EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 20

Results Generated From:
Embase <1980 to 2016 Week 10>
Embase (updates since 2016-02-25)

<1>
Accession Number
24913334
Author
Li Y.; Yin S.; Fang J.; Hua Y.; Wang C.; Mu D.; Zhou K.
Institution
(Li) Department of Pediatric Cardiovascular Disease, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
(Li) Ministry of Education Key Laboratory of Women and Children's Diseases
and Birth Defects, West China Second University Hospital, Sichuan
University, Chengdu, Sichuan, China
(Li) West China Medical School, Sichuan University, Chengdu, Sichuan,
China
(Yin) West China Medical School, Sichuan University, Chengdu, Sichuan,
China
(Fang) West China Stomatology School, Sichuan University, Chengdu,
Sichuan, China
(Hua) Department of Pediatric Cardiovascular Disease, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
(Hua) Ministry of Education Key Laboratory of Women and Children's
Diseases and Birth Defects, West China Second University Hospital, Sichuan
University, Chengdu, Sichuan, China
(Hua) Program for Changjiang Scholars and Innovative Research Team in
University, West China Second University Hospital, Sichuan University,
Chengdu, Sichuan, China
(Wang) Department of Pediatric Cardiovascular Disease, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
(Wang) Ministry of Education Key Laboratory of Women and Children's
Diseases and Birth Defects, West China Second University Hospital, Sichuan
University, Chengdu, Sichuan, China
(Wang) West China Medical School, Sichuan University, Chengdu, Sichuan,
China
(Mu) Department of Pediatric Cardiovascular Disease, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
(Mu) Ministry of Education Key Laboratory of Women and Children's Diseases
and Birth Defects, West China Second University Hospital, Sichuan
University, Chengdu, Sichuan, China
(Mu) Program for Changjiang Scholars and Innovative Research Team in
University, West China Second University Hospital, Sichuan University,
Chengdu, Sichuan, China
(Zhou) Department of Pediatric Cardiovascular Disease, West China Second
University Hospital, Sichuan University, Chengdu, Sichuan, China
(Zhou) Ministry of Education Key Laboratory of Women and Children's
Diseases and Birth Defects, West China Second University Hospital, Sichuan
University, Chengdu, Sichuan, China
(Zhou) Program for Changjiang Scholars and Innovative Research Team in
University, West China Second University Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Neurodevelopmental delay with critical congenital heart disease is mainly
from prenatal injury not infant cardiac surgery: current evidence based on
a meta-analysis of functional magnetic resonance imaging.
Source
Ultrasound in obstetrics & gynecology : the official journal of the
International Society of Ultrasound in Obstetrics and Gynecology. 45 (6)
(pp 639-648), 2015. Date of Publication: 01 Jun 2015.
Abstract
OBJECTIVE: No consensus has been reached regarding whether brain injury
related to congenital heart disease (CHD) is caused by infant cardiac
surgery and/or prenatal injury resulting from the CHD. We performed this
meta-analysis to identify the likely cause of neurodevelopmental delay in
CHD patients.
METHODS: We carried out a literature search without language restriction
in December 2013, retrieving records from PubMed, EMBASE, the Cochrane
Library and the World Health Organization trials center, to identify
studies applying functional magnetic resonance imaging (fMRI) evaluation
of brain function before surgery and, in some cases, after surgery (both
immediate term and short term postoperatively). The preoperative and
postoperative fMRI results were extracted, and meta-analysis was performed
using Revman 5.1.1 and STATA 11.0, according to the guidelines from the
Cochrane review and MOOSE groups.
RESULTS: The electronic search yielded 937 citations. Full text was
retrieved for 15 articles and eight articles (nine studies) were eligible
for inclusion: six studies (n=312 cases) with fMRI analysis before surgery
and three (n=36 cases) with complete perioperative fMRI analysis. The
overall average diffusivity of CHD cases was significantly higher than
that of controls, with a summarized standard (std) mean difference of 1.39
(95% CI, 0.70-2.08), and the fractional anisotropy was lower in CHD cases,
with a summarized mean difference of -1.43 (95% CI, -1.95 to -0.91).
N-acetylaspartate (NAA)/choline (Cho) for the whole brain was
significantly lower in CHD cases compared with healthy ones, while
lactate/Cho was significantly higher in CHD cases. Immediate term
postoperatively, significant changes in NAA/creatine and NAA/Cho, relative
to preoperative values, were found. However, the difference did not
persist at the short-term follow-up.
CONCLUSION: This meta-analysis suggests that the delay in neurological
development in newborns with CHD is due mainly to prenatal injury, and
cardiac surgery might lead to mild brain injuries postoperatively, but
fMRI shows recovery within a short period.

<2>
Accession Number
26256300
Author
Rogers C.A.; Bryan A.J.; Nash R.; Suleiman M.S.; Baos S.; Plummer Z.;
Hillier J.; Davies I.; Downes R.; Nicholson E.; Reeves B.C.; Angelini G.D.
Institution
(Rogers) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom. Electronic address:
chris.rogers@bristol.ac.uk
(Bryan) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Nash) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Suleiman) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Baos) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Plummer) Clinical Trials and Evaluation Unit, School of Clinical
Sciences, University of Bristol, Bristol, United Kingdom
(Hillier) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Davies) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Downes) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Nicholson) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Angelini) Bristol Heart Institute, University Hospitals Bristol National
Health Service Foundation Trust and University of Bristol, Bristol, United
Kingdom
Title
Propofol cardioplegia: A single-center, placebo-controlled, randomized
controlled trial.
Source
The Journal of thoracic and cardiovascular surgery. 150 (6) (pp
1610-1619), 2015. Date of Publication: 01 Dec 2015.
Abstract
OBJECTIVES: Cardiac surgery with cardiopulmonary bypass and cardioplegic
arrest is an effective treatment for coronary artery and aortic valve
diseases. However, the myocardium sustains reperfusion injury after
ischemic cardioplegic arrest. Our objective was to assess the benefits of
supplementing cardioplegia solution with the general anesthetic propofol
in patients undergoing either coronary artery bypass grafting (CABG) or
aortic valve replacement (AVR).
METHODS: A single-center, double-blind randomized controlled trial was
carried out to compare cardioplegia solution supplemented with propofol
(concentration 6 mug/mL) versus intralipid (placebo). The primary outcome
was cardiac troponin T release over the first 48 hours after surgery.
RESULTS: We recruited 101 participants (51 in the propofol group, 50 in
the intralipid group); 61 underwent CABG and 40 underwent AVR. All
participants were followed to 3 months. Cardiac troponin T release was on
average 15% lower with propofol supplementation (geometric mean ratio,
0.85; 95% confidence interval [CI], 0.73-1.01; P = .051). There were no
differences for CABG participants but propofol-supplemented participants
undergoing AVR had poorer postoperative renal function (geometric mean
ratio, 1.071; 95% CI, 1.019-1.125; P = .007), with a trend toward longer
intensive care stay (median, 89.5 vs 47.0 hours; hazard ratio, 0.58; 95%
CI, 0.31-1.09; P = .09) and fewer with perfect health (based on the EQ-5D
health utility index) at 3 months (odds ratio, 0.26; 95% CI, 0.06-1.05; P
= .058) compared with the intralipid group. Safety profiles were similar.
There were no deaths.
CONCLUSIONS: Propofol supplementation in cardioplegia appears to be
cardioprotective. Its influence on early clinical outcomes may differ
between CABG and AVR surgery. A larger, multicenter study is needed to
confirm or refute these suggestions.

