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Embase <1980 to 2016 Week 16>
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<1>
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Accession Number
25607740
Author
Cholette J.M.; Pietropaoli A.P.; Henrichs K.F.; Alfieris G.M.; Powers
K.S.; Phipps R.; Spinelli S.L.; Swartz M.; Gensini F.; Daugherty L.E.;
Nazarian E.; Rubenstein J.S.; Sweeney D.; Eaton M.; Blumberg N.
Institution
(Cholette, Pietropaoli, Henrichs, Alfieris, Powers, Phipps, Spinelli,
Swartz, Gensini, Daugherty, Nazarian, Rubenstein, Sweeney, Eaton,
Blumberg) 1Department of Pediatrics, University of Rochester, Rochester,
NY. 2Department of Medicine, University of Rochester, Rochester, NY.
3Department of Pathology and Laboratory Medicine, University of Rochester,
Rochester, NY. 4Congenital Cardiac Surgery, University of Rochester,
Rochester, NY. 5Department of Environmental Medicine, University of
Rochester, Rochester, NY. 6Department of Anesthesiology, University of
Rochester, Rochester, NY
Title
Longer RBC storage duration is associated with increased postoperative
infections in pediatric cardiac surgery.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 16 (3) (pp 227-235), 2015. Date of Publication: 01 Mar
2015.
Abstract
OBJECTIVES: Infants and children undergoing open heart surgery routinely
require multiple RBC transfusions. Children receiving greater numbers of
RBC transfusions have increased postoperative complications and mortality.
Longer RBC storage age is also associated with increased morbidity and
mortality in critically ill children. Whether the association of increased
transfusions and worse outcomes can be ameliorated by use of fresh RBCs in
pediatric cardiac surgery for congenital heart disease is unknown.
INTERVENTIONS: One hundred and twenty-eight consecutively transfused
children undergoing repair or palliation of congenital heart disease with
cardiopulmonary bypass who were participating in a randomized trial of
washed versus standard RBC transfusions were evaluated for an association
of RBC storage age and clinical outcomes. To avoid confounding with dose
of transfusions and timing of infection versus timing of transfusion, a
subgroup analysis of patients only transfused 1-2 units on the day of
surgery was performed.
MEASUREMENTS AND MAIN RESULTS: Mortality was low (4.9%) with no
association between RBC storage duration and survival. The postoperative
infection rate was significantly higher in children receiving the oldest
blood (25-38 d) compared with those receiving the freshest RBCs (7-15 d)
(34% vs 7%; p = 0.004). Subgroup analysis of subjects receiving only 1-2
RBC transfusions on the day of surgery (n = 74) also demonstrates a
greater prevalence of infections in subjects receiving the oldest RBC
units (0/33 [0%] with 7- to 15-day storage; 1/21 [5%] with 16- to 24-day
storage; and 4/20 [20%] with 25- to 38-day storage; p = 0.01). In
multivariate analysis, RBC storage age and corticosteroid administration
were the only predictors of postoperative infection. Washing the oldest
RBCs (> 27 d) was associated with a higher infection rate and increased
morbidity compared with unwashed RBCs.
DISCUSSION: Longer RBC storage duration was associated with increased
postoperative nosocomial infections. This association may be secondary in
part, to the large doses of stored RBCs transfused, from single-donor
units. Washing the oldest RBCs was associated with increased morbidity,
possibly from increased destruction of older, more fragile erythrocytes
incurred by washing procedures. Additional studies examining the effect of
RBC storage age on postoperative infection rate in pediatric cardiac
surgery are warranted.
<2>
Accession Number
24686003
Author
Benedetto U.; Raja S.G.; Albanese A.; Amrani M.; Biondi-Zoccai G.; Frati
G.
Institution
(Benedetto) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Raja) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Albanese) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Amrani) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Frati) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Rome, Italy Department of AngioCardio
Neurology, IRCCS NeuroMed, Pozzilli, Italy
Title
Searching for the second best graft for coronary artery bypass surgery: a
network meta-analysis of randomized controlled trials+.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp 59-65), 2015.
Date of Publication: 01 Jan 2015.
Abstract
OBJECTIVES: There is a lack of unequivocal evidence basis for selecting
the best second conduit in coronary artery bypass grafting (CABG). We thus
aimed to perform head-to-head relative effect estimate on angiographic
outcomes for second conduits, including the right internal mammary artery
(RIMA), radial artery (RA), right gastroepiploic artery (RGEA) and
saphenous vein graft (SVG) by means of network meta-analysis of randomized
controlled trials (RCTs).
METHODS: Databases were searched for RCTs comparing angiographic outcomes
(>4 weeks) of second conduits in CABG. Odds ratios (95% confidence
intervals) were computed with Markov Chain Monte Carlo simulation.
RESULTS: A total of nine RCTs were identified, including 2780 patients and
1620 angiographic results available for analysis to compare RIMA (n=145)
versus RA (n=871) versus RGEA (n=92) versus SVG (n=845). The mean time to
angiographic follow-up ranged from 1 to 7.7 years. An SVG was
significantly associated with a 4-fold (1.67-16.00) and 3-fold
(0.78-22.20) increased risk of late (>4 years) functional graft occlusion
when compared with the RIMA and RA, respectively. A RIMA was associated
with a non-significant 27% absolute risk reduction for functional graft
occlusion when compared with the RA.
CONCLUSIONS: The present network meta-analysis consistently demonstrated
an angiographic superiority of RIMA and RA over SVG. The RIMA is expected
to achieve a better patency rate than the RA, but further studies are
needed.
<3>
Accession Number
25273886
Author
Kodali S.; Pibarot P.; Douglas P.S.; Williams M.; Xu K.; Thourani V.;
Rihal C.S.; Zajarias A.; Doshi D.; Davidson M.; Tuzcu E.M.; Stewart W.;
Weissman N.J.; Svensson L.; Greason K.; Maniar H.; Mack M.; Anwaruddin S.;
Leon M.B.; Hahn R.T.
Institution
(Kodali) Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
sk2427@columbia.edu
(Pibarot) Laval University, Quebec, QC, USA
(Douglas) Duke Clinical Research Institute, Durham, NC, USA
(Williams) Herbert and Sandi Feinberg Interventional Cardiology, Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
(Xu) Cardiovascular Research Foundation, New York, NY, USA
(Thourani) Emory University School of Medicine, Atlanta, GA, USA
(Rihal) Mayo Clinic, Rochester, MN, USA
(Zajarias) Washington University School of Medicine, Saint Louis, MO, USA
(Doshi) Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
(Davidson) Brigham and Women's Hospital, Boston, MA, USA
(Tuzcu) Cleveland Clinic, Cleveland, OH, USA
(Stewart) Cleveland Clinic, Cleveland, OH, USA
(Weissman) Medstar Health Research Institute, Washington, DC, USA
(Svensson) Cleveland Clinic, Cleveland, OH, USA
(Greason) Mayo Clinic, Rochester, MN, USA
(Maniar) Washington University School of Medicine, Saint Louis, MO, USA
(Mack) Baylor Healthcare System, Plano, TX, USA
(Anwaruddin) Hospital of the University of Pennsylvania, Philadelphia, PA,
USA
(Leon) Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
(Hahn) Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
Title
Paravalvular regurgitation after transcatheter aortic valve replacement
with the Edwards sapien valve in the PARTNER trial: characterizing
patients and impact on outcomes.
Source
European heart journal. 36 (7) (pp 449-456), 2015. Date of Publication: 14
Feb 2015.
Abstract
AIM: The impact of paravalvular regurgitation (PVR) following
transcatheter aortic valve replacement (TAVR) remains uncertain. In this
analysis, we sought to evaluate the impact of varying degrees of PVR on
both mortality and changes in ventricular geometry and function.
METHODS AND RESULTS: Clinical and echocardiographic outcomes of patients
who underwent TAVR from the randomized cohorts and continued access
registries in the PARTNER trial were analysed after stratifying by
severity of post-implant PVR, which was graded as none/trace in 52.9% (n =
1288), mild in 38.0% (n = 925), and moderate/severe in 9.1% (n = 221).
There were significant differences in baseline clinical and
echocardiographic characteristics. After TAVR, all the patients
demonstrated increase in left ventricular (LV) function and reduction in
the LV mass index, although the magnitude of mass regression was lower in
the moderate/severe PVR group. The 30-day mortality (3.1 vs. 3.4 vs. 4.5%,
P = 0.56) and stroke (3.4 vs. 3.7 vs. 2.3%, P = 0.59) were similar in all
groups (none/trace, mild, and moderate/severe). At 1 year, there was
increased all-cause mortality (15.9 vs. 22.2 vs. 35.1%, P < 0.0001),
cardiac mortality (6.1 vs. 7.4% vs. 16.3%, P < 0.0001) and
re-hospitalization (14.4 vs. 23.0 vs. 31.3%, P < 0.0001) with worsening
PVR. A multivariable analysis indicated that the presence of
moderate/severe PVR (HR: 2.18, 95% CI: 1.57-3.02, P < 0.0001) or mild PVR
(HR: 1.37, 95% CI: 1.14-1.90, P = 0.012) was associated with higher late
mortality.
CONCLUSION: Differences in baseline characteristics in patients with
increasing severities of PVR may increase the risk of this complication.
Despite these differences, multivariable analysis demonstrated that both
mild and moderate/severe PVR predicted higher 1-year mortality.
<4>
Accession Number
25312529
Author
Martucci N.; Tracey M.; La Rocca A.; La Manna C.; De Luca G.; Rocco G.
Institution
(Martucci) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Tracey) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Rocca) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(La Manna) Division of Thoracic Surgery, Department of Thoracic Surgery
and Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(De Luca) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy
(Rocco) Division of Thoracic Surgery, Department of Thoracic Surgery and
Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS,
Naples, Italy g.rocco@istitutotumori.na.it
Title
A pilot prospective randomized, controlled trial comparing LigaSureTM
tissue fusion technology with the ForceTriadTM energy platform to the
electrosurgical pencil on rates of atrial fibrillation after pulmonary
lobectomy and mediastinal lymphadenectomy.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp e13-e18),
2015. Date of Publication: 01 Jan 2015.
Abstract
CONCLUSIONS: The incidence of atrial fibrillation with LS tissue fusion
technology with the ForceTriadTM energy platform is not reduced as
compared with conventional electrosurgical pencil. However, the use of LS
during mediastinal nodal dissection is associated to shorter duration of
lymphadenectomy and duration of chest tube drainage.
OBJECTIVES: The use of bipolar sealing devices during pulmonary resection
is particularly useful in thoracoscopic surgery. Theoretically, a bipolar
device, which contains the current in a smaller area and completes the
current cycle only through the tissue between the electrodes, may reduce
the proportion of patients experiencing atrial fibrillation compared with
monopolar devices such as the electrosurgical pencil using which the
current completes the cycle through the patient. We investigated the
impact of the LigaSureTM (LS) tissue fusion technology with the
ForceTriadTM energy platform device on the incidence of postoperative
atrial fibrillation and on the reduction of postoperative chest tube
output and hospital length of stay after open pulmonary lobectomy.
METHODS: A pilot prospective randomized, controlled trial comparing LS
tissue fusion technology with the ForceTriadTM energy platform to the
conventional electrosurgical pencil. Overall, 146 patients with resectable
lung cancer were recruited at the Division of Thoracic Surgery of the
Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, between January 2011
and July 2013. Of these, 119 candidates to open lobectomy for
non-small-cell lung cancer were randomized to either LS tissue fusion
technology with the ForceTriadTM energy platform (LS: 57 patients) or
standard haemostatic procedure (standard treatment, ST: 62 patients) for
hilar and mediastinal nodal dissection. The primary end-point was to
compare the incidence of postoperative atrial fibrillation of LS compared
with ST. The secondary end-point was to compare the efficacy of LS
compared with ST in terms of total chest tube drainage, daily chest tube
drainage and chest tube duration.
RESULTS: There was no statistically significant difference between LS and
ST in terms of postoperative atrial fibrillation (P=0.31). However, LS was
associated to significant reduction of duration of both mediastinal nodal
dissection (P=0.017) and the cumulative chest tube drainage (P=0.025).
<5>
Accession Number
25123674
Author
Sharma V.; Deo S.V.; Altarabsheh S.E.; Cho Y.H.; Erwin P.J.; Park S.J.
Institution
(Sharma) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
USA ctvsteam@hotmail.com
(Deo) Adventist Wockhardt Heart Institute, Athawalines, Surat, India
Division of Cardiovascular Surgery, University Hospitals, Case Western
Reserve University, Cleveland, OH, USA
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Cho) Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul, South Korea
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
(Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, USA
Title
Comparison of the early haemodynamics of stented pericardial and porcine
aortic valves.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp 4-10), 2015.
Date of Publication: 01 Jan 2015.
Abstract
Data comparing the haemodynamic performance of stented pericardial and
porcine aortic valves are conflicting. Hence, we performed a systematic
review and meta-analysis comparing the early haemodynamic parameters of
stented pericardial and porcine valves in patients undergoing isolated
aortic valve replacement. Medline, EMBASE and Web of Science were queried
for English language original publications from 2000 to 2013. Studies
comparing porcine (PoV) and pericardial (PeV) with regard to their
haemodynamic parameters were included in this review. Continuous data were
pooled using the mean difference (MD) or the standardized mean difference
(SMD). A random-effect inverse weighted analysis was conducted; a
P-value<0.05 is considered statistically significant. Results are
presented with 95% confidence intervals. Thirteen studies (1265 PeV
patients and 871 PoV patients) were included in this analysis. The pooled
transvalvular mean gradient was lower for PeV [MD -4.6 (-6.45 to -2.77)
mmHg; P<0.01]. Limiting this analysis to small valves (19 and 21 mm; eight
studies; 714 patients) revealed that the PeV gradients were significantly
lower [MD -4.5 (-5.7 to -3.2); P=0.001]. The corresponding effective
orifice area of PeV was significantly larger than PoV [SMD 0.42
(0.15-0.69); P<0.01]. A sensitivity analysis comprising only randomized
controlled trials did not significantly alter results. When compared with
porcine valves, stented pericardial aortic valves have lower mean
transvalvular gradients early after implant. Even pericardial valves in
smaller sizes (19 and 21 mm) have a better haemodynamic profile when
compared with their counterparts.
<6>
Accession Number
25928276
Author
Zhu P.; Zhou P.; Sun Y.; Guo Y.; Mai M.; Zheng S.
Institution
(Zhu) Department of Cardiovascular Surgery, Southern Medical University,
Guangzhou, People's Republic of China. doctff@gmail.com
(Zhu) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China. doctff@gmail.com
(Zhu) Department of Cardiovascular Surgery, Xiamen Heart Center, Xiamen,
People's Republic of China. doctff@gmail.com
(Zhou) Department of Cardiovascular Surgery, Southern Medical University,
Guangzhou, People's Republic of China. alienchoulinger@126.com
(Zhou) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China. alienchoulinger@126.com
(Sun) Department of Cardiovascular Surgery, Southern Medical University,
Guangzhou, People's Republic of China.
(Sun) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China.
(Sun) Department of Cardiovascular Surgery, Xiamen Heart Center, Xiamen,
People's Republic of China.
(Guo) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China. 847287951@qq.com
(Mai) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China. 770592050@qq.com
(Zheng) Department of Cardiovascular Surgery, Guangdong General Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of
China.
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
for multivessel coronary artery disease: systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 10 (pp 63), 2015. Date of Publication:
2015.
Abstract
BACKGROUND: The concept of hybrid coronary revascularization (HCR)
combines the left internal mammary artery (LIMA)-left anterior descending
(LAD) graft and percutaneous coronary intervention (PCI) to non-LAD
vessels. Multiple comparative studies have evaluated the safety and
feasibility of HCR and coronary artery bypass grafting (CABG) for
multivessel coronary artery disease (MCAD). However, the sample size of
each study was small, and evidences based on single-institutional
experience. The purpose of this meta-analysis was to compare the
short-term outcomes of HCR with those of CABG for MCAD.
METHOD: PubMed, EMBASE and Cochrane Library databases, as well as
conference proceedings, were searched for eligible studies published up to
March 2014. We calculated summary odds ratios (OR) for primary endpoints
(death, stroke; myocardial infarction (MI); target vessel
revascularization (TVR); major adverse cardiac or cerebrovascular events
(MACCEs)) and secondary endpoints (atrial fibrillation (AF); renal
failure; length of stay in the intensive care unit (LoS in ICU); length of
stay in hospital (LoS in hospital); red blood cell (RBC) transfusion).
Data from 6176 participants were derived from ten cohort studies.
RESULTS: HCR was non-inferior to CABG in terms of MACCEs during
hospitalization (odds ratio (OR), 0.68, 95% confidence interval (CI),
0.34-1.33)and at one-year follow-up(0.32, 0.05-1.89) , and no significant
difference was found between HCR and CABG groups in in-hospital and
one-year follow-up outcomes of death, MI, stroke, the prevalence of AF and
renal failure, whereas HCR was associated with a lower requirement of RBC
transfusion and shorter LoS in ICU and LoS in hospital than CABG (weighted
mean difference (WMD) -1.25, 95% CI, -1.62 to -0.88; -17.47, -31.01 to
-3.93; -1.77, -3.07 to -0.46; respectively).
CONCLUSION: Our meta-analysis indicates that HCR is feasible, safe and
effective for the treatment of MCAD, with similar in-hospital and one-year
follow-up outcome, significantly lower requirement of RBC transfusion, and
faster recovery compared with CABG.
<7>
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Accession Number
26237622
Author
Klinger R.Y.; Thunberg C.A.; White W.D.; Fontes M.; Waldron N.H.; Piccini
J.P.; Hughes G.C.; Podgoreanu M.V.; Stafford-Smith M.; Newman M.F.; Mathew
J.P.
Institution
(Klinger, Thunberg, White, Fontes, Waldron, Piccini, Hughes, Podgoreanu,
Stafford-Smith, Newman, Mathew) From the Departments of *Anesthesiology,
+Medicine-Cardiology, and ++Surgery, Duke University Medical Center,
Durham, North Carolina
Title
Intraoperative Magnesium Administration Does Not Reduce Postoperative
Atrial Fibrillation After Cardiac Surgery.
Source
Anesthesia and analgesia. 121 (4) (pp 861-867), 2015. Date of Publication:
01 Oct 2015.
Abstract
BACKGROUND: Hypomagnesemia has been associated with an increased risk of
postoperative atrial fibrillation (POAF). Although previous studies have
suggested a beneficial effect of magnesium (Mg) therapy, almost all of
these are limited by small sample size and relatively low Mg dose. We
hypothesized that high-dose Mg decreases the occurrence of new-onset POAF,
and we tested this hypothesis by using data from a prospective trial that
assessed the effect of Mg on cognitive outcomes in patients undergoing
cardiac surgery.
METHODS: A total of 389 patients undergoing cardiac surgery were enrolled
in this double-blind, placebo-controlled trial. Subjects were randomized
to receive Mg as a 50-mg/kg bolus immediately after induction of
anesthesia followed by another 50 mg/kg as an infusion given over 3 hours
(total dose, 100 mg/kg) or placebo. We tested the effect of Mg therapy on
POAF with logistic regression, adjusting for the risk of atrial
fibrillation (AF) by using the Multicenter Study of Perioperative Ischemia
risk index for Atrial Fibrillation after Cardiac Surgery.
RESULTS: Among the 363 patients analyzed, after we excluded patients with
chronic or acute preoperative AF (placebo: n = 177; Mg: n = 186), the
incidence of new-onset POAF was 42.5% (95% confidence interval [CI],
35%-50%) in the Mg group compared with 37.9% (95% CI, 31%-45%) in the
placebo group (P = 0.40). The 95% CI for this absolute risk difference of
4.6% is -5.5% to 14.7%. The time to onset of POAF also was identical
between the groups, and no significant effect of Mg was found in logistic
regression analysis after we adjusted for AF risk (odds ratio, 1.09; 95%
CI, 0.69-1.72; P = 0.73).
CONCLUSIONS: High-dose intraoperative Mg therapy did not decrease the
incidence of new-onset POAF after cardiac surgery.
<8>
Accession Number
25798568
Author
Obadia J.-F.; Armoiry X.; Iung B.; Lefevre T.; Mewton N.; Messika-Zeitoun
D.; Cormier B.; Berthiller J.; Maucort-Boulch D.; Boutitie F.; Vaz B.;
Trochu J.-N.; Vahanian A.
Institution
(Obadia, Armoiry, Iung, Lefevre, Mewton, Messika-Zeitoun, Cormier,
Berthiller, Maucort-Boulch, Boutitie, Vaz, Trochu, Vahanian) Service de
Chirurgie Cardiothoracique et Transplantation, Hopital Cardiothoracique
Louis Pradel, Lyon-Bron, France
Title
The MITRA-FR study: design and rationale of a randomised study of
percutaneous mitral valve repair compared with optimal medical management
alone for severe secondary mitral regurgitation.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
10 (11) (pp 1354-1360), 2015. Date of Publication: 01 Mar 2015.
Abstract
AIMS: Percutaneous mitral valve repair (pMVR) is a new therapeutic option
for mitral valve regurgitation. Positive preliminary results in
non-randomised studies have been published supporting the use of the
MitraClip system in patients with secondary mitral regurgitation (MR) and
poor left ventricular (LV) function contraindicated to surgery. The aim of
the MITRA-FR study is to provide a higher level of evidence for the
efficacy of the MitraClip device in this setting.
METHODS AND RESULTS: The MITRA-FR study is a national, multicentre,
investigator-initiated, open-label, randomised trial to evaluate the
benefits and safety of pMVR using the MitraClip system plus optimal
medical therapy (OMT) compared with OMT alone (control) in patients with
severe symptomatic secondary MR contraindicated to surgical repair. The
trial aims to enrol 144 MitraClip-treated subjects and 144 control (OMT
alone) patients. The primary endpoint is a composite of all-cause
mortality and unplanned hospitalisations for heart failure at 12 months
after randomisation
CONCLUSIONS: MITRA-FR is a randomised controlled national trial designed
to evaluate the performance of pMVR in comparison to OMT in patients with
severe symptomatic secondary MR contraindicated to cardiac surgery.
<9>
Accession Number
25598216
Author
Deo S.V.; Altarabsheh S.E.; Shah I.K.; Cho Y.H.; McGraw M.; Sarayyepoglu
B.; Medalion B.; Markowitz A.H.; Park S.J.
Institution
(Deo) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA.
Electronic address: svd14@case.edu
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Shah) Department of Surgery, University of Minnesota,
Minneapolis-St.Paul, MN, USA
(Cho) Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan
School of Medicine, Samsung Hospital, Seoul, South Korea
(McGraw) Health Sciences Library, Case Western Reserve University,
Cleveland, OH, USA
(Sarayyepoglu) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Medalion) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Markowitz) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
(Park) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
Title
Are two really always better than one? Results, concerns and controversies
in the use of bilateral internal thoracic arteries for coronary artery
bypass grafting in the elderly: a systematic review and meta-analysis.
Source
International journal of surgery (London, England). 16 (Pt B) (pp
163-170), 2015. Date of Publication: 01 Apr 2015.
Abstract
INTRODUCTION: Bilateral internal thoracic artery grafting appears to be
the preferred method to achieve durable long-term coronary artery
revascularization. However, data reporting the benefit of this technique
in the elderly is very conflicting.
METHOD: We performed a systematic review of available literature (till
November 2014) using multiple databases to identify studies comparing
clinical events in patients undergoing coronary artery bypass grafting
using either a single or double internal thoracic artery in the elderly.
