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<1>
Accession Number
26005776
Authors
Abbasi S.H. Mohammadinejad P. Shahmansouri N. Salehiomran A. Beglar A.A.
Zeinoddini A. Forghani S. Akhondzadeh S.
Institution
(Abbasi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran; Family Health Research Center, Iranian Petroleum Industry
Health Research Institute, Tehran, Iran
(Mohammadinejad) Psychiatric Research Center, Roozbeh Psychiatric
Hospital, Tehran University of Medical Sciences, Tehran, Iran
(Shahmansouri) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Salehiomran) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Beglar) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Zeinoddini) Psychiatric Research Center, Roozbeh Psychiatric Hospital,
Tehran University of Medical Sciences, Tehran, Iran
(Forghani) Razi Vaccine and Serum Research Institute, Karaj, Iran
(Akhondzadeh) Psychiatric Research Center, Roozbeh Psychiatric Hospital,
Tehran University of Medical Sciences, Tehran, Iran. Electronic address:
s.akhond@neda.net
Title
Simvastatin versus atorvastatin for improving mild to moderate depression
in post-coronary artery bypass graft patients: A double-blind,
placebo-controlled, randomized trial.
Source
Journal of affective disorders. 183 (pp 149-155), 2015. Date of
Publication: 01 Sep 2015.
Abstract
BACKGROUND: A decreased risk of developing depression has been reported
among statin users. Aside from their lipid-lowering effects, statins are
considered immunomodulatory agents and have protective effects against
oxidative stress and inflammation which are well known for their
association with depression. The aim of the present study was to compare
the probable antidepressant effects of simvastatin and atorvastatin among
post-coronary artery bypass graft (CABG) surgery patients with high and
low potentials for blood-brain-barrier penetration, respectively.
METHOD: Forty-six outpatients who had undergone CABG in the last 6 months
and suffered from mild to moderate depression participated in a parallel,
double-blind, placebo-controlled trial, and were randomized to undergo 6
weeks of treatment with either simvastatin (20mg/day) or atorvastatin
(20mg/day). Participants were evaluated using Hamilton depression rating
scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to
evaluate the efficacy of simvastatin in improving the depressive symptoms.
RESULT: General linear model repeated measures demonstrated significant
effect for timextreatment interaction on the HDRS scores [F (1.62,
71.06)=3.41, P=0.048]. There was no significant difference between the
treatment groups regarding the adverse events. No one experienced serious
adverse event.
LIMITATION: The limitations of the present study were its small sample
size and the short-term follow-up period.
CONCLUSION: Treatment with simvastatin seems to be well tolerated with
superior antidepressant effects compared to atorvastatin in post-CABG
patients. Long-term outcomes of this practice and its probable influence
on other psychological aspects are yet to be investigated in future
studies.
TRIAL REGISTRATION: Iranian registry of clinical trials
(http://www.irct.ir): IRCT201410271556N68.

<2>
Accession Number
25577748
Authors
Stochkendahl M.J. Mickley H. Vach W. Aziz A. Christensen H.W. Hartvigsen
J. Hoilund-Carlsen P.F.
Institution
(Stochkendahl) Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark. Electronic address: m.jensen@nikkb.dk
(Mickley) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Vach) Clinical Epidemiology, Institute of Medical Biometry and Medical
Informatics, University Medical Center Freiburg, Freiburg, Germany
(Aziz) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Christensen) Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark
(Hartvigsen) Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark; Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark, Odense, Denmark
(Hoilund-Carlsen) Department of Nuclear Medicine, Odense University
Hospital, Odense, Denmark
Title
Clinical characteristics, myocardial perfusion deficits, and clinical
outcomes of patients with non-specific chest pain hospitalized for
suspected acute coronary syndrome: a 4-year prospective cohort study.
Source
International journal of cardiology. 182 (pp 126-131), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Although the prognostic role of stress SPECT MPI is generally
well established, its value in predicting non-fatal cardiac events in
patients with acute, non-specific chest pain (NSCP) remains unclear. The
aims of this study are 1) to describe the baseline clinical
characteristics and prevalence of myocardial perfusion (MP) deficits, by
use of an adenosine stress SPECT MPI, in NSCP patients without known CAD
discharged after hospitalization for suspected ACS; and 2) to
prospectively describe the 4-year clinical outcome in terms of all-cause
and cardiac mortality; hospitalization and coronary revascularization
procedures; and cardio-vascular events in patients with and without MP
deficits.
METHODS AND RESULTS: We evaluated a series of 272 consecutive patients
with acute NSCP and aged 18-75years. ICD10-based registries were used to
determine the primary outcome (a composite measure of incident CAD death,
ACS, or revascularization) and two secondary outcomes (1. all-cause death;
2. a composite measure of cardiovascular death, ACS, revascularization, or
stroke). Forty two (15%) participants had a MP deficit. During follow-up
(median 1361days), 7 participants had a primary event, 4 died, and 20 had
a secondary composite event. Annual event rates were 0.70, 0.39 and 2.07,
respectively. MP deficits predicted both subsequent primary and composite
secondary events (HR: 7.54; 95% CI=[1.69; 33.69] and 2.93 (95% CI=[1.10;
7.81], respectively). Usual clinical cardiac risk classification could not
meaningfully differentiate between patients with and without MP deficits.
CONCLUSION: SPECT MPI substantially improved prediction of incident CAD
beyond usual clinical procedures and risk classification systems among
NSCP patients.

<3>
Accession Number
26069175
Authors
Zarrabi K. Dehghani P. Abdi Ardekani A. Zarrabi M.A. Zolghadrasli A.
Institution
(Zarrabi) Department of Cardiac Surgery, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. zarrabisx@gmail.com
(Dehghani) Department of Cardiology, School of Medicine, Shiraz University
of Medical Sciences, Shiraz, Iran. p.dehghani@gmail.com
(Abdi Ardekani) Department of Cardiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. ayat.dr@yahoo.com
(Zarrabi) Student Research Committee, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. aminz487@gmail.com
(Zolghadrasli) Department of Cardiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran. abdolali.zolghadr@gmail.com
Title
The Comparison Between Two Surgical Methods for Left Internal Mammary
Artery (LIMA) Anastomosis on Left Anterior Descending (LAD) Artery in
Patients with Severe Diffuse Lesions: Short to Mid-Term Results.
Source
Acta medica Iranica. 53 (6) (pp 369-372), 2015. Date of Publication: 2015.
Abstract
Coronary artery disease is the leading cause of death worldwide. In this
study, we compared two surgical methods of left internal mammary artery
(LIMA) anastomosis on left anterior descending (LAD) artery in patients
with severe diffuse lesions. A total of 40 patients were included in our
study and randomly assigned into two groups. In group A, after a long
arteriotomy on LAD, the posterior surface of left internal mammary artery
(LIMA) was opened by the same length and was anastomosed along the LAD
course through normal and diseased parts. In group B instead of complete
opening of LAD, a small arteriotomy was done only in areas where the wall
of the vessel was nearly normal (especially the anterolateral wall), and
LIMA was anastomosed to these areas in a sequential (Jump) method. The
patients were then followed for post-operation results. The two groups
showed equal results regarding early mortality, post-operation bleeding,
and infection, pleural and pericardial effusion. There were two cases of
myocardial infarction (MI) in group A with one mortality after 18 months,
while no MI was reported in group B. Group B demonstrated significantly
superior results regarding the rise in ejection fraction and the
improvement in functional class. In this study it was demonstrated that
diffuse coronary artery lesions of LAD should be preferably operated using
LIMA with the sequential-jump anastomoses method and the surgeon should
avoid long arteriotomy with single long anastomosis because of lower
chance of long-term patency.

<4>
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Accession Number
26330412
Authors
Bohula E.A. Giugliano R.P. Cannon C.P. Zhou J. Murphy S.A. White J.A.
Tershakovec A.M. Blazing M.A. Braunwald E.
Institution
(Bohula) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.).
ebohula@partners.org
(Giugliano) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Cannon) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Zhou) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Murphy) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(White) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Tershakovec) From TIMI Study Group, Cardiovascular Division, Department
of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Blazing) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
(Braunwald) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research
Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
Title
Achievement of dual low-density lipoprotein cholesterol and
high-sensitivity C-reactive protein targets more frequent with the
addition of ezetimibe to simvastatin and associated with better outcomes
in IMPROVE-IT.
Source
Circulation. 132 (13) (pp 1224-1233), 2015. Date of Publication: 29 Sep
2015.
Abstract
BACKGROUND: Statins lower low-density lipoprotein cholesterol (LDL-C) and
high-sensitivity C-reactive protein (hs-CRP); addition of ezetimibe to
statins further reduces LDL-C and hs-CRP. An analysis of the relationship
between achieved LDL-C and hs-CRP targets and outcomes for simvastatin and
ezetimibe/simvastatin was prespecified in Improved Reduction of Outcomes:
Vytorin Efficacy International Trial (IMPROVE-IT).
METHODS AND RESULTS: The IMPROVE-IT trial randomly assigned 18 144
patients stabilized after acute coronary syndrome to simvastatin or
ezetimibe/simvastatin. LDL-C and hs-CRP were measured at baseline and 1
month after randomization. Outcomes were assessed in those achieving one
or both of the prespecified targets of LDL-C<70 mg/dL and hs-CRP<2 mg/L
versus achieving neither target, adjusting for differences in baseline
characteristics. An exploratory analysis examined targets of LDL-C<50
mg/dL and hs-CRP<1 mg/L. Patients meeting both targets at baseline, with
no 1-month values, or with end points before 1 month were excluded. Of 15
179 patients, 39% achieved the dual LDL-C (<70 mg/dL) and hs-CRP (<2 mg/L)
targets at 1 month, 14% met neither target, 14% met only the hs-CRP
target, and 33% met only the LDL-C target. Those achieving dual targets
had lower primary end point rates than those meeting neither target
(cardiovascular death, major coronary event, or stroke; 38.9% versus
28.0%; adjusted hazard ratio, 0.73; 0.66-0.81; P<0.001). More patients
treated with ezetimibe/simvastatin met dual targets than those treated
with simvastatin alone (50% versus 29%, P<0.001). The association of
dual-target attainment with improved outcomes was similar irrespective of
treatment assignment (P-interaction=0.65). Similar findings were observed
using the exploratory targets.
CONCLUSIONS: Significantly more patients treated with
ezetimibe/simvastatin met prespecified and exploratory dual LDL-C and
hs-CRP targets than patients treated with simvastatin alone. Reaching both
LDL-C and hs-CRP targets was associated with improved outcomes after
multivariable adjustment.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov; Unique
identifier: NCT00202878.

<5>
Accession Number
25482283
Authors
Taha S. Moretti C. D'Ascenzo F. Van Mieghem N.M. Omede P. Montefusco A.
Ghany M.A. Fouaad D. Demitry S. Zoccai G.B. Gaita F.
Institution
(Taha) Citta della Salute e della Scienza Hospital, Division of Cardiology
1, University of Turin, Italy; Assuit University Hospital, Egypt.
Electronic address: esmaeil.salma@gmail.com
(Moretti) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(D'Ascenzo) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Van Mieghem) Department of Interventional Cardiology Thoraxcenter,
Erasmus Medical Center, Rotterdam, The Netherlands
(Omede) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Montefusco) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Ghany) Assuit University Hospital, Egypt
(Fouaad) Assuit University Hospital, Egypt
(Demitry) Assuit University Hospital, Egypt
(Zoccai) Division of Cardiology, Rome, Italy
(Gaita) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
Title
Impact of residual coronary artery disease on patients undergoing TAVI: A
meta-analysis of adjusted observational studies.
Source
International journal of cardiology. 181 (pp 77-80), 2015. Date of
Publication: 15 Feb 2015.

<6>
Accession Number
25596472
Authors
van Osch D. Dieleman J.M. van Dijk D. Jacob K.A. Kluin J. Doevendans P.A.
Nathoe H.M.
Institution
(van Osch) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Dieleman) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(van Dijk) Department of Anesthesiology and Intensive Care, University
Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The
Netherlands
(Jacob) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Kluin) Department of Cardiothoracic surgery, University Medical Center
Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Doevendans) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
(Nathoe) Department of Cardiology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address:
h.m.nathoe@umcutrecht.nl
Title
Dexamethasone for the prevention of postoperative atrial fibrillation.
Source
International journal of cardiology. 182 (pp 431-437), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Postoperative atrial fibrillation (AF) is a common
complication after cardiac surgery. Inflammation is believed to play a
pivotal role in the etiology of postoperative AF. There is a suggestion
from small studies that perioperative treatment with corticosteroids may
reduce postoperative AF. The DExamethasone for Cardiac Surgery (DECS)
study was a large randomized trial showing no protective effect of
dexamethasone on major adverse events. The aim of this study was to
investigate the effect of dexamethasone treatment on the occurrence of AF
after cardiac surgery.
METHODS: The DECS study compared intra-operative dexamethasone (1mg/kg) or
placebo treatment in 4494 adult patients undergoing cardiac surgery. AF
was defined by the occurrence of any reported AF within 30days after
surgery. We also performed an in-depth analysis of a subset of 1565
patients on new-onset AF. Relative risks (RRs) with 95% confidence
intervals (CIs) were calculated.
RESULTS: The incidence of any AF in the main study of 4494 patients was
33.1% in the dexamethasone and 35.2% in the placebo group (RR 0.94, 95%
CI: 0.87-1.02, p=0.14). In the substudy of 1565 patients, the incidence of
new-onset AF was 33.0% vs. 35.5% (RR 0.93, 95% CI: 0.81-1.07, p=0.31),
respectively. There was no protective effect of dexamethasone across
clinically important patient subgroups.
CONCLUSION: Intraoperative administration of dexamethasone had no
protective effect on the occurrence of any or new-onset atrial
fibrillation after cardiac surgery. Therefore, the use of dexamethasone
for the reduction of postoperative AF should not be recommended.

<7>
Accession Number
25596468
Authors
Reuter P.-G. Rouchy C. Cattan S. Benamer H. Jullien T. Beruben A. Montely
J.-M. Assez N. Raphael V. Hennequin B. Boccara A. Javaud N. Soulat L.
Adnet F. Lapostolle F.
Institution
(Reuter) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France. Electronic address:
(Rouchy) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Cattan) Departement de Cardiologie, Groupe Hospitalier Intercommunal Le
Raincy-Montfermeil, 10 Rue du General Leclerc, 93370 Montfermeil, France
(Benamer) Departement de Cardiologie, Clinique la Roseraie, 120 Avenue de
la Republique, 93300 Aubervilliers, France
(Jullien) Departement de Cardiologie, Centre Cardiologique du Nord, 36 Rue
des Moulins Gemeaux, 93200 Saint-Denis, France
(Beruben) Service Mobile d'Urgence et de Reanimation, Groupe Hospitalier
Intercommunal Le Raincy-Montfermeil, 10 Rue du General Leclerc, 93370
Montfermeil, France
(Montely) Departement de Cardiologie, Centre Hospitalier Intercommunal
Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois,
France
(Assez) Service d'Aide Medicale Urgente du Nord Pole de l'Urgence, Centre
Hospitalier Regional Universitaire de Lille, 5 avenue Oscar-Lambret, 59037
Lille Cedex, France
(Raphael) Service Mobile d'Urgence et de Reanimation, Centre Hospitalier
Intercommunal Robert Ballanger, Boulevard Robert Ballanger, 93600
Aulnay-sous-Bois, France
(Hennequin) Service Mobile d'Urgence et de Reanimation, Centre hospitalier
de Saint-Denis, 2 Rue du Docteur Delafontaine, 93200 Saint-Denis, France
(Boccara) Departement de Cardiologie, Centre Hospitalier Intercommunal
Andre Gregoire, 56 Boulevard de la Boissiere, 93100 Montreuil, France
(Javaud) Service des Urgences, Centre Hospitalier Universitaire Jean
Verdier, Assistance Publique-Hopitaux de Paris, Avenue du 14 Juillet,
93140 Bondy, France
(Soulat) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux,
France
(Adnet) Service des Urgences et Service d'Aide Medicale Urgente, Centre
Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de Paris,
125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite Paris 13,
Sorbonne Paris Cite, EA 3509 Bobigny, France
(Lapostolle) Service des Urgences et Service d'Aide Medicale Urgente,
Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hopitaux de
Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Universite
Paris 13, Sorbonne Paris Cite, EA 3509 Bobigny, France
Title
Early invasive strategy in high-risk acute coronary syndrome without
ST-segment elevation. The Sisca randomized trial.
Source
International journal of cardiology. 182 (pp 414-418), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: The optimal therapeutic strategy for patients with high-risk
acute coronary syndrome without ST-segment elevation (NSTE-ACS) remains
unclear.
OBJECTIVE: Our aim was to compare the effectiveness of an early invasive
strategy and a delayed invasive strategy in the management of high-risk
NSTE-ACS patients.
METHODS: This randomized clinical trial in a primarily pre-hospital
setting enrolled patients with chest pain, electrocardiographic criteria
for an NSTE-ACS, and at least one criterion of severity (ESC criterion or
TIMI score >5). Patients were randomized to either an early invasive
strategy (tirofiban infusion and coronary angiography within 6h) or
delayed invasive strategy (as per guidelines and physician discretion;
coronary angiography within 6h was not advised). The primary endpoint was
the cumulative incidence of deaths, myocardial infarctions, or urgent
revascularizations at 30days of follow-up. Secondary endpoints were
failure of delayed management, length of hospital stay and long-term
mortality.
RESULTS: Between January 2007 and February 2010, 170 patients were
enrolled. The cumulative incidence of adverse outcomes was significantly
lower for early invasive than delayed management (2% [95% CI 0-9] vs. 24%
[95% CI 16-35], p<10(-4)). Delayed management failed in 24% of cases. The
length of hospital stay was significantly shorter in patients undergoing
angioplasty or treated with tirofiban within 6h (p=0.0003). Long-term
mortality was 16% in both arms after a median follow-up of 4.1years.
CONCLUSION: An early invasive strategy reduced major adverse cardiac
events in patients with high-risk NSTE-ACS. Early angiography or tirofiban
(GP IIb/IIIa inhibitor) infusion proved necessary in a quarter of patients
assigned to delayed management.

