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

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

<3>
Accession Number
2015148147
Authors
Duan X. Li J. Zhang Q. Zeng Z. Luo Y. Jiang J. Chen Y.
Institution
(Duan, Zhang, Zeng, Luo, Jiang, Chen) Division of Cardiology, West China
Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
(Li) Department of Clinical Epidemiology, West China Hospital, Sichuan
University, Chengdu, Sichuan Province 610041, China
Title
Prognostic value of late gadolinium enhancement in dilated cardiomyopathy
patients: A meta-analysis.
Source
Clinical Radiology. 70 (9) (pp 999-1008), 2015. Date of Publication: 01
Sep 2015.
Publisher
W.B. Saunders Ltd
Abstract
Aim To evaluate the association between late gadolinium enhancement (LGE)
at cardiac magnetic resonance (CMR) and major adverse events in dilated
cardiomyopathy (DCM) patients. Materials and methods Databases, including
PubMed, Ovid, and EMBASE, were searched for studies evaluating LGE at CMR
in DCM patient prognostication. Clinical outcomes were analysed using
fixed-effects models or, in cases of significant heterogeneity,
random-effects models. Results In the meta-analysis of 13 studies on 1675
DCM patients with a mean follow-up of 3 years, LGE is associated with
all-cause mortality (pooled odds ratio, 3.43 [95% confidence interval,
2.26-5.22], p<0.00001), cardiac death/transplantation (3.65 [1.80-7.40],
p=0.0003), hospitalisation for heart failure (2.87 [1.53-5.39], p=0.001),
major arrhythmia events (sudden cardiac death, sustained ventricular
tachycardia or fibrillation, appropriate implantable
cardioverter-defibrillator (ICD) discharge/pacing, and syncope: 4.24
[2.95-6.08], p<0.00001), and sudden cardiac death (3.33 [1.80-6.17],
p=0.0001). Conclusion LGE in DCM patients appears to be associated with
mortality and major cardiac events, underscoring its potential as an
independent index for risk stratification and treatment guidance.

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

<5>
Accession Number
2015097696
Authors
Qi Z. Duan F. Liu S. Lv X. Wang H. Gao Y. Wang J.
Institution
(Qi, Duan, Lv, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, Beijing, China
Title
Effects of bone marrow mononuclear cells delivered through a graft vessel
for patients with previous myocardial infarction and chronic heart
failure: An echocardiographic study of left ventricular function.
Source
Echocardiography. 32 (6) (pp 937-946), 2015. Date of Publication: 01 Jun
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives The graft of stem cells to treat ischemic cardiomyopathy is
popular in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through graft vessels to
improve left ventricular function of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Methods
Forty-two patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: CABG only (18 in
CABG group), or CABG with BMMNC transplantation (24 in CABG + BMMNC
group). Echocardiographic parameters of systolic function were measured on
B-mode imaging, tissue Doppler imaging (TDI), two-dimensional (2D) strain
imaging, and 8 parameters were measured totally. Echocardiographic
parameters of diastolic function were measured on pulsed-wave Doppler
imaging, TDI, and 2D strain rate imaging; 17 parameters were measured
totally. Results Postoperative left ventricular ejection fraction (LVEF)
versus preoperative LVEF were 49.083 +/- 1.914% versus 36.042 +/- 1.185%
(P < 0.05) in CABG + BMMMNC group and 41.389 +/- 2.210% versus 34.667 +/-
1.369% (P < 0.05) in CABG group, global longitudinal strain were -12.542
+/- 0.512% versus -7.083 +/- 0.583% (P < 0.05) in CABG + BMMMNC group and
-9.278 +/- 0.591% versus -7.000 +/- 0.673% (P < 0.05) in CABG group, mLsr1
were -0.108 +/- 0.018/sec versus -0.039 +/- 0.017/sec (P < 0.05) in
CABG+BMMMNC group and -0.048 +/- 0.021/sec versus 0.004 +/- 0.020/sec (P <
0.05) in CABG group, mLsr2 were -0.055 +/- 0.013/sec versus -0.009 +/-
0.015/sec (P < 0.05) in CABG + BMMMNC group and 0.004 +/- 0.015/sec versus
0.024 +/- 0.017/sec (P < 0.05) in CABG group, and Aa1 were 7.303 +/- 0.479
cm/sec versus 5.131 +/- 0.381 cm/sec (P < 0.05) in CABG + BMMMNC group and
7.908 +/- 0.553 cm/sec versus 6.764 +/- 0.440 cm/sec (P < 0.05) in CABG
group. Parameters above were significantly improved postoperatively in
both groups. The degree of the improvement was significantly different
between the two groups with the CABG + BMMNC group improved more versus
the group of CABG only (P < 0.05). Conclusions The improvement of left
ventricular function in CABG + BMMNC group is better than CABG group. 2D
strain and strain rate imaging is a more sensitive tool to evaluate left
ventricular function.

<6>
Accession Number
2014914951
Authors
Wang H.-X. Dong P.-S. Li Z.-J. Wang H.-L. Wang K. Liu X.-Y.
Institution
(Wang, Dong, Li, Wang, Wang, Liu) Department of Cardiology, First
Affiliated Hospital of Henan Science and Technology University, No. 24
Jinghua Road, Jianxi District, Luoyang 471003, China
Title
Application of intravascular ultrasound in the emergency diagnosis and
treatment of patients with ST-segment elevation myocardial infarction.
Source
Echocardiography. 32 (6) (pp 1003-1008), 2015. Date of Publication: 01 Jun
2015.
Publisher
Blackwell Publishing Inc.
Abstract
Purpose This study aimed to examine the application of intravascular
ultrasound (IVUS) in ST-segment elevation myocardial infarction (STEMI)
patients with high thrombus burden (thrombus grade >3) undergoing
emergency diagnosis and primary percutaneous coronary intervention.
Methods Eighty STEMI patients were enrolled and randomly assigned to the
IVUS-guided group (38 patients) or non-IVUS group (42 patients). Stent
implantation was performed in non-IVUS group patients. IVUS group patients
were further divided into low-risk and high-risk patients on the basis of
IVUS evaluation for determining whether stenting should be performed.
Major adverse cardiac event (MACE) rates, changes in the left ventricular
end-diastolic diameter (LVEDD) and ejection fraction (EF) values, and
stent numbers were examined during hospitalization, and follow-up was
performed at 1, 3, 6, and 12 months postoperatively. Results During
hospitalization, there were no significant differences in the MACE rates,
LVEDD, and EF values and in the follow-up outcomes at 1, 3, 6, and 12
months postoperatively among the patients in the 2 groups (P > 0.05). A
significantly lower number of stents were implanted in the IVUS group than
in the non-IVUS group patients (P < 0.05). Conclusion During the
IVUS-guided emergency intervention, enhanced antithrombotic therapy and
best medical care for low-risk STEMI patients may be feasible.

<7>
Accession Number
2015472713
Authors
Reinohl J. Kaier K. Gutmann A. Sorg S. von zur Muhlen C. Siepe M. Baumbach
H. Moser M. Geibel A. Zirlik A. Blanke P. Vach W. Beyersdorf F. Bode C.
Zehender M.
Institution
(Reinohl, Kaier, Gutmann, von zur Muhlen, Moser, Geibel, Zirlik, Bode,
Zehender) Heart Center Freiburg University, Department of Cardiology and
Angiology I, Hugstetter Str. 55, Freiburg 79106, Germany
(Sorg, Siepe, Beyersdorf) Heart Center Freiburg University, Department of
Cardiovascular Surgery, Freiburg, Germany
(Blanke) Medical Center-University of Freiburg, Department of Diagnostic
Radiology, Freiburg, Germany
(Baumbach) Robert-Bosch-Krankenhaus Stuttgart, Department of
Cardiovascular Surgery, Stuttgart, Germany
(Kaier, Vach) Medical Center-University of Freiburg, Center for Medical
Biometry and Medical Informatics, Freiburg, Germany
Title
In-hospital resource utilization in surgical and transcatheter aortic
valve replacement.
Source
BMC Cardiovascular Disorders. 15 (1) , 2015. Article Number: 132. Date of
Publication: October 22, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Little is known about preoperative predictors of resource
utilization in the treatment of high-risk patients with severe symptomatic
aortic valve stenosis. We report results from the prospective,
medical-economic "TAVI Calculation of Costs Trial". Methods: In-hospital
resource utilization was evaluated in 110 elderly patients (age > 75
years) treated either with transfemoral (TF) or transapical (TA)
transcatheter aortic valve implantation (TAVI, N = 83), or surgical aortic
valve replacement (AVR, N = 27). Overall, 22 patient-specific baseline
parameters were tested for within-group prediction of resource use.
Results: Baseline characteristics differed between groups and reflected
the non-randomized, real-world allocation of treatment options. Overall
procedural times were shortest for TAVI, intensive care unit (ICU) length
of stay (LoS) was lowest for AVR. Length of total hospitalization since
procedure (THsP) was lowest for TF-TAVI; 13.4 +/- 11.4 days as compared to
15.7 +/- 10.5 and 21.2 +/- 15.4 days for AVR and TA-TAVI, respectively.
For TAVI and AVR, EuroScore I remained the main predictor for prolonged
THsP (p <0.01). Within the TAVI group, multivariate regression analyses
showed that TA-TAVI was associated with a substantial increase in THsP (55
to 61 %, p <0.01). Additionally, preoperative aortic valve area (AVA) was
identified as an independent predictor of prolonged THsP in TAVI patients,
irrespective of risk scores (p <0.05). Conclusions: Our results
demonstrate significant heterogeneity in patients baseline characteristics
dependent on treatment and corresponding differences in resource
utilization. Prolonged ThsP is not only predicted by risk scores but also
by baseline AVA, which might be useful in stratifying TAVI patients. Trial
registration: German Clinical Trial Register Nr. DRKS00000797.

<8>
Accession Number
2015333515
Authors
Ramesh C. Pai V.B. Patil N. Nayak B.S. George A. George L.S. Devi E.S.
Institution
(Ramesh, Nayak, George, George, Devi) Manipal College of Nursing, Manipal
University, Manipal, India
(Pai, Patil) Kasturba Medical College, Manipal University, Manipal, India
Title
Effectiveness of massage therapy on post-operative outcomes among patients
undergoing cardiac surgery: A systematic review.
Source
International Journal of Nursing Sciences. 2 (3) (pp 304-312), 2015. Date
of Publication: September 2015.
Publisher
Chinese Nursing Association
Abstract
The incidence and prevalence of cardiovascular disease (CVD) are
increasing rapidly in developing countries. Most patients with CVD do not
respond to medical treatment and have to undergo cardiac surgery. This
highly stressful experience results in increased levels of anxiety for
patients. The objective of this review was to evaluate the efficacy of
massage therapy on postoperative outcomes among patients undergoing
cardiac surgery. A comprehensive literature search was made on
PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the
Cochrane library databases for original research articles published
between 2000 and 2015. Original articles that reported the efficacy of
massage therapy in patients undergoing cardiac surgery were included. The
Cochrane data extraction form was used to extract data. A total of 297
studies were identified in the literature search. However, only seven
studies were eligible for analysis. Of the seven studies, six studies
demonstrated the effects of massage therapy on improving post-operative
outcomes of patients, while one study found no evidence of improvement.
Although the methods varied considerably, most of the studies included in
this review reported positive results. Therefore, there is some evidence
that massage therapy can lead to positive postoperative outcomes. Evidence
of the effectiveness of massage therapy in patients undergoing cardiac
surgery remains inconclusive. Additional research is needed to provide a
strong evidence base for the use of massage therapy to improve
post-operative outcomes and recovery among cardiac surgery patients.

<9>
Accession Number
2015474571
Authors
Liu S. Jing Y. Zhang J. Bian C. Zhang Y. Zhang X.
Institution
(Liu, Jing, Zhang, Zhang) Department of Cardiology, Affiliated Hospital of
Hangzhou Normal University, #126 Wenzhou Road, Hangzhou, Zhejiang Province
310015, China
(Bian, Zhang) Department of Cardiology, Second Affiliated Hospital School
of Medicine Zhejiang University, Hangzhou, Zhejiang Province, China
Title
Does Anterior Fat Pad Removal Reduce the Incidence of Atrial Fibrillation
after CABG? A Meta-Analysis of Randomized Controlled Trials.
Source
PACE - Pacing and Clinical Electrophysiology. 38 (11) (pp 1363-1368),
2015. Date of Publication: November 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Atrial fibrillation (AF) is a common complication after
coronary artery bypass grafting (CABG). Several prospective randomized
controlled trials (RCTs) have evaluated the effect of intact and removed
anterior fat pads on the incidence of AF after CABG with conflicting
results. We collected these RCTs and conducted a meta-analysis to
determine whether anterior fat pad removal is effective in preventing the
new onset of AF after CABG. Methods and Results Prospective RCTs were
collected for analysis and the main outcomes include the occurrence of AF
after CABG, total hospital stay, and major complications. Statistical
analysis was conducted using RevMan 5.0.18 software (The Cochrane
Collaboration), and pooled estimates of the effect were reported as risk
ratios (RRs) or mean differences (MDs) with their 95% confidence intervals
(CIs). The results of this meta-analysis indicate that anterior fat pad
removal was not associated with a decreased risk of occurrence of AF after
CABG (RR = 1.34, 95% CI: 0.88-2.03; P = 0.18), and it also did not
increase the risk of major complications (RR = 1.05, 95% CI: 0.75-1.47; P
= 0.79) or lengthen total hospital stay (MD = 0.06, 95% CI: -0.46 to 0.58;
P = 0.83) compared with the control group. Conclusion Anterior fat pad
removal did not decrease the risk of the occurrence of AF after CABG
despite its safety and convenience, and it should not be used to prevent
new-onset AF after CABG unless new evidence is provided.

<10>
Accession Number
2015444272
Authors
Goh S.L. Yap K.H. Chua K.C. Chao V.T.T.
Institution
(Goh) Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney,
NSW 2050, Australia
(Yap, Chua, Chao) Department of Cardiothoracic Surgery, National Heart
Centre, Singapore General Hospital, Singapore, Singapore
Title
Does preoperative statin therapy prevent postoperative atrial fibrillation
in patients undergoing cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (3) (pp 422-428),
2015. Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
Best evidence topic was written according to a structured protocol. The
question addressed was: does preoperative statin therapy prevent
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery? There were 445 papers found using the reported search. From
these, 12 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. This paper includes three systematic reviews with
meta-analysis, five randomized controlled trials and four retrospective
studies. All the papers compared either all or some of the following
postoperative complications: mortality, morbidity, AF, length of hospital
stay (intensive care unit and hospital) and inflammatory markers. The
largest study in this paper includes a systematic review of 91 491
patients that showed a reduction in postoperative AF with preoperative
statin therapy (OR = 0.71, 95% CI 0.61-0.82, P <0.0001). However, the
durations (3 days to 2 months preoperatively), doses and types of
preoperative statin differed between these papers. Although the majority
of studies (10 of 12) support the use of statins preoperatively, 2 studies
found no association between preoperative statin therapy and the reduction
of postoperative AF. In conclusion, the available evidence suggests that
preoperative statin therapy in patients undergoing elective cardiac
surgery is associated with the following: (1) a lower incidence and risk
of developing postoperative AF, (2) reduced stroke, (3) a shorter hospital
stay and (4) reduced levels of inflammatory markers postoperatively.
However, while the evidence supports the use of statins preoperatively,
the optimal duration, dose and type of statin cannot be concluded from
this review.

