EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2015072084
Author
Agren S.; Stromberg A.; Jaarsma T.; Luttik M.L.A.
Institution
(Agren) Department of Medical and Health Sciences, Linkoping University,
Department of Cardiothoracic Surgery, Linkoping, Sweden
(Agren, Stromberg, Luttik) Department of Medical and Health Sciences,
Linkoping University, Division of Nursing Sciences, Department of
Cardiology, Linkoping, Sweden
(Jaarsma) Department of Social and Welfare Studies, Linkoping University,
Linkoping, Sweden
(Luttik) Research Group Nursing Diagnostics, Hanze University of Applied
Sciences, Groningen, Netherlands
Title
Caregiving tasks and caregiver burden; effects of an psycho-educational
intervention in partners of patients withpost-operative heart failure.
Source
Heart and Lung: Journal of Acute and Critical Care. 44 (4) (pp 270-275),
2015. Date of Publication: 01 Jul 2015.
Publisher
Mosby Inc.
Abstract
Objective: To evaluate the effects of a psycho-educational intervention on
caregiver burden in partners of patients with postoperative heart failure.
Background: Since partners of cardiac surgery patients play a significant
role in the patient's recovery, it is important to address their needs
during hospitalization and after discharge. Methods: Forty-two patients
with postoperative heart failure and their partners participated in a
randomized controlled pilot study. Dyads in the intervention group
received psycho-educational support from a multidisciplinary team. Dyads
in the control group received usual care. Results: No significant
differences were found in the performance of caregiving tasks and
perceived caregiver burden in the control versus the intervention group.
Conclusion: A pilot study exploring the effects of a psycho-educational
intervention in patients and their partners did not reveal significant
effects with regard to reduced feelings of burden in partners. Alleviating
caregiver burden in partners may need a more intense or specific approach.

<2>
Accession Number
2015903115
Author
Cooke M.; Rapchuk I.; Doi S.A.; Spooner A.; Wendt T.; Best J.; Edwards M.;
O'Connell L.; McCabe D.; McDonald J.; Fraser J.; Rickard C.
Institution
(Cooke, Rickard) NHMRC Centre for Research Excellence in Nursing
Interventions, Menzies Health Institute Queensland, Centre for Health
Practice Innovation, Australia
(Rapchuk) Department of Anaesthesia and Perfusion, Critical Care Research
Group, The Prince Charles Hospital, Australia
(Doi) Research School of Population Health, Australian National
University, Australia
(Spooner, Wendt, Best, Edwards, O'Connell, McCabe) Critical Care Research
Group, Adult Intensive Care Services, The Prince Charles Hospital,
Australia
(McDonald) Microbiology and Immunology Research Group, Griffith
University, Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital,
University of Queensland, Australia
Title
Wrist acupressure for post-operative nausea and vomiting (WrAP): A pilot
study.
Source
Complementary Therapies in Medicine. 23 (3) (pp 372-380), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Churchill Livingstone
Abstract
Post-operative nausea and vomiting are undesirable complications following
anaesthesia and surgery. It is thought that acupressure might prevent
nausea and vomiting through an alteration in endorphins and serotonin
levels. In this two-group, parallel, superiority, randomised control pilot
trial we aimed to test pre-defined feasibility outcomes and provide
preliminary evidence for the efficacy of PC 6 acupoint stimulation vs.
placebo for reducing post-operative nausea and vomiting in cardiac surgery
patients. Eighty patients were randomly assigned to either an intervention
PC 6 acupoint stimulation via beaded intervention wristbands group (n =
38) or placebo sham wristband group (n = 42). The main outcome was
assessment of pre-defined feasibility criteria with secondary outcomes for
nausea, vomiting, rescue anti-emetic therapy, quality of recovery and
adverse events. Findings suggest that a large placebo-controlled
randomised controlled trial to test the efficacy of PC 6 stimulation on
PONV in the post-cardiac surgery population is feasible and justified
given the preliminary clinically significant reduction in vomiting in the
intervention group in this pilot. The intervention was tolerated well by
participants and if wrist acupressure of PC 6 acupoint is proven effective
in a large trial it is a simple non-invasive intervention that could
easily be incorporated into practice.

<3>
Accession Number
2015864213
Author
Hong S.J.; Choi S.C.; Cho J.Y.; Joo H.J.; Park J.H.; Yu C.W.; Lim D.-S.
