EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2011469006
Authors
Montalescot G. Zeymer U. Silvain J. Boulanger B. Cohen M. Goldstein P.
Ecollan P. Combes X. Huber K. Pollack Jr. C. Benezet J.-F. Stibbe O.
Filippi E. Teiger E. Cayla G. Elhadad S. Adnet F. Chouihed T. Gallula S.
Greffet A. Aout M. Collet J.-P. Vicaut E.
Institution
(Montalescot, Silvain, Collet) Institut de Cardiologie, CHU
Pitie-Salpetrire (AP-HP), Universite Paris 6, Paris, France
(Ecollan) SMUR, CHU Pitie-Salpetrire (AP-HP), Universite Paris 6, Paris,
France
(Zeymer) Herzzentrum Klinikum Ludwigshafen, Medizinische Klinik B,
Ludwigshafen, Germany
(Boulanger) SAMU, CH Bretagne Atlantique, Vannes, France
(Filippi) Cardiology Department, CH Bretagne Atlantique, Vannes, France
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States
(Goldstein) SAMU, CHU Lille, France
(Combes) SAMU, Henri Mondor Hospital, Creteil, France
(Teiger) Cardiology Department, Henri Mondor Hospital, Creteil, France
(Huber) Department of Internal Medicine, Cardiology and Emergency
Medicine, Wilhelminenhospital, Vienna, Austria
(Pollack Jr.) Pennsylvania Hospital, University of Pennsylvania,
Philadelphia, PA, United States
(Benezet) SAMU, CH Caremeau, Nimes, France
(Cayla) Cardiology Department, CH Caremeau, Nimes, France
(Stibbe) SAMU, CH de Lagny, Lagny-sur-Marne, France
(Elhadad) Cardiology Department, CH de Lagny, Lagny-sur-Marne, France
(Adnet) SAMU, Hopital Avicenne, Bobigny, France
(Chouihed) SAMU, Hopital Central, Nancy, France
(Gallula) SMUR, Hopital Lariboisire, Paris, France
(Greffet) SAMU, Hopital Necker, Paris, France
(Aout, Vicaut) Unite de Recherche Clinique, Lariboisire Hospital (AP-HP),
Universite Paris 7, Paris, France
Title
Intravenous enoxaparin or unfractionated heparin in primary percutaneous
coronary intervention for ST-elevation myocardial infarction: The
international randomised open-label ATOLL trial.
Source
The Lancet. 378 (9792) (pp 693-703), 2011. Date of Publication: August
20-26, 2011.
Publisher
Lancet Publishing Group
Abstract
Background Primary percutaneous coronary intervention (PCI) for
ST-elevation myocardial infarction has traditionally been supported by
unfractionated heparin, which has never been directly compared with a new
anticoagulant using consistent anticoagulation and similar antiplatelet
strategies in both groups. We compared traditional heparin treatment with
intravenous enoxaparin in primary PCI. Methods In a randomised open-label
trial, patients presenting with ST-elevation myocardial infarction were
randomly assigned (1:1) to receive an intravenous bolus of 05 mg/kg of
enoxaparin or unfractionated heparin before primary PCI. Wherever
possible, medical teams travelling in mobile intensive care units
(ambulances) selected, randomly assigned (using an interactive voice
response system at the central randomisation centre), and treated
patients. Patients who had received any anticoagulant before randomisation
were excluded. Patients and caregivers were not masked to treatment
allocation. The primary endpoint was 30-day incidence of death,
complication of myocardial infarction, procedure failure, or major
bleeding. The main secondary endpoint was the composite of death,
recurrent acute coronary syndrome, or urgent revascularisation. Analysis
was by intention to treat. This trial is registered at ClinicalTrials.gov,
number NCT00718471. Findings 910 patients were assigned to treatment with
enoxaparin (n=450) or unfractionated heparin (n=460). The primary endpoint
occurred in 126 (28) patients after anticoagulation with enoxaparin versus
155 (34) patients on unfractionated heparin (relative risk [RR] 083, 95 CI
068-101, p=006). The incidence of death (enoxaparin, 17 [4] vs heparin, 29
[6] patients; p=008), complication of myocardial infarction (20 [4] vs 29
[6]; p=021), procedure failure (100 [26] vs 109 [28]; p=061), and major
bleeding (20 [5] vs 22 [5]; p=079) did not differ between groups.
Enoxaparin resulted in a significantly reduced rate of the main secondary
endpoint (30 [7] vs 52 [11] patients; RR 059, 95 CI 038-091, p=0015).
Death, complication of myocardial infarction, or major bleeding (46 [10]
vs 69 [15] patients; p=003), death or complication of myocardial
infarction (35 [8] vs 57 [12]; p=002), and death, recurrent myocardial
infarction, or urgent revascularisation (23 [5] vs 39 [8]; p=004) were all
reduced with enoxaparin. Interpretation Intravenous enoxaparin compared
with unfractionated heparin significantly reduced clinical ischaemic
outcomes without differences in bleeding and procedural success.
Therefore, enoxaparin provided an improvement in net clinical benefit in
patients undergoing primary PCI. Funding Direction de la Recherche
Clinique, Assistance Publique-Hopitaux de Paris; Sanofi-Aventis. &#xa9;
2011 Elsevier Ltd.

<2>
Accession Number
2009061461
Authors
Bost M. Blouin E.
Institution
(Bost) Trace Element-Institute for UNESCO, 1, Place de l'Ecole, 69342 Lyon
Cedex 07, France
(Bost) Laboratory of Trace Element Analysis, UF 21303, Biochemical
Department, Lyon, France
(Blouin) Labcatal Pharmaceuticals, Montrouge, France
Title
Effect of supplementation with Se-enriched yeast and factors influencing
Se concentration in plasma of transplant recipients.
Source
Journal of Trace Elements in Medicine and Biology. 23 (1) (pp 36-42),
2009. Date of Publication: January 2009.
Publisher
Elsevier GmbH
Abstract
The aim of this study was to assess the bioavailability of selenium (Se)
in Se-enriched yeast and the possible impact of age, sex and area of
residence on the Se concentration in plasma in 179 transplant recipients,
as Se clinical effects in the prevention of cutaneous epithelial lesions
in organ transplant recipients has been reported elsewhere. Subjects were
randomized to receive either 200 mug Se/day (group 1:91 patients) or
placebo (group 2: 88 patients) for 3 years. Plasma Se levels were measured
at the beginning of the study and after 4, 12, 24 and 36 months of Se or
placebo supplementation. Initial plasma Se levels were 90.9+/-26.1 mug/L
for placebo and 94.0+/-25.3 mug/L for Se-supplemented groups. At baseline,
the Se level was not linked to sex and age but to area of residence,
although the number of subjects in each area was insufficient to draw any
conclusions. Plasma Se levels were statistically lower in cases of liver
transplant compared to kidney and heart transplant (p=0.03). Over the
3-year period of supplementation, plasma Se in the supplemented subjects
was significantly higher than in the placebo group (p<0.01) and there was
an interaction (p<0.01) between supplementation and time for plasma Se.
Supplementation with Se-enriched yeast significantly increased the Se
concentration in plasma of the patients to a plateau: the mean plasma Se
of the Se-supplemented patients increased to 164.7+/-35.8 mug/L at 4
months and then remained similar at 12 (176.1+/-48.3 mug/L), 24
(176.1+/-54.2 mug/L) and 36 (182.2+/-46.4 mug/L) months. &#xa9; 2008
Elsevier GmbH. All rights reserved.

<3>
Accession Number
2015309388
Authors
Ng R.R.G. Chew S.T.H. Liu W. Ong P. Caleb M.G. Ti L.K.
Institution
(Ng, Liu, Ti) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Chew) Department of Anaesthesiology, Singapore General Hospital,
Singapore, Singapore
(Chew) Department of Cardiovascular and Metabolic Disorders, Duke-National
University of Singapore, Graduate Medical School, Singapore, Singapore
(Ong, Caleb) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Singapore, Singapore
(Ti) Department of Anaesthesia, National University Health System, 5 Lower
Kent Ridge Road, Singapore 119074, Singapore
Title
The inflammatory response between miniaturised and conventional
cardiopulmonary bypass after cardiac surgery in an Asian population.
Source
Perfusion (United Kingdom). 30 (6) (pp 487-494), 2015. Date of
Publication: 19 Sep 2015.
Publisher
SAGE Publications Ltd
Abstract
Introduction: We compared the systemic inflammatory response of the MCPB
system to the CCPB system with cell salvage and phosphorylcholine-coated
tubing amongst Asian patients undergoing coronary artery bypass grafting.
Methods: Seventy-eight patients were randomly assigned to the MCPB or the
CCPB groups equally and followed up in a prospective, single-blinded,
randomised, controlled trial. Levels of TNF-alpha, IL-6, CRP and LDH were
measured peri-operatively. Results: The systemic inflammatory response was
similar in both groups (TNF-alpha: p=0.222; IL-6: p=0.991; CRP: p=0.258).
Only haemolysis was significantly higher in the CCPB group (LDH: p=0.011).
The MCPB system was twice more expensive, but had a near 4-fold cost
saving in tranfusions. Overall, the MCPB system cost 20% more than the
modified CCPB system. Conclusion: These results corroborate with studies
that demonstrated the avoidance of cardiotomy suction rather than the MCPB
system, itself, leads to an attenuated inflammatory response. The absence
of obvious clinical benefit and the higher costs involved with the MCPB
system would preclude its routine use.

<4>
Accession Number
2015215961
Authors
Smits P.C. Vlachojannis G.J. McFadden E.P. Royaards K.-J. Wassing J.
Joesoef K.S. Van Mieghem C. Van De Ent M.
Institution
(Smits, Vlachojannis, McFadden, Royaards, Wassing, Joesoef, Van Mieghem,
Van De Ent) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
Title
Final 5-Year Follow-Up of a Randomized Controlled Trial of Everolimus- and
Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice
the COMPARE Trial (A Trial of Everolimus-Eluting Stents and Paclitaxel
Stents for Coronary Revascularization in Daily Practice).
Source
JACC: Cardiovascular Interventions. 8 (9) (pp 1157-1165), 2015. Date of
Publication: 17 Aug 2015.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to report the 5-year outcomes of
everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in an
all-comers population undergoing percutaneous coronary intervention (PCI).
Background The medium-term 1 and 2-year results of the prospective
randomized COMPARE trial (A Trial of Everolimus-Eluting Stents and
Paclitaxel-Eluting Stents for Coronary Revascularization in Daily
Practice) showed superior clinical outcomes with EES compared with PES in
an all-comers PCI population. Whether this benefit is sustained over
longer-term follow-up is unknown. Furthermore, systematic long-term
follow-up data on these metallic drug eluting stents with durable polymers
are scarce. Methods We randomly assigned 1,800 patients undergoing PCI to
EES or PES. The pre-specified composite primary endpoint was death,
myocardial infarction (MI), or target vessel revascularization (TVR).
Results Follow-up at 5 years was completed in 1,791 (99.5%) patients.
Treatment with EES compared with PES led to a relative risk reduction of
the primary endpoint by 27% (18.4% vs. 25.1%, p = 0.0005), driven by lower
rates of MI (7.0% vs. 11.5%, p = 0.001) and TVR (7.4% vs. 11.4%, p =
0.003), but not with mortality (9.0% vs. 10.3%, relative risk 0.88, p =
0.36). Moreover, patients treated with EES compared with PES had lower
rates of definite/probable stent thrombosis at 5 years (3.1% vs. 5.9%, p =
0.005). The hazard curves for TVR, MI, and stent thrombosis diverge over
the first 3 years and, subsequently, progress in parallel. Conclusions The
early- and medium-term superiority of EES over PES measured both by safety
and efficacy endpoints is sustained at 5 years in this all-comer
population. (A Trial of Everolimus-Eluting Stents and Paclitaxel-Eluting
Stents for Coronary Revascularization in Daily Practice [COMPARE];
NCT01016041).

<5>
Accession Number
2015311537
Authors
Lansky A.J. Schofer J. Tchetche D. Stella P. Pietras C.G. Parise H. Abrams
K. Forrest J.K. Cleman M. Reinohl J. Cuisset T. Blackman D. Bolotin G.
Spitzer S. Kappert U. Gilard M. Modine T. Hildick-Smith D. Haude M.
Margolis P. Brickman A.M. Voros S. Baumbach A.
Institution
(Lansky, Pietras, Parise, Forrest, Cleman) Division of Cardiology, Yale
School of Medicine, New Haven, CT, United States
(Lansky, Pietras, Parise) Yale Cardiovascular Research Group, New Haven,
CT, United States
(Schofer) Cardiovascular Center, Hamburg University, Hamburg, Germany
(Tchetche) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Abrams) Department of Radiology, Baptist Hospital of Miami, Miami, FL,
United States
(Reinohl) Department of Cardiology and Angiology i, Heart Center,
University of Freiburg, Freiburg, Germany
(Cuisset) Department of Cardiology, CHU Timone, Marseille, France
(Blackman) Department of Cardiology, Leeds Teaching Hospitals NHS Trust,
Leeds General Infirmary, Leeds, United Kingdom
(Bolotin) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa,
Israel
(Spitzer) Praxisklinik Herz und Gefase, Dresden, Germany
(Kappert) Herzzentrum Dresden GmbH, Universitatsklinik, Dresden, Germany
(Gilard) Department of Cardiology, Brest University, Brest, France
(Modine) Department of Cardiovascular Surgery, Hopital Cardiologique,
Lille, France
(Hildick-Smith, Haude) Sussex Cardiac Centre, Brighton and Sussex
University Hospital NHS Trust, Brighton, United Kingdom
(Margolis) Keystone Heart Ltd., Caesarea, Israel
(Brickman) Department of Neurology, College of Physicians and Surgeons,
Columbia University, New York, NY, United States
(Brickman) Taub Institute for Research on Alzheimer's Disease and the
Aging Brain, College of Physicians and Surgeons, Columbia University, New
York, NY, United States
(Voros) Global Institute for Research, Richmond, VA, United States
(Baumbach) Bristol Heart Institute, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
Title
A prospective randomized evaluation of the TriGuardTM HDH embolic
DEFLECTion device during transcatheter aortic valve implantation: Results
from the DEFLECT III trial.
Source
European Heart Journal. 36 (31) (pp 2070-2078), 2015. Date of Publication:
14 Aug 2015.
Publisher
Oxford University Press
Abstract
Aims To evaluate the safety, efficacy, and performance of the TriGuardTM
HDH Embolic Deflection Device (TriGuard) compared with no cerebral
protection in patients undergoing transcatheter aortic valve implantation
(TAVI). Methods and results From February 2014 to March 2015, 85 subjects
undergoing TAVI at 13 centres in Europe and Israel were randomized to
TriGuard protection vs. no protection. Subjects underwent neurologic and
cognitive evaluation at baseline, pre-discharge and 30 days; cerebral
diffusion-weighted magnetic resonance imaging was performed at 4 +/- 2
days post-procedure and at 30 days. Technical success, which included
complete 3-vessel cerebral coverage, was achieved in 88.9% (40/45) of
cases. The primary in-hospital procedural safety endpoint (death, stroke,
life-threatening or disabling bleeding, stage 2 or 3 acute kidney injury,
or major vascular complications) occurred in 21.7% of TriGuard and 30.8%
of control subjects (P = 0.34). In the Per Treatment population (subjects
with complete three-vessel cerebral coverage), TriGuard use was associated
with greater freedom from new ischaemic brain lesions (26.9 vs. 11.5%),
fewer new neurologic deficits detected by the National Institutes of
Health Stroke Scale (3.1 vs. 15.4%), improved Montreal Cognitive
Assessment (MoCA) scores, better performance on a delayed memory task (P =
0.028) at discharge, and a >2-fold increase in recovery of normal
cognitive function (MoCA score >26) at 30 days. Conclusion TriGuard
cerebral protection during TAVI is safe and complete cerebral vessel
coverage was achieved in 89% of subjects. In this exploratory study,
subjects undergoing protected TAVI had more freedom from ischaemic brain
lesions, fewer neurologic deficits, and improved cognitive function in
some domains at discharge and 30 days compared with controls.

