EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015707352
Authors
Sezai A. Soma M. Nakata K.-I. Osaka S. Ishii Y. Yaoita H. Hata H. Shiono
M.
Institution
(Sezai, Nakata, Osaka, Ishii, Yaoita, Hata, Shiono) Department of
Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
(Soma) Department of General Medicine, Nihon University School of
Medicine, Tokyo, Japan
Title
Comparison of febuxostat and allopurinol for hyperuricemia in cardiac
surgery patients with chronic kidney disease (NU-FLASH trial for CKD).
Source
Journal of Cardiology. 66 (4) (pp 298-303), 2015. Date of Publication: 01
Oct 2015.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The NU-FLASH trial demonstrated that febuxostat was more
effective for hyperuricemia than allopurinol. This time, we compared these
medications in patients with chronic kidney disease (CKD) from the
NU-FLASH trial. Methods and results: In the NU-FLASH trial, 141 cardiac
surgery patients with hyperuricemia were randomized to a febuxostat group
or an allopurinol group. This study analyzed 109 patients with an
estimated glomerular filtration rate (eGFR) <60mL/min/1.73m²,
and also analyzed 87 patients with stage 3 CKD. The primary endpoint was
the serum uric acid level. Secondary endpoints included serum creatinine,
urinary albumin, cystatin-C, oxidized low-density lipoprotein,
eicosapentaenoic acid/arachidonic acid ratio, total cholesterol,
triglycerides, low-density lipoprotein, high-density lipoprotein, and
high-sensitivity C-reactive protein.Among patients with an
eGFR<60mL/min/1.73m², uric acid levels were significantly lower
in the febuxostat group than the allopurinol group from 1 month of
treatment onward. The serum creatinine, urinary albumin, cystatin-C,
oxidized low-density lipoprotein, eicosapentaenoic acid/arachidonic acid
ratio, and high-sensitivity C-reactive protein were also significantly
lower in the febuxostat group. Similar results were obtained in the
patients with stage 3 CKD. Conclusion: In cardiac surgery patients with
renal dysfunction, febuxostat reduced uric acid earlier than allopurinol,
had a stronger renoprotective effect than allopurinol, and also had
superior antioxidant and anti-inflammatory effects.

<2>
Accession Number
2014909153
Authors
Okajima H. Tanaka O. Ushio M. Higuchi Y. Nagai Y. Iijima K. Horikawa Y.
Ijichi K.
Institution
(Okajima, Tanaka, Higuchi, Nagai, Iijima, Ijichi) Department of
Anesthesiology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishiku, Kobe,
Hyogo 651-2273, Japan
(Ushio) Department of Anesthesiology, Kakogawa West City Hospital, 384-1
Yonedachohiratsu, Kakogawa, Hyogo 675-8611, Japan
(Horikawa) Department of Anesthesiology, Hyogo Brain and Heart Center At
Himeji, 520 Saisyo-ko, Himeji-city, Hyogo 670-0981, Japan
Title
Ultrasound-guided continuous thoracic paravertebral block provides
comparable analgesia and fewer episodes of hypotension than continuous
epidural block after lung surgery.
Source
Journal of Anesthesia. 29 (3) (pp 373-378), 2015. Date of Publication: 15
Nov 2015.
Publisher
Springer-Verlag Tokyo
Abstract
Purpose: Both paravertebral block (PVB) and thoracic epidural block (TEB)
are recommended for postoperative pain relief after lung surgery. The
addition of fentanyl to the anesthetic solution became popular for TEB
because of the stronger effects; however, there have been few comparable
trials about the addition of fentanyl to PVB. The purpose of this study
was thus to compare postoperative analgesia, side effects, and
complications between ultrasound-guided PVB (USG-PVB) and TEB with the
addition of fentanyl to ropivacaine after lung surgery. Methods: We
examined 90 consecutive patients (age 18-75 years) scheduled for
video-assisted thoracic surgery (VATS). In both groups, all blocks (four
blocks in USG-PVB and one block in TEB) and one catheter insertion were
performed preoperatively. Continuous postoperative infusion (0.1 %
ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both
groups. The recorded data included the verbal rating scale (VRS) for pain,
blood pressure, side effects, complications for 2 days, and overall
satisfaction score. Results: There was no difference in the frequency of
taking supplemental analgesics (twice or more frequently), or in VRS.
Hypotension occurred significantly more frequently in TEB (n = 7/33) than
in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV
and pruritus, as well as overall satisfaction score, were similar. There
were no complications in both groups; however, the catheters migrated
intrathoracically in four patients in PVB. Conclusion: USG-PVB achieved
similar pain relief and lowered the incidence of hypotension compared with
TEB. We conclude that both blocks with the same concentration of
ropivacaine and fentanyl can provide adequate postoperative analgesia for
VATS.

<3>
Accession Number
2015119433
Authors
Wang J. Gu C. Gao M. Yu W. Yu Y.
Institution
(Wang, Gu, Gao, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Preoperative Statin Therapy and Renal Outcomes After Cardiac Surgery: A
Meta-analysis and Meta-regression of 59,771 Patients.
Source
Canadian Journal of Cardiology. 31 (8) (pp 1051-1060), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: The purpose of this study was to investigate the effects of
preoperative statin therapy (PST) on short- and long-term renal
dysfunction after cardiac surgery. Methods: We searched for reports that
investigated the effects of PST on renal outcomes after cardiac surgery in
the electronic literature databases PubMed, Ovid, and Elsevier. Results:
Twenty-six reports including 59,771 patients were selected for
meta-analysis. The meta-analysis revealed that PST significantly reduced
the incidence of postoperative renal dysfunction (odds ratio [OR], 0.89;
95% confidence interval [CI], 0.84-0.95; P < 0.0001) without significant
heterogeneity (I² = 28.1%; P = 0.093). PST also significantly
reduced the need for postoperative renal replacement therapy (OR = 0.76;
95% CI, 0.62-0.92; z = 2.77; P = 0.006); particularly in the subgroup of
patients who underwent isolated coronary artery bypass grafting, the rate
of renal replacement therapy was reduced by 56% (OR, 0.44; 95% CI,
0.30-0.66; z = 4.08; P < 0.0001) with low heterogeneity (I² =
18.7%; P = 0.297). Meta-analysis for the outcome of acute kidney injury
(AKI) revealed that PST reduced the incidence of postoperative AKI by 13%
(OR, 0.87; 95% CI, 0.80-0.94; P = 0.001) and 7% (OR, 0.93; 95% CI,
0.86-0.99; P = 0.031), respectively, for subgroups of patients whose AKI
was evaluated using the Acute Kidney Injury Network (AKIN) or the Risk,
Injury, Failure, Loss, and End Stage (RIFLE) criteria, without significant
heterogeneity for either. Conclusions: PST might be a promising therapy to
reduce renal complications after cardiac surgery although large-scaled
randomized controlled trials are needed to further verify the conclusion.

<4>
Accession Number
2015312548
Authors
Borde D. Asegaonkar B. Apsingekar P. Khade S. Futane S. Khodve B.
Annachatre A. Puranik M. Borgaonkar V. Belapurkar Y. Joshi S.
Institution
(Borde, Asegaonkar, Apsingekar, Khade, Futane, Khodve, Annachatre) Ozone
Anesthesia Group, Department of Cardiac Surgery, Aurangabad, M.S, India
(Puranik) Department of Cardiac Surgery, Aurangabad, M.S, India
(Borgaonkar) Department of Surgery, Seth Nandlad Dhoot Hospital,
Aurangabad, M.S, India
(Belapurkar) Department of Cardiac Surgery, M.G.M. Medical College and
Hospital, Aurangabad, M.S., India
(Joshi) Department of Anesthesia, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bengaluru, India
Title
Risk Stratification in Off-Pump Coronary Artery Bypass (OPCAB) Surgery -
Role of EuroSCORE II.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1167-1171),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objectives To evaluate the EuroSCORE II for risk stratification in
patients undergoing off-pump coronary artery bypass (OPCAB) surgery.
Design A retrospective observational study. Setting Two tertiary care
hospitals. Participants Participants were 1,211 patients undergoing OPCAB
surgery. Interventions No interventions were implemented. Measurements and
Main Results The EuroSCORE II estimated the operative risk for each
patient. The calibration of the scoring system was assessed using the
Hosmer Lemeshow test, and the discriminative capacity was estimated with
area under receiver operating characteristic curves. The incidence,
patient characteristics, causes of intraoperative conversion to on-pump
coronary artery bypass (ONCAB), and outcome were studied. The all-cause
in-hospital mortality was 2.39%. Predicted mortality with the EuroSCORE II
was 2.03+/-1.63. Using the Hosmer Lemeshow test, a C statistic of 8.066 (p
= 0.472) was obtained, indicating satisfactory model fit. The calculated
area under the receiver operating characteristic curve was 0.706 (p =
0.0002), indicating good discriminatory power. Emergency intraoperative
conversion to ONCAB occurred in 6.53% of patients. The mortality in the
ONCAB group was significantly higher compared with patients who underwent
successful OPCAB surgery (15.18% v 1.5%, p<0.0001). On multiple regression
analysis with conversion to ONCAB as the endpoint, associated factors were
patients with a higher EuroSCORE II (odds ratio = 1.13, confidence
interval = 1.03-1.27) and more-than-trivial mitral regurgitation (odds
ratio = 1.84, confidence interval = 1.07-3.06). Net reclassification
improvement of 0.714 (p<0.0001) was obtained when on-pump conversion was
added to the EuroSCORE II. Conclusions The EuroSCORE II has satisfactory
calibration and discrimination power to predict mortality after OPCAB
surgery. Intraoperative conversion to ONCAB is a major complication of
OPCAB surgery. A higher EuroSCORE II also predicts higher probability of
conversion to ONCAB.

