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<1>
Accession Number
2015214395
Authors
Hernesniemi J.A. Vanni V. Hakala T.
Institution
(Hernesniemi, Vanni, Hakala) Departments of Internal Medicine and Surgery,
North Karelia Central Hospital, Joensuu, Finland
Title
The prevalence of abdominal aortic aneurysm is consistently high among
patients with coronary artery disease.
Source
Journal of Vascular Surgery. 62 (1) (pp 232-240), 2015. Article Number:
7941. Date of Publication: 01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Objective Emerging evidence suggests high prevalence of abdominal aortic
aneurysm (AAA) among patients with coronary disease. Accurate
characterization of the association between coronary disease and AAA and
of the actual prevalence of AAA among patients with angiography-verified
coronary artery disease (CAD) is needed to evaluate the possible benefits
of systematic screening for AAA. Methods We searched for studies that
reported the association between AAA and CAD or coronary heart disease
(CHD; wider phenotype definition) in the general population (randomized
controlled trials, prospective population cohorts) and those that reported
the prevalence of AAA among patients with angiography-verified CAD through
PubMed, Embase, and reference lists for the period between 1980 and 2014.
Random-effects models were applied because of the high heterogeneity
between included studies. Results Among the general population, 23 studies
reported the association between CHD and the occurrence of subclinical AAA
(positive ultrasound screening; meta-analyzed odds ratio of 2.38 with 95%
confidence interval [CI] of 1.78-3.19; P = 4.1 x 10^-9).
According to four prospective studies, CHD is a strong predictor of future
AAA events (fatal and nonfatal; meta-analyzed hazard ratio of 3.49 with
95% CI of 2.56-4.76; P = 2.4 x 10^-15). Altogether, 10 studies
reported the prevalence of AAA among patients with angiography-verified
CAD or undergoing coronary artery bypass grafting. Among men,
meta-analyzed prevalence was 9.5% (95% CI, 7.6%-11.7%). Among men
undergoing coronary artery bypass grafting or with three-vessel disease,
the prevalence was 11.4% (95% CI, 9.1%-13.9%). Among women, the prevalence
was low (0.35%). Conclusions The risk of subclinical AAA and future AAA
events is high among patients with coronary disease. Screening for AAA
among CAD patients by cardiologists would be easy and inexpensive, with
possible benefits to survival and risk evaluation.

<2>
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Accession Number
2015214290
Authors
Afilalo J. Grapsa J. Nihoyannopoulos P. Beaudoin J. Gibbs J.S.R. Channick
R.N. Langleben D. Rudski L.G. Hua L. Handschumacher M.D. Picard M.H.
Levine R.A.
Institution
(Afilalo, Langleben, Rudski) Division of Cardiology, Jewish General
Hospital, McGill University, 3755 Cote Ste Catherine, Montreal, QC H3T
1E2, Canada
(Grapsa, Nihoyannopoulos) Cardiac Ultrasound Laboratory, Division of
Cardiology, Hammersmith Hospital, Imperial College, Healthcare NHS Trust,
London, United Kingdom
(Gibbs) National Pulmonary Hypertension Service, Division of Cardiology,
Hammersmith Hospital, Imperial College, Healthcare NHS Trust, London,
United Kingdom
(Channick) Pulmonary Hypertension and Thromboendarterectomy Program,
Division of Pulmonary and Critical Care Medicine, Massachusetts General
Hospital, Harvard University, Boston, United States
(Afilalo, Beaudoin, Hua, Handschumacher, Picard, Levine) Cardiac
Ultrasound Laboratory, Division of Cardiology, Massachusetts General
Hospital, Harvard University, Boston, United States
Title
Leaflet Area as a Determinant of Tricuspid Regurgitation Severity in
Patients with Pulmonary Hypertension.
Source
Circulation: Cardiovascular Imaging. 8 (5) , 2015. Article Number:
e002714. Date of Publication: 21 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Tricuspid regurgitation (TR) is a risk factor for mortality
in pulmonary hypertension (PH). TR severity varies among patients with
comparable degrees of PH and right ventricular remodeling. The
contribution of leaflet adaptation to the pathophysiology of TR has yet to
be examined. We hypothesized that tricuspid leaflet area (TLA) is
increased in PH, and that the adequacy of this increase relative to right
ventricular remodeling determines TR severity. Methods and Results - A
prospective cohort of 255 patients with PH from pre and postcapillary
pathogeneses was assembled from 2 centers. Patients underwent a
3-dimensional echocardiogram focused on the tricuspid apparatus. TLA was
measured with the Omni 4D software package. Compared with normal controls,
patients with PH had a 2-fold increase in right ventricular volumes, 62%
increase in annular area, and 49% increase in TLA. Those with severe TR
demonstrated inadequate increase in TLA relative to the closure area, such
that the ratio of TLA:closure area <1.78 was highly predictive of severe
TR (odds ratio, 68.7; 95% confidence interval, 16.2-292.7). The median
vena contracta width was 8.5 mm in the group with small TLA and large
closure area as opposed to 4.8 mm in the group with large TLA and large
closure area. Conclusions - TLA plays a significant role in determining
which patients with PH develop severe functional TR. The ratio of
TLA:closure area, reflecting the balance between leaflet adaptation versus
annular dilation and tethering forces, is an indicator of TR severity that
may identify which patients stand to benefit from leaflet augmentation
during tricuspid valve repair.

<3>
Accession Number
2015214280
Authors
Clavel M.-A. Mantovani F. Malouf J. Michelena H.I. Vatury O. Jain M.S.
Mankad S.V. Suri R.M. Enriquez-Sarano M.
Institution
(Clavel, Mantovani, Malouf, Michelena, Vatury, Jain, Mankad, Suri,
Enriquez-Sarano) Division of Cardiovascular Diseases and Internal
Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
Title
Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease.
Source
Circulation: Cardiovascular Imaging. 8 (5) , 2015. Article Number:
e002989. Date of Publication: 21 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Fibro-elastic deficiency (FED) and diffuse myxomatous
degeneration (DMD) are phenotypes of degenerative mitral valve disease
defined morphologically. Whether physiological differences in annular and
valvular dynamics exist between these phenotypes remains unknown. Methods
and Results - We performed triple quantitation of cardiac remodeling and
of mitral regurgitation severity and of annular and valvular dimensions by
real-time 3-dimensional-transesophageal-echocardiography. Forty-nine
patients with degenerative mitral valve disease classified as FED (n=31)
and DMD (n=18) by surgical observation showed no difference in age
(65+/-10 versus 59+/-13; P=0.5), body surface area (2.0+/-0.2 versus
2.0+/-0.2 m 2; P=0.5), left ventricular and atrial dimensions (all
P>0.55), and mitral regurgitation regurgitant orifice (P=0.62). On
average, annular dimensions were larger in DMD versus FED, but height was
similar resulting in lower saddle shape. Dynamically, annular DMD versus
FED display poorer contraction and saddle-shape accentuation in early
systole and abnormal enlargement, particularly intercommissural, in
late-systole (all P<0.05). Valvular dynamics showed stable valvular area
in systole in FED versus considerable systolic increased area in DMD
(P<0.001). Prolapse height and volume increased little throughout systole
in FED versus marked increase in DMD (P<0.001). Conclusions - Our novel
observations show that FED and DMD, although both labeled myxomatous,
display considerable physiological phenotypic differences. In DMD, the
annular increased size and profoundly abnormal dynamics demonstrate
DMD-specific annular degeneration compared with the enlarged but
relatively normal FED annulus. DMD does not incur more severe mitral
regurgitation, despite larger prolapse and valve redundancy, underscoring
potential compensatory role of tissue redundancy of DMD (or aggravating
role of tissue paucity of FED) on mitral regurgitation severity.

<4>
Accession Number
2015211874
Authors
Alfonso F. Perez-Vizcayno M.J. Cardenas A. Garcia Del Blanco B.
Garcia-Touchard A. Lopez-Minguez J.R. Benedicto A. Masotti M. Zueco J.
Iniguez A. Velazquez M. Moreno R. Mainar V. Dominguez A. Pomar F. Melgares
R. Rivero F. Jimenez-Quevedo P. Gonzalo N. Fernandez C. Macaya C.
Institution
(Alfonso, Benedicto, Rivero) Hospital Universitario de la Princesa,
Departamento de Cardiologia, Diego de Leon 62, Madrid 28006, Spain
(Perez-Vizcayno, Cardenas, Jimenez-Quevedo, Gonzalo, Fernandez, Macaya)
Hospital Universitario Clinico San Carlos, Madrid, Spain
(Garcia Del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina, Badajoz, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Iniguez) Hospital Universitario de Meixoeiro, Vigo, Spain
(Velazquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Moreno) Hospital Universitario la Paz, Madrid, Spain
(Mainar) Hospital Universitario de Alicante, Alicante, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Pomar) Hospital Universitario General de Valencia, Valencia, Spain
(Melgares) Hospital Universitario Virgen de Las Nieves, E-Granada, Spain
Title
A Prospective Randomized Trial of Drug-Eluting Balloons Versus
Everolimus-Eluting Stents in Patients with In-Stent Restenosis of
Drug-Eluting Stents the RIBS IV Randomized Clinical Trial.
Source
Journal of the American College of Cardiology. 66 (1) (pp 23-33), 2015.
Date of Publication: 07 Jul 2015.
Publisher
Elsevier USA
Abstract
Background Treatment of patients with drug-eluting stent (DES) in-stent
restenosis (ISR) remains a major challenge. Objectives This study
evaluated the comparative efficacy of drug-eluting balloons (DEB) and
everolimus-eluting stents (EES) in patients presenting with DES-ISR.
Methods The study design of this multicenter randomized clinical trial
assumed superiority of EES for the primary endpoint, in-segment minimal
lumen diameter at the 6- to 9-month angiographic follow-up. Results A
total of 309 patients with DES-ISR from 23 Spanish university hospitals
were randomly allocated to DEB (n = 154) or EES (n = 155). At late
angiography (median 247 days; 90% of eligible patients), patients in the
EES arm had a significantly larger minimal lumen diameter (2.03 +/- 0.7 mm
vs. 1.80 +/- 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI:
00.7 to 0.38), net lumen gain (1.28 +/- 0.7 mm vs. 1.01 +/- 0.7 mm; p <
0.01), and lower percent diameter stenosis (23 +/- 22% vs. 30 +/- 22%; p <
0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with
patients in the DEB arm. Consistent results were observed in the in-lesion
analysis. At the 1-year clinical follow-up (100% of patients), the main
clinical outcome measure (composite of cardiac death, myocardial
infarction, and target vessel revascularization) was significantly reduced
in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to
0.98), mainly driven by a lower need for target vessel revascularization
(8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES
provided superior long-term clinical and angiographic results compared
with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting
Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940)