Institution
(Hong, Choi, Cho, Joo, Park, Yu, Lim) Department of Cardiology,
Cardiovascular Center, Korea University Anam Hospital, Seoul, South Korea
Title
Pioglitazone increases circulating microRNA-24 with decrease in coronary
neointimal hyperplasia in type 2 diabetic patients: Optical coherence
tomography analysis.
Source
Circulation Journal. 79 (4) (pp 880-888), 2015. Date of Publication: 2015.
Publisher
Japanese Circulation Society
Abstract
Background: Aberrant expression of microRNAs is associated with neointimal
hyperplasia (NIH) in type 2 diabetes. We prospectively compared the
effects of pioglitazone on coronary NIH and changes in microRNAs according
to NIH status in type 2 diabetic patients during 9-month follow-up.
Methods and Results: Type 2 diabetic patients were randomly assigned to
the pioglitazone (n=36) or control groups (n=36) after coronary stenting.
Primary endpoint was the comparison of changes in neointimal volume on OCT
and in the level of circulating microRNA-17,-24,-92a,-126 and -145 during
9-month follow-up. Secondary endpoint was the comparison of changes in
brachial artery flow-mediated dilation and inflammatory markers such as
IL-6, TNF-alpha, hsCRP, adiponectin, sICAM-1, and sVCAM-1 between the 2
groups. Neointimal volume was significantly lower in the pioglitazone
group (25.02+/-17.78 mm3 vs. 55.10+/-30.01 mm3, P<0.001) with significant
increases in circulating microRNA-24 (0.264+/-0.084 vs. 0.006+/-0.030,
P<0.001) during follow-up. FMD was significantly greater in the
pioglitazone than control group at 9 months (0.47+/-0.14 mm vs.
0.28+/-0.18 mm, P<0.05, respectively). Decreases in inflammatory markers
such as IL-6, TNF-alpha, and sVCAM-1 were significantly greater in the
pioglitazone than the control group during the follow-up. Conclusions:
Pioglitazone significantly decreased NIH with increases in circulating
microRNA-24 at 9-month followup. The decrease in microRNA-24 could be used
as a potential predictor of increases in NIH in type 2 diabetic patients.

<4>
Accession Number
2015806084
Author
Clayton-Smith A.; Bennett K.; Alston R.P.; Adams G.; Brown G.; Hawthorne
T.; Hu M.; Sinclair A.; Tan J.
Institution
(Clayton-Smith, Bennett, Alston, Adams, Brown, Hawthorne, Hu, Sinclair,
Tan) College of Medicine and Veterinary Medicine, Academic Administration,
University of Edinburgh, Chancellors Building, 49 Little France Crescent,
Edinburgh L1116 45B, United Kingdom
Title
A Comparison of the Efficacy and Adverse Effects of Double-Lumen
Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A
Systematic Review and Meta-analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 955-966),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective To compare the efficacy and adverse effects of using bronchial
blockers (BBs) and double-lumen endobronchial tubes (DLTs). Design
Systematic review and meta-analysis of randomized controlled trials (RCTs)
comparing BBs and DLTs. Setting Hospital units undertaking thoracic
surgery Participants Patients undergoing thoracic surgery requiring lung
isolation. Interventions BBs and DLTs. Measurements and Main Results A
systematic literature search was conducted for RCTs comparing BBs and DLTs
using Google Scholar, Ovid Medline, and Cochrane library databases up to
October 2013. Inclusion criteria were RCTs comparing BBs and DLTs,
intubation carried out by qualified anesthesiologists or trainee
specialists, outcome measures relating to either efficacy or adverse
effects. Studies that were inaccessible in English were excluded.
Mantel-Haenszel fixed-effect meta-analysis of recurring outcome measures
was performed using RevMan 5 software. The search produced 39 RCTs
published between 1996 and 2013. DLTs were quicker to place (mean
difference: 51 seconds, 95% confidence intervals [CI] 8-94 seconds; p =
0.02) and less likely to be incorrectly positioned (odds ratio [OR] 2.70;
95% CI 1.18-6.18, p = 0.02) than BBs. BBs were associated with fewer
patients having a postoperative sore throat (OR 0.39, 95% CI: 0.23-0.68, p
= 0.0009), less hoarseness (OR: 0.43,95%, CI 0.24-0.75, p = 0.003), and
fewer airway injuries (OR 0.40, 95% CI 0.21-0.75, p = 0.005) than DLTs.
Conclusion While BBs are associated with a lower incidence of airway
injury and a lower severity of injury, DLTs can be placed quicker and more
reliably.

<5>
Accession Number
2015168707
Author
Lawley C.M.; Lain S.J.; Algert C.S.; Ford J.B.; Figtree G.A.; Roberts C.L.