<8>
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Accession Number
26206854
Authors
Dipchand A.I. Mahle W.T. Tresler M. Naftel D.C. Almond C. Kirklin J.K.
Pruitt E. Webber S.A.
Institution
(Dipchand) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.).
anne.dipchand@sickkids.ca
(Mahle) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Tresler) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Naftel) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Almond) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Kirklin) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Pruitt) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
(Webber) From the Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA
(W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K.,
E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt
University School of Medicine, Nashville, TN (S.A.W.)
Title
Extracorporeal Membrane Oxygenation as a Bridge to Pediatric Heart
Transplantation: Effect on Post-Listing and Post-Transplantation Outcomes.
Source
Circulation. Heart failure. 8 (5) (pp 960-969), 2015. Date of Publication:
01 Sep 2015.
Abstract
BACKGROUND: Current organ allocation algorithms direct hearts to the
sickest recipients to mitigate death while waiting. This may result in
lower post-transplant (Tx) survival for high-risk candidates mandating
close examination to determine the appropriateness of different
technologies as a bridge to Tx.
METHODS AND RESULTS: We analyzed all patients (<18 years old) from the
Pediatric Heart Transplant Study (PHTS) database listed for heart Tx
(1993-2013) to determine the effect of extracorporeal membrane oxygenation
(ECMO) support at the time of listing and the time of Tx on waitlist
mortality and post-Tx outcomes. Eight percent of patients were listed on
ECMO, and within 12 months, 49% had undergone Tx, 35% were deceased, and
16% were alive waiting. Survival at 12 months after listing (censored at
Tx) was worse in patients on ECMO at listing (50%) compared with
ventricular assist device at listing (76%) or not on ECMO or ventricular
assist device at listing (76%; P<0.0001). Two hundred three (5%) patients
underwent Tx from ECMO; 135 (67%) had been on ECMO since listing, and 67
(33%) had deteriorated to ECMO support while waiting. Survival after Tx
was worse in patients who underwent Tx from ECMO (3 years: 64%) versus on
ventricular assist device at Tx (3 years: 84%) or not on ECMO/ventricular
assist device at Tx (3 years: 85%; P<0.0001). Patients transplanted from
ECMO at age <1 year had the worst survival.
CONCLUSIONS: Pediatric patients requiring ECMO support before heart Tx
have poor outcomes. Prioritization of donor hearts to children waitlisted
on ECMO warrants careful consideration because of ECMO's high pre- and
post-Tx mortality.

<9>
Accession Number
25068802
Authors
Lalonde F. Curnier D.Y.
Institution
(Lalonde, Curnier) 1Department of Kinesiology, University of Montreal,
Montreal, Quebec, Canada; 2University of Montreal Hospital Research Centre
(CRCHUM), Quebec, Canada; and 3Laboratory of Pathophysiology of Exercise
(LPEX), Department of Kinesiology University de Montreal, Quebec, Canada
Title
Can anaerobic performance be improved by remote ischemic preconditioning?.
Source
Journal of strength and conditioning research / National Strength &
Conditioning Association. 29 (1) (pp 80-85), 2015. Date of Publication: 01
Jan 2015.
Abstract
Remote ischemic preconditioning (RIPC) provides a substantial benefit for
heart protection during surgery. Recent literature on RIPC reveals the
potential to benefit the enhancement of sports performance as well. The
aim of this study was to investigate the effect of RIPC on anaerobic
performance. Seventeen healthy participants who practice regular physical
activity participated in the project (9 women and 8 men, mean age 28 +/- 8
years). The participants were randomly assigned to an RIPC intervention
(four 5-minute cycles of ischemia reperfusion, followed by 5 minutes using
a pressure cuff) or a SHAM intervention in a crossover design. After the
intervention, the participants were tested for alactic anaerobic
performance (6 seconds of effort) followed by a Wingate test (lactic
system) on an electromagnetic cycle ergometer. The following parameters
were evaluated: average power, peak power, the scale of perceived
exertion, fatigue index (in watt per second), peak power (in Watt), time
to reach peak power (in seconds), minimum power (in Watt), the average
power-to-weight ratio (in watt per kilogram), and the maximum
power-to-weight ratio (in watt per kilogram). The peak power for the
Wingate test is 794 W for RIPC and 777 W for the control group (p =
0.208). The average power is 529 W (RIPC) vs. 520 W for controls (p =
0.079). Perceived effort for RIPC is 9/10 on the Borg scale vs. 10/10 for
the control group (p = 0.123). Remote ischemic preconditioning does not
offer any significant benefits for anaerobic performance.

<10>
[Use Link to view the full text]
Accession Number
26251182
Authors
Loyaga-Rendon R.Y. Acharya D. Pamboukian S.V. Tallaj J.A. Cantor R.
Starling R.C. Naftel D.C. Kirklin J.K.
Institution
(Loyaga-Rendon) From the Division of Cardiovascular Diseases, Department
of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
rloyagar@uab.edu
(Acharya) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Pamboukian) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Tallaj) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Cantor) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Starling) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Naftel) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
(Kirklin) From the Division of Cardiovascular Diseases, Department of
Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic
Surgery, Department of Surgery (R.C.), and Department of Epidemiology,
School of Public Health (R.C.), and Division of Cardiothoracic Surgery
(D.N., J.K.), University of Alabama at Birmingham; and Section of Heart
Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.)
Title
Duration of Heart Failure Is an Important Predictor of Outcomes After
Mechanical Circulatory Support.
Source
Circulation. Heart failure. 8 (5) (pp 953-959), 2015. Date of Publication:
01 Sep 2015.
Abstract
BACKGROUND: Heart failure (HF) progression results in worsening functional
capacity and end-organ compromise. HF may occur acutely or be associated
with a chronic presentation. We hypothesized that the duration of HF
affects outcomes after mechanical circulatory support.
METHODS AND RESULTS: A total of 10 730 patients registered in Interagency
Registry for Mechanically Assisted Circulatory Support (INTERMACS) who
received primary implant of a mechanical circulatory support device were
stratified according to the duration of HF symptoms: acute HF (AHF; <1
month), sub-AHF (1-12 months), and chronic HF (Cr-HF; > 12 months). AHF
patients were younger with a higher proportion of women and white and with
a lower prevalence of peripheral vascular disease and history of prior
cardiac surgeries. Sixty percent of AHF patients were INTERMACS profile 1
at the time of implantation versus 24% and 13.2% in the sub-AHF and Cr-HF
groups, respectively (P=0.0001). Patients with AHF had the highest
utilization of biventricular support (14.4%). The estimated survival at 4
years was 58%, 51%, and 45% for the AHF, sub-AHF, and Cr-HF patients
(P=0.006). The proportion of patients with AHF who received heart
transplantation at 1 year was 29% compared with 22.6% in the patients with
Cr-HF. After adjustment for known risk factors of adverse outcome,
patients with AHF have a better late phase prognosis compared with
patients with Cr-HF (hazard ratio, 0.34; P=0.0003).
CONCLUSIONS: The duration of HF before durable mechanical circulatory
support implant is an important variable influencing outcome. Patients
with AHF had improved survival at 4 years and higher rates of
transplantation at 1 year despite higher acuity of presentation.

<11>
Accession Number
26228603
Authors
Arabkhani B. Mookhoek A. Di Centa I. Lansac E. Bekkers J.A. De Lind Van
Wijngaarden R. Bogers A.J. Takkenberg J.J.
Institution
(Arabkhani) Erasmus University Medical Center, Rotterdam, The Netherlands.
Electronic address: b.arabkhani@erasmusmc.nl
(Mookhoek) Erasmus University Medical Center, Rotterdam, The Netherlands
(Di Centa) Hopital Foch, Suresnes, France
(Lansac) Institut Mutualiste Montsouris, Paris, France
(Bekkers) Erasmus University Medical Center, Rotterdam, The Netherlands
(De Lind Van Wijngaarden) Erasmus University Medical Center, Rotterdam,
The Netherlands
(Bogers) Erasmus University Medical Center, Rotterdam, The Netherlands
(Takkenberg) Erasmus University Medical Center, Rotterdam, The Netherlands
Title
Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic
Root Aneurysm: A Systematic Review and Meta-Analysis.
Source
The Annals of thoracic surgery. 100 (3) (pp 1126-1131), 2015. Date of
Publication: 01 Sep 2015.
Abstract
Valve-sparing aortic root techniques have progressively gained ground in
the treatment of aortic root aneurysm and aortic insufficiency. By
avoiding anticoagulation therapy they offer a good alternative to
composite graft replacement. This systematic review describes the reported
outcome of valve-sparing aortic root replacement, focusing on the
remodeling and reimplantation technique. A systematic literature search on
the characteristics of and outcomes after valve-sparing aortic root
replacement revealed 1,659 articles. The inclusion criteria were a focus
on valve-sparing aortic root replacement in adults with aortic root
aneurysm, presentation of survival data, and inclusion of at least 30
patients. Data were pooled by inverse variance weighting and analyzed by
linear regression. Of 1,659 articles published between January 1, 2000,
and January 1, 2014, 31 were included (n = 4,777 patients). The mean age
at operation was 51 +/- 14.7 years, and 14% of patients had a bicuspid
aortic valve. The reimplantation technique was used in 72% and remodeling
in 27% (1% other). No clinical advantage in terms of survival and
reoperation of one technique over the other was found. Cusp repair was
performed in 33%. Pooled early mortality was 2% (n = 103). During
follow-up (21,716 patient-years), 262 patients died (survival 92%), and
228 (5%) underwent reoperation, mainly valve replacement. Major adverse
valve-related events were low (1.66% patient-years). Preoperative severe
aortic valve regurgitation showed a trend toward higher reoperation rate.
Remodeling and reimplantation techniques show comparable survival and
valve durability results, providing a valid alternative to composite valve
replacement. The heterogeneity in the data underlines the need for a
collaborative effort to standardize outcome reporting.

<12>
Accession Number
26242213
Authors
Thourani V.H. Jensen H.A. Babaliaros V. Kodali S.K. Rajeswaran J.
Ehrlinger J. Blackstone E.H. Suri R.M. Don C.W. Aldea G. Williams M.R.
Makkar R. Svensson L.G. McCabe J.M. Dean L.S. Kapadia S. Cohen D.J.
Pichard A.D. Szeto W.Y. Herrmann H.C. Devireddy C. Leshnower B.G. Ailawadi
G. Maniar H.S. Hahn R.T. Leon M.B. Mack M.
Institution
(Thourani) Emory University, Atlanta, Georgia. Electronic address:
vthoura@emory.edu
(Jensen) Emory University, Atlanta, Georgia
(Babaliaros) Emory University, Atlanta, Georgia
(Kodali) Columbia University Medical Center, New York, New York
(Rajeswaran) Cleveland Clinic, Cleveland, Ohio
(Ehrlinger) Cleveland Clinic, Cleveland, Ohio
(Blackstone) Cleveland Clinic, Cleveland, Ohio
(Suri) Cleveland Clinic, Cleveland, Ohio
(Don) University of Washington, Seattle, Washington
(Aldea) University of Washington, Seattle, Washington
(Williams) New York University, Langone Medical Center, New York, New York
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California
(Svensson) Cleveland Clinic, Cleveland, Ohio
(McCabe) University of Washington, Seattle, Washington
(Dean) University of Washington, Seattle, Washington
(Kapadia) Cleveland Clinic, Cleveland, Ohio
(Cohen) Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
(Pichard) MedStar Washington Hospital Center, Washington, District of
Columbia
(Szeto) University of Pennsylvania Health System, Philadelphia,
Pennsylvania
(Herrmann) University of Pennsylvania Health System, Philadelphia,
Pennsylvania
(Devireddy) Emory University, Atlanta, Georgia
(Leshnower) Emory University, Atlanta, Georgia
(Ailawadi) University of Virginia Health System, Charlottesville, Virginia
(Maniar) Washington University, St. Louis, Missouri
(Hahn) Columbia University Medical Center, New York, New York
(Leon) Columbia University Medical Center, New York, New York
(Mack) Baylor, Scott & White Health, Plano, Texas
Title
Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve
Replacement in the PARTNER-I Trial.
Source
The Annals of thoracic surgery. 100 (3) (pp 785-793), 2015. Date of
Publication: 01 Sep 2015.
Abstract
BACKGROUND: This study describes short-term and mid-term outcomes of
nonagenarian patients undergoing transfemoral or transapical transcatheter
aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter
Valve (PARTNER)-I trial.
METHODS: From April 2007 to February 2012, 531 nonagenarians, mean age 93
+/- 2.1 years, underwent TAVR with a balloon-expandable prosthesis in the
PARTNER-I trial: 329 through transfemoral (TF-TAVR) and 202 transapical
(TA-TAVR) access. Clinical events were adjudicated and echocardiographic
results analyzed in a core laboratory. Quality of life (QoL) data were
obtained up to 1 year post-TAVR. Time-varying all-cause mortality was
referenced to that of an age-sex-race-matched US population.
RESULTS: For TF-TAVR, post-procedure 30-day stroke risk was 3.6%; major
adverse events occurred in 35% of patients; 30-day paravalvular leak was
greater than moderate in 1.4%; median post-procedure length of stay (LOS)
was 5 days. Thirty-day mortality was 4.0% and 3-year mortality 48% (44%
for the matched population). By 6 months, most QoL measures had stabilized
at a level considerably better than baseline, with Kansas City
Cardiomyopathy Questionnaire (KCCQ) 72 +/- 21. For TA-TAVR, post-procedure
30-day stroke risk was 2.0%; major adverse events 32%; 30-day paravalvular
leak was greater than moderate in 0.61%; and median post-procedure LOS was
8 days. Thirty-day mortality was 12% and 3-year mortality 54% (42% for the
matched population); KCCQ was 73 +/- 23.
CONCLUSIONS: A TAVR can be performed in nonagenarians with acceptable
short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not
directly comparable, TA-TAVR appears to carry a higher risk of early death
without a difference in intermediate-term mortality. Age alone should not
preclude referral for TAVR in nonagenarians.

<13>
Accession Number
25617608
Authors
Orlandini A. Castellana N. Pascual A. Botto F. Cecilia Bahit M. Chacon C.
Luz Diaz M. Diaz R.
Institution
(Orlandini) ECLA (Estudios Clinicos Latino America), Argentina. Electronic
address: aorlandinimd@eclainternational.org
(Castellana) ECLA (Estudios Clinicos Latino America), Argentina
(Pascual) ECLA (Estudios Clinicos Latino America), Argentina
(Botto) ECLA (Estudios Clinicos Latino America), Argentina
(Cecilia Bahit) ECLA (Estudios Clinicos Latino America), Argentina
(Chacon) ECLA (Estudios Clinicos Latino America), Argentina
(Luz Diaz) ECLA (Estudios Clinicos Latino America), Argentina
(Diaz) ECLA (Estudios Clinicos Latino America), Argentina
Title
Myocardial viability for decision-making concerning revascularization in
patients with left ventricular dysfunction and coronary artery disease: a
meta-analysis of non-randomized and randomized studies.
Source
International journal of cardiology. 182 (pp 494-499), 2015. Date of
Publication: 01 Mar 2015.
Abstract
BACKGROUND: Myocardial viability tests have been proposed as a key factor
in the decision-making process concerning coronary revascularization
procedures in patients with left ventricular dysfunction and coronary
artery disease (LVD-CAD).
METHODS: We performed a systematic review and meta-analysis of studies
that compared medical treatment with revascularization in patients with
viable and non-viable myocardium and recorded mortality as outcome.
RESULTS: Thirty-two non-randomized (4328 patients) and 4 randomized (1079
patients) studies were analyzed. In non-randomized studies,
revascularization provided a significant mortality benefit compared with
medical treatment (p<0.05). Since the heterogeneity was significant
(p<0.05) a viability subgroup analysis was performed, showing that
revascularization provided a significant mortality benefit compared with
medical treatment in patients with viable myocardium (p<0.05) but not in
patients without (p=0.34). There was a significant subgroup effect
(p<0.05) related to the intensity of the effect, but not to the direction.
In randomized studies, revascularization did not provide a significant
mortality benefit compared with medical treatment in either patients with
viable myocardium or those without (p=0.21). There was no significant
subgroup effect (p=0.72). Neither non-randomized nor randomized studies
demonstrated any significant difference in outcomes between patients with
and without viable myocardium.
CONCLUSIONS: The available data are inconclusive regarding the usefulness
of myocardial viability tests for the decision-making process concerning
revascularization in LVD-CAD patients. Patients with viable myocardium
appear to benefit from revascularization, but similar benefits were
observed in patients without viable myocardium. Moreover, a neutral or
adverse effect of revascularization cannot be excluded in either group of
patients.

<14>
Accession Number
24675993
Authors
Perez-Granda M.J. Barrio J.M. Munoz P. Hortal J. Rincon C. Rabadan P.M.
Pernia M.S. Bouza E.
Institution
(Perez-Granda) Department of Anesthesiology, School of Medicine,
Universidad Complutense, Madrid, Spain; Instituto de Investigacion
Biomedica Gregorio Maranon, Madrid, Spain; CIBER Enfermedades
Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
(Barrio) Department of Anesthesiology, School of Medicine, Universidad
Complutense, Madrid, Spain; Instituto de Investigacion Biomedica Gregorio
Maranon, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES
(CB06/06/0058), Madrid, Spain
(Munoz) Department of Clinical Microbiology and Infectious Diseases,
School of Medicine, Universidad Complutense, Madrid, Spain; Medicine
Department, School of Medicine, Universidad Complutense, Madrid, Spain;
Instituto de Investigacion Biomedica Gregorio Maranon, Madrid, Spain;
CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
(Hortal) Department of Anesthesiology, School of Medicine, Universidad
Complutense, Madrid, Spain; Instituto de Investigacion Biomedica Gregorio
Maranon, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES
(CB06/06/0058), Madrid, Spain
(Rincon) Department of Anesthesiology, School of Medicine, Universidad
Complutense, Madrid, Spain
(Rabadan) Department of Clinical Microbiology and Infectious Diseases,
School of Medicine, Universidad Complutense, Madrid, Spain; Medicine
Department, School of Medicine, Universidad Complutense, Madrid, Spain;
Instituto de Investigacion Biomedica Gregorio Maranon, Madrid, Spain;
CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
(Pernia) Department of Pharmacy, Hospital General Universitario Gregorio
Maranon, Madrid, Spain
(Bouza) Department of Clinical Microbiology and Infectious Diseases,
School of Medicine, Universidad Complutense, Madrid, Spain; Medicine
Department, School of Medicine, Universidad Complutense, Madrid, Spain;
Instituto de Investigacion Biomedica Gregorio Maranon, Madrid, Spain;
CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
Title
Ethanol lock therapy (E-Lock) in the prevention of catheter-related
bloodstream infections (CR-BSI) after major heart surgery (MHS): a
randomized clinical trial.
Source
PloS one. 9 (3) (pp e91838), 2014. Date of Publication: 2014.
Abstract
BACKGROUND: Lock-therapy with antimicrobials has been used for the
treatment and prevention of catheter-related bloodstream infections
(CR-BSI). Experiences with Ethanol-Locks (E-locks) have included
therapeutic interventions with variable results. Patients undergoing Major
Heart Surgery (MHS) are a high-risk population for CR-BSI.The aim of this
study was to assess the efficacy and tolerance to E-Locks in the
prevention of CR-BSI of patients undergoing MHS.
METHODS AND FINDINGS: This is an academic, prospective, randomized,
non-blinded and controlled clinical trial assessing the incidence of
CR-BSI of patients with E-locks (E-lock) and the tolerance to the
procedure in comparison with patients receiving conventional catheter-care
(CCC). Patients undergoing MHS with intravascular catheters for more than
48 hours were randomly assigned into treatment or control group by a
computer-generated list of randomly assigned numbers. In the treatment
group, all their catheter lumens were locked with an ethanol solution at
70% for two hours, every three days (E-Locks). The control group received
conventional catheter-care (CCC). Overall, 200 patients with 323 catheters
were included in the study, which was stopped after 10 months due to
adverse events. Of them, 179 catheters (113 patients) had E-Locks and 144
catheters (87 patients) were CCC. Euroscore Surgical Risk in both groups
was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and
CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2
(p = 0.33), catheter tip colonization 14 (7.8%) vs 6 (4.2%) patients (p =
0.17), median length of hospital stay, 15 vs 16 days (p = 0.77). Seven
patients (6.19%), all in the ethanol branch, had to discontinue the trial
due to intolerance or adverse events.
CONCLUSIONS: We do not recommend prophylaxis of CR-BSI with ethanol-lock
on a routine basis in patients undergoing Major Heart Surgery.
TRIAL REGISTRATION: Clinical Trials.gov NCT01229592.