<5>
Accession Number
2015213925
Authors
Zhao D. Song J. Gao X. Gao F. Wu Y. Lu Y. Hou K.
Institution
(Zhao, Hou) Department of Neurosurgery, The First Hospital of Hebei
Medical University, Shijiazhuang, China
(Song, Wu) Department of Neurosurgery, Shijiazhuang, China
(Gao) Department of Neurology, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
(Gao) Hebei Provincial Procurement Centers for Medical Drugs and Devices,
Shijiazhuang, China
(Lu) Department of Neurosurgery, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
Title
Selective oropharyngeal decontamination versus selective digestive
decontamination in critically ill patients: A meta-analysis of randomized
controlled trials.
Source
Drug Design, Development and Therapy. 9 (pp 3617-3624), 2015. Date of
Publication: 14 Jul 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Selective digestive decontamination (SDD) and selective
oropharyngeal decontamination (SOD) are associated with reduced mortality
and infection rates among patients in intensive care units (ICUs);
however, whether SOD has a superior effect than SDD remains uncertain.
Hence, we conducted a meta-analysis of randomized controlled trials (RCTs)
to compare SOD with SDD in terms of clinical outcomes and antimicrobial
resistance rates in patients who were critically ill. Methods: RCTs
published in PubMed, Embase, and Web of Science were systematically
reviewed to compare the effects of SOD and SDD in patients who were
critically ill. Outcomes included day-28 mortality, length of ICU stay,
length of hospital stay, duration of mechanical ventilation, ICU-acquired
bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria.
Results were expressed as risk ratio (RR) with 95% confidence intervals
(CIs), and weighted mean differences (WMDs) with 95% CIs. Pooled estimates
were performed using a fixed-effects model or random-effects model,
depending on the heterogeneity among studies. Results: A total of four
RCTs involving 23,822 patients met the inclusion criteria and were
included in this meta-analysis. Among patients whose admitting specialty
was surgery, cardiothoracic surgery (57.3%) and neurosurgery (29.7%) were
the two main types of surgery being performed. Pooled results showed that
SOD had similar effects as SDD in day-28 mortality (RR =1.03; 95% CI:
0.98, 1.08; P=0.253), length of ICU stay (WMD =0.00 days; 95% CI: -0.2,
0.2; P=1.00), length of hospital stay (WMD =0.00 days; 95% CI: -0.65,
0.65; P=1.00), and duration of mechanical ventilation (WMD =1.01 days; 95%
CI: -0.01, 2.02; P=0.053). On the other hand, compared with SOD, SDD had a
lower day-28 mortality in surgical patients (RR =1.11; 95% CI: 1.00, 1.22;
P=0.050), lower incidence of ICU-acquired bacteremia (RR =1.38; 95% CI:
1.24, 1.54; P=0.000), and lower rectal carriage of aminoglycosides (RR
=2.08; 95% CI: 1.68, 2.58; P=0.000), ciprofloxacin-resistant Gram-negative
bacteria (RR =1.84; 95% CI: 1.48, 2.29; P=0.000), and respiratory carriage
of third-generation cephalosporin-resistant Gram-negative bacteria (RR
=2.50; 95% CI: 1.78, 3.5; P=0.000). Conclusion: SOD has similar effects as
SDD in clinical outcomes, but has higher incidence of ICU-acquired
bacteremia, and higher carriage of antibiotic-resistant Gram-negative
bacteria. However, due to the high cost of SDD and the increased risk of
development of antibiotic resistance with the widespread use of
cephalosporins in SDD, we would recommend SOD as prophylactic antibiotic
regimens in patients in the ICU. More well-designed, large-scale RCTs are
needed to confirm our findings.

<6>
Accession Number
2015067216
Authors
Magliano C.A.S. Saraiva R.M. Azevedo V.M.P. Innocenzi A.M. Tura B.R.
Santos M.
Institution
(Magliano, Azevedo, Innocenzi, Tura, Santos) Instituto Nacional de
Cardiologia, Mexico
(Saraiva) Instituto Nacional de Infectologia Evandro Chagas, Fundacao
Oswaldo Cruz, Brazil
Title
EFFICACY of CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW
and META-ANALYSIS.
Source
International Journal of Technology Assessment in Health Care. 31 (1-2)
(pp 19-26), 2015. Date of Publication: 14 Jul 2015.
Publisher
Cambridge University Press
Abstract
Objectives: The Carpentier-Edwards pericardial (CEP) prostheses are the
type of bioprostheses most used worldwide. Although they were designed to
minimize the rate of valve deterioration and reoperation, their clinical
superiority over other prostheses models still lacks confirmation. The
objective of this study was to evaluate its effectiveness. Methods: We
performed a systematic review and meta-analysis in the PubMed, Embase,
Cochrane, and Lilacs databases. Operative mortality, overall mortality and
reoperation rates after heart valve surgery were compared between the use
of CEP and other cardiac prostheses. Two independent reviewers screened
studies for inclusion and extracted the data. Disagreements were resolved
by consensus. The GRADE criterion was used to assess the evidence quality.
Results: A total of twenty-eight studies were selected, including 19,615
individuals. The studies presented a high heterogeneity and low quality of
evidence what limited the reliability of the results. The pooled data from
the selected studies did not demonstrate significant differences between
CEP and porcine, pericardial or stentless prostheses regarding operative
mortality, overall mortality and reoperation rates. However, the pooled
data from 3 observational trials pointed out a higher risk for reoperation
after valve replacement using CEP prostheses against mechanical prostheses
(OR 4.92 [95 percent confidence interval 2.43-9.96]). Conclusions: The
current data present in the literature still does not support a clinical
advantage for the use of CEP prostheses over other bioprostheses. The
quality of the studies in the literature is limited and further studies
are needed to address if CEP prostheses will have a clinical advantage
over other prostheses.

<7>
Accession Number
2015214823
Authors
Chatterjee S. Herrmann H.C. Wilensky R.L. Hirshfeld J. McCormick D.
Frankel D.S. Yeh R.W. Armstrong E.J. Kumbhani D.J. Giri J.
Institution
(Chatterjee) Division of Cardiology, St Lukes-Roosevelt Hospital Center of
the Mount Sinai Health System, New York, NY, United States
(Herrmann, Wilensky, Hirshfeld, McCormick, Frankel, Giri) Cardiovascular
Medicine Division, University of Pennsylvania, Perelman School of
Medicine, 3400 Spruce St, Philadelphia, PA 19104, United States
(Yeh) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(Armstrong) Division of Cardiology, University of Colorado, Denver, United
States
(Kumbhani) Division of Cardiology, University of Texas-Southwestern
Medical School, Dallas, United States
Title
Safety and procedural success of left atrial appendage exclusion with the
lariat device: A systematic review of published reports and analytic
review of the FDAMAUDE database.
Source
JAMA Internal Medicine. 175 (7) (pp 1104-1109), 2015. Date of Publication:
01 Jul 2015.
Publisher
American Medical Association
Abstract
IMPORTANCE The Lariat device has received US Food and Drug Administration
(FDA) 510(k) clearance for soft-tissue approximation and is being widely
used off-label for left atrial appendage (LAA) exclusion. A comprehensive
analysis of safety and effectiveness has not been reported. OBJECTIVES To
perform a systematic review of published literature to assess safety and
procedural success, defined as successful closure of the LAA during the
index procedure, of the Lariat device.We performed a formal analytic
review of the FDAMAUDE (Manufacturer and User Facility Device Experience)
database to compile adverse event reports from real-world practice with
the Lariat. DATA SOURCES For the systematic review, PubMed, EMBASE,
CINAHL, and the Cochrane Library were searched from January 2007 through
August 2014 to identify all studies reporting use of the Lariat device in
3 or more patients. The FDA MAUDE database was queried for adverse events
reports related to Lariat use. DATA EXTRACTIONS AND SYNTHESIS Datawere
abstracted in duplicate by 2 physician reviewers. Events from published
literature were pooled using a generic inverse variance weighting with a
random effects model. Cumulative and individual adverse events were also
reported using the FDAMAUDE data set. MAIN OUTCOMES AND MEASURES
Procedural adverse events and procedural success. RESULTS In the
systematic review, 5 reports of Lariat device use in 309 participants were
identified. Specific complications weighted for inverse of variance of
individual studies were urgent need for cardiac surgery (2.3%; 7 of 309
procedures) and death (0.3%; 1 of 309 procedures). Procedural success was
90.3%(279 of 309 procedures). In the FDAMAUDE database, there were 35
unique reports of adverse events with use of the Lariat device. Among
these, we identified 5 adverse event reports that noted pericardial
effusion and death and an additional 23 reported urgent cardiac surgery
without mention of death. CONCLUSIONS AND RELEVANCE This review of
published reports and case reports identified risks of adverse events with
off-label use of the Lariat device for LAA exclusion. Formal, controlled
investigations into the safety and efficacy of the device for this
indication are warranted.

<8>
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Accession Number
2015205948
Authors
Gossl M. Kane G.C. Mauermann W. Holmes D.R.
Institution
(Gossl) Department of Cardiology, SSM, 700 S. Park St, Madison, WI 53715,
United States
(Kane, Holmes) Division of Cardiology, United States
(Mauermann) Department of Anesthesiology, Mayo Clinic, Rochester, MN,
United States
Title
Pulmonary hypertension in patients undergoing transcatheter aortic valve
replacement.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002253. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins

<9>
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Accession Number
2015205943
Authors
Bagai A. Huang Z. Lokhnygina Y. Harrington R.A. Armstrong P.W. Strony J.
White H.D. Leonardi S. Held C. Van De Werf F. Wallentin L. Tricoci P.
Mahaffey K.W.
Institution
(Bagai) Terrence Donnelly Heart Center, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Bagai, Huang, Lokhnygina, Leonardi, Tricoci) Department of Medicine, Duke
Clinical Research Center, Duke University, Durham, NC, United States
(Harrington, Mahaffey) Department of Medicine, Stanford University, CA,
United States
(Armstrong) Department of Medicine, University of Alberta, Edmonton,
Canada
(Strony) Merck and Co, Whitehouse Station, NJ, United States
(White) Department of Medicine, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Leonardi) Department of Medicine, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Held, Wallentin) Department of Medicine, Uppsala Clinical Research
Center, Uppsala University, Sweden
(Van De Werf) Department of Medicine, University Hospitals Leuven, Leuven,
Belgium
Title
Magnitude of troponin elevation and long-term clinical outcomes in acute
coronary syndrome patients treated with and without revascularization.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002314. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
In patients with non-ST-segment-elevation acute coronary syndrome (NSTE
ACS), elevated troponin levels identify patients at high risk for adverse
outcomes; however, it is unknown whether the magnitude of troponin
elevation during hospitalization remains predictive of subsequent events
in patients undergoing coronary revascularization. Methods and Results-We
studied 12 635 patients with NSTE ACS in the Thrombin Receptor Antagonist
for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study
with at least 1 troponin measurement during index hospitalization. Cox
proportional hazards regression was used to examine the relationship
between peak troponin level (standardized as the ratio of peak troponin
value measured during hospitalization and local laboratory upper reference
limit [URL]) and revascularization on all-cause mortality at 2 years.
Revascularization (percutaneous coronary intervention or coronary artery
bypass graft) was performed during index hospitalization in 8586 patients
(68.0%); revascularized patients had higher peak troponin ratios (median,
23 versus 9.5x URL). Among patients that did not undergo
revascularization, the mortality rate at 2 years increased in a
curvilinear fashion with increasing levels of peak troponin. In contrast,
the mortality rate at 2 years remained constant irrespective of peak
troponin levels among revascularized patients (P for interaction=0.004).
This relationship was unchanged after multivariable adjustment.
Conclusions-There is a differential relationship between the magnitude of
troponin elevation and long-term mortality in ACS patients treated with
and without revascularization. Although prognostically important in
patients treated without revascularization, the prognostic implications of
peak troponin level seem to be minimal in revascularized patients.