Institution
(Lawley, Lain, Algert, Ford, Roberts) Clinical Population Perinatal Health
Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
(Lawley, Figtree) Department of Cardiology, Clinical Population Perinatal
Health Research, University of Sydney, Royal North Shore Hospital, St
Leonards, NSW, Australia
Title
Prosthetic heart valves in pregnancy, outcomes for women and their babies:
A systematic review and meta-analysis.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. 122 (11) (pp
1446-1455), 2015. Date of Publication: 01 Oct 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background Historically, pregnancies among women with prosthetic heart
valves have been associated with an increased incidence of adverse
outcomes. Objectives Systematic review to assess risk of adverse pregnancy
outcomes among women with a prosthetic heart valve(s) over the last 20
years. Search strategy Electronic literature search of Medline, The
Cochrane Library, Cumulative Index to Nursing and Allied Health Literature
and Embase to find recent studies. Selection criteria Studies of pregnant
women with heart valve prostheses including trials, cohort studies and
unselected case series. Data collection and analysis Primary analysis
calculated absolute risks and 95% confidence intervals (CI) for pregnancy
outcomes using a random effects model. The Freeman-Tukey transformation
was utilised in secondary analysis due to the large number of individual
study outcomes with zero events. Main results Eleven studies capturing 499
pregnancies among women with heart valve prostheses, including 256
mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled
estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2),
for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic
subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100
pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI
1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5).
Conclusions Women with heart valve prostheses experienced higher rates of
adverse outcomes than expected in a general obstetric population; however,
lower than previously reported. Women with bioprostheses had significantly
fewer thromboembolic events compared to women with mechanical valves.
Women should be counselled pre-pregnancy about risk of maternal death and
pregnancy loss. Vigilant surveillance by a multidisciplinary team
throughout the perinatal period remains warranted for these women and
their infants. Tweetable abstract Metaanalysis suggests improvement in
#pregnancy outcomes among women with #heartvalveprostheses.

<6>
Accession Number
2015028323
Author
Kirkeby-Garstad I.; Tronnes H.; Stenseth R.; Sellevold O.F.M.; Aadahl P.;
Skogvoll E.
Institution
(Kirkeby-Garstad, Tronnes, Stenseth, Sellevold, Aadahl, Skogvoll)
Department of Anesthesiology and Intensive Care, St. Olav University
Hospital, Prinsesse Kristinas gate 3, Trondheim N-7006, Norway
(Stenseth, Sellevold, Aadahl, Skogvoll) Department of Circulation and
Medical Imaging, Norwegian University of Science and Technology,
Trondheim, Norway
Title
The Precision of Pulmonary Artery Catheter Bolus Thermodilution Cardiac
Output Measurements Varies with the Clinical Situation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (4) (pp 881-888),
2015. Date of Publication: 2015.
Publisher
W.B. Saunders
Abstract
Objective To investigate the effects of ventilatory mode, injectate
temperature, and clinical situation on the precision of cardiac output
measurements. Design Randomized, prospective observational study. Setting
Single university hospital. Participants Forty patients undergoing planned
cardiac surgery, receiving a pulmonary artery catheter according to
institutional routine. Interventions Cardiac output was measured at 4
predefined time points during the perioperative patient course, twice
during controlled and twice during spontaneous ventilation, using 2 blocks
of 8 measurement replications with cold and tepid injectate in random
order. Measurements and Main Results The data were analyzed using a
hierarchical linear mixed model. Clinical precision was determined as half
the width of the 95% confidence interval for the underlying true value.
The single-measurement precision measured in 2 different clinical
situations for each temperature/ventilation combination was 8% to 10%, 11%
to 13%, 13% to 15%, and 23% to 24% in controlled ventilation with cold
injectate, controlled ventilation with tepid injectate, spontaneous
breathing with cold injectate, and spontaneous breathing with tepid
injectate, respectively. Tables are provided for the number of
replications needed to achieve a certain precision and for how to identify
significant changes in cardiac output. Conclusions Clinical precision of
cardiac output measurements is reduced significantly during spontaneous
relative to controlled ventilation. The differences in precision between
repeated measurement series within the temperature/ventilation
combinations indicate influence of other situation-specific factors not
related to ventilatory mode. Compared with tepid injectate in patients
breathing spontaneously, the precision is 3-fold better with cold
injectate and controlled ventilation.

<7>
Accession Number
2015000431
Author
Bikmoradi A.; Seifi Z.; Poorolajal J.; Araghchian M.; Safiaryan R.;
Oshvandi K.
