EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015230557
Authors
Hu R.-T. Liu J. Zhou Y. Hu B.-L.
Institution
(Hu) Minzu Affiliated Hospital of Guangxi Medical University, Nanning
530001, China
(Liu) Department of Cardiology, People's Hospital of Guangxi Zhuang
Autonomous Region, Nanning 530021, China
(Zhou) Minerva Foundation Institute for Medical Research, Helsinki
FI-00290, Finland
(Hu) First Affiliated Hospital of Guangxi Medical University, Nanning
530021, China
Title
Association of smoking with restenosis and major adverse cardiac events
after coronary stenting: A meta-analysis.
Source
Pakistan Journal of Medical Sciences. 31 (4) (pp 1002-1008), 2015. Date of
Publication: 2015.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Background and Objective: The association between smoking and clinical
outcomes after coronary stenting is controversial. The aim of this
meta-analysis was to assess the association between smoking and in stent
restenosis (ISR), major adverse cardiac events (MACE), or major adverse
cardiac and cerebrovascular events (MACCE) after coronary stenting.
Methods: A search for studies published before December 2014 was conducted
in PubMed, Embase, and Cochrane library. An inverse random weighted
meta-analysis was conducted using logarithm of the odds ratio (OR) and its
standard error for each study. Results: Ten studies investigated the
association between smoking and ISR. Overall, smoking was not associated
with ISR (OR: 1.05, 95% CI: 0.79-1.41; I² = 47.8%). Subgroup
analysis also failed to show a significant association between smoking and
ISR risk regardless of bare metal stent (BMS) and drug-eluting stent (DES)
implantation. Eight studies explored the association between smoking and
MACE, but no association was found (OR: 0.92, 95% CI: 0.77-1.10;
I² = 25.5%), and subgroup analysis revealed that no distinct
difference was found between BMS and DES implantation. Three studies
investigated the association between smoking and MACCE and significant
association was found (OR: 2.09, 95% CI: 1.43-3.06; I² =
21.6%). Conclusions: Our results suggest that in patients undergoing
percutaneous coronary intervention with stent implantation, smoking is not
associated with ISR and MACE; however, smoking is an independent risk
factor for MACCE.

<2>
Accession Number
2015232645
Authors
Geukers V.G. Dijsselhof M.E. Jansen N.J.G. Breur J.M.P.J. Van Harskamp D.
Schierbeek H. Van Goudoever J.B. Bos A.P. Sauerwein H.P.
Institution
(Geukers, Bos) Pediatric Intensive Care Department H8-190, Emma Children's
Hospital (EKZ), Academic Medical Center (AMC), Meibergdreef 9, Amsterdam
1105 AZ, Netherlands
(Dijsselhof) Department of Clinical Nutrition, AMC, Amsterdam, Netherlands
(Jansen) Pediatric Intensive Care Department, Wilhelmina Children's
Hospital (WKZ), University Medical Center Utrecht (UMCUtrecht), Lundlaan
6, Utrecht 3584 EA, Netherlands
(Breur) Department of Pediatric Cardiology, WKZ, UMCUtrecht, Utrecht,
Netherlands
(Geukers, Van Harskamp, Schierbeek, Van Goudoever, Bos) Department of
Pediatrics, EKZ, AMC, Amsterdam, Netherlands
(Van Goudoever) Department of Pediatrics, VU University Medical Center,
Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(Sauerwein) Department of Endocrinology and Metabolism, AMC, Amsterdam,
Netherlands
Title
The effect of short-term high versus normal protein intake on whole-body
protein synthesis and balance in children following cardiac surgery: A
randomized double-blind controlled clinical trial.
Source
Nutrition Journal. 14 (1) , 2015. Article Number: 72. Date of Publication:
28 Jul 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Infants undergoing cardiac surgery are at risk of a negative
protein balance, due to increased proteolysis in response to surgery and
the cardiopulmonary bypass circuit, and limited intake. The aim of the
study was to quantify the effect on protein kinetics of a short-term
high-protein (HP) diet in infants following cardiac surgery. Methods: In a
prospective, double-blinded, randomized trial we compared the effects of a
HP (5 g kg^-1 d^-1) versus normal protein (NP, 2 g
kg^-1 d^-1) enteral diet on protein kinetics in
children <24 months, on day 2 following surgical repair of congenital
heart disease. Valine kinetics and fractional albumin synthesis rate
(FSR<inf>alb</inf>) were measured with mass spectrometry using
[1-¹³C]valine infusion. The Mann-Whitney U test was used to
investigate differences between group medians. Additionally, the
Hodges-Lehmann procedure was used to create a confidence interval with a
point estimate of median differences between groups. Results: Twenty-eight
children (median age 9 months, median weight 7 kg) participated in the
study, of whom in only 20 subjects isotopic data could be used for final
calculations. Due to underpowering of our study, we could not draw
conclusions on the primary outcome parameters. We observed valine
synthesis rate of 2.73 (range: 0.94 to 3.36) and 2.26 (1.85 to 2.73) mumol
kg^-1 min^-1 in the HP and NP diet, respectively. The
net valine balance was 0.54 (-0.73 to 1.75) and 0.24 (-0.20 to 0.63) mumol
kg^-1 min^-1 in the HP and NP group. Between groups,
there was no difference in FSR<inf>alb</inf>. We observed increased
oxidation and BUN in the HP diet, compared to the NP diet, as a plausible
explanation of the metabolic fate of surplus protein. Conclusions: It is
plausible that the surplus protein in the HP group has caused the increase
of valine oxidation and ureagenesis, compared to the NP group. Because too
few patients had completed the study, we were unable to draw conclusions
on the effect of a HP diet on protein synthesis and balance. We present
our results as new hypothesis generating data. Trial registration: Dutch
Trial Register NTR2334.

<3>
Accession Number
2015165215
Authors
Thongprayoon C. Cheungpasitporn W. Srivali N. Ungprasert P.
Kittanamongkolchai W. Greason K.L. Kashani K.B.
Institution
(Thongprayoon, Cheungpasitporn, Kittanamongkolchai, Kashani) Division of
Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester,
MN 55905, United States
(Srivali, Kashani) Division of Pulmonary and Critical Care Medicine, Mayo
Clinic, Rochester, MN, United States
(Ungprasert) Division of Rheumatology, Mayo Clinic, Rochester, MN, United
States
(Greason) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
Title
Acute Kidney Injury after Transcatheter Aortic Valve Replacement: A
Systematic Review and Meta-Analysis.
Source
American Journal of Nephrology. 41 (4-5) (pp 372-382), 2015. Date of
Publication: 25 Jul 2015.
Publisher
S. Karger AG
Abstract
Background: The objective of this meta-analysis was to evaluate the risk
of acute kidney injury (AKI) in patients who underwent transcatheter
aortic valve replacement (TAVR). Methods: A literature search was
performed using MEDLINE, EMBASE, the Cochrane Database of Systematic
Reviews and clinicaltrials.gov from inception through October, 2014.
Studies that reported relative risks, ORs, or hazard ratios comparing the
AKI risk in patients who underwent TAVR versus those who underwent
surgical aortic valve replacement were included. We performed the
pre-specified sensitivity analysis including only propensity score-based
studies. Mortality risk was evaluated among the studies that reported AKI
outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were
calculated using a random-effect, generic inverse variance method.
Results: Three randomized controlled trials (RCTs) with 1,852 patients and
14 cohort studies with 3,113 patients were analyzed to assess the AKI risk
in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing
TAVR were 0.65 (95% CI 0.36-1.15, I² = 75%) in the analysis of
RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34,
I² = 79%) in the analysis of observational studies. Sensitivity
analysis in RCTs and propensity score-based studies using a standard AKI
definition demonstrated a significant association between TAVR and lower
AKI risk (RR 0.35, 95% CI 0.25-0.50, I² = 0%). Our
meta-analyses of RCTs and propensity score-based studies did not find
associations between TAVR and reduced risks of severe AKI requiring
dialysis (RR 0.82, 95% CI 0.38-1.79, I² = 63%). Conclusions:
Our meta-analysis demonstrates an association between TAVR and lower AKI
risk.

