EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2013063844
Author
Pahwa A.K.; Arbab-Zadeh A.; Brotman D.J.; Feldman L.S.
Institution
(Pahwa, Brotman, Feldman) Department of Medicine, The Johns Hopkins
University, Baltimore, United States
(Arbab-Zadeh) Division of Cardiology, Department of Medicine, The Johns
Hopkins University, Baltimore, United States
Title
Potential role of coronary computed tomography-angiography for guiding
perioperative cardiac management for non-cardiac surgery.
Source
Heart International. 8 (1) (pp 1-3), 2013. Date of Publication: 2013.
Publisher
Wichtig Publishing
Abstract
Perioperative cardiac events can be a major consequence of surgery. The
American College of Cardiology Foundation/American Heart Association has
set out guidelines to aid physicians in identifying patients at the
highest risk for these events. The guidelines do recommend for some
patients to undergo noninvasive cardiac stress testing for further risk
stratification, but their sensitivity and specificity for predicting
cardiac events is not optimal. With more data emerging of the superior
performance of computed coronary tomography angiography (CCTA) compared to
noninvasive stress testing, CCTA could be more useful in risk
stratification for these patients.&#xa9; A.K. Pahwa et al., 2013 Licensee
PAGEPress, Italy.

<2>
Accession Number
2011532024
Author
Baradari A.G.; Habibi M.R.; Khezri H.D.; Aarabi M.; Khademloo M.; Jalali
Z.; Ghafari R.
Institution
(Baradari, Habibi) Department of CardicAnestesia, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Khezri) Faculty of Nursing and Midwif y, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Aarabi) Cardiovascular Research Center, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Khademloo, Jalali) Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
Title
Does high-dose metformin cause lactic acidosis in type 2 diabetic patients
after CABG surgery? A double blind randomized clinical trial.
Source
Heart International. 6 (1) (pp 26-30), 2011. Date of Publication: 2011.
Publisher
Wichtig Publishing
Abstract
Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic
acidosis due to metformin is a fatal metabolic condition that limits its
use in patients in poor clinical condition, consequently reducing the
number of patients who benefit from this medication. In a double blind
randomized clinical trial, we investigated 200 type 2 diabetic patients
after coronary artery bypass surgery in the open heart ICU of the
Mazandaran Heart Center, and randomly assigned them to equal intervention
and control groups. The intervention group received regular insulin
infusion along with 2 metformin 500 mg tablets every twelve hours, while
the control group received only intravenous insulin with 2 placebo tablets
every twelve hours. Lactate level, pH, base excess, blood glucose and
serum creatinine were measured over five 12 h periods, with data averaged
for each period. The primary outcome in this study was high lactate
levels. Comparison between the 2 groups was made by independent Student's
t-test. To compare changes in multiple measures in each group and analysis
of group interaction, a repeated measurement ANOVA test was used. There
was no significant difference between the 2 groups regarding pH, base
excess, or bicarbonate intake (P>0.05). No patient showed lactic acidosis
in either group. Lactate levels were 23.0 vs 23.4 in the insulin-metformin
and insulin only groups when the study was started, respectively. At the
end of the study, those levels were 18.7 vs 18.9, respectively. In
addition, the ANOVA repeated measurement test did not show a significant
difference in terms of changes in the amount of lactate level between the
2 groups during the five measurement tests of the study period (P>0.05).
High-dose metformin (1,000 mg twice daily with insulin) does not cause
lactic acidosis in type 2 diabetic patients after coronary artery bypass
surgery. &#xa9; A.G. Baradari et al., 2011.

<3>
Accession Number
20160234757
Author
Epps J.; Dieberg G.; Smart N.A.
Institution
(Epps, Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2351, Australia
Title
Repeat remote ischaemic pre-conditioning for improved cardiovascular
function in humans: A systematic review.
Source
IJC Heart and Vasculature. 11 (pp 55-58), 2016. Date of Publication: June
01, 2016.
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Single exposure to remote ischaemic pre-conditioning (RIPC)
has been shown to be effective in reducing major adverse events during
cardiac surgery. We evaluated the efficacy of repeated exposure RIPC to
elicit improvements in cardiovascular function. Methods: A systematic
search was conducted up until May 1st, 2015, using the following
databases: EMBASE, PubMed (Medline), Web of Science and the Cochrane
Central Registry of Controlled Trials (CENTRAL). Data was extracted and
synthesized from published studies of repeat RIPC. Results: Data from
seven studies showed evidence of improvements in vascular function and
anti-hypertensive effects of systolic, diastolic and mean arterial blood
pressure following repeat RIPC. Currently existing work justifies a
systematic review but not data pooling of individual study data. Repeat
RIPC has also produced evidence of improvements in endothelial dependent
vasodilation, but not non-endothelial dependent vasodilation, cutaneous
vascular conductance or cardiorespiratory fitness. Conclusion: Repeated
RIPC exposure has produced evidence of improvements in endothelial
dependent vasodilation, ulcer healing and blood pressure but no benefit in
non-endothelial dependent vasodilation, cutaneous vascular conductance or
cardiorespiratory fitness. The optimal delivery of RIPC remains unclear,
but at least 3 or preferably 4, 5 min exposures appears to be most
beneficial, at least for reducing blood pressure. Aside from those
undertaking cardiac surgery, other study populations with endothelial
dysfunction may benefit from repeat exposure to RIPC.

<4>
Accession Number
20160208489
Author
Ueda H.; Kido A.; Matsuhisa S.; Asawa K.; Yoshida N.; Tsujimoto M.; Sasaki
Y.; Kuga Y.; Yamasaki M.; Ueda K.; Shinohara S.; Nishida Y.
Institution
(Ueda, Matsuhisa, Asawa, Yoshida, Sasaki, Kuga, Yamasaki, Ueda, Nishida)
Department of Cardiovascular Medicine, Takai Hospital, Tenri, Nara
632-0006, Japan
(Kido) Department of Cardiovascular Medicine, Komatsu Hospital, Neyagawa,
Japan
(Tsujimoto) Department of Cardiovascular Medicine, Veritas Hospital,
Kawanishi, Japan
(Shinohara) Department of Cardiovascular Medicine, Kitajima Taoka
Hospital, Itano, Japan
Title
Addition of cilostazol to aspirin therapy for secondary prevention of
cardiovascular and cerebrovascular disease in patients undergoing
percutaneous coronary intervention: A randomized, open-label trial.
Source
American Heart Journal. 173 (pp 134-142), 2016. Date of Publication: 01
Mar 2016.
Publisher
Mosby Inc.
Abstract
Background Patients with established coronary artery disease are at
increased risk for future ischemic events and require secondary prevention
for systemic vascular disease. We performed a randomized clinical trial to
evaluate the impact of cilostazol on cardiovascular and cerebrovascular
disease in patients undergoing percutaneous coronary intervention. Methods
A total of 514 patients who had undergone coronary stent implantation >6
months previously and were thought to no longer need dual antiplatelet
therapy with aspirin and a thienopyridine were randomly assigned to
receive aspirin plus cilostazol therapy or aspirin therapy alone after
discontinuation of thienopyridine therapy. The primary efficacy end point
was a composite of all-cause death, myocardial infarction, stroke, or
cardiovascular or cerebrovascular revascularization at 2 years after
randomization. The main safety end point was major or minor bleeding,
according to the Thrombolysis in Myocardial Infarction bleeding
definition. Results At 2 years, follow-up clinical data were available for
98.1% of patients. The primary efficacy end point occurred in 13.9% of the
aspirin plus cilostazol group versus 22.1% of the aspirin-only group
(hazard ratio 0.61, 95% CI 0.40-0.93, P =.021). The rate of major or minor
bleeding was not significantly different between the aspirin plus
cilostazol and aspirin-only groups (1.6% and 4.0%, respectively, hazard
ratio 0.40, 95% CI 0.13-1.28, P =.12). Conclusions In patients who
underwent coronary stent implantation, the addition of cilostazol to
aspirin therapy was associated with lower rates of cardiovascular and
cerebrovascular events at 2 years compared with aspirin monotherapy.

<5>
Accession Number
20160208445
Author
Vassalli G.; Klersy C.; De Servi S.; Galatius S.; Erne P.; Eberli F.;
Rickli H.; Hornig B.; Bertel O.; Bonetti P.; Moccetti T.; Kaiser C.;
Pfisterer M.; Pedrazzini G.
Institution
(Vassalli, Moccetti, Pedrazzini) Fondazione Cardiocentro Ticino, Lugano,
Switzerland
(Vassalli) Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Klersy) IRCCS Policlinico San Matteo, Servizio di Biometria e Statistica,
Pavia, Italy
(De Servi) Ospedale Civile di Legnano, Milan, Italy
(Galatius) Gentofte University Hospital, Hellerup, Denmark
(Erne) State Hospital, Lucerne, Switzerland
(Eberli) Triemli Hospital, Zurich, Switzerland
(Rickli) State Hospital, St Gallen, Switzerland
(Hornig) Clara Hospital, Basel, Switzerland
(Bertel) Cardiovascular Center Zurich, Zurich, Switzerland
(Bonetti) State Hospital, Chur, Switzerland
(Kaiser, Pfisterer) University Hospital Basel, Basel, Switzerland
Title
Can the optimal type of stent be predicted based on clinical risk factors?
A subgroup analysis of the randomized BASKET-PROVE trial.
Source
American Heart Journal. 173 (pp 1-7), 2016. Date of Publication: 01 Mar
2016.
Publisher
Mosby Inc.
Abstract
Background The randomized BASKET-PROVE study showed no significant
differences between sirolimus-eluting stents (SES), everolimus-eluting
stents (EES), and bare-metal stents (BMS) with respect to the primary end
point, rates of death from cardiac causes, or myocardial infarction (MI)
at 2 years of follow-up, in patients requiring stenting of a large
coronary artery. Clinical risk factors may affect clinical outcomes after
percutaneous coronary interventions. We present a retrospective analysis
of the BASKET-PROVE data addressing the question as to whether the optimal
type of stent can be predicted based on a cumulative clinical risk score.
Methods A total of 2,314 patients (mean age 66 years) who underwent
coronary angioplasty and implantation of >1 stents that were >3.0 mm in
diameter were randomly assigned to receive SES, EES, or BMS. A cumulative
clinical risk score was derived using a Cox model that included age,
gender, cardiovascular risk factors (hypercholesterolemia, hypertension,
family history of cardiovascular disease, diabetes, smoking), presence of
>2 comorbidities (stroke, peripheral artery disease, chronic kidney
disease, chronic rheumatic disease), a history of MI or coronary
revascularization, and clinical presentation (stable angina, unstable
angina, ST-segment elevation MI). Results An aggregate drug-eluting stent
(DES) group (n = 1,549) comprising 775 patients receiving SES and 774
patients receiving EES was compared to 765 patients receiving BMS. Rates
of death from cardiac causes or nonfatal MI at 2 years of follow-up were
significantly increased in patients who were in the high tertile of risk
stratification for the clinical risk score compared to those who were in
the aggregate low-mid tertiles. In patients with a high clinical risk
score, rates of death from cardiac causes or nonfatal MI were lower in
patients receiving DES (2.4 per 100 person-years, 95% CI 1.6-3.6) compared
with BMS (5.5 per 100 person-years, 95% CI 3.7-8.2, hazard ratio 0.45, 95%
CI 0.26-0.80, P =.007). However, they were not significantly different
between receivers of DES and BMS in patients in the low-mid risk tertiles.
Conclusions This exploratory analysis suggests that, in patients who
require stenting of a large coronary artery, use of a clinical risk score
may identify those patients for whom DES use may confer a clinical
advantage over BMS, beyond lower restenosis rates.

