EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 33

Results Generated From:
Embase <1980 to 2015 Week 33>
Embase (updates since 2015-08-07)
Embase <1980 to 2015 Week 33>
Embase (updates since 2015-08-07)

<1>
Accession Number
2015248023
Authors
Agarwal S. Parashar A. Kumbhani D.J. Svensson L.G. Krishnaswamy A. Tuzcu
E.M. Kapadia S.R.
Institution
(Agarwal, Krishnaswamy, Tuzcu, Kapadia) Department of Cardiovascular
Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44195, United States
(Parashar) Department of Internal Medicine, Cleveland Clinic, Cleveland,
United States
(Svensson) Department of Cardiovascular Surgery, Cleveland Clinic, United
States
(Kumbhani) Interventional Cardiology, UT Southwestern Medical Center,
United States
Title
Comparative meta-analysis of balloon-expandable and self-expandable valves
for transcatheter aortic valve replacement.
Source
International Journal of Cardiology. 197 (pp 87-97), 2015. Article
Number: 20658. Date of Publication: 05 Aug 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Abstract Background Balloon-expandable valves (BEVs) and self-expandable
valves (SEVs) are two major types of valves utilized for transcatheter
aortic valve replacement (TAVR). We conducted a meta-analysis of available
studies to compare the safety and efficacy of these two valve types.
Methods Medline search was conducted using standard search terms to
determine eligible studies. Primary outcomes of the meta-analysis included
death and stroke at 30 days and 1 year. Pooled estimates of procedural
outcomes were also compared between the valve types. Analysis was
performed for entire cohort and separately for patients undergoing
transfemoral TAVR (TF-TAVR). Results Analysis of entire cohort revealed
similar 30-day mortality in the SEV and BEV cohorts. There was no
significant difference in the incidence of stroke at 30 days between the
two study groups. Both pooled comparisons demonstrated a significant
heterogeneity with I² > 50%, necessitating the use of random
effect modeling. We observed a significantly higher incidence of new
pacemaker implantation, aortic regurgitation > 2 + at 30 days, valve
embolization, and need for > 1 valve following SEV implantation compared
with BEV implantation. Analysis of TF-TAVR cohort showed higher 30 day
[IRR (95% CI): 1.34 (1.19-1.52)] but a similar 1-year mortality [IRR (95%
CI): 1.07 (0.96-1.19)] for SEV compared to BEV implantation. Conclusion
Compared to BEV implantation, SEV implantation was associated with a
similar risk of mortality and stroke at 30-day and 1-year follow-up
duration. Analysis of the TF-TAVR cohort revealed a significantly higher
mortality at 30 days among patients undergoing SEV implantation, compared
with BEV implantation. In addition, there was a significantly higher
incidence of other adverse events noted above, following SEV implantation,
compared with BEV implantation.

<2>
Accession Number
2015252710
Authors
Laine M. Gaubert M. Frere C. Peyrol M. Thuny F. Yvorra S. Chelini V.
Bultez B. Luigi S. Mokrani Z. Bessereau J. Toesca R. Champenois A.
Dignat-George F. Paganelli F. Bonello L.
Institution
(Laine, Gaubert, Peyrol, Thuny, Paganelli, Bonello) Service de
Cardiologie, Centre Hospitalo-Universitaire Nord, Assistance-Publique
Hopitaux de Marseille, Chemin des Bourrely, Marseille 13015, France
(Frere, Dignat-George) Service de Pharmacie, Hopital de la Conception,
Marseille, France
(Yvorra, Chelini) Service de Cardiologie, Centre Hospitalier de Martigues,
Martigues, France
(Bultez) Service DAccueil des Urgences, Hopital de Sisteron, Sisteron,
France
(Luigi) Service DAccueil des Urgences, Centre Hospitalier de Martigues,
Martigues, France
(Mokrani) Service DAccueil des Urgences, Centre Hospitalier de Salon de
Provence, Salon de Provence, France
(Bessereau, Toesca, Champenois) Service DAide Medical DUrgence, CHU
Marseille, Marseille, France
Title
COM parison of P latelet reactivity following pr A sugrel and ticagrelor
loading dose in S T- S egment elevation myocardial infarctI on patients:
The COMPASSION study.
Source
Platelets. 26 (6) (pp 570-572), 2015. Date of Publication: 18 Aug 2015.
Publisher
Taylor and Francis Ltd
Abstract
Prasugrel and ticagrelor are potent P2Y12-ADP receptor antagonists which
are superior to clopidogrel in acute coronary syndromes. To date no
clinical trial directly compared these two drugs. Platelet reactivity
correlates with ischemic and bleeding events in patients undergoing
percutaneous coronary intervention. Recent pharmacological studies have
observed a delayed onset of action of these two drugs in ST-segment
elevation myocardial infarction (STEMI). We provide the first adequately
powered pharmacological study comparing PR following ticagrelor and
prasugrel loading dose (LD) in STEMI patients when the maximal biological
effect is reached. In the present study, ticagrelor was associated with a
lower rate of high on-treatment PR compared to prasugrel.

<3>
Accession Number
2015253422
Authors
Qi W.-W. Liu T. Xu G. Li L.-F. Liang Y.-Z. Ye L. Li G.-P.
Institution
(Qi, Liu, Xu, Li, Liang, Ye, Li) Tianjin Key Laboratory of Ionic-Molecular
Function of Cardiovascular disease, Department of Cardiology, Tianjin
Institute of Cardiology, Second Hospital of Tianjin Medical University,
Tianjin 300211, China
Title
Upstream therapeutic strategies of Valsartan and Fluvastatin on
Hypertensive patients with non-permanent Atrial Fibrillation (VF-HT-AF):
Study protocol for a randomized controlled trial.
Source
Trials. 16 (1) , 2015. Article Number: 336. Date of Publication: August
07, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Previous studies regarding rhythm control in patients with
atrial fibrillation (AF) could not sufficiently demonstrate the efficacy
of available anti-arrhythmic drugs. 'Upstream therapy' has emerged as a
potential strategy for the prevention and treatment of AF. The use of
angiotensin II receptor blockers and statins has been suggested to
decrease new-onset AF, but which remains inadequately explored. This study
was designed to examine whether valsartan or fluvastatin can reduce the
risk of non-permanent AF in patients with hypertension. Methods/design:
The VF-HT-AF study is a multicenter, randomized, open-label, four-arm
parallel group study with comparative evaluation of valsartan and
fluvastatin as upstream therapies for the treatment of non-permanent AF
complicated by hypertension. The primary outcome measure is change in the
development of paroxysmal AF into persistent or permanent AF, the
development of persistent AF to permanent AF, and change in incidence of
overall and persistent AF recurrence, as evaluated by 7-days ambulatory
electrocardiograph monitoring (Holter) and patients' diaries during 2
years' follow-up. Secondary outcome measures of this study include the
occurrence of: (1) fatal and nonfatal myocardial infarction; (2) heart
failure (New York Heart Association stage III or IV); (3) cardiogenic
shock; (4) serious bleeding necessitating hospitalization; (5) malignant
ventricular arrhythmia; (6) revascularization therapy; (7) radiofrequency
catheter ablation of AF; (8) changes of left atrial dimension, as measured
by ultrasound echocardiography; (9) stroke; (10) cardiovascular mortality;
and (11) all-cause mortality. A total of 1879 patients will be
investigated from 15 medical centers throughout China to obtain the
relevant information. Discussion: This is the first study in hypertensive
patients complicated non-permanent AF in the Chinese population. Results
of this study will inform the use of upstream therapies of AF.

<4>
Accession Number
2015215423
Authors
Galipeau J. Pussegoda K. Stevens A. Brehaut J.C. Curran J. Forster A.J.
Tierney M. Kwok E.S.H. Worthington J.R. Campbell S.G. Moher D.
Institution
(Galipeau, Pussegoda, Stevens, Forster, Moher) Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Brehaut, Kwok) Faculty of Medicine, University of Ottawa, Ottawa, ON,
Canada
(Curran) IWK Health Centre, Halifax, NS, Canada
(Tierney, Worthington) Ottawa Hospital, Ottawa, ON, Canada
(Campbell) Queen Elizabeth II Health Science Centre, Halifax, NS, Canada
Title
Effectiveness and Safety of Short-stay Units in the Emergency Department:
A Systematic Review.
Source
Academic Emergency Medicine. 22 (8) (pp 893-907), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives Overcrowding is a serious and ongoing challenge in Canadian
hospital emergency departments (EDs) that has been shown to have negative
consequences for patient outcomes. The American College of Emergency
Physicians recommends observation/short-stay units as a possible solution
to alleviate this problem. However, the most recent systematic review
assessing short-stay units shows that there is limited synthesized
evidence to support this recommendation; it is over a decade old and has
important methodologic limitations. The aim of this study was to conduct a
more methodologically rigorous systematic review to update the evidence on
the effectiveness and safety of short-stay units, compared with usual
care, on hospital and patient outcomes. Methods A literature search was
conducted using MEDLINE, the Cochrane Library, Embase, ABI/INFOM, and
EconLit databases and gray literature sources. Randomized controlled
trials of ED short-stay units (stay of 72 hours or less) were compared
with usual care (i.e., not provided in a short-stay unit), for adult
patients. Risk-of-bias assessments were conducted. Important
decision-making (gradable) outcomes were patient outcomes, quality of
care, utilization of and access to services, resource use, health
system-related outcomes, economic outcomes, and adverse events. Results
Ten reports of five studies were included, all of which compared
short-stay units with inpatient care. Studies had small sample sizes and
were collectively at a moderate risk of bias. Most outcomes were only
reported by one study and the remaining outcomes were reported by two to
four studies. No deaths were reported. Three of the four included studies
reporting length of stay found a significant reduction among short-stay
unit patients, and one of the two studies reporting readmission rates
found a significantly lower rate for short-stay unit patients. All four
economic evaluations indicated that short-stay units were a cost-saving
intervention compared to inpatient care from both hospital and health care
system perspectives. Results were mixed for outcomes related to quality of
care and patient satisfaction. Conclusions Insufficient evidence exists to
make conclusions regarding the effectiveness and safety of short-stay
units, compared with inpatient care.

