pp 921-932), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Background The hemodynamic vascular consequences of implanting left
ventricular assist devices (LVADs) have not been studied in detail. We
investigated the effect of LVAD implantation compared with heart
transplant (HTx) on microvascular and macrovascular function in patients
with end-stage heart failure and evaluated whether microparticles may play
a role in LVAD-related endothelial dysfunction. Methods Vascular function
was assessed in patients with end-stage heart failure awaiting HTx,
patients who had undergone implantation of a continuous-flow centrifugal
LVAD, and patients who had already received a HTx. Macrovascular function
was measured by flow-mediated vasodilation (FMD) using high-resolution
ultrasound of the brachial artery. Microvascular function was assessed in
the forearm during reactive hyperemia using laser Doppler perfusion
imaging and pulsed wave Doppler. Age-matched patients without heart
failure and without coronary artery disease (CAD) (healthy control
subjects) and patients with stable CAD served as control subjects.
Circulating red blood cell (CD253⁺), leukocyte
(CD45⁺), platelet (CD31⁺/CD41⁺), and
endothelial cell (CD31⁺/CD41^-, CD62e⁺,
CD144⁺) microparticles were determined by flow cytometry and
free hemoglobin by enzyme-linked immunosorbent assay. Results FMD and
microvascular function were significantly impaired in patients with
end-stage heart failure compared with healthy control subjects and
patients with stable CAD. LVAD implantation led to recovery of
microvascular function, but not FMD. In parallel, increased free
hemoglobin was observed along with red and white cell microparticles and
endothelial and platelet microparticles. This finding indicates
destruction of blood cells with release of hemoglobin and activation of
endothelial cells. HTx and LVAD implantation led to similar improvements
in microvascular function. FMD increased and microparticle levels
decreased in patients with HTx, whereas shear stress during reactive
hyperemia was similar in patients with LVADs and patients with HTx.
Conclusions Our data suggest that LVAD support leads to significant
improvements in microvascular perfusion and hemodynamics. However,
destruction of blood cells may contribute to residual endothelial
dysfunction potentially by increasing nitric oxide scavenging capacity.

<10>
Accession Number
2015834608
Authors
Lehtinen M. Patila T. Kankuri E. Lauerma K. Sinisalo J. Laine M. Kupari M.
Vento A. Harjula A.
Institution
(Lehtinen, Patila, Vento, Harjula) Department of Cardiothoracic Surgery,
Heart and Lung Center, Helsinki University Central Hospital, Finland
(Kankuri, Harjula) Institute of Biomedicine, Pharmacology, University of
Helsinki, Finland
(Lauerma) Division of Roentgenology, HUS Medical Imaging Center, Finland
(Sinisalo, Laine, Kupari) Department of Cardiology, Heart and Lung Center,
Helsinki University Central Hospital, Helsinki, Finland
Title
Intramyocardial bone marrow mononuclear cell transplantation in ischemic
heart failure: Long-term follow-up.
Source
Journal of Heart and Lung Transplantation. 34 (7) (pp 899-905), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Background Long-term results regarding treatment of chronic ischemic heart
failure with bone marrow mononuclear cells (BMMCs) have been few. We
received encouraging results at the 1-year follow-up of patients treated
with combined coronary artery bypass grafting (CABG) and BMMCs, so we
decided to extend the follow-up. Methods The study patients had received
injections of BMMCs or vehicle into the myocardial infarction border area
during CABG in a randomized and double-blind manner. We could contact 36
of the 39 patients recruited for the original study. Pre-operatively and
after an extended follow-up period, we performed magnetic resonance
imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed
patient records from the follow-up period, and determined current quality
of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health
Survey. Results The median follow-up time was 60.7 months (interquartile
range [IQR], 45.1-72.6 months). No statistically significant difference
was detected in change of pro-B-type amino-terminal natriuretic peptide
values or in quality of life between groups. The median change in left
ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls
and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall
thickening in injected segments increased by a median of 17% (IQR, -5% to
30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p =
0.434). Scar size in injected segments increased by a median of 2% (IQR,
-7% to 19%) for controls but diminished for BMMC patients, with a median
change of -17% (IQR, -30% to -6%; p = 0.011). Conclusions In the treatment
of chronic ischemic heart failure, combining intramyocardial BMMC therapy
with CABG fails to affect cardiac function but can sustainably reduce scar
size, even in the long-term.

<11>
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Accession Number
2014954944
Authors
Tian M.-L. Hu Y. Yuan J. Zha Y.
Institution
(Tian, Hu, Yuan, Zha) Department of Nephrology, Institute of Nephritic and
Urinary Disease, Guizhou Provincial Peoples Hospital, 83 Zhongshan Road,
Guiyang 550002, China
Title
Efficacy and safety of perioperative sodium bicarbonate therapy for
cardiac surgery-associated acute kidney injury: A meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 65 (2) (pp 130-136), 2015. Date of
Publication: February 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVE:: Urinary alkalinization with sodium bicarbonate infusion can
theoretically protect against the mechanisms of acute kidney injury (AKI).
Controversy exists regarding whether sodium bicarbonate infusion can
reduce the incidence of AKI from cardiac surgery. A meta-analysis was
conducted to show the efficacy and safety of perioperative sodium
bicarbonate use for preventing AKI in patients undergoing cardiac surgery.
DATA SOURCES:: PubMed, CBM, EMBASE, CENTRAL, and Cochrane renal group
specialized register were searched for pertinent studies. STUDY
SELECTION:: Randomized controlled trails and prospective observational
cohort studies that compared sodium bicarbonate with sodium chloride or
blank control in cardiac surgery with cardiopulmonary bypass were
included. Exclusion criteria were duplicate publications, nonadult
studies, oral administration of sodium bicarbonate, retrospective
analyses, and studies with small sample size (n < 50) or with no data on
AKI. DATA EXTRACTION:: Study end points, study design, population,
operation information, and sodium bicarbonate doses were extracted. DATA
SYNTHESIS:: Data from 1673 patients in 5 randomized trials and 1
prospective observational cohort study were analyzed. The analysis showed
that sodium bicarbonate did not reduce the incidence of postoperative AKI
and the need for renal replacement therapy. Postoperative ventilation
time, hospital length of stay, hospital death, and mortality within 90
days had no statistical difference between 2 groups. Time in intensive
care unit was even slightly longer in the experimental group.
CONCLUSIONS:: Urinary alkalinization using sodium bicarbonate infusion
failed to reduce the incidence rate of AKI or other outcomes in patients
undergoing cardiac surgery. This intervention might even prolong intensive
care unit stay.

