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<1>
Accession Number
2014727661
Author
Besic K.M.; Strozzi M.; Margetic E.; Bulum J.; Kolaric B.
Institution
(Besic, Strozzi, Margetic, Bulum) Department of Cardiovascular Medicine,
University Hospital Centre Zagreb, Zagreb, Croatia
(Kolaric) Department for Social Medicine and Epidemiology, Medical School,
University of Rijeka, Rijeka, Croatia
Title
Drug-eluting balloons in patients with non-ST elevation acute coronary
syndrome.
Source
Journal of Cardiology. 65 (3) (pp 203-207), 2015. Date of Publication: 01
Mar 2015.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: We compared efficacy of bare-metal stent (BMS) and
drug-eluting balloon (DEB) combination vs BMS alone, in patients with
non-ST elevation acute coronary syndrome treated with percutaneous
coronary intervention (PCI). Methods: Patients with non-ST elevation
myocardial infarction (NSTEMI) or unstable angina (UA) were randomized to
BMS only or BMS. +. DEB group. Angiographic follow-up was performed after
6 months. The primary endpoints were binary in-stent restenosis (ISR) and
late lumen loss (LLL) and the secondary endpoints were target lesion
revascularization (TLR), stent thrombosis (ST), and new acute coronary
syndrome (ACS). Results: A total of 85 patients were enrolled, 44 (BMS)
and 41 (BMS. +. DEB). The median age was 67 (36-84) years and 68 (80%)
were male. Fifty-two patients (61.2%) had NSTEMI and 33 patients (38.8%)
UA. There was no difference in patient demographics, risk factors, and
clinical characteristics, except for more smokers in the BMS. +. DEB group
18/41 (43.9%) vs 9/44 (20.5%). At follow-up, no significant difference in
binary ISR was found; p=. 0.593, but LLL was significantly lower in the
BMS. +. DEB group 0.68 (0.00-2.15) mm vs 0.22 (0.00-2.35) mm; p=. 0.002.
The difference in major adverse cardiac events (MACE) rate combining TLR,
ST, and ACS, between the groups was also non-significant, 29.5% (BMS) vs
24.4% (BMS. +. DEB); p=. 0.835. One patient had a subacute ST (BMS. +.
DEB) due to clopidogrel resistance. Conclusion: Patients treated with BMS.
+. DEB combination for non-ST elevation acute coronary syndrome had
significantly less LLL in comparison to patients treated with BMS alone
but without an impact on patient clinical outcomes.

<2>
Accession Number
2015644357
Author
Tregay J.; Wray J.; Bull C.; Franklin R.C.; Daubeney P.; Barron D.J.;
Brown K.; Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2015.
Publisher
Cambridge University Press
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway.

<3>
Accession Number
2015637807
Author
Sarathy K.; Nagaraja V.; Kapur A.; Szirt R.; Raval J.; Eslick G.D.;
Burgess D.; Denniss A.R.
Institution
(Sarathy, Nagaraja, Kapur, Szirt) Prince of Wales Hospital, University of
New South Wales, Sydney, Australia
(Raval, Burgess, Denniss) Department of Cardiology, Blacktown Hospital,
Sydney, Australia
(Nagaraja, Eslick) The Whiteley-Martin Research Centre, University of
Sydney, Nepean Hospital, Sydney, Australia
Title
Target-vessel versus multivessel revascularisation in st-elevation
myocardial infarction: A meta-analysis of randomised trials.
Source
Heart Lung and Circulation. 24 (4) (pp 327-334), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: In acute ST-segment elevation myocardial infarction (STEMI),
coronary reperfusion with percutaneous coronary intervention (PCI) to
treat the culprit lesion responsible for infarction improves clinical
outcomes in nearly all patients. The concurrent treatment of non-infarct
vessels with significant stenoses during initial angiography remains an
area of controversy. Methods: A systematic search was conducted using
MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library,
Google Scholar, Science Direct, and Web of Science. Original data were
abstracted from each study and used to calculate a pooled odds ratio (OR)
and 95% confidence interval (95% CI). Results: Only four randomised trials
comprising 775 patients met full criteria for analysis. The incidence of
non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory
angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat
revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was
lower in the multivessel revascularisation cohort. Death from cardiac
causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336,
95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26%
vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the
multivessel revascularisation cohort. The Median Contrast Volume and
Procedure Length were similar in both cohorts. Conclusions: In patients
with acute STEMI who undergo primary PCI, a strategy of treatment of
significant non-infarct stenosis (preventive PCI) in addition to the
culprit lesion responsible for infarction may result in improved
cardiovascular outcomes and reduced overall mortality; however there is
insufficient data to fully validate this from currently published
literature.

<4>
Accession Number
2015748633
Author
Neuburger P.J.; Ngai J.Y.; Chacon M.M.; Luria B.; Manrique-Espinel A.M.;
Kline R.P.; Grossi E.A.; Loulmet D.F.
Institution
(Neuburger, Ngai, Chacon, Luria, Manrique-Espinel, Kline) NYU Langone
Medical Center, Department of Anesthesiology, 550 First Avenue, New York,
NY 10282, United States
(Grossi, Loulmet) Department of Cardiothoracic Surgery, NYU Langone
Medical Center, New York, United States
Title
A Prospective Randomized Study of Paravertebral Blockade in Patients
Undergoing Robotic Mitral Valve Repair.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 930-936),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to evaluate the addition of
paravertebral blockade to general anesthesia in patients undergoing
robotic mitral valve repair. Design A randomized, prospective trial.
Setting A single tertiary referral academic medical center. Participants
60 patients undergoing robotic mitral valve surgery. Interventions
Patients were randomized to receive 4-level paravertebral blockade with
0.5% bupivicaine before induction of general anesthesia. All patients were
given a fentanyl patient-controlled analgesia upon arrival to the
intensive care unit, and visual analog scale pain scores were queried for
24 hours. On postoperative day 2, patients were given an anesthesia
satisfaction survey. Measurements and Main Results After obtaining
institutional review board approval, surgical and anesthetic data were
recorded perioperatively and compared between groups. Compared to general
anesthesia alone, patients receiving paravertebral blockade and general
anesthesia reported significantly less postoperative pain and required
fewer narcotics intraoperatively and postoperatively. Patients receiving
paravertebral blockade also reported significantly higher satisfaction
with anesthesia. Successful extubation in the operating room at the
conclusion of surgery was 90% and similar in both groups. Hospital length
of stay also was similar. No adverse reactions were reported. Conclusions
The addition of paravertebral blockade to general anesthesia appears safe
and can reduce postoperative pain and narcotic usage in patients
undergoing minimally invasive cardiac surgery. These findings were similar
to previous studies of patients undergoing thoracic procedures.
Paravertebral blockade alone likely does not reduce hospital length of
stay. This may be more closely related to early extubation, which is
possible with or without paravertebral blockade.

<5>
Accession Number
2014612570
Author
Khan M.F.; Brilakis E.S.; Wendel C.S.; Thai H.
Institution
(Khan, Wendel) Department of Medicine, Southern Arizona VA Health Care
System, Tucson, AZ, United States
(Khan) Department of Medicine, University of Arizona, Tucson, AZ, United
States
(Brilakis) Division of Cardiology, VA North Texas Health Care System,
Dallas, TX, United States
(Brilakis) Division of Cardiology, University of Texas, Southwestern
Medical School, Dallas, TX, United States
(Thai) Division of Cardiology, Southern Arizona VA Health Care System,
Tucson, AZ, United States
(Thai) Division of Cardiology, University of Arizona, Tucson, AZ, United
States
Title
Comparison of procedural complications and in-hospital clinical outcomes
between patients with successful and failed percutaneous intervention of
coronary chronic total occlusions: A Meta-Analysis of Observational
Studies.
Source
Catheterization and Cardiovascular Interventions. 85 (5) (pp 781-794),
2015. Date of Publication: 01 Apr 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Multiple attempts to pass guidewires and balloons across
totally occluded segments may result in significant mechanical trauma and
higher rates of coronary complications in patients undergoing PCI
(percutaneous coronary intervention) for CTOs (chronic total occlusion).
It is unknown whether these procedural complications affect short-term
survival and in-hospital clinical outcomes after the PCI. The goal of this
analysis was to clarify this issue by comparing the rates of adverse
in-hospital clinical outcomes between successful and failed CTO-PCI
groups. Methods We performed a meta-analysis of 25 studies (16,490
patients) to determine the rates of in-hospital death, myocardial
infarction (MI), major adverse cardiovascular events (MACE), and urgent
CABG (coronary artery bypass grafting) for the successful and failed
CTO-PCI groups. Results Compared to successful CTO PCI, failed CTO PCI
procedures were associated with higher in-hospital mortality (1.44% versus
0.5%) [relative risk (RR) of 2.88, 95% confidence interval [CI]
(1.96-4.24), P < 0.001], a higher risk of in-hospital MACE (8.88% versus
3.75%) [RR of 2.25, CI (1.69-2.98), P < 0.001], slightly higher risk of
in-hospital MI (3.17% versus 2.4%) [RR of 1.35, CI (1.03-1.78), P = 0.03]
and increased need for urgent CABG (4.0% versus 0.5%) [RR of 6.67, CI
(4.26-10.43), P < 0.001]. Furthermore, higher rates of coronary
perforations [RR of 5.0, CI (3.93-6.59), P < 0.001] and cardiac tamponade
[RR of 5.0, CI (1.97-12.69), P < 0.001] were observed in the unsuccessful
PCI arm. Conclusions As compared to successful interventions, failed PCI
attempts for CTOs appear to be associated with higher risk of adverse
short-term clinical outcomes.

<6>
Accession Number
2014754418
Author
Biancari F.; Martin M.; Bordin G.; Vettore E.; Vinco G.; Anttila V.;
Airaksinen J.; Vasques F.
Institution
(Biancari, Martin, Bordin, Vettore, Vinco, Anttila, Vasques) Department of
Surgery, Oulu University Hospital, Kajaanintie 50, Oulu PL 21, 90029,
Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
Title
Basic data from 176 studies on the immediate outcome after aortic valve
replacement with or without coronary artery bypass surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1251-1256),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to summarize the immediate outcome
after aortic valve replacement (AVR) with or without coronary artery
bypass grafting (CABG).
Design Systematic review and meta-analysis.
Setting University hospitals.
Participants Participants were 683,286 patients who underwent AVR with or
without CABG. Patients undergoing other major cardiac procedures were
excluded from this analysis.
Interventions AVR with or without CABG.
Measurements and Main Results Operative mortality after AVR with or
without concomitant CABG was 4.3%, stroke 2.1%, pacemaker implantation
5.9%, and dialysis 2.2%. After isolated AVR, operative mortality was 3.3%,
stroke 1.7%, pacemaker implantation 3.3%, and dialysis 1.6%. Mortality was
increased among very elderly (<60 years: 3.3%, 60-69 years: 2.7%, 70-79
years: 3.8%,80 years: 6.1%, p<0.001). Prevalence of minimally invasive AVR
(mini-AVR) was associated with significantly lower operative mortality (p
= 0.039, 46 studies). Mini-AVR only tended toward lower mortality when
included in meta-regression analysis as a dichotomous variable (mini-AVR
4,367 patients: 2.3%, 95% CI 1.8-2.9% v full sternotomy 11,076 patients:
3.5%, 95% CI 28-4.1%, p = 0.088). Operative mortality after AVR plus CABG
was 5.5% (versus isolated AVR: p<0.001), stroke 3.0%, pacemaker
implantation 3.9%, and dialysis 5.6%. Mortality was high in all age
strata, particularly among very elderly (mean age<70 years: 4.8%, mean age
70-79 years: 4.7%; mean age80 years: 8.4%, p = 0.002).
Conclusions Isolated AVR is associated with low mortality and morbidity.
Coronary artery disease requiring concomitant CABG increases the operative
mortality. Patients requiring AVR and CABG should be the main target of
less-invasive treatment strategies.