<6>
Accession Number
2015310098
Authors
Raksakietisak M. Ngamlamiad C. Duangrat T. Soontarinka S. Raksamani K.
Institution
(Raksakietisak, Ngamlamiad, Duangrat, Soontarinka, Raksamani) Department
of Anesthesiology, Mahidol University, Bangkok, Thailand
Title
The changes in cortisol levels during cardiac surgery: A randomized
double-blinded study between two induction agents etomidate and
thiopentone.
Source
Journal of the Medical Association of Thailand. 98 (8) (pp 775-781), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Medical Association of Thailand
Abstract
Objective: To study the changes in cortisol levels during and after
cardiac surgery after an inductive dose of either etomidate or thiopentone
and their consequences. Material and Method: A prospective, randomized,
double-blinded study was conducted in 26 patients undergoing elective
cardiac surgery. They received either etomidate or thiopentone for
induction. Serum cortisol levels were measured preoperatively, and then at
2-, 4-, 8-, and 24-hour. All of the patients received standard anesthesia
and surgery. The data also included patients perioperative management and
outcome. Results: There is no difference in patients' characteristics. The
baseline plasma morning cortisols in the two groups were comparable
(11.7?7.5 mcg/dL in etomidate group vs. 12.0?8.2 mcg/dL in thiopentone
group). In both groups, during surgery, the cortisol levels rose to higher
levels and reached peak levels at four to eight hours and related to
surgical stress. At all times, the etomidate group had lower cortisol
levels but only at 8-hour, the etomidate group had significantly lower
cortisol level (39.9+/-14.2 vs. 65.9+/-20.0 mcg/dL). At 24 hours, in both
groups, cortisol levels were lower than at 8-hour but did not return to
normal baseline levels. There were no differences in the dose of inotropic
use and ICU stay. However, surprisingly the etomidate group had shorter
hospital stay. Conclusion: A single dose of etomidate used for induction
in elective cardiac patients can partially and reversibly inhibit of the
cortisol synthesis for, at least, 24 hours, but its association with any
hemodynamic consequences cannot be concluded. Registration:
ClinicalTrials.gov as NCT01495949.

<7>
Accession Number
2015305470
Authors
George P. Chander R. Liddle D. Abraham V.
Institution
(George, Chander, Liddle, Abraham) Department of Anesthesiology, Christian
Medical College, Ludhiana, Punjab, India
Title
Premedication dilemmas, is Pregabalin the answer?.
Source
Journal of Research in Pharmacy Practice. 4 (3) (pp 142-146), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: Laryngoscopy and intubation are associated with sympathetic
stimulation which can prove deleterious in patients with cardiovascular
compromise; so, various methods have been tried to obtund this pressor
response. In this study, we have assessed the efficacy of pregabalin in
attenuating the pressor response to laryngoscopy and intubation. Methods:
This prospective randomized study included 80 patients with American
Society of Anesthesiologists physical status grades I-II, in the age group
of 18-60 years of age. The patients were randomized into two groups of 40
patients each. Group A received the placebo orally, 90 min prior to
surgery. Group B received 150 mg of pregabalin orally, 90 min prior to
surgery. These patients were assessed in terms of sedation with Ramsay
sedation scale (RSS). In the operation theatre, the heart rate (HR),
systolic blood pressure, diastolic blood pressure, mean arterial pressure,
and oxygen saturation recorded at baseline and 1, 3, 5, and 10 min after
intubation. The rate pressure product (RPP) was calculated for these time
intervals. In the postoperative period, patients were assessed for
complications like dizziness, nausea, and blurred vision. Statistical
analysis was performed using Chi-square and ANOVA tests. Findings: The
group receiving 150 mg of pregabalin as premedication was found to be
adequately sedated at 1 h post-premedication with 52% patients having a
RSS score of 3 compared to 4% with the same RSS score in the placebo group
(P < 0.0001). Hemodynamics was more stable post-intubation with
significant stability in the HR (P = 0.002) and RPP (P = 0.004) in the
pregabalin group. Conclusion: Pregabalin when given as a premedication
provides adequate sedation and obtunds the pressor response seen with
intubation.

<8>
Accession Number
2015295620
Authors
Blaha J. Mraz M. Kopecky P. Stritesky M. Lips M. Matias M. Kunstyr J.
Porizka M. Kotulak T. Kolnikova I. Simanovska B. Zakharchenko M. Rulisek
J. Sachl R. Anyz J. Novak D. Lindner J. Hovorka R. Svacina S. Haluzik M.
Institution
(Blaha, Kopecky, Stritesky, Lips, Matias, Kunstyr, Porizka, Kotulak,
Kolnikova, Simanovska, Zakharchenko, Rulisek, Sachl) Department of
Anesthesia, General University Hospital, Charles University in Prague
First Faculty of Medicine, Prague 1 128 08, Czech Republic
(Mraz, Svacina, Haluzik) Third Department of Medicine-Department of
Endocrinology and Metabolism, General University Hospital, Charles
University in Prague First Faculty of Medicine, Prague 1 128 08, Czech
Republic
(Lindner) Second Department of Surgery-Department of Cardiovascular
Surgery, General University Hospital, Charles University in Prague First
Faculty of Medicine, Prague 1 128 08, Czech Republic
(Anyz, Novak) Department of Cybernetics, Faculty of Electrical
Engineering, Czech Technical University, Prague 2 121 35, Czech Republic
(Hovorka) Institute of Metabolic Science, University of Cambridge,
Cambridge CB2 3AD, United Kingdom
Title
Perioperative tight glucose control reduces postoperative adverse events
in nondiabetic cardiac surgery patients.
Source
Journal of Clinical Endocrinology and Metabolism. 100 (8) (pp 3081-3089),
2015. Date of Publication: 01 Aug 2015.
Publisher
Endocrine Society
Abstract
Context: Tight glucose control (TGC) reduces morbidity and mortality in
patients undergoing elective cardiac surgery, but only limited data about
its optimal timing are available to date. Objective: The purpose of this
article was to compare the effects of perioperative vs postoperative
initiation of TGC on postoperative adverse events in cardiac surgery
patients. Design: This was a single center, single-blind, parallel-group,
randomized controlled trial. Settings: The setting was an academic
tertiary hospital. Participants: Participants were 2383 hemodynamically
stable patients undergoing major cardiac surgery with expected
postoperative intensive care unit treatment for at least 2 consecutive
days. Intervention: Intensive insulin therapy was initiated
perioperatively or postoperatively with a target glucose range of 4.4 to
6.1 mmol/L. Main Outcome Measures: Adverse events from any cause during
postoperative hospital stay were compared. Results: In the whole cohort,
perioperatively initiated TGC markedly reduced the number of postoperative
complications (23.2% vs 34.1%,95% confidence interval [CI],
0.60-0.78)despite only minimal improvement in glucose control (blood
glucose, 6.6 +/- 0.7 vs 6.7 +/- 0.8 mmol/L, P < .001; time in target
range, 39.3% +/- 13.7% vs 37.3% +/- 13.8%, Po < .001). The positive
effects of TGC on postoperative complications were driven by nondiabetic
subjects (21.3% vs 33.7%, 95% CI, 0.54-0.74; blood glucose 6.5 +/- 0.6 vs
6.6 +/- 0.8 mmol/L, not significant; time in target range, 40.8% +/- 13.6%
vs 39.7% +/- 13.8%, not significant), whereas no significant effect was
seen in diabetic patients (29.4% vs 35.1%, 95% CI, 0.66-1.06) despite
significantly better glucose control in the perioperative group (blood
glucose, 6.9 +/- 1.0 vs 7.1 +/- 0.8 mmol/L, P < .001; time in target
range, 34.3% +/- 12.7% vs 30.8% +/- 11.5%, P < .001). Conclusions:
Perioperative initiation of intensive insulin therapy during cardiac
surgery reduces postoperative morbidity in nondiabetic patients while
having a minimal effect in diabetic subjects.

<9>
Accession Number
2015308290
Authors
Ilic M.K. Adam V.N. Matolic M. Kogler J. Butkovic D.
Institution
(Ilic, Adam, Matolic) Sveti Duh Univesity Hospital, Department of
Anesthesiology, Reanimatology and Intensive Care, Croatia
(Kogler) University Hospital Centre Zagreb, Department of Anesthesiology,
Reanimatology and Intensive Care, Croatia
(Butkovic) Childrens's Hospital Zagreb, Department of Anesthesiology,
Reanimatology and Intensive Care, Croatia
Title
Paravertebral block: Review of the literature.
Source
Periodicum Biologorum. 117 (2) (pp 315-317), 2015. Date of Publication: 01
Jun 2015.
Publisher
Croatian Society of Natural Sciences
Abstract
Background: Paravertebral Block (PVB) is an established regional
anesthetic technique. It is technically easy to perform and is being used
increasingly for intra-operative and post-operative analgesia. This
popularity is mainly due to the ease of the technique and fewer
complications. Materials and Methods: This is quantitative systematic
review of literature database with the aim to assess the efficacy and
safety of Paravertebral block in thoracic, abdominal and breast surgery.
Results: Six randomised control trials that included 386 patients were
reviewed. Authors of reviewed articles reported 100% success in block
effectivenes and low incidence of complications. Conclusion: Paravertebral
block is effectiv anesthetic/analgetic technique with very few
complications.

<10>
Accession Number
2015303125
Authors
Molnar A.O. Fergusson D. Tsampalieros A.K. Bennett A. Fergusson N. Ramsay
T. Knoll G.A.
Institution
(Molnar, Fergusson, Tsampalieros, Bennett, Fergusson, Ramsay, Knoll)
Division of Nephrology, Kidney Research Centre, Department of Medicine,
University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Canada
(Molnar, Tsampalieros, Bennett, Fergusson) Clinical Epidemiology Program,
Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa K1H 8L6, Canada
(Fergusson) Division of Nephrology, Children's Hospital of Eastern
Ontario, 401 Smyth Road, Ottawa K1H 8L1, Canada
Title
Generic immunosuppression in solid organ transplantation: Systematic
review and meta-analysis.
Source
BMJ (Online). 350 , 2015. Article Number: h3163. Date of Publication: 22
Jun 2015.
Publisher
BMJ Publishing Group
Abstract
OBJECTIVE: To compare the clinical efficacy and bioequivalence of generic
immunosuppressive drugs in patients with solid organ transplants. DESIGN:
Systematic review and meta-analysis of all studies comparing generic with
innovator immunosuppressive drugs. DATA SOURCES: Medline and Embase from
1980 to September 2014. REVIEW METHODS: A literature search was performed
for all studies comparing a generic to an innovator immunosuppressive drug
in solid organ transplantation. Two reviewers independently extracted data
and assessed quality of studies. Meta-analyses of prespecified outcomes
were performed when deemed appropriate. Outcomes included patient
survival, allograft survival, acute rejection, adverse events and
bioequivalence. RESULTS: 1679 citations were screened, of which 50 studies
met eligibility criteria (17 randomized trials, 15 non-randomized
interventional studies, and 18 observational studies). Generics were
compared with Neoral (cyclosporine) (32 studies), Prograf (tacrolimus) (12
studies), and Cellcept (mycophenolate mofetil) (six studies). Pooled
analysis of randomized controlled trials in patients with kidney
transplants that reported bioequivalence criteria showed that Neoral (two
studies) and Prograf (three studies) were not bioequivalent with generic
preparations according to criteria of the European Medicines Agency. The
single Cellcept trial also did not meet bioequivalence. Acute rejection
was rare but did not differ between groups. For Neoral, the pooled Peto
odds ratio was 1.23 (95% confidence interval 0.64 to 2.36) for kidney
randomized controlled trials and 0.66 (0.40 to 1.08) for observational
studies. For kidney observational studies, the pooled Peto odds ratios
were 0.98 (0.37 to 2.60) for Prograf and 0.49 (0.09 to 2.56) for Cellcept.
Meta-analyses for non-renal solid organ transplants were not performed
because of a lack of data. There were insufficient data reported on
patient or graft survival. Pooling of results was limited by inconsistent
study methods and reporting of outcomes. Many studies did not report
standard criteria used to determine bioequivalence. While rates of acute
rejection seemed similar and were relatively rare, few studies were
designed to properly compare clinical outcomes. Most studies had short
follow-up times and included stable patients without a history of
rejection. CONCLUSIONS: High quality data showing bioequivalence and
clinical efficacy of generic immunosuppressive drugs in patients with
transplants are lacking. Given the serious consequences of rejection and
allograft failure, well designed studies on bioequivalence and safety of
generic immunosuppression in transplant recipients are needed.

<11>
Accession Number
2015974708
Authors
Liu C. Liu M. Chen D. Liu H. Jiang Q. Lu J. Zuo L.
Institution
(Liu, Chen, Liu, Jiang, Lu, Zuo) Department of Critical Care Medicine, The
First Peoples Hospital of Shunde, No.1 Penglai Rd. Foshan, Foshan 528300,
China
(Liu) Department of Cardiology, The Fifth Affiliated Hospital of Sun
Yat-Sen University, Zhuhai, China
Title
Effectiveness of prolonged clopidogrel-based dual antiplatelet therapy
after drug-eluting stent implantation: Evidence-based meta-analysis.
Source
Herz. 40 (5) (pp 795-802), 2015. Date of Publication: 25 Apr 2015.
Publisher
Urban und Vogel GmbH
Abstract
The use of drug-eluting stents (DESs) for patients with coronary artery
disease is widespread. DESs have been associated with a lower rate of
repeat revascularization, death, and myocardial infarction compared with
bare metal stents. However, DESs can lead to a prothrombotic environment
in the coronary arteries, resulting in a higher rate of thrombotic events.
To counteract this, dual-antiplatelet therapy (DAPT) consisting of aspirin
and clopidogrel is recommended. Currently, there are no clear guidelines
on the duration of DAPT. We therefore conducted a meta-analysis to assess
the effectiveness of prolonged DAPT after DES implantation.

