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<1>
Accession Number
2015657396
Authors
Goto T. Kadota Y. Mori T. Yamashita S.-I. Horio H. Nagayasu T. Iwasaki A.
Institution
(Goto, Kadota, Mori, Yamashita, Horio, Nagayasu, Iwasaki) Guidelines
Committees of Japanese Association for Chest Surgery, Kyoto, Japan
(Goto) Division of General Thoracic Surgery, Department of Surgery, School
of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan
(Kadota) Department of General Thoracic Surgery, Osaka Prefectural Medical
Center for Respiratory and Allergic Diseases, Osaka, Japan
(Mori) Department of Thoracic Surgery, Kumamoto University Hospital,
Kumamoto, Japan
(Yamashita, Iwasaki) Department of General Thoracic, Breast, and Pediatric
Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
(Horio) Department of General Thoracic Surgery, Tokyo Metropolitan Cancer
and Infectious Diseases Center, Tokyo, Japan
(Nagayasu) Division of Surgical Oncology, Department of Surgery, Nagasaki
University Graduate School of Biomedical Sciences, Nagasaki, Japan
Title
Video-assisted thoracic surgery for pneumothorax: republication of a
systematic review and a proposal by the guideline committee of the
Japanese Association for Chest Surgery 2014.
Source
General Thoracic and Cardiovascular Surgery. 63 (1) (pp 8-13), 2015. Date
of Publication: 2015.
Publisher
Springer-Verlag Tokyo
Abstract
Objective: The purpose of this consensus conference was to determine
whether video-assisted thoracic surgery (VATS) improves clinical outcomes
compared with conventional thoracotomy in patients undergoing surgery for
pneumothorax, and to outline evidence-based recommendations for the use of
VATS. Methods: Before the consensus conference, the best available
evidence was reviewed, with systematic reviews, randomized trials, and
nonrandomized trials all taken into consideration in descending order of
validity and importance. At the consensus conference, evidence-based
interpretative statements were created, and consensus processes were used
to determine the ensuing recommendations. The Medical Information Network
Distribution Service in Japan (Minds) system was used to label the levels
of evidence for the references and the classes of recommendations. Results
and recommendations: The consensus panel agreed upon the following
statements and recommendations for patients with pneumothorax undergoing
surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS
is judged to be less invasive, as it results in minimal postoperative
pain, the periods of chest tube placement and hospitalization are short,
and it shows a trend toward early realization of social integration. 3.
There is no difference in terms of safety and complications between VATS
and open thoracotomy. 4. As it is anticipated that VATS will result in a
higher recurrence rate than open thoracotomy, it may be desirable to add a
supplemental procedure during surgery. In summary, VATS can be recommended
as pneumothorax surgery (Recommendation grade: Level B).

<2>
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.

<3>
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Accession Number
26418025
Authors
Rimoldi S.F. Ott S. Rexhaj E. de Marchi S.F. Allemann Y. Gugger M.
Scherrer U. Seiler C.
Institution
(Rimoldi) From the Department of Cardiology and Clinical Research (S.F.R.,
E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O.,
M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad
de Ciencias, Departamento de Biologia, Universidad de Tarapaca, Arica,
Chile (U.S.). christian.seiler@insel.ch stefano.rimoldi@insel.ch
(Ott) From the Department of Cardiology and Clinical Research (S.F.R.,
E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O.,
M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad
de Ciencias, Departamento de Biologia, Universidad de Tarapaca, Arica,
Chile (U.S.)
(Rexhaj) From the Department of Cardiology and Clinical Research (S.F.R.,
E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O.,
M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad
de Ciencias, Departamento de Biologia, Universidad de Tarapaca, Arica,
Chile (U.S.)
(de Marchi) From the Department of Cardiology and Clinical Research
(S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology
(S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and
Facultad de Ciencias, Departamento de Biologia, Universidad de Tarapaca,
Arica, Chile (U.S.)
(Allemann) From the Department of Cardiology and Clinical Research
(S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology
(S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and
Facultad de Ciencias, Departamento de Biologia, Universidad de Tarapaca,
Arica, Chile (U.S.)
(Gugger) From the Department of Cardiology and Clinical Research (S.F.R.,
E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O.,
M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad
de Ciencias, Departamento de Biologia, Universidad de Tarapaca, Arica,
Chile (U.S.)
(Scherrer) From the Department of Cardiology and Clinical Research
(S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology
(S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and
Facultad de Ciencias, Departamento de Biologia, Universidad de Tarapaca,
Arica, Chile (U.S.)
(Seiler) From the Department of Cardiology and Clinical Research (S.F.R.,
E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O.,
M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad
de Ciencias, Departamento de Biologia, Universidad de Tarapaca, Arica,
Chile (U.S.). stefano.rimoldi@insel.ch
Title
Patent Foramen Ovale Closure in Obstructive Sleep Apnea Improves Blood
Pressure and Cardiovascular Function.
Source
Hypertension. 66 (5) (pp 1050-1057), 2015. Date of Publication: 01 Nov
2015.
Abstract
UNLABELLED: Obstructive sleep apnea (OSA) is a frequent syndrome
characterized by intermittent hypoxemia and increased prevalence of
arterial hypertension and cardiovascular morbidity. In OSA, the presence
of patent foramen ovale (PFO) is associated with increased number of
apneas and more severe oxygen desaturation. We hypothesized that PFO
closure improves sleep-disordered breathing and, in turn, has favorable
effects on vascular function and arterial blood pressure. In 40
consecutive patients with newly diagnosed OSA, we searched for PFO. After
initial cardiovascular assessment, the 14 patients with PFO underwent
initial device closure and the 26 without PFO served as control group.
Conventional treatment for OSA was postponed for 3 months in both groups,
and polysomnographic and cardiovascular examinations were repeated at the
end of the follow-up period. PFO closure significantly improved the
apnea-hypopnea index (DELTAAHI -7.9+/-10.4 versus +4.7+/-13.1 events/h,
P=0.0009, PFO closure versus control), the oxygen desaturation index
(DELTAODI -7.6+/-16.6 versus +7.6+/-17.0 events/h, P=0.01), and the number
of patients with severe OSA decreased significantly after PFO closure (79%
versus 21%, P=0.007). The following cardiovascular parameters improved
significantly in the PFO closure group, although remained unchanged in
controls: brachial artery flow-mediated vasodilation, carotid artery
stiffness, nocturnal systolic and diastolic blood pressure (-7 mm Hg,
P=0.009 and -3 mm Hg, P=0.04, respectively), blood pressure dipping, and
left ventricular diastolic function. In conclusion, PFO closure in OSA
patients improves sleep-disordered breathing and nocturnal oxygenation.
This translates into an improvement of endothelial function and vascular
stiffening, a decrease of nighttime blood pressure, restoration of the
dipping pattern, and improvement of left ventricular diastolic function.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT01780207.