<7>
Accession Number
2014859820
Author
Dehghani M.R.; Madjidi N.; Rahmani A.; Asgari B.; Rezaei Y.
Institution
(Dehghani) Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia
University of Medical Sciences, Urmia, Iran, Islamic Republic of
(Madjidi, Rahmani) Department of Medical Surgical Nursing, School of
Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Asgari) Department of Cardiovascular Surgery, Seyyed-al-Shohada Heart
Center, Urmia University of Medical Sciences, Urmia, Iran, Islamic
Republic of
(Rezaei) Seyyed-al-Shohada Heart Center, Urmia University of Medical
Sciences, Urmia, Iran, Islamic Republic of
Title
Effect of oral vitamin C on atrial fibrillation development after isolated
coronary artery bypass grafting surgery: A prospective randomized clinical
trial.
Source
Cardiology Journal. 21 (5) (pp 492-499), 2014. Date of Publication: 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Some evidences have shown the role of antioxidant vitamins in
preventing atrial fibrillation (AF) after coronary artery bypass grafting
(CABG) surgery. We sought to determine the effect of oral vitamin C on the
incidence of postoperative AF in patients undergoing elective isolated
on-pump CABG surgery.
Methods: One-hundred patients who underwent isolated CABG surgery were
prospectively assigned into two groups: Group 1 - 50 patients received 2 g
of oral vitamin C before and 500 mg twice daily lasting for 5 days after
surgery; Group 2 - 50 patients as the control group did not receive any.
All patients were continuously monitored after surgery in the intensive
care unit (ICU), and then Holter monitoring was implemented for 72 h.
Results: The mean of patients' age was 61.31 +/- 6.42 years. Postoperative
AF occurred in 16 and 4 patients in control and treatment groups,
respectively (32% vs. 8%, p = 0.003). The ICU stay was 1.79 +/- 0.313 and
2.10 +/- 0.61 days for vitamin C and control groups, respectively (p =
0.002). The hospital stay was significantly lower in vitamin C group
compared with that of the control group (5.32 +/- 0.59 vs. 5.74 +/- 1.30
days, respectively, p = 0.041). Baseline erythrocyte sedimentation rate
(OR 1.030, 95% CI 1.003-1.058, p = 0.030) and taking vitamin C (OR 8.068,
95% CI 1.783-36.517, p = 0.007) were the independent predictors of
postoperative AF.
Conclusions: Oral vitamin C can be safely used to decrease the incidence
of postoperative AF in patients undergoing elective isolated on-pump CABG
surgery.

<8>
Accession Number
2014729426
Author
Lomivorotov V.V.; Efremov S.M.; Pokushalov E.A.; Romanov A.B.; Ponomarev
D.N.; Cherniavsky A.M.; Shilova A.N.; Karaskov A.M.; Lomivorotov V.N.
Institution
(Lomivorotov, Efremov, Ponomarev, Lomivorotov) Department of
Anaesthesiology and Intensive Care, Research Institute of Circulation
Pathology, Rechkunovskaya 15 street, Novosibirsk 630055, Russian
Federation
(Pokushalov, Romanov, Karaskov) Department of Arrhythmia, Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation
(Cherniavsky) Department of Cardiac Surgery, Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Shilova) Laboratory of Biochemistry, Research Institute of Circulation
Pathology, Novosibirsk, Russian Federation
Title
Randomized trial of fish oil infusion to prevent atrial fibrillation after
cardiac surgery: Data from an implantable continuous cardiac monitor.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1278-1284),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Objective To test the hypothesis that perioperative OMEGA-3
polyunsaturated fatty acid infusion would reduce the incidence of
postoperative atrial fibrillation in patients after coronary artery bypass
grafting as assessed by an implantable continuous cardiac monitor.
Design Prospective, randomized, double-blind, placebo-controlled study.
Setting Tertiary cardiothoracic referral center.
Participants Thirty-nine patients with coronary artery disease who
underwent surgery with cardiopulmonary bypass.
Interventions Patients were assigned randomly to receive either OMEGA-3
polyunsaturated fatty acids (200 mg/kg/day starting before anesthesia
induction for 24 hours followed by 100 mg/kg/day for 7 days) or placebo.
The primary outcome was freedom from atrial fibrillation at 2-year
follow-up. Revealcardiac monitor was implanted subcutaneously in all
patients. Data from the cardiac monitor were collected on the 10th day and
3, 6, 12, and 24 months postoperatively. Measurement and Main Results
Postoperative atrial fibrillation developed in 4 (19%) patients in the
control group and in 5 (27.8%) patients in the study group at 10-day
follow-up (p = 0.88). At 2-year follow-up, 5 (27.8%) patients in the
control group and 6 (35.3%) patients in the study group had atrial
fibrillation (p = 0.9). Atrial fibrillation duration predicted risk of
cardiovascular hospitalization at the 2-year follow-up (regression
coefficient estimate = 0.24, standard error 0.02, p<0.0001; R2= 0.74).
Conclusions Infusion of OMEGA-3 polyunsaturated fatty acids failed to
prevent the occurrence of atrial fibrillation in 2 years after coronary
artery bypass grafting surgery. The cumulative atrial fibrillation
duration registered by the continuous cardiac monitor at the 2-year
follow-up was a significant predictor of an adverse outcome.

<9>
Accession Number
2014234656
Author
Nishimura M.; Okamoto Y.; Tokoro T.; Sato N.; Nishida M.; Hashimoto T.;
Kobayashi H.; Yamazaki S.; Okino K.; Iwamoto N.; Takahashi H.; Ono T.
Institution
(Nishimura) Cardiovascular Division, Toujinkai Hospital, 83-1, Iga,
Momoyama-cho Fushimi-ku, Kyoto 612-8026, Japan
(Okamoto) Division of Anesthesiology, Toujinkai Hospital, Kyoto, Japan
(Tokoro) Division of Nephrology, Toujinkai Hospital, Kyoto, Japan
(Sato, Nishida, Hashimoto, Kobayashi, Iwamoto, Ono) Division of Urology,
Toujinkai Hospital, Kyoto, Japan
(Yamazaki) Toujinkai Clinic, Kyoto, Japan
(Okino) Toujinkai Satellite Clinic, Kyoto, Japan
(Takahashi) Department of Clinical Sciences and Laboratory Medicine,
Kansai Medical University, Osaka, Japan
Title
Clinical potential of oral nicorandil to improve myocardial fatty acid
metabolism after percutaneous coronary intervention in hemodialysis
patients.
Source
Nephron - Clinical Practice. 126 (1) (pp 24-32), 2014. Date of
Publication: April 2014.
Publisher
S. Karger AG
Abstract
Background/Aims: The assessment of myocardial fatty acid metabolism
impairment by single-photon emission computed tomography (SPECT) using
123I-beta-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the
risk of cardiac death in hemodialysis patients. We investigated the
potential of oral nicorandil to improve myocardial fatty acid metabolism
after percutaneous coronary intervention (PCI) in this population.
Methods: We evaluated 128 hemodialysis patients who had obtained coronary
revascularization by PCI (90 men and 38 women, 66 +/- 9 years).
Participants for the analysis were randomly assigned to either the
nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed
every year after coronary revascularization by PCI. Uptake on SPECT was
graded in 17 segments on a 5-point scale (0, normal; 4, absent) and
assessed as BMIPP summed scores (SS). Results: The incidence of cardiac
death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in
the control group (21/65, 32.3%) during a mean follow-up of 2.7 +/- 1.4
years. BMIPP SS reduction rates improved in the nicorandil group compared
with the control group from 3 years of administration. In Kaplan-Meier
analyses, free survival rate of cardiac death was higher in patients with
a >20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS
reduction rate (p = 0.0001). In multiple logistic analysis, oral
administration of nicorandil was associated with >20% reduction rates of
BMIPP SS (odds ratio 2.823, p = 0.011). Conclusion: Long-term oral
administration of nicorandil may improve impaired myocardial fatty acid
metabolism after coronary revascularization by PCI in hemodialysis
patients. &#xa9; 2014 S. Karger AG, Basel.

<10>
Accession Number
2014767852
Author
Du Y.; Xu J.; Wang G.; Shi J.; Yang L.; Shi S.; Lu H.; Wang Y.; Ji B.;
Zheng Z.
Institution
(Du, Wang, Shi, Yang, Shi, Lu, Wang) Department of Anesthesiology, Fuwai
Hospital, Peking Union Medical College, 167 Beilishi Road, Xicheng
District, Beijing 100037, China
(Ji) Department of Cardiopulmonary Bypass, Fuwai Hospital, Peking Union
Medical College, Beijing, China
(Zheng) Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
(Xu) Department of Anesthesiology, Chinese Academy of Medical Sciences,
Peking Union Medical College Hospital, Beijing, China
Title
Comparison of two tranexamic acid dose regimens in patients undergoing
cardiac valve surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1233-1237),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Objective Tranexamic acid (TA), a synthetic antifibrinolytic drug, has
been shown to reduce postoperative bleeding and the need for allogeneic
blood transfusion in cardiac surgery. However, the optimal dose regimen of
TA is still under debate. The aim of this study was to evaluate whether a
lower-dose TA regimen produced equivalent efficacy to its higher-dose
counterpart in reducing postoperative bleeding and transfusion needs.
Design A prospective, randomized, double-blind trial.
Setting National Center for Cardiovascular Diseases & University Hospital,
Beijing, People's Republic of China.
Measurements and Main Results The amount of postoperative bleeding, the
amount and frequency of allogeneic transfusion, mortality, and morbidities
were recorded. There was no significant difference in the volume of
24-hour postoperative bleeding between the lower-dose group and the
higher-dose group. Other measurements also showed no statistical
difference between the 2 groups, including the amount and frequency of
allogeneic transfusion, mortality, and morbidities. Conclusion Lower-dose
TA regimen was as effective as the higher-dose regimen in reducing
postoperative bleeding and transfusion needs in patients undergoing
cardiac valve surgery.
Participants One hundred seventy-five patients undergoing cardiac valve
surgery were enrolled in the study.
Interventions All patients were divided randomly into 2 groups. The
lower-dose TA group received a loading dose of 10 mg/kg, maintenance dose
of 2 mg/kg/h, and a cardiopulmonary bypass pump prime dose of 40 mg; the
higher-dose TA group received a loading dose of 30 mg/kg, maintenance dose
of 16 mg/kg/h, and a pump prime dose of 2 mg/kg.

<11>
Accession Number
26973269
Author
Dong Z.; Yu B.; Zhang Q.; Pei H.; Xing J.; Fang W.; Sun Y.; Song Z.
Institution
(Dong, Yu, Zhang, Pei, Xing, Fang, Sun, Song) ICU, The Affiliated Hospital
of Qingdao University
Title
Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged
Mechanical Ventilation After Coronary Artery Bypass Surgery.
Source
International heart journal. 57 (2) (pp 241-246), 2016. Date of
Publication: 2016.
Abstract
We investigated the effects of early rehabilitation therapy on prolonged
mechanically ventilated patients after coronary artery bypass surgery
(CABG).A total of 106 patients who underwent CABG between June 2012 and
May 2015 were enrolled and randomly assigned into an early rehabilitation
group (53 cases) and a control group (53 cases). The rehabilitation
therapy consisted of 6 steps including head up, transferring from
supination to sitting, sitting on the edge of bed, sitting in a chair,
transferring from sitting to standing, and walking along a bed. The
patients received rehabilitation therapy in the intensive care unit (ICU)
after CABG in the early rehabilitation group. The control group patients
received rehabilitation therapy after leaving the ICU.The results showed
that the early rehabilitation therapy could significantly decrease the
duration of mechanical ventilation (early rehabilitation group: 8.1 +/-
3.3 days; control group: 13.9 +/- 4.1 days, P < 0.01), hospital stay
(early rehabilitation group: 22.0 +/- 3.8 days; control group: 29.1 +/-
4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 +/-
3.2 days; control group: 18.3 +/- 4.2 days, P < 0.01) for patients
requiring more than 72 hours prolonged mechanical ventilation. The results
of Kaplan-Meier analysis showed that the proportions of patients remaining
on mechanical ventilation in the early rehabilitation group were larger
than that in the control group after 7 days of rehabilitation therapy
(logrank test: P < 0.01). The results provide evidence for supporting the
application of early rehabilitation therapy in patients requiring
prolonged mechanical ventilation after CABG.