<5>
Accession Number
2015959346
Authors
Florkiewicz P. Musialowicz T. Pitkanen O. Lahtinen P.
Institution
(Florkiewicz, Musialowicz, Pitkanen, Lahtinen) Department of
Anesthesiology, Kuopio University Hospital, PL 100, Kuopio FI 70029,
Finland
Title
The effect of two different doses of remifentanil on postoperative pain
and opioid consumption after cardiac surgery - A randomized controlled
trial.
Source
Acta Anaesthesiologica Scandinavica. 59 (8) (pp 999-1008), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Blackwell Munksgaard
Abstract
Background Remifentanil, an ultra-short-acting opioid, provides intensive
analgesia without prolonged respiratory depression and is widely used in
cardiac surgery. Diminished dosing may also offer stable hemodynamics,
even during sternotomy and sternal retraction. However, increased
postoperative pain and induced opioid tolerance after remifentanil dosing
during abdominal surgery was reported. We tested whether remifentanil 0.3
mug/kg/min infusion increased postoperative opioid consumption and pain
compared to 0.1 mug/kg/min dosing. Methods Ninety coronary artery bypass
grafting or heart valve surgery patients were randomized to remifentanil
0.1 mug/kg/min or 0.3 mug/kg/min infusions during surgery. All patients
received oxycodone bolus 0.15 mug/kg postoperatively, and
patient-controlled analgesia (PCA) with oxycodone thereafter.
Postoperative pain was estimated thrice daily by visual analogue scale,
and 48-h opioid consumption was recorded from the PCA-device. Results
Total remifentanil dosing was 64 mug/kg in the higher and 22 mug/kg in the
lower dosing group during the 3-h cardiac operations. Mean postoperative
opioid consumption was 107 (SD 36) mg in the lower and 104 (SD 33) mg in
the higher dose remifentanil groups. Postoperative pain did not differ
between groups, at rest or during deep breathing, at any time (P = 0.110
and 0.941, respectively). Conclusions Remifentanil 0.3 mug/kg/min infusion
did not increase postoperative pain or opioid consumption after cardiac
surgery compared to the 0.1 mug/kg/min infusion. Remifentanil infusion
0.1-0.3 mug/kg/min during cardiac surgery was safe, with no exaggerated
postoperative pain or opioid consumption.

<6>
Accession Number
2015250235
Authors
Sarikaya S. Onk A. Boztosun B. Kocabay G. Sahin M. Fedakar A. Koksal C.
Institution
(Sarikaya, Onk, Fedakar, Koksal) Department of Cardiovascular Surgery,
Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital,
Kartal, Istanbul, Turkey
(Boztosun, Kocabay, Sahin) Department of Cardiology, Kartal Kosuyolu
Yuksek Ihtisas Heart Education and Research Hospital, Kartal, Istanbul
34846, Turkey
Title
The effect of nebivolol on internal mammary artery blood flow during
coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). 29 (4) (pp 315-320), 2014. Date of
Publication: 2014.
Publisher
SAGE Publications Ltd
Abstract
Background: During coronary artery bypass grafting (CABG), one of the most
important complications related to the internal mammary artery (IMA) is
perioperative spasm. Nebivolol causes endothelium-dependent vascular
relaxation by increasing nitric oxide (NO) release and prevents
endothelial dysfunction in long-term use. In our study, we measured the
effect of a third generation beta blocker, nebivolol, on the flow dynamics
of IMA grafts. Methods: We recruited 90 hypertensive patients undergoing
isolated CABG operation, who were divided into three groups and each group
included 30 patients: Group 1 patients were under antihypertensive
treatment other than betablockers (angiontensin-converting enzyme [ACE]
inhibitors, calcium channel blockers or diuretics; monotherapy or
combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3
received nebivolol (5 mg/day). These antihypertensive therapies were given
for at least one week before the operation and continued thereafter. IMA
blood flow volume was measured for one minute just before cardiopulmonary
bypass (measurement A) and before left internal mammary artery (LIMA)-left
anterior descending (LAD) artery anastomosis (measurement B) in the three
groups. Cardiac output measurements were also achieved simultaneously.
Results: The measurement A results were 56.3 +/- 36.2, 54.6 +/- 28.1 and
66.8 +/- 34.2 mL/min in Groups 1, 2 and 3, respectively (p<0.05). The
measurement B results were 78.3 +/- 29.6, 80 +/- 28.8 and 91.1 +/- 40.8
mL/min in Groups 1, 2 and 3 (p<0.05), respectively. There were no
differences in cardiac outputs among the groups; 5.2 +/- 1.4, 5.0 +/- 1.6
and 5.3 +/- 1.1 L/min (p>0.05). While the cardiac outputs were similar
within the three groups, the IMA free flow volume was higher in the
nebivolol group after local papaverine use. Conclusion: Nebivolol might
represent a good choice in hypertensive patients undergoing cardiac
surgery by preventing perioperative myocardial hypoperfusion which
increases early morbidity and mortality.

<7>
Accession Number
2015250059
Authors
Soykan E.A. Butzelaar L. De Kroon T.L. Beelen R.H.J. Ulrich M.M.W. Mink
Van Der Molen A.B. Niessen F.B.
Institution
(Soykan, Butzelaar, Ulrich, Niessen) Department of Plastic and
Reconstructive Surgery, VU University Medical Centre, Van der
Boechorststraat 7 P.O. Box 7057, Amsterdam 1007 MB, Netherlands
(De Kroon) Department of Cardio-Thoracic Surgery, Saint Antonius Hospital,
Nieuwegein, Netherlands
(Beelen) Department of Molecular Cell Biology and Immunology, VU
University Medical Centre, Amsterdam, Netherlands
(Ulrich) Association of Dutch Burn Centres, Beverwijk, Netherlands
(Mink Van Der Molen) Department of Plastic and Reconstructive Surgery,
Saint Antonius Hospital, Nieuwegein, Netherlands
Title
Minimal extracorporeal circulation (MECC) does not result in less
hypertrophic scar formation as compared to conventional extracorporeal
circulation (CECC) with dexamethasone.
Source
Perfusion (United Kingdom). 29 (3) (pp 249-259), 2014. Date of
Publication: 2014.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Cardiopulmonary bypass surgery is associated with a systemic
inflammatory response through the interaction of air, blood and synthetic
components in the bypass system and the physical trauma of surgery. An
alternative cardiopulmonary bypass system, minimal extracorporeal
circulation (MECC), has shown promising results in terms of reducing the
inflammatory response. We hypothesized that this system may reduce
pathological excessive scarring. To study this assumption, the effects of
MECC and the effects of conventional extracorporeal circulation (CECC)
with dexamethasone on skin scarring were compared in a standardized
wound-healing model. Methods and Results: Pre-sternal scars were evaluated
prospectively at four and 12 months postoperatively. The height and width
of the scars were measured, using a slide caliper and sonography. The
scars were scored using the validated Patient and Observer Scar Assessment
Scale. Additional risk factors for hypertrophic scar formation were
identified by means of a questionnaire. During surgery, MECC was used in
45 patients and CECC/dexamethasone in 42 patients. Four months
postoperatively, 22 patients of the MECC group (49%) and 18 patients in
the CECC/dexamethasone group (43%) had developed hypertrophic scars.
Twelve months postoperatively, the hypertrophic scars in four patients of
the MECC group and in two patients of the CECC/dexamethasone group had
become normotrophic. In 18 patients of the MECC group (38%) and 16
patients of the CECC group (41%) the scars remained hypertrophic at 12
months. These differences between the two groups were not statistically
significant. Conclusion: MECC does not reduce hypertrophic scar formation
compared with CECC with dexamethasone, but its use is more beneficial than
the use of CECC/dexamethasone because of the circulatory and immunological
advantages and because treatment with dexamethasone can be omitted