<12>
Accession Number
2015299589
Authors
Basaria S. Harman S.M. Travison T.G. Hodis H. Tsitouras P. Budoff M.
Pencina K.M. Vita J. Dzekov C. Mazer N.A. Coviello A.D. Knapp P.E. Hally
K. Pinjic E. Yan M. Storer T.W. Bhasin S.
Institution
(Basaria, Travison, Pencina, Hally, Pinjic, Storer, Bhasin) Department of
Medicine, Harvard Medical School, Research Program in Men's Health: Aging
and Metabolism, Boston Claude D. Pepper Older Americans Independence
Center, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115,
United States
(Harman, Tsitouras) Kronos Longevity Research Institute, Phoenix, AZ,
United States
(Harman) Phoenix VA Health Care System, Phoenix, AZ, United States
(Hodis, Yan) Atherosclerosis Research Unit, Keck School of Medicine,
University of Southern California, Los Angeles, CA, United States
(Tsitouras) DWR Department of Geriatric Medicine, University of Oklahoma,
Oklahoma City, OK, United States
(Budoff) Los Angeles Biomedical Research Institute, Division of
Cardiology, Harbor-UCLA, Medical Center, Torrance, CA, United States
(Vita) Division of Cardiology, Boston University, School of Medicine,
Boston, MA, United States
(Dzekov) Division of Endocrinology, Metabolism, and Molecular Medicine,
Charles R. Drew University of Medicine and Science, Los Angeles, CA,
United States
(Mazer, Coviello, Knapp) Roche Pharmaceutical Research and Early
Development, Roche Innovation Center Basel, Basel, Switzerland
(Mazer) Division of Endocrinology, Boston University, School of Medicine,
Boston, MA, United States
(Travison) Institute for Aging Research, Hebrew SeniorLife, Boston, MA,
United States
Title
Effects of testosterone administration for 3 years on subclinical
atherosclerosis progression in older men with lowor low-normal
testosterone levels: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 314 (6) (pp 570-581),
2015. Date of Publication: 11 Aug 2015.
Publisher
American Medical Association
Abstract
Importance: Testosterone use in older men is increasing, but its long-term
effects on progression of atherosclerosis are unknown. Objective: To
determine the effect of testosterone administration on subclinical
atherosclerosis progression in older men with low or low-normal
testosterone levels. DESIGN, SETTING, AND PARTICIPANTS Testosterone's
Effects onAtherosclerosis Progression in AgingMen(TEAAM)was a
placebo-controlled, double-blind, parallel-group randomized trial
involving 308men60years or older with lowor low-normal testosterone levels
(100-400 ng/dL; free testosterone <50 pg/mL), recruited at 3US centers.
Recruitment took place between September 2004and February 2009; the last
participant completed the study inMay 2012. INTERVENTIONS One hundred
fifty-six participants were randomized to receive 7.5 g of 1% testosterone
and 152 were randomized to receive placebo gel packets daily for 3 years.
The dose was adjusted to achieve testosterone levels between 500 and 900
ng/dL. Main Outcomes and Measures: Coprimary outcomes included common
carotid artery intima-media thickness and coronary artery calcium;
secondary outcomes included sexual function and health-related quality of
life. Results: Baseline characteristics were similar between groups:
patients were a mean age of 67.6 years; 42% had hypertension; 15%,
diabetes; 15%, cardiovascular disease; and 27%, obesity. The rate of
change in intima-media thickness was 0.010 mm/year in the placebo group
and 0.012 mm/year in the testosterone group (mean difference adjusted for
age and trial site, 0.0002 mm/year; 95%CI, -0.003 to 0.003, P = .89). The
rate of change in the coronary artery calcium score was 41.4 Agatston
units/year in the placebo group and 31.4 Agatston units/year in the
testosterone group (adjusted mean difference, -10.8 Agatston units/year;
95%CI, -45.7 to 24.2; P = .54). Changes in intima-media thickness or
calcium scores were not associated with change in testosterone levels
among individuals assigned to receive testosterone. Sexual desire,
erectile function, overall sexual function scores, partner intimacy, and
health-related quality of life did not differ significantly between
groups. Hematocrit and prostate-specific antigen levels increased more in
testosterone group. Conclusions and Relevance: Among older men with lowor
low-normal testosterone levels, testosterone administration for 3 years vs
placebo did not result in a significant difference in the rates of change
in either common carotid artery intima-media thickness or coronary artery
calcium nor did it improve overall sexual function or health-related
quality of life. Because this trialwas only powered to evaluate
atherosclerosis progression, these findings should not be interpreted as
establishing cardiovascular safety of testosterone use in older men.

<13>
Accession Number
2015251466
Authors
Engstrom T. Kelbaek H. Helqvist S. Hofsten D.E. Klovgaard L. Holmvang L.
Jorgensen E. Pedersen F. Saunamaki K. Clemmensen P. De Backer O. Ravkilde
J. Tilsted H.-H. Villadsen A.B. Aaroe J. Jensen S.E. Raungaard B. Kober L.
Institution
(Engstrom, Kelbaek, Helqvist, Hofsten, Klovgaard, Holmvang, Jorgensen,
Pedersen, Saunamaki, Clemmensen, De Backer, Kober) Department of
Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
(Ravkilde, Tilsted, Villadsen, Aaroe, Jensen, Raungaard) Department of
Cardiology, Aalborg University Hospital, Aalborg, Denmark
(Kelbaek) Department of Cardiology, Roskilde Hospital, Roskilde DK-4000,
Denmark
Title
Complete revascularisation versus treatment of the culprit lesion only in
patients with ST-segment elevation myocardial infarction and multivessel
disease (DANAMI-3 - PRIMULTI): An open-label, randomised controlled trial.
Source
The Lancet. 386 (9994) (pp 665-671), 2015. Date of Publication: 15 Aug
2015.
Publisher
Lancet Publishing Group
Abstract
Summary Background Patients with acute ST-segment elevation myocardial
infarction (STEMI) and multivessel coronary disease have a worse prognosis
compared with individuals with single-vessel disease. We aimed to study
the clinical outcome of patients with STEMI treated with fractional flow
reserve (FFR)-guided complete revascularisation versus treatment of the
infarct-related artery only. Methods We undertook an open-label,
randomised controlled trial at two university hospitals in Denmark.
Patients presenting with STEMI who had one or more clinically significant
coronary stenosis in addition to the lesion in the infarct-related artery
were included. After successful percutaneous coronary intervention (PCI)
of the infarct-related artery, patients were randomly allocated (in a 1:1
ratio) either no further invasive treatment or complete FFR-guided
revascularisation before discharge. Randomisation was done electronically
via a web-based system in permuted blocks of varying size by the clinician
who did the primary PCI. All patients received best medical treatment. The
primary endpoint was a composite of all-cause mortality, non-fatal
reinfarction, and ischaemia-driven revascularisation of lesions in
non-infarct-related arteries and was assessed when the last enrolled
patient had been followed up for 1 year. Analysis was on an
intention-to-treat basis. This trial is registered with
ClinicalTrials.gov, number NCT01960933. Findings From March, 2011, to
February, 2014, we enrolled 627 patients to the trial; 313 were allocated
no further invasive treatment after primary PCI of the infarct-related
artery only and 314 were assigned complete revascularisation guided by FFR
values. Median follow-up was 27 months (range 12-44 months). Events
comprising the primary endpoint were recorded in 68 (22%) patients who had
PCI of the infarct-related artery only and in 40 (13%) patients who had
complete revascularisation (hazard ratio 056, 95% CI 038-083; p=0004).
Interpretation In patients with STEMI and multivessel disease, complete
revascularisation guided by FFR measurements significantly reduces the
risk of future events compared with no further invasive intervention after
primary PCI. This effect is driven by significantly fewer repeat
revascularisations, because all-cause mortality and non-fatal reinfarction
did not differ between groups. Thus, to avoid repeat revascularisation,
patients can safely have all their lesions treated during the index
admission. Future studies should clarify whether complete
revascularisation should be done acutely during the index procedure or at
later time and whether it has an effect on hard endpoints. Funding Danish
Agency for Science, Technology and Innovation and Danish Council for
Strategic Research.

<14>
Accession Number
2015102629
Authors
Turrini F. Scarlini S. Mannucci C. Messora R. Giovanardi P. Magnavacchi P.
Cappelli C. Evandri V. Zanasi A. Romano S. Cavani R. Ghidoni I. Tondi S.
Bondi M.
Institution
(Turrini, Scarlini, Mannucci, Messora, Giovanardi, Bondi) Cardiovascular
Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile
sant'Agostino Estense, Via Giardini 1355, Modena 41125, Italy
(Magnavacchi, Cappelli, Tondi) Cardiology Clinic, Department of
Cardiovascular Disease, Nuovo Ospedale Civile sant'Agostino Estense, Via
Giardini 1355, Modena 41125, Italy
(Evandri, Zanasi) Geriatrics Clinic, Department of Internal Medicine,
Endocrinology, Metabolism and Geriatrics, University of Modena, Via
Giardini 1355, Modena 41125, Italy
(Romano, Cavani) Diabetology Service, AUSL Modena, Via del Pozzo 71,
Modena 41124, Italy
(Ghidoni) Department of Cardiovascular and Thoracic Surgery, Hesperia
Hospital, Modena, Via Arqua 80, Modena 41125, Italy
Title
Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic
patients? the DADDY-D trial. Screening diabetic patients for unknown
coronary disease.
Source
European Journal of Internal Medicine. 26 (6) (pp 407-413), 2015. Article
Number: 2929. Date of Publication: 01 Jul 2015.
Publisher
Elsevier
Abstract
Abstract Objectives To evaluate if screening and treatment of asymptomatic
coronary artery disease (CAD) are effective in preventing first cardiac
event in diabetics. Methods Diabetic patients without known CAD were
randomly assigned to undergo a screening for silent myocardial ischemia
followed by revascularization or to continue follow-up. The reduction of
cardiac death (CD) or nonfatal myocardial infarction (MI) represented the
primary aim; secondary aim was the prevention of heart failure (HF).
Results From September 2007 to May 2012, 520 patients (62 years; 104
female) were enrolled. Silent CAD was found in 20 of 262 patients (7.6%),
revascularization was performed in 12 (4.6%). After a mean follow-up of
3.6 years 12 events (4.6%) occurred in the study group and 14 (5.4%) in
the follow-up (HR = 0.849, 95% CI: 0.393-1.827, P = 0.678). The occurrence
of first HF episode did not differ between groups: 2 (0.8%) in screened
and 7 (2.7%) in follow-up (HR = 0.273, 95% CI: 0.057-1.314, P = 0.083).
Subgroup analysis revealed a significantly lower HF episodes among
patients with intermediate cardiovascular risk (Log rank P = 0.022).
Additionally, when CD and MI were analysed within subgroups, a significant
lower number of CDs was observed among older than 60 years (P = 0.044).
Conclusion Screening and revascularization of silent CAD in diabetics,
failed to demonstrate a significant reduction in cardiac events and HF
episodes. However, our data indicate that further research is warranted in
patients older than 60 years and those with an intermediate cardiovascular
risk. ClinicalTrials.gov NCT00547872.

<15>
Accession Number
2015995121
Authors
Furukawa H. Tanemoto K.
Institution
(Furukawa, Tanemoto) Department of Cardiovascular Surgery, Kawasaki
Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
Title
Frailty in cardiothoracic surgery: systematic review of the literature.
Source
General Thoracic and Cardiovascular Surgery. 63 (8) (pp 425-433), 2015.
Date of Publication: 28 Apr 2015.
Publisher
Springer-Verlag Tokyo
Abstract
A preoperative surgical risk analysis is necessary and important for
predicting clinical and surgical outcomes in a clinical setting. Various
tools for evaluating the patient characteristics in order to forecast
perioperative clinical outcomes have previously been described; however,
an objective and precise preoperative risk assessment has not yet been
established. In the last decade, the concept of frailty, which is a
geriatric assessment that identifies disabilities and weaknesses in
patients, has been used in order to predict clinical mortality and
morbidity following invasive surgical interventions because the prevalence
of elderly patients among those undergoing surgical interventions is
increasing. Since there is currently no single generally accepted clinical
definition of frailty, many clinical modalities are needed to evaluate the
patients' geriatric activity of daily living. Quantifying the quality of
frailty is an evolving challenge for predicting surgical risks
preoperatively. In recent years, with the development of transcatheter
aortic valve implantation (TAVI), this newly definitive preoperative
surgical risk assessment tool, frailty, has become more important and is
attracting interest in cardiothoracic surgical settings. Thus, this review
summarized current consideration on the preoperative risk analysis by
frailty as well as future perspectives and the potential of an ideal
frailty risk assessment in cardiothoracic surgery, including the
management of elderly patients and high-risk aortic valve stenosis by
TAVI.

<16>
Accession Number
2015068490
Authors
Tanoubi I. Sun J.N.M. Drolet P. Fortier L.-P. Donati F.
Institution
(Tanoubi, Drolet, Fortier, Donati) Departement d'anesthesiologie,
Universite de Montreal, Hopital Maisonneuve-Rosemont, 5415 boulevard de
l'Assomption, Montreal, QC H1T 2M4, Canada
(Sun) Departement d'anesthesiologie, Hopital Charles-LeMoyne, Greenfield
Park, QC, Canada
Title
Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask
airway device to reduce coughing at emergence after thoracic surgery: a
randomized controlled single-blind trial.
Source
Canadian Journal of Anesthesia. 62 (9) (pp 988-995), 2015. Date of
Publication: 17 Sep 2015.
Publisher
Springer New York LLC
Abstract
Background: Coughing episodes occur frequently at extubation after
thoracic surgery, and this may be due in part to the double-lumen tube
(DLT). In this study, the DLT was replaced with either a single-lumen
endotracheal tube (ETT) or a laryngeal mask airway (LMA) device or left in
place, and the incidence of coughing at emergence was compared between the
three groups. Methods: Fifty-eight adults scheduled for thoracic surgery
with a DLT were included. Exclusion criteria were an anticipated difficult
airway, obesity, and contraindication to the use of an LMA ProSealTM
(LMA-P). After surgery but before emergence, patients were randomized to
having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2)
removed and replaced by an ETT (ETT Group), or (3) left in place (DLT
Group). The primary outcome was the number of coughing episodes at
extubation. Results: Among 184 patients screened, 124 did not meet
inclusion criteria, and two patients, both in the ETT Group, were excluded
after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT,
and DLT Groups, respectively. There were fewer coughing episodes (median
[quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2[1-3],
respectively; P = 0.01). In the DLT Group, 90% of patients coughed at
least once. This incidence was not significantly different in the ETT
Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group
(35%; P < 0.001). No patient had oxygen desaturation during airway
exchange or at extubation. The incidence and severity of hoarseness and
sore throat were similar in all groups. Conclusion: Coughing at extubation
after thoracic surgery can be reduced if the DLT is replaced by an LMA-P
before emergence. The number of patients in this trial was too small to
evaluate the risks associated with exchanging the airway device. This
trial was registered at ClinicalTrials.gov: NCT00925613.