<3>
Accession Number
25904437
Author
Holland B.J.; Myers J.A.; Woods C.R.
Institution
(Holland) Division of Pediatric Cardiology, Department of Pediatrics,
University of Louisville School of Medicine, Louisville, KY, USA
(Myers) Child and Adolescent Health Research and Design Support Unit,
Department of Pediatrics, University of Louisville School of Medicine,
Louisville, KY, USA
(Woods) Child and Adolescent Health Research and Design Support Unit,
Department of Pediatrics, University of Louisville School of Medicine,
Louisville, KY, USA
Title
Prenatal diagnosis of critical congenital heart disease reduces risk of
death from cardiovascular compromise prior to planned neonatal cardiac
surgery: a meta-analysis.
Source
Ultrasound in obstetrics & gynecology : the official journal of the
International Society of Ultrasound in Obstetrics and Gynecology. 45 (6)
(pp 631-638), 2015. Date of Publication: 01 Jun 2015.
Abstract
OBJECTIVE: To determine if prenatal diagnosis improves the chance that a
newborn with critical congenital heart disease will survive to undergo
planned cardiac surgery.
METHODS: A systematic review of the medical literature identified eight
studies which met the following criteria: compared outcomes between
newborns with prenatal and those with postnatal diagnosis of critical
congenital heart disease; compared groups of patients with the same
anatomical diagnosis; provided detailed information on cardiac anatomy;
included detailed information on preoperative cause of death. A
meta-analysis was performed to assess differences in preoperative
mortality rates between newborns with prenatal diagnosis and those with
postnatal diagnosis. Patients with established risk factors for increased
mortality (high risk) and those whose families chose comfort care rather
than cardiac surgery were excluded.
RESULTS: In patients with comparable anatomy, standard risk, a parental
desire to treat and optimal care, newborns with a prenatal diagnosis of
critical congenital heart disease were significantly less likely to die
prior to planned cardiac surgery than were those with a comparable
postnatal diagnosis (pooled odds ratio, 0.26; 95% CI, 0.08-0.84).
CONCLUSIONS: For newborns most likely to benefit from treatment for their
critical congenital heart disease, because they did not have additional
risk factors and their families pursued treatment, prenatal diagnosis
reduced the risk of death prior to planned cardiac surgery relative to
patients with a comparable postnatal diagnosis. Further study and efforts
to improve prenatal diagnosis of congenital heart disease should therefore
be considered.

<4>
Accession Number
26167637
Author
Combes A.; Brechot N.; Amour J.; Cozic N.; Lebreton G.; Guidon C.; Zogheib
E.; Thiranos J.-C.; Rigal J.-C.; Bastien O.; Benhaoua H.; Abry B.;
Ouattara A.; Trouillet J.-L.; Mallet A.; Chastre J.; Leprince P.; Luyt
C.-E.
Institution
(Combes) 1 Medical-Surgical Intensive Care Unit
(Brechot) 1 Medical-Surgical Intensive Care Unit
(Amour) 2 Anesthesiology and Critical Care Medicine Department
(Cozic) 3 Unite de Recherche Clinique, and
(Lebreton) 4 Cardiac Surgery Department, Institute of Cardiometabolism and
Nutrition, Hopital de la Pitie-Salpetriere, Assistance Publique-Hopitaux
de Paris, Universite Pierre et Marie Curie-Paris 6, Paris, France
(Guidon) 5 Anesthesiology and Critical Care Medicine Department, CHU La
Timone, Marseille, France
(Zogheib) 6 Anesthesiology and Critical Care Medicine Department, Amiens
University Hospital, INSERM U-1088, Universite de Picardie Jules-Verne,
Amiens, France
(Thiranos) 7 Anesthesiology and Critical Care Medicine Department, CHU de
Strasbourg, Strasbourg, France
(Rigal) 8 Department d'Anesthesiologie et Reanimation, CHU de Nantes,
Nantes, France
(Bastien) 9 Anesthesiology and Critical Care Medicine Department, CHU de
Lyon, Lyon, France
(Benhaoua) 10 Anesthesiology and Critical Care Medicine Department, CHU de
Toulouse, Toulouse, France
(Abry) 11 Anesthesiology and Critical Care Medicine Department, Clinique
Jacques Cartier, Massy, France; and
(Ouattara) 12 Department of Anesthesia and Critical Care II, CHU de
Bordeaux, and Universite de Bordeaux, Adaptation Cardiovasculaire a
l'Ischemie, U1034, Pessac, France
(Trouillet) 1 Medical-Surgical Intensive Care Unit
(Mallet) 3 Unite de Recherche Clinique, and
(Chastre) 1 Medical-Surgical Intensive Care Unit
(Leprince) 4 Cardiac Surgery Department, Institute of Cardiometabolism and
Nutrition, Hopital de la Pitie-Salpetriere, Assistance Publique-Hopitaux
de Paris, Universite Pierre et Marie Curie-Paris 6, Paris, France
(Luyt) 1 Medical-Surgical Intensive Care Unit
Title
Early High-Volume Hemofiltration versus Standard Care for Post-Cardiac
Surgery Shock. The HEROICS Study.
Source
American journal of respiratory and critical care medicine. 192 (10) (pp
1179-1190), 2015. Date of Publication: 15 Nov 2015.
Abstract
RATIONALE: Post-cardiac surgery shock is associated with high morbidity
and mortality. By removing toxins and proinflammatory mediators and
correcting metabolic acidosis, high-volume hemofiltration (HVHF) might
halt the vicious circle leading to death by improving myocardial
performance and reducing vasopressor dependence.
OBJECTIVES: To determine whether early HVHF decreases all-cause mortality
30 days after randomization.
METHODS: This prospective, multicenter randomized controlled trial
included patients with severe shock requiring high-dose catecholamines
3-24 hours post-cardiac surgery who were randomized to early HVHF (80
ml/kg/h for 48 h), followed by standard-volume continuous venovenous
hemodiafiltration (CVVHDF) until resolution of shock and recovery of renal
function, or conservative standard care, with delayed CVVHDF only for
persistent, severe acute kidney injury.
MEASUREMENTS AND MAIN RESULTS: On Day 30, 40 of 112 (36%) HVHF and 40 of
112 (36%) control subjects (odds ratio, 1.00; 95% confidence interval,
0.64-1.56; P=1.00) had died; only 57% of the control subjects had received
renal-replacement therapy. Between-group survivors' Day-60, Day-90,
intensive care unit, and in-hospital mortality rates, Day-30
ventilator-free days, and renal function recovery were comparable. HVHF
patients experienced faster correction of metabolic acidosis and tended to
be more rapidly weaned off catecholamines but had more frequent
hypophosphatemia, metabolic alkalosis, and thrombocytopenia.
CONCLUSIONS: For patients with post-cardiac surgery shock requiring
high-dose catecholamines, the early HVHF onset for 48 hours, followed by
standard volume until resolution of shock and recovery of renal function,
did not lower Day-30 mortality and did not impact other important
patient-centered outcomes compared with a conservative strategy with
delayed CVVHDF initiation only for patients with persistent, severe acute
kidney injury. Clinical trial registered with www.clinicaltrials.gov (NCT
01077349).