<8>
Accession Number
2015879393
Authors
Reuter P.-G. Rouchy C. Cattan S. Benamer H. Jullien T. Beruben A. Montely
J.-M. Assez N. Raphael V. Hennequin B. Boccara A. Javaud N. Soulat L.
Adnet F. Lapostolle F.
Institution
(Reuter, Adnet, Lapostolle) Service des Urgences et Service d'Aide
Medicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance
Publique-Hopitaux de Paris, 125 rue de Stalingrad, Bobigny Cedex 93009,
France
(Reuter, Adnet, Lapostolle) Universite Paris 13, Sorbonne Paris Cite,
Bobigny EA 3509, France
(Rouchy, Soulat) Service des Urgences et Service d'Aide Medicale Urgente,
Centre Hospitalier de Chateauroux, 216 Avenue de Verdun, Chateauroux
36000, France
(Cattan) Departement de Cardiologie, Groupe Hospitalier Intercommunal le
Raincy-Montfermeil, 10 Rue du General Leclerc, Montfermeil 93370, France
(Benamer) Departement de Cardiologie, Clinique la Roseraie, 120 Avenue de
la Republique, Aubervilliers 93300, France
(Jullien) Departement de Cardiologie, Centre Cardiologique du Nord, 36 Rue
des Moulins Gemeaux, Saint-Denis 93200, France
(Beruben) Service Mobile d'Urgence et de Reanimation, Groupe Hospitalier
Intercommunal le Raincy-Montfermeil, 10 Rue du General Leclerc,
Montfermeil 93370, France
(Montely) Departement de Cardiologie, Centre Hospitalier Intercommunal
Robert Ballanger, Boulevard Robert Ballanger, Aulnay-sous-Bois 93600,
France
(Assez) Service d'Aide Medicale Urgente du Nord Pole de l'Urgence, Centre
Hospitalier Regional Universitaire de Lille, 5 avenue Oscar-Lambret, Lille
Cedex 59037, France
(Raphael) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
Intercommunal Robert Ballanger, Boulevard Robert Ballanger,
Aulnay-sous-Bois 93600, France
(Hennequin) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
de Saint-Denis, 2 Rue du Docteur Delafontaine, Saint-Denis 93200, France
(Boccara) Departement de Cardiologie, Centre Hospitalier Intercommunal
Andre Gregoire, 56 Boulevard de la Boissiere, Montreuil 93100, France
(Javaud) Service des Urgences, Centre Hospitalier Universitaire Jean
Verdier, Assistance Publique-Hopitaux de Paris, Avenue du 14 Juillet,
Bondy 93140, France
Title
Early invasive strategy in high-risk acute coronary syndrome without
ST-segment elevation. The Sisca randomized trial.
Source
International Journal of Cardiology. 182 (pp 414-418), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The optimal therapeutic strategy for patients with high-risk
acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains
unclear. Objective Our aim was to compare the effectiveness of an early
invasive strategy and a delayed invasive strategy in the management of
high-risk NSTE-ACS patients. Methods This randomized clinical trial in a
primarily pre-hospital setting enrolled patients with chest pain,
electrocardiographic criteria for an NSTE-ACS, and at least one criterion
of severity (ESC criterion or TIMI score > 5). Patients were randomized to
either an early invasive strategy (tirofiban infusion and coronary
angiography within 6 h) or delayed invasive strategy (as per guidelines
and physician discretion; coronary angiography within 6 h was not
advised). The primary endpoint was the cumulative incidence of deaths,
myocardial infarctions, or urgent revascularizations at 30 days of
follow-up. Secondary endpoints were failure of delayed management, length
of hospital stay and long-term mortality. Results Between January 2007 and
February 2010, 170 patients were enrolled. The cumulative incidence of
adverse outcomes was significantly lower for early invasive than delayed
management (2% [95% CI 0-9] vs. 24% [95% CI 16-35], p < 10^{- 4}).
Delayed management failed in 24% of cases. The length of hospital stay was
significantly shorter in patients undergoing angioplasty or treated with
tirofiban within 6 h (p = 0.0003). Long-term mortality was 16% in both
arms after a median follow-up of 4.1 years. Conclusion An early invasive
strategy reduced major adverse cardiac events in patients with high-risk
NSTE-ACS. Early angiography or tirofiban (GP IIb/IIIa inhibitor) infusion
proved necessary in a quarter of patients assigned to delayed management.

<9>
Accession Number
2015879342
Authors
Lim J.Y. Deo S.V. Altarabsheh S.E. Cho Y.H. Shin E. Markowitz A.H.
Institution
(Lim, Shin) Asan Medical Center, Ulsan School of Medicine, Seoul, South
Korea
(Deo, Markowitz) University Hospitals, Case Medical Center, Cleveland, OH,
United States
(Altarabsheh) Queen Alia Heart Institute, Amman, Jordan
(Cho) Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul,
South Korea
Title
Off-pump coronary artery bypass grafting may prevent acute renal failure
in patients with non-dialysis dependent chronic renal dysfunction: An
aggregate meta-analysis.
Source
International Journal of Cardiology. 182 (pp 181-183), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier Ireland Ltd

<10>
Accession Number
2015251850
Authors
Etnel J.R.G. Takkenberg J.J.M. Spaans L.G. Bogers A.J.J.C. Helbing W.A.
Institution
(Etnel, Takkenberg, Spaans, Bogers) Department of Cardio-Thoracic Surgery,
Erasmus MC, Rotterdam, Netherlands
(Etnel, Spaans, Helbing) Department of Pediatrics, Division of Cardiology,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
Title
Paediatric subvalvular aortic stenosis: A systematic review and
meta-analysis of natural history and surgical outcome.
Source
European Journal of Cardio-thoracic Surgery. 48 (2) (pp 212-220), 2015.
Article Number: ezu423. Date of Publication: 01 Aug 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Sub-valvular aortic stenosis (SAS) is a common form of left ventricular
outflow tract (LVOT) obstruction, which can lead to aortic valve damage.
Although surgery for SAS is an accepted treatment, the timing of surgical
intervention of SAS remains controversial. This review aims to establish
an overview of the natural history and outcome after surgery and factors
associated with prognosis in paediatric SAS patients. We searched PubMed
and EMBASE for studies that reported factors that negatively affected the
prognosis of patients with SAS. Studies were included if they were written
in English, published between 1 January 1997 and 31 December 2012 and the
mean patient age was < 18 years at the time of study entry. Studies were
excluded if the study size was < 20 patients. A distinction was made
between natural history and surgical cohorts. Twenty-four studies were
included in this review, encompassing a total of 809 natural history and
1476 surgical patients. Fifty-one percent of natural history patients
required surgery. After surgery, there was a substantial reoperation rate.
Higher LVOT gradient and the presence of aortic regurgitation (AR) were
identified as the foremost independent predictors of a worse outcome.
Valve-to-membrane distance was also found to be associated with prognosis,
although the results were contradictory. This systematic review underlines
the importance of LVOT gradient, aortic valve-to-membrane distance and AR
in surgical decision-making in paediatric SAS patients. There is need for
collaborative effort to further study the optimal timing of surgery based
on LVOT gradient, valve-to-membrane distance and the presence of AR.

<11>
Accession Number
2015251849
Authors
Phan K. Xie A. Kumar N. Wong S. Medi C. La Meir M. Yan T.D.
Institution
(Phan, Xie, Yan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan) Westmead Hospital, Sydney Medical School, University of Sydney,
Sydney, Australia
(Kumar, La Meir) Department of Cardiothoracic Surgery and Cardiology,
Academic Hospital Maastricht, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(Wong) Gosford District Hospital, Gosford, Australia
(Medi, Yan) Department of Cardiology and Cardiothoracic Surgery, Royal
Prince Alfred Hospital, Sydney, Australia
(La Meir) University Hospital Brussels, Brussels, Belgium
Title
Comparing energy sources for surgical ablation of atrial fibrillation: A
Bayesian network meta-analysis of randomized, controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 48 (2) (pp 201-211), 2015.
Article Number: ezu408. Date of Publication: 01 Aug 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Simplified maze procedures involving radiofrequency, cryoenergy and
microwave energy sources have been increasingly utilized for surgical
treatment of atrial fibrillation as an alternative to the traditional
cut-and-sew approach. In the absence of direct comparisons, a Bayesian
network meta-analysis is another alternative to assess the relative effect
of different treatments, using indirect evidence. A Bayesian meta-analysis
of indirect evidence was performed using 16 published randomized trials
identified from 6 databases. Rank probability analysis was used to rank
each intervention in terms of their probability of having the best
outcome. Sinus rhythm prevalence beyond the 12-month follow-up was similar
between the cut-and-sew, microwave and radiofrequency approaches, which
were all ranked better than cryoablation (respectively, 39, 36, and 25 vs
1%). The cut-and-sew maze was ranked worst in terms of mortality outcomes
compared with microwave, radiofrequency and cryoenergy (2 vs 19, 34, and
24%, respectively). The cut-and-sew maze procedure was associated with
significantly lower stroke rates compared with microwave ablation [odds
ratio < 0.01; 95% confidence interval 0.00, 0.82], and ranked the best in
terms of pacemaker requirements compared with microwave, radiofrequency
and cryoenergy (81 vs 14, and 1, < 0.01% respectively). Bayesian rank
probability analysis shows that the cut-and-sew approach is associated
with the best outcomes in terms of sinus rhythm prevalence and stroke
outcomes, and remains the gold standard approach for AF treatment. Given
the limitations of indirect comparison analysis, these results should be
viewed with caution and not over-interpreted.

<12>
Accession Number
2015249787
Authors
Abdelsattar Z.M. Hendren S. Wong S.L. Campbell D.A. Ramachandran S.K.
Institution
(Abdelsattar, Hendren, Wong, Campbell) Center for Healthcare Outcomes and
Policy, University of Michigan, Ann Arbor, MI, United States
(Ramachandran) Department of Anesthesiology, University of Michigan,
Medical School, 1500 East Medical Center Drive, 1H247 UH, SPC 5048, Ann
Arbor, MI 48109-5048, United States
Title
The impact of untreated obstructive sleep apnea on cardiopulmonary
complications in general and vascular surgery: A cohort study.
Source
Sleep. 38 (8) (pp 1205-1210), 2015. Date of Publication: 01 Aug 2015.
Publisher
Associated Professional Sleep Societies,LLC (2510 N. Frontage Road, Darien
IL 60561, United States)
Abstract
Study Objective: To determine whether preoperatively untreated obstructive
sleep apnea (OSA) affects postoperative outcomes. Design: Cohort study of
patients undergoing surgery between July 2012 and September 2013,
utilizing prospectively collected data from the Michigan Surgical Quality
Collaborative. Multivariable regression models were used to compare
complication rates between treated and untreated OSA, while adjusting for
important patient covariates and clustering within hospitals. Setting:
Fifty-two community and academic hospitals in Michigan. Patients: Adult
patients undergoing various general or vascular operations were
categorized as: (1) no diagnosis or low risk of OSA; (2) documented OSA
without therapy or suspicion of OSA; and (3) diagnosis of OSA with
treatment (e.g., positive airway pressure). Exposures: OSA, preoperatively
treated or untreated, was the exposure variable. Postoperative 30-day
cardiopulmonary complications including arrhythmias, cardiac arrest,
myocardial infarction, unplanned reintubation, pulmonary embolism, and
pneumonia were the outcomes of interest. Measurements and Results: Of
26,842 patients, 2,646 (9.9%) had a diagnosis or suspicion of OSA. Of
those, 1,465 (55.4%) were untreated. Patient and procedural risk factors
were evenly balanced between treated and untreated groups. Compared with
treated OSA, untreated OSA was independently associated with more
cardiopulmonary complications (risk-adjusted rates 6.7% versus 4.0%;
adjusted odds ratio [aOR] = 1.8, P = 0.001), particularly unplanned
reintubations (aOR = 2.5, P = 0.003) and myocardial infarction (aOR = 2.6,
P = 0.031). Conclusions: Patients with obstructive sleep apnea (OSA) who
are not treated with positive airway pressure preoperatively are at
increased risks for cardiopulmonary complications after general and
vascular surgery. Improving the recognition of OSA and ensuring adequate
treatment may be a strategy to reduce risk for surgical patients with OSA.