<5>
Accession Number
2015204496
Authors
Jia L. Dong R. Zhang F. Wang W. Lu H. Luo Y. Xue Q. Yu B.
Institution
(Jia, Dong, Zhang, Lu, Luo, Xue, Yu) Department of Anesthesiology, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er
Road, Shanghai 200025, China
(Wang) Department of Anesthesiology, Zhejiang Provincial People's
Hospital, Hangzhou, China
Title
Propofol Provides More Effective Protection for Circulating Lymphocytes
Than Sevoflurane in Patients Undergoing Off-Pump Coronary Artery Bypass
Graft Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1172-1179),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objectives To compare the effects of propofol, sevoflurane, and the
combination of the 2 on circulating lymphocytes in patients undergoing
off-pump coronary artery bypass graft (OPCAB) surgery. Design A
prospective, randomized study. Setting A university hospital. Participants
One hundred five patients undergoing elective OPCAB surgery. Interventions
Participants were randomized to receive sevoflurane (group S), propofol
(group P), or coadministration (group C) of sevoflurane- and
propofol-maintained anesthesia. Measurements and Main Results Blood
samples were obtained before, during, and after surgery. Caspase-3 and
apoptosis-inducing factor in lymphocytes were evaluated by Western blot.
During surgery, 5 minutes after revascularization of the left anterior
descending artery, 5 minutes after all anastomoses (T4), and after the
sternal closure (T5), caspase-3 expression of group S was higher than that
of group P (p = 0.02) and group C (p = 0.02). At T4 and T5, expression of
active apoptosis-inducing factor in group S was higher than that in the
other 2 groups (p = 0.03 and p = 0.04, respectively). 24 hours after
surgery, the lymphocyte count of group S (0.55/nL) was lower than that of
group P (0.73/nL, p = 0.02) and group C (0.73/nL, p = 0.03). Intensive
care unit stay of group S (3.0 days) was longer than that of the other 2
groups (2.2 days, p = 0.02 and 2.1 days, p = 0.01). Conclusions OPCAB
surgery was associated with postoperative lymphopenia. Regarding a
protective effect for circulating lymphocytes, propofol and the
combination of sevoflurane- and propofol-maintained anesthesia were both
superior to sevoflurane-maintained anesthesia.

<6>
Accession Number
2015155686
Authors
Kim J.H. Kim H.J. Kim J.Y. Sik Ahn H. Ahn I.M. Choe W.J. Lim C.-H.
Institution
(Kim, Kim, Choe) Department of Anesthesiology and Pain Medicine, Ilsan
Paik Hospital, Inje University, 170 JuHwaRo, IlsanSeoGu, Goyang,
GyungGiDo, South Korea
(Kim, Sik Ahn, Ahn) Department of Preventive Medicine, College of
Medicine, Korea University, Seoul, South Korea
(Ahn) Department of Literary Arts, Brown University, Providence, RI,
United States
(Lim) Department of Anesthesiology and Pain Medicine, Korea University
Medical Center, Seoul, South Korea
Title
Meta-Analysis of Sodium Bicarbonate Therapy for Prevention of Cardiac
Surgery-Associated Acute Kidney Injury.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1248-1256),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to determine whether or not
perioperative administration of sodium bicarbonate had a preventive effect
on cardiac surgery-associated acute kidney injury (CSA-AKI) as shown in
randomized controlled trials. Design The authors conducted a systematic
review and meta-analysis using MEDLINE, EMBASE, the Cochrane Central
Register of Controlled Trials (CENTRAL), and KoreaMed. Setting The authors
searched MEDLINE, EMBASE, CENTRAL, and KoreaMed without language and date
restrictions. They used both MeSH and free-text terms to identify relevant
studies. Electronic searches were undertaken on July 31, 2014.
Participants Five randomized controlled studies included in this review.
Measurements and Main Results There were no differences in the development
of CSA-AKI among patients in the sodium bicarbonate group compared with
those in the control group (5 trials, 1,092 patients; n = 233 of 547 in
sodium bicarbonate (SB) group versus 225 of 545 in control group (SC);
risk ratio (RR), 0.95; 95% confidence interval (CI), 0.74-1.22. Also,
there were no statistical differences in in-hospital mortality (3 trials,
573 patients; n = 21 of 288 in SB versus 14 of 285 in SC; RR, 1.44; 95%
CI, 0.76-2.72), need for renal replacement therapy (4 trials, 1,000
patients; n = 21 of 503 in SB versus 23 of 497 in SC; RR, 0.90; 95% CI,
0.50-1.60), length of stay in the intensive care unit (ICU) (hours) (4
trials, n = 969 patients, weighted men difference (WMD), 2.17; 95% CI,
-1.15-5.49), and length of ventilation (hours) (4 trials, 969 patients;
WMD, 0.34; 95% CI,-0.80-1.48). Conclusions Perioperative administration of
sodium bicarbonate did not reduce the rate of CSA-AKI in randomized
controlled trials. Therefore, use of perioperative administration of
sodium bicarbonate for the prevention of CSA-AKI is questionable.

<7>
Accession Number
2015153297
Authors
Matata B.M. Scawn N. Morgan M. Shirley S. Kemp I. Richards S. Lane S.
Wilson K. Stables R. Jackson M. Haycox A. Mediratta N.
Institution
(Matata, Scawn, Morgan, Shirley, Kemp, Wilson, Stables, Jackson,
Mediratta) Liverpool Heart and Chest Hospital, NHS Foundation Trust,
Thomas Drive, Liverpool L14 3PE, United Kingdom
(Richards, Haycox) School of Management, United Kingdom
(Lane) Department of Biostatistics, University of Liverpool, Liverpool,
United Kingdom
Title
A Single-Center Randomized Trial of Intraoperative Zero-Balanced
Ultrafiltration during Cardiopulmonary Bypass for Patients with Impaired
Kidney Function Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1236-1247),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objectives The authors investigated whether zero-balance ultrafiltration
(Z-BUF) during bypass significantly improves clinical and cost outcomes or
biomarkers of kidney injury for patients with preoperative kidney
impairment (estimated glomerular filtration rate [eGFR]<60 mL/minute)
undergoing cardiac surgery. Design A single-center randomized controlled
trial recruited, patients between 2010 and 2013, with a 12-months
follow-up. Setting Hospital. Participants One hundred ninety-nine patients
undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Interventions Patients were assigned randomly to receive zero-balance
ultrafiltration (Z-BUF) or not, with stratification for degree of kidney
dysfunction and diabetes. Measurements and Main Results The authors
assessed clinical efficacy and kidney function biomarkers. Cumulative
probability of discharge from the intensive care unit (ICU) was assessed
by Kaplan-Meier plots and was found not to be significantly different
between the two trial arms (p = 0.61). After adjusting for EuroSCORE,
diabetes, eGFR, cardioplegia types and type of surgery in a Cox
proportional hazard model, hazard ratios (HR) for ICU length of stay
between the Z-BUF and no-Z-BUF groups was not significantly different: HR
(95% CI): 0.89 (0.66, 1.20; p = 0.44). In contrast, significant reductions
in postoperative chest infections and the composite of clinical endpoints
(death, strokes, and myocardial infarctions) in the Z-BUF group were
observed. In addition, Z-BUF significantly abrogated the rise in the
kidney damage markers urinary NGAL/creatinine ratio, urea, creatinine and
eGFR during CPB and adverse events risks. Conclusions Z-BUF during bypass
surgery is associated with significant reductions in morbidity and
biomarkers of CPB-induced acute kidney injury soon after CPB, which are
indicative of clearance of inflammatory/immune mediators from the
circulation.

<8>
Accession Number
2015054774
Authors
Brusen R.M. Hahn R. Cabreriza S.E. Cheng B. Wang D.Y. Truong W. Spotnitz
H.M.
Institution
(Brusen, Hahn, Wang, Spotnitz) Department of Medicine, Columbia
University, New York, NY, United States
(Cabreriza, Truong, Spotnitz) Department of Surgery, Columbia University
Medical Center, Vanderbilt Clinic, 622 West 168th Street, New York, NY
10032, United States
(Cheng) Department of Biostatistics, Columbia University, New York, NY,
United States
Title
Wall Thickness, Pulmonary Hypertension, and Diastolic Filling
Abnormalities Predict Response to Postoperative Biventricular Pacing.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1155-1161),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objective Post-cardiopulmonary bypass biventricular pacing improves
hemodynamics but without clearly defined predictors of response. Based on
preclinical studies and prior observations, it was suspected that
diastolic dysfunction or pulmonary hypertension is predictive of
hemodynamic benefit. Design Randomized controlled study of temporary
biventricular pacing after cardiopulmonary bypass. Setting Single-center
study at university-affiliated tertiary care hospital. Interventions
Patients who underwent bypass with preoperative ejection fraction<40% and
QRS duration>100 ms or double-valve surgery were enrolled. At 3 time
points between separation from bypass and postoperative day 1, pacing
delays were varied to optimize hemodynamics. Participants Data from 43
patients were analyzed. Measurements and Main Results Cardiac output and
arterial pressure were measured under no pacing, atrial pacing, and
biventricular pacing. Preoperative echocardiograms and pulmonary artery
catheterizations were reviewed, and measures of both systolic and
diastolic function were compared to hemodynamic response. Early after
separation, improvement in cardiac output was positively correlated with
pulmonary vascular resistance (R² = 0.97, p<0.001), ventricle
wall thickness (R² = 0.72, p = 0.002)), and E/e', a measure of
abnormal diastolic ventricular filling velocity (R² = 0.56, p =
0.04). Similar trends were seen with mean arterial pressure. QRS duration
and ejection fraction did not correlate significantly with improvements in
hemodynamics. Conclusions There may be an effect of biventricular pacing
related to amelioration of abnormal diastolic filling patterns rather than
electrical resynchronization in the postoperative state.

