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<1>
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Accession Number
2015424638
Authors
De Egea V. Munoz P. Valerio M. De Alarcon A. Lepe J.A. Miro J.M.
Galvez-Acebal J. Garcia-Pavia P. Navas E. Goenaga M.A. Farinas M.C.
Vazquez E.G. Marin M. Bouza E.
Institution
(De Egea, Munoz, Valerio, Marin, Bouza) Microbiology and Infectious
Diseases Department, Servicio de Microbiologia Clinica y Enfermedades
Infecciosas, Hospital General Universitario Gregorio Maranon, Doctor
Esquerdo 46, Madrid, Spain
(Munoz, Marin, Bouza) Department of Medicine, Universidad Complutense
Madrid (UCM), Madrid, Spain
(Munoz, Marin, Bouza) CIBER de Enfermedades Respiratorias, Instituto de
Salud Carlos III (CIBERES), Madrid, Spain
(Munoz, Valerio, Marin, Bouza) Instituto de Investigacion Sanitaria
Gregorio Maranon (IiSGM), Madrid, Spain
(De Alarcon, Lepe) Microbiology and Infectious Disease Department,
Hospital Universitario Virgen Del Rocio, Sevilla, Spain
(Miro) Infectious Diseases Department, Hospital Clinic-IDIBAPS, University
of Barcelona (Barcelona), Madrid, Spain
(Galvez-Acebal) Department of Medicine, Unidad Clinica Intercentros de
Enfermedades Infecciosas, Microbiolo Gia y Medicina Preventiva Hospital
Universitario Virgen Macarena, Departamento de Medicina, Universidad de
Sevilla, Madrid, Spain
(Garcia-Pavia) Department of Cardiology, Hospital Universitario Puerta de
Hierro Majadahonda, Madrid, Spain
(Navas) Hospital Ramon y Cajal, Madrid, Spain
(Goenaga) UEI HU Donostia, San Sebastian, Spain
(Farinas) Hospital Marques de Valdecilla, University of Catabria,
Santander, Spain
(Vazquez) Hospital Clinico Universitario Virgen de la Arrixaca, Instituto
Murciano de Investigacion Biosanitaria (IMIB), Facultad de
Medicina-Universidad de Murcia, Spain
Title
Characteristics and outcome of Streptococcus pneumoniae endocarditis in
the XXI century: A systematic review of 111 cases (2000-2013).
Source
Medicine (United States). 94 (39) (pp e1562), 2015. Date of Publication:
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Streptococcus pneumoniae is an infrequent cause of severe infectious
endocarditis (IE). The aim of our study was to describe the epidemiology,
clinical and microbiological characteristics, and outcome of a series of
cases of S. pneumoniae IE diagnosed in Spain and in a series of cases
published since 2000 in the medical literature. We prospectively collected
all cases of IE diagnosed in a multicenter cohort of patients from 27
Spanish hospitals (n=2539). We also performed a systematic review of the
literature since 2000 and retrieved all cases with complete clinical data
using a pre-established protocol. Predictors of mortality were identified
using a logistic regression model. We collected 111 cases of pneumococcal
IE: 24 patients from the Spanish cohort and 87 cases from the literature
review. Median age was 51 years, and 23 patients (20.7%) were under 15
years. Men accounted for 64% of patients, and infection was
community-Acquired in 96.4% of cases. The most important underlying
conditions were liver disease (27.9%) and immunosuppression (10.8%). A
predisposing heart condition was present in only 18 patients (16.2%).
Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided
endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The
microbiological diagnosis was obtained from blood cultures in 84.7% of
cases. In the Spanish cohort, nonsusceptibility to penicillin was detected
in 4.2%. The most common clinical manifestations included fever (71.2%), a
new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and
Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of
patients. The in-hospital mortality rate was 20.7%. The multivariate
analysis revealed the independent risk factors for mortality to be
meningitis (OR, 4.3; 95% CI, 1.4-12.9; P<0.01). Valve surgery was
protective (OR, 0.1; 95% CI, 0.04-0.4; P<0.01). Streptococcus pneumoniae
IE is a community-Acquired disease that mainly affects native aortic
valves. Half of the cases in the present study had concomitant pneumonia,
and a considerable number developed meningitis. Mortality was high, mainly
in patients with central nervous system (CNS) involvement. Surgery was
protective.

<2>
Accession Number
2015422294
Authors
Wang L. Mao S. Qi J.-Y. Ren Y. Guo X.-F. Chen K.-J. Zhang M.-Z.
Institution
(Wang, Mao, Guo, Zhang) The Second Clinical Medical College, Guangzhou
University of Chinese Medicine, Guangzhou 510405, China
(Wang, Mao, Qi, Ren, Guo, Zhang) Guangdong Provincial Hospital of
Traditional Chinese Medicine, Guangzhou 510120, China
(Chen) Department of Cardiovascular Disease, Xiyuan Hospital, Chinese
Academy of Chinese Medical Sciences, Beijing 100091, China
Title
Effect of Danlou Tablet () on peri-procedural myocardial injury among
patients undergoing percutaneous coronary intervention for non-ST
elevation acute coronary syndrome: A study protocol of a multicenter,
randomized, controlled trial.
Source
Chinese Journal of Integrative Medicine. 21 (9) (pp 662-666), 2015. Date
of Publication: 01 Sep 2015.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
Abstract
Background: It has been shown that administration of statins reduced the
risk of peri-procedural myocardial damage. However, it remains unclear
whether Chinese medicine Danlou Tablet (), similar to statins, may protect
patients undergoing percutaneous coronary intervention (PCI) from
peri-procedural myocardial damage. Objective: To demonstrate the
hypothesis whether treatment with Danlou Tablet would improve clinical
outcome in patients undergoing selective PCI with non-ST elevation acute
coronary syndrome (NSTE-ACS) in China. Methods: Approximately 220 patients
with unstable angina or non-ST-segment elevation myocardial infarction
undergoing PCI will be enrolled and randomized to Danlou Tablet treatment
(4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90
days thereafter) or placebo. All patients will not receive Danlou Tablet
before procedure. The primary end point is to evaluate the incidence of
cardiac death, myocardial infarction or unplanned re-hospitalization and
revascularization after 30 days in patients undergoing selective PCI
treated with Danlou Tablet compared with placebo. Secondary endpoints
include the incidence of peri-procedural myocardial injury, 3-month
clinical outcomes, the quality of life and Chinese medicine syndromes
assessment. Conclusion: This study protocol will provide important
evidence of Danlou Tablet treatment on the peri-procedural myocardial
injury in patients with NSTE-ACS undergoing selective PCI, which may
support a strategy of routine Danlou Tablet therapy to improve the
clinical outcomes.

<3>
Accession Number
2015425675
Authors
Belley-Cote E.P. Hanif H. D'Aragon F. Eikelboom J.W. Anderson J.L. Borgman
M. Jonas D.E. Kimmel S.E. Manolopoulos V.G. Baranova E. Maitland-van der
Zee A.H. Pirmohamed M. Whitlock R.P.
Institution
(Belley-Cote, D'Aragon, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Hanif, Whitlock) Division of Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(D'Aragon) Anaesthesiology Department, Sherbrooke University, QC, Canada
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Eikelboom, Whitlock) Population Health Research Institute, Hamilton, ON,
Canada
(Anderson) Intermountain Medical Center, Murray, UT, United States
(Borgman) PGXL Labs, Louisville, KY, United States
(Jonas) University of North Carolina Chapel Hill, Chapel Hill, NC, United
States
(Kimmel) University of Pennsylvania, Philadelphia, PA, United States
(Manolopoulos) Laboratory of Pharmacology, Democritus University of Thrace
Medical School, Alexandroupolis, Greece
(Baranova, Maitland-van der Zee) Division of Pharmacoepidemiology and
Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences,
Utrecht University, Utrecht, Netherlands
(Pirmohamed) University of Liverpool, Liverpool, United Kingdom
Title
Genotype-guided versus standard vitamin K antagonist dosing algorithms in
patients initiating anticoagulation: A systematic review and
meta-analysis.
Source
Thrombosis and Haemostasis. 114 (4) (pp 768-777), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Schattauer GmbH
Abstract
Variability in vitamin K antagonist (VKA) dosing is partially explained by
genetic polymorphisms. We performed a meta-analysis to determine whether
genotype-guided VKA dosing algorithms decrease a composite of death,
thromboembolic events and major bleeding (primary outcome) and improve
time in therapeutic range (TTR). We searched MEDLINE, EMBASE, CENTRAL,
trial registries and conference proceedings for randomised trials
comparing genotype-guided and standard (non genotype-guided) VKA dosing
algorithms in adults initiating anticoagulation. Data were pooled using a
random effects model. Of the 12 included studies (3,217 patients), six
reported all components of the primary outcome of mortality,
thromboembolic events and major bleeding (2,223 patients, 87 events). Our
metaanalysis found no significant difference between groups for the
primary outcome (relative risk 0.85, 95 % confidence interval [CI]
0.54-1.34; heterogeneity X²=4.46, p=0.35, I²=10 %).
Based on 10 studies (2,767 patients), TTR was significantly higher in the
genotypeguided group (mean difference (MD) 4.31 %; 95 % CI 0.35, 8.26;
heterogeneity _2=43.31, p< 0.001, I2=79 %). Pre-specified exploratory
analyses demonstrated that TTR was significantly higher when
genotype-guided dosing was compared with fixed VKA dosing (6 trials, 997
patients: MD 8.41 %; 95 % CI 3.50,13.31; heterogeneity
X²=15.18, p<0.01, I²=67 %) but not when compared
with clinical algorithmguided dosing (4 trials, 1,770 patients: MD-0.29 %;
95 % CI-2.48,1.90; heterogeneity X²=1.53, p=0.68,
I²=0 %; p for interaction= 0.002). In conclusion,
genotype-guided compared with standard VKA dosing algorithms were not
found to decrease a composite of death, thromboembolism and major
bleeding, but did result in improved TTR. An improvement in TTR was
observed in comparison with fixed VKA dosing algorithms, but not with
clinical algorithms.

<4>
Accession Number
2015420760
Authors
Mennuni M.G. Dangas G.D. Mehran R. Ben-Gal Y. Xu K. Genereux P. Brener
S.J. Feit F. Lincoff A.M. Ohman E.M. Hamon M. Stone G.W.
Institution
(Mennuni, Dangas, Mehran) Icahn School of Medicine at Mount Sinai, One
Gustave L. Levy Place, New York, NY 10029, United States
(Dangas, Mehran, Xu, Genereux, Brener, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Ben-Gal) Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv,
Israel
(Genereux, Stone) Columbia University Medical Center, New York, NY, United
States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Feit) NYU Langone Medical Center, New York, NY, United States
(Lincoff) Cleveland Clinic, Lerner College of Medicine, Case Western
Reserve University, Cleveland, OH, United States
(Ohman) Duke Heart Center, Durham, NC, United States
(Hamon) University Hospital of Caen Normandy, France
Title
Coronary Artery Bypass Surgery Compared with Percutaneous Coronary
Intervention for Proximal Left Anterior Descending Artery Treatment in
Patients with Acute Coronary Syndrome: Analysis from the ACUITY Trial.
Source
Journal of Invasive Cardiology. 27 (10) (pp 468-473), 2015. Date of
Publication: 01 Oct 2015.
Publisher
HMP Communications
Abstract
BACKGROUND: The optimal revascularization strategy in patients with acute
coronary syndrome (ACS) and proximal left anterior descending (pLAD)
coronary artery lesions is not well defined. The aim of this study was to
compare the outcomes of ACS patients with pLAD culprit lesions receiving
percutaneous coronary intervention (PCI) vs coronary artery bypass graft
(CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of
patients with ACS treated with an early invasive strategy. Major adverse
cardiac event (MACE; defined as death, myocardial infarction [MI], and
repeat revascularization) and stroke were compared at 30 days and 1 year
between PCI and CABG in patients with significant stenosis of the pLAD
undergoing revascularization. Postprocedural major bleeding was evaluated
at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n <
842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG.
Baseline characteristics, including age, sex, diabetes, and TIMI risk
score, were well matched between groups; however, patients undergoing PCI
were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death,
MI, MACE, and stroke rates did not differ between groups at 1 year. PCI
patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood
product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates
of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These
results were consistent in patients with single vs multivessel disease and
in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD
culprit lesions, an initial revascularization strategy of PCI compared
with CABG yields similar 1-year death, MI, and MACE rates, although
unplanned revascularization is more common after PCI.

<5>
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Accession Number
2015421610
Authors
Kobashigawa J. Patel J. Azarbal B. Kittleson M. Chang D. Czer L. Daun T.
Luu M. Trento A. Cheng R. Esmailian F.
Institution
(Kobashigawa, Patel, Azarbal, Kittleson, Chang, Czer, Daun, Luu, Trento,
Cheng, Esmailian) Advanced Heart Disease Section, Cedars-Sinai Heart
Institute, 127 S. San Vicente Blvd, Los Angeles, CA 90048, United States
Title
Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in
the First Year after Heart Transplant: Early Invasive Monitoring
Attenuation Through Gene Expression Trial.
Source
Circulation: Heart Failure. 8 (3) (pp 557-564), 2015. Date of Publication:
04 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The endomyocardial biopsy (EMB) is considered the gold standard
in rejection surveillance post cardiac transplant, but is invasive, with
risk of complications. A previous trial suggested that the gene expression
profiling (GEP) blood test was noninferior to EMB between 6 and 60 months
post transplant. As most rejections occur in the first 6 months, we
conducted a single-center randomized trial of GEP versus EMB starting at
55 days post transplant (when GEP is valid). Methods and Results-Sixty
heart transplant patients meeting inclusion criteria were randomized
beginning at 55 days post transplant to either GEP or EMB arms. A positive
GEP >30 between 2 and 6 months, or >34 after 6 months, prompted a
follow-up biopsy. The primary end point included a composite of
death/retransplant, rejection with hemodynamic compromise or graft
dysfunction at 18 months post transplant. A coprimary end point included
change in first-year maximal intimal thickness by intravascular
ultrasound, a recognized surrogate for long-term outcome. Corticosteroid
weaning was assessed in both the groups. The composite end point was
similar between the GEP and EMB groups (10% versus 17%; log-rank P=0.44).
The coprimary end point of first-year intravascular ultrasound change
demonstrated no difference in mean maximal intimal thickness (0.35+/-0.36
versus 0.36+/-0.26 mm; P=0.944). Steroid weaning was successful in both
the groups (91% versus 95%). Conclusions-In this pilot study, GEP starting
at 55 days post transplant seems comparable with EMB for rejection
surveillance in selected heart transplant patients and does not result in
increased adverse outcomes. GEP also seems useful to guide corticosteroid
weaning. Larger randomized trials are required to confirm these findings.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00962377.