<13>
Accession Number
2015248694
Authors
Ziyaeifard M. Alizadehasl A. Aghdaii N. Sadeghi A. Azarfarin R. Masoumi G.
Golbargian G.
Institution
(Ziyaeifard, Alizadehasl, Aghdaii, Sadeghi, Azarfarin, Golbargian) Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Masoumi) Department of Anesthesiology, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Title
Heparinized and saline solutions in the maintenance of arterial and
central venous catheters after cardiac surgery.
Source
Anesthesiology and Pain Medicine. 5 (4) , 2015. Article Number: e23963.
Date of Publication: 01 Aug 2015.
Publisher
Kowsar Medical Publishing Company
Abstract
Background: Heparinized saline solution is used to prevent occlusion in
the arterial catheters and central venous pressure monitoring catheters.
Even at low dose, heparin administration can be associated with serious
complications. Normal saline solution can maintain patency of arterial
catheters and central venous pressure monitoring catheters. Objectives:
The current study aimed to compare the efficacy of normal saline with that
of heparinized one to maintain patency of arterial and central venous
catheters after cardiac surgery. Patients and Methods: In the current
randomized controlled trial, 100 patients, with an age range of 18 - 65
years of valve and coronary artery surgery were studied in Rajaie heart
center, Tehran, Iran. Patients were randomized to receive either
heparinized saline (n = 50) or normal saline flush solutions (n = 50). In
the study, arterial catheters and central venous pressure monitoring
catheters were daily checked for any signs of occlusion in three
postoperative days as primary end-point of the study. Results: According
to the information obtained from the study, four (8%) arterial catheters
in the saline group (P value: 0.135) and three (6%) arterial catheters in
the heparin group (P value = 0.097) were obstructed. Statistical analysis
showed that the incidence of obstruction and changes in all other
parameters between the two groups during the three-day follow-up was not
significant (all P values > 0.05). Conclusions: It seems that there is no
difference in the use of heparinized and normal saline solutions to
prevent catheter occlusion of arterial and central venous pressure.

<14>
Accession Number
2015242994
Authors
Dianatkhah M. Ghaeli P. Talasaz A.H. Karimi A. Salehiomran A. Bina P.
Jalali A. Ghaffary S. Shahmansouri N. Vejdani S.
Institution
(Dianatkhah, Ghaeli, Talasaz, Ghaffary, Vejdani) Department of
Pharmacotherapy, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Talasaz, Karimi, Salehiomran, Bina, Jalali, Shahmansouri) Tehran Heart
Centre, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Evaluating the potential effect of melatonin on the post- cardiac surgery
sleep disorder.
Source
Journal of Tehran University Heart Center. 10 (3) (pp 122-128), 2015. Date
of Publication: 03 Aug 2015.
Publisher
Tehran Heart Center
Abstract
Background: Postoperative neurological injuries, including cognitive
dysfunction, sleep disorder, delirium, and anxiety, are the important
consequences of coronary artery bypass graft surgery (CABG). Evidence has
shown that postoperative sleep disturbance is partly due to disturbed
melatonin secretion in the perioperative period. The aim of this study was
to evaluate the effect of melatonin on postoperative sleep disorder in
patients undergoing CABG. Methods: One hundred forty-five elective CABG
patients participated in a randomized double-blind study during the
preoperative period. The patients were randomized to receive either 3 mg
of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group
received the medication from 3 days before surgery until the time of
discharge. Sleep quality was evaluated using the Groningen Sleep Quality
Score (GSQS), and the incidence of delirium was evaluated by nursing
records. Sleep quality and anxiety scores were compared before and after
surgery through the Wilcoxon signed-rank test. The analysis of covariance
(ANCOVA) and independent t-test were used to compare the sleep and anxiety
scores between the groups. P values < 0.05 were considered statistically
significant. Results: Totally, 137 patients at a mean age of 60 years
completed the study (76% male). The analysis of the data showed that sleep
was significantly disturbed after surgery in both groups. The patients in
the Oxazepam group demonstrated significantly higher disturbance in their
mean postoperative GSQS score than did their counterparts in the melatonin
group (p value < 0.001). A smaller proportion of the participants
experienced delirium in the melatonin group (0.06%) than in the Oxazepam
group (0.12%); however, this difference was not statistically significant.
Conclusion: The result of the present study revealed that melatonin
improved sleep in post-cardiac surgery patients more than what was
observed with Oxazepam. Therefore, melatonin may be considered an
effective alternative for Benzodiazepines in the management of
postoperative sleep disorder.

<15>
Accession Number
2015245129
Authors
Lin F. Pan L. Qian W. Ge W. Dai H. Liang Y.
Institution
(Lin, Pan, Qian, Ge, Dai, Liang) Department of Anesthesiology, Affiliated
Tumor Hospital of Guangxi Medical University, Nanning 530021, China
Title
Comparison of three ventilatory modes during one-lung ventilation in
elderly patients.
Source
International Journal of Clinical and Experimental Medicine. 8 (6) (pp
9955-9960), 2015. Date of Publication: 30 Jun 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: The purpose of this study was to explore the effects of three
different ventilatory modes: volume controlled ventilation (VCV), pressure
controlled ventilation (PCV) and pressure controlled ventilation-volume
guaranteed (PCV-VG) on arterial oxygenation and airway pressure during
one-lung ventilation (OLV) in elderly patients. Methods: We enrolled 66
patients who underwent thoracic surgery requiring at least 1 hour of OLV
and aged above 65 years into the study. Patients were classified into VCV,
PCV and PCV-VG groups according to a controlled, randomized design.
Patients were ventilated to obtain a tidal volume (TV) of 8 mL/kg with
three different ventilatory modes during OLV. The Hemodynamic and
respiratory data had been recorded during intraoperation and arterial
blood gases were obtained at baseline, 20, 40, 60 minutes after OLV, end
of surgery. Results: Compared with VCV group, Ppeak was significantly
lower in PCV and PCV-VG group (P<0.05), and the difference was not found
between the PCV and PCV-VG group. PaO<inf>2</inf> in PCV and PCV-VG group
were higher than VCV group after the point of OLV+40 (P<0.05). Comparison
of PCV group, PaO<inf>2</inf> in PCV-VG group was higher, but did not show
a significantly improved during OLV (P>0.05). Conclusions: Compared with
VCV, the use of PCV and PCV-VG have a significant advantage in
intraoperative oxygenation and airway pressure for eldly patients
undergoing OLV.

<16>
Accession Number
2015239775
Authors
Kopic J.
Institution
(Kopic) Anesthesiology and Intensive Care Ward, Dr. Josip Bencevic General
Hospital, Stamparova 42, Slavonski Brod 35000, Croatia
Title
Volatile anaesthetics and cardiac protection in abdominal surgery.
Source
Wiener Klinische Wochenschrift. 127 (13-14) (pp 543-548), 2015. Date of
Publication: 28 Jul 2015.
Publisher
Springer-Verlag Wien
Abstract
Background: Clinical studies have shown that sevoflurane is
cardio-protective in cardiac surgery patients, but this effect is doubtful
in general surgery patients. This study has researched the influence of
sevoflurane on the perioperative cardiac function and the incidence of
cardiac ischaemic events in abdominal surgical patients. Methods: Out of
80 patients scheduled for elective colorectal surgery, 42 received
balanced sevoflurane-fentanyl anaesthesia, while 38 received intravenous
midazolam-fentanyl anaesthesia. The cardiac index (CI) and cardiac
function index (CFI) were measured by the PiCCO device, and Troponin I
levels were measured at the beginning of surgery, as well as 4, 12 and 24
h afterwards. BNP was measured at the beginning of surgery, and 24 h
afterwards. The data analysis was conducted using the Mann-Whitney
nonparametric test, with statistical significance set at p < 0.05.
Results: There was no statistical difference in perioperative Troponin I,
BNP, CI and CFI values between the SEVO and TIVA groups throughout the
perioperative period. Conclusions: Sevoflurane had no effect on the
cardiac biomarkers Troponin I and BNP, and on the PiCCO parameters of
cardiac function in abdominal surgical patients. Further research on the
preconditioning effect of volatile anaesthetics in general surgical
population should be concentrated on the population of patients with a
high perioperative cardiac risk.

