EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
20160433226
Author
Pawliszak W.; Kowalewski M.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Szwed K.A.; Borkowska A.; Kowalewski J.; Anisimowicz L.
Institution
(Pawliszak, Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Division of Ergonomics and Physical Effort, Department of
Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz,
Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton
NHS Foundation Trust, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Department of Clinical Neuropsychology, Collegium
Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Nicolaus Copernicus University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
Title
Cerebrovascular events after no-touch off-pump coronary artery bypass
grafting, conventional side-clamp off-pump coronary artery bypass, and
proximal anastomotic devices: A meta-analysis.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002802. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Off-pump coronary artery bypass (OPCAB) has been shown to
reduce the risk of neurologic complications as compared to coronary artery
bypass grafting performed with cardiopulmonary bypass. Side-clamping of
the aorta while constructing proximal anastomoses, however, still carries
substantial risk of cerebral embolization. We aimed to perform a
comprehensive meta-analysis of studies assessing 2 clampless techniques:
aortic "no-touch" and proximal anastomosis devices (PAD) for OPCAB.
Methods and Results--PubMed, CINAHL, CENTRAL, and Google Scholar databases
were screened for randomized controlled trials and observational studies
comparing "no-touch" and/or PAD with side-clamp OPCAB and reporting
short-term (=30 days) outcomes: cerebrovascular accident and all-cause
mortality. A total of 18 studies (3 randomized controlled trials)
enrolling 25 163 patients were included. Aortic "no-touch" was associated
with statistically lower risk of cerebrovascular accident as compared to
side-clamp OPCAB: risk ratio 95% CI: 0.41 (0.27-0.61); P<0.01; I2=0%.
Event rates were 0.36% and 1.28% for "no-touch" and sideclamp OPCAB,
respectively. No difference was seen between PAD and side-clamp OPCAB:
0.71 (0.33-1.55); P=0.39; I2=39%. A trend towards increased 30-day
all-cause mortality with PAD and no difference with "no-touch" were
observed when compared to side-clamp OPCAB. In a subset analysis,
"no-touch" consistently reduced the risk of cerebrovascular accident
regardless of patients' baseline risk characteristics. A benefit with PAD
was observed in low-risk patients. Conclusions--Aortic "no-touch"
technique was associated with nearly 60% lower risk of postoperative
cerebrovascular events as compared to conventional side-clamp OPCAB with
effect consistent across patients at different risk.

<2>
Accession Number
2015433046
Author
Meybohm P.; Bein B.; Brosteanu O.; Cremer J.; Gruenewald M.; Stoppe C.;
Coburn M.; Schaelte G.; Boning A.; Niemann B.; Roesner J.; Kletzin F.;
Strouhal U.; Reyher C.; Laufenberg-Feldmann R.; Ferner M.; Brandes I.F.;
Bauer M.; Stehr S.N.; Kortgen A.; Wittmann M.; Baumgarten G.;
Meyer-Treschan T.; Kienbaum P.; Heringlake M.; Schon J.; Sander M.;
Treskatsch S.; Smul T.; Wolwender E.; Schilling T.; Fuernau G.;
Hasenclever D.; Zacharowski K.
Institution
(Meybohm, Strouhal, Reyher, Zacharowski) Department of Anesthesiology,
Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt,
Theodor-Stern-Kai 7, Frankfurt 60590, Germany
(Meybohm, Bein, Gruenewald) Department of Anesthesiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel,
Germany
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Brosteanu) Clinical Trial Center, Department of Internal
Medicine/Cardiology, University of Leipzig, Leipzig, Germany
(Fuernau) University of Leipzig Heart Center, University of Leipzig,
Leipzig, Germany
(Hasenclever) Institute for Medical Informatics, Statistics, and
Epidemiology, University of Leipzig, Leipzig, Germany
(Stoppe, Coburn, Schaelte) Department of Anesthesiology, University
Hospital Aachen, Aachen, Germany
(Boning, Niemann) Department of Cardiovascular Surgery, University of
Giessen, Giessen, Germany
(Roesner, Kletzin) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital Rostock, Rostock, Germany
(Laufenberg-Feldmann, Ferner) Department of Anesthesiology, Medical Center
of Johannes Gutenberg University, Mainz, Germany
(Brandes, Bauer) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Gottingen, Gottingen, Germany
(Stehr, Kortgen) Department of Anesthesiology and Intensive Care Medicine,
Center for Sepsis Control and Care, Jena University Hospital, Jena,
Germany
(Wittmann, Baumgarten) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Bonn, Bonn, Germany
(Meyer-Treschan, Kienbaum) Department of Anesthesiology and Intensive Care
Medicine, University Hospital Dusseldorf, Dusseldorf, Germany
(Heringlake, Schon) Department of Anesthesiology and Intensive Care
Medicine, University of Lubeck, Lubeck, Germany
(Sander, Treskatsch) Department of Anesthesiology and Intensive Care
Medicine, Charite-Universitatsmedizin Berlin, Campus Charite Mitte,
Berlin, Germany
(Smul, Wolwender) Department of Anesthesiology, University Hospital
Wurzburg, Wurzburg, Germany
(Schilling) Department of Anesthesiology, University Hospital Magdeburg,
Magdeburg, Germany
Title
A multicenter trial of remote ischemic preconditioning for heart surgery.
Source
New England Journal of Medicine. 373 (15) (pp 1397-1407), 2015. Date of
Publication: 08 Oct 2015.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) is reported to reduce
biomarkers of ischemic and reperfusion injury in patients undergoing
cardiac surgery, but uncertainty about clinical outcomes remains. METHODS
We conducted a prospective, double-blind, multicenter, randomized,
controlled trial involving adults who were scheduled for elective cardiac
surgery requiring cardiopulmonary bypass under total anesthesia with
intravenous propofol. The trial compared upper-limb RIPC with a sham
intervention. The primary end point was a composite of death, myocardial
infarction, stroke, or acute renal failure up to the time of hospital
discharge. Secondary end points included the occurrence of any individual
component of the primary end point by day 90. RESULTS A total of 1403
patients underwent randomization. The full analysis set comprised 1385
patients (692 in the RIPC group and 693 in the sham-RIPC group). There was
no significant between-group difference in the rate of the composite
primary end point (99 patients [14.3%] in the RIPC group and 101 [14.6%]
in the sham-RIPC group, P = 0.89) or of any of the individual components:
death (9 patients [1.3%] and 4 [0.6%], respectively; P = 0.21), myocardial
infarction (47 [6.8%] and 63 [9.1%], P = 0.12), stroke (14 [2.0%] and 15
[2.2%], P = 0.79), and acute renal failure (42 [6.1%] and 35 [5.1%], P =
0.45). The results were similar in the per-protocol analysis. No treatment
effect was found in any subgroup analysis. No significant differences
between the RIPC group and the sham-RIPC group were seen in the level of
troponin release, the duration of mechanical ventilation, the length of
stay in the intensive care unit or the hospital, new onset of atrial
fibrillation, and the incidence of postoperative delirium. No RIPC-related
adverse events were observed. CONCLUSIONS Upper-limb RIPC performed while
patients were under propofol-induced anesthesia did not show a relevant
benefit among patients undergoing elective cardiac surgery.

<3>
Accession Number
25926678
Author
Marazia S.; Urso L.; Contini M.; Pano M.; Zaccaria S.; Lenti V.; Sarullo
F.M.; Di Mauro M.
Institution
(Marazia) Cardiology Department, S. G. Moscati Hospital, Taranto, Italy
(Urso) Department of Cardiology, "Prof Petrucciani" Rehabilitation Clinic,
Lecce, Italy
(Contini) Cardiovascular Surgery, "Villa Verde" Clinic, Taranto, Italy
(Pano) Cardiovascular Surgery, V. Fazzi Hospital, Lecce, Italy
(Zaccaria) Cardiovascular Surgery, V. Fazzi Hospital, Lecce, Italy
(Lenti) Cardiology Department, S. G. Moscati Hospital, Taranto, Italy
(Sarullo) Cardiovascular Rehabilitation Unit, Buccheri La
FerlaFatebenefratelli Hospital, Palermo, Italy
(Di Mauro) Department of Cardiovascular Disease, University of L'Aquila,
L'Aquila, Italy
Title
The Role of Ivabradine in Cardiac Rehabilitation in Patients With Recent
Coronary Artery Bypass Graft.
Source
Journal of cardiovascular pharmacology and therapeutics. 20 (6) (pp
547-553), 2015. Date of Publication: 01 Nov 2015.
Abstract
BACKGROUND: Little is known about ivabradine in cardiac rehabilitation in
patients with coronary artery bypass graft (CABG).
METHODS: In this prospective, randomized study, suitable patients admitted
for cardiac rehabilitation after recent CABG were randomized to ivabradine
5 mg twice a day + standard medical therapy including bisoprolol 1.25 mg
once daily (group I-BB, n = 38) or standard medical therapy including
bisoprolol 2.5 to 3.75 mg once daily (group BB, n = 43). Patients were
evaluated at admission, discharge, and 3 months. The primary end point was
improvement in functional status, and other end points were improvement in
diastolic function and recovery of systolic function. End points were
assessed by distance covered in 6-minute walking test (6MWT), percentage
with normal diastolic function, and percentage increase in left
ventricular ejection fraction (LVEF).
RESULTS: Cardiac rehabilitation improved functional capacity in both
groups. In group BB, distances covered in the 6MWT at admission,
discharge, and 3 months were 215 +/- 53, 314 +/- 32, and 347 +/- 42 m,
respectively. Corresponding distances in group I-BB were 180 +/- 91, 311
+/- 58, and 370 +/- 55 m. Normal diastolic function was restored in I-BB
patients, increasing from 24% at admission to 50% and 79% at discharge and
3 months; in BB patients, it decreased from 23% to 19% and 16%. The LVEF
improved in I-BB patients, from 57% +/- 3% at admission to 62% +/- 4% at
discharge and 66% +/- 3% at 3 months, while remaining unchanged in BB
patients (57% +/- 3%, 59% +/- 4%, and 59% +/- 3%).
CONCLUSION: Adding ivabradine to low-dose bisoprolol during cardiac
rehabilitation in patients with CABG improved functional capacity,
enhanced recovery of systolic function, and reduced diastolic dysfunction.

<4>
[Use Link to view the full text]
Accession Number
25901540
Author
Robert S.M.; Borasino S.; Dabal R.J.; Cleveland D.C.; Hock K.M.; Alten
J.A.
Institution
(Robert, Borasino, Dabal, Cleveland, Hock, Alten) 1Department of Pediatric
Critical Care, University of Alabama at Birmingham, Birmingham, AL.
2Department of Cardiothoracic Surgery, University of Alabama at
Birmingham, Birmingham, AL
Title
Postoperative Hydrocortisone Infusion Reduces the Prevalence of Low
Cardiac Output Syndrome After Neonatal Cardiopulmonary Bypass.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 16 (7) (pp 629-636), 2015. Date of Publication: 01 Sep
2015.
Abstract
OBJECTIVE: Neonatal cardiac surgery with cardiopulmonary bypass is often
complicated by morbidity associated with inflammation and low cardiac
output syndrome. Hydrocortisone "stress dosing" is reported to provide
hemodynamic benefits in some patients with refractory shock. Development
of cardiopulmonary bypass-induced adrenal insufficiency may provide
further rationale for postoperative hydrocortisone administration. We
sought to determine whether prophylactic, postoperative hydrocortisone
infusion could decrease prevalence of low cardiac output syndrome after
neonatal cardiac surgery with cardiopulmonary bypass.
DESIGN: Double-blind, randomized control trial.
SETTING: Pediatric cardiac ICU and operating room in tertiary care center.
PATIENTS: Forty neonates undergoing cardiac surgery with cardiopulmonary
bypass were randomized (19 hydrocortisone and 21 placebo). Demographics
and known risk factors were similar between groups.
INTERVENTIONS: After cardiopulmonary bypass separation, bolus
hydrocortisone (50mg/m2) or placebo was administered, followed by
continuous hydrocortisone infusion (50mg/m2/d) or placebo tapered over 5
days. Adrenocorticotropic hormone stimulation testing (1 mug) was
performed before and after cardiopulmonary bypass, prior to steroid
administration. Blood was collected for cytokine analysis before and after
cardiopulmonary bypass.
MEASUREMENTS AND MAIN RESULTS: Subjects receiving hydrocortisone were less
likely to develop low cardiac output syndrome (5/19, 26% vs 12/21, 57%; p
= 0.049). Hydrocortisone group had more negative net fluid balance at 48
hours (-114 vs -64mL/kg; p = 0.01) and greater urine output at 0-24 hours
(2.7 vs 1.2mL/kg/hr; p = 0.03). Hydrocortisone group weaned off
catecholamines and vasopressin sooner than placebo, with a difference in
inotrope-free subjects apparent after 48 hours (p = 0.033). Five placebo
subjects (24%) compared with no hydrocortisone subjects required rescue
steroids (p = 0.02). Thirteen (32.5%) had adrenal insufficiency after
cardiopulmonary bypass. Patients with adrenal insufficiency randomized to
receive hydrocortisone had lower prevalence of low cardiac output syndrome
compared with patients with adrenal insufficiency randomized to placebo
(1/6 vs 6/7, respectively; p = 0.02). Hydrocortisone significantly reduced
proinflammatory cytokines. Ventilator-free days, hospital length of stay,
and kidney injury were similar.
CONCLUSIONS: Prophylactic, postoperative hydrocortisone reduces low
cardiac output syndrome, improves fluid balance and urine output, and
attenuates inflammation after neonatal cardiopulmonary bypass surgery.
Further studies are necessary to show if these benefits lead to
improvements in more important clinical outcomes.