<9>
Accession Number
2015028228
Authors
Chang J.-E. Min S.-W. Kim C.-S. Lee J.-M. No H. Hwang J.-Y.
Institution
(Chang, Min, Kim, Lee, Hwang) Department of Anesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul
156-707, South Korea
(No) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul, South Korea
Title
Effect of Jaw Thrust on Transesophageal Echocardiography Probe Insertion
and Concomitant Oropharyngeal Injury.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (5) (pp 1266-1271),
2015. Date of Publication: 01 Oct 2015.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to evaluate the effect of jaw thrust
on transesophageal echocardiography probe insertion and concomitant
oropharyngeal injury. Design A prospective, randomized study Setting
Medical center governed by a university hospital Participants Forty-two
adult patients undergoing cardiovascular surgery were included.
Interventions After the induction of anesthesia, a transesophageal
echocardiography probe was inserted using an anterior jaw lift technique
(conventional group, n = 21) or a jaw thrust-assisted technique (jaw
thrust group, n = 21). Measurements and Main Results The incidence of
oropharyngeal injury, number of insertion attempts, blood on the probe
tip, and presence of persistent oropharyngeal bleeding were evaluated. In
the conventional group, oropharyngeal injury occurred more frequently than
in the jaw-thrust group (52.4% v 9.5%, respectively; p = 0.006). Regarding
transesophageal echocardiography probe insertion, the conventional group
required more attempts than the jaw-thrust group (p = 0.043). The
incidence of blood on the probe tip was higher in the conventional group
than in the jaw-thrust group (p = 0.020), but the presence of persistent
oropharyngeal bleeding was similar between the 2 groups. Conclusions The
jaw-thrust maneuver facilitated the insertion of the transesophageal
echocardiography probe and reduced concomitant oropharyngeal injury.

<10>
Accession Number
2015389408
Authors
Pislaru S.V. Abel M.D. Schaff H.V. Pellikka P.A.
Title
Aortic Stenosis and Noncardiac Surgery: Managing the Risk.
Source
Current Problems in Cardiology. 40 (11) (pp 483-503), 2015. Date of
Publication: November 2015.
Publisher
Mosby Inc.
Abstract
Managing the risk of noncardiac surgery in patients with aortic stenosis
is a problem that is frequently confronted in clinical practice.
Traditionally, patients with severe aortic stenosis were considered to be
at substantial risk during noncardiac surgery, and as such, elective
procedures were avoided before intervention on the aortic valve in most
patients other than those who were ineligible or refused aortic valve
replacement. Recent data suggest that with contemporary anesthesia and
surgical techniques, the risk of noncardiac surgery is substantially lower
than previously believed. We review the existent literature in the field,
and propose a practical approach to complex patients.

<11>
Accession Number
2015875110
Authors
Dall C.H. Gustafsson F. Christensen S.B. Dela F. Langberg H. Prescott E.
Institution
(Dall, Prescott) Department of Cardiology, Bispebjerg Hospital, University
of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
(Dall) Institute of Sports Medicine Copenhagen ISMC, MRRU, Denmark
(Gustafsson) Department of Cardiology, Heart Centre, Rigshospitalet,
University of Copenhagen, Belgium
(Christensen) Department of Cardiology, Gentofte Hospital, University of
Copenhagen, Australia
(Dela) Xlab, Center for Healthy Aging, University of Copenhagen, Australia
(Langberg) CopenRehab, Department of Public Health, University of
Copenhagen, Copenhagen, Denmark
Title
Effect of moderate- versus high-intensity exercise on vascular function,
biomarkers and quality of life in heart transplant recipients: A
randomized, crossover trial.
Source
Journal of Heart and Lung Transplantation. 34 (8) (pp 1033-1041), 2015.
Article Number: 5978. Date of Publication: August 2015.
Publisher
Elsevier USA
Abstract
Background Growing evidence in long-term treatment of heart transplant
(HTx) recipients indicates effects of high-intensity interval training
(HIIT) on several parameters, including oxygen uptake, vascular function
and psychological distress. In this study we compare the effect of HIIT vs
continued moderate training (CON) on vascular function, biomarkers and
health-related quality of life (HRQoL) in HTx recipients. Methods A
randomized, controlled crossover trial of stable HTx recipients >12 months
after transplantation was done on patients with 12 weeks of HIIT or 12
weeks of CON, followed by a 5-month washout and crossover. Outcomes
included endothelial function, arterial stiffness, biomarkers, HRQoL and
markers of anxiety and depression. Results Sixteen HTx recipients (mean
age 52 years, 75% male) completed the study. HIIT increased
VO_2peak more than CON (between-group difference, p < 0.001).
The physical component score of the 36-item Short Form (SF-36) was
increased significantly in HIIT patients (p = 0.02) and borderline
increased in CON patients (p = 0.07), whereas there was no significant
effect of exercise on the mental component. Depression score decreased
significantly in HIIT patients (p = 0.04) with no change in CON patients
(p = 0.75), whereas anxiety score decreased significantly in both HIIT (p
< 0.01) and CON (p < 0.05) patients. There were no between-group
differences in any of the measures (all p > 0.05). Arterial stiffness and
biomarkers were not changed, nor did endothelial function change after
HIIT (p = 0.08) or CON (p = 0.68). Conclusions HIIT and CON are both well
tolerated and induce similar improvements in physical components of HRQoL
and in markers of anxiety. Effects of either training modality on vascular
function and biomarkers could not be confirmed.

<12>
Accession Number
2015434312
Authors
Ryan L. Rajah C. Simmers D. Potgieter D. Rodseth R.N.
Institution
(Ryan, Rajah, Rodseth) Perioperative Research Group, Department of
Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine,,
University of KwaZulu-Natal, Pietermaritzburg, South Africa
(Simmers, Potgieter) Department of Anaesthetics, Nelson R. Mandela School
of Medicine, University of KwaZulu-Natal, Durban, South Africa
(Rodseth) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
Title
Preoperative B-type natriuretic peptides in patients undergoing noncardiac
surgery: A cumulative meta-analysis.
Source
Southern African Journal of Anaesthesia and Analgesia. 21 (4) (pp 12-22),
2015. Date of Publication: 2015.
Publisher
Medpharm Publications (PO Box 14804, Lyttelton, Gauteng 0157, South
Africa)
Abstract
Background: A plethora of studies have shown elevated preoperative
natriuretic peptide measurements to predict postoperative mortality and
adverse cardiac events. Objectives: The current study aimed to demonstrate
this overwhelming association and to show that further studies of this
nature are unwarranted. Methods: A cumulative meta-analysis of 28 studies
was conducted where the primary outcomes of mortality and adverse cardiac
events were associated with elevated preoperative natriuretic peptides.
Results: Cumulative meta-analysis demonstrated an odds ratio trending to a
constant of 5.66, with a marked narrowing in the 95% confidence interval.
Conclusions: Further studies aiming only to demonstrate an association
between a preoperative natriuretic peptide threshold and the risk of
postoperative adverse cardiac events are not justified. Future
investigation should focus on the clinical implications of these data and
the application of these findings with regard to further investigation,
optimisation and appropriate adaptation of perioperative management.

<13>
Accession Number
2015433504
Authors
Khand A. Patel B. Palmer N. Jones J. Andron M. Perry R. Mehrotra S.
Mitsudo K.
Institution
(Khand, Jones) Department of Cardiology, University Hospital Aintree NHS
Foundation Trust, Liverpool, United Kingdom
(Khand, Patel, Palmer, Andron, Perry) Department of Cardiology, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Khand) School of Ageing and Chronic Diseases, University of Liverpool,
Liverpool, United Kingdom
(Mehrotra) Department of Cardiology, Narayana Hrudayalaya, Bangalore,
India
(Mitsudo) Department of Cardiology, Kurashiki Central Hospital, Okayama,
Japan
Title
Retrograde wiring of collateral channels of the heart in chronic total
occlusions: A systematic review and meta-analysis of safety, feasibility,
and incremental value in achieving revascularization.
Source
Angiology. 66 (10) (pp 925-932), 2015. Date of Publication: 01 Nov 2015.
Publisher
SAGE Publications Inc.
Abstract
Aim: To conduct a systematic review and meta-analysis on retrograde wiring
in chronic total occlusions (CTOs) with focus on its safety and
feasibility. Methods and Results: We searched publications from 1990 to
December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting
a number of terms relating to the collateral circulation of the heart in
CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO
revascularization attempts fulfilled criteria for a study of retrograde
wiring of collateral channels in CTOs. There were no randomized studies
comparing a primary antegrade with a primary retrograde approach.
Procedural CTO revascularization rates ranged from 67% to 90.6% with a
large proportion having previously failed an "antegrade" approach. The
septal perforator collaterals and epicardial channels were used in 73.2%
(n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary
perforation was not infrequent (n = 90, 5%), serious acute complications
were uncommon; in the combined population 18 cases of cardiac tamponade
(0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was
significantly more likely to be successful compared to epicardial coronary
artery wiring (72.5%) when chosen by the operator as a route of retrograde
access to the CTO body (relative risk 1.11 [95% confidence interval:
1.02-1.20; P =.013]). Conclusion: Successful retrograde wiring of
collateral channels in selected patients undertaken by "CTO dedicated"
operators can significantly enhance the chances of revascularization of
complex CTOs with a low risk of acute serious complications. Septal
perforator channels are significantly more likely to be successfully
retrogradely wired compared to epicardial vessels when either is selected,
by reference to their anatomical suitability by the operator, as a route
of access.

