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

<2>
Accession Number
20160194019
Author
Allen K.B.; Fowler V.G.; Gammie J.S.; Hartzel J.S.; Onorato M.T.; DiNubile
M.J.; Sobanjo-ter Meulen A.
Institution
(Allen) St. Luke's Mid-America Heart and Vascular Institute, Kansas City,
MO, United States
(Fowler) Duke University Medical Center, Durham, NC, United States
(Gammie) University of Maryland School of Medicine, Baltimore, United
States
(Hartzel, Onorato, DiNubile, Sobanjo-ter Meulen) Merck Sharp and Dohme,
Whitehouse Station, NJ, United States
(Sobanjo-ter Meulen) The Bill and Melinda Gates Foundation, New York, NY,
United States
Title
Staphylococcus aureus infections after elective cardiothoracic surgery:
Observations from an international randomized placebo-controlled trial of
an investigational S aureus vaccine.
Source
Open Forum Infectious Diseases. 1 (2) (no pagination), 2014. Date of
Publication: 2014.
Publisher
Oxford University Press
Abstract
Background. An unmet need to prevent Staphylococcus aureus (SA) infections
after cardiothoracic surgery persists despite current practices.
Cost-effective implementation of preventive strategies requires
contemporary knowledge about modifiable risk factors. Methods. From 2007
to 2011, an international, double-blind, randomized placebo-controlled
trial of a novel SA vaccine (V710) was conducted in 7664 adults scheduled
for median sternotomy at 164 sites. We analyzed SA infections developing
up to 360 days postoperatively in 3832 placebo recipients. Results.
Coronary artery bypass grafting was performed in 80.8% (3096 of 3832) of
placebo recipients. The overall incidence of any postoperative SA
infection was 3.1% (120 of 3832). Invasive SA infections (including
bacteremia and deep sternal-wound infections) developed in 1.0%.
Methicillin-resistant SA (MRSA) accounted for 19% (23 of 120) of SA
infections, with 57% (13 of 23) of the MRSA infections occurring in
diabetic patients. All-cause mortality was 4.1% (153 of 3712) in patients
without SA infection, 7.2% (7 of 97) in methicillin-susceptible SA (MSSA)
infections, and 17.3% (4 of 23) in MRSA infections (P < .01).
Staphylococcus aureus nasal carriage was detected preoperatively in 18.3%
(701 of 3096) patients, including 1.6% colonized with MRSA. Postoperative
SA infections occurred in 7.0% (49 of 701) of colonized patients versus
2.3% (71 of 3131) of patients without colonization (relative risk = 3.1
[95% confidence interval, 2.2-4.4]). Conclusions. In this large
international cohort of patients undergoing cardiac surgery and observed
prospectively, invasive postoperative SA infections occurred in 1% of
adult patients despite modern perioperative management. The attributable
mortality rates were 3% for MSSA and 13% for MRSA infections. Preoperative
nasal colonization with SA increased the risk of postoperative infection
threefold. The utility of strategies to reduce this incidence warrants
continued investigation.

<3>
Accession Number
26518388
Author
Zhou C.; Gong J.; Chen D.; Wang W.; Liu M.; Liu B.
Institution
(Zhou) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Gong) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Chen) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Wang) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Liu) Department of Anesthesiology, State Key Laboratory of Cardiovascular
Disease, National Center for Cardiovascular Disease, Fuwai Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Liu) Department of Anesthesiology, Laboratory of Anesthesia & Critical
Care Medicine, Translational Neuroscience Center, West China Hospital,
Sichuan University, Chengdu, China. Electronic address:
Title
Levosimendan for Prevention of Acute Kidney Injury After Cardiac Surgery:
A Meta-analysis of Randomized Controlled Trials.
Source
American journal of kidney diseases : the official journal of the National
Kidney Foundation. 67 (3) (pp 408-416), 2016. Date of Publication: 01 Mar
2016.
Abstract
BACKGROUND: Levosimendan has been shown to confer direct renoprotection in
renal endotoxemic and ischemia-reperfusion injury and could increase renal
blood flow in patients with low-cardiac-output heart failure. Results from
clinical trials of levosimendan on acute kidney injury (AKI) following
cardiac surgery are controversial.
STUDY DESIGN: A random-effect meta-analysis was conducted based on
evidence from PubMed, EMBASE, and Cochrane Library.
SETTINGS & POPULATION: Adult patients undergoing cardiac surgery.
SELECTION CRITERIA FOR STUDIES: Randomized controlled trials comparing the
renal effect of levosimendan versus placebo or other inotropic drugs
during cardiac surgery.
INTERVENTION: Perioperative levosimendan continuous infusion at a rate of
0.1 to 0.2mug/kg/min following a loading dose (6-24mug/kg) for 24 hours or
only 1 loading dose (24mug/kg) within 1 hour.
OUTCOMES: AKI, need for renal replacement therapy, mechanical ventilation
duration, intensive care unit stay during hospitalization, and
postoperative mortality (in-hospital or within 30 days).
RESULTS: 13 trials with a total of 1,345 study patients were selected.
Compared with controls, levosimendan reduced the incidence of
postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P=0.001;
I(2)=0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI,
0.25-0.76; P=0.002; I(2)=0.0%), postoperative mortality (35/658 vs 94/657;
OR, 0.41; 95% CI, 0.27-0.62; P<0.001; I(2)=0.0%), mechanical ventilation
duration (in days; n=235; weighted mean difference, -0.34; 95% CI, -0.58
to -0.09; P=0.007], and intensive care unit stay (in days; n=500; weighted
mean difference, -2.2; 95% CI, -4.21 to -0.13; P=0.04).
LIMITATIONS: Different definitions for AKI among studies. Small sample
size for some trials.
CONCLUSIONS: Perioperative administration of levosimendan in patients
undergoing cardiac surgery may reduce complications. Future trials are
needed to determine the dose effect of levosimendan in improving outcomes,
especially in patients with decreased baseline kidney function.

<4>
Accession Number
20160356134
Author
Bendixen M.; Jorgensen O.D.; Kronborg C.; Andersen C.; Licht P.B.
Institution
(Bendixen, Jorgensen, Licht) Department of Cardiothoracic Surgery, Odense
University Hospital, Odense, Denmark
(Andersen) Department of Cardiothoracic Anaesthesia, Odense University
Hospital, Odense, Denmark
(Kronborg) Centre of Health Economics Research (COHERE), University of
Southern Denmark, Odense, Denmark
(Licht) Odense Patient data Explorative Network (OPEN), University of
Southern Denmark, Odense, Denmark
Title
Postoperative pain and quality of life after lobectomy via video-assisted
thoracoscopic surgery or anterolateral thoracotomy for early stage lung
cancer: a randomised controlled trial.
Source
The Lancet Oncology. 17 (6) (pp 836-844), 2016. Date of Publication: 01
Jun 2016.
Publisher
Lancet Publishing Group
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is used
increasingly as an alternative to thoracotomy for lobectomy in the
treatment of early-stage non-small-cell lung cancer, but remains
controversial and worldwide adoption rates are low. Non-randomised studies
have suggested that VATS reduces postoperative morbidity, but there is
little high-quality evidence to show its superiority over open surgery. We
aimed to investigate postoperative pain and quality of life in a
randomised trial of patients with early-stage non-small-cell lung cancer
undergoing VATS versus open surgery. Methods We did a randomised
controlled patient and observer blinded trial at a public university-based
cardiothoracic surgery department in Denmark. We enrolled patients who
were scheduled for lobectomy for stage I non-small-cell lung cancer. By
use of a web-based randomisation system, we assigned patients (1:1) to
lobectomy via four-port VATS or anterolateral thoracotomy. After surgery,
we applied identical surgical dressings to ensure masking of patients and
staff. Postoperative pain was measured with a numeric rating scale (NRS)
six times per day during hospital stay and once at 2, 4, 8, 12, 26, and 52
weeks, and self-reported quality of life was assessed with the EuroQol 5
Dimensions (EQ5D) and the European Organisation for Research and Treatment
of Cancer (EORTC) 30 item Quality of Life Questionnaire (QLQ-C30) during
hospital stay and 2, 4, 8, 12, 26, and 52 weeks after discharge. The
primary outcomes were the proportion of patients with clinically relevant
moderate-to-severe pain (NRS >3) and mean quality of life scores. These
outcomes were assessed longitudinally by logistic regression across all
timepoints. Data for the primary analysis were analysed by modified
intention to treat (ie, all randomised patients with pathologically
confirmed non-small-cell lung cancer). This trial is registered with
ClinicalTrials.gov, number NCT01278888. Findings Between Oct 1, 2008, and
Aug 20, 2014, we screened 772 patients, of whom 361 were eligible for
inclusion and 206 were enrolled. We randomly assigned 103 patients to VATS
and 103 to anterolateral thoracotomy. 102 patients in the VATS group and
99 in the thoracotomy group were included in the final analysis. The
proportion of patients with clinically relevant pain (NRS >3) was
significantly lower during the first 24 h after VATS than after
anterolateral thoracotomy (VATS 38%, 95% CI 0.28-0.48 vs thoracotomy 63%,
95% CI 0.52-0.72, p=0.0012). During 52 weeks of follow-up, episodes of
moderate-to-severe pain were significantly less frequent after VATS than
after anterolateral thoracotomy (p<0.0001) and self-reported quality of
life according to EQ5D was significantly better after VATS (p=0.014). By
contrast, for the whole study period, quality of life according to QLQ-C30
was not significantly different between groups (p=0.13). Postoperative
surgical complications (grade 3-4 adverse events) were similar between the
two groups, consisting of prolonged air leakage over 4 days (14 patients
in the VATS group vs nine patients in the thoracotomy group), re-operation
for bleeding (two vs none), twisted middle lobe (one vs three) or
prolonged air leakage over 7 days (five vs six), arrhythmia (one vs one),
or neurological events (one vs two). Nine (4%) patients died during the
follow-up period (three in the VATS group and six in the thoracotomy
group). Interpretation VATS is associated with less postoperative pain and
better quality of life than is anterolateral thoracotomy for the first
year after surgery, suggesting that VATS should be the preferred surgical
approach for lobectomy in stage I non-small-cell lung cancer. Funding
Simon Fougner Hartmanns Familiefond, Guldsmed AL & D Rasmussens Mindefond,
Karen S Jensens legat, The University of Southern Denmark, The Research
Council at Odense University Hospital, and Department of Cardiothoracic
Surgery, Odense University Hospital.