<17>
Accession Number
2015185322
Authors
Kadam S. Tailor K. Kulkarni S. Mohanty S. Joshi P. Rao S.
Institution
(Kadam, Tailor) Departments of Pediatric Cardiac Anaesthesia, Kokilaben
Dhirubhai Ambani Hospital, Medical Research Centre, Mumbai, Maharashtra
400053, India
(Kulkarni) Pediatric Cardiology, India
(Mohanty, Rao) Pediatric Cardiac Surgery, India
(Joshi) Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani
Hospital, Medical Research Centre, Mumbai, Maharashtra, India
Title
Effect of dexmeditomidine on postoperative junctional ectopic tachycardia
after complete surgical repair of tetralogy of Fallot: A prospective
randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 323-328), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Incidence of junctional ectopic tachycardia (JET) after repair of
tetralogy of Fallot (TOF) is 5.6-14%. Dexmeditomidine is a alpha-2
adrenoceptor agonist modulates the release of catecholamine, resulting in
bradycardia and hypotension. These effects are being explored as a
therapeutic option for the prevention of perioperative tachyarrhythmia. We
undertook this study to examine possible preventive effects of
dexmedetomidine on postoperative JET and its impact on the duration of
ventilation time and length of Intensive Care Unit stay. Methods: After
obtaining approval from the hospitals ethics committee and written
informed consent from parents, this quasi-randomized trial was initiated.
Of 94 patients, 47 patients received dexmedetomidine (dexmedetomidine
group) and 47 patients did not receive the drug (control group). Results:
Dexmedetomidine group had more number of complex variants like TOF with an
absent pulmonary valve or pulmonary atresia (P = 0.041). Hematocrit on
cardiopulmonary bypass (CPB), heart rate while coming off from CPB and
inotrope score was significantly low in the dexmedetomidine group compared
to control group. The incidence of JET was significantly low in
dexmedetomidine group (P = 0.040) compared to control group. Conclusions:
Dexmedetomidine may have a potential benefit of preventing perioperative
JET.

<18>
Accession Number
2015185321
Authors
Karlekar A. Bharati S. Saxena R. Mehta K.
Institution
(Karlekar, Bharati, Saxena) Departments of Anaesthesiology, Critical Care,
Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
(Mehta) Departments of Physiotherapy, Fortis Escorts Heart Institute, New
Delhi, India
Title
Assessment of feasibility and efficacy of Class IV laser therapy for
postoperative pain relief in off-pump coronary artery bypass surgery
patients: A pilot study.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 317-322), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Laser therapy, for its established analgesic properties with minimal side
effects, has been used for the treatment of chronic pain. However, it has
not been used for the treatment of acute postoperative pain. This pilot
study was designed to assess the feasibility and efficacy of Class IV
laser on postoperative pain relief following off-pump coronary artery
bypass graft (OPCABG) surgery, as a component of multimodal analgesia
(MMA) technique. Methods: This open observational prospective study
comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG
through sternotomy. For postoperative analgesia, they were subjected to
laser therapy subjected to laser therapy in addition to the standard
institutional pain management protocol comprising of IV infusion/bolus of
tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain
intensity was measured by Verbal Rating Scale (VRS). The laser therapy was
scheduled as once a day regime for three consecutive postoperative days
(PODs) starting on POD 1, 30 min following tracheal extubation. The
subsequent laser applications were also scheduled at the same time of the
day as on day 1 if VRS was >5. 10 W Class IV laser was applied over 150
cm² sternal wound area for 150 s. VRS was used to assess pain
severity and was recorded for statistical analysis using Friedman Test.
Results: The mean (standard deviation [SD]) VRS of all the 100 patients
just before application of the first dose of laser was 7.31 (0.94) while
on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h
respectively following first dose of laser. The change of VRS over first
24 h among all the 100 patients was statistically significant (P = 0.000).
Laser was re-applied in 40 patients whose VRS was >5 (mean [SD]-6.38
[0.868]) at 24^th h. After receiving the 2^nd dose of
laser the VRS scores fell significantly (P = 0.000) and became 0 at
54^th h. No patients required 3^rd dose of the laser.
No patient required rescue analgesic while on laser therapy. Conclusion:
Class IV laser can be an effective technique for postoperative analgesia
following OPCABG surgery through sternotomy when included as a component
of MMA technique.

<19>
Accession Number
2015185319
Authors
Desai P. Kane D. Sarkar M.
Institution
(Desai, Kane, Sarkar) Department of Anesthesiology, Seth GSMC, KEM
Hospital, Mumbai, Maharashtra, India
Title
Cardioversion: What to choose? Etomidate or propofol.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 306-311), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Electrical cardioversion is a short painful procedure to regain normal
sinus rhythm requiring anaesthesia for haemodynamic stability, sedation,
analgesia and early recovery. Aims: To compare propofol and etomidate as
sedatives during cardioversion. Settings and Design: Single centred,
prospective and randomized single blind study comprising 60 patients.
Subjects and Methods: Patients more than 18 years, American Society of
Anesthesiologists I/II/III grades undergoing elective cardioversion,
randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus
followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1
mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 mu
g/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP
[SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate,
Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed
at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of
hypotension, respiratory depression and side effects were compared.
Statistical analysis used: Student's unpaired t-test, Chi-square test and
Mann-Whitney test. P > 0.05 was taken as significant. Results: Group P
showed significant fall in SBP, DBP, and mean BP at 2 min after
cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred
more with propofol (P > 0.05). Group E showed better ARS at 1, 2, 5, 10,
15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7
s Group E) indicated longer recovery with propofol. Left atrial size
(35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P
vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%)
showed significant difference. Conclusions: Etomidate/fentanyl is superior
over propofol/fentanyl during cardioversion for quick recovery and
haemodynamic stability.

<20>
Accession Number
2015126050
Authors
Booij H.G. Damman K. Warnica J.W. Rouleau J.L. van Gilst W.H. Westenbrink
B.D.
Institution
(Booij, Damman, van Gilst, Westenbrink) Department of Cardiology,
University Medical Center Groningen, Hanzeplein 1, P O Box 30001,
Groningen 9700 RB, Netherlands
(Warnica) Foothills Hospital, University of Calgary, 1403-29 Street NW,
Calgary, AB T2N 2T9, Canada
(Rouleau) Institut de Cardiologie de Montreal, University of Montreal,
5000 Belanger St East, Montreal, QC H1T1C8, Canada
Title
beta-blocker Therapy is Not Associated with Reductions in Angina or
Cardiovascular Events After Coronary Artery Bypass Graft Surgery: Insights
from the IMAGINE Trial.
Source
Cardiovascular Drugs and Therapy. 29 (3) (pp 277-285), 2015. Date of
Publication: 03 Jun 2015.
Publisher
Springer New York LLC
Abstract
Purpose: To evaluate whether beta-blockers were associated with a
reduction in cardiovascular events or angina after Coronary Artery Bypass
Graft (CABG) surgery, in otherwise stable low-risk patients during a
mid-term follow-up. Methods: We performed a post-hoc analysis of the
IMAGINE (Ischemia Management with Accupril post-bypass Graft via
Inhibition of angiotensin coNverting Enzyme) trial, which tested the
effect of Quinapril in 2553 hemodynamically stable patients with left
ventricular ejection fraction (LVEF) >40 %, after scheduled CABG. The
association between beta-blocker therapy and the incidence of
cardiovascular events (death, cardiac arrest, myocardial infarction,
revascularizations, angina requiring hospitalization, stroke or
hospitalization for heart failure) or angina that was documented to be due
to underlying ischemia was tested with Cox regression and propensity
adjusted analyses. Results: In total, 1709 patients (76.5 %) were using a
beta-blocker. Patients had excellent control of risk factors; with mean
systolic blood pressure being 121 +/- 14 mmHg, mean LDL cholesterol of 2.8
mmol/l, 59 % of patients received statins and 92 % of patients received
antiplatelet therapy. During a median follow-up of 33 months, beta-blocker
therapy was not associated with a reduction in cardiovascular events
(hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina
(hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the
individual components of the combined endpoint. There were no relevant
interactions for demographics, comorbidities or surgical characteristics.
Propensity matched and time-dependent analyses revealed similar results.
Conclusions: beta-blocker therapy after CABG is not associated with
reductions in angina or cardiovascular events in low-risk patients with
preserved LVEF, and may not be systematically indicated in such patients.

<21>
[Use Link to view the full text]
Accession Number
2014755408
Authors
Dai J.G. Liu Q.X.
Institution
(Dai) Department of Thoracic Surgery, Xinqiao Hospital, Third Military
Medical University, Chongqing, China
Title
Is there no significant difference in the incidence of anastomotic leakage
between the hand-sewn and mechanical esophagogastric anastomosis?.
Source
Annals of Surgery. 262 (2) (pp e81), 2015. Date of Publication: 30 Aug
2015.
Publisher
Lippincott Williams and Wilkins

<22>
Accession Number
2015245151
Authors
Alizadehas A. Ziyaeifard M. Peighambari M. Azarfarin R. Golbargian G.
Bakhshandeh H.
Institution
(Alizadehas, Ziyaeifard, Peighambari, Azarfarin, Golbargian, Bakhshandeh)
Rajaie Cardiovascular Medical and Research Center, Iran University of
Medical Sciences, Tehran, IR, Iran, Islamic Republic of
Title
Avoiding heparinization of arterial line and maintaining acceptable
arterial waveform after cardiac surgery: A randomized clinical trial.
Source
Research in Cardiovascular Medicine. 4 (3) , 2015. Article Number: e28086.
Date of Publication: 01 Aug 2015.
Publisher
KOWSAR Medical Publishing Company
Abstract
Invasive and continuous blood pressure (BP) monitoring is crucial after
cardiac surgery. Accuracy of BP measurement mostly depends on patency of
arterial catheter and acceptable waveform. Heparinized saline flush
usually used for this purpose may be accompanied by potential heparin
adverse effects. Objectives: The aim of this study was to compare
heparinized and non-heparinized saline flush to maintain acceptable
arterial waveform after cardiac surgery. Materials and Methods: In a
double blind randomized trial study, 100 patients undergoing elective
cardiac surgery were randomized to using heparinized (n=50) or
non-heparinized (normal) saline flush (n=50) to maintain patency of
arterial catheter after operation. Indwelling arterial catheters were
checked daily for acceptable arterial waveform for three days as primary
outcome measures. Results: Frequency of acceptable arterial waveform
ranged from 66% to 80%, in first, second and third postoperative days.
There were no statistically significant differences between heparinized
and non-heparinized saline groups regarding acceptable arterial waveforms
in all the three postoperative days (all P values>0.05). Conclusions:
Using non-heparinized normal saline is suitable to maintain acceptable
arterial waveform for short-term (three days) after adult cardiac surgery
considering potential adverse effects of heparin.

