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<1>
Accession Number
2014483211
Author
Makara-Studzinska M.; Partyka I.; Ziemecki P.; Ziemecka A.
Institution
(Makara-Studzinska) Department of Applied Psychology, Medical University
of Lublin, Poland
(Partyka) Neuropsychiatric Hospital in Lublin, Poland
(Ziemecki, Ziemecka) Individual Medical Practice, Poland
Title
The occurrence of emotional problems in somatic diseases based on
psychodermatology.
Source
Archives of Psychiatry and Psychotherapy. 16 (2) (pp 23-28), 2014. Date of
Publication: June 2014.
Publisher
Polish Psychiatric Association
Abstract
Aim of the study. The aim of this study is to present selected aspects of
psychosocial problems in chronic somatic diseases based on the example of
dermatology with an impact on psoriasis as a model type of
psychodermatological disease. This review does not include the theoretical
basis for somatization as the issue exceeds the size of this article.
Material and methods. The analysis of present literature related to the
subject. Results. Confirmed the connection between emotional problems and
the course of an illness and proved the usefulness of psychodermatology in
improving the quality of life of patients with chronic skin diseases.
Discussion. Comparison of demographically and culturally varied groups.
The use of different research methods evokes the need of unification.
Conclusions. Relation between emotional factors and the course of
psychosomatic disease is unquestionable and mutual. Promising trends
include social support, multidisciplinary care and creating adequate tools
for assessment of emotional problems in psychosomatic problems and
practical use. Developing research tendencies compare impairment in
dermatological problems with other somatic disease.

<2>
Accession Number
27040324
Author
Leon M.B.; Smith C.R.; Mack M.J.; Makkar R.R.; Svensson L.G.; Kodali S.K.;
Thourani V.H.; Tuzcu E.M.; Miller D.C.; Herrmann H.C.; Doshi D.; Cohen
D.J.; Pichard A.D.; Kapadia S.; Dewey T.; Babaliaros V.; Szeto W.Y.;
Williams M.R.; Kereiakes D.; Zajarias A.; Greason K.L.; Whisenant B.K.;
Hodson R.W.; Moses J.W.; Trento A.; Brown D.L.; Fearon W.F.; Pibarot P.;
Hahn R.T.; Jaber W.A.; Anderson W.N.; Alu M.C.; Webb J.G.
Institution
(Leon) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Smith) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Mack) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Makkar) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Svensson) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Kodali) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Thourani) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Tuzcu) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Miller) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Herrmann) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Doshi) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Cohen) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Pichard) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Kapadia) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Dewey) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Babaliaros) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Szeto) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Williams) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Kereiakes) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Zajarias) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Greason) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Whisenant) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Hodson) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Moses) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Trento) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Brown) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Fearon) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Pibarot) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Hahn) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Jaber) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Anderson) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Alu) From the Columbia University Medical Center (M.B.L., C.R.S., S.K.K.,
D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone Medical
Center (M.R.W.) - both in New York; Baylor Scott and White Healthcare,
Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los Angeles
(R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.), and
independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
(Webb) From the Columbia University Medical Center (M.B.L., C.R.S.,
S.K.K., D.D., J.W.M., R.T.H., M.C.A.) and New York University Langone
Medical Center (M.R.W.) - both in New York; Baylor Scott and White
Healthcare, Plano, TX (M.J.M., D.L.B.); Cedars-Sinai Medical Center, Los
Angeles (R.R.M., A.T.), Stanford University, Stanford (D.C.M., W.F.F.),
and independent consultant (W.N.A.), Lake Forest - all in California;
Cleveland Clinic, Cleveland (L.G.S., E.M.T., S.K., W.A.J.); Emory
University, Atlanta (V.H.T., V.B.); University of Pennsylvania,
Philadelphia (H.C.H., W.Y.S.); St. Luke's Mid America Heart Institute,
Kansas City (D.J.C.), and Washington University, St. Louis (A.Z.) - both
in Missouri; Medstar Washington Hospital Center, Washington, DC (A.D.P.);
HCA Medical City Dallas Hospital, Dallas (T.D.); Christ Hospital,
Cincinnati (D.K.); Mayo Clinic, Rochester, MN (K.L.G.); Intermountain
Medical Center, Salt Lake City (B.K.W.); Providence St. Vincent Hospital,
Portland, OR (R.W.H.); and Laval University, Quebec, QC (P.P.), and St.
Paul's Hospital, Vancouver, BC (J.G.W.) - both in Canada
Title
Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk
Patients.
Source
The New England journal of medicine. 374 (17) (pp 1609-1620), 2016. Date
of Publication: 28 Apr 2016.
Abstract
BACKGROUND: Previous trials have shown that among high-risk patients with
aortic stenosis, survival rates are similar with transcatheter
aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We
evaluated the two procedures in a randomized trial involving
intermediate-risk patients.
METHODS: We randomly assigned 2032 intermediate-risk patients with severe
aortic stenosis, at 57 centers, to undergo either TAVR or surgical
replacement. The primary end point was death from any cause or disabling
stroke at 2 years. The primary hypothesis was that TAVR would not be
inferior to surgical replacement. Before randomization, patients were
entered into one of two cohorts on the basis of clinical and imaging
findings; 76.3% of the patients were included in the transfemoral-access
cohort and 23.7% in the transthoracic-access cohort.
RESULTS: The rate of death from any cause or disabling stroke was similar
in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2
years, the Kaplan-Meier event rates were 19.3% in the TAVR group and 21.1%
in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence
interval [CI], 0.73 to 1.09; P=0.25). In the transfemoral-access cohort,
TAVR resulted in a lower rate of death or disabling stroke than surgery
(hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the
transthoracic-access cohort, outcomes were similar in the two groups. TAVR
resulted in larger aortic-valve areas than did surgery and also resulted
in lower rates of acute kidney injury, severe bleeding, and new-onset
atrial fibrillation; surgery resulted in fewer major vascular
complications and less paravalvular aortic regurgitation.
CONCLUSIONS: In intermediate-risk patients, TAVR was similar to surgical
aortic-valve replacement with respect to the primary end point of death or
disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2
ClinicalTrials.gov number, NCT01314313.).

<3>
Accession Number
26409713
Author
Ansari B.M.; Hogan M.P.; Collier T.J.; Baddeley R.A.; Scarci M.; Coonar
A.S.; Bottrill F.E.; Martinez G.C.; Klein A.A.
Institution
(Ansari) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom
(Hogan) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom
(Collier) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Baddeley) Department of Physiotherapy, Papworth Hospital, Papworth
Everard, Cambridge, United Kingdom
(Scarci) Department of Cardiothoracic Surgery, Papworth Hospital, Papworth
Everard, Cambridge, United Kingdom
(Coonar) Department of Cardiothoracic Surgery, Papworth Hospital, Papworth
Everard, Cambridge, United Kingdom
(Bottrill) Department of Research and Development, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom
(Martinez) Department of Anaesthesia and Intensive Care, Papworth
Hospital, Papworth Everard, Cambridge, United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom. Electronic address:
andrew.klein@nhs.net
Title
A Randomized Controlled Trial of High-Flow Nasal Oxygen (Optiflow) as Part
of an Enhanced Recovery Program After Lung Resection Surgery.
Source
The Annals of thoracic surgery. 101 (2) (pp 459-464), 2016. Date of
Publication: 01 Feb 2016.
Abstract
BACKGROUND: Patients undergoing thoracic surgery are at risk of
postoperative pulmonary complications, which are associated with increased
morbidity and mortality. High-flow nasal oxygen therapy delivers
humidified, warmed positive airway pressure but has not been tested
routinely after thoracic surgery.
METHODS: We performed a randomized, controlled, blinded study. Patients
undergoing elective lung resection were randomly assigned to either
high-flow nasal oxygen or standard oxygen therapy. Patients were otherwise
treated within an established enhanced recovery program. The primary
outcome was the difference between the preoperative and postoperative
6-minute walk test. Secondary outcomes included hospital length of stay,
spirometry, and patient-reported outcomes measured using the Postoperative
Quality of Recovery Scale.
RESULTS: Fifty-nine patients were randomly assigned to either high-flow
nasal oxygen (n = 28) or standard oxygen (n = 31) therapy. We found no
difference in the 6-minute walk test outcome or spirometry; however,
length of hospital stay was significantly lower in the high-flow nasal
oxygen group, median 2.5 days (range, 1 to 22), compared with the standard
oxygen group, median 4.0 days (range, 2 to 18); geometric mean ratio was
0.68 (95% confidence interval: 0.48 to 0.86, p = 0.03). No significant
differences in recovery domains were found, but patients in the high-flow
nasal oxygen group reported significantly higher satisfaction (p = 0.046).
CONCLUSIONS: Prophylactic high-flow nasal oxygen therapy, when
incorporated into an enhanced recovery program, did not improve 6-minute
walk test results but was associated with reduced length of hospital stay
and improved satisfaction after lung resection, compared with standard
oxygen. This finding has implications for reduced costs and better service
provision, and a multicenter trial powered for length of stay is required.

