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<1>
Accession Number
2015681857
Author
Fulcher J.; O'Connell R.; Voysey M.; Mihaylova B.; Colhoun H.; De Lemos
J.; Blazing M.; Downs J.R.; Gotto A.; Clearfield M.; Gordon D.; Davis B.;
Koren M.; Dahlof B.; Poulter N.; Sever P.; Knopp R.H.; Fellstrom B.;
Holdaas H.; Jardine A.; Schmieder R.; Zannad F.; Goldbourt U.; Kaplinsky
E.; Colhoun H.M.; Betteridge D.J.; Durrington P.N.; Hitman G.A.; Fuller
J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.; Hawkins
C.M.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.; Marchioli R.; Tognoni
G.; Franzosi M.G.; Maggioni A.; Bloomfield H.; Robins S.; Pedersen T.R.;
Ridker P.M.; Holman R.; Meade T.; Keech A.; MacMahon S.; Marschner I.;
Tonkin A.; Shaw J.; Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.;
Byington R.; Murphy M.; Blauw G.J.; Packard C.; Kjekshus J.; Pedersen T.;
Wilhelmsen L.; Braunwald E.; Cannon C.; Murphy S.; Armitage J.; Bowman L.;
Parish S.; Peto R.; Sleight P.; Landray M.; La Rosa J.; Rossouw J.;
Probstfield J.; Shepherd J.; Cobbe S.; Macfarlane P.; Ford I.; Flather M.;
Kastelein J.; Newman C.; Shear C.; Tobert J.; Varigos J.; White H.; Yusuf
S.; Barnes E.H.; Keech A.C.; Kirby A.; Marschner I.C.; Simes J.; Baigent
C.; Blackwell L.; Collins R.; Emberson J.; Herrington W.G.; Holland L.E.;
Reith C.
Institution
(Barnes, Keech, Kirby, Marschner, Simes) CTC, University of Sydney,
Australia
(Mihaylova, Baigent, Blackwell, Collins, Emberson, Herrington, Holland,
Reith) CTSU, University of Oxford, United Kingdom
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385 (9976) (pp 1397-1405), 2015. Date of Publication: 2015.
Publisher
Lancet Publishing Group
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. Methods: We performed meta-analyses on data from 22 trials
of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 1.0 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin
vs control trials and roughly 0.5 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 1.0 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99%
CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for
those women and men at less than 10% predicted 5 year absolute
cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the
proportional reductions in major coronary events, coronary
revascularisation, and stroke did not differ significantly by sex. No
adverse effect on rates of cancer incidence or non-cardiovascular
mortality was noted for either sex. These net benefits translated into
all-cause mortality reductions with statin therapy for both women (RR
0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted
heterogeneity p=0.43). Interpretation In men and women at an equivalent
risk of cardiovascular disease, statin therapy is of similar effectiveness
for the prevention of major vascular events.

<2>
Accession Number
2014706585
Author
Sannino A.; Losi M.A.; Schiattarella G.G.; Gargiulo G.; Perrino C.;
Stabile E.; Toscano E.; Giugliano G.; Brevetti L.; Franzone A.; Cirillo
P.; Imbriaco M.; Trimarco B.; Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Toscano,
Giugliano, Brevetti, Franzone, Cirillo, Imbriaco, Trimarco, Esposito)
Division of Cardiology, Department of Advanced Biomedical Sciences,
Federico II University, Naples, Italy
Title
Meta-analysis of mortality outcomes and mitral regurgitation evolution in
4,839 patients having transcatheter aortic valve implantation for severe
aortic stenosis.
Source
American Journal of Cardiology. 114 (6) (pp 875-882), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative
therapy in selected patients with severe aortic stenosis. The role and
effects of coexistent moderate to severe mitral regurgitation (msMR) in
patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839
patients who underwent TAVI, including patients with msMR, were considered
in a meta-analysis and analyzed for all-cause-mortality; a further
metaanalysis was performed to assess mitral regurgitation (MR) evolution
after TAVI. In patients with msMR, all-cause-mortality after TAVI was
significantly increased at 30-day (effect size [ES] L0.18, 95% confidence
interval [CI] L0.31 to L0.04, I2 [ 46.51, Q [ 7.48), 1-year (ES L0.22, 95%
CI L0.36 to L0.08, I2 [ 56.20, Q [ 11.41), and 2-year (ES L0.15, 95% CI
L0.27 to L0.02, I2 [ 0.00, Q [ 2.64) follow-up compared with patients with
absent or mild MR, independent of baseline left ventricular ejection
fraction. Interestingly, the impact of msMR on outcomes was statistically
stronger when the CoreValve system was used. TAVI was also associated with
an improvement in MR entity at 3- and 6-month follow-up (overall ES L0.19,
95% CI L0.37 to L0.01, I2 [ 61.52, Q [ 10.39). In conclusion, the presence
of preoperative msMR in patients with severe, symptomatic aortic stenosis
who undergo TAVI negatively affects outcomes after TAVI. In addition, in
the same group of patients, a trend toward a reduction in MR severity was
observed. Whether the decrease in MR severity affects mortality after TAVI
remains to be defined.

<3>
Accession Number
2015333515
Author
Ramesh C.; Pai V.B.; Patil N.; Nayak B.S.; George A.; George L.S.; Devi
E.S.
Institution
(Ramesh, Nayak, George, George, Devi) Manipal College of Nursing, Manipal
University, Manipal, India
(Pai, Patil) Kasturba Medical College, Manipal University, Manipal, India
Title
Effectiveness of massage therapy on post-operative outcomes among patients
undergoing cardiac surgery: A systematic review.
Source
International Journal of Nursing Sciences. 2 (3) (pp 304-312), 2015. Date
of Publication: September 2015.
Publisher
Chinese Nursing Association
Abstract
The incidence and prevalence of cardiovascular disease (CVD) are
increasing rapidly in developing countries. Most patients with CVD do not
respond to medical treatment and have to undergo cardiac surgery. This
highly stressful experience results in increased levels of anxiety for
patients. The objective of this review was to evaluate the efficacy of
massage therapy on postoperative outcomes among patients undergoing
cardiac surgery. A comprehensive literature search was made on
PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the
Cochrane library databases for original research articles published
between 2000 and 2015. Original articles that reported the efficacy of
massage therapy in patients undergoing cardiac surgery were included. The
Cochrane data extraction form was used to extract data. A total of 297
studies were identified in the literature search. However, only seven
studies were eligible for analysis. Of the seven studies, six studies
demonstrated the effects of massage therapy on improving post-operative
outcomes of patients, while one study found no evidence of improvement.
Although the methods varied considerably, most of the studies included in
this review reported positive results. Therefore, there is some evidence
that massage therapy can lead to positive postoperative outcomes. Evidence
of the effectiveness of massage therapy in patients undergoing cardiac
surgery remains inconclusive. Additional research is needed to provide a
strong evidence base for the use of massage therapy to improve
post-operative outcomes and recovery among cardiac surgery patients.

<4>
Accession Number
2012673219
Author
Mozaffarian D.; Marchioli R.; Macchia A.; Silletta M.G.; Ferrazzi P.;
Gardner T.J.; Latini R.; Libby P.; Lombardi F.; O'Gara P.T.; Page R.L.;
Tavazzi L.; Tognoni G.; Santini M.; Albert C.M.; Maggioni A.P.; Murray
K.T.; Harris B.; Saffitz J.E.; Siscovick D.; Stein P.; Corradi D.; Masson
S.; Brown N.J.; Ely E.W.; Jackson J.C.; Shintani A.; Milne G.L.; Song X.;
Sellke F.W.; Pioggiarella R.; Marfisi L.; King S.L.; Mills K.E.; Ogunleye
A.; Schelling N.H.; Wu J.; Simon C.; Iascone M.; Sinatra R.; Benedetto U.;
Dreas L.; Aleksova A.; Rinaldi M.; Salizzoni S.; Marchetto G.; Lamarra M.;
Pagliaro M.; Jori M.C.; Dozza L.; Calvi S.; Casabona R.; Zingarelli E.;
Flocco R.; Eusebio A.; Raffa G.; Tarelli G.; Parolari A.; Cavallotti L.;
Miyasoedova V.; Laguzzi F.; Gregorini R.; Mangia F.; Gazzoli F.; Raviola
E.; Vigano M.; Livi U.; Pompei E.; Salvador L.; Lamascese N.; Bilotta M.;
Martinelli L.; Cannata A.; Byrne J.; Leacche M.; Petracek M.R.; Ball S.K.;
Jessen M.E.; Weyant M.; Damiano R.J.; Singh A.K.; McDonald M.J.; Bolman
R.M.; Conboy D.A.; Burgess A.; Puskas J.D.; Vander-Woude J.; Bell M.C.;
Sethi G.; Lee D.C.; Favaloro R.R.; Hershson A.R.; Figal J.C.; Domenech A.;
Halac M.; Nicolosi L.N.; Moros C.G.; Del Carmen Rubio M.; Suarez R.F.;
Cacheda H.; Casal J.P.; Medrano J.C.; Cucurell M.C.; Scattini F.; Nojek
C.; Camporrotondo M.; Herrington D.M.; Brooks M.M.; De Caterina R.;
Gillinov M.; Padeletti L.; Pellegrini F.; Rothschild B.B.; Rubinstein F.;
Diep P.Q.; Guzman J.B.; Palmarini L.; Sacchetti S.; Flamminio A.V.;
Marfisi R.; Scarano M.; Afshin A.; Huang H.; Otite F.; Ambrosio M.;
Lincesso A.; Pezzoli L.; Anzini M.; Carriere C.; Belfiore R.; Fortunato
G.; Pellegrini A.; Reale V.; Sorrentino P.; Schiavina G.; Negrosanti M.;
Ravenni G.; Moro F.; Brambilla M.; Nava C.; Giroli M.; Daprati A.; Gennari
M.; Cusihuaman D.E.P.; Spagnolo B.; Francia M.; Stanca M.; Paris M.;
Berwick D.; Lusona B.; Castiglione N.; De Biasio M.; Daffarra C.; Ahmad
R.; Meisch C.A.; Maltais S.; Balaguer J.; Donahue T.; Guyton R.A.;
Thourani V.; Halkos M.; Lattouf O.; Baio K.T.; Levine S.R.; Pitts Z.E.;
Janssen K.; Ruhlman M.; Sharp S.; Pang K.; Mungo M.N.; Servian A.L.;
Battellini R.; Marenchino R.; Kotowicz V.; Cesareo V.; Sanchez R.; Romero
V.; Avila S.; Donnini F.; Biancospino L.; Laurino R.; Portalea R.
Institution
(Mozaffarian, Libby, O'Gara) Division of Cardiovascular Medicine, 665
Huntington Ave, Bldg 2-319, Boston, MA 02115, United States
(Mozaffarian, Libby, O'Gara, Albert, Saffitz, Bolman, Conboy, Burgess)
Channing Division of Network Medicine, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, 665 Huntington Ave, Bldg 2-319,
Boston, MA 02115, United States
(Mozaffarian) Department of Epidemiology and Nutrition, Harvard School of
Public Health, 665 Huntington Ave, Bldg 2-319, Boston, MA 02115, United
States
(Marchioli, Silletta, Tognoni, Pellegrini) Department of Clinical
Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Laboratory of
Clinical Epidemiology of Cardiovascular Disease, Via Nazionale 8,
Santa-Maria-Imbaro CH 66030, Italy
(Macchia) GESICA Foundation, Buenos-Aires, Argentina
(Ferrazzi, Simon, Iascone, Ambrosio, Lincesso, Pezzoli) Ospedali Riuniti
di Bergamo, Bergamo, Italy
(Gardner) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
(Latini, Masson) Department of Cardiovascular Research, Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Lombardi) Department of Health Sciences, University of Milan, Milan,
Italy
(Page) Department of Medicine, University of Wisconsin, School of Medicine
and Public Health, Madison, United States
(Tavazzi) GVM Hospitals of Care and Research, Villa Maria Cecilia
Hospital, Cotignola, Italy
(Santini) Ospedale San Filippo Neri, Rome, Italy
(Maggioni) Centro Studi Associazione Nazionale Medici Cardiologi
Ospedalieri, Florence, Italy
(Murray, Brown, Ely, Jackson, Shintani, Milne, Byrne, Leacche, Petracek,
Ball, Ahmad, Meisch, Maltais, Balaguer) Vanderbilt University, School of
Medicine, Nashville, TN, United States
(Harris) Sanford School of Medicine, Sioux Falls, SD, United States
(Siscovick) University of Washington, Seattle, United States
(Stein, Damiano, Donahue) Washington University, School of Medicine, St.
Louis, MO, United States
(Corradi) University of Parma, Parma, Italy
(Song, Diep, Guzman) Fred Hutchinson Cancer Research Center, Seattle, WA,
United States
(Sellke, Singh, McDonald) Brown Medical School, Rhode Island Hospital,
Providence, United States
(Silletta, Pioggiarella, Marfisi, Palmarini, Sacchetti, Flamminio,
Marfisi, Scarano) Main Data Coordinating Center, Consorzio Mario Negri
Sud, Santa-Maria-Imbaro, Italy
(King, Mills, Ogunleye, Schelling, Wu, Afshin, Huang, Otite) US Clinical
Coordinating Center, Harvard School of Public Health, Boston, MA, United
States
(Sinatra, Benedetto) Ospedale S. Andrea, Universita la Sapienza, Roma,
Italy
(Dreas, Aleksova, Anzini, Carriere, Belfiore) Ospedali Riuniti, University
of Trieste, Trieste, Italy
(Rinaldi, Salizzoni, Marchetto, Raviola, Fortunato, Pellegrini, Reale,
Sorrentino) Department of Surgical Sciences, Division of Cardiac Surgery,
University of Torino, Torino, Italy
(Lamarra, Pagliaro, Jori, Dozza, Calvi, Schiavina, Negrosanti) GVM Care
and Research, E.S. Health Science Foundation, Cotignola, Italy
(Casabona, Zingarelli, Flocco, Ravenni) Azienda Ospedaliera Ordine
Mauriziano di Torino, Ospedale Mauriziano Umberto I, Torino, Italy
(Eusebio, Raffa, Tarelli) Unit of Cardiac Surgery, Humanitas Clinical and
Research Center, Rozzano, Italy
(Parolari, Cavallotti, Miyasoedova, Laguzzi, Moro, Brambilla, Nava,
Giroli, Daprati, Gennari, Cusihuaman) Centro Cardiologico Monzino,
I.R.C.C.S., Milano, Italy
(Gregorini, Mangia, Spagnolo, Francia, Stanca) GVM Care and Research, E.S.
Health Science Foundation, Lecce, Italy
(Gazzoli, Raviola, Vigano, Paris, Berwick, Lusona, Castiglione) Fondazione
I.R.C.C.S. Policlinico S. Matteo, Pavia, Italy
(Livi, Pompei, De Biasio, Daffarra) Azienda Ospedaliero, Universitaria
Santa Maria della Misericordia, Udine, Italy
(Salvador, Lamascese, Bilotta) Ospedale San Bortolo, Vicenza, Italy
(Martinelli, Cannata) Niguarda Ca' Granda Hospital, Department of Cardiac
Surgery, Milan, Italy
(Jessen, Weyant) University of Texas Southwestern Medical Center, Dallas,
United States
(Puskas, Guyton, Thourani, Halkos, Lattouf, Baio, Levine, Pitts) Emory
Healthcare, Atlanta, GA, United States
(Vander-Woude, Bell, Janssen, Ruhlman) Sanford Health, Sanford University
of South Dakota Medical Center, Sioux Falls, United States
(Sethi, Sharp) University of Arizona, Tucson Medical Center, Tucson,
United States
(Lee, Pang) State University of New York Downstate, Brooklyn, United
States
(Favaloro, Hershson, Figal, Mungo, Servian) Fundacion Favaloro, Buenos
Aires, Argentina
(Domenech, Halac, Battellini, Marenchino, Kotowicz, Cesareo, Sanchez,
Romero, Avila) Hospital Italiano, Buenos Aires, Argentina
(Nicolosi, Moros, Del Carmen Rubio, Suarez, Donnini, Biancospino) Hospital
Espanol, Buenos Aires, Argentina
(Cacheda, Casal, Laurino, Portalea) Instituto de Cardiologia de
Corrientes, Corrientes, Argentina
(Medrano, Cucurell, Scattini) Clinica y Maternidadde Suizo, Buenos Aires,
Argentina
(Nojek, Camporrotondo) Instituto Fundacion de Lucha Contra Las
Enfermedades Neurologicas en la Infancia, Buenos Aires, Argentina
(Herrington) Wake Forest University, School of Medicine, Winston-Salem,
NC, United States
(Brooks) University of Pittsburgh, Pittsburgh, PA, United States
(De Caterina) Universita degli Studi G. d'Annunzio, Chieti, Italy
(Gillinov) Cleveland Clinic Main Campus, Cleveland, OH, United States
(Padeletti) University of Florence, Florence, Italy
(Rothschild) University of North Carolina, Chapel Hill, United States
(Rubinstein) IECS - Instituto de Efectividad Clinica y Sanitaria, Buenos
Aires, Argentina
Title
Fish oil and postoperative atrial fibrillation: The omega-3 fatty acids
for prevention of post-operative atrial fibrillation (OPERA) randomized
trial.
Source
JAMA - Journal of the American Medical Association. 308 (19) (pp
2001-2011), 2012. Date of Publication: 21 Nov 2012.
Publisher
American Medical Association
Abstract
Context: Postoperative atrial fibrillation or flutter (AF) is one of the
most common complications of cardiac surgery and significantly increases
morbidity and health care utilization. A few small trials have evaluated
whether long-chain n-3-polyunsaturated fatty acids (PUFAs) reduce
postoperative AF, with mixed results. Objective: To determine whether
perioperative n-3-PUFA supplementation reduces postoperative AF. Design,
Setting, and Patients: The Omega-3 Fatty Acids for Prevention of
Postoperative Atrial Fibrillation (OPERA) double-blind,
placebo-controlled, randomized clinical trial. A total of 1516 patients
scheduled for cardiac surgery in 28 centers in the United States, Italy,
and Argentina were enrolled between August 2010 and June 2012. Inclusion
criteria were broad; the main exclusions were regular use of fish oil or
absence of sinus rhythm at enrollment. Intervention: Patients were
randomized to receive fish oil (1-g capsules containing >840 mg n-3-PUFAs
as ethyl esters) or placebo, with preoperative loading of 10 g over 3 to 5
days (or 8 g over 2 days) followed postoperatively by 2 g/d until hospital
discharge or postoperative day 10, whichever came first. Main Outcome
Measure: Occurrence of postoperative AF lasting longer than 30 seconds.
Secondary end points were postoperative AF lasting longer than 1 hour,
resulting in symptoms, or treated with cardioversion; postoperative AF
excluding atrial flutter; time to first postoperative AF; number of AF
episodes per patient; hospital utilization; and majoradverse
cardiovascular events, 30-day mortality, bleeding, and other adverse
events. Results: At enrollment, mean age was 64 (SD, 13) years; 72.2% of
patients were men, and 51.8% had planned valvular surgery. The primary end
point occurred in 233 (30.7%) patients assigned to placebo and 227 (30.0%)
assigned to n-3-PUFAs (odds ratio, 0.96 [95% CI, 0.77-1.20]; P=74). None
of the secondary end points were significantly different between the
placebo and fish oil groups, including postoperative AF that was
sustained, symptomatic, or treated (231 [30.5%] vs224 [29.6%], P=70) or
number of postoperative AF episodes per patient (1 episode: 156 [20.6%] vs
157 [20.7%]; 2 episodes: 59 [7.8%] vs 49 [6.5%]; >3 episodes: 18 [2.4%] vs
21 [2.8%]) (P=.73). Supplementation with n-3-PUFAs was generally well
tolerated, with no evidence for increased risk of bleeding or serious
adverse events. Conclusion: In this large multinational trial among
patients undergoing cardiac surgery, perioperative supplementation with
n-3-PUFAs, compared with placebo, did not reduce the risk of postoperative
AF.