Institution
(Bikmoradi) Chronic Diseases (Home Care) Research Center of Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Seifi, Oshvandi) Department of Medical-Surgical Nursing, School of
Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan,
Iran, Islamic Republic of
(Poorolajal) Modeling of Noncommunicable Diseases Research Center,
Department of Epidemiology and Biostatistics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Araghchian) Department of Pharmacology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Safiaryan) Department of Heart Surgery, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Effect of inhalation aromatherapy with lavender essential oil on stress
and vital signs in patients undergoing coronary artery bypass surgery: A
single-blinded randomized clinical trial.
Source
Complementary Therapies in Medicine. 23 (3) (pp 331-338), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Churchill Livingstone
Abstract
Objectives: At present, aromatherapy is used widely in medical research.
This study aimed to investigate the effects of inhalation aromatherapy
using lavender essential oil to reduce mental stress and improve the vital
signs of patients after coronary artery bypass surgery (CABG). Design: A
single-blinded randomized controlled trial was conducted with 60 patients
who had undergone CABG in a 2-day intervention that targeted stress
reduction. Participants: Sixty subjects following coronary artery bypass
surgery in two aromatherapy and control groups. Setting: The study was
conducted in Ekbatan Therapeutic and Educational Center, Hamadan, Iran, in
2013. Interventions: On the second and third days after surgery, the
aromatherapy group patients received two drops of 2% lavender essential
oil for 20 min and the control group received two drops of distilled water
as a placebo. Main outcome measures: The primary outcome was mental
stress, which was measured before and after the intervention using the
DASS-21 questionnaire. The secondary outcomes were vital signs, including
the heart rate, respiratory rate, and systolic and diastolic blood
pressure, which were measured before and after the intervention. Results:
The individual characteristics of the aromatherapy and control groups were
the same. There were no significant difference in the mean mental stress
scores and vital signs of the aromatherapy and control groups on the
second or third days after surgery. Conclusion: Inhalation aromatherapy
with lavender essential oil had no significant effects on mental stress
and vital signs in patients following CABG, except the systolic blood
pressure.

<8>
Accession Number
20151004271
Author
Combes A.; Brechot N.; Amour J.; Cozic N.; Lebreton G.; Guidon C.; Zogheib
E.; Thiranos J.-C.; Rigal J.-C.; Bastien O.; Benhaoua H.; Abry B.;
Ouattara A.; Trouillet J.-L.; Mallet A.; Chastre J.; Leprince P.; Luyt
C.-E.
Institution
(Combes, Brechot, Trouillet, Chastre, Luyt) Medical-Surgical Intensive
Care Unit, Institute of Cardiometabolism and Nutrition, Universite Pierre,
Marie Curie-Paris 6, Paris, France
(Amour) Anesthesiology and Critical Care Medicine Department, Institute of
Cardiometabolism and Nutrition, Universite Pierre, Marie Curie-Paris 6,
Paris, France
(Cozic, Mallet) Unite de Recherche Clinique, Institute of Cardiometabolism
and Nutrition, Universite Pierre, Marie Curie-Paris 6, Paris, France
(Lebreton, Leprince) Cardiac Surgery Department, Institute of
Cardiometabolism and Nutrition, Universite Pierre, Marie Curie-Paris 6,
Paris, France
(Guidon) Anesthesiology and Critical Care Medicine Department, CHU la
Timone, Marseille, France
(Zogheib) Anesthesiology and Critical Care Medicine Department, Amiens
University Hospital, Universite de Picardie Jules-Verne, Amiens, France
(Thiranos) Anesthesiology and Critical Care Medicine Department, CHU de
Strasbourg, Strasbourg, France
(Rigal) Department D'Anesthesiologie et Reanimation, CHU de Nantes,
Nantes, France
(Bastien) Anesthesiology and Critical Care Medicine Department, CHU de
Lyon, Lyon, France
(Benhaoua) Anesthesiology and Critical Care Medicine Department, CHU de
Toulouse, Toulouse, France
(Abry) Anesthesiology and Critical Care Medicine Department, Clinique
Jacques Cartier, Massy, France
(Ouattara) Department of Anesthesia and Critical Care II, CHU de Bordeaux
and Universite de Bordeaux, Adaptation Cardiovasculaire A L'Ischemie,
Pessac U1034, France
Title
Early high-volume hemofiltration versus standard care for post-cardiac
surgery shock the HEROICS study.
