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<1>
Accession Number
20160181538
Author
Lee J.Z.; Singh N.; Howe C.L.; Low S.-W.; Huang J.J.; Ortega G.; Lee K.S.;
Pandit A.
Institution
(Lee, Singh, Low, Huang) Department of Internal Medicine, University of
Arizona, Tucson, AZ, United States
(Howe) Arizona Health Sciences Library, University of Arizona, Tucson, AZ,
United States
(Ortega) College of Medicine, University of Arizona, Tucson, AZ, United
States
(Lee) Department of Cardiovascular Diseases, University of Arizona,
Tucson, AZ, United States
(Pandit) DeBakey Heart Institute, Hays, KS, United States
Title
Colchicine for Prevention of Post-Operative Atrial Fibrillation A
Meta-Analysis.
Source
JACC: Clinical Electrophysiology. 2 (1) (pp 78-85), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to investigate the efficacy and safety of
colchicine for prevention of post-operative atrial fibrillation.
Background Proinflammatory processes induced during cardiac surgery may
contribute toward post-operative atrial fibrillation (AF). Colchicine is a
potent anti-inflammatory agent, which may have a role in post-operative AF
prevention. Methods We searched PubMed, EMBASE, Web of Science, CINAHL,
ClinicalTrials.gov, and the Cochrane Library databases for randomized
controlled trials (RCT) comparing colchicine versus placebo for prevention
of post-operative AF. The main outcome measure of interest was the
development of AF within 12 months after cardiac surgery. The overall risk
ratio (RR) for the development of post-operative AF was computed using a
random-effects model. Results Data analyzed from 3 randomized studies with
a total of 912 patients, where 457 patients received colchicine and 455
patients received placebo, showed that perioperative colchicine therapy
was associated with a reduced incidence of post-operative AF (RR: 0.65;
95% confidence interval [CI]: 0.46 to 0.91; p < 0.01). Although colchicine
therapy was associated with increased incidence of gastrointestinal
intolerance (RR: 2.20; 95% CI: 1.31 to 3.70; p = 0.003), it was not
associated with early treatment discontinuation (RR: 1.37; 95% CI: 0.95 to
1.96; p = 0.09). Conclusions In conclusion, current evidence suggests that
colchicine therapy is efficacious for the prevention of post-operative AF,
and may be considered as adjunctive prophylaxis. Further studies may be
required to determine the optimal treatment protocol to reduce the
incidence of gastrointestinal intolerance.

<2>
Accession Number
20151009063
Author
Palma A.; Viegas J.; Manlhiot C.; McCrindle B.; Benson L.
Institution
(Palma, Viegas, Manlhiot, McCrindle, Benson) Department of Pediatrics,
Division of Cardiology, Labatt Family Heart Centre, Cardiac Diagnostic and
Interventional Unit, Hospital for Sick Children, University of Toronto
School of Medicine, Toronto, ON, Canada
Title
Use of local anesthetic (0.25% bupivacaine) for pain control after
pediatric cardiac catheterization: A randomized controlled trial.
Source
Catheterization and Cardiovascular Interventions. 87 (2) (pp 318-323),
2016. Date of Publication: 01 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To investigate the effects of local infiltration of 0.25%
bupivacaine on post-operative pain and analgesic use in children
undergoing cardiac catheterization procedures. Background In pediatric
catheterization procedures performed under general anesthesia, a local
anesthetic is often used prior to femoral sheath removal. There are no
published reports of the impact of local anesthetic infiltration on pain
after pediatric procedures, and mixed reports on its effectiveness in
adults. Methods A randomized controlled trial was undertaken of 140
children, aged 7-18 years undergoing cardiac catheterization under general
anesthesia via the femoral vein or artery. Participants received a
subcutaneous infiltration of 0.25% bupivacaine at the access site prior to
sheath removal, or usual care without bupivacaine. Outcomes included
patient reported pain scores and analgesic use up to 6 hr after the
procedure. Results Pain scores were similar between groups through the
6-hr post-procedure period. The proportion of children reporting a maximal
pain score of <2/10 was higher in the bupivacaine group (64% vs. 44%, P =
0.03). A significantly higher proportion of children in the control group
required IV morphine (18.8% vs. 4.5%, P = 0.02). Conclusions Morphine use
can be reduced with the use of 0.25% bupivacaine given prior to femoral
sheath removal and should be considered for post-procedural pain control
for pediatric patients undergoing cardiac catheterization. This study is
the first to contribute evidence to the effectiveness of 0.25% bupivacaine
after pediatric cardiac catheterization.

<3>
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Accession Number
20160051574
Author
Yan S.; Chen Q.; Xu M.; Sun J.; Liebeskind D.S.; Lou M.
Institution
(Yan, Chen, Xu, Sun, Lou) Department of Neurology, 2nd Affiliated
Hospital, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, China
(Liebeskind) Department of Neurology, University of California, Los
Angeles Stroke Center, United States
Title
Thrombus Length Estimation on Delayed Gadolinium-Enhanced T1.
Source
Stroke. 47 (3) (pp 756-761), 2016. Date of Publication: 01 Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Purpose-Previous studies revealed a close relationship
between thrombus length and recanalization rate after intravenous
thrombolysis (IVT). As a novel approach, we prospectively adjusted the
order of sequence acquisition to obtain delayed gadolinium-enhanced T1
(dGE-T1) and thereby assess thrombus length on dGE-T1 to evaluate its
predictive value for recanalization after IVT. Methods-We reviewed
prospectively collected clinical and imaging data from acute ischemic
stroke patients with middle cerebral artery occlusion who underwent
multimodal magnetic resonance imaging before and 24 hours after IVT.
Perfusion-weighted imaging was performed followed by conventional T1. We
measured thrombus length on dGE-T1 and examined its association with
middle cerebral artery recanalization. Results-Of the included 74
patients, the median age was 66 years and 28 (37.8%) were women. Thrombus
length was 8.18+/-4.56 mm on dGE-T1, which was an acceptable predictor for
no recanalization (odds ratio, 1.196; 95% confidence interval,
1.015-1.409; P=0.033), with a receiver-operator characteristic of 0.732
(95% confidence interval, 0.619-0.845; P=0.001). The optimal cut-off point
was identified at 6.77 mm, which yielded a sensitivity of 77.8%, a
specificity of 57.9%, and an odds ratio of 4.81 (95% confidence interval,
1.742-13.292; P=0.002). Moreover, no one achieved recanalization after IVT
when length of thrombus exceeded 14 mm on dGE-T1. Conclusions-The dGE-T1,
obtained by simply adjusting scanning order in multimodal magnetic
resonance imaging protocol, is a useful tool for thrombus length
estimation and middle cerebral artery recanalization prediction after IVT.

<4>
Accession Number
20151059530
Author
Vedovelli L.; Padalino M.; Simonato M.; D'Aronco S.; Bertini D.; Stellin
G.; Ori C.; Carnielli V.P.; Cogo P.E.
Institution
(Vedovelli, Simonato) GPYIPR and PCare Laboratories, Pediatric Research
Inst.Citta della Speranza, Padova, Italy
(Padalino, Bertini, Stellin) Pediatric and Congenital Cardiovascular
Surgery Unit, Centro V. Gallucci, Padova University Hospital, Padova,
Italy
(D'Aronco) Department of Women's and Children's Health, Padova University
Hospital, Padova, Italy
(Ori) Department of Medicine DIMED, Anesthesia and Resuscitation
Institute, Padova University Hospital, Padova, Italy
(Carnielli) Division of Neonatology, Department of Clinical Sciences,
Polytechnic University of Marche and Azienda Ospedaliero-Universitaria
Ospedali Riuniti, Ancona, Italy
(Cogo) Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of
Pediatric Cardiology and Cardiac Surgery, Bambino Gesu Children's
Hospital, Rome, Italy
Title
Cardiopulmonary Bypass Increases Plasma Glial Fibrillary Acidic Protein
Only in First Stage Palliation of Hypoplastic Left Heart Syndrome.
Source
Canadian Journal of Cardiology. 32 (3) (pp 355-361), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Pulsus Group Inc.
Abstract
Background: Univentricular congenital heart defects require open-heart
surgery soon after birth, and are associated with risk of brain injury and
poor neurologic outcome. Methods: This is a prospective, observational
study on children undergoing cardiac surgery. Plasma glial fibrillary
acidic protein (GFAP), as an early marker of brain injury, was measured by
ELISA at the end of anaesthesia induction, initiation of cardiopulmonary
bypass (CPB), the end of cooling, the end of rewarming, the end of CPB,
and after protamine administration. We recorded clinical and surgical
parameters to assess which CPB phase and clinical parameters were
associated with a GFAP increase. Results: We studied 13 children less than
50 months of age: 8 underwent Norwood or Damus-Kaye-Stansel palliation
(group 1) and 5 underwent Fontan procedure (group 2). A GFAP increase was
only observed in group 1, with the highest median value at the end of
rewarming. No quantifiable levels of GFAP were measured at pre-bypass and
the start of CPB stages in all patients. End of cooling and CPB-end GFAP,
GFAP maximum value, and GFAP area under the curve all correlated with the
CPB time spent at a cerebral regional saturation < 45% (P = 0.021, 0.028,
0.007, 0.021, respectively). Conclusions: Children with univentricular
heart defects exhibit a CPB plasma-GFAP increase only after stage 1
palliation. The maximum GFAP increase occurred at the end of rewarming.
Further studies are needed to identify which clinical or surgical
parameter(s) could reflect a GFAP increase during surgery for congenital
heart defects, and whether GFAP levels correlate with the neurologic
outcome.

<5>
Accession Number
2014891452
Author
Bae J.S.; Jang J.-S.
Institution
(Bae) Department of Medicine, Kangdong Sacred Heart Hospital, Hallym
University College of Medicine, Seoul, South Korea
(Jang) Cardiovascular Outcomes Research, Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, Kansas City, MO, United
States
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South
Korea
Title
Comparison of new adenosine diphosphate receptor antagonists with
clopidogrel in patients with coronary artery disease: a meta-analysis.
Source
Heart and Vessels. 31 (3) (pp 275-287), 2016. Date of Publication: 01 Mar
2016.
Publisher
Springer-Verlag Tokyo
Abstract
Recent data suggest the superiority of new adenosine diphosphate (ADP)
receptor antagonists compared with clopidogrel in acute coronary syndrome
patients. We aimed to assess the risks and benefits of new ADP receptor
antagonists in patients with coronary artery disease (CAD). Relevant
studies published through February 28, 2014 were searched and identified
in the MEDLINE, EMBASE, and Cochrane databases. Summary estimates were
obtained using a random-effects model. All nine published randomized
controlled studies comparing new ADP receptor antagonists with clopidogrel
in CAD were included. The database consisted of 66,900 patients; 33,782 on
novel agents, and 33,118 on clopidogrel. New ADP receptor antagonists
reduced the composite incidence of all-cause mortality, myocardial
infarction or stroke (odds ratio [OR] 0.89, 95 % confidence interval [CI]
0.81-0.97, p = 0.01) but increased the incidence of non-coronary artery
bypass grafting-related major bleeding (OR 1.24, 95 % CI 1.08-1.42, p =
0.003). The composite end point of the net rate of adverse clinical
events, which was the combination of the primary efficacy end point and
the primary safety end point, was significantly lower in the new agent
group compared to the clopidogrel group (9.7 versus 10.6 %, OR 0.92, 95 %
CI 0.85-1.00). Use of recently introduced new ADP receptor antagonists
results in a reduction in adverse clinical outcomes but a substantial
increase in bleeding. New agents revealed an improved combined efficacy
and safety outcome compared to that of clopidogrel in patients with CAD.