While early mortality was the primary end-point of inclusion, other
adverse events compared were sternal wound infection (deep and
superficial), stroke and peri-operative myocardial infarction. Individual
and pooled odd's ratios were calculated using the Mantel-Haenzel method
(random effect model); sensitivity analysis was performed. Results are
presented using 95% confidence intervals.
RESULT: Nine retrospective studies (4479 BITA, 7733 LITA patients)
fulfilled search criteria. Deep sternal wound infection was significantly
higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early
mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p =
0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p
= 0.1) were comparable in both cohorts. Long-term survival favored the
BITA cohort in two propensity matched studies.
CONCLUSION: The incidence of deep sternal wound infection may be
significantly higher after the harvest of both internal thoracic arteries
in the elderly. While other post-operative adverse events are comparable,
data regarding the long-term survival advantage in this cohort is
conflicting. Hence, the use of both internal thoracic arteries in this age
group needs to be invidualized.
<10>
Accession Number
25448641
Author
Sa M.P.; Cavalcanti P.E.; de Andrade Costa Santos H.J.; Soares A.F.;
Albuquerque Miranda R.G.; Araujo M.L.; Lima R.C.
Institution
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br
(Cavalcanti) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in
Health Sciences of Faculty of Medical Sciences and Biological Sciences
Institute (FCM/ICB), Recife, Brazil
(de Andrade Costa Santos) Division of Cardiovascular Surgery of Pronto
Socorro Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University
of Pernambuco - UPE, Recife, Brazil
(Soares) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil
(Albuquerque Miranda) Division of Cardiovascular Surgery of Pronto Socorro
Cardiologico de Pernambuco - PROCAPE, Recife, Brazil; University of
Pernambuco - UPE, Recife, Brazil
(Araujo) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil
(Lima) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico
de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE,
Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB),
Recife, Brazil
Title
Skeletonized versus pedicled bilateral internal mammary artery grafting:
outcomes and concerns analyzed through a meta-analytical approach.
Source
International journal of surgery (London, England). 16 (Pt B) (pp
146-152), 2015. Date of Publication: 01 Apr 2015.
Abstract
BACKGROUND: It is suggested that the internal thoracic artery (ITA)
harvesting technique influences the incidence of sternal wound infection
(SWI) after coronary artery bypass graft (CABG) surgery when both right
and left ITAs are used. We conducted a meta-analysis to determine whether
there is any difference between skeletonized versus pedicled bilateral ITA
in terms of SWI after CABG.
METHODS: We performed a systematic-review using MEDLINE, EMBASE,
CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of
relevant articles to search for studies that compared the incidence of SWI
after CABG between skeletonized versus pedicled bilateral ITA until May
2014. The principal summary measures were odds ratio (OR) with 95%
Confidence Interval (CI) and P values (statistically significant when
<0.05). The ORs were combined across studies using weighted
DerSimonian-Laird random effects model. Meta-analysis, sensitivity
analysis and meta-regression were carried out by using the software
Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New
Jersey).
RESULTS: Eight studies involving 2633 patients (1698 skeletonized; 935
pedicled) met the eligibility criteria. There was no evidence for
important heterogeneity of the effects among the studies. The overall OR
(95% CI) of SWI showed statistical significant difference in favor to
skeletonized ITA (random effect model: OR 0.327; 95% CI 0.217-0.492; P <
0.001). In sensitivity analysis, the difference in favor to skeletonized
ITA was observed mainly in the presence of diabetes. In meta-regression,
we observed no modulation of the effects.
CONCLUSION: When both ITAs are used, the skeletonized technique appears to
reduce the incidence of SWI after CABG in comparison to the pedicled
technique.
<11>
Accession Number
26349842
Author
Fowler A.J.; Ahmad T.; Phull M.K.; Allard S.; Gillies M.A.; Pearse R.M.
Institution
(Fowler) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
(Ahmad) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
(Phull) Departments of Anaesthesia, Royal London Hospital, Barts Health
NHS Trust, London, UK
(Allard) Departments of Haematology, Royal London Hospital, Barts Health
NHS Trust, London, UK
(Gillies) Department of Anaesthesia, Critical Care and Pain Medicine,
Royal Infirmary of Edinburgh, Edinburgh, UK
(Pearse) Barts and the London School of Medicine and Dentistry, Queen Mary
University of London, London, UK
Title
Meta-analysis of the association between preoperative anaemia and
mortality after surgery.
Source
The British journal of surgery. 102 (11) (pp 1314-1324), 2015. Date of
Publication: 01 Oct 2015.
Abstract
RESULTS: From 8973 records, 24 eligible studies including 949445 patients
were identified. Some 371594 patients (39.1 per cent) were anaemic.
Anaemia was associated with increased mortality (OR 2.90, 2.30 to 3.68;
I(2) =97 per cent; P<0.001), acute kidney injury (OR 3.75, 2.95 to 4.76;
I(2) =60 per cent; P<0.001) and infection (OR 1.93, 1.17 to 3.18; I(2) =99
per cent; P=0.01). Among cardiac surgical patients, anaemia was associated
with stroke (OR 1.28, 1.06 to 1.55; I(2) =0 per cent; P=0.009) but not
myocardial infarction (OR 1.11, 0.68 to 1.82; I(2) =13 per cent; P=0.67).
Anaemia was associated with an increased incidence of red cell transfusion
(OR 5.04, 4.12 to 6.17; I(2) =96 per cent; P<0.001). Similar findings were
observed in the cardiac and non-cardiac subgroups.
CONCLUSION: Preoperative anaemia is associated with poor outcomes after
surgery, although heterogeneity between studies was significant. It
remains unclear whether anaemia is an independent risk factor for poor
outcome or simply a marker of underlying chronic disease. However, red
cell transfusion is much more frequent amongst anaemic patients.
BACKGROUND: Numerous published studies have explored associations between
anaemia and adverse outcomes after surgery. However, there are no evidence
syntheses describing the impact of preoperative anaemia on postoperative
outcomes.
METHODS: A systematic review and meta-analysis of observational studies
exploring associations between preoperative anaemia and postoperative
outcomes was performed. Studies investigating trauma, burns, transplant,
paediatric and obstetric populations were excluded. The primary outcome
was 30-day or in-hospital mortality. Secondary outcomes were acute kidney
injury, stroke and myocardial infarction. Predefined analyses were
performed for the cardiac and non-cardiac surgery subgroups. A post hoc
analysis was undertaken to evaluate the relationship between anaemia and
infection. Data are presented as odds ratios (ORs) with 95 per cent c.i.
<12>
Accession Number
26551304
Author
Rodes-Cabau J.; Horlick E.; Ibrahim R.; Cheema A.N.; Labinaz M.; Nadeem
N.; Osten M.; Cote M.; Marsal J.R.; Rivest D.; Marrero A.; Houde C.
Institution
(Rodes-Cabau) Department of Cardiology, Quebec Heart and Lung Institute,
Quebec City, Quebec, Canada
(Horlick) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Ibrahim) Department of Cardiology, Montreal Heart Institute, Montreal,
Quebec, Canada
(Cheema) Department of Cardiology, St. Michael's Hospital, Toronto,
Ontario, Canada
(Labinaz) Department of Cardiology, Ottawa Heart Institute, Ottawa,
Ontario, Canada
(Nadeem) Department of Cardiology, Queen Elizabeth II Health Sciences
Centre, Halifax, Nova Scotia, Canada
(Osten) Department of Cardiology, Toronto General Hospital, Toronto,
Ontario, Canada
(Cote) Department of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Marsal) Epidemiology Unit of the Cardiology Department, Vall d'Hebron
Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
(Rivest) Department of Neurology, Hotel Dieu de Levis, Quebec City,
Quebec, Canada
(Marrero) Department of Neurology, Centre Hospitalier Universitaire
Georges. L Dumont, Moncton, New Brunswick, Canada
(Houde) Department of Pediatric Cardiology, Centre Hospitalier
Universitaire de Quebec, Quebec City, Quebec, Canada
Title
Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches
After Transcatheter Atrial Septal Defect Closure: The CANOA Randomized
Clinical Trial.
Source
JAMA. 314 (20) (pp 2147-2154), 2015. Date of Publication: 24 Nov 2015.
Abstract
IMPORTANCE: The occurrence of new-onset migraine attacks is a complication
of transcatheter atrial septal defect (ASD) closure. It has been suggested
that clopidogrel may reduce migraine attacks after ASD closure.
OBJECTIVE: To assess the efficacy of clopidogrel, used in addition to
taking aspirin, for the prevention of migraine attacks following ASD
closure.
DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind clinical trial
performed in 6 university hospitals in Canada. Participants were 171
patients with an indication for ASD closure and no history of migraine.
INTERVENTIONS: Patients were randomized (1:1) to receive dual antiplatelet
therapy (aspirin+clopidogrel [the clopidogrel group], n=84) vs single
antiplatelet therapy (aspirin+placebo [the placebo group], n=87) for 3
months following transcatheter ASD closure. The first patient was enrolled
in December 2008, and the last follow-up was completed in February 2015.
MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was the monthly
number of migraine days within the 3 months following ASD closure in the
entire study population. The incidence and severity of new-onset migraine
attacks, as evaluated by the Migraine Disability Assessment questionnaire,
were prespecified secondary end points. A zero-inflated Poisson regression
model was used for data analysis.
RESULTS: The mean (SD) age of the participants was 49 (15) years and 62%
(106) were women. Patients in the clopidogrel group had a reduced mean
(SD) number of monthly migraine days within the 3 months following the
procedure (0.4 [95% CI, 0.07 to 0.69] days) vs the placebo group (1.4 [95%
CI, 0.54 to 2.26] days; difference, -1.02 days [95% CI, -1.94 to -0.10
days]; incident risk ratio [IRR], 0.61 [95% CI, 0.41 to 0.91]; P=.04) and
a lower incidence of migraine attacks following ASD closure (9.5% for the
clopidogrel group vs 21.8% for the placebo group; difference, -12.3% [95%
CI, -23% to -1.6%]; odds ratio [OR], 0.38 [95% CI, 0.15 to 0.89]; P=.03).
Among patients with migraines, those in the clopidogrel group had
less-severe migraine attacks (zero patients with moderately or severely
disabling migraine attacks vs 37% [7 patients] in the placebo group;
difference, -36.8% [95% CI, -58.5% to -15.2%]; P=.046). There were no
between-group differences in the rate of patients with at least 1 adverse
event (16.7% [14 patients] in the clopidogrel group vs 21.8% [19 patients]
in the placebo group; difference, -5.2% [95% CI, -17% to 6.6%]; P=.44).
CONCLUSIONS AND RELEVANCE: Among patients who underwent transcatheter ASD
closure, the use of clopidogrel and aspirin, compared with aspirin alone,
resulted in a lower monthly frequency of migraine attacks over 3 months.
Further studies are needed to assess generalizability and durability of
this effect.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00799045.
<13>
Accession Number
26436963
Author
Makkar R.R.; Fontana G.; Jilaihawi H.; Chakravarty T.; Kofoed K.F.; de
Backer O.; Asch F.M.; Ruiz C.E.; Olsen N.T.; Trento A.; Friedman J.;
Berman D.; Cheng W.; Kashif M.; Jelnin V.; Kliger C.A.; Guo H.; Pichard
A.D.; Weissman N.J.; Kapadia S.; Manasse E.; Bhatt D.L.; Leon M.B.;
Sondergaard L.
Institution
(Makkar, Fontana, Jilaihawi, Chakravarty, Kofoed, de Backer, Asch, Ruiz,
Olsen, Trento, Friedman, Berman, Cheng, Kashif, Jelnin, Kliger, Guo,
Pichard, Weissman, Kapadia, Manasse, Bhatt, Leon, Sondergaard) From
Cedars-Sinai Heart Institute (R.R.M., H.J., T.C., A.T., J.F., D.B., W.C.,
M.K.) and Cedars-Sinai Medical Center (G.F.) - both in Los Angeles;
Rigshospitalet, University of Copenhagen, Copenhagen (K.F.K., O.B.,
N.T.O., L.S.); MedStar Health Research Institute, Washington, DC (F.M.A.,
A.D.P., N.J.W.); Hackensack University Medical Center and Joseph M.
Sanzari Children's Hospital, Hackensack, NJ (C.E.R., V.J.); Lenox Hill
Heart and Vascular Institute of New York (C.A.K.) and Columbia University
Medical Center-New York Presbyterian Hospital (M.B.L.) - both in New York;
St. Jude Medical, Plymouth, MN (H.G., E.M.); Cleveland Clinic, Cleveland
(S.K.); and Brigham and Women's Hospital Heart and Vascular Center and
Harvard Medical School - both in Boston (D.L.B.)
Title
Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves.
Source
The New England journal of medicine. 373 (21) (pp 2015-2024), 2015. Date
of Publication: 19 Nov 2015.
Abstract
METHODS: We analyzed data obtained from 55 patients in a clinical trial of
TAVR and from two single-center registries that included 132 patients who
were undergoing either TAVR or surgical aortic-valve bioprosthesis
implantation. We obtained four-dimensional, volume-rendered CT scans along
with data on anticoagulation and clinical outcomes (including strokes and
transient ischemic attacks [TIAs]).
BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on
computed tomography (CT) in a patient who had a stroke after transcatheter
aortic-valve replacement (TAVR) during an ongoing clinical trial. This
finding raised a concern about possible subclinical leaflet thrombosis and
prompted further investigation.
RESULTS: Reduced leaflet motion was noted on CT in 22 of 55 patients (40%)
in the clinical trial and in 17 of 132 patients (13%) in the two
registries. Reduced leaflet motion was detected among patients with
multiple bioprosthesis types, including transcatheter and surgical
bioprostheses. Therapeutic anticoagulation with warfarin, as compared with
dual antiplatelet therapy, was associated with a decreased incidence of
reduced leaflet motion (0% and 55%, respectively, P=0.01 in the clinical
trial; and 0% and 29%, respectively, P=0.04 in the pooled registries). In
patients who were reevaluated with follow-up CT, restoration of leaflet
motion was noted in all 11 patients who were receiving anticoagulation and
in 1 of 10 patients who were not receiving anticoagulation (P<0.001).
There was no significant difference in the incidence of stroke or TIA
between patients with reduced leaflet motion and those with normal leaflet
motion in the clinical trial (2 of 22 patients and 0 of 33 patients,
respectively; P=0.16), although in the pooled registries, a significant
difference was detected (3 of 17 patients and 1 of 115 patients,
respectively; P=0.007).
CONCLUSIONS: Reduced aortic-valve leaflet motion was shown in patients
with bioprosthetic aortic valves. The condition resolved with therapeutic
anticoagulation. The effect of this finding on clinical outcomes including
stroke needs further investigation. (Funded by St. Jude Medical and
Cedars-Sinai Heart Institute; Portico-IDE ClinicalTrials.gov number,
NCT02000115; SAVORY registry, NCT02426307; and RESOLVE registry,
NCT02318342.).
<14>
[Use Link to view the full text]
Accession Number
25992877
Author
Saager L.; Duncan A.E.; Yared J.-P.; Hesler B.D.; You J.; Deogaonkar A.;
Sessler D.I.; Kurz A.
Institution
(Saager, Duncan, Yared, Hesler, You, Deogaonkar, Sessler, Kurz) From the
Departments of Outcomes Research (L.S., A.E.D., J.-P.Y., B.D.H., J.Y.,
D.I.S., A.K.), Cardiothoracic Anesthesia (A.E.D., J.-P.Y.), Quantitative
Health Sciences (J.Y.), Regional Practice Anesthesiology (A.D.), and
General Anesthesiology (A.K.), Cleveland Clinic, Cleveland, Ohio
Title
Intraoperative tight glucose control using hyperinsulinemic normoglycemia
increases delirium after cardiac surgery.
Source
Anesthesiology. 122 (6) (pp 1214-1223), 2015. Date of Publication: 01 Jun
2015.
Abstract
BACKGROUND: Postoperative delirium is common in patients recovering from
cardiac surgery. Tight glucose control has been shown to reduce mortality
and morbidity. Therefore, the authors sought to determine the effect of
tight intraoperative glucose control using a
hyperinsulinemic-normoglycemic clamp approach on postoperative delirium in
patients undergoing cardiac surgery.
METHODS: The authors enrolled 198 adult patients having cardiac surgery in
this randomized, double-blind, single-center trial. Patients were randomly
assigned to either tight intraoperative glucose control with a
hyperinsulinemic-normoglycemic clamp (target blood glucose, 80 to 110
mg/dl) or standard therapy (conventional insulin administration with blood
glucose target, <150 mg/dl). Delirium was assessed using a comprehensive
delirium battery. The authors considered patients to have experienced
postoperative delirium when Confusion Assessment Method testing was
positive at any assessment. A positive Confusion Assessment Method was
defined by the presence of features 1 (acute onset and fluctuating course)
and 2 (inattention) and either 3 (disorganized thinking) or 4 (altered
consciousness).
RESULTS: Patients randomized to tight glucose control were more likely to
be diagnosed as being delirious than those assigned to routine glucose
control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to
3.37; P = 0.03), after adjusting for preoperative usage of calcium channel
blocker and American Society of Anesthesiologist physical status. Delirium
severity, among patients with delirium, was comparable with each glucose
management strategy.
CONCLUSION: Intraoperative hyperinsulinemic-normoglycemia augments the
risk of delirium after cardiac surgery, but not its severity.
<15>
Accession Number
25963221
Author
Green P.; Arnold S.V.; Cohen D.J.; Kirtane A.J.; Kodali S.K.; Brown D.L.;
Rihal C.S.; Xu K.; Lei Y.; Hawkey M.C.; Kim R.J.; Alu M.C.; Leon M.B.;
Mack M.J.
Institution
(Green) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York. Electronic address: pg2336@columbia.edu
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, Missouri
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, Missouri
(Kirtane) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Kodali) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Brown) Baylor Healthcare System, Plano, Texas
(Rihal) Mayo Clinic, Rochester, Minnesota
(Xu) Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Lei) Saint Luke's Mid America Heart Institute, Kansas City, Missouri
(Hawkey) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Kim) Cardiopulmonary Research Science and Technology Institute (CRSTI),
Plano, Texas
(Alu) Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve
Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Leon) Herbert and Sandi Feinberg Interventional Cardiology and Heart
Valve Center at Columbia University Medical Center/New York-Presbyterian
Hospital, New York, New York; Cardiovascular Research Foundation, New
York, New York
(Mack) Cardiopulmonary Research Science and Technology Institute (CRSTI),
Plano, Texas; Baylor Scott and White Health, Plano, Texas
Title
Relation of frailty to outcomes after transcatheter aortic valve
replacement (from the PARTNER trial).
Source
The American journal of cardiology. 116 (2) (pp 264-269), 2015. Date of
Publication: 15 Jul 2015.
Abstract
Transcatheter aortic valve replacement (TAVR) is an effective treatment
for severe symptomatic aortic stenosis (AS) in patients who are inoperable
or at high risk for surgery. However, the intermediate- to long-term
mortality is high, emphasizing the importance of patient selection. We,
therefore, sought to evaluate the prognostic value of frailty in older
recipients of TAVR, hypothesizing that frail patients would experience a
higher mortality rate and a higher likelihood of poor outcome 1 year after
TAVR. This substudy of the Placement of Aortic Transcatheter Valves trial
was conducted at 3 high-enrolling sites where frailty was assessed
systematically before TAVR. In total, 244 patients received TAVR at the
participating sites. Frailty was assessed using a composite of 4 markers
(serum albumin, dominant handgrip strength, gait speed, and Katz activity
of daily living survey), which were combined into a frailty score. The
cohort was dichotomized at median frailty score. Outcomes measures were
the time to death from any cause for >1 year of follow-up and poor outcome
at 1 year. Poor outcome was defined as (1) death, (2) Kansas City
Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score <60, or (3)
decrease of >10 points in the KCCQ-OS score from baseline to 1 year. At 1
year, the Kaplan-Meier-estimated all-cause mortality rate was 32.7% in the
frail group and 15.9% in the nonfrail group (log-rank p = 0.004). At 1
year, poor outcome occurred in 50.0% of the frail group and 31.5% of the
nonfrail group (p = 0.02). In conclusion, frailty was associated with
increased mortality and a higher rate of poor outcome 1 year after TAVR.
<16>
Accession Number
25962930
Author
Zyblewski S.C.; Nietert P.J.; Graham E.M.; Taylor S.N.; Atz A.M.; Wagner
C.L.
Institution
(Zyblewski) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC. Electronic address:
chois@musc.edu
(Nietert) Department of Public Health Sciences, Medical University of
South Carolina, Charleston, SC
(Graham) Division of Pediatric Cardiology, Department of Pediatrics,
Medical University of South Carolina, Charleston, SC
(Taylor) Division of Neonatology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC
(Atz) Division of Pediatric Cardiology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC
(Wagner) Division of Neonatology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC
Title
Randomized Clinical Trial of Preoperative Feeding to Evaluate Intestinal
Barrier Function in Neonates Requiring Cardiac Surgery.
Source
The Journal of pediatrics. 167 (1) (pp 47-51), 2015. Date of Publication:
01 Jul 2015.
Abstract
OBJECTIVES: To evaluate intestinal barrier function in neonates undergoing
cardiac surgery using lactulose/mannitol (L/M) ratio measurements, and to
determine correlations with early breast milk feeding.
STUDY DESIGN: This was a single-center, prospective, randomized pilot
study of 27 term-born neonates (> 37 weeks gestation) requiring cardiac
surgery who were randomized to 1 of 2 preoperative feeding groups: nil per
os (NPO) or trophic (10 mL/kg/day) breast milk feeds. At 3 time points
(preoperative [preop], postoperative [postop] day 7, and postop day 14),
subjects were administered an oral L/M solution, after which urine L/M
ratios were measured using gas chromatography, with higher ratios
indicative of increased intestinal permeability. Trends over time in the
mean urine L/M ratios for each group were estimated using a general linear
mixed model.
RESULTS: There were no adverse events related to preoperative trophic
feeding. In the NPO group (n = 13), the mean urine L/M ratio was 0.06 at
preop, 0.12 at postop day 7, and 0.17 at postop day 14. In the trophic
breast milk feeds group (n = 14), the mean urine L/M ratio was 0.09 at
preop, 0.19 at postop day 7, and 0.15 at postop day 14. In both groups,
L/M ratios were significantly higher at postop day 7 and postop day 14
compared with preop (P < .05).
CONCLUSION: Neonates have increased intestinal permeability after cardiac
surgery extending to at least postop day 14. This pilot study was not
powered to detect differences in benefit or adverse events comparing the
NPO and trophic breast milk feeds groups. Further studies to identify
mechanisms of intestinal injury and therapeutic interventions are
warranted.
TRIAL REGISTRATION: Registered with ClinicalTrials.gov: NCT01475357.
<17>
Accession Number
26469104
Author
Wypasek E.; Ciesla M.; Suder B.; Janik L; Sadowski J.; Undas A.
Institution
(Wypasek) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
(Ciesla) John Paul II Hospital, Krakow, Poland
(Suder) John Paul II Hospital, Krakow, Poland
(Janik) John Paul II Hospital, Krakow, Poland
(Sadowski) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
(Undas) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
Title
CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients
Within the First 3 Months Following Heart Valve Replacement.
Source
Advances in clinical and experimental medicine : official organ Wroclaw
Medical University. 24 (4) (pp 607-614), 2015. Date of Publication: 01 Jul
2015.
Abstract
BACKGROUND: Warfarin dose requirements are partly determined by common
single nucleotide polymorphisms in VKORC1 and CYP2C9 genes.
OBJECTIVES: The aim of this study was to investigate how the presence of
allelic variants in CYP2C9 affects the stability of anticoagulation in
patients within the first 3 months following elective heart valve
replacement.