<5>
Accession Number
26654448
Author
Mungroop T.H.; Veelo D.P.; Busch O.R.; van Dieren S.; van Gulik T.M.;
Karsten T.M.; de Castro S.M.; Godfried M.B.; Thiel B.; Hollmann M.W.; Lirk
P.; Besselink M.G.
Institution
(Mungroop) Department of Surgery, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. t.h.mungroop@amc.nl
(Mungroop) Department of Anesthesiology, Academic Medical Center,
University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD,
Amsterdam, The Netherlands. t.h.mungroop@amc.nl
(Veelo) Department of Anesthesiology, Academic Medical Center, University
of Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. d.p.veelo@amc.nl
(Busch) Department of Surgery, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. o.r.busch@amc.nl
(van Dieren) Department of Surgery, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. s.vandieren@amc.nl
(van Dieren) Department of Anesthesiology, Academic Medical Center,
University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD,
Amsterdam, The Netherlands. s.vandieren@amc.nl
(van Gulik) Department of Surgery, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. t.m.vangulik@amc.nl
(Karsten) Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9,
1091, AC, Amsterdam, The Netherlands. t.m.karsten@olvg.nl
(de Castro) Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark
9, 1091, AC, Amsterdam, The Netherlands. s.m.m.decastro@olvg.nl
(Godfried) Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, 1091, AC, Amsterdam, The Netherlands. m.b.godfried@olvg.nl
(Thiel) Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis,
Oosterpark 9, 1091, AC, Amsterdam, The Netherlands. b.thiel@olvg.nl
(Hollmann) Department of Anesthesiology, Academic Medical Center,
University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD,
Amsterdam, The Netherlands. m.w.hollmann@amc.nl
(Lirk) Department of Anesthesiology, Academic Medical Center, University
of Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. p.lirk@amc.nl
(Besselink) Department of Surgery, Academic Medical Center, University of
Amsterdam, Meibergdreef 9, Postbus 22660, 1100, DD, Amsterdam, The
Netherlands. m.g.besselink@amc.nl
Title
Continuous wound infiltration or epidural analgesia for pain prevention
after hepato-pancreato-biliary surgery within an enhanced recovery program
(POP-UP trial): study protocol for a randomized controlled trial.
Source
Trials. 16 (pp 562), 2015. Date of Publication: 2015.
Abstract
DISCUSSION: POP-UP is a pragmatic trial that will provide evidence of
whether CWI+PCA is noninferior as compared to (P)CEA after elective
hepato-pancreato-biliary surgery via laparotomy in an enhanced recovery
setting. If this hypothesis is confirmed, this finding could contribute to
more widespread implementation of this technique, especially when the
described disadvantages of epidural analgesia are less often observed with
CWI+PCA.
TRIAL REGISTRATION: Netherlands Trial Register NTR4948 (registry date 2
January 2015).
BACKGROUND: Postoperative pain prevention is essential for the recovery of
surgical patients. Continuous (thoracic) epidural analgesia (CEA) is
routinely practiced for major abdominal surgery, but evidence is
conflicting on its benefits in this setting. Potential disadvantages of
epidural analgesia are a) perioperative hypotension, frequently requiring
additional intravenous fluid boluses or prolonged use of vasopressors; b)
relatively high failure rates, with periods of inadequate analgesia; and
c) the risk of rare but serious, at times persistent, neurologic
complications (hematoma and abscess). In recent years, continuous
(subfascial) wound infiltration (CWI) plus patient-controlled analgesia
(PCA) has been suggested as a safe and reliable alternative, which does
not have the previously mentioned disadvantages, but evidence from
multicenter trials targeting a specific surgical population is lacking. We
hypothesize that CWI+PCA is equally as effective as CEA, without the
mentioned disadvantages.
METHODS/DESIGN: POP-UP is a randomized controlled noninferiority
multicenter trial, recruiting adult patients scheduled for elective
hepato-pancreato-biliary surgery via laparotomy in an enhanced recovery
setting. A total of 102 patients are being randomly allocated to CWI+PCA
or (P)CEA. Our primary endpoint is the Overall Benefit of Analgesic Score
(OBAS), a composite endpoint of pain intensity, opioid-related adverse
effects and patient satisfaction, during postoperative days 1 to 5.
Secondary endpoints include length of the hospital stay, number of
patients with severe pain, and the use of rescue medication.

<6>
Accession Number
20160515132
Author
Zarpelon C.S.; Netto M.C.; Jorge J.C.M.; Fabris C.C.; Desengrini D.;
Jardim M.S.; da Silva D.G.
Institution
(Zarpelon, Netto, Jorge, Fabris, Desengrini, Jardim, da Silva) Irmandade
da Santa Casa de Misericordia de Curitiba, Curitiba, PR, Brazil
Title
Colchicine to reduce atrial fibrillation in the postoperative period of
myocardial revascularization.
Source
Arquivos Brasileiros de Cardiologia. 107 (1) (pp 4-8), 2016. Date of
Publication: July 2016.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: The high prevalence of atrial fibrillation (AF) in the
postoperative period of myocardial revascularization surgery increases
morbidity and mortality. Objective: To assess the efficacy of colchicine
to prevent AF in the postoperative period of myocardial revascularization
surgery, the impact of AF on hospital length of stay and death, and to
identify its risk factors. Methods: Between May 2012 and November 2013,
140 patients submitted to myocardial revascularization surgery were
randomized, 69 to the control group and 71 to the colchicine group.
Colchicine was used at the dose of 1 mg orally, twice daily,
preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A
single dose of 1 mg was administered to those admitted 12 hours or less
before surgery. Results: The primary endpoint was AF rate in the
postoperative period of myocardial revascularization surgery. Colchicine
group patients showed no reduction in AF incidence as compared to control
group patients (7.04% versus 13.04%, respectively; p = 0.271). There was
no statistically significant difference between the groups regarding death
from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of
stay (14.5 +/- 11.5 versus 13.3 +/- 9.4 days; p = 0.490). However,
colchicine group patients had a higher infection rate (26.8% versus 8.7%;
p = 0.007). Conclusion: The use of colchicine to prevent AF after
myocardial revascularization surgery was not effective in the present
study. Brazilian Registry of Clinical Trials number RBR-556dhr.

<7>
Accession Number
20160503426
Author
Dogan Y.; Eren G.A.; Tulubas E.; Oduncu V.; Sahin A.; Ciftci S.
Institution
(Dogan, Oduncu, Sahin, Ciftci) Department of Cardiology, Fatih Medical
Park Hospital, Bahcesehir Medical University, Istanbul, Turkey
(Eren, Tulubas) Bakirkoy Dr. Sadi Konuk Education and Research Hospital,
Department of Anaesthesiology and Intensive Care, Istanbul, Turkey
Title
The effect of sedation during transoesophageal echocardiography on heart
rate variability: A comparison of hypnotic sedation with medical sedation.
Source
Kardiologia Polska. 74 (6) (pp 591-597), 2016. Date of Publication: 15 Jun
2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: There is no ideal sedation technique that can be used during
transoesophageal echocardiography (TEE), and the data concerning the
effects of available sedation techniques on heart rate variability (HRV)
are limited. Aim: To compare the effects of sedation through hypnotherapy
with medical sedation achieved by midazolam on HRV. Methods: We recruited
76 patients with an indication of TEE; the age range was 18-83 years. In
Group T there were 26 patients who had the procedure under topical
pharyngeal anaesthesia, in Group D there were 23 patients who received
midazolam, and in Group H there were 27 patients receiving hypnosis. All
patients had an IV access; throughout the procedure heart rate, rhythm
electrocardiography, and peripheric O2 saturation were monitored with a
non-invasive monitor, and blood pressure measurements were taken every 3
min. Rhythm Holter recordings were obtained from all patients and TEE was
performed. Results: When time domain parameters for HRV were compared in
all three groups, the hypnosis group had significant increases in pNN50
and RMSSD compared to Groups D and T (p < 0.05). As concerns frequency
domain parameters, there were no significant differences between groups
where low frequency (LF) was decreased in hypnosis group and high
frequency (HF) was increased (p > 0.05). However, LF/HF was decreased
statistically significantly (p < 0.05) when compared with the midazolam
group. Conclusions: Contrary to standard sedation in TEE patients, when
hypnosis is used autonomic cardiac tone is modified to a significant
extent. Hypnotic sedation achieves this by increasing the parasympathetic
activity, decreasing the sympathetic activity, and changing the
sympathovagal interaction balance.

<8>
Accession Number
20160498560
Author
Chang L.; Fang H.; Xie H.; Wang C.; Zhu J.; Li M.; Wang X.; Xu Y.
Institution
(Chang, Xie, Wang, Zhu) Department of Anesthesiology, The Second
Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou,
Jiangsu 215123, China
(Fang) Department of Anesthesiology, Bengbu Medical College, Bengbu,
Anhui, China
(Fang, Wang) Department of Anesthesiology, Renji Hospital, School of
Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Shanghai
200127, China
(Li) Department of Experimental Center, The Second Affiliated Hospital of
Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu 215123, China
(Xu) Department of Orthopedics, The Second Affiliated Hospital of Soochow
University, 1055 Sanxiang Road, Suzhou, Jiangsu 215123, China
Title
Evaluation of dexmedetomidine versus propofol sedation therapy in
mechanically ventilated cardiac surgery patients: A systematic review and
meta-analysis of randomized controlled trials and observational studies.
Source
International Journal of Clinical and Experimental Medicine. 9 (6) (pp
9694-9704), 2016. Date of Publication: 30 Jun 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: During mechanical ventilation, adequate sedation is a vital
factor after cardiac surgery; dexmedetomidine is applied to provide a
better efficacy of sedation therapy. However, the prognosis is still
controversial in clinical. This meta-analysis aims to compare the effects
of dexmedetomidine with propofol administration for MV cardiac surgery
patients. Methods: We searched multiple electronic databases including
PubMed, Embase, Google Scholar and The Cochrane Library and Cochrane
Central Register of Controlled Trials, and the results were updated to
July 2015. All statistical analysis was performed by Review Manager, and
the Cochrane Collaboration's software was used for preparation and
maintenance of Cochrane systematic reviews. Results: Eight trials (three
RCTs and five observational studies of 1392 patients) were included, with
a sample size ranging from 56 to 582. Pooled analysis suggested that
dexmedetomidine had no correlation with decreased duration in MV among
cardiac surgery patients in RCTs (WMD: 0.41 D; 95% CI: -1.58-0.76; P =
0.24), but statistically reduced the duration of MV in the observational
studies (WMD: -3.80 D; 95% CI: -5.48--2.11; P = 0.15). No statistically
significant shorter length of ICU was associated with dexmedetomidine in
cardiac surgery patients in two RCTs (WMD: -0.48 D; 95% CI: -1.55-0.59; P
= 0.006). Conclusions: Dexmedetomidine has an indispensable role in
achieving effective sedation in cardiac surgery patients. Current
evidences demonstrate that dexmedetomidine decreases the duration of MV in
cardiac surgery patients. Nevertheless, most results relying on the data
from observational studies only might cause the selection bias.

