EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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.

<2>
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.

<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
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).
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.

<5>
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
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).
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.

<6>
Accession Number
26041151
Author
Salluh J.I.; Wang H.; Schneider E.B.; Nagaraja N.; Yenokyan G.; Damluji
A.; Serafim R.B.; Stevens R.D.
Institution
(Salluh) D'OR Institute for Research and Education, Rio de Janeiro, Brazil
(Wang) Department of Surgery, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
(Schneider) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
(Nagaraja) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
(Yenokyan) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
(Damluji) Elaine and Sydney Sussman Cardiac Catheterization Laboratories,
Cardiovascular Division, University of Miami Miller School of Medicine,
Miami, FL, USA
(Serafim) D'OR Institute for Research and Education, Rio de Janeiro,
Brazil Department of Internal Medicine, Federal University of Rio de
Janeiro, Rio de Janeiro, Brazil
(Stevens) Department of Anesthesiology and Critical Care Medicine,
Neurology, Neurosurgery, and Radiology, Johns Hopkins University School of
Medicine, Baltimore, MD 21287, USA
Title
Outcome of delirium in critically ill patients: systematic review and
meta-analysis.
Source
BMJ (Clinical research ed.). 350 (pp h2538), 2015. Date of Publication:
2015.
Abstract
OBJECTIVES: To determine the relation between delirium in critically ill
patients and their outcomes in the short term (in the intensive care unit
and in hospital) and after discharge from hospital.
DESIGN: Systematic review and meta-analysis of published studies.
DATA SOURCES: PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO,
with no language restrictions, up to 1 January 2015.
ELIGIBILITY CRITERIA FOR SELECTION STUDIES: Reports were eligible for
inclusion if they were prospective observational cohorts or clinical
trials of adults in intensive care units who were assessed with a
validated delirium screening or rating system, and if the association was
measured between delirium and at least one of four clinical endpoints
(death during admission, length of stay, duration of mechanical
ventilation, and any outcome after hospital discharge). Studies were
excluded if they primarily enrolled patients with a neurological disorder
or patients admitted to intensive care after cardiac surgery or
organ/tissue transplantation, or centered on sedation management or
alcohol or substance withdrawal. Data were extracted on characteristics of
studies, populations sampled, identification of delirium, and outcomes.
Random effects models and meta-regression analyses were used to pool data
from individual studies.
RESULTS: Delirium was identified in 5280 of 16,595 (31.8%) critically ill
patients reported in 42 studies. When compared with control patients
without delirium, patients with delirium had significantly higher
mortality during admission (risk ratio 2.19, 94% confidence interval 1.78
to 2.70; P<0.001) as well as longer durations of mechanical ventilation
and lengths of stay in the intensive care unit and in hospital (standard
mean differences 1.79 (95% confidence interval 0.31 to 3.27; P<0.001),
1.38 (0.99 to 1.77; P<0.001), and 0.97 (0.61 to 1.33; P<0.001),
respectively). Available studies indicated an association between delirium
and cognitive impairment after discharge.
CONCLUSIONS: Nearly a third of patients admitted to an intensive care unit
develop delirium, and these patients are at increased risk of dying during
admission, longer stays in hospital, and cognitive impairment after
discharge.

<7>
Accession Number
26271057
Author
Bittner V.; Bertolet M.; Barraza Felix R.; Farkouh M.E.; Goldberg S.;
Ramanathan K.B.; Redmon J.B.; Sperling L.; Rutter M.K.
Institution
(Bittner) Division of Cardiovascular Disease, Department of Medicine,
University of Alabama at Birmingham, Birmingham, Alabama. Electronic
address: vbittner@uab.edu
(Bertolet) Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, Pennsylvania
(Barraza Felix) Mexican Institute of Social Security, Mexico City, Mexico
(Farkouh) Mount Sinai School of Medicine, New York, New York
(Goldberg) National Heart, Lung, and Blood Institute, National Institutes
of Health, Bethesda, Maryland
(Ramanathan) VA Medical Center Memphis, Memphis, Tennessee
(Redmon) Department of Medicine and Urologic Surgery, University of
Minnesota, Minneapolis, Minnesota
(Sperling) Emory University, Atlanta, Georgia
(Rutter) The Endocrinology and Diabetes Research Group, Institute of Human
Development, Faculty of Medical and Human Sciences, University of
Manchester, Manchester, United Kingdom; Manchester Diabetes Centre,
Central Manchester University Hospitals NHS Foundation Trust, Manchester
Academic Health Science Centre, Manchester, United Kingdom
Title
Comprehensive Cardiovascular Risk Factor Control Improves Survival: The
BARI 2D Trial.
Source
Journal of the American College of Cardiology. 66 (7) (pp 765-773), 2015.
Date of Publication: 18 Aug 2015.
Abstract
METHODS: We performed a nonrandomized analysis of survival/cardiovascular
events and control of 6 RFs (no smoking, non-high-density lipoprotein
cholesterol <130 mg/dl, triglycerides <150 mg/dl, blood pressure [systolic
<130 mm Hg; diastolic <80 mm Hg], glycosylated hemoglobin <7%) in BARI 2D.
Cox models with time-varying number of RFs in control were adjusted for
baseline number of RFs in control, clinical characteristics, and trial
randomization assignments.
RESULTS: In 2,265 patients (mean age 62 years, 29% women) followed up for
5 years, the mean +/- SD number of RFs in control improved from 3.5 +/-
1.4 at baseline to 4.2 +/- 1.3 at 5 years (p < 0.0001). The number of RFs
in control during the trial was strongly related to death (global p =
0.0010) and the composite of death, myocardial infarction, and stroke
(global p = 0.0035) in fully adjusted models. Participants with 0 to 2 RFs
in control during follow-up had a 2-fold higher risk of death (hazard
ratio: 2.0; 95% confidence interval: 1.3 to 3.3; p = 0.0031) and a
1.7-fold higher risk of the composite endpoint (hazard ratio: 1.7; 95%
confidence interval: 1.2 to 2.5; p = 0.0043), compared with those with 6
RFs in control.
CONCLUSIONS: Simultaneous control of multiple RFs through protocol-guided
intensive medical therapy is feasible and relates to cardiovascular
morbidity and mortality in patients with coronary disease and type 2
diabetes mellitus. (Bypass Angioplasty Revascularization Investigation in
Type 2 Diabetes [BARI 2D]; NCT00006305).
BACKGROUND: It is unclear whether achieving multiple risk factor (RF)
goals through protocol-guided intensive medical therapy is feasible or
improves outcomes in type 2 diabetes mellitus.
OBJECTIVES: This study sought to quantify the relationship between
achieved RF goals in the BARI 2D (Bypass Angioplasty Investigation
Revascularization 2 Diabetes) trial and cardiovascular events/survival.

<8>
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Accession Number
26266376
Author
Ren C.; Zhang X.; Liu Z.; Li C.; Zhang Z.; Qi F.
Institution
(Ren, Zhang, Liu, Li, Zhang, Qi) From the Department of Anaesthesiology
(CR, FQ), Qilu Hospital of Shandong University, Jinan; and Department of
Anaesthesiology (CR, XZ, ZL, CL, ZZ), Liaocheng People's Hospital,
Liaocheng, China
Title
Effect of Intraoperative and Postoperative Infusion of Dexmedetomidine on
the Quality of Postoperative Analgesia in Highly Nicotine-Dependent
Patients After Thoracic Surgery: A CONSORT-Prospective, Randomized,
Controlled Trial.
Source
Medicine. 94 (32) (pp e1329), 2015. Date of Publication: 01 Aug 2015.
Abstract
UNLABELLED: Smoking is one of the most common addictions in the world.
Nicotine inhalation could increase the risk of cardiorespiratory diseases.
However, the solution that improved postoperative analgesia for highly
nicotine-dependent patients undergoing thoracic surgery has not been
specifically addressed.This CONSORT-prospective, randomized,
double-blinded, controlled trial investigated the efficacy of combination
of dexmedetomidine and sufentanil for highly nicotine (Fagerstrom test of
nicotine dependence >6)-dependent patients after thoracic surgery.One
hundred seventy-four male patients who underwent thoracic surgery were
screened between February 2014 and November 2014, and a total of
forty-nine were excluded. One hundred thirty-two highly nicotine-dependent
male patients who underwent thoracic surgery and received postoperative
patient-controlled intravenous analgesia were divided into 3 groups after
surgery in this double-blind, randomized study: sufentanil (0.02 mug/kg/h,
Group S), sufentanil plus dexmedetomidine (0.02 mug/kg/h each, Group D1),
or sufentanil (0.02 mug/kg/h) plus dexmedetomidine (0.04 mug/kg/h) (Group
D2). The patient-controlled analgesia (PCA) program was programmed to
deliver a bolus dose of 2 ml, with background infusion of 2 ml/h and a
lockout of 5 min, 4-hour limit of 40 ml, as our retrospective study. The
primary outcome measure was the cumulative amount of self-administered
sufentanil; the secondary outcome measures were pain intensity (numerical
rating scale, NRS), level of sedation (LOS), Bruggrmann comfort scale
(BCS), functional activity score (FAS), and concerning adverse effects.The
amount of self-administered sufentanil were lower in group D2 compared
with S and D1 groups during the 72 hours after surgery (P < 0.05), whereas
the total dosage and dosage per body weight of sufentanil were
significantly lower in D1 group than that of S group only at 4, 8, and 16
hours after surgery (P < 0.05). Compared with S group, the NRS scores at
rest at 1, 4, and 8 hours after surgery and with coughing at 4, 8, 16, and
24 hours after surgery were significantly lower in D2 group (P < 0.05).
However, compared with D1 group, the NRS scores both at rest and with
coughing at 4 and 8 hours after surgery were significantly lower in D2
group (P < 0.05). The NRS scores both at rest and with coughing show that
there were no significant differences between D1 group and S group at each
time point after surgery (P > 0.05). LOS of group D2 was higher than S and
D1 groups at 1 hour after surgery (P < 0.05), BCS of group D2 was higher
than S and D1 groups at 4, 8, and 16 hours after surgery (P < 0.05), and
FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after
surgery (P < 0.05). The number of rescue analgesia during 72 hours after
surgery in D2 group was lower than S and D1 groups (P < 0.05). There were
no significant differences among the 3 groups in terms of baseline
clinical characteristics and postoperative adverse effects except for
itching (P > 0.05).Among the tested patient-controlled analgesia options,
the addition of dexmedetomidine (0.04 mug/kg/h) and sufentanil (0.02
mug/kg/h) showed better analgesic effect and greater patient satisfaction
without other clinically relevant side effects for highly
nicotine-dependent patients during the initial 72 hours after thoracic
surgery.
TRIAL REGISTRATION: chictr.org (ChiCTR-TRC-14004191).