<17>
Accession Number
2015002406
Authors
Ottens T.H. Nijsten M.W.N. Hofland J. Dieleman J.M. Hoekstra M. van Dijk
D. van der Maaten J.M.A.A.
Institution
(Ottens, Dieleman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center Utrecht, Mail stop Q.04.2.313, PO Box
85500, Utrecht, GA 3508, Netherlands
(Nijsten, van der Maaten) Department of Critical Care, University Medical
Center, University of Groningen, Hanzeplein 1, Groningen, RB 9700,
Netherlands
(Hofland) Department of Anesthesiology, Erasmus University Medical Center,
s Gravendijkwal 230, Rotterdam, CE 3015, Netherlands
(Hoekstra, van der Maaten) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Hanzeplein 1,
Groningen, RB 9700, Netherlands
Title
Effect of high-dose dexamethasone on perioperative lactate levels and
glucose control: A randomized controlled trial.
Source
Critical Care. 19 (1) , 2015. Article Number: 41. Date of Publication:
February 13, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Blood lactate levels are increasingly used to monitor
patients. Steroids are frequently administered to critically ill patients.
However, the effect of steroids on lactate levels has not been adequately
investigated. We studied the effect of a single intraoperative high dose
of dexamethasone on lactate and glucose levels in patients undergoing
cardiac surgery. Methods: The Dexamethasone for Cardiac Surgery (DECS)
trial was a multicenter randomized trial on the effect of dexamethasone 1
mg/kg versus placebo on clinical outcomes after cardiac surgery in adults.
Here we report a pre-planned secondary analysis of data from DECS trial
participants included at the University Medical Center Groningen. The use
of a computer-assisted glucose regulation protocol-Glucose Regulation for
Intensive care Patients (GRIP)-was part of routine postoperative care.
GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters
were area under the lactate and glucose curves over the first 15 hours of
ICU stay (AUC<inf>15</inf>). ICU length of stay and mortality were
observed as well. Results: The primary outcome could be determined in 497
patients of the 500 included patients. During the first 15 hours of ICU
stay, lactate and glucose levels were significantly higher in the
dexamethasone group than in the placebo group: lactate AUC<inf>15</inf>
25.8 (13.1) versus 19.9 (11.2) mmol/L x hour, P <0.001 and glucose
AUC<inf>15</inf> 126.5 (13.0) versus 114.4 (13.9) mmol/L x hour, P <0.001.
In this period, patients in the dexamethasone group required twice as much
insulin compared with patients who had received placebo. Multivariate and
cross-correlation analyses suggest that the effect of dexamethasone on
lactate levels is related to preceding increased glucose levels. Patients
in the placebo group were more likely to stay in the ICU for more than 24
hours (39.2%) compared with patients in the dexamethasone group (25.0%, P
= 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P =
0.759). Conclusions: Intraoperative high-dose dexamethasone increased
postoperative lactate and glucose levels in the first 15 hours of ICU
stay. Still, patients in the dexamethasone group had a shorter ICU length
of stay and similar mortality compared with controls. Trial registration:
ClinicalTrials.gov NCT00293592. Registered 16 February 2006.

<18>
Accession Number
2015998812
Authors
Ruf B. Bonelli V. Balling G. Horer J. Nagdyman N. Braun S.L. Ewert P.
Reiter K.
Institution
(Ruf, Balling, Nagdyman, Ewert) Department of Pediatric Cardiology and
Congenital Heart Disease, German Heart Centre Munich, Technical
University, Lazarettstr. 36, Munich 80636, Germany
(Bonelli) Department of Anaesthesiology, German Heart Centre Munich,
Technical University, Lazarettstr. 36, Munich 80636, Germany
(Horer) Department of Thoracic and Cardiovascular Surgery, German Heart
Centre Munich, Technical University, Lazarettstr. 36, Munich 80636,
Germany
(Braun) Institute of Laboratory Medicine, German Heart Centre Munich,
Technical University, Lazarettstr. 36, Munich 80636, Germany
(Reiter) Department of Pediatric Intensive Care, University Children's
Hospital, von Haunersche Children hospital, Ludwigs-Maximilian University,
Lindwurmstr. 4, Munich 80337, Germany
Title
Intraoperative renal near-infrared spectroscopy indicates developing acute
kidney injury in infants undergoing cardiac surgery with cardiopulmonary
bypass: A case-control study.
Source
Critical Care. 19 (1) , 2015. Article Number: 27. Date of Publication:
January 29, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Acute kidney injury (AKI) is a frequent complication after
cardiac surgery with cardiopulmonary bypass in infants. Renal
near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in
a non-invasive continuous real-time fashion, and reflects tissue
perfusion. The aim of this study was to evaluate the relationship between
renal oximetry and development of AKI in the operative and post-operative
setting in infants undergoing cardiopulmonary bypass surgery. Methods: In
this prospective study, we enrolled 59 infants undergoing cardiopulmonary
bypass surgery for congenital heart disease for univentricular (n = 26) or
biventricular (n = 33) repair. Renal NIRS was continuously measured
intraoperatively and for at least 24 hours postoperatively and analysed
for the intraoperative and first 12 hours, first 24 hours and first 48
hours postoperatively. The renal oximetry values were correlated with the
paediatric risk, injury, failure, loss, end (pRIFLE) classification for
AKI, renal biomarkers and the postoperative course. Results: Twenty-eight
(48%) infants developed AKI based on pRIFLE classification. Already during
intraoperative renal oximetry and further in the first 12 hours, 24 hours
and 48 hours postoperatively, significantly lower renal oximetry values in
AKI patients compared with patients with normal renal function were
recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed
renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths
occurred. Infants with decreased renal oximetry values developed
significantly higher lactate levels 24 hours after surgery. Cystatin C was
a late parameter of AKI, and neutrophil gelatinase-associated lipocalin
values were not correlated with AKI occurrence. Conclusion: Our results
suggest that prolonged low renal oximetry values during cardiac surgery
correlate with the development of AKI and may be superior to conventional
biochemical markers. Renal NIRS might be a promising non-invasive tool of
multimodal monitoring of kidney function and developing AKI in infants
undergoing cardiac surgery with cardiopulmonary bypass.

<19>
Accession Number
2015297668
Authors
Ricci Z. Haiberger R. Pezzella C. Garisto C. Favia I. Cogo P.
Institution
(Ricci, Haiberger, Pezzella, Garisto, Favia, Cogo) Department of
Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit,
Bambino Gesu Children's Hospital, IRCCS, Piazza S. Onofrio 4, Rome 00165,
Italy
Title
Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac
surgery: A randomized controlled trial.
Source
Critical Care. 19 (1) , 2015. Article Number: 2. Date of Publication:
January 07, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Clinical effects of furosemide (F) and ethacrynic acid (EA)
continuous infusion on urine output (UO), fluid balance, and renal,
cardiac, respiratory, and metabolic function were compared in infants
undergoing surgery for congenital heart diseases. Methods: A prospective
randomized double-blinded study was conducted. Patients received
0.2mg/kg/h (up to 0.8mg/kg/h) of either F or EA. Results: In total, 38
patients were enrolled in the F group, and 36, in the EA group. No adverse
reactions were recorded. UO at postoperative day (POD) 0 was significantly
higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6
(2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups
thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with
0.22 (0.13) mg/kg/h of EA (P < 0.0001). Fluid balance was significantly
more negative in the EA group at postoperative day 0: -43 (54) ml/kg/h
versus -17 (32) ml/kg/h in the F group (P = 0.01). Serum creatinine,
cystatin C and neutrophil gelatinase-associated lipocalin levels and
incidence of acute kidney injury did not show significant differences
between groups. Metabolic alkalosis occurred frequently (about 70% of
cases) in both groups, but mean bicarbonate level was higher in the EA
group: 27.8 (1.5) M in the F group versus 29.1 (2) mM in the EA group (P =
0.006). Mean cardiac index (CI) values were 2.6 (0.1) L/min/m2 in the F
group compared with 2.98 (0.09) L/min/m2 in the EA group (P = 0.0081).
Length of mechanical ventilation was shorter in the EA group, 5.5 (8.8)
days compared with the F group, 6.7 (5.9) (P = 0.06). Length of Pediatric
Cardiac Intensive Care Unit (PCICU) admission was shorter in the EA group:
14 (19) days compared with 16 (15) in the F group (P = 0.046).
Conclusions: In cardiac surgery infants, EA produced more UO compared with
F on POD0. Generally, a smaller EA dose is required to achieve similar UO
than F. EA and F were safe in terms of renal function, but EA caused a
more-intense metabolic alkalosis. EA patients achieved better CI, and
shorter mechanical ventilation and PCICU admission time. Trial
registration: Clinicaltrials.gov NCT01628731. Registered 24 June 2012.

<20>
Accession Number
2015297613
Authors
Zangrillo A. Pappalardo F. Dossi R. Di Prima A.L. Sassone M.E. Greco T.
Monaco F. Musu M. Finco G. Landoni G.
Institution
(Zangrillo, Pappalardo, Dossi, Di Prima, Sassone, Greco, Monaco, Landoni)
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan 20132, Italy
(Zangrillo, Landoni) Vita-Salute University San Raffaele of Milan, Via
Olgettina, 58, Milan 20132, Italy
(Musu, Finco) Department of Medical Sciences M. Aresu, Cagliari
University, Bivio di Sestu 554, Monserrato, Cagliari 09042, Italy
Title
Preoperative intra-aortic balloon pump to reduce mortality in coronary
artery bypass graft: A meta-analysis of randomized controlled trials.
Source
Critical Care. 19 (1) , 2015. Article Number: 10. Date of Publication:
January 14, 2015.
Publisher
BioMed Central Ltd.
Abstract
Introduction: The intra-aortic balloon pump is routinely used in cardiac
surgery; however, its impact on outcome is still a matter of debate and
several randomized trials have been published recently. We perform an
updated meta-analysis of randomized controlled trials that investigated
the use of preoperative intra-aortic balloon pump in adult patients
undergoing coronary artery bypass grafting. Methods: Potentially eligible
trials were identified by searching the Medline, Embase, Scopus, ISI Web
of Knowledge and The Cochrane Library. Searches were not restricted by
language or publication status and were updated in August 2014. Randomized
controlled trials on preoperative intra-aortic balloon pump in patients
undergoing coronary artery bypass grafting either with or without
cardiopulmonary bypass were identified. The primary end point was
mortality at the longest follow-up available and the secondary end point
was 30-day mortality. Results: The eight included randomized clinical
trials enrolled 625 patients (312 to the intra-aortic balloon pump group
and 313 to control). The use of intra-aortic balloon pump was associated
with a significant reduction in the risk of mortality (11 of 312 (3.5%)
versus 33 of 313 (11%), risk ratio = 0.38 (0.20 to 0.73), P for effect =
0.004, P for heterogeneity = 0.7, I-square = 0%, with eight studies
included). The benefit on mortality reduction was confirmed restricting
the analysis to trials with low risk of bias, to those reporting 30-day
follow-up and to patients undergoing coronary artery bypass graft surgery
with cardiopulmonary bypass. Conclusions: Preoperative intra-aortic
balloon pump reduces perioperative and 30-day mortality in high-risk
patients undergoing elective coronary artery bypass grafting.

<21>
Accession Number
2015297260
Authors
dos Santos E.C. Lunardi A.C.
Institution
(dos Santos, Lunardi) Universidade Cidade de Sao Paulo, Master's and
Doctoral Programs in Physical Therapy, Cesario Galeno Street, 448/475, Sao
Paulo 03071-000, Brazil
(dos Santos) Universidade Federal do Amapa, Department of Biological and
Health Sciences, Macapa, Brazil
(Lunardi) Universidade de Sao Paulo, Department of Physical Therapy,
School of Medicine, Sao Paulo, Brazil
Title
The effect of non-invasive positive airway pressure therapy following
thoracic surgical procedures: Protocol for a systematic review.
Source
Systematic Reviews. 4 (1) , 2015. Article Number: 83. Date of Publication:
June 12, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Thoracic surgical procedures impair respiratory function,
decreasing ventilation and oxygenation and increasing the risk of acute
respiratory failure and pulmonary complications. To prevent these clinical
repercussions, positive airway pressure therapy is widely used to increase
pulmonary ventilation, decrease muscle overload, and ensure adequate
oxygenation; however, the benefit of this therapy remains unclear.
Methods/design: A systematic search of the literature including PubMed,
CINAHL, AMED, PsycINFO, LILACS, Scielo, Scopus, PEDro, and the Cochrane
Library will identify the randomized and quasi-randomized trials that used
CPAP, Bilevel, or IPPB compared with a control without intervention, a
sham treatment or other lung expansion techniques following thoracic
surgical procedures. From these trials, we will extract data on a
predefined list of outcomes, including oxygenation, ventilation,
respiratory failure, pulmonary complications, and time of resolution of
the clinical condition. The methodological quality of each trial included
will be assessed using the PEDro scale. The strength of the
recommendations will be summarized using the GRADE scale. Meta-analyses
will be performed, if appropriate. Discussion: This review aims to promote
greater knowledge regarding the efficiency of the use of non-invasive
positive airway pressure on recovery of respiratory function and on
prevention of pulmonary complications following thoracic surgical
procedures. This review could help health professionals improve the care
for patients undergoing thoracic surgical procedures. Systematic review
registration: PROSPERO CRD42015019004

<22>
Accession Number
2015297244
Authors
Anastasiadis K. Antonitsis P. Haidich A.-B. Argiriadou H. Deliopoulos A.
Papakonstantinou C.
Institution
(Anastasiadis, Antonitsis, Argiriadou, Deliopoulos, Papakonstantinou)
Department of Cardiothoracic Surgery, Aristotle University of
Thessaloniki, AHEPA Hospital, Sakellaridi 25, Thessaloniki 542 48, Greece
(Haidich) Department of Medical Statistics, Medical School, Aristotle
University of Thessaloniki, Greece
Title
Use of minimal extracorporeal circulation improves outcome after heart
surgery; a systematic review and meta-analysis of randomized controlled
trials.
Source
International Journal of Cardiology. 164 (2) (pp 158-169), 2013. Article
Number: 14385. Date of Publication: 05 Apr 2013.
Publisher
Elsevier Ireland Ltd
Abstract
Abstract Background The question whether use of minimal extracorporeal
circulation (MECC) influences patients' outcome remains unanswered. We
performed a systemic review of the literature and a meta-analysis of
randomized controlled trials to evaluate the impact of MECC compared to
conventional extracorporeal circulation (CECC) on mortality and major
adverse cardiovascular events in patients undergoing heart surgery.
Methods We independently conducted a systemic review of English and
non-English articles using Medline, Embase and Cochrane database. Random
allocation to treatment with a minimum of 40 patients in both groups was
considered mandatory for inclusion in the meta-analysis. Primary outcomes
were operative mortality and major adverse cardiac and cerebrovascular
events comprising death before discharge, myocardial infarction and
neurologic damage. Results We included 24 studies comparing MECC vs. CECC
with a total of 2770 patients. Use of MECC was associated with a
significant decrease in mortality (0.5% vs. 1.7%, P = 0.02), in the risk
of postoperative myocardial infarction (1.0% vs. 3.8%, P = 0.03) and
reduced rate of neurologic events (2.3% vs. 4.0%, P = 0.08). Additionally,
MECC was associated with reduced systemic inflammatory response as
measured by polymorphonuclear elastase, hemodilution as calculated by
hematocrit drop after procedure, need for red blood cell transfusion,
reduced levels of peak troponin release, incidence of low cardiac output
syndrome, need for inotropic support, peak creatinine level, occurrence of
postoperative atrial fibrillation, duration of mechanical ventilation and
intensive care unit stay. Conclusions Use of MECC in heart surgery
resulted in improved short-term outcome as reflected by reduced mortality
and morbidity compared with conventional extracorporeal circulation.