<10>
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Accession Number
2015205936
Authors
Franzone A. Pilgrim T. Heg D. Roffi M. Tuller D. Vuilliomenet A. Muller O.
Cook S. Weilenmann D. Kaiser C. Jamshidi P. Raber L. Stortecky S.
Wenaweser P. Juni P. Windecker S.
Institution
(Franzone, Pilgrim, Raber, Stortecky, Wenaweser, Windecker) Department of
Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern
CH-3010, Switzerland
(Heg, Juni) Institute of Social and Preventive Medicine, Clinical Trials
Unit, United States
(Roffi) University Hospital, Bern, Switzerland
(Roffi) Department of Cardiology, University Hospital, Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Vuilliomenet, Muller) Department of Cardiology, University Hospital,
Lausanne, Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
Title
Clinical outcomes according to diabetic status in patients treated with
biodegradable polymer sirolimus-eluting stents versus durable polymer
everolimus-eluting stents: Prespecified subgroup analysis of the
BIOSCIENCE trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002319. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES)
proved noninferior to durable polymer everolimus-eluting stents (DP-EES)
for a composite clinical end point in a population with minimal exclusion
criteria. We performed a prespecified subgroup analysis of the Ultrathin
Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer
Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation
(BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in
patients with diabetes mellitus. Methods and Results-BIOSCIENCE trial was
an investigator-initiated, single-blind, multicentre, randomized,
noninferiority trial comparing BP-SES versus DP-EES. The primary end
point, target lesion failure, was a composite of cardiac death,
target-vessel myocardial infarction, and clinically indicated target
lesion revascularization within 12 months. Among a total of 2119 patients
enrolled between February 2012 and May 2013, 486 (22.9%) had diabetes
mellitus. Overall diabetic patients experienced a significantly higher
risk of target lesion failure compared with patients without diabetes
mellitus (10.1% versus 5.7%; hazard ratio [HR], 1.80; 95% confidence
interval [CI], 1.27-2.56; P=0.001). At 1 year, there were no differences
between BP-SES versus DP-EES in terms of the primary end point in both
diabetic (10.9% versus 9.3%; HR, 1.19; 95% CI, 0.67-2.10; P=0.56) and
nondiabetic patients (5.3% versus 6.0%; HR, 0.88; 95% CI, 0.58-1.33;
P=0.55). Similarly, no significant differences in the risk of definite or
probable stent thrombosis were recorded according to treatment arm in both
study groups (4.0% versus 3.1%; HR, 1.30; 95% CI, 0.49-3.41; P=0.60 for
diabetic patients and 2.4% versus 3.4%; HR, 0.70; 95% CI, 0.39-1.25;
P=0.23, in nondiabetics). Conclusions-In the prespecified subgroup
analysis of the BIOSCIENCE trial, clinical outcomes among diabetic
patients treated with BP-SES or DP-EES were comparable at 1 year.

<11>
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Accession Number
2015205935
Authors
Hamon M. Coste P. Van'T Hof A. Ten Berg J. Clemmensen P. Tabone X. Benamer
H. Kristensen S.D. Cavallini C. Marzocchi A. Hamm C. Kanic V. Bernstein D.
Anthopoulos P. Deliargyris E.N. Steg P.G.
Institution
(Hamon) Department of Clinical Research, University of Caen, Ave Cote de
Nacre, Caen, Normandie 14033, France
(Coste) Department of Cardiology, Centre Hospitalier Universitaire
Bordeaux, Universite de Bordeaux, Pessac, France
(Van'T Hof) Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Clemmensen) Department of Cardiology, University of Copenhagen,
Copenhagen, Denmark
(Tabone) Department of Cardiology, Hopital Jacques Coeur, Bourges, France
(Benamer) Department of Cardiology, Hopital de la Roseraie, Aubervilliers,
France
(Kristensen) Department of Cardiology, Aarhus University, Aarhus, Denmark
(Cavallini) Department of Cardiology, S.Maria della Misericordia
University Hospital, Perugia, Italy
(Marzocchi) Department of Cardiology, Cardiologia Azienda
Ospedaliero-Universitaria, Bologna, Italy
(Hamm) Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad
Nauheim, Germany
(Kanic) Department of Cardiology, Medical Centre Maribor, Maribor,
Slovenia
(Bernstein, Anthopoulos, Deliargyris) Medicines Company, Parsippany, NJ,
United States
(Steg) Universite Paris-Diderot, Departement Hospitalo, Universitaire
Fibrosis Inflammation Remodeling, Paris, France
(Steg) French Alliance for Cardiovascular Trials, Paris, France
(Steg) National Heart Lung Institute, Royal Brompton Hospital, Imperial
College, London, United Kingdom
Title
Impact of arterial access site on outcomes after primary percutaneous
coronary intervention: Prespecified subgroup analysis from the EUROMAX
trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002049. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX),
bivalirudin improved 30-day clinical outcomes with reduced major bleeding
compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We
assessed whether choice of access site (radial or femoral) had an impact
on 30-day outcomes and whether it interacted with the benefit of
bivalirudin. Methods and Results-In EUROMAX, choice of arterial access was
left to operator discretion. Overall, 47% of patients underwent radial and
53% femoral access. Baseline risk was higher in the femoral access group.
Unadjusted proportions for the primary outcome (death or noncoronary
artery bypass graft protocol major bleeding at 30 days) were lower with
radial access, however, without differences in major or major plus minor
bleeding proportions. After multivariable adjustment, ischemic outcomes
were no longer different between access site groups, except for a lower
risk of stroke in radial patients. Bivalirudin was associated with lower
proportions of the primary outcome in both the radial (odds ratio, 0.58;
95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95%
CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly
lower in the bivalirudin group both in the radial-and femoral-treated
patients but no significant difference was observed in ischemic outcomes.
In multivariable analysis, bivalirudin emerged as the only independent
predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74;
P=0.002). Conclusions-In this prespecified analysis from EUROMAX, radial
access was preferred in lower risk patients and did not improve clinical
outcomes. Bivalirudin was associated with less bleeding irrespective of
access site.

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Accession Number
2015205933
Authors
Iqbal J. Serruys P.W. Silber S. Kelbaek H. Richardt G. Morel M.-A. Negoita
M. Buszman P.E. Windecker S.
Institution
(Iqbal, Serruys) Department of Interventional Cardiology, Erasmus Medical
Centre, PO Box 2125, Rotterdam 3000, Netherlands
(Iqbal) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Serruys) International Centre for Circulatory Health, Imperial College
London, London, United Kingdom
(Silber) Department of Cardiology, Heart Centre at the Isar, Munich,
Germany
(Kelbaek) Righshospitalet, Heart Center, Copenhagen, Denmark
(Richardt) Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany
(Morel) Cardialysis BV, Rotterdam, Netherlands
(Negoita) Department of Medtronic, Santa Rosa, CA, United States
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
Title
Comparison of zotarolimus-and everolimus-eluting coronary stents: Final
5-year report of the RESOLUTE all-comers trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002230. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Newer-generation drug-eluting stents that release zotarolimus or
everolimus have been shown to be superior to the first-generation
drug-eluting stents. However, data comparing long-term safety and efficacy
of zotarolimus-(ZES) and everolimus-eluting stents (EES) are limited.
RESOLUTE all-comers (Randomized Comparison of a Zotarolimus-Eluting Stent
With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)
trial compared these 2 stents and has shown that ZES was noninferior to
EES at 12-month for the primary end point of target lesion failure. We
report the secondary clinical outcomes at the final 5-year follow-up of
this trial. Methods and Results-RESOLUTE all-comer clinical study is a
prospective, multicentre, randomized, 2-arm, open-label, noninferiority
trial with minimal exclusion criteria. Patients (n=2292) were randomly
assigned to treatment with either ZES (n=1140) or EES (n=1152).
Patient-oriented composite end point (combination of all-cause mortality,
myocardial infarction, and any revascularizations), device-oriented
composite end point (combination of cardiac death, target vessel
myocardial infarction, and clinically indicated target lesion
revascularization), and major adverse cardiac events (combination of
all-cause death, all myocardial infarction, emergent coronary bypass
surgery, or clinically indicated target lesion revascularization) were
analyzed at 5-year follow-up. The 2 groups were well-matched at baseline.
Fiveyear follow-up data were available for 98% patients. There were no
differences in patient-oriented composite end point (ZES 35.3% versus EES
32.0%, P=0.11), device-oriented composite end point (ZES 17.0% versus EES
16.2%, P=0.61), major adverse cardiac events (ZES 21.9% versus EES 21.6%,
P=0.88), and definite/probable stent thrombosis (ZES 2.8% versus EES 1.8%,
P=0.12). Conclusions-At 5-year follow-up, ZES and EES had similar efficacy
and safety in a population of patients who had minimal exclusion criteria.

<13>
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Accession Number
2015205931
Authors
Ben-Gal Y. Mohr R. Feit F. Ohman E.M. Kirtane A. Xu K. Mehran R. Stone
G.W.
Institution
(Ben-Gal, Mohr) Department of Cardiothoracic Surgery, Tel Aviv Sourasky
Medical Center, Tel Aviv University, 6 Weizman St, Tel Aviv 64239, Israel
(Feit) Department of Cardiology, New York University, School of Medicine,
United States
(Ohman) Department of Cardiology, Duke University, Medical Center, Durham,
NC, United States
(Kirtane, Xu, Stone) Department of Cardiology, Columbia University, New
York-Presbyterian Hospital, United States
(Mehran) Department of Cardiology, Mount Sinai Medical Center, New York,
NY, United States
(Kirtane, Xu, Mehran, Stone) Cardiovascular Research Foundation, New York,
NY, United States
Title
Surgical versus percutaneous coronary revascularization for multivessel
disease in diabetic patients with non-ST-segment-elevation acute coronary
syndrome: Analysis from the acute catheterization and early intervention
triage strategy trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) , 2015. Article Number:
e002032. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The preferred revascularization strategy for diabetic patients with acute
coronary syndromes and multivessel coronary artery disease is uncertain.
We evaluated the outcomes of diabetic patients with moderate and high-risk
acute coronary syndrome and multivessel disease managed with percutaneous
coronary intervention (PCI) versus coronary artery bypass grafting (CABG).
Methods and Results-Among 13 819 moderate and high-risk acute coronary
syndrome patients enrolled in the Acute Catheterization and Early
Intervention Triage Strategy (ACUITY) trial, 1772 diabetic patients had
multivessel disease with left anterior descending artery involvement and
were managed by PCI (n=1349) or CABG (n=423). Propensity scoring was
applied to adjust for differences in baseline clinical and angiographic
characteristics, yielding a total of 326 matched patients (163 managed by
PCI and 163 managed by CABG). At 30 days, treatment with PCI compared with
CABG was associated with lower rates of major bleeding (15.3% versus
55.6%; P<0.0001), blood transfusions (9.2% versus 43.2%; P<0.0001), and
acute kidney injury (13.4% versus 33.6%; P<0.0001), but more unplanned
revascularization procedures (6.9% versus 1.9%; P=0.03). At 1 year PCI was
associated with higher rates of repeat revascularization procedures (19.5%
versus 5.2%; P=0.0001), with nonsignificantly different rates of
myocardial infarction, stroke, and death at either 30 days or 1 year.
Conclusions-In the large-scale ACUITY trial, diabetic patients with acute
coronary syndrome and multivessel disease treated with PCI rather than
CABG had less bleeding and acute kidney injury, greater need for repeat
revascularization procedures, and comparable rates of myocardial
infarction, stroke, and death through 1-year follow-up.

