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<1>
Accession Number
2014958987
Authors
Wang L. Peng P. Zhang O. Xu X. Yang S. Zhao Y. Zhou Y.
Institution
(Wang, Peng, Zhang, Xu, Yang, Zhao, Zhou) Key Laboratory of
Remodeling-Related Cardiovascular Disease, Beijing Anzhen Hospital,
Ministry of Education, Beijing 100029, China
Title
High-dose statin pretreatment decreases periprocedural myocardial
infarction and cardiovascular events in patients undergoing elective
percutaneous coronary intervention: A meta-analysis of twenty-four
randomized controlled trials.
Source
PLoS ONE. 9 (12) (no pagination), 2014. Article Number: e113352. Date of
Publication: 04 Dec 2014.
Publisher
Public Library of Science
Abstract
Background: Evidence suggests that high-dose statin pretreatment may
reduce the risk of periprocedural myocardial infarction (PMI) and major
adverse cardiac events (MACE) for certain patients; however, previous
analyses have not considered patients with a history of statin maintenance
treatment. In this meta-analysis of randomized controlled trials (RCTs),
we reevaluated the efficacy of short-term high-dose statin pretreatment to
prevent PMI and MACE in an expanded set of patients undergoing elective
percutaneous coronary intervention.
Methods: We searched the PubMed/Medline database for RCTs that compared
high-dose statin pretreatment with no statin or low-dose statin
pretreatment as a prevention of PMI and MACE. We evaluated the incidence
of PMI and MACE, including death, spontaneous myocardial infarction, and
target vessel revascularization at the longest follow-up for each study
for subgroups stratified by disease classification and prior low-dose
statin treatment.
Results: Twenty-four RCTs with a total of 5,526 patients were identified.
High-dose statin pretreatment was associated with 59% relative reduction
in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.49;
P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI:
0.45-0.83; P=0.002). The benefit of highdose statin pretreatment on MACE
was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50-0.95;
P=0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI:
0.12-0.65; P=0.003); and for patients with acute coronary syndrome (OR:
0.52; 95% CI: 0.34-0.79; P=0.003), but not for patients with stable angina
(OR: 0.71; 95% CI 0.45-1.10; P=0.12). Long-term effects on survival were
less obvious.
Conclusions: High-dose statin pretreatment can result in a significant
reduction in PMI and MACE for patients undergoing elective PCI. The
positive effect of highdose statin pretreatment on PMI and MACE is
significant for statin-naive patients and patients with prior treatment.
The positive effect of high-dose statin pretreatment on MACE is
significant for patients with acute coronary syndrome.

<2>
Accession Number
2015511172
Authors
Kleinbongard P. Neuhauser M. Thielmann M. Kottenberg E. Peters J. Jakob H.
Heusch G.
Institution
(Kleinbongard, Heusch) Institute for Pathophysiology, Westdeutsches Herz
und Gefasszentrum, Universitatsklinikum Essen, Hufelandstrasse 55, Essen
DE-45122, Germany
(Thielmann, Jakob) Department of Thoracic and Cardiovascular Surgery, West
German Heart and Vascular Center Essen, University Hospital Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
University Hospital Essen, Germany
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitat Duisburg-Essen, Essen, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
Title
Confounders of Cardioprotection by Remote Ischemic Preconditioning in
Patients Undergoing Coronary Artery Bypass Grafting.
Source
Cardiology (Switzerland). 133 (2) (pp 128-133), 2016. Date of Publication:
01 Jan 2016.
Publisher
S. Karger AG
Abstract
Objectives: Remote ischemic conditioning (RIC) by repetitive blood
pressure cuff inflation/deflation around a limb provides cardioprotection
in patients undergoing coronary artery bypass grafting (CABG).
Cardioprotection is confounded by risk factors, comorbidities and
comedications. We aimed to identify confounders that possibly attenuate
the protection provided by RIC. Methods: In a retrospective analysis of
our single-center, randomized, double-blind trial of patients undergoing
elective CABG with/without RIC prior to ischemic cardioplegic arrest, we
analyzed demographics, medications and intraoperative variables. The
primary end point was myocardial injury, as reflected by the area under
the curve for serum troponin I (TnI) from baseline to 72 h after surgery.
Results: In models with 2 independent variables and in the multivariate
analysis, age and aortic cross-clamp time impacted on TnI release.
Subgroup analyses confirmed RIC-induced protection in all age tertiles.
There was no protection with an aortic cross-clamp time . 56 min
(RIC/control = 1.026 not significant), but there was protection with 57.75
min (RIC/control = 0.757; p = 0.0348) and . 76 min (RIC/control = 0.735; p
= 0.0277). Gender, A-blockers, statins, angiotensin-converting enzyme
(ACE) inhibitors or angiotensin receptor blockers (ARBs) and
intraoperative nitroglycerine did not impact on TnI release. Conclusion:
Age, gender,-blockers, statins, ACE inhibitors, ARBs and intraoperative
nitroglycerine have no significant impact on RIC-induced cardioprotection
during CABG. However, greater myocardial ischemia/reperfusion injury at
longer cross-clamp time facilitates the detection of protection by RIC.

<3>
Accession Number
20160105202
Authors
Narayanan A.L.T. Hamid S.R.G.S. Supriyanto E.
Institution
(Narayanan) IJN-UTM Cardiovascular Engineering Centre, Faculty of
Biosciences and Medical Engineering, Universiti Teknologi Malaysia, Johor
Department of Clinical Sciences, Johor Bahru, Malaysia
(Hamid) Department of Cardiothoracic Surgery, Hospital Sultanah Aminah,
Johor Bahru, Johor, Malaysia
Title
Evidence regarding patient compliance with incentive spirometry
interventions after cardiac, thoracic and abdominal surgeries: A
systematic literature review.
Source
Canadian Journal of Respiratory Therapy. 52 (1) (pp 17-26), 2016. Date of
Publication: 2016.
Publisher
Canadian Society of Respiratory Therapists
Abstract
background: Evidence regarding the effectiveness of incentive spirometry
(ISy) on postoperative pulmonary outcomes after thoracic, cardiac and
abdominal surgery remains inconclusive. This is attributed to various
methodological issues inherent in ISy trials. Patient compliance has also
been highlighted as a possible confounding factor; however, the status of
evidence regarding patient compliance in these trials is unknown.
Objective: To explore the status of evidence on patient compliance with
ISy interventions in randomized controlled trials (RCTs) in the above
contexts. Method: A systematic search using MEDLINE, EMBASE and CINAHL
databases was conducted to obtain relevant RCTs from 1972 to 2015 using
the inclusion criteria. These were examined for specific ISy parameters,
methods used for determining compliance and reporting on compliance. Main
outcome measures were comparison of ISy parameters prescribed and
assessed, and reporting on compliance. RESULTS: Thirty-six relevant RCTs
were obtained. Six ISy parameters were identified in ISy prescriptions
from these trials. Almost all (97.2%) of the trials had ISy prescriptions
with specific parameters. Wilcoxon signedrank test revealed that the ISy
parameters assessed were significantly lower (Z=-5.433; P<0.001) than
those prescribed; 66.7% of the trials indicated use of various methods to
assess these parameters. Only six (16.7%) trials included reports on
compliance; however, these were also incomprehensive. Conclusions: There
is a scarcity and inconsistency of evidence regarding ISy compliance.
Compliance data should be obtained using reliable and standardized methods
to facilitate comparisons between and among trials. These should be
reported comprehensively to facilitate valid inferences regarding ISy
intervention effectiveness.

<4>
Accession Number
20160091889
Authors
Fischer A. Spiegl M. Altmann K. Winkler A. Salamon A. Themessl-Huber M.
Mouhieddine M. Strasser E.M. Schiferer A. Paternostro-Sluga T. Hiesmayr M.
Institution
(Fischer, Mouhieddine, Schiferer, Hiesmayr) Medical University of Vienna,
Division of Cardiothoracic and Vascular Anesthesia and Intensive Care
Medicine, Department of Anesthesia, General Intensive Care and Pain
Control, Wahringergurtel 18-20, Vienna 1090, Austria
(Spiegl) Kantonsspital Sankt Gallen, Rorschacherstrasse 95, St. Gallen
9007, Switzerland
(Altmann) Krankenhaus der Barmherzigen Schwestern Ried, Schlossberg 1,
Ried im Innkreis 4910, Austria
(Winkler) University Hospital Landeskrankenhaus Salzburg, Mullner
Hauptstrase 48, Salzburg 5020, Austria
(Salamon) Medical University of Vienna, Spitalgasse 23, Vienna 1090,
Austria
(Themessl-Huber) Medical University of Vienna, Center for Medical
Statistics, Informatics and Intelligent Systems, Spitalgasse 23, Vienna
1090, Austria
(Strasser) Kaiser-Franz-Josef-Spital Wien, Institute for Physical Medicine
and Rehabilitation, Kundratstrasse 3, Vienna 1100, Austria
(Paternostro-Sluga) Institute for Physical Medicine and Rehabilitation,
Donauspital Wien, Langobardenstrase 122, Vienna 1220, Austria
Title
Muscle mass, strength and functional outcomes in critically ill patients
after cardiothoracic surgery: Does neuromuscular electrical stimulation
help? The Catastim 2 randomized controlled trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 30. Date of
Publication: January 29, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: The effects of neuromuscular electrical stimulation (NMES) in
critically ill patients after cardiothoracic surgery are unknown. The
objectives were to investigate whether NMES prevents loss of muscle layer
thickness (MLT) and strength and to observe the time variation of MLT and
strength from preoperative day to hospital discharge. Methods: In this
randomized controlled trial, 54 critically ill patients were randomized
into four strata based on the SAPS II score. Patients were blinded to the
intervention. In the intervention group, quadriceps muscles were
electrically stimulated bilaterally from the first postoperative day until
ICU discharge for a maximum of 14 days. In the control group, the
electrodes were applied, but no electricity was delivered. The primary
outcomes were MLT measured by ultrasonography and muscle strength
evaluated with the Medical Research Council (MRC) scale. The secondary
functional outcomes were average mobility level, FIM score, Timed Up and
Go Test and SF-12 health survey. Additional variables of interest were
grip strength and the relation between fluid balance and MLT. Linear mixed
models were used to assess the effect of NMES on MLT, MRC score and grip
strength. Results: NMES had no significant effect on MLT. Patients in the
NMES group regained muscle strength 4.5 times faster than patients in the
control group. During the first three postoperative days, there was a
positive correlation between change in MLT and cumulative fluid balance
(r=0.43, P=0.01). At hospital discharge, all patients regained
preoperative levels of muscle strength, but not of MLT. Patients did not
regain their preoperative levels of average mobility (P=0.04) and FIM
score (P=0.02) at hospital discharge, independent of group allocation.
Conclusions: NMES had no effect on MLT, but was associated with a higher
rate in regaining muscle strength during the ICU stay. Regression of
intramuscular edema during the ICU stay interfered with measurement of
changes in MLT. At hospital discharge patients had regained preoperative
levels of muscle strength, but still showed residual functional disability
and decreased MLT compared to pre-ICU levels in both groups. Trial
registration: Clinicaltrials.gov identifier NCT02391103. Registered on 7
March 2015.

<5>
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Accession Number
2014717663
Authors
Kannan A. Poongkunran C. Medina R. Ramanujam V. Poongkunran M.
Balamuthusamy S.
Institution
(Kannan, Poongkunran) Department of Inpatient Medicine, University of
Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724, United States
(Medina, Ramanujam, Poongkunran, Balamuthusamy) Angiocare, Tucson, AZ,
United States
Title
Coronary revascularization in chronic and end-stage renal disease: A
systematic review and meta-analysis.
Source
American Journal of Therapeutics. 23 (1) (pp e16-e28), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Patients with chronic kidney disease (CKD) and end-stage renal disease
(ESRD) on dialysis have an increased risk for cardiovascular mortality and
morbidity secondary to occlusive coronary artery disease. Optimal
revascularization strategy is unclear in this high-risk population. We
have performed a meta-analysis to compare coronary artery bypass grafting
(CABG) versus percutaneous coronary intervention (PCI) in patients with
ESRD and CKD. We searched PubMed, Ovid, MEDLINE, CINAHL, and EMBASE
(19802013) and found 17 trials (N 5 33,584) in the ESRD arm and 6 studies
(n 5 15,493) in the CKD arm. Two investigators independently collected the
data. All the studies were retrospective trials. In the ESRD and CKD
groups, we found significantly reduced early mortality with the PCI group
with the odds ratio of 2.08 (1.902.26; P , 0.00001) and 2.55 (1.454.51; P
5 0.001), respectively. Contrary to the early mortality results, we found
decreased late mortality with the CABG group when compared with the PCI
group [odds ratio: 0.86 (0.830.89; P , 0.000001) and 0.82 (0.760.88; P ,
0.00001)] in the ESRD and CKD arm, respectively. When compared with PCI,
there was decreased cardiovascular mortality with an odds ratio of 0.61
(0.400.92; P 5 0.02) in patients who underwent CABG in ESRD population.
Similar trends were observed in the incidence of myocardial infarction and
repeat revascularization. There is a strong trend for decreased risk of
stroke with PCI when compared with CABG in ESRD and CKD populations.

<6>
Accession Number
20160100674
Authors
Shinjo D. Fushimi K.
Institution
(Shinjo, Fushimi) Department of Health Policy and Informatics, Tokyo
Medical and Dental University Graduate School, Tokyo, Japan
Title
Preoperative factors affecting cost and length of stay for isolated
off-pump coronary artery bypass grafting: Hierarchical linear model
analysis.
Source
BMJ Open. 5 (11) (no pagination), 2015. Article Number: e008750. Date of
Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Objective: To determine the effect of preoperative patient and hospital
factors on resource use, cost and length of stay (LOS) among patients
undergoing offpump coronary artery bypass grafting (OPCAB). Design:
Observational retrospective study. Settings: Data from the Japanese
Administrative Database. Participants: Patients who underwent isolated,
elective OPCAB between April 2011 and March 2012. Primary outcome
measures: The primary outcomes of this study were inpatient cost and LOS
associated with OPCAB. A two-level hierarchical linear model was used to
examine the effects of patient and hospital characteristics on inpatient
costs and LOS. The independent variables were patient and hospital
factors. Results: We identified 2491 patients who underwent OPCAB at 268
hospitals. The mean cost of OPCAB was $40 665 +/-7774, and the mean LOS
was 23.4+/-8.2 days. The study found that select patient factors and
certain comorbidities were associated with a high cost and long LOS. A
high hospital OPCAB volume was associated with a low cost (-6.6%; p=0.024)
as well as a short LOS (-17.6%, p<0.001). Conclusions: The hospital OPCAB
volume is associated with efficient resource use. The findings of the
present study indicate the need to focus on hospital elective OPCAB volume
in Japan in order to improve cost and LOS.