<6>
Accession Number
2015417760
Authors
Morillo C.A. Marin-Neto J.A. Avezum A. Sosa-Estani S. Rosas F. Villena E.
Quiroz R. Bonilla R. Britto C. Guhl F. Velazquez E. Bonilla L. Meeks B.
Rao-Melacini P. Pogue J. Mattos A. Lazdins J. Rassi A. Connolly S.J. Yusuf
S.
Institution
(Morillo, Bonilla, Meeks, Rao-Melacini, Pogue, Connolly, Yusuf) Hamilton
Health Sciences, Population Health Research Institute, McMaster
University, David Braley CVSRI Rm. 3C-120, Hamilton, ON L8L2X2, Canada
(Marin-Neto) Cardiology Division, Internal Medicine Department, Medical
School of Riberao Preto, Canada
(Avezum, Mattos) Instituto Dante Pazzanese de Cardiologia, S.o Paulo,
Brazil
(Rassi, Rassi) Hospital do Cora..o Anis Rassi, Goi.nia, Brazil
(Britto) Laboratorio de Biologia Molecular E Doen.as Endemicas, Instituto
Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
(Sosa-Estani, Villena) Administracion Nacional de Laboratorios, Instituto
Nacional de Parasitologia, Institutos de Salud, Buenos Aires, Argentina
(Rosas) Fundacion Clinica Abood Shaio, Colombia
(Guhl) CIMPAT-Facultad de Ciencias, Universidad de Los Andes, Colombia
(Quiroz) Fundacion Cardiovascular de Colombia, Bogota, Bucaramanga,
Colombia
(Velazquez) Programa Chagas, Hospital Eduardo Eguia, Tupiza, Bolivia,
United States
(Bonilla) Hospital Nacional Rosales, San-Salvador, El Salvador
(Lazdins) Independent Advisor, Neglected Tropical Diseases, Geneva,
Switzerland
Title
Randomized trial of benznidazole for chronic chagas' cardiomyopathy.
Source
New England Journal of Medicine. 373 (14) (pp 1295-1306), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The role of trypanocidal therapy in patients with established
Chagas' cardiomyopathy is unproven. METHODS We conducted a prospective,
multicenter, randomized study involving 2854 patients with Chagas'
cardiomyopathy who received benznidazole or placebo for up to 80 days and
were followed for a mean of 5.4 years. The primary outcome in the
time-to-event analysis was the first event of any of the components of the
composite outcome of death, resuscitated cardiac arrest, sustained
ventricular tachycardia, insertion of a pacemaker or implantable
cardioverter-defibrillator, cardiac transplantation, new heart failure,
stroke, or other thromboembolic event. RESULTS The primary outcome
occurred in 394 patients (27.5%) in the benznidazole group and in 414
(29.1%) in the placebo group (hazard ratio, 0.93; 95% confidence interval
[CI], 0.81 to 1.07; P = 0.31). At baseline, a polymerase-chain-reaction
(PCR) assay was performed on blood samples obtained from 1896 patients;
60.5% had positive results for Trypanosoma cruzi on PCR. The rates of
conversion to negative PCR results (PCR conversion) were 66.2% in the
benznidazole group and 33.5% in the placebo group at the end of treatment,
55.4% and 35.3%, respectively, at 2 years, and 46.7% and 33.1%,
respectively, at 5 years or more (P<0.001 for all comparisons). The effect
of treatment on PCR conversion varied according to geographic region: in
Brazil, the odds ratio for PCR conversion was 3.03 (95% CI, 2.12 to 4.34)
at 2 years and 1.87 (95% CI, 1.33 to 2.63) at 5 or more years; in Colombia
and El Salvador, the odds ratio was 1.33 (95% CI, 0.90 to 1.98) at 2 years
and 0.96 (95% CI, 0.63 to 1.45) at 5 or more years; and in Argentina and
Bolivia, the odds ratio was 2.63 (95% CI, 1.89 to 3.66) at 2 years and
2.79 (95% CI, 1.99 to 3.92) at 5 or more years (P<0.001 for interaction).
However, the rates of PCR conversion did not correspond to effects on
clinical outcome (P = 0.16 for interaction). CONCLUSIONS Trypanocidal
therapy with benznidazole in patients with established Chagas'
cardiomyopathy significantly reduced serum parasite detection but did not
significantly reduce cardiac clinical deterioration through 5 years of
follow-up. (Funded by the Population Health Research Institute and others;
ClinicalTrials.gov number, NCT00123916; Current Controlled Trials number,
ISRCTN13967269.).

<7>
Accession Number
2015425577
Authors
Chai-Adisaksopha C. Hillis C. Monreal M. Witt D.M. Crowther M.
Institution
(Chai-Adisaksopha, Hillis, Crowther) Department of Medicine, McMaster
University, Hamilton, Canada
(Hillis) Department of Oncology, McMaster University, Hamilton, Canada
(Monreal) Servicio de Medicina Interna, Hospital Universitari Germans
Trias i Pujol, Badalona, Spain
(Witt) Department of Pharmacotherapy, University of Utah College of
Pharmacy, Salt Lake City, UT, United States
(Crowther) HamiltonCanada
Title
Thromboembolic events, recurrent bleeding and mortality after resuming
anticoagulant following gastrointestinal bleeding: A meta-analysis.
Source
Thrombosis and Haemostasis. 114 (4) (pp 819-825), 2015. Date of
Publication: 2015.
Publisher
Schattauer GmbH
Abstract
Gastrointestinal (GI) bleeding commonly complicates anticoagulant therapy.
We aimed to systematically review the published literature to determine
the risk of thromboembolism, recurrent GI bleeding and mortality for
patients on long-term anticoagulation who experience GI bleeding based on
whether anticoagulation therapy was resumed. We performed a systematic
review of phase III randomised controlled trials and cohort studies in
patients with atrial fibrillation or venous thromboembolism who received
oral anticoagulant. We searched MEDLINE, EMBASE and CENTRAL (from
1996-July 2014), conferences abstracts (from January 2006-July 2014) and
www.clinicaltrials.gov (up to the last week of July 2014) with no language
restriction. Two reviewers independently performed study selection, data
extraction and study quality assessment. A total of three studies were
included in the meta-analysis. The resumption of warfarin was associated
with a significant reduction in thromboembolic events (hazard ratio [HR]
0.68, 95 % confidence interval [CI] 0.52 to 0.88, p < 0.004,
I²=82 %). There was an increase in recurrent GI bleeding but
not statistically significant for patients who restarted warfarin compared
to those who did not (HR 1.20, 95 % CI 0.97 to 1.48, p = 0.10,
I² = 0 %). Resumption of warfarin was associated with
significant reduction in mortality (HR 0.76, 95 % CI 0.66 to 0.88, p <
0.001, I² = 87 %). This meta-analysis demonstrates that
resumption of warfarin following interruption due to GI bleeding is
associated with a reduction in thromboembolic events and mortality without
a statistically significant increase in recurrent GI bleeding.

<8>
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Accession Number
2015416906
Authors
Gyongyosi M. Wojakowski W. Lemarchand P. Lunde K. Tendera M. Bartunek J.
Marban E. Assmus B. Henry T.D. Traverse J.H. Moye L.A. Surder D. Corti R.
Huikuri H. Miettinen J. Wohrle J. Obradovic S. Roncalli J. Malliaras K.
Pokushalov E. Romanov A. Kastrup J. Bergmann M.W. Atsma D.E. Diederichsen
A. Edes I. Benedek I. Benedek T. Pejkov H. Nyolczas N. Pavo N.
Bergler-Klein J. Pavo I.J. Sylven C. Berti S. Navarese E.P. Maurer G.
Institution
(Gyongyosi, Pavo, Bergler-Klein, Pavo, Maurer) Cardiology Department,
Medical University of Vienna, Wahringer Gurtel 18-20, Vienna A-1090,
Austria
(Wojakowski, Tendera) Third Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland
(Lemarchand) Inserm, UMR1087, CNRS UMR6291, University of Nantes, Nantes,
France
(Lunde) Cardiology Department, Rikshospitalet University Hospital, Oslo,
Norway
(Bartunek) Cardiovascular Center, OLV Hospital, Aalst, Belgium
(Marban, Henry, Malliaras) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
(Assmus) Cardiology Division, Department of Medicine III, Goethe
University Frankfurt, Frankfurt, Germany
(Traverse) Minneapolis Heart Institute, Abbott Northwestern Hospital,
Minneapolis, MN, United States
(Moye) Coordinating Center for Clinical Trials, University of Texas School
of Public Health, Houston, United States
(Surder) Cardiology Division, Cardiovascular Center, University Hospital,
Zurich, Switzerland
(Surder, Corti) Fondazione Cardiocentro Ticino, Lugano, Switzerland
(Corti) Heart Clinic Hirslanden, Zurich, Switzerland
(Huikuri, Miettinen) Department of Internal Medicine, Institute of
Clinical Medicine, Medical Research Center, University of Oulu, Finland
(Wohrle) Cardiology Department, University of Ulm, Ulm, Germany
(Obradovic) Clinic of Emergency Medicine, Military Medical Academy,
Belgrade, Serbia
(Roncalli) Cardiology Division, Institute CARDIOMET, CIC Biotherapies,
University Hospital of Toulouse, France
(Pokushalov, Romanov) State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Kastrup) Cardiology Department, Rigshospitalet, Copenhagen University,
Copenhagen, Denmark
(Bergmann) Asklepios Klinik St. Georg, Hamburg, Germany
(Atsma) Cardiology Department, Leiden University Medical Center, Leiden,
Netherlands
(Diederichsen) Cardiology Department, Odense University Hospital, Denmark
(Edes) Cardiology Department, University of Debrecen, Hungary
(Benedek, Benedek) Cardiology Department, University of Tirgu Mures,
Romania
(Pejkov) University Clinic for Cardiology, Skopje, Macedonia
(Nyolczas) Medical Centre, Hungarian Defense Forces, Budapest, Hungary
(Sylven) Karolinska Institute, Stockholm, Sweden
(Berti) Invasive Cardiology, National Research Council Institute of
Clinical Physiology (CNR-IFC), Pisa, Italy
(Navarese) Internal Medicine, Division of Cardiology, Pulmonology and
Vascular Medicine, Heinrich-Heine-University, Dusseldorf, Germany
(Navarese) Systematic Investigation and Research on Interventions and
Outcomes MEDICINE Research Network, 10th Military Research Hospital and
Polyclinic, Bydgoszcz, Poland
Title
Meta-analysis of cell-based CaRdiac stUdiEs (ACCRUE) in patients with
acute myocardial infarction based on individual patient data.
Source
Circulation Research. 116 (8) (pp 1346-1360), 2015. Date of Publication:
10 Apr 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Rationale: The meta-Analysis of Cell-based CaRdiac study is the first
prospectively declared collaborative multinational database, including
individual data of patients with ischemic heart disease treated with cell
therapy. Objective: We analyzed the safety and efficacy of intracoronary
cell therapy after acute myocardial infarction (AMI), including individual
patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI,
CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME;
n=1252). Methods and Results: The primary end point was freedom from
combined major adverse cardiac and cerebrovascular events (including
all-cause death, AMI recurrance, stroke, and target vessel
revascularization). The secondary end point was freedom from hard clinical
end points (death, AMI recurrence, or stroke), assessed with
random-effects meta-analyses and Cox regressions for interactions.
Secondary efficacy end points included changes in end-diastolic volume,
end-systolic volume, and ejection fraction, analyzed with random-effects
meta-analyses and ANCOVA. We reported weighted mean differences between
cell therapy and control groups. No effect of cell therapy on major
adverse cardiac and cerebrovascular events (14.0% versus 16.3%; hazard
ratio, 0.86; 95% confidence interval, 0.63-1.18) or death (1.4% versus
2.1%) or death/AMI recurrence/stroke (2.9% versus 4.7%) was identified in
comparison with controls. No changes in ejection fraction (mean
difference: 0.96%; 95% confidence interval, -0.2 to 2.1), end-diastolic
volume, or systolic volume were observed compared with controls. These
results were not influenced by anterior AMI location, reduced baseline
ejection fraction, or the use of MRI for assessing left ventricular
parameters. Conclusions: This meta-analysis of individual patient data
from randomized trials in patients with recent AMI revealed that
intracoronary cell therapy provided no benefit, in terms of clinical
events or changes in left ventricular function.

