EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
20160357339
Author
Madsen S.; Baczuk J.; Thorup K.; Barton R.; Patwari N.; Langell J.T.
Institution
(Madsen, Baczuk, Thorup, Patwari) Department of Electrical Engineering,
University of Utah, Salt Lake City, UT, United States
(Barton, Langell) Department of Surgery, University of Utah, Salt Lake
City, UT, United States
(Langell) Center for Medical Innovation, University of Utah, 10 North 1900
East Eccles Library, Room 15, Salt Lake City, UT 84132, United States
Title
A noncontact RF-based respiratory sensor: Results of a clinical trial.
Source
Journal of Surgical Research. 203 (1) (pp 1-5), 2016. Date of Publication:
01 Jun 2016.
Publisher
Academic Press Inc.
Abstract
Background: Respiratory rate (RR) is a critical vital signs monitored in
health care setting. Current monitors suffer from sensor-contact failure,
inaccurate data, and limited patient mobility. There is a critical need
for an accurate and reliable and noncontact system to monitor RR. We
developed a contact-free radio frequency (RF)-based system that measures
movement using WiFi signal diffraction, which is converted into
interpretable data using a Fourier transform. Here, we investigate the
system's ability to measure fine movements associated with human
respiration. Materials and methods: Testing was conducted on subjects
using visual cue, fixed-tempo instruction to breath at standard RRs.
Blinded instruction-based RRs were compared to RF-acquired data to
determine measurement accuracy. The RF-based technology was studied on
postoperative ventilator-dependent patients. Blinded ventilator
capnographic RR data were collected for each patient and compared to
RF-acquired data to determine measurement accuracy. Results: Respiratory
rate data collected from 10 subjects breathing at a fixed RR (14, 16, 18,
or 20) demonstrated 95.5% measurement accuracy between the patient's
actual rate and that measured by our RF technology. Ten patients were
enrolled into the clinical trial. Blinded ventilator capnographic RR data
were compared to RF-based acquired data. The RF-based data showed 88.8%
measurement accuracy with ventilator capnography. Conclusions: Initial
clinical pilot trials with our contact-free RF-based monitoring system
demonstrate a high degree of RR measurement accuracy when compared to
capnographic data. Based on these results, we believe RF-based systems
present a promising noninvasive, inexpensive, and accurate tool for
continuous RR monitoring.

<2>
Accession Number
20160298620
Author
Tarantini G.; Mojoli M.; Windecker S.; Wendler O.; Lefevre T.; Saia F.;
Walther T.; Rubino P.; Bartorelli A.L.; Napodano M.; D'Onofrio A.; Gerosa
G.; Iliceto S.; Vahanian A.
Institution
(Tarantini, Mojoli, Napodano, D'Onofrio, Gerosa, Iliceto) Department of
Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova,
Via Giustiniani 2, Padua 35128, Italy
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Wendler) King's College Hospital, London, United Kingdom
(Lefevre) Cardiovascular Institute Paris-Sud, Massy, France
(Saia) University Hospital Policlinic S. Orsola-Malpighi, Institute of
Cardiology, Bologna, Italy
(Walther) Kerckhoff Clinic, Bad Nauheim, Germany
(Rubino) Cardiology Division, Clinica Montevergine, Mercogliano, Italy
(Bartorelli) Centro Cardiologico Monzino, IRCCS, University of Milan,
Milan, Italy
(Vahanian) Cardiology Department, Hospital Bichat-Claude Bernard, Paris,
France
Title
Prevalence and Impact of Atrial Fibrillation in Patients with Severe
Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement An
Analysis from the SOURCE XT Prospective Multicenter Registry.
Source
JACC: Cardiovascular Interventions. 9 (9) (pp 937-946), 2016. Date of
Publication: 09 May 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The aims of this study were to assess the epidemiology of
atrial fibrillation (AF) in patients treated with transcatheter aortic
valve replacement (TAVR) and included in the large prospective SOURCE XT
(SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) study and
to evaluate their outcomes according to the presence of pre-existing or
new-onset AF (NOAF) (defined as AF occurring within 30 days after TAVR).
Background Data on the epidemiology and clinical impact of AF in patients
undergoing TAVR are scant and limited to small retrospective studies.
Methods The SOURCE XT study is a multicenter, prospective registry of
consecutive patients treated with the SAPIEN XT valve at 99 sites in 17
countries. Follow-up was scheduled at discharge, 1 month, 1 year, and
yearly thereafter. Patients (n = 2,706) were categorized according to the
presence of pre-existing or NOAF. Results The prevalence of pre-existing
AF was 35.6%, whereas NOAF occurred in 7.2% of patients. Both pre-existing
AF and NOAF correlated with worse clinical outcomes compared with patients
in sinus rhythm, including all-cause death, cardiac death, and bleeding
events. NOAF was associated with higher rates of stroke at 2 years
compared with sinus rhythm. Independent predictors of NOAF were age
(hazard ratio: 1.1), New York Heart Association class III or IV (hazard
ratio: 1.9), nontransfemoral access route (hazard ratio: 3), and balloon
post-dilation (odds ratio: 1.6). No interaction was observed between any
degree of post-implantation paravalvular leak and NOAF. Conclusions In the
large dataset of the SOURCE XT registry, the presence of either
pre-existing or NOAF increased all-cause and cardiac mortality and
bleeding events. NOAF was associated with increased stroke rates at
long-term follow-up.

<3>
Accession Number
20160372686
Author
Gao L.; Chen L.; Fan L.; Gao D.; Liang Z.; Wang R.; Lu W.
Institution
(Gao, Gao, Liang, Wang, Lu) Department of Comprehensive Surgery, General
Hospital of Chinese People's Liberation Army, Beijing 100853, China
(Chen) Department of Thoracic Surgery, General Hospital of Chinese
People's Liberation Army, Beijing 100853, China
(Fan) Department of Geriatric Cardiology, General Hospital of Chinese
People's Liberation Army, Beijing 100853, China
Title
The effect of losartan on progressive aortic dilatation in patients with
Marfan's syndrome: A meta-analysis of prospective randomized clinical
trials.
Source
International Journal of Cardiology. 217 (pp 190-194), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To assess the effect of losartan therapy on progressive aortic
dilatation and on clinical outcome in patients with Marfan's syndrome
(MFS). Methods The meta-analysis was instituted, which included studies
identified by a systematic review of MEDLINE of peer-reviewed
publications. Echocardiogram or MRI measurements of the aortic root
dimension and outcome measures of death, cardiovascular surgery and aortic
dissection or rupture were compared between patients who were treated and
untreated with losartan therapy. Results Six randomized trials with 1398
subjects met all the inclusion criteria and were included in the
meta-analysis. Compared with non-losartan treatment, losartan therapy
significantly decreased the rate of aortic dilatation (SMD = - 0.13 with
95% CI - 0.25 to 0.00, p = 0.04). The clinical outcome beneficial was not
observed in the losartan treatment group when compared with no losartan
treatment group (odds ratio = 1.04 with 95% CI of 0.57-1.87). Conclusion
Given the current results of the meta-analysis and together with the lack
of associated side effects, it would be reasonable to use losartan in MFS
patients with aortic root dilatation. However, no clinical outcome
benefits were observed in the losartan treatment group when compared with
no losartan treatment group.