<9>
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Accession Number
26200180
Author
Duncan A.E.; Kateby Kashy B.; Sarwar S.; Singh A.; Stenina-Adognravi O.;
Christoffersen S.; Alfirevic A.; Sale S.; Yang D.; Thomas J.D.; Gillinov
M.; Sessler D.I.
Institution
(Duncan, Kateby Kashy, Sarwar, Singh, Stenina-Adognravi, Christoffersen,
Alfirevic, Sale, Yang, Thomas, Gillinov, Sessler) From the Departments of
Cardiothoracic Anesthesia (A.E.D., A.A., S. Sale), Outcomes Research
(A.E.D., B.K.K., S. Sarwar, A.S., D.Y., D.I.S.), Molecular Cardiology
(O.S.-A., S.C.), Quantitative Health Sciences (D.Y.), Cardiovascular
Medicine (J.D.T.), and Cardiac Surgery (M.G.), Cleveland Clinic,
Cleveland, Ohio. Current affiliations: Department of Anesthesiology,
Northwestern University, Chicago, Illinois (B.K.K.); Department of Family
Medicine, Case Medical Center, University Hospitals of Cleveland,
Cleveland, Ohio (S.Sarwar); Hepatobiliary Anesthesia, Toronto General
Hospital, University of Toronto, Toronto, Ontario, Canada (A.S.); Case
Western Reserve University, Cleveland, Ohio (S.C.); and Bluhm
Cardiovascular Institute, Northwestern Memorial Hospital, Chicago,
Illinois (J.D.T.)
Title
Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial
Performance during Cardiac Surgery: A Randomized Trial.
Source
Anesthesiology. 123 (2) (pp 272-287), 2015. Date of Publication: 01 Aug
2015.
Abstract
BACKGROUND: Glucose-insulin-potassium (GIK) administration during cardiac
surgery inconsistently improves myocardial function, perhaps because
hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic
normoglycemic clamp (HNC) technique may better enhance the myocardial
benefits of GIK. The authors extended previous GIK investigations by (1)
targeting normoglycemia while administering a GIK infusion (HNC); (2)
using improved echocardiographic measures of myocardial deformation,
specifically myocardial longitudinal strain and strain rate; and (3)
assessing the activation of glucose metabolic pathways.
METHODS: A total of 100 patients having aortic valve replacement for
aortic stenosis were randomly assigned to HNC (high-dose insulin with
concomitant glucose infusion titrated to normoglycemia) versus standard
therapy (insulin treatment if glucose >150mg/dl). The primary outcomes
were left ventricular longitudinal strain and strain rate, assessed using
speckle-tracking echocardiography. Right atrial tissue was analyzed for
activation of glycolysis/pyruvate oxidation and alternative metabolic
pathways.
RESULTS: Time-weighted mean glucose concentrations were lower with HNC
(127+/-19mg/dl) than standard care (177+/-41mg/dl; P < 0.001).
Echocardiographic data were adequate in 72 patients for strain analysis
and 67 patients for strain rate analysis. HNC did not improve myocardial
strain, with an HNC minus standard therapy difference of -1.2% (97.5% CI,
-2.9 to 0.5%; P = 0.11). Strain rate was significantly better, but by a
clinically unimportant amount: -0.16 s (-0.30 to -0.03 s; P = 0.007).
There was no evidence of increased glycolytic, pyruvate oxidation, or
hexosamine biosynthetic pathway activation in right atrial samples (HNC, n
= 20; standard therapy, 22).
CONCLUSION: Administration of glucose and insulin while targeting
normoglycemia during aortic valve replacement did not meaningfully improve
myocardial function.

<10>
[Use Link to view the full text]
Accession Number
25840580
Author
Sezai A.; Iida M.; Yoshitake I.; Wakui S.; Osaka S.; Kimura H.; Yaoita H.;
Hata H.; Shiono M.; Nakai T.; Takayama T.; Kunimoto S.; Kasamaki Y.;
Hirayama A.
Institution
(Sezai) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan.
asezai.med@gmail.com
(Iida) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Yoshitake) From the Departments of Cardiovascular Surgery (A.S., M.I.,
I.Y., S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T.,
S.K., Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Wakui) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Osaka) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Kimura) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Yaoita) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Hata) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Shiono) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Nakai) From the Departments of Cardiovascular Surgery (A.S., M.I., I.Y.,
S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T., S.K.,
Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Takayama) From the Departments of Cardiovascular Surgery (A.S., M.I.,
I.Y., S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T.,
S.K., Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Kunimoto) From the Departments of Cardiovascular Surgery (A.S., M.I.,
I.Y., S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T.,
S.K., Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Kasamaki) From the Departments of Cardiovascular Surgery (A.S., M.I.,
I.Y., S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T.,
S.K., Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
(Hirayama) From the Departments of Cardiovascular Surgery (A.S., M.I.,
I.Y., S.W., S.O., H.K., H.Y., H.H., M.S.) and Cardiology (T.N., T.T.,
S.K., Y.K., A.H.), Nihon University, School of Medicine, Tokyo, Japan
Title
Carperitide and atrial fibrillation after coronary bypass grafting: the
Nihon University working group study of low-dose HANP infusion therapy
during cardiac surgery trial for postoperative atrial fibrillation.
Source
Circulation. Arrhythmia and electrophysiology. 8 (3) (pp 546-553), 2015.
Date of Publication: 01 Jun 2015.
Abstract
BACKGROUND: Occurrence of atrial fibrillation after cardiac surgery is
associated with long-term mortality. We investigated whether infusion of
human atrial natriuretic peptide (carperitide) could prevent postoperative
atrial fibrillation.
METHODS AND RESULTS: A total of 668 patients who underwent isolated
coronary artery bypass grafting were randomized to receive infusion of
carperitide or physiological saline from the initiation of cardiopulmonary
bypass. Patients were monitored continuously for 1 week after surgery to
detect atrial fibrillation. The risk factors were investigated by Cox
proportional hazard model. Postoperative atrial fibrillation occurred in
41 of 335 patients (12.2%) from the carperitide group versus 110 of 333
patients (32.7%) from the placebo group (P<0.0001). Postoperative levels
of angiotensin-II, aldosterone, creatine kinase MB isoenzyme, human heart
fatty acid-binding protein, and brain natriuretic peptide were all
significantly lower in the carperitide group. The risk factors for
postoperative atrial fibrillation by the Cox proportional hazard model
were an age >70 years, emergency surgery, preoperative aldosterone level
>150 ng/mL, preoperative nonuse of angiotensin receptor antagonists,
preoperative use of calcium antagonists, postoperative nonuse of
beta-blockers, postoperative nonuse of aldosterone blockers, and nonuse of
carperitide.
CONCLUSIONS: -Perioperative carperitide infusion reduced the occurrence of
postoperative atrial fibrillation. Accordingly, carperitide could be a
useful option for preventing postoperative atrial fibrillation.
CLINICAL TRIAL REGISTRATION: -URL: http://www.umin.ac.jp. Unique
Identifier: UMIN000003958.

<11>
Accession Number
25475406
Author
Jacob M.; Fellahi J.-L.; Chappell D.; Kurz A.
Institution
(Jacob) Department of Anesthesiology, Surgical Intensive Care Medicine and
Pain Therapy, Harlaching Hospital, Munich Municipal Hospital Group,
Munich, Germany.
(Fellahi) Department of Anesthesiology and Critical Care, Hopital
Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon,
28 avenue du Doyen Lepine, Lyon, Bron, Cedex 69677, France.
(Fellahi) Faculte de Medecine Lyon Est, Universite Lyon 1, Lyon, 69008,
France.
(Chappell) Department of Anesthesiology, University Hospital of Munich,
Nussbaumstrasse 20, Munich, 80336, Germany.
(Kurz) Department of General Anesthesiology, Cleveland Clinic Main Campus,
Mail Code E31, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. ak@or.org
Title
The impact of hydroxyethyl starches in cardiac surgery: a meta-analysis.
Source
Critical care (London, England). 18 (6) (pp 656), 2014. Date of
Publication: 2014.
Abstract
INTRODUCTION: Recent studies in septic patients showed that adverse
effects of hydroxyethyl starches (HESs) possibly outweigh their benefits
in severely impaired physiological haemostasis. It remains unclear whether
this also applies to patient populations that are less vulnerable. In this
meta-analysis, we evaluated the impact of various HES generations on
safety and efficacy endpoints in patients undergoing cardiac surgery.
METHODS: We searched the PubMed, Embase and Cochrane Central Register of
Controlled Trials databases for randomised controlled trials (RCTs) in the
English or German language comparing the use of HES to any other colloid
or crystalloid during open heart surgery.
RESULTS: Blood loss and transfusion requirements were higher for older
starches with mean molecular weights more than 200 kDa compared to other
volume substitutes. In contrast, this effect was not observed with
latest-generation tetrastarches (130/0.4), which performed even better
when compared to albumin (blood loss of tetrastarch versus albumin:
standardised mean difference (SMD), -0.34; 95% CI, -0.63, -0.05; P = 0.02;
versus gelatin: SMD, -0.06; 95% CI, -0.20, 0.08; P = 0.39; versus
crystalloids: SMD, -0.05; 95% CI, -0.20, 0.10; P = 0.54). Similar results
were found for transfusion needs. Lengths of stay in the intensive care
unit or hospital were significantly shorter with tetrastarches compared to
gelatin (intensive care unit: SMD, -0.10; 95% CI, -0.15, -0.05; P =
0.0002) and crystalloids (hospital: SMD, -0.52; 95% CI, -0.90, -0.14; P =
0.007).
CONCLUSIONS: In this meta-analysis of RCTs, we could not identify safety
issues with tetrastarches compared with other colloid or crystalloid
solutions in terms of blood loss, transfusion requirements or hospital
length of stay in patients undergoing cardiac surgery. The safety data on
coagulation with older starches raise some issues that need to be
addressed in future trials.

<12>
Accession Number
25608502
Author
Kurapeev D.I.; Kabanov V.O.; Grebennik V.K.; Sheshurina T.A.; Dorofeykov
V.V.; Galagudza M.M.; Shlyakhto E.V.
Institution
(Kurapeev) Institute of Experimental Medicine, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation. dkurapeev@gmail.com
(Kabanov) Institute of Heart and Vessels, Federal Almazov Medical Research
Centre, Saint Petersburg, Russian Federation. kabanov_vo@mail.ru
(Grebennik) Institute of Heart and Vessels, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation. vadikdoc@mail.ru
(Sheshurina) Institute of Heart and Vessels, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation. mitralis@list.ru
(Dorofeykov) Institute of Heart and Vessels, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation.
vdorofeykov@yandex.ru
(Galagudza) Institute of Experimental Medicine, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation. galagoudza@mail.ru
(Galagudza) Department of Pathophysiology, First I.P. Pavlov Federal
Medical University of St. Petersburg, Saint Petersburg, Russian
Federation. galagoudza@mail.ru
(Shlyakhto) Institute of Heart and Vessels, Federal Almazov Medical
Research Centre, Saint Petersburg, Russian Federation.
e.shlyakhto@almazovcentre.ru
Title
New technique of local ischemic preconditioning induction without
repetitive aortic cross-clamping in cardiac surgery.
Source
Journal of cardiothoracic surgery. 10 (pp 9), 2015. Date of Publication:
2015.
Abstract
BACKGROUND: Several studies have demonstrated that local ischemic
preconditioning can reduce myocardial ischemia-reperfusion injury in
cardiac surgery patients; however, preconditioning has not become a
standard cardioprotective intervention, primarily because of the increased
risk of atheroembolism during repetitive aortic cross-clamping. In the
present study, we aimed to describe and validate a novel technique of
preconditioning induction.
METHODS: Patients undergoing coronary artery bypass grafting (12 women and
78 men; mean age, 56+/-11 years) were randomized into 3 groups: (1)
Controls (n=30), (2) Perfusion (n=30), and (3) Preconditioning (n=30). All
patients were operated under cardiopulmonary bypass using normothermic
blood cardioplegia. Preconditioning was induced by subjecting the
hemodynamically unloaded heart to 2 cycles of 3 min of ischemia and 3 min
of reperfusion with normokalemic blood prior to cardioplegia. In the
Perfusion group, the heart perfusion remained unaffected for 12 min.
Troponin I (TnI) levels were analyzed before surgery, and 12, 24, 48 h,
and 7 days after surgery. The secondary endpoints included the cardiac
index, plasma natriuretic peptide level, and postoperative use of
inotropes.
RESULTS: Preconditioning resulted in a significant reduction in the TnI
level on the 7th postoperative day only (0.10+/-0.05 and 0.33+/-0.88 ng/ml
in Preconditioning and Perfusion groups, respectively, P<0.05). In
addition, cardiac index was significantly higher in the Preconditioning
group than in the Control and Perfusion groups just after weaning from
cardiopulmonary bypass. The number of patients requiring inotropic support
with>2 agents after surgery was significantly lower in the Preconditioning
and Perfusion group than in the Control group (P<0.05). No complications
of the procedure were recorded in the Preconditioning group.
CONCLUSIONS: The preconditioning procedure described can be performed
safely in cardiac surgery patients. The application of this technique of
preconditioning was associated with certain benefits, including improved
left ventricular function after weaning from cardiopulmonary bypass and a
reduced need for inotropic support. However, the infarct-limiting effect
of preconditioning in the early postoperative period was not evident. The
procedure does not involve repetitive aortic cross-clamping, thus avoiding
possible embolic complications.