<12>
Accession Number
2015140709
Authors
Huang F. Lai W. Chan C. Peng H. Zhang F. Zhou Y. Teng S. Huang Z.
Institution
(Huang, Lai, Chan, Zhang, Teng, Huang) Department of Cardiology, Nanfang
Hospital, Southern Medical University, Guangzhou, Guangdong, China
(Peng) Department of Sleep Disorder Center, Nanfang Hospital, Southern
Medical University, Guangzhou, Guangdong, China
(Zhou) Department of Obstetrics and Gynecology, Nanfang Hospital, Southern
Medical University, Guangzhou, Guangdong, China
Title
Comparison of bypass surgery and drug-eluting stenting in diabetic
patients with left main and/or multivessel disease: A systematic review
and meta-analysis of randomized and nonrandomized studies.
Source
Cardiology Journal. 22 (2) (pp 123-134), 2015. Date of Publication: 2015.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
viamedica@viamedica.com.pl)
Abstract
Background: With advances in theinterventional feld, the choice between
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention with drug-eluting stents (PCI-DES) for the diabetic subset
with left main (LM) and/or multivessel disease (MVD) remains consistently
controversial. Methods and results: We conducted a systematic review of
randomized controlled trials (RCTs) and observational controlled trials
(OCTs) comparing the two strategies for the diabetic subset with LM and/or
MVD. PubMed, EMBASE, CENTRAL databases, Google Scholar and SinoMed were
systematically searched for eligible studies without language and
publication restrictions. We identifed 19 trials (4 randomized and 15
nonrandomized), enrolling 5,805 patients in OCTs and 3,060 patients in
RCTs, respectively. PCI-DES was associated with higher mortality compared
with CABG (11.7% DES vs. 9.1% CABG, RR 1.23, 95% CI 1.00-1.53, p = 0.06).
Patients after PCI-DES had higher prevalence of myocardial infarction (MI)
when compared with CABG (8.5% DES vs. 4.6% CABG, RR 1.68, 95% CI
1.20-2.37, p = 0.003). PCI-DES patients were at substantially lower risk
of stroke (2.0% DES vs. 3.9% CABG, RR 0.51, 95% CI 0.39-0.67, p <
0.00001), but at several-fold higher risk of repeat revascularization
(19.0% DES vs. 6.3% CABG, RR 2.95, 95% CI 2.46-3.55, p < 0.00001). The OCT
patients risked a lower mortality as compared to the RCT patients (9.6%
OCTs vs. 11.9% RCTs, RR 0.81, 95% CI 0.71-0.92, p = 0.001). Conclusions:
CABG for patients with diabetes mellitus and LM and/or MVD had advantages
over PCI-DES in all-cause death, nonfatal MI, and repeat
revascularization, but the substantial disadvantage in nonfatal stroke.
The high-selected patients (RCTs) risked a higher mortality than the
real-world patients (OCTs).

<13>
Accession Number
2015134872
Authors
Erlinge D. Gotberg M. Noc M. Lang I. Holzer M. Clemmensen P. Jensen U.
Metzler B. James S. Botker H.E. Omerovic E. Koul S. Engblom H. Carlsson M.
Arheden H. Ostlund O. Wallentin L. Klos B. Harnek J. Olivecrona G.K.
Institution
(Erlinge, Gotberg, Koul, Harnek) Department of Cardiology, Clinical
Sciences, Lund University, Lund S-221 85, Sweden
(Noc) Center for Intensive Internal Medicine, Ljubljana, Slovenia
(Lang, Holzer) Department of Cardiology, Medical University of Vienna,
Vienna, Austria
(Lang, Holzer) Department of Emergency Medicine, Medical University of
Vienna, Vienna, Austria
(Clemmensen, Olivecrona) Department of Cardiology, Nykoebing F Hospital,
Nykoebing F, Denmark
(Jensen) Cardiology Unit, Department of Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Metzler) Department of Cardiology, University Hospital for Internal
Medicine, Innsbruck, Austria
(James, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Botker) Department of Cardiology, Aarhus University Hospital Skejby,
Aarhus, Denmark
(Omerovic) Department of Cardiology, Sahlgrenska University, Gothenburg,
Sweden
(Engblom, Carlsson, Arheden) Department of Clinical Physiology, Lund
University, Lund, Sweden
(Ostlund) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(Klos) Philips Healthcare, San Diego, CA, United States
Title
Therapeutic Hypothermia for the Treatment of Acute Myocardial
Infarction-Combined Analysis of the RAPID MI-ICE and the CHILL-MI Trials.
Source
Therapeutic Hypothermia and Temperature Management. 5 (2) (pp 77-84),
2015. Date of Publication: 01 Jun 2015.
Publisher
Mary Ann Liebert Inc.
Abstract
In the randomized rapid intravascular cooling in myocardial infarction as
adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid
endovascular catheter core cooling combined with cold saline as an adjunct
to percutaneous coronary intervention for the treatment of acute
myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in
conscious patients with ST-elevation myocardial infarction (STEMI) by a
combination of cold saline and endovascular cooling. Twenty patients in
RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary
percutaneous coronary intervention (PCI) within <6 hours after symptom
onset were randomized to hypothermia induced by rapid infusion of 600-2000
mL cold saline combined with endovascular cooling or standard of care.
Hypothermia was initiated before PCI and continued for 1-3 hours after
reperfusion aiming at a target temperature of 33degreeC. The primary
endpoint was myocardial infarct size (IS) as a percentage of myocardium at
risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4+/-2
days. Patients randomized to hypothermia treatment achieved a mean core
body temperature of 34.7degreeC before reperfusion. Although significance
was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in
the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs.
46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was
predominantly reduced in early anterior STEMI (0-4h) in the hypothermia
group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR).
There was no mortality in either group. The incidence of heart failure was
reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large
MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in
the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR;
hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30%
did not show effect of hypothermia (35.8, 28.3-57.5 vs. 38.4, 27.4-59.7,
median, IQR; hypothermia n=15 vs. control n=19, p=0.50). The prespecified
pooled analysis of RAPID MI-ICE and CHILL-MI indicates a reduction of
myocardial IS and reduction in heart failure by 1-3 hours with
endovascular cooling in association with primary PCI of acute STEMI
predominantly in patients with large area of myocardium at risk.
(ClinicalTrials.gov id NCT00417638 and NCT01379261).