Source
American Journal of Respiratory and Critical Care Medicine. 192 (10) (pp
1179-1190), 2015. Date of Publication: 15 Nov 2015.
Publisher
American Thoracic Society
Abstract
Rationale: Post-cardiac surgery shock is associated with high morbidity
and mortality. By removing toxins and proinflammatory mediators and
correcting metabolic acidosis, high-volume hemofiltration (HVHF) might
halt the vicious circle leading to death by improving myocardial
performance and reducing vasopressor dependence. Objectives: To determine
whether early HVHF decreases all-cause mortality 30 days after
randomization. Methods: This prospective, multicenter randomized
controlled trial included patients with severe shock requiring high-dose
catecholamines 3-24 hours post-cardiac surgery who were randomized to
early HVHF (80 ml/kg/h for 48 h), followed by standard-volume continuous
venovenous hemodiafiltration (CVVHDF) until resolution of shock and
recovery of renal function, or conservative standard care, with delayed
CVVHDF only for persistent, severe acute kidney injury. Measurements and
Main Results: On Day 30, 40 of 112 (36%) HVHF and 40 of 112 (36%) control
subjects (odds ratio, 1.00; 95% confidence interval, 0.64-1.56; P = 1.00)
had died; only 57% of the control subjects had received renal-replacement
therapy. Between-group survivors' Day-60, Day-90, intensive care unit, and
in-hospital mortality rates, Day-30 ventilator-free days, and renal
function recovery were comparable. HVHF patients experienced faster
correction of metabolic acidosis and tended to be more rapidly weaned off
catecholamines but had more frequent hypophosphatemia, metabolic
alkalosis, and thrombocytopenia. Conclusions: For patients with
post-cardiac surgery shock requiring high-dose catecholamines, the early
HVHF onset for 48 hours, followed by standard volume until resolution of
shock and recovery of renal function, did not lower Day-30 mortality and
did not impact other important patient-centered outcomes compared with a
conservative strategy with delayed CVVHDF initiation only for patients
with persistent, severe acute kidney injury. Clinical trial registered
with www.clinicaltrials.gov (NCT 01077349).

<9>
Accession Number
20160217814
Author
Jolicoeur E.M.; Dunning A.; Castelvecchio S.; Dabrowski R.; Waclawiw M.A.;
Petrie M.C.; Stewart R.; Jhund P.S.; Desvigne-Nickens P.; Panza J.A.;
Bonow R.O.; Sun B.; San T.R.; Al-Khalidi H.R.; Rouleau J.L.; Velazquez
E.J.; Cleland J.G.F.
Institution
(Jolicoeur, Rouleau) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Canada
(Dunning, Al-Khalidi, Velazquez) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Castelvecchio) IRCCS Policlinico San Donato, Milan, Italy
(Dabrowski) National Institute of Cardiology, Warsaw, Poland
(Waclawiw, Desvigne-Nickens) National Institutes of Health, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Petrie) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Stewart) Auckland City Hospital, Auckland, New Zealand
(Jhund) British Heart Foundation Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Panza) Westchester Medical Center and New York Medical College, Valhalla,
NY, United States
(Bonow) Northwestern University Feinberg, School of Medicine, Chicago, IL,
United States
(Sun) Allina Health, Minneapolis, MN, United States
(San) National Heart Centre, Singapore, Singapore
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Cleland) National Heart and Lung Institute, Heart Sciences Building,
Imperial College, Harefield Hospital, Hill End Road, London UB9 6JH,
United Kingdom
Title
Importance of Angina in Patients with Coronary Disease, Heart Failure, and
Left Ventricular Systolic Dysfunction Insights from STICH.