<5>
Accession Number
26436600
Author
Katsura M.; Kuriyama A.; Takeshima T.; Fukuhara S.; Furukawa T.A.
Institution
(Katsura, Kuriyama, Takeshima, Fukuhara, Furukawa) Department of
Healthcare Epidemiology, Kyoto University Graduate School of Medicine and
Public Health, Konoe-cho,, Yoshida, Sakyo-ku, Kyoto, Japan, 606-8501
Title
Preoperative inspiratory muscle training for postoperative pulmonary
complications in adults undergoing cardiac and major abdominal surgery.
Source
The Cochrane database of systematic reviews. 10 (pp CD010356), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) have an impact on
the recovery of adults after surgery. It is therefore important to
establish whether preoperative respiratory rehabilitation can decrease the
risk of PPCs and to identify adults who might benefit from respiratory
rehabilitation.
OBJECTIVES: Our primary objective was to assess the effectiveness of
preoperative inspiratory muscle training (IMT) on PPCs in adults
undergoing cardiac or major abdominal surgery. We looked at all-cause
mortality and adverse events.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL; 2014, Issue 10), MEDLINE (1966 to October 2014), EMBASE
(1980 to October 2014), CINAHL (1982 to October 2014), LILACS (1982 to
October 2014), and ISI Web of Science (1985 to October 2014). We did not
impose any language restrictions.
SELECTION CRITERIA: We included randomized controlled trials that compared
preoperative IMT and usual preoperative care for adults undergoing cardiac
or major abdominal surgery.
DATA COLLECTION AND ANALYSIS: Two or more review authors independently
identified studies, assessed trial quality, and extracted data. We
extracted the following information: study characteristics, participant
characteristics, intervention details, and outcome measures. We contacted
study authors for additional information in order to identify any
unpublished data.
MAIN RESULTS: We included 12 trials with 695 participants; five trials
included participants awaiting elective cardiac surgery and seven trials
included participants awaiting elective major abdominal surgery. All
trials contained at least one domain judged to be at high or unclear risk
of bias. Of greatest concern was the risk of bias associated with
inadequate blinding, as it was impossible to blind participants due to the
nature of the study designs. We could pool postoperative atelectasis in
seven trials (443 participants) and postoperative pneumonia in 11 trials
(675 participants) in a meta-analysis. Preoperative IMT was associated
with a reduction of postoperative atelectasis and pneumonia, compared with
usual care or non-exercise intervention (respectively; risk ratio (RR)
0.53, 95% confidence interval (CI) 0.34 to 0.82 and RR 0.45, 95% CI 0.26
to 0.77). We could pool all-cause mortality within postoperative period in
seven trials (431 participants) in a meta-analysis. However, the effect of
IMT on all-cause postoperative mortality is uncertain (RR 0.40, 95% CI
0.04 to 4.23). Eight trials reported the incidence of adverse events
caused by IMT. All of these trials reported that there were no adverse
events in both groups. We could pool the mean duration of hospital stay in
six trials (424 participants) in a meta-analysis. Preoperative IMT was
associated with reduced length of hospital stay (MD -1.33, 95% CI -2.53 to
-0.13). According to the Grades of Recommendation, Assessment, Development
and Evaluation (GRADE) Working Group guidelines for evaluating the impact
of healthcare interventions, the overall quality of studies for the
incidence of pneumonia was moderate, whereas the overall quality of
studies for the incidence of atelectasis, all-cause postoperative death,
adverse events, and duration of hospital stay was low or very low.
AUTHORS' CONCLUSIONS: We found evidence that preoperative IMT was
associated with a reduction of postoperative atelectasis, pneumonia, and
duration of hospital stay in adults undergoing cardiac and major abdominal
surgery. The potential for overestimation of treatment effect due to lack
of adequate blinding, small-study effects, and publication bias needs to
be considered when interpreting the present findings.

<6>
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Accession Number
26501386
Author
Turan A.; Belley-Cote E.P.; Vincent J.; Sessler D.I.; Devereaux P.J.;
Yusuf S.; van Oostveen R.; Cordova G.; Yared J.-P.; Yu H.; Legare J.-F.;
Royse A.; Rochon A.; Nasr V.; Ayad S.; Quantz M.; Lamy A.; Whitlock R.P.
Institution
(Turan, Belley-Cote, Vincent, Sessler, Devereaux, Yusuf, van Oostveen,
Cordova, Yared, Yu, Legare, Royse, Rochon, Nasr, Ayad, Quantz, Lamy,
Whitlock) From the Department of Outcomes Research, Anesthesiology
Institute, Cleveland Clinic, Cleveland, Ohio (A.T., D.I.S., J.-P.Y., V.N.,
S.A.); Departments of Clinical Epidemiology and Biostatistics (E.P.B.-C.,
P.J.D., A.L., R.P.W.) and Medicine (P.J.D., S.Y.), McMaster University,
Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton
Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.V.,
P.J.D., S.Y., A.L., R.P.W.); Department of Surgery, Population Health
Research Institute, Hamilton Health Sciences, McMaster University,
Hamilton, Ontario, Canada (R.v.O., G.C., A.L., R.P.W.); Department of
Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
(H.Y.); Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, Nova Scotia, Canada (J.-F.L.); Department of Surgery,
Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
(A. Royse); Department of Anesthesiology, Montreal Heart Institute,
Universite de Montreal, Montreal, Quebec, Canada (A. Rochon); and
Department of Surgery, London Health Sciences Centre, London, Ontario,
Canada (M.Q.)
Title
Methylprednisolone Does Not Reduce Persistent Pain after Cardiac Surgery.
Source
Anesthesiology. 123 (6) (pp 1404-1410), 2015. Date of Publication: 01 Dec
2015.
Abstract
BACKGROUND: Persistent incisional pain is common after cardiac surgery and
is believed to be in part related to inflammation and poorly controlled
acute pain. Methylprednisolone is a corticosteroid with substantial
antiinflammatory and analgesic properties and is thus likely to ameliorate
persistent surgical pain. Therefore, the authors tested the primary
hypothesis that patients randomized to methylprednisolone have less
persistent incisional pain than those given placebo.
METHODS: One thousand forty-three patients having cardiopulmonary bypass
for cardiac surgery via a median sternotomy were included in this substudy
of Steroids in Cardiac Surgery (SIRS) trial. Patients were randomized to
500 mg intraoperative methylprednisolone or placebo. Incisional pain was
assessed at 30 days and 6 months after surgery, and the potential risk
factors were also evaluated.
RESULTS: Methylprednisolone administration did not reduce pain at 30 days
or persistent incisional pain at 6 months, which occurred in 78 of 520
patients (15.7%) in the methylprednisolone group and in 88 of 523 patients
(17.8%) in the placebo group. The odds ratio for methylprednisolone was
0.93 (95% CI, 0.79 to 1.09, P = 0.37). Furthermore, there was no
difference in worst pain and average pain in the last 24 h, pain
interference with daily life, or use of pain medicine at 6 months. Younger
age, female sex, and surgical infections were associated with the
development of persistent incisional pain.
CONCLUSIONS: Intraoperative methylprednisolone administration does not
reduce persistent incisional pain at 6 months in patients recovering from
cardiac surgery.

<7>
Accession Number
25588568
Author
Zangrillo A.; Pappalardo F.; Dossi R.; Di Prima A.L.; Sassone M.E.; Greco
T.; Monaco F.; Musu M.; Finco G.; Landoni G.
Institution
(Zangrillo) Department of Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Zangrillo) Vita-Salute University San Raffaele of Milan, Via Olgettina,
58, 20132, Milan, Italy.
(Pappalardo) Department of Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Dossi) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Di Prima) Department of Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
ambra.diprima@gmail.com
(Sassone) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
antigone47@libero.itl
(Greco) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Monaco) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Musu) Department of Medical Sciences "M. Aresu", Cagliari University,
Bivio di Sestu 554, 09042, Monserrato, Cagliari, Italy.
mmusu@medicina.unica.it
(Finco) Department of Medical Sciences "M. Aresu", Cagliari University,
Bivio di Sestu 554, 09042, Monserrato, Cagliari, Italy.
(Landoni) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan, 20132, Italy.
(Landoni) Vita-Salute University San Raffaele of Milan, Via Olgettina, 58,
20132, Milan, Italy.
Title
Preoperative intra-aortic balloon pump to reduce mortality in coronary
artery bypass graft: a meta-analysis of randomized controlled trials.
Source
Critical care (London, England). 19 (pp 10), 2015. Date of Publication:
2015.
Abstract
METHODS: Potentially eligible trials were identified by searching the
Medline, Embase, Scopus, ISI Web of Knowledge and The Cochrane Library.
Searches were not restricted by language or publication status and were
updated in August 2014. Randomized controlled trials on preoperative
intra-aortic balloon pump in patients undergoing coronary artery bypass
grafting either with or without cardiopulmonary bypass were identified.
The primary end point was mortality at the longest follow-up available and
the secondary end point was 30-day mortality.
RESULTS: The eight included randomized clinical trials enrolled 625
patients (312 to the intra-aortic balloon pump group and 313 to control).
The use of intra-aortic balloon pump was associated with a significant
reduction in the risk of mortality (11 of 312 (3.5%) versus 33 of 313
(11%), risk ratio=0.38 (0.20 to 0.73), P for effect=0.004, P for
heterogeneity=0.7, I-square=0%, with eight studies included). The benefit
on mortality reduction was confirmed restricting the analysis to trials
with low risk of bias, to those reporting 30-day follow-up and to patients
undergoing coronary artery bypass graft surgery with cardiopulmonary
bypass.
CONCLUSIONS: Preoperative intra-aortic balloon pump reduces perioperative
and 30-day mortality in high-risk patients undergoing elective coronary
artery bypass grafting.
INTRODUCTION: The intra-aortic balloon pump is routinely used in cardiac
surgery; however, its impact on outcome is still a matter of debate and
several randomized trials have been published recently. We perform an
updated meta-analysis of randomized controlled trials that investigated
the use of preoperative intra-aortic balloon pump in adult patients
undergoing coronary artery bypass grafting.

<8>
Accession Number
25563826
Author
Ricci Z.; Haiberger R.; Pezzella C.; Garisto C.; Favia I.; Cogo P.
Institution
(Ricci) Department of Cardiology and Cardiac Surgery, Pediatric Cardiac
Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Piazza S.
Onofrio 4, 00165, Rome, Italy. z.ricci@libero.it
(Haiberger) Department of Cardiology and Cardiac Surgery, Pediatric
Cardiac Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS,
Piazza S. Onofrio 4, 00165, Rome, Italy. rhaiber31@gmail.com
(Pezzella) Department of Cardiology and Cardiac Surgery, Pediatric Cardiac
Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Piazza S.
Onofrio 4, 00165, Rome, Italy.
(Garisto) Department of Cardiology and Cardiac Surgery, Pediatric Cardiac
Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Piazza S.
Onofrio 4, 00165, Rome, Italy.
(Favia) Department of Cardiology and Cardiac Surgery, Pediatric Cardiac
Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Piazza S.
Onofrio 4, 00165, Rome, Italy.
(Cogo) Department of Cardiology and Cardiac Surgery, Pediatric Cardiac
Intensive Care Unit, Bambino Gesu Children's Hospital, IRCCS, Piazza S.
Onofrio 4, 00165, Rome, Italy.
Title
Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac
surgery: a randomized controlled trial.
Source
Critical care (London, England). 19 (pp 2), 2015. Date of Publication:
2015.
Abstract
INTRODUCTION: Clinical effects of furosemide (F) and ethacrynic acid (EA)
continuous infusion on urine output (UO), fluid balance, and renal,
cardiac, respiratory, and metabolic function were compared in infants
undergoing surgery for congenital heart diseases.
METHODS: A prospective randomized double-blinded study was conducted.
Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.
RESULTS: In total, 38 patients were enrolled in the F group, and 36, in
the EA group. No adverse reactions were recorded. UO at postoperative day
(POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h,
compared with the F group, 4.6 (2.3) ml/kg/h (P=0.002) but tended to be
similar in the two groups thereafter. Mean administered F dose was 0.33
(0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P<0.0001). Fluid
balance was significantly more negative in the EA group at postoperative
day 0: -43 (54) ml/kg/h versus -17 (32) ml/kg/h in the F group (P=0.01).
Serum creatinine, cystatin C and neutrophil gelatinase-associated
lipocalin levels and incidence of acute kidney injury did not show
significant differences between groups. Metabolic alkalosis occurred
frequently (about 70% of cases) in both groups, but mean bicarbonate level
was higher in the EA group: 27.8 (1.5) M in the F group versus 29.1 (2) mM
in the EA group (P=0.006). Mean cardiac index (CI) values were 2.6 (0.1)
L/min/m(2) in the F group compared with 2.98 (0.09) L/min/m(2) in the EA
group (P=0.0081). Length of mechanical ventilation was shorter in the EA
group, 5.5 (8.8) days compared with the F group, 6.7 (5.9) (P=0.06).
Length of Pediatric Cardiac Intensive Care Unit (PCICU) admission was
shorter in the EA group: 14 (19) days compared with 16 (15) in the F group
(P=0.046).
CONCLUSIONS: In cardiac surgery infants, EA produced more UO compared with
F on POD0. Generally, a smaller EA dose is required to achieve similar UO
than F. EA and F were safe in terms of renal function, but EA caused a
more-intense metabolic alkalosis. EA patients achieved better CI, and
shorter mechanical ventilation and PCICU admission time.
TRIAL REGISTRATION: Clinicaltrials.gov NCT01628731. Registered 24 June
2012.

<9>
Accession Number
25705899
Author
Billings F.T.; Petracek M.R.; Roberts L.J.; Pretorius M.
Institution
(Billings) Department of Anesthesiology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Petracek) Department of Cardiac Surgery, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Roberts) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University Medical School, Nashville, Tennessee, United States
of America; Department of Pharmacology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Pretorius) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University Medical School, Nashville, Tennessee, United States
of America; Department of Anesthesiology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
Title
Perioperative intravenous acetaminophen attenuates lipid peroxidation in
adults undergoing cardiopulmonary bypass: a randomized clinical trial.
Source
PloS one. 10 (2) (pp e0117625), 2015. Date of Publication: 2015.
Abstract
BACKGROUND: Cardiopulmonary bypass (CPB) lyses erythrocytes and induces
lipid peroxidation, indicated by increasing plasma concentrations of free
hemoglobin, F2-isoprostanes, and isofurans. Acetaminophen attenuates
hemeprotein-mediated lipid peroxidation, reduces plasma and urine
concentrations of F2-isoprostanes, and preserves kidney function in an
animal model of rhabdomyolysis. Acetaminophen also attenuates plasma
concentrations of isofurans in children undergoing CPB. The effect of
acetaminophen on lipid peroxidation in adults has not been studied. This
was a pilot study designed to test the hypothesis that acetaminophen
attenuates lipid peroxidation in adults undergoing CPB and to generate
data for a clinical trial aimed to reduce acute kidney injury following
cardiac surgery.
METHODS AND RESULTS: In a prospective double-blind placebo-controlled
clinical trial, sixty adult patients were randomized to receive
intravenous acetaminophen or placebo starting prior to initiation of CPB
and for every 6 hours for 4 doses. Acetaminophen concentrations measured
30 min into CPB and post-CPB were 11.9 +/- 0.6 mug/mL (78.9 +/- 3.9 muM)
and 8.7 +/- 0.3 mug/mL (57.6 +/- 2.0 muM), respectively. Plasma free
hemoglobin increased more than 15-fold during CPB, and haptoglobin
decreased 73%, indicating hemolysis. Plasma and urinary markers of lipid
peroxidation also increased during CPB but returned to baseline by the
first postoperative day. Acetaminophen reduced plasma isofuran
concentrations over the duration of the study (P = 0.05), and the
intraoperative plasma isofuran concentrations that corresponded to peak
hemolysis were attenuated in those subjects randomized to acetaminophen (P
= 0.03). Perioperative acetaminophen did not affect plasma concentrations
of F2-isoprostanes or urinary markers of lipid peroxidation.
CONCLUSIONS: Intravenous acetaminophen attenuates the increase in
intraoperative plasma isofuran concentrations that occurs during CPB,
while urinary markers were unaffected.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01366976.

<10>
Accession Number
26488559
Author
Elbarbary M.; Madani W.H.; Robertson-Malt S.
Institution
(Elbarbary, Madani, Robertson-Malt) King Abdulaziz Cardiac Center, PO Box
22490, Riyadh, Saudi Arabia, 11426
Title
WITHDRAWN: Prophylactic steroids for pediatric open heart surgery.
Source
The Cochrane database of systematic reviews. 10 (pp CD005550), 2015. Date
of Publication: 2015.

<11>
Accession Number
26052677
Author
Levsky J.M.; Spevack D.M.; Travin M.I.; Menegus M.A.; Huang P.W.; Clark
E.T.; Kim C.-W.; Hirschhorn E.; Freeman K.D.; Tobin J.N.; Haramati L.B.
Title
Coronary Computed Tomography Angiography Versus Radionuclide Myocardial
Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry: A
Randomized Trial.
Source
Annals of internal medicine. 163 (3) (pp 174-183), 2015. Date of
Publication: 04 Aug 2015.
Abstract
BACKGROUND: The role of coronary computed tomography angiography (CCTA) in
the management of symptomatic patients suspected of having coronary artery
disease is expanding. However, prospective intermediate-term outcomes are
lacking.
OBJECTIVE: To compare CCTA with conventional noninvasive testing.
DESIGN: Randomized, controlled comparative effectiveness trial.
(ClinicalTrials.gov: NCT00705458).
SETTING: Telemetry-monitored wards of an inner-city medical center.
PATIENTS: 400 patients with acute chest pain (mean age, 57 years); 63%
women; 54% Hispanic and 37% African-American; and low socioeconomic
status.
INTERVENTION: CCTA or radionuclide stress myocardial perfusion imaging
(MPI).
MEASUREMENTS: The primary outcome was cardiac catheterization not leading
to revascularization within 1 year. Secondary outcomes included length of
stay, resource utilization, and patient experience. Safety outcomes
included death, major cardiovascular events, and radiation exposure.
RESULTS: Thirty (15%) patients who had CCTA and 32 (16%) who had MPI
underwent cardiac catheterization within 1 year. Fifteen (7.5%) and 20
(10%) of these patients, respectively, did not undergo revascularization
(difference, -2.5 percentage points [95% CI, -8.6 to 3.5 percentage
points]; hazard ratio, 0.77 [CI, 0.40 to 1.49]; P = 0.44). Median length
of stay was 28.9 hours for the CCTA group and 30.4 hours for the MPI group
(P = 0.057). Median follow-up was 40.4 months. For the CCTA and MPI
groups, the incidence of death (0.5% versus 3%; P = 0.12), nonfatal
cardiovascular events (4.5% versus 4.5%), rehospitalization (43% versus
49%), emergency department visit (63% versus 58%), and outpatient
cardiology visit (23% versus 21%) did not differ. Long-term, all-cause
radiation exposure was lower for the CCTA group (24 versus 29 mSv; P <
0.001). More patients in the CCTA group graded their experience favorably
(P = 0.001) and would undergo the examination again (P = 0.003).
LIMITATION: This was a single-site study, and the primary outcome depended
on clinical management decisions.
CONCLUSION: The CCTA and MPI groups did not significantly differ in
outcomes or resource utilization over 40 months. Compared with MPI, CCTA
was associated with less radiation exposure and with a more positive
patient experience.
PRIMARY FUNDING SOURCE: American Heart Association.

<12>
[Use Link to view the full text]
Accession Number
26826179
Author
Bonaca M.P.; Gutierrez J.A.; Creager M.A.; Scirica B.M.; Olin J.; Murphy
S.A.; Braunwald E.; Morrow D.A.
Institution
(Bonaca) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.). mbonaca@partners.org
(Gutierrez) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Creager) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Scirica) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Olin) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Murphy) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Braunwald) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
(Morrow) From TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA(M.P.B., J.A.G., B.M.S., S.A.H., E.B., D.A.M.); Dartmouth-Hitchcock
Heart and Vascular Center, Geisel School of Medicine at Dartmouth,
Lebanon, NH(M.A.C.); and Wiener Cardiovascular Institute and Marie-Jose
and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School
of Medicine, New York, NY (J.O.)
Title
Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With
Peripheral Artery Disease: Results From the Trial to Assess the Effects of
Vorapaxar in Preventing Heart Attack and Stroke in Patients With
Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2degreeP-TIMI
50).
Source
Circulation. 133 (10) (pp 997-1005), 2016. Date of Publication: 08 Mar
2016.
Abstract
BACKGROUND: Patients with peripheral artery disease (PAD) are at
heightened risk of acute limb ischemia (ALI), a morbid event that may
result in limb loss. We investigated the causes, sequelae, and predictors
of ALI in a contemporary population with symptomatic PAD and whether
protease-activated receptor 1 antagonism with vorapaxar reduced ALI
overall and by type.
METHODS AND RESULTS: The Trial to Assess the Effects of Vorapaxar in
Preventing Heart Attack and Stroke in Patients With
Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2degreeP-TIMI
50) was a randomized, double-blind, placebo-controlled trial of vorapaxar
in stable patients, including 3787 with symptomatic PAD. ALI was a
prespecified adjudicated end point using a formal definition. A total of
150 ALI events occurred in 108 patients during follow-up (placebo 3-year
rate, 3.9%; 1.3% annualized). For patients with symptomatic PAD, previous
peripheral revascularization, smoking, and the ankle-brachial index were
predictive of ALI. The majority of ALI events occurred as a result of
surgical graft thrombosis (56%), followed by native vessel in situ
thrombosis (27%). Stent thrombosis and thromboembolism caused ALI in 13%
and 5%, respectively. Amputation occurred in 17.6% presenting with ALI.
Vorapaxar reduced first ALI events by 41% (hazard ratio, 0.58; 95%
confidence interval, 0.39-0.86; P=0.006) and total ALI events by 41% (94
versus 56 events; risk ratio, 0.59; 95% confidence interval, 0.38-0.93;
P=0.022). The efficacy of vorapaxar was consistent across types of ALI.
CONCLUSIONS: In selected patients with symptomatic PAD and without atrial
fibrillation, ALI occurs at a rate of 1.3%/y, is most frequently caused by
acute bypass graft thrombosis or in situ thrombosis of a diseased vessel,
and often results in limb loss. Vorapaxar reduces ALI in patients with
symptomatic PAD with consistency across type, including PAD resulting from
surgical graft thrombosis and in-situ thrombosis.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00526474.