<9>
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Accession Number
2015415927
Authors
Elgendy I.Y. Huo T. Bhatt D.L. Bavry A.A.
Institution
(Elgendy, Bavry) Florida/South Georgia Veterans Health System (Malcom
Randall Veterans Administration Medical Center), Medical Service, 1601 SW
Archer Rd, Gainesville, FL 32608, United States
(Huo) Department of Medicine, Brigham and Women's Hospital Heart and
Vascular Center, Harvard Medical School, Boston, MA, United States
(Bhatt) Medicine Service, North Florida/South Georgia Veterans Health
System, Gainesville, United States
Title
Is aspiration thrombectomy beneficial in patients undergoing primary
percutaneous coronary intervention meta-Analysis of randomized trials.
Source
Circulation: Cardiovascular Interventions. 8 (7) , 2015. Article Number:
e002258. Date of Publication: 01 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-It is unclear whether intravenous glycoprotein IIb/IIIa
inhibitors or ischemic time might modify any clinical benefits observed
with aspiration thrombectomy before primary percutaneous coronary
intervention (PCI) in patients with ST-segment-elevation myocardial
infarction. Methods and Results-Electronic databases were searched for
trials that randomized ST-segment-elevation myocardial infarction patients
to aspiration thrombectomy before PCI versus conventional PCI. Summary
estimates were constructed using a DerSimonian-Laird model. Seventeen
trials with 20 960 patients were available for analysis. When compared
with conventional PCI, aspiration thrombectomy was not associated with a
significant reduction in the risk of mortality 2.8% versus 3.2% (risk
ratio [RR], 0.89; 95% confidence interval [CI], 0.76-1.04; P=0.13),
reinfarction 1.3% versus 1.4% (RR, 0.93; 95% CI, 0.73-1.17; P=0.52), the
combined outcome of mortality or reinfarction 4.1% versus 4.6% (RR, 0.90;
95% CI, 0.79-1.02; P=0.11), or stent thrombosis 0.9% versus 1.2% (RR,
0.82; 95% CI, 0.62-1.08; P=0.15). Aspiration thrombectomy was associated
with a nonsignificant increase in the risk of stroke 0.6% versus 0.4% (RR,
1.45; 95% CI, 0.96-2.21; P=0.08). Meta-regression analysis did not
identify a difference for the log RR of mortality, reinfarction, and the
combined outcome of mortality or reinfarction with intravenous
glycoprotein IIb/IIIa inhibitors (P=0.17, 0.70, and 0.50, respectively) or
with ischemic time (P=0.29, 0.66, and 0.58, respectively).
Conclusions-Aspiration thrombectomy before primary PCI is not associated
with any benefit on clinical end points and might increase the risk of
stroke. Concomitant administration of intravenous glycoprotein IIb/IIIa
inhibitors and ischemic time did not seem to influence any potential
benefits observed with aspiration thrombectomy.

<10>
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Accession Number
2015415926
Authors
Kim B.-K. Shin D.-H. Hong M.-K. Park H.S. Rha S.-W. Mintz G.S. Kim J.-S.
Kim J.S. Lee S.-J. Kim H.-Y. Hong B.-K. Kang W.-C. Choi J.-H. Jang Y.
Institution
(Hong, Jang) Division of Cardiology, Severance Cardiovascular Hospital,
Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul
120-752, South Korea
(Kim, Kang) Kyungpook National University Hospital, Taegu, South Korea
(Shin, Choi) Korea University Guro Hospital, Seoul, South Korea
(Hong) Cardiovascular Research Foundation, New York, NY, United States
(Park) Sejong General Hospital, Bucheon, South Korea
(Rha, Kim) Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
(Mintz) Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon,
South Korea
(Kim, Jang) Gachon University Gil Hospital, Incheon, South Korea
(Kim, Lee) Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
Title
Clinical impact of intravascular ultrasound-guided chronic total occlusion
intervention with zotarolimus-eluting versus biolimus-eluting stent
implantation randomized study.
Source
Circulation: Cardiovascular Interventions. 8 (7) , 2015. Article Number:
e002592. Date of Publication: 01 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-There have been no randomized studies comparing intravascular
ultrasound (IVUS)-guided versus conventional angiography-guided chronic
total occlusion (CTO) intervention using new-generation drug-eluting stent
Therefore, we conducted a prospective, randomized, multicenter trial
designed to test the hypothesis that IVUS-guided CTO intervention is
superior to angiography-guided intervention. Methods and Results-After
successful guidewire crossing, 402 patients with CTOs were randomized to
the IVUS-guided group (n=201) or the angiography-guided group (n=201) and
secondarily randomized to Resolute zotarolimus-eluting stents or Nobori
biolimus-eluting stents. The primary and secondary end points were cardiac
death and a major adverse cardiac event defined as the composite of
cardiac death, myocardial infarction, or target-vessel revascularization,
respectively. After 12-month follow-up, the rate of cardiac death was not
significantly different between the IVUSguided group (0%) and the
angiography-guided group (1.0%; P by log-rank test=0.16). However, major
adverse cardiac event rates were significantly lower in the IVUS-guided
group than that in the angiography-guided group (2.6% versus 7.1%;
P=0.035; hazard ratio, 0.35; 95% confidence interval, 0.13-0.97).
Occurrence of the composite of cardiac death or myocardial infarction was
significantly lower in the IVUS-guided group (0%) than in the
angiography-guided group (2.0%; P=0.045). The rates of target-vessel
revascularization were not significantly different between the 2 groups.
In the comparison between Resolute zotarolimus-eluting stent and Nobori
biolimus-eluting stent, major adverse cardiac event rates were not
significantly different (4.0% versus 5.7%; P=0.45). Conclusions-Although
IVUS-guided CTO intervention did not significantly reduce cardiac
mortality, this randomized study demonstrated that IVUS-guided CTO
intervention might improve 12-month major adverse cardiac event rate after
new-generation drug-eluting stent implantation when compared with
conventional angiography-guided CTO intervention.

<11>
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Accession Number
2015416704
Authors
Blackstone E.H. Suri R.M. Rajeswaran J. Babaliaros V. Douglas P.S. Fearon
W.F. Miller D.C. Hahn R.T. Kapadia S. Kirtane A.J. Kodali S.K. Mack M.
Szeto W.Y. Thourani V.H. Tuzcu E.M. Williams M.R. Akin J.J. Leon M.B.
Svensson L.G.
Institution
(Blackstone, Rajeswaran, Kapadia, Tuzcu, Svensson) Cleveland Clinic, 9500
Euclid Ave, Cleveland, OH 44195, United States
(Suri) Mayo Clinic, Rochester, MN, United States
(Babaliaros, Thourani) Emory University, Atlanta, GA, United States
(Douglas) Duke University Clinical Research Institute, Duke University
Medical Center, Durham, United States
(Fearon, Miller) Stanford University Medical Center, Stanford, CA, United
States
(Hahn, Kirtane, Kodali, Leon) Columbia University Medical Center, New
York-Presbyterian Hospital, New York, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Szeto) Hospital of the University of Pennsylvania, Philadelphia, United
States
(Williams, Akin) New York University Langone Medical Center, New York,
United States
Title
Propensity-matched comparisons of clinical outcomes after transapical or
transfemoral transcatheter aortic valve replacement: A placement of aortic
transcatheter valves (PARTNER)-I trial substudy.
Source
Circulation. 131 (22) (pp 1989-2000), 2015. Date of Publication: 02 Jun
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background -The higher risk of adverse outcomes after transapical (TA)
versus transfemoral (TF) transcatheter aortic valve replacement (TAVR)
could be attributable to TA-TAVR being an open surgical procedure or to
clinical differences between TA-and TF-TAVR patients. We compared outcomes
after neutralizing patient differences using propensity score matching.
Methods and Results -From April 2007 to February 2012, 1100 Placement of
Aortic Transcatheter Valves (PARTNER)-I patients underwent TA-TAVR and
1521 underwent TF-TAVR with Edwards SAPIEN balloon-expandable
bioprostheses. Propensity matching based on 111 preprocedural variables,
exclusive of femoral access morphology, identified 501 well-matched
patient pairs (46% of possible matches), 95% of whom had peripheral
arterial disease. Matched TA-TAVR patients experienced more adverse
procedural events, longer length of stay (5 versus 8 days; P<0.0001), and
slower recovery (New York Heart Association class I, 31% versus 38% at 30
days, equalizing by 6 months at 51% versus 47%); stroke risk was similar
(3.4% versus 3.3% at 30 days and 6.0% versus 6.7% at 3 years); mortality
was elevated for the first 6 postprocedural months (19% versus 12%;
P=0.01); but aortic regurgitation was less (34% versus 52% mild and 8.9%
versus 12% moderate to severe at discharge, P=0.001; 36% versus 50% mild
and 10% versus 15% moderate to severe at 6 months, P<0.0001). Conclusions
-The likelihood of adverse periprocedural events and prolonged recovery is
greater after TA-TAVR than TF-TAVR in vasculopathic patients after
accounting for differences in cardiovascular risk factors, although stroke
risk is equivalent and aortic regurgitation is less. As smaller delivery
systems permit TF-TAVR in many of these patients, we recommend a TF-first
access strategy for TAVR when anatomically feasible.

<12>
Accession Number
2015416587
Authors
Shao Q. Chen K. Rha S.-W. Lim H.-E. Li G. Liu T.
Institution
(Shao, Chen, Li, Liu) Department of Cardiology, Tianjin Key Laboratory of
Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Rha, Lim) Division of Cardiology, Cardiovascular Center, Korea University
Guro Hospital, Seoul, South Korea
Title
Usefulness of neutrophil/lymphocyte ratio as a predictor of atrial
fibrillation: A meta-analysis.
Source
Archives of Medical Research. 46 (3) (pp 199-206), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc.
Abstract
Background and Aims,. Current evidence suggests that a high
neutrophil/lymphocyte ratio (NLR) may increase the risk of atrial
fibrillation (AF), but this association is still uncertain. The aim of the
comprehensive meta-analysis was to evaluate the potential association
between NLR and the risk of AF. Methods. We conducted a systematic
literature search using electronic databases (PubMed, Ovid, Embase,
Cochrane Database and Web of Science) to identify the studies reporting
the association between NLR and risk of AF. We searched the literature
published January 2015 or earlier. We used both fixed-effects and
random-effects models to calculate the overall effect estimate. An
I² > 50% indicates at least moderate statistical heterogeneity.
A sensitivity analysis and subgroup analysis were performed to find the
origin of heterogeneity. Results. We retrieved 11 studies involving a
total of 2,766 participants. The combined odds ratio (OR) of incident AF
for baseline NLR level was 1.25 (95% confidence interval [CI] 1.16-1.35)
with significant heterogeneity across studies (I² = 82.7%, p <
0.01) and for the post-NLR level (following CABG, RFCA and cardioversion)
was 1.518 (95% CI 1.076-2.142) with significant heterogeneity across
studies (I² = 93.7%, p = 0.017). We also showed an association
between AF recurrence following CABG, RFCA and cardioversion and baseline
NLR level (OR 1.517, 95% CI 1.108-2.079) with significant heterogeneity
across studies (I² = 86.8%, p < 0.01). Conclusions. Our
comprehensive meta-analysis suggests that the high level of NLR, whether
baseline or postsurgery/procedure, is associated with the increased risk
of AF recurrence/occurrence.

<13>
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Accession Number
2015417708
Authors
Voeks J.H. Howard G. Roubin G. Farb R. Heck D. Logan W. Longbottom M.
Sheffet A. Meschia J.F. Brott T.G.
Institution
(Voeks) Department of Neurology, Medical University of South Carolina,
Charleston, United States
(Howard) Department of Biostatistics, University of Alabama, Birmingham,
United States
(Roubin) Cardiovascular Asociates of the Southeast, Birmingham, AL, United
States
(Farb) Division of Neuroradiology, Department of Medical Imaging,
University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
(Heck) Department of Radiology, Novant Health Forsyth Medical Center,
Winston-Salem, NC, United States
(Logan) Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO, United
States
(Longbottom, Meschia, Brott) Department of Neurology, Mayo Clinic, 4500
San Pablo Rd, Jacksonville, FL 32224, United States
(Sheffet, Brott) Department of Surgery, New Jersey Medical School,
Rutgers, State University of New Jersey, Newark, United States
Title
Mediators of the age effect in the carotid revascularization
endarterectomy versus stenting trial (CREST).
Source
Stroke. 46 (10) (pp 2868-2873), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose-There is higher combined risk of stroke or death
(S+D) at older ages with carotid stenting. We assess whether this can be
attributed to patient or arterial characteristics that are in the pathway
between older age and higher risk. Methods-Mediation analysis of selected
patient (hypertension, diabetes mellitus, and dyslipidemia) and arterial
characteristics assessed at the clinical sites and the core laboratory
(plaque length, eccentric plaque, ulcerated plaque, percent stenosis, peak
systolic velocity, and location) was performed in 1123 carotid artery
stenting-treated patients in the Carotid Revascularization Endarterectomy
Versus Stenting Trial (CREST). We assessed the association of age with
these characteristics, the association of these characteristics with
stroke risk, and the amount of mediation of the association of age on the
combined risk of periprocedural S+D with adjustment for these factors.
Results-Only plaque length as measured at the sites increased with age,
was associated with increased S+D risk and significantly mediated the
association of age on S+D risk. However, adjustment for plaque length
attenuated the increased risk per 10 years of age from 1.72 (95%
confidence interval, 1.26-2.37) to 1.66 (95% confidence interval,
1.20-2.29), accounting for only 8% of the increased risk.
Conclusions-Plaque length seems to be in the pathway between older age and
higher risk of S+D among carotid artery stenting-treated patients, but it
mediated only 8% of the age effect excess risk of carotid artery stenting
in CREST. Other factors and mechanisms underlying the age effect need to
be identified as plaque length will not identify elderly patients for whom
stenting is safe relative to endarterectomy.