<5>
Accession Number
20160044634
Author
Islam A.K.M.M.; Majumder A.A.S.
Institution
(Islam) Department of Cardiology, Jessore Medical College, Jessore,
Bangladesh
(Majumder) National Institute of Cardiovascular Diseases, Dhaka, National
Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka,
Bangladesh
Title
Rheumatic fever and rheumatic heart disease in Bangladesh: A review.
Source
Indian Heart Journal. 68 (1) (pp 88-98), 2016. Date of Publication: 01 Jan
2016.
Publisher
Elsevier
Abstract
Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common
cardiovascular disease in young people aged <25 years, globally. They are
important contributors to cardiovascular morbidity and mortality in
Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance,
and insufficient health care services were responsible for the high
incidence and prevalence of these diseases over the last century. In
concert with the progresses in socioeconomic indicators, advances in
health sectors, improved public awareness, and antibiotic prophylaxis,
acute RF came into control. However, chronic RHD continues to be
prevalent, and the actual disease burden may be much higher. RHD
predominantly affects the young adults, seriously incapacitates them,
follows a protracted course, gets complicated because of delayed diagnosis
and is sometimes maltreated. The treatment is often palliative and
expensive. Large-scale epidemiological and clinical researches are needed
to formulate evidence-based national policy to tackle this important
public health issue in future.

<6>
Accession Number
20160142863
Author
Andreas M.; Doll N.; Livesey S.; Castella M.; Kocher A.; Casselman F.;
Voth V.; Bannister C.; Palacios J.F.E.; Pereda D.; Laufer G.; Czesla M.
Institution
(Andreas, Kocher, Laufer) Department of Surgery, Division of Cardiac
Surgery, Medical University of Vienna, Vienna, Austria
(Doll, Voth, Czesla) Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
(Livesey, Bannister) Department of Cardiothoracic Surgery, Southampton
General Hospital, Southampton, United Kingdom
(Castella, Palacios, Pereda) Department of Cardiovascular Surgery,
Institut Clinic del Torax, Hospital Clinic, University of Barcelona,
Barcelona, Spain
(Casselman) Department of Cardiovascular and Thoracic Surgery, OLV Clinic,
Aalst, Belgium
Title
Safety and feasibility of a novel adjustable mitral annuloplasty ring: A
multicentre European experience.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 249-254), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Recurrent mitral regurgitation is a significant problem after
mitral valve repair in patients with functional valve disease. We report
the safety and feasibility of a novel adjustable mitral annuloplasty
device that permits downsizing of the anterior-posterior diameter late
after initial surgery. METHODS: In this multicentre, non-randomized,
observational register, patients with moderate or severe mitral
regurgitation undergoing surgical mitral valve repair with the MiCardia
EnCorSQTM Mitral Valve Repair system were evaluated. Patient
characteristics, operative specifications and results as well as
postoperative follow-up were collected for all five centres. RESULTS:
Ninety-four patients with a median age of 71 (64-75) years (EuroSCORE II
6.7 +/- 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and
15% degenerative disease) were included. Operative mortality was 1% and
the 1-year survival was 93%. Ring adjustment was attempted in 12 patients
at a mean interval of 9 +/- 6 months after surgery. In three of these
attempts, a technical failure occurred. In 1 patient, mitral regurgitation
was reduced two grades, in 2 patients mitral regurgitation was reduced one
grade and in 6 patients, mitral regurgitation did not change
significantly. The mean grade of mitral regurgitation changed from 2.9 +/-
0.9 to 2.1 +/- 0.7 (P = 0.02). Five patients were reoperated after 11 +/-
9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION: We
conclude that this device may provide an additional treatment option in
patients with functional mitral regurgitation, who are at risk for
reoperation due to recurrent mitral regurgitation. Clinical results in
this complex disease were ambiguous and patient selection seems to be a
crucial step for this device. Further trials are required to estimate the
clinical value of this therapeutic concept.

<7>
Accession Number
20160142805
Author
Fiorelli A.; Izzo A.C.; Frongillo E.M.; Prete A.D.; Liguori G.; Di
Costanzo E.; Vicidomini G.; Santini M.
Institution
(Fiorelli, Izzo, Frongillo, Prete, Vicidomini, Santini) Thoracic Surgery
Unit, Second University of Naples, Naples, Italy
(Liguori) Anestesiology and Intensive Care Unit, Cardarelli Hospital,
Naples, Italy
(Di Costanzo) Anestesiology and Intensive Care Unit, Monaldi Hospital,
Naples, Italy
Title
Efficacy of wound analgesia for controlling post-thoracotomy pain: A
randomized double-blind study.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 339-347), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Continuous wound infusion of local anaesthetics has been
successfully applied for postoperative pain control in several procedures
but, surprisingly, it is underused in thoracic surgery. We aimed to
investigate the effects of wound analgesia associated with systemic
patient-controlled analgesia in patients undergoing lung cancer resection
with muscle-sparing thoracotomy. METHODS: Sixty consecutive patients
undergoing lung cancer resection via standard muscle-sparing thoracotomy
were randomized into two groups (wound analgesia and placebo groups).
Bupivacaine in the wound group and free-saline solution in the placebo
group were injected using a multiholed catheter connected to an
elastomeric pump inserted at the end of operation between the pericostal
sutures and the serratus muscle and removed 48 h after. The inter-group
differences were assessed by the following criteria: (i) level of
cytokines [IL-6, IL-10 and tumour necrosis factor-alpha (TNF-alpha)]; (ii)
pain on a visual analogue scale at rest and after coughing; (iii) recovery
of respiratory functions (flow expiratory volume in 1 s % and forced vital
capacity %) and (iv) narcotic medication consumption at different time
points of the postoperative course. RESULTS: Five out of a total of 60
patients were excluded from the final analysis. Thus, the wound and
placebo groups comprised 27 and 28 patients, respectively. The wound group
compared with the placebo group had a significant decrease of IL-6 (P <
0.001), IL-10 (P < 0.001) and TNF-alpha (P < 0.001) blood concentration
levels, pain scores at rest (P < 0.001) and after coughing (P = 0.01), and
a reduction of additional morphine intake (P = 0.03) and Ketorolac (P =
0.01) during the entire postoperative course. The recovery of the flow
expiratory volume in one second % (P = 0.01) and the forced vital capacity
% (P = 0.02) was also better in the wound than in the placebo group.
CONCLUSIONS: Our data prove that wound analgesia is an effective, easy and
safe procedure. It significantly reduces systemic inflammatory markers,
pain scores and opioid intake; and accelerates the recovery of respiratory
function. Catheter placement does not require particular manoeuvres by the
surgeon nor does the elastomeric pump need any adjustment or care by
physicians or nurses.