<7>
Accession Number
20160089731
Authors
Narayan O. Leung M.C.H. Wong D.T.L. Meredith I.T. Cameron J.D.
Institution
(Narayan, Leung, Wong, Meredith, Cameron) Monash Cardiovascular Research
Centre, MonashHeart and School of Clinical Sciences at Monash Health,
Monash University, Melbourne, Australia
Title
Percutaneous Coronary Intervention Enhances Accelerative Wave Intensity in
Coronary Arteries.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0142998. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science
Abstract
Background The systolic forward travelling compression wave (sFCW) and
diastolic backward travelling decompression waves (dBEW) predominantly
accelerate coronary blood flow. The effect of a coronary stenosis on the
intensity of these waves in the distal vessel is unknown. We investigated
the relationship between established physiological indices of hyperemic
coronary flow and the intensity of the two major accelerative coronary
waves identified by Coronary Wave Intensity analysis (CWIA). Methodology /
Principal Findings Simultaneous intracoronary pressure and velocity
measurement was performed during adenosine induced hyperemia in 17
patients with pressure / Doppler flow wires positioned distal to the
target lesion. CWI profiles were generated from this data. Fractional Flow
Reserve (FFR) and Coronary Flow Velocity Reserve (CFVR) were calculated
concurrently. The intensity of the dBEW was significantly correlated with
FFR (R = -0.70, P = 0.003) and CFVR (R = -0.73, P = 0.001). The intensity
of the sFCW was also significantly correlated with baseline FFR (R = 0.71,
p = 0.002) and CFVR (R = 0.59, P = 0.01). Stenting of the target lesion
resulted in a median 178% (interquartile range 55-280%) (P0.0001) increase
in sFCW intensity and a median 117% (interquartile range 27-509%) (P =
0.001) increase in dBEW intensity. The increase in accelerative wave
intensity following PCI was proportionate to the baseline FFR and CFVR,
such that stenting of lesions associated with the greatest flow limitation
(lowest FFR and CFVR) resulted in the largest increases in wave intensity.
Conclusions Increasing ischemia severity is associated with proportionate
reductions in cumulative intensity of both major accelerative coronary
waves. Impaired diastolic microvascular decompression may represent a
novel, important pathophysiologic mechanism driving the reduction in
coronary blood flow in the setting of an epicardial stenosis.

<8>
Accession Number
20160082615
Authors
Shahi V. Brinjikji W. Murad M.H. Asirvatham S.J. Kallmes D.F.
Institution
(Shahi) Mayo Medical School, College of Medicine, Mayo Clinic, Rochester,
MN, United States
(Brinjikji, Kallmes) Department of Radiology, Mayo Clinic, 200 First St
SW, Rochester, MN 55905, United States
(Murad) Center for Science of Healthcare Delivery, Mayo Clinic, 200 First
St SW, Rochester, MN 55905, United States
(Asirvatham) Department of Cardiology, Mayo Clinic, 200 First St SW,
Rochester, MN 55905, United States
Title
Safety of uninterrupted warfarin therapy in patients undergoing
cardiovascular endovascular procedures: A systematic review and
meta-analysis.
Source
Radiology. 278 (2) (pp 383-394), 2016. Date of Publication: February 2016.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To conduct a systematic review and meta-analysis of complication
rates and outcomes in patients undergoing endovascular procedures who
receive uninterrupted versus interrupted warfarin therapy. Materials and
Methods: Literature published between 1990 and 2014 was searched for
reports of comparative studies of vascular procedures. Information on
periprocedural complications and patient deaths less than 30 days after
the procedure was extracted. A random effects model was used and odds
ratios (ORs) were reported. An OR of less than 1 was considered to
indicate lower risk of the outcome with uninterrupted warfarin therapy.
Meta-analysis was conducted by using meta-analysis software. Results: A
total of 27 studies of 20 376 patients were included. For arterial
procedures, there were no significant differences between the
uninterrupted and interrupted warfarin therapy groups in access site
hematoma (OR, 0.59; 95% confidence interval [CI]: 0.33, 1.03; P = .06),
any bleeding complications (OR, 0.56; 95% CI: 0.30, 1.06; P = .07),
mortality (OR, 1.40; 95% CI: 0.37, 5.25; P = .62), intracranial hemorrhage
(OR, 0.55; 95% CI: 0.03, 8.91; P = .68), ischemic stroke (OR, 0.85; 95%
CI: 0.12, 5.84; P = .87), and major bleeding (OR, 0.56; 95% CI: 0.21,
1.51; P = .25). For venous procedures, uninterrupted warfarin was
associated with lower odds of access site hematoma (OR, 0.70; 95% CI:
0.50, 0.99; P = .04), any bleeding complications (OR, 0.61; 95% CI: 0.48,
0.77; P <01), ischemic stroke (OR, 0.21; 95% CI: 0.10, 0.45; P <01), and
major bleeding (OR, 0.64; 95% CI: 0.51, 0.80; P <01). For arterial and
venous procedures combined, uninterrupted warfarin was associated with
lower odds of access site hematoma (OR, 0.68; 95% CI: 0.51, 0.91; P =
.01), bleeding complications (OR, 0.59; 95% CI: 0.48, 0.74; P <01),
ischemic stroke (OR, 0.25; 95% CI: 0.12, 0.50; P <01), and major bleeding
(OR, 0.61; 95% CI: 0.49, 0.77; P <01). Heterogeneity in most analyses was
low, and confidence in the estimates was moderate. Conclusion:
Uninterrupted perioperative warfarin therapy is safe for patients
undergoing arterial procedures, but interrupted warfarin may be preferred
for those undergoing venous procedures; no differences in outcome rates
were found in the randomized controlled trials. Future studies should be
performed to validate these results.

<9>
Accession Number
20160075702
Authors
Athappan G. Gajulapalli R.D. Tuzcu M.E. Svensson L.G. Kapadia S.R.
Institution
(Athappan) Department of Cardiovascular Medicine, Mount Sinai Hospital,
New York, NY, United States
(Gajulapalli, Tuzcu, Svensson, Kapadia) Department of Cardiovascular
Medicine, Heart and Vascular Institute, Cleveland Clinic, Cardiac
Catheterization Laboratory, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195,
United States
Title
A systematic review on the safety of second-generation transcatheter
aortic valves.
Source
EuroIntervention. 11 (9) (pp 1034-1043), 2016. Date of Publication:
January 2016.
Publisher
EuroPCR
Abstract
Aims: To review the outcomes of studies and the safety of newer
transcatheter aortic valves (THV). Methods and results: All studies
reporting on second-generation THV were identified and pooled using the
systematic review guidelines. Twenty-four reports on 1,708 patients and
eight THV were included in the analysis. The pooled 30-day event rate for
mortality after transcatheter aortic valve implantation (TAVI) was 5.7%
(95% CI: 4.0-7.8), myocardial infarction (MI) was 1.7% (95% CI: 1.1-2.6),
stage 3 acute kidney injury (AKI) was 3.4% (95% CI: 2.0-5.6),
life-threatening bleeding was 5.1% (95% CI: 3.3-7.8), major vascular
complications was 4.9% (95% CI: 3.5-6.6%), major bleeding was 10.5% (95%
CI: 5.1-20.4), major stroke was 2.4% (95% CI: 1.7-3.4), permanent
pacemaker utilisation was 13.5% (95% CI: 10.8-16.9), and coronary
obstruction was 1.2% (95% CI: 0.6%-2.4%). Moderate or severe aortic
insufficiency (AI) after TAVI was 4.2% (95% CI: 2.0-8.5). The pooled
30-day mean gradient and effective orifice area (EOA) were 11.63 mmHg (95%
CI: 10.19-13.07) and 1.60 cm2 (95% CI: 1.5-1.7), respectively. All
estimates compare favourably to events reported for first-generation
valves. Conclusions: Our findings suggest that the new THV have a low risk
of TAVI-related short-term complications.

<10>
Accession Number
2015482932
Authors
Conte J.V. Gleason T.G. Resar J.R. Adams D.H. Deeb G.M. Popma J.J. Chad
Hughes G. Zorn G.L. Reardon M.J.
Institution
(Conte, Gleason, Resar, Adams, Deeb, Popma, Chad Hughes, Zorn, Reardon)
Department of Surgery and Medicine, Johns Hopkins University, Baltimore,
MD; Department of Surgery, University of Pittsburgh Medical Center,
Pittsburgh, PA; Department of Surgery, Mount Sinai Medical Center, New
York, New York; Department of Surgery, University of Michigan, Ann Arbor,
Michigan; Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, MA; Department of Surgery, Duke University, Durham, NC; Department
of Surgery, University of Kansas, Lawrence, KS; Dept Surgery,
Houston-Methodist DeBakey Heart and Vascular Center, Houston, TX
Title
Transcatheter or surgical aortic valve replacement in patients with prior
coronary artery bypass grafting.
Source
Annals of Thoracic Surgery. 101 (1) (pp 72-79), 2016. Date of Publication:
01 Jan 2016.
Publisher
Elsevier USA
Abstract
Background Transcatheter aortic valve replacement (TAVR) and surgical
aortic valve replacement (SAVR) are treatment options for aortic stenosis
in patients with prior coronary artery bypass graft surgery. We assessed
the major clinical outcomes of such patients enrolled in the CoreValve
High Risk (CHR) study. Methods Of the 795 CHR study patients, 226 had
prior coronary artery bypass graft surgery; 115 underwent TAVR and 111
underwent SAVR. The primary endpoint was a comparison of all-cause
mortality at 1 year. Important secondary clinical endpoints were assessed.
Results At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for
SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8%
for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons
risk score greater than 7 and age greater than 80 years was a significant
predictor of mortality, with TAVR demonstrating a survival advantage (p =
0.03). No differences were seen for stroke. The SAVR group had longer
intensive care unit and hospital stays, increased incidence of acute
kidney injury, life-threatening or disabling bleeding, and major adverse
cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and
paravalvular regurgitation were greater with TAVR at all timepoints.
Conclusions For patients with prior coronary artery bypass graft surgery
and aortic stenosis, TAVR offers a significant morbidity advantage and a
strong trend toward improved survival over SAVR at 1 year.

<11>
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Accession Number
2015523661
Authors
Djaiani G. Silverton N. Fedorko L. Carroll J. Styra R. Rao V. Katznelson
R.
Institution
(Djaiani, Silverton, Fedorko, Carroll, Styra, Rao, Katznelson) Department
of Anesthesia and Pain Management, Department of Psychiatry, Division of
Cardiovascular Surgery, 200 Elizabeth Street, Toronto, ON M5G2C4, Canada
(Rao) Toronto General Hospital, University Health Network, University of
Toronto, Toronto, ON, Canada
Title
Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac
Surgery: A Randomized Controlled Trial.
Source
Anesthesiology. 124 (2) (pp 362-368), 2016. Date of Publication: 01 Feb
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative delirium (POD) is a serious complication after
cardiac surgery. Use of dexmedetomidine to prevent delirium is
controversial. The authors hypothesized that dexmedetomidine sedation
after cardiac surgery would reduce the incidence of POD. Methods: After
institutional ethics review board approval, and informed consent, a
single-blinded, prospective, randomized controlled trial was conducted in
patients 60 yr or older undergoing cardiac surgery. Patients with a
history of serious mental illness, delirium, and severe dementia were
excluded. Upon admission to intensive care unit (ICU), patients received
either dexmedetomidine (0.4 mug/kg bolus followed by 0.2 to 0.7 mug
kg^-1 h^-1 infusion) or propofol (25 to 50 mug
kg^-1 min^-1 infusion) according to a
computer-generated randomization code in blocks of four. Assessment of
delirium was performed with confusion assessment method for ICU or
confusion assessment method after discharge from ICU at 12-h intervals
during the 5 postoperative days. Primary outcome was the incidence of POD.
Results: POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients
in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46;
95% CI, 0.23 to 0.92; P = 0.028). Median onset of POD was on postoperative
day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD
2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in
dexmedetomidine and propofol groups, respectively. Conclusions: When
compared with propofol, dexmedetomidine sedation reduced incidence,
delayed onset, and shortened duration of POD in elderly patients after
cardiac surgery. The absolute risk reduction for POD was 14%, with a
number needed to treat of 7.1.