<14>
Accession Number
2015425778
Authors
Yuan S.-M.
Institution
(Yuan) The First Hospital of Putian, Teaching Hospital, Fujian Medical
University, Putian, Fujian Province, China
Title
A systematic review of acquired left ventricle to right atrium shunts
(Gerbode Defects).
Source
Hellenic Journal of Cardiology. 56 (September-October) (pp 357-372), 2015.
Date of Publication: september-October 2015.
Publisher
Hellenic Cardiological Society

<15>
Accession Number
2015427671
Authors
Peters C. Schwarz S.K.W. Yarnold C.H. Kojic K. Kojic S. Head S.J.
Institution
(Peters, Schwarz, Yarnold, Kojic, Kojic, Head) Department of Anesthesia,
St. Paul's Hospital, Providence Level 3, 1081 Burrard Street, Vancouver,
BC V6Z 1Y6, Canada
(Peters, Schwarz, Yarnold, Kojic, Kojic, Head) Department of
Anesthesiology, Pharmacology & Therapeutics, The University of British
Columbia, Vancouver, BC, Canada
Title
Ultrasound guidance versus direct palpation for radial artery
catheterization by expert operators: a randomized trial among Canadian
cardiac anesthesiologists.
Source
Canadian Journal of Anesthesia. 62 (11) (pp 1161-1168), 2015. Date of
Publication: 01 Nov 2015.
Publisher
Springer New York LLC
Abstract
Purpose: The use of ultrasound (US) for radial arterial catheterization
has been reported to result in faster insertion times with fewer
complications when compared with traditional direct palpation (DP). We
sought to determine if this applies to expert operators and tested the
hypothesis that, among cardiac anesthesiologists, US-guided insertion
similarly results in faster insertion times as well as fewer re-directs,
attempts, and complications. Methods: Following Research Ethics Board
Approval, we conducted a randomized clinical trial in 125 patients
scheduled for cardiac surgery at a single tertiary/quaternary care centre.
Patients were randomized to either US- or DP-guided radial artery
catheterization by attending cardiac anesthesiologists. The primary
endpoint was time to catheter placement. Secondary endpoints included the
number of attempts and re-directs as well as the failure rate. Results:
There were no differences between the DP- (n = 62) vs US-guided (n = 63)
groups in median [interquartile range] time to placement (104 [76-212] sec
vs 104 [68-270] sec, respectively; P = 0.66), number of re-directs (2
[0-6] vs 3 [1-5], respectively; P = 0.82), or number of attempts (1 [1-2]
vs 1 [1-2], respectively; P = 0.08). The first-attempt success rate was
56.4% in the DP group and 71.4 % in the US group (P = 0.10). Failure rate
and hematoma rate in the DP group were 21.0% and 22.6%, respectively,
compared with 12.7% and 11.1% in the US group (P = 0.24 and 0.10,
respectively). Conclusions: Among experienced cardiac anesthesiologists,
the use of US to facilitate radial arterial catheterization did not affect
insertion times, the number of re-directs, or the number of attempts when
compared with DP. Ultrasound use had no significant effects on the rates
of success on first attempt, failure, or hematoma formation. This trial
was registered at www.clinicaltrials.gov: NCT02118441.

<16>
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Accession Number
2015418049
Authors
Sezai A. Iida M. Yoshitake I. Wakui S. Osaka S. Kimura H. Yaoita H. Hata
H. Shiono M. Nakai T. Takayama T. Kunimoto S. Kasamaki Y. Hirayama A.
Institution
(Sezai, Iida, Yoshitake, Wakui, Osaka, Kimura, Yaoita, Hata, Shiono)
Department of Cardiovascular Surgery, Nihon University, School of
Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
(Nakai, Takayama, Kunimoto, Kasamaki, Hirayama) Department of Cardiology,
Nihon University, School of Medicine, Tokyo, Japan
Title
Carperitide and Atrial Fibrillation after Coronary Bypass Grafting: The
Nihon University Working Group Study of Low-Dose HANP Infusion Therapy
during Cardiac Surgery Trial for Postoperative Atrial Fibrillation.
Source
Circulation: Arrhythmia and Electrophysiology. 8 (3) (pp 546-553), 2015.
Date of Publication: 04 Jun 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Occurrence of atrial fibrillation after cardiac surgery is
associated with long-term mortality. We investigated whether infusion of
human atrial natriuretic peptide (carperitide) could prevent postoperative
atrial fibrillation. Methods and Results - A total of 668 patients who
underwent isolated coronary artery bypass grafting were randomized to
receive infusion of carperitide or physiological saline from the
initiation of cardiopulmonary bypass. Patients were monitored continuously
for 1 week after surgery to detect atrial fibrillation. The risk factors
were investigated by Cox proportional hazard model. Postoperative atrial
fibrillation occurred in 41 of 335 patients (12.2%) from the carperitide
group versus 110 of 333 patients (32.7%) from the placebo group
(P<0.0001). Postoperative levels of angiotensin-II, aldosterone, creatine
kinase MB isoenzyme, human heart fatty acid-binding protein, and brain
natriuretic peptide were all significantly lower in the carperitide group.
The risk factors for postoperative atrial fibrillation by the Cox
proportional hazard model were an age >70 years, emergency surgery,
preoperative aldosterone level >150 ng/mL, preoperative nonuse of
angiotensin receptor antagonists, preoperative use of calcium antagonists,
postoperative nonuse of beta-blockers, postoperative nonuse of aldosterone
blockers, and nonuse of carperitide. Conclusions - Perioperative
carperitide infusion reduced the occurrence of postoperative atrial
fibrillation. Accordingly, carperitide could be a useful option for
preventing postoperative atrial fibrillation. Clinical Trial Registration
- URL: http://www.umin.ac.jp. Unique Identifier: UMIN000003958.

<17>
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Accession Number
2015417881
Authors
Badar A.A. Perez-Moreno A.C. Hawkins N.M. Jhund P.S. Brunton A.P.T. Anand
I.S. McKelvie R.S. Komajda M. Zile M.R. Carson P.E. Gardner R.S. Petrie
M.C. McMurray J.J.V.
Institution
(Badar, Perez-Moreno, Jhund, Brunton, Gardner, Petrie, McMurray) BHF
Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and
Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom
(Badar, Gardner, Petrie) Scottish National Advanced Heart Failure Service,
Golden Jubilee National Hospital, Glasgow, United Kingdom
(Hawkins) Division of Cardiology, University of British Columbia,
Vancouver, Canada
(Anand) Veterans Affairs Medical Center and University of Minnesota,
Minneapolis, United States
(McKelvie) Hamilton Health Sciences, McMaster University, Hamilton, ON,
Canada
(Komajda) Pitie-Salpetriere Hospital, Paris, France
(Zile) Ralph H. Johnson Veterans Affairs Medical Center, Medical
University of South Carolina, Charleston, United States
(Carson) Georgetown University, Washington DC Veterans Affairs Medical
Center, United States
Title
Clinical characteristics and outcomes of patients with coronary artery
disease and Angina: Analysis of the irbesartan in patients with heart
failure and preserved systolic function trial.
Source
Circulation: Heart Failure. 8 (4) (pp 717-724), 2015. Date of Publication:
01 May 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The aim of our study was to investigate the relationship
between coronary artery disease (CAD), angina, and clinical outcomes in
patients with heart failure and preserved ejection fraction enrolled in
the irbesartan in patients with heart failure and preserved systolic
function (I-Preserve) trial. Methods and Results-The mean follow-up period
for the 4128 patients enrolled in I-Preserve was 49.5 months. Patients
were divided into 4 mutually exclusive groups according to history of CAD
and angina: patients with no history of CAD or angina (n=2008), patients
with no history of CAD but a history of angina (n=649), patients with a
history of CAD but no angina (n=468), and patients with a history of CAD
and angina (n=1003); patients with no known CAD or angina were the
reference group. After adjustment for other prognostic variables using Cox
proportional-hazard models, patients with CAD but no angina were found to
be at higher risk of all-cause mortality (hazard ratio [HR], 1.58
[1.22-2.04]; P<0.01) and sudden death (HR, 2.12 [1.33-3.39]; P<0.01),
compared with patients with no CAD or angina. Patients with CAD and angina
were also at higher risk of all-cause mortality (HR, 1.29 [1.05-1.59];
P=0.02) and sudden death (HR, 1.83 [1.24-2.69]; P<0.01) compared with the
same reference group and had the highest risk of unstable angina or
myocardial infarction (HR, 5.84 [3.43-9.95]; P<0.01). Conclusions-Patients
with heart failure and preserved ejection fraction and CAD are at higher
risk of all-cause mortality and sudden death when compared with those
without CAD. copy; 2015 American Heart Association, Inc.

<18>
Accession Number
2015417975
Authors
Pucher P.H. Johnston M.J. Aggarwal R. Arora S. Darzi A.
Institution
(Pucher, Johnston, Arora, Darzi) Division of Surgery, Department of
Surgery and Cancera, Centre for Patient Safety and Service Quality, 10th
Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY,
United Kingdom
(Johnston, Arora, Darzi) Imperial College London, London, United Kingdom
(Aggarwal) Department of Surgery, Faculty of Medicine, Montreal, Canada
(Aggarwal) Arnold and Blema Steinberg Centre for Medical Simulation,
McGill University, Montreal, Canada
Title
Effectiveness of interventions to improve patient handover in surgery: A
systematic review.
Source
Surgery (United States). 158 (1) (pp 85-95), 2015. Date of Publication:
2015.
Publisher
Mosby Inc.
Abstract
Background: Handover of patient care is a critical process in the transfer
of information between clinical teams and clinicians during transitions in
patient care. The handover process may take many forms and is often
unstructured and unstandardized, potentially resulting in error and the
potential for patient harm. The Joint Commission has implicated such
errors in up to 80% of sentinel events and has published guidelines (using
an acronym termed SHARE) for the development of intervention tools for
handover. This study aims to review interventions to improve handovers in
surgery and to assess compliance of described methodologies with the
guidelines of the Joint Commission for design and implementation of
handover improvement tools. Methods: A systematic review was conducted in
line with MOOSE guidelines. Electronic databases Medline, EMBASE, and
PsyInfo were searched and interventions to improve surgical handover
identified. Intervention types, development methods, and outcomes were
compared between studies and assessed against SHARE criteria. Results:
Nineteen studies were included. These studies included paper and
computerized checklists, proformas, and/or standardized operating
protocols for handover. All reported some degree of improvement in
handover. Description of development methods, staff training, and
follow-up outcome data was poor. Only a single study was able to
demonstrate compliance with all 5 domains guidelines of the of Joint
Commission. Conclusion: Improvements in information transfer may be
achieved through checklist- or proforma-based interventions in surgical
handover. Although initial data appear promising, future research must be
backed by robust study design, relevant outcomes, and clinical
implementation strategies to identify the most effective means to improve
information transfer and optimize patient outcomes.

<19>
Accession Number
2015189672
Authors
Li Y. Du Y. Luo T.Y. Yang H.F. Yu J.H. Xu X.X. Zheng H.J. Li B.
Institution
(Li, Luo) Department of Radiology, First Affiliated Hospital of Chongqing
Medical University, 1 Youyi Road, Chongqing City 400016, China
(Li, Du, Yang, Xu, Zheng, Li) Department of Radiology, Affiliated Hospital
of North Sichuan Medical College, 63 Wenhua Road, Nanchong City, Sichuan
Province 637000, China
(Yu) Department of Ultrasound, Affiliated Hospital of North Sichuan
Medical College, 63 Wenhua Road, Nanchong City, Sichuan Province 637000,
China
Title
Usefulness of normal saline for sealing the needle track after CT-guided
lung biopsy.
Source
Clinical Radiology. 70 (11) (pp 1192-1197), 2015. Date of Publication: 01
Nov 2015.
Publisher
W.B. Saunders Ltd
Abstract
Aim To determine whether the use of normal saline for sealing the needle
track can reduce the incidence of pneumothorax and chest tube placement
after computed tomography (CT)-guided lung biopsy. Materials and methods A
prospective, randomised, controlled trial enrolling 322 patients was
conducted. All patients were randomly assigned to one of two groups: those
in whom the needle track was not sealed with normal saline (n=161, Group
A) and those who did receive normal saline (n=161, Group B). CT-guided
biopsy was performed with coaxial technique. Normal saline, which ranged
from 1-3 ml, was injected while the trocar needle was being withdrawn.
Patient characteristics, lesion, and procedure variables were analysed as
potential risk variables for occurrence of pneumothorax and chest tube
placement. Results The incidence of pneumothorax was 26.1% in Group A and
6.2% in Group B (p<0.001). Nine patients in Group A and one patient in
Group B required chest tube placement (p=0.010). Using multiple logistic
regression analysis, smaller lesion size, greater needle-pleural angle,
longer lesion-pleural distance, presence of emphysema, and no sealing the
needle track with normal saline were significantly associated with an
increased risk of pneumothorax, and that the latter three factors were
also associated with an increased risk of pneumothorax requiring chest
tube placement. Conlusion Normal saline for sealing the needle track
significantly reduces the incidence of pneumothorax and prevents
subsequent chest tube placement after CT-guided lung biopsy.