<8>
Accession Number
20160142825
Author
Bender B.; Murthy V.; Chamberlain R.S.
Institution
(Bender, Chamberlain) Saint George's University School of Medicine,
Grenada
(Bender) Department of Internal Medicine, Hahnemann University Hospital,
Philadelphia, PA, United States
(Murthy, Chamberlain) Department of Surgery, Saint Barnabas Medical
Center, Livingston, NJ, United States
(Chamberlain) Department of Surgery, Rutgers University, New Jersey
Medical School, Newark, NJ, United States
Title
The changing management of chylothorax in the modern era.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 18-24), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Initial conservative therapy is applied to all cases of chylothorax (CTx)
with expected excellent outcomes. The indication for aggressive surgical
treatment of early CTx remains uncertain and requires rigorous scientific
scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize
the leak and assess thoracic duct patency as well as to differentiate
partial from complete thoracic duct transection. The aetiology of the CTx,
flow rate and patient condition dictate the preferred management.
Octreotide/somatostatin and etilefrine therapy is highly efficacious in
the conservative management of CTx. For patients in whom conservative
management fails, those who are good surgical candidates, and those in
whom the site of the leak is well identified, surgical repair and/or
ligation using minimally invasive techniques is highly successful with
limited adverse outcomes. Similarly, if the site of the chylous effusion
cannot be well visualized, a thoracic duct ligation via video-assisted
thoracic surgery is the gold standard approach. A pleuroperitoneal or less
often a pleurovenous shunt is a final option and may be curative in some
patients.

<9>
Accession Number
20160142824
Author
Pilarczyk K.; Boening A.; Jakob H.; Langebartels G.; Markewitz A.; Haake
N.; Heringlake M.; Trummer G.
Institution
(Pilarczyk, Jakob) Department of Thoracic and Cardiovascular Surgery, West
German Heart Centre Essen, University Hospital Essen, Essen, Germany
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giessen, Germany
(Langebartels) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Cologne, Germany
(Markewitz) Department of Cardiovascular Surgery, Bundeswehr Central
Hospital, Koblenz, Germany
(Haake) Department of Cardiovascular Surgery, School of Medicine,
University of Schleswig-Holstein, Kiel, Germany
(Heringlake) Department of Anesthesiology, University of Lubeck, Lubeck,
Germany
(Trummer) Department of Cardiovascular Surgery, Heart Center Freiburg
University, Freiburg, Germany
Title
Preoperative intra-aortic counterpulsation in high-risk patients
undergoing cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 5-17), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
In contrast to the results of previous studies, recent randomized
controlled trials (RCTs) failed to show a benefit of prophylactic aortic
counterpulsation in high-risk patients undergoing cardiac surgery. The
present analysis aims to redefine the effects of this treatment modality
in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google
Scholar and reference lists of relevant articles were searched for
full-text articles of RCTs in English or German. Assessments for
eligibility, relevance, study validity and data extraction were performed
by two reviewers independently using prespecified criteria. The primary
outcome was hospital mortality. A total of nine eligible RCTs with 1171
patients were identified: 577 patients were treated preoperatively with
intra-aortic balloon pump (IABP) and 594 patients served as controls. The
pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the
intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629;
P < 0.001). The pooled analyses of five RCTs including only patients
undergoing isolated on-pump coronary artery bypass grafting (n[IABP] =
348, n[control] = 347) also showed a statistically significant improvement
in mortality for preoperative IABP implantation (fixed-effects model: OR
0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital
mortality from two randomized off-pump trials was 0.556 (fixed-effects
model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic
counterpulsation was associated with a significant reduction in low
cardiac output syndrome (LCOS) in the total population (fixed-effects
model: OR 0.330, 95% CI 0.214- 0.508, P < 0.001) as well as in the
subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI
0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump
population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238).
Preoperative IABP implantation was associated with a reduction of
intensive care unit (ICU) stay in all investigated populations with a
greater effect in the total population [fixed-effects model: standard mean
difference (SMD) -0.931 +/- 0.198, P < 0.001] as well as in the subgroup
of CAGB patients (fixedeffects model: SMD -1.240 +/- 0.156, P < 0.001),
compared with the off-pump group (fixed-effects model: SMD -0.723 +/-
0.128, P < 0.001). Despite contradictory results from recent trials, the
present study confirms the findings of previous meta-analyses that
prophylactic aortic counterpulsation reduces hospital mortality, incidence
of LCOS and ICU requirement in high-risk patients undergoing on-pump
cardiac surgery. However, owing to small sample sizes and the lack of a
clear-cut definition of high-risk patients, an adequately powered,
prospective RCT is necessary to find a definite answer to the question, if
certain groups of patients undergoing cardiac surgery benefit from a
prophylactic IABP insertion.

