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<1>
Accession Number
2015864213
Author
Hong S.J.; Choi S.C.; Cho J.Y.; Joo H.J.; Park J.H.; Yu C.W.; Lim D.-S.
Institution
(Hong, Choi, Cho, Joo, Park, Yu, Lim) Department of Cardiology,
Cardiovascular Center, Korea University Anam Hospital, Seoul, South Korea
Title
Pioglitazone increases circulating microRNA-24 with decrease in coronary
neointimal hyperplasia in type 2 diabetic patients: Optical coherence
tomography analysis.
Source
Circulation Journal. 79 (4) (pp 880-888), 2015. Date of Publication: 2015.
Publisher
Japanese Circulation Society
Abstract
Background: Aberrant expression of microRNAs is associated with neointimal
hyperplasia (NIH) in type 2 diabetes. We prospectively compared the
effects of pioglitazone on coronary NIH and changes in microRNAs according
to NIH status in type 2 diabetic patients during 9-month follow-up.
Methods and Results: Type 2 diabetic patients were randomly assigned to
the pioglitazone (n=36) or control groups (n=36) after coronary stenting.
Primary endpoint was the comparison of changes in neointimal volume on OCT
and in the level of circulating microRNA-17,-24,-92a,-126 and -145 during
9-month follow-up. Secondary endpoint was the comparison of changes in
brachial artery flow-mediated dilation and inflammatory markers such as
IL-6, TNF-alpha, hsCRP, adiponectin, sICAM-1, and sVCAM-1 between the 2
groups. Neointimal volume was significantly lower in the pioglitazone
group (25.02+/-17.78 mm3 vs. 55.10+/-30.01 mm3, P<0.001) with significant
increases in circulating microRNA-24 (0.264+/-0.084 vs. 0.006+/-0.030,
P<0.001) during follow-up. FMD was significantly greater in the
pioglitazone than control group at 9 months (0.47+/-0.14 mm vs.
0.28+/-0.18 mm, P<0.05, respectively). Decreases in inflammatory markers
such as IL-6, TNF-alpha, and sVCAM-1 were significantly greater in the
pioglitazone than the control group during the follow-up. Conclusions:
Pioglitazone significantly decreased NIH with increases in circulating
microRNA-24 at 9-month followup. The decrease in microRNA-24 could be used
as a potential predictor of increases in NIH in type 2 diabetic patients.

<2>
Accession Number
2015829142
Author
Zarea K.; Maghsoudi S.; Dashtebozorgi B.; Hghighizadeh M.H.; Javadi M.
Institution
(Zarea, Dashtebozorgi) Chronic Disease Care Research Center, Nursing and
Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Maghsoudi) Alzahra Heart Charity Hospital, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Hghighizadeh) School of Health, Ahvaz Jundishapur University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Javadi) Research Center for Nursing and Midwifery Care in Family Health,
School of Nursing and Midwifery, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
Title
The impact of Peplau's therapeutic communication model on anxiety and
depression in patients candidate for coronary artery bypass.
Source
Clinical Practice and Epidemiology in Mental Health. 10 (1) (pp 159-165),
2014. Date of Publication: 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background and Objective: Anxiety and depression are among the
psychological disorders in heart surgeries. Establishing a simple
communication is essential to reduce anxiety and depression. Hence, the
objective of the present studywas to examine the impact of Peplau
therapeutic communication model on anxiety and depression in patients, who
were candidate for coronary artery bypass in Al-Zahra Heart Hospital,
Shiraz during 2012-2013. Methods: This is a clinical trial in which 74
patients were randomly divided into intervention and control groups, each
consisted of 37 patients. Anxiety and depression levels were assessed
before, and two and four months after intervention using the Hospital
Anxiety and Depression Scale (HADS). Seven therapeutic communication
sessions were held in four stages. Data were analyzed with the SPSS
(version 16) using analysis of covariance. Results: The mean anxiety and
depression levels decreased in the intervention group after the
therapeutic communication (p<0.01). Anxiety scores in the intervention
group before and after intervention were 10.23 and 9.38, respectively.
While the corresponding scores in the control group were 10.26 and 11.62,
respectively. Depression scores in the intervention group before and after
intervention were 11 and 9.13, respectively. The corresponding scores in
the control group were 11.30 and 12.08, respectively. Conclusion: The
results demonstrated the positive role of therapeutic communication in
reducing anxiety and depression of the patients. Therefore, the
therapeutic communication is recommended as a simple, cost effective and
efficient method in this area.

<3>
Accession Number
26903039
Author
Kodali S.; Williams M.R.; Doshi D.; Hahn R.T.; Humphries K.H.; Nkomo V.T.;
Cohen D.J.; Douglas P.S.; Mack M.; Xu K.; Svensson L.; Thourani V.H.;
Tuzcu E.M.; Weissman N.J.; Leon M.; Kirtane A.J.
Title
Sex-Specific Differences at Presentation and Outcomes Among Patients
Undergoing Transcatheter Aortic Valve Replacement: A Cohort Study.
Source
Annals of internal medicine. 164 (6) (pp 377-384), 2016. Date of
Publication: 15 Mar 2016.
Abstract
BACKGROUND: Female sex is associated with poorer outcomes after surgical
aortic valve replacement (SAVR). Data on sex-specific differences after
transcatheter aortic valve replacement (TAVR) are conflicting.
OBJECTIVE: To examine sex-specific differences in patients undergoing TAVR
in the PARTNER (Placement of Aortic Transcatheter Valves) trial.
DESIGN: Secondary analysis of the randomized and nonrandomized portions of
the PARTNER trial. (ClinicalTrials.gov: NCT00530894).
SETTING: 25 hospitals in the United States, Canada, and Germany.
PATIENTS: High-risk and inoperable patients (1220 women and 1339
men).TAVR.
MEASUREMENTS: Demographic characteristics, cardiac and noncardiac
comorbidities, mortality, stroke, rehospitalization, vascular
complications, bleeding complications, and echocardiographic valve
parameters.
RESULTS: At baseline, women had lower rates of hyperlipidemia, diabetes,
smoking, and renal disease but higher Society of Thoracic Surgeons
Predicted Risk of Mortality scores (11.9% vs. 11.1%; P < 0.001). After
TAVR, women had more vascular complications (17.3% vs. 10.0%; difference,
7.29 percentage points [95% CI, 4.63 to 9.95 percentage points]; P <
0.001) and major bleeding (10.5% vs. 7.7%; difference, 2.8 percentage
points [CI, 0.57 to 5.04 percentage points]; P = 0.012) but less frequent
moderate and severe paravalvular regurgitation (6.0% vs. 14.3%;
difference, -8.3 percentage points [CI, -11.7 to -5.0 percentage points];
P < 0.001). At 30 days, the unadjusted all-cause mortality rate (6.5% vs.
5.9%; difference, 0.6 percentage point [CI, -1.29 to 2.45 percentage
points]; P = 0.52) and stroke incidence (3.8% vs. 3.0%; difference, 0.8
percentage point [CI, -0.62 to 2.19 percentage points]; P = 0.28) were
similar. At 1 year, all-cause mortality was significantly lower in women
than in men (19.0% vs. 25.9%; hazard ratio, 0.72 [CI, 0.61 to 0.85]; P <
0.001).
LIMITATION: Secondary analysis that included nonrandomized trial data.
CONCLUSION: Despite a higher incidence of vascular and bleeding
complications, women having TAVR had lower mortality than men at 1 year.
Thus, sex-specific risk in TAVR is the opposite of that in SAVR, for which
female sex has been shown to be independently associated with an adverse
prognosis.
PRIMARY FUNDING SOURCE: Edwards Lifesciences.

<4>
Accession Number
27092951
Author
Marti-Carvajal A.J.; Dayer M.; Conterno L.O.; Gonzalez Garay A.G.;
Marti-Amarista C.E.; Simancas-Racines D.
Institution
(Marti-Carvajal, Dayer, Conterno, Gonzalez Garay, Marti-Amarista,
Simancas-Racines) Iberoamerican Cochrane Network, Valencia, Venezuela
Title
A comparison of different antibiotic regimens for the treatment of
infective endocarditis.
Source
The Cochrane database of systematic reviews. 4 (pp CD009880), 2016. Date
of Publication: 2016.
Abstract
BACKGROUND: Infective endocarditis is a microbial infection of the
endocardial surface of the heart. Antibiotics are the cornerstone of
treatment, but their use is not standardised, due to the differences in
presentation, populations affected and the wide variety of micro-organisms
that can be responsible.
OBJECTIVES: To assess the existing evidence about the clinical benefits
and harms of different antibiotics regimens used to treat people with
infective endocarditis.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, EMBASE Classic and EMBASE, LILACS, CINAHL and
the Conference Proceedings Citation Index on 30 April 2015. We also
searched three trials registers and handsearched the reference lists of
included papers. We applied no language restrictions.
SELECTION CRITERIA: We included randomised controlled trials assessing the
effects of antibiotic regimens for treating possible infective
endocarditis diagnosed according to modified Duke's criteria. We
considered all-cause mortality, cure rates and adverse events as the
primary outcomes. We excluded people with possible infective endocarditis
and pregnant women.
DATA COLLECTION AND ANALYSIS: Three review authors independently performed
study selection, 'Risk of bias' assessment and data extraction in
duplicate. We constructed 'Summary of findings' tables and used GRADE
methodology to assess the quality of studies. We described the included
studies narratively.
MAIN RESULTS: Four small randomised controlled trials involving 728
allocated/224 analysed participants met our inclusion criteria. These
trials had a high risk of bias. Drug companies sponsored two of the
trials. We were unable to pool the data due to the heterogeneity in
outcome definitions and the different antibiotics used.The included trials
compared the following antibiotic schedules. The first trial compared
quinolone (levofloxacin) plus standard treatment (anti-staphylococcal
penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or
netilmicin) and rifampicin) versus standard treatment alone reporting
uncertain effects on all-cause mortality (8/31 (26%) with levofloxacin
plus standard treatment versus 9/39 (23%) with standard treatment alone;
RR 1.12, 95% CI 0.49 to 2.56, very low quality evidence). The second trial
compared daptomycin versus low-dose gentamicin plus an anti-staphylococcal
penicillin (nafcillin, oxacillin or flucloxacillin) or vancomycin. This
showed uncertain effects in terms of cure rates (9/28 (32.1%) with
daptomycin versus 9/25 (36%) with low-dose gentamicin plus
anti-staphylococcal penicillin or vancomycin, RR 0.89 95% CI 0.42 to 1.89;
very low quality evidence). The third trial compared cloxacillin plus
gentamicin with a glycopeptide (vancomycin or teicoplanin) plus
gentamicin. In participants receiving gentamycin plus glycopeptide only
13/23 (56%) were cured versus 11/11 (100%) receiving cloxacillin plus
gentamicin (RR 0.59, 95% CI 0.40 to 0.85; very low quality evidence). The
fourth trial compared ceftriaxone plus gentamicin versus ceftriaxone alone
and found no conclusive differences in terms of cure (15/34 (44%) with
ceftriaxone plus gentamicin versus 21/33 (64%) with ceftriaxone alone, RR
0.69, 95% CI 0.44 to 1.10; very low quality evidence).The trials reported
adverse events, need for cardiac surgical interventions, uncontrolled
infection and relapse of endocarditis and found no conclusive differences
between comparison groups (very low quality evidence). No trials assessed
septic emboli or quality of life.
AUTHORS' CONCLUSIONS: Limited and very low quality evidence suggested that
there were no conclusive differences between antibiotic regimens in terms
of cure rates or other relevant clinical outcomes. However, because of the
very low quality evidence, this needs confirmation. The conclusion of this
Cochrane review was based on randomised controlled trials with high risk
of bias. Accordingly, current evidence does not support or reject any
regimen of antibiotic therapy for treatment of infective endocarditis.

<5>
Accession Number
26418205
Author
Xiong H.-Y.; Liu Y.; Shu D.-C.; Zhang S.-L.; Qian X.; Duan W.-X.; Cheng
L.; Yu S.-Q.; Jin Z.-X.
Institution
(Xiong, Liu, Shu, Zhang, Qian, Duan, Cheng, Yu, Jin) From the *Department
of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical
University, Xi'an, China; +Department of Thoracic & Cardiovascular
Surgery, Xi'an Central Hospital, Xi'an, China; ++Department of
Cardiovascular Surgery, Baoji Municipal Central Hospital, Baoji, China;
Department of Cardiovascular Surgery, Shaanxi General Hospital of CAPF,
Xi'an, China; and PDepartment of Pediatrics, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
Title
Effects of Sevoflurane Inhalation During Cardiopulmonary Bypass on
Pediatric Patients: A Randomized Controlled Clinical Trial.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 62
(1) (pp 63-68), 2016. Date of Publication: 01 Jan 2016.
Abstract
The effects of sevoflurane inhalation during cardiopulmonary bypass (CPB)
on postoperative courses and serum cardiac troponin I (cTnI)
concentrations in pediatric patients undergoing cardiac surgery have not
been extensively investigated. In this single-center, prospective,
randomized trial, an anesthetic regimen containing 2% sevoflurane used
throughout the CPB process was compared with a total intravenous
anesthesia (TIVA) regimen. One hundred and three patients undergoing
congenital heart defect repair with CPB were included in this prospective
randomized controlled study. They were randomized into two groups: the
sevoflurane group, who received 2% sevoflurane during CPB via an
oxygenator, and the control group, who received only an oxygen-air
mixture. The pre- and intra-operative parameters were comparable between
the two groups. There was a slight but significant increase of arterial
diastolic pressure in the sevoflurane group immediately after CPB compared
with control patients (46.9 +/- 9.3 mm Hg vs. 43.6 +/- 8.9 mm Hg; p =
0.033). There was no death in either group. The postoperative ventilation
time (in mean [95% confidence interval]) was shorter in the sevoflurane
group than that in the control group (26.1 [19.2, 33.0] h vs. 37.7 [24.4,
50.9] h; p = 0.014). The postoperative ICU time, hospital days, and serial
serum cTnI concentrations were not significantly different between the two
groups. Inhalation of 2% sevoflurane during CPB is beneficial to the
recovery of pediatric patients undergoing cardiac surgery but has no
significant effect on postoperative cTnI release.