<14>
Accession Number
2015139620
Authors
Cannon C.P. Blazing M.A. Giugliano R.P. McCagg A. White J.A. Theroux P.
Darius H. Lewis B.S. Ophuis T.O. Jukema J.W. De Ferrari G.M. Ruzyllo W. De
Lucca P. Im K. Bohula E.A. Reist C. Wiviott S.D. Tershakovec A.M. Musliner
T.A. Braunwald E. Califf R.M.
Institution
(Cannon, Giugliano, McCagg, Im, Bohula, Wiviott, Braunwald) Thrombolysis
in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital,
Harvard Medical School, Boston, United States
(Blazing, White, Reist, Califf) Duke Clinical Research Institute (DCRI),
Durham, NC, United States
(Theroux) Montreal Heart Institute, Montreal, Canada
(Darius) Vivantes Neukolln Medical Center, Berlin, Germany
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ophuis) Canisius-Wilhelmina Ziekenhuis, Nijmegen, Netherlands
(Jukema) Netherlands Leiden University Medical Center, Leiden, Netherlands
(De Ferrari) Fondazione IRCCS Policlinico San Matteo, University of Pavia,
Pavia, Italy
(Ruzyllo) National Institute of Cardiology, Warsaw, Poland
(De Lucca, Tershakovec, Musliner) Merck, Kenilworth, NJ, United States
Title
Ezetimibe added to statin therapy after acute coronary syndromes.
Source
New England Journal of Medicine. 372 (25) (pp 2387-2397), 2015. Date of
Publication: 18 Jun 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL)
cholesterol levels and the risk of cardiovascular events, but whether the
addition of ezetimibe, a nonstatin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further is not known. METHODS: We conducted a double-blind, randomized
trial involving 18,144 patients who had been hospitalized for an acute
coronary syndrome within the preceding 10 days and had LDL cholesterol
levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they
were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3
to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy.
The combination of simvastatin (40 mg) and ezetimibe (10 mg)
(simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo
(simvastatin monotherapy). The primary end point was a composite of
cardiovascular death, nonfatal myocardial infarction, unstable angina
requiring rehospitalization, coronary revascularization (>30 days after
randomization), or nonfatal stroke. The median follow-up was 6 years.
RESULTS: The median time-weighted average LDL cholesterol level during the
study was 53.7 mg per deciliter (1.4 mmol per liter) in the
simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8
mmol per liter) in the simvastatin-monotherapy group (P<0.001). The
Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in
the simvastatin-ezetimibe group, as compared with 34.7% in the
simvastatin-monotherapy group (absolute risk difference, 2.0 percentage
points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P =
0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse
effects and cancer were similar in the two groups. CONCLUSIONS: When added
to statin therapy, ezetimibe resulted in incremental lowering of LDL
cholesterol levels and improved cardiovascular outcomes. Moreover,
lowering LDL cholesterol to levels below previous targets provided
additional benefit.

<15>
Accession Number
2015655814
Authors
Sunitha Suresh B.S. De Oliveira G.S. Suresh S.
Institution
(Sunitha Suresh, De Oliveira, Suresh) Department of Pediatric
Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago,
Chicago, IL, United States
(Sunitha Suresh) Johns Hopkins Medical School, Baltimore, MD, United
States
(De Oliveira) Department of Anesthesiology, Northwestern University, 241
East Huron St F5-704, Chicago, IL, United States
Title
The effect of audio therapy to treat postoperative pain in children
undergoing major surgery: a randomized controlled trial.
Source
Pediatric Surgery International. 31 (2) (pp 197-201), 2015. Date of
Publication: 2015.
Publisher
Springer Verlag
Abstract
Purpose: To evaluate the analgesic effect of music and audiobooks in
children undergoing major surgical procedures when compared to a control
(silence) group.
Methods: The study was a prospective and randomized trial. Children
undergoing major surgeries were randomized to one of the three groups:
music, audiobook or control (silence). The primary outcome was the pain
burden reduction by two treatments within 48 h postoperatively. Pain
burden was measured using the area under the pain scale versus the 30 min
interval for each treatment.
Results: 60 patients were recruited and 56 completed the study. Pain
burden was reduced in the music and audiobook groups compared to control,
median (IQR) of -60 (-90 to 0), -45 (-90 to 0) and 0 (-30 to 90) (min x
pain score), respectively, P = 0.04. A linear regression analysis
demonstrated an independent group effect on pain reduction even after
adjusting for the mean pain scores recorded at the beginning of the
treatment, slope of regression line -56.8 +/- 24 goodness of fit
r² = 0.25 and slope significantly different from 0 (P = 0.02).
Conclusions: Audio therapy is an efficacious adjunct method to decrease
post-surgical pain in children undergoing major surgeries. Audio therapy
should be considered as an important strategy to minimize pain in children
undergoing major surgery.