<4>
Accession Number
26856215
Author
Hoekstra M.; Hessels L.; Rienstra M.; Yeh L.; Lansink A.O.; Vogelzang M.;
van der Horst I.C.; van der Maaten J.M.; Mariani M.A.; de Smet A.M.;
Struys M.M.; Zijlstra F.; Nijsten M.W.
Institution
(Hoekstra) Department of Anesthesiology of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: m.hoekstra01@umcg.nl
(Hessels) Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: l.hessels@umcg.nl
(Rienstra) Department of Cardiology of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: m.rienstra@umcg.nl
(Yeh) Department of Anesthesiology of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: l.yeh@umcg.nl
(Lansink) Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: a.oudelansink@umcg.nl
(Vogelzang) Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: m.vogelzang@umcg.nl
(van der Horst) Department of Critical Care of the University of
Groningen, University Medical Center Groningen, Groningen, The
Netherlands. Electronic address: i.c.c.van.der.horst@umcg.nl
(van der Maaten) Department of Anesthesiology of the University of
Groningen, University Medical Center Groningen, Groningen, The
Netherlands; Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: j.m.a.a.van.der.maaten@umcg.nl
(Mariani) Department of Cardiothoracic Surgery of the University of
Groningen, University Medical Center Groningen, Groningen, The
Netherlands. Electronic address: m.mariani@umcg.nl
(de Smet) Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: a.m.g.a.de.smet@umcg.nl
(Struys) Department of Anesthesiology of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: m.m.r.f.struys@umcg.nl
(Zijlstra) Department of Cardiology, Erasmus Medical Center, Rotterdam,
The Netherlands. Electronic address: f.zijlstra1@erasmc.nl
(Nijsten) Department of Critical Care of the University of Groningen,
University Medical Center Groningen, Groningen, The Netherlands.
Electronic address: m.w.n.nijsten@umcg.nl
Title
Computer-guided normal-low versus normal-high potassium control after
cardiac surgery: No impact on atrial fibrillation or atrial flutter.
Source
American heart journal. 172 (pp 45-52), 2016. Date of Publication: 01 Feb
2016.
Abstract
INTRODUCTION: This study was designed to determine the effect of 2
different potassium regulation strategies with different targets (within
the reference range) on atrial fibrillation (AF) or atrial flutter (AFL)
in a cohort of intensive care unit patients after cardiac surgery.
METHODS: The GRIP-COMPASS study was a prospective double-blinded
interventional study in 910 patients after cardiac surgery (coronary
artery bypass grafting and/or valvular surgery). Patients were assigned to
either the normal-low potassium target (nLP group, 4.0 mmol/L) or the
normal-high potassium target (nHP group, 4.5 mmol/L) in alternating blocks
of 50 patients. Potassium levels were regulated using a validated
computer-assisted potassium replacement protocol (GRIP-II). The primary
end point was the incidence of AF/AFL on a 12-lead electrocardiogram
during the first postoperative week.
RESULTS: Of the 910 patients, 447 were assigned to the nLP group; and 463,
to the nHP group, with no baseline differences between the 2 groups. The
mean daily administered dose of potassium was 30 +/- 23 mmol (nLP) versus
52 +/- 27 mmol (nHP) (P < .001), which resulted in mean intensive care
unit potassium concentration of 4.22 +/- 0.36 mmol/L and 4.33 +/- 0.34
mmol/L, respectively (P < .001). The incidence of AF/AFL after cardiac
surgery did not differ: 38% in the nLP group and 41% in the nHP group.
Also in several subgroups (eg, patients not known with prior AF/AFL or
with valve surgery), there were no differences.
CONCLUSIONS: There were no differences in incidence of AF/AFL with 2
potassium regulation strategies with different potassium targets and
different amounts of potassium administered in patients after cardiac
surgery.

<5>
Accession Number
26173169
Author
Lee R.J.; Hinson A.; Bauernschmitt R.; Matschke K.; Fang Q.; Mann D.L.;
Dowling R.; Schiller N.; Sabbah H.N.
Institution
(Lee) Cardiovascular Research Institute, University of California-San
Francisco, San Francisco, CA, USA; Department of Medicine, University of
California-San Francisco, San Francisco, CA, USA; Institute for
Regeneration Medicine, University of California-San Francisco, San
Francisco, CA, USA. Electronic address: lee@medicine.ucsf.edu
(Hinson) LoneStar Heart, Inc., Laguna Hills, CA, USA
(Bauernschmitt) Department for Thoracic and Cardiovascular Surgery,
University of Ulm, Ulm, Germany
(Matschke) Cardiovascular Surgery, University Hospital Dresden, Dresden,
Germany
(Fang) Cardiovascular Research Institute, University of California-San
Francisco, San Francisco, CA, USA; Department of Medicine, University of
California-San Francisco, San Francisco, CA, USA
(Mann) Cardiovascular Division, Washington University School of Medicine,
St Louis, MO, USA
(Dowling) Dowling Consulting, Louisville, KY, USA
(Schiller) Cardiovascular Research Institute, University of California-San
Francisco, San Francisco, CA, USA; Department of Medicine, University of
California-San Francisco, San Francisco, CA, USA
(Sabbah) Department of Medicine, Division of Cardiovascular Medicine,
Henry Ford Hospital, Detroit, MI, USA
Title
The feasibility and safety of Algisyl-LVRTM as a method of left
ventricular augmentation in patients with dilated cardiomyopathy: initial
first in man clinical results.
Source
International journal of cardiology. 199 (pp 18-24), 2015. Date of
Publication: 15 Nov 2015.
Abstract
BACKGROUND: A tissue engineering approach to augment the left ventricular
wall has been suggested as a means to treat patients with advanced heart
failure. This study evaluated the safety and feasibility of Algisyl-LVRTM
as a method of left ventricular augmentation in patients with dilated
cardiomyopathy undergoing open-heart surgery.
METHODS AND RESULTS: Eleven male patients (aged 44 to 74years) with
advanced heart failure (NYHA class 3 or 4), a left ventricular ejection
fraction (LVEF) of <40% and requiring conventional heart surgery received
Algisyl-LVR delivered into the LV myocardial free wall. Serial
echocardiography, assessment of NYHA class, Kansas City Cardiomyopathy
Questionnaire (KCCQ) and 24-hour Holter monitoring were obtained at
baseline, days 3 and 8 (for echocardiography and Holter monitoring), and
at 3, 6, 12, 18 and 24months. A total of 9 (81.8%) patients completed
24months of follow-up. Two patients withdrew consent after day 8 and at
the 3month visit. Operative mortality was 0% (n=10 with 30day follow-up).
There were no adverse events attributed to Algisyl-LVR. Mean LVEF improved
from 27.1 (+/-7.3) % at screening to a mean LVEF of 34.8 (+/-18.6) %
24months post-discharge. Improvements of NYHA class were corroborated with
improvements in KCCQ summary scores. Holter monitor data showed a
significant decrease in the episodes of nonsustained ventricular
tachycardia following administration of Algisyl-LVR.
CONCLUSIONS: Administration of Algisyl-LVR to patients with advanced HF at
the time of cardiac surgery is feasible and safe; warranting continued
development of Algisyl-LVR as a potential therapy in patients with
advanced HF.

<6>
[Use Link to view the full text]
Accession Number
26565136
Author
Bode L.G.; van Rijen M.M.; Wertheim H.F.; Vandenbroucke-Grauls C.M.;
Troelstra A.; Voss A.; Verbrugh H.A.; Vos M.C.; Kluytmans J.A.
Institution
(Bode, van Rijen, Wertheim, Vandenbroucke-Grauls, Troelstra, Voss,
Verbrugh, Vos, Kluytmans) *Erasmus University Medical Center, Department
of Medical Microbiology and Infectious Diseases, Rotterdam, The
Netherlands +Amphia Hospital, Laboratory for Microbiology and Infection
Control, Breda, The Netherlands ++VU Medical Center, Department of Medical
Microbiology and Infection Control, Amsterdam, The Netherlands University
Medical Center, Department of Medical Microbiology, Utrecht, The
Netherlands PCanisius Wilhelmina Hospital/Sint Maartenskliniek, Department
of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands
Title
Long-term Mortality After Rapid Screening and Decolonization of
Staphylococcus Aureus Carriers: Observational Follow-up Study of a
Randomized, Placebo-controlled Trial.
Source
Annals of surgery. 263 (3) (pp 511-515), 2016. Date of Publication: 01 Mar
2016.
Abstract
OBJECTIVE: To identify patients who benefit most from Staphylococcus
aureus screening and decolonization treatment upon admission.
BACKGROUND: S. aureus carriers are at increased risk of developing
surgical-site infections with S. aureus. Previously, we demonstrated in a
randomized, placebo-controlled trial (RCT) that these infections can
largely be prevented by detection of carriage and decolonization treatment
upon admission. In this study, we analyzed 1- and 3-year mortality rates
in both treatment arms of the RCT to identify patient groups that should
be targeted when implementing the screen-and-treat strategy.
METHODS: Three years after enrolment in the RCT, mortality dates of all
surgical patients were checked. One- and 3-year mortality rates were
calculated for all patients and for various subgroups.
RESULTS: After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients
had died in the mupirocin/chlorhexidine and placebo groups, respectively.
No significant differences in mortality rates were observed between the
treatment groups or the subgroups according to type of surgery. In the
subgroup of patients with clean procedures (382 cardiothoracic, 167
orthopedic, 61 vascular, and 56 other), mupirocin/chlorhexidine reduced
1-year mortality: 11 of 365 (3.0%) died in the mupirocin/chlorhexidine
versus 21 of 301 (7.0%) in the placebo group [hazard ratio = 0.38 (95% CI:
0.18-0.81)].
CONCLUSIONS: Detection and decolonization of S. aureus carriage not only
prevents S. aureus surgical-site infections but also reduces 1-year
mortality in surgical patients undergoing clean procedures. Such patients
with a high risk of developing S. aureus infections should therefore be
the primary target when implementing the screen-and-treat strategy in
clinical practice.