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Accession Number
2015212700
Authors
Bangalore S. Toklu B. Wetterslev J.
Institution
(Bangalore, Toklu) Division of Cardiology, New York University, School of
Medicine, New York, NY, United States
(Wetterslev) Division of Cardiology, Copenhagen Trial Unit, Centre for
Clinical Intervention Research, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Title
Complete Versus Culprit-Only Revascularization for ST-Segment-Elevation
Myocardial Infarction and Multivessel Disease.
Source
Circulation: Cardiovascular Interventions. 8 (4) , 2015. Article Number:
e002142. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - The 2013 American College of Cardiology Foundation/American
Heart Association guidelines for patients with ST-segment-elevation
myocardial infarction gives a class III indication for nonculprit artery
percutaneous coronary intervention at the time of primary percutaneous
coronary intervention, driven by data from observational studies. However,
more recent trials suggest otherwise. Methods and Results - We conducted
PUBMED, EMBASE, and CENTRAL searches for randomized trials comparing
complete versus culprit-only revascularization in patients with
ST-segment-elevation myocardial infarction. Efficacy outcomes were major
adverse cardiovascular events, as well as death, cardiovascular death,
myocardial infarction, and repeat revascularization. Safety outcomes were
contrast-induced nephropathy, contrast volume used, and procedure time.
Five trials with 1165 patients fulfilled the inclusion criteria. Complete
revascularization (68% during index percutaneous coronary intervention)
was associated with significant reduction in major adverse cardiovascular
events (rate ratio =0.48; 95% confidence interval =0.37-0.61), death (rate
ratio =0.60; 95% confidence interval =0.38-0.97), cardiovascular death
(rate ratio =0.38, 95% confidence interval =0.20-0.73), and repeat
revascularization (rate ratio =0.42; 95% confidence interval =0.31-0.57)
when compared with culprit-only revascularization. However, trial
sequential analyses (similar to interim analysis of a randomized trial)
powered for a 25% relative reduction showed firm evidence (cumulative
z-curve crossed the monitoring boundary) only for major adverse
cardiovascular events driven by a decrease in repeat revascularization
with no firm evidence for reduction in death and myocardial infarction.
Moreover, there was a significant increase in contrast volume use (mean
difference 85.12 [70.41-83.00] ml) and procedure time (mean difference
16.42 [13.22-19.63] mins) with complete revascularization without increase
in contrast-induced nephropathy. Conclusions - In patients with
ST-segment-elevation myocardial infarction, immediate or staged complete
revascularization results in significant reduction in major adverse
cardiovascular events driven largely by reduction in repeat
revascularization with no firm evidence for the reduction in death or
myocardial infarction when compared with culprit-only revascularization.

<15>
Accession Number
2015212695
Authors
Nikolsky E. Mehran R. Dangas G.D. Xu K. Parvataneni R. Witzenbichler B.
Guagliumi G. Kornowski R. Genereux P. Brener S.J. Stone G.W.
Institution
(Nikolsky) Cardiology Department, Rambam Health Care Campus,
Technion-Israel Institute of Technology, Intermediate Cardiac Care Unit,
Cardiovascular Research Unit, 8 Ha'Aliyah St., Haifa 35254, Israel
(Mehran, Dangas, Xu, Parvataneni, Genereux, Brener, Stone) Cardiovascular
Research Foundation, New York, NY, United States
(Mehran, Dangas) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Guagliumi) Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Kornowski) Rabin Medical Center, Petach-Tikva, Israel
(Genereux) Hopital du Sacre-Coeur de Montreal, QC, Canada
(Genereux, Stone) Columbia University, Medical Center, New York, NY,
United States
(Brener) New York Methodist Hospital, Brooklyn, United States
Title
Cerebrovascular Events after a Primary Percutaneous Coronary Intervention
Strategy for Acute ST-Segment- Elevation Myocardial Infarction.
Source
Circulation: Cardiovascular Interventions. 8 (4) , 2015. Article Number:
e002283. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Patients with ST-segment-elevation myocardial infarction are
at increased risk of cerebrovascular events. We assessed the incidence,
predictors, and implications of cerebrovascular events in patients with
ST-segment-elevation myocardial infarction managed with a primary
percutaneous coronary intervention strategy. Methods and Results - In the
Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial
Infarction (HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at
least 1 cerebrovascular event (stroke: 63 patients; transient ischemic
attack: 12 patients) during the 3-year follow-up (40.3% within 30 days,
20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke
was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients.
More than half of all strokes (52.3%) were disabling. By principal
management strategy, cerebrovascular events developed in 2.0%, 14.9%, and
1.9% of patients triaged to primary percutaneous coronary intervention,
coronary artery bypass grafting, and medical therapy, respectively
(P<0.0001). Cerebrovascular events were independently predicted by older
age, creatinine clearance <60 mL/min, treatment with coronary artery
bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events
were associated with significantly increased rates of 3-year mortality
(20.5% versus 6.5%; P<0.0001), as well as reinfarction (14.3% versus 3.8%;
P=0.0007), ischemia-driven target vessel revascularization (22.8% versus
13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001).
Conclusions - In HORIZONS-AMI, cerebrovascular events within 3 years after
ST-segment-elevation myocardial infarction in patients undergoing a
primary percutaneous coronary intervention management strategy occurred in
2.0% of patients and were most frequent after coronary artery bypass
grafting. Cerebrovascular events were often disabling and were strongly
associated with high rates of death, reinfarction, recurrent ischemia, and
major bleeding. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

<16>
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Accession Number
2015212688
Authors
Piccolo R. Stefanini G.G. Franzone A. Spitzer E. Blochlinger S. Heg D.
Juni P. Windecker S.
Institution
(Piccolo, Stefanini, Franzone, Spitzer, Blochlinger, Windecker) Department
of Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Heg, Juni, Windecker) Clinical Trials Unit, University of Bern, Bern,
Switzerland
(Heg) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
(Juni) Institute of Primary Health Care (BIHAM), University of Bern, Bern,
Switzerland
Title
Safety and Efficacy of Resolute Zotarolimus-Eluting Stents Compared with
Everolimus-Eluting Stents.
Source
Circulation: Cardiovascular Interventions. 8 (4) , 2015. Article Number:
e002223. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Although new-generation drug-eluting stents represent the
standard of care among patients undergoing percutaneous coronary
intervention, there remains debate about differences in efficacy and the
risk of stent thrombosis between the Resolute zotarolimus-eluting stent
(R-ZES) and the everolimus-eluting stent (EES). The aim of this study was
to evaluate the safety and efficacy of the R-ZES compared with EES in
patients undergoing percutaneous coronary intervention. Methods and
Results - A systematic literature search of electronic resources was
performed using specific search terms until September 2014. Random-effects
meta-analysis was performed comparing clinical outcomes between patients
treated with R-ZES and EES up to maximum available follow-up. The primary
efficacy end point was target-vessel revascularization. The primary safety
end point was definite or probable stent thrombosis. Secondary safety end
points were cardiac death and target-vessel myocardial infarction. Five
trials were identified, including a total of 9899 patients. Compared with
EES, R-ZES had similar risks of target-vessel revascularization (risk
ratio [RR], 1.06; 95% confidence interval [CI], 0.90-1.24; P=0.50),
definite or probable stent thrombosis (RR, 1.26; 95% CI, 0.86-1.85;
P=0.24), cardiac death (RR, 1.01; 95% CI, 0.79-1.30; P=0.91), and
target-vessel myocardial infarction (RR, 1.10; 95% CI, 0.89-1.36; P=0.39).
Moreover, R-ZES and EES had similar risks of late definite or probable
very late stent thrombosis (RR, 1.06; 95% CI, 0.53-2.11; P=0.87). No
evidence of significant heterogeneity was observed across trials.
Conclusions - R-ZES and EES provide similar safety and efficacy among
patients undergoing percutaneous coronary intervention.

<17>
Accession Number
2015000431
Authors
Bikmoradi A. Seifi Z. Poorolajal J. Araghchian M. Safiaryan R. Oshvandi K.
Institution
(Bikmoradi) Chronic Diseases (Home Care) Research Center of Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Seifi, Oshvandi) Department of Medical-Surgical Nursing, School of
Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan,
Iran, Islamic Republic of
(Poorolajal) Modeling of Noncommunicable Diseases Research Center,
Department of Epidemiology and Biostatistics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Araghchian) Department of Pharmacology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Safiaryan) Department of Heart Surgery, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Effect of inhalation aromatherapy with lavender essential oil on stress
and vital signs in patients undergoing coronary artery bypass surgery: A
single-blinded randomized clinical trial.
Source
Complementary Therapies in Medicine. 23 (3) (pp 331-338), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Churchill Livingstone
Abstract
Objectives: At present, aromatherapy is used widely in medical research.
This study aimed to investigate the effects of inhalation aromatherapy
using lavender essential oil to reduce mental stress and improve the vital
signs of patients after coronary artery bypass surgery (CABG). Design: A
single-blinded randomized controlled trial was conducted with 60 patients
who had undergone CABG in a 2-day intervention that targeted stress
reduction. Participants: Sixty subjects following coronary artery bypass
surgery in two aromatherapy and control groups. Setting: The study was
conducted in Ekbatan Therapeutic and Educational Center, Hamadan, Iran, in
2013. Interventions: On the second and third days after surgery, the
aromatherapy group patients received two drops of 2% lavender essential
oil for 20 min and the control group received two drops of distilled water
as a placebo. Main outcome measures: The primary outcome was mental
stress, which was measured before and after the intervention using the
DASS-21 questionnaire. The secondary outcomes were vital signs, including
the heart rate, respiratory rate, and systolic and diastolic blood
pressure, which were measured before and after the intervention. Results:
The individual characteristics of the aromatherapy and control groups were
the same. There were no significant difference in the mean mental stress
scores and vital signs of the aromatherapy and control groups on the
second or third days after surgery. Conclusion: Inhalation aromatherapy
with lavender essential oil had no significant effects on mental stress
and vital signs in patients following CABG, except the systolic blood
pressure.

<18>
Accession Number
2015903115
Authors
Cooke M. Rapchuk I. Doi S.A. Spooner A. Wendt T. Best J. Edwards M.
O'Connell L. McCabe D. McDonald J. Fraser J. Rickard C.
Institution
(Cooke, Rickard) NHMRC Centre for Research Excellence in Nursing
Interventions, Menzies Health Institute Queensland, Centre for Health
Practice Innovation, Australia
(Rapchuk) Department of Anaesthesia and Perfusion, Critical Care Research
Group, The Prince Charles Hospital, Australia
(Doi) Research School of Population Health, Australian National
University, Australia
(Spooner, Wendt, Best, Edwards, O'Connell, McCabe) Critical Care Research
Group, Adult Intensive Care Services, The Prince Charles Hospital,
Australia
(McDonald) Microbiology and Immunology Research Group, Griffith
University, Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital,
University of Queensland, Australia
Title
Wrist acupressure for post-operative nausea and vomiting (WrAP): A pilot
study.
Source
Complementary Therapies in Medicine. 23 (3) (pp 372-380), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Churchill Livingstone
Abstract
Post-operative nausea and vomiting are undesirable complications following
anaesthesia and surgery. It is thought that acupressure might prevent
nausea and vomiting through an alteration in endorphins and serotonin
levels. In this two-group, parallel, superiority, randomised control pilot
trial we aimed to test pre-defined feasibility outcomes and provide
preliminary evidence for the efficacy of PC 6 acupoint stimulation vs.
placebo for reducing post-operative nausea and vomiting in cardiac surgery
patients. Eighty patients were randomly assigned to either an intervention
PC 6 acupoint stimulation via beaded intervention wristbands group (n =
38) or placebo sham wristband group (n = 42). The main outcome was
assessment of pre-defined feasibility criteria with secondary outcomes for
nausea, vomiting, rescue anti-emetic therapy, quality of recovery and
adverse events. Findings suggest that a large placebo-controlled
randomised controlled trial to test the efficacy of PC 6 stimulation on
PONV in the post-cardiac surgery population is feasible and justified
given the preliminary clinically significant reduction in vomiting in the
intervention group in this pilot. The intervention was tolerated well by
participants and if wrist acupressure of PC 6 acupoint is proven effective
in a large trial it is a simple non-invasive intervention that could
easily be incorporated into practice.