<4>
Accession Number
26110914
Authors
Ohlsson A. Shah P.S.
Institution
(Ohlsson, Shah) Departments of Paediatrics, Obstetrics and Gynaecology and
Institute of Health Policy, Management and Evaluation, University of
Toronto, 600 University Avenue, Toronto, ON, Canada, M5G 1X5
Title
Paracetamol (acetaminophen) for prevention or treatment of pain in
newborns.
Source
The Cochrane database of systematic reviews. 6 (pp CD011219), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Newborn infants have the ability to experience pain. Newborns
treated in neonatal intensive care units are exposed to numerous painful
procedures. Healthy newborns are exposed to pain if the birth process
consists of assisted vaginal birth by vacuum extraction or by forceps and
during blood sampling for newborn screening tests.
OBJECTIVES: Primary objectiveTo determine the efficacy and safety of
paracetamol for the prevention or treatment of procedural/postoperative
pain or pain associated with clinical conditions in neonates. Secondary
objectiveTo review the effects of various doses and routes of
administration (enteral, intravenous or rectal) of paracetamol for the
prevention or treatment of pain in neonates. We designed the main
comparisons according to intention of use, that is, paracetamol for
prevention or treatment of pain. We included separate comparisons based on
the painful intervention/procedure/condition (heel lance, insertion of
nasogastric tube, insertion of intravenous catheter, lumbar puncture,
assisted vaginal birth, postoperative pain, birth trauma, congenital
anomalies such as myelomeningocoele and open cutaneous lesions) and the
mode of administration of paracetamol. Within these comparisons, we
planned to assess in subgroups (when possible) effects based on
postmenstrual age (PMA) at the birth of randomly assigned infants (< 28
weeks, 28 weeks to 31 + 6 weeks, 32 weeks to 36 + 6 weeks and > 37 weeks)
or based on birth weight (or current weight) categories (< 1000 grams,
1001 to 1500 grams, 1501 to 2500 grams and > 2501 grams)
SEARCH METHODS: We used the standard search strategy of the Cochrane
Neonatal Review Group including electronic searches of the Cochrane
Central Register of Controlled Trials (CENTRAL) (October 2014), MEDLINE
(1966 to October 2014), EMBASE (1980 to October 2014) and the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (1982 to October
2014). We applied no language restrictions.We conducted electronic
searches of abstracts from meetings of the Pediatric Academic Societies
(2000 to 2014) and the Perinatal Society of Australia and New Zealand
(2010 to 2014).We searched clinical trial registries for ongoing trials
and the Web of Science for articles quoting identified randomised
controlled trials. We searched the first 200 hits on Google Scholar(TM) to
identify grey literature.
SELECTION CRITERIA: We included randomised and quasi-randomised controlled
trials of paracetamol for the prevention or treatment of pain in neonates
(< 30 days of age).
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
data from the full-text articles using a specifically designed form. We
used this form to decide trial inclusion/exclusion, to extract data from
eligible trials and to request additional published information from
authors of the original reports. We entered and cross-checked data using
RevMan 5.3.3 software. When noted, we resolved differences by mutual
discussion and consensus.
MAIN RESULTS: We included eight trials with low risk of bias, which
assessed paracetamol use for the treatment of pain in 614 infants. Painful
interventions studied included heel lance, assisted vaginal birth, eye
examination for ascertainment of retinopathy of prematurity (ROP) and
postoperative care following major surgery. Results of individual studies
could not be combined in meta-analyses as the painful conditions, the use
of paracetamol and comparison interventions and the outcome measures
differed. Paracetamol compared with water, cherry elixir or EMLA cream did
not significantly reduce pain following heel lance. The Premature Infant
Pain Profile score (PIPP) within three minutes following lancing was
higher in the paracetamol group than in the oral glucose group (mean
difference (MD) 2.21, 95% confidence interval (CI) 0.72 to 3.70; one
study, 38 infants). Paracetamol did not reduce "modified facies scores"
after assisted vaginal birth (one study, 119 infants). In another study (n
= 123), the Echelle de Douleur et d'Inconfort du Nouveau-Ne score at two
hours of age was significantly higher in the group that received
paracetamol suppositories than in the placebo suppositories group (MD
1.00, 95% CI 0.60 to 1.40). In that study, when infants were subjected to
a heel lance at two to three days of age, Bernese Pain Scale for Neonates
scores were higher in the paracetamol group than in the placebo group, and
infants spent a longer time crying (MD 19 seconds, 95% CI 14 to 24). For
eye examinations, no significant reduction in PIPP scores in the first or
last 45 seconds of eye examination was reported, nor at five minutes after
the eye examination. In one study (n = 81), the PIPP score was
significantly higher in the paracetamol group than in the 24% sucrose
group (MD 3.90, 95% CI 2.92 to 4.88). For postoperative care following
major thoracic or abdominal surgery, the total amount of morphine
(micro&#32;g/kg) administered over 48 hours was significantly less among
infants randomly assigned to the paracetamol group than in those randomly
assigned to the morphine group (MD -157 micro&#32;g/kg, 95% CI -27 to
-288). No adverse events were noted in any study.
AUTHORS' CONCLUSIONS: Paracetamol does not significantly reduce pain
associated with heel lance or eye examinations. Paracetamol given after
assisted vaginal birth may increase the response to later painful
exposures. Paracetamol should not be used for painful procedures given its
lack of efficacy and its potential for adverse effects. Paracetamol may
reduce the total need for morphine following major surgery, and for this
aspect of paracetamol use, further research is needed.

<5>
Accession Number
26215778
Authors
Kopjar T. Petricevic M. Gasparovic H. Svetina L. Milicic D. Biocina B.
Institution
(Kopjar) University of Zagreb School of Medicine, Department of Cardiac
Surgery, University Hospital Center Zagreb, Zagreb, Croatia. Electronic
address: tkopjar@gmail.com
(Petricevic) University of Zagreb School of Medicine, Department of
Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
(Gasparovic) University of Zagreb School of Medicine, Department of
Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia
(Svetina) University of Zagreb School of Medicine, Department of Cardiac
Surgery, University Hospital Center Zagreb, Zagreb, Croatia
(Milicic) University of Zagreb School of Medicine, Department of
Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb,
Croatia
(Biocina) University of Zagreb School of Medicine, Department of Cardiac
Surgery, University Hospital Center Zagreb, Zagreb, Croatia
Title
Postoperative Atrial Fibrillation Is Associated With High On-Aspirin
Platelet Reactivity.
Source
The Annals of thoracic surgery. 100 (5) (pp 1704-1711), 2015. Date of
Publication: 01 Nov 2015.
Abstract
BACKGROUND: Atrial fibrillation (AF) contributes to a prothrombotic state
through platelet activation. It is unclear whether increased platelet
aggregability in patients with AF is caused by the underlying
cardiovascular condition rather than the arrhythmia per se. We
investigated the effect of postoperative atrial fibrillation (POAF) on
platelet reactivity after coronary artery bypass grafting (CABG).
METHODS: This study is a post hoc analysis from a randomized controlled
trial (ClinicalTrials.gov: NCT01159639) based on patients undergoing
elective primary CABG. Patients were dichotomized according to POAF.
Postoperative platelet function testing with arachidonic acid as the
platelet agonist (ASPI test) was used to define high on-aspirin platelet
reactivity (HAPR). DELTAASPI presented the difference between pre- and
postoperative ASPI test values. To account for the isolated effect of POAF
on platelet reactivity, a propensity score analysis was applied.
RESULTS: Overall incidence of POAF was 23% (92 of 398 patients). HAPR was
detected in 54% (214 of 398) of patients. HAPR was more prevalent among
patients with POAF when compared with patients without POAF (64.1% versus
50.7%; odds ratio [OR], 1.74; 95% confidence interval [CI], 1.08-2.82; p =
0.023). The propensity score model produced a subcohort of patients that
was well balanced for comorbidities. When compared with the matched group
without POAF, the POAF group maintained its prevalence for HAPR (64.1%
versus 45.7%; OR, 2.13; 95% CI, 1.18-3.85; p = 0.012) and had greater
DELTAASPI values (15.0 [IQR, 0.0-36.0] vs 8.0 [IQR, -5.5-19.5]; p =
0.030).
CONCLUSIONS: The main finding of our study indicates there is added
platelet activation in patients with POAF after CABG before and after
controlling for pathologic conditions through propensity matching. The
present study does not prove a causal association between POAF and HAPR.

<6>
Accession Number
24647318
Authors
Buyukates M. Barut F. Aktunc E.
Institution
(Buyukates, Barut, Aktunc) Department of Cardiovascular Surgery, Bulent
Ecevit University, School of Medicine, Zonguldak, Turkey -
Title
The comparison of traditional and modified harvesting techniques of left
internal mammary artery regarding endothelin-1/2/3 expression and free
flow capacity.
Source
The Journal of cardiovascular surgery. 56 (6) (pp 913-918), 2015. Date of
Publication: 01 Dec 2015.
Abstract
AIM: We have conducted this study to seek and observe visual clues through
immunohistochemical staining for differences in Et-1/2/3 expression and
the free-flow capacity measuring the blood flow through grafts, in the
left internal mammary artery grafts prepared either with clipped or
nonclipped techniques.
METHODS: A total of 40 consecutive patients with a diagnosis of coronary
artery disease who would benefit from elective coronary artery bypass
graft surgery were randomised into two groups consisting 20 patients each.
Left internal mammary artery was harvested by a traditional clipped
(control group) and a modified nonclipped (study group) technique in each
of the groups. All harvested arterial segments were evaluated for luminal
endothelial integrity through hematoxylin&eosin and immunohistochemical
staining.
RESULTS: The free-flow capacity of left internal mammary artery grafts
were significantly higher in nonclipped arteries when compared with that
of clipped ones (P=0.001). The arterial lumen of the nonclipped segments
were visibly more dilated than the clipped ones. Nonclipped segments
presented a lighter immunostaining for Et-1/2/3 when compared with the
clipped ones (P<0.001).
CONCLUSION: We believe that lesser endothelial damage caused by the lower
intraluminal pressure in modifiedly harvested left internal mammary artery
segments has positive implications on intraoperative and postoperative
cardiac events related to graft vasospasm, especially related with
endothelins. We recommend modified left internal mammary artery harvesting
in patients going under coronary artery bypass graft operation.