<4>
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Accession Number
2015227317
Authors
Kroin J.S. Buvanendran A. Li J. Moric M. Im H.-J. Tuman K.J. Shafikhani
S.H.
Institution
(Kroin, Buvanendran, Li, Moric, Tuman) Department of Anesthesiology, Rush
University Medical Center, 1653 W. Congress Pkwy., Chicago, IL 60612,
United States
(Im) Department of Biochemistry, Rush University Medical Center, Chicago,
IL, United States
(Shafikhani) Department of Immunology/Microbiology, Rush University
Medical Center, Chicago, IL, United States
Title
Short-term glycemic control is effective in reducing surgical site
infection in diabetic rats.
Source
Anesthesia and Analgesia. 120 (6) (pp 1289-1296), 2015. Date of
Publication: 25 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Patients and animals with diabetes exhibit enhanced
vulnerability to bacterial surgical infections. Despite multiple
retrospective studies demonstrating the benefits associated with glycemic
control in reducing bacterial infection after cardiac surgery, there are
fewer guidelines on the use of glycemic control for noncardiac surgeries.
In the current study, we investigated whether long-term (begun 2 weeks
before surgery) or immediate (just before surgery) glycemic controls,
continued postoperatively, can reduce surgical site infection in type 1
diabetic-induced rats. METHODS: Rats were injected with streptozotocin to
induce type 1 diabetes. Four groups of animals underwent surgery and thigh
muscle Staphylococcus aureus bacteria challenge (1 x 10⁸ colony
forming units) at the time of surgery. Group 1 diabetic rats received
insulin treatment just before surgery and continued until the end of study
(short-term glycemic control group). Group 2 diabetic rats received
insulin treatment 2 weeks before surgery and continued until the end of
study (long-term glycemic control). Group 3 diabetic rats received no
insulin treatment (no glycemic control group). Group 4 nondiabetic rats
served as a healthy control group. Rats were euthanized at 3 or 6 days
after surgery. Blood glucose and muscle bacterial burden were measured at
3 or 6 days after surgery. RESULTS: Glycemic control was achieved in both
long- and short-term insulin-treated diabetic rats. Compared with
untreated diabetic rats, the bacterial burden in muscle was significantly
lower in both groups of glycemic controlled diabetic rats at 3 (all P <
0.003) and 6 (all P < 0.0001) days after surgery. CONCLUSIONS: A
short-term glycemic control regimen, initiated just before surgery and
bacterial exposure, was as effective in reducing surgical site infection
as a long-term glycemic control in type 1 diabetic rats. These data
suggest that immediately implementing glycemic control in type 1 diabetic
surgical patients before undergoing noncardiac surgery may decrease the
risk of infection.

<5>
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Accession Number
2015226057
Authors
Un Roh G. Shim J.K. Song J.W. Kang H.M. Kwak Y.L.
Institution
(Un Roh, Shim, Song, Kang, Kwak) Department of Anaesthesiology and Pain
Medicine, Anaesthesia and Pain Research Institute, Yonsei University,
Seoul 120-752, South Korea
Title
Effect of glucose-insulin-potassium on hyperlactataemia in patients
undergoing valvular heart surgery.
Source
European Journal of Anaesthesiology. 32 (8) (pp 555-562), 2015. Date of
Publication: 25 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Hyperlactataemia represents oxygen imbalance in the tissues and its
occurrence during cardiac surgery is associated with adverse outcomes.
Glucose-insulin-potassium (GIK) infusion confers myocardial protection
against ischaemia-reperfusion injury and has the potential to reduce
lactate release while improving its clearance. OBJECTIVES The objective of
this study is to compare the effect of GIK on the incidence of
hyperlactataemia in patients undergoing valvular heart surgery. DESIGN A
randomised controlled study. SETTING Single university teaching hospital.
PATIENTS One hundred and six patients scheduled for elective valvular
heart surgery with at least two of the known risk factors for
hyperlactataemia. INTERVENTION Patients were randomly allocated to receive
either GIK solution (insulin 0.1IUkg^-1 h^-1 and an
infusion of 30% dextrose and 80mmoll^-1 potassium at
0.5mlkg^-1 h^-1) or 0.9% saline (control) throughout
surgery. MAIN OUTCOME MEASURES The primary outcome was the incidence of
hyperlactataemia (lactate >4mmoll^-1) during the operation and
until 24h after the operation. Secondary outcomes included haemodynamic
parameters, use of vasopressor or inotropic drugs, and fluid balance until
24h postoperatively. Postoperative morbidity endpoints were also assessed.
RESULTS The incidences of hyperlactataemia were similar in the groups
(32/53 patients in each of the control and GIK groups, P>0.999). There
were no intergroup differences in haemodynamic parameters, use of
vasopressor and inotropic drugs, or fluid balance. The incidences of
postoperative morbidity endpoints were similar in both groups. CONCLUSION
Despite its theoretical advantage, GIK did not provide beneficial effects
in terms of the incidence of hyperlactataemia or outcome in patients
undergoing valvular heart surgery.

<6>
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Accession Number
2015226055
Authors
Luger M. Hiesmayr M. Koppel P. Sima B. Ranz I. Weiss C. Konig J. Luger E.
Kruschitz R. Ludvik B. Schindler K.
Institution
(Luger, Kruschitz, Ludvik, Schindler) Department of Internal Medicine III,
Division of Endocrinology and Metabolism, Medical University of Vienna,
Vienna, Austria
(Luger) Special Institute for Preventive Cardiology and Nutrition, SIPCAN,
Salzburg, Austria
(Hiesmayr, Koppel, Sima, Ranz, Weiss) Division Cardiac Thoracic Vascular
Anaesthesia, Intensive Care Medicine, Medical University of Vienna,
Waehringer Guertel 18-20, Vienna 1090, Austria
(Konig) Department of Nutritional Sciences, University of Vienna, Austria
(Luger) Institute of Social Medicine, Centre for Public Health, Medical
University of Vienna, Vienna, Austria
Title
Influence of intravenous thiamine supplementation on blood lactate
concentration prior to cardiac surgery.
Source
European Journal of Anaesthesiology. 32 (8) (pp 543-548), 2015. Date of
Publication: 25 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Stress related to surgery and critical illness depletes thiamine,
essential in energy metabolism, and might result in high blood lactate
concentrations and higher mortality. OBJECTIVES We hypothesised that
thiamine supplementation would increase blood concentration of thiamine
and reduce blood lactate concentration postoperatively. Moreover, we aimed
to identify the prevalence of, and risk factors for, high blood lactate
concentrations. DESIGN This was a double-blind, randomised controlled
pilot study from February to July 2012 including 30 patients scheduled for
cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Patients were
assigned randomly to receive thiamine (300mg in 0.9% Normal saline
solution) or placebo (0.9% Normal saline) preoperatively. MAIN OUTCOME
MEASURES One arterial blood sample was taken preoperatively and another
postoperatively to measure thiamine concentration, and multiple samples
were taken during surgery and ICU stay to determine lactate
concentrations. Twenty-four hour urine samples were collected to measure
urinary thiamine concentration. Preoperatively, we assessed extracellular
mass to body cell mass ratio (ECM/BCM). RESULTS The mean (SD) age of the
patients was 58 (12) years, 73% were overweight, 10% were malnourished and
the prevalence of thiamine deficiency was 10%. Patients in the thiamine
group had significantly higher blood thiamine concentrations 2 days
postoperatively [805.2+/-289.8ng g-1 haemoglobin (Hb)] than those in the
placebo group (591.2+/-100.7ng g-1 Hb, P<0.01). The mean blood lactate
concentration changed significantly over time, but did not differ
significantly between the groups. Patients with ECM/BCM more than 1 had
higher lactate concentrations on admission to ICU than those with ECM/BCM
less than 1 (2.1+/-0.7 vs. 1.7+/-0.6, P=0.09) and were at a significantly
greater risk of having a higher lactate concentration on ICU admission
[odds ratio (OR) 13.5, 95% confidence interval (95% CI) 1.0 to 179.4,
P<0.05]. On the basis of these results, a sample size calculation for a
larger study has been facilitated. CONCLUSION Thiamine supplementation
caused normalisation of blood and urine concentrations postoperatively but
without a significant reduction in lactate concentration or clinical
outcome. Body composition played an important role in lactate formation.
Further research focusing on preoperative screening and optimal treatment
of high lactate concentrations in this specific population is warranted.