<11>
Accession Number
2015436923
Authors
Li H. Wang B. Wang F. Xu Z. Zhou N. Wang X. Wang K.
Institution
(Li, Wang, Wang, Xu, Zhou, Wang, Wang) Department of Anesthesiology,
Shandong Cancer Hospital and Institute, No. 440 Jiyan Road, Jinan,
Shandong 250117, China
Title
Effects of epidural analgesia with different concentrations of bupivacaine
plus fentanyl on pain in patients undergoing thoracic surgery.
Source
International Journal of Clinical and Experimental Medicine. 8 (8) (pp
14123-14126), 2015. Date of Publication: 30 Aug 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To investigate and compared the efficacy and safety of epidural
analgesia with different concentrations of bupivacaine plus fentanyl on
pain in patients undergoing thoracic surgery. Methods: 120 cases
undergoing elective thoracic surgery were randomly divided into A, B, C
and D four groups each with 30 cases, and they were treated with 0.25% (A
group), 0.375% (B group), 0.50% (C group) and 0.75% (D group) bupivacaine
plus fentanyl 0.4 mg. The pain conditions postoperative 4 h, 8 h, 12 h, 24
h and 48 h were evaluated by visual analogue scale (VAS). The PCA pressing
numbers and incidence of adverse reactions were compared between the four
groups. Results: By postoperative 4 h, the VAS in D group were obviously
lower than those in the other three groups (P all <0.05), and the other
three groups showed no significances (P>0.05). However, the four groups
showed no significant differences in VAS by postoperative 8 h, 12 h, 24 h
and 48 h (P all >0.05). The incidences of respiratory depression in C and
D groups were markedly higher than those in A and B groups (P all <0.05).
Conclusions: 0.25%~0.375% bupivacaine plus fentanyl 0.4 mg using in
epidural analgesia in patients undergoing thoracic surgery can lead to
safe and effective analgesic effect.

<12>
Accession Number
2015466996
Authors
Sharma V.K. Joshi S. Joshi A. Kumar G. Arora H. Garg A.
Institution
(Sharma) Department of Cardiothoracic Anesthesiology, Military Hospital
(Cardiothoracic Center), Armed Forces Medical College, Pune, Maharashtra,
India
(Joshi, Kumar, Arora) Military Hospital (Cardiothoracic Center), Armed
Forces Medical College, Pune, Maharashtra, India
(Joshi) Department of Anesthesiology and Critical Care, Armed Forces
Medical College, Pune, Maharashtra, India
(Garg) Department of Cardiothoracic Surgery, Military Hospital
(Cardiothoracic Center), Armed Forces Medical College, Pune, Maharashtra,
India
Title
Does intravenous sildenafil clinically ameliorate pulmonary hypertension
during perioperative management of congenital heart diseases in
children?-A prospective randomized study.
Source
Annals of Cardiac Anaesthesia. 18 (4) (pp 510-516), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Pulmonary hypertension (PHT), if present, can be a significant
cause of increased morbidity and mortality in children undergoing surgery
for congenital heart diseases (CHD). Various techniques and drugs have
been used perioperatively to alleviate the effects of PHT. Intravenous
(IV) sildenafil is one of them and not many studies validate its clinical
use. Aims and Objectives: To compare perioperative PaO ₂-FiO
₂ ratio peak filling rate (PFR), systolic pulmonary artery
pressure (PAP)-systolic aortic pressure (AoP) ratio, extubation time, and
Intensive Care Unit (ICU) stay between two groups of children when one of
them is administered IV sildenafil perioperatively during surgery for
CHDs. Materials and Methods: Patients with ventricular septal defects and
proven PHT, <14 years of age, all American Society of Anesthesiologists
physical status III, undergoing cardiac surgery, were enrolled into two
groups-Group S (IV sildenafil) and Group C (control)-over a period of 14
months, starting from October 2013. Independent t-test and Mann-Whitney
U-test were used to compare the various parameters between two groups.
Results: PFR was higher throughout, perioperatively, in Group S. PAP/AoP
was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean
group extubation time was 7 +/- 7.34 h, whereas in Group C it was 22.1 +/-
10.6. Postoperative ICU stay in Group S and Group C were 42.3 +/- 8.8 h
and 64.4 +/- 15.9 h, respectively. Conclusion: IV sildenafil, when used
perioperatively, in children with CHD having PHT undergoing corrective
surgery, improves not only PaO ₂-FiO ₂ ratio and
PAP-AoP ratio but also reduces extubation time and postoperative ICU stay.

<13>
Accession Number
2015466984
Authors
Samir A. Gandreti N. Madhere M. Khan A. Brown M. Loomba V.
Institution
(Samir, Gandreti, Madhere, Khan, Brown, Loomba) Department of Anesthesia,
Henry Ford Hospital, 2799 W, Grand Blvd., Detroit, MI 48202, United States
Title
Anti-inflammatory effects of propofol during cardiopulmonary bypass: A
pilot study.
Source
Annals of Cardiac Anaesthesia. 18 (4) (pp 495-501), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Propofol has been suggested as a useful adjunct to
cardiopulmonary bypass (CPB) because of its potential protective effect on
the heart mediated by a decrease in ischemia-reperfusion injury and
inflammation at clinically relevant concentrations. In view of these
potentially protective properties, which modulate many of the deleterious
mechanism of inflammation attributable to reperfusion injury and CPB, we
sought to determine whether starting a low dose of propofol infusion at
the beginning of CPB would decrease inflammation as measured by
pro-inflammatory markers. Materials and Methods: We enrolled 24 patients
undergoing elective coronary artery bypass graft (CABG). The study group
received propofol at rate of 120 mcg/kg/min immediately after starting CPB
and was maintained throughout the surgery and for the following 6 hours in
the intensive care unit (ICU). The control group received propofol dose of
30-50 mcg/kg/min which was started at the time of chest closure with wires
and continued for the next 6 hours in the ICU. Interleukins (IL)-6,-8
and-10 and tumor necrosis factor alpha (TNFalpha) were assayed. Result:
The most significant difference was in the level of IL-6 which had a P
value of less than 0.06. Starting a low dose propofol early during the CPB
was not associated with significant hemodynamic instability in comparison
with the control group. Conclusion: Our study shows that propofol may be
suitable as an anti-inflammatory adjunct for patients undergoing CABG.

<14>
Accession Number
2015465180
Authors
Houtekie L. Moerman D. Bourleau A. Reychler G. Detaille T. Derycke E. De
Clety S.C.
Institution
(Houtekie, Moerman, Detaille, Derycke, De Clety) Pediatric Critical Care
Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
(Moerman) Department of Physical Medicine and Rehabilitation, Cliniques
Universitaires Saint-Luc, Brussels, Belgium
(Bourleau) Department of Physical Medicine and Rehabilitation, Centre
Hospitalier Universitaire Dinant-Mont-Godinne, Yvoir, Belgium
(Reychler) Service de Pneumologie, Cliniques Universitaires Saint-Luc,
Pole de Pneumologie, ORL and Dermatologie, Universite Catholique de
Louvain, and the Institut de Recherche Experimentale et Clinique,
Brussels, Belgium
Title
Feasibility study on neurally adjusted ventilatory assist in noninvasive
ventilation after cardiac surgery in infants.
Source
Respiratory Care. 60 (7) (pp 1007-1014), 2015. Date of Publication: 01 Jul
2015.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Our objective was to evaluate the feasibility, the quality of
synchronization, and the influence on respiratory parameters of the
noninvasive neurally adjusted ventilatory assist (NIV-NAVA) mode in
infants after cardiac bypass surgery. We conducted a prospective,
randomized cross-over study in infants undergoing noninvasive ventilation
(NIV) after cardiac surgery. METHODS: Subjects were 10 infants < 5 kg.
After extubation, subjects underwent 2 consecutive ventilatory modes after
randomization into groups. In the CPAP first group, the subjects were
ventilated first in nasal CPAP-1 and then in NIV-NAVA-2 for 30 min in each
mode. In the NIV-NAVA first group, periods were reversed. All children
were ventilated using the same interface. RESULTS: The analysis of curves
showed a synchronization rate of 99.3% for all respiratory cycles. The
rate of pneumatic inspiratory trigger was 3.4%. Asynchronies were
infrequent. Some typical respiratory patterns (continuous effort and
discontinuous inspiration) were found at rates of 10.9% and 31.1%,
respectively. The respiratory trends showed a lower maximum diaphragmatic
electrical activity (EA_di(max)) in NIV-NAVA periods compared
with CPAP periods (P <.001 in the beginning of periods). The breathing
frequency decreased significantly during the nasal CPAP-2 and NIV-NAVA-1
periods (P <.05). The inspiratory pressure increased significantly during
the NIV-NAVA-1 and NIV-NAVA-2 periods (P <.05), but there was no
significant difference for each parameter when comparing _ values between
the beginning and the end of each period. The EAdi signal was easy to
obtain in all subjects, and no major side effects were associated with the
use of NIV-NAVA. CONCLUSIONS: NIV-NAVA allows good synchronization in
bi-level NIV in infant cardiac subjects weighing < 5 kg. The analysis of
respiratory parameters shows that NIV NAVA decreases the work of breathing
more effectively than nasal CPAP. The study shows some typical respiratory
patterns in infants.

<15>
[Use Link to view the full text]
Accession Number
2015464993
Authors
Theis C. Konrad T. Mollnau H. Sonnenschein S. Kampfner D. Potstawa M.
Ocete B.Q. Bock K. Himmrich E. Munzel T. Rostock T.
Institution
(Theis, Konrad, Mollnau, Sonnenschein, Kampfner, Potstawa, Ocete, Bock,
Himmrich, Munzel, Rostock) II. Medical Clinic, Department of
Electrophysiology, University Medical Center, Johannes
Gutenberg-University Mainz, Langenbeckstr. 1, Mainz D-55131, Germany
Title
Arrhythmia Termination Versus Elimination of Dormant Pulmonary Vein
Conduction as a Procedural End Point of Catheter Ablation for Paroxysmal
Atrial Fibrillation.
Source
Circulation: Arrhythmia and Electrophysiology. 8 (5) (pp 1080-1087), 2015.
Date of Publication: 01 Oct 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Pulmonary vein isolation (PVI) is still associated with a
substantial number of arrhythmia recurrences in paroxysmal atrial
fibrillation (AF). This prospective, randomized study aimed to compare 2
different procedural strategies. Methods and Results - A total of 152
patients undergoing de novo ablation for paroxysmal AF were randomized to
2 different treatment arms. The procedure in group A consisted of PVI
exclusively. In this group, all isolated PVs were challenged with
adenosine to reveal and ablate dormant conduction. In group B, PVI was
performed with the patient either in spontaneous or in induced AF. If AF
did not terminate with PVI, ablation was continued by targeting extra-PV
AF sources with the desired procedural end point of termination to sinus
rhythm. Primary study end point was freedom from arrhythmia during 1-year
follow-up. In group A, adenosine provoked dormant conduction in 31 (41%)
patients with a mean of 1.6+/-0.8 transiently recovered PVs per patient.
Termination of AF during PVI was observed in 31 (65%) patients, whereas AF
persisted afterward in 17 (35%) patients. AF termination occurred in 13
(76%) patients by AF source ablation. After 1-year follow-up,
significantly more group B patients were free of arrhythmia recurrences
(87 versus 68%; P=0.006). During redo ablation, the rate of PV
reconduction did not differ between both groups (group A: 55% versus group
B: 61%; P=0.25). Conclusions - Elimination of extra-PV AF sources after
PVI is superior to sole PV isolation with the adjunct of abolishing
potential dormant conduction.

<16>
Accession Number
2015467859
Authors
Green A.C. Olsen C.M.
Institution
(Green, Olsen) QIMR Berghofer Medical Research Institute, Brisbane,
Australia
(Green) Institute of Inflammation and Repair, University of Manchester,
United Kingdom
(Green) Cancer Research UK Manchester Institute, Manchester, United
Kingdom
Title
Increased risk of melanoma in organ transplant recipients: Systematic
review and meta-analysis of cohort studies.
Source
Acta Dermato-Venereologica. 95 (8) (pp 923-927), 2015. Date of
Publication: November 2015.
Publisher
Medical Journals/Acta D-V (St: Johannesgatan 22A, Uppsala SE-753 12,
Sweden)
Abstract
Transplant recipients have a raised risk of melanoma but the relative
magnitude is uncertain. We undertook a systematic review by searching
major databases for relevant publications to June 2014. Cohort studies
quantifying the association between transplantation and melanoma were
included and data were pooled using the weighted average method. Among 20
eligible studies the pooled relative risk (pRR) of melanoma was 2.71 (95%
confidence interval (CI), 2.23-3.30) with significant heterogeneity (p <
0.001). There was no indication of publication bias. Sub-group analyses by
study design, follow-up period, adjustment for confounding and quality
score did not materially alter results. Among liver and heart transplant
patients pRR for melanoma was 5.27 (95% CI 4.50-6.62), higher than the pRR
of 2.54 (95% CI 2.18-2.96) among kidney transplant patients. Transplant
recipients are at more than double the risk of melanoma overall compared
with the general population.

<17>
Accession Number
2015443214
Authors
Wong C.X. Sullivan T. Sun M.T. Mahajan R. Pathak R.K. Middeldorp M. Twomey
D. Ganesan A.N. Rangnekar G. Roberts-Thomson K.C. Lau D.H. Sanders P.
Institution
(Wong, Sullivan, Sun, Mahajan, Pathak, Middeldorp, Twomey, Ganesan,
Rangnekar, Roberts-Thomson, Lau, Sanders) Centre for Heart Rhythm
Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA
5000, Australia
Title
Obesity and the risk of incident, post-operative, and post-ablation atrial
fibrillation: A meta-analysis of 626,603 individuals in 51 studies.
Source
JACC: Clinical Electrophysiology. 1 (3) (pp 139-152), 2015. Date of
Publication: June 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to quantify the magnitude of
association between incremental increases in body mass index (BMI) and the
development of incident, post-operative, and post-ablation atrial
fibrillation (AF). Background Obesity has been estimated to account for
one-fifth of all AF and approximately 60% of recent increases in
population AF incidence. From a public health perspective, obesity,
therefore, is a modifiable risk factor that could be profitably targeted.
Methods A systematic review and meta-analysis was conducted. Medline and
EMBASE databases were searched for observational studies reporting data on
the association between obesity and incident, post-operative, and
post-ablation AF. Studies were included if they reported or provided data
allowing calculation of risk estimates. Results Data from 51 studies
including 626,603 individuals contributed to this analysis. There were 29%
(odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.23 to 1.36) and
19% (OR: 1.19, 95% CI: 1.13 to 1.26) greater excess risks of incident AF
for every 5-U BMI increase in cohort and case-control studies,
respectively. Similarly, there were 10% (OR: 1.10, 95% CI: 1.04 to 1.17)
and 13% (OR: 1.13, 95% CI: 1.06 to 1.22) greater excess risks of
post-operative and post-ablation AF for every 5-U increase in BMI,
respectively. Conclusions Incremental increases in BMI are associated with
a significant excess risk of AF in different clinical settings. For every
5-U increase in BMI, there were 10% to 29% greater excess risks of
incident, post-operative, and post-ablation AF. By providing a
comprehensive and reliable quantification of the relationship between
incremental increases in obesity and AF across different clinical
settings, our findings highlight the potential for even moderate
reductions in population body mass indexes to have a significant effect in
mitigating the rising burden of AF.

<18>
Accession Number
2015464365
Authors
Redeker N.S. Jeon S. Andrews L. Cline J. Jacoby D. Mohsenin V.
Institution
(Redeker, Jeon, Andrews) Yale University School of Nursing, PO Box 27399,
West Haven, CT 06516-7399, United States
(Cline, Jacoby, Mohsenin) Yale University School of Medicine, New Haven,
CT, United States
Title
Feasibility and efficacy of a self-management intervention for insomnia in
stable heart failure.
Source
Journal of Clinical Sleep Medicine. 11 (10) (pp 1109-1119), 2015. Date of
Publication: 2015.
Publisher
American Academy of Sleep Medicine (2510 N. Frontage Road, Darien IL
60561, United States)
Abstract
Background: Chronic insomnia is common among patients with heart failure
(HF) and may contribute to fatigue and poor function. However, to date
there have been no randomized controlled trials focused on treatment of
insomnia or daytime symptoms in this population. Objective: The purpose of
this study was to examine the preliminary effi cacy, feasibility, and
acceptability of a selfmanagement intervention (cognitive behavioral
therapy [CBT-I]) for insomnia among patients with stable HF. Methods: We
conducted a pilot randomized controlled trial (RCT) in which patients with
stable Class I-III HF (n = 25/52.1% women; mean age = 59 +/- 14.8 years)
were randomized in groups to CBT-I (n = 29) or an attention control
condition (HF self-management with sleep hygiene; n = 19). Participants
completed 2 weeks of wrist actigraphy, the insomnia severity index, and
measures of fatigue, depression, sleepiness, and functional performance at
baseline and follow-up. We computed the size of the effects on the
dependent variables and used MANOVA to evaluate the effects of CBT-I on
insomnia and fatigue. Results: CBT-I was feasible and acceptable and had a
statistically signifi cant effect on insomnia and fatigue, while
controlling for the effects of comorbidity and age. Conclusions: CBT-I has
short-term effi cacy as a treatment for chronic insomnia among patients
with stable HF. Future studies are needed to address its sustained
effects.