<7>
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Accession Number
26512608
Authors
Tie H.-T. Luo M.-Z. Li Z.-H. Wang Q. Wu Q.-C. Li Q. Zhang M.
Institution
(Tie, Luo, Li, Wang, Wu, Li, Zhang) From the Department of Cardiothoracic
Surgery (H-TT, Q-CW, MZ, QL); The First Affiliated Hospital of Chongqing
Medical University; Division of Immunology (M-ZL); The Children's Hospital
of Chongqing Medical University; The First College of Clinical Medicine
(Z-HL, QW); and Chongqing Medical University, Chongqing, China
Title
Remote Ischemic Preconditioning Fails to Benefit Pediatric Patients
Undergoing Congenital Cardiac Surgery: A Meta-Analysis of Randomized
Controlled Trials.
Source
Medicine. 94 (43) (pp e1895), 2015. Date of Publication: 01 Oct 2015.
Abstract
Remote ischemic preconditioning (RIPC) has been proven to reduce the
ischemia-reperfusion injury. However, its effect on children receiving
congenital cardiac surgery (CCS) was inconsistent. We therefore performed
the current meta-analysis of randomized controlled trials (RCTs) to
comprehensively evaluate the effect of RIPC in pediatric patients
undergoing CCS.PubMed, Embase, and Cochrane library were searched to
identify RCTs assessing the effect of RIPC in pediatric patients
undergoing CCS. The outcomes included the duration of mechanical
ventilation (MV), intensive care unit (ICU) length of stay, postoperative
cardiac troponin (cTnI) level, hospital length of stay (HLOS),
postoperative inotropic score, and mortality. Subgroup and sensitivity
analysis were also performed as predesigned. The meta-analysis was
performed with random-effects model despite of heterogeneity. Sensitivity
and subgroup analysis were predesigned to identify the robustness of the
pooled estimate.Nine RCTs with 697 pediatric patients were included in the
meta-analysis. Overall, RIPC failed to alter clinical outcomes of duration
of MV (standard mean difference [SMD] -0.03, 95% confidence interval [CI]
-0.23-0.17), ICU length of stay (SMD -0.22, 95% CI -0.47-0.04), or HLOS
(SMD -0.14, 95% CI -0.55-0.26). Additionally, RIPC could not reduce
postoperative cTnI (at 4-6 hours: SMD -0.25, 95% CI -0.73-0.23; P = 0.311;
at 20-24 hours: SMD 0.09, 95% CI -0.51-0.68; P = 0.778) or postoperative
inotropic score (at 4-6 hours: SMD -0.19, 95% CI -0.51-0.14; P = 0.264; at
24 hours: SMD -0.15, 95% CI -0.49-0.18; P = 0.365).RIPC may have no
beneficial effects in children undergoing CCS. However, this finding
should be interpreted with caution because of heterogeneity and
large-scale RCTs are still needed.

<8>
Accession Number
26171897
Authors
Desborough M. Sandu R. Brunskill S.J. Doree C. Trivella M. Montedori A.
Abraha I. Stanworth S.
Institution
(Desborough, Sandu, Brunskill, Doree, Trivella, Montedori, Abraha,
Stanworth) Haematology/Transfusion Medicine, NHS Blood and Transplant,
Oxford, UK
Title
Fresh frozen plasma for cardiovascular surgery.
Source
The Cochrane database of systematic reviews. 7 (pp CD007614), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Fresh frozen plasma (FFP) is a blood component containing
procoagulant factors, which is sometimes used in cardiovascular surgery
with the aim of reducing the risk of bleeding. The purpose of this review
is to assess the risk of mortality for patients undergoing cardiovascular
surgery who receive FFP.
OBJECTIVES: To evaluate the risk to benefit ratio of FFP transfusion in
cardiovascular surgery for the treatment of bleeding patients or for
prophylaxis against bleeding.
SEARCH METHODS: We searched 11 bibliographic databases and four ongoing
trials databases including the Cochrane Central Register of Controlled
Trials (CENTRAL, Issue 3, 2015), MEDLINE (OvidSP, 1946 to 21 April 2015),
EMBASE (OvidSP, 1974 to 21 April 2015), PubMed (e-publications only:
searched 21 April 2015), ClinicalTrials.gov, World Health Organization
(WHO) ICTRP and the ISRCTN Register (searched 21 April 2015). We also
searched the references of all identified trials and relevant review
articles. We did not limit the searches by language or publication status.
SELECTION CRITERIA: We included randomised controlled trials in patients
undergoing major cardiac or vascular surgery who were allocated to a FFP
group or a comparator (no plasma or an active comparator, either clinical
plasma (any type) or a plasma-derived blood product). We included
participants of any age (neonates, children and adults). We excluded
studies of plasmapheresis and plasma exchange.
DATA COLLECTION AND ANALYSIS: Two authors screened all electronically
derived citations and abstracts of papers identified by the review search
strategy. Two authors assessed risk of bias in the included studies and
extracted data independently. We took care to note whether FFP was used
therapeutically or prophylactically within each trial.
MAIN RESULTS: We included 15 trials, with a total of 755 participants for
analysis in the review. Fourteen trials compared prophylactic use of FFP
against no FFP. One study compared therapeutic use of two types of plasma.
The timing of intervention varied, including FFP transfusion at the time
of heparin neutralisation and stopping cardiopulmonary bypass (CPB) (seven
trials), with CPB priming (four trials), after anaesthesia induction (one
trial) and postoperatively (two trials). Twelve trials excluded patients
having emergency surgery and nine excluded patients with
coagulopathies.Overall the trials were small, with only four reporting an
a priori sample size calculation. No trial was powered to determine
changes in mortality as a primary outcome. There was either high risk of
bias, or unclear risk, in the majority of trials included in this
review.There was no difference in the number of deaths between the
intervention arms in the six trials (with 287 patients) reporting
mortality (very low quality evidence). There was also no difference in
blood loss in the first 24 hours for neonatal/paediatric patients (four
trials with 138 patients; low quality evidence): mean difference (MD)
-1.46 ml/kg (95% confidence interval (CI) -4.7 to 1.78 ml/kg); or adult
patients (one trial with 120 patients): MD -12.00 ml (95% CI -101.16 to
77.16 ml).Transfusion with FFP was inferior to control for preventing
patients receiving any red cell transfusion: Peto odds ratio (OR) 2.57
(95% CI 1.30 to 5.08; moderate quality evidence). There was a difference
in prothrombin time within two hours of FFP transfusion in eight trials
(with 210 patients; moderate quality evidence) favouring the FFP arm: MD
-0.71 seconds (95% CI -1.28 to -0.13 seconds). There was no difference in
the risk of returning to theatre for reoperation (eight trials with 398
patients; moderate quality evidence): Peto OR 0.81 (95% CI 0.26 to 2.57).
Only one included study reported adverse events as an outcome and reported
no significant adverse events following FFP transfusion.
AUTHORS' CONCLUSIONS: This review has found no evidence to support the
prophylactic administration of FFP to patients without coagulopathy
undergoing elective cardiac surgery. There was insufficient evidence about
treatment of patients with coagulopathies or those who are undergoing
emergency surgery. There were no reported adverse events attributable to
FFP transfusion, although there was a significant increase in the number
of patients requiring red cell transfusion who were randomised to FFP.
Variability in outcome reporting between trials precluded meta-analysis
for many outcomes across all trials, and there was evidence of a high risk
of bias in most of the studies. Further adequately powered studies of FFP,
or comparable pro-haemostatic agents, are required to assess whether
larger reductions in prothrombin time translate into clinical benefits.
Overall the evidence from randomised controlled trials for the safety and
efficacy of prophylactic transfusion of FFP for cardiac surgery is
insufficient.

<9>
Accession Number
25392071
Authors
Izawa A. Kashima Y. Miura T. Ebisawa S. Kitabayashi H. Yamamoto H. Sakurai
S. Kagoshima M. Tomita T. Miyashita Y. Koyama J. Ikeda U.
Institution
(Izawa, Kashima, Miura, Ebisawa, Kitabayashi, Yamamoto, Sakurai,
Kagoshima, Tomita, Miyashita, Koyama, Ikeda) Department of Cardiovascular
Medicine, Shinshu University School of Medicine
Title
Assessment of lipophilic vs. hydrophilic statin therapy in acute
myocardial infarction - ALPS-AMI study.
Source
Circulation journal : official journal of the Japanese Circulation
Society. 79 (1) (pp 161-168), 2015. Date of Publication: 2015.
Abstract
BACKGROUND: Statins reduce the incidence of cardiovascular events, but no
randomized trial has investigated the best statins for secondary
prevention. We compared the efficacy of hydrophilic pravastatin with that
of lipophilic atorvastatin in patients with acute myocardial infarction
(AMI).
METHODS AND RESULTS: A prospective, multicenter study enrolled 508
patients (410 men; mean age, 66.0 +/- 11.6 years) with AMI who were
randomly assigned to atorvastatin (n=255) or pravastatin (n=253). The
target control level of low-density lipoprotein cholesterol (LDL-C) was
<100 mg/dl, and patients were followed for 2 years. The primary endpoint
was the composite of death due to any cause, non-fatal myocardial
infarction, non-fatal stroke, unstable angina or congestive heart failure
requiring hospital admission, or any type of coronary revascularization.
The primary endpoint occurred in 77 patients (30.4%) and in 80 patients
(31.4%) in the pravastatin and atorvastatin groups, respectively (hazard
ratio, 1.181; 95% confidence interval: 0.862-1.619; P=0.299), whereas
greater reductions in serum total cholesterol and LDL-C were achieved in
the atorvastatin group (P<0.001 for each). Changes in hemoglobin A1c,
brain natriuretic peptide, and creatinine were not significant between the
2 regimens, and safety and treatment adherence were similar.
CONCLUSIONS: On 2-year comparison of hydrophilic and lipophilic statins
there was no significant difference in prevention of secondary
cardiovascular outcome.

