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<1>
Accession Number
2015186107
Authors
Lee J.-H. No H.-J. Song I.-K. Kim H.-S. Kim C.-S. Kim J.-T.
Institution
(Lee, No, Song, Kim, Kim, Kim) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, # 101 Daehakno, Jongnogu,
Seoul 110-744, South Korea
Title
Prediction of fluid responsiveness using a non-invasive cardiac output
monitor in children undergoing cardiac surgery.
Source
British Journal of Anaesthesia. 115 (1) (pp 38-44), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Oxford University Press
Abstract
Background This study evaluated the ability of a non-invasive cardiac
output monitoring device (NICOM) to predict fluid responsiveness in
paediatric patients undergoing cardiac surgery. Methods Children aged <5
yr undergoing congenital heart surgery were included. Once the sternum had
been closed after repair of the congenital heart defect, 10 ml
kg^-1 colloid solution was administered for volume expansion.
Transoesophageal echocardiography (TOE) was performed to measure stroke
volume (SV) and respiratory variation in aortic blood flow peak velocity
(DELTAV<inf>peak</inf>) before and after volume expansion. Haemodynamic
and NICOM variables, including SV<inf>NICOM</inf>, stroke volume variance
(SVV<inf>NICOM</inf>), cardiac index (CI<inf>NICOM</inf>), and percentage
change in thoracic fluid content compared with baseline (TFCd0%), were
also recorded. Patients in whom the stroke volume index (SVI), measured
using TOE, increased by >15% were defined as fluid responders. Results
Twenty-nine patients were included (13 responders and 16 non-responders).
Before volume expansion, only DELTAV<inf>peak</inf> differed between
groups (P=0.036). The SVV<inf>NICOM</inf>, HR, and central venous pressure
did not predict fluid responsiveness, but DELTAV<inf>peak</inf> did. The
CI<inf>NICOM</inf> was not correlated with CI<inf>TOE</inf> (r=0.107,
P=0.43). Using Bland-Altman analysis, the mean bias between
CI<inf>TOE</inf> and CI<inf>NICOM</inf> was 0.89 litre min^-1
m^-2, with a precision of 1.14 litre min^-1
m^-2. Trending ability of NICOM for SVI and CI was poor when TOE
was a reference method. Conclusions The SVV<inf>NICOM</inf> did not
predict fluid responsiveness in paediatric patients during cardiac
surgery. In addition, there was no correlation between CI<inf>TOE</inf>
and CI<inf>NICOM</inf>. Fluid management guided by NICOM should be
performed carefully. Clinical trial registration ClinicalTrials.gov
NCT01996956.

<2>
Accession Number
2015186094
Authors
Parke R.L. McGuinness S.P. Gilder E. McCarthy L.W. Cowdrey K.-A.L.
Institution
(Parke, McGuinness, Gilder, McCarthy, Cowdrey) Cardiothoracic and Vascular
Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
(Parke, McGuinness) Australian and New Zealand Intensive Care Research
Centre, Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Parke, McGuinness) Medical Research Institute of New Zealand, Wellington,
New Zealand
Title
A Randomised feasibility study to assess a novel strategy to rationalise
fluid in patients after cardiac surgery.
Source
British Journal of Anaesthesia. 115 (1) (pp 45-52), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Oxford University Press
Abstract
Background After cardiac surgery, patients receive large amounts of fluid
in the Intensive Care Unit (ICU). We plan to conduct a multi-centre
randomised controlled trial, of a conservative fluid regime, in patients
after cardiac surgery, and have reported results of a feasibility study
that evaluated efficacy and safety of the proposed regime. Methods After
ethical approval, a single-centre, prospectively randomised interventional
study was undertaken. Participants were randomised to either usual care,
or to a protocolised algorithm, utilising stroke volume variation, to
guide fluid administration to patients who were deemed to have inadequate
cardiac output and were likely to be volume responsive. The study protocol
lasted from ICU admission to de-sedation or 24 h, whichever occurred
first. Results We randomised 144 subjects over 9 months. Less bolus fluid
and less total overall fluid volume was administered in the intervention
group (median (IQR) 1620 ml (500-3410) and 2525 ml (1440-5250; P<0.001),
compared with the usual care group (2050 ml (910-4280) and 2980 ml
(2070-6580; P=0.001), from ICU admission to extubation. There was no
significant difference in incidence of acute kidney injury or the average
amount of fluid administered to the usual care group at the beginning
compared with the end of the study. Conclusion It is both possible and
safe to achieve a significant reduction in the amount of fluid
administered to patients, allocated to a conservative fluid protocol.