<6>
Accession Number
20160192353
Author
Martindale J.L.; Wakai A.; Collins S.P.; Levy P.D.; Diercks D.; Hiestand
B.C.; Fermann G.J.; Desouza I.; Sinert R.
Institution
(Martindale, Desouza, Sinert) Department of Emergency Medicine, SUNY
Downstate Medical Center, New York, NY, United States
(Wakai, Sinert) Emergency Care Research Unit, Royal College of Surgeons in
Ireland, Dublin, Ireland
(Collins) Department of Emergency Medicine, Vanderbilt University,
Nashville, TN, United States
(Levy) Department of Emergency Medicine, Wayne State University, School of
Medicine, Detroit, MI, United States
(Diercks) Department of Emergency Medicine, University of Texas
Southwestern, Dallas, TX, United States
(Hiestand) Department of Emergency Medicine, Wake Forest University,
School of Medicine, Winston-Salem, NC, United States
(Fermann) Department of Emergency Medicine, University of Cincinnati,
Cincinnati, OH, United States
Title
Diagnosing Acute Heart Failure in the Emergency Department: A Systematic
Review and Meta-analysis.
Source
Academic Emergency Medicine. 23 (3) (pp 223-242), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background Acute heart failure (AHF) is one of the most common diagnoses
assigned to emergency department (ED) patients who are hospitalized.
Despite its high prevalence in the emergency setting, the diagnosis of AHF
in ED patients with undifferentiated dyspnea can be challenging.
Objectives The primary objective of this study was to perform a systematic
review and meta-analysis of the operating characteristics of diagnostic
elements available to the emergency physician for diagnosing AHF.
Secondary objectives were to develop a test-treatment threshold model and
to calculate interval likelihood ratios (LRs) for natriuretic peptides
(NPs) by pooling patient-level results. Methods PubMed, EMBASE, and
selected bibliographies were searched from January 1965 to March 2015
using MeSH terms to address the ability of the following index tests to
predict AHF as a cause of dyspnea in adult patients in the ED: history and
physical examination, electrocardiogram, chest radiograph (CXR), B-type
natriuretic peptide (BNP), N-terminal proB-type natriuretic peptide
(NT-proBNP), lung ultrasound (US), bedside echocardiography, and
bioimpedance. A diagnosis of AHF based on clinical data combined with
objective test results served as the criterion standard diagnosis. Data
were analyzed using Meta-DiSc software. Authors of all NP studies were
contacted to obtain patient-level data. The Quality Assessment Tool for
Diagnostic Accuracy Studies-2 (QUADAS-2) for systematic reviews was
utilized to evaluate the quality and applicability of the studies
included. Results Based on the included studies, the prevalence of AHF
ranged from 29% to 79%. Index tests with pooled positive LRs > 4 were the
auscultation of S3 on physical examination (4.0, 95% confidence interval
[CI] = 2.7 to 5.9), pulmonary edema on both CXR (4.8, 95% CI = 3.6 to 6.4)
and lung US (7.4, 95% CI = 4.2 to 12.8), and reduced ejection fraction
observed on bedside echocardiogram (4.1, 95% CI = 2.4 to 7.2). Tests with
low negative LRs were BNP < 100 pg/mL (0.11, 95% CI = 0.07 to 0.16),
NT-proBNP < 300 pg/mL (0.09, 95% CI = 0.03 to 0.34), and B-line pattern on
lung US LR (0.16, 95% CI = 0.05 to 0.51). Interval LRs of BNP
concentrations at the low end of "positive" results as defined by a cutoff
of 100 pg/mL were substantially lower (100 to 200 pg/mL; 0.29, 95% CI =
0.23 to 0.38) than those associated with higher BNP concentrations (1000
to 1500 pg/mL; 7.12, 95% CI = 4.53 to 11.18). The interval LR of NT-proBNP
concentrations even at very high values (30,000 to 200,000 pg/mL) was 3.30
(95% CI = 2.05 to 5.31). Conclusions Bedside lung US and echocardiography
appear to the most useful tests for affirming the presence of AHF while
NPs are valuable in excluding the diagnosis.

<7>
Accession Number
20160009272
Author
Ansley D.M.; Raedschelders K.; Choi P.T.; Wang B.; Cook R.C.; Chen D.D.Y.
Institution
(Ansley, Choi, Wang) Department of Anesthesiology, Pharmacology and
Therapeutics, The University of British Columbia, Vancouver, BC, Canada
(Ansley, Choi) Department of Anesthesiology and Perioperative Care,
Vancouver General Hospital, Vancouver, BC, Canada
(Raedschelders) Heart Institute - Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Choi) Center for Clinical Epidemiology and Evaluation, Vancouver Coastal
Health Research Institute, Vancouver, BC, Canada
(Cook) Department of Surgery (Division of Cardiac Surgery), The University
of British Columbia, Vancouver, BC, Canada
(Chen) Department of Chemistry, The University of British Columbia,
Vancouver, BC, Canada
(Ansley) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Room 3300, 3rd Floor JPP, 910 West 10th
Ave, Vancouver, BC V5Z 1M9, Canada
Title
Propofol cardioprotection for on-pump aortocoronary bypass surgery in
patients with type 2 diabetes mellitus (PRO-TECT II): a phase 2
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 63 (4) (pp 442-453), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC
Abstract
Purpose: The efficacy of myocardial conditioning strategies is compromised
in patients with advanced age, diabetes, or low ejection fraction. We
conducted a single-centre parallel-arm blinded randomized-controlled trial
to determine whether propofol provides perioperative myocardial
protection. Methods: Patients enrolled in this study were scheduled for
primary aortocoronary bypass surgery utilizing normothermic
cardiopulmonary bypass (CPB) with blood cardioplegia. The participants
were stratified by diabetic status and left ventricular ejection fraction
and randomly assigned to receive either an elevated dose of propofol
-previously associated with experimental cardioprotection- or an
isoflurane preconditioning regime. The primary endpoint was the coronary
sinus (CS) concentration of 15-F<inf>2t</inf>-isoprostane (isoP).
Secondary endpoints included in-hospital low cardiac output syndrome
(LCOS) and major adverse cardiac events, 12- and 24-hr CS cardiac troponin
I (cTnI) release, and myocardial B-cell lymphoma 2 (Bcl-2) protein
expression. Results: Data were analyzed from 125 of 137 randomized
participants. Participants receiving propofol experienced a greater mean
(SD) increase from baseline in CS 15-F<inf>2t</inf>-isoP levels compared
with those receiving isoflurane [26.9 (10.9) pg.mL^-1vs 12.1
(10.4) pg.mL^-1, respectively; mean difference, 14.8; 95%
confidence interval (CI), 11.0 to 18.6; P < 0.001] but a decreased
incidence of LCOS (20.9% vs 57.1%, respectively; relative risk [RR],0.37;
95% CI, 0.22 to 0.62; P < 0.001). The incidence of LCOS was similar
between groups in participants without type 2 diabetes mellitus (DM2) (P =
0.382) but significantly decreased in the propofol DM2 subgroup compared
with the isoflurane DM2 subgroup (17.9% vs 70.3%, respectively; RR, 0.26;
95% CI, 0.13 to 0.52; P < 0.001). Propofol was associated with an increase
in myocardial Bcl-2 protein expression (P = 0.005), a lower incidence of a
CS cTnI threshold for myocardial infarction (P = 0.014), and fewer heart
failure events (P < 0.001). Conclusion: Propofol may be a preemptive
intraoperative cardioprotectant for patients with DM2 under conditions of
normothermic CPB and blood cardioplegic arrest. The study is registered at
www.clinicaltrials.gov (NCT00734383) and www.controlled-trials.com
(ISRCTN70879185).

<8>
Accession Number
2015484044
Author
Jasudavisius A.; Arellano R.; Martin J.; McConnell B.; Bainbridge D.
Institution
(Jasudavisius, Arellano, Martin, Bainbridge) Schulich School of Medicine
and Dentistry, London Health Sciences Centre, Western University, London,
ON, Canada
(McConnell, Bainbridge) Department of Anesthesiology and Perioperative
Medicine, Western University, London, ON, Canada
Title
A systematic review of transthoracic and transesophageal echocardiography
in non-cardiac surgery: implications for point-of-care ultrasound
education in the operating room.
Source
Canadian Journal of Anesthesia. 63 (4) (pp 480-487), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC
Abstract
Purpose: Point-of-care ultrasound (POCU) is an evolving field in
anesthesia. Therefore a systematic review of common diagnoses made by POCU
during non-cardiac surgery was conducted. The information obtained from
the review may be used to develop POCU curricula for the perioperative
setting during non-cardiac surgery. Source: A systematic review was
conducted for perioperative use of transthoracic /transesophageal
echocardiography (TTE/TEE) in high-risk patients or in other patients
experiencing periods of hemodynamic instability. The diagnoses included
segmental wall motion abnormalities (SWMAs), low left ventricular ejection
fraction (LVEF), hypovolemia, air embolism, cardiac/aortic thrombus,
pulmonary embolus (PE), aortic valve disease, mitral valve disease,
tricuspid valve disease, right ventricular (RV) failure, pericardial
disease, and patent foramen ovale. Principal findings: Three hundred
twenty-one studies were found using our search terms, and thirteen studies
were retained that met our inclusion criteria for review. The studies
included 968 patients analyzed as either preoperative exams in high-risk
patients (n = 568) or intraoperative exams during times of hemodynamic
compromise/cardiac arrest (n = 400). The most common diagnoses in the
preoperative exam group were low ejection fraction (25.4%), aortic valve
disease (24.4%), mitral valve disease (20.0%), RV failure (6.6%), and
hypovolemia (6.3%). In the intraoperative exam group, the most common
diagnoses were hypovolemia (33.2%), low ejection fraction (20.5%), RV
failure (13.1%), SWMAs (10.1%), and PE (5.8%). Conclusion: In this
systematic review examining the use of TTE or TEE in non-cardiac surgery,
the most frequent diagnoses were valvulopathy, low LVEF, hypovolemia, PE,
SWMAs, and RV failure. This information should be used to inform
evidence-based curricula for POCU in anesthesiology.

<9>
Accession Number
2015301696
Author
Ahmad I.G.; Abdulla R.K.; Klem I.; Margulis R.; Ivanov A.; Mohamed A.;
Judd R.M.; Borges-Neto S.; Kim R.J.; Heitner J.F.
Institution
(Klem, Judd, Kim, Heitner) Duke Cardiovascular Magnetic Resonance Center,
Duke University Medical Center, Durham, NC, United States
(Klem, Judd, Kim, Heitner) Department of Medicine, Duke University Medical
Center, Durham, NC, United States
(Borges-Neto) Department of Radiology, Duke University Medical Center,
Durham, NC, United States
(Ahmad, Abdulla, Margulis, Ivanov, Mohamed, Heitner) Department of
Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY,
United States
Title
Comparison of stress cardiovascular magnetic resonance imaging (CMR) with
stress nuclear perfusion for the diagnosis of coronary artery disease.
Source
Journal of Nuclear Cardiology. 23 (2) (pp 287-297), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC
Abstract
Objectives: To assess the diagnostic performance of stress cardiac
magnetic resonance (stress CMR) vs stress single-photon emission computed
tomography (SPECT) in patients presenting to the emergency department (ED)
with chest pain. Background: SPECT imaging is the most utilized outpatient
procedure in the United States. The diagnostic accuracy of SPECT can be
limited by soft tissue attenuation and low spatial resolution. Stress CMR
has much higher spatial resolution and without the susceptibility to soft
tissue attenuation. Methods: Eighty-seven patients without a history of
CAD presenting to the ED with chest pain were prospectively enrolled.
Patients underwent both stress CMR and stress SPECT imaging within 12
hours of presentation. Both the stress imaging tests were interpreted
immediately for clinical purposes and coronary angiography was performed
if either was abnormal. Patients were considered to have significant CAD
if identified by angiography (>50%) or if a cardiac event (cardiac death,
myocardial infarction or revascularization) occurred during follow-up
(mean 2.6 +/- 1.1 years). Results: Thirty-seven patients were referred for
coronary angiography; 29 due to a positive stress test and eight patients
for persistent chest pain despite two negative stress tests. There were 22
patients who had significant CAD (>50%). The remaining patients were
followed for 2.6 +/- 1.1 years. At the conclusion of the follow-up period,
there were four clinical events. The sensitivity, specificity, and
diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The
sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%,
91%, and 88%, respectively. Conclusion: Stress CMR has similar diagnostic
accuracy as stress SPECT in diagnosis of CAD.

