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
2015397558
Authors
McKavanagh P. Lusk L. Ball P.A. Verghis R.M. Agus A.M. Trinick T.R. Duly
E. Walls G.M. Stevenson M. James B. Hamilton A. Harbinson M.T. Donnelly
P.M.
Institution
(McKavanagh, Lusk, Ball, Trinick, Duly, Walls, James, Hamilton, Donnelly)
Cardiology Department, Ulster Hospital, South Eastern Health and Social
Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, United
Kingdom
(McKavanagh, Harbinson, Donnelly) Centre for Vision and Vascular Science,
Institute of Clinical Science A, Queen's University Belfast, Royal
Victoria Hospital Belfast, Belfast BT126BA, United Kingdom
(Verghis, Agus, Stevenson) Northern Ireland Clinical Trials Unit,
Education and Research Centre, Royal Hospitals, Belfast BT12 6BA, United
Kingdom
Title
A comparison of cardiac computerized tomography and exercise stress
electrocardiogramtest for the investigation of stable chest pain: The
clinical results of the CAPP randomized prospective trial.
Source
European Heart Journal Cardiovascular Imaging. 16 (4) (pp 441-448), 2015.
Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
Aims To determine the symptomatic and prognostic differences resulting
from a novel diagnostic pathway based on cardiac computerized tomography
(CT) compared with the traditional exercise stress electrocardiography
test (EST) in stable chest pain patients. Methods and results A
prospective randomized controlled trial compared selected patient outcomes
in EST and cardiac CT coronary angiography groups. Five hundred patients
with troponin-negative stable chest pain and without known coronary artery
disease were recruited. Patients completed the Seattle Angina
Questionnaires (SAQ) at baseline, 3, and 12 months to assess angina
symptoms. Patients were also followed for management strategies and
clinical events. Over the year 12 patients withdrew, resulting in 245 in
the EST cohort and 243 in the CT cohort. There was no significant
difference in baseline demographics. The CT arm had a statistical
difference in angina stability and quality-of-life domains of the SAQ at 3
and12 months, suggesting less angina compared with the EST arm. In the CT
arm, there was more significant disease identified and more
revascularizations. Significantly, more inconclusive results were seen in
the EST arm with a higher number of additional investigations ordered.
There was also a longer mean time to management. There were no differences
in major adverse cardiac events between the cohorts. At 1 year in the EST
arm, there were more Accident and Emergency (A&E) attendances and cardiac
admission. Conclusion Cardiac CTas an index investigation for stable chest
pain improved angina symptoms and resulted in fewer investigations and
re-hospitalizations compared with EST. Clinical trial registration
http://www.controlled-trials.com/ISRCTN52480460.

<3>
Accession Number
2015309010
Authors
Saha S.P. Saha S. Vyas K.S.
Institution
(Saha, Vyas) Cardiothoracic and Vascular Surgery, Charles T Wethington
Building, University of Kentucky, 900 South Limestone, Lexington, KY
40536-0200, United States
(Saha) MediCiti Institute of Medical Science, Hyderabad, India
Title
Carotid endarterectomy: Current concepts and practice patterns.
Source
International Journal of Angiology. 24 (3) (pp 223-235), 2014. Date of
Publication: 16 Jul 2014.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Background Stroke is the number one cause of disability and third leading
cause of death among adults in the United States. A major cause of stroke
is carotid artery stenosis (CAS) caused by atherosclerotic plaques.
Randomized trials have varying results regarding the equivalence and
perioperative complication rates of stents versus carotid endarterectomy
(CEA) in the management of CAS. Objectives We review the evidence for the
current management of CAS and describe the current concepts and practice
patterns of CEA. Methods A literature search was conducted using PubMed to
identify relevant studies regarding CEA and stenting for the management of
CAS. Results The introduction of CAS has led to a decrease in the
percentage of CEA and an increase in the number of CAS procedures
performed in the context of all revascularization procedures. However, the
efficacy of stents in patients with symptomatic CAS remains unclear
because of varying results among randomized trials, but the perioperative
complication rates exceed those found after CEA. Conclusions Vascular
surgeons are uniquely positioned to treat carotid artery disease through
medical therapy, CEA, and stenting. Although data from randomized trials
differ, it is important for surgeons to make clinical decisions based on
the patient. We believe that CAS can be adopted with low complication rate
in a selected subgroup of patients, but CEA should remain the standard of
care. This current evidence should be incorporated into practice of the
modern vascular surgeon.

<4>
Accession Number
2015392749
Authors
Van Der Heijden M.J.E. Araghi S.O. Van Dijk M. Jeekel J. Hunink M.G.M.
Institution
(Van Der Heijden) Department of Pediatrics, Erasmus MC, Rotterdam,
Netherlands
(Araghi, Jeekel) Department of Neuroscience, Erasmus MC, Rotterdam,
Netherlands
(Van Dijk) Department of Pediatrics, Division of Neonatology, Department
of Pediatric Surgery, Intensive Care Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
Title
The effects of perioperative music interventions in pediatric surgery: A
systematic review and meta-analysis of randomized controlled trials.
Source
PLoS ONE. 10 (8) , 2015. Article Number: e0133608. Date of Publication: 06
Aug 2015.
Publisher
Public Library of Science
Abstract
Objective: Music interventions are widely used, but have not yet gained a
place in guidelines for pediatric surgery or pediatric anesthesia. In this
systematic review and meta-analysis we examined the effects of music
interventions on pain, anxiety and distress in children undergoing
invasive surgery. Data Sources: We searched 25 electronic databases from
their first available date until October 2014. Study Selection: Included
were all randomized controlled trials with a parallel group, crossover or
cluster design that included pediatric patients from 1 month to 18 years
old undergoing minimally invasive or invasive surgical procedures, and
receiving either live music therapy or recorded music. Data Extraction and
Synthesis: 4846 records were retrieved from the searches, 26 full text
reports were evaluated and data was extracted by two independent
investigators. Main Outcome Measures: Pain was measured with the Visual
Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale.
Anxiety and distress were measured with an emotional index scale (not
validated), the Spielberger short State Trait Anxiety Inventory and a
Facial Affective Scale. Results: Three RCTs were eligible for inclusion
encompassing 196 orthopedic, cardiac and day surgery patients (age of 1
day to 18 years) receiving either live music therapy or recorded music.
Overall a statistically significant positive effect was demonstrated on
postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and
distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; -
0.16. Conclusions and Relevance: This systematic review and meta-analysis
indicates that music interventions may have a statistically significant
effect in reducing post-operative pain, anxiety and distress in children
undergoing a surgical procedure. Evidence from this review and other
reviews suggests music therapy may be considered for clinical use.

<5>
Accession Number
2015396629
Authors
Guo B.-L. Lin Y. Hu W. Zhen C.-X. Bao-Cheng Z. Wu H.-H. Kaye A.D. Duan
J.-H. Qu Y.
Institution
(Guo, Lin, Qu) Department of Neurosurgery, Tang'du Hospital, Fourth
Military Medical University, Xi'an 71032, China
(Guo, Lin, Zhen, Wu) Department of Neurobiology and Collaborative
Innovation Center for Brain Science, Fourth Military Medical University,
Xi'an 710032, China
(Hu, Duan) State Key Laboratory of Military Stomatology, College of
Stomatology, Fourth Military Medical University, Xi'an 710032, China
(Bao-Cheng) The Healthcare Department of General Political Department
Hospital, Beijing 100120, China
(Wu) Department of Anesthesiology, Fuzhou General Hospital Affiliated to
Fujian Medical University, Fuzhou 350025, China
(Kaye) Department of Anesthesiology, Louisiana State University Health
Sciences Center, New Orleans, LA, United States
Title
Effects of systemic magnesium on postoperative analgesia: Is the current
evidence strong enough?.
Source
Pain Physician. 18 (5) (pp 405-418), 2015. Date of Publication: 01 Sep
2015.
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Clinical studies have been previously carried out on the
efficacy of systemic magnesium to minimize postoperative pain, however,
with controversial results. A quantitative meta-analysis was performed to
evaluate the analgesic efficacy and safety of systemic magnesium on
post-operative pain. Study Design: Comprehensive systematic review of all
relevant, publsished randomized controlled trials. Methods: A search was
conducted of published literature in MEDLINE, PsycINFO, Scopus, EMBASE,
and the Cochrane Central Register of Controlled Trials (CENTRAL) databases
from inception to September 2014. Randomized controlled trials (RCTs) that
compared magnesium with placebo were identified. Effects were summarized
using standardized mean differences (SMDs), weighed mean differences
(WMD), or odds ratio (OR) with suitable effect model. Results:
Twenty-seven RCTs involving 1,504 patients were included. In total,
peri-operative magnesium significantly reduced the pain score at rest
(SMD, -1.43, 95% CI, -2.74 to -0.12, < 0.01). Magnesium significantly
reduced analgesic consumption (SMD, -1.72, 95% CI, -3.21 to -0.23) in
patients undergoing urogenital, orthopaedic, and cardiovascular surgeries,
but was inconclusive for patients receiving gastrointestinal surgeries.
The obvious analgesia of systemic magnesium was observed on reducing the
pain score during movement at 24 hours after operation (SMD, -0.05, 95%
CI, -0.43 to 0.32). Moreover, magnesium administration showed a beneficial
effect with regard to intra-operative hemodynamics and reduced extubation
time in the cardiovascular surgery patients (WMD, -29.34 min, 95% CI,
-35.74 to -22.94, P < 0.01). Limitations: Focused only on the quality of
analgesia on postoperative pain with regards to surgery type. Conclusions:
Our study suggests that systemic magnesium during general anesthesia
significantly decreases post-operative pain scores without increasing
adverse events. It should be noted that since there are 18 ongoing RCTs
without published data, it is still premature to draw conclusions on the
long-term analgesic effects of magnesium as well as potential gender or
age difference.

<6>
Accession Number
2015394615
Authors
Li W. Li L. Xu X. An Z. Chao Q. Zhou Z. Hua G. Zhou H. Liu A. Wan Z.
Institution
(Li, Xu, Zhou, Liu) Department of Cardiac Surgery, Beijing Anzhen
Hospital, Capital Medical University, Beijing Institute of Heart Lung and
Blood Vessel Diseases, Anzhen Road 2, Chaoyang District, Beijing 100029,
China
(Li, Wan) 306 Hopital of People's Liberal Army, Beijing, China
(An, Chao) First Hospital Affiliated to Henan Science and Technology
University, Henan, China
(Hua, Zhou) Jiaozhou Mine Hospital, Henan, China
Title
Aortic Root Wrapped Procedure for Treating Aortic Root Sinus Aneurysm.
Source
Surgical Innovation. 22 (5) (pp 479-483), 2015. Date of Publication: 22
Oct 2015.
Publisher
SAGE Publications Inc.
Abstract
Background. To develop a relatively simple and effective and low-risk
operation, aortic root wrapped procedure, to treat aortic root aneurysm or
ectasia. Methods. From June 2008 to September 2010, 15 patients were
accepted for aortic root wrapped angioplasty procedure, Marfan's syndrome
with aortic root ectasia in 2 cases, and aortic sinus aneurysm with middle
to severe aortic valve stenosis and/or regurgitation in 13 cases. The
diameter of aortic valve annulus was 25.43 +/- 2.34 mm (range = 22-32 mm)
and the diameter of aortic sinus was 50.45 +/- 7.32 mm (range = 45-60 mm).
All patients underwent aortic root wrapped angioplasty procedures with
artificial blood vessel combined with aortic valve plasty or replacement
with tissue valve prosthesis. Results. Fifteen patients survived well, and
the perioperative mortality was 0%. Cardiopulmonary bypass time was 82.31
+/- 16.34 minutes (range = 55-128 minutes). Predischarge echocardiography
check result showed trace aortic regurgitation in 3 cases and normal
aortic valve function in 12 cases. Compared with preoperative
echocardiography results, the aortic annulus diameter (22.63 +/- 1.25 mm
[range = 21-25 mm]) decreased significantly (P <.01) and the aortic sinus
diameter (36.86 +/- 7.41 mm [range = 30-41 mm]) decreased significantly (P
<.001). Follow-up results: All 15 patients survived well, and heart
function (New York Heart Association classification) of the patients are
all class I. The late mortality was 0%. Conclusion. Aortic root wrapped
procedures combined with aortic valve plastic or replacement operation is
an alternative surgical procedure in patients with aortic sinus aneurysm
and aortic valve disease.