<15>
Accession Number
25712464
Authors
Luo X. Zhao Z. Chai H. Zhang C. Liao Y. Li Q. Peng Y. Liu W. Ren X. Meng
Q. Chen C. Chen M. Feng Y. Huang D.
Institution
(Luo, Zhao, Chai, Zhang, Liao, Li, Peng, Liu, Ren, Meng, Chen, Chen, Feng,
Huang) Department of Cardiology, West China Hospital of Sichuan
University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu,
Sichuan, P.R. China
Title
Efficacy of transcatheter aortic valve implantation in patients with
aortic stenosis and reduced LVEF. A systematic review.
Source
Herz. 40 (pp 168-180), 2015. Date of Publication: 01 Apr 2015.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is safe and
effective for patients with aortic stenosis (AS) who have a high operative
risk. However, there is still debate on the effect of TAVI in AS patients
with reduced left ventricular ejection fraction (REF). The objective of
the review is to clarify the efficacy of TAVI and the impact of REF on the
30-day and midterm mortality in these patients.
METHODS: Studies on TAVI were searched in PubMed, Embase, and the Cochrane
Library databases and were included in this review following predefined
criteria. Data were extracted and pooled risk ratios (RR) were synthesized
to explore the relationship between REF and 30-day plus midterm mortality.
RESULTS: Twenty-eight studies comprising 14,099 patients were included in
the analysis of the association of REF with the prognosis of patients
after TAVI. An average increase in left ventricular ejection fraction of
8-10% was observed among these patients after TAVI. REF was not related to
the 30-day mortality [RR =1.90, 95% confidence interval (CI) =0.80-4.47];
however, it was related to the midterm mortality (RR =1.49, 95%CI
=1.14-1.93) of patients undergoing TAVI. Patients with low-flow and
low-gradient AS had a higher 30-day mortality (RR =1.54, 95%CI =1.11-2.13)
and midterm mortality rate (RR =1.69, 95%CI =1.33-2.14) compared with AS
patients without these characteristics. The mortality of TAVI patients was
significantly lower than that of those undergoing conservative therapy,
and was similar to that of patients undergoing surgical aortic valve
replacement.
CONCLUSION: REF was not associated with 30-day mortality, but it was
associated with the midterm mortality of TAVI patients. Patients with REF
could benefit from TAVI compared with conservative therapy.

<16>
[Use Link to view the full text]
Accession Number
26121076
Authors
Lee Y.H. Kim T.K. Jung Y.S. Cho Y.J. Yoon S. Seo J.-H. Jeon Y. Bahk J.H.
Hong D.M.
Institution
(Lee, Kim, Jung, Cho, Yoon, Seo, Jeon, Bahk, Hong) Department of
Anesthesiology and Pain Medicine, Seoul National University Hospital,
Seoul, Korea
Title
Comparison of Needle Insertion and Guidewire Placement Techniques During
Internal Jugular Vein Catheterization: The Thin-Wall Introducer Needle
Technique Versus the Cannula-Over-Needle Technique.
Source
Critical care medicine. 43 (10) (pp 2112-2116), 2015. Date of Publication:
01 Oct 2015.
Abstract
OBJECTIVES: For needle insertion and guidewire placement during central
venous catheterization, a thin-wall introducer needle technique and a
cannula-over-needle technique have been used. This study compared these
two techniques regarding the success rates and complications during
internal jugular vein catheterization.
DESIGN: Prospective, randomized, controlled study.
SETTING: A university-affiliated hospital.
PATIENTS: Two hundred sixty-six patients scheduled for thoracic surgery,
gynecologic surgery, or major abdominal surgery, who required central
venous catheterization.
INTERVENTIONS: Patients were randomly assigned to either the thin-wall
introducer needle group (n = 134) or the cannula-over-needle group (n =
132). Central venous catheterization was performed on the right internal
jugular vein under assistance with real-time ultrasonography. Needle
insertion and guidewire placement were performed using a thin-wall
introducer needle technique in the thin-wall introducer needle group and a
cannula-over-needle technique in the cannula-over-needle group.
MEASUREMENTS AND MAIN RESULTS: The guidewire placement on the first skin
puncture was regarded as a successful guidewire insertion on the first
attempt. The number of puncture attempts for internal jugular vein
catheterization was recorded. Internal jugular vein was assessed by
ultrasonography to identify complications. The rate of successful
guidewire insertion on the first attempt was higher in the thin-wall
introducer needle group compared with the cannula-over-needle group (87.3%
vs 77.3%; p = 0.037). There were fewer puncture attempts in the thin-wall
introducer needle group than in the cannula-over-needle group (1.1 +/- 0.4
vs 1.3 +/- 0.6; p = 0.026). There was no significant difference in
complications of internal jugular vein catheterization between the two
groups.
CONCLUSIONS: The thin-wall introducer needle technique showed a superior
success rate for first attempt of needle and guidewire insertion and
required fewer puncture attempts during internal jugular vein
catheterization.

<17>
Accession Number
26265447
Authors
Tavilla G. Bruggemans E.F. Gielen C.L. Brand A. van den Hout W.B. Klautz
R.J. van Hilten J.A.
Institution
(Tavilla) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(Bruggemans) Departments of Cardiothoracic Surgery, Leiden University
Medical Centre, Leiden, The Netherlands
(Gielen) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(Brand) Centre of Clinical Transfusion Research, Sanquin Blood Supply,
Leiden, The Netherlands
(van den Hout) Departments of Medical Decision-Making, Leiden University
Medical Centre, Leiden, The Netherlands
(Klautz) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(van Hilten) Centre of Clinical Transfusion Research, Sanquin Blood
Supply, Leiden, The Netherlands
Title
Multicentre randomized clinical trial to investigate the
cost-effectiveness of an allogeneic single-donor fibrin sealant after
coronary artery bypass grafting (FIBER Study).
Source
The British journal of surgery. 102 (11) (pp 1338-1347), 2015. Date of
Publication: 01 Oct 2015.
Abstract
BACKGROUND: Reduction of blood transfusion in cardiac surgery is an
important target. The aim of this study was to investigate the
cost-effectiveness of the use of CryoSeal, an allogeneic single-donor
fibrin sealant, in patients undergoing coronary artery bypass grafting
(CABG).
METHODS: This randomized clinical study involved seven cardiac surgery
centres in the Netherlands. Patients undergoing elective isolated CABG
with the use of at least one internal thoracic artery (ITA) graft were
assigned randomly to receive either CryoSeal (5ml per ITA bed) or no
CryoSeal. Primary efficacy endpoints were units of transfused red blood
cells, fresh frozen plasma and platelet concentrates, and duration of
intensive care unit stay. Secondary efficacy endpoints were 48-h blood
loss, reoperation for bleeding, mediastinitis, 30-day mortality and
duration of hospital stay.
RESULTS: Between March 2009 and January 2012, 1445 patients were
randomized. The intention-to-treat (ITT) population comprised 1436
patients; the per-protocol (PP) population 1292. In both the ITT and the
PP analysis, no significant difference between the treatment groups was
observed for any of the primary and secondary efficacy endpoints. In
addition, no significant difference between the groups was seen in the
proportion of transfused patients. Estimated CryoSeal costs were 822 (95
per cent c.i. 808 to 836) per patient, which translated to 72,000 per
avoided transfusion (unbounded 95 per cent c.i.).
CONCLUSION: The use of the fibrin sealant CryoSeal did not result in
health benefits. Combined with the high cost per avoided transfusion, this
study does not support the implementation of routine CryoSeal use in
elective isolated CABG.
REGISTRATION NUMBER: NTR1386 ( http://www.trialregister.nl).

<18>
Accession Number
25598216
Authors
Deo S.V. Altarabsheh S.E. Shah I.K. Cho Y.H. McGraw M. Sarayyepoglu B.
Medalion B. Markowitz A.H. Park S.J.
Institution
(Deo) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA.
Electronic address: svd14@case.edu
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Shah) Department of Surgery, University of Minnesota,
Minneapolis-St.Paul, MN, USA
(Cho) Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan
School of Medicine, Samsung Hospital, Seoul, South Korea
(McGraw) Health Sciences Library, Case Western Reserve University,
Cleveland, OH, USA
(Sarayyepoglu) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Medalion) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Markowitz) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Park) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
Title
Are two really always better than one? Results, concerns and controversies
in the use of bilateral internal thoracic arteries for coronary artery
bypass grafting in the elderly: a systematic review and meta-analysis.
Source
International journal of surgery (London, England). 16 (Pt B) (pp
163-170), 2015. Date of Publication: 01 Apr 2015.
Abstract
INTRODUCTION: Bilateral internal thoracic artery grafting appears to be
the preferred method to achieve durable long-term coronary artery
revascularization. However, data reporting the benefit of this technique
in the elderly is very conflicting.
METHOD: We performed a systematic review of available literature (till
November 2014) using multiple databases to identify studies comparing
clinical events in patients undergoing coronary artery bypass grafting
using either a single or double internal thoracic artery in the elderly.
While early mortality was the primary end-point of inclusion, other
adverse events compared were sternal wound infection (deep and
superficial), stroke and peri-operative myocardial infarction. Individual
and pooled odd's ratios were calculated using the Mantel-Haenzel method
(random effect model); sensitivity analysis was performed. Results are
presented using 95% confidence intervals.
RESULT: Nine retrospective studies (4479 BITA, 7733 LITA patients)
fulfilled search criteria. Deep sternal wound infection was significantly
higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early
mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p =
0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p
= 0.1) were comparable in both cohorts. Long-term survival favored the
BITA cohort in two propensity matched studies.
CONCLUSION: The incidence of deep sternal wound infection may be
significantly higher after the harvest of both internal thoracic arteries
in the elderly. While other post-operative adverse events are comparable,
data regarding the long-term survival advantage in this cohort is
conflicting. Hence, the use of both internal thoracic arteries in this age
group needs to be invidualized.

<19>
Accession Number
25448641
Authors
Sa M.P. Cavalcanti P.E. de Andrade Costa Santos H.J. Soares A.F.
Albuquerque Miranda R.G. Araujo M.L. Lima R.C.
Institution
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br
(Cavalcanti) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in
Health Sciences of Faculty of Medical Sciences and Biological Sciences
Institute (FCM/ICB), Recife, Brazil
(de Andrade Costa Santos) Division of Cardiovascular Surgery of Pronto
Socorro Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University
of Pernambuco - UPE, Recife, Brazil
(Soares) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil
(Albuquerque Miranda) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil
(Araujo) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil
(Lima) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil
Title
Skeletonized versus pedicled bilateral internal mammary artery grafting:
outcomes and concerns analyzed through a meta-analytical approach.
Source
International journal of surgery (London, England). 16 (Pt B) (pp
146-152), 2015. Date of Publication: 01 Apr 2015.
Abstract
BACKGROUND: It is suggested that the internal thoracic artery (ITA)
harvesting technique influences the incidence of sternal wound infection
(SWI) after coronary artery bypass graft (CABG) surgery when both right
and left ITAs are used. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled bilateral ITA
in terms of SWI after CABG.
METHODS: We performed a systematic-review using MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of
relevant articles to search for studies that compared the incidence of SWI
after CABG between skeletonized versus pedicled bilateral ITA until May
2014. The principal summary measures were odds ratio (OR) with 95%
Confidence Interval (CI) and P values (statistically significant when
<0.05). The ORs were combined across studies using weighted
DerSimonian-Laird random effects model. Meta-analysis, sensitivity
analysis and meta-regression were carried out by using the software
Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New
Jersey).
RESULTS: Eight studies involving 2633 patients (1698 skeletonized; 935
pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of the effects among the studies. The overall OR
(95% CI) of SWI showed statistical significant difference in favor to
skeletonized ITA (random effect model: OR 0.327; 95% CI 0.217-0.492; P <
0.001). In sensitivity analysis, the difference in favor to skeletonized
ITA was observed mainly in the presence of diabetes. In meta-regression,
we observed no modulation of the effects.
CONCLUSION: When both ITAs are used, the skeletonized technique appears to
reduce the incidence of SWI after CABG in comparison to the pedicled
technique.

<20>
Accession Number
26349842
Authors
Fowler A.J. Ahmad T. Phull M.K. Allard S. Gillies M.A. Pearse R.M.
Institution
(Fowler) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
(Ahmad) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
(Phull) Departments of Anaesthesia, Royal London Hospital, Barts Health
NHS Trust, London, UK
(Allard) Departments of Haematology, Royal London Hospital, Barts Health
NHS Trust, London, UK
(Gillies) Department of Anaesthesia, Critical Care and Pain Medicine,
Royal Infirmary of Edinburgh, Edinburgh, UK
(Pearse) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
Title
Meta-analysis of the association between preoperative anaemia and
mortality after surgery.
Source
The British journal of surgery. 102 (11) (pp 1314-1324), 2015. Date of
Publication: 01 Oct 2015.
Abstract
BACKGROUND: Numerous published studies have explored associations between
anaemia and adverse outcomes after surgery. However, there are no evidence
syntheses describing the impact of preoperative anaemia on postoperative
outcomes.
METHODS: A systematic review and meta-analysis of observational studies
exploring associations between preoperative anaemia and postoperative
outcomes was performed. Studies investigating trauma, burns, transplant,
paediatric and obstetric populations were excluded. The primary outcome
was 30-day or in-hospital mortality. Secondary outcomes were acute kidney
injury, stroke and myocardial infarction. Predefined analyses were
performed for the cardiac and non-cardiac surgery subgroups. A post hoc
analysis was undertaken to evaluate the relationship between anaemia and
infection. Data are presented as odds ratios (ORs) with 95 per cent c.i.
RESULTS: From 8973 records, 24 eligible studies including 949445 patients
were identified. Some 371594 patients (39.1 per cent) were anaemic.
Anaemia was associated with increased mortality (OR 2.90, 2.30 to 3.68;
I(2) =97 per cent; P<0.001), acute kidney injury (OR 3.75, 2.95 to 4.76;
I(2) =60 per cent; P<0.001) and infection (OR 1.93, 1.17 to 3.18; I(2) =99
per cent; P=0.01). Among cardiac surgical patients, anaemia was associated
with stroke (OR 1.28, 1.06 to 1.55; I(2) =0 per cent; P=0.009) but not
myocardial infarction (OR 1.11, 0.68 to 1.82; I(2) =13 per cent; P=0.67).
Anaemia was associated with an increased incidence of red cell transfusion
(OR 5.04, 4.12 to 6.17; I(2) =96 per cent; P<0.001). Similar findings were
observed in the cardiac and non-cardiac subgroups.
CONCLUSION: Preoperative anaemia is associated with poor outcomes after
surgery, although heterogeneity between studies was significant. It
remains unclear whether anaemia is an independent risk factor for poor
outcome or simply a marker of underlying chronic disease. However, red
cell transfusion is much more frequent amongst anaemic patients.

<21>
Accession Number
20160013577
Authors
Zhao B.-C. Deng W.-T. Li B.-C. Deng Q.-W. Xia Z.-Q. Li Y.-Y. Liu K.-X.
Institution
(Zhao, Deng, Li, Deng, Xia, Li, Liu) Department of Anesthesiology, First
Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road,
Guangzhou 510080, China
Title
Remote ischemic preconditioning for preventing acute kidney injury
following cardiovascular surgery: A meta-analysis with trial sequential
analysis.
Source
International Journal of Cardiology. 203 (pp 842-844), 2016. Date of
Publication: 15 Jan 2016.
Publisher
Elsevier Ireland Ltd

<22>
Accession Number
20160010881
Authors
Zhou X. Zhang W. Lv W. Zhou Q. Li Y. Zhang L. Lu Y. Zhang J. Xing Q. Wang
H. Tang B.
Institution
(Zhou, Zhang, Lv, Zhou, Li, Zhang, Lu, Zhang, Xing, Wang, Tang) Pacing and
Electrophysiological Division, First Affiliated Hospital of Xinjiang
Medical University, Urumqi, Xinjiang 830011, China
Title
Left atrial appendage occlusion in atrial fibrillation for stroke
prevention: A systemic review.
Source
International Journal of Cardiology. 203 (pp 55-59), 2016. Date of
Publication: 15 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Atrial fibrillation (AF) is an arrthymia characterized by
increased risk of ventricle arrthymias and thromboembolism especially
ischemic stroke. Most thrombus originated in the left atrial appendage,
thus left atrial occlusion (LAAO) may be an effective alternative for
stroke prevention in atrial fibrillation. Objective To assess the effect
and safety of left atrial occlusion for stroke prevention in atrial
fibrillation. Methods and results We searched Pub Med, CENTRAL in The
Cochrane Library, Embase, CBM-Disk, CNKI for published trials,
ClinicalTrials.gov, ISI Proceedings for conference abstracts, and WHO
International Clinical Trial registration Platform for ongoing studies.
The search results were extracted, and then the quality of included
studies was assessed. By RevMan 5.3, meta analysis was used if there was
low heterogeneity. Three randomized controlled clinical trials involving
1165 participants were included (percutaneous 1114 in 2 trials, surgical
51 in 1 trial). The current data suggest that left atrial occlusion may be
as efficacious as warfarin in stroke prevention (RR 0.78 [0.33, 1.84]) and
mortality reduction (RR 0.68 [0.40, 1.16]) for AF. Conclusion In contrast
to warfarin left atrial occlusion with Watchman device may have the same
effectivity in stroke reduction. Surgical LAAO may also get positive
outcomes compared with warfarin, but owing to the small sample size the
evidence is less powerful. Total outcomes of percutaneous and surgical
LAAO support this approach.