<10>
Accession Number
20160114470
Authors
Hermiller J.B. Krucoff M.W. Kereiakes D.J. Windecker S. Steg P.G. Yeh R.W.
Cohen D.J. Cutlip D.E. Massaro J.M. Hsieh W.-H. Mauri L.
Institution
(Hermiller) St. Vincent Heart Center, Indianapolis, IN, United States
(Krucoff) Department of Medicine, Duke University Medical Center, Durham,
NC, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire FIRE, Assistance Publique-Hopitaux de
Paris, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Yeh, Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
(Yeh, Cutlip, Massaro, Hsieh, Mauri) Harvard Clinical Research Institute,
Boston, MA, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, School of Medicine, Kansas
City, MO, United States
(Cutlip) Department of Medicine, Cardiology Division, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Massaro) School of Public Health, Boston University, School of Medicine,
Boston, MA, United States
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Womens Hospital, 75 Francis Street, Bostona, MA 02115, United
States
Title
Benefits and Risks of Extended Dual Antiplatelet Therapy after
Everolimus-Eluting Stents.
Source
JACC: Cardiovascular Interventions. 9 (2) (pp 138-147), 2016. Date of
Publication: 25 Jan 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The purpose of this study was to characterize outcomes for
everolimus-eluting stent (EES)-treated subjects according to treatment
with continued thienopyridine plus aspirin versus aspirin alone 12 to 30
months after stenting. Background In the DAPT (Dual Antiplatelet Therapy)
study, continued thienopyridine plus aspirin beyond 1 year after coronary
stenting reduced ischemic events. Given low rates of stent thrombosis and
myocardial infarction (MI) for current drug-eluting stents, we examined
outcomes among EES-treated subjects in the DAPT study. Methods The DAPT
study enrolled 25,682 subjects (11,308 EES-treated) after coronary
stenting. Following 12 months of treatment with thienopyridine and
aspirin, eligible subjects continued treatment with aspirin and 9,961
(4,703 with EES) were randomized to 18 months of continued thienopyridine
or placebo. Stent type was not randomized, and the EES subset analysis was
post hoc. Results Among EES-treated patients, continued thienopyridine
reduced stent thrombosis (0.3% vs. 0.7%, hazard ratio [HR]: 0.38, 95%
confidence interval [CI]: 0.15 to 0.97; p = 0.04) and MI (2.1% vs. 3.2%,
HR: 0.63, 95% CI: 0.44 to 0.91; p = 0.01) versus placebo but did not
reduce a composite of death, MI, and stroke (4.3% vs. 4.5%, HR: 0.89, 95%
CI: 0.67 to 1.18; p = 0.42), and increased moderate/severe bleeding (2.5%
vs. 1.3%, HR: 1.79, 95% CI: 1.15 to 2.80; p = 0.01), and death (2.2% vs.
1.1%, HR: 1.80, 95% CI: 1.11 to 2.92; p = 0.02). Death due to cancer and
not related to bleeding was increased (0.64% vs. 0.17%; p = 0.01).
Conclusions In EES-treated subjects, significant reductions in stent
thrombosis and MI and an increase in bleeding were observed with continued
thienopyridine beyond 1 year compared with aspirin alone. (The Dual
Antiplatelet Therapy Study [DAPT Study]); NCT00977938)

<11>
[Use Link to view the full text]
Accession Number
2015484056
Authors
Pesonen E.J. Suominen P.K. Keski-Nisula J. Mattila I.P. Rautiainen P.
Jahnukainen T.
Institution
(Pesonen, Suominen, Keski-Nisula, Rautiainen) Department of Anesthesiology
and Intensive Care Medicine, Helsinki University Hospital, University of
Helsinki, Helsinki, Finland
(Mattila) Department Of Pediatric Cardiac and Transplantation Surgery,
Children's Hospital, University of Helsinki, Helsinki, Finland
(Jahnukainen) Department of Pediatric Nephrology and Transplantation,
Children's Hospital, University of Helsinki, Helsinki, Finland
Title
The Effect of Methylprednisolone on Plasma Concentrations of Neutrophil
Gelatinase-Associated Lipocalin in Pediatric Heart Surgery.
Source
Pediatric Critical Care Medicine. 17 (2) (pp 121-127), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Plasma neutrophil gelatinase-associated lipocalin is a kidney
injury marker used in pediatric heart surgery. Neutrophil
gelatinase-associated lipocalin is also a constituent of specific granules
of neutrophils. Corticosteroids are widely used in pediatric heart
surgery. Methylprednisolone inhibits degranulation of neutrophil-specific
granules. Use of corticosteroids has not been taken into account in
studies of neutrophil gelatinase-associated lipocalin in pediatric heart
surgery. We studied the influence of systemically administered
methylprednisolone on plasma neutrophil gelatinase-associated lipocalin
concentrations in pediatric heart surgery. Design: Two separate
double-blinded randomized trials. Setting: PICU at a university-affiliated
hospital. Patients: Forty neonates undergoing open-heart surgery and 45
children undergoing ventricular and atrioventricular septal defect
correction. Interventions: First trial (neonate trial), 40 neonates
undergoing open-heart surgery received either 30 mg/kg IV
methylprednisolone (n = 20) or placebo (n = 20). Second trial (ventricular
septal defect trial), 45 children undergoing ventricular or
atrioventricular septal defect correction received one of the following:
30 mg/kg of methylprednisolone IV after anesthesia induction (n = 15), 30
mg/kg methylprednisolone in the cardiopulmonary bypass prime solution (n =
15), or placebo (n = 15). Measurements and Main Results: Plasma neutrophil
gelatinase-associated lipocalin and creatinine were measured in both
series. Lactoferrin levels were measured as a marker of
neutrophil-specific granules in the ventricular septal defect trial only.
No differences in creatinine levels occurred between the groups of either
trial. Preoperative, neutrophil gelatinase-associated lipocalin did not
differ between the study groups of either trial. Preoperatively
administered methylprednisolone in the neonate trial reduced neutrophil
gelatinase-associated lipocalin by 41% at 6 hours postoperatively (p =
0.002). Preoperatively administered methylprednisolone in the ventricular
septal defect trial reduced neutrophil gelatinase-associated lipocalin by
47% (p = 0.010) and lactoferrin by 52% (p = 0.013) 6 hours
postoperatively. Lactoferrin levels in the ventricular septal defect trial
correlated with neutrophil gelatinase-associated lipocalin (R = 0.492; p =
0.001) preoperatively and after weaning from cardiopulmonary bypass (R =
0.471; p = 0.001). Conclusions: Preoperatively administered
methylprednisolone profoundly decreases plasma neutrophil
gelatinase-associated lipocalin levels. Neutrophil gelatinase-associated
lipocalin seems to originate to a significant extent from activated
neutrophils. Preoperative methylprednisolone is a confounding factor when
interpreting plasma neutrophil gelatinase-associated lipocalin levels as a
kidney injury marker in pediatric heart surgery.

<12>
Accession Number
20160003897
Authors
Frontera J.A. Lewin III J.J. Rabinstein A.A. Aisiku I.P. Alexandrov A.W.
Cook A.M. del Zoppo G.J. Kumar M.A. Peerschke E.I.B. Stiefel M.F.
Teitelbaum J.S. Wartenberg K.E. Zerfoss C.L.
Institution
(Frontera) The Cerebrovascular Center, Neurological Institute, Cleveland
Clinic and Case Western Reserve University, 9500 Euclid Ave. S80,
Cleveland, OH 44195, United States
(Lewin III) The Departments of Pharmacy and Anesthesiology & Critical Care
Medicine, The Johns Hopkins Hospital and Johns Hopkins University School
of Medicine, Baltimore, MD, United States
(Rabinstein) The Department of Neurology, Mayo Clinic, Rochester, MN,
United States
(Aisiku) Harvard Medical School, Brigham and Women's Hospital, Boston, MA,
United States
(Alexandrov) The University of Tennessee Health Science Center, Memphis,
TN, United States
(Alexandrov) Australian Catholic University, Sydney, Australia
(Cook) Department of Pharmacy (UK Healthcare) & Department of Pharmacy
Practice & Science (UK College of Pharmacy), University of Kentucky,
Lexington, KY, United States
(del Zoppo) The Departments of Medicine (Hematology) and Neurology,
University of Washington School of Medicine, Seattle, WA, United States
(Kumar) The Departments of Neurology, Neurosurgery, Anesthesiology &
Critical Care, Perelman School of Medicine, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Peerschke) The Department of Laboratory Medicine and Pathology, Memorial
Sloan Kettering Cancer Center and Weill Cornell Medical School, New York,
NY, United States
(Stiefel) The Department of Neurosurgery, Westchester Medical Center, New
York Medical College, Valhalla, NY, United States
(Teitelbaum) Hopital du Sacre-Coeur and University of Montreal and
Montreal Neurological Institute and McGill University, Montreal, QC,
Canada
(Wartenberg) Klinik fur Neurologie, Martin-Luther-Universitat
Halle-Wittenberg, Halle, Germany
(Zerfoss) The Neuroscience and Neurosurgery Departments, Centra Lynchburg
General Hospital, Lynchburg, VA, United States
Title
Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A
Statement for Healthcare Professionals from the Neurocritical Care Society
and Society of Critical Care Medicine.
Source
Neurocritical Care. 24 (1) (pp 6-46), 2016. Date of Publication: 01 Feb
2016.
Publisher
Humana Press Inc.
Abstract
Background: The use of antithrombotic agents, including anticoagulants,
antiplatelet agents, and thrombolytics has increased over the last decade
and is expected to continue to rise. Although antithrombotic-associated
intracranial hemorrhage can be devastating, rapid reversal of coagulopathy
may help limit hematoma expansion and improve outcomes. Methods: The
Neurocritical Care Society, in conjunction with the Society of Critical
Care Medicine, organized an international, multi-institutional committee
with expertise in neurocritical care, neurology, neurosurgery, stroke,
hematology, hemato-pathology, emergency medicine, pharmacy, nursing, and
guideline development to evaluate the literature and develop an
evidence-based practice guideline. Formalized literature searches were
conducted, and studies meeting the criteria established by the committee
were evaluated. Results: Utilizing the GRADE methodology, the committee
developed recommendations for reversal of vitamin K antagonists, direct
factor Xa antagonists, direct thrombin inhibitors, unfractionated heparin,
low-molecular weight heparin, heparinoids, pentasaccharides,
thrombolytics, and antiplatelet agents in the setting of intracranial
hemorrhage. Conclusions: This guideline provides timely, evidence-based
reversal strategies to assist practitioners in the care of patients with
antithrombotic-associated intracranial hemorrhage.