<7>
Accession Number
2015225908
Authors
Asha S.E. Cooke A. Walter E. Weaver J.
Institution
(Asha, Cooke, Walter) Emergency Department, St. George Hospital, Gray St,
Kogarah, Sydney, NSW 2217, Australia
(Asha, Weaver) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Weaver) Cardiology Department, St. George Hospital, Sydney, NSW,
Australia
Title
Three-month outcome of patients with suspected acute coronary syndrome
using point-of-care cardiac troponin-T testing compared with
laboratory-based cardiac troponin-T testing: A randomised trial.
Source
Emergency Medicine Journal. 32 (8) (pp 601-607), 2015. Date of
Publication: 01 Aug 2015.
Publisher
BMJ Publishing Group
Abstract
Objective: The aim of this randomised trial was to determine clinical
outcomes in patients suspected of an acute coronary syndrome (ACS) who had
cardiac troponin-T measured by point-of-care (POC) compared with
laboratory-based cardiac troponin-T testing. A secondary aim was to
describe the correlation between the two troponin assays. Methods: Adults
suspected of ACS were allocated to have troponin processed by POC or
laboratory analyser. The primary outcome was a composite of acute
myocardial infarction, coronary revascularisation, cardiac arrest and
mortality at 3 months. Paired troponins taken on participants allocated to
POC were used to determine correlation between troponin values obtained
from laboratory and POC analysers. Results: There were 452 participants.
30 (13.1%) of 229 participants allocated to POC had at least one primary
outcome event compared with 29 (13.0%) of 223 allocated to laboratory
testing, a difference of 0.1% (95% CI -6.2% to 6.4%, p=0.98). Of 215
available paired troponins results, both analysers gave congruent results
in 196 (91%) cases. The POC troponin was negative when the laboratory
sample was positive in 16 (7%) cases. The POC troponin was positive when
the laboratory sample was negative in 3 (1%) samples. Passing-Bablok
regression analysis demonstrated both a constant and proportional
difference between the two analytic methods. Conclusions: Among patients
suspected of an ACS, we found no evidence for a difference in adverse
outcome when POC troponin was used in comparison with laboratory troponin.
Due to the small sample size, an absolute difference of up to 6% in
adverse outcome is possible. Trial registration number:
ANZCTR#12612000319875.

<8>
Accession Number
2015224140
Authors
Faraoni D. Van Linden P.D.
Institution
(Faraoni, Van Linden) Department of Anesthesiology, Centre Hospitalier
Universitaire (CHU) Brugmann, Queen Fabiola Children's University Hospital
(QFCUH), Place Van Gehuchten 4, Brussels 1020, Belgium
Title
A systematic review of antifibrinolytics and massive injury.
Source
Minerva Anestesiologica. 80 (10) (pp 1115-1122), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Edizioni Minerva Medica
Abstract
Every year, more than a million people die as a result of trauma. This
huge mortality could be partially explained by the development of an acute
traumatic coagulopathy, present in a large part of all major trauma
patients, soon after injury, which contributes to ongoing hemorrhage. The
coagulopathy induced by trauma is independently associated with mortality,
increased transfusion requirements, multiple organ dysfunction,
infections, increased intensive care unit (ICU) length of stay, and costs.
The pathophysiological mechanisms implicated in this acute traumatic
coagulopathy are complexes and lead to generate a vicious circle leading
to the activation of different pathways: thrombin generation, plasmin
generation, inflammation activation. All of these processes will impair
the balance between clot formation and clot lysis, with an increased
tendency of hyperfibrinolysis. In 2010, the CRASH-2 trial demonstrated
that tranexamic acid (TXA) administration was associated with a reduction
in all cause mortality (14.5% vs. 16%, P=0.0035), including the risk of
death due to bleeding (4.9% vs. 5.8%, P=0.0077), without an increase in
fatal or non-fatal vascular occlusive events. Finally, the CRASH-3 trial
is now recruiting patients with traumatic brain injury without
extracranial bleeding. This study aims at determining the safety and
efficacy of TXA administration in this particular setting. Our experience
from the cardiac surgery setting highlighted a dose-dependent increased
seizure incidence associated with the administration of TXA. For this
reason, further studies are needed to better define the "optimal" dose
scheme based on pharmacokinetic and pharmacodynamic studies.

<9>
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Accession Number
2015220969
Authors
Dahl J.S. Eleid M.F. Michelena H.I. Scott C.G. Suri R.M. Schaff H.V.
Pellikka P.A.
Institution
(Dahl, Eleid, Michelena, Pellikka) Division of Cardiovascular Diseases,
Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
(Scott) Division of Biostatistics, Mayo Clinic, Rochester, MN, United
States
(Suri, Schaff) Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
Title
Effect of left ventricular ejection fraction on postoperative outcome in
patients with severe aortic stenosis undergoing aortic valve replacement.
Source
Circulation: Cardiovascular Imaging. 8 (4) , 2015. Article Number:
e002917. Date of Publication: 22 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - In asymptomatic patients with severe aortic stenosis,
guidelines recommend left ventricular ejection fraction (LVEF) of <50% as
the threshold for referral for aortic valve replacement. We investigated
the importance of LVEF on long-term outcome after aortic valve replacement
in symptomatic and asymptomatic patients with severe aortic stenosis.
Methods and Results - We retrospectively identified 2017 patients with
severe aortic stenosis (aortic valve area<1 cm², mean
gradient>40 mm Hg, or indexed aortic valve area<0.6
cm²/m²) who underwent surgical aortic valve
replacement from January 1995 to June 2009. Patients were divided into 4
groups depending on preoperative LVEF (<50% in 300 [15%] patients, 50%-59%
in 331 [17%], 60%-69% in 908 [45%], and >70% in 478 [24%]). During
follow-up of 5.3+/-4.4 years, 1056 (52%) patients died. A decrease in
mortality was observed with increasing LVEF, P<0.0001; 5-year mortality
estimates (95% confidence interval) were 0.41 (0.35-0.47), LVEF<50%; 0.35
(0.29-0.41), LVEF 50% to 59%; 0.26 (0.23-0.29), LVEF 60% to 69%; and 0.22
(0.18-0.26), LVEF>70%. Compared with patients with LVEF>60%, patients with
LVEF 50% to 59% had increased mortality (hazard ratio [HR], 1.58;
P<0.001), with similar risk increase in both symptomatic (HR, 1.56;
P<0.001) and asymptomatic patients (HR, 1.58; P=0.006). Correcting for
risk factors, LV mass index, aortic valve area, and stroke volume index,
LVEF was independently predictive of mortality (HR, 0.88 per 10%;
P<0.001). When this analysis was repeated in the subset of 1333 patients
without history of coronary artery disease, LVEF remained associated with
mortality (HR, 0.90 per 10%; P=0.009). Conclusions - LVEF is a powerful
predictor of outcome in patients with severe aortic stenosis undergoing
aortic valve replacement, independent of the presence of valve-related
symptoms.