<5>
Accession Number
20160336760
Author
Sadhwani A.; Asaro L.A.; Goldberg C.; Ware J.; Butcher J.; Gaies M.; Smith
C.; Alexander J.L.; Wypij D.; Agus M.S.D.
Institution
(Sadhwani, Ware) Cardiac Neurodevelopmental Program, Boston Children's
Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115,
United States
(Sadhwani, Ware) Department of Psychiatry, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Asaro, Wypij) Department of Cardiology, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Goldberg, Gaies, Smith) Division of Cardiology, C.S. Mott Children's
Hospital, University of Michigan Medical School, Ann Arbor, MI, United
States
(Goldberg, Butcher, Gaies, Smith) Department of Pediatrics and
Communicable Diseases, C.S. Mott Children's Hospital, University of
Michigan Medical School, Ann Arbor, MI, United States
(Butcher) Division of Pediatric Psychology, C.S. Mott Children's Hospital,
University of Michigan Medical School, Ann Arbor, MI, United States
(Alexander, Agus) Division of Medicine Critical Care, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
Title
Impact of Tight Glycemic Control on Neurodevelopmental Outcomes at 1 Year
of Age for Children with Congenital Heart Disease: A Randomized Controlled
Trial.
Source
Journal of Pediatrics. 174 (pp 193-198.e2), 2016. Date of Publication: 01
Jul 2016.
Publisher
Mosby Inc.
Abstract
Objective To assess the association of postoperative tight glycemic
control and hypoglycemia in children undergoing cardiac surgery with
neurodevelopmental outcomes at 1 year of age. Study design A 2-center,
prospective, randomized trial of postoperative tight glycemic control vs
standard care was conducted in 980 children undergoing cardiac surgery.
Neurodevelopmental outcomes were assessed at nine to 18 months using the
Bayley Scales of Infant and Toddler Development, Third Edition
(Bayley-III), the Adaptive Behavior Assessment System, Second Edition, the
Ages and Stages Questionnaire, Third Edition, and the Brief Infant Toddler
Social-Emotional Assessment. Results Neurodevelopmental follow-up was
performed on 237 patients with a mean age of 13 months. No significant
treatment group differences were found in the Bayley-III and Adaptive
Behavior Assessment System, Second Edition composite scores or percentage
at risk based on the Ages and Stages Questionnaire, Third Edition and the
Brief Infant Toddler Social-Emotional Assessment. Patients who experienced
moderate to severe hypoglycemia (n = 8) had lower Bayley-III composite
scores compared with patients with no to mild hypoglycemia, even after
controlling for factors known to be associated with poorer
neurodevelopmental outcomes. Conclusion For infants undergoing cardiac
surgery, tight glycemic control did not impact neurodevelopmental outcomes
compared with standard care. These data suggest a possible association
between moderate to severe hypoglycemia and poorer neurodevelopmental
outcomes at 1 year of age.

<6>
[Use Link to view the full text]
Accession Number
20160481620
Author
Savage S.A.; Cibulas G.A.; Ward T.A.; Davis C.A.; Croce M.A.; Zarzaur B.L.
Institution
(Savage, Zarzaur) Indiana University-Purdue University, School of
Medicine, 1604 N. Capitol Ave, Indianapolis, IN, United States
(Ward, Davis, Croce) University of Tennessee Health Sciences Center,
Memphis, TN, United States
(Cibulas) University of Michigan Health System, Ann Arbor, MI, United
States
Title
Suction evacuation of hemothorax: A prospective study.
Source
Journal of Trauma and Acute Care Surgery. 81 (1) (pp 58-62), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although tube thoracostomy is a common procedure after
thoracic trauma, incomplete evacuation of fluid places the patient at risk
for retained hemothorax.As little as 300 to 500 cm³ of bloodmay
result in the need for an additional thoracostomy tube or, inmore severe
cases, lung entrapment and empyema.We hypothesized that suction evacuation
of the thoracic cavity before tube placement would decrease the incidence
of late complications. METHODS: Patients requiring tube thoracostomy
within 96 hours of admission were prospectively identified and underwent
suction evacuation of the pleural space (SEPS) before tube placement.
These patients were compared to historical controlswithout suction
evacuation. Demographics, admission vital signs, laboratory values,
details of chest tube placement, and outcomes were collected on all
patients. Multivariable logistic regression was used to compare outcomes
between groups. RESULTS: A total of 199 patients were identified,
consisting of 100 retrospective controls and 99 SEPS patients. Therewere
no differences in age, sex, admission injury severity score or chest
abbreviated injury score, admission laboratory values or vital signs, or
hospital length of stay.Mean (SD) volume of hemothorax in SEPS patientswas
220 (297)cm³; with only 48% having a volume greater than 100
cm³ at the time of tube placement. Three patients developed
empyema, and 19 demonstrated retained blood; there was no difference
between SEPS and control patients. Suction evacuation of the pleural space
was significantly protective against recurrent pneumothorax after chest
tube removal (odds ratio, 0.332; 95% confidence interval, 0.148-0.745).
CONCLUSION: Preemptive suction evacuation of the thoracic cavity did not
have a significant impact on subsequent development of retained hemothorax
or empyema. Suction evacuation of the pleural space significantly
decreased incidence of recurrent pneumothorax after thoracostomy removal.
Although the mechanism is unclear, such a benefit may make this simple
procedure worthwhile. A larger sample size is required for validation and
to determine if preemptive thoracic evacuation has a clinical benefit.

<7>
Accession Number
20160491211
Author
Gullestad L.; Eiskjaer H.; Gustafsson F.; Riise G.C.; Karason K.; Dellgren
G.; Radegran G.; Hansson L.; Gude E.; Bjortuft O.; Jansson K.; Schultz
H.H.; Solbu D.; Iversen M.
Institution
(Gullestad, Gude) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Gullestad, Gude) Faculty of Medicine, K.G. Jebsen Cardiac Research Centre
and Center for Heart Failure Research, University of Oslo, Oslo, Norway
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Riise) Department of Respiratory Medicine, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Karason, Dellgren) Department of Cardiology and Transplant Institute,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Radegran) Department of Clinical Sciences Lund, Cardiology, Lund
University and the Section for Heart Failure and Valvular Disease, Skane
University Hospital, Lund, Sweden
(Hansson) Department of Respiratory Medicine, Lund University Hospital and
Skane University Hospital, Lund, Sweden
(Bjortuft) Department of Respiratory Medicine, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Jansson) Department of Cardiology, Heart Center, University Hospital,
Linkoping, Sweden
(Schultz, Iversen) Division of Lung Transplantation, Department of
Cardiology, Rigshospitalet, Copenhagen, Denmark
(Solbu) Novartis Norge AS, Oslo, Norway
Title
Long-term outcomes of thoracic transplant recipients following conversion
to everolimus with reduced calcineurin inhibitor in a multicenter,
open-label, randomized trial.
Source
Transplant International. 29 (7) (pp 819-829), 2016. Date of Publication:
01 Jul 2016.
Publisher
Blackwell Publishing Ltd
Abstract
The NOCTET study randomized 282 patients >1 year after heart or lung
transplantation to continue conventional calcineurin inhibitor (CNI)
therapy or to start everolimus with reduced-exposure CNI. Last follow-up,
at >5 years postrandomization (mean: 5.6 years) was attended by 72/140
everolimus patients (51.4%) and 91/142 controls (64.1%). Mean measured GFR
remained stable in the everolimus group from randomization (51.3 ml/min)
to last visit (51.4 ml/min) but decreased in controls (from 50.5 ml/min to
45.3 ml/min) and was significantly higher with everolimus at last
follow-up (P = 0.004). The least squares mean (SE) change from
randomization was -1.5 (1.7)ml/min with everolimus versus -7.2 (1.7)ml/min
for controls (difference: 5.7 [95% CI 1.7; 9.6]ml/min; P = 0.006). The
difference was accounted for by heart transplant patients (difference: 6.9
[95% 2.3; 11.5]ml/min; P = 0.004). Lung transplant patients showed no
between-group difference at last follow-up. Rates of rejection, death, and
major cardiac events were similar between groups, as was graft function.
Pneumonia was more frequent with everolimus (18.3% vs. 6.4%). In
conclusion, introducing everolimus in maintenance heart transplant
patients, with reduced CNI, achieves a significant improvement in renal
function which is maintained for at least 5 years, but an early renal
benefit in lung transplant patients was lost. Long-term immunosuppressive
efficacy was maintained.