<13>
[Use Link to view the full text]
Accession Number
20151042424
Authors
Axelrod D.M. Sutherland S.M. Anglemyer A. Grimm P.C. Roth S.J.
Institution
(Axelrod, Roth) Department of Pediatrics (Cardiology), Stanford University
Medical Center, Stanford, CA, United States
(Sutherland, Grimm) Department of Pediatrics (Nephrology), Stanford
University Medical Center, Stanford, CA, United States
(Anglemyer) Department of Clinical Pharmacy, School of Pharmacy,
University of California-San Francisco, San Francisco, CA, United States
Title
A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial of
Aminophylline to Prevent Acute Kidney Injury in Children Following
Congenital Heart Surgery with Cardiopulmonary Bypass.
Source
Pediatric Critical Care Medicine. 17 (2) (pp 135-143), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Acute kidney injury occurs commonly in children following
congenital cardiac surgery with cardiopulmonary bypass and has been
associated with increased morbidity and mortality. Aminophylline, a
methylxanthine nonselective adenosine receptor antagonist, has been
effective in the management of acute kidney injury in certain populations.
This study sought to determine whether postoperative administration of
aminophylline attenuates acute kidney injury in children undergoing
congenital cardiac surgery with cardiopulmonary bypass. Design:
Single-center, double-blinded, placebo-controlled, randomized clinical
trial. Setting: Tertiary center, pediatric cardiovascular ICU. Patients: A
total of 144 children after congenital heart surgery with cardiopulmonary
bypass. Interventions: Seventy-two patients were randomized to receive
aminophylline and 72 patients received placebo. Study drug was
administered every 6 hours for 72 hours. Measurements and Main Results:
The primary outcome variable was the development of any acute kidney
injury, defined by the serum creatinine criteria of the Kidney Diseases:
Improving Global Outcomes. Secondary outcomes included the development of
severe acute kidney injury, time between cardiovascular ICU admission and
first successful extubation, percent fluid overload, total fluid balance,
urine output, bioelectrical impedance, and serum neutrophil
gelatinase-associated lipocalin. The unadjusted rate and severity of acute
kidney injury were not different between groups; 43 of 72 (60%) of the
treatment group and 36 of 72 (50%) of the placebo group developed acute
kidney injury (p = 0.32). Stage 2/3 acute kidney injury occurred in 23 of
72 (32%) of the treatment group and 15 of 72 (21%) of the placebo group (p
= 0.18). Secondary outcome measures also demonstrated no significant
difference between treatment and placebo groups. Aminophylline
administration was safe; no deaths occurred in either group, and rates of
adverse events were similar (14% in the treatment group vs 18% in the
placebo group; p = 0.30). Conclusions: In this placebo-controlled
randomized clinical trial, we found no effect of aminophylline to prevent
acute kidney injury in children recovering from cardiac surgery performed
with cardiopulmonary bypass. Future study of preoperative aminophylline
administration to prevent acute kidney injury may be warranted.

<14>
Accession Number
20160114516
Authors
Chatterjee S. Tripathi B. Virk H.U.H. Ahmed M. Bavishi C. Krishnamoorthy
P. Sardar P. Giri J. Omidvari K. Chikwe J.
Institution
(Chatterjee, Tripathi, Virk, Ahmed, Bavishi, Omidvari, Chikwe)
Cardiovascular Diseases, Division of Cardiology, Mount Sinai St. Luke's
Roosevelt Hospitals, 1111 Amsterdam Avenue, Clark building 3rd floor, New
York, NY 10025, United States
(Krishnamoorthy) Division of Cardiology, Albert Einstein Medical Center,
Philadelphia, PA, United States
(Sardar) Division of Cardiology, University of Utah, Salt Lake City, UT,
United States
(Giri) Division of Cardiology, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
(Omidvari, Chikwe) Department of Cardiothoracic Surgery, Icahn School of
Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, United
States
Title
Does Surgical Repair of Moderate Ischemic Mitral Regurgitation Improve
Survival? A Systematic Review.
Source
Current Cardiology Reports. 18 (3) (pp 1-7), 2016. Article Number: 22.
Date of Publication: 01 Mar 2016.
Publisher
Current Medicine Group LLC 1
Abstract
Mitral regurgitation (MR) is one of the common complications in myocardial
infarction (MI) patients. Almost half of the post MI patients have MR
(ischemic MR)¹⁷ which is moderate to severe (grade II-IV).
Whether there is a mortality benefit of performing mitral valve repair
(MVR) along with coronary artery bypass grafting (CABG) in patients with
post MI moderate MR remains inconclusive. Literature search was done from
PubMed, Google scholar, Ovid, and Medline databases. Studies which
included post MI patients with moderate ischemic MR and reported mortality
outcomes of performing CABG and MVR were chosen for the systematic review.
Our preliminary literature search identified 194 studies, of which 11
studies met our inclusion criteria. Nine studies showed no survival
benefit of performing simultaneous MVR and CABG. One study demonstrated
survival benefit of performing CABG plus MVR only in the New York Heart
Association (NYHA) class III-IV, and one study suggested survival benefit
of performing CABG plus MVR as compared to CABG alone in patient with
ischemic MR irrespective of preoperative NYHA functional class. Review of
current literature showed mixed results in terms of improvement in
functional status but failed to show any survival benefit of performing
MVR along with CABG. Limitations of studies include small sample size,
difference in baseline demographic variables, and short follow-up period
which might influence the outcome of the study. Prospective randomized
studies are required to establish clear benefit of performing MVR
simultaneously with CABG.

<15>
[Use Link to view the full text]
Accession Number
20160107289
Authors
Robert S.M. Borasino S. Dabal R.J. Cleveland D.C. Hock K.M. Alten J.A.
Institution
(Robert, Borasino, Hock, Alten) Department of Pediatric Critical Care,
University of Alabama at Birmingham, Birmingham, AL, United States
(Dabal, Cleveland) Department of Cardiothoracic Surgery, University of
Alabama at Birmingham, Birmingham, AL, United States
Title
Postoperative hydrocortisone infusion reduces the prevalence of low
cardiac output syndrome after neonatal cardiopulmonary bypass.
Source
Pediatric Critical Care Medicine. 16 (7) (pp 629-636), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Neonatal cardiac surgery with cardiopulmonary bypass is often
complicated by morbidity associated with inflammation and low cardiac
output syndrome. Hydrocortisone "stress dosing" is reported to provide
hemodynamic benefits in some patients with refractory shock. Development
of cardiopulmonary bypass-induced adrenal insufficiency may provide
further rationale for postoperative hydrocortisone administration. We
sought to determine whether prophylactic, postoperative hydrocortisone
infusion could decrease prevalence of low cardiac output syndrome after
neonatal cardiac surgery with cardiopulmonary bypass. Design:
Double-blind, randomized control trial. Setting: Pediatric cardiac ICU and
operating room in tertiary care center. Patients: Forty neonates
undergoing cardiac surgery with cardiopulmonary bypass were randomized (19
hydrocortisone and 21 placebo). Demographics and known risk factors were
similar between groups. Interventions: After cardiopulmonary bypass
separation, bolus hydrocortisone (50 mg/m²) or placebo was
administered, followed by continuous hydrocortisone infusion (50
mg/m²/d) or placebo tapered over 5 days. Adrenocorticotropic
hormone stimulation testing (1 mug) was performed before and after
cardiopulmonary bypass, prior to steroid administration. Blood was
collected for cytokine analysis before and after cardiopulmonary bypass.
Measurements and Main Results: Subjects receiving hydrocortisone were less
likely to develop low cardiac output syndrome (5/19, 26% vs 12/21, 57%; p
= 0.049). Hydrocortisone group had more negative net fluid balance at 48
hours (-114 vs -64 mL/kg; p = 0.01) and greater urine output at 0-24 hours
(2.7 vs 1.2 mL/kg/hr; p = 0.03). Hydrocortisone group weaned off
catecholamines and vasopressin sooner than placebo, with a difference in
inotrope-free subjects apparent after 48 hours (p = 0.033). Five placebo
subjects (24%) compared with no hydrocortisone subjects required rescue
steroids (p = 0.02). Thirteen (32.5%) had adrenal insufficiency after
cardiopulmonary bypass. Patients with adrenal insufficiency randomized to
receive hydrocortisone had lower prevalence of low cardiac output syndrome
compared with patients with adrenal insufficiency randomized to placebo
(1/6 vs 6/7, respectively; p = 0.02). Hydrocortisone significantly reduced
proinflammatory cytokines. Ventilator-free days, hospital length of stay,
and kidney injury were similar. Conclusions: Prophylactic, postoperative
hydrocortisone reduces low cardiac output syndrome, improves fluid balance
and urine output, and attenuates inflammation after neonatal
cardiopulmonary bypass surgery. Further studies are necessary to show if
these benefits lead to improvements in more important clinical outcomes.