<6>
Accession Number
20160509874
Author
de Waha A.; Sandner S.; von Scheidt M.; Boening A.; Koch-Buettner K.;
Hammel D.; Hambrecht R.; Danner B.C.; Schondube F.A.; Goerlach G.;
Fischlein T.; Schmoeckel M.; Oberhoffer M.; Schulz R.; Walther T.;
Ziegelhoffer T.; Knosalla C.; Schonrath F.; Beyersdorf F.; Siepe M.;
Attmann T.; Misfeld M.; Mohr F.-W.; Sievers H.-H.; Joost A.; Putman L.M.;
Laufer G.; Hamm C.; Zeymer U.; Kastrati A.; Radke P.W.; Lange R.; Cremer
J.; Schunkert H.
Institution
(de Waha, von Scheidt, Koch-Buettner, Kastrati, Schunkert) German Heart
Center Munich, Technische Universitat Munchen, Munich, Germany
(de Waha, von Scheidt, Koch-Buettner, Kastrati, Schunkert) DZHK (German
Center for Cardiovascular Research), Partner site Munich Heart Alliance,
Munich, Germany
(Sandner, Laufer) Department of Cardiac Surgery, Vienna General Hospital,
Medical University of Vienna, Vienna, Austria
(Boening, Goerlach) Department of Cardiovascular Surgery, Justus-Liebig
University, Giesen, Germany
(Hammel) Department of Cardiac Surgery, Klinikum Links der Weser, Bremen,
Germany
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links der
Weser, Bremen, Germany
(Danner, Schondube) Department of Thoracic and Cardiovascular Surgery,
Georg-August-University Goettingen, Goettingen, Germany
(Fischlein) Department of Cardiac Surgery, Paracelsus Medical University,
Klinikum Nurnberg, Germany
(Schmoeckel, Oberhoffer) Department of Cardiac Surgery, Asklepios Klinik
St. Georg/Cardioclinic, Harburg, Hamburg, Germany
(Schulz) Institute of Physiology, Justus-Liebig University, Giessen,
Germany
(Walther, Ziegelhoffer) Department of Cardiac Surgery, Kerckhoff Heart and
Thorax Center, Bad Nauheim, Germany
(Knosalla, Schonrath) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute, Berlin, Germany
(Schonrath) DZHK (German Center for Cardiovascular research)-partner side
Berlin, Germany
(Beyersdorf, Siepe, Cremer) Department of Cardiovascular Surgery, Heart
Center Freiburg University, Freiburg, Germany
(Attmann) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Misfeld, Mohr) Department of Cardiac Surgery, Heart Center Leipzig,
University of Leipzig, Leipzig, Germany
(Sievers) Department of Cardiac and Thoracic Vascular Surgery, University
of Lubeck, Lubeck, Germany
(Joost, Putman) Medical Clinic II, Cardiology, Angiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Lubeck,
Lubeck, Germany
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center,
Germany Justus Liebig University of Giessen, Department of Internal
Medicine I, Giesen, Germany
(Zeymer) Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen
am Rhein, Germany
(Radke) Klinik fur Innere Medizin, Schon Klinik Neustadt, Neustadt i.H.,
Germany
(Lange) Department of Cardiovascular Surgery, German Heart Center, Munich,
Germany
Title
A randomized, parallel group, double-blind study of ticagrelor compared
with aspirin for prevention of vascular events in patients undergoing
coronary artery bypass graft operation: Rationale and design of the
Ticagrelor in CABG (TiCAB) trial: An Investigator-Initiated trial.
Source
American Heart Journal. 179 (pp 69-76), 2016. Date of Publication: 01 Sep
2016.
Publisher
Mosby Inc.
Abstract
For patients with coronary artery disease undergoing coronary bypass
surgery, acetylsalicylic acid (ASA) currently represents the gold standard
of antiplatelet treatment. However, adverse cardiovascular event rates in
the first year after coronary artery bypass grafting (CABG) still exceed
10%. Graft failure, which is predominantly mediated by platelet
aggregation, has been identified as a major contributing factor in this
context. Therefore, intensified platelet inhibition is likely to be
beneficial. Ticagrelor, an oral, reversibly binding and direct-acting
P2Y<inf>12</inf> receptor antagonist, provides a rapid, competent, and
consistent platelet inhibition and has shown beneficial results compared
with clopidogrel in the subset of patients undergoing bypass surgery in a
large previous trial. Hypothesis Ticagrelor is superior to ASA for the
prevention of major cardiovascular events within 1 year after CABG. Study
design The TiCAB trial (NCT01755520) is a multicenter, phase III,
double-blind, double-dummy, randomized trial comparing ticagrelor with ASA
for the prevention of major cardiovascular events within 12 months after
CABG. Patients undergoing CABG will be randomized in a 1:1 fashion to
either ticagrelor 90 mg twice daily or ASA 100 mg once daily. The study
medication will be started within 24 hours after surgery and maintained
for 12 months. The primary end point is the composite of cardiovascular
death, myocardial infarction, stroke, and repeat revascularization at 12
months after CABG. The sample size is based on an expected event rate of
13% of the primary end point within the first 12 months after
randomization in the control group, a 2-sided alpha level of .0492 (to
preserve the overall significance level of .05 after planned interim
analysis), a power of 0.80%, 2-sided testing, and an expected relative
risk of 0.775 in the active group compared with the control group and a
dropout rate of 2%. According to power calculations based on a superiority
design for ticagrelor, it is estimated that 3,850 patients should be
enrolled. Summary There is clinical equipoise on the issue of optimal
platelet inhibition after CABG. The TiCAB trial will provide a pivotal
comparison of the efficacy and safety of ticagrelor compared with ASA
after CABG.

<7>
Accession Number
20160536481
Author
Gontijo de Deus K.; Diogo Filho A.; Cesar Santos P.
Institution
(Gontijo de Deus) Health Technical School of the Federal Univ. of
Uberlandia - UFU, Brazil
(Diogo Filho) Graduate Health Sciences and the Department of Surgery,
Faculty of Medicine, Federal University of Uberlandia - UFU, Brazil
(Cesar Santos) Cardiovascular Surgery Service of Clinical Hospital the
Federal Univ. of Uberlandia - UFU, Brazil
Title
A randomised controlled trial of mini incision or conventional incision
for saphenous vein harvesting in patients undergoing myocardial
revascularization.
Source
Annals of Medicine and Surgery. 7 (pp 1-6), 2016. Date of Publication: 01
May 2016.
Publisher
Elsevier Ltd
Abstract
Objective: Compare the evolution regarding the complications concerning
two types of incision (conventional x mini-incision), for saphenectomy in
patients that go under myocardial revascularization or otherwise known as
coronary artery bypass surgery. Methods: In January 2012 to August 2013,
66 patients were prospectively selected for coronary artery bypass with
cardiopulmonary bypass surgery. These were divided into two groups:
Conventional and Mini-Incision, with 33 patients in each group chosen in a
random fashion and with knowledge of which technique to be used being
presented only at the start of the surgery. In the conventional group, the
patients received an incision to the lower member of 7-10 cm. The patients
in the Mini-Incision group received an incision to the lower member of 3-4
cm, both performed without the use of any special material. Results: The
groups were similar in terms of clinical data and in the preoperative
period. Males made up a greater part of the group with 63.7% and 81.9% in
groups C and M, respectively. Among the complications analysed, edema (p =
0.011), hematoma (p = 0.020), dehiscence (p = 0.012) and infection (p =
0.012), were significantly greater in group C when compared to group M.
When the matter comes to the variable in relation to the risk of Surgical
Site Infections (SSI), no difference was found between the groups.
Conclusion: Coronary artery bypass surgery with mini-incision for
saphenectomy, demonstrated a lower rate for preoperative complications
when compared to saphenectomy under conventional incision procedures.

<8>
Accession Number
20160524087
Author
Tan Z.; Zhou L.; Qin Z.; Luo M.; Chen H.; Xiong J.; Li J.; Liu T.; Du L.;
Zhou J.
Institution
(Tan, Zhou, Qin, Luo, Xiong, Li, Liu, Du) Department of Anesthesiology and
Translational Neuroscience Center, West China Hospital, China
(Chen, Zhou) Department of Laboratory Medicine, West China Hospital,
Sichuan University, No. 37, Guoxue Xiang, Chengdu, Sichuan 610041, China
Title
Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products
after Cardiac Surgery.
Source
Medicine (United States). 95 (17) (no pagination), 2016. Article Number:
e3424. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Patients undergoing cardiac surgery often experience abnormal bleeding,
due primarily to cardiopulmonary bypass (CPB)-induced activation of
platelets. Sevoflurane may inhibit platelet activation, raising the
possibility that administering it during CPB may reduce blood loss.
Patients between 18 and 65 years old who were scheduled for cardiac
surgery under CPB at our hospital were prospectively enrolled and
randomized to receive intravenous anesthetics alone (control group, n =
77) or together with sevoflurane (0.5-1.0 vol/%) from an oxygenator
(sevoflurane group, n = 76). The primary outcome was postoperative blood
loss, the secondary outcome was postoperative need for blood products.
Volume of blood loss was 48% lower in the sevoflurane group than the
control group at 4 hours after surgery, and 33% lower at 12 hours after
surgery. Significantly fewer patients in the sevoflurane group lost >700
mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result,
the sevoflurane group received significantly smaller volumes of packed red
blood cells (1.25 +/- 2.36 vs 2.23 +/- 3.75 units, P = 0.011) and fresh
frozen plasma (97 +/- 237 vs 236 +/- 344 mL, P = 0.004). Thus the
sevoflurane group was at significantly lower risk of requiring complex
blood products after surgery (adjusted odds ratio [OR] 0.34, 95%
confidence interval [CI] 0.17-0.68, P = 0.002). Sevoflurane inhalation
from an oxygenator during CPB may reduce blood loss and need for blood
products after cardiac surgery.

<9>
Accession Number
20160527278
Author
Chan M.; Ridley L.; Dunn D.J.; Tian D.H.; Liou K.; Ozdirik J.; Cheruvu C.;
Cao C.
Institution
(Chan, Ridley) Department of Radiology, Concord Repatriation and General
Hospital, Sydney, Australia
(Dunn) The University of Sydney, Sydney, Australia
(Tian, Liou, Ozdirik, Cao) The Collaborative Research Group, Macquarie
University, Sydney, Australia
(Cheruvu) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
Title
A systematic review and meta-analysis of multidetector computed tomography
in the assessment of coronary artery bypass grafts.
Source
International Journal of Cardiology. 221 (pp 898-905), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose The present meta-analysis aimed to compare the diagnostic accuracy
of more recent computed tomography coronary angiography (CTCA) with
invasive coronary angiography (ICA) in the assessment of graft patency
after coronary artery bypass graft surgery (CABG). Material and methods A
systematic review was performed using nine electronic databases from their
dates of inception to July 2015. Predefined inclusion criteria included
studies reporting on comparative outcomes using > 64 slice multidetector
computed tomography (MDCT) and ICA. The primary endpoints included graft
occlusion and significant graft stenosis > 50%. Secondary analyses
included the comparison of arterial versus venous graft conduits, and the
use of different MDCT techniques. Results Thirty-one studies were
identified according to selection criteria, involving 1975 patients with
5364 assessed grafts. Combined assessment of stenosis and occlusion for
all grafts demonstrated a sensitivity of 96.1% [95% confidence interval
(CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA
assessment of venous grafts demonstrated higher sensitivity compared to
arterial grafts, when testing for both occlusion and stenosis (97.6% vs
89.2%, p = 0.004). Conclusion Results of this study demonstrated that CTCA
had a relatively high pooled sensitivity, specificity and negative
predictive value compared to ICA. However, patient baseline
characteristics varied between studies, and the results should be
interpreted with caution. Nonetheless, our results indicate that CTCA
should be recognized as an accurate and non-invasive investigation for
graft patency in symptomatic patients after CABG.

<10>
Accession Number
20160528147
Author
Karami A.; Khosravi M.B.; Shafa M.; Azemati S.; Khademi S.; Akhlagh S.H.;
Maghsodi B.
Institution
(Karami, Khosravi, Azemati, Khademi, Akhlagh, Maghsodi) Shiraz
Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Faghihi Hospital, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
Cardioprotective effect of extended remote ischemic preconditioning in
patients undergoing coronary artery bypass grafting: A randomized clinical
trial.
Source
Iranian Journal of Medical Sciences. 41 (4) (pp 265-274), 2016. Date of
Publication: July 2016.
Publisher
Shiraz University of Medical Sciences
Abstract
Background: The cardioprotective effect of ischemic preconditioning has
been known for many years. Since the temporary ischemia in the heart may
cause lethal cardiac effects, the idea of creating ischemia in organs far
from the heart such as limbs was raised as remote ischemic preconditioning
(RIPC). We hypothesized that the extension of RIPC has more
cardioprotective effect in patients undergoing coronary artery bypass
graft (CABG) surgeries. Methods: In this triple-blind randomized clinical
trial study, 96 patients were randomly divided into 3 groups and two blood
pressure cuffs were placed on both upper and lower extremities. In group
A, only upper extremity cuff and in group B upper limb and lower limb cuff
was inflated intermittently and group C was the control group. RIPC was
induced with three 5-min cycles of cuff inflation about 100 mmHg over the
initial systolic blood pressure before starting cardiopulmonary bypass.
The primary endpoints were troponin I and creatine phosphokinasemyoglobin
isoenzyme (CK-MB). Results: Six hours after the termination of CPB, there
was a peak release of the troponin I level in all groups (group A=4.90
ng/ml, group B=4.40 ng/ml, and group C=4.50 ng/ml). There was a rise in
plasma CK-MB in all groups postoperatively and there were not any
significant differences in troponin I and CK-MB release between the three
groups. Conclusion: RIPC induced by upper and lower limb ischemia does not
reduce postoperative myocardial enzyme elevation in adult patients
undergoing CABG.