These results suggest that a planned multi-centre study is both justified
and feasible. Clinical trial registration Australia New Zealand Clinical
Trials Registry www.anzctr.org.au (ACTRN12612000754842).

<3>
Accession Number
2015186082
Authors
Landoni G. Isella F. Greco M. Zangrillo A. Royse C.F.
Institution
(Landoni, Isella, Greco, Zangrillo) Department of Anaesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Via Olgettina
60, Milan 20132, Italy
(Royse) Anaesthesia and Pain Management Unit, Royal Melbourne Hospital,
Melbourne, VIC 3050, Australia
(Royse) Department of Surgery, University of Melbourne, Royal Melbourne
Hospital, Melbourne, VIC 3050, Australia
Title
Benefits and risks of epidural analgesia in cardiac surgery.
Source
British Journal of Anaesthesia. 115 (1) (pp 25-32), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Oxford University Press
Abstract
Background Epidurals provide excellent analgesia for cardiac surgery and
may reduce complications. However, their use has been tempered because of
concern of the rare, but serious complication of epidural haematoma. The
aim of this meta-analysis was to assess the effect of epidural on survival
and the risk estimate of epidural haematoma. Methods A systematic review
of the literature (Pubmed, Embase, Scopus and the Cochrane Register) and a
meta-analysis of the available randomized and case-matched studies were
performed to estimate the effect on survival. An international, directed
and viral anonymous survey was performed to identify the incidence of
haematomas with a corresponding estimate of the number of epidurals
performed. Results Of 66 randomized and case-matched studies, 57 trials
including 6383 patients reported the incidence of all-cause mortality at
the longest follow up available, with a significant reduction with
epidurals (59/3123 [1.9%] vs 108/3260 [3.3%] in the control arm, RR 0.65
[95% CI 0.48-0.86], P=0.003, NNT=70). No epidural haematoma was reported
in these 66 trials (3320 epidurals). All other literature revealed nine
haematomas in 13 100 patients. Through the anonymous, web-based, viral,
international survey, we identified 16 further, non-published, epidural
haematomas from 72 400 positioned epidurals. Therefore, a total of 25
haematomas have been identified from an estimate of 88 820 positioned
epidurals, producing an estimated risk of 1:3552 (95% CI 1:2552-1:5841).
Conclusions The use of epidural analgesia in cardiac surgery is associated
with a reduction in mortality (NNT=70), and with an estimated risk of
epidural haematoma of 1:3552.

<4>
Accession Number
2015183308
Authors
Song J.-C. Lu Z.-J. Jiao Y.-F. Yang B. Gao H. Zhang J. Yu W.-F.
Institution
(Song, Lu, Jiao, Gao, Zhang, Yu) Department of Anesthesiology, Eastern
Hepatobiliary Surgery Hospital, Second Military Medical University,
Shanghai, China
(Yang) Department of Anesthesiology, Shanghai first people's hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
Title
Etomidate anesthesia during ERCP caused more stable haemodynamic responses
compared with propofol: A randomized clinical trial.
Source
International Journal of Medical Sciences. 12 (7) (pp 559-565), 2015. Date
of Publication: 03 Jul 2015.
Publisher
Ivyspring International Publisher
Abstract
Background: Propofol may result in hypotension and respiratory depression,
while etomidate is considered to be a safe induction agent for
haemodynamically unstable patients because of its low risk of hypotension.
We hypothesized that etomidate anesthesia during ERCP caused more stable
haemodynamic responses compared with propofol. The primary endpoint was to
compare the haemodynamic effects of etomidate vs. propofol in ERCP cases.
The secondary endpoint was overall survival. Methods: A total of 80
patients undergoing ERCP were randomly assigned to an etomidate or
propofol group. Patients in the etomidate group received etomidate
induction and maintenance during ERCP, and patients in the propofol group
received propofol induction and maintenance. Cardiovascular parameters and
procedure-related time were measured and recorded during ERCP. Results:
The average percent change to baseline in MBP was -8.4+/-7.8 and
-14.4+/-9.4 with P = 0.002, and in HR was 1.8+/-16.6 and 2.4+/-16.3 with P
= 0.874 in the etomidate group and the propofol group, respectively. MBP
values in the etomidate group decreased significantly less than those in
the propofol group (P<0.05). The ERCP duration and recovery time in both
groups was similar. There was no significant difference in the survival
rates between groups (p = 0.942). Conclusions: Etomidate anesthesia during
ERCP caused more stable haemodynamic responses compared with propofol.