MATERIAL AND METHODS: In a case-control study we compared 18 consecutive
carriers of CYP2C9*2 and/or *3 and 25 well-matched patients with the wild
type CYP2C9*1/*1 genotype. The former group was randomly assigned to use
coagulometers or monitor international normalized ratio (INR) in local
outpatient clinics. Subjects receiving drugs potently interfering with
warfarin were ineligible. Anticoagulation with the baseline warfarin
regimens based on pharmacogenetic algorithm was assessed by time in the
therapeutic INR range (TTR) within the first 3 months following
implantation.
RESULTS: Carriers of the CYP2C9*2 and/or *3 genotypes were characterized
by lower estimated warfarin dose (median, 21 [interquartile range, 21-35]
vs. 35 [28-42] mg/week, p=0.02) and actual (27.8+/-13.2 vs. 46.3+/-13.9
mg/week, p<0.001), together with lower TTR values (56 [38.6-74.9] vs. 75.4
[58.1-83.6] %, p=0.03) and longer time above the therapeutic range (13.8
[4.9-34.5] vs. 4.5 [0-15.3]%, p=0.047) than patients with the CYP2C9*1/*1
genotype. There were no differences in the estimated and actual warfarin
doses, TTR values and adverse events between the self-testing and
standard-care subgroups.
CONCLUSIONS: The presence of CYP2C9*2 and/or *3 genotypes is associated
with unstable warfarin treatment in patients after heart valve
replacement, regardless of the type of INR testing.
<18>
Accession Number
26242213
Author
Thourani V.H.; Jensen H.A.; Babaliaros V.; Kodali S.K.; Rajeswaran J.;
Ehrlinger J.; Blackstone E.H.; Suri R.M.; Don C.W.; Aldea G.; Williams
M.R.; Makkar R.; Svensson L.G.; McCabe J.M.; Dean L.S.; Kapadia S.; Cohen
D.J.; Pichard A.D.; Szeto W.Y.; Herrmann H.C.; Devireddy C.; Leshnower
B.G.; Ailawadi G.; Maniar H.S.; Hahn R.T.; Leon M.B.; Mack M.
Institution
(Thourani) Emory University, Atlanta, Georgia. Electronic address:
vthoura@emory.edu
(Jensen) Emory University, Atlanta, Georgia
(Babaliaros) Emory University, Atlanta, Georgia
(Kodali) Columbia University Medical Center, New York, New York
(Rajeswaran) Cleveland Clinic, Cleveland, Ohio
(Ehrlinger) Cleveland Clinic, Cleveland, Ohio
(Blackstone) Cleveland Clinic, Cleveland, Ohio
(Suri) Cleveland Clinic, Cleveland, Ohio
(Don) University of Washington, Seattle, Washington
(Aldea) University of Washington, Seattle, Washington
(Williams) New York University, Langone Medical Center, New York, New York
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California
(Svensson) Cleveland Clinic, Cleveland, Ohio
(McCabe) University of Washington, Seattle, Washington
(Dean) University of Washington, Seattle, Washington
(Kapadia) Cleveland Clinic, Cleveland, Ohio
(Cohen) Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
(Pichard) MedStar Washington Hospital Center, Washington, District of
Columbia
(Szeto) University of Pennsylvania Health System, Philadelphia,
Pennsylvania
(Herrmann) University of Pennsylvania Health System, Philadelphia,
Pennsylvania
(Devireddy) Emory University, Atlanta, Georgia
(Leshnower) Emory University, Atlanta, Georgia
(Ailawadi) University of Virginia Health System, Charlottesville, Virginia
(Maniar) Washington University, St. Louis, Missouri
(Hahn) Columbia University Medical Center, New York, New York
(Leon) Columbia University Medical Center, New York, New York
(Mack) Baylor, Scott & White Health, Plano, Texas
Title
Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve
Replacement in the PARTNER-I Trial.
Source
The Annals of thoracic surgery. 100 (3) (pp 785-793), 2015. Date of
Publication: 01 Sep 2015.
Abstract
BACKGROUND: This study describes short-term and mid-term outcomes of
nonagenarian patients undergoing transfemoral or transapical transcatheter
aortic valve replacement (TAVR) in the Placement of Aortic Transcatheter
Valve (PARTNER)-I trial.
METHODS: From April 2007 to February 2012, 531 nonagenarians, mean age 93
+/- 2.1 years, underwent TAVR with a balloon-expandable prosthesis in the
PARTNER-I trial: 329 through transfemoral (TF-TAVR) and 202 transapical
(TA-TAVR) access. Clinical events were adjudicated and echocardiographic
results analyzed in a core laboratory. Quality of life (QoL) data were
obtained up to 1 year post-TAVR. Time-varying all-cause mortality was
referenced to that of an age-sex-race-matched US population.
RESULTS: For TF-TAVR, post-procedure 30-day stroke risk was 3.6%; major
adverse events occurred in 35% of patients; 30-day paravalvular leak was
greater than moderate in 1.4%; median post-procedure length of stay (LOS)
was 5 days. Thirty-day mortality was 4.0% and 3-year mortality 48% (44%
for the matched population). By 6 months, most QoL measures had stabilized
at a level considerably better than baseline, with Kansas City
Cardiomyopathy Questionnaire (KCCQ) 72 +/- 21. For TA-TAVR, post-procedure
30-day stroke risk was 2.0%; major adverse events 32%; 30-day paravalvular
leak was greater than moderate in 0.61%; and median post-procedure LOS was
8 days. Thirty-day mortality was 12% and 3-year mortality 54% (42% for the
matched population); KCCQ was 73 +/- 23.
CONCLUSIONS: A TAVR can be performed in nonagenarians with acceptable
short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not
directly comparable, TA-TAVR appears to carry a higher risk of early death
without a difference in intermediate-term mortality. Age alone should not
preclude referral for TAVR in nonagenarians.
<19>
Accession Number
26228603
Author
Arabkhani B.; Mookhoek A.; Di Centa I.; Lansac E.; Bekkers J.A.; De Lind
Van Wijngaarden R.; Bogers A.J.; Takkenberg J.J.
Institution
(Arabkhani) Erasmus University Medical Center, Rotterdam, The Netherlands.
Electronic address: b.arabkhani@erasmusmc.nl
(Mookhoek) Erasmus University Medical Center, Rotterdam, The Netherlands
(Di Centa) Hopital Foch, Suresnes, France
(Lansac) Institut Mutualiste Montsouris, Paris, France
(Bekkers) Erasmus University Medical Center, Rotterdam, The Netherlands
(De Lind Van Wijngaarden) Erasmus University Medical Center, Rotterdam,
The Netherlands
(Bogers) Erasmus University Medical Center, Rotterdam, The Netherlands
(Takkenberg) Erasmus University Medical Center, Rotterdam, The Netherlands
Title
Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic
Root Aneurysm: A Systematic Review and Meta-Analysis.
Source
The Annals of thoracic surgery. 100 (3) (pp 1126-1131), 2015. Date of
Publication: 01 Sep 2015.
Abstract
Valve-sparing aortic root techniques have progressively gained ground in
the treatment of aortic root aneurysm and aortic insufficiency. By
avoiding anticoagulation therapy they offer a good alternative to
composite graft replacement. This systematic review describes the reported
outcome of valve-sparing aortic root replacement, focusing on the
remodeling and reimplantation technique. A systematic literature search on
the characteristics of and outcomes after valve-sparing aortic root
replacement revealed 1,659 articles. The inclusion criteria were a focus
on valve-sparing aortic root replacement in adults with aortic root
aneurysm, presentation of survival data, and inclusion of at least 30
patients. Data were pooled by inverse variance weighting and analyzed by
linear regression. Of 1,659 articles published between January 1, 2000,
and January 1, 2014, 31 were included (n = 4,777 patients). The mean age
at operation was 51 +/- 14.7 years, and 14% of patients had a bicuspid
aortic valve. The reimplantation technique was used in 72% and remodeling
in 27% (1% other). No clinical advantage in terms of survival and
reoperation of one technique over the other was found. Cusp repair was
performed in 33%. Pooled early mortality was 2% (n = 103). During
follow-up (21,716 patient-years), 262 patients died (survival 92%), and
228 (5%) underwent reoperation, mainly valve replacement. Major adverse
valve-related events were low (1.66% patient-years). Preoperative severe
aortic valve regurgitation showed a trend toward higher reoperation rate.
Remodeling and reimplantation techniques show comparable survival and
valve durability results, providing a valid alternative to composite valve
replacement. The heterogeneity in the data underlines the need for a
collaborative effort to standardize outcome reporting.
<20>
Accession Number
25814356
Author
van Loon R.B.; Veen G.; Baur L.H.; Twisk J.W.; van Rossum A.C.
Institution
(van Loon) Department of Cardiology, VU University Medical Center,
Amsterdam, The Netherlands. Electronic address: rb.vanloon@vumc.nl
(Veen) Department of Cardiology, VU University Medical Center, Amsterdam,
The Netherlands
(Baur) Atrium Medical Center Parkstad, Heerlen and Faculty of Health,
Medicine and Life Sciences, University Maastricht, The Netherlands
(Twisk) Department of Clinical Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, The Netherlands
(van Rossum) Department of Cardiology, VU University Medical Center,
Amsterdam, The Netherlands
Title
Long-term follow-up of the viability guided angioplasty after acute
myocardial infarction (VIAMI) trial.
Source
International journal of cardiology. 186 (pp 111-116), 2015. Date of
Publication: 2015.
Abstract
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) not
treated with primary or rescue percutaneous coronary intervention (PCI)
are at risk for recurrent ischemia. In non-high risk patients, with proven
viability in the infarct-area, the VIAMI trial showed benefit of early
in-hospital stenting of the infarct-related coronary artery for the
composite of death, myocardial infarction (MI), or unstable angina (UA) at
1 year follow-up. In this study we evaluated the long-term outcome (median
8 years) of patients included in the VIAMI-trial.
METHODS: After being stable during the first 48 h of their acute MI, we
randomly assigned 216 patients with viability to an invasive (PCI) or a
conservative (ischemia-guided) strategy. The primary outcome was the
composite endpoint of death from any cause, recurrent myocardial
infarction, or unstable angina. The secondary outcome of this study was
the need for (repeat) revascularization.
RESULTS: The combined endpoint of death, recurrent MI and UA was 20.8% in
the invasive group and 32.7% in the conservative group (hazard ratio 0.59;
95% CI 0.36-0.99, p = 0.049). No differences were seen in death (8.5% vs.
8.2%, p = 0.80) or MI (7.5% vs. 10.9%, p = 0.48). Only UA showed a
significant difference (4.7% vs. 13.6%, p = 0.002). Repeated
revascularization was performed in 22.6% of the invasive group and 41.8%
of the conservative group (hazard ratio 0.43; 95% CI 0.29-0.74, p <
0.001).`
CONCLUSION: In patients with acute MI (treated with thrombolysis or
without reperfusion therapy) and proven viability in the infarct-area, we
demonstrated a long-term benefit of early in-hospital stenting of the
infarct-related coronary artery.
<21>
Accession Number
26906014
Author
Billings F.T.; Hendricks P.A.; Schildcrout J.S.; Shi Y.; Petracek M.R.;
Byrne J.G.; Brown N.J.
Institution
(Billings) Department of Anesthesiology, Vanderbilt University School of
Medicine, Nashville, Tennessee2Department of Medicine, Vanderbilt
University School of Medicine, Nashville, Tennessee
(Hendricks) Department of Anesthesiology, Vanderbilt University School of
Medicine, Nashville, Tennessee
(Schildcrout) Department of Biostatistics, Vanderbilt University School of
Medicine, Nashville, Tennessee
(Shi) Department of Biostatistics, Vanderbilt University School of
Medicine, Nashville, Tennessee
(Petracek) Department of Cardiac Surgery, Vanderbilt University School of
Medicine, Nashville, Tennessee
(Byrne) Department of Cardiac Surgery, Harvard University School of
Medicine, Boston, Massachusetts
(Brown) Department of Medicine, Vanderbilt University School of Medicine,
Nashville, Tennessee
Title
High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following
Cardiac Surgery: A Randomized Clinical Trial.
Source
JAMA. 315 (9) (pp 877-888), 2016. Date of Publication: 01 Mar 2016.
Abstract
IMPORTANCE: Statins affect several mechanisms underlying acute kidney
injury (AKI).
OBJECTIVE: To test the hypothesis that short-term high-dose perioperative
atorvastatin would reduce AKI following cardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: Double-blinded, placebo-controlled,
randomized clinical trial of adult cardiac surgery patients conducted from
November 2009 to October 2014 at Vanderbilt University Medical Center.
INTERVENTIONS: Patients naive to statin treatment (n=199) were randomly
assigned 80 mg of atorvastatin the day before surgery, 40 mg of
atorvastatin the morning of surgery, and 40 mg of atorvastatin daily
following surgery (n=102) or matching placebo (n=97). Patients already
taking a statin prior to study enrollment (n=416) continued taking the
preenrollment statin until the day of surgery, were randomly assigned 80
mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the
morning after (n=206) or matching placebo (n=210), and resumed taking the
previously prescribed statin on postoperative day 2.
MAIN OUTCOMES AND MEASURES: Acute kidney injury defined as an increase of
0.3 mg/dL in serum creatinine concentration within 48 hours of surgery
(Acute Kidney Injury Network criteria).
RESULTS: The data and safety monitoring board recommended stopping the
group naive to statin treatment due to increased AKI among these
participants with chronic kidney disease (estimated glomerular filtration
rate <60 mL/min/1.73 m2) receiving atorvastatin. The board later
recommended stopping for futility after 615 participants (median age, 67
years; 188 [30.6%] were women; 202 [32.8%] had diabetes) completed the
study. Among all participants (n=615), AKI occurred in 64 of 308 (20.8%)
in the atorvastatin group vs 60 of 307 (19.5%) in the placebo group
(relative risk [RR], 1.06 [95% CI, 0.78 to 1.46]; P=.75). Among patients
naive to statin treatment (n=199), AKI occurred in 22 of 102 (21.6%) in
the atorvastatin group vs 13 of 97 (13.4%) in the placebo group (RR, 1.61
[0.86 to 3.01]; P=.15) and serum creatinine concentration increased by a
median of 0.11 mg/dL (10th-90th percentile, -0.11 to 0.56 mg/dL) in the
atorvastatin group vs by a median of 0.05 mg/dL (10th-90th percentile,
-0.12 to 0.33 mg/dL) in the placebo group (mean difference, 0.08 mg/dL
[95% CI, 0.01 to 0.15 mg/dL]; P=.007). Among patients already taking a
statin (n=416), AKI occurred in 42 of 206 (20.4%) in the atorvastatin
group vs 47 of 210 (22.4%) in the placebo group (RR, 0.91 [0.63 to 1.32];
P=.63).
CONCLUSIONS AND RELEVANCE: Among patients undergoing cardiac surgery,
high-dose perioperative atorvastatin treatment compared with placebo did
not reduce the risk of AKI overall, among patients naive to treatment with
statins, or in patients already taking a statin. These results do not
support the initiation of statin therapy to prevent AKI following cardiac
surgery.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00791648.
<22>
[Use Link to view the full text]
Accession Number
26121076
Author
Lee Y.H.; Kim T.K.; Jung Y.S.; Cho Y.J.; Yoon S.; Seo J.-H.; Jeon Y.; Bahk
J.H.; Hong D.M.
Institution
(Lee, Kim, Jung, Cho, Yoon, Seo, Jeon, Bahk, Hong) Department of
Anesthesiology and Pain Medicine, Seoul National University Hospital,
Seoul, Korea
Title
Comparison of Needle Insertion and Guidewire Placement Techniques During
Internal Jugular Vein Catheterization: The Thin-Wall Introducer Needle
Technique Versus the Cannula-Over-Needle Technique.
Source
Critical care medicine. 43 (10) (pp 2112-2116), 2015. Date of Publication:
01 Oct 2015.
Abstract
MEASUREMENTS AND MAIN RESULTS: The guidewire placement on the first skin
puncture was regarded as a successful guidewire insertion on the first
attempt. The number of puncture attempts for internal jugular vein
catheterization was recorded. Internal jugular vein was assessed by
ultrasonography to identify complications. The rate of successful
guidewire insertion on the first attempt was higher in the thin-wall
introducer needle group compared with the cannula-over-needle group (87.3%
vs 77.3%; p = 0.037). There were fewer puncture attempts in the thin-wall
introducer needle group than in the cannula-over-needle group (1.1 +/- 0.4
vs 1.3 +/- 0.6; p = 0.026). There was no significant difference in
complications of internal jugular vein catheterization between the two
groups.
CONCLUSIONS: The thin-wall introducer needle technique showed a superior
success rate for first attempt of needle and guidewire insertion and
required fewer puncture attempts during internal jugular vein
catheterization.
OBJECTIVES: For needle insertion and guidewire placement during central
venous catheterization, a thin-wall introducer needle technique and a
cannula-over-needle technique have been used. This study compared these
two techniques regarding the success rates and complications during
internal jugular vein catheterization.
DESIGN: Prospective, randomized, controlled study.
SETTING: A university-affiliated hospital.
PATIENTS: Two hundred sixty-six patients scheduled for thoracic surgery,
gynecologic surgery, or major abdominal surgery, who required central
venous catheterization.
INTERVENTIONS: Patients were randomly assigned to either the thin-wall
introducer needle group (n = 134) or the cannula-over-needle group (n =
132). Central venous catheterization was performed on the right internal
jugular vein under assistance with real-time ultrasonography. Needle
insertion and guidewire placement were performed using a thin-wall
introducer needle technique in the thin-wall introducer needle group and a
cannula-over-needle technique in the cannula-over-needle group.
<23>
Accession Number
25660078
Author
He S.; Lin K.; Ma R.; Xu R.; Xiao Y.
Institution
(He) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing, China; Department of
Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu,
Sichuan, China
(Lin) Department of Oncology, Xinqiao Hospital, Third Military Medical
University, Chongqing, China
(Ma) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing, China
(Xu) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing, China
(Xiao) Department of Cardiovascular Surgery, Xinqiao Hospital, Third
Military Medical University, Chongqing, China. Electronic address:
Title
Effect of the urinary tryptin inhibitor ulinastatin on cardiopulmonary
bypass-related inflammatory response and clinical outcomes: a
meta-analysis of randomized controlled trials.
Source
Clinical therapeutics. 37 (3) (pp 643-653), 2015. Date of Publication: 01
Mar 2015.
Abstract
PURPOSE: Cardiopulmonary bypass (CPB) can cause systemic inflammatory
responses and a series of subsequent complications that may harm patients.
The aim of this study was to explore the effects of ulinastatin on
inflammatory responses and clinical outcomes of CPB via a meta-analysis of
published randomized controlled trials.
METHODS: A literature search was conducted, both manually and by using the
PubMed, EMBASE, Cochrane Library, and Web of Knowledge databases from
inception to February 2013, to identify randomized controlled trials. The
abstracted efficacy measures included changes in the plasma levels of
cytokines (interleukin-6 [IL-6], IL-8, and tumor necrosis factor-alpha
[TNF-alpha]) measured during the perioperative period and clinical
indicators of efficacy, including the duration of mechanical ventilation
and the length of intensive care unit stay. Ten ulinastatin-related
randomized controlled trials related to cardiac surgeries involving CPB
were selected.
FINDINGS: In terms of cytokine concentrations, there were no significant
differences between patients who received ulinastatin and those who
received placebo before CPB. However, as the surgeries progressed,
cytokine concentrations were all significantly lower in the ulinastatin
group (P < 0.05 at 1 hour; P < 0.0001 at 6 hours), and the respective
plasma concentrations returned to baseline values 24 hours after CPB. In
terms of the clinical outcome indices, the length of intensive care unit
stay was not significantly different, but the duration of mechanical
ventilation (95% CI, -6.75 to -0.39; P = 0.03) was significantly shorter
in the ulinastatin group.
IMPLICATIONS: This meta-analysis found that changes in inflammatory
cytokines occurred in a time-dependent manner and that the use of
ulinastatin resulted in decreased duration of mechanical ventilation with
CPB compared with placebo.
<24>
Accession Number
26310261
Author
Alam S.R.; Lewis S.C.; Zamvar V.; Pessotto R.; Dweck M.R.; Krishan A.;
Goodman K.; Oatey K.; Harkess R.; Milne L.; Thomas S.; Mills N.M.; Moore
C.; Semple S.; Wiedow O.; Stirrat C.; Mirsadraee S.; Newby D.E.; Henriksen
P.A.
Institution
(Alam) British Heart Foundation/Centre for Population Health Sciences,
University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
(Lewis) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Zamvar) Department of Cardio-thoracic Surgery, Edinburgh Royal Infirmary,
Edinburgh, UK
(Pessotto) Department of Cardio-thoracic Surgery, Edinburgh Royal
Infirmary, Edinburgh, UK
(Dweck) British Heart Foundation/Centre for Population Health Sciences,
University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
(Krishan) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Goodman) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Oatey) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Harkess) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Milne) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Thomas) Edinburgh Clinical Trials Unit, University of Edinburgh, Western
General Hospital, Edinburgh, UK
(Mills) British Heart Foundation/Centre for Population Health Sciences,
University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
(Moore) Department of Cardio-thoracic Surgery, Edinburgh Royal Infirmary,
Edinburgh, UK
(Semple) Clinical Research Imaging Centre, University of Edinburgh,
Edinburgh, UK
(Wiedow) Department of Dermatology, University of Kiel, Kiel, Germany
(Stirrat) British Heart Foundation/Centre for Population Health Sciences,
University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
(Mirsadraee) Clinical Research Imaging Centre, University of Edinburgh,
Edinburgh, UK
(Newby) British Heart Foundation/Centre for Population Health Sciences,
University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
(Henriksen) British Heart Foundation/Centre for Population Health
Sciences, University of Edinburgh Centre for Cardiovascular Science,
Edinburgh, UK
Title
Perioperative elafin for ischaemia-reperfusion injury during coronary
artery bypass graft surgery: a randomised-controlled trial.
Source
Heart (British Cardiac Society). 101 (20) (pp 1639-1645), 2015. Date of
Publication: 01 Oct 2015.
Abstract
BACKGROUND: Elafin is a potent endogenous neutrophil elastase inhibitor
that protects against myocardial inflammation and injury in preclinical
models of ischaemic-reperfusion injury. We investigated whether elafin
could inhibit myocardial ischaemia-reperfusion injury induced during
coronary artery bypass graft (CABG) surgery.
METHODS AND RESULTS: In a randomised double-blind placebo-controlled
parallel group clinical trial, 87 patients undergoing CABG surgery were
randomised 1:1 to intravenous elafin 200 mg or saline placebo administered
after induction of anaesthesia and prior to sternotomy. Myocardial injury
was measured as cardiac troponin I release over 48 h (area under the curve
(AUC)) and myocardial infarction identified with MRI. Postischaemic
inflammation was measured by plasma markers including AUC high-sensitive C
reactive protein (hs-CRP) and myeloperoxidase (MPO). Elafin infusion was
safe and resulted in >3000-fold increase in plasma elafin concentrations
and >50% inhibition of elastase activity in the first 24 h. This did not
reduce myocardial injury over 48 h (ratio of geometric means
(elafin/placebo) of AUC troponin I 0.74 (95% CI 0.47 to 1.15, p=0.18))
although post hoc analysis of the high-sensitive assay revealed lower
troponin I concentrations at 6 h in elafin-treated patients (median 2.4 vs
4.1 mug/L, p=0.035). Elafin had no effect on myocardial infarction
(elafin, 7/34 vs placebo, 5/35 patients) or on markers of inflammation:
mean differences for AUC hs-CRP of 499 mg/L/48 h (95% CI -207 to 1205,
p=0.16), and AUC MPO of 238 ng/mL/48 h (95% CI -235 to 711, p=0.320).