<7>
Accession Number
2015393654
Authors
Zangrillo A. Musu M. Greco T. Di Prima A.L. Matteazzi A. Testa V. Nardelli
P. Febres D. Monaco F. Calabro M.G. Ma J. Finco G. Landoni G.
Institution
(Zangrillo, Di Prima, Matteazzi, Testa, Nardelli, Febres, Monaco, Calabro,
Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Zangrillo, Greco, Landoni) Vita-Salute San Raffaele University, Milan,
Italy
(Musu, Finco) Department of Medical Sciences M. Aresu, Cagliari
University, Cagliari, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Additive effect on survival of anaesthetic cardiac protection and remote
ischemic preconditioning in cardiac surgery: A Bayesian network
meta-analysis of randomized trials.
Source
PLoS ONE. 10 (7) , 2015. Article Number: e0134264. Date of Publication: 31
Jul 2015.
Publisher
Public Library of Science
Abstract
Introduction: Cardioprotective properties of volatile agents and of remote
ischemic preconditioning have survival effects in patients undergoing
cardiac surgery. We performed a Bayesian network meta-analysis to confirm
the beneficial effects of these strategies on survival in cardiac surgery,
to evaluate which is the best strategy and if these strategies have
additive or competitive effects. Methods: Pertinent studies were
independently searched in BioMedCentral, MEDLINE/PubMed, Embase, and the
Cochrane Central Register (updated November 2013). A Bayesian network
meta-analysis was performed. Four groups of patients were compared: total
intravenous anesthesia (with or without remote ischemic preconditioning)
and an anesthesia plan including volatile agents (with or without remote
ischemic preconditioning). Mortality was the main investigated outcome.
Results: We identified 55 randomized trials published between 1991 and
2013 and including 6,921 patients undergoing cardiac surgery. The use of
volatile agents (posterior mean of odds ratio = 0.50, 95% CrI 0.28-0.91)
and the combination of volatile agents with remote preconditioning
(posterior mean of odds ratio = 0.15, 95% CrI 0.04-0.55) were associated
with a reduction in mortality when compared to total intravenous
anesthesia. Posterior distribution of the probability of each treatment to
be the best one, showed that the association of volatile anesthetic and
remote ischemic preconditioning is the best treatment to improve shortand
long-term survival after cardiac surgery, suggesting an additive effect of
these two strategies. Conclusions: In patients undergoing cardiac surgery,
the use of volatile anesthetics and the combination of volatile agents
with remote preconditioning reduce mortality when compared to TIVA and
have additive effects. It is necessary to confirm these results with
large, multicenter, randomized, double-blinded trials comparing these
different strategies in cardiac and non-cardiac surgery, to establish
which volatile agent is more protective than the others and how to best
apply remote ischemic preconditioning.

<8>
Accession Number
2015391887
Authors
Ghisi D. Fanelli A. Jouguelet-Lacoste J. La Colla L. Auroux A.-S. Chelly
J.E.
Institution
(Ghisi, Fanelli, Jouguelet-Lacoste, La Colla, Auroux, Chelly) Department
of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
(Fanelli) Anesthesia and Intensive Care Unit, Policlinico
S.Orsola-Malpighi, Bologna, Italy
(Ghisi) Department of Anesthesia and Postoperative Intensive Care,
Istituto Ortopedico Rizzoli, Bologna, Italy
(La Colla) Department of Anesthesia, Intensive Care and Pain Therapy,
Universita degli Studi di Parma, Parma, Italy
(Auroux) Institut des Sciences Pharmaceutiques et Biologiques, Lyon,
France
Title
Lidocaine versus ropivacaine for postoperative continuous paravertebral
nerve blocksin patients undergoing laparoscopic bowel surgery: A
randomized, controlled, double-blinded, pilot study.
Source
Local and Regional Anesthesia. 8 (pp 71-77), 2015. Date of Publication:
14 Sep 2015.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background and objectives: Lidocaine could provide many advantages in
continuous regional anesthesia techniques, including faster onset, greater
titratability, and lower cost than long-acting local anesthetics. This
prospective, randomized, double-blinded, pilot study is therefore intended
to compare lidocaine to ropivacaine in bilateral continuous paravertebral
blocks using a multimodal approach for postoperative pain management
following laparoscopic bowel surgery. Methods: Thirty-five ASA I-III
consecutive patients undergoing elective laparoscopic bowel surgery and
bilateral thoracic paravertebral continuous blocks were analyzed:
bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group
Ropi, n=18) or lidocaine 0.25% (Group Lido, n=17) were started at 7 mL/h
in the postanesthesia care unit. For each patient, we collected numerical
rating scores (NRS) for pain at rest and during movement at baseline, at
postanesthesia care unit discharge, at 24 hours and 48 hours after the end
of surgery, as well as hydromorphone patient-controlled analgesia
requirements, local anesthetic consumption, side effects, postoperative
complications, and functional outcomes. Results: No effect of group
distribution on NRS scores for pain at rest or at movement (P=0.823 and
P=0.146), nor on hydromorphone (P=0.635) or local anesthetic consumption
(P=0.063) was demonstrated at any analyzed time point. Hospital length of
stay and spontaneous ambulation were comparable between groups (P=0.636
and P=0.148). In the context of a multimodal approach, the two drugs
showed comparable safety profiles. Discussion: Lidocaine 0.25% and
ropivacaine 0.2% provided similar analgesic profiles after elective
abdominal surgeries, without any difference in terms of functional
outcomes. The easier titratability of lidocaine together with its lower
cost induced our clinical practice to definitely switch from ropivacaine
to lidocaine for postoperative bilateral paravertebral continuous
infusions.

<9>
[Use Link to view the full text]
Accession Number
2015393560
Authors
Watanabe G. Yamaguchi S. Tomita S. Nishida Y.
Institution
(Watanabe, Yamaguchi, Tomita, Nishida) Department of General and
Cardiothoracic Surgery, Kanazawa University Graduate School of Medical
Science, Kanazawa, Japan
Title
Fasudil is an effective graft vasodilator for gastroepiploic artery in
coronary artery bypass grafting.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (4) (pp 268-272), 2015. Date of Publication: 01 Sep 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The gastroepiploic artery (GEA) has been used as an alternative
arterial in situ graft for coronary artery bypass grafting (CABG).
However, because of the large individual differences and the spastic
nature of the GEA, caution has to be exercised during harvesting. We
evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a
vasodilator for rightGEA(RGEA) graft after harvesting, compared with the
conventional agents papaverine and verapamil-nitroglycerin. Methods:
Between June 2009 and January 2013, 30 patients with ischemic heart
disease who underwent isolated CABG using RGEA graft were randomly
assigned to fasudil (n = 10), papaverine (n = 10), or
verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine
(1.0 mmol/L) mixed with heparinized blood, or verapamilnitroglycerin (30
Kmol/L each) was injected intraluminally into the RGEA graft after
harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and
histopathology of RGEA were evaluated. Results: Intraluminal injection of
fasudil increased GFF significantly (PG 0.001) andmarkedly from41.5 T
31.5mL/min at baseline to 149.3 T 46.7mL/min after injection. Papaverine
increasedGFF (P G 0.001) from 40.0 T 35.8 to 64.9 T 33.7 mL/min, and
verapamil-nitroglycerin also increasedGFF (P G 0.001) from38.8 T 32.1 to
79.0 T 35.2 mL/min. The GFF was significantly higher (P = 0.001) in the
fasudil group than in the other two groups. Histopathologically, fasudil
treatment markedly increased the diameter of RGEA graft, while maintaining
integrity of the multiple elastic lamellae. Blood pressure did not change
significantly after drug injection in all groups. Conclusions: Fasudil is
more potent than papaverine or verapamilnitroglycerin in increasing GFF of
RGEA graft for CABG.

<10>
[Use Link to view the full text]
Accession Number
2015393553
Authors
Puskas J.D. Martin J. Cheng D.C.H. Benussi S. Bonatti J.O. Diegeler A.
Ferdinand F.D. Kieser T.M. Lamy A. Mack M.J. Patel N.C. Ruel M. Sabik J.F.
Yanagawa B. Zamvar V.
Institution
(Puskas, Yanagawa) Department of Cardiovascular Surgery, Icahn School of
Medicine, Mount Sinai Beth Israel, New York, NY, United States
(Martin, Cheng) Centre for Medical Evidence, Decision Integrity, Clinical
Impact (MEDICI), Department of Anesthesia and Perioperative Medicine,
Department of Epidemiology and Biostatistics, Western University, London,
ON, Canada
(Benussi) Division of Cardiovascular Surgery, University Hospital Zurich,
Zurich, Switzerland
(Bonatti) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
(Diegeler) Herz-Und Gefasse Klinik Bad Neustadt, University of Leipzig,
Bad Neustadt, Germany
(Ferdinand) Division of Cardiovascular and Thoracic Surgery, Lankenau
Medical Center, Wynnewood, PA, United States
(Kieser) Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB, Canada
(Lamy) Division of Cardiac Surgery and Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON, Canada
(Mack) Baylor Health System, Heart Hospital Baylor Plano, Dallas, TX,
United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill, New York, NY,
United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Sabik) Heart Vascular Institute, Cleveland Clinic, Cleveland, OH, United
States
(Zamvar) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
ISMICS consensus conference and statements of randomized controlled trials
of off-pump versus conventional coronary artery bypass surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (4) (pp 219-229), 2015. Date of Publication: 01 Sep 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: At this consensus conference, we developed evidenceinformed
consensus statements and recommendations on the practice of off-pump
coronary artery bypass graft (OPCAB) by systematically reviewing and
performing meta-analysis of the randomized controlled trials (RCTs)
comparing OPCAB and conventional coronary artery bypass (CCAB). Methods:
All RCTs of OPCAB versus CCAB through April 2013 were screened, and 102
relevant RCTs (19, 101 patients) were included in a systematic review and
meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs of 9550
low-risk patients) in accordance with the Cochrane Collaboration and
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) methodology. Consensus statements for the risks and
benefits of OPCAB surgery in mortality, morbidity, and resource use were
developed based on best available evidence. Results: Compared to CCAB, it
is reasonable to perform OPCAB to reduce risks of stroke [class IIa, level
of evidence (LOE) A], renal dysfunction/failure (class IIa, LOE A), blood
transfusion (class I, LOE A), respiratory failure (class I, LOE A), atrial
fibrillation (class I, LOE A), wound infection (class I, LOE A),
ventilation time, and ICU and hospital length of stay (class I, LOE A).
However, OPCAB may be associated with a reduced number of grafts performed
(class I, LOE A) and with diminished graft patency (class IIa, LOE A, with
increased coronary reintervention at 1 year and beyond (class IIa, LOE A),
aswell as increased mortality at a median follow-up of 5 years (class IIb,
LOE A). Conclusions: OPCAB compared with CCAB may improve outcomes in the
short-term (stroke, renal dysfunction, blood transfusion, respiratory
failure, atrial fibrillation, wound infection, ventilation time, and
length of stay). However, over the longer-term, OPCAB may be associated
with reduced graft patency, and increased risk of cardiac re-intervention
and death.

