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<1>
Accession Number
2015861683
Author
Guzzetti S.; Bassani T.; Latini R.; Masson S.; Barlera S.; Citerio G.;
Porta A.
Institution
(Guzzetti) Department of Emergency Medicine Luigi Sacco Hospital, Milan,
Italy
(Bassani) Internal Medicine - Clinical and Research Center, IRCCS
Humanitas Clinical Institute, Rozzano, Milan, Italy
(Latini, Masson, Barlera) Department of Cardiovascular Research, IRCCS -
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
(Citerio) Neuroanaesthesia and Neurointensive Care Unit, Anestesia E
Rianimazione, San Gerardo Hospital, Monza, Italy
(Porta) Department of Biomedical Sciences for Health, Galeazzi Orthopedic
Institute, University of Milan, Milano, Italy
Title
Autonomic cardiovascular modulation with three different anesthetic
strategies during neurosurgical procedures.
Source
Minerva Anestesiologica. 81 (1) (pp 3-11), 2015. Date of Publication: 01
Jan 2015.
Publisher
Edizioni Minerva Medica
Abstract
Background. Autonomic cardiovascular modulation during surgery might be
affected by different anesthetic strategies. Aim of the present study was
to assess autonomic control during three different anesthetic strategies
in the course of neurosurgical procedures by the linear and non-linear
analysis of two cardiovascular signals. Methods. Heart rate (EKG-RR
intervals) and systolic arterial pressure (SAP) signals were analyzed in
93 patients during elective neurosurgical procedures at fixed points:
anesthetic induction, dura mater opening, first and second hour of
surgery, dura mater and skin closure. Patients were randomly assigned to
three anesthetic strategies: sevoflurane+fentanyl (S-F),
sevoflurane+remifentanil (S-R) and propofol+remifentanil (P-R). Results.
All the three anesthetic strategies were characterized by a reduction of
RR and SAP variability. A more active autonomic sympathetic modulation, as
ratio of low to high frequency spectral components of RR variability
(LF/HF), was present in the P-R group vs. S-R group. This is confirmed by
non-linear symbolic analysis of RR series and SAP variability analysis. In
addition, an increased parasympathetic modulation was suggested by
symbolic analysis of RR series during the second hour of surgery in S-F
group. Conclusion. Despite an important reduction of cardiovascular signal
variability, the analysis of RR and SAP signals were capable to detect
information about autonomic control during anesthesia. Symbolic analysis
(non-linear) seems to be able to highlight the differences of both the
sympathetic (slow) and vagal (fast) modulation among anesthetics, while
spectral analysis (linear) underlines the same differences but only in
terms of balance between the two neural control systems.

<2>
Accession Number
2015741186
Author
Schwartzman D.; Housel D.; Bazaz R.; Jain S.; Saba S.; Gorcsan J.;
Adelstein E.
Institution
(Schwartzman, Housel, Bazaz, Jain, Saba, Gorcsan, Adelstein) Heart, Lung
and Vascular Medicine Institute, University of Pittsburgh, B535,
Pittsburgh, PA 15213, United States
Title
A pilot study to assess benefit of atrial rhythm control after cardiac
resynchronization therapy and atrioventricular node ablation.
Source
PACE - Pacing and Clinical Electrophysiology. 38 (2) (pp 275-281), 2015.
Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Atrial fibrillation (AF) is frequently comorbid in patients
receiving cardiac resynchronization therapy (CRT), and suppression is
typically difficult. Herein, we sought to understand the benefit of atrial
rhythm control in the setting of ventricular rate and regularity control
induced by atrioventricular node (AVN) ablation. Methods Fifty-two
patients with heart failure, persistent AF, left ventricular (LV) ejection
fraction <35%, and left bundle branch block underwent cardiac
resynchronization therapy (CRT) + AVN ablation, and were randomized to one
of the following groups: (1) Atrial Rhythm Control (ARC); (2) AF. Patients
were subsequently followed for up to 1 year. Results Similar numbers of
patients in each group were lost to follow-up or have withdrawn (ARC two;
AF three). Rhythm control in four patients in the ARC group was
inadequate. Among the remaining patients, the incidence of death (ARC=1,
AF=2) or left ventricular assist device +/- transplantation (ARC=2, AF=1)
were similar. Among the remaining patients (ARC 16, AF 19), at 1 year,
there were no significant differences in CRT response rate, Minnesota
Living with Heart Failure survey score, 6-minute hall walk distance,
ventricular tachyarrhythmia occurrence, or LV dimensions. A significantly
higher hospital encounter rate among ARC patients was attributable to
efforts to maintain uniform atrial rhythm. Conclusions In this pilot
study, no incremental benefit for ARC was apparent. A larger study will be
necessary to adequately examine these issues.

<3>
Accession Number
2015722609
Author
Enter D.H.; Lou X.; Hui D.S.; Andrei A.-C.; Barner H.B.; Sheen L.; Lee R.
Institution
(Enter, Lou, Andrei, Sheen) Division of Cardiac Surgery, Bluhm
Cardiovascular Institute, Northwestern University, 201 E Huron St, Galter
Pavilion, Ste 11-140, Chicago, IL 60611-2968, United States
(Hui, Barner, Lee) Center for Comprehensive Cardiovascular Care, Saint
Louis University, St Louis, MO, United States
Title
Practice improves performance on a coronary anastomosis simulator,
attending surgeon supervision does not.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (1) (pp 12-16), 2015.
Date of Publication: 2015.
Publisher
Mosby Inc.
Abstract
Objectives: Enthusiasm for simulation early in cardiothoracic surgery
training is growing, yet evidence demonstrating its utility is limited. We
examined the effect of supervised and unsupervised training on coronary
anastomosis performance in a randomized trial among medical students.
Methods: Forty-five medical students were recruited for this
single-blinded, randomized controlled trial using a low-fidelity
simulator. After viewing an instructional video, all participants
attempted an anastomosis. Subsequently, the participants were randomized
to 1 of 3 groups: control (n = 15), unsupervised training (n = 15), or
supervised training with a cardiothoracic surgeon or fellow (n = 15). Both
the supervised and unsupervised groups practiced for 1 hour per week.
After 4 weeks, the participants repeated the anastomosis. All pre- and
posttraining performances were videotaped and rated independently by 3
cardiothoracic surgeons blinded to the randomization. All raters scored 13
assessment items on a 1 to 5 (low-high) scale along with an overall
pass/fail rating. Results: After the training period, all 3 groups showed
significant improvements in composite scores (control: +0.52 +/- 0.69 [P =
.014], unsupervised: +1.05 +/- 0.48 [P<.001], and supervised: +1.10 +/-
0.84 [P<.001]). Compared with control group, both supervised (P = .005)
and unsupervised trainees (P = .005) demonstrated a significant
improvement. Between the supervised and unsupervised groups there were no
statistically significant differences in composite scores. Conclusions:
Practice on low-fidelity simulators enabled trainees to improve on a broad
range of skills; however, the additional effect of attending-level
supervision is limited. In an era of increasing staff surgeon
responsibilities, unsupervised practice may be sufficient for
inexperienced trainees.

<4>
Accession Number
2015428001
Author
Gaudino M.; Leone A.; Lupascu A.; Toesca A.; Mazza A.; Ponziani F.R.;
Flore R.; Tondi P.; Massetti M.
Institution
(Gaudino, Leone, Mazza, Massetti) Department of Cardiovascular Science,
Catholic University, Rome, Italy
(Lupascu, Ponziani, Flore, Tondi) Department of Angiology, Catholic
University, Rome, Italy
(Toesca) Department of Human Anatomy, Catholic University, Rome, Italy
Title
Morphological and functional consequences of transradial coronary
angiography on the radial artery: Implications for its use as a bypass
conduit.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 370-374), 2015.
Date of Publication: 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: To assess the degree of damage to the radial artery (RA) in
coronary artery bypass grafting (CABG) patients who underwent preoperative
transradial coronary angiography (RA-CA). METHODS: From May 2012 to
October 2013, 50 consecutive CABG patients who underwent RA-CA were
prospectively enrolled in the study. All patients underwent echo-Doppler
evaluation of the RA of the catheterized arm; the contralateral RA was
used as control. The distal segment of the RA was submitted to
immunohistochemical assessment of endothelial integrity. Patients were
divided in three groups according to the time interval from angiography to
evaluation: <24 h, >24 h to <7 days and >7 days. RESULTS: Baseline RA
median diameters were 0.25 +/- 0.04 cm in the cannulated arm and 0.22 +/-
0.04 cm in the non-cannulated arm (P = 0.01). The flow-mediated dilatation
(FMD) in the RA in the catheterized arm and in the control arm were 11.6
+/- 7.9 and 14.2 +/- 8.9 (P = 0.01), respectively. A statistically
significant correlation was found between FMD of the catheterized RA and
the time from RA-CA (Pearson's r = 0.348). Linear regression analysis
confirmed that the FMD of the catheterized RA was dependent on days
elapsed from the procedure (P = 0.032; OR 1.11, CI 0.009-0.203).
Immunohistochemical evaluation showed extensive endothelial lesion in all
examined RAs, with a trend towards reduction of the damage with time.
Endothelial function and integrity of the cannulated arm did not reach
those of the control arm in any of the study patients. CONCLUSIONS: RA-CA
produces extensive damage to the RA. The lesions tend to heal with time
but incomplete recovery of endothelial integrity and function is still
present more than 30 days after the procedure. After RA-CA, the cannulated
RA should not be used for CABG.

<5>
[Use Link to view the full text]
Accession Number
2015869091
Author
Ruwald A-C.; Schuger C.; Moss A.J.; Kutyifa V.; Olshansky B.; Greenberg
H.; Cannom D.S.; Estes N.A.M.; Ruwald M.H.; Huang D.T.; Klein H.; McNitt
S.; Beck C.A.; Goldstein R.; Brown M.W.; Kautzner J.; Shoda M.; Wilber D.;
Zareba W.; Daubert J.P.
Institution
(Ruwald, Schuger, Ruwald) University of Rochester Medical Center, NY,
United States
(Ruwald, Moss, Kutyifa, Ruwald, Huang, Klein, McNitt, Beck, Brown, Shoda,
Zareba) Department of Cardiology, Gentofte University Hospital, Hellerup,
Denmark
(Schuger) Division of Cardiology, Henry Ford Hospital, Detroit, MI, United
States
(Olshansky) Department of Medicine, University of Iowa Health Care, Iowa
City, United States
(Greenberg) St Luke's and Roosevelt Hospitals, Departments of Medicine and
Epidemiology, Columbia University, New York, NY, United States
(Cannom) Division of Cardiology, Hospital of the Good Samaritan,
Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Estes) New England Cardiac Arrhythmia Center, Tufts-New England Medical
Center, Boston, MA, United States
(Goldstein) Department of Medicine, Uniformed Services University of the
Health Sciences, Bethesda, MD, United States
(Kautzner) Cardiology Department, Institute for Clinical and Experimental
Medicine, Prague, Czech Republic
(Shoda) Department of Cardiology, Tokyo Women's Medical University, Tokyo,
Japan
(Wilber) Cardiovascular Institute, Loyola University Medical Center,
Chicago, IL, United States
(Daubert) Cardiology Division, Department of Medicine, Duke University
Medical Center, Durham, NC, United States
Title
Mortality reduction in relation to implantable cardioverter defibrillator
programming in the multicenter automatic defibrillator implantation
trial-reduce inappropriate therapy (MADIT-RIT).
Source
Circulation: Arrhythmia and Electrophysiology. 7 (5) (pp 785-792), 2014.
Date of Publication: 01 Oct 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The benefit of novel implantable cardioverter defibrillator
(ICD) programming in reducing inappropriate ICD therapy and mortality was
demonstrated in Multicenter Automatic Defibrillator Implantation
Trial-Reduce Inappropriate Therapy (MADIT-RIT). However, the cause of
mortality reduction remains incompletely evaluated. We aimed to identify
factors associated with mortality, with focus on ICD therapy and
programming in the MADIT-RIT population. Methods and Results: In
MADIT-RIT, 1500 patients with a primary prophylactic indication for ICD or
cardiac resynchronization therapy with defibrillator were randomized to 1
of 3 different ICD programming arms: conventional programming (ventricular
tachycardia zone >170 beats per minute), high-rate programming
(ventricular tachycardia zone >200 beats per minute), and delayed
programming (60-second delay before therapy >170 beats per minute).
Multivariate Cox models were used to assess the influence of
time-dependent appropriate and inappropriate ICD therapy (shock and
antitachycardia pacing) and randomized programming arm on all-cause
mortality. During an average follow-up of 1.4+/-0.6 years, 71 of 1500 (5%)
patients died: cardiac in 40 patients (56.3%), noncardiac in 23 patients
(32.4%), and unknown in 8 patients (11.3%). Appropriate shocks (hazard
ratio, 6.32; 95% confidence interval, 3.13-12.75; P<0.001) and
inappropriate therapy (hazard ratio, 2.61; 95% confidence interval,
1.28-5.31; P=0.01) were significantly associated with an increased
mortality risk. There was no evidence of increased mortality risk in
patients who experienced appropriate antitachycardia pacing only (hazard
ratio, 1.02; 95% confidence interval, 0.36-2.88; P=0.98). Randomization to
conventional programming was identified as an independent predictor of
death when compared with patients randomized to high-rate programming
(hazard ratio, 2.0; 95% confidence interval, 1.06-3.71; P=0.03).
Conclusions: In MADIT-RIT, appropriate shocks, inappropriate ICD therapy,
and randomization to conventional ICD programming were independently
associated with an increased mortality risk. Appropriate antitachycardia
pacing was not related to an adverse outcome.

<6>
[Use Link to view the full text]
Accession Number
2015868313
Author
Basili S.; Tanzilli G.; Raparelli V.; Calvieri C.; Pignatelli P.;
Carnevale R.; Dominici M.; Placanica A.; Arrivi A.; Farcomeni A.; Barilla
F.; Mangieri E.; Violi F.
Institution
(Basili, Raparelli, Pignatelli, Carnevale, Violi) Division of i Clinica
Medica, Sapienza-University of Rome, Viale del Policlinico 155, Rome
00161, Italy
(Tanzilli, Calvieri, Barilla, Mangieri) Department of the Heart and Great
Vessels Attilio Reale, Sapienza-University of Rome, Rome, Italy
(Farcomeni) Department of Public Health and Infectious Diseases,
Sapienza-University of Rome, Rome, Italy
(Dominici, Placanica, Arrivi) Division of Cardiology, Department of
Interventional Cardiology, Santa Maria University Hospital, Terni, Italy
Title
Aspirin reload before elective percutaneous coronary intervention: Impact
on serum thromboxane B2 and myocardial reperfusion indexes.
Source
Circulation: Cardiovascular Interventions. 7 (4) (pp 577-584), 2014. Date
of Publication: 01 Aug 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Microvascular obstruction seems to predict poor outcome in
patients undergoing elective percutaneous coronary intervention (PCI), but
the underlying mechanism is still unclear. We analyzed whether serum
thromboxane B2, a stable metabolite of thromboxane A2, may be implicated
in post-PCI microvascular obstruction. Methods and Results-We enrolled 91
patients (74 males, 66+/-10 years) on chronic low-dose aspirin therapy
(aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned
to receive aspirin reload (325 mg orally, n=46) or no reload (control
group, n=45) >1 hour before elective PCI. Serum levels of thromboxane B2,
reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame
count and myocardial blush grade), and serum cardiac troponin I were
assessed before and after PCI. Serum thromboxane B2 significantly
increased after 120 minutes (P=0.0447) from PCI in control but not in
aspirin reload group. After PCI, both groups showed a statistically
significant reduction in corrected Thrombolysis In Myocardial Infarction
frame count more evident in aspirin reload group (P=0.0023). Moreover,
after PCI, 61% of patients allocated to aspirin reload and only 32% of
patients allocated to control group reached normal microcirculatory
reperfusion (myocardial blush grade=3); patients with myocardial blush
grade=3 exhibited lower values of serum thromboxane B2 compared with those
with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I
significantly increased (F=3.64; P=0.01334) and correlated with serum
thromboxane B2 (rho=0.31; P=0.0413) in control but not in aspirin reload
group. In addition, left ventricular ejection fraction significantly
increased after PCI only in the aspirin reload group (P=0.0005).
Conclusions-Aspirin loading dose before elective PCI improves myocardial
reperfusion and injury indexes, suggesting a possible role of platelet
thromboxane A2 in microvascular occlusion.