<8>
Accession Number
20160472320
Author
Zughaft D.J.L.; Hyllen S.; Harnek J.; Nozohoor S.; Bjursten H.; Gotberg M.
Institution
(Zughaft, Harnek, Gotberg) Departments of Coronary Heart Disease,
Anesthesia and Intensive Care, Skane University Hospital, Lund University,
Lund, Sweden
(Zughaft, Harnek, Gotberg) Departments of Cardiology, Anesthesia and
Intensive Care, Skane University Hospital, Lund University, Getingev 1-5,
Lund SE-221 85, Sweden
(Hyllen, Nozohoor, Bjursten) Departments of Cardiothoracic Surgery,
Anesthesia and Intensive Care, Skane University Hospital, Lund University,
Lund, Sweden
Title
Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in
Transcatheter Aortic Valve Replacement: The TAVR-CHILL Trial.
Source
Therapeutic Hypothermia and Temperature Management. 5 (4) (pp 209-216),
2015. Date of Publication: 2015.
Publisher
Mary Ann Liebert Inc.
Abstract
The safety, feasibility, and hemodynamic effects of mild hypothermia (MH)
induced by transnasal cooling were studied in transcatheter aortic valve
replacement (TAVR). MH is a common therapy following cardiac arrest and
seems to have favorable effects in myocardial infarction and on
hemodynamic stability. In TAVR, hemodynamic instability is common during
rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to
hypothermia or normothermia. Hemodynamic endpoints were mean arterial
blood pressure and required dosage of vasoactive and inotropic drugs.
Patients were followed up at 6 months. All patients in the MH group (n=10)
reached the target temperature of 34degreeC before first rapid pacing.
Tympanic and urinary bladder temperature remained significantly lower in
the MH group during the procedure. No adverse effects of cooling were
observed. Mean arterial pressure was higher in the MH group (90+/-20 mm
Hg) than in the control group (71+/-13 mm Hg) at the start of the
procedure, at first rapid pacing (94+/-19 vs. 80+/-16 mm Hg), and at
balloon aortic valvuloplasty (90+/-17 vs. 73+/-14 mm Hg). Less
norepinephrine was administered to the hypothermia group. Transnasal
cooling during TAVR was safe and well tolerated. We observed a more stable
hemodynamic profile in the MH group, indicated by higher blood pressure
and lower levels of vasoactive drugs required. A larger study of patients
with severe ventricular dysfunction is required to more comprehensively
investigate the hemodynamic effects of transnasal cooling in TAVR.

<9>
Accession Number
20160488754
Author
Xiong T.-Y.; Liao Y.-B.; Zhao Z.-G.; Xu Y.-N.; Wei X.; Zuo Z.-L.; Li
Y.-J.; Cao J.-Y.; Tang H.; Jilaihawi H.; Feng Y.; Chen M.
Institution
(Xiong, Liao, Zhao, Xu, Wei, Zuo, Li, Cao, Tang, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, Chengdu, China
(Jilaihawi) Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
Title
Causes of death following transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Journal of the American Heart Association. 4 (9) (no pagination), 2015.
Article Number: e002096. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Transcatheter aortic valve replacement (TAVR) is an effective
alternative to surgical aortic valve replacement in patients at high
surgical risk. However, there is little published literature on the exact
causes of death. Methods and Results-The PubMed database was
systematically searched for studies reporting causes of death within and
after 30 days following TAVR. Twenty-eight studies out of 3934 results
retrieved were identified. In the overall analysis, 46.4% and 51.6% of
deaths were related to noncardiovascular causes within and after the first
30 days, respectively. Within 30 days of TAVR, infection/ sepsis (18.5%),
heart failure (14.7%), and multiorgan failure (13.2%) were the top 3
causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure
(14.1%), and sudden death (10.8%) were the most common causes. All
possible subgroup analyses were made. No significant differences were seen
for proportions of cardiovascular deaths except the comparison between
moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk
patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005).
Conclusions-Cardiovascular and noncardiovascular causes of death are
evenly balanced both in the perioperative period and at long-term
follow-up after TAVR. Infection/sepsis and heart failure were the most
frequent noncardiovascular and cardiovascular causes of death. This study
highlights important areas of clinical focus that could further improve
outcomes after TAVR. 2015 The Authors.

<10>
[Use Link to view the full text]
Accession Number
20160477412
Author
Khan J.N.; Nazir S.A.; Singh A.; Shetye A.; Lai F.Y.; Peebles C.; Wong J.;
Greenwood J.P.; McCann G.P.
Institution
(Khan, Nazir, Singh, Lai, Greenwood) Department of Cardiovascular
Sciences, University of Leicester and the NIHR Leicester Cardiovascular
BRU, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, United Kingdom
(Peebles) Department of Cardiology, University Hospital Southampton NHS
Trust, United Kingdom
(Wong) Department of Cardiology, Royal Brompton and Harefield NHS Trust,
London, United Kingdom
(McCann) Leeds Institute of Cardiovascular and Metabolic Medicine
(LICAMM), University of Leeds, United Kingdom
Title
Relationship of Myocardial Strain and Markers of Myocardial Injury to
Predict Segmental Recovery after Acute ST-Segment-Elevation Myocardial
Infarction.
Source
Circulation: Cardiovascular Imaging. 9 (6) (no pagination), 2016. Article
Number: e003457. Date of Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Late gadolinium-enhanced cardiovascular magnetic resonance
imaging overestimates infarct size and underestimates recovery of
dysfunctional segments acutely post ST-segment-elevation myocardial
infarction. We assessed whether cardiovascular magnetic resonance
imaging-derived segmental myocardial strain and markers of myocardial
injury could improve the accuracy of late gadolinium-enhancement in
predicting functional recovery after ST-segment-elevation myocardial
infarction. Methods and Results - A total of 164 ST-segment-elevation
myocardial infarction patients underwent acute (median 3 days) and
follow-up (median 9.4 months) cardiovascular magnetic resonance imaging.
Wall-motion scoring, feature tracking-derived circumferential strain
(Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular
obstruction, intramyocardial hemorrhage, and salvage index (MSI) were
assessed in 2624 segments. We used logistic regression analysis to
identify markers that predict segmental recovery. At acute CMR 32% of
segments were dysfunctional, and at follow-up CMR 19% were dysfunctional.
Segmental function at acute imaging and odds ratio (OR) for functional
recovery decreased with increasing SEE, although 33% of dysfunctional
segments with SEE 76% to 100% improved. SEE was a strong predictor of
functional improvement and normalization (area under the curve [AUC],
0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI,
0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI,
0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization).
Its predictive accuracy for improvement, as assessed by areas under the
receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI,
0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and
AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for
normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95%
CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI,
0.818-0.871]; OR, 1.07 [95% CI, 1.05-1.10] per +1% SEE for normalization),
and for normalization was greater than the other predictors. MSI and Ecc
remained as significant after adjustment for SEE but provided no
significant increase in predictive accuracy for improvement and
normalization compared with SEE alone. MSI had similar predictive accuracy
to SEE for functional recovery but was not assessable in 25% of patients.
Microvascular obstruction provided no incremental predictive accuracy
above SEE. Conclusions - This multicenter study confirms that SEE is a
strong predictor of functional improvement post ST-segment-elevation
myocardial infarction, but recovery occurs in a substantial proportion of
dysfunctional segments with SEE >75%. Feature tracking-derived Ecc and MSI
provide minimal incremental benefit to SEE in predicting segmental
recovery. Clinical Trial Registration - URL: http://www.isrctn.com. Unique
identifier: ISRCTN70913605.