<10>
[Use Link to view the full text]
Accession Number
20160155296
Author
Meccariello A.; Buono F.; Verrengia E.; Orefice G.; Grieco F.; Romeo F.;
Trimarco B.; Morisco C.
Institution
(Meccariello, Buono, Verrengia, Orefice, Grieco, Morisco) Dipartimento di
Scienze Mediche Traslazionali, Universita FEDERICO II, Via S. Pansini n.
5, Naples 80131, Italy
(Trimarco) Dipartimento di Scienze Biomediche Avanzate, Universita
FEDERICO II, Naples, Italy
(Romeo) Daichi Sankyo Italia SPA, Rome, Italy
Title
Microalbuminuria predicts the recurrence of cardiovascular events in
patients with essential hypertension.
Source
Journal of Hypertension. 34 (4) (pp 646-653), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Microalbuminuria (MAU) is associated with an enhanced risk of
cardiovascular events. The prevalence of MAU and its prognostic impact has
an important role in the stratification of cardiovascular risk in patients
with essential hypertension. This is an observational, prospective study
performed by 13 general practitioners aiming at assessing the prevalence
and prognostic relevance of MAU in essential hypertension. Methods:
Patients with essential hypertension and with recent determination of MAU
were enrolled into the study by general practitioners, and were followed
up for 3 years. Primary end point was the occurrence of major
cardiovascular events during the follow-up. Results: Out of 1024
unselected patients, consecutively enrolled from January 2009 to March
2010, 804 completed the 3-year follow-up. Patients were categorized into
two groups according to the absence (n=523, 65%) or presence (n=281, 35%)
of MAU. During the follow-up, 41 cardiovascular events (1.69events/100
patient-years) were reported. The presence of MAU was not associated with
increased risk of cardiovascular events (adjusted hazard ratio=1.32; 95%
confidence interval 0.290-4.340, P=0.097). When the analysis was
restricted to the patients with previous cardiovascular event, MAU
(adjusted hazard ratio=2.18; 95% confidence interval 0.42-2.43, P=0.031),
together with age, metabolic syndrome, diabetes, and smoking,
independently predicted the occurrence of cardiovascular events.
Conclusion: Presence of MAU in patients with essential hypertension is not
associated with increased risks of cardiovascular events. At the variance,
in patients with previous cardiovascular events, MAU was found to predict
recurrent events. Thus, the assessment of MAU could be considered a useful
tool in secondary prevention.

<11>
Accession Number
20160217814
Author
Jolicoeur E.M.; Dunning A.; Castelvecchio S.; Dabrowski R.; Waclawiw M.A.;
Petrie M.C.; Stewart R.; Jhund P.S.; Desvigne-Nickens P.; Panza J.A.;
Bonow R.O.; Sun B.; San T.R.; Al-Khalidi H.R.; Rouleau J.L.; Velazquez
E.J.; Cleland J.G.F.
Institution
(Jolicoeur, Rouleau) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Canada
(Dunning, Al-Khalidi, Velazquez) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Castelvecchio) IRCCS Policlinico San Donato, Milan, Italy
(Dabrowski) National Institute of Cardiology, Warsaw, Poland
(Waclawiw, Desvigne-Nickens) National Institutes of Health, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Petrie) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Stewart) Auckland City Hospital, Auckland, New Zealand
(Jhund) British Heart Foundation Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Panza) Westchester Medical Center and New York Medical College, Valhalla,
NY, United States
(Bonow) Northwestern University Feinberg, School of Medicine, Chicago, IL,
United States
(Sun) Allina Health, Minneapolis, MN, United States
(San) National Heart Centre, Singapore, Singapore
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Cleland) National Heart and Lung Institute, Heart Sciences Building,
Imperial College, Harefield Hospital, Hill End Road, London UB9 6JH,
United Kingdom
Title
Importance of Angina in Patients with Coronary Disease, Heart Failure, and
Left Ventricular Systolic Dysfunction Insights from STICH.
Source
Journal of the American College of Cardiology. 66 (19) (pp 2092-2100),
2015. Date of Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Patients with left ventricular (LV) systolic dysfunction,
coronary artery disease (CAD), and angina are often thought to have a
worse prognosis and a greater prognostic benefit from coronary artery
bypass graft (CABG) surgery than those without angina. Objectives This
study investigated: 1) whether angina was associated with a worse
prognosis; 2) whether angina identified patients who had a greater
survival benefit from CABG; and 3) whether CABG improved angina in
patients with LV systolic dysfunction and CAD. Methods We performed an
analysis of the STICH (Surgical Treatment for Ischemic Heart Failure)
trial, in which 1,212 patients with an ejection fraction <35% and CAD were
randomized to CABG or medical therapy. Multivariable Cox and logistic
models were used to assess long-term clinical outcomes. Results At
baseline, 770 patients (64%) reported angina. Among patients assigned to
medical therapy, all-cause mortality was similar in patients with and
without angina (hazard ratio [HR]: 1.05; 95% confidence interval [CI]:
0.79 to 1.38). The effect of CABG was similar whether the patient had
angina (HR: 0.89; 95% CI: 0.71 to 1.13) or not (HR: 0.68; 95% CI: 0.50 to
0.94; p interaction = 0.14). Patients assigned to CABG were more likely to
report improvement in angina than those assigned to medical therapy alone
(odds ratio: 0.70; 95% CI: 0.55 to 0.90; p < 0.01). Conclusions Angina
does not predict all-cause mortality in medically treated patients with LV
systolic dysfunction and CAD, nor does it identify patients who have a
greater survival benefit from CABG. However, CABG does improve angina to a
greater extent than medical therapy alone. (Comparison of Surgical and
Medical Treatment for Congestive Heart Failure and Coronary Artery Disease
[STICH]; NCT00023595)

<12>
Accession Number
20160123300
Author
Shimbo D.; Abdalla M.; Falzon L.; Townsend R.R.; Muntner P.
Institution
(Shimbo, Abdalla, Falzon) Department of Medicine, Columbia University
Medical Center, 622 West 168th Street, New York, NY 10032, United States
(Townsend) Department of Medicine, Perelman School of Medicine, University
of Pennsylvania, PA, United States
(Muntner) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
Title
Studies comparing ambulatory blood pressure and home blood pressure on
cardiovascular disease and mortality outcomes: A systematic review.
Source
Journal of the American Society of Hypertension. 10 (3) (pp 224-234),
2016. Date of Publication: 01 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Ambulatory blood pressure monitoring (ABPM) is more commonly recommended
for assessing out-of-clinic blood pressure (BP) than home blood pressure
monitoring (HBPM). We conducted a systematic review to examine whether
ABPM or HBPM is more strongly associated with cardiovascular disease
events and/or mortality. Of 1007 abstracts published through July 20,
2015, nine articles, reporting results from seven cohorts, were
identified. After adjustment for BP on HBPM, BP on ABPM was associated
with an increased risk of outcomes in two of four cohorts for systolic
blood pressure and two of three cohorts for diastolic blood pressure.
After adjustment for BP on ABPM, systolic blood pressure on HBPM was
associated with outcomes in zero of three cohorts; an association was
present in one of two cohorts for diastolic blood pressure on HBPM. There
is a lack of strong empiric evidence supporting ABPM or HBPM over the
other approach for predicting cardiovascular events or mortality.

<13>
Accession Number
20160208145
Author
Nijenhuis V.J.; Bennaghmouch N.; Hassell M.; Baan J.; Van Kuijk J.P.;
Agostoni P.; Van 'T Hof A.; Kievit P.C.; Veenstra L.; Van Der Harst P.;
Van Den Heuvel A.F.M.; Den Heijer P.; Kelder J.C.; Deneer V.H.; Van Der
Kley F.; Onorati F.; Collet J.P.; Maisano F.; Latib A.; Huber K.; Stella
P.R.; Ten Berg J.M.
Institution
(Nijenhuis, Bennaghmouch, Van Kuijk, Agostoni, Kelder, Ten Berg)
Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein
3435 CM, Netherlands
(Hassell, Baan) Department of Cardiology, Academic Medical Centre,
Amsterdam, Netherlands
(Van 'T Hof) Department of Cardiology, Isala Klinieken, Zwolle,
Netherlands
(Kievit) Department of Cardiology, University Medical Centre St Radboud,
Nijmegen, Netherlands
(Veenstra) Department of Cardiology, Medical University Centre,
Maastricht, Netherlands
(Van Der Harst, Van Den Heuvel) Department of Cardiology, University
Medical Centre, Groningen, Netherlands
(Den Heijer) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Deneer) Department of Clinical Pharmacy, St Antonius Hospital,
Nieuwegein, Netherlands
(Van Der Kley) Department of Cardiology, University Medical Centre,
Leiden, Netherlands
(Onorati) Department of Cardiac Surgery, University of Verona, Verona,
Italy
(Collet) Department of Cardiology, Hopital Universitaire Pitie
Salpetriere, Paris, France
(Maisano) Department of Cardiovascular Surgery, UniversitatsSpital Zurich,
Zurich, Switzerland
(Latib) Department of Cardiology, Universita Vita-Salute San Raffaele
Milano, Milan, Italy
(Huber) Department of Cardiology, Wilhelminenspital, Vienna, Austria
(Stella) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
Title
Rationale and design of POPular-TAVI: AntiPlatelet therapy for Patients
undergoing Transcatheter Aortic Valve Implantation.
Source
American Heart Journal. 173 (pp 78-85), 2016. Date of Publication: 01 Mar
2016.
Publisher
Mosby Inc.
Abstract
Background Despite improving experience and techniques, ischemic and
bleeding complications after transcatheter aortic valve implantation
(TAVI) remain prevalent and impair survival. Current guidelines recommend
the temporary addition of clopidogrel in the initial period after TAVI to
prevent thromboembolic events. However, explorative studies suggest that
this is associated with a higher rate of major bleeding without a decrease
in thromboembolic complications. Methods The POPular TAVI trial is a
prospective randomized, controlled, open-label multicenter clinical trial
to test the hypothesis that monotherapy with aspirin or oral
anticoagulation (OAC) after TAVI is safer than the addition of clopidogrel
for 3 months, without compromising clinical benefit. This trial
encompasses 2 cohorts: cohort A, patients are randomized 1:1 to aspirin vs
aspirin + clopidogrel, and cohort B, patients on OAC therapy are
randomized 1:1 to OAC vs OAC + clopidogrel. Primary outcome is freedom
from non-procedure-related bleeding at 1 year. Secondary net-clinical
benefit outcome is freedom from the composite of cardiovascular death,
non-procedural-related bleeding, myocardial infarction, or stroke at 1
year. The primary outcome is analyzed for superiority, whereas the
secondary outcome is analyzed for noninferiority. Recruitment began in
February 2014, and the trial will continue until a total of 1,000 patients
(684 expected in cohort A and 316 in cohort B) are included and followed
up for 1 year. Summary The POPular TAVI trial (NCT02247128) is the first
large randomized controlled trial to test if monotherapy with aspirin or
OAC vs additional clopidogrel after TAVI reduces bleeding with a favorable
net-clinical benefit.

<14>
Accession Number
20160205753
Author
Herbison P.; Wong C.-K.
Institution
(Herbison) Department of Preventive and Social Medicine, Dunedin School of
Medicine, University of Otago, Dunedin, New Zealand
(Wong) Department of Medicine, Dunedin School of Medicine, University of
Otago, Dunedin, New Zealand
(Wong) Department of Medicine and Therapeutics, Chinese University of Hong
Kong Shatin, New Territories, Hong Kong
Title
Has the difference in mortality between percutaneous coronary intervention
and coronary artery bypass grafting in people with heart disease and
diabetes changed over the years? A systematic review and meta-regression.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e010055. Date of
Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives: To examine the difference in outcome between percutaneous
coronary intervention (PCI) and coronary artery bypass grafting (CABG), to
see if it has changed over the years in diabetics deemed eligible for both
treatments; and to contrast the long-term mortality findings with those in
non-diabetics. Design: Meta-analyses using data from randomised controlled
trials found by searches on MEDLINE, EMBASE and the Cochrane Controlled
Trials Register, from their inception until March 2015. Setting: Studies
had to be randomised controlled trials comparing PCI with CABG.
Participants: Those taking part in the studies had to have multivessel
cardiac or left main artery cardiac disease and be deemed eligible for
both treatments. Interventions: PCI or CABG. Primary and secondary
outcomes: The primary outcome was all cause mortality. Secondary outcomes
were a composite of mortality, stroke and myocardial infarction;
cardiovascular death; and MACCE (Major Adverse Cardiac or Cerebrovascular
Event). The longest follow-up was used in the analysis. Results: Among 14
studies (4868 diabetics) reported over three decades, meta-regression
shows no relationship between the year of publication and the difference
in long term all cause mortality between PCI and CABG. CABG has maintained
an approximately 30% mortality advantage compared to PCI. The other
outcomes used showed the same lack of change over the years. These
findings held true among insulin-requiring and non-insulin-requiring
diabetics. However, among non-diabetics included in the 14 studies, there
was no difference in mortality outcome between PCI and CABG. Conclusions:
The difference in outcome between PCI and CABG in diabetics has not
narrowed from the beginning-with balloon angioplasty to current PCI- with
the second generation of drug eluting stents. In contrast to the
non-diabetics, there is a persistent 30% benefit in all cause mortality
favouring CABG in diabetics, and this should be a major factor in
treatment recommendation.