<7>
Accession Number
20160431790
Author
Camaro C.; Damen S.A.J.; Brouwer M.A.; Kedhi E.; Lee S.W.; Verdoia M.;
Barbieri L.; Rognoni A.; Van T'Hof A.W.J.; Ligtenberg E.; De Boer M.-J.;
Suryapranata H.; De Luca G.
Institution
(Camaro, Damen, Brouwer, De Boer, Suryapranata) Department of Cardiology,
Radboud University Medical Center, P.O. Box 9101, Nijmegen 6500 HB,
Netherlands
(Kedhi, Van T'Hof) Department of Cardiology, Isala Hospital, Zwolle,
Netherlands
(Lee) Department of Cardiology, University of Hong Kong, Queen Mary
Hospital, Hong Kong
(Verdoia, Barbieri, Rognoni, De Luca) Department of Cardiology, AOU
Maggiore della Carita, Eastern Piedmont University, Novara, Italy
(Ligtenberg) OrbusNeich Medical Inc., Fort Lauderdale, United States
Title
Randomized evaluation of short-term dual antiplatelet therapy in patients
with acute coronary syndrome treated with the COMBO dual therapy stent:
Rationale and design of the REDUCE trial.
Source
American Heart Journal. 178 (pp 37-44), 2016. Date of Publication: 01 Aug
2016.
Publisher
Mosby Inc.
Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) in
acute coronary syndrome (ACS) patients treated with drug eluting stents
(DES) is still under debate. Recent meta-analyses on <6 months versus 12
months DAPT suggest that bleeding rates can be reduced, without a higher
rate of thrombotic complications. In particular, the COMBO dual therapy
stent, being associated with early re-endothelialization, may allow for a
reduction of the duration of DAPT without increasing the thrombotic risk,
while reducing the risk of bleeding complications. Aim The aim of the
REDUCE trial is to demonstrate the non-inferiority of a combined efficacy
and safety endpoint of a short-term 3 months DAPT strategy as compared to
standard 12-month DAPT strategy in ACS patients treated with the COMBO
stent. Design A prospective, multicenter, randomized study designed to
enroll 1500 patients with ACS treated with the COMBO stent. Patients will
be randomized before discharge in a 1:1 fashion to either 3 or 12 months
of DAPT. A clinical follow-up is scheduled at 3, 6, 12, and 24 months. The
primary endpoint is the time to event as defined by the occurrence of one
of the following: all cause mortality, myocardial infarction, stent
thrombosis, stroke, target vessel revascularization or bleeding (Bleeding
Academic Research Council type II, III and V) within 12 months. The study
has recruited patients since July 2014, and the results are expected in
2017. Summary A reduction of the DAPT duration in ACS patients after PCI
without affecting the thrombotic risk is an attractive option with regard
to the associated bleeding risk. The REDUCE trial will be the first to
investigate the efficacy and safety of a 3-month DAPT strategy compared to
a 12-month DAPT strategy in an ACS only population treated with the COMBO
stent.

<8>
Accession Number
20160433271
Author
Ahmadreza A.; Nehzat A.; Masoume M.
Institution
(Ahmadreza, Masoume) Department of Cardiology, Atherosclerosis Research
Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
Islamic Republic of
(Nehzat) Department of Echocardiography, Atherosclerosis Research Center,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic
Republic of
Title
Effect of cardiac rehabilitation on endothelial function and HbA1c in
diabetic patients with ischemic heart disease (IHD).
Source
Research Journal of Pharmaceutical, Biological and Chemical Sciences. 7
(3) (pp 2633-2636), 2016. Date of Publication: 2016.
Publisher
Research Journal of Pharmaceutical, Biological and Chemical Sciences
Abstract
Endothelial dysfunction imagined that is an independent agent that
increase mortality in patients encountered with cardiovascular events.
Diabetes mellitus is another factor that fortifies these effects. There is
not obvious evidence that cardiac rehabilitation and improve endothelial
dysfunction in non-smoker diabetic patients. We accomplished a two months
controlled trial in 53 diabetic non-smoker patients with recent history of
prior CABG or PCI, doing regular exercise as cardiac rehabilitations in 28
people of participants and others had usual care as control group, before
and after trial HbA1C and Ankle Brachial Index (ABI) was measured and mean
differences in the middle of two groups was assessed. After 24 sessions of
exercise, changes and reduction in HbA1c was significant in patients under
rehabilitation than control group, (p value = 0.002).others variable such
as METS score, ABI and HDL was decrease statically significant in
intervention group. But blood pressure, GFR and LDL was not significantly
differing between groups.

<9>
Accession Number
20160432469
Author
Weibel S.; Jokinen J.; Pace N.L.; Schnabel A.; Hollmann M.W.; Hahnenkamp
K.; Eberhart L.H.J.; Poepping D.M.; Afshari A.; Kranke P.
Institution
(Weibel, Jokinen, Schnabel, Kranke) Department of Anaesthesia and Critical
Care, University Hospitals of Wuerzburg, Oberduerrbacher Str. 6, Wuerzburg
97080, Germany
(Pace) Department of Anaesthesiology, University of Utah, Salt Lake City,
UT, United States
(Hollmann) Department of Anaesthesiology, Academic Medical Centre (AMC),
University of Amsterdam, Amsterdam, Netherlands
(Hahnenkamp) Department of Anaesthesiology, Intensive Care, Emergency and
Pain Medicine, University Medicine, Greifswald, Germany
(Eberhart) Department of Anaesthesiology and Intensive Care Medicine,
Philipps-University Marburg, Marburg, Germany
(Poepping) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Muenster, Muenster, Germany
(Afshari) Department of Anaesthesia, Juliane Marie Centre, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
Title
Efficacy and safety of intravenous lidocaine for postoperative analgesia
and recovery after surgery: A systematic review with trial sequential
analysis.
Source
British Journal of Anaesthesia. 116 (6) (pp 770-783), 2016. Date of
Publication: 19 Jun 2016.
Publisher
Oxford University Press
Abstract
Background Improvement of postoperative pain and other perioperative
outcomes remain a significant challenge and a matter of debate among
perioperative clinicians. This systematic review aims to evaluate the
effects of perioperative i.v. lidocaine infusion on postoperative pain and
recovery in patients undergoing various surgical procedures. Methods
CENTRAL, MEDLINE, EMBASE, and CINAHL databases and ClinicalTrials.gov, and
congress proceedings were searched for randomized controlled trials until
May 2014, that compared patients who did or did not receive continuous
perioperative i.v. lidocaine infusion. Results Forty-five trials (2802
participants) were included. Meta-analysis suggested that lidocaine
reduced postoperative pain (visual analogue scale, 0 to 10 cm) at 1-4 h
(MD -0.84, 95% CI -1.10 to -0.59) and at 24 h (MD -0.34, 95% CI -0.57 to
-0.11) after surgery, but not at 48 h (MD -0.22, 95% CI -0.47 to 0.03).
Subgroup analysis and trial sequential analysis suggested pain reduction
for patients undergoing laparoscopic abdominal surgery or open abdominal
surgery, but not for patients undergoing other surgeries. There was
limited evidence of positive effects of lidocaine on postoperative
gastrointestinal recovery, opioid requirements, postoperative nausea and
vomiting, and length of hospital stay. There were limited data available
on the effect of systemic lidocaine on adverse effects or surgical
complications. Quality of evidence was limited as a result of
inconsistency (heterogeneity) and indirectness (small studies).
Conclusions There is limited evidence suggesting that i.v. lidocaine may
be a useful adjuvant during general anaesthesia because of its beneficial
impact on several outcomes after surgery.

<10>
[Use Link to view the full text]
Accession Number
20160400376
Author
Zheng J.; Cheng J.; Zhang Q.; Qi C.; Wang T.; Xiao X.
Institution
(Zheng, Zhang, Qi, Wang, Xiao) Department of Endocrinology, Key Laboratory
of Endocrinology, Ministry of Health, Peking Union Medical College
Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences,
Peking Union Medical College, Wangfujing Street, Dongcheng District,
Beijing 100730, China
(Cheng) Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education and Chinese Ministry of Public Health,
Department of Cardiology, Qilu Hospital of Shandong University, Jinan,
China
Title
Association between glycosylated hemoglobin level and cardiovascular
outcomes in diabetic patients after percutaneous coronary intervention.
Source
Medicine (United States). 95 (19) (no pagination), 2016. Article Number:
e3696. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Glycosylated hemoglobin (HbA1c) is a critical measure of glycemic control,
which may be a reliable predictor of complications after percutaneous
coronary intervention (PCI). This systematic review and meta-analysis
evaluates the association between HbA1c levels and clinical outcomes in
diabetic patients after PCI. Pubmed, Embase, and Cochrane Library
databases (dated to December 2015) were screened for relevant studies.
Appropriate diabetic cases and controls, assessed using blood HbA1c
levels, were extracted, and statistical analysis was conducted using
RevMan 5.3 software. Summary odds ratios (ORs) with 95% confidence
intervals (CIs) were used to calculate the associations between HbA1c
levels and clinical outcomes in diabetic patients after PCI. Ethics review
and approval was not necessary because this systematic meta-analysis did
not involve any direct human trials or animal experiments. Eight studies
that reported HbA1c levels for a total of 3290 diabetic subjects after PCI
were included in this meta-analysis. Comprehensive integration and
analysis revealed a significant correlation between higher HbA1c levels
and the risk of target vessel revascularization progression (OR 1.36, 95%
CI 1.03-1.82) and nonfatal myocardial infarction after PCI (OR 2.47, 95%
CI 1.38-4.44). However, no significant association was found between HbA1c
levels and major adverse cardiovascular events (OR 1.02, 95% CI
0.83-1.27), all-cause mortality (OR 0.73, 95% CI 0.52-1.02), cardiac death
(OR 1.12, 95% CI 0.62-2.03), or in-stent thrombosis (OR 0.65, 95% CI
0.23-1.87) among diabetic patients after PCI. Sensitivity analysis
indicated a statistically robust result and revealed no publication bias.
Our meta-analysis demonstrated that blood HbA1c levels might be associated
with higher risks of target vessel revascularization progression and
nonfatal myocardial infarction among diabetic patients after PCI. However,
further studies with larger sample sizes are required to verify the
association.