<10>
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Accession Number
2015219171
Authors
Fisher J.G. Sparks E.A. Khan F.A. Alexander J.L. Asaro L.A. Wypij D. Gaies
M. Modi B.P. Duggan C. Agus M.S.D. Yu Y.-M. Jaksic T.
Institution
(Fisher, Sparks, Khan, Modi, Jaksic) Center for Advanced Intestinal
Rehabilitation, Department of Surgery, Boston Children's Hospital, Boston,
MA, United States
(Fisher, Sparks, Khan, Wypij, Modi, Duggan, Agus, Yu, Jaksic) Harvard
Medical School, Boston, MA, United States
(Alexander, Agus) Division of Medicine Critical Care, Boston Children's
Hospital, Boston, MA, United States
(Asaro, Wypij) Department of Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Gaies) Division of Pediatric Cardiology, C.S. Mott Children's Hospital,
University of Michigan Medical School, Ann Arbor, MI, United States
(Duggan) Center for Advanced Intestinal Rehabilitation, Division of
Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA,
United States
(Yu) Shriners Hospital for Children, Massachusetts General Hospital,
Boston, MA, United States
Title
Tight glycemic control with insulin does not affect skeletal muscle
degradation during the early postoperative period following pediatric
cardiac surgery.
Source
Pediatric Critical Care Medicine. 16 (6) (pp 515-521), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Critical illness is associated with significant catabolism, and
persistent protein loss correlates with increased morbidity and mortality.
Insulin is a potent anticatabolic hormone; high-dose insulin decreases
skeletal muscle protein breakdown in critically ill pediatric surgical
patients. However, insulin's effect on protein catabolism when given at
clinically utilized doses has not been studied. The objective was to
evaluate the effect of postoperative tight glycemic control and clinically
dosed insulin on skeletal muscle degradation in children after cardiac
surgery with cardiopulmonary bypass. Design: Secondary analysis of a
two-center, prospective randomized trial comparing tight glycemic control
with standard care. Randomization was stratified by study center.
Patients: Children 0-36 months who were admitted to the ICU after cardiac
surgery requiring cardiopulmonary bypass. Interventions: In the tight
glycemic control arm, insulin was titrated to maintain blood glucose
between 80 and 110 mg/dL. Patients in the control arm received standard
care. Skeletal muscle breakdown was quantified by a ratio of urinary
3-methylhistidine to urinary creatinine. Measurements and Main Results: A
total of 561 patients were included: 281 in the tight glycemic control arm
and 280 receiving standard care. There was no difference in
3-methylhistidine to creatinine between groups (tight glycemic control,
249 +/- 127 vs standard care, 253 +/- 112, mean +/- sd in mumol/g; p =
0.72). In analyses restricted to the patients in tight glycemic control
arm, higher 3-methylhistidine to creatinine correlated with younger age,
as well as lower weight, weight-for-age z score, length, and body surface
area (p < 0.005 for each) and lower postoperative day 3 serum creatinine
(r = -0.17; p = 0.02). Sex, prealbumin, and albumin were not associated
with 3-methylhistidine to creatinine. During urine collection, 245
patients (87%) received insulin. However, any insulin exposure did not
impact 3-methylhistidine to creatinine (t test, p = 0.45), and there was
no dose-dependent effect of insulin on 3-methylhistidine to creatinine (r
= -0.03; p = 0.60). Conclusion: Although high-dose insulin has an anabolic
effect in experimental conditions, at doses necessary to achieve
normoglycemia, insulin appears to have no discernible impact on skeletal
muscle degradation in critically ill pediatric cardiac surgical patients.

<11>
Accession Number
2015219019
Authors
Murphy E. Vellinga A. Byrne M. Cupples M.E. Murphy A.W. Buckley B. Smith
S.M.
Institution
(Murphy, Vellinga, Byrne, Murphy) Discipline of General Practice, National
University of Ireland Galway 1, School of Psychology, Distillery Road,
Galway, Ireland
(Cupples) Department of General Practice and UKCRC Centre for Excellence
for Public Health Research (NI), Queen's University, Belfast, United
Kingdom
(Buckley) Department of Surgery, University of the Philippines Manila,
Manila Philippines, Philippines
(Buckley) Discipline of General Practice, National University of Ireland,
Galway, Ireland
(Smith) Department of General Practice, Royal College of Surgeons in
Ireland, I-Dublin, Ireland
Title
Primary care organisational interventions for secondary prevention of
ischaemic heart disease: A systematic review and meta-Analysis.
Source
British Journal of General Practice. 65 (636) (pp e460-e468), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Royal College of General Practitioners
Abstract
Background Ischaemic heart disease (IHD) is the most common cause of death
worldwide. Aim To determine the long-term impact of organisational
interventions for secondary prevention of IHD. Design and setting
Systematic review and meta-Analysis of studies from CENTRAL, MEDLINE,
Embase, and CINAHL published January 2007 to January 2013. Method Searches
were conducted for randomised controlled trials of patients with
established IHD, with long-term follow-up, of cardiac secondary prevention
programmes targeting organisational change in primary care or community
settings. A random-effects model was used and risk ratios were calculated.
Results Five studies were included with 4005 participants. Meta-Analysis
of four studies with mortality data at 4.7-6 years showed that
organisational interventions were associated with approximately 20%
reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79
(95% confidence interval [CI] = 0.66 to 0.93), and a RR for
cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies
reported mortality data at 10 years. Analysis of these data showed no
significant differences between groups. There were insufficient data to
conduct a meta-Analysis on the effect of interventions on hospital
admissions. Additional analyses showed no significant association between
organisational interventions and risk factor management or appropriate
prescribing at 4.7-6 years. Conclusion Cardiac secondary prevention
programmes targeting organisational change are associated with a reduced
risk of death for at least 4-6 years. There is insufficient evidence to
conclude whether this beneficial effect is maintained indefinitely.