<11>
Accession Number
20160474595
Author
Singh S.M.; D'Avila A.; Kim Y.-H.; Aryana A.; Mangrum J.M.; Michaud G.F.;
Dukkipati S.R.; Barrett C.D.; Heist E.K.; Parides M.K.; Thorpe K.E.; Reddy
V.Y.
Institution
(Singh) Schulich Heart Program, Sunnybrook Health Sciences Center,
University of Toronto, Toronto, ON, Canada
(D'Avila, Dukkipati, Parides, Reddy) Helmsley Cardiac Arrhythmia Service,
Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New
York, NY 10029, United States
(D'Avila) Instituto de Pesquisa em Arritmia Cardiaca, Florianopolis, South
Carolina, Brazil
(Kim) Cardiovascular Division, Korea University Medical Center, Seoul,
South Korea
(Aryana) Mercy General Hospital, Dignity Health Heart and Vascular
Institute, Sacramento, CA, United States
(Mangrum) Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
(Michaud) Cardiovascular Division, Brigham and Women's Hospital, Harvard
University, Boston, MA, United States
(Barrett) Al-Sabah Arrhythmia Institute, Mount Sinai St Luke's-Roosevelt
Hospital, New York, NY, United States
(Heist) Heart Center, Massachusetts General Hospital, Boston, MA, United
States
(Thorpe) Dalla Lana School of Public Health, Keenan Research Centre, Li Ka
Shing Knowledge Institute of St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Title
The modified stepwise ablation guided by low-dose ibutilide in chronic
atrial fibrillation trial (The MAGIC-AF Study).
Source
European Heart Journal. 37 (20) (pp 1614-1621), 2016. Date of Publication:
21 May 2016.
Publisher
Oxford University Press
Abstract
Aims Complex fractionated atrial electrograms (CFAE) are targeted during
persistent atrial fibrillation (AF) ablation. However, many CFAE sites are
non-specific resulting in extensive ablation. Ibutilide has been shown to
reduce left atrial surface area exhibiting CFAE. We hypothesized that
ibutilide administration prior to CFAE ablation would identify sites
critical for persistent AF maintenance allowing for improved procedural
efficacy and long-term freedom from atrial arrhythmias. Methods and
results Two hundred patients undergoing a first-ever persistent AF
catheter ablation procedure were randomly assigned to receive either 0.25
mg of intravenous ibutilide or saline placebo upon completion of pulmonary
vein isolation. Complex fractionated atrial electrogram sites were then
targeted with ablation. The primary efficacy endpoint was the 1-year
single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs.
Similar procedural characteristics (procedure, fluoroscopy, and ablation
times) were observed with both strategies despite a greater reduction in
left atrial surface area with CFAE sites (8 vs. 1%, P < 0.0001) and AF
termination during CFAE ablation with ibutilide compared with placebo (75
vs. 57%, P = 0.007). The primary efficacy endpoint was achieved in 56% of
patients receiving ibutilide and 49% receiving placebo (P = 0.35). No
significant differences in peri-procedural complications were observed in
both groups. Conclusion Despite a reduction in CFAE area and greater AF
termination during CFAE ablation, procedural characteristics and clinical
outcomes were unchanged when CFAE ablation was guided by ibutilide
administration. Clinical trial registration information ClinicalTrials.gov
number: NCT01014741. Published on behalf of the European Society of
Cardiology. All rights reserved.

<12>
[Use Link to view the full text]
Accession Number
20160474174
Author
Sondergaard L.; Steinbruchel D.A.; Ihlemann N.; Nissen H.; Kjeldsen B.J.;
Petursson P.; Ngo A.T.; Olsen N.T.; Chang Y.; Franzen O.W.; Engstrom T.;
Clemmensen P.; Olsen P.S.; Thyregod H.G.Ho.
Institution
(Sondergaard, Ihlemann, Ngo, Olsen, Franzen, Engstrom) Departments of
Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9,
Copenhagen 2100, Denmark
(Steinbruchel, Olsen, Thyregod) Departments of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Nissen) Departments of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Departments of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Petursson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chang) Department of Statistics, Medtronic, Mounds View, MN, United
States
(Clemmensen) Department of Medicine, Nykoebing F Hospital, University of
Southern Denmark, Odense, Denmark
Title
Two-year outcomes in patients with severe aortic valve stenosis randomized
to transcatheter versus surgical aortic valve replacement: The all-comers
nordic aortic valve intervention randomized clinical trial.
Source
Circulation: Cardiovascular Interventions. 9 (6) (no pagination), 2016.
Article Number: e003665. Date of Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - The Nordic Aortic Valve Intervention (NOTION) trial was the
first to randomize all-comers with severe native aortic valve stenosis to
either transcatheter aortic valve replacement (TAVR) with the CoreValve
self-expanding bioprosthesis or surgical aortic valve replacement (SAVR),
including a lower-risk patient population than previous trials. This
article reports 2-year clinical and echocardiographic outcomes from the
NOTION trial. Methods and Results - Two-hundred eighty patients from 3
centers in Denmark and Sweden were randomized to either TAVR (n=145) or
SAVR (n=135) with follow-up planned for 5 years. There was no difference
in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%,
respectively; P=0.54) or cardiovascular mortality (6.5% versus 9.1%;
P=0.40). The composite outcome of all-cause mortality, stroke, or
myocardial infarction was also similar (15.8% versus 18.8%, P=0.43).
Forward-flow hemodynamics were improved following both procedures, with
effective orifice area significantly more improved after TAVR than SAVR
(effective orifice area, 1.7 versus 1.4 cm² at 3 months). Mean
valve gradients were similar after TAVR and SAVR. When patients were
categorized according to Society of Thoracic Surgeons Predicted Risk of
Mortality (STS-PROM) (<4% versus >4%), there was no statistically
significant difference for TAVR and SAVR groups in the composite outcome
for low-risk (14.7%, 95% confidence interval, 8.3-21.2 versus 16.8%; 95%
confidence interval, 9.7-23.8; P=0.58) or intermediate-risk patients
(21.1% versus 27.1%; P=0.59). Conclusions - Two-year results from the
NOTION trial demonstrate the continuing safety and effectiveness of TAVR
in lower-risk patients. Longer-term data are needed to verify the
durability of this procedure in this patient population.

<13>
Accession Number
20160374663
Author
Ozaydin M.; Yucel H.; Kocyigit S.; Adali M.K.; Aksoy F.; Kahraman F.;
Uysal B.A.; Erdogan D.; Varol E.; Dogan A.
Institution
(Ozaydin, Kahraman, Erdogan, Varol) Department of Cardiology, Suleyman
Demirel University, Kardiyoloji AD, Cunur, Isparta TR'32200, Turkey
(Yucel) State Hospital, Manisa, Turkey
(Kocyigit) Servergazi State Hospital, Denizli, Turkey
(Adali) State Hospital, Bucak, Turkey
(Aksoy) State Hospital, Dinar, Turkey
(Uysal) State Hospital, Manavgat, Turkey
(Dogan) Katip Celebi University, Izmir, Turkey
Title
Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with
Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.
Source
Medical Principles and Practice. 25 (4) (pp 316-322), 2016. Date of
Publication: 15 Jun 2016.
Publisher
S. Karger AG
Abstract
Objective: The aim of this study was to evaluate the efficacy of
nebivolol, carvedilol or metoprolol succinate on the outcome of patients
presenting with acute myocardial infarction (AMI) complicated by left
ventricular dysfunction. Subjects and Methods: Patients (n = 172, aged
28-87 years) with AMI and left ventricular ejection fraction <0.45 were
randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol
succinate (n = 57) groups. Baseline demographic and clinical
characteristics and composite event rates of nonfatal MI, cardiovascular
mortality, hospitalization due to unstable angina pectoris or heart
failure, stroke or revascularization during the 12-month follow-up were
compared among the groups using the chi² test, t test or
log-rank test as appropriate. Results: Baseline demographic and clinical
characteristics were similar in the three groups. The composite end point
during follow-up was lower in the patients treated with nebivolol than
those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event
rates were similar between the patients treated with carvedilol and those
treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the
patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05).
Conclusion: The patients treated with nebivolol experienced 12-month
cardiovascular events at a lower rate than those treated with metoprolol
succinate. However, event rates were similar between the carvedilol and
the metoprolol succinate groups and between the nebivolol and the
carvedilol groups.