<19>
Accession Number
2015445291
Authors
Li Y.-W. Li H.-J. Feng Y. Yu Y. Guo X.-Y. Li Y. Zhao B.-J. Hu X.-Y. Zuo
M.-Z. Zhang H.-Y. Wang M.-R. Ji P. Yan X.-Y. Wu Y.-F. Wang D.-X.
Institution
(Li, Li, Wang) Peking University First Hospital, Department of
Anesthesiology and Critical Care Medicine, No.8 Xishiku Street, Xicheng
District, Beijing 100034, China
(Li, Wang, Ji, Yan, Wu) Peking University Clinical Research Institute,
No.38 Xueyuan Road, Haidian District, Beijing 100191, China
(Feng, Yu) Peking University People's Hospital, Department of
Anesthesiology, No.11 Xizhimen South Street, Xicheng District, Beijing
100044, China
(Guo, Li) Peking University Third Hospital, Department of Anesthesiology,
No.49 Huayuan North Road, Haidian District, Beijing 100191, China
(Zhao, Hu) Beijing Shijitan Hospital, Department of Anesthesiology, No.10
Tieyi Road, Haidian District, Beijing 100038, China
(Zuo, Zhang) Beijing Hospital, Department of Anesthesiology, No.1 Dahua
Road, Dongcheng District, Beijing 100730, China
Title
Effects of two different anesthesia-analgesia methods on incidence of
postoperative delirium in elderly patients undergoing major thoracic and
abdominal surgery: Study rationale and protocol for a multicenter
randomized controlled trial.
Source
BMC Anesthesiology. 15 (1) , 2015. Article Number: 144. Date of
Publication: October 13, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Delirium is a common complication in elderly patients after
surgery and associated with increased morbidity and mortality. Studies
suggest that deep anesthesia and intense pain are important precipitating
factors of postoperative delirium. Neuraxial block is frequently used in
combination with general anesthesia for patients undergoing major thoracic
and abdominal surgery. Compared with general anesthesia alone and
postoperative intravenous analgesia, combined epidural-general anesthesia
and postoperative epidural analgesia decreases the requirement of general
anesthetics during surgery and provided better pain relief after surgery.
However, whether combined epidural-general anesthesia plus epidural
analgesia is superior to general anesthesia plus intravenous analgesia in
decreasing the incidence of postoperative delirium remains unknown.
Methods/design: This is a multicenter, open-label, randomized,
parallel-controlled clinical trial. One thousand eight hundred elderly
patients (age range 60-90 years) who are scheduled to undergo major
thoracic or abdominal surgery are randomized to receive either general
anesthesia plus postoperative intravenous analgesia or combined
epidural-general anesthesia plus postoperative epidural analgesia. The
primary outcome is the 7-day incidence of postoperative delirium.
Secondary outcomes include the duration of postoperative delirium, the
intensity of pain during the first three days after surgery, the 30-day
incidences of postoperative non-delirium complications, the length of stay
in hospital after surgery and 30-day all-cause mortality. Discussion:
Results of the present study will provide information to guide clinical
practice in choosing appropriate anesthesia-analgesia method for elderly
patients undergoing major thoracic and abdominal surgery. Trial
registration: The study is registered on ClinicalTrials.gov NCT01661907and
Chinese Clinical Trial Registry ChiCTR-TRC-12002371.

<20>
Accession Number
2015454890
Authors
Jacob K.A. Dieleman J.M. Nathoe H.M. Van Osch D. De Waal E.E.C. Cramer
M.J. Kluin J. Van Dijk D.
Institution
(Jacob, Dieleman, De Waal, Van Dijk) Department of Anesthesiology and
Intensive Care, University Medical Center Utrecht, Mail Stop F.06.149, PO
Box 85500, Utrecht 3508, Netherlands
(Jacob, Kluin) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Nathoe, Van Osch, Cramer) Department of Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
Title
The effects of intraoperative dexamethasone on left atrial function and
postoperative atrial fibrillation in cardiac surgical patients.
Source
Netherlands Heart Journal. 23 (3) (pp 168-173), 2015. Date of Publication:
2015.
Publisher
Bohn Stafleu van Loghum
Abstract
Postoperative new-onset atrial fibrillation (PNAF) is very common after
cardiac surgery and postoperative inflammation may contribute to PNAF by
inducing atrial dysfunction. Corticosteroids reduce inflammation and may
thus reduce atrial dysfunction and PNAF development. This study aimed to
determine whether dexamethasone protects against left atrial dysfunction
and PNAF in cardiac surgical patients. Cardiac surgical patients were
randomised to a single dose of dexamethasone (1 mg.kg^-1) or
placebo after inducing anaesthesia. Transoesophageal echocardiography was
performed in patients before and after surgery. Primary outcome was left
atrial total ejection fraction (LA-TEF) after sternal closure; secondary
outcomes included left atrial diameter and PNAF. 62 patients were
included. Baseline characteristics were well balanced. Postoperative
LA-TEF was 36.4%in the dexamethasone group and 40.2 % in the placebo group
(difference -3.8 %; 95 % confidence interval (CI) -9.0 to 1.4 %; P= 0.15).
Postoperative left atrial diameter was 4.6 and 4.3 cm, respectively
(difference 0.3; 95 % CI -0.2 to 0.7; P=0.19). The incidence of PNAF was
30 % in the dexamethasone group and 39 % in the placebo group (P = 0.47).
Intraoperative high-dose dexamethasone did not protect against
postoperative left atrial dysfunction and did not reduce the risk of PNAF
in cardiac surgical patients.

<21>
Accession Number
2015434544
Authors
Virk S.A. Liou K. Chandrakumar D. Gupta S. Cao C.
Institution
(Virk, Liou, Chandrakumar, Gupta, Cao) Systematic Review Unit,
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
Title
Percutaneous pulmonary valve implantation: A systematic review of clinical
outcomes.
Source
International Journal of Cardiology. 201 (pp 487-489), 2015. Date of
Publication: 10 Oct 2015.
Publisher
Elsevier Ireland Ltd

<22>
Accession Number
2015438040
Authors
Bundhun P.K. Qin T. Chen M.-H.
Institution
(Bundhun, Qin, Chen) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530027,
China
Title
Comparing the effectiveness and safety between triple antiplatelet therapy
and dual antiplatelet therapy in type 2 diabetes mellitus patients after
coronary stents implantation: A systematic review and meta-analysis of
randomized controlled trials.
Source
BMC Cardiovascular Disorders. 15 (1) , 2015. Article Number: 118. Date of
Publication: October 09, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Since antiplatelet therapy in type 2 diabetes mellitus (T2DM)
patients is very important after intracoronary stenting, and because the
most commonly used therapies have been the dual antiplatelet therapy
(DAPT) consisting of aspirin and clopidogrel and the triple antiplatelet
therapy (TAPT) consisting of aspirin, clopidogrel and cilostazol, we aim
to compare the effectiveness and safety between triple antiplatelet
therapy and dual antiplatelet therapy in T2DM patients. Methods:
Systematic literature search was done from the databases of PubMed,
Cochrane, Embase, China National Knowledge Infrastructure (CNKI) and
WanFang. Randomized controlled trials (RCTs) comparing the effectiveness
and safety between triple therapy and dual therapy in T2DM patients after
coronary stents placement were included. Endpoints included major adverse
cardiac effects (MACEs), target lesion revascularization (TLR), target
vessel revascularization (TVR), death, stent thrombosis, bleeding and
adverse drug reactions during a 9-12 months period, as well as platelet
activities. Results: Four studies including 1005 patients reporting the
adverse clinical outcomes and six studies including 519 patients reporting
the platelet activities, with a total of 1524 patients have been analyzed
in this meta-analysis. The pooling analysis shows that TAPT has
significantly decreased the occurrence of MACEs (RR: 0.55; 95% CI:
0.36-0.86, P=0.009), TLR (RR 0.41; 95% CI: 0.21-0.80, P=0.008), TVR (RR
0.55; 95% CI: 0.34-0.88, P=0.01) and the overall incidence of Death/
Myocardial Infarction (MI)/TVR (RR 0.54; 95% CI: 0.31-0.94, P=0.03) during
this 9 to 12months follow up period after stents implantation. Stent
thrombosis was almost similar in both groups. Bleeding seemed to favor
DAPT but the result was not statistically significant. Platelet
aggregation, platelet reactivity index (PRI) and platelet reactivity unit
(PRU) were also reduced with Weight Mean Difference (WMD) of (-13.80; 95%
CI: -17.03 to -10.56, P<0.00001), (-22.87; 95% CI: -23.66 to -22.07,
P<0.00001) and (-44.17; 95% CI: -58.56 to -29.77, P<0.00001) respectively.
Conclusion: Since MACEs have been significantly decreased in the triple
group, TAPT appears to be more effective than DAPT in T2DM patients after
intracoronary stenting. No significant difference in stent thrombosis and
bleeding risks between these 2 groups shows TAPT to be almost as safe as
DAPT in these diabetic patients.

<23>
Accession Number
2015438999
Authors
Chevalier B. Wijns W. Silber S. Garcia E. Serra A. Paunovic D. Serruys P.
Institution
(Chevalier) Institut Cardiovasculaire Paris-Sud, Hopital Prive Jacques
Cartier, Massy 91300, France
(Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Silber) Kardiologische Gemeinschaftspraxis und HKL, Munich, Germany
(Garcia) Hospital Monteprincipe, Madrid, Spain
(Serra) Hospital Sant Pau, Barcelona, Spain
(Paunovic) Terumo Europe, Leuven, Belgium
(Serruys) Erasmus MC, Rotterdam, Netherlands
Title
Five-year clinical outcome of the Nobori drug-eluting coronary stent
system in the treatment of patients with coronary artery disease: Final
results of the NOBORI 1 trial.
Source
EuroIntervention. 11 (5) (pp 549-554), 2015. Date of Publication: 01 Sep
2015.
Publisher
EuroPCR
Abstract
Aims: To assess the safety and performance of the Nobori drug-eluting
stent with biodegradable polymer versus the TAXUS drug-eluting stent with
permanent polymer, in the treatment of patients with de novo coronary
artery lesions. Methods and results: NOBORI 1 was a multicentre,
randomised (2:1), prospective, controlled, clinical trial which enrolled
363 patients (238 Nobori and 125 TAXUS) with up to two de novo lesions in
two epicardial vessels. The primary endpoint was in-stent late loss at
nine months, while secondary endpoints included safety and efficacy up to
five years. At five years, clinical data were available for 350 patients
(96%). There were no differences in the composite of death and myocardial
infarction (10.9% vs. 11.2%) and target lesion failure (9.2% and 10.4%),
while ischaemia- and non-ischaemia-driven target lesion revascularisations
were less frequent in the Nobori (6.3%) than in the TAXUS arm (16.0%). The
rates of stent thrombosis (definite and probable according to the ARC
definitions) were 0.0% and 3.2%, in the Nobori and TAXUS stents,
respectively (p=0.014). Conclusions: Five years after implantation, the
Nobori DES resulted in durable treatment effects with very low TLR and no
stent thrombosis. The study was not powered to assess the differences in
clinical endpoints. These data are hypothesis-generating.

<24>
Accession Number
2015438996
Authors
Qiao Y. Li W. Mohamed S. Nie S. Du X. Zhang Y. Jia C. Wang X. Liu X. Ma C.
Institution
(Qiao, Mohamed, Nie, Du, Zhang, Jia, Wang, Liu, Ma) Department of
Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen
Road, Chaoyang District, Beijing 100029, China
(Li) Department of Cardiology, Peking University Hospital, Beijing, China
Title
A comparison of multivessel and culprit vessel percutaneous coronary
intervention in non-ST-segment elevation acute coronary syndrome patients
with multivessel disease: A meta-analysis.
Source
EuroIntervention. 11 (5) (pp 525-532), 2015. Date of Publication: 01 Sep
2015.
Publisher
EuroPCR
Abstract
Aims: Percutaneous revascularisation triage has not been evaluated in
randomised controlled trials of patients with non-ST-segment elevation
acute coronary syndromes (NSTE-ACS) and multivessel disease. As a result,
current guidelines are not available. The objective of our meta-analysis
was to investigate the use of percutaneous coronary intervention (PCI) in
culprit and non-culprit vessels. Methods and results: We undertook a
meta-analysis of controlled studies where patients were assigned to
multivessel PCI or culprit vessel PCI. Summary odds ratios (OR) for
all-cause mortality, myocardial infarction, unplanned revascularisation
and major adverse cardiac events (MACE) were calculated using randomor
fixed-effect models. Six registry studies (n=5,414) were included in this
meta-analysis. There was no difference in the rate of mortality (OR, 0.85;
95% CI: 0.70 to 1.04; p=0.114) or myocardial infarction (OR, 0.75; 95% CI:
0.43 to 1.32; p=0.319) between the two treatment groups. Multivessel PCI
may decrease longterm MACE (OR, 0.69; 95% CI: 0.51 to 0.93; p=0.015) and
unplanned revascularisation (OR, 0.64; 95% CI: 0.45 to 93; p=0.018)
compared with culprit vessel PCI. Conclusions: No significant difference
was demonstrated in the long-term risk of myocardial infarction and
mortality between multivessel PCI and culprit vessel PCI. Therefore,
multivessel PCI may be a safe and reasonable option for NSTE-ACS patients
with multivessel disease.

<25>
[Use Link to view the full text]
Accession Number
2015454674
Authors
Wang J. Gu C. Yu W. Gao M. Yu Y.
Institution
(Wang, Gu, Yu, Gao, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Short-and long-term patient outcomes from combined coronary endarterectomy
and coronary artery bypass grafting: A meta-analysis of 63,730 patients
(PRISMA).
Source
Medicine (United States). 94 (41) , 2015. Article Number: e1781. Date of
Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
This meta-analysis aimed to compare the short-and longterm outcomes in
patients undergoing combined coronary endarterectomy and coronary artery
bypass grafting (CE + CABG) versus isolated CABG, and particularly to
examine subgroup patients with high-risk profile and patients with diffuse
disease in the left anterior descending artery (LAD). Studies published
between January 1, 1970 and May 31, 2015 were searched in the literature
databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science.
A total of 30 eligible studies including 63,730 patients were analyzed.
Five authors extracted data from the included studies independently.
Meta-analysis on the total patients revealed that CE + CABG was associated
with significantly increased 30-day postoperative all-cause mortality
compared with isolated CABG (OR=1.86, 95% CI: 1.66- 2.08, z=10.99,
P<0.0001). Subgroup analysis on patients with highrisk profile and
patients with diffuse disease in the LAD showed that 30-day mortality
after CE + CABG was 2.6 folds (OR=2.60, 95% CI: 1.39-4.86, z=2.99,
P=0.003) and 3.93 folds (OR=3.93, 95% CI: 1.40-11.0, z=2.60, P=0.009) of
that after isolated CABG in the respective subgroup. In contrast, the
mortality was comparable in CE + off-pump CABG and CE + on-pump CABG
groups (OR=0.53, 95% CI: 0.18-1.55, z=1.16, P=0.248). In addition, the
incidences of perioperative myocardial infarction (MI) and 30-day
postoperative complications, including low output syndrome (LOS), MI,
ventricular tachycardia (VT), and renal dysfunction after CE + CABG were
significantly higher than those after isolated CABG (all P<0.05). In
high-risk patient subgroup, CE + CABG significantly increased the
incidences of postoperative LOS, MI, and renal function compared with
isolated CABG (all P<0.05). The incidence of perioperative myocardial
after CE + CABG was 2.86 and 2.92 times of that after isolated CABG in
high-risk patients and patients with diffuse disease in LAD, respectively.
Analysis on the recent reports (published later than 2000) showed
consistent results as the analysis including all the eligible reports.
Long-term survival was comparable in CE + CABG and isolated CABG groups
(hazardous ratio=1.16, 95% CI: 0.32-4.22, z=0.23, P=0.819). CE + CABG
appears to be associated with poor short-term outcomes, particularly in
high-risk patients and patients with diffuse disease in the LAD.