<23>
Accession Number
2015239562
Authors
Fink H.A. Hemmy L.S. MacDonald R. Carlyle M.H. Olson C.M. Dysken M.W.
McCarten J.R. Kane R.L. Garcia S.A. Rutks I.R. Ouellette J. Wilt T.J.
Institution
(Fink, Hemmy, Dysken, McCarten) Geriatric Research Education and Clinical
Center, Veterans Affairs Health Care System (11-G), One Veterans Drive,
Minneapolis, MN 55417, United States
(MacDonald, Wilt) Center for Chronic Disease Outcomes Research (111-0),
Veterans Affairs Health Center, One Veterans Drive, Minneapolis, MN 55417,
United States
(Carlyle) Optum Health, 12125 Technology Drive, Eden Prairie, MN 55344,
United States
(Olson) Veterans Affairs Health Care System, Building 9, One Veterans
Drive, Minneapolis, MN 55417, United States
(Kane, Ouellette) University of Minnesota, School of Public Health, Mayo
D351, MMC 197, 420 Delaware Street SE, Minneapolis, MN 55455, United
States
(Garcia) Division of Cardiology, Veterans Affairs Health Care System, One
Veterans Drive (111-C), Minneapolis, MN 55417, United States
(Rutks) Center for Chronic Disease Outcomes Research (152), Veterans
Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417,
United States
Title
Intermediate- and long-term cognitive outcomes after cardiovascular
procedures in older adults a systematic review.
Source
Annals of Internal Medicine. 163 (2) (pp 107-117), 2015. Date of
Publication: 21 Jul 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Risks for intermediate- and long-term cognitive impairment
after cardiovascular procedures in older adults are poorly understood.
Purpose: To summarize evidence about cognitive outcomes in adults aged 65
years or older at least 3 months after coronary or carotid
revascularization, cardiac valve procedures, or ablation for atrial
fibrillation. Data Sources: MEDLINE, Cochrane, and Scopus databases from
1990 to January 2015; ClinicalTrials.gov; and bibliographies of reviews
and eligible studies. Study Selection: English-language trials and
prospective cohort studies. Data Extraction: One reviewer extracted data,
a second checked accuracy, and 2 independently rated quality and strength
of evidence (SOE). Data Synthesis: 17 trials and 4 cohort studies were
included; 80% of patients were men, and mean age was 68 years. Cognitive
function did not differ after the procedure between on- and off-pump
coronary artery bypass grafting (CABG) (n = 6; low SOE), hypothermic and
normothermic CABG (n = 3; moderate to low SOE), or CABG and medical
management (n = 1; insufficient SOE). One trial reported lower risk for
incident cognitive impairment with minimal versus conventional
extracorporeal CABG (risk ratio, 0.34 [95% CI, 0.16 to 0.73]; low SOE).
Two trials found no difference between surgical carotid revascularization
and carotid stenting or angioplasty (low and insufficient SOE,
respectively). One cohort study reported increased cognitive decline after
transcatheter versus surgical aortic valve replacement but had large
selection and outcome measurement biases (insufficient SOE). Limitations:
Mostly low to insufficient SOE; no pertinent data for ablation; limited
generalizability to the most elderly patients, women, and persons with
substantial baseline cognitive impairment; and possible selective
reporting and publication bias. Conclusion: Intermediate- and long-term
cognitive impairment in older adults attributable to the studied
cardiovascular procedures may be uncommon. Nevertheless, clinicians
counseling patients before these procedures should discuss the uncertainty
in their risk for adverse cognitive outcomes. Primary Funding Source:
Agency for Healthcare Research and Quality.

<24>
Accession Number
2015238288
Authors
Zurakowski A. Buszman P.P. Milewski K.P. Janas A. Gorycki B. Kondys M.
Gasior P. Michalak M. Boxberger M. Peppas A. Granada J.F. Buszman P.E.
Institution
(Zurakowski, Buszman, Milewski, Janas, Gorycki, Kondys, Michalak, Buszman)
Center for Cardiovascular Research and Development, American Heart of
Poland Inc., 41 Czajek str., Katowice, Poland
(Buszman, Gasior) Silesian Center for Heart Diseases, Zabrze, Poland
(Boxberger) B.Braun, Melsungen AG, Berlin, Germany
(Peppas, Granada) Cardiovascular Research Foundation, Orangeburg, NY,
United States
Title
Stenting and Adjunctive Delivery of Paclitaxel Via Balloon Coating Versus
Durable Polymeric Matrix for de Novo Coronary Lesions: Clinical and
Angiographic Results from the Prospective Randomized Trial.
Source
Journal of Interventional Cardiology. 28 (4) (pp 348-357), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background There is limited comparative clinical data regarding the safety
and efficacy profile of paclitaxel delivery via balloon versus
stent-polymer matrix. In this study, we aimed to compare the clinical and
angiographic results of two different methods of paclitaxel delivery among
patients undergoing percutaneous coronary intervention (PCI) for single de
novo coronary lesions. Methods A total of 202 patients undergoing PCI due
to symptomatic heart disease and at least one significant coronary artery
lesion were prospectively enrolled in a multicenter non-inferiority trial.
Eligible patients were randomized to a revascularization with either a
paclitaxel eluting stent (PES = Coroflex Please, B.Braun) or a bare metal
stent (BMS) followed by a paclitaxel coated balloon (PCB) dilation (BMS =
Coroflex + PCB = Sequent Please, B.Braun). Clinical follow-up was obtained
at 9 months in all patients, whereas angiographic in a subset of 94
(46.5%) patients. Results The baseline characteristics were well balanced
between groups. At 9 months, the primary endpoint of in-stent late lumen
loss in BMS + PCB was comparable and non-inferior to PES (0.21 +/- 0.5 vs.
0.30 +/- 0.7 mm, respectively. P<inf>non-inf</inf> < 0.05). At 9 months,
the incidence of MACE (7.0 vs. 6.9%, HR = 1, 95%CI: 0.3-2.8; P = 0.99),
comprising the occurrence of myocardial infarction (4.9 vs. 3.0%, HR =
1.62, 95%CI: 0.4-6.5; P = 0.32), target lesion revascularization (6.9 vs.
5.0%, HR = 1.42, 95%CI: 0.4-4.4; p = 0.54) and stent thrombosis (4.9 vs.
3.0%, HR = 2.01, 95%CI: 0.5-7.4; P = 0.74) was comparable between BMS +
PCB and PES, respectively. In the BMS + PCB group, thrombosis tended to
occur within 30 days (3.9 vs. 1.0%; P = 0.38). Conclusions Paclitaxel
delivery via drug coated balloon or polymer-stent matrix achieved
comparable angiographic and clinical results among patients with de novo
coronary lesions. BMS + PCB revascularization was associated with a higher
rate of stent thrombosis when compared to newer generation drug eluting
stents, therefore, should be recommended as a bail-out for PCB alone
angioplasty.

<25>
Accession Number
2015240808
Authors
Vranckx P. Leebeek F.W. G. Tijssen J.G. P. Koolen J. Stammen F. Herman
J.P.R. de Winter R.J. van t Hof A.W.J. Backx B. Lindeboom W. Kim S.-Y.
Kirsch B. van Eickels M. Misselwitz F. Verheugt F.W.A.
Institution
(Vranckx) Department of Cardiac Intensive Care and Interventional
Cardiology Jessaziekenhuis Hasselt, Hartcentrum Hasselt, Belgium
(Leebeek) Department of Hematology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Tijssen, de Winter) Department of Cardiology, Academisch Medisch Centrum,
Amsterdam, Netherlands
(Koolen) Department of Cardiology, Catharina- Ziekenhuis, Eindhoven,
Netherlands
(Stammen) Department of Cardiology, AZ Delta, Roeselare, Belgium
(Herman, Verheugt) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(van t Hof) Department of Cardiology, Insala ziekenhuizen Zwolle,
Netherlands
(Backx, Lindeboom) Cardialysis, Rotterdam, Netherlands
(Kim, Kirsch, van Eickels, Misselwitz) Bayer Pharma AG, Leverkusen,
Germany
Title
Peri-procedural use of rivaroxaban in elective percutaneous coronary
intervention to treat stable coronary artery disease the X- PLORER trial.
Source
Thrombosis and Haemostasis. 114 (2) (pp 258-267), 2015. Date of
Publication: 2015.
Publisher
Schattauer GmbH
Abstract
Patients on rivaroxaban requiring percutaneous coronary intervention (PCI)
represent a clinical conundrum. We aimed to investigate whether
rivaroxaban, with or without an additional bolus of unfractionated heparin
(UFH), effectively inhibits coagulation activation during PCI. Stable
patients (n=108) undergoing elective PCI and on stable dual antiplatelet
therapy were randomised (2:2:2:1) to a short treatment course of
rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus
UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for
markers of thrombin generation and coagulation activation were drawn prior
to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients
treated with rivaroxaban (10 or 20 mg) and patients treated with
rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h
post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and
0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2
h post-PCI were 3.90 [6.8] mug/l and 3.90 [10.1] mug/l, respectively,
remaining below the upper reference limit (URL) after PCI and stenting.
This was comparable to the control group of UFH treatment alone. However,
median values for thrombin-antithrombin complex passed above the URL with
increasing tendency, starting at 2 h post-PCI in the UFHalone arm but not
in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban
effectively suppressed coagulation activation after elective PCI and
stenting.