<5>
Accession Number
2014909153
Authors
Okajima H. Tanaka O. Ushio M. Higuchi Y. Nagai Y. Iijima K. Horikawa Y.
Ijichi K.
Institution
(Okajima, Tanaka, Higuchi, Nagai, Iijima, Ijichi) Department of
Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe,
Hyogo 651-2273, Japan
(Ushio) Department of Anesthesiology, Kakogawa West City Hospital, 384-1
Yonedachohiratsu, Kakogawa, Hyogo 675-8611, Japan
(Horikawa) Department of Anesthesiology, Hyogo Brain and Heart Center At
Himeji, 520 Saisyo-ko, Himeji-city, Hyogo 670-0981, Japan
Title
Ultrasound-guided continuous thoracic paravertebral block provides
comparable analgesia and fewer episodes of hypotension than continuous
epidural block after lung surgery.
Source
Journal of Anesthesia. 29 (3) (pp 373-378), 2015. Date of Publication: 15
Nov 2014.
Publisher
Springer-Verlag Tokyo
Abstract
Purpose: Both paravertebral block (PVB) and thoracic epidural block (TEB)
are recommended for postoperative pain relief after lung surgery. The
addition of fentanyl to the anesthetic solution became popular for TEB
because of the stronger effects; however, there have been few comparable
trials about the addition of fentanyl to PVB. The purpose of this study
was thus to compare postoperative analgesia, side effects, and
complications between ultrasound-guided PVB (USG-PVB) and TEB with the
addition of fentanyl to ropivacaine after lung surgery. Methods: We
examined 90 consecutive patients (age 18-75 years) scheduled for
video-assisted thoracic surgery (VATS). In both groups, all blocks (four
blocks in USG-PVB and one block in TEB) and one catheter insertion were
performed preoperatively. Continuous postoperative infusion (0.1 %
ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both
groups. The recorded data included the verbal rating scale (VRS) for pain,
blood pressure, side effects, complications for 2 days, and overall
satisfaction score. Results: There was no difference in the frequency of
taking supplemental analgesics (twice or more frequently), or in VRS.
Hypotension occurred significantly more frequently in TEB (n = 7/33) than
in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV
and pruritus, as well as overall satisfaction score, were similar. There
were no complications in both groups; however, the catheters migrated
intrathoracically in four patients in PVB. Conclusion: USG-PVB achieved
similar pain relief and lowered the incidence of hypotension compared with
TEB. We conclude that both blocks with the same concentration of
ropivacaine and fentanyl can provide adequate postoperative analgesia for
VATS.

<6>
Accession Number
2015179357
Authors
Tang X. Li R. Jing Q. Liu Y. Liu P.
Institution
(Tang) Department of Cardiology, First Hospital of QinHuangDao,
Qinhuangdao, Hebei, China
(Li) Department of Emergency Medicine, First Hospital of QinHuangDao,
Qinhuangdao, Hebei, China
(Jing) Department of Cardiology, General Hospital of Shenyang Military
Area Command, Shenyang, Liaoning, China
(Liu, Liu) Department of Cardiology, Zhujiang Hospital, Southern Medical
University, Guangzhou, Guangdong, China
Title
Efficacy and safety of intracoronary versus intravenous administration of
tirofiban during percutaneous coronary intervention for acute coronary
syndrome: A meta-analysis of randomized controlled trials.
Source
PLoS ONE. 10 (6) , 2015. Article Number: e0129718. Date of Publication: 11
Jun 2015.
Publisher
Public Library of Science
Abstract
Background: Percutaneous coronary intervention (PCI) is known as the most
effective treatment for acute coronary syndrome (ACS). However, without
proper therapy and patient management, stent thrombosis after PCI may lead
to another myocardial infarction. In addition to aspirin and clopidogrel,
tirofiban is often used as an antiplatelet therapy in patients with ACS.
To date, there has been no comprehensive evaluation of the efficacy and
safety of intracoronary (IC) tirofiban administration for ACS patients
undergoing PCI compared with intravenous (IV) administration. Therefore,
this meta-analysis was conducted to investigate the clinical efficiency
and safety of IC versus intravenous (IV) tirofiban in ACS patients
undergoing PCI. Methods: We searched PubMed and Medline for randomized
controlled trials (RCTs) comparing IC versus IV administration of
tirofiban in ACS patients undergoing PCI. We evaluated the effects of
tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow
after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left
ventricular ejection fraction (LVEF), major adverse cardiovascular events
(MACE), target vessel revascularization (TVR), death, reinfarction and
adverse drug effects (specifically bleeding events). Results: Seven trials
involving 1,027 patients were included in this meta-analysis. IC
administration of tirofiban significantly increased TIMI grade 3 flow (OR
2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09
to 6.49; P = 0.03, I² = 64%) while reducing MACE (OR 0.46, 95%
CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban.