<14>
[Use Link to view the full text]
Accession Number
20160370763
Author
Hovaguimian F.; Myles P.S.
Institution
(Hovaguimian) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia
(Myles) Department of Anesthesia and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Victoria, Australia
(Hovaguimian) Current Position: Division of Anesthesiology, University
Hospital of Zurich, Zurich, Switzerland
Title
Restrictive versus Liberal Transfusion Strategy in the Perioperative and
Acute Care Settings: A Context-specific Systematic Review and
Meta-analysis of Randomized Controlled Trials.
Source
Anesthesiology. 125 (1) (pp 46-61), 2016. Date of Publication: 01 Jul
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Blood transfusions are associated with morbidity and
mortality. However, restrictive thresholds could harm patients less able
to tolerate anemia. Using a context-specific approach (according to
patient characteristics and clinical settings), the authors conducted a
systematic review to quantify the effects of transfusion strategies.
Methods: The authors searched MEDLINE, EMBASE, CENTRAL, and grey
literature sources to November 2015 for randomized controlled trials
comparing restrictive versus liberal transfusion strategies applied more
than 24 h in adult surgical or critically ill patients. Data were
independently extracted. Risk ratios were calculated for 30-day
complications, defined as inadequate oxygen supply (myocardial, cerebral,
renal, mesenteric, and peripheral ischemic injury; arrhythmia; and
unstable angina), mortality, composite of both, and infections.
Statistical combination followed a context-specific approach. Additional
analyses explored transfusion protocol heterogeneity and cointerventions
effects. Results: Thirty-one trials were regrouped into five
context-specific risk strata. In patients undergoing cardiac/vascular
procedures, restrictive strategies seemed to increase the risk of events
reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97
to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events
(RR, 1.12; 95% CI, 1.01 to 1.24 - 3322, 3245, and 3322 patients,
respectively). Similar results were found in elderly orthopedic patients
(inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR,
1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to
1.54 - 3465, 3546, and 3749 patients, respectively), but not in critically
ill patients. No difference was found for infections, although a
protective effect may exist. Risk estimates varied with
successful/unsuccessful transfusion protocol implementation. Conclusions:
Restrictive transfusion strategies should be applied with caution in
high-risk patients undergoing major surgery.

<15>
Accession Number
20160478729
Author
Ho K.M.; Bham E.; Pavey W.
Institution
(Ho) Department of Intensive Care, Royal Perth Hospital, Perth, WA,
Australia
(Ho) School of Population Health, University of Western Australia, Perth,
WA, Australia
(Ho, Pavey) School of Veterinary and Life Sciences, Murdoch University,
Perth, WA, Australia
(Bham, Pavey) Department of Anesthesia, Fiona Stanley Hospital, Perth, WA,
Australia
Title
Incidence of venous thromboembolism and benefits and risks of
thromboprophylaxis after cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 4 (10) (no pagination), 2015.
Article Number: e002652. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Optimal thromboprophylaxis after cardiac surgery is uncertain.
This systematic review aimed to define the incidence and risk factors for
deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE),
and assess whether venous thromboembolism (VTE) prophylaxis was effective
in reducing VTE without complications after cardiac surgery. Methods and
Results--Two reviewers independently searched and assessed the quality and
outcomes of randomized, controlled trials (RCTs) and observational studies
on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane
controlled trial register (1966 to December 2014). Sixty-eight studies
provided data on VTE outcomes or complications related to
thromboprophylaxis after cardiac surgery. The majority of the studies were
observational studies (n=49), 16 studies were RCTs, and 3 were
meta-analyses. VTE prophylaxis was associated with a reduced risk of PE
(relative risk [RR], 0.45; 95% confidence interval [CI], 0.28-0.72;
P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28-0.71; P=0.0006)
compared to the control without significant heterogeneity. Median
incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were
3.2% (0.6-8.1), 0.6% (0.3-2.9), and 0.3% (0.08-1.7), respectively.
Previous history of VTE, obesity, left or right ventricular failure, and
prolonged bed rest, mechanical ventilation, or use of a central venous
catheter were common risk factors for VTE. Bleeding or cardiac tamponade
requiring reoperation owing to pharmacological VTE prophylaxis alone,
without systemic anticoagulation, was not observed. Conclusions--Unless
proven otherwise by adequately powered RCTs, initiating pharmacological
VTE prophylaxis as soon as possible after cardiac surgery for patients who
have no active bleeding is highly recommended.

<16>
Accession Number
20160477502
Author
Erlebach M.; Head S.J.; Mylotte D.; Leon M.B.; Serruys P.W.; Pieter
Kappetein A.; Martucci G.; Genereux P.; Windecker S.; Lange R.; Piazza N.
Institution
(Erlebach, Lange, Piazza) Department of Cardiovascular Surgery, German
Heart Center Munich, Munich, Germany
(Head, Pieter Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mylotte, Martucci, Piazza) Department of Medicine, Division of Cardiology
Interventional Cardiology, McGill University Health Centre, 1001 Decarie
Boulevard, Montreal, QC H4A 3J1, Canada
(Mylotte) Department of Medicine, University Hospital Galway, Galway,
Ireland
(Leon, Genereux) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
(Serruys) Department of Interventional Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Windecker) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern, Switzerland
Title
VARC endpoint definition compliance rates in contemporary transcatheter
aortic valve implantation studies.
Source
EuroIntervention. 12 (3) (pp 375-380), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: The Valve Academic Research Consortium (VARC) endpoint definitions
were established to standardise the reporting of clinical outcomes
following transcatheter aortic valve implantation (TAVI). It remains
unclear, however, to what extent and in which manner these definitions are
applied. Therefore, we sought to investigate the utilisation and adherence
to VARC guidelines since their introduction in 2011 across peerreviewed
TAVI-related publications. Methods and results: We performed a systematic
literature review to identify TAVI-related manuscripts published between
February 2011 and February 2014. Manuscripts were categorised into three
groups: a "compliant" group of manuscripts using only VARC-defined
endpoints, a "non-compliant" group of manu scripts with only
non-VARC-defined endpoints, and a "mixed compliant" group of manuscripts
with both VARC-and non-VARC-defined endpoints. Multivariate analyses were
performed to identify predictors of VARC use. Among 5,023 published
manuscripts, 498 were included in the final analysis. At least one VARC
definition was used in 275 (54%), while 223 (43%) did not use any VARC
definitions. After publication of the first VARC manuscript (VARC-1,
January 2011), VARC use increased from 31% (n=15) at six months to 69%
(n=84) at 36 months. Following the publication of VARC-2 (October 2012),
VARC-1 use declined (from 58% [n=47] to 36% [n=24]), while VARC-2 use
increased from 4% (n=3) at six months to 35% (n=23) at 18 months. Of the
manuscripts using VARC, 49 (10%) were classified as compliant and 226
(46%) as mixed compliant. The following endpoints were more often defined
using VARC vs. non-VARC: myocardial infarction (64% vs. 36%); stroke (56%
vs. 44%); bleeding (79% vs. 21%); vascular complications (70% vs. 30%);
acute kidney injury (63% vs. 37%); reintervention (67% vs. 33%); and
composite endpoints (52% vs. 48%). Mortality, valve dysfunction,
TAVI-related complications, and quality of life were more often defined
using non-VARC criteria. Conclusions: Implementation of VARC criteria in
peer-reviewed manuscripts has increased over time. There remain, however,
a considerable number (43%) of publications that do not report outcomes
according to VARC. These data will inform the future development of VARC
criteria.

<17>
Accession Number
20160470821
Author
Mah D.Y.; Cheng H.; Alexander M.E.; Sleeper L.; Newburger J.W.; Del Nido
P.J.; Thiagarajan R.R.; Rajagopal S.K.
Institution
(Mah, Cheng, Alexander, Sleeper, Newburger, Thiagarajan, Rajagopal)
Department of Cardiology, Boston Children's Hospital, Harvard Medical
School, 300 Longwood Ave, Boston, MA 02115, United States
(Del Nido) Department of Cardiovascular Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
Title
Heart block following stage 1 palliation of hypoplastic left heart
syndrome.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 189-194),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc.
Abstract
Objectives Publicly available data from the Pediatric Heart Network's
Single Ventricle Reconstruction Trial was analyzed to determine the
prevalence, timing, risk factors for, and impact of second- and
third-degree heart block (HB) on outcomes in patients who underwent stage
1 palliation (S1P) for hypoplastic left heart syndrome (HLHS). Methods The
presence and date of onset of post-S1P HB occurring within the first year
of life, potential risk factors for HB, and factors known to predict poor
outcomes after S1P were extracted. Multivariable logistic and Cox
regression analyses were performed to identify risk factors for HB and to
determine the effect of HB on 3-year transplantation-free survival.
Results Among the 549 patients in the cohort, 33 (6%) developed HB after
S1P. The median interval between S1P and HB was 8 days (interquartile
range, 0-133 days). Regression analysis showed that tricuspid valve repair
during S1P and obstruction of pulmonary venous drainage requiring pre-S1P
intervention were independently associated with HB (adjusted odds ratio
[aOR], 11.6, 95% confidence interval [CI] 3.3-40; P <.001 and aOR, 5.1;
95% CI, 1.3-20.6; P =.02, respectively). Transplantation-free survival at
3 years was lower for those with HB (39% vs 65%; P =.004). HB remained
associated with transplantation-free survival after controlling for known
risk factors (adjusted hazard ratio, 3.1; 95% CI, 1.9-5.0; P <.001). Nine
children (27%) had a pacemaker implanted, and 7 of these children (78%)
died or underwent heart transplantation. Conclusions HB after S1P is rare
but heralds a poor outcome. Careful monitoring of these patients is
recommended given their significantly increased risks of death and heart
transplantation.