<26>
Accession Number
2015334115
Authors
Alam S.R. Lewis S.C. Zamvar V. Pessotto R. Dweck M.R. Krishan A. Goodman
K. Oatey K. Harkess R. Milne L. Thomas S. Mills N.M. Moore C. Semple S.
Wiedow O. Stirrat C. Mirsadraee S. Newby D.E. Henriksen P.A.
Institution
(Alam, Dweck, Mills, Stirrat, Newby, Henriksen) British Heart Foundation,
Centre for Population Health Sciences, University of Edinburgh, Centre for
Cardiovascular Science, Edinburgh EH16 4SB, United Kingdom
(Lewis, Krishan, Goodman, Oatey, Harkess, Milne, Thomas) Edinburgh
Clinical Trials Unit, University of Edinburgh, Western General Hospital,
Edinburgh, United Kingdom
(Zamvar, Pessotto, Moore) Department of Cardio-Thoracic Surgery, Edinburgh
Royal Infirmary, Edinburgh, United Kingdom
(Semple, Mirsadraee, Newby) Clinical Research Imaging Centre, University
of Edinburgh, Edinburgh, United Kingdom
(Wiedow) Department of Dermatology, University of Kiel, Kiel, Germany
Title
Perioperative Elafin for ischaemia-reperfusion injury during coronary
artery bypass graft surgery: A randomised-controlled trial.
Source
Heart. 101 (20) (pp 1639-1645), 2015. Date of Publication: 26 Aug 2015.
Publisher
BMJ Publishing Group
Abstract
Background: Elafin is a potent endogenous neutrophil elastase inhibitor
that protects against myocardial inflammation and injury in preclinical
models of ischaemic-reperfusion injury. We investigated whether elafin
could inhibit myocardial ischaemia-reperfusion injury induced during
coronary artery bypass graft (CABG) surgery. Methods and results: In a
randomised double-blind placebo-controlled parallel group clinical trial,
87 patients undergoing CABG surgery were randomised 1:1 to intravenous
elafin 200 mg or saline placebo administered after induction of
anaesthesia and prior to sternotomy. Myocardial injury was measured as
cardiac troponin I release over 48 h (area under the curve (AUC)) and
myocardial infarction identified with MRI. Postischaemic inflammation was
measured by plasma markers including AUC high-sensitive C reactive protein
(hs-CRP) and myeloperoxidase (MPO). Elafin infusion was safe and resulted
in >3000-fold increase in plasma elafin concentrations and >50% inhibition
of elastase activity in the first 24 h. This did not reduce myocardial
injury over 48 h (ratio of geometric means (elafin/placebo) of AUC
troponin I 0.74 (95% CI 0.47 to 1.15, p=0.18)) although post hoc analysis
of the high-sensitive assay revealed lower troponin I concentrations at 6
h in elafin-treated patients (median 2.4 vs 4.1 mug/L, p=0.035). Elafin
had no effect on myocardial infarction (elafin, 7/34 vs placebo, 5/35
patients) or on markers of inflammation: mean differences for AUC hs-CRP
of 499 mg/L/48 h (95% CI-207 to 1205, p=0.16), and AUC MPO of 238 ng/mL/48
h (95% CI-235 to 711, p=0.320). Conclusions: There was no strong evidence
that neutrophil elastase inhibition with a single-dose elafin treatment
reduced myocardial injury and inflammation following CABG-induced
ischaemia-reperfusion injury.

<27>
Accession Number
2015333118
Authors
Perez-Romero P. Bulnes-Ramos A. Torre-Cisneros J. Gavalda J. Aydillo T.A.
Moreno A. Montejo M. Farinas M.C. Carratala J. Munoz P. Blanes M. Fortun
J. Suarez-Benjumea A. Lopez-Medrano F. Barranco J.L. Peghin M. Roca C.
Lara R. Cordero E. Alamo J.M. Gasch A. Gentil-Govantes M.A. Molina-Ortega
F.J. Lage E. Martinez-Atienza J. Sanchez M. Rosso C. Arizon J.M. Aguera M.
Cantisan S. Montero J.L. Paez A. Rodriguez A. Santos S. Vidal E.
Berasategui C. Campins M. Lopez-Meseguer M. Saez B. Marcos M.A.
Sanclemente G. Diez N. Goikoetxea J. Casafont F. Cobo-Belaustegy M. Duran
R. Fabrega-Garcia E. Fernandez-Rozas S. Gonzalez-Rico C. Zurbano-Goni F.
Bodro M. Niubo J. Oriol S. Sabe N. Anaya F. Bouza E. Catalan P. Diez P.
Eworo A. Kestler M. Lopez-Roa P. Rincon D. Rodriguez M. Salcedo M. Sousa
Y. Valerio M. Morales-Barroso I. Aguado J.M. Origuen J.
Institution
(Perez-Romero, Bulnes-Ramos, Aydillo, Roca, Cordero) Instituto de
Biomedicina de Sevilla (IBIS), University Hospital Virgen del
Rocio/CSIC/University of Sevilla, Seville, Spain
(Torre-Cisneros, Barranco, Lara) Reina Sofia University
Hospital-Maimonides Institute for Biomedical Research (IMIBIC), University
of Cordoba (UCO), Cordoba, Spain
(Gavalda, Peghin) Vall d'Hebron University Hospital-VHIR, Barcelona, Spain
(Moreno) University Clinic Hospital, Barcelona, Spain
(Montejo) University Hospital Cruces, Bilbao, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Carratala) University Hospital Belltvitge-IDIBELL, University of
Barcelona, Barcelona, Spain
(Munoz) General University Hospital Gregorio Maranon, Madrid, Spain
(Blanes) University Hospital La Fe, Valencia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Sevilla, Spain
(Lopez-Medrano) University Hospital 12 de Octubre, Madrid, Spain
(Alamo, Gasch, Gentil-Govantes, Molina-Ortega, Lage, Martinez-Atienza,
Sanchez, Rosso) University Hospital Virgen del Rocio-IBIS, Spain
(Arizon, Aguera, Cantisan, Montero, Paez, Rodriguez, Santos, Vidal)
University Hospital Reina Sofia-IMIBIC-UCO, Cordoba, Spain
(Berasategui, Campins, Lopez-Meseguer, Saez) Val d'Hebron Hospital,
Barcelona, Spain
(Marcos, Sanclemente) Clinic Hospital, Barcelona, Spain
(Diez, Goikoetxea) University Hospital Cruces, Bilbao, Spain
(Casafont, Cobo-Belaustegy, Duran, Fabrega-Garcia, Fernandez-Rozas,
Gonzalez-Rico, Zurbano-Goni) University Hospital Marques de Valdecilla,
Santander, Spain
(Bodro, Niubo, Oriol, Sabe) University Hospital Belltvitge-IDIBELL,
University of Barcelona, Barcelona, Spain
(Anaya, Bouza, Catalan, Diez, Eworo, Kestler, Lopez-Roa, Rincon,
Rodriguez, Salcedo, Sousa, Valerio) General University Hospital Gregorio
Maranon, Madrid, Spain
(Morales-Barroso) University Hospital Virgen Macarena, Seville, Spain
(Aguado, Origuen) Universty Hospital 12 de Octubre, Madrid, Spain
Title
Influenza vaccination during the first 6 months after solid organ
transplantation is efficacious and safe.
Source
Clinical Microbiology and Infection. 21 (11) (pp 1040.e11-1040.e18), 2015.
Date of Publication: November 2015.
Publisher
Elsevier
Abstract
Preventing influenza infection early after transplantation is essential,
given the disease's high mortality. A multicentre prospective cohort study
in adult solid organ transplant recipients (SOTR) receiving the influenza
vaccine during four consecutive influenza seasons (2009-2013) was
performed to assess the immunogenicity and safety of influenza vaccination
in SOTR before and 6 months after transplantation. A total of 798 SOTR,
130 of them vaccinated within 6 months of transplantation and 668 of them
vaccinated more than 6 months since transplantation. Seroprotection was
similar in both groups: 73.1% vs. 76.5% for A/(H1N1)pdm (p 0.49), 67.5%
vs. 74.1% for A/H3N2 (p 0.17) and 84.2% vs. 85.2% for influenza B (p
0.80), respectively. Geometric mean titres after vaccination did not
differ among groups: 117.32 (95% confidence interval (CI) 81.52, 168.83)
vs. 87.43 (95% CI 72.87, 104.91) for A/(H1N1)pdm, 120.45 (95% CI 82.17,
176.57) vs. 97.86 (95% CI 81.34, 117.44) for A/H3N2 and 143.32 (95% CI
103.46, 198.53) vs. 145.54 (95% CI 122.35, 174.24) for influenza B,
respectively. After adjusting for confounding factors, time since
transplantation was not associated with response to vaccination. No cases
of rejection or severe adverse events were detected in patients vaccinated
within the first 6 months after transplantation. In conclusion, influenza
vaccination within the first 6 months after transplantation is as safe and
immunogenic as vaccination thereafter. Thus, administration of the
influenza vaccine can be recommended as soon as 1 month after
transplantation.

<28>
Accession Number
2015210134
Authors
Virk S.A. Chandrakumar D. Villanueva C. Wolfenden H. Liou K. Cao C.
Institution
(Virk, Chandrakumar, Cao) Systematic Review Unit, Collaborative Research
(CORE) Group, Sydney, Australia
(Villanueva) Department of Cardiothoracic Surgery, St. George Hospital,
Sydney, Australia
(Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Liou) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
(Virk, Chandrakumar, Villanueva, Wolfenden, Liou, Cao) University of New
South Wales, Sydney, Australia
Title
Systematic review of percutaneous interventions for malignant pericardial
effusion.
Source
Heart. 101 (20) (pp 1619-1626), 2015. Date of Publication: 15 Jul 2015.
Publisher
BMJ Publishing Group
Abstract
The present systematic review assessed the safety and efficacy of
percutaneous interventions for malignant pericardial effusion (MPE), with
primary endpoint of recurrence of pericardial effusion. Electronic
searches of six databases identified thirty-one studies, reporting
outcomes following isolated pericardiocentesis (n=305), pericardiocentesis
followed by extended catheter drainage (n=486), pericardial instillation
of sclerosing agents (n=392) or percutaneous balloon pericardiotomy (PBP)
(n=157). Isolated pericardiocentesis demonstrated a pooled recurrence rate
of 38.3%. Pooled recurrence rates for extended catheter drainage,
pericardial sclerosis and PBP were 12.1%, 10.8% and 10.3%, respectively.
Procedure-related mortality ranged from 0.5-1.0% across the percutaneous
interventions. Although isolated pericardiocentesis can safely deliver
immediate symptomatic relief, subsequent catheter drainage or
sclerotherapy are required to minimize recurrence. PBP has been shown to
be highly effective and may be particularly useful in managing recurrent
effusions. Ultimately, the choice of intervention must be based on the
clinical status of patients, their underlying malignancy and the expertise
available.

<29>
Accession Number
2015461723
Authors
Smith P.K. Shernan S.K. Chen J.C. Carrier M. Verrier E.D. Adams P.X.
Todaro T.G. Muhlbaier L.H. Levy J.H.
Institution
(Smith, Muhlbaier) Division of Cardiovascular and Thoracic Surgery, Duke
University Medical Center, Box 3442, Durham, NC 27710, United States
(Shernan) Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Chen) Kaiser Permanente Medical Center, University of Hawaii, Honolulu,
HI, United States
(Carrier) Montreal Heart Institute, Montreal, ON, Canada
(Verrier) University of Washington School of Medicine, Seattle, WA, United
States
(Adams) Alexion Pharmaceuticals, Cheshire, CT, United States
(Todaro) Procter and Gamble Pharmaceuticals, Cincinnati, OH, United States
(Levy) Emory University Hospital, Emory University, Atlanta, GA, United
States
Title
Effects of C5 complement inhibitor pexelizumab on outcome in high-risk
coronary artery bypass grafting: Combined results from the PRIMO-CABG i
and II trials.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (1) (pp 89-98), 2011.
Date of Publication: 2011.
Publisher
Mosby Inc.
Abstract
Objective The previous Pexelizumab for Reduction of Infarction and
Mortality in Coronary Artery Bypass Graft Surgery I (PRIMO-CABG I) trial
(n = 3099) indicated that C5 complement inhibition with pexelizumab might
reduce myocardial infarction (MI) and postoperative mortality. PRIMO-CABG
II was designed to investigate the safety and efficacy of terminal
complement inhibition in reducing perioperative MI and mortality in
patients undergoing CABG surgery who have 2 or more predefined
preoperative risk factors. Methods PRIMO-CABG II, a randomized,
double-blind, placebo-controlled trial, enrolled 4254 patients undergoing
CABG with or without valve surgery at 249 hospitals in North America and
Western Europe from June 2004 to July 2005. The patients were randomly
assigned to receive intravenous pexelizumab or placebo. The primary
composite endpoint was the incidence of death or MI within 30 days of
randomization. Results The PRIMO-CABG II trial did not meet its
prespecified primary endpoint of death or MI at 30 days, the secondary
endpoints of death at 30 days, or the development of new or worsening
congestive heart failure (relative risk 0.91, 0.82, and 1.01,
respectively; P >.05). However, in a combined analysis of both pivotal
trials, PRIMO-CABG I and II (n = 7353), death at 30 days was significantly
reduced for the greatest risk subset (n = 2156, pexelizumab 5.7% vs
placebo 8.1%, P = .024). Furthermore, this mortality reduction persisted
throughout the 180-day follow-up period (pexelizumab 11.1% vs placebo
14.4%, P = .036). Conclusions Pexelizumab was associated with a
nonsignificant 6.7% reduction in the primary composite endpoint of death
or MI at postoperative day 30 in CABG patients enrolled in the PRIMO-CABG
II trial, despite the suggestion of a more favorable treatment effect in
the previous PRIMO-CABG I trial. However, an exploratory analysis of the
combined PRIMO I and II data set using an established predictive risk
model showed a mortality benefit for high-risk surgical patients.

<30>
Accession Number
2015461711
Authors
Choi Y.S. Shim J.K. Kim J.C. Kang K.-S. Seo Y.H. Ahn K.-R. Kwak Y.L.
Institution
(Choi, Shim, Kim, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 250 Seongsanno, Seodaemun-Ku, Seoul 120-752, South Korea
(Kang, Seo, Ahn) Department of Anesthesiology and Pain Medicine,
University of Soonchunhyang Cheonan Hospital, Cheonan, South Korea
(Kwak) Severance Biomedical Science Institute, Seoul, South Korea
Title
Effect of remote ischemic preconditioning on renal dysfunction after
complex valvular heart surgery: A randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (1) (pp 148-154),
2011. Date of Publication: 2011.
Publisher
Mosby Inc.
Abstract
Objective Acute kidney injury after cardiac surgery with cardiopulmonary
bypass is closely related to systemic inflammatory reactions and oxidative
stresses. Remote ischemic preconditioning is a systemic protective
strategy whereby brief limb ischemia confers systemic protection against
prolonged ischemia and inflammatory reactions in distant organs. This
study investigated whether remote ischemic preconditioning provides
systemic protective effect on kidneys that are not directly exposed to
ischemia-reperfusion injury during complex valvular heart surgery. Methods
Seventy-six adult patients undergoing complex valvular heart surgery were
randomly assigned to either remote ischemic preconditioning group (n = 38)
or control group (n = 38). Remote ischemic preconditioning consisted of 3
10-minute cycles of lower limb ischemia and reperfusion with an automated
cuff inflator. Primary end points were comparisons of biomarkers of renal
injury including serum creatinine, cystatin C and neutrophil
gelatinase-associated lipocalin, and incidence of acute kidney injury.
Secondary end points were comparisons of myocardial enzyme release and
pulmonary parameters. Results There were no significant differences in
serum levels of biomarkers of renal injury between groups throughout the
study period. The incidence of acute kidney injury did not differ between
groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower,
and intensive care unit stay was shorter in the remote ischemic
preconditioning group than in the control group. Conclusions In patients
undergoing complex valvular heart surgery, remote ischemic preconditioning
did not reduce degree of renal injury or incidence of acute kidney injury
whereas it did reduce myocardial injury and intensive care unit stay.