<12>
Accession Number
26988949
Author
Lopes R.D.; Leonardi S.; Neely B.; Neely M.L.; Ohman E.M.; Ardissino D.;
Hamm C.W.; Goodman S.G.; Bhatt D.L.; White H.D.; Prabhakaran D.; Martinez
F.; Nicolau J.C.; Winters K.J.; Fox K.A.; Armstrong P.W.; Roe M.T.
Institution
(Lopes) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, North Carolina; Division of Cardiology, Department of
Medicine, Duke University School of Medicine, Durham, North Carolina.
Electronic address: renato.lopes@duke.edu
(Leonardi) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Neely) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, North Carolina
(Neely) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, North Carolina
(Ohman) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, North Carolina; Division of Cardiology, Department of
Medicine, Duke University School of Medicine, Durham, North Carolina
(Ardissino) Ospedale Maggiore di Parma, Parma, Italy
(Hamm) Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
(Goodman) Division of Cardiology, Department of Medicine, St. Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian VIGOUR
Centre, Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, Alberta, Canada
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, Massachusetts
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
(Martinez) Cordoba National University, Cordoba, Argentina
(Nicolau) Heart Institute-InCor, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Winters) Eli Lilly and Company, Indianapolis, Indiana
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, Scotland, United Kingdom
(Armstrong) Canadian VIGOUR Centre, Division of Cardiology, Department of
Medicine, University of Alberta, Edmonton, Alberta, Canada
(Roe) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, North Carolina; Division of Cardiology, Department of
Medicine, Duke University School of Medicine, Durham, North Carolina
Title
Spontaneous MI After Non-ST-Segment Elevation Acute Coronary Syndrome
Managed Without Revascularization: The TRILOGY ACS Trial.
Source
Journal of the American College of Cardiology. 67 (11) (pp 1289-1297),
2016. Date of Publication: 22 Mar 2016.
Abstract
BACKGROUND: Patients with acute coronary syndrome (ACS), especially those
receiving medical management without revascularization, are at high risk
for spontaneous myocardial infarction (MI), but its frequency and
predictors are unknown.
OBJECTIVES: This study sought to characterize spontaneous MI events in a
randomized population during 30 months of follow-up and develop a
prediction model for spontaneous MI to assign risk of spontaneous MI
events in ACS populations.
METHODS: We analyzed data from the randomized TRILOGY ACS (TaRgeted
platelet Inhibition to cLarify the Optimal strateGy to medically manage
Acute Coronary Syndromes) trial of aspirin plus prasugrel or clopidogrel
following ACS. The trial included 9,326 patients with non-ST-segment
elevation myocardial infarction (NSTEMI)/unstable angina (UA) who were
managed medically without planned revascularization. Our study population
included 9,294 patients. A multivariable Cox proportional hazards model
was developed to determine predictors of time to first spontaneous MI
event through 30 months. After model validation, we developed a calculator
for model implementation.
RESULTS: Among 9,294 patients, 695 spontaneous MI events occurred over a
median of 17 months, representing 94% of adjudicated MI events (n = 737).
The Kaplan-Meier event rate of spontaneous MI through 30 months was 10.7%.
The strongest predictors of spontaneous MI were older age, NSTEMI versus
UA as index event, diabetes mellitus, no pre-randomization angiography,
and higher baseline creatinine values. The model exhibited good predictive
capabilities (c-index = 0.732) and had good calibration, especially for
patients with low-to-moderate risk of spontaneous MI.
CONCLUSIONS: Spontaneous MI following a medically managed UA/NSTEMI event
is common. Baseline characteristics can be used to predict subsequent risk
of spontaneous MI in this population. These findings provide insight into
the long-term natural history of medically managed UA/NSTEMI patients and
could be used to optimize risk stratification and treatment of these
patients. (A Comparison of Prasugrel and Clopidogrel in Acute Coronary
Syndrome Subjects [TRILOGY ACS]; NCT00699998).

<13>
Accession Number
26995381
Author
Banovic M.; Iung B.; Bartunek J.; Asanin M.; Beleslin B.; Biocina B.;
Casselman F.; da Costa M.; Deja M.; Gasparovic H.; Kala P.; Labrousse L.;
Loncar Z.; Marinkovic J.; Nedeljkovic I.; Nedeljkovic M.; Nemec P.;
Nikolic S.D.; Pencina M.; Penicka M.; Ristic A.; Sharif F.; Van Camp G.;
Vanderheyden M.; Wojakowski W.; Putnik S.
Institution
(Banovic) Belgrade Medical School, Belgrade, Serbia; University Clinical
Centre of Serbia, Belgrade, Serbia. Electronic address:
(Iung) University Hospital Bichat, Paris, France
(Bartunek) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Asanin) Belgrade Medical School, Belgrade, Serbia; University Clinical
Centre of Serbia, Belgrade, Serbia
(Beleslin) Belgrade Medical School, Belgrade, Serbia; University Clinical
Centre of Serbia, Belgrade, Serbia
(Biocina) Clinical Center "Rebro", Zagreb, Croatia
(Casselman) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(da Costa) University Hospital Galway, Galway, Republic of Ireland
(Deja) Medical University of Silesia, Katowice, Poland
(Gasparovic) Clinical Center "Rebro", Zagreb, Croatia
(Kala) Centre of Cardiovascular Surgery and Transplantations, Medical
Faculty of Masaryk University, Brno, Czech Republic; University Hospital
Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
(Labrousse) Hopital Cardiologique de Haut Leveque, Pessac, France
(Loncar) Belgrade Medical School, Belgrade, Serbia
(Marinkovic) Belgrade Medical School, Belgrade, Serbia; University
Clinical Centre of Serbia, Belgrade, Serbia
(Nedeljkovic) Belgrade Medical School, Belgrade, Serbia; University
Clinical Centre of Serbia, Belgrade, Serbia
(Nedeljkovic) Belgrade Medical School, Belgrade, Serbia; University
Clinical Centre of Serbia, Belgrade, Serbia
(Nemec) Centre of Cardiovascular Surgery and Transplantations, Medical
Faculty of Masaryk University, Brno, Czech Republic
(Nikolic) Bioventrix, San Ramon, CA
(Pencina) Biostatistics and Bioinformatics, Duke Clinical Research
Institute, Duke University, Durham, NC
(Penicka) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Ristic) Belgrade Medical School, Belgrade, Serbia; University Clinical
Centre of Serbia, Belgrade, Serbia
(Sharif) University Hospital Galway, Galway, Republic of Ireland
(Van Camp) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Vanderheyden) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Wojakowski) Medical University of Silesia, Katowice, Poland
(Putnik) Belgrade Medical School, Belgrade, Serbia; University Clinical
Centre of Serbia, Belgrade, Serbia. Electronic address:
svetozar073@yahoo.com
Title
Rationale and design of the Aortic Valve replAcemenT versus conservative
treatment in Asymptomatic seveRe aortic stenosis (AVATAR trial): A
randomized multicenter controlled event-driven trial.
Source
American heart journal. 174 (pp 147-153), 2016. Date of Publication: 01
Apr 2016.
Abstract
Aortic valve replacement (AVR) therapy is an obvious choice for
symptomatic severe aortic stenosis (AS) patients as it improves symptoms,
left ventricular function, and survival. The treatment decisions and
indication for AVR in asymptomatic patients with severe AS and normal left
ventricular ejection fraction are less well established and the subject of
ongoing debate. Many efforts have been made to define the best treatment
option in asymptomatic AS patients with normal left ventricular ejection
fraction. Retrospective and observational data imply that elective AVR for
asymptomatic severe AS may lead to improvement in outcomes in comparison
to surgery performed after onset of symptoms. The AVATAR trial will aim to
assess outcomes among asymptomatic AS patients randomized to either
elective early AVR or medical management with vigilant follow-up. In the
latter group, AVR would be delayed until either the onset of symptoms or
changes in predefined echocardiographic parameters. To the best of the
authors' knowledge, it will be the first large prospective, randomized,
controlled, multicenter clinical trial that will evaluate the safety and
efficacy of elective AVR in this specific group of patients.

<14>
Accession Number
26614412
Author
Zorn G.L.; Little S.H.; Tadros P.; Deeb G.M.; Gleason T.G.; Heiser J.;
Kleiman N.S.; Oh J.K.; Popma J.J.; Adams D.; Huang J.; Reardon M.J.
Institution
(Zorn) Cardiovascular Research Institute, University of Kansas Hospital,
Kansas City, Kan. Electronic address: gzorn@kumc.edu
(Little) Houston Methodist DeBakey Heart and Vascular Center, The Houston
Methodist Hospital, Houston, Tex
(Tadros) Cardiovascular Research Institute, University of Kansas Hospital,
Kansas City, Kan
(Deeb) University of Michigan Medical Center, Ann Arbor, Mich
(Gleason) University of Pittsburgh School of Medicine, Pittsburg, Pa
(Heiser) Spectrum Health Hospitals, Grand Rapids, Mich
(Kleiman) Houston Methodist DeBakey Heart and Vascular Center, The Houston
Methodist Hospital, Houston, Tex
(Oh) Mayo Clinic, Rochester, Minn
(Popma) Beth Israel Deaconess Medical Center, Boston, Mass
(Adams) Mount Sinai Medical Center, New York, NY
(Huang) Medtronic, Minneapolis, Minn
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, The Houston
Methodist Hospital, Houston, Tex
Title
Prosthesis-patient mismatch in high-risk patients with severe aortic
stenosis: A randomized trial of a self-expanding prosthesis.
Source
The Journal of thoracic and cardiovascular surgery. 151 (4) (pp
1014-1022), 2016. Date of Publication: 01 Apr 2016.
Abstract
OBJECTIVES: We compared the incidence of prosthesis-patient mismatch (PPM)
between transcatheter aortic valve replacement (TAVR) using a
self-expanding bioprosthesis and surgical aortic valve replacement (SAVR)
in the CoreValve US High Risk Pivotal Trial. We sought to determine the
influence of PPM on clinical outcomes.
METHODS: Patients with severe aortic stenosis and at increased risk for
surgery were randomized 1:1 to TAVR or SAVR. Postoperative PPM was defined
by the effective orifice area index (EOAi) as severe PPM (EOAi < 0.65
cm(2)/m(2)) and no severe PPM (EOAi > 0.65 cm(2)/m(2)); clinical outcomes
were analyzed in the TAVR arm (n = 389) and SAVR arm (n = 353). Left
ventricular mass index and regression were analyzed at baseline and 1
year.
RESULTS: The incidence of severe PPM in the SAVR group at 1 year was 25.7%
versus 6.2% in the TAVR group (P < .0001). Left ventricular mass index
regression at 1 year was 6.8% for TAVR and 15.1% for SAVR in patients with
severe PPM. At 1 year the rate of all-cause mortality and acute kidney
injury were significantly greater in all patients (TAVR + SAVR) with
severe PPM compared with no severe PPM (20.6% vs 12.0% [P = .0145] for
death and 19.2% vs 8.5% [P = .0008] for acute kidney injury).
CONCLUSIONS: In patients with high surgical risk and severe aortic
stenosis, severe PPM is more common in patients treated with SAVR than
those treated with TAVR. Patients with severe PPM are a greater risk for
death and acute kidney injury than patients without severe PPM.