<11>
Accession Number
20160433226
Author
Pawliszak W.; Kowalewski M.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Szwed K.A.; Borkowska A.; Kowalewski J.; Anisimowicz L.
Institution
(Pawliszak, Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Division of Ergonomics and Physical Effort, Department of
Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz,
Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton
NHS Foundation Trust, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Department of Clinical Neuropsychology, Collegium
Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Nicolaus Copernicus University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
Title
Cerebrovascular events after no-touch off-pump coronary artery bypass
grafting, conventional side-clamp off-pump coronary artery bypass, and
proximal anastomotic devices: A meta-analysis.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002802. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Off-pump coronary artery bypass (OPCAB) has been shown to
reduce the risk of neurologic complications as compared to coronary artery
bypass grafting performed with cardiopulmonary bypass. Side-clamping of
the aorta while constructing proximal anastomoses, however, still carries
substantial risk of cerebral embolization. We aimed to perform a
comprehensive meta-analysis of studies assessing 2 clampless techniques:
aortic "no-touch" and proximal anastomosis devices (PAD) for OPCAB.
Methods and Results--PubMed, CINAHL, CENTRAL, and Google Scholar databases
were screened for randomized controlled trials and observational studies
comparing "no-touch" and/or PAD with side-clamp OPCAB and reporting
short-term (=30 days) outcomes: cerebrovascular accident and all-cause
mortality. A total of 18 studies (3 randomized controlled trials)
enrolling 25 163 patients were included. Aortic "no-touch" was associated
with statistically lower risk of cerebrovascular accident as compared to
side-clamp OPCAB: risk ratio 95% CI: 0.41 (0.27-0.61); P<0.01; I2=0%.
Event rates were 0.36% and 1.28% for "no-touch" and sideclamp OPCAB,
respectively. No difference was seen between PAD and side-clamp OPCAB:
0.71 (0.33-1.55); P=0.39; I2=39%. A trend towards increased 30-day
all-cause mortality with PAD and no difference with "no-touch" were
observed when compared to side-clamp OPCAB. In a subset analysis,
"no-touch" consistently reduced the risk of cerebrovascular accident
regardless of patients' baseline risk characteristics. A benefit with PAD
was observed in low-risk patients. Conclusions--Aortic "no-touch"
technique was associated with nearly 60% lower risk of postoperative
cerebrovascular events as compared to conventional side-clamp OPCAB with
effect consistent across patients at different risk.

<12>
Accession Number
20160416160
Author
Kanamori H.; Weber D.J.; Rutala W.A.
Institution
(Kanamori, Weber, Rutala) Division of Infectious Diseases, University of
North Carolina, School of Medicine, 101 Manning Drive, Chapel Hill, NC
27514, United States
(Kanamori, Weber, Rutala) Hospital Epidemiology, University of North
Carolina Health Care, Chapel Hill, NC, United States
Title
Healthcare outbreaks associated with a water reservoir and infection
prevention strategies.
Source
Clinical Infectious Diseases. 62 (11) (pp 1423-1435), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Oxford University Press
Abstract
Hospital water may serve as a reservoir of healthcare-associated
pathogens, and contaminated water can lead to outbreaks and severe
infections. The clinical features of waterborne outbreaks and infections
as well as prevention strategies and control measures are reviewed. The
common waterborne pathogens were bacteria, including Legionella and other
gram-negative bacteria, and nontuberculous mycobacteria, although fungi
and viruses were occasionally described. These pathogens caused a variety
of infections, including bacteremia and invasive and disseminated
diseases, particularly among immunocompromised hosts and critically ill
adults as well as neonates. Waterborne outbreaks occurred in healthcare
settings with emergence of new reported reservoirs, including electronic
faucets (Pseudomonas aeruginosa and Legionella), decorative water wall
fountains (Legionella), and heater-cooler devices used in cardiac surgery
(Mycobacterium chimaera). Advanced molecular techniques are useful for
achieving a better understanding of reservoirs and transmission pathways
of waterborne pathogens. Developing prevention strategies based on water
reservoirs provides a practical approach for healthcare personnel.

<13>
Accession Number
20160429943
Author
Stonier T.; Harrison M.; Choong A.M.T.L.
Institution
(Stonier) Royal Free Hospital, London, United Kingdom
(Stonier) University College London, School of Medicine, London, United
Kingdom
(Harrison) Deparment of Cardiology, Hammersmith Hospital, London, United
Kingdom
(Harrison) Imperial College School of Medicine, London, United Kingdom
(Choong) Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Level 9, 1E Kent Ridge Road, Singapore 119228,
Singapore
(Choong) School of Medicine, University of Queensland, Brisbane, QLD,
Australia
(Choong) School of Medicine, Griffith University, Gold Coast, QLD,
Australia
Title
A systematic review of transcatheter aortic valve implantation via carotid
artery access.
Source
International Journal of Cardiology. 219 (pp 41-55), 2016. Date of
Publication: 15 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The carotid artery is a novel access route for transcatheter
aortic valve implantation (TAVI). This may represent a viable alternative
in patients unsuitable for TAVI via traditional transfemoral access, up to
20%, as well as other access routes such as subclavian, transapical and
aortic. This systematic review summarises the current evidence for its
safety and feasibility. Methods A systematic review was conducted as per
the Preferred Reporting Instructions for Systematic Reviews and
Meta-analysis (PRISMA) guidelines using five electronic databases. Results
16 studies were identified, including three prospective cohort studies,
one retrospective cohort study, three case series and eight case reports.
Data on 74 patients (mean age 76.9 years) was extracted including
pre-operative work-up, technical procedure details and outcomes. This
found 1 intraoperative death, 2 further deaths within 30 days, two
incidences of transient ischaemic attack, no incidences of stroke,
myocardial infarction, carotid access site complications or infection, 1
patient required new dialysis and 1 patient had an intraoperative
dissection which resolved. Follow-up from 30 days to 1 year showed
symptomatic improvement and echocardiographic improvement in line with
those seen in transfemoral TAVI. Conclusions The available data on TAVI
via carotid access demonstrate technical feasibility with comparable
outcomes to other traditional access routes. A low number of patients,
heterogeneous clinical endpoints and relatively short follow-up periods
limit formal meta-analysis and firmer conclusions. For patients in which
other access routes are impossible, TAVI via carotid access represents a
viable and potentially crucial alternative in patients who might otherwise
be untreatable.

<14>
Accession Number
20160428046
Author
Liu Y.; Li P.; Cheng X.; Yu W.; Yang L.; Zhu H.
Institution
(Liu, Li, Cheng, Yu, Yang, Zhu) Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200127, China
Title
Plasma MicroRNA-21 Predicts Postoperative Pulmonary Complications in
Patients Undergoing Pneumoresection.
Source
Mediators of Inflammation. 2016 (no pagination), 2016. Article Number:
3591934. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Postoperative pulmonary complication (PPC) remains the most common
postoperative complication in patients undergoing noncardiac thoracic
surgery. We conducted the clinical study to determine the diagnostic role
of miRNA-21 in noncardiac thoracic surgery. 368 patients undergoing
noncardiac thoracic surgery were recruited. Blood samples were collected
before anesthesia and 2 hours after incision during surgery for RT-PCR
measurement of miRNA-21. PPC occurrence, extrapulmonary complications,
duration of ICU stay, and death within 1 year were evaluated. The overall
rate of PPCs following surgery was 10.32%. A high relative miRNA-21 level
was an independent risk factor for PPCs within 7 days (OR, 2.69; 95% CI,
1.25-5.66; and P<0.001). High miRNA-21 was also associated with an
increased risk of extrapulmonary complications (OR, 3.62; 95% CI,
2.26-5.81; and P<0.001), prolonged ICU stay (OR, 6.54; 95% CI, 2.26-18.19;
and P<0.001), increased death within 30 days (OR, 6.17; 95% CI,
2.11-18.08; and P<0.001), and death within 1 year (OR, 7.30; 95% CI,
2.76-19.28; and P<0.001). In summary, plasma miRNA-21 may serve as a novel
biomarker of PPCs for patients undergoing noncardiac thoracic surgery.