<20>
Accession Number
2015417613
Authors
Di Lorenzo E. Sauro R. Varricchio A. Capasso M. Lanzillo T. Manganelli F.
Carbone G. Lanni F. Pagliuca M.R. Stanco G. Rosato G. Suryapranata H. De
Luca G.
Institution
(Di Lorenzo, Sauro, Varricchio, Capasso, Lanzillo, Manganelli, Carbone,
Lanni, Pagliuca, Stanco, Rosato) Division of Cardiology, S.G. Moscati,
Avellino, Italy
(Suryapranata) Department of Cardiology, University Medical Center St.
Radboud, Nijmegen, Netherlands
(De Luca) Division of Cardiology, Ospedale Maggiore della Carita, Eastern
Piedmont University, Novara, Italy
(De Luca) Centro di Biotecnologie per la Ricerca Medica Applicata, Eastern
Piedmont University, Novara, Italy
Title
Randomized comparison of everolimus-eluting stents and sirolimus-eluting
stents in patients with ST elevation myocardial infarction: RACES-MI
trial.
Source
JACC: Cardiovascular Interventions. 7 (8) (pp 849-856), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of the current study was to compare everolimus-eluting
stents (EES) with sirolimus-eluting stents (SES) in patients undergoing
primary angioplasty. Background Drug-eluting stents may offer benefits in
terms of repeat revascularization. However, as shown for first-generation
drug-eluting stents, they may be counterbalanced by a potential higher
risk of stent thrombosis, especially among patients with ST-segment
elevation myocardial infarction (STEMI). No data have been reported so far
on the long-term benefits and safety of the new generation of drug-eluting
stents in STEMI. Methods Consecutive STEMI patients admitted within 12 h
of symptom onset and undergoing primary angioplasty and stent implantation
at a tertiary center with 24-h primary percutaneous coronary intervention
capability were randomly assigned to SES or EES. The primary endpoint was
a major adverse cardiac event at 3-year follow-up. The secondary endpoints
were death, reinfarction, definite or probable stent thrombosis, and
target vessel revascularization at 3-year follow-up. No patient was lost
to follow-up. Results From April 2007 to May 2009, 500 patients with STEMI
were randomized to EES (n = 250) or SES (n = 250). No difference was
observed in terms of baseline demographic and clinical characteristics
between the groups. No difference was observed between the groups in terms
of number of implanted stents per patient or total stent length. However,
a larger reference diameter was observed with SES (3.35 +/- 0.51 mm vs.
3.25 +/- 0.51 mm, p = 0.001), whereas patients randomized to EES more
often received glycoprotein IIb/IIIa inhibitors (54.4% vs. 42.4%, p =
0.006). Follow-up data were available in all patients (1,095 +/- 159
days). No significant difference was observed between EES and SES in major
adverse cardiac events (16% vs. 20.8%, adjusted hazard ratio [HR]: 0.75
[95% confidence interval (CI): 0.5 to 1.13], p = 0.17), cardiac death
(4.4% vs. 5.6%, adjusted HR: 0.77 [95% CI: 0.35 to 1.71], p = 0.53),
recurrent MI (6.4% vs. 10%, adjusted HR: 0.62 [95% CI: 0.33 to 1.16], p =
0.13), and target vessel revascularization (4.8% vs. 4.8%, adjusted HR:
1.00 [95% CI: 0.45 to 2.32], p = 0.99). However, EES was associated with a
significant reduction in stent thrombosis (1.6% vs. 5.2%, adjusted HR: 0.3
[95% CI: 0.1 to 0.92], p = 0.035). Conclusions This study shows that among
STEMI patients undergoing primary angioplasty, EES has similar efficacy as
SES, but is associated with a significant reduction in stent thrombosis.
(Randomized Comparison of Everolimus Eluting Stents and Sirolimus Eluting
Stent in Patients With ST Elevation Myocardial Infarction [RACES-MI];
NCT01684982)

<21>
Accession Number
2015417629
Authors
Jensen L.O. Thayssen P. Maeng M. Christiansen E.Ho. Ravkilde J. Hansen
K.No. Kaltoft A. Tilsted H.H. Madsen M. Lassen J.F.
Institution
(Jensen, Thayssen, Hansen) Department of Cardiology, Odense University
Hospital, Sdr. Boulevard 29, Odense C 5000, Denmark
(Maeng, Christiansen, Kaltoft, Lassen) Department of Cardiology, Aarhus
University Hospital, Skejby Hospital, Aarhus, Denmark
(Ravkilde, Tilsted) Department of Cardiology, Aalborg University Hospital,
Aalborg, Aalborg, Denmark
(Madsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
Title
Three-year outcomes after revascularization with everolimus- and
sirolimus-eluting stents from the SORT OUT IV trial.
Source
JACC: Cardiovascular Interventions. 7 (8) (pp 840-848), 2014. Date of
Publication: 2014.
Publisher
Elsevier Inc.
Abstract
Objectives The study sought to compare the risk of late outcome with a
focus on very late definite stent thrombosis of the everolimus-eluting
stent (EES) with that of the sirolimus-eluting stent (SES) at 3-year
follow-up. Background In the SORT OUT IV (SORT OUT IV Trial), comparing
the EES with the SES in patients with coronary artery disease, the EES was
noninferior to the SES at 9 months. The SORT OUT IV trial provides
long-term head-to-head randomized comparison of the EES with the SES.
Methods We prospectively randomized 2,774 patients in the SORT OUT IV
trial. Follow-up through 3 years was complete in 2,771 patients (99.9%).
The 3-year pre-specified endpoints were composites of safety and efficacy
(major adverse cardiac events [MACE]: cardiac death, myocardial
infarction, target vessel revascularization, and definite stent
thrombosis). Results At 3 years, the composite endpoint MACE occurred in
9.8% of the EES group and in 11.1% of the SES group (hazard ratio [HR]:
0.89, 95% confidence interval [CI]: 0.70 to 1.12). Overall rate of
definite stent thrombosis was lower in the EES group (0.2% vs. 1.4%; HR:
0.15, 95% CI: 0.04 to 0.50), which was largely attributable to a lower
risk of very late definite stent thrombosis: 0.1% versus 0.8% (HR: 0.09,
95% CI: 0.01 to 0.70). Conclusions At 3-year follow-up, the MACE rate did
not differ significantly between EES- and SES-treated patients. A
significant reduction of overall and very late definite stent thrombosis
was found in the EES group. (The SORT OUT IV TRIAL [SORT OUT IV];
NCT00552877).

<22>
Accession Number
2015297856
Authors
Samano N. Geijer H. Liden M. Fremes S. Bodin L. Souza D.
Institution
(Samano, Souza) Department of Cardiothoracic and Vascular Surgery, Faculty
of Medicine and Health, Orebro University, Orebro SE-70185, Sweden
(Geijer, Liden) Department of Radiology, Faculty of Medicine and Health,
Orebro University, Orebro, Sweden
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada
(Bodin) Intervention and Implementation Research, Institute of
Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Title
The no-touch saphenous vein for coronary artery bypass grafting maintains
a patency, after 16 years, comparable to the left internal thoracic
artery: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (4) (pp 880-888),
2015. Date of Publication: 01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Objectives This study investigates whether the no-touch (NT) vein graft,
at a mean time of 16 years, maintains a significantly higher patency rate
than conventional (C) vein grafts and still has patency comparable to that
of the left internal thoracic artery (LITA). Methods A total of 156
patients accepted for coronary artery bypass grafting were randomly
allocated to 1 of 3 groups. In the C group, the saphenous vein (SV) was
stripped and distended. In the intermediate group, the SV was stripped but
not distended. In the NT group, the SV was neither stripped nor distended,
but rather harvested with a fat pedicle. This study is an angiographic
follow-up of the C and NT groups, at a mean time of 16 years
postoperatively. Results Fifty-four patients were included (C group = 27;
NT group = 27). In all, 72 and 75 vein grafts were completed in groups C
and NT, respectively. Crude SV graft patency was 64% in the C group versus
83% in the NT group (P =.03), which was similar to the patency of the LITA
(88%). The harvesting technique had a major impact on the patency with a
hazard ratio for occlusion of 1.83 for the C group (P =.04). Conclusions
Harvesting the SV with the NT technique conferred, at a mean time of 16
years, a significantly higher patency than the conventional technique that
was still comparable to that of the LITA.

<23>
Accession Number
2015251401
Authors
Sezai A. Osaka S. Yaoita H. Ishii Y. Arimoto M. Hata H. Shiono M.
Institution
(Sezai, Osaka, Yaoita, Ishii, Arimoto, Hata, Shiono) Department of
Cardiovascular Surgery, Nihon University, School of Medicine, 30-1
Oyaguchi-kamimachi, Itabashi-ku Tokyo 173-8610, Japan
Title
Safety and efficacy of landiolol hydrochloride for prevention of atrial
fibrillation after cardiac surgery in patients with left ventricular
dysfunction: Prevention of Atrial Fibrillation after Cardiac Surgery with
Landiolol Hydrochloride for Left Ventricular Dysfunction (PLATON) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (4) (pp 957-964),
2015. Date of Publication: 01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Objectives We previously conducted a prospective study of landiolol
hydrochloride (INN landiolol), an ultrashort-acting beta-blocker, and
reported that it could prevent atrial fibrillation after cardiac surgery.
This trial was performed to investigate the safety and efficacy of
landiolol hydrochloride in patients with left ventricular dysfunction
undergoing cardiac surgery. Methods Sixty patients with a preoperative
left ventricular ejection fraction of less than 35% were randomly assigned
to 2 groups before cardiac surgery and then received intravenous infusion
with landiolol hydrochloride (landiolol group) or without landiolol
(control group). The primary end point was occurrence of atrial
fibrillation as much as 1 week postoperatively. The secondary end points
were blood pressure, heart rate, intensive care unit and hospital stays,
ventilation time, ejection fraction, biomarkers of ischemia, and brain
natriuretic peptide. Results Atrial fibrillation occurred in 3 patients
(10%) in the landiolol group versus 12 (40%) in the control group, and its
frequency was significantly lower in the landiolol group (P =.002). During
the early postoperative period, levels of brain natriuretic peptide and
ischemic biomarkers were significantly lower in the landiolol group than
the control group. The landiolol group also had a significantly shorter
hospital stay (P =.019). Intravenous infusion was not discontinued for
hypotension or bradycardia in either group. Conclusions Low-dose infusion
of landiolol hydrochloride prevented atrial fibrillation after cardiac
surgery in patients with cardiac dysfunction and was safe, with no effect
on blood pressure. This intravenous beta-blocker seems useful for
perioperative management of cardiac surgical patients with left
ventricular dysfunction.

<24>
Accession Number
2015240591
Authors
Meirson T. Orion E. Di Mario C. Webb C. Patel N. Channon K.M. Ben Gal Y.
Taggart D.P.
Institution
(Meirson) Department of Bio-Medical Engineering, Afeka Academic College of
Engineering, Tel Aviv, Israel
(Orion) Vascular Graft Solutions, Ltd, 24 Raoul Wallenberg St, Tel Aviv
6971921, Israel
(Di Mario, Webb) Department of Cardiology, Royal Brompton Hospital,
London, United Kingdom
(Webb) National Heart and Lung Institute, Imperial College London, London,
United Kingdom
(Patel, Channon) Department of Cardiovascular Medicine, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Ben Gal) Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical
Center, Tel Aviv University, Tel Aviv, Israel
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
Title
Flow patterns in externally stented saphenous vein grafts and development
of intimal hyperplasia Read at the 95th Annual Meeting of the American
Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (4) (pp 871-878),
2015. Date of Publication: 01 Oct 2015.
Publisher
Mosby Inc.
Abstract
Background Low and oscillatory wall shear stress promotes endothelial
dysfunction and vascular disease. The aim of the study was to investigate
the impact of an external stent on hemodynamic flow parameters in
saphenous vein grafts (SVGs) and their correlation with the development of
intimal hyperplasia. Methods We performed post hoc computational fluid
dynamics analysis of the randomized Venous External Support Trial, in
which angiography and intravascular ultrasound data were available for 29
patients, 1 year after coronary artery bypass grafting. Each patient
received 1 external stent, to either the right or left coronary
territories; 1 patients with nonstented SVGs served as control(s). Diffuse
flow patterns were assessed using mean values of various hemodynamic
parameters, including time-averaged wall shear stress and oscillatory
shear index (OSI). Focal flow disturbances were characterized using
percentile analysis of each parameter. Results Angiography and
intravascular ultrasound data were available for 53 and 43 SVGs,
respectively. The stented versus nonstented SVG failure rates were
significantly lower in the left territory (17.6% vs 27.5%; P =.02), and
significantly higher in the right territory (46.2% vs 13.4%; P =.01). In
both diffuse and focal flow-pattern analyses, OSI was significantly lower
in the stented versus nonstented SVG group (P =.009 and P <.003,
respectively), whereas no significant differences were observed in
time-averaged wall shear stress values. High OSI values were correlated
with the development of intimal hyperplasia (P =.01). Conclusions External
stenting affects SVG's hemodynamics 1 year after coronary artery bypass
grafting and may mitigate the progression of intimal hyperplasia by
reducing oscillatory shear stress.

<25>
Accession Number
2015422605
Authors
Denault A.Y. Beaulieu Y. Couture P. Haddad F. Shi Y. Page P. Levesque S.
Tardif J.-C. Lambert J.
Institution
(Denault, Couture) Department of Anesthesiology, and Division of Critical
Care, Montreal Heart Institute, Universite de Montreal, Canada
(Denault) Division of Critical Care, Centre Hospitalier de l'Universite de
Montreal, Canada
(Beaulieu) Department of Medicine and Critical Care Division, Hopital du
Sacre-Coeur, Universite de Montreal, Canada
(Haddad) Stanford Division of Cardiovascular Medicine, Stanford University
School of Medicine, United States
(Shi, Tardif) Department of Medicine, Montreal Heart Institute and
Universite de Montreal, Canada
(Page) Department of Cardiac Surgery, Montreal Heart Institute, Universite
de Montreal, Canada
(Levesque) Montreal Heart Institute Coordinating Center, Canada
(Lambert) Department of Preventive and Social Medicine, Universite de
Montreal, Canada
Title
Acute intraoperative effect of intravenous amiodarone on right ventricular
function in patients undergoing valvular surgery.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (4) (pp 316-325),
2015. Date of Publication: 01 Apr 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: Amiodarone is commonly used in the acute care setting. However
the acute hemodynamic and echocardiographic effect of intravenous
amiodarone administered intraoperatively on right ventricular (RV)
systolic and diastolic function using transesophageal echocardiography
(TEE) has not been described. Methods: The study design was a randomized
controlled trial in elective cardiac surgical patients undergoing valvular
surgery. Patients received an intravenous loading dose of 300 mg of either
amiodarone or placebo in the operating room, followed by an infusion of 15
mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of
RV and left ventricular (LV) dimensions, Doppler interrogation of
tricuspid and mitral valve, hepatic and pulmonary venous flow combined
with tissue Doppler imaging of the tricuspid and mitral valve annulus were
obtained before and after bolus. Results: Although more patients in the
placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and
diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline
hemodynamic, 2D and Doppler variables. After bolus, a significant increase
in pulmonary artery pressure, central venous pressure and pulmonary
vascular resistance index (p<0.05) was observed in the amiodarone group
with reduction in systolic to diastolic (S/D) ratio of the hepatic
(p=0.0247) and pulmonary venous (p=0.0052) velocity. Conclusion: Acute
administration of amiodarone is associated with alteration in RV diastolic
properties and has minimal negative inotropic effect on RV systolic
function in cardiac surgical patients with valvular disease.