<10>
Accession Number
20160132032
Author
Erdil N.; Eroglu T.; Akca B.; Disli O.M.; Yetkin O.; Colak M.C.; Erdil F.;
Battaloglu B.
Institution
(Erdil, Disli, Colak, Battaloglu) Department of Cardiovascular Surgery,
Turgut Ozal Medical Center, Inonu University, Faculty of Medicine,
Malatya, Turkey
(Eroglu) Department of Cardiovascular Surgery, Kayseri State Hospital,
Kayseri, Turkey
(Akca) Department of Cardiovascular Surgery, Kilis State Hospital, Kilis,
Turkey
(Yetkin) Department of Pulmonary and Sleep Medicine, Turgut Ozal Medical
Center, Inonu University, Faculty of Medicine, Malatya, Turkey
(Erdil) Department of Anesthesiology and Reanimation, Turgut Ozal Medical
Center, Inonu University, Faculty of Medicine, Malatya, Turkey
(Erdil, Eroglu, Akca, Disli, Yetkin, Colak, Erdil, Battaloglu) Inonu
University, Faculty of Medicine, Turkey
Title
The effects of N-acetylcysteine on pulmonary functions in patients
undergoing on-pump coronary artery surgery: A double blind placebo
controlled study.
Source
European Review for Medical and Pharmacological Sciences. 20 (1) (pp
180-187), 2016. Date of Publication: 2016.
Publisher
Verduci Editore
Abstract
OBJECTIVE: To investigate the effects of N-acetylcysteine (NAC) on
pulmonary function tests and arterial blood gases in patients undergoing
on-pump coronary artery surgery. PATIENTS AND METHODS: The effect of NAC
was assessed within the scope of a prospective, single center,
double-blind, placebo-controlled, parallel group study. Eighty-two
patients undergoing coronary artery bypass grafting were randomized into
two groups to receive either placebo (group 1, n = 40) or NAC (group 2,
n=42). Both the NAC group and the placebo-receiving control group also
included a COPD subgroup consist ing of pat ients wi th an FEV1/FVC ratio
of < 0.7 and an FEV1 value of 50- 80%. Pulmonary function tests were
performed preoperatively and on postoperative day 60. RESULTS: Both groups
were similar with respect to age, gender, preoperative risk factors,
ejection fraction (EF), mean cross-clamp time, ventilation time, intensive
care unit (ICU) stay, atrial fibrillation (AF) and hospital stay (p >
0.05). Postoperative FVC and FEV1 values in group 1 and the postoperative
FEV1, FEV1/FVC and FEF 25-75 values in group 2 were lower in comparison to
their preoperative values. However, in both group 1 and 2, the decreases
observed in these parameters were not statistically significant (p >
0.05). In the COPD subgroup of group 1, a postoperative decrease was
observed in the FEV1 and FEF25-75 values, with the FEV1 decreasing by
4.55%, and the FEF25-75 decreasing by 4.2% (p < 0.05). In the COPD
subgroup of group 2, no significant decrease was observed in the pulmonary
function test values (p > 0.05). CONCLUSIONS: This study demonstrated that
NAC administration in COPD patients undergoing on-pump coronary artery
surgery resulted in the preservation of pulmonary functions.

<11>
Accession Number
20160149464
Author
Helviz Y.; Dzigivker I.; Raveh-Brawer D.; Hersch M.; Zevin S.; Einav S.
Institution
(Helviz, Hersch) Intensive Care Unit, Shaare Zedek Medical Center,
Jerusalem, Israel
(Dzigivker) Department of Cardiothoracic Surgery, Shaare Zedek Medical
Center, Jerusalem, Israel
(Raveh-Brawer) Infectious Diseases Unit, Shaare Zedek Medical Center,
Jerusalem, Israel
(Zevin) Department of Internal Medicine, Shaare Zedek Medical Center,
Jerusalem, Israel
(Einav) Surgical Intensive Care Unit, Shaare Zedek Medical Center,
Jerusalem, Israel
(Hersch, Zevin, Einav) Hadassah-Hebrew University Medical School,
Jerusalem, Israel
Title
Anti-factor Xa activity of prophylactic enoxaparin regimens in critically
ill patients.
Source
Israel Medical Association Journal. 18 (2) (pp 108-113), 2016. Date of
Publication: February 2016.
Publisher
Israel Medical Association (2 Twin Towers,11th Floor,35 Jabotinsky
Street,PO Box 3566, Ramat Gan 52135, Israel)
Abstract
Background: Enoxaparin is frequently used as prophylaxis for deep venous
thrombosis in critically ill patients. Objectives: To evaluate three
enoxaparin prophylactic regimens in critical care patients with and
without administration of a vasopressor. Methods: Patients admitted to
intensive care units (general and post-cardiothoracic surgery) without
renal failure received, once daily, a subcutaneous fixed dose of 40 mg
enoxaparin, a subcutaneous dose of 0.5 mg/kg enoxaparin, or an intravenous
dose of 0.5 mg/kg enoxaparin. Over 5 days anti-activated factor X levels
were collected before the daily administration and 4 hours after the
injection. Results: Overall, 16 patients received the subcutaneous fixed
dose, 15 received the subcutaneous weight-based dosage, and 8 received the
dose intravenously. Around two-fifths (38%) of the patients received
vasopressors. There was no difference between anti-activated factor X
levels regarding vasopressor administration. However, in all three groups
the levels were outside the recommended range of 0.1 IU/ml and 0.3 IU/ml.
Conclusions: Although not influenced by vasopressor administration, the
enoxaparin regimens resulted in blood activity levels outside the
recommended range.

<12>
Accession Number
20160140056
Author
O'Gallagher K.; Dancy L.; Sinha A.; Sado D.
Institution
(O'Gallagher, Dancy, Sinha, Sado) Cardiology Department, King's College
Hospital, NHS Foundation Trust, London, United Kingdom
Title
Rosai-dorfman disease and the heart.
Source
Intractable and Rare Diseases Research. 5 (1) (pp 1-5), 2016. Date of
Publication: 2016.
Publisher
International Advancement Center for Medicine and Health Research
Abstract
Rosai-Dorfman disease (RDD) is a non-malignant pathology of histiocyte
proliferation. The classical clinical presentation is with painless
cervical lymphadenopathy, but extranodal involvement is frequent,
occurring in approximately 40% of cases. The literature was systematically
reviewed to identify reported cases of RDD with cardiac involvement.
Eighteen cases were identified (3 pediatric and 15 adult). In adult
cardiac RDD (cRDD), three patterns of disease were noted: an intra-cardiac
mass, epicardial involvement, and pulmonary artery involvement. Reported
cases suggest that surgical excision of intra-cardiac masses confers a
good prognosis.