<19>
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Accession Number
2015207610
Authors
Murphy G.S. Szokol J.W. Avram M.J. Greenberg S.B. Marymont J.H. Shear T.
Parikh K.N. Patel S.S. Gupta D.K.
Institution
(Murphy, Szokol, Greenberg, Marymont, Shear, Parikh, Patel) Department of
Anesthesiology, North-Shore University HealthSystem, Pritzker School of
Medicine, University of Chicago, 2650 Ridge Ave., Chicago, IL 60201,
United States
(Avram, Gupta) Department of Anesthesiology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Title
Intraoperative Methadone for the Prevention of Postoperative Pain: A
Randomized, Double-blinded Clinical Trial in Cardiac Surgical Patients.
Source
Anesthesiology. 122 (5) (pp 1112-1122), 2015. Date of Publication: 20 May
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The intensity of pain after cardiac surgery is often
underestimated, and inadequate pain control may be associated with poorer
quality of recovery. The aim of this investigation was to examine the
effect of intraoperative methadone on postoperative analgesic
requirements, pain scores, patient satisfaction, and clinical recovery.
Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass
(n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12
mug/kg) intraoperatively. Postoperative analgesic requirements were
recorded. Patients were assessed for pain at rest and with coughing 15 min
and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were
also evaluated for level of sedation, nausea, vomiting, itching,
hypoventilation, and hypoxia at these times. Results: Postoperative
morphine requirements during the first 24 h were reduced from a median of
10 mg in the fentanyl group to 6 mg in the methadone group (median
difference [99% CI],-4 [-8 to-2] mg; P < 0.001). Reductions in pain scores
with coughing were observed during the first 24 h after extubation; the
level of pain with coughing at 12 h was reduced from a median of 6 in the
fentanyl group to 4 in the methadone group (-2 [-3 to-1]; P < 0.001).
Improvements in patient-perceived quality of pain management were
described in the methadone group. The incidence of opioid-related adverse
events was not increased in patients administered methadone. Conclusions:
Intraoperative methadone administration resulted in reduced postoperative
morphine requirements, improved pain scores, and enhanced
patient-perceived quality of pain management.

<20>
[Use Link to view the full text]
Accession Number
2015206007
Authors
Saager L. Duncan A.E. Yared J.-P. Hesler B.D. You J. Deogaonkar A. Sessler
D.I. Kurz A.
Institution
(Saager, Duncan, Yared, Hesler, You, Sessler, Kurz) Department of Outcomes
Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, OH 44195,
United States
(Duncan, Yared) Department of Cardiothoracic Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
(You) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Deogaonkar) Department of Regional Practice Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Kurz) Department of General Anesthesiology, Cleveland Clinic, Cleveland,
OH, United States
Title
Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia
Increases Delirium after Cardiac Surgery.
Source
Anesthesiology. 122 (6) (pp 1214-1223), 2015. Date of Publication: 20 Jun
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative delirium is common in patients recovering from
cardiac surgery. Tight glucose control has been shown to reduce mortality
and morbidity. Therefore, the authors sought to determine the effect of
tight intraoperative glucose control using a
hyperinsulinemic-normoglycemic clamp approach on postoperative delirium in
patients undergoing cardiac surgery. Methods: The authors enrolled 198
adult patients having cardiac surgery in this randomized, double-blind,
single-center trial. Patients were randomly assigned to either tight
intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp
(target blood glucose, 80 to 110 mg/dl) or standard therapy (conventional
insulin administration with blood glucose target, <150 mg/dl). Delirium
was assessed using a comprehensive delirium battery. The authors
considered patients to have experienced postoperative delirium when
Confusion Assessment Method testing was positive at any assessment. A
positive Confusion Assessment Method was defined by the presence of
features 1 (acute onset and fluctuating course) and 2 (inattention) and
either 3 (disorganized thinking) or 4 (altered consciousness). Results:
Patients randomized to tight glucose control were more likely to be
diagnosed as being delirious than those assigned to routine glucose
control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to
3.37; P = 0.03), after adjusting for preoperative usage of calcium channel
blocker and American Society of Anesthesiologist physical status. Delirium
severity, among patients with delirium, was comparable with each glucose
management strategy. Conclusion: Intraoperative
hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac
surgery, but not its severity.

<21>
[Use Link to view the full text]
Accession Number
2015205641
Authors
Mahler S.A. Riley R.F. Hiestand B.C. Russell G.B. Hoekstra J.W. Lefebvre
C.W. Nicks B.A. Cline D.M. Askew K.L. Elliott S.B. Herrington D.M. Burke
G.L. Miller C.D.
Institution
(Mahler, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Elliott,
Miller) Department of Emergency Medicine, Wake Forest School of Medicine,
Medical Center Boulevard, Winston-Salem, NC 27157, United States
(Riley, Herrington) Division of Cardiology, Department of Internal
Medicine, United States
(Russell) Department of Biostatistical Sciences, United States
(Burke) Division of Public Health Sciences, Public Health Sciences, Wake
Forest School of Medicine, Winston-Salem, NC, United States
Title
The HEART Pathway Randomized Trial: Identifying Emergency Department
Patients with Acute Chest Pain for Early Discharge.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (2) (pp 195-203),
2015. Date of Publication: 21 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The HEART Pathway is a decision aid designed to identify emergency
department patients with acute chest pain for early discharge. No
randomized trials have compared the HEART Pathway with usual care. Methods
and Results-Adult emergency department patients with symptoms related to
acute coronary syndrome without ST-elevation on ECG (n=282) were
randomized to the HEART Pathway or usual care. In the HEART Pathway arm,
emergency department providers used the HEART score, a validated decision
aid, and troponin measures at 0 and 3 hours to identify patients for early
discharge. Usual care was based on American College of Cardiology/American
Heart Association guidelines. The primary outcome, objective cardiac
testing (stress testing or angiography), and secondary outcomes, index
length of stay, early discharge, and major adverse cardiac events (death,
myocardial infarction, or coronary revascularization), were assessed at 30
days by phone interview and record review. Participants had a mean age of
53 years, 16% had previous myocardial infarction, and 6% (95% confidence
interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of
randomization. Compared with usual care, use of the HEART Pathway
decreased objective cardiac testing at 30 days by 12.1% (68.8% versus
56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours;
P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%;
P<0.001). No patients identified for early discharge had major adverse
cardiac events within 30 days. Conclusions-The HEART Pathway reduces
objective cardiac testing during 30 days, shortens length of stay, and
increases early discharges. These important efficiency gains occurred
without any patients identified for early discharge suffering MACE at 30
days.

<22>
Accession Number
2015079690
Authors
Bonello L. Laine M. Cluzel M. Frere C. Mancini J. Hasan A. Thuny F.
Gaubert M. Guieu R. Dignat-George F. Michelet P. Paganelli F. Kerbaul F.
Institution
(Bonello, Laine, Cluzel, Thuny, Gaubert, Paganelli) Centre Hospitalier
Universitaire de Marseille, Hopital NORD, Aix-Marseille Universite,
Marseille, France
(Bonello, Frere, Dignat-George) Vascular Research Center of Marseille,
INSERM UMR-S 1076, Aix-Marseille Universite, Marseille, France
(Mancini) Faculte de Medecine de Marseille, INSERM, Aix-Marseille
Universite, Marseille, France
(Guieu, Michelet, Kerbaul) UMR MD2, Aix-Marseille Universite, Marseille,
France
(Mancini) BiosTIC, Hopital de la Timone, Hopitaux de Marseille, Marseille,
France
(Dignat-George) Laboratoire d'Hematologie et de Biologie Vasculaire,
Centre Hospitalo-Universitaire de la Conception, Hopitaux de Marseille,
Marseille, France
(Michelet) Service d'Accueil des Urgences Hopital Timone, Marseille,
France
(Kerbaul) Pole RUSH, Hopitaux de Marseille, Marseille, France
(Hasan) Service de Cardiologie, Hopital de Martigues, Martigues, France
(Guieu) Laboratory of Biochemistry, Timone University Hospital, Marseille,
France
Title
Comparison of Ticagrelor Versus Prasugrel to Prevent Periprocedural
Myonecrosis in Acute Coronary Syndromes.
Source
American Journal of Cardiology. 116 (3) (pp 339-343), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Inc.
Abstract
Guidelines recommend a ticagrelor loading dose (LD) before PCI or a
prasugrel LD at the time of percutaneous coronary intervention (PCI) in
intermediate and high-risk non-ST-elevation acute coronary syndrome
(NSTE-ACS). However, achieving an optimal PR inhibition at the time of PCI
is critical to prevent adverse events and depends on the timing of LD
intake in relation to PCI. We aimed to compare the rate of myonecrosis
related to PCI in patients with NSTE-ACS receiving ticagrelor pretreatment
versus prasugrel at the time of intervention. We prospectively randomized
213 patients with NSTE-ACS to a 180 mg of ticagrelor LD given as soon as
possible after admission and before PCI or to a 60 mg LD of prasugrel
given at the time of PCI. The primary end point was the rate of
periprocedural myonecrosis as defined by an increase of >5 times the
ninety-ninth percentiles in troponin-negative patients or a 20% increase
in troponin-positive patients. The 2 groups were similar regarding
baseline characteristics including clinical setting (p = 0.2). Procedural
characteristics were also identical including the number of treated
vessels and stenting procedures. Patients in the prasugrel group more
often required emergent PCI (p = 0.001). Patients in the ticagrelor group
had less periprocedural myonecrosis compared with those in the prasugrel
group (19.8% vs 38.3%; p = 0.03). The rate of major adverse cardiovascular
events and Bleeding Academic Research Consortium >2 at 1-month follow-up
was low and similar between the 2 groups. In conclusion, a ticagrelor LD
as soon as possible before PCI is superior to prasugrel at the time of PCI
to prevent periprocedural myonecrosis in NSTE-ACS.

<23>
Accession Number
2015995643
Authors
Tam D.Y. Jones P.M. Kiaii B. Diamantouros P. Teefy P. Bainbridge D.
Cleland A. Fernandes P. Chu M.W.A.
Institution
(Tam) Division of Cardiac Surgery, Department of Surgery, University of
Toronto, Toronto, ON, Canada
(Jones, Bainbridge) Department of Anesthesia & Perioperative Medicine,
Western University, Toronto, ON, Canada
(Kiaii, Chu) Division of Cardiac Surgery, Department of Surgery, Western
University, B6 - 106 University Hospital, LHSC, 339 Windermere Road,
London, ON N6A 5A5, Canada
(Diamantouros, Teefy) Division of Cardiology, Department of Medicine,
Western University, London, ON, Canada
(Cleland, Fernandes) Clinical Perfusion Services, London Health Sciences
Centre, London, ON, Canada
(Jones) Department of Epidemiology & Biostatistics, Western University,
London, ON, Canada
Title
Salvaging catastrophe in transcatheter aortic valve implantation:
rehearsal, preassigned roles, and emergency preparedness.
Source
Canadian Journal of Anesthesia. 62 (8) (pp 918-926), 2015. Date of
Publication: 29 Apr 2015.
Publisher
Springer New York LLC
Abstract
Purpose: Emergency rescue plans for acute complications during
transcatheter aortic valve implantation (TAVI) commonly include
cardiopulmonary resuscitation, femoro-femoral cardiopulmonary bypass
(CPB), and hemodynamic stabilization before definitive intervention is
achieved. Nevertheless, most cases of emergency resuscitation remain
chaotic and disorganized and often take longer than necessary, even in
experienced centres. We sought to determine which factors and procedures
may be associated with improved patient outcomes when emergencies arise
during TAVI. Sources: MEDLINE and EMBASETM were searched with
the following key words: "TAVI" or "TAVR" or "transcatheter valve
implantation" or "transcatheter valve replacement" and "emergency cardiac
surgery" or "conversion". Two hundred seventeen articles met the criteria
and were reviewed. Principal findings: Utilization of a formal emergency
checklist by a multidisciplinary TAVI team may reduce procedural errors,
smooth the transition to CPB, and ultimately speed the delivery of
corrective measures including emergency cardiac surgery. Conclusion: A
well-organized regularly-rehearsed emergency rescue plan that preassigns
resuscitative roles may shorten the duration of patient instability and
resuscitation and improve patient outcomes when catastrophe occurs in
TAVI. The anesthesia team plays a central role in preventing, detecting,
and treating intraprocedural complications during TAVI.