<23>
Accession Number
2015359433
Authors
Elkomy M.H. Drover D.R. Glotzbach K.L. Galinkin J.L. Frymoyer A. Su F.
Hammer G.B.
Institution
(Elkomy, Drover, Hammer) Department of Anesthesiology, Perioperative and
Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive,
Stanford, CA 94305-5117, United States
(Elkomy) Department of Pharmaceutics and Industrial Pharmacy, Beni Suef
University, Beni Suef, Egypt
(Glotzbach) Division of Pediatric Critical Care Medicine, Duke University
Medical Center, Durham, NC, United States
(Frymoyer, Su, Hammer) Department of Pediatrics, Stanford University
School of Medicine, Stanford, CA, United States
(Galinkin) Department of Anesthesiology, University of Colorado, Anschutz
Medical Campus, Aurora, CO, United States
Title
Pharmacokinetics of Morphine and Its Metabolites in Infants and Young
Children After Congenital Heart Surgery.
Source
AAPS Journal. 18 (1) (pp 124-133), 2016. Date of Publication: 01 Jan 2016.
Publisher
Springer New York LLC
Abstract
The objective of this study was to characterize morphine glucuronidation
in infants and children following cardiac surgery for possible treatment
individualization in this population. Twenty children aged 3 days to 6
years, admitted to the cardiovascular intensive care unit after congenital
heart surgery, received an intravenous (IV) loading dose of morphine (0.15
mg/kg) followed by subsequent intermittent IV bolus doses based on a
validated pain scale. Plasma samples were collected over 6 h after the
loading dose and randomly after follow-up doses to measure morphine and
its major metabolite concentrations. A population pharmacokinetic model
was developed with the non-linear mixed effects software NONMEM. Parent
disposition was adequately described by a linear two-compartment model.
Effect of growth (size and maturation) on morphine parameters was
accounted for by allometric body weight-based models. An intermediate
compartment with Emax model best characterized glucuronide concentrations.
Glomerular filtration rate was identified as a significant predictor of
glucuronide formation time delay and maximum concentrations. Clearance of
morphine in children with congenital heart disease is comparable to that
reported in children without cardiac abnormalities of similar age.
Children 1-6 months of age need higher morphine doses per kilogram to
achieve an area under concentration-time curve comparable to that in older
children. Pediatric patients with renal failure receiving morphine therapy
are at increased risk of developing opioid toxicity due to accumulation of
morphine metabolites.

<24>
Accession Number
20160014858
Authors
Anderson L. Oldridge N. Thompson D.R. Zwisler A.-D. Rees K. Martin N.
Taylor R.S.
Institution
(Anderson, Taylor) Institute of Health Research, University of Exeter
Medical School, South Cloisters, St Lukes Campus, Exeter EX1 2LU, United
Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
Milwaukee, WI, United States
(Thompson) Centre for the Heart and Mind, Australian Catholic University,
Melbourne, Australia
(Zwisler) National Centre of Rehabilitation and Palliation, University
Hospital Odense, University of Southern Denmark, Odense, Denmark
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Martin) Department of Non-Communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, United Kingdom
Title
Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease Cochrane
Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. 67 (1) (pp 1-12), 2016.
Date of Publication: 05 Jan 2016.
Publisher
Elsevier USA
Abstract
Background Although recommended in guidelines for the management of
coronary heart disease (CHD), concerns have been raised about the
applicability of evidence from existing meta-analyses of exercise-based
cardiac rehabilitation (CR). Objectives The goal of this study is to
update the Cochrane systematic review and meta-analysis of exercise-based
CR for CHD. Methods The Cochrane Central Register of Controlled Trials,
MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched
to July 2014. Retrieved papers, systematic reviews, and trial registries
were hand-searched. We included randomized controlled trials with at least
6 months of follow-up, comparing CR to no-exercise controls following
myocardial infarction or revascularization, or with a diagnosis of angina
pectoris or CHD defined by angiography. Two authors screened titles for
inclusion, extracted data, and assessed risk of bias. Studies were pooled
using random effects meta-analysis, and stratified analyses were
undertaken to examine potential treatment effect modifiers. Results A
total of 63 studies with 14,486 participants with median follow-up of 12
months were included. Overall, CR led to a reduction in cardiovascular
mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and
the risk of hospital admissions (relative risk: 0.82; 95% confidence
interval: 0.70 to 0.96). There was no significant effect on total
mortality, myocardial infarction, or revascularization. The majority of
studies (14 of 20) showed higher levels of health-related quality of life
in 1 or more domains following exercise-based CR compared with control
subjects. Conclusions This study confirms that exercise-based CR reduces
cardiovascular mortality and provides important data showing reductions in
hospital admissions and improvements in quality of life. These benefits
appear to be consistent across patients and intervention types and were
independent of study quality, setting, and publication date.

<25>
Accession Number
20160014853
Authors
Reynolds M.R. Lei Y. Wang K. Chinnakondepalli K. Vilain K.A. Magnuson E.A.
Galper B.Z. Meduri C.U. Arnold S.V. Baron S.J. Reardon M.J. Adams D.H.
Popma J.J. Cohen D.J.
Institution
(Reynolds) Harvard Clinical Research Institute, 930 Commonwealth Avenue,
Boston, MA 02215, United States
(Reynolds) Department of Cardiology, Lahey Hospital and Medical Center,
Burlington, MA, United States
(Lei, Wang, Chinnakondepalli, Vilain, Magnuson, Arnold, Baron, Cohen)
Saint Luke's Mid America Heart Institute, Kansas City, KS, United States
(Lei) University of Kansas School of Medicine, Kansas City, KS, United
States
(Magnuson, Arnold, Baron, Cohen) University of Missouri-Kansas City,
Kansas City, MO, United States
(Galper) Brigham and Women's Hospital, Boston, MA, United States
(Meduri) Piedmont Heart Institute, Atlanta, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Adams) The Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
Title
Cost-Effectiveness of Transcatheter Aortic Valve Replacement with a
Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 67 (1) (pp 29-38), 2016.
Date of Publication: 05 Jan 2016.
Publisher
Elsevier USA
Abstract
Background Previous studies of the cost-effectiveness of transcatheter
aortic valve replacement (TAVR) have been based primarily on a single
balloon-expandable system. Objectives The goal of this study was to
evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis
compared with surgical aortic valve replacement (SAVR) for patients with
severe aortic stenosis and high surgical risk. Methods We performed a
formal economic analysis on the basis of individual, patient-level data
from the CoreValve U.S. High Risk Pivotal Trial. Empirical data regarding
survival and quality of life over 2 years, and medical resource use and
hospital costs through 12 months were used to project life expectancy,
quality-adjusted life expectancy, and lifetime medical costs in order to
estimate the incremental cost-effectiveness of TAVR versus SAVR from a
U.S. perspective. Results Relative to SAVR, TAVR reduced initial length of
stay an average of 4.4 days, decreased the need for rehabilitation
services at discharge, and resulted in superior 1-month quality of life.
Index admission and projected lifetime costs were higher with TAVR than
with SAVR (differences $11,260 and $17,849 per patient, respectively),
whereas TAVR was projected to provide a lifetime gain of 0.32
quality-adjusted life-years ([QALY]; 0.41 LY) with 3% discounting.
Lifetime incremental cost-effectiveness ratios were $55,090 per QALY
gained and $43,114 per LY gained. Sensitivity analyses indicated that a
reduction in the initial cost of TAVR by ~$1,650 would lead to an
incremental cost-effectiveness ratio <$50,000/QALY gained. Conclusions In
a high-risk clinical trial population, TAVR with a self-expanding
prosthesis provided meaningful clinical benefits compared with SAVR, with
incremental costs considered acceptable by current U.S. standards. With
expected modest reductions in the cost of index TAVR admissions, the value
of TAVR compared with SAVR in this patient population would become high.
(Safety and Efficacy Study of the Medtronic CoreValve System in the
Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High
Risk Subjects Who Need Aortic Valve Replacement [Medtronic CoreValve U.S.
Pivotal Trial]; NCT01240902)

<26>
Accession Number
20160014846
Authors
Milojevic M. Head S.J. Parasca C.A. Serruys P.W. Mohr F.W. Morice M.-C.
Mack M.J. Stahle E. Feldman T.E. Dawkins K.D. Colombo A. Kappetein A.P.
Holmes D.R.
Institution
(Milojevic, Head, Parasca, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Mohr) Department of Cardiovascular Surgery, Herzzentrum Universitat
Leipzig, Leipzig, Germany
(Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital
Prive Jacques Cartier, Massy, France
(Mack) Department of Cardiovascular Surgery, Heart Hospital Baylor Plano,
Baylor Healthcare System, Plano, TX, United States
(Stahle) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Uppsala, Sweden
(Feldman) Cardiology Division, Evanston Hospital, Evanston, IL, United
States
(Dawkins) Boston Scientific Corporation, Natick, MA, United States
(Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus,
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Holmes) Division of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic Rochester, Rochester, MN 55905, United States
Title
Causes of Death Following PCI Versus CABG in Complex CAD 5-Year Follow-Up
of SYNTAX.
Source
Journal of the American College of Cardiology. 67 (1) (pp 42-55), 2016.
Date of Publication: 05 Jan 2016.
Publisher
Elsevier USA
Abstract
Background There are no data available on specific causes of death from
randomized trials that have compared coronary artery bypass grafting
(CABG) with percutaneous coronary intervention (PCI). Objectives The
purpose of this study was to investigate specific causes of death, and its
predictors, after revascularization for complex coronary disease in
patients. Methods An independent Clinical Events Committee consisting of
expert physicians who were blinded to the study treatment subclassified
causes of death as cardiovascular (cardiac and vascular),
noncardiovascular, or undetermined according to the trial protocol.
Cardiac deaths were classified as sudden cardiac, related to myocardial
infarction (MI), and other cardiac deaths. Results In the randomized
cohort, there were 97 deaths after CABG and 123 deaths after PCI during a
5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with
the greatest cause being heart failure, arrhythmia, or other causes
(24.6%), whereas after PCI, the majority of deaths were cardiovascular
(67.5%) and as a result of MI (29.3%). The cumulative incidence rates of
all-cause death were not significantly different between CABG and PCI
(11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant
differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p =
0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which
were caused primarily by a reduction in MI-related death with CABG
compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with
PCI versus CABG was an independent predictor of cardiac death (hazard
ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The
difference in MI-related death was seen largely in patients with diabetes,
3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary
Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial
scores. Conclusions During a 5-year follow-up, CABG in comparison with PCI
was associated with a significantly reduced rate of MI-related death,
which was the leading cause of death after PCI. Treatments following PCI
should target reducing post-revascularization spontaneous MI. Furthermore,
secondary preventive medication remains essential in reducing events
post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery
Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX];
NCT00114972)

<27>
Accession Number
20160014844
Authors
Dedic A. Lubbers M.M. Schaap J. Lammers J. Lamfers E.J. Rensing B.J. Braam
R.L. Nathoe H.M. Post J.C. Nielen T. Beelen D. Le Cocq D'Armandville M.-C.
Rood P.P.M. Schultz C.J. Moelker A. Ouhlous M. Boersma E. Nieman K.
Institution
(Dedic, Lubbers, Schultz, Boersma, Nieman) Department of Cardiology,
Erasmus University Medical Center, s-Gravendijkwal 230, CE Rotterdam 3015,
Netherlands
(Dedic, Lubbers, Moelker, Ouhlous, Nieman) Department of Radiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Schaap, Beelen) Department of Cardiology, Amphia Ziekenhuis, Breda,
Netherlands
(Lammers, Post) Department of Cardiology, Catharina Ziekenhuis, Eindhoven,
Netherlands
(Lamfers, Nielen) Department of Cardiology, Canisius Wilhelmina
Ziekenhuis, Nijmegen, Netherlands
(Rensing) Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Braam, Le Cocq D'Armandville) Department of Cardiology, Gelre Ziekenhuis,
Apeldoorn, Netherlands
(Nathoe) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Rood) Department of Emergency Medicine, Erasmus University Medical
Center, Rotterdam, Netherlands
(Schultz) Department of Cardiology, Royal Perth Hospital Campus,
University of Western Australia, Perth, Australia
Title
Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity
Troponins Randomized Multicenter Study.
Source
Journal of the American College of Cardiology. 67 (1) (pp 16-26), 2016.
Date of Publication: 05 Jan 2016.
Publisher
Elsevier USA
Abstract
Background It is uncertain whether a diagnostic strategy supplemented by
early coronary computed tomography angiography (CCTA) is superior to
contemporary standard optimal care (SOC) encompassing high-sensitivity
troponin assays (hs-troponins) for patients suspected of acute coronary
syndrome (ACS) in the emergency department (ED). Objectives This study
assessed whether a diagnostic strategy supplemented by early CCTA improves
clinical effectiveness compared with contemporary SOC. Methods In a
prospective, open-label, multicenter, randomized trial, we enrolled
patients presenting with symptoms suggestive of an ACS at the ED of 5
community and 2 university hospitals in the Netherlands. Exclusion
criteria included the need for urgent cardiac catheterization and history
of ACS or coronary revascularization. The primary endpoint was the number
of patients identified with significant coronary artery disease requiring
revascularization within 30 days. Results The study population consisted
of 500 patients, of whom 236 (47%) were women (mean age 54 +/- 10 years).
There was no difference in the primary endpoint (22 [9%] patients
underwent coronary revascularization within 30 days in the CCTA group and
17 [7%] in the SOC group [p = 0.40]). Discharge from the ED was not more
frequent after CCTA (65% vs. 59%, p = 0.16), and length of stay was
similar (6.3 h in both groups; p = 0.80). The CCTA group had lower direct
medical costs (337 vs. 511, p < 0.01) and less outpatient testing after
the index ED visit (10 [4%] vs. 26 [10%], p < 0.01). There was no
difference in incidence of undetected ACS. Conclusions CCTA, applied early
in the work-up of suspected ACS, is safe and associated with less
outpatient testing and lower costs. However, in the era of hs-troponins,
CCTA does not identify more patients with significant CAD requiring
coronary revascularization, shorten hospital stay, or allow for more
direct discharge from the ED. (Better Evaluation of Acute Chest Pain with
Computed Tomography Angiography [BEACON]; NCT01413282)

<28>
Accession Number
20160014579
Authors
Costa R.A. Abizaid A. Mehran R. Schofer J. Schuler G.C. Hauptmann K.E.
Magalhaes M.A. Parise H. Grube E.
Institution
(Costa, Abizaid) Department of Invasive Cardiology, Institute Dante
Pazzanese of Cardiology, Cardiovascular Research Center, Rua Dr. Altolfo
Araujo, 521Vila Mariana, Sao Paulo, SP 04012-070, Brazil
(Costa, Abizaid, Magalhaes) Cardiovascular Research Center, Sao Paulo,
Brazil
(Mehran, Parise) Cardiovascular Research Foundation, New York, NY, United
States
(Schofer) Medical Care Center, Hamburg University Cardiovascular Center,
Hamburg, Germany
(Schuler) Herzzentrum Leipzig GmbH, Leipzig, Germany
(Hauptmann) Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Grube) University of Bonn, Bonn, Germany
Title
Polymer-Free Biolimus A9-Coated Stents in the Treatment of de Novo
Coronary Lesions 4- and 12-Month Angiographic Follow-Up and Final 5-Year
Clinical Outcomes of the Prospective, Multicenter BioFreedom FIM Clinical
Trial.
Source
JACC: Cardiovascular Interventions. 9 (1) (pp 51-54), 2016. Date of
Publication: 11 Jan 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to evaluate the efficacy and
long-term outcomes of a novel polymer/carrier-free drug-coated stent (DCS)
in patients with de novo coronary lesions. Background The BioFreedom (BFD)
DCS incorporates a low-profile, stainless-steel platform, with a surface
that has been modified to create a selectively microstructured abluminal
surface that allows adhesion and further release of Biolimus A9
(Biosensors Europe SA, Morges, Switzerland). Methods A total of 182
patients (183 lesions) were randomized into a 1:1:1 ratio for treatment
with BFD "standard dose" (BFD) or BFD "low dose" (BFD-LD) versus
first-generation paclitaxel-eluting stents (PES) at 4 sites in Germany.
Results Baseline and procedural characteristics were well matched. At
4-month angiographic follow-up (Cohort 1, n = 75), in-stent late lumen
loss (LLL) was significantly lower with BFD and BFD-LD versus PES (0.08
and 0.12 mm vs. 0.37 mm, respectively; p < 0.0001 for BFD vs. PES, and p =
0.002 for BFD-LD vs. PES). At 12 months (Cohort 2, n = 107), in-stent LLL
(primary endpoint) was 0.17 mm in BFD versus 0.35 mm in PES (p = 0.001 for
noninferiority; p = 0.11 for superiority); however, the BFD-LD (0.22 mm)
did not reach noninferiority (p = 0.21). At 5 years (175 of 182), there
were no significant differences in major adverse cardiac events (23.8%,
26.4%, and 20.3%) and clinically indicated target lesion revascularization
(10.8%, 13.4%, and 10.2%) for BFD, BFD-LD, and PES, respectively; also,
there was no definite/probable stent thrombosis reported. Conclusions The
BFD, but not the BFD-LD, demonstrated noninferiority versus PES in terms
of in-stent LLL, a surrogate of neointimal hyperplasia, at 12-month
follow-up. At 5 years, clinical event rates were similar, without
occurrence of stent thrombosis in all groups. (BioFreedom FIM Clinical
Trial; NCT01172119)

<29>
Accession Number
20160011474
Authors
Bangalore S. Fakheri R. Toklu B. Ogedegbe G. Weintraub H. Messerli F.H.
Institution
(Bangalore, Fakheri, Ogedegbe, Weintraub) Leon H. Charney Division of
Cardiology, New York University, School of Medicine, New York, NY 10016,
United States
(Toklu) Mount Sinai Beth Israel Medical Center, New York, NY, United
States
(Messerli) University Hospital, Bern, Switzerland
(Messerli) Mount Sinai, Icahn School of Medicine, New York, NY, United
States
Title
Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers
in Patients Without Heart Failure? Insights from 254,301 Patients from
Randomized Trials.
Source
Mayo Clinic Proceedings. 91 (1) (pp 51-60), 2016. Date of Publication: 01
Jan 2016.
Publisher
Elsevier Ltd
Abstract
Objectives To compare the efficacy and safety of angiotensin-converting
enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in
patients without heart failure. Patients and Methods Meta-analysis of
randomized trials identified using PubMed, Embase, and Cochrane Central
Register of Controlled Trials searches from January 1, 1980, through April
13, 2015, of ACEis and ARBs compared with placebo or active controls and
corroborated with head-to-head trials of ARBs vs ACEis. Outcomes were
all-cause mortality, cardiovascular death, myocardial infarction (MI),
angina, stroke, heart failure, revascularization, and new-onset diabetes.
Results Our search yielded 106 randomized trials that enrolled 254,301
patients. Compared with placebo, ACEis but not ARBs reduced the outcomes
of all-cause mortality (ACEis vs placebo: relative risk [RR], 0.89; 95%
CI, 0.80-1.00; ARBs vs placebo: RR, 1.01; 95% CI, 0.96-1.06;
P<inf>interaction</inf>=.04), cardiovascular death (RR, 0.83; 95% CI,
0.70-0.99 and RR, 1.02; 95% CI, 0.92-1.14; P<inf>interaction</inf>=.05),
and MI (RR, 0.83; 95% CI, 0.78-0.90 and RR, 0.93; 95% CI, 0.85-1.03;
P<inf>interaction</inf>=.06). The meta-regression analysis revealed that
the difference between ACEis and ARBs compared with placebo was due to a
higher placebo event rate in the ACEis trials (most of these trials were
conducted a decade earlier than the ARB trials) for the outcome of
all-cause mortality (P=.001), cardiovascular death (P<.001), and MI
(P=.02). Sensitivity analyses restricted to trials published after 2000
revealed similar outcomes with ACEis vs placebo and ARBs vs placebo
(P<inf>interaction</inf>>.05). Head-to-head comparison trials of ARBs vs
ACEis exhibited no difference in outcomes except for a lower risk of drug
withdrawal due to adverse effects with ARBs (RR, 0.72; 95% CI, 0.65-0.81).
Conclusion In patients without heart failure, evidence from
placebo-controlled trials (restricted to trials after 2000), active
controlled trials, and head-to-head randomized trials all suggest ARBs to
be as efficacious and safe as ACEis, with the added advantage of better
tolerability.