<14>
Accession Number
2015433047
Authors
Hausenloy D.J. Candilio L. Evans R. Ariti C. Jenkins D.P. Kolvekar S.
Knight R. Kunst G. Laing C. Nicholas J. Pepper J. Robertson S. Xenou M.
Clayton T. Yellon D.M.
Institution
(Hausenloy, Candilio, Xenou, Yellon) Hatter Cardiovascular Institute,
University College London, 67 Chenies Mews, London WC1E 6HX, United
Kingdom
(Hausenloy, Yellon) National Institute of Health Research, University
College London Hospitals, Biomedical Research Centre, India
(Evans, Knight, Nicholas, Robertson, Clayton) Clinical Trials Unit, London
School of Hygiene and Tropical Medicine, United Kingdom
(Ariti) Nuffield Trust, United Kingdom
(Kolvekar) Heart Hospital, University College London Hospital, United
Kingdom
(Kunst) King's College London and King's College Hospital, United Kingdom
(Laing) Royal Free Hospital, United Kingdom
(Pepper) National Institute of Health Research Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Trust, London, United
Kingdom
(Jenkins) Papworth Hospital, Cambridge, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Title
Remote ischemic preconditioning and outcomes of cardiac surgery.
Source
New England Journal of Medicine. 373 (15) (pp 1408-1417), 2015. Date of
Publication: 08 Oct 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Whether remote ischemic preconditioning (transient ischemia and
reperfusion of the arm) can improve clinical outcomes in patients
undergoing coronary-artery bypass graft (CABG) surgery is not known. We
investigated this question in a randomized trial. METHODS We conducted a
multicenter, sham-controlled trial involving adults at increased surgical
risk who were undergoing on-pump CABG (with or without valve surgery) with
blood cardioplegia. After anesthesia induction and before surgical
incision, patients were randomly assigned to remote ischemic
preconditioning (four 5-minute inflations and deflations of a standard
blood-pressure cuff on the upper arm) or sham conditioning (control
group). Anesthetic management and perioperative care were not
standardized. The combined primary end point was death from cardiovascular
causes, nonfatal myocardial infarction, coronary revascularization, or
stroke, assessed 12 months after randomization. RESULTS We enrolled a
total of 1612 patients (811 in the control group and 801 in the ischemic-
preconditioning group) at 30 cardiac surgery centers in the United
Kingdom. There was no significant difference in the cumulative incidence
of the primary end point at 12 months between the patients in the remote
ischemic preconditioning group and those in the control group (212
patients [26.5%] and 225 patients [27.7%], respectively; hazard ratio with
ischemic preconditioning, 0.95; 95% confidence interval, 0.79 to 1.15; P =
0.58). Furthermore, there were no significant between- group differences
in either adverse events or the secondary end points of perioperative
myocardial injury (assessed on the basis of the area under the curve for
the high-sensitivity assay of serum troponin T at 72 hours), inotrope
score (calculated from the maximum dose of the individual inotropic agents
administered in the first 3 days after surgery), acute kidney injury,
duration of stay in the intensive care unit and hospital, distance on the
6-minute walk test, and quality of life. CONCLUSIONS Remote ischemic
preconditioning did not improve clinical outcomes in patients undergoing
elective on-pump CABG with or without valve surgery.

<15>
Accession Number
2015433046
Authors
Meybohm P. Bein B. Brosteanu O. Cremer J. Gruenewald M. Stoppe C. Coburn
M. Schaelte G. Boning A. Niemann B. Roesner J. Kletzin F. Strouhal U.
Reyher C. Laufenberg-Feldmann R. Ferner M. Brandes I.F. Bauer M. Stehr
S.N. Kortgen A. Wittmann M. Baumgarten G. Meyer-Treschan T. Kienbaum P.
Heringlake M. Schon J. Sander M. Treskatsch S. Smul T. Wolwender E.
Schilling T. Fuernau G. Hasenclever D. Zacharowski K.
Institution
(Meybohm, Strouhal, Reyher, Zacharowski) Department of Anesthesiology,
Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt,
Theodor-Stern-Kai 7, Frankfurt 60590, Germany
(Meybohm, Bein, Gruenewald) Department of Anesthesiology and Intensive
Care Medicine, United States
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Brosteanu) Clinical Trial Center, Germany
(Fuernau) Department of Internal Medicine/Cardiology, University of
Leipzig Heart Center, Germany
(Hasenclever) Institute for Medical Informatics, Statistics and
Epidemiology, University of Leipzig, Leipzig, Germany
(Stoppe, Coburn, Schaelte) Department of Anesthesiology, University
Hospital Aachen, Aachen, Germany
(Boning, Niemann) Department of Cardiovascular Surgery, University of
Giessen, Giessen, Germany
(Roesner, Kletzin) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Laufenberg-Feldmann, Ferner) Department of Anesthesiology, Medical Center
of Johannes Gutenberg University, Mainz, Germany
(Brandes, Bauer) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Gottingen, Gottingen, Germany
(Stehr, Kortgen) Department of Anesthesiology and Intensive Care Medicine
and Center for Sepsis Control and Care, Jena University Hospital, Jena,
Germany
(Wittmann, Baumgarten) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Meyer-Treschan, Kienbaum) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Dusseldorf, Dusseldorf, Germany
(Heringlake, Schon) Department of Anesthesiology and Intensive Care
Medicine, University of Lubeck, Lubeck, Germany
(Sander, Treskatsch) Department of Anesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite Mitte,
Germany
(Smul, Wolwender) Department of Anesthesiology, University Hospital
Wurzburg, Wurzburg, Germany
(Schilling) Department of Anesthesiology, University Hospital Magdeburg,
Magdeburg, Germany
Title
A multicenter trial of remote ischemic preconditioning for heart surgery.
Source
New England Journal of Medicine. 373 (15) (pp 1397-1407), 2015. Date of
Publication: 08 Oct 2015.
Publisher
Massachussetts Medical Society
Abstract
Remote ischemic preconditioning (RIPC) is reported to reduce biomarkers of
ischemic and reperfusion injury in patients undergoing cardiac surgery,
but uncertainty about clinical outcomes remains. METHODS We conducted a
prospective, double-blind, multicenter, randomized, controlled trial
involving adults who were scheduled for elective cardiac surgery requiring
cardiopulmonary bypass under total anesthesia with intravenous propofol.
The trial compared upper-limb RIPC with a sham intervention. The primary
end point was a composite of death, myocardial infarction, stroke, or
acute renal failure up to the time of hospital discharge. Secondary end
points included the occurrence of any individual component of the primary
end point by day 90. RESULTS A total of 1403 patients underwent
randomization. The full analysis set comprised 1385 patients (692 in the
RIPC group and 693 in the sham-RIPC group). There was no significant
between-group difference in the rate of the composite primary end point
(99 patients [14.3%] in the RIPC group and 101 [14.6%] in the sham-RIPC
group, P = 0.89) or of any of the individual components: death (9 patients
[1.3%] and 4 [0.6%], respectively; P = 0.21), myocardial infarction (47
[6.8%] and 63 [9.1%], P = 0.12), stroke (14 [2.0%] and 15 [2.2%], P =
0.79), and acute renal failure (42 [6.1%] and 35 [5.1%], P = 0.45). The
results were similar in the per-protocol analysis. No treatment effect was
found in any subgroup analysis. No significant differences between the
RIPC group and the sham-RIPC group were seen in the level of troponin
release, the duration of mechanical ventilation, the length of stay in the
intensive care unit or the hospital, new onset of atrial fibrillation, and
the incidence of postoperative delirium. No RIPC-related adverse events
were observed. CONCLUSIONS Upper-limb RIPC performed while patients were
under propofol-induced anesthesia did not show a relevant benefit among
patients undergoing elective cardiac surgery.

<16>
Accession Number
2015430150
Authors
Al Tmimi L. Van de Velde M. Herijgers P. Meyns B. Meyfroidt G. Milisen K.
Fieuws S. Coburn M. Poesen K. Rex S.
Institution
(Al Tmimi, Van de Velde, Rex) University Hospitals of Leuven, Department
of Anesthesiology, KU Leuven - University of Leuven, Herestraat 49, Leuven
B-3000, Belgium
(Van de Velde, Herijgers, Meyns, Rex) KU Leuven - University of Leuven,
Department of Cardiovascular Sciences, Leuven B-3000, Belgium
(Herijgers, Meyns) University Hospitals of Leuven, Department of Cardiac
Surgery, KU Leuven - University of Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Meyfroidt) University Hospitals Leuven, Department of Intensive Care
Medicine, KU Leuven - University of Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Meyfroidt) KU Leuven - University of Leuven, Department of Intensive Care
Medicine and Cellular and Molecular Medicine, Herestraat 49, Leuven
B-3000, Belgium
(Milisen) KU Leuven - University of Leuven, Department of Public Health
and Primary Care, Leuven B-3000, Belgium
(Fieuws) KU Leuven - University of Leuven, I-Biostat, Leuven B-3000,
Belgium
(Coburn) University Hospital of the RWTH Aachen, Department of
Anesthesiology, Aachen, Germany
(Poesen) University Hospitals Leuven, Laboratory Medicine, KU Leuven -
University of Leuven, Herestraat 49, Leuven B-3000, Belgium
(Poesen) KU Leuven - University of Leuven, Department of Neurosciences,
Laboratory for Molecular Neurobiomarker Research, Herestraat 49, Leuven
B-3000, Belgium
Title
Xenon for the prevention of postoperative delirium in cardiac surgery:
Study protocol for a randomized controlled clinical trial.
Source
Trials. 16 (1) , 2015. Article Number: 449. Date of Publication: October
09, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Postoperative delirium (POD) is a manifestation of acute
postoperative brain dysfunction that is frequently observed after cardiac
surgery. POD is associated with short-term complications such as an
increase in mortality, morbidity, costs and length of stay, but can also
have long-term sequelae, including persistent cognitive deficits, loss of
independence, and increased mortality for up to 2 years. The noble gas
xenon has been demonstrated in various models of neuronal injury to
exhibit remarkable neuroprotective properties. We therefore hypothesize
that xenon anesthesia reduces the incidence of POD in elderly patients
undergoing cardiac surgery with the use of cardiopulmonary bypass.
Methods/Design: One hundred and ninety patients, older than 65 years, and
scheduled for elective cardiac surgery, will be enrolled in this
prospective, randomized, controlled trial. Patients will be randomized to
receive general anesthesia with either xenon or sevoflurane. Primary
outcome parameter will be the incidence of POD in the first 5
postoperative days. The occurrence of POD will be assessed by trained
research personnel, blinded to study group, with the validated 3-minute
Diagnostic Confusion Assessment Method (3D-CAM) (on the intensive care
unit in its version specifically adapted for the ICU), in addition to
chart review and the results of delirium screening tools that will be
performed by the bedside nurses). Secondary outcome parameters include
duration and severity of POD, and postoperative cognitive function as
assessed with the Mini-Mental State Examination. Discussion: Older
patients undergoing cardiac surgery are at particular risk to develop POD.
Xenon provides remarkable hemodynamic stability and has been suggested in
preclinical studies to exhibit neuroprotective properties. The present
trial will assess whether the promising profile of xenon can be translated
into a better outcome in the geriatric population. Trial registration:
EudraCT Identifier: 2014-005370-11(13 May 2015).