<12>
Accession Number
20160076717
Authors
Webb J.G. Doshi D. Mack M.J. Makkar R. Smith C.R. Pichard A.D. Kodali S.
Kapadia S. Miller D.C. Babaliaros V. Thourani V. Herrmann H.C. Bodenhamer
M. Whisenant B.K. Ramee S. Maniar H. Kereiakes D. Xu K. Jaber W.A. Menon
V. Tuzcu E.M. Wood D. Svensson L.G. Leon M.B.
Institution
(Webb, Wood) St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z
1Y6, Canada
(Doshi, Smith, Kodali, Leon) Columbia University Medical Center, New York,
NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Pichard) Medstar Washington Hospital Center, Washington, DC, United
States
(Kapadia, Jaber, Menon, Tuzcu, Svensson) Cleveland Clinic, Cleveland, OH,
United States
(Miller) Stanford University, Stanford, CA, United States
(Babaliaros, Thourani) Emory University, School of Medicine, Atlanta, GA,
United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Bodenhamer) Oklahoma Heart Hospital, Oklahoma City, OK, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Ramee) Ochsner Clinic, New Orleans, LA, United States
(Maniar) Washington University School of Medicine, Saint Louis, MO, United
States
(Kereiakes) Christ Hospital, Cincinnati, OH, United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
Title
A Randomized Evaluation of the SAPIEN XT Transcatheter Heart Valve System
in Patients with Aortic Stenosis Who Are Not Candidates for Surgery.
Source
JACC: Cardiovascular Interventions. 8 (14) (pp 1797-1806), 2015. Date of
Publication: 21 Dec 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to determine the safety and
effectiveness of the SAPIEN XT versus SAPIEN systems (Edwards
Lifesciences, Irvine, California) in patients with symptomatic, severe
aortic stenosis (AS) who were not candidates for surgery. Background
Transcatheter aortic valve replacement (TAVR) has become the standard of
care for inoperable patients with severe, symptomatic AS. In the PARTNER
(Placement of Aortic Transcatheter Valves) IB trial, a reduction in
all-cause mortality was observed in patients undergoing TAVR with the
balloon-expandable SAPIEN transcatheter heart valve compared with standard
therapy, but the SAPIEN valve was associated with adverse periprocedural
complications, including vascular complications, major bleeding, and
paravalvular regurgitation. The newer, low-profile SAPIEN XT system was
developed to reduce these adverse events. Methods A total of 560 patients
were enrolled at 28 sites in the United States from April 2011 to February
2012. Patients were randomized to receive the SAPIEN or SAPIEN XT systems.
The primary endpoint was a nonhierarchical composite of all-cause
mortality, major stroke, and rehospitalization at 1 year in the
intention-to-treat population, assessed by noninferiority testing.
Pre-specified secondary endpoints included cardiovascular death, New York
Heart Association functional class, myocardial infarction, stroke, acute
kidney injury, vascular complications, bleeding, 6-min walk distance, and
valve performance (by echocardiography). Results Both overall and major
vascular complications were higher at 30 days in patients undergoing TAVR
with SAPIEN compared with SAPIEN XT (overall: 22.1% vs. 15.5%; p = 0.04;
major: 15.2% vs. 9.5%; p = 0.04). Bleeding requiring blood transfusions
was also more frequent with SAPIEN compared with SAPIEN XT (10.6% vs.
5.3%; p = 0.02). At 1-year follow-up, the nonhierarchical composite of
all-cause mortality, major stroke, or rehospitalization was similar (37.7%
SAPIEN vs. 37.2% SAPIEN XT; noninferiority p value <0.002); no differences
in the other major pre-specified endpoints were found. Conclusions In
inoperable patients with severe, symptomatic AS, the lower-profile SAPIEN
XT is noninferior to SAPIEN with fewer vascular complications and a lesser
need for blood transfusion. (The PARTNER II Trial: Placement of AoRTic
TraNscathetER Valves; NCT01314313).

<13>
Accession Number
20160081305
Authors
Goldfarb M. Drudi L. Almohammadi M. Langlois Y. Noiseux N. Perrault L.
Piazza N. Afilalo J.
Institution
(Goldfarb, Afilalo) Division of Cardiology, Jewish General Hospital,
McGill University, Montreal, QC, Canada
(Langlois) Division of Cardiac Surgery, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Drudi) Division of Vascular Surgery, Centre for Clinical Epidemiology,
McGill University, Montreal, QC, Canada
(Afilalo) Lady Davis Institute, McGill University, Montreal, QC, Canada
(Almohammadi) Division of Medicine, McGill University Health Center,
McGill University, Montreal, QC, Canada
(Piazza) Division of Cardiology, McGill University Health Center, McGill
University, Montreal, QC, Canada
(Noiseux) Division of Cardiac Surgery, Centre Hospitalier de L'Universite
de Montreal, Montreal, QC, Canada
(Perrault) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
Title
Outcome reporting in cardiac surgery trials: Systematic review and
critical appraisal.
Source
Journal of the American Heart Association. 4 (8) (no pagination), 2015.
Article Number: e002204. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-There is currently no accepted standard for reporting outcomes
following cardiac surgery. The objective of this paper was to
systematically review the literature to evaluate the current use and
definition of perioperative outcomes reported in cardiac surgery trials.
Methods and Results-We reviewed 5 prominent medical and surgical journals
on Medline from January 1, 2010, to June 30, 2014, for randomized
controlled trials involving coronary artery bypass grafting and/or valve
surgery. We identified 34 trials meeting inclusion criteria. Sample sizes
ranged from 57 to 4752 participants (median 351). Composite end points
were used as a primary outcome in 56% (n=19) of the randomized controlled
trials and as a secondary outcome in 12% (n=4). There were 14 different
composite end points. Mortality at any time (all-cause and/or
cardiovascular) was reported as an individual end point or as part of a
combined end point in 82% (n=28), myocardial infarction was reported in
68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered
outcomes, such as quality of life and functional classification, were
reported in 29% (n=10). Definition of clinical events such as myocardial
infarction, stroke, renal failure, and bleeding varied considerably among
trials, particularly for postoperative myocardial infarction and bleeding,
for which 8 different definitions were used for each. Conclusions-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 development of standardizing outcome reporting
is an essential step toward strengthening the process of evidence-based
care in cardiac surgery.

<14>
Accession Number
20160076174
Authors
Dangas G.D. Lefevre T. Kupatt C. Tchetche D. Schafer U. Dumonteil N. Webb
J.G. Colombo A. Windecker S. Ten Berg J.M. Hildick-Smith D. Mehran R.
Boekstegers P. Linke A. Tron C. Van Belle E. Asgar A.W. Fach A. Jeger R.
Sardella G. Hink H.U. Husser O. Grube E. Deliargyris E.N. Lechthaler I.
Bernstein D. Wijngaard P. Anthopoulos P. Hengstenberg C.
Institution
(Dangas, Mehran) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New
York, NY 10029, United States
(Lefevre) Institut Cardio Vasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
(Kupatt) LMU Munich, Munich, Germany
(Tchetche) Clinique Pasteur, Toulouse, France
(Schafer) University Heart Center, Hamburg, Germany
(Dumonteil) CHU Rangueil, Toulouse, France
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Colombo) San Raffaele Hospital, Milan, Italy
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Ten Berg) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Hildick-Smith) Sussex Cardiac Centre-Brighton and Sussex University
Hospitals NHS Trust, Brighton-East-Sussex, United Kingdom
(Boekstegers) Helios Heart Center Siegburg, Siegburg, Germany
(Linke) Universitat Leipzig, Herzzentrum, Leipzig, Germany
(Tron) CHU de Rouen, Rouen, France
(Van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital, CHRU Lille, Lille, France
(Asgar) Institut de Cardiologie de Montreal, Montreal, QC, Canada
(Fach) Klinikum Links der Weser Bremen, Bremen, Germany
(Jeger) Cardiology University Hospital Basel, Basel, Switzerland
(Sardella) Policlinico Umberto i, Rome, Italy
(Hink) Universitatsmedizin Mainz, Mainz, Germany
(Husser) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Germany
(Grube) Universitaetsklinikum Bonn, Bonn, Germany
(Deliargyris, Bernstein) Medicines Company, Parsippany, NJ, United States
(Lechthaler, Wijngaard, Anthopoulos) Medicines Company, Zurich,
Switzerland
(Hengstenberg) DZHK (German Centre for Cardiovascular Research), Partner
Site Munich Heart Alliance, Munich, Germany
(Schafer) Asklepios Clinics St. Georg, Hamburg, Germany
(Hengstenberg) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
Title
Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve
Replacement the Randomized BRAVO-3 Trial.
Source
Journal of the American College of Cardiology. 66 (25) (pp 2860-2868),
2015. Date of Publication: 29 Dec 2015.
Publisher
Elsevier USA
Abstract
Background Anticoagulation is required during transcatheter aortic valve
replacement (TAVR) procedures. Although an optimal regimen has not been
determined, heparin is mainly used. Direct thrombin inhibition with
bivalirudin may be an effective alternative to heparin as the procedural
anticoagulant agent in this setting. Objectives The goal of this study was
to determine whether bivalirudin offers an alternative to heparin as the
procedural anticoagulant agent in patients undergoing TAVR. Methods A
total of 802 patients with aortic stenosis were randomized to undergo
transfemoral TAVR with bivalirudin versus unfractionated heparin during
the procedure. The 2 primary endpoints were major bleeding within 48 h or
before hospital discharge (whichever occurred first) and 30-day net
adverse clinical events, defined as the combination of major adverse
cardiovascular events (all-cause mortality, myocardial infarction, or
stroke) and major bleeding. Results Anticoagulation with bivalirudin
versus heparin did not meet superiority because it did not result in
significantly lower rates of major bleeding at 48 h (6.9% vs. 9.0%;
relative risk: 0.77; 95% confidence interval [CI]: 0.48 to 1.23; p = 0.27)
or net adverse cardiovascular events at 30 days (14.4% vs. 16.1%; relative
risk: 0.89; 95% CI: 0.64 to 1.24; risk difference: -1.72; 95% CI: -6.70 to
3.25; p = 0.50); regarding the latter, the prespecified noninferiority
hypothesis was met (p<inf>noninferiority</inf> < 0.01). Rates of major
adverse cardiovascular events at 48 h were not significantly different
(3.5% vs. 4.8%; relative risk: 0.73; 95% CI: 0.37 to 1.43; p = 0.35). At
48 h, the bivalirudin group had significantly fewer myocardial infarctions
but more acute kidney injury events than the heparin group; at 30 days,
these differences were no longer significant. Conclusions In this
randomized trial of TAVR procedural pharmacotherapy, bivalirudin did not
reduce rates of major bleeding at 48 h or net adverse cardiovascular
events within 30 days compared with heparin. Although superiority was not
shown, the noninferiority hypothesis was met with respect to the latter
factor. Given the lower cost, heparin should remain the standard of care,
and bivalirudin can be an alternative anticoagulant option in patients
unable to receive heparin in TAVR. (International, Multi-center,
Open-label, Randomized Controlled Trial in Patients Undergoing TAVR to
Determine the Treatment Effect [Both Safety and Efficacy] of Using
Bivalirudin Instead of UFH [BRAVO-2/3]; NCT01651780)

<15>
Accession Number
20160076172
Authors
Feldman T. Kar S. Elmariah S. Smart S.C. Trento A. Siegel R.J. Apruzzese
P. Fail P. Rinaldi M.J. Smalling R.W. Hermiller J.B. Heimansohn D. Gray
W.A. Grayburn P.A. Mack M.J. Lim D.S. Ailawadi G. Herrmann H.C. Acker M.A.
Silvestry F.E. Foster E. Wang A. Glower D.D. Mauri L.
Institution
(Feldman, Smart) Department of Medicine, Division of Cardiology, Evanston
Hospital, Evanston, IL, United States
(Kar, Siegel) Department of Medicine, Division of Cardiology, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(Elmariah) Department of Medicine, Division of Cardiology, Massachusetts
General Hospital, Boston, MA, United States
(Elmariah, Apruzzese, Mauri) Department of Medicine, Division of
Cardiology, Harvard Clinical Research Institute, Boston, MA, United States
(Trento) Department of Surgery, Division of Cardiovascular Surgery,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Fail) Department of Medicine, Division of Cardiology, Terrebonne General
Medical Center, Houma, LA, United States
(Rinaldi) Department of Medicine, Division of Cardiology, Sanger Heart and
Vascular Institute, Carolinas Medical Center, Charlotte, NC, United States
(Smalling) Department of Medicine, Division of Cardiology, Memorial
Hermann Heart and Vascular Institute, Houston, TX, United States
(Hermiller) Department of Medicine, Division of Cardiology, St. Vincent
Medical Group, Indianapolis, IN, United States
(Heimansohn) Department of Surgery, Division of Cardiovascular Surgery,
St. Vincent Medical Group, Indianapolis, IN, United States
(Gray) Department of Medicine, Division of Cardiology, Columbia University
Medical Center, New York, NY, United States
(Grayburn) Department of Medicine, Division of Cardiology, Baylor
University, Dallas, TX, United States
(Mack) Department of Surgery, Division of Cardiovascular Surgery, Baylor
University, Dallas, TX, United States
(Lim) Department of Medicine, Division of Cardiology, University of
Virginia, Charlottesville, VA, United States
(Ailawadi) Department of Surgery, Division of Cardiovascular Surgery,
University of Virginia, Charlottesville, VA, United States
(Herrmann, Silvestry) Department of Medicine, Division of Cardiology,
University of Pennsylvania, Philadelphia, PA, United States
(Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania, Philadelphia, PA, United States
(Foster) Department of Medicine, Division of Cardiology, University of
California, San Francisco, CA, United States
(Wang) Department of Medicine, Division of Cardiology, Duke University
Medical Center, Durham, NC, United States
(Glower) Department of Surgery, Division of Cardiovascular Surgery, Duke
University Medical Center, Durham, NC, United States
(Mauri) Department of Medicine, Division of Cardiology, Brigham and
Women's Hospital, Boston, MA, United States
Title
Randomized Comparison of Percutaneous Repair and Surgery for Mitral
Regurgitation 5-Year Results of EVEREST II.
Source
Journal of the American College of Cardiology. 66 (25) (pp 2844-2854),
2015. Date of Publication: 29 Dec 2015.
Publisher
Elsevier USA
Abstract
Background In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study),
treatment of mitral regurgitation (MR) with a novel percutaneous device
showed superior safety compared with surgery, but less effective reduction
in MR at 1 year. Objectives This study sought to evaluate the final 5-year
clinical outcomes and durability of percutaneous mitral valve (MV) repair
with the MitraClip device compared with conventional MV surgery. Methods
Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous
repair with the device or conventional MV surgery in a 2:1 ratio (178:80).
Patients prospectively consented to 5 years of follow-up. Results At 5
years, the rate of the composite endpoint of freedom from death, surgery,
or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the
percutaneous repair and surgical groups, respectively (p = 0.01). The
difference was driven by increased rates of 3+ to 4+ MR (12.3% vs. 1.8%; p
= 0.02) and surgery (27.9% vs. 8.9%; p = 0.003) with percutaneous repair.
After percutaneous repair, 78% of surgeries occurred within the first 6
months. Beyond 6 months, rates of surgery and moderate-to-severe MR were
comparable between groups. Five-year mortality rates were 20.8% and 26.8%
(p = 0.4) for percutaneous repair and surgery, respectively. In
multivariable analysis, treatment strategy was not associated with
survival. Conclusions Patients treated with percutaneous repair more
commonly required surgery for residual MR during the first year after
treatment, but between 1- and 5-year follow-up, comparably low rates of
surgery for MV dysfunction with either percutaneous or surgical therapy
endorse the durability of MR reduction with both repair techniques.
(EVEREST II Pivotal Study High Risk Registry; NCT00209274)