<12>
[Use Link to view the full text]
Accession Number
2015219122
Authors
Kragholm K. Halim S.A. Yang Q. Schulte P.J. Hochman J.S. Melloni C.
Mahaffey K.W. Moliterno D.J. Harrington R.A. White H.D. Armstrong P.W.
Ohman E.M. Van De Werf F. Tricoci P. Alexander J.H. Giugliano R.P. Newby
L.K.
Institution
(Kragholm, Halim, Yang, Schulte, Melloni, Ohman, Tricoci, Alexander,
Newby) Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715,
United States
(Hochman) Cardiovascular Clinical Research Center, Leon H. Charney
Division of Cardiology, New York University School of Medicine and NYU
Langone Medical Center, New York, NY, United States
(Mahaffey, Harrington) Department of Medicine, Stanford University,
Stanford, CA, United States
(Moliterno) Gill Heart Institute, Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Armstrong) Department of Medicine, University of Alberta, Edmonton,
Canada
(Van De Werf) Department of Cardiology, University Hospitals Leuven,
Leuven, Belgium
(Giugliano) Department of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
Title
Sex-Stratified Trends in Enrollment, Patient Characteristics, Treatment,
and Outcomes among Non-ST-Segment Elevation Acute Coronary Syndrome
Patients: Insights from Clinical Trials over 17 Years.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (4) (pp 357-367),
2015. Date of Publication: 23 Jul 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Adequate representation by sex in trials allows
generalizability of results. We examined representation of women in
clinical trials during a 17-year period in which inclusion criteria were
broadened and federal mandates for representativeness were launched.
Methods and Results - Using mixed models, we studied sex-stratified
temporal trends in enrollment, clinical characteristics, treatment, and
outcomes among 76 148 non-ST-segment elevation acute coronary syndrome
patients using patient-level data merged from 11 phase III trials
conducted from 1994 to 2010. Overall, 33.3% of patients were women, which
changed minimally over time. Women were consistently 4 to 5 years older
than men (median age 68 [interquartile range 61-75] versus 64
[interquartile range 56-72] years) and more frequently had diabetes
mellitus, hypertension, and heart failure; men more frequently had prior
myocardial infarction and revascularization. GRACE risk scores increased
over time for both sexes with the inclusion of older patients with more
comorbidities. Use of percutaneous coronary intervention, in-hospital and
discharge angiotensin-converting enzyme inhibitor/angiotensin II receptor
blockers, beta-blockers, and lipid-lowering drugs also increased among
both sexes. Kaplan-Meier estimates of 6-month mortality declined from 7.0%
[95% confidence interval 6.5%-7.6%] to 4.5% [95% confidence interval
4.0%-5.0%] among women and 6.3% [95% confidence interval 6.0%-6.7%] to
3.1% [95% confidence interval 2.9%-3.4%] among men during the 17-year
period. Conclusions - The relative proportion of women in non-ST-segment
elevation acute coronary syndrome trials changed minimally over time.
Nevertheless, in parallel with men, use of evidence-based care and
outcomes improved significantly over time among women.

<13>
[Use Link to view the full text]
Accession Number
2015219120
Authors
Gada H. Kirtane A.J. Wang K. Lei Y. Magnuson E. Reynolds M.R. Williams
M.R. Kodali S. Vahl T.P. Arnold S.V. Leon M.B. Thourani V. Szeto W.Y.
Cohen D.J.
Institution
(Gada) Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Kirtane, Kodali, Vahl, Leon) Columbia University Medical Center, New York
Presbyterian Hospital and the Cardiovascular Research Foundation, New
York, NY, United States
(Wang, Lei, Magnuson, Arnold, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine, 4401
Wornall Rd, Kansas City, MO 64111, United States
(Reynolds) Lahey Hospital and Medical Center, Burlington, MA, United
States
(Reynolds) Harvard Clinical Research Institute, Boston, MA, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Szeto) University of Pennsylvania School of Medicine, Philadelphia,
United States
Title
Temporal Trends in Quality of Life Outcomes after Transapical
Transcatheter Aortic Valve Replacement: A Placement of AoRTic
TraNscathetER Valve (PARTNER) Trial Substudy.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (4) (pp 338-346),
2015. Date of Publication: 23 Jul 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - In the Placement of AoRTic TraNscathetER Valve (PARTNER)
randomized controlled trial (RCT), which represented the first exposure to
transapical transcatheter aortic valve replacement (TA-TAVR) for many
clinical sites, high-risk patients undergoing TA-TAVR derived similar
health-related quality of life (HRQoL) outcomes when compared with
surgical aortic valve replacement (SAVR). With increasing experience, it
is possible that HRQoL outcomes of TA-TAVR may have improved. Methods and
Results - We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-ups
among 875 patients undergoing TA-TAVR in the PARTNER nonrandomized
continued access (NRCA) registry and compared these outcomes with those of
the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with
the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes
Study Short-Form 12, and the EuroQoL-5D, with the KCCQ overall summary
score serving as the primary end point. The NRCA TA-TAVR and RCT TA-TAVR
and SAVR groups were generally similar. The primary outcome, the KCCQ
summary score, did not differ between the NRCA TA-TAVR and the RCT TA-TAVR
group at any follow-up timepoints, although there were small differences
in favor of the NRCA cohort on several KCCQ subscales at 1 month. There
were no significant differences in follow-up HRQOL between the NRCA-TAVR
and the RCT SAVR cohorts on the KCCQ overall summary scale or any of the
disease-specific or generic subscales. Conclusions - Despite greater
experience with TA-TAVR in the NRCA registry, HRQoL outcomes remained
similar to those of TA-TAVR in the original RCT cohort and no better than
those with SAVR. These findings have important implications for patient
selection for TAVR when transfemoral access is not an option.

<14>
Accession Number
2015217569
Authors
Pascoalino L.N. Ciolac E.G. Tavares A.C. Ertner Castro R. Ayub-Ferreira
S.M. Bacal F. Issa V.S. Alcides Bocchi E. Veiga Guimaraes G.
Institution
(Pascoalino, Tavares, Ertner Castro, Ayub-Ferreira, Bacal, Issa, Alcides
Bocchi, Veiga Guimaraes) Heart Institute, School of Medicine, University
of Sao Paulo - USP, Sao Paulo, SP, Brazil
(Ciolac) Exercise and Chronic Disease Research Laboratory, Physical
Education Department, School of Sciences, Sao Paulo State University -
UNESP, Av Engenheiro Luiz Edmundo Carrijo Coube 14-06, Bauru SP
17033-360B, Brazil
(Tavares) Syrian-Lebanese Hospital, Sao Paulo, Brazil
Title
Exercise training improves ambulatory blood pressure but not arterial
stiffness in heart transplant recipients.
Source
Journal of Heart and Lung Transplantation. 34 (5) (pp 693-700), 2015. Date
of Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Hypertension is the most prevalent comorbidity after heart
transplantation (HT). Exercise training (ET) is widely recommended as a
key non-pharmacologic intervention for the prevention and management of
hypertension, but its effects on ambulatory blood pressure (ABP) and some
mechanisms involved in the pathophysiology of hypertension have not been
studied in this population. The primary purpose of this study was to
investigate the effects of ET on ABP and arterial stiffness of HT
recipients. Methods 40 HT patients, randomized to ET (n = 31) or a control
group (n = 9) underwent a maximal graded exercise test, 24-hour ABP
monitoring, and carotid-femoral pulse wave velocity (PWV) assessment
before the intervention and at a 12-week follow-up assessment. The ET
program was performed thrice-weekly and consisted primarily of endurance
exercise (40 minutes) at ~70% of maximum oxygen uptake
(Vo<inf>2MAX</inf>). Results The ET group had reduced 24-hour (4.0 +/- 1.4
mm Hg, p < 0.01) and daytime (4.8 +/- 1.6 mm Hg, p < 0.01) systolic ABP,
and 24-hour (7.0 +/- 1.4 mm Hg, p < 0.001) daytime (7.5 +/- 1.6 mm Hg, p <
0.001) and nighttime (5.9 +/- 1.5 mm Hg, p < 0.001) diastolic ABP after
the intervention. The ET group also had improved Vo<inf>2MAX</inf> (9.7%
+/- 2.6%, p < 0.001) after the intervention. However, PWV did not change
after ET. No variable was changed in the control group after the
intervention. Conclusions The 12-week ET program was effective for
reducing ABP but not PWV in heart transplant recipients. This result
suggests that endurance ET may be a tool to counteract hypertension in
this high-risk population.