<7>
Accession Number
26707761
Author
Virk S.A.; Bowman S.R.; Chan L.; Bannon P.G.; Aty W.; French B.G.; Saxena
A.
Institution
(Virk) South Western Sydney Clinical School, University of New South
Wales, Sydney, Australia. Electronic address: sohaib.211@gmail.com
(Bowman) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Chan) Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney,
Australia
(Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia; Discipline of Surgery, Sydney Medical School,
University of Sydney, Sydney, Australia
(Aty) Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney,
Australia
(French) Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney,
Australia
(Saxena) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, Australia; Discipline of Surgery, Sydney Medical School,
University of Sydney, Sydney, Australia
Title
Equivalent outcomes after coronary artery bypass graft surgery performed
by consultant versus trainee surgeons: A systematic review and
meta-analysis.
Source
The Journal of thoracic and cardiovascular surgery. 151 (3) (pp 647-654),
2016. Date of Publication: 01 Mar 2016.
Abstract
OBJECTIVE: In recent years, concerns have been raised about the learning
opportunities available to cardiac surgical trainees. This meta-analysis
was conducted to assess the impact of trainee operator status on clinical
outcomes after coronary artery bypass graft (CABG) surgery.
METHODS: Medline, EMBASE, and the Cochrane Library were systematically
searched for studies that reported CABG outcomes according to the training
status of the primary operator (consultant vs trainee). Data were
independently extracted by 2 investigators; a meta-analysis was conducted
according to predefined clinical endpoints.
RESULTS: Sixteen observational studies (n = 52,966) met criteria for
inclusion, with 8 studies (n = 36,479) reporting propensity-adjusted
analyses. Trainee cases were associated with increased aortic crossclamp
duration (mean difference: 4.80; 95% confidence interval [CI], 0.76-8.83)
and cardiopulmonary bypass duration (mean difference: 4.24; 95% CI,
0.00-8.47). Perioperative mortality was similar for CABG performed
primarily by trainees versus consultants (odds ratio 0.98; 95% CI,
0.81-1.18). No significant difference was found in the incidence of
perioperative stroke, myocardial infarction, acute renal failure,
reoperation for bleeding, or wound infection. Trainee operator status was
not associated with increased midterm mortality (hazard ratio 1.00; 95%
CI, 0.90-1.11). In subgroup analysis that included 5 studies and 8025
patients, off-pump CABG trainee cases were not associated with increased
perioperative mortality or morbidity.
CONCLUSIONS: With appropriate supervision, conventional CABG can be
performed by trainee surgeons without an adverse impact on perioperative
outcomes or midterm survival. Data regarding off-pump CABG are limited,
and further research is warranted to ascertain the impact of trainee
operator status on long-term outcomes after off-pump CABG.

<8>
Accession Number
26518376
Author
Bin C.; Junsheng M.; Jianqun Z.; Ping B.
Institution
(Bin) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Junsheng) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China. Electronic address:
wesleymu@hotmail.com
(Jianqun) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Ping) Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
Title
Meta-Analysis of Medium and Long-Term Efficacy of Loading Statins After
Coronary Artery Bypass Grafting.
Source
The Annals of thoracic surgery. 101 (3) (pp 990-995), 2016. Date of
Publication: 01 Mar 2016.
Abstract
BACKGROUND: The aim of this study was to evaluate the medium- and
long-term efficacy of loading statins after coronary artery bypass
grafting (CABG) by comparing using a loading dose of statins or a regular
dose of statins in patients undergoing CABG.
METHODS: We conducted a literature search of numerous databases for
randomized controlled trials on the efficacy of a loading dose of statins
in patients undergoing CABG. The quality of included studies was evaluated
according to the Newcastle-Ottawa Scale. Statistical results of treatment
were represented by weighted mean difference, odds ratio, and 95%
confidence interval.
RESULTS: There were 8 studies including 8,676 patients (4,352 who had a
loading dose of statins and 4,324 who had a regular dose). Meta-analysis
showed statistically significant differences in the following in patients
who took a loading dose of statins: lower level of low-density lipoprotein
cholesterol (LDL-C) after CABG (p < 0.00001), fewer deaths caused by
myocardial infarction (p = 0.005), fewer patients with myocardial
infarction (p = 0.004), fewer patients undergoing secondary CABG (p <
0.00001), and fewer patients undergoing graft restenosis by intravascular
ultrasonography (p < 0.0001).
CONCLUSIONS: Comparing patients receiving a loading dose of statins with
those receiving a regular dose after CABG, the medium- and long-term
efficacy of a loading dose showed significant reduction in LDL-C, lower
occurrence of adverse cardiac events, and reduction in graft restenosis.
Although the incidence of drug-related side effects was slightly higher in
the loading-dose group, in the majority of patients they were not serious.
Overall, a loading dose of statins is superior to regular dosing of
statins after CABG.

<9>
Accession Number
26603021
Author
Moscarelli M.; Fattouch K.; Casula R.; Speziale G.; Lancellotti P.;
Athanasiou T.
Institution
(Moscarelli) National Heart and Lung Institute, Imperial College London,
London, United Kingdom. Electronic address: m.moscarelli@imperial.ac.uk
(Fattouch) GVM Care and Research, Villa Maria Eleonora, Palermo, Italy
(Casula) Department of Surgery and Cancer, Imperial College London,
London, United Kingdom
(Speziale) GVM Care, Anthea Hospital, Bari, Italy
(Lancellotti) Department of Cardiology, University of Liege Hospital,
Liege, Belgium; and the GVM Care and Research Group
(Athanasiou) Department of Surgery and Cancer, Imperial College London,
London, United Kingdom
Title
What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk
Patients? A Meta-Analysis of Observational Studies.
Source
The Annals of thoracic surgery. 101 (3) (pp 981-989), 2016. Date of
Publication: 01 Mar 2016.
Abstract
BACKGROUND: Minimally invasive valve surgery is related to certain better
postoperative outcomes. We aimed to assess the role of minimally invasive
mitral valve surgery in high-risk patients.
METHODS: A systematic literature review identified eight studies of which
seven fulfilled criteria for meta-analysis. Outcomes for a total of 1,254
patients (731 were conventional standard sternotomy and 523 were minimally
invasive mitral valve surgery) were submitted to meta-analysis using
random effects modeling. Heterogeneity and subgroup analysis with quality
scoring were assessed. The primary end point was early mortality.
Secondary end points were intraoperative and postoperative outcomes and
long-term follow-up.
RESULTS: Minimally invasive mitral valve surgery conferred comparable
early mortality to standard sternotomy (p = 0.19); it was also associated
with a lower number of units of blood transfused (weighted mean
difference, -1.93; 95% confidence interval [CI], -3.04 to -0.82; p =
0.0006) and atrial fibrillation rate (odds ratio, 0.49; 95% CI, 0.32 to
0.74; p = 0.0007); however, cardiopulmonary bypass time was longer
(weighted mean difference, 20.88; 95% CI, -1.90 to 43.65; p = 0.07). There
was no difference in terms of valve repair rate (odds ratio, 1.51; 95% CI,
0.89 to 2.54; p = 0.12), and the incidence of stroke was significantly
lower in the high-quality analysis with no heterogeneity (odds ratio,
0.35; 95% CI, 0.15 to 0.82; p = 0.02; chi(2), 1.67; I(2), 0%; p = 0.43).
CONCLUSIONS: Minimally invasive mitral valve surgery is a safe and
comparable alternative to standard sternotomy in patients at high risk,
with similar early mortality and repair rate and better postoperative
outcomes, although a longer cardiopulmonary bypass time is required.

<10>
Accession Number
25783974
Author
Arora S.; Andreassen A.K.; Andersson B.; Gustafsson F.; Eiskjaer H.;
Botker H.E.; Radegran G.; Gude E.; Ioanes D.; Solbu D.; Sigurdardottir V.;
Dellgren G.; Erikstad I.; Solberg O.G.; Ueland T.; Aukrust P.; Gullestad
L.
Institution
(Arora) Department of Cardiology, Oslo University Hospital Rikshospitalet,
Oslo, Norway
(Andreassen) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Botker) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Radegran) The Clinic for Heart Failure and Valvular Disease, Skane
University Hospital and Lund University, Lund, Sweden
(Gude) Department of Cardiology, Oslo University Hospital Rikshospitalet,
Oslo, Norway
(Ioanes) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Sigurdardottir) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Erikstad) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Solberg) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Ueland) Research Institute for Internal Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen Inflammatory Research Center, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Aukrust) Research Institute for Internal Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Aukrust) K.G. Jebsen Inflammatory Research Center, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Aukrust) Section of Clinical Immunology and Infectious Diseases, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Gullestad) Department of Cardiology, Oslo University Hospital
Rikshospitalet, Oslo, Norway
(Gullestad) K.G. Jebsen Cardiac Research Center and Center for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
The Effect of Everolimus Initiation and Calcineurin Inhibitor Elimination
on Cardiac Allograft Vasculopathy in De Novo Recipients: One-Year Results
of a Scandinavian Randomized Trial.
Source
American journal of transplantation : official journal of the American
Society of Transplantation and the American Society of Transplant
Surgeons. 15 (7) (pp 1967-1975), 2015. Date of Publication: 01 Jul 2015.
Abstract
Early initiation of everolimus with calcineurin inhibitor therapy has been
shown to reduce the progression of cardiac allograft vasculopathy (CAV) in
de novo heart transplant recipients. The effect of de novo everolimus
therapy and early total elimination of calcineurin inhibitor therapy has,
however, not been investigated and is relevant given the morbidity and
lack of efficacy of current protocols in preventing CAV. This 12-month
multicenter Scandinavian trial randomized 115 de novo heart transplant
recipients to everolimus with complete calcineurin inhibitor elimination
7-11 weeks after HTx or standard cyclosporine immunosuppression.
Ninety-five (83%) patients had matched intravascular ultrasound
examinations at baseline and 12 months. Mean (+/- SD) recipient age was
49.9 +/- 13.1 years. The everolimus group (n = 47) demonstrated
significantly reduced CAV progression as compared to the calcineurin
inhibitor group (n = 48) (DELTAMaximal Intimal Thickness 0.03 +/- 0.06 and
0.08 +/- 0.12 mm, DELTAPercent Atheroma Volume 1.3 +/- 2.3 and 4.2 +/-
5.0%, DELTATotal Atheroma Volume 1.1 +/- 19.2 mm(3) and 13.8 +/- 28.0
mm(3) [all p-values < 0.01]). Everolimus patients also had a significantly
greater decline in levels of soluble tumor necrosis factor receptor-1 as
compared to the calcineurin inhibitor group (p = 0.02). These preliminary
results suggest that an everolimus-based CNI-free can potentially be
considered in suitable de novo HTx recipients.

<11>
Accession Number
26371452
Author
Puskas J.D.; Martin J.; Cheng D.C.; Benussi S.; Bonatti J.O.; Diegeler A.;
Ferdinand F.D.; Kieser T.M.; Lamy A.; Mack M.J.; Patel N.C.; Ruel M.;
Sabik J.F.; Yanagawa B.; Zamvar V.
Institution
(Puskas, Martin, Cheng, Benussi, Bonatti, Diegeler, Ferdinand, Kieser,
Lamy, Mack, Patel, Ruel, Sabik, Yanagawa, Zamvar) From the *Department of
Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai, New York,
NY USA; +Centre for Medical Evidence, Decision Integrity, Clinical Impact
(MEDICI), Department of Anesthesia & Perioperative Medicine, and
Department of Epidemiology & Biostatistics, Western University, London,
Ontario, Canada; ++Division of Cardiovascular Surgery, University Hospital
Zurich, Zurich, Switzerland; Heart and Vascular Institute, Cleveland
Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Herz-Und Gefasse Klinik
Bad Neustadt, University of Leipzig, Bad Neustadt, Germany; PDivision of
Cardiovascular and Thoracic Surgery, Lankenau Medical Center, Wynnewood,
PA USA; #Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB Canada; **Division of Cardiac Surgery and Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton,
Ontario, Canada; ++Baylor Health System, Heart Hospital Baylor Plano,
Dallas, TX USA; ++++Department of Cardiothoracic Surgery, Lenox Hill, New
York, NY USA; University of Ottawa Heart Institute, Ottawa, Ontario,
Canada; Heart Vascular Institute, Cleveland Clinic, Cleveland, OH USA; and
PPRoyal Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
ISMICS Consensus Conference and Statements of Randomized Controlled Trials
of Off-Pump Versus Conventional Coronary Artery Bypass Surgery.
Source
Innovations (Philadelphia, Pa.). 10 (4) (pp 219-229), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: At this consensus conference, we developed evidence-informed
consensus statements and recommendations on the practice of off-pump
coronary artery bypass graft (OPCAB) by systematically reviewing and
performing meta-analysis of the randomized controlled trials (RCTs)
comparing OPCAB and conventional coronary artery bypass (CCAB).
METHODS: All RCTs of OPCAB versus CCAB through April 2013 were screened,
and 102 relevant RCTs (19,101 patients) were included in a systematic
review and meta-analysis (15 RCTs of 9551 high-risk patients; and 87 RCTs
of 9550 low-risk patients) in accordance with the Cochrane Collaboration
and PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) methodology. Consensus statements for the risks and
benefits of OPCAB surgery in mortality, morbidity, and resource use were
developed based on best available evidence.
RESULTS: Compared to CCAB, it is reasonable to perform OPCAB to reduce
risks of stroke [class IIa, level of evidence (LOE) A], renal
dysfunction/failure (class IIa, LOE A), blood transfusion (class I, LOE
A), respiratory failure (class I, LOE A), atrial fibrillation (class I,
LOE A), wound infection (class I, LOE A), ventilation time, and ICU and
hospital length of stay (class I, LOE A). However, OPCAB may be associated
with a reduced number of grafts performed (class I, LOE A) and with
diminished graft patency (class IIa, LOE A, with increased coronary
reintervention at 1 year and beyond (class IIa, LOE A), as well as
increased mortality at a median follow-up of 5 years (class IIb, LOE A).
CONCLUSIONS: OPCAB compared with CCAB may improve outcomes in the
short-term (stroke, renal dysfunction, blood transfusion, respiratory
failure, atrial fibrillation, wound infection, ventilation time, and
length of stay). However, over the longer-term, OPCAB may be associated
with reduced graft patency, and increased risk of cardiac re-intervention
and death.

<12>
Accession Number
26360979
Author
Watanabe G.; Yamaguchi S.; Tomita S.; Nishida Y.
Institution
(Watanabe, Yamaguchi, Tomita, Nishida) From the Department of General and
Cardiothoracic Surgery, Kanazawa University Graduate School of Medical
Science, Kanazawa, Japan
Title
Fasudil Is an Effective Graft Vasodilator for Gastroepiploic Artery in
Coronary Artery Bypass Grafting.
Source
Innovations (Philadelphia, Pa.). 10 (4) (pp 268-272), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: The gastroepiploic artery (GEA) has been used as an alternative
arterial in situ graft for coronary artery bypass grafting (CABG).
However, because of the large individual differences and the spastic
nature of the GEA, caution has to be exercised during harvesting. We
evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a
vasodilator for right GEA (RGEA) graft after harvesting, compared with the
conventional agents papaverine and verapamil-nitroglycerin.
METHODS: Between June 2009 and January 2013, 30 patients with ischemic
heart disease who underwent isolated CABG using RGEA graft were randomly
assigned to fasudil (n = 10), papaverine (n = 10), or
verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine
(1.0 mmol/L) mixed with heparinized blood, or verapamil-nitroglycerin (30
mumol/L each) was injected intraluminally into the RGEA graft after
harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and
histopathology of RGEA were evaluated.
RESULTS: Intraluminal injection of fasudil increased GFF significantly (P
< 0.001) and markedly from 41.5 +/- 31.5 mL/min at baseline to 149.3 +/-
46.7 mL/min after injection. Papaverine increased GFF (P < 0.001) from
40.0 +/- 35.8 to 64.9 +/- 33.7 mL/min, and verapamil-nitroglycerin also
increased GFF (P < 0.001) from 38.8 +/- 32.1 to 79.0 +/- 35.2 mL/min. The
GFF was significantly higher (P = 0.001) in the fasudil group than in the
other two groups. Histopathologically, fasudil treatment markedly
increased the diameter of RGEA graft, while maintaining integrity of the
multiple elastic lamellae. Blood pressure did not change significantly
after drug injection in all groups.
CONCLUSIONS: Fasudil is more potent than papaverine or
verapamil-nitroglycerin in increasing GFF of RGEA graft for CABG.