No significant differences were observed in the occurrence of TVR, death,
reinfarction and the incidence of bleeding events between the two groups.
Conclusions: This meta-analysis supports the use of IC over IV
administration of tirofiban in patients with ACS to improve TIMI flow, TMP
flow and MACE. However, there was no statistically significant difference
in the risk of bleeding complications between the two groups.

<7>
Accession Number
2015179237
Authors
Hoenicka M. Rupp P. Muller-Eising K. Deininger S. Kunert A. Liebold A.
Gorki H.
Institution
(Hoenicka, Rupp, Muller-Eising, Deininger, Kunert, Liebold, Gorki)
Department of Cardio-Thoracic and Vascular Surgery, University of Ulm
Medical Center, Ulm, Germany
Title
Anticoagulation management during multivessel coronary artery bypass
grafting: A randomized trial comparing individualized heparin management
and conventional hemostasis management.
Source
Journal of Thrombosis and Haemostasis. 13 (7) (pp 1196-1206), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Individualized heparin management (IHM) uses heparin
dose-response curves to improve hemostasis management during cardiac
surgery as compared with activated clotting time-based methods.
Objectives: IHM was compared with conventional hemostasis management (CHM)
in a randomized, prospective study (ID DRKS00007580). Methods: One-hundred
and twenty patients undergoing multivessel coronary artery bypass grafting
(CABG) were enrolled. Heparin and protamine consumption, blood losses,
blood transfusions and administration of hemostatic agents were recorded.
Time courses of platelet counts and of coagulation parameters were
determined. Coagulation was analyzed at intensive care unit (ICU) arrival
by thromboelastometry. Results: IHM patients received significantly lower
initial heparin doses (289.3IUkg^-1 [interquartile range
(IQR)221.5-376.2IUkg^-1] versus 350.5IUkg^-1
[IQR346.8-353.7IUkg^-1], P<0.0001) but similar total heparin
doses (418.5IUkg^-1 [IQR346.9-590.5 IUkg^-1] versus
435.8IUkg^-1 [IQR411.7-505.1IUkg^-1]). IHM patients
received significantly less protamine, resulting in protamine/total
heparin ratios of 0.546 [IQR0.469-0.597] versus 0.854 [IQR0.760-0.911] in
CHM patients (P<0.0001). Activated partial thromboplastin time (50.5s
[IQR40.0-60.0s] versus 37.0s [IQR33.0-40.0s], P<0.0001), activated
clotting time (136s [IQR129.0-150.5s] versus 126.5s [IQR120.3-134.0s],
P=0.0002) and INTEM clotting times (215s [IQR192-237] versus 201s
[IQR191-216s], P=0.0397) were significantly longer in IHM patients than in
CHM patients at ICU arrival, with no difference in prothrombin time
(P=0.538). IHM patients lost significantly more blood within 12h
postoperatively (420mL [IQR337.5-605.0mL] versus 345mL [IQR230.0-482.5mL],
P=0.0041), and required significantly more hemostatic agents to control
bleeding. Red blood cell transfusion requirements and time courses of
platelet counts did not differ between groups. Conclusions: Multivessel
CABG patients did not benefit from IHM in comparison with our established
protocol based on activated clotting time.

<8>
Accession Number
2015167943
Authors
Ariturk C. Ozgen S.U. Okten M. Danisan B. Karabulut H. Toraman F.
Institution
(Ariturk, Okten, Karabulut) Department of Cardiovascular Surgery, Acibadem
University, School of Medicine, Fenerbahce Mah. Haci Mehmet Sok. Ali Bey
D:14, Kadikoy-Istanbul 34000, Turkey
(Ozgen, Toraman) Department of Anesthesiology and Reanimation, Acibadem
University, School of Medicine, Istanbul, Turkey
(Danisan) Acibadem Healthcare Group, Kadikoy Hospital, Cardiovascular
Surgery Clinic, Istanbul 34000, Turkey
Title
Oxygen fraction adjustment according to body surface area during
extracorporeal circulation.