<11>
Accession Number
20160510145
Author
Vazquez F.J.; Gonzalez J.P.; LeGal G.; Carrier M.; Gandara E.
Institution
(Vazquez) Internal Medicine Research Unit, Internal Medicine Department,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
(Vazquez) Internal Medicine Department, Hospital Italiano de Buenos Aires,
Buenos Aires, Argentina
(Gonzalez) Hospital Universitario, Universidad Nacional de Cuyo, Mendoza,
Argentina
(LeGal, Carrier, Gandara) Thrombosis Program, Division of
Hematology-Department of Medicine, University of Ottawa-Ottawa Hospital,
Ottawa, Canada
(LeGal, Carrier, Gandara) Ottawa Hospital Research Institute, Ottawa,
Canada
Title
Risk of major bleeding in patients receiving vitamin K antagonists or low
doses of aspirin. A systematic review and meta-analysis.
Source
Thrombosis Research. 138 (pp 1-6), 2016. Date of Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Prior meta-analysis and observational studies have suggested that the
bleeding risks associated with anticoagulation using vitamin K antagonists
(VKA) or aspirin (ASA) are similar. Objective The aim of this systematic
review was to provide the odds ratios (ORs) of major bleeding,
intracranial bleeding or major extra-cranial bleeding of anticoagulation
with VKA compared to low doses of ASA. Methods We conducted a systematic
review of Ovid MEDLINE, Embase and the Cochrane Central Register of
Controlled Trials (RCT). Randomized controlled trials reporting bleeding
rates in adult patients randomized to a VKA (INR 2-3) or to ASA alone (<
325 mg daily). Random effects OR were calculated. Results Fifteen trials
reporting the outcome of 2511 participants treated with VKA alone and 2471
treated with ASA alone were included; most common conditions evaluated
were non-valvular atrial fibrillation (five trials) and heart failure
(three trials). Overall, the use of VKA was associated with an increased
risk of major bleeding (OR 1.76 (95% CI 1.33-2.33) when compared to ASA.
The OR associated with VKA use for intracranial bleeding and extra-cranial
bleeding were 1.74 (95% CI 0.83-3.62) and 1.66 (95% CI 0.94-2.92),
respectively. In trials achieving good control of anticoagulation [time in
therapeutic range (TTR) > 65%], the risk of bleeding with VKA was similar
to that of ASA [OR 1.16 (95% CI 0.79-1.71)]. Conclusion Contrary to prior
reports our results suggest that the risk of major bleeding with the use
VKA is higher compared to those of patients treated with ASA alone.
However, in patients achieving a good TTR, the risk of major bleeding with
VKA or ASA is similar.

<12>
Accession Number
20160510363
Author
King N.; Dieberg G.; Smart N.A.
Institution
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
Title
Effects of pre-procedural remote ischaemic pre-conditioning on the
outcomes of elective percutaneous coronary intervention. A systematic
review and meta-analysis.
Source
Clinical Trials and Regulatory Science in Cardiology. 21 (pp 1-6), 2016.
Date of Publication: 01 Sep 2016.
Publisher
Elsevier
Abstract
Objectives Trials of remote ischemic pre-conditioning (RIPC) have
suggested this intervention reduces complications of percutaneous coronary
intervention and coronary by-pass surgery. The aims of this work were to
(i) conduct a systematic review and meta-analysis of the effects of RIPC
on cardiac and renal damage in patients undertaking elective percutaneous
coronary intervention (PCI); (ii) summarize the results in an
evidence-based clinical context. Methods We conducted a systematic search
of published randomized controlled trials of RIPC for elective PCI up
until May 1st, 2015. Studies of peri- or post-ischemic conditioning or
emergency PCI were excluded. Results Nine studies, totalling 1253 patients
were included. Compared to control, RIPC groups exhibited reduced
peri-procedural myocardial infarction (MI) Odds Ratio (OR) 0.72 (95% CI
0.54 to 0.97, p = 0.03); ST-segment deviation OR 0.42 (95% CI 0.28 to
0.63, p < 0.0001); major adverse cardiac events (MACE) OR 0.41 (95% CI
0.21 to 0.84, p = 0.01); and acute kidney injury (AKI) OR 0.47 (95% CI
0.26 to 0.86, p = 0.01), but not mortality OR 1.00 (95% CI 0.27 to 3.73, p
= 1.00). Conclusions RIPC is likely to prevent major adverse cardiac and
renal events in patients undertaking elective PCI.

<13>
Accession Number
20160259237
Author
El-Hamamsy M.H.; Elsisi G.H.; Eldessouki R.; Elmazar M.M.; Taha A.S.; Awad
B.F.; Elmansy H.
Institution
(El-Hamamsy) Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
(Elsisi) Faculty of Pharmacy, German University in Cairo, Cairo, Egypt
(Elsisi) Pharmacoeconomic Unit, Central Administration for Pharmaceutical
Affairs, Cairo, Egypt
(Eldessouki) Faculty of Medicine, Fayoum University, Fayoum, Egypt
(Elmazar) Faculty of Pharmacy, The British University in Egypt (BUE),
Cairo, Egypt
(Taha, Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Taha, Awad) Cardiothoracic Surgery Unit, Ain Shams University Hospitals,
Cairo, Egypt
(Elmansy) Faculty of Business Administration, Canadian International
College, Cairo, Egypt
Title
Economic Evaluation of the Combined Use of Warfarin and Low-dose Aspirin
Versus Warfarin Alone in Mechanical Valve Prostheses.
Source
Applied Health Economics and Health Policy. 14 (4) (pp 431-440), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Springer International Publishing
Abstract
Background: The use of combined therapy of antiplatelet and anticoagulant
versus anticoagulant alone to reduce instances of thromboembolic events in
patients with heart valve prostheses is an established standard of care in
many countries but not in Egypt. A previous Markov model
cost-effectiveness study on Egyptian patients aged 50-60 years
demonstrated that the combined therapy reduces the overall treatment cost.
However, due to the lack of actual real-world data on cost-effectiveness
and the limitation of the Markov model study to 50- to 60-year-old
patients, the Egyptian medical community is still questioning whether the
added benefit is worth the cost. Objective: To assess, from the
perspective of the Egyptian health sector, the cost-effectiveness of the
combined use of warfarin and low-dose aspirin (75 mg) versus that of
warfarin alone in patients with mechanical heart valve prostheses who
began therapy between the age of 15 and 50 years. Methods: An economic
evaluation was conducted alongside a randomized, controlled trial to
assess the cost-effectiveness of the combined therapy in patients with
mechanical valve prostheses. A total of 316 patients aged between 15 and
50 years were included in the study and randomly assigned to a group
treated with both warfarin and aspirin or a group treated with warfarin
alone. Results: The patients in the combined therapy group exhibited a
significantly longer duration of protection against the first event. Fewer
primary events were observed in the patients treated with warfarin plus
aspirin than in those treated with warfarin alone (1.4 %/year, vs. 4.8
%/year), and a higher mean quality-adjusted life-years (QALYs) value over
4 years was obtained for the group treated with warfarin plus aspirin
(difference 0.058; 95 % CI 0.013-0.118), although this difference did not
reach a conventional level of statistical significance. The total costs
over a 4-year period were lower with the combined therapy (difference
-US$244; 95 % CI -US$483.1 to -US$3.8), which yielded an incremental
cost-effectiveness ratio of -US$4206 per QALY gained. Thus, the combined
therapy was dominant. All costs were reported in US dollars (USD) for the
financial year 2014. Conclusions: The results of this analysis indicate
that from the perspective of the Egyptian health sector, the addition of
aspirin to the typical warfarin therapy is more effective and less costly
for patients with mechanical valve prostheses than treatment with warfarin
alone. This combined strategy could be adopted to prevent the
complications of mechanical valve prostheses. Our study adds to the body
of evidence supporting the option of warfarin-plus-aspirin therapy for
patients with mechanical valve prostheses.

<14>
Accession Number
20160522216
Author
Wyatt C.M.; Shineski M.; Chertow G.M.; Bangalore S.
Institution
(Wyatt) Department of Medicine, Division of Nephrology, Icahn School of
Medicine at Mount Sinai, New York, New York, United States
(Shineski) ISCHEMIA Clinical Coordinating Center, New York University
School of Medicine, New York, New York, United States
(Chertow) Department of Medicine, Division of Nephrology, Stanford School
of Medicine, Stanford, California, United States
(Bangalore) Department of Medicine, Division of Cardiology, New York
University School of Medicine, New York, New York, United States
Title
ISCHEMIA in chronic kidney disease: improving the representation of
patients with chronic kidney disease in cardiovascular trials.
Source
Kidney International. 89 (6) (pp 1178-1179), 2016. Date of Publication:
2016.
Publisher
Elsevier
Abstract
Despite the high cardiovascular risk associated with chronic kidney
disease, a recent systematic review confirmed that patients with kidney
disease remain underrepresented in cardiovascular trials. Two ongoing
trials are assessing the risk:benefit of aggressive evaluation and
intervention for ischemic heart disease in patients with advanced chronic
kidney disease.

<15>
Accession Number
20160510731
Author
Ostergaard B.; Holbaek E.; Sorensen J.; Steinbruchel D.
Institution
(Ostergaard) Research Unit of Nursing, Clinical Institute, University of
Southern Denmark, Campusvej 55, Odense M DK-5230, Denmark
(Holbaek) Department of Cardiothoracic Surgery, Heart Centre, Copenhagen
University Hospital, Rigshospitalet, Denmark
(Sorensen) Centre for Applied Health Services Research, University of
Southern, Denmark
(Steinbruchel) Emergency Department, Nykobing Falster Hospital, Denmark
Title
Health-related quality of life after off-pump compared with on-pump
coronary bypass grafting among elderly high-risk patients: A randomized
trial with eight years of follow-up.
Source
European Journal of Cardiovascular Nursing. 15 (2) (pp 126-133), 2016.
Date of Publication: 01 Apr 2016.
Publisher
SAGE Publications Inc.
Abstract
Background: Potential long-term gain in health-related quality of life
(HRQoL) using off-pump coronary revascularization in elderly patients >70
years has not yet been fully elucidated. Aim: We compared HRQoL in elderly
moderate- to high-risk patients 3 months, 12 months, and 8 years after
randomization to either off-pump or on-pump coronary artery bypass
grafting (CABG). Methods: After randomization and before heart surgery,
120 consecutive patients were asked to fill in the Medical Outcome Study
Short Form 36 (SF-36) and Major Depression Inventory diagnostic scale for
self-report of HRQoL. Postoperatively, the same questionnaires were mailed
to the patients. Results: No significant difference was found in the
change of SF-36 scores between the groups except in the social functioning
subscale, where the 8-year score was significantly higher for the on-pump
group than the off-pump group (p=0.038). In the on-pump group, all scores
improved from baseline to 8 years, with the highest improvement in most of
the domains after 8 years. In the off-pump group, there was an improvement
in four of the eight domains from baseline to 8 years, with the highest
improvement in most of the domains after 12 months. By contrast, there was
a noticeable decrease in bodily pain, social functioning, and mental
health at 8 years after off-pump operation. No patients showed signs of
depression after 8 years. Conclusion: HRQoL SF-36 scores seemed to improve
more in patients undergoing on-pump CABG compared with patients undergoing
off-pump surgery, although no long-term clinically relevant difference
between the groups could be demonstrated.

<16>
Accession Number
20160510092
Author
Deeb G.M.; Reardon M.J.; Chetcuti S.; Patel H.J.; Grossman P.M.; Yakubov
S.J.; Kleiman N.S.; Coselli J.S.; Gleason T.G.; Lee J.S.; Hermiller J.B.;
Heiser J.; Merhi W.; Zorn G.L.; Tadros P.; Robinson N.; Petrossian G.;
Hughes G.C.; Harrison J.K.; Maini B.; Mumtaz M.; Conte J.; Resar J.;
Aharonian V.; Pfeffer T.; Oh J.K.; Qiao H.; Adams D.H.; Popma J.J.
Institution
(Deeb, Chetcuti, Patel, Grossman) University of Michigan Medical Center,
Ann Arbor, Michigan, United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart & Vascular Center,
Houston, Texas, United States
(Yakubov) Riverside Methodist Hospital, Columbus, Ohio, United States
(Coselli) Texas Heart Institute at St. Luke's Medical Center, Houston,
Texas, United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh,
Pennsylvania, United States
(Hermiller) St. Vincent Medical Center, Indianapolis, Indiana, United
States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, Michigan, United
States
(Zorn, Tadros) The University of Kansas Hospital, Kansas City, Kansas,
United States
(Robinson, Petrossian) St. Francis Hospital, Roslyn, New York, United
States
(Hughes, Harrison) Duke University Medical Center, Durham, North Carolina,
United States
(Maini, Mumtaz) Pinnacle Health, Wormleysburg, Pennsylvania, United States
(Conte, Resar) The Johns Hopkins Hospital, Baltimore, Maryland, United
States
(Aharonian, Pfeffer) Kaiser Permanente-Los Angeles Medical Center, Los
Angeles, California, United States
(Oh) Mayo Clinical Foundation, Rochester, Minnesota, United States
(Qiao) Medtronic, Minneapolis, Minnesota, United States
(Adams) Mount Sinai Health System, New York, New York, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, Massachusetts,
United States
Title
3-Year Outcomes in High-Risk Patients Who Underwent Surgical or
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 67 (22) (pp 2565-2574),
2016. Date of Publication: 07 Jun 2016.
Publisher
Elsevier USA
Abstract
Background In patients with severe aortic stenosis at increased risk for
surgery, self-expanding transcatheter aortic valve replacement (TAVR) is
associated with improved 2-year survival compared with surgery. Objectives
This study sought to determine whether this clinical benefit was sustained
over time. Methods Patients with severe aortic stenosis deemed at
increased risk for surgery by a multidisciplinary heart team were
randomized 1:1 to TAVR or open surgical valve replacement (SAVR).
Three-year clinical and echocardiographic outcomes were obtained in those
patients with an attempted procedure. Results A total of 797 patients
underwent randomization at 45 U.S. centers; 750 patients underwent an
attempted procedure. Three-year all-cause mortality or stroke was
significantly lower in TAVR patients (37.3% vs. 46.7% in SAVR; p = 0.006).
Adverse clinical outcome components were also reduced in TAVR patients
compared with SAVR patients, including all-cause mortality (32.9% vs.
39.1%, respectively; p = 0.068), all stroke (12.6% vs. 19.0%,
respectively; p = 0.034), and major adverse cardiovascular or
cerebrovascular events (40.2% vs. 47.9%, respectively; p = 0.025). At 3
years aortic valve hemodynamics were better with TAVR patients (mean
aortic valve gradient 7.62 +/- 3.57 mm Hg vs. 11.40 +/- 6.81 mm Hg in
SAVR; p < 0.001), although moderate or severe residual aortic
regurgitation was higher in TAVR patients (6.8% vs. 0.0% in SAVR; p <
0.001). There was no clinical evidence of valve thrombosis in either
group. Conclusions Patients with severe aortic stenosis at increased risk
for surgery had improved 3-year clinical outcomes after TAVR compared with
surgery. Aortic valve hemodynamics were more favorable in TAVR patients
without differences in structural valve deterioration. (Safety and
Efficacy Study of the Medtronic CoreValve System in the
Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High
Risk Subjects Who Need Aortic Valve Replacement; NCT01240902)