<16>
Accession Number
20160114785
Authors
Hinz J. Mansur A. Hanekop G.G. Weyland A. Popov A.F. Schmitto J.D. Grune
F.F. Bauer M. Kazmaier S.
Institution
(Hinz, Mansur) Department of Anesthesiology, University Medical Center
Goettingen, Germany
(Hanekop, Kazmaier) Department of Anesthesiology, University Medical
Center Goettingen, Goettingen, Germany
(Weyland) Department of Anesthesiology and Intensive Care Medicine,
University of Oldenburg, Oldenburg, Germany
(Popov) Department of Cardiothoracic Surgery, Transplantation and
Mechanical Support, Royal Brompton and Harefield Hospital, London, United
Kingdom
(Schmitto) Department of Cardiothoracic, Transplant and Vascular Surgery,
Hannover Medical School, Hannover, Germany
(Grune) Department of Anesthesiology, Erasmus University/Rotterdam,
Rotterdam, Netherlands
(Bauer) Department of Anesthesiology, University Medical Center
Goettingen, Gottingen, Germany
Title
Influence of isoflurane on the diastolic pressure-flow relationship and
critical occlusion pressure during arterial CABG surgery: A randomized
controlled trial.
Source
PeerJ. 2016 (1) (no pagination), 2016. Article Number: 1619. Date of
Publication: 2016.
Publisher
PeerJ Inc.
Abstract
The effects of isoflurane on the determinants of blood flow during
Coronary Artery Bypass Graft (CABG) surgery are not completely understood.
This study characterized the influence of isoflurane on the diastolic
Pressure-Flow (P-F) relationship and Critical Occlusion Pressure (COP)
during CABG surgery. Twenty patients undergoing CABG surgery were studied.
Patients were assigned to an isoflurane or control group. Hemodynamic and
flow measurements during CABG surgery were performed twice (15 minutes
after the discontinuation of extracorporeal circulation (T15) and again 15
minutes later (T30)). The zero flow pressure intercept (a measure of COP)
was extrapolated from a linear regression analysis of the instantaneous
diastolic P-F relationship. In the isoflurane group, the application of
isoflurane significantly increased the slope of the diastolic P-F
relationship by 215% indicating a mean reduction of Coronary Vascular
Resistance (CVR) by 46%. Simultaneously, the Mean Diastolic Aortic
Pressure (MDAP) decreased by 19% mainly due to a decrease in the systemic
vascular resistance index by 21%. The COP, cardiac index, heart rate, Left
Ventricular End-Diastolic Pressure (LVEDP) and Coronary Sinus Pressure
(CSP) did not change significantly. In the control group, the parameters
remained unchanged. In both groups, COP significantly exceeded the CSP and
LVEDP at both time points. We conclude that short-term application of
isoflurane at a sedative concentration markedly increases the slope of the
instantaneous diastolic P-F relationship during CABG surgery implying a
distinct decrease with CVR in patients undergoing CABG surgery.

<17>
Accession Number
20160105036
Authors
Won H. Her A.-Y. Kim B.-K. Kim Y.H. Shin D.-H. Kim J.-S. Ko Y.-G. Choi D.
Kwon H.M. Jang Y. Hong M.-K.
Institution
(Won) Cardiovascular and Arrhythmia Center, College of Medicine, Chung-Ang
University, Seoul, South Korea
(Her, Kim) Department of Medicine, School of Medicine, Kangwon National
University, Chuncheon, South Korea
(Kim, Shin, Kim, Ko, Choi, Jang, Hong) Division of Cardiology, Severance
Cardiovascular Hospital, Yonsei University Health System, Seoul, South
Korea
(Kim, Shin, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seoul, South Korea
(Kwon) Division of Cardiology, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Percutaneous coronary intervention is more beneficial than optimal medical
therapy in elderly patients with angina pectoris.
Source
Yonsei Medical Journal. 57 (2) (pp 382-387), 2016. Date of Publication:
March 2016.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Data comparing the clinical benefits of medical treatment with
those of percutaneous coronary intervention (PCI) in an elderly population
with angina pectoris are limited. Therefore, we evaluated the efficacy of
elective PCI versus optimal medical treatment (OMT) in elderly patients
(between 75 and 84 years old) with angina pectoris. Materials and Methods:
One hundred seventy-seven patients with significant coronary artery
stenosis were randomly assigned to either the PCI group (n=90) or the OMT
group (n=87). The primary outcome was a composite of major adverse events
in the 1-year follow-up period that included cardiovascular death,
non-fatal myocardial infarction, coronary revascularization, and stroke.
Results: Major adverse events occurred in 5 patients (5.6%) of the PCI
group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no
significant differences between the PCI group and the OMT group in cardiac
death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval
(CI) 0.041-5.019,p=0.520], myocardial infarction (HR 0.399; 95% CI
0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952).
However, the PCI group showed a significant preventive effect of the
composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015)
and against the need for coronary revascularization (HR 0.157; 95% CI
0.035-0.703, p=0.016). Conclusion: Elective PCI reduced major adverse
events and was found to be an effective treatment modality in elderly
patients with angina pectoris and significant coronary artery stenosis,
compared to OMT.

<18>
Accession Number
2015543887
Authors
Kunihara T.
Institution
(Kunihara) The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku,
Tokyo 106-0031, Japan
Title
Annular management during aortic valve repair: a systematic review.
Source
General Thoracic and Cardiovascular Surgery. 64 (2) (pp 63-71), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Springer-Verlag Tokyo
Abstract
Annuloplasty is considered to play a key role to control aortic valve
regurgitation (AR) and prevent recurrence of AR after aortic valve repair,
because aortic root dilatation has emerged as a risk factor for recurrence
of AR. Various modifications of annuloplasty have been advocated, however,
none of them has become standardized. Thus in this review they are
outlined and classified (internal/external, with/without ring,
rigid/flexible ring), and their advantages and disadvantages are
clarified. Their clinical outcomes seem currently acceptable in general,
and external flexible annuloplasty has been performed more frequently with
favorable outcomes. However, they are still performed for a minority of
patients by special experienced teams with limited follow-up periods.
Therefore, it seems too early to determine the superiority or inferiority
of each approach. We must carefully conduct evaluation to clarify which
approach will become reproducible, effective, and standardized.

<19>
Accession Number
20160098201
Authors
Zhao Y. Nicoll R. He Y.H. Henein M.Y.
Institution
(Zhao, He) Ultrasound Department, Beijing Anzhen Hospital, Capital Medical
University, Beijing 100029, China
(Nicoll, Henein) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
Title
The effect of statins on valve function and calcification in aortic
stenosis: A meta-analysis.
Source
Atherosclerosis. 246 (pp 318-324), 2016. Date of Publication: March 01,
2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aortic calcification has been shown to share the same risk
factors as atherosclerosis which suggested a potential benefit from
statins therapy. In view of the existing conflicting results, we aimed to
provide objective evidence on the effect of statins in aortic stenosis
(AS). Methods and results: A meta-analysis of eligible studies that used
statins in AS was performed. Fourteen studies were identified, 5
randomized controlled trials (RCTs) and 9 observational studies. In the 14
studies as a whole, no significant differences were found in all cause
mortality (OR = 0.98, p = 0.91), cardiovascular mortality (OR = 0.80, P =
0.23) or the need for valve replacement (OR = 0.93, p = 0.45) between the
statins and the control groups. LDL-cholesterol dropped in the statins
groups in both < 24 months and >24 months follow-up (p < 0.001 for both)
but not in controls (p = 0.35 and p = 0.33, respectively). In the <24
months statins group, the annual increase in peak aortic velocity and peak
gradient was less (p < 0.0001 and p = 0.004, respectively), but the mean
gradient, valve area and calcification score were not different from
controls. In the > 24 months statins group, none of the above parameters
was different from controls. Conclusions: Despite the consistent
beneficial effect of statins on LDL-cholesterol levels, the available
evidence showed no effect on aortic valve structure, function or
calcification and no benefit for clinical outcomes.