<11>
Accession Number
2015391681
Authors
Yumun G. Aydin U. Ata Y. Toktas F. Pala A.A. Ozyazicioglu A.F. Turk T.
Yavuz S.
Institution
(Yumun, Yavuz) Department of Cardiovascular Surgery, Namik Kemal
University, Tekirdag, Turkey
(Aydin, Ata, Toktas, Pala, Ozyazicioglu, Turk) Department of
Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research
Hospital, Bursa, Turkey
Title
Analysis of clinical outcomes of intra-aortic balloon pump use during
coronary artery bypass surgery.
Source
Cardiovascular Journal of Africa. 26 (4) (pp 155-158), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Aim: The mortality rate of coronary artery bypass surgery increases with
advanced patient age. This intra-aortic balloon pump (IABP) study was
conducted to compare older patients (above 65 years of age) with younger
patients (below 65 years of age) who had undergone coronary artery bypass
surgery and had had an IABP inserted, with regard to hospital stay,
clinical features, intensive care unit stay, postoperative complications,
and mortality and morbidity rates. Methods: One hundred and ninety
patients who had undergone coronary artery bypass surgery and had required
IABP support were enrolled in this study. Patients younger than 65 years
of age were considered younger, and the others were considered older.
Ninety-two patients were in younger group and 98 patients were older
group. The mortality rates, pre-operative clinical characteristics,
postoperative complications, and duration of intensive care unit and
hospital stay of the groups were compared. The risk factors for mortality
and complications were analysed. Results: One hundred and thirty-eight of
the patients were male, and the mean age was 62.7 +/- 9.9 years. The
mortality rate was higher in the older patient group than the younger
group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The
crossclamp time, mean ejection fraction, cardiopulmonary bypass time, and
length of stay in the intensive care unit were similar between the two
groups (p > 0.05). Cardiopulmonary bypass time was the unique independent
risk factor for mortality in both groups. Conclusion: In this study, high
mortality rates in the postoperative period were similar to those in prior
studies regarding IABP support. The complication rates were higher in the
older patient group. Prolonged cardiopulmonary bypass time and advanced
age were determined to be significant risk factors for mortality.

<12>
[Use Link to view the full text]
Accession Number
2015391187
Authors
Lee Y.H. Kim T.K. Jung Y.S. Cho Y.J. Yoon S. Seo J.-H. Jeon Y. Bahk J.H.
Hong D.M.
Institution
(Lee, Kim, Jung, Cho, Yoon, Seo, Jeon, Bahk, Hong) Department of
Anesthesiology and Pain Medicine, Seoul National University Hospital,
Seoul, South Korea
Title
Comparison of needle insertion and guidewire placement techniques during
internal jugular vein catheterization: The thin-wall introducer needle
technique versus the cannula-over-needle technique.
Source
Critical Care Medicine. 43 (10) (pp 2112-2116), 2015. Date of Publication:
01 Oct 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: For needle insertion and guidewire placement during central
venous catheterization, a thin-wall introducer needle technique and a
cannula-over-needle technique have been used. This study compared these
two techniques regarding the success rates and complications during
internal jugular vein catheterization. Design: Prospective, randomized,
controlled study. Setting: A university-affiliated hospital. Patients: Two
hundred sixty-six patients scheduled for thoracic surgery, gynecologic
surgery, or major abdominal surgery, who required central venous
catheterization. Interventions: Patients were randomly assigned to either
the thinwall introducer needle group (n = 134) or the cannula-over-needle
group (n = 132). Central venous catheterization was performed on the right
internal jugular vein under assistance with real-time ultrasonography.
Needle insertion and guidewire placement were performed using a thin-wall
introducer needle technique in the thin-wall introducer needle group and a
cannula-over-needle technique in the cannula-over-needle group.
Measurements and Main Results: The guidewire placement on the first skin
puncture was regarded as a successful guidewire insertion on the first
attempt. The number of puncture attempts for internal jugular vein
catheterization was recorded. Internal jugular vein was assessed by
ultrasonography to identify complications. The rate of successful
guidewire insertion on the first attempt was higher in the thin-wall
introducer needle group compared with the cannula-over-needle group (87.3%
vs 77.3%; p = 0.037). There were fewer puncture attempts in the thin-wall
introducer needle group than in the cannula-over-needle group (1.1 +/- 0.4
vs 1.3 +/- 0.6; p = 0.026). There was no significant difference in
complications of internal jugular vein catheterization between the two
groups. Conclusions: The thin-wall introducer needle technique showed a
superior success rate for first attempt of needle and guidewire insertion
and required fewer puncture attempts during internal jugular vein
catheterization.

<13>
Accession Number
2015344304
Authors
Kereiakes D.J. Ellis S.G. Popma J.J. Fitzgerald P.J. Samady H.
Jones-Mcmeans J. Zhang Z. Cheong W.-F. Su X. Ben-Yehuda O. Stone G.W.
Institution
(Kereiakes) Christ Hospital Heart and Vascular Center, Carl and Edyth
Lindner Center for Research and Education, Christ Hospital, Cincinnati,
OH, United States
(Ellis) Cleveland Clinic Foundation, Cleveland, OH, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Fitzgerald) Stanford University, School of Medicine, Stanford, CA, United
States
(Samady) Emory University Hospital, Atlanta, GA, United States
(Jones-Mcmeans, Zhang, Cheong, Su) Abbott Vascular, Santa Clara, CA,
United States
(Ben-Yehuda, Stone) Columbia University Medical Center, New York
Presbyterian Hospital, Cardiovascular Research Foundation, 111 E. 59th St,
New York, NY 10022, United States
Title
Evaluation of a fully bioresorbable vascular scaffold in patients with
coronary artery disease: Design of and rationale for the ABSORB III
randomized trial.
Source
American Heart Journal. 170 (4) (pp 641-651), 2015. Date of Publication:
01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background Randomized trials have demonstrated progressive improvements in
clinical and angiographic measures of restenosis with technologic
iterations from balloon angioplasty to bare-metal stents and subsequently
to drug-eluting stents (DES). However, the permanent presence of a metal
stent prevents coronary vasomotion, autoregulation, and adaptive coronary
remodeling. The limitations imposed by a permanent metal implant may be
overcome with a bioresorbable scaffold. ABSORB III is a large-scale,
multicenter, randomized trial designed to support US premarket approval of
the ABSORB BVS platform and is the first study with sufficient size to
allow valid examination of the relative clinical outcomes between metallic
DES and bioresorbable scaffold. Design ABSORB III (ClincalTrials.gov
NCT01751906) will register approximately 2,262 patients and includes a
lead-in phase (n = 50), the primary randomized analysis group (n = 2,000),
an imaging cohort (n = 200), and a pharmacokinetic substudy (n = 12). In
the primary analysis group, approximately 2,000 patients with up to 2 de
novo native coronary artery lesions in separate epicardial vessels will be
prospectively assigned in a 2:1 ratio to ABSORB BVS versus XIENCE
everolimus-eluting stents (EES). The primary end point is target lesion
failure (the composite of cardiac death, target vessel-related myocardial
infarction, or ischemia-driven target lesion revascularization) at 1 year,
powered for noninferiority of ABSORB BVS compared to XIENCE EES. Clinical
follow-up will continue for 5 years. Enrollment has been completed, and
the principal results will be available in the fall of 2015. Conclusions
The large-scale ABSORB III randomized trial will evaluate the safety and
effectiveness of ABSORB BVS compared to XIENCE EES in the treatment of
patients with coronary artery disease.

<14>
Accession Number
2015313817
Authors
Kurz D.J. Bernheim A.M. Tuller D. Zbinden R. Jeger R. Kaiser C. Galatius
S. Hansen K.W. Alber H. Pfisterer M. Eberli F.R.
Institution
(Kurz, Bernheim, Tuller, Zbinden, Eberli) Department of Cardiology,
Triemli Hospital, Birmensdorferstrasse 497, Zurich CH 8063, Switzerland
(Jeger, Kaiser, Pfisterer) Department of Cardiology, University Hospital,
Basel, Switzerland
(Galatius, Hansen) Department of Cardiology, Gentofte University Hospital,
Copenhagen, Denmark
(Alber) Department of Cardiology, University Hospital, Innsbruck, Austria
Title
Improved outcomes of elderly patients treated with drug-eluting versus
bare metal stents in large coronary arteries: Results from the BAsel Stent
Kosten-Effektivitats Trial PROspective Validation Examination randomized
trial.
Source
American Heart Journal. 170 (4) (pp 787-795), 2015. Date of Publication:
01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background Drug-eluting stents (DES) improve outcomes in elderly patients
with small coronary artery disease compared with bare-metal stents (BMS),
but randomized data in elderly patients in need of large coronary stents
are not available. Methods Planned secondary analysis of patients >75
years recruited to the "BASKET-PROVE" trial, in which 2,314 patients
undergoing percutaneous coronary intervention for large (>3.0 mm) native
vessel disease were randomized 2:1 to DES (everolimus- vs
sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months
of dual antiplatelet therapy. The primary end point was a composite of
cardiac death or nonfatal myocardial infarction at 2 years. Results
Comparison of DES versus BMS among 405 patients >75 years showed
significantly lower rates of the primary end point for DES (5.0% vs 11.6%;
hazard ration (HR) 0.64 [0.44-0.91]; P =.014). Rates of nonfatal
myocardial infarction (1.2% vs 5.5%, hazard ration (HR) 0.44 [0.21-0.83];
P =.009), all-cause death (7.4% vs 14.4%; HR 0.7 [0.51-0.95]; P =.02), and
target vessel revascularization (TVR) (2.3% vs 6.2%; HR 0.59 [0.34-0.99];
P =.046) were also lower, whereas stent thrombosis and bleeding rates were
similar. In contrast, among patients <75 years (n = 1,909), the only
significant benefit of DES was a reduced rate of TVR (4.0% vs 8.7%, HR
0.66 [0.55-0.80]; P <.0001). Conclusions In patients >75 years requiring
large (>3.0 mm) coronary stents, use of DES was beneficial compared with
BMS and reduced the rate of ischemic events, mortality, and TVR. These
data suggest that DES should be preferred over BMS in elderly patients.

<15>
Accession Number
2015285222
Authors
Clemmensen P. Roe M.T. Hochman J.S. Cyr D.D. Neely M.L. McGuire D.K.
Cornel J.H. Huber K. Zamoryakhin D. White H.D. Armstrong P.W. Fox K.A.A.
Prabhakaran D. Ohman E.M.
Institution
(Clemmensen) Department of Medicine, Division of Cardiology, Nykoebing F
Hospital, Rigshospitalet Copenhagen University Hospital, Copenhagen,
Denmark
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University, School of Medicine, Durham, NC, United States
(Roe, Cyr, Neely, Ohman) Duke Clinical Research Institute, Durham, NC,
United States
(Hochman) New York University Langone Medical Center, New York, NY, United
States
(McGuire) University of Texas, Southwestern Medical Center, Dallas, TX,
United States
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Huber) Department of Cardiology and Intensive Care Medicine, Wilhelminen
Hospital, Vienna, Austria
(Zamoryakhin) Daiichi Sankyo Development Ltd, London, United Kingdom
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton,
Alberta, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
Title
Long-term outcomes for women versus men with unstable
angina/non-ST-segment elevation myocardial infarction managed medically
without revascularization: Insights from the TaRgeted platelet Inhibition
to cLarify the Optimal strateGy to medicallY manage Acute Coronary
Syndromes trial.
Source
American Heart Journal. 170 (4) (pp 695-705), 2015. Date of Publication:
01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background Women with acute coronary syndromes (ACS) are less likely to
undergo invasive revascularization than men, but sex-specific differences
in long-term outcomes and platelet reactivity among medically managed ACS
patients remain uncertain. We examined sex-specific differences in
long-term ischemic and bleeding outcomes and platelet reactivity for
medically managed ACS patients randomized to prasugrel versus clopidogrel
plus aspirin. Methods Data from 9,326 patients enrolled in TRILOGY ACS
were analyzed to determine differences in long-term ischemic and bleeding
outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%])
randomized to prasugrel 10 mg/d (5 mg/d for patients >75 years and/or <60
kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day
platelet reactivity were analyzed in 2,564 (27%) patients participating in
a platelet function substudy. Results Compared with men, women were older,
weighed less, were less likely to have prior myocardial infarction or
revascularization, and had lower baseline creatinine clearance and
hemoglobin level values. Rates of the composite of cardiovascular
death/myocardial infarction/stroke (20.2% vs 19.1%; P =.56), all-cause
mortality (12.2% vs 11.7%; P =.88), and Global Use of Strategies to Open
Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%;
P =.74) through 30 months were similar in women versus men. After
adjustment, women had significantly lower risk for ischemic outcomes and
all-cause mortality. There were no sex-specific, treatment-related
differences in 30-day platelet reactivity. Conclusions Long-term ischemic
and bleeding outcomes in medically managed ACS patients were similar for
women versus men, as was treatment-related platelet reactivity. Women had
a higher baseline risk profile and, after adjustment, significantly lower
risk of the primary composite end point and all-cause death through 30
months.