<23>
Accession Number
2015295765
Authors
Tian Y. Li H. Liu P. Xu J.-M. Irwin M.G. Xia Z. Tian G.
Institution
(Tian, Tian) Department of Anesthesiology, Haikou Municipal Hospital,
Affiliated Haikou Hospital Xiangya School of Medicine, Central South
University, Haikou 570208, China
(Li, Irwin, Xia) Department of Anesthesiology, University of Hong Kong,
Hong Kong, Hong Kong
(Liu) Department of Anesthesiology, Hainan Municipal Corps Hospital,
Chinese People's Armed Police Force, Haikou 570203, China
(Xu) Department of Anesthesiology, Second Xiangya Hospital, Central South
University, Changsha, Hunan 410011, China
(Xia) Department of Anesthesiology, Affiliated Hospital of Guangdong
Medical College, Zhanjiang 524023, China
Title
Captopril pretreatment produces an additive cardioprotection to isoflurane
preconditioning in attenuating myocardial ischemia reperfusion injury in
rabbits and in humans.
Source
Mediators of Inflammation. 2015 , 2015. Article Number: 819232. Date of
Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. Pretreatment with the angiotensin-converting inhibitor
captopril or volatile anesthetic isoflurane has, respectively, been shown
to attenuate myocardial ischemia reperfusion (MI/R) injury in rodents and
in patients. It is unknown whether or not captopril pretreatment and
isoflurane preconditioning (Iso) may additively or synergistically
attenuate MI/R injury. Methods and Results. Patients selected for heart
valve replacement surgery were randomly assigned to five groups: untreated
control (Control), captopril pretreatment for 3 days (Cap3d), or single
dose captopril (Cap1hr, 1 hour) before surgery with or without Iso
(Cap3d+Iso and Cap1hr+Iso). Rabbit MI/R model was induced by occluding
coronary artery for 30 min followed by 2-hour reperfusion. Rabbits were
randomized to receive sham operation (Sham), MI/R (I/R), captopril (Cap,
24 hours before MI/R), Iso, or the combination of captopril and Iso
(Iso+Cap). In patients, Cap3d+Iso but not Cap1hr+Iso additively reduced
postischemic myocardial injury and attenuated postischemic myocardial
inflammation. In rabbits, Cap or Iso significantly reduced postischemic
myocardial infarction. Iso+Cap additively reduced cellular injury that was
associated with improved postischemic myocardial functional recovery and
reduced myocardial apoptosis and attenuated oxidative stress. Conclusion.
A joint use of 3-day captopril treatment and isoflurane preconditioning
additively attenuated MI/R by reducing oxidative stress and inflammation.

<24>
Accession Number
2015295139
Authors
Xia R. Xu J. Yin H. Wu H. Xia Z. Zhou D. Xia Z.-Y. Zhang L. Li H. Xiao X.
Institution
(Xia, Yin) Department of Anesthesiology, First Affiliated Hospital,
Yangtze University, Jingzhou 434000, China
(Xu, Xia) Department of Anesthesiology, Wuhan University Renmin Hospital,
Wuhan 430060, China
(Wu) Department of Cardiothoracic Surgery, Fifth Affiliated Hospital of
Zunyi Medical College, Zhuhai 519100, China
(Xia) Department of Anesthesiology, Second Affiliated Hospital and Yuying
Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000,
China
(Xia, Zhang, Li) Department of Anesthesiology, Affiliated Hospital of
Guangdong Medical College, Zhanjiang, Guangdong 524001, China
(Xia, Zhang, Li) Department of Anesthesiology, University of Hong Kong,
Hong Kong, Hong Kong
(Zhou, Xiao) Department of Anesthesiology, Guangdong No. 2 Provincial
People's Hospital, Guangdong Provincial Emergency Hospital, Guangzhou,
Guangdong 510317, China
Title
Intravenous infusion of dexmedetomidine combined isoflurane inhalation
reduces oxidative stress and potentiates hypoxia pulmonary
vasoconstriction during one-lung ventilation in patients.
Source
Mediators of Inflammation. 2015 , 2015. Article Number: 238041. Date of
Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Inhalation anesthetic isoflurane inhibits hypoxia pulmonary
vasoconstriction (HPV), while dexmedetomidine (Dex) could reduce the dose
of isoflurane inhalation and potentiate HPV, but the mechanism is unclear.
Inhibition of reactive oxygen species (ROS) production can favor HPV
during one-lung ventilation (OLV). Similarly, nitric oxide (NO), an
important endothelium-derived vasodilator in lung circulation, can
decrease the regional pulmonary vascular resistance of ventilated lung and
reduce intrapulmonary shunting. We hypothesized that Dex may augment HPV
and improve oxygenation during OLV through inhibiting oxidative stress and
increasing NO release. Patients undergoing OLV during elective thoracic
surgery were randomly allocated to either isoflurane + saline (NISO, n =
24) or isoflurane + dexmedetomidine (DISO, n = 25) group. Anesthesia was
maintained with intravenous remifentanil and inhalational isoflurane
(1.0-2.0%), with concomitant infusion of dexmedetomidine 0.7
gkg^-1h^-1 in DISO and saline 0.25 mL
kg^-1h^-1 in NISO group. Hemodynamic variables or
depth of anesthesia did not significantly differ between groups.
Administration of Dex significantly reduced Qs/Qt and increased
PaO<inf>2</inf> after OLV, accompanied with reduced lipid peroxidation
product malondialdehyde and higher levels of SOD activity as well as serum
NO (all P < 0.05 DISO versus NISO). In conclusion, reducing oxidative
stress and increasing NO release during OLV may represent a mechanism
whereby Dex potentiates HPV.

<25>
Accession Number
2015294932
Authors
Yadava O.P. Dinda A.K. Mohanty B.K. Mishra R. Ahlawat V. Kundu A.
Institution
(Yadava, Dinda, Mohanty, Mishra, Ahlawat, Kundu) Department of Cardiac
Surgery, National Heart Institute, 49-50 Community Centre, East of
Kailash, New Delhi 110065, India
Title
Is radial artery Doppler scanning mandatory for use as coronary bypass
conduit?.
Source
Asian Cardiovascular and Thoracic Annals. 23 (7) (pp 822-827), 2015. Date
of Publication: 13 Sep 2015.
Publisher
SAGE Publications Inc.
Abstract
Background Screening of the radial artery prior to harvesting as a conduit
for coronary bypass may be performed clinically by the Allen test or by
Doppler ultrasound. In a developing country like ours, the use of
resources for Doppler studies may be questioned when Allen tests lead to a
low rate of clinical sequelae. However, the rare occurrence of hand
ischemia may be devastating and could justify the routine use of Doppler
screening. This study aimed to address this question. Methods One hundred
patients undergoing elective coronary artery bypass grafting were screened
by the modified Allen test and Doppler ultrasound for suitability of use
of a radial artery conduit. After harvesting, proximal and distal segments
of the radial artery were subjected to histopathological examination.
Results Of the 95 patients deemed suitable for radial artery grafting, 6
had mild calcification on Doppler ultrasound and 9 had calcification on
histopathological examination. While Doppler showed atherosclerosis in 9
patients, only 6 had histopathological evidence of this (false-positive
rate 3%). Of the 6 patients with histopathologic evidence of
atherosclerosis, 2 were negative on Doppler (false-negative rate 2%).
Conclusion Routine preoperative Doppler screening of the radial artery in
the setting of limited resources is not justified. On the other hand, the
time-tested Allen test which is easy to perform, interpret, and reproduce
can be safely used as the sole screening test to harvest the radial
artery.

<26>
Accession Number
2015857138
Authors
Vida V.L. Gallo M. Barzon E. Olivato V. De Franceschi M. Guariento A.
Padalino M. Stellin G.
Institution
(Vida, Gallo, De Franceschi, Guariento, Padalino, Stellin) Pediatric and
Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and
Vascular Sciences, University of Padua, Via Giustiniani, 2, Padua 35100,
Italy
(Barzon, Olivato) Cardiac Intensive Care Unit, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua, Padua, Italy
Title
A Single Institution Evaluation of the Performance of Two Different Chest
Drainage Systems in Pediatric Patients after Surgery for Congenital Heart
Disease.
Source
Thoracic and Cardiovascular Surgeon. 63 (5) (pp 404-408), 2015. Date of
Publication: 18 Mar 2015.
Publisher
Georg Thieme Verlag
Abstract
Background The study compares the efficacy and advantages of two different
drainage systems in pediatric patients during surgery for congenital heart
disease (CHD). Methods A total of 200 consecutive pediatric patients (< 16
years) were enrolled; in 100 patients we used a polyvinyl chloride drain
(PVCD) and in the other 100 we used a silicone drain (SD). Demographics,
drain's technical data, and postoperative complications and costs were
evaluated. A pain score was calculated in patients older than 6 years.
Results The SDs were significantly smaller when compared with PVCDs
(median of 1.63 vs. 3.09 French/kg, p=0.0006), were kept in site for a
median shorter period (23 vs. 40 hours, p=0.002), drained more thoracic
spaces (median of 2 vs. 1, p < 0.0001), and were associated to a lower
pain score (p=0.01). The overall drain-related complication rate was lower
for the SD group than for the PVCD group (3 vs. 9%, p=0.1) as well as the
drain-related adverse event required additional interventional maneuvers
(0 vs. 6%, p=0.04). Patients who were treated with a PVCD reported a
higher perceived pain score than patients treated with a SD, both at the
time when the drain was in site (p=0.016) and during the drain's removal
(p=0.0001). Conclusion SDs can be used safely in pediatric patients during
surgery for CHD. Sizes required are smaller than other conventional drains
and multiple cavities can be drained with a single tube. The use of SD is
associated to a lower complication rate, lower requirement of additional
procedures, and lesser perceived pain from the patient, when compared with
other more traditional drains.

<27>
Accession Number
2015837389
Authors
Zhang X. Xing Q. Wu Q.
Institution
(Zhang, Xing, Wu) Heart Center, Qingdao Women and Children's Hospital,
Qingdao University, Qingdao, Shandong, China
(Zhang) Department of Cardiac Surgery, People's Hospital of Jilin
Province, Changchun, China
Title
Treatment of Perimembranous Ventricular Septal Defect in Children Weighing
Less than 15 kg: Minimally Invasive Periventricular Device Occlusion
versus Right Subaxillary Small Incision Surgical Repair.
Source
Thoracic and Cardiovascular Surgeon. 63 (5) (pp 409-418), 2015. Date of
Publication: 13 Mar 2015.
Publisher
Georg Thieme Verlag
Abstract
Background To compare the treatment outcomes between minimally invasive
periventricular device occlusion (MIPDO) and right subaxillary incision
surgical repair (RSISR) on perimembranous ventricular septal defect
(PmVSD) in children weighing less than 15 kg. Methods From January 2010 to
January 2013, 538 infants (age < 3 years, weight < 15 kg) with PmVSD were
randomly divided into two groups according to different treatment methods.
Group 1 (265 cases) had periventricular device occlusion through a lower
partial median sternotomy under transesophageal echocardiography (TEE);
group 2 (265 cases) underwent surgical repair on cardiopulmonary bypass
(CPB) through a right subaxillary incision. A prospective randomized
controlled study was performed regarding success rate, operation time,
volume of blood loss and transfusion, length of intubation and intensive
care unit (ICU) stay, complications, expenses, and follow-up results.
Results All patients had effective treatment with no death or serious
life-threatening complications. In group 1, 255 cases (96.23%) underwent
successful periventricular device occlusion. The remaining 10 cases
(3.77%) were successfully converted to conventional operation. Different
arrhythmias arose in 30 cases (11.76%), trivial residual shunt (RS) in 18
cases (7.06%), and new trivial tricuspid regurgitation (TR) in 29 cases
(11.37%). In group 2, all patients (100%) underwent successful surgical
repair. Different arrhythmias occurred in 116 cases (43.77%), trivial RS
in 16 cases (6.04%), new trivial TR in 11 cases (4.15%), and heart
dysfunction in 17 patients (6.42%). All patients were followed for more
than 12 months. The final treatment effects were similar in both groups,
but group 1 was significantly superior to group 2 regarding operation
time, volume of blood loss, length of intubation and ICU stay,
hospitalizations, and costs (all p < 0.05). TR incidence was higher in
group 1 (p < 0.05), and that of right bundle branch block was higher in
group 2 (p < 0.05). The incision was longer in group 2, but in a less
exposed location. CPB was not needed in group 1, but anticoagulants were
required for 3 to 6 months. Conclusion Both RSISR and MIPDO are effective
treatment methods for PmVSD. Though having some limitations, MIPDO not
only minimized the surgical trauma to patients but also ensured safety to
the maximum extent. However, patient selection is vital. For selected
patients, especially those with moderate PmVSDs with obvious clinical
symptoms and no valve regurgitation, it seems an ideal approach.