<31>
Accession Number
2015461697
Authors
Stocker C.F. Shekerdemian L.S. Horton S.B. Lee K.J. Eyres R. D'Udekem Y.
Brizard C.P.
Institution
(Stocker) Pediatric Intensive Care Unit, Mater Children's Hospital,
Brisbane, Australia
(Stocker, Shekerdemian, Brizard) Australia New Zealand Children's Heart
Research Center, Melbourne, Australia
(Shekerdemian) Departments of Pediatric Intensive Care, Royal Children's
Hospital, Melbourne, Australia
(Horton, D'Udekem, Brizard) Cardiac Surgery Department, Royal Children's
Hospital, Flemington Road, Parkville, VIC 3052, Australia
(Eyres) Department of Anaesthesiology, Royal Children's Hospital,
Melbourne, Australia
(Shekerdemian, Horton, D'Udekem, Brizard) University of Melbourne,
Melbourne, Australia
(Lee) Clinical Epidemiology and Biostatistics Unit, Murdoch Children's
Research Institute, Melbourne, Australia
Title
The influence of bypass temperature on the systemic inflammatory response
and organ injury after pediatric open surgery: A randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (1) (pp 174-180),
2011. Date of Publication: 2011.
Publisher
Mosby Inc.
Abstract
Objective Systemic cooling for cardiopulmonary bypass is widely used to
attenuate the systemic inflammatory response syndrome and organ injury in
children after open surgery. We compared the effects of moderate
(24degreeC) and mild (34degreeC) hypothermia during bypass on markers of
the systemic inflammatory response syndrome and organ injury, and on
clinical outcome after corrective surgery for congenital heart disease.
Methods Sixty-six children (mean age, 6.8 +/- 5.7 months; mean weight, 6.2
+/- 2.3 kg) were randomized to 24degreeC or 34degreeC bypass temperature
during cardiac surgery. Perfusion strategies were otherwise strictly
identical. Clinical data and blood samples were collected before bypass, 5
minutes after aortic crossclamp release, and 4, 24, and 48 hours after
bypass. Patients were followed up until discharge from the hospital.
Results In the 54 children with outcome data, bypass temperature did not
influence the duration of mechanical ventilation between the 24degreeC
group and the 34degreeC group (median [interquartile range] 22 [13-40]
hours vs 14 [8-40] hours, P = .14), intensive care unit stay (43 [24-49]
hours vs 29 [23-47] hours, P = .79), blood loss (29 [20-38] mL/kg vs 23
[13-38] mL/kg, P = .36), or incidence of postoperative infection (9% vs
11%, P = 1.0). There was no evidence of an influence of bypass temperature
on the markers of acute inflammation, innate immune response, organ
injury, coagulation, or hemodynamics. Conclusions There is no evidence
that the systemic inflammatory response syndrome and organ injury after
pediatric open surgery are influenced by bypass temperature. The routine
use of hypothermic bypass may not be warranted in the pediatric
population.

<32>
Accession Number
2015461695
Authors
Speziale G. Nasso G. Esposito G. Conte M. Greco E. Fattouch K. Fiore F.
Del Giglio M. Coppola R. Tavazzi L.
Institution
(Speziale, Nasso, Fiore, Coppola) Division of Cardiac Surgery, Anthea
Hospital, GVM Hospitals of Care and Research, Via Camillo Rosalba 35-37,
Bari 70124, Italy
(Esposito, Conte) Division of Cardiac Surgery, Citta di Lecce Hospital,
GVM Hospitals of Care and Research, Lecce, Italy
(Greco) Division of Cardiac Surgery, Villa Maria Pia Hospital, GVM
Hospitals of Care and Research, Torino, Italy
(Fattouch) Division of Cardiac Surgery, University of Palermo, Palermo,
Italy
(Del Giglio, Tavazzi) Division of Cardiac Surgery, Villa Maria Cecilia
Hospital, GVM Hospitals of Care and Research, Cotignola, Italy
Title
Results of mitral valve repair for Barlow disease (bileaflet prolapse) via
right minithoracotomy versus conventional median sternotomy: A randomized
trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (1) (pp 77-83), 2011.
Date of Publication: 2011.
Publisher
Mosby Inc.
Abstract
Objective The results of mitral repair for complex Barlow valves are
adequate and support earlier intervention. It is unknown whether these
results are reproducible in the context of minimally invasive surgery via
right minithoracotomy. Methods We randomized patients with Barlow mitral
disease (bileaflet prolapse) to have conventional open repair via median
sternotomy (MS group) or minimally invasive (MI group) repair. Repair was
done using polytetrafluoroethylene chordal reimplantation for both
leaflets. In the MI group, we adopted right minithoracotomy, peripheral
cannulation, external aortic clamping, and surgery under direct vision.
Results Both groups comprised 70 patients. The operative and the
cardiopulmonary bypass times were significantly longer in the MI group (P
= .003 and P = .012). Mitral repair was successful in 98.5% MI patients
and 100% MS patients. Operative mortality was comparable. The mean
mechanical ventilation time, intensive care unit stay, and hospital stay
were lower in the MI group (P = .014, P =.02, and P = .03,). Mean pain
score was lower in the MI group at postoperative days 2 and 4. At
follow-up, the freedom from moderate (2+) or severe (3+ or 4+) mitral
regurgitation was 98% versus 97% (P = .9). Two patients underwent
reoperation (1 in each group) for late failure of repair. The Kaplan-Meier
analysis confirmed these results. Conclusions Our data indicate that the
optimal standard-of-care results of mitral repair for complex disease
(Barlow) are reproducible in the minimally invasive settings through right
minithoracotomy and direct vision. The minimally invasive technique can be
proposed for complex mitral disease and early referral of these patients
can be encouraged.

<33>
Accession Number
72060361
Authors
Van Der Meij E. Schaafsma F. Anema J. Huirne J.
Institution
(Van Der Meij, Huirne) VUMC, Department of Gynaecology, Amsterdam,
Netherlands
(Schaafsma, Anema) VUMC, Department of Public and Occupational Health,
Amsterdam, Netherlands
Title
The effect of perioperative e-health interventions on the postoperative
course: A systematic review of randomised and non-randomised controlled
trials.
Source
Gynecological Surgery. Conference: 24th Annual Congress of the European
Society for Gynaecological Endoscopy, ESGE 2015 Budapest Hungary.
Conference Start: 20151007 Conference End: 20151010. Conference
Publication: (var.pagings). 12 (1 SUPPL. 1) (pp S101), 2015. Date of
Publication: October 2015.
Publisher
Springer Verlag
Abstract
Background The objective of the study was to evaluate the effect of
perioperative e-health interventions on the postoperative course. Methods
We conducted a systematic review and searched for relevant articles in the
MEDLINE, EMBASE, CINAHL and COCHRANE databases. Controlled trials written
in English, with participants of 18 years and older, who underwent any
type of surgery, which evaluated any type of e-health interventions by
reporting patient-related outcome measures focussing on the period after
surgery, were included. Data of all included studies were extracted and
study quality was assessed by using the Downs and Black scoring system.
Results A total of 32 articles were included, reporting 26 unique studies.
Nine studies focused on perioperative care for cardiac surgery, six on
orthopaedic surgery, two on head and neck surgery, two on gynaecological
procedures (one of the studies also focused on gastro-intestinal
procedures), two on urologic surgery, one on lung surgery, one on gastric
bypass surgery, one on eye surgery, and two studied included all types of
elective surgery. All studies focused on replacing perioperative usual
care (face to face) with some form of care via ICT such as telemonitoring,
a webportal, or an electronic symptom alert system. 26 articles measured
clinical patient outcomes (e.g. general health functioning, quality of
life, complications, symptom threshold events, postoperative pain). Five
articles measured costs and two focused only on patient satisfaction.
Follow-up periods varied from 24 hours post surgery up to 6 months post
surgery. Due to heterogeneity in terms of type of surgery, type of
intervention and follow-up period, it was not possible to conduct a
meta-analysis. Most of the studies found significant positive effects on
these patient outcomes for the intervention group. More detailed results
will be presented on the ESGE 24th annual meeting. Conclusions Based on
this systematic review we conclude that e-health probably improves
clinical patient outcomes and patient satisfaction compared to
conservative face to face perioperative care for patients who have
undergone various forms of surgery.

<34>
Accession Number
72059626
Authors
Tesdal I.K.
Institution
(Tesdal) Institut fur Radiologie und Nuklearmedizin, Klinikum
Friedrichshafen, Friedrichshafen, Germany
Title
Percutaneous management of Budd-Chiari syndrome.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2015 Lisbon
Portugal. Conference Start: 20150926 Conference End: 20150930. Conference
Publication: (var.pagings). 38 (3 SUPPL. 1) (pp S150-S151), 2015. Date of
Publication: September 2015.
Publisher
Springer New York LLC
Abstract
Learning Objectives 1. To review the indications, pre-procedural imaging
and clinical evaluation 2. To outline IR techniques for patients with
Budd-Chiari syndrome 3. To discuss the results of early TIPS in comparison
with other treatments in acute, subacute and chronic Budd-Chiari syndrome
Budd-Chiari Syndrome Synonyms Thrombotic hepatic vein obstruction,
nonthrombotic hepatic vein obstruction, obliterating hepatic vein
endophlebitis, hepatic obstruction, and acute parenchymatous jaundice.
Definition Budd-Chiari syndrome (BCS) is a rare condition, and it
describes an entity of diseases characterized by thrombotic or
nonthrombotic obstruction to hepatic venous outflow (1). The obstruction
may completely or partially block the hepatic veins. George Budd (1808-
1882) described it in 1845, and Hans Chiari added the first pathologic
description of the liver with "obliterating endophlebitis of hepatic
veins" in 1899. Pathology/histopathology Obstruction of intrahepatic veins
leads to hepatic congestion and hepatopathy as blood flows into but not
out of the liver. Characteristically, the caudate lobe of the liver is
spared due to direct venous channels from the inferior vena cava. The
blood accumulation in the liver raises the pressure in non-occluded
hepatic veins and portal veins leading to portal hypertension.
Hepatocellular injury results from microvascular ischemia due to
congestion, thereby resulting in liver insufficiency. Clinical
presentation In the western world, BCS is predominantly seen in women. Age
at presentation is usually the third or fourth decade of life, although
the condition may also occur in children or elderly persons. Rajani et al.
(2) found an incidence of approximately one case per million population
per year in Sweden. Symptoms of BCS may begin suddenly and severely, but
usually, they begin gradually. Hepatomegaly, ascites, and abdominal pain
characterize BCS, but all these symptoms are nonspecific. Four main
clinical variants have been described (3): A) acute form (20%), which is
characterized by rapid development of abdominal pain, ascites,
hepatomegaly, jaundice, and renal failure; B) fulminant form (5%) in which
the patients may present with fulminant or subfulminant hepatic failure
along with ascites, tender hepatomegaly, jaundice, and renal failure; C)
subacute/chronic form that is the most common form (60%) complicated by
the symptoms of portal hypertension and varying degrees of liver
insufficiency, and approximately 50% of patients also have renal
impairment. Further severe complications in these patients and parameters
determining the outcome are progressive liver insufficiency, hydrothorax,
hepatic encephalopathy, portal vein thrombosis, inferior vena cava
thrombosis, and variceal bleeding. Approximately 15%-20% of patients with
BCS may be asymptomatic (4). Imaging As imaging modalities, we use
ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT)
scan to diagnose BCS. Using ultrasound, thrombi can be visualized, and
duplex sonography is the preferred mode. Sensitivity and specificity on
combining different modes of ultrasound are 85%-90%. MRI scanning with
pulsed sequencing helps in the assessment of hepatic venous and portal
blood flow, and sensitivity and specificity are more than 90%. CT is the
workhorse imaging system in most radiology departments and diagnostic
centers dealing with liver diseases. Contrast CT is fast and patient
friendly, and it has the unique ability to image all thoracic and
abdominal structures. Advances in technology and clinical performance
using multidetector CT enable the diagnosis of BCS and the accompanying
complications (e.g., liver cirrhosis, ascites, and hydrothorax). Diagnosis
The most important diagnostic workup is the imaging modalities such as
duplex sonography and CT. In addition to routine laboratory tests (usually
nonspecific), the following tests should be performed to evaluate
hypercoagulable state: protein C activity, antithrombin, total and free
protein S, activated protein C resistance, prothombin gene G2021OA
mutation, homocysteine concentration, factor V Leiden mutation, lupus
anticoagulants, plasminogen, fibrinogen, and heparin antibodies. The
diagnosis of bone marrow disorders, such as polycythemia vera, essential
thrombocytosis, myeloproliferative syndrome, and myelofibrosis, has to be
established or excluded according to international definitions (3, 5).
Examination of ascitic fluid provides useful clues to the diagnosis
because patients usually have high protein concentrations (>2 g/dL), but
this may not be present in persons with the acute form of BCS. A biopsy of
the liver is not compulsory for the diagnosis. Typical histologic findings
after liver biopsy are high-grade venous congestion and centrilobular
liver cell atrophy and thrombi within terminal hepatic venules. The extent
of fibrosis and cirrhosis can be determined based on biopsy findings.
Interventional radiological treatment Treatment options include medical
therapy, balloon dilation (PTA) of hepatic vein, portal systemic shunt
surgery, transjugular intrahepatic portosystemic shunt (TIPS), and liver
transplantation. Irrespective of the course of the disease, a side-to-side
shunt or liver transplantation is indicated if medical treatment fails. In
recent years, a number of reports of TIPS as a treatment for BCS have
appeared (3, 5, 6, 7). TIPS Definition and pathophysiological background
Patients with severe liver diseases, such as cirrhosis and BCS, suffer
from circulation problems. The blood from the lower part of the body
normally returns to the heart through blood vessels passing through the
liver (hepatic portal vein). If the liver is damaged or the hepatic venous
outflow is obstructed, this upward flow of blood becomes difficult,
leading to portal hypertension. The consequences are that the fluid tends
to pool in the legs (edema) and inside the abdomen (ascites) and blood may
flow in unusual pathways such as through vessels around the esophagus and
stomach. These vessels may become swollen with blood over time (esophageal
and gastral varices) and bleed. One way to treat this portal hypertension
is to form a new connection inside the damaged liver, which allows for the
better flow of blood back to the heart (7). This procedure is called as
the intrahepatic shunt (tube connection inside the liver). It can be
performed by inserting a metallic endoprosthesis (stent) into place
through a vein in the neck (transjugular) down into the liver. The link
between the high-pressure portal and low-pressure hepatic vein is an
incomplete side-to-side shunt (H-shunt). In patients with bleeding, TIPS
can be combined with the embolotherapy of varices (8). The rationale for
embolotherapy is at the same setting via the transjugular vein to use
long-acting occluding agents embolizing proximal and peripheral collateral
veins by combining liquid and mechanical materials in order to prevent
collateralization and reperfusion. Indication and contraindication The
purpose of TIPS is to achieve portal decompression. Since the first TIPS
was performed on patients with poor liver function and active variceal
hemorrhage in 1988, indications for performing TIPS have increased.
Recommendations from a consensus meeting are to discuss accepted
indications (+++), potential indications with proven efficacy (++),
experimental indications with efficacy not proven by large-scale series
(+), indications not accepted (case reports only) (-), and absolute
contraindications (--) for shunting with TIPS. Accepted indications (+++)
are as follows: 1. acute variceal bleeding that can neither be
successfully controlled with pharmacological agents nor can it be
controlled with mechanical compression or endoscopic techniques and 2.
recurrent variceal bleeding in patients who are refractory or intolerant
to conventional medical management, including sclerotherapy and
pharmacological therapy. Potential indications with proven efficacy (++)
are as follows: 1. refractory ascites (serious tense ascites that does not
respond to standard therapy within 4 weeks or when the patient develops
secondary effects, making treatment impossible) and 2. symptomatic BCS and
veno-occlusive syndrome if medical therapy fails. The rationale for TIPS
in BCS is to improve hepatic blood flow and function by the creation of an
artificial outflow via the portal vein bed. The sideto- side shunt allows
retrograde arterial perfusion of sinusoids thus reducing the hypoxic
damage of hepatocytes, leading to improvement in liver histology. Absolute
contraindications are as follows: 1) hepatic insufficiency and chronic,
severe encephalopathy; 2) severe right heart cardiac insufficiency; 3)
diffuse or multinodular liver cancer or tumors in the proposed route of
TIPS; 4) advanced cancer; 5) bacterial peritonitis or systemic infection;
and 6) unrelieved biliary obstruction. Results From a technical point of
view, successful placement of TIPS is achieved in more than 95% of
patients. Performing TIPS in a patient with BCS can be difficult if the
hepatic vein is completely occluded. In meta-analyses of the TIPS
literature, the incidence of fatal complications (intra-abdominal
hemorrhage, laceration of the hepatic artery or the portal vein, and right
heart failure) was 1.7% (range, 0.6%-4.3%). Major procedural complications
are expected in no more than 3% of cases. Both randomized and
nonrandomized studies have strengthened the evidence that TIPS is more
effective than endoscopic therapy in the prevention of variceal bleeding.
In randomized trials, the 1-year rebleeding rate ranged between 10% and
27% for TIPS and between 21% and 57% for endoscopic treatment.