Source
Heart Surgery Forum. 18 (3) (pp E98-E102), 2015. Date of Publication: 01
Jun 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Background: The inspiratory oxygen fraction (FiO<inf>2</inf>) is usually
set between 60% and 100% during conventional extracorporeal circulation
(ECC). However, this strategy causes partial oxygen pressure
(PaO<inf>2</inf>) to reach hyperoxemic levels (>180 mmHg). During
anesthetic management of cardiothoracic surgery it is important to keep
PaO<inf>2</inf> levels between 80-180 mmHg. The aim of this study was to
assess whether adjusting FiO<inf>2</inf> levels in accordance with body
temperature and body surface area (BSA) during ECC is an effective method
for maintaining normoxemic PaO<inf>2</inf> during cardiac surgery.
Methods: After approval from the Ethics Committee of the University of
Acibadem, informed consent was given from 60 patients. FiO<inf>2</inf>
adjustment strategies applied to the patients in the groups were as
follows: FiO<inf>2</inf> levels were set as 0.21 x BSA during hypothermia
and 0.21 x BSA + 10 during rewarming in Group I; 0.18 x BSA during
hypothermia and 0.18 x BSA + 15 during rewarming in Group II; and 0.18 x
BSA during hypothermia and variable with body temperature during rewarming
in Group III. Arterial blood gas values and hemodynamic parameters were
recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the
esophageal temperature (OT) reached 34degreeC (T3); when OT reached
36degree C (T4); and just before the cessation of ECC (T5). Results: Mean
PaO<inf>2</inf> was significantly higher in Group I than in Group II at T2
and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group
III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4
(P = .0001 for all). Conclusion: Adjustment of FiO<inf>2</inf> according
to BSA rather than keeping it at a constant level is more appropriate for
keeping PaO<inf>2</inf> between safe level limits. However, since oxygen
consumption of cells vary with body temperature, it would be appropriate
to set FiO2 levels in concordance with the body temperature in the
rewarming period.

<9>
Accession Number
2015063322
Authors
Dunne B. Tan D. Chu D. Yau V. Xiao J. Ho K.M. Yong G. Larbalestier R.
Institution
(Dunne, Tan, Chu, Yau, Xiao, Ho, Yong, Larbalestier) Department of
Cardiothoracic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
(Ho, Larbalestier) Western Australian Cardiothoracic Research, Department
of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia
Title
Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A
Systematic Review.
Source
Annals of Thoracic Surgery. 100 (1) (pp 354-361), 2015. Article Number:
28136. Date of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Two alternative approaches for transcatheter aortic valve implantation
(TAVI) exist for patients unsuitable for the transfemoral approach; the
transapical and the transaortic approaches. It is unclear as to which
approach has superior short-term outcomes. A systematic review and
meta-analysis was performed to answer this question. Mortality was
equivalent in the 2 groups. There was a trend toward a lower rate of
stroke in the transaortic group (0.9% vs 2.1%) but this was not
statistically significant. Conversion to surgical aortic valve
replacement, paravalvular leak, pacemaker requirement, and major bleeding
occurred at equivalent rates.

<10>
Accession Number
2015916666
Authors
Mavrakanas T.A. Chatzizisis Y.S.
Institution
(Mavrakanas) McGill University Health Center, Montreal, Canada
(Mavrakanas) General Internal Medicine Division, Geneva University
Hospitals, Geneva, Switzerland
(Chatzizisis) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
Title
Bivalirudin in stable angina and acute coronary syndromes.
Source
Pharmacology and Therapeutics. 152 (pp 1-10), 2015. Date of Publication:
29 Jun 2015.
Publisher
Elsevier Inc.
Abstract
A parenteral anticoagulant is indicated in patients with acute coronary
syndromes. Which anticoagulant should be preferred in each setting is not
clearly established. Bivalirudin administration was considered in acute
coronary syndromes after several clinical trials showed decreased bleeding
risk with its use compared with the association of unfractionated heparin
(UFH) with glycoprotein IIb/IIIa inhibitors (GPIs). Most recent data
demonstrate that the bleeding benefit identified in the previous studies
was not due to bivalirudin's properties but to higher bleeding incidence
in the comparator arm due to the disproportional use of GPIs with heparin.
This paper reviews clinical evidence on bivalirudin as anticoagulant in
stable angina and acute coronary syndromes.

<11>
Accession Number
2015802141
Authors
Fanari Z. Weiss S.A. Zhang W. Sonnad S.S. Weintraub W.S.