<4>
Accession Number
20160369487
Author
Phan K.; Khuong J.N.; Xu J.; Kanagaratnam A.; Yan T.D.
Institution
(Phan, Khuong, Xu, Kanagaratnam, Yan) Collaborative Research (CORE) Group,
Macquarie University, 2 Technology Place, Sydney, Australia
Title
Obesity and postoperative atrial fibrillation in patients undergoing
cardiac surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 217 (pp 49-57), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Post-operative atrial fibrillation (POAF) is one of the most
common complications following cardiac surgery. However, it is unclear
whether there is a relationship between obesity and POAF. We thus assessed
all available evidence investigating the association between obesity and
POAF, also considering any link between POAF and other post-operative
conditions such as mortality, stroke, myocardial infarctions and
respiratory complications. Methods Five electronic databases were searched
and relevant studies were identified. Data was extracted and meta-analyzed
from the identified studies. Results We found that obese patients had
significantly higher odds of POAF when compared with non-obese patients (P
= 0.006). There was also significant heterogeneity among the identified
studies. POAF when compared with no-POAF was associated with an increased
risk of stroke (P < 0.0001), 30-day mortality (P = 0.005) and respiratory
complications (P < 0.00001). However, we found no significant link between
POAF and myocardial infarctions (P = 0.79). Conclusions Our findings
suggest that obesity is associated with a moderately higher risk of POAF.
While POAF is also associated with an increased incidence of stroke,
30-day mortality and respiratory complications, further studies must be
conducted before conclusions can be made about the long-term outcomes.

<5>
Accession Number
20160359188
Author
Kowalewski M.; Pawliszak W.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Zaborowska K.; Kowalewski J.; Tarelli G.; Taggart D.P.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Zaborowska, Anisimowicz) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz,
Bydgoszcz, Poland
(Kowalewski) Faculty of Health Sciences, Collegium Medicum, Nicolaus
Copernicus Univeristy in Torun, Torun, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per iTrapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology and
Oncological Gynecology, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Kowalewski) Department of Lung Cancer and Thoracic Surgery, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Tarelli) Department of Cardiac Surgery, Humanitas Clinical and Research
Center, Rozzano, Milan, Italy
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
Title
Safety and efficacy of miniaturized extracorporeal circulation when
compared with off-pump and conventional coronary artery bypass grafting:
Evidence synthesis from a comprehensive Bayesian-framework network
meta-analysis of 134 randomized controlled trials involving 22 778
patients.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1428-1440), 2016.
Article Number: ezv387. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Coronary artery bypass grafting (CABG) remains the standard of
care in patients with extensive coronary artery disease. Yet the use of
cardiopulmonary bypass (CPB) is believed to be a major determinant of
perioperative morbidity. Novel techniques are sought to tackle the
shortcomings of CPB, among them off-pump coronary artery bypass (OPCAB)
and miniaturized extracorporeal circulation (MECC) systems have been
extensively tested in randomized controlled trials (RCTs). To assess
perioperative safety and efficacy of MECC and OPCAB when compared with
conventional extracorporeal circulation (CECC). METHODS: Published
literature and major congress proceedings were screened for RCTs
evaluating the safety and efficacy of MECC, OPCAB and CECC. Selected
end-points such as 30-day all-cause mortality, myocardial infarction (MI),
cerebral stroke, postoperative atrial fibrillation (POAF) and renal
dysfunction were assessed in a Bayesian-framework network meta-analysis.
RESULTS: A total of 134 studies with 22 778 patients were included. When
compared with CECC, both OPCAB and MECC significantly reduced 30-day
all-cause mortality [odds ratios (95% credible intervals): 0.75
(0.51-0.99) and 0.46 (0.22-0.91)], respectively. No differences in respect
to MI were demonstrated with either strategy. OPCAB, when compared with
CECC, reduced the odds of cerebral stroke [0.57 (0.34-0.80)]; 60%
reduction was observed with MECC when compared with CECC [0.40
(0.19-0.78)]. Both OPCAB and MECC reduced the odds of POAF [0.66
(0.48-0.90) and 0.62 (0.35-0.98), respectively] when compared with CECC.
OPCAB conferred over 30% reduction of renal dysfunction when compared with
CECC [0.69 (0.46-0.92)]. MECC reduced these odds by more than 50% [0.47
(0.24-0.89)]. Ranking of treatments emerging from the probability analysis
(highest to lowest SUCRA values) was MECC followed by OPCAB and CECC.
CONCLUSIONS: MECC and OPCAB both improve perioperative outcomes following
coronary bypass surgery when compared with conventional CABG performed
with extracorporeal circulation. MECC may represent an attractive
compromise between OPCAB and CECC.

<6>
Accession Number
20160359183
Author
Walavalkara V.; Eversb E.; Pujara S.; Viralama K.; Maiyaa S.; Frerichc S.;
Johnd C.; Raod S.; Reddyd C.; Sproncke B.; Prinzenb F.W.; Delhaasc T.;
Vanagt W.Y.
Institution
(Walavalkara, Pujara, Viralama, Maiyaa) Department of Pediatric
Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
(Eversb, Prinzenb, Vanagt) Department of Physiology, Cardiovascular
Research Institute Maastricht CARIM, Maastricht University, Maastricht,
Netherlands
(Frerichc, Delhaasc, Vanagt) Department of Pediatric Cardiology,
Cardiovascular Research Institute Maastricht CARIM, Maastricht University,
Maastricht, Netherlands
(Johnd, Raod, Reddyd) Department of Pediatric Cardiac Surgery, Narayana
Institute of Cardiac Sciences, Bangalore, India
(Sproncke, Delhaasc) Department of Biomedical Engineering, Cardiovascular
Research Institute Maastricht CARIM, Maastricht University, Maastricht,
Netherlands
Title
Preoperative sildenafil administration in children undergoing cardiac
surgery: A randomized controlled preconditioning study.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1403-1410), 2016.
Article Number: ezv353. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Sildenafil has strong cardiac preconditioning properties in
animal studies and has a safe side-effect profile in children. Therefore,
we evaluated the application of Sildenafil preconditioning to reduce
myocardial ischaemia/reperfusion injury in children undergoing surgical
ventricular septal defect (VSD) closure. METHODS: This is a randomized,
double-blind study. Children (1-17 years) undergoing VSD closure were
randomized into three groups: placebo (Control group), preconditioning
with 0.06 mg/kg (Sild-L group) and 0.6 mg/kg Sildenafil (Sild-H group).
Primary endpoint: troponin release. CK-MB, Troponin I, inflammatory
response (IL-6 and TNF-alpha ), bypass and ventilation weaning times,
inotropy score and echocardiographic function were assessed. Data
expressed as median (range), and a value of P < 0.05 was considered
significant. RESULTS: Thirty-nine patients were studied (13/group). Aortic
cross-clamp time was similar [27 (18-85) and 27 (12-39) min] in the
Control and Sild-L groups, respectively, but significantly longer [39
(20-96) min] in the Sild-H group when compared with the Control group.
Area under the curve of CK-MB release was 1105 (620-1855) h ng/ml in the
Control group, 1672 (564-2767) h ng/ml in the Sild- L group and was
significantly higher in the Sild-H group [1695 (1252-3377) h ng/ml] when
compared with the Control group. There were no significant differences in
inflammatory response markers, cardiopulmonary bypass and ventilation
weaning times, inotropy scores and echocardiographic function between the
groups. CONCLUSIONS: In this small study, Sildenafil failed to reduce
myocardial injury in children undergoing cardiac surgery, nor does it
alter cardiac function, inotropic needs or postoperative course. A
subclinical increase in cardiac enzyme release after Sildenafil
preconditioning cannot be excluded. Clinical Trials Registry:
CTRI/2014/03/004468.