<9>
Accession Number
20160501984
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Worse survival after transcatheter aortic valve implantation than surgical
aortic valve replacement: A meta-analysis of observational studies with a
propensity-score analysis.
Source
International Journal of Cardiology. 220 (pp 320-327), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether transcatheter aortic valve implantation
(TAVI) improves (or impairs) follow-up overall survival compared with
surgical aortic valve replacement (SAVR), we performed a meta-analysis of
observational studies with a propensity-score analysis and another
meta-analysis of randomized controlled trials (RCTs). Methods Databases
including MEDLINE and EMBASE were searched through October 2015 using
PubMed and OVID. Eligible studies were observational studies with a
propensity-score analysis or RCTs of TAVI versus SAVR enrolling patients
with severe aortic stenosis and reporting follow-up overall survival or
all-cause mortality as an outcome. A hazard ratio (HR) with its 95%
confidence interval (CI) of follow-up (including early) all-cause
mortality for TAVI versus SAVR was abstracted from each individual study.
Results Our search identified 19 observational studies with a
propensity-score analysis enrolling a total of 6234 patients. The
arithmetic means of 1-year and 3-year survival rates were 82.7% and 71.3%
after TAVI and 84.8% and 77.9% after SAVR, respectively. A pooled analysis
demonstrated a statistically significant 21% increase in the hazard of
mortality with TAVI relative to SAVR (HR, 1.21; 95% CI, 1.05 to 1.39; p =
0.010). Another pooled analysis of 4 RCTs (enrolling a total of 1795
patients) demonstrated no statistically significant difference in
mortality between TAVI and SAVR (HR, 0.92; 95% CI, 0.62 to 1.37; p =
0.69). Conclusions The arithmetic mean of 3-year survival rates was 71.3%
after TAVI and 77.9% after SAVR. Compared with SAVR, TAVI appears to be
associated with a significant increase in follow-up all-cause mortality.

<10>
Accession Number
20160488912
Author
Faber M.M.; Noordzij P.G.; Hennink S.; Kelder H.; De Vroege R.; Waanders
F.G.; Daeter E.; Stehouwer M.C.
Institution
(Faber, Waanders, Stehouwer) Department of Extracorporeal Circulation, St.
Antonius Hospital, Nieuwegein, Netherlands
(Noordzij, Hennink) Department of Anaesthesiology, Intensive Care and Pain
Management, St. Antonius Hospital, Nieuwegein, Netherlands
(Kelder) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(De Vroege) Department of Extracorporeal Circulation, Haga Hospital, The
Hague, Netherlands
(Daeter) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Comparison of warm blood cardioplegia delivery with or without the use of
a roller pump.
Source
Journal of Extra-Corporeal Technology. 47 (4) (pp 209-216), 2015. Date of
Publication: 2015.
Publisher
American Society of Extra-Corporeal Technology
Abstract
Various techniques for administration of blood cardioplegia are used
worldwide. In this study, the effect of warm blood cardioplegia
administration with or without the use of a roller pump on perioperative
myocardial injury was studied in patients undergoing coronary artery
bypass grafting using minimal extracorporeal circuits (MECCs). Sixty-eight
patients undergoing elective coronary bypass surgery with an MECC system
were consecutively enrolled and randomized into a pumpless group (PL
group: blood cardioplegia administration without roller pump) or roller
pump group (RP group: blood cardioplegia administration with roller pump).
No statistically significant differences were found between the PL group
and RP group regarding release of cardiac biomarkers. Maximum
postoperative biomarker values reached at T1 (after arrival intensive care
unit) for hearttype fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL
group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first
postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L
PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal
probrain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6;
3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175]
mug/mL PL group vs. 129 [105; 161] mug/mL RP group, p = .65). Besides
this, blood cardioplegia flow, blood cardioplegia line pressure, and
aortic root pressure during blood cardioplegia administration were similar
between the two groups. Administration of warm blood cardioplegia with or
without the use of a roller pump results in similar clinically acceptable
myocardial protection.

<11>
[Use Link to view the full text]
Accession Number
2014747576
Author
Lu C.; Qin F.; Yan Y.; Liu T.; Li J.; Chen H.
Institution
(Lu, Qin, Yan, Liu, Chen) Division of Cardiology, Chengdu First People's
Hospital, 18 North Wan Xiang Road, High-Tech District, Chengdu 610016,
China
(Li) Department of Evidence-Based Medicine, West China Hospital, Sichuan
University, Chengdu, China
Title
Immunosuppressive treatment for myocarditis: A meta-analysis of randomized
controlled trials.
Source
Journal of Cardiovascular Medicine. 17 (8) (pp 631-637), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Immunosuppressive treatment for myocarditis is controversial. Several
small-scale randomized controlled trials (RCTs) reported inconsistent
outcomes for patients with myocarditis. Methods We searched on the
Medline, Embase, and Cochrane databases for articles in English language
between January 1966 and May 2013, as well as on the China National
Knowledge Internet (CNKI, 1979 to May 2012) and the Chinese Biomedical
Literature Database (CBM, 1978 to May 2013) for articles in Chinese
language. Statistical analysis was performed using Review Manager 5.0.
Results Nine articles were finally selected, in which 342 patients were in
immunosuppressive treatment group and 267 patients in conventional
treatment group. The immunosuppressive treatment group showed a
significant improvement in left ventricular ejection fraction at both
short-term (<3 months) [difference: 0.08, 95% confidence interval (CI):
0.05-0.10) and long-term (difference: 0.10, 95% CI: 0.00-0.21)] follow-up.
Moreover, left ventricular end-diastolic dimension decreased significantly
in the immunosuppressive treatment group after short-term follow-up
(difference:-1.85 mm, 95% CI:-3.18 to-0.52 mm), but a long-term beneficial
effect was not sustained (difference:-5.79 mm, 95% CI:-15.30 to 3.72 mm).
There was no difference, however, between the two groups in the rate of
death or heart transplantation (odds ratio: 1.33, 95% CI: 0.77, 2.31).
Conclusion Immunosuppressive treatment might be beneficial for improving
left ventricular systolic function and remodeling in patients with
myocarditis, which could be considered as a therapeutic alternative when
optimal conventional therapy is not effective. More large RCTs, however,
are required.

<12>
Accession Number
20160508477
Author
Zheng X.-Y.; Wang Y.; Chen Y.; Wang X.; Chen L.; Li J.; Zheng Z.-G.
Institution
(Zheng, Wang, Chen, Wang, Chen, Li, Zheng) China-Japan Friendship
Hospital, Department of Senior Official Ward, 2 Yinghua Dongjie, Beijing
100029, China
Title
The effectiveness of intra-aortic balloon pump for myocardial infarction
in patients with or without cardiogenic shock: A meta-analysis and
systematic review.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 148. Date of Publication: 08 Jul 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Conflicting reports on the efficacy of intra-aortic balloon
pump (IABP) during percutaneous coronary intervention (PCI) incited us to
evaluate the utility of IABP in patients with acute myocardial infarction
(AMI). Methods: Randomized clinical trials comparing patients, who
received IABP vs. control (no IABP) during PCI, were hand-searched from
MEDLINE, Cochrane, and EMBASE databases using the terms "intra-aortic
balloon pump, percutaneous coronary intervention, myocardial infarction,
acute coronary syndrome". Mortality rate (30-day and 6-month mortality)
was the primary outcome, while the secondary outcomes included 30-day
bleeding rate, reinfarction rate, revascularization rate and stroke rate.
Results: Pooled results of the seven trials identified indicated that the
30-day and 6-month mortality rate were not significantly different between
the IABP and control groups. However, in patients with MI, but without
cardiogenic shock (CS), IABP was associated with lower odds of 30-day
mortality (OR = 0.35, p = 0.015) and 6-month mortality (OR = 0.41, p =
0.020). The pooled results of 30-day bleeding rate was not significantly
higher in patients with IABP than the control group, but for the patients
with high risk PCI without CS, it was higher in patients with IABP than
the control group (OR = 1.58, p = 0.009). The re-infarction,
revascularization, and the stroke rate at 30 days of follow-up were not
significantly different between the two groups. Conclusions: The present
results do not favor the clinical utility of IABP in patients suffering
high-risk PCI without CS and AMI complicated with CS. However, in patients
with AMI, but without CS, IABP may reduce the 30-day and 6-month mortality
rate.

<13>
Accession Number
20160498641
Author
Feng D.; Wei J.; Luo J.; Chen Y.-Y.; Zhu M.-Y.; Zhang Y.; Yang H.; Cheng
X.-Y.; Lv X.
Institution
(Feng, Wei, Luo, Chen, Zhu, Zhang, Yang, Cheng, Lv) Department of
Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of
Medicine, Shanghai, China
(Feng, Wei, Lv) Department of Anesthesiology, Shanghai Pulmonary Hospital,
Soochow University, Suzhou, China
(Luo, Lv) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou
Medical College, Xuzhou, Jiangsu, China
(Luo, Lv) Jiangsu Province Key Laboratory of Anesthesia and Analgesia
Application Technology, Jiangsu, China
Title
Preoperative single dose of pregabalin alleviates postoperative pain:
Systematic review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 9 (6) (pp
9665-9680), 2016. Date of Publication: 30 Jun 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Purpose: The aim of this meta-analysis is to probe the impact of
preoperative single dose of pregabalin on postoperative pain. Methods:
PubMed, Embase and Cochrane library were searched for randomized
controlled trials investigating preoperative single dose of pregabalin for
postoperative analgesia. Pain scores at rest, opioid consumption and
adverse effects were assessed in our meta-analysis. Findings: Eighteen
trials with 1224 patients were finally included in our meta-analysis.
Studies indicated that pre-emptive pregabalin significantly reduced the
postoperative pain scores (SMD, -0.41, 95% CI: -0.72 to -0.11) and
postoperative opioid consumption (SMD, -1.76, 95% CI: -2.27 to -1.26). In
analysis of subgroups by different doses, 300 mg of pregabalin showed
reduction of pain scores at rest (SMD, -0.51, 95% CI: -0.94 to -0.08)
whereas 75 mg and 150 mg of pregabalin did not. In addition, 150 mg and
300 mg pregabalin reduced the opioid consumption significantly (SMD,
-1.47, 95% CI: -2.07 to -0.87, SMD, -2.10, 95% CI: -2.98 to -1.22,
respectively). Static pain scores decreased at 24 h in the thoracic and
abdominal surgeries (SMD, -0.48, 95% CI: -0.95 to -0.01) and the ENT
surgeries (SMD, -0.91, 95% CI: -1.60 to -0.23) rather than in the
gynecological or orthopedic surgeries. Preoperative pregabalin
significantly diminished the postoperative opioid consumption in
orthopedic surgeries (SMD, -1.32, 95% CI: -2.22 to -0.42) and thoracic and
abdominal surgeries (SMD, -2.21, 95% CI: -2.98 to -1.44) but did not show
remarkable reduction of postoperative opioid consumption in ENT surgeries
(SMD, -0.36, 95% CI: -0.87 to 0.15) or gynecological surgeries (SMD,
-1.70, 95% CI: -4.06 to 0.66). The side effects were limited to the first
postoperative 24 h. Pregabalin decreased the risk of PONV (RR, 0.60, 95%
CI: 0.41 to 0.88) and nausea (RR, 0.61, 95% CI: 0.38 to 0.99) but not
visual disturbance, sedation, vomiting, dizziness, headache or respiratory
depression. Conclusions: This current meta-analysis suggested that
pregabalin could attenuate postoperative pain and reduce opioid
consumption compared to placebo but not in all doses or surgeries.

<14>
Accession Number
20160513673
Author
Garcia M.; Miller V.M.; Gulati M.; Hayes S.N.; Manson J.E.; Wenger N.K.;
Bairey Merz C.N.; Mankad R.; Pollak A.W.; Mieres J.; Kling J.; Mulvagh
S.L.
Institution
(Garcia, Hayes, Mankad, Mulvagh) Division of Cardiovascular Diseases, Mayo
Clinic, Rochester, MN, United States
(Miller) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Miller) Department of Physiology, Mayo Clinic, Rochester, MN, United
States
(Miller) Department of Biomedical Engineering, Mayo Clinic, Rochester, MN,
United States
(Gulati) Division of Cardiovascular Medicine, The Ohio State University
Wexner Medical Center, Columbus, OH, United States
(Manson) Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Wenger) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Bairey Merz) Barbra Streisand Women's Heart Center, Cedars-Sinai Heart
Institute, Los Angeles, CA, United States
(Pollak) Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville,
FL, United States
(Mieres) Department of Cardiology, Hofstra North Short-LIJ School of
Medicine, Hempstead, NY, United States
(Kling) Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ,
United States
Title
Focused Cardiovascular Care for Women: The Need and Role in Clinical
Practice.
Source
Mayo Clinic Proceedings. 91 (2) (pp 226-240), 2016. Date of Publication:
01 Feb 2016.
Publisher
Elsevier Ltd
Abstract
Over the past decade, an emerging clinical research focus on
cardiovascular (CV) disease (CVD) risk in women has highlighted
sex-specific factors that are uniquely important in the prevention and
early detection of coronary atherosclerosis in women. Concurrently, a 30%
decrease in the number of female deaths from CVD has been observed.
Despite this, CVD continues to be the leading cause of death in women,
outnumbering deaths from all other causes combined. Clinical practice
approaches that focus on the unique aspects of CV care for women are
needed to provide necessary resources for the prevention, diagnosis, and
treatment of CVD in women. In addition to increasing opportunities for
women to participate in CV research, Women's Heart Clinics offer unique
settings in which to deliver comprehensive CV care and education, ensuring
appropriate diagnostic testing, while monitoring effectiveness of
treatment. This article reviews the emerging need and role of focused CV
care to address sex-specific aspects of diagnosis and treatment of CVD in
women.