<30>
[Use Link to view the full text]
Accession Number
20151016445
Authors
Peng Y. Zhang W. Zhou X. Ji Y. Kass I.S. Han R.
Institution
(Peng, Zhang, Zhou, Ji, Han) Department of Anesthesiology, Beijing Tiantan
Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng
District, Beijing 100050, China
(Kass) Department of Anesthesiology, State University of New York,
Downstate Medical Center, Brooklyn, NY, United States
(Kass) Department of Physiology and Pharmacology, State University of New
York, Downstate Medical Center, Brooklyn, NY, United States
Title
Lidocaine did not reduce neuropsychological-cognitive decline in patients
6 months after supratentorial tumor surgery: A randomized, controlled
trial.
Source
Journal of Neurosurgical Anesthesiology. 28 (1) (pp 6-13), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
There is equivocal evidence examining cognitive improvement in response to
lidocaine during cardiac surgery; however, no study has examined its
effect on postoperative neuropsychological-cognitive decline after
supratentorial tumor surgery. Methods: Ninety-four patients scheduled for
supratentorial craniotomy were enrolled. Patients received either a dose
of lidocaine (2%) via an intravenous bolus (1.5 mg/kg) after induction
followed by an infusion at a rate of 2 mg/kg/h until the end of surgery
(Lidocaine group) or the same volume of normal saline. The
neuropsychological-cognitive decline was evaluated using the following
tests: the Mini-Mental State Examination, the
Information-Memory-Concentration test, the Hamilton Rating Scale for
Depression, and the Hamilton Rating Scale for Anxiety. The cerebral oxygen
extraction ratio and the difference in lactic acid levels between the bulb
of the jugular vein and a peripheral artery were measured. Results: Eighty
patients completed the neuropsychological tests, with 40 patients in each
group. The incidence of postoperative decline at up to 6 months in the
Lidocaine group was not significantly different than that in the Normal
saline group. When the 2 cognitive tests were examined independent of the
other tests, there was no difference between groups at 6 months. The
cerebral oxygen extraction ratio was significantly lower in the Lidocaine
group after surgery (P<0.05), and the arteriovenous difference of lactic
acid was lower in the Lidocaine group (P<0.05). Conclusions:
Intraoperative infusion of lidocaine does not significantly decrease the
incidence of postoperative neuropsychological-cognitive decline in
patients 6 months after supratentorial tumor surgery.

<31>
[Use Link to view the full text]
Accession Number
2015448269
Authors
Xiong H.-Y. Liu Y. Shu D.-C. Zhang S.-L. Qian X. Duan W.-X. Cheng L. Yu
S.-Q. Jin Z.-X.
Institution
(Xiong, Liu, Duan, Cheng, Yu, Jin) Department of Cardiovascular Surgery,
Xijing Hospital, Fourth Military Medical University, 169 Chengle West RD,
Xi'an 710032, China
(Xiong) Department of Thoracic and Cardiovascular Surgery, Xi'an Central
Hospital, Xi'an, China
(Shu) Department of Cardiovascular Surgery, Baoji Municipal Central
Hospital, Baoji, China
(Zhang) Department of Cardiovascular Surgery, Shaanxi General Hospital of
CAPF, Xi'an, China
(Qian) Department of Pediatrics, Xijing Hospital, Fourth Military Medical
University, Xi'an, China
Title
Effects of sevoflurane inhalation during cardiopulmonary bypass on
pediatric patients: A randomized controlled clinical trial.
Source
ASAIO Journal. 62 (1) (pp 63-68), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
The effects of sevoflurane inhalation during cardiopulmonary bypass (CPB)
on postoperative courses and serum cardiac troponin I (cTnI)
concentrations in pediatric patients undergoing cardiac surgery have not
been extensively investigated. In this single-center, prospective,
randomized trial, an anesthetic regimen containing 2% sevoflurane used
throughout the CPB process was compared with a total intravenous
anesthesia (TIVA) regimen. One hundred and three patients undergoing
congenital heart defect repair with CPB were included in this prospective
randomized controlled study. They were randomized into two groups: The
sevoflurane group, who received 2% sevoflurane during CPB via an
oxygenator, and the control group, who received only an oxygen-air
mixture. The pre-and intra-operative parameters were comparable between
the two groups. There was a slight but significant increase of arterial
diastolic pressure in the sevoflurane group immediately after CPB compared
with control patients (46.9 +/- 9.3 mm Hg vs. 43.6 +/- 8.9 mm Hg; p =
0.033). There was no death in either group. The postoperative ventilation
time (in mean [95% confidence interval]) was shorter in the sevoflurane
group than that in the control group (26.1 [19.2, 33.0] h vs. 37.7 [24.4,
50.9] h; p = 0.014). The postoperative ICU time, hospital days, and serial
serum cTnI concentrations were not significantly different between the two
groups. Inhalation of 2% sevoflurane during CPB is beneficial to the
recovery of pediatric patients undergoing cardiac surgery but has no
significant effect on postoperative cTnI release.

<32>
Accession Number
20160007291
Authors
Phan K. Ha H. Phan S. Misfeld M. Di Eusanio M. Yan T.D.
Institution
(Phan, Phan, Di Eusanio, Yan) Collaborative Research (CORE) Group,
Macquarie University Hospital, Macquarie University, 2 Technology Pl,
Sydney, NSW 2109, Australia
(Phan) Westmead Clinical School, Sydney Medical School, University of
Sydney, Sydney, Australia
(Phan, Ha) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Misfeld) University of Leipzig, Heart Center, Leipzig, Germany
(Di Eusanio) Cardiovascular Surgery Department, Sant'Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Early hemodynamic performance of the third generation St Jude Trifecta
aortic prosthesis: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (6) (pp 1567-1575e2),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objective The Trifecta aortic prosthesis is a latest-generation trileaflet
stented pericardial valve designed for supra-annular placement in the
aortic position. Robust clinical evidence and long-term follow-up data for
this new prosthesis are lacking; a systematic review was conducted to
assess current evidence. Methods A comprehensive search from 6 electronic
databases was performed, with time period parameters dating from database
inception to January 2014. Results utilizing Trifecta prosthesis for
aortic valve replacement (AVR) were identified. Results A total of 13
studies with 2549 patients undergoing AVR with this prosthesis were
included in this review. The mean proportion of patients with aortic
stenosis was 82.4%, with a mean gradient of 47.4 mm Hg, and a pooled
effective orifice area (EOA) of 0.74 cm². Valve sizes of 21 mm
and 23 mm were implanted in 71.3% of patients. The pooled rates of 30-day
mortality, cerebrovascular accidents, and acute kidney injuries were 2.7%,
1.9%, and 2.6%, respectively. After implantation, the pooled mean gradient
decreased to 9.2 mm Hg, whereas discharge EOA increased to 1.8
cm², compared with preoperative parameters. Among included
studies with significant heterogeneity detected, most patients had
satisfactory patient-prosthesis mismatch, with 2.7% having severe
mismatch. Conclusions The present systematic review demonstrated that
short-term AVR with this prosthesis provided excellent early safety and
hemodynamic outcomes with acceptable mean gradients and EOA. Long-term
follow-up and randomized controlled trials are warranted to confirm the
early results.

<33>
[Use Link to view the full text]
Accession Number
20160007278
Authors
Zhang J.-R. Wang D.-Q. Du J. Qu G.-S. Du J.-L. Deng S.-B. Liu Y.-J. Cai
J.-X. She Q.
Institution
(Zhang, Wang, Du, Qu, Du, Deng, Liu, She) Department of Cardiology, Second
Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road,
Chongqing, China
(Zhang) Department of Cardiology, DongNan Hospital, Chongqing, China
(Cai) Department of Hematology, Second Affiliated Hospital, Chongqing
Medical University, Chongqing, China
Title
Efficacy of clopidogrel and clinical outcome when clopidogrel is
coadministered with atorvastatin and lansoprazole: A prospective,
randomized, controlled trial.
Source
Medicine (United States). 94 (50) (no pagination), 2015. Article Number:
2262. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
This prospective, randomized, nonblind, controlled trial evaluated the
effects of clopidogrel on platelet function upon coadministration with
atorvastatin and lansoprazole. One hundred four adult patients with
non-ST-segment elevated acute coronary syndrome (NSTE-ACS) who underwent
percutaneous coronary intervention (PCI) with drug-eluting stent
implantation were included. All patients were treated with standard dual
antiplatelet therapy (DAPT) plus rosuvastatin 10mg daily after the
operation. On the sixth day after PCI, patients were randomly divided into
4 groups, Group A: DAPT+atorvastatin 20mg daily (a change from
rosuvastatin to atorvastatin)+lansoprazole 30mg daily, Group B:
DAPT+atorvastatin 20mg daily (a change from rosuvastatin to atorvastatin),
Group C: DAPT+lansoprazole 30mg daily (continuing to take rosuvastatin),
Group D is the control group. Additional drugs were used according to the
situation of patients. Platelet function and concentrations of platelet
activation markers (granular membrane protein 140 (P-selectin),
thromboxane B2(TXB2), and human soluble cluster of differentiation 40
ligand (sCD40L)) were assessed before randomization and at 15- and 30-day
follow-up visits. All patients were maintained on treatment for 6 months
and observed for bleeding and ischemic events. A total of 104 patients
were enrolled, 27 patients in group A, 26 patients in Group B/C, 25
patients in Group D separately, and all the patients were analyzed. There
were no differences in platelet function and the levels of platelet
activation markers (P-selectin, TXB<inf>2</inf>, and sCD40L) among or
within the 4 groups at the 3 time points of interest (P>0.05). In the
subsequent 6 months, no significant bleeding events occurred, and 12
patients experienced ischemic events, these results were also not
significantly different among the groups (P>0.05). In patients diagnosed
with NSTE-ACS who have had drug-eluting stent implantation, simultaneously
administering clopidogrel, atorvastatin, and lansoprazole did not decrease
the antiplatelet efficacy of clopidogrel or increase adverse event
frequency over 6 months.

<34>
[Use Link to view the full text]
Accession Number
20160007998
Authors
Choi J.W. Ahn H.J. Yang M. Kim J.A. Lee S.M. Ahn J.H.
Institution
(Choi, Ahn, Yang, Kim, Lee, Ahn) Department of Anesthesiology and Pain
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, 50 Ilwondong, Kangnam-gu, Seoul 135-710, South Korea
Title
Comparison between phenylephrine and dopamine in maintaining cerebral
oxygen saturation in thoracic surgery: A randomized controlled trial.
Source
Medicine (United States). 94 (49) (no pagination), 2015. Article Number:
e2212. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Fluid is usually restricted during thoracic surgery, and vasoactive agents
are often administered to maintain blood pressure. One-lung ventilation
(OLV) decreases arterial oxygenation; thus oxygen delivery to the brain
can be decreased. In this study, we compared phenylephrine and dopamine
with respect to maintaining cerebral oxygenation during OLV in major
thoracic surgery. Sixty-three patients undergoing lobectomies were
randomly assigned to the dopamine (D) or phenylephrine (P) group. The
patients' mean arterial pressure was maintained within 20% of baseline by
a continuous infusion of dopamine or phenylephrine. Maintenance fluid was
kept at 5mL/kg/h. The depth of anesthesia was maintained with desflurane
1MAC and remifentanil infusion under bispectral index guidance. Regional
cerebral oxygen saturation (rScO<inf>2</inf>) and hemodynamic variables
were recorded using near-infrared spectroscopy and esophageal cardiac
Doppler. The rScO<inf>2</inf> was higher in the D group than the P group
during OLV (OLV 60 min: 71+/-6% vs 63+/-12%; P=0.03). The number of
patients whose rScO<inf>2</inf> dropped more than 20% from baseline was 0
and 6 in the D and P groups, respectively (P=0.02). The D group showed
higher cardiac output, but lower mean arterial pressure than the P group
(4.7+/-1.0 vs 3.9+/-1.2 L/min; 76.7+/-8.1 vs 84.5+/-7.5mm Hg; P=0.02,
P=0.02). Among the variables, age, hemoglobin concentration, and cardiac
output were associated with rScO<inf>2</inf> by correlation analysis.
Dopamine was superior to phenylephrine in maintaining cerebral oxygenation
during OLV in thoracic surgery.

<35>
Accession Number
2015766953
Authors
Kowalewski M. Pawliszak W. Zaborowska K. Navarese E.P. Szwed K.A.
Kowalkowska M.E. Kowalewski J. Borkowska A. Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Zaborowska, Anisimowicz) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital, Maria Curie
Sklosowska Str 9, Bydgoszcz 85-094, Poland
(Pawliszak, Anisimowicz) Cardiac Surgery, Nicolaus Copernicus University
in Torun, Collegium Medicum, Bydgoszcz, Poland
(Navarese) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Szwed, Borkowska) Department of Clinical Neuropsychology, Nicolaus
Copernicus University in Torun, Collegium Medicum, Bydgoszcz, Poland
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Kowalewski, Navarese, Kowalkowska) Systematic Investigation and Research
on Interventions and Outcomes, Medicine Research Network, Poland
Title
Gentamicin-collagen sponge reduces the risk of sternal wound infections
after heart surgery: Meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (6) (pp 1631-1640e6),
2015. Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objectives Sternal wound infections are serious postoperative
complications that increase the length of hospital stay and healthcare
costs. The benefit of implantable gentamicin-collagen sponges in reducing
sternal wound infections has been questioned in a recent multicenter
trial. We aimed to perform a comprehensive meta-analysis of studies
assessing the efficacy of implantable gentamicin-collagen sponges in
sternal wound infection prevention. Methods Multiple databases were
screened for studies assessing the efficacy of implantable
gentamicin-collagen sponges after heart surgery. The primary end point was
sternal wound infection, and secondary end points were the occurrence of
deep sternal wound infection, superficial sternal wound infection,
mediastinitis, and mortality. Randomized controlled trials and
observational studies were analyzed separately. By means of
meta-regression, we examined the correlation between sternal wound
infection and extent to which the bilateral internal thoracic artery was
harvested. Results A total of 14 studies (N = 22,135, among them 4
randomized controlled trials [N = 4672]) were included in the analysis.
Implantable gentamicin-collagen sponges significantly reduced the risk of
sternal wound infection by approximately 40% when compared with control
(risk ratio [RR], 0.61; 95% confidence interval [CI], 0.39-0.98; P =.04
for randomized controlled trials and RR, 0.61; 95% CI, 0.42-0.89; P =.01
for observational studies). A similar, significant benefit was
demonstrated for deep sternal wound infection (RR, 0.60; 95% CI,
0.42-0.88; P =.008) and superficial sternal wound infection (RR, 0.60; 95%
CI, 0.43-0.83; P =.002). The overall analysis revealed a reduced risk of
mediastinitis (RR, 0.64; 95% CI, 0.45-0.91; P =.01). The risk of death was
unchanged. A significant positive linear correlation (P =.05) was found
between the log RR of sternal wound infection and the percentage of
patients receiving bilateral internal thoracic artery grafts. Conclusions
Implantable gentamicin-collagen sponges significantly reduce the risk of
sternal wound infection after cardiac surgery, with evidence consistent in
randomized and observational-level data. However, the extent of this
benefit might be attenuated in patients receiving bilateral internal
thoracic artery grafts.