<7>
Accession Number
20160350651
Author
Shah S.B.; Bhargava A.K.; Hariharan U.; Mittal A.K.; Goel N.; Choudhary M.
Institution
(Shah, Bhargava, Hariharan, Mittal, Goel, Choudhary) Department of
Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5,
Rohini, New Delhi, India
Title
A randomized clinical trial comparing the standard mcintosh laryngoscope
and the C-Mac D blade video laryngoscopeTM for double lumen tube insertion
for one lung ventilation in onco surgical patients.
Source
Indian Journal of Anaesthesia. 60 (5) (pp 312-318), 2016. Date of
Publication: May 2016.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Several devices enabling double-lumen tube (DLT)
placement for thoracic surgeries are available, but there are no studies
for D-blade video laryngoscope-guided DLT insertion. We compared the CMac
D-blade videolaryngoscopeTM and the Macintosh laryngoscope for DLT
endobronchial intubation using parameters of time and attempts required
for intubation, glottic view, incidence of complications and haemodynamic
changes. Methods: Prospective, parallel group, randomised controlled
clinical trial where sixty American Society of Anesthesiologists I and II
patients aged 18-80 years scheduled for thoracic surgeries entailing DLT
placement were randomly allocated in two groups based on the laryngoscopic
device used for endobronchial intubation. Data were subjected to
statistical analysis SPSS (version 17), the paired and Student's t-test
for equality of means. Nominal categorical data between the groups were
compared using Chi-squared test or Fisher's exact test as appropriate. P <
0.05 was considered statistically significant. Results: Time required for
intubation was comparable (37.41 +/- 18.80 s in Group-M and 32.27 +/-
11.13 s in Group-D). Number of attempts and incidence of complications
(trauma, DLT cuff rupture, oesophageal intubation) was greater in the
Macintosh group, except malpositioning into the wrong bronchus (easily
rectified fibre-optic bronchoscopically), which was greater with the
D-blade. Greater haemodynamic changes were observed during Macintosh
laryngoscopy. Conclusion: D-blade videolaryngoscopeTM is a useful
alternative to the standard Macintosh laryngoscope for routine DLT
insertion.

<8>
Accession Number
20160356257
Author
Clavijo L.C.; Cortes G.A.; Jolly A.; Tun H.; Mehra A.; Gaglia M.A.;
Shavelle D.; Matthews R.V.
Institution
(Clavijo, Cortes, Jolly, Tun, Mehra, Gaglia, Shavelle, Matthews)
University of Southern California, Los Angeles, CA, United States
Title
Same-day discharge after coronary stenting and femoral artery device
closure: A randomized study in stable and low-risk acute coronary syndrome
patients.
Source
Cardiovascular Revascularization Medicine. 17 (3) (pp 155-161), 2016. Date
of Publication: 01 Apr 2016.
Publisher
Elsevier Inc.
Abstract
Objective: To compare same-day (SD) vs. delayed hospital discharge (DD)
after single and multivessel coronary stenting facilitated by femoral
closure device in patients with stable angina and low-risk acute coronary
syndrome (ACS). Methods: University of Southern California patients were
screened and coronary stenting was performed in 2480 patients. Four
hundred ninety-three patients met screening criteria and consented. Four
hours after percutaneous coronary intervention, 100 were randomized to SD
(n = 50) or DD (n = 50). Patients were followed for one year; outcomes-,
patient satisfaction-, and cost analyses were performed. Results: Groups
were well distributed, with similar baseline demographic and angiographic
characteristics. Mean age was 58.1 +/- 8.8 years and 86% were male.
Non-ST-elevation myocardial infarction and unstable angina were the
clinical presentations in 30% and 44% of the SD and DD groups,
respectively (p = 0.2). Multivessel stenting was performed in 36% and 30%
of SD and DD groups, respectively (p = 0.14). At one year, two patients
from each group (4%) required unplanned revascularization and one patient
in the SD group had a gastrointestinal bleed that required a blood
transfusion. Six SD and four DD patients required repeat hospitalization
(p = 0.74). There were no femoral artery vascular complications in either
group. Patient satisfaction scores were equivalent. SD discharge was
associated with $1200 savings per patient. Conclusions: SD discharge after
uncomplicated single and multivessel coronary stenting of patients with
stable, low-risk ACS, via the femoral approach facilitated by a closure
device, is associated with similar clinical outcomes, patient
satisfaction, and cost savings compared to overnight (DD) hospital stay.

<9>
Accession Number
20160150330
Author
Budoff M.J.; Nakazato R.; Mancini G.B.J.; Gransar H.; Leipsic J.; Berman
D.S.; Min J.K.
Institution
(Budoff) Department of Medicine, Los Angeles Biomedical Research Center,
Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502,
United States
(Nakazato, Gransar, Berman) Cedars-Sinai Heart Institute, Department of
Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Mancini, Leipsic) Department of Medicine and Radiology, University of
British Columbia, Vancouver, BC, Canada
(Min) Department of Radiology, New York-Presbyterian Hospital, Weill
Cornell Medical College, New York, NY, United States
Title
CT Angiography for the Prediction of Hemodynamic Significance in
Intermediate and Severe Lesions Head-to-Head Comparison with Quantitative
Coronary Angiography Using Fractional Flow Reserve as the Reference
Standard.
Source
JACC: Cardiovascular Imaging. 9 (5) (pp 559-564), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The goal of this study was to compare the diagnostic
performance of coronary computed tomography angiography (CTA) versus
quantitative coronary angiography (QCA) for the detection of
lesion-specific ischemia using fractional flow reserve (FFR) as the gold
standard. Background Coronary CTA has emerged as a noninvasive method for
accurate detection and exclusion of high-grade coronary stenoses. FFR is
the gold standard for determining lesion-specific ischemia and has been
shown to improve clinical outcomes when guiding revascularization. Methods
A total of 252 patients from 5 countries were prospectively enrolled (mean
age 63 years; 71% male). Patients underwent coronary CTA and invasive
coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and
FFR were interpreted by independent core laboratories. Stenosis severity
according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%,
50% to 69%, and 70% to 100%; stenosis >50% was considered anatomically
obstructive. Lesion-specific ischemia was defined according to FFR <0.8,
whereas QCA and coronary CTA stenosis >50% were considered obstructive.
Diagnostic accuracy and areas under the receiver-operating characteristics
curve (AUC) for lesion-specific ischemia was assessed. Results According
to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic
accuracy, sensitivity, specificity, positive predictive value, and
negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary
CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of
ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for
QCA (p = 0.6). No differences between CTA and QCA existed for
discrimination of ischemia within the left anterior descending artery (AUC
0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p =
0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6). Conclusions
CTA and ICA exhibited similar diagnostic performance for the detection and
exclusion of lesion-specific ischemia. Using a true reference standard to
determine appropriate revascularization targets, 3-dimensional coronary
CTA performed as well as 2-dimensional ICA.

<10>
Accession Number
20151062332
Author
Weinsaft J.W.; Kim J.; Medicherla C.B.; Ma C.L.; Codella N.C.F.; Kukar N.;
Alaref S.; Kim R.J.; Devereux R.B.
Institution
(Weinsaft, Kim, Medicherla, Ma, Alaref, Devereux) Greenberg Cardiology
Division, Department of Medicine, Weill Cornell Medical College, New York,
NY, United States
(Weinsaft, Kim) Department of Radiology, Weill Cornell Medical College,
New York, NY, United States
(Codella) IBM T.J. Watson Research Center, Yorktown Heights, NY, United
States
(Kukar) Memorial Sloan Kettering Cancer Center, New York, NY, United
States
(Kim) Duke Cardiovascular Magnetic Resonance Center, Durham, NC, United
States
(Weinsaft) Cardiac Magnetic Resonance Imaging Program, Weill Medical
College of Cornell University, 525 East 68th Street, Starr-4, New York, NY
10021, United States
Title
Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus A
Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR.
Source
JACC: Cardiovascular Imaging. 9 (5) (pp 505-515), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The goal of this study was to determine the prevalence of
post-myocardial infarction (MI) left ventricular (LV) thrombus in the
current era and to develop an effective algorithm (predicated on
echocardiography [echo]) to discern patients warranting further testing
for thrombus via delayed enhancement (DE) cardiac magnetic resonance
(CMR). Background LV thrombus affects post-MI management. DE-CMR provides
thrombus tissue characterization and is a well-validated but an
impractical screening modality for all patients after an MI. Methods A
same-day echo and CMR were performed according to a tailored protocol,
which entailed uniform echo contrast (irrespective of image quality) and
dedicated DE-CMR for thrombus tissue characterization. Results A total of
201 patients were studied; 8% had thrombus according to DE-CMR. All
thrombi were apically located; 94% of thrombi occurred in the context of a
left anterior descending (LAD) infarct-related artery. Although patients
with thrombus had more prolonged chest pain and larger MI (p < 0.01), only
18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast
(64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus
was associated with stepwise increments in basal -> apical contractile
dysfunction on echo and quantitative cine-CMR; the echo-measured apical
wall motion score was higher among patients with thrombus (p < 0.001) and
paralleled cine-CMR decrements in apical ejection fraction and peak
ejection rates (both p < 0.005). Thrombus-associated decrements in apical
contractile dysfunction were significant even among patients with LAD
infarction (p < 0.05). The echo-based apical wall motion score improved
overall performance (area under the curve 0.89 +/- 0.44) for thrombus
compared with ejection fraction (area under the curve 0.80 +/- 0.61; p =
0.01). Apical wall motion partitions would have enabled all patients with
LV thrombus to be appropriately referred for DE-CMR testing (100%
sensitivity and negative predictive value), while avoiding further testing
in more than one-half (56% to 63%) of patients. Conclusions LV thrombus
remains common, especially after LAD MI, and can occur even in the absence
of aneurysm. Although DE-CMR yielded improved overall thrombus detection,
apical wall motion on a noncontrast echocardiogram can be an effective
stratification tool to identify patients in whom DE-CMR thrombus
assessment is most warranted. (Diagnostic Utility of Contrast
Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial
Infarction; NCT00539045).