<13>
Accession Number
26853953
Author
Damluji A.A.; Pomenti S.F.; Ramireddy A.; Al-Damluji M.S.; Alfonso C.E.;
Schob A.H.; Marso S.P.; Gilchrist I.C.; Moscucci M.; Kandzari D.E.; Cohen
M.G.
Institution
(Damluji) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida
(Pomenti) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida
(Ramireddy) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida
(Al-Damluji) Department of Internal Medicine, University of Connecticut,
Farmington, Connecticut
(Alfonso) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida
(Schob) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida
(Marso) Division of Cardiology, University of Texas Southwestern, Dallas,
Texas
(Gilchrist) Department of Medicine, Penn State Heart and Vascular
Institute, Hershey, Pennsylvania
(Moscucci) Department of Medicine, Cardiovascular Institute, Sinai
Hospital, Baltimore, Maryland Sinai Hospital, Baltimore, Maryland
(Kandzari) Division of Interventional Cardiology, Piedmont Heart
Institute, Atlanta, Georgia
(Cohen) Cardiovascular Division, Elaine and Sydney Sussman Cardiac
Catheterization Laboratory, University of Miami Miller School of Medicine,
Miami, Florida. Electronic address: mgcohen@med.miami.edu
Title
Influence of Total Coronary Occlusion on Clinical Outcomes (from the
Bypass Angioplasty Revascularization Investigation 2 DiabetesTrial).
Source
The American journal of cardiology. 117 (7) (pp 1031-1038), 2016. Date of
Publication: 01 Apr 2016.
Abstract
Our aim was to evaluate the influence of chronic total occlusions (CTOs)
on long-term clinical outcomes of patients with coronary heart disease and
diabetes mellitus. We evaluated patients with coronary heart disease and
diabetes mellitus enrolled in the Bypass Angioplasty Revascularization
Investigation 2 Diabetes, who underwent either prompt revascularization
(PR) with intensive medical therapy (IMT) or IMT alone according to the
presence or absence of CTO. Of 2,368 patients enrolled in the trial, 972
patients (41%) had CTO of coronary arteries. Of those, 482 (41%) and 490
(41%) were in the PR with IMT versus IMT only groups, respectively. In the
PR group, patients with CTO were more likely to be selected for the
coronary artery bypass grafting stratum (coronary artery bypass grafting
62% vs percutaneous coronary intervention 31%, p <0.001). Compared to the
non-CTO group, patients with CTO had more abnormal Q wave, abnormal ST
depression, and abnormal T waves. The myocardial jeopardy score was higher
in the CTO versus non-CTO group (52 [36 to 69] vs 37 [21 to 53], p
<0.001). After adjustment, 5-year mortality rate was significantly higher
in the CTO group in the entire cohort (hazard ratio [HR] 1.35, p = 0.013)
and in patients with CTO managed with IMT (HR 1.46, p = 0.031). However,
the adjusted risk of death was not increased in patients managed with PR
(HR 1.26, p = 0.180). In conclusion, CTO of coronary arteries is
associated with increased mortality in patients treated medically.
However, the presence of a CTO may not increase mortality in patients
treated with revascularization. Larger randomized trials are needed to
evaluate the effects of revascularization on long-term survival in
patients with CTO.

<14>
[Use Link to view the full text]
Accession Number
26808629
Author
Deschamps A.; Hall R.; Grocott H.; Mazer C.D.; Choi P.T.; Turgeon A.F.; de
Medicis E.; Bussieres J.S.; Hudson C.; Syed S.; Seal D.; Herd S.; Lambert
J.; Mutch A.; Turgeon A.; Denault A.; Todd A.; Jerath A.; Fayad A.;
Finnegan B.; Kent B.; Kennedy B.; Cuthbertson B.H.; Kavanagh B.; Warriner
B.; MacAdams C.; Lehmann C.; Fudorow C.; McCartney C.; McIsaac D.; Dubois
D.; Campbell D.; Mazer D.; Neilpovitz D.; Rosen D.; Cheng D.; Drapeau D.;
Dillane D.; Tran D.; Mckeen D.; Wijeysundera D.; Jacobsohn E.; Couture E.;
Alam F.; Abdallah F.; Ralley F.E.; Chung F.; Lellouche F.; Dobson G.;
Germain G.; Djaiani G.; Gilron I.; Hare G.; Bryson G.; Clarke H.; McDonald
H.; Roman-Smith H.; Yang H.; Douketis J.; Paul J.; Beaubien J.; Bussieres
J.; Pridham J.; Armstrong J.N.; Parlow J.; Murkin J.; Gamble J.; Duttchen
K.; Karkouti K.; Turner K.; Baghirzada L.; Szabo L.; Lalu M.; Wasowicz M.;
Bautista M.; Jacka M.; Murphy M.; Schmidt M.; Verret M.; Perrault M.-A.;
Beaudet N.; Buckley N.; Choi P.; MacDougall P.; Jones P.; Drolet P.;
Beaulieu P.; Taneja R.; Martin R.; George R.; Chun R.; McMullen S.;
Beattie S.; Sampson S.; Choi S.; Kowalski S.; McCluskey S.; Boet S.;
Ramsay T.; Saha T.; Mutter T.; Chowdhury T.; Uppal V.; Mckay W.
Institution
(Deschamps, Deschamps, Hall, Hall, Grocott, Grocott, Mazer, Choi, Turgeon,
de Medicis, de Medicis, Bussieres, Hudson, Hudson, Syed, Syed, Seal, Herd,
Lambert, Denault, Mutch, Turgeon, Denault, Todd, Jerath, Fayad, Finnegan,
Kent, Kennedy, Cuthbertson, Kavanagh, Warriner, MacAdams, Lehmann,
Fudorow, McCartney, McIsaac, Dubois, Campbell, Mazer, Neilpovitz, Rosen,
Cheng, Drapeau, Dillane, Tran, Mckeen, Wijeysundera, Jacobsohn, Couture,
Alam, Abdallah, Ralley, Chung, Lellouche, Dobson, Germain, Djaiani,
Gilron, Hare, Bryson, Clarke, McDonald, Roman-Smith, Yang, Douketis, Paul,
Beaubien, Bussieres, Pridham, Armstrong, Parlow, Murkin, Gamble, Duttchen,
Karkouti, Turner, Baghirzada, Szabo, Lalu, Wasowicz, Bautista, Jacka,
Murphy, Schmidt, Verret, Perrault, Beaudet, Buckley, Choi, MacDougall,
Jones, Drolet, Beaulieu, Taneja, Martin, George, Chun, McMullen, Beattie,
Sampson, Choi, Kowalski, McCluskey, Boet, Ramsay, Saha, Mutter, Chowdhury,
Uppal, Mckay) From the Department of Anesthesiology (A. Deschamps, A.
Denault) and Department of Intensive Care Medicine (A. Denault), Montreal
Heart Institute, University of Montreal, Montreal, Quebec, Canada;
Department of Anesthesiology and Critical Care Medicine, Queen Elizabeth
II Health Science Centre, Dalhousie University, Halifax, Canada (R.H.);
Department of Anesthesiology, University of Manitoba, St. Boniface
Hospital, Winnipeg, Manitoba, Canada (H.G.); Department of Anesthesia,
University of Toronto, Keenan Research Centre for Biomedical Science, Li
Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario,
Canada (C.D.M.); Department of Anesthesiology Pharmacology and
Therapeutics, University of British Columbia, Vancouver, British Columbia,
Canada (P.T.C.); Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, and Population Health and Optimal
Health Practices, CHU de Quebec Research Center, CHU de Quebec, Universite
Laval, Quebec City, Quebec, Canada (A.F.T.); Department of Anesthesiology,
CHU de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
(E.d.M.); Department of Anesthesiology, Institut universitaire de
cardiologie et de pneumologie de Quebec, Universite Laval, Quebec, Canada
(J.S.B.); Department of Anesthesiology, Ottawa Heart Institute, University
of Ottawa, Ottawa, Ontario, Canada (C.H.); Department of Anesthesiology,
McMaster University, Hamilton, Ontario, Canada (S.S.); Department of
Anesthesiology, Calgary Foothills Hospital, University of Calgary,
Calgary, Alberta, Canada (D.S.); Department of Anesthesiology, Vancouver
General Hospital, University of British Columbia, Vancouver, British
Columbia, Canada (S.H.); and Department of Social and Preventive Medicine,
University of Montreal, Montreal, Quebec, Canada (J.L.).Montreal Heart
Institute, Montreal, QuebecUniversity of Manitoba, Winnipeg,
ManitobaUniversite Laval, Quebec, QuebecPh.D., Montreal Heart Institute,
Montreal, Qu
Title
Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation
during High-risk Cardiac Surgery: A Randomized Controlled Feasibility
Trial.
Source
Anesthesiology. 124 (4) (pp 826-836), 2016. Date of Publication: 01 Apr
2016.
Abstract
METHODS: Eight Canadian sites randomized 201 patients between April 2012
and October 2013. The primary outcome was the success rate of reversing
cerebral desaturations below 10% relative to baseline in the intervention
group. Anesthesiologists were blinded to the cerebral saturation values in
the control group. Intensive care unit personnel were blinded to cerebral
saturation values for both groups. Secondary outcomes included the area
under the curve of cerebral desaturation load, enrolment rates, and a
30-day follow-up for adverse events.
RESULTS: Cerebral desaturations occurred in 71 (70%) of the 102
intervention group patients and 56 (57%) of the 99 control group patients
(P = 0.04). Reversal was successful in 69 (97%) of the intervention group
patients. The mean cerebral desaturation load (SD) in the operating room
was smaller for intervention group patients compared with control group
patients (104 [217] %.min vs. 398 [869] %.min, mean difference, -294; 95%
CI, -562 to -26; P = 0.03). This was also true in the intensive care unit
(P = 0.02). There were no differences in adverse events between the
groups.
CONCLUSIONS: Study sites were successful in reversal of desaturation,
patient recruitment, randomization, and follow-up in cardiac surgery,
supporting the feasibility of conducting a large multicenter RCT.
BACKGROUND: Cerebral oxygen desaturation during cardiac surgery has been
associated with adverse perioperative outcomes. Before a large multicenter
randomized controlled trial (RCT) on the impact of preventing
desaturations on perioperative outcomes, the authors undertook a
randomized prospective, parallel-arm, multicenter feasibility RCT to
determine whether an intervention algorithm could prevent desaturations.

<15>
Accession Number
26920599
Author
Nijenhuis V.J.; Bennaghmouch N.; Hassell M.; Baan J.; van Kuijk J.P.;
Agostoni P.; van 't Hof A.; Kievit P.C.; Veenstra L.; van der Harst P.;
van den Heuvel A.F.; den Heijer P.; Kelder J.C.; Deneer V.H.; van der Kley
F.; Onorati F.; Collet J.P.; Maisano F.; Latib A.; Huber K.; Stella P.R.;
Ten Berg J.M.
Institution
(Nijenhuis) Department of Cardiology, St Antonius Hospital, Nieuwegein,
the Netherlands
(Bennaghmouch) Department of Cardiology, St Antonius Hospital, Nieuwegein,
the Netherlands
(Hassell) Department of Cardiology, Academic Medical Centre, Amsterdam,
the Netherlands
(Baan) Department of Cardiology, Academic Medical Centre, Amsterdam, the
Netherlands
(van Kuijk) Department of Cardiology, St Antonius Hospital, Nieuwegein,
the Netherlands
(Agostoni) Department of Cardiology, St Antonius Hospital, Nieuwegein, the
Netherlands
(van 't Hof) Department of Cardiology, Isala Klinieken, Zwolle, the
Netherlands
(Kievit) Department of Cardiology, University Medical Centre St Radboud,
Nijmegen, the Netherlands
(Veenstra) Department of Cardiology, Medical University Centre,
Maastricht, the Netherlands
(van der Harst) Department of Cardiology, University Medical Centre,
Groningen, the Netherlands
(van den Heuvel) Department of Cardiology, University Medical Centre,
Groningen, the Netherlands
(den Heijer) Department of Cardiology, Amphia Hospital, Breda, the
Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein, the
Netherlands
(Deneer) Department of Clinical Pharmacy, St Antonius Hospital,
Nieuwegein, the Netherlands
(van der Kley) Department of Cardiology, University Medical Centre,
Leiden, the Netherlands
(Onorati) Department of Cardiac Surgery, University of Verona, Verona,
Italy
(Collet) Department of Cardiology, Hopital Universitaire Pitie
Salpetriere, Paris, France
(Maisano) Department of Cardiovascular Surgery, UniversitatsSpital Zurich,
Zurich, Switzerland
(Latib) Department of Cardiology, Universita Vita-Salute San Raffaele
Milano, Milan, Italy
(Huber) Department of Cardiology, Wilhelminenspital, Vienna, Austria
(Stella) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, the Netherlands
(Ten Berg) Department of Cardiology, St Antonius Hospital, Nieuwegein, the
Netherlands. Electronic address: j.ten.berg@antoniusziekenhuis.nl
Title
Rationale and design of POPular-TAVI: antiPlatelet therapy fOr Patients
undergoing Transcatheter Aortic Valve Implantation.
Source
American heart journal. 173 (pp 77-85), 2016. Date of Publication: 01 Mar
2016.
Abstract
BACKGROUND: Despite improving experience and techniques, ischemic and
bleeding complications after transcatheter aortic valve implantation
(TAVI) remain prevalent and impair survival. Current guidelines recommend
the temporary addition of clopidogrel in the initial period after TAVI to
prevent thromboembolic events. However, explorative studies suggest that
this is associated with a higher rate of major bleeding without a decrease
in thromboembolic complications.
METHODS: The POPular TAVI trial is a prospective randomized, controlled,
open-label multicenter clinical trial to test the hypothesis that
monotherapy with aspirin or oral anticoagulation (OAC) after TAVI is safer
than the addition of clopidogrel for 3 months, without compromising
clinical benefit. This trial encompasses 2 cohorts: cohort A, patients are
randomized 1:1 to aspirin vs aspirin + clopidogrel, and cohort B, patients
on OAC therapy are randomized 1:1 to OAC vs OAC + clopidogrel. Primary
outcome is freedom from non-procedure-related bleeding at 1 year.
Secondary net-clinical benefit outcome is freedom from the composite of
cardiovascular death, non-procedural-related bleeding, myocardial
infarction, or stroke at 1 year. The primary outcome is analyzed for
superiority, whereas the secondary outcome is analyzed for noninferiority.
Recruitment began in February 2014, and the trial will continue until a
total of 1,000 patients (684 expected in cohort A and 316 in cohort B) are
included and followed up for 1 year.
SUMMARY: The POPular TAVI trial (NCT02247128) is the first large
randomized controlled trial to test if monotherapy with aspirin or OAC vs
additional clopidogrel after TAVI reduces bleeding with a favorable
net-clinical benefit.

<16>
Accession Number
27219528
Author
Kuhn E.W.; Slottosch I.; Wahlers T.; Liakopoulos O.J.
Institution
(Kuhn, Slottosch, Wahlers, Liakopoulos) Department of Cardiothoracic
Surgery, Heart Center, University of Cologne, Kerpener Strasse 62,
Cologne, Germany, 50924
Title
WITHDRAWN: Preoperative statin therapy for patients undergoing cardiac
surgery.
Source
The Cochrane database of systematic reviews. (5) (pp CD008493), 2016. Date
of Publication: 2016.

<17>
Accession Number
26005776
Author
Abbasi S.H.; Mohammadinejad P.; Shahmansouri N.; Salehiomran A.; Beglar
A.A.; Zeinoddini A.; Forghani S.; Akhondzadeh S.
Institution
(Abbasi) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran; Family Health Research Center, Iranian Petroleum Industry
Health Research Institute, Tehran, Iran
(Mohammadinejad) Psychiatric Research Center, Roozbeh Psychiatric
Hospital, Tehran University of Medical Sciences, Tehran, Iran
(Shahmansouri) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Salehiomran) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Beglar) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran
(Zeinoddini) Psychiatric Research Center, Roozbeh Psychiatric Hospital,
Tehran University of Medical Sciences, Tehran, Iran
(Forghani) Razi Vaccine and Serum Research Institute, Karaj, Iran
(Akhondzadeh) Psychiatric Research Center, Roozbeh Psychiatric Hospital,
Tehran University of Medical Sciences, Tehran, Iran. Electronic address:
s.akhond@neda.net
Title
Simvastatin versus atorvastatin for improving mild to moderate depression
in post-coronary artery bypass graft patients: A double-blind,
placebo-controlled, randomized trial.
Source
Journal of affective disorders. 183 (pp 149-155), 2015. Date of
Publication: 01 Sep 2015.
Abstract
BACKGROUND: A decreased risk of developing depression has been reported
among statin users. Aside from their lipid-lowering effects, statins are
considered immunomodulatory agents and have protective effects against
oxidative stress and inflammation which are well known for their
association with depression. The aim of the present study was to compare
the probable antidepressant effects of simvastatin and atorvastatin among
post-coronary artery bypass graft (CABG) surgery patients with high and
low potentials for blood-brain-barrier penetration, respectively.
METHOD: Forty-six outpatients who had undergone CABG in the last 6 months
and suffered from mild to moderate depression participated in a parallel,
double-blind, placebo-controlled trial, and were randomized to undergo 6
weeks of treatment with either simvastatin (20mg/day) or atorvastatin
(20mg/day). Participants were evaluated using Hamilton depression rating
scale (HDRS) at baseline and weeks 3 and 6. The primary outcome was to
evaluate the efficacy of simvastatin in improving the depressive symptoms.
RESULT: General linear model repeated measures demonstrated significant
effect for timextreatment interaction on the HDRS scores [F (1.62,
71.06)=3.41, P=0.048]. There was no significant difference between the
treatment groups regarding the adverse events. No one experienced serious
adverse event.
LIMITATION: The limitations of the present study were its small sample
size and the short-term follow-up period.
CONCLUSION: Treatment with simvastatin seems to be well tolerated with
superior antidepressant effects compared to atorvastatin in post-CABG
patients. Long-term outcomes of this practice and its probable influence
on other psychological aspects are yet to be investigated in future
studies.
TRIAL REGISTRATION: Iranian registry of clinical trials
(http://www.irct.ir): IRCT201410271556N68.

<18>
Accession Number
26113391
Author
Thongprayoon C.; Cheungpasitporn W.; Srivali N.; Ungprasert P.;
Kittanamongkolchai W.; Greason K.L.; Kashani K.B.
Institution
(Thongprayoon, Cheungpasitporn, Srivali, Ungprasert, Kittanamongkolchai,
Greason, Kashani) Division of Nephrology and Hypertension, Mayo Clinic,
Rochester, Minn., USA
Title
Acute kidney injury after transcatheter aortic valve replacement: a
systematic review and meta-analysis.
Source
American journal of nephrology. 41 (4-5) (pp 372-382), 2015. Date of
Publication: 2015.
Abstract
BACKGROUND: The objective of this meta-analysis was to evaluate the risk
of acute kidney injury (AKI) in patients who underwent transcatheter
aortic valve replacement (TAVR).
METHODS: A literature search was performed using MEDLINE, EMBASE, the
Cochrane Database of Systematic Reviews and clinicaltrials.gov from
inception through October, 2014. Studies that reported relative risks,
ORs, or hazard ratios comparing the AKI risk in patients who underwent
TAVR versus those who underwent surgical aortic valve replacement were
included. We performed the pre-specified sensitivity analysis including
only propensity score-based studies. Mortality risk was evaluated among
the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95%
confidence interval (CI) were calculated using a random-effect, generic
inverse variance method.
RESULTS: Three randomized controlled trials (RCTs) with 1,852 patients and
14 cohort studies with 3,113 patients were analyzed to assess the AKI risk
in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing
TAVR were 0.65 (95% CI 0.36-1.15, I(2) = 75%) in the analysis of RCTs and
propensity score-based studies and 0.76 (95% CI 0.44-1.34, I(2) = 79%) in
the analysis of observational studies. Sensitivity analysis in RCTs and
propensity score-based studies using a standard AKI definition
demonstrated a significant association between TAVR and lower AKI risk (RR
0.35, 95% CI 0.25-0.50, I(2) = 0%). Our meta-analyses of RCTs and
propensity score-based studies did not find associations between TAVR and
reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79,
I(2) = 63%).
CONCLUSIONS: Our meta-analysis demonstrates an association between TAVR
and lower AKI risk.