<28>
Accession Number
2014731119
Authors
Bobylev D. Boethig D. Breymann T. Mathoni A. Horke A. Ono M.
Institution
(Bobylev, Boethig, Breymann, Mathoni, Horke, Ono) Department of
Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical
School, Hannover, Germany
(Boethig) Department of Pediatric Cardiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(Bobylev) Department of Cardiothoracic, Transplantation and Vascular
Surgery Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625,
Germany
Title
Surgical Treatment of Thoracic Aortic Aneurysms in Patients with
Congenital Heart Disease.
Source
Thoracic and Cardiovascular Surgeon. 63 (5) (pp 388-396), 2014. Date of
Publication: 04 Jul 2014.
Publisher
Georg Thieme Verlag
Abstract
Background This study we evaluate our results for surgical treatment of
thoracic aortic aneurysms in patients with congenital heart disease.
Patients and Methods Fifty patients aged between 12 and 71 years were
treated for 51 thoracic aortic aneurysms. Forty-four of the patients
developed aneurysms in the ascending aorta and seven developed aneurysms
in the descending aorta. The underlying diseases for ascending aortic
aneurysms included 16 congenital aortic stenosis, 16 bicuspid aortic
valves, 4 transposition of the great arteries, 3 tetralogy of Fallot, 2
truncus arteriosus communis, and 3 other diseases. Patients with
connective tissue disorders were excluded. All descending aortic aneurysms
developed late after coarctation repair. The time interval between the
correction and aneurysm operations was 15 years in ascending aneurysms and
28 years in descending aneurysms. Results The operative procedures for 44
ascending aortic aneurysms included 38 ascending aortic replacements, with
or without aortic valve replacement (including 31 conduits), and 6 David
operations. Graft replacement was undertaken for the seven descending
aortic aneurysms. There were two hospital deaths. Forty-eight hospital
survivors were in New York Heart Association functional class II or less
at follow-up, which was conducted up to a maximum of 8 years after the
procedure. All patients were free from reoperation and thromboembolic
events. Aortic valve function was good in all six patients after the
valve-sparing operation. Conclusion Thoracic aortic aneurysms in patients
with congenital heart disease is highly associated with bicuspid aortic
valve and aortic coarctation. For ascending aortic aneurysms, conduit
replacement is the method of choice. The David procedure provides good
results in selected patients. For descending aortic aneurysms, graft
replacement is the preferred procedure. The relatively late development of
thoracic aortic aneurysms indicates that long-term follow-up in patients
with congenital heart disease, especially in patients with bicuspid aortic
valve and aortic coarctation, is essential.

<29>
Accession Number
71980210
Authors
Duarte-Rodrigues J. Vasconcelos M. Rodrigues R. Amorim M. Campelo M. Silva
J.C. Pinho P. Maciel M.J.
Institution
(Duarte-Rodrigues, Vasconcelos, Rodrigues, Amorim, Campelo, Silva, Pinho,
Maciel) Centro Hospitalar Sao Joao, EPE, Porto, Portugal
Title
Hybrid Coronary Revascularisation in 100 patients with multi-vessel
disease: What can we expect?.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Hybrid coronary revascularisation (HCR) arises as a combined
approach of surgical and percutaneous coronary intervention (PCI). This
strategy joins the best of two traditionally isolated treatment options in
multi-vessel coronary artery disease (CAD). We aim to assess the safety
and clinical outcomes of patients submitted to HCR. Methods and results:
From May 2008 to December 2014 one hundred consecutive patients underwent
two-stage coronary revascularisation (PCI after coronary artery bypass
grafting), in our hospital, after Heart Team evaluation. Death, myocardial
infarction and repeated target vessel revascularisation (MACE) were
analysed in index hospitalisation and at follow-up. Mean age was 67+/-10
years and 66% of patients were male. HCR was performed after an acute
coronary syndrome in 47% of the population and two thirds of the patients
had preserved left ventricular ejection fraction. In all cases an arterial
graft to the left main was performed. Forty nine percent of patients also
underwent other arterial or veins grafts. CABG was carried out off-pump in
76% of patients. PCI occurred 5+/-3 days after surgery, with 100% of
angiographic success and using drug-eluting stents (67%), bare-metal
stents (32%) or both (1%). No intra-operative or in-hospital deaths were
reported. At a mean follow-up of 22+/-14 months, eighty three patients
were evaluated and overall population freedom from MACE was 97%: one case
died from pneumonia and two had non-STEMI, treated with conservative
approach. No cardiac death occurred. Conclusions: Hybrid coronary
revascularisation may be considered a viable option in patients with
multi-vessel CAD. In our experience HCR has a good outcome at short and
mid-term follow-up. In spite of the lack of large randomised controlled
trials with long term follow-up, it seems reasonable to consider that this
strategy can have an important role in CAD treatment.

<30>
Accession Number
71980138
Authors
Mallow P. Ryan M. Johnson M. Lim L. David G.
Institution
(Mallow, Ryan) CTI Clinical Trial and Consulting, Inc., Cincinnati, United
States
(Johnson) GE Healthcare, Chalfont-St.-Giles, United Kingdom
(Lim) GE Healthcare, Princeton, United States
(David) University of Pennsylvania, Philadelphia, United States
Title
The effect of the choice of contrast media on MARCE events in angioplasty
procedures.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Millions of cardiovascular procedures have been performed with
contrast media (CM) to improve imaging in the United States. The VICC and
COURT randomised clinical trials found iodixanol, an iso-osmolar CM
(IOCM), was associated with less major adverse cardiovascular events
(MACE) than the low-osmolar CMs (LOCM) ioxaglate and iopamidol,
respectively. A meta-analysis by McCullough et al. 2006 found IOCM to be
associated with fewer contrast-induced nephropathy than LOCM. However,
there is limited evidence examining MARCE (major adverse renal and
cardiovascular events) in today's clinical practice with respect to IOCM
and LOCM agents. Therefore, the objective of this study was to assess the
relationship between CM agents and MARCE events in patients undergoing
inpatient angioplasty. Methods and results: The Premier database was used
to identify patients between January 2008 and September 2013. Eligible
patients had a primary procedure of angioplasty defined by International
Classification of Diseases, 9 Revision (ICD-9) and/or Current Procedural
Terminology (CPT) codes, inpatient admission, and LOCM or IOCM agent. CM
agents were identified by Standard Charge Master codes and text mining
algorithms. One IOCM, iodixanol, was identified. Six LOCMs were
identified: iohexol, hyperosmolar ioversol, iopamidol, ioxaglate, ioxilan,
and iopromide. MARCE events during the visit were determined by ICD-9
diagnosis codes for the following: contrast-induced nephropathy, acute
myocardial infarction, stent occlusion/thrombosis, acute kidney injury,
renal failure, angina and stroke. Death was identified from the discharge
status of claim. Multivariable regression analysis was conducted using
Ordinary Least Square (OLS) and hospital fixed-effects specifications to
assess the relationship between contrast media usage and MARCE events.
Theses analyses controlled for patient demographics, clinical
characteristics, and hospital characteristics. For hospitals using solely
IOCM or LOCM, Coarsened Exact Matching (CEM) was used to match patients
across hospitals and assess the incidence of MARCE between the groups. A
total of 334,001 angioplasty procedures met the inclusion criteria.
Patients receiving IOCM comprised 30.75% of the visits. IOCM was used in
older patients (66.76 vs. 63.82; p <0.01). Patients receiving IOCM were
generally sicker as measured by Charlson Comorbidity Index Score (3.95 vs.
3.4; p <0.01) compared to patients receiving LOCM. IOCMs were used more
often in trauma and emergency procedures, and in patients classified as
major or extreme on the 3MTM APR-DRG Mortality and Severity Indexes.
Univariate OLS analysis indicated that patients receiving an IOCM had a
7.3% (p <0.01) decrease in the probability of a MARCE event during the
visit compared to patients receiving a LOCM. After controlling for patient
demographics, comorbid conditions, hospital characteristics, and year,
IOCM was associated with an 8.1% (p <0.01) decrease in MARCE events.
Controlling for within hospital variation with the hospital fixed-effect
specification found a further decrease in the probability of MARCE events
(10.5%; p <0.01) with the use of IOCM. In hospitals using solely IOCM or
LOCM, a 26.7% decrease in MARCE events was observed in IOCM compared to
LOCM. Conclusions: In this retrospective study using real-world data, the
use of the IOCM iodixanol was associated with a significant decrease in
MARCE events compared to LOCMs in patients undergoing angioplasty
procedures.

<31>
Accession Number
71980047
Authors
O'Connor S. Morice M.-C. Gilard M. Leon M. Webb J. Dvir D. Rodes-Cabau J.
Tamburino C. Capodanno D. D'Ascenzo F. Garot P. Chevalier B. Mikhail G.
Ludman P.
Institution
(O'Connor) University Hospital Waterford, Waterford, Ireland
(Morice, Garot, Chevalier) Generale de Sante, Institut Cardiovasculaire
Paris Sud (ICPS), Hopital Prive Jacques Cartier, Paris, France
(Gilard) CHU de la Cavale Blanche, Brest, France
(Leon) Columbia University Medical Center, New York Presbyterian Hospital,
New York, NY, United States
(Webb, Dvir) University of British Columbia, Vancouver, Canada
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, Canada
(Tamburino, Capodanno) Ferrarotto Hospital, University of Catania, Italy
and ETNA Foundation, Catania, Italy
(D'Ascenzo) Division of Cardiology, Citta Della Salute e della Scienza,
University of Turin, Turin, Italy
(Mikhail) Division of Cardiology, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Ludman) Queen Elizabeth Hospital, University of Birmingham, Birmingham,
United Kingdom
Title
The outcomes of TAVI; revisiting gender equality? Insight from a
collaborative, patient-level meta-analysis of 11,310 patients.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: There has been conflicting clinical evidence with respect to the
influence of female sex on outcome after transcatheter aortic valve
implantation (TAVI). We aimed to assess the impact of gender on clinical
outcome in TAVI. Methods and results: We conducted searches of the
published literature using MEDLINE, EMBASE, and the Cochrane library
databases through June 2014. A database containing individual
patient-level time-to-event data was generated from the registries of each
of the studies selected. The primary outcome of interest was all-cause
mortality. The safety endpoint was the combined 30-day safety endpoints of
major vascular complications, bleeds and stroke as defined by the Valve
Academic Research Consortium (VARC) where available. A total of 5 studies
and their ongoing registry data with 11,310 patients were included. Women
comprised 48.6% of the cohort and had less comorbidities than men. The
majority of the overall cohort had a TAVI performed via the transfemoral
approach followed by transapical and transsubclavian approaches. Women had
a higher rate major vascular complications (6.3% vs. 3.4%, p<0.001), major
bleeding (10.5% vs. 8.5%, p=0.003) and stroke (4.4% vs. 3.6%, p=0.029) but
a lower rate of significant aortic incompetence (> Grade 2; 19.4% vs.
24.5%, p<0.001). There was no difference in procedural or 30-day mortality
between women and men (2.6% vs. 2.2%, p=0.24 and 6.5% vs. 6.5%, p=0.93)
but female sex was independently associated with improved survival at
median follow-up of 387 days (interquartile range [IQR] 192 to 730 days)
from the index procedure (adjusted hazard ratio (HR) 0.79 (95% CI: 0.73 to
0.86, p=0.001). Female sex was consistently associated with improved
survival regardless of valve type and route of access when sub-analyses
were performed in these subgroups. Conclusions: Although women experience
more bleeding, vascular and stroke complications, female gender is an
independent predictor of long-term survival after TAVI. This should be
taken into account during patient selection for treatment of severe aortic
stenosis.

<32>
Accession Number
71980042
Authors
Aminian A. Lalmand J. Devuyst E. Dubois P.
Institution
(Aminian, Lalmand, Devuyst, Dubois) Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
Title
Embolisation of left atrial appendage closure devices: A systematic review
of cases reported with the WATCHMAN device and the Amplatzer Cardiac Plug.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Device embolisation is a known complication of LAA closure
procedures. The goal of this study is to provide a systematic review of
reported cases of LAA closure device embolisation by focusing on the two
most commonly implanted devices: the WATCHMAN (WM) (Boston Scientific,
Plymouth, MA, USA), and the Amplatzer Cardiac Plug (ACP; St. Jude Medical,
Minneapolis, MN, USA). Methods and results: A comprehensive search of
PubMed database from inception through October 1, 2014, was conducted
using pre-defined criteria. Studies were included if they described at
least one case of embolisation of the WM and/or the ACP. A total of 20
studies reporting 31 cases of device embolisation was identified including
13 cases with WM and 18 cases with ACP. The timing of embolisation was
described in 29 cases and was categorised as "acute" (i.e., during
hospital stay) in 20 cases (65%, 13 out of 20 cases were intraprocedural)
and "late" (i.e., following hospital discharge) in nine cases (30%). The
anatomical location of embolised devices was reported in 21 cases: into
the aorta in 9 cases (30%; WM 7/9, ACP 2/9), into the left ventricle (LV)
in 9 cases (30%; WM 3/9, ACP 6/9) and into the left atrial cavity in 3
cases (10%; ACP 3/3). The device was retrieved by percutaneous methods in
17 patients (55%, WM 8/17, ACP 9/17), while 10 patients underwent surgical
retrieval (32%, WM 4/10, ACP 6/10). As compared to embolisation into the
Ao or the LA cavity, device embolisation into the LV was associated with a
higher rate of surgical retrieval (8/9 vs 2/12; 88% vs. 17%, p=0.0019).
Major adverse events related to device embolisation occurred in 3
patients: 1 case of internal bleeding during percutaneous retrieval, 1
case of Ao cusps damage requiring Ao valve replacement and 1 case of death
due to cardiogenic shock. Conclusions: Device embolisation is a rare but
serious complication of percutaneous LAA closure and occurs mainly in the
periprocedural period. Although embolisation into the Ao or the LA can be
successfully managed by percutaneous techniques in most cases, device
embolisation into the LV is associated with a high rate of surgical
retrieval, increasing thereby procedure-related morbidity.