<17>
Accession Number
20160521006
Author
Ando T.; Briasoulis A.; Holmes A.A.; Taub C.C.; Takagi H.; Afonso L.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY 10003, United States
(Briasoulis, Afonso) Wayne State University/Detroit Medical Center,
Division of Cardiology, Detroit, MI 48226, United States
(Holmes, Taub) Division of Cardiology, Montefiore Medical Center; Albert
Einstein College of Medicine, Bronx, NY 10467, United States
(Takagi) Shizuoka Medical Center, Department of Cardiovascular Surgery,
Shizuoka, Japan
Title
Sapien 3 versus Sapien XT prosthetic valves in transcatheter aortic valve
implantation: A meta-analysis.
Source
International Journal of Cardiology. 220 (pp 472-478), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives The S3 prosthetic valve was introduced to overcome several
issues with its predecessor, the SXT, in transcatheter aortic valve
implantation (TAVI), however, the clinical outcomes of this new model are
not clearly defined. We performed a meta-analysis to compare the outcomes
in Sapien 3 (S3) and Sapien XT (SXT) recipients. Methods A literature
search through PUBMED and EMBASE was conducted. Articles that included at
least one of the clinical outcomes of interest were included in the
meta-analysis: moderate to severe paravalvular regurgitation (PVR),
permanent pacemaker implantation (PPI), major vascular complications
(MVC), cerebrovascular events (stroke and transient ischemic attack)
(CVE), failure rate of device implantation, life-threatening, disabling or
major bleeding, need for post-dilation and early all-cause-mortality.
Results A total of 9 observational cohort studies were included. S3 was
implanted in 945 and SXT in 1553 patients. S3 was associated with a lower
incidence of moderate to severe PVR (1.6% vs 6.9%, p < 0.0001), lower MVC
(5.1% vs 8.9%, p = 0.01) and less serious bleeding (8.1% vs 15.2%, p =
0.003) compared to the SXT. Device deployment failure rate was lower in
the S3 (1.2% vs 5.9%, p = 0.004) and the S3 required less post-dilation
(16.9% vs 26.9%, p = 0.05). Rates of CVE, perioperative mortality and PPI
were similar between the two valves. Conclusions Implantation of the S3
prosthetic valve results in lower rates of moderate to severe PVR, MVC,
post-dilation and serious bleeding however it does not improve on the SXT
in terms of CVE, PPI and early mortality.

<18>
Accession Number
20160364665
Author
Yalonetsky S.; Aronson D.
Institution
(Yalonetsky, Aronson) Department of Cardiology, Rambam Healthcare Campus,
Ha-Alia Street, POB 9602, Haifa IL-31096, Israel
(Yalonetsky, Aronson) Ruth and Bruce Rappaport Faculty of Medicine,
Technion, Israel Institute of Technology, Haifa, Israel
Title
Biventricular Rupture with Extracardiac Left-to-Right Shunt Complicating
Acute Myocardial Infarction.
Source
Cardiology (Switzerland). 134 (4) (pp 389-393), 2016. Date of Publication:
27 Apr 2016.
Publisher
S. Karger AG
Abstract
Background: Simultaneous rupture of the left and right ventricles is an
extremely rare mechanical complication of acute myocardial infarction
(MI). When associated with the formation of a false aneurysm, an
extracardiac left-to-right shunt may occur. Methods: We summarized all
published data describing this unique condition. We searched the PubMed
and Google Scholar databases for case reports in peer-reviewed journals
from 1 January 1980 to 1 May 2015. We identified 16 articles describing 17
cases. Results: In all but 1 case, biventricular wall rupture (BVWR)
resulted from an inferior MI. The clinical presentations of BVWR were
variable and included cardiogenic shock, congestive heart failure and an
absence of any cardiac symptoms. In most cases, there was a
hemodynamically significant left-to-right shunt, with pulmonary to
systemic blood flow (Qp/Qs) >2. Diagnostic difficulties were reported in
most cases, and some patients were initially misdiagnosed as having
ventricular septal rupture (VSR). Surgical closure of the defect was
successful in most cases, and some asymptomatic patients were managed
conservatively. Conclusion: BVWR with an intact interventricular septum
and extracardiac left-to-right shunt is a rare mechanical complication of
acute MI, often misdiagnosed as VSR. It has a variable clinical course,
probably related to the magnitude of the shunt.

<19>
[Use Link to view the full text]
Accession Number
20160173278
Author
Stehouwer M.C.; De Vroege R.; Kelder J.C.; Hofman F.N.; De Mol B.A.;
Bruins P.
Institution
(Stehouwer) Department of Extracorporeal Circulation, St Antonius
Hospital, Koekoekslaan 1, Nieuwegein 3430 EM, Netherlands
(De Vroege) Department of Extracorporeal Circulation, HAGA Hospital, The
Hague, Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Hofman) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(De Mol) Section Cardiovascular Biomechanics, Faculty of Biomedical
Technology, Technical University Eindhoven, Eindhoven, Netherlands
(Bruins) Department of Anaesthesiology, Intensive Care and Pain
Management, St Antonius Hospital, Nieuwegein, Netherlands
Title
Effect of oxygenator size on air removal characteristics: A clinical
evaluation.
Source
ASAIO Journal. 62 (4) (pp 421-426), 2016. Date of Publication: 01 Aug
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
During cardiopulmonary bypass (CPB), gaseous microemboli (GME) are
released into the patients' arterial bloodstream. Gaseous microemboli may
contribute to the adverse outcome after cardiac surgery. Recently, two
oxygenator models with or without integrated arterial filter (IAF) were
designed and only differ in size, leading to a change of 20% in surface
area of the hollow fibers and 25% in blood velocities. The aim of this
study was to assess the air removal characteristics of the inspire
oxygenators with or without IAF. Sixty-eight patients were randomly
assigned to four different groups: optimized adult and full adult and an
additional IAF. Gaseous microemboli reduction rates were measured with a
bubble counter. The number of GME reduction rates showed no differences.
However, both models reduced significantly less volume of GME (optimized
adult: 40.6% and full adult: 50.3%) compared with both models with IAF
(88.7% and 88.5%, respectively). No significant differences of reduction
rates were found between both devices without IAF and also not between
both models with IAF. In conclusion, the larger inspire oxygenator tends
to remove more GME. No effect from size of oxygenator device with
integrated screen filter on GME reduction was observed. The inspire
oxygenators with IAF may be considered as an adequate GME filter.

<20>
Accession Number
20160023823
Author
Katsanos K.; Spiliopoulos S.; Diamantopoulos A.; Siablis D.; Karnabatidis
D.; Scheinert D.
Institution
(Katsanos, Diamantopoulos) Department of Interventional Radiology, Guy's
and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners,
London, United Kingdom
(Katsanos, Spiliopoulos, Siablis, Karnabatidis) Department of
Interventional Radiology, Patras University Hospital, School of Medicine,
Rion, Greece
(Scheinert) Department of Angiology, Park Hospital and
Universitatsklinikum, Leipzig, Germany
Title
Wound Healing Outcomes and Health-Related Quality-of-Life Changes in the
ACHILLES Trial: 1-Year Results From a Prospective Randomized Controlled
Trial of Infrapopliteal Balloon Angioplasty Versus Sirolimus-Eluting
Stenting in Patients With Ischemic Peripheral Arterial Disease.
Source
JACC: Cardiovascular Interventions. 9 (3) (pp 259-267), 2016. Date of
Publication: 08 Feb 2016.
Publisher
Elsevier Inc.
Abstract
Objectives The authors sought to report the wound healing outcomes,
health-related quality-of-life changes and quality-adjusted life-years
(QALYs) gain in the 2 treatment arms of the ACHILLES (Comparing
Angioplasty and DES in the Treatment of Subjects With Ischemic
Infrapopliteal Arterial Disease) multicenter randomized trial. Background
The ACHILLES randomized trial has previously shown that sirolimus-eluting
stents (SES) may achieve lower vessel restenosis and higher event-free
survival rates compared with plain balloon angioplasty (PTA) for
infrapopliteal lesions. Methods A total of 200 patients were randomly
assigned between SES and PTA for the treatment of infrapopliteal arterial
occlusive lesions. Progression of wound healing was serially assessed by
digital photography. Health-related quality-of-life scores were assessed
with the self-administered EQ-5D questionnaire up to 1 year from
randomization. QALYs gained were calculated with a standard multiplicative
model using distribution-free Bayesian modeling. Results In total, 109
open wounds (n = 54 in SES; n = 55 in PTA) were documented at baseline. At
6 months, wound volume reduction (%) was significantly higher in the SES
group (95% healing [95% confidence interval (CI): 80% to 99%] compared
with 60% healing [95% CI: 13% to 90%] in the PTA group; p = 0.048). At 1
year, rates of complete wound closure were higher in the case of SES
(72.9% vs. 55.6% closed wounds in PTA; p = 0.088). The recorded weighted
EQ-5D score improved significantly up to 1 year in case of SES (p <
0.0001), but not in case of PTA. There was a trend of more QALYs gained
with SES compared with PTA up to 1 year after randomization. Relative QALY
gain was 0.10 (95% CI: -0.01 to 0.21; p = 0.08) in the whole study and
0.17 (95% CI: -0.03 to 0.35; p = 0.09) in the wound subgroups comparison.
Conclusions Infrapopliteal SES accelerates wound healing and may improve
quality of life compared with PTA. (Comparing Angioplasty and DES in the
Treatment of Subjects With Ischemic Infrapopliteal Arterial Disease
[ACHILLES]; NCT00640770)

<21>
Accession Number
20160513639
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Impact of paravalvular aortic regurgitation after transcatheter aortic
valve implantation on survival.
Source
International Journal of Cardiology. 221 (pp 46-51), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether > moderate paravalvular aortic
regurgitation (PAR) after transcatheter aortic valve implantation (TAVI)
independently impairs overall survival and how much the impact on survival
is, we performed an updated meta-analysis pooling not unadjusted but
adjusted hazard ratios (HRs). Methods Databases including MEDLINE and
EMBASE were searched through January 2016 using PubMed and OVID. Search
terms included paravalvular or perivalvular; regurgitation, leak, or
leakage; percutaneous, transcatheter, transluminal, transarterial,
transapical, transaortic, transcarotid, transaxillary, transsubclavian,
transiliac, transfemoral, or transiliofemoral; and aortic valve. Studies
considered for inclusion met the following criteria: the design was an
observational comparative study; the study population was patients
undergoing TAVI; patients were divided into > moderate and < mild
post-TAVI PAR; outcomes included > 1-year all-cause mortality; and the
adjustment method was a multivariate Cox proportional hazards analysis. An
adjusted HR with its 95% confidence interval (CI) for > moderate post-TAVI
PAR was abstracted from each individual study. Results Our search
identified 17 eligible studies including a total of 15,131 patients. A
pooled analysis of all the 17 studies demonstrated a statistically
significant 2.12-fold increase in mortality with > moderate PAR (HR, 2.12;
95% CI, 1.79 to 2.51; p < 0.00001). Exclusion of any single study from the
meta-analysis did not substantively alter the overall result disfavoring >
moderate PAR. Although the statistical tests suggested funnel plot
asymmetry, the corrected effect estimate from the trim-and-fill method
demonstrated still a statistically significant 1.83-fold risk of mortality
with > moderate PAR. Conclusions > Moderate post-TAVI PAR is associated
with a 2.12-fold increase in overall (> 1-year) all-cause mortality.