<13>
[Use Link to view the full text]
Accession Number
2014733754
Author
Haugen A.S.; Softeland E.; Almeland S.K.; Sevdalis N.; Vonen B.; Eide
G.E.; Nortvedt M.W.; Harthug S.
Institution
(Haugen, Softeland) Department of Anesthesia and Intensive Care, Haukeland
University Hospital, Jonas Liesvei 65, Bergen N-5021, Norway
(Haugen, Harthug) Department of Clinical Science, Faculty of Medicine and
Dentistry, University of Bergen, Bergen, Norway
(Almeland) Department of Surgery, Forde Central Hospital, Forde, Norway
(Sevdalis) Centre for Patient Safety and Service Quality, Department of
Surgery and Cancer, Imperial College, London, United Kingdom
(Vonen) Department of Surgery, Nordland Hospital, Bodo, Norway
(Eide) Centre for Clinical Research, Haukeland University Hospital,
Bergen, Norway
(Eide) Department of Global Public Health and Primary Care, Faculty of
Medicine and Dentistry, University of Bergen, Bergen, Norway
(Nortvedt) Centre for Evidence Based Practice, Bergen University College,
Bergen, Norway
(Harthug) Department of Research and Development, Haukeland University
Hospital, Bergen, Norway
Title
Effect of the World Health Organization Checklist on Patient Outcomes: A
Stepped Wedge Cluster Randomized Controlled Trial.
Source
Annals of Surgery. 261 (5) (pp 821-828), 2015. Date of Publication: 01 May
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: We hypothesized reduction of 30 days' in-hospital morbidity,
mortality, and length of stay postimplementation of the World Health
Organization's Surgical Safety Checklist (SSC). Background: Reductions of
morbidity and mortality have been reported after SSC implementation in
pre-/postdesigned studies without controls. Here, we report a randomized
controlled trial of the SSC. Methods: A stepped wedge cluster randomized
controlled trial was conducted in 2 hospitals. We examined effects on
in-hospital complications registered by International Classification of
Diseases, Tenth Revision codes, length of stay, and mortality. The SSC
intervention was sequentially rolled out in a random order until all 5
clusters-cardiothoracic, neurosurgery, orthopedic, general, and urologic
surgery had received the Checklist. Data were prospectively recorded in
control and intervention stages during a 10-month period in 2009-2010.
Results: A total of 2212 control procedures were compared with 2263 SCC
procedures. The complication rates decreased from 19.9% to 11.5% (P <
0.001), with absolute risk reduction 8.4 (95% confidence interval,
6.3-10.5) from the control to the SSC stages. Adjusted for possible
confounding factors, the SSC effect on complications remained significant
with odds ratio 1.95 (95% confidence interval, 1.59-2.40). Mean length of
stay decreased by 0.8 days with SCC utilization (95% confidence interval,
0.11-1.43). In-hospital mortality decreased significantly from 1.9% to
0.2% in 1 of the 2 hospitals post-SSC implementation, but the overall
reduction (1.6%-1.0%) across hospitals was not significant. Conclusions:
Implementation of the WHO SSC was associated with robust reduction in
morbidity and length of in-hospital stay and some reduction in mortality.

<14>
Accession Number
20160137177
Author
Matchar D.B.; Love S.R.; Jacobson A.K.; Edson R.; Uyeda L.; Phibbs C.S.;
Dolor R.J.
Institution
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar, Dolor) Division of General Internal Medicine, Department of
Medicine and Center for Clinical Health Policy Research, Duke University
Medical Center, 2400 Pratt Street, Durham, NC 27705, United States
(Matchar, Love) Health Services and Systems Research Program,
Duke-National University of Singapore Graduate Medical School, 8 College
Road, Singapore 169857, Singapore
(Jacobson) Research and Development Service (151), Jerry L. Pettis VA
Medical Center, 11201 Benton Street, Loma Linda, CA 92357, United States
(Jacobson) Department of Internal Medicine, Loma Linda Healthcare System,
Loma Linda University, 24851 Circle Drive, Loma Linda, CA 92354, United
States
(Edson, Uyeda) Cooperative Studies Program Coordinating Center (151K), VA
Palo Alto Health Care System, 701-B N. Shoreline Blvd, Mountain View, CA
94043-3208, United States
(Phibbs) Health Economics Resource Center, VA Palo Alto Health Care
System, 701-B N. Shoreline Blvd, Mountain View, CA 94043, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, 921 Campus Drive,
Stanford, CA 94305, United States
(Love) Warren Alpert Medical School of Brown University, 222 Richmond
Street, Providence, RI 02903, United States
(Phibbs) Health Economic Resource Center (152), VA Palo Alto Health Care
System, 795 Willow Road, Menlo Park, CA 94025, United States
Title
The impact of frequency of patient self-testing of prothrombin time on
time in target range within VA Cooperative Study #481: The Home INR Study
(THINRS), a randomized, controlled trial.
Source
Journal of Thrombosis and Thrombolysis. 40 (1) (pp 17-25), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Springer New York LLC
Abstract
Anticoagulation (AC) is effective in reducing thromboembolic events for
individuals with atrial fibrillation (AF) or mechanical heart valve (MHV),
but maintaining patients in target range for international normalized
ratio (INR) can be difficult. Evidence suggests increasing INR testing
frequency can improve time in target range (TTR), but this can be
impractical with in-clinic testing. The objective of this study was to
test the hypothesis that more frequent patient-self testing (PST) via home
monitoring increases TTR. This planned substudy was conducted as part of
The Home INR Study, a randomized controlled trial of in-clinic INR testing
every 4 weeks versus PST at three different intervals. The setting for
this study was 6 VA centers across the United States. 1,029 candidates
with AF or MHV were trained and tested for competency using ProTime INR
meters; 787 patients were deemed competent and, after second consent,
randomized across four arms: high quality AC management (HQACM) in a
dedicated clinic, with venous INR testing once every 4 weeks; and
telephone monitored PST once every 4 weeks; weekly; and twice weekly. The
primary endpoint was TTR at 1-year follow-up. The secondary endpoints
were: major bleed, stroke and death, and quality of life. Results showed
that TTR increased as testing frequency increased (59.9 +/- 16.7 %, 63.3
+/- 14.3 %, and 66.8 +/- 13.2 % [mean +/- SD] for the groups that
underwent PST every 4 weeks, weekly and twice weekly, respectively). The
proportion of poorly managed patients (i.e., TTR <50 %) was significantly
lower for groups that underwent PST versus HQACM, and the proportion
decreased as testing frequency increased. Patients and their care
providers were unblinded given the nature of PST and HQACM. In conclusion,
more frequent PST improved TTR and reduced the proportion of poorly
managed patients.

<15>
Accession Number
20160124579
Author
Kanwar S.M.; Noheria A.; Desimone C.V.; Rabinstein A.A.; Asirvatham S.J.
Institution
(Kanwar) University of Wisconsin, Madison, WI, United States
(Noheria, Desimone, Asirvatham) Division of Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Rabinstein) Department of Neurology, Mayo Clinic, Rochester, MN, United
States
(Asirvatham) Department of Pediatrics and Adolescent Medicine, Mayo
Clinic, Rochester, MN, United States
Title
Coincidental impact of transcatheter patent foramen ovale closure on
migraine with and without aura - A comprehensive meta-analysis.
Source
Clinical Trials and Regulatory Science in Cardiology. 15 (pp 7-13), 2016.
Date of Publication: 01 Mar 2016.
Publisher
Elsevier
Abstract
Background We analyzed the literature to assess the coincidental impact on
migraines of transcatheter patent foramen ovale (PFO) closure performed
for secondary stroke prevention. Methods We searched Medline, EMBASE, and
the Cochrane database for studies published up until August 2013. We
included English-language studies that provided information on complete
resolution or improvement in migraine headaches following PFO closure. Two
study authors identified 375 original articles and both independently
reviewed 32 relevant manuscripts. Data including study methodology,
inclusion criteria, PFO closure and migraine outcomes were extracted
manually from all eligible studies. Pooled odds (and probability) of
resolution or improvement of migraine headaches were calculated using
random-effects models. Results Twenty studies were analyzed. Most were
uncontrolled studies that included a small number of patients with
cryptogenic stroke who had undergone PFO closure and had variable time of
follow-up. The probability of complete resolution of migraine with PFO
closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39,
0.53) and of any improvement in migraine (17 studies, 881 patients) was
0.78 (0.74, 0.82). There was evidence for publication bias in studies
reporting on improvement in migraines (Begg's p = 0.002), but not for
studies on complete resolution of migraine (p = 0.3). In patients with
aura, the probability of complete resolution of migraine post-PFO closure
was 0.54 (0.43, 0.65), and in those without aura, complete resolution
occurred in 0.39 (0.29, 0.51). Conclusions Among patients with unexplained
stroke and migraine undergoing transcatheter PFO closure, resolution of
headaches occurred in a majority of patients with aura and for a smaller
proportion of patients without aura.