<6>
Accession Number
20160181543
Author
Thapmongkol S.; Masaratana P.; Subtaweesin T.; Sayasathid J.; Thatsakorn
K.; Namchaisiri J.
Institution
(Thapmongkol, Sayasathid, Thatsakorn) Division of Cardiothoracic Surgery,
Department of Surgery, Faculty of Medicine, Naresuan University Hospital,
Naresuan University, Phitsanulok 65000, Thailand
(Masaratana) Department of Biochemistry, Faculty of Medicine, Siriraj
Hospital, Bangkok 10700, Thailand
(Subtaweesin) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700,
Thailand
(Namchaisiri) Division of Cardiovascular and Thoracic Surgery, Department
of Surgery, King Chulalongkorn Memorial Hospital, Chulalongkorn
University, Bangkok 10330, Thailand
Title
The effects of modified ultrafiltration on clinical outcomes of adult and
pediatric cardiac surgery.
Source
Asian Biomedicine. 9 (5) (pp 591-599), 2015. Date of Publication: October
2015.
Publisher
Asian Biomedicine
Abstract
Background: Cardiopulmonary bypass (CPB) can contribute to the development
of an inflammatory response and postsurgical morbidity. Conventional
ultrafiltration and modified ultrafiltration (MUF) can mitigate the
adverse effects of CPB by removing free water and inflammatory mediators,
at least in part. Objectives: To evaluate evidence for the effects of MUF
on clinical outcomes of cardiac surgery in pediatric and adult patients.
Methods: A literature review of MEDLINE-indexed articles published between
1990 and June 2014 was conducted on PubMed. A search on the CTS.net
website and the Cochrane Central Register of Controlled Trials was also
performed with relevant keywords. The search was limited to English
language articles and human studies. Results: Our primary search
identified 84 potential articles, of which 55 articles were relevant to
conventional ultrafiltration, modified ultrafiltration, ultrafiltration,
cardiopulmonary bypass, extracorporeal circulation, pediatric and adult
cardiac surgery. There were 3 meta-analyses, 7 review literatures, 21
randomized controlled trials. The remainder consisted of 18 controlled and
6 observational studies. MUF has been beneficial effects on postoperative
bleeding, chest drainage, transfusion requirement, and improvement cardiac
function, but effects in adult cardiac surgery inconclusive because data
was relatively limited. Conclusions: MUF may improve post-CPB hemodynamic
activity and cardiac function in pediatric cardiac surgery. By contrast,
the clinical trials in adults are limited mostly by small sample sizes
that preclude an adequately powered assessment of clinically relevant
outcomes. The available data are conflicting and several studies show no
differential outcomes. Further studies are required to identify patients
who will most likely benefit from ultrafiltration and to establish
standard protocols.

<7>
Accession Number
20160181395
Author
Sucha D.; Tuncay V.; Prakken N.H.J.; Leiner T.; Van Ooijen P.M.A.; Oudkerk
M.; Budde R.P.J.
Institution
(Sucha, Leiner, Budde) Department of Radiology, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht 3508 GA, Netherlands
(Tuncay, Van Ooijen) Center for Medical Imaging - North East Netherlands
(CMINEN), University Medical Center, Groningen, Netherlands
(Prakken, Van Ooijen, Oudkerk) Department of Radiology, University Medical
Center, Groningen, Netherlands
Title
Does the aortic annulus undergo conformational change throughout the
cardiac cycle? A systematic review.
Source
European Heart Journal Cardiovascular Imaging. 16 (12) (pp 1307-1317),
2015. Date of Publication: 2015.
Publisher
Oxford University Press
Abstract
Accurate annular sizing in transcatheter aortic valve implantation (TAVI)
planning is essential. It is now widely recognized that the annulus is an
oval structure in most patients, but it remains unclear if the annulus
undergoes change in size and shape during the cardiac cycle that may
impact prosthesis size selection. Our aim was to assess whether the aortic
annulus undergoes dynamic conformational change during the cardiac cycle
and to evaluate possible implications for prosthesis size selection. We
performed a systematic search in PubMed and Embase databases and reviewed
all available literature on aortic annulus measurements in at least two
cardiac phases. Twenty-nine articles published from 2001 to 2014 were
included. In total, 2021 subjects with and without aortic stenosis were
evaluated with a mean age ranging from 11+/-3.6 to 84.9+/-7.2 years.
Two-and three-dimensional echocardiography was performed in six studies
each, magnetic resonance imaging was used in one and computed tomography
in 17 studies. In general, the aortic annulus was more circular in systole
and predominantly oval in diastole. Whereas the annular long-axis diameter
showed insignificant change throughout the cycle, the short-axis diameter,
area, and perimeter were significantly larger in systole compared with
diastole. Hence, the aortic annulus does undergo dynamic changes during
the cardiac cycle. In patients with large conformational changes,
diastolic compared with systolic measurements can result in undersizing
TAVI prostheses. Due to the complex annular anatomy and dynamic change,
three-dimensional assessment in multiple phases has utmost importance in
TAVI planning to improve prosthesis sizing.

<8>
Accession Number
20151064385
Author
Serpa Neto A.; Schultz M.J.; Gama De Abreu M.
Institution
(Serpa Neto) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Av. Albert Einstein, 627, Sao Paulo, Brazil
(Serpa Neto) Program of Post-Graduation, Research and Innovation,
Faculdade de Medicina Do ABC, Santo Andre, Brazil
(Serpa Neto, Schultz) Department of Intensive Care, Academic Medical
Center at the University of Amsterdam, Amsterdam, Netherlands
(Schultz) Laboratory of Experimental Intensive Care and Anesthesiology
(LEICA), Academic Medical Center at the University of Amsterdam,
Amsterdam, Netherlands
(Gama De Abreu) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Carl Gustav Carus, Technische Universitat Dresden,
Dresden, Germany
(Gama De Abreu) Pulmonary Engineering Group, University Hospital Carl
Gustav Carus, Technische Universitat Dresden, Dresden, Germany
Title
Intraoperative ventilation strategies to prevent postoperative pulmonary
complications: Systematic review, meta-analysis, and trial sequential
analysis.
Source
Best Practice and Research: Clinical Anaesthesiology. 29 (3) (pp 331-340),
2015. Date of Publication: 01 Sep 2015.
Publisher
Bailliere Tindall Ltd
Abstract
For many years, mechanical ventilation with high tidal volumes
(V<inf>T</inf>) was common practice in operating theaters because this
strategy recruits collapsed lung tissue, improves ventilation-perfusion
mismatch, and thus decreases the need for high oxygen fractions. Positive
end-expiratory pressure (PEEP) was seldom used because it could cause
cardiac compromise. Increasing advances in the understanding of the
mechanisms of ventilator-induced lung injury from animal studies and
randomized controlled trials in patients with uninjured lungs in intensive
care unit and operation room have pushed anesthesiologists to consider
lung-protective strategies during intraoperative ventilation. These
strategies at least include the use of low V<inf>T</inf>, and perhaps also
the use of PEEP, which when compared to high V<inf>T</inf> with low PEEP
may prevent the occurrence of postoperative pulmonary complications
(PPCs). Such protective effects, however, are likely ascribed to low
V<inf>T</inf> rather than to PEEP. In fact, at least in nonobese patients
undergoing open abdominal surgery, high PEEP does not protect against
PPCs, and it can impair the hemodynamics. Further studies shall determine
whether a strategy consisting of low V<inf>T</inf> combined with PEEP and
recruitment maneuvers reduces PPCs in obese patients and other types of
surgery (e.g., laparoscopic and thoracic), compared to low V<inf>T</inf>
with low PEEP. Furthermore, the role of driving pressure for titrating
ventilation settings in patients with uninjured lungs shall be
investigated.

<9>
Accession Number
20151006394
Author
Alderman M.H.; Davis B.R.; Piller L.B.; Ford C.E.; Baraniuk M.S.; Pressel
S.L.; Assadi M.A.; Einhorn P.T.; Haywood L.J.; Ilamathi E.; Oparil S.;
Retta T.M.
Institution
(Alderman) Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States
(Davis, Piller, Ford, Baraniuk, Pressel) University of Texas School of
Public Health, Coordinating Center for Clinical Trials, Houston, TX,
United States
(Assadi) State University of New York, Health Sciences Center at Brooklyn,
Brooklyn, NY, United States
(Einhorn) Division of Prevention and Population Sciences, National Heart,
Lung, and Blood Institute, Bethesda, MD, United States
(Haywood) LAC + USC Medical Center, Keck School of Medicine, Los Angeles,
CA, United States
(Ilamathi) Suffolk Nephrology Consultants, Stony Brook, NY, United States
(Oparil) Department of Medicine and Physiology and Biophysics, University
of Alabama at Birmingham, Birmingham, AL, United States
(Retta) Department of Medicine, Howard University College of Medicine,
Washington, DC, United States
Title
Should Antihypertensive Treatment Recommendations Differ in Patients with
and Without Coronary Heart Disease? (from the Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]).
Source
American Journal of Cardiology. 117 (1) (pp 105-115), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Inc.
Abstract
Thiazide-type diuretics have been recommended for initial treatment of
hypertension in most patients, but should this recommendation differ for
patients with and without coronary heart disease (CHD)? The
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT) was a randomized, double-blind hypertension treatment trial
in 42,418 participants with high risk of combined cardiovascular disease
(CVD) (25% with preexisting CHD). This post hoc analysis compares
long-term major clinical outcomes in those assigned amlodipine (n = 9048)
or lisinopril (n = 9,054) with those assigned chlorthalidone (n = 15,255),
stratified by CHD status. After 4 to 8 years, randomized treatment was
discontinued. Total follow-up (active treatment + passive surveillance
using national databases for deaths and hospitalizations) was 8 to 13
years. For most CVD outcomes, end-stage renal disease, and total
mortality, there were no differences across randomized treatment arms
regardless of baseline CHD status. In-trial rates of CVD were
significantly higher for lisinopril compared with chlorthalidone, and
rates of heart failure were significantly higher for amlodipine compared
with chlorthalidone in those with and without CHD (overall hazard ratios
[HRs] 1.10, p <0.001, and 1.38, p <0.001, respectively). During extended
follow-up, significant outcomes according to CHD status interactions (p =
0.012) were noted in amlodipine versus chlorthalidone comparison for CVD
and CHD mortality (HR 0.88, p = 0.04, and 0.84, p = 0.04, respectively) in
those with CHD at baseline (HR 1.06, p = 0.15, and 1.08, p = 0.17) and in
those without. The results of the overall increased stroke mortality in
lisinopril compared with chlorthalidone (HR 1.2; p = 0.03) and
hospitalized heart failure in amlodipine compared with chlorthalidone (HR
1.12; p = 0.01) during extended follow-up did not differ by baseline CHD
status. In conclusion, these results provide no reason to alter our
previous recommendation to include a properly dosed diuretic (such as
chlorthalidone 12.5 to 25 mg/day) in the initial antihypertensive regimen
for most hypertensive patients.

<10>
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Accession Number
2015498512
Author
Al-Qadheeb N.S.; Skrobik Y.; Schumaker G.; Pacheco M.N.; Roberts R.J.;
Ruthazer R.R.; Devlin J.W.
Institution
(Al-Qadheeb, Devlin) School of Pharmacy, Northeastern University, Boston,
MA, United States
(Skrobik) Department of Medicine, McGill University, Montreal, QC, Canada
(Schumaker, Devlin) Division of Pulmonary, Critical Care and Sleep
Medicine, Tufts Medical Center, Boston, MA, United States
(Pacheco) Department of Psychiatry, Tufts Medical Center, Boston, MA,
United States
(Roberts) Department of Pharmacy, Tufts Medical Center, Boston, MA, United
States
(Ruthazer) Biostatistics Research Center, Tufts Clinical and Translational
Science Institute, Tufts Medical Center, Boston, MA, United States
Title
Preventing ICU Subsyndromal Delirium Conversion to Delirium with Low-Dose
IV Haloperidol: A Double-Blind, Placebo-Controlled Pilot Study.
Source
Critical Care Medicine. 44 (3) (pp 583-591), 2016. Date of Publication: 01
Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
To compare the efficacy and safety of scheduled low-dose haloperidol
versus placebo for the prevention of delirium (Intensive Care Delirium
Screening Checklist > 4) administered to critically ill adults with
subsyndromal delirium (Intensive Care Delirium Screening Checklist = 1-3).
Design: Randomized, double-blind, placebo-controlled trial. Setting: Three
10-bed ICUs (two medical and one surgical) at an academic medical center
in the United States. Patients: Sixty-eight mechanically ventilated
patients with subsyndromal delirium without complicating neurologic
conditions, cardiac surgery, or requiring deep sedation. Interventions:
Patients were randomly assigned to receive IV haloperidol 1 mg or placebo
every 6 hours until delirium occurred (Intensive Care Delirium Screening
Checklist > 4 with psychiatric confirmation), 10 days of therapy had
elapsed, or ICU discharge. Measurements and Main Results: Baseline
characteristics were similar between the haloperidol (n = 34) and placebo
(n = 34) groups. A similar number of patients given haloperidol (12/34
[35%]) and placebo (8/34 [23%]) developed delirium (p = 0.29). Haloperidol
use reduced the hours per study day spent agitated (Sedation Agitation
Scale > 5) (p = 0.008), but it did not influence the proportion of 12-hour
ICU shifts patients spent alive without coma (Sedation Agitation Scale <
2) or delirium (p = 0.36), the time to first delirium occurrence (p =
0.22), nor delirium duration (p = 0.26). Days of mechanical ventilation (p
= 0.80), ICU mortality (p = 0.55), and ICU patient disposition (p = 0.22)
were similar in the two groups. The proportion of patients who developed
corrected QT-interval prolongation (p = 0.16), extrapyramidal symptoms (p
= 0.31), excessive sedation (p = 0.31), or new-onset hypotension (p = 1.0)
that resulted in study drug discontinuation was comparable between the two
groups. Conclusions: Low-dose scheduled haloperidol, initiated early in
the ICU stay, does not prevent delirium and has little therapeutic
advantage in mechanically ventilated, critically ill adults with
subsyndromal delirium.