<13>
Accession Number
25567131
Author
Le J.; Baskett R.J.; Buth K.J.; Hirsch G.M.; Brydie A.; Gayner R.; Legare
J.-F.
Institution
(Le) Department of Surgery, Dalhousie University, Halifax, Nova Scotia,
Canada. htjle@dal.ca
(Baskett) Department of Surgery, Dalhousie University, Halifax, Nova
Scotia, Canada. rbaskett@dal.ca
(Buth) Department of Surgery, Dalhousie University, Halifax, Nova Scotia,
Canada. K.J.Buth@Dal.Ca
(Hirsch) Department of Surgery, Dalhousie University, Halifax, Nova
Scotia, Canada. Greg.hirsch@dal.ca
(Brydie) Department of Radiology, Dalhousie University, Halifax, Nova
Scotia, Canada. Abrydie@eastlink.ca
(Gayner) Department of Surgery, Dalhousie University, Halifax, Nova
Scotia, Canada. RGAINER@dal.ca
(Legare) Department of Surgery, Dalhousie University, Halifax, Nova
Scotia, Canada. jean.legare@cdha.nshealth.ca
(Legare) Division of Cardiovascular Surgery, The Maritime Heart Center,
2269-1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
jean.legare@cdha.nshealth.ca
Title
A pilot randomized controlled trial comparing CABG surgery performed with
total arterial grafts or without.
Source
Journal of cardiothoracic surgery. 10 (pp 1), 2015. Date of Publication:
2015.
Abstract
OBJECTIVE: To date only a few randomized controlled studies have compared
grafting strategies in patients with multi-vessel coronary disease. This
study represents a pilot RCT designed to test the feasibility of a trial
comparing conventional CABG performed with a LIMA-LAD plus saphenous vein
grafts (LIMA+SVG) and CABG performed with total arterial grafting (TAG).
METHODS: Consenting patients undergoing non-redo isolated CABG surgery at
a single institution were randomized to TAG or LIMA+SVG groups. Exclusion
criteria included prior CABG, emergent procedure, concomitant procedure,
varicose veins and renal dysfunction. The primary endpoints were:
enrolment >20% and completion of CT coronary angiography at 6 months >80%.
Statistical investigation was performed on an intention to treat analysis.
RESULTS: Of 421 eligible patients, 60 were enrolled and 2 withdrew (n=30
in TAG, n=28 LIMA+SVG) for 14% enrolment rate. Patient characteristics
were similar in each group. No patients died in hospital and adverse
events such as MI, stroke and deep sternal wound infection were not
significantly different between groups. Clinical follow-up was complete in
100% of patients, with 44/58 (76%) undergoing CT coronary angio at 6
months. Graft occlusion occurred in 2 patients in each group for patency
rates of 89% (TAG) and 91% (LIMA+SVG).
CONCLUSIONS: We provide evidence that an RCT comparing grafting strategy
is possible but also show that achieving recruitment or follow-up CT may
be difficult. Given the excellent patency results and little difference
between groups, our findings suggest that the sample size required may
make it infeasible to compare graft patency at 6 months as a study
end-point.
TRIAL REGISTRATION: Randomized Controlled Trial number: ISRCTN80270323 .
Few RCT's exist comparing conventional CABG performed with a LIMA-LAD plus
saphenous vein grafts (LIMA+SVG) compared to CABG performed with total
arterial grafting (TAG). This study is a pilot RCT designed to test the
feasibility of such a trial and identify pitfalls.

<14>
Accession Number
25833533
Author
Averin E.
Institution
(Averin) Department of Cardiology of Faculty of Postgraduate Education,
Russian National Research Medical University, Moscow, Russia,
averin76@bk.ru
Title
Use of taurine during rehabilitation after cardiac surgery.
Source
Advances in experimental medicine and biology. 803 (pp 637-649), 2015.
Date of Publication: 2015.

<15>
Accession Number
26933848
Author
Myles P.S.; Smith J.A.; Forbes A.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; Wallace S.
Institution
(Myles) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Smith) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Forbes) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Silbert) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Jayarajah) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and
Monash University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne,
VIC, St. Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide
Hospital, Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School,
Devon, United Kingdom (M.J.); and Institut Universitaire de Cardiologie et
de Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Painter) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Cooper) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Marasco) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(McNeil) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Bussieres) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and
Monash University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne,
VIC, St. Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide
Hospital, Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School,
Devon, United Kingdom (M.J.); and Institut Universitaire de Cardiologie et
de Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
(Wallace) From the Alfred Hospital (P.S.M., D.J.C, S.M., S.W.) and Monash
University (P.S.M., J.A.S., A.F., D.J.C., S.M., J.M.), Melbourne, VIC, St.
Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital,
Adelaide, SA (T.P.) - all in Australia; Plymouth Medical School, Devon,
United Kingdom (M.J.); and Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada (J.S.B)
Title
Stopping vs. Continuing Aspirin before Coronary Artery Surgery.
Source
The New England journal of medicine. 374 (8) (pp 728-737), 2016. Date of
Publication: 25 Feb 2016.
Abstract
BACKGROUND: Most patients with coronary artery disease receive aspirin for
primary or secondary prevention of myocardial infarction, stroke, and
death. Aspirin poses a risk of bleeding in patients undergoing surgery,
but it is unclear whether aspirin should be stopped before coronary artery
surgery.
METHODS: We used a 2-by-2 factorial trial design to randomly assign
patients who were scheduled to undergo coronary artery surgery and were at
risk for perioperative complications to receive aspirin or placebo and
tranexamic acid or placebo. The results of the aspirin trial are reported
here. Patients were randomly assigned to receive 100 mg of aspirin or
matched placebo preoperatively. The primary outcome was a composite of
death and thrombotic complications (nonfatal myocardial infarction,
stroke, pulmonary embolism, renal failure, or bowel infarction) within 30
days after surgery.
RESULTS: Among 5784 eligible patients, 2100 were enrolled; 1047 were
randomly assigned to receive aspirin and 1053 to receive placebo. A
primary outcome event occurred in 202 patients in the aspirin group
(19.3%) and in 215 patients in the placebo group (20.4%) (relative risk,
0.94; 95% confidence interval, 0.80 to 1.12; P=0.55). Major hemorrhage
leading to reoperation occurred in 1.8% of patients in the aspirin group
and in 2.1% of patients in the placebo group (P=0.75), and cardiac
tamponade occurred at rates of 1.1% and 0.4%, respectively (P=0.08).
CONCLUSIONS: Among patients undergoing coronary artery surgery, the
administration of preoperative aspirin resulted in neither a lower risk of
death or thrombotic complications nor a higher risk of bleeding than that
with placebo. (Funded by the Australian National Health and Medical
Research Council and others; Australia New Zealand Clinical Trials
Registry number, ACTRN12605000557639.).

<16>
Accession Number
25592946
Author
Lin Y.; Wang Y.-F.; Lin D.-Q.; Chen J.-W.; Li J.-Z.; Lan T.-H.; Ou A.-H.;
Ruan X.-M.
Institution
(Lin, Wang, Lin, Chen, Li, Lan, Ou, Ruan) Heart Center, The Second
Affiliated Hospital of Guangzhou University of Chinese Medicine,
Guangzhou, China
Title
Efficacy and safety of Huxin formula in patients after CABG: a
multicenter, double-blind, randomized clinical trial.
Source
Forschende Komplementarmedizin (2006). 21 (6) (pp 351-359), 2014. Date of
Publication: 2014.
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is widely used in the
treatment of coronary artery disease. A multicenter, double-blind,
randomized, controlled clinical trial was designed to evaluate the
efficacy and safety of Huxin Formula post CABG.
PATIENTS AND METHODS: 270 inpatients with coronary heart disease
participated in this study. CABG patients in the control group were
treated with placebo, while patients in the experimental group were
treated with Huxin Formula 1 week after the surgery. All patients were
treated for 6 months and followed up for another 6 months. The main
outcomes (death, nonfatal myocardial infarction, repeat revascularization,
and readmission) were assessed 360 days after treatment, and secondary
outcomes (frequency and scores of angina pectoris, etc.) were assessed 0,
90, 180, 270, and 360 days after treatment.
RESULTS: Our results showed no significant difference between the 2 groups
for the primary endpoints. In patients with cardiac function class II (New
York Heart Association), the score of angina pectoris was significantly
lower (3.88 +/- 3.86 vs. 5.45 +/- 3.59) and the frequency of angina
pectoris attacks was less (0.96 +/- 1.01 vs. 1.36 +/- 0.94) after 90 days
of treatment with Huxin Formula compared to placebo (p < 0.05). In
patients with 3 coronary vessel lesions, the cardiac function class (1.14
+/- 0.35 vs. 1.05 +/- 0.21) after 360 days was significantly higher in the
control group compared to the treatment group (p < 0.05). There were no
obvious adverse reactions.
CONCLUSION: Huxin Formula may improve cardiac function of patients with 3
coronary vessel lesions and relieve symptoms of patients with cardiac
function class II but failed to show superiority in primary outcomes.

<17>
Accession Number
25465811
Author
Phan K.; Wong S.; Wang N.; Phan S.; Yan T.D.
Institution
(Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia; Sydney Medical School, University of Sydney, Sydney,
Australia
(Wong) Gosford Hospital, Gosford, Australia
(Wang) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Phan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Yan) The Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia; Sydney Medical School, University of Sydney, Sydney,
Australia. Electronic address: tristanyan@annalscts.com
Title
Hybrid coronary revascularization versus coronary artery bypass surgery:
systematic review and meta-analysis.
Source
International journal of cardiology. 179 (pp 484-488), 2015. Date of
Publication: 20 Jan 2015.