<13>
Accession Number
26469104
Author
Wypasek E.; Ciesla M.; Suder B.; Janik L; Sadowski J.; Undas A.
Institution
(Wypasek) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
(Ciesla) John Paul II Hospital, Krakow, Poland
(Suder) John Paul II Hospital, Krakow, Poland
(Janik) John Paul II Hospital, Krakow, Poland
(Sadowski) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
(Undas) John Paul II Hospital, Institute of Cardiology, Jagiellonian
University School of Medicine, Krakow, Poland
Title
CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients
Within the First 3 Months Following Heart Valve Replacement.
Source
Advances in clinical and experimental medicine : official organ Wroclaw
Medical University. 24 (4) (pp 607-614), 2015. Date of Publication: 01 Jul
2015.
Abstract
BACKGROUND: Warfarin dose requirements are partly determined by common
single nucleotide polymorphisms in VKORC1 and CYP2C9 genes.
OBJECTIVES: The aim of this study was to investigate how the presence of
allelic variants in CYP2C9 affects the stability of anticoagulation in
patients within the first 3 months following elective heart valve
replacement.
MATERIAL AND METHODS: In a case-control study we compared 18 consecutive
carriers of CYP2C9*2 and/or *3 and 25 well-matched patients with the wild
type CYP2C9*1/*1 genotype. The former group was randomly assigned to use
coagulometers or monitor international normalized ratio (INR) in local
outpatient clinics. Subjects receiving drugs potently interfering with
warfarin were ineligible. Anticoagulation with the baseline warfarin
regimens based on pharmacogenetic algorithm was assessed by time in the
therapeutic INR range (TTR) within the first 3 months following
implantation.
RESULTS: Carriers of the CYP2C9*2 and/or *3 genotypes were characterized
by lower estimated warfarin dose (median, 21 [interquartile range, 21-35]
vs. 35 [28-42] mg/week, p=0.02) and actual (27.8+/-13.2 vs. 46.3+/-13.9
mg/week, p<0.001), together with lower TTR values (56 [38.6-74.9] vs. 75.4
[58.1-83.6] %, p=0.03) and longer time above the therapeutic range (13.8
[4.9-34.5] vs. 4.5 [0-15.3]%, p=0.047) than patients with the CYP2C9*1/*1
genotype. There were no differences in the estimated and actual warfarin
doses, TTR values and adverse events between the self-testing and
standard-care subgroups.
CONCLUSIONS: The presence of CYP2C9*2 and/or *3 genotypes is associated
with unstable warfarin treatment in patients after heart valve
replacement, regardless of the type of INR testing.

<14>
Accession Number
24686003
Author
Benedetto U.; Raja S.G.; Albanese A.; Amrani M.; Biondi-Zoccai G.; Frati
G.
Institution
(Benedetto) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Raja) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Albanese) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Amrani) Department of Cardiac Surgery, Harefield Hospital, London, UK
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Frati) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Rome, Italy Department of AngioCardio
Neurology, IRCCS NeuroMed, Pozzilli, Italy
Title
Searching for the second best graft for coronary artery bypass surgery: a
network meta-analysis of randomized controlled trials+.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (1) (pp 59-65), 2015.
Date of Publication: 01 Jan 2015.
Abstract
OBJECTIVES: There is a lack of unequivocal evidence basis for selecting
the best second conduit in coronary artery bypass grafting (CABG). We thus
aimed to perform head-to-head relative effect estimate on angiographic
outcomes for second conduits, including the right internal mammary artery
(RIMA), radial artery (RA), right gastroepiploic artery (RGEA) and
saphenous vein graft (SVG) by means of network meta-analysis of randomized
controlled trials (RCTs).
METHODS: Databases were searched for RCTs comparing angiographic outcomes
(>4 weeks) of second conduits in CABG. Odds ratios (95% confidence
intervals) were computed with Markov Chain Monte Carlo simulation.
RESULTS: A total of nine RCTs were identified, including 2780 patients and
1620 angiographic results available for analysis to compare RIMA (n=145)
versus RA (n=871) versus RGEA (n=92) versus SVG (n=845). The mean time to
angiographic follow-up ranged from 1 to 7.7 years. An SVG was
significantly associated with a 4-fold (1.67-16.00) and 3-fold
(0.78-22.20) increased risk of late (>4 years) functional graft occlusion
when compared with the RIMA and RA, respectively. A RIMA was associated
with a non-significant 27% absolute risk reduction for functional graft
occlusion when compared with the RA.
CONCLUSIONS: The present network meta-analysis consistently demonstrated
an angiographic superiority of RIMA and RA over SVG. The RIMA is expected
to achieve a better patency rate than the RA, but further studies are
needed.

<15>
Accession Number
26431120
Author
Guo B.-L.; Lin Y.; Hu W.; Zhen C.-X.; Bao-Cheng Z.; Wu H.-H.; Kaye A.D.;
Duan J.-H.; Qu Y.
Institution
(Zhen) Department of Neurobiology and Collaborative Innovation Center for
Brain Science, Fourth Military Medical University, Xi'an 710032, China
(Bao-Cheng, Wu, Kaye) State Key Laboratory of Military Stomatology,
College of Stomatology, Fourth Military Medical University
(Duan) State Key Laboratory of Military Stomatology, College of
Stomatology, Fourth Military Medical University, Xi'an
(Qu) Department of Neurosurgery, Tang'du Hospital, Fourth Military Medical
University, Xi'an
Title
Effects of Systemic Magnesium on Post-operative Analgesia: Is the Current
Evidence Strong Enough?.
Source
Pain physician. 18 (5) (pp 405-418), 2015. Date of Publication: 01 Sep
2015.
Abstract
BACKGROUND: Clinical studies have been previously carried out on the
efficacy of systemic magnesium to minimize postoperative pain, however,
with controversial results. A quantitative meta-analysis was performed to
evaluate the analgesic efficacy and safety of systemic magnesium on
post-operative pain.
STUDY DESIGN: Comprehensive systematic review of all relevant, publsished
randomized controlled trials.
METHODS: A search was conducted of published literature in MEDLINE,
PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled
Trials (CENTRAL) databases from inception to Sep-Oct 2014. Randomized
controlled trials (RCTs) that compared magnesium with placebo were
identified. Effects were summarized using standardized mean differences
(SMDs), weighed mean differences (WMD), or odds ratio (OR) with suitable
effect model.
RESULTS: Twenty-seven RCTs involving 1,504 patients were included. In
total, peri-operative magnesium significantly reduced the pain score at
rest (SMD, -1.43, 95% CI, -2.74 to -0.12, < 0.01). Magnesium significantly
reduced analgesic consumption (SMD, -1.72, 95% CI, -3.21 to -0.23) in
patients undergoing urogenital, orthopaedic, and cardiovascular surgeries,
but was inconclusive for patients receiving gastrointestinal surgeries.
The obvious analgesia of systemic magnesium was observed on reducing the
pain score during movement at 24 hours after operation (SMD, -0.05, 95%
CI, -0.43 to 0.32). Moreover, magnesium administration showed a beneficial
effect with regard to intra-operative hemodynamics and reduced extubation
time in the cardiovascular surgery patients (WMD, -29.34 min, 95% CI,
-35.74 to -22.94, P < 0.01).
LIMITATIONS: Focused only on the quality of analgesia on postoperative
pain with regards to surgery type.
CONCLUSIONS: Our study suggests that systemic magnesium during general
anesthesia significantly decreases post-operative pain scores without
increasing adverse events. It should be noted that since there are 18
ongoing RCTs without published data, it is still premature to draw
conclusions on the long-term analgesic effects of magnesium as well as
potential gender or age difference.

<16>
Accession Number
26117654
Author
Agarwal S.; Parashar A.; Kumbhani D.J.; Svensson L.G.; Krishnaswamy A.;
Tuzcu E.M.; Kapadia S.R.
Institution
(Agarwal) Department of Cardiovascular Medicine, J2-3, Heart and Vascular
Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,
United States
(Parashar) Department of Internal Medicine, Cleveland Clinic, United
States
(Kumbhani) Interventional Cardiology, UT Southwestern Medical Center,
United States
(Svensson) Department of Cardiovascular Surgery, Cleveland Clinic, United
States
(Krishnaswamy) Department of Cardiovascular Medicine, J2-3, Heart and
Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH
44195, United States
(Tuzcu) Department of Cardiovascular Medicine, J2-3, Heart and Vascular
Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,
United States
(Kapadia) Department of Cardiovascular Medicine, J2-3, Heart and Vascular
Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,
United States. Electronic address: kapadis@ccf.org
Title
Comparative meta-analysis of balloon-expandable and self-expandable valves
for transcatheter aortic valve replacement.
Source
International journal of cardiology. 197 (pp 87-97), 2015. Date of
Publication: 15 Oct 2015.
Abstract
BACKGROUND: Balloon-expandable valves (BEVs) and self-expandable valves
(SEVs) are two major types of valves utilized for transcatheter aortic
valve replacement (TAVR). We conducted a meta-analysis of available
studies to compare the safety and efficacy of these two valve types.
METHODS: Medline search was conducted using standard search terms to
determine eligible studies. Primary outcomes of the meta-analysis included
death and stroke at 30days and 1year. Pooled estimates of procedural
outcomes were also compared between the valve types. Analysis was
performed for entire cohort and separately for patients undergoing
transfemoral TAVR (TF-TAVR).
RESULTS: Analysis of entire cohort revealed similar 30-day mortality in
the SEV and BEV cohorts. There was no significant difference in the
incidence of stroke at 30days between the two study groups. Both pooled
comparisons demonstrated a significant heterogeneity with I(2)>50%,
necessitating the use of random effect modeling. We observed a
significantly higher incidence of new pacemaker implantation, aortic
regurgitation>2+ at 30days, valve embolization, and need for >1 valve
following SEV implantation compared with BEV implantation. Analysis of
TF-TAVR cohort showed higher 30day [IRR (95% CI): 1.34 (1.19-1.52)] but a
similar 1-year mortality [IRR (95% CI): 1.07 (0.96-1.19)] for SEV compared
to BEV implantation.
CONCLUSION: Compared to BEV implantation, SEV implantation was associated
with a similar risk of mortality and stroke at 30-day and 1-year follow-up
duration. Analysis of the TF-TAVR cohort revealed a significantly higher
mortality at 30days among patients undergoing SEV implantation, compared
with BEV implantation. In addition, there was a significantly higher
incidence of other adverse events noted above, following SEV implantation,
compared with BEV implantation.

<17>
Accession Number
20160389178
Author
Saji M.; Lim D.S.; Ragosta M.; LaPar D.J.; Downs E.; Ghanta R.K.; Kern
J.A.; Dent J.M.; Ailawadi G.
Institution
(Saji, Lim, Ragosta, Dent) Division of Cardiovascular Medicine, Department
of Medicine, Advanced Cardiac Valve Center, University of Virginia,
Charlottesville, VA, United States
(Saji) Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
(LaPar, Downs, Ghanta, Kern, Ailawadi) Division of Cardiothoracic Surgery,
Department of Surgery, Advanced Cardiac Valve Center, University of
Virginia, Charlottesville, VA, United States
Title
Usefulness of Psoas Muscle Area to Predict Mortality in Patients
Undergoing Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 118 (2) (pp 251-257), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Inc.
Abstract
Frailty has become high-priority theme in cardiovascular diseases because
of aging and increasingly complex nature of patients. Low muscle mass is
characteristic of frailty, in which invasive interventions are avoided if
possible because of decreased physiological reserve. This study aimed to
determine if the psoas muscle area (PMA) could predict mortality and to
investigate its utility in patients who underwent transcatheter aortic
valve replacement (TAVR). We retrospectively reviewed 232 consecutive
patients who underwent TAVR. Cross-sectional areas of the psoas muscles at
the level of fourth lumbar vertebra were measured by computed tomography
and normalized to body surface area. Patients were divided into tertiles
according to the normalized PMA for each gender (men: tertile 1, 1,708 to
1,178 mm²/m²; tertile 2, 1,176 to 1,011
mm²/m²; and tertile 3, 1,009 to 587
mm²/m²; women: tertile 1, 1,436 to 962
mm²/m²; tertile 2, 952 to 807
mm²/m²; and tertile 3, 806 to 527
mm²/m²). Smaller normalized PMA was independently
correlated with women and higher New York Heart Association
classification. After adjustment for multiple confounding factors, the
normalized PMA tertile was independently associated with mortality at 6
months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21).
Kaplan-Meier analysis showed that tertile 3 had higher mortality rates
than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029).
Receiver-operating characteristic analysis showed that normalized PMA
provided the increase of C-statistics for predicting mortality for a
clinical model and gait speed. In conclusion, PMA is an independent
predictor of mortality after TAVR and can complement a clinical model and
gait speed.

<18>
Accession Number
20160043334
Author
Zhao D.F.; Seco M.; Wu J.J.; Edelman J.B.; Wilson M.K.; Vallely M.P.;
Byrom M.J.; Bannon P.G.
Institution
(Zhao, Seco, Wu, Edelman, Wilson, Vallely, Byrom, Bannon) Sydney Medical
School, University of Sydney, Sydney; Baird Institute of Applied Heart and
Lung Surgical Research, Sydney; Cardiothoracic Surgery Unit and Institute
of Academic Surgery, Royal Prince Alfred Hospital, Sydney; and Australian
School of Advanced Medicine, Macquarie University, Sydney, Australia
Title
Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged
Adults: A Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 102 (1) (pp 315-327), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in
middle-aged adults undergoing aortic valve replacement is a complex
decision that must account for numerous prosthesis and patient factors. A
systematic review and meta-analysis was performed to compare long-term
survival, major adverse prosthesis-related events, anticoagulant-related
events, major bleeding, reoperation, and structural valve degeneration in
middle-aged patients receiving a BV or MV. A comprehensive search from six
electronic databases was performed from their inception to February 2016.
Results. from patients aged less than 70 years undergoing aortic valve
replacement with a BV or MV were included. There were 12 studies involving
8,661 patients. Baseline characteristics were similar. There was no
significant difference in long-term survival among patients aged 50 to 70
or 60 to 70 years. Compared with MVs, BVs had significantly fewer
long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006)
and bleeding (HR 0.48, p < 0.00001) but significantly greater major
adverse prosthesis-related events (HR 1.82, p = 0.02), including
reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no
significant difference in survival between BVs and MVs in patients aged 50
to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major
bleeding and anticoagulant-related events but increased risk of structural
valve degeneration and reoperation. However, the mortality consequences of
reoperation appear lower than that of major bleeding, and recent advances
may further lower the reoperation rate for BV. Therefore, this review
supports the current trend of using BVs in patients more than 60 years of
age.

<19>
Accession Number
20160463121
Author
Baggen V.J.M.; Driessen M.M.P.; Post M.C.; van Dijk A.P.; Roos-Hesselink
J.W.; van den Bosch A.E.; Takkenberg J.J.M.; Sieswerda G.T.
Institution
(Baggen, Driessen, Sieswerda) Department of Cardiology, University Medical
Centre Utrecht, Utrecht 3508 GA, Netherlands
(Baggen, Roos-Hesselink, van den Bosch) Department of Cardiology, Erasmus
Medical Centre, Rotterdam, Netherlands
(Post) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(van Dijk) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Takkenberg) Department of Cardio-Thoracic Surgery, Erasmus Medical
Centre, Rotterdam, Netherlands
Title
Echocardiographic findings associated with mortality or transplant in
patients with pulmonary arterial hypertension: A systematic review and
meta-analysis.
Source
Netherlands Heart Journal. 24 (6) (pp 374-389), 2016. Date of Publication:
June 2016.
Publisher
Bohn Stafleu van Loghum
Abstract
Background Identification of patients at risk of deterioration is
essential to guide clinical management in pulmonary arterial hypertension
(PAH). This study aims to provide a comprehensive overview of
well-investigated echocardiographic findings that are associated with
clinical deterioration in PAH. Methods MEDLINE and EMBASE databases were
systematically searched for longitudinal studies published by April 2015
that reported associations between echocardiographic findings and
mortality, transplant or clinical worsening. Meta-analysis using random
effect models was performed for echocardiographic findings investigated by
four or more studies. In case of statistical heterogeneity a sensitivity
analysis was conducted. Results Thirty-seven papers investigating 51
echocardiographic findings were included. Meta-analysis of univariable
hazard ratios (HRs) and sensitivity analysis showed that presence of
pericardial effusion (pooled HR 1.70; 95% CI 1.44-1.99), right atrial area
(pooled HR 1.71; 95% CI 1.38-2.13) and tricuspid annular plane systolic
excursion (TAPSE; pooled HR 1.72; 95% CI 1.34-2.20) were the most
well-investigated and robust predictors of mortality or transplant.
Conclusions This meta-analysis substantiates the clinical yield of
specific echocardiographic findings in the prognostication of PAH patients
in day-to-day practice. In particular, pericardial effusion, right atrial
area and TAPSE are of prognostic value.