<11>
Accession Number
2015803896
Author
Ammirati E.; Oliva F.G.; Colombo T.; Russo C.F.; Cipriani M.G.; Garascia
A.; Guida V.; Colombo G.; Verde A.; Perna E.; Cannata A.; Paino R.;
Martinelli L.; Frigerio M.
Institution
(Ammirati, Oliva, Colombo, Russo, Cipriani, Garascia, Guida, Colombo,
Verde, Perna, Cannata, Paino, Martinelli, Frigerio) Cardiothoracic and
Vascular Department, Azienda Ospedaliera Ospedale Niguarda Ca' Granda,
Piazza Ospedale Maggiore 3, Milan 20162, Italy
Title
Mid-term survival after continuous-flow left ventricular assist device
versus heart transplantation.
Source
Heart and Vessels. 31 (5) (pp 722-733), 2016. Date of Publication: 01 May
2016.
Publisher
Springer-Verlag Tokyo
Abstract
There is a paucity of data about mid-term outcome of patients with
advanced heart failure (HF) treated with left ventricular assist device
(LVAD) in Europe, where donor shortage and their aging limit the
availability and the probability of success of heart transplantation
(HTx). The aim of this study is to compare Italian single-centre mid-term
outcome in prospective patients treated with LVAD vs. HTx. We evaluated
213 consecutive patients with advanced HF who underwent continuous-flow
LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1
year (3/2013). We compared outcome in patients who received a LVAD (n =
49) with those who underwent HTx (n = 164) and in matched groups of 39
LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse
risk profile in comparison with HTx patients. Kaplan-Meier survival curves
estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx
patients, a difference that was non-statistically significant [hazard
ratio (HR) 1.46; 95 % confidence interval (CI) 0.74-2.86; p = 0.27 for
LVAD vs. HTx]. After group matching 1-year survival was similar between
LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44-2.98; p = 0.78).
Concordant data was observed at 2-year follow-up. Patients treated with
LVAD as bridge-to-transplant indication (n = 22) showed a non significant
better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1-
and 2-year follow-up, respectively. Despite worse preoperative conditions,
survival is not significantly lower after LVAD than after HTx at 2-year
follow-up. Given the scarce number of donors for HTx, LVAD therapy
represents a valid option, potentially affecting the current allocation
strategy of heart donors also in Europe.

<12>
Accession Number
20160369690
Author
Vranckx P.; White H.D.; Huang Z.; Mahaffey K.W.; Armstrong P.W.; Van De
Werf F.; Moliterno D.J.; Wallentin L.; Held C.; Aylward P.E.; Cornel J.H.;
Bode C.; Huber K.; Nicolau J.C.; Ruzyllo W.; Harrington R.A.; Tricoci P.
Institution
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Huang, Tricoci) Duke Clinical Research Institute, 2400 Pratt Street,
Durham, NC 27705, United States
(Mahaffey, Harrington) Stanford University, Stanford, CA, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton,
Canada
(Van De Werf) Department of Cardiology, University of Leuven, Leuven,
Belgium
(Moliterno) Gill Heart Institute, Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(Wallentin, Held) Department of Medical Sciences, Cardiology, Uppsala
Clinical Research Center, Uppsala University, Uppsala, Sweden
(Aylward) SAHMRI, Flinders University and Medical Centre, Adelaide,
Australia
(Cornel) Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar,
Netherlands
(Bode) Internal Medicine and Cardiology, Universitatsklinikum, Freiburg,
Germany
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminen Hospital, Vienna, Austria
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
Title
Validation of BARC Bleeding Criteria in Patients with Acute Coronary
Syndromes the TRACER Trial.
Source
Journal of the American College of Cardiology. 67 (18) (pp 2135-2144),
2016. Date of Publication: 10 May 2016.
Publisher
Elsevier USA
Abstract
Background The Bleeding Academic Research Consortium (BARC) scale has been
proposed to standardize bleeding endpoint definitions and reporting in
cardiovascular trials. Validation in large cohorts of patients is needed.
Objectives This study sought to investigate the relationship between
BARC-classified bleeding and mortality and compared its prognostic value
against 2 validated bleeding scales: TIMI (Thrombolysis In Myocardial
Infarction) and GUSTO (Global Use of Strategies to Open Occluded
Arteries). Methods We analyzed bleeding in 12,944 patients with acute
coronary syndromes without ST-segment elevation, with or without early
invasive strategy. The main outcome measure was all-cause death. Results
During follow-up (median: 502 days), noncoronary artery bypass graft
(CABG) bleeding occurred in 1,998 (15.4%) patients according to BARC
(grades 2, 3, or 5), 484 (3.7%) patients according to TIMI minor/major,
and 514 (4.0%) patients according to GUSTO moderate/severe criteria.
CABG-related bleeding (BARC 4) occurred in 155 (1.2%) patients. Patients
with BARC (2, 3, or 4) bleeding had a significant increase in risk of
death versus patients without bleeding (BARC 0 or 1); the hazard was
highest in the 30 days after bleeding (hazard ratio: 7.35; 95% confidence
interval: 5.59 to 9.68; p < 0.0001) and remained significant up to 1 year.
The hazard of mortality increased progressively with non-CABG BARC grades.
BARC 4 bleeds were significantly associated with mortality within 30 days
(hazard ratio: 10.05; 95% confidence interval: 5.41 to 18.69; p < 0.0001),
but not thereafter. Inclusion of BARC (2, 3, or 4) bleeding in the 1-year
mortality model with baseline characteristics improved it to an extent
comparable to TIMI minor/major and GUSTO moderate/severe bleeding.
Conclusions In patients with acute coronary syndromes without ST-segment
elevation, bleeding assessed with the BARC scale was significantly
associated with risk of subsequent death up to 1 year after the event and
risk of mortality increased gradually with higher BARC grades. Our results
support adoption of the BARC bleeding scale in ACS clinical trials.