<15>
Accession Number
20160504370
Author
Alborzi Z.; Zangouri V.; Paydar S.; Ghahramani Z.; Shafa M.; Ziaeian B.;
Radpey M.R.; Amirian A.; Khodaei S.
Institution
(Alborzi) Department of Cardiology, Medical School, Yasouj University of
Medical Sciences, Yasouj, Iran, Islamic Republic of
(Zangouri, Khodaei) Department of General Surgery, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Paydar, Ghahramani, Amirian) Trauma Research Center, Shahid Rajaee
(Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz,
Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Ziaeian) Department of Thoracic Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Radpey) Department of Vascular Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Title
Diagnosing myocardial contusion after blunt chest trauma.
Source
Journal of Tehran University Heart Center. 11 (2) (pp 49-54), 2016. Date
of Publication: 2016.
Publisher
Tehran Heart Center
Abstract
A myocardial contusion refers to a bruise of the cardiac muscle, the
severity of which can vary depending on the severity of the injury and
when the injury occurs. It is a major cause of rapid death which happens
after blunt chest trauma and should be suspected at triage in the
emergency department. We demonstrated that suspected myocardial contusion
patients who have normal electrocardiograms (ECGs) and biomarker tests can
be safely discharged. However, if the test results are abnormal, the next
steps should be echocardiography and more advanced measures. Diagnosing
myocardial contusion is very difficult because of its nonspecific
symptoms. If a myocardial contusion happens, cardiogenic shock or
arrhythmia must be anticipated, and the patient must be carefully
monitored.

<16>
Accession Number
20160501781
Author
Bagur R.; Kwok C.S.; Nombela-Franco L.; Ludman P.F.; de Belder M.A.;
Sponga S.; Gunning M.; Nolan J.; Diamantouros P.; Teefy P.J.; Kiaii B.;
Chu M.W.A.; Mamas M.A.
Institution
(Bagur, Diamantouros, Teefy) Division of Cardiology, Department of
Medicine, London Health Sciences Centre, London, ON, Canada
(Bagur) Department of Epidemiology and Biostatistics, London, ON, Canada
(Chu) Department of Surgery, London, ON, Canada
(Gunning, Nolan, Chu, Mamas) Department of Western University, London, ON,
Canada
(Kwok, Mamas) Department of Royal Stoke University Hospital,
Stoke-on-Trent, Staffordshire, United Kingdom
(Kwok) Department of Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine and Primary Care, Keele University,
Stoke-on-Trent, Staffordshire, United Kingdom
(Nombela-Franco) Division of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(de Belder) James Cook University Hospital, Middlesbrough, North
Yorkshire, United Kingdom
(Sponga) Cardiothoracic Department, University Hospital of Udine, Italy
(Kiaii) Division of Cardiac Surgery, London Health Sciences Centre,
University Hospital, London, ON, Canada
Title
Transcatheter aortic valve implantation with or without preimplantation
balloon aortic valvuloplasty: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003191. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Preimplantation balloon aortic valvuloplasty (BAV) is
considered a routine procedure during transcatheter aortic valve
implantation (TAVI) to facilitate prosthesis implantation and expansion;
however, it has been speculated that fewer embolic events and/or less
hemodynamic instability may occur if TAVI is performed without
preimplantation BAV. The aim of this study was to systematically review
the clinical outcomes associated with TAVI undertaken without
preimplantation BAV. Methods and Results--We conducted a search of Medline
and Embase to identify studies that evaluated patients who underwent TAVI
with or without preimplantation BAV for predilation. Pooled analysis and
random-effects meta-analyses were used to estimate the rate and risk of
adverse outcomes. Sixteen studies involving 1395 patients (674 with and
721 without preimplantation BAV) fulfilled the inclusion criteria. Crude
device success was achieved in 94% (1311 of 1395), and 30-day all-cause
mortality occurred in 6% (72 of 1282) of patients. Meta-analyses
evaluating outcomes of strategies with and without preimplantation BAV
showed no statistically significant differences in terms of mortality
(relative risk [RR] 0.61, 95% CI 0.32-1.14, P=0.12), safety composite end
point (RR 0.85, 95% CI 0.62-1.18, P=0.34), moderate to severe paravalvular
leaks (RR 0.68, 95% CI 0.23-1.99, P=0.48), need for postdilation (RR 0.86,
95% CI 0.66-1.13, P=0.58), stroke and/or transient ischemic attack (RR
0.72, 95% CI 0.30-1.71, P=0.45), and permanent pacemaker implantation (RR
0.80, 95% CI 0.49-1.30, P=0.37). Conclusions--Our analysis suggests that
TAVI procedures with or without preimplantation BAV were associated with
similar outcomes for a number of clinically relevant end points. Further
studies including a large number of patients are needed to ascertain the
impact of TAVI without preimplantation BAV as a standard practice.

<17>
Accession Number
20160501776
Author
Khan J.N.; Greenwood J.P.; Nazir S.A.; Lai F.Y.; Dalby M.; Curzen N.;
Hetherington S.; Kelly D.J.; Blackman D.; Peebles C.; Wong J.; Flather M.;
Swanton H.; Gershlick A.H.; McCann G.P.
Institution
(Khan, Nazir, Lai, Gershlick, McCann) Department of Cardiovascular
Sciences, University of Leicester, United Kingdom
(Khan, Nazir, Lai, Gershlick, McCann) NIHR Leicester Cardiovascular
Biomedical Research Unit, University Hospitals of Leicester NHS Trust,
Glenfield Hospital, Leicester, United Kingdom
(Greenwood, Blackman) Multidisciplinary Cardiovascular Research Centre,
The Division of Cardiovascular and Diabetes Research, University of Leeds,
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
(Dalby, Wong) Royal Brompton and Harefield Foundation Trust, Harefield
Hospital, Middlesex, United Kingdom
(Curzen, Peebles) University Hospital Southampton NHS Foundation Trust,
University of Southampton, United Kingdom
(Hetherington) Kettering General Hospital, Kettering, United Kingdom
(Kelly) Royal Derby Hospital, Derby, United Kingdom
(Flather) Norfolk and Norwich University Hospitals NHS Foundation Trust,
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
(Swanton) The Heart Hospital, University College London Hospitals, London,
United Kingdom
Title
Infarct size following treatment with second-versus third-generation
P2Y<inf>12</inf> antagonists in patients with multivessel coronary disease
at ST-segment elevation myocardial infarction in the CvLPRIT study.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003403. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Third-generation P2Y<inf>12</inf> antagonists (prasugrel and
ticagrelor) are recommended in guidelines on ST-segment elevation
myocardial infarction. Mechanisms translating their more potent
antiplatelet activity into improved clinical outcomes versus the
second-generation P2Y<inf>12</inf> antagonist clopidogrel are unclear. The
aim of this post hoc analysis of the Complete Versus Lesion-Only PRImary
PCI Trial-CMR (CvLPRIT-CMR) substudy was to assess whether prasugrel and
ticagrelor were associated with reduced infarct size compared with
clopidogrel in patients undergoing primary percutaneous coronary
intervention. Methods and Results-CvLPRIT-CMR was a multicenter,
prospective, randomized, open-label, blinded end point trial in 203
STsegment elevation myocardial infarction patients with multivessel
disease undergoing primary percutaneous coronary intervention with either
infarct-related artery-only or complete revascularization.
P2Y<inf>12</inf> inhibitors were administered according to local
guidelines. The primary end point of infarct size on cardiovascular
magnetic resonance was not significantly different between the randomized
groups. P2Y<inf>12</inf> antagonist administration was not randomized.
Patients receiving clopidogrel (n=70) compared with those treated with
either prasugrel or ticagrelor (n=133) were older (67.8+/-12 versus
61.5+/-10 years, P < 0.001), more frequently had hypertension (49% versus
29%, P=0.007), and tended to have longer symptom-to-revascularization time
(234 versus 177 minutes, P=0.05). Infarct size (median 16.1% [quartiles
1-3, 10.5-27.7%] versus 12.1% [quartiles 1-3, 4.8-20.7%] of left
ventricular mass, P=0.013) and microvascular obstruction incidence (65.7%
versus 48.9%, P=0.022) were significantly greater in patients receiving
clopidogrel. Infarct size remained significantly different after
adjustment for important covariates using both generalized linear models
(P=0.048) and propensity score matching (P=0.025). Conclusions-In this
analysis of CvLPRIT-CMR, third-generation P2Y<inf>12</inf> antagonists
were associated with smaller infarct size and lower microvascular
obstruction incidence versus the second-generation P2Y<inf>12</inf>
antagonist clopidogrel for ST-segment elevation myocardial infarction.