<16>
Accession Number
2015256966
Authors
Vasdekis S.N. Roussopoulou A. Lazaris A. Antonopoulos C.N. Voumvourakis K.
Darviri C. Tsivgoulis G.
Institution
(Vasdekis, Lazaris, Antonopoulos) Vascular Unit, 3rd Surgical Department,
Athens University Medical School, Athens, Greece
(Vasdekis, Lazaris, Antonopoulos) Department of Vascular Surgery,
University of Athens Medical School, Attikon University Hospital, Athens,
Greece
(Vasdekis, Roussopoulou, Darviri) Postgraduate Course in Stress Management
and Health Promotion, University of Athens Medical School, Athens, Greece
(Vasdekis, Roussopoulou, Darviri) Biomedical Research Foundation, Academy
of Athens, Athens, Greece
(Roussopoulou, Voumvourakis, Tsivgoulis) Second Department of Neurology,
University of Athens Medical School, Attikon University Hospital, Athens,
Greece
Title
Stress Management in Patients Undergoing Carotid Endarterectomy for
Carotid Artery Stenosis: A Pilot Randomized Controlled Trial.
Source
Annals of Vascular Surgery. 29 (7) (pp 1400-1407), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Elsevier Inc.
Abstract
Background Psychological stress is common to patients submitted to
cardiovascular operations. The purpose of this pilot, single-center,
open-label, randomized controlled trial was to investigate the effects of
a stress management program (SMP) on patients undergoing carotid
endarterectomy (CEA). Methods A sample of 24 patients with significant
(>70%) carotid stenosis was finally randomized to SMP (intervention group;
n = 12) or no-stress management intervention (control group; n = 12)
before CEA. SMP consisted of 2 relaxation techniques (relaxation-breathing
and guided imagery) before and 8 weeks after CEA. Measurements included
Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale
(HADS), Health Locus of Control Scale (HLC), and blood pressure and heart
rate. Results The 2 groups did not differ in terms of demographic
characteristics, vascular risk factors, and baseline psychometric
measurements. No delay on the time of surgery was caused by the practice
of the relaxation techniques. Both perceived stress and anxiety improved
within the intervention group at the end of the program (P = 0.005 and P =
0.007, respectively). No improvement in PSS-14, HLC, and HADS scores were
documented in control group at the end of the 8-week follow-up period. The
intervention group had lower PSS-14 scores at 8 weeks after CEA (median
PSS-14 score, 20 points; range, 10-28) compared with control group (median
PSS, 25 points; range, 11-47; P = 0.026). No significant effect of SMP was
found for blood pressure and heart rate measurements. Conclusions Our
results indicate that relaxation techniques appear to be beneficial in
terms of stress and anxiety reduction in patients undergoing CEA. These
findings require independent confirmation in the setting of a larger,
double-blind randomized controlled trial.

<17>
Accession Number
2015255387
Authors
Gotzmann M. Knoop H. Ewers A. Mugge A. Walther J.W.
Institution
(Gotzmann, Ewers, Mugge) Bergmannsheil, Cardiology and Angiology,
Ruhr-University, Bochum, Germany
(Knoop) Bergmannsheil, Respiratory and Sleep Medicine Allergology,
Ruhr-University, Bochum, Germany
(Walther) Institute for Prevention and Occupational Medicine, German
Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA),
Bochum, Germany
Title
Impact of lung diseases on morbidity and mortality after transcatheter
aortic valve implantation: Insights from spirometry and body
plethysmography.
Source
American Heart Journal. 170 (4) (pp 837-842), 2015. Date of Publication:
01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background The study aims to determine the impact of different lung
diseases on morbidity and mortality after transcatheter aortic valve
implantation (TAVI). Methods Transcatheter aortic valve implantation was
performed transfemoral or transaxillary with CoreValve prosthesis or
Edwards SAPIEN prosthesis in patients with symptomatic severe aortic valve
stenosis and high surgical risk. Examinations comprised spirometry, body
plethysmography echocardiography, and x-ray before TAVI. The primary study
end point was death from any cause after TAVI. Results During follow-up of
750 +/- 538 days, 63 of 212 patients died. Logistic European System for
Cardiac Operative Risk Evaluation (hazard risk [HR] 1.032, P <.001),
aortic mean gradient (HR 0.96, P <.001), chronic obstructive pulmonary
disease (COPD; each degree of COPD: HR 1.436, P =.001), restrictive
ventilatory disease (HR 2.252, P =.002), oxygen dependency (HR 3.291, P
=.004), and noninvasive ventilation (HR 3.799, P =.005) were independent
predictors of long-term mortality. Restrictive ventilatory disease was
associated with lower left ventricular ejection fraction, higher B-type
natriuretic peptide levels, and pulmonary edema. Conclusion In patients
undergoing TAVI, lung diseases are an independent predictor of all-cause
mortality. In particular, oxygen dependency patients and patients with
severe COPD and noninvasive ventilation indicate a dismal prognosis.
Transcatheter aortic valve implantation seems to have a dubious prognostic
benefit in these patients.

<18>
Accession Number
2015251137
Authors
Zimmermann F.M. De Bruyne B. Pijls N.H.J. Desai M. Oldroyd K.G. Park S.-J.
Reardon M.J. Wendler O. Woo J. Yeung A.C. Fearon W.F.
Institution
(Zimmermann, Pijls) Department of Cardiology, Catharina Hospital
Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(Pijls) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
(Desai) Stanford University, School of Medicine and Cancer Institute,
Stanford, CA, United States
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Park) Heart Institute, University of Ulsan, College of Medicine, Asan
Medical Center, Seoul, South Korea
(Reardon) Department of Cardiothoracic Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Wendler) Department of Cardiothoracic Surgery, King's College Hospital,
King's Health Partners, London, United Kingdom
(Woo, Yeung, Fearon) Division of Cardiovascular Medicine, Stanford
University Medical Center, Stanford, CA, United States
Title
Rationale and design of the Fractional Flow Reserve versus Angiography for
Multivessel Evaluation (FAME) 3 Trial: A comparison of fractional flow
reserve-guided percutaneous coronary intervention and coronary artery
bypass graft surgery in patients with multivessel coronary artery disease.
Source
American Heart Journal. 170 (4) (pp 619-626), 2015. Date of Publication:
01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background Guidelines recommend coronary artery bypass graft (CABG)
surgery over percutaneous coronary intervention (PCI) for the treatment of
3-vessel coronary artery disease (3-VD). The inferior results of PCI
demonstrated by previous large randomized trials comparing PCI and CABG
might be explained by the use of suboptimal stent technology and by the
lack of fractional flow reserve (FFR) guidance of PCI. Trial design The
objective of this investigator-initiated, multicenter, randomized clinical
trial is to investigate whether FFR-guided PCI with new-generation stents
is noninferior to CABG in patients with 3-VD, not including the left main
coronary artery. Eligible patients must have >50% coronary stenoses in all
3 major epicardial vessels or major side branches. Patients with a
nondominant right coronary artery may be included only if the left
anterior descending artery and left circumflex have >50% stenoses.
Consecutive patients who meet all of the inclusion criteria and none of
the exclusion criteria will be randomized in a 1:1 fashion to either CABG
or FFR-guided PCI. Coronary artery bypass graft will be performed based on
the angiogram as per clinical routine. Patients assigned to FFR-guided PCI
will have FFR measured in each diseased vessel and only undergo stenting
if the FFR is & 0.80. The primary end point of the study is a composite of
major adverse cardiac and cerebrovascular events, including death,
myocardial infarction, repeat coronary revascularization, and stroke at 1
year. Key secondary end point will be a composite of death, myocardial
infarction, and stroke at 3-year follow-up. Other secondary end points
include the individual adverse events, cost-effectiveness, and quality of
life at 2-year, 3-year, with up to 5-year follow-up. Conclusion The FAME 3
study will compare in a multicenter, randomized fashion FFR-guided PCI
with contemporary drug-eluting stents to CABG in patients with 3-VD.

<19>
Accession Number
2015236910
Authors
Mese B. Bozoglan O. Eroglu E. Erdem K. Acipayam M. Ekerbicer H.C. Yasim A.
Institution
(Mese, Bozoglan, Eroglu, Acipayam, Yasim) Department of Cardiovascular
Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University,
Kahramanmaras, Turkey
(Erdem) Department of Cardiovascular Surgery, Faculty of Medicine, Abant
Izzet Baysal University, Bolu, Turkey
(Ekerbicer) Department of Public Health, Faculty of Medicine, Sakarya
University, Sakarya, Turkey
Title
A Comparison of 1,470-nm Endovenous Laser Ablation and Radiofrequency
Ablation in the Treatment of Great Saphenous Veins 10 mm or More in Size.
Source
Annals of Vascular Surgery. 29 (7) (pp 1368-1372), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Elsevier Inc.
Abstract
Background To compare 1,470-nm endovenous laser ablation (EVLA) and
radiofrequency ablation (RFA) in the treatment of patients with great
saphenous vein diameters of 10 mm or more. Methods One hundred twenty
consecutive patients presenting to the cardiovascular surgery department
with a great saphenous vein diameter exceeding 10 mm at the saphenofemoral
junction between January and December 2013 were included in the study. The
first randomly selected 60 patients (group 1) received 1,470-nm EVLA and
the other 60 patients (group 2) received RFA. Patients were assessed on
the second day, the first week, and the first, third, and sixth months.
Major and minor complications were recorded. Results Minor complications
in EVLA and RFA were hyperemia at 20% and 30% (P = 0.50), ecchymosis at
16.7% and 48.3% (P = 0.02), and edema at 40.0% and 65.5% (P < 0.08),
respectively. No major complication was observed in any patient.
Recanalization developed during monitoring in 3 patients in the RFA group,
a rate of 5%. No recanalization was observed in the EVLA group. Success
rates in the EVLA and RFA groups were 100% and 95%, respectively. Mean
time to return to daily activity was 0.7 days in the EVLA group and 1.4
days in the RFA group (P < 0.006), whereas mean time to return to work was
1.8 days in the EVLA group and 2.2 days in the RFA group (P < 0.07). There
was no statistically significant difference between the groups in terms of
pain during the procedure or postoperatively. Less pain was reported in
the EVLA during both (P < 0.02). Conclusions EVLA using a 1,470-nm radial
fiber is superior to RFA in the treatment of saphenous veins larger than
10 mm in diameter.