<11>
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Accession Number
2015498223
Author
Kok L.; Hillegers M.H.; Veldhuijzen D.S.; Cornelisse S.; Nierich A.P.; Van
Der Maaten J.M.; Rosseel P.M.; Hofland J.; Sep M.S.; Dieleman J.M.;
Vinkers C.H.; Peelen L.M.; Joels M.; Van Dijk D.
Institution
(Kok, Veldhuijzen, Dieleman, Van Dijk) Department of Anesthesiology and
Intensive Care, Brain Center Rudolf Magnus, University Medical Center
Utrecht, Utrecht, Netherlands
(Hillegers, Vinkers) Department of Psychiatry, Brain Center Rudolf Magnus,
University Medical Center Utrecht, Utrecht, Netherlands
(Veldhuijzen) Institute of Psychology, Leiden University, Leiden,
Netherlands
(Cornelisse, Sep, Joels) Department of Translational Neuroscience, Brain
Center Rudolf Magnus, University Medical Center Utrecht, Utrecht,
Netherlands
(Nierich) Department of Anesthesiology, Isala Clinics, Zwolle, Netherlands
(Van Der Maaten) Department of Anesthesiology, University Medical Center
Groningen, Groningen, Netherlands
(Rosseel) Department of Anesthesiology, Amphia Hospital, Breda,
Netherlands
(Hofland) Department of Anesthesiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Peelen) Department of Epidemiology, Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
Title
The Effect of Dexamethasone on Symptoms of Posttraumatic Stress Disorder
and Depression after Cardiac Surgery and Intensive Care Admission:
Longitudinal Follow-Up of a Randomized Controlled Trial.
Source
Critical Care Medicine. 44 (3) (pp 512-520), 2016. Date of Publication: 01
Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Cardiac surgery and postoperative admission to the ICU may lead
to posttraumatic stress disorder and depression. Perioperatively
administered corticosteroids potentially alter the risk of development of
these psychiatric conditions, by affecting the
hypothalamic-pituitary-adrenal axis. However, findings of previous studies
are inconsistent. We aimed to assess the effect of a single dose of
dexamethasone compared with placebo on symptoms of posttraumatic stress
disorder and depression and health-related quality of life after cardiac
surgery and ICU admission. Design: Follow-up study of a randomized
clinical trial. Setting: Five Dutch heart centers. Patients: Cardiac
surgery patients (n = 1,244) who participated in the Dexamethasone for
Cardiac Surgery trial. Interventions: A single intraoperative IV dose of
dexamethasone or placebo was administered in a randomized, double-blind
way. Measurements and Main Results: Symptoms of posttraumatic stress
disorder, depression, and health-related quality of life were assessed
with validated questionnaires 1.5 years after randomization. Data were
available for 1,125 patients (90.4%); of which 561 patients received
dexamethasone and 564 patients received placebo. Overall, the prevalence
of psychopathology was not influenced by dexamethasone. Posttraumatic
stress disorder and depression were present in, respectively, 52 patients
(9.3%) and 69 patients (12.3%) who received dexamethasone and in 66
patients (11.7%) and 78 patients (13.8%) who received placebo
(posttraumatic stress disorder: odds ratio, 0.82; 95% CI, 0.55-1.20; p =
0.30; depression: odds ratio, 0.92; 95% CI, 0.64-1.31; p = 0.63). Subgroup
analysis revealed a lower prevalence of posttraumatic stress disorder
(odds ratio, 0.23; 95% CI, 0.07-0.72; p < 0.01) and depression (odds
ratio, 0.29; 95% CI, 0.11-0.77; p < 0.01) in female patients after
dexamethasone administration. Health-related quality of life did not
differ between groups and was not associated with psychopathology.
Conclusions: Overall, our findings suggest that exogenous administration
of the glucocorticoid receptor agonist dexamethasone-compared with
placebo-during cardiac surgery does not positively or negatively affect
the prevalence of posttraumatic stress disorder and depression. However,
in female patients, beneficial effects on the occurrence of posttraumatic
stress disorder and depression may be present.

<12>
Accession Number
2015482946
Author
Kowalewski M.; Pawliszak W.; Malvindi P.G.; Bokszanski M.P.; Perlinski D.;
Raffa G.M.; Kowalkowska M.E.; Zaborowska K.; Navarese E.P.; Kolodziejczak
M.; Kowalewski J.; Tarelli G.; Taggart D.P.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Bokszanski, Perlinski, Zaborowska, Anisimowicz)
Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University
Hospital, Maria Curie Sklodowska Str 9, Bydgoszcz 85-094, Poland
(Kowalewski) Faculty of Health Sciences, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz, Poland
(Kowalewski, Kowalkowska, Navarese, Kolodziejczak) Systematic
Investigation and Research on Interventions and Outcomes MEDICINE Research
Network, Dusseldorf, Germany
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo
per i Trapianti e Terapie Ad Alta Specializzazione), Palermo, Italy
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Navarese) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Kolodziejczak) Collegium Medicum in Bydgoszcz, Nicolaus Copernicus
University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Tarelli) Department of Cardiac Surgery, Humanitas Clinical and Research
Center, Rozzano, Milan, Italy
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
Title
Off-pump coronary artery bypass grafting improves short-term outcomes in
high-risk patients compared with on-pump coronary artery bypass grafting:
Meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (1) (pp 60-77e58),
2016. Date of Publication: 01 Jan 2016.
Publisher
Mosby Inc.
Abstract
Objectives To assess the benefits and risks of off-pump coronary artery
bypass (OPCAB) versus coronary artery bypass grafting (CABG) through a
meta-analysis of randomized controlled trials (RCTs), and to investigate
the relationship between outcomes and patient risk profile. Methods
PubMed, Embase, the Cumulative Index of Nursing and Allied Health
Literature, Scopus, Web of Science, Cochrane Library, and major conference
proceedings databases were searched for RCTs comparing OPCAB and CABG and
reporting short-term (<30 days) outcomes. Endpoints assessed were
all-cause mortality, myocardial infarction (MI), and cerebral stroke.
Results The meta-analysis included 100 studies, with a total of 19,192
subjects. There was no difference between the 2 techniques with respect to
all-cause mortality and MI (odds ratio [OR], 0.88; 95% confidence interval
[CI], 0.71-1.09; P =.25; I² = 0% and OR, 0.90; 95% CI,
0.77-1.05; P =.19; I² = 0%, respectively). OPCAB was associated
with a significant 28% reduction in the odds of cerebral stroke (OR, 0.72;
95% CI, 0.56-0.92; P =.009; I² = 0%). A significant
relationship between patient risk profile and benefits from OPCAB was
found in terms of all-cause mortality (P <.01), MI (P <.01), and cerebral
stroke (P <.01). Conclusions OPCAB is associated with a significant
reduction in the odds of cerebral stroke compared with conventional CABG.
In addition, benefits of OPCAB in terms of death, MI, and cerebral stroke
are significantly related to patient risk profile, suggesting that OPCAB
should be strongly considered in high-risk patients.

<13>
Accession Number
2015460389
Author
Gomes-Neto M.; Saquetto M.B.; da Silva e Silva C.M.; Conceicao C.S.;
Carvalho V.O.
Institution
(Gomes-Neto, Saquetto, da Silva e Silva, Conceicao) Departamento de
Biofuncao, Curso de Fisioterapia, Instituto de Ciencias da Saude,
Universidade Federal da Bahia, UFBA, Av. Reitor Miguel Calmon s/n - Vale
do Canela, Salvador, BA CEP 40.110-100, Brazil
(Gomes-Neto) Programa de Pos Graduacao em Medicina e Saude, Universidade
Federal da Bahia, UFBA, Salvador, BA, Brazil
(Gomes-Neto, Carvalho) The GREAT Group (GRupo de Estudos em ATividade
fisica), Aracaju, Brazil
(Carvalho) Departamento de Fisioterapia, Universidade Federal de Sergipe,
UFS, Aracaju, SE, Brazil
Title
Impact of Exercise Training in Aerobic Capacity and Pulmonary Function in
Children and Adolescents After Congenital Heart Disease Surgery: A
Systematic Review with Meta-analysis.
Source
Pediatric Cardiology. 37 (2) (pp 217-224), 2016. Date of Publication: 01
Feb 2016.
Publisher
Springer New York LLC
Abstract
The aim of the study was to examine the effects of exercise training on
aerobic capacity and pulmonary function in children and adolescents after
congenital heart disease surgery. We searched MEDLINE, Cochrane Controlled
Trials Register, EMBASE, (from the earliest date available to January
2015) for controlled trials that evaluated the effects of exercise
training on aerobic capacity and pulmonary function (forced expiratory
volume in 1 s and forced vital capacity) in children and adolescents after
congenital heart disease surgery. Weighted mean differences and 95 %
confidence intervals (CIs) were calculated,, and heterogeneity was
assessed using the I² test. Eight trials (n = 292) met the
study criteria. The results suggested that exercise training compared with
control had a positive impact on peak VO<inf>2</inf>. Exercise training
resulted in improvement in peak VO<inf>2</inf> weighted mean difference
(3.68 mL kg^-1 min^-1, 95 % CI 1.58-5.78). The
improvement in forced expiratory volume in 1 s and forced vital capacity
after exercise training was not significant. Exercise training may improve
peak VO<inf>2</inf> in children and adolescents after congenital heart
disease surgery and should be considered for inclusion in cardiac
rehabilitation. Further larger randomized controlled trials are urgently
needed to investigate different types of exercise and its effects on the
quality of life.

<14>
Accession Number
2015390678
Author
Dutta S.; Cohn S.L.; Pfeifer K.J.; Slawski B.A.; Smetana G.W.; Jaffer A.K.
Institution
(Dutta, Jaffer) Department of Medicine, Rush Medical College, Chicago, IL,
United States
(Cohn) University of Miami Miller School of Medicine, Miami, FL, United
States
(Pfeifer, Slawski) Froedtert Memorial Lutheran Hospital Clinical Cancer
Center, Medical College of Wisconsin, Milwaukee, WI, United States
(Smetana) Division of General Medicine and Primary Care, Harvard Medical
School, Boston, MA, United States
Title
Updates in perioperative medicine.
Source
Journal of Hospital Medicine. 11 (3) (pp 231-236), 2016. Date of
Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
BACKGROUND: As our surgical population becomes older and more medically
complex, knowledge of the most recent perioperative literature is
necessary to optimize perioperative care. We aim to summarize and critique
literature published over the past year with the highest potential to
impact the clinical practice of perioperative medicine. METHODS: We
reviewed articles published between January 2014 and April 2015,
identified via MEDLINE search. The final 10 articles selected were
determined by consensus among all authors, with criteria for inclusion
including scientific rigor and relevance to perioperative medicine
practice. RESULTS: Key findings include: long term beta-blockade should be
continued prior to surgery, routine screening with postoperative troponin
is not recommended, initiation/continuation of aspirin or clonidine in the
perioperative period is not beneficial and may increase adverse outcomes,
preoperative diagnosis and treatment of obstructive sleep apnea may reduce
risk of postoperative cardiovascular complications, new pulmonary risk
indices are available that accurately estimate postoperative pulmonary
complications, postoperative atrial fibrillation is associated with
increased long-term stroke risk, risk scores such as the CHADS<inf>2</inf>
(Congestive heart failure, Hypertension, Age >75 years, Diabetes Mellitus,
previous stroke or transient ischemic attack) are superior to the Revised
Cardiac Risk Index in predicting adverse postoperative outcomes for
patients with nonvalvular atrial fibrillation, and utilization of bridging
anticoagulation comes with a much higher risk of bleeding compared to
patients who are not bridged. CONCLUSIONS: The body of literature reviewed
provides important information for clinicians caring for surgical patients
across multiple fronts, including preoperative risk assessment, medication
management, and postoperative medical care.

<15>
Accession Number
20160184884
Author
Fatima K.; Yousuf-Ul-Islam M.; Ansari M.; Bawany F.I.; Khan M.S.; Khetpal
A.; Khetpal N.; Lashari M.N.; Arshad M.H.; Amir R.B.; Kakalia H.R.; Zaidi
Q.H.; Mian S.K.; Kazani B.
Institution
(Fatima, Yousuf-Ul-Islam, Ansari, Bawany, Khan, Khetpal) MBBS-Dow
University of Health Sciences (DUHS), Karachi 74100, Pakistan
(Khetpal) Kharadar General Hospital, Karachi, Pakistan
(Lashari) Cardiology, Civil Hospital, DUHS, Karachi 74100, Pakistan
(Arshad) Aga Khan University of Health Sciences, Karachi 74800, Pakistan
(Amir, Kakalia, Zaidi, Mian) Department of Biological Sciences, Lyceum,
Karachi 75600, Pakistan
(Kazani) Karachi Grammar School, Karachi 75600, Pakistan
Title
Comparison of the Postprocedural Quality of Life between Coronary Artery
Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic
Review.
Source
Cardiology Research and Practice. 2016 (no pagination), 2016. Article
Number: 7842514. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The treatment of choice between coronary artery bypass graft surgery
(CABG) and percutaneous coronary intervention (PCI) has remained unclear.
Considering quality of life (QOL) increases life expectancy, we believe
QOL should be important in determining the optimum treatment. Thus the
objective of this review was to illustrate the comparative effects of CABG
and PCI on postprocedural QOL. Methods. We searched PubMed (Medline) and
Embase from inception of the databases to May 2014 using "PCI versus CABG
quality of life", "Percutaneous Coronary intervention versus Coronary
artery bypass graft surgery Quality of life", "PCI versus CABG health
status", "Angioplasty versus CABG", "Percutaneous coronary intervention
versus coronary artery bypass surgery health status", and different
combinations of the above terms. 447 articles were found. After applying
strict exclusion criteria, we included 13 studies in this review. Results.
From the 9 studies that compared QOL scores at 6 months after procedure, 5
studies reported CABG to be superior. From the 10 studies that compared
QOL among patients at 1 year after procedure, 9 reported CABG to be
superior. Conclusion. It can be established that CABG is superior to PCI
in improving patient's QOL with respect to all scales used to determine
quality of life.