<18>
Accession Number
20160501756
Author
Wallentin L.; Held C.; Armstrong P.W.; Cannon C.P.; Davies R.Y.; Granger
C.B.; Hagstrom E.; Harrington R.A.; Hochman J.S.; Koenig W.; Krug-Gourley
S.; Mohler E.R.; Siegbahn A.; Tarka E.; Steg P.G.; Stewart R.A.H.; Weiss
R.; Ostlund O.; White H.D.; Budaj A.; Ardissino D.; Avezum A.; Aylward
P.E.; Bryce A.; Chen H.; Chen M.-F.; Corbalan R.; Dalby A.J.; Danchin N.;
De Winter R.J.; Denchev S.; Diaz R.; Elisaf M.; Flather M.D.; Goudev A.R.;
Grinfeld L.; Husted S.; Kim H.-S.; Linhart A.; Lonn E.; Lopez-Sendon J.;
Manolis A.J.; Nicolau J.C.; Pais P.; Parkhomenko A.; Pedersen T.R.; Pella
D.; Ramos-Corrales M.A.; Ruda M.; Sereg M.; Siddique S.; Sinnaeve P.;
Sritara P.; Swart H.P.; Sy R.G.; Teramoto T.; Tse H.-F.; Douglas Weaver
W.; Viigimaa M.; Vinereanu D.; Zhu J.
Institution
(Wallentin, Held, Hagstrom) Department of Medical Sciences, Cardiology,
Uppsala University, Uppsala, Sweden
(Wallentin, Held, Hagstrom, Siegbahn, Ostlund) Uppsala Clinical Research
Center (UCR), Uppsala University, Uppsala, Sweden
(Siegbahn) Department of Medical Sciences, Clinical Chemistry, Uppsala
University, Uppsala, Sweden
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Cannon) Harvard Clinical Research Institute, Boston, MA, United States
(Davies, Krug-Gourley) Metabolic Pathways and Cardiovascular Therapeutic
Area, GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) Former Employee of Metabolic Pathways and Cardiovascular
Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, United States
(Granger) Medical Center, Duke University, Durham, NC, United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Mohler) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), Paris, France
(Steg) DHU FIRE, Universite Paris-Diderot, Sorbonne Paris-Cite, Paris,
France
(Steg) Hopital Bichat, INSERUM U-1148, Paris, France
(Steg) NHLI, ICMS, Imperial College, Royal Brompton Hospital, London,
United Kingdom
(Stewart, White) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Stewart, White) University of Auckland, New Zealand
(Weiss) Maine Research Associates, Auburn, ME, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Wallentin) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Budaj) Grochowski Hospital, Warsaw, Poland
(Cannon) TIMI Study Group, Brigham and Women's Hospital, Boston, MA,
United States
(Harrington) Stanford University, Stanford, CA, United States
(Steg) INSERM-Unite, APHP, Hopital Bichat and Universite Paris-Diderot,
Paris, France
(Davies) GlaxoSmithKline, King of Prussia, PA, United States
(Tarka) GlaxoSmithKline, King of Prussia, PA, United States
(Ardissino) Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
(Armstrong) University of Alberta, Edmonton, CA, United States
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, SA, Australia
(Bryce) Cardiogolf/Clinica El Golf, Lima, Peru
(Chen) Peking University People's Hospital, Beijing, China
(Chen) National Taiwan University Hospital, Taipei, Taiwan (Republic of
China)
(Corbalan) Pontificia Universidad Catolica de Chile, Santiago, Chile
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Danchin) AP-HP and Universite Paris Descartes, Paris, France
(De Winter) University of Amsterdam, Amsterdam, Netherlands
(Denchev) University Hospital Alexandrovska, Sofia, Bangladesh
(Diaz) ECLA Estudios Cardiologicos, Latinoamerica, Rosario, Argentina
(Elisaf) University of Ioannina, Ioannina, Greece
(Flather) University of East Anglia and Norfolk, Norwich University
Hospital, United Kingdom
(Goudev) Queen Giovanna University Hospital, Sofia, Bangladesh
(Granger) Duke University, Medical Center, Durham, NC, United States
(Grinfeld) University of Buenos Aires, School of Medicine, Buenos Aires,
Argentina
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Hochman) NYU Langone Medical Center, New York, NY, United States
(Husted) Hospital Unit West, Herning/Holstebro, Denmark
(Kim) Seoul National University Hospital, Seoul, South Korea
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Linhart) Charles University in Prague, Prague, Czech Republic
(Lonn) McMaster University, Hamilton, ON, Canada
(Lopez-Sendon) Hospital Universitario La Paz, Madrid, Spain
(Manolis) Asklepeion Hospital, Athens, Greece
(Mohler) University of Pennsylvania, Philadelphia, PA, United States
(Nicolau) University of Sao Paulo Medical School, Sao Paulo, Brazil
(Pais) St. John's Medical Collage, Bangalore, India
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Pedersen) University of Oslo, Oslo University Hospital, Oslo, Norway
(Pella) PJ Safarik University, Kosice, Slovakia
(Ramos-Corrales) San Jose Satelite Hospital, Naucalpan, Mexico
(Ruda) Russian Cardiologic Research and Production Complex of
Rosmedtechnology, Moscow, Russian Federation
(Sereg) St. George Hospital, Szekesfehervar, Hungary
(Siddique) Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan
(Sinnaeve) University Hospitals Leuven, Leuven, Belgium
(Sritara) Mahidol University, Bangkok, Thailand
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland University, Auckland, New Zealand
(Swart) Antonius Hospital Sneek, Netherlands
(Sy) University of the Philippines, Manila, Philippines
(Teramoto) Teikyo Academic Research Center, Itabashi-ku, Tokyo, Japan
(Tse) University of Hong Kong, Hong Kong
(Douglas Weaver) Henry Ford Heart and Vascular Institute, Wayne State
University, Detroit, MI, United States
(Weiss) Maine Research Associates, Auburn, ME, United States
(Viigimaa) Tallinn University of Technology, Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy, University and Emergency
Hospital, Bucharest, Romania
(Zhu) Fudan University, Shanghai, China
(Steg) Royal Brompton Hospital, London, United Kingdom
Title
Lipoprotein-associated phospholipase A<inf>2</inf> activity is a marker of
risk but not a useful target for treatment in patients with stable
coronary heart disease.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003407. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--We evaluated lipoprotein-associated phospholipase
A<inf>2</inf> (Lp-PLA<inf>2</inf>) activity in patients with stable
coronary heart disease before and during treatment with darapladib, a
selective Lp-PLA<inf>2</inf> inhibitor, in relation to outcomes and the
effects of darapladib in the STABILITY trial. Methods and Results--Plasma
Lp-PLA<inf>2</inf> activity was determined at baseline (n=14 500); at 1
month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end
of treatment. Adjusted Cox regression models evaluated associations
between Lp-PLA<inf>2</inf> activity levels and outcomes. At baseline, the
median Lp-PLA<inf>2</inf> level was 172.4 lmol/min per liter
(interquartile range 143.1-204.2 lmol/min per liter). Comparing the
highest and lowest Lp-PLA<inf>2</inf> quartile groups, the hazard ratios
were 1.50 (95% CI 1.23-1.82) for the primary composite end point
(cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI
1.29-2.93) for hospitalization for heart failure, 1.42 (1.07-1.89) for
cardiovascular death, and 1.37 (1.03-1.81) for myocardial infarction after
adjustment for baseline characteristics, standard laboratory variables,
and other prognostic biomarkers. Treatment with darapladib led to a =65%
persistent reduction in median Lp-PLA<inf>2</inf> activity. There were no
associations between on-treatment Lp-PLA<inf>2</inf> activity or changes
of Lp-PLA<inf>2</inf> activity and outcomes, and there were no significant
interactions between baseline and on-treatment Lp- PLA<inf>2</inf>
activity or changes in Lp-PLA<inf>2</inf> activity levels and the effects
of darapladib on outcomes. Conclusions--Although high Lp-PLA<inf>2</inf>
activity was associated with increased risk of cardiovascular events,
pharmacological lowering of Lp-PLA<inf>2</inf> activity by =65% did not
significantly reduce cardiovascular events in patients with stable
coronary heart disease, regardless of the baseline level or the magnitude
of change of Lp-PLA<inf>2</inf> activity.

<19>
Accession Number
20160501689
Author
Bajaj N.S.; Kalra R.; Aggarwal H.; Ather S.; Gaba S.; Arora G.; McGiffin
D.C.; Ahmed M.; Aslibekyan S.; Arora P.
Institution
(Bajaj, Aggarwal, Ather, Gaba, Arora, Ahmed, Arora) Division of
Cardiology, Department of Medicine, University of Alabama, Birmingham, AL,
United States
(Bajaj, Aslibekyan) Ryals School of Public Health, Department of
Epidemiology, University of Alabama, Birmingham, AL, United States
(Kalra) Department of Medicine, University of Alabama, Birmingham, AL,
United States
(McGiffin) Alfred Hospital and Monash University, Melbourne, VIC,
Australia
(Ahmed) Division of Cardiology, Baptist Princeton, Birmingham, AL, United
States
Title
Comparison of approaches to revascularization in patients with multivessel
coronary artery disease presenting with st-segment elevation myocardial
infarction: Meta-analyses of randomized control trials.
Source
Journal of the American Heart Association. 4 (12) (no pagination), 2015.
Article Number: e002540. Date of Publication: 01 Dec 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Significant controversy exists regarding the best approach for
nonculprit vessel revascularization in patients with multivessel coronary
artery disease presenting with ST-segment elevation myocardial infarction.
We conducted a systematic investigation to pool data from current
randomized controlled trials (RCTs) to assess optimal treatment strategies
in this patient population. Methods and Results-A comprehensive search of
SCOPUS from inception through May 2015 was performed using predefined
criteria. We compared efficacy and safety outcomes of different approaches
by categorizing the studies into 3 groups: (1) complete revascularization
(CR) versus culprit lesion revascularization (CL) at index
hospitalization, (2) CR at index hospitalization versus staged
revascularization (SR) of nonculprit vessels at a separate
hospitalization, and (3) comparison of SR versus CL. Eight eligible RCTs
met the inclusion criteria: (1) CR versus CL (6 RCTs, n=1727) (2) CR
versus SR (3 RCTs, n=311), and (3) SR versus CL (1 RCT, n=149). We
observed significantly lower rates of major adverse cardiovascular events,
revascularization, and repeat percutaneous coronary interventions among
patients treated with CR and SR compared with a CL approach (P < 0.05).
The rates of all-cause mortality, cause-specific mortality, major
bleeding, reinfarction, stroke, and contrast-induced nephropathy did not
differ in the CR arm compared with the CL arm. The rates of these outcomes
were similar in the CR and SR arms. Conclusion-Results suggest that CR and
SR compared with CL reduce major adverse cardiovascular event and
revascularization rates primarily by lowering repeated percutaneous
coronary intervention rates. We did not observe any increase in the rate
of adverse events while using a CR or SR strategy compared with a CL
approach. Current guidelines discouraging CR need to be reevaluated, and
clinical judgment should prevail in treating multivessel coronary artery
disease patients with ST-segment elevation myocardial infarction as data
from larger RCTs accumulate.

<20>
Accession Number
20160497350
Author
Rahe-Meyer N.; Levy J.H.; Mazer C.D.; Schramko A.; Klein A.A.; Brat R.;
Okita Y.; Ueda Y.; Schmidt D.S.; Ranganath R.; Gill R.; Myles P.S.
Institution
(Rahe-Meyer) Clinic for Anesthesiology and Intensive Care Medicine,
Franziskus Hospital, Kiskerstrase 26, Bielefeld D-33615, Germany
(Levy) Duke University School of Medicine, Durham, NC, United States
(Mazer) St Michael's Hospital University of Toronto, Toronto, ON, Canada
(Schramko) Helsinki University Hospital, Helsinki, Finland
(Klein) Papworth Hospital, Cambridge, United Kingdom
(Brat) Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
(Okita) Kobe University Hospital, Kobe, Japan
(Ueda) Nagoya University Graduate School of Medicine, Nagoya, Japan
(Schmidt) CSL Behring, Marburg, Germany
(Ranganath) CSL Behring, King of Prussia, PA, United States
(Gill) University Hospital of Southampton, Southampton, United Kingdom
Title
Randomized evaluation of fibrinogen vs placebo in complex cardiovascular
surgery (REPLACE): A double-blind phase III study of haemostatic therapy.
Source
British Journal of Anaesthesia. 117 (1) (pp 41-51), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
Background Single-dose human fibrinogen concentrate (FCH) might have
haemostatic benefits in complex cardiovascular surgery. Methods Patients
undergoing elective aortic surgery requiring cardiopulmonary bypass were
randomly assigned to receive FCH or placebo. Study medication was
administered to patients with a 5 min bleeding mass of 60-250 g after
separation from bypass and surgical haemostasis. A standardized algorithm
for allogeneic blood product transfusion was followed if bleeding
continued after study medication. Results 519 patients from 34 centres
were randomized, of whom 152 (29%) met inclusion criteria for study
medication. Median (IQR) pretreatment 5 min bleeding mass was 107 (76-138)
and 91 (71-112) g in the FCH and placebo groups, respectively (P=0.13).
More allogeneic blood product units were administered during the first 24
h after FCH, 5.0 (2.0-11.0), when compared with placebo, 3.0 (0.0-7.0),
P=0.026. Fewer patients avoided transfusion in the FCH group (15.4%)
compared with placebo (28.4%), P=0.047. The FCH immediately increased
plasma fibrinogen concentration and fibrin-based clot strength. Adverse
event rates were comparable in each group. Conclusions Human fibrinogen
concentrate was associated with increased allogeneic blood product
transfusion, an unexpected finding contrary to previous studies. Human
fibrinogen concentrate may not be effective in this setting when
administered according to 5-minute bleeding mass. Low bleeding rates and
normal-range plasma fibrinogen concentrations before study medication, and
variability in adherence to the complex transfusion algorithm, may have
contributed to these results. Clinical trial registration
ClinicalTrials.gov identifier no. NCT01475669; EudraCT trial no.
2011-002685-20.

<21>
Accession Number
20160497334
Author
Distelmaier K.; Roth C.; Schrutka L.; Binder C.; Steinlechner B.; Heinz
G.; Lang I.M.; Maurer G.; Koinig H.; Niessner A.; Hulsmann M.; Speidl W.;
Goliasch G.; Thompson J.P.
Institution
(Distelmaier, Roth, Schrutka, Binder, Heinz, Lang, Maurer, Niessner,
Hulsmann, Speidl, Goliasch) Department of Internal Medicine II, Medical
University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
(Steinlechner) Division of Cardiothoracic and Vascular Anaesthesia and
Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel
18-20, Vienna A-1090, Austria
(Koinig) Department of Anaesthesia and Intensive Care Medicine, University
Hospital Krems, Karl Landsteiner University of Health Sciences, Krems,
Austria
Title
Beneficial effects of levosimendan on survival in patients undergoing
extracorporeal membrane oxygenation after cardiovascular surgery.
Source
British Journal of Anaesthesia. 117 (1) (pp 52-58), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
Background The impact of levosimendan treatment on clinical outcome in
patients undergoing extracorporeal membrane oxygenation (ECMO) support
after cardiovascular surgery is unknown. We hypothesized that the
beneficial effects of levosimendan might improve survival when adequate
end-organ perfusion is ensured by concomitant ECMO therapy. We therefore
studied the impact of levosimendan treatment on survival and failure of
ECMO weaning in patients after cardiovascular surgery. Methods We enrolled
a total of 240 patients undergoing veno-arterial ECMO therapy after
cardiovascular surgery at a university-affiliated tertiary care centre
into our observational single-centre registry. Results During a median
follow-up period of 37 months (interquartile range 19-67 months), 65% of
patients died. Seventy-five per cent of patients received levosimendan
treatment within the first 24 h after initiation of ECMO therapy. Cox
regression analysis showed an association between levosimendan treatment
and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95%
confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR
0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR
0.64; 95% CI 0.42-0.98; P=0.04). Conclusions These data suggest an
association between levosimendan treatment and improved short- and
long-term survival in patients undergoing ECMO support after
cardiovascular surgery.