CONCLUSIONS: There was no strong evidence that neutrophil elastase
inhibition with a single-dose elafin treatment reduced myocardial injury
and inflammation following CABG-induced ischaemia-reperfusion injury.
TRIAL REGISTRATION NUMBER: (EudraCT 2010-019527-58, ISRCTN82061264).
<25>
Accession Number
25564510
Author
Anastasiadis K.; Antonitsis P.; Argiriadou H.; Deliopoulos A.;
Grosomanidis V.; Tossios P.
Institution
(Anastasiadis) Cardiothoracic Department, Aristotle University of
Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
(Antonitsis) Cardiothoracic Department, Aristotle University of
Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
antonits@otenet.gr
(Argiriadou) Cardiothoracic Department, Aristotle University of
Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
(Deliopoulos) Cardiothoracic Department, Aristotle University of
Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
(Grosomanidis) Cardiothoracic Department, Aristotle University of
Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
(Tossios) Cardiothoracic Department, Aristotle University of Thessaloniki,
AHEPA University Hospital, Thessaloniki, Greece
Title
Modular minimally invasive extracorporeal circulation systems; can they
become the standard practice for performing cardiac surgery?.
Source
Perfusion. 30 (3) (pp 195-200), 2015. Date of Publication: 01 Apr 2015.
Abstract
Minimally invasive extracorporeal circulation (MiECC) has been developed
in an attempt to integrate all advances in cardiopulmonary bypass
technology in one closed circuit that shows improved biocompatibility and
minimizes the systemic detrimental effects of CPB. Despite well-evidenced
clinical advantages, penetration of MiECC technology into clinical
practice is hampered by concerns raised by perfusionists and surgeons
regarding air handling together with blood and volume management during
CPB. We designed a modular MiECC circuit, bearing an accessory circuit for
immediate transition to an open system that can be used in every adult
cardiac surgical procedure, offering enhanced safety features. We
challenged this modular circuit in a series of 50 consecutive patients.
Our results showed that the modular AHEPA circuit design offers 100%
technical success rate in a cohort of random, high-risk patients who
underwent complex procedures, including reoperation and valve and aortic
surgery, together with emergency cases. This pilot study applies to the
real world and prompts for further evaluation of modular MiECC systems
through multicentre trials.
<26>
Accession Number
25475464
Author
Krone R.J.; Althouse A.D.; Tamis-Holland J.; Venkitachalam L.; Campos A.;
Forker A.; Jacobs A.K.; Ocampo S.; Steiner G.; Fuentes F.; Pena Sing I.R.;
Brooks M.M.
Institution
(Krone) Division of Cardiology, Washington University, St. Louis,
Missouri, USA. Electronic address: rkrone@dom.wustl.edu
(Althouse) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, Pennsylvania, USA
(Tamis-Holland) Mount Sinai Saint Luke's Hospital, New York, New York, USA
(Venkitachalam) Department of Biomedical and Health Informatics,
University of Missouri-Kansas City, Kansas City, Missouri, USA
(Campos) Department of Cardiology, Hospital de Especialidades, Centro
Medico La Raza, IMSS, Mexico City, Mexico
(Forker) Mid America Heart Institute, University of Missouri-Kansas City,
Kansas City, Missouri, USA
(Jacobs) Boston University and Boston Medical Center, Boston,
Massachusetts, USA
(Ocampo) Department of Cardiology, Hospital de Especialidades, Centro
Medico La Raza, IMSS, Mexico City, Mexico
(Steiner) The University of Toronto, Toronto, Ontario, Canada
(Fuentes) Division of Cardiology, The University of Texas Health Science
Center at Houston, Houston, Texas, USA
(Pena Sing) Heart and Vascular Catheterization Laboratories, Nanticoke
Memorial Hospital, Seaford, Delaware, USA; New York University, New York,
New York, USA
(Brooks) Department of Epidemiology, University of Pittsburgh, Pittsburgh,
Pennsylvania, USA
Title
Appropriate revascularization in stable angina: lessons from the BARI 2D
trial.
Source
The Canadian journal of cardiology. 30 (12) (pp 1595-1601), 2014. Date of
Publication: 01 Dec 2014.
Abstract
CONCLUSIONS: With the possible exception of patients with severe angina
and proximal left anterior descending artery disease, this analysis
supports the recommendation of the 2012 guidelines for a trial of OMT
before revascularization. Patients could not be identified at the time of
catheterization, but a short period of close follow-up during OMT
identified the nearly 40% of patients who underwent revascularization.
BACKGROUND: The 2012 Guidelines for Diagnosis and Management of Patients
with Stable Ischemic Heart Disease recommend intensive antianginal and
risk factor treatment (optimal medical management [OMT]) before
considering revascularization to relieve symptoms. The Bypass Angioplasty
Revascularization Investigation 2 Diabetes (BARI 2D) trial randomized
patients with ischemic heart disease and anatomy suitable to
revascularization to (1) initial OMT with revascularization if needed or
(2) initial revascularization plus OMT and found no difference in major
cardiovascular events. Ultimately, however, 37.9% of the OMT group was
revascularized during the 5-year follow-up period.
METHODS: Data from the 1192 patients randomized to OMT were analyzed to
identify subgroups in which the incidence of revascularization was so high
that direct revascularization without a trial period could be justified.
Multivariate logistic analysis, Cox regression models of baseline data,
and a landmark analysis of participants who did not undergo
revascularization at 6 months were constructed.
RESULTS: The models that used only data available at the time of study
entry had limited predictive value for revascularization by 6 months or by
5 years; however, the model incorporating severity of angina during the
first 6 months could better predict revascularization (C statistic =
0.789).
<27>
Accession Number
25835756
Author
Lam J.Y.; Lopushinsky S.R.; Ma I.W.; Dicke F.; Brindle M.E.
Title
Treatment Options for Pediatric Patent Ductus Arteriosus: Systematic
Review and Meta-analysis.
Source
Chest. 148 (3) (pp 784-793), 2015. Date of Publication: 01 Sep 2015.
Abstract
BACKGROUND: Patent ductus arteriosus (PDA) in the nonpremature pediatric
patient is currently treated by surgical ligation or catheter occlusion.
There is no clear superiority of one technique over the other. This
meta-analysis compares the clinical outcomes of the two treatment options
for PDA.
METHODS: We performed a literature search of MEDLINE, Embase, PubMed, and
the Cochrane database of randomized controlled trials (RCTs) that took
place between 1950 and February 2014 and hand-searched references from
included studies. We excluded studies of adult or premature patients and
those without a direct comparison between surgical and catheter-based
treatments of PDAs. Outcomes of interest were reintervention, total
complications, length of stay, and cost.
RESULTS: One thousand three hundred thirty-three manuscripts were
screened. Eight studies fulfilled the inclusion criteria (one RCT and
seven observational studies [N = 1,107]). In pooled observational studies,
there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for
reintervention in the surgical ligation group but insignificantly higher
odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were
no complications reported in the RCT, but surgical ligation was associated
with decreased odds for reintervention and a longer length of stay. Funnel
plots revealed a possible publication bias and a quality review identified
comparability bias.
CONCLUSIONS: Both therapies have comparable outcomes. Reintervention is
more common with catheter-based treatment, but overall complication rates
are not higher and hospital stay is shorter. Our data span > 2 decades and
may not reflect current surgical and catheterization outcomes. Large,
randomized, prospective studies may help determine the optimal treatment
strategy.
<28>
Accession Number
26069111
Author
Lee S.; Lee S.H.; Chang B.-C.; Shim J.-K.
Institution
(Lee) Department of Thoracic and Cardiovascular Surgery, Cardiovascular
Research Institute, Yonsei University College of Medicine, Seoul, Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Cardiovascular
Research Institute, Yonsei University College of Medicine, Seoul, Korea
(Chang) Department of Thoracic and Cardiovascular Surgery, Cardiovascular
Research Institute, Yonsei University College of Medicine, Seoul, Korea
(Shim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, Seoul, Korea.
aneshim@yuhs.ac
Title
Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output
Monitoring after Valvular Heart Surgery.
Source
Yonsei medical journal. 56 (4) (pp 913-920), 2015. Date of Publication: 01
Jul 2015.
Abstract
MATERIALS AND METHODS: Fifty eight patients were randomized into two
groups of GDT with common goals to maintain a mean arterial pressure of
60-80 mm Hg and cardiac index >2 L/min/m2: the PAC group (n=29), based on
pulmonary capillary wedge pressure, and the NICOM group (n=29), based on
changes in stroke volume index after passive leg raising. The primary
efficacy variable was length of hospital stay. Secondary efficacy
variables included resource utilization including vasopressor and
inotropic requirement, fluid balance, and major morbidity endpoints.
RESULTS: Patient characteristics and operative data were similar between
the groups, except that significantly more patients underwent double valve
replacement in the NICOM group. The lengths of hospital stay were not
different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days,
p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and
ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the
PAC group. The PAC group also required significantly larger amounts of
colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004).
CONCLUSION: NICOM-based postoperative hemodynamic GDT showed promising
results in patients with atrial fibrillation undergoing valvular heart
surgery in terms of resource utilization.
PURPOSE: We compared the efficacy of postoperative hemodynamic
goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and
bioreactance-based noninvasive cardiac output monitoring (NICOM) in
patients with atrial fibrillation undergoing valvular heart surgery.
<29>
Accession Number
20160263657
Author
Chen H.-L.; Liu K.
Institution
(Chen) Nantong University, Nantong, China
(Liu) Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong
University, Nantong, China
Title
Clinical outcomes for transcatheter valve-in-valve in treating surgical
bioprosthetic dysfunction: A meta-analysis.
Source
International Journal of Cardiology. 212 (pp 138-141), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier Ireland Ltd
<30>
Accession Number
20160284719
Author
Aldahash R.; Al Dera H.S.
Institution
(Aldahash, Al Dera) College of Medicine, King Saud bin Abduaziz University
for Health Science (KSAU-HS), Saudi Arabia
(Al Dera) Kind Abdullah International Medical Research Center (KAIMRC),
Saudi Arabia
Title
Physical therapy program improves the physiological impact towards better
quality of life and low cardiac risk factors in patients following
coronary artery bypass grafting. Systematic review.
Source
Acta Medica International. 3 (1) (pp 185-195), 2016. Date of Publication:
01 Jan 2016.
Publisher
Teerthanker Mahaveer University
Abstract
Introduction: Studies suggest that exercise therapy may enhance heart rate
variability in myocardial infarction, chronic heart failure and
revascularization patients by increasing vagal tone and decreasing
sympathetic activity. This review addressed the impact of cardiac
rehabilitation programs (CRPs) in post CABG patients on the quality of
life, in terms of physical function and cardiac risk factors. Methods:
OVID, Science direct, Embase, AMED and Cochrane controlled Trial Register
were searched for studies published from 2005 up to 2015. Two reviewers
assessed the eligibility of each study based on predefined inclusion
criteria. Results: Of 35 abstracts reviewed, 9 studies met the inclusion
criteria. All studies compared CRPs of different interventions to a
control (non-intervention) group. From the selected 9 studies, 6 studies
included interventions compared with control groups (usual or standard
care) while 3 studies compared two different intervention strategies with
groups and included a no-intervention control group. Conclusion: This
systematic review concludes that all types of CRPs lead to improvements in
the quality of life and reduction of cardiac risk factors in post CABG
patients. However, these improvements were quite varied between the 9
studies according to variations in the components of CRPs.
<31>
Accession Number
20160264033
Author
Min J.J.; Bae J.-Y.; Kim T.K.; Kim J.H.; Hwang H.Y.; Kim K.-H.; Ahn H.; Oh
A.Y.; Bahk J.-H.; Hong D.M.; Jeon Y.
Institution
(Min, Bae, Kim, Bahk, Hong, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Inje University
Ilsan Paik Hospital, Gyeonggi, South Korea
(Hwang, Kim, Ahn) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
(Oh) Department of Anesthesiology and Pain Medicine, Seoul National
University Bundang Hospital, Seongnam, Gyeonggi, South Korea
Title
Pulmonary Protective Effects of Remote Ischaemic Preconditioning with
Postconditioning in Patients Undergoing Cardiac Surgery Involving
Cardiopulmonary Bypass: A Substudy of the Remote Ischaemic Preconditioning
with Postconditioning Outcome trial.
Source
Heart Lung and Circulation. 25 (5) (pp 484-492), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ltd
Abstract
Background: The RISPO (Remote Ischemic Preconditioning with
Postconditioning Outcome) trial evaluated whether remote ischaemic
preconditioning (RIPC) combined with remote ischaemic postconditioning
(RIPostC) improves the clinical outcomes of patients undergoing cardiac
surgery. This substudy of the RISPO trial aimed to evaluate the effect of
RIPC with RIPostC on pulmonary function in patients undergoing cardiac
surgery with cardiopulmonary bypass (CPB). Methods: Sixty-five patients
were enrolled (32: control and 33: RIPC-RIPostC). In the RIPC-RIPostC
group, four cycles of 5 min ischaemia and 5 min reperfusion were
administered before and after CPB to the upper limb. Peri-operative
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio, intra-operative
pulmonary shunt, and dynamic and static lung compliance were determined.
Results: The mean PaO<inf>2</inf>/ F<inf>I</inf>O<inf>2</inf> was
significantly higher in the RIPC-RIPostC group at 24h after surgery [290
(96) vs. 387 (137), p = 0.001]. The incidence of mechanical ventilation
for longer than 48h was significantly higher in the control group (23% vs.
3%, p < 0.05). However, there were no significant differences in other
pulmonary profiles, post-operative mechanical ventilation time, and
duration of intensive care unit stay. Conclusions: In our study,
RIPC-RIPostC improved the post-operative 24h
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio. Remote ischaemic
preconditioning-Remote ischaemic postconditioning has limited and delayed
pulmonary protective effects in cardiac surgery patients with CPB.
<32>
Accession Number
2015332685
Author
Chandrasekhar J.; Hibbert B.; Ruel M.; Lam B.-K.; Labinaz M.; Glover C.
Institution
(Chandrasekhar, Hibbert, Labinaz, Glover) University of Ottawa Heart
Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, ON,
Canada
(Ruel, Lam) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Chandrasekhar) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Title
Transfemoral vs Non-transfemoral Access for Transcatheter Aortic Valve
Implantation: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (12) (pp 1427-1438), 2015. Date of
Publication: 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is the
definitive therapy for high-risk patients with severe aortic stenosis. The
aim of this study was to determine the effect of non-transfemoral access
on clinical outcomes in TAVI. Methods: We conducted a computerized
literature search on SCOPUS and selected all studies published in the
English language, from 2002 until March 12 2014, that compared
transfemoral access with a non-transfemoral access cohort. Two independent
reviewers evaluated the studies and extracted data for analysis. Results:
A total 17,020 patients (11,079 transfemoral, 5941 non-transfemoral)
encompassing 28 studies underwent TAVI between 2007 to 2013. Overall, the
30-day mortality was 4.7% with the transfemoral approach and 8.1% with a
non-transfemoral approach (odds ratio [OR], 0.56; 95% confidence interval
[CI], 0.49-0.64; P < 0.01). The 1-year mortality was 16.4% with
transfemoral access and 24.8% with non-transfemoral access (OR, 0.68; 95%
CI, 0.60-0.75; P < 0.01). Transfemoral access was associated with a
greater incidence of vascular complications (OR, 2.1; 95% CI, 1.48-2.99; P
< 0.01) but a lower rate of surgical conversion (OR, 0.59; 95% CI,
0.42-0.81; P < 0.01) and similar bleeding (OR, 1.01; 95% CI, 0.81-1.27; P
= 0.91) compared with non-transfemoral access. The incidence of
cerebrovascular events was similar in both groups (1.6% vs 2.1%; OR, 0.86;
95% CI, 0.64-1.15; P = 0.31). Conclusions: Transfemoral access was
associated with lower rate of 30-day and 1-year mortality compared with
non-transfemoral access for TAVI. Randomized studies are needed to
ascertain the effect of alternative access sites on clinical outcomes in
prohibitive-risk, high-risk, and intermediate-risk populations, using
currently available technologies.
<33>
Accession Number
20160244742
Author
Newhall K.A.; Saunders E.C.; Larson R.J.; Stone D.H.; Goodney P.P.
Institution
(Newhall, Larson, Goodney) Veterans Affairs Outcomes Group, Department of
Veterans Affairs Medical Center, White River Junction, VT, United States
(Newhall) Department of Surgery, Dartmouth Hitchcock Medical Center,
Lebanon, NH, United States
(Saunders, Larson, Goodney) Dartmouth Institute for Health Policy and
Clinical Practice, Lebanon, NH, United States
(Saunders) Dartmouth Psychiatric Research Center, Lebanon, NH, United
States
(Stone, Goodney) Section of Vascular Surgery, Dartmouth Hitchcock Medical
Center, Lebanon, NH, United States
Title
Use of protamine for anticoagulation during carotid endarterectomy a
meta-analysis.
Source
JAMA Surgery. 151 (3) (pp 247-255), 2016. Date of Publication: March 2016.
Publisher
American Medical Association
Abstract
Importance Protamine sulfate can be administered at the conclusion of
carotid endarterectomy (CEA) to reverse the anticoagulant effects of
heparin and to limit the risk for postoperative bleeding. Protamine use
remains controversial owing to concern for increased thrombotic
complications with its use. OBJECTIVE To review the evidence for and
against protamine use, both in its association with increased thrombotic
complications and with decreased bleeding. DATA SOURCES We searched
Medline (1946-2014), EMBASE (1966-2014), Cochrane Library (1972-2014),
clinical trial registries (World Health Organization International
Clinical Trials Registry and clinicaltrials.gov), and abstracts from
conferences of the Society of Vascular Surgery (2002-2014) and American
Heart Association Scientific Sessions (1980-2014) in November 2014. No
language restrictions were applied. STUDY SELECTION We included clinical
trials and observational studies comparing reversal of heparin with
protamine sulfate vs no reversal in patients undergoing carotid
revascularization and reporting stroke during hospitalization. Of 360
records screened, 12 studies (3%) of CEA were eligible for data pooling.
DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed
quality. Random-effects models were used to summarize relative risks
(RRs). MAIN OUTCOME AND MEASURE Stroke after CEA. RESULTS We included 12
observational studies involving 10 621 patients in the meta-analysis.
Event rates did not differ significantly between patients who received
protamine vs those who did not for the following outcomes: stroke (RR,
0.84; 95%CI, 0.55-1.29; I<sup>2</sup> = 15%;9 studies),myocardial
infarction (RR, 0.89; 95%CI, 0.53-1.51; I<sup>2</sup> = 0%; 3 studies), or
mortality (RR, 0.9, 95%CI, 0.62-1.29; I<sup>2</sup> = 0%; 7 studies). The
use of protamine was associated with a significant decrease in major
bleeding complications requiring reoperation (RR, 0.57; 95%CI, 0.39-0.84;
I<sup>2</sup> = 32%; 10 studies). CONCLUSIONS AND RELEVANCE Based on
available evidence, the use of protamine following CEA is associated with
a reduction in bleeding complications, without increasing major thrombotic
outcomes, including stroke,myocardial infarction, or death.
<34>
Accession Number
20160265915
Author
Puri R.; Abdul-Jawad Altisent O.; Del Trigo M.; Campelo-Parada F.;
Regueiro A.; Barbosa Ribeiro H.; Delarochelliere R.; Paradis J.-M.; Dumont
E.; Rodes-Cabau J.
Institution
(Puri, Abdul-Jawad Altisent, Del Trigo, Campelo-Parada, Regueiro, Barbosa
Ribeiro, Delarochelliere, Paradis, Dumont, Rodes-Cabau) Quebec Heart and
Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, QC G1V
4G5, Canada
Title
Transcatheter mitral valve implantation for inoperable severely calcified
native mitral valve disease: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 87 (3) (pp 540-548),
2016. Date of Publication: 15 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Transcatheter mitral valve implantation (TMVI) for severely
calcified native mitral valve disease recently emerged as a treatment
option in patients deemed inoperable by conventional techniques. Yet no
systematic appraisal currently exists characterizing this novel treatment
paradigm. Methods A systematic literature review summarizing the clinical,
anatomical, peri- and post-procedural characteristics underscoring the
technical feasibility of this procedure was performed. Results Nine
publications describing 11 patients [mean age 68 +/- 10 years, 82% female,
82% severe mitral stenosis (MS), 18% severe mitral regurgitation (MR)]
were identified. Mean STS score, trans-mitral gradient and effective
orifice area were 10.5 +/- 4.6%, 12 +/- 2.4 mm Hg and 0.93 +/- 0.06
cm<sup>2</sup> respectively. All patients had severe, circumferential
mitral annular calcification on imaging. Dedicated balloon-expanding
transcatheter aortic valves were used in 10/11 cases, with 8/11 cases
involving a true percutaneous approach with peri-procedural 3D
trans-esophageal echocardiographic guidance; 3/11 cases involved an open
left atrial approach. Following initial balloon inflation and valve
deployment, procedural success rate was 73%, without residual paravalvular
leaks (PVL). Successful immediate re-deployment of a 2nd valve was needed
in 2 instances following significant PVL detection. Residual
trans-valvular gradients ranged from 3 to 7 mm Hg, with no patient
demonstrating >grade 2 MR. All patients survived the procedure, with 2
reported deaths on days 10- and 41 post-TMVI being non-cardiac-related.
Mid-term clinical follow-up, reported in 8 patients, revealed 6 patients
to be alive at 3-months with much improved functional status. Conclusions
TMVI for native severely calcified mitral valve disease appears
technically feasible with acceptable initial acute and mid-term
hemodynamic and clinical outcomes. The outcomes of an ongoing, dedicated
global Sapien TMVI registry will shed further light on this evolving
treatment paradigm.
<35>
[Use Link to view the full text]
Accession Number
20160051459
Author
Khan A.R.; Farid T.A.; Pathan A.; Tripathi A.; Ghafghazi S.; Wysoczynski
M.; Bolli R.
Institution
(Khan, Farid, Pathan, Tripathi, Ghafghazi, Wysoczynski, Bolli) Institute
of Molecular Cardiology, University of Louisville, 550 S Jackson St,
Louisville, KY 40292, United States
Title
Impact of cell therapy on myocardial perfusion and cardiovascular outcomes
in patients with angina refractory to medical therapy: A systematic review
and meta-analysis.
Source
Circulation Research. 118 (6) (pp 984-993), 2016. Date of Publication: 18
Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Rationale: The effect of stem/progenitor cells on myocardial perfusion and
clinical outcomes in patients with refractory angina remains unclear
because studies published to date have been small phase I-II trials.