<15>
Accession Number
20160423206
Author
Nigwekar S.U.; Kang A.; Zoungas S.; Cass A.; Gallagher M.P.; Kulshrestha
S.; Navaneethan S.D.; Perkovic V.; Strippoli G.F.M.; Jardine M.J.
Institution
(Nigwekar) Harvard Medical School, Division of Nephrology, Massachusetts
General Hospital, Boston, MA, United States
(Kang) The University of Sydney, Sydney Medical School, Sydney, NSW,
Australia
(Kang, Cass, Gallagher, Perkovic, Jardine) The George Institute for Global
Health, The University of Sydney, Renal and Metabolic Division,
Camperdown, NSW, Australia
(Zoungas) Monash University, Monash Centre for Health Research and
Implementation, School of Public Health and Preventive Medicine, Clayton,
VIC, Australia
(Cass) Menzies School of Health Research, PO Box 41096, Casuarina, NT
0811, Australia
(Kulshrestha) University of Iowa Carver College of Medicine, Department of
Nephrology, 200 Hawkins Drive-T307GH, Iowa City, IA 52242, United States
(Navaneethan) Baylor College of Medicine, 1 Baylor Plaza, Houston, TX
77030, United States
(Strippoli) The Children's Hospital at Westmead, Cochrane Kidney and
Transplant, Centre for Kidney Research, Westmead, NSW 2145, Australia
(Strippoli) University of Bari, Department of Emergency and Organ
Transplantation, Bari, Italy
(Strippoli) Diaverum, Medical Scientific Office, Lund, Sweden
(Strippoli) Diaverum Academy, Bari, Italy
(Strippoli) The University of Sydney, Sydney School of Public Health,
Sydney, Australia
(Jardine) Concord Repatriation General Hospital, Department of Renal
Medicine, Hospital Road, Concord, NSW 2139, Australia
Title
Interventions for lowering plasma homocysteine levels in dialysis
patients.
Source
Cochrane Database of Systematic Reviews. 2016 (5) (no pagination), 2016.
Article Number: CD004683. Date of Publication: 31 May 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: People with end-stage kidney disease (ESKD) have high rates of
cardiovascular events. Randomised controlled trials (RCTs) of
homocysteine-lowering therapies have not shown reductions in
cardiovascular event rates in the general population. However, people with
kidney disease have higher levels of homocysteine and may have different
mechanisms of cardiovascular disease. We performed a systematic review of
the effect of homocysteine-lowering therapies in people with ESKD.
Objectives: To evaluate the benefits and harms of established homocysteine
lowering therapy (folic acid, vitamin B<inf>6</inf>, vitamin
B<inf>12</inf>) on all-cause mortality and cardiovascular event rates in
patients with ESKD. Search methods: We searched Cochrane Kidney and
Transplant's Specialised Register to 25 January 2016 through contact with
the Information Specialist using search terms relevant to this review.
Selection criteria: Studies conducted in people with ESKD that reported at
least 100 patient-years of follow-up and assessed the effect of therapies
that are known to have homocysteine-lowering properties were included.
Data collection and analysis: Two authors independently extracted data
using a standardised form. The primary outcome was cardiovascular
mortality. Secondary outcomes included all-cause mortality, incident
cardiovascular disease (fatal and nonfatal myocardial infarction and
coronary revascularisation), cerebrovascular disease (stroke and
cerebrovascular revascularisation), peripheral vascular disease (lower
limb amputation), venous thromboembolic disease (deep vein thrombosis and
pulmonary embolism), thrombosis of dialysis access, and adverse events.
The effects of homocysteine-lowering therapies on outcomes were assessed
with meta-analyses using random-effects models. Prespecified subgroup and
sensitivity analyses were conducted. Main results: We included six studies
that reported data on 2452 participants with ESKD. Interventions
investigated were folic acid with or without other vitamins (vitamin
B<inf>6</inf>, vitamin B<inf>12</inf>). Participants' mean age was 48 to
65 years, and proportions of male participants ranged from 50% to 98%.
Homocysteine-lowering therapy probably leads to little or no effect on
cardiovascular mortality (4 studies, 1186 participants: RR 0.93, 95% CI
0.70 to 1.22). There was no evidence of heterogeneity among the included
studies (I2 = 0%). Homocysteine-lowering therapy had little or no effect
on all-cause mortality or any other of this review's secondary outcomes.
All prespecified subgroup and sensitivity analyses demonstrated little or
no difference. Reported adverse events were mild and there was no increase
in the incidence of adverse events from homocysteine-lowering therapies (3
studies, 1248 participants: RR 1.12, 95% CI 0.51 to 2.47; I² =
0%). Overall, studies were assessed as being at low risk of bias and there
was no evidence of publication bias. Authors' conclusions:
Homocysteine-lowering therapies were not found to reduce mortality
(cardiovascular and all-cause) or cardiovascular events among people with
ESKD.

<16>
Accession Number
20160436259
Author
Michler R.E.; Smith P.K.; Parides M.K.; Ailawadi G.; Thourani V.;
Moskowitz A.J.; Acker M.A.; Hung J.W.; Chang H.L.; Perrault L.P.; Gillinov
A.M.; Argenziano M.; Bagiella E.; Overbey J.R.; Moquete E.G.; Gupta L.N.;
Miller M.A.; Taddei-Peters W.C.; Jeffries N.; Weisel R.D.; Rose E.A.;
Gammie J.S.; DeRose J.J.; Puskas J.D.; Dagenais F.; Burks S.G.; El-Hamamsy
I.; Milano C.A.; Atluri P.; Voisine P.; O'Gara P.T.; Gelijns A.C.
Institution
(Michler, DeRose) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
United States
(Parides, Moskowitz, Chang, Bagiella, Overbey, Moquete, Gupta, Gelijns)
International Center for Health Outcomes and Innovation Research
(InCHOIR), Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1077, New
York, NY 10029, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, Columbia University, New York, United
States
(Rose, Puskas) Department of Cardiac Surgery, Mount Sinai Health System,
New York, United States
(Smith, Milano) Division of Cardiovascular and Thoracic Surgery,
Department of Surgery, Duke University Medical Center, Durham, NC, United
States
(Ailawadi, Burks) Division of Thoracic and Cardiovascular Surgery,
University of Virginia, School of Medicine, Charlottesville, United States
(Thourani) Clinical Research Unit, Division of Cardiothoracic Surgery,
Emory University, School of Medicine, Atlanta, United States
(Acker, Atluri) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania, School of Medicine, Philadelphia, United
States
(Hung) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
(Perrault, El-Hamamsy) Montreal Heart Institute, University of Montreal,
Montreal, Canada
(Weisel) Peter Munk Cardiac Centre, Division of Cardiovascular Surgery,
Toronto General Hospital, University Health Network, Division of Cardiac
Surgery, University of Toronto, Toronto, Canada
(Dagenais, Voisine) Institut Universitaire de Cardiologie de Quebec,
Hopital Laval, Quebec, QC, Canada
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Miller, Taddei-Peters) Division of Cardiovascular Sciences, United States
(Jeffries) Office of Biostatistics Research, United States
(Gammie) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Gammie) Department of Surgery, University of Maryland Medical Center,
Baltimore, MD, United States
Title
Two-year outcomes of surgical treatment of moderate ischemic mitral
regurgitation.
Source
New England Journal of Medicine. 374 (20) (pp 1932-1941), 2016. Date of
Publication: 19 May 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: In a trial comparing coronary-artery bypass grafting (CABG)
alone with CABG plus mitral-valve repair in patients with moderate
ischemic mitral regurgitation, we found no significant difference in the
left ventricular end-systolic volume index (LVESVI) or survival after 1
year. Concomitant mitral-valve repair was associated with a reduced
prevalence of moderate or severe mitral regurgitation, but patients had
more adverse events. We now report 2-year outcomes. METHODS: We randomly
assigned 301 patients to undergo either CABG alone or the combined
procedure. Patients were followed for 2 years for clinical and
echocardiographic outcomes. RESULTS: At 2 years, the mean (+/-SD) LVESVI
was 41.2+/-20.0 ml per square meter of bodysurface area in the CABG-alone
group and 43.2+/-20.6 ml per square meter in the combined-procedure group
(mean improvement over baseline, -14.1 ml per square meter and -14.6 ml
per square meter, respectively). The rate of death was 10.6% in the
CABG-alone group and 10.0% in the combined-procedure group (hazard ratio
in the combined-procedure group, 0.90; 95% confidence interval, 0.45 to
1.83; P = 0.78). There was no significant between-group difference in the
rank-based assessment of the LVESVI (including death) at 2 years (z score,
0.38; P = 0.71). The 2-year rate of moderate or severe residual mitral
regurgitation was higher in the CABG-alone group than in the
combined-procedure group (32.3% vs. 11.2%, P<0.001). Overall rates of
hospital readmission and serious adverse events were similar in the two
groups, but neurologic events and supraventricular arrhythmias remained
more frequent in the combined-procedure group. CONCLUSIONS: In patients
with moderate ischemic mitral regurgitation undergoing CABG, the addition
of mitral-valve repair did not lead to significant differences in left
ventricular reverse remodeling at 2 years. Mitral-valve repair provided a
more durable correction of mitral regurgitation but did not significantly
improve survival or reduce overall adverse events or readmissions and was
associated with an early hazard of increased neurologic events and
supraventricular arrhythmias.