<26>
[Use Link to view the full text]
Accession Number
2015412710
Authors
Ariotti S. Costa F. Valgimigli M.
Institution
(Ariotti, Costa, Valgimigli) Thoraxcenter, Ba 587, Erasmus Medical Center,
Rotterdam, Netherlands
Title
Coronary stent selection and optimal course of dual antiplatelet therapy
in patients at high bleeding or thrombotic risk: Navigating between
limited evidence and clinical concerns.
Source
Current Opinion in Cardiology. 30 (4) (pp 325-332), 2015. Date of
Publication: 24 Aug 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Optimal duration of dual antiplatelet therapy (DAPT)
after coronary revascularization, in particular after drug-eluting stent
(DES) implantation, is a matter of ongoing debate. Recent findings First
generation of DES, as compared with bare metal stents (BMS), reduce
restenosis rates but increase very late stent thrombosis rates, thus
requiring a prolonged course of DAPT. As a consequence, patients with high
thrombotic and/or bleeding risk: have been systematically excluded from
randomized trials comparing DES versus BMS; remain 'uncertain' DES
candidates; should preferentially undergo BMS implantation at the time of
percutaneous coronary intervention instead of DES. The Zotarolimus-eluting
Endeavor Sprint Stent in Uncertain DES Candidates (ZEUS) trial is the
first randomized study that demonstrated the superiority of the
Zotarolimus-eluting Endeavor Sprint versus BMS in uncertain DES candidates
who followed a personalized DAPT duration, which was tailored to
patients's, not stent's, characteristics. Summary The results of the ZEUS
trial may support a paradigm shift in our current understanding of the
most proper use of DES in practice and should trigger further research in
patients at high bleeding or thrombotic risk, who have been so far largely
deprived of the potential benefit provided by DES.

<27>
Accession Number
2015416221
Authors
Mekaj Y.H. Daci F.T. Mekaj A.Y.
Institution
(Mekaj) Institute of Pathophysiology, University of Prishtina, Serbia
(Mekaj, Daci) Department of Hemostasis and Thrombosis, National Blood
Transfusion Center of Kosovo, Serbia
(Mekaj) Clinic of Neurosurgery, University of Prishtina, Prishtina, Serbia
Title
New insights into the mechanisms of action of aspirin and its use in the
prevention and treatment of arterial and venous thromboembolism.
Source
Therapeutics and Clinical Risk Management. 11 (pp 1449-1456), 2015. Date
of Publication: 24 Sep 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
The antithrombotic action of aspirin has long been recognized. Aspirin
inhibits platelet function through irreversible inhibition of
cyclooxygenase (COX) activity. Until recently, aspirin has been mainly
used for primary and secondary prevention of arterial antithrombotic
events. The aim of this study was to review the literature with regard to
the various mechanisms of the newly discovered effects of aspirin in the
prevention of the initiation and development of venous thrombosis. For
this purpose, we used relevant data from the latest numerous scientific
studies, including review articles, original research articles,
double-blinded randomized controlled trials, a prospective combined
analysis, a meta-analysis of randomized trials, evidence-based clinical
practice guidelines, and multicenter studies. Aspirin is used in the
prevention of venous thromboembolism (VTE), especially the prevention of
recurrent VTE in patients with unprovoked VTE who were treated with
vitamin K antagonists (VKAs) or with non-vitamin K antagonist oral
anticoagulants (NOACs). Numerous studies have shown that aspirin reduces
the rate of recurrent VTE in patients, following cessation of VKAs or
NOACs. Furthermore, low doses of aspirin are suitable for long-term
therapy in patients recovering from orthopedic or other surgeries. Aspirin
is indicated for the primary and secondary prevention as well as the
treatment of cardiovascular diseases, including acute coronary syndrome,
myocardial infarction, peripheral artery disease, acute ischemic stroke,
and transient ischemic attack (especially in atrial fibrillation or
mechanical heart valves). Aspirin can prevent or treat recurrent
unprovoked VTEs as well as VTEs occurring after various surgeries or in
patients with malignant disease. Recent trials have suggested that the
long-term use of low-dose aspirin is effective not only in the prevention
and treatment of arterial thrombosis but also in the prevention and
treatment of VTE. Compared with VKAs and NOACs, aspirin has a reduced risk
f bleeding.

<28>
Accession Number
72027077
Authors
Kumar C.
Institution
(Kumar) Khoo Teck Puat Hospital, Anaesthesia, Singapore, Singapore
Title
Refresher course: Ophthalmic regional anaesthesia in patients on
antithrombotics.
Source
Regional Anesthesia and Pain Medicine. Conference: 34th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2015
Ljubljana Slovenia. Conference Start: 20150902 Conference End: 20150905.
Conference Publication: (var.pagings). 40 (5 SUPPL. 1) (pp e67-e69), 2015.
Date of Publication: September-October 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Eye surgery patients are often elderly and may have
significant co-morbidity. Many receive antithrombotic agents such as
aspirin, anticoagulant, antiplatelet, direct oral anticoagulant (DOA) and
others. Regional anaesthesia is commonly used. Drugs with longer half-life
(warfarin, clopidogrel) need a specific time before their effects are over
and their effects can be revered with antidotes. Where as drugs such
newerDOAhave a shorter half-life but no known antidote. Antithrombotics
withdrawal predisposes to risk of thromboembolic events. There may not be
enough time to stop these agent specifically when surgery is urgent or
emergency. Their continuation on the other hand predisposes to the risk of
bleeding during regional anaesthesia and surgery. There are several
published guidelines on antithrombotics and regional anaesthesia but these
guidelines are generic 1, 2. There are no specific guidelines for patients
undergoing ophthalmic surgery and for regional or eye blocks. There are
lack firm recommendations as published literature is limited to reviews 3,
4. This refresher lecture concentrate on why patients receive
antithrombotic agents, consequences of their withdrawal, consequences of
their continuation on regional anaesthesia and surgery and finally
recommendations will be made for clinical practice based on current
published literature. Why patients receive antithrombotic agents?: The
patients usually receive one or combined antithrombotic agents if they
suffer from medical conditions such as angina, STEMI, Non-STEMI, acute
coronary syndrome, post bypass surgery, AF, ventricular arrhythmia,
valvular disease, hypertension, secondary prevention of heart disease,
bleeding disorders, stroke prevention & TIA. Consequences of
antithrombotics withdrawal: Aspirin withdrawal: A large meta-analysis
inmore than 50,279 patientswho received aspirin for secondary prevention
confirmed that stopping aspirin increases the risk of major cardiovascular
events three times 5. The risk was much higher in patient who coronary
stents and there increases risk of myocardial infarction or death 2-3
fold. However a recent trial POISE 2 has shown that continuation of
aspirin does not significantly affect the composite death or non-fatal
myocardial infarction but increased the bleeding 6. Warfarin withdrawal: A
survey of cataract surgeons 7 revealed that if warfarin was discontinued,
6 patients had acute strokes and 2 died, 1 had deep vein thrombosis and 1
had pulmonary embolism. They also recommended that sudden withdrawal of
warfarin may lead to hypercoagulable state. Antiplatelet withdrawal:
Several studies have shown that stopping antiplatelet increases the risk
of thrombotic events in coronary stent patients. If noncardiac surgery is
performed within 6 weeks of BMS (Bare Metal Stent), 5-30%sufferMajor
Adverse Cardiac Event (MACE) such as death, MI, or stent thrombosis
requiring urgent revascularisation if antiplatelet is withdrawn 8, 9. In
another study, 192 patients underwent non-cardiac surgery with coronary
stent within less than 1 month after BMS or 3-6 months after DES 10.
Thirty percent of early surgery group who stopped DAP suffered a MACE, 4
of whom died. No patient who continued antiplatelet therapy had an event
10. The risk may be reduced undergoing non-cardiac surgery within 6 weeks
of Bare Metal Stent if surgery is deferred for at least 3 months. Stent
thrombosis is known to have fatality up to 50% 8, 9 if there are
additional risk factors. The additional factors 11 are broadly divided
into clinical or anatomical factors. Clinical factors include previous
stent thrombosis, age >80 years, Acute Coronary Syndrome, indications for
stent, diabetes, renal impairment and lowejection fraction. Anatomical
risk factors include left main stent, bifurcation stent, ostial stent,
small stent <3mm, long stent >18mm and multiple stents. Consequences of
continuation of antithrombotics on regional anaesthesia: Risks of RA when
on antithrombotics: Retrobulbar haemorrhage is a known complication of
needle based block 12 although much rarer with sub- Tenon's block 13: In a
case series of 19283 patients there was no significant increase in
retrobulbar haemorrhage during needle blocks when patients were taking
aspirin & warfarin but there was an increased incidence of conjunctival
haemorrhage 14. In another case series of cases in patients on aspirin,
warfarin and clopidogrel, there was no significant increase in retrobulbar
haemorrhage 15. According a large series consisting of 55567 patients 16,
the incidence of haemorrhagic events doubled during sharp needle and
sub-Tenon's block if patients were receiving warfarin and clopidogrel.
Retrobulbar haemorrhage or orbital haemorrhage is very rare following
sub-Tenon's block 13 but incidence of subconjunctival haemorrhage is
increased 17, 18. Risks of bleeding during eye surgery when on
antithrombotics: Risks during cataract surgery: Phacoemulsification
surgery is routinely performed through a small phacoemulsification probe
in which significant complications related to bleeding, even in patients
on antithrombotics are extremely rare 3. There is no published literature
on intraoperative bleeding during large excision extra capsular cataract
extraction. However, there is an increased risk of hyphaema and
suprachoroidal haemorrhage especially in diabetics, myopic,
atherosceloris, vascular diseases and hypertensive patients. Risks during
glaucoma surgery: Trabeculectomy (filtration) is the most common surgery.
Perioperative bleeding complications such as hyphaema, intrableb bleeding
and suprachoroidal haemorrhage may occur during surgery but they are more
frequent in patients taking antithrombotics which may result in surgical
failure or loss of sight 19. If aspirin is continued, there may be an
increased risk of hyphaema 20. However, patients on warfarin have been
found to be at increased risk of bleeding and treatment failure 20.
Trabeculectomy tube surgery has also been associated with a risk of
hyphaema and suprachoroidal haemorrhage 21. Risks during VR surgery: The
results of published studies relating to bleeding in patients on
antithrombotics undergoing pars plana vitrectomy (PPV) are conflicting.
Chauvaud et al22 & Fu et al23 concluded that some patients suffered from
sub-retinal haemorrhage however, this was a known complication of scleral
buckling & vitreous drainage procedure. They suggested that continuation
of anticoagulation does not increase risk of haemorrhage. In another study
by Dayani et al 24 & Grant (Narindaran) 25 in a series of 1737 patients,
54 received warfarin and there was no anaesthetic or surgical haemorrhagic
complications. Another study by Chandra et al 26, 120 cases were on
warfarin and there was no increase in perioperative haemorrhagic
complications. In another study of 289 diabetic patients 27 who were on
anticoagulants or antiplatelet agents, there was no increased risk of
vitreous haemorrhage. However, in one study of 139 high risk diabetic
patients who were on antithrombotic therapy, there were more persistent
vitreous cavity haemorrhage (27.6%) and required reoperation (13.8%)
compared to those not on such therapy (6.9% and 0% respectively) but
luckily there was no effect on final visual outcome 28. In another study
of 289 patients (25 gauge vitrectomy, 110 control, 61 warfarin & 118
clopidogrel) there were transient vitreous haemorrhage (control 3.6%,
warfarin 1.6%, clopidogrel 3.7%). Risks during oculoplastic surgery: There
may not be evidence to strongly support or refute that there is a
significant risk of haemorrhage during lacrimal surgery, orbital surgery,
postseptal eyelid surgery and skin grafts in patients receiving
antithrombotics but most authors recommend an approach tailored to each
patient. In 1130 oculoplastic procedures there was no difference whether
patients were on anticoagulants & antiplatelet agents or whether these
were stopped 29, 30. Risks during strabismus surgery: No serious bleeding
other than rare retrobulbar haemorrhage has been reported 31. Risks during
corneal graft surgery: Suprachoroidal haemorrhage 32 is a rare
complication of penetrating keratoplasty and endothelial keratoplasty 33
but there are no studies indicating any increased risk in patients taking
antithrombotics. Risk assessment: The decision to stop, continue
antithrombotic or use bridging therapy is based on risk assessment. Risk
assessment comprises of identification of risk factors, risk calculation,
risk prediction & stratification. Identification of risk factors: Factors
predisposing patients to haemorrhagic risks include increasing age,
uncontrolled hypertension, anaemia, cardiac stent, coexisting
haematological, vascular, renal or hepatic disease, concurrent medication
with steroids or antiplatelet agents, type of proposed procedure, its
complexity and anticipated difficulty and herbal drugs 34. Risk
calculation & prediction: The risk of a thromboembolic complication in
patients with non-valvular atrial fibrillation is often estimated by means
of the CHA2DS2-VASc score 35. Scores of 1 or 2 are allocated based on the
presence or absence of the following characteristics: congestive cardiac
failure, hypertension, age >75, diabetes, prior stroke or transient
ischaemic attack (TIA) or thromboembolism, vascular disease, age 65-74 and
female sex. The greater the cumulative score, the greater the risk of
thromboembolic events. Stopping antithrombotics in patients with AF,
prosthetic heart valve, coronary stent caries a higher risk of thrombotic
events, Antithrombotic agents should be continued 36. Risk stratification:
The patients are stratified into high risk, moderate risk and low risk
group for thromboembolic complications (Figure 1). Practice
recommendations: Cataract surgery: There is no increase in haemorrhagic
complication.