<20>
Accession Number
20160490036
Author
Lai V.K.W.; Lee A.; Leung P.; Chiu C.H.; Ho K.M.; Gomersall C.D.;
Underwood M.J.; Joynt G.M.
Institution
(Lai, Lee, Leung, Chiu, Ho, Gomersall, Joynt) Department of Anaesthesia
and Intensive Care, Chinese University of Hong Kong, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, Hong Kong
Title
Patient and family satisfaction levels in the intensive care unit after
elective cardiac surgery: study protocol for a randomised controlled trial
of a preoperative patient education intervention.
Source
BMJ Open. 6 (6) (no pagination), 2016. Article Number: e011341. Date of
Publication: 01 Jun 2016.
Publisher
BMJ Publishing Group
Abstract
Introduction Patients and their families are understandably anxious about
the risk of complications and unfamiliar experiences following cardiac
surgery. Providing information about postoperative care in the intensive
care unit (ICU) to patients and families may lead to lower anxiety levels,
and increased satisfaction with healthcare. The objectives of this study
are to evaluate the effectiveness of preoperative patient education
provided for patients undergoing elective cardiac surgery. Methods and
analysis 100 patients undergoing elective coronary artery bypass graft,
with or without valve replacement surgery, will be recruited into a
2-group, parallel, superiority, double-blinded randomised controlled
trial. Participants will be randomised to either preoperative patient
education comprising of a video and ICU tour with standard care
(intervention) or standard education (control). The primary outcome
measures are the satisfaction levels of patients and family members with
ICU care and decision-making in the ICU. The secondary outcome measures
are patient anxiety and depression levels before and after surgery. Ethics
and dissemination Ethical approval has been obtained from the Joint
Chinese University of Hong Kong - New Territories East Cluster Clinical
Research Ethics Committee (reference number CREC 2015.308). The findings
will be presented at conferences and published in peer-reviewed journals.
Study participants will receive a 1-page plain language summary of
results.

<21>
Accession Number
20160468181
Author
Liu T.; Korantzopoulos P.; Shao Q.; Zhang Z.; Letsas K.P.; Li G.
Institution
(Liu, Shao, Zhang, Li) Tianjin Key Laboratory of Ionic-Molecular Function
of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital, Tianjin Medical University, No. 23 Pingjiang
Road, Hexi District, Tianjin 300211, China
(Korantzopoulos) First Department of Cardiology, University of Ioannina,
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
Title
Mineralocorticoid receptor antagonists and atrial fibrillation: A
meta-analysis.
Source
Europace. 18 (5) (pp 672-678), 2016. Date of Publication: 24 May 2016.
Publisher
Oxford University Press
Abstract
Aims Aldosterone has been implicated in atrial remodelling representing a
potential target for upstream therapies. Accumulating evidence suggests
that mineralocorticoid receptor blockade may have favourable effects on
atrial fibrillation (AF) development, although some controversial results
have been published. We, therefore, conducted a meta-analysis of
randomized clinical trials (RCTs) and observational studies in order to
examine the protective role of mineralocorticoid receptor antagonists
(MRAs) on AF. Methods and results Of the 1337 initially identified
records, 3 RCTs and 2 observational studies with 3640 patients were
finally analysed. The pooled analysis of the included studies demonstrated
that patients treated with MRAs have 31% lower risk of AF compared with
controls [relative ratio (RR): 0.69; 95% confidence interval (CI):
0.58-0.83] without any heterogeneity across the studies (I² =
0%). This effect was consistent across RCTs (RR: 0.72; 95% CI: 0.55-0.94)
and observational studies (RR: 0.67; 95% CI: 0.53-0.84) without
heterogeneity. Also, MRAs reduce the risk of AF in both heart failure (HF)
(RR: 0.63; 95% CI: 0.50-0.80) and after cardiac surgery (RR: 0.77; 95% CI:
0.61-0.98). Analysing the relative impact of eplerenone and
spironolactone, we showed that only eplerenone significantly reduces AF
burden (RR: 0.64; 95% CI: 0.44-0.90). Conclusion Our meta-analysis
suggests that MRAs may be effective in AF prevention especially in the HF
setting. However, there are insufficient data for the widespread use of
aldosterone antagonists solely for AF prevention. Larger RCTs with
long-term follow-up in different clinical settings are needed to clarify
the impact of MRAs on AF.

<22>
Accession Number
20160474314
Author
Somberg J.C.; Molnar J.
Institution
(Somberg) Department of Medicine, Pharmacology Rush University, Chicago,
IL, United States
(Molnar) American Institute of Therapeutics, Lake Bluff, IL, United States
Title
Sotalol versus amiodarone in treatment of atrial fibrillation.
Source
Journal of Atrial Fibrillation. 8 (5) (pp 6-12), 2016. Date of
Publication: February-March 2016.
Publisher
CardioFront LLC
Abstract
The availability of intravenous (IV) Sotalol has equalized the treatment
options since both amiodarone and sotalol are available in both IV and
oral formulations. A review of the efficacy of sotalol as compared to
amiodarone both for conversion of atrial fibrillation (AF) and maintenance
of normal sinus rhythm (NSR) following cardiac surgery was undertaken.
Standard methods of meta-analysis were employed. Full text publications of
clinical trials written in English that compared the efficacy of sotalol
to amiodarone were included in the analysis. For the conversion of AF to
NSR, five studies were found eligible for the analysis. Two studies
clinically compared sotalol to amiodarone for the maintenance of NSR after
cardiac surgery. The common relative success of sotalol was 0.947 (95Cl:
0.837 to 1.071, P = 0.385), revealing essentially no differences in
efficacy for conversion between amiodarone and sotalol. The average
conversion rate was 47% with sotalol and 52% with amiodarone. The
conversion rates were lower for persistent AF (sotalol 22% and amiodarone
27%), while greatest for recent onset AF (88% sotalol and 77% for
amiodarone). The risk of developing post-operative atrial fibrillation was
practically the same in both regimes, relative risk = 1.214 (95% CI:
0.815-1.808, p=0.339). In summary, sotalol and amiodarone are equally
effective in AF conversion and maintenance of NSR post-cardiac surgery.

<23>
Accession Number
20160471815
Author
Wang D.; Yang X.-L.; Chai X.-Q.; Shu S.-H.; Zhang X.-L.; Xie Y.-H.; Wei
X.; Wu Y.-J.; Wei W.
Institution
(Wang, Yang, Chai, Shu, Zhang, Xie, Wei) Department of Anesthesiology,
Affiliated Provincial Hospital of Anhui Medical University, Anhui
Provincial Hospital, Hefei 230001, China
(Wu, Wei) Institute of Clinical Pharmacology, Anhui Medical University,
Hefei 230032, China
Title
A short-term increase of the postoperative naturally circulating dendritic
cells subsets in flurbiprofen-treated patients with esophageal carcinoma
undergoing thoracic surgery.
Source
Oncotarget. 7 (14) (pp 18705-18712), 2016. Date of Publication: 2016.
Publisher
Impact Journals LLC
Abstract
The present study evaluated whether flurbiprofen increased the naturally
circulating dendritic cells (DCs) subsets in patients with esophageal
squamous cell carcinoma (ESCC) undergoing esophageal resection. Compared
to healthy donors (n=20), the significantly depressed percentages of
plasmacytoid DCs (pDCs), CD1c⁺ myeloid DCs (mDCs), and
CD141⁺ mDCs among ESCC patients (n=60) were confirmed.
Flurbiprofen was administered before skin incision and at the end of
operation in group F (n=30), as well as placebo in group C (n=30). The
postoperative suppressed percentages of pDCs, CD1c⁺ mDCs, and
CD141⁺ mDCs increased significantly following the perioperative
treatment with flurbiprofen. Flurbiprofen also significantly stimulated
the postoperative IFN-gamma and IL-17 production, but inhibited the
immunosuppressive IL-10 and TGF-beta levels. Furthermore, flurbiprofen
exerted a similar analgesic effect and brought a significantly less
sufentanil consumption compared to group C. Taken together, flurbiprofen
provided a short-term increase of postoperative naturally circulating DCs
in ESCC patients.

<24>
Accession Number
20160353759
Author
Bussieres J.S.; Somma J.; del Castillo J.L.C.; Lemieux J.; Conti M.;
Ugalde P.A.; Gagne N.; Lacasse Y.
Institution
(Bussieres, Somma, del Castillo, Lemieux) Department of Anesthesiology,
IUCPQ-UL, Quebec City, QC, Canada
(Conti, Ugalde) Department of Thoracic Surgery, IUCPQ-UL, Quebec City, QC,
Canada
(Bussieres, Gagne) Research Centre, IUCPQ-UL, Quebec City, QC, Canada
(Lacasse) Pneumology Center, IUCPQ-UL, Quebec City, QC, Canada
(Bussieres) Institut universitaire de cardiologie et de pneumologie de
Quebec - Universite Laval, 2725, Chemin Sainte-Foy, Quebec City, QC G1V
4G5, Canada
Title
Bronchial blocker versus left double-lumen endotracheal tube in
video-assisted thoracoscopic surgery: a randomized-controlled trial
examining time and quality of lung deflation.
Source
Canadian Journal of Anesthesia. 63 (7) (pp 818-827), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Springer New York LLC
Abstract
Introduction: Double-lumen endotracheal tubes (DL-ETT) and bronchial
blockers (BB) have both been used for lung isolation in video-assisted
thoracic surgery (VATS). Though not well studied, it is widely thought
that a DL-ETT provides faster and better quality lung collapse. The aim of
this study was to compare a BB technique vs a left-sided DL-ETT strategy
with regard to the time and quality of lung collapse during one-lung
ventilation (OLV) for elective VATS. Methods: Forty patients requiring OLV
for VATS were randomized to receive a BB (n = 20) or a left-sided DL-ETT
(n = 20). The primary endpoint was the time from pleural opening
(performed by the surgeon) until complete lung collapse. The time was
evaluated offline by reviewing video recorded during the VATS. The quality
of lung deflation was also graded offline using a visual scale (1 = no
lung collapse; 2 = partial lung collapse; and 3 = total lung collapse) and
was recorded at several time points after pleural incision. The surgeon
also graded the time to complete lung collapse and quality of lung
deflation during the procedure. The surgeon's guess as to which device was
used for lung isolation was also recorded. Results: Of the 40 patients
enrolled in the study, 20 patients in the DL-ETT group and 18 in the BB
group were analyzed. There mean (standard deviation) time to complete lung
collapse of the operative lung was significantly faster using the BB
compared with using the DL-ETT [7.5 (3.8) min vs 36.6 (29.1) min,
respectively; mean difference, 29.1 min; 95% confidence interval, 1.8 to
7.2; P < 0.001]. Overall, a higher proportion of patients in the BB group
than in the DL-ETT group achieved a quality of lung collapse score of 3 at
five minutes (57% vs 6%, respectively; P < 0.004), ten minutes (73% vs
14%, respectively; P = 0.005), and 20 min (100% vs 25%, respectively; P =
0.002) after opening the pleura. The surgeon incorrectly guessed the type
of device used in 78% of the BB group and 50% of the DL-ETT group (P =
0.10). Conclusion: The time and quality of lung collapse during OLV for
VATS was significantly better when using a BB than when using a left-sided
DL-ETT. Surgeons could not reliably determine which device was being used
based on the time and quality of lung collapse. This trial was registered
at ClinicalTrials.gov number, NCT01615263.

<25>
Accession Number
20160468652
Author
Abdelnoor M.; Vengen O.A.; Johansen O.; Sandven I.; Abdelnoor A.M.
Institution
(Abdelnoor) Centre for Clinical Heart Research, Department of Cardiology,
Oslo University Hospital, Oslo, Norway
(Abdelnoor, Sandven) Oslo Centre for Biostatistics and Epidemiology, Oslo
University Hospital, Oslo, Norway
(Vengen) Department of Cardiovascular Surgery, Oslo University Hospital,
Oslo, Norway
(Johansen) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
(Abdelnoor) Department of Experimental Pathology, Immunology and
Microbiology, American University of Beirut, Beirut, Lebanon
Title
Latitude of the study place and age of the patient are associated with
incidence of mediastinitis and microbiology in open-heart surgery: A
systematic review and meta-analysis.
Source
Clinical Epidemiology. 8 (pp 151-163), 2016. Date of Publication: 02 Jun
2016.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand)
Abstract
Objective: We aimed to summarize the pooled frequency of mediastinitis
following open-heart surgery caused by Gram-positive bacteria, including
methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative
bacteria. Design: This study was a systematic review and a meta-analysis
of prospective and retrospective cohort studies. Materials and methods: We
searched the literature, and a total of 97 cohort studies were identified.
Random-effect model was used to synthesize the results. Heterogeneity
between studies was examined by subgroup and meta-regression analyses,
considering study and patient-level variables. Small-study effect was
evaluated. Results: Substantial heterogeneity was present. The estimated
incidence of mediastinitis evaluated from 97 studies was 1.58% (95%
confidence intervals [CI] 1.42, 1.75) and that of Gram-positive bacteria,
Gram-negative bacteria, and MRSA bacteria evaluated from 63 studies was
0.90% (95% CI 0.81, 1.21), 0.24% (95% CI 0.18, 0.32), and 0.08% (95% CI
0.05, 0.12), respectively. A meta-regression pinpointed negative
association between the frequency of mediastinitis and latitude of study
place and positive association between the frequency of mediastinitis and
the age of the patient at operation. Multivariate meta-regression showed
that prospective cohort design and age of the patients and latitude of
study place together or in combination accounted for 17% of heterogeneity
for end point frequency of mediastinitis, 16.3% for Gram-positive
bacteria, 14.7% for Gram-negative bacteria, and 23.3% for MRSA bacteria.
Conclusion: Evidence from this study suggests the importance of latitude
of study place and advanced age as risk factors of mediastinitis. Latitude
is a marker of thermally regulated bacterial virulence and other local
surgical practice. There is concern of increasing risk of mediastinitis
and of MRSA in elderly patients undergoing sternotomy.

<26>
Accession Number
20160166856
Author
Narayanan M.A.; Haddad T.M.; Kalil A.C.; Kanmanthareddy A.; Suri R.M.;
Mansour G.; Destache C.J.; Baskaran J.; Mooss A.N.; Wichman T.; Morrow L.;
Vivekanandan R.
Institution
(Narayanan, Haddad, Mansour) Department of Internal Medicine, Creighton
University School of Medicine, Omaha, Nebraska 68154, United States
(Kalil) Division of Infectious Diseases, University of Nebraska School of
Medicine, Omaha, Nebraska, United States
(Kanmanthareddy, Mooss) Division of Cardiology, Creighton University
School of Medicine, Omaha, Nebraska, United States
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Destache) School of Pharmacy and Health Professions and School of
Medicine, Creighton University, Omaha, Nebraska, United States
(Baskaran) University of Texas Southwestern at Dallas, Dallas, Texas,
United States
(Wichman, Morrow) Division of Pulmonary Critical Care and Sleep Medicine,
Creighton University School of Medicine, Omaha, Nebraska, United States
(Vivekanandan) Division of Infectious Diseases, Creighton University
School of Medicine, Omaha, Nebraska, United States
Title
Early versus late surgical intervention or medical management for
infective endocarditis: A systematic review and meta-analysis.
Source
Heart. 102 (12) (pp 950-957), 2016. Date of Publication: 15 Jun 2016.
Publisher
BMJ Publishing Group
Abstract
Objective Infective endocarditis is associated with high morbidity and
mortality and optimal timing for surgical intervention is unclear. We
performed a systematic review and meta-analysis to compare early surgical
intervention with conservative therapy in patients with infective
endocarditis. Methods PubMed, Cochrane, EMBASE, CINAHL and Google-scholar
databases were searched from January 1960 to April 2015. Randomised
controlled trials, retrospective cohorts and prospective observational
studies comparing outcomes between early surgery at 20 days or less and
conservative management for infective endocarditis were analysed. Results
A total of 21 studies were included. OR of allcause mortality for early
surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and
0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups
(matched for baseline variables). For patients who had surgical
intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI
0.39 to 0.96, p=0.034) and in those who had surgical intervention within
8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003)
compared with conservative management. In propensity-matched groups, the
OR of mortality in patients with surgical intervention at 7 days or less
was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients
who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72,
p<0.001). There was no significant difference in in-hospital mortality,
embolisation, heart failure and recurrence of endocarditis between the
overall unmatched cohorts. Conclusion The results of our meta-analysis
suggest that early surgical intervention is associated with significantly
lower risk of mortality in patients with infective endocarditis.