<17>
Accession Number
20160436258
Author
Gillinov A.M.; Bagiella E.; Moskowitz A.J.; Raiten J.M.; Groh M.A.;
Bowdish M.E.; Ailawadi G.; Kirkwood K.A.; Perrault L.P.; Parides M.K.;
Smith R.L.; Kern J.A.; Dussault G.; Hackmann A.E.; Jeffries N.O.; Miller
M.A.; Taddei-Peters W.C.; Rose E.A.; Weisel R.D.; Williams D.L.; Mangusan
R.F.; Argenziano M.; Moquete E.G.; O'Sullivan K.L.; Pellerin M.; Shah
K.J.; Gammie J.S.; Mayer M.L.; Voisine P.; Gelijns A.C.; O'Gara P.T.; Mack
M.J.
Institution
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, NY, United States
(Bagiella, Moskowitz, Kirkwood, Parides, Williams, Moquete, O'Sullivan,
Shah, Gelijns) International Center for Health Outcomes and Innovation
Research, Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1077, New York, NY
10029, United States
(Rose) Department of Cardiac Surgery, Mount Sinai Health System, New York,
United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, New York, United States
(Raiten) Department of Anesthesiology and Critical Care, University of
Pennsylvania, Philadelphia, United States
(Mayer) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania, School of Medicine, Philadelphia, United
States
(Groh, Mangusan) Cardiovascular and Thoracic Surgery, Mission Health and
Hospitals, Asheville, NC, United States
(Bowdish, Hackmann) Department of Surgery, Keck School of Medicine of USC,
University of Southern California, Los Angeles, United States
(Ailawadi, Kern) Division of Thoracic and Cardiovascular Surgery,
University of Virginia, School of Medicine, Charlottesville, United States
(Perrault, Pellerin) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Dussault, Voisine) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Hopital Laval, Quebec, QC, Canada
(Weisel) Peter Munk Cardiac Centre, Division of Cardiovascular Surgery,
Toronto General Hospital, University Health Network, Division of Cardiac
Surgery, University of Toronto, Toronto, Canada
(Smith, Mack) Department of Cardiovascular Surgery, Heart Hospital Baylor
Plano, Baylor Health Care System, Plano, TX, United States
(Jeffries) Office of Biostatistics Research, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Miller, Taddei-Peters) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Gammie) Department of Surgery, University of Maryland Medical Center,
Baltimore, MD, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
Title
Rate control versus rhythm control for atrial fibrillation after cardiac
surgery.
Source
New England Journal of Medicine. 374 (20) (pp 1911-1921), 2016. Date of
Publication: 19 May 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Atrial fibrillation after cardiac surgery is associated with
increased rates of death, complications, and hospitalizations. In patients
with postoperative atrial fibrillation who are in stable condition, the
best initial treatment strategy - heart-rate control or rhythm control -
remains controversial. METHODS: Patients with new-onset postoperative
atrial fibrillation were randomly assigned to undergo either rate control
or rhythm control. The primary end point was the total number of days of
hospitalization within 60 days after randomization, as assessed by the
Wilcoxon ranksum test. RESULTS: Postoperative atrial fibrillation occurred
in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of
these patients, 523 underwent randomization. The total numbers of hospital
days in the rate-control group and the rhythm-control group were similar
(median, 5.1 days and 5.0 days, respectively; P = 0.76). There were no
significant between-group differences in the rates of death (P = 0.64) or
overall serious adverse events (24.8 per 100 patient-months in the
rate-control group and 26.4 per 100 patient-months in the rhythm-control
group, P = 0.61), including thromboembolic and bleeding events. About 25%
of the patients in each group deviated from the assigned therapy, mainly
because of drug ineffectiveness (in the rate-control group) or amiodarone
side effects or adverse drug reactions (in the rhythm-control group). At
60 days, 93.8% of the patients in the rate-control group and 97.9% of
those in the rhythm-control group had had a stable heart rhythm without
atrial fibrillation for the previous 30 days (P = 0.02), and 84.2% and
86.9%, respectively, had been free from atrial fibrillation from discharge
to 60 days (P = 0.41). CONCLUSIONS: Strategies for rate control and rhythm
control to treat postoperative atrial fibrillation were associated with
equal numbers of days of hospitalization, similar complication rates, and
similarly low rates of persistent atrial fibrillation 60 days after onset.
Neither treatment strategy showed a net clinical advantage over the other.

<18>
Accession Number
20160240591
Author
Karthikesalingam A.; Holt P.J.; Thompson M.M.; Bak A.A.A.; Pattynama P.M.;
Van Voorthuisen A.E.; Grobbee D.E.; Hunink M.G.; Van Engelshoven J.M.;
Jacobs M.J.H.M.; De Mol B.A.J.M.; Van Bockel J.H.; Reekers J.; Tielbeek
X.; Boekema N.; Heuveling L.M.; Sikking I.; Cuypers P.W.M.; De Bruin J.L.;
Baas A.F.; Prinssen M.; Buth J.; Tielbeek A.V.; Blankensteijn J.D.; Balm
R.; Reekers J.A.; Van Sambeek M.R.H.M.; Pattynama P.; Verhoeven E.L.G.;
Prins T.; Van Der Ham A.C.; Van Der Velden J.J.I.M.; Van Sterkenburg
S.M.M.; Ten Haken G.B.; Bruijninckx C.M.A.; Van Overhagen H.; Tutein
Nolthenius R.P.; Hendriksz T.R.; Teijink J.A.W.; Odink H.F.; De Smet
A.A.E.A.; Vroegindeweij D.; Van Loenhout R.M.M.; Rutten M.J.; Hamming
J.F.; Lampmann L.E.H.; Bender M.H.M.; Pasmans H.; Vahl A.C.; De Vries C.;
MacKaay A.J.C.; Van Dortmont L.M.C.; Van Der Vliet A.J.; Schultze Kool
L.J.; Boomsma J.H.B.; Van H.R.; De Mol Van Otterloo J.C.A.; De Rooij
T.P.W.; Smits T.M.; Yilmaz E.N.; Wisselink W.; Van Den Berg F.G.; Visser
M.J.T.; Van Der Linden E.; Schurink G.W.H.; De Haan M.; Smeets H.J.;
Stabel P.; Van Elst F.; Poniewierski J.; Vermassen F.E.G.
Institution
(De Bruin, Blankensteijn) Division of Vascular Surgery, Department of
Surgery, VU University Medical Center, Amsterdam, Netherlands
(De Bruin, Karthikesalingam, Holt, Thompson) Division of Vascular Surgery,
St George's Vascular Institute, St George's Healthcare NHS Trust, St James
Wing, Blackshaw Rd, London SW17 0QT, United Kingdom
(Prinssen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Title
Predicting reinterventions after open and endovascular aneurysm repair
using the St George's Vascular Institute score.
Source
Journal of Vascular Surgery. 63 (6) (pp 1428-1433e1), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Mosby Inc.
Abstract
Background Identifying patients at risk for aneurysm rupture and sac
expansion after open and endovascular abdominal aortic aneurysm (AAA)
repair (EVAR) may help to attenuate this risk by intensifying follow-up
and early detection of problems. The goal of this study was to validate
the St George's Vascular Institute (SGVI) score to identify patients at
risk for a secondary intervention after elective aneurysm repair. Methods
A post hoc on-treatment analysis of a randomized trial comparing open AAA
repair and EVAR was performed. In this multicenter trial, 351 patients
were randomly assigned to undergo open AAA repair or EVAR. Information on
survival and reinterventions was available for all patients at 5 years
postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair
was completed in 173 patients and EVAR in 171, based on an on-treatment
analysis. Because 17 patients had incomplete anatomic data, 327 patients
(157 open repair and 170 EVAR) were available for analysis. During 6 years
of follow-up, 78 patients underwent at least one reintervention. The SGVI
score, which is calculated from preoperative AAA morphology using aneurysm
and iliac diameter, predictively dichotomized patients into groups at
high-risk or low-risk for a secondary intervention. The observed freedom
from reintervention was compared between groups at predicted high-risk and
predicted low-risk. Results The 20 patients in the high-risk group were
indeed at higher risk for a secondary intervention compared with the 307
patients predicted to be at low risk (hazard ratio [HR], 3.82; 95%
confidence interval [CI], 2.05-7.11; P <.001). Discrimination between
high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI,
1.93-8.51; P <.001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P
=.033). Conclusions The SGVI score appears to be a useful tool to predict
reintervention risk in patients after open repair and EVAR.

<19>
Accession Number
20160421938
Author
Landenhed M.; Cunha-Goncalves D.; Al-Rashidi F.; Pierre L.; Hoglund P.;
Koul B.
Institution
(Landenhed, Cunha-Goncalves, Al-Rashidi, Pierre, Koul) Department of
Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University
Hospital, Lund University, Lund SE-221 85, Sweden
(Hoglund) Clinical Research and Competence Center, Skane University
Hospital, Lund University, Lund, Sweden
Title
Pulmonary collapse alone provides effective de-airing in cardiac surgery:
A prospective randomized study.
Source
Perfusion (United Kingdom). 31 (4) (pp 320-326), 2015. Date of
Publication: 2015.
Publisher
SAGE Publications Ltd
Abstract
Objectives: We previously described and showed that the method for cardiac
de-airing involving: (1) bilateral, induced pulmonary collapse by opening
both pleurae and disconnecting the ventilator before cardioplegic arrest
and (2) gradual pulmonary perfusion and ventilation after cardioplegic
arrest is superior to conventional de-airing methods, including carbon
dioxide insufflation of the open mediastinum. This study investigated
whether one or both components of this method are responsible for the
effective de-airing of the heart. Methods: Twenty patients scheduled for
open, left heart surgery were randomized to two de-airing techniques: (1)
open pleurae, collapsed lungs and conventional pulmonary perfusion and
ventilation; and (2) intact pleurae, expanded lungs and gradual pulmonary
perfusion and ventilation. Results: The number of cerebral microemboli
measured by transcranial Doppler sonography was lower in patients with
open pleurae 9 (6-36) vs 65 (36-210), p=0.004. Residual intra-cardiac air
grade I or higher as monitored by transesophageal echocardiography 4-6
minutes after weaning from cardiopulmonary bypass was seen in few patients
with open pleurae 0 (0%) vs 7 (70%), p=0.002. Conclusions: Bilateral,
induced pulmonary collapse alone is the key factor for quick and effective
de-airing of the heart. Gradual pulmonary perfusion and ventilation, on
the other hand, appears to be less important.