<29>
Accession Number
72027056
Authors
Aguirre J.A.
Institution
(Aguirre) Balgrist University Hospital, Zurich, Switzerland
Title
Refresher course: Regional anesthesia to avoid postoperative cognitive
dysfunction: What is the evidence?.
Source
Regional Anesthesia and Pain Medicine. Conference: 34th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2015
Ljubljana Slovenia. Conference Start: 20150902 Conference End: 20150905.
Conference Publication: (var.pagings). 40 (5 SUPPL. 1) (pp e36-e38), 2015.
Date of Publication: September-October 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Postoperative cognitive dysfunction Postoperative cognitive dysfunction
(POCD) is a syndrome of prolonged impairment of cognitive function
associated with surgery with limitation in intellectual ability, memory
and executive functions. This state usually last for weeks, sometimes
months. Postoperative cognitive dysfunction (POCD) has been reported to
happen in 7% and 25% one week and up to 9.9% - 12.7% 3 months after
surgery. (1-3) After hip fracture the incidence of POCD is considerably
higher (18-50%). (4)Multiple factors like inflammatory response, drug use,
the level of postoperative pain etc. have been described as possible
contributing factors. (5) If the use of regional anesthesia has positive
impact in the incidence of POCD is controversially discussed in
literature. (2, 4) Also the effects of analgesia techniques are
inconclusive. (6, 7) Subjective symptoms or behavioural changes after
surgery might arouse suspicion but the formal diagnosis of POCD requires a
preoperative neuropsychological test (baseline) and a definition of
howmuch of impairment is called a cognitive dysfunction. (8) Pre- and
postoperative testing is necessary to diagnose POCD because self-reporting
of cognitive symptoms differs quite remarkably from objective test. s (9)
The "Statement of Consensus on Assessment of Neurobehavioral Outcomes
After Cardiac Surgery" provided a good overview of commonly used testing
instruments (10). However, to date, no formal diagnostic criteria have
been established for POCD. Moreover, it is as yet unclear how big a
decline ought to be deemed clinically significant. One possible method
could be the percentage change method which looks as follows:
postoperative score - preoperative score / preoperative score As POCD has
been shown to improve with time, the incidence needs to be described at a
defined interval after surgery, e.g. 1 day, 10 days, 3 months, 6 months
and 1 year after surgery. (11) Moreover, recognition is of pivotal
importance, as POCD has been associated with increased mortality, risk of
prematurely leaving the work market and dependence of the social system.
(3, 12) Several hypothesis regarding the etiology of POCD have been
postulated including perioperative ischemia and hypoxemia (13, 14),
surgical stress associated systemic or localised inflammatory reactions,
alterations in hormonal homeostasis, as well as direct anesthetic agent
toxicity. (15, 16) It is still to be determined towhat extent
postoperative decline in cognitive function is attributable specifically
to either surgical or anesthetic management compared to patient-related
risk factors such as co-morbid cerebrovascular and systemic vascular
disease or even undiagnosed mild cognitive dysfunction, which might be of
greater etiological importance. (17) Additionally, the impact of the
different anesthesia techniques (regional versus general anesthesia) on
POCD remain controversial. (4, 18, 19) A recent review and meta-analysis
by Mason et al. concluded that general anesthesia might increase the risk
of developing POCD compared to other anesthesia regimens. However, this
was not seen for postoperative delirium. (20) However, this review suffers
from different methodological weaknesses as it includes studies of
doubtful quality. (21) Moyce et al. performed a reviewand meta-analysis to
detect interventions to decrease postoperative delirium in non-cardiac
surgery. The found out that perioperative geriatric consultations with
multicomponent interventions and lighter anesthesia were potentially
effective in decreasing the incidence of postoperative delirium. (22)
Surprisingly, general anesthesia was considered to be potentially more
favorable to avoid delirium compared to regional anesthesia. In shoulder
surgery the research concerning the impact on cerebral oxygenation and
neurocognitive outcome has increased due to the challenging beach chair
position and different case reports describing devastating neurologic
outcome. Several randomized controlled trials have demonstrated that
detection and treatment of cerebral oxygen desaturation leads to better
clinical outcomes. (23-25). However, without extensive neurocognitive
monitoring, subtle changes induced by cerebral hypoxia may go unnoticed
until functional organ damage becomes evident. Six of the included studies
measured (regional cerebral saturation) rScO2 and performed neurologic /
neurocognitive outcome measurement. However, the quality of this
assessment was variable. Lee et al. assessed the cognitive function using
the MMSE prior to surgery and the day after surgery. No difference between
the groups was found. (26) Moerman et al. used a "gross neurological
(motor and sensory evaluation) and gross cognitive evaluation (orientation
in time and space, recall of name, date of birth and address)" pre and 1
day postoperatively without showing a difference after general anesthesia.
(27) Jeong et al. performed the evening after surgery "a gross motor and
sensory neurologic evaluation and gross cognitive evaluation (orientation
in time and space, recall of name, date of birth, and address)" and found
no difference between the sevoflurane and the propofol groups. (28)
Salazar et al. were the first to use a validated tool for neurocognitive
function evaluation: Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS) was used to assess the neurocognitive
outcome preoperatively, at discharge and at POD3 without any impairment in
neurocognitive outcome. (29) Aguirre et al. performed the evening prior to
surgery and the day after surgery a neurologic (Glasgow Coma Scale, pupil
size, lateralization signs, MMSE) assessment and two validated POCD
assessment tools: Trailmaking Test A and B (TMTA / TMTB). They could
demonstrate a difference between the general and the regional anesthesia
group with noworsening of the neurological outcome in either group but
with an impairment of the early cognitive function in the general
anesthesia group. Moreover, patients with CDEs in the general anesthesia
group showed a worse early cognitive function compared to those without
CDEs. (30) Cho et al. performed only the evening after surgery a
"grossmotor and sensory neurological evaluation and gross cognitive
evaluation (orientation in time and space, recall of name, date of birth
and address)" after general total intravenous anesthesia and found no
difference between the group treated with arginine vasopressin to prevent
hypotension and the placebo group. (31) Postoperative delirium Delirium is
a condition with a wide range of possible etiologies and is defined as a
confusional state emerging clinically by acute and fluctuating changes in
consciousness and attention. Postoperative delirium is seen in 36.8% of
surgical patients (32) with a higher incidence in the over 70 years
population (33) and in the orthopedic population (28%-52-6%). (34) There
is a strong association between delirium and serious postoperative
complications (35) leading to prolonged hospital stay, persistent
functional and cognitive decline, increased morbidity and mortality (36,
37) with subsequent institutionalisation (8, 38) and finally leading to
increased costs ranging from 38 - 152 billion USD / year. (39)
Additionally, patients suffering delirium have a higher numbers of
surgical complications such as urinary and respiratory tract infections,
fractures and vascular events. (40) Moreover, delirium increases the
incidence of postoperative depression. (41) In hospitalized patients up to
40%of cases of delirium are thought to be preventable (42, 43) but
preventions strategies are unproven or even untested. Delirium is thought
to result from neuroinflammation, neurotransmitter imbalance, pain,
infection, sleep disorders and metabolic abnormalities. (44, 45) A recent
meta-analysis showed great inconsistencies in incidence, definition,
duration and severity of postoperative delirium. (46) Russo et al. (47)
studied the effects of controlled hypotension by epidural anesthesia on
delirium in patients for hip replacement surgery. Their intraoperative
mean arterial blood pressure (MAP) was maintained in the range of 45 - 55
mmHg or 55 - 70mmHg. They found no difference in the incidences of
postoperative delirium (8.5%vs 4.2%,MAP 45 - 55mmHg vs. MAP 55 - 70mmHg, p
= 0.167). However, there were many inaccuracies in this study, which was
underpowered, had no standardized anesthesia/analgesia regimen and did not
analyze the effects of sedation and blood loss on the primary outcome.
According to literature there is no difference in the incidence of
postoperative delirium between neuraxial and general anesthesia. (48-51)
However, also these studies show relevant limitations and do not focus on
major hip surgery, which is known to be a risk for co-occurrence of
cognitive dysfunction in elderly patients. (52) Depth of sedation has
recently been shown to correlate with an increased incidence and duration
of postoperative delirium. (53) However, these were induced low levels of
sedation and not normal clinical standard sedation for regional
anesthesia. (54) Nishikawa et al. (55) showed on abdominal surgery
patients that the severity of delirium based on the Delirium Rating Scale
was higher in the propofol group (intravenous anesthesia) compared to the
sevoflurane (inhalative anesthesia) group. However, the incidence was of
postoperative delirium was not different between the groups. Additionally,
also this study was underpowered. Three randomized controlled trials in
orthopedic and abdominal surgery compared postoperative epidural analgesia
to intravenous analgesia and could not find a difference between the
groups. However, also these studies were underpowered. (46)Mouzopoulos et
al. investigated the effects of additional fascia iliaca compartment block
on postoperative deliriumin hip surgery patients.

<30>
Accession Number
72027033
Authors
Borgeat A.
Institution
(Borgeat) Anesthesiology, Universitatsklinik Balgrist, Zurich, Switzerland
Title
Pro-con debate: The anti-inflammatory effects of local anesthetics are of
no major clinical relevance-con.
Source
Regional Anesthesia and Pain Medicine. Conference: 34th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2015
Ljubljana Slovenia. Conference Start: 20150902 Conference End: 20150905.
Conference Publication: (var.pagings). 40 (5 SUPPL. 1) (pp e7-e8), 2015.
Date of Publication: September-October 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The use of local anesthetics has long been focused on the treatment of
pain and cardiac arrhythmias. During the last decades several studies have
demonstrated that local anesthetics are able to interfere with other
receptors(1). This has led to the administration of local anesthetics in
different settings including postoperative ileus, neuroprotection,
decompression sickness, cerebral air embolism, cancer recurrence and
various types of inflammation. On the other hand some concerns including
chondrotoxicity have been the focus of different investigations. The aim
of this lecture is to provide an overview of recent progress in terms of
new indications and limitations of local anesthetic application.
Antimicrobial properties: Local anesthetics have long been known to
inhibit the growth of different species in vitro(2). Infiltration of
surgical wound with 2ml lidocaine 2% prior to inoculation was associated
with an average decrease in bacterial count of >70%(3). Epidural abscess
is an uncommon yet serious complication of epidural catheterisation.
Coghlan et al(4) investigated the antibacterial activity of various local
anesthetics and additives used in epidural infusions, against a range of
micro-organisms associated with epidural abscess. Different concentrations
of bupivacaine, ropivacaine and levobupivacaine with or without fentanyl,
adrenaline or clonidine were tested. Bupivacaine was shown to have the
most efficient activity against micro-organisms. It showed antibacterial
activity against staphylococcus aureus, enterococcus faecalis and
escherichia coli with minimum inhibitory concentrations between 0.125% and
0.25%. However, bupivacaine did not inhibit the growth of pseudomonas
aeruginosa. Levobupivacaine and ropivacaine had no activity against any of
the micro organisms tested. The presence of fentanyl, adrenaline and
clonidine had no additional effect on the antimicrobial activity of any of
the local anesthetic tested. While the clinical implications of this in
vitro study are not known, consideration should be given to use higher
concentration of LA (bupivacaine 0.25% has a greater antimicrobial
activity than 0.125%) in epidural infusion in order to take advantage of
this property. Neuroprotection: Several studies have previously shown that
lidocaine at antiarrhythmic doses(5) or lower doses(6) demonstrates
neuroprotective effects. These potential properties are of great
importance since the severity of neurologic sequelae and the relatively
limited therapeutic interventions make this an important area of research.
Postoperative neurocognitive decline is detected in more than 50% of
patients after cardiac surgery and is still present 6 months later in 30%.
Mathew et al(7) investigated in a prospective, randomized double-blinded,
placebo controlled study whether a continuous infusion of lidocaine (bolus
1mg/kg followed by 1mg/min for the next 48h) would reduce postoperative
cognitive dysfunction after cardiac surgery using cardiopulmonary bypass.
This work demonstrated that lidocaine did not reduce the incidence of
cognitive dysfunction, but in non-diabetic patients a secondary analysis
did show a protective effect, which was still present 1 year after
surgery. This study suggests that certain patients, but not all, may
benefit from this treatment. Recovery of bowel function: Postsurgical
ileus is a common occurrence after abdominal surgery, and is one of the
major reasons to delay patient's discharge. Previous studies have shown
that continuous infusion of lidocaine has positive effects in this
setting(8,9). Among the possible hypothesis to explain the salutary
effects of i.v. lidocaine, a reduction of the inflammatory reaction
secondary to peritoneal distension and / or reduction of post-traumatic -
post-surgical stress have been suggested(10,11). Cancer recurrence:
Surgery still remains a cornerstone in the management of cancer patients.
However, surgery inevitably induces a profound neuroendocrine, metabolic,
and cytokine response. General anesthesia, pain, sympathetic blockade, all
are involved in the modulation of the immune system. The natural killer
cells (NK) are an important part of non-specific cellular-mediated and
antitumoral immunity. Forget and De Kock(12) performed a systematic review
to recapitulate data over NK activity during the perioperative period and
the influence of anesthesia, analgesia andmodulation of sympathetic
system. It came out from this review that local anesthetics, contrary to
opioids, stimulate the activity of NK cells during the perioperative
period. However, it is important to keep in mind that the long term
consequences of each technique on patient's outcome warrant further
investigations. Yardeni et al(13) assessed pain intensity and immune
reactivity in two groups of female patients scheduled for transabdominal
surgery assigned either to i.v. lidocaine started 20min before surgery or
a placebo. All patients had patient-controlled epidural analgesia. In the
lidocaine group postoperative pain at rest and during coughing was less in
the first 8 postoperative hours. The in vivo production of IL-1ra and IL-6
was significantly reduced, whereas the lymphocyte proliferation response
to phytohemmaglutinin-M was better maintained in the control group. This
study indicates that i.v. lidocaine reduces surgery-induced immune
alterations. The long-term clinical implications of these findings are
unknown and warrant future investigations. Conclusions: It is fascinating
that more than decades after the introduction of local anesthetics for
perioperative analgesia, we may still discover new properties and
anticipate new applications of this class of drugs. Various types of
inflammation including neuroprotection, acute lung injury, bowel function
recovery and maybe cancer recurrence may be positively influenced by the
application of local anesthetics. These issues are without any doubt the
challenges of the coming years.