Institution
(Fanari, Weiss, Weintraub) Section of Cardiology, Christiana Care Health
System, Newark, DE, United States
(Zhang, Sonnad, Weintraub) Value Institute, Christiana Care Health System,
Newark, DE, United States
Title
Comparison of percutaneous coronary intervention with drug eluting stents
versus coronary artery bypass grafting in patients with multivessel
coronary artery disease: Meta-analysis of six randomized controlled
trials.
Source
Cardiovascular Revascularization Medicine. 16 (2) (pp 70-77), 2015. Date
of Publication: 2015.
Publisher
Elsevier Inc.
Abstract
Objective: To compare outcomes of percutaneous coronary intervention (PCI)
with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG)
in patients with multivessel Coronary Artery Disease (CAD) using data from
randomized controlled trials (RCT). Background: PCI and CABG are
established strategies for coronary revascularization in the setting of
ischemic heart disease. Multiple RCTs have compared outcomes of the two
modalities in patients with multivessel CAD. Methods: We did a
meta-analysis from six RCTs in the contemporary era comparing the
effectiveness of PCI with DES to at 1 year, 2 years and 5 years
respectively. Results: Compared to CABG, at one year PCI was associated
with a significantly higher incidence of TVR (RR = 2.31; 95% CI:
[1.80-2.96]; P = < 0.0001), lower incidence of stroke (RR = 0.35; 95% CI:
[0.19-0.62]; P = 0.0003), and no difference in death (RR = 1.02; 95% CI:
[0.77-1.36]; P = 0.88) or MI (RR = 1.16; 95% CI: [0.72-1.88]; P = 0.53).
At 5 years, PCI was associated with a higher incidence of death (RR = 1.3;
95% CI: [1.10-1.54]; P = 0.0026) and MI (RR = 2.21; 95% CI: [1.75-2.79]; P
= < 0.0001). While the higher incidence of MI with PCI was noticed in both
diabetic and non-diabetics, death was increased mainly in diabetic
patients. Conclusion: In patients with multi-vessel CAD, PCI with DES is
associated with no significant difference in death or MI at 1 or 2 years.
However at 5 years, PCI is associated with higher incidence of death and
MI.

<12>
Accession Number
2015164478
Authors
Lin B.-Q. Yang S.-S. Zeng Z.-Y. Zhuang C.-W.
Institution
(Lin, Yang, Zeng, Zhuang) Division of Cardiothoracic Surgery, Fuzhou
General Hospital of PLA, Fuzhou, China
Title
Efficacy assessment of CRYO storage of donor hearts by imagej based image
analysis.
Source
Russian Journal of Cardiology. 105 (1) (pp 45-48), 2014. Date of
Publication: 2014.
Publisher
Silicea-Poligraf
Abstract
Aim. Donor organ injury during cold preservation before transplantation
negatively impacts graft survival. The current study was to examine
available evidences for the efficacy of different cold storage solutions
that are used to preserve donor hearts in vitro prior to orthotopic
transplantation. Material and methods. A systematic search of full-length
articles published from 1980 to August 2012 was performed in PubMed and
Google Scholar. Detailed searches were also made for availability of any
sourceware for histopathology images of endomyocardial biopsies of stored
hearts. Results. Not even a single controlled trial has been published
relating to this topic. However, we assessed all available literature
pertaining to this topic, and performed original, simple yet innovative
analyses using ImageJ, a Java based image analyses program, to show the
tremendous power to objectively examine the efficacy of the storage
solution. Our analysis suggest that ImageJ may be conveniently used to
obtain evidences (or lack of it) of ischemic injury of donor hearts during
cold storage. Conclusions. Even the UNOS database does not provide
histopathological evidences of cardiac biopsies of orthotopically
transplanted hearts. We, however, make the case of the need for image
analyses and making availability of images to allow establishing evidence
of the usefulness of these storage solutions. We recommend obtaining
endomyocardial biopsy prior to orthotopic transplantation and create a
registry of H&E stained slides. This is the only step that will direct us
towards evidence based care of such highly critical patients who need the
equally challenging surgical intervention of cardiac transplantation.

<13>
Accession Number
2015176191
Authors
Gasparovic H. Kopjar T. Anticevic A. Rados M. Malojcic B. Ivancan V.
Fabijanic T. Cikes M. Milicic D. Gasparovic V. Biocina B.