<18>
Accession Number
25453403
Author
Moretti C.; D'Ascenzo F.; Quadri G.; Omede P.; Montefusco A.; Taha S.;
Cerrato E.; Colaci C.; Chen S.-L.; Biondi-Zoccai G.; Gaita F.
Institution
(Moretti) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(D'Ascenzo) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy. Electronic
address: fabrizio.dascenzo@gmail.com
(Quadri) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(Omede) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(Montefusco) Division of Cardiology, Department of Internal Medicine,
Citta Della Salute e Della Scienza, University of Turin, Italy
(Taha) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(Cerrato) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(Colaci) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
(Chen) Nanjing Medical University, Nanjing, China
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, Rome,
Italy
(Gaita) Division of Cardiology, Department of Internal Medicine, Citta
Della Salute e Della Scienza, University of Turin, Italy
Title
Management of multivessel coronary disease in STEMI patients: a systematic
review and meta-analysis.
Source
International journal of cardiology. 179 (pp 552-557), 2015. Date of
Publication: 20 Jan 2015.
Abstract
BACKGROUND: Appropriate management for patients with multivessel coronary
disease presenting with ST segment Elevation Myocardial Infarction (STEMI)
remains to be defined.
METHODS AND RESULTS: Medline and Cochrane Library were searched for
randomized controlled trials (RCTs) or observational studies adjusted with
multivariate analysis, reporting about STEMI patients with multivessel
coronary disease treated with either a culprit only or complete
revascularization strategy, excluding patients in cardiogenic shock.
Prespecified analysis was performed according to the strategy of complete
revascularization, either during the same procedure of primary
percutaneous coronary intervention (PCI) or during the index
hospitalization. MACE (a composite and mutually exclusive end point of
death or myocardial infarction or revascularization) at follow-up of at
least one year was the primary end point. 9 studies with 4686 patients
compared culprit only versus complete PCI performed during the primary
PCI. Rates of MACE did not differ at 90 days (OR 0.70 [0.38, 1.27],
I(2)=0%) or at 1 year (1-2.5) (OR 0.70 [0.47, 1.03], I(2)=0%). No
significant difference was found for the components of the primary
outcome, apart from a reduction in repeated revascularization for patients
undergoing complete PCI during the STEMI procedure (OR 0.62 [0.39, 0.98],
I(2)=0%). 6 studies (1 RCT) with 5855 patients compared culprit only
lesions versus complete PCI performed during index hospitalization. 90 day
risk of MACE did not differ nor 1 year (1-2.5) MACE (OR 0.86 [0.62, 1.08],
I(2)=0%), with a similar reduction in repeated revascularization (0.60
[0.40, 0.90], I(2)=0%).
CONCLUSIONS: Complete revascularization performed during primary PCI or
index hospitalizations for patients presenting with STEMI appears safe at
short term follow-up and offers a reduction in repeated revascularization
at one year.

<19>
Accession Number
25174443
Author
Hein E.; Munthe-Fog L.; Thiara A.S.; Fiane A.E.; Mollnes T.E.; Garred P.
Institution
(Hein, Munthe-Fog, Thiara, Fiane, Mollnes, Garred) Laboratory of Molecular
Medicine, Department of Clinical Immunology, Rigshospitalet, Faculty of
Health Sciences, University of Copenhagen, Copenhagen, Norway
Title
Heparin-coated cardiopulmonary bypass circuits selectively deplete the
pattern recognition molecule ficolin-2 of the lectin complement pathway in
vivo.
Source
Clinical and experimental immunology. 179 (2) (pp 294-299), 2015. Date of
Publication: 01 Feb 2015.
Abstract
The complement system can be activated via the lectin pathway by the
recognition molecules mannose-binding lectin (MBL) and the ficolins.
Ficolin-2 exhibits binding against a broad range of ligands, including
biomaterials in vitro, and low ficolin-2 levels are associated with
increased risk of infections. Thus, we investigated the biocompatibility
of the recognition molecules of the lectin pathway in two different types
of cardiopulmonary bypass circuits. Bloods were drawn at five time-points
before, during and postoperatively from 30 patients undergoing elective
cardiac surgery. Patients were randomized into two groups using different
coatings of cardiopulmonary bypass circuits, Phisio (phosphorylcholine
polymer coating) and Bioline (albumin-heparin coating). Concentrations of
MBL, ficolin-1, -2 and -3 and soluble C3a and terminal complement complex
(TCC) in plasma samples were measured. Ficolin-3-mediated complement
activation potential was evaluated with C4, C3 and TCC as output. There
was no significant difference between the two circuit materials regarding
MBL, ficolin-1 and -3. In the Bioline group the ficolin-2 levels decreased
significantly after initiation of surgery (P < 0.0001) and remained
reduced throughout the sampling period. This was not seen for
Phisio-coated circuits. Ficolin-3-mediated complement activation potential
was reduced significantly in both groups after start of operation (P <
0.0001), whereas soluble C3a and TCC in the samples were increased (P <
0.0001). Ficolin-2 was depleted from plasma during cardiac surgery when
using heparin-coated bypass circuits and did not reach baseline level 24 h
postoperation. These findings may have implications for the postoperative
susceptibility to infections in patients undergoing extracorporeal
circulation procedures.

<20>
Accession Number
20160258742
Author
Bazoukis G.; Tsimos K.; Korantzopoulos P.
Institution
(Bazoukis) Department of Internal Medicine, General Hospital of Athens,
Athens, Elpis, Greece
(Tsimos, Korantzopoulos) First Department of Cardiology, University of
Ioannina, Medical School, Ioannina 45110, Greece
Title
Episodic Left Bundle Branch Block - A Comprehensive Review of the
Literature.
Source
Annals of Noninvasive Electrocardiology. 21 (2) (pp 117-125), 2016. Date
of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Episodic (transient/ intermittent) left bundle branch block (LBBB) has
been associated with different conditions such as bradycardia,
tachycardia, anesthesia, acute pulmonary embolism, changes in
intrathoracic pressure, chest trauma, cardiac interventional procedures,
mad honey poisoning, and in other clinical settings. Of note, exclusion of
an acute coronary syndrome in the setting of episodic LBBB is of great
importance. Moreover, episodic LBBB is sometimes symptomatic and may be
associated with left ventricular systolic and/or diastolic dysfunction or
conduction disturbances leading to syncope. This review article provides a
comprehensive overview of the conditions associated with episodic LBBB and
discusses the clinical impact of this phenomenon.

<21>
Accession Number
20160256923
Author
Moludi J.; Keshavarz S.; Tabaee A.S.; Safiri S.; Pakzad R.
Institution
(Moludi) Department of Biochemistry and Diet Therapy, Faculty of
Nutrition, Nutrition Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Keshavarz) School of Nutritional Sciences and Dietetics, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Tabaee) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Safiri) Managerial Epidemiology Research Center, Department of Public
Health, School of Nursing and Midwifery, Maragheh University of Medical
Sciences, Maragheh, Iran, Islamic Republic of
(Pakzad) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Q10 supplementation effects on cardiac enzyme CK-MB and troponin in
patients undergoing coronary artery bypass graft: A
randomized,double-blinded, placebo-controlled clinical trial.
Source
Journal of Cardiovascular and Thoracic Research. 8 (1) (pp 1-7), 2016.
Date of Publication: 2016.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Coronary artery bypass surgery (CABG) is associated with
ischemia-reperfusion injury and tissue damage. CoQ10 as an antioxidant has
an important role and may have cardioprotective effects after myocardial
dysfunction and CABG. We aimed to evaluate whether CoQ10 has a myocardial
cardio protective impact on cardiac biomarkers after CABG. Methods: In
this double-blind study, 80 patients with coronary artery disease (CAD)
who underwent CABG surgery were divided into intervention and control
groups and received Q10 supplement or placebo, respectively. The surgical
characteristics of the patients in the two groups were similar. The
intervention group received 150 mg of Q10 supplement per day for 7 days
before the surgery. The control group received placebo capsule. After
operation the inter- and intra-group blood levels of CK-MB and troponin,
before and after supplementation and 12 hours after the CABG, and
postoperative outcomes such as intensive care unit (ICU) stay and hospital
stay were compared. Results: In this study, 40 subjects were located in
each group. The participation rate was 97.5% and men and women accounted
for 52.5% and 47.5% respectively. The mean age of the subjects was 58.17
+/- 8.55. The two groups were not significantly different in terms of
basic variables. Within-group comparison showed a significant increase in
the level of troponin enzymes over time (P < 0.001) and CK-MB (P < 0.001).
However, between-group comparison showed no significant difference between
the two groups in terms of CK-MB (P = 0.384) and troponin (P = 0.115). In
the end, no interaction was observed between the intervention and time on
CK-MB (P = 0.095) and troponin (P = 0.198) variables. Conclusion: Q10
supplementation 7 days before surgery was not effective in reducing CK-MB
and troponin after CABG.

<22>
Accession Number
20160250752
Author
Badings E.A.; Remkes W.S.; Dambrink J.-H.E.; The S.H.K.; Van Wijngaarden
J.; Tjeerdsma G.; Rasoul S.; Timmer J.R.; van der Wielen M.L.J.; Lok
D.J.A.; van 't Hof A.W.J.
Institution
(Badings, Van Wijngaarden, Lok) Deventer Hospital, Deventer, Netherlands
(Remkes, Dambrink, Timmer, van 't Hof) Isala Klinieken, Dokter van Heesweg
2, Zwolle 8025AB, Netherlands
(The, van der Wielen) Treant Zorggroep location Bethesda, Hoogeveen,
Netherlands
(Tjeerdsma) Hospital De Tjongerschans, Heerenveen, Netherlands
(Rasoul) Atrium Medisch Centrum, Heerlen, Netherlands
(Rasoul) Maastricht UMC, Maastricht, Netherlands
Title
Timing of intervention in high-risk non-ST-elevation acute coronary
syndromes in PCI versus non-PCI centres: Sub-group analysis of the ELISA-3
trial.
Source
Netherlands Heart Journal. 24 (3) (pp 181-187), 2016. Date of Publication:
March 2016.
Publisher
Bohn Stafleu van Loghum
Abstract
Aims To compare the effect of timing of intervention in patients with
non-ST-elevation acute coronary syndrome (NSTE-ACS) in percutaneous
coronary intervention (PCI) versus non-PCI centres. Methods and results A
post-hoc sub-analysis was performed of the ELISA III trial, a randomised
multicentre trial investigating outcome of early (< 12 h) versus late (>
48 h) angiography and revascularisation in 542 patients with highrisk
NSTE-ACS. 90 patients were randomised in non-PCI centres and tended to
benefit more from an early invasive strategy than patients included in the
PCI centre (relative risk 0.23 vs. 0.85 [p for interaction = 0.089] for
incidence of the combined primary endpoint of death, reinfarction and
recurrent ischaemia after 30 days of follow-up). This was largely driven
by reduction in recurrent ischaemia. In non- PCI centres, patients
randomised to the late group had a 4 and 7 day longer period until PCI or
coronary artery bypass grafting, respectively. This difference was less
pronounced in the PCI centre. Conclusions This post-hoc analysis from the
ELISA-3 trial suggests that NSTE-ACS patients initially hospitalised in
non-PCI centres show the largest benefit from early angiography and
revascularisation, associated with a shorter waiting time to
revascularisation. Improved patient logistics and transfer between non-PCI
and PCI centres might therefore result in better clinical outcome.