<20>
Accession Number
2015067138
Authors
Mittnacht J. Choukair D. Kneppo C. Brunner R. Parzer P. Gorenflo M.
Bettendorf M.
Institution
(Mittnacht, Choukair, Kneppo, Bettendorf) Division of Paediatric
Endocrinology and Diabetes, Department of Paediatrics, Heidelberg, Germany
(Brunner, Parzer) Department of Child and Adolescent Psychiatry, Centre of
Psychosocial Medicine, Heidelberg, Germany
(Gorenflo) Department of Paediatric and Congenital Cardiology, University
Hospital Heidelberg, Heidelberg, Germany
(Mittnacht) Division of Paediatric Endocrinology and Diabetes, Department
of Paediatrics, University Hospital Heidelberg, Im Neuenheimer Feld 430,
Heidelberg DE-69120, Germany
Title
Long-Term Neurodevelopmental Outcome of Children Treated with
Tri-Iodothyronine after Cardiac Surgery: Follow-Up of a Double-Blind,
Randomized, Placebo-Controlled Study.
Source
Hormone Research in Paediatrics. 84 (pp 130-136), 2015. Date of
Publication: 27 Aug 2015.
Publisher
S. Karger AG
Abstract
Background: Transient thyroid dysfunction occurs in children after
cardiopulmonary bypass (CPB). We demonstrated significant benefits of
acute postoperative tri-iodothyronine (T3) treatment for recovery and
myocardial function. Now we report the long-term neurodevelopment of these
children. Methods: Twenty-eight children (70% of the original study
population) could be recruited for a follow-up examination (median age
10.7 years, range 10-19.6 years) retaining the double-blind, randomized,
placebo-controlled protocol. Cognitive function and motor development were
tested, as were growth and thyroid and cardiac functions. Results: The
median full-scale intelligence quotient of all children was within the
reference range and similar in the placebo and T3 groups. Tests for motor
and cognitive functions, growth, and thyroid and cardiac functions
revealed concurrent results. Conclusions: Overall intellectual development
is preserved in adolescents treated with CPB in infancy irrespectively of
low postoperative thyroid hormone concentrations. While acute
postoperative T3 treatment in children after CPB improves recovery, no
significant long-term effects on neurodevelopment could be detected. We
therefore speculate that transient postoperative thyroid dysfunction by
means of nonthyroidal illness syndrome is predominantly mediated by
extranuclear, nongenomic mechanisms and thus acutely affects the
cardiovascular system but not the development of the central nervous
system mediated by genomic mechanisms.

<21>
Accession Number
2015377192
Authors
Rana B.S. Calvert P.A. Punjabi P.P. Hildick-Smith D.
Institution
(Rana) Department of Cardiology, Papworth Hospital NHS Foundation Trust,
Cambridge CB23 3RE, United Kingdom
(Calvert) Queen Elizabeth Hospital, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, United Kingdom
(Calvert) University of Birmingham, Birmingham, United Kingdom
(Punjabi) Cardiothoracic Department, Hammersmith Hospital, Imperial
College London, London, United Kingdom
(Hildick-Smith) Brighton University Hospital, United Kingdom
Title
Role of percutaneous mitral valve repair in the contemporary management of
mitral regurgitation.
Source
Heart. 101 (19) (pp 1531-1539), 2015. Date of Publication: 01 Oct 2015.
Publisher
BMJ Publishing Group
Abstract
Percutaneous mitral valve (MV) repair has been performed in over 20 000
patients worldwide. As clinical experience in this technique grows
indications for its use are being defined. Mitral regurgitation (MR)
encompasses a complex heterogeneous group and its treatment is governed by
determining a clear understanding of the underlying aetiology. Surgical MV
repair remains the gold standard therapy for severe MR. However in select
groups of high-risk surgical patients, a percutaneous approach to MV
repair is establishing its role. This review gives an overview of the
published data in percutaneous MV repair and its impact on the
contemporary management of MR.

<22>
Accession Number
2015389344
Authors
Ma B.-X. Li H. Li J.-S. Wu S.-S.
Institution
(Ma, Li, Li) Department of Cardiology, Affiliated Hospital of Binzhou
Medical University, Binzhou, China
(Wu) Department of Geriatrics, First Hospital of Jilin University,
Changchun, China
Title
Effect of statins on preventing infectious complications after surgery:
Systematic review and meta-analysis.
Source
Journal of International Medical Research. 43 (5) (pp 610-618), 2015. Date
of Publication: 22 Oct 2015.
Publisher
SAGE Publications Ltd
Abstract
Objective A meta-analysis to investigate the association between
preoperative statin use and the risk of postoperative infectious
complications in patients undergoing surgery. These authors contributed
equally to this work. Methods PubMed and Embase databases were searched
for relevant studies. Data were extracted using a standardized data
collection form. The primary effect measure was the odds ratio (OR) of
postoperative infectious complications. Summary OR were calculated.
Results The analysis included 10 cohort studies with a total of 147 263
participants. Statin use was associated with a lower incidence of
postoperative infectious complications in all studies (summary OR 0.917,
95% confidence intervals [CI] 0.862, 0.975, fixed-effects model; summary
OR 0.731, 95% CI 0.584, 0.870, random-effects model); cardiac surgery
(summary OR 0.673; 95% CI 0.535, 0.847); treatment in the USA (summary OR
0.678; 95% CI 0.597, 0.770); retrospective cohort studies (summary OR
0.664; 95% CI 0.521, 0.846). Conclusion Preoperative statin use is
associated with a reduced risk of postoperative infectious complications.

<23>
Accession Number
72022507
Authors
Deek H. Newton P.J. Inglis S.C. Noureddine S. Macdonald P.S. Davidson P.M.
Institution
(Deek, Newton, Inglis, Noureddine, Macdonald) University of Technology,
Sydney, Faculty of Health, Sydney, Australia
(Davidson) Johns Hopkins University of Baltimore, Johns Hopkins School of
Nursing, Baltimore, United States
Title
Family focused approach to improve heart failure care in Lebanon quality
(family) intervention: Randomized controlled trial for implementing an
education family session.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 1005-1006),
2015. Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Introduction: Heart failure is a complex clinical condition with poor
outcomes. Self-care is a vital component in maintaining wellbeing and
avoiding complications of heart failure. Family involvement in care of
patients with this health condition is common in a non-western culture,
but is not well established and not well studied. Aim: To evaluate the
effect of involving the primary family caregiver in self-care on improving
outcomes in patients with heart failure. Methods: The FAMILY study was a
Randomised controlled trial conducted in three hospitals in Lebanon. Adult
patients were recruited if they had presented to one of the sites for
heart failure exacerbation and were willing along with their primary
family caregiver to participate. Patients with life expectancy of less
than 30 days of planned heart surgery with limited functionality were
excluded. A total of 256 patients were randomised into an intervention
group (n=126 patients) or a usual care group (n=130 patients).
Family-centred education was provided to the intervention group on
self-care and symptom management. The primary endpoint was 30 day
readmission, and the secondary endpoints were emergency department
presentation, health related quality of life, self-care and health care
utilization. Results: Participants were mostly older adults (67 years),
men (55%) and married (63%). The average ejection fraction for the sample
was 36% and the majority had a NYHA class of II or III upon discharge. At
30 days, 218 (85%) cases were analysed. Readmission was significantly
reduced in the intervention group as compared to the usual care group
[n=10 (33%) vs. n=20 (67%), p<0.05]. Sim ilar trends were seen in
mortality (n=26, 10%). Self-care scores, low at baseline, improved
significantly in the maintenance and confidence scales (all p<0.0).
Significantly more participants in the usual care group needed health care
facilities than in the intervention group (n=24 (23%) vs. n=12 (11%)
respectively, p<0.05). Conclusion: Involving the family in self-care of
heart failure is a new approach in the Lebanese context. Significant
improvement is noted when this care is structured through a family-centred
educational intervention.

<24>
Accession Number
72022474
Authors
Belley-Cote E.P. Lamy A. Vincent J. Kavsak P. Ou Y. Zhang M. Devereaux
P.J. Whitlock R.P.
Institution
(Belley-Cote, Lamy, Kavsak, Devereaux, Whitlock) McMaster University,
Hamilton, Canada
(Vincent, Ou, Zhang) Population Health Research Institute, Hamilton,
Canada
Title
An event driven myocardial infarction definition using troponins after
coronary artery bypass surgery in the coronary trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 997), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: The Third Universal definition for myocardial infarction (MI)
after coronary artery bypass (CABG) surgery is arbitrarily based on
cardiac biomarker threshold >10 times the 99th percentile of the upper
limit of normal (ULN). Given the ubiquitous release of troponins during
CABG surgery and the sensitivity of troponins for cardiomyocyte injury,
the prognostic value of this threshold is debated after CABG. Methods: The
CORONARY Trial was a large randomized controlled trial that compared
on-pump versus off-pump CABG. Using data from CORONARY, we aimed to
establish the peak troponin thresholds during the first 3 postoperative
days associated with an increase at least 2-fold in 30-day mortality. In
order to combine different troponin assays, we analysed the troponins in
multiples of their respective ULN. We used a modification of the Mazumdar
method to identify the lowest troponin threshold that had an independent
hazard ratio (HR) greater than 2 for 30-day mortality after adjustment for
EuroSCORE and on-pump versus offpump surgery. Results: Peak troponin
results were available for 1528 patients who underwent on-pump (n=760) or
off-pump CABG (n=768) in the CORONARY trial. Peak troponins were >10xULN
in 46% (705/1538) of patients. The median peak troponin results were
8.7xULN (interquartile range 27.83). The sensitivity of a peak troponin
>10xULN for 30-day mortality was 65% (95% CI 46-80). The associated
specificity was 54% (95% CI 52-57). With the Mazumdar method, the first
threshold we evaluated was 180xULN because 177xULN corresponded to the
95th percentile. This threshold was associated with an adjusted HR for
30-day mortality of 7.6 (95% CI 3.4-17.1) when compared to <130xULN. The
next independent threshold was 130xULN with an adjusted HR for 30-day
mortality of 7.8 (95% CI 2.3-26.1) when compared to <130xULN. The next
threshold that we tested (70xULN) did not meet our criteria for
significance. Discussion and conclusion: In light of the very high
incidence of troponin elevations >10xULN after CABG surgery, the current
MI definition biomarker criterion is neither sensitive nor specific. Our
results suggest that a clinically relevant troponin threshold is much
higher. However, our sample size did not allow a finer exploration of
thresholds between 70xULN and 130xULN. The VISION (Vascular events In
Surgery patIents cOhort evaluatioN) Cardiac Surgery Study, a 15,000-
patient cohort that is currently recruiting will allow derivation of a
more precise estimate for the optimal event driven MI definition after
cardiac surgery.

<25>
Accession Number
72022413
Authors
Parish S. Offer A. Clarke R. Bennett D. Bowman L. Bulbulia R. Haynes R.
Landray M. Armitage J. Collins R.
Institution
(Parish, Offer, Clarke, Bennett, Bowman, Bulbulia, Haynes, Landray,
Armitage, Collins) University of Oxford, Nuffield Department of Population
Health, Oxford, United Kingdom
Title
Cognitive aging and the incidence of cardiovascular events and diabetes: A
meta-analysis of the HPS, SEARCH and HPS2-THRIVE studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 981), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Purpose: Cognitive aging has been linked to stroke and vascular risk
factors, such as diabetes, but small study sizes have limited inference.
The relationship of cognitive aging to the incidence of cardiovascular
events and diabetes is investigated among >45 000 individuals at high
vascular risk who participated in the HPS, SEARCH and HPS2-THRIVE studies.
Methods: Participants in the studies were followed-up for the incidence of
events during a mean of 5 years (>11 000 major vascular or diabetic
events). Cognitive function at the end of follow-up was assessed via a
modified Telephone Interview for Cognitive Status (TICS-m) test. In each
study the associations of standardized cognitive function Z-scores with
incident events were assessed by a linear regression adjusting for years
of follow-up and baseline predictors of cognitive function. Results were
then combined in a meta-analysis. The relationship between Z-scores and
age was used to convert Z-score differences to years of cognitive aging.
Results: The strongest baseline predictors of cognitive function were age,
shorter height, prior stroke and diabetes. The incidence of stroke was
associated with 7 years greater cognitive aging and incidence of transient
ischemic attack (TIA), myocardial infarction (MI), new onset diabetes and
diabetic complications requiring hospitalisation were each associated with
2-3 years greater cognitive aging. In contrast, undergoing CABG, PTCA or
non-coronary revascularisation procedures was not associated with greater
cognitive aging (Figure). Conclusions: Clinical events were associated
with 2-7 years of cognitive aging whereas undergoing a revascularisation
procedure was not associated with cognitive aging, highlighting the value
for cognition of vascular disease prevention. (Table Presented).