<16>
Accession Number
20160076158
Authors
Anyanwu A.C. Adams D.H.
Institution
(Anyanwu, Adams) Department of Cardiovascular Surgery, Mount Sinai Medical
Center, 1190 Fifth Avenue, New York, NY 10029, United States
Title
Evaluating Catheter-Based Mitral Valve Therapies Lessons Learned and
Future Directions.
Source
Journal of the American College of Cardiology. 66 (25) (pp 2855-2859),
2015. Date of Publication: 29 Dec 2015.
Publisher
Elsevier USA

<17>
Accession Number
20160086877
Authors
Filho M.F.S. Barral M. Barrucand L. Cavalcanti I.L. Vercosa N.
Institution
(Filho, Barrucand, Vercosa) Federal University of Rio de Janeiro, Rio de
Janeiro, Brazil
(Barral) Faculty of Medical Sciences of Juiz de Fora, Juiz de Fora, Brazil
(Cavalcanti) Fluminense Federal University, Niteroi, Brazil
Title
A randomized blinded study of the left ventricular myocardial performance
index comparing epinephrine to levosimendan following cardiopulmonary
bypass.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0143315. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science
Abstract
The objective was to evaluate the effect of epinephrine and levosimendan
on the left ventricle myocardial performance index in patients undergoing
on-pump coronary artery by-pass grafting (CABG). Methods In a
double-blind, randomized clinical trial, 81 patients (age: 45a"65 years)
of both genders were randomly divided to receive either epinephrine at a
dosage of 0.06 mcg.kg1.min-1 (epinephrine group, 39 patients) or
levosimendan at 0.2 mcg.kg1.min-1 (levosimendan group, 42 patients) during
the rewarming of cardiopulmonary by-pass (CPB). Hemodynamic data were
collected 30 minutes after tracheal intubation, before chest open
(pre-CPB) and 10 minutes after termination of protamine (post-CPB). As the
primary outcome, we evaluated the left ventricle myocardial performance
index by the Doppler echocardiography. The myocardial performance index is
the sum of the isovolumetric contraction time and the isovolumetric
relaxation time, divided by the ejection time. Secondary outcomes were
systolic and diastolic evaluations of the left ventricle and postoperative
troponin I and MB-CK levels. Results Of the 81 patients allocated to the
research, we excluded 2 patients in the epinephrine group and 6 patients
in the levosimendan group because they didnaTMt wean from CPB in the first
attempt. There was no statistical difference between the groups in terms
of patient characteristics, risk factors, or CPB time. The epinephrine
group had a lower left ventricle myocardial performance index (p =
0.0013), higher cardiac index (p = 0.03), lower systemic vascular
resistance index (p = 0.01), and higher heart rate (p = 0.04) than the
levosimendan group at the post-CPB period. There were no differences
between the groups in diastolic dysfunction. The epinephrine group showed
higher incidence of weaning from CPB in the first attempt (95% vs 85%, p =
0.0001) when compared to the levosimendan group and the norepinephrine
requirement was higher in the levosimenandan group than epinephrine group
(16% vs. 47%; p = 0.005) in post-CPB period. Twenty-four hours after
surgery, the plasma levels of troponin I (epinephrine group: 4.5 A+/- 5.7
vs. levosimendan group: 2.5 A+/- 3.2 g/dl; p = 0.09) and MB-CK
(epinephrine group: 50.7 A+/- 31 vs. levosimendan group: 37 A+/- 17.6
g/dl; p = 0.08) were not significantly different between the two groups.
Conclusion When compared to levosimendan, patients treated with
epinephrine had a lower left ventricle myocardial performance index in the
immediate post-CPB period, encouraging an efficient weaning from CPB in
patients undergoing on-pump CABG.

<18>
Accession Number
20160079018
Authors
Younge J.O. Wery M.F. Gotink R.A. Utens E.M.W.J. Michels M. Rizopoulos D.
Van Rossum E.F.C. Hunink M.G.M. Roos-Hesselink J.W.
Institution
(Younge, Michels, Roos-Hesselink) Department of Cardiology, Erasmus MC,
University Medical Center Rotterdam, Rotterdam, Netherlands
(Younge, Wery, Gotink, Hunink) Department of Epidemiology, Erasmus MC,
University Medical Center Rotterdam, Rotterdam, Netherlands
(Gotink) Department of Psychiatry (Section Medical Psychology and
Psychotherapy), Erasmus MC Rotterdam, University Medical Center,
Rotterdam, Netherlands
(Utens) Department of Adolescent Psychiatry/Psychology, Erasmus MC
Rotterdam, University Medical Center, Rotterdam, Netherlands
(Gotink, Hunink) Department of Radiology, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
(Rizopoulos) Department of Biostatistics, Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands
(Van Rossum) Department of Internal Medicine, Erasmus MC, University
Medical Center Rotterdam, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
Title
Web-based mindfulness intervention in heart disease: A randomized
controlled trial.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0143843. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science
Abstract
Background Evidence is accumulating that mindfulness training has
favorable effects on psychological outcomes, but studies on physiological
outcomes are limited. Patients with heart disease have a high incidence of
physiological and psychological problems and may benefit from mindfulness
training. Our aim was to determine the beneficial physiological and
psychological effects of online mindfulness training in patients with
heart disease. Methods The study was a pragmatic randomized controlled
single-blind trial. Between June 2012 and April 2014 we randomized 324
patients (mean age 43.2 years, 53.7%male) with heart disease in a 2:1
ratio (n = 215 versus n = 109) to a 12-week onlinemindfulness training in
addition to usual care (UC) compared to UC alone. The primary outcome was
exercise capacity measured with the 6 minute walk test (6MWT). Secondary
outcomes were other physiological parameters (heart rate, blood pressure,
respiratory rate, and NT-proBNP), subjective health status (SF-36),
perceived stress (PSS), psychological well-being (HADS), social support
(PSSS12) and a composite endpoint (all-cause mortality, heart failure,
symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac
intervention). Linear mixed models were used to evaluate differences
between groups on the repeated outcome measures. Results Compared to UC,
mindfulness showed a borderline significant improved 6MWT (effect size,
meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant
lower heart rate in favor of the mindfulness group (effect size, beats per
minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences
were seen on other outcomes. Conclusions Mindfulness training showed
positive effects on the physiological parameters exercise capacity and
heart rate and it might therefore be a useful adjunct to current clinical
therapy in patients with heart disease.

<19>
Accession Number
20160074678
Authors
Belletti A. Musu M. Silvetti S. Saleh O. Pasin L. Monaco F. Hajjar L.A.
Fominskiy E. Finco G. Zangrillo A. Landoni G.
Institution
(Belletti, Silvetti, Saleh, Pasin, Monaco, Zangrillo, Landoni) Department
of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Musu, Finco) Department of Medical Sciences M. Aresu, Cagliari
University, Cagliari, Italy
(Hajjar) Surgical Intensive Care Unit, Department of Cardiopneumology,
University of Sao Paulo, Sao Paulo, Brazil
(Fominskiy) Department of Anaesthesiology and Intensive Care, Academician
EN Meshalkin Novosibirsk State Budget Research, Institute of Circulation
Pathology, Novosibirsk, Russian Federation
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Non-adrenergic vasopressors in patients with or at risk for vasodilatory
shock. A systematic review and meta-analysis of randomized trials.
Source
PLoS ONE. 10 (11) (no pagination), 2015. Article Number: e0142605. Date of
Publication: 01 Nov 2015.
Publisher
Public Library of Science
Abstract
Introduction: Hypotensive state is frequently observed in several critical
conditions. If an adequate mean arterial pressure is not promptly
restored, insufficient tissue perfusion and organ dysfunction may develop.
Fluids and catecholamines are the cornerstone of critical hypotensive
states management. Catecholamines side effects such as increased
myocardial oxygen consumption and development of arrhythmias are well
known. Thus, in recent years, interest in catecholamine-sparing agents
such as vasopressin, terlipressin and methylene blue has increased;
however, few randomized trials, mostly with small sample sizes, have been
performed. We therefore conducted a meta-analysis of randomized trials to
investigate the effect of non-catecholaminergic vasopressors on mortality.
Methods: PubMed, BioMed Central and Embase were searched (update December
31^st, 2014) by two independent investigators. Inclusion
criteria were: random allocation to treatment, at least one group
receiving a non-catecholaminergic vasopressor, patients with or at risk
for vasodilatory shock. Exclusion criteria were: crossover studies,
pediatric population, nonhuman studies, studies published as abstract
only, lack of data on mortality. Studied drugs were vasopressin,
terlipressin and methylene blue. Primary endpoint was mortality at the
longest follow-up available. Results: A total of 1,608 patients from 20
studies were included in our analysis. The studied settings were sepsis
(10/20 studies [50%]), cardiac surgery (7/20 [35%]), vasodilatory shock
due to any cause (2/20 [19%]), and acute traumatic injury (1/20 [5%]).
Overall, pooled estimates showed that treatment with non-catecholaminergic
agents improves survival (278/810 [34.3%] versus 309/798 [38.7%], risk
ratio = 0.88, 95%confidence interval = 0.79 to 0.98, p = 0.02). None of
the drugs was associated with significant reduction inmortality when
analyzed independently. Results were not confirmed when analyzing studies
with a low risk of bias. Conclusions: Catecholamine-sparing agents in
patients with or at risk for vasodilatory shock may improve survival.
Further researches on this topic are needed to confirm the finding.

<20>
Accession Number
72182124
Authors
Marill K.A. Salcido D.D. Sundermann M.L. Koller A.C. Menegazzi J.J.
Institution
(Marill, Salcido, Sundermann, Koller, Menegazzi) Emergency Medicine, Univ
of Pittsburgh Med Cntr, Pittsburgh, PA, United States
Title
Potassium cardioplegia during CPR for porcine VF arrest: A blinded
randomized controlled trial.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Potassium cardioplegia-induced transient asystole may
conserve myocardial energy and improve outcome in ventricular fibrillation
(VF) cardiac arrest. Hypothesis: We hypothesized potassium infusion during
VF arrest would lead to an increase in intra-arrest amplitude spectrum
area (AMSA) prior to defibrillation, and improved hemodynamic parameters
in those animals that attained return of spontaneous circulation (ROSC).
Methods: Twelve swine were randomized to KCl or placebo in a randomized
controlled trial, and 10 were included in an amended protocol. After
initiation of monitoring, induction of anesthesia, and instrumentation of
the aorta and right atrium, VF was electrically induced. After 4 minutes,
1.5 meq/kg KCl or placebo was infused in blinded fashion in a peripheral
ear vein and mechanical chest compressions and ventilations were begun.
Initial defibrillation was performed 10 minutes post VF induction, as
appropriate. Animals without ROSC received continued resuscitation per
Advanced Cardiac Life Support(ACLS) guidelines for 10 more minutes.
Animals that achieved ROSC were monitored for 30 more minutes. The primary
outcome, change in AMSA from just before study drug infusion to 5 minutes
post infusion, was compared using nonparametric statistics. Results: Six
animals were randomized to KCl and 4 to Placebo. KCl infusion induced
approximately 1 minute of transient asystole at the dosage used. The mean
change in normalized AMSA was -0.24 in the KCl and 0.21 in the Placebo
group, with a median difference of -0.50 (95%CI -0.79 to -0.09), p=0.038,
favoring Placebo. Five of 6 (83%) animals in the KCl group and 2 of 4
(50%) in the Placebo group developed an organized, though not necessarily,
perfusing rhythm with the difference in proportion 33% (95% CI -33 to 86).
One of 6 (17%) animals in the KCl and 2 of 4 (50%) in the Placebo group
achieved ROSC with the difference in proportion -33% (95%CI -93 to 33).
Hemodynamics were not quantitatively compared post ROSC due to limited
survivors. One animal in each group required norepinephrine infusion.
Conclusions: Potassium as a single agent did not benefit AMSA or ROSC in
this porcine model of VF arrest.

<21>
Accession Number
72181470
Authors
Ford C. McCormick D. Teng W. Parkosewich J.
Institution
(Ford, McCormick) Heart and Vascular Cntr, Yale-New Haven Hosp, New Haven,
CT, United States
(Teng) Data Analytics, Yale-New Haven Health System, New Haven, CT, United
States
(Parkosewich) Cntr for Professional Practice, Yale-New Haven Hosp, New
Haven, CT, United States
Title
Early initiation of oral intake in adult patients after cardiothoracic
surgery is safe and reduces thirst: Results of a randomized clinical
trial.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: Tradition-based care dictates that patients fast for several hours
post-cardiothoracic (CT) surgery due to concerns for adverse events
(nausea, vomiting, dysphagia, aspiration pneumonia), although evidence is
lacking to support this practice. Prolonged fasting causes patients
significant distress from thirst. Our aim was to determine the effect of
an early liberal regimen of ice chips and water on adverse events and
thirst after CT surgery. We hypothesized that a liberal regimen vs. usual
care (UC) would not increase adverse events and would reduce thirst.
Method: We used a randomized controlled trial design with a sample of 149
patients from an 18-bed CTICU. Written informed consent was obtained and
patients were randomized to UC (6-hour fast post-extubation) or liberal
regimen during the pre-operative visit. After fasting 1 hour
post-extubation, patients in the liberal regimen were first assessed with
a 6-item protocol for oral intake readiness, and then offered ice chips.
An hour later, they were advanced to water. Results: The mean age was
66+/-12.4 years; 73.8% were male; 91.3% had coronary artery and/or valve
surgery. The two groups were equivalent except for the post-operative mean
dose of ketorolac that was higher in the UC group (p=.04). The table below
shows no differences in nausea, vomiting, or dysphagia between the UC vs.
liberal group, and no aspiration pneumonia. Complaints of high thirst
levels 6 hours after extubation were greater in the UC group. In analysis
adjusted for relevant demographic and clinical variables (logistic
regression), patients in the liberal group were less likely to report high
thirst levels, compared with UC patients (B=-.299, OR=.273, 95% CI
.118-.630). Conclusion: Early initiation of ice chips and water
post-extubation after CT surgery was not associated with adverse events,
but was associated with significantly less thirst. In appropriate
patients, early oral intake can reduce thirst, a distressing symptom.