<19>
Accession Number
26134462
Author
Pettersson H.; Faager G.; Westerdahl E.
Institution
(Pettersson, Faager, Westerdahl) Department of Neurobiology, Care Sciences
and Society, Division of Physiotherapy, Karolinska Institute, , Sweden
Title
Improved oxygenation during standing performance of deep breathing
exercises with positive expiratory pressure after cardiac surgery: A
randomized controlled trial.
Source
Journal of rehabilitation medicine. 47 (8) (pp 748-752), 2015. Date of
Publication: 01 Sep 2015.
Abstract
OBJECTIVE: Breathing exercises after cardiac surgery are often performed
in a sitting position. It is unknown whether oxygenation would be better
in the standing position. The aim of this study was to evaluate
oxygenation and subjective breathing ability during sitting vs standing
performance of deep breathing exercises on the second day after cardiac
surgery.
METHODS: Patients undergoing coronary artery bypass grafting (n=189) were
randomized to sitting (controls) or standing. Both groups performed 3x10
deep breaths with a positive expiratory pressure device. Peripheral oxygen
saturation was measured before, directly after, and 15 min after the
intervention. Subjective breathing ability, blood pressure, heart rate,
and pain were assessed.
RESULTS: Oxygenation improved significantly in the standing group compared
with controls directly after the breathing exercises (p<0.001) and after
15 min rest (p=0.027). The standing group reported better deep breathing
ability compared with controls (p=0.004). A slightly increased heart rate
was found in the standing group (p=0.047).
CONCLUSION: After cardiac surgery, breathing exercises with positive
expiratory pressure, performed in a standing position, significantly
improved oxygenation and subjective breathing ability compared with
sitting performance. Performance of breathing exercises in the standing
position is feasible and could be a valuable treatment for patients with
postoperative hypoxaemia.

<20>
Accession Number
25885876
Author
Gargiulo G.; Capodanno D.; Sannino A.; Perrino C.; Capranzano P.; Stabile
E.; Trimarco B.; Tamburino C.; Esposito G.
Institution
(Gargiulo) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Capodanno) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Sannino) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Perrino) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Capranzano) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Stabile) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Trimarco) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation,
Catania, Italy
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy. Electronic address:
espogiov@unina.it
Title
Impact of moderate preoperative chronic kidney disease on mortality after
transcatheter aortic valve implantation.
Source
International journal of cardiology. 189 (pp 77-78), 2015. Date of
Publication: 2015.

<21>
[Use Link to view the full text]
Accession Number
26656357
Author
Choi J.W.; JooAhn H.; Yang M.; Kim J.A.; Lee S.M.; Ahn J.H.
Institution
(Choi, JooAhn, Yang, Kim, Lee, Ahn) From the Department of Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School
of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea
Title
Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral
Oxygen Saturation in Thoracic Surgery: A Randomized Controlled Trial.
Source
Medicine. 94 (49) (pp e2212), 2015. Date of Publication: 01 Dec 2015.
Abstract
Fluid is usually restricted during thoracic surgery, and vasoactive agents
are often administered to maintain blood pressure. One-lung ventilation
(OLV) decreases arterial oxygenation; thus oxygen delivery to the brain
can be decreased. In this study, we compared phenylephrine and dopamine
with respect to maintaining cerebral oxygenation during OLV in major
thoracic surgery.Sixty-three patients undergoing lobectomies were randomly
assigned to the dopamine (D) or phenylephrine (P) group. The patients'
mean arterial pressure was maintained within 20% of baseline by a
continuous infusion of dopamine or phenylephrine. Maintenance fluid was
kept at 5 mL/kg/h. The depth of anesthesia was maintained with desflurane
1MAC and remifentanil infusion under bispectral index guidance. Regional
cerebral oxygen saturation (rScO2) and hemodynamic variables were recorded
using near-infrared spectroscopy and esophageal cardiac Doppler.The rScO2
was higher in the D group than the P group during OLV (OLV 60 min: 71 +/-
6% vs 63 +/- 12%; P = 0.03). The number of patients whose rScO2 dropped
more than 20% from baseline was 0 and 6 in the D and P groups,
respectively (P = 0.02). The D group showed higher cardiac output, but
lower mean arterial pressure than the P group (4.7 +/- 1.0 vs 3.9 +/- 1.2
L/min; 76.7 +/- 8.1 vs 84.5 +/- 7.5 mm Hg; P = 0.02, P = 0.02). Among the
variables, age, hemoglobin concentration, and cardiac output were
associated with rScO2 by correlation analysis.Dopamine was superior to
phenylephrine in maintaining cerebral oxygenation during OLV in thoracic
surgery.

<22>
Accession Number
25689550
Author
Bail D.H.
Institution
(Bail) Competence-Center Quality Assurance, Medical Service of Statutory
Healthcare Insurance, Tuebingen and Stuttgart, Germany
Title
(Meta)-analysis of safety and efficacy following edge-to-edge mitral valve
repair using the MitraClip system.
Source
Journal of interventional cardiology. 28 (1) (pp 69-75), 2015. Date of
Publication: 01 Feb 2015.
Abstract
OBJECTIVES: The authors investigated safety and efficacy of the
MitraClip-System (MCS) using a systematic analysis.
BACKGROUND: The safety and efficacy of the MCS continues to be debated,
and randomized trials are still lacking.
METHOD: A systematic literature search was conducted using common medical
and scientific databases. The following kinds of data were obtained: at
baseline, 30 days, 6 and 12 month post-procedure. For safety and efficacy
mortality-rate (survival), mitral regurgitation <2+ (MR), adverse event
rate (AE), NYHA class and reoperation-rate were documented. A
meta-analysis with quantitative summary was performed.
RESULTS: Twenty-six studies including 3821 patient's who were treated with
MCS, were analyzed. Weighted mean age was 73.9+/-2.3 years and
LogEuroScore was 25.2+/-6.0%. Post-procedural MR<2+ was achieved in 86.4%
and 66.3% of the patients were in NYHA class I/II within 30 days, AE-rate
was 18.3%, mortality-rate was 2.8% and reoperation-rate was 3.5%. Freedom
from MR>3+-4 was 80.2% (80.1%), from NYHA III/IV was 78.6% (66.1%) and
freedom from death was 82.6% (87.8%) and from reoperation 95.6% (88.6%) at
6 and 12 month.
CONCLUSION: Based on the analysis of the current literature treatment with
MCS is associated with good short-term success and low mortality. MCS is
safe and effective for patients with limited surgical options. The results
are comparable with open mitral valve repair (oMVR) but patients are
markedly older and have a higer risk profile than patients who undergo
oMVR. Prospective randomized controlled trials are warranted to determine
potential AEs, device durability and long-term follow-up.

<23>
Accession Number
25991422
Author
Ghatak A.; Bavishi C.; Cardoso R.N.; Macon C.; Singh V.; Badheka A.O.;
Padala S.; Cohen M.G.; Mitrani R.; O'Neill W.; De Marchena E.
Institution
(Ghatak) University of Miami, Miller School of Medicine, Miami, Florida
(Bavishi) Mount Sinai St. Luke's-Roosevelt Hospital, New York, New York
(Cardoso) University of Miami, Miller School of Medicine, Miami, Florida
(Macon) University of Miami, Miller School of Medicine, Miami, Florida
(Singh) University of Miami, Miller School of Medicine, Miami, Florida
(Badheka) Wayne State University, Detroit, Michigan
(Padala) Albany Medical Center, Albany, New York
(Cohen) University of Miami, Miller School of Medicine, Miami, Florida
(Mitrani) University of Miami, Miller School of Medicine, Miami, Florida
(O'Neill) Henry Ford Hospital, Detroit, Michigan
(De Marchena) University of Miami, Miller School of Medicine, Miami,
Florida
Title
Complications and Mortality in Patients Undergoing Transcatheter Aortic
Valve Replacement With Edwards SAPIEN & SAPIEN XT Valves: A Meta-Analysis
of World-Wide Studies and Registries Comparing the Transapical and
Transfemoral Accesses.
Source
Journal of interventional cardiology. 28 (3) (pp 266-278), 2015. Date of
Publication: 01 Jun 2015.
Abstract
INTRODUCTION: Both transfemoral (TF) and transapical (TA) routes are
utilized for Transcatheter Aortic Valve Replacement (TAVR) using Edwards
SAPIEN & SAPIEN XT valves. We intended to perform a meta-analysis
comparing the complication rates between these two approaches in studies
published before and after the standardized Valve Academic Research
Consortium (VARC) definitions.
METHODS: We performed a comprehensive electronic database search for
studies published until January 2014 comparing TF and TA approaches using
the Edwards SAPIEN/SAPIEN XT aortic valve. Studies were analyzed based on
the following endpoints: 1-year mortality, 30-day mortality, stroke, new
pacemaker implantation, bleeding, and acute kidney injury.
RESULTS: Seventeen studies were included in the meta-analysis. Patients
undergoing TA TAVR had a significantly higher logistic EuroSCORE
(24.6+/-12.9 vs. 21.3+/-12.0; P<0.001). The cumulative risks for 30-day
mortality (RR 0.61; 95%CI 0.46-0.81; P=0.001), 1-year mortality (RR 0.68;
95%CI 0.55-0.84; P<0.001), and acute kidney injury (RR 0.53; 95%CI
0.38-0.73; P<0.001) were significantly lower for patients undergoing TF as
compared to TA approach. Both approaches had a similar incidence of 30-day
stroke, pacemaker implantation, and major or life-threatening bleeding.
Studies utilizing the VARC definitions and those pre-dating VARC yielded
similar results.
CONCLUSION: This meta-analysis demonstrates a decreased 30-day and 1-year
mortality in TF TAVR as compared to TA TAVR. Post-procedure acute kidney
injury and the need for renal replacement therapy are also significantly
lower in the TF group. These differences hold true even after utilizing
the standardized Valve Academic Research Consortium criteria.

<24>
[Use Link to view the full text]
Accession Number
26962814
Author
Munnee K.; Bundhun P.K.; Quan H.; Tang Z.
Institution
(Munnee, Bundhun, Quan, Tang) From the Department of Oral and
Maxillofacial Surgery, Xiangya Hospital, Central South University,
Changsha, Hunan (KM, HQ, ZT, ); Institute of Cardiovascular Diseases, the
First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi,
People's Republic of China (PKB)
Title
Comparing the Clinical Outcomes Between Insulin-treated and
Non-insulin-treated Patients With Type 2 Diabetes Mellitus After Coronary
Artery Bypass Surgery: A Systematic Review and Meta-analysis.
Source
Medicine. 95 (10) (pp e3006), 2016. Date of Publication: 01 Mar 2016.
Abstract
Several studies have shown coronary artery bypass surgery (CABG) to be
beneficial in patients with type 2 diabetes mellitus (T2DM) and
multivessel coronary artery diseases. Patients with insulin-treated T2DM
(ITDM) are usually patients with poor glycemic control and are expected to
suffer more complications compared with patients with non-insulin-treated
T2DM (NITDM). However, the adverse clinical outcomes in patients with ITDM
and NITDM after CABG are still not very clear. Hence, to solve this issue,
we aim to compare the short-and long-term adverse clinical outcomes in a
larger number of patients with ITDM and NITDM after CABG,
respectively.Randomized controlled trials and observational studies
comparing the adverse clinical outcomes such as mortality, major adverse
events (MAEs), stroke, myocardial infarction, and repeated
revascularization in patients with ITDM and NITDM after CABG have been
searched from Medline, EMBASE, Cochrane, and PubMed databases. A
short-term follow-up (<30 days) and a long-term follow-up (>1 year) were
considered. Odds ratio (OR) with 95% confidence interval (CI) was used to
express the pooled effect on discontinuous variables and the pooled
analyses were performed with RevMan 5.3.Eleven studies involving a total
of 64,152 patients with T2DM (23,781 patients with ITDM and 40,371
patients with NITDM) have been included in this meta-analysis. During the
short-term follow-up period, patients with ITDM had a significantly higher
mortality (OR: 1.47; 95% CI: 1.33-1.61, P < 0.00001) and MAEs (OR: 1.66;
95% CI: 1.48-1.87, P < 0.00001). During the long-term follow-up period,
patients with ITDM still had a significantly higher rate of mortality,
MAEs, and stroke (OR: 1.23, 95% CI: 1.02-1.49, P = 0.03; OR: 1.50, 95% CI:
1.07-2.12, P = 0.02; OR: 1.39, 95% CI: 1.22-1.59, P < 0.00001,
respectively) after CABG. However, our results showed similar repeated
revascularization rate between the ITDM and NITDM groups after CABG (OR:
1.31, 95% CI: 0.81-2.12, P = 0.27).According to this study, patients with
ITDM had a significantly higher rate of mortality and MAEs compared with
patients with NITDM after CABG. Stroke was also significantly higher in
patients with ITDM during a long-term follow-up period. However, since the
result for the long-term mortality had a higher heterogeneity as compared
with the other subgroups, and because a similar revascularization rate was
observed between the ITDM and NITDM groups after CABG maybe because of a
limited number of patients analyzed, further studies still need to be
conducted to completely solve this issue.

<25>
Accession Number
20160546321
Author
Cassina T.; Putzu A.; Santambrogio L.; Villa M.; Licker M.
Institution
(Cassina, Putzu, Santambrogio, Villa) Department of Cardiac Anesthesia and
Intensive Care, Cardiocentro Ticino Foundation, Via Tesserete 48, Lugano
6900, Switzerland
(Licker) Department of Anesthesiology, Pharmacology and Intensive Care,
Faculty of Medicine, University Hospital of Geneva, Geneva 1206,
Switzerland
Title
Hemodynamic challenge to early mobilization after cardiac surgery: A pilot
study.
Source
Annals of Cardiac Anaesthesia. 19 (3) (pp 425-432), 2016. Date of
Publication: July-September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Active mobilization is a key component in fast-track surgical
strategies. Following major surgery, clinicians are often reluctant to
mobilize patients arguing that circulatory homeostasis would be impaired
as a result of myocardial stunning, fluid shift, and autonomic
dysfunction. Aims: We examined the feasibility and safety of a
mobilization protocol 12-24 h after elective cardiac surgery. Setting and
Design: This observational study was performed in a tertiary nonacademic
cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month
period, we prospectively evaluated the hemodynamic response to a
two-staged mobilization procedure in 53 consecutive patients. Before,
during, and after the mobilization, hemodynamics parameters were recorded,
including the central venous oxygen saturation (ScvO <inf>2</inf> ),
lactate concentrations, mean arterial pressure (MAP), heart rate (HR),
right atrial pressure (RAP), and arterial oxygen saturation (SpO
<inf>2</inf> ). Any adverse events were documented. Results: All patients
successfully completed the mobilization procedure. Compared with the
supine position, mobilization induced significant increases in arterial
lactate (34.6% [31.6%, 47.6%], P = 0.0022) along with reduction in RAP
(-33% [-21%, -45%], P < 0.0001) and ScvO <inf>2</inf> (-7.4% [-5.9%,
-9.9%], P = 0.0002), whereas HR and SpO <inf>2</inf> were unchanged.
Eighteen patients (34%) presented a decrease in MAP > 10% and nine of them
(17%) required treatment. Hypotensive patients experienced a greater
decrease in ScvO <inf>2</inf> (-18 +/- 5% vs. -9 +/- 4%, P = 0.004) with
similar changes in RAP and HR. All hemodynamic parameters, but arterial
lactate, recovered baseline values after resuming the horizontal position.
Conclusions: Early mobilization after cardiac surgery appears to be a safe
procedure as far as it is performed under close hemodynamic and clinical
monitoring in an intensive care setting.

<26>
Accession Number
20160546319
Author
Das D.; Sen C.; Goswami A.
Institution
(Das, Sen, Goswami) Department of Cardiac Anaesthesiology, Institute of
Postgraduate Medical Education and Research, Waves Apartment, 67 Beleghata
Main Road, Kolkata, West-Bengal 700 010, India
Title
Effect of Vitamin C on adrenal suppression by etomidate induction in
patients undergoing cardiac surgery: A randomized controlled trial.
Source
Annals of Cardiac Anaesthesia. 19 (3) (pp 410-417), 2016. Date of
Publication: July-September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Etomidate is usually preferred in the induction of cardiac
compromised patients due to its relative cardiovascular stability.
However, the use of this drug has been limited as etomidate induces
suppression of cortisol biosynthesis as a result of blockade of
11-beta-hydroxylation in the adrenal gland, mediated by the imidazole
radical of etomidate. This study was carried out to observe the effect of
Vitamin C on adrenal suppression after etomidate induction in patients
undergoing cardiac surgery. Materials and Methods: A total of 78 patients
were randomly distributed into two groups. Group-I received oral Vitamin C
(500 mg) twice daily and Group-II received antacid tablet as placebo twice
daily instead of Vitamin C for 7 consecutive days prior to surgery till
morning of surgery. Patients of both the groups induced with etomidate
(0.1-0.3 mg/kg). Blood cortisol was estimated at different points of time
till 24 ^th postinduction hour/blood lactate, glucose,
hemodynamic parameters, and perioperative outcomes were assessed. Results:
Data of seventy patients (n = 35 in each group) were finally analyzed.
Cortisol level is statistically significantly higher in Group-I (69.51 +/-
7.65) as compared to Group-II (27.74 +/- 4.72) (P < 0.05) in the 1
^st postinduction hour. In Group-II, cortisol was consistently
lower for 1 ^st 24 postinduction hour. Total adrenaline
requirement was statistically significantly high in Group-II. Time of
extubation, length of Intensive Care Unit stay arrhythmia was similar in
both the groups. Conclusion: Vitamin C effectively inhibits
etomidate-induced adrenal suppression in cardiac patients, thereby
etomidate can be used as a safe alternative for induction in cardiac
surgery under cardiopulmonary bypass when pretreated with Vitamin C.

<27>
Accession Number
20160288965
Author
Gabel B.C.; Schnell E.C.; Dettori J.R.; Jeyamohan S.; Oskouian R.
Institution
(Gabel, Jeyamohan, Oskouian) Swedish Neuroscience Institute, 1600 E.
Jefferson Street Jefferson Tower Suite 101, Seattle, WA 98122, United
States
(Schnell, Dettori) Spectrum Research Inc, Tacoma, WA, United States
Title
Pulmonary complications following thoracic spinal surgery: A systematic
review.
Source
Global Spine Journal. 6 (3) (pp 296-303), 2016. Date of Publication: 01
Jul 2016.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Study Design Systematic review Objective To determine the frequency of
pulmonary effusion, pneumothorax, and hemothorax in adult patients
undergoing thoracic corpectomy or osteotomy for any condition and to
determine if these frequencies vary by surgical approach (i.e., anterior,
posterior, or lateral). Methods Electronic databases and reference lists
of key articles were searched through September 21, 2015, to identify
studies specifically evaluating the frequency of pulmonary effusion,
pneumothorax, and hemothorax in patients undergoing thoracic spine
surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met
inclusion criteria. The frequency across studies of pulmonary effusion
ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to
50%. There was no clear pattern of pulmonary complications with respect to
surgical approach. Conclusions There is insufficient data to determine the
risk of pulmonary complications following anterior, posterior, or lateral
approaches to the thoracic spine. Methods for assessing pulmonary
complications were not well reported, and data is sparse.

<28>
Accession Number
20160513504
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Coexisting Mitral Regurgitation Impairs Survival After Transcatheter
Aortic Valve Implantation.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2270-2276), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background It remains unclear whether coexisting and untreated mitral
regurgitation (MR) affects survival after transcatheter aortic valve
implantation (TAVI) for aortic stenosis (AS). To summarize contemporary
evidence, we performed the first metaanalysis of adjusted observational
studies reporting post-TAVI mortality in patients with various grades of
MR. Methods MEDLINE and EMBASE were searched until February 2015, with a
bibliographic review of secondary sources. Eligible studies were
observational studies enrolling patients undergoing TAVI for AS and
reporting adjusted odds ratios (ORs), hazard ratios (HRs), or both for
early (30-day or in-hospital) all-cause mortality, overall all-cause
mortality, or both in patients with apparent (significant) versus
unapparent (nonsignificant) MR as outcomes. Results Sixteen eligible
studies enrolling a total of 13,672 patients undergoing TAVI for AS were
identified and included. Pooled analyses of eight studies (representing
9,356 patients) and 14 studies (representing 7,405 patients) respectively
demonstrated a statistically significant increase in early (OR 2.17; 95%
confidence interval [CI] 1.50 to 3.14; p < 0.0001) and overall all-cause
mortality (HR 1.81; 95% CI 1.37 to 2.40; p < 0.0001) in patients with
apparent relative to unapparent MR. The exclusion of any single study from
the analyses did not substantively alter the overall results of our
analyses, and there was no evidence of significant publication bias.
Conclusions Coexisting and untreated apparent (usually moderate or severe)
MR appears to be associated with an increase in both early and overall
mortality after TAVI for AS.