<16>
Accession Number
20160182799
Author
Billings F.T.; Hendricks P.A.; Schildcrout J.S.; Shi Y.; Petracek M.R.;
Byrne J.G.; Brown N.J.
Institution
(Billings, Hendricks) Department of Anesthesiology and Medicine,
Vanderbilt University, School of Medicine, 1211 21st Ave S, Ste 526,
Nashville, TN 37212, United States
(Billings, Brown) Department of Medicine, Vanderbilt University, School of
Medicine, Nashville, TN, United States
(Schildcrout, Shi) Department of Biostatistics, Vanderbilt University,
School of Medicine, Nashville, TN, United States
(Petracek) Department of Cardiac Surgery, Vanderbilt University, School of
Medicine, Nashville, TN, United States
(Byrne) Department of Cardiac Surgery, Harvard University, School of
Medicine, Boston, MA, United States
Title
High-dose perioperative atorvastatin and acute kidney injury following
cardiac surgery: A randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 315 (9) (pp 877-888),
2016. Date of Publication: 01 Mar 2016.
Publisher
American Medical Association
Abstract
Importance Statins affect several mechanisms underlying acute kidney
injury (AKI). Objective To test the hypothesis that short-term high-dose
perioperative atorvastatin would reduce AKI following cardiac surgery.
Design, Setting, and Participants Double-blinded, placebo-controlled,
randomized clinical trial of adult cardiac surgery patients conducted from
November 2009 to October 2014 at Vanderbilt University Medical Center.
Interventions Patients naive to statin treatment (n = 199) were randomly
assigned 80 mg of atorvastatin the day before surgery, 40 mg of
atorvastatin the morning of surgery, and 40 mg of atorvastatin daily
following surgery (n = 102) or matching placebo (n = 97). Patients already
taking a statin prior to study enrollment (n = 416) continued taking the
preenrollment statin until the day of surgery, were randomly assigned 80
mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the
morning after (n = 206) or matching placebo (n = 210), and resumed taking
the previously prescribed statin on postoperative day 2. Main Outcomes and
Measures Acute kidney injury defined as an increase of 0.3 mg/dL in serum
creatinine concentration within 48 hours of surgery (Acute Kidney Injury
Network criteria). Results The data and safety monitoring board
recommended stopping the group naive to statin treatment due to increased
AKI among these participants with chronic kidney disease (estimated
glomerular filtration rate <60 mL/min/1.73 m2) receiving atorvastatin. The
board later recommended stopping for futility after 615 participants
(median age, 67 years; 188 [30.6%] were women; 202 [32.8%] had diabetes)
completed the study. Among all participants (n = 615), AKI occurred in 64
of 308 (20.8%) in the atorvastatin group vs 60 of 307 (19.5%) in the
placebo group (relative risk [RR], 1.06 [95% CI, 0.78 to 1.46]; P =.75).
Among patients naive to statin treatment (n = 199), AKI occurred in 22 of
102 (21.6%) in the atorvastatin group vs 13 of 97 (13.4%) in the placebo
group (RR, 1.61 [0.86 to 3.01]; P =.15) and serum creatinine concentration
increased by a median of 0.11 mg/dL (10th-90th percentile,-0.11 to 0.56
mg/dL) in the atorvastatin group vs by a median of 0.05 mg/dL (10th-90th
percentile,-0.12 to 0.33 mg/dL) in the placebo group (mean difference,
0.08 mg/dL [95% CI, 0.01 to 0.15 mg/dL]; P =.007). Among patients already
taking a statin (n = 416), AKI occurred in 42 of 206 (20.4%) in the
atorvastatin group vs 47 of 210 (22.4%) in the placebo group (RR, 0.91
[0.63 to 1.32]; P =.63). Conclusions and Relevance Among patients
undergoing cardiac surgery, high-dose perioperative atorvastatin treatment
compared with placebo did not reduce the risk of AKI overall, among
patients naive to treatment with statins, or in patients already taking a
statin. These results do not support the initiation of statin therapy to
prevent AKI following cardiac surgery.

<17>
Accession Number
2015251637
Author
Wang W.; Mei Y.Q.; Yuan X.H.; Feng X.D.
Institution
(Wang) Department of Cardiovascular Surgery, Scripps Memorial Hospital,
San Diego, CA, United States
(Mei) Department of Cardiovascular Surgery, Shanghai Tongji Hospital,
Shanghi, China
(Yuan) Department of Cardiovascular Surgery, Changzhi Peace Hospital,
Changzhi, Shanxi, China
(Feng) Department of Cardiovascular Surgery, Shanghai East Hospital,
Shanghai, China
Title
Clinical efficacy of epicardial application of drug-releasing hydrogels to
prevent postoperative atrial fibrillation.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (1) (pp 80-85), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Mosby Inc.
Abstract
Objective Postoperative atrial fibrillation is the most frequent
complication arising after cardiac surgery, occurring in 40% of cases. The
treatment of postoperative atrial fibrillation with epicardial
amiodarone/corticosteroid hydrogel delivery can increase efficacy and
reduce side effects. To further evaluate whether amiodarone hydrogel is
superior to corticosteroid hydrogel or placebo, we performed a randomized
prospective study in 150 patients with coronary artery bypass grafting to
compare the effectiveness with different epicardial drug approaches in the
postoperative period. Methods After institutional review board approval,
150 patients, from January 2012 to July 2014, who had undergone cardiac
surgery were randomized to 3 equal groups. Group I received poly-based
hydrogel with amiodarone, and group II received poly-based hydrogel with
triamcinolone. Both hydrogels were sprayed diffusely over the biatrial
epicardium. The control group underwent the procedure with only hydrogel
spray. Continuous telemetry monitored for postoperative atrial
fibrillation, and amiodarone or triamcinolone levels in the atria, plasma,
and tissue were measured postoperatively. Daily electrocardiographic
parameters were measured until postoperative day 14. Results The incidence
of postoperative atrial fibrillation was significantly less in group I,
with 4 of 50 patients (8%) incurring atrial fibrillation compared with 11
of 50 patients (22%) in group II and 13 of 50 patients (26%) in the
control group (P <.01). The mean amiodarone and triamcinolone
concentrations in the atria (12.06 +/- 3.1/1.5 +/- 0.7) were significantly
greater than those in the extracardiac tissues (1.32 +/- 0.9/0.2 +/- 0.4;
P <.01). The plasma amiodarone and triamcinolone levels remained below the
detection limit (<8 mug/mL and <0.2 mug/mL) during the 14 days of
follow-up. Bradycardia was observed less in the control group (93 +/- 18)
than in study group I (76 +/- 29; P <.01). Conclusions Epicardial
application of amiodarone-releasing adhesive hydrogel is a less-invasive,
well-tolerated, quick, and effective therapeutic option for preventing
postoperative atrial fibrillation with minimal risk of extracardiac
adverse side effects. However, there was no clinical evidence that
epicardial corticosteroid prevented postoperative atrial fibrillation.

<18>
Accession Number
2015206552
Author
Abdelrahman A.M.; Bingener J.; Yu D.; Lowndes B.R.; Mohamed A.; McConico
A.L.; Hallbeck M.S.
Institution
(Abdelrahman, Yu, Lowndes, Hallbeck) Robert D. and Patricia E. Kern Center
for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN,
United States
(Bingener, Mohamed, McConico, Hallbeck) Department of Surgery, Mayo
Clinic, Rochester, MN, United States
(Abdelrahman, Yu, Lowndes, Mohamed, Hallbeck) Division of Health Care
Policy and Research, Department of Health Sciences Research, Mayo Clinic,
200 First Street SW, Rochester, MN 55905, United States
Title
Impact of single-incision laparoscopic cholecystectomy (SILC) versus
conventional laparoscopic cholecystectomy (CLC) procedures on surgeon
stress and workload: a randomized controlled trial.
Source
Surgical Endoscopy and Other Interventional Techniques. 30 (3) (pp
1205-1211), 2016. Date of Publication: 01 Mar 2016.
Publisher
Springer New York LLC
Abstract
Introduction: Single-incision laparoscopic cholecystectomy (SILC) may lead
to higher patient satisfaction; however, SILC may expose the surgeon to
increased workload. The goal of this study was to compare surgeon stress
and workload between SILC and conventional laparoscopic cholecystectomy
(CLC). Methods: During a double-blind randomized controlled trial
comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon
workload was assessed by four measures: surgery task load index
questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and
instruments usability survey. The maximum heart rate and salivary cortisol
levels were sampled from the surgeon before the random assignment of the
surgical procedure, intraoperatively after the cystic duct was clipped,
and at skin closure. After each procedure, the surgeon completed the
Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon
rank sum test, and Kruskal-Wallis nonparametric ANOVAs on the dependent
variables by the technique (SILC vs. CLC) were performed with alpha =
0.05. Results: Twenty-three SILC and 25 CLC procedures were included in
the intent-to-treat analysis. No significant differences were observed
between SILC and CLC for patient demographics and procedure duration. SILC
had significantly higher post-surgery surgeon maximum heart rates than CLC
(p < 0.05). SILC also had significantly higher mean change in the maximum
heart rate between during and post-procedure (p < 0.05) than CLC. Salivary
cortisol level was significantly higher during SILC than CLC (p < 0.01).
Awkward manipulation of the instruments and limited fine motions were
reported significantly more frequently with SILC than CLC (p < 0.01). In
the surgeon-reported Surg-TLX, subscale of physical demand was
significantly more demanding for SILC than CLC (p < 0.05). Conclusions:
Surgeon heart rate, salivary cortisol level, instrument usability, and
Surg-TLX ratings indicate that SILC is significantly more stressful and
physically demanding than the CLC. Surgeon stress and workload may impact
patients' outcomes; thus, ergonomic improvement on SILC is necessary.

<19>
Accession Number
20160179864
Author
Tan W.-F.; Guo B.; Ma H.; Li X.-Q.; Fang B.; Lv H.-W.
Institution
(Tan, Guo, Ma, Li, Fang, Lv) Department of Anaesthesiology, The First
Hospital of China Medical University, Shenyang, China
Title
Changes in postoperative night bispectral index of patients undergoing
thoracic surgery with different types of anaesthesia management: A
randomized controlled trial.
Source
Clinical and Experimental Pharmacology and Physiology. 43 (3) (pp
304-311), 2016. Date of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing
Abstract
Summary: This study hypothesized that different types of anaesthesia
management would result in similar postoperative sleep quality. In this
prospective single-blind investigation, 219 patients undergoing elective
thoracic surgery were randomized into three arms: general anaesthesia, as
the control group (group C); general anaesthesia combined with thoracic
epidural anaesthesia (TEA) (group E); and general anaesthesia combined
with infusion of 1 mug/kg dexmedetomidine (group D). Plasma samples were
obtained to measure the amine and inflammatory cytokine concentrations.
All patients underwent assessment with the bispectral index (BIS) for
sleep quality and the visual analogue scale (VAS) for pain. The primary
outcomes were inflammatory cytokine [interleukin-6 (IL-6) and tumor
necrosis factor alpha (TNF-alpha)] secretion and postoperative sleep
quality on the first and second postoperative nights. The secondary
outcomes were amine (adrenaline and noradrenaline) secretion during the
surgical period and haemodynamic stability. The postoperative BIS area
under the curve was significantly lower in group E (75.7%) than in group C
(87.3%) or group D (86.5%). Patients in group E had the highest BIS of
sleep efficiency index (29.2%, P < 0.05) and the lowest VAS scores (3.5, P
< 0.05). Group E had lower IL-6 levels than the other two groups 24 h
after surgery (P < 0.05). Patients given TEA may show reduced sleep
disturbances on the first night after surgery, perhaps due to better pain
management and inhibition of IL-6 release.