<36>
Accession Number
2015354972
Authors
Williams A.M. Watson J. Mansour M.A. Sugiyama G.T.
Institution
(Williams, Watson, Mansour) Department of Surgery, Michigan State
University, College of Human Medicine, 15 Michigan Street NE, Grand
Rapids, MI 49503, United States
(Watson, Mansour, Sugiyama) Department of Surgery, Spectrum Health Medical
Group, Grand Rapids, MI, United States
Title
Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm
Repair: Presentation of 3 Cases and a Review of the Literature.
Source
Annals of Vascular Surgery. 30 (pp 321-330), 2016. Date of Publication: 01
Jan 2016.
Publisher
Elsevier Inc.
Abstract
Background Coronary artery disease and abdominal aortic aneurysmal disease
can occur in a single patient, and a therapeutic conundrum presents when
open surgical repair is indicated for both conditions. The traditional
standard of care is to conduct coronary artery bypass grafting (CABG)
followed by abdominal aortic aneurysm (AAA) repair 2-6 months later, but
there is significant risk with staging these 2 major surgeries. An
alternative method is to surgically repair both diseases in 1 combined
operation. The aim of our study is to review our own experience with the
combined procedure and to review the published literature to assess
morbidity and mortality of combined CABG and AAA repair. Methods A
systematic search for relevant studies was performed in the PubMed/Medline
database. Short-term mortality (<30 days) and postoperative complications
were assessed from relevant case series from 1993 to 2013. We also
conducted a retrospective chart review of all patients undergoing the
combined procedure at our institution. Results Thirty case series with a
total of 369 patients averaged a 30-day mortality of 3.0%. Fourteen
percent and 6% of patients experienced a cardiovascular or respiratory
complication, respectively. Other postoperative events included acute
renal failure (7%) and superficial wound complications (5%). In our own
experience, 3 patients underwent combined CABG and AAA repair. The mean
age was 71 years, the average AAA size was 8.9 cm, and average operative
time was 328 min. None experienced any postoperative complications. Two
are still alive at 9 and 10 years after surgery, and 1 died of unrelated
causes 8 years postoperatively. Conclusions The results of this systematic
review suggest that combined CABG and AAA repair is a viable procedure
with low operative mortality. Patients with preserved ejection fractions,
large AAA, and limited comorbidities appear to receive the most benefit
from a combined approach based on reported data from the literature. We
have experienced promising results in our highly selected patient
population. More research is warranted to devise criteria to determine
which patients would be good surgical candidates for this combined
procedure.

<37>
Accession Number
20151066213
Authors
Shah R. Rogers K.C. Matin K. Askari R. Rao S.V.
Institution
(Shah, Askari) Section of Cardiology, University of Tennessee, School of
Medicine, Memphis, TN, United States
(Shah) Veterans Affairs Medical Center, Memphis, TN, United States
(Rogers) University of Tennessee, College of Pharmacy, Memphis, TN, United
States
(Matin) Virginia Commonwealth University, Richmond, VA, United States
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Shah, Rogers, Matin, Askari, Rao) Memphis, TN; Richmond, VA; and Durham,
NC
Title
An updated comprehensive meta-analysis of bivalirudin vs heparin use in
primary percutaneous coronary intervention.
Source
American Heart Journal. 171 (1) (pp 14-24), 2016. Date of Publication: 01
Jan 2016.
Publisher
Mosby Inc.
Abstract
Background Despite several randomized controlled trials and meta-analyses,
the ideal anticoagulant for patients undergoing primary percutaneous
coronary intervention (PCI) remains controversial. We performed an updated
meta-analysis including recently reported randomized clinical trials that
compare bivalirudin and heparin with or without provisional administration
of a glycoprotein IIb/IIIa inhibitor (GPI) for primary PCI. Methods and
Results Scientific databases and Web sites were searched for randomized
clinical trials. Data from 6 trials involving 14,095 patients were
included. The pooled risk ratios (RRs) were calculated using
random-effects models. Moderator analyses examined the impact of routine
use of GPI, radial access, and P2Y12 inhibitors on safety outcomes. At 30
days, patients receiving bivalirudin had rates of major adverse cardiac
events similar to those receiving heparin with or without provisional GPI
(RR 1.02, 95% CI 0.87-1.19, P =.800), myocardial infarction (RR 1.41, 95%
CI 0.94-2.11, P =.089), target vessel revascularization (RR 1.37, 95% CI
0.91-2.04, P =.122), and net adverse clinical events (RR 0.81, 95% CI
0.64-1.01, P =.069). However, bivalirudin use decreased the risk of
all-cause mortality (RR 0.81, 95% CI 0.67-0.99, P =.041) and cardiac
mortality (RR 0.68, 95% CI 0.51-0.91, P =.009) at 30 days, There were
higher rates of acute stent thrombosis (RR 3.31, 95% CI 1.79-6.10, P
<.001) in patients receiving bivalirudin. Bivalirudin use also decreased
the risk of major bleeding at 30 days by 37% (RR 0.63, 95% CI 0.44-0.90, P
=.012), but bleeding risk varied depending on routine GPI use with heparin
(RR 0.44, 95% CI 0.23-0.81, P =.009) vs bailout (RR 0.73, 95% CI
0.42-1.25, P =.252), predominantly radial access (RR 0.54, 95% CI
0.25-1.15, P =.114) vs non-radial access (RR 0.60, 95% CI 0.36-0.99, P
=.049), and second-generation P2Y12 inhibitor use with bivalirudin (RR
0.70, 95% CI 0.40-1.24, P =.226) vs clopidogrel use (RR 0.39, 95% CI
0.18-0.85, P =.018). Conclusions In primary PCI, relative to heparin,
bivalirudin reduces the risk for all-cause mortality, cardiac mortality,
and major bleeding but yields similar rates of major adverse cardiac event
and net adverse clinical event at 30 days. However, the benefit of a
reduction in bleeding with bivalirudin appears to be modulated by the
concurrent administration of second-generation P2Y12 inhibitors with
bivalirudin, using radial access, and avoiding routine GPI use with
heparin.

<38>
Accession Number
20151066208
Authors
Kolluri R. Plessa A.L. Sanders M.C. Singh N.K. Lucore C.
Institution
(Kolluri) Ohio Health Heart and Vascular Physicians, Columbus, OH 43214,
United States
(Plessa, Sanders) Prairie Education and Research Cooperative, Springfield,
IL, United States
(Singh) IU Health Arnett Hospital, Lafayette, IN, United States
(Lucore) St John's Hospital, Springfield, IL, United States
(Kolluri, Plessa, Sanders, Singh, Lucore) Columbus, OH; Springfield, IL;
and Lafayette, IN
Title
A randomized study of the safety and efficacy of fondaparinux versus
placebo in the prevention of venous thromboembolism after coronary artery
bypass graft surgery.
Source
American Heart Journal. 171 (1) (pp 1-6), 2016. Date of Publication: 01
Jan 2016.
Publisher
Mosby Inc.
Abstract
Background Venous thromboembolism (VTE) after coronary artery bypass graft
(CABG) surgery may increase the postoperative morbidity and mortality.
Therefore, we examined the current postoperative need for prophylactic
antithrombotic therapy after CABG surgery. Methods This randomized,
placebo-controlled, double-blind study was designed to compare the safety
and efficacy of fondaparinux versus placebo in the prevention of VTE after
CABG surgery. Between March 2010 and January 2013, 78 patients free from
preoperative deep vein thrombosis (DVT) were enrolled, of whom 37 were
randomly assigned to placebo and 41 to treatment with fondaparinux. The
primary study end point was a composite, up to day 11, of (a) cumulative
incidence of all VTE events, defined as symptomatic and asymptomatic DVT,
and fatal and nonfatal pulmonary embolisms (efficacy end point), and (b)
cumulative incidence of major hemorrhages (safety end point). Results A
single asymptomatic DVT of a lower extremity was detected by duplex
ultrasound at the time of discharge from the hospital in the
placebo-treated group, and a single major postoperative hemorrhage
occurred in the fondaparinux-treated group. Conclusions The incidence of
postprocedural asymptomatic DVT in this sample of patients undergoing CABG
surgery was low. The overall incidence of DVT in the control and
investigational treatment groups was similar. Our results showed no
benefit of prophylactic postoperative fondaparinux in this population.
These findings are congruent with other published studies and provide
additional support for recent recommendations not to routinely use
anticoagulant prophylaxis after cardiac surgery.

<39>
Accession Number
20160006494
Authors
Belhan Z. Karabulut E.H. Ariturk C. Okten E.M. Toraman F. Gormez S. Orhan
P.
Institution
(Belhan) Acibadem Saglik Grubu, Turkey
(Karabulut, Ariturk, Okten) Acibadem Saglik Grubu, Kalp ve Damar
Cerrahisi, Turkey
(Toraman, Gormez) IstanbulTurkey
(Orhan) Acibadem Saglik Grubu, Bodrum Hastanesi Kalp ve Damar Cerrahisi,
Mugla, Turkey
Title
Koroner arter cerrahisi uygulanan hastalarda kullanilan drenaj tupu
tiplerinin ve uygulanma yerlerinin ameliyat sonrasi donemde agri ve
efuzyon uzerine etkisi.
Source
Medical Journal of Bakirkoy. 11 (4) (pp 154-158), 2015. Date of
Publication: 2015.
Publisher
Yerkure Tanitim ve Yayincilik Hizmetleri A.S.
Abstract
Effect of different types of drain to postoperative effusion and pain on
patients who underwent coronary artery bypass grafting Objective: The
study was done to determine the effect of different types of drain to
postoperative effusion and pain on patients who enderwent coronary artery
bypass grafting (CABG). Material and Methods: 50 patients data were
evaluated prospectively. Standart drain was placed into 7-8th intercostal
area (Group 1). L drain was placed into pleural area (Group 2).
Demographic data, drainage amounts were written from hospital documents.
Postoperative phericardial and pleural effusion was determined by
echocardiography and chest x-ray. Verbal Rating Scale was used to dedicate
pain score. Data were analyzed by T test. Results: Groups demographic data
were similar. Drainage was 652.0+/-328.3 ml (Group 1), 620.0 +/- 169.5 ml
(p=0.04) in Group 2. Pain score before taking of drain was 2.0+/-2.6
(Group 1), 1.0+/-1.6 (p=0.01) in Group 2, after taking of drain was
4.7+/-3.0 (Group 1), 2.1+/-2.0 (p=0.05) in Group 2. Fifteen day mean
phericardial effusion was 0.2+/-0.4 cm (Group 1), 0.1+/-0.3 (p=0.05) in
Group 2. There was no difference between other parameters. Conclusion:
Using both types of drain seems to be safe but L drain is more comfortable
because of less pain.

<40>
Accession Number
20151062311
Authors
Rittger H. Waliszewski M. Brachmann J. Hohenforst-Schmidt W. Ohlow M.
Brugger A. Thiele H. Birkemeyer R. Kurowski V. Schlundt C. Zimmermann S.
Lonke S. Von Cranach M. Markovic S. Daniel W.G. Achenbach S. Wohrle J.
Institution
(Rittger, Hohenforst-Schmidt, Lonke) Medizinische Klinik i, Klinikum
Fuerth, Jakob-Henle-Strasse 1, Fuerth D-90766, Germany
(Waliszewski) Medical Scientific Affairs, B. Braun Vascular Systems,
Berlin, Germany
(Brachmann) Medizinische Klinik II, Klinikum Coburg, Coburg, Germany
(Ohlow) Klinik fur Kardiologie, Zentralklinikum Bad Berka, Bad Berka,
Germany
(Brugger) Klinik fur Kardiologie, Klinikum Kulmbach, Kulmbach, Germany
(Thiele) Medizinische Klinik II, Universitatsklinikum Lubeck, Lubeck,
Germany
(Birkemeyer) Herzklinik Ulm, Ulm, Germany
(Kurowski) Abteilung fur Innere Medizin/Kardiologie, Krankenhaus
Molln-Ratzeburg, Molln-Ratzeburg, Germany
(Schlundt, Daniel, Achenbach) Medizinische Klinik 2, Universitatsklinikum
Erlangen, Erlangen, Germany
(Zimmermann) Klinik fur Innere/Medizin Kardiologie, Diakonissenhaus
Flensburg, Flensburg, Germany
(Von Cranach) Klinik fur Neurologie, Universitatsklinikum Freiburg,
Freiburg, Germany
(Markovic, Wohrle) Klinik fur Innere Medizin II, Universitatsklinikum Ulm,
Ulm, Germany
Title
Long-term outcomes after treatment with a paclitaxel-coated balloon versus
balloon angioplasty: Insights from the PEPCAD-DES study (Treatment of
Drug-eluting Stent [DES] In-Stent Restenosis with SeQuent Please
Paclitaxel-Coated Percutaneous Transluminal Coronary Angioplasty [PTCA]
Catheter).
Source
JACC: Cardiovascular Interventions. 8 (13) (pp 1695-1700), 2015. Date of
Publication: 01 Nov 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The intention this PEPCAD-DES (Treatment of Drug-eluting Stent
[DES] In-Stent Restenosis With SeQuent Please Paclitaxel Eluting
Percutaneous Transluminal Coronary Angioplasty [PTCA] Catheter) study
update was to demonstrate the safety and efficacy of paclitaxel-coated
balloon (PCB) angioplasty in patients with DES-ISR at 3 years. Background
In the PEPCAD-DES trial late lumen loss and the need for repeat target
lesion revascularization (TLR) was significantly reduced with PCB
angioplasty compared with plain old balloon angioplasty (POBA) in patients
with drug-eluting stent in-stent restenosis (DES-ISR) at 6 months. We
evaluated whether the clinical benefit of reduced TLR and major adverse
cardiac events (MACE) was maintained up to 3 years. Methods A total of 110
patients with DES-ISR in native coronary arteries with reference diameters
ranging from 2.5 mm to 3.5 mm and lesion lengths <22 mm were randomized to
treatment with either PCB or POBA in a multicenter, randomized,
single-blind clinical study. With a 2:1 randomization, 72 patients were
randomized to the PCB group and 38 patients to the POBA group. At
baseline, there were lesions with at least 2 stent layers in PCB (52.8%,
38 of 72) and POBA (55.3%, 21 of 38) patients. Results At 36 months, the
TLR rates were significantly lower in the PCB group compared with the POBA
control group (19.4% vs. 36.8%; p = 0.046). Multiple TLRs in individual
patients were more frequent in the POBA group compared with the PCB group
(more than 1 TLR: POBA, 13.2%; PCB, 1.4%; p = 0.021). The 36-month MACE
rate was significantly reduced in the PCB group compared with the POBA
group (20.8% vs. 52.6%, log-rank p = 0.001). Conclusions PCB angioplasty
was superior to POBA for the treatment of DES-ISR patients in terms of
MACE and TLR for up to 36 months. There was no late catch-up phenomenon.
(Treatment of Drug-eluting Stent [DES] In-Stent Restenosis With SeQuent
Please Paclitaxel Eluting Percutaneous Transluminal Coronary Angioplasty
[PTCA] Catheter [PEPCAD-DES]; NCT00998439).

<41>
Accession Number
20151014922
Authors
Mungroop T.H. Veelo D.P. Busch O.R. van Dieren S. van Gulik T.M. Karsten
T.M. de Castro S.M. Godfried M.B. Thiel B. Hollmann M.W. Lirk P. Besselink
M.G.
Institution
(Mungroop, Busch, van Dieren, van Gulik, Besselink) Department of Surgery,
Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus
22660, Amsterdam, DD 1100, Netherlands
(Mungroop, Veelo, van Dieren, Hollmann, Lirk) Department of
Anesthesiology, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, Postbus 22660, Amsterdam, DD 1100, Netherlands
(Karsten, de Castro) Department of Surgery, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, Amsterdam, AC 1091, Netherlands
(Godfried, Thiel) Department of Anesthesiology, Onze Lieve Vrouwe
Gasthuis, Oosterpark 9, Amsterdam, AC 1091, Netherlands
Title
Continuous wound infiltration or epidural analgesia for pain prevention
after hepato-pancreato-biliary surgery within an enhanced recovery program
(POP-UP trial): Study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 562. Date of
Publication: December 09, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Postoperative pain prevention is essential for the recovery of
surgical patients. Continuous (thoracic) epidural analgesia (CEA) is
routinely practiced for major abdominal surgery, but evidence is
conflicting on its benefits in this setting. Potential disadvantages of
epidural analgesia are a) perioperative hypotension, frequently requiring
additional intravenous fluid boluses or prolonged use of vasopressors; b)
relatively high failure rates, with periods of inadequate analgesia; and
c) the risk of rare but serious, at times persistent, neurologic
complications (hematoma and abscess). In recent years, continuous
(subfascial) wound infiltration (CWI) plus patient-controlled analgesia
(PCA) has been suggested as a safe and reliable alternative, which does
not have the previously mentioned disadvantages, but evidence from
multicenter trials targeting a specific surgical population is lacking. We
hypothesize that CWI+PCA is equally as effective as CEA, without the
mentioned disadvantages. Methods/design: POP-UP is a randomized controlled
noninferiority multicenter trial, recruiting adult patients scheduled for
elective hepato-pancreato-biliary surgery via laparotomy in an enhanced
recovery setting. A total of 102 patients are being randomly allocated to
CWI+PCA or (P)CEA. Our primary endpoint is the Overall Benefit of
Analgesic Score (OBAS), a composite endpoint of pain intensity,
opioid-related adverse effects and patient satisfaction, during
postoperative days 1 to 5. Secondary endpoints include length of the
hospital stay, number of patients with severe pain, and the use of rescue
medication. Discussion: POP-UP is a pragmatic trial that will provide
evidence of whether CWI+PCA is noninferior as compared to (P)CEA after
elective hepato-pancreato-biliary surgery via laparotomy in an enhanced
recovery setting. If this hypothesis is confirmed, this finding could
contribute to more widespread implementation of this technique, especially
when the described disadvantages of epidural analgesia are less often
observed with CWI+PCA. Trial registration: Netherlands Trial Register
NTR4948(registry date 2 January 2015).

<42>
Accession Number
20151066445
Authors
Gillies M.A. Kakar V. Parker R.J. Honore P.M. Ostermann M.
Institution
(Gillies) Royal Infirmary of Edinburgh, Department of Anaesthesia,
Critical Care and Pain Medicine, Edinburgh, United Kingdom
(Kakar) King's College Hospital NHS Foundation Hospital, Department of
Critical Care, London, United Kingdom
(Parker) Aintree University Hospital NHS Foundation Hospital, Department
of Critical Care Medicine, Liverpool, United Kingdom
(Honore) Vrije Universiteit Brussel (VUB University), Department of ICU,
Universitair Ziekenhuis Brussel, Brussels, Belgium
(Ostermann) Guy's and St Thomas' Foundation Hospital, Department of
Nephrology and Critical Care Medicine, King's College London, London,
United Kingdom
Title
Fenoldopam to prevent acute kidney injury after major surgery-a systematic
review and meta-analysis.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 449. Date of
Publication: December 25, 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Acute kidney injury (AKI) after surgery is associated with
increased mortality and healthcare costs. Fenoldopam is a selective
dopamine-1 receptor agonist with renoprotective properties. We conducted a
systematic review and meta-analysis of randomised controlled trials
comparing fenoldopam with placebo to prevent AKI after major surgery.
Methods: We searched EMBASE, PubMed, meta-Register of randomised
controlled trials and Cochrane CENTRAL databases for trials comparing
fenoldopam with placebo in patients undergoing major surgery. The primary
outcome was incidence of new AKI. Secondary outcomes were requirement for
renal replacement therapy and hospital mortality. Results: Eighty-three
publications were screened; 23 studies underwent full data extraction and
scoring. Six trials were suitable for inclusion in the data synthesis
(total of 507 subjects undergoing cardiovascular surgery, partial
nephrectomy, liver transplant surgery). Five studies were rated at high
risk of bias. Data on post-operative incidence of AKI were available in
five of the six trials (total of 471 patients) but definitions of AKI
varied between studies. Of the 238 patients receiving fenoldopam, 45 (18.9
%) developed AKI compared to 62 (26.6 %) of the 233 patients who received
placebo (p = 0.004, I ² = 0 %; random-effects model odds ratio
0.46, 95 % confidence interval 0.27-0.79). In patients treated with
fenoldopam, there was no difference in renal replacement therapy (n = 478;
p = 0.11, I ² = 47 %; fixed-effect model odds ratio 0.27, 95 %
confidence interval 0.06-1.19) or hospital mortality (p = 0.60, I
² = 0 %; fixed-effect model odds ratio 1.0, 95 % confidence
interval 0.14-7.37). Conclusions: In this analysis, peri-operative
treatment with fenoldopam was associated with a significant reduction in
post-operative AKI but it had no impact on renal replacement therapy or
hospital mortality. Equipoise remains for further large trials in this
area since the studies were conducted in three types of surgery, the
majority of studies were rated at high risk of bias and the criteria for
AKI varied between trials.