<29>
Accession Number
20160513446
Author
Kara I.; Koksal C.; Erkin A.; Sacli H.; Demirtas M.; Percin B.; Diler
M.S.; Kirali K.
Institution
(Kara, Erkin, Sacli, Percin, Diler, Kirali) Department of Cardiovascular
Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
(Koksal) Department of Cardiovascular Surgery, Kartal Kosuyolu Research
and Training Hospital, Kartal, Istanbul, Turkey
(Demirtas) Department of Cardiovascular Surgery, State Hospital of
Beyhekim, Konya, Turkey
Title
Outcomes of Mild to Moderate Functional Tricuspid Regurgitation in
Patients Undergoing Mitral Valve Operations: A Meta-Analysis of 2,488
Patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2398-2407), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
This meta-analysis examined the prognosis of patients who were found to
have mild to moderate functional tricuspid regurgitation during mitral
valve operations. Overall, this meta-analysis included 2,488 patients in
10 studies. Compared with the group without tricuspid valve annuloplasty,
the probability of not progressing to moderate to severe functional
tricuspid regurgitation was significantly higher in the tricuspid valve
annuloplasty group. A more aggressive surgical approach involving
concomitant tricuspid repair with mitral valve operations may be
considered to avoid the development of moderate to severe functional
tricuspid regurgitation in the follow-up.

<30>
Accession Number
20160513444
Author
Luthra S.; Leiva-Juarez M.M.; Taggart D.P.
Institution
(Luthra, Leiva-Juarez) Division of Cardiac Surgery, Corrigan Minehan Heart
Center, Massachusetts General Hospital, Boston, Massachusetts, United
States
(Taggart) Oxford Heart Center, John Radcliffe Hospital, Headley Way,
Oxford, United Kingdom
Title
Systematic Review of Therapies for Stable Coronary Artery Disease in
Diabetic Patients.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2383-2397), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Diabetes mellitus is a significant risk modifier for stable coronary
artery disease, causing patients to have more extensive and diffuse
lesions. Opposing treatment strategies remain a matter of debate. A
multiple database search was conducted and outcomes, lesion, and patient
characteristics were compared. Overall mortality, cardiac death, major
adverse cardiovascular and cerebrovascular events, and need for
revascularization were higher with percutaneous coronary intervention than
with coronary artery bypass graft surgery. Multivessel disease and high
Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac
Surgery (SYNTAX) scores were associated with better outcomes for coronary
artery bypass graft surgery.

<31>
Accession Number
20160513494
Author
Chaudhry U.A.R.; Harling L.; Sepehripour A.H.; Stavridis G.; Kokotsakis
J.; Ashrafian H.; Athanasiou T.
Institution
(Chaudhry, Harling, Sepehripour, Ashrafian, Athanasiou) Imperial College
London, London, United Kingdom
(Stavridis) Onassis Cardiac Surgery Centre, Athens, Greece
(Kokotsakis) Evangelismos General Hospital, Athens, Greece
Title
Beating-Heart Versus Conventional On-Pump Coronary Artery Bypass Grafting:
A Meta-Analysis of Clinical Outcomes.
Source
Annals of Thoracic Surgery. 100 (6) (pp 2251-2260), 2015. Date of
Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Beating-heart on-pump coronary artery bypass grafting
(BH-ONCAB) offers a hybrid coronary revascularization technique that may
confer the benefits of an "off-pump" operation while maintaining the
hemodynamic stability and mechanical support of conventional on-pump CABG
(C-ONCAB). This study aimed to identify whether BH-ONCAB confers a
morbidity or mortality benefit over C-ONCAB in the immediate and midterm
postoperative period. Methods A systematic literature review identified 13
studies incorporating 3,930 patients (937 BH-ONCAB; 2,993 C-ONCAB)
fulfilling our inclusion criteria. Outcomes were meta-analyzed using
random-effects modelling. Between-study heterogeneity was investigated
through quality assessment, subgroup, and risk of bias analysis. Results
No difference was seen in overall 30-day mortality (13 studies; odds
ratio, 0.60; 95% confidence interval, 0.32 to 1.14; p = 0.12), or midterm
survival (5 studies; hazard ratio, 0.65; 95% confidence interval, 0.22 to
1.88; p = 0.43) between BH-ONCAB and C-ONCAB. BH-ONCAB was associated with
significantly fewer postoperative myocardial infarction events (odds
ratio, 0.32; 95% confidence interval, 0.11 to 0.92; p = 0.03); however, no
significant difference was observed in other postoperative morbidity
outcomes. Intraoperatively, BH-ONCAB resulted in significantly less
intraaortic balloon pump use, shorter cardiopulmonary bypass time, and
less blood loss. The number of anastomoses and vessels grafted were not
significantly different between BH-ONCAB and C-ONCAB. Conclusions BH-ONCAB
is a safe and comparable alternative to C-ONCAB in terms of early
mortality and late survival. Furthermore, BH-ONCAB may confer a particular
advantage in preventing perioperative myocardial infarction and reducing
overall blood loss. Future work should focus on larger matched studies and
multicenter randomized controlled trials that risk-stratify patients
according to preoperative ventricular function and renal insufficiency to
allow us to optimize our surgical revascularization strategy in these
high-risk patients.

<32>
Accession Number
20160536736
Author
Pouwels S.; Hageman D.; Gommans L.N.M.; Willigendael E.M.; Nienhuijs S.W.;
Scheltinga M.R.; Teijink J.A.W.
Institution
(Pouwels, Hageman, Gommans, Nienhuijs, Teijink) Department of Surgery,
Catharina Hospital, Eindhoven, Netherlands
(Pouwels, Hageman, Gommans, Teijink) Department of Epidemiology, CAPHRI
Research School, Maastricht University, Maastricht, Netherlands
(Willigendael) Department of Surgery, Medisch Spectrum Twente, Enschede,
Netherlands
(Scheltinga) CARIM Research School, Maastricht University, Maastricht,
Netherlands
(Scheltinga) Department of Vascular Surgery, Maxima Medical Centre,
Veldhoven, Netherlands
Title
Preoperative exercise therapy in surgical care: a scoping review.
Source
Journal of Clinical Anesthesia. 33 (pp 476-490), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc.
Abstract
Objectives Several systematic reviews have focused on the role of
preoperative exercise therapy (PET) in various fields of surgical care.
Aims of the present scoping review are to summarize research findings and
to identify gaps in existing literature. Methods Two authors independently
conducted a comprehensive literature search on systematic reviews
regarding PET. The risk of bias was assessed using "the methodology
checklist for systematic reviews and meta-analyses of the Scottish
Intercollegiate Guidelines Network (SIGN)." Findings of the included
systematic reviews were summarized according to type of surgery and type
of PET. Results Twenty-one reviews on PET with a low risk of bias were
included. Seven reviews investigated PET in multiple surgical fields and
14 in just a single surgical field. PET was studied before cardiac surgery
(n = 9), orthopedic surgery (n = 8), abdominal surgery (n = 8), thoracic
surgery (n = 8), vascular surgery (n = 3), and urologic surgery (n = 1).
Conclusion Overall, it seems that PET exerts beneficial effects on
physical fitness and postoperative outcome measures. Gaps in current
literature are the heterogeneity in selected patient populations and
outcome measures as well as lack of guidelines on the specific PET
regimes. Therefore, there is increasing need for multicenter randomized
trials with specifically designed PET programs and a carefully selected
patient population to strengthen current evidence.

<33>
Accession Number
20160532782
Author
Sorgaard M.; Linde J.J.; Hove J.D.; Petersen J.R.; Jorgensen T.B.S.;
Abdulla J.; Heitmann M.; Kragelund C.; Hansen T.F.; Udholm P.M.; Pihl C.;
Kuhl J.T.; Engstrom T.; Jensen J.S.; Hofsten D.E.; Kelbaek H.; Kofoed K.F.
Institution
(Sorgaard, Linde, Udholm, Pihl, Kuhl, Engstrom, Hofsten, Kofoed)
Department of Cardiology, The Heart Centre, University of Copenhagen,
Rigshospitalet, Copenhagen, Denmark
(Hove) Department of Cardiology, Hvidovre Hospital, University of
Copenhagen, Copenhagen, Denmark
(Petersen, Jorgensen) Department of Cardiology, Amager Hospital,
Copenhagen, University of Copenhagen, Copenhagen, Denmark
(Abdulla) Department of Medicine, Division of Cardiology, Glostrup
Hospital, University of Copenhagen, Copenhagen, Denmark
(Heitmann) Department of Cardiology, Bispebjerg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Kragelund) Department of Cardiology, Herlev Hospital, University of
Copenhagen, Copenhagen, Denmark
(Hansen, Jensen) Department of Cardiology, Gentofte Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Roskilde Sygehus, University of
Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Radiology, The Diagnostic Centre, University of
Copenhagen, Rigshospitalet, Copenhagen, Denmark
Title
Myocardial perfusion 320-row multidetector computed tomography-guided
treatment strategy for the clinical management of patients with recent
acute-onset chest pain: Design of the CArdiac cT in the treatment of acute
CHest pain (CATCH)-2 randomized controlled trial.
Source
American Heart Journal. 179 (pp 127-135), 2016. Date of Publication: 01
Sep 2016.
Publisher
Mosby Inc.
Abstract
Patients admitted with chest pain are a diagnostic challenge because the
majority does not have coronary artery disease (CAD). Assessment of CAD
with coronary computed tomography angiography (CCTA) is safe,
cost-effective, and accurate, albeit with a modest specificity. Stress
myocardial computed tomography perfusion (CTP) has been shown to increase
the specificity when added to CCTA, without lowering the sensitivity. This
article describes the design of a randomized controlled trial, CATCH-2,
comparing a clinical diagnostic management strategy of CCTA alone against
CCTA in combination with CTP. Methods Patients with acute-onset chest pain
older than 50 years and with at least one cardiovascular risk factor for
CAD are being prospectively enrolled to this study from 6 different
clinical sites since October 2013. A total of 600 patients will be
included. Patients are randomized 1:1 to clinical management based on CCTA
or on CCTA in combination with CTP, determining the need for further
testing with invasive coronary angiography including measurement of the
fractional flow reserve in vessels with coronary artery lesions. Patients
are scanned with a 320-row multidetector computed tomography scanner.
Decisions to revascularize the patients are taken by the invasive
cardiologist independently of the study allocation. The primary end point
is the frequency of revascularization. Secondary end points of clinical
outcome are also recorded. Discussion The CATCH-2 will determine whether
CCTA in combination with CTP is diagnostically superior to CCTA alone in
the management of patients with acute-onset chest pain.

<34>
Accession Number
20160545911
Author
Giblett J.P.; Axell R.G.; White P.A.; Clarke S.J.; McCormick L.; Read
P.A.; Reinhold J.; Brown A.J.; O'Sullivan M.; West N.E.J.; Dutka D.P.;
Hoole S.P.
Institution
(Giblett, McCormick, Read, Brown, O'Sullivan, West, Hoole) Papworth
Hospital, Department of Interventional Cardiology, Papworth Everard,
Cambridge CB23 3RE, United Kingdom
(Giblett, Clarke, Reinhold, Brown, Dutka) University of Cambridge,
Department of Cardiovascular Medicine, Cambridge, United Kingdom
(Axell, White) Addenbrooke's Hospital, Department of Clinical Engineering,
Cambridge, United Kingdom
Title
Glucagon-like peptide-1 derived cardioprotection does not utilize a
KATP-channel dependent pathway: Mechanistic insights from human supply and
demand ischemia studies.
Source
Cardiovascular Diabetology. 15 (1) (no pagination), 2016. Article Number:
99. Date of Publication: 19 Jul 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Glucagon-like peptide-1 (7-36) amide (GLP-1) protects against
stunning and cumulative left ventricular dysfunction in humans. The
mechanism remains uncertain but GLP-1 may act by opening mitochondrial
K-ATP channels in a similar fashion to ischemic conditioning. We
investigated whether blockade of K-ATP channels with glibenclamide
abrogated the protective effect of GLP-1 in humans. Methods: Thirty-two
non-diabetic patients awaiting stenting of the left anterior descending
artery (LAD) were allocated into 4 groups (control, glibenclamide, GLP-1,
and GLP-1 + glibenclamide). Glibenclamide was given orally prior to the
procedure. A left ventricular conductance catheter recorded
pressure-volume loops during a 1-min low-pressure balloon occlusion (BO1)
of the LAD. GLP-1 or saline was then infused for 30-min followed by a
further 1-min balloon occlusion (BO2). In a non-invasive study, 10
non-diabetic patients were randomized to receive two dobutamine stress
echocardiograms (DSE) during GLP-1 infusion with or without oral
glibenclamide pretreatment. Results: GLP-1 prevented stunning even with
glibenclamide pretreatment; the DELTA % dP/dt<inf>max</inf> 30-min
post-BO1 normalized to baseline after GLP-1: 0.3 +/- 6.8 % (p = 0.02) and
GLP-1 + glibenclamide: -0.8 +/- 9.0 % (p = 0.04) compared to control:
-11.5 +/- 10.0 %. GLP-1 also reduced cumulative stunning after BO2: -12.8
+/- 10.5 % (p = 0.02) as did GLP-1 + glibenclamide: -14.9 +/- 9.2 % (p =
0.02) compared to control: -25.7 +/- 9.6 %. Glibenclamide alone was no
different to control. Glibenclamide pretreatment did not affect global or
regional systolic function after GLP-1 at peak DSE stress (EF 74.6 +/- 6.4
vs. 74.0 +/- 8.0, p = 0.76) or recovery (EF 61.9 +/- 5.7 vs. 61.4 +/- 5.6,
p = 0.74). Conclusions: Glibenclamide pretreatment does not abrogate the
protective effect of GLP-1 in human models of non-lethal myocardial
ischemia. Trial registration Clinicaltrials.gov Unique Identifier:
NCT02128022

<35>
Accession Number
20160525012
Author
Bonaca M.P.; Bhatt D.L.; Storey R.F.; Steg P.G.; Cohen M.; Kuder J.;
Goodrich E.; Nicolau J.C.; Parkhomenko A.; Lopez-Sendon J.; Dellborg M.;
Dalby A.; Spinar J.; Aylward P.; Corbalan R.; Abola M.T.B.; Jensen E.C.;
Held P.; Braunwald E.; Sabatine M.S.
Institution
(Bonaca, Bhatt, Kuder, Goodrich, Braunwald, Sabatine) TIMI Study Group,
Brigham and Women's Hospital Heart & Vascular Center, Boston,
Massachusetts, United States
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Steg) French Alliance for Cardiovascular Trials, Universite
Paris-Diderot, Paris, France
(Cohen) Cardiovascular Division, Newark Beth Israel Medical Center, Icahn
School of Medicine at Mount Sinai, New York, New York, United States
(Nicolau) Heart Institute (InCor)-University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Lopez-Sendon) Hospital Universitario La Paz, Instituto de Investigacion
La Paz, Madrid, Spain
(Dellborg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Dalby) Life Fourways Hospital, Randburg, South Africa
(Spinar) University Hospital, Jihlavska, Brno, Czech Republic
(Aylward) Division of Medicine, Cardiac & Critical Care Services, Flinders
Medical Centre, South Australia, Australia
(Corbalan) Cardiovascular Division, Pontificia Universidad Catolica de
Chile, Santiago, Chile
(Abola) Philippine Heart Center, University of the Philippines College of
Medicine, Manila, Philippines
(Jensen, Held) AstraZeneca R&D, Molndal, Sweden
Title
Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction
in Patients With Peripheral Artery Disease.
Source
Journal of the American College of Cardiology. 67 (23) (pp 2719-2728),
2016. Date of Publication: 2016.
Publisher
Elsevier USA
Abstract
Background Peripheral artery disease (PAD) is associated with heightened
ischemic and bleeding risk in patients with prior myocardial infarction
(MI). Objectives This study evaluated the efficacy and safety of
ticagrelor on major cardiovascular (CV) events and major adverse limb
events in patients with PAD and a prior MI. Methods PEGASUS-TIMI 54
(Prevention of Cardiovascular Events in Patients With Prior Heart Attack
Using Ticagrelor Compared to Placebo on a Background of
Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162
patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily,
ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose
aspirin. History of PAD was obtained at baseline. Occurrences of major
adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke)
and major adverse limb events (MALE) (defined as acute limb ischemia or
peripheral revascularization for ischemia) were recorded in follow-up.
Results A total of 1,143 patients (5%) had known PAD. In the placebo arm,
those with PAD (n = 404) had higher rates of MACE at 3 years than those
without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after
adjusting for baseline differences (adjusted hazard ratio: 1.60; 95%
confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute
limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures
(9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with
ticagrelor was consistent, regardless of PAD, patients with PAD had a
greater absolute risk reduction of 4.1% (number needed to treat: 25) due
to their higher absolute risk. The absolute excess of TIMI major bleeding
was 0.12% (number needed to harm: 834). The 60-mg dose had particularly
favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled
doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence
interval: 0.44 to 0.95; p = 0.026). Conclusions Among stable patients with
prior MI, those with concomitant PAD have heightened ischemic risk. In
these patients, ticagrelor reduced MACE, with a large absolute risk
reduction, and MALE. (Prevention of Cardiovascular Events in Patients With
Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of
Aspirin [PEGASUS-TIMI 54]; NCT01225562)

<36>
[Use Link to view the full text]
Accession Number
20160387923
Author
Beck-Schimmer B.; Bonvini J.M.; Braun J.; Seeberger M.; Neff T.A.; Risch
T.J.; Stuber F.; Vogt A.; Weder W.; Schneiter D.; Filipovic M.; Puhan M.
Institution
(Beck-Schimmer, Bonvini) Institute of Anesthesiology, University Hospital
Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
(Weder, Schneiter) Department of Thoracic Surgery, University Hospital
Zurich, Zurich, Switzerland
(Beck-Schimmer) Institute of Physiology, Zurich Center for Integrative
Human Physiology, University of Zurich, Zurich, Switzerland
(Braun, Puhan) Epidemiology,Biostatistics and Prevention Institute,
University of Zurich, Zurich, Switzerland
(Beck-Schimmer) Department of Anesthesiology, University of Illinois,
College of Medicine, Chicago, IL, United States
(Seeberger) Department of Anesthesia, Surgical Intensive Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Neff, Risch) Department of Anesthesiology and Intensive Care Medicine,
Kantonsspital Muensterlingen (Cantonal Hospital of Muensterlingen),
Muensterlingen, Switzerland
(Stuber, Vogt) Department of Anesthesiology and Pain Medicine, University
Hospital Bern, Bern, Switzerland
(Filipovic) Division of Anesthesiology, Intensive Care, Rescue and Pain
Medicine, Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), St.
Gallen, Switzerland
(Seeberger) Institute of Anesthesia and Intensive Care, Klinik Hirslanden
Zurich, Zurich, Switzerland
Title
Which anesthesia regimen is best to reduce morbidity and mortality in lung
surgery?.
Source
Anesthesiology. 125 (2) (pp 313-321), 2016. Date of Publication: 01 Aug
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: One-lung ventilation during thoracic surgery is associated
with hypoxia-reoxygenation injury in the deflated and subsequently
reventilated lung. Numerous studies have reported volatile
anesthesia-induced attenuation of inflammatory responses in such
scenarios. If the effect also extends to clinical outcome is yet
undetermined. We hypothesized that volatile anesthesia is superior to
intravenous anesthesia regarding postoperative complications. Methods:
Five centers in Switzerland participated in the randomized controlled
trial. Patients scheduled for lung surgery with one-lung ventilation were
randomly assigned to one of two parallel arms to receive either propofol
or desflurane as general anesthetic. Patients and surgeons were blinded to
group allocation. Time to occurrence of the first major complication
according to the Clavien-Dindo score was defined as primary (during
hospitalization) or secondary (6-month follow-up) endpoint. Cox regression
models were used with adjustment for prestratification variables and age.
Results: Of 767 screened patients, 460 were randomized and analyzed (n =
230 for each arm). Demographics, disease and intraoperative
characteristics were comparable in both groups. Incidence of major
complications during hospitalization was 16.5% in the propofol and 13.0%
in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75;
95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6
months from surgery was 40.4% in the propofol and 39.6% in the desflurane
groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to
1.28; P = 0.71). Conclusions: This is the first multicenter randomized
controlled trial addressing the effect of volatile versus intravenous
anesthetics on major complications after lung surgery. No difference
between the two anesthesia regimens was evident.