<13>
Accession Number
20160369713
Author
Yamamoto M.; Shimura T.; Kano S.; Kagase A.; Kodama A.; Koyama Y.;
Watanabe Y.; Tada N.; Takagi K.; Araki M.; Shirai S.; Hayashida K.
Institution
(Yamamoto, Shimura, Kagase, Kodama) Department of Cardiology, Toyohashi
Heart Center, 21-1 Gohundori, Oyama-Cho, Toyohashi, Aichi 441-8530, Japan
(Yamamoto, Kano, Koyama) Department of Cardiology, Nagoya Heart Center,
Nagoya, Japan
(Watanabe) Department of Cardiology, Teikyo University, School of
Medicine, Tokyo, Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
(Takagi) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Hayashida) Department of Cardiology, Keio University, School of Medicine,
Tokyo, Japan
Title
Impact of preparatory coronary protection in patients at high anatomical
risk of acute coronary obstruction during transcatheter aortic valve
implantation.
Source
International Journal of Cardiology. 217 (pp 58-63), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background This study aimed to assess the effectiveness of preparatory
coronary protection (CP) in patients considered at high risk of acute
coronary obstruction (ACO) after transcatheter aortic valve implantation
(TAVI). Methods The Optimized CathEter vAlvular iNtervention (OCEAN-TAVI)
Japanese multicenter registry enrolled 666 consecutive patients. All
patients were assessed by preprocedural multidetector computed tomography.
CP using a guide wire with or without a balloon was prospectively
performed according to the following criteria: 1) coronary height length
from the annulus < 10 mm, 2) evidence of ACO during balloon aortic
valvuloplasty with simultaneous aortic injection, and 3) shallow valsalva
or bulky calcification on the leaflet. The incidence of ACO and other
procedural outcomes were compared between the CP and non-CP groups.
Results CP was performed in 14.1% of all patients (94/666). ACO had an
incidence of 1.5% (10/666) and mainly occurred in women (70%) and the left
coronary artery (70%). The ACO rate was significantly higher in the CP
group than in the non-CP group (7.4% [7/94] vs. 0.5% [3/572]; p < 0.001),
although notably 30% of ACO were occurred in non-CP group. All 10 ACO
cases were successfully treated by catheter intervention, although
periprocedural myocardial injury occurred in 42.9% of patients with CP
group and 33.3% of those without CP group. Mortality and other
periprocedural complications did not significantly differ between the 2
groups. Conclusion The preparatory CP strategy was feasible for the
management of ACO during TAVI, but the complication of ACO was difficult
to predict completely.

<14>
Accession Number
20160375534
Author
Nappi F.; Lusini M.; Spadaccio C.; Nenna A.; Covino E.; Acar C.; Chello M.
Institution
(Nappi, Lusini, Spadaccio, Nenna, Covino, Chello) Department of
Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, 36 Rue des Moulins Gemeaux, Saint-Denis 93200, France
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
Title
Papillary muscle approximation versus restrictive annuloplasty alone for
severe ischemic mitral regurgitation.
Source
Journal of the American College of Cardiology. 67 (20) (pp 2334-2346),
2016. Date of Publication: 24 May 2016.
Publisher
Elsevier USA
Abstract
Background Guidelines recommend surgery for patients with severe ischemic
mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular
repair is associated with longer survival, but randomized studies are
lacking. Objectives This study sought to investigate the benefit of
papillary muscle surgery on long-term clinical outcomes of patients with
ischemic MR. Methods Ninety-six patients with severe ischemic MR were
randomized to either undersizing restrictive mitral annuloplasty (RA) or
papillary muscle approximation with undersizing restrictive mitral
annuloplasty (PMA) associated with complete surgical myocardial
revascularization. The primary endpoint was change in left ventricular
end-diastolic diameter (LVEDD) after 5 years, measured as the absolute
difference from baseline, which was evaluated by paired Student t tests.
Secondary endpoints included changes in echocardiographic parameters,
overall mortality, the composite cardiac endpoint (major adverse cardiac
and cerebrovascular events [MACCE]), and quality of life (QOL) during the
5-year follow-up. Results At 5 years, mean LVEDD was 56.5 +/- 5.7 mm with
PMA versus 60.6 +/- 4.6 mm with RA (mean change from baseline -5.8 +/- 4.1
mm and -0.2 +/- 2.3 mm, respectively; p < 0.001). Ejection fraction was
44.1 +/- 6% in the PMA group versus 39.9 +/- 3.9% in the RA group (mean
change from baseline 8.8 +/- 5.9% and 2.5 +/- 4.3%, respectively; p <
0.001). There was no statistically significant difference in mortality at
5 years, but freedom from MACCE favored PMA in the last year of follow-up.
PMA significantly reduced tenting height, tenting area, and interpapillary
distance soon after surgery and for the long-term, and significantly
lowered moderate-to-severe MR recurrence. No differences were found in QOL
measures. Conclusions Compared with RA only, PMA exerted a long-term
beneficial effect on left ventricular remodeling and more effectively
restored the mitral valve geometric configuration in ischemic MR, which
improved long-term cardiac outcomes, but did not produce differences in
overall mortality and QOL.

<15>
[Use Link to view the full text]
Accession Number
20160348488
Author
Arnuntasupakul V.; Van Zundert T.C.R.V.; Vijitpavan A.; Aliste J.;
Engsusophon P.; Leurcharusmee P.; Ah-Kye S.; Finlayson R.J.; Tran D.Q.H.
Institution
(Arnuntasupakul, Vijitpavan) Department of Anesthesia, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Van Zundert, Aliste, Engsusophon, Ah-Kye, Finlayson, Tran) Department of
Anesthesia, Montreal General Hospital, McGill University, Montreal, QC,
Canada
(Leurcharusmee) Department of Anesthesia, Maharaj Nakorn Chiang Mai
Hospital, Chiang Mai University, Chiang Mai, Thailand
(Tran) Department of Anesthesia, Montreal General Hospital, 1650 Cedar
Ave, Montreal, QC H3G-1A4, Canada
Title
A randomized comparison between conventional and waveform-confirmed loss
of resistance for thoracic epidural blocks.
Source
Regional Anesthesia and Pain Medicine. 41 (3) (pp 368-373), 2016. Date of
Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Objectives Epidural waveform analysis (EWA) provides a
simple confirmatory adjunct for loss of resistance (LOR): when the needle
tip is correctly positioned inside the epidural space, pressure
measurement results in a pulsatile waveform. In this randomized trial, we
compared conventional and EWA-confirmed LOR in 2 teaching centers. Our
research hypothesis was that EWA-confirmed LOR would decrease the failure
rate of thoracic epidural blocks. Methods One hundred patients undergoing
thoracic epidural blocks for thoracic surgery, abdominal surgery, or rib
fractures were randomized to conventional LOR or EWA-LOR. The operator was
allowed as many attempts as necessary to achieve a satisfactory LOR (by
feel) in the conventional group. In the EWA-LOR group, LOR was confirmed
by connecting the epidural needle to a pressure transducer using a rigid
extension tubing. Positive waveforms indicated that the needle tip was
positioned inside the epidural space. The operator was allowed a maximum
of 3 different intervertebral levels to obtain a positive waveform. If
waveforms were still absent at the third level, the operator simply
accepted LOR as the technical end point. However, the patient was retained
in the EWA-LOR group (intent-to-treat analysis). After achieving a
satisfactory tactile LOR (conventional group), positive waveforms (EWA-LOR
group), or a third intervertebral level with LOR but no waveform (EWA-LOR
group), the operator administered a 4-mL test dose of lidocaine 2% with
epinephrine 5 mug/mL. Fifteen minutes after the test dose, a blinded
investigator assessed the patient for sensory block to ice. Results
Compared with LOR, EWA-LOR resulted in a lower rate of primary failure (2%
vs 24%; P = 0.002). Subgroup analysis based on experience level reveals
that EWA-LOR outperformed conventional LOR for novice (P = 0.001) but not
expert operators. The performance time was longer in the EWA-LOR group
(11.2 +/- 6.2 vs 8.0 +/- 4.6 minutes; P = 0.006). Both groups were
comparable in terms of operator's level of expertise, depth of the
epidural space, approach, and LOR medium. In the EWA-LOR group, operators
obtained a pulsatile waveform with the first level attempted in 60% of
patients. However, 40% of subjects required performance at a second or
third level. Conclusions Compared with its conventional counterpart,
EWA-confirmed LOR results in a lower failure rate for thoracic epidural
blocks (2% vs 24%) in our teaching centers. Confirmatory EWA provides
significant benefits for inexperienced operators.