<22>
Accession Number
72181431
Authors
Zhou C. Li L. Li Y. Hausenloy D. Jeon Y.
Institution
(Zhou, Li) Anesthesiology, Fuwai Cardiovascular Hosp, Beijing, China
(Li) Cardiology, Fuwai Cardiovascular Hosp, Beijing, China
(Hausenloy) Anesthesiology, Hatter Cardiovascular Institute, Univ College
London, London, United Kingdom
(Jeon) Anesthesiology and Pain Medicine, Seoul National Univ Hosp, Seoul,
South Korea
Title
Renal evidence of remote ischemic conditioning for elective coronary
revascularization: A meta-analysis of 13 randomized trials.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Several early small trials have concerned about the renal
effect of periprocedural remote ischemic conditioning(RIC) in patients
with coronary artery disease(CAD), however, negative results were widely
obtained. Hence, we sought to summarize the renal evidence of RIC in
patients undergoing coronary artery bypass grafting(CABG) or percutaneous
coronary intervention(PCI). Methods: A systematic search was performed in
Pubmed, Embase, Cochrane library, and scientific sessions of AHA, ACC and
ESC (up to April 2015). Randomized controlled trials with data on
postoperative acute kidney injury(AKI) during elective coronary
revascularization were included. Odds ratio(OR) with 95% confidence
interval(CI) was calculated. Random-effect models were used for the
potential clinical inconsistency. Publication bias assessment and
sensitivity analysis were performed to evaluate the robustness of the
results. Results: Thirteen RCTs with a total of 1861 CAD patients were
identified and selected. Compared with controls, RIC significantly reduced
the incidence of AKI (6.61% vs 11.6%;OR= 0.54; 95% CI, 0.37 to 0.78;
P=0.001; I2=8.5%; Figure 1). No evidence of significant publication bias
were observed (P=0.784, Begg's test; P=0.096, Egger's test). Sensitivity
analysis of mortality excluding each included study at one time revealed
that most individual study was consisted with the direction and size of
the overall effect (All P>0.01).There was no significant difference
between CABG subgroup (9.8% vs 16.6%;OR=0.54;95%CI, 0.32 to 0.92; P=0.02;
I2=0.0%) and PCI subgroup(5.3% vs 9.4%;OR=0.54; 95% CI, 0.30 to
1.00;P=0.05; I2=36.5%) (P=1.00 for subgroup difference). Conclusions:
Based on the available evidence, RIC provides renal protection by reducing
the postprocedural AKI in elective coronary revascularization. Such effect
is similar between CABG and PCI.

<23>
Accession Number
72181264
Authors
Saung M.T. McCracken C. Sachdeva R. Petit C.J.
Institution
(Saung, Sachdeva, Petit) Pediatrics, Emory Univ, Sch of Medicine, Atlanta,
GA, United States
(McCracken) Biostatistics, Emory Univ, Sch of Medicine, Atlanta, GA,
United States
Title
Reintervention rates following balloon aortic valvuloplasty versus
surgical valve repair in isolated congenital aortic valve stenosis-a
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction:The optimal treatment for congenital aortic stenosis (AS) is
debated despite decades of experience with both balloon aortic
valvuloplasty (BAV) and surgical aortic valve repair (SAV). While BAV has
been the mainstay of therapy for AS, recent single-center reports suggest
optimal results following SAV. Hypothesis: We propose that reintervention
rates following SAV and BAV are equivalent. Methods: We queried Medline,
EMBASE and Web of Science for eligible studies using the keywords:
"congenital aortic stenosis", "balloon valvotomy", "aortic valve stenosis
surgery" and "treatment outcome or reintervention". Studies were excluded
when cohort size was <20 pts, when follow-up was < 2.5 yrs from primary
intervention, and when primary indication was not AS (e.g. SAV in the
setting of aortic valve regurgitation (AR)). Outcomes analyzed included
death, reintervention and moderate or severe AR. Analysis was performed
using Comprehensive Meta Analysis v3 using random effects models. Results:
A total of 20 studies were included in our meta-analysis: SAV alone (n=3),
BAV alone (n=12), and both (n=5). The mean age at BAV was 3.1 years
(range, 4 days - 7 years) with a mean follow-up duration of 6.8 years,
while mean age at SAV was 2.8 years (range, 14.2 days - 7.1 years) with a
mean follow-up duration of 9.1 years. Mortality rates following BAV and
SAV were 12.3% (95% CI: 7.7 - 19.1) and 10.2% (95% CI: 7.0 - 14.5),
respectively (p=0.27). Reintervention following initial procedure for
treatment of AS was higher following BAV (35.7% [95% CI: 29 - 43.1])
compared to SAV (25.2% [95% CI: 19.9 - 31.3])(p=0.012). Long-term and
mid-term follow-up in these studies showed moderate to severe AR was
present in 24.1% and 28.1% of BAV and SAV patients, respectively.
Conclusions: Notwithstanding publication bias, both survival rates and
development of late AR following BAV and SAV are similar. However,
reintervention rates are significantly higher following BAV compared to
SAV.

<24>
Accession Number
72181230
Authors
Wang X. Li X. Ma K. Yang J. Zeng M. Li S. Duan L.
Institution
(Wang, Li, Li, Ma, Yang, Zeng, Li, Duan) Dept of Pediatric, Fuwai Hosp,
Peking Union Med College, Beijing, China
Title
A randomized controlled trial of moderate glucose control after complex
pediatric cardiac surgery.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Infants and children after cardiac surgery may develop
hyper- or hypoglycemia, associating with higher nosocomial infection or
neurological morbidities. Hypothesis: The hypothesis of this perspective
randomized control study is moderate glucose control may improve clinical
outcomes. Methods: We randomly assigned children(<3 years of age) who were
admitted to the pediatric cardiac intensive care unit (PICU) after
cardiopulmonary bypass surgery into either moderate glucose control group
(target blood glucose: 110-143mg per deciliter) or conventional glucose
control group (target level below 200mg per deciliter). The primary
outcome was the rate of nosocomial infection in PICU. Second outcomes
include hospital mortality, duration of mechanical ventilation and PICU
stay, and a composite morbidity variable included events of requiring
extracorporeal membrane oxygenation, delayed sternal closure,
dialysis-dependent renal failure and hypoglycemia. Results: A total of 593
patients underwent randomization: 293 to moderate glucose control group
and 300 to conventional glucose control group. The baseline data were
balanced between these two groups. Mean 72 hours time-weighted blood
glucose average was lower in the moderate control group than in the
conventional group (129.9+/-22.1 mg per deciliter vs. 138.8+/-28.6 mg per
deciliter, p<0.001). Although no statistically significance reached, there
is a trend that nosocomial infection occurred less in moderate glucose
group (17 (5.80%) vs. 29 (9.67%), P=0.054). Duration of mechanical
ventilation was shorter in the moderate control group (18 (range, 4-300)
hours vs 22 (range 3-771) hours, p=0.046). Hypoglycaemia (blood glucose
<65mg per deciliter) which occurred in 7(2.39%) patients in the moderate
group versus 8 (2.67%) in the conventional group, was statistically
similar between groups. Other secondary outcomes did not differ
significantly between groups. Conclusions: With moderate glucose control,
although the major clinical outcomes did not change, this randomized
control study showed shorter ventilation time after pediatric cardiac
surgery, substantially benefit for patients with complex congenital
cardiac anomalies.

<25>
Accession Number
72181183
Authors
James C.S. Horton S. Brizard C. Molesworth C. Millar J. Butt W.
Institution
(James, Millar, Butt) Intensive Care, Royal Children's Hosp, Melbourne,
Australia
(Horton) Perfusion, Royal Children's Hosp, Melbourne, Australia
(Brizard) Cardiac Surgery, Royal Children's Hosp, Melbourne, Australia
(Molesworth) MCRI, Royal Children's Hosp, Melbourne, Australia
Title
Nitric oxide during cardiopulmonary bypass improves clinical outcome: A
blinded, randomized controlled trial.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Children requiring cardiac surgery with cardiopulmonary bypass
(CPB) frequently develop Low Cardiac Output Syndrome (LCOS), particularly
when very young, A pilot study of 16 children by Checchia et al. (2013)
showed that the delivery of nitric oxide (NO) to the CPB circuit shortened
duration of mechanical ventilation and ICU stay. We hypothesized that
administering NO to oxygenator gas flow during CPB would decrease the
incidence of LCOS and effect subsequent clinical outcomes. Methods: We
conducted a prospective, blinded, randomized controlled trial in children
with congenital heart disease having surgery with CPB. Randomization was
stratified by age and 'blocked' at six in each group. Children received
oxygen alone or 20 ppm gaseous NO and oxygen to the CPB gas administration
line. Only the study perfusionist was aware of the allocation and all
equipment and devices were otherwise identical in each group; in
particular the cardiac surgeon and anesthetist remained blinded to patient
allocation. Results: 198 children were enrolled following written consent.
There were no differences in patient characteristics, diagnoses or
surgeries between groups. 101 children received NO and had a significant
reduction in LCOS (14% vs 31%, p=0.004), use of ECMO (1% vs 8%, p=0.014)
and a non-significant reduction in ICU length of stay (48hrs vs 72hrs,
p=0.111), compared to the 97 children who did not receive NO. The
reduction in LCOS was most pronounced in children less than 6 weeks of age
(20% vs 52%, p=0.012) and in those aged 6 weeks to 2 years (6% vs 24%,
p=0.026), who also had significantly reduced ICU length of stay (43hrs vs
84hrs, p=0.031). LCOS occurred equally between groups in children greater
than 2 years of age (17% vs 21%, p=0.678). There was no difference in the
amount of post-operative bleeding in any age group. Children greater than
2 years of age who received NO required fewer blood transfusions (8.3% vs
24.1%, p=0.096). Conclusions: Delivery of NO to the CPB circuit for
children undergoing cardiac surgery significantly reduces the incidence of
LCOS, use of ECMO and ICU length of stay by varying degrees, according to
age group.

<26>
Accession Number
72181157
Authors
Kwiatkowski D.M. Goldstein S.L. Cooper D.S. Nelson D.P. Morales D.L.
Krawczeski C.D.
Institution
(Kwiatkowski, Krawczeski) Pediatric Cardiology, Lucile Packard Children's
Hosp Stanford, Palo Alto, CA, United States
(Goldstein) Pediatric Nephrology, Cincinnati Children's Hosp Med Cntr,
Cincinnati, OH, United States
(Cooper, Nelson, Morales) Heart Cntr, Cincinnati Children's Hosp Med Cntr,
Cincinnati, OH, United States
Title
Peritoneal dialysis vs. furosemide for the treatment of oliguria in
infants after cardiopulmonary bypass.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Acute kidney injury (AKI) is a frequent and serious
complication in infants after cardiac surgery with cardiopulmonary bypass
(CPB). Often the earliest sign is oliguria, which can lead to fluid
overload, prolonged mechanical ventilation and ICU stay, abnormal
electrolytes and increased mortality. We hypothesized that the use of
peritoneal dialysis (PD) compared to furosemide use would mitigate these
complications. Methods: This is a single-center, surgical
complexity-stratified, randomized controlled trial performed within a
cohort of patients younger than 6mo undergoing cardiac surgery with a
preoperative plan of PD catheter placement due to risk of post-CPB kidney
injury. If enrolled patients had urine output < 1mL/kg/hour for 4 hours
during the first postoperative day, the patient was randomized to either a
standardized regimen of furosemide or PD. If the patient demonstrated poor
response to furosemide, PD could be initiated on postoperative day 2.
Results: A total of 73 patients were randomized and completed the trial,
including 2 patients who were randomized to furosemide and subsequently
received PD. Using intention-to-treat analysis, the PD group was less
likely to have fluid overload, had a lower delayed-extubation rate and
fewer electrolyte replacements. There were no differences in mortality or
ICU/hospital stay. No serious PD related complications were observed. PD
was discontinued early in 9 patients due to pleural-peritoneal
communication. Conclusions: Our study demonstrates that the use of PD in
neonates with oliguria after CPB is associated with reduced morbidity but
not differences in mortality or ICU/hospital stay. A multi-center study is
necessary to further support these findings as well as determine
association with mortality.