<15>
Accession Number
2015155636
Authors
Rogers J.H. Thomas M. Morice M.-C. Narbute I. Zabunova M. Hovasse T.
Poupineau M. Rudzitis A. Kamzola G. Zvaigzne L. Greene S. Erglis A.
Institution
(Rogers) Division of Cardiovascular Medicine, University of California,
Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817,
United States
(Thomas) Guy's and St Thomas' Hospital, London, United Kingdom
(Morice, Hovasse) Generale de Sante, Institut Cardiovasculaire Paris Sud,
Massy, France
(Narbute, Zabunova, Rudzitis, Kamzola, Zvaigzne, Erglis) Latvian Centre of
Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
(Poupineau) Cardiology Department, Centre Hospitalier Prive, Claude
Galien, Quincy Sous-Senart, France
(Greene) MVRx Inc., Belmont, CA, United States
Title
Treatment of Heart Failure with Associated Functional Mitral Regurgitation
Using the ARTO System Initial Results of the First-in-Human MAVERIC Trial
(Mitral Valve Repair Clinical Trial).
Source
JACC: Cardiovascular Interventions. 8 (8) (pp 1095-1104), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
Objectives MAVERIC (Mitral Valve Repair Clinical Trial) reports the safety
and efficacy of the ARTO system in patients with symptomatic heart failure
and functional mitral regurgitation (FMR). Background The ARTO system
percutaneously modifies the mitral annulus to improve leaflet coaptation
in FMR. Methods The MAVERIC trial is a prospective, nonrandomized
first-in-human study. Key inclusion criteria were systolic heart failure
New York Heart Association functional classes II to IV, FMR grade >2+,
left ventricular (LV) ejection fraction 40%, LV end-diastolic diameter >50
mm and;75 mm. Exclusion criteria were clinical variables that precluded
feasibility of the ARTO procedure. Primary outcomes were safety (30-day
major adverse events) and efficacy (MR reduction, LV volumes, and
functional status). Results Eleven patients received the ARTO system, and
there were no procedural adverse events. From baseline to 30 days, there
were meaningful improvements. Effective regurgitant orifice area decreased
from 30.3 +/- 11.1 mm² to 13.5 +/- 7.1 mm² and
regurgitant volumes from 45.4 +/- 15.0 ml to 19.5 +/- 10.2 ml. LV
end-systolic volume index improved from 77.5 +/- 24.3 ml/m² to
68.5 +/- 21.4 ml/m², and LV end-diastolic volume index 118.7
+/- 28.6 ml/m² to 103.9 +/- 21.2 ml/m². Mitral
annular anteroposterior diameter decreased from 45.0 +/- 3.3 mm to 38.7
+/- 3.0 mm. Functional status was 81.8% New York Heart Association
functional class III/IV improving to 54.6% functional class I/II. At 30
days, there were 2 adverse events: 1 pericardial effusion requiring
surgical drainage; and 1 asymptomatic device dislodgement. Conclusions The
ARTO system is a novel transcatheter device that can be used safely with
meaningful efficacy in the treatment of FMR. (Mitral Valve Repair Clinical
Trial [MAVERIC]; NCT02302872)

<16>
Accession Number
2015153442
Authors
Cho J.R. Rollini F. Franchi F. Degroat C. Bhatti M. Dunn E.C. Ferrante E.
Muniz-Lozano A. Suryadevara S. Zenni M.M. Guzman L.A. Bass T.A. Angiolillo
D.J.
Institution
(Cho, Rollini, Franchi, Degroat, Bhatti, Dunn, Ferrante, Muniz-Lozano,
Suryadevara, Zenni, Guzman, Bass, Angiolillo) University of Florida
College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL
32209, United States
Title
Pharmacodynamic Effects of Ticagrelor Dosing Regimens in Patients on
Maintenance Ticagrelor Therapy Results from a Prospective, Randomized,
Double-Blind Investigation.
Source
JACC: Cardiovascular Interventions. 8 (8) (pp 1075-1083), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of this study was to assess the impact of ticagrelor
dosing regimens on pharmacodynamic (PD) profiles in patients on
maintenance ticagrelor therapy. Background Many patients on maintenance
P2Y<inf>12</inf>-inhibiting therapies may require coronary
revascularization procedures, raising a common clinical question with
regard to the dosing regimen of the P2Y<inf>12</inf>-inhibiting agent to
be used. To date, investigations assessing dosing regimens of
P2Y<inf>12</inf> receptor inhibitors in patients on maintenance therapy
have been only assessed with thienopyridines, but not with ticagrelor.
Methods This was a prospective, randomized, double-blind,
placebo-controlled study assessing the PD effects of 2 dosing regimens of
ticagrelor in patients on standard aspirin and ticagrelor maintenance
therapy. A total of 60 patients were randomized to either 90 mg
(maintenance dose [MD] group) or 180 mg (loading dose [LD] group) dose of
ticagrelor. PD assessments were conducted at 3 time points (baseline, 1 h
and 4 h). PD assessments were defined according to the platelet reactivity
index (PRI) (vasodilator-stimulated phosphoprotein phosphorylation assay),
P2Y<inf>12</inf> reaction unit (VerifyNow P2Y12 assay) and adenosine
diphosphate-induced platelet aggregation by light transmittance
aggregometry. Results There were no differences in baseline levels of
platelet reactivity with all assays. Intergroup comparisons by means of
repeated-measures analysis adjusted for baseline PRI values showed that
the LD group had significantly lower PRI levels compared with the MD group
during the overall study time course (p = 0.031). Consistent findings were
found for P2Y<inf>12</inf> reaction unit (p = 0.026) and light
transmittance aggregometry (p = 0.004). Intragroup comparisons showed that
a more prompt and sustained platelet inhibitory effect was achieved more
consistently with an LD regimen compared with a MD regimen. Conclusions In
patients on maintenance ticagrelor therapy, a 180-mg LD regimen of
ticagrelor is associated with more potent and prompt platelet inhibition
compared with a 90-mg MD. (Impact of Ticagrelor Re-Load Pharmacodynamic
Profiles; NCT01731041).