<16>
Accession Number
20160246687
Author
Liao Y.-B.; Meng Y.; Zhao Z.-G.; Zuo Z.-L.; Li Y.-J.; Xiong T.-Y.; Cao
J.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, Zhao, Zuo, Li, Xiong, Cao, Xu, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, Chengdu, China
(Meng) Department of Urology Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Meta-analysis of the effectiveness and safety of transcatheter aortic
valve implantation without balloon predilation.
Source
American Journal of Cardiology. 117 (10) (pp 1629-1635), 2016. Date of
Publication: 15 May 2016.
Publisher
Elsevier Inc.
Abstract
Evidence regarding the safety and feasibility of transcatheter aortic
valve implantation without balloon predilation (BP) is scarce. A
literature search of PubMed, EMBASE, CENTRAL, and major conference
proceedings was performed from January 2002 to July 2015. There were 18
studies incorporating 2,443 patients included in the present study. No
differences were observed in the baseline characteristics between patients
without BP (no-BP) and with BP. Compared with BP, no-BP had a shorter
procedure time (no-BP vs BP, 124.2 vs 138.8 minutes, p = 0.008), used
less-contrast medium (no-BP vs BP, 126.3 vs 156.3 ml, p = 0.0005) and had
a higher success rate (odds ratio [OR] 2.24, 95% CI 1.40 to -3.58). In
addition, no-BP was associated with lower incidences of permanent
pacemaker implantation (OR 0.45, 95% CI 0.3 to 0.67), grade 2 or greater
paravalvular leakage (OR 0.55, 95% CI 0.37 to 0.83), and stroke (OR 0.57,
95% CI 0.32 to 1.0). Furthermore, no-BP was associated with a 0.6-fold
decreased risk for 30-day all-cause mortality (OR 0.60, 95% CI 0.39 to
0.92). However, the difference in the risk for permanent pacemaker
implantation, grade 2, or higher aortic regurgitation, stroke was noted to
be significant only in the subgroup of the CoreValve-dominating studies.
In conclusion, no-BP before transcatheter aortic valve implantation was
not only safe and feasible but was also associated with fewer
complications and short-term mortality in selected patients especially
using self-expandable valve.

<17>
Accession Number
20160235758
Author
Krishnaswami A.; Goh A.C.H.; Go A.S.; Lundstrom R.J.; Zaroff J.; Jang
J.J.; Allen E.
Institution
(Krishnaswami, Jang) Division of Cardiology, Kaiser Permanente San Jose
Medical Center, San Jose, CA, United States
(Goh, Lundstrom, Zaroff) Division of Cardiology, Kaiser Permanente San
Francisco Medical Center, San Francisco, CA, United States
(Go) Division of Research, Kaiser Permanente Northern California, Oakland,
CA, United States
(Go, Allen) Department of Epidemiology and Biostatistics, University of
California, San Francisco, San Francisco, CA, United States
(Go) Department of Medicine, University of California, San Francisco, San
Francisco, CA, United States
(Go) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
Title
Effectiveness of percutaneous coronary intervention versus coronary artery
bypass grafting in patients with end-stage renal disease.
Source
American Journal of Cardiology. 117 (10) (pp 1596-1603), 2016. Date of
Publication: 15 May 2016.
Publisher
Elsevier Inc.
Abstract
The optimal coronary revascularization strategy (coronary artery bypass
grafting [CABG] or percutaneous coronary intervention [PCI]) in patients
with end-stage renal disease (ESRD) remains uncertain. We performed an
updated systematic review and meta-analysis of observational studies
comparing CABG and PCI in patients with ESRD using a random-effects model
for the primary outcome of long-term all-cause mortality. Our review
registered through PROSPERO included observational studies published after
2011 to ensure overlap with previous studies and identified 7 new studies
for a total of 23. We found that the median sample size in the selected
studies was 125 patients (25 to 15,784) with a large variation in the
covariate risk adjustment and only 3 studies reporting the indications for
the revascularization strategy. CABG was associated with a small reduction
in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant
heterogeneity demonstrated (p = 0.005, I² = 48.6%). Subgroup
analysis by categorized "year of study initiation" (<1990, 1991 to 2003,
>2004) further confirmed the summary estimate trending toward survival
benefit of CABG along with a substantial decrease in heterogeneity after
2004 (p = 0.64, I² = 0%). In conclusion, our updated systematic
review and meta-analysis demonstrated that in patients with ESRD referred
for coronary revascularization, CABG was associated with a small decrease
in the relative risk of long-term mortality compared with PCI. The
generalizability of the finding to all patients with ESRD referred for
coronary revascularization is limited because of a lack of known
indications for coronary revascularization, substantial variation in
covariate risk adjustment, and lack of randomized clinical trial data.

<18>
Accession Number
20151047149
Author
Zeinah M.; Elghanam M.; Benedetto U.
Institution
(Zeinah, Elghanam) Ain Shams University, Cairo, Egypt
(Zeinah, Benedetto) Oxford Heart Centre, United Kingdom
Title
Which beta-blocker should be used for the prevention of postoperative
atrial fibrillation in cardiac surgery? A multi-treatment benefit-risk
meta-analysis.
Source
Egyptian Heart Journal. 68 (2) (pp 89-96), 2016. Date of Publication: 01
Jun 2016.
Publisher
Egyptian Society of Cardiology
Abstract
Background: Post-operative atrial fibrillation (POAF) is amongst the most
common complications following cardiac surgery. Current guidelines
recommend oral beta-blockers as a first-line medication to prevent POAF.
However, the ideal choice of beta-blocker is unclear, making a
comprehensive review crucial. We aimed to provide a clinically useful
summary of the results of a multiple-treatment meta-analysis of randomized
controlled trials (RCT). Methods and Results: A MEDLINE/PubMed search was
conducted to identify eligible RCTs. Efficacy (POAF prevention rate) and
acceptability (dropout for side effect rate) outcomes were investigated. A
frequentist approach to network meta-analysis using the graph-theoretical
method was implemented to obtain network estimates. A total of 16 trials
were included in the final analysis and 4727 subjects were investigated.
Network estimates showed that betaxolol (OR 0.36; 95%CI 0.25-0.52),
carvedilol (OR 0.36; 95%CI 0.23-0.58) and sotalol (OR 0.38; 95%CI
0.30-0.50) were more effective than propranolol (OR 0.51; 95%CI
0.27-0.95), metoprolol (OR 0.72; 95%CI 0.58-0.90) and atenolol (OR 0.81;
95%CI 0.42-1.56) in reducing the incidence of POAF when compared to
placebo. Amongst beta-blockers investigated, carvedilol showed the best
safety profile being associated with the lowest risk of patient dropped
out for side effect (OR 1.14; 955CI 0.36-3.61). No evidence of
heterogeneity/inconsistency was found in the whole network for both
efficacy (P = 0.8) and acceptability (P = 0.4) outcomes. Conclusion:
Overall, carvedilol was found to be effective in preventing POAF while
maintaining a good safety profile.