<20>
Accession Number
20160312546
Author
Bayes-Genis A.; Gastelurrutia P.; Camara M.-L.; Teis A.; Lupon J.; Llibre
C.; Zamora E.; Alomar X.; Ruyra X.; Roura S.; Revilla A.; San Roman J.A.;
Galvez-Monton C.
Institution
(Bayes-Genis, Teis, Lupon, Llibre, Zamora) Cardiology Service, Germans
Trias i Pujol University Hospital, Badalona, Spain
(Bayes-Genis, Lupon) Department of Medicine, Universitat Autonoma de
Barcelona, Barcelona, Spain
(Bayes-Genis, Gastelurrutia, Roura, Galvez-Monton) ICREC Research Program,
Health Science Research Institute Germans Trias i Pujol, Badalona, Spain
(Camara, Ruyra) Cardiac Surgery Service, Germans Trias i Pujol University
Hospital, Badalona, Spain
(Teis, Alomar) Clinica Creu Blanca, Barcelona, Spain
(Roura) Center of Regenerative Medicine in Barcelona, Barcelona, Spain
(Revilla, San Roman) ICICORELAB, Clinic University Hospital, Valladolid,
Spain
Title
First-in-man Safety and Efficacy of the Adipose Graft Transposition
Procedure (AGTP) in Patients With a Myocardial Scar.
Source
EBioMedicine. 7 (pp 248-254), 2016. Date of Publication: 01 May 2016.
Publisher
Elsevier
Abstract
Background: The present study evaluates the safety and efficacy of the
Adipose Graft Transposition Procedure (AGTP) as a biological regenerative
innovation for patients with a chronic myocardial scar. Methods: This
prospective, randomized single-center controlled study included 10
patients with established chronic transmural myocardial scars. Candidates
for myocardial revascularization were randomly allocated into two
treatment groups. In the control arm (n = 5), the revascularizable area
was treated with CABG and the non-revascularizable area was left
untouched. Patients in the AGTP-treated arm (n = 5) were treated with CABG
and the non-revascularizable area was covered by a biological adipose
graft. The primary endpoint was the appearance of adverse effects derived
from the procedure including hospital admissions and death, and 24-hour
Holter monitoring arrhythmias at baseline, 1 week, and 3 and 12 months.
Secondary endpoints of efficacy were assessed by cardiac MRI. Findings: No
differences in safety were observed between groups in terms of clinical or
arrhythmic events. On follow-up MRI testing, participants in the
AGTP-treated arm showed a borderline smaller left ventricular end systolic
volume (LVESV; p = 0.09) and necrosis ratio (p = 0.06) at 3 months but not
at 12 months. The AGTP-treated patient with the largest necrotic area and
most dilated chambers experienced a noted improvement in necrotic mass
size (- 10.8%), and ventricular volumes (LVEDV: - 55.2 mL and LVESV: -
37.8 mL at one year follow-up) after inferior AGTP. Interpretation: Our
results indicate that AGTP is safe and may be efficacious in selected
patients. Further studies are needed to assess its clinical value.
(ClinicalTrials.org NCT01473433, AdiFlap Trial).

<21>
Accession Number
72314050
Author
Lowres N.; Mulcahy G.; Freedman S.B.; Jin K.; Neubeck L.
Institution
(Lowres, Mulcahy, Jin, Neubeck) Sydney Nursing School, Sydney, Australia
(Freedman) Faculty of Medicine, University of Sydney, Sydney, Australia
Title
Screening for recurrence of new-onset post-operative atrial fibrillation:
A systematic review and meta-analysis.
Source
Global Heart. Conference: World Congress of Cardiology Scientific Sessions
2016, WCC 2016 Mexico City Mexico. Conference Start: 20160604 Conference
End: 20160607. Conference Publication: (var.pagings). 11 (2 SUPPL. 1) (pp
e101), 2016. Date of Publication: June 2016.
Publisher
Elsevier
Abstract
Introduction: Post-operative atrial fibrillation (POAF) is associated with
increased mortality and risk of stroke post-discharge. POAF is often
thought to be transient, however recurrence is likely under-recognized as
symptoms are an unreliable guide. Surveillance post-discharge may identify
asymptomatic recurrences of AF. Objectives: Determine the recurrence of
POAF identified through post-discharge screening, in cardiac surgery
patients with new-onset POAF discharged in stable sinus rhythm. Methods: A
systematic review and meta-analysis of studies investigating POAF
recurrence post-discharge, in patients with new-onset POAF who reverted to
sinus rhythm prior to discharge. Two independent reviewers searched
medical databases (MEDLINE, EMBASE, and Cochrane Library); clinical trials
registries; reference lists; and the internet, using predetermined search
terms to identify relevant articles. The primary outcome was recurrence of
POAF post-discharge. Results: 5,638 studies were screened, 47 full
manuscripts reviewed, and 7 unique studies identified (n=1,136
participants; mean age 66 years; 73% male). Inter-rater agreement was k
0.47 (CI, 0.28-0.66) for study selection stage one and k 0.78 (CI, 0.58-
0.98) for stage two. Monitoring methods varied widely, including:
telemetry during twice daily exercise sessions (n=2); continuous telemetry
for 3 weeks (n=1); daily 20-second ECG using wearable event recorder
(n=1); 30-second single lead ECG, 4x/day (n=1); and implanted continuous
monitoring (n=1). Incidence of POAF recurrence post-discharge was 30.1%
(CI, 23.8-37.2%): Incidence varied depending on monitoring mode: extended
telemetry monitoring identified 32-38%; implanted continuous monitoring
identified 100% (9/9 patients); and intermittent brief recordings
identified 23-26%. POAF recurred 12+/-5 days (mean+/-SD) post-surgery, and
40-69% of episodes were asymptomatic. In the one study reporting stroke
risk, 80% of patients with recurrent AF had
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >2, an indication for prescribing
oral anticoagulation for stroke prevention. Conclusion: Monitoring for
POAF recurrence after hospital discharge, can identify significant numbers
of asymptomatic recurrences in patients who are at high risk of stroke and
may benefit from early detection of POAF recurrence and anticoagulation
for stroke prevention. More intense monitoring is more likely to identify
POAF recurrence.

<22>
Accession Number
72312438
Author
Anonymous
Title
ISPOR 21st Annual International Meeting Research Abstracts.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(no pagination), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
The proceedings contain 1758 papers. The topics discussed include: return
on investment of a digital lifestyle management program in a medicare
population; assessing prescription drug value in the United States: a
hypothetical example comparing Asco And Icer framework outcomes;
estimating the costs of supporting safety-net transformation into patient
-centered medical homes in post-Katrina New Orleans; comparative
effectiveness of coronary artery bypass grafting versus percutaneous
coronary intervention among elderly medicare beneficiaries in terms of
cost and resource use; Bayesian network meta -analysis to assess
comparative effectiveness of beta -blockers in patients with heart failure
and reduced ejection fraction; comparative cost and resource utilization
in hospitalized patients treated with unfractionated heparin monitored by
anti-XA or APTT; and analysis of indication expansions for
orphan-designated, FDA-approved drugs launched in the United States
between 2005 and 2015.

<23>
Accession Number
72312397
Author
Valls Palleja M.; Almazan Del Castillo R.; Fernandez Soto J.R.; Gay Molina
J.G.; Zanela O.O.; Cabra H.A.; Sosa C.; Sanchez D.
Institution
(Valls Palleja) T.I. Salud, Mexico DF, Mexico
(Almazan Del Castillo, Fernandez Soto, Gay Molina) TI-Salud, Mexico DF,
Mexico
(Zanela, Cabra, Sosa, Sanchez) Johnson and Johnson Medical, Mexico DF,
Mexico
Title
Systematic revision and meta-analysis of gelatin-thrombin hemostatic
matrices for bleeding control.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(pp A311), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Achieving hemostasis in surgical procedures is critical to
prevent surgical bleeding progression, its associated complications and
consequent additional hospital resource utilization. Gelatin-thrombin
matrices (SurgifloTM & FlosealTM) are well-known products indicated as
adjuncts to achieve hemostasis, with proven safety and efficacy in several
types of surgeries. The objective of this study was to perform a
systematic review and a meta-analysis to assess and compare safety,
effectiveness and additional outcomes of SurgifloTM & FlosealTM hemostatic
matrices for bleeding control during surgical procedures. Methods: A
systematic search of PubMed, Science Direct, Cochrane Library, Google
Scholar and Medigraphic for published literature comparing both hemostatic
matrices was conducted using the following key words: "Surgiflo",
"Floseal", "gelatin thrombin matrix", "metaanalysis", "clinical trial" and
"systematic review". Inclusion criteria included RCTs and retrospective
analyses comparing hemostatic matrices in procedures with high risk of
surgical bleeding. For all relevant discrete outcomes (mayor & minor
complications, blood transfusion, % patients achieving hemostasis < 7
minutes), cumulative incidences and 95% CIs were estimated; for continuous
outcomes (surgical time & length of stay), differences in means were
evaluated. Results were pooled across studies by means of random- or
fixed-effects models, depending on observed heterogeneity by means of the
I2 statistic. All statistical analyses were performed with RevMan v.5.3.
Results: 193 studies were identified; only six studies met inclusion
criteria (39,660 patients undergoing cranial & spinal procedures,
laparoscopic nephrectomy and cardiac surgery). Forest plots were
elaborated for all assessed outcomes; results demonstrate there are no
statistically significant differences between evaluated hemostatic
matrices in any of the considered outcomes. Substantial (> 50%) and small
(< 25%) heterogeneity was observed. Conclusions: According to the results
of this study, both hemostatic matrices are similar in terms of
effectiveness, safety and other outcomes. Therefore, both technologies
could be used indistinctly for any surgical procedure, with product choice
having no impact on clinical outcomes.