Objective: We performed a meta-analysis of randomized controlled trials to
evaluate the effect of cell-based therapy in patients with refractory
angina who were ineligible for coronary revascularization. Methods and
Results: Several data sources were searched from inception to September
2015, which yielded 6 studies. The outcomes pooled were indices of angina
(anginal episodes, Canadian Cardiovascular Society angina class, exercise
tolerance, and antianginal medications), myocardial perfusion, and
clinical end points. We combined the reported clinical outcomes
(myocardial infarction, cardiac-related hospitalization, and mortality)
into a composite end point (major adverse cardiac events). Mean difference
(MD), standardized mean differences, or odds ratio were calculated to
assess relevant outcomes. Our analysis shows an improvement in anginal
episodes (MD, -7.81; 95% confidence interval [CI], -15.22 to -0.41), use
of antianginal medications (standardized MD, -0.59; 95% CI, -1.03 to
-0.14), Canadian Cardiovascular Society class (MD, -0.58; 95% CI, -1.00 to
-0.16), exercise tolerance (standardized MD, 0.331; 95% CI, 0.08 to 0.55),
and myocardial perfusion (standardized MD, -0.49; 95% CI, -0.76 to -0.21)
and a decreased risk of major adverse cardiac events (odds ratio, 0.49;
95% CI, 0.25 to 0.98) and arrhythmias (odds ratio, 0.25; 95% CI, 0.06 to
0.98) in cell-treated patients when compared with patients on maximal
medical therapy. Conclusions: The present meta-analysis indicates that
cell-based therapies are not only safe but also lead to an improvement in
indices of angina, relevant clinical outcomes, and myocardial perfusion in
patients with refractory angina. These encouraging results suggest that
larger, phase III randomized controlled trials are in order to
conclusively determine the effect of stem/progenitor cells in refractory
angina.
<36>
Accession Number
20160252770
Author
Pollesello P.; Parissis J.; Kivikko M.; Harjola V.-P.
Institution
(Pollesello, Kivikko) Critical Care Proprietary Products, Orion Pharma,
Espoo, Finland
(Parissis) Second Department of Cardiology, Heart Failure Unit, University
of Athens Medical School, Attikon University Hospital, Athens, Greece
(Harjola) Emergency Medicine, Helsinki University, Helsinki University
Hospital, Helsinki, Finland
Title
Levosimendan meta-analyses: Is there a pattern in the effect on
mortality?.
Source
International Journal of Cardiology. 209 (pp 77-83), 2016. Date of
Publication: 15 Apr 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Levosimendan is an inodilator developed for treatment of acute
heart failure and other cardiac conditions where the use of an inodilator
is considered appropriate. Levosimendan has been studied in different
therapeutic settings including acutely decompensated chronic heart
failure, advanced heart failure, right ventricular failure, cardiogenic
shock, septic shock, and cardiac and non-cardiac surgery. This variety of
data has been re-analysed in 25 meta-analyses from 15 different
international research groups, based on different rationales to select the
studies included. Methods We here review all previously published
meta-analyses on levosimendan to determine any common denominators for its
effects on patient mortality. In addition, we also perform a comparative
meta-analysis of the six phase II and III randomized double-blind trials
which were taken into consideration by the regulatory authorities for the
purpose of introducing levosimendan into the market. Results Irrespective
of clinical setting or comparator, all meta-analyses consistently show
benefits for levosimendan, with lower relative risk (or odds ratio) for
patient mortality. In 3/25 of the meta-analyses these beneficial trends
did not reach statistical significance, while in 22/25 significance was
reached. The relative risk is consistent overall, and very similar to that
obtained in our own meta-analysis that considered only the 'regulatory'
studies. Conclusion The existing meta-analyses, now based on a population
of over 6000 patients, provide the general message of significant benefits
for levosimendan in terms of patient mortality. The weight of evidence is
now clearly in favour of usefulness/efficacy of levosimendan, with data
from multiple randomized trials and meta-analyses.
<37>
Accession Number
20160238268
Author
King N.; Dieberg G.; Smart N.A.
Institution
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula, Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
Title
Remote ischaemic pre-conditioning does not affect clinical outcomes
following coronary Artery bypass grafting. A systematic review and
meta-analysis.
Source
Clinical Trials and Regulatory Science in Cardiology. 17 (pp 1-8), 2016.
Date of Publication: 01 May 2016.
Publisher
Elsevier
Abstract
Background Trials of remote ischemic pre-conditioning (RIPC) have
suggested this intervention reduces complications of angioplasty and
coronary artery by-pass grafting (CABG). The aim of this work was to
conduct a systematic review and meta-analysis of the effects of RIPC on
mortality and myocardial damage in patients undertaking coronary artery
bypass grafting with/without valve surgery. Methods A systematic review
and subsequent meta-analysis of randomized controlled trials of RIPC
versus usual care or sham RIPC was performed. Results Eighteen studies,
totalling 4551 participants were analysed. RIPC reduced post troponin
release as indicated by area under the curve at 72 h (mug.L<sup>- 1</sup>)
Mean Difference (MD) - 3.72 (95% CI - 3.92 to - 3.53, p < 0.00001).
However there was no significant difference between RIPC and control when
mortality odds ratio (OR) 1.27 (95% CI 0.87 to 1.86, p = 0.22); the
incidence of new onset atrial fibrillation OR 0.82 (95% CI 0.67 to 1.01, p
= 0.06); inotropic support OR 1.27 (95% CI 0.84 to 1.91, p = 0.25);
intensive care unit stay in days MD - 0.02 (95% CI - 0.12 to 0.07, p =
0.61); Hospital stay in days MD 0.18 (95% CI - 0.30 to 0.66, p = 0.47) and
serum creatinine MD - 0.00 (95% CI - 0.07 to 0.07, p = 0.97) were
compared. Conclusions RIPC reduces does not confer any clinical benefit in
patients undertaking CABG with/without valve surgery.
<38>
Accession Number
20160238315
Author
Wijeysundera D.N.; Pearse R.M.; Shulman M.A.; Abbott T.E.F.; Torres E.;
Croal B.L.; Granton J.T.; Thorpe K.E.; Grocott M.P.W.; Farrington C.;
Myles P.S.; Cuthbertson B.H.; Wallace S.; Thompson B.; Ellis M.; Borg B.;
Kerridge R.; Douglas J.; Brannan J.; Pretto J.; Godsall M.G.; Beauchamp
N.; Allen S.; Kennedy A.; Wright E.; Malherbe J.; Ismail H.; Riedel B.;
Melville A.; Sivakumar H.; Murmane A.; Kenchington K.; Gurunathan U.;
Stonell C.; Brunello K.; Steele K.; Tronstand O.; Masel P.; Dent A.; Smith
E.; Bodger A.; Abolfathi M.; Sivalingam P.; Hall A.; Painter T.; Elliott
A.; Carrera A.M.; Terblanche N.C.S.; Pitt S.; Samuels J.; Wilde C.;
MacCormick M.; Leslie K.; Bramley D.; Southcott A.M.; Grant J.; Taylor H.;
Bates S.; Towns M.; Tippett A.; Marshall F.; Mazer C.D.; Kunasingam J.;
Yagnik A.; Crescini C.; McCartney C.J.L.; Choi S.; Somascanthan P.; Flores
K.; Beattie W.S.; Karkouti K.; Clarke H.A.; Jerath A.; McCluskey S.A.;
Wasowicz M.; Day L.; Pazmino-Canizares J.; Oh P.; Belliard R.; Lee L.;
Dobson K.; Chan V.; Brull R.; Ami N.; Stanbrook M.; Kagen K.; Campbell D.;
Short T.; Van Der Westhuizen J.; Higgie K.; Lindsay H.; Jang R.; Wong C.;
McAllister D.; Ali M.; Kumar J.; Waymouth E.; Dimech J.; Lorimer M.; Sara
R.; Collingwood A.; Olliff S.; Gabriel S.; Houston H.; Dalley P.; Hurford
S.; Hunt A.; Andrews L.; Navarra L.; Jason-Smith A.; Lum M.; Martin D.;
James S.; Phull M.; Beilstein C.; Bodger P.; Everingham K.; Hu Y.;
Niebrzegowska E.; Corriea C.; Creary T.; Januszekska M.; Ahmad T.; Whalley
J.; Haslop R.; McNeil J.; Brown A.; MacDonald N.; Jhani S.; Raobaikady R.;
Black E.; Rooms M.; Lawrence H.; Jack S.; Celinski M.; Levett D.; Edwards
M.; Salmon K.; Bolger C.; Loughney L.; Seaward L.; Collins H.; Tyrell B.;
Tantony N.; Golder K.; Ackland G.; Stephens R.C.M.; Gagello-Paredes L.;
Raj A.; Lifford R.; Melo M.; Mamdani M.; Hillis G.; Wijeysundera H.C.
Institution
(Wijeysundera) St. Michael's Hospital, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Pearse, Abbott) Queen Mary University of London, London, United Kingdom
(Shulman, Farrington, Myles) Alfred Hospital, Monash University,
Melbourne, VIC, Australia
(Torres) St. Michael's Hospital, Toronto, ON, Canada
(Croal) NHS Grampian, Aberdeen, United Kingdom
(Granton) University Health Network, Mount Sinai Hospital, University of
Toronto, Toronto, ON, Canada
(Thorpe) University of Toronto, St. Michael's Hospital, Toronto, ON,
Canada
(Grocott) University Hospital Southampton, University of Southampton,
Southampton, United Kingdom
(Cuthbertson) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
Title
Measurement of Exercise Tolerance before Surgery (METS) study: A protocol
for an international multicentre prospective cohort study of
cardiopulmonary exercise testing prior to major non-cardiac surgery.
Source
BMJ Open. 6 (3) (no pagination), 2016. Article Number: e010359. Date of
Publication: 2016.
Publisher
BMJ Publishing Group
Abstract
Introduction: Preoperative functional capacity is considered an important
risk factor for cardiovascular and other complications of major
non-cardiac surgery. Nonetheless, the usual approach for estimating
preoperative functional capacity, namely doctors' subjective assessment,
may not accurately predict postoperative morbidity or mortality. 3
possible alternatives are cardiopulmonary exercise testing; the Duke
Activity Status Index, a standardised questionnaire for estimating
functional capacity; and the serum concentration of N-terminal pro-B-type
natriuretic peptide (NT pro-BNP), a biomarker for heart failure and
cardiac ischaemia. Methods and analysis: The Measurement of Exercise
Tolerance before Surgery (METS) Study is a multicentre prospective cohort
study of patients undergoing major elective non-cardiac surgery at 25
participating study sites in Australia, Canada, New Zealand and the UK. We
aim to recruit 1723 participants. Prior to surgery, participants undergo
symptom-limited cardiopulmonary exercise testing on a cycle ergometer,
complete the Duke Activity Status Index questionnaire, undergo blood
sampling to measure serum NT pro-BNP concentration and have their
functional capacity subjectively assessed by their responsible doctors.
Participants are followed for 1 year after surgery to assess vital status,
postoperative complications and general health utilities. The primary
outcome is all-cause death or non-fatal myocardial infarction within 30
days after surgery, and the secondary outcome is all-cause death within 1
year after surgery. Both receiver-operating-characteristic curve methods
and risk reclassification table methods will be used to compare the
prognostic accuracy of preoperative subjective assessment, peak oxygen
consumption during cardiopulmonary exercise testing, Duke Activity Status
Index scores and serum NT pro- BNP concentration. Ethics and
dissemination: The METS Study has received research ethics board approval
at all sites. Participant recruitment began in March 2013, and 1- year
follow-up is expected to finish in 2016. Publication of the results of the
METS Study is anticipated to occur in 2017.
<39>
Accession Number
20160260795
Author
Sun H.; Du B.; Liu X.; Yang S.; Yang P.
Institution
(Sun, Du, Liu, Yang, Yang) Department of Cardiology, China-Japan Union
Hospital of Jilin University, Changchun, China
Title
Warfarin continuation vs interruption during procedures of cardiac rhythm
devices: A meta-analysis of randomized controlled trials.
Source
Journal of the Pakistan Medical Association. 66 (4) (pp 458-463), 2016.
Date of Publication: April 2016.
Publisher
Pakistan Medical Association
Abstract
To compare the safetyand efficacy of warfarin treatment continuation and
heparin-bridging therapy during cardiac rhythm device (CRD) implantation
in patients chronically treated with anticoagulants.We performed a search
and analysis of peer-reviewed studies Four randomized controlled trials
(RCTs)were included in our analysis with 941 patients. The bleeding risk
in patients continuing warfarin perioperatively was lower than those
interrupting warfarin and using a heparin-bridge (RD -0.08, 95% CI -0.17
to 0.02, p<0.05). There was no significant difference in ischaemic risk
between two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00). Hence, in
patients undergoing long-term warfarin therapy, continuation of warfarin
treatment is a safe and efficacious perioperative strategy for during CRD
implantations, while interruption of warfarin with a heparin bridge may
increase the bleeding risk in these patients.
<40>
Accession Number
20160274810
Author
Cheung C.X.; Healy D.A.; Walsh S.R.
Institution
(Cheung, Healy) Department of Surgery, University Hospital Waterford,
Waterford, Ireland
(Walsh) Department of Surgery, National University of Ireland Galway,
University Road, Galway, Ireland
Title
Remote preconditioning and cardiac surgery: Regrouping after Remote
Ischemic Preconditioning for Heart Surgery (RIPHeart) and Effect Of Remote
Ischemic Preconditioning On Clinical Outcomes In Patients Undergoing
Coronary Artery Bypass Surgery (ERICCA).
Source
Journal of Thoracic Disease. 8 (3) (pp E197-E199), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Pioneer Bioscience Publishing
Abstract
Remote ischaemic preconditioning (RIPC) is an attractive cardioprotective
strategy. Although results from animal studies and phase II study on
humans are convincing, it cannot have a role in clinical practice until
benefits in clinical outcomes are proven in phase III study. Two phase III
studies were recently published [Remote Ischemic Preconditioning for Heart
Surgery (RIPHeart) and Effect of Remote Ischemic Preconditioning on
Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery
(ERICCA)] and this article discusses their design, results and
implications.
<41>
Accession Number
20160260902
Author
Cai Q.; Gu X.; Li J.; Zhang Z.
Institution
(Cai, Gu, Li, Zhang) Department of Anesthesiology, Navy General Hospital,
Beijing 100048, China
Title
Dezocine in patients during recovery after anesthesia for thoracotomy: A
prospective randomized controlled trial.
Source
International Journal of Clinical and Experimental Medicine. 9 (2) (pp
5077-5082), 2016. Date of Publication: 29 Feb 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To study the safety and efficacy of dezocine in patients during
recovery from general anesthesia after thoracic surgery. Methods: A total
of 90 patients (ASA physical status I and II) receiving thoracotomy were
randomly divided into three groups. Fifteen minutes before the end of
operation, patients in the control group were given 2 mL saline
intravenously, patients in sufentanil group received 0. 2 mug/kg
sufentanil diluted in 2 mL saline, and those in dezocine group received 0.
1 mg/kg dezocine diluted in 2 mL saline. Results: Compared with control
group, the MAP and HR of patients in sufentanil and dezocine groups were
significantly reduced at the time points T1 to T4 (P<0. 05). The time of
tracheal extubation and orientation recovery time did not differ
significantly among the three groups (P>0. 05). The dwelling time in PACU
of patients from dezocine group was significantly reduced compared with
those from the control group and sufentanil group (56+/-11 min vs. 73+/-12
min and 68+/-12 min, P<0. 05). In addition, patients from dezocine group
had significantly reduced sedation-agitation scale and Ramsay sedation
scale compared with those from sufentanil group at all time points during
the time of extubation (P<0. 05). Conclusion: The use of dezocine in
patients during anesthesia recovery period after thoracotomy can maintain
hemodynamic stability, ensure a smooth recovery, and lead to a low rate of
respiratory depression.
<42>
Accession Number
20151065890
Author
Cardoso R.; Ansari M.; Garcia D.; Sandhu S.; Brinster D.; Piazza N.
Institution
(Cardoso, Sandhu) Division of Cardiology Department of Medicine,
University of Miami, Jackson, Memorial Hospital, Miami, FL, United States
(Ansari) Division of Structural Heart Diseases, Department of
Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York,
NY, United States
(Garcia) Department of Cardiology, Ochsner Medical Center, New Orleans,
LA, United States
(Brinster) Department of Cardiothoracic Surgery, Lenox Hill Heart and
Vascular Institute, New York, NY, United States
(Piazza) Division of Cardiology, Department of Medicine, McGill University
Health Centre, Montreal, QC, Canada
Title
Prestenting for prevention of melody valve stent fractures: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (3) (pp 534-539),
2016. Date of Publication: 15 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction The role of right ventricular outflow tract (RVOT)
prestenting in the prevention of Melody valve stent fractures (SFs) is not
well defined. We aimed to perform a systematic review and meta-analysis
comparing the incidence of SF in Melody valve transcatheter pulmonary
implants with and without prestenting. Methods PubMed, EMBASE, and
Cochrane Central were searched for studies that reported the incidence of
SF in Melody valve transcatheter pulmonary implants stratified by the
presence or absence of RVOT prestenting. Subgroup analyses were performed
for (1) SF associated with a loss of stent integrity and (2) SF requiring
reintervention. Results Five studies and 360 patients were included, of
whom 207 (57.5%) received prestenting. Follow-up ranged from 15 to 30
months. SF were significantly reduced in the prestenting group (16.7%)
when compared to no prestenting (33.5%) (odds-ratio [OR] 0.39; 95%CI
0.22-0.69). Patients who received prestenting also had a lower incidence
of (1) SF associated with loss of stent integrity (OR 0.16; 95%CI
0.05-0.48) and (2) SF requiring reintervention (OR 0.15; 95%CI 0.02-0.91).
Conclusion Our findings suggest that stenting of the RVOT prior to Melody
valve implantation is associated with a reduction in the incidence of SF
and fracture-related reinterventions.
<43>
Accession Number
2015487603
Author
Lin Y.J.; Xu L.; Huang X.Z.; Jiang F.; Li S.L.; Lin F.; Ye Q.Y.; Chen
M.L.; Lin J.L.
Institution
(Lin, Xu, Huang, Jiang, Li, Lin, Ye, Chen, Lin) Department of Cardiac
Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian
Province, China
Title
Reduced occurrence of ventilator-associated pneumonia after cardiac
surgery using preoperative 0.2% chlorhexidine oral rinse: Results from a
single-centre single-blinded randomized trial.
Source
Journal of Hospital Infection. 91 (4) (pp 362-366), 2015. Date of
Publication: 2015.
Publisher
W.B. Saunders Ltd
Abstract
Since mechanical ventilation after cardiac surgery increases the risk of
ventilator-associated pneumonia (VAP), we conducted a prospective
randomized controlled trial to investigate the effect of preoperative 0.2%
chlorhexidine on postoperative VAP. Ninety-four patients scheduled for
heart surgery were randomized to a chlorhexidine group (N = 47) or control
(saline) group (N = 47). On the day before surgery, patients gargled three
times with 0.2% chlorhexidine or saline 30. min after each meal and 5. min
after teeth brushing at bedtime. VAP occurred in 8.5% of the chlorhexidine
group and in 23.4% of the controls. Preoperative chlorhexidine mouthwash
reduced the incidence of postoperative VAP significantly.
<44>
Accession Number
20160230162
Author
Zorn G.L.; Little S.H.; Tadros P.; Deeb G.M.; Gleason T.G.; Heiser J.;
Kleiman N.S.; Oh J.K.; Popma J.J.; Adams D.; Huang J.; Reardon M.J.
Institution
(Zorn, Tadros) Cardiovascular Research Institute, University of Kansas
Hospital, 3901 Rainbow Blvd, Kansas City, KS 66160, United States
(Little, Kleiman, Reardon) Houston Methodist DeBakey Heart and Vascular
Center, Houston Methodist Hospital, Houston, TX, United States
(Deeb) University of Michigan Medical Center, Ann Arbor, MI, United States
(Gleason) University of Pittsburgh, School of Medicine, Pittsburg, PA,
United States
(Heiser) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Oh) Mayo Clinic, Rochester, MN, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Adams) Mount Sinai Medical Center, New York, NY, United States
(Huang) Medtronic, Minneapolis, MN, United States
Title
Prosthesis-patient mismatch in high-risk patients with severe aortic
stenosis: A randomized trial of a self-expanding prosthesis.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (4) (pp 1014-1023.e3),
2016. Date of Publication: 01 Apr 2016.
Publisher
Mosby Inc.
Abstract
Objectives We compared the incidence of prosthesis-patient mismatch (PPM)
between transcatheter aortic valve replacement (TAVR) using a
self-expanding bioprosthesis and surgical aortic valve replacement (SAVR)
in the CoreValve US High Risk Pivotal Trial. We sought to determine the
influence of PPM on clinical outcomes. Methods Patients with severe aortic
stenosis and at increased risk for surgery were randomized 1:1 to TAVR or
SAVR. Postoperative PPM was defined by the effective orifice area index
(EOAi) as severe PPM (EOAi < 0.65 cm<sup>2</sup>/m<sup>2</sup>) and no
severe PPM (EOAi > 0.65 cm<sup>2</sup>/m<sup>2</sup>); clinical outcomes
were analyzed in the TAVR arm (n = 389) and SAVR arm (n = 353). Left
ventricular mass index and regression were analyzed at baseline and 1
year. Results The incidence of severe PPM in the SAVR group at 1 year was
25.7% versus 6.2% in the TAVR group (P <.0001). Left ventricular mass
index regression at 1 year was 6.8% for TAVR and 15.1% for SAVR in
patients with severe PPM. At 1 year the rate of all-cause mortality and
acute kidney injury were significantly greater in all patients (TAVR +
SAVR) with severe PPM compared with no severe PPM (20.6% vs 12.0% [P
=.0145] for death and 19.2% vs 8.5% [P =.0008] for acute kidney injury).
Conclusions In patients with high surgical risk and severe aortic
stenosis, severe PPM is more common in patients treated with SAVR than
those treated with TAVR. Patients with severe PPM are a greater risk for
death and acute kidney injury than patients without severe PPM.
<45>
Accession Number
20160233647
Author
Tegn N.; Abdelnoor M.; Aaberge L.; Endresen K.; Smith P.; Aakhus S.;
Gjertsen E.; Dahl-Hofseth O.; Ranhoff A.H.; Gullestad L.; Bendz B.
Institution
(Tegn, Aaberge, Endresen, Aakhus, Gullestad, Bendz) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo 0424, Norway
(Abdelnoor) Centre for Biostatistics and Epidemiology, Oslo University
Hospital, Oslo, Norway
(Abdelnoor) Centre for Clinical Heart Research, Oslo University Hospital,
Oslo, Norway
(Tegn, Smith, Gullestad, Bendz) Faculty of Medicine, University of Oslo,
Oslo, Norway
(Smith) Department of Cardiology, Akershus University Hospital, Lorenskog,
Norway
(Gjertsen) Department of Cardiology, Drammen Hospital, Drammen, Norway
(Dahl-Hofseth) Department of Cardiology, Lillehammer Hospital,
Lillehammer, Norway
(Ranhoff) Diakonhjemmet Hospital, Department of Clinical Science,
University of Bergen, Bergen, Norway
Title
Invasive versus conservative strategy in patients aged 80 years or older
with non-ST-elevation myocardial infarction or unstable angina pectoris
(After Eighty study): An open-label randomised controlled trial.
Source
The Lancet. 387 (10023) (pp 1057-1065), 2016. Date of Publication: 12 Mar
2016.
Publisher
Lancet Publishing Group
Abstract
Background Non-ST-elevation myocardial infarction (NSTEMI) and unstable
angina pectoris are frequent causes of hospital admission in the elderly.
However, clinical trials targeting this population are scarce, and these
patients are less likely to receive treatment according to guidelines. We
aimed to investigate whether this population would benefit from an early
invasive strategy versus a conservative strategy. Methods In this
open-label randomised controlled multicentre trial, patients aged 80 years
or older with NSTEMI or unstable angina admitted to 16 hospitals in the
South-East Health Region of Norway were randomly assigned to an invasive
strategy (including early coronary angiography with immediate assessment
for percutaneous coronary intervention, coronary artery bypass graft, and
optimum medical treatment) or to a conservative strategy (optimum medical
treatment alone). A permuted block randomisation was generated by the
Centre for Biostatistics and Epidemiology with stratification on the
inclusion hospitals in opaque concealed envelopes, and sealed envelopes
with consecutive inclusion numbers were made. The primary outcome was a
composite of myocardial infarction, need for urgent revascularisation,
stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014.