<43>
Accession Number
2015786919
Authors
Viswesh V. Yost S.E. Kaplan B.
Institution
(Viswesh) College of Pharmacy, California Northstate University, 9700 West
Taron Drive, Elk Grove, CA 95757, United States
(Yost) Department of Pharmacy, The University of Arizona Medical Center,
University Campus, 1501 N. Campbell Ave, Tucson, AZ 85724, United States
(Kaplan) Division of Nephrology and Hypertension, Department of Internal
Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard,
Kansas City, KS 66160, United States
Title
The prevalence and implications of BK virus replication in non-renal solid
organ transplant recipients: A systematic review.
Source
Transplantation Reviews. 29 (3) (pp 175-180), 2015. Date of Publication:
2015.
Publisher
W.B. Saunders
Abstract
The significance of BK viruria and viremia in non-renal solid organ
transplants is poorly understood. A systematic review was performed
reviewing the incidence and implications of BK virus replication in
non-renal solid organ transplants. Ninety-seven studies were identified,
of which 18 including lung, heart, liver and pancreas transplants were
included. The overall incidence of BK viruria and viremia was 20% and 3%
respectively and 17 cases of BK nephropathy were identified. Heart
transplant recipients had a higher overall incidence of BK viremia than
other non-renal organ types, and the majority of cases of BK
virus-associated nephropathy were in heart transplant recipients. The
incidence of BK viremia was significantly lower in non-renal solid organ
transplants than that of renal transplant recipients and BK
virus-associated nephropathy was rare. BK virus-associated nephropathy may
be considered in heart transplant recipients who have unexplained and
persistent renal dysfunction not attributable to other causes.

<44>
Accession Number
72149314
Authors
Sinskey J. Feiner J. Ferschl M.
Institution
(Sinskey, Feiner, Ferschl) Anesthesia and Perioperative Care, University
of California, San Francisco, CA, United States
Title
The role of intraoperative IV acetaminophen in postoperative pain
management in patients undergoing cleft lip surgery.
Source
Anesthesia and Analgesia. Conference: 2015 Annual Meeting of the
International Anesthesia Research Society, IARS 2015 Honolulu, HI United
States. Conference Start: 20120321 Conference End: 20120324. Conference
Publication: (var.pagings). 120 (3 SUPPL. 1) (pp S511), 2015. Date of
Publication: March 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Pediatric pain management has evolved considerably since a
1987 landmark study demonstrated that neonates are capable of feeling pain
through functional pain pathways1. Opiates provide excellent postoperative
analgesia in children in the perioperative setting; however, these agents
can have adverse effects, most notably respiratory depression.
Acetaminophen is widely used for analgesia in pediatric patients as an
alternative to opiates. Intravenous (IV) acetaminophen was first
introduced to the US in 2011. The efficacy of IV acetaminophen was
demonstrated in a recent randomized controlled trial which showed that
patients <1 year old having major abdominal/thoracic (noncardiac) surgery
who received IV acetaminophen postoperatively required significantly less
morphine to achieve similar pain scores as those with a continuous
morphine infusion2. Patients undergoing cleft lip surgery could likely
also benefit from IV acetaminophen. These procedures are performed in
small infants (generally <6 months) who may be more susceptible to
postoperative apnea. We sought to determine whether intraoperative IV
acetaminophen reduced postoperative pain and/or opiate consumption in
infants undergoing primary cleft lip repair. METHODS: After IRB approval,
a retrospective review of all primary cleft lip repairs in patients <8
months old between 6/2012- 11/2013 at a US tertiary care hospital was
performed. Comparisons of patients who received intraoperative IV
acetaminophen vs. those who did not were analyzed using Mann-Whitney U
test or Fisher's exact test. RESULTS: 14 of 27 patients (51.9%) received
IV acetaminophen intraoperatively. Time to first rescue opiate in the
post-anesthesia care unit was longer in patients who received IV
acetaminophen compared to those who did not; these results approached but
did not achieve statistical significance (mean +/- SD: 115 +/- 131 vs. 46
+/- 71 minutes, median (interquartile range 77.5 (20.3-164.5) vs. 16.0
(12.0-32.0) minutes, p=0.069). FLACC scores and opiate doses received 6
and 12 hours postoperatively did not differ significantly between groups.
CONCLUSIONS: Intraoperative IV acetaminophen may improve postoperative
pain management. Our study is probably underpowered to detect difference
between groups. This study provides preliminary data for a power analysis
to plan a future prospective study to further determine the effects of IV
acetaminophen on perioperative pain management in pediatric patients.

<45>
Accession Number
72149224
Authors
O'Neal J. Dighe S. Gray K. Lerner A. Talmor D. Marcantonio E. Subramaniam
B.
Institution
(O'Neal, Dighe, Gray, Lerner, Talmor, Subramaniam) Anesthesia, Critical
Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA,
United States
(Marcantonio) Medicine, Beth Israel Deaconess Medical Center, Boston, MA,
United States
Title
The use of dexmedetomidine and intravenous acetaminophen for the
prevention of postoperative delirium in cardiac surgery patients over 60
years of age: A pilot study.
Source
Anesthesia and Analgesia. Conference: 2015 Annual Meeting of the
International Anesthesia Research Society, IARS 2015 Honolulu, HI United
States. Conference Start: 20120321 Conference End: 20120324. Conference
Publication: (var.pagings). 120 (3 SUPPL. 1) (pp S411), 2015. Date of
Publication: March 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Following cardiac surgery, up to 50% of patients older than 60
years of age experience postoperative delirium1. Delirium is associated
with many negative hospital outcomes, including a 10-fold increased risk
of death, a 5-fold increased risk of nosocomial complications2, poor one
year functional recovery, and postoperative cognitive decline3.
Postoperative sedation and opiate administration may contribute to
delirium in this patient population. A meta-analysis suggested that the
use of dexmedetomidine for sedation in cardiac surgery patients may reduce
the incidence of delirium4. However, the studies which formed the basis of
the metaanalysis were poorly designed with inconsistent measurements of
delirium. Consequently, clinical practice is unlikely to change with the
reported results. The use of intravenous acetaminophen (IVA) has been
shown in multiple studies to reduce the amount of opiates consumed by
surgical patients5, but no study has investigated its role in
postoperative delirium. We hypothesize that these medications may lead to
a reduction in opiate consumption and the sparing of deliriogenic receptor
stimulation, and thereby decrease the incidence and/or duration of
postoperative delirium. This pilot study aims to a) assess feasibility of
using dexmedetomidine and IVA in the cardiac surgical intensive care unit,
and b) to obtain effect size estimates for primary study
outcomes-incidence and duration of delirium. METHODS: A total of 12 adult
patients >60 years of age undergoing coronary artery bypass graft surgery
(CABG) or combined CABG/ valve surgery were recruited for the study with
IRB approval. The subjects were randomized into 4 groups: 1. usual care,
propofol only (PROP) 2. propofol with IVA (PROP+IVA) 3. dexmedetomidine
only (DEX) 4. dexmedetomidine with IVA (DEX+IVA). Baseline cognition was
evaluated preoperatively and postoperative delirium was assessed daily
until discharge using the Mini Mental State Examination (MMSE) and the
Confusion Assessment Method (CAM, CAM-Intensive Care Unit and verbal). The
feasibility of the study was tested by the number of patients who
completed the study. A descriptive data analysis on the incidence and
duration of postoperative delirium is presented. No formal statistical
analysis was completed due to the limited number of subjects in the pilot.
RESULTS: All patients completed the study protocol successfully. The
incidence of delirium in all groups was 42%. The DEX and PROP groups each
had an incidence of 67% while DEX+IVA had an incidence of 33%. The
PROP+IVA group had no occurrences of delirium. Interestingly, only 17% of
the subjects receiving IVA were diagnosed with delirium compared to 67% in
the subjects not receiving IVA. The duration of delirium ranged from 1 to
3 days among patients found to have delirium. Secondary outcomes including
opiate consumption, length of stay, and time to extubations were similar
between the groups. One patient expired after surgery, unrelated to the
study protocol. Only one patient experienced a significant side effect of
hypotension with systolic blood pressure <90 mm of Hg in the DEX group.
CONCLUSIONS: Delirium assessments were completed on all study subjects
every day until the time of discharge/expiration. The study protocol was
easily incorporated into patient care. The feasibility of completing the
large-scale project was justified through our pilot study. The overall
incidence of delirium at 42% is consistent with previous reports1.
Although a trend towards reducing delirium was observed in patients
receiving IVA, this finding was insignificant given the small sample size.
A multi-center randomized, controlled trial will be the next step in
investigating the role of dexmedetomidine and IVA in reducing the
incidence of delirium.

<46>
Accession Number
72149221
Authors
Nanayakkara R. Li Z. Truong S. Liu H.
Institution
(Nanayakkara, Truong, Liu) Anesthesiology and Pain Medicine, UC Davis
Medical Center, Sacramento, CA, United States
(Li) Internal Medicine, UC Davis Medical Center, Sacramento, CA, United
States
Title
Incidence of postoperative acute kidney injury and transfusion of blood
products after synthetic colloid administration during cardiac surgery.
Source
Anesthesia and Analgesia. Conference: 2015 Annual Meeting of the
International Anesthesia Research Society, IARS 2015 Honolulu, HI United
States. Conference Start: 20120321 Conference End: 20120324. Conference
Publication: (var.pagings). 120 (3 SUPPL. 1) (pp S408), 2015. Date of
Publication: March 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Hydroxyethyl starches (HES) are synthetic colloids that are
commonly used to maintain hemodynamic stability while limiting crystalloid
administration. A number of studies that have shown higher incidence of
acute kidney injury (AKI) and overall adverse events in critically ill
patients receiving these products have questioned their safety1,2,3. HES'
safety in the perioperative setting, specifically in cardiovascular
surgery, remains unclear due to few meta-analyses consisting of small,
single outcome studies, and conflicting data4,5 This larger study seeks
assess the effect of two different types of HES on renal integrity and
transfusion of blood products in patients who underwent cardiac surgery.
METHODS: After obtaining IRB approval, colloid administration of patients
who underwent cardiac surgery from 2007 to 2013 was recorded. Inclusion
criteria included coronary artery bypass graft (CABG) and/or valve
surgeries that underwent cardiopulmonary bypass with aortic cross
clamping. Exclusion criteria included pediatric patients, emergency
surgeries, circulatory arrest, and other cardiac surgeries not included in
inclusion criteria. Total of 1265 patients met these criteria. Variables
included a colloid group that received various volumes of two different
types of HES- Voluven (6% hydroxyethyl starch 130/0.4) and Hextend (6%
hydroxyethyl starch 670/0.75) and a non-colloid group. Primary endpoints
were incidences of acute kidney injury and intraoperative blood product
usage. Secondary endpoints were operative mortality and postoperative
complications. Propensity weighted adjusted odds ratios (ORs) were
calculated for assessment of risk for developing these mentioned
endpoints. RESULTS: Overall 70.1% of cases utilized colloids, and the
average colloids administration were 641+/-612ml (mean +/- SD). There was
no difference in the development of AKI between the colloid and the
non-colloid group, and no difference when the colloid group was further
divided into Voluven and Hextend groups. There was no difference in the
administration of fresh frozen plasma, cryoprecipitate, and platelets
between the two groups except with PRBC unit transfusion with 1.92 [95%
CI: 1.77-2.08] units in colloid group vs. 2.24 [2.00-2.49] units in
non-colloid group (P=0.028). Odds ratio for complications rate was
significantly higher in the colloid group. However, overall operative
mortality was not significant between the colloid and non-colloid group.
CONCLUSION: Results from this study failed to show any association in the
development of AKI between patients who received and did not receive
synthetic colloids. Analysis does not show increased blood product
transfusion in the HES group. Although overall complication rate was
higher in the synthetic colloid group, it did not lead to a difference in
operative mortality between the two groups.

<47>
Accession Number
72148942
Authors
Carvalho A.R. El Dib R. Pugliesi F. Rodriguez I.S. Braz L.G. Modolo M.P.
Modolo N.P.
Institution
(Carvalho, El Dib, Pugliesi, Rodriguez, Modolo) Anaesthesiology, Univ
Estadual Paulista, Botucatu, Brazil
(Braz) Anaesthesiology, Botucatu Medical School, Univ Estadual Paulista,
Botucatu, Brazil
(Modolo) Anaesthesiology, Botucatu Medical School, Botucatu, Brazil
Title
Intravenous versus inhalation anesthesia for patients undergoing on-pump
or off-pump coronary artery bypass grafting: A systematic review and
meta-analysis.
Source
Anesthesia and Analgesia. Conference: 2015 Annual Meeting of the
International Anesthesia Research Society, IARS 2015 Honolulu, HI United
States. Conference Start: 20120321 Conference End: 20120324. Conference
Publication: (var.pagings). 120 (3 SUPPL. 1) (pp S82), 2015. Date of
Publication: March 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Coronary artery disease is the most common cardiac disease
with approximately 500,000 new and 300,000 recurrent events each year in
the United States alone, making this disease one of the greatest public
health concerns worldwide. Coronary artery bypass graft (CABG) is most
commonly performed with the assistance of cardiopulmonary bypass (on-pump
CABG). However, an increasing number of cardiac surgical procedures are
being performed off-pump. Intravenous or inhalational techniques may be
used to administer anaesthesia to patients undergoing CABG. Despite the
evidence that inhalational anaesthetics protect the myocardium, some
studies have suggested otherwise. To verify the efficacy and safety of
intravenous versus inhalation anaesthesia in decreasing mortality and
morbidity for patients undergoing onpump or off-pump CABG. METHODS: We
searched the CENTRAL, MEDLINE, EMBASE, and LILACS (from inception to
September 2014). We included randomized controlled trials of intravenous
versus inhalation anaesthesia in adults undergoing on-pump or off-pump
CABG. RESULTS: We included 34 studies with a total of 3201 participants in
this review. The methodological quality was difficult to assess as it was
poorly reported in almost half of the included studies, but the other half
was ranked as low risk of bias. We were able to include data from 33
studies in the meta-analysis. There was statistically significance
difference favouring sevoflurane compared to propofol regarding death1-2
within 180 to 365 days of surgery RR 4.10 (95% CI 1.42 to 11.79), P =
0.009] (Figure 1) as well as related to length of stay in hospital [MD
4.00 (95% CI 2.75 to 5.25), P < 0.00001] and in the intensive care unit
(ICU) [MD 1080.00 (95% CI 612.10 to 1547.90), P<0.00001]. There was no
statistically significance difference between propofol versus isoflurane
in onpump for the death within 180 to 365 days of surgery [RR 3.84 (95% CI
0.43 to 34.22), P = 0.23, I²=0%] as well as for renal
insufficiency [RR 1.31 (95% CI 0.09 to 19.00), P = 0.84]. There was also
no statistically significance difference between propofol versus
desflurane regarding death within 180 to 365 days of surgery [RR 1.81 (95%
CI 0.86 to 3.77), P = 0.12]. There was no evidence that intravenous and
inhalation anaesthesia are effective with regards to renal insufficiency,
cardiac depression, intraoperative awareness and adverse postoperative
outcomes. CONCLUSIONS: There is moderate quality evidence regarding the
efficacy and safe of anesthetic agents in decreasing mortality and
morbidity for patients undergoing on-pump or off-pump CABG. Some evidence
showed a decrease regarding both death within 180 to 365 days of surgery
and in both length of stay in hospital and in the intensive care unit
rates favouring sevoflurane compared to propofol. (Figure Presented).

<48>
Accession Number
72148937
Authors
Schlapfer M. Bonvini J.M. Kuhn S. Neff T.A. Beck-Schimmer B.
Institution
(Schlapfer, Bonvini, Kuhn, Beck-Schimmer) Institute of Anesthesiology,
University Hospital Zurich, Zurich 8091, Switzerland
(Neff) Institute of Anesthesiology, Kantonsspital Muensterlingen,
Muensterlingen, Switzerland
Title
Sevoflurane postconditioning might reduce severity of cardiac and
non-cardiac complications after elective cardiac valve surgery. Results of
a 6 month follow-up.
Source
Anesthesia and Analgesia. Conference: 2015 Annual Meeting of the
International Anesthesia Research Society, IARS 2015 Honolulu, HI United
States. Conference Start: 20120321 Conference End: 20120324. Conference
Publication: (var.pagings). 120 (3 SUPPL. 1) (pp S76), 2015. Date of
Publication: March 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Anesthetic conditioning with volatile anesthetics has
reduced ischemia-reperfusion injuries in various settings of pre- and
postconditioning, which is reflected by a significant decrease of
surrogate markers such as troponin. However, it is still less clear if
these findings in changes in biomarkers can be translated into a clinical
benefit for the patient. In a recent randomized controlled trial from our
center, including 102 patients undergoing elective cardiac surgery, we
were able to show significant lower troponin levels on the first
postoperative day after a 4 hour sedation with sevoflurane in comparison
to propofol on the intensive care unit1. In order to assess the clinical
long-term implications of these findings, we performed a 6-month follow
up, focusing on cardiac and non cardiac events. METHODS: All patients who
successfully completed the postconditioning trial were included into this
follow-up study, approved by the local ethical committee (KEK-ZH
2014-0040). Primary and secondary endpoints were assessment of Cardiac
events (dysrhythmias, congestive heart failure and cardiac ischemia) and
non-cardiac complications (pulmonary embolism, bleeding, infection,
cerebral events and chronic kidney failure) resulting in diagnostic or
therapeutic interventions. Data were retrieved from the hospital database,
secondary care units and family doctors. Statistical analysis was
performed in R (R Foundation for Statistical Computing). Mixed linear
models with propofol as reference group were chosen. RESULTS: Ninety-four
of the 102 from the primary study were evaluated in this 6-month
follow-up. Sixteen out of 41(35%) patients in the sevoflurane and 17
patients out of 53 (32%) in the propofol group suffered from one or
several cardiac events during the first 6 months after participating in
the primary study (p=0.752). In 4 (10%) patients treated with sevoflurane
vs. 7 (13%) patients treated with propofol non-cardiac events were
reported (p=0.607). Therapeutic or medical intervention was required only
in 12 patients in the sevoflurane compared to 20 patients in the propofol
group (OR: 0.24, CI: 0.040-1.43, p=0.118). Eleven patients in the propofol
arm compared to only 2 patients in the sevoflurane group were hospitalized
due to complication (OR 0.233, CI: 0.042-1.293, p=0.095). CONCLUSIONS: We
document a similar number of adverse events (cardiac and non cardiac) in
patients treated with sevoflurane compared to propofol. Despite not
reaching statistical significance, we observed less severe complications
in the sevoflurane group (less need for treatment, fewer admissions to the
hospital). Statistical significance might not have been reached because
the original study was powered for biochemical surrogate markers and not
for clinical outcomes.