<26>
Accession Number
72022313
Authors
Wong K.Y.-K. Malik T. Allgar V.
Institution
(Wong, Malik) University of Hull, Hull York Medical School, Hull, United
Kingdom
(Allgar) University of York, Hull York Medical School, York, United
Kingdom
Title
Transcatheter aortic valve implant vs surgical aortic valve replacement in
low-to intermediate risk patients: A Meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 954-955),
2015. Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Objectives: To test the hypothesis that Transcatheter aortic valve implant
(TAVI), when compared with surgical aortic valve replacement (SAVR), have
favourable clinical outcomes in patients with low or intermediate risk.
Methods and results: A PubMed, EMBASE and Medline search yielded 6
studies, of which 2 were abstracts. Over 2100 patients were randomised to
TAVI vs SAVR. 30-day mortality was not different (Risk ratio was 1.4 (95%
CI 0.88, 2.3). There was also no statistically significant difference in
1-year mortality, stroke, life-threatening bleeds, and major vascular
complications. However, TAVI was associated with significantly shorter
hospital stay. (Table presented) Conclusion: In low to intermediate risk
patients, 30-day or 1-year mortality, risk of stroke, major vascular
complications and life-threatening bleeds were not significantly different
between patients treated by TAVI when compared with SAVR. (Table
presented) However, TAVI was associated with significantly shorter
hospital stay which may be an important consideration in patient-centred
decision making.

<27>
Accession Number
72022310
Authors
Kayvanpour E. Haas J. Sedaghat-Hamedani F. Waldenstrom A. Monserrat L.
Charron P.H. Elliott P. Arbustini E. Meder B. Katus H.A.
Institution
(Kayvanpour, Haas, Sedaghat-Hamedani, Meder, Katus) University Hospital of
Heidelberg, Department of Medicine III, Heidelberg, Germany
(Waldenstrom) Umea University, Department of Public Health and Clinical
Medicine, Umea, Sweden
(Monserrat) University Hospital Complex A Coruna, Cardiology Department,
Biomedical Research Institute INIBIC, A Coruna, Spain
(Charron) Hospital Pitie-Salpetriere, INSERM UMRS-956, UPMC Univ. Paris 6,
AP-HP, Paris, France
(Elliott) University College London, University College, London, United
Kingdom
(Arbustini) Policlinic Foundation San Matteo IRCCS, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
Title
Genetic cardiomyopathy overlaps can modify phenotypic features in dilated
cardiomyopathy patients-a comprehensive next-generation sequencing (NGS)
study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 953-954),
2015. Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Introduction: Patients with dilated cardiomyopathy (DCM) show
heterogeneous phenotypic features and outcomes, some of which are typical
for other major CM types. We hypothesize that this may be a result of
overlapping mutations. Purpose: In this study we aimed to investigate CM
types on a genomic level and to evaluate if phenotypic features of DCM
patients are associated with mutations known to cause CMs other than DCM.
Methods: We performed a meta-analysis of the INHERITANCE sequencing
project of a cohort of 639 patients with DCM. Individuals were classified
according to their known and annotated disease mutations from Human Gene
Mutation Database (HGMD). As a control cohort we used a number of 448
individuals from the 1000 genomes project. Benign variants, those reported
in Exome Sequencing Project (ESP) database and those with a frequency of
>1% in the control cohort, were removed. Patients were categorized into
subgroups with variants associated with CM types other than DCM and their
phenotypic variables were compared with each other. Results: After
applying our filtering protocol, 139 unique variants were found in the DCM
cohort that matched one of the HGMD CM entity mutations. Eighty-three
(13%) DCM patients of the cohort presented variants which are already
reported to cause DCM. Variants annotated to Brugada syndrome (BrS),
hypertrophic cardiomyopathy (HCM) or long QT syndrome (LQTS) were present
in 2.3-10% of DCM patients of the cohort, whereas 68 (10.6%) DCM patients
of the cohort presented variants annotated to ARVC. Comparing the
phenotypes in these subgroups showed noticeable findings: DCM patients
with BrS-associated variants showed a significantly higher rate of heart
transplantation. DCM patients who carried HCM-associated variants showed
milder clinical manifestations and disease progression (lower NYHA
functional class, higher left ventricular ejection fraction and lower
cardiac transplantation rate). DCM patients with LQTS-associated variants
presented more often with advanced NYHA functional classes, whereas
patients with ARVC-associated variants did not show any significant
phenotypic deviations in comparison to patients without these variants.
Conclusions: We showed in this large-scale genotype-phenotype association
study that coexistence of variants which are normally known to cause CMs
other than DCM could influence phenotypic features and the clinical course
of DCM patients. Performing NGS in these patients helps to identify all
relevant variants and enables physicians to better risk stratify DCM
patients.

<28>
Accession Number
72022217
Authors
Quadri G. Moretti C. D'Ascenzo F. Omede' P. Montefusco A. Frati G. Mancone
M. Palmerini T. Biondi Zoccai G. Gaita F.
Institution
(Quadri, Moretti, D'Ascenzo, Omede', Montefusco, Gaita) University of
Turin, A.O. Citta Della Salute e Della Scienza, Division of Cardiology,
Turin, Italy
(Frati, Mancone, Biondi Zoccai) Sapienza University of Rome, Rome, Italy
(Palmerini) University Hospital Policlinic S. Orsola-Malpighi, Bologna,
Italy
Title
Percutaneous coronary revascularization reduces risk of acute renal
failure when compared to coronary artery bypass graft: A metaanalysis of 8
studies and 257980 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 928), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Introduction: Incidence of acute renal failure after PCI (Percutaneous
Coronary Intervention) and CABG (Coronary Artery Bypass Graft) remains to
be determined. Methods: Pubmed, Google Scholar and Cochrane Collaboration
were searched for randomized controlled trials or studied with
multivariable analysis comparing incidence of acute renal failure after
PCI and CABG. Metaregression analysis was also performed for baseline
features. Results: Four randomized controlled trials with four hundred and
thirty five patients and for observational studies with two hundred
fifty-seven thousand and five hundred forty-five patients were included.
Three vessels revascularization was performed in 54.0% (23.0-78.3) of
patients, and acute renal failure was significantly reduced by PCI when
compared to CABG with an Odds Ratio (OR) of (0.76 [0.58-0.99] I2 99%):
this result was mainly driven by data derived from observational studies
adjusted with multivariable analysis (OR of 0.67 ([0.65-0.68] I2 0%),
while it did not reach significance for RCTs only (OR of 0.83 [0.42-1.61]
I2 99%). At meta regression analysis, the benefit of PCI in reducing renal
failure compared to CABG was significantly increased in patients with
diabetes mellitus (B -0.01; [-0.02; -0.01], p=0.01) and with congestive
heart failure (B -0.09 [-0.16; -0.03]; p=0.01). Conclusion: Risk of acute
renal failure is significantly reduced by PCI when compared to CABG: this
benefit, although derived mainly from observational studies, is
significantly increased in patients with diabetes mellitus and congestive
heart failure.

<29>
Accession Number
72022084
Authors
Angeloni E. Melina G. Refice S. Capuano F. Roscitano A. Comito C. Sinatra
R.
Institution
(Angeloni, Melina, Refice, Capuano, Roscitano, Comito, Sinatra) Sapienza
University of Rome, Sant'Andrea Hospital, Rome, Italy
Title
Outcomes of tricuspid valve replacement: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 893), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Tricuspid valve replacement (TVR) is a quite uncommon
intervention historically associated with high mortality and morbidity.
Due to its low prevalence among cardiac surgical procedures, current
knowledge of long-term results of TVR is limited. Purpose: Aim of the
present meta-analysis was to assess rates of mortality and reoperation
after TVR, and to investigate factors influencing these outcomes. Methods:
On December 5th 2014, PubMed, Embase, and Cochrane library were searched
for studies reporting on mortality and need for reoperation after TVR; and
a total of 204 papers were identified. After careful screening, a total of
35 studies were included in the analysis, heterogeneity was investigated
with Cochrane-Q-statistic, and the Egger's test was used to assess
publication bias for the outcomes investigated. Results: Finally, a total
of 3095 patients receiving TVR with a mean follow-up of 6.7 years were
included; of those 1654/3095 (53%) received a biological prosthesis.
Pooled analysis showed a rate of 16.9% (95% CI 14.7-19.3,I260.6) for
30-day mortality; which was not influenced by prostheses used (Qmodel
1.03,p=0.85, for biological prostheses). At follow-up, cumulative
mortality was 41.5% (95% CI 35.4-47.7,I2 89.2), and was not influenced by
type of prostheses used (Qmodel 1.98,p=0.16, for biological prostheses).
Rate of reoperation on the tricuspid valve was 9.4% (95% CI 6.8-12.8,
I277.2), it was more likely to occur in smaller series (Egger's p=0.05),
and was not influenced by type of prostheses implanted (Qmodel 1.6,
p=0.26). Conclusions: Despite scientific progresses, TVR is still burdened
by considerable mortality rates, both early and late after surgery. Type
of prostheses implanted (biological vs. mechanical) does not influence any
of the outcomes investigated, whilst incidence of reoperation is increased
in small volume centres.

<30>
Accession Number
72021840
Authors
Jang J.-S. Shin H.-C. Yang T.-H. Jin H.-Y. Seo J.-S. Kim D.-K. Kim D.-S.
Institution
(Jang, Shin, Yang, Jin, Seo, Kim, Kim) Inje University, College of
Medicine, Busan Paik Hospital, Busan, South Korea
Title
Impact of successful recanalization of chronic total occlusions using
coronary stents on long-term clinical outcomes: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 824), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Although coronary stent implantation dramatically reduced the
occurrences of restenosis and the needs for repeat revascularization,
there is still uncertainty as to the prognostic impact of successful
recanalization of chronic total occlusion (CTO) lesions. Methods:
Databases were searched for clinical studies that compared outcomes after
successful recanalization of CTO lesions using coronary stent deployment
with those of unsuccessful recanalization from January 2003 to October
2014. The end points of this study were mortality; myocardial infarction
(MI); major adverse cardiac events (MACE); and the need for coronary
artery bypass graft surgery (CABG) at the longest follow-up. Results: We
identified 18 studies encompassing 11,425 patients with a median follow-up
period of 12-60 months after successful vs. unsuccessful CTO
recanalization using coronary stent. There were 396 (4.9%) deaths of 8,037
patients after successful recanalization compared to 329 (10.6%) among
3,111 patients after unsuccessful recanalization (odds ratio [OR] 0.46,
95% confidence interval [CI] 0.37 to 0.58). Successful CTO recanalization
significantly reduced the incidence of MI (OR 0.67, 95% CI 0.45 to 0.99)
and MACE (OR 0.58, 95% CI 0.43 to 0.77). The need for subsequent CABG was
significantly lower after successful recanalization (OR 0.16, 95% CI 0.12
to 0.21). There was no evidence of publication bias, as evidenced by a
symmetrical funnel plot (Figure). Conclusions: Successful recanalization
of CTO lesions using coronary stents deployment appears to be associated
with improvement in mortality and reduced needs for CABG as compared with
unsuccessful PCI. (Figure Presented).