<16>
[Use Link to view the full text]
Accession Number
20151056728
Author
Rodrigues G.; De Araujo Goncalves P.; Madeira S.; Rodrigues R.; Santos
M.B.; Brito J.; Raposo L.; Gabriel H.M.; Teles R.C.; Almeida M.; Mendes M.
Institution
(Rodrigues, De Araujo Goncalves, Madeira, Rodrigues, Santos, Brito,
Raposo, Gabriel, Teles, Almeida, Mendes) Hospital de Santa Cruz, Centro
Hospitalar de Lisboa Ocidental, Lisbon, Portugal
(De Araujo Goncalves, Almeida) CEDOC, Nova Medical School, Lisbon,
Portugal
Title
Impact of complete revascularization in patients with ST-elevation
myocardial infarction: Analysis of a 10-year all-comers prospective
registry.
Source
Coronary Artery Disease. 27 (2) (pp 122-127), 2016. Date of Publication:
28 Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background The benefit of complete revascularization (CR) during a primary
percutaneous coronary intervention (PCI) in patients with multivessel
disease (MVD) is still not clear. The aim of the present study was to
evaluate the impact of CR in a nonselected population from an allcomers
prospective registry of patients with ST-elevation myocardial infarction
(STEMI) over a long period of time. Methods and results Between 2004 and
2014, 671 noncardiogenic shock STEMI patients with MVD were included in
the present study, of whom 522 were subjected to incomplete
revascularization and 149 were subjected to CR. Patients in the CR group
were younger [61 (SD 12) vs. 64 (SD 12.4) years old, P=0.001], more often
subjected to femoral access (79.4 vs. 67.1%, P=0.002), and had a lower
number of segments with lesion [2 (2.2) vs. 3 (3.4), P=0.001]. The CR
group tended to have a lower 1-year major adverse cardiac event (MACE)
rate (17.8 vs. 25.7%; P=0.05) that reached statistical significance at 2
years (19.4 vs. 28.5%, P=0.03). The rates of the individual endpoints were
not different between groups. Independent predictors of 2-year MACE were
age, femoral access, and previous PCI. Index CR was associated with lower
MACE (hazard ratio 0.5, 0.36-0.79). MACE-free survival was higher in the
CR group throughout the 2 years of follow-up. Conclusion In patients with
STEMI and MVD undergoing culprit lesion PCI, preventive PCI in noninfarct
coronary arteries with significant stenosis was associated with a lower
risk of MACE compared with incomplete revascularization in this all-comers
prospective registry.

<17>
Accession Number
20160141478
Author
Wan Y.-D.; Sun T.-W.; Kan Q.-C.; Guan F.-X.; Liu Z.-Q.; Zhang S.-G.
Institution
(Wan, Sun, Liu, Zhang) Department of Integrated ICU, First Affiliated
Hospital of Zhengzhou University, Zhengzhou, China
(Kan) Pharmaceutical Department, First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Guan) Academy of Medical Science, Henan Province, Zhengzhou, China
Title
The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients
Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of
Randomized Controlled Trials of Coronary Artery Bypass Grafting and
Stenting Era.
Source
PLoS ONE. 11 (1) (no pagination), 2016. Article Number: e0147291. Date of
Publication: 01 Jan 2016.
Publisher
Public Library of Science
Abstract
Background Intra-aortic balloon pumps (IABP) have generally been used for
patients undergoing highrisk mechanical coronary revascularization.
However, there is still insufficient evidence to determine whether they
can improve outcomes in reperfusion therapy patients, mainly by
percutaneous coronary intervention (PCI) with stenting or coronary artery
bypass graft (CABG). This study was designed to determine the difference
between high-risk mechanical coronary revascularization with and without
IABPs on mortality, by performing a metaanalysis on randomized controlled
trials of the current era. Methods Pubmed and Embase databases were
searched from inception to May 2015. Unpublished data were obtained from
the investigators. Randomized clinical trials of IABP and non-IABP in
high-risk coronary revascularization procedures (PCI or CABG) were
included. In the case of PCI procedures, stents should be used in more
than 80% of patients. Numbers of events at the short-term and long-term
follow-up were extracted. Results A total of 12 randomized trials
enrolling 2155 patients were included. IABPs did not significantly
decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42
1.01), or longterm mortality (RR 0.79; 95% CI, 0.47 1.35), with low
heterogeneity across the studies. The findings remained stable in patients
with acute myocardial infarction with or without cardiogenic shock. But in
high-risk CABG patients, IABP was associated with reduced mortality (71
events in 846 patients; RR 0.40; 95%CI 0.25 0.67). Conclusion In patients
undergoing high-risk coronary revascularization, IABP did not
significantly decrease mortality. But high-risk CABG patients may be
benefit from IABP. Rigorous criteria should be applied to the use of
IABPs.