An intention-to-treat analysis was used. This study is registered with
ClinicalTrials.gov, number NCT01255540. Findings During a median follow-up
of 1.53 years of participants recruited between Dec 10, 2010, and Feb 21,
2014, the primary outcome occurred in 93 (40.6%) of 229 patients assigned
to the invasive group and 140 (61.4%) of 228 patients assigned to the
conservative group (hazard ratio [HR] 0.53 [95% CI 0.41-0.69], p=0.0001).
Five patients dropped out of the invasive group and one from the
conservative group. HRs for the four components of the primary composite
endpoint were 0.52 (0.35-0.76; p=0.0010) for myocardial infarction, 0.19
(0.07-0.52; p=0.0010) for the need for urgent revascularisation, 0.60
(0.25-1.46; p=0.2650) for stroke, and 0.89 (0.62-1.28; p=0.5340) for death
from any cause. The invasive group had four (1.7%) major and 23 (10.0%)
minor bleeding complications whereas the conservative group had four
(1.8%) major and 16 (7.0%) minor bleeding complications. Interpretation In
patients aged 80 years or more with NSTEMI or unstable angina, an invasive
strategy is superior to a conservative strategy in the reduction of
composite events. Efficacy of the invasive strategy was diluted with
increasing age (after adjustment for creatinine and effect modification).
The two strategies did not differ in terms of bleeding complications.
Funding Norwegian Health Association (ExtraStiftelsen) and Inger and John
Fredriksen Heart Foundation.
<46>
Accession Number
20160236836
Author
Munnee K.; Bundhun P.K.; Quan H.; Tang Z.
Institution
(Munnee, Quan, Tang) Department of Oral and Maxillofacial Surgery, Xiangya
Hospital, Central South University, No.87, Xiangya Road, Changsha, Hunan
410008, China
(Bundhun) Institute of Cardiovascular Diseases, First Affiliated Hospital
of Guangxi Medical University, Nanning, Guangxi, China
Title
Comparing the clinical outcomes between insulin-treated and
non-insulin-treated patients with type 2 diabetes mellitus after coronary
artery bypass surgery: A systematic review and meta-analysis.
Source
Medicine (United States). 95 (10) (no pagination), 2016. Article Number:
e3006. Date of Publication: 04 Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Several studies have shown coronary artery bypass surgery (CABG) to be
beneficial in patients with type 2 diabetes mellitus (T2DM) and
multivessel coronary artery diseases. Patients with insulin-treated T2DM
(ITDM) are usually patients with poor glycemic control and are expected to
suffer more complications compared with patients with non-insulin-treated
T2DM (NITDM). However, the adverse clinical outcomes in patients with ITDM
and NITDM after CABG are still not very clear. Hence, to solve this issue,
we aim to compare the short-and long-term adverse clinical outcomes in a
larger number of patients with ITDM and NITDM after CABG, respectively.
Randomized controlled trials and observational studies comparing the
adverse clinical outcomes such as mortality, major adverse events (MAEs),
stroke, myocardial infarction, and repeated revascularization in patients
with ITDM and NITDM after CABG have been searched from Medline, EMBASE,
Cochrane, and PubMed databases. A shortterm follow-up (-30 days) and a
long-term follow-up (-1 year) were considered. Odds ratio (OR) with 95%
confidence interval (CI) was used to express the pooled effect on
discontinuous variables and the pooled analyses were performed with RevMan
5.3. Eleven studies involving a total of 64,152 patients with T2DM (23,781
patients with ITDM and 40,371 patients with NITDM) have been included in
this meta-analysis. During the short-term follow-up period, patients with
ITDM had a significantly higher mortality (OR: 1.47; 95% CI: 1.33-1.61,
P<0.00001) andMAEs (OR: 1.66; 95% CI: 1.48-1.87, P<0.00001). During the
long-term follow-up period, patients with ITDM still had a significantly
higher rate of mortality, MAEs, and stroke (OR: 1.23, 95% CI: 1.02-1.49,
P=0.03; OR: 1.50, 95% CI: 1.07-2.12, P=0.02; OR: 1.39, 95% CI: 1.22-1.59,
P<0.00001, respectively) after CABG. However, our results showed similar
repeated revascularization rate between the ITDM and NITDMgroups after
CABG (OR: 1.31, 95% CI: 0.81-2.12, P=0.27). According to this study,
patientswith ITDMhad a significantly higher rate of mortality and MAEs
compared with patients with NITDM after CABG. Strokewas also significantly
higher in patientswith ITDMduring a long-term follow-up period. However,
since the result for the long-term mortality had a higher heterogeneity as
compared with the other subgroups, and because a similar revascularization
rate was observed between the ITDM and NITDM groups after CABG maybe
because of a limited number of patients analyzed, further studies still
need to be conducted to completely solve this issue.
<47>
[Use Link to view the full text]
Accession Number
20160236808
Author
Violi F.; Lip G.Y.H.; Pignatelli P.; Pastori D.
Institution
(Violi, Pignatelli, Pastori) Center of Atherothrombosis, I Medical Clinic,
Department of Internal Medicine and Medical Specialties, Sapienza
University of Rome, Umberto i Policlinic of Rome, Viale del Policlinico
155, Rome 00161, Italy
(Lip) Centre for Cardiovascular Sciences, City Hospital, University of
Birmingham, Birmingham, United Kingdom
Title
Interaction between dietary Vitamin K intake and anticoagulation by
Vitamin K antagonists: is it really true?: A systematic review.
Source
Medicine (United States). 95 (10) (no pagination), 2016. Article Number:
e2895. Date of Publication: 04 Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Educational advice is often given to patients starting treatment with
vitamin K Antagonists (VKAs). A great emphasis is made on nutritional
information. Common belief is that dietary vitamin K intake could
counteract the anticoagulant effect by VKAs and for many years, patients
have been discouraged to consume vitamin-K-rich foods, such as green leafy
vegetables. The objective of this study is to summarize the current
evidence supporting the putative interaction between dietary vitamin K
intake and changes in INR with the VKAs. Data sources are MEDLINE via
PubMed and Cochrane database. All clinical studies investigating the
relationship between dietary vitamin K and measures of anticoagulation
were included. We excluded all studies of supplementation of vitamin K
alone. We performed a systematic review of the literature up to October
2015, searching for a combination of "food," "diet," "vitamin K,"
"phylloquinone," "warfarin," "INR," "coagulation," and "anticoagulant."
Two dietary interventional trials and 9 observational studies were
included. We found conflicting evidence on the effect of dietary intake of
vitamin K on coagulation response. Some studies found a negative
correlation between vitamin K intake and INR changes, while others
suggested that a minimum amount of vitamin K is required to maintain an
adequate anticoagulation. Median dietary intake of vitamin K1 ranged from
76 to 217mg/day among studies, and an effect on coagulation may be
detected only for high amount of vitamin intake (>150mg/day). Most studies
included patients with various indications for VKAs therapy, such as
atrial fibrillation, prosthetic heart valves, and venous thromboembolism.
Thus, INR target was dishomogeneous and no subanalyses for specific
populations or different anticoagulants were conducted. Measures used to
evaluate anticoagulation stability were variable. The available evidence
does not support current advice to modify dietary habits when starting
therapy with VKAs. Restriction of dietary vitamin K intake does not seem
to be a valid strategy to improve anticoagulation quality with VKAs. It
would be, perhaps, more relevant to maintain stable dietary habit,
avoiding wide changes in the intake of vitamin K.
<48>
Accession Number
72243728
Author
Akinapelli A.; Azzouz M.S.; Koduri H.; Ayan M.; Alla V.; Esterbrooks D.
Institution
(Akinapelli, Azzouz, Koduri, Ayan, Alla, Esterbrooks) Creighton University
Medical Center, Omaha, NE, United States
Title
Efficacy of anticoagulation in preventing thromboembolism after bio
prosthetic aortic valve replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 2225), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: The efficacy of oral anticoagulation (AC) after bio prosthetic
aortic valve replacement (BPAVR) remains unclear. Current guidelines
recommend AC for first three months after BPAVR, but there is significant
variation in clinical practice. We performed a metaanalysis of studies
comparing AC to aspirin or no therapy after BPAVR. Methods: PubMed,
Cochrane databases were queried electronically to identify studies
comparing AC (warfarin with or without aspirin) with no AC (either aspirin
or no therapy) in patients with BPAVR with no other indications for AC
from 2000-2015. Primary outcomes assessed were thromboembolic events (TAE)
and major bleeding. Analysis was performed following the PRISMA guidelines
using random effects. Results: One randomized controlled & 7 observational
studies with 29,257 patients (60% male) were included. All patients in AC
group had at least 3 months of AC. Mean follow up was 9 months. There was
no significant difference in TAE between AC and no AC groups (Risk ratio
[RR] 0.89, 95% CI 0.5-1.61). There was significant increase in bleeding
with AC (RR 2.05, 95% CI 1.29-3.24). Studies comparing AC with aspirin
alone (n=5) showed no significant difference between TAE (RR 1.37 95% CI
0.95-1.99) with increase in bleeding (RR 2.63, 95% CI 1.10-6.29) with AC.
Conclusions: In our analysis, AC after BPAVR did not result in a
significant decrease in TAE but was associated with an increased risk of
bleeding. Further studies are needed to clarify efficacy and optimal
duration of AC after BPAVR. (Table Presented) .
<49>
Accession Number
72243713
Author
Genereux P.; Stone G.; O'Gara P.; Gravel G.M.; Redfors B.; Giustino G.;
Pibarot P.; Bax J.; Bonow R.; Leon M.
Institution
(Genereux, Stone, O'Gara, Gravel, Redfors, Giustino, Pibarot, Bax, Bonow,
Leon) Cardiovascular Research Foundation, New York, NY, USA, Columbia
University Medical Center, New York, NY, USA
Title
Early aortic valve replacement versus a conservative strategy for
asymptomatic severe aortic stenosis: Meta-analysis of observational
studies.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 2210), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Approximately 50% of patients with severe aortic stenosis (AS)
are asymptomatic. Whether a strategy of early aortic valve replacement
(AVR) compared to a conservative "watchful waiting" approach is preferred
in these patients is uncertain and controversial. We performed a
study-level meta-analysis of all available published studies comparing
early surgical AVR to the current conservative approach in patients with
severe asymptomatic AS. Methods: A systematic review of studies of
patients >18 years old with asymptomatic severe AS in which survival was
reported was performed through October 24, 2015. Results: A total of 4
observational studies (no randomized trials) including 2,486 patients met
inclusion criteria and were included in the analysis. Unadjusted and
adjusted rates of all-cause mortality were 3.5-fold and 3.7-fold higher,
respectively, with a watchful-waiting strategy compared to early AVR
(Figure), although substantial heterogeneity between studies in the
magnitude of effect was present. Conclusions: Our findings suggest that
early surgical AVR might improve outcomes in patients with severe
asymptomatic AS. As unmeasured confounders cannot be excluded, these data
warrant a large-scale, prospective, randomized clinical trial to evaluate
routine early AVR (using surgical and/or transcatheter technology) in
severe asymptomatic AS. (Table Presented) .
<50>
Accession Number
72243468
Author
Papageorgiou N.; Briasoulis A.; Lazaros G.; Androulakis E.; Siasos G.;
Charakida M.; Toutouzas K.; Afonso L.; Tousoulis D.
Institution
(Papageorgiou, Briasoulis, Lazaros, Androulakis, Siasos, Charakida,
Toutouzas, Afonso, Tousoulis) Barts Heart Centre, London, United Kingdom,
Athens University Medical School, Athens, Greece
Title
Colchicine for prevention and treatment of cardiac diseases: An updated
metaanalysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 1965), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Colchicine has been suggested to be beneficial in preventing
recurrent pericarditis. The goal of this study was to review all
randomized controlled trials that assess the use of colchicine for the
prevention and treatment of cardiac diseases. Methods: We performed a
meta-analysis of the effects of colchicine on pericarditis,
post-pericardiotomy syndrome and post-procedural atrial fibrillation
recurrence, in-stent restenosis, gastrointestinal adverse effects and
treatment discontinuation rates. We conducted an EMBASE and MEDLINE search
for prospective controlled trials. Results: We identified 17 prospective
controlled randomized studies with 2082 patients that received colchicine
and 1982 control with an average follow up duration of 12 months.
Treatment with colchicine is associated with reduced risk of pericarditis
recurrence/postpericardiotomy syndrome (OR: 0.37; 95% CI 0.29-0.47;
P<0.001) and lower recurrence of atrial fibrillation rates (p<0.001) after
cardiac surgery and ablation procedures (OR: 0.54, 95% CI: 0.41-0.7; P=
0.001). However, gastrointestinal side effects were more common in
patients treated with colchicine (OR: 2.6; 95% CI 1.82-3.72; P<0.001) in
all subgroups except for those treated for prevention of recurrent
pericarditis. The higher rates of side effects resulted in higher
incidence of treatment discontinuation in patients treated with colchicine
(OR: 2.89, 95% CI: 1.76 - 4.74; P= 0.001) . Conclusions: Colchicine
appears to be efficacious and well tolerated for recurrent
pericarditis/post-pericardiotomy syndrome and recurrence of post
procedural atrial fibrillation. However, its efficacy may be limited by
its gastrointestinal adverse events and treatment discontinuation rates
particularly in post-operative patients.
<51>
Accession Number
72243387
Author
Koduri H.; Kanmanthareddy A.; Akinapelli A.; Bansal O.; Pandya J.;
Aggarwal S.; Azzouz M.S.; Del Core M.; Mooss A.
Institution
(Koduri, Kanmanthareddy, Akinapelli, Bansal, Pandya, Aggarwal, Azzouz, Del
Core, Mooss) Creighton University Medical Center, Omaha, NE, United States
Title
Efficacy of ezetimibe and statin versus statin: A meta-analysis of
randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 1884), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Current ACC/AHA guidelines do not make recommendation to use
Ezetimibe to reduce Atherosclerotic cardiovascular disease. Most recently,
the IMPROVE-IT trial demonstrated improved cardiovascular outcomes with
addition of Ezetimibe to statin (ES) compared to statin alone (S). We
performed a Meta-Analysis to compare the clinical efficacy of ES vs S.
Methods: PubMed, EBSCO and Google Scholar databases were electronically
queried for RCTs comparing outcomes of ES vs S. We calculated risk ratios
(RR) and 95% CIs using random or fixed effects model depending on
heterogeneity for the outcomes of Major Adverse Vascular Events (MAVE),
Stroke, Myocardial Infarction (MI), Coronary Revascularization (CR),
Cardiovascular Death (CVD) and weighted mean difference (WMD) for
difference in LDL levels between groups. RevMan 5.3 was used for
statistical analysis. Results: 5 RCTs with a total of 19,293 patients met
inclusion criteria. There is a statistically significant reduction in MAVE
(RR 0.93; CI: 0.89-0.97, p = 0.002), Stroke (RR 0.8; CI: 0.68-0.94, p =
0.008) and MI (RR 0.87; CI: 0.81-0.94, p = 0.001) in ES group compared to
S group. There is a trend towards lower CR (RR 0.94; CI: 0.89-1.00, p =
0.06) and lower LDL levels (WMD -25.23; CI: -51.08 - 0.61, p = 0.06) in ES
group. There was no difference in CVD. Table 1. Conclusions: The results
of our meta-analysis suggest that adding Ezetimibe to statin significantly
reduces MAVE, MI and Stroke compared to statin alone. Furthermore there is
a decreased trend for CR with ES. (Table presented).
<52>
Accession Number
72242428
Author
Godfrey M.E.; Friedman K.; Freud L.; Drogosz M.; Wilkins-Haug L.; Benson
C.; Lock J.; Marshall A.; Tworetzky W.
Institution
(Godfrey, Friedman, Freud, Drogosz, Wilkins-Haug, Benson, Lock, Marshall,
Tworetzky) Boston Children's Hospital, Boston, MA, USA, Brigham and
Women's Hospital, Boston, MA, USA
Title
Fetal aortic valvuloplasty improves likelihood of biventricular outcome in
live born infants.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 925), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Fetal aortic valvuloplasty (FAV) is performed to avert
progression to hypoplastic left heart syndrome (HLHS) and promote a
biventricular (BiV) outcome. However, it is not yet known if FAV results
in increased rates of BiV outcome. Methods: Between 2000 and 2015, 123
patients underwent attempted FAV. We compared rates of BiV outcome from
birth and HLHS in fetuses with technically successful (TS, visible balloon
inflation across the aortic annulus with improved flow, n=101) or
unsuccessful (TU, n=22) procedures. Results: Of the 101 TS procedures, 94
were live born, of which 40 (42.6%) were managed as a BiV circulation from
birth. Of the 22 TU procedures, 18 fetuses were live born. Of these 18,
only 2 (11.1%) were managed as BiV (Fisher's exact test p= 0.0152). There
was no significant difference in gestational age, aortic valve z-scores,
mitral valve z-scores or left ventricular pressure between the 2 groups.
Conclusions: TS FAV is associated with increased rates of BiV circulation.
The TU cohort may be seen as a form of control, as they were considered
appropriate candidates for FAV, but the aortic valve was not successfully
dilated. In the absence of a randomized controlled trial, these data may
provide support for the theory that FAV alters the natural history of
severe fetal aortic stenosis, resulting in a higher rate of BiV outcome.
(Figure presented).
<53>
Accession Number
72242296
Author
Kundu A.; Sardar P.; Ghosh S.; Chatterjee S.; McManus D.
Institution
(Kundu, Sardar, Ghosh, Chatterjee, McManus) University of Massachusetts
Medical School, Worcester, MA, United States
Title
Remote ischemic preconditioning for prevention of post-operative atrial
fibrillation in patients undergoing cardiac surgery: A meta-analysis of
randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 793), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Post-operative Atrial Fibrillation (POAF) is a common
complication of cardiac surgery. Remote Ischemic Preconditioning (RIPC) -
a technique which has recently gained popularity as a novel method to
protect against ischemia reperfusion injury during cardiac surgery, has
shown favorable effects on reducing peri-procedural myocardial infarction
and postoperative acute kidney injury. However, data is lacking regarding
the effects of RIPC on POAF. We performed a meta-analysis investigating
the role of RIPC in reducing POAF in patients undergoing cardiac surgery.
Methods: We searched PubMed, EMBASE, and Cochrane Library from the
inception to October 15th, 2015 for Randomized Controlled Trials (RCTs)
involving RIPC for cardiac surgery. Only trials which reported data on
POAF were included. The main outcome of interest was incidence of POAF
with RIPC compared to control . The random effects model of DerSimonian
and Laird was used. Statistical Analysis was performed using Review
Manager (RevMan) version 5.3. Results: Six RCTs involving a total of 3440
patients were included in the final analysis. Compared to patients
undergoing cardiac surgery without ischemic preconditioning, RIPC did not
reduce the incidence of POAF [ Odd's Ratio 0.87, 95 % Confidence Interval
0.67 to 1.14] (Figure). No significant heterogeneity was identified [I2
=47 %]. Conclusions: Based on the results of our analysis, there is no
evidence that RIPC reduces the incidence of POAF in patients undergoing
cardiac surgery (Figure Presented).
<54>
Accession Number
72242219
Author
Anouti K.; Qureshi W.; El Baba M.; Refaat M.
Institution
(Anouti, Qureshi, El Baba, Refaat) Lankenau Medical Center, Wynnewood, PA,
United States
Title
Postoperative atrial fibrillation and stroke following left atrial
appendage closure during routine cardiac surgery.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 716), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: The left atrial appendage (LAA) is the most common source of
thrombus resulting in stroke. Several percutaneous techniques for LAA
occlusion have been recently proposed; including intracardiac plugs and
external ligation. Only one device, WATCHMAN, has been compared to the
standard therapy in randomized clinical trials. Mechanical approaches to
LAA occlusion, on the other hand, have been used for more than half a
century in cardiac surgery. It is not known if left atrial appendage
closure during routine cardiac surgery leads to lower risk of stroke and
postoperative atrial fibrillation (AF). Methods: We systematically
reviewed studies evaluating LAA closure during routine cardiac surgery and
the risk of post procedure stroke or transient ischemic attack (TIA) and
AF. We searched MEDLINE, CINAHL, Web of Science, meeting abstracts,
presentations and Cochrane central databases from inception through June
2015. For a study to be selected, it had to report the rates of incident
stroke and AF in individuals with and without LAA closure. Data were
extracted by 2 independent authors. Forrest plot was created to show the
effect sizes. Results: A total of 11 studies including 16403 patients were
analyzed. There were 3237 patients that underwent LAA closure and 13166
patients that did not undergo LAA closure. Over a mean follow up of 21.6
months, there were 65 (2.0%) stroke/TIA and 685 (21.9%) incident AF that
occurred in LAA exclusion group, while 596 (4.5%) stroke/TIA and 2978
(31.9%) incident AF occurred in non LAA closure group. In a random effects
model, there was a trend towards lower risk of stroke/TIA in individuals
with LAA exclusion [pooled hazard ratio (95% confidence interval); 0.78
(0.60 - 1.01) p-value= 0.06] while there was no significant association of
LAA closure with incident AF (p-value >0.71). Conclusions: In this
meta-analysis of studies, LAA closure during routine cardiac surgery
showed a trend towards lower risk of post procedure stroke/TIA but did not
show an association with reduced risk of AF. Further trials are needed to
show the long-term safety and effectiveness of prophylactic LAA closure
during cardiac surgery as an effective alternative to anticoagulation in
reducing stroke.
<55>
Accession Number
72242192
Author
Garg J.; Chaudhary R.; Krishnamoorthy P.; Shah N.; Sharma A.; Bozorgnia
B.; Valley L.
Institution
(Garg, Chaudhary, Krishnamoorthy, Shah, Sharma, Bozorgnia, Valley) Health
Network, Allentown, PA, United States
Title
Role of prophylactic magnesium supplementation in prevention of
postoperative atrial fibrillation in patients undergoing coronary artery
bypass grafting: A meta-analysis of 23 randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 689), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Several randomized clinical trials have evaluated the efficacy
of prophylactic magnesium (Mg) supplementation in prevention of
post-operative atrial fibrillation (POAF) in patients undergoing cardiac
artery bypass grafting (CABG). We aim to determine the role of
prophylactic Mg in 3 settings (intraoperative, postoperative,
intraoperative + postoperative) in prevention of POAF. Methods: A systemic
literature search was performed (until October 20, 2015) using PubMed,
EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials
to identify trials evaluating Mg supplementation post CABG. Primary
outcome of our study was reduction in the POAF.. For each study, the
incidence of atrial fibrillation in both the intervention and placebo
groups was extracted to calculate odd ratio and 95% confidence intervals
(CIs). Results: We included a total of 2,973 participants (1,471 in the Mg
group and 1,502 in the placebo group) enrolled in 23 randomized controlled
trials. By using random-effects models, pooled analysis demonstrated no
significant reduction in POAF (OR 0.81; 95% CI, 0.64- 1.02; p = 0.08) in
Mg group as compared to placebo. However, there was reduction in POAF in
the group that received prophylactic Mg postoperatively (OR 0.66; 95% CI
0.44-0.99; p = 0.04) with no significant heterogeneity. Number needed to
treat in our study = 13 (95% CI 7.04-81.34). Conclusions: Prophylactic
postoperative Mg supplementation resulted in a lower incidence of POAF in
patients undergoing CABG. (Table Presented).