<31>
Accession Number
72021535
Authors
Budera P. Osmancik P. Straka Z.
Institution
(Budera, Straka) Faculty Hospital Kralovske Vinohrady, Cardiocenter,
Department of Cardiac Surgery, Prague, Czech Republic
(Osmancik) Faculty Hospital Kralovske Vinohrady, Cardiocenter, Department
of Cardiology, Prague, Czech Republic
Title
Having sinus rhythm definitely pays off. PRAGUE-12 randomized study
sub-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 743), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Concomitant surgical ablation (SA) of atrial fibrillation (AF)
is routinely performed in cardiac surgery patients. Recent meta-analyses
and reviews have shown its good efficacy in restoring and maintaining
sinus rhythm but also an unclear clinical benefit for patients. Methods:
PRAGUE-12 is a prospective, randomized study, assessing the effect of
adding SA of AF to other cardiac surgery (SA patients vs. Non-SA
patients). In present sub-analysis, patients from the study were examined
and grouped according to their complete AF-free survival during the first
postoperative year (patients who had sinus rhythm in all postoperative
check-ups were considered AFfree, patient with AF recurrence were Non
AF-Free). Occurrence of death, stroke, heart failure and bleeding was
compared between both groups (AF-Free vs. Non AF-free). Results: One
hundred ninety-two patients were analyzed (104 SA patients and 88 Non-SA
patients), out of which 61 (32%) were AF-free and 131 (68%) were Non
AF-Free. The primary combined endpoint (death, stroke, heart failure) was
positive in 6 AF-free patients vs 45 Non AF-free patients (HR 0.25, 95% CI
0.11- 0.59, p=0.001; Figure 1). Separately, only heart failure was
significantly different between both groups (5 patients AF-Free vs. 39
patients Non AF-Free, HR 0.25, 95% CI 0.09-0.062, p=0.003), other
endpoints were nonsignificant. Adjusted Cox-regression analysis has shown
that the AF-Free survival (p=0.001), but not the surgical ablation
(p=0.844) was the predictor of occurence of clinical complications after
the surgery. Conclusions: In AF patients who undergo a cardiac surgery,
restoring and maintaining of stable sinus rhythm is related with
significantly lower occurence of clinical complications during one year
after the surgery. (Figure Presented).

<32>
Accession Number
72020120
Authors
Patel N.N. Fiorentino F. Taghavi Azar Sharabiani M. Angelini G.D.
Institution
(Patel, Fiorentino, Taghavi Azar Sharabiani, Angelini) Imperial College
London, Cardiothoracic Surgery, London, United Kingdom
Title
Long-term survival after off-pump coronary artery bypass graft surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 361), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Randomised controlled trials demonstrate that Off-Pump
Coronary Artery Bypass (OPCAB) is equivalent to On-Pump Coronary artery
bypass graft surgery (ONCAB) for in-hospital and short-term outcomes.
Recent observational data suggests that OPCAB may be associated with
increased mid-term mortality although there are several conflicting
studies. Objective: There is little data on the impact of OPCAB on
long-term survival. The objective of this study was to determine the
impact of OPCAB on long-term survival compared to ONCAB. Methods: We
conducted a retrospective cohort study using the Bristol PATS database of
all patients who underwent primary isolated CABG surgery from 1996 to
2011. Mortality data was obtained from the Office of National Statistics.
Multivariate regression models were used to estimate the association
between OPCAB and long-term survival. Results: We evaluated long-term
survival in 11,981 patients (mean age 65.5+/-9.3 years, 2202 females) who
underwent CABG (OPCAB, n=6133; ONCAB, n=5848). Survival data was complete
in 99.2% of patients, with a median follow-up duration of 8 years
(interquartile range: 4.8 to 11.8 years; maximum 17.3 years). Both groups
were similar in terms of baseline characteristics and intraoperative
variables. Euroscore (3.7 (0.03) vs 3.8 (0.03), SMD=0.038) was similar
between OPCAB and ONCAB groups and mean number of distal anastomoses
performed were 2.5 (0.81) in the OPCAB group and 2.9 (0.78) in the ONCAB
group (SMD=0.505). Long-term survival was similar between patients
undergoing OPCAB and ONCAB (Log-rank test for equality of survivor
functions (chi² (1) =2.93; Pr>chi²=0.0870). HR for
death: 0.94, 95% CI [0.87, 1.01], p=0.087). Conclusion: In patients
undergoing CABG surgery, long term survival is similar using OPCAB and
ONCAB strategies.

<33>
Accession Number
72020117
Authors
Belley-Cote E.P. Lamy A. Tagarakis G.I. Ou Y. Vincent J. Kavsak P. Zhang
M. Devereaux P.J. Whitlock R.P.
Institution
(Belley-Cote, Lamy, Kavsak, Devereaux, Whitlock) McMaster University,
Hamilton, Canada
(Tagarakis) University of Thessaly, Larissa, Greece
(Ou, Vincent, Zhang) Population Health Research Institute, Hamilton,
Canada
Title
An evaluation of the incidence and prognosis of post coronary artery
bypass grafting myocardial infarction according to different definitions
in the CORONARY trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 360), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Over the years, clinical studies in cardiac surgery have used
different diagnostic criteria for post coronary artery bypass grafting
(CABG) myocardial infarction (MI). These diagnostic criteria, even though
widely accepted, are based on arbitrary biomarker thresholds sometimes in
association with ECG signs of cardiac necrosis (new pathologic Q waves or
new left bundle branch block). The validation of these diagnostic criteria
in terms of their association with clinical events is limited. Methods:
Using data from the CORONARY trial (n=4752), a randomized controlled trial
evaluating on-pump versus off-pump CABG, we evaluated the incidence of MI
according to five different post CABG MI definitions. To evaluate the
clinical relevance of the definitions, we calculated the associated hazard
ratio (HR) for 30-day mortality adjusted for the EUROscore. Results:
Depending on the diagnostic criteria used, the incidence of MI after CABG
surgery varied from 0.6 to 19% and the associated HR for 30-day mortality
ranges from 2.7 to 6.9. On-pump versus off-pump surgery was not a
significant interaction term. Discussion and conclusion: A clinically
relevant post CABG MI definition should be independently associated with
mortality. Diagnostic criteria that are associated with a 4.0 to 6.9 fold
increase in 30-day mortality may lack sensitivity to identify patients at
substantial risk of short-term mortality. Our results illustrate the need
for a validated post CABG MI diagnostic criteria formulated from its
independent association with important clinical outcomes, especially with
the movement towards the use of high sensitivity troponin assays.

<34>
Accession Number
72020050
Authors
Sannino A. Gargiulo G. Schiattarella G.G. Perrino C. Stabile E. Losi M.A.
Galderisi M.A. De Simone G.G. Trmarco B. Esposito G.
Institution
(Sannino, Gargiulo, Schiattarella, Perrino, Stabile, Losi, Galderisi, De
Simone, Trmarco, Esposito) University Hospital Federico II, Naples, Italy
Title
Pre-existing and new-onset atrial fibrillation: A meta-analysis of
mortality outcomes and cerebrovascular events in 13,795 patients
undergoing transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 342), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) and new-onset atrial fibrillation
(NOAF) predict morbidity and mortality in several conditions but little is
known about their role in transcatheter aortic valve implantation (TAVI).
Methods and results: Twenty-five studies, enrolling 13,795 patients
undergoing TAVI, with a 28.8% of patients with pre-existing AF and 15.5%
with NOAF, were analyzed for early and long-term all-cause mortality; a
further meta-analysis was performed to assess the occurrence of
cerebrovascular events (CVE). In patients with baseline AF, 30-day
all-cause mortality was similar to patients in sinus rhythm. Conversely,
long-term all-cause mortality was significantly greater in AF patients
than in patients with baseline sinus rhythm (HR: 1.66; 95% [CI]: 1.43 to
1.92, p<0.0001). Surprisingly, baseline AF was not predictor of CVE at
long-termfollow- up (HR: 1.68; 95% [CI]: 0.86 to 3.30, p=0.131). NOAF
patients showed a similar short- and long-term all-cause mortality, when
compared to patients in sinus rhythm, whereas experienced significantly
higher incidence of CVE at shortterm follow-up (HR: 2.54; 95% [CI]: 1.51
to 4.25, p<0.0001). Only a trend towards a higher incidence of CVE was
observed at long-term follow-up (HR: 1.44; 95% [CI]: 0.50 to 4.10,
p=0.497). Conclusions: Pre-existing AF, but not NOAF, is predictor of
all-cause mortality in patients undergoing TAVI. Moreover, NOAF is related
to the occurrence of CVE at short-term follow-up. Similar to SAVR, the
optimal management and risk stratification of these patients need to be
further investigated in ad-hoc trials.

<35>
Accession Number
72019926
Authors
Baker W. Coleman C.
Institution
(Baker, Coleman) University of Connecticut, Department of Pharmacy
Practice, Storrs, United States
Title
Impact of ascorbic acid on post-cardiothoracic surgery atrial fibrillation
and length of stay: A meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 308), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: While the etiology of post-cardiothoracic (CTS) atrial
fibrillation (AF) is likely multifactorial, inflammation and oxidative
stress likely play pivotal roles. The prophylactic use of therapies with
antioxidant properties, such as ascorbic acid, presents an intriguing
option to improve postoperative outcomes. Purpose: We performed a
systematic review and meta-analysis of published randomized controlled
trials (RCTs) evaluating the impact of prophylactic ascorbic acid on
post-CTS AF, intensive care unit (ICU) length-of stay (LOS) and total
hospital LOS. Methods: We searched Medline, SCOPUS and the Cochrane
Central Register of Controlled Trials from inception through January 2015
for RCTs comparing ascorbic acid versus placebo in patients undergoing
CTS. Outcomes were pooled using a random-effects model producing either
odds ratios (OR) or mean differences (MD) and 95% confidence intervals
(CI). We carried out cumulative metaanalysis based on date of publication
to detect temporal trends in effect and to assess whether further RCTs are
likely to change overall conclusions. Results: Eight RCTs, including 955
participants, were included. One study included coronary artery bypass
grafting (CABG) and/or valve surgery, with the remainder being CABG only.
Two studies used intravenous ascorbic acid with the remainder using an
oral formulation. Post-operative beta-blocker use ranged from 70 to 100%
across studies. Use of prophylactic ascorbic acid resulted in a
significant reduction in post-CTS AF (OR 0.42, 95% CI 0.27 to 0.65), ICU
LOS (MD -0.38, 95% CI -0.53 to -0.24) and total hospital LOS (MD -1.12,
95% CI -1.84 to -0.39). Cumulative meta-analysis showed that reliable
evidence supporting ascorbic acid efficacy stabilized with inclusion of
the three 2014 RCTs. Conclusions: Ascorbic acid appears to reduce the
incidence of post-CTS AF and shorten ICU and total hospital LOS. Following
the publication on 3 RCTs in 2014, cumulative meta-analysis suggests
future RCTs are unlikely to alter these conclusions.