<24>
Accession Number
2015904763
Authors
Sasse M. Dziuba F. Jack T. Koditz H. Kaussen T. Bertram H. Beerbaum P.
Boehne M.
Institution
(Sasse, Dziuba, Jack, Koditz, Kaussen, Bertram, Beerbaum, Boehne)
Department of Pediatric Cardiology and Intensive Care Medicine, Hannover
Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, Germany
Title
In-line Filtration Decreases Systemic Inflammatory Response Syndrome,
Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care
Patients.
Source
Pediatric Cardiology. 36 (6) (pp 1270-1278), 2015. Date of Publication: 07
Apr 2015.
Publisher
Springer New York LLC
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to
systemic inflammatory response syndrome (SIRS) with concomitant organ
malfunction. Infused particles may exacerbate inflammatory syndromes since
they activate the coagulation cascade and alter inflammatory response or
microvascular perfusion. In a randomized, controlled, prospective trial,
we have previously shown that particle-retentive in-line filtration
prevented major complications in critically ill children. Now, we
investigated the effect of in-line filtration on major complications in
the subgroup of cardiac patients. Children admitted to tertiary pediatric
intensive care unit were randomized to either control or filter group
obtaining in-line filtration throughout complete infusion therapy. Risk
differences and 95 % confidence intervals (CI) of several complications
such as SIRS, sepsis, mortality, various organ failure and dysfunction
were compared between both groups using the Wald method. 305 children (n =
150 control, n = 155 filter group) with cardiac diseases were finally
analyzed. The majority was admitted after cardiac surgery with CPB. Risk
of SIRS (-11.3 %; 95 % CI -21.8 to -0.5 %), renal (-10.0 %; 95 % CI -17.0
to -3.0 %) and hematologic (-8.1 %; 95 % CI -14.2 to -0.2 %) dysfunction
were significantly decreased within the filter group. No risk differences
were demonstrated for occurrence of sepsis, any other organ failure or
dysfunctions between both groups. Infused particles might aggravate a
systemic hypercoagulability and inflammation with subsequent organ
malfunction in pediatric cardiac intensive care patients.
Particle-retentive in-line filtration might be effective in preventing
SIRS and maintaining renal and hematologic function. In-line filtration
offers a novel therapeutic option to decrease morbidity in cardiac
intensive care.

<25>
[Use Link to view the full text]
Accession Number
2014970720
Authors
Emery R.W. Solien E. Klima U.
Institution
(Emery) St. Josephs Hospital, St. Paul, MN, United States
(Solien) Kips Bay Medical Inc., Minneapolis, MN, United States
(Klima) Burjeel Hospital Abu Dhabi, Abu Dhabi, United Arab Emirates
Title
Clinical Evaluation of the eSVS Mesh: First-In-Man Trial Outcomes.
Source
ASAIO Journal. 61 (2) (pp 178-183), 2015. Date of Publication: 21 Jul
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
In coronary artery bypass graft surgery, saphenous vein graft (SVG)
patency is much lower than that of the internal mammary artery (IMA). To
address this problem, an external support device, the eSVS Mesh was
developed. A prospective randomized First-in-Man feasibility trial was
conducted in 90 patients after institutional ethics committee approval at
seven international centers. The left IMA was used to bypass the anterior
descending artery. A mesh-supported (treated) saphenous vein was
randomized to either the right or the circumflex coronary system, and an
unsupported (control) vein was grafted to the opposing territory. Device
diameters available for use were 3.0, 3.5, 4.0, and 4.5 mm. Primary
end-points were 30 day adverse cardiac and cerebral events and
angiographic patency at 9-12 months. Eighty-five of 90 patients returned
for 30 day clinical follow-up (94%). Five patients refused to return, but
by telephone contacts were asymptomatic. There was one late noncardiac
death and 73 patients returned for angiography (82%), thus 12 additional
patients were lost to follow-up at 1 year. Overall patency rate was 49%
for the treated versus 81% for controls (p < 0.001). Subset analysis
revealed significantly lower patency at one center and with use of the 3.0
mm device (p < 0.05). Removing these data, patency was 72% vs. 81% (p =
NS). Sternal wound infection was higher than expected at 5.0%, but this
was center specific. The eSVS Mesh is safe, but at up to 1 year, patency
is equivalent to untreated vein grafts after removal of outlying data.
This study provides insight into operative events and parameters that may
optimize outcomes and point to potential improvements in the external SVG
support device. Furthermore, longer term studies are pending.

<26>
[Use Link to view the full text]
Accession Number
2015209060
Authors
Helmerhorst H.J.F. Roos-Blom M.-J. Van Westerloo D.J. De Jonge E.
Institution
(Helmerhorst, Van Westerloo, De Jonge) Department of Intensive Care
Medicine, Leiden University Medical Center, Leiden, Netherlands
(Helmerhorst) Laboratory of Experimental Intensive Care and
Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
(Roos-Blom) Department of Medical Informatics, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Association between arterial hyperoxia and outcome in subsets of critical
illness: A systematic review, meta-analysis, and meta-regression of cohort
studies.
Source
Critical Care Medicine. 43 (7) (pp 1508-1519), 2015. Date of Publication:
21 Jul 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Oxygen is vital during critical illness, but hyperoxia may harm
patients. Our aim was to systematically evaluate the methodology and
findings of cohort studies investigating the effects of hyperoxia in
critically ill adults. Data Source: A meta-analysis and meta-regression
analysis of cohort studies published between 2008 and 2015 was conducted.
Electronic databases of MEDLINE, EMBASE, and Web of Science were
systematically searched for the keywords hyperoxia and mortality or
outcome. Study Selection: Publications assessing the effect of arterial
hyperoxia on outcome in critically ill adults (> 18 yr) admitted to
critical care units were eligible. We excluded studies in patients with
chronic obstructive pulmonary disease, extracorporeal life support or
hyperbaric oxygen therapy, and animal studies. Due to a lack of data, no
studies dedicated to patients with acute lung injury, sepsis, shock, or
multiple trauma could be included. Data Extraction: Studies were included
independent of admission diagnosis and definition of hyperoxia. The
primary outcome measure was in-hospital mortality, and results were
stratified for relevant subgroups (cardiac arrest, traumatic brain injury,
stroke, post-cardiac surgery, and any mechanical ventilation). The effects
of arterial oxygenation on functional outcome, long-term mortality, and
discharge variables were studied as secondary outcomes. Data Synthesis:
Twenty-four studies were included of which five studies were only for a
subset of the analyses. Nineteen studies were pooled for meta-analyses and
showed that arterial hyperoxia during admission increases hospital
mortality: adjusted odds ratio, 1.21 (95% CI, 1.08-1.37) (p = 0.001).
Functional outcome measures were diverse and generally showed a more
favorable outcome for normoxia. Conclusions: In various subsets of
critically ill patients, arterial hyperoxia was associated with poor
hospital outcome. Considering the substantial heterogeneity of included
studies and the lack of a clinical definition, more evidence is needed to
provide optimal oxygen targets to critical care physicians.

<27>
Accession Number
2015208766
Authors
Badar A.A. Brunton A.P.T. Mahmood A.H. Dobbin S. Pozzi A. McMinn J.F.
Sinclair A.J.E. Gardner R.S. Petrie M.C. Curry P.A. Al-Attar N.H.K. Pettit
S.J.
Institution
(Badar, Brunton, Pozzi, Gardner, Petrie) University of Glasgow, Glasgow,
United Kingdom
(Badar, Gardner, Petrie, Curry, Al-Attar) Scottish National Advanced Heart
Failure Service, Golden Jubilee National Hospital, Glasgow, United Kingdom
(Mahmood) Division of Medicine, Southern General Hospital, Glasgow, United
Kingdom
(Dobbin) Division of Medicine, Hairmyres Hospital, Lanarkshire, United
Kingdom
(McMinn) Division of Cardiology, South Tyneside District Hospital, Tyne
and Wear, United Kingdom
(Sinclair) Division of Anesthesia, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Pettit) Division of Cardiology, Papworth Hospital, Cambridge, United
Kingdom
Title
The management of patients with aortic regurgitation and severe left
ventricular dysfunction: A systematic review.
Source
Expert Review of Cardiovascular Therapy. 13 (8) (pp 915-922), 2015. Date
of Publication: 01 Aug 2015.
Publisher
Taylor and Francis Ltd
Abstract
A systematic search of Medline, EMBASE and CINAHL electronic databases was
performed. Original research articles reporting all-cause mortality
following surgery in patients with aortic regurgitation and severe left
ventricular systolic dysfunction (LVSD) were identified. Nine of the 10
eligible studies were observational, single-center, retrospective
analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year
and 68 to 84% at 5 years. Three studies described an improvement in mean
left ventricular ejection fraction (LVEF) following aortic valve
replacement (AVR) of 5-14%; a fourth study reported an increase in mean
left ventricular ejection fraction (LVEF) of 9% in patients undergoing
isolated AVR but not when AVR was combined with coronary artery bypass
graft and/or mitral valve surgery. Three studies demonstrated improvements
in functional New York Heart Association (NYHA) class following AVR.
Additional studies are needed to clarify the benefits of AVR in patients
with more extreme degrees of left ventricular systolic dysfunction (LVSD)
and the potential roles of cardiac transplantation and transaortic valve
implantation.

<28>
[Use Link to view the full text]
Accession Number
2015208505
Authors
Stone G.W.
Institution
(Stone) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, New York-Presbyterian Hospital, United States
(Stone) Cardiovascular Research Foundation, 111 E 59th St, United States
Title
Left Main Revascularization: Reality Versus the Real World.
Source
Circulation: Cardiovascular Interventions. 8 (3) , 2015. Article Number:
e002380. Date of Publication: 21 Mar 2015.
Publisher
Lippincott Williams and Wilkins

<29>
Accession Number
2015208886
Authors
Gargiulo G. Tamburino C. Capodanno D.
Institution
(Gargiulo, Tamburino, Capodanno) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Italy
(Tamburino) Excellence Through Newest Advances (ETNA) Foundation, Catania,
Italy
Title
Five-year outcomes of percutaneous coronary intervention versus coronary
artery bypass graft surgery in patients with left main coronary artery
disease: An updated meta-analysis of randomized trials and adjusted
observational studies.
Source
International Journal of Cardiology. 195 (pp 79-81), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Elsevier Ireland Ltd

<30>
Accession Number
2015208552
Authors
Ahmad Y. Nijjer S. Cook C.M. El-Harasis M. Graby J. Petraco R. Kotecha T.
Baker C.S. Malik I.S. Bellamy M.F. Sethi A. Mikhail G.W. Al-Bustami M.
Khan M. Kaprielian R. Foale R.A. Mayet J. Davies J.E. Francis D.P. Sen S.
Institution
(Ahmad, Nijjer, Cook, El-Harasis, Graby, Petraco, Kotecha, Baker, Malik,
Bellamy, Sethi, Mikhail, Al-Bustami, Khan, Kaprielian, Foale, Mayet,
Davies, Francis, Sen) International Centre for Circulatory Health,
National Heart and Lung Institute, Imperial College London, 59-61 North
Wharf Road, London W2 1LA, United Kingdom
Title
A new method of applying randomised control study data to the individual
patient: A novel quantitative patient-centred approach to interpreting
composite end points.
Source
International Journal of Cardiology. 195 (pp 216-224), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background Modern randomised controlled trials typically use composite
endpoints. This is only valid if each endpoint is equally important to
patients but few trials document patient preference and seek the relative
importance of components of combined endpoints. If patients weigh
endpoints differentially, our interpretation of trial data needs to be
refined. Methods and results We derive a quantitative, structured tool to
determine the relative importance of each endpoint to patients. We then
apply this tool to data comparing angioplasty with drug-eluting stents to
bypass surgery. The survey was administered to patients undergoing cardiac
catheterisation. A meta-analysis comparing coronary artery bypass grafting
(CABG) to percutaneous coronary interventuin (PCI) was then performed
using (a) standard MACE and (b) patient-centred MACE. Patients considered
stroke worse than death (stroke 102.3 +/- 19.6%, p < 0.01), and MI and
repeat revascularisation less severe than death (61.9 +/- 26.8% and 41.9
+/- 25.4% respectively p < 0.01 for both). 7 RCTs (5251 patients) were
eligible. Meta-analysis demonstrated that standard MACE occurs more
frequently with PCI than surgery (OR 1.44; 95% CI 1.10 to 1.87; p =
0.007). Re-analysis using patient-centred MACE found no significant
difference between PCI and CABG (OR 1.22, 95% CI 0.97 to 1.53; p = 0.10).
Conclusions Patients do not consider the constituent endpoints of MACE
equal. We derive a novel patient-centred metric that recognises and
quantifies the differences attributed to each endpoint. When patient
preference data are applied to contemporary trial results, there is no
significant difference between PCI and CABG. Responses from individual
patients in clinic could be used to give individual patients a
recommendation that is truly personalised.