<35>
Accession Number
72059536
Authors
Berczi V.
Institution
(Berczi) Department of Radiology and Oncotherapy, Semmelweis University,
Budapest, Hungary
Title
Patient selection and treatment: Upper limb DVT.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2015 Lisbon
Portugal. Conference Start: 20150926 Conference End: 20150930. Conference
Publication: (var.pagings). 38 (3 SUPPL. 1) (pp S75-S77), 2015. Date of
Publication: September 2015.
Publisher
Springer New York LLC
Abstract
Learning Objectives 1. To describe the entity of Paget-Schroetter syndrome
2. To describe the technique of endovascular therapy 3. To describe
results of thrombectomy and thrombolysis Introduction and background Upper
extremity deep venous thrombosis has an incidence of 2%-10% of all deep
venous thromboses. Primary upper extremity deep vein thrombosis (UEDVT) is
defined as spontaneously developed thrombosis without any clinically
apparent risk factors or after strenuous exercise (effort thrombosis).
Screening for occult cancer should be performed in idiopathic thrombosis,
while effort thrombosis (Paget-Schrotter syndrome; PSS) typically occurs
in young and physically active patients due to repetitive injury to the
vein due to the tight thoracic outlet and the frequently repetitive use of
arms above the shoulder level. Secondary UEDVT is far more common than the
primary form, it develops in the setting of central venous catheter,
pregnancy, malignancy, recent surgery, or recent trauma. The incidence of
UEDVT is increasing, partly due to an exponential growth in the use of
central venous catheters and the increasing placement of permanent cardiac
pacemaker or defibrillator devices. Risk factors for catheter-related
thrombosis include malignancy, chemotherapy, increased age, diabetes,
obesity, and thrombophilia. Paget-Schrotter syndrome PSS, first described
in 1875, is the venous component of thoracic outlet syndrome, with only 4%
of all thoracic outlet syndrome cases. Usually, the dominant arm is
affected. Its annual incidence is two cases per 100,000 persons. The
subclavian vein can be compressed when the arm is externally rotated or
abducted at extreme degrees. Differential diagnosis includes arterial and
neurogenic TOS, rotator cuff disorders, Pancoast tumor, vasculitis,
infections, and inherited or acquired thrombophilias. The most common
signs and syndromes include unilateral arm swelling, heaviness of the
affected upper limb, erythema, discomfort, dilated superficial veins,
low-grade fever, dyspnea, and superior vena cava syndrome. Recent studies
showed that D-dimer has a negative predictive value of 98% and 93% for
upper extremity deep thrombosis and superficial venous thrombosis,
respectively. The main complication of effort UEDVT thrombosis is the
postthrombotic syndrome (venous distension, swelling of the arm, blue
discoloration, and pain with exercise). UEDVT thrombosis, especially the
secondary form carries a substantial risk of pulmonary embolism (3%-12%).
Symptomatic PE with lower limb DVT was three times more frequent compared
with UEDVT in the RIETE registry (29% vs. 9%); however, 3-month mortality
rate was higher in the UEDVT group (11% vs. 7%). Recurrence rate is
smaller in UEDVT than lower limb DVT. Imaging Plain radiography This may
be useful in identifying cervicothoracic osseous abnormalities (e.g.,
abnormal first rib). Ultrasound On B-mode imaging, echogenicity may vary
in acute thrombosis. As usual, noncompressibility defines the presence of
DVT. Obviously, this evaluation technique cannot be used either for the
centrally situated veins (i.e., brachiocephalic veins and superior vena
cava) or for the medial segment of subclavian veins near the clavicle.
Absence of flow and the normal biphasic pattern on pulsed wave Doppler can
also suggest DVT (75% sensitivity; 100% specificity). A recent guideline
suggests the use of compressions and Doppler US ("Combined modality US")
as the initial diagnostic test. Contrast venography (CV) Earlier, it has
been the reference standard for suspected lower limb DVT. Contrast medium
is injected into the distal vein of the upper extremity. Thrombus is
identified as a filling defect present in more than one view. However,
interobserver agreement on venogram interpretation in suspected DVT is
only 70%-80%. This technique is reserved when initial noninvasive imaging
is insufficient for a conclusive diagnosis or is negative in case of
high-clinical suspicion of DVT. CV visualizes veins at the thoracic
outlet. However, it requires radiation exposure and intravenous contrast,
and is technically demanding. CO₂ venography has been used in
small studies with acceptable results (97% sensitivity and 85% specificity
against standard contrast venography). Computed tomography venography
(CTV) Pooled sensitivity of 96% and specificity of 95% was found in a
recent study against US or CV in lower limb studies; upper extremity
investigations were scarce. Obvious disadvantages of CTV include ionizing
radiation and risk associated with intravenous iodinated contrast medium.
Magnetic resonance venography (MRV) There are very few studies on MR
diagnosis of UEDVT; most of our current experience is from publications
investigating lower extremity. Pooled sensitivity and specificity of
CE-MRV was 91% and 95%, respectively, against CV as the reference standard
in lower limb veins. TOF-MRV is also promising. Magnetic resonance direct
thrombus imaging (MRDTI) can distinguish recent from chronic thrombus in
case of recurrent DVT in the lower extremity. Treatment possibilities
Anticoagulation The mainstay therapy is therapeutically dosed parenteral
anticoagulant bridged to an oral anticoagulant. INR should reach 2.0 or
higher in two measurements with a difference in time of at least 24 hours.
Acute phase therapy is for 3 months. Complication rate of anticoagulation
therapy includes 2%-4% of major bleeding. A retrospective analysis
reported increased symptomatic resolution (48% vs. 70%). Indications of
anticoagulation therapy beyond 3 months are uncertain; provoked situations
(e.g., cancer and central venous catheter) or UEDVT with tight thoracic
outlet (not corrected surgically) may justify long-term anticoagulation
treatment. In case of PSS, if compressive forces are not eliminated, then
benefits of anticoagulation may be limited. Endovascular therapies
Thrombolysis and thrombectomy Systemic thrombolysis has been largely
replaced by catheterdirected thrombolysis in the lower limb DVT due to the
smaller number of bleeding complications and better rates of valvular
competence. Catheter-directed thrombolysis (CDT) uses a multiport catheter
placed directly into the thrombus using image guidance. The risk of
bleeding is directly proportional to the volume and duration of CDT. For
lower limb treatment, typical regimen consists of continuous high-volume
drip regimen with dilute thrombolytics and concomitant unfractionated
heparin. Clearance rates are 70%-90%. Clots older than 2 weeks are
generally less susceptible for thrombolysis. Most common complications are
typically access site bleeding (major bleeding rate is approximately 10%).
Appropriate case selection is challenging. Thrombolysis can be followed by
elective thoracic outlet decompression procedure. There are only scarce
data on percutaneous mechanical thrombectomy for the upper limb DVT.
Angioplasty and stenting Limited data are available in the literature.
Stent placement for central and peripheral limb obstruction in 65 patients
showed a clinical success rate of 75% and 42% at 12 and 24 months,
respectively, with a high rate of reintervention. A smaller study (22
patients) reported occlusion of stents in all patients with
Paget-Schrotter syndrome. Angioplasty has higher failure rate if attempted
before decompression. Indications for these interventions are uncertain,
and longterm data are lacking. Unless contraindicated, anticoagulation
should follow all interventional treatments. Superior vena cava filter A
recent systematic review analysis on 209 SVC filter placements showed a
complication rate of 3.8% (mainly filter strut perforation causing cardiac
tamponade, pneumothorax, and aortic perforation). The benefit is yet
uncertain. Currently, SCV filter has little role in the management of
UEDVT. Conclusions The combination of clinical decision score, D-dimer
testing, and ultrasonography can safely and effectively exclude UEDVT. The
cornerstone of UEDVT treatment is anticoagulation. Angioplasty has higher
failure rates if attempted before decompression; stenting may be indicated
if PTA fails and decompressive forces are eliminated. The long-term
benefit of thrombolysis and thrombectomy is currently unclear; selective
patients with acute thrombosis having severe syndromes and low-bleeding
risk may be considered. Placement of superior vena cava filter may only be
considered in patients with contraindications for anticoagulation therapy
and pulmonary embolism. Clear indications for endovascular therapies
warrant data from larger-scale studies or randomized trials.

<36>
Accession Number
72059510
Authors
Sailer A.M.H.
Institution
(Sailer) Radiology, Maastricht University Medical Centre, Maastricht,
Netherlands
Title
Should balloon angioplasty be the first-line treatment for aorto-iliac
occlusive disease?.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2015 Lisbon
Portugal. Conference Start: 20150926 Conference End: 20150930. Conference
Publication: (var.pagings). 38 (3 SUPPL. 1) (pp S54-S55), 2015. Date of
Publication: September 2015.
Publisher
Springer New York LLC
Abstract
Learning Objectives 1. Know the different technologies available 2. Learn
about the role of these for treatment of stenosis and occlusive disease 3.
To learn about the anatomical considerations Know the different
technologies available Aorto-iliac occlusive disease (AIOD) is common and
can present anywhere from the distal aorta to the common femoral arteries.
One of the main contributing factors for AIOD is age, leading to an
anticipated increase in prevalence with increase of average age of the
population. The aorto-iliac region is affected in about one third of
patients with peripheral artery disease, and morphology varies from
localized stenosis to complete aorto-iliac occlusion (Leriche syndrome).
Due to a strong correlation between AIOD and coronary artery disease
(CAD), all patients with AIOD should be assessed for CAD and vice versa.
AIOD causes a spectrum of symptoms from intermittent claudication to
critical limp ischemia. Symptomatic AIOD requires treatment, but
asymptomatic patients might also be treated in order to facilitate access
for other endovascular procedures like transcatheter aortic valve repair
(TAVR) or before renal transplant implantation. Lifestyle changes and risk
factor modification, mainly consisting of smoking cessation, blood
pressure control, and statin therapy, should be part of the disease
management for all patients with AIOD. The role of exercise therapy for
mild claudication is controversial due to limited collateral growth
potential in this territory. Invasive treatment options include
percutaneous transluminal angioplasty (PTA) with or without stent
placement or surgical therapy with anatomical or extra-anatomical bypass
grafting. Endarterectomy is performed mainly in combination with bypass
surgery or in hybrid procedures. Learn about the role of these for
treatment of stenosis and occlusive disease The primary goal in the
treatment of AIOD is to relieve symptoms and to improve patient's quality
of life and functional status. Surgical therapy is effective in achieving
these goals with high longterm patency rates. However, open surgery has
significant perioperative mortality and morbidity due to wound and graft
infection, hernia, and other complications. Endovascular therapy offers
adequate hemodynamic results and at the same time lower morbidity and
mortality, shorter hospital stays, and lower expected costs than does open
surgery. Ongoing development in devices and increased experience with
endografts in aortic repair have made angioplasty and stenting the
treatment of choice for more and more challenging AIOD pathology, unless
open revascularization is required for other reasons. In experienced
hands, endovascular treatment for Trans- Atlantic Inter-Society Consensus
(TASC) C and D lesions is safe and effective with low complication and
high technical success rates. Restenosis or occlusion after endovascular
treatment is the main problem. It is caused by residual plaque,
constrictive remodeling, or intimal hyperplasia. Primary patency further
depends on the status of the run-off vessels, which have to be kept in
mind when comparing patency rates, especially in small studies. Recurrent
AIOD can almost always be managed effectively with a percutaneous approach
achieving secondary patency rates and limp salvage rates of endovascular
therapy comparable to surgical therapy. However, optimal primary clinical
results at lowest costs are desired. In a review of angioplasty for focal
AIOD, mean technical success rate of 95% and 5-year patency of 80-90% are
reported. The only randomized controlled trial comparing angioplasty to
surgical therapy shows no difference in 3-year patency between both
groups. Direct and late success of angioplasty, however, is limited by
recoil stenosis and late re-stenosis. Little disagreement exists about
stenting as a secondary procedure after failed angioplasty with residual
systolic pressure gradient > 10 mmHg or residual stenosis > 30% or in
order to treat flow-limiting dissections and ulcerative plaques.
Predilatation may be performed in order to facilitate stent placement. One
area of continuous debate is the role of direct (primary) versus selective
(after failure of PTA) stenting. Advocates for direct stenting maintain
that there is less intimal hyperplasia after stenting. In irregular and
calcified lesions, direct hemodynamic results may be better with stenting
due to smoothing of the surface and leaving fewer irregularities and less
dissection flaps. Especially after recanalization of occlusions, direct
stenting potentially causes decreased risk for peripheral embolization as
the thrombus and plaque are trapped between the mesh of the stent and the
arterial wall. The Dutch iliac trial provides a randomized comparison of
direct stent placement compared to primary angioplasty followed by
selective stent placement in case of a residual gradient > 10 mmHg after
PTA. In this study, 279 patients with mainly short iliac stenosis and few
occlusions were included, and those with complex lesions were excluded. No
significant differences in technical success, short-term and 5-year
patency, and quality of life were found between groups. By applying the
selective stenting strategy, stent placement was avoided in 60% of the
cases. The STAG trial compared primary stenting with angioplasty in iliac
artery occlusions shorter than 8 cm in length; 112 patients were randomly
assigned to each group, and technical success of the procedures, distal
embolization complications, and patency were assessed. No differences in
primary and secondary patency after 1 and 2 years were observed, but
initial technical success rates were significantly higher and embolization
complications lower in the direct stenting group. Direct stenting for
aorto-iliac lesions has become common practice and is advocated by many
studies. Reported technical success and clinical success are excellent,
but late failure due to in-stent restenosis do occur, which often requires
more advanced devices in re-treatment. In a retrospective review of 151
patients with AIOD who underwent either direct stenting or PTA with
selective stenting, the authors found 100% clinical success rates for TASC
A and B lesions in both groups. Short- and long-term patency were
significantly higher for the direct stenting group in TASC C and D
lesions, and overall perioperative complication rate was lower for direct
stenting than for angioplasty and selective stenting (3% versus 24%).
Currently, level 1b evidence data support that in AIOC, angioplasty can be
an acceptable firstline treatment for focal, concentric, non-calcified,
non-ostial stenosis. Aorto-iliac occlusions and complex lesions can be
treated safely with primary stenting. To learn about the anatomical
considerations In patients with concurrent stenosis of the common femoral
artery, a hybrid procedure of iliac artery angioplasty with or without
stent placement in combination with endarterectomy (with or without
profundoplasty) is appropriate. Current evidence for device choice and
procedure planning for specific AIOD pathology (e.g., in-stent
restenosis), anatomical location (e.g., complete aorto-iliac occlusion),
and AIOD morphology (e.g., common iliac artery versus external iliac
artery) will be discussed during the session.