Source
Journal of the American College of Cardiology. 66 (19) (pp 2092-2100),
2015. Date of Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Patients with left ventricular (LV) systolic dysfunction,
coronary artery disease (CAD), and angina are often thought to have a
worse prognosis and a greater prognostic benefit from coronary artery
bypass graft (CABG) surgery than those without angina. Objectives This
study investigated: 1) whether angina was associated with a worse
prognosis; 2) whether angina identified patients who had a greater
survival benefit from CABG; and 3) whether CABG improved angina in
patients with LV systolic dysfunction and CAD. Methods We performed an
analysis of the STICH (Surgical Treatment for Ischemic Heart Failure)
trial, in which 1,212 patients with an ejection fraction <35% and CAD were
randomized to CABG or medical therapy. Multivariable Cox and logistic
models were used to assess long-term clinical outcomes. Results At
baseline, 770 patients (64%) reported angina. Among patients assigned to
medical therapy, all-cause mortality was similar in patients with and
without angina (hazard ratio [HR]: 1.05; 95% confidence interval [CI]:
0.79 to 1.38). The effect of CABG was similar whether the patient had
angina (HR: 0.89; 95% CI: 0.71 to 1.13) or not (HR: 0.68; 95% CI: 0.50 to
0.94; p interaction = 0.14). Patients assigned to CABG were more likely to
report improvement in angina than those assigned to medical therapy alone
(odds ratio: 0.70; 95% CI: 0.55 to 0.90; p < 0.01). Conclusions Angina
does not predict all-cause mortality in medically treated patients with LV
systolic dysfunction and CAD, nor does it identify patients who have a
greater survival benefit from CABG. However, CABG does improve angina to a
greater extent than medical therapy alone. (Comparison of Surgical and
Medical Treatment for Congestive Heart Failure and Coronary Artery Disease
[STICH]; NCT00023595)

<10>
Accession Number
20160156556
Author
Tomasello S.D.; Boukhris M.; Giubilato S.; Marza F.; Garbo R.;
Contegiacomo G.; Marzocchi A.; Niccoli G.; Gagnor A.; Varbella F.;
Desideri A.; Rubartelli P.; Cioppa A.; Baralis G.; Galassi A.R.
Institution
(Tomasello, Boukhris, Giubilato, Marza, Galassi) Ospedale Cannizz Aro,
Universita di Catania, Via Antonello da Messina 75, Acicastello, Catania
95021, Italy
(Garbo) Ospedale G. Bosco, Torino, Italy
(Contegiacomo) Casa di Cura S. Maria, Bari, Italy
(Marzocchi) Policlinico S. Orsola Malpigli, Bologna, Italy
(Niccoli) Ospedale Policlinico Gemelli, Roma, Italy
(Gagnor, Varbella) Ospedale Degli Infermi, Rivoli, Italy
(Desideri) Ospedale S. Giacomo, Castelfranco, Veneto Genova, Italy
(Rubartelli) Ospedale Villa Scassi, Genova, Italy
(Cioppa) Casa di Cura Montevergine, Mercogliano, Italy
(Baralis) Ospedale S. Croce e Carle, Cuneo, Italy
(Boukhris) Faculty of Medicine of Tunis, University Tunis El Manar,
Tunisia
Title
Management strategies in patients affected by chronic total occlusions:
Results from the Italian Registry of Chronic Total Occlusions.
Source
European Heart Journal. 36 (45) (pp 3189-3198a), 2015. Date of
Publication: 2015.
Publisher
Oxford University Press
Abstract
Background Through contemporary literature, the optimal strategy to manage
coronary chronic total occlusions (CTOs) remains under debate. Objectives
The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to
provide data on prevalence, characteristics, and outcome of CTO patients
according to the management strategy. Methods The IRCTO is a prospective
real world multicentre registry enrolling patients showing at least one
CTO. Clinical and angiographic data were collected independently from the
therapeutic strategy [optimal medical therapy (MT), percutaneous coronary
intervention (PCI), or coronary artery bypass grafting (CABG)]; a
comparative 1-year clinical followup was performed. Results A total of
1777 patients were enrolled for an overall CTO prevalence of 13.3%. The
adopted therapeutic strategies were as follows: MT in 826 patients
(46.5%), PCI in 776 patients (43.7%), and CABG in the remaining 175
patients (9.8%). At 1-year follow-up, patients undergoing PCI showed lower
rate of major adverse cardiac and cerebrovascular events (MACCE) (2.6% vs.
8.2% and vs. 6.9%; P < 0.001 and P < 0.01) and cardiac death (1.4% vs.
4.7% and vs. 6.3%; P < 0.001 and P < 0.001) in comparison with those
treated with MT and CABG, respectively. After propensity scorematching
analysis, patients treated with PCI showed lower incidence of cardiac
death (1.5 vs. 4.4%; P < 0.001), acute myocardial infarction (1.1 vs.
2.9%; P = 0.03), and re-hospitalization (2.3 vs. 4.4% P = 0.04) in
comparison with those managed by MT. Conclusions Our data showed how CTO
PCI might significantly improve the survival and decrease MACCE occurrence
at 1 year follow-up in comparison with MT and/or CABG.

<11>
Accession Number
20160156555
Author
Leitman M.; Shmueli R.; Rubchevsky V.; Hendler A.; Vered Z.