<31>
[Use Link to view the full text]
Accession Number
72027029
Authors
Dewinter G. Teunkens A. Altmi L. Van De Velde M. Rex S.
Institution
(Van De Velde, Rex) Department of Cardiovascular Sciences, KU Leuven,
University of Leuven, Leuven, Belgium
(Dewinter, Teunkens, Altmi, Van De Velde, Rex) Department of
Anesthesiology, University Hospitals of the KU Leuven, Leuven, Belgium
Title
Refresher course: The role of intravenous lidocaine in modern anesthesia.
Source
Regional Anesthesia and Pain Medicine. Conference: 34th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2015
Ljubljana Slovenia. Conference Start: 20150902 Conference End: 20150905.
Conference Publication: (var.pagings). 40 (5 SUPPL. 1) (pp e1-e4), 2015.
Date of Publication: September-October 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
The role of intravenous lidocaine in modern anesthesia: Lidocaine
(dietylamino-2,6 aceto-xylidide), an amide local anesthetic, was
discovered in 1943 by Nils Lofgren and his assistant Bent Lundqvist.1 It
has analgesic, anti-hyperalgesic and anti-inflammatory properties2. For
over 50 years, lidocaine has been used intravenously for several
indications including the improvement of acoustic function, regional
anesthesia, the treatment of arrhythmias, and the treatment of neuropathic
and central pain.3 De Clive-Lowe et al. in 1958 and Bartlett et al. in
1962 were the first to describe the intravenous use of lidocaine in the
management of postoperative pain.4,5 Pharmacokinetics and toxicity of
lidocaine: The therapeutic plasma concentration of lidocaine ranges
between 2 to 5mug/ml, with side effects occurring at levels above 6 to
10mug/mL. Lidocaine is metabolized primarily by the liver, only 10% is
excreted unchanged in urine. It is degraded to two active metabolites,
monoethylglycinexylidide (MEGX) and glycinexylidide. The elimination
half-life of lidocaine after an intravenous bolus injection is 1.5 to 2
hours. The pharmacokinetics of lidocaine appear to change with prolonged
infusions, which is attributed to the inhibitory effect of MEGX on the
clearance of lidocaine. Lidocaine and MEGX competitively bind to hepatic
enzymes. Additionally, congestive heart failure is also a cause of
decreased clearance of lidocaine because of a smaller volume of
distribution of the central compartment and a diminished cardiac index.
Hsu et al. investigated the pharmacokinetics of a 48 hours infusion of
lidocaine in patients undergoing cardiac surgery with cardiopulmonary
bypass. The authors concluded that weight-dosing is recommended to reduce
the risk of toxicity and that the infusion rate should be reduced by 20%
after 24 hours of infusion to minimize the risk of toxicity.6 In most of
the studies with intravenous lidocaine, a bolus dose between 1 and 2 mg/kg
is administered followed by a continuous infusion of 1.5 mg/ kg/h, which
corresponds with a plasma concentration of 2mug/mL.3 Mechanisms of action
of intravenous lidocaine: Although the exact mechanisms of action of
intravenous lidocaine are still not fully understood, several potential
mechanisms have been described. The best known action of lidocaine (and of
its active metabolite,i.e. monoethylglycinexylidide, MEGX) is the blockade
of the peripheral and central voltage-gated Na+-channels at the
intracellular side of the cellmembrane, hereby inhibiting the propagation
of action potentials.7 The prolonged effect of lidocaine is thought to
reflect its inhibition of the spontaneous pulse generation arising from
injured nerve fibers and from the dorsal root ganglion neurons proximal to
the injured nerve.8 Recently, Wolff et al. have shown that local
anesthetics act also on different types of voltage-gated
potassiumchannels.9 In fact, at lowconcentrations, lidocaine suppresses
tonic firing neurons by interacting with voltage-gated potassium channels.
Contrariwise, the effects on the adapting firing neurons can be explained
by interaction with the voltage-gated sodium channels. The different
sensitivity to a blockade of voltage-gated sodium and potassium channels
in different types of neurons can offer a differentiated approach in pain
therapy. It is known that the plasma levels reached with systemic
administration of lidocaine are too low to directly block the sodium
channels. 7,10,11 Therefore, there must be other mechanisms to explain the
effect of intravenous administered lidocaine. It is thought that the
antinociceptive effect of lidocaine is partially mediated through an
interaction with receptor mechanisms. First, intravenously administrated
lidocaine increases the intraspinal release of achetylcholine (Ach),
resulting in an increased pain threshold by stimulating inhibitory
pathways.3 This effect of lidocaine on ACh release is mediated through an
activation of muscarinic (probably muscarinic receptors of the subtype M3)
and nicotinic receptors.3,12 Second, already in 1993, Biella et al. have
suggested a glycine-like action of lidocaine in the central nervous
system. 13 Glycine is, besides gamma-aminobutyric acid, the major
inhibitory neurotransmitter in the central nervous system where it binds
to and activates glycine receptors to cause hyperpolarization.14 In
addition, glycine is also an excitatory neurotransmitter by its action as
co-agonist of glutamate at the N-methyl-D-aspartate (NMDA) receptor. The
glycinergic neurons contribute to the inhibition of nociceptive signaling
and have important roles in segregating nociceptive and non-noxious
information pathways.14 The synaptic glycine concentration is regulated by
two glycine transporters (GlyT).15 The GlyT1removes glycine from the
synaptic cleft and the GlyT2 mediates the glycine reuptake into the nerve
terminals. It is not lidocaine itself, but its major metabolites
mono-ethylglycinexylidide (MEGX) and glycinexylidide, that cause the
inhibition of the GlyT1-mediated uptake of glycine. This inhibition of the
GlyT might provide a novel molecular mechanism for the antinociceptive
effect of systemic lidocaine. A third possible mechanism to explain the
analgesic effect of lidocaine is the inhibition of glutamatergic
neurotransmission. Glutamate is the most important excitatory
neurotransmitter in the central nervous system and binds to several
receptors, one of which the NMDA receptor. It is known that the activation
of the NMDA receptor can lead to postoperative hyperalgesia and central
sensitization. Both Hahnenkamp et al. and Gronwald et al. showed that
local anesthetics inhibit the NMDA receptor in a concentrationdependent
manner.16,17 Finally, lidocaine exerts anti-inflammatory effects by
inhibition of nuclear factor kappaB activation and decreased up-regulation
of pro-inflammatory cytokines. 18 Lidocaine attenuates the production of
inflammatory cytokines such as IL-1, IL-6, IL-8 and stimulates the
production of IL1-receptor antagonist.11 The inflammatory response is an
important determinant of outcome after surgery, as an excessive
stimulation of the inflammatory cascade can lead to a systemic
inflammatory response syndrome, organ dysfunction and pain.19 The
analgesic effect of lidocaine in abdominal surgery: During the last
decade, the use of systemic lidocaine as a co-analgesic has gained renewed
interest for the treatment of acute postoperative pain. Four meta-analyses
(Sun et al. 2012, Marret et al. 2008, Mc Carthy et al. 2010 and Vigneault
et al. 2011) showed that the use of intravenous lidocaine perioperatively
in abdominal surgery decreased postoperative pain intensity, reduced
opioid consumption, accelerated the recovery of gastro-intestinal function
and shortened hospital stay.2,20,21,22 In a randomized, placebo
controlled, double-blind study, Kaba et al. showed for laparoscopic
colectomy that patients receiving systemic lidocaine perioperatively
required 50% less opiate medication during the first 24 hours
postoperative my.23 Likewise, Tikuisis et al. investigated systemic
lidocaine in laparoscopic colon surgery24 and found significantly lower
pain scores both in rest and during movement. Kuo et al. compared the use
of thoracic epidural analgesia and intravenous lidocaine in patients
undergoing colonic surgery and reported that intravenous lidocaine can be
an alternative for an epidural catheter to improve postoperative pain
relief.

<32>
Accession Number
25392341
Authors
Balkanay O.O. Goksedef D. Omeroglu S.N. Ipek G.
Institution
(Balkanay) Department of Cardiovascular Surgery, Manisa State Hospital,
Manisa, Turkey balkanay@doctor.com
(Goksedef) Department of Cardiovascular Surgery, Cerrahpasa Medical
Faculty, Istanbul University, Istanbul, Turkey
(Omeroglu) Department of Cardiovascular Surgery, Cerrahpasa Medical
Faculty, Istanbul University, Istanbul, Turkey
(Ipek) Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty,
Istanbul University, Istanbul, Turkey
Title
The dose-related effects of dexmedetomidine on renal functions and serum
neutrophil gelatinase-associated lipocalin values after coronary artery
bypass grafting: a randomized, triple-blind, placebo-controlled study.
Source
Interactive cardiovascular and thoracic surgery. 20 (2) (pp 209-214),
2015. Date of Publication: 01 Feb 2015.
Abstract
METHODS: Our randomized, triple-blinded, placebo-controlled study was
conducted among 295 patients scheduled for CABG surgery between August
2009 and March 2011 in a tertiary cardiac and vascular surgery clinic. A
total of 90 consecutive patients who met inclusion criteria were
randomized and divided into three groups. The first group received a
placebo. The second and the third groups received 4 and 8 micro&#32;g/cc
concentration of the Dexmedetomidine infusion, respectively. Infusion
rates were regulated to obtain sedation with a Ramsey sedation score of 2
or 3. Patients were regrouped according to the total Dexmedetomidine dose.
Statistical analyses of variables including serum neutrophil
gelatinase-associated lipocalin values and conventional renal function
tests were made for all six possibilities before the blind was broken.
RESULTS: Results of conventional renal function tests were not
significantly different. However, neutrophil gelatinase-associated
lipocalin levels for the first postoperative day for placebo, low-dose and
high-dose Dexmedetomidine groups were 176.8 +/- 145.9, 97.7 +/- 63.4 and
67.3 +/- 10.9 ng/ml, respectively. These values were significantly
different among the groups (P <0.001).
CONCLUSIONS: In our study, we found that Dexmedetomidine infusion for
sedation after CABG under cardiopulmonary bypass can be useful in the
prevention of kidney injury. Conventional renal function tests, including
blood urea nitrogen, serum creatinine, urine output and creatinine
clearance rate measurements typically may not detect the development of
acute kidney dysfunction in the first 48-h postoperative period.
Differences were detected in renal function in the early postoperative
period and the development of acute kidney injury, as determined by
measurements of blood NGAL levels, was significant and dose-dependent.
OBJECTIVES: Acute kidney failure after coronary artery bypass grafting
(CABG) is a serious complication that increases morbidity and mortality
rates. Early detection and prevention of this complication are very
important. A novel biomarker named neutrophil gelatinase-associated
lipocalin (NGAL) can play an important role in early diagnosis of acute
kidney injury. Recent studies on the favourable effects of Dexmedetomidine
on cardiac surgery have been published. The aim of this study is to
investigate whether there is a dose-dependent positive effect of
Dexmedetomidine on neutrophil gelatinase-associated lipocalin levels and
renal functions when used after CABG.

<33>
Accession Number
24734237
Authors
He Q.-L. Zhong F. Ye F. Wei M. Liu W.-F. Li M.-N. Li Q.-B. Huang W.-Q. Sun
L.-B. Shu H.-H.
Institution
(He) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Zhong) School of Public Health, Sun Yat-sen University, No. 74 Zhongshan
2nd Road, Guangzhou, Guangdong 510080, China ; Guangzhou Municipal Center
for Disease Control and Prevention, Guangzhou 0086-510080, China
(Ye) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Wei) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Liu) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Li) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Li) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Huang) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Sun) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
(Shu) Department of Anesthesiology, The First Affiliated Hospital of Sun
Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong
510080, China
Title
Does intraoperative ulinastatin improve postoperative clinical outcomes in
patients undergoing cardiac surgery: a meta-analysis of randomized
controlled trials.
Source
BioMed research international. 2014 (pp 630835), 2014. Date of
Publication: 2014.
Abstract
INTRODUCTION: The systematic meta-analysis of randomized controlled trials
(RCTs) evaluated the effects of intraoperative ulinastatin on
early-postoperative recovery in patients undergoing cardiac surgery.
METHODS: RCTs comparing intraoperative ulinastatin with placebo in cardiac
surgery were searched through PubMed, Cochrane databases, Medline,
SinoMed, and the China National Knowledge Infrastructure (1966 to May
20th, 2013). The primary endpoints included hospital mortality,
postoperative complication rate, length of stay in intensive care unit,
and extubation time. The physiological and biochemical parameters
illustrating postoperative cardiac and pulmonary function as well as
inflammation response were considered as secondary endpoints.
RESULTS: Fifteen RCTs (509 patients) met the inclusion criteria.
Ulinastatin did not affect hospital mortality, postoperative complication
rate, or ICU length of stay but reduced extubation time. Ulinastatin also
increased the oxygenation index on postoperative day 1 and reduced the
plasma level of cardiac troponin-I. Additionally, ulinastatin inhibited
the increased level of tumor necrosis factor-alpha, polymorphonuclear
neutrophil elastase, interleukin-6, and interleukin-8 associated with
cardiac surgery.
CONCLUSION: Ulinastatin may be of value for the inhibition of
postoperative increased inflammatory agents and most likely provided
pulmonary protective effects in cardiac surgery. However, larger
adequately powered RCTs are required to define the clinical effect of
ulinastatin on postoperative outcomes in cardiac surgery.