<15>
Accession Number
20160204865
Author
Preston L.; Turner J.; Booth A.; O'Keeffe C.; Campbell F.; Jesurasa A.;
Cooper K.; Goyder E.
Institution
(Preston, Turner, Booth, O'Keeffe, Campbell, Jesurasa, Cooper, Goyder)
School for Health and Related Research (ScHARR), University of Sheffield,
Sheffield, United Kingdom
Title
Is there a relationship between surgical case volume and mortality in
congenital heart disease services? A rapid evidence review.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e009252. Date of
Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Objective: To identify and synthesise the evidence on the relationship
between surgical volume and patient outcomes for adults and children with
congenital heart disease. Design: Evidence synthesis of interventional and
observational studies. Data sources: MEDLINE, EMBASE, CINAHL, Cochrane
Library and Web of Science (2009-2014) and citation searching, reference
lists and recommendations from stakeholders (2003-2014) were used to
identify evidence. Study selection: Quantitative observational and
interventional studies with information on volume of surgical procedures
and patient outcomes were included. Results: 31 of the 34 papers
identified (91.2%) included only paediatric patients. 25 (73.5%)
investigated the relationship between volume and mortality, 7 (20.6%)
mortality and other outcomes and 2 (5.9%) non-mortality outcomes only.
88.2% were from the US, 97% were multicentre studies and all were
retrospective observational studies. 20 studies (58.8%) included all
congenital heart disease conditions and 14 (41.2%) single conditions or
procedures. No UK studies were identified. Most studies showed a
relationship between volume and outcome but this relationship was not
consistent. The relationship was stronger for single complex conditions or
procedures. We found limited evidence about the impact of volume on
non-mortality outcomes. A mixed picture emerged revealing a range of
factors, in addition to volume, that influence outcome including condition
severity, individual centre and surgeon effects and clinical advances over
time. Conclusions: The heterogeneity of findings from observational
studies suggests that, while a relationship between volume and outcome
exists, this is unlikely to be a simple, independent and directly causal
relationship. The effect of volume on outcome relative to the effect of
other, as yet undetermined, health system factors remains a complex and
unresolved research question.

<16>
Accession Number
20160222354
Author
Lee T.W.R.; Kowalski S.; Falk K.; Maguire D.; Freed D.H.; HayGlass K.T.
Institution
(Lee, Kowalski, Maguire) Department of Anesthesia and Perioperative
Medicine, St. Boniface Hospital, University of Manitoba, Winnipeg, MB,
Canada
(Falk, HayGlass) Department of Immunology, University of Manitoba,
Winnipeg, MB, Canada
(Freed) Section of Cardiac Surgery, Department of Surgery, University of
Manitoba, Winnipeg, MB, Canada
(Freed) Division of Cardiac Surgery, University of Alberta, Edmonton,
Canada
Title
High spinal anesthesia enhances anti-inflammatory responses in patients
undergoing coronary artery bypass graft surgery and aortic valve
replacement: Randomized pilot study.
Source
PLoS ONE. 11 (3) (no pagination), 2016. Article Number: e0149942. Date of
Publication: 01 Mar 2016.
Publisher
Public Library of Science
Abstract
Background Cardiac surgery induces many physiologic changes including
major inflammatory and sympathetic nervous system responses. Here, we
conducted a single-centre pilot study to generate hypotheses on the
potential immune impact of adding high spinal anaesthesia to general
anaesthesia during cardiac surgery in adults. We hypothesized that this
strategy, previously shown to blunt the sympathetic response and improve
pain management, could reduce the undesirable systemic inflammatory
responses caused by cardiac surgery. Methods This prospective randomized
unblinded pilot study was conducted on 14 patients undergoing cardiac
surgery for coronary artery bypass grafting and/or aortic valve
replacement secondary to severe aortic stenosis. The primary outcome
measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b,
CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein
(CRP, PTX3) and cardiovascular risk (sST2) biomarkers. Results The
kinetics of pro- and anti-inflammatory biomarker was determined following
surgery. All pro-inflammatory and acute phase reactant biomarker responses
induced by surgical stress were indistinguishable in intensity and
duration between control groups and those who also received high spinal
anaesthesia. Conversely, IL-10 levels were markedly elevated in both
intensity and duration in the group receiving high spinal anesthesia (p =
0.005). Conclusions This hypothesis generating pilot study suggests that
high spinal anesthesia can alter the net inflammatory response that
results from cardiac surgery. In appropriately selected populations, this
may add incremental benefit by dampening the net systemic inflammatory
response during the week following surgery. Larger population studies,
powered to assess immune, physiologic and clinical outcomes in both acute
and longer term settings, will be required to better assess potential
benefits of incorporating high spinal anesthesia.

<17>
Accession Number
20160207733
Author
Ortega-Deballon I.; Hornby L.; Shemie S.D.; Bhanji F.; Guadagno E.
Institution
(Ortega-Deballon) Canadian National Transplant Research Program, Canada
(Ortega-Deballon) Research Institute McGill University Health Centre,
Montreal, Canada
(Ortega-Deballon) Centre de Prelevement d'Organes, Laboratoire de
Simulation, Hopital du Sacre-Coeur, Montreal, Canada
(Ortega-Deballon) Faculty of Medicine and Health Sciences, Universidad de
Alcala de Henares, Madrid, Spain
(Ortega-Deballon) Helicopter Emergency Medical Service (SUMMA 112),
Madrid, Spain
(Hornby) DePPaRT Study, Pediatric Critical Care, Children's Hospital of
Eastern Ontario Research Institute, Ottawa, Canada
(Hornby, Shemie) Deceased Donation, Canadian Blood Services, Ottawa,
Canada
(Shemie, Bhanji) Division of Critical Care, Montreal Children's Hospital,
McGill University Health Centre, Montreal, Canada
(Shemie, Bhanji) McGill University, Montreal, Canada
(Bhanji) Royal College of Physicians and Surgeons of Canada, Canada
(Guadagno) Medical Library, McConnell Resource Centre, McGill University
Health Centre, Montreal, Canada
Title
Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest
in adults: A systematic review of international practices and outcomes.
Source
Resuscitation. 101 (pp 12-20), 2016. Date of Publication: April 01, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aim: Extracorporeal resuscitation during cardiopulmonary resuscitation
(ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated
circulation until the return of spontaneous circulation (ROSC). The
purpose of this systematic review is to address the defining elements and
outcomes (quality survival and organ donation) of currently active
protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of
cardiac origin in adult patients. The results may inform policy and
practices for ECPR and help clarify the corrresponding intersection with
deceased organ donation. Methods: We searched Medline, Embase, Cochrane
and seven other electronic databases from 2005 to 2015, with no language
restrictions. Internal validity and the quality of the studies reporting
outcomes and guidelines were assessed. The review was included in the
international prospective register of systematic reviews (Prospero,
CRD42014015259). Results: One guideline and 20 outcome studies were
analyzed. Half of the studies were prospective observational studies
assessed to be of fair to good methodological quality. The remainder were
retrospective cohorts, case series, and case studies. Ages ranged from 16
to 75 years and initial shockable cardiac rhythms, witnessed events, and a
reversible primary cause of cardiac arrest were considered favorable
prognostic factors. CPR duration and time to hospital cannulation varied
considerably. Coronary revascularization, hemodynamic interventions and
targeted temperature management neuroprotection were variable. A total of
833 patients receiving this ECPR approach had an overall reported survival
rate of 22%, including 13% with good neurological recovery. Additionally,
88 potential and 17 actual deceased organ donors were identified among the
non-survivor population in 8 out of 20 included studies. Study
heterogeneity precluded a meta-analysis preventing any meaningful
comparison between protocols, interventions and outcomes. Conclusions:
ECPR is feasible for refractory OHCA of cardiac origin in adult patients.
It may enable neurologically good survival in selected patients, who
practically have no other alternative in order to save their lives with
quality of life, and contribute to organ donation in those who die. Large,
prospective studies are required to clarify patient selection, modifiable
outcome variables, risk-benefit and cost-effectiveness.

<18>
Accession Number
20160221856
Author
Toutouzas K.; Latsios G.; Stathogiannis K.; Drakopoulou M.; Synetos A.;
Sanidas E.; Mastrokostopoulos A.; Trantalis G.; Kaitozis O.; Lazaros G.;
Yuecel S.; Gerckens U.; Grube E.; Tousoulis D.
Institution
(Toutouzas, Latsios, Stathogiannis, Drakopoulou, Synetos,
Mastrokostopoulos, Trantalis, Kaitozis, Lazaros, Tousoulis) First
Department of Cardiology, Hippokration Hospital, Athens Medical School,
Athens, Greece
(Sanidas) Cardiology Department, Laikon Hospital, Athens, Greece
(Yuecel, Gerckens) Gemeinschaftskrankenhaus Bonn, Germany
(Grube) University Hospital, Dept. of Medicine II, Bonn, Germany
Title
One-year outcomes after direct transcatheter aortic valve implantation
with a self-expanding bioprosthesis. A two-center international
experience.
Source
International Journal of Cardiology. 202 (pp 631-635), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Balloon aortic valvuloplasty (BAV) is considered to be an
essential part of the transcatheter aortic valve implantation (TAVI)
procedure and is being performed routinely. At present there is
insufficient long-term data as to the benefits of routine BAV prior to
TAVI. Aim: The aim of this study was to evaluate the safety of direct TAVI
and the mortality rate at 1-year in patients undergoing TAVI with or
without BAV with a self-expanding bioprosthesis. Methods: Between January
2008 and September 2013 consecutive patients undergoing TAVI with the
Medtronic CoreValve in two experienced centers in Athens, Greece and in
Siegburg, Germany were studied. All data were prospectively collected and
retrospectively analyzed. Primary endpoint was mortality at 1 year.
Procedural data and clinical data (bleeding, vascular complications and
echocardiographic parameters) were analyzed. Results: A total of 210
patients undergoing TAVI were evaluated (non-direct = 120 patients, direct
= 90 patients). All-cause mortality at 30 days and at 1 year was similar
in both groups (4% in non-direct versus 2% in direct, p = 0.6 and 15% in
non-direct versus 11% in direct, p = 0.5, respectively). Device success
rate was similar in both groups (77% in non-direct versus 83% in direct, p
= 0.2). Major vascular complications were comparable for both groups (5%
in non-direct versus 3% in direct, p = 0.5). The direct group had less
moderate/severe paravalvular leakage than the non-direct group after the
device implantation (7% versus 33%, p< 0.01). Conclusions: Performing
direct TAVI with the self-expanding bioprosthesis is safe and feasible
showing similar mortality rates compared to patients undergoing non-direct
TAVI at 30 days and at 1-year.

<19>
Accession Number
20160221871
Author
Roberts E.B.; Perry R.; Booth J.; Sigwart U.; Stables R.H.
Institution
(Roberts) University Hospitals of Leicester, Leicester NIHR Cardiovascular
Biomedical Research Unit, Glenfield Hospital, Leicester LE3 9QP, United
Kingdom
(Perry, Stables) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Thomas Drive, Liverpool L14 3PE, United Kingdom
(Booth) Clinical Trials and Evaluation Unit, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, United Kingdom
(Sigwart) Cardiology Center, University Hospital of Geneva, 24 Rue Micheli
du Crest, Geneva 1211, Switzerland
Title
Adverse events following percutaneous and surgical coronary
revascularisation: Analysis of non-MACE outcomes in the Stent or Surgery
(SoS) Trial.
Source
International Journal of Cardiology. 202 (pp 7-12), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: To analyse adverse events requiring or prolonging
hospitalisation in the Stent or Surgery (SoS) trial. Background: Many
adverse events following coronary revascularisation are non-major adverse
cardiovascular events (non-MACE). Trials comparing percutaneous coronary
intervention (PCI) and coronary artery bypass surgery (CABG) have reported
rates of mortality and MACE only. Material and methods: Comparisons
between PCI and CABG groups in the SOS trial were by intention to treat.
For patients with non-fatal/non-MACE, number of events per 100 patient
years follow-up and duration of hospital stay were assessed. Competing
risk analysis was used to illustrate temporal pattern of adverse outcomes.
Results: During 2y median follow up, 1 one or more adverse event occurred
in 47.3% (231) of the PCI group and 53% (265) of the CABG group (p =
0.086). Non-fatal/non-MACE occurred in 11.9% of the PCI group and 38.6% of
the CABG group (p < 0.001). Non-fatal/non-MACE per 100 patient years
follow-up was 17.49 (PCI) and 35.04 (CABG), rate ratio 2.0, 95% CI 1.7 to
2.4, p < 0.001. Cumulative non-fatal/non-MACE associated hospital stays
were 1387 and 3287 days in PCI and CABG groups respectively. Median
duration of hospitalisation per non-fatal/non-MACE was 5 days
(interquartile range 2 to 11.75 days) in the PCI group and 6 days
(interquartile range 2 to 12 days) in the CABG group, p = 0.245.
Conclusions: CABG had lower cumulative incidence of fatal or MACE
outcomes, higher cumulative incidence of non-fatal/non-MACE outcomes, and
longer cumulative hospitalisation periods compared to the PCI group.