<37>
Accession Number
20160540544
Author
Liu Z.; Xu Y.; Hao H.; Yin C.; Xu J.; Li J.; Wang Y.; Xu D.
Institution
(Liu, Hao, Yin, Xu, Li, Wang, Xu) Division of Cardiology, Xuanwu Hospital
Capital Medical University, Beijing, China
(Xu) Division of Neurosurgery, Xuanwu Hospital Capital Medical University,
Beijing, China
Title
Efficacy of high intensity atorvastatin versus moderate intensity
atorvastatin for acute coronary syndrome patients with diabetes mellitus.
Source
International Journal of Cardiology. 222 (pp 22-26), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To investigate whether more benefits can be achieved through
high intensity atorvastatin compared with moderate intensity atorvastatin
in acute coronary syndrome (ACS) patients with diabetes mellitus (DM).
Methods This was a randomized controlled trail. Total 591 ACS patients
with DM who underwent percutaneous coronary intervention were enrolled,
297 in high intensity atorvastatin group (40 mg/day) and 294 in moderate
intensity atorvastatin group (20 mg/day). The primary end point was
one-year incidence of major adverse cardiovascular events (MACE, including
cardiovascular death, spontaneous myocardial infarction, unplanned
revascularization). Cox proportional hazard regression models were used to
analyze the association between clinical endpoints and atorvastatin
treatment. Results At the end of one-year, low-density lipoprotein
cholesterol level was lower in high intensity group than in moderate group
(1.6 +/- 0.6 vs 1.8 +/- 0.6, p = 0.041). MACE in high intensity group
decreased 44.5% than moderate group (8.4% vs. 14.6%, p = 0.018). The
adjusted hazard ratio (HR) for MACE in patients with atorvastatin 40 mg/d
was lower compared to patients with atorvastatin 20 mg/d (HR [95% CI] 0.61
[0.36 to 0.91], p = 0.026). The rates of adverse events were no
significantly different between the two groups. Conclusions For ACS
patients with DM, high intensity atorvastatin induced better long-term
outcomes compared with moderate intensity.

<38>
Accession Number
20160536859
Author
Mukete B.N.; van der Heijden L.C.; Tandjung K.; Baydoun H.; Yadav K.;
Saleh Q.A.; Doggen C.J.M.; Rafeh N.A.; Le Jemtel T.H.; von Birgelen C.
Institution
(Mukete, Baydoun, Yadav, Saleh, Rafeh, Le Jemtel) Division of Cardiology,
Department of Medicine, Tulane University School of Medicine, Heart and
Vascular Institute, New Orleans, LA, United States
(van der Heijden, Tandjung, von Birgelen) Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, Netherlands
(Doggen, von Birgelen) Health Technology and Services Research, MIRA
Institute for Biomedical Technology and Technical Medicine, University of
Twente, Enschede, Netherlands
Title
Safety and efficacy of everolimus-eluting bioresorbable vascular scaffolds
versus durable polymer everolimus-eluting metallic stents assessed at
1-year follow-up: A systematic review and meta-analysis of studies.
Source
International Journal of Cardiology. 221 (pp 1087-1094), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The Absorb bioresorbable vascular scaffold (BVS) was developed
to address long-term safety issues of metallic drug-eluting stents.
However, it may be associated with an increased event risk during the
first year. Methods A systematic literature search was performed (in
MEDLINE/PubMed, Cochrane CENTRAL, EMBASE, and scientific meeting
abstracts) to identify studies that compared BVS and cobalt-chromium
durable polymer everolimus-eluting stents (EES). For randomized clinical
trials and non-randomized propensity score matched studies that reported
1-year outcome data, fixed/random-effects models were used to generate
pooled estimates of outcomes, presented as odds ratios (OR) with
95%-confidence intervals (CI). Results The 1-year follow-up data of 6
trials with 5588 patients were analyzed. A device-oriented composite
endpoint (DOCE - cardiac death, target vessel myocardial infarction (MI),
or target lesion revascularization (TLR)) was reached by 308 BVS or EES
patients (195/3253 vs. 113/2315). Meta-analysis showed that patients who
received BVS had an increased risk of MI (4.3% vs. 2.3%; OR:1.63, 95%-CI:
1.18-2.25, p < 0.01) and definite-or-probable scaffold thrombosis (1.3%
vs. 0.6%; OR:2.10, 95%-CI: 1.13-3.87, p = 0.02). However, there was no
significant between-group difference in risk of DOCE (6.0% vs. 4.9%;
OR:1.19, 95%-CI: 0.94-1.52, p = 0.16), cardiac death (0.8% vs. 0.7%;
OR:1.14, 95%-CI: 0.54-2.39, p = 0.73), or TLR (2.5% vs. 2.5%; OR: 0.98,
95%-CI:0.69-1.40, p = 0.92). Conclusions During the first year of
follow-up, patients treated with BVS had a higher incidence of MI and
scaffold thrombosis. The risk of DOCE was not significantly different. As
BVS may pay off later, future robust data on long-term clinical outcome
will be of paramount importance.

<39>
[Use Link to view the full text]
Accession Number
20160552011
Author
Noelck N.; Papak J.; Freeman M.; Paynter R.; Low A.; Motu'apuaka M.; Kondo
K.; Kansagara D.
Institution
(Noelck, Papak, Kansagara) Department of Medicine, VA Portland Healthcare
System, Portland, OR, United States
(Noelck, Papak, Kansagara) Department of Medicine, Oregon Health and
Science University, Portland, OR, United States
(Freeman, Paynter, Low, Motu'apuaka, Kondo, Kansagara) VA Evidence-based
Synthesis Program, VA Portland Healthcare System, Portland, OR, United
States
Title
Effectiveness of left atrial appendage exclusion procedures to reduce the
risk of stroke: A systematic review of the evidence.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (4) (pp 395-405),
2016. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Atrial fibrillation is an important cause of cardioembolic
stroke. Oral anticoagulants (OAC) reduce stroke risk but increase the risk
of serious bleeding. Left atrial appendage (LAA) procedures have been
developed to isolate the LAA from circulating blood flow, as an
alternative to OAC. We conducted a systematic review of the benefits and
harms of surgical and percutaneous LAA exclusion procedures. Methods and
Results - We searched multiple data sources, including Ovid MEDLINE,
Cochrane, and Embase, through January 7, 2015. Of 2567 citations, 20
primary studies met prespecified inclusion criteria. We abstracted data on
patient characteristics, stroke, mortality, and adverse effects. We
assessed study quality and graded the strength of evidence using published
criteria. Trials found low-strength evidence that percutaneous LAA
exclusion confers similar risks of stroke and mortality as continued OAC,
but this evidence was limited to the Watchman device in patients eligible
for long-term OAC. Observational studies found moderate-strength evidence
of serious harms with a variety of percutaneous LAA procedures. There is
low-strength evidence that surgical LAA exclusion does not add significant
harm during heart surgery for another indication, but evidence on stroke
reduction is insufficient. Conclusions - There is limited evidence that
the Watchman device may be noninferior to long-term OAC in selected
patients. Data on effectiveness of LAA exclusion devices is lacking in
patients ineligible for long-term OAC. Percutaneous LAA devices are
associated with high rates of procedure-related harms. Although surgical
LAA exclusion during heart surgery does not seem to add incremental harm,
there is insufficient evidence of benefit.

<40>
[Use Link to view the full text]
Accession Number
20160544692
Author
Jensen L.O.; Thayssen P.; Maeng M.; Ravkilde J.; Krusell L.R.; Raungaard
B.; Junker A.; Terkelsen C.J.; Veien K.T.; Villadsen A.B.; Kaltoft A.;
Tilsted H.-H.; Hansen K.No.; Aaroe J.; Kristensen S.D.; Hansen H.S.;
Jensen S.E.; Madsen M.; Botker H.E.; Berencsi K.; Lassen J.F.;
Christiansen E.Ho.
Institution
(Jensen, Thayssen, Junker, Veien, Hansen, Hansen) Department of
Cardiology, Odense University Hospital, Sdr. Blvd 29, Odense C 5000,
Denmark
(Maeng, Krusell, Terkelsen, Kaltoft, Kristensen, Botker, Lassen,
Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Ravkilde, Raungaard, Villadsen, Tilsted, Aaroe, Jensen) Department of
Cardiology, Aalborg University Hospital, Aalborg, Denmark
(Madsen, Berencsi) Department of Clinical Epidemiology, Aarhus University,
Aalborg, Denmark
Title
Randomized comparison of a biodegradable polymer ultrathin strut
sirolimus-eluting stent with a biodegradable polymer biolimus-eluting
stent in patients treated with percutaneous coronary intervention.
Source
Circulation: Cardiovascular Interventions. 9 (7) (no pagination), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Coronary drug-eluting stents with biodegradable polymers have
been designed to improve safety and efficacy. Methods and Results - The
Scandinavian Organization for Randomized Trials With Clinical Outcome
(SORT OUT) VII trial - a large-scale registry-based randomized,
multicenter, single-blind, 2-arm, noninferiority trial - compared 2
biodegradable polymer drug-eluting stents: the thin-strut cobalt-chromium
sirolimus-eluting Orsiro stent and the stainless steel biolimus-eluting
Nobori stent in an all-comer patient population. The primary end point
target lesion failure was a composite of cardiac death, myocardial
infarction (not related to other than index lesion), or target lesion
revascularization within 1 year, analyzed by intention to treat
(noninferiority margin of 3.0%). Clinically driven event detection based
on Danish registries was used. A total of 1261 patients were assigned to
receive the sirolimus-eluting stent (1590 lesions) and 1264 patients to
the biolimus-eluting stent (1588 lesions). At 1 year, the composite end
point target lesion failure occurred in 48 patients (3.8%) in the
sirolimus-eluting group and in 58 patients (4.6%) in the biolimus-eluting
group (absolute risk difference, -0.78% [upper limit of 1-sided 95%
confidence interval, 0.61%]; P<0.0001). Rates of definite stent thrombosis
occurred in 5 (0.4%) of the sirolimus-eluting group compared with 15
(1.2%) biolimus-eluting stent-treated patients (rate ratio, 0.33; 95%
confidence interval, 0.12-0.92; P=0.034), which largely was attributable
to a lower risk of subacute definite stent thrombosis: 0.1% versus 0.6%
(rate ratio, 0.12; 95% confidence interval, 0.02-1.00; P=0.05).
Conclusions - The thin-strut sirolimus-eluting Orsiro stent was
noninferior to the biolimus-eluting Nobori stent in unselected patients
for target lesion failure at 1 year.

<41>
Accession Number
20160544687
Author
Glineur D.; Boodhwani M.; Hanet C.; De Kerchove L.; Navarra E.; Astarci
P.; Noirhomme P.; El Khoury G.
Institution
(Glineur, Boodhwani, Hanet, De Kerchove, Navarra, Astarci, Noirhomme, El
Khoury) Department of Cardiovascular Medicine and Surgery, Cliniques
Universitaires St Luc, Brussels, Belgium
(Glineur, Boodhwani) Division of Cardiac Surgery, University of Ottawa
Heart institute, Ottawa Heart Institute, Ottawa, Canada
Title
Bilateral internal thoracic artery configuration for coronary artery
bypass surgery.
Source
Circulation: Cardiovascular Interventions. 9 (7) (no pagination), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Bilateral internal thoracic arteries (BITA) have demonstrated
superior patency and improved survival in patients undergoing coronary
artery bypass grafting. However, the optimal configuration for BITA
utilization and its effect on long-term outcome remains uncertain. Methods
and Results - We randomly assigned 304 patients undergoing coronary artery
bypass grafting using BITA to either in situ or Y grafting configurations.
The primary end point was 3-year angiographic patency. Secondary end
points included major adverse cardiac and cerebrovascular events (ie,
death from any cause, stroke, myocardial infarction, or repeat
revascularization) at 7 years. More coronary targets were able to be
revascularized using internal thoracic arteries in patients randomized to
Y grafting versus in situ group (3.2+/-0.8 versus 2.4+/-0.5
arteries/patient; P<0.01). The primary end point did not show significant
differences in graft patency between groups. Secondary end points occurred
more frequently in the in situ group (P=0.03), with 7-year rates of
34+/-10% in the in situ and 25+/-12% in the Y grafting groups, driven
largely by a higher incidence of repeat revascularization in the in situ
group (14+/-4.5% versus 7.4+/-3.2% at 7 years; P=0.009). There were no
significant differences in hospital mortality or morbidity or in late
survival, myocardial infarction, or stroke between groups. Conclusions -
Three-year systematic angiographic follow-up revealed no significant
difference in graft patency between the 2 BITA configurations. However,
compared with in situ configuration, the use of BITA in a Y grafting
configuration results in lower rates of major adverse cardiovascular and
cerebrovascular events at 7 years.

<42>
Accession Number
20160544255
Author
Long K.H.; Moriarty J.P.; Ransom J.E.; Lennon R.J.; Mathew V.; Gulati R.;
Sandhu G.S.; Rihal C.S.
Institution
(Long) Health Economics Consulting LLC, 855 Village Center Dr #111, St.
Paul, MN 55127, United States
(Moriarty) Division of Health Care Policy and Research, College of
Medicine, Mayo Clinic, Rochester, MN, United States
(Ransom, Lennon) Division of Biomedical Statistics and Informatics,
College of Medicine, Mayo Clinic, Rochester, MN, United States
(Mathew, Gulati, Sandhu, Rihal) Department of Cardiovascular Diseases,
College of Medicine, Mayo Clinic, Rochester, MN, United States
(Mathew) Department of Radiology, College of Medicine, Mayo Clinic,
Rochester, MN, United States
Title
Economic and clinical impact of routine weekend catheterization services.
Source
American Journal of Managed Care. 22 (7) (pp e233-e240), 2016. Date of
Publication: July 2016.
Publisher
Ascend Media
Abstract
Objectives: To assess the impact of weekend cardiac catheterization (cath)
services for nonemergent inpatients. Study Design: Retrospective cohort
study of patients undergoing cath before and after Saturday cath service
availability (CSA). Methods: Cohorts included Friday and Saturday
admissions with cath (with or without revascularization) on the subsequent
Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and
Friday or Saturday admissions undergoing cath the subsequent or same
Saturday from January 1, 2009, to December 31, 2010 (post-CSA events).
Administrative and registry data provided demographics, comorbidities,
percutaneous coronary intervention (PCI) details, adverse events, hospital
length of stay (LOS), and inpatient expenditures. We used generalized
linear modeling to predict LOS and costs, and logistic regression to
estimate the likelihood of adverse events during follow-up. Results: We
identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243
patients). Cohorts were similar in age (66 years), sex (59% male), and
level of comorbidity. PCI use was higher following CSA (42% vs 26%; P
<.001), with procedural success accomplished in 95% and 94% of pre- and
post-CSA patients, respectively. Adjusted clinical outcomes were similar
(odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P =
.55; OR for 30-day revascularization, 1.14; P = .68). Models predict an
average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001)
yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of
difference, -$3611 to $3576). Conclusions: Weekend CSA for routine
inpatients was clinically safe and effective, and reduced hospital LOS.
Similar inpatient costs likely reflect a shift in case mix in this
nonrandomized study.

<43>
Accession Number
20160547027
Author
Zhang J.; Chen Z.; Chen C.
Institution
(Zhang) Department of Pharmacy, Fujian Medical University Union Hospital,
Fuzhou 350001, China
(Chen, Chen) Department of Neurosurgery, Fujian Medical University Union
Hospital, Fuzhou 350001, China
Title
Impact of CYP2C9, VKORC1 and CYP4F2 genetic polymorphisms on maintenance
warfarin dosage in Han-Chinese patients: A systematic review and
meta-analysis.
Source
Meta Gene. 9 (pp 197-209), 2016. Date of Publication: 01 Sep 2016.
Publisher
Elsevier
Abstract
Introduction: Warfarin is the most commonly used antithrombotic drug.
Single nucleotide polymorphisms (SNPs) of CYP2C9, CYP4F2, VKORC1 1173 and
VKORC1-1639 influence warfarin maintenance dosage. We aimed to determine
the impact of SNPs of these genes on mean daily warfarin dosage (MDWD) in
Han-Chinese patients. Methods: Strict literature inclusion criteria were
established, and literature searching was performed on PubMed, Embase and
Cochrane Library for English articles and CNKI, CBM and Wanfang database
for Chinese articles before September 2, 2014. Revman 5.3 was used to
analyze the relationship between gene SNPs and MDWD in Han-Chinese
subjects. Results: We included 33 studies researching the impact of gene
SNPs on MDWD in Han-Chinese subjects. CYP2C9 *3/*3, *1/*3 and *3 carriers
needed a 72% (95% confidence interval [CI]: 62.0%-81.0%), 28%
(22.0%-33.0%) and 26% (21.0%-32.0%) lower MDWD, respectively, than CYP2C9
*1/*1 carriers. CYP4F2 TT, CT and T carriers required a 18% (7.0%-30.0%),
7% (7.0%-7.0%) and 11% (7.0%-14.0%) higher MDWD, respectively, than CYP4F2
CC carriers. VKORC1 1173 CC, CT and C carriers required a 98%
(78.0%-118.0%), 49% (37.0%-62.0%) and 56% (44.0%-67.0%) higher MDWD,
respectively, than VKORC1 1173 TT carriers. VKORC1-1639 GG, GA and G
carriers needed a 101% (53.0%-149.0%), 40% (36.0%-45.0%) and 38%
(35.0%-42.0%) higher MDWD, respectively, than VKORC1-1639 AA carriers.
Conclusions: This meta-analysis is the first to report the relationship
between genotypes and MDWD among Han-Chinese patients. The results showed
that SNPs of CYP2C9, CYP4F2, VKORC1 1173 and VKORC1-1639 significantly
influenced the MDWD in Han-Chinese patients.

<44>
Accession Number
20151019817
Author
Briasoulis A.; Papageorgiou N.; Zacharia E.; Palla M.; El Abdallah M.D.;
Androulakis E.; Tousoulis D.
Institution
(Briasoulis, Palla, El Abdallah) Division of Cardiology, Wayne State
University, Detroit Medical Center, Detroit, MI, United States
(Papageorgiou) Barts Heart Centre, St Bartholomew's Hospital, London,
United Kingdom
(Papageorgiou, Zacharia, Androulakis, Tousoulis) 1st Department of
Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
(Androulakis) John Radcliffe Hospital, University of Oxford, Oxford,
United Kingdom
Title
Meta-analysis of oral anticoagulants with dual versus single antiplatelet
therapy in patients after percutaneous coronary intervention.
Source
American Journal of Cardiovascular Drugs. 16 (2) (pp 103-110), 2016. Date
of Publication: 09 Dec 2016.
Publisher
Springer International Publishing
Abstract
Background: The combined use of dual antiplatelet therapy with oral
anticoagulation (OAC) is required after coronary artery stenting or acute
coronary syndromes (ACS). Methods and Results: We performed a
meta-analysis (Embase and MEDLINE search) of the comparative effects of
triple antithrombotic therapy (TT) versus OAC with single antiplatelet
therapy (dual therapy [DT]) on allcause mortality, stroke, cardiovascular
death, myocardial infarction (MI), target vessel revascularization, and
major bleeding. Three prospective controlled studies and five cohort
studies compared TT versus DT. We identified three prospective controlled
and five cohort studies with 4564 patients on TT and 1848 on DT with an
average follow-up duration of 10.1 months. TT is associated with similar
rates of all-cause mortality, stroke, and major bleeding but significantly
lower rates of MI compared with DT. Conclusions: Triple antithrombotic
therapy is associated with similar mortality and bleeding rates but fewer
MIs compared with OAC and single antiplatelet therapy.

<45>
Accession Number
2015286204
Author
Elgendy I.Y.; Mahmoud A.; Shuster J.J.; Doukky R.; Winchester D.E.
Institution
(Elgendy, Winchester) Division of Cardiovascular Medicine, University of
Florida College of Medicine, 1600 SW Archer Rd, PO Box 100277,
Gainesville, FL 32610, United States
(Mahmoud) Department of Medicine, University of Florida College of
Medicine, Gainesville, FL, United States
(Shuster) Department of Health Outcomes and Policy, University of Florida,
Gainesville, FL, United States
(Doukky) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
Title
Outcomes after inappropriate nuclear myocardial perfusion imaging: A
meta-analysis.
Source
Journal of Nuclear Cardiology. 23 (4) (pp 680-689), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Springer New York LLC
Abstract
Background: The relationship between inappropriate MPI and cardiovascular
outcomes is poorly understood. We sought to systematically review the
literature on appropriate use criteria (AUC) for MPI, including temporal
trend of inappropriate testing and resulting cardiovascular outcomes.
Methods: We searched the MEDLINE database for studies related to AUC and
MPI. The co-primary outcomes were abnormal test results and the presence
of cardiac ischemia. Random effects odds ratios (OR) were constructed
using DerSimonian-Laird method. Results: A total of 22 studies with 23,443
patients were included. The prevalence of inappropriate testing was 14.8%
[95% confidence interval (CI) 11.6%-18.7%]. Inappropriate MPI studies were
less likely to be abnormal (OR 0.41 95% CI 0.35-0.49, P < .0001) and to
demonstrate ischemia (OR 0.40, 95% CI 0.24-0.67, P < .0001) compared to
appropriate testing. No difference in the rate of inappropriate tests was
detected based on the midpoint of the enrollment year (P = .54). The
pattern of ordering inappropriate studies was not different between
cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51-1.06, P =
.10). Conclusion: Inappropriate MPI studies are less likely to yield
abnormal results or demonstrate myocardial ischemia. The rate of
inappropriate MPI has not decreased over time.