Institution
(Leitman, Shmueli, Hendler, Vered) Department of Cardiology, Assaf Harofeh
Medical Center, Zerifin 70300, Israel
(Leitman, Shmueli, Rubchevsky, Hendler, Vered) Sackler School of Medicine
Tel Aviv University, Tel Aviv, Israel
(Rubchevsky) Department of Cardiac Surgery, Rabin Medical Center, Petah
Tikva, Israel
Title
A 45-year-old woman with chest pain after coronary stenting.
Source
European Heart Journal. 36 (45) (pp 3188), 2015. Date of Publication:
2015.
Publisher
Oxford University Press

<12>
Accession Number
20160156554
Author
Zimmermann F.M.; Ferrara A.; Johnson N.P.; Van Nunen L.X.; Escaned J.;
Albertsson P.; Erbel R.; Legrand V.; Gwon H.-C.; Remkes W.S.; Stella P.R.;
Van Schaardenburgh P.; Jan Willem Bech G.; De Bruyne B.; Pijls N.H.J.
Institution
(Zimmermann, Van Nunen, Pijls) Department of Cardiology, Catharina
Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Ferrara, De Bruyne) Cardiovascular Center, Aalst, Belgium
(Johnson) Weatherhead PET Center for Preventing and Reversing
Atherosclerosis, Division of Cardiology, Department of Medicine,
University of Texas Medical, School and Memorial Hermann Hospital,
Houston, TX, United States
(Van Nunen, Pijls) Department of Biomedical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Escaned) Hospital Clinico San Carlos, Faculty of Medicine, Complutense
University of Madrid, Centro Nacional de Investigaciones Cardiovasculares
Carlos III (CNIC), Madrid, Spain
(Albertsson) Department of Cardiology, Sahlgrenska University Hospital
Gothenburg, Sweden
(Erbel) Department of Cardiology, West-German Heart and Vascular Centre,
University Hospital of Essen, Essen, Germany
(Legrand) Department of Cardiology, University Hospital of Liege, Liege,
Belgium
(Gwon) Division of Cardiology, Cardiac and Vascular Center, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Remkes) Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Stella) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Van Schaardenburgh) Department of Cardiology, VieCuri, Venlo, Netherlands
(Jan Willem Bech) Department of Cardiology, HagaZiekenhuis, The Hague,
Netherlands
(Jan Willem Bech) Reinier de Graaf Groep, Delft, Netherlands
Title
Deferral vs. performance of percutaneous coronary intervention of
functionally non-significant coronary stenosis: 15-year follow-up of the
DEFER trial.
Source
European Heart Journal. 36 (45) (pp 3182-3188), 2015. Date of Publication:
2015.
Publisher
Oxford University Press
Abstract
Aims Stenting an angiographically intermediate but functionally
non-significant stenosis is controversial. Nevertheless, it has been
questioned if deferral of a functionally non-significant lesion on the
basis of fractional flow reserve (FFR) measurement, is safe, especially on
the long term. Five-year follow-up of the DEFER trial showed that outcome
after deferral of percutaneous coronary intervention (PCI) of an
intermediate coronary stenosis based on FFR = 0.75 is excellent and was
not improved by stenting. The aim of this study was to investigate the
validity of this position on the very long term. Met hods and resul ts In
325 patients scheduled for PCI of an intermediate stenosis, FFR was
measured just before the planned intervention. If FFR was = 0.75, patients
were randomly assigned to deferral (Defer group; n = 91) or performance
(Perform group; n = 90) of PCI. If FFR was, 0.75, PCI was performed as
planned (Reference group; n = 144). Clinical follow-up was 15 years. There
were no differences in baseline clinical characteristics between the
randomized groups. Complete 15-year follow-up was obtained in 92% of
patients. After 15 years of follow-up, the rate of death was not different
between the three groups: 33.0% in the Defer group, 31.1% in the Perform
group, and 36.1% in the Reference group (Defer vs. Perform, RR 1.06, 95%
CI: 0.69 1.62, P = 0.79). The rate of myocardial infarction was
significantly lower in the Defer group (2.2%) compared with the Perform
group (10.0%), RR 0.22, 95% CI: 0.05 0.99, P = 0.03. Conclusion Deferral
of PCI of a functionally non-significant stenosis is associated with a
favourable very long-term follow-up without signs of late 'catch-up'
phenomenon.

<13>
Accession Number
20160156552
Author
De Maria G.L.; Cuculi F.; Patel N.; Dawkins S.; Fahrni G.; Kassimis G.;
Choudhury R.P.; Forfar J.C.; Prendergast B.D.; Channon K.M.; Kharbanda
R.K.; Banning A.P.