<15>
Accession Number
26995371
Author
Zimerman A.; Lopes R.D.; Stebbins A.L.; Guimaraes P.O.; Haque G.; Melloni
C.; Trollinger K.; James S.K.; Alexander J.H.; Tricoci P.; Roe M.T.; Ohman
E.M.; Mahaffey K.W.; Held C.; Tinga B.; Pieper K.S.; Alexander K.P.
Institution
(Zimerman) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Lopes) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Stebbins) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Guimaraes) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Haque) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Melloni) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Trollinger) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(James) Uppsala Clinical Research Center, UCR, Uppsala University,
Uppsala, Sweden
(Alexander) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Tricoci) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Roe) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Ohman) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Mahaffey) Department of Medicine, Stanford University, Stanford, CA
(Held) Uppsala Clinical Research Center, UCR, Uppsala University, Uppsala,
Sweden
(Tinga) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Pieper) Duke Clinical Research Institute, Duke Medicine, Durham, NC
(Alexander) Duke Clinical Research Institute, Duke Medicine, Durham, NC.
Electronic address: karen.alexander@duke.edu
Title
Pooled analysis of adverse event collection from 4 acute coronary syndrome
trials.
Source
American heart journal. 174 (pp 60-67), 2016. Date of Publication: 01 Apr
2016.
Abstract
BACKGROUND: Adverse event collection in randomized clinical trials
establishes drug safety. Although costly and regulated, it is rarely
studied.
METHODS: Adverse event data from 4 clinical trials (APPRAISE-2, PLATO,
TRACER, TRILOGY ACS) comprising 48,118 participants with acute coronary
syndromes were pooled to compare patterns and determinants of reporting.
Events were classified as serious (SAE) or nonserious (AE) from hospital
discharge to 1 year; study end points were excluded.
RESULTS: In total, 84,901 events were reported. Of those, 12,266 (14.4%)
were SAEs and 72,635 (85.6%) were AEs. Of all participants, 7,823 (16.3%)
had SAEs, 18,124 (37.7%) had only AEs, and 22,171 (46.1%) had neither.
Nonserious adverse events were distributed across system organ classes:
general disorders (11%), infection (10%), gastrointestinal (10%),
respiratory (9%), cardiovascular (8.4%), and other (35%). Serious adverse
events had a higher proportion of cardiovascular causes (14.0%). Event
reporting was highest after hospital discharge, decreasing rapidly during
the following 3 months. In a Cox proportional hazards model, chronic
obstructive pulmonary disease (hazard ratio 1.58, 95% CI 1.44-1.74), heart
failure (1.55, 1.40-1.70), older age, and female sex were independent
predictors of more SAEs, whereas enrollment in Eastern Europe (0.63,
0.58-0.69) or Asia (0.84, 0.75-0.94) were independent predictors of fewer
SAEs.
CONCLUSIONS: Half of all participants reported adverse events in the year
after acute coronary syndrome; most were AEs and occurred within 3 months.
The high volume of events, as well as the variation in SAE reporting by
characteristics and enrollment region, indicates that efforts to refine
event collection in large trials are warranted.

<16>
Accession Number
25361738
Author
Wang J.; Ma H.-P.; Ti A.L.; Zhang Y.-Q.; Zheng H.
Institution
(Wang) Department of Anesthesiology, The First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Ma) Department of Anesthesiology, The First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Ti) Department of Anesthesiology, The First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Zhang) Department of Anesthesiology, The First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Zheng) Department of Anesthesiology, The First Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
Title
Prothrombotic SERPINC1 gene polymorphism may affect heparin sensitivity
among different ethnicities of Chinese patients receiving heart surgery.
Source
Clinical and applied thrombosis/hemostasis : official journal of the
International Academy of Clinical and Applied Thrombosis/Hemostasis. 21
(8) (pp 760-767), 2015. Date of Publication: 01 Nov 2015.
Abstract
The purpose of this study was to investigate a possible correlation
between single-nucleotide polymorphisms (SNPs) of the antithrombin (gene,
SERPINC1, and perioperative sensitivity to heparin in patients receiving
heart surgery. The SERPINC1 genotype and allele frequency, coagulation
parameters 24 hours before and after surgery, and clinical findings were
compared among 3 ethnic groups, Han, Uighur, and Kazakh, patientswho
received heart surgery. In Han patients, longer coagulation time as well
as higher heparin and protamine dosage was observed. SERPINC1 gene
sequencing identified 2 mutations in exon 5, g.981A>G (rs5877) and
g.1011A>G (rs5878). The minor allele frequency of allele (A>G) for rs5877
and rs5878 was higher in the Han patients and was significantly different
among the ethnic groups (P = .004 and P = .006, respectively). The
increased SERPINC1 SNP frequency among Han patients receiving heart
surgery might contribute to the differences in their perioperative
sensitivity to heparin.

<17>
Accession Number
20160567644
Author
Shen S.; Zhang J.; Wang W.; Zheng J.; Xie Y.
Institution
(Shen, Wang) Zhejiang Provincial People's Hospital, Department of
Anesthesiology, Hangzhou, Zhejiang, China
(Zhang) Zhejiang Provincial People's Hospital, Department of Orthopedics,
Hangzhou, Zhejiang, China
(Zheng) School of Mathematical Sciences, Beijing University, Department of
Probability and Statistics, Beijing, China
(Xie) Zhejiang Provincial People's Hospital, Department of Cardiothoracic
Surgery, Hangzhou, Zhejiang, China
Title
Impact of intra-operative cell salvage on blood coagulation in
high-bleeding-risk patients undergoing cardiac surgery with
cardiopulmonary bypass: A prospective randomized and controlled trial.
Source
Journal of Translational Medicine. 14 (1) (no pagination), 2016. Article
Number: 228. Date of Publication: 29 Jul 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Intra-operative cell salvage (CS) was reported to have no
impairment on blood coagulation in low-bleeding-risk cardiac surgery with
cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac
surgery are limited. The objective of this study is to evaluate the impact
of CS on blood coagulation in high-bleeding-risk cardiac surgery with CPB.
Methods: One hundred and ten patients were randomly assigned to either
with intra-operative CS group (Group CS) or without intra-operative CS
group (Group C). Study endpoints included the incidence of impairment of
blood coagulation during perioperative period (peri-op) and the incidence
of adverse events during postoperative period (post-op). Peri-op was
defined as the period from beginning of anesthesia (anesthesia induction)
to 24 h after end of surgery. Post-op was defined as the period from the
end of surgery to 24 h after end of surgery. The types of impairment of
blood coagulation included heparin residual, coagulopathy due to low PLT,
coagulopathy due to low FIB, coagulopathy due to low coagulation factors,
hyperfibrinolytic. The sum of above five types was total impairment of
blood coagulation. Adverse events included excessive bleeding,
resternotomy, etc. Results: The incidence of heparin residual measured
both at the end of surgery and during post-op were significantly higher in
Group CS than in Group C (15.09 vs 4.00, 13.21 vs 2.00 %; p = 0.024,
0.010, respectively). Similarly, the incidence of total impairment of
blood coagulation at the end of surgery and during post-op were
significantly higher in Group CS than in Group C (32.08 vs 18.00, 26.42 vs
12.00 %; p = 0.043, 0.040, respectively). The incidence of excessive
bleeding during post-op was 32.08 % in Group CS compared with 16.00 % in
Group C (p = 0.038). Intriguingly, CS was associated with a significantly
increase in the relative risk ratios for heparin residual and excessive
bleeding (p = 0.034, 0.049, respectively). Conclusions: Intra-operative CS
could impair blood coagulation in the scenario of high-risk-bleeding
cardiac surgery with CPB.

<18>
Accession Number
20160568310
Author
Stratz C.; Bomicke T.; Younas I.; Kittel A.; Amann M.; Valina C.M.;
Nuhrenberg T.; Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Stratz, Bomicke, Younas, Amann, Valina, Nuhrenberg, Trenk, Neumann,
Hochholzer) University Heart Center Freiburg Bad Krozingen, Department of
Cardiology and Angiology II, Bad Krozingen, Germany
(Kittel) Institute of Experimental and Clinical Pharmacology and
Toxicology, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen,
Germany
Title
Comparison of Immature Platelet Count to Established Predictors of
Platelet Reactivity During Thienopyridine Therapy.
Source
Journal of the American College of Cardiology. 68 (3) (pp 286-293), 2016.
Date of Publication: 19 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Previous data suggest that reticulated platelets significantly
affect antiplatelet response to thienopyridines. It is unknown whether
parameters describing reticulated platelets can predict antiplatelet
response to thienopyridines. Objectives The authors sought to determine
the extent to which parameters describing reticulated platelets can
predict antiplatelet response to thienopyridine loading compared with
established predictors. Methods This study randomized 300 patients
undergoing elective coronary stenting to loading with clopidogrel 600 mg,
prasugrel 30 mg, or prasugrel 60 mg. Adenosine diphosphate (ADP)-induced
platelet reactivity was assessed by impedance aggregometry before loading
(intrinsic platelet reactivity) and again on day 1 after loading. Multiple
parameters of reticulated platelets were assessed by automated whole blood
flow cytometry: absolute immature platelet count (IPC), immature platelet
fraction, and highly fluorescent immature platelet fraction. Results Each
parameter of reticulated platelets correlated significantly with
ADP-induced platelet reactivity (p < 0.01 for all 3 parameters). In a
multivariable model including all 3 parameters, only IPC remained a
significant predictor of platelet reactivity (p < 0.001). In models
adjusting each of the 3 parameters for known predictors of on-treatment
platelet reactivity including cytochrome P450 2C19 (CYP2C19)
polymorphisms, age, body mass index, diabetes, and intrinsic platelet
reactivity, only IPC prevailed as an independent predictor (p = 0.001). In
this model, IPC was the strongest predictor of on-treatment platelet
reactivity followed by intrinsic platelet reactivity. Conclusions IPC is
the strongest independent platelet count-derived predictor of antiplatelet
response to thienopyridine treatment. Given its easy availability,
together with its even stronger association with on-treatment platelet
reactivity compared with known predictors, including the CYP2C19*2
polymorphism, IPC may become the preferred predictor of antiplatelet
response to thienopyridine treatment. (Impact of Extent of
Clopidogrel-Induced Platelet Inhibition During Elective Stent Implantation
on Clinical Event Rate-Advanced Loading Strategies [ExcelsiorLOAD];
DRKS00006102)

<19>
Accession Number
20160567940
Author
Nishiyama N.; Komatsu T.; Kuroyanagi T.; Fujikake A.; Komatsu S.; Nakamura
H.; Yamada K.; Nakahara S.; Kobayashi S.; Taguchi I.
Institution
(Nishiyama, Komatsu, Kuroyanagi, Fujikake, Komatsu, Nakamura, Yamada,
Nakahara, Kobayashi, Taguchi) Department of Cardiology, Dokkyo Medical
University Koshigaya Hospital, Japan
Title
Clinical value of drug-coated balloon angioplasty for de novo lesions in
patients with coronary artery disease.
Source
International Journal of Cardiology. 222 (pp 113-118), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite the low restenosis rates of drug-eluting stents (DES),
several problems remain, including stent thrombosis, stent fracture, and
neo-atherosclerosis. 'Stent-less' (balloon alone) percutaneous coronary
intervention (PCI) is still being used, and several clinical trials have
supported the efficacy of DCB. The aim of this study was to investigate
the efficacy of a drug-coated balloon (DCB) in the treatment of de novo
coronary artery disease. Methods We enrolled 60 consecutive patients who
had been given elective PCI between May 2014 and June 2015. They were
randomly assigned to a 'stent-less' group (n = 30) and a 'stent' group (n
= 30). Twenty-seven patients were treated with DCB alone and 33 with DES,
and then evaluated for target lesion revascularization (TLR) rate and by
quantitative coronary angiography (QCA) eight months later. Results TLR
rates were similar in the two groups (DCB; 0.0%, DES; 6.1%, P = 0.169). In
the QCA analysis, minimal lumen diameter (MLD) and acute gain were
significantly smaller in the DCB group than in the DES group immediately
after PCI (2.36 +/- 0.46 vs 2.64 +/- 0.37, P = 0.011, and 1.63 +/- 0.41 vs
2.08 +/- 0.37, P < 0.0001, respectively). Eight months after PCI, however,
there was no significant difference in MLD or late lumen loss between the
two groups. Conclusions A 'stent-less' PCI using DCB could be useful even
in the DES era. After 'stent-less' PCI, antiplatelet agents might be
reduced or discontinued more safely than after DES implantation.