<31>
Accession Number
2015208223
Authors
Wohrle J. Gonska B. Rodewald C. Trepte U. Koch S. Scharnbeck D. Seeger J.
Markovic S. Rottbauer W.
Institution
(Wohrle, Gonska, Rodewald, Trepte, Koch, Scharnbeck, Seeger, Markovic,
Rottbauer) Dept. of Internal Medicine II - Cardiology, University of Ulm,
Ulm, Germany
Title
Transfemoral aortic valve implantation with the repositionable Lotus valve
compared with the balloon-expandable Edwards Sapien 3 valve.
Source
International Journal of Cardiology. 195 (pp 171-175), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The rate of paravalvular aortic insufficiency (AI) with
transcatheter aortic valve implantation (TAVI) with first generation
devices was higher compared with surgical replacement. Residual AI after
TAVI has been linked to an increased mortality rate. We compared two
second generation TAVI devices - the repositionable Lotus valve with the
balloon-expandable Edwards Sapien 3 valve - regarding procedural and 30
day outcome. Methods and results In 78 patients with severe aortic
stenosis undergoing transfemoral TAVI we evaluated post-procedural
paravalvular AI, device success and early safety according to VARC
criteria. Valve size was based on a 256-multislice computed tomography.
Patients were followed for 30 days. The Lotus valve (N = 26) and the
Edwards Sapien 3 valve (N = 52) were implanted under fluoroscopic
guidance. Baseline characteristics were similar between groups. Perimeter
derived annulus diameter did not differ with 25.7 +/- 1.6 mm for Lotus and
25.2 +/- 2.1 mm for Edwards Sapien 3 patients. After TAVI aortography and
transthoracic echocardiography revealed no moderate or severe AI. The rate
of mild AI was 12% for Lotus and 15% for Edwards Sapien 3 (p = 0.62).
There were no deaths, stroke, annulus rupture or coronary obstruction.
Device success was 96% and 98% (p = 0.61), early safety according to VARC
11.5% in both groups (p = 1.0) and the need for pacemaker implantation 27%
and 4% (p < 0.003), respectively. Conclusions TAVI with second-generation
devices was associated with no moderate or severe AI and a low rate of
mild AI. Device success was high for Lotus and Edwards Sapien 3 while the
need for permanent pacemaker was significantly higher with the Lotus
valve.

<32>
Accession Number
2015208176
Authors
Pijuan-Domenech A. Galian L. Goya M. Casellas M. Merced C.
Ferreira-Gonzalez I. Marsal-Mora J.R. Dos-Subira L. Subirana-Domenech M.T.
Pedrosa V. Baro-Marine F. Manrique S. Casaldaliga-Ferrer J. Tornos P.
Cabero L. Garcia-Dorado D.
Institution
(Pijuan-Domenech, Dos-Subira, Subirana-Domenech, Pedrosa,
Casaldaliga-Ferrer) Integrated Hospital Vall d'Hebron-Hospital Sant Pau
Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron,
Barcelona, Spain
(Goya, Casellas, Merced, Baro-Marine, Cabero) Department of Obstetrics and
Gynaecology, Maternal-Fetal Medicine Unit, University Hospital Vall
d'Hebron, Barcelona, Spain
(Pijuan-Domenech, Galian, Ferreira-Gonzalez, Marsal-Mora, Dos-Subira,
Pedrosa, Casaldaliga-Ferrer, Tornos, Garcia-Dorado) Department of
Cardiology, University Hospital valld'Hebron, Barcelona, Spain
(Subirana-Domenech) Department of Cardiology, University Hospital of Sant
Pau i la Santa Creu, Barcelona, Spain
(Manrique) Department of Anesthesiology, Hospital valld'Hebron, Barcelona,
Spain
Title
Cardiac complications during pregnancy are better predicted with the
modified WHO risk score.
Source
International Journal of Cardiology. 195 (pp 149-154), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objective Several risk scores (RSs) have been used to stratify
risk of cardiac complications (CCs) in pregnant patients with heart
disease. We aimed to compare and contrast the accuracy of several RSs for
predicting CC in this population. Methods Prospective inclusion of all
consecutive pregnant patients with heart disease, and follow-up until 6
months postpartum. CCs were defined as primary if admission was required
due to heart failure, arrhythmia or thromboembolic events, and secondary
if the decline in NYHA class compared with baseline was > 2 or urgent
invasive cardiac procedures were needed. The discriminatory power of each
RS was assessed by the area-under-the receiver-operating characteristic
(ROC) curve (AUC). Results 179 patients, mean age: 32 years, accounted for
13.4% of CC (primary 11.7%, secondary 1.7%); the main diagnosis was
congenital heart disease (CHD) in 68% followed by valvulopathies in 16%,
arrhythmia in 7% and myocardiopathies in 5%. 22% (n = 40) were classified
as mWHO = 1, 59% (n = 105) mWHO = 2 including subgroup 2-3, 14% (n = 26)
mWHO = 3 and 4%(n = 7) mWHO = 4; 1 patient was unclassifiable. mWHO showed
a better AUC (0.763) than CARPREG (0.67). For the CHD population, ZAHARA
RS showed an AUC of 0.74, and Khairy an AUC of 0.632. Conclusions mWHO was
better at predicting CC than CARPREG; mWHO was also better at predicting
CC than the specific CHD RS in the CHD subgroup. Practice There are an
increasing number of pregnant women with HD. Implications Improved
prediction of CC risk during pregnancy can provide better preconception
assessment in women with HD.

<33>
Accession Number
2015212230
Authors
Ardehali A. Esmailian F. Deng M. Soltesz E. Hsich E. Naka Y. Mancini D.
Camacho M. Zucker M. Leprince P. Padera R. Kobashigawa J.
Institution
(Ardehali, Deng) UCLA Medical Center, Division of Cardiac Surgery, Los
Angeles, CA 90049, United States
(Esmailian, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
(Soltesz, Hsich) Cleveland Clinic Foundation, Cleveland, OH, United States
(Naka, Mancini) Columbia University Medical Center, New York, NY, United
States
(Camacho, Zucker) St Barnabas Heart Center, Newark Beth Israel Medical
Center, Newark, NJ, United States
(Leprince) Hopital de la Pitie-Salpetriere, Paris, France
(Padera) Brigham and Women's Hospital, Boston, MA, United States
Title
Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED
II): A prospective, open-label, multicentre, randomised non-inferiority
trial.
Source
The Lancet. 385 (9987) (pp 2577-2584), 2015. Date of Publication: 27 Jun
2015.
Publisher
Lancet Publishing Group
Abstract
Background The Organ Care System is the only clinical platform for ex-vivo
perfusion of human donor hearts. The system preserves the donor heart in a
warm beating state during transport from the donor hospital to the
recipient hospital. We aimed to assess the clinical outcomes of the Organ
Care System compared with standard cold storage of human donor hearts for
transplantation. Methods We did this prospective, open-label, multicentre,
randomised non-inferiority trial at ten heart-transplant centres in the
USA and Europe. Eligible heart-transplant candidates (aged >18 years) were
randomly assigned (1:1) to receive donor hearts preserved with either the
Organ Care System or standard cold storage. Participants, investigators,
and medical staff were not masked to group assignment. The primary
endpoint was 30 day patient and graft survival, with a 10% non-inferiority
margin. We did analyses in the intention-to-treat, as-treated, and
per-protocol populations. This trial is registered with
ClinicalTrials.gov, number NCT00855712. Findings Between June 29, 2010,
and Sept 16, 2013, we randomly assigned 130 patients to the Organ Care
System group (n=67) or the standard cold storage group (n=63). 30 day
patient and graft survival rates were 94% (n=63) in the Organ Care System
group and 97% (n=61) in the standard cold storage group (difference 28%,
one-sided 95% upper confidence bound 88; p=045). Eight (13%) patients in
the Organ Care System group and nine (14%) patients in the standard cold
storage group had cardiac-related serious adverse events. Interpretation
Heart transplantation using donor hearts adequately preserved with the
Organ Care System or with standard cold storage yield similar short-term
clinical outcomes. The metabolic assessment capability of the Organ Care
System needs further study. Funding TransMedics.

<34>
[Use Link to view the full text]
Accession Number
2015206239
Authors
Jerath A. Beattie S.W. Chandy T. Karski J. Djaiani G. Rao V. Yau T.
Wasowicz M.
Institution
(Jerath, Beattie, Karski, Djaiani, Wasowicz) Department Anesthesia and
Pain Management, Toronto General Hospital, 200 Elizabeth St, Toronto, ON
M5G 2C4, Canada
(Chandy) Department Anesthesia and Pain Management, Christian Medical
College, Vellore, India
(Rao, Yau) Divison of Cardiac Surgery, Toronto General Hospital, Toronto,
ON, Canada
Title
Volatile-based short-term sedation in cardiac surgical patients: A
prospective randomized controlled trial.
Source
Critical Care Medicine. 43 (5) (pp 1062-1069), 2015. Date of Publication:
20 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To evaluate the differences in extubation times in a group of
cardiac surgical patients who were anesthetized and sedated with either IV
propofol or inhaled volatile anesthetic agents. Design: This was a
prospective randomized controlled trial performed between September 2009
and August 2011. Setting: Cardiovascular ICU within a tertiary referral
university-affiliated teaching hospital. Patients: One hundred forty-one
patients undergoing coronary artery bypass graft surgery with normal or
mildly reduced left ventricular systolic function. Intervention:
Participants were randomly assigned to receive anesthesia and
postoperative sedation using IV propofol (n = 74) or inhaled volatile
(isoflurane or sevoflurane) anesthetic agent (n = 67). Measurements and
Main Results: Patients sedated using inhaled volatile agent displayed
faster readiness to extubation time at 135 minutes (95-200 min) compared
with those receiving IV propofol at 215 minutes (150-280 min) (p < 0.001).
Extubation times were faster within the volatile group at 182 minutes
(140-255 min) in comparison with propofol group at 291 minutes (210-420
min) (p < 0.001). The volatile group showed a higher prevalence of
vasodilatation with hypotension and higher cardiac outputs necessitating
greater use of vasoconstrictors. There was no difference in postoperative
pain scores, opioid consumption, sedation score, ICU or hospital length of
stay, or patient mortality. Conclusions: Inhaled volatile anesthesia and
sedation facilitates faster extubation times in comparison with IV
propofol for patient undergoing coronary artery bypass graft surgery.