<22>
Accession Number
20160519605
Author
Jujo K.; Saito K.; Ishida I.; Kim A.; Suzuki Y.; Furuki Y.; Ouchi T.;
Ishii Y.; Sekiguchi H.; Yamaguchi J.; Ogawa H.; Hagiwara N.
Institution
(Jujo, Sekiguchi, Yamaguchi, Ogawa, Hagiwara) Department of Cardiology,
Tokyo Women's Medical University, Tokyo, Japan
(Jujo, Saito, Ishida, Kim, Suzuki, Furuki, Ouchi) Department of
Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
(Ishii) Department of Cardiology, Cardiovascular Center, Ogikubo Hospital,
Tokyo, Japan
Title
Intimal disruption affects drug-eluting cobalt-chromium stent expansion: A
randomized trial comparing scoring and conventional balloon predilation.
Source
International Journal of Cardiology. 221 (pp 23-31), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Stent expansion remains one of the most important predictors of
restenosis and subacute thrombosis, even with the use of drug-eluting
stents. This study was designed to clarify the impact of lesion
preparation on final stent expansion. Methods Sixty-six consecutive
patients were included in this trial, and ultimately 52 enrolled
non-calcified de novo lesions were randomly assigned to undergo single
predilation with either a semi-compliant scoring balloon or a
semi-compliant conventional balloon. Lesions were treated with a single
2.5- to 3.0-mm cobalt-chromium everolimus-eluting stent under optical
coherence tomography (OCT) guidance without post-stenting dilation. Stent
expansion was defined as the ratio of OCT-measured minimum stent area to
the predicted stent area. Results Stent expansion was significantly higher
after predilation by a scoring balloon (68.0% vs. 62.1%, p = 0.017) with
similar stent lumen eccentricity (0.84 vs. 0.80, p = 0.18). Intimal
disruption was induced significantly more frequently (68.0% vs. 38.4%, p =
0.035) and was more extensive in the scoring group (122degree vs.
65degree, p = 0.038). Lesions with intimal disruption after predilation
achieved significantly higher stent expansion than that without it (67.7%
vs. 61.6%, p = 0.023). One case in the conventional group required target
lesion revascularization; however, any other adverse clinical events
including death, myocardial infarction, and stent thrombosis were not
observed up to 9 months after PCI in both groups. Conclusions In this
randomized study, pretreatment with a scoring balloon enhanced stent
expansion partly through induction of intimal disruption. Clinical trial
registration: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier:
UMIN000014176.

<23>
Accession Number
20160516286
Author
Fei Y.; Tsoi M.F.; Cheung T.T.; Cheung B.M.Y.
Institution
(Fei, Tsoi, Cheung, Cheung) Division of Clinical Pharmacology and
Therapeutics, Department of Medicine, The University of Hong Kong,
Pokfulam, China
(Cheung, Cheung) Partner State Key Laboratory of Pharmaceutical
Biotechnology, The University of Hong Kong, Pokfulam, China
(Cheung) Research Centre of Heart, Brain, Hormone and Healthy Aging, The
University of Hong Kong, Pokfulam, China
(Cheung) Institute of Cardiovascular Science and Medicine, The University
of Hong Kong, Pokfulam, China
Title
Optimal duration of dual antiplatelet therapy after drug-eluting stent
implantation: Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 220 (pp 895-900), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective After implantation of drug-eluting stents (DES), patients
usually receive 6-12 months of dual antiplatelet therapy (DAPT). However,
the optimal duration of DAPT is controversial. Therefore, we performed a
meta-analysis of randomized controlled trials to assess the risks and
benefits of different DAPT durations. Methods We searched the literature
using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library,
ClinicalTrials.gov and recent conference proceedings, and included those
trials randomizing patients to receive different durations of DAPT after
DES implantation and reporting frequencies of cardiovascular and bleeding
events. Data from eleven trials were analyzed using RevMan. Results
Compared to 12-month DAPT treatment, extended DAPT significantly reduced
the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43-0.66; p <
0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24-0.55; p < 0.00001),
but the risks of major bleeding (OR 1.54 95% CI 1.22-1.96) and all-cause
mortality (OR 1.43 95% CI 1.14-1.81) were substantially increased. There
was no significant difference in stroke, cardiovascular mortality or
repeat revascularization. Compared to short-term DAPT, 12-month DAPT or
longer was associated with increased major bleeds (OR 1.98 95% CI:
1.26-3.11). No significant differences were found in the risk of other
primary outcomes. Conclusion 12-month DAPT appears to be a pragmatic
compromise between preventing stent thrombosis and increasing bleeding
risk. Patients at high bleeding risk should have shorter duration DAPT
while those with low bleeding risk can be considered for DAPT beyond 12
months.

<24>
Accession Number
20160516249
Author
Sardar P.; Chatterjee S.; Kundu A.; Samady H.; Owan T.; Giri J.; Nairooz
R.; Selzman C.H.; Heusch G.; Gersh B.J.; Abbott J.D.; Mukherjee D.; Fang
J.C.
Institution
(Sardar, Owan, Fang) Division of Cardiovascular Medicine, University of
Utah, Salt Lake City, UT, United States
(Chatterjee) St Luke's-Roosevelt Hospital of the Mount Sinai Health
System, New York, NY, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Samady) Division of Cardiology, Department of Medicine, Emory University
School of Medicine, Atlanta, GA, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Nairooz) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Selzman) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Heusch) Institute for Pathophysiology, West German Heart and Vascular
Center, University of Essen Medical School, Hufelandstr. 55, Essen 45122,
Germany
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
(Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, RI, United States
(Mukherjee) Texas Tech University Health Sciences Center, El Paso, TX,
United States
Title
Remote ischemic preconditioning in patients undergoing cardiovascular
surgery: Evidence from a meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 221 (pp 34-41), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has been associated with
reduced risk of myocardial injury in patients undergoing cardiovascular
surgery, but uncertainty about clinical outcomes remains, particularly in
the light of 2 recent large randomized clinical trials (RCTs) which were
neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on
clinically relevant outcomes in patients undergoing cardiovascular
surgery. Methods We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web
of Science and CINAHL databases from inception through November 30, 2015.
RCTs that compared the effects of RIPC vs. control in patients undergoing
cardiac and/or vascular surgery were selected. We calculated summary
random-effect odds ratios (ORs) and 95% confidence intervals (CI). Results
The analysis included 5652 patients from 27 RCTs. RIPC reduced the risk of
myocardial infarction (MI) (OR 0.72, 95% CI, 0.52 to 1.00; p = 0.05;
number needed to treat (NNT) = 42), acute renal failure (OR 0.73, 95% CI,
0.53 to 1.00; p = 0.05; NNT = 44) as well as the composite of all cause
mortality, MI, stroke or acute renal failure (OR 0.60, 95% CI, 0.39 to
0.90; p = 0.01; NNT = 25). No significant difference between RIPC and the
control groups was observed for the outcome of all-cause mortality (OR
1.10, 95% CI, 0.81 to 1.51). Randomization to RIPC group was also
associated with significantly shorter hospital stay (weighted mean
difference - 0.15 days; 95% CI - 0.27 to - 0.03 days). Conclusions RIPC
did not decrease overall mortality, but was associated with less MI and
acute renal failure and shorter hospitalizations in patients undergoing
cardiac or vascular surgery.

<25>
Accession Number
20160512659
Author
Povsic T.J.; Roe M.T.; Ohman E.M.; Steg P.G.; James S.; Plotnikov A.;
Mundl H.; Welsh R.; Bode C.; Gibson C.M.
Institution
(Povsic, Roe, Ohman) Division of Cardiology, Duke Medicine, Durham, NC,
United States
(Povsic, Roe, Ohman) Duke Clinical Research Institute, Duke Medicine,
Durham, NC, United States
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, FACT, DHU-FIRE,
AP-HP and INSERM U-1148, Paris, France
(Steg) NHLI, Royal Brompton Hospital, Imperial College, London, United
Kingdom
(James) Department of Medical Sciences and Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Plotnikov) Janssen Research & Development, Raritan, NJ, United States
(Mundl) Bayer HealthCare, Wuppertal, Germany
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, AB, Canada
(Bode) University of Freiburg, Freiburg, Germany
(Gibson) Cardiovascular Division, Department of Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
Title
A randomized trial to compare the safety of rivaroxaban vs aspirin in
addition to either clopidogrel or ticagrelor in acute coronary syndrome:
The design of the GEMINI-ACS-1 phase II study.
Source
American Heart Journal. 174 (pp 120-128), 2016. Date of Publication: 01
Apr 2016.
Publisher
Mosby Inc.
Abstract
Dual antiplatelet therapy (DAPT), the combination of aspirin and a P2Y12
inhibitor, given for 12 months remains the standard of care after
presentation with acute coronary syndrome (ACS) because it has been shown
to be associated with a significant reduction in ischemic events compared
with aspirin monotherapy. The factor Xa inhibitor rivaroxaban was shown to
be associated with a significant reduction in the composite of
cardiovascular death, myocardial infarction, and stroke, and resulted in a
nominal reduction in cardiovascular death, when added to background DAPT
in the ATLAS ACS 2-TIMI 51 trial; however, there was excessive bleeding
with this "triple-therapy" approach. The combination of rivaroxaban with
P2Y12 inhibition in a "dual-pathway" approach may be an effective
therapeutic regimen for the treatment of ACS, given the known importance
of P2Y12 inhibition after stenting and intriguing data that the
combination of an anticoagulant with clopidogrel after stenting in
patients with atrial fibrillation appears an attractive option to this
patient population. GEMINI-ACS-1 is a prospective, randomized,
double-dummy, double-blind, active-controlled trial that will assess the
safety of dual antithrombotic therapy (rivaroxaban [2.5 mg twice daily] +
P2Y12 inhibitor) as compared with DAPT (aspirin [100 mg] + P2Y12
inhibitor) within 10 days of an ACS event in 3,000 patients. Patients will
be randomized in a 1:1 ratio stratified by intended P2Y12 inhibitor use
(clopidogrel 75 mg daily or ticagrelor 90 mg twice daily), with 1500
patients expected in each P2Y12 inhibitor strata. The primary end point is
Thrombolysis in Myocardial Infarction clinically significant bleeding
(major, minor, or requiring medical attention). The exploratory efficacy
determination will be a composite of cardiovascular death, myocardial
infarction, ischemic stroke, and stent thrombosis. GEMINI-ACS-1 will
assess the safety and feasibility of dual antithrombotic therapy with
rivaroxaban and a P2Y12 inhibitor compared with conventional DAPT for the
treatment for patients with recent ACS.

<26>
Accession Number
20160519767
Author
Blot S.I.; Rello J.; Koulenti D.
Institution
(Blot) Ghent University, Department of Internal Medicine, Campus UZ Gent,
De Pintelaan 185, Ghent 9000, Belgium
(Rello) CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain
(Koulenti) Burns Trauma and Critical Care Research Centre, The University
of Queensland, Brisbane, Australia
(Koulenti) Attikon University Hospital, 2nd Critical Care Department,
Athens, Greece
Title
The value of polyurethane-cuffed endotracheal tubes to reduce
microaspiration and intubation-related pneumonia: A systematic review of
laboratory and clinical studies.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 203. Date of
Publication: 24 Jun 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: When conventional high-volume, low-pressure cuffs of
endotracheal tubes (ETTs) are inflated, channel formation due to folds in
the cuff wall can occur. These channels facilitate microaspiration of
subglottic secretions, which is the main pathogenic mechanism leading to
intubation-related pneumonia. Ultrathin polyurethane (PU)-cuffed ETTs are
developed to minimize channel formation in the cuff wall and therefore the
risk of microaspiration and respiratory infections. Methods: We
systematically reviewed the available literature for laboratory and
clinical studies comparing fluid leakage or microaspiration and/or rates
of respiratory infections between ETTs with polyvinyl chloride (PVC) cuffs
and ETTs with PU cuffs. Results: The literature search revealed nine in
vitro experiments, one in vivo (animal) experiment, and five clinical
studies. Among the 9 in vitro studies, 10 types of PU-cuffed ETTs were
compared with 17 types of PVC-cuffed tubes, accounting for 67 vs. 108
experiments with 36 PU-cuffed tubes and 42 PVC-cuffed tubes, respectively.
Among the clinical studies, three randomized controlled trials (RCTs) were
identified that involved 708 patients. In this review, we provide evidence
that PU cuffs protect more efficiently than PVC cuffs against fluid
leakage or microaspiration. All studies with leakage and/or
microaspiration as the primary outcome demonstrated significantly less
leakage (eight in vitro and two clinical studies) or at least a tendency
toward more efficient sealing (one in vivo animal experiment). In
particular, high-risk patients intubated for shorter periods may benefit
from the more effective sealing capacity afforded by PU cuffs. For
example, cardiac surgery patients experienced a lower risk of early
postoperative pneumonia in one RCT. The evidence that PU-cuffed tubes
prevent ventilator-associated pneumonia (VAP) is less robust, probably
because microaspiration is postponed rather than eliminated. One RCT
demonstrated no difference in VAP risk between patients intubated with
either PU-cuffed or PVC-cuffed tubes, and one before-after trial
demonstrated a favorable reduction in VAP rates following the introduction
of PU-cuffed tubes. Conclusions: Current evidence can support the use of
PU-cuffed ETTs in high-risk surgical patients, while there is only very
limited evidence that PU cuffs prevent pneumonia in patients ventilated
for prolonged periods.

<27>
Accession Number
20160505734
Author
Siddik-Sayyid S.M.; Aouad M.T.; Ibrahim M.H.; Taha S.K.; Nawfal M.F.;
Tfaili Y.J.; Kaddoum R.N.; Ramamoorthy C.
Institution
(Siddik-Sayyid, Aouad, Ibrahim, Taha, Nawfal, Tfaili, Kaddoum) Department
of Anesthesiology, American University of Beirut - Medical Center, Beirut,
Lebanon
Title
Femoral arterial cannulation performed by residents: a comparison between
ultrasound-guided and palpation technique in infants and children
undergoing cardiac surgery.
Source
Paediatric Anaesthesia. 26 (8) (pp 823-830), 2016. Date of Publication: 01
Aug 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Percutaneous cannulation of the femoral artery in the
pediatric age group can be technically challenging, especially when
performed by residents in training. Objective: We examined whether the use
of real-time ultrasound guidance is superior to a palpation landmark
technique for femoral artery catheterization in children undergoing heart
surgery. Methods: Patients were prospectively randomized into two groups.
In the palpation group, the femoral artery was cannulated using the
traditional landmark method of palpation of arterial pulse. In the
ultrasound group, cannulation was guided by real-time scanning with an
ultrasound probe. Ten minutes were set as time limit for the resident's
trials during which the time taken for attempted cannulation (primary
outcome), number of attempts, number of successful cannulations on first
attempt, and success rate were compared between the two groups. Adverse
events were monitored on postoperative days 1 and 3. Results: A total of
106 patients were included in the study. The time taken for attempted
femoral artery cannulation was shorter (301 +/- 234 vs 420 +/- 248 s;
difference in mean: 119; 95% confidence interval (CI) of difference:
26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2
(1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P =
0.003] in the ultrasound group compared with the palpation group. The
number of successful cannulations on first attempt was higher in the
ultrasound group compared with palpation group [24/53 (45%) vs 13/53
(25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of
patients who had successful cannulation was 31 of 55 (58%) in the
palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95%
CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days
1 and 3. Conclusions: Ultrasound-guided femoral arterial cannulation in
children when performed by anesthesia residents is superior to the
palpation technique based on the reduction of the time taken for attempted
cannulation and the number of attempts, and improvement in first attempt
success.