<20>
Accession Number
20160189030
Author
Bhatheja S.; Panchal H.B.; Barry N.; Mukherjee D.; Uretsky B.F.; Paul T.
Institution
(Bhatheja, Panchal, Paul) Division of Cardiology, Department of Internal
Medicine, East Tennessee State University, 329 N State of Franklin Rd,
Johnson City, TN 37604, United States
(Barry) Department of Internal Medicine, East Tennessee State University,
VA Building #1, Johnson City, TN, United States
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, 4800 Alberta, El Paso, TX 79905, United States
(Uretsky) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United
States
Title
Valvular performance and aortic regurgitation following transcatheter
aortic valve replacement using Edwards valve versus CoreValve for severe
aortic stenosis: A Meta-analysis.
Source
Cardiovascular Revascularization Medicine. 17 (4) (pp 248-255), 2015. Date
of Publication: 02 Oct 2015.
Publisher
Elsevier Inc.
Abstract
Objectives To compare incidence of aortic regurgitation (AR), paravalvular
AR and valvular performance with Doppler hemodynamic parameters following
transcatheter aortic valve replacement (TAVR) with Edwards valve (EV)
versus CoreValve (CV). Currently, there are scarce data on post-TAVR
echocardiographic outcomes comparing EV and CV. Methods PubMed and the
Cochrane Center Register of Controlled Trials were searched through May
2015. Twenty studies (n = 11,244) comparing TAVR procedure that used EV (n
= 6445) and CV (n = 4799) were included. End points were post-TAVR
moderate to severe AR and paravalvular AR, effective orifice area (EOA),
mean trans-aortic pressure gradient (MPG), peak trans-aortic pressure
gradient (PPG) and left ventricular ejection fraction (LVEF). The mean
difference (MD) or relative risk (RR) with 95% confidence interval (CI)
was computed and p < 0.05 was considered as a level of significance.
Results Moderate to severe AR and paravalvular AR were significantly lower
in EV group (RR: 0.57, CI: 0.52-0.63, p < 0.00001 and RR: 0.40, CI:
0.25-0.63, p < 0.0001 respectively) compared to CV group. EOA and PPG were
not significantly different between EV and CV groups. MPG was
significantly lower among patients in CV group (MD: 1.08, CI: 0.05-2.10, p
= 0.04). LVEF was significantly higher in patients in EV group (MD: 2.26,
CI: 0.77-3.74, p = 0.03). Conclusions This study showed CV is associated
with higher incidence of post-TAVR moderate to severe paravalvular AR.
Echocardiographic valvular performance measures (MPG, LVEF) showed minimal
but significant difference, which may not be clinically significant.

<21>
Accession Number
20160569189
Author
Mas J.-L.; Derumeaux G.; Amarenco P.; Arquizan C.; Aubry P.; Barthelet M.;
Bertrand B.; Brochet E.; Cabanes L.; Donal E.; Dubois-Rande J.-L.;
Durand-Zaleski I.; Ernande L.; Finet G.; Fraisse A.; Giroud M.; Guerin P.;
Habib G.; Juliard J.-M.; Leys D.; Lievre M.; Lusson J.-R.; Marcon F.;
Michel P.; Moulin T.; Mounier-Vehier F.; Pierard L.; Piot C.; Rey C.;
Rodier G.; Roudaut R.; Schleich J.-M.; Teiger E.; Turc G.; Vuillier F.;
Weimar C.; Woimant F.; Chatellier G.
Institution
(Mas, Turc) Department of Neurology, Sainte-Anne Hospital, Paris Descartes
University, Inserm 894, DHU NeuroVasc, Paris, France
(Derumeaux, Ernande, Teiger) Department of Physiology, Henri Mondor
Hospital, Paris Est Creteil University, Inserm 955, DHU ATVB, Creteil,
France
(Amarenco) APHP, Department of Neurology and Stroke Center, Bichat
Hospital, Paris-Diderot University, Inserm 1148, DHU FIRE, Paris, France
(Arquizan) Department of Neurology, Gui de Chauliac Hospital, Montpellier,
France
(Aubry, Brochet, Juliard) APHP, Department of Cardiology, Bichat Hospital,
Paris Diderot University, Inserm 1148, DHU FIRE, Paris, France
(Barthelet) Department of Cardiovascular Investigations, Louis Pradel
Hospital, Lyon University, Bron, France
(Bertrand) Department of Cardiology, CHU A. Michallon, Joseph Fourier
University, Grenoble, France
(Cabanes) AP-HP, Department of Cardiology, Cochin Hospital,
Paris-Descartes University, Paris, France
(Donal, Schleich) Department of Cardiology and Vascular Diseases,
Pontchaillou Hospital, Rennes University, Rennes, France
(Dubois-Rande) APHP, Department of Cardiology, Henri-Mondor Hospital,
Paris Est Creteil University, Inserm 955, DHU ATVB, Creteil, France
(Durand-Zaleski) AP-HP, Department of Public Health, Henri Mondor
Hospital, Paris Est Creteil University, Creteil, France
(Finet) Department of Cardiology, Cardiovascular Hospital, Claude Bernard
University, Inserm 1060, Lyon, France
(Fraisse) Department of Pediatric Cardiology, La Timone Hospital,
Aix-Marseille Universite, Marseille, France
(Giroud) Department of Neurology, CHU Dijon, Bourgogne University, Dijon
Stroke Registry, Dijon, France
(Guerin) Department of Cardiology, Institut du Thorax, CHU Nantes, Nantes,
France
(Habib) Department of Cardiology, La Timone Hospital, Aix-Marseille
Universite, Marseille, France
(Leys) Department of Neurology and Stroke Unit, Roger Salengro Hospital,
Lille 2 University, Inserm 1171, Lille, France
(Lievre) UMR CNRS 5558, Lyon 1 University, Lyon, France
(Lusson) Department of Cardiology and Vascular Diseases, Gabriel Montpied
Hospital, Auvergne University, UMR 6284, Clermont-Ferrand, France
(Marcon) Department of Cardiovascular Diseases, Pediatric Cardiology Unit,
Nancy University, Nancy, France
(Michel) Stroke Center, Department of Neurology, Centre Hospitalier
Universitaire Vaudois and Lausanne University, Lausanne, Switzerland
(Moulin, Vuillier) Department of Neurology, CHU Besancon, Franche-Comte
University, CIC 1431, Besancon, France
(Mounier-Vehier) Department of Neurology, Doctor Schaffner Hospital, Lens,
France
(Pierard) Department of Cardiology, Sart Tilman Hospital, Liege
University, Liege, Belgium
(Piot) Department of Interventional Cardiology, Clinique du Millenaire,
Montpellier University, UMR 5203, Montpellier, France
(Rey) Department of Pediatric Cardiology, Cardiology Hospital, Lille 2
University, Lille, France
(Rodier) Department of Neurology, Annecy-Genevois Hospital, Annecy, France
(Roudaut) Department of Cardiology and Vascular Diseases, Haut Leveque
Hospital, Bordeaux University, Bordeaux, France
(Weimar) Department of Neurology, University Hospital, University of
Duisburg-Essen, Essen, Germany
(Woimant) APHP, Department of Neurology, Lariboisiere Hospital, Agence
Regionale de Sante Ile-de-France, Paris, France
(Chatellier) APHP, Epidemiology and Clinical Research Unit, Georges
Pompidou European hospital, Paris Descartes University, Paris, France
Title
close: Closure of patent foramen ovale, oral anticoagulants or
antiplatelet therapy to prevent stroke recurrence: Study design.
Source
International Journal of Stroke. 11 (6) (pp 724-732), 2016. Date of
Publication: 01 Aug 2016.
Publisher
SAGE Publications Inc.
Abstract
Rationale: Currently available data do not provide definitive evidence on
the comparative benefits of closure of patent foramen ovale, oral
anticoagulants and antiplatelet therapy in patients with patent foramen
ovale-associated cryptogenic stroke Aim: To assess whether transcatheter
patent foramen ovale closure plus antiplatelet therapy is superior to
antiplatelet therapy alone and whether oral anticoagulant therapy is
superior to antiplatelet therapy, for secondary stroke prevention in
patients aged 16 to 60 years with a large patent foramen ovale or a patent
foramen ovale associated with an atrial septal aneurysm, and an otherwise
unexplained ischaemic stroke or retinal ischaemia. Sample size: Six
hundred and sixty-four patients were included in the study. Methods and
design: CLOSE is an academic-driven, multicentre, randomized, open-label,
three-group, superiority trial with blinded adjudication of outcome
events. The trial has been registered with Clinical Trials Register
(Clinicaltrials.gov, NCT00562289). Patient recruitment started in December
2007. Patient follow-up will continue until December 2016. Expected mean
follow-up = 5.6 years. Study outcomes: The primary efficacy outcome is the
occurrence of fatal or nonfatal stroke. Safety outcomes include fatal,
life-threatening or major procedure- or device-related complications and
fatal, life-threatening or major haemorrhagic complications. Discussion:
CLOSE is the first specifically designed trial to assess the superiority
of patent foramen ovale closure over antiplatelet therapy alone and the
superiority of oral anticoagulants over antiplatelet therapy to prevent
stroke recurrence in patients with patent foramen ovale-associated
cryptogenic stroke.

<22>
Accession Number
20160561970
Author
Zhang Y.; Peng L.; Fan Y.-Y.; Lu C.-Y.
Institution
(Zhang, Peng, Fan, Lu) Department of Cardiology, Chinese PLA General
Hospital, Fuxing Road 28, Haidian District, Beijing 100853, China
Title
Additional manual thrombus aspiration for ST-segment elevation myocardial
infarction during percutaneous coronary intervention: An updated
meta-analysis.
Source
Journal of Geriatric Cardiology. 13 (4) (pp 344-354), 2016. Date of
Publication: 2016.
Publisher
Science Press
Abstract
Background: The clinical efficacy and safety of adjunctive thrombus
aspiration (TA) in patients with ST-segment elevation myocardial
infarction (STEMI) during percutaneous coronary intervention (PCI) remain
controversial. Methods Twenty five eligible randomized controlled trials
were included to compare the use of thrombus aspiration (TA) with PCI and
PCI-only for STEMI. The primary endpoint was all-cause mortality and
death. The secondary endpoints were major adverse cardiac events (MACE),
recurrent infarction (RI), target vessel revascularization (TVR), stent
thrombosis (ST), perfusion surrogate markers and stroke. Results: TIMI
flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI
arm compared with the PCI-only arm [relative risk (RR): 1.05, 95%
confidence intervals (CI): 1.02-1.09, P = 0.004] and (RR: 1.68, 95% CI:
1.40-2.00, P < 0.001), respectively. There were no significant differences
in all-cause mortality, MACEs, TVR and ST rates between the two groups.
The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm
with short-term follow-up duration (RR: 0.60, 95% CI: 0.38-0.96, P =
0.03), but there was no significant difference in RI incidence over the
medium- or long-term follow-up periods (RR: 1.00, 95% CI: 0.77-1.29, P =
0.98), and (RR: 0.96, 95% CI: 0.81-1.15, P = 0.69), respectively. There
were statistically significant differences in the rates of crude stroke
and stroke over the medium- or long-term follow-up periods and the crude
stroke rate in the TA plus PCI (RR: 1.60, 95% CI: 1.08-2.38, P = 0.02) and
(RR: 1.43, 95% CI: 1.03-1.98, P = 0.03), respectively; this was not
observed between the two arms during the short-term follow-up period (RR:
1.47, 95% CI: 0.97-2.21, P = 0.07). Conclusions: Routine TA-assisted PCI
in STEMI patients can improve myocardial reperfusion and get limited
benefits related to the clinical endpoints, which may be associated with
stroke risk.