<27>
Accession Number
72181070
Authors
Luni F.K. Riaz H. Khan A.R. Khuder S. Kanjwal Y.
Institution
(Luni, Kanjwal) Dept of Cardiology, Mercy Saint Vincent Med Cntr, Toledo,
OH, United States
(Riaz) Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
(Khan) Dept of Cardiology, Univ of Louisville, Louisville, KY, United
States
(Khuder) Depts of Medicine and Public Health and Homeland Security, Univ
of Toledo, Toledo, OH, United States
Title
Risk of thrombotic events after discontinuation of aspirin in
perioperative period in patients with established or at risk of coronary
artery disease: A systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aspirin for prolonged duration is commonly prescribed to
patients with a history of cardiovascular events who are at continued risk
for occlusive vascular events (secondary prevention). Patients in the
peri-operative period are not only at an increased risk of bleeding but
also for thrombotic vascular events because of the pro-thrombotic milieu.
Hypothesis: The objective of our study was to do a systematic review and
meta-analysis to compare the risk of thrombotic events and the risk of
bleeding in patients with early (3-5 days) versus late discontinuation/no
discontinuation of aspirin. Methods: PubMed and Embase were searched to
identify the studies that report discontinuation or non-adherence of
aspirin in patients undergoing surgery. The studies were included if they
reported thrombotic events (stroke, all-cause mortality, MI, stent
thrombosis & restenosis, stroke, heart failure, VTE, acute limb ischemia,
perioperative cardiovascular complications) and perioperative bleeding.
Odds ratio was calculated for the measured outcomes. The outcomes were
pooled by generic inverse variance method in a random effects model and
corresponding forest plots were made. Quality assessment was done as per
Newcastle-Ottawa scale. Results: Our search strategy revealed 1018 studies
out of which 6 observational studies (3 evaluating cardiac and 3
non-cardiac surgeries) met the inclusion criteria. There was no difference
in the risk of thrombotic events both in early or late discontinuation of
aspirin (OR 1.17, 95% CI= 0.74-1.84, p =0.50; I2 = 56%) (Figure 1). Early
discontinuation of aspirin showed a decreased risk of peri-operative
bleeding (OR 0.82, 95% CI= 0.67-0.99; p =0.04; I2 = 42%) (Figure 2).
Conclusion: Planned discontinuation of aspirin is acceptable with no
increased risk of thrombotic events and with a decreased risk of bleeding.
Moreover the decreased risk of peri-operative complications may help
reduce the length of stay and associated co-morbidities.

<28>
Accession Number
72181057
Authors
Khan A.R. Khan S. Simo H. Luni F.K. Abdulhak A.A.B. Bavishi C. Riaz H.
Flaherty M.P.
Institution
(Khan, Flaherty) Cardiovascular Div, Dept of Internal Medicine, Univ of
Louisville, Louisville, KY, United States
(Khan, Simo) Dept of Internal Medicine, Univ of Toledo, Toledo, OH, United
States
(Luni) Cardiovascular Div, Dept of Internal Medicine, Mercy Saint Vincent
Med Cntr, Toledo, OH, United States
(Abdulhak) Cardiovascular Div, Dept of Internal Medicine, Univ of Iowa,
Iowa City, IA, United States
(Bavishi) Cardiovascular Div, Dept of Internal Medicine, Mount Sinai St.
Luke's and Roosevelt Hosps, New York, NY, United States
(Riaz) Dept of Internal Medicine, Cleveland Clinic, Cleveland, OH, United
States
Title
Efficacy and safety of transcatheter aortic valve replacement in
low-moderate surgical risk patients: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The efficacy of transcatheter aortic valve replacement (TAVR)
in patients at high surgical risk has been established. The data in
patients with low-moderate risk for surgery is still not conclusive. We
sought to perform a meta-analysis of studies comparing the safety and
efficacy of TAVR with surgical aortic valve replacement (SAVR). Methods:
Several databases were searched from inception to February 2015, which
yielded 10 eligible studies. Studies were selected if they compared TAVR
to SAVR in patients at low-moderate risk for surgery. The measured
outcomes of efficacy were all-cause and cardiovascular mortality. Data on
safety included cerebrovascular events (CVA), permanent pacemaker
implantation (PPI), aortic regurgitation (AR), vascular access
complications and major bleeding reported during the procedure. Outcomes
were pooled and relative risk was calculated using the Mantel-Haenszel
method using a random effects or a fixed effect model based on
heterogeneity. If studies had zero events in any of the arms, Peto odds
ratio was used to pool data. Results: There were 10 studies with 3107
participants in our analysis. There was no difference in either short-term
(RR, 0.85; CI: 0.57-1.28; p=0.44; I2=0%) or medium to long-term all-cause
mortality (RR, 0.97; CI: 0.80-1.18; p=0.78; I2=0%). Our analysis suggested
a decreased risk of cardiovascular mortality in the short-term (RR, 0.42;
CI: 0.19-0.91; p=0.03; I2=0%) and a statistically non-significant trend
towards decrease in long-term mortality (RR, 0.53; CI: 0.26-1.08; p=0.08;
I2=0%) with TAVR. There was increased incidence of AR (RR, 4.01; CI:
2.24-7.19; p< 0.00001; I2=0%), PPI (RR, 5.00; CI: 3.47-7.19; p< 0.00001;
I2=21%) and vascular access complications (RR, 6.36; CI: 3.75-10.76; p<
0.00001; I2=27%) in patients with TAVR. There was no difference in the
risk of stroke between TAVR and SAVR (RR, 1.17; CI: 0.62-2.21; p=0.64;
I2=15%) and an increased risk of major bleeding with SAVR was found (RR,
1.81; CI: 1.08-3.03; p< 0.0001; I2=86%). Conclusions: In this
meta-analysis we found that TAVR may be an acceptable alternative to SAVR
in patients with low-moderate risk for surgery. However, more evidence is
needed from the current randomized trials before more widespread adoption
of the procedure.

<29>
Accession Number
72181024
Authors
Berwanger O. Soares R.M. Ikeoka D.T. Paisani D.M. Silva B.G.
Bernardez-Pereira S. Barros P.G. Devereaux P.J. Lopes R.D.
Institution
(Berwanger, Soares, Ikeoka, Paisani, Silva, Bernardez-Pereira) Rsch
Institute, Heart Hosp - HCor, Sao Paulo, Brazil
(Barros) DMC, Brazilian Clinical Rsch Institute, Sao Paulo, Brazil
(Devereaux) Dept of Clinical Epidemiology and Biostatistics, Population
Health Rsch Institute, Hamilton, Canada
(Lopes) Brazilian Clinical Rsch Institute, Sao Paulo, Brazil
Title
Atorvastatin for the prevention of major vascular events in patients
undergoing non-cardiac surgery: The load-pilot randomized clinical trial.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There is not a single established effective and safe
intervention to prevent major perioperative vascular complications that
commonly occur in the first 30 days after noncardiac surgery. Hypothesis:
We evaluated the feasibility of a multicenter randomized controlled trial
(RCT) testing the perioperative effects of statins. Methods: This is a
double blind, placebo-controlled RCT testing a short course of
atorvastatin 80mg before surgery, followed by 40mg 12 hours after surgery
and then 40mg/day for 7 days in patients undergoing noncardiac surgery who
were at risk of a major perioperative vascular complication. The primary
outcome (major vascular events) was a composite of all-cause mortality,
nonfatal myocardial infarction, MINS (myocardial injury after noncardiac
surgery) without myocardial infarction and nonfatal stroke at 30 days
after randomization. All analysis followed the intention-to-treat
principle. Results: We enrolled 587 patients from 30 centers in Brazil.
Mean age was 66.6 years, 37.1% were males, 22.0% had previous
cardiovascular disease, 50.2% had diabetes and 89.7 % had hypertension.
The majority of participants underwent general (35.9%), orthopedic
(30.0%), gynecologic (8.4%), urologic (7.3%), and vascular (6.6%) surgery.
A total of 51 out of 300 patients (17.0%) suffered a major vascular
complication in the atorvastatin group compared to 49 out of 287 patients
(17.1%) in the control group at 30 days (hazard ratio [HR] 1,02; 95%
confidence interval (CI) 0.68 to 1.52; P = 0.93). No significant effect
was observed on the 30-day secondary outcomes of death or myocardial
infarction (8.0% versus [vs.] 7.7%, respectively; HR 0.94; 95% CI 0.52 to
1.70; P = 0.84), myocardial infarction (3.7% vs. 4.5%, respectively; HR
0.84; 95% CI 0.37 to 1.93; P = 0.68), MINS (14.0% vs.15.0%; HR 0.94; 95%
CI 0.53 to 1.67; P = 0.84), and all-cause mortality (4.7% vs. 4.5%; HR
1.22; 95% CI 0.53 to 2.78; P = 0.64). Conclusions: The LOAD Trial confirms
that a multicenter perioperative statin trial is feasible and highlights
the need for large RCTs to establish effective and safe interventions. The
study also suggests that effects of a perioperative statin on major
vascular complications are, at best, moderate in size, questioning the
robustness of prior data.

<30>
Accession Number
72180954
Authors
Gaddam S. Anugu V.R. Asti D. Raza M. Pandya B. Kandov R. McCord D.
Lafferty J.
Institution
(Gaddam, Asti, Raza, Pandya, Kandov, McCord, Lafferty) Cardiology, Staten
Island Univ Hosp, Staten Island, NY, United States
(Anugu) Medicine, Staten Island Univ Hosp, Staten Island, NY, United
States
Title
Multivessel coronary artery revascularization during index hospitalization
has favorable outcomes compared to infarct related artery only
revascularization in stemi patients-meta-analysis of randomized control
trials.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Multivessel coronary artery disease is present in about half
of the patients presenting with STEMI. Timing of revascularization for the
non-culprit vessels has been a long debate, with few trials suggesting
benefit at index hospitalization rather than staging them at a later time.
Current ACCF/AHA 2013 STEMI guidelines do not recommend PCI of non-infarct
artery at the time of primary PCI but recommend it at a later time if
patients are symptomatic. We hypothesized, complete revascularization
during primary PCI or index hospitalization would have favorable outcomes
compared to culprit vessel only revascularization. Aim: We performed
meta-analysis of randomized control trials comparing multivessel vs.
infarct artery only revascularization during primary PCI or index
hospitalization. Methods and Results: Pubmed, Embace and Google scholar
databases were searched for randomized control trials comparing
multivessel vs. culprit vessel only revascularization during primary PCI
or index hospitalization. We compared deaths, non-fatal MI and repeat
revascularization events for the groups. Total number of patients in our
study was 1819, with 919 patients in multivessel revascularization and 900
patients in infarct artery only revascularization groups. Mean follow up
period was 28 months. Pooled analysis showed significant favorability for
multivessel coronary revascularization comparing events of repeat
revascularization (OR= 0.39, p<0.0001). There was also non-significant
decrease in mortality (OR=0.92, p=0.7) and non-fatal MI (OR=0.68, p=0.09)
with complete revascularization. Conclusions: In our study of STEMI
patients, complete revascularization during primary PCI or index
hospitalization has significantly decreased need for repeat
revascularization and there was also non-significant decrease in mortality
and non-fatal MI. Studies with larger sample size and longer follow up are
needed for stronger evidence.

<31>
Accession Number
72180939
Authors
Qureshi W. Nasir U.B. Soliman E.Z. Belford P.M. Gandhi S.K. Applegate R.J.
Zhao D.X.
Institution
(Qureshi, Gandhi, Applegate, Zhao) Cardiovascular Medicine, Wake Forest
Univ, Winston Salem, NC, United States
(Nasir) Internal Medicine, Rawalpindi Medicine College, Rawalpindi,
Pakistan
(Soliman) Dept of Public Health Sciences, Wake Forest Univ, Winston Salem,
NC, United States
(Belford) Internal Medicine, Wake Forest Univ, Winston Salem, NC, United
States
Title
Risk of post procedural atrial fibrillation in patients undergoing
transcatheter aortic valvular replacement-a meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation is a common postoperative complication
of surgical aortic valve replacement (SAVR). However, it is not known if
the incidence of post procedure AF is impacted by performing Transcatheter
Aortic Valvular Replacement (TAVR) instead of SAVR. Hypothesis: There is
no difference in risk of post procedure incident AF in patients undergoing
TAVR vs. SAVR. Methods: We systematically reviewed studies evaluating TAVR
vs. SAVR and risk of post procedure AF. We searched MEDLINE, EMBASE,
CINAHL, Web of Science, meeting abstracts, presentations and Cochrane
central databases from inception through May 2015. For a study to be
selected, it had to report the rates of incident AF in individuals
undergoing TAVR. Data were extracted by 2 independent authors (WTQ and
UBN). Forrest plot was created to show the effect sizes (Figure 1).
Results: A total of 8 studies including 2483 patients (mean age 81.4
years, 70.3% male) were analyzed. There were 1293 patients that underwent
TAVR and 1190 patients that underwent SAVR. The 1- year incidence of AF
was 231 (17.9%) in TAVR group vs. 377 (31.6%) in SAVR group. In a random
effects model, patients treated with TAVR had a 48% decreased risk of post
procedural 1 year risk of AF [pooled Risk Ratio (95% confidence interval)
0.52 (0.37-0.73), p <0.001]. There was moderate heterogeneity in the
results (I2 = 80%). The risk of AF was higher in studies with older
patients and was lower in studies with higher proportion of patients that
underwent transfemoral TAVR vs. transapical TAVR. Conclusions: In this
meta-analysis, the post procedure risk of AF was lower in TAVR group as
compared to SAVR group. The risk of post procedure AF should be considered
while making decision for TAVR vs. SAVR.

<32>
Accession Number
72180913
Authors
Aggarwal S. Akinapelli A. Kabach A. Ayan M. Saurav A. Bansal O. Smer A.
Pandya J. Kaushik M. Alla V.
Institution
(Aggarwal, Akinapelli, Kabach, Ayan, Saurav, Bansal, Smer, Pandya,
Kaushik, Alla) Medicine, Creighton Univ, Sch of Medicine, Omaha, NE,
United States
Title
Concomitant left atrial appendage closure during cardiac surgery: A
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Surgical left atrial appendage (LAA) closure is an option in
patients undergoing cardiac surgery who have a history of atrial
fibrillation. Despite multiple studies, it is not clear whether LAA
closure during cardiac surgery results in improved outcomes. Hypothesis:
We hypothesized that LAA closure is associated with significant decrease
in risk of stroke and mortality. Methods: We conducted Pubmed, EMBASE and
CENTRAL searches for studies comparing cardiac surgery alone or with
concomitant LAA closure. Efficacy outcome was future risk of stroke.
Safety outcomes were total mortality and postoperative bleeding. Results:
A total of six studies with 3267 patients fulfilled the inclusion
criteria. Primary surgeries were mitral valve surgeries in four studies
and coronary artery bypass grafting in 2 studies. Successful LAA closure
confirmed by trans-esophageal echocardiography was achieved in 97.8% of
patients. Concomitant left atrial appendage closure was not associated
with any significant difference in risk of future stroke (Odds ratio (OR)
0.61, 95% Confidence Interval (CI) 0.30 to 1.24, p=0.12) or recurrence of
atrial fibrillation (OR 0.92, 95% CI 0.66 to 1.29, p=0.63). However, the
combined procedure was associated with lower long-term mortality (OR 0.41,
95% CI 0.22 to 0.77, p=0.005) when compared to cardiac surgery alone.
Conclusions: Concomitant left atrial appendage closure is a safe procedure
but is not associated with a significant decrease in future risk of
stroke. Patients with LAA closure had significantly lower mortality but
this may be related to lower long term use of anticoagulants and bleeding
events in this group. These findings need to be investigated further in
large prospective studies.