<17>
Accession Number
2015430147
Authors
Crespo-Leiro M.G. Stypmann J. Schulz U. Zuckermann A. Mohacsi P. Bara C.
Ross H. Parameshwar J. Zakliczynski M. Fiocchi R. Hoefer D. Deng M.
Leprince P. Hiller D. Eubank L. Deljkich E. Yee J.P. Vanhaecke J.
Institution
(Crespo-Leiro) Instituto de Investigacion Biomedica de A Coruna (INIBIC),
Complexo Hospitalario Universitario de A Coruna (CHUAC), SERGAS,
Universidade da Coruna (UDC), Coruna, Spain
(Stypmann) University Hospital Muenster, Muenster, Germany
(Schulz) Ruhr University of Bochum, Bad Oeynhausen, Germany
(Zuckermann) Medical University of Vienna, Vienna, Austria
(Mohacsi) University Hospital Bern, Bern, Switzerland
(Bara) Hannover Medical School, Hannover, Germany
(Ross) Toronto General Hospital, Toronto, Canada
(Parameshwar) Papworth Hospital, Papworth Everard, Cambridge, United
Kingdom
(Zakliczynski) Silesian Center for Heart Disease, Zabrze, Poland
(Fiocchi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Hoefer) Innsbruck Medical University, Innsbruck, Austria
(Deng) David Geffen School of Medicine, University of California, Los
Angeles, United States
(Leprince) Groupe Hospitalier Pitie-Salpetriere, Paris, France
(Hiller, Eubank, Deljkich, Yee) CareDx, Brisbane, United States
(Vanhaecke) University Hospital of Leuven, Leuven, Belgium
(Vanhaecke) Department of Cardiology, Herestraat 49, Leuven 3000, Belgium
Title
Performance of gene-expression profiling test score variability to predict
future clinical events in heart transplant recipients.
Source
BMC Cardiovascular Disorders. 15 (1) , 2015. Article Number: 120. Date of
Publication: October 09, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: A single non-invasive gene expression profiling (GEP) test
(AlloMap) is often used to discriminate if a heart transplant recipient is
at a low risk of acute cellular rejection at time of testing. In a
randomized trial, use of the test (a GEP score from 0-40) has been shown
to be non-inferior to a routine endomyocardial biopsy for surveillance
after heart transplantation in selected low-risk patients with respect to
clinical outcomes. Recently, it was suggested that the within-patient
variability of consecutive GEP scores may be used to independently predict
future clinical events; however, future studies were recommended. Here we
performed an analysis of an independent patient population to determine
the prognostic utility of within-patient variability of GEP scores in
predicting future clinical events. Methods: We defined the GEP score
variability as the standard deviation of four GEP scores collected >315
days post-transplantation. Of the 737 patients from the Cardiac Allograft
Rejection Gene Expression Observational (CARGO) II trial, 36 were assigned
to the composite event group (death, re-transplantation or graft failure
>315 days post-transplantation and within 3 years of the final GEP test)
and 55 were assigned to the control group (non-event patients). In this
case-controlled study, the performance of GEP score variability to predict
future events was evaluated by the area under the receiver operator
characteristics curve (AUC ROC). The negative predictive values (NPV) and
positive predictive values (PPV) including 95 % confidence intervals (CI)
of GEP score variability were calculated. Results: The estimated
prevalence of events was 17 %. Events occurred at a median of 391
(inter-quartile range 376) days after the final GEP test. The GEP
variability AUC ROC for the prediction of a composite event was 0.72 (95 %
CI 0.6-0.8). The NPV for GEP score variability of 0.6 was 97 % (95 % CI
91.4-100.0); the PPV for GEP score variability of 1.5 was 35.4 % (95 % CI
13.5-75.8). Conclusion: In heart transplant recipients, a GEP score
variability may be used to predict the probability that a composite event
will occur within 3 years after the last GEP score. Trial registration:
Clinicaltrials.gov identifier NCT00761787

<18>
Accession Number
2015363529
Authors
Spoelstra-De Man A.M.E. Smit B. Oudemans-Van Straaten H.M. Smulders Y.M.
Institution
(Spoelstra-De Man, Smit, Oudemans-Van Straaten) Department of Intensive
Care, VU University Medical Centre, Amsterdam, Netherlands
(Smulders) Department of Internal Medicine, VU University Medical Centre,
Amsterdam, Netherlands
Title
Cardiovascular effects of hyperoxia during and after cardiac surgery.
Source
Anaesthesia. 70 (11) (pp 1307-1319), 2015. Date of Publication: November
2015.
Publisher
Blackwell Publishing Ltd
Abstract
During and after cardiac surgery with cardiopulmonary bypass, high
concentrations of oxygen are routinely administered, with the intention of
preventing cellular hypoxia. We systematically reviewed the literature
addressing the effects of arterial hyperoxia. Extensive evidence from
pre-clinical experiments and clinical studies in other patient groups
suggests predominant harm, caused by oxidative stress, vasoconstriction,
perfusion heterogeneity and myocardial injury. Whether these alterations
are temporary and benign, or actually affect clinical outcome, remains to
be demonstrated. In nine clinical cardiac surgical studies in low-risk
patients, higher oxygen targets tended to compromise cardiovascular
function, but did not affect clinical outcome. No data about potential
beneficial effects of hyperoxia, such as reduction of gas micro-emboli or
post-cardiac surgery infections, were reported. Current evidence is
insufficient to specify optimal oxygen targets. Nevertheless, the safety
of supraphysiological oxygen suppletion is unproven. Randomised studies
with a variety of oxygen targets and inclusion of high-risk patients are
needed to identify optimal oxygen targets during and after cardiac
surgery.

<19>
Accession Number
2015094380
Authors
Reardon M.J. Adams D.H. Kleiman N.S. Yakubov S.J. Coselli J.S. Deeb G.M.
Gleason T.G. Lee J.S. Hermiller J.B. Chetcuti S. Heiser J. Merhi W. Zorn
G.L. Tadros P. Robinson N. Petrossian G. Hughes G.C. Harrison J.K. Maini
B. Mumtaz M. Conte J.V. Resar J.R. Aharonian V. Pfeffer T. Oh J.K. Qiao H.
Popma J.J.
Institution
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
6550 Fannin, Suite 1401, Houston, TX 77030, United States
(Adams) Mount Sinai Health System, New York, NY, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Coselli) Texas Heart Institute, St. Luke's Medical Center, Houston, TX,
United States
(Deeb, Chetcuti) University of Michigan Medical Center, Ann Arbor, MI,
United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Hermiller) St. Vincent Medical Center, Indianapolis, IN, United States
(Heiser, Merhi) Spectrum Health System, Grand Rapids, MI, United States
(Zorn, Tadros) University of Kansas Hospital, Kansas City, KS, United
States
(Robinson, Petrossian) St. Francis Hospital, Roslyn, NY, United States
(Hughes, Harrison) Duke University Medical Center, Durham, NC, United
States
(Maini, Mumtaz) PinnacleHealth, Wormleysburg, PA, United States
(Conte, Resar) Johns Hopkins Hospital, Baltimore, MD, United States
(Aharonian, Pfeffer) Kaiser Permanente-Los Angeles Medical Center, Los
Angeles, CA, United States
(Oh) Mayo Clinic, Rochester, MN, United States
(Qiao) Medtronic, Inc., Minneapolis, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Title
2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 66 (2) (pp 113-121), 2015.
Article Number: 21354. Date of Publication: 14 Jul 2015.
Publisher
Elsevier USA
Abstract
Background The U.S. pivotal trial for the self-expanding valve found that
among patients with severe aortic stenosis at increased risk for surgery,
the 1-year survival rate was 4.9 percentage points higher in patients
treated with a self-expanding transcatheter aortic valve bioprosthesis
than in those treated with a surgical bioprosthesis. Objectives
Longer-term clinical outcomes were examined to confirm if this mortality
benefit is sustained. Methods Patients with severe aortic stenosis who
were at increased surgical risk were recruited. Eligible patients were
randomly assigned in a 1:1 ratio to transcatheter aortic valve replacement
with the self-expanding transcatheter valve (transcatheter aortic valve
replacement [TAVR] group) or to aortic valve replacement with a surgical
bioprosthesis (surgical group). The 2-year clinical and echocardiographic
outcomes were evaluated in these patients. Results A total of 797 patients
underwent randomization at 45 centers in the United States. The rate of
2-year all-cause mortality was significantly lower in the TAVR group
(22.2%) than in the surgical group (28.6%; log-rank test p < 0.05) in the
as-treated cohort, with an absolute reduction in risk of 6.5 percentage
points. Similar results were found in the intention-to-treat cohort
(log-rank test p < 0.05). The rate of 2-year death or major stroke was
significantly lower in the TAVR group (24.2%) than in the surgical group
(32.5%; log-rank test p = 0.01). Conclusions In patients with severe
aortic stenosis who are at increased surgical risk, the higher rate of
survival with a self-expanding TAVR compared with surgery was sustained at
2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in
the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very
High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).