<20>
Accession Number
20160171671
Author
Rezaei Y.; Gholami-Fesharaki M.; Dehghani M.R.; Arya A.; Haghjoo M.;
Arjmand N.
Institution
(Rezaei, Arjmand) Seyyed-al-Shohada Heart Center, Urmia University of
Medical Science, 17 Shahrivar Blvd, Urmia 5718749441, Iran, Islamic
Republic of
(Gholami-Fesharaki) Department of Biostatistics, Faculty of Medical
Sciences, Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Dehghani) Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia
University of Medical Sciences, Urmia, Iran, Islamic Republic of
(Arya) Department of Electrophysiology, Heart Center, University of
Leipzig, Leipzig, Germany
(Haghjoo) Cardiac Electrophysiology Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Statin Antiarrhythmic Effect on Atrial Fibrillation in Statin-Naive
Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 21 (2) (pp
167-176), 2016. Date of Publication: 01 Mar 2016.
Publisher
SAGE Publications Ltd
Abstract
Background: Statin therapy has been thought to improve outcomes in cardiac
surgeries. We aimed to determine the statin effects on the development of
postoperative atrial fibrillation (AF), hospital length of stay (LOS), and
inflammatory status in patients undergoing cardiac surgeries. Methods: A
systematic literature search in databases was performed, until January
2015. Randomized clinical trial (RCT) studies evaluating statin effect on
statin-naive patients with sinus rhythm undergoing cardiac surgeries were
eligible to be analyzed. Results: Twelve RCTs involving 1116 patients, 559
receiving statin and 557 receiving control regimen, were analyzed.
Postoperative AF occurred in 17.9% and 36.1% of patients in the statin and
control groups, respectively. The statin therapy was associated with
decreases in the postoperative AF (risk ratio [RR] 0.50, 95% confidence
interval [CI] 0.41-0.61, P <.000010), hospital LOS (mean difference in
days, RR -'0.44, 95% CI -'0.67 to -'0.20, P =.0002), and postoperative
C-reactive protein (CRP) compared with control (mean difference in mg/L,
RR -'12.37, 95% CI -'23.87 to -'0.87, P =.04). The beneficial effects on
AF and CRP were more marked in patients receiving atorvastatin compared to
other statins. Decrease in postoperative AF was greater in coronary artery
bypass graft surgery compared to that in isolated valvular surgery.
Conclusion: Perioperative statin therapy in statin-naive patients with
sinus rhythm undergoing cardiac surgeries was associated with decreases in
the development of postoperative AF, the hospital LOS, and the CRP level.
However, there were insufficient data to provide evidences regarding
statin impacts in patients undergoing isolated valvular surgery.

<21>
Accession Number
20160175228
Author
Myles P.S.; Smith J.A.; Forbes A.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; Wallace S.
Institution
(Myles, Cooper, Marasco, Wallace) Alfred Hospital, Department of
Anaesthesia and Perioperative Medicine, Commercial Rd., Melbourne, VIC
3004, Australia
(Myles, Smith, Forbes, Cooper, Marasco, McNeil) Monash University,
Melbourne, VIC, Australia
(Silbert) St. Vincent's Hospital, Fitzroy, VIC, Australia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(Jayarajah) Plymouth Medical School Devon, United Kingdom
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
Title
Stopping vs. continuing aspirin before coronary artery surgery.
Source
New England Journal of Medicine. 374 (8) (pp 728-737), 2016. Date of
Publication: 25 Feb 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Most patients with coronary artery disease receive aspirin for
primary or secondary prevention of myocardial infarction, stroke, and
death. Aspirin poses a risk of bleeding in patients undergoing surgery,
but it is unclear whether aspirin should be stopped before coronary artery
surgery. METHODS We used a 2-by-2 factorial trial design to randomly
assign patients who were scheduled to undergo coronary artery surgery and
were at risk for perioperative complications to receive aspirin or placebo
and tranexamic acid or placebo. The results of the aspirin trial are
reported here. Patients were randomly assigned to receive 100 mg of
aspirin or matched placebo preoperatively. The primary outcome was a
composite of death and thrombotic complications (nonfatal myocardial
infarction, stroke, pulmonary embolism, renal failure, or bowel
infarction) within 30 days after surgery. RESULTS Among 5784 eligible
patients, 2100 were enrolled; 1047 were randomly assigned to receive
aspirin and 1053 to receive placebo. A primary outcome event occurred in
202 patients in the aspirin group (19.3%) and in 215 patients in the
placebo group (20.4%) (relative risk, 0.94; 95% confidence interval, 0.80
to 1.12; P = 0.55). Major hemorrhage leading to reoperation occurred in
1.8% of patients in the aspirin group and in 2.1% of patients in the
placebo group (P = 0.75), and cardiac tamponade occurred at rates of 1.1%
and 0.4%, respectively (P = 0.08). CONCLUSIONS Among patients undergoing
coronary artery surgery, the administration of preoperative aspirin
resulted in neither a lower risk of death or thrombotic complications nor
a higher risk of bleeding than that with placebo. (Funded by the
Australian National Health and Medical Research Council and others;
Australia New Zealand Clinical Trials Registry number,
ACTRN12605000557639.).

<22>
Accession Number
20160178590
Author
Murphy S.A.; Cannon C.P.; Blazing M.A.; Giugliano R.P.; White J.A.;
Lokhnygina Y.; Reist C.; Im K.; Bohula E.A.; Isaza D.; Lopez-Sendon J.;
Dellborg M.; Kher U.; Tershakovec A.M.; Braunwald E.
Institution
(Murphy, Cannon, Giugliano, Im, Bohula, Braunwald) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham, Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Blazing, White, Lokhnygina, Reist) Duke Clinical Research Institute,
Durham, NC, United States
(Isaza) Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota
Cundinamarca, Colombia
(Lopez-Sendon) Hospital Universitario la Paz, Cardiology Department,
Madrid, Spain
(Dellborg) Sahlgrenska University Hospital/Ostra, Sahlgrenska Academy,
University of Gothenburg, Gotenburg, Sweden
(Kher, Tershakovec) Merck and Company, Inc., Kenilworth, NJ, United States
Title
Reduction in Total Cardiovascular Events with Ezetimibe/Simvastatin
Post-Acute Coronary Syndrome the IMPROVE-IT Trial.
Source
Journal of the American College of Cardiology. 67 (4) (pp 353-361), 2016.
Date of Publication: 02 Feb 2016.
Publisher
Elsevier USA
Abstract
Background Intensive low-density lipoprotein cholesterol therapy with
ezetimibe/simvastatin in IMPROVE-IT (IMProved Reduction of Outcomes:
Vytorin Efficacy International Trial) significantly reduced the first
primary endpoint (PEP) in patients post-acute coronary syndrome (ACS)
compared to placebo/simvastatin. Objectives This analysis tested the
hypothesis that total events, including those beyond the first event,
would also be reduced with ezetimibe/simvastatin therapy. Methods All PEP
events (cardiovascular [CV] death, myocardial infarction [MI], stroke,
unstable angina [UA] leading to hospitalization, coronary
revascularization >30 days post-randomization) during a median 6-year
follow-up were analyzed in patients randomized to receive
ezetimibe/simvastatin or placebo/simvastatin in IMPROVE-IT. Negative
binomial regression was used for the primary analysis. Results Among
18,144 patients, there were 9,545 total PEP events (56% were first events
and 44% subsequent events). Total PEP events were significantly reduced by
9% with ezetimibe/simvastatin vs placebo/simvastatin (incidence-rate ratio
[RR]: 0.91; 95% confidence interval [CI]: 0.85 to 0.97; p = 0.007), as
were the 3 pre-specified secondary composite endpoints and the exploratory
composite endpoint of CV death, MI, or stroke (RR: 0.88; 95% CI: 0.81 to
0.96; p = 0.002). The reduction in total events was driven by decreases in
total nonfatal MI (RR: 0.87; 95% CI: 0.79 to 0.96; p = 0.004) and total NF
stroke (RR: 0.77; 95% CI: 0.65 to 0.93; p = 0.005). Conclusions
Lipid-lowering therapy with ezetimibe plus simvastatin improved clinical
outcomes. Reductions in total PEP events, driven by reductions in MI and
stroke, more than doubled the number of events prevented compared with
examining only the first event. These data support continuation of
intensive combination lipid-lowering therapy after an initial CV event.
(IMProved Reduction of Outcomes: Vytorin Efficacy International Trial
[IMPROVE-IT]; NCT00202878)

<23>
Accession Number
20160019344
Author
Etnel J.R.G.; Elmont L.C.; Ertekin E.; Mokhles M.M.; Heuvelman H.J.;
Roos-Hesselink J.W.; De Jong P.L.; Helbing W.A.; Bogers A.J.J.C.;
Takkenberg J.J.M.
Institution
(Etnel, Elmont, Ertekin, Mokhles, Heuvelman, De Jong, Bogers, Takkenberg)
Department of Cardiothoracic Surgery, Erasmus University Medical Center,
PO Box 2040, Rotterdam 3000 CA, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Helbing) Department of Pediatric Cardiology, Erasmus University Medical
Center, Sophia Children's Hospital, Rotterdam, Netherlands
Title
Outcome after aortic valve replacement in children: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (1) (pp 143-152e3),
2016. Date of Publication: 01 Jan 2016.
Publisher
Mosby Inc.
Abstract
Objective Despite an increasing interest in pediatric aortic valve repair,
aortic valve replacement in children may be unavoidable. The evidence on
outcome after pediatric aortic valve replacement is limited and usually
reported in small case series. This systematic review and meta-analysis
aims to provide an overview of reported outcome of pediatric patients
after aortic valve replacement. Methods A systematic literature search for
publications reporting outcome after pediatric aortic valve replacement
published between January 1990 and May 2015 was conducted. Studies written
in English with a study size of more than 30 patients were included.
Results Thirty-four publications reporting on 42 cohorts were included in
this review: 26 concerning the Ross procedure (n = 2409), 13 concerning
mechanical prosthesis aortic valve replacement (n = 696), and 3 concerning
homograft aortic valve replacement (n = 224). There were no studies on
bioprostheses that met our inclusion criteria. The pooled mean patient age
was 9.4 years, 12.8 years, and 8.9 years for Ross, mechanical prosthesis,
and homograft recipients, respectively. Pooled mean follow-up was 6.6
years. The Ross procedure was associated with lower early (4.20%; 95%
confidence interval [CI], 3.37-5.22 vs 7.34%; 95% CI, 5.21-10.34 vs
12.82%; 95% CI, 8.91-18.46) and late mortality (0.64%/y; 95% CI, 0.49-0.84
vs 1.23%/y; 95% CI, 0.85-1.79 vs 1.59%/y; 95% CI, 1.03-2.46) compared with
mechanical prosthesis aortic valve replacement and homograft aortic valve
replacement, respectively. No significantly different aortic valve
reoperation rates were observed between the Ross procedure and mechanical
prosthesis aortic valve replacement (1.60%/y; 95% CI, 1.27-2.02 vs
1.07%/y; 95% CI, 0.68-1.68, respectively), whereas homograft aortic valve
replacement was associated with significantly higher aortic valve
reoperation rates (5.44%/y; 95% CI, 4.24-6.98). The Ross
procedure-associated right ventricular outflow tract reoperation rate was
1.91% per year (95% CI, 1.50-2.44). Conclusions This systematic review
illustrates that all currently available aortic valve substitutes are
associated with suboptimal results in children, reflecting the urgent need
for reliable and durable repair techniques and innovative replacement
solutions for this challenging group of patients.

<24>
Accession Number
20151018907
Author
Alexopoulos D.; Davlouros P.; Tsigkas G.; Koutsogiannis N.; Hassapi A.;
Scortsanitis C.; Pentara I.; Vogiatzi C.; Xanthopoulou I.
Institution
(Alexopoulos, Davlouros, Tsigkas, Koutsogiannis, Hassapi, Scortsanitis,
Pentara, Vogiatzi, Xanthopoulou) Department of Cardiology, Patras
University Hospital, Patras, Greece
Title
Comparison of Ticagrelor Versus Thienopyridine Loading Effect on
Fractional Flow Reserve in Patients with Coronary Artery Disease.
Source
American Journal of Cardiology. 117 (1) (pp 22-28), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Inc.
Abstract
Ticagrelor loading dose (LD) increases adenosine plasma levels, which
might interfere with fractional flow reserve (FFR) assessment because the
latter is based on adenosine-induced hyperemia. In a prospective study,
consecutive patients who underwent coronary angiography with at least 1 de
novo stenosis >50% and <90% in severity amenable to intervention underwent
FFR assessment using intravenous adenosine 140 mug/kg/min for 3 minutes.
Patients were subsequently randomized to either ticagrelor 180 mg (n = 38)
or control thienopyridine (n = 38) (prasugrel 60 mg [n = 28] or
clopidogrel 600 mg [n = 10]), followed by a second FFR assessment of the
target lesion 2 hours after drug. Pre-drug, steady hyperemia FFR (sFFR,
median, first to third quartiles) was 0.82 (0.75 to 0.88) and 0.81 (0.75
to 0.88), p = 0.9, whereas post-drug, 0.82 (0.72 to 0.87) and 0.79 (0.73
to 0.86), p = 0.5, in thienopyridine and ticagrelor-treated patients,
respectively. The primary end point of percent relative change in sFFR
between pre- and post-drug periods was greater in ticagrelor- than
thienopyridine-treated patients, -1.24 (-5.54 to 0.0) versus -0.51 (-3.68
to 3.21), p = 0.03, respectively. Absolute change in sFFR between pre- and
post-drug periods was marginally higher in ticagrelor- than
thienopyridine-treated patients -0.01 (-0.04 to 0.0) versus -0.005 (-0.03
to 0.02), p = 0.048, respectively. Reclassification of treatment decision
at the sFFR <0.80 cutoff post-drug occurred in 6 (15.8%) versus 5 (13.2%)
of ticagrelor- and thienopyridine-treated patients, respectively. In
conclusion, after ticagrelor LD, an absolute and relative reduction in
sFFR compared with thienopyridine LD is observed. Administration of
ticagrelor should be considered as a potential source, albeit minor, of
FFR variability.