<18>
[Use Link to view the full text]
Accession Number
20160469576
Author
Cai X.; Zhang P.; Lu S.; Zhang Z.; Yu A.; Liu D.; Wu S.
Institution
(Cai, Zhang, Lu, Zhang, Yu, Liu, Wu) Department of Anesthesiology,
Liaocheng People's Hospital, 67 Dongchang West Road, Liaocheng City,
Shandong 252000, China
(Wu) Xuzhou Medical College, Xuzhou, Jiangsu, China
Title
Effects of intraoperative dexmedetomidine on postoperative pain in highly
nicotine-dependent patients after thoracic surgery.
Source
Medicine (United States). 95 (22) (no pagination), 2016. Article Number:
e3814. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
To investigate the effects of intraoperative dexmedetomidine on pain in
highly nicotine-dependent patients after thoracic surgery. Highly
nicotine-dependent men underwent thoracic surgery and received
postoperative patient-controlled intravenous analgesia with sufentanil. In
dexmedetomidine group (experimental group, n=46), dexmedetomidine was
given at a loading dose of 1mug/kg for 10 minutes, followed by continuous
infusion at 0.5mug/kg/h until 30 minutes before the end of surgery. The
saline group (control group, n=48) received the same volume of saline.
General anesthesia was administered via a combination of inhalation and
intravenous anesthetics. If necessary, patients were administered a
loading dose of sufentanil by an anesthesiologist immediately after
surgery (0hours). Patient-controlled analgesia was started when the
patient's resting numerical rating scale (NRS) score was less than 4.
Resting and coughing NRS scores and sufentanil dosage were recorded 0, 1,
4hours, and every 4hours until 48hours after surgery. Dosages of other
rescue analgesics were converted to the sufentanil dosage. Surgical data,
adverse effects, and degree of satisfaction were obtained. Cumulative
sufentanil dosage, resting NRS, and coughing NRS in the first 24hours
after surgery and heart rate were lower in the experimental compared with
the control group (P<0.05). No patient experienced sedation or respiratory
depression. Frequency of nausea and vomiting and degree of satisfaction
were similar in both groups. Intraoperative dexmedetomidine was associated
with reduced resting and coughing NRS scores and a sufentanil-sparing
effect during the first 24hours after thoracic surgery.

<19>
Accession Number
20160469545
Author
Dadjou Y.; Safavi S.; Kojuri J.
Institution
(Dadjou) Atherosclerosis Research Center, Baqiyatallah University of
Medical Science, Tehran, Iran, Islamic Republic of
(Safavi) Quality Improvement in Clinical Education Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kojuri) Quality Improvement in Clinical Education Research Center, Shiraz
Cardiovascular Research Center, Zand St Namazi Hosp. Cardiology Office,
Shiraz, Iran, Islamic Republic of
Title
Risks and benefits of dual antiplatelet therapy beyond 12 months after
coronary stenting.
Source
Medicine (United States). 95 (22) (no pagination), 2016. Article Number:
e3663. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
The optimal duration of dual antiplatelet therapy (DAT) after coronary
stenting remains poorly define. The aim of this study was to evaluate the
impact of longer than 24 months DAT in patients who received drug-eluting
and bare-metal stents. A total of 1010 individuals who underwent elective,
urgent or emergency coronary angioplasty with intended stent implantation
at reference or specialized cardiac hospitals were randomized to receive
long-term and short-term DAT to determine the benefits and adverse effects
of long-term DAT. Total of 508 patients were randomized to long-term and
502 patients to <1 year DAT, and all of them were followed for more than
36 months for major adverse cardiac and cerebvascular events and bleeding
major adverse cardiac and cerebvascular events (MACCE) Mean age of the
1010 patients (364 women and 646 men) was 60 years. Stent reocclusion
occurred in 15 patients. Mean Syntax score was 23.00+/-5.08 for whole
samples, 25.00+/-5.27 in 28 patients with MACCE and 23+/-5.00 in 982
patients without MACCE (P=0.057). According to all specified bleeding
definitions, clopidogrel therapy for >12 months was not associated with a
greater risk of hemorrhage. A regimen of >12 months of clopidogrel therapy
in patients who had received drug-eluting or bare-metal stents did not
differ significantly from a regimen of <12 months on clopidogrel with
regard to MACCE. Long-term DAT might not significantly affect the
reduction in the risk of death from any cause, myocardial infarction, or
stroke, and not associated with minor or major bleeding events.

<20>
Accession Number
20160324216
Author
Gleason T.G.; Schindler J.T.; Adams D.H.; Reardon M.J.; Kleiman N.S.;
Caplan L.R.; Conte J.V.; Deeb G.M.; Hughes G.C.; Chenoweth S.; Popma J.J.
Institution
(Gleason, Schindler) University of Pittsburgh School of Medicine, Division
of Cardiac Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave,
Suite 715, Pittsburgh, PA 15232, United States
(Adams) Department of Surgery Mount Sinai Medical Center, New York, NY,
United States
(Reardon, Kleiman) Houston-Methodist-Debakey Heart and Vascular Center,
Houston, TX, United States
(Caplan, Popma) Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Conte) Johns Hopkins University School of Medicine, Baltimore, MD, United
States
(Deeb) University of Michigan, Ann Arbor, MI, United States
(Hughes) Duke University Medical Center, Durham, NC, United States
(Chenoweth) Medtronic, Inc, Minneapolis, MN, United States
Title
The risk and extent of neurologic events are equivalent for high-risk
patients treated with transcatheter or surgical aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 85-96), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc.
Abstract
Objectives This study was designed to characterize the incidence of new
clinically detectable neurologic events, or any comparative change in
indices of higher cognitive function following transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) within the
framework of a prospective, randomized clinical trial for high-risk
patients. Methods High-risk patients (predicted SAVR mortality 15%) with
severe aortic stenosis (n = 750) were randomized 1:1 to TAVR or SAVR and
underwent evaluation using the National Institutes of Health Stroke Scale
(NIHSS) and modified Rankin Scale assessment at each follow-up and any
suspected event. Neurologic outcomes were ascertained by a neurologist and
further evaluated by Mini-Mental State Examination (MMSE), visual fields
testing, gait assessment, hand function, writing evaluation, and drawing
assessment. Results The 30-day, 1-year, and 2-year stroke rates were 4.9%,
8.7%, and 10.9%, respectively, for TAVR and 6.2%, 12.5%, and 16.6%,
respectively, for SAVR (P =.46,.11, and.05, respectively). All-cause
mortality in patients with a major stroke was 83.3% for TAVR and 54.5% for
SAVR at 2 years (P =.29). Late major stroke was disproportionately higher
(23.8% at 2 years) among patients with poor iliofemoral access randomized
to SAVR. Peripheral vascular disease and falls within 6 months predicted
early stroke, and severe aortic calcification and high Charlson score (>5)
predicted 1-year stroke post-TAVR. NIHSS and MMSE scores trended higher
after SAVR than after TAVR. Lack of dual antiplatelet therapy use during
and after TAVR was associated with early stroke. Conclusions This study
defines an equivalent postprocedural stroke risk, stroke extent, and
degree of cognitive change after TAVR or SAVR in a high-risk population,
and also defines several predictors of stroke after TAVR.

<21>
Accession Number
20160276240
Author
Squiers J.J.; Lima B.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Research Institute, Baylor Scott and White
Health, 3310 Live Oak, Ste 501, Dallas, TX 75204, United States
(Lima, DiMaio) Department of Cardiac and Thoracic Surgery, Baylor
University Medical Center, Baylor Healthcare System, Dallas, TX, United
States
Title
Contemporary extracorporeal membrane oxygenation therapy in adults:
Fundamental principles and systematic review of the evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 20-32), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc.
Abstract
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of
support for patients with respiratory, cardiac, or combined
cardiopulmonary failure. Since ECMO was first reported in 1974, nearly
70,000 runs of ECMO have been implemented, and the use of ECMO in adults
increased by more than 400% from 2006 to 2011 in the United States. A
variety of factors, including the 2009 influenza A epidemic, results from
recent clinical trials, and improvements in ECMO technology, have
motivated this increased use in adults. Because ECMO is increasingly
becoming available to a diverse population of critically ill patients, we
provide an overview of its fundamental principles and a systematic review
of the evidence basis of this treatment modality for a variety of
indications in adults.