<20>
Accession Number
2015071348
Authors
Seripa D. Latina P. Fontana A. Gravina C. Lattanzi M. Savino M. Gallo A.P.
Melchionda G. Santini S.A. Margaglione M. Copetti M. di Mauro L. Panza F.
Greco A. Pilotto A.
Institution
(Seripa, Gravina, Panza, Greco, Pilotto) Geriatric Unit and
Gerontology-Geriatrics Research Laboratory, Department of Medical
Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG),
Italy
(Latina, Melchionda) Recovery Unit 1, Emergency Department, IRCCS Casa
Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
(Fontana, Copetti) Biostatistics Unit, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo (FG), Italy
(Lattanzi) Medical Systems S.p.A., Genova, Italy
(Savino, Gallo, di Mauro) Laboratory of Clinical Chemistry, Department of
Clinical Pathology, IRCCS Casa Sollievo della Sofferenza, San Giovanni
Rotondo (FG), Italy
(Santini) Laboratory of Hormonal Analyses and Clinical Molecular Biology,
Department of Diagnostics and Laboratory Medicine, Catholic University
School of Medicine, Rome, Italy
(Margaglione) Chair of Medical Genetics, Department of Biomedical
Sciences, University of Foggia, Foggia, Italy
(Panza) Neurodegenerative Disease Unit, Department of Basic Medicine,
Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
(Panza) Department of Clinical Research in Neurology, University of Bari
Aldo Moro, Pia Fondazione Cardinale G. Panico, Lecce, Italy
(Pilotto) Geriatrics Unit, Azienda ULSS16 Padova, S. Antonio Hospital,
Padova, Italy
Title
Role of CYP2D6 Polymorphisms in the Outcome of Postoperative Pain
Treatment.
Source
Pain Medicine (United States). 16 (10) (pp 2012-2023), 2015. Date of
Publication: October 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objective: To investigate the role of CYP2D6 phenotype in the outcome of
postoperative (PO) pain (POP) treatment. Design: Longitudinal cohort
study. Open-label trial with post hoc analysis. Setting: General Hospital
Surgery and Recovery Units. Patients: Ninety unrelated Caucasians
submitted to abdominal/thoracic surgery. Interventions: Standard
multimodal POP treatment including opioids (tramadol) and nonsteroidal
anti-inflammatory drugs (ketoprofen) at different dosages and infusion
rates according to the predicted mild, moderate, or severe POP. Outcome
Measures: Pain (Numeric Rating Scale-NRS) and sedation (Ramsay Sedation
Scale-RSS) up to 24 hours after surgery. By genotyping 16 CYP2D6 alleles,
the four CYP2D6 phenotypes poor metabolizer (PM), intermediate
metabolizers (IM), extensive metabolizers (EM) and ultrarapid metabolizers
(UM) were predicted. Results: As compared with the CYP2D6-EM phenotype, in
the early PO time (30 min) a higher RSS mean score in IM was observed
(P=0.035). A suggestion towards higher mean score in PM (P=0.091) and a
minor mean score in UM (P=0.091) was also detected. No difference in the
outcome of pain across the CYP2D6 phenotypes was observed. Conclusions: In
respect to the normal CYP2D6 phenotype, our results suggested that slowly
metabolizers (IMs and PMs) might have a major sedation, whereas more rapid
metabolizers (UM) a minor sedation, in the early time after surgery. A
minor role of CYP2D6 phenotype in PO analgesia may be suggested.

<21>
Accession Number
2015433022
Authors
Heiberg J. Redington A. Hjortdal V.E.
Institution
(Heiberg, Hjortdal) Dept. of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200,
Denmark
(Heiberg, Hjortdal) Dept. of Clinical Medicine, Aarhus University
Hospital, Denmark
(Redington) Dept. of Pediatrics, Cincinnati Children's Hospital, United
States
Title
Exercise capacity and cardiac function after surgical closure of
ventricular septal defect - Is there unrecognized long-term morbidity?.
Source
International Journal of Cardiology. 201 (pp 590-594), 2015. Date of
Publication: 10 Oct 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Adult survivors of congenital heart disease form a continuously growing
population, as each successive cohort graduating from pediatric care
expands the total number of patients worldwide. Consequently, there is an
increasing interest and study of their late pathophysiology, the
understanding of which can only truly be understood during very long-term
follow-up. Indeed, we have already learned that, for some patient groups,
hitherto unexpected problems may only develop decades after surgery.
Consequently, many patients require careful follow-up in ACHD clinics
throughout life. However, in the most frequent congenital heart disease,
ventricular septal defect (VSD), most guidelines recommend that
specialized follow-up in ACHD clinics may only be indicated for those
patients with significant residual anatomic problems, or overt pulmonary
hypertension. Indeed, the late outcome for patients undergoing
'uncomplicated' repair in childhood has been described as benign. However,
recent data suggest that such characterization may be premature. Several
studies have described abnormalities of right ventricular structure and
function which, in turn, may be directly related to abnormal functional
capacity when formally tested. Furthermore, the longer-term implications
of e.g. right bundle branch block and chronotropic incompetence continue
to be explored. In this review we will examine these emerging data, and
discuss whether amendments to the international guidelines for these
patients' may be justified.

<22>
Accession Number
2015432631
Authors
Whitlock R.P. Devereaux P.J. Teoh K.H. Lamy A. Vincent J. Pogue J.
Paparella D. Sessler D.I. Karthikeyan G. Villar J.C. Zuo Y. Avezum A.
Quantz M. Tagarakis G.I. Shah P.J. Abbasi S.H. Zheng H. Pettit S.
Chrolavicius S. Yusuf S.
Institution
(Whitlock, Devereaux, Lamy, Vincent, Pogue, Pettit, Chrolavicius, Yusuf)
Population Health Research Institute, Hamilton Health Sciences and
McMaster University, Hamilton, ON L8L 2X2, Canada
(Whitlock, Lamy) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock, Devereaux, Lamy) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Devereaux, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Teoh) Department of Surgery, Southlake Regional Health Centre, Newmarket,
ON, Canada
(Paparella) University of Bari Aldo Moro, Bari, Italy
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Karthikeyan) All India Institute of Medical Sciences, New Delhi, India
(Villar) Fundacion Cardio Infantil, Instituto de Cardiologia, Bogota,
Colombia
(Zuo) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Avezum) Divisao de Pesquisa, Instituto Dante Pazzanese de Cardiologia,
Sao Paulo, Brazil
(Quantz) London Health Sciences Centre, London, ON, Canada
(Tagarakis) Department of Cardiovascular and Thoracic Surgery, University
of Thessaly, Larissa, Greece
(Shah) Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD,
Australia
(Abbasi) Tehran Heart Centre, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Zheng) First Teaching Hospital, Xinjiang Medical University, Urumqi,
China
Title
Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): A
randomised, double-blind, placebo-controlled trial.
Source
The Lancet. 386 (10000) (pp 1243-1253), 2015. Date of Publication: 26 Sep
2015.
Publisher
Lancet Publishing Group
Abstract
Background Cardiopulmonary bypass initiates a systemic inflammatory
response syndrome that is associated with postoperative morbidity and
mortality. Steroids suppress inflammatory responses and might improve
outcomes in patients at high risk of morbidity and mortality undergoing
cardiopulmonary bypass. We aimed to assess the effects of steroids in
patients at high risk of morbidity and mortality undergoing
cardiopulmonary bypass. Methods The Steroids In caRdiac Surgery (SIRS)
study is a double-blind, randomised, controlled trial. We used a central
computerised phone or interactive web system to randomly assign (1:1)
patients at high risk of morbidity and mortality from 80 hospital or
cardiac surgery centres in 18 countries undergoing cardiac surgery with
the use of cardiopulmonary bypass to receive either methylprednisolone
(250 mg at anaesthetic induction and 250 mg at initiation of
cardiopulmonary bypass) or placebo. Patients were assigned with block
randomisation with random block sizes of 2, 4, or 6 and stratified by
centre. Patients aged 18 years or older were eligible if they had a
European System for Cardiac Operative Risk Evaluation of at least 6.
Patients were excluded if they were taking or expected to receive systemic
steroids in the immediate postoperative period or had a history of
bacterial or fungal infection in the preceding 30 days. Patients,
caregivers, and those assessing outcomes were masked to allocation. The
primary outcomes were 30-day mortality and a composite of death and major
morbidity (ie, myocardial injury, stroke, renal failure, or respiratory
failure) within 30 days, both analysed by intention to treat. Safety
outcomes were also analysed by intention to treat. This study is
registered with ClinicalTrials.gov, number NCT00427388. Findings Patients
were recruited between June 21, 2007, and Dec 19, 2013. Complete 30-day
data was available for all 7507 patients randomly assigned to
methylprednisolone (n=3755) and to placebo (n=3752). Methylprednisolone,
compared with placebo, did not reduce the risk of death at 30 days (154
[4%] vs 177 [5%] patients; relative risk [RR] 087, 95% CI 070-107, p=019)
or the risk of death or major morbidity (909 [24%] vs 885 [24%]; RR 103,
95% CI 095-111, p=052). The most common safety outcomes in the
methylprednisolone and placebo group were infection (465 [12%] vs 493
[13%]), surgical site infection (151 [4%] vs 151 [4%]), and delirium (295
[8%] vs 289 [8%]). Interpretation Methylprednisolone did not have a
significant effect on mortality or major morbidity after cardiac surgery
with cardiopulmonary bypass. The SIRS trial does not support the routine
use of methylprednisolone for patients undergoing cardiopulmonary bypass.
Funding Canadian Institutes of Health Research.

<23>
Accession Number
2015430681
Authors
Al Tmimi L. Van Hemelrijck J. Van De Velde M. Sergeant P. Meyns B. Missant
C. Jochmans I. Poesen K. Coburn M. Rex S.
Institution
(Al Tmimi, Van Hemelrijck, Van De Velde, Missant, Rex) Department of
Anaesthesiology, KU Leuven, University of Leuven, Herestraat 49, Leuven
B-3000, Belgium
(Sergeant, Meyns) Department of Cardiac Surgery, KU Leuven, University of
Leuven, Herestraat 49, Leuven B-3000, Belgium
(Jochmans) Department of Abdominal Transplant Surgery, KU Leuven,
University of Leuven, Herestraat 49, Leuven B-3000, Belgium
(Poesen) Department of Laboratory Medicines, KU Leuven, University of
Leuven, Herestraat 49, Leuven B-3000, Belgium
(Van Hemelrijck, Van De Velde, Sergeant, Meyns, Missant, Rex) Department
of Cardiovascular Sciences, KU Leuven, University of Leuven, Herestraat
49, Leuven B-3000, Belgium
(Jochmans) Department of Microbiology and Immunology, KU Leuven,
University of Leuven, Herestraat 49, Leuven B-3000, Belgium
(Poesen) Department of Neurosciences, KU Leuven, University of Leuven,
Herestraat 49, Leuven B-3000, Belgium
(Coburn) Department of Anaesthesiology, University Hospital of the RWTH
Aachen, Aachen, Germany
Title
Xenon anaesthesia for patients undergoing off-pump coronary artery bypass
graft surgery: A prospective randomized controlled pilot trial.
Source
British Journal of Anaesthesia. 115 (4) (pp 550-559), 2015. Date of
Publication: October 2015.
Publisher
Oxford University Press
Abstract
Background Off-pump coronary artery bypass (OPCAB) surgery carries a high
risk for haemodynamic instability and perioperative organ injury.
Favourable haemodynamic effects and organ-protective properties could
render xenon an attractive anaesthetic for OPCAB surgery. The primary aim
of this study was to assess whether xenon anaesthesia for OPCAB surgery is
non-inferior to sevoflurane anaesthesia with regard to intraoperative
vasopressor requirements. Methods Forty-two patients undergoing elective
OPCAB surgery were enrolled in this prospective, single-blind, randomized
controlled pilot trial. Patients were randomized to either xenon (50-60
vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was
intraoperative noradrenaline requirements necessary to achieve predefined
haemodynamic goals. Secondary outcomes included safety variables such as
the occurrence of adverse events (intraoperatively and during a 6-month
follow-up after surgery) and the perioperative cardiorespiratory and
inflammatory profile. Results Baseline and intraoperative data did not
differ between groups. Xenon was non-inferior to sevoflurane, as xenon
patients required significantly less noradrenaline intraoperatively to
achieve the predefined haemodynamic goals {geometric mean 428 [95%
confidence interval (CI) 312, 588] vs 1702 [1267, 2285] mug, P<0.0001}. No
differences were found for safety. Significantly more sevoflurane patients
developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The
average arterial pressure was lower in the sevoflurane group {median75
[interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences
were found for other haemodynamic parameters, the respiratory profile and
the perioperative release of inflammatory cytokines, troponin T, serum
protein S-100beta and erythropoietin. Conclusions Compared with
sevoflurane, xenon anaesthesia allows a significant reduction in
vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia
was associated with a lower risk for POD, a finding that has to be
confirmed in larger studies. Clinical trial registration
ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12).