<28>
Accession Number
20160503230
Author
Stewart R.A.H.; Wallentin L.; Benatar J.; Danchin N.; Hagstrom E.; Held
C.; Husted S.; Lonn E.; Stebbins A.; Chiswell K.; Vedin O.; Watson D.;
White H.D.
Institution
(Stewart, Benatar, White) Green Lane Cardiovascular Service, Auckland City
Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New
Zealand
(Wallentin, Hagstrom, Held, Vedin) Department of Medical Sciences,
Cardiology, Uppsala Clinical Research Center (UCR), Uppsala University,
Uppsala, Sweden
(Danchin) Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux
de Paris, INSERM U-970, Universite Paris Descartes, Paris, France
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Lonn) Department of Medicine, Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(Stebbins, Chiswell) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Watson) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Research Triangle Park, NC, United States
Title
Dietary patterns and the risk of major adverse cardiovascular events in a
global study of high-risk patients with stable coronary heart disease.
Source
European Heart Journal. 37 (25) (pp 1993-2001), 2016. Date of Publication:
01 Jul 2016.
Publisher
Oxford University Press
Abstract
Objectives To determine whether dietary pattern assessed by a simple
self-administered food frequency questionnaire is associated with major
adverse cardiovascular events (MACE) in high-risk patients with stable
coronary artery disease. Background A Mediterranean dietary pattern has
been associated with lower cardiovascular (CV) mortality. It is less
certain whether foods common in western diets are associated with CV risk.
Methods At baseline, 15 482 (97.8%) patients (mean age 67 +/- 9 years)
with stable coronary heart disease from 39 countries who participated in
the Stabilisation of atherosclerotic plaque by initiation of darapladib
therapy (STABILITY) trial completed a life style questionnaire which
included questions on common foods. A Mediterranean diet score (MDS) was
calculated for increasing consumption of whole grains, fruits, vegetables,
legumes, fish, and alcohol, and for less meat, and a 'Western diet score'
(WDS) for increasing consumption of refined grains, sweets and deserts,
sugared drinks, and deep fried foods. A multi-variable Cox proportional
hazards models assessed associations between MDS or WDS and MACE, defined
as CV death, non-fatal myocardial infarction, or non-fatal stroke. Results
After a median follow-up of 3.7 years MACE occurred in 7.3% of 2885
subjects with an MDS >15, 10.5% of 4018 subjects with an MDS of 13-14, and
10.8% of 8579 subjects with an MDS <12. A one unit increase in MDS >12 was
associated with lower MACE after adjusting for all covariates (+1 category
HR 0.95, 95% CI 0.91, 0.98, P = 0.002). There was no association between
WDS (adjusted model +1 category HR 0.99, 95% CI 0.97, 1.01) and MACE.
Conclusion Greater consumption of healthy foods may be more important for
secondary prevention of coronary artery disease than avoidance of less
healthy foods typical of Western diets.

<29>
Accession Number
20160502774
Author
Gui Y.-Y.; Huang F.-Y.; Huang B.-T.; Peng Y.; Liu W.; Zhang C.; Chen
S.-J.; Pu X.-B.; Wang P.-J.; Chen M.
Institution
(Gui, Huang, Huang, Peng, Liu, Zhang, Chen, Pu, Wang, Chen) Department of
Cardiology, West China Hospital, Sichuan University, China
Title
The effect of activated clotting time values for patients undergoing
percutaneous coronary intervention: A systematic review and meta-analysis.
Source
Thrombosis Research. 144 (pp 202-209), 2016. Date of Publication: 01 Aug
2016.
Publisher
Elsevier Ltd
Abstract
Our aim was to illustrate the effect of higher activated clotting time
(ACT) values versus lower ACT values on thrombotic or hemorrhagic events
in coronary atherosclerotic heart disease (CHD) patients undergoing
percutaneous coronary intervention (PCI). PubMed, Embase, Web of Science,
and Cochrane Library were searched. Observational studies assessing ACT
related major adverse cardiac event (MACE) and major bleeding were
included. Studies were allocated into three groups. Group 1 included
studies with low percentage of participants prescribed with glycoprotein
IIb/IIIa inhibitors ([GPI] < 30%), Group 2 with high percentage of
participants prescribed with GPI (> 30%), and Group 3 with routine direct
thrombin inhibitors (DTI) prescription. The cutoff is designed as 300 s
(290-310 s) for Group 1, and 250 s (240-260 s) for Group 2. With regard to
MACE and major bleeding in Group 1, there was no significant difference
between higher ACT values and lower ACT values (risk ratio [RR] for MACE,
1.16, 95% confidence interval [CI], 0.65-2.05, p = 0.62, I² =
94%, RR for major bleeding, 0.96, 95% CI, 0.66-1.40, p = 0.83,
I² = 0%). Likewise, no significant difference was found in
Group 2 between higher ACT values and lower ACT values (RR for MACE, 1.15,
95% CI, 0.97-1.35, p = 0.10, I² = 0%, RR for major bleeding,
0.85, 95% CI, 0.45-1.60, p = 0.61, I² = 83%). In conclusion,
ACT may not have a substantial effect on thrombotic or hemorrhagic
complications. Under current clinical practice, target ACT may be higher
than what is necessary to prevent thrombotic events. We may achieve a
relative low ACT level to preserve efficacy and enhance safety.

<30>
Accession Number
20160504316
Author
Zhao Y.; He Y.H.; Liu W.X.; Sun L.; Han J.C.; Man T.T.; Gu X.Y.; Chen Z.;
Wen Z.Y.; Henein M.Y.
Institution
(Zhao, He, Liu, Sun, Han, Man, Gu, Chen) Ultrasound Department, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
(Wen) Radiology Department, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Henein) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
Title
Intramyocardial Dissecting Hematoma after Acute Myocardial
Infarction-Echocardiographic Features and Clinical Outcome.
Source
Echocardiography. 33 (7) (pp 962-969), 2016. Date of Publication: 01 Jul
2016.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: Intramyocardial dissecting hematoma (IDH) after acute
myocardial infarction (MI) is a rare form of subacute cardiac rupture and
hence management uncertainties. The objective of this study was to
describe the clinical course of a small series of IDH patients and to
review the available evidence for managing similar cases. Methods: Eight
IDH patients from our center had echocardiographic, coronary angiographic
and clinical outcome data reviewed. PubMed was also searched for IDH
following MI. Cases were divided into three groups and compared according
to the dissection location. Results: In our 8 patients, 3 had septal, 1
right ventricular (RV), and 4 left ventricular (LV) dissection. Five were
medically treated and 3 surgically repaired. Reviewing the literature
revealed 68 IDH patients, of mean age 66 +/- 10 years, 43 males. The
percentage of IDH involving the LV free wall, septal, and RV free wall
were 47%, 26.5%, and 26.5%, respectively. In the cohort as a whole,
mortality was not different between surgically and medically treated
patients (33.3% vs. 54.3%, P = 0.08), neither based on the IDH location (P
= 0.49). While surgical and medical treatment of the LV free wall (20.0%
vs. 40.9%, P = 0.25) and septal (46.2% vs. 60.0%, P = 0.60) were not
different, surgical repair of RV free wall had significantly better
survival (30.0% vs. 87.5%, P = 0.015). The LVEF (P = 0.82), mitral
regurgitation (P = 0.49) failed to predict mortality. Conclusion: While
survival following medical and surgical treatment of LV IDH is not
different, patients with RV free wall dissection benefit significantly
from surgical repair.

<31>
Accession Number
20160515204
Author
Gholipour Baradari A.; Emami Zeydi A.; Ghafari R.; Aarabi M.; Jafari M.
Institution
(Gholipour Baradari) Department of Anesthesiology and Critical Care
Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
(Emami Zeydi) Student Research Committee, Department of Medical-Surgical
Nursing, School of Nursing and Midwifery, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
(Emami Zeydi) Department of Nursing, Faculty of Nursing and Midwifery,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Aarabi) Department of Epidemiology, Health Sciences Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Jafari) Faculty of Medicine, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
Title
A double-blind randomized clinical trial comparing different doses of
magnesium in cardioplegic solution for prevention of atrial fibrillation
after coronary artery bypass graft surgery.
Source
Cardiovascular Therapeutics. 34 (4) (pp 276-282), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Aims: This study aims to compare different doses of magnesium administered
via cardioplegic solutions to prevent atrial fibrillation (AF) after
coronary artery bypass graft (CABG) surgery. Methods: A total of 120
patients who were scheduled for elective CABG surgery using
cardiopulmonary bypass were enrolled in this double-blind, randomized
clinical trial. After fulfilling the inclusion criteria, they were
randomly allocated into three groups (A, B, and C). Patients in groups A,
B, and C received 60, 80, and 100 mg/kg of magnesium sulfate via
cardioplegic solutions during aortic cross-clamp, respectively.
Postoperative AF was assessed by continuous ECG monitoring during 3 days
after surgery. Also serum magnesium, potassium, and calcium levels were
assessed during the study period. Results: The findings revealed
significant differences in four point measurements of serum magnesium
level after surgery (P<.001). In particular, it was observed that 10
(26.3%) patients in group A, 4 (10%) patients in group B, and 2 (5.4%)
patients in group C had AF after surgery. This indicates patients
receiving magnesium at doses of 80 and 100 mg/kg had lower rates of AF
occurrence than those receiving 60 mg/kg dose of magnesium (P=.02).
Additionally, no significant difference was found in serum calcium and
potassium concentration between the three groups throughout the study
period. Conclusion: Magnesium administration via the cardioplegic solution
during aortic cross-clamping at doses of 80 and 100 mg/kg can reduce the
risk of AF occurrence after CABG compared to the dose of 60 mg/kg.
Considering the lower rate of AF incidence and shorter length of ICU stay
in patients receiving 100 mg/kg of magnesium, it seems reasonable to
administer 100 mg/kg magnesium during aortic cross-clamp to prevent
postoperative AF.

<32>
Accession Number
20160515201
Author
Aslanabadi N.; Safaie N.; Asgharzadeh Y.; Houshmand F.; Ghaffari S.;
Garjani A.; Dousti S.; Hamishehkar H.; Entezari-Maleki T.
Institution
(Aslanabadi, Safaie, Asgharzadeh, Ghaffari, Garjani, Entezari-Maleki)
Cardiovascular Research Center, Tabriz University of Medical Sciences,
Tabriz, Iran, Islamic Republic of
(Houshmand, Hamishehkar, Entezari-Maleki) Drug Applied Research Center,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Dousti) Department of Pediatrics, Children's Hospital, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
The randomized clinical trial of coenzyme Q10 for the prevention of
periprocedural myocardial injury following elective percutaneous coronary
intervention.
Source
Cardiovascular Therapeutics. 34 (4) (pp 254-260), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Periprocedural myocardial injury (PMI) following elective
percutaneous coronary intervention (PCI) is an important therapeutic
concern with remaining some mortality and morbidity. To the best of our
knowledge, there is no published study that investigates the potential
benefit of CoQ10 in preventing PMI following elective PCI. Methods: In a
randomized, clinical trial, 100 patients who scheduled for elective PCI
were allocated in to the intervention (n=50) and control group (n=50). The
intervention received a 300 mg loading dose CoQ10 12 hours before
procedure. The level of CK-MB and troponin-I was measured before
procedure, and 8 and 24 hours after. Furthermore, hs-CRP was measured at
baseline and 24 hours after. All patients were assessed for the incidence
of major adverse cardiac effects (MACEs) after 1 month. Results: The CK-MB
elevation (above the upper limit normal) was occurred in 22% (n=11) of
CoQ10 and 20% (n=10) of control (P=.806). The elevation of troponin-I was
documented in 8% (n=4) of both groups. No significant change in the level
of cardiac biomarkers was noted. However, the significant reduction in
hs-CRP level was occurred in CoQ10 group (P=.032). Conclusion: The results
showed that pretreatment with 300 mg CoQ10 12 hours before procedure could
not reduce PMI following elective PCI, however, significantly decreased
hs-CRP.

<33>
Accession Number
20160515198
Author
Xu L.-X.; Chen K.-Y.; Liu T.; Zheng X.-T.; Jiao Z.-Q.; Xu Y.; Li G.
Institution
(Xu, Chen, Liu, Zheng, Jiao, Xu, Li) Department of Cardiology, Tianjin Key
Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin
Institute of Cardiology, Second Hospital of Tianjin Medical University,
Tianjin, China
Title
Adjunctive loading dose of cilostazol in preventing periprocedural
myocardial infarction.
Source
Cardiovascular Therapeutics. 34 (4) (pp 225-233), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Periprocedural myocardial infarction (PMI) is a common
complication of percutaneous coronary intervention (PCI). This study
evaluated the safety and efficacy of adjunctive loading dose of cilostazol
in preventing PMI in patients with acute coronary syndrome (ACS). Methods:
A total of 113 patients with ACS undergoing PCI were randomized to receive
loading doses of dual (aspirin plus clopidogrel; DAPT group; n=57) or
triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol;
TAPT group; n=56). The loading and maintenance doses were 100 and 50 mg
bid for cilostazol. Patients in the TAPT group received adjunctive
cilostazol for 1 week. Cardiac biomarkers were measured before PCI, 8 and
24 hours after PCI to determine the incidence of PMI. Results: There was
no significant difference in the incidence of PMI between the TAPT and
DAPT groups (32.1% vs 47.4%, P=.098). However, in the antiplatelet-naive
subgroup, TAPT significantly lowered the incidence of PMI compared to DAPT
(17.9% vs 42.9%, P=.042). In the antiplatelet-treated subgroup, the
incidences of PMI were comparable (46.4% vs 51.7%, P=.698). Multivariable
logistic analysis showed that antiplatelet-treated (vs antiplatelet-naive)
(hazard ratio [HR]: 2.45; 95% confidence interval [CI]: 1.09-5.52; P=.030)
subgroup was independently associated with PMI. However, TAPT (vs DAPT)
(HR: 0.51; 95% CI: 0.23-1.14; P=.102) was not an independent protective
factor of PMI. Conclusions: The present single-center, randomized study
indicates that TAPT with adjunctive cilostazol was not associated with
lower incidence of PCI-related PMI in patients with ACS. Further study
with large study population is needed to get definite conclusions.