<26>
Accession Number
2015148147
Authors
Duan X. Li J. Zhang Q. Zeng Z. Luo Y. Jiang J. Chen Y.
Institution
(Duan, Zhang, Zeng, Luo, Jiang, Chen) Division of Cardiology, West China
Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
(Li) Department of Clinical Epidemiology, West China Hospital, Sichuan
University, Chengdu, Sichuan Province 610041, China
Title
Prognostic value of late gadolinium enhancement in dilated cardiomyopathy
patients: A meta-analysis.
Source
Clinical Radiology. 70 (9) (pp 999-1008), 2015. Date of Publication: 01
Sep 2015.
Publisher
W.B. Saunders Ltd
Abstract
Aim To evaluate the association between late gadolinium enhancement (LGE)
at cardiac magnetic resonance (CMR) and major adverse events in dilated
cardiomyopathy (DCM) patients. Materials and methods Databases, including
PubMed, Ovid, and EMBASE, were searched for studies evaluating LGE at CMR
in DCM patient prognostication. Clinical outcomes were analysed using
fixed-effects models or, in cases of significant heterogeneity,
random-effects models. Results In the meta-analysis of 13 studies on 1675
DCM patients with a mean follow-up of 3 years, LGE is associated with
all-cause mortality (pooled odds ratio, 3.43 [95% confidence interval,
2.26-5.22], p<0.00001), cardiac death/transplantation (3.65 [1.80-7.40],
p=0.0003), hospitalisation for heart failure (2.87 [1.53-5.39], p=0.001),
major arrhythmia events (sudden cardiac death, sustained ventricular
tachycardia or fibrillation, appropriate implantable
cardioverter-defibrillator (ICD) discharge/pacing, and syncope: 4.24
[2.95-6.08], p<0.00001), and sudden cardiac death (3.33 [1.80-6.17],
p=0.0001). Conclusion LGE in DCM patients appears to be associated with
mortality and major cardiac events, underscoring its potential as an
independent index for risk stratification and treatment guidance.

<27>
Accession Number
2015034683
Authors
Casey A. Itrakjy A. Birkett C. Clethro A. Bonser R. Graham T. Mascaro J.
Pagano D. Rooney S. Wilson I. Nightingale P. Crosby C. Elliott T.
Institution
(Casey, Elliott) Department of Clinical Microbiology, University Hospitals
Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham,
Edgbaston, Birmingham, United Kingdom
(Itrakjy, Birkett, Clethro, Bonser, Graham, Mascaro, Pagano, Rooney,
Wilson) Department of Cardiothoracic Surgery, University Hospitals
Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham,
Edgbaston, Birmingham, United Kingdom
(Nightingale) Wolfson Computer Laboratory, University Hospitals Birmingham
NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston,
Birmingham, United Kingdom
(Crosby) CareFusion Corporation, San Diego, CA, United States
Title
A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5%
w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest
of the long saphenous vein used in coronary artery bypass grafting.
Source
American Journal of Infection Control. 43 (8) (pp 816-820), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Mosby Inc.
Abstract
Background Chlorhexidine gluconate (CHG) is often recommended for skin
antisepsis; however, the most efficacious concentration is currently
unclear. Our objective was to compare the efficacy of 70% isopropyl
alcohol (IPA) containing either 0.5% or 2% CHG for antiseptic skin
preparation in patients undergoing coronary artery bypass grafting.
Methods One hundred patients were randomized to 1 of the 2 CHG
concentrations. The designated antiseptic was applied to the skin of the
operative site of patients before long saphenous vein harvest. Bacterial
counts on the skin incision site were determined at various time points to
assess any immediate and persistent antimicrobial activity. The number of
patients developing surgical site infection was also determined. Results
The total numbers of microorganisms on the skin 2 minutes after skin
antisepsis and after wound closure was lower with 2% CHG/70% IPA compared
with 0.5% CHG/70% IPA (P =.033 and P =.016, respectively). Six of 41
patients in the 0.5% CHG/70%IPA group developed a superficial surgical
site infection compared with 2 of 44 patients in the 2% CHG/70% IPA group
(relative risk, 3.22; 95% confidence interval, 0.63-22.75; P =.147).
Conclusions Isopropyl alcohol (70%) containing 2% CHG compared with 0.5%
CHG reduces the number of microorganisms detectable on a surgical
patient's skin perioperatively.

<28>
Accession Number
2015949526
Authors
Sutherland N. Jones B. d'Udekem Y.
Institution
(Sutherland, d'Udekem) Cardiac Surgery Department, Royal Children's
Hospital, Melbourne, VIC, Australia
(Jones, d'Udekem) Murdoch Childrens Research Institute, Melbourne, VIC,
Australia
(Jones, d'Udekem) Department of Paediatrics, Faculty of Medicine, The
University of Melbourne, Melbourne, VIC, Australia
(Jones) Department of Cardiology, The Royal Children's Hospital,
Melbourne, VIC, Australia
Title
Should We Recommend Exercise after the Fontan Procedure?.
Source
Heart Lung and Circulation. 24 (8) (pp 753-768), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Elsevier Ltd
Abstract
Background: The Fontan procedure, the last of a series of operations
performed in patients with congenital heart defects, offers improved
exercise capacity compared to baseline function but is still reduced
compared to healthy peers. Exercise training may improve exercise
tolerance but there is no consensus on the safety of this practice or the
optimal training regimen. We performed a systematic literature review on
the effects of exercise training in patients with a Fontan circulation.
Methods: Medline and Embase databases were systematically searched for
articles regarding Fontan Procedure and cardiac rehabilitation. Results: A
total of 23 articles met all inclusion criteria; in total, 201 Fontan
subjects were included. Characteristics of the exercise training programs
varied significantly. There were no adverse effects related to training
programs reported in the literature. Most studies reported benefit across
various exercise parameters related to exercise tolerance. Conclusions:
Exercise training is safe and beneficial in patients with a Fontan
circulation. Exercise training should become a standard of care within
this population. Physiological adaptation following exercise training
needs to be investigated more extensively.

<29>
Accession Number
2015243162
Authors
Yang M. Xie X.-S. Yuan W.-J.
Institution
(Yang, Yuan) Department of Nephrology, Shanghai General Hospital, Shanghai
Jiao Tong University, No. 100 Haining Road, Hongkou District, Shanghai
200080, China
(Xie) Department of Nephrology, Second Clinical Medical Institution of
North Sichuan Medical College (Nanchong Central Hospital), No. 97 South
Renmin Road, Shunqing District, Nanchong 637000, China
Title
A meta-analysis of the effects of statin treatment on cardiovascular
events and all-cause mortality in diabetic dialysis patients.
Source
International Journal of Clinical and Experimental Medicine. 8 (6) (pp
8415-8424), 2015. Date of Publication: 30 Jun 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objectives: Diabetic dialysis patients have higher risk of cardiovascular
disease (CVD) than general population. While statin treatment is effective
in prevention of CVD and all-cause mortality in general population, the
use of statin in diabetic dialysis patients remains controversial. Thus,
we aimed to assess the effects of statin treatment on prevention of CVD
and all-cause mortality in diabetic dialysis patients by meta-analysis.
Materials and methods: Pubmed, Embase and Cochrane Library were searched
between each database's inception and July, 2014. Hazard ratio (HR) with
95% confidence interval (CI) for CVD and all-cause mortality was extracted
from each study. The pooled analysis was performed using random-effects
models by Stata 12.0. Results: Our search yielded five eligible articles
including two RCTs and three observational studies. By pooled estimate,
statin treatment was associated with a decreased risk of the cardiac
endpoint which included cardiac death and nonfatal MI (HR=0.84, 95% CI:
0.78-0.90) and all cardiac events combined (HR=0.89, 95% CI: 0.82-0.96).
There was no difference in the overall incidence of fatal or nonfatal
stroke (HR=1.24, 95% CI: 0.99-1.53) and all cerebrovascular events
combined (HR=1.14, 95% CI: 0.98-1.33) between statin treatment and control
group. Finally, statin treatment was associated with a decreased risk of
all-cause mortality (HR=0.81, 95% CI: 0.71-0.92). Conclusions: Statin
treatment may be beneficial for reducing the risk of cardiac events and
all-cause mortality while have no effect on overall cerebrovascular events
in diabetic dialysis patients. More RCTs were needed to validate the
results.