<56>
Accession Number
72242120
Author
Narayanan M.A.; Devineni H.; Murray J.; Kanmanthareddy A.; Baskaran J.;
Suri R.M.
Institution
(Narayanan, Devineni, Murray, Kanmanthareddy, Baskaran, Suri) CHI Health,
Creighton University Medical Center, Omaha, NE, USA, Cleveland Clinic
Foundation, Abu Dhabi, United Arab Emirates
Title
Is there any evidence to prefer one arterial graft over the other? a
meta-analysis comparing radial artery versus right internal thoracic
artery for coronary artery bypass grafting.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 617), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Studies comparing radial artery (RA) to right internal
thoracic artery (RITA) for coronary artery bypass grafting (CABG) have
reported conflicting results. Methods: We searched PubMed,Cochrane
library, EMBASE, CINAHL and Google-scholar from inception for clinical
trials comparing RA to RITA as second arterial graft for CABG. Cochrane's
Q-statistics were calculated and used to determine heterogeneity of
included studies. Random effects model was used for analyses. Results: A
total of 28 studies with 19,267 patients were included with mean follow-up
of 79.2 months. Primary outcome was all cause mortality, mentioned in 12
studies and was similar between the groups (odds ratio (OR):0.93,95%
confidence interval (CI):0.55- 1.58,p=.798). There was no difference in
cross clamp time (standard mean difference (SMD): -0.21, 95% CI:
-0.43-0.01,p=.058), bypass time (SMD: -0.52,95% CI: 0.29-0.09,p=.078),
hospital discharge time (SMD: 0.09, 95% CI: - 0.52-0.70, p=.774) and
30-day mortality (OR 1.36, 95% CI:0.88-2.12,p=.165) between the groups.
Comparison of only propensity matched and randomized controlled studies
showed no difference in all-cause mortality (OR:0.95, 95% CI:
0.67-1.37,P=.795) or 30 day mortality (OR: 0.69,95% CI:0.36-1.33, P=.268)
between the RA and RITA grafts. Conclusions: Both RA and RITA grafts as
second arterial grafts in CABG and are associated with similar mortality,
procedural and discharge time and should be considered equally as a second
graft for multi vessel CABG. (Figure Presented).
<57>
Accession Number
72241956
Author
Briasoulis A.; Androulakis E.; Papageorgiou N.; Zacharia E.; Palla M.;
Charakida M.; Mallikethi-Reddy S.; Siasos G.; Toutouzas K.; Afonso L.;
Tousoulis D.
Institution
(Briasoulis, Androulakis, Papageorgiou, Zacharia, Palla, Charakida,
Mallikethi-Reddy, Siasos, Toutouzas, Afonso, Tousoulis) Wayne State
University/Detroit Medical Center, Division of Cardiology, Detroit, MI,
United States
Title
Oral anticoagulants with dual versus single antiplatelet therapy in
patients after percutaneous coronary intervention: An updated
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 453), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Combined use of dual antiplatelet therapy with oral
anticoagulation (OAC) is required after coronary artery stenting or acute
coronary syndromes (ACS). Methods: We performed a meta-analysis (EMBASE
and MEDLINE search) of the comparative effects of triple antithrombotic
therapy (TT) vs OAC with single antiplatelet therapy (DT) on all-cause
mortality, stroke, cardiovascular death, myocardial infarction, target
vessel revascularization and major bleeding. Three prospective controlled
studies and 5 cohort studies compared TT vs dual therapy (DT). We
identified 3 prospective controlled and 5 cohort studies with 4,564
patients on TT and 1,848 on DT with an average follow up duration of 10.1
months. Results: No significant difference in all-cause mortality between
TT and DT was noted in the prospective controlled and cohort study groups.
Myocardial infarction rates were significantly lower in the TT group in
both prospective and cohort studies. Target vessel revascularization was
reported in two prospective controlled studies and one cohort study but no
significant differences between groups were observed. Similarly, stroke
rates were comparable between TT and DT groups. Finally, TT and DT groups
did not differ significantly in major bleeding rates. Conclusions: Triple
antithrombotic therapy is associated with similar mortality and bleeding
rates but less myocardial infarctions compared with OAC and single
antiplatelet therapy. (Table Presented).
<58>
Accession Number
72241914
Author
Bagur R.; Kwok C.S.; Nombela-Franco L.; Ludman P.; De Belder M.; Sponga
S.; Gunning M.; Nolan J.; Kiaii B.; Diamantouros P.; Chu M.; Teefy P.;
Mamas M.A.
Institution
(Bagur, Kwok, Nombela-Franco, Ludman, De Belder, Sponga, Gunning, Nolan,
Kiaii, Diamantouros, Chu, Teefy, Mamas) University Hospital, Department of
Medicine, Western University, London, Canada
Title
Transcatheter aortic valve implantation with or without pre-implantation
balloon aortic valvuloplasty: A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 411), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Pre-implantation baloon-aortc valvuloplasty (BAV) is
considered routine procedure during transcatheter aortic valve
implantation (TAVI) to facilitate prosthesis implantation and expansion;
however, it has been speculated that fewer embolic events and/or
hemodynamic instability may occur if TAVI is performed without
pre-implantation BAV. The aim of the present work was to systematically
review the clinical outcomes associated with TAVI undertaken without
pre-implantation BAV. Methods: We conducted a search of MEDLINE and EMBASE
to identify studies that evaluated patients who underwent TAVI
with/without pre-implantation BAV for predilation. Pooled analysis and
random effects meta-analyses were used to estimate the rate and risk of
adverse outcomes. Results: Sixteen studies involving 1395 patients
(674/721 with/without pre-implantation BAV) fulfilled the inclusion
criteria. Crude device success was achieved in 94% (1311/1395) and 30-day
all-cause mortality occurred in 6% (72/1282) of patients. Meta-analyses
evaluating outcomes between pre-implantation BAV versus without BAV
strategies showed no statistically significant differences in terms of
mortality (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.32-1.14,
P=0.12), safety composite endpoint (RR: 0.85, 95%CI: 0.62-1.18, P=0.34),
moderate-to-severe paravalvular leaks (RR: 0.68, 95%CI: 0.23-1.99,
P=0.48), need for postdilation (RR: 0.86 95%CI: 0.66-1.13, P=0.58), stroke
and/or transient ischemic attack (RR: 0.72 95%CI: 0.30-1.71, P=0.45), and
permanent pacemaker implantation (RR: 0.80 95%CI: 0.49-1.30, P=0.37).
Conclusions: Our analysis suggests that TAVI procedures with or without
pre-implantation BAV were associated with similar outcomes in a number of
clinically relevant endpoints. Further studies including a significant
number of patients are needed to ascertain the impact of TAVI without
pre-implantation BAV as a standard practice.
<59>
Accession Number
72241846
Author
Cardoso R.; Ansari M.; Garcia D.; Martucci G.; Piazza N.
Institution
(Cardoso, Ansari, Garcia, Martucci, Piazza) University of Miami, Jackson
Memorial Hospital, Miami, FL, United States
Title
A meta-analysis of controlled studies comparing mitraclip versus surgery
for severe mitral regurgitation: Is there a mortality benefit?.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 343), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: The MitraClip is a transcatheter device for percutaneous
edge-to-edge mitral valve (MV) repair. Registries have shown safety and
efficacy of MitraClip in the reduction of mitral regurgitation (MR)
severity. Studies comparing MitraClip to MV surgery have shown conflicting
results. Methods: We aimed to perform a meta-analysis of MitraClip vs.
surgical repair for patients with functional or degenerative MR. PubMed,
EMBASE, Cochrane, and study references were searched. Results: Seven
studies (1 RCT, 6 non-randomized) with 1015 patients were included. At
baseline, patients undergoing MitraClip (56.5%) were typically older, more
symptomatic, and with a higher co-morbidity burden. There were no
differences between MitraClip and surgery in cardiovascular (CV)
in-hospital mortality, AKI, or stroke. Length of hospital stay and new
atrial fibrillation were significantly decreased in the MitraClip group.
In follow-up ranging from 6 months to 2.9 years, CV mortality was
significantly decreased in the MitraClip group (Fig 1A). Overall mortality
(Fig 1B) and NYHA III-IV symptoms were not different between groups,
whereas >3+ MR was more prevalent in the MitraClip group. Conclusions:
Despite a higher baseline risk of the MitraClip population, our
meta-analysis suggests that these patients have a lower CV mortality as
compared to MV surgery in intermediate term follow-up. Further randomized
trials are warranted to compare MitraClip and surgical repair in
populations a with similar risk profile. (Figure Presented).
<60>
Accession Number
72241840
Author
Fernandes G.; Cardoso R.; Mendirichaga R.; Garcia D.; Fernandes A.; Ansari
M.
Institution
(Fernandes, Cardoso, Mendirichaga, Garcia, Fernandes, Ansari) University
of Miami, Miami, FL, United States
Title
Mitral valve surgery after failed mitraclip therapy: A systematic review.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 337), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: The MitraClip percutaneous mitral valve repair system is
evolving as a minimally invasive technique to repair mitral valve
regurgitation in high risk patients. There is very limited data to guide
physicians regarding the appropriate approach following unsuccessful
mitral valve clipping, whether surgical valve repair, valve replacement or
serial mitral valve clipping. Currently, data on this topic is limited to
case reports and small case series. Methods: PubMed, EMBASE and Cochrane
Central were searched for studies that reported cases of surgical
intervention after failed mitral clipping. Data was collected regarding
indication for surgical intervention, complications of clipping and
outcomes after surgery. Results: A total of 7 studies and 67 patients were
included. The most common indication for subsequent surgical intervention
after MitraClip insertion was recurrent mitral valve regurgitation greater
than 2+ (61.7%), followed by partial clip detachment (21.3%) and provoked
mitral stenosis (8.5%). In 5 of the studies, all the patients experienced
leaflet or chordal damage secondary to clipping, what turned the
subsequent valve repair more difficult, and overall this complication was
described in 77% of the patients. Atrial septal defect was described as a
complication of clipping in 45.3% of cases. Valve repair was the procedure
of choice to 27 patients (40.3%), while the remaining 49.7% underwent
valve replacement. One study showed that mitral valve repair could be
performed in 83% of patients who had only one clip and in only 23% of
patients with 2 or more clips. Bacterial endocarditis was reported in 4.5%
of the patients. Only 2 deaths were reported in the peri-procedure time.
Two studies reported 1 year survival, that ranged from 68 to 77%.
Conclusions: In summary, we report the overall rate of complications of
mitral valve clipping and the outcomes of surgical intervention after
failed clipping in pooled data from previously published studies. Data
from these studies points towards good outcomes with mitral valve surgery
after MitraClip failure. Also, data suggests that the presence of more
than one mitral valve clip decreases the potential for a subsequent
surgical repair.
<61>
Accession Number
72241837
Author
Wang T.K.M.; Wang M.T.M.; Ruygrok P.
Institution
(Wang, Wang, Ruygrok) Auckland City Hospital, Auckland, New Zealand
Title
Comparison of mitraclip and mitral valve surgery for severe mitral
regurgitation: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 334), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Mitral valve surgery (MVS) is recommended for severe
symptomatic mitral regurgitation (MR). The recent introduction of
percutaneous Mitraclip procedure especially in high risk patients adds
another dimension to MR management. We compared the characteristics and
outcomes of MitraClip and MVS in this meta-analysis. Methods: PubMed,
MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30
June 2015 were searched for original studies. Two authors evaluated these
studies for inclusion independently, then extracted and pooled data using
random-effects models. Results: Seven studies (one randomised trial and
six observational studies) were included from the 547 papers searched,
totaling 574 Mitraclip and 441 MVS procedures. Functional MR made up 47.2%
of MitraClip and 59.6% of MVS (P=0.003). At baseline, mitralclip patients
were significantly older (P<0.001), more likely to have previous cardiac
surgery (P<0.001) and had lower ejection fraction (P<0.001) and higher
EuroSCORE (P<0.001). MitraClip had higher rate of at least moderate MR
post-operatively compared to MVS (15.8% vs 0.5%, P<0.001). There were no
differences in mortality (1.6% vs 3.1%, P=0.58), neurological events (0.7%
vs 1.6%, P=0.34) or re-operations for prosthetic incompetence (2.0% vs
1.0%, P=0.56) in-hospital or within 30 days respectively. At 12 months
there were no differences in mortality (11.3% vs 10.2%, P=0.41) or New
York Heart Association Class III/IV (5.7% vs 11.3%, P=0.42). Conclusions:
Patients undergoing MitraClip had higher baseline risk than MVS, but there
were no significant differences in mortality, morbidity or symptoms up to
12 months, except for higher rates of significant MR post-operatively.
<62>
Accession Number
72241835
Author
Hassan H.; Chatterjee S.; Ahmed M.; Tripathi B.; Herzog E.; Palazzo A.;
Bavishi C.; Giri J.; Kornberg R.
Institution
(Hassan, Chatterjee, Ahmed, Tripathi, Herzog, Palazzo, Bavishi, Giri,
Kornberg) Mount Sinai St. Lukes Roosevelt Hospital, New York, NY, United
States
Title
All-cause mortality benefit in patients undergoing mitral valve surgery
with coronary artery bypass as compared to isolated coronary artery bypass
surgery in patients with moderate ischemic mitral regurgitation: A
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 332), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Functional ischemic mitral regurgitation (MR) is a common
sequel of acute myocardial infarction (AMI) and is associated with poor
outcomes. Management of moderate Ischemic MR (grade 2+/3+) remains
controversial and mitral valve surgery (MVS) (repair/ replacement) at the
time of coronary artery bypass grafting (CABG) remains a debated topic. We
performed a meta-analysis of studies comparing MVS with CABG versus CABG
alone in patients with moderate ischemic MR. Methods: We searched Medline,
PubMed and Scopus databases for studies comparing MVS+CABG vs CABG in
patients with moderate IMR. Mortality at 1 and 5 years were extracted.
Results: 2 randomized studies, 3 prospective and 1 retrospective study fit
our selection criteria. Among 590 patients, 275 patients underwent
MVS+CABG and 315 patients underwent CABG only. During long-term
follow-up(range 1 to 5 years, mean 21.6 mo), as compared to CABG only
group, patient treated with CABG+MVS had no significant difference in
all-cause mortality after 1 year[Odds Ratio (OR): 0.94, 95% confidence
interval(CI):0.58-1.55, P=0.928][figure 1]and after 5 years [OR
1.39,95%CI:0.88-2.20][figure 2]. Conclusions: All-cause mortality does not
improve with MVS+CABG as compared to CABG alone in patients with moderate
ischemic MR. (Figure Presented).
<63>
Accession Number
72241793
Author
Bavishi C.; Panwar S.; Pirrotta S.; Baber U.; Dangas G.; Moreno P.;
Tamis-Holland J.; Kini A.; Sharma S.
Institution
(Bavishi, Panwar, Pirrotta, Baber, Dangas, Moreno, Tamis-Holland, Kini,
Sharma) Mount Sinai St. Lukes's and Roosevelt Hospitals, New York, NY,
United States
Title
Efficacy and safety of first generation versus newer generation
drug-eluting stents in patients with diabetes: A direct comparison
meta-analysis of 8,438 patients from randomized trials.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 290), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Patients with diabetes remain at a higher risk of adverse
cardiovascular events after coronary stenting. The long term efficacy and
safety of the various drug eluting stents (DES) in patients with diabetes
is controversial. Methods: Randomized controlled trials comparing first
generation DES [paclitaxel eluting stents (PES) and sirolimus eluting
stents(SES)] with newer generation DES [everolimus eluting stents (EES)
and zotarolimus eluting stents(ZES)] were systematically searched.
Efficacy [target vessel revascularization (TVR) and target lesion
revascularization (TLR)] and safety [MACE, mortality, myocardial
infarction (MI), stent thrombosis) outcomes were evaluated. Random effects
model was used to pool the study results. Results: A total of 18 trials
comprising of 8,438 patients (17,720 patient-years of follow-up) were
included. Compared to first generation DES, EES significantly decreased
MACE by 18%, MI by 43% and stent thrombosis by 40% in patients with
diabetes (Table). Moreover EES showed a trend towards reduction in rates
of TLR and TVR. While ZES showed a trend towards reduction in mortality
compared to first generation stents, it was associated with 89% increased
risk for TLR in diabetic patients. Conclusions: In patients with diabetes
and coronary artery disease undergoing coronary stenting, EES demonstrated
superior efficacy and appears to be most efficacious and safe DES. (Table
Presented).
<64>
Accession Number
72241745
Author
Ando T.; Arasteh K.
Institution
(Ando, Arasteh) Mount Sinai Beth Israel, New York, NY, United States
Title
Predictors of acute kidney injury following transcatheter aortic valve
replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 242), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Acute kidney injury (AKI) after transcatheter aortic valve
replacement (TAVR) is known to be a strong negative predictor of the
prognosis. The predictors of AKI after TAVR vary among each study. The aim
of this study was to summarize and provide clinical predictors of AKI
after TAVR. Methods: A systematic literature search through PUBMED and
EMBASE was conducted. Articles that included at least one of the risk
factors of interest were included. Only the published data were included.
Unadjusted risk ratio (RR) was calculated for each risk factor. Potential
risk factors included, sex, hypertension, diabetes, chronic kidney
disease, blood transfusion, history of myocardial infarction, history of
coronary bypass artery graft, peripheral vascular disease, transapical
approach and chronic pulmonary lung disease. Results: We identified 24
studies including 6,279 TAVR patients. Overall, AKI occurred in 19.4%
patients. Significant risk factors were peripheral vascular disease (RR
1.59, 95%CI 1.39-1.82, p<0.0001, I2=0%), general anesthesia (RR 1.41,
95%CI 1.16-1.71, p=0.0006, I2=0%), chronic kidney disease (RR 1.75, 95%CI
1.21-2.52, p=0.0028, I2=84.1%), transfusion (RR 1.89, 95%CI 1.64-2.18,
p<0.0001, I2=4.8%) transapical approach (RR 1.85, 95%CI 1.34-2.57,
p=0.0002, I2=60.2%) and history of myocardial infarction (RR 1.26, 95%CI
1.04-1.54, p=0.02, I2=42.4%). Other risk factors were not significant.
Conclusions: We identified risk factors associated with AKI post TAVR.
This study provides clinicians with useful risk factors to identify high
risk patients of AKI following TAVR.
<65>
Accession Number
72241686
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.; Cowell J.; MacLullich A.;
Shenkin S.; Mills N.
Institution
(Anand, Harley, Visvanathan, Shah, Cowell, MacLullich, Shenkin, Mills)
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh,
United Kingdom
Title
Preoperative frailty as a predictor of outcomes following transcatheter
aortic valve implantation: A systematic literature review and
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 183), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Current surgical prognostic calculators do not capture the
risk for older patients undergoing transcatheter aortic valve implantation
(TAVI). We assessed whether frailty, a reflection of physiological
reserve, may be a better determinant in this population. Methods: We
conducted a systematic review of evidence published between 1st January
2000 and 30th May 2015 using the key search terms of frailty (and
synonyms) and TAVI (and synonyms). Studies met the inclusion criteria by
reporting: 1) any operationalised measure of frailty, and 2) post-TAVI
early (<30 days) or late (>30 days) mortality and procedural complications
as defined by the Vascular Academic Research Consortium (VARC). Results:
Ten observational cohort studies (n=4,592) met the inclusion criteria.
Frailty was associated with higher early mortality in four studies
(n=1,900, HR 2.35, 95% CI 1.78-3.09, p<0.001), and increased late
mortality in seven studies (n=3,159, HR 1.72, 95% CI 1.40- 2.12,
p<0.001)(see Figure). Use of objective tools to determine frailty
identified those at even higher risk of late mortality (HR 2.63, 95% CI
1.87-3.70, p<0.001). Limited reporting of VARC outcomes in relation to
frailty prevented meta-analysis. Conclusions: Frailty assessment in an
already vulnerable TAVI population detects those at highest risk of poor
outcomes, with a greater than doubling of early and late mortality.
Objective assessment of frailty may inform patient selection for TAVI and
should be further studied in large registries. (Figure presented).
<66>
Accession Number
72241612
Author
Khan M.; Kayani W.; Dadu R.; Virani S.; Hamzeh I.; Jneid H.; Alam M.;
El-Refai M.; Lakkis N.
Institution
(Khan, Kayani, Dadu, Virani, Hamzeh, Jneid, Alam, El-Refai, Lakkis) Baylor
College of Medicine, Houston, TX, United States
Title
Short and long term outcomes of percutaneous coronary intervention versus
coronary artery bypass grafting in older (>70 years) patients with
unprotected left main coronary artery disease in the era of drug eluting
stents.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 109), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: There is paucity of data regarding outcomes of PCI with DES
vs. CABG in elderly patients treated for unprotected left main coronary
artery disease (LMCA). Methods: We performed aggregate data meta-analyses
of clinical outcomes (all-cause mortality, nonfatal MI, repeat
revascularization & MACCE at 30 days, 12-24 month & >36 month in studies
comparing PCI vs. CABG in patients with mean age >70 years & unprotected
LMCA disease. A comprehensive literature search to October 1, 2015
identified 14 studies with 3,950 patients (PCI = 1,581; CABG = 2,369).
Summary odds ratios (OR) and 95% confidence intervals (CI) were estimated
using random-effects model. Age stratified analyses (70-79 yr vs. >80 yr)
were performed. Results: Although comparable at 30 days & 12-24 month,
all-cause mortality was higher with PCI at 36 month(OR 1.56; 95% CI 1.21-
2.01). No significant differences were found between PCI and CABG for MI
and MACCE. Higher rates of repeat revascularization at 12-24 month & 36
month were seen with PCI. Patients >80 years of age were more likely to
undergo repeat revascularization if treated with PCI (Table 1).
Conclusions: Elderly patients with unprotected LMCA disease had higher
rate of all cause mortality with PCI at >36 month follow up. The two
groups had comparable rates of non-fatal MI & MACCE. The patients
undergoing PCI had higher repeat revascularization rates at longer term
follow-up. Patients >80 years were more likely to undergo repeat
revascularization at >36 months after PCI. (Table presented).
<67>
Accession Number
72241609
Author
Saurav A.; Kandasamy V.; Kaja A.K.; Kanmanthareddy A.; Aggarwal S.; Smer
A.; Kaushik M.; Alla V.; Mooss A.
Institution
(Saurav, Kandasamy, Kaja, Kanmanthareddy, Aggarwal, Smer, Kaushik, Alla,
Mooss) Creighton University Medical Center, Omaha, United States
Title
Syntax score and its impact on long term outcomes of coronary
revascularization: A meta-analysis and meta-regression.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 106), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: We sought to compare the long term outcomes of Percutaneous
Coronary Revascularization (PCI) Vs CABS (Coronary Artery Bypass Surgery)
for coronary stenoses with low (0-22) & intermediate (23-32) SYNTAX score
Methods: PubMed & Web of Science were searched up to 15th October 2015 for
studies comparing long term (3 year or more) outcomes of PCI Vs CABS,
stratified by SYNTAX score. Study quality, heterogeneity & publication
bias were assessed. Incidence rate ratio (IRR) was used as effect size &
random effects method was used for meta-analysis. Subgroup analysis
between low & intermediate SYNTAX score groups was performed using random
effects meta-regression. Primary outcome was composite of death/MI/stroke.
Secondary outcomes were any death, cardiac death, non fatal MI, stroke &
repeat revascularization Results: 7 studies (n= PCI: 4148 CABS: 2934) were
selected. Age & gender distribution was similar between PCI & CABS groups.