<33>
Accession Number
72180912
Authors
Patel N.N. Fiorentino F. Sharabiani M.T. Angelini G.D.
Institution
(Patel, Fiorentino, Sharabiani, Angelini) National Heart and Lung
Institute, Imperial College London, London., United Kingdom
Title
Long-term survival after off-pump coronary artery bypass graft surgery: A
cohort study.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Randomised controlled trials demonstrate that Off-Pump
Coronary Artery Bypass (OPCAB) is equivalent to On-Pump Coronary artery
bypass graft (ONCAB) for in-hospital and short-term outcomes. Recent
observational data, however, suggests that OPCAB may be associated with
increased mid-term mortality although there are several conflicting
studies. There is little data on long-term survival after OPCAB. The
objective of this study was to determine the impact of OPCAB on long-term
survival compared to ONCAB. Methods: We conducted a retrospective cohort
study using the Bristol PATS database of all patients who underwent
primary isolated CABG surgery from 1996 to 2011. Mortality data was
obtained from the Office of National Statistics. Multivariate regression
models were used to estimate the association between OPCAB and long-term
survival. Results: We evaluated long-term survival in 11,981 patients
(mean age 65.5+/-9.3 years, 2202 females) who underwent CABG (OPCAB,
n=6133; ONCAB, n=5848). Survival data was complete in 99.2% of patients,
with a median follow-up duration of 8 years (interquartile range: 4.8 to
11.8 years; maximum 17.3 years). Both groups were similar in terms of
baseline characteristics and intraoperative variables. Euroscore was 3.7
(0.03) and 3.8 (0.03) and number of distal anastomoses performed were 2.53
(0.81) and 2.92 (0.78) in the OPCAB and ONCAB groups, respectively.
Long-term survival was similar between patients undergoing OPCAB and ONCAB
(HR for death: 0.94, 95%CI 0.87 - 1.01, p=0.087). Conclusions: In patients
undergoing coronary revascularisation both ONCAB and OPCAB offer excellent
long-term survival.

<34>
Accession Number
72180843
Authors
Wozniak M.J. Sullo N. Qureshi S. Patel N. Will D. Nielsen P. Kumar T.
Joel-David L. Wiltshire M. Cardigan R. Murphy G.
Institution
(Wozniak, Sullo, Qureshi, Will, Nielsen, Kumar, Joel-David, Cardigan,
Murphy) Cardiovascular Sciences, Univ of Leicester, Leicester, United
Kingdom
(Patel) National Heart and Lung Institute, Imperial Colledge, London,
United Kingdom
(Wiltshire) Component Development, NHSBT, Cambridge, United Kingdom
Title
Red blood cell washing increases kidney injury in cardiac surgery
patients-the role of oxidised lipids and oxidative stress.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Allogeneic red blood cell (RBC) transfusion in cardiac
surgery patients increases the risk of pulmonary and renal morbidity.
These associations are attributable to the 'storage lesion' - accumulation
of metabolites in the RBC supernatant that includes pro-inflammatory
lipids, cell-free hemoglobin and energy depletion. Hypothesis: Storage
lesion components trigger different events that lead to organ injury.
Reducing storage lesion by RBC washing or rejuvenation will reduce organ
injury. Methods: Samples from 60 cardiac patients participating in a
randomized controlled trial of RBC washing prior to transfusion versus
standard care were analysed for inflammatory markers. In a complementary
experiment, 4 groups of pigs received crystalloid infusion or 14-day old
RBC that were left untreated, washed or rejuvenated (Rejuvesol, Citra
Labs, IN). Inflammatory markers, free hemoglobin and iron were measured in
blood. Leukocyte invasion was determined by immunohistochemistry. The
results were verified and further analysed in an in vitro inflammatory
model. Results: Transfusion of stored RBC (~22 days) into humans or pigs
was associated with leukocyte activation, and attenuated by washing. That
was attributed to oxidised lipids on transfused RBC derived microvesicles
that activated monocytes and platelets, as revealed in depletion
experiments. Unexpectedly, transfusion of washed RBC increased kidney
injury, which correlated with higher free haemoglobin levels, oxidative
stress (confirmed by HMOX-1 levels and protein carbonylation), and
endothelial injury in washed RBC recipients. Oxidative stress triggered
non-standard endothelial activation defined by expression of VLA5 and
fibronectin retention. Either pathway was reduced when rejuvenated blood
was transfused. Conclusion: Monocytes/platelets and endothelium are
activated by oxidized lipids/MV and reactive free haem, respectively, and
can be alleviated by RBC rejuvenation.

<35>
Accession Number
72180274
Authors
Vallakati A. Reddy S. Dunlap M. Taylor D.
Institution
(Vallakati, Reddy, Dunlap) Cardiology, MetroHealth Med Cntr, Cleveland,
OH, United States
(Taylor) Cardiology, Cleveland Clinic, Cleveland, OH, United States
Title
Role of statins in heart transplant recipients: A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Statins, through their immunomodulatory effects, may prevent
cardiac allograft dysfunction in heart transplant recipients. Current
International Society of Heart and Lung Transplantation (ISHLT) guidelines
recommend the use of statins in these patients. Though several studies
have demonstrated significant survival benefit with statin use, a pooled
analysis evaluating the role of statins in heart transplant recipients has
not been performed to date. We conducted a meta-analysis to study the
effect of statins on outcomes in heart transplant recipients. Methods: We
searched PubMed for all published studies comparing statins with controls
in heart transplant recipients. Outcomes studied included all-cause
mortality and hemodynamically significant / fatal rejection. All studies
reporting these outcomes were included in the pooled analysis. Random
effects model with Mantel-Haenszel method was used to analyze the
outcomes. Results: We identified 9 studies (n = 2062) which compared
outcomes in heart transplant recipients receiving statins (n = 1449) with
that of those not receiving statins (n = 613). Of the 9 studies, 4 were
randomized controlled trials and 5 were retrospective studies. There was
no heterogeneity across the studies (mortality - I2 = 0%, rejection - I2 =
19%). The use of statins was associated with a significant reduction in
all-cause mortality (OR 0.28, 95% CI 0.21-0.37, p < 0.0001). Statins also
significantly decreased hemodynamically significant / fatal rejections (OR
0.41, 95% CI 0.25-0.69, p < 0.0001) Conclusion: Statins provide
significant survival benefit and reduce cardiac allograft rejection in
heart transplant recipients.

<36>
Accession Number
72180251
Authors
Riaz H. Khan M.S. Riaz T. Idrees J. Riaz I.B. Khan M.Q. Sanghi V. Raza S.
Krasuski R.
Institution
(Riaz) Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Khan) Dow Med College, Dow Univ of Health Sciences, Karachi, Pakistan
(Riaz) Internal Medicine, Bronx Lebanon Med Cntr, Bronx, NY, United States
(Idrees, Raza) Cardiothoracic Surgery, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Riaz) Internal Medicine, Univ of Arizona, Tuscon, AZ, United States
(Khan, Krasuski) Cardiovascular Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Sanghi) Internal Medicine, Mediciti Institute of Med Sciences, Hyderabad,
India
Title
Efficacy and safety of anticoagulation following bioprosthetic aortic
valve replacement: A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The American College of Cardiology (ACC) guidelines recommend
three months of anticoagulation (AC) after replacement of the aortic valve
with a bioprosthesis (BP). However, there remains great variability in the
current clinical practice and conflicting results from clinical studies.
To assist clinical decision making, we pooled the existing evidence to
assess whether AC in the setting of a new BP was associated with improved
outcomes and/or greater risk of bleeding. Methods: We searched the PubMed
database from the inception of these databases until April 2015 to
identify original studies (observational studies or clinical trials) that
assessed AC with warfarin in comparison with either aspirin or no
antiplatelet or anticoagulant therapy. We included the studies if their
outcomes included thromboembolism or stroke/transient ischemic attacks
(TIA) and bleeding events. Quality assessment was performed in accordance
with the Newland Ottawa scale and random effects was used to pool the data
from the available studies. I2 testing was done to assess the
heterogeneity of the included studies. Results: After screening through
170 papers, a total of 13 studies (cases=6431, controls=18210) were
included in the final analyses. Use of warfarin use was associated with a
significantly increased risk of overall bleeding (OR= 1.96, 95% CI
1.25-3.08, P<0.0001) or bleeding risk at 3 months (OR= 1.92, 95% CI
1.10-3.34), P<0.0001) compared with aspirin or placebo. With regard to
composite primary outcome variables (risk of venous thromboembolism,
stroke or TIA) at 3 months, no significant difference was seen with
warfarin (OR= 1.13, 95% CI 0.82-1.56, P=0.67). Moreover AC was also not
shown to improve outcomes at time interval >3 months (OR= 1.12, 95% CI
0.80-1.58, P=0.79). Conclusion: Contrary to the current guidelines, a
meta-analysis of prior studies suggests that AC in the setting of an
aortic bioprosthesis significantly increases bleeding risk without a
favorable impact on thromboembolic events. Larger, randomized controlled
studies should be performed to further guide this clinical practice.

<37>
Accession Number
72180215
Authors
Munoz-Mendoza J. Miranda V.P. Tamariz L. Garcia M.
Institution
(Munoz-Mendoza, Garcia) Dept of Medicine, Div of Cardiology, Montefiore
Med Cntr/Albert Einstein College of Medicine, Bronx, NY, United States
(Miranda, Tamariz) Dept of Medicine, Univ of Miami/Jackson Health System,
Miami, FL, United States
Title
Does pregnancy increase the risk of deterioration of homograft valves? A
systematic review and meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: A previous meta-analysis found that pregnancy increases the
risk of structural valve deterioration (SVD) of bioprosthetic valves.
However both homografts and xenografts were included indistinctly in the
analysis. The purpose of this study is to conduct a meta-analysis to
determine if pregnancy independently increases the risk of SVD in women
recipient of homograft and xenograft valves. Methods: We searched MEDLINE,
EMBASE, CINAHL, Web of Knowledge, and Cochrane Library databases for
articles published from inception until May 2015. Only cohort and case
control studies were included. We calculated the relative risk (RR) and
the corresponding 95% confidence interval (CI) of having SVD by pregnancy
status using the DeSirmonian-Laird method. Meta-regression examined the RR
of SVD by age, number of pregnancies and time from valve replacement to
delivery. Results: Our search strategy yielded 23 publications; nine
studies met inclusion criteria. Two studies (75 women) were performed in
recipients of homografts. They were divided in two groups according to
their history of pregnancies, 22 who were pregnant at least once and 53
who never were pregnant. Eight studies (1071 women) assessed SVD in women
recipient of xenografts, including 282 women who had been pregnant and 789
who never were pregnant. Twenty (26.6%) and 341 (31.8%) women recipients
of homografts and xenografts respectively developed SVD. Among the
recipients of xenografts, the RR of having SVD in pregnant women was 1.70;
95% CI 1.26-2.29; p<0.01 (Figure), whereas it was 1.03 (95% CI 0.45-2.33;
p<0.01) in recipients of homografts. None of the factors evaluated in
meta-regression in recipients of xenografts were statistically
significant. Conclusion: Pregnancy does increase the risk of SVD in
recipients of xenografts, but no homografts. Homografts would be a better
option than xenografts in women of childbearing age non suitable for
long-term anticoagulation.

<38>
Accession Number
72180187
Authors
Sanam K. Aggarwal H. Arora P. Gaba S. Bhatia V. Bajaj N.S.
Institution
(Sanam) Cardiovascular Disease, St John Providence Hosp, Southfield, MI,
United States
(Aggarwal, Arora, Bhatia, Bajaj) Internal Medicine, Univ of Alabama at
Birmingham, Birmingham, AL, United States
(Gaba) Internal Medicine, Univ of Alabama at Birmingham, Southfield, AL,
United States
Title
Transcatheter aortic valve replacement using transfemoral vs transapical
approach: A comprehensive meta-analysis comparing 30-day & 1-year
cerebrovascular event rates.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter Aortic valve replacement (TAVR) has emerged as
new technique for the management of patient with severe Aortic Stenosis
(AS). Stroke is a potential complication associated with the procedure,
when performed via both transfemoral (TF) and transapical approach (TA).
Due to limited data, we performed a comprehensive meta-analysis comparing
30-day and 1-year stroke rates with TAVR performed using TF vs TA
approach. Methods: We searched SCOPUS since inception to July 2014 using
pre-defined criteria. The cerebrovascular event rates and type were
estimated at different time points using standard random effects model.
Results: 5 studies, with total 1956 valves placed, reported 30-day stroke
rates with TA approach, and 9 studies, with 1146 valves, reported stroke
rates with TF approach. No significant difference (p=0.313) was noted with
TA vs TF approach with stroke rates 1.74 (0.61-2.87), 1.52 (0.71-2.33)
respectively (Figure 1, Panel A). Similarly, 4 studies, with total 1657
valves, reported 1-year stroke rates with TA approach, and 8 studies, with
1034 valves, reported stroke using TF approach. Again, no significant
difference (p=0.161) was noted with TA vs TF approach with adjusted stroke
rates 3.78 (1.72-5.85), 3.11 (1.49-4.74) respectively (Figure 1, Panel B).
Conclusion: We did not observe any difference in stroke rates when TAVR is
performed using transapical versus transfemoral approach..