<34>
Accession Number
20160512935
Author
Pagnesi M.; Martino E.A.; Chiarito M.; Mangieri A.; Jabbour R.J.; Van
Mieghem N.M.; Kodali S.K.; Godino C.; Landoni G.; Colombo A.; Latib A.
Institution
(Pagnesi, Chiarito, Mangieri, Jabbour, Godino, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Jabbour, Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus, Milan, Italy
(Jabbour) Imperial College, London, United Kingdom
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
(Kodali) Department of Medicine, Columbia University Medical Center/New
York Presbyterian Hospital, New York, NY, United States
(Landoni, Colombo) Vita-Salute San Raffaele University, Milan, Italy
Title
Silent cerebral injury after transcatheter aortic valve implantation and
the preventive role of embolic protection devices: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 221 (pp 97-106), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The aims of this study were: 1) to evaluate silent cerebral
injury detected by cerebral diffusion weighted magnetic resonance imaging
(DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to
assess the efficacy of embolic protection devices (EPDs) on DW-MRI
endpoints. Methods We included in a pooled analysis 25 prospective studies
reporting post-procedural cerebral DW-MRI data after TAVI (n = 1225).
Among these studies, we included in a meta-analysis 6 studies
investigating TAVI performed with versus without EPDs (n = 384). Primary
endpoints were the number of new lesions per patient and the total lesion
volume, while secondary endpoints were the number of patients with new
lesions and the single lesion volume. Results The main pooled DW-MRI
outcomes were: patients with new ischemic lesions, 77.5% (95% confidence
interval = 71.7-83.3%); total lesion volume, 437.5 mm³
(286.7-588.3 mm³); single lesion volume, 78.1 mm³
(56.7-99.5 mm³); and number of new lesions per patient, 4.2
(3.4-5.0). The use of EPDs was associated with a significant reduction in
total lesion volume (mean difference [95% confidence interval] = - 111.1
mm³ [- 203.6 to - 18.6 mm³]; p = 0.02) and single
lesion volume (- 12.1 mm³ [- 18.3 to - 6.0 mm³]; p =
0.0001) after TAVI. Conclusions Silent cerebral injury occurs in the
majority of patients undergoing TAVI and DW-MRI allows a precise
characterization of new ischemic brain lesions. EPDs reduce the total and
single volume of such lesions detected after the procedure, although the
number of new lesions per patient and the number of patients with new
lesions are not significantly reduced by such devices.

<35>
Accession Number
20160491315
Author
Gao F.; Yang L.-H.; He H.-R.; Ma X.-C.; Lu J.; Zhai Y.-J.; Guo L.-T.; Wang
X.; Zheng J.
Institution
(Gao, Yang, He, Ma, Lu, Zheng) Clinical Research Center, The First
Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road,
Xi'an, Shaanxi, China
(Ma) Department of Psychiatry, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
(Zhai) Department of Pharmacy, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
(Guo, Wang) Department of Critical Care Medicine, The First Affiliated
Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an,
Shaanxi, China
Title
The effect of reintubation on ventilator-associated pneumonia and
mortality among mechanically ventilated patients with intubation: A
systematic review and meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (4) (pp 363-371),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc.
Abstract
Objectives: This meta-analysis summarized the risks that reintubation
impose on ventilator-associated pneumonia (VAP) and mortality. Background:
Extubation failure increases the probability of poor clinical outcomes
pertaining to mechanical ventilation. Methods: Literature published during
a 15-year period was retrieved from PubMed, Web of Knowledge databases,
the Embase (Excerpa Medica database), and the Cochrane Library. Data
involving reintubation, VAP, and mortality were extracted for a
meta-analysis. Results: Forty-one studies involving 29,923 patients were
enrolled for the analysis. The summary odds ratio (OR) between VAP and
reintubation was 7.57 (95% confidence interval [CI] = 3.63-15.81). The
merged ORs for mortality in hospital and intensive care unit were 3.33
(95% CI = 2.02-5.49) and 7.50 (95% CI = 4.60-12.21), respectively.
Conclusions: Reintubation can represent a threat to survival and increase
the risk of VAP. The risk of mortality after reintubation differs between
planned and unplanned extubation. Extubation failure is associated with a
higher risk of VAP in the cardiac surgery population than in the general
population.

<36>
Accession Number
20160491534
Author
Saracoglu A.; Saracoglu K.T.
Institution
(Saracoglu, Saracoglu) Department of Anesthesiology and Reanimation,
Istanbul Bilim University Medical School, Florence Nightingale Hospital,
Abide-i Hurriyet Cad. No. 164 Sisli Caglayan, Istanbul, Turkey
Title
VivaSight: A new era in the evolution of tracheal tubes.
Source
Journal of Clinical Anesthesia. 33 (pp 442-449), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc.
Abstract
Study objective To evaluate the available data describing the use of
single and double lumen VivaSight tubes. Design Systematic review. Setting
The use of VivaSight tubes for elective surgeries including advantages,
disadvantages, and possible complications. Patients Systematic review of
randomized controlled trials from databases including Medline, Web of
Knowledge, Google Scholar, and Cochrane Central Register of Controlled
Trials. Interventions Comparison of VivaSight single and double-lumen
tubes with conventional tubes during normal airway and expected difficult
airway management. The effectiveness of the devices was also evaluated
during 1-lung ventilation for patients undergoing thoracic surgery.
Measurements Intubation time, success rate, the requirement for fiberoptic
bronchoscope, and the rate of complications. Main Results Following a
VivaSight double-lumen tube, a flexible bronchoscope is still needed. It
is difficult to agree that VivaSight tube reduces the need or use of a
bronchoscope. According to the current literature, it is unclear if there
is any advantage of the VivaSight compared with using flexible
bronchoscopy to direct a blocker into the correct lung. The cost may be
another issue. Studies comparing VivaSight tubes with standard double
lumen tubes reported faster tracheal intubation rate and higher success
rate at first attempt for VivaSight. However, VivaSight tubes may cause
soft tissue trauma such as bleeding, hematoma, edema, and erythema. Sore
throat and dysphonia are other reported complications. Due to the outer
thickness, smaller-sized double-lumen tube may be necessary. It has been
reported to have the disadvantages, such as melting due to the heat of
light source before insertion and sudden shutdown without warning.
Conclusions Problems such as overheating and melting on the distal end of
the tube due to the light source and potential breakdowns of the cable
should be solved by the manufacturer. This will probably require a
redesign and necessitate further studies.

<37>
Accession Number
72344001
Author
Anonymous
Title
Abstracts for the Cardiac Society of Australia and New Zealand Annual
Scientific Meeting and the International Society for Heart Research
Australasian Section Annual Scientific Meeting 2016.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (no pagination), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
The proceedings contain 98 papers. The topics discussed include: utility
of endocarditis-specific risk scores to predict mortality and morbidity
after infective endocarditis surgery; meta-analysis of risk scores at
predicting mortality after surgery for infective endocarditis; renal
failure after isolated aortic valve replacement: predictors and outcomes;
investigation into resuscitated sudden death; how are we doing?; atrial
fibrillation in New Zealand primary care; outcome comparison between
endotracheal intubation and laryngeal mask airway use in out-of-hospital
cardiac arrest: a New Zealand registry study; impact of a heart failure
discharge pathway on quality of care markers among heart failure patients
admitted to general medicine; resurrect: resumption of platelet function
by verify now P2Y12 assay after the cessation of ticagelor in patients
with acute coronary syndrome awaiting coronary artery bypass grafting
surgery; inter-observer agreement and variability using 3D
echocardiography based mitral valve reconstruction; and system change to
deliver timely reperfusion for myocardial infarction in regional New
Zealand: the NMDHB STEMI pathway experience.

<38>
Accession Number
72343979
Author
Wang T.K.M.; Min Wang M.T.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Min Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Meta-analysis of risk scores at predicting mortality after surgery for
infective endocarditis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (pp S31), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Surgery is indicated in infective endocarditis patients with
heart failure, uncontrolled infection and prevention of systemic embolism.
Risk scores play an important role in stratification for cardiac surgery,
but have been rarely utilised in the endocarditis setting. We
meta-analysed the performance of surgical risk models in endocarditis
surgery. Methods: MEDLINE, Embase, Cochrane and Web of Science databases
from 1 January 1980 to 31 December 2015 were searched. Two authors
independently assessed studies for inclusion, and then extracted data for
pooled analyses. Results: Amongst 480 articles searched, 20 full-text
articles were screened and 8 studies (1,743 cases) included for analyses.
Mean Euro SCORE was 20.2% with overall operative mortality 16.3% (O/E
ratio 0.80) and EuroSCORE II 12.3% with overall operative mortality 14.9%
(O/E ratio 1.21); other scores (STS, De Feo, Pulsuse and Costa) were
excluded as their performance were reported in no more than one external
validation study. Areas under curve (95% confidence interval) of operative
mortality were 0.76 (0.72-0.81) for Euro- SCORE in seven studies and 0.79
(0.72-0.85) for Euro SCORE II in three studies. Peto's odds ratios (95%
confidence interval) were 0.76 (0.57-1.01) for EuroSCORE and 1.25
(0.84-1.86) for Euro SCORE II. Conclusion: The general EuroSCORE and Euro
SCORE II had good discrimination of operative mortality for endocarditis
surgery, however Euro SCORE had a trend to over-estimating operative
mortality. There is a need for further studies of general and
endocarditis-specific risk scores for endocarditis surgery, as well as
development of logistic risk models.

<39>
Accession Number
72343977
Author
Wang M.T.M.; Wang T.K.M.; Pemberton J.
Institution
(Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
Title
Meta-analysis of mitral valve repair versus replacement for infective
endocarditis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (pp S30-S31), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve repair has superior results to replacement for
severe degenerative mitral valve disease, however in the infective
endocarditis setting, mixed results have been reported. We compared the
outcomes of mitral valve repair and replacement for infective endocarditis
in this meta-analysis. Methods: MEDLINE, Embase and Cochrane databases
from 1 January 1980 to 31 December 2015 were searched for original
studies. Two authors evaluated these studies for inclusion independently,
then data were extracted and pooled. Results: A total of 3,976 papers was
obtained from the search, 99 full-texts were reviewed, and 13 studies
which included both mitral valve repair and replacement patients involving
8,130 patients were included for analyses. Pooled rates and odds ratio
(95% confidence interval) for operative mortality of repair versus
replacement were 3.7% vs 10.9%, 0.33 (0.26-0.41). Odds ratio for long-term
mortality at 1-year (n = 4) was 0.31 (0.14-0.72), and at 5 years (n = 8)
was 0.42 (0.25-0.69). Perioperative stroke rates and odds ratio (n = 4)
were 2.8% vs 3.8%, 0.75 (0.55-1.00). Five-year recurrent endocarditis and
redo-operations (n = 6 for both) odds ratios were 0.39 (0.10-1.58) and
0.49 (0.12-2.02) respectively. Similar results were observed when one
large study making up 85% of the meta-analysis cohort population was
removed. Conclusion: Mitral valve repair is associated with reduction
inmortality and stroke, and similar recurrent endocarditis and
redo-operation rates compared to mitral valve replacement in mitral valve
endocarditis. It is therefore preferred when feasible, similar to surgery
for degenerative mitral valve disease.

<40>
Accession Number
72343976
Author
Wang M.T.M.; Wang T.K.M.; Pemberton J.
Institution
(Wang) University of Auckland, Auckland, New Zealand
(Wang, Pemberton) Auckland City Hospital, Auckland, New Zealand
Title
Early versus delayed surgery for infective endocarditis complicated by
cerebral embolism: A meta-analysis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (pp S30), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Surgery is recommended for infective endocarditis patients who
develop ischaemic stroke, however the optimal timing of surgery remains
controversial. In this metaanalysis, we compared the outcomes of early and
delayed cardiac surgery for infective endocarditis in this setting.
Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases from 1
January 1980 to 30 June 2015 were searched for original studies. Two
authors evaluated these studies for inclusion independently, then
extracted and pooled data for analyses. Results: Amongst 2,423 papers
obtained from the search, 23 full-texts were reviewed, and 6 studies
involving 701 patients were included for analyses. Early surgery was
defined as less than 7 days from diagnosis in 2 studies and less than 14
days in 4 studies. Rates and pooled odds ratio (95% confidence interval)
for operative mortality of early or late surgery set at 7 days were 13.5%
vs 10.8%, 1.40 (0.61-3.02); 14 days were 20.7% vs 13.0%, 1.95 (0.95-4.01);
and all "early or late surgery" 14.5% vs 10.2%, 1.58 (1.01-2.47). Pooled
odds ratio of early versus late surgery for long-term mortality was 2.95
(0.35- 25.0), and for neurological events during follow-up, pooled odds
ratio for embolic events was 1.22 (0.33-4.56) and for intracranial
bleeding 1.55 (0.16-15.32). Conclusion: Early surgery within 1-2 weeks of
diagnosis of infective endocarditis with cerebral embolism can be safely
performed, and is not associated with statistically higher long-term
mortality or neurological events. Data is however limited and larger and
randomised studies would help to determine the optimal timing.