<35>
[Use Link to view the full text]
Accession Number
2015203950
Authors
Zhu F. Gomersall C.D. Ng S.K. Underwood M.J. Lee A.
Institution
(Zhu, Gomersall, Ng, Lee) Department of Anaesthesia and Intensive Care,
Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing
Street, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong
Title
A randomized controlled trial of adaptive support ventilation mode to wean
patients after fast-track cardiac valvular surgery.
Source
Anesthesiology. 122 (4) (pp 832-840), 2015. Date of Publication: 20 Apr
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Adaptive support ventilation can speed weaning after coronary
artery surgery compared with protocolized weaning using other modes. There
are no data to support this mode of weaning after cardiac valvular
surgery. Furthermore, control group weaning times have been long,
suggesting that the results may reflect control group protocols that delay
weaning rather than a real advantage of adaptive support ventilation.
Methods: Randomized (computer-generated sequence and sealed opaque
envelopes), parallel-arm, unblinded trial of adaptive support ventilation
versus physician-directed weaning after adult fast-track cardiac valvular
surgery. The primary outcome was duration of mechanical ventilation.
Patients aged 18 to 80 yr without significant renal, liver, or lung
disease or severe impairment of left ventricular function undergoing
uncomplicated elective valve surgery were eligible. Care was standardized,
except postoperative ventilation. In the adaptive support ventilation
group, target minute ventilation and inspired oxygen concentration were
adjusted according to blood gases. A spontaneous breathing trial was
carried out when the total inspiratory pressure of 15 cm H<inf>2</inf>O or
less with positive end-expiratory pressure of 5 cm H<inf>2</inf>O. In the
control group, the duty physician made all ventilatory decisions. Results:
Median duration of ventilation was statistically significantly shorter (P
= 0.013) in the adaptive support ventilation group (205 [141 to 295] min,
n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual
ventilator changes and alarms were less common in the adaptive support
ventilation group, and arterial blood gas estimations were more common.
Conclusion: Adaptive support ventilation reduces ventilation time by more
than 2 h in patients who have undergone fast-track cardiac valvular
surgery while reducing the number of manual ventilator changes and alarms.

<36>
Accession Number
71958303
Authors
Rees C. Sultani Z. Theologou T. Poon S. Field L.M. Kuduvalli M. Oo A.Y.
Fabri B.M.
Institution
(Rees, Sultani, Theologou, Poon, Field, Kuduvalli, Oo, Fabri) Department
of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool,
United Kingdom
Title
Prophylactic treatment of atrial fibrillation post coronary artery bypass
grafting. A randomised controlled trial of sotalol and magnesium versus
placebo.
Source
European Surgical Research. Conference: 50th Congress of the European
Society for Surgical Research Liverpool United Kingdom. Conference Start:
20150610 Conference End: 20150613. Conference Publication: (var.pagings).
55 (pp 89), 2015. Date of Publication: June 2015.
Publisher
S. Karger AG
Abstract
Background: Atrial fibrillation is a well known complication following
coronary surgery, carrying significant impact on patient morbidity and
duration of hospital stay. Objectives: In this study, we investigated the
efficacy of Sotalol and Magnesium used in combination for preventing
postoperative atrial fibrillation, and compared its effect on reducing
hospital morbidity and duration of hospital stay when compared to a
placebo group. Method: 158 patients treated with CABG were randomised in a
double blind randomiszed controlled trial into an intervention group
(Group A) or placebo group (Group B). Group A recieved 4g Magnesium IV
daily, together with Sotalol 80mg orally twice daily for 5 days and
continued with a reducing scheme of the Sotalol to 50mg twice daily for
the next 6 weeks. Group B received matching Sodium Chloride 0. 9% IV and
placebo tablets given in the same dosing regime as the intervention group.
All patients were continuously monitored in ITU, had daily ECG'S and
monitoring of their potassium and magnesium levels during hospital stay.
Results: Incidence of AF has been significantly reduced from 55. 76 % seen
in the placebo group (group B), to 20. 83% seen in those treated with
Sotalol and Magnesium sulphate p < 0. 001 (Group A). Length of hospital
stay was reduced in Group A in comparison of Group B by one and a half
days. Hospital morbidity was not significant between both groups.
Conclusion: Combination of Sotalol and Magnesium in the early
post-operative period is effective in reducing AF after coronary surgery
in selected population of patients.

<37>
Accession Number
71958130
Authors
Knipe M. Ahmad M. Kimptom J. Furnari A. Abdelnour A. Fok M. Bashir M.
Institution
(Knipe, Ahmad) School of Medicine, University of Liverpool, Cedar House,
Ashton Street, Liverpool L69 3GE, United Kingdom
(Kimptom, Furnari, Abdelnour, Fok, Bashir) Liverpool Heart and Chest
Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
Title
A systematic review of valve-sparing aortic root replacement compared to
composite replacement.
Source
European Surgical Research. Conference: 50th Congress of the European
Society for Surgical Research Liverpool United Kingdom. Conference Start:
20150610 Conference End: 20150613. Conference Publication: (var.pagings).
55 (pp 10), 2015. Date of Publication: June 2015.
Publisher
S. Karger AG
Abstract
Background: Aortic root dilation represents a potentially life threatening
cardiovascular disease. Composite root replacement was the original gold
standard for aortic root replacement surgery. Over the past two decades
however there has been a movement towards valve-sparing techniques
preserving the native aortic valve. This aims to avoid prosthetic valve
complications and maintain native valve haemodynamic benefits. Methods: A
systematic review was carried out on electronic databases to identify all
relevant papers. Articles were excluded if they contained less than 50
patients, or were entirely Marfan's or paediatric populations. Results: A
total of 13 comparative papers were identified encompassing 2123 patients
(656 valve-sparing and 1467 composite). Average age 57.3, male 67.3%, mean
follow-up time 4. 6 years, Marfans 10. 6%. Perioperative bleeding was
significantly higher in mechanical composite group compared to the
biological composite and valvesparing groups (9. 8% +/- 6. 4 vs 4. 4%
+/-6. 2 vs 3. 3% +/- 4. 2 respectively, p < 0. 01). In-hospital mortality
was low and non-significant between all groups. Only one study reported
long-term follow up. Reoperation rates were higher in the valve sparing
group compared to the composite group (6. 7% vs 2. 8%, p <0. 001 ).
Conclusions: Little difference was found in early post-operative outcomes
of the two techniques. Similar hospital mortality rates indicate similar
safety profiles. The only notable difference was the association of
mechanical composite valves with an increased post-operative bleeding
risk. Further research is needed to compare the long term outcomes to see
whether they diverge, particularly in terms of reoperation rates.

<38>
Accession Number
71956077
Authors
Bjornnes A.K. Lie I. Rustoen T. Stubhaug A. Leegaard M.
Institution
(Bjornnes, Rustoen) Oslo University Hospital, Department of Research and
Development, Division of Emergencies and Critical Care, Oslo, Norway
(Lie) Oslo University Hospital, Department of Cardiothoracic Surgery,
Oslo, Norway
(Stubhaug) Oslo University Hospital, Department of Pain Management and
Research, Oslo, Norway
(Leegaard) Oslo and Akershus University College, Institute of Nursing,
Oslo, Norway
Title
A RCT of the effectiveness of an intervention to enhance pain management
after discharge from cardiac surgery.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2015
Dubrovnik Croatia. Conference Start: 20150614 Conference End: 20150615.
Conference Publication: (var.pagings). 14 (pp 95-96), 2015. Date of
Publication: June 2015.
Publisher
SAGE Publications Inc.
Abstract
Purpose: Relevant discharge information about pain relief and use of
analgesic medication may help reduce postoperative pain and prevent
persistent pain after cardiac surgery. The purpose of this study was to
assess the effectiveness of an educational discharge intervention compared
to usual care on pain characteristics after cardiac surgery. Participants
description of barriers to pain management prior surgery will also be
described. Methods: Patients undergoing elective coronary artery bypass
grafting and/or valve surgery were consecutively enrolled in this
randomized controlled trial. Participants randomized to the intervention
group (n = 208) received an educational booklet at discharge from hospital
and the control group received usual care (n = 208). The primary outcome
was the Brief Pain Inventory- Short Form, and barriers to pain management
were assessed at baseline by using the Barriers to Management of Pain-
Short Form questionnaire, and data were collected at two weeks, one,
three, six and 12 months after surgery. General linear mixed models were
used to determine between group differences over time. The study conforms
with principles as outlined in the Declaration of Helsinki and was
approved by the institutional clinical research panel and the Regional
Committee for Medical Research Ethics, Health Region South-East, Norway.
Results: Exclusion included 67 (16 %) out of 416 participating patients
mainly due to complications related to surgery (n = 35) and no
statistically significant differences between control and intervention
groups were demonstrated at baseline in outcome variable data.No
statistically significant differences between the groups were observed in
the outcome measures following surgery. In total sample, two weeks after
surgery 84 % reported pain at rest and 40 % stated their worst pain to be
moderate/severe. Despite the pain decreased significantly over time, still
28 % reported pain at rest at 12 months and 8 % reported moderate/severe
worst pain. Approximately half of the sample holds incorrect beliefs about
pain and pain management. Conclusion: The intervention did not result in a
significant difference between control and intervention groups. Misbeliefs
about pain and pain management are common among the participants. The
study justify the need for educational interventions both to address the
patients' misbeliefs and to enhance pain management before and after
discharge from cardiac surgery. Further research is needed in finding the
most potent ways to educate the patients in pain management after cardiac
surgery.

<39>
Accession Number
71956065
Authors
Doyle L.
Institution
(Doyle) Trinity College Dublin, Specialist Nursing, Cardiovascular Care,
Dublin, Ireland
Title
A systematic review to enquire is Advanced Nurse Practitioner care more
effectivve for the cardiac surgery patient, compared to standard care.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare 2015
Dubrovnik Croatia. Conference Start: 20150614 Conference End: 20150615.
Conference Publication: (var.pagings). 14 (pp 90), 2015. Date of
Publication: June 2015.
Publisher
SAGE Publications Inc.
Abstract
Purpose: This systematic review was performed to answer the question; is
Advanced Nurse Practitioner (ANP) care more effective for the cardiac
surgery patient, compared to standard care? The objectives were firstly,
to compare care delivered by the ANP to physicians or other models of care
and secondly, to evaluate are there any added benefits to having an ANP in
the cardiac surgery setting. Methods: A comprehensive search was performed
and based on this, studies were methodically selected. Quality appraisal
was conducted using the Cochrane Collaboration Risk of Bias Tool. Data
were extracted using the modified Cochrane pregnancy and childbirth form,
then synthesised using Cochrane Revman software. Results: After an
extensive and thorough search, three randomised controlled trials (RCTs)
that met the inclusion criteria were found for the review. The three
Canadian studies were by Goldie et al. (2012), Sawatzky et al.(2013) and
Tranmer & Parry (2004). Of these, two had a high Risk of Bias and one had
a low Risk of Bias. The findings of this review show within areas that are
grounded in nursing such as education, preparedness for
intervention/discharge and perception of being well cared for, there were
statistically significant differences favouring the ANP. When comparing
ANP capabilities to physicians, looking at postoperative complications,
the care provided by ANPs was equal to that of the physician. There was no
statistical difference in Health Related Quality of Life, physical or
mental component between ANP care and standard care. There was no
statistically significant difference in participants' symptoms at one to
two weeks post-operatively or five to six weeks post-operatively. There
was also no statistically significant difference in hospital readmission
or length of stay in hospital between ANP care and standard care.
Conclusions: The ANP role has evolved to incorporate the therapeutic model
of medicine with the caring model of nursing. Evidence is emerging of the
effectiveness of the ANP care for the cardiac surgery patient, but there
is an ongoing need for it to be fully established. The endeavour remains,
to perform rigorous research including more good quality RCTs to offer
evidence of this effectiveness. From this systematic review the results
are positive. There are added benefits to having an ANP in the cardiac
surgery and the care delivered by the ANP is equivalent or better compared
to standard care. Therefore this systematic review concludes that ANP care
is effective for the cardiac surgery patient compared to standard care.