<46>
Accession Number
20160540791
Author
Tourmousoglou C.; Lalos S.
Institution
(Tourmousoglou, Lalos) Department of Cardiothoracic Surgery, Hippokratio
General Hospital, Athens, Greece
Title
E-Comment: Conducting meta-analyses of off-pump versus on-pump coronary
artery bypass surgery: Where we stand.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 881), 2013.
Date of Publication: 2013.
Publisher
Oxford University Press

<47>
Accession Number
20160540789
Author
Takagi H.; Mizuno Y.; Niwa M.; Goto S.-N.; Umemoto T.
Institution
(Takagi, Mizuno, Niwa, Goto, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shizuoka, Shimizu-cho,
Sunto-gun 411-8611, Japan
Title
A meta-analysis of randomized trials for repeat revascularization
following off-pump versus on-pump coronary artery bypass grafting.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 878-880),
2013. Date of Publication: 2013.
Publisher
Oxford University Press
Abstract
To determine whether repeat revascularization rates are increased
following off-pump coronary artery bypass grafting (CABG), we performed a
meta-analysis of randomized controlled trials of off-pump vs on-pump CABG.
Databases including MEDLINE, EMBASE and the Cochrane Central Register of
Controlled Trials were searched through March 2013 using web-based search
engines (PubMed, OVID). Studies considered for inclusion met the following
criteria: The design was a prospective randomized controlled clinical
trial; the study population was patients undergoing CABG; patients were
randomly assigned to off-pump vs on-pump CABG and outcomes included repeat
revascularization rates at >1 year. Our exhaustive search identified 12
prospective randomized controlled trials of off-pump vs onpump CABG.
Pooled analysis demonstrated a statistically significant 38% increase in
repeat revascularization rates with off-pump relative to on-pump CABG in
the fixed-effects model (odds ratio, 1.38; 95% confidence interval,
1.09-1.76; P = 0.008). In general, exclusion of any single trial from the
analysis did not substantively alter the overall result of our analysis.
There was no evidence of significant publication bias. The results of our
analysis suggest that off-pump CABG may increase repeat revascularization
rates by 38% over on-pump CABG.

<48>
Accession Number
20160540784
Author
Yu A.W.; Rippel R.A.; Smock E.; Jarral O.A.
Institution
(Yu, Rippel) Royal Free and University College Medical School, London,
United Kingdom
(Smock) Department of Plastic Surgery, St. George's Hospital, London,
United Kingdom
(Jarral) Department of Cardiothoracic Surgery, London Chest Hospital,
London, United Kingdom
Title
In patients with post-sternotomy mediastinitis is vacuum-assisted closure
superior to conventional therapy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 861-865),
2013. Date of Publication: 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether vacuumassisted
closure therapy (VAC) is superior to conventional therapy for treating
post-sternotomy mediastinitis. Altogether >261 papers were found using the
reported search, of which 9 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Several studies indicate that VAC therapy is
associated with shorter lengths of intensive care and in-hospital stay as
well as faster rates of wound healing and fewer dressing changes. It has
also been shown that VAC therapy is correlated with a statistically
significant reduction in reinfection rates, particularly those that occur
in the early postoperative period (at the 1-week follow-up). Patients can
be discharged with the dressing in situ and managed in the community with
a view to delayed closure or reconstruction. However, the studies
comparing VAC with conventional therapy are all retrospective in nature
and reinforce the need for randomized controlled trials in order to more
accurately establish differences in outcomes between VAC and conventional
therapy. Additionally, owing tlo the variability of treatment protocols
within the non-VAC arm, it is more challenging to draw definitive
conclusions regarding the superiority of VAC therapy to every modality
that is considered conventional treatment. We conclude that VAC therapy is
a portable and an increasingly economical option for the treatment of post
sternotomy mediastinitis. Although reductions in mortality rates were not
reproduced in all studies, evidence suggests that VAC should still be
considered as a first-line therapy for post-sternotomy mediastinitis and
as a bridge therapy to musculocutaneous reconstruction or primary closure.

<49>
Accession Number
20160540780
Author
Mahmood S.; Bilal H.; Faivre-Finn C.; Shah R.
Institution
(Mahmood) Royal Oldham Hospital, Oldham, Lancashire, United Kingdom
(Bilal, Shah) Department of Cardiothoracic Surgery, University Hospital
South Manchester, Wythenshawe, Manchester M239LT, United Kingdom
(Faivre-Finn) Department of Clinical Oncology, Christie Hospital NHS
Trust, Withington, Manchester, United Kingdom
Title
Is stereotactic ablative radiotherapy equivalent to sublobar resection in
high-risk surgical patients with Stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 845-853),
2013. Date of Publication: 2013.
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Is stereotactic ablative
radiotherapy equivalent to sublobar resection in high-risk surgical
patients with Stage I non-small cell lung cancer?'. Altogether over 318
papers were found, of which 18 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Stereotactic ablative radiotherapy (SABR) and
sublobar resection (SLR) offer clear survival benefit in the treatment of
early-stage non-small-cell lung cancer (NSCLC) in high-risk patients
unsuitable for lobectomy and SABR has shown good results in medically
operable patients. No randomized data are available comparing SLR and
SABR, and therefore, data from prospective studies were compared. Overall
survival at 1 year was similar between patients treated with SABR and SLR
(81-85.7 vs 92%); however, overall 3-year survival was higher following
SLR (87.1 vs 45.1- 57.1%). There was no statistically significant
difference in local recurrence in patients treated with SABR compared with
SLR (3.5-14.5 vs 4.8-20%). Both treatment modalities are associated with
complications. Fatigue (31-32.6%), pneumonitis (2.1-12.5%) and chest wall
pain (3.1-12%) were common following SABR; however, serious grade 3 and 4
toxicity were rare. Morbidity following SLR was reported between 7.3 and
33.7%. Thirty-day mortality following SABR was 0%, while predicted 30-day
mortality following a lung resection, using the thoracoscore predictive
model ranges between 1 and 2.6%. Treatment for early-stage NSCLC should be
tailored to individual patients. SABR is an acceptable alternative to SLR
in high-risk patients but comparative data are required.

<50>
Accession Number
20160540774
Author
Milano A.D.; Dodonov M.; Onorati F.; Menon T.; Gottin L.; Malerba G.;
Mazzucco A.; Faggian G.
Institution
(Milano, Dodonov, Onorati, Menon, Mazzucco, Faggian) Division of Cardiac
Surgery, University of Verona Medical School, Piazzale Stefani, 1, Verona
37126, Italy
(Gottin) Division of Anesthesiology, University of Verona Medical School,
Verona, Italy
(Malerba) Division of Genetics and Bioinformatics, University of Verona
Medical School, Verona, Italy
Title
Pulsatile flow decreases gaseous micro-bubble filtering properties of
oxygenators without integrated arterial filters during cardiopulmonary
bypass.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 811-817),
2013. Date of Publication: 2013.
Publisher
Oxford University Press
Abstract
OBJECTIVES: Cardiopulmonary bypass (CPB) has a risk of embolic injury with
an important role of gaseous micro-bubbles (GMBs), coming from
CPB-circuit. Pulsatile perfusion (PP) can provide specific conditions for
supplementary GMB-activity with respect to non-pulsatile (NP). We aimed to
test GMB-filtering properties of three modern oxygenators under pulsatile
and non-pulsatile conditions. METHODS: Seventy-eight patients undergoing
on-pump myocardial revascularization were randomized prospectively into
three equal groups according to the oxygenator model used during CPB.
Terumo Capiox-FX25, Sorin Synthesis or Maquet Quadrox-i-Adult membrane
oxygenators were tested. Each group was divided equally to undergo PP or
NP. GMBs were counted by means of a GAMPT-BCC200 bubble-counter with two
probes placed at preoxygenator and arterial post-filter positions. Results
were evaluated in terms of GMBvolume, GMB-number, amount of large
over-ranged GMBs, a series of filtering indices and major neurological
outcomes. RESULTS: PP decreased GMB-filtering properties of the tested
oxygenators. Those with integrated filters (CAPIOX-FX25 and SYNTHESIS) did
not show significant differences between perfusion groups, while QUADROX-i
oxygenator with external arterial filter showed significantly higher
GMB-volume (P < 0.001), GMB-number (P < 0.001) and amount of over-ranged
bubbles (P < 0.001) detected in arterial line during PP. Despite the
differences in filtering capacity of all circuits with both types of
perfusion, no important differences in clinical outcomes and major
neurological events were observed. CONCLUSIONS: Pulsatile flow decreases
gaseous micro-bubble filtering properties of oxygenators without
integrated arterial filters during CPB. PP requires specially designed
circuit components to avoid the risk of additional GMB delivery.

<51>
Accession Number
20160540762
Author
Shrestha M.; Maeding I.; Hoffler K.; Koigeldiyev N.; Marsch G.; Siemeni
T.; Fleissner F.; Haverich A.
Institution
(Shrestha, Maeding, Hoffler, Koigeldiyev, Marsch, Siemeni, Fleissner,
Haverich) Division of Cardiac-Thoracic, Hannover Medical School,
Transplantation and Vascular Surgery, Carl-Neuberg-Str. 1, Hannover 30625,
Germany
Title
Aortic valve replacement in geriatric patients with small aortic roots:
Are sutureless valves the future?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 778-782),
2013. Date of Publication: 2013.
Publisher
Oxford University Press
Abstract
OBJECTIVES: Aortic valve replacement (AVR) in geriatric patients (>75
years) with small aortic roots is a challenge. Patient-prosthesis mismatch
and the long cross-clamp time necessary for stentless valves or root
enlargement are matters of concern. We compared the results of AVR with
sutureless valves (Sorin Perceval), against those with conventional
biological valves. METHODS: Between April 2007 and December 2012, 120
isolated AVRs were performed in patients with a small annulus (<22 mm) at
our centre. In 70 patients (68 females, age 77.4 +/- 5.5 years),
conventional valves (C group) and in 50 patients (47 females, age 79.8 +/-
4.5 years), sutureless valves (P group) were implanted. The Logistic
EuroSCORE of the C group was 16.7 +/- 10.4 and that of the P group 20.4
+/- 10.7, (P = 0.054). Minimal-access surgery was performed in 4.3% (3/70)
patients in the C group and 72% (36/50) patients in the P group. RESULTS:
The cardiopulmonary bypass (CPB) and cross-clamp times of the C group were
75.3 +/- 23 and 50.3 +/- 14.2 min vs 58.7 +/- 20.9 and 30.1 +/- 9 min in
the P group, (P < 0.001). In the C group, two annulus enlargements were
performed. Thirty-day mortality was 4.3% (n = 3) in the C group and 0 in
the P group, (n.s.). At follow-up (up to 5 years), mortalities were 17.4%
(n = 12) in the C group and 14% (n = 7) in the P group, (n.s.).
CONCLUSIONS: This study highlights the advantages of sutureless valves for
geriatric patients with small aortic roots reflected by shorter
cross-clamp and CPB times, even though most of these patients were
operated on via a minimally invasive access. Moreover, due to the absence
of a sewing ring, these valves are also almost stentless, with greater
effective orifice area (EOA) for any given size. This may potentially
result in better haemodynamics even without the root enlargement. This is
of advantage, as several studies have shown that aortic root enlargement
can significantly increase the risks of AVR. Moreover, as seen in this
series, these valves may also enable a broader application of minimally
invasive AVR.

<52>
[Use Link to view the full text]
Accession Number
20160540197
Author
Bundhun P.K.; Zafooruddin Sani Soogund M.; Pursun M.; Chen M.-H.
Institution
(Bundhun, Chen) Institute of Cardiovascular Diseases, First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi 530027, China
(Zafooruddin Sani Soogund, Pursun) Guangxi Medical University, Nanning,
Guangxi, China
Title
Stent thrombosis and adverse cardiovascular outcomes observed between six
months and five years with sirolimus-eluting stents and other drug-eluting
stents in patients with Type 2 diabetes mellitus complicated by coronary
artery disease.
Source
Medicine (United States). 95 (27) (no pagination), 2016. Article Number:
e4130. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
This study aimed to compare 6 months to 5 years stent thrombosis (ST) and
adverse cardiovascular outcomes associated with sirolimus-eluting stents
(SES) and other drug-eluting stents (DES) in patients with type 2 diabetes
mellitus (T2DM). Electronic databases were searched for studies comparing
SES with other DES in patients with T2DM. Total ST, definite ST, probable
ST, and other adverse cardiovascular outcomes reported between 6 months
and 5 years were considered as the clinical end points in this study. Odds
ratios (ORs) with 95% confidence intervals (CIs) were calculated for
categorical variables and the pooled analyses were performed with RevMan
5.3 software. Twenty-nine studies involving a total number of 25,729
patients with diabetes were included in this meta-analysis. SES were not
associated with significantly higher total, definite, and probable STs
with OR: 0.95, 95% CI: 0.77-1.17, P = 0.62; OR: 0.94, 95% CI: 0.65-1.37, P
= 0.76; and OR: 1.05, 95% CI: 0.77-1.45, P = 0.74, respectively. SES were
also noninferior to the other non-sirolimus eluting drug eluting stents
(non-SE DES) in terms of all-cause mortality, cardiac death, myocardial
infarction, and stroke with OR: 0.92, 95% CI: 0.82-1.03, P = 0.16; OR:
1.09, 95% CI: 0.88-1.35, P = 0.44; OR: 0.92, 95% CI: 0.80-1.06, P = 0.26;
and OR: 0.79, 95% CI: 0.49-1.28, P = 0.43, respectively. Target vessel
revascularization, target lesion revascularization, and major adverse
cardiac events were also similarly reported between SES and non-SE DES
with OR: 1.04, 95% CI: 0.83-1.31, P = 0.72; OR: 1.25, 95% CI: 0.95-1.64, P
= 0.11; and OR: 1.06, 95% CI: 0.90-1.25, P = 0.49, respectively. During
this particular follow-up period, SES were not associated with any
increase in ST among these patients with T2DM. Mortality and other adverse
cardiovascular outcomes were also not significantly different between
these 2 groups. Hence, SES should be considered neither superior nor
inferior to other DES. They are expected to be equally effective and safe
to use in patients with T2DM.

<53>
[Use Link to view the full text]
Accession Number
20160540196
Author
Bundhun P.K.; Bhurtu A.; Chen M.-H.
Institution
(Bundhun, Bhurtu, Chen) Institute of Cardiovascular Diseases, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Impact of coronary artery bypass surgery and percutaneous coronary
intervention on mortality in patients with chronic kidney disease and on
dialysis.
Source
Medicine (United States). 95 (27) (no pagination), 2016. Article Number:
e4129. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Controversies have been observed among previously published and recently
published studies comparing coronary artery bypass surgery (CABG) and
percutaneous coronary intervention (PCI) in patients with chronic kidney
disease (CKD) and patients on chronic dialysis. This study aimed to show
the impact of CABG and PCI on mortality in these patients. Electronic
databases were searched for studies comparing CABG and PCI in patients
with CKD. The primary outcome was all-cause death whereas the secondary
endpoints included other adverse cardiovascular outcomes reported. Causes
of death were also analyzed. Odds ratios (ORs) with 95% confidence
intervals (CIs) were used to express the pooled effect on discontinuous
variables and the pooled analyses were performed with RevMan 5.3. Eighteen
studies involving a total number of 69,456 patients (29,239 patients in
the CABG group and 40,217 patients in the PCI group) were included in this
meta-analysis. Short-term mortality insignificantly favored PCI with OR:
1.24, 95% CI: 0.93-1.65; P = 0.15. Mortality at 1 year was similar in both
groups with OR: 0.99, 95% CI: 0.91-1.08; P = 0.86, whereas the long-term
mortality significantly favored CABG in patients with CKD and in patients
on chronic dialysis with OR: 0.81, 95% CI: 0.70-0.94; P = 0.007 and OR:
0.81, 95% CI: 0.69-0.96; P = 0.01, respectively. In patients with CKD, the
impact of CABG on the short-term mortality was insignificantly higher
compared to PCI whereas at 1 year, a similar impact was observed. However,
the impact of PCI on mortality was significantly higher during a long-term
follow-up period in patients with CKD and in patients on chronic dialysis.
Nevertheless, due to a high level of heterogeneity observed among several
subgroups analyzed, randomized trials are required to completely solve
this issue.

<54>
Accession Number
20160537509
Author
Wu S.-G.; Dai M.-M.; He Z.-Y.; Sun J.-Y.; Lin H.-X.; Lin H.; Li Q.
Institution
(Wu, Dai) Department of Radiation Oncology, Xiamen Cancer Center, First
Affiliated Hospital of Xiamen University, Xiamen, China
(He, Sun, Lin, Li) Department of Radiation Oncology, Sun Yat-sen
University Cancer Center, State Key Laboratory of Oncology in South China,
Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
(Lin) Department of Cardiovascular and Thoracic Surgery, The People's
Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
Title
Patterns of Regional Lymph Node Recurrence After Radical Surgery for
Thoracic Esophageal Squamous Cell Carcinoma.
Source
Annals of Thoracic Surgery. 101 (2) (pp 551-557), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier USA
Abstract
Background This study aimed to investigate the patterns of regional lymph
node recurrence after radical surgery for thoracic esophageal squamous
cell carcinoma (ESCC). Methods We retrospectively reviewed clinical
characteristics of ESCC patients admitted to two institutions from 1990 to
2011, and analyzed the patterns of regional lymph node recurrence. Results
The records of 315 eligible patients with ESCC were reviewed. Of the 378
regional lymph node recurrence sites, 177 (46.8%) were in the
supraclavicular areas, 120 (31.7%) in the mediastinum, and 81 (21.4%) in
the upper abdominal areas. The most common sites of recurrence were the
supraclavicular and mediastinum areas in patients with upper and middle
thoracic ESCC. Approximately equal percentages of patients with lower
thoracic tumors had supraclavicular, mediastinal, and upper abdominal
(celiac) lymph node recurrence. Patients with tumor located in the lower
thoracic esophagus had a lower probability of supraclavicular lymph node
recurrence (p = 0.013). None of the assessed factors was associated with
mediastinal lymph node recurrence. Celiac lymph node recurrence was more
frequent among patients with lower thoracic ESCC (p = 0.004) and advanced
pathologic nodal (pN) stage (pN2, p = 0.034; pN3, p = 0.009). Conclusions
After radical surgery for thoracic ESCC, the patterns of regional lymph
node recurrence are related to the tumor location and pN stage.

<55>
Accession Number
20160505966
Author
Spillane N.T.; Kashyap S.; Bateman D.; Weindler M.; Krishnamurthy G.
Institution
(Spillane) Department of Pediatrics, Hackensack UMC, Rutgers University
New Jersey Medical School, Hackensack, NJ, United States
(Kashyap, Bateman, Weindler, Krishnamurthy) Department of Pediatrics,
Columbia University Medical Center, New York, NY, United States
Title
Comparison of Feeding Strategies for Infants With Hypoplastic Left Heart
Syndrome: A Randomized Controlled Trial.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 7 (4) (pp
446-453), 2016. Date of Publication: 01 Jul 2016.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Infants with hypoplastic left heart syndrome are at risk for
growth failure, particularly after stage 1 procedures. The effect of
continuous enteral feedings on weight gain has not been previously
investigated. Methods: A randomized controlled trial was performed in
infants with hypoplastic left heart syndrome and single ventricle variants
after stage 1 procedures. Eligible infants were randomized to a continuous
and intermittent feeding regimen or an exclusive intermittent feeding
regimen after stage 1 procedures and continued until hospital discharge.
Anthropometric measures and markers of nutritional status were assessed
throughout hospitalization. Results: Twenty-six infants completed the
study. There were no significant differences in weight gain, growth, or
nutritional status. Weight gain on full enteral feedings was 24.3 versus
23.6 g/d (P =.88) for the combination (continuous and intermittent) versus
intermittent feeding groups. Weight-for-age Z scores at discharge were
-1.37 versus -1.2 (P =.59) for the combination versus intermittent groups.
Conclusions: No significant differences in weight gain, growth, or
nutritional status were observed at hospital discharge between the two
feeding strategies. Despite both groups achieving target daily weight gain
after attaining full feeds, growth failure continued to be a problem after
stage 1 procedures. Further strategies to improve growth during initial
hospitalization are needed.