<24>
Accession Number
72312328
Author
Boissonnet C.P.; Giorgi M.; Thierer J.; Guetta J.N.; Giglio N.; Micone P.;
Gonzalez C.D.
Institution
(Boissonnet, Giorgi, Thierer, Guetta, Micone, Gonzalez) Intituto
Universitario CEMIC, Buenos Aires, Argentina
(Giglio) Hospital De Ninos Ricardo Gutierrez Ciudad De Buenos Aires
Argentina, Buenos Aires, Argentina
Title
Transcatheter aortic valve replacement in south-America: A meta-analysis
of real-life outcomes.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(pp A298-A299), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: TAVR consists in the replacement of a dysfunctional aortic
valve (mostly due to severe aortic stenosis) using a percutaneously
implanted device. Its use is worldwide accepted as an alternative to
surgical valve replacement and it has been available in South America
since 2008. In order to know the clinical outcomes of this technology in a
real-life setting we conducted this meta-analysis of data from this
region. Methods: a systematic literature search of both abstracts
(presented in regional and national scientific sessions) and published
papers reporting clinical outcomes since 2008 to 2015 were conducted. We
identify cohorts from South America that fulfill the inclusion criteria.
The primary endpoint was procedure success defined by the Valve Academic
Research Consortium (VARC2) criteria. All outcomes were assessed during
hospitalization and at 30 days. We tested for between-study heterogeneity
using Cochrane's Q and I2 statistic; given that most analysis yield high
heterogeneity (p < 0.05 or I2> 50%) we used a random-effects model to
calculate the pooled estimates. Results: Twenty seven cohorts comprising
1156 patients were included in the meta-analysis. Regarding the devices
implanted, 12 studies used only Core Valve, 1 study only Inovare and 1
study only SAPIEN. Procedure success was 86.9% (95CI 81.8% -90.8%; I2 71%
p< 0.001) using VARC2 criteria. In-hospital complications were: moderate
or severe aortic regurgitation 7.2% (95CI 3.6%-13.7%; I2 76% p< 0.001),
in-hospital mortality 8.1% (95CI 5.8%-11.1%; I236% p< 0.049), in-hospital
stroke 3.5% (95CI 2.1%-5.7%; I2 0% p< 0.99), permanent pacemaker
implantation 23.0% (95CI 18.4%-28.4%; I2 56% p= 0.0001), 30-day mortality
12.5% (95CI 10.2%-15.3%; I2 6% p< 0.38). Conclusions: this study provides
a real life benchmark for the performance of this technology in the
region. In general terms, clinical results are similar to those reported
in the literature. We observed a great heterogeneity possibly due to the
disparity of populations included, learning curve and reporting biases.

<25>
Accession Number
72310941
Author
Ariyaratne T.; Ademi Z.; Huq M.; Duffy S.; Billah B.; Rosenfeldt F.;
Parkinson B.; Yap C.; Yan B.; Smith J.; Brennan A.; Tran L.; Reid C.
Institution
(Ariyaratne, Billah, Brennan, Tran, Reid) Monash University, Melbourne,
Australia
(Ademi) University of Basel, Basel, Australia
(Huq) University of Melbourne, Melbourne, Australia
(Duffy, Rosenfeldt) Alfred Hospital, Melbourne, Australia
(Parkinson) Macquarie University, Sydney, Australia
(Yap) Geelong Hospital, Geelong, Australia
(Yan) Chinese University of Hong Kong, Shatin, Hong Kong
(Smith) Monash Medical Centre, Melbourne, Australia
Title
The real-world cost-effectiveness of coronary artery bypass grafting
versus stenting in high-risk patients: Propensity score analysis of a
single centre experience.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(pp A48), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: To-date, several studies have evaluated the cost-effectiveness
of coronary artery bypass grafting surgery (CABG) surgery versus
percutaneous coronary intervention (PCI) using data from randomised
controlled trials. This study will investigate the real-world
cost-effectiveness of CABG compared with PCI with stents in high-risk
patients with multi-vessel coronary artery disease (MVCAD). An Australian
public hospital payer perspective will be adopted. Methods: Data for 3508
patients (CABG: N= 1,440; PCI:N= 2,068 ) admitted to a major metropolitan
hospital was obtained from two clinical registries, the Melbourne
Interventional Group (MIG) and the Australian & New Zealand Society of
Cardiac & Thoracic Surgeons (ANZSCTS). Hospital readmissions and related
patient-level costs were obtained for the period of June 2009 to December
2014, from the same institution. The maximum follow-up period was five
years. Adjustments for inflation and discounting will be performed over
this period. Propensity score matching through the Nearest Neighbour
technique will be used to balance the characteristics between the
treatment (CABG) and comparator (PCI) groups. The primary and secondary
measures of effectiveness will be major adverse cerebrovascular and
cardiac events (MACCE), and mortality, respectively. The incremental
cost-effectiveness ratios (ICERs) per MACCE avoided, and life years gained
will be evaluated. Propensity score bin bootstrapping (PSBB) will be
performed to further validate the results. Results: Although several
limitations apply to this analysis, we expect results to be similar to
existing literature, which favours CABG compared with PCI with stents in
the medium to long term. We expect highly favourable ICERs for CABG in
sub-groups of patients at highest risk of complications. Conclusions: This
study will reveal the cost-effectiveness of CABG compared with PCI using
real-world data and new propensity score techniques.

<26>
Accession Number
72310922
Author
Avdeyev A.; Mendykulov S.; Tabarov A.; Sharip B.; Zhanabekova L.;
Gizatullina A.
Institution
(Avdeyev, Mendykulov, Tabarov, Sharip, Zhanabekova, Gizatullina) Hospital
of the Medical Center of the President's Affairs Administration, Astana,
Kazakhstan
Title
Simultaneous coronary artery bypass grafting and carotid endarterectomy.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(pp A44), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Simultaneous coronary artery bypass grafting and carotid
endarterectomy (CABG/CEA) includes two different surgical operations doing
by two teams of operating surgeons during one anaesthetic support.
Patients with concomitant coronary and carotid artery disease stay in
group of high risk of perioperative acute stroke and myocardial
infarction, and therefore conducting of simultaneous CABG/CEA can reduce
the incidence of late myocardial infarction and postoperative stroke in
this group of patients and can improve survival in the long-term period.
This research aim is to evaluate clinical and economic effectiveness of
simultaneous CABG/CEA compared with conducting these surgical operations
separately. Methods: For opportunity to evaluate clinical effectiveness,
safety and economic effectiveness of simultaneous CABG/CEA the systematic
literature search was conducted in databases of evidence-based medicine
named MEDLINE, Tripdatabase, CADTH, Embase, NICE, The Cochrane Library,
Clinical Trials. Types of articles: systematic review, meta-analysis,
review, randomized controlled trial (RCT). Publication date: no later than
5 years (since 2010). Results: As a result of systematic search we found
one systematic review, 3 guidelines, 3 RCTs, 2 reviews confirming clinical
effectiveness and safety of simultaneous CABG/CEA 1) in patients with
hemodynamically significant carotid stenosis (> 70%) directed to coronary
artery bypass grafting; 2) in patients with hemodynamically significant
stenosis of the coronary arteries (> 50%) directed to carotid
revascularization. From the side of cost-effectiveness conducting
simultaneous CABG/CEA can reduce costs for 1 patient treatment by a mean
of 10.8% due to 1) reducing duration of hospital stay and postoperative
rehabilitation; 2) no need for additional anaesthetic support; 3)
decreasing in incidence of post-operative heart attacks or strokes in
patients with concomitant coronary and carotid artery diseases.
Conclusions: Simultaneous coronary artery bypass grafting and carotid
endarterectomy has advantages in clinical and economic effectiveness over
conducting these surgical operations separately for treatment of patients
with hemodynamically significant concomitant stenosis of coronary and
carotid arteries.

<27>
Accession Number
72310917
Author
Alexander G.C.; Iyer G.; Lucas E.; Lin D.; Singh S.
Institution
(Alexander, Iyer, Lucas, Lin) Johns Hopkins Bloomberg School of Public
Health, Center for Drug Safety and Effectiveness, Baltimore, MD, United
States
(Singh) Johns Hopkins University, School of Medicine, Baltimore, MD,
United States
Title
Cardiovascular risks of exogenous testosterone use among men: A systematic
review and meta-analysis.
Source
Value in Health. Conference: ISPOR 21st Annual International Meeting
Research Washington, DC United States. Conference Start: 20160521
Conference End: 20160525. Conference Publication: (var.pagings). 19 (3)
(pp A43), 2016. Date of Publication: May 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Exogenous testosterone products are widely used for symptoms
of hypogonadism. Their cardiovascular safety remains uncertain. We
evaluated whether exogenous testosterone therapy is associated with
serious cardiovascular events. Methods: We searched Pubmed, MEDLINE,
EMBASE, Cochrane Collaboration Clinical Trials, clinicaltrials.gov, and
the US Food and Drug Administration website, through August 28, 2015.
Randomized controlled trials (RCTs) and observational studies which
enrolled men > 18 years receiving testosterone for > 3 days were included.
Two reviewers independently conducted all stages of review, with
adjudication by a third reviewer when necessary. The primary outcomes were
death due to all causes, myocardial infarction, and stroke. Secondary
outcomes included heart failure, arrhythmia, and cardiac procedures. The
risk of bias of RCTs and observational studies was evaluated using the
Cochrane Collaboration tool and the Newcastle and Ottawa scale,
respectively. The Peto odds ratio was used for meta-analysis. PROSPERO
(#CRD42015019259). Results: A total of 39 RCTs and 10 observational
studies were included. Meta-analysis was conducted on 30 RCTs. Compared to
placebo, exogenous testosterone treatment did not show any statistically
significant increase in risk of myocardial infarction (odds ratio [OR]
0.87, 95% confidence interval [CI] 0.39-1.93, 16 RCTs), stroke (OR 2.17,
CI 0.63-7.54, 9 RCTs) or mortality (OR 0.88, CI 0.55-1.41, 20 RCTs).
Sensitivity analysis showed similar results. The design and methodology of
the studies were poorly reported. Observational studies showed conflicting
results with marked clinical and methodological heterogeneity.
Conclusions: We did not find any significant association between exogenous
testosterone treatment and myocardial infarction, stroke or mortality,
although the evidence was imprecise. Our results may differ from previous
reviews because of choice of outcomes and analytic approaches used. The
low quality of the evidence precludes definitive conclusion.