<37>
Accession Number
72053271
Authors
McGuinness S. Parke R. Drummond K.E.
Institution
(McGuinness, Parke) Auckland City Hospital, Auckland, New Zealand
(McGuinness, Drummond) Royal Adelaide Hospital, Adelaide, SA, Australia
Title
The avoidance of hyperoxaemia during cardiopulmonary bypass-a multi-center
phase IIB randomized controlled trial.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2015 Denver, CO
United States. Conference Start: 20150515 Conference End: 20150520.
Conference Publication: (var.pagings). 191 , 2015. Date of Publication:
2015.
Publisher
American Thoracic Society
Abstract
Rationale Cardiac surgery utilising cardiopulmonary bypass (CPB) is one of
the most common forms of major surgery worldwide, with more than 1 million
patients undergoing this surgery each year. Despite recent improvements to
both surgical techniques and the equipment used for CPB mortality and
significant morbidity remains high. Cardiac surgery associated multi-organ
dysfunction (CSA-MOD) is well recognised and includes cardiac surgery
associated Acute Kidney Injury (CSA-AKI), acute hepatic impairment,
myocardial damage and post-operative neurological deficit. The
pathophysiology of CSA-MOD may involve numerous injurious pathways linked
to the use of CPB including oxidative stress and the formation of reactive
iron species. During cardiac surgery with CPB it is standard practice to
oxygenate the arterial return blood to supra-normal levels. This study
aimed to determine whether the avoidance of arterial hyperoxaemia would
decrease oxidative stress and reduce the severity of the multi-organ
dysfunction that is common following cardiac surgery utilising CPB.
METHODS Design: A multi-center, Phase IIb parallel group, randomized
controlled trial of the avoidance of arterial hyperoxaemia vs. usual care
in patients undergoing cardiac surgery involving CPB. Hypothesis: That the
avoidance of hyperoxaemia during cardiopulmonary bypass reduces
postoperative organ dysfunction. Outcomes: Primary: Incidence and severity
of CSA-AKI Secondary: CSA-MOD determined by serum biomarkers (Troponin T,
AST, Amylase, C-reactive protein, lactate, selenium), duration of
mechanical ventilation, length of ICU and hospital stay and mortality.
RESULTS Between December 2012 and May 2014 298 patients were randomized to
either the avoidance of hyperoxaemia or usual care at two hospitals in New
Zealand and Australia. All patients were followed to day 90. There were no
significant differences in baseline characteristics between the two
groups. Excellent treatment separation was achieved during CPB for both
inspired oxygen concentration and arterial oxygen content (Fig 1). There
was no difference between the intervention arm and the control arm in the
development of any AKI (72% vs. 66%; p=0.28) or more severe AKI (KDIGO 2
or 3; 27% vs. 30%; p=0.56). There was also no difference in the multiple
markers of other organ damage measured or in ICU and hospital length of
stay. CONCLUSIONS This is the first study to report the effects of
avoiding arterial hyperoxaemia during CPB. Despite achieving excellent
treatment separation we failed to demonstrate any difference in either
organ damage or other outcomes. As this practice requires more intense
monitoring and carries some theoretical risk this study does not support
its adoption into routine practice. (Figure Presented).

<38>
Accession Number
72051893
Authors
Hsieh S.J. Fuster D. D'Alessandro D.A. Leff J.D. Gong M.N.
Institution
(Hsieh) Albert Einstein College of Medicine, Montefiore Medical Center,
Bronx, NY, United States
(Hsieh, Fuster, D'Alessandro, Leff) Montefiore Medical Center, Bronx, NY,
United States
(Gong) BronxNYUnited States
Title
Feasibility and efficacy of intranasal insulin for post-operative
delirium: The CNS-elders randomized controlled trial.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2015 Denver, CO
United States. Conference Start: 20150515 Conference End: 20150520.
Conference Publication: (var.pagings). 191 , 2015. Date of Publication:
2015.
Publisher
American Thoracic Society
Abstract
Rationale: Older cardiac surgery patients are at high risk for developing
post-operative delirium. Studies in Alzheimer's patients suggest that
centrally-administered insulin improves cognitive function and may have
neuroprotective effects. We sought to demonstrate the feasibility of a
placebo-controlled trial of intranasal insulin in an older critically ill
cardiac surgery population and to determine if intranasal insulin would
decrease the incidence and duration of post-operative delirium. Methods:
Pilot phase II, randomized, double-blind, placebo-controlled trial of
adults >55 years old undergoing elective or semi-urgent coronary artery
bypass graft and/or valvular surgery requiring cardiopulmonary bypass.
Patients were randomized to receive either 40 IU of aspart insulin (n=11)
or normal saline (n=10) administered intranasally with a mucosal atomizer
device within 2 hours prior to surgery, and then every 6 hours after
surgery for 7 days or until hospital discharge, whichever occurred
earlier. Level of consciousness and delirium was assessed twice daily
using the Richmond Agitation and Sedation Scale and Confusion Assessment
Method ICU (CAM-ICU) for up to 7 days post-operatively. Results: Of the 22
enrolled patients, 21 participated in the study protocol (mean age 73 +10)
and received 24+4 doses of study drug. Patients in the placebo group had
more baseline depression (20% vs 0%, p=0.12) and longer surgical time (313
vs 271 minutes, p=0.13) compared to the insulin group, though neither were
statistically significant. Sedative use did not differ between the two
groups. During the 7-day study period, the insulin group had a similar
incidence of delirium (18% vs 40%, p=0.36) and days alive without delirium
and coma as the placebo group (7 [7,7] vs 7 [3,7], p=0.17). In addition,
the duration of mechanical ventilation, ICU and hospital length of stay,
and discharge location did not differ between the two groups. Conclusions:
A randomized, placebo-controlled trial of intranasal insulin for
post-operative delirium in older cardiac surgery patients is feasible.
Treatment with intranasal insulin did not reduce the incidence or duration
of delirium and coma. Larger trials are needed to determine if intranasal
insulin can prevent and/or reduce delirium in a critically ill population.
(Table Presented).

<39>
Accession Number
72048681
Authors
Sucha D. Tuncay V. Prakken N. Leiner T. Van Ooijen P. Oudkerk M. Budde R.
Institution
(Tuncay) Center for Medical Imaging North East Netherlands (CMINEN),
Groningen, Netherlands
(Budde) Erasmus University Medical Center, Rotterdam, Netherlands
(Prakken, Van Ooijen, Oudkerk) University Medical Center Groningen,
Groningen, Netherlands
(Sucha, Leiner) University Medical Center Utrecht, Utrecht, Netherlands
Title
The dynamic behavior of the aortic annulus and its implications for TAVI
prosthesis sizing: A systematic review.
Source
Journal of Cardiovascular Computed Tomography. Conference: 10th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography,
SCCT 2015 Las Vegas, NV United States. Conference Start: 20150716
Conference End: 20150719. Conference Publication: (var.pagings). 9 (4
SUPPL. 1) (pp S53), 2015. Date of Publication: July-August 2015.
Publisher
Elsevier Inc.
Abstract
Introduction: Appropriate prosthesis size selection is required for
successful transcatheter aortic valve implantation (TAVI) outcomes and
relies completely on cardiac imaging. A key feature in TAVI sizing is the
understanding of the dynamic behavior of the aortic annulus. Studies have
shown the annulus to often have an ellipsoid shape, but no consensus
exists on its dynamic changes throughout the cardiac cycle. The purpose of
this study was to assess the conformational change of the aortic annulus
during the cardiac cycle and to evaluate possible implications for TAVI
prosthesis selection. Methods: A systematic search was performed in Pubmed
and Embase using predefined criteria to acquire all original articles on
the dynamic behavior of the aortic annulus throughout the cardiac cycle.
Only studies evaluating the aortic annulus in at least one diastolic and
systolic phase were included for analysis. Results: The search yielded 29
original studies published from 2001 to 2014 of in total 2021 patients
with a mean age ranging from 11+/-3.6 to 84.9+/-7.2 years. Both patients
with (n=1079) and without (n=942) aortic stenosis were evaluated.
Three-dimensional modalities used for assessment were echocardiography
(n=6), MRI (n=1) and CT (n=17). The short axis diameter, area and
perimeter of the aortic annulus showed significant change throughout the
cardiac cycle with larger dimensions during systole compared to diastole.
Maximal difference during the cycle for short axis diameter ranged up to
8.7 mm and a maximal mean difference of 122+/-33 mm2 was reported for area
change. Contrarily, the long-axis diameter and coronal diameter remained
relatively stable throughout the cycle. Between patients, the annulus
showed to reach its maximal dimensions at different time points within the
cycle (mostly 0-30% of the RR-interval, range 0-90%). Selection of the
cardiac phase with the annulus in its ultimate dimensions showed better
prosthesis agreement and less TAVI undersizing compared to predefined
systolic (35%) and/or diastolic (75%) phase measurements. Conclusion: The
aortic annulus undergoes significant conformational change throughout the
cardiac cycle that may impact prosthesis size selection and result in
undesired prosthesis undersizing. Hence, it is required to use
three-dimensional imaging for annulus assessment and it is crucial for
TAVI sizing to take the dynamic deformation into consideration by
selecting the optimal cardiac phase and annular parameter.

<40>
Accession Number
72048663
Authors
Opolski M. Staruch A. Jakubczyk M. Staruch M. Kepka C. Witkowski A.
Institution
(Opolski, Staruch, Kepka, Witkowski) Institute of Cardiology, Warsaw,
Poland
(Staruch) Medical University of Warsaw, Warsaw, Poland
(Jakubczyk) Warsaw School of Economics, Warsaw, Poland
Title
Computed tomography angiography for the detection of coronary artery
disease in patients referred for cardiac valve surgery: A meta-analysis.
Source
Journal of Cardiovascular Computed Tomography. Conference: 10th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography,
SCCT 2015 Las Vegas, NV United States. Conference Start: 20150716
Conference End: 20150719. Conference Publication: (var.pagings). 9 (4
SUPPL. 1) (pp S45), 2015. Date of Publication: July-August 2015.
Publisher
Elsevier Inc.
Abstract
Introduction: Coronary computed tomography angiography (CTA) is not
routinely performed for detecting coronary artery disease (CAD) before
cardiac valve surgery. We thus aimed to evaluate the diagnostic accuracy
of coronary CTA for detecting CAD in comparison with invasive coronary
angiography (ICA) in patients with valvular heart disease (VHD) undergoing
valve surgery. Methods: A systematic review of PubMed, EMBASE, and
Cochrane databases for all studies assessing CAD in VHD using >16-detector
row CTA until October 2014 was performed. Standard random-effects models
and a bivariate approach were applied for meta-analysis of the diagnostic
test. Results: Seventeen studies analyzing 1,107 patients and 12,851
coronary segments were included. Patient-based analysis comparing CTA with
ICA for detection of significant CAD (stenosis >50%) showed pooled
sensitivity of 89% (95% CI 85-92%), specificity of 89% (95% CI 86-91%), a
negative predictive value (NPV) of 95% (95% CI 94-97%), and a positive
predictive value of 75% (95% CI 71-80%). Analyses of diagnostic accuracy,
stratified by the presence of aortic stenosis (AS) showed improved
specificity (95% vs. 87%, p = 0.01) and a trend toward improved NPV (98%
vs. 95%, p = 0.13) in patients without vs. with AS. The meta-regression
analysis showed a significant impact of AS (coefficient -0.02, p = 0.011)
and publication year (coefficient -0.21, p = 0.014) on the diagnostic
performance of CTA. Conclusions: Coronary CTA may be a reliable
noninvasive imaging alternative to ICA with an excellent NPV for the
detection of CAD in patients with VHD other than AS prior to cardiac valve
surgery. (Table Presented).

<41>
Accession Number
72048626
Authors
Slim A. Fentanes E. PearceMoore D. Suarez N. Slim J. Ahmadian H. McDonough
R. Saucedo J. Kirchner L. Conner W. Thomas D. Hulten E. Branch K. Cury R.
Institution
(Slim, Fentanes, PearceMoore, Suarez, Ahmadian, McDonough, Saucedo,
Conner, Thomas) Brooke Army Medical Center, San Antonio, TX, United States
(Kirchner) Geisinger Medical Center, Danville, PA, United States
(Slim) Louisiana State University, New Orleans, LA, United States
(Cury) Miami Cardiac and Vascular Institute, Coral Gables, FL, United
States
(Branch) University of Washington, Seattle, WA, United States
(Hulten) Walter Reed, Bethesda, MD, United States
Title
Aspirin and plavix following coronary bypass grafting (ASAPCABG): A
randomized, double-blind, placebo-controlled clinical trial.
Source
Journal of Cardiovascular Computed Tomography. Conference: 10th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography,
SCCT 2015 Las Vegas, NV United States. Conference Start: 20150716
Conference End: 20150719. Conference Publication: (var.pagings). 9 (4
SUPPL. 1) (pp S29), 2015. Date of Publication: July-August 2015.
Publisher
Elsevier Inc.
Abstract
Background: Vein graft thrombosis is the leading cause of acute graft
failure with-in the first post-operative month and several studies have
shown the benefit of dual anti-platelet therapy (DAT) in preventing acute
graft thrombosis. The purpose of this study is to determine whether
peri-operative initiation of DAT will improve graft patency at 2 and 52
weeks, respectively. Methods: This is a randomized,double-blind, placebo
controlled trial evaluating the efficacy of DAT vs.aspirin and placebo to
maintain graft patency 2 and 52 weeks post-operatively utilizing cardiac
computed tomography angiography (CCTA). The secondary outcome was major
adverse cardiovascular events (MACE) defined as recurrent
angina,myocardial infarction, and all thrombotic events as well as safety
end-points defined as TIMI major and minor events. Results: The study
population consisted predominately of men (19/20 patients). The primary
outcome was incidence of more than 50% stenosis in a bypass graft. All
LIMA grafts were patent at 2 weeks. The two-week patency of all vein
grafts was 84% (37/44). The patency rate in the placebo group was 90.0%
(18/20) as compared to a patency of 79.20% (19/24); in the dual
anti-platelet therapy arm (p=0.428). Conclusion: The addition of
clopidogrel to aspirin did not reduce the incidence of acute vein graft
failure 2 weeks post-bypass surgery. There was a trend favoring venous
graft patency at 52 weeks with dual anti-platelet therapy; however, it was
not statistically significant due to the limitation of small sample size.

<42>
Accession Number
72048621
Authors
Aggarwal S. Loomba R. Gupta N. Arora R. Alla V. Mooss A.
Institution
(Arora) Chicago Medical School, North Chicago, IL, United States
(Aggarwal, Alla, Mooss) Creighton University, School of Medicine, Omaha,
NE, United States
(Loomba, Gupta) Medical College of Wisconsin, Milwaukee, WI, United States
Title
Coronary computed tomography angiography versus invasive angiography in
patients referred for transcatheter aortic valve replacement.
Source
Journal of Cardiovascular Computed Tomography. Conference: 10th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography,
SCCT 2015 Las Vegas, NV United States. Conference Start: 20150716
Conference End: 20150719. Conference Publication: (var.pagings). 9 (4
SUPPL. 1) (pp S27-S28), 2015. Date of Publication: July-August 2015.
Publisher
Elsevier Inc.
Abstract
Introduction: The diagnostic accuracy of coronary computed tomography
angiography (CCTA) is unclear in patients being referred for transcatheter
aortic valve replacement (TAVR). We performed a meta-analysis of published
studies comparing CCTA versus invasive coronary angiography (ICA) for
evaluation of coronary artery disease (CAD) in all patients referred for
TAVR. Methods: We searched Pubmed, EMBASE, Cochrane and Google scholar for
studies with terms "coronary computed tomography angiography", "invasive
coronary angiography", "transcatheter aortic valve replacement" and their
combinations. Studies in language other than English were excluded.
Results: Total 5 studies including 1075 patients were included. In
per-patient analysis, the sensitivity(Se), specificity(Sp), positive
predictive value(PPV) and negative predictive value(NPV) for CCTA were
0.96, 0.66, 0.75 and 0.95. For per-segment analysis, the numbers for CCTA
were Se 0.84, Sp 0.89, PPV 0.46 and NPV 0.98. For per-vessel analysis, the
numbers for CCTA were Se 0.94, Sp 0.53, PPV 0.49 and NPV 0.95.
Conclusions: Coronary computed tomography angiography is a feasible and an
accurate alternative to invasive coronary angiography for evaluation of
coronary artery disease in patients referred for transcatheter aortic
valve replacement.