<16>
Accession Number
2015135993
Authors
Duan F. Qi Z. Liu S. Lv X. Wang H. Gao Y. Wang J.
Institution
(Duan, Qi, Lv, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital and Cardiovascular Institute, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Tsinghua University,
Peking Union Medical College, Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital and
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Tsinghua University, Peking Union
Medical College, Beijing, China
Title
Effectiveness 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 remodeling.
Source
Medical Ultrasonography. 17 (2) (pp 160-166), 2015. Date of Publication:
2015.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie
Abstract
Aims: 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 remodeling of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Material and
methods: Patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: CABG only (18
patients), or CABG with BMMNC transplantation (24 patients).
Echocardiographic parameters were measured on B-mode imaging, 3D imaging
and color flow imaging. Results Post-operative LVEDD (end-diastolic
dimension of left ventricle), LVESD (end-systolic dimension of left
ventricle), LVEDV (end-diastolic volume of left ventricle), LVESV
(end-systolic volume of left ventricle), LVEDVI (LVEDV indexed to body
surface area), LVESVI (LVESV indexed to body surface area), LV-mass (mass
of left ventricle) and LV-massI (LV-mass indexed to body surface area)
were significantly improved compared with those obtained prior to
operation in CABG+BMMNC group (al p<0.05). The same parameters were not
significantly different pre- and postoperative in the CABG group (al
p>0.05). Postoperative mitral regurgitation score was not significantly
different from those prior to operation in both groups (al p>0.05). In
Chi-square tests, LVEDD, LVESD, LVEDV, LVESV, LVEDVI, LVESVI, LV-mass,
LV-massI were determinants of the left ventricular remodeling. Conclusion:
The improvement of left ventricular remodeling in CABG+BMMNC group was
better than in the CABG group and this improvement was verified by
echocardiography.

<17>
Accession Number
2014831282
Authors
Bibek S.-B. Xie Y. Gao J.-J. Wang Z. Wang J.-F. Geng D.-F.
Institution
(Bibek) Department of Cardiology, Shahid Gangalal National Heart Center,
Kathmandu, Nepal
(Xie, Gao, Wang, Geng) Department of Cardiology, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou
510120, China
(Wang) Department of Anesthesiology, Sun Yat-sen Memorial Hospital,
Guangzhou 510120, China
(Xie, Gao, Wang, Geng) Guangdong Province Key Laboratory of Arrhythmia and
Electrophysiology, Sun Yat-sen University, Guangzhou 510120, China
Title
Role of Pre-procedural C-reactive Protein Level in the Prediction of Major
Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary
Intervention: a Meta-analysisof Longitudinal Studies.
Source
Inflammation. 38 (1) (pp 159-169), 2014. Date of Publication: 2014.
Publisher
Springer New York LLC
Abstract
Numerous studies have reported the relation between pre-procedural
C-reactive protein (CRP) levels and the risk of major adverse cardiac
events (MACEs) in patients undergoing percutaneous coronary intervention
(PCI). However, the results across the studies were inconsistent. The aim
of this study was to evaluate the predictive effect of pre-procedural CRP
levels and the risk of MACEs in patients undergoing PCI. Longitudinal
studies on the association between pre-procedural CRP levels and MACEs
were identified by electronic and manual searches. Summary risk ratios
(RRs) and 95 % confidence intervals (CI) were calculated employing an
inverse variance random-effects model irrespective of between-study
heterogeneity. Thirty-three studies involving 34,367 patients with 4119
MACEs were included in this study. High CRP level was associated with
increased incidences of MACEs, all-cause death, myocardial infarction,
coronary revascularization, and clinical restenosis, with pooled RRs of
1.97 (95 % CI, 1.65, 2.35), 2.88 (95 % CI, 2.15, 3.86), 1.81 (95 % CI,
1.48, 2.21), 1.31 (95 % CI, 1.11, 1.56), and 1.45 (95 % CI, 1.07, 1.96),
respectively. Dose-response analysis showed that every 1 mg/L increment in
pre-procedural serum CRP level was associated with a significant 12 %
increase in the risk of MACEs. In spite of heterogeneity across the
included studies, this meta-analysis suggests that pre-procedural serum
CRP level is a valuable predictor of MACEs in patients undergoing PCI.

<18>
Accession Number
2014979679
Authors
Koster G. Wetterslev J. Gluud C. Zijlstra J.G. Scheeren T.W.L. van der
Horst I.C.C. Keus F.
Institution
(Koster, Zijlstra, van der Horst, Keus) Department of Critical Care,
University of Groningen, University Medical Centre Groningen, P.O. Box
30.001, Groningen 9700 RB, Netherlands
(Wetterslev, Gluud) The Copenhagen Trial Unit (CTU), Centre for Clinical
Intervention Research, Department 7812, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
(Scheeren) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Groningen, Netherlands
Title
Effects of levosimendan for low cardiac output syndrome in critically ill
patients: systematic review with meta-analysis and trial sequential
analysis.
Source
Intensive Care Medicine. 41 (2) (pp 203-221), 2014. Date of Publication:
2014.
Publisher
Springer Verlag
Abstract
Conclusions: The available evidence is inconclusive whether or not
levosimendan may have a beneficial effect on mortality due to risks of
systematic errors and random errors. Further well-designed randomised
trials are needed.
Results: A total of 88 trials were included in the systematic review and
49 trials (6,688 patients) in the meta-analysis. One trial had low risk of
bias and nine trials (2,490 patients) were considered lower risk of bias.
Trials compared levosimendan with placebo, control interventions, and
other inotropes. Pooling all trials including heterogenous populations was
considered inappropriate. Pooled analysis of 30 trials including
critically ill patients not having cardiac surgery showed an association
between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI
0.59-0.97), while trials with lower risk of bias showed no significant
difference (RR 0.83, TSA-adjusted 95 % CI 0.48-1.55). Conventional
meta-analysis of all 14 trials including cardiac surgery patients showed
an association, while lower risk of bias trials showed no association
between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR
1.02, 95 % CI 0.48-2.16).
Purpose: To assess the benefits and harms of levosimendan for low cardiac
output syndrome in critically ill patients.
Methods: We conducted a systematic review with meta-analyses and trial
sequential analyses (TSA) of randomised clinical trials comparing
levosimendan with any type of control. Two reviewers independently
assessed studies for inclusion. The Cochrane Collaboration methodology was
used. Random-effects risk ratios (RR) and 95 % confidence intervals (CI)
were derived for the principal primary outcome mortality at maximal
follow-up.