<49>
Accession Number
72133953
Authors
Valdis M. Chu M.W. Schlachta C. Kiaii B.
Institution
(Valdis, Chu, Schlachta, Kiaii) LondonONCanada
Title
Validation and comparison of novel robotic cardiac surgery
simulation-based training programs.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S268), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Simulation based exercises have improved the efficiency of
robotic cardiac surgery training. This training mainly involves animal and
cadaveric models (wet labs), inanimate models (dry labs), or more recently
virtual reality simulation. To date no standardized robotic surgical
training program has been developed for any of these techniques to teach
the skills necessary for robotic cardiac surgery. METHODS: Using the
experience of two fellowship trained robotic cardiac surgeons we created
three different simulation training curriculums; a wet lab, a dry lab and
a virtual reality lab, each focusing on the skills used in robotic cardiac
surgery. We then enrolled 40 surgical trainees who first completed a
standardized robotic 10cm dissection of the internal thoracic artery and
then placed three sutures of a mitral valve annuloplasty in porcine
models. Trainees were then randomized to one of the three training streams
or a control group that received no additional training. All groups
trained in their assigned stream to a level of proficiency determined by
our two expert robotic cardiac surgeons. After completing the training in
their assigned stream, the trainees repeated the original assessments. All
assessments were evaluated using a time-based scoring system adapted from
the Fundaments of Laparoscopic Surgery program and the Global Evaluative
Assessment of Robotic Skills in a blinded fashion. RESULTS: All three
training streams were effective methods for learning robotic surgical
skills to varying degrees. Trainees in the wet lab, not only met the
levels of proficiency set by our expert robotic surgeons, they were the
only group to surpass their scores on the time-based assessments. The
control group was the only group not able to meet the level of proficiency
set by our expert surgeons for any of the primary objectives. The average
duration of training was least for the dry lab and most for the virtual
reality lab, to reach the levels of proficiency set by our experts for
these tasks (1.6hr vs. 9.3hr, p<0.001). CONCLUSION: Here we have created
and validated a cardiac surgery simulation training curriculum for the
three major types of simulation currently used in robotic surgical
training by showing that novice trainees can attain expert level
performance, through the first ever prospective randomized controlled
trial to objectively compare the different robotic surgery simulation
modalities currently in use. This work highlights key differences in
current training metods and will serve to help training programs invest
resources in costeffective, high-yield simulation exercises.

<50>
Accession Number
72133781
Authors
Goldfarb M. Drudi L. Almohammadi M. Langlois Y. Perrault L. Noiseux N.
Piazza N. Afilalo J.
Institution
(Goldfarb, Drudi, Almohammadi, Langlois, Perrault, Noiseux, Piazza,
Afilalo) MontrealQCCanada
Title
Outcome reporting in cardiac surgery trials: Systematic review and
critical appraisal.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S174), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: There is currently no standardized outcome reporting for
adverse events following cardiac surgery. The objective was to review the
cardiac surgery literature to evaluate the current use of perioperative
outcome reporting in cardiac surgery trials. METHODS AND RESULTS: We
reviewed five highly-ranked medical and surgical journals on Medline from
January 1, 2010 to June 30, 2014 for randomized controlled trials (RCTs)
involving coronary artery bypass grafting and/or valve surgery. We
identified 34 trials meeting inclusion criteria. Sample size ranged from
57- 4752 participants (median 351). Composite endpoints were used as a
primary outcome in 56%(n=19) of RCTs and as a secondary outcome in 12%
(n=4) of RCTs. There were 14 different composite endpoints. Mortality at
any time (all-cause and/or cardiovascular) was reported as an individual
or part of a combined endpoint complication in 82% (n=28) of RCTs,
myocardial infarction (MI) in 68% (n=23) of RCTs and bleeding in 24% (n=8)
of RCTs. Patient functional status outcomes, such as quality of life and
functional classification, were reported in 29% (n=10) of trials.
Definition of clinical events such as MI, stroke, renal failure and
bleeding varied considerably between trials, particularly for
postoperative MI and bleeding for which there were 8 different definitions
used for each. CONCLUSION: Outcome reporting in the cardiac surgery
literature is heterogeneous and efforts should be made to standardize the
outcomes reported and the definitions used to ascertain them. The full
scope of heterogeneity in cardiac surgery trial reporting may have been
underestimated by our systematic review. The development of standardizing
outcome reporting is an essential step towards strengthening the process
of evidence-based care in cardiac surgery.

<51>
Accession Number
72133756
Authors
Belley-Cote E.P. Lamy A. Vincent J. Kavsak P. Ou Y. Zhang M. Devereaux P.
Whitlock R.P.
Institution
(Belley-Cote, Lamy, Vincent, Kavsak, Ou, Zhang, Devereaux, Whitlock)
HamiltonONCanada
Title
An event driven myocardial infarction definition using troponins after
coronary artery bypass surgery in the coronary trial.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S161-S162), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The Third Universal definition for myocardial infarction (MI)
after coronary artery bypass (CABG) surgery is arbitrarily based on
cardiac biomarker threshold >10 times the 99th percentile of the upper
limit of normal (ULN). Given the ubiquitous release of troponins during
CABG surgery and the sensitivity of troponins for cardiomyocyte injury,
the prognostic value of this threshold is debated after CABG. METHODS: The
CORONARY Trial was a randomized controlled trial comparing on-pump versus
off-pump CABG. Using data from CORONARY, we aimed to establish the peak
troponin thresholds during the first 3 postoperative days associated with
an increase at least 2-fold in 30-day mortality. In order to combine
different troponin assays, we analysed troponins in multiples of their
respective ULN. We used a modified Mazumdar method to identify the lowest
troponin threshold that had an independent hazard ratio (HR) greater than
2 for 30-day mortality after adjustment for EuroSCORE and on-pump versus
off-pump surgery. RESULTS: Peak troponin results were available for 1528
patients who underwent on-pump (n=760) or off-pump CABG (n=768) in the
CORONARY trial. Peak troponins were > 10xULN in 46% (705/1538) of
patients. The median peak troponin results were 8.7xULN (interquartile
range 27.8). The sensitivity of a peak troponin >10xULN for 30-day
mortality was 65% (95% CI 46-80). The associated specificity was 54% (95%
CI 52-57). With the Mazumdar method, the first threshold we evaluated was
180xULN because 177xULN corresponded to the 95th percentile. This
threshold was associated with an adjusted HR for 30-day mortality of 7.6
(95% CI 3.4-17.1) when compared to <130xULN. The next independent
threshold was 130xULN with an adjusted HR for 30-day mortality of 7.8 (95%
CI 2.3-26.1). The next threshold that we tested (70xULN) did not meet our
criteria for significance. CONCLUSION: Given the very high incidence of
troponin elevations >10xULN after CABG surgery, the current MI definition
biomarker criterion is neither sensitive nor specific. Our results suggest
that a clinically relevant troponin threshold is much higher. However, our
sample size did not allow a finer exploration of thresholds between 70xULN
and 130xULN. The VISION (Vascular events In Surgery patIents cOhort
evaluatioN) Cardiac Surgery Study, a 15,000-patient cohort that is
currently recruiting will allow derivation of a more precise estimate for
the optimal event driven MI definition after cardiac surgery. CIHR.

<52>
Accession Number
72133755
Authors
Belley-Cote E.P. Lamy A. Tagarakis G. Ou Y. Vincent J. Kavsak P. Zhang M.
Devereaux P. Whitlock R.P.
Institution
(Belley-Cote, Lamy, Tagarakis, Ou, Vincent, Kavsak, Zhang, Devereaux,
Whitlock) HamiltonONCanada
Title
An evaluation of the incidence and prognosis of post coronary artery
bypass grafting myocardial infarction according to different definitions
in the coronary trial.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S161), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Over the years, clinical studies in cardiac surgery have used
different diagnostic criteria for post coronary artery bypass grafting
(CABG) myocardial infarction (MI). These diagnostic criteria, even though
widely accepted, are based on arbitrary biomarker thresholds sometimes in
association with ECG signs of cardiac necrosis (new pathologic Q waves or
new left bundle branch block). The validation of these diagnostic criteria
in terms of their association with clinical events is limited. METHODS:
Using data from the CORONARY Trial (n=4752), a randomized controlled trial
evaluating on-pump versus off-pump CABG, we evaluated the incidence of MI
according to 5 different post CABG MI definitions. To evaluate the
clinical relevance of the definitions, we calculated the associated hazard
ratio (HR) for 30-day mortality adjusted for the EUROscore. RESULTS:
Depending on the diagnostic criteria used, the incidence of MI after CABG
surgery varied from 0.6 to 19% and the associated HR for 30-day mortality
ranged from 2.7 to 6.9. On-pump versus off-pump surgery was not a
significant interaction term. CONCLUSION: A clinically relevant post CABG
MI definition should be independently associated with mortality.
Diagnostic criteria that are associated with a 4.0 to 6.9 fold increase in
30-day mortality may lack sensitivity to identify patients at substantial
risk of short-term mortality. Our results illustrate the need for
validated post CABG MI diagnostic criteria formulated from their
independent association with important clinical outcomes, especially with
the movement towards the use of high sensitivity troponin assays. (Figure
Presented).

<53>
Accession Number
72133670
Authors
Potter B.J. Meduri C.U. Baron S.J. Arnold S.V. Reynolds M.R. Popma J.J.
Cohen D.J.
Institution
(Potter, Meduri, Baron, Arnold, Reynolds, Popma, Cohen) MontrealQCCanada
Title
Impact of complication cost assumptions on the real-world
cost-effectiveness of transcatheter aortic valve replacement in the United
States.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S116), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Prior studies have supported the cost-effectiveness of
transcatheter aortic valve replacement (TAVR) for patients considered to
be high-risk for conventional surgical aortic valve replacement (SAVR).
However, the extent to which these results are sensitive to the frequency
and cost of specific procedural complications remains unknown and data
have recently emerged suggesting that TAVR complications may be
considerably more costly than previously assumed. METHODS: Using a Markov
decision-analytic model based on a meta-analysis of real-world outcomes
for 13,408 TAVR and 2,046 SAVR patients, we examined the impact of
alternative assumptions with respect to the cost of complications based on
three different sources: HCUP databases (base case); the CoreValve US
pivotal extreme risk study; and the PARTNER I trial. All analyses we
performed from the perspective of the US healthcare system with a lifetime
time horizon. In the base case analysis, complication costs were assumed
to be the same whether a patient underwent TAVR or SAVR. RESULTS: In the
primary analysis, TF TAVR was economically dominant compared with SAVR,
resulting in cost savings of $3,191/patient and a gain of 0.57 QALYs.
Under base case assumptions there was an 81.3% likelihood that the TF TAVR
incremental cost-effectiveness ratio (ICER) was <$50,000/QALY. This
probability was 82.2% under cost assumptions derived from the CoreValve US
Pivotal trial and 80.8% using Partner I cost data. The likelihood an ICER
<$50,000/QALY with alternative access (AA) TAVR was considerably lower
(26%), but there was similarly little impact of alternate complications
cost-structures. However, sensitivity analyses revealed that the different
cost-structures were indeed important considerations when the cost of
specific complications following TAVR and SAVR were assumed to differ.
This was particularly true for AA TAVR, which was projected to be an
economically dominated strategy if the cost of specific complications
after SAVR were 30% lower than the cost of the same complications after
TAVR, but the optimal choice only when SAVR complication costs were
assumed to be 2 or more times the cost following TAVR. The exact economic
projection was heavily influenced by the complication cost-structure
assumed (interaction). CONCLUSION: Assuming differential complication
costs between TAVR and SAVR had an important impact on the probability
that AA-TAVR would be economically attractive compared with SAVR. Studies
are therefore needed to determine the extent to which the incremental
costs of complications differ between TAVR and SAVR.

<54>
Accession Number
72133492
Authors
Fredericks S.M. Lapum J. Hui G.
Institution
(Fredericks, Lapum, Hui) TorontoONCanada
Title
Examining the effect of patient-centered care on patient outcomes: A
systematic review.
Source
Canadian Journal of Cardiology. Conference: 68th Annual Meeting of the
Canadian Cardiovascular Society Totonto, Ont. Canada. Conference Start:
20151024 Conference End: 20151027. Conference Publication: (var.pagings).
31 (10 SUPPL. 1) (pp S18-S19), 2015. Date of Publication: October 2015.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Patient centered care (PCC) is a dynamic and individualized
approach to care delivery. It encompasses the integration of an
individual's values, beliefs, and preferences regarding their overall
health and well-being in the design and implementation of health care
related activities. While there has been recent interest in conducting
systematic reviews to examine the effectiveness of PCC interventions,
various studies fall short in explaining the type of intervention that is
most effective in producing significant changes to desired outcomes.
Specifically, the characteristics of these interventions that include the
mode and dose is rarely presented. This information is vital to facilitate
the design of future PCC interventions that will result in increased
quality of care during the hospitalization period, as well as increased
performance of self-care behaviours post-hospital discharge. METHODS: The
purpose of this systematic review was to determine the characteristics of
PCC interventions that have demonstrated effectiveness in enhancing the
quality of care during in-patient hospitalization, and the performance of
selfcare behaviors during the post-hospital discharge period. The PRISMA
framework was used to ensure the accurate and complete conduct and
reporting throughout this review. A total of 40 studies met the selection
criteria of involving samples over the age of 18 years of age, and being
published between 1995 and 2014 and were included in this systematic
review. Descriptive statistics were used to delineate study, participant,
and intervention characteristics. RESULTS: The effectiveness of PCC
interventions were noted in a quarter of these trials (approximately 5
studies), even though these studies were designed to reflect a rigorous
process, (i.e. use of randomized controlled trial design) and had a low
attrition rate. Of particular interest, the intervention studies that
reported non-statistically significant findings in relation to the
effectiveness of PCC interventions, contained populations that were
diagnosed and living with chronic conditions. These studies reported small
effect sizes suggesting PCC interventions may not be worthwhile to
implement to individuals diagnosed and living with chronic illnesses, as
these individuals, over time, may have developed their own self-care
behaviours and may have formed a unique, long-term relationship with their
immediate health care provider. CONCLUSION: Thus, PCC interventions may be
more effective when delivered to individuals experiencing acute conditions
such as a person who has had a myocardial infarct and requires cardiac
bypass surgery to enhance coronary blood flow. This individual will
require short-term health care support, in which PCC interventions may be
worthwhile.

<55>
Accession Number
72125422
Authors
Abner E.L. Ding X. Caban-Holt A.M. Schmitt F.A. Kryscio R.J.
Institution
(Abner, Ding, Caban-Holt, Schmitt, Kryscio) University of Kentucky,
Lexington, KY, United States
Title
Comorbid subjective cognitive decline and sleep apnea significantly
increase the risk of incident dementia: Results from the prevention of
Alzheimer's disease with vitamin E and selenium study.
Source
Alzheimer's and Dementia. Conference: Alzheimer's Association
International Conference 2015 Washington, DC United States. Conference
Start: 20150718 Conference End: 20150723. Conference Publication:
(var.pagings). 11 (7 SUPPL. 1) (pp P733), 2015. Date of Publication: July
2015.
Publisher
Elsevier Inc.
Abstract
Background: Subjective memory complaints (SMC) reflect patientidentified
deficits in memory and have been linked to increased risk of future
dementia in non-demented (including cognitively intact) older adults, but
the relationship between SMC and comorbid medical conditions is not well
understood. Methods: Double-blind, placebo controlled 2x2 randomized
controlled trial that transformed into an exposure cohort following
discontinuation of supplementation in the SELECT parent trial. Setting:
Prevention of Alzheimer's with Vitamin E and Selenium (PREADVISE)
participants were assessed for incident dementia at 130 local clinical
study sites in the United States, Canada, and Puerto Rico during the
controlled trial phase and were later followed by telephone from a
centralized location during the post exposure (observational) phase.
PREADVISE enrolled a total of 7,547 non-demented men age 60 and older;
4,271 were able to participate in the observational study. Participants
were interviewed at baseline for memory complaints ("Do you have more
problems with your memory than most people?") and presence of
comorbidities including sleep apnea, stroke, hypertension, diabetes,
history of traumatic brain injury (TBI), coronary artery bypass graft
(CABG), and congestive heart failure. Results: Men who reported memory
problems (SMC) (n=123) at baseline were significantly more likely to also
report history of sleep apnea and TBI and had significantly worse scores
on the baseline memory screen (Table 1). Cox proportional hazards
regression revealed that the effect of baseline SMC depended on the
presence of sleep apnea (p for interaction=0.015). Men who reported sleep
apnea and SMC at baseline had 14.9 times (95%CI: 6.0-37.0) the hazard of
incident dementia compared to men with sleep apnea but no SMC. For men
without sleep apnea, SMC more than tripled the hazard (HR=3.86). History
of CABG and stroke also significantly increased the hazard of incident
dementia (Table 2). Conclusions: Memory complaints and comorbidities in
non-demented older men strongly predicted future dementia in the PREADVISE
cohort. Special care should be paid to management of comorbidities in
older adult men who report memory problems, as these may be modifiable
risk factors for dementia onset. (Table Presented).