<22>
Accession Number
20160497331
Author
Aziz M.F.; Bayman E.O.; Van Tienderen M.M.; Todd M.M.; Brambrink A.M.;
Asai T.; Abrons R.O.; Cattano D.; Swanson D.E.; Hagberg C.A.
Institution
(Aziz, Van Tienderen, Brambrink) Oregon Health and Science University,
Mail Code KPV 5A, 3181 SW Sam Jackson Park Road, Portland, OR 97239,
United States
(Bayman, Todd) University of Iowa Hospitals and Clinics, 200 Hawkins
Drive, Iowa City, IA 52242, United States
Title
Predictors of difficult videolaryngoscopy with GlideScope or
C-MAC with D-blade: Secondary analysis from a large comparative
videolaryngoscopy trial.
Source
British Journal of Anaesthesia. 117 (1) (pp 118-123), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
Background Tracheal intubation using acute-angle videolaryngoscopy
achieves high success rates, but is not without difficulty. We aimed to
determine predictors of 'difficult videolaryngoscopy'. Methods We
performed a secondary analysis of a data set (n=1100) gathered from a
multicentre prospective randomized controlled trial of patients for whom
difficult direct laryngoscopy was anticipated and who were intubated with
one of two videolaryngoscopy devices (GlideScope or
C-MAC with D-blade). 'Difficult videolaryngoscopy' was defined
as 'first intubation time >60 s' or 'first attempt intubation failure'. A
multivariate logistic regression model along with stepwise model selection
techniques was performed to determine independent predictors of difficult
videolaryngoscopy. Results Of 1100 patients, 301 were identified as
difficult videolaryngoscopies. By univariate analysis, head and neck
position, provider, type of surgery, and mouth opening were associated
with difficult videolaryngoscopy (P<0.05). According to the multivariate
logistic regression model, characteristics associated with greater risk
for difficult videolaryngoscopy were as follows: (i) head and neck
position of 'supine sniffing' vs 'supine neutral' {odds ratio (OR) 1.63,
95% confidence interval (CI) [1.14, 2.31]}; (ii) undergoing
otolaryngologic or cardiac surgery vs general surgery (OR 1.89, 95% CI
[1.19, 3.01] and OR 6.13, 95% CI [1.85, 20.37], respectively); (iii)
intubation performed by an attending anaesthestist vs a supervised
resident (OR 1.83, 95% CI [1.14, 2.92]); and (iv) small mouth opening (OR
1.18, 95% CI [1.02, 1.36]). Conclusion This secondary analysis of an
existing data set indicates four covariates associated with difficult
acute-angle videolaryngoscopy, of which patient position and provider
level are modifiable.

<23>
Accession Number
20160497330
Author
Balogh A.L.; Petak F.; Fodor G.H.; Tolnai J.; Csorba Z.; Babik B.; Asai T.
Institution
(Balogh, Csorba, Babik) Department of Anaesthesiology and Intensive
Therapy, University of Szeged, 6 Semmelweis u. H-6725, Szeged, Hungary
(Balogh, Petak, Fodor, Tolnai) Department of Medical Physics and
Informatics, University of Szeged, 9 Koranyi fasor, Szeged H-6720, Hungary
Title
Capnogram slope and ventilation dead space parameters: Comparison of
mainstream and sidestream techniques.
Source
British Journal of Anaesthesia. 117 (1) (pp 109-117), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
Background Capnography may provide useful non-invasive bedside information
concerning heterogeneity in lung ventilation, ventilation-perfusion
mismatching and metabolic status. Although the capnogram may be recorded
by mainstream and sidestream techniques, the capnogram indices furnished
by these approaches have not previously been compared systematically.
Methods Simultaneous mainstream and sidestream time and volumetric
capnography was performed in anaesthetized, mechanically ventilated
patients undergoing elective heart surgery. Time capnography was used to
assess the phase II (S<inf>II,T</inf>) and III slopes (S<inf>III,T</inf>).
The volumetric method was applied to estimate phase II (S<inf>II,V</inf>)
and III slopes (S<inf>III,V</inf>), together with the dead space values
according to the Fowler (V<inf>DF</inf>), Bohr (V<inf>DB</inf>), and
Enghoff (V<inf>DE</inf>) methods and the volume of CO<inf>2</inf>
eliminated per breath (VCO2). The partial pressure of end-tidal
CO<inf>2</inf> (PETCO2) was registered. Results Excellent correlation and
good agreement were observed in S<inf>III,T</inf> measured by the
mainstream and sidestream techniques [ratio=1.05 (sem 0.16),
R²=0.92, P<0.0001]. Although the sidestream technique
significantly underestimated VCO2 and overestimated S<inf>III,V</inf>
[1.32 (0.28), R²=0.93, P<0.0001], V<inf>DF</inf>,
V<inf>DB</inf>, and V<inf>DE</inf>, the agreement between the mainstream
and sidestream techniques in the difference between V<inf>DE</inf> and
V<inf>DB</inf>, reflecting the intrapulmonary shunt, was excellent [0.97
(0.004), R²=0.92, P<0.0001]. The PETCO2 exhibited good
correlation and mild differences between the mainstream and sidestream
approaches [0.025 (0.005) kPa]. Conclusions Sidestream capnography
provides adequate quantitative bedside information about uneven alveolar
emptying and ventilation-perfusion mismatching, because it allows reliable
assessments of the phase III slope, PETCO2 and intrapulmonary shunt.
Reliable measurement of volumetric parameters (phase II slope, dead
spaces, and eliminated CO<inf>2</inf> volumes) requires the application of
a mainstream device.

<24>
Accession Number
20160501916
Author
Villablanca P.A.; Briceno D.F.; Massera D.; Hlinomaz O.; Lombardo M.;
Bortnick A.E.; Menegus M.A.; Pyo R.T.; Garcia M.J.; Mookadam F.;
Ramakrishna H.; Wiley J.; Faggioni M.; Dangas G.D.
Institution
(Villablanca, Briceno, Massera, Bortnick, Menegus, Pyo, Garcia, Wiley)
Division of Cardiovascular Diseases, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, United States
(Hlinomaz) International Clinical Research Center, St. Anne University
Hospital, Brno, Czech Republic
(Lombardo) Department of Internal Medicine, New York-Presbyterian
Hospital/Weill Cornell Medical College, New York, NY, United States
(Mookadam) Cardiovascular Division, Mayo Clinic College of Medicine,
Scottsdale, AZ, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
(Faggioni, Dangas) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, United
States
Title
Culprit-lesion only versus complete multivessel percutaneous intervention
in ST-elevation myocardial infarction: A systematic review and
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 220 (pp 251-259), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background ST-segment elevation myocardial infarction (STEMI) in patients
with concomitant multivessel (MV) coronary artery disease (CAD) is
associated with poor outcomes. Percutaneous coronary intervention (PCI) of
the culprit-lesion only (CLO) as compared with a MV PCI approach to
revascularization remains uncertain. Our objective is to gain a better
understanding of the efficacy and safety of CLO as compared with MV PCI in
patients with STEMI by conducting an updated meta-analysis. Methods A
comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central
Register, the ClinicalTrials.gov Website, and Google Scholar databases of
randomized controlled trials (RCTs) was performed. Results Seven RCTs were
included, enrolling a total of 2006 patients. We found that there was a
significant reduction in major adverse cardiovascular events (MACE) (OR,
0.62; 95% CI, 0.43-0.90), cardiovascular mortality (OR, 0.46; 95% CI,
0.27-0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI,
0.30-0.51) favoring MV over the CLO approach for patients undergoing
primary PCI. The number needed to treat in order to prevent one CV
mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No
differences were observed between MV vs. CLO PCI for subsequent myocardial
infarction (OR, 0.74; 95% CI, 0.40-1.39), all-cause mortality (OR, 0.78;
95% CI, 0.53-1.15), non-cardiovascular mortality (OR, 1.35; 95% CI,
0.74-2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40-1.65),
contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33-1.54), and stroke
(OR, 1.28; 95% CI, 0.47-3.46). Conclusions MV PCI significantly reduces
the rate of MACE, CV mortality, and RRV without significant harm as
compared to CLO PCI.

<25>
Accession Number
20160502773
Author
Amber K.I.; Hadi N.R.; Muhammad-Baqir B.M.; Jamil D.A.; Al-Aubaidy H.A.
Institution
(Amber) Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy,
Iraq
(Hadi) Department of Pharmacology and Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Muhammad-Baqir) Department of Pharmacology and Toxicology, Faculty of
Pharmacy, University of Kufa, Iraq
(Jamil, Al-Aubaidy) School of Medicine, University of Tasmania, TAS 7001,
Australia
Title
Trimetazidine attenuates the acute inflammatory response induced by
Novolimus eluting bioresorbable coronary scaffold implantation.
Source
International Journal of Cardiology. 220 (pp 514-519), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background This study aims to investigate the inflammatory response in
Novolimus bioresorbable coronary scaffold implantation after a course
treatment with trimetazidine (35 mg tablet/twice daily for 4 days).
Methods This was a randomized single blind study. Forty diabetic patients
with critical coronary stenosis were subjected to elective coronary
scaffold implantation in Al-Najaf Center for Cardiac Surgery and
Trans-Catheter Therapy, Najaf, Iraq, between January and July 2015. All
patients were informed about the nature of the study and they signed the
consent form before they included in the study. Patients were randomly
allocated into the two study groups: Group 1 included 20 patients who did
the elective coronary scaffold implementation without trimetazidine
medication. Group 2 included 20 patients who did the elective coronary
scaffold implementation with a course of the trimetazidine (35 mg
tablet/twice daily for 4 days). Results There were significant reduction
in the levels of the interleukin-6 and cardiac troponin-I in the
trimetazidine-treated group (group 2) compared to the control group (group
1) (P < 0.001), after 12 h and 24 h post-operative. This was associated
with a significant rise in the levels of interleukin 10 in group 2
compared to group 1 (P < 0.001). Pentraxin-3 was significantly reduced in
group 2 but only 24 h post-operative (P < 0.006). Conclusion Our study
concluded that trimetazidine minimizes the acute inflammatory response
occurred due to systemic release of inflammatory markers into blood in
diabetic patients undergoing elective Novolimus bioresorbable coronary
scaffold implementation.

<26>
Accession Number
20160492624
Author
Stillman A.E.; Gatsonis C.; Lima J.A.C.; Black W.C.; Cormack J.; Gareen
I.; Hoffmann U.; Liu T.; Mavromatis K.; Schnall M.D.; Udelson J.E.;
Woodard P.K.
Institution
(Stillman) Department of Radiology and Imaging Sciences, Emory University,
Atlanta, GA, United States
(Stillman, Mavromatis) Division of Cardiology, Emory University, Atlanta,
GA, United States
(Gatsonis, Cormack, Gareen, Liu) Center for Statistical Sciences, Brown
University, Providence, RI, United States
(Gatsonis, Liu) Department of Biostatistics, Brown University School of
Public Health, Providence, RI, United States
(Lima) Departments of Medicine and Radiology, Johns Hopkins University,
Baltimore, MD, United States
(Black) Department of Radiology, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(Hoffmann) Department of Radiology, Massachusetts General Hospital,
Boston, MA, United States
(Schnall) Department of Radiology, University of Pennsylvania,
Philadelphia, PA, United States
(Udelson) Division of Cardiology, Tufts-New England Medical Center,
Boston, MA, United States
(Woodard) Department of Radiology, Mallinckrodt Institute of Radiology,
Washington University, St. Louis, MO, United States
(Gareen) Department of Epidemiology, United States
Title
Rationale and design of the Randomized Evaluation of patients with Stable
angina Comparing Utilization of noninvasive Examinations (RESCUE) trial.
Source
American Heart Journal. 179 (pp 19-28), 2016. Date of Publication: 01 Sep
2016.
Publisher
Mosby Inc.
Abstract
RESCUE is a phase III, randomized, controlled, multicenter, comparative
efficacy study, designed to compare two diagnostic imaging/treatment
paradigms that use coronary computed tomography angiography (CCTA) or
single photon emission computed tomography myocardial perfusion imaging
(SPECT MPI) for assisting in the diagnosis of ischemic heart disease in
patients with stable angina symptoms, and guiding subsequent treatment.
The study is based on the hypothesis that CCTA as a diagnostic tool is
associated with no increase in cardiac risk, decreased cost, and reduced
radiation exposure compared with SPECT MPI. The RESCUE trial was funded by
the Agency for Healthcare Research and Quality (AHRQ) and the American
College of Radiology Imaging Network (ACRIN) Fund for Imaging Innovation,
began in 2011, and completed in 2014.