<27>
Accession Number
20160042564
Author
Sabzi F.; Faraji R.
Institution
(Sabzi, Faraji) Preventive Cardiovascular Research Centre Kermanshah,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
Title
The effect of magnesium sulfate on post off-pump coronary artery bypass
grafting bleeding.
Source
Indian Heart Journal. 68 (3) (pp 349-354), 2016. Date of Publication: 01
May 2016.
Publisher
Elsevier
Abstract
Background Magnesium level alteration may cause coagulation abnormality
resulting in bleeding complication after off-pump coronary artery bypass
grafting. In this study, we investigated the effect of magnesium on the
postoperative coagulation profile and bleeding in OPCAB patients. Methods
In a double blind clinical trial, six hundred patients were randomly
allocated to two groups: group A (n = 150) and group B (n = 450). Group A
received 50 mg/kg of magnesium sulfate (MS) in 100 ml 0.9% NaCl solution
over 20 min before the anesthesia induction. Group B or control group
received only 100 ml 0.9% NaCl solution at the same time points. OPCAB was
performed with standard technique and device. Blood samples were collected
30 min before and 6 h after the surgery to analyze hemoglobin and blood
coagulation tests. Postoperative exploration for bleeding, blood
transfusion, and volume of transfusion was recorded. The two groups
compared with t-test and chi² tests and p-valve <0.05 were
considered as significant. Results However, postoperative hemoglobin was
statistically lower in group A compared with group B, but platelet, PT,
and aPTT tests were not statistically different between two groups. The
serum MS level, exploration for bleeding, volume of packed cell
transfusion, and volume of postoperative bleeding were statistically
different between group A vs group B. Conclusion Preoperative MS use may
be associated with the postoperative platelet dysfunction and increased
tendency to bleeding. This is an important risk factor for postoperative
bleeding in the OPCAB in absence of CPB use.

<28>
Accession Number
20160461432
Author
Hartman J.E.; Klooster K.; Slebos D.-J.; Ten Hacken N.H.T.
Institution
(Hartman, Klooster, Slebos, Ten Hacken) Department of Pulmonary Diseases,
University of Groningen, University Medical Center Groningen, PO Box
30001, Groningen 9700 RB, Netherlands
(Hartman, Klooster, Slebos, Ten Hacken) Groningen Research Institute for
Asthma and COPD, University of Groningen, University Medical Center
Groningen, PO Box 30001, Groningen 9700 RB, Netherlands
Title
Improvement of physical activity after endobronchial valve treatment in
emphysema patients.
Source
Respiratory Medicine. 117 (pp 116-121), 2016. Date of Publication: 01 Aug
2016.
Publisher
W.B. Saunders Ltd
Abstract
Rationale Bronchoscopic lung volume reduction using endobronchial valves
is a promising treatment for severe emphysema patients without collateral
ventilation. Physical activity is an important contributing factor for the
autonomy, morbidity and mortality of these patients. Objective We
investigated the impact of endobronchial valve treatment on physical
activity in severe emphysema patients. Methods Physical activity was
measured for 7 days by a triaxial accelerometer at baseline and 6 months
follow-up after EBV treatment, and compared with standard medical care in
a randomized controlled trial. Results Forty-three patients (77%female,
age 59 +/- 9years, FEV<inf>1</inf> 30 +/- 7%pred, steps 3563 +/-
2213per/day) wore the accelerometer and were included in the analysis.
Nineteen patients received EBV treatment and 24 standard medical care. At
baseline, physical activity level was comparable between groups. After 6
months, the endobronchial valve group significantly improved compared to
the controls in steps/day (+1252vs-148) and locomotion time (+17vs-2
min/day). Change in sit duration (0vs + 27 min/day) did not significantly
differ. Conclusions Physical activity significantly improved after
endobronchial valve treatment in severe emphysema patients. This
improvement was without any specific encouragement on physical activity.
Clinical trial number Dutch trial register: NTR2876.

<29>
Accession Number
20160469063
Author
Patel H.C.; Rosen S.D.; Hayward C.; Vassiliou V.; Smith G.C.; Wage R.R.;
Bailey J.; Rajani R.; Lindsay A.C.; Pennell D.J.; Underwood S.R.; Prasad
S.K.; Mohiaddin R.; Gibbs J.S.R.; Lyon A.R.; Di Mario C.
Institution
(Patel, Hayward, Vassiliou, Smith, Wage, Bailey, Lindsay, Pennell,
Underwood, Prasad, Mohiaddin, Lyon, Di Mario) Royal Brompton Hospital,
London, United Kingdom
(Rosen) Ealing Hospital, Southall, London, United Kingdom
(Rajani) Guys and St Thomas' Hospital, London, United Kingdom
(Gibbs) Hammersmith Hospital, London, United Kingdom
Title
Renal denervation in heart failure with preserved ejection fraction
(RDT-PEF): a randomized controlled trial.
Source
European Journal of Heart Failure. 18 (6) (pp 703-712), 2016. Date of
Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aim: Heart failure with preserved ejection fraction (HFpEF) is associated
with increased sympathetic nervous system (SNS) tone. Attenuating the SNS
with renal denervation (RDT) might be helpful and there are no data
currently in humans with HFpEF. Methods and results: In this
single-centre, randomized, open-controlled study we included 25 patients
with HFpEF [preserved left ventricular (LV) ejection fraction, left atrial
(LA) dilatation or LV hypertrophy and raised B-type natriuretic peptide
(BNP) or echocardiographic assessment of filling pressures]. Patients were
randomized (2:1) to RDT with the SymplicityTM catheter or continuing
medical therapy. The primary success criterion was not met in that there
were no differences between groups at 12 months for Minnesota Living with
Heart Failure Questionnaire score, peak oxygen uptake (VO<inf>2</inf>) on
exercise, BNP, E/e', LA volume index or LV mass index. A greater
proportion of patients improved at 3 months in the RDT group with respect
to VO<inf>2</inf> peak (56% vs. 13%, P = 0.025) and E/e' (31% vs. 13%, P =
0.04). Change in estimated glomerular filtration rate was comparable
between groups. Two patients required plain balloon angioplasty during the
RDT procedure to treat renal artery wall oedema. Conclusion: This study
was terminated early because of difficulties in recruitment and was
underpowered to detect whether RD improved the endpoints of quality of
life, exercise function, biomarkers, and left heart remodelling. The
procedure was safe in patients with HFpEF, although two patients did
require intraprocedure renal artery dilatation.

<30>
Accession Number
20160463507
Author
Dominguez A.C.; Bittl J.A.; El-Hayek G.; Contreras E.; Tamis-Holland J.E.
Institution
(Dominguez, El-Hayek, Tamis-Holland) Mount Sinai Saint Luke's-Roosevelt
Hospital, New York, NY, United States
(Bittl) Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL,
United States
(Contreras) Instituto Tecnologico De Santo Domingo, Santo Domingo,
Dominican Republic
Title
Meta-analysis of randomized controlled trials comparing percutaneous
coronary intervention with aspiration thrombectomy Vs. Conventional
percutaneous coronary intervention during ST-segment elevation myocardial
infarction.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1203-1210),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Evaluate the impact of aspiration thrombectomy (AT) during
primary coronary intervention (PCI) for ST-segment elevation myocardial
infarction (STEMI) on clinical outcomes. Background: AT during PCI for
STEMI may improve microvascular reperfusion, but its impact on clinical
outcomes has remained controversial. Methods: We searched Pubmed, EMBASE,
Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31,
2015 for randomized controlled trials that evaluated the use of AT with
PCI compared with PCI alone for STEMI. The primary end point was all-cause
mortality. Secondary end points included major adverse cardiac events
(MACE, consisting of death, myocardial infarction, and target-vessel
revascularization), recurrent myocardial infarction (MI), target-vessel
revascularization (TVR), stent thrombosis and stroke. Results: Eighteen
randomized controlled trials (n = 21,501) fulfilled the inclusion
criteria. A total of 10,544 patients were treated with AT and PCI,
compared to 10,957 control patients. The use of AT was not associated with
a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01;
P = 0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P = 0.06), recurrent MI (RR
0.97: 95% CI 0.81-1.17; P = 0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P =
0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P = 0.17), or stroke
(RR 1.35; 95% CI 0.86-2.11; P = 0.19). Conclusions: Using the totality of
evidence available through 2015, this meta-analysis failed to show that
the routine use of aspiration thrombectomy in patients with ST-elevation
myocardial infarction significantly reduces all-cause mortality, MACE,
recurrent MI, TVR, or stent thrombosis. The role of aspiration
thrombectomy in selected patients with angiographic evidence of large
thrombus burden requires further clinical investigation. &#xa9; 2015 Wiley
Periodicals, Inc.

<31>
Accession Number
20160463497
Author
Vos N.S.; van der Schaaf R.J.; Amoroso G.; Herrman J.-P.R.; Patterson
M.S.; Slagboom T.; Vink M.A.
Institution
(Vos, van der Schaaf, Amoroso, Herrman, Patterson, Slagboom, Vink)
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam,
Netherlands
Title
REVascularization with paclitaxEL-coated balloon angioplasty versus
drug-eluting stenting in acute myocardial infarcTION-A randomized
controlled trial: Rationale and design of the REVELATION trial.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1213-1221),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: In primary percutaneous coronary intervention (PPCI) for ST-elevation
myocardial infarction (STEMI), stenting has proved to reduce the need for
repeat revascularization compared with balloon angioplasty alone. The
incidence of cardiac death or recurrent myocardial infarction, though, is
not reduced by stenting. This is in part attributable to stent-related
complications like stent thrombosis which may occur even years after
implantation. A strategy of drug coated balloon (DCB) angioplasty without
stenting would abolish the potential disadvantages of stent implantation
while reducing the probability of restenosis observed in plain old balloon
angioplasty. Our aim is to evaluate the efficacy and safety of a DCB only
strategy versus drug-eluting stents (DES) in PPCI for STEMI. Study design:
The REVELATION trial is a prospective, single center, randomized study, in
which 120 patients presenting with STEMI will be allocated to treatment
with a DCB versus DES. Appertaining to the established prognostic value of
fractional flow reserve (FFR) rather than angiographic lesion severity,
the functional assessment of the infarct-related lesion by FFR at 9 months
after initial treatment is the primary end point. Assuming an FFR value of
0.90 after stenting and an increased risk of adverse events if post-PCI
FFR <0.85, we decided to accept an FFR value of >0.85 after DCB only at
follow-up as noninferiority margin. Secondary end points include major
adverse cardiac events up to 5-year follow-up. Conclusion: Our trial will
address the efficacy and safety of DCB angioplasty versus DES in the
setting of PPCI for STEMI. The REVELATION trial will introduce the
recognized prognostic significance of physiologic assessment of the
infarct-related lesion by FFR at 9 months follow-up as primary end point.
&#xa9; 2015 Wiley Periodicals, Inc.

<32>
Accession Number
20160463496
Author
Genereux P.; Kini A.; Lesiak M.; Kumsars I.; Fontos G.; Slagboom T.; Ungi
I.; Metzger D.C.; Wykrzykowska J.J.; Stella P.R.; Bartorelli A.L.; Fearon
W.F.; Lefevre T.; Feldman R.L.; Tarantini G.; Bettinger N.; Minalu Ayele
G.; LaSalle L.; Francese D.P.; Onuma Y.; Grundeken M.J.; Garcia-Garcia
H.M.; Laak L.L.; Cutlip D.E.; Kaplan A.V.; Serruys P.W.; Leon M.B.
Institution
(Genereux, Bettinger, Leon) Columbia University Medical Center/NewYork
Presbyterian Hospital, New York, NY, United States
(Genereux, Bettinger, Minalu Ayele, LaSalle, Francese, Leon)
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Hopital Du Sacre-Coeur De Montreal, Universite De Montreal,
Montreal, QC, Canada
(Kini) Mount Sinai Medical Center, New York, NY, United States
(Lesiak) 1st Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Kumsars) Latvian Center of Cardiology, Paul Stradins Clinical University
Hospital, Riga, Latvia
(Fontos) Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
(Slagboom) Department of Cardiology, OLVG, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Ungi) 2nd Department of Medicine and Cardiology Center Medical Faculty,
Albert Szent-Gyorgyi Clinical Center, University of Szeged- Department of
Cardiology, Szeged, Hungary
(Metzger) Wellmont CVA Heart Institute, Kingsport, TN, United States
(Wykrzykowska, Grundeken) Department of Cardiology, Academic Medical
Center, Amsterdam, Netherlands
(Stella) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Bartorelli) Centro Cardiologico Monzino, University of Milan, Milan,
Italy
(Fearon) Division of Cardiovascular Medicine, Stanford University Medical
Center, Stanford, CA, United States
(Lefevre) Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
(Feldman) MediQuest Research Group, Ocala, FL, United States
(Tarantini) Azienda Ospedaliera Di Padova, Padova, Italy
(Onuma, Garcia-Garcia, Serruys) Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Laak, Kaplan) Tryton Medical Inc., Durham, NC, United States
(Cutlip) Harvard Clinical Research Institute, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Kaplan) Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
Title
Outcomes of a dedicated stent in coronary bifurcations with large side
branches: A subanalysis of the randomized TRYTON bifurcation study.
Source
Catheterization and Cardiovascular Interventions. 87 (7) (pp 1231-1241),
2016. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To examine the benefit of the Tryton dedicated side branch
(SB) stent compared with provisional stenting in the treatment of complex
bifurcation lesions involving large SBs. Background: The TRYTON Trial was
designed to evaluate the utility of a dedicated SB stent to treat true
bifurcation lesions involving large (>2.5 mm by visual estimation) SBs.
Patient enrolled in the trial had smaller SB diameters than intended (59%
SB <2.25 mm by Core Lab QCA). The TRYTON Trial did not meet its primary
endpoint due to an increased rate of peri-procedural myocardial
infarctions (MIs). Methods: The TRYTON Trial randomized 704 patients to
the Tryton SB stent with main vessel DES versus provisional SB treatment
with main vessel DES. The rates of the primary end point of target vessel
failure and the secondary powered end point of angiographic percent
diameter stenosis in the SB at 9 months were assessed and compared between
the two treatment strategies among patients with a SB >2.25 mm diameter at
baseline determined by Core Lab QCA. Results: Among the 704 patients
enrolled in the TRYTON Trial, 289 patients (143 provisional and 146 Tryton
stent; 41% of entire cohort) had a SB >2.25 mm. The primary end point of
TVF was numerically lower in the Tryton group compared with the
provisional group (11.3% vs. 15.6%, P = 0.38), and was within the
non-inferiority margin. No difference among the rates of clinically driven
target vessel revascularization (3.5% vs. 4.3% P = 0.77) or cardiac death
(0% both groups) were seen. In-segment percent diameter stenosis of the SB
was significantly lower in the Tryton group compared with the provisional
group (30.4% vs. 40.6%, P = 0.004). Conclusions: Analysis of the TRYTON
Trial cohort of SB >2.25 mm supports the safety and efficacy of the Tryton
SB stent compared with a provisional stenting strategy in the treatment of
bifurcation lesions involving large SBs. &#xa9; 2015 Wiley Periodicals,
Inc.