<20>
Accession Number
20160210404
Author
Smit B.; Smulders Y.M.; de Waard M.C.; Boer C.; Vonk A.B.A.; Veerhoek D.;
Kamminga S.; de Grooth H.-J.S.; Garcia-Vallejo J.J.; Musters R.J.P.;
Girbes A.R.J.; Oudemans-van Straaten H.M.; Spoelstra-de Man A.M.E.
Institution
(Smit, de Waard, de Grooth, Girbes, Oudemans-van Straaten, Spoelstra-de
Man) VU University Medical Center, Department of Intensive Care,
Amsterdam, Netherlands
(Smulders) VU University Medical Center, Department of Internal Medicine,
Amsterdam, Netherlands
(Boer, Kamminga) VU University Medical Center, Department of
Anaesthesiology, Amsterdam, Netherlands
(Vonk, Veerhoek) VU University Medical Center, Department of
Cardiothoracic Surgery, Amsterdam, Netherlands
(Garcia-Vallejo) VU University Medical Center, Department of Molecular
Cell Biology and Immunology, Amsterdam, Netherlands
(Musters) VU University Medical Center, Department of Physiology,
Amsterdam, Netherlands
Title
Moderate hyperoxic versus near-physiological oxygen targets during and
after coronary artery bypass surgery: A randomised controlled trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 55. Date of
Publication: March 10, 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: The safety of perioperative hyperoxia is currently unclear.
Previous studies in patients undergoing coronary artery bypass surgery
suggest reduced myocardial damage when avoiding extreme perioperative
hyperoxia (>400 mmHg). In this study we investigated whether an
oxygenation strategy from moderate hyperoxia to a near-physiological
oxygen tension reduces myocardial damage and improves haemodynamics, organ
dysfunction and oxidative stress. Methods: This was a single-blind,
single-centre, open-label, randomised controlled trial in patients
undergoing elective coronary artery bypass surgery. Fifty patients were
randomised to a partial pressure of oxygen in arterial blood
(P<inf>a</inf>O<inf>2</inf>) target of 200-220 mmHg during cardiopulmonary
bypass and 130-150 mmHg during intensive care unit (ICU) admission
(control group) versus lower targets of 130-150 mmHg during
cardiopulmonary bypass and 80-100 mmHg at the ICU (conservative group).
Primary outcome was myocardial injury (CK-MB and Troponin-T) at ICU
admission and 2, 6 and 12 hours thereafter. Results: Weighted
P<inf>a</inf>O<inf>2</inf> during cardiopulmonary bypass was 220 mmHg
(interquartile range (IQR) 211-233) vs. 157 (151-162) in the control and
conservative group, respectively (P < 0.0001). During ICU admission,
weighted P<inf>a</inf>O<inf>2</inf> was 107 mmHg (86-141) vs. 90 (84-98)
(P = 0.03), respectively. Area under the curve of CK-MB was median 23.5
mug/L/h (IQR 18.4-28.1) vs. 21.5 (15.8-26.6) (P = 0.35) and 0.30 mug/L/h
(0.25-0.44) vs. 0.39 (0.24-0.43) (P = 0.81) for Troponin-T. Cardiac index,
systemic vascular resistance index, creatinine, lactate and F2-isoprostane
levels were not different between groups. Conclusions: Compared to
moderate hyperoxia, a near-physiological oxygen strategy does not reduce
myocardial damage in patients undergoing coronary artery bypass surgery.
Conservative oxygen administration was not associated with increased
lactate levels or hypoxic events. Trial registration: Netherlands Trial
Registry NTR4375 , registered on 30 January 2014

<21>
Accession Number
20160216955
Author
Li X.; Hu B.; Miao J.; Li H.
Institution
(Li, Hu, Miao, Li) Department of Thoracic Surgery, Beijing Chaoyang
Hospital, Capital Medical University, Beijing 100020, China
Title
Reduce chest pain using modified silicone fluted drain tube for chest
drainage after video-assisted thoracic surgery (VATS) lung resection.
Source
Journal of Thoracic Disease. 8 (pp S93-S98), 2016. Date of Publication:
2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Background: The aim of this study was to assess the feasibility, efficacy
and safety of a modified silicone fluted drain tube after video-assisted
thoracic surgery (VATS) lung resection. Methods: The prospective
randomized study included 50 patients who underwent VATS lung resection
between March 2015 and June 2015. Eligible patients were randomized into
two groups: experimental group (using the silicone fluted drain tubes for
chest drainage) and control group (using standard drain tubes for chest
drainage). The volume and characteristics of drainage, postoperative (PO)
pain scores and hospital stay were recorded. All patients received
standard care during hospital admission. Results: In accordance with the
exit criteria, three patients were excluded from study. The remaining 47
patients included in the final analysis were divided into two groups:
experiment group (N=24) and control group (N=23). There was no significant
difference between the two groups in terms of age, sex, height, weight,
clinical diagnosis and type of surgical procedure. There was a trend
toward less PO pain in experimental group on postoperative day (POD) 1,
with a statistically significant difference. Patients in experimental
group had a reduced occurrence of fever [temperature (T) >37.4 degree]
compared to the control group. Conclusions: The silicone fluted drain tube
is feasible and safe and may relieve patient PO pain and reduce occurrence
of fever without the added risk of PO complications.

<22>
Accession Number
20160209156
Author
Krishnamoorthy B.; Shepherd N.; Critchley W.R.; Nair J.; Devan N.; Nasir
A.; Barnard J.B.; Venkateswaran R.V.; Waterworth P.D.; Fildes J.E.; Yonan
N.
Institution
(Krishnamoorthy, Nair, Devan, Nasir, Barnard, Venkateswaran, Waterworth,
Yonan) Department of Cardiothoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester M23 9LT, United Kingdom
(Shepherd, Critchley, Fildes) Transplant Centre, University Hospital of
South Manchester NHS Foundation Trust, Manchester, United Kingdom
Title
A randomized study comparing traditional monofilament knotted sutures with
barbed knotless sutures for donor leg wound closure in coronary artery
bypass surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (2) (pp 161-167),
2016. Date of Publication: 01 Feb 2016.
Publisher
Oxford University Press
Abstract
OBJECTIVES Surgical knots on the suture line provide an anchoring
function, but also represent a potential source of infection and
irritation on the donor leg after coronary artery bypass surgery. Knotless
barbed sutures were designed to prevent knot-related complications. This
study compared knot-related wound complication rates between patients
receiving traditional monofilament sutures and those receiving barbed
knotless sutures for closure of the donor leg. METHODS One hundred and
forty-two patients were randomized into two groups. Group 1 (n = 70)
received traditional monofilament sutures and Group 2 (n = 72) received
barbed knotless sutures. All wounds were assessed on postoperative days 3
and 5 and weeks 2, 4 and 6 using a validated wound scoring system.
Antibiotics usage and general practitioner and district nurse visits were
recorded. RESULTS No demographic differences were observed between groups.
Leg wound skin closure times were significantly shorter in Group 2
compared with Group 1 (P < 0.001). Group 1 demonstrated a greater
incidence of excessive scarring (P < 0.001), itching (P < 0.001),
irritation (P < 0.001) and adverse skin tissue reactions (P < 0.001) than
Group 2. Fewer general practitioner visits were recorded in Group 1
compared with Group 2 (P = 0.051). CONCLUSION Knotless barbed suture usage
significantly reduces the incidence of knot-related leg wound
complications compared with traditional monofilament knotted sutures. This
may be related to differences in the rate of absorption of the suture
material or an associated decrease in the incidence of adverse skin tissue
reactions that may delay postoperative wound healing.

<23>
Accession Number
20160215472
Author
Mariani J.; Macchia A.; De Abreu M.; Monte G.G.V.; Tajer C.
Institution
(Mariani, De Abreu, Monte, Tajer) Cardiology Department, Hospital El Cruce
Nestor Carlos Kirchner, Av. Calchaqui 5401 (B1888AAE), Florencio Varela,
Buenos Aires, Argentina
(Mariani, Macchia) Fundacion GESICA, Av. Rivadavia 2358 (C1034ACP), Ciudad
Autonoma de Buenos Aires, Argentina
Title
Multivessel versus single vessel angioplasty in non-ST elevation acute
coronary syndromes: A systematic review and metaanalysis.
Source
PLoS ONE. 11 (2) (no pagination), 2016. Article Number: e0148756. Date of
Publication: February 2016.
Publisher
Public Library of Science
Abstract
Background Multivessel disease is common in acute coronary syndrome
patients. However, if multivessel percutaneous coronary intervention is
superior to culprit-vessel angioplasty has not been systematically
addressed. Methods A metaanalysis was conducted including studies that
compared multivessel angioplasty with culprit-vessel angioplasty among
non-ST elevation ACS patients. Since all studies were observational
adjusted estimates of effects were used. Pooled estimates of effects were
computed using the generic inverse of variance with a random effects
model. Results Twelve studies were included (n = 117,685). Median age was
64.1 years, most patients were male, 29.3%were diabetic and 36,9%had
previous myocardial infarction. Median follow- up was 12 months. There
were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to
1.09; I² 67.9%), with moderate inconsistency. Also, there were
no significant differences in the risk of death or MI (HR 0.90; 95% CI
0.69 to 1.17; I² 62.3%), revascularization (HR 0.76; 95% CI
0.55 to 1.05; I² 49.9%) or in the combined incidence of death,
myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03;
I² 70.8%). All analyses exhibited a moderate degree of
inconsistency. Subgroup analyses by design reduced the inconsistency of
the analyses on death or myocardial infarction, revascularization and
death, myocardial infarction or revascularization. There was evidence of
publication bias (Egger's test p = 0.097). Conclusion Routine multivessel
angioplasty in non-ST elevation acute coronary syndrome patients with
multivessel disease was not superior to culprit-vessel angioplasty.
Randomized controlled trials comparing safety and effectiveness of both
strategies in this setting are needed.

<24>
Accession Number
20160075215
Author
Castelino T.; Fiore J.F.; Niculiseanu P.; Landry T.; Augustin B.; Feldman
L.S.
Institution
(Castelino, Fiore, Niculiseanu, Feldman) Steinberg-Bernstein Centre for
Minimally Invasive Surgery and Innovation, McGill University Health
Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC H3G
1A4, Canada
(Landry) Montreal General Hospital Medical Library, McGill University
Health Centre, Montreal, QC, Canada
(Augustin) Division of Anesthesia, Montreal General Hospital, Montreal,
QC, Canada
Title
The effect of early mobilization protocols on postoperative outcomes
following abdominal and thoracic surgery: A systematic review.
Source
Surgery (United States). 159 (4) (pp 991-1003), 2016. Date of Publication:
01 Apr 2016.
Publisher
Mosby Inc.
Abstract
Background Early mobilization is considered an important element of
postoperative care; however, how best to implement this intervention in
clinical practice is unknown. This systematic review summarizes the
evidence regarding the impact of specific early mobilization protocols on
postoperative outcomes after abdominal and thoracic surgery. Method The
review was performed according to PRISMA guidelines. We searched 8
electronic databases to identify studies comparing patients receiving a
specific protocol of early mobilization to a control group. Methodologic
quality was assessed using the Downs and Black tool. Results Four studies
in abdominal surgery (3 randomized controlled trials [RCTs] and 1
observational prospective study) and 4 studies in thoracic surgery (3 RCTs
and 1 observational retrospective study) were identified. None of the 5
studies evaluating postoperative complications reported differences
between groups. One of 4 studies evaluating duration of stay reported a
significant decrease in the intervention group. One of 3 studies
evaluating gastrointestinal function reported differences in favor of the
intervention group. One of 4 studies evaluating performance-based outcomes
reported differences in favor of the intervention group. One of 5 studies
evaluating patient-reported outcomes reported differences in favor of the
intervention group. Overall methodologic quality was poor. Conclusion Few
comparative studies have evaluated the impact of early mobilization
protocols on outcomes after abdominal and thoracic surgery. The quality of
these studies was poor and results were conflicting. Although bed rest is
harmful, there is little available evidence to guide clinicians in
effective early mobilization protocols that increase mobilization and
improve outcomes.