<39>
Accession Number
72179949
Authors
Briasoulis A. Sharma S. Mallikethi-Reddy S. Papageorgiou N. Palla M.
Tousoulis D.
Institution
(Briasoulis, Sharma, Mallikethi-Reddy, Papageorgiou, Palla) Cardiovascular
Medicine, Wayne State Univ, Detroit Med Cntr, Detroit, MI, United States
(Tousoulis) Cardiovascular Medicine, Univ of Athens, Med Sch, Hippokration
Hosp, Athens, Greece
Title
Meta-analysis of oral anticoagulants with dual vs single antiplatelet
therapy in patients after coronary intervention.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Combined use of dual antiplatelet therapy with oral
anticoagulation (OAC) is required in some patients with after coronary
artery stenting or acute coronary syndrome (ACS) Methods: We performed a
meta-analysis of the comparative effects of triple antithrombotic therapy
(TT) vs OAC with single antiplatelet therapy (DT) on all-cause mortality,
stroke, cardiovascular death, myocardial infarction, target vessel
revascularization and major bleeding. We conducted an EMBASE and MEDLINE
search for prospective controlled trials and cohort studies of patients
requiring anticoagulation after coronary stenting Results: We identified 3
prospective controlled studies and 5 cohort studies, which compared TT vs
dual therapy (DT). We identified 4 prospective controlled and 6 cohort
studies with 4564 patients on TT and 1848 on DT with an average follow up
duration of 10.1 months. TT is associated with similar rates of all-cause
mortality, stroke and major bleeding but significantly lower rates of
myocardial infarction compared to DT (mainly OAC plus clopidogrel)
Conclusion: Triple antithrombotic therapy is associated with similar
mortality and bleeding rates but less myocardial infarctions compared with
OAC and single antiplatelet therapy.

<40>
Accession Number
72179948
Authors
Sharma S. Briasoulis A. Mallikethi-Reddy S. Palla M. Sudhakar R. Siddiqui
F. Afonso L.
Institution
(Sharma, Briasoulis, Mallikethi-Reddy, Palla, Sudhakar, Siddiqui, Afonso)
Cardiovascular Medicine, Wayne State Univ, Detroit Med Cntr, Detroit, MI,
United States
Title
Long (>12 months) and short (<6 months) versus standard duration of dual
antiplatelet therapy after coronary stenting: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Dual antiplatelet therapy (DAPT) is recommended for 6-12 month
after drug-eluting stent (DES) implantation to prevent ischemic events and
late stent thrombosis. The optimal duration of DAPT has not been
established Methods: We performed a meta-analysis of the comparative
effects of short- and long- vs standard DAPT duration on adverse
cardiovascular and major bleeding. We conducted an EMBASE and MEDLINE
search for studies in which patients were randomized to treatment with a
different duration of DAPT Results: We identified 5 prospective randomized
studies comparing short- vs standard DAPT and 3 comparing long vs.
standard DAPT duration with a total of 28,343 patients. Short term DAPT
has similar incidence of stent thrombosis, MI and death compared to
standard DAPT whereas major bleeding was significantly lower in short DAPT
therapy. Long term DAPT was associated with lower rates of stent
thrombosis and MI but significantly increased major bleeding and all-cause
mortality compared to standard therapy Conclusion: We found that short
DAPT is safer and as effective as standard DAPT in patients with second
generation DES. Extended DAPT is associated with less ischemic events at
the expense of high bleeding and mortality rates.

<41>
Accession Number
72179873
Authors
Mancini G.B.J. Farkouh M.E. Chaitman B.R. Boden W.E. Frye R.L. Hartigan
P.M. Vlachos H. Siami F.S. Sidhu M.S. Bittner V.A. Fuster V. Brooks M.M.
Institution
(Mancini) Medicine/Cardiology, Univ of British Columbia, Vancouver, Canada
(Farkouh) Cardiology, Peter Munk Cardiac Cntr and the Toronto
Cardiovascular Rsch Network, Univ of Toronto, Toronto, Canada
(Chaitman) Medicine/Cardiology, St. Louis Univ, St. Louis, MO, United
States
(Boden, Sidhu) Medicine/Cardiology, Albany Med College, Albany, NY, United
States
(Frye) Medicine/Cardiology, Mayo Clinic, Rochester, MN, United States
(Hartigan) Medicine/Cardiology, West Haven VA Coordinating Cntr, West
Haven, CT, United States
(Vlachos) Graduate Sch of Public Health, Univ of Pittsburgh, Pittsburgh,
PA, United States
(Siami) Clinical and Regulatory Affairs, New England Rsch Institutes, Inc,
Watertown, MA, United States
(Bittner) Preventive Cardiology, Univ of Alabama at Birmingham,
Birmingham, AL, United States
(Fuster) Medicine/Cardiology, Ichan Sch of Medicine at Mount Sinai, New
York, NY, United States
(Brooks) Graduate Sch of Public Health/Epidemiology, Univ of Pittsburgh,
Pittsburgh, PA, United States
Title
Comparative assessment of medical therapy, PCI, or CABG on clinical
outcomes in diabetic patients with stable cad according to coronary
angiography and left ventricular function: Patient-level meta-analysis of
the BARI-2D, courage, and freedom trials.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The benefits of optimal medical therapy (OMT) with or
without percutaneous coronary intervention (PCI) or coronary artery bypass
graft (CABG) surgery have been evaluated in patients with Type 2 Diabetes
Mellitus (T2DM) and stable coronary artery disease (CAD) but analyses have
not been stratified by detailed angiographic CAD burden or left
ventricular ejection fraction (LVEF) Methods: A patient-level
meta-analysis was undertaken among T2DM patients enrolled in COURAGE, BARI
2D and FREEDOM to assess the impact of randomization to OMT, PCI + OMT, or
CABG + OMT on a composite end-point of Death/MI/Stroke and stratified by
LVEF (> 50%, < 50%), 1, 2 or 3 vessel disease (VD) (% diameter stenosis >
50%) and presence or absence of proximal left anterior descending (pLAD)
disease. Hazard ratios (HR) for treatment groups were calculated from Cox
regression models including all patients adjusting for trial and
revascularization stratum in BARI 2D. Multivariable adjustment for risk
factors was performed as a sensitivity analysis Results: There were 5,034
patients included in the analysis (BARI 2D: n=2,368, COURAGE: n=766,
FREEDOM: n=1,900) of whom 17% had LVEF < 50%, 29% had pLAD, and 77% had 2
or 3 VD. A total of 1,591 patients were randomized to OMT alone, 2,118 to
PCI + OMT, and 1,325 to CABG + OMT. There were 1,116 events during a
median 4.5 year follow-up. There was no significant effect on outcomes
with OMT vs PCI + OMT irrespective of LVEF, presence/absence of pLAD and
number of VD. By contrast, CABG + OMT significantly reduced the risk of
Death/MI/Stroke in patients with 2 or 3 VD, irrespective of LVEF and
presence/absence of pLAD (see Table). Results were similar with
multivariable adjustment Conclusions: In patients with T2DM and stable
CAD, OMT alone appears to be as effective as PCI + OMT while CABG + OMT
significantly reduces cardiovascular events in those with multivessel CAD,
irrespective of LVEF or presence of pLAD.

<42>
Accession Number
72179387
Authors
Wenner J. Bami K. Samardhi H. Nery P. Birnie D. Nair G. Redpath C.
Institution
(Wenner) Cardiology, Univ of British Columbia, Vancouver, Canada
(Bami, Samardhi, Nery, Birnie, Nair, Redpath) Electrophysiology, Univ of
Ottawa, Heart Institute, Ottawa, Canada
Title
Peri-operative atrial fibrillation (POAF) complicating non-cardiothoracic
surgery: A systematic review.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: More than 37 million non cardiothoracic operations are
performed in the USA per annum. Single studies have reported that
peri-operative atrial fibrillation (POAF) complicates non-cardiac surgery
in <12% of patients. It is not clear if POAF is associated with adverse
outcomes. Purpose: We conducted a systematic review to determine the
frequency and implications of POAF. Methods: We conducted a literature
search of MEDLINE, Embase, HTA, Cochrane, and Pubmed databases. We defined
POAF as a single episode of AF confirmed by ECG within 30 days of non
cardiothoracic surgery. Inclusion criteria were published manuscripts and
abstracts containing patient level information. We excluded studies which
were not published in English, described cardiothoracic surgery, were
missing patient-level AF data or included patients aged <18 years.
Results: Our search produced 4445 publications, from which 716 abstracts
and 534 manuscripts were identified for review. After applying
inclusion/exclusion criteria, 225 manuscripts were analysed. Combining all
studies, POAF occurred in 18789/650120 patients (2.9%, n=172, median [IQR]
2.2% [0.9-5.8]). Among 37 prospective studies, POAF occurred in 517/10990
patients (4.7%, n=37, 3.23% [1.0-8.8]). AF was prospectively identified
pre-op in 875/26596 (3.3%, n=18, 9.0% [5.5-13.1]) and post-op in 472/14719
(3.2%, n=18, 8.8% [5.5-13.0]). In 135 retrospective studies, POAF occurred
in 18272/639130 patients (2.9% n=135, 2.13 [0.8-4.4]). In retrospective
analyses, AF was pre-existent in 49756/2440489, (2.0%, n=44, 6.7%
[4.3-13.1]) and de novo in 12043/1641875, (0.7%, n=23, 6.0% [1.6-12.3]).
Stratifying by surgery type, POAF was most common in vascular (104/1380,
7.5%), followed by orthopaedic (128/2384, 5.4%), and neurosurgical
(197/4390, 4.5%) patients. Patient outcomes were not systematically
reported: at 1 year, mortality occurred in 927/4136 (22.4%) POAF patients,
compared to 8498/63746 (13.3%) non-POAF patients (n=7). Conclusions: POAF
occurred in 2.9% of 650120 patients and was associated with a 68% increase
in mortality. Prospective research is required to determine whether any
specific intervention(s) in POAF patients will improve outcomes.

<43>
Accession Number
72179345
Authors
Trivedi C. Di Biase L. Mohanty S. Gianni C. Gunes M. Gokoglan Y. Natale A.
Institution
(Trivedi, Mohanty, Gunes, Gokoglan, Natale) Electrophysiology, Texas
Cardiac Arrhythmia Institute, St David's Med Cntr, Austin, TX, United
States
(Di Biase) Electrophysiology, Albert Einstein College of Medicine,
Montefiore Hosp, Austin, TX, United States
(Gianni) Electrophysiology, Texas Cardiac Arrhythmia Institute, St.
David's Med Cntr, Austin, TX, United States
Title
Ranolazine: A novel anti-ischemic drug in preventing post-operative AF in
patients undergoing coronary artery bypasses grafting: Meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation (AF) is common after coronary artery
bypass grafting (CABG). Ranolazine is a novel drug used in the treatment
of angina, which also has antiarrhythmic properties. Recent studies
demonstrated the benefit of ranolazine in preventing post-operative AF
(POAF) in patients undergoing CABG. Hypothesis: To assess the role of
ranolazine in preventing POAF in patients undergoing CABG surgery.
Methods: We performed comprehensive search of PubMed, MEDLINE, and
Cochrane library database on the study assessing the effectiveness of
ranolazine in preventing POAF by comparing it with standard therapy.
Meta-analysis was performed by fixed effect model by entering POAF events
and the total population from each study. Data are expressed as Odds ratio
(OR) with 95% confidence interval (CI). Results: A total of three studies
with 628 patients (259 pts in ranolazine group, 369 pts in standard
therapy group) were included in the meta-analysis. In pooled analysis,
ranolazine was associated with 54% reduction in post-operative AF events
compared to standard therapy [odds ratio = 0.46 (0.31, 0.70), P<0.001].
The number needed to be treated was 7.14. In one of the study, more
patients in ranolazine group (52.2%) had symptomatic hypotension three
days after the surgery. Conclusions: Ranolazine may prove beneficial in
the prevention of POAF following CABG. However, because of small number of
studies further research with large randomized clinical trial is warranted
to determine specific dose and duration of ranolazine therapy.

<44>
Accession Number
72179239
Authors
Metz T. Mohanty S. Mohanty P. Trivedi C. Gianni C. Di Biase L. Natale A.
Institution
(Metz, Mohanty, Mohanty, Trivedi, Gianni, Di Biase, Natale) EP, Texas
Cardiac Arrhythmia Institute, St. David's Med Cntr, Austin, TX, United
States
Title
Atrial fibrillation after orthotopic heart transplantation: Results from a
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2015 Scientific
Sessions and Resuscitation Science Symposium Orlando, FL United States.
Conference Start: 20151107 Conference End: 20151111. Conference
Publication: (var.pagings). 132 (no pagination), 2015. Date of
Publication: 10 Nov 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Atrial fibrillation (AF) is a known complication of orthotopic
heart transplantation (OHT). However, post-OHT AF is yet to be well
characterized as studies report diverse data on the incidence rate and
clinical characteristics of this arrhythmia. This study provides a review
and meta-analysis of the existing evidences on the incidence rate, time of
onset and association with allograft rejection of post-OHT AF. Methods: An
extensive literature search was performed on PubMed, MEDLINE and EMBASE
databases (from 1990 to August 2014) and reference lists of selected
articles for studies on the incidence of atrial fibrillation in OHT
patients. Post OHT arrhythmia incidence data along with population
characteristics were collected and pooled prevalence rate and associated
95% confidence intervals (CIs) were calculated. Results: Ten prospective
studies with 3,852 patients undergoing OHT were included in the primary
meta-analysis. The pooled prevalence of AF across studies was 5.4% (95% CI
7.0-10.1). AF was the most common early arrhythmia; 74% (95% CI 65-83) of
the reported AF episodes were observed in <30 days of OHT. The pooled
prevalence of AF was much higher with allograft rejection (41.5%, 95% CI
32-52, p<0.001). Additionally, two studies reported lower incidence of AF
following OHT compared to the AF-incidence after other cardiac surgeries
such as MAZE and double- lung transplantation, despite pulmonary vein
isolation in both groups (relative OR 0.25, 95% CI 0.07-0.56), which they
attributed to the antiarrhythmic benefit of cardiac denervation in the
transplanted heart. Conclusion: In heart transplant recipients atrial
fibrillation is uncommon; mostly seen in the early post-operative period
and often in the presence of graft rejection. Of note, cardiac autonomic
denervation may have a protective antiarrhythmic effect in the
post-operative setting of orthotopic heart transplantation.