<23>
Accession Number
20160556235
Author
Cho Y.J.; Lee S.Y.; Kim T.K.; Hong D.M.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
Title
Effect of prewarming during induction of anesthesia on microvascular
reactivity in patients undergoing off-pump coronary artery bypass surgery:
A randomized clinical trial.
Source
PLoS ONE. 11 (7) (no pagination), 2016. Article Number: e0159772. Date of
Publication: 01 Jul 2016.
Publisher
Public Library of Science
Abstract
Background: General anesthesia may induce inadvertent hypothermia and this
may be related to perioperative cardiovascular complications.
Microvascular reactivity, measured by the recovery slope during a vascular
occlusion test, is decreased during surgery and is also related to
postoperative clinical outcomes. We hypothesized that microvascular
changes during surgery may be related to intraoperative hypothermia. To
evaluate this, we conducted a randomized study in patients undergoing
off-pump coronary artery bypass surgery, in which the effect of prewarming
on microvascular reactivity was evaluated. Methods: Patients scheduled for
off-pump coronary artery bypass surgery were screened. Enrolled patients
were randomized to the prewarming group to receive forced-air warming
during induction of anesthesia or to the control group. Measurement of
core and skin temperatures and vascular occlusion test were conducted
before anesthesia induction, 1, 2, and 3 h after induction, and at the end
of surgery. Results: In total, 40 patients were enrolled and finished the
study (n = 20 in the prewarming group and n = 20 in the control group).
During the first 3 h of anesthesia, core temperature was higher in the
prewarming group than the control group (p < 0.001). The number of
patients developing hypothermia was lower in the prewarming group than the
control group (4/20 vs. 13/20, p = 0.004). However, tissue oxygen
saturation and changes in recovery slope following a vascular occlusion
test at 3 h after anesthesia induction did not differ between the groups.
There was no difference in clinical outcome, including perioperative
transfusion, wound infection, or hospital stay, between the groups.
Conclusions: Prewarming during induction of anesthesia decreased
intraoperative hypothermia, but did not reduce the deterioration in
microvascular reactivity in patients undergoing off-pump coronary artery
bypass surgery. Trial Registration: ClinicalTrials.gov NCT02186210.

<24>
Accession Number
20160548593
Author
Patel N.; Minhas J.S.; Chung E.M.L.
Institution
(Patel, Minhas, Chung) University of Leicester, RKCSB, Leicester Royal
Infirmary, Leicester LE2 7LX, United Kingdom
Title
Intraoperative embolization and cognitive decline after cardiac surgery: A
systematic review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 20 (3) (pp 225-231),
2016. Date of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc.
Abstract
Since the advent of cardiac surgery, complications have existed in many
forms. Recent work has focused on the safety of current cardiac surgery
with particular emphasis on cognitive outcomes. Cardiopulmonary bypass has
improved the safety of operative practice; however, increasing concern
surrounds the measurable and immeasurable impact embolization has on the
brain. New ischemic lesions have been associated with distant emboli,
which intraoperatively enter the cardiovascular system. This has prompted
better characterization of the nature of emboli manifesting as cognitive
impairment postoperatively. The difficulty in attributing causation
relates to the subclinical damage that does not necessarily manifest as
clinical stroke. Transcranial Doppler has become an important tool in
documenting cerebral emboli during surgery. The purpose of this systematic
review is to focus on the current literature to improve our understanding
of the impact embolization has on the brain. We also aim to investigate
which cardiac interventions hold the greatest burden of embolic load and
how previous literature has investigated the impact of emboli on cognition
by monitoring emboli during specific cardiac interventions. Significant
intraoperative factors such as the cardiopulmonary bypass machine and
surgical interventions have been highlighted to summarize the current
literature associating cerebral embolization with these factors and
postoperative cognitive outcomes. The findings of this review report that
the current literature is divided as to whether the impact of embolization
during cardiac surgery has any adverse impact on cognition. This review
highlights that the ultimate goal of improving cognitive safety will
involve further careful consideration of multifactorial events.

<25>
Accession Number
20160548242
Author
Ski C.F.; Jelinek M.; Jackson A.C.; Murphy B.M.; Thompson D.R.
Institution
(Ski, Jelinek, Thompson) Centre for the Heart and Mind, Mary MacKillop
Institute for Health Research, Australian Catholic University, 215 Spring
Street, Melbourne, VIC 3000, Australia
(Ski, Thompson) Department of Psychiatry, University of Melbourne,
Melbourne, Australia
(Jelinek) Department of Cardiology, St Vincent's Hospital, Melbourne,
Australia
(Jackson, Murphy) Heart Research Centre, Melbourne, Australia
(Murphy) Department of Psychology, University of Melbourne, Melbourne,
Australia
Title
Psychosocial interventions for patients with coronary heart disease and
depression: A systematic review and meta-analysis.
Source
European Journal of Cardiovascular Nursing. 15 (5) (pp 305-316), 2016.
Date of Publication: 01 Aug 2016.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Depression is common in patients with coronary heart
disease, and together these conditions significantly affect health
outcomes. Impaired social support is also considered an important
predictor of coronary heart disease prognosis and, as there is a complex
interplay between social isolation and depression, interventions to
address both may be required. This review aimed to assess the
effectiveness of psychosocial interventions addressing both depression and
social support for people with coronary heart disease and depression.
Methods: PRISMA guidelines were used to search major health databases to
identify randomised controlled trials that evaluated psychosocial
interventions compared with usual care in patients with coronary heart
disease and depression; the primary outcome was depressive symptoms and
secondary outcomes were mortality (all-cause and cardiac), myocardial
infarction, revascularisation, anxiety, social support and quality of
life. Data, when suitable, were pooled using a random-effects
meta-analysis model. Results: Five studies (n=1358 participants) were
eligible and included. The psychosocial intervention group had
significantly lower levels of depressive symptoms (standardised mean
difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03;
P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to
0.30; P=0.01) but no differences were found for mortality (all-cause and
cardiac), myocardial infarction, revascularisation, anxiety or quality of
life. Conclusions: Psychosocial interventions for patients with coronary
heart disease and depression result in modest reductions in depressive
symptoms and improvements in social support. However, caution is warranted
in view of the small number of studies included in the review and
potential heterogeneity in outcomes and in differences in treatment.

<26>
Accession Number
20160546677
Author
Salmasi M.Y.; Acharya M.; Humayun N.; Baskaran D.; Hubbard S.; Vohra H.
Institution
(Salmasi, Humayun) Department of Cardiothoracic Surgery, University
Hospitals of Leicester, Leicester, United Kingdom
(Acharya) Department of Cardiac Surgery, Harefield Hospital, London,
United Kingdom
(Baskaran) Department of Surgery, Bradford Hospitals Trust, Bradford,
United Kingdom
(Hubbard) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Vohra) Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United
Kingdom
Title
Is valve repair preferable to valve replacement in ischaemic mitral
regurgitation? A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (1) (pp 17-28), 2016.
Article Number: ezw053. Date of Publication: 01 Jul 2016.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Ischaemic mitral regurgitation (MR) is associated with poor survival. The
favoured surgical option remains debatable. Our aim was to perform a
meta-analysis to compare the outcomes of mitral valve repair (MVRp) with
replacement (MVR). A literature search was conducted in PubMed, Medline
and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and
'replacement'. The primary outcome measure was 30-day survival. The
secondary outcome measures were MR recurrence and reoperation. Out of 310
articles, 18 fulfilled the inclusion criteria. A total of 3978 patients
were included: 2563 (64%) MVRp cases and 1415 (36%) MVR cases. Operative
techniques included annuloplasty for MVRp and subvalvular
apparatus-sparing MVR techniques. Thirty-day mortality was lower after
MVRp compared with MVR [OR 0.42; (95% CI 0.33-0.54; P = 0.0001)]. There
was no difference in long-term survival ranging 1-5 years (HR 0.85, 95% CI
0.65-1.12). Recurrence of MR was significantly higher in the MVRp group
(OR 4.26, 95% CI 2.52-7.22), as was the rate of reoperation (OR 2.03, 95%
CI 1.49-2.77). Although MVR for ischaemic MR has a higher 30-day mortality
rate compared with MVRp, MVRp is associated with the higher rate of MR
recurrence and the need for reoperation. MVR remains an attractive option
for ischaemic MR.

<27>
Accession Number
20160541320
Author
Zeymer U.; Montalescot G.; Ardissino D.; Bolognese L.; Clemmensen P.;
Collet J.-P.; Lopez-Sendon J.; Widimsky P.
Institution
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung,
Germany
(Montalescot, Collet) Centre Hospitalier Universitaire Pitie-Salpetriere,
France
(Ardissino) Azienda Ospedaliero-Universitaria, Italy
(Bolognese) Azienda Ospedaliero, Italy
(Clemmensen) Department of Medicine, Division of Cardiology, Nykoebing F
Hospital, Denmark
(Lopez-Sendon) University Hospital La Paz, Spain
(Widimsky) Cardiology Department at the Third Faculty of Medicine, Charles
University and University Hospital, Kralovske Vinohrady, Czech Republic
Title
Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in
patients with non-ST elevation acute coronary syndromes. Lessons learnt
from the ACCOAST-trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (3) (pp 282-288),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc.
Abstract
The optimal time-point of the initiation of P2Y12 antagonist therapy in
patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is
still a matter of debate. European guidelines recommend P2Y12 as soon as
possible after first medical contact. However, the only trial which
compared the two strategies did not demonstrate any benefit of
pretreatment with prasugrel before angiography compared to starting
therapy after angiography and just prior to percutaneous coronary
intervention (PCI). This paper summarizes the results of pharmacodynamic
and previous studies, and gives recommendations for the initiation of
P2Y12 antagonist therapy in NSTE-ACS in different clinical situations.