<33>
Accession Number
20160369123
Author
Giustino G.; Mehran R.; Bansilal S.; Feit F.; Lincoff M.; Deliargyris
E.N.; Kirtane A.J.; Genereux P.; Redfors B.; Prats J.; Bernstein D.;
Brener S.J.; Skerjanec S.; Lansky A.J.; Francese D.P.; Dangas G.D.; Stone
G.W.
Institution
(Giustino, Mehran, Bansilal, Dangas) Interventional Cardiovascular
Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Mehran, Kirtane, Genereux, Redfors, Francese, Dangas, Stone) Clinical
Trials Center, Cardiovascular Research Foundation, New York, NY, United
States
(Feit) Department of Cardiology, New York University Medical Center, New
York, NY, United States
(Lincoff) Department of Medicine, Cleveland Clinic, Lerner College of
Medicine of Case Western Reserve University, Cleveland, OH, United States
(Deliargyris, Prats, Bernstein, Skerjanec) Medicines Company, Parsippany,
NJ, United States
(Kirtane, Genereux, Stone) Division of Cardiology, NewYork-Presbyterian
Hospital, Columbia University Medical Center, New York, NY, United States
(Genereux) Department of Cardiology, Hopital du Sacre-Coeur de Montreal,
Montreal, QC, Canada
(Brener) Department of Medicine, New York Methodist Hospital, Brooklyn,
NY, United States
(Lansky) Division of Cardiology, Yale University School of Medicine, New
Haven, CT, United States
Title
Safety and efficacy of bivalirudin in patients with diabetes mellitus
undergoing percutaneous coronary intervention: From the REPLACE-2, ACUITY
and HORIZONS-AMI trials.
Source
American Journal of Cardiology. 118 (1) (pp 6-16), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier Inc.
Abstract
Optimal antithrombotic pharmacotherapy in patients affected by diabetes
mellitus (DM) undergoing percutaneous coronary intervention is unclear. We
sought to evaluate the safety and efficacy of bivalirudin compared with
heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) in patients with DM
undergoing percutaneous coronary intervention. We pooled patient-level
data from the Randomized Evaluation of PCI Linking Angiomax to Reduced
Clinical Events-2, Acute Catheterization and Urgent Intervention Triage
strategy, and Harmonizing Outcomes with Revascularization and Stents in
Acute Myocardial Infarction trials. The primary efficacy end point was the
incidence of major adverse cardiac events, defined as the composite of
death, myocardial infarction, or unplanned revascularization at 30 days.
The primary safety end point was the incidence of 30-day non-coronary
artery bypass graft-related major bleeding. All-cause mortality was
reported at 30 days and 1 year. Of the 14,737 patients included in the
pooled database, 3,641 (24.7%) had DM. Patients with DM had higher rates
of 30-day major bleeding and 30-day and 1-year all-cause mortality. There
were no differences in 30-day major adverse cardiac events between
bivalirudin versus heparin plus GPI in patients with DM (6.9% vs 7.8%;
relative risk [RR] 0.89, 95% CI 0.71 to 1.12) or without DM (7.5% vs 6.7%;
RR 1.11, 95% CI 0.97 to 1.27; p<inf>interaction</inf> = 0.10). Bivalirudin
treatment was associated with reduced risk of major bleeding in similar
magnitude in patients with DM (4.3% vs 6.6% RR 0.68, 95% CI 0.51 to 0.89)
or without DM (3.2% vs 6.1%; RR 0.51, 95% CI 0.43 to 0.61;
p<inf>interaction</inf> = 0.15). The hemorrhagic benefit of bivalirudin
was noted for both access site- and non-access site-related bleeding.
Overall, bivalirudin treatment was associated with a significant 1-year
mortality benefit (2.7% vs 3.3%; RR 0.82, 95% CI 0.68 to 0.98; p = 0.03),
which was consistent between patients with or without DM
(p<inf>interaction</inf> = 0.30). In conclusion, compared with heparin
plus GPI, bivalirudin was associated with similar 30-day antithrombotic
efficacy and better 30-day freedom from bleeding and 1-year mortality,
irrespective of diabetic status.

<34>
Accession Number
20160368997
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Zeng
Y.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys
P.W.; Park S.-J.
Institution
(Chang, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Department of
Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Zeng, Serruys) Thoraxcenter, Erasmus University
Medical Center, Rotterdam, Netherlands
(Sotomi) Heart Center, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Serruys) International Center for Circulatory Health, Imperial College of
London, London, United Kingdom
Title
Coronary artery bypass grafting versus drug-eluting stents implantation
for previous myocardial infarction.
Source
American Journal of Cardiology. 118 (1) (pp 17-22), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier Inc.
Abstract
Patients with previous myocardial infarction (MI) have a high risk of
recurrence. Little is known about the effectiveness of coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention (PCI)
with drug-eluting stents (DES) in patients with a previous MI and left
main or multivessel coronary artery disease (CAD). We compared long-term
outcomes of these 2 strategies in 672 patients with previous MI and left
main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n =
323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was
analyzed, and the primary outcome was a composite of death from any
causes, MI, or stroke. Baseline characteristics were similar between the 2
groups. The median follow-up duration was 59.8 months. The rate of the
primary outcome was significantly lower with CABG than PCI (hazard ratio
[HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by
a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p
<0.001). The benefit of CABG over PCI was consistent across all major
subgroups. The individual risks of death from any causes or stroke were
comparable between the 2 groups. Conversely, the rate of repeat
revascularization was significantly lower with CABG than PCI (HR 0.34, 95%
CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous
MI and left main or multivessel CAD, compared to PCI with DES, CABG
significantly reduces the risk of death from any causes, MI, or stroke.

<35>
Accession Number
20160340972
Author
Nikrahan G.R.; Laferton J.A.C.; Asgari K.; Kalantari M.; Abedi M.R.;
Etesampour A.; Rezaei A.; Suarez L.; Huffman J.C.
Institution
(Nikrahan, Asgari, Kalantari) Department of Psychology, University of
Isfahan, Isfahan, Iran, Islamic Republic of
(Nikrahan) Department of Psychology, Islamic Azad University of Borujen,
Borujen, Iran, Islamic Republic of
(Laferton) Department of Psychiatry, Brigham and Women's Hospital, Boston,
MA, United States
(Laferton, Suarez, Huffman) Department of Psychiatry, Harvard Medical
School, Boston, MA, United States
(Abedi) Department of Consulting, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Etesampour) Department of Internal Medicine, Najafabad Islamic Azad
University, Najafabad, Iran, Islamic Republic of
(Rezaei) Department of Immunology, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Suarez, Huffman) Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, United States
Title
Effects of Positive Psychology Interventions on Risk Biomarkers in
Coronary Patients: A Randomized, Wait-List Controlled Pilot Trial.
Source
Psychosomatics. 57 (4) (pp 359-368), 2016. Date of Publication: 01 Jul
2016.
Publisher
Elsevier Inc.
Abstract
Background: Among cardiac patients, positive psychologic factors are
consistently linked with superior clinical outcomes and improvement in key
markers of inflammation and hypothalamic-pituitary-adrenal axis
functioning. Further, positive psychology interventions (PPI) have
effectively increased psychologic well-being in a wide variety of
populations. However, there has been minimal study of PPIs in cardiac
patients, and no prior study has evaluated their effect on key prognostic
biomarkers of cardiac outcome. Accordingly, we investigated the effect of
3 distinct PPIs on risk biomarkers in cardiac patients. Methods: In an
exploratory trial, 69 patients with recent coronary artery bypass graft
surgery or percutaneous intervention were randomized to (1) one of three
6-week in-person PPIs (based on the work of Seligman, Lyubomirsky, or
Fordyce) or (2) a wait-list control group. Risk biomarkers were assessed
at baseline, postintervention (7 weeks), and at 15-week follow-up.
Between-group differences in change from baseline biomarker levels were
examined via random effects models. Results: Compared with the control
group, participants randomized to the Seligman (B = -2.06; p = 0.02) and
Fordyce PPI (B = -1.54; p = 0.04) had significantly lower high-sensitivity
C-reactive protein levels at 7 weeks. Further, the Lyubomirsky PPI (B =
-245.86; p = 0.04) was associated with a significantly lower cortisol
awakening response at 7 weeks when compared with control participants.
There were no other significant between-group differences. Conclusion:
Despite being an exploratory pilot study with multiple between-group
comparisons, this initial trial offers the first suggestion that PPIs
might be effective in reducing risk biomarkers in high-risk cardiac
patients.

<36>
Accession Number
20160227580
Author
Chaney M.A.; Devin Roberts J.; Wroblewski K.; Shahul S.; Gaudet R.;
Jeevanandam V.
Institution
(Chaney, Devin Roberts, Shahul, Gaudet) Department of Anesthesia and
Critical Care, University of Chicago Medical Center, 5841 S. Maryland Ave,
MC 4028, Chicago, IL 60637, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago
Medical Center, Chicago, IL, United States
(Jeevanandam) Department of Cardiac and Thoracic Surgery, University of
Chicago Medical Center, Chicago, IL, United States
Title
Protamine Administration Via the Ascending Aorta May Prevent
Cardiopulmonary Instability.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 647-655),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective The method of protamine administration may influence adverse
reactions. The authors investigated the effects of 3 different methods of
protamine administration on cardiopulmonary function. Design Prospective,
randomized clinical study. Setting Single university hospital.
Participants Human volunteer patients. Interventions Ninety-five patients
undergoing cardiac surgery were randomized prospectively into 3 groups.
Group central vein control (CVC) and group central vein (CV) received
protamine via a central vein over 10 minutes and 2 minutes, respectively.
Group ascending aorta (AA) received protamine via the ascending aorta over
2 minutes. Hemodynamic parameters were assessed at 7 intraoperative time
points, and pulmonary parameters were assessed at 4 intraoperative time
points. Measurements and Main Results The groups were similar regarding
preoperative demographics, intraoperative care, and baseline
cardiopulmonary function. However, both the CVC and CV groups exhibited
decreased blood pressure and impaired pulmonary oxygenation after
protamine administration; these changes were not observed in the AA group.
Within-group changes in mean arterial blood pressure after protamine
administration were significant in the AA group (mean increase 6.5 mmHg; p
= 0.01) but not in the CVC (mean decrease 3.1 mmHg, p = 0.13) or CV (mean
decrease 4.3 mmHg, p = 0.14) groups. Within-group changes in arterial
oxygenation after protamine administration were significant in the CVC
(mean decrease 85 mmHg; p<0.001) and CV (mean decrease 47 mmHg; p = 0.009)
groups but not in the AA group (mean decrease 8 mmHg; p = 0.82).
Conclusions The results indicated that administration of protamine via the
ascending aorta may be the preferred route. The potential ability of
administering protamine via the ascending aorta to prevent cardiopulmonary
instability in patients undergoing cardiac surgery deserves further
clinical investigation.

<37>
Accession Number
20151056333
Author
Bolzan D.W.; Trimer R.; Begot I.; Nasrala M.L.S.; Forestieri P.; Mendez
V.M.F.; Arena R.; Gomes W.J.; Guizilini S.
Institution
(Bolzan, Begot, Nasrala, Forestieri, Mendez, Gomes, Guizilini)
Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista
de Medicina, Federal University of Sao Paulo, Rua Napoleao Barros,715, 30,
Vila Clementino, Sao Paulo/SP CEP:04024-002, Brazil
(Guizilini) Department of Human Movement Sciences, Physiotherapy School,
Federal University of Sao Paulo, Sao Paulo, Brazil
(Trimer) Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in
Physical Exercise, Federal University of Sao Paulo, Sao Paulo, Brazil
(Arena) Department of Physical Therapy, Integrative Physiology Laboratory,
College of Applied Health Sciences, University of Illinois, Chicago,
Chicago, IL, United States
Title
Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary
Artery Bypass Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 702-708),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective To compare pulmonary function, functional capacity, and clinical
outcomes among conventional mechanical ventilation (CMV), early open-lung
(EOL), and late open-lung (LOL) strategies after off-pump coronary artery
bypass surgery (OPCAB). Design Prospective, randomized, and double-blinded
study. Setting Two hospitals of the Federal University of Sao Paulo,
Brazil. Participants Ninety-three patients undergoing elective first-time
OPCAB. Interventions Patients were randomized into 3 groups: CMV (n=31);
LOL (n=32) initiated upon intensive care unit (ICU) arrival; EOL (n = 30)
initiated after intubation. Measuraments and Main Results Spirometry was
performed at bedside preoperatively and on postoperative days (PODs) 1, 3,
and 5. Partial pressure of arterial oxygen (PaO<inf>2</inf>) and pulmonary
shunt fraction were evaluated presurgically and on POD 1; 6-minute walk
test (6MWT) was performed presurgically and on POD 5. Both open-lung
groups demonstrated higher forced vital capacity and forced expiratory
volume in 1 second on PODs 1, 3 and 5 compared to the CMV group (p<0.05).
Similar results were found in relation to the 6MWT distance. Shunt
fraction was lower and PaO<inf>2</inf> was higher in both open-lung groups
(p<0.05). Open-lung groups had shorter intubation time and hospital stay
as well as fewer respiratory events (p<0.05). No statistical difference
was found relative to the aforementioned results when the EOL and LOL
groups were compared. Conclusions Both open-lung strategies were able to
promote higher pulmonary function preservation and greater recovery of
functional capacity with better clinical outcomes after OPCAB. No
difference in outcome was found when comparing initiation of OLS
intraoperatively or after ICU arrival.

<38>
Accession Number
20151044285
Author
Maeda T.; Sakurai R.; Nakagawa K.; Morishima K.; Maekawa M.; Furumoto K.;
Kono T.; Egawa A.; Kubota Y.; Kato S.; Okamura H.; Yoshitani K.; Ohnishi
Y.
Institution
(Maeda, Sakurai, Nakagawa, Morishima, Maekawa, Furumoto, Kono, Egawa,
Kubota, Kato, Yoshitani, Ohnishi) Department of Anesthesiology, National
Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka
565-8565, Japan
(Okamura) Department of Cardiovascular Medicine, Division of Arrhythmia,
National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Title
Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured
by Three-Dimensional Echocardiography Can Predict Decreases in Brain
Natriuretic Peptide.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 599-605),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objectives First, to examine the perioperative association between
increased cardiac index (CI) measured using three-dimensional
echocardiography (CI<inf>3D</inf>), two-dimensional echocardiography
(CI<inf>2D</inf>), and FloTrac/Vigileo (CI<inf>FT</inf>) (Edwards
Lifesciences, Irvine, CA) after cardiac resynchronization therapy (CRT)
and decreased brain natriuretic peptide (BNP) 6 months after CRT. Second,
to evaluate the accuracy and tracking ability of CI<inf>2D</inf> and
CI<inf>FT</inf>. Design A prospective clinical study. Setting A cardiac
surgery operating room in a single cardiovascular center. Participants
Forty-five patients undergoing elective CRT lead implantation.
Interventions CI<inf>FT</inf> and CI<inf>2D</inf> were determined
simultaneously before and after CRT using CI<inf>3D</inf> as the reference
method. Measurements and Main Results BNP was measured before CRT and 6
months after CRT. Areas under the receiver operator characteristic curves
(AUCs) were calculated for each method of measurement to predict BNP
decrease. AUC was largest for CI<inf>3D</inf> (AUC = 0.735, p = 0.017).
Bland-Altman analysis revealed that the percentage error was 58% for
CI<inf>FT</inf> and 28% for CI<inf>2D.</inf> A polar plot analysis showed
that the mean angular bias was -7.26degree and 0.64degree, the radial
limits of agreement were 70degree and 29.4degree, and the concordance rate
was 67.7% and 93.8% for CI<inf>FT</inf> and CI<inf>2D,</inf> respectively.
Conclusions CI significantly increased after CRT in patients whose BNP
level decreased 6 months after CRT. However, only CI<inf>3D</inf> could
predict decreases in BNP 6 months after CRT. Although CI<inf>2D</inf> was
acceptable compared with CI<inf>3D</inf>, the tracking ability of CI
changes was just below acceptable. CI<inf>FT</inf> has a wide limit of
agreement with CI<inf>3D,</inf> with a poor tracking ability.

<39>
Accession Number
20160452771
Author
Vandenberghe W.; Gevaert S.; Kellum J.A.; Bagshaw S.M.; Peperstraete H.;
Herck I.; Decruyenaere J.; Hoste E.A.J.
Institution
(Vandenberghe, Peperstraete, Herck, Decruyenaere, Hoste) Department of
Intensive Care Medicine, Ghent University Hospital, Ghent University,
Ghent BE-9000, Belgium
(Gevaert) Department of Cardiology, Ghent University Hospital, Ghent
University, Ghent, Belgium
(Hoste) Research Foundation-Flanders (FWO), Brussels, Belgium
(Kellum) Centre for Critical Care Nephrology, University of Pittsburgh,
United States
(Kellum, Hoste) Clinical Research, Investigation, Systems Modelling of
Acute Illness (CRISMA) Centre, Department of Critical Care Medicine,
University of Pittsburgh, School of Medicine, Pittsburgh, PA, United
States
(Bagshaw) Division of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, AB, Canada
Title
Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients:A Systematic
Review and Meta-Analysis.
Source
CardioRenal Medicine. 6 (2) (pp 116-128), 2016. Date of Publication: 01
Feb 2016.
Publisher
S. Karger AG
Abstract
Background: We evaluated the epidemiology and outcome of acute kidney
injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its
subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and
after cardiac surgery (CS). Summary: We performed a systematic review and
meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO),
worsening renal failure (WRF) and renal replacement therapy (RRT). We
investigated the three most common clinical causes of CRS-1: AHF, ACS and
CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41
studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by
AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had
a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI:
47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types
of acute cardiac disease. AKI was associated with an increased mortality
rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227
patients), a longer length of stay in the intensive care unit
[LOS<inf>ICU</inf>] (median duration = 1.37 days, 95% CI 0.41-2.33; 9
studies and 10,758 patients) and a longer LOS in hospital
[LOS<inf>hosp</inf>] (median duration = 3.94 days, 95% CI 1.74-6.15; 8
studies and 35,227 patients). Increasing AKI severity was associated with
worse outcomes. The impact of CRS-1 defined by AKI on mortality was
greatest in CS patients. RRT had an even greater impact compared to AKI
(mortality risk ratio = 9.2, median duration of LOS<inf>ICU</inf> = 10.6
days and that of LOS<inf>hosp</inf> = 20.2 days). Key Messages: Of all
included patients, almost one quarter developed AKI and approximately 3%
needed RRT. AHF patients experienced the highest occurrence rate of AKI,
but the impact on mortality was greatest in CS patients.