<30>
Accession Number
2015194056
Authors
El Messaoudi S. Nederlof R. Zuurbier C.J. van Swieten H.A. Pickkers P.
Noyez L. Dieker H.-J. Coenen M.J. Donders A.R.T. Vos A. Rongen G.A. Riksen
N.P.
Institution
(El Messaoudi, Vos, Rongen, Riksen) Department of Pharmacology-Toxicology,
Radboud University Medical Center, Nijmegen, Netherlands
(El Messaoudi, Dieker) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(van Swieten, Noyez) Department of Cardiothoracic Surgery, Radboud
University Medical Center, Nijmegen, Netherlands
(Pickkers) Department of Intensive Care Medicine, Radboud University
Medical Center, Nijmegen, Netherlands
(Coenen) Department of Human Genetics, Radboud University Medical Center,
Nijmegen, Netherlands
(Donders) Department for Health Evidence, Radboud University Medical
Center, Nijmegen, Netherlands
(Rongen, Riksen) Department of Internal Medicine, Radboud University
Medical Center, Nijmegen, Netherlands
(Nederlof, Zuurbier) Laboratory of Experimental Intensive Care and
Anesthesiology, Department of Anesthesiology, Academic Medical Center,
Amsterdam, Netherlands
Title
Effect of metformin pretreatment on myocardial injury during coronary
artery bypass surgery in patients without diabetes (MetCAB): A
double-blind, randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 3 (8) (pp 615-623), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Lancet Publishing Group
Abstract
Background: During coronary artery bypass graft (CABG) surgery, ischaemia
and reperfusion damage myocardial tissue, and increased postoperative
plasma troponin concentration is associated with a worse outcome. We
investigated whether metformin pretreatment limits cardiac injury,
assessed by troponin concentrations, during CABG surgery in patients
without diabetes. Methods: We did a placebo-controlled, double-blind,
single-centre study in an academic hospital in Nijmegen (Netherlands) in
adult patients without diabetes undergoing an elective on-pump CABG
procedure. We randomly assigned patients (1:1) in blocks of ten via a
computer-generated randomisation sequence to either metformin
hydrochloride (500 mg three times per day) or placebo (three times per
day) for 3 days before surgery. The last dose was given roughly 3 h before
surgery. Patients, investigators, trial staff, and the statistician were
all masked to treatment allocation. The primary endpoint was the plasma
concentration of high-sensitive troponin I at 6, 12, and 24 h
postreperfusion after surgery, analysed in the per-protocol population
with a mixed-model analysis using all these timepoints. Secondary
endpoints included the occurrence of clinically relevant arrhythmias
within 24 hours after reperfusion, the need for inotropic support, time to
detubation, duration of stay in the intensive-care unit, and postoperative
use of insulin. This study is registered with ClinicalTrials.gov, number
NCT01438723. Findings: Between Nov 8, 2011, and Nov 22, 2013, we randomly
assigned 111 patients to treatment (57 to metformin and 54 to placebo).
Five patients dropped out from the metformin group, and six from the
placebo group. 52 patients in the metformin group and 48 patients in the
placebo group were included in the per-protocol analysis. Geometric mean
high-sensitivity troponin I increased from 0 mug/L to 367 mug/L (95% CI
306-441) with metformin and to 332 mug/L (275-401) with placebo at 6 h
after reperfusion; 284 mug/L (237-341) and 245 mug/L (202-296),
respectively, at 12 h; and to 177 mug/L (147-212) and 160 mug/L (132-194)
at 24 h. The concentrations did not differ significantly between the
groups (difference 123% for all timepoints [95% CI -124 to 441] p=035).
Occurrence of arrhythmias did not differ between groups (three [58%] of 52
patients who received metformin vs three [63%] of 48 patients who received
placebo; p=100). There was no difference between groups in the need for
inotropic support, time to detubation, duration of stay in the
intensive-care unit, or postoperative use of insulin. No patients died
within 30 days after surgery. Occurrence of gastrointestinal discomfort
(mostly diarrhoea) was significantly higher with metformin than with
placebo (11 [212%] of 52 vs two [42%] of 48 patients; p=001).
Interpretation: Short-term metformin pretreatment, although safe, does not
seem to be an effective strategy to reduce periprocedural myocardial
injury in patients without diabetes undergoing CABG surgery.

<31>
Accession Number
71972116
Authors
Rahimtoola S.H. Huang G.
Institution
(Rahimtoola, Huang) University of Southern California, Los Angeles, CA,
United States
Title
Treatment of obstructive thrombosed prosthetic heart valve.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
20th World Congress on Heart Disease Annual Scientific Sessions 2015
Vancouver, BC Canada. Conference Start: 20150725 Conference End: 20150727.
Conference Publication: (var.pagings). 131 (pp 98), 2015. Date of
Publication: July 2015.
Publisher
S. Karger AG
Abstract
A systematic review of the literature from 1996 -2012 revealed 9 studies
with 48 patients with tricuspid OT PHV in whom thrombolytic therapy was
successful in 88%. For left sided OT PHV, 17 studies comprising 756
patients had received thrombolytic therapy (TT) and in 13 studies
comprising 662 patients had received surgical therapy (ST). Females were
present 59% (TT) and 66% (ST). All but 3 patients had a mechanical valve.
In 10 ST comprising 518 patients, thrombus was present in 41%, pannus in
38%, thrombus + pannus in 21%. Anticoagulants were described as inadequate
in 39%. Mitral valve was involved in 68% (TT), 73% (ST); remainder had
aortic valve; NYHA Class III/IV 65% (TT) 81% (ST); remainder were in NYHA
Class I/II. Recurrence rate was 13% (TT) 6% (ST); CVA/Emboli 14% (TT) 6%
(ST). In TT, complete success was 70%. 30 day mortality was 8%. In (TT)
failure rate was 30% with mortality up to 28%. In TT Failure group, 15
patients died while waiting for surgery. In ST, complete success occurred
in 100% with 30 day mortality of 15%. Suggested therapeutic strategies:
Tricuspid OT PHV Thrombolytic TT is first choice. Left sided OT PHV: TT
first choice in NYHA FCI/II, those with very severe comorbid conditions,
ST not a viable option or patient refuses surgery. Left sided OT PHV: ST
is first choice if prosthesis replacement is necessary or appropriate,
coronary flow is compromised TT is contraindicated, pannus is a
significant contributor, TT fails.

<32>
Accession Number
71972057
Authors
Manda Y.R. Agrawal S. Sarnoski C. Durkin R. Puleo P. Shirani J.
Institution
(Manda, Agrawal, Sarnoski, Durkin, Puleo, Shirani) St Lukes University
Health Network, Bethlehem, PA, United States
Title
Radial approach to coronary artery bypass graft angiography and
intervention reduces access site complications.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
20th World Congress on Heart Disease Annual Scientific Sessions 2015
Vancouver, BC Canada. Conference Start: 20150725 Conference End: 20150727.
Conference Publication: (var.pagings). 131 (pp 39), 2015. Date of
Publication: July 2015.
Publisher
S. Karger AG
Abstract
Background: Transradial (TR) approach to coronary artery angiography and
intervention is gaining popularity with reduced morbidity and mortality
compared to transfemoral (TF). Safety and effectiveness of TR approach in
setting of bypass graft angiography and intervention is not well studied.
Methods: Systemic review of literature identified 1 randomized and 6
observational studies (n=1370) that addressed this issue. Meta-analysis
compared characteristics and outcomes of each approach including vascular
access site complications, major adverse cardiovascular events (MACE),
access site crossover rates, fluoroscopy time, procedure time and contrast
volume use. Results: (figure). Baseline patient characteristics were
similar in both groups. Compared to TF, TR had decreased vascular access
site complications (1.4%-vs-3.8%; OR: 0.34, 95% CI 0.16-0.75; p=0.008) and
a tendency towards lower MACE (2.39%-vs- 4.7%; OR 0.57, 95% CI 0.25-1.3;
p=0.18). No difference was found in rates of major bleeding
(0.17%-vs-0.57%; p=0.58) or in-hospital death (0.29%-vs-0.7%, p=0.54).
Risk of vascular access site crossover was higher in TR (5.16%-vs-0.4%;
p=0.0003). TR was associated with comparable fluoroscopy time, procedure
time and contrast volume usage to TF (all p>0.05). Conclusion: Transradial
approach to bypass graft angiography and intervention reduces vascular
access site complications and has comparable fluoroscopy time and contrast
volume usage. (Table Presented).

<33>
Accession Number
71962545
Authors
Al-Khabori M. Al-Riyami A. Siddiqi S. Al-Sabti H.
Institution
(Al-Khabori, Al-Riyami) Hematology, Muscat, Oman
(Siddiqi, Al-Sabti) Surgery, Sultan Qaboos University Hospital, Muscat,
Oman
Title
Cell salvage during cardiac surgery may decrease red blood cell
transfusion: A systematic review and meta-analysis.
Source
Haematologica. Conference: 20th Congress of the European Hematology
Association Vienna Austria. Conference Start: 20150611 Conference End:
20150614. Conference Publication: (var.pagings). 100 (pp 138-139), 2015.
Date of Publication: 22 Jun 2015.
Publisher
Ferrata Storti Foundation
Abstract
Background: Red blood cell transfusion in cardiac surgery is known to be
associated with increased morbidity and mortality. The use of the cell
salvage (CS) as a blood conservative strategy in cardiac surgery has been
under debate with conflicting results from different studies. Aims: We
examined the current evidence behind the use of the CS by performing a
systematic review and meta-analysis of existing randomized clinical trials
that assessed the impact of the CS use on red blood cell (RBC)
transfusion. Methods: We searched MEDLINE, CENTRAL, American Society of
Hematology and bibliographies of relevant studies (all searched July 2014)
for randomized clinical trials comparing CS versus non-CS strategies in
cardiac surgeries. We performed a meta-analysis using random effects model
(DerSimonian- Laird) to estimate the pooled odds ratio and used I2
statistic to assess the heterogeneity. Results: Total of 587 citations
were retrieved, out of which 14 trials were eligible for inclusion with a
total of 1661 patients (899 in the CS group and 762 in the non-CS group).
The vast majority of patients had coronary artery bypass graft surgery.
All trials used shed blood for CS. In the CS group, 345 patients (38%)
received RBC transfusion compared to 340 patients (45%) in the non-CS
group. The odds of receiving blood transfusion were lower in the CS group
(odds ratio of 0.66, 95% confidence interval [CI]: 0.45-0.96; Figure).
Nevertheless, there was substantial heterogeneity between the trails in
the outcome [I2 of 60% (95% CI: 19-87%) which was statistically
significant (P<0.01). Summary and Conclusions: Available evidence suggests
that the use of CS during cardiac surgery as a blood conservative strategy
may decrease RBC transfusion with a reasonable effect size. However, these
findings need to be taken with caution, given the substantial
between-study heterogeneity in the outcome. We therefore recommend a large
randomized controlled clinical trial to confirm these findings.