<24>
Accession Number
2015431844
Authors
Wang M. Zhang G. Wang Y. Zhou K. Liu T. Zhang Y. Guo A. An Y. Zhang X. Li
Y.
Institution
(Wang, Zhang, Wang, Zhou, Liu, Zhang, Guo, An, Zhang, Li) Department of
Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang,
Hebei, China
Title
Bivalirudin plus loading dose of cilostazol-based triple-antiplatelet in
treatment of non-ST-elevation myocardial infarction following percutaneous
coronary intervention.
Source
Therapeutics and Clinical Risk Management. 11 (pp 1469-1473), 2015. Date
of Publication: 28 Sep 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objective: To study the effect of bivalirudin plus loading dose of
cilostazol-based triple-antiplatelet therapy strategy in patients
undergoing percutaneous coronary intervention (PCI). Methods: One hundred
and fifty-three patients with non-ST-segment elevation myocardial
infarction who underwent PCI were divided into control group and
cilostazol group. Patients in control group were given aspirin and
clopidogrel and those in cilostazol group were given aspirin, clopidogrel,
and cilostazol once 2 hours before PCI and for 30 days after PCI.
Bivalirudin was given to all patients before and during the PCI. Results:
After PCI, the Thrombolysis In Myocardial Infarction myocardial perfusion
grade (TMPG) III in cilostazol group was higher than that in control group
(89.19% versus 72.15%, P, 0.05). At 30 days, the incidence of major
adverse cardiac events was significantly lower in cilostazol group
compared with that in control group (6.76% versus 17.72%, P, 0.05).
However, the rates of cardiac death, nonfatal reinfarction, target vessel
revascularization, new congestive heart failure, and subacute stent
thrombosis did not significantly differ between the two groups. In
addition, the rates of minor or major bleeding or thrombocytopenia did not
significantly differ between the two groups. Conclusion: Bivalirudin plus
loading dose of cilostazol-based triple-antiplatelet therapy strategy in
PCI increased TMPG III, decreased major adverse cardiac events, and did
not increase the incidence of bleeding and thrombocytopenia.

<25>
Accession Number
2015325292
Authors
Xu L. Yu C. Jiang J. Zheng H. Yao S. Pei L. Sun L. Xue F. Huang Y.
Institution
(Xu, Yu, Huang) Department of Anesthesiology, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Jiang, Xue) Department of Epidemiology and Biostatistics, Institute of
Basic Medical Science, Chinese Academy of Medical Sciences, Beijing, China
(Zheng) Department of Anesthesiology, First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Yao) Department of Anesthesiology, Union Hospital, Tong Ji Medical
College, Huazhong University of Science and Technology, Wuhan, Hubei,
China
(Pei) Department of Anesthesiology, First Affiliated Hospital of China
Medical University Graduate School, Shenyang, Liaoning, China
(Sun) Department of Anesthesiology, Cancer Hospital of Chinese Academy of
Medical Sciences, Beijing, China
Title
Major adverse cardiac events in elderly patients with coronary artery
disease undergoing noncardiac surgery: A multicenter prospective study in
China.
Source
Archives of Gerontology and Geriatrics. 61 (3) (pp 503-509), 2015. Date of
Publication: November 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Major adverse cardiac events (MACEs) are important causes of
perioperative morbidity and mortality for elderly patients undergoing
non-cardiac surgery. Treatment and control rates for coronary artery
disease (CAD) in Chinese patients are poorer than rates in western
countries. However, no previous prospective study has focused on
perioperative MACE in this population. Our aim was to ascertain the
incidence and risk factors associated with MACEs in Chinese patients.
Methods: Consecutive CAD patients, aged >60 years, who underwent
non-cardiac surgery at five medical centers in China, were prospectively
enrolled. Clinical variables, including electrocardiogram and troponin I
levels, were evaluated to estimate MACEs. The main outcome was occurrence
of at least one perioperative MACE from admittance to 30 days after
surgery, defined as any of the following complications: cardiac death,
nonfatal cardiac arrest, acute myocardial infarction (MI), congestive
heart failure (CHF), and angina. MACE independent risk factors were based
on the Andersen-Gill multiplicative intensity model. Results: Of the 1422
patients recruited, 129 (9.1%) developed at least one MACE, and cardiac
death occurred in 11 patients (0.8%). The independent risk factors
contributing to postoperative MACE included age >75 years, female gender,
history of MI, history of hypertension, high-risk surgery, intraoperative
hypotension, and intraoperative hypoxemia. Conclusions: The incidence of
MACE in Chinese elderly patients with CAD who underwent non-cardiac
surgery was 9.1%. Seven independent risk factors for a perioperative MACE
were identified. Preventing intraoperative hypoxemia and hypotension may
reduce the occurrence of MACE in these high risk patients.

<26>
Accession Number
2015428009
Authors
Nosotti M. Rosso L. Tosi D. Palleschi A. Mendogni P. Righi I. Marenghi C.
Santambrogio L.
Institution
(Nosotti, Rosso, Tosi, Palleschi, Mendogni, Righi, Santambrogio) Thoracic
Surgery and Lung Transplant Unit, Fondazione IRCCS Ca Granda Ospedale
Maggiore Policlinico, University of Milan, Milan, Italy
(Marenghi) Department of Anesthesia and Intensive Care, Fondazione IRCCS
Ca Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Title
Preventive analgesia in thoracic surgery: Controlled, randomized,
double-blinded study.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 428-434), 2015.
Date of Publication: 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Preventive analgesia is defined as a treatment that is
commenced before the surgical procedure in order to diminish the
physiological consequences of afferent nociceptive transmission caused by
the procedure and prevent central sensitization. The analysis of
randomized studies of preventive analgesia is controversial. The aim of
this study was to check the analgesic efficacy of preoperative
administration of dextromethorphan associated with intercostal nerve block
with levobupivacaine in thoracotomy patients who refused or had a
contraindication to epidural analgesia. METHODS: This study was a
four-arm, double-blinded, randomized placebo-controlled trial. Patients
were allocated following close block randomization into four arms: 'Group
A' preoperative dextromethorphan and preoperative intercostal block (IB),
'Group B' preoperative placebo and preoperative IB, 'Group C' preoperative
dextromethorphan and postoperative IB, 'Group D' preoperative placebo and
postoperative block. The primary end-point was the cumulative morphine
consumption (CMC) within the first 14 days after surgery. RESULTS: A total
of 400 patients were enrolled and 395 completed the study. There were no
statistical differences among the groups in terms of demographic and
surgical data; in contrast, preoperative quality-of-life scores were
heterogeneous. The mean CMCs were as follows: Group A 111.4 mg, Group B
121.5 mg, Group C 126.8 mg, Group D 138.3 mg. Group A mean was lower than
the maximum (P = 0.0001). The CMC value did not correlate with age, sex,
body mass index, education, type of surgery, length or width of the
incision and rib fracture. Postoperative functional data and
post-thoracotomy syndrome prevalence were homogeneous; female gender
resulted predictive for post-thoracotomy syndrome. CONCLUSIONS: Results
indicate that preoperative administration of dextromethorphan associated
with preoperative IB with levobupivacaine provided preventive analgesia,
decreasing analgesic administration during the early postoperative period
compared with placebo and/or postoperative IB. This study failed in
detecting any effect of preventive analgesia on functional items and
post-thoracotomy syndrome.

<27>
Accession Number
2015428001
Authors
Gaudino M. Leone A. Lupascu A. Toesca A. Mazza A. Ponziani F.R. Flore R.
Tondi P. Massetti M.
Institution
(Gaudino, Leone, Mazza, Massetti) Department of Cardiovascular Science,
Catholic University, Rome, Italy
(Lupascu, Ponziani, Flore, Tondi) Department of Angiology, Catholic
University, Rome, Italy
(Toesca) Department of Human Anatomy, Catholic University, Rome, Italy
Title
Morphological and functional consequences of transradial coronary
angiography on the radial artery: Implications for its use as a bypass
conduit.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 370-374), 2015.
Date of Publication: 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: To assess the degree of damage to the radial artery (RA) in
coronary artery bypass grafting (CABG) patients who underwent preoperative
transradial coronary angiography (RA-CA). METHODS: From May 2012 to
October 2013, 50 consecutive CABG patients who underwent RA-CA were
prospectively enrolled in the study. All patients underwent echo-Doppler
evaluation of the RA of the catheterized arm; the contralateral RA was
used as control. The distal segment of the RA was submitted to
immunohistochemical assessment of endothelial integrity. Patients were
divided in three groups according to the time interval from angiography to
evaluation: <24 h, >24 h to <7 days and >7 days. RESULTS: Baseline RA
median diameters were 0.25 +/- 0.04 cm in the cannulated arm and 0.22 +/-
0.04 cm in the non-cannulated arm (P = 0.01). The flow-mediated dilatation
(FMD) in the RA in the catheterized arm and in the control arm were 11.6
+/- 7.9 and 14.2 +/- 8.9 (P = 0.01), respectively. A statistically
significant correlation was found between FMD of the catheterized RA and
the time from RA-CA (Pearson's r = 0.348). Linear regression analysis
confirmed that the FMD of the catheterized RA was dependent on days
elapsed from the procedure (P = 0.032; OR 1.11, CI 0.009-0.203).
Immunohistochemical evaluation showed extensive endothelial lesion in all
examined RAs, with a trend towards reduction of the damage with time.
Endothelial function and integrity of the cannulated arm did not reach
those of the control arm in any of the study patients. CONCLUSIONS: RA-CA
produces extensive damage to the RA. The lesions tend to heal with time
but incomplete recovery of endothelial integrity and function is still
present more than 30 days after the procedure. After RA-CA, the cannulated
RA should not be used for CABG.