Institution
(Gasparovic, Kopjar, Ivancan, Fabijanic, Biocina) University of Zagreb,
Department of Cardiac Surgery, University Hospital Center Zagreb,
Kispaticeva 12, Zagreb 10 000, Croatia
(Rados) School of Medicine University of Zagreb, Croatian Institute for
Brain Research, Zagreb, Croatia
(Anticevic) Yale University School of Medicine, Departments of Psychiatry
and Psychology, New Haven, United States
(Rados) University of Zagreb, Department of Radiology, University Hospital
Center Zagreb, Zagreb, Croatia
(Malojcic) University of Zagreb, Department of Neurology, University
Hospital Center Zagreb, Zagreb, Croatia
(Cikes, Milicic, Gasparovic) University of Zagreb, Departments of
Cardiology and Internal Medicine, University Hospital Center Zagreb,
Zagreb, Croatia
Title
Impact of remote ischemic preconditioning preceding coronary artery bypass
grafting on inducing neuroprotection (RIPCAGE): Study protocol for a
randomized controlled trial.
Source
Trials. 15 (1) , 2014. Article Number: 414. Date of Publication: October
27, 2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Neurological complications after cardiac surgery have a
profound impact on postoperative survival and quality of life. The
increasing importance of strategies designed to improve neurological
outcomes mirrors the growing risk burden of the contemporary cardiac
surgical population. Remote ischemic preconditioning (RIPC) reduces
adverse sequelae of ischemia in vulnerable organs by subjecting tissues
with high ischemic tolerance to brief periods of hypoperfusion. This trial
will evaluate the neuroprotective effect of RIPC in the cardiac surgical
arena, by employing magnetic resonance imaging (MRI) and neurocognitive
testing. Methods: Patients scheduled for elective coronary artery bypass
grafting with the use of cardiopulmonary bypass will be screened for the
study. Eligible patients will be randomized to undergo either a validated
RIPC protocol or a sham procedure. The RIPC will be induced by inflation
of a blood pressure cuff to 200mmHg for 5minutes, followed by a 5-minute
reperfusion period. Three sequences of interchanging cuff inflations and
deflations will be employed. Neurocognitive testing and MRI imaging will
be performed preoperatively and on postoperative day 7. Paired pre- and
postoperative neurocognitive and neuroimaging data will then be compared.
The primary composite outcome measure will consist of new ischemic lesions
on brain MRI, postprocedural impairment in brain connectivity on
resting-state functional MRI (rs-fMRI), and significant new declines in
neurocognitive performance. The secondary endpoint measures will be the
individual components of the primary endpoint measures, expressed as
continuous variables, troponin T release on postoperative day 1 and the
incidence of major adverse cardiovascular events at 3months
postoperatively. Major adverse cardiovascular events, including
accumulating cardiovascular mortality, stroke, nonfatal myocardial
infarction, and rehospitalization for ischemia, will form a composite
endpoint measure. Discussion: This trial will aim to assess whether RIPC
in patients subjected to surgical myocardial revascularization employing
cardiopulmonary bypass initiates a neuroprotective response. Should the
results of this trial indicate that RIPC is effective in reducing the
incidence of adverse neurological events in patients undergoing coronary
artery bypass grafting, it could impact on the current standard of care.
Trial registration: ClinicalTrials.gov NCT02177981.

<14>
Accession Number
2015681857
Authors
Fulcher J. O'Connell R. Voysey M. Colhoun H. De Lemos J. Blazing M. Downs
J.R. Gotto A. Clearfield M. Gordon D. Davis B. Koren M. Dahlof B. Poulter
N. Sever P. Knopp R.H. Fellstrom B. Holdaas H. Jardine A. Schmieder R.
Zannad F. Goldbourt U. Kaplinsky E. Colhoun H.M. Betteridge D.J.
Durrington P.N. Hitman G.A. Fuller J. Neil A. Wanner C. Krane V. Sacks F.
Moye L. Pfeffer M. Hawkins C.M. Wedel H. Wikstrand J. Barter P. Tavazzi L.
Marchioli R. Tognoni G. Franzosi M.G. Maggioni A. Bloomfield H. Robins S.
Pedersen T.R. Ridker P.M. Holman R. Meade T. Keech A. MacMahon S.
Marschner I. Tonkin A. Shaw J. Serruys P.W. Nakamura H. Knatterud G.
Furberg C. Byington R. Murphy M. Blauw G.J. Packard C. Kjekshus J.
Pedersen T. Wilhelmsen L. Braunwald E. Cannon C. Murphy S. Armitage J.
Bowman L. Parish S. Peto R. Sleight P. Landray M. La Rosa J. Rossouw J.
Probstfield J. Shepherd J. Cobbe S. Macfarlane P. Ford I. Flather M.
Kastelein J. Newman C. Shear C. Tobert J. Varigos J. White H. Yusuf S.