<18>
[Use Link to view the full text]
Accession Number
2015503380
Author
Alamir M.A.; Ellenberg S.S.; Swerdloff R.S.; Wenger N.K.; Mohler E.R.;
Lewis C.E.; Barrett-Conner E.; Nakanishi R.; Darabian S.; Alani A.;
Matsumoto S.; Nezarat N.; Snyder P.J.; Budoff M.J.
Institution
(Alamir, Swerdloff, Darabian, Alani, Matsumoto, Nezarat, Budoff) Los
Angeles Biomedical Research Institute at Harbor-UCLA, 1124WCarson Street,
Torrance, CA 90502, United States
(Ellenberg) Center for Clinical Epidemiology and Biostatistics, United
States
(Mohler) Division of Cardiovascular Disease, Section of Vascular Medicine,
United States
(Snyder) Division of Endocrinology, Diabetes, and Metabolism, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Wenger) Department of Medicine, Division of Cardiology, Emory University
School of Medicine, Emory Heart and Vascular Center, Atlanta, GA, United
States
(Lewis) Division of Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, United States
(Barrett-Conner) Department of Family and Preventive Medicine, Division of
Epidemiology, University of California San Diego, San Diego, CA, United
States
(Nakanishi) Cardiology Department, University of Florida, Gainesville, FL,
United States
Title
The Cardiovascular Trial of the Testosterone Trials: Rationale, design,
and baseline data of a clinical trial using computed tomographic imaging
to assess the progression of coronary atherosclerosis.
Source
Coronary Artery Disease. 27 (2) (pp 95-103), 2016. Date of Publication: 28
Jan 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background Data from prior studies have yielded inconsistent results on
the association of serum testosterone levels with the risk for
cardiovascular disease. There are no clinical trial data on the effects of
testosterone replacement therapy on plaque progression. Objective We
designed a study to investigate the effect of testosterone therapy on
coronary artery plaque progression using serial coronary computed
tomographic angiography (CCTA). In this paper, we describe the study
design, methods, and characteristics of the study population. Methods The
Cardiovascular Trial of the Testosterone Trials (TTrials; NCT00799617) is
a double-blind, placebocontrolled trial of 1 year of testosterone therapy
in men 65 years or older with clinical manifestations of androgen
deficiency and unequivocally low serum testosterone concentrations (<275
ng/dl). CCTA performed at baseline and after 12 months of therapy will
determine the effects of testosterone on the progression of the total
volume of noncalcified plaques. All scans are evaluated at a central
reading center by an investigator blinded to treatment assignment. Results
A total of 165 men were enrolled. The average age is 71.1 years, and the
average BMI is 30.7. About 9% of men had a history of myocardial
infarction, 6% angina, and 10% coronary artery revascularization. A
majority reported hypertension and/or high cholesterol; 31.8% reported
diabetes. Total noncalcified plaque at baseline showed a slight but
nonsignificant trend toward lower plaque volume with higher serum
testosterone concentrations (P=0.12). Conclusion The Cardiovascular Trial
will test the hypothesis that testosterone therapy inhibits coronary
plaque progression, as assessed by serial CCTA.

<19>
Accession Number
20160135013
Author
Costa A.S.M.; Costa P.H.M.; de Lima C.E.B.; Padua L.E.M.; Campos L.A.;
Baltatu O.C.
Institution
(Costa, Campos, Baltatu) Center of Innovation, Technology and Education,
Camilo Castelo Branco University, Sao Jose dos Campos, Brazil
(Costa) Health Sciences Center, State University of Piaui, Teresina,
Brazil
(Costa, de Lima) Hospital Sao Marcos, Teresina, Brazil
(de Lima, Padua) Health Sciences Center, Federal University of Piaui,
Teresina, Brazil
Title
ICU blood pressure variability may predict nadir of respiratory depression
after coronary artery bypass surgery.
Source
Frontiers in Neuroscience. 9 (JAN) (no pagination), 2016. Article Number:
506. Date of Publication: 2016.
Publisher
Frontiers Research Foundation
Abstract
Objectives: Surgical stress induces alterations on sympathovagal balance
that can be determined through assessment of blood pressure variability.
Coronary artery bypass graft surgery (CABG) is associated with
postoperative respiratory depression. In this study we aimed at
investigating ICU blood pressure variability and other perioperative
parameters that could predict the nadir of postoperative respiratory
function impairment. Methods: This prospective observational study
evaluated 44 coronary artery disease patients subjected to coronary artery
bypass surgery (CABG) with cardiopulmonary bypass (CPB). At the ICU, mean
arterial pressure (MAP) was monitored every 30 min for 3 days. MAP
variability was evaluated through: standard deviation (SD), coefficient of
variation (CV), variation independent of mean (VIM), and average
successive variability (ASV). Respiratory function was assessed through
maximal inspiratory (MIP) and expiratory (MEP) pressures and peak
expiratory flow (PEF) determined 1 day before surgery and on the
postoperative days 3rd to 7th. Intraoperative parameters (volume of
cardioplegia, CPB duration, aortic cross-clamp time, number of grafts)
were also monitored. Results: Since, we aimed at studying patients without
confounding effects of postoperative complications on respiratory
function, we had enrolled a cohort of low risk EuroSCORE (European System
for Cardiac Operative Risk Evaluation) with < 2. Respiratory parameters
MIP, MEP, and PEF were significantly depressed for 4-5 days
postoperatively. Of all MAP variability parameters, the ASV had a
significant good positive Spearman correlation (rho coefficients ranging
from 0.45 to 0.65, p < 0.01) with the 3-day nadir of PEF after cardiac
surgery. Also, CV and VIM of MAP were significantly associated with nadir
days of MEP and PEF. None of the intraoperative parameters had any
correlation with the postoperative respiratory depression. Conclusions:
Variability parameters ASV, CV, and VIM of the MAP monitored at ICU may
have predictive value for the depression of respiratory function after
cardiac surgery as determined by peak expiratory flow and maximal
expiratory pressure.

<20>
Accession Number
20160133038
Author
Teixeira R.; Vieira M.J.; Ribeiro M.A.; Goncalves L.; Gersh B.J.
Institution
(Teixeira, Ribeiro) Departamento de Medicina, Servico de Cardiologia,
Hospital Beatriz Angelo, Loures, Portugal
(Teixeira, Vieira, Goncalves) Universidade de Coimbra, Coimbra, Portugal
(Goncalves) Servico de Cardiologia, Centro Hospitalar e Universitario de
Coimbra, Hospital Geral, Coimbra, Portugal
(Gersh) Division of Cardiovascular Disease and Internal Medicine, Mayo
Clinic, Rochester, United States
Title
Prognosis following acute coronary syndromes according to prior coronary
artery bypass grafting: Meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (6) (pp 518-527),
2015. Date of Publication: 2015.
Publisher
SAGE Publications Inc.
Abstract
Purpose: Conduct a meta-analysis to study the prognostic influence of a
previous coronary artery bypass grafting (CABG) in patients admitted for
an acute coronary syndrome (ACS). Methods: A systematic review of the
literature was performed using electronic reference databases through
January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar
and references cited in other studies). Studies in which ACS outcomes with
a previous history of CABG were compared with ACS outcomes with no history
of previous CABG were considered for inclusion. The main endpoints of
interest were mortality and non-fatal acute myocardial infarction. Data
was aggregated at three follow-up times using random-effects meta-analysis
models. Results: Twenty-four studies were included which provided 387,181
patients for analysis. Previous CABG ACS patients were older, more
diabetic and had a more frequent history of a previous myocardial
infarction. Pooled in-hospital mortality was higher for the previous CABG
ACS patients (OR 1.22 [1.04-1.44], p<0.01, I² 88%). The pooled
adjusted OR showed no significant differences for the two groups (adjusted
OR 1.13 [0.93-1.37], p=0.22, I² 92%). Previous CABG ACS patient
had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02,
I² 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01,
I² 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01,
I² 0%) long-term mortality. Both the in-hospital and the
long-term re-infarction rates were higher for the previous CABG ACS
patients. Conclusions: According to our data, ACS patients with previous
CABG history had a higher risk for short- and longterm adverse events.