<28>
Accession Number
2015427999
Authors
Senanayake E.L. Howell N.J. Ranasinghe A.M. Drury N.E. Freemantle N.
Frenneaux M. Oelofse T. Green D. Wilson I.C. Rooney S.J. Mascaro J. Graham
T.R. Bhudia S. Lewis M. Pagano D.
Institution
(Senanayake, Howell, Ranasinghe, Drury, Wilson, Rooney, Mascaro, Graham,
Pagano) Department of Cardiothoracic Surgery, University Hospitals
Birmingham NHS FT, Birmingham, United Kingdom
(Senanayake, Howell, Ranasinghe) School of Clinical and Experimental
Medicine, University of Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Frenneaux) School of Medicine, University of Aberdeen, Aberdeen, United
Kingdom
(Oelofse, Green) Department of Cardiothoracic Anaesthesia, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
(Bhudia) Department of Cardiothoracic Surgery, University Hospital
Coventry and Warwickshire, Coventry, United Kingdom
(Lewis) Department of Cardiothoracic Surgery, Royal Sussex County
Hospital, Brighton, United Kingdom
Title
Multicentre double-blind randomized controlled trial of perhexiline as a
metabolic modulator to augment myocardial protection in patients with left
ventricular hypertrophy undergoing cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 354-362), 2015.
Date of Publication: 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Patients undergoing cardiac surgery require adequate
myocardial protection. Manipulating myocardial metabolism may improve the
extent of myocardial protection. Perhexiline has been shown to be an
effective anti-anginal agent due to its metabolic modulation properties by
inhibiting the uptake of free fatty acids into the mitochondrion, and
thereby promoting a more efficient carbohydrate- driven myocardial
metabolism. Metabolic modulation may augment myocardial protection,
particularly in patients with left ventricular hypertrophy (LVH) known to
have a deranged metabolic state and are at risk of poor postoperative
outcomes. This study aimed to evaluate the role of perhexiline as an
adjunct in myocardial protection in patients with LVH secondary to aortic
stenosis (AS), undergoing an aortic valve replacement (AVR). METHODS: In a
multicentre double-blind randomized controlled trial of patients with AS
undergoing AVR +/- coronary artery bypass graft surgery, patients were
randomized to preoperative oral therapy with either perhexiline or
placebo. The primary end point was incidence of inotrope use to improve
haemodynamic performance due to a low cardiac output state during the
first 6 h of reperfusion, judged by a blinded end points committee.
Secondary outcome measures included haemodynamic measurements,
electrocardiographic and biochemical markers of new myocardial injury and
clinical safety outcome measures. RESULTS: The trial was halted early on
the advice of the Data Safety and Monitoring Board. Sixty-two patients
were randomized to perhexiline and 65 to placebo. Of these, 112 (54
perhexiline and 48 placebo) patients received the intervention, remained
in the trial at the time of the operation and were analysed. Of 110
patients who achieved the primary end point, 30 patients (16 perhexiline
and 14 placebo) had inotropes started appropriately; there was no
difference in the incidence of inotrope usage OR of 1.65 [confidence
interval (CI): 0.67- 4.06] P = 0.28. There was no difference in myocardial
injury as evidenced by electrocardiogram odds ratio (OR) of 0.36 (CI:
0.07-1.97) P = 0.24 or postoperative troponin release. Gross secondary
outcome measures were comparable between the groups. CONCLUSIONS:
Perhexiline as a metabolic modulator to enhance standard myocardial
protection does not provide an additional benefit in haemodynamic
performance or attenuate myocardial injury in the hypertrophied heart
secondary to AS. The role of perhexiline in cardiac surgery is limited.

<29>
Accession Number
2015427998
Authors
Saurav A. Alla V.M. Kaushik M. Hunter C.C. Mooss A.V.
Institution
(Saurav, Alla, Kaushik, Hunter, Mooss) Division of Cardiology, Creighton
University Medical Center, Omaha, NE, United States
Title
Outcomes of mitral valve repair compared with replacement in patients
undergoing concomitant aortic valve surgery: A meta-analysis of
observational studies.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 347-353), 2015.
Date of Publication: 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Long-term superiority of mitral valve (MV) repair compared with
replacement is well established in degenerative MV disease. In rheumatic
heart disease, its advantages are unclear and it is often performed in
conjunction with aortic valve (AV) replacement. Herein, we performed a
systematic review and meta-analysis comparing outcomes of MV repair vs
replacement in patients undergoing concomitant AV replacement. PubMed,
Cochrane and Web of Science databases were searched up to 25 January 2014
for English language studies comparing outcomes of MV repair vs
replacement in patients undergoing simultaneous AV replacement. Data of
selected studies were extracted. Study quality, publication bias and
heterogeneity were assessed. Analysis was performed using a random effects
model (meta-analysis of observational studies in epidemiology
recommendation). A total of 1202 abstracts/titles were screened. Of these,
20 were selected for full text review and 8 studies (3924 patients) were
included in the final analysis: 1255 underwent MV repair and 2669
underwent replacement. Late outcome data were available in seven studies
(cumulative follow-up: 15 654 patient-years). The early (in hospital and
up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95%
confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days
post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were
significantly lower in the MV repair group compared with the MV
replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P
= 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI:
0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI:
0.49-1.57, P = 0.659) were found to be comparable between the two groups.
In a separate analysis of studies with exclusively rheumatic patients (n =
1106), the early as well as late mortality benefit of MV repair was lost
(RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P
= 0.199, respectively), whereas the MV reoperation rate became
significantly higher (RR: 5.10, 95% CI: 1.62- 16.05, P = 0.005) with MV
repair. In patients undergoing concomitant mitral and AV surgery, MV
repair is associated with improved early and late survival without any
increased risk for mitral valve reoperation. However, in patients with
rheumatic heart disease MV repair does not impart any survival advantage
while the risk forMV reoperation remains significantly higher.

<30>
Accession Number
72036862
Authors
Binaghi G. Boi A. Congia D. Deidda M. Lilliu M. Loi B. Melis M. Pani A.
Serra E. Porcu M.
Institution
(Binaghi, Boi, Congia, Loi, Melis, Pani, Serra, Porcu) G. Brotzu Hospital,
Department of Cardiology, Cagliari, Italy
(Deidda, Lilliu) University of Cagliari, Cagliari, Italy
Title
Intra-aortic balloon pump counterpulsation in acute coronary syndromes
complicated by cardiogenic shock: What has changed after the IABP-SHOCK II
trial.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2014 Geneva Switzerland. Conference Start: 20141018
Conference End: 20141020. Conference Publication: (var.pagings). 3 (2
SUPPL. 1) (pp 116), 2014. Date of Publication: October 2014.
Publisher
SAGE Publications Inc.
Abstract
Cardiogenic shock (CS) complicates about 4-12% of acute coronary syndromes
(ACS) and is characterized by a high mortality, regardless of its
treatment. In the past, intraaortic balloon counterpulsation (IABP) has
been widely used in CS. However, its efficacy has been questioned by
recent meta-analysis and, in particular by the results of the IABP-SHOCK
II trial. Aim: To evaluate if the clinical use of IABP in CS in a tertiary
referral center was influenced by the more recent data of literature.
Methods: We evaluated retrospectively the use of IABP in patients who were
intended to undergo a primary PCI (pPCI) for ACS fifteen months before
(preS) and fifteen months after (postS) the presentation of the IABP-SHOCK
II trial (ESC Congress 2012, Munich). The analyzed period started on June
2011 and finished in December 2013. The whole month of September 2012 was
intended as a blanking period and was excluded from this analysis. The use
of IABP was decided by the cardiological team on the basis of the clinical
profile of each patient. Results: A total of 554 accesses for pPCI were
performed in the study period, 259 in preS and 295 in postS. In the whole
population, 23 pts (4,1%) underwent IABP, 12 (4,6%) in the preS and 11
(3,7%) in the postS group, p:0.67; of them, 21 (91%) were males (11 of
preS and 10 of postS, p:0.39). The mean age was 61,4+/-10,4 years
(59,6+/-10,2 in preS and 63,4+/-10,7 in postS, p:0.39). In only 13 pts
(56%) the time elapsed between the onset of symptoms and the PCI (TIT) was
<3 hours and no significant difference were found between preS and postS
groups (p:0.68). A left main and/ or 3-vessel coronary artery disease was
detected in all pts of preS, while in postS in 73% (n:8) of the cases
(p:0.09). Total in-hospital mortality was 43% (n:10), of which, 3 pts in
preS (25%) and 7 in postS (64%) [p:0.10]. In the whole population 3 pts
died in cath lab, all belonging to postS. Two pts for each analyzed period
underwent urgent cardiac surgery. Conclusions: Our data, albeit limited
and related to a monocentric series, confirm that utilization of IABP in
ACS is rare and show a non significant difference in the use of that in
the two analyzed periods. Moreover, the data suggest that, in the postS
period, our centre used IABP likely in pts even more critical; in fact,
they had more than twice the mortality, despite is not a significant
difference, maybe due to the small population size, and regardless of TIT
was similar between two groups and the coronary disease had a tendency to
be more complex in preS. Further and larger studies will likely confirm
whether or not these data.