<40>
Accession Number
20160449598
Author
Nikrahan G.R.; Suarez L.; Asgari K.; Beach S.R.; Celano C.M.; Kalantari
M.; Abedi M.R.; Etesampour A.; Abbas R.; Huffman J.C.
Institution
(Nikrahan, Asgari, Kalantari) Department of Psychology, University of
Isfahan, Isfahan, Iran, Islamic Republic of
(Suarez, Beach, Celano, Huffman) Department of Psychology, Islamic Azad
University of Borujen, Borujen, Iran, Islamic Republic of
(Suarez, Beach, Celano, Huffman) Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, United States
(Beach, Celano) Department of Psychiatry, Harvard Medical School, Boston,
MA, United States
(Abedi) Department of Consulting, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Etesampour) Department of Internal Medicine, Najafabad Islamic Azad
University, Najafabad, Iran, Islamic Republic of
(Abbas) Department of Immunology, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Title
Positive Psychology Interventions for Patients With Heart Disease: A
Preliminary Randomized Trial.
Source
Psychosomatics. 57 (4) (pp 348-358), 2016. Date of Publication: 01 Jul
2016.
Publisher
Elsevier Inc.
Abstract
Background: Positive psychologic characteristics have been linked to
superior cardiac outcomes. Objective: Accordingly, in this exploratory
study, we assessed positive psychology interventions in patients who had
recently undergone a procedure to treat cardiovascular disease. Method:
Participants were randomly assigned to receive 1 of 3 different 6-week
face-to-face interventions or a wait-list control condition. We assessed
intervention feasibility and compared changes in psychologic outcome
measures postintervention (7 wk) and at follow-up (15 wk) between
intervention and control participants. Across the interventions, 74% of
assigned sessions were completed. Results: When comparing outcomes between
interventions and control participants (N = 55 total), there were no
between-group differences post-intervention, but at follow-up intervention
participants had greater improvements in happiness (beta = 14.43, 95% CI:
8.66-20.2, p < 0.001), depression (beta = -3.87, 95% CI: -7.72 to 0.02, p
= 0.049), and hope (beta = 7.12, 95% CI: 1.25-13.00, p =0.017), with
moderate-large effect sizes. Efficacy of the 3 interventions was similar.
Conclusions: Future studies are needed to identify an optimal positive
psychology intervention for cardiac patients.

<41>
Accession Number
20160457246
Author
Mishra A.; Kumar B.; Dutta V.; Arya V.K.; Mishra A.K.
Institution
(Mishra, Kumar, Dutta, Arya) Department of Anaesthesia and Intensive Care,
Post Graduate Institute of Medical Education and Research, Chandigarh
160012, India
(Mishra) Cardiothoracic and Vascular Surgery, Post Graduate Institute of
Medical Education and Research, Chandigarh, India
Title
Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery
Patients with Pulmonary Hypertension and Left Ventricular Dysfunction.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 639-646),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective To compare the effects of levosimendan with milrinone in cardiac
surgical patients with pulmonary hypertension and left ventricular
dysfunction. Design A prospective, randomized study. Setting Tertiary care
teaching hospital. Participants The study included patients with valvular
heart disease and pulmonary artery hypertension undergoing valve surgery.
Interventions Forty patients were allocated randomly to receive either
milrinone, 50 mug/kg bolus followed by infusion at a rate of 0.5
mug/kg/min (group 1), or levosimendan, 10 mug/kg bolus followed by
infusion at a rate of 0.1 mug/kg/min (group 2) for 24 hours after surgery.
Measurements and Main Results Hemodynamic parameters were measured using a
pulmonary artery catheter, and biventricular functions were assessed using
echocardiography. Mean pulmonary artery pressures and the pulmonary
vascular resistance index were comparable between the 2 groups at several
time points in the intensive care unit. Biventricular function was
comparable between both groups. Postcardiopulmonary bypass right
ventricular systolic and diastolic functions decreased in both groups
compared with baseline, whereas 6 hours postbypass left ventricular
ejection fraction improved in patients with stenotic valvular lesions.
Levosimendan use was associated with higher heart rate, increased cardiac
index, decreased systemic vascular resistance index, and increased
requirement of norepinephrine infusion compared with milrinone.
Conclusions The results of this study demonstrated that levosimendan was
not clinically better than milrinone. Levosimendan therapy resulted in a
greater increase in heart rate, decrease in systemic vascular resistance,
and a greater need for norepinephrine than in patients who received
milrinone.

<42>
Accession Number
20160457244
Author
Hori D.; Max L.; Laflam A.; Brown C.; Neufeld K.J.; Adachi H.; Sciortino
C.; Conte J.V.; Cameron D.E.; Hogue C.W.; Mandal K.
Institution
(Hori, Sciortino, Conte, Cameron, Mandal) Division of Cardiac Surgery,
Department of Surgery, Johns Hopkins Hospital, Sheikh Zayed Tower, 1800
Orleans St, Baltimore, MD 21287-4618, United States
(Max, Laflam, Brown, Hogue) Department of Anesthesiology and Critical Care
Medicine, United States
(Neufeld) Department of Psychiatry, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Adachi) Department of Cardiovascular Surgery, Saitama Medical Center,
Jichi Medical University, Saitama, Japan
Title
Blood Pressure Deviations from Optimal Mean Arterial Pressure during
Cardiac Surgery Measured with a Novel Monitor of Cerebral Blood Flow and
Risk for Perioperative Delirium: A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 606-612),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to evaluate whether excursions of
blood pressure from the optimal mean arterial pressure during and after
cardiac surgery are associated with postoperative delirium identified
using a structured examination. Design Prospective, observational study.
Setting University hospital. Participants The study included 110 patients
undergoing cardiac surgery. Interventions Patients were monitored using
ultrasound-tagged near-infrared spectroscopy to assess optimal mean
arterial pressure by cerebral blood flow autoregulation monitoring during
cardiopulmonary bypass and the first 3 hours in the intensive care unit.
Measurements and Main Results The patients were tested preoperatively and
on postoperative days 1 to 3 with the Confusion Assessment Method or
Confusion Assessment Method for the Intensive Care Unit, the Delirium
Rating Scale-Revised-98, and the Mini Mental State Examination. Summative
presence of delirium on postoperative days 1 through 3, as defined by the
consensus panel following Diagnostic and Statistical Manual of Mental
Disorders-IV-TR criteria, was the primary outcome. Delirium occurred in 47
(42.7%) patients. There were no differences in blood pressure excursions
above and below optimal mean arterial pressure between patients with and
without summative presence of delirium. Secondary analysis showed blood
pressure excursions above the optimal mean arterial pressure to be higher
in patients with delirium (mean+/-SD, 33.2+/-26.51 mmHgxh v 23.4+/-16.13
mmHgxh; p = 0.031) and positively correlated with the Delirium Rating
Scale score on postoperative day 2 (r = 0.27, p = 0.011). Conclusions
Summative presence of delirium was not associated with perioperative blood
pressure excursions; but on secondary exploratory analysis, excursions
above the optimal mean arterial pressure were associated with the
incidence and severity of delirium on postoperative day 2.

<43>
Accession Number
20160450532
Author
Bhatt S.P.; Connett J.E.; Voelker H.; Lindberg S.M.; Westfall E.; Wells
J.M.; Lazarus S.C.; Criner G.J.; Dransfield M.T.
Institution
(Bhatt, Westfall, Wells, Dransfield) Division of Pulmonary, Allergy and
Critical Care Medicine, UAB Lung Health Center, University of Alabama at
Birmingham, Birmingham, AL, United States
(Connett, Voelker, Lindberg) Division of Biostatistics, University of
Minnesota, Minneapolis, MN, United States
(Wells, Dransfield) Birmingham Veterans Affairs Hospital, Birmingham, AL,
United States
(Lazarus) Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California, San Francisco, San Francisco, CA,
United States
(Criner) Department of Thoracic Medicine and Surgery, Temple University
Hospital, Philadelphia, PA, United States
Title
beta-Blockers for the prevention of acute exacerbations of chronic
obstructive pulmonary disease (betaLOCK COPD): A randomised controlled
study protocol.
Source
BMJ Open. 6 (6) (no pagination), 2016. Article Number: e012292. Date of
Publication: 01 Jun 2016.
Publisher
BMJ Publishing Group
Abstract
Introduction A substantial majority of chronic obstructive pulmonary
disease (COPD)-related morbidity, mortality and healthcare costs are due
to acute exacerbations, but existing medications have only a modest effect
on reducing their frequency, even when used in combination. Observational
studies suggest beta-blockers may reduce the risk of COPD exacerbations;
thus, we will conduct a randomised, placebo-controlled trial to
definitively assess the impact of metoprolol succinate on the rate of COPD
exacerbations. Methods and analyses This is a multicentre,
placebo-controlled, double-blind, prospective randomised trial that will
enrol 1028 patients with at least moderately severe COPD over a 3-year
period. Participants with at least moderate COPD will be randomised in a
1:1 fashion to receive metoprolol or placebo; the cohort will be enriched
for patients at high risk for exacerbations. Patients will be screened and
then randomised over a 2-week period and will then undergo a dose
titration period for the following 6weeks. Thereafter, patients will be
followed for 42 additional weeks on their target dose of metoprolol or
placebo followed by a 4-week washout period. The primary end point is time
to first occurrence of an acute exacerbation during the treatment period.
Secondary end points include rates and severity of COPD exacerbations;
rate of major cardiovascular events; all-cause mortality; lung function
(forced expiratory volume in 1s (FEV 1)); dyspnoea; quality of life;
exercise capacity; markers of cardiac stretch (pro-NT brain natriuretic
peptide) and systemic inflammation (high-sensitivity C reactive protein
and fibrinogen). Analyses will be performed on an intent-to-treat basis.
Ethics and dissemination The study protocol has been approved by the
Department of Defense Human Protection Research Office and will be
approved by the institutional review board of all participating centres.

<44>
Accession Number
72329063
Author
El Shora H.; Amr Y.; El Sherief S.
Institution
(El Shora, Amr, El Sherief) Tanta University, Department of Anaesthesia
and Surgical Intensive Care, Tanta, Gharbia, Egypt
Title
Prospective study on the effect of inhalational versus intravenous
sedation on delirium and agitation in patients admitted to ICU postcardiac
surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 31st Annual
Meeting of the European Association of Cardiothoracic Anaesthesiologists,
EACTA 2016 Basel Switzerland. Conference Start: 20160511 Conference End:
20160513. Conference Publication: (var.pagings). 30 (pp S34), 2016. Date
of Publication: May 2016.
Publisher
W.B. Saunders
Abstract
Background. Postoperative cognitive dysfunction (POCD) is a
multi-factorial disease. Patients undergoing major surgery, including
cardiac surgery, are at increased risk of developing delirium. Objectives.
The aim of this study was to evaluate the effect of inhalational versus
intravenous sedation on postoperative delirium & agitation in patients
admitted to ICU post cardiac surgery. Methods. This study was as
prospective randomized controlled trial. Sixty adult patients scheduled
for elective cardiac surgery were enrolled. On arrival in the ICU,
sedation was provided by either inhalational route or intravenous route.
Patients were assessed for postoperative cognitive dysfunction using
intensive care delirium chick list and CAM-ICU on a daily basis up to five
days post extubation. Results. Elderly individuals were more vulnerable
for POCD. The time needed for patients to respond, extubate, restore clear
mind after the end of sedation in the two groups there was statistical
significance in favour of the inhalational group. Regarding incidence of
POCD in the two groups there were lower absolute numbers in the
inhalational group but no statistical significance. Aortic cross-clamp
time had a significant effect on POCD. Hospital and ICU stay of POCD
patients were significantly increased. Conclusions. Despite, the route of
sedation did not affect the incidence of POCD; however, inhaling
sevoflurane for sedation had the privilege of shorter time for patients to
respond and to regain clear mind and shorter time for extubation from
mechanical ventilation as well than intravenous sedation. Elderly patients
have the highest risk for developing POCD, and they should be the targeted
group for prophylactic treatment.

<45>
Accession Number
72329057
Author
Gronlykke L.; Ihlemann N.; Nilsson J.C.; Kjaergaard J.; Korshin A.;
Gustafsson F.; Thyregod H.G.; Sondergaard L.; Ravn H.B.
Institution
(Gronlykke, Nilsson, Korshin, Ravn) Department of Cardiothoracic
Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
(Ihlemann, Kjaergaard, Gustafsson, Sondergaard) Department of Cardiology,
Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
(Thyregod) Department of Cardiothoracic Surgery, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
Title
Echocardiographic changes in right ventricular function after
transcatheter versus surgical aortic valve replacement for severe aortic
valve stenosis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 31st Annual
Meeting of the European Association of Cardiothoracic Anaesthesiologists,
EACTA 2016 Basel Switzerland. Conference Start: 20160511 Conference End:
20160513. Conference Publication: (var.pagings). 30 (pp S31-S32), 2016.
Date of Publication: May 2016.
Publisher
W.B. Saunders
Abstract
Introduction. Cardiac surgery has been shown to affect right ventricular
(RV) longitudinal function. It is unclear what the mechanisms are and to
what extent the type of surgical procedure might influence this effect. We
compared the effect of either surgical (SAVR) or transcatheter aortic
valve replacement (TAVR) on RV longitudinal and circumferential function
using data from a randomized controlled trial. Methods. Data from NOTION
trial was used for this study (1). The trial was designed to compare
clinical outcome following TAVR versus SAVR in all-comers with severe
aortic stenosis. For TAVR, a self-expandable prosthesis was used.
Transthoracic echocardiography was performed before valve replacement,
three and 12 months postoperatively. Longitudinal as well as combined
longitudinal and circumferential RV function were assessed using tricuspid
annular systolic excursion (TAPSE) and fractional area change (RVFAC),
respectively. Echocardiographic data were available in 220 patients
included in this analysis (SAVR, n= 106 vs. TAVR, n=114). Anthropometric
data were similar in the two groups (Mean age, SAVR 78 years vs. TAVR 79
years; males, SAVR 56% vs. TAVR 55%; logistic EuroSCORE, SAVR 8+/-4% vs.
TAVR 9+/-4%). Results. RV measurements at baseline and post procedural are
presented in Table 1. In the SAVR group TAPSE was reduced by 35% three
months after surgery (p<0.001) and 30% after 12 months (p<0.001). RVFAC
was reduced by 12% after three months (p=0.001), but had recovered at 12
months (p=0.34). In the TAVR group neither TAPSE nor RVFAC changed
significantly after valve replacement (P>0.05). We found a statistically
significant increase in LVEF post-procedural in the SAVR group, but not in
the TAVR group. Discussion. Both TAPSE and RVFAC were reduced after SAVR,
but not after TAVR. These findings are likely to be related to the type of
intervention rather than the population, as baseline characteristics were
similar between the two randomised groups in the NOTION study. A follow-up
at 12 months indicates that the reduction in RVFAC is reversible, whereas
the observed decrease in TAPSE remained unaltered in the SAVR group. The
clinical importance of these observations needs to be elucidated. (Table
Presented).