<43>
Accession Number
72048340
Authors
Obeidat M. Hao K. Bosse Y. Laviolette M. Nickle D.C. Postma D.S. Timens W.
Gharib S.A. Tobin M.D. Hall I.P. London S.J. Sin D.D. Pare P.D.
Institution
(Obeidat, Sin, Pare) University of British Columbia Centre for Heart Lung
Innovation, St. Paul's Hospital, Vancouver, BC, Canada
(Hao) Mount Sinai School of Medicine, New York, NY, United States
(Bosse) Laval University, Quebec, QC, Canada
(Laviolette) Laval University, Quebec, QC, Canada
(Nickle) Merck Research Laboratories, Boston, MA, United States
(Postma, Timens) University of Groningen, Groningen, Netherlands
(Gharib) University of Washington, Seattle, WA, United States
(Tobin) University of Leicester, Leicester, United Kingdom
(Hall) University of Nottingham, Nottingham, United Kingdom
(London) National Institute of Environmental Health Sciences, North
Carolina, NC, United States
Title
Integrative genomics approach to unravel the molecular mechanisms
underlying variations in lung function measures.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2014 San Diego, CA
United States. Conference Start: 20140516 Conference End: 20140521.
Conference Publication: (var.pagings). 189 , 2014. Date of Publication:
2014.
Publisher
American Thoracic Society
Abstract
Rationale: The SpiroMeta-CHARGE consortium undertook the largest
genome-wide association study (GWAS) for forced expiratory volume in one
second (FEV1) and its ratio to forced vital capacity (FEV1/FVC) in ~50,000
individuals. The study identified a large number of SNPs with strong
statistical association with FEV1 and FEV1/FVC. However, the exact
mechanisms underlying these associations are not fully understood. We
hypothesized that by determining which lung function-related SNPs also
influence the level of mRNA in lung tissue-i.e, act as expression
quantitative trait loci (eQTL)-we will gain more insight into the
mechanisms and pathways regulating lung function. Methods: The lung eQTLs
were derived from genome-wide genotyping and gene expression analysis of
1,111 non-tumor lung tissue samples obtained at the time of thoracic
surgery from three sites: UBC, Laval and Groningen universities. The eQTL
study identified ~47,000 SNPs related to the level of gene expression in
cis (within 1 Mb from transcription start site) and ~17,000 SNPs in trans.
We utilised data from a GWAS of ~2.5 million SNPs on FEV1 and FEV1/FVC in
48,000 individuals (the SpiroMeta-CHARGE meta-analysis). SNPs associated
with either FEV1 or FEV1/FVC at P < 0.001 and are eQTLs were identified
(eSNPs) and mapped to their target genes. Pathway and network analyses
were undertaken on the identified genes. Results: For FEV1, 6790 SNPs
showed association at P < 0.001 in the GWAS. Of those, 3419 (50%) SNPs
acted as cis-eQTL and 1568 (23%) acted as trans-eQTL. For FEV1/FVC, 5417
SNPs showed association in the GWAS at P < 0.001, and 2214 (40%) of those
SNPs acted as cis -eQTL, and 442 (20%) as trans-eQTL in lung tissue. 523
cis eSNPs and 223 trans eSNPs were shared between FEV1 and FEV1/FVC.
FEV1-associated cis and trans eSNPs mapped to 271 and 29 unique genes,
respectively. FEV1/FVC cis and trans eSNPs mapped to 275 and 21 unique
genes, respectively. These identified genes were enriched in pathways
related to interferon gamma signaling and immune response, tissue
remodeling and repair, and developmental and cytoskeleton remodeling
processes. The top eSNPs are presented in the table below. Conclusion: A
large number of SNPs associated with lung function in the SpiroMeta-CHARGE
GWAS act as lung-specific eQTL suggesting that their effects are mediated
through gene expression. Our integrative genomics approach is a powerful
method for identifying genes and molecular pathways involved in
determining lung function, and shows promise as an analytical pipeline to
prioritize genes for future functional studies. (Table Presented).

<44>
Accession Number
72047331
Authors
Schmickl C.N. Mastrobuoni S. Filippidis F. Shah S. Radic J. Murad M.H. Toy
P. Gajic O.
Institution
(Schmickl, Murad, Gajic) Mayo Clinic, Rochester, MN, United States
(Schmickl, Mastrobuoni) Cliniques Universitaires Saint-Luc, Universite'
Catholique De Louvain, Bruxelles, Belgium
(Filippidis) School of Public Health, Imperial College, London, United
Kingdom
(Shah) Harvard School of Public Health, Boston, MA, United States
(Radic) Dalhousie University, Halifax, NS, Canada
(Toy) University of California San Francisco, San Francisco, CA, United
States
Title
Male-predominant plasma transfusion strategy for preventing
transfusion-related acute lung injury (TRALI): A systematic review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2014 San Diego, CA
United States. Conference Start: 20140516 Conference End: 20140521.
Conference Publication: (var.pagings). 189 , 2014. Date of Publication:
2014.
Publisher
American Thoracic Society
Abstract
Background: Transfusion-related acute lung injury (TRALI), the leading
cause of transfusion-related mortality in the USA, has been linked to
antibodies against Human-Leucocyte-Antigens (HLA) in donor plasma, more
common in ever-pregnant females. To prevent TRALI many countries
restricted the plasma donor pool to predominantly males in the last
decade, but the effectiveness of this strategy has not been systematically
evaluated and concerns exist that subgroups like cardiac surgery patients
may be harmed by it. Methods: Data were identified by querying MEDLINE and
EMBASE, searching the Internet for hemovigilance reports, reviewing
reference lists of eligible articles and contacting experts in the field.
Eligible were all studies reporting TRALI incidence, all-cause mortality
(primary outcomes), hospital length of stay, time to extubation,
PaO2/FiO2-ratio or blood pressure changes (secondary outcomes) in
recipients of plasma transfusions containing relatively more plasma from
individuals at low risk of carrying HLA-antibodies ("male plasma") than
those receiving comparator plasma ("control plasma"). No limits were
placed on study design, population or language. The only exclusion
criteria were non-human subjects and lack of control group. Pre-specified
study quality indicators (including risk of bias assessment) and potential
effect modifiers were tested using Cochran's Q-Test. Final analyses using
random-effects models and I2 to assess heterogeneity were performed in the
subset of studies judged to provide the best evidence and separately for
significantly different subgroups using STATA 12.1. Results: From a total
of 850 retrieved records we identified 45 eligible studies. For TRALI
incidence, final analysis was restricted to 13 cohort studies and 1
randomised controlled trial in which TRALI cases only involved plasma
transfusions. Risk of TRALI and mortality in plasma recipients exposed to
male compared to control plasma were 0.27 (95%-CI=0.20 to 0.38; P<0.001;
I2=0%; n=14; Figure1) and 0.89 (95%-CI=0.80 to 1.00; P=0.04; I2=79%; n=7),
respectively. No other significant interactions were found. Secondary
outcomes showed similar results, but were less reported and the studies
more heterogeneous. Sensitivity analyses did not alter the results. There
was no evidence of publication bias. Discussion: More than 800 million
people in 17 countries are subject to male-predominant plasma transfusion
policy and at least 3 more countries are planning or considering adoption
of this strategy. Based on mostly observational data, judged to be of high
quality, male-predominant plasma transfusion strategy reduces plasma
related TRALI incidence and possibly mortality. There was no evidence that
the effect differs across patient subgroups but power to detect such
differences was low. (Table Presented).

<45>
Accession Number
72047330
Authors
Parke R. McGuinness S. Gilder E. McCarthy L. Cowdrey K.-A.
Institution
(Parke, McGuinness, Gilder, McCarthy, Cowdrey) Auckland City Hospital,
Auckland, New Zealand
Title
A study to assess efficacy and safety of a novel restrictive fluid
strategy following cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2014 San Diego, CA
United States. Conference Start: 20140516 Conference End: 20140521.
Conference Publication: (var.pagings). 189 , 2014. Date of Publication:
2014.
Publisher
American Thoracic Society
Abstract
Rationale Following cardiac surgery, patients receive large amounts of
fluid in the Intensive Care Unit. We plan to conduct a multi-centre
randomised controlled trial of a restrictive fluid regime in patients
following cardiac surgery, and report here the results of a feasibility
study that evaluated the efficacy and safety of the proposed regime.
Methods A single-centre, prospectively randomised interventional study was
undertaken to assess the ability of the algorithm to reduce intravenous
fluid administration after cardiac surgery; determine any difference in
incidence of acute kidney injury (as defined by the KDIGO guidelines) and
assess the extent of any Hawthorne effect from this unblinded study.
Following ethical approval patients scheduled to undergo elective cardiac
surgery at a tertiary centre were consented and enrolled into this study.
Participants were excluded if they had an intra-aortic balloon pump or
were in atrial fibrillation. Participants were randomised to either
standard care with intravenous fluid administered according to usual
practice or to the protocolised algorithm. The protocol included
measurements of stroke volume variation to restrict fluid administration
to patients who were deemed to have an inadequate cardiac output and in
whom administration of fluid was likely to result in an increase in
cardiac output (Figure 1). The study protocol lasted from admission to ICU
to extubation or 24 hours, whichever occurred first. All other care
remained unchanged. Results 144 patients were randomised over a 9 month
period. No difference was seen in baseline demographics. Less bolus fluid
and less total overall fluid was administered in the intervention group as
compared to the control group from ICU admission to extubation (mean (sd)
2137mls (2218) vs. 3355mls (2617), p = 0.003 and 2717mls (2571) vs.
4048mls (2974), p = 0.005 respectively). There was no difference in
incidence of acute kidney injury (intervention = 52% vs. 48% p=0.36) or
the mean (sd) amount of fluid administered at the beginning of the study
to that administered at the end (4248mls (663) vs. 3302mls (684) p =
0.33). Conclusions This feasibility study demonstrates that it was
possible to achieve a reduction in the amount of fluid administered to
patients allocated to the restrictive fluid protocol. There was no
increase in acute kidney injury in the intervention group and there was no
evidence of a Hawthorn effect in the standard care group over the course
of the study. These results suggest that the planned multi-centre study is
both justified and feasible. (Figure Presented).

<46>
Accession Number
26271061
Authors
Abdel-Wahab M. Neumann F.-J. Mehilli J. Frerker C. Richardt D. Landt M.
Jose J. Toelg R. Kuck K.-H. Massberg S. Robinson D.R. El-Mawardy M.
Richardt G.
Institution
(Abdel-Wahab) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
Electronic address:
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Mehilli) Munich University Clinic, Munich, Germany
(Frerker) Cardiology Department, Asklepios Clinic St. Georg, Hamburg,
Germany
(Richardt) Cardiosurgery Department, Lubeck University Hospital, Lubeck,
Germany
(Landt) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Jose) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Toelg) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Kuck) Cardiology Department, Asklepios Clinic St. Georg, Hamburg, Germany
(Massberg) Munich University Clinic, Munich, Germany
(Robinson) Mathematics Department, University of Sussex, Brighton, United
Kingdom
(El-Mawardy) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Richardt) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
Title
1-Year Outcomes After Transcatheter Aortic Valve Replacement With
Balloon-Expandable Versus Self-Expandable Valves: Results From the CHOICE
Randomized Clinical Trial.
Source
Journal of the American College of Cardiology. 66 (7) (pp 791-800), 2015.
Date of Publication: 18 Aug 2015.
Abstract
BACKGROUND: The use of a balloon-expandable transcatheter heart valve
previously resulted in a greater rate of device success compared with a
self-expandable transcatheter heart valve.
OBJECTIVES: The aim of this study was to evaluate clinical and
echocardiographic outcome data at longer term follow-up.
METHODS: The investigator-initiated trial randomized 241 high-risk
patients with symptomatic severe aortic stenosis and anatomy suitable for
treatment with both balloon- and self-expandable transcatheter heart
valves to transfemoral transcatheter aortic valve replacement with either
device. Patients were followed-up for 1 year, with assessment of clinical
outcomes and echocardiographic evaluation of valve function.
RESULTS: At 1 year, the rates of death of any cause (17.4% vs. 12.8%;
relative risk [RR]: 1.35; 95% confidence interval [CI]: 0.73 to 2.50; p =
0.37) and of cardiovascular causes (12.4% vs. 9.4%; RR: 1.32; 95% CI: 0.63
to 2.75; p = 0.54) were not statistically significantly different in the
balloon- and self-expandable groups, respectively. The frequencies of all
strokes (9.1% vs. 3.4%; RR: 2.66; 95% CI: 0.87 to 8.12; p = 0.11) and
repeat hospitalization for heart failure (7.4% vs. 12.8%; RR: 0.58; 95%
CI: 0.26 to 1.27; p = 0.19) did not statistically significantly differ
between the 2 groups. Elevated transvalvular gradients during follow-up
were observed in 4 patients in the balloon-expandable group (3.4% vs. 0%;
p = 0.12); all were resolved with anticoagulant therapy, suggesting a
thrombotic etiology. More than mild paravalvular regurgitation was more
frequent in the self-expandable group (1.1% vs. 12.1%; p = 0.005).
CONCLUSIONS: Despite the higher device success rate with the
balloon-expandable valve, 1-year follow-up of patients in CHOICE
(Randomized Comparison of Transcatheter Heart Valves in High Risk Patients
With Severe Aortic Stenosis: Medtronic CoreValve Versus Edwards SAPIEN XT
Trial), with limited statistical power, revealed clinical outcomes after
transfemoral transcatheter aortic valve replacement with both balloon- and
self-expandable prostheses that were not statistically significantly
different. (A Comparison of Transcatheter Heart Valves in High Risk
Patients With Severe Aortic Stenosis: The CHOICE Trial; NCT01645202).

<47>
Accession Number
25073881
Authors
Mailhot T. Cossette S. Bourbonnais A. Cote J. Denault A. Cote M.-C.
Lamarche Y. Guertin M.-C.
Institution
(Mailhot, Cossette, Bourbonnais, Cote, Denault, Cote, Lamarche, Guertin)
Faculty of Nursing, University of Montreal, C,P, 6128 succ, Centre-ville,
Montreal, Quebec H3C 3J7, Canada. t.mailhot@umontreal.ca
Title
Evaluation of a nurse mentoring intervention to family caregivers in the
management of delirium after cardiac surgery (MENTOR_D): a study protocol
for a randomized controlled pilot trial.
Source
Trials. 15 (pp 306), 2014. Date of Publication: 2014.
Abstract
BACKGROUND: Despite the use of evidence-based preventive measures,
delirium affects about 40% of patients following cardiac surgery with the
potential for serious clinical complications and anxiety for caregivers.
There is some evidence that family involvement as a core component of
delirium management may be beneficial since familiarity helps patients
stay in contact with reality, however, this merits further investigation.
There is also currently a gap in the scientific literature regarding
objective indicators that could enhance early detection and monitoring of
delirium. Therefore, this randomized pilot trial examines the
acceptability, feasibility, and preliminary efficacy of an experimental
nursing intervention to help family caregivers manage post-cardiac surgery
delirium in their relatives. It also explores the validity of a new and
innovative measure that has potential as an indicator for delirium.
METHODS/DESIGN: In this two-group randomized pilot study (n=30), the
control group will receive usual care and the intervention group will
receive the experimental intervention aimed at reducing delirium severity.
The intervention nurse's objective will be to foster the family
caregiver's self-efficacy in behaving in a supportive manner during
delirium episodes. Data will be collected from standard delirium
assessment scales and a novel measure of delirium, i.e., cerebral oximetry
obtained using near infrared spectroscopy, as well as medical records and
participants' responses to questionnaires.
DISCUSSION: New strategies for early detection, monitoring, and management
of delirium are needed in order to improve outcomes for both patients and
families. The present article exposes feasibility issues based on the
first few months of the empirical phase of the study that may be useful to
the scientific community interested in improving the care of patients with
delirium. Another potentially important contribution is in the exploration
of cerebral oximetry, a promising measure as an objective indicator for
early detection and continuous monitoring of delirium. The proposed pilot
study will build towards a larger trial with the potential to improve
knowledge about delirium management and monitoring.
TRIAL REGISTRATION: This pilot study was registered at Controlled Trials
on March 27th 2013 and was assigned #ISRCTN95736036.