<20>
Accession Number
20160109352
Authors
Phan K. Zhao D.-F. Wang N. Huo Y.R. Eusanio M.D. Yan T.D.
Institution
(Phan, Zhao, Wang, Huo, Yan) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
(Eusanio) Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini'
Hospital Piazza Italia, Teramo 64100, Italy
Title
Transcatheter valve-in-valve implantation versus reoperative conventional
aortic valve replacement: A systematic review.
Source
Journal of Thoracic Disease. 8 (1) (pp E83-E93), 2016. Date of
Publication: 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Transcatheter valve-in-valve (VIV) implantation for degenerated aortic
bioprostheses has emerged as a promising alternative to redo conventional
aortic valve replacement (cAVR). However there are concerns surrounding
the efficacy and safety of VIV. This systematic review aims to compare the
outcomes and safety of transcatheter VIV implantation with redoes cAVR.
Six databases were systematically searched. A total of 18 relevant studies
(823 patients) were included. Pooled analysis demonstrated VIV achieved
significant improvements in mean gradient (38 mmHg preoperatively to 15.2
mmHg postoperatively, P < 0.001) and peak gradient (59.2 to 23.2 mmHg,
P=0.0003). These improvements were similar to the outcomes achieved by
cAVR. The incidence of moderate paravalvular leaks (PVL) were
significantly higher for VIV compared to cAVR (3.3% vs. 0.4%, P=0.022). In
terms of morbidity, VIV had a significantly lower incidence of stroke and
bleeding compared to redo cAVR (1.9% vs. 8.8%, P=0.002 & 6.9% vs. 9.1%,
P=0.014, respectively). Perioperative mortality rates were similar for VIV
(7.9%) and redo cAVR (6.1%, P=0.35). In conclusion, transcatheter VIV
implantation achieves similar haemodynamic outcomes, with lower risk of
strokes and bleeding but higher PVL rates compared to redo cAVR. Future
randomized studies and prospective registries are essential to compare the
effectiveness of transcatheter VIV with cAVR, and clarify the rates of
PVLs.

<21>
Accession Number
20160095862
Authors
Rose A.J. Phibbs C.S. Uyeda L. Su P. Edson R. Shih M.-C. Jacobson A.
Matchar D.B.
Institution
(Rose) Center for Healthcare Organization and Implementation Research,
Bedford VA Medical Center, 200 Springs Rd, Bedford, MA 01730, United
States
(Rose) Department of Medicine, Section of General Internal Medicine,
Boston University School of Medicine, Boston, MA, United States
(Phibbs, Su) Health Economics Resource Center, VA Palo Alto Health Care
System, Palo Alto, CA, United States
(Uyeda, Edson, Shih) Cooperative Studies Program Coordinating Center, VA
Palo Alto Health Care System, Palo Alto, CA, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, Stanford, CA, United
States
(Shih) Department of Health Research and Policy, Division of
Biostatistics, Stanford University, Stanford, CA, United States
(Jacobson) Research and Development Service, Jerry L. Pettis VA Medical
Center, Loma Linda, CA, United States
(Jacobson) Department of Internal Medicine, School of Medicine, Loma Linda
University, Loma Linda, CA, United States
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar) Department of Medicine and Center for Clinical Health Policy
Research, Division of General Medicine, Duke University Medical Center,
Durham, NC, United States
(Matchar) Health Services and Systems Research Program, Duke-National
University of Singapore Graduate Medical School, Singapore
Title
Does distance modify the effect of self-testing in oral anticoagulation?.
Source
American Journal of Managed Care. 22 (1) (pp 65-71), 2016. Date of
Publication: January 2016.
Publisher
Ascend Media
Abstract
Objectives: Patient self-testing (PST) improves anticoagulation control
and patient satisfaction. It is unknown whether these effects are more
pronounced when the patient lives farther from the anticoagulation clinic
(ACC). If the benefits of PST are limited to a subset of patients (those
living farther from care), selectively providing PST to that subset could
enhance cost-effectiveness. Study Design: This is a secondary analysis of
a randomized trial of PST versus usual ACC care, which involved 2922
patients of the Veterans Health Administration (VHA). Methods: Our 3
outcomes were the primary composite clinical end point (stroke, major
hemorrhage, or death), anticoagulation control (percent time in
therapeutic range), and satisfaction with anticoagulation care. We
measured the driving distance between the patient's residence and the
nearest VHA facility. We divided patients into quartiles by distance and
looked for evidence of an interaction between distance and the effect of
the intervention on the 3 outcomes. Results: The median driving distance
was 12 miles (interquartile range = 6-21). Patients living in the farthest
quartile had higher rates of the primary composite clinical end point in
both groups compared with patients living in the nearest quartile. For
PST, the hazard ratio (HR) was 1.77 (95% CI, 1.18-2.64), and for usual
care, the HR was 1.81 (95% CI, 1.19-2.75). Interaction terms did not
suggest that distance to care modified the effect of the intervention on
any outcome. Conclusions: The benefits of PST were not enhanced among
patients living farther from care. Restricting PST to patients living more
than a certain distance from the ACC is not likely to improve its
cost-effectiveness.

<22>
Accession Number
2015955171
Authors
Chen Z. Rong L.
Institution
(Chen, Rong) Department of Spine Surgery, Third Affiliated Hospital of Sun
Yat-sen University, No. 600, Tianhe Road, Guangzhou 510630, China
Title
Comparison of combined anterior-posterior approach versus posterior-only
approach in treating adolescent idiopathic scoliosis: a meta-analysis.
Source
European Spine Journal. 25 (2) (pp 363-371), 2016. Date of Publication: 01
Feb 2016.
Publisher
Springer Verlag
Abstract
Purpose: Choosing a surgical approach to treat adolescent idiopathic
scoliosis (AIS) is still controversial. To compare the effectiveness and
safety of combined anterior-posterior approach to posterior-only approach,
we conducted a meta-analysis. Methods: We searched electronic database for
relevant studies that compared anterior-posterior approach with posterior
approach in AIS. Then data extraction and quality assessment were
conducted. We used RevMan 5.1 for data analysis. A random effects model
was used for heterogeneous data, while a fixed effect model was used for
homogeneous data. Results: A total of ten non-randomized controlled
studies involving 872 patients were included. There was no significant
difference in Cobb angle (95 % CI -0.33 to 4.91, P = 0.09) and
percent-predicted FEV1 (95 % CI -6.79 to 4.54, P = 0.70) between the two
groups. In subgroup analysis, the kyphosis angle correction was
significantly higher than posterior group in severe subgroup (95 % CI
0.72-6.50, P = 0.01), while no significant difference was found in
no-restriction subgroup (95 % CI -2.75 to 5.42, P = 0.52). Patients in
posterior group obtained a better percent-predicted FVC than those in
anterior-posterior group (95 % CI -13.18 to -4.74, P < 0.0001).
Significant less complication rate (95 % CI 2.75-17.49, P < 0.0001), blood
loss (95 % CI 363.28-658.91, P < 0.00001), operative time (95 % CI
2.65-3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98-22.94, P
= 0.02) were found in posterior group. Conclusions: Posterior-only
approach can achieve similar coronal plane correction and
percent-predicted FEV1 compared to combined anterior-posterior approach.
The posterior approach even does better in sagittal correction in severe
AIS patients. Significantly less complication rate, blood loss, operative
time, length of hospital stay and better percent-predicted FVC are also
achieved by posterior-only approach. Posterior-only approach seems to be
effective and safe in treating AIS for experienced surgeons.