<25>
Accession Number
20151005604
Author
Linde J.J.; Hove J.D.; Sorgaard M.; Kelbaek H.; Jensen G.B.; Kuhl Jo.T.;
Hindso L.; Kober L.; Nielsen W.B.; Kofoed K.F.
Institution
(Linde, Hove, Jensen, Nielsen) Department of Cardiology, Hvidovre
Hospital, University of Copenhagen, Hvidovre, Denmark
(Linde, Sorgaard, Kuhl, Hindso, Kober, Kofoed) Department of Cardiology,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Hove) Center for Functional and Diagnostic Imaging and Research, Hvidovre
Hospital, University of Copenhagen, Hvidovre, Denmark
(Kelbaek) Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
(Kofoed) Department of Radiology, Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Linde) Department of Cardiology, Hvidovre University Hospital, Kettegard
Alle 30, Hvidovre 2650, Denmark
Title
Long-Term Clinical Impact of Coronary CT Angiography in Patients with
Recent Acute-Onset Chest Pain: The Randomized Controlled CATCH Trial.
Source
JACC: Cardiovascular Imaging. 8 (12) (pp 1404-1413), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Elsevier Inc.
Abstract
Objectives The aim of the CATCH (CArdiac cT in the treatment of acute
CHest pain) trial was to investigate the long-term clinical impact of a
coronary computed tomographic angiography (CTA)-guided treatment strategy
in patients with recent acute-onset chest pain compared to standard care.
Background The prognostic implications of a coronary CTA-guided treatment
strategy have not been compared in a randomized fashion to standard care
in patients referred for acute-onset chest pain. Methods Patients with
acute chest pain but normal electrocardiograms and troponin values were
randomized to treatment guided by either coronary CTA or standard care
(bicycle exercise electrocardiogram or myocardial perfusion imaging). In
the coronary CTA-guided group, a functional test was included in cases of
nondiagnostic coronary CTA images or coronary stenoses of borderline
severity. The primary endpoint was a composite of cardiac death,
myocardial infarction (MI), hospitalization for unstable angina pectoris
(UAP), late symptom-driven revascularizations, and readmission for chest
pain. Results We randomized 299 patients to coronary CTA-guided strategy
and 301 to standard care. After inclusion, 24 patients withdrew their
consent. The median (interquartile range) follow-up duration was 18.7
(range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients
(11%) had a primary endpoint versus 47 patients (16%) in the standard care
group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to
0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization
for UAP, and late symptom-driven revascularization) was observed in 5
patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14
patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven
revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI:
0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were
insignificant (p = 0.06). Conclusions A coronary CTA-guided treatment
strategy appears to improve clinical outcome in patients with recent
acute-onset chest pain and normal electrocardiograms and troponin values
compared to standard care with a functional test. (Cardiac-CT in the
Treatment of Acute Chest Pain [CATCH]; NCT01534000)

<26>
Accession Number
20160175681
Author
Yi J.; Xiang Z.; Deng X.; Fan T.; Fu R.; Geng W.; Guo R.; He N.; Li C.; Li
L.; Li M.; Li T.; Tian M.; Wang G.; Wang L.; Wang T.; Wu A.; Wu D.; Xue
X.; Xu M.; Yang X.; Yang Z.; Yuan J.; Zhao Q.; Zhou G.; Zuo M.; Pan S.;
Zhan L.; Yao M.; Huang Y.
Institution
(Yi, Huang) Peking Union Medical College Hospital, Beijing, China
(Xiang, Pan, Zhan, Yao) 3M China R And D Center, Shanghai, China
(Deng) Plastic Surgery Hospital and Institute, CAMS, PUMC, Beijing, China
(Fan) Tsinghua University Yuquan Hospital, Beijing, China
(Fu) Beijing Chuiyangliu Hospital, Beijing, China
(Geng) Beijing Chest Hospital, Capital Medical University, Beijing, China
(Guo) Miyunxian Hospital, Beijing, China
(He) Peking University Shougang Hospital, Beijing, China
(Li) China-Japan Friendship Hospital, Beijing, China
(Li) China Meitan General Hospital, Beijing, China
(Li) Peking University Third Hospital, Beijing, China
(Li) Beijing Tongren Hospital Capital Medical University, Beijing, China
(Tian) Beijing Friendship Hospital, Capital Medical University, Beijing,
China
(Wang) Beijing Jishuitan Hospital, Beijing, China
(Wang) Haidian Maternal and Child Health Hospital, Beijing, China
(Wang) Xuanwu Hospital Capital Medical University, Beijing, China
(Wu) Beijing Chao-Yang Hospital, Beijing, China
(Wu) Luhe Teaching Hospital of the Capital Medical University, Beijing,
China
(Xue, Yang) Air Force General Hospital, PLA, Beijing, China
(Xu) Beijing Obstetrics and Gynecology Hospital, Capital Medical
University, Beijing, China
(Yang) Central Hospital of China Aerospace Corporation, Beijing, China
(Yuan) Beijing Rectum Hospital, Beijing, China
(Zhao) Beijing Shi Jing Shan Hospital, Beijing, China
(Zhou) Beijing Pinggu Hospital, Beijing, China
(Zuo) Beijing Hospital of the Ministry of Health, Beijing, China
Title
Incidence of inadvertent intraoperative hypothermia and its risk factors
in patients undergoing general anesthesia in Beijing: A prospective
regional survey.
Source
PLoS ONE. 10 (9) (no pagination), 2015. Article Number: e0136136. Date of
Publication: 11 Sep 2015.
Publisher
Public Library of Science
Abstract
Background/Objective Inadvertent intraoperative hypothermia (core
temperature <360 C) is a recognized risk in surgery and has adverse
consequences. However, no data about this complication in China are
available. Our study aimed to determine the incidence of inadvertent
intraoperative hypothermia and its associated risk factors in a sample of
Chinese patients. Methods We conducted a regional cross-sectional survey
in Beijing from August through December, 2013. Eight hundred thirty
patients who underwent various operations under general anesthesia were
randomly selected from 24 hospitals through a multistage probability
sampling. Multivariate logistic regression analyses were applied to
explore the risk factors of developing hypothermia. Results The overall
incidence of intraoperative hypothermia was high, 39.9%. All patients were
warmed passively with surgical sheets or cotton blankets, whereas only
10.7%of patients received active warming with space heaters or electric
blankets. Pre-warmed intravenous fluid were administered to 16.9%of
patients, and 34.6%of patients had irrigation of wounds with pre-warmed
fluid. Active warming (OR = 0.46, 95%CI 0.26a"0.81), overweight or obesity
(OR = 0.39, 95%CI 0.28a"0.56), high baseline core temperature before
anesthesia (OR = 0.08, 95%CI 0.04a"0.13), and high ambient temperature (OR
= 0.89, 95%CI 0.79a"0.98) were significant protective factors for
hypothermia. In contrast, major-plus operations (OR = 2.00, 95%CI
1.32a"3.04), duration of anesthesia (1a"2 h) (OR = 3.23, 95%CI 2.19a"4.78)
and >2 h (OR = 3.44, 95%CI 1.90a"6.22,), and intravenous un-warmed fluid
(OR = 2.45, 95%CI 1.45a" 4.12) significantly increased the risk of
hypothermia. Conclusions The incidence of inadvertent intraoperative
hypothermia in Beijing is high, and the rate of active warming of patients
during operation is low. Concern for the development of intraoperative
hypothermia should be especially high in patients undergoing major
operations, requiring long periods of anesthesia, and receiving un-warmed
intravenous fluids.

<27>
Accession Number
20160194019
Author
Allen K.B.; Fowler V.G.; Gammie J.S.; Hartzel J.S.; Onorato M.T.; DiNubile
M.J.; Sobanjo-ter Meulen A.
Institution
(Allen) St. Luke's Mid-America Heart and Vascular Institute, Kansas City,
MO, United States
(Fowler) Duke University Medical Center, Durham, NC, United States
(Gammie) University of Maryland School of Medicine, Baltimore, United
States
(Hartzel, Onorato, DiNubile, Sobanjo-ter Meulen) Merck Sharp and Dohme,
Whitehouse Station, NJ, United States
(Sobanjo-ter Meulen) The Bill and Melinda Gates Foundation, New York, NY,
United States
Title
Staphylococcus aureus infections after elective cardiothoracic surgery:
Observations from an international randomized placebo-controlled trial of
an investigational S aureus vaccine.
Source
Open Forum Infectious Diseases. 1 (2) (no pagination), 2014. Date of
Publication: 2014.
Publisher
Oxford University Press
Abstract
Background. An unmet need to prevent Staphylococcus aureus (SA) infections
after cardiothoracic surgery persists despite current practices.
Cost-effective implementation of preventive strategies requires
contemporary knowledge about modifiable risk factors. Methods. From 2007
to 2011, an international, double-blind, randomized placebo-controlled
trial of a novel SA vaccine (V710) was conducted in 7664 adults scheduled
for median sternotomy at 164 sites. We analyzed SA infections developing
up to 360 days postoperatively in 3832 placebo recipients. Results.
Coronary artery bypass grafting was performed in 80.8% (3096 of 3832) of
placebo recipients. The overall incidence of any postoperative SA
infection was 3.1% (120 of 3832). Invasive SA infections (including
bacteremia and deep sternal-wound infections) developed in 1.0%.
Methicillin-resistant SA (MRSA) accounted for 19% (23 of 120) of SA
infections, with 57% (13 of 23) of the MRSA infections occurring in
diabetic patients. All-cause mortality was 4.1% (153 of 3712) in patients
without SA infection, 7.2% (7 of 97) in methicillin-susceptible SA (MSSA)
infections, and 17.3% (4 of 23) in MRSA infections (P < .01).
Staphylococcus aureus nasal carriage was detected preoperatively in 18.3%
(701 of 3096) patients, including 1.6% colonized with MRSA. Postoperative
SA infections occurred in 7.0% (49 of 701) of colonized patients versus
2.3% (71 of 3131) of patients without colonization (relative risk = 3.1
[95% confidence interval, 2.2-4.4]). Conclusions. In this large
international cohort of patients undergoing cardiac surgery and observed
prospectively, invasive postoperative SA infections occurred in 1% of
adult patients despite modern perioperative management. The attributable
mortality rates were 3% for MSSA and 13% for MRSA infections. Preoperative
nasal colonization with SA increased the risk of postoperative infection
threefold. The utility of strategies to reduce this incidence warrants
continued investigation.