<28>
Accession Number
20160541318
Author
White H.D.; Westerhout C.M.; Alexander K.P.; Roe M.T.; Winters K.J.; Cyr
D.D.; Fox K.A.A.; Prabhakaran D.; Hochman J.S.; Armstrong P.W.; Ohman E.M.
Institution
(White) Green Lane Cardiovascular Service, Auckland City Hospital and
University of Auckland, Auckland, New Zealand
(Westerhout, Armstrong) Canadian VIGOUR Centre, University of Alberta,
Canada
(Alexander, Roe, Cyr, Ohman) Duke Clinical Research Institute, United
States
(Alexander, Roe, Ohman) Division of Cardiology, Department of Medicine,
Duke University School of Medicine, United States
(Winters) Eli Lilly and Company, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh, United
Kingdom
(Prabhakaran) Centre for Chronic Disease Control, Public Health Foundation
of India, India
(Hochman) Division of Cardiology, Department of Medicine, Langone Medical
Center, New York University, United States
(Armstrong) Division of Cardiology, Department of Medicine, University of
Alberta, Canada
Title
Frailty is associated with worse outcomes in non-ST-segment elevation
acute coronary syndromes: Insights from the TaRgeted platelet Inhibition
to cLarify the Optimal strateGy to medicallY manage Acute Coronary
Syndromes (TRILOGY ACS) trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (3) (pp 231-242),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc.
Abstract
Aims: Little is known regarding consequences of frailty in patients with
acute coronary syndrome (ACS). We assessed the associations of frailty and
outcomes in ACS patients who were participating in a clinical trial.
Methods and results: The TaRgeted platelet Inhibition to cLarify the
Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY
ACS) trial randomized 9326 patients planned for medical management to
prasugrel or clopidogrel. The primary endpoint was a composite of
cardiovascular death, myocardial infarction (MI), or stroke over a period
of 30 months. A frailty score based upon the Fried score was self-reported
at baseline in patients aged >65 years. Five frailty questions were
recorded for 4996/5102 (97.9%) patients: 72.3% were classified as
not-frail (0 items), 23.0% as pre-frail (1-2 items), and 4.7% as frail (>3
items). Increasing frailty score was associated with older age, diabetes,
and higher Global Registry of Acute Coronary Events (GRACE) scores.
Frailty was associated with a higher unadjusted incidence of the primary
endpoint (pre-frail vs not-frail: 29.2% vs 23.1%; hazard ratio [HR]: 1.39;
95% confidence interval [CI]: 1.19-1.61; p<0.001; frail vs not-frail:
39.7% vs 23.1%; HR: 1.76; 95% CI: 1.36-2.28; p<0.001), and all-cause
mortality (pre-frail vs not-frail: 21.7% vs 15.0%; HR: 1.45; 95% CI:
1.22-1.73; p<0.001; frail vs not-frail: 30.2% vs 15.0%; HR: 1.98; 95% CI:
1.47-2.68; p<0.001). After adjustment for baseline characteristics and
GRACE covariates, frailty remained independently associated with the
primary endpoint: pre-frail vs not-frail, HR: 1.33; 95% CI: 1.15-1.54;
p<0.001; frail vs not-frail, HR: 1.52; 95% CI: 1.18-1.98; p=0.002. There
was no association of frailty with bleeding. Conclusion: Frailty is
associated with the composite of cardiovascular death, MI, or stroke.
Frailty assessment contributes to risk prediction and adds to the GRACE
score.

<29>
Accession Number
20160539461
Author
Bignami E.; Cattaneo M.; Crescenzi G.; Ranucci M.; Guarracino F.; Cariello
C.; Baldassarri R.; Isgro G.; Baryshnikova E.; Fano G.; Franco A.; Gerli
C.; Crivellari M.; Zangrillo A.; Landoni G.
Institution
(Bignami, Crescenzi, Fano, Franco, Gerli, Crivellari, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Cattaneo) ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute,
Universita degli Studi di Milano, Italy
(Ranucci, Isgro, Baryshnikova) Department of Cardiothoracic and Vascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
(Guarracino, Cariello, Baldassarri) Department of Anesthesia and Intensive
Care, University Hospital of Pisa, Pisa, Italy
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Desmopressin after cardiac surgery in bleeding patients. A multicenter
randomized trial.
Source
Acta Anaesthesiologica Scandinavica. 60 (7) (pp 892-900), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Munksgaard
Abstract
Background: Previous studies showed that desmopressin decreases
post-operative blood loss in patients undergoing cardiac surgery. These
studies were small and never studied the effect of desmopressin in
patients with active bleeding. Objective of the study was to determine
whether desmopressin reduces red blood cells transfusion requirements in
patients with active bleeding after cardiac surgery who had been
pre-treated with tranexamic acid. Methods: This multicenter, randomized,
double-blind, placebo-controlled, parallel-group study randomized elective
patients with bleeding after cardiac surgery despite pre-treatment with
tranexamic acid, to receive placebo (saline solution) or a single
administration of desmopressin (0.3 mug/kg in saline solution). The
primary endpoint was the number of patients requiring red blood cells
transfusion after randomization and during hospital stay. Secondary end
points were: blood loss from chest tubes during the first 24 h after study
drug administration, hours of mechanical ventilation, intensive care unit
stay, and in-hospital mortality. Results: The study was interrupted after
inclusion of 67% of the planned patients for futility. The number of
patients requiring red blood cells transfusion after randomization was
37/68 (54%) in desmopressin group and 33/67 (49%) in placebo group (P =
0.34) with no difference in blood loss: 575 (interquartile 422-770) ml in
desmopressin group and 590 (476-1013) ml in placebo group (P = 0.42),
mechanical ventilation, intensive care unit stay or mortality.
Conclusions: This multicenter randomized trial demonstrated that, in
patients pre-treated with tranexamic acid, desmopressin should not be
expected to improve treatment of patients who experience bleeding after
cardiac surgery.

<30>
Accession Number
20160319781
Author
Kim M.S.; Bracken J.; Eshuis P.; Chen S.Y.J.; Fullerton D.; Cleveland J.;
Messenger J.C.; Carroll J.D.
Institution
(Kim, Chen, Fullerton, Cleveland, Messenger, Carroll) University of
Colorado Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132,
Aurora, CO 80045, United States
(Bracken) Philips Healthcare, Markham, ON, Canada
(Eshuis) Philips Healthcare, Best, Netherlands
Title
Use of short roll C-arm computed tomography and fully automated 3D
analysis tools to guide transcatheter aortic valve replacement.
Source
International Journal of Cardiovascular Imaging. 32 (7) (pp 1145-1152),
2016. Date of Publication: 01 Jul 2016.
Publisher
Springer Netherlands
Abstract
Determination of the coplanar view is a critical component of
transcatheter aortic valve replacement (TAVR). The safety and accuracy of
a novel reduced angular range C-arm computed tomography (CACT) approach
coupled with a fully automated 3D analysis tool package to predict the
coplanar view in TAVR was evaluated. Fifty-seven patients with severe
symptomatic aortic stenosis deemed prohibitive-risk for surgery and who
underwent TAVR were enrolled. Patients were randomized 2:1 to CACT vs.
angiography (control) in estimating the coplanar view. These approaches to
determine the coplanar view were compared quantitatively. Radiation doses
needed to determine the coplanar view were recorded for both the CACT and
control patients. Use of CACT offered good agreement with the actual
angiographic view utilized during TAVR in 34 out of 41 cases in which a
CACT scan was performed (83 %). For these 34 cases, the mean angular
magnitude difference, taking into account both oblique and cranial/caudal
angulation, was 1.3degree +/- 0.4degree, while the maximum difference was
7.3degree. There were no significant differences in the mean total
radiation dose delivered to patients between the CACT and control groups
as measured by either dose area product (207.8 +/- 15.2 Gy cm²
vs. 186.1 +/- 25.3 Gy cm², P = 0.47) or air kerma (1287.6 +/-
117.7 mGy vs. 1098.9 +/- 143.8 mGy, P = 0.32). Use of reduced-angular
range CACT coupled with fully automated 3D analysis tools is a safe,
practical, and feasible method by which to determine the optimal
angiographic deployment view for guiding TAVR procedures.

<31>
Accession Number
20160553446
Author
Bablekos G.D.; Analitis A.; Michaelides S.A.; Charalabopoulos K.A.; Tzonou
A.
Institution
(Bablekos) Technological Educational Institute of Athens, Faculty of
Health and Caring Professions, Agiou Spyridonos, Egaleo, Athens 12243,
Greece
(Bablekos, Charalabopoulos) Department of Physiology, Medical School,
Democritus University of Thrace, Dragana, Alexandroupolis 68100, Greece
(Analitis, Tzonou) Department of Hygiene, Epidemiology and Medical
Statistics, Medical School, National and Kapodistrian University of
Athens, Goudi, Athens 11527, Greece
(Michaelides) Department of Occupational Lung Diseases and Tuberculosis,
'Sismanogleio' General Hospital, Maroussi, Athens 15126, Greece
Title
Management and postoperative outcome in primary lung cancer and heart
disease co-morbidity: A systematic review and metaanalysis.
Source
Annals of Translational Medicine. 4 (11) (no pagination), 2016. Article
Number: 213. Date of Publication: June 2016.
Publisher
AME Publishing Company
Abstract
Background: Co-morbidity of primary lung cancer (LC) and heart disease
(HD), both requiring surgical therapy, characterizes a high risk group of
patients necessitating prompt diagnosis and treatment. The aim of this
study is the review of available evidence guiding the management of these
patients. Methods: Postoperative outcome of patients operated for primary
LC (first meta-analysis) and for both primary LC and HD co-morbidity
(second meta-analysis), were studied. Parameters examined in both
meta-analyses were thirty-day postoperative mortality, postoperative
complications, three- and five-year survival probabilities. The last 36
years were reviewed by using the PubMed data base. Thirty-seven studies
were qualified for both meta-analyses. Results: The pooled 30-day
mortality percentages (%) were 4.16% [95% confidence interval (CI):
2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second
meta-analysis). Higher percentages of squamous histology and lobectomy,
were significantly associated with increased (P=0.001) and decreased
(P<0.001) thirty-day postoperative mortality, respectively (first
meta-analysis). The pooled percentages for postoperative complications
were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95%
CI: 35.62-55.74) (second metaanalysis). Higher percentages of squamous
histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were
associated with higher proportions of postoperative complications (second
meta-analysis). The pooled threeand five- year survival probabilities were
68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11),
respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009)
significantly reduced the five-year survival probability. Conclusions:
Lobectomy and age were both accompanied by reduced five-year survival
rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy
for squamous pT1 or pT2 LC displayed a higher risk of postoperative
complications. Moreover, medical decision between combined or staged
surgery is suggested to be individualized based on adequacy of coronary
arterial perfusion, age, patient's preoperative performance status (taking
into account possible co-morbidities per patient), tumor's staging and
extent of lung resection.

<32>
Accession Number
20160548769
Author
Ruotsalainen H.; Bellsham-Revell H.; Bell A.; Pihkala J.; Ojala T.;
Simpson J.
Institution
(Ruotsalainen, Pihkala, Ojala) Department of Pediatric Cardiology,
Children's Hospital, University Hospital of Helsinki and University of
Helsinki, Stenbackinkatu 11, Helsinki 00029 HUS, Finland
(Ruotsalainen) Department of Pediatrics, Kuopio University Hospital,
Kuopio, Finland
(Bellsham-Revell, Bell, Simpson) Department of Congenital Heart Disease,
Evelina London Children's Hospital, London, United Kingdom
Title
Right ventricular systolic function in hypoplastic left heart syndrome: A
comparison of velocity vector imaging and magnetic resonance imaging.
Source
European Heart Journal Cardiovascular Imaging. 17 (6) (pp 687-692), 2016.
Date of Publication: 01 Jun 2016.
Publisher
Oxford University Press
Abstract
Aims Velocity vector imaging (VVI) is an echocardiographic technique based
on speckle tracking, which has been validated for the left ventricle (LV).
It has not been validated to assess the systemic right ventricle (RV) in
patients with hypoplastic left heart syndrome (HLHS). The aim of this
study was to evaluate whether VVI measurements reliably reflect RV
systolic function in patients with HLHS when compared with RV ejection
fraction (EF) calculated using magnetic resonance imaging (MRI). Methods
and results In this prospective study, 49 children with HLHS underwent
transthoracic echocardiography and cardiac MRI under the same general
anaesthetic as a part of routine assessment between the different stages
of palliative surgery. Global RV fractional area change (FAC-VVI), strain
(S), strain rate (SR), and peak systolic velocity (V) were analysed from
the apical four-chamber view using the VVI technique. MRI-derived EF was
calculated from a short-Axis cine stack of images. Intraand interobserver
reproducibility was excellent for all VVI parameters (intraclass
correlation coefficient .0.9). All VVI-derived parameters, except
myocardial velocity, correlated with MRI-derived EF (FAC-VVI: R = 0.7, P <
0.001; S: R = 20.5, P < 0.001; SR: R = 0.5, P = 0.001, and V: R = 0.1, P =
0.4). Conclusions All VVI-derived parameters, except V, correlate with
MRI-derived EF, with FAC being the best predictor of it. Reproducibility
of all VVI parameters is excellent. VVI provides a useful tool for the
follow-up of RV function during the staged treatment protocol for HLHS.