<36>
Accession Number
72019423
Authors
Blaschke F. Lacour P. Boldt L.H. Wutzler A. Parwani A. Huemer M. Attanasio
P. Haverkamp W.
Institution
(Blaschke, Lacour, Boldt, Wutzler, Parwani, Huemer, Attanasio, Haverkamp)
Charite-Campus Virchow-Klinikum (CVK), Medizinische Klinik mit Schwerpunkt
Kardiologie, Berlin, Germany
Title
Managing periprocedural anticoagulation therapy in patients undergoing
cardiac electronic device surgery: Survey in Austria, Germany and
Switzerland.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 171-172),
2015. Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Physicians must balance the thrombembolic and bleeding risks
when deciding on the periprocedural anticoagulation strategy for patients
undergoing cardiac device implantation. Previous data indicate that it is
safer to continue phenprocoumon therapy than heparin bridging because of
an increased risk of complications such as hematomas and infections.
Currently novel oral antico agulation (NOAC) agents are increasingly
replacing phenprocoumon as oral anticoagulant. However, data regarding the
management of NOACs in the context of pacemaker or ICD implantation are
missing. The purpose of this study was to survey clinical practice with
regard to the use of phenprocoumon and NOACs in relation to device
implantation in Austria, Germany and German-speaking Switzerland. Methods
and results: We conducted a web-based survey across centres in Austria,
Germany and German-speaking Switzerland using the tool Surveymonkey. The
questionnaire included 17 questions and was sent to 202 Austrian centers,
1045 German centres and 145 Swiss centres. The survey was completed by 252
of the 1392 centres (18.10% response rate). In managing patients on NOACs
common practice was to stop NOACs in 95.83% (Austria), 89.52% (Germany)
and 87.50% (Switzerland). NOACs were stopped in 68.18% (Austria), 51.40%
(Germany), 53.85% (Switzerland) one day before device implantation and
usually restarted on the following day after device implantation. In the
centres where NOACs were stopped for implantation, bridging with heparin
was performed in patients with atrial fibrillation in 45.45% in Austria,
in 41.90% in Germany, and only in 23.08% in Switzerland. In patients with
a history of thrombosis/pulmonary embolism the percentage of bridging was
higher. Most centres use low molecular weight heparin in therapeutic
dosage. Management of patients on phenprocoumon varied significantly
between each country. Anticoagulation was stopped in 66.67% of the centres
in Austria, 46.00% of the centres in Germany, and 13.33% of the centres in
Switzerland. In patients with prosthetic valves, most centres discontinued
oral anticoagulation and bridged with heparin. Conclusions: Implantation
of cardiac devices in patients on oral anticoagulation is increasingly
common in clinical practice. Our data demonstrate that timing of NOAC and
phenprocoumon cessation, bridging with heparin, and restarting of oral
anticoagulation vary a lot among all centres. Our findings emphasize the
need for further randomized controlled studies to determine the optimal
strategy for managing anticoagulation in patients undergoing device
surgery.

<37>
Accession Number
72019292
Authors
Hwang D. Lee J.M. Park J. Kim K.J. Koo B.K. Kim H.S.
Institution
(Hwang, Lee, Park, Kim, Koo, Kim) Seoul National University Hospital,
Cardiovascular Center, Seoul, South Korea
Title
Clinical outcomes of percutaneous coronary intervention at centers with or
without on-site surgical back-up: An updated meta-analysis of 23 studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 134), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Objective: Emergency coronary artery bypass graft surgery (CABG) for
unsuccessful percutaneous coronary intervention (PCI) has become a rare
event. We performed an updated meta-analysis to compare the rates of
all-cause mortality and emergency CABG after primary and non-primary PCI
at centers with or without on-site surgery. Design: Systematic reviews and
meta-analysis using random-effects model. The primary outcome was
all-cause mortality after PCI. Secondary outcomes were rates of emergency
CABG and various complications during or after PCI. Odds ratios (OR) with
95% confidence intervals (CI) between with and without on-site surgical
back-up were compared. Data sources: PubMed, EMBASE, BioMed Central,
Cochrane Central Register of Controlled Trials, ClinicalTrials.gov,
conference proceedings through January 2015. Eligibility Criteria for
Selecting Studies: Randomized controlled trials (RCT) or prospective
observational studies with adjustment of baseline differences were
identified. Risks of bias assessment were performed with Cochrane
checklist for the 4 RCT and the New-Cattle Ottawa scoring system for 19
prospective observational studies. Results: The 23 high-quality studies
which compared clinical outcomes and complication rates of 1,101,123
patients after PCI at centers with or without on-site surgery were
included. For primary PCI for ST-segment elevation myocardial infarction
(133,574 patients), there were no increases in the rate of all-cause
mortality (no on-site surgery vs. on-site surgery: 4.8% vs. 7.2%, OR 0.99,
95% CI 0.91-1.06, p=0.702, I2=0.0%) or emergency CABG (1.5% vs. 2.4%, OR
0.74, 95% CI 0.54-1.02, p=0.067, I2=49.4%) at centers without on-site
surgery. For non-primary PCI (967,549 patients), the rate of all-cause
mortality (1.6% vs. 2.1%, OR 1.13, 95% CI 0.87-1.47, p=0.369, I2=81.0%)
and emergency CABG (0.5% vs. 0.8%, OR 1.15, 95% CI 0.63-2.08, p=0.652,
I2=80.1%) were not significantly different. Cumulative meta-analysis for
non-primary PCI showed temporal decrease of the difference in all-cause
mortality since 2007. The rate of complications of PCI (cardiogenic shock,
stroke, aortic dissection, tamponade, recurrent infarction) also did not
show any differences between centers with and without on-site surgery.
Conclusions: The clinical outcomes and complication rates of PCI at
centers without on-site surgery did not differ from those with on-site
surgery, regardless of primary or non-primary PCI. The temporal trends of
improving outcomes in non-primary PCI at centers without on-site surgery
were observed.

<38>
Accession Number
72018927
Authors
Ishigami S. Tarui S. Goto T. Ousaka D. Okuyama M. Baba K. Ohtsuki S.
Kasahara S. Sano S. Oh H.
Institution
(Ishigami, Tarui, Goto, Ousaka, Okuyama, Kasahara, Sano) Okayama
University, Department of Cardiovascular Surgery, Okayama, Japan
(Baba, Ohtsuki) Okayama University Hospital, Department of Pediatrics,
Okayama, Japan
(Oh) Okayama University Hospital, Department of Regenerative Medicine,
Center for Innovative Clinical Medicine, Okayama, Japan
Title
Transcoronary infusion of cardiac progenitor cells in hypoplastic left
heart syndrome: 3-year results of the TICAP trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2015 London United Kingdom. Conference Start: 20150829 Conference
End: 20150902. Conference Publication: (var.pagings). 36 (pp 36), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Oxford University Press
Abstract
Background: Hypoplastic left heart syndrome (HLHS) is one of the severe
congenital heart malformation. Initial results of TICAP phase I trial
(NCT01273857) carried out in our hospital have revealed that intracoronary
infusion of cardiosphere-derived cells (CDCs) in children with HLHS was
feasible and safe; however, the long-term safety and efficacy of CDCs
infusion in these patients remain unclear. Purpose: The purpose of this
study is to evaluate the safety and efficacy of CDCs injection during
long-term period and to determine the factors that may be associated with
the beneficial effects of cardiac function after cell injection. Methods
and design: This phase 1 trial is a prospective controlled study. Fourteen
patients with HLHS undergoing staged-2 or -3 palliations were enrolled
between January 2011, and January 2012. Seven patients assigned to receive
intracoronary CDCs infusion 1 month after the cardiac surgery followed by
7 patients allocated to a control with standard care alone. The primary
endpoint was to assess the safety and the secondary endpoint was to
evaluate the cardiac function and heart failure status from the baseline
through 3 years of follow-up. Results: In CDC-treated group, no
complications and tumor formation were observed within 3 years after cell
infusion. All 3 patients of stage-2 palliation (Glenn) at cell infusion
were undergone stage-3 palliation (Fontan) along with schedule. Compared
with CDC-treated patients, control group had higher incidence of coil
occlusion for collaterals (P=0.002), and one among five patients of
stage-2 palliation at enrollment were unable to undergo stage-3 palliation
due to poor cardiac function. Heart failure status assessed by NYUPHFI
index and serum BNP showed significantly lower levels in CDC-treated group
(P=0.02). Cardiac function-assessed by echocardiogram showed that changes
in right ventricular ejection fraction (RVEF) were greater in the
CDC-treated group than in controls at 3 years (+7.2+/-4.8% vs.
+2.7+/-2.2%, P=0.04). As independent predictors of treatment
responsiveness, absolute changes in RVEF at 3 years were negatively
correlated with age, weight for age z-score (WAZ), and RVEF at CDC
infusion (age: r=-0.77, P=0.045; WAZ: r=-0.97, P=0.005; EF: r=-0.88,
P=0.008). Conclusion: Intracoronary CDC infusion in patients with HLHS was
safe for longterm and improved RVEF during 3 years of follow-up. This
therapeutic strategy may reduce heart failure status as well as catheter
intervention for collaterals. A randomized controlled trial is ongoing to
assess the efficacy of this novel therapeutic approach.

<39>
Accession Number
23915489
Authors
Hu Y. Li Z. Chen J. Shen C. Song Y. Zhong Q.
Title
The effect of the time interval between coronary angiography and on-pump
cardiac surgery on risk of postoperative acute kidney injury: a
meta-analysis.
Source
Journal of cardiothoracic surgery. 8 (pp 178), 2013. Date of Publication:
2013.
Abstract
BACKGROUND: Reports of the association between the time interval from
coronary angiography (CAG) to cardiac surgery and risk of postoperative
acute kidney injury (AKI) are controversial. We attempted to examine this
association by conducting a meta-analysis.
METHODS: We searched the Pubmed, MEDLINE, EMBASE, Web of Science
databases, and the Cochrane Library from January 1966 to March 2013. A
meta-analysis of studies reporting data for 1-day and 3-day time intervals
between CAG and cardiac surgery was conducted after evaluation of
heterogeneity and publication bias. Study-specific estimates were combined
with inverse variance-weighted averages of logarithmic odds ratios (ORs)
in fixed-effects models.
RESULTS: From 8 studies involving 11542 persons, the pooled OR of AKI
associated with an interval of 1 day or less between CAG and surgery was
1.21 (95% confidence interval (CI), 1.04 to 1.39) relative to an interval
of more than 1 day. From 4 studies involving 5420 persons in the
cardiopulmonary-bypass subgroup, the pooled OR of AKI associated with an
interval of 3 days or less between CAG and surgery was 1.25 (95% CI, 1.07
to 1.43) relative to an interval of more than 3 days. The adjusted OR of
the study in the cardiopulmonary bypass/ deep hypothermic circulatory
arrest subgroup was 0.35 (95% CI, 0.17 to 0.73).
CONCLUSIONS: A time interval of 1 day or less between CAG and on-pump
cardiac surgery was significantly associated with increased risk of AKI. A
delay of on-pump cardiac surgery until 24 hours after CAG can potentially
decrease postoperative AKI.

<40>
Accession Number
23842141
Authors
Jerzewski K. Ruel M. Voisine P. Le May M.R. Kulik A.
Title
Does high-density lipoprotein influence the development of saphenous vein
graft disease after coronary bypass surgery?: exploratory analysis from
the CASCADE trial.
Source
Journal of cardiothoracic surgery. 8 (pp 172), 2013. Date of Publication:
2013.
Abstract
BACKGROUND: Low levels of high-density lipoprotein (HDL) purportedly
increase the risk after coronary bypass surgery. This may relate to the
development of saphenous vein graft (SVG) disease early postoperatively,
but this premise has never been evaluated in the context of a prospective
trial.
METHODS: The CASCADE Trial was a multi-center study of 113 patients
evaluating the use of postoperative clopidogrel. Patients received
standard lipid management after surgery (96% statins). At 12 months,
angiography and intravascular ultrasound was performed to assess SVG
occlusion and intimal hyperplasia, respectively. In this exploratory
analysis, we evaluated the influence of HDL levels on the development of
SVG disease at 12 months, using the established cut-off of <40 mg/dL
suggesting increased risk.
RESULTS: While HDL levels increased over the time-period of the trial
(P<0.0001), 51.1% of patients had HDL levels <40 mg/dL 12 months after
surgery. Slightly more SVG occlusions occurred amongst patients with HDL
levels <40 mg/dL (6.8%), compared to patients with HDL levels >40 mg/dL
(4.0%, P=0.5). With multivariate adjustment, HDL level <40 mg/dL was
associated with a trend towards more SVG occlusions (odds ratio: 3.2;
P=0.12). Lower HDL level was also associated with more intimal hyperplasia
on ultrasound at 12 months (P=0.10). Patients who had HDL levels >60 mg/dL
had the least amount of intimal hyperplasia, significantly less than the
remainder of the cohort (P=0.01).
CONCLUSIONS: Within this population, lower HDL levels were associated with
trends towards more graft occlusions and more vein intimal hyperplasia.
Modulation of postoperative HDL levels may represent a valuable future
strategy for the reduction of SVG disease.