<28>
Accession Number
20160174488
Author
Leone A.M.; D'Amario D.; Teofili L.; Basile E.; Cannata F.; Graziani F.;
Marzilli M.; Russo A.M.; Tarantini G.; Ceconi C.; Leone G.; Trani C.;
Rebuzzi A.G.; Crea F.
Institution
(Leone, D'Amario, Basile, Cannata, Graziani, Trani, Rebuzzi, Crea)
Dipartimento di Scienze Cardiovascolari, Universita Cattolica del Sacro
Cuore, Largo Agostino Gemelli, 8, Rome 00168, Italy
(Teofili, Leone) Istituto di Ematologia, Universita Cattolica del Sacro
Cuore, Largo Agostino Gemelli, 8, Rome 00168, Italy
(Marzilli) Dipartimento Cardio-Toraco-Vascolare, Universita di Pisa, Via
Paradisa, 2, Pisa 56124, Italy
(Russo) MEBIC, Universita San Raffaele, Via di Val Cannuta, 247 - 00166,
Rome, Italy
(Tarantini) Dipartimento di Scienze Cardiologiche Toraciche e Vascolari,
Universita di Padova, Via Giustiniani, 2, Padova 35128, Italy
(Ceconi) Dipartimento di Medicina Clinica e Sperimentale, Universita di
Ferrara, Corso Giovecca, 203, Ferrara 44100, Italy
Title
The combined effect of subcutaneous granulocyte- colony stimulating factor
and myocardial contrast echocardiography with intravenous infusion of
sulfur hexafluoride on post-infarction left ventricular function, the
RIGENERA 2.0 trial: Study protocol for a randomized controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 97. Date of
Publication: February 19, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Several clinical trials and recent meta-analyses have
demonstrated that administration of recombinant human granulocyte-colony
stimulating factor (G-CSF) is safe and, only in patients with large acute
myocardial infarction (AMI), is associated with an improvement in left
ventricular ejection fraction. Moreover, the mobilization and engraftment
of the bone marrow-derived cells may differ significantly among patients,
interfering with the restoration of left ventricular function after
treatment. Therefore, the clinical potential application of the G-CSF has
not yet been fully elucidated. Methods/Design: The RIGENERA 2.0 trial is a
multicenter, phase II, placebo-controlled, randomized, open-label, with
blinded evaluation of endpoints (PROBE) trial in which 120 patients with
an acute ST-elevation myocardial infarction (STEMI) undergoing successful
revascularization but with residual myocardial dysfunction will be
enrolled. In cases where there is a left ventricular ejection fraction
(LVEF) <45% the patient will be electronically randomized (1:1 ratio) to
receive either subcutaneous recombinant human G-CSF (group 1) or placebo
(group 2) both added on top of optimal standard of care. Both groups will
undergo myocardial contrast echocardiography with intravenous infusion of
sulfur hexafluoride (MCE) whilst undergoing the echocardiogram. The
primary efficacy endpoint is the evaluation of the LVEF at 6months after
AMI assessed by cardiac magnetic resonance. Secondary efficacy endpoints
are the evaluation of LVEF at 6months after AMI assessed by
echocardiography, left ventricular end-diastolic volume (LVEDV) and left
ventricular end-systolic volume (LVESV) assessed by cardiac magnetic
resonance and echocardiography at 6months, together with the incidence of
major adverse clinical events (MACE) defined as death, myocardial
infarction, sustained cardiac arrhythmias, cardiogenic shock, stroke and
re-hospitalization due to heart failure at 1year. Discussion: The RIGENERA
2.0 trial will test whether G-CSF administration and MCE, through the
enhancement of the bone marrow-derived cells homing in the myocardium,
determines an improvement in regional and global contractile function,
myocardial perfusion and infarct extension in patients with large AMI. The
results of the present study are expected to envision routine clinical use
of this safe, affordable and reproducible approach in patients with
successful revascularization after AMI. Trial registration:
ClinicalTrials.gov: NCT02502747(29 June 2015); EudraCT: 2015-002189-21 (10
July 2015).

<29>
Accession Number
20151047782
Author
Panchal H.B.; Barry N.; Bhatheja S.; Albalbissi K.; Mukherjee D.; Paul T.
Institution
(Panchal, Bhatheja, Albalbissi, Paul) Division of Cardiology, Department
of Internal Medicine, East Tennessee State University, 329 N State of
Franklin Rd, Johnson City, TN 37604, United States
(Barry) Department of Internal Medicine, East Tennessee State University,
VA Building #1, Johnson City, TN, United States
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, 4800 Alberta, El Paso, TX 79905, United States
Title
Mortality and major adverse cardiovascular events after transcatheter
aortic valve replacement using Edwards valve versus CoreValve: A
meta-analysis.
Source
Cardiovascular Revascularization Medicine. 17 (1) (pp 24-33), 2016. Date
of Publication: 01 Jan 2016.
Publisher
Elsevier Inc.
Abstract
Objectives: In patients with severe aortic stenosis who are at high risk
for surgery, transcatheter aortic valve replacement (TAVR) has emerged as
an alternative procedure using EV or CV. The objective of this
meta-analysis is to compare 1-year mortality and major adverse
cardiovascular and cerebrovascular events (MACCE) between Edwards valve
(EV) and Medtronic CoreValve (CV). Methods: PubMed and the Cochrane Center
Register of Controlled Trials were searched through December 2014. Twenty
seven studies (n = 12,249) comparing TAVR procedure that used EV (n =
5745) and CV (n = 6504) were included. End points were procedural success
rates, post-procedural mortality, myocardial infarction (MI), stroke,
major bleeding, major vascular complications, incidence of new permanent
pacemaker (PPM) placement and new left bundle branch block (LBBB). The
odds ratio (OR) with 95% confidence interval (CI) was computed and p <
0.05 was considered for significance. Results: There were no significant
differences between EV and CV for post-procedural in-hospital, 30-day and
1-year all-cause mortality rates (p = 0.53, 0.33 and 0.94 respectively),
cardiovascular mortality (p = 0.61), stroke (p = 0.54), major bleeding (p
= 0.25) and major vascular complications (p = 0.27). MI was significantly
lower with EV compared to CV (OR: 0.56, CI: 0.35-0.89, p = 0.01).
Placement of new PPM and new onset LBBB were significantly higher in CV
compared to EV (OR: 3.35, CI: 2.96-3.79, p < 0.00001 and OR: 6.55, CI:
4.76-9.03, p < 0.00001 respectively). Conclusions: The results of our
meta-analysis suggest that TAVR procedure using CV may be associated with
a higher incidence of MI, new PPM placement, and new onset LBBB compared
to EV. However, the type of valve placed does not affect mortality.

<30>
Accession Number
20151038494
Author
Zhou C.; Gong J.; Chen D.; Wang W.; Liu M.; Liu B.
Institution
(Zhou, Gong, Chen, Wang, Liu) Department of Anesthesiology, State Key
Laboratory of Cardiovascular Disease, National Center for Cardiovascular
Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Liu) Department of Anesthesiology, Laboratory of Anesthesia and Critical
Care Medicine, Translational Neuroscience Center, West China Hospital,
Sichuan University, No. 17 Renmin South Road Third Section, Wuhou
District, Chengdu 610041, China
Title
Levosimendan for prevention of acute kidney injury after cardiac surgery:
A meta-analysis of randomized controlled trials.
Source
American Journal of Kidney Diseases. 67 (3) (pp 408-416), 2016. Date of
Publication: 01 Mar 2016.
Publisher
W.B. Saunders
Abstract
Background Levosimendan has been shown to confer direct renoprotection in
renal endotoxemic and ischemia-reperfusion injury and could increase renal
blood flow in patients with low-cardiac-output heart failure. Results from
clinical trials of levosimendan on acute kidney injury (AKI) following
cardiac surgery are controversial. Study Design A random-effect
meta-analysis was conducted based on evidence from PubMed, EMBASE, and
Cochrane Library. Settings & Population Adult patients undergoing cardiac
surgery. Selection Criteria for Studies Randomized controlled trials
comparing the renal effect of levosimendan versus placebo or other
inotropic drugs during cardiac surgery. Intervention Perioperative
levosimendan continuous infusion at a rate of 0.1 to 0.2 mug/kg/min
following a loading dose (6-24 mug/kg) for 24 hours or only 1 loading dose
(24 mug/kg) within 1 hour. Outcomes AKI, need for renal replacement
therapy, mechanical ventilation duration, intensive care unit stay during
hospitalization, and postoperative mortality (in-hospital or within 30
days). Results 13 trials with a total of 1,345 study patients were
selected. Compared with controls, levosimendan reduced the incidence of
postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P =
0.001; I² = 0.0%), renal replacement therapy (22/492 vs 49/491;
OR, 0.43; 95% CI, 0.25-0.76; P = 0.002; I² = 0.0%),
postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P
< 0.001; I² = 0.0%), mechanical ventilation duration (in days;
n = 235; weighted mean difference, -0.34; 95% CI, -0.58 to -0.09; P =
0.007], and intensive care unit stay (in days; n = 500; weighted mean
difference, -2.2; 95% CI, -4.21 to -0.13; P = 0.04). Limitations Different
definitions for AKI among studies. Small sample size for some trials.
Conclusions Perioperative administration of levosimendan in patients
undergoing cardiac surgery may reduce complications. Future trials are
needed to determine the dose effect of levosimendan in improving outcomes,
especially in patients with decreased baseline kidney function.

<31>
Accession Number
72215150
Author
Turgeon R.; Barry A.
Institution
(Turgeon) Faculty of Pharmaceutical Sciences, University of British
Columbia, Vancouver, BC, Canada
(Barry) Faculty of Pharmacy and Pharmaceutical Sciences, University of
Alberta, Edmonton, AB, Canada
Title
Single versus dual antiplatelet therapy following transcatheter aortic
valve implantation: A systematic review.
Source
Canadian Journal of Hospital Pharmacy. Conference: CSHP Professional
Practice Conference 2015 Toronto, ON Canada. Conference Start: 20150131
Conference End: 20150204. Conference Publication: (var.pagings). 68 (1)
(pp 72-73), 2015. Date of Publication: 2015.
Publisher
Canadian Society of Hospital Pharmacists
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a viable
alternative to surgical aortic valve replacement or medical management in
individuals with calcific aortic stenosis at high-risk for surgical
complications or who are not surgical candidates. Guidelines currently
recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA)
and clopidogrel for 1 to 6 months following TAVI primarily based on expert
consensus. Objective: To evaluate the efficacy and safety of DAPT compared
to single antiplatelet therapy in patients undergoing TAVI. Methods:
CENTRAL, EMBASE, MEDLINE and unpublished sources of literature were
searched from inception to July 2014. Included were randomized controlled
trials (RCTs), cohort and case-control studies that compared DAPT to
single antiplatelet therapy post-TAVI. Risk of bias for RCTs was assessed
using the Cochrane Risk of Bias Tool. The Newcastle-Ottawa Scale was used
to evaluate the quality of cohort and case-control studies. Outcomes of
interest included all-cause mortality, major thrombotic events and
bleeding events. Results: Four articles met the inclusion criteria (2 RCTs
and 2 cohort studies) for a total of 662 patients. Included trials
compared the combi nation of ASA plus clopidogrel to ASA alone. Duration
of DAPT ranged from 1 to 6 months. All included studies were deemed to be
at high-risk of bias and could not be meta-analyzed due to selective
outcome reporting and variable follow-up. Qualitative analysis of
individual studies demonstrated no statistically significant reduction in
all-cause mortality with DAPT compared to single antiplatelet therapy.
Furthermore, DAPT did not reduce thrombotic events and resulted in a
similar or higher risk of bleeding. Conclusions: Current published
evidence, though limited by low methodological quality, suggests a lack of
benefit and potential harm with DAPT compared to single antiplatelet
therapy in patients post-TAVI. Therefore, the routine use of DAPT in these
patients should be reevaluated until more evidence is available.

<32>
Accession Number
72210399
Author
Cho S.-M.; Deshpande A.; Hernandez A.; Uchino K.
Institution
(Cho, Deshpande, Hernandez, Uchino) Cleveland Clinic, Cleveland, OH,
United States
Title
Systematic review of radiographic and symptomatic brain infarcts in
carotid artery interventions.
Source
Stroke. Conference: American Heart Association/American Stroke Association
2016 International Stroke Conference and State-of-the-Science Stroke
Nursing Symposium Los Angeles, CA United States. Conference Start:
20160216 Conference End: 20160219. Conference Publication: (var.pagings).
47 (no pagination), 2016. Date of Publication: February 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Reports vary in incidence of silent brain infarcts after
cardiovascular and cerebrovascular procedures. In a systematic review we
compared rates of radiographic brain infarcts (RBI) and clinical strokes
among different carotid artery procedures: carotid endarterectomy (CEA),
and carotid stenting (CAS) with or without protection devices. Methods: We
searched MEDLINE and 4 other databases for subject headings and text
related to brain infarcts in carotid artery interventions from inception
through February 2015. We included articles with carotid interventions if
brain MRI was performed systematically, RBI and stroke incidence were
reported, and compared infarct rates between different devices in CAS.
Results: Of 6332 articles retrieved, 65 studies (5982 patients) met the
inclusion criteria. There were 26 cohorts in CEA, 39 in CAS with distal
protection, 8 in CAS with proximal protection with or without flow
reversal, 10 in CAS with unspecified devices and 10 in CAS without
protection. MRI diffusion-weighted imaging scan was performed
pre-procedure in 64 studies and post-procedure in all 65 studies. Overall,
1761 subjects (29.4%) had infarcts on MRI, whereas only 191 (3.2%)
manifested as clinical strokes. Only 11% of subjects with infarcts were
found to have clinical strokes and the rate did not differ between 36
studies that determined strokes systematically and the remainder without
systematic examination. CEA had lower incidence of RBI compared to CAS
(15.9% (239/1524) vs 34.0% (1522/4482), p<0.001) but not of strokes (2.5%
(37/1500) vs 3.4% (154/4482), p=0.07). RBI incidences differed among
embolism protection methods in CAS: 24.3% (70/288) in proximal protection,
35.7% (740/2075) in distal protection, 32.6% (489/1502) in unspecified
devices, and 36.1% (223/617) without protection; incidence of stroke were
not significantly different among the procedures with 2.4% (7/288), 3.3%
(69/2075), 3.1% (46/1502), and 5.2% (32/617), respectively. Conclusion:
Only 1 of 9 periprocedural radiographic infarcts during carotid
endarterectomy or stent result in clinical strokes. CEA has a lower
incidence of RBI compared to CAS.