<19>
Accession Number
2015136412
Authors
Stephan F. Barrucand B. Petit P. Rezaiguia-Delclaux S. Medard A. Delannoy
B. Cosserant B. Flicoteaux G. Imbert A. Pilorge C. Berard L. Camous J.
Kortchinsky T. Massabie P. Samain E. Bastien O. Richecoeur J. Boulet E.
Sarrabay P. Ouattara A.
Institution
(Stephan, Rezaiguia-Delclaux, Imbert, Pilorge, Camous, Kortchinsky,
Massabie) Service de Reanimation Adulte, Centre Chirurgical Marie
Lannelongue, 133 avenue de la Resistance, Le Plessis-Robinson 92350,
France
(Barrucand, Petit, Flicoteaux, Samain) Departement
d'Anesthesie-Reanimation, Centre Hospitalier Universitaire, Besancon,
France
(Medard, Cosserant) Departement d'Anesthesie-Reanimation, Centre
Hospitalier Universitaire, Clermont-Ferrand, France
(Delannoy, Bastien) Departement d'Anesthesie-Reanimation, Centre
Hospitalier Universitaire, Lyon, France
(Berard) Hopital St. Antoine, Plateforme de Recherche Clinique de l'Est
Parisien, Paris, France
(Richecoeur, Boulet) Hopital de Pontoise, Pontoise, France
(Sarrabay, Ouattara) CHU Bordeaux, Bordeaux, France
Title
High-flow nasal oxygen vs noninvasive positive airway pressure in
hypoxemic patients after cardiothoracic surgery: A randomized clinical
trial.
Source
JAMA - Journal of the American Medical Association. 313 (23) (pp
2331-2339), 2015. Date of Publication: 16 Jun 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE: Noninvasive ventilation delivered as bilevel positive airway
pressure (BiPAP) is often used to avoid reintubation and improve outcomes
of patients with hypoxemia after cardiothoracic surgery. High-flow nasal
oxygen therapy is increasingly used to improve oxygenation because of its
ease of implementation, tolerance, and clinical effectiveness. OBJECTIVE:
To determine whether high-flow nasal oxygen therapy was not inferior to
BiPAP for preventing or resolving acute respiratory failure after
cardiothoracic surgery. DESIGN AND SETTING: Multicenter, randomized,
noninferiority trial (BiPOP Study) conducted between June 15, 2011, and
January 15, 2014, at 6 French intensive care units. PARTICIPANTS: A total
of 830 patients who had undergone cardiothoracic surgery, of which
coronary artery bypass, valvular repair, and pulmonary
thromboendarterectomy were the most common, were included when they
developed acute respiratory failure (failure of a spontaneous breathing
trial or successful breathing trial but failed extubation) or were deemed
at risk for respiratory failure after extubation due to preexisting risk
factors. INTERVENTIONS: Patients were randomly assigned to receive
high-flow nasal oxygen therapy delivered continuously through a nasal
cannula (flow, 50 L/min; fraction of inspired oxygen [FIO<inf>2</inf>],
50%) (n = 414) or BiPAP delivered with a full-face mask for at least 4
hours per day (pressure support level, 8 cmH<inf>2</inf>O; positive
end-expiratory pressure, 4 cmH<inf>2</inf>O; FIO<inf>2</inf>, 50%) (n =
416). MAIN OUTCOMES AND MEASURES: The primary outcomewas treatment
failure, defined as reintubation, switch to the other study treatment, or
premature treatment discontinuation (patient request or adverse effects,
including gastric distention). Noninferiority of high-flow nasal oxygen
therapy would be demonstrated if the lower boundary of the 95%CI were less
than 9%. Secondary outcomes included mortality during intensive care unit
stay, changes in respiratory variables, and respiratory complications.
RESULTS High-flow nasal oxygen therapy was not inferior to BiPAP: the
treatment failed in 87 of 414 patients with high-flow nasal oxygen therapy
(21.0%) and 91 of 416 patients with BiPAP (21.9%) (absolute difference,
0.9%; 95%CI, -4.9%to 6.6%; P =.003). No significant differences were found
for intensive care unit mortality (23 patients with BiPAP [5.5%] and 28
with high-flow nasal oxygen therapy [6.8%]; P =.66) (absolute difference,
1.2%[95%CI, -2.3%to 4.8%]. Skin breakdown was significantly more common
with BiPAP after 24 hours (10% vs 3%; 95%CI, 7.3%-13.4%vs 1.8%-5.6%; P
<.001). CONCLUSIONS AND RELEVANCE: Among cardiothoracic surgery patients
with or at risk for respiratory failure, the use of high-flow nasal oxygen
therapy compared with intermittent BiPAP did not result in a worse rate of
treatment failure. The findings support the use of high-flow nasal oxygen
therapy in similar patients.