<23>
Accession Number
20160249751
Author
Dong Z.; Yu B.; Zhang Q.; Pei H.; Xing J.; Fang W.; Sun Y.; Song Z.
Institution
(Dong, Yu, Xing, Fang, Sun) Department of ICU, The Affiliated Hospital of
Qingdao University, Qingdao, China
(Zhang) Department of Cardiology, The Affiliated Hospital of Qingdao
University, Qingdao, China
(Pei) Department of Neurology, The Affiliated Hospital of Qingdao
University, Qingdao, China
(Song) Department of Breast Surgery, The Affiliated Hospital of Qingdao
University, Qingdao, China
Title
Early rehabilitation therapy is beneficial for patients with prolonged
mechanical ventilation after coronary artery bypass surgery a prospective
random study.
Source
International Heart Journal. 57 (2) (pp 241-246), 2016. Date of
Publication: 22 Mar 2016.
Publisher
International Heart Journal Association
Abstract
We investigated the effects of early rehabilitation therapy on prolonged
mechanically ventilated patients after coronary artery bypass surgery
(CABG). A total of 106 patients who underwent CABG between June 2012 and
May 2015 were enrolled and randomly assigned into an early rehabilitation
group (53 cases) and a control group (53 cases). The rehabilitation
therapy consisted of 6 steps including head up, transferring from
supination to sitting, sitting on the edge of bed, sitting in a chair,
transferring from sitting to standing, and walking along a bed. The
patients received rehabilitation therapy in the intensive care unit (ICU)
after CABG in the early rehabilitation group. The control group patients
received rehabilitation therapy after leaving the ICU. The results showed
that the early rehabilitation therapy could significantly decrease the
duration of mechanical ventilation (early rehabilitation group: 8.1 +/-
3.3 days; control group: 13.9 +/- 4.1 days, P < 0.01), hospital stay
(early rehabilitation group: 22.0 +/- 3.8 days; control group: 29.1 +/-
4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 +/-
3.2 days; control group: 18.3 +/- 4.2 days, P < 0.01) for patients
requiring more than 72 hours prolonged mechanical ventilation. The results
of Kaplan-Meier analysis showed that the proportions of patients remaining
on mechanical ventilation in the early rehabilitation group were larger
than that in the control group after 7 days of rehabilitation therapy
(logrank test: P < 0.01). The results provide evidence for supporting the
application of early rehabilitation therapy in patients requiring
prolonged mechanical ventilation after CABG.

<24>
Accession Number
20160249740
Author
Lv J.; Zhang X.; Ou S.; Gu S.; Su Z.; Tong S.; Liu B.; Song Z.; Chi L.
Institution
(Lv, Ou, Su, Tong, Liu, Song, Chi) Department of Cardiology, Southwest
Hospital of Third Military Medical University, Chongqing, China
(Lv) The Heart Center, General Hospital Affiliated to Ningxia Medical
University, China
(Zhang) Department of Neurology, Fifth Hospital of the People's Liberation
Army, Yinchuan, China
(Gu) Department of Clinical Psychology, Southwest Hospital of Third
Military Medical University, Chongqing, China
Title
Influence of cognitive behavioral therapy on mood and quality of life
after stent implantation in young and middle-aged patients with coronary
heart disease.
Source
International Heart Journal. 57 (2) (pp 167-172), 2016. Date of
Publication: 22 Mar 2016.
Publisher
International Heart Journal Association
Abstract
Cognitive behavioral therapy (CBT), established only a few decades ago, is
widely used by clinical psychologists. This study aimed to investigate the
effects of CBT on mental status and quality of life (QOL) after
percutaneous coronary intervention (PCI) in young and middle-aged patients
with coronary heart disease (CHD). Seventy-five anxiety/depression
patients (mean age, 52.2 +/- 6.2 years, including 8 individuals < 45 years
old) with CHD treated with PCI were randomly divided into a CBT group (n =
38) and control group (n = 37). The CBT group received 8 weeks of CBT in
addition to the routine postoperative treatment that was also administered
to control patients. The 17-item Hamilton Depression Rating Scale
(HAM-D17), Hamilton anxiety scale (HAM-A), and Coronary Revascularization
Outcome Questionnaire (CROQ-PTCA-POST, Chinese version) were administered
before, 3 days, and 8 weeks after intervention. HAM-D17 and HAM-A scores
were decreased after treatment, but were more substantially reduced in
patients that underwent CBT than those in the control group (11.7 +/- 4.5
versus 15.1 +/- 3.9, P = 0.001 and 10.6 +/- 3.4 versus 16.5 +/- 4.6, P =
0.003, respectively). QOL was improved in both groups, but overall
satisfaction was higher in the CBT group compared with control patients
(89.3 +/- 5.2 versus 77.8 +/- 9.5, P < 0.05). CBT can relieve depression
and anxiety after PCI in young and middle-aged patients with CHD. CBT can
improve patient QOL.

<25>
Accession Number
20160236738
Author
Tariq N.; Tepper S.J.; Kriegler J.S.
Institution
(Tariq) Michigan Headache and Neurological Institute, Ringgold Standard
Institution Neurology, 3120 Professional Drive, Ann Arbor, MI, United
States
(Tepper) Dartmouth College, Geisel School of Medicine, Ringgold Standard
Institution - Neurology, Hanover, NH, United States
(Kriegler) Cleveland Clinic, Center for Neurological Restoration,
Cleveland, OH, United States
Title
Patent Foramen Ovale and Migraine: Closing the Debate - A Review.
Source
Headache. 56 (3) (pp 462-478), 2016. Date of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background A link between patent foramen ovale (PFO) and migraine as well
as the utility of closure of PFO and its effect on migraine have been
subjects of debate. The present review is an effort to gather the
available evidence on this topic and formulate recommendations. Methods A
systematic search of electronic databases (Medline, Embase, Cochrane
Library) was performed. A separate search in associated reference lists of
identified studies was done. Observational studies and clinical trials
published in English using the International Headache Society criteria for
diagnosis of migraine were included in the analysis. The search was
performed in 3 categories: prevalence of migraine in patients with PFO,
prevalence of PFO in migraine patients, and effect of PFO closure and its
effect on migraine. The quality of evidence and strength of
recommendations during review of these studies was analyzed. Results About
14 observational studies with 2602 subjects who had PFO were identified.
Migraine prevalence ranged from 16% to 64%. Another 20 studies reported
2444 patients with migraine; the prevalence of PFO ranged from 15% to 90%.
About 20 observational studies (1194 patients) that examined the effect of
PFO closure on migraine were identified. Resolution of migraine was
reported in 10% to 83% of patients, improvement in 14% to 83%, no change
in 1% to 54%, and worsening in 4% to 8%. The overall quality of these
observational studies was poor. Finally, 3 randomized clinical trials
included a total of 238 patients who underwent PFO closure compared with
234 patients in the control groups. All 3 trials failed to meet their
primary end points defined as migraine resolution and greater than 50%
reduction in migraine days at 1 year. In 2 of the clinical trials, there
was some benefit noted in a small subset of migraine patients with aura,
but the numbers were too small to extrapolate the findings to the general
migraine population. Conclusions There is no good quality evidence to
support a link between migraine and PFO. Closure of PFO for migraine
prevention does not significantly reduce the intensity and severity of
migraine. We do not recommend the routine use of this procedure in current
practice.

<26>
Accession Number
20160223403
Author
Shinnick J.K.; Short H.L.; Heiss K.F.; Santore M.T.; Blakely M.L.; Raval
M.V.
Institution
(Shinnick, Short, Heiss, Santore, Raval) Division of Pediatric Surgery,
Department of Surgery, Emory University School of Medicine, Children's
Healthcare of Atlanta, 1405 Clifton Road, 3rd Floor Surgical Suite,
Atlanta, GA 30322-1101, United States
(Blakely) Department of Pediatric Surgery, Vanderbilt University Medical
Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville,
TN, United States
Title
Enhancing recovery in pediatric surgery: A review of the literature.
Source
Journal of Surgical Research. 202 (1) (pp 165-176), 2016. Date of
Publication: 01 May 2016.
Publisher
Academic Press Inc.
Abstract
Enhanced recovery after surgery (ERAS), guidelines entail a strategy of
perioperative management proven to hasten postoperative recovery and
reduce complications in adult populations. Relatively few studies have
investigated the applicability of this paradigm to pediatric populations.
Our objective was to perform a systematic review of existing evidence
regarding the use and efficacy of enhanced recovery protocols (ERPs) in
the pediatric population. Materials and methods Data were collected
through a PubMed/MEDLINE literature search. Study eligibility criteria
included a pediatric population and implementation of at least four
components of published ERAS Society recommendations. Results One
retrospective and four prospective cohort studies evaluating children
undergoing gastrointestinal, urologic, and thoracic surgeries were
identified. The overall quality of reporting was fair with few studies
acknowledging limitations and bias and inconsistent outcome reporting.
Studies included six or fewer interventions compared to 20 recommended
interventions in most adult ERAS Society guidelines. None of the studies
were well controlled. Nevertheless, these studies suggest that ERPs
applied to the appropriate pediatric surgical populations may be
associated with decreased length of stay, decreased narcotic use, and no
detectable increase in complications. Conclusions There is a paucity of
high-quality literature evaluating implementation of ERPs in pediatric
populations. The limited literature available indicates that ERPs would be
safe and potentially effective. More studies are needed to assess the
efficacy of ERPs in pediatric surgery.

<27>
Accession Number
20160234091
Author
Liang F.; Song B.; Liu R.; Yang L.; Tang H.; Li Y.
Institution
(Liang, Song, Liu, Tang, Li) First Clinical College, Lanzhou University,
No. 1, DongGang Xi Road, Chengguan District, Lanzhou City, Gansu Province,
China
(Liang, Song, Liu, Yang, Tang, Li) Department of Cardiovascular Surgery,
First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
Title
Optimal timing for early surgery in infective endocarditis: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (3) (pp 336-345),
2016. Date of Publication: 01 Mar 2016.
Publisher
Oxford University Press
Abstract
To systematically review early surgery and the optimal timing of surgery
in patients with infective endocarditis (IE), a search for foreign and
domestic articles on cohort studies about the association between early
surgery and infective endocarditis published from inception to January
2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature
(CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI)
databases. The studies were screened according to the inclusion and
exclusion criteria, the data were extracted and the quality of the method
of the included studies was assessed. Then, the meta-analysis was
performed using the Stata 12.0 software. Sixteen cohort studies, including
8141 participants were finally included. The results of the meta-analysis
revealed that, compared with non-early surgery, early surgery in IE lowers
the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95%
confidence interval (CI) (0.42, 0.77); P = 0.000, I² = 73.1%]
and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001,
I² = 67.4%]. Further, performing operation within 2 weeks had a
more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41,
0.97); P = 0.192, I² = 39.4%] than non-early surgery. In
different kinds of IE, we found that early surgery for native valve
endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31,
0.69); P = 0.001, I² = 73.0%] and long-term [OR = 0.57, 95% CI
(0.40, 0.81); P = 0.001, I² = 68.9%] mortality than the
non-early surgery group. However, for prosthetic valve endocarditis (PVE),
in-hospital mortality did not differ significantly [OR = 0.83, 95% CI
(0.65, 1.06); P = 0.413, I² = 0.0%] between early and non-early
surgery. We concluded that early surgery was associated with lower
in-hospital and long-term mortality compared with non-early surgical
treatment for IE, especially in NVE. However, the optimal timing of
surgery remains unclear. Additional larger prospective clinical trials
will be required to clarify the optimal timing for surgical intervention
and determine its efficacy in PVE.