<17>
Accession Number
2015128990
Authors
Murbraech K. Massey R. Undset L.H. Midtvedt K. Holdaas H. Aakhus S.
Institution
(Murbraech, Massey, Aakhus) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Norway
(Undset) Department of Medicine, Baerum County Hospital, Baerum, Norway
(Midtvedt, Holdaas) Department of Nephrology, Department of Transplant
Medicine, Oslo University Hospital, Rikshospitalet, Norway
Title
Cardiac response to early conversion from calcineurin inhibitor to
everolimus in renal transplant recipients - a three-yr serial
echocardiographic substudy of the randomized controlled CENTRAL trial.
Source
Clinical Transplantation. 29 (8) (pp 678-684), 2015. Date of Publication:
01 Aug 2015.
Publisher
Blackwell Publishing Ltd
Abstract
In transplant recipients, calcineurin inhibitors (CNIs) are associated
with adverse cardiac effects while mTOR inhibitors have been reported to
be beneficial. We performed a randomized controlled trial (RCT) in de novo
renal transplant recipients examining cardiac responses of everolimus vs.
CNI. Methods: This was a substudy of the three-yr CENTRAL study, an RCT on
safety and efficacy of early (week 7 post-engraftment) conversion from
cyclosporine A (CsA) to everolimus vs. continued CsA. Thirty-nine
recipients [median age 64yr, (range 31-81)] completed echocardiographic
evaluations at baseline, one, and threeyr. Results: After threeyr, there
was no difference between groups in left ventricle (LV) diastolic
function, LV systolic function, LV morphology, and blood pressure
response. We observed a relevant decrease in LV mass (CsA; 9.6%, p=0.008,
vs. everolimus; 7.0% reduction, p=0.15), stabilized LV diastolic function,
and a trend toward lower systolic blood pressure with 6mmHg decrease in
both arms (CsA, p=0.08; everolimus, p=0.14). Diastolic blood pressure was
significantly reduced (8mmHg decrease, p=0.002) only in everolimus
patients. Conclusions: After three-yr follow-up, no clinically relevant
effect on cardiac function of an early conversion from CsA to an
everolimus-based immunosuppressive regimen was detected in de novo renal
transplant recipients.

<18>
Accession Number
2015119433
Authors
Wang J. Gu C. Gao M. Yu W. Yu Y.
Institution
(Wang, Gu, Gao, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Preoperative Statin Therapy and Renal Outcomes After Cardiac Surgery: A
Meta-analysis and Meta-regression of 59,771 Patients.
Source
Canadian Journal of Cardiology. 31 (8) (pp 1051-1060), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: The purpose of this study was to investigate the effects of
preoperative statin therapy (PST) on short- and long-term renal
dysfunction after cardiac surgery. Methods: We searched for reports that
investigated the effects of PST on renal outcomes after cardiac surgery in
the electronic literature databases PubMed, Ovid, and Elsevier. Results:
Twenty-six reports including 59,771 patients were selected for
meta-analysis. The meta-analysis revealed that PST significantly reduced
the incidence of postoperative renal dysfunction (odds ratio [OR], 0.89;
95% confidence interval [CI], 0.84-0.95; P < 0.0001) without significant
heterogeneity (I² = 28.1%; P = 0.093). PST also significantly
reduced the need for postoperative renal replacement therapy (OR = 0.76;
95% CI, 0.62-0.92; z = 2.77; P = 0.006); particularly in the subgroup of
patients who underwent isolated coronary artery bypass grafting, the rate
of renal replacement therapy was reduced by 56% (OR, 0.44; 95% CI,
0.30-0.66; z = 4.08; P < 0.0001) with low heterogeneity (I² =
18.7%; P = 0.297). Meta-analysis for the outcome of acute kidney injury
(AKI) revealed that PST reduced the incidence of postoperative AKI by 13%
(OR, 0.87; 95% CI, 0.80-0.94; P = 0.001) and 7% (OR, 0.93; 95% CI,
0.86-0.99; P = 0.031), respectively, for subgroups of patients whose AKI
was evaluated using the Acute Kidney Injury Network (AKIN) or the Risk,
Injury, Failure, Loss, and End Stage (RIFLE) criteria, without significant
heterogeneity for either. Conclusions: PST might be a promising therapy to
reduce renal complications after cardiac surgery although large-scaled
randomized controlled trials are needed to further verify the conclusion.

<19>
Accession Number
2015026441
Authors
Zyblewski S.C. Nietert P.J. Graham E.M. Taylor S.N. Atz A.M. Wagner C.L.
Institution
(Zyblewski, Graham, Atz) Division of Pediatric Cardiology, Department of
Pediatrics, Medical University of South Carolina, Charleston, SC, United
States
(Nietert) Department of Public Health Sciences, Medical University of
South Carolina, Charleston, SC, United States
(Taylor, Wagner) Division of Neonatology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC, United States
Title
Randomized clinical trial of preoperative feeding to evaluate intestinal
barrier function in neonates requiring cardiac surgery.
Source
Journal of Pediatrics. 167 (1) (pp 47-51.e1), 2015. Date of Publication:
01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Objectives To evaluate intestinal barrier function in neonates undergoing
cardiac surgery using lactulose/mannitol (L/M) ratio measurements, and to
determine correlations with early breast milk feeding. Study design This
was a single-center, prospective, randomized pilot study of 27 term-born
neonates (>37 weeks gestation) requiring cardiac surgery who were
randomized to 1 of 2 preoperative feeding groups: nil per os (NPO) or
trophic (10 mL/kg/day) breast milk feeds. At 3 time points (preoperative
[preop], postoperative [postop] day 7, and postop day 14), subjects were
administered an oral L/M solution, after which urine L/M ratios were
measured using gas chromatography, with higher ratios indicative of
increased intestinal permeability. Trends over time in the mean urine L/M
ratios for each group were estimated using a general linear mixed model.
Results There were no adverse events related to preoperative trophic
feeding. In the NPO group (n = 13), the mean urine L/M ratio was 0.06 at
preop, 0.12 at postop day 7, and 0.17 at postop day 14. In the trophic
breast milk feeds group (n = 14), the mean urine L/M ratio was 0.09 at
preop, 0.19 at postop day 7, and 0.15 at postop day 14. In both groups,
L/M ratios were significantly higher at postop day 7 and postop day 14
compared with preop (P <.05). Conclusion Neonates have increased
intestinal permeability after cardiac surgery extending to at least postop
day 14. This pilot study was not powered to detect differences in benefit
or adverse events comparing the NPO and trophic breast milk feeds groups.
Further studies to identify mechanisms of intestinal injury and
therapeutic interventions are warranted. Trial registration Registered
with ClinicalTrials.gov: NCT01475357.