<20>
Accession Number
2015134817
Authors
Holmes D.R. Doshi S.K. Kar S. Price M.J. Sanchez J.M. Sievert H.
Valderrabano M. Reddy V.Y.
Institution
(Holmes) Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905,
United States
(Doshi) St. John's Health Center, Santa Monica, CA, United States
(Kar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Price) Scripps Clinic, La Jolla, CA, United States
(Sanchez) Mercy Hospital, St. Louis, MO, United States
(Sievert) Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt,
Germany
(Valderrabano) Methodist Hospital, Houston, TX, United States
(Reddy) Mount Sinai School of Medicine, New York, NY, United States
Title
Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke
Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis.
Source
Journal of the American College of Cardiology. 65 (24) (pp 2614-2623),
2015. Article Number: 21282. Date of Publication: 23 Jun 2015.
Publisher
Elsevier USA
Abstract
Abstract Background The risk-benefit ratio of left atrial appendage
closure (LAAC) versus systemic therapy (warfarin) for prevention of
stroke, systemic embolism, and cardiovascular death in nonvalvular atrial
fibrillation (NVAF) requires continued evaluation. Objectives This study
sought to assess composite data regarding left atrial appendage closure
(LAAC) in 2 randomized trials compared to warfarin for prevention of
stroke, systemic embolism, and cardiovascular death in patients with
nonvalvular AF. Methods Our meta-analysis included 2,406 patients with
5,931 patient-years (PY) of follow-up from the PROTECT AF (Watchman Left
Atrial Appendage System for Embolic Protection in Patients with Atrial
Fibrillation) and PREVAIL (Prospective Randomized Evaluation of the
Watchman LAA Closure Device In Patients With Atrial Fibrillation Versus
Long Term Warfarin Therapy) trials, and their respective registries
(Continued Access to PROTECT AF registry and Continued Access to PREVAIL
registry). Results With mean follow-up of 2.69 years, patients receiving
LAAC with the Watchman device had significantly fewer hemorrhagic strokes
(0.15 vs. 0.96 events/100 patient-years [PY]; hazard ratio [HR]: 0.22; p =
0.004), cardiovascular/unexplained death (1.1 vs. 2.3 events/100 PY; HR:
0.48; p = 0.006), and nonprocedural bleeding (6.0% vs. 11.3%; HR: 0.51; p
= 0.006) compared with warfarin. All-cause stroke or systemic embolism was
similar between both strategies (1.75 vs. 1.87 events/100 PY; HR: 1.02;
95% CI: 0.62 to 1.7; p = 0.94). There were more ischemic strokes in the
device group (1.6 vs. 0.9 and 0.2 vs. 1.0 events/100 PY; HR: 1.95 and
0.22, respectively; p = 0.05 and 0.004, respectively). Both trials and
registries identified similar event rates and consistent device effect in
multiple subsets. Conclusions In patients with NVAF at increased risk for
stroke or bleeding who are candidates for chronic anticoagulation, LAAC
resulted in improved rates of hemorrhagic stroke,
cardiovascular/unexplained death, and nonprocedural bleeding compared to
warfarin.

<21>
Accession Number
2015109066
Authors
Kuhn E.W. Choi Y.-H. Pyun J.-M. Neef K. Liakopoulos O.J. Stamm C. Wittwer
T. Wahlers T.
Institution
(Kuhn, Choi, Pyun, Neef, Liakopoulos, Wittwer, Wahlers) Department of
Cardiothoracic Surgery, Heart Center of the University of Cologne,
Kerpener Strasse 62, Cologne 50924, Germany
(Choi, Neef, Wittwer, Wahlers) Center for Molecular Medicine Cologne,
University of Cologne, Kerpener Strasse 62, Cologne 50924, Germany
(Stamm) Department of Cardiothoracic Surgery, German Heart Institute
Berlin, Augustenburger Platz 1, Berlin 13353, Germany
Title
Endothelial injury associated with cold or warm blood cardioplegia during
coronary artery bypass graft surgery.
Source
BioMed Research International. 2015 , 2015. Article Number: 256905. Date
of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The aim of this investigation was to analyze the impact of intermittent
cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia
(IWC) on endothelial injury in patients referred to elective on-pump
coronary artery bypass graft (CABG) surgery. Patients undergoing CABG
procedures were randomized to either ICC or IWC. Myocardial injury was
assessed by CK-MB and cardiac troponin T (cTnT). Endothelial injury was
quantified by circulating endothelial cells (CECs), von Willebrand factor
(vWF), and soluble thrombomodulin (sTM). Perioperative myocardial injury
(PMI) and major adverse cardiac events (MACE) were recorded. Demographic
data and preoperative risk profile of included patients (ICC: n=32, IWC:
n=36) were comparable. No deaths, PMI, or MACE were observed. Levels of
CK-MB and cTnT did not show intergroup differences. Concentrations of CECs
peaked at 6 h postoperatively with significantly higher values for
IWC-patients at 1 h (ICC: 10.1 +/- 3.9/mL; IWC: 18.4 +/- 4.1/mL; P=0.012)
and 6 h (ICC: 19.3 +/- 6.2/mL; IWC: 29.2 +/- 6.7/mL; P<0.001).
Concentrations of vWF (ICC: 178.4 +/- 73.2 U/dL; IWC: 258.2 +/- 89.7 U/dL;
P<0.001) and sTM (ICC: 3.2 +/- 2.1 ng/mL; IWC: 5.2 +/- 2.4 ng/mL; P=0.011)
were significantly elevated in IWC-group at 1 h postoperatively. This
study shows that the use of IWC is associated with a higher extent of
endothelial injury compared to ICC without differences in clinical
endpoints.

<22>
Accession Number
71926914
Authors
Mijajlovic M.
Institution
(Mijajlovic) Neurology Clinic, Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia
Title
Cerebral vasomotor reactivity testing and functional tcd in cardiac
sources of stroke.
Source
Cerebrovascular Diseases. Conference: 20th Meeting of the European Society
of Neurosonology and Cerebral Hemodynamics Zadar Croatia. Conference
Start: 20150507 Conference End: 20150511. Conference Publication:
(var.pagings). 39 (pp 8-9), 2015. Date of Publication: May 2015.
Publisher
S. Karger AG
Abstract
Many factors influence cerebral vasomotor reactivity (VMR), which reflects
cerebral small vessels functional status, including morphological and
functional parameters of large and small brain blood vessels.
Autoregulation of cerebral blood flow (CBF) ensures delivery of oxygenated
blood to the brain commensurate with cerebral O2 demand. Intact
autoregulation protects the brain from ischaemia caused by acute arterial
pressure fluctuations. In contrast, disturbed autoregulation has been
found to be independently associated with mortality after brain Injury. It
is generally accepted that cerebral autoregulation may become impaired
after stroke by damage to cerebral arterioles and capillaries during
ischemia or other chronic insults (like hypertension). Significant
alterations in autonomic nervous system (ANS) function, VMR, and CBF may
also develop from damage to brain ANS regulatory areas in heart failure.
Impaired VMR is usually affected by a presence of carotid stenosis.
However, in some cases it can be impaired in the absence of carotid
stenosis due to several poorly characterized mechanisms. One of the
potential reasons could be atrial fibrillation that is knowing to be one
of the major risk factors for ischemic stroke. Stroke could also occur in
approximately 2% to 3% of adult cardiac surgery patients due to impaired
VMR/CBF. In a meta-analysis of stroke incidence after myocardial
infarction, the risk of stroke was estimated to be approximately 1.1%
during hospitalization and 2.1% at 1 year usually caused by systemic
embolisation, including mural thrombus, cardiac arrhythmias and impaired
left ventricular ejection fraction. Many asymptomatic patients with
potential sources of cardiac embolism have signs of cerebral embolism on
brain imaging studies and transcranial Doppler monitoring. It remains
unclear whether impaired cerebral vasomotor reactivity also reflects more
systemic vascular damage.