<33>
Accession Number
20160544600
Author
Clemmensen T.S.; Logstrup B.B.; Eiskjaer H.; Poulsen S.H.
Institution
(Clemmensen, Logstrup, Eiskjaer, Poulsen) Department of Cardiology, Aarhus
University Hospital, Brendstrupgardsvej 100, Skejby 8200, Denmark
Title
Serial changes in longitudinal graft function and implications of acute
cellular graft rejections during the first year after heart
transplantation.
Source
European Heart Journal Cardiovascular Imaging. 17 (2) (pp 184-193), 2016.
Date of Publication: 2016.
Publisher
Oxford University Press
Abstract
Aims The aim of this prospective study was to use left ventricular global
longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of
graft function in relation to acute cellular rejection (ACR) during the
first year after heart transplantation (HTX). Methods and results The
study population consisted of 36 patients undergoingHTXfrom November 2010
until October 2013. Patients were followed by comprehensive
echocardiography and biopsies at 2weeks and 1, 3, 6, and 12 months after
HTX. ACRs were classified based on the ISHLT classification (0R-3R).
Patientswere divided into two groups according to the presence of one or
more episodes of biopsy proven >grade 2R ACR during follow-up.We found
that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were
significantly related to ACR burden in a linear regression model. The
absolute difference in LV-GLS between patients in the ACR group (-14.4%)
and patients in the ACR-free group (-16.8%) was -2.4% (P<0.01) 12 months
after HTX. In the ACR group, patients' LV-GLS did not improve between 1
and 12 months, whereas an improvement of 22.9% was seen in the ACR-free
group in this period (P<0.01). The two groups appeared not to differ in
terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE
was 15.3+/-2.8 mm in the ACR-free group vs. 13.2+/-2.1 mm ACR group,
P<0.05, 12 months after HTX. Conclusion Gradual improvement of
longitudinal LV and RV function was seen within the first year after HTX,
but the degree of recovery was strongly influenced by ACR episodes.

<34>
Accession Number
20160543035
Author
Deng H.-Y.; Zhu Z.-J.; Wang Y.-C.; Wang W.-P.; Ni P.-Z.; Chen L.-Q.
Institution
(Deng, Wang, Wang, Ni, Chen) Department of Thoracic Surgery, West China
Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan
610041, China
(Zhu) Department of Thoracic Surgery, Gansu Provincial Hospital, Gansu,
China
Title
Non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia for thoracic surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (1) (pp 31-40), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Oxford University Press
Abstract
OBJECTIVES The short-term feasibility and safety of non-intubated
video-assisted thoracoscopic surgery under loco-regional anaesthesia for
thoracic surgery remains unknown. Therefore, we conducted a meta-analysis
to provide evidence for the short-term efficacy and safety profile of
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia for thoracic surgery. METHODS We performed a systematic
literature search in PubMed, Embase, Cochrane Library databases and Google
Scholar, as well as American Society of Clinical Oncology to identify
relevant studies comparing non-intubated video-assisted thoracoscopic
surgery under loco-regional anaesthesia with conventionally intubated
video-assisted thoracoscopic surgery under general anaesthesia, dated up
to 31 August 2015. Data concerning global in-operating room time, hospital
stays, rate of postoperative complications and perioperative mortality
were extracted and analysed. We conducted a meta-analysis of the overall
results and two subgroup analyses based on study design (a meta-analysis
of randomized controlled trials and a second meta-analysis of
observational studies). RESULTS Four randomized controlled trials and six
observational studies with a total of 1283 patients were included. We
found that in the overall analysis, patients treated with non-intubated
video-assisted thoracoscopic surgery under loco-regional anaesthesia
achieved significantly shorter global in-operating room time [weighted
mean difference = -41.96; 95% confidence interval (CI) = (-57.26, -26.67);
P < 0.001] and hospital stays [weighted mean difference = -1.24; 95% CI =
(-1.46, -1.02); P < 0.001] as well as a lower rate of postoperative
complications [relative risk = 0.55; 95% CI = (0.40, 0.74); P < 0.001]
than patients treated with intubated video-assisted thoracoscopic surgery
under general anaesthesia. Subgroup meta-analyses based on study design
achieved the same outcomes as overall analysis. In our meta-analysis, no
perioperative mortality was observed in patients treated with
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia. CONCLUSIONS Non-intubated video-assisted thoracoscopic
surgery under loco-regional anaesthesia for thoracic surgery proved to be
feasible and safe. Future multicentre and well-designed randomized
controlled trials with longer follow-up are needed to confirm and update
the findings of our study, as well as the long-term efficacy of
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia.

<35>
Accession Number
20160043324
Author
Barakat A.F.; Saad M.; Abuzaid A.; Mentias A.; Mahmoud A.; Elgendy I.Y.
Institution
(Barakat, Mentias) Department of Medicine, Cleveland Clinic Foundation,
Cleveland, Ohio, United States
(Saad) Department of Medicine, Seton Hall University School of Health and
Medical Sciences, Trinitas Regional Medical Center, Elizabeth, New Jersey,
United States
(Abuzaid) Department of Cardiovascular Medicine, Jefferson Medical
College/Christiana Care Health System, Newark, Delaware, United States
(Mahmoud) Department of Medicine, University of Florida, Gainesville,
Florida, United States
(Elgendy) Division of Cardiovascular Medicine, University of Florida,
Gainesville, Florida, United States
Title
Perioperative Statin Therapy for Patients Undergoing Coronary Artery
Bypass Grafting.
Source
Annals of Thoracic Surgery. 101 (2) (pp 818-825), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier USA
Abstract
Coronary artery bypass grafting is associated with an intense systemic
inflammatory response, which is linked to postoperative complications.
Beyond lipid lowering, statins exert a constellation of beneficial
actions, including an antiinflammatory role, known as pleiotropic effects.
There is increasing evidence that perioperative statin therapy improves
outcomes in patients undergoing coronary artery bypass grafting. Statins
are underused in the coronary artery bypass grafting population, because
perioperative discontinuation remains a common practice. This article
provides an extensive review of the available literature on the effect of
perioperative statin therapy on post-coronary artery bypass grafting
outcomes and weighs the evidence for the concerns about increased
incidence of statin-related adverse effects in this setting.

<36>
Accession Number
2015539580
Author
Kim J.E.; Song S.W.; Kim J.Y.; Lee H.J.; Chung K.-H.; Shim Y.H.
Institution
(Kim, Lee, Shim) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, Seoul, South Korea
(Song) Department of Thoracic and Cardiovascular Surgery, Yonsei
University College of Medicine, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Ajou University
School of Medicine, Suwon, South Korea
(Chung) Department of Anesthesiology and Pain Medicine, CHA Bundang
Medical Center, CHA University, Seongnam, South Korea
Title
Effect of a Single Bolus of Erythropoietin on Renoprotection in Patients
Undergoing Thoracic Aortic Surgery With Moderate Hypothermic Circulatory
Arrest.
Source
Annals of Thoracic Surgery. 101 (2) (pp 690-696), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier USA
Abstract
Background Acute kidney injury (AKI) is associated with high morbidity and
mortality. Recombinant human erythropoietin has been shown to exert
cytoprotection against ischemia. This study examined the effect of
erythropoietin in preventing AKI during thoracic aortic surgery with
moderate hypothermic circulatory arrest. Methods In this double-blind,
randomized study, 66 patients undergoing thoracic aortic surgery with
moderate hypothermic circulatory arrest (target temperature, 28degreeC)
randomly received either erythropoietin 500 IU.kg^-1 or the same
amount of normal saline intravenously after anesthesia induction. The
primary endpoint was incidence of AKI defined according to the RIFLE
criteria during the first 7 postoperative days. Results AKI occurred in
60% of all patients. The two groups did not show any differences in the
incidence and severity of AKI. Also, there was no difference in the level
of serum neutrophil gelatinase-associated lipocalin between the groups.
The cardiac index was higher in the erythropoietin group, however,
immediately after weaning from cardiopulmonary bypass (p = 0.02).
Furthermore, postoperative cardiac complications and prolonged vasopressor
dependence were reduced in the erythropoietin group (p = 0.04 and p =
0.049, respectively). Conclusions A single bolus administration of
erythropoietin 500 IU.kg^-1 at anesthesia induction failed to
provide renoprotection in patients who underwent thoracic aortic surgery
with moderate hypothermic circulatory arrest. However, erythropoietin
significantly reduced cardiac complications, and lowered the incidence of
prolonged vasopressor dependence.

<37>
Accession Number
2015478052
Author
Ansari B.M.; Hogan M.P.; Collier T.J.; Baddeley R.A.; Scarci M.; Coonar
A.S.; Bottrill F.E.; Martinez G.C.; Klein A.A.
Institution
(Ansari, Hogan, Martinez, Klein) Department of Anaesthesia and Intensive
Care, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom
(Baddeley) Department of Physiotherapy, Papworth Hospital, Papworth
Everard, Cambridge, United Kingdom
(Scarci, Coonar) Department of Cardiothoracic Surgery, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom
(Bottrill) Department of Research and Development, Papworth Hospital,
Papworth Everard, Cambridge, United Kingdom
(Collier) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Title
A Randomized Controlled Trial of High-Flow Nasal Oxygen (Optiflow) as Part
of an Enhanced Recovery Program After Lung Resection Surgery.
Source
Annals of Thoracic Surgery. 101 (2) (pp 459-464), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Elsevier USA
Abstract
Background Patients undergoing thoracic surgery are at risk of
postoperative pulmonary complications, which are associated with increased
morbidity and mortality. High-flow nasal oxygen therapy delivers
humidified, warmed positive airway pressure but has not been tested
routinely after thoracic surgery. Methods We performed a randomized,
controlled, blinded study. Patients undergoing elective lung resection
were randomly assigned to either high-flow nasal oxygen or standard oxygen
therapy. Patients were otherwise treated within an established enhanced
recovery program. The primary outcome was the difference between the
preoperative and postoperative 6-minute walk test. Secondary outcomes
included hospital length of stay, spirometry, and patient-reported
outcomes measured using the Postoperative Quality of Recovery Scale.
Results Fifty-nine patients were randomly assigned to either high-flow
nasal oxygen (n = 28) or standard oxygen (n = 31) therapy. We found no
difference in the 6-minute walk test outcome or spirometry; however,
length of hospital stay was significantly lower in the high-flow nasal
oxygen group, median 2.5 days (range, 1 to 22), compared with the standard
oxygen group, median 4.0 days (range, 2 to 18); geometric mean ratio was
0.68 (95% confidence interval: 0.48 to 0.86, p = 0.03). No significant
differences in recovery domains were found, but patients in the high-flow
nasal oxygen group reported significantly higher satisfaction (p = 0.046).
Conclusions Prophylactic high-flow nasal oxygen therapy, when incorporated
into an enhanced recovery program, did not improve 6-minute walk test
results but was associated with reduced length of hospital stay and
improved satisfaction after lung resection, compared with standard oxygen.
This finding has implications for reduced costs and better service
provision, and a multicenter trial powered for length of stay is required.