<22>
Accession Number
20160477313
Author
Belgaid D.R.; Khan Z.; Zaidi M.; Hobbs A.
Institution
(Belgaid, Khan, Zaidi) Barts and the London School of Medicine and
Dentistry, London, United Kingdom
(Hobbs) William Harvey Research Institute, Barts and the London School of
Medicine and Dentistry, QMUL, Charterhouse Square, London EC1M 6BQ, United
Kingdom
Title
Prospective randomized evaluation of the watchman left atrial appendage
closure device in patients with atrial fibrillation versus long-term
warfarin therapy the PREVAIL trial.
Source
International Journal of Cardiology. 219 (pp 177-179), 2016. Date of
Publication: 15 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives Assessing the safety and effectiveness of left atrial appendage
(LAA) (pouch found in the upper chambers of the heart) occlusion, using
the Watchman device compared to long term warfarin therapy (drug that
reduces clot formation), in preventing the risk of stroke in patients with
atrial fibrillation (most common type of irregular heart beat). 90% of
strokes in atrial fibrillation arise from clots forming in this pouch. By
mechanically blocking it using the device less clots are suggested to be
formed. This is an alternative to taking warfarin especially in patients
who cannot take it. Setting and participants 50 sites in the United States
enrolled 407 participants. After being randomly allocated, the device
group had 269 participants and warfarin group (comparator)had 138
participants. Method Patients with atrial fibrillation and at high risk of
stroke were randomly allocated a group after they were deemed eligible.
Patients in the device group had to take warfarin and aspirin for 45 days
till the complete closure of the LAA. The oral anticoagulant was followed
by dual antiplatelet therapy until 6 months and then ASA. Patients in the
warfarin group have to take it for life and were continually monitored.
The study ran for 26 months. Main outcome measures The trial assessed the
rate of adverse events using three endpoints:Primary efficacy endpoint:
overall rates of stroke and death,Late ischemic primary efficacy endpoint:
stroke or systemic embolism > 1 week post-randomization,Early safety
primary endpoint: complications within 1 week of the procedure. Results
The PREVAIL trial was not designed to show superiority, but
non-inferiority. It met the safety endpoint and one efficacy endpoint for
the watchman device compared to long term warfarin for overall efficacy of
the device. The results established that LAA occlusion is not worse than
warfarin intake for the prevention of stroke more than 1 week after
randomization. Compared to previous trials, the safety of the device has
also improved. Conclusion LAA occlusion is a reasonable alternative to
chronic warfarin therapy in stroke prevention for patients with atrial
fibrillation.

<23>
Accession Number
20160477173
Author
Banach M.; Serban M.-C.; Sahebkar A.; Garcia-Garcia H.M.; Mikhailidis
D.P.; Martin S.S.; Brie D.; Rysz J.; Toth P.P.; Jones S.R.; Hasan R.K.;
Mosteoru S.; Rifai M.A.; Pencina M.J.; Serruys P.W.
Institution
(Banach, Rysz) Department of Hypertension, Medical University of Lodz, WAM
University Hospital in Lodz, Zeromskiego 113, Lodz 90-549, Poland
(Serban) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Serban) Department of Functional Sciences, Discipline of Pathophysiology,
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
(Sahebkar) Biotechnology Research Center, Imam Reza Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Metabolic Research Centre, Royal Perth Hospital, School of
Medicine and Pharmacology, University of Western Australia, Perth,
Australia
(Garcia-Garcia) Department of Interventional Cardiology, Thoraxcenter,
Erasmus MC, Rotterdam, Netherlands
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Campus,
University College London Medical School, University College London (UCL),
London, United Kingdom
(Martin, Toth, Jones, Hasan) Johns Hopkins Ciccarone Center for the
Prevention of Heart Disease, Baltimore, MD, United States
(Brie, Mosteoru, Rifai) Cardiology Department, Institute for
Cardiovascular Medicine Timisoara, University of Medicine and Pharmacy
Victor Babes, Timisoara, Romania
(Toth) Preventive Cardiology, CGH Medical Center, Sterling, IL, United
States
(Pencina) Duke Clinical Research Institute (DCRI), Biostatistics and
Bioinformatics, Duke University, Durham, NC, United States
(Serruys) International Centre for Cardiovascular Health, Imperial College
London, London, United Kingdom
Title
Comparison of clinical outcomes between bioresorbable vascular stents
versus conventional drug-eluting and metallic stents: A systematic review
and meta-analysis.
Source
EuroIntervention. 12 (2) (pp e175-e189), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: Several studies have suggested good procedural and similar clinical
outcomes between everolimus-eluting Absorb bioresorbable stents (BRS)
versus conventional drug-eluting stents (DES), but the evidence is not
definitive. Our aim was to perform a systematic review and meta-analysis
to investigate the effects of BRS versus conventional drug-eluting and
bare metallic stents on the cardiovascular endpoints and all-cause
mortality. Methods and results: The follow-up in the included studies was
up to 13 months. The following endpoints were evaluated: all-cause
mortality, cardiac death, patient-oriented major adverse cardiac events
(POCE), device-oriented major adverse cardiac events (DOCE), any-cause
myocardial infarction (MI), target vessel MI (TVMI), target vessel
revascularisation (TVR) and target lesion revascularisation (TLR). The
results of 10 studies with 5,773 subjects showed a statistically
significant increase in the risk of TVMI between BRS and conventional
stents (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.03-2.05,
p=0.032). None of the other differences reached statistical significance:
all-cause mortality (OR: 0.67, 95% CI: 0.30-1.49, p=0.333), cardiac death
(OR: 1.00, 95% CI: 0.47-2.12, p=0.996), POCE (OR: 0.91, 95% CI: 0.68-1.22,
p=0.546), DOCE (OR: 1.12, 95% CI: 0.86-1.46, p=0.387), any-cause MI (OR:
1.34, 95% CI: 0.98-1.82, p=0.064), TVR (OR: 0.99, 95% CI: 0.73-1.33,
p=0.934) and TLR (OR: 0.92, 95% CI: 0.66-1.29, p=0.641). Similar results
were observed after restricting the meta-analysis to the comparison of BRS
vs. EES. Conclusions: Our meta-analysis suggests a significantly higher
risk of TVMI with BRS compared with conventional stents and no significant
differences in the rates of occurrence of the other outcomes during
one-year follow-up. Further studies with larger samples sizes, longer
follow-up, different clinical scenarios and more complex lesions are
required to confirm or refute our findings.

<24>
Accession Number
20160477172
Author
Wohrle J.; Markovic S.; Rottbauer W.; Muramatsu T.; Kadota K.;
Vazquez-Gonzalez N.; Odenstedt J.; Serra A.; Antoniucci D.; Varenne O.;
Saito S.; Wijns W.
Institution
(Wohrle, Markovic, Rottbauer) Department of Internal Medicine II,
University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
(Muramatsu) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Kanagawa, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Okayama,
Japan
(Vazquez-Gonzalez) Cardiac Catheterization Laboratory, Complexo
Hospitalario Universitario A Coruna, A Coruna, Spain
(Odenstedt) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Serra) Interventional Cardiology Unit, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Antoniucci) Division of Cardiology, Careggi Hospital, Florence, Italy
(Varenne) Service de Cardiologie, Hopital Cochin, Paris, France
(Saito) Cardiology and Catheterization Laboratories, Shonan Kamakura
General Hospital, Kanagawa, Japan
(Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
Title
Bioresorbable polymer sirolimus-eluting coronary stent compared with
permanent polymer everolimus-eluting coronary stent implantation for
treatment of small vessel coronary artery disease: CENTURY II trial.
Source
EuroIntervention. 12 (2) (pp e167-e174), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: CENTURY II is a prospective, multicentre, randomised, single-blind
trial comparing the bioresorbable polymer sirolimus-eluting Ultimaster
stent (BP-SES) with the permanent polymer everolimus-eluting XIENCE stent
(PP-EES). Here we present a pre-specified analysis of safety and efficacy
outcomes in a subgroup of patients with small vessel coronary artery
disease. Methods and results: CENTURY II included 525 patients with
lesions of reference diameter <2.5 mm. Treatment was randomly assigned:
277 patients received BP-SES (399 lesions) and 248 patients received
PP-EES (377 lesions). The primary outcome was target lesion failure (TLF),
which is a composite of cardiac death, target vessel-related myocardial
infarction (MI) and target lesion revascularisation (TLR). There was no
significant difference between treatment groups in baseline or procedural
data. Mean pre-procedural reference diameter was similar (BP-SES
2.30+/-0.40 mm, PP-EES 2.31+/-0.42 mm, p=0.59). Stented length was
24.0+/-11.7 mm for BP-SES and 23.5+/-11.5 mm for PP-EES (p=0.45). At 12
months, there was no significant difference between the BP-SES and PP-EES
groups in TLF (6.9% vs. 7.7%; p=0.72), cardiac death (1.1% vs. 1.2%;
p=0.90), target vessel MI (1.8% vs. 3.2%; p=0.30), TLR (4.0% vs. 5.7%;
p=0.37), or definite or probable stent thrombosis (0.7% vs. 1.2%; p=0.57).
Conclusions: In the large-scale, randomised CENTURY II trial, use of
BP-SES and PP-EES for the treatment of small vessel coronary artery
disease resulted in similar outcomes at 12 months.