Barnes E.H. Keech A.C. Kirby A. Marschner I.C. Simes J. Baigent C.
Blackwell L. Collins R. Emberson J. Herrington W.G. Holland L.E. Mihaylova
B. Reith C.
Institution
(Barnes, Keech, Kirby, Marschner, Simes) CTC, University of Sydney,
Australia
(Baigent, Blackwell, Collins, Emberson, Herrington, Holland, Mihaylova,
Reith) CTSU, University of Oxford, United Kingdom
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385 (9976) (pp 1397-1405), 2015. Date of Publication: 2015.
Publisher
Lancet Publishing Group
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. Methods: We performed meta-analyses on data from 22 trials
of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 10 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 11 mmol/L in statin
vs control trials and roughly 05 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 10 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 084, 99% CI 078-091) and men (RR 078, 99% CI
075-081, adjusted p value for heterogeneity by sex=033) and also for those
women and men at less than 10% predicted 5 year absolute cardiovascular
risk (adjusted heterogeneity p=011). Likewise, the proportional reductions
in major coronary events, coronary revascularisation, and stroke did not
differ significantly by sex. No adverse effect on rates of cancer
incidence or non-cardiovascular mortality was noted for either sex. These
net benefits translated into all-cause mortality reductions with statin
therapy for both women (RR 091, 99% CI 084-099) and men (RR 090, 99% CI
086-095; adjusted heterogeneity p=043). Interpretation In men and women at
an equivalent risk of cardiovascular disease, statin therapy is of similar
effectiveness for the prevention of major vascular events.

<15>
Accession Number
71938675
Authors
Lafarge A.L. Kerneis C.K. Scalbert F. Larnier L.L. Brusset A.B. Estagnasie
P.E. Squara P.S.
Institution
(Lafarge, Kerneis, Scalbert, Larnier, Brusset, Estagnasie, Squara)
Clinique Ambroise Pare, Neuilly-sur-Seine, France
Title
Systematic alveolar recruitment after cardiac surgery.
Source
Critical Care. Conference: 35th International Symposium on Intensive Care
and Emergency Medicine Brussels Belgium. Conference Start: 20150317
Conference End: 20150320. Conference Publication: (var.pagings). 19 (pp
S95), 2015. Date of Publication: 16 Mar 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction We designed a pilot study to evaluate the interest of an
early systematic acute recruitment maneuver (ARM) in postcardiac surgery
hypoxemic patients in order to properly design a larger trial. Methods
This randomized controlled trial included consecutive patients operated on
in our institution. Three hours after surgery, hypoxemic patients
(PaO₂ <300 mmHg, FIO₂ = 1) were randomly assigned to
ARM or control (H0). ARM was performed by applying once a positive
end-expiratory pressure of 35 cmH₂O during 45 seconds. Blood
gases and hemodynamic variables were collected at H1, H8, H24 and H48. The
primary endpoint was the duration of mechanical ventilation (MV).
Secondary endpoints were survival rate, ICU length of stay and the
occurrence of pneumonia. Results We included 124 patients, age 67.5 +/-
10.6 years, M/F sex ratio 95/29, left ventricle ejection fraction 58.8 +/-
10.6%, forced expiratory volume 94 +/- 23% of the predicted value,
bypass/valve ratio 82/53. The preoperative and postoperative
PaO₂ /FIO₂ were 401 +/- 66 and 204 +/- 66 mmHg,
respectively (P <0.0001). The hemodynamic and ventilation status as well
as the fluid and inotrope supports were comparable in the two groups. At
H1, PaO₂ /FIO₂ was 367 +/- 15 in the recruited group
versus 299 +/- 15 mmHg in the control group, P = 0.002. At H8 and 24 the
difference was not significant. At H48, the PaO₂
/FIO₂ was lower in the recruited group (296 +/- 10 vs. 343 +/-
11 mmHg, P = 0.003) (Figure 1). The duration of mechanical ventilation
(invasive + non-invasive) was lower in the recruited group (total 6.4 +/-
1.4 vs. 8.4 +/- 1.4 hours, P = 0.02). The survival rate, the length of
stay in the ICU and the occurrence of pneumonia were similar in the two
groups (P >0.2). Conclusion We can speculate that the inverse evolution of
the blood oxygenation between the ARM group versus control may be due to:
barotraumatism of normal alveoli during the ARM and/or a higher
derecruitment rate after ARM due to the shorter mechanical ventilation
support. This pilot study shows that a unique ARM decreased the duration
of MV in cardiac surgery patients but this may have subsequent detrimental
effects on blood oxygenation.