<28>
Accession Number
20160234078
Author
Rodham P.; Batty J.A.; McElnay P.J.; Immanuel A.
Institution
(Rodham) Medical School, Newcastle University, Newcastle-upon-Tyne, United
Kingdom
(Batty) Department of Colorectal Surgery, Newcastle Upon Tyne Hospitals
NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
(McElnay, Immanuel) Department of Upper Gastrointestinal Surgery,
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
NE1 4LP, United Kingdom
Title
Does minimally invasive oesophagectomy provide a benefit in hospital
length of stay when compared with open oesophagectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (3) (pp 360-367),
2016. Date of Publication: 01 Mar 2016.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: 'in patients undergoing
oesophagectomy, does a minimally invasive approach convey a benefit in
hospital length of stay (LOS), when compared to an open approach?' A total
of 647 papers were identified, using an a priori defined search strategy;
24 papers represented the best evidence to answer the clinical question.
The authors, journal, date, country of publication, patient group, study
type, relevant outcomes and key results are tabulated. Of the studies
identified, data from two randomized controlled trials were available. The
first randomized study compared the use of open thoracotomy and laparotomy
versus thoracoscopy and laparoscopy. Those undergoing minimally invasive
oesophagectomy (MIO) left hospital on average 3 days earlier than those
treated with the open oesophagectomy (OO) technique (P = 0.044). The other
randomized trial, which compared thoracotomy with thoracoscopy and
laparoscopy, demonstrated a reduction of 1.8 days in the LOS when
employing the MIO technique (P < 0.001). With the addition of the
remaining 22 non-randomized studies, comprising 3 prospective and 19
retrospective cohort studies, which are heterogeneous with regard to their
design, study populations and outcomes; data are available representing
3173 MIO and 25 691 OO procedures. In total, 13 studies (including the
randomized trials) demonstrate a significant reduction in hospital LOS
associated with MIO; 10 suggest no significant difference between
techniques; and only 1 suggests a significantly greater length of stay
associated with MIO. The only two randomized trials comparing MIO and OO
demonstrated a reduction in length of stay in the MIO group, without
compromising survival or increasing complication rates. All bar one of the
non-randomized studies demonstrated either a significant reduction in
length of stay with MIO or no difference. The benefit in reduced length of
stay was not at the cost of worsened survival or increased complications,
and conversion rates in all studies were low.

<29>
Accession Number
20160221080
Author
Huisman J.; Van Der Heijden L.C.; Kok M.M.; Danse P.W.; Jessurun G.A.J.;
Stoel M.G.; Van Houwelingen K.G.; Lowik M.M.; Hautvast R.W.M.; Ijzerman
M.J.; Doggen C.J.; Von Birgelen C.
Institution
(Huisman, Van Der Heijden, Kok, Stoel, Van Houwelingen, Lowik, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Ijzerman, Doggen, Von Birgelen) Health Technology and Services Research,
MIRA, Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
(Von Birgelen) Thoraxcentrum Twente, University of Twente, Medisch
Spectrum Twente (MST), Department of Cardiology, Postbus 50.000, Enschede
7500 KA, Netherlands
Title
Impact of severe lesion calcification on clinical outcome of patients with
stable angina, treated with newer generation permanent polymer-coated
drug-eluting stents A patient-level pooled analysis from TWENTE and DUTCH
PEERS (TWENTE II).
Source
American Heart Journal. 175 (pp 121-129), 2016. Date of Publication: 01
May 2016.
Publisher
Mosby Inc.
Abstract
Background The outcome of percutaneous coronary intervention with newer
generation permanent polymer-coated drug-eluting stents (DES) in patients
with severely calcified lesions is greatly unknown. We assessed the impact
of severe lesion calcification on clinical outcome in patients with stable
angina who underwent percutaneous coronary intervention with newer
generation DES. Methods TWENTE and DUTCH PEERS randomized trials enrolled
1423 patients with stable angina, who were categorized into patients with
versus without severe target lesion calcification. A patient-level pooled
analysis assessed clinical outcome, including target vessel failure (TVF),
a composite of cardiac death, target vessel-related myocardial infarction,
or target vessel revascularization (TVR). Results Patients with severe
calcification (n = 342) were older (66.6 +/- 9.1 vs 64.2 +/- 9.8 years, P
<.001) and had more diabetes (25.7% vs 20.4%, P =.04) than other patients
(n = 1081). Patients with calcified lesions had higher rates of TVF (16.4%
vs 9.8%, pLogrank =.001), cardiac death (4.4% vs 1.5%, P =.03), target
vessel myocardial infarction (7.6% vs 3.4%, P =.001), and definite stent
thrombosis (1.8% vs 0.4%, P =.02). Multivariate analysis demonstrated that
severe calcification was an independent risk factor of 2-year TVF (HR
1.42, 95% CI: 1.02-1.99, pLogrank =.04); landmark analysis showed that
this was based on a difference during the first year (periprocedural: 5.8%
vs. 3.1%, pLogrank =.02; first year: 7.5% vs. 3.8%, pLogrank =.007; second
year: 4.1% vs. 3.3%, pLogrank =.54). Conclusion In patients with stable
angina, severe target lesion calcification is associated with an increased
risk of adverse cardiovascular events following treatment with newer
generation permanent polymer-coated DES. This increase in risk is
restricted to the first year of follow-up, which is an encouraging
finding.

<30>
Accession Number
20160213005
Author
Messaoudi S.E.L.; Wouters C.W.; Van Swieten H.A.; Pickkers P.; Noyez L.;
Kievit P.C.; Abbink E.J.; Rasing-Hoogveld A.; Bouw T.P.; Peters J.G.;
Coenen M.J.H.; Donders A.R.T.; Riksen N.P.; Rongen G.A.
Institution
(Messaoudi, Wouters, Rasing-Hoogveld, Peters, Riksen, Rongen) Department
of Pharmacology and Toxicology, Radboud University Medical Center,
Nijmegen, Netherlands
(Messaoudi, Wouters, Kievit) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Van Swieten, Noyez) Department of Cardio-thoracic Surgery, Radboud
University Medical Center, Nijmegen, Netherlands
(Pickkers, Bouw) Department of Intensive Care Medicine, Radboud University
Medical Center, Nijmegen, Netherlands
(Abbink, Riksen, Rongen) Department of Internal Medicine, Radboud
University Medical Center, Nijmegen, Netherlands
(Coenen) Department of Human Genetics, Radboud University Medical Center,
Nijmegen, Netherlands
(Donders) Department for Health Evidence, Radboud University Medical
Center, Nijmegen, Netherlands
Title
Effect of dipyridamole on myocardial reperfusion injury: A double-blind
randomized controlled trial in patients undergoing elective coronary
artery bypass surgery.
Source
Clinical Pharmacology and Therapeutics. 99 (4) (pp 381-389), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Dipyridamole reduces reperfusion-injury in preclinical trials and may be
beneficial in patients undergoing coronary angioplasty, but its effect on
patients undergoing coronary artery bypass grafting (CABG) is unknown. We
hypothesized that dipyridamole limits myocardial reperfusion-injury in
patients undergoing CABG. The trial design was a double-blind trial
randomizing between pretreatment with dipyridamole or placebo. In all, 94
patients undergoing elective on-pump CABG were recruited between February
2010 and June 2012. The primary endpoint was plasma high-sensitive (hs-)
troponin-I at 6, 12, and 24 hours after reperfusion. Secondary endpoints
were the occurrence of bleeding, arrhythmias, need for inotropic support,
and intensive care unit length of stay. Finally, 79 patients (33
dipyridamole) were included in the per-protocol analysis. Dipyridamole did
not significantly affect postoperative hs-troponin-I (change in plasma
hs-troponin I -3% [95% confidence interval -23% to 36%]; P > 0.1).
Secondary endpoints did not differ between groups. Dipyridamole prior to
CABG does not significantly reduce postoperative hs-troponin release.

<31>
Accession Number
20160213672
Author
Romeo F.; Acconcia M.C.; Sergi D.; Romeo A.; Francioni S.; Chiarotti F.;
Caretta Q.
Institution
(Romeo, Sergi, Romeo) Department of Cardiovascular Disease, University of
Rome - Tor Vergata, Rome 00133, Italy
(Acconcia) Department of Cardiovascular Disease, University of Rome - La
Sapienza, Rome 00161, Italy
(Francioni) Center for Biomedical Technology, Integrated Department
Services to Education, University of Florence, Florence 50134, Italy
(Chiarotti) Department of Cell Biology and Neuroscience, Italian National
Institute of Health, Rome 00161, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Florence 50134, Italy
Title
Percutaneous assist devices in acute myocardial infarction with
cardiogenic shock: Review, meta-analysis.
Source
World Journal of Cardiology. 8 (1) (pp 98-111), 2016. Date of Publication:
2016.
Publisher
Baishideng Publishing Group Co
Abstract
AIM: To assess the impact of percutaneous cardiac support in cardiogenic
shock (CS) complicating acute myocardial infarction (AMI), treated with
percutaneous coronary intervention. METHODS: We selected all of the
studies published from January 1^st, 1997 to May
15^st, 2015 that compared the following percutaneous mechanical
support in patients with CS due to AMI undergoing myocardial
revascularization: (1) intra-aortic balloon pump (IABP) vs Medical
therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs
IABP; (3) complete extracorporeal life support with extracorporeal
membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus
IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial
revascularization. We evaluated the impact of the support devices on
primary and secondary endpoints. Primary endpoint was the inhospital
mortality due to any cause during the same hospital stay and secondary
endpoint late mortality at 6-12 mo RESULTS: One thousand two hundred and
seventytwo studies met the initial screening criteria. After detailed
review, only 30 were selected. There were 6 eligible randomized controlled
trials and 24 eligible observational studies totaling 15799 patients. We
found that the inhospital mortality was: (1) significantly higher with
IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher,
although not significantly, with PLVADs compared to IABP (RR = +14%, P =
0.21); and (3) significantly lower in patients treated with ECMO plus IABP
vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In
addition, Trial Sequential Analysis showed that in the comparison of IABP
vs medical therapy, the sample size was adequate to demonstrate a
significant increase in risk due to IABP. CONCLUSION: Inhospital mortality
was significantly higher with IABP vs medical therapy. PLVADs did not
reduce early mortality. ECMO plus IABP significantly reduced inhospital
mortality compared to IABP.