<25>
Accession Number
72330347
Author
Ahmed N.; Rungatscher A.; Linardi D.; Molon G.; Luciani G.B.; Faggian G.
Institution
(Ahmed, Rungatscher, Linardi, Luciani, Faggian) Department of Cardiac
Surgery, University of Verona, Medical School, Verona, Italy
(Molon) Department of Cardiology, Sacro-Cuore Hospital, Negrar, VR, Italy
Title
Coronary sinus can be target for permanent atrial fibrillation ablation
therapy?.
Source
American Journal of Cardiology. Conference: 12th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20160310 Conference End: 20160313. Conference Publication:
(var.pagings). 117 (pp S98), 2016. Date of Publication: 02 Jun 2016.
Publisher
Elsevier Inc.
Abstract
Objectives: Atrial fibrillation is most common type of arrhythmias. During
last few decades with lot of new advancements in electrophysiological
field, we reached up to satisfactory outcomes for Paroxysmal atrial
fibrillation with help of ablation procedures. But still most challenging
type is chronic atrial fibrillation. Recurrence rate of atrial
fibrillation in patients with chronic atrial fibrillation is very high
that shows inadequacy of Pulmonary Veins Isolation. Since last few decades
we are trying to understand insight of mechanism of atrial fibrillation,
we conclude there must be some triggers and substrate other than pulmonary
veins according to many studies have been described in literature that
pulmonary veins isolation alone is not sufficient to deal with permanant
atrial fibrillation. Purpose of our review is to summarize updates and to
understand role of coronary sinus in induction, propagation and
maintenance of atrial fibrillation. Methods: For this systematic review,
we searched thoroughly major medical libraries including scientific
material including Pubmed, Embase and Scopus. Mesh terms used in our
search strategy were "Atrial Fibrillation, Coronary Sinus and Substrate".
We used all relevant articles available in english language. In addition
we also used text books and heart human to find relation of coronary sinus
with other rhythmogenic structure in heart. Results: In literature, we
found many indications about role of arhythmogenesis of coronary sinus
from different aspects. We found embryological, anatomical and
physiological correlation between coronary sinus and atrial tissues as
shown in figure 1. Complex Fractionated Atrial Electrograms were also
dominant in coronary sinus. Multiple studied demonstrated electrical
conductivity through coronary sinus from right atrium to left atrium.
Conclusions: Coronary Sinus play major role in propagation and maintenance
of chronic atrial fibrillation. Coronary Sinus can be target therapy for
chronic atrial fibrillation with recurrence of atrial fibrillation after
pulmonary vein isolation therapy. It can be first target for ablation in
case of permanent atrial fibrillation. (Figure Presented).

<26>
Accession Number
72330270
Author
Lezha M.; Gjypi R.; Hasani E.
Institution
(Lezha, Gjypi, Hasani) UHC, Departament of Cardiology and Cardiovascular
Surgery, Tirana, Albania
Title
The correlation between uric acid level and body mass index in patients
with and without paroxysmal atrial fibrillation.
Source
American Journal of Cardiology. Conference: 12th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20160310 Conference End: 20160313. Conference Publication:
(var.pagings). 117 (pp S58-S59), 2016. Date of Publication: 02 Jun 2016.
Publisher
Elsevier Inc.
Abstract
Background: Several meta-analyses have been conducted to evaluate
associations between body mass index(BMI) and coronary heart disease( CHD)
mortality. Furthermore, uric acid as a CV risk factor has been addressed
in numerous prospective and cohort studies. Serum uric acid levels are
also positively correlated with body mass index (BMI) in adult. However,
there are no many studies about the correlation between uric acid and BMI.
Aim: To study the correlation between uric acid level and body mass index
in patients with and without paroxysmal atrial fibrillation. Methods: Two
hundred patients(pts) who were admitted in the emergency department of
University Hospital Center "Mother Tereza", Tirana, Albania were enrolled
in the study; 100 of them with paroxysmal atrial fibrillation(PAF) and 100
pts without PAF(control group). Exclusion criteria included: presence of
valvular and congenital heart disease, gout, severe heart failure.
Demographic, clinical, electrocardiographic, and echocardiographic
characteristics were recorded for every pts. A venous route was opened to
all patients to measure serum uric acid(UA) levels and BMI was calculated.
Results: There was a significant difference between two groups in the age:
67,5 +/- 10,18 years in pts with PAF vs 59,67 +/- 10,63 in control group,
p = 0,0001. Serum uric acid levels was significantly higher in pts with
PAF than in control group, 6,72 +/- 2,2 mg/dL vs 5,23 +/- 1,56 mg/dL, p =
0,0001. BMI in pts with PAF was 27,6+/-5,52 kg/m² vs
26,8+/-3,36 in pts without AF, p=0,99. In the two groups of the study
there was a positive correlation between BMI and serum uric acid level. In
pts with PAF, the Pearson correlation coefficient r = 0,0063, p = 0,95,
determinant coefficient r2(%) = 0,039 revealed that correlation is not
significant. The change in the level of uric acid from the rise of BMI is
very small. In the control group, there was a very weak correlation
between BMI and uric acid level, r = 0,095, determinant coefficient
r² (%) = 0,91 and p = 0,34. Conclusions: There is a positive
correlation between BMI and uric acid level in patients with paroxysmal
atrial fibrillation and in patients without atrial fibrillation, but in
our study this correlation is not significant.

<27>
Accession Number
72330158
Author
Pektas I.; Yilmaz D.C.; Turkseven C.H.; Buyukakilli B.
Institution
(Pektas, Yilmaz) Department of Cardiology, Mersin University, Mersin,
Turkey
(Turkseven, Buyukakilli) Department of Biophysics, Mersin University,
Mersin, Turkey
Title
Assessment of AV interval optimisation results with echocardiography and
impedance cardiography in patients with biventricular pacemaker.
Source
American Journal of Cardiology. Conference: 12th International Congress of
Update in Cardiology and Cardiovascular Surgery Antalya Turkey. Conference
Start: 20160310 Conference End: 20160313. Conference Publication:
(var.pagings). 117 (pp S5), 2016. Date of Publication: 02 Jun 2016.
Publisher
Elsevier Inc.
Abstract
Objective: Cardiac resynchronization treatment (CRT) is a way of treatment
which is recommended in the current guidelines for the patients in sinus
rhythm whose survival for a year is expected and whose EF>35%, QRS
duration >120 ms and who have LBBB morphology and also for the patients in
sinus rhythm whose QRS duration >150 ms not withstanding the morphology.
In many randomized controlled studies, although the rate of the treatment
response is high, there is a patient group of 20-30% who do not respond to
the treatment. As a result of small randomized uncontrolled studies made
in these patients, biventricular pacemaker optimisation is recommended in
guidelines. Although the best optimisation techniques are invasive
techniques, non-invasive techniques are used (preferred) more on account
of applicability and affordability. In our study, we made atrioventricular
(AV) optimisation with echocardiographic techniques to the patients whom
were applied CRT and we evaluated the hemodynamical changes occurred as a
result of optimisation by means of impedance cardiography which is again a
non-invasive technique. We aimed to search the benefit of the optimisation
operation in patients with biventricular pacemaker. Methods-Results: 10
male (50%) and 10 female (50%) patients (totally 20) who were implanted
biventricular pacemaker were included in the study. There was ischemic
cardiomyopathy diagnosis in 5 patients (25%) and non-ischemic
cardiomyopathy diagnosis in 15 patients (75%). None of the patients were
applied optimisation before. The average EF was % 42.25+/-10.75, the
average QRS duration was 121.40+/-14.97 msn. We used Iterative technique,
Mitral Inflow VTI and Aortic Valve VTI for optimisation. In the evaluation
after optimisation, statistically significant increases were determined in
Mitral Inflow VTI and Aortic Valve VTI determined with echocardiography.
Although little increases were observed in cardiac output and cardiac
indexes determined with impedance cardiography, statistically significant
variation was not observed. Conclusions: Consequently, the necessity of AV
optimisation in the patients who were implemented biventricular cardiac
pacemaker is still a topic being discussed. In this study which is done
with restricted patient group, we observed the increase seen in
echocardiographic measurement has no influence on cardiac flow or cardiac
index measured by impedance cardiography It is necessary that this topic
should be determined in further studies with invasive and non-invasive
techniques in larger patient groups and its benefits should be discussed.
(Figure Presented).