<23>
Accession Number
2015208056
Authors
Mao Z. Zhong X. Yin J. Zhao Z. Hu X. Hackett M.L.
Institution
(Mao, Zhong, Yin, Zhao, Hu) Department of Neurology, Third Affiliated
Hospital of Sun Yat-Sen University, Multiple Sclerosis Center, 600 Tianhe
Road, Guangzhou, Guangdong Province 510630, China
(Hackett) George Institute for Global Health, University of Sydney,
Australia
(Hackett) School of Health, University of Central Lancashire, Preston,
United Kingdom
Title
Predictors associated with stroke after coronary artery bypass grafting: A
systematic review.
Source
Journal of the Neurological Sciences. 357 (1-2) (pp 1-7), 2015. Date of
Publication: 13 Mar 2015.
Publisher
Elsevier
Abstract
Background Stroke is a major cause of morbidity and mortality after
coronary artery bypass grafting (CABG). The purpose of this systematic
review was to evaluate the predictors of perioperative stroke after CABG.
Methods We reviewed the published literature on prognostic factors for
perioperative stroke after CABG in articles using multivariate regression
models. The statistical validity of prognostic models and a qualitative
synthesis were performed. Results We identified 14 studies. The
methodological quality of study reporting was variable. Overall, the
incidence of stroke after CABG was 1.1-5.7%. About 37-59% of strokes
occurred early (intraoperatively). No validated stroke outcome scale was
used to assess morbidity and mortality in any of the included studies.
Advanced age, prior (before CABG) cerebrovascular disease/stroke, prior
carotid artery stenosis, prior peripheral vascular disease, prior unstable
angina, and prolonged cardiopulmonary bypass time were found to be the
most consistent independent predictors of perioperative stroke after CABG.
Postoperative atrial fibrillations were found to be the most consistent
independent variables associated with postoperative stroke after CABG. No
association was found with hypercholesterolemia, prior myocardial infarct,
and smoking. Other risk factors, such as gender, prior hypertension,
diabetes mellitus, congestive heart failure, and chronic renal failure,
showed inconsistent results. Conclusions Seven variables (advanced age,
prior cerebrovascular disease/stroke, prior carotid artery stenosis, prior
peripheral vascular disease, prior unstable angina, prolonged
cardiopulmonary bypass time, and postoperative atrial fibrillation),
representing and high atherosclerotic burden, were found to be associated
with more perioperative stroke events. Stroke assessment scales should be
included to enable a detailed description of stroke morbidity post CABG.
Lessons learned from the present study should also help to improve the
quality and relevance of future studies on prognostic factors in stroke
after CABG.

<24>
Accession Number
72182623
Authors
Sanders D. Beringer R.
Institution
(Sanders) Plymouth Hospitals NHS Trust, United Kingdom
(Beringer) Bristol Children's Hospital, United Kingdom
Title
The hidden dangers of paediatric blood transfusion.
Source
Anaesthesia. Conference: Winter Scientific Meeting of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI WSM 2016 London United
Kingdom. Conference Start: 20160113 Conference End: 20160115. Conference
Publication: (var.pagings). 71 (pp 69), 2016. Date of Publication: January
2016.
Publisher
Blackwell Publishing Ltd
Abstract
Paediatric surgery often requires intra-operative red cell transfusions.
Stored packed red cells (PRC) suffer biochemical and structural changes
known as 'storage lesions.' During a recent neonatal laparotomy at Bristol
Children's Hospital (BCH) surgery was paused to allow resolution of
significant hyperkalaemic ECG changes caused by blood transfusion. Whilst
large randomised controlled trials in adults and children have reached no
conclusion about the relationship of longer blood storage times with worse
patient outcomes [1, 2] there is literature evidence that infants having
large volume blood transfusions are susceptible to arrhythmias and
myocardial dysfunction [3]. This observational study looked at the
biochemical status of PRC prior to transfusion. It aimed to quantify the
degree of biochemical disturbance in stored PRC and the effects of storage
time and irradiation. Methods Blood samples were drawn from PRC used in
paediatric cardiac theatres over a three month period and analysed
immediately in the blood gas machine. Samples with incomplete blood gas
data were excluded from analysis. Results Thirty-one blood samples were
analysed. Of these, six had been irradiated. Storage time ranged from 4-21
days (median 6 days) All samples, independent of storage time, had a pH <
6.8, an incalculable BE and lactate concentrations above 6
mmol.l^-1. Irradiated blood samples had a higher median
potassium concentration (20 vs 12 mmol.l^-1) and lower median
sodium concentration (120 vs 135 mmol.l^-1) than non-irradiated
blood. In the non-irradiated blood samples both potassium levels and
lactate levels increased as storage time increased and by 13 days the
potassium levels were over 20 mmol.l^-1. (Figure presented)
Discussion Biochemical disturbance in PRC increases with length of storage
time. This is exacerbated by irradiation. Whilst no consistent evidence of
worse patient outcomes with longer blood storage times exists there are
enough anecdotal reports of harm to warrant caution. The BCH transfusion
guideline for elective paediatric cardiac surgery recommends that, in
infants, cross-matched blood should be less than five days old and
irradiated blood should be used before midnight the day following
irradiation. Subsequent to this study we recommend that the above
guideline should be extended to apply to all clinical scenarios where
infants may require > 20 ml.kg ^-1 of blood. If possible, blood
transfusions should be given slowly and, for replacement of significant
blood loss, it may be necessary to 'wash' the blood using a cell saver to
allow rapid infusion without the deleterious effects of acidaemia and
hyperkalaemia.

<25>
Accession Number
72182716
Authors
O'Sullivan K.E. Hurley E.T. Segurado R. Hurley J.P.
Institution
(O'Sullivan, Hurley, Segurado, Hurley) Mater Private Hospital, Dublin,
Ireland
Title
Is transaortic comparable with transapical TAVI? A meta-analysis examining
procedural outcomes.
Source
EuroIntervention. Conference: PCR London Valves 2015 Berlin Germany.
Conference Start: 20150920 Conference End: 20150922. Conference
Publication: (var.pagings). (no pagination), 2015. Date of Publication:
September 2015.
Publisher
EuroPCR
Abstract
Aims: Transapical access has dominated as the alternative to transfemoral
TAVI to date. Feasibility of the transaortic approach has recently been
demonstrated by a number of groups and may provide a superior or at least
equivalent alternative. The aim of this study was to compare early
procedural outcomes of transapical vs. transaortic TAVI utilising
metaanalysis of data published to date. Methods and results: Data was
extracted from eligible studies reporting post procedural outcomes from
patients undergoing transapical and transaortic TAVI. A randomeffects
meta-analysis was performed using DerSimonian Laird betweenstudy variance
estimation. Multilevel mixed effects meta-regression with fixed moderator
variable for access type was run using package meta (v3.20) and metafor
(v1.92) in the R statistical software version 3.0.2 (cran.rproject.org),
and SAS (v 9.3). A total of 10 studies and 1,736 patients were included. A
total of 193 patients underwent transaortic and 1,543 transapical TAVI.
There was no difference identified in STS or EuroSCORE between groups
confirming comparability. No difference in 30 day mortality was
identified. There were no differences identified in procedural success
rate, stroke and transient ischaemic attack (TIA) incidence, major bleed
or pacemaker insertion rates. In addition, the incidence of clinically
significant paravalvular regurgitation (PVR) was the same between groups.
Conclusions: Provisional comparison of transapical and transaortic
approaches revealed equivalent outcomes in 30 day mortality, procedural
success, stroke and TIA incidence and pacemaker insertion rates. This
preliminary analysis suggests transaortic is a valid alternative to
transapical TAVI. Furthermore it is reasonable to suggest that centres
attain experience in both considering transaortic access may be more
suitable in certain patients such as those with a poor ejection fraction.

<26>
Accession Number
72182672
Authors
O'Sullivan K.E. Hurley E.T. Segurado R. Hurley J.P.
Institution
(O'Sullivan, Hurley, Segurado, Hurley) Mater Private Hospital, Dublin,
Ireland
Title
Sutureless aortic prostheses are associated with a higher incidence of
permanent pacemaker insertion than conventional: A meta-analysis.
Source
EuroIntervention. Conference: PCR London Valves 2015 Berlin Germany.
Conference Start: 20150920 Conference End: 20150922. Conference
Publication: (var.pagings). (no pagination), 2015. Date of Publication:
September 2015.
Publisher
EuroPCR
Abstract
Aims: Sutureless aortic valve prostheses are anchored by radial force in a
mechanism similar to that of transcatheter aortic valve implantation
(TAVI). TAVI is associated with an increased permanent pacemaker (PPM)
requirement in a significant proportion of patients. The aim of this
metaanalysis is to examine the incidence of PPM insertion associated with
sutureless compared with conventional SAVR. Methods and results: A
systematic review was conducted in accordance with the Prisma guidelines
(1). PubMed was searched by entering the following in the searching
algorithm: sutureless AND aortic AND valve, tissue AND aortic AND valve,
mechanical AND aortic AND valve. English was set as a language
restriction. All searches were performed on August 10th 2014. Studies
between 2007 and 2014 were included in the search. A mixed effects
metaregression with sutureless vs. conventional as a fixed moderator
variable was performed. In total, 832 patients were included in the
sutureless group and 3,740 in the conventional group. Permanent pacemaker
implantation rate was higher in the sutureless cohort (9.1 vs. 2.4%
p=0.025). Cardiopulmonary bypass and aortic cross clamp times were shorter
in the sutureless group (64.9 vs. 86.7 min p=0.002, 39.8 vs. 62.4 min
p<0.001). No statistically significant differences in PVR grades 14 were
identified between groups (grade 1: 3.6 vs. 1.4% p=0.107, grade 2: 0.9 vs.
0.3% p=0.264, grade 34 0 vs. 0.4% p=0.942). There was no difference in 30
day mortality between sutureless and conventional cohorts (1.9 vs. 3.2%
p=0.146). Conclusions: Sutureless aortic valve prostheses are associated
with a higher incidence of PPM insertion but shorter implantation time
than conventional, with no difference in 30 day mortality. Further
investigation as to the prognostic significance of pacemaker requirement
following sutureless aortic valve replacement is required.