<33>
Accession Number
71980008
Authors
Theriault-Lauzier P. Dorfmeister M. Mylotte D. Andalib A. Spaziano M.
Martucci G. Lange R. Bilodeau L. Piazza N.
Institution
(Theriault-Lauzier, Andalib, Spaziano, Martucci, Bilodeau, Piazza) McGill
University Health Centre, Montreal, Canada
(Dorfmeister, Lange) German Heart Centre, Munich, Germany
(Mylotte) University Hospital Galway, Galway, Ireland
Title
Quantitative multislice computed tomography assessment of the mitral
valvular complex for transcatheter mitral valve interventions.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Geometrical measurements of the mitral valvular complex may have
implications for the design of transcatheter mitral valve replacement
(TMVR) devices and for patient selection. This study sought to quantify
the dynamic geometry of the mitral valvular complex in patients with
significant functional mitral regurgitation (FMR) using multislice
computed tomography (MSCT). Methods and results: MSCT images were acquired
in 32 patients with symptomatic, moderate or severe FMR. Two independent
observers analysed image sets using a dedicated software package and a
standard measurement methodology. A meta-analysis of 24 studies reporting
equivalent measurements in patients without mitral regurgitation (MR) was
performed. In patients with FMR, the mean mitral annulus intercommissural
and aorto-mural diameters were respectively 41.5+/-5.2 mm and 38.7+/-5.9
mm in systole, and were 41.5+/-4.4 mm and 40.0+/-4.7 in diastole. In
patients without MR, the diameters were respectively 33.6+/-5.1 mm and
28.8+/-8.0 mm in systole, and 36.2+/-4.5 mm and were 31.6+/-7.9 mm in
diastole. The obstacle-free zone below the mitral annulus averaged more
than 20.0 mm and varied by less than 1 mm between systole and diastole,
which is not statistically significant. The aorto-mitral angle was
129.7+/-10.5degree in systole 131.0+/-9.4degree in diastole. Conclusions:
The mitral annulus is larger in dimension, more circular and less dynamic
in patients with FMR. In FMR, the obstacle-free zone below the mitral
annulus is relatively constant during the cardiac cycle. Measurements of
the mitral valvular apparatus vary considerably between patients, which
suggests that tri-dimensional imaging will play an important role in the
sizing and patient selection for TMVR.

<34>
Accession Number
71979948
Authors
Van Der Heijden M.
Institution
(Van Der Heijden) Mercy Angiography, Auckland, New Zealand
Title
The nurse's role in the informed consent process.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: The practice of informed consent presents complex legal and ethical
challenges. Complete, clear and individualised information should be
provided, and enough time should be allowed for multidisciplinary (e.g.,
the Heart Team) and patient-centred discussion. Challenging scenarios
include ad hoc PCI, emergencies and mental capacity of an ageing
population. Methods and results: The informed consent process allows
patients to meaningfully participate in the decision-making process and
make important decisions about their healthcare choices. To be able to do
this their physician is responsible for informing them of (a) the nature
of the procedure, (b) its risks and benefits, and (c) its alternatives
with their risks and benefits. This makes the informed consent process the
legal, ethical, and moral responsibility of the physician. Nevertheless,
as patient advocates, nurses also have a professional interest in fully
understanding the legal guidelines and ethical considerations of the
informed consent process. Physicians and nurses facilitating this process
should keep in mind that the seemingly complex process is simply the
practical application of respect for persons not just a waiver of
liability. The priority in any decision making process should be effective
communication, and physicians and nurses should ensure that medico-legal
requirements do not obscure this key element of the decision-making
process. Comprehension of the information provided is a precondition for
obtaining a valid informed consent and the physician is responsible for
ensuring patient's understanding of the risks and benefits of a proposed
procedure. Nurses could contribute toward maximizing comprehension by
using a repeat-back process after informed consent discussions. This
method has been suggested to improve patient's understanding when they are
asked to recount what they have been told in the informed consent
discussion. Nurses may be more familiar with and skilled in the
repeat-back method and identify gaps or inaccuracies in the information
relayed back to them. It has been shown that patients are excessively
optimistic about the potential benefits of intervention. A systematic
review of observational studies of patient understanding of coronary
revascularisation demonstrated that 78% of patients erroneously believed
that PCI would extend life expectancy and 71% erroneously believed that
PCI would prevent future myocardial infarction even though such claims
were not made by their physician. Also, for the majority of the age group
we are seeing in our cathlabs, the medical profession is considered
authoritative, and the consent process one of acceptance, whereby the
patient simply agrees with what the physician recommends and entirely
dependent on him or her, rather than on their own comprehension,
reflection and decision. It is not unusual for nurses to be asked for more
information after the physician has left the room. Conclusions: With this
understanding, educated nurses possess a unique opportunity to collaborate
with the physicians and achieve patient autonomy, especially in the
presence of challenging scenarios, such as patients who decline surgery
and prefer a percutaneous option (PCI, TAVI), ageing patients with limited
mental capacity, and patients with surrogate decision makers. Therefore,
the topic of informed consent is worthy of studying further and conduct
research into to determine the extent and importance of the nurse's role
in this process.

<35>
Accession Number
71979932
Authors
Anderson M. Tuluca A. Shah S. Witzke C. Morris L.
Institution
(Anderson, Tuluca, Shah, Witzke, Morris) Einstein Healthcare Network,
Philadelphia, PA, United States
Title
The extra-corporeal membrane oxygenation epidemic: Is there an answer?.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Extra-corporeal membrane oxygenation (ECMO) has experienced an
exponential rise in utilisation over recent years. In order to understand
this increase, we undertook a systematic review of the literature with the
intent to determine if there had been a significant improvement in
outcomes that might explain this surge in the use of this technique.
Methods and results: A PubMed review of all studies enrolling ECMO
patients from 1992 through 2011 was undertaken. Only studies enrolling 40
or greater patients were included to minimise the bias of small
observational reports. An assumption was made that the increase in
utilisation of ECMO has been based on improved outcomes. As such, the
studies were reviewed specifically for complication rates including
neurologic, renal, vascular and major bleeding. In addition, mortality,
both 30-day and in-hospital was collected. Heart recovery, defined as
successful weaning from ECMO, was also reviewed. These results were
examined by era of enrolment in order to determine if there was evidence
of any improvement over time. In addition, the results were compared to
another recent study for validation. Nineteen studies were identified with
a total of 2,448 patients. Renal injury was the most common complication
seen, occurring in 30-87% of patients. A similar number of patients
required haemodialysis. Vascular complications including limb ischaemia
were seen in 5-21% with amputation required in up to 7%. Major bleeding
was seen in 21-50% of patients with 100% of reported patients being
transfused. Haemolysis was reported in 14-33% of patients.
Gastrointestinal bleeding was noted in up to 25% of patients. Neurologic
complications were seen in one third of patients with stroke in up to 15%
and other cerebrovascular events in up to 22%. A left ventricular assist
device or heart transplantation was required in up to 52% of patients.
Weaning of ECMO and heart recovery was achieved in only 7-29%. Thirty-day
mortality occurred in 62-79% and in-hospital mortality in 47-79%. When the
results were reviewed by era of enrolment, the only complication that was
seen to decrease was that of renal injury. However, this decrease was not
consistent. The incidence of all other complications appeared to be
consistent or showing a trend toward an increase. When we compared our
results to a recently published meta-analysis of 20 studies from 1992 to
2010 our findings were similar in all regards. Conclusions: The results of
our review demonstrate that complications remain prevalent and mortality
rates are high with the use of ECMO. In addition, there appears to be no
improvement in the incidence of complications, mortality rates or the
ability to achieve heart recovery. These results do not explain the
exponential rise in the utilisation of ECMO.

<36>
Accession Number
71979727
Authors
Giacoppo D. Gargiulo G. Capranzano P. Tamburino C. Capodanno D.
Institution
(Giacoppo, Gargiulo, Capranzano, Tamburino, Capodanno) Ferrarotto,
Catania, Italy
Title
Dual antiplatelet therapy duration following drug-eluting stent
implantation: Insights from a network meta-analysis of randomised trials.
Source
EuroIntervention. Conference: EuroPCR 2015 Paris France. Conference Start:
20150519 Conference End: 20150522. Conference Publication: (var.pagings).
, 2015. Date of Publication: May 2015.
Publisher
EuroPCR
Abstract
Aims: Dual antiplatelet therapy is the standard of care following
percutaneous coronary intervention (PCI) with drug-eluting stent (DES).
However, the safest and most effective dual antiplatelet therapy duration
still remains controversial. We sought to define the optimal dual
antiplatelet therapy duration performing a hierarchical Bayesian network
meta-analysis of randomised trials comparing different dual antiplatelet
therapy regimens. Methods and results: The search was performed in PubMed,
Embase, Scopus, Cochrane Library and Web of Science electronic databases.
Inclusion criteria were the following: 1) randomised trials comparing two
or more dual antiplatelet therapy durations; 2) patients of any age,
ischaemic risk profile and clinical presentation, with or without
documented pre-existing coronary artery disease, undergoing PCI with
implantation of one or more DESs. Exclusion criteria were the following:
1) trials comparing a dual antiplatelet therapy regimen with
acetylsalicylic acid as control; 2) trials with primary clinical setting
different from coronary artery disease or including patients with coronary
artery disease undergoing medical therapy or surgical coronary artery
revascularisation. The primary efficacy endpoint was all-cause death,
while the primary safety endpoint was major bleeding. A Bayesian network
meta-analysis was carried out for each endpoint using a consistency
random-effect model computed with Markov Chain Monte Carlo simulation.
Convergence was confirmed using the Brooks-Gelman-Rubin diagnostic after a
50,000-iteration "burn-in" phase, and direct probability statements were
based on a further 100,000-iteration phase. Inferences were calculated by
sampling from the posterior distribution of the parameters and reported as
mean odds ratio with corresponding 95% credible interval. Heterogeneity
was explored using I statistic. Dual antiplatelet therapy durations were
ranked attempting to define the probability of each treatment to be the
best. A total of 7 randomised trials (15,870 patients) were identified: 2
trials compared 3-month dual antiplatelet therapy with 12-month, 3 trials
compared 6-month dual antiplatelet therapy with 12-month, and 2 trials
compared 6-month dual antiplatelet therapy with 24-months. Although the
observed differences in the risk of all-cause death between the different
dual antiplatelet therapy durations were not statically significant, we
observed a trend toward a low-to-moderate risk reduction with 24-month
duration, which was associated with a probability of 44% to be the best
treatment. Conversely, we observed a progressive increase in the risk of
major bleeding from shorter to longer dual antiplatelet therapy duration:
3-month duration was associated with a probability of 59% to be the best
treatment. Conclusions: Long-term dual antiplatelet therapy was associated
with a reduced risk of all-cause death but also with a higher risk of
major bleeding.

<37>
Accession Number
71973962
Authors
Franke R. Brauer A. Emmert A. Hinterthaner M. Brandes I. Quintel M. Danner
B. Schondube F.
Institution
(Franke, Emmert, Hinterthaner, Danner, Schondube) Universitatsmedizin
Gottingen, Thorax-, Herz- und Gefaschirurgie, Gottingen, Germany
(Brauer, Brandes, Quintel) Universtatsmedizin Gottingen, Zentrum fur
Anasthesiologie, Rettungs- und Intensivmedizin, Gottingen, Germany
Title
Prevention of perioperative hypothermia in vats: A prospective randomised
controlled trial comparing forced-air warming with conductive warming.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Perioperative hypothermia increases the morbidity after
surgery. Different warming devices are known to prevent hypothermia. Up to
know there are no scientific studies which compare the efficiency of those
methods in minimal invasive thoracic surgery. After approval by the local
ethics committee and written informed consent we examined the efficiency
of forced-air warming and conductive warming to prevent perioperative
hypothermia in video-assisted thoracic surgery (VATS). Methods: We
randomized 60 patients with indication for VATS in two groups (forced-air
warming versus conductive warming). All patients were pre-warmed before
induction of anesthesia. The core temperature was measured on forehead and
in the nasopharyngeal. In postanaesthetic care unit (PACU) we calculated
the Aldrete-Score (post anesthetic recovery score). Results: Both groups
were not significant different in regard to clinical parameter,
pre-warming and starting temperature (forced-air 36.71degreeC +/-
0.53degreeC versus conductive 36.66degreeC +/- 0.66degreeC; p = 0.792).
The patients in conduction-group become mildly hypothermic. The forehead
temperature at the end of surgery showed a significant difference between
both groups (forced-air 36.68degreeC +/- 0.6degreeC versus conductive
35.98degreeC +/- 0.5degreeC; p < 0.001). The postoperative Aldrete-Score
was slightly better in forced-air warming, without significance
(forced-air 7.7 +/- 2.1 versus conductive 7.1 +/- 1.7; p = 0.254). The
time spent in the PACU was comparable in both groups. Conclusions: Pre-
and intraoperative forced-air warming prevents perioperative hypothermia
in VATS. The inferior prevention in conductive warming group may caused by
reduced body contact to the warming mattresses in lateral position.

<38>
Accession Number
71973961
Authors
Dorr F. Macherey S. Heldwein M. Wahlers T. Hekmat K.
Institution
(Dorr, Macherey) Universitat zu Koln, Koln, Germany
(Heldwein, Wahlers, Hekmat) Klinik und Poliklinik fur Herz- und
Thoraxchirurgie, Universitat zu Koln, Koln, Germany
Title
Is surgical therapy of pulmonary metastases from malignant melanoma
feasible?.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Introduction: Resection of lung metastases is an accepted procedure in
oncology. In case of primary malignant melanoma pulmonary metastasectomy
is frequently refused due to worse long-term survival rates demonstrated
by the International Registry of Lung Metastases in 1997. These results
might not reflect current therapeutic options. Hence, we performed a
meta-analysis to evaluate the impact and discuss the perspectives of
metastasectomy patients with primary malignant melanoma. Methods: We
performed a literature research on 29.08.2014 in the Pub Med database
using "metastasectomy," "lung resection," "lung metastases," "pulmonary
metastases" and "malignant melanoma" for articles published since
01.01.2000. All articles with operative data and post-metastasectomy
survival of at least 25 patients were included. Results: Nine studies
report a total of 1.265 patients undergoing metastasectomy for pulmonary
lesions from malignant melanoma. The 5-year survival rates after the first
metastasectomy range from 18% to 39.4%. Patients reached a median survival
between 17 and 40 months. Rates for intrathoracic relapse vary between
17.4% and 30%. Prognostic factors for post-metastasectomy survival are the
number of metastases and the status of resection. The application of neo-
or adjuvant therapies showed no statistical significance. Non-surgical
therapy leads with a median survival < 17 months to a shorter long-term
survival compared with surgical excision. Conclusions: These results show
an improved long-term survival due to metastasectomy. The long-term
survival correlates with radicalness of surgery and the number of resected
metastases. Intrathoracic relapse is often observed but re-operations are
an adequate treatment option, since they have no negative influence on
overall survival. While metastasectomy increases long-term survival
compared with non-surgical therapies, monoclonal antibodies and
BRAF-inhibition show comparable median survival rates.