<32>
Accession Number
20160213659
Author
Pandya B.; Gaddam S.; Raza M.; Asti D.; Nalluri N.; Vazzana T.; Kandov R.;
Lafferty J.
Institution
(Pandya) Department of Internal Medicine, Staten Island University
Hospital, Staten Island, NY 10305, United States
(Gaddam, Raza, Asti, Nalluri, Vazzana, Kandov, Lafferty) Department of
Cardiology, Staten Island University Hospital, Staten Island, NY 10305,
United States
Title
Biodegradable polymer stents vs second generation drug eluting stents: A
meta-analysis and systematic review randomized controlled trials.
Source
World Journal of Cardiology. 8 (2) (pp 240-246), 2016. Date of
Publication: 2016.
Publisher
Baishideng Publishing Group Co
Abstract
AIM: To evaluate the premise, that biodegradable polymer drug eluting
stents (BD-DES) could improve clinical outcomes compared to second
generation permanent polymer drug eluting stents (PP-DES), we pooled the
data from all the available randomized control trials (RCT) comparing the
clinical performance of both these stents. METHODS: A systematic
literature search of PubMed, Cochrane, Google scholar databases, EMBASE,
MEDLINE and SCOPUS was performed during time period of January 2001 to
April 2015 for RCT and comparing safety and efficacy of BD-DES vs second
generation PP-DES. The primary outcomes of interest were definite stent
thrombosis, target lesion revascularization, myocardial infarction,
cardiac deaths and total deaths during the study period. RESULTS: A total
of 11 RCT's with a total of 12644 patients were included in the
meta-analysis, with 6598 patients in BD-DES vs 6046 patients in second
generation PP-DES. The mean follow up period was 16 mo. Pooled analysis
showed non-inferiority of BD-DES, comparing events of stent thrombosis (OR
= 1.42, 95%CI: 0.79-2.52, P = 0.24), target lesion revascularization (OR =
0.99, 95%CI: 0.84-1.17, P = 0.92), myocardial infarction (OR = 1.06,
95%CI: 0.86-1.29, P = 0.92), cardiac deaths (OR = 1.07, 95%CI 0.82-1.41, P
= 0.94) and total deaths (OR = 0.96, 95%CI: 0.80-1.17, P = 0.71).
CONCLUSION: BD-DES, when compared to second generation PP-DES, showed no
significant advantageand the outcomes were comparable between both the
groups.

<33>
Accession Number
20160222652
Author
Lei Q.; Zeng Q.-S.; Zhang X.-S.; Xie B.; Huang H.-L.; Wang S.; Guo H.-M.;
Chen J.-M.; Zhuang J.
Institution
(Lei, Zeng, Zhang, Xie, Huang, Wang, Guo, Chen, Zhuang) Department of
Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute,
Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106
ZhongShanEr Road, Guangzhou 510080, China
Title
Bilateral subclavian vein sheaths for superior vena cava drainage during
thoracoscopic repair of atrial septal defects: Cosmetic outcomes, safety
and effectiveness.
Source
Perfusion (United Kingdom). 31 (3) (pp 240-246), 2016. Date of
Publication: 01 Apr 2016.
Publisher
SAGE Publications Ltd
Abstract
Objective: To investigate the cosmetic outcomes, safety and effectiveness
of using bilateral subclavian vein sheaths for superior vena cava drainage
during thoracoscopic repair of atrial septal defects. Methods: Sixty-one
consecutive adults scheduled for thoracoscopic repair of atrial septal
defects between July 2012 and June 2013 were randomized into two groups:
one group underwent placement of a 16 Fr percutaneous superior vena cava
cannula (n = 30) and the other group underwent placement of bilateral 8 Fr
subclavian vein sheaths (n = 31) for superior vena cava drainage during
peripheral cardiopulmonary bypass. The perioperative data, central venous
pressure during cardiopulmonary bypass, complications and the patient
satisfaction scale scores for the incisions were compared between the two
groups. Results: The theoretical cardiopulmonary bypass flow rate was
reached without complications in all patients. The average central venous
pressure during cardiopulmonary bypass was not significantly different
between the two groups [(6.9 +/- 3.1) mmHg vs. (7.0 +/- 3.5) mmHg,
p=0.92]. The patient satisfaction scale scores for the incisions were
significantly higher in the patients who underwent placement of bilateral
subclavian vein sheaths than in the patients who underwent placement of a
percutaneous superior vena cava cannula [(2.81 +/- 0.75) vs. (2.07 +/-
0.74), p<0.001]. Conclusions: Placement of bilateral subclavian vein
sheaths is a safe and effective alternative to placement of a percutaneous
superior vena cava cannula for superior vena cava drainage during
thoracoscopic repair of atrial septal defects and results in greater
patient satisfaction with the cosmetic outcome.

<34>
Accession Number
20160222641
Author
Itoh H.; Ichiba S.; Ujike Y.; Douguchi T.; Kasahara S.; Arai S.; Sano S.
Institution
(Itoh) Department of Medical Engineering, Faculty of Health Sciences,
Junshin Gakuen University, 1-1-1, Chikushigaoka, Minami-ku, Fukuoka
815-8510, Japan
(Itoh, Ujike) Department of Emergency and Critical Care Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Ichiba) Department of Community and Emergency Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Douguchi, Kasahara, Arai, Sano) Department of Cardiovascular Surgery,
Okayama University Hospital, Okayama, Japan
Title
A prospective randomized trial comparing the clinical effectiveness and
biocompatibility of heparin-coated circuits and PMEA-coated circuits in
pediatric cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 31 (3) (pp 247-254), 2016. Date of
Publication: 01 Apr 2016.
Publisher
SAGE Publications Ltd
Abstract
Object: We compared the clinical effectiveness and biocompatibility of
poly-2-methoxyethyl acrylate (PMEA)-coated and heparin-coated
cardiopulmonary bypass (CPB) circuits in a prospective pediatric trial.
Methods: Infants randomly received heparin-coated (n=7) or PMEA-coated
(n=7) circuits in elective pediatric cardiac surgery with CPB for
ventricular septum defects. Clinical and hematologic variables,
respiratory indices and hemodynamic changes were analyzed perioperatively.
Results: Demographic and clinical variables were similar in both groups.
Leukocyte counts were significantly lower 5 minutes after CPB in the PMEA
group than the heparin group. Hemodynamic data showed that PMEA caused
hypotension within 5 minutes of CPB. The respiratory index was
significantly higher immediately after CPB and 1 hour after transfer to
the intensive care unit (ICU) in the PMEA group, as were levels of
C-reactive protein 24 hours after transfer to the ICU. Conclusion: Our
study shows that PMEA-coated circuits, unlike heparin-coated circuits,
cause transient leukopenia during pediatric CPB and, perhaps, systemic
inflammatory respiratory syndrome after pediatric CPB.

<35>
Accession Number
20160220331
Author
Walsh M.; Whitlock R.; Garg A.X.; Legare J.-F.; Duncan A.E.; Zimmerman R.;
Miller S.; Fremes S.; Kieser T.; Karthikeyan G.; Chan M.; Ho A.; Nasr V.;
Vincent J.; Ali I.; Lavi R.; Sessler D.I.; Kramer R.; Gardner J.; Syed S.;
Van T.; Guyatt G.; Rao-Melacini P.; Thabane L.; Devereaux P.J.
Institution
(Walsh, Whitlock, Vincent, Rao-Melacini, Thabane, Devereaux) Population
Health Research Institute, Hamilton, ON, Canada
(Walsh, Whitlock, Syed, Van, Guyatt, Devereaux) McMaster University,
Hamilton, ON, Canada
(Garg, Lavi) London Health Sciences Centre, Western University, London,
ON, Canada
(Legare) Dalhousie University, Halifax, NS, Canada
(Duncan, Nasr, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Zimmerman, Miller, Fremes, Gardner) Maine Medical Center, Portland, ME,
United States
(Miller, Gardner) Wake Forest University, Winston-Salem, NC, United States
(Fremes, Kramer) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Kieser, Ali) University of Calgary, Calgary, AB, Canada
(Karthikeyan) All India Institute of Medical Sciences, New Delhi, India
(Chan, Ho) Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Effects of remote ischemic preconditioning in high-risk patients
undergoing cardiac surgery (Remote IMPACT): A randomized controlled trial.
Source
CMAJ. 188 (5) (pp 329-336), 2016. Date of Publication: 15 Mar 2016.
Publisher
Canadian Medical Association (1867 Alta Vista Drive, Ottawa KIG5W8,
Canada)
Abstract
Background: Remote ischemic preconditioning is a simple therapy that may
reduce cardiac and kidney injury. We undertook a randomized controlled
trial to evaluate the effect of this therapy on markers of heart and
kidney injury after cardiac surgery. Methods: Patients at high risk of
death within 30 days after cardiac surgery were randomly assigned to
undergo remote ischemic preconditioning or a sham procedure after
induction of anesthesia. The preconditioning therapy was three 5-minute
cycles of thigh ischemia, with 5 minutes of reperfusion between cycles.
The sham procedure was identical except that ischemia was not induced. The
primary outcome was peak creatine kinase myocardial band (CK-MB) within 24
hours after surgery (expressed as multiples of the upper limit of normal,
with log transformation). The secondary outcome was change in creatinine
level within 4 days after surgery (expressed as log-transformed micromoles
per litre). Patient-important outcomes were assessed up to 6 months after
randomization. Results: We randomly assigned 128 patients to remote
ischemic preconditioning and 130 to the sham therapy. There were no
significant differences in postoperative CK-MB (absolute mean difference
0.15, 95% confidence interval [CI] 0.07 to 0.36) or creatinine (absolute
mean difference 0.06, 95% CI-0.10 to 0.23). Other outcomes did not differ
significantly for remote ischemic preconditioning relative to the sham
therapy: for myocardial infarction, relative risk (RR) 1.35 (95% CI 0.85
to 2.17); for acute kidney injury, RR 1.10 (95% CI 0.68 to 1.78); for
stroke, RR 1.02 (95% CI 0.34 to 3.07); and for death, RR 1.47 (95% CI 0.65
to 3.31). Interpretation: Remote ischemic preconditioning did not reduce
myocardial or kidney injury during cardiac surgery. This type of therapy
is unlikely to substantially improve patient-important outcomes in cardiac
surgery.

<36>
Accession Number
20160213255
Author
Udell J.A.; Bonaca M.P.; Collet J.-P.; Lincoff A.M.; Kereiakes D.J.; Costa
F.; Lee C.W.; Mauri L.; Valgimigli M.; Park S.-J.; Montalescot G.;
Sabatine M.S.; Braunwald E.; Bhatt D.L.
Institution
(Udell) Peter Munk Cardiac Centre and Cardiovascular Division, University
Health Network, Heart and Stroke Richard Lewar Centre of Excellence, 76
Grenville Street, Toronto, ON M5S1B1, Canada
(Udell) Department of Medicine, Women's College Hospital, University of
Toronto, Toronto, Canada
(Bonaca, Sabatine, Braunwald, Bhatt) TIMI Study Group, Brigham and Women's
Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115,
United States
(Collet, Montalescot) ACTION Study Group, INSERM, Universite Paris, Paris,
France
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic,
Coordinating Center for Clinical Research, Cleveland, OH, United States
(Kereiakes) Lindner Center for Research and Education, Christ Hospital,
Cincinnati, OH, United States
(Costa, Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam 3015,
Netherlands
(Lee, Park) Heart Institute, University of Ulsan, College of Medicine,
Seoul, South Korea
(Mauri) Harvard Clinical Research Institute, Cardiovascular Division,
Harvard Medical School, Boston, MA, United States
(Valgimigli) University Hospital of Bern, Bern, Switzerland
Title
Long-term dual antiplatelet therapy for secondary prevention of
cardiovascular events in the subgroup of patients with previous myocardial
infarction: A collaborative meta-analysis of randomized trials.
Source
European Heart Journal. 37 (4) (pp 390-399), 2016. Date of Publication: 21
Jan 2016.
Publisher
Oxford University Press
Abstract
Recent trials have examined the effect of prolonged dual antiplatelet
therapy (DAPT) in a variety of patient populations, with heterogeneous
results regarding benefit and safety, specifically with regard to
cardiovascular and non-cardiovascular mortality. We performed a
meta-analysis of randomized trials comparing more than a year of DAPT with
aspirin alone in high-risk patients with a history of prior myocardial
infarction (MI). Methods and results A total of 33 435 patients were
followed over a mean 31 months among one trial of patients with prior MI
(63.3% of total) and five trials with a subgroup of patients that
presented with, or had a history of, a prior MI (36.7% of total). Extended
DAPT decreased the risk of major adverse cardiovascular events compared
with aspirin alone (6.4 vs. 7.5%; risk ratio, RR 0.78, 95% confidence
intervals, CI, 0.67-0.90; P = 0.001) and reduced cardiovascular death (2.3
vs. 2.6%; RR 0.85, 95% CI 0.74-0.98; P = 0.03), with no increase in
non-cardiovascular death (RR 1.03, 95% CI 0.86-1.23; P = 0.76). The
resultant effect on all-cause mortality was an RR of 0.92 (95% CI
0.83-1.03; P = 0.13). Extended DAPT also reduced MI (RR 0.70, 95% CI
0.55-0.88; P = 0.003), stroke (RR 0.81, 95% CI 0.68-0.97; P = 0.02), and
stent thrombosis (RR 0.50, 95% CI 0.28-0.89; P = 0.02). There was an
increased risk of major bleeding (1.85 vs. 1.09%; RR 1.73, 95% CI
1.19-2.50; P = 0.004) but not fatal bleeding (0.14 vs. 0.17%; RR 0.91, 95%
CI 0.53-1.58; P = 0.75). Conclusion Compared with aspirin alone, DAPT
beyond 1 year among stabilized high-risk patients with prior MI decreases
ischaemic events, including significant reductions in the individual
endpoints of cardiovascular death, recurrent MI, and stroke. Dual
antiplatelet therapy beyond 1 year increases major bleeding, but not fatal
bleeding or non-cardiovascular death.