<20>
Accession Number
2015766917
Authors
Shreenivas S.S. Lilly S.M. Szeto W.Y. Desai N. Anwaruddin S. Bavaria J.E.
Hudock K.M. Thourani V.H. Makkar R. Pichard A. Webb J. Dewey T. Kapadia S.
Suri R.M. Xu K. Leon M.B. Herrmann H.C.
Institution
(Shreenivas, Lilly, Anwaruddin, Herrmann) Department of Cardiology,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
(Szeto, Desai, Bavaria) Department of Surgery, University of Pennsylvania,
Philadelphia, PA, United States
(Hudock) Department of Pulmonary and Critical Care, University of
Pennsylvania, Philadelphia, PA, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Dewey) Medical City Dallas Hospital, Dallas, TX, United States
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Suri) Mayo Clinic, Rochester, MN, United States
(Xu, Leon) Cardiovascular Research Foundation, New York, NY, United States
(Leon) Columbia University Medical Center, New York Presbyterian Hospital,
New York, NY, United States
Title
Cardiopulmonary bypass and intra-aortic balloon pump use is associated
with higher short and long term mortality after transcatheter aortic valve
replacement: A PARTNER trial substudy.
Source
Catheterization and Cardiovascular Interventions. 86 (2) (pp 316-322),
2015. Date of Publication: 01 Aug 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Transcatheter aortic valve replacement (TAVR) with the
balloon-expandable Sapien transcatheter heart valve improves survival
compared to standard therapy in patients with severe aortic stenosis (AS)
and is noninferior to surgical aortic valve replacement (AVR) in patients
at high operative risk. Nonetheless, a significant proportion of patients
may require pre-emptive or emergent support with cardiopulmonary bypass
(CPB) and/or intra-aortic balloon pump (IABP) during TAVR due to
pre-existing comorbid conditions or as a result of procedural
complications. Objectives: We hypothesized that patients who required CPB
or IABP would have increased periprocedural complications and reduced
long-term survival. In addition, we sought to determine whether
preprocedural variables could predict the need for CPB and IABP. Methods:
The study population included 2,525 patients in the PARTNER Trial (Cohort
A and B) and the continuing access registry (CAR). Patients that received
CPB or IABP were compared to patients that did not receive either, and
then further divided into those that received support pre-TAVR and those
that were placed on support emergently. Results: One-hundred sixty-three
patients (6.5%) were placed on CPB and/or IABP. The use of CPB or IABP was
associated with higher 1 year mortality (49.1% vs. 21.6%, P-<-0.001). In
multivariable analysis, utilization of CPB or IABP was an independent
predictor of 30 day (HR 6.95) and 1-year (HR 2.56) mortality. Although
mortality was highest in emergent cases, mortality was also greater in
planned CPB and IABP cases compared with non-CPB/IABP cases (53.3% and
40.3% vs. 21.6%, P-<-0.001). Conclusions: These findings indicate that CPB
and IABP use in TAVR portends a poor prognosis and its utilization,
particularly in the setting of pre-emptive use, needs reconsideration.

<21>
Accession Number
2014906941
Authors
Soofi M.A. Alsamadi F.
Institution
(Soofi, Alsamadi) Prince Salman Heart Center, King Fahad Medical City,
Riyadh, Saudi Arabia
Title
Restoration of normal left ventricular geometry after percutaneous mitral
annuloplasty: Case report and review of literature.
Source
Catheterization and Cardiovascular Interventions. 86 (2) (pp E107-E110),
2015. Date of Publication: 01 Aug 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Surgical mitral valve intervention is not considered suitable in patients
with severe functional mitral regurgitation due to severe dilated
cardiomyopathy and severe systolic dysfunction. In such patients
percutaneous mitral valve intervention is the next best alternative. We
are presenting case report of a patient who presented with severe dyspnea
progressing to orthopnea and paroxysmal nocturnal dyspnea. He was found to
have severe functional mitral regurgitation and severe left ventricle
systolic dysfunction. Surgical mitral intervention was not considered
suitable and percutaneous mitral annuloplasty was done. At one month
follow-up significant improvement in symptoms were noted with improvement
in severity of mitral regurgitation severity. At 6 months follow-up
further improvement in symptoms were noted along with significant
improvement in the severity of mitral regurgitation and normalization of
left ventricle geometry. At 1 year follow-up his symptoms further
improved, left ventricle geometry remained normal and mitral regurgitation
severity remained mild to moderate. Our case demonstrate that in patient
with severe LV systolic dysfunction, severe mitral regurgitation and left
bundle branch block percutaneous mitral annuloplasty can obviate the need
for CRT-D due to significant improvement in LV function and geometry along
with regression in severity of mitral regurgitation. Improvement in mitral
regurgitation severity and LV geometry started early and kept improving
with excellent result at 6 and 12 months.

<22>
Accession Number
2015217644
Authors
Bejar D. Colombo P.C. Latif F. Yuzefpolskaya M.
Institution
(Bejar, Colombo, Latif, Yuzefpolskaya) Division of Cardiology, Columbia
University Medical Center, New York, NY, United States
Title
Infiltrative cardiomyopathies.
Source
Clinical Medicine Insights: Cardiology. 9 (pp 29-38), 2015. Date of
Publication: 18 Mar 2015.
Publisher
Libertas Academica Ltd. (PO Box 300-874, Albany 0751, Mairangi Bay,
Auckland 0751, New Zealand)
Abstract
Infiltrative cardiomyopathies can result from a wide spectrum of both
inherited and acquired conditions with varying systemic manifesta-tions.
They portend an adverse prognosis, with only a few exceptions (ie,
glycogen storage disease), where early diagnosis can result in potentially
curative treatment. The extent of cardiac abnormalities varies based on
the degree of infiltration and results in increased ventricular wall
thickness, chamber dilata-tion, and disruption of the conduction system.
These changes often lead to the development of heart failure,
atrioventricular (AV) block, and ventricular arrhythmia. Because these
diseases are relatively rare, a high degree of clinical suspicion is
important for diagnosis. Electrocardiography and echocardiog-raphy are
helpful, but advanced techniques including cardiac magnetic resonance
(CMR) and nuclear imaging are increasingly preferred. Treatment is
dependent on the etiology and extent of the disease and involves
medications, device therapy, and, in some cases, organ transplantation.
Cardiac amyloid is the archetype of the infiltrative cardiomyopathies and
is discussed in great detail in this review.

<23>
Accession Number
71962545
Authors
Al-Khabori M. Al-Riyami A. Siddiqi S. Al-Sabti H.
Institution
(Al-Khabori, Al-Riyami) Hematology, Muscat, Oman
(Siddiqi, Al-Sabti) Surgery, Sultan Qaboos University Hospital, Muscat,
Oman
Title
Cell salvage during cardiac surgery may decrease red blood cell
transfusion: A systematic review and meta-analysis.
Source
Haematologica. Conference: 20th Congress of the European Hematology
Association Vienna Austria. Conference Start: 20150611 Conference End:
20150614. Conference Publication: (var.pagings). 100 (pp 138-139), 2015.
Date of Publication: 22 Jun 2015.
Publisher
Ferrata Storti Foundation
Abstract
Background: Red blood cell transfusion in cardiac surgery is known to be
associated with increased morbidity and mortality. The use of the cell
salvage (CS) as a blood conservative strategy in cardiac surgery has been
under debate with conflicting results from different studies. Aims: We
examined the current evidence behind the use of the CS by performing a
systematic review and meta-analysis of existing randomized clinical trials
that assessed the impact of the CS use on red blood cell (RBC)
transfusion. Methods: We searched MEDLINE, CENTRAL, American Society of
Hematology and bibliographies of relevant studies (all searched July 2014)
for randomized clinical trials comparing CS versus non-CS strategies in
cardiac surgeries. We performed a meta-analysis using random effects model
(DerSimonian- Laird) to estimate the pooled odds ratio and used I2
statistic to assess the heterogeneity. Results: Total of 587 citations
were retrieved, out of which 14 trials were eligible for inclusion with a
total of 1661 patients (899 in the CS group and 762 in the non-CS group).
The vast majority of patients had coronary artery bypass graft surgery.
All trials used shed blood for CS. In the CS group, 345 patients (38%)
received RBC transfusion compared to 340 patients (45%) in the non-CS
group. The odds of receiving blood transfusion were lower in the CS group
(odds ratio of 0.66, 95% confidence interval [CI]: 0.45-0.96; Figure).
Nevertheless, there was substantial heterogeneity between the trails in
the outcome [I2 of 60% (95% CI: 19-87%) which was statistically
significant (P<0.01). Summary and Conclusions: Available evidence suggests
that the use of CS during cardiac surgery as a blood conservative strategy
may decrease RBC transfusion with a reasonable effect size. However, these
findings need to be taken with caution, given the substantial
between-study heterogeneity in the outcome. We therefore recommend a large
randomized controlled clinical trial to confirm these findings.