<23>
Accession Number
71921169
Authors
Herial N. Mohammad N. Morad C. Qureshi M. Qureshi A.
Title
Cerebral ischemic events associated with transcatheter aortic valve
replacement (TAVR): A systematic review.
Source
Neurology. Conference: 67th American Academy of Neurology Annual Meeting,
AAN 2015 Washington, DC United States. Conference Start: 20150418
Conference End: 20150425. Conference Publication: (var.pagings). 84 ,
2015. Date of Publication: 06 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has recently
emerged as a treatment option in patients with symptomatic severe aortic
stenosis. Cerebral ischemic events are recognized events associated with
TAVR, however, a detailed analysis of such events is not performed.
Methods: We performed a literature search to identify studies reporting
outcome data at different time intervals following TAVR (peri-procedural/
30-days, 1, 2, and 3 yrs). Data on the incidence of stroke/TIA was
extracted from studies that used the Valve Academic Research Consortium
criteria and a comparison of stroke/TIA incidence between TAVR vs.
surgical AVR, transfemoral (TF) vs. transapical (TA) approach, and
self-expanding vs. balloon expanding valves is reported. Results:
Peri-procedural stroke/TIA incidence after TAVR ranged from 1.6[percnt] to
5.5[percnt]. Incidence rates from the registries and meta-analyses were
lower (2.3-2.8[ percnt]) than those reported in the randomized clinical
trials (RCTs) (4.6-5.5[ percnt]). At 1yr, pooled incidence rates from
meta-analyses and RCTs ranged from 3.8 4.5[ percnt] and 7.6 8.8[ percnt],
respectively. Incidence at 2 and 3 yrs was 11.2[percnt] and 8.2[percnt] as
reported in the RCT. Meta-analyses revealed no difference in incidence
rates between TAVR and SAVR at 30d or 1 yr, but one RCT suggested a higher
incidence of stroke/TIA with TAVR at both these intervals. At 3 yrs, the
stroke/TIA incidence rates were similar between TAVR and SAVR. No
difference in stroke incidence between the TFTAVR and TATAVR approaches or
the valve type was noted. Conclusions: In comparison to SAVR, existing
data indicates marginally higher incidence of stroke with TAVR during the
peri-procedural period. Inconsistencies were noted in long term clinical
outcomes including stroke/TIA incidence with TAVR. Future research should
focus on patient selection, improvement in valve technology and procedural
techniques to minimize the observed risk.

<24>
Accession Number
71926033
Authors
Hooper C. Edey A. Wallis A. Clive A. Morley A. Darby M. Zahan N. Medford
A. Maskell N.
Title
Pleural irrigation trial (PIT): Standard care versus pleural irrigation, a
randomised controlled trial in patients with pleural infection.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2012 Vienna Austria. Conference Start: 20120901 Conference
End: 20120905. Conference Publication: (var.pagings). 40 , 2012. Date of
Publication: 01 Sep 2012.
Publisher
European Respiratory Society
Abstract
Background: Pleural infection remains common with an increasing incidence
and high mortality. Despite chest tube drainage and antibiotic therapy up
to 30% of patients will die or require surgery. Case reports suggest that
irrigation of the pleural space with saline may be beneficial but this has
never been the tested in the form of a randomised controlled trial Method:
Randomised controlled pilot study comparing standard care plus saline
irrigation, with best standard care alone, in patients with pleural
infection requiring chest tube drainage, who had a residual pleural
collection on baseline CT thorax. Primary outcome was percentage change in
CT pleural volume from day 0 to day 3. Secondary outcomes included
referral for surgery, hospital stay & adverse events Results: 65 patients
approached, 38 randomised, 3 excluded. Saline irrigation resulted in
significant reduction in CT pleural collection volume compared to standard
care - Irrigation group 29.2% reduction (95% CI 16.2- 62) vs Standard care
13.9% (95% CI -4.1- 26.3) p<0.04. There was also a significant reduction
in the need for thoracic surgery in the irrigation group 2/18 vs 9/17
p=0.01 (OR 9.0, 95% CI 1.6-51.9). No differences were seen in length of
hospital stay or fall in inflammatory markers (CPR, WCC and
procalcitonin). Safety profile of saline irrigation was good with no
serious complications and similar adverse events between groups.
Conclusion: Saline irrigation improves fluid drainage in pleural
infection, leading to reduction in referral for surgery. This study now
needs to be repeated as a large multicentre RCT using the hard endpoints
of mortality and length of hospital stay.

<25>
Accession Number
71925584
Authors
Bridevaux P.-O. Tschopp J.-M. Bhatia C. Fresard I. Triponez F. Schnyder
J.-M. Robert J. Rochat T. Licker M.
Title
Effect of pre-operative short-term rehabilitation on peak VO2 in patients
with NSCLC.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2012 Vienna Austria. Conference Start: 20120901 Conference
End: 20120905. Conference Publication: (var.pagings). 40 , 2012. Date of
Publication: 01 Sep 2012.
Publisher
European Respiratory Society
Abstract
Preoperative fitness is best assessed with cardio-pulmonary exercise
testing (CPET) in patients with non-small cell lung cancer (NSCLC). Peak
Oxygen consumption (VO2 peak) is predictive of short-term complications
after thoracic surgery. Feasibility and effect of short-term (2 to 3
weeks) rehabilitation on fitness and short-term outcomes are unknown. We
planned a pragmatic, randomized controlled trial (RCT) comparing
short-term rehabilitation (R) with usual care (UC) in patients with
operable NSCLC. Method: This ongoing study enrolls patients after baseline
CPET from 2 centres in Switzerland. Intervention: preoperative three-times
a week, intensive, respiratory physiotherapist supervised interval
training. Controls: usual care Outcomes: post-operative complication rate,
short-term change in VO2 (baseline and immediately before surgery),
long-term fitness and quality of life. Results: Up to december 2011, 65
patients were randomized, R n=31, UC n=34 (mean age 63.4 [10.5], FEV1
86.7% [23.5], DLCO 70.5% [19.0], VO2 peak 19.5 ml/min/kg [5.7] watt peak
86 W[38], 6MWT 370 m [101]). As reassessed immediately before surgery VO2
peak (+2.3 [0.7] ml/min/kg, p=0.04), watt (+15.5 [4.6] W, p=0.04), 6MWT
(+87 [15.5] m, p<0.01) improved in R but not in UC patients. Conclusion:
This interim analysis shows that short-term intensive rehabilitation is
feasible and improves fitness before surgery in patients with resectable
NSCLC. (Figure Presented).