<41>
Accession Number
72343945
Author
Wang T.K.M.; Wang M.T.M.; Ruygrok P.
Institution
(Wang, Ruygrok) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wang, Ruygrok) Department of Medicine, University of Auckland, Auckland,
New Zealand
Title
Percutaneous mitraclip versus mitral valve surgery: Meta-analysis of
treating severe mitral regurgitation.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (pp S18-S19), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve surgery (MVS) is recommended for severe
symptomatic mitral regurgitation (MR). The recent introduction of
percutaneous Mitraclip procedure especially in high risk patients adds
another dimension to MR management. We compared the characteristics and
outcomes of MitraClip and MVS in this meta-analysis. Methods: PubMed,
MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30
June 2015 were searched for original studies. Two authors evaluated these
studies for inclusion independently, then extracted and pooled data using
random-effects models. Results: Seven studies (one randomised trial and
six observational studies) were included from the 547 papers searched,
totaling 574 Mitraclip and 441 MVS procedures. Functional MR made up 47.2%
of MitraClip and 59.6% of MVS (P=0.003). At baseline, mitralclip patients
were significantly older (P<0.001), more likely to have previous cardiac
surgery (P<0.001) and had lower ejection fraction (P<0.001) and higher
EuroSCORE (P<0.001). MitraClip had higher rate of at least moderate MR
postoperatively compared to MVS (15.8% vs 0.5%, P<0.001). There were no
differences in mortality (1.6% vs 3.1%, P=0.58), neurological events (0.7%
vs 1.6%, P=0.34) or re-operations for prosthetic incompetence (2.0% vs
1.0%, P=0.56) in-hospital or within 30 days respectively. At 12 months
there were no differences in mortality (11.3% vs 10.2%, P=0.41) or New
York Heart Association Class III/IV (5.7% vs 11.3%, P=0.42). Conclusion:
Patients undergoing MitraClip had higher baseline risk than MVS, but there
were no significant differences in mortality, morbidity or symptoms up to
12 months, except for higher rates of significant MR postoperatively.

<42>
Accession Number
72343943
Author
Wang T.K.M.; Ruygrok P.
Institution
(Wang, Ruygrok) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Ruygrok) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Surgical risk scores in transcatheter aortic valve implantation:
Meta-analysis of performance.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting and the International Society for
Heart Research Australasian Section Annual Scientific Meeting 2016 Rotorua
New Zealand. Conference Start: 20160623 Conference End: 20160625.
Conference Publication: (var.pagings). 25 (pp S17-S18), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is considered
in patients with severe aortic valve disease at high risk for surgical
aortic valve replacement. Risk stratification plays a critical role in
selecting the appropriate treatment modality. We compared the prognostic
utility of surgical risk scores at predicting mortality after TAVI in this
meta-analysis. Methods: MEDLINE, Embase, Cochrane and Web of Science
databases from 1 January 1980 to 31 December 2015 were searched. Studies
were systematically reviewed for inclusion, then data extracted for pooled
analyses. Results: Amongst 1688 articles searched, 47 full-text articles
were screened and 23 studies (11,936 TAVI cases) included for analyses.
Areas under curve (95% confidence interval) for operative mortality were
Euro SCORE 0.61 (0.56- 0.66) in 20 studies, Euro SCORE II 0.62 (0.59-0.66)
in 15 studies, STS Score 0.62 (0.59-0.65) in 20 studies, Ambler Score 0.54
(0.49-0.58) in 4 studies and Parsonnet Score 0.51 (0.44-0.58) in 2
studies. Respective Peto's odds ratios (95% confidence interval) were Euro
SCORE 0.32 (0.30-0.35), Euro SCORE II 1.31 (1.14-1.50), STS 0.84
(0.76-0.94), Ambler Score 1.46 (1.09- 1.96) and Parsonnet Score 0.38
(0.29-0.50). Areas under curve (95% confidence interval) for 1-year
mortality were Euro- SCORE 0.62 (0.57-0.67), EuroSCORE II 0.66 (0.61-0.71)
and STS Score 0.58 (0.53-0.64). Conclusion: Only the widely used Euro
SCORE, Euro- SCORE II and STS Scores moderately discriminated operative
and 1-year mortality. Euro SCORE and Parsonnet score grossly
over-estimated operative mortality, while Euro SCORE II/Ambler Score and
STS Score marginally under-estimated and over-estimated operative
mortality respectively, but this varied by the level of estimated surgical
risk.

<43>
Accession Number
72346830
Author
Ando T.; Taub C.
Institution
(Ando) Mount Sinai Beth Israel, New York, NY, United States
(Taub) Montefiore Medical Center, Bronx, NY, United States
Title
Paravalvular regurgitation in sapien 3 versus sapien xt following
transcatheter aortic valve replacement: A meta-analysis.
Source
Journal of the American Society of Echocardiography. Conference: 27th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2016 Seattle, WA United States. Conference Start: 20160610 Conference
End: 20160614. Conference Publication: (var.pagings). 29 (6) (pp B44),
2016. Date of Publication: June 2016.
Publisher
Mosby Inc.
Abstract
Background: Paravalvular regurgitation (PVR) is a known negative predictor
for survival in patients undergoing transcatheter aortic valve replacement
(TAVR). The new generation Sapien 3 (S3) was designed to decrease PVR. We
sought to assess its effect on PVR compared to its predecessor model,
Sapien XT (SXT). Methods: A systematic literature search through PUBMED,
EMBASE and Cochran library was conducted. Only the published data were
included. Random effect model was used to calculate odds ratio (OR) and
95% confidence intervals (CI) were calculated for the PVR risk for S3
against SXT. PAR was defined according to the Valve Academic Research
Consortium-2. Meta- Analysis was performed with EZR. Results: We
identified 6 observational cohort studies including total of 1,575
patients (481 patients in S3, 1.094 patients in SXT). More than mild PVR
was observed in 31.9% in S3 and 62.0% in SXT. More than moderate PVR was
seen in 1.2% in S3 whereas it was 7.5% in SXT. More than Mild PVR (OR
0.31, 95%CI 0.24-0.40, I2=0%, p<0.0001) as well as more than moderate PVR
(OR 0.19, 95%CI 0.09-0.42, I2=0%, p<0.0001) were observed less in S3
compared to SXT. There were no differences in all-cause short-term
mortality (range: in-hospital to 30 day) (OR 0.55, 95%CI 0.26-1.17, I2=0%,
p=0.12). Conclusion: S3 resulted in less PVR in both more than mild and
moderate PVR compared to SXT. The short-term mortality did not differ
between S3 and SXT. Whether this observation is associated with improved
outcome needs long-term follow up and further investigation..

<44>
Accession Number
72345352
Author
O'Sullivan K.; Hurley E.T.; Segurado R.; Hurley J.P.
Institution
(O'Sullivan) Mater Misericordiae University Hospital, Dublin, Ireland
(Hurley, Hurley) Department of Cardiothoracic Surgery, Mater Private
Hospital, Dublin, Ireland
(Segurado) Centre for Statistical Training and Research, University
College Dublin, Ireland
Title
A meta analysis examining the incidence of permanent pacemaker
implantation following sutureless aortic valve implantation.
Source
Heart. Conference: 2015 Annual Conference of the Irish Cardiac Society and
AGM Killarney Ireland. Conference Start: 20151008 Conference End:
20151010. Conference Publication: (var.pagings). 101 (pp A33-A34), 2015.
Date of Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Background Sutureless aortic valve prostheses are anchored by radial force
in a mechanism similar to that of transcatheter aortic valve implantation
(TAVI). TAVI is associated with an increased permanent pacemaker (PPM)
requirement in a significant proportion of patients. We undertook a
meta-analysis to examine the incidence of PPM insertion associated with
sutureless compared with conventional SAVR. Methods A systematic review
was conducted in accordance with the Prisma guidelines (1). PubMed was
searched by entering the following in the searching algorithm: sutureless
AND aortic AND valve, tissue AND aortic AND valve, mechanical AND aortic
AND valve. English was set as a language restriction. All searches were
performed on August 10th2014. Studies between 2007 and 2014 were included
in the search. A mixed-effects meta-regression with sutureless vs
conventional as a fixed moderator variable was performed. Results In
total, 832 patients were included in the sutureless group and 3,740 in the
conventional group. Permanent pacemaker implantation rate was higher in
the sutureless cohort (9.1 vs 2.4% p = 0.025). Cardiopulmonary bypass and
aortic cross clamp times were shorter in the sutureless group (64.9 vs.
86.7 min p = 0.002, 39.8 vs. 62.4 min p < 0.001). No statistically
significant differences in PVR grades 1-4 were identified between groups
(Grade 1: 3.6 vs. 1.4% p = 0.107, Grade 2: 0.9 vs. 0.3% p = 0.264, Grade
3-4 0 vs. 0.4% p = 0.942). There was no difference in 30-day mortality
between sutureless and conventional cohorts (1.9 vs. 3.2% p = 0.146).
Conclusion Sutureless aortic valve prostheses are associated with a higher
incidence of PPM insertion but shorter implantation time than
conventional, with no difference in 30-day mortality. Further
investigation as to the prognostic significance of pacemaker requirement
following sutureless aortic valve replacement is required.

<45>
Accession Number
72345307
Author
Mahon N.; O'Neill J.; O'Brien S.; McCarthy J.; O'Loughlin C.; Carton E.
Institution
(Mahon, O'Neill, O'Brien, McCarthy, O'Loughlin, Carton) Mater
Misericordiae University Hospital, Dublin, Ireland
Title
Outcome of extra-corporeal life support for fulminant heart
failure/cardiogenic shock.
Source
Heart. Conference: 2015 Annual Conference of the Irish Cardiac Society and
AGM Killarney Ireland. Conference Start: 20151008 Conference End:
20151010. Conference Publication: (var.pagings). 101 (pp A9), 2015. Date
of Publication: 2015.
Publisher
BMJ Publishing Group
Abstract
Background Fulminant heart failure (so called 'crash and burn') are
associated with a grim prognosis, and the outcomes of ventricular assist
device (VAD) implantation in this group are poor. Accordingly
extracorporeal life support (ECLS) systems have emerged as options for
stabilisation of these patients allowing for a more definitive
intervention at a later stage ('bridge to decision' or 'bridge to
bridge'). Aim and methods To evaluate ECLS outcomes for fulminant heart
failure / cardiogenic shock (CS) and to compare these with ECLS outcomes
for other indications. A systematic review of all cases of ECLS for
cardiac indications in one institution since program inception was
undertaken. Results Between 2009 and 2015, 37 patients underwent cardiac
ECLS (Cardiohelp Maquest, Germany) for a median of 5 days range (range:
1-13 days) and a total of 193 ELCS days. Fourteen patients (37%) had CS,
16 patients (43%) had post-cardiotomy cardiogenic shock (PCCS) and 7
patients (19%) had ECLS during cardiopulmonary resuscitation (ECPR).
Survival to hospital discharge was 75% and 57% among the PCCS and ECPR
groups respectively. Of the 14 CS patients, 3 (21%) survived, one to
hospital discharge ('bridge to recovery') and 2 to VAD implantation as
bridge to transplantation ('bridge to bridge'). The remaining 11 CS
patients were deemed unsuitable for further intervention and did not
survive. Conclusion ECLS for fulminant heart failure can be life saving.
However, expectations should be tempered by the fact that overall outcomes
in this group remains poor. While certain presentations, such as fulminant
myocarditis, can neither be prevented nor predicted, in less acute
situations timely recognition of patients who might ultimately require
cardiac transplantation is desirable.

<46>
Accession Number
72340288
Author
Gordon L.E.; Scallan O.; Forbes T.
Institution
(Gordon, Forbes) University of Toronto, Toronto, ON, Canada
(Scallan) London Health Sciences Centre, London, ON, Canada
Title
Learning curves in vascular surgery: A systematic review of current
practice.
Source
Journal of Vascular Surgery. Conference: 2016 Vascular Annual Meeting of
the Society for Vascular Surgery Harbor, MD United States. Conference
Start: 20160608 Conference End: 20160611. Conference Publication:
(var.pagings). 63 (6 SUPPL. 1) (pp 99S), 2016. Date of Publication: June
2016.
Publisher
Mosby Inc.
Abstract
Objectives: Defining learning curves in vascular surgery assists in
adopting new techniques and educating new vascular trainees. Cumulative
sum (CUSUM) analysis is often used for these learning curves and has been
readily adopted in both cardiac and general surgery for quality monitoring
and medical education research. This technique graphs sequential
procedures and can detect deviations in performance for the better or
worse. A number of comparatively new CUSUM methods, including
risk-adjusted (RA-CUSUM) analysis and learning curve (LC-CUSUM) methods,
provide opportunities to analyze learning with diverse case mixes and
determine the length of learning curve, respectively. We sought to
categorize how cumulative sum methods have been used in the vascular
literature to analyze learning curves. Methods: We searched the databases
Medline, EMBASE, Web of Science, MathSciNet, and Current Index to
Statistics for articles using cumulative sum for learning curve estimation
in vascular surgery. The references were screened by two independent
reviewers. Included articles used CUSUM to construct learning curves for
vascular surgical interventions and training in simulation. We excluded
animal studies and articles exclusively analyzing vascular medicine.
Results: Fourteen articles were identified during our search of the
literature, published between 2004 and 2015, by nine different first
authors. Seven articles identified learning curves in abdominal aortic
repair, three articles focused on thoracic aortic repair, two on carotid
endarterectomy, one on combined arterial procedures, and one on skills in
simulation. Twelve articles used a classic cumulative sum technique, while
only two of these articles used a risk-adjusted CUSUM method. Notably, no
articles used an LC-CUSUM technique. Setting, reporting, and
interpretation of CUSUM parameters varied considerably between articles.
Conclusions: CUSUM analysis has been slow to be adopted in the vascular
surgery literature, perhaps due to lack of publicity or lack of knowledge
as to how to construct CUSUM charts. Reporting standards for CUSUM
analysis are still needed in order to critically evaluate and compare
these statistical techniques in the literature. Furthermore, we would
encourage the use of RA-CUSUM to determine the effects of a diverse case
mix on a learning curve as well as LC-CUSUM to answer questions about time
to proficiency and durability of learning when a surgeon adopts a new
procedure.