<33>
Accession Number
72210377
Author
Zhao W.; Ma C.; Ovbiagele B.; Hou B.; Sun Y.; Feng W.; Meng R.; Ding Y.;
Wu W.; Duan Y.; Shi J.; Ji X.
Institution
(Zhao, Sun, Meng, Wu) Neurology, Xuanwu Hosp, Capital Med Univ, Beijing,
China
(Ma) Surgical Intensive Care Unit, Beijing Anzhen Hosp, Capital Med Univ,
Beijing, China
(Ovbiagele) Nuerology, Med Univ of South Carolina, Charleston, SC, United
States
(Hou) Intensive Care Unit, Shanxian Central Hopital, Heze, Shandong
Province, China
(Feng) Neurology, Med Univ of South Carolina, Charleston, SC, United
States
(Ding) Neurosurgery, Wayne State Univ Sch of Medicine, Detroit, MI, United
States
(Duan, Shi) China-America Joint Institute of Neuroscience, Xuanwu Hosp,
Capital Med Univ, Beijing, China
(Ji) Neurosurgery, Xuanwu Hosp, Capital Med Univ, Beijing, China
Title
Remote ischemic preconditioning reduces new vascular brain injury early
after carotid artery stenting: A randomized controlled trial.
Source
Stroke. Conference: American Heart Association/American Stroke Association
2016 International Stroke Conference and State-of-the-Science Stroke
Nursing Symposium Los Angeles, CA United States. Conference Start:
20160216 Conference End: 20160219. Conference Publication: (var.pagings).
47 (no pagination), 2016. Date of Publication: February 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cerebral embolization is a major complication of carotid
artery stenting (CAS). Remote ischemic preconditioning (RIPC) have been
shown to reduce distal embolization in coronary stenting, but it is
unclear whether RIPC can reduce embolization after CAS. Objective: To
evaluate the effect of RIPC on cerebral embolization after CAS Hypothesis:
We assessed the hypothesis that RIPC can reduce new vascular brain injury
early after CAS. Methods: 189 symptomatic carotid artery stenosis patients
treated with CAS, were allocated randomly to RIPC group, control group,
and sham RIPC group. All patients received standard background medical
therapy. Patients in the RIPC and sham RIPC group underwent RIPC and sham
RIPC twice daily respectively. The primary outcome was incidence of new
brain parenchymal lesions on MRI at 48hr after CAS. The secondary outcomes
were lesion size and occurrence of clinical events within 6 months after
CAS. One-way ANOVA, Chi-Square test and Wilcoxon signed-rank test were
used accordingly. Results: 162 patients, who completely finished CAS and
MRI, were included in the primary analysis. Incidence of new lesions on
post-treatment MRI was 19.23% in the RIPC group, 46.43% in the control
group (RR, 0.41; 95% CI 0.22-0.77; p=0.003) and 42.59% in the sham RIPC
group (RR, 0.45; 95% CI 0.24-0.85; p=0.009). Median volumes of new lesions
and median total lesion volume were both smaller in RIPC group than other
2 groups (p<0.01 each). However, no statistical difference was observed
between the groups regarding clinical events. Conclusions: RIPC was
associated with a significant reduction in the occurrence of new brain
parenchymal lesions within 2 days of CAS. These results need to be
replicated and future larger studies should be sufficiently powered to
examine the effect of RIPC on clinical events after CAS.

<34>
Accession Number
72208066
Author
Forbes S.; Ashman N.; Cove-Smith A.; Mark B.
Institution
(Forbes, Ashman, Cove-Smith, Mark) Royal London Hospital, Department of
Renal Medicine and Transplantation, London, United Kingdom
Title
Mechanical versus bioprosthetic heart valves: A comparison study in
end-stage renal disease.
Source
Nephrology Dialysis Transplantation. Conference: 52nd ERA-EDTA Congress
London United Kingdom. Conference Start: 20150528 Conference End:
20150531. Conference Publication: (var.pagings). 30 (pp iii622), 2015.
Date of Publication: May 2015.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Little evidence guides the choice of valve
replacement in patients with end-stage renal disease (ESRD) patients;
meta-analyses suggest no survival difference between bio- and mechanical
prostheses. Current AHA/ACC guidelines make no specific recommendations,
having previously advocated the use of metallic valves in such patients
owing to the risk of accelerated calcification of tissue valves. The use
of metal valves necessitates life-long anticoagulation, usually with
warfarin. It is increasingly recognised that ESRD patients have
significant increased bleeding risk, and that warfarin should be
avoided.We examined outcomes in such patients with both bio- and
mechanical valve replacements. Methods:We retrospectively studied all
patients known to our services with ESRD and a valve replacement.We
gathered demographics from the time of replacement and data on
anticoagulation, including time in the therapeutic range (TTR). TTR was
calculated using the Rosendaal linear interpolation method, giving a
percentage of days and results within the therapeutic target (target TTR
should be >65%).We noted outcomes including major bleeding, endocarditis,
tissue valve redo and mortality. Results:We included 82 patients; 43 metal
valves, 39 tissue. A total of 419 patient-at-risk years were examined.
Median age at replacement was 58 years. 62% were male and 23% diabetic.
39% had been identified as having ischaemic heart disease and 23% had
simultaneous coronary artery bypass-grafting. The majority of valves were
aortic (68%). All patients with metal valves were anticoagulated with
warfarin, 3 with concomitant aspirin. 5 patients with tissue valves took
warfarin because of AF and 21 were on aspirin. TTR for warfarinised
patients was 37% days in range, 36% results in range. 63% of patients with
a metal valve and 59% with a tissue valve were on haemodialysis or
peritoneal dialysis at the time of operation. There were 44 major bleeding
events (2 fatal) across 24 patients with metal valves, versus 9 with
tissue; a bleed rate of 19.6 versus 4.6 per 100-patient-years (p=0.004).
Endocarditis rates were higher in metal valves (23% vs 10%, p=0.05).
Median time before death was 5.7yrs in metal valves and 3.6 in tissue. 3
warfarinised patients developed calciphylaxis (2 fatal). 3 patients with
tissue valves required redo operations (1 paediatric valve, 2 due to
endocarditis). Echo reports suggested no significant accelerated
calcification in any of the tissue valves. Conclusions: The main
indication formetal valves is in younger patients where tissue valve
lifespan must be considered. Poor 5 year survival in ESRD makes this less
relevant. The likelihood of future procedures (vascular access,
transplantation, biopsy) in a population at increased risk of major
bleeding makes anticoagulation hazardous.We demonstrate increased major
bleeding, endocarditis and calciphylaxis with metal valves with no
valve-survival advantage, suggesting metal valves should be avoided in
ESRD.

<35>
Accession Number
72207591
Author
Jiaqi X.; Lu C.; Xinling L.; Zhimin D.; Yuanhan C.; Zhilian L.; Wei D.;
Wei S.
Institution
(Jiaqi, Lu, Xinling, Yuanhan, Zhilian, Wei, Wei) Guangdong General
Hospital, Guangdong Academy of Medical Sciences, Nephrology, Guangzhou,
China
(Zhimin) First Affiliated Hospital, Sun Yat-sen University, Cardiology,
Guangzhou, China
Title
ACEI/ARB can decrease the risk of cardiorenal syndrome type I and
in-Hospital mortality.
Source
Nephrology Dialysis Transplantation. Conference: 52nd ERA-EDTA Congress
London United Kingdom. Conference Start: 20150528 Conference End:
20150531. Conference Publication: (var.pagings). 30 (pp iii467), 2015.
Date of Publication: May 2015.
Publisher
Oxford University Press
Abstract
Introduction and Aims: A great many of studies have demonstrated that
angiotensin-converting enzyme inhibitors(ACEIs) and angiotensin receptor
blockers (ARBs) play an integral role in the treatment of patients with
renal and heart diseases. However, in circumstances in which maintenance
of glomerular filtration requires efferent arteriolar constriction,
ACEI/ARB may cause acute kidney injury (AKI). A meta analysis has reported
that preoperative use of RAS blockers was associated with increased odds
of postoperative AKI in patients undergoing cardiovascular surgery.
Whether ACEI/ARB will increase the morbility of cardiorenal syndrome(CRS)
type I is unclear. Methods: Clinical datas were collected from 1058 acute
heart failure(AHF) patients in Guangdong General Hospital and the First
Affiliated Hospital of Sun Yat-sen University between July 2005 and July
2012. Baseline SCr was estimated from either the admission value (if this
was within the normal range) or if available, from another value within 3
months, whichever was lowest. AKI was diagnosed according to KDIGO
criteria. Logistic regression analysis was used to determine whether
ACEI/ARB is an independent risk factor for the occurrence of CRS type I
and in-hospital mortality or not. Results: Among 1058 patients, 599 cases
(56.6%) developed AKI and 142 patients died. The use of ACEI/ARB in AKI
group was significantly lower than non-AKI group(63.9% VS 71.3%, P=0.01).
Multiple logistic regression analysis showed that, after adjusted for
diabetes mellitus, eGFR<60 ml/min/1.73m², hemoglobin<110g/l,
albumin<30g/l, diuretics and vasoactive agents use, ACEI/ARB was an
independent protective factor for the development of CRS type
I(OR=0.754,P=0.046). The use of ACEI/ARB in death group was significantly
different from the non-death group(52.8% VS 69.7%, P<0.001). Datas were
adjusted for age, diabetes mellitus, cerebrovascular disease, AKI,
hemoglobin<110g/l, beta blockers and vasoactive agents use. ACEI/ARB could
also decrease the in-hospital motality(OR=0.565,95%CI 0.384-0.832).
Conclusions: ACEI/ARB may protect the AHF patients from cardiorenal
syndrome type I and death.

<36>
Accession Number
72207516
Author
Laing C.; Candilio L.; Evans R.; Jenkins D.P.; Kolvekar S.; Knight R.;
Kunst G.; Nicholas J.; Pepper J.; Ritchie A.; Robertson S.; Xenou M.;
Clayton T.; Yellon D.M.; Hausenloy D.J.
Institution
(Laing) Royal Free London NHS Foundation Trust/UCL, Nephrology, London,
United Kingdom
(Candilio) University College London, Institute of Cardiovascular Science,
London, United Kingdom
(Evans, Knight, Nicholas, Robertson, Clayton) London School of Hygiene and
Tropical Medicine, Clinical Trials Unit, London, United Kingdom
(Jenkins) Papworth Hospital, Cardiothoracic Surgery, Cambridge, United
Kingdom
(Kolvekar, Xenou) University College London Hospitals, Cardiothoracic
Surgery, London, United Kingdom
(Kunst) Kings College Hospital, Cardiac Anaesthesia, London, United
Kingdom
(Pepper) Royal Brompton and Harefield NHS Foundation Trust, Cardiac
Anaesthesia, London, United Kingdom
(Ritchie) Essex Cardiothoracic Centre, Cardiothoracic Surgery, Basildon,
United Kingdom
(Yellon, Hausenloy) University College London, Hatter Cardiovascular
Institute, London, United Kingdom
Title
Effect of remote ischemic preconditioning on AKI incidence and outcomes
following cardiac surgery: Results of a multi-centre randomised controlled
trial.
Source
Nephrology Dialysis Transplantation. Conference: 52nd ERA-EDTA Congress
London United Kingdom. Conference Start: 20150528 Conference End:
20150531. Conference Publication: (var.pagings). 30 (pp iii440), 2015.
Date of Publication: May 2015.
Publisher
Oxford University Press
Abstract
Introduction and Aims: Acute Kidney Injury (AKI) following cardiac surgery
is associated with adverse outcomes. Novel therapies are required to
reduce the development of AKI in this context. Remote ischemic
preconditioning (RIPC) - in which nonlethal ischemia applied to an organ
or tissue protects another organ or tissue as an adaptive response - is a
promising renoprotective intervention. We have investigated the effect of
RIPC on renal outcomes as part of the Effect of Remote Ischaemic
preConditioning on clinical outcomes in patients undergoing Coronary
Artery bypass graft surgery (ERICCA) study. Methods: This was a large,
multi-centre, randomised controlled study to investigate the effects of
RIPC on outcomes in higher risk patients undergoing on-pump CABG
(+/-valve) surgery. Patients were randomised to receive either RIPC four x
5 minute inflations/deflations of a cuff placed on the upper arm or
control (a sham RIPC protocol) following anesthesia but prior to surgical
incision. Results: We recruited 1612 patients (original target 1610) in 28
UK sites. By March 2015 all patients will have completed 12 months of
follow up. We will present renal outcome data on postoperative AKI
incidence, severity and changes in serum Neutrophil Gelatinase Associated
Lipocalcin (NGAL) as well as renal function at 12 months. Conclusions: The
ERICCA study should establish whether RIPC - a simple, low-cost,
pre-operative intervention - can reduce AKI incidence, severity and longer
term renal outcomes in higher risk patients undergoing CABG (+/- valve)
surgery.