<25>
Accession Number
20160200099
Author
Mayr N.P.; Hapfelmeier A.; Martin K.; Kurz A.; Van Der Starre P.; Babik
B.; Mazzitelli D.; Lange R.; Wiesner G.; Tassani-Prell P.; Thompson J.P.
Institution
(Mayr, Martin, Wiesner, Tassani-Prell) Institut fur Anasthesiologie,
Deutsches Herzzentrum Munchen des Freistaates Bayern, Technische
Universitat Munchen, Lazarettstr. 36, Munich D-80636, Germany
(Hapfelmeier) Institut fur Medizinische Statistik und Epidemiologie,
Klinikum Rechts der Isar, Technische Universitat Munchen, Ismaningerstr.
22, Munich D-81675, Germany
(Kurz) Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Klinikum
Rechts der Isar, Technische Universitat Munchen, Ismaningerstr. 22, Munich
D-81675, Germany
(Van Der Starre) Department of Anesthesia, Stanford University Medical
Center, 300 Pasteur Drive, MC 5640, Stanford, CA 94305, United States
(Babik) Department of Anesthesiology and Intensive Therapy, University of
Szeged, 6. Semmelweis st., Szeged 6725, Hungary
(Mazzitelli, Lange) Klinik fur Herz- und Gefaschirurgie, Deutsches
Herzzentrum Munchen des Freistaates Bayern, Technische Universitat
Munchen, Lazarettstr. 36, Munich D-80636, Germany
Title
Comparison of sedation and general anaesthesia for transcatheter aortic
valve implantation on cerebral oxygen saturation and neurocognitive
outcome.
Source
British Journal of Anaesthesia. 116 (1) (pp 90-99), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Oxford University Press
Abstract
Background. Transcatheter aortic valve implantation (TAVI) is a treatment
strategy for patients with severe aortic stenosis. Although general
anaesthesia (TAVI-GA) and sedation (TAVI-S) have previously been described
for TAVI, the difference in safety and efficacy of both methods has not
been studied in a randomized trial. Methods. The INSERT trial was a single
centre, controlled parallel-group trial with balanced randomization.
Sixty-six patients (68-94 yr) with acquired aortic stenosis undergoing
transfemoral CoreValveTM were assigned to TAVI-GA or TAVI-S. Comparable
operative risk was determined from risk-scores (EUROscore, STS-Score).
Monitoring and anaesthetic drugs were standardized.
Near-Infrared-Spectroscopy was used to monitor cerebral-oxymetry blinded.
Primary outcome was the perioperative cumulative cerebral desaturation. As
secondary outcomes, changes in neurocognitive function and respiratory and
haemodynamic adverse events were evaluated. Results. Of 66 included
patients, 62 (TAVI-GA: n=31, TAVI-S: n=31) were finally analysed. Baseline
characteristics were comparable. In 24 patients (39%) cerebral
desaturation was observed. Cumulative cerebral desaturation was comparable
(TAVI-GA:(median [IQR]) (0[0/1308] s%) vs. TAVI-S:(0[0/276] s%); P=0.505)
between the groups. Neurocognitive function did not change within and
between groups. Adverse events were more frequently observed in TAVI-S
patients (P<0.001). Bradypnoea (n=16, 52%) and the need for airway
manoeuvres (n=11, 36%) or bag-mask-ventilation (n=6, 19%) were the most
common respiratory adverse events. Conclusions. Cerebral desaturation
occurred in both patient groups, but there was no significant difference
between the two groups. Based on primary outcome, both methods were shown
to be comparable. Neurocognitive outcome was similar. The higher incidence
of adverse events in the sedation group suggests a potential advantage of
general anaesthesia. Clinical trial registration. NCT 01251328.

<26>
Accession Number
20160204143
Author
Yong M.S.; Coffey S.; Prendergast B.D.; Marasco S.F.; Zimmet A.D.;
McGiffin D.C.; Saxena P.
Institution
(Yong, Marasco, Zimmet, McGiffin, Saxena) Department of Cardiothoracic
Surgery, Alfred Hospital, 55 Commercial Road, Prahran, Melbourne 3181,
Australia
(Coffey, Prendergast) Department of Cardiology, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
Title
Surgical management of tricuspid valve endocarditis in the current era: A
review.
Source
International Journal of Cardiology. 202 (pp 44-48), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
The incidence of isolated tricuspid valve infective endocarditis is
increasing. Medical management is the mainstay of treatment but surgical
intervention is required in a subset of patients. Surgical treatment
options include valve excision and replacement or valve reconstruction. We
searched PubMed and the Cochrane library to identify articles to be
included in this review of surgical outcomes. References of selected
articles were crosschecked for other relevant studies. Surgical management
of tricuspid valve endocarditis can be achieved with satisfactory
outcomes. However, the optimal indication and timing of surgery remain
unclear, and the frequent association with intravenous drug use
complicates management. Repair techniques are preferable though there is
no clear evidence supporting one method over another.

<27>
Accession Number
20160204194
Author
Petrou P.; Dias S.
Institution
(Petrou) Health Insurance Organization, Cyprus
(Dias) School of Social and Community Medicine, University of Bristol,
United Kingdom
Title
A mixed treatment comparison for short- and long-term outcomes of
bare-metal and drug-eluting coronary stents.
Source
International Journal of Cardiology. 202 (pp 448-462), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The increasing use of drug eluting stents in interventional
cardiology calls for assessment of their efficacy and safety, both among
drug-eluting and bare-metal stents, in the context of rational decision
making. Methods: We searched for papers that compared any of the
sirolimus-eluting stent, paclitaxel-eluting stent, drug- eluting stent,
biodegradable stent, everolimus-eluting stent, zotarolimus-resolute
eluting stent, biolimus- eluting stent, bare-metal stent and
zotarolimus-eluting stent. The search was contacted through Medline, the
Cochrane database, Embase, TCTMD, ClinicalTrials.gov, Clinical Trial
Results, CardioSource, abstracts and presentations from major
cardiovascular meetings. We also searched for further articles cited by
selected papers. Furthermore, important conferences and relevant
proceedings and abstracts, such as the American Heart Association,
American College of Cardiology, Transcatheter Cardiovascular Therapeutics,
Society of Cardiovascular Angiography and Intervention, European Society
of Cardiology, and Euro-PCR, were also searched. Inclusion criteria were:
randomised controlled trials (RCTs), size of study (> 100 patients),
duration more than 6 months and definition of reported endpoints (target
vessel revascularization, thrombosis, myocardial infarction and cardiac
death). Analysis of the data was performed for short-term (less than a
year) and long-term outcomes (more than a year). A mixed treatment
comparison approach was utilised for the data analysis. Conclusions: Based
on the rankings of each treatment, a distinct difference between the 2nd
and 1st generation stents was identified. We can conclude that everolimus,
zotarolimus-resolute and biolimus eluting stents carry the highest
probabilities of being superior for all endpoints.

<28>
Accession Number
20160202143
Author
Lin Z.; Xiaoyi Z.
Institution
(Lin, Xiaoyi) Department of Neurology, West China Hospital, Sichuan
University, No.37 Guoxuexiang, Chengdu 610041, China
Title
Tranexamic acid-associated seizures: A meta-analysis.
Source
Seizure. 36 (pp 70-73), 2016. Date of Publication: 01 Mar 2016.
Publisher
W.B. Saunders Ltd
Abstract
Purpose To investigate the incidence rate of tranexamic acid
(TXA)-associated seizures. Methods Two electronic databases (Medline and
Embase) were searched. We looked for additional studies in the references
of all identified publications. The cutoff day was 2015 Dec 06. Two
authors independently reviewed the titles and abstracts of the
publications identified firstly. Odds ratio (OR) and 95% confidence
interval (CI) were used to compare discontinuous variables. Results Ten
studies enrolling 26,079 patients with TXA exposure and 7395 patients with
non-TXA exposure were included. The cumulative incidence rate of
TXA-associated seizures is 2.7%. The odds ratio of seizure is 5.39 (95%CI:
3.29-8.85; I² = 0%; P < 0.001) in patients with TXA exposure vs
patients with non-TXA exposure. The incidence rate of TXA-associated
seizures increased when the dose levels increased. Conclusion The risk of
seizure increased in patients with TXA exposure and the incidence rate of
TXA-associated seizures increased when the dose levels increased.

<29>
Accession Number
25429720
Author
de Hoogd S.; Ahlers S.J.; van Dongen E.P.; Tibboel D.; Dahan A.; Knibbe
C.A.
Institution
(Knibbe) Department of Clinical Pharmacy, St Antonius Hospital,
Koekoeklaan 1, 3435 CM Nieuwegein, The Netherlands.
c.knibbe@antoniusziekenhuis.nl
Title
Remifentanil versus fentanyl during cardiac surgery on the incidence of
chronic thoracic pain (REFLECT): study protocol for a randomized
controlled trial.
Source
Trials. 15 (pp 466), 2014. Date of Publication: 2014.
Abstract
DISCUSSION: Chronic thoracic pain is prevalent after cardiac surgery, and
research is needed to minimize the risk of chronic persistent
postoperative pain, which is an invalidating, long-term complication of
surgery. The objective of this trial is to determine the influence of
perioperative remifentanil on long-term pain outcomes for cardiac patients
in a prospective randomized trial. The results may be used to optimize
perioperative analgesia techniques and, thereby, improve quality of life
after cardiac surgery.
TRIAL REGISTRATION: Clinicaltrials.gov NCT02031016 on 13 December 2013.
BACKGROUND: Chronic thoracic pain after cardiac surgery is prevalent (11
to 56%) and may affect patients' physical and mental health status.
Despite its favorable pharmacokinetic and pharmacodynamic properties, high
doses of remifentanil administered during surgery are reported to cause
acute postoperative pain and increased requirements for analgesics.
Recently, an association between remifentanil use and the incidence of
chronic thoracic pain in the long term was also reported. Our objective is
to investigate the influence of the intraoperative remifentanil on chronic
postoperative pain in a prospective randomized controlled trial.
METHODS/DESIGN: In this prospective, randomized, single-blind clinical
trial, all patients (N = 126) between 18 and 85 years undergoing cardiac
surgery via sternotomy receive a continuous infusion of propofol together
with intermittent intravenous fentanyl at predetermined times
perioperatively. Patients are randomized to receive either an additional
continuous infusion of remifentanil (0.15 mug(-1)kgIBW(-1) min(-1)) or
additional fentanyl (200 to 500 mug) as needed during surgery.The primary
end point is the prevalence of chronic thoracic pain 12 months after
surgery. Secondary end points include acute postoperative pain;
postoperative analgesic use; chronic thoracic pain 3 and 6 months after
surgery; quality of life (SF-12) at 3, 6 and 12 months after surgery; work
productivity; and use of health care. In addition, thermal detection and
pain thresholds are measured preoperatively, 3 days after surgery and 12
months after surgery using quantitative sensory testing (QST). Finally,
the influence of several genetic variances on the different outcomes will
be measured.