<19>
Accession Number
20151022707
Author
Goel S.S.; Dilip Gajulapalli R.; Athappan G.; Philip F.; Gupta S.; Murat
Tuzcu E.; Ellis S.G.; Mishkel G.; Kapadia S.R.
Institution
(Goel, Mishkel) Prairie Cardiovascular Consultants, St John's Hospital,
Springfield, IL, United States
(Dilip Gajulapalli, Gupta, Murat Tuzcu, Ellis, Kapadia) Department of
Cardiovascular Medicine, Cleveland Clinic Foundation, J2-3, 9500 Euclid
Ave, Cleveland, OH 44195, United States
(Athappan) Mount Sinai Medical Center, New York, NY, United States
(Philip) Division of Cardiovascular Medicine, University of California
(Davis) Medical Center, Sacramento, CA, United States
Title
Management of drug eluting stent in-stent restenosis: A systematic review
and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (6) (pp 1080-1091),
2016. Date of Publication: 01 May 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background The optimal management for coronary drug eluting stent in-stent
restenosis (DES ISR) is unclear. We performed a meta-analysis of
observational and randomized studies to compare the outcomes of management
of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty
(BA). Methods Eligible studies (25 single arm and 13 comparative,
including 4 randomized studies with a total of 7,474 patients with DES
ISR) were identified using MEDLINE search and proceedings of international
meetings. Outcomes studied include major adverse cardiac events (MACE),
target lesion revascularization (TLR), target vessel revascularization
(TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality.
Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years). Results The rate
of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95%
confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55)
groups compared to BA. Similarly, TVR rate was significantly lower in the
DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups
compared to BA. All other outcomes were similar between the DES/BA and
DEB/BA comparisons. TLR was significantly lower in the DES group compared
to BA for vessels < or > 2.75 mm. Conclusion Treatment of coronary DES ISR
with DES or DEB is associated with a reduction in the risk of TLR and TVR
compared to BA alone. The relative risk reduction for TLR with DES is
similar to DEB. DEBs have a potential role in the treatment of DES ISR by
avoiding placement of another layer of stent.

<20>
Accession Number
20151008853
Author
Li Y.; Guo S.; Liu G.; Yuan Y.; Wang W.; Zheng Z.; Hu S.; Ji B.
Institution
(Li, Guo, Liu, Yuan, Ji) Department of Cardiopulmonary Bypass, State Key
Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing, China
(Wang, Zheng, Hu) Department of Cardiac Surgery, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing, China
(Li) Department of Cardiac Surgery, Lanzhou University Second Hospital,
Lanzhou, China
Title
Three Preservation Solutions for Cold Storage of Heart Allografts: A
Systematic Review and Meta-Analysis.
Source
Artificial Organs. 40 (5) (pp 489-496), 2016. Date of Publication: 01 May
2016.
Publisher
Blackwell Publishing Inc.
Abstract
Organ preservation solution has been designed to attenuate the detrimental
effects during the ischemic period. The aim of this study was to
systematically evaluate the evidence comparing preservation solutions for
heart preservation. Studies were searched in PubMed, Embase, the Cochrane
Library, the Transplant Library, and the International Clinical Trials
Registry Platform. The primary outcomes were patient survival and donor
heart dysfunction. The secondary outcomes were in-hospital mortality and
enzyme gene expression. The University of Wisconsin solution (UW) was
associated with a significantly improved survival at 30 days and 90 days
(hazard ratio=1.16, 95% confidence interval [CI]=1.11-1.22, P<0.00001;
risk difference [RD]=0.03, 95% CI=0.01-0.05, P=0.002), compared with
Celsior. Hearts preserved with UW exhibited less ischemic necrosis than
those preserved with Celsior (RD=-0.07, 95% CI=-0.08 to 0.05, P<0.00001).
UW was associated with better survival compared with
histidine-tryptophan-ketoglutarate solution (HTK). There was no
statistical difference in donor heart dysfunction and in-hospital
mortality outcomes when comparing HTK with Celsior solution. During static
cold storage preservation, this study suggests that UW solution has better
clinical outcomes for heart transplantation compared with the other two
organ preservation solutions. Besides, the protective effect of Celsior
solution is similar to HTK solution in donor heart preservation.

<21>
Accession Number
2015526865
Author
Schmitt K.R.L.; Fedarava K.; Justus G.; Redlin M.; Bottcher W.; Delmo
Walter E.M.; Hetzer R.; Berger F.; Miera O.
Institution
(Schmitt, Fedarava, Justus, Berger, Miera) Department of Congenital Heart
Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin,
Germany
(Redlin) Department of Anesthesiology, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Bottcher, Delmo Walter, Hetzer) Department of Cardiothoracic and Vascular
Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
(Berger) Department of Pediatrics, Division of Cardiology,
Charite-Universitatsmedizin, Berlin, Germany
Title
Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic
Support but Does Not Impact Inflammation in Children Undergoing Surgical
Ventricular Septal Defect Closure.
Source
Artificial Organs. 40 (5) (pp 470-479), 2016. Date of Publication: 01 May
2016.
Publisher
Blackwell Publishing Inc.
Abstract
Minimizing the systemic inflammatory response caused by cardiopulmonary
bypass is a major concern. It has been suggested that the perfusion
temperature affects the inflammatory response. The aim of this prospective
study was to compare the effects of moderate hypothermia (32degreeC) and
normothermia (36degreeC) during cardiopulmonary bypass on markers of the
inflammatory response and clinical outcomes (time on ventilator) after
surgical closure of ventricular septal defects. During surgical closure of
ventricular septal defects under cardiopulmonary bypass, 20 children
(median age 4.9 months, range 2.3-38 months; median weight 7.2kg, range
5.2-11.7kg) were randomized to a perfusion temperature of either 32degreeC
(Group 1, n=10) or 36degreeC (Group 2, n=10). The clinical data and blood
samples were collected before cardiopulmonary bypass, directly after
aortic cross-clamp release, and 4 and 24h after weaning from
cardiopulmonary bypass. Time on ventilation as primary outcome did not
differ between the two groups. Other clinical outcome parameters like
fluid balance or length of stay in the intensive care were also similar in
the two groups. Compared with Group 2, Group 1 needed significantly higher
and longer inotropic support (P<0.001). In Group 1, two infants had
junctional ectopic tachycardia, and another had a pulmonary hypertensive
crisis. Perfusion temperature did not influence cytokine release, organ
injury, or coagulation. Cardiopulmonary bypass temperature does not
influence time on ventilation or inflammatory marker release. However, in
the present study, with a small patient cohort, patients operated under
hypothermic bypass needed higher and longer inotropic support. The use of
hypothermic cardiopulmonary bypass in infants and children should be
approached with care.

<22>
Accession Number
20160342472
Author
Steppich B.; Hadamitzky M.; Ibrahim T.; Groha P.; Schunkert H.; Laugwitz
K.-L.; Kastrati A.; Ott I.
Institution
(Steppich, Hadamitzky, Groha, Schunkert, Kastrati, Ott) Deutsches
Herzzentrum der Technischen Universitat Munchen, Munchen, Germany
(Ibrahim, Laugwitz) Klinikum rechts der Isar, 1. Medizinische Klinik,
Munchen, Germany
Title
Stem cell mobilisation by granulocyte-colony stimulating factor in
patients with acute myocardial infarction: Long-term results of the
REVIVAL-2 trial.
Source
Thrombosis and Haemostasis. 115 (4) (pp 864-868), 2016. Date of
Publication: April 2016.
Publisher
Schattauer GmbH
Abstract
Treatment with granulocyte-colony stimulating factor (G-CSF) mobilises
cells from the bone marrow to the peripheral blood. Previous preclinical
and early clinical trials may suggest that treatment with G-CSF leads to
improved myocardial perfusion and function in acute or chronic ischaemic
heart disease. In the REVIVAL-2 study we found that stem cell mobilisation
by G-CSF does not influence infarct size, left ventricular function and
coronary restenosis in patients with acute myocardial infarction (MI) that
underwent successful percutaneous coronary intervention. The objective of
the present analysis was to assess the impact of G-CSF treatment on
seven-year clinical outcomes from the REVIVAL-2 trial. In the randomized,
double-blind, placebo-controlled REVIVAL-2 study, 114 patients with the
diagnosis of acute myocardial infarction were enrolled five days after
successful reperfusion by percutaneous coronary intervention. Patients
were assigned to receive 10 micro&#32;g/kg G-CSF (n=56) or placebo (n=58)
for five days. The primary endpoint for this long-term outcome analysis
was the composite of death, myocardial infarction or stroke seven years
after randomisation. The endpoint occurred in 14.3 % of patients in the
G-CSF group versus 17.2 % assigned to placebo (p=0.67). The combined
incidence of death or myocardial infarction occurred in 14.3 % of the
patients assigned to G-CSF and 15.5 % of the patients assigned to placebo
(p=0.85). In conclusion, these long-term follow-up data show that G-CSF
does not improve clinical outcomes of patients with acute myocardial
infarction.