<39>
Accession Number
71973948
Authors
Sathyamorthy M.
Institution
(Sathyamorthy) Cardiovascular Division, Baylor All Saints Medical Center,
Fort Worth, United States
Title
A review of anticoagulation progress and promise in mechanical valves.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Objective: This systematic review was conducted to evaluate the
progression of oral anticoagulant therapeutics from inception to current
practice and how the field may evolve with regard to use in thromboembolic
(TE) protection of mechanical heart valves. Methods: This review includes
examination of the history and pharmacology of oral anticoagulants from
warfarin to emerging novel oral anticoagulants (NOACS). As the field of
anticoagulation has rapidly advanced over the past five years, this review
assesses the literature for evidence related to 1) changes in target
anticoagulation thresholds based on advances in valve design and material
science, 2) pharmacogenetic investigation of anticoagulation thresholds,
and 3) evidence for application of NOACS to TE-prophylaxis for current
mechanical valves. Results: The interaction between anticoagulation
therapy and device design has required continuous investigation to ensure
optimal therapy tailored to both. The PROACT trial has confirmed a
significantly reduced level of anticoagulation necessary to prevent
thromboembolism for On-X mechanical valves in the aortic position.1 The
trial is ongoing and at its conclusion a reduced INR for On-X valves in
the mitral position is anticipated. The RE-ALIGN trial investigating the
use of dabigatran for TE risk reduction in traditional mechanical valves
was stopped prematurely due to excess TE events.2 It is not clear whether
this was due to pharmacokinetic factors related to dabigatran, design
features and TE risk of traditional mechanical valve architecture, or a
combination of both. Based on the reduced anticoagulation burden evidenced
in the PROACT trial, work is proposed to determine if the unique
biomaterial and design features of the On-X valve would present a more
ideal platform for investigation of NOACS to reduce TE risk in On-X
valves. Conclusions: Advancements in anticoagulation therapy and valve
design have occurred together over the years and will continue as NOACS
emerge and influence current and future valve design. These advancements
will ultimately lead to changes in clinical practice favoring more optimal
valve and anticoagulant drug pairing for patients based on their unique
circumstances.

<40>
Accession Number
71973934
Authors
Deppe A.-C. Weber C. Kuhn E. Scherner M. Slottosch I. Liakopoulos L.J.
Choi Y.-H. Wahlers T.
Institution
(Deppe, Weber, Kuhn, Scherner, Slottosch, Choi, Wahlers) Klinik und
Poliklinik Fur Herz- und Thoraxchirurgie, Universitatsklinikum Koln, Koln,
Germany
(Liakopoulos) Universitatsklinik Essen, Herz- und Thoraxchirurgie, Essen,
Germany
Title
Prophylactic intra-aortic balloon pump therapy before cardiac
revascularization surgery-a systematic review and meta-analysis of 3,247
patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Aims: Prophylactic intra-aortal balloon pump (IABP) therapy for high risk
patients before surgical revascularization is still widely discussed.
Recently published trials raised serious concerns regarding the value of
IABP use in cardiogenic shock patients before revascularization. The aim
of the present systematic review with meta-analysis is to determine the
current strength of evidence for or against IABP use before surgical
revascularization. Methods: We performed a meta-analysis solely of
randomized (RCT) and observational trials (OT) that fulfilled all of the
following inclusion criteria: (1) Controlled group comparisons of patients
with prophylactic IABP implantation before cardiac surgery; (2) reporting
at least one of the following mandatory clinical endpoints: including
all-cause mortality, myocardial infarction, cerebrovascular accident
(CVA), renal failure; (3) in case of observational trials the studies
needed to be risked adjusted. The pooled treatment effects (odds ratio
(OR) or weighted mean difference (WMD), 95%-confidence intervals (95%-CI))
were assessed using a fixed or random effects model. Results: A total of
3,247 patients from 14 trials (6 RCT, 8 OT) were identified after the
literature search of the major databases (PubMed, EMBASE, Cochrane) using
a predefined keyword list. Absolute risk reduction for mortality in RCTs
was 4.5% (OR 0.36; 95%-CI 0.19 to 0.68); p = 0.0002). Prophylactic IABP
use before cardiac surgery also decreased the risk for myocardial
infarction (OR 0.61; 95%-CI 0.43 to 0.86; p = 0.005), CVA (OR 0.64; 95%-CI
0.43 to 0.95; p = 0.03), renal failure (OR 0.68; 95%-CI 0.48 to 0.96; p =
0.03). Length of ICU stay (WMD -1.12d; 95%-CI -1.70 to -0.54d; p = 0.0002)
and length of hospital stay (WMD -1.93d; 95%-CI -3.03 to -0.84d; p =
0.0005) were significantly reduced in patients with preoperative IABP use.
Conclusion: The present systematic review reveals a substantial benefit
for high risk patient who undergo preoperative IABP treatment before
surgical revascularization.

<41>
Accession Number
71973907
Authors
Deppe A.-C. Kuhn E.W. Scherner M. Slottosch I. Liakopoulos O.J. Rahmanian
P.B. Choi Y.-H. Wahlers T.
Institution
(Deppe, Kuhn, Scherner, Slottosch, Rahmanian, Choi, Wahlers) Klinik und
Poliklinik Fur Herz- und Thoraxchirurgie, Universitatsklinikum Koln, Koln,
Germany
(Liakopoulos) Universitatsklinik Essen, Herz- und Thoraxchirurgie, Essen,
Germany
Title
MIDCAB or PCI for single lad lesions a systematic review with
meta-analysis of 3,491 patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Aims: The present systematic review with meta-analysis aims to determine
the current evidence for minimally invasive direct coronary artery bypass
grafting (MIDCAB) or percutaneous coronary intervention (PCI) for
revascularization of the left anterior descending artery (LAD). Both
techniques are established therapeutic options. Internal mammary artery
grafts (IMA) have proven survival benefits and 10 year patency rates
greater than 90% after LAD revascularization. However, due to lower costs,
quicker recovery and lesser invasiveness PCI with stenting is currently
the most common used treatment for isolated LAD stenosis. Methods: We
performed a meta-analysis of solely randomized (RCT) or observational
trials (OT) that reported clinical outcome after isolated LAD
revascularization. Pooled treatment effects (odds ratio (OR) or weighted
mean difference (WMD), 95%-confidence intervals (95%-CI)) were assessed
using a fixed or random effects model. Results: The literature search
revealed a total of 3,491 patients in 13 studies (6 RCT, 7 OT). The
incidence for repeat target vessel revascularization (TVR) was more than
doubled after PCI (7.4%) when compared with MIDCAB (3.2%) at 6 months
after the procedure (OR 2.32; 95%-CI 1.56-3.46; p < 0.0001). The subgroup
analysis of studies rated as high quality revealed an impact on all-cause
mortality in a median follow-up of 47.4 months (OR 1.46; 95%-CI 1.03-2.06;
p < 0.029). In terms of stroke, there was no statistically significant
difference between both revascularization strategies. Conclusion: There is
clear evidence that the single vessel LAD disease should be exclusively
revascularized surgically.

<42>
Accession Number
71973903
Authors
Deppe A.-C. Choi Y.-H. Arbash W. Kuhn E.W. Scherner M. Slottosch I.
Liakopoulos O.J. Wahlers T.
Institution
(Deppe, Choi, Arbash, Kuhn, Scherner, Slottosch, Wahlers) Klinik und
Poliklinik Fur Herz- und Thoraxchirurgie, Universitatsklinikum Koln, Koln,
Germany
(Liakopoulos) Universitatsklinik Essen, Herz- und Thoraxchirurgie, Essen,
Germany
Title
ONPUMP vs. OFFPUMP coronary artery bypass grafting a systematic review
with Meta-analysis of 49 randomized controlled trials and more than 16,500
patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Aims: There is an ongoing debate about ON and OFFPUMP coronary artery
bypass surgery. The well-known adverse effects of the CPB, the accuracy of
anastomosis performed on a beating heart and graft patency are subject of
the ongoing discussion. To determine the current strength of evidence for
ONPUMP versus OFFPUMP coronary artery bypass grafting (CABG) with respect
to hard clinical endpoints, the present systematic review with
meta-analysis was performed. Methods: Exclusively randomized controlled
trials (RCT) that reported at least one of the mandatory endpoints were
included. Analyzed postoperative outcomes included major adverse cardiac
and cerebrovascular events (MACCE), low cardiac output (LCO), all-cause
mortality, myocardial infarction, cerebrovascular accident, repeat
revascularization, graft patency and cost effectiveness. The pooled
treatment effects (odds ratio (OR) or weighted mean difference (WMD),
95%-confidence intervals (95%-CI)) were assessed using a fixed or random
effects model. Results: The literature search of major databases (PubMed,
EMBASE, Cochrane) using a predefined keywords list revealed 49 unique
trials including 16,795 patients. No differences were seen in regard to
mortality or stroke. The collective incidence of 30-day repeat
revascularization was 0.6%. However, OPCAB is associated with a 1.9-fold
increased risk of repeat revascularization within the first 30 days (OR
1.87, 95%-CI 1.13 to 3.11, p = 0.0191). The over-all incidence of LCO was
6.8% and 2-fold increased after the use of the cardiopulmonary bypass (OR
0.52; 95%-CI 0.37 to 0.73; p = 0.0002). OPCAB accounted for an absolute
risk reduction of 2.1% for renal dysfunction after coronary artery bypass
surgery (OR 0.80; 95%-CI 0.71 to 0.89; p = 0.0001). OPCAB was associated
to fewer allogeneic blood product transfusion. The length of ventilation,
ICU stay, and hospital stay were significantly reduced in the OPCAB group.
Conclusion: The present systematic review emphasizes that both strategies,
ONPUMP and OFFPUMP, are suitable alternatives for CABG procedures. The
choice for either procedure should be done individualized for each single
patient with regard to the co-morbidities, life expectancy and the
surgeon's dexterity.

<43>
Accession Number
71973869
Authors
Weber C. Deppe A.-C. Kuhn E.W. Scherner M. Slottosch I. Liakopoulos O.J.
Choi Y.-H. Wahlers T.
Institution
(Weber, Deppe, Kuhn, Scherner, Slottosch, Choi, Wahlers) Klinik und
Poliklinik Fur Herz- und Thoraxchirurgie, Universitatsklinikum Koln, Koln,
Germany
(Liakopoulos) Universitatsklinik Essen, Herz- und Thoraxchirurgie, Essen,
Germany
Title
Point-of-care TEG/ROTEM based coagulation management in cardiac surgery: A
meta-analysis of 8,321 patients.
Source
Thoracic and Cardiovascular Surgeon. Conference: 44th Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery Freiburg
Germany. Conference Start: 20150208 Conference End: 20150211. Conference
Publication: (var.pagings). 63 , 2015. Date of Publication: January 2015.
Publisher
Georg Thieme Verlag
Abstract
Objectives: Severe bleeding related to cardiac surgery is associated with
increased morbidity and mortality. Thrombelastography (TEGO) and
thrombelastometry (ROTEMO) are point-of-care tests (POCT). Bedside
ROTEMO/TEGO can rapidly detect changes in blood coagulation and therefore
provide a goal-directed, individualized coagulation therapy. In this
meta-analysis we aimed to determine the current evidence for or against
POCT-guided algorithm with ROTEMO/TEGO in patients with severe bleeding
after cardiac surgery. Methods: We performed a meta-analysis of randomized
controlled trials (RCT) and observational trials (OT) retrieved from a
literature search in PubMed, EMBASE and Cochrane Library. Only the trials
comparing transfusion strategy guided by TEG/ROTEM with a standard of care
control group undergoing cardiac surgery were included. In addition at
least one clinical outcome had to be mentioned: mortality, re-thoracotomy
rate, sternal would infection, and acute kidney injury. Also surrogate
parameters such as transfusion requirements and amount of blood loss were
analyzed. The pooled treatment effects (odds ratio (OR), 95%-confidence
intervals (95%-CI)) were assessed using a fixed or random effects model.
Results: The literature search retrieved a total of 15 trials (8 RCT and 7
OT) involving 8,321 cardiac surgery patients. The TEG/ROTEM-guided
transfusion algorithm was performed in 4,406 patients (53%), standard
transfusion treatment in 3,915 (47%) patients. The demographic and
intraoperative data did not show statistical differences between groups.
The proportion of patients receiving blood products was reduced by POCT
guided transfusion management (OR: 0.65; 95%-CI: 0.57-0.74; p < 0.00001)
and re-thoracotomy rate due to postoperative bleeding was significantly
diminished (OR: 0.58; 95%-CI: 0.46-0.73; p < 0.00001). Furthermore, the
incidence of postoperative acute kidney injury was significantly decreased
in the TEG/ROTEM group (6%) compared with control group (8%) (OR: 0.78;
95%-CI: 0.61-0.99; p < 0.04). No statistical differences were found with
regard to mortality. Conclusions: TEG/ROTEM based coagulation management
reduces postoperative blood loss, Furthermore, it results in a lower
re-thoracotomy rate and decreases the incidence of postoperative acute
kidney injury in cardiac surgery patients.

<44>
Accession Number
71974610
Authors
McCaul J. Kulkarni R.R. Cymerman J. Moss C. Gilbert K. Kreiss I. McMahon
J.
Institution
(McCaul, Kulkarni) Royal Marsden and Northwick Park Hospitals, London,
United Kingdom
(Cymerman, Gilbert) Northwick Park Hospital, London, United Kingdom
(Moss) Royal London Hospital, London, United Kingdom
(Kreiss) Royal College of Surg., London, United Kingdom
(McMahon) Southern General Hospital, Glasgow, United Kingdom
Title
Enhanced recovery after surgery (ERAS): A systematic review in head and
neck cancer surgery.
Source
Head and Neck. Conference: 5th World Congress of the International Academy
of Oral Oncology, IAOO 2015 Sao Paulo Brazil. Conference Start: 20150708
Conference End: 20150711. Conference Publication: (var.pagings). 37 (pp
E116-E117), 2015. Date of Publication: July 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Introduction: Enhanced recovery after surgery (ERAS) programs are being
developed to reduce morbidity and mortality in patients undergoing major
surgery. The aims of ERAS are to optimize the patient before and during
major surgery and in the post-operative phase and so reduce morbidity and
mortality. Implementation of these programs in the fields of colorectal,
vascular and thoracic surgery is proving to be successful in reducing
morbidity and mortality. The aim of our systematic review is to evaluate
the existing body of evidence regarding ERAS in major head and neck cancer
surgery. Methods: A literature search on MEDLINE, Ovid, PubMed and
Cochrane library Database on Enhanced recovery after head and neck cancer
surgery published in English language between 1980 to 2014 was performed.
Title and abstract search revealed 114 papers for further analysis. We
used the PRISMA statement for the clear reporting of our systematic
review. Results: The literature on enhanced recovery in major head and
neck surgery is very limited at the present time. We present the current
literature evidence supporting measures intended to reduce morbidity and
mortality in major head and neck surgery. Conclusion: Further studies of
high quality are required to establish a basis for ERAS in head and neck
cancer surgery. This will lead to an enhanced recovery program
encompassing all three phases of the patient journey reducing patient
morbidity and mortality.