<30>
Accession Number
25239650
Author
Wald R.M.; Altaha M.A.; Alvarez N.; Caldarone C.A.; Cavalle-Garrido T.;
Dallaire F.; Drolet C.; Grewal J.; Hancock Friesen C.L.; Human D.G.;
Hickey E.; Kayedpour C.; Khairy P.; Kovacs A.H.; Lebovic G.; McCrindle
B.W.; Nadeem S.N.; Patton D.J.; Redington A.N.; Silversides C.K.; Tham
E.B.; Therrien J.; Warren A.E.; Wintersperger B.J.; Vonder Muhll I.F.;
Farkouh M.E.
Institution
(Wald) Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac
Centre, University Health Network, University of Toronto, Toronto,
Ontario, Canada; Department of Medical Imaging, University Health Network,
University of Toronto, Toronto, Ontario, Canada; Division of Pediatric
Cardiology, Hospital for Sick Children, University of Toronto, Toronto,
Ontario, Canada. Electronic address: rachel.wald@uhn.ca
(Altaha) Department of Medical Imaging, University Health Network,
University of Toronto, Toronto, Ontario, Canada
(Alvarez) Adult Congenital Heart Disease Clinic, Division of
Cardiovascular Diseases, Peter Lougheed Hospital, Calgary, Alberta, Canada
(Caldarone) Cardiovascular Surgery, Hospital for Sick Children, University
of Toronto, Toronto, Ontario, Canada
(Cavalle-Garrido) Pediatric Cardiology, Montreal Children's Hospital,
McGill University, Montreal, Quebec, Canada
(Dallaire) Division of Pediatric Cardiology, University Hospital of
Sherbrooke, University of Sherbrooke, Sherbrooke, Quebec, Canada
(Drolet) Division of Pediatric and Congenital Cardiology, Department of
Pediatrics, Laval University Hospital, Faculty of Medicine, Laval
University, Quebec City, Quebec, Canada
(Grewal) Pacific Adult Congenital Heart Clinic, Division of Cardiology, St
Paul's Hospital, University of British Columbia, Vancouver, British
Columbia, Canada
(Hancock Friesen) Division of Cardiovascular Surgery, IWK Health Centre,
Halifax, Nova Scotia, Canada
(Human) Children's Heart Centre, Division of Cardiology, British Columbia
Children's Hospital, Vancouver, British Columbia, Canada
(Hickey) Cardiovascular Surgery, Hospital for Sick Children, University of
Toronto, Toronto, Ontario, Canada
(Kayedpour) Toronto Congenital Cardiac Centre for Adults, Peter Munk
Cardiac Centre, University Health Network, University of Toronto, Toronto,
Ontario, Canada
(Khairy) Adult Congenital Center, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Kovacs) Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac
Centre, University Health Network, University of Toronto, Toronto,
Ontario, Canada
(Lebovic) Applied Health Research Centre, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada; Institute of Health
Policy Management and Evaluation, University of Toronto, Toronto, Ontario,
Canada
(McCrindle) Division of Pediatric Cardiology, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Nadeem) Division of Cardiology, Queen Elizabeth II Health Sciences
Centre, Halifax, Nova Scotia, Canada
(Patton) Pediatric Cardiology, Department of Pediatrics, University of
Calgary, Calgary, Alberta, Canada
(Redington) Division of Pediatric Cardiology, Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
(Silversides) Toronto Congenital Cardiac Centre for Adults, Peter Munk
Cardiac Centre, University Health Network, University of Toronto, Toronto,
Ontario, Canada
(Tham) Pediatric Cardiology, Stollery Children's Hospital, Edmonton,
Alberta, Canada
(Therrien) MAUDE Unit (McGill University Health Network/Beth Raby Adult
Congenital Heart Disease Clinic, Jewish General Hospital), McGill
University, Montreal, Quebec, Canada
(Warren) Division of Pediatric Cardiology, Department of Pediatrics, IWK
Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
(Wintersperger) Department of Medical Imaging, University Health Network,
University of Toronto, Toronto, Ontario, Canada
(Vonder Muhll) Division of Cardiology, Mazankowski Alberta Heart
Institute, Edmonton, Alberta, Canada
(Farkouh) Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac
Centre, University Health Network, University of Toronto, Toronto,
Ontario, Canada
Title
Rationale and design of the Canadian Outcomes Registry Late After
Tetralogy of Fallot Repair: the CORRELATE study.
Source
The Canadian journal of cardiology. 30 (11) (pp 1436-1443), 2014. Date of
Publication: 01 Nov 2014.
Abstract
BACKGROUND: Chronic hemodynamically relevant pulmonary regurgitation (PR)
resulting in important right ventricular dilation and ventricular
dysfunction is commonly seen after tetralogy of Fallot (TOF) repair. Late
adverse clinical outcomes, including exercise intolerance, arrhythmias,
heart failure and/or death accelerate in the third decade of life and are
cause for considerable concern. Timing of pulmonary valve replacement
(PVR) to address chronic PR is controversial, particularly in asymptomatic
individuals, and effect of PVR on clinical measures has not been
determined.
METHODS: Canadian Outcomes Registry Late After Tetralogy of Fallot Repair
(CORRELATE) is a prospective, multicentre, Canada-wide cohort study.
Candidates will be included if they are > 12 years of age, have had
surgically repaired TOF resulting in moderate or severe PR, and are able
to undergo cardiovascular magnetic resonance imaging. Enrollment of > 1000
individuals from 15 participating centres (Toronto, Montreal, Quebec City,
Sherbrooke, Halifax, Calgary, Edmonton, and Vancouver) is anticipated.
Clinical data, health-related quality of life metrics, and adverse
outcomes will be entered into a web-based database. A central core lab
will analyze all cardiovascular magnetic resonance studies (PR severity,
right ventricular volumes, and ventricular function). Major adverse
outcomes (sustained ventricular tachycardia and cardiovascular cause of
death) will be centrally adjudicated.
RESULTS: To the best of our knowledge, CORRELATE will be the first
prospective pan-Canadian cohort study of congenital heart disease in
children and adults.
CONCLUSIONS: CORRELATE will uniquely link clinical, imaging, and
functional data in those with repaired TOF and important PR, thereby
enabling critical evaluation of clinically relevant outcomes in those
managed conservatively compared with those referred for PVR.

<31>
Accession Number
25228130
Author
Ji Q.; Ding W.; Mei Y.; Wang X.; Feng J.; Cai J.
Institution
(Ji) Department of Thoracic Cardiovascular Surgery of Tongji Hospital of
Tongji University, Shanghai, China
(Ding) Department of Cardiovascular Surgery of Zhongshan Hospital of Fudan
University, Shanghai, China
(Mei) Department of Thoracic Cardiovascular Surgery of Tongji Hospital of
Tongji University, Shanghai, China. Electronic address:
jiqiang1977@aliyun.com
(Wang) Department of Thoracic Cardiovascular Surgery of Tongji Hospital of
Tongji University, Shanghai, China
(Feng) Department of Thoracic Cardiovascular Surgery of Tongji Hospital of
Tongji University, Shanghai, China
(Cai) Department of Thoracic Cardiovascular Surgery of Tongji Hospital of
Tongji University, Shanghai, China
Title
Protective effects of tight glucose control during cardiopulmonary bypass
on myocardium in adult nondiabetic patients undergoing valve replacement.
Source
The Canadian journal of cardiology. 30 (11) (pp 1429-1435), 2014. Date of
Publication: 01 Nov 2014.
Abstract
BACKGROUND: In this study, we aimed to evaluate the protective effect of
tight glucose control during cardiopulmonary bypass on myocardium in adult
nondiabetic patients undergoing isolated aortic valve replacement in a
prospective and randomized trial.
METHODS: Sixty-five adult nondiabetic patients undergoing selective
isolated aortic valve replacement were enrolled and randomly assigned to
an insulin group (patients received a continuous insulin infusion during
surgery; n = 33) or a control group (patients were not administered
insulin unless their blood glucose level exceeded 200 mg/dL; n = 32).
Cardiac troponin I was assayed preoperatively, and then at 2, 6, 12, 24,
and 48 hours after aortic cross-declamping. The pre-, intra-, and
postoperative relevant data of all selected patients were analyzed.
RESULTS: Tight glucose control reduced postoperative peak release by 48%
for cardiac troponin I compared with the control group (0.48 +/- 0.12 vs
0.71 +/- 0.17 ng/mL; P < 0.0001). Patients with continuous insulin
infusion had lower peak inotropic score during the first postoperative 24
hours and peak level of blood glucose (5.8 +/- 2.2 vs 8.2 +/- 3.1
mug/kg/min; P < 0.0001; 131.9 +/- 23.8 vs 191.1 +/- 38.5 mg/dL; P < 0.001,
respectively), shorter duration of mechanical ventilation and intensive
care unit stay and hospital stay compared with the control group (11.6 +/-
2.9 hours vs 14.8 +/- 3.5 hours; P = 0.0002; 28.4 +/- 7.2 hours vs 36.5
+/- 7.8 hours; P < 0.0001; 9.4 +/- 3.3 days vs 11.5 +/- 4.2 days; P =
0.0283, respectively).
CONCLUSIONS: Tight glucose control during cardiopulmonary bypass might
provide myocardial protection in adult nondiabetic patients undergoing
isolated aortic valve replacement.

<32>
Accession Number
25447444
Author
Kim H.-J.; Kim W.H.; Kim G.; Kim E.; Park M.-H.; Shin B.S.; Sim W.S.; Kim
C.S.; Lee Y.T.; Cho H.S.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Samsung Changwon
Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic
of Korea; Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Kim) Department of Anesthesiology and Pain Medicine, Samsung Changwon
Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic
of Korea. Electronic address: wonhokim.ane@gmail.com
(Kim) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Kim) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Park) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Shin) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Sim) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Kim) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
(Cho) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea
Title
A comparison among infusion of lidocaine and dexmedetomidine alone and in
combination in subjects undergoing coronary artery bypass graft: a
randomized trial.
Source
Contemporary clinical trials. 39 (2) (pp 303-309), 2014. Date of
Publication: 01 Nov 2014.
Abstract
BACKGROUND: Previous studies have reported the cardioprotective effect of
dexmedetomidine and lidocaine. We compared the effect of lidocaine and
dexmedetomidine infusion during off-pump coronary artery bypass graft
(OPCAB).
METHODS: 153 patients undergoing OPCAB were enrolled. The lidocaine group
(n=36, Group LIDO) received an infusion of lidocaine 2 mg/kg/h after bolus
1.5 mg/kg; the dexmedetomidine group (n=40, Group DEX) received
dexmedetomidine 0.3-0.7 mug/kg/h; the combined group (n=39, Group
Combined) received infusion of both drugs; and the control group (n=38)
received nothing. We measured serum creatinine kinase-myocardial band
(CK-MB) and cardiac troponin I (cTnI) concentration before and immediately
after the surgery, postoperative day (POD)#1 and #2. The complication rate
and clinical outcomes were compared.
RESULTS: The concentration of cTnI was significantly lower in the Group
LIDO and Group Combined than the control group on POD#2. The concentration
of CK-MB was significantly lower in the Group LIDO and Group Combined
compared to the control group on POD#1 and #2 [CK-MB on POD#1: 7.67
(5.78-11.92) vs. 7.18 (5.01-11.72) vs. 13.19 (6.85-23.87) in the Group
LIDO, combined and control, respectively, Group LIDO vs. control: p=0.003,
Group Combined vs. control: p=0.015]. The AUC of CK-MB was significantly
lower in the Group LIDO and Group Combined than the control group.
However, clinical variables including complication rate, ICU stay and
one-year mortality were not different.
CONCLUSIONS: Lidocaine infused at 2 mg/kg/h, but not dexmedetomidine
infused at 0.3-0.7 mug/kg/h reduced postoperative myocardial injury marker
levels compared with the control group. However, no other clinical
benefits were observed.

<33>
Accession Number
25372911
Author
Aydin E.; Arslan A.; Ozkokeli M.
Institution
(Aydin) Department of Cardiovascular Surgery, Kartal Kosuyolu Training and
Research Hospital, Istanbul, Turkey
(Arslan) Department of Cardiovascular Surgery, Kartal Kosuyolu Training
and Research Hospital, Istanbul, Turkey
(Ozkokeli) Department of Cardiovascular Surgery, Kartal Kosuyolu Training
and Research Hospital, Istanbul, Turkey
Title
Comparison of superior septal approach with left atriotomy in mitral valve
surgery.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 29 (3) (pp 367-373), 2014. Date of
Publication: 01 Jul 2014.
Abstract
OBJECTIVE: In this study, we aimed to compare clinical outcomes of
superior transseptal approach with the conventional left atriotomy in
patients undergoing mitral valve surgery.
METHODS: Between January 2010 and November 2012, a total of 91 consecutive
adult patients (39 males, 52 females; mean age: 54.0+/-15.4 years; range,
16 to 82 years) who underwent mitral valve surgery in the Division of
Cardiovascular Surgery at Kosuyolu Training Hospital were included. The
patients were randomized to either superior transseptal approach (n=47) or
conventional left atriotomy (n=44). Demographic characteristics of the
patients, comorbidities, additional interventions, intraoperational data,
pre- and postoperative electrophysiological study findings, and
postoperative complications were recorded.
RESULTS: Of all patients, 86.7% (n=79) were in New York Heart Association
Class III, while 12 were in New York Heart Association Class IV. All
patients underwent annuloplasty (42.9%) or valve replacement surgery
(57.1%). There was no significant difference in pre- and postoperative
electrocardiogram findings between the groups. Change from baseline in the
cardiac rhythm was statistically significant in superior transseptal
approach group alone (P<0.001). There was no statistically significant
difference in mortality rate between the groups. Permanent pacemaker
implantation was performed in 10.6% of the patients in superior
transseptal approach group and 4.5% in the conventional left atriotomy
group. No statistically significant difference in bleeding, total length
of hospital and intensive care unit stay, the presence of low cardiac
output syndrome was observed between the groups.
CONCLUSION: Our study results suggest that superior transseptal approach
does not lead to serious or fatal adverse effects on sinus node function
or atrial vulnerability, compared to conventional approach.