<56>
Accession Number
20160529867
Author
Dwaich K.H.; Al-Amran F.G.Y.; AL-Sheibani B.I.M.; Al-Aubaidy H.A.
Institution
(Dwaich) Ministry of Health & Environment, Karbala Health Directorate,
Iraq
(Al-Amran) Al-Najaf Center for Cardiothoracic surgery, Iraq
(AL-Sheibani) College of Pharmacy, University of Al-Qadisiyah, Iraq
(Al-Aubaidy) School of Medicine, University of Tasmania, Hobart, TAS,
Australia
Title
Melatonin effects on myocardial ischemia-reperfusion injury: Impact on the
outcome in patients undergoing coronary artery bypass grafting surgery.
Source
International Journal of Cardiology. 221 (pp 977-986), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Myocardial ischemia/reperfusion injury represents a clinically
critical problem associated with coronary artery bypass graft surgery
(CABG). The degree of oxidative stress, inflammation and apoptosis are
increased during the reperfusion of the heart muscles following ischemia.
The present study aims to examine the protective role of melatonin in
ameliorating the degree of cardiac injury in patients undergoing bypass
surgery, and whether this effect is a dose related. Methods A total of
forty-five patients who were undergoing elective CABG in (Al-Najaf Cardiac
Center, Al-Najaf, Iraq) were included in this study for the period between
January, 2015 and November, 2015. Participants were randomly allocated
into 3 study groups: Placebo-controlled group (C), low dose melatonin
treatment group, 10 mg capsule once daily (M1) and high dose melatonin
treatment group 20 mg capsule once daily (M2). Results Compared to the
control group, there was a significant increase in the ejection fraction
(EF%) associated with a significant decline in heart rate (HR) among the
M1 and M2 groups compared to the C group (P < 0.05). In addition, there
was a significant reduction in plasma levels of cardiac Troponin-I (CTnI),
interleukin-1beta (IL-1beta), Inducible nitric oxide synthase (iNOS) and
caspase-3 enzymes in the melatonin groups (group M1 and M2) compared to
the control group, (P < 0.05) in Melatonin-treated groups. Comparing the
two melatonin study groups, the changes in the parameters mentioned above
were more significant in the M2 group compared to the M1 group (P < 0.05).
Conclusion These findings suggested that melatonin supplementation can
ameliorate the degree of myocardial ischemic-reperfusion injury, dose
dependent effects.

<57>
Accession Number
20160526282
Author
Ebrahimi-Rigi H.; Feizi A.; Abdollahimohammad A.; Ebrahimi-Rigi Z.;
Salehi-Ardabili S.
Institution
(Ebrahimi-Rigi, Ebrahimi-Rigi) Nursing Department, Nursing and Midwifery
School, Iranshahr University of Medical Sciences, Iranshahr, Iran, Islamic
Republic of
(Feizi) Nursing Department, Nursing and Midwifery School, Iranshahr
University of Medical Sciences, Urmia, Iran, Islamic Republic of
(Abdollahimohammad) Nursing Department, Nursing and Midwifery School,
Iranshahr University of Medical Sciences, Zabol, Iran, Islamic Republic of
(Salehi-Ardabili) Seyed Al-Shohada Cardiovascular Center, Department of
Cardiac Surgery, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
Title
Effect of cold therapy on the pain of deep-breathing and coughing in
patients after coronary artery bypass grafting.
Source
Der Pharmacia Lettre. 8 (10) (pp 201-205), 2016. Date of Publication:
2016.
Publisher
Scholars Research Library
Abstract
Cold therapy, non-pharmacological pain management, can be used as a
short-strong analgesic in relieving musculoskeletal pain. The aim of this
study was to assess the impact of cold therapy on the pain relieving in
patient undergoing coronary artery bypass grafting. This randomized
clinical trial study was conducted in 46 eligible and consenting patients
who recruited and randomly allocated to gel pack and non-gel pack groups
after the first postsurgical day. All participants performed two episodes
of deep breathing and coughing, with and without gel pack. In the gel pack
group the quality of pain was measured before applying cold gel pack and
after deep breathing and coughing (DB & C) and in the non-gel pack group
was measured before and after DB & C episodes. The data were analyzed
using repeated measures analysis of variance (RM-ANOVA), ANCOVA, t-test,
and pair-t-test. The ANCOVA analysis revealed a significant reduction in
sensory pain scores between pre- and post- application of the gel pack.
Cold therapy reduces pain relating to deep breathing and coughing in
patient undergoing coronary artery bypass grafting.

<58>
Accession Number
20160524996
Author
Zheng Z.; Xu B.; Zhang H.; Guan C.; Xian Y.; Zhao Y.; Fan H.; Yang Y.;
Wang W.; Gao R.; Hu S.
Institution
(Zheng, Xu, Zhang, Guan, Zhao, Fan, Yang, Wang, Gao, Hu) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Zheng, Zhang, Fan, Wang, Hu) Department of Cardiovascular Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Xu, Guan, Yang, Gao) Department of Cardiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Xian) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Zhao) Medical Research & Biometrics Center, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
Title
Coronary Artery Bypass Graft Surgery and Percutaneous Coronary
Interventions in Patients With Unprotected Left Main Coronary Artery
Disease.
Source
JACC: Cardiovascular Interventions. 9 (11) (pp 1102-1111), 2016. Date of
Publication: 2016.
Publisher
Elsevier Inc.
Abstract
Objectives This study sought to investigate long-term clinical outcomes
following coronary artery bypass graft (CABG) and percutaneous coronary
intervention (PCI) in patients with unprotected left main disease (ULMD).
Background PCI has been increasingly used as an alternative mode of
revascularization for ULMD. However, there are limited data comparing
clinical outcomes between CABG surgery and PCI. Methods Between 2004 and
2010, 4,046 consecutive patients with ULMD were treated with either CABG
surgery (n = 2,604) or PCI (n = 1,442) with drug-eluting stents. The
primary outcome was 3-year all-cause mortality and the secondary outcome
was the composite of death, nonfatal myocardial infarction, or nonfatal
stroke. Results The unadjusted 3-year all-cause mortality was higher in
the PCI group as compared with the CABG group (3.8% vs. 2.5%; log-rank p =
0.03), although there was no significant difference in the composite
outcome (7.5% vs. 9.4%; log-rank p = 0.07). After adjustment for
differences in baseline risk factors, PCI was associated with
significantly higher risk of all-cause mortality (hazard ratio [HR]: 1.71;
95% confidence interval [CI]: 1.32 to 2.21; p < 0.001) but similar risk of
the composite outcome (HR: 0.94; 95% CI: 0.82 to 1.09; p = 0.43). These
differences were not statistically significant among patients with low or
intermediate SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)
score (<32) or diabetes; however, PCI was associated with an increased
risk among those with high SYNTAX score (>32), with HRs of 3.10 (95% CI:
1.84 to 5.22; p < 0.001) for all-cause mortality and 1.82 (95% CI: 1.36 to
2.45; p < 0.001) for the composite outcome. CABG was associated with lower
risk of repeat revascularization but higher risk of stroke in each
clinically relevant subgroup. Conclusions In this single-center
observational study among patients with ULMD, CABG was associated with
improved long-term outcomes, especially in patients with more complex
disease.

<59>
Accession Number
20160538723
Author
Chen I.-C.; Lee C.-H.; Chao T.-H.; Tseng W.-K.; Lin T.-H.; Chung W.-J.; Li
J.-K.; Huang H.-L.; Liu P.-Y.; Chao T.-K.; Chu C.-Y.; Lin C.-C.; Hsu
P.-C.; Lee W.-H.; Lee P.-T.; Li Y.-H.; Tseng S.-Y.; Tsai L.-M.; Hwang
J.-J.
Institution
(Chen) Tainan Municipal Hospital, Department of Internal Medicine, Tainan,
Taiwan (Republic of China)
(Lee, Chao, Liu, Lin, Lee, Lee, Li, Tseng, Tsai) National Cheng Kung
University College of Medicine and Hospital, Department of Internal
Medicine, Tainan, Taiwan (Republic of China)
(Chao) National Cheng Kung University College of Medicine and Hospital,
Division of Cardiology, Department of Internal Medicine, No. 138, Sheng-Li
Road, North District, Tainan 704, Taiwan (Republic of China)
(Tseng) E-Da University College of Medicine and Hospital, Division of
Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (Republic
of China)
(Lin, Chu, Hsu) Kaohsiung Medical University and Hospital, Division of
Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (Republic
of China)
(Chung) Chang-Gung Memorial Hospital Kaohsiung, Division of Cardiology,
Department of Internal Medicine, Kaohsiung, Taiwan (Republic of China)
(Li, Hwang) National Taiwan University Hospital, Division of Cardiology,
Department of Internal Medicine, Taipei, Taiwan (Republic of China)
(Huang) Buddhist Tzu Chi General Hospital, Taipei Branch, Division of
Cardiology, Department of Internal Medicine, Taipei, Taiwan (Republic of
China)
(Chao) Far Eastern Memorial Hospital, Department of Otolaryngology, New
Taipei City, Taiwan (Republic of China)
(Chao) Faculty of Medicine and Dentistry, University of Alberta, Division
of Public Health and Preventive Medicine, Department of Medicine,
Edmonton, AB, Canada
Title
Impact of routine coronary catheterization in low extremity artery disease
undergoing percutaneous transluminal angioplasty: Study protocol for a
multi-center randomized controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 112. Date of
Publication: 29 Feb 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: The prevalence of significant obstructive coronary artery
disease with complex lesions is high in patients who have low extremity
artery disease (LEAD). However, intermediate- or long-term cardiovascular
prognosis of LEAD patients undergoing percutaneous transluminal
angioplasty (PTA) remains poor. Accordingly, prophylactic coronary
revascularization may modify short- and long-term cardiovascular outcomes
of LEAD patients receiving PTA. Because myocardial ischemic symptoms are
often masked in LEAD and the accuracy of non-invasive stress tests is
usually limited, a high-quality randomized controlled trial aimed at the
investigation of the prognostic role of coronary evaluation strategies
before PTA is warranted. Methods/Design: The proposed study is designed as
a prospective, multi-center, open-label, superiority, randomized
controlled trial. The study is conducted in high-volume centers for PTA
and coronary revascularization in Taiwan. To meet the inclusion criteria,
the patients must be at least 20years old, have known LEAD, and have been
admitted for elective PTA. We plan to enroll 450 participants who are
randomly allocated to a routine group (routine coronary angiography
without a previous non-invasive stress test before PTA) and a selective
group (selective coronary angiography based on the results of non-invasive
stress tests before PTA) with 1:1 ratio. Besides, we expect to enroll
about 250 additional participants, who are not willing to be randomly
assigned, in the registration group. The choice of revascularization
procedure depends on the operator's or cardiovascular team's suggestion
and the patient's decision. Clinical follow-up will be performed 30days
after PTA and every 6months until the end of the 1-year follow-up for the
last randomly assigned participant. The primary endpoint is the composite
major adverse cardiac event on long-term follow-up. Pre-specified
secondary and other endpoints are also evaluated. Those assessing
biomarkers and clinical endpoints are all blinded after assignment to
interventions. Discussion: The results of the trial will, for the first
time, support better decision-making for coronary evaluation before PTA in
LEAD. If favorable, routine coronary angiography followed by
revascularization will improve cardiovascular outcomes in LEAD patients
undergoing PTA. Trial registration: ClinicalTrials.gov identifier:
NCT02169258(registered on 21 June 2014); registry name: Routine Coronary
Catheterization in Low Extremity Artery Disease Undergoing Percutaneous
Transluminal Angioplasty (PIROUETTE-PTA).

<60>
[Use Link to view the full text]
Accession Number
20160198084
Author
Hou W.-H.; Lai C.-H.; Jeng C.; Hsu C.-C.; Shih C.-M.; Tsai P.-S.
Institution
(Hou) Master Program in Long-Term Care, School of Gerontology and Health
Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Jeng, Tsai) Graduate Institute of Nursing, School of Nursing, College of
Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist,
Taipei City 110, Taiwan (Republic of China)
(Hou, Lai) Department of Physical Medicine and Rehabilitation, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
(Tsai) Sleep Science Center, Taipei Medical University Hospital, Taipei,
Taiwan (Republic of China)
(Lai) Department of Physical Medicine and Rehabilitation, School of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Hsu) Division of Cardiovascular Surgery, Department of Surgery, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
(Hsu) Department of Surgery, College of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Shih) Department of Medicine School of Medicine, College of Medicine,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Shih) Division of Cardiovascular Medicine, Department of Medicine, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
Title
Cardiac rehabilitation prevents recurrent revascularization in patients
with coronary heart disease: A population-based cohort study in Taiwan.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 36 (4) (pp
250-257), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose: To evaluate the effects of cardiac rehabilitation (CR) provided
within the first 3 months of revascularization on reducing recurrent
revascularization in patients with coronary heart disease in Taiwan.
Methods: In this population-based cohort study, we used the claims data of
1 million beneficiaries who were randomly selected from all beneficiaries
enrolled in Taiwan's National Health Insurance program from 1996 to 2000.
Between 2000 and 2007, 2838 patients underwent a first-event
revascularization. Of these patients, 442 (15.6%) underwent CR within the
first 3 months of admission for revascularization. The remaining
84.4%(n=2396) served as the non-CR group. All the study patients were
followed-up until the end of 2008 for any recurrent revascularization. A
propensity score-adjusted Cox proportional hazard model was used to
estimate the relative risk of recurrent revascularization associated with
CR. Result: During the 1- to 9-year follow-up, 69 patients (15.6%) in the
CR group and 840 (35.1%) patients in the non-CR group experienced
recurrent revascularization. The results of the propensity scoreadjusted
Cox proportional hazard regression analysis showed that CR was
significantly associated with a reduced risk of recurrent
revascularization with a hazard ratio of 0.48 (95%CI, 0.37 to - 0.62).
Conclusions: Cardiac rehabilitation within the first 3 months of
revascularization is significantly associated with a reduced risk of
recurrent revascularization. This preventive effect was more pronounced in
men compared with other subgroups of patients.

<61>
Accession Number
20160528604
Author
Philip F.; Stewart S.; Southard J.A.
Institution
(Philip, Stewart, Southard) Department of Internal Medicine and
Biostatistics, University of California, Davis, CA, United States
Title
Very late stent thrombosis with second generation drug eluting stents
compared to bare metal stents: Network meta-analysis of randomized primary
percutaneous coronary intervention trials.
Source
Catheterization and Cardiovascular Interventions. 88 (1) (pp 38-48), 2016.
Date of Publication: 01 Jul 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The relative safety of drug-eluting stents (DES) and
bare-metal stents (BMS) in primary percutaneous coronary intervention
(PPCI) in ST elevation myocardial infarction (STEMI) continues to be
debated. The long-term clinical outcomes between second generation DES and
BMS for primary percutaneous coronary intervention (PCI) using network
meta-analysis were compared. Methods: Randomized controlled trials
comparing stent types (first generation DES, second generation DES, or
BMS) were considered for inclusion. A search strategy used Medline,
Embase, Cochrane databases, and proceedings of international meetings.
Information about study design, inclusion criteria, and sample
characteristics were extracted. Network meta-analysis was used to pool
direct (comparison of second generation DES to BMS) and indirect evidence
(first generation DES with BMS and second generation DES) from the
randomized trials. Results: Twelve trials comparing all stents types
including 9,673 patients randomly assigned to treatment groups were
analyzed. Second generation DES was associated with significantly lower
incidence of definite or probable ST (OR 0.59, 95% CI 0.39-0.89), MI (OR
0.59, 95% CI 0.39-0.89), and TVR at 3 years (OR 0.50: 95% CI 0.31-0.81)
compared with BMS. In addition, there was a significantly lower incidence
of MACE with second generation DES versus BMS (OR 0.54, 95% CI 0.34-0.74)
at 3 years. These were driven by a higher rate of TVR, MI and stent
thrombosis in the BMS group at 3 years. There was a non-significant
reduction in the overall and cardiac mortality [OR 0.83, 95% CI
(0.60-1.14), OR 0.88, 95% CI (0.6-1.28)] with the use of second generation
DES versus BMS at 3 years. Conclusions: Network meta-analysis of
randomized trials of primary PCI demonstrated lower incidence of MACE, MI,
TVR, and stent thrombosis with second generation DES compared with BMS.
&#xa9; 2016 Wiley Periodicals, Inc.

<62>
Accession Number
20160528598
Author
Singh K.; Qutub M.; Carson K.; Hibbert B.; Glover C.
Institution
(Singh, Qutub, Hibbert, Glover) Department of Cardiology, University of
Ottawa Heart Institute, Ottawa, ON K1Y 1J7, Canada
(Singh, Carson) Department of Cardiology, Basil Hetzel Institution,
University of Adelaide, SA 5000, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
Title
A meta analysis of current status of alcohol septal ablation and surgical
myectomy for obstructive hypertrophic cardiomyopathy.
Source
Catheterization and Cardiovascular Interventions. 88 (1) (pp 107-115),
2016. Date of Publication: 01 Jul 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Our objective was to perform an updated systematic review to
compare the efficacy and short- and long-term mortality of surgical
myectomy (SM) and alcohol septal ablation (ASA) by including most recent
and largest cohort studies published in last few years. Background: SM and
ASA are the two invasive strategies used to relieve left ventricular
outflow tract obstruction (LVOTO) in patients with drug refractory
symptomatic hypertrophic cardiomyopathy (HCM). In the absence of a
randomized trial, we tried to compare the pros and cons of the two
procedures using a systematic review and meta-analysis. Method: A
comprehensive search of three major databases was performed. We included
original research studies comparing data on ASA and SM. Of 1,143
citations, 10 studies were included in the analysis. Results: A total of
805 patients underwent ASA and 1,019 underwent SM. Patients undergoing SM
were younger (MD 6.3, P = 0.0001) and had higher reduction in the LVOT
gradient (MD -9.56, P = 0.05). However, there was similar resolution of
class III and IV symptoms between the two groups (P = 0.56). There was no
difference in sudden cardiac death (SCD) (P = 0.93), short-term (P =
0.36), long-term all cause (P = 0.27), and long-term cardiac mortality (P
= 0.58). Patients undergoing ASA had higher incidence of post procedure
device implantation (OR 3.09, P < 0.00001). Conclusion: No significant
difference in symptom relief was noted between the two approaches. ASA was
as safe a myectomy with regards to SCD, short-term, and long-term
mortality. &#xa9; 2015 Wiley Periodicals, Inc.

<63>
Accession Number
20160528592
Author
Scheller B.; Fontaine T.; Mangner N.; Hoffmann S.; Bonaventura K.; Clever
Y.P.; Chamie D.; Costa R.; Gershony G.; Kelsch B.; Kutschera M.; Genereux
P.; Cremers B.; Bohm M.; Speck U.; Abizaid A.
Institution
(Scheller, Fontaine, Clever, Cremers, Bohm) Universitatsklinikum des
Saarlandes, Homburg, Saar, Germany
(Mangner) Herzzentrum Leipzig, Germany
(Hoffmann) Werner Forsmann Krankenhaus, Eberswalde, Germany
(Bonaventura) Ernst Von Bergmann Klinikum, Potsdam, Germany
(Chamie, Costa, Abizaid) Instituto Dante Pazzanese De Cardiologia, Sao
Paulo, Brazil
(Gershony) John Muir Cardiovascular Institute, Concord, CA, United States
(Kelsch, Kutschera, Speck) Experimentelle Radiologie, Charite, Berlin,
Germany
(Genereux) Columbia University and Cardiovascular Research Foundation, New
York, NY, United States
Title
A novel drug-coated scoring balloon for the treatment of coronary in-stent
restenosis: Results from the multi-center randomized controlled PATENT-C
first in human trial.
Source
Catheterization and Cardiovascular Interventions. 88 (1) (pp 51-59), 2016.
Date of Publication: 01 Jul 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Scoring balloons produce excellent acute results in the
treatment of in-stent restenosis (ISR), fibro-calcific and bifurcation
lesions but have not been shown to affect the restenosis rate. A novel
paclitaxel-coated scoring balloon (SB) was developed and tested to
overcome this limitation. Methods and Results: SB were coated with
paclitaxel admixed with a specific excipient. Patients at four clinical
sites in Germany and one in Brazil with ISR of coronary bare metal stent
(BMS) were randomized 1:1 to treatment with either a drug-coated or
uncoated SB. Baseline and 6-month follow-up quantitative coronary
angiography was performed by an independent blinded core lab and all
patients will be evaluated clinically for up to one year. The primary
endpoint was angiographic in-segment late lumen loss (LLL). Secondary
endpoints included the rate of clinically driven target lesion
revascularization (TLR), composite of major adverse cardiovascular events
(MACE), stent thrombosis and other variables. Sixty-one patients were
randomized (28 uncoated and 33 drug-coated SB); mean age 65 years, males
72%, and presence of diabetes 39%. At 6-month angiography, in-segment LLL
was 0.48 +/- 0.51 mm in the uncoated SB group versus 0.17 +/- 0.40 mm in
the drug-coated SB group (P = 0.01; ITT analysis). The rate of binary
restenosis was 41% in the uncoated SB group versus 7% in the drug-coated
SB group (P = 0.004). The MACE rate was 32% with the uncoated SB vs. 6% in
the drug-coated SB group (P = 0.016). This difference was primarily due to
the reduced need for clinically driven TLR in the coated SB group (3% vs.
32% P = 0.004). Conclusions: A novel paclitaxel-coated coronary SB has
been developed and successfully used in a first-in-human randomized
controlled trial [ClinicalTrials.gov Identifier: NCT01495533]. &#xa9; 2015
Wiley Periodicals, Inc.