<27>
Accession Number
20160503181
Author
Corra U.
Institution
(Corra) Fondazione Maugeri, Italy
Title
Exercise oscillatory ventilation in heart failure.
Source
International Journal of Cardiology. 206 (pp S13-S15), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Ventilation inefficiency has become a matter of interest for heart failure
(HF) specialists, the most remarkable being exertional oscillatory
ventilation (EOV). EOV is an abnormal ventilatory phenomenon, originally
described as anecdotal, but now considered a marker of disease severity
and worst prognosis in HF. EOV is a cyclic fluctuation of minute
ventilation (VE) and expired gas kinetics occurring during exercise: it is
a slow, prominent, consistent rather than random, fluctuation in VE that
may be evanescent or transient and can follow several distinct patterns.
In contrast to the periodic breathing observed in Cheyne-Stokes
respiration and central sleep apnea, the gradual increase and decrease in
minute ventilation (VE) are not spaced by periods of apnea. This review
will discuss EOV in HF and the overlap with Cheyne-Stokes respiration.

<28>
Accession Number
20160482766
Author
Anderson L.; Dall C.H.; Nguyen T.T.; Burgess L.; Taylor R.S.
Institution
(Anderson, Nguyen, Taylor) University of Exeter Medical School, Institute
of Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG,
United Kingdom
(Dall) Bispebjerg Hospital, University of Copenhagen, Department of
Cardiology, MRRU and IOC Sports Institute Copenhagen, Bispebjerg Bakke 23,
Copenhagen, Denmark
(Burgess) Wythenshawe Hospital, University Hospital of South Manchester
NHS Foundation Trust, Cardiac Rehabilitation Unit, Manchester, United
Kingdom
Title
Exercise-based cardiac rehabilitation in heart transplant recipients.
Source
Cochrane Database of Systematic Reviews. 2016 (6) (no pagination), 2016.
Article Number: CD012264. Date of Publication: 23 Jun 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
This is the protocol for a review and there is no abstract. The objectives
are as follows: To determine the effectiveness and safety of
exercise-based rehabilitation on the mortality, hospital admissions,
morbidity, exercise capacity, health-related quality of life, and return
to work of people after heart transplantation.

<29>
Accession Number
20160479005
Author
Goto A.; Goto M.; Terauchi Y.; Yamaguchi N.; Noda M.
Institution
(Goto, Yamaguchi) Department of Public Health, Tokyo Women's Medical
University, Tokyo, Japan
(Goto, Goto, Noda) Department of Diabetes Research, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Terauchi) Department of Endocrinology and Metabolism, Graduate School of
Medicine, Yokohama City University, Yokohama, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Title
Association between severe hypoglycemia and cardiovascular disease risk in
japanese patients with type 2 diabetes.
Source
Journal of the American Heart Association. 5 (3) (no pagination), 2015.
Article Number: e002875. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: It remains unclear whether severe hypoglycemia is associated
with cardiovascular disease (CVD) in Asian populations with type 2
diabetes (T2D). Furthermore, no study in Japan, where the prescription
patterns differ from those in other countries, has examined this
association. Methods and Results: We retrospectively included 58 223
patients (18-74 years old) with T2D. First, we examined the potential
predictors of severe hypoglycemia. Then, we investigated the association
between severe hypoglycemia and CVD risk. Finally, we performed an updated
systematic review and meta-analysis to incorporate our findings and
recently published studies into the previous systematic review and
meta-analysis. During 134 597 person-years from cumulative observation
periods, 128 persons experienced severe hypoglycemia and 550 developed CVD
events. In a multivariate Cox proportional hazard model, severe
hypoglycemia was strongly and positively associated with the risk of CVD
(multivariate-adjusted adjusted hazard ratio, 3.39; 95% CI, 1.25-9.18). In
a propensity score-matched cohort that had similar baseline
characteristics for patients with severe hypoglycemia and those without,
severe hypoglycemia was more strongly associated with the risk of CVD. An
updated systematic review and meta-analysis that included 10 studies found
that severe hypoglycemia was associated with an =2-fold increased risk of
CVD (pooled relative risk, 1.91; 95% CI, 1.69-2.15). Conclusions: Our
results suggest that severe hypoglycemia is strongly associated with an
increased risk of CVD in Japanese patients with T2D, further supporting
the notion that avoiding severe hypoglycemia may be important in
preventing CVD in this patient population.

<30>
Accession Number
20160344413
Author
Bajaj A.; Sethi A.; Rathor P.; Sehgal V.; Pancholy S.
Institution
(Bajaj, Pancholy) Wright Center for Graduate Medical Education, Scranton,
PA, United States
(Sethi) St.Luke's Cardiology Associates, Bethlehem, PA, United States
(Rathor) Zhengzhou University, China
(Sehgal) University of Tennessee, Memphis, United States
Title
Impact of previous cardiac surgery on patients undergoing transcatheter
aortic valve implantation: A meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (4) (pp 350-358),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc.
Abstract
The objective of our meta-analysis is to evaluate the impact of previous
cardiac surgery in patients undergoing transcatheter aortic valve
implantation (TAVI). We did a systemic search of databases, including
Pubmed, EMBASE and Cochrane to identify relevant studies. We included
studies comparing clinical outcomes in patients undergoing TAVI, with and
without previous cardiac surgery. The 30 days as well as 1 year mortality
was not significantly different between the two groups: 30 days (RR, 0.95;
95% CI, 0.82-1.09, I² = 0%), 1 year (RR, 0.94; 95% CI,
0.86-1.02, I² = 0%). The risk of acute myocardial infarction
was significantly higher in patients with previous cardiac surgery and the
risk of major vascular complications was lower in patients with previous
cardiac surgery. Our meta-analysis suggests that the presence of previous
cardiac surgery does not impair outcomes after TAVI, making this subset of
patients particularly applicable for this evolving approach.

<31>
Accession Number
20160301766
Author
Pierri M.D.; Crescenzi G.; Zingaro C.; D'Alfonso A.; Capestro F.; Scocco
V.; Brugia M.; Torracca L.
Institution
(Pierri, Zingaro, D'Alfonso, Capestro, Torracca) Division of Cardiac
Surgery of Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona,
Italy
(Crescenzi) Division of Postoperative Intensive Care of Azienda
Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
(Scocco, Brugia) Central Analysis Laboratory of Azienda
Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
Title
Prevention of atrial fibrillation and inflammatory response after on-pump
coronary artery bypass using different statin dosages: a randomized,
controlled trial.
Source
General Thoracic and Cardiovascular Surgery. 64 (7) (pp 395-402), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Springer-Verlag Tokyo
Abstract
Background: This randomized controlled trial aimed to evaluate the effects
of seven-day preoperative treatment with two different dosages of
atorvastatin on the incidence of postoperative atrial fibrillation (POAF)
and release of inflammatory markers such as high-sensitive C-reactive
protein (hsCRP) and interleukin-6 in patients undergoing elective
first-time on-pump coronary artery bypass grafting (CABG). Methods: The
cohort study comprised 212 consecutive patients, already taking statins,
who underwent elective first-time CABG with cardiopulmonary bypass without
history of atrial fibrillation (AF). Patients were randomly divided into
two groups: those who received atorvastatin 40 mg (TOR40 group, 111
patients) and those who received 80 mg (TOR80 group, 101 patients) once a
day for 7 days before the planned operation. The primary endpoint was the
incidence of AF. The secondary endpoints were the postoperative variations
of inflammatory markers, hospital length of stay, and the incidence of
major adverse cardiac and clinical events. Results: A total of 26 patients
(23.6 %) pretreated with atorvastatin 40 mg and 16 (15.8 %) patients
pretreated with atorvastatin 80 mg had postoperative AF but the difference
did not reach the statistical significance (p = 0.157). Median values of
interleukin-6 and hsCRP at 12 and 24 h did not have differences between
the two groups. No statistically significant differences in the other
secondary endpoints were detected. Conclusions: According to our result,
7-day preoperative treatment with a high dose of atorvastatin is
associated with a trend to a decrease in the incidence of POAF compared
with treatment at a lower dose, although it does not impact on the level
of inflammatory markers. Clinical Trial Registration: European Clinical
Trials Database (EudraCT: 2006-005757-30).

<32>
Accession Number
20160495083
Author
Matsuyama K.; Koizumi N.; Nishibe T.; Iwasaki T.; Iwahasi T.; Toguchi K.;
Takahashi S.; Iwahori A.; Maruno K.; Ogino H.
Institution
(Matsuyama, Koizumi, Nishibe, Iwasaki, Iwahasi, Toguchi, Takahashi,
Iwahori, Maruno, Ogino) Department of Cardiovascular Surgery, Tokyo
Medical University Hospital, 6-7-1 Nishshinjuku Shinjyuku-ku Tokyo
160-0023, Japan
Title
Effects of short-term administration of tolvaptan after open heart
surgery.
Source
International Journal of Cardiology. 220 (pp 192-195), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Postoperative fluid overload following cardiac surgery is
associated with increased morbidity and mortality. Unlike loop diuretics,
tolvaptan (TLV) promotes aquaretic effect. Relatively little has been
documented regarding the efficacy of TLV after cardiac surgery. The aim of
the study was to investigate the effectiveness and safety of tolvaptan for
the management of immediately postoperative fluid retention following
cardiac surgery. Methods Between January to May 2014, patients undergoing
cardiac surgery were randomly assigned to control or TLV group immediately
after cardiac surgery. In control group, patients received 20 mg of
furosemide and 25 mg of spironolactone as conventional diuretics. In the
TLV group, 7.5 mg of TLV was administered in combination with conventional
diuretics. Results TLV use was associated with increased urine output from
postoperative day 1 to 3.Body weight reduction in the TLV group was
significantly greater than the control group from postoperative day 2 to
4, and serum creatinine levels decreased to below preoperative values in
the TLV group. Conclusions The combination of tolvaptan with conventional
diuretics increases urine output without renal dysfunction and can be
effective for postoperative fluid management and appropriate body weight
reduction.

<33>
Accession Number
20160490035
Author
Yang S.-S.; Tang L.; Ge G.-G.; Li R.-G.; Qu X.-K.; Fang W.-Y.; Ma J.-G.;
Qiao Z.-Y.; Hou Y.-M.; Cao H.; Liu H.-J.; Zhang L.; Hao Z.-M.; Weng H.
Institution
(Yang, Ge, Ma, Qiao, Hou, Cao, Liu, Zhang, Hao, Weng) Department of
Cardiology, Central Hospital of Fengxian District, Shanghai Sixth People's
Hospital of Fengxian Branch, Shanghai, China
(Tang) School of Medical Graduate, Shanghai Jiaotong University, Shanghai,
China
(Li, Qu, Fang) Department of Cardiology, Shanghai Chest Hospital,
Shanghai, China
(Weng) Department of Anesthesiology, Central Hospital of Fengxian
District, Shanghai Sixth People's Hospital of Fengxian Branch, Shanghai,
China
Title
Efficacy of drug-eluting stent for chronic total coronary occlusions at
different follow-up duration: A systematic review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 19 (6) (pp
1101-1116), 2015. Date of Publication: 2015.
Publisher
Verduci Editore
Abstract
OBJECTIVE: DESs have been proved to be beneficial for patients with
chronic total coronary occlusions (CTO) in terms of cardiac function and
other prognosis. We aim to compare the efficacy and safety of drug-eluting
stent (DES) and bare-metal stent (BMS) in CTO recanalization at different
follow-up duration. METHODS: Articles comparing outcomes between DES and
BMS implantation in patients with CTO was searched. A fixed-effect
(inversevariance weighted) and random-effect (DerSimonian and Laird) model
were used to analyze the pooling results. RESULTS: A total of 29
comparative studies including 24 cohort studies and 5 randomized
controlled studies were identified with a total of 9140 patients (5008
received BMS and 4132 received DES). The risk of all cause death for DES
was higher at 6 months and lower at 12 months than BMS, and no significant
difference was shown at 24, 36 and 60 months. DES group had lower risk of
MI after 12 months implantation, and no difference was shown at 6, 24, 36
and 60 months. Major adverse cardiovascular event (MACE)-free survival was
clinically and significantly improved by 73%, 68%, 49%, 40% and 37%
respectively in DES group at 6,12, 24, 36, and 60 months. CONCLUSIONS: DES
is superior to BMS in binary restenosis, reocclusion and MACE-free
survival during long-term follow up. The occurrences of all-cause death
and MI show that the risk rate of BMS is higher than that of DES at 12
months. The frequency of all-cause death of DES is higher than BMS at 6
months. DES has higher risk of in-stent thrombosis than BMS at 36 months
of implantation.