Death (IRR 1.1 p=0.33), cardiac death (IRR 1.15 p=0.32) & stroke (IRR 0.83
p=0.23) rates were similar where as non fatal MI (IRR 2.73 p<0.001) &
repeat revascularization (IRR 3.16 p<0.001) rates were higher with PCI.
These results were consistent among low & intermediate SYNTAX subgroups.
Primary outcome (death/MI/stroke) favored CABS in intermediate SYNTAX
group (IRR 1.3 p=0.003) but was similar in low SYNTAX subgroup (IRR 1.14
p=0.35) Conclusions: CABS is associated with superior long term outcomes
in intermediate SYNTAX group where as PCI is a reasonable option in low
SYNTAX group. (Figure presented).
<68>
Accession Number
72241608
Author
Sardar P.; Chatterjee S.; Kundu A.; Nairooz R.; Tuwairqi K.; Bashir R.;
O'Neill B.; O'Murchu B.; Mukherjee D.; Giri J.; Cohen H.; Owan T.
Institution
(Sardar, Chatterjee, Kundu, Nairooz, Tuwairqi, Bashir, O'Neill, O'Murchu,
Mukherjee, Giri, Cohen, Owan) University of Utah, Salt Lake City, UT,
United States
Title
Long term outcomes in patients with left main coronary artery disease
treated with either percutaneous coronary intervention or bypass
surgery-evidence from a meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 65th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.16 Chicago, IL United States. Conference
Start: 20160402 Conference End: 20160404. Conference Publication:
(var.pagings). 67 (13 SUPPL. 1) (pp 105), 2016. Date of Publication: 05
Apr 2016.
Publisher
Elsevier USA
Abstract
Background: Long term benefits of percutaneous coronary intervention (PCI)
for left main disease compared to coronary artery bypass grafting (CABG)
remain controversial. This analysis was performed to determine 5-year
outcomes of PCI compared with CABG, for the treatment of left main
coronary artery (LMCA) stenosis. Methods: Databases were searched from
January 2000 and August 2015. Randomized controlled trials and
observational studies comparing PCI versus CABG for LMCA stenosis were
identified. We calculated summary odds ratios (ORs) and 95% Confidence
Intervals (CI) with the random-effects model. The primary outcome of
interest was all cause mortality. Results: The analysis included 4,546
patients from 7 studies (2 randomized controlled trials and 5
observational studies). Compared to the CABG group, patients who underwent
PCI had a significantly lower risk of all cause mortality [OR 0.77; 95% CI
0.61 to 0.97] and stroke [OR 0.38; 95% CI 0.21 to 0.68]. The 5-year risk
of myocardial infarction (MI) [OR 1.32; 95% CI 0.74 to 2.37] and the
combined risk of death, MI, or stroke [OR 0.76; 95% CI 0.55 to 1.04] were
not significantly different for patients undergoing PCI versus CABG. The
risk of target vessel revascularization (TVR) was significantly higher in
the PCI group than in the CABG group [OR 4.10; 95% CI 2.55 to 6.59].
Conclusions: Five years follow up data suggests that, in selected
patients, PCI with DES is a safe and effective alternative to CABG for
revascularization of LMCA stenosis. (Figure presented).
<69>
Accession Number
72236093
Author
Bhattacharjee H.K.; Bansal V.; Jalaludeen A.; Kumar S.; Krishna A.;
Subramaniam R.; Ramachandran R.; Misra M.
Institution
(Bhattacharjee, Bansal, Jalaludeen, Kumar, Krishna, Subramaniam,
Ramachandran, Misra) All India Institute of Medical Sciences, India
Title
Impact of standard pressure and low pressure pneumoperitoneum in shoulder
pain following laparoscopic cholecystectomy: A double blind randomized
controlled trial.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: 2016
Scientific Session of the Society of American Gastrointestinal and
Endoscopic Surgeons, SAGES 2016 Boston, MA United States. Conference
Start: 20160316 Conference End: 20160319. Conference Publication:
(var.pagings). 30 (pp S221), 2016. Date of Publication: March 2016.
Publisher
Springer New York LLC
Abstract
Background: Laparoscopic cholecystectomy (LC) is the standard of care for
gallstone disease. 30-60 % of patients following LC suffer from shoulder
pain in the immediate post-operative period. Exact mechanism of shoulder
pain following LC is not well elucidated. This double blind randomized
study is designed to evaluate the incidence and severity of shoulder pain
following LC at low pressure and standard pressure pneumoperitoneum.
Materials and Methods: The study was conducted in a tertiary care referral
hospital from November 2014 to September 2015. Consecutive patients
undergoing LC for gallstone disease who met the inclusion criteria were
enrolled. Sample size calculated was 80. 40 patients were randomized to
Standard Pressure Laparoscopic Cholecystectomy (Group I - Pressure of 14
mmHg) and 40 to Low Pressure Laparoscopic Cholecystectomy (Group II-
Pressure of 9 -10 mmHg). Randomisation was done using computer generated
random numbers, divided into blocks of eight. Sealed envelopes were used
to conceal allocation. Data were collected in concurrence with CONSORT
guidelines. Primary outcome measured was incidence of shoulder pain and
its severity on Visual Analogue Scale (VAS) at 4, 8, 24 hours and 7 days
after LC. Secondary outcomes measured were duration of surgery, technical
difficulty during LC, intra-operative variation in heart rate and blood
pressure and post-operative abdominal pain. The patient and the resident
who measured the pain were blinded about the allocated group. Results: A
total of 170 LC were performed and 80 were randomised. All patients
received the allocated treatment. There was no conversion to open surgery
or major bile duct injury on either group. 23 patients (57.5 %) in Group I
and 9 patients (22.5 %) in Group II had shoulder pain. This difference was
statistically significant (p = 0.001). The severity of pain (VAS score,
mean +/- SD) at 4 hrs, 8 hrs, 24 hrs and 7 days following surgery were
0.125 +/- 0.79, 1.8 +/- 2.64, 2.35 +/- 2.63 and 0, respectively in Group I
and 0.125 +/- 0.79, 0.7 +/- 1.92, 0.925 +/- 1.87 and 0 respectively in
Group II. The difference was significant at 8 and 12 hrs after surgery (p
= 0.009, 0.005). The difference in procedural time, technical difficulty,
intraoperative variations in heart rate and blood pressure and
post-operative abdominal pain were not significant. Conclusion:
Laparoscopic cholecystectomy with intra-abdominal pressure of 9-10 mmHg
significantly reduces the incidence and severity of post-operative
shoulder pain. Performing LC at a lower intra-abdominal pressure is safe
and effective.
<70>
Accession Number
72232488
Author
ElSaegh M.M.M.; Khan K.; Burdett C.L.; Kenny L.; Hasan M.; Goodwin A.;
Kendall S.; Hunter S.; Akowuah E.
Institution
(ElSaegh, Khan, Burdett, Kenny, Hasan, Goodwin, Kendall, Hunter, Akowuah)
James Cook University Hospital, Middlesbrough, United Kingdom
Title
A comparison of minimally invasive versus conventional surgery for mitral
valve repair in a single center.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S77), 2015. Date of Publication: June
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Current evidence for minimally invasive mitral valve repair
(MVR) is dominated by "case" series. The ISMICS consensus document 2011
emphasized the need for more "comparative" series. Methods: We
retrospectively reviewed all patients undergoing isolated MVR in our
institution between April, 2008, and March, 2013, (n=223). Patients either
had conventional sternotomy (CON, n=119) or minimally invasive surgery
(MINI, n=104). Data were obtained from a prospectively maintained
departmental database, echo reports, blood bank database, and pathology
database. Results: The 2 groups differed significantly with respect to
mean age (CON 67.3 vs. MINI 61 years, P<0.0001) and mean EuroSCORE (CON
5.81 vs. MINI 3.5, P<0.0001). Intraoperatively, the MINI group had longer
AXC (104.4 vs. 67.8 minutes, P<0.0001) and cardiopulmonary bypass times
(158.3 vs. 91.7 minutes, P<0.0001). There were no differences in rates of
postoperative death (1.7% in CON vs. 0% in MINI), stroke (1.7% in CON vs.
1% in MINI), reoperation for bleeding (10.1% in CON vs. 5.8% in MINI), and
continuous venovenous hemofiltration (0.8% in CON vs. 1.9% in MINI).
However, rates of blood transfusion were significantly higher in the CON
group (42.9% vs. 13.5, P=0.001). Postoperatively, atrial fibrillation was
more frequent (31.9% vs. 21.2%, P=0.048) and length of hospital stay was
significantly longer (12.1 vs. 6.4 days, P=0.001). More patients in the
MINI group had mitral regurgitation grade mild or less on the predischarge
transthoracic echocardiogram compared with the CON group (91.2% vs. 96.2%,
P<0.0001). Conclusions: This is the largest UK report comparing minimally
invasive versus conventional MVR. These data suggest that minimally
invasive MVR is probably as safe and effective as conventional surgery.
There may also be significant clinical advantages. These findings should
be confirmed in a randomized controlled trial.
<71>
Accession Number
72232454
Author
Ziankou A.; Laiko M.; Vykhrystsenka K.
Institution
(Ziankou, Laiko, Vykhrystsenka) Vitebsk State Medical University, Vitebsk,
Belarus
Title
Early results of the prospective randomized controlled trial micsrevs:
Minimally invasive cardiac surgery revascularization strategy.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S64-S65), 2015. Date of Publication:
June 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The minimally invasive multivessel coronary revascularization
is still in the pipeline and is being established, which is why the basic
comparative studies of immediate and, even more so, long-term results are
a matter of present and future research. We evaluated early results of
prospective randomized controlled trial (RCT) MICSREVS (Minimally Invasive
Cardiac Surgery REVascularization Strategy)-comparative effectiveness of
the minimally invasive coronary artery bypass grafting (MICS-CABG) versus
off pump (OPCABG) and on-pump coronary artery bypass grafting (ONCABG).
Methods: The RCT MICSREVS was started at our clinic in January, 2014,
(http://www.clinicaltrials.gov/show/NCT02047266). The trial design
includes 150 patients, who were divided in 3 groups of 50 people. In group
I, the MICSCABG strategy is directed to perform multivessel arterial
revascularization by the left minithoracotomy on the beating heart with
aortic no-touch technique. A hybrid approach and parallel transfemoral
cardiopulmonary bypass without cardioplegia are acceptable for achieving
the required revascularization. In control groups II (OPCABG) and III
(ONCABG), conventional surgery is performed by median sternotomy. Criteria
of inclusion in our trial are multivessel coronary artery disease, II-IV
Canadian Cardiovascular Society functional class of angina, and patients
at 1 month after acute myocardial infarction. Exclusion criteria are
previous CABG, single-vessel disease, and need for emergency
revascularization. Randomization is carried out by the blind method
(''envelopes''). Primary outcome measures of the trial are accepted death
from any cause and major adverse cardiac and cerebrovascular events
(MACCE). Hospitalization period and 12 and 36 months after primary
myocardial revascularization were planned as the control points.
Seventy-six patients are included in the research at this moment. Thirty
patients were randomized to group I and 24 and 22 patients to the groups
II and III, respectively. Patient's clinical characteristics did not
differ significantly between treatment groups. Results: In treatment
groups, myocardial revascularization was successfully performed in all
cases. There were no deaths from any cause and MACCE during
hospitalization period. There were no cases of incomplete myocardial
revascularization, technical difficulties, and other complications.
Conclusions: The MICS-CABG strategy at in-hospital point of RCT MICSREVS
showed the good results comparable with results of conventional OPCABG and
ONCABG.
<72>
Accession Number
72232440
Author
Ziankou A.
Institution
(Ziankou) Vitebsk State Medical University, Vitebsk, Belarus
Title
Minimally invasive composite coronary artery bypass grafting using in situ
bilateral internal thoracic arteries and radial artery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S59-S60), 2015. Date of Publication:
June 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Multivessel small thoracotomy coronary artery bypass grafting
(MVST-CABG) using in situ left internal thoracic artery (LITA) and
composite in situ right internal thoracic artery-radial artery (RITA-RA)
has never been done or described before. We evaluated early results of
this full arterial minimally invasive beating heart aortic no-touch
technique within the scope of the prospective randomized controlled trial
MICSREVS (http://www. clinicaltrials.gov/show/NCT02047266). Methods:
Between January and October, 2014, 23 patients underwent composite
MVST-CABG using in situ bilateral internal thoracic arteries and radial
artery (BITA-RA). The LITA and RITA were harvested in a pedicle fashion
under direct vision as in situ grafts from a left small thoracotomy. The
RA was harvested by the assistant. Then LITA was used to graft the left
anterior descending artery (LAD); end-to-end anastomosis between RITA and
RA was performed using a graft extension technique. The composite RITARA
extension terminated in a single distal anastomosis to the right coronary
artery (RCA) branches or as a sequential graft with a side-to-side
anastomosis to the posterior descending artery and an end-to-side
anastomosis with the circumflex artery (CX). The mean patient age was
60.3+/-5.2 years. Eight (34.8%) patients had diabetes mellitus; 14
(60.9%), obesity; and 9 (39.1%), chronic obstructive pulmonary disease.
Results: The mean number of distal anastomoses was 2.91+/-0.42; mean
operation time, 375.6+/-81.4 minutes; intraoperative blood loss, 275 (200;
387) mL, first 24-hour postoperative blood loss, 270 (215; 310) mL;
postoperative ventilation time, 2.3 (1.2; 4.7) hours; intensive care unit
stay, 18 (16.5; 21) hours. There were no cases of incompletemyocardial
revascularization, hypoperfusion, or competitive blood flow at the
intraoperative flowmetry. The mean volumetric blood flow (mL/min) and
pulsatility index constituted 67.1+/-22.7 and 1.86+/-0.72, 40.0+/-18.3 and
1.9+/-0.6, 32.0+/-12.1 and 2.2+/-0.5 in LAD, RCA, and CX territory,
respectively. There were no deaths or other complications. Conclusions: It
is expected that the use of composite in situ BITA-RA MVST CABG leads to
the reduction of the perioperative complications rate, especially in
high-risk patients. Two sources of the myocardium blood supply from both
ITAs allow the prevention of incomplete revascularization, reduce the
probability of hypoperfusion and competitive blood flow at composite
multivessel grafting.
<73>
Accession Number
72232366
Author
Vonk A.; Meesters M.
Institution
(Vonk, Meesters) VU University Medical Center, Amsterdam, Netherlands
Title
High versus low protamine-to-heparin dosing ratio after cardiopulmonary
bypass: A multicenter, randomized controlled trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S31), 2015. Date of Publication: June
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Guidelines for perioperative blood management advise to dose
protamine in a 1.0-1.3:1.0 ratio with heparin. However, because of the
degrading and loss of heparin during surgery, protamine can be overdosed.
The present study investigated whether the use of a lower
protamine-to-heparin dosing ratio is superior to a high dosing ratio with
respect to postoperative hemostasis. Methods: In this multicenter
investigation, patients undergoing coronary artery bypass graft surgery
were randomized into a low (0.8; n=46) or high protamine-to-heparin (1.3;
n=36) dosing group based on total heparin administration. Patient
hemostasis was monitored using rotational thromboelastometry before and 3
and 30 minutes after cardiopulmonary bypass. Results: Cardiopulmonary
bypass time estimated 89+/-29 versus 90+/-36 minutes (P=0.92) in the low
and high dosing groups. There were no differences in total heparin dosing
(412+/-121 vs. 420+/-92 mg; P=0.75), whereas protamine administration was
lower in the 0.8 (331+/-97 mg) than in the 1.3 group (545+/-120; P<0.001).
Activated cloting times following protamine administration were similar
between groups. Clotting times for the INTEM (293+/-64 vs. 243+/-37
seconds; P<0.001) and HEPTEM (298+/-60 vs. 243+/-40 seconds; P<0.001) were
prolonged at 3 minutes after protamine administration in the high-dosing
group but were normalized 30 minutes later. Median 24-hour blood loss was
increased in the high-protamine dosing group. Conclusions: A
protamine-to-heparin dosing ratio of 1.3 is associated with a temporary
prolongation of postoperative clotting times and increased blood loss when
compared with a lower dosing strategy. Protamine overdosing should
therefore be considered harmful for the restoration of perioperative
hemostasis.
<74>
Accession Number
72232340
Author
O'Sullivan K.E.; Hurley E.T.; Segurado R.; Hurley J.P.
Institution
(O'Sullivan, Hurley, Hurley) Mater Private Hospital, Dublin, Ireland
(Segurado) CSTAR Centre for Statistical Training and Research, University
College Dublin, Dublin, Ireland
Title
A meta-analysis examining the incidence of permanent pacemaker
implantation after sutureless aortic valve implantation.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S20), 2015. Date of Publication: June
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Sutureless aortic valve prostheses are anchored by radial force
in a mechanism similar to that of transcatheter aortic valve implantation.
Transcatheter aortic valve implantation is associated with an increased
permanent pacemaker (PPM) requirement in a significant proportion of
patients. We undertook a meta-analysis to examine the incidence of PPM
insertion associated with sutureless compared with conventional surgical
aortic valve replacement. Methods: A systematic review was conducted in
accordance with the Prisma guidelines (1). PubMed was searched by entering
the following in the searching algorithm: "sutureless AND aortic AND
valve, tissue AND aortic AND valve, mechanical AND aortic AND valve."
English was set as a language restriction. All searches were performed on
August 10, 2014. Studies between 2007 and 2014 were included in the
search. Results: In total, 832 patients were included in the sutureless
group and 3740 in the conventional group. Permanent pacemaker implantation
rate was higher in the sutureless cohort (9.1 vs. 2.4%, P=0.025).
Conclusions: Sutureless aortic valve prostheses are associated with a
higher incidence of PPM insertion than conventional. Further investigation
as to the prognostic significance of pacemaker requirement after
sutureless aortic valve replacement is required.
<75>
Accession Number
72232314
Author
Valdis M.; Chu M.W.A.; Schlachta C.; Kiaii B.
Institution
(Valdis, Chu, Schlachta, Kiaii) Univesity of Western Ontario, London, ON,
Canada
Title
Evaluation of robotic cardiac surgery training modalities.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. Conference: 18th Annual Meeting of the International Society for
Minimally Invasive Cardiothoracic Surgery, ISMICS 2015 Berlin Germany.
Conference Start: 20150603 Conference End: 20150606. Conference
Publication: (var.pagings). 10 (pp S9), 2015. Date of Publication: June
2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Implementation of training exercises, such as wet labs, dry
labs, and virtual reality simulation, have improved the efficiency of
training and shortened learning curves of robotic cardiac surgery. These
different training modalities have been individually validated as reliable
training methods; however, despite the fact that implementing a robotic
training program is a costly and resource-heavy endeavor, no objective
comparison exists to help determine the efficacy and cost-effectiveness of
these training modalities. Methods: Forty surgical trainees were observed
while they completed a standardized robotic 10-cm dissection of the
internal thoracic artery and placed 3 sutures of a mitral valve
annuloplasty in porcine models. The subjects were then randomized to 1 of
4 training streams: awet labwhere the same 2 tasks were repeated, a dry
lab or virtual reality simulation curriculum focusing on basic robotic
surgical skills, and a control group that received no additional training.
All of the groups were allowed to train to a level of proficiency,
determined by the performance of 3 expert robotic surgeons. After
completing the training in their assigned stream, the trainees repeated
the original assessments. The initial and final assessments were evaluated
by expert surgeons using the Global Evaluative Assessment of Robotic
Skills (GEARS) in a blinded fashion. Results: All 3 training streams were
effective methods for learning robotic surgical skills compared with
expert performances; however, subjects assigned to the control group were
not able to meet the level set by our expert surgeons. The average
duration of training required to reach proficiency was least for the dry
lab and most for the virtual reality simulation (2.5 vs. 9.5 hours,
P<0.05). No significant difference was detected in our objective GEARS
assessment between the 3 training groups, but all outperformed the control
group. Conclusions: Here we have completed the first randomized,
controlled trial to objectively compare the efficacy of different training
modalities in robotic cardiac surgery. This work highlights key
differences in current training methods and will serve to help training
programs invest resources in cost-effective, high-yield simulation methods
to improve training for new robotic cardiac surgeons.
<76>
Accession Number
72231588
Author
Li J.; Salfati E.; Patel C.; Eaton C.; Nassir R.; Stefanick M.; Reiner
A.P.; Assimes T.L.
Institution
(Li, Salfati, Stefanick, Assimes) Stanford Univ, Palo Alto, CA, United
States
(Patel) Harvard Med Sch, Boston, MA, United States
(Eaton) Alpert Med Sch, Brown Univ, Providence, RI, United States
(Nassir) Univ of California-Davis, Sacramento, CA, United States
(Reiner) Fred Hutchinson Cancer Rsch Cntr, Seattle, WA, United States
Title
A multi-ethnic mendelian randomization study of moderate alcohol use and
the risk of atherosclerotic cardiovascular disease in the women's health
initiative.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Lifestyle and Cardiometabolic Health 2016 Scientific Sessions
Phoenix, AZ United States. Conference Start: 20160301 Conference End:
20160304. Conference Publication: (var.pagings). 133 (no pagination),
2016. Date of Publication: 01 Mar 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Many cohort studies have reported a protective effect of
moderate alcohol use (EtOH) on the risk of adverse cardiovascular health
outcomes. The exact nature of this association remains unclear in the
absence of data from a randomized controlled trial. Hypothesis: We
hypothesized that the protective effect of moderate EtOH on the risk of
atherosclerotic cardiovascular disease (ASCVD) is not causal in nature and
tested our hypothesis by conducting a Mendelian randomization study among
European, African American, and Hispanic participants in the Women's
Health Initiative (WHI) study. Methods: A total of 154,643 European,
African American, and Hispanic post-menopausal women participated in the
WHI study. We first used logistic regression to examine the association
between EtOH and ASCVD in 8,105 incident ASCVD cases and 63,094 non-cases
reporting moderate use at baseline (>0 to 15 drinks / week). ASCVD
outcomes included in the case group were adjudicated fatal and non-fatal
myocardial infarction, coronary revascularization, angina, ischemic
stroke, peripheral arterial disease, and carotid artery disease. We
adjusted our analysis for baseline covariates including age, self-reported
race, BMI, hypertension status, systolic blood pressure, diabetes status,
smoking status, physical activity, education, and family income. We then
performed an instrumental variable analysis in a subset of 1,888 cases and
9,746 non-cases with GWAS and imputed data available for rs1229984, a
polymorphism in ADH1B known to be strongly associated with the degree of
lifetime alcohol consumption. Lastly, we assessed whether the instrumental
variable assumptions are likely to be satisfied by testing for association
between rs1229984 and ASCVD as well as all risk factors for ASCVD in 3,434
WHI participants who reported never using alcohol. Results: Observational
analysis confirmed a strong inverse linear association between the degree
of moderate alcohol use and the risk of ASCVD even after adjusting for all
established risk factors of ASCVD (2.2% reduction in risk per doubling of
the no. of drinks/week among moderate EtOH users, p = 3.8 x 10-3). In
contrast, our instrumental variable analyses among the subset of subjects
with genetic data revealed that moderate alcohol use was associated with a
markedly higher risk of ASCVD (47% increase in risk per doubling of EtOH
use, p = 4.9 x 10-3). We found rs1229984 to be valid instrument as it was
well imputed (mean r2 = 0.74), strongly associated with the degree of
moderate alcohol use (F statistic = 44.4), and not associated with ASCVD
or any ASCVD risk factor among never drinkers. Conclusions: The
observational association between alcohol use and improved cardiovascular
health is not causal. Our instrumental variable analysis suggests that
alcohol use even among moderate users markedly increases risk of ASCVD in
a multi-ethic population of post-menopausal women.
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