<26>
Accession Number
71919399
Authors
Ana Teresa Timoteo A.T. Mota Carmo M. Soares C. Cruz Ferreira R.
Institution
(Ana Teresa Timoteo, Soares, Cruz Ferreira) Hospital Santa Marta, CHLC,
Lisbon, Portugal
(Mota Carmo) New University of Lisbon, Faculty of Medical Sciences,
Lisbon, Portugal
Title
Has metabolic syndrome a paradoxical effect on long-term outcome of
patients with established coronary artery disease?.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2015
Lisbon Portugal. Conference Start: 20150514 Conference End: 20150516.
Conference Publication: (var.pagings). 22 (1 SUPPL. 1) (pp S66), 2015.
Date of Publication: May 2015.
Publisher
SAGE Publications Inc.
Abstract
In the general population, obesity has a significant impact on prognosis.
However, in populations with established cardiovascular disease it is
described a paradoxical effect of obesity. Also with metabolic syndrome
(MS), several meta-analysis showed the unfavourable impact of MS in the
occurrence of cardiovascular events, although the impact in stable
coronary disease is debated. We sought to analyse in a population of
patients with coronary artery disease the long-term prognostic impact of
MS. Methods: We included patients admitted electively for coronary
angiograhy. All patients had documented significant coronary artery
disease and were submitted to coronary angioplasty. Patients were divided
in two groups according to the presence of MS (AHA/NHLBI definition) in
the baseline evaluation. In a five-year follow-up, we evaluated the
occurrence of allcause mortality, cardiovascular hospitalisation and a
composite of both endpoints. Results: In our study, we included 548
patients, 76% males, with a mean age of 65 +/- 10 years. From these, 95%
had hypertension, 16% were smokers, 36% had diabetes and 71% had
hyperlipidemia. In 59.3%, MS was present. In previous history, 23% had a
previous myocardial infarction, 34% coronary angioplasty and 7% coronary
artery bypass grafting. In the follow-up, there were 36 deaths (6.6%) and
246 patients (44.8%) were re-admitted for cardiovascular reasons. Patients
with MS did not have higher incidence of death (7.1% vs. 5.8%, p=0.687),
cardiovascular admission (47.7% vs. 40.8%, p=0.111) or the composite
endpoint (51.4% vs. 43.9%, p=0.087). Kaplan-Meier curves weren't
significantly different in patients with and without MS for the three
endpoints considered. MS wasn't a predictor of mortality (OR 1.23, 95% CI
0.61 +/- 2.48), cardiovascular admission (OR 1.32, 95% CI 0.94 +/- 1.87)
or death / cardiovascular admission (OR 1.35, 95% CI 0.96 +/- 1.90), even
after adjustment for the other baseline characteristics. Smoking and age
were the only independent predictors of mortality. Conclusion: MS isn't a
predictor of outcome (mortality, cardiovascular hospitalisation or death /
cardiovascular hospitalisation) in a long-term follow-up in patients with
established coronary artery disease. Also we did not found any paradoxical
effect.

<27>
Accession Number
71919257
Authors
Karsten M. Cargnin C. Guaragna J.C.V.C. Dal Lago P.
Institution
(Karsten, Cargnin, Dal Lago) Universidade Federal De Ciencias Da Saude De
Porto Alegre, Sciences of Rehabilitation, Porto Alegre, Brazil
(Guaragna) Hospital Sao Lucas, Porto Alegre, Brazil
Title
Inspiratory muscle training after heart valve replacement surgery improves
inspiratory muscle strength, lung function and functional capacity:
Randomized controlled trial.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2015
Lisbon Portugal. Conference Start: 20150514 Conference End: 20150516.
Conference Publication: (var.pagings). 22 (1 SUPPL. 1) (pp S17), 2015.
Date of Publication: May 2015.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To analyze the effects of inspiratory muscle training (IMT) as a
therapeutic strategy after heart valve replacement surgery. Methods:
Double-blinded randomized clinical trial that included patients undergoing
to elective surgery, without postoperative complications, which were
allocated into two groups: IMT group (IMT-G) and IMT placebo group
(IMT-PG). The IMT has started on the third day after surgery, being
performed twice daily, for one month. Pulmonary function, inspiratory
muscle strength (MIP), functional capacity and quality of life were
assessed in the preoperative and at the end of training. Statistical
significance was set as p<0.05. Results: The IMT-G recovered inspiratory
muscle strength and pulmonary function values after training. This group
also had an increase in walked distance during the six-minute walk test
(6-MWD). In IMT-PG, the values of MIP were bellow than those found in the
preoperative, with impairment of lung function and lower 6-MWD in the
final evaluation. At the end of IMT, MIP was correlated with the 6-MWD,
with the spirometric variables and with the SF- 36's domains: functional
capacity, pain, general health, social aspects and mental health.
Conclusion: This study is an original work that was developed to test the
effects of inspiratory muscle training in patients undergoing to the heart
valve replacement surgery. The IMT performed for four weeks after valve
replacement surgery is effective in restore the values of inspiratory
muscle strength and lung function to the preoperative level, and to
increase the functional capacity assessed by the distance walked in 6-MWD,
with association between lung function and functional capacity, showing
the clinical relevance of the use of IMT in the process of rehabilitation
of these patients.