<34>
[Use Link to view the full text]
Accession Number
20160483662
Author
Lee S.Y.; Yoo J.Y.; Kim J.Y.; Kim D.H.; Lee J.D.; Rho G.U.; Park H.; Park
S.Y.
Institution
(Lee, Yoo, Kim, Kim, Rho, Park, Park) Department of Anesthesiology and
Pain Medicine, Ajou University, School of Medicine, 5 Wonchon-Dong,
Youngtong-Gu, Suwon 443-721, South Korea
(Lee) Office of Biostatistics, Ajou University, School of Medicine, Suwon,
South Korea
Title
Optimal effect-site concentration of remifentanil for preventing cough
during removal of the double-lumen endotracheal tube from
sevoflurane-remifentanil anesthesia A prospective clinical trial.
Source
Medicine (United States). 95 (24) (no pagination), 2016. Article Number:
e3878. Date of Publication: 21 Jun 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Opioids are used as a treatment for coughing. Recent studies have reported
an antitussive effect of remifentanil during recovery from general
anesthesia by suppressed coughing. The coughing reflex may differ
throughout the respiratory tract from the larynx to the bronchi. But the
proper dose of remifentanil to prevent cough during double-lumen tube
(DLT) extubation is unknown. Twenty-five ASA physical status 1 and 2
patients, 20 to 65 years of age who were undergoing video-assisted
thoracoscopic lung surgery requiring 1-lung ventilation were enrolled. The
effective effect-site concentration (Ce) of remifentanil for 50% and 95%
of patients (EC<inf>50</inf> and EC<inf>95</inf>) for preventing cough was
determined using the isotonic regression method with a bootstrapping
approach, following the Dixon up-and-down method. Recovery profiles and
hemodynamic values after anesthesia were compared between patients with
cough and patients without cough. EC<inf>50</inf> and EC<inf>95</inf> of
remifentanil was 1.670ng/mL [95% confidence interval (95% CI) 1.393-1.806]
and 2.275ng/mL (95% CI 1.950-2.263), respectively. There were no
differences in recovery profiles and hemodynamic values after anesthesia
between patients with/without cough. No patients suffered respiratory
complications during the emergence period. Remifentanil can be a safe and
reliable method of cough prevention during emergence from sevoflurane
anesthesia after thoracic surgery requiring DLT. EC<inf>50</inf> and
EC<inf>95</inf> of remifentanil that suppresses coughing is 1.670 and
2.275 ng/mL, respectively.

<35>
Accession Number
20160486551
Author
Patel N.; Amin P.; Shenoy A.
Institution
(Patel) Department of Cardiology, New York Harbor VA Healthcare System,
Brooklyn, NY, United States
(Amin) Department of Medicine, St. Francis Hospital, Roslyn, NY, United
States
(Patel, Shenoy) Department of Medicine, SUNY Downstate Medical Center,
Brooklyn, NY, United States
Title
Is vitamin E supplementation effective in reducing mortality related to
cardiovascular events in people with type 2 diabetes mellitus? A
systematic review.
Source
IJC Metabolic and Endocrine. 12 (pp 42-45), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier Ireland Ltd (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objective: To determine the effect of vitamin E in reducing cardiovascular
mortality in diabetic patients. Data source: Review of several English
language primary studies published from 2004 to 2015. Outcome measured:
The primary outcomes measure by all studies included 30-day mortality due
to congestive heart failure, myocardial infarction, stroke, and HDL
function as it relates to cardiovascular outcomes. The secondary outcomes
included hospitalization for CHF and coronary revascularization. Results:
Five Randomized, double-blind, placebo-controlled trials and 11 studies
were used for this review. The study published by Jaxa-Chamiec et al.
showed that vitamin E is beneficial along with vitamin C but is not
effective when used alone. The study facilitated by Marchioli et al.,
showed that vitamin E supplementation is associated with a statistically
non-significant (p = 0.18) increased risk of developing CHF. Finally, a
study by Milman et al. showed that vitamin E supplementation is beneficial
compared with a placebo group. This was a recurring theme and common
finding among the studies explored within the context of this review.
Conclusions: Although, two studies showed no benefit from vitamin E
supplementation, the remaining studies demonstrated that vitamin E
supplementation provided cardiovascular benefits in a specific diabetic
subpopulation. The study population that derived a favorable outcome from
vitamin E supplementation consisted of diabetic patients with the Hp 2-2
genotype. Hence, further studies should be conducted in diabetic
populations with the Hp 2-2 genotype for identifying the definitive
effects of vitamin E.

<36>
Accession Number
20160481656
Author
Alkherayf F.; Xu Y.; Gandara E.; Westwick H.; Moldovan I.D.; Wells P.S.
Institution
(Alkherayf) Division of Neurosurgery, Department of Surgery, University of
Ottawa, Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada
(Alkherayf, Moldovan, Wells) Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, Canada
(Xu) School of Medicine, Queen's University, Kingston, Canada
(Gandara, Wells) Division of Hematology, Department of Medicine,
University of Ottawa, Ottawa, Canada
(Westwick) Division of Neurosurgery, Department of Surgery, Hopital du
Sacre-Coeur de Montreal, Montreal, Canada
Title
Timing of Vitamin K antagonist re-initiation following intracranial
hemorrhage in mechanical heart valves: Systematic review and
meta-analysis.
Source
Thrombosis Research. 144 (pp 152-157), 2016. Date of Publication: 01 Aug
2016.
Publisher
Elsevier Ltd
Abstract
Background While evidence supports resumption of vitamin K antagonists
(VKAs) among mechanical heart valve (MHV) patients presenting with
anticoagulant-associated intracranial hemorrhage (ICH), ideal timing of
resumption is uncertain. Objective To determine the optimal timing of VKA
re-initiation and its associated clinical outcomes. Methods We performed a
systematic review and a meta-analysis of studies published from January
1950 to August 2015. We extracted data on the location of initial ICH, use
of cranial surgery, presence of atrial fibrillation, MHV type and
position, number of MHVs, and timing of VKA resumption. Outcomes including
valve thrombosis, thromboembolic events or ICH recurrence were recorded.
Meta-regression analysis was conducting with controlling for covariates.
We calculated absolute risks, and assessed the effect of anticoagulant
resumption timing on ICH recurrence. Results 23 case-series and
case-reports were identified. Overall ICH recurrence was 13% (95%
confidence interval [CI], 7%-25%), while valve thrombosis and ischemic
strokes occurred at 7% (95% CI, 3%-17%) and 12% (95% CI, 5%-23%)
respectively. A trend towards lower ICH recurrence was observed with
delayed VKA resumption (slope estimate - 0.2154, p = 0.10). Recurrence
rate ranged from 50% with VKA resumption at 3 days to 0% with resumption
at 16 days. Conclusion Among patients with MHV, there is inadequate data
to suggest an optimal timing of VKA re-initiation following an ICH, though
delayed restart appears to be protective against recurrence but is
associated with higher risk of thrombosis. Our analysis suggests 4-7 days
might be an ideal time with least risk of thrombosis or ICH recurrence.

<37>
Accession Number
20160048487
Author
Kleber F.X.; Rittger H.; Ludwig J.; Schulz A.; Mathey D.G.; Boxberger M.;
Degenhardt R.; Scheller B.; Strasser R.H.
Institution
(Kleber, Schulz) Cardio Centrum Berlin, Academic Teaching Institution,
Charite University Medicine Berlin, Unter den Linden 21, Berlin 10117,
Germany
(Rittger, Ludwig) Universitatsklinikum Erlangen, Erlangen, Germany
(Mathey) Universitares Herz- und Gefaszentrum Hamburg, Hamburg, Germany
(Boxberger) Medical Scientific Affairs, B. Braun Melsungen AG, Melsungen,
Germany
(Degenhardt) Center for Cardiovascular Diseases, Rotenburg a.d. Fulda,
Germany
(Scheller) Universitatsklinikum des Saarlandes, Homburg, Saar, Germany
(Strasser) Technische Universitat Dresden, Herzzentrum Dresden,
Universitatsklinik Dresden, Dresden, Germany
Title
Drug eluting balloons as stand alone procedure for coronary bifurcational
lesions: results of the randomized multicenter PEPCAD-BIF trial.
Source
Clinical Research in Cardiology. 105 (7) (pp 613-621), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objectives: We set out to investigate the benefit of distal main or side
branch treatment with a DCB compared to POBA in coronary bifurcation
lesions. Background: The standard treatment of bifurcation lesions is
application of a DES to the main branch with provisional side branch
stenting. While this resulted in considerable improvement in overall MACE
rate suboptimal side branch results remained a problem. Methods: The study
was performed from 2011 to 2013 in six German centers. Native bifurcation
lesions were included if side branch vessel diameter was >2 and <3.5 mm
and no proximal main branch lesions was found. After successful
predilatation randomization was performed to either DCB application or no
further treatment. Follow-up angiograms for QCA analysis were done after 9
months. Primary endpoint was late lumen loss (LLL). Results: 64 patients
were successfully randomized. Minimal lumen diameter and grade of stenosis
were equal in both groups. Only five stents were used as bail out.
Angiographic follow-up was achieved in 75 % of patients. No patient died.
There was one NSTEMI in the POBA group. Restenosis rate was 6 % in the DCB
group vs 26 % in the POBA group (p = 0.045). TLR was necessary in one
patient of the DCB group vs three patients of the POBA. The primary
endpoint LLL was 0.13 mm in the DCB vs 0.51 mm in the POBA group (p =
0.013). Conclusion: In bifurcation lesions that show only class A or B
dissection and recoil not beyond 30 % the use of DCBs is a sound strategy.

<38>
Accession Number
72336938
Author
Mathew I.; Grimes M.C.; Rao R.H.; Cunningham C.A.; Muder R.; Perreiah P.L.
Institution
(Mathew, Grimes) VA Pittsburgh Health System, Pittsburgh, PA, United
States
(Rao, Cunningham, Perreiah) VA Pittsburgh Healthcare System, Pittsburgh,
PA, United States
(Muder) VA Pittsburgh Health System, United States
Title
Eliminating deaths from mediastinitis after cardiac surgery using
aggressive glycemic intervention to maintain blood glucose 80-140mg/ Dl:
The VA Pittsburgh experience.
Source
Endocrine Reviews. Conference: 96th Annual Meeting and Expo of the
Endocrine Society, ENDO 2014 Chicago, IL United States. Conference Start:
20140621 Conference End: 20140624. Conference Publication: (var.pagings).
35 (no pagination), 2014. Date of Publication: 2014.
Publisher
Endocrine Society
Abstract
Hyperglycemia is a major risk factor for wound infections in patients with
diabetes undergoing surgery. Early indications of its importance in
cardiac surgery, in particular, evident in the Portland Project1, were
validated by the Leuven study, a randomized controlled trial in which a
majority of patients had undergone cardiac surgery. It established
unequivocally that aggressive glycemic management (BG <110mg/dl) reduces
the risk of sepsis-related mortality by 46%2, although the study did not
specifically detail the impact of aggressive control on the risk or the
severity of postoperative sternal wound infections (SWI). The VA
Pittsburgh has been engaged in a 13 year project aimed at reducing
hyperglycemia-related mortality with an intravenous insulin infusion to
maintain blood glucose (BG) <140mg/dl during intensive care in patients
undergoing cardiac surgery. A standard formula-based program used in the
first 8 years (Formula, n=1264) was replaced by a complex automated
software program called Glycemic Expert system for Nurse Implemented
Euglycemia (GENIE, n=870), in order to achieve tight glycemic control
(TGC) without provoking the severe hypoglycemia (BG<40mg/dl) that
inevitably occurs with TGC in all studies to date. Despite similar BG
targets, glycemic control was significantly better in the GENIE cohort
(Mean Time-Averaged Glucose: GENIE 134+/-0.7mg/dl versus Formula
152+/-1.0, p<0.001), with many more patients maintaining Mean BG<140mg/dl
(GENIE ~83%, Formula ~57%, p<0.001), and fewer patients with Mean
BG>200mg/dl (GENIE ~1 in 500, Formula ~1 in 12, p<0.001). Even though
glycemic control was much more aggressive with GENIE, the incidence of
severe hypoglycemia was substantially decreased (BG<40mg/dl, GENIE ~1 in
100 versus Formula ~1 in 40, p=0.02) and less repetitive (~1 fewer
episode/patient, p=0.006) or prolonged (Dwell Time BG<70mg/dl shorter by
~1.3h, p=0.002). The incidence of all wound infections after cardiac
surgery did not change significantly (Formula 3.2% vs GENIE 2.5%, p=NS).
The incidence of deep sternal wound infections (DSWI) declined but did not
reach statistical significance (Formula 2.1% vs GENIE 1.35%, p=0.07). A
preliminary analysis revealed that the introduction of GENIE eliminated
deaths associated with DSWI (6 deaths on Formula versus none on GENIE).
The reduction in mortality could be attributed to the improvement in
glycemic management, and not to any changes in infection control
procedures, because the overall incidence of wound infections in surgical
procedures other than cardiac surgery did not change significantly across
the study period (during the Formula years, versus during the GENIE
years). We conclude that the elimination of fatal mediastinitis is a major
benefit from TGC and, although it does not change the incidence of SWI,
TGC may protect patients with deep organ space infection after cardiac
surgery from death.