<34>
Accession Number
25023813
Author
Stewart R.A.; Szalewska D.; She L.; Lee K.L.; Drazner M.H.; Lubiszewska
B.; Kosevic D.; Ruengsakulrach P.; Nicolau J.C.; Coutu B.; Choudhary S.K.;
Mark D.B.; Cleland J.G.; Pina I.L.; Velazquez E.J.; Rynkiewicz A.; White
H.
Institution
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital, and
University of Auckland, Auckland, New Zealand. Electronic address:
rstewart@adhb.govt.nz
(Szalewska) Medical University of Gdansk, Department of Rehabilitation,
Gdansk, Poland
(She) Duke Clinical Research Institute, Clinical Trial Biostatistics,
Durham, North Carolina
(Lee) Duke Clinical Research Institute, Department of Biostatistics and
Bioinformatics, Duke University School of Medicine, Durham, North Carolina
(Drazner) University of Texas Southwestern Medical Center, Dallas, Texas
(Lubiszewska) National Institute of Cardiology, Warsaw, Poland
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Ruengsakulrach) Bangkok Heart Hospital, Bangkok Hospital Group, Bangkok,
Thailand
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Coutu) Hotel-Dieu du CHUM, Montreal, Canada
(Choudhary) All India Institute of Medical Sciences, New Delhi, India
(Mark) Duke Clinical Research Institute, Department of
Medicine-Cardiology, Duke University School of Medicine, Durham, North
Carolina
(Cleland) Castle Hill Hospital/Hull Royal Infirmary, Kingston-upon-Hull,
United Kingdom
(Pina) Albert Einstein College of Medicine, Montefiore Medical Center, New
York, New York
(Velazquez) Duke Clinical Research Institute, Department of
Medicine-Cardiology, Duke University School of Medicine, Durham, North
Carolina
(Rynkiewicz) University of Waria and Mazury, Department of Cardiology and
Cardiosurgery, Olsztyn, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital, and
University of Auckland, Auckland, New Zealand
Title
Exercise capacity and mortality in patients with ischemic left ventricular
dysfunction randomized to coronary artery bypass graft surgery or medical
therapy: an analysis from the STICH trial (Surgical Treatment for Ischemic
Heart Failure).
Source
JACC. Heart failure. 2 (4) (pp 335-343), 2014. Date of Publication: 01 Aug
2014.
Abstract
OBJECTIVES: The objective of this study was to assess the prognostic
significance of exercise capacity in patients with ischemic left
ventricular (LV) dysfunction eligible for coronary artery bypass graft
surgery (CABG).
BACKGROUND: Poor exercise capacity is associated with mortality, but it is
not known how this influences the benefits and risks of CABG compared with
medical therapy.
METHODS: In an exploratory analysis, physical activity was assessed by
questionnaire and 6-min walk test in 1,212 patients before randomization
to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical
Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was
compared by treatment allocation during 56 months (interquartile range: 48
to 68 months) of follow-up for subjects able (n = 682) and unable (n =
530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS]
>55, n = 749) and more (PAS <55, n = 433) limitation by dyspnea or
fatigue.
RESULTS: Compared with medical therapy, mortality was lower for patients
randomized to CABG who walked >300 m (hazard ratio [HR]: 0.77; 95%
confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS
>55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk
300 m or with a PAS <55 had higher mortality during the first 60 days with
CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant
benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19;
p = 0.626; interaction p = 0.167).
CONCLUSIONS: These observations suggest that patients with ischemic left
ventricular dysfunction and poor exercise capacity have increased early
risk and similar 5-year mortality with CABG compared with medical therapy,
whereas those with better exercise capacity have improved survival with
CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart
Failure and Coronary Artery Disease [STICH]; NCT00023595).

<35>
Accession Number
24958780
Author
Burch P.T.; Gerstenberger E.; Ravishankar C.; Hehir D.A.; Davies R.R.;
Colan S.D.; Sleeper L.A.; Newburger J.W.; Clabby M.L.; Williams I.A.; Li
J.S.; Uzark K.; Cooper D.S.; Lambert L.M.; Pemberton V.L.; Pike N.A.;
Anderson J.B.; Dunbar-Masterson C.; Khaikin S.; Zyblewski S.C.; Minich
L.L.
Institution
(Burch) Department of Surgery, University of Utah, Salt Lake City, UT
(P.T.B., L.M.L.)
(Gerstenberger) New England Research Institutes, Watertown, MA (E.G.,
L.A.S.)
(Ravishankar) The Children's Hospital of Philadelphia, Philadelphia, PA
(C.R.)
(Hehir) The Children's Hospital of Wisconsin, Milwaukee, WI (D.A.H.)
(Davies) Nemours/A.I. DuPont Hospital for Children, Wilmington, DE
(R.R.D.)
(Colan) Children's Hospital Boston and Harvard Medical School, Boston, MA
(S.D.C., J.W.N., C.D.M.)
(Sleeper) New England Research Institutes, Watertown, MA (E.G., L.A.S.)
(Newburger) Children's Hospital Boston and Harvard Medical School, Boston,
MA (S.D.C., J.W.N., C.D.M.)
(Clabby) The Hospital for Sick Children, Toronto, Ontario, Canada (M.L.C.,
S.K.)
(Williams) Columbia University Medical Center, New York, NY (I.A.W.)
(Li) Duke University Medical Center, Durham, NC (J.S.L.)
(Uzark) University of Michigan Medical School, Ann Arbor, MI (K.U.)
(Cooper) University of Cincinnati, Cincinnati, OH (D.S.C., J.B.A.)
(Lambert) Department of Surgery, University of Utah, Salt Lake City, UT
(P.T.B., L.M.L.)
(Pemberton) National Institutes of Health, Bethesda, MD (V.L.P.)
(Pike) University of California Los Angeles, Los Angeles, CA (N.A.P.)
(Anderson) University of Cincinnati, Cincinnati, OH (D.S.C., J.B.A.)
(Dunbar-Masterson) Children's Hospital Boston and Harvard Medical School,
Boston, MA (S.D.C., J.W.N., C.D.M.)
(Khaikin) The Hospital for Sick Children, Toronto, Ontario, Canada
(M.L.C., S.K.)
(Zyblewski) Medical University of South Carolina, Charleston, SC (S.C.Z.)
(Minich) Department of Pediatrics, University of Utah, Salt Lake City, UT
(L.A.M.)
Title
Longitudinal assessment of growth in hypoplastic left heart syndrome:
results from the single ventricle reconstruction trial.
Source
Journal of the American Heart Association. 3 (3) (pp e000079), 2014. Date
of Publication: 01 Jun 2014.
Abstract
BACKGROUND: We sought to characterize growth between birth and age 3 years
in infants with hypoplastic left heart syndrome who underwent the Norwood
procedure.
METHODS AND RESULTS: We performed a secondary analysis using the Single
Ventricle Reconstruction Trial database after excluding patients <37 weeks
gestation (N=498). We determined length-for-age z score (LAZ) and
weight-for-age z score (WAZ) at birth and age 3 years and change in WAZ
over 4 clinically relevant time periods. We identified correlates of
change in WAZ and LAZ using multivariable linear regression with
bootstrapping. Mean WAZ and LAZ were below average relative to the general
population at birth (P<0.001, P=0.05, respectively) and age 3 years
(P<0.001 each). The largest decrease in WAZ occurred between birth and
Norwood discharge; the greatest gain occurred between stage II and 14
months. At age 3 years, WAZ and LAZ were <-2 in 6% and 18%, respectively.
Factors associated with change in WAZ differed among time periods. Shunt
type was associated with change in WAZ only in the Norwood discharge to
stage II period; subjects with a Blalock-Taussig shunt had a greater
decline in WAZ than those with a right ventricle-pulmonary artery shunt
(P=0.002).
CONCLUSIONS: WAZ changed over time and the predictors of change in WAZ
varied among time periods. By age 3 years, subjects remained small and
three times as many children were short as were underweight (>2 SD below
normal). Failure to find consistent risk factors supports the strategy of
tailoring nutritional therapies to patient- and stage-specific targets.
CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/. Unique
identifier: NCT00115934.

<36>
Accession Number
23577663
Author
Wittwer T.; Sabashnikov A.; Rahmanian P.B.; Choi Y.-H.; Zeriouh M.; Mehler
T.O.; Wahlers T.
Title
Less invasive coronary artery revascularization with a minimized
extracorporeal circulation system: preliminary results of a comparative
study with off-pump-procedures.
Source
Journal of cardiothoracic surgery. 8 (pp 75), 2013. Date of Publication:
2013.
Abstract
BACKGROUND: Coronary-artery-bypass-grafting (CABG) with conventional
extracorporeal circulation (CECC) is associated with adverse effects such
as systemic inflammatory response leading to a decrease in systemic
vascular resistance and hemodynamic instability. Modern "less invasive"
procedures have been established recently which potentially avoid negative
side effects of CECC. The aim of this study was to compare perioperative
outcome following coronary revascularization using either a minimized
extracorporeal circuit (Mini-HLM) or off-pump technique (OPCAB).
METHODS: In this prospective ethics-approved trial, 120 patients referred
for CABG were randomly assigned either to off-pump coronary artery bypass
(OPCAB) or to a Mini-HLM procedure. Patient demographics, preoperative
characteristics and extensive postoperative outcome were analyzed for both
groups. Hemodynamic data were measured at seven time points
perioperatively.
RESULTS: Operation-time was longer in the Mini-HLM group (178,3+/-32,9
min) compared to OPCAB (133,2+/-32,7 min, p<0,001) with higher graft
numbers in Mini-HLM group (3,11+/-0,7 vs. 1,78+/-0,7, p<0.001). There were
no significant differences in perioperative hemodynamic criteria,
catecholaminergic support, hospital (p=0,534) and intensive care unit stay
(p=0,880), ventilation time (p=0,113), blood loss (p=0,570), transfusion
requirements, postoperative atrial fibrillation rate (p=0,706) and
neurocognitive disturbance (p=0,297). No deaths and no myocardial
infarctions were observed.
CONCLUSIONS: Coronary revascularisation with Mini-HLM represents a
suitable and "less invasive" procedure which achieves all benefits of
OPCAB but may allow for less demanding revascularisation than OPCAB in
special patients with complex coronary anatomy and can therefore be used
both on a routine basis and in all "conversion" cases of OPCAB.

<37>
Accession Number
23531208
Author
Galas F.R.; Almeida J.P.; Fukushima J.T.; Osawa E.A.; Nakamura R.E.; Silva
C.M.; de Almeida E.P.; Auler J.O.; Vincent J.-L.; Hajjar L.A.
Title
Blood transfusion in cardiac surgery is a risk factor for increased
hospital length of stay in adult patients.
Source
Journal of cardiothoracic surgery. 8 (pp 54), 2013. Date of Publication:
2013.
Abstract
BACKGROUND: Allogeneic red blood cell (RBC) transfusion has been proposed
as a negative indicator of quality in cardiac surgery. Hospital length of
stay (LOS) may be a surrogate of poor outcome in transfused patients.
METHODS: Data from 502 patients included in Transfusion Requirements After
Cardiac Surgery (TRACS) study were analyzed to assess the relationship
between RBC transfusion and hospital LOS in patients undergoing cardiac
surgery and enrolled in the TRACS study.
RESULTS: According to the status of RBC transfusion, patients were
categorized into the following three groups: 1) 199 patients (40%) who did
not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer
(low transfusion requirement group), and 3) 62 patients (12%) who received
more than 3 RBC units (high transfusion requirement group). In a
multivariable Cox proportional hazards model, the following factors were
predictive of a prolonged hospital length of stay: age higher than 65
years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than
40% and RBC transfusion of>3 units.
CONCLUSION: RBC transfusion is an independent risk factor for increased
LOS in patients undergoing cardiac surgery. This finding highlights the
adequacy of a restrictive transfusion therapy in patients undergoing
cardiac surgery.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: http://NCT01021631.