<46>
Accession Number
72329028
Author
Fominskiy E.; Lomivorotov V.; Nepomniashchikh V.; Likhvantsev V.; Ma J.;
Lembo R.; Baiardo Redaelli M.; Abubakirov M.; Perovsky P.; Zangrillo A.;
Landoni G.
Institution
(Fominskiy, Lomivorotov, Nepomniashchikh, Abubakirov, Perovsky)
Academician EN Meshalkin Novosibirsk State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
(Lembo, Baiardo Redaelli, Zangrillo, Landoni) IRCCS San Raffaele
Scientific Institute, Milan, Italy
Title
Cardiac protection with phosphocreatine: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 31st Annual
Meeting of the European Association of Cardiothoracic Anaesthesiologists,
EACTA 2016 Basel Switzerland. Conference Start: 20160511 Conference End:
20160513. Conference Publication: (var.pagings). 30 (pp S16), 2016. Date
of Publication: May 2016.
Publisher
W.B. Saunders
Abstract
Introduction. Phosphocreatine (PCr) plays an important role in the energy
metabolism of the heart and a decrease in its intracellular concentration
results in alteration of myocardium energetics and work. Method. We
conducted a meta-analysis of all randomised and matched trials that
compared PCr with placebo or standard treatment in patients with coronary
artery disease or chronic heart failure or in those undergoing cardiac
surgery. We systematically searched PubMed/Medline, Embase, Cochrane
Central Register of Controlled Trials, and Google Scholar up to November
1st, 2015, for pertinent trials. The primary outcome was the longest
follow-up all-cause mortality. Secondary outcomes included inotropes use,
ejection fraction (EF), peak creatinine kinase-myocardial band (CK-MB)
release, and the incidence of major arrhythmias, as well as spontaneous
recovery of the heart performance in the subgroup of patients undergoing
cardiac surgery with cardiopulmonary bypass. We pooled odds ratio (OR) and
mean difference (MD) using fixed- and random effects models. We tested for
heterogeneity using the Q statistic and quantified it with the
I² statistic. Meta-analysis was performed using Review Manager
5.3.5. Results. We identified 41 controlled trials, 31 of them randomised.
Patients receiving PCr had lower all-cause mortality when compared to the
control group (61/1731 [3.5%] vs. 177/1667 [10.6%]; OR 0.71, 95% CI
0.51-0.99; P=0.04; I²=0%; with 3,400 patients and 22 trials
included). Phosphocreatine administration was associated with higher LVEF
(MD 3.82, 95% CI 1.18-6.46; P=0.005; I²=98%), lower peak CK-MB
release (MD -6.08, 95% CI -8.01, -4.15; P<0.001; I²=97%), lower
rate of major arrhythmias (OR 0.42; 95% CI 0.27-0.66; P<0.001;
I²=0%), lower incidence of inotropic support (OR 0.39, 95% CI
0.25-0.61; P<0.001; I²=56%) and a higher level of spontaneous
recovery of the heart performance after cardiopulmonary bypass (OR 3.49,
95% CI 2.28-5.35; P<0.001; I²=49%) when compared with the
control group. Discussion. In a mixed population of patients with coronary
artery disease, chronic heart failure or in those undergoing cardiac
surgery PCr administration was associated with improved cardiac outcomes
and with a reduction in all-cause mortality at the longest follow up
available. Due to the pharmacological plausibility of this effect and to
the concordance of the beneficial effects of PCr on several secondary but
important outcomes and survival, there is urgent need of a large
multicentre randomised trial to confirm these findings.

<47>
Accession Number
72329012
Author
Fominskiy E.; Lomivorotov V.; Nepomniashchikh V.; Monaco F.; Vitiello C.;
Votta C.D.; Camarda V.; Landoni G.
Institution
(Fominskiy, Lomivorotov, Nepomniashchikh) Academician EN Meshalkin
Novosibirsk State Budget Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Monaco, Vitiello, Votta, Camarda, Landoni) IRCCS San Raffaele Scientific
Institute, Milan, Italy
Title
Efficacy and safety of fibrinogen concentrate in surgical patients: A
meta-analysis of randomised controlled trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 31st Annual
Meeting of the European Association of Cardiothoracic Anaesthesiologists,
EACTA 2016 Basel Switzerland. Conference Start: 20160511 Conference End:
20160513. Conference Publication: (var.pagings). 30 (pp S8-S9), 2016. Date
of Publication: May 2016.
Publisher
W.B. Saunders
Abstract
Introduction. The evidence in support of fibrinogen concentrate (FC) use
for treatment of bleeding remains weak. The aim of this meta-analysis was
to investigate the efficacy and safety of FC in surgical patients by
including data from randomised controlled studies (RCTs). Methods. We
searched PubMed/Medline, Embase, Cochrane Central Register of Controlled
Trials, Transfusion Evidence Library, Google Scholar, and the proceedings
from major international anaesthesiological meetings up to November 1st,
2015 for RCTs that compared FC with placebo or other comparators in
surgical patients. The primary outcome was all-cause mortality. We derived
pooled risk ratios (RRs) and mean differences (MDs) with either fixed
effect or random effects models. Results. We included 13 RCTs comprising
965 patients, of whom the majority underwent cardiac surgery. All-cause
mortality was lower in the fibrinogen group (3/355 [0.8%] vs. 12/356
[3.4%]; RR 0.25; 95% CI 0.07

0.87; P=0.03; I²=0%). The use of FC was associated with reduced
bleeding (MD -125 mL; 95% CI -211, -39; P=0.004; I²=60%), a
lower proportion of patients receiving red blood cell transfusions (RR
0.76; 95% CI 0.63

0.93; P=0.007; I²=47%), and a lower number of red blood cell
units transfused versus comparator (MD -0.87; 95% CI -1.33, -0.41;
P=0.0002; I²=55%). There was no difference in the rate of
thrombotic events and myocardial infarction. Discussion. In surgical
patients FC is associated with reduced bleeding, lower transfusion
requirements, and might reduce mortality with no increase in the adverse
events such as thrombotic events and myocardial infarction.

<48>
Accession Number
72329005
Author
Yildirim F.; Kurdal A.T.; Ozturk T.; Yuksel O.; Gozukara C.; Taneli F.;
Horasan G.D.; Cerrahoglu M.
Institution
(Yildirim, Kurdal, Yuksel, Cerrahoglu) Celal Bayar University, Department
of Cardiovascular Surgery, Manisa, Turkey
(Ozturk) Department of Anesthesiology, Manisa, Turkey
(Gozukara, Taneli) Department of Biochemistry, Manisa, Turkey
(Horasan) Department of Biostatistics, Manisa, Turkey
Title
Remote preconditioning protects early renal functions in low risk cardiac
surgery patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 31st Annual
Meeting of the European Association of Cardiothoracic Anaesthesiologists,
EACTA 2016 Basel Switzerland. Conference Start: 20160511 Conference End:
20160513. Conference Publication: (var.pagings). 30 (pp S5), 2016. Date of
Publication: May 2016.
Publisher
W.B. Saunders
Abstract
Introduction. Acute kidney injury is highly prevalent and important
complication of open heart surgery. This study is designed to investigate
the protective effects of remote ischemic preconditioning against kidney
injury in low risk coronary artery bypass grafting surgery (CABG)
patients. Methods. Prospective, randomized controlled study was performed
in patients who underwent CABG surgery with cardiopulmonary bypass. The 60
patients were examined and divided into two groups: 30 in control group,
30 in study group who was applied the remote ischemic preconditioning
procedure (RIPC). Blood samples were obtained for the measurement of
cystatin C, neutrophil gelatinase associated lipocalin (NGAL), creatinine
before induction of anaesthesia (T0), 1 hour (T1) and 6 hours (T2) after
skin closure, and 24 hours postoperatively (T3). Results. There were no
differences between the two groups in demographic values and the
hemodynamic parameters. Plasma cystatin C levels were significantly higher
in Group C than those of Group S at all time periods , p=0,01 and p=0,583
for time, respectively. Plasma NGAL levels were higher in Group C than
those of Group S at two sampling time, p=0,001, p=0,243 for time
respectively. Plasma creatinin levels were significantly higher in Group C
than those of Group S at all sample time periods, p=0,001for groups,
p=0,131 for time respectively. Discussion. This study confirm the findings
of similar single center and multi center studies that RIPC reduces the
rate of acute kidney injury after coronary artery bypass graft operation
in low-risk patients (1,2). In low risk patients with on pump CABG
surgery, RIPC seems to protect renal functions. We did not observe acute
kidney injury in our patients and not start any renal replacement
theraphy. This could be the result of the low risk of the patients who
were included the trial. Further studies with different risk groups should
also be planned whether this procedure is useful in cardiac surgery
patients.

<49>
Accession Number
72328816
Author
Tan C.; Anderson J.E.; Maskon O.; Chin S.; Che Hassan H.; Choor C.; Paul
S.K.; Abu Bakar N.; Azreen N.; Amran Azman N.; Ismahadi Z.; Qizhou L.;
Cheong S.; Abdul Wahid S.S.
Institution
(Tan, Anderson) Penang Adventist Hospital, Penang, Malaysia
(Maskon, Che Hassan, Choor, Paul, Azreen, Ismahadi, Abdul Wahid)
Cardiology Unit, Department of Medicine, Universiti Kebangsaan Malaysia
Medical Centre, Kuala Lumpur, Malaysia
(Chin, Amran Azman, Cheong) Cytopeutics, Selangor, Malaysia
(Abu Bakar) Radiology Unit, Faculty of Medicine, Universiti Kebangsaan
Malaysia Medical Centre, Kuala Lumpur, Malaysia
(Qizhou) Department of Medicine, University of Hong Kong, Hong Kong, Hong
Kong
(Cheong) Tunku Abdul Rahman University, Selangor, Malaysia
(Abdul Wahid) Cell Therapy Center, Faculty of Medicine, Universiti
Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Title
Autologous MSC infusion improves ejection fraction and wall thickness in
severe ischemic cardiomyopathy: Results from a clinical multicentre phase
II/III randomized controlled trial.
Source
Cytotherapy. Conference: 22nd Annual Meeting of the International Society
for Cellular Therapy, ISCT 2016 Singapore Singapore. Conference Start:
20160525 Conference End: 20160528. Conference Publication: (var.pagings).
18 (6 SUPPL. 1) (pp S25), 2016. Date of Publication: June 2016.
Publisher
Taylor and Francis Ltd
Abstract
Background: We have previously demonstrated that mesenchymal stromal cell
(MSC) may improve cardiac function and reduce scar tissue in end-stage
cardiomyopathy when administered concurrently with revascularization
(either cardiac bypass operation or coronary angioplasty). In this study
we compared the effects of MSC with concurrent revascularization (Group
A), MSC only (Group B) and revascularization only (Group C). Methodology:
Twenty-seven patients were recruited. All patients had anterior myocardial
infarction previously and baseline cardiac function (left ventricular
ejection fraction, LVEF) less than 40%. Patients who were suitable for
revascularization were divided into Group A or C. Patients who have had
revascularization previously or were unsuitable for revascularization were
allocated to receive MSC by intracoronary infusion (Group B). Patients
received between 50-100 x 10⁶ autologous bone-marrow MSC. The
LVEF, LV end diastolic diameter (LVEDD) and interventricular septum
thickness (IVST) were estimated at baseline, 3 months, 6 months and 12
months follow-up. Magnitude of change in LVEF (DELTAEF) was calculated as
percentage of baseline value. Results: All patients tolerated the
procedure well with no proarrythmia, calcification or tumor formation.
There was no difference in baseline parameters between Groups A, B and C
including LVEF (27.5 +/- 5.6 vs. 32.0 +/- 4.5 vs. 28.0 +/- 8.3%; P =
0.26). LVEF improved in all groups during follow-up. The improvements were
statistically significant compared to baseline for Group B at 3 months and
for Groups A and C at 6 months. The DELTAEF was largest in Group A
compared to Groups B and C at 12 months (130 +/- 83 vs. 46 +/- 37 vs. 31
+/- 29%; ANOVA P = 0.02). IVST improved in Group B while LVEDD improved in
Groups B and C. Conclusions: MSC restores myocardial myocardial wall
thickness and cardiac function. Concurrent MSC administration with
revascularization appeared to be superior to either procedure alone for
patients with ischemic cardiomyopathy.

<50>
Accession Number
72325706
Author
Eastwood G.; Zhang L.; Tanaka A.; Glassford N.; Bellomo R.
Institution
(Eastwood, Zhang, Tanaka, Glassford, Bellomo) Austin Hospital, Heidelberg,
Australia
Title
Remote ischemic conditioning for kidney protection: A meta-analysis.
Source
Anaesthesia and Intensive Care. Conference: 40th Annual Scientific Meeting
of the Australia and New Zealand Intensive Care Society and Australian
College of Critical Care Nurses, ANZICS/ACCCN ASM 2015 Auckland New
Zealand. Conference Start: 20151029 Conference End: 20151031. Conference
Publication: (var.pagings). 44 (2) (pp 318), 2016. Date of Publication:
March 2016.
Publisher
Australian Society of Anaesthetists
Abstract
Findings of recent randomized controlled trials (RCTs) into the effect of
remote ischemic conditioning (RIC) on the kidney are inconsistent. In
response we performed a systematic review and meta-analysis of all
eligible RCTs of RIC with acute kidney injury as the primary outcome.
Secondary outcomes were the incidence of renal replacement therapy (RRT),
estimated glomerular filtration rate (eGFR), serum creatinine (Scr) and
mortality. We searched Medline, Embase, the Cochrane Library, Google
Scholar and Chinese database (SinoMed) from their inception to June 2015
to identify studies with acute kidney injury (AKI) as the primary outcome.
We pooled relative risk (RR) or standardized mean difference (SMD) with
95% confidence intervals (95% CI) using Stata 12.0 and Review Manager 5.2.
Thirty-four RCTs from 2007 to 2015 involving 5171 patients were included.
Pooled analyses of showed RIC significantly reduced the incidence of AKI
(as defined by investigators in each study) compared to the control group
(RR 0.78, 95% CI: 0.67 to 0.91, P =0.001) with no evidence of
heterogeneity (I2 =17%). In subgroup analysis, similar results were found
in patients undergoing cardiac surgery (RR 0.86, 95% CI: 0.73 to 1.01) or
percutaneous coronary intervention (PCI) (RR 0.64, 95% CI: 0.46 to 0.87).
However, there was no difference in patients with abdominal aortic
aneurysm repair, contrast administration or liver transplantation. Remote
ischemic preconditioning (RR 0.77, 95% CI: 0.64 to 0.92) and
post-conditioning (RR 0.70, 95% CI: 0.52 to 0.95) were both associated
with lower incidence of AKI respectively. There was no difference in
incidence of RRT, changes in eGFR or Scr between RIPC and control group.
There was a trend to favours RIC in mortality (RR 0.69, 95% CI: 0.48,
1.01, P= 0.056). Large prospective RCTs focusing on RIC for kidney
protection in various patient cohorts appear warranted.

<51>
Accession Number
72325687
Author
Parke R.; McGuinness S.; Drummond K.
Institution
(Parke, McGuinness) Auckland DHB, Auckland, New Zealand
(Drummond) Royal Adelaide Hospital, Adelaide, Australia
Title
The avoidance of hyperoxaemia during cardiopulmonary bypass: A
multi-centre phase IIB randomized controlled trial.
Source
Anaesthesia and Intensive Care. Conference: 40th Annual Scientific Meeting
of the Australia and New Zealand Intensive Care Society and Australian
College of Critical Care Nurses, ANZICS/ACCCN ASM 2015 Auckland New
Zealand. Conference Start: 20151029 Conference End: 20151031. Conference
Publication: (var.pagings). 44 (2) (pp 312), 2016. Date of Publication:
March 2016.
Publisher
Australian Society of Anaesthetists
Abstract
Introduction: Cardiac surgery utilising cardiopulmonary bypass (CPB) is
one of the most common forms of major surgery with significant mortality
and morbidity. Cardiac surgery associated multi-organ dysfunction
(CSA-MOD) includes cardiac surgery associated acute kidney injury
(CSA-AKI), acute hepatic impairment, myocardial damage and post-operative
neurological deficit. Pathophysiology of CSA-MOD involves numerous
injurious pathways linked to the use of CPB including oxidative stress and
the formation of reactive iron species. During cardiac surgery with CPB it
is routine practice to oxygenate the arterial return blood to supra-normal
levels. This study aimed to determine whether the avoidance of arterial
hyperoxaemia would decrease oxidative stress and reduce severity of the
multi-organ dysfunction that is common following cardiac surgery utilising
CPB. Methods: A multi-center, Phase IIb parallel group, randomized
controlled trial of the avoidance of arterial hyperoxaemia vs. usual care
in patients undergoing cardiac surgery involving CPB. Outcomes: Primary:
Incidence and severity of CSA-AKI; Secondary: CSA-MOD determined by serum
biomarkers, duration of mechanical ventilation, length of ICU and hospital
stay and mortality. Results: 298 patients were randomized at two hospitals
in New Zealand and Australia. There were no significant differences in
baseline characteristics and excellent treatment separation was achieved
between the two groups. There was no difference in the development of any
AKI (72% vs. 66%; p=0.28) or more severe AKI (KDIGO 2 or 3; 27% vs. 30%;
p=0.56). There was also no difference in the multiple markers of other
organ damage measured or in ICU and hospital length of stay. Conclusion:
This is the first study to report the effects of avoiding arterial
hyperoxaemia during CPB. Despite achieving excellent treatment separation
we failed to demonstrate any difference in either organ damage or other
outcomes. As this practice requires more intense monitoring and carries
some theoretical risk this study does not support its adoption into
routine practice.