<37>
Accession Number
20160213284
Author
Den Harder A.M.; De Heer L.M.; Meijer R.C.A.; Das M.; Krestin G.P.;
Maessen J.G.; Bogers A.J.J.C.; De Jong P.A.; Leiner T.; Budde R.P.J.
Institution
(Den Harder, De Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508 GA, Netherlands
(De Heer, Meijer) Department of Cardiothoracic Surgery, University Medical
Center, P.O. Box 85000, Utrecht 3508 GA, Netherlands
(Das) Department of Radiology, Maastricht University Medical Center,
Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Krestin, Budde) Department of Radiology, Erasmus Medical Center, P.O. Box
2040, Rotterdam 3000 CA, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Bogers) Department of Cardiothoracic Surgery, Erasmus Medical Center,
P.O. Box 2040, Rotterdam 3000 CA, Netherlands
Title
Effect of computed tomography before cardiac surgery on surgical strategy,
mortality and stroke.
Source
European Journal of Radiology. 85 (4) (pp 744-750), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aim To investigate whether preoperative chest computed tomography (CT)
decreases postoperative mortality and stroke rate in cardiac surgery by
detection of calcifications and visualization of postoperative anatomy in
redo cardiac surgery which can be used to optimize the surgical approach.
Methods The PubMed, EMBASE and Cochrane databases were searched and
articles concerning preoperative CT in cardiac surgery were included.
Articles not reporting mortality, stroke rate or change in surgical
approach were excluded. Studies concerning primary cardiac surgery as well
as articles concerning redo cardiac surgery were both included. Results
Eighteen studies were included (n = 4057 patients) in which 2584 patients
received a preoperative CT. Seven articles (n = 1754 patients) concerned
primary surgery and eleven articles (n = 2303 patients) concerned redo
cardiac surgery. None of the studies was randomized but 8 studies provided
a comparison to a control group. Stroke rate decreased with 77-96%
(primary surgery) and 18-100% (redo surgery) in patients receiving a
preoperative CT. Mortality decreased up to 66% in studies investigating
primary surgery while the effect on mortality in redo surgery varied
widely. Change in surgical approach based on CT-findings consisted of
choosing a different cannulation site, opting for off-pump surgery and
cancellation of surgery. Conclusions Current evidence suggests that
preoperative CT imaging may lead to decreased stroke and mortality rate in
patients undergoing primary cardiac surgery by optimizing surgical
approach. In patients undergoing redo cardiac surgery stroke rate is also
decreased but the effect on mortality is unclear. However, evidence is
weak and included studies were of moderate quality.

<38>
Accession Number
20160212559
Author
Tully P.J.; Baumeister H.
Institution
(Tully, Baumeister) Department of Rehabilitation Psychology and
Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg,
Germany
(Tully) Freemasons Foundation Centre for Men's Health, Discipline of
Medicine, School of Medicine, University of Adelaide, Adelaide, SA,
Australia
(Tully) INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France
(Baumeister) Faculty of Medicine, Medical Psychology and Medical
Sociology, University of Freiburg, Freiburg, Germany
Title
Collaborative care for comorbid depression and coronary heart disease: A
systematic review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 5 (12) (no pagination), 2015. Article Number: e009128. Date of
Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Objectives: To systematically review the efficacy of collaborative care
(CC) for depression in adults with coronary heart disease (CHD) and
depression. Design: Systematic review and meta-analysis. Data sources:
Electronic databases (Cochrane Central Register of Controlled Trials
MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.
Inclusion criteria: Population, depression comorbid with CHD;
intervention, randomised controlled trial (RCT) of CC; comparison, either
usual care, wait-list control group or no further treatment; and outcome,
(primary) major adverse cardiac events (MACE), (secondary) standardised
measure of depression, anxiety, quality of life (QOL) and
cost-effectiveness. Data extraction and analysis: RevMan V.5.3 was used to
synthesise the data as risk ratios (RRs), ORs and standardised mean
differences (SMD) with 95% CIs in random effect models. Results: Six RCTs
met the inclusion criteria and comprised 655 participants randomised to CC
and 629 participants randomised to the control group (total 1284).
Collaborative depression care led to a significant reduction in MACE in
the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that
was not sustained in the longer term. Small reductions in depressive
symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95%
CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to
be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005).
Likewise, a significant effect was observed for anxiety symptoms (SMD
-0.36) and mental QOL (SMD 0.24). The timing of the intervention was a
source of between-group heterogeneity for depression symptoms (between
groups p=0.04, I2=76.5%). Conclusions: Collaborative depression care did
not lead to a sustained reduction in the primary MACE end point. Small
effects were observed for depression, depression remission, anxiety and
mental QOL. Trials registration number: PROSPERO CRD42014013653.

<39>
Accession Number
72228589
Author
Tawfik A.; Soliman M.; Aboelenen M.
Institution
(Tawfik, Soliman, Aboelenen) Tanta University Educational Hospital, Dept.
of Urology, Tanta, Egypt
Title
Can transrectal intraprostatic injection of local vasoconstrictor reduces
blood loss during transurethral resection of moderately enlarged prostate:
A randomized controlled trial.
Source
European Urology, Supplements. Conference: 31st Annual Congress of the
European Association of Urology, EAU16 Munich Germany. Conference Start:
20160311 Conference End: 20160315. Conference Publication: (var.pagings).
15 (3) (pp e971), 2016. Date of Publication: March 2016.
Publisher
Elsevier
Abstract
INTRODUCTION & OBJECTIVES: Bleeding is one of the most undesirable
perioperative events during transurethral resection of the prostate
(TURP). In current study we tried to reduce TURP related blood loss by
intraoperative transrectal intraprostatic injection of vasoconstrictor
agents. MATERIAL & METHODS: Patients with moderately enlarged prostates
(80-100gm) with refractory lower urinary tract symptoms (LUTS) requiring
TURP were included. Exclusion criteria included those with history of
angina, coronary surgery, uncontrolled hypertension or bleeding tendency.
Patients were randomly divided into group I (controls) or II (treatment
group). Both groups underwent monopolar TURP by the same surgeon with
patients in group II managed by 1-2ml of 1/100000 epinephrine
finger-guided transrectally injected in each prostatic lobe immediately
before resection. Evaluation parameters included operative time, weight of
resected prostatic tissue, perioperative hematocrit (HCT) changes and
estimation of intraoperative blood loss. TURP syndrome or
epinephrine-related side effects including intra/peri-operative
significant change in blood pressure (elevation >20mmHg). RESULTS: 42 and
45 patients were available in groups I and II respectively. Changes in HCT
values' and operative time were significantly less in group "II" (p<0.05).
Total operative blood loss was significantly lower in group "II"
(238.56+/-69.43ml Vs.309.62+/-89.47ml). When adjusted per gram-weight of
resected tissue, blood loss was also significantly lower in group II
(5.35+/-2.71ml/g vs. 9.19+/-2.31ml/gm). No TURP syndrome or blood
transfusion was required in both groups. Significant intraoperative
hypertension was recorded in only 1 patient (2.2%) in group II who was
managed successfully with diuretics. CONCLUSIONS: Immediate preoperative
transrectal intraprostatic injection of 1/100000 epinephrine is safe and
effective in reducing surgical blood loss during TURP.

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Accession Number
72227182
Author
Su Y.; Xie S.; Zhong L.; Wu Y.; Tian Y.; Liao X.
Institution
(Su, Xie, Zhong, Wu, Tian, Liao) Chongqing Medical University, Chongqing,
China
Title
Diagnostic value of urine [timp-2]$[IGFBP7] in AKI: A meta-analysis.
Source
Hong Kong Journal of Nephrology. Conference: 1st International Congress of
Chinese Nephrologists, ICCN 2015 Hong Kong Hong Kong. Conference Start:
20151211 Conference End: 20151213. Conference Publication: (var.pagings).
17 (2 SUPPL. 1) (pp S95), 2015. Date of Publication: October 2015.
Publisher
Elsevier (Singapore) Pte Ltd
Abstract
Objective: Acute kidney injury (AKI) is a common and serious clinic
syndrome. Early diagnosis becomes a key point of AKI treatment. The search
for a better biomarker is now becoming a central issue in AKI field.
TIMP-2 and IGFBP7 are both involved in renal tubular epithelial cell cycle
arrest in AKI. And recently, several researches' reports showed that urine
TIMP-2 multiply IGFBP7 is promising as biomarker in predicting AKI.
Methods: Meta analysis was performed to assess the diagnostic value of
urine [TIMP-2]$[IGFBP7] in AKI. Relevant studies were searched from
Pubmed, Elsevier science Direct Database, EMBASE, SpringerLink, Cochrane
Library and clinical research registration website ClinicalTrials.gov.
Meta-analysis methods were used to synthesis sensitivity and specificity
and to construct summary receiver operating characteristic (SROC) curves.
Results: 5 full-text prospective studies and 1 with unknown study design
were enrolled in our meta-analysis. The estimated sensitivity of urine
[TIMP-2]$ [IGFBP7] for the diagnosis of AKI was 0.858 (95% CI,
0.802-0.903), and the specificity was 0.548 (95% CI, 0.506-0.590). The
SROC analysis showed an area under the curve of 0.8389. Subgroup analysis
suggested that urine [TIMP-2]$[IGFBP7] did better in cardiac surgery
patients. Small number of studies and language limitation might affect the
evaluation. Conclusion: Urine [TIMP-2]$[IGFBP7] may be a promising
biomarker for early detection of AKI, especially in patients after cardiac
surgery. Its potential value needs to be validated in large studies and
broader spectrum of clinical settings. (Figure presented).