<23>
Accession Number
20160343159
Author
Fu G.W.; Nie Y.F.; Jiao Z.Y.; Zhao W.Z.
Institution
(Fu, Nie, Jiao, Zhao) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
Title
Clinical applications of retrograde autologous priming in cardiopulmonary
bypass in pediatric cardiac surgery.
Source
Brazilian Journal of Medical and Biological Research. 49 (5) (no
pagination), 2016. Article Number: e5138. Date of Publication: 26 Apr
2016.
Publisher
Associacao Brasileira de Divulgacao Cientifica
Abstract
Retrograde autologous priming (RAP) has been routinely applied in cardiac
pediatric cardiopulmonary bypass (CPB). However, this technique is
performed in pediatric patients weighing more than 20 kg, and research
about its application in pediatric patients weighing less than 20 kg is
still scarce. This study explored the clinical application of RAP in CPB
in pediatric patients undergoing cardiac surgery. Sixty pediatric patients
scheduled for cardiac surgery were randomly divided into control and
experimental groups. The experimental group was treated with CPB using
RAP, while the control group was treated with conventional CPB (priming
with suspended red blood cells, plasma and albumin). The hematocrit (Hct)
and lactate (Lac) levels at different perioperative timepoints, mechanical
ventilation time, hospitalization duration, and intraoperative and
postoperative blood usage were recorded. Results showed that Hct levels at
15 min after CPB beginning (T2) and at CPB end (T3), and number of
intraoperative blood transfusions were significantly lower in the
experimental group (Po0.05). There were no significant differences in CPB
time, aortic blocking time, T2-Lac value or T3-Lac between the two groups
(P40.05). Postoperatively, there were no significant differences in Hct (2
h after surgery), mechanical ventilation time, intensive care unit time,
or postoperative blood transfusion between two groups (P40.05). RAP can
effectively reduce the hemodilution when using less or not using any
banked blood, while meeting the intraoperative perfusion conditions, and
decreasing the perioperative blood transfusion volume in pediatric
patients.

<24>
Accession Number
20160123013
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Shahidzadeh A.; Mahdavi P.;
Tahernejad M.; Haddad F.; Lotfaliani M.R.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Shahidzadeh, Mahdavi, Tahernejad, Haddad,
Lotfaliani) Cardiovascular Research Center, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Sabashnikov, Popov) Department of Cardiothoracic Transplantation and
Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Administration of low molecular weight and unfractionated heparin during
percutaneous coronary intervention.
Source
Indian Heart Journal. 68 (2) (pp 213-224), 2016. Date of Publication: 01
Mar 2016.
Publisher
Elsevier
Abstract
This systematic review with meta-analysis sought to determine the efficacy
and safety of unfractionated heparin (UFH) and low molecular weight
heparin (LMWH) on clinical outcomes following percutaneous coronary
intervention. Medline, Embase, Elsevier, and web of knowledge as well as
Google scholar literature were used for selecting appropriate studies with
randomized controlled design. After screening 445 studies, a total of 23
trials (including a total of 43,912 patients) were identified that
reported outcomes. Pooled analysis revealed that LMWH compared to UFH
could significantly increase thrombolysis in myocardial infarction grade 3
flow (p < 0.001), which was associated with similar target vessel
revascularization (p = 0.6), similar incidence of stroke (p = 0.7), and
significantly lower incidence of re-myocardial infarction (p < 0.001),
major bleeding (p = 0.02) and mortality (p < 0.001). Overall, LMWH was
shown to be a useful type of heparin for patients with MI undergoing PCI,
due to its higher efficacy and lower rate of complication compared to UFH.
It is also associated with increased myocardial perfusion, decreased major
hemorrhage, and mortality.

<25>
Accession Number
20160358189
Author
Kirmani B.H.; Brazier A.; Sriskandarajah S.; Azzam R.; Keenan D.J.
Institution
(Kirmani, Brazier, Sriskandarajah, Azzam, Keenan) Department of
Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road,
Manchester M13 9WL, United Kingdom
Title
A meta-analysis of computerized tomography scan for reducing complications
following repeat sternotomy for cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (4) (pp 472-479),
2016. Date of Publication: 01 Apr 2016.
Publisher
Oxford University Press
Abstract
Cardiac reoperation carries additional risks compared with surgery in
patients who are sternotomy-naive. To identify if preoperative
computerized tomography (CT) can reduce this risk, we performed a
systematic review of the literature and meta-analysis. Literature search
identified 178 studies of which 4 retrospective cohort studies
incorporating 900 patients met inclusion criteria. There were no
statistically significant differences in the risk of death, re-entry
injury, renal failure or perfusion/ischaemic times. CT scan reduced the
risk of stroke by 0.42 [95% confidence interval (CI): 0.19-0.93, P = 0.03]
and a composite of major complications by 0.65 (95% CI: 0.47-0.88, P =
0.006). The use of preoperative cross-sectional imaging to reduce the risk
of complications following cardiac reoperation is advocated.

<26>
Accession Number
72259845
Author
Salzmann S.; Euteneuer F.; Auer C.J.; Laferton J.A.; Schedlowski M.;
Moosdorf R.; Rief W.
Institution
(Salzmann, Euteneuer, Auer, Laferton, Rief) Clinical Psychology and
Psychotherapy, Philipps University of Marburg, Marburg, Hessen, Germany
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Clinic Essen, Essen, Nordrhein-Westfalen,
Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Germany
Title
Pre-surgical psychological interventions lead to reduced levels of
adrenaline and cortisol after surgery in coronary artery bypass graft
patients: The PSY-heart study.
Source
Psychosomatic Medicine. Conference: 74th Annual Meeting of the American
Psychosomatic Society, APS 2016 Denver, CO United States. Conference
Start: 20160309 Conference End: 20160312. Conference Publication:
(var.pagings). 78 (3) (pp A29), 2016. Date of Publication: April 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Outcomes of coronary artery bypass graft (CABG) surgeries are
associated with patients' pre-surgical expectations. Pre-surgical
psychological interventions targeting patients' expectations could help to
buffer patients stress response and to improve recovery after heart
surgery. This study examines whether pre-surgical psychological
interventions are capable of influencing the biological stress response
after CABG-surgery. Methods: Randomized controlled trial with assessments
at 10 days before surgery, post psychological intervention (day of
hospital admission, but before surgery) and post-surgery (6-8 days later).
Eligible patients (N=92) scheduled for elective on pump CABG or CABG with
valve replacement surgery were approached before hospital admission.
Standard medical care (SMC) was compared to two additional preoperative
psychological interventions: Either the expectation manipulation
intervention (EMI) to optimize patients' expectations about course and
outcomes, or the same amount of therapeutic attention with a focus on a
good therapeutic relationship and emotional expression, but without
specifically working on expectations (supportive therapy, or SUP). Main
outcomes were plasma adrenaline, noradrenaline and cortisol levels and
patients' disability expectations post-surgery. Results:EMI (P=.018) and
SUP (P=.009) led to significantly lower post-surgery adrenaline levels
compared to SMC only. SUP led to lower cortisol levels compared to SMC
after surgery (P=.021); time and treatment group interacted significantly
(F=2.01;P=.029;eta²=.147) while controlling for disability
expectations, demographic, psychological and medical variables. Higher
disability expectations at baseline were associated with higher adrenaline
levels after surgery (F=5.682;P=.021;eta²=.071), and patients'
baseline expectations were associated with changes of patients' adrenaline
levels over time(F=10.32,P<.001;eta² =.122). Conclusions: In
addition to standard medical care, preoperative psychological
interventions seem to be able to buffer psychobiological stress responses
and could thus facilitate recovery from CABG-surgery. (Figure Presented).