Institution
(De Maria, Cuculi, Patel, Dawkins, Fahrni, Kassimis, Forfar, Prendergast,
Channon, Kharbanda, Banning) Oxford Heart Centre, NIHR Biomedical Research
Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, United
Kingdom
(Cuculi) Department of Cardiology, LuzernerKantonsspital, Luzern,
Switzerland
(Choudhury) Acute Vascular Imaging Centre, Radcliffe Department of
Medicine, University of Oxford, Oxford, United Kingdom
(Choudhury) Division of Cardiovascular Medicine, BHF Centre of Research
Excellence, University of Oxford, Oxford, United Kingdom
Title
How does coronary stent implantation impact on the status of the
microcirculation during primary percutaneous coronary intervention in
patients with ST-elevation myocardial infarction?.
Source
European Heart Journal. 36 (45) (pp 3165-3177), 2015. Date of Publication:
2015.
Publisher
Oxford University Press
Abstract
Aims Primary percutaneous coronary intervention (PPCI) is the optimal
treatment for patients presenting with ST-elevation myocardial infarction
(STEMI). An elevated index of microcirculatory resistance (IMR) reflects
microvascular function and when measured after PPCI, it can predict an
adverse clinical outcome. We measured coronary microvascular function in
STEMI patients and compared sequential changes before and after stent
implantation. Methods and results In 85 STEMI patients, fractional flow
reserve, coronary flow reserve, and IMR were measured using a pressure
wire (Certus, St Jude Medical, St Paul, MN, USA) immediately before and
after stent implantation. Stenting significantly improved all of the
measured parameters of coronary physiology including IMR from 67.7
[interquartile range (IQR): 56.2 95.8] to 36.7 (IQR: 22.7 59.5), P, 0.001.
However, after stenting, IMR remained elevated (. 40) in 28 (32.9%)
patients. In 15 of these patients (17.6% of the cohort), only a partial
reduction in IMR occurred and these patients were more likely to be late
presenters (pain to wire time. 6 h). The extent of jeopardized myocardium
[standardized beta: 2 0.26 (IMR unit/Bypass Angioplasty Revascularization
Investigation score unit), P: 0.009] and pre-stenting IMR [standardized
beta: 2 0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after
stenting (DIMR 14 post-stenting IMR 2 pre-stenting IMR), whereas
thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit),
P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm3
of stent), P: 0.01] were associated with a potentially deleterious
increase in IMR. Conclusion Improved perfusion of the myocardium by stent
deployment during PPCI is not universal. The causes of impaired
microvascular function at the completion of PPCI treatment are
heterogeneous, but can reflect a later clinical presentation and/or the
location and extent of the thrombotic burden.

<14>
Accession Number
20160421938
Author
Landenhed M.; Cunha-Goncalves D.; Al-Rashidi F.; Pierre L.; Hoglund P.;
Koul B.
Institution
(Landenhed, Cunha-Goncalves, Al-Rashidi, Pierre, Koul) Department of
Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University
Hospital, Lund University, Lund SE-221 85, Sweden
(Hoglund) Clinical Research and Competence Center, Skane University
Hospital, Lund University, Lund, Sweden
Title
Pulmonary collapse alone provides effective de-airing in cardiac surgery:
A prospective randomized study.
Source
Perfusion (United Kingdom). 31 (4) (pp 320-326), 2015. Date of
Publication: 2015.
Publisher
SAGE Publications Ltd
Abstract
Objectives: We previously described and showed that the method for cardiac
de-airing involving: (1) bilateral, induced pulmonary collapse by opening
both pleurae and disconnecting the ventilator before cardioplegic arrest
and (2) gradual pulmonary perfusion and ventilation after cardioplegic
arrest is superior to conventional de-airing methods, including carbon
dioxide insufflation of the open mediastinum. This study investigated
whether one or both components of this method are responsible for the
effective de-airing of the heart. Methods: Twenty patients scheduled for
open, left heart surgery were randomized to two de-airing techniques: (1)
open pleurae, collapsed lungs and conventional pulmonary perfusion and
ventilation; and (2) intact pleurae, expanded lungs and gradual pulmonary
perfusion and ventilation. Results: The number of cerebral microemboli
measured by transcranial Doppler sonography was lower in patients with
open pleurae 9 (6-36) vs 65 (36-210), p=0.004. Residual intra-cardiac air
grade I or higher as monitored by transesophageal echocardiography 4-6
minutes after weaning from cardiopulmonary bypass was seen in few patients
with open pleurae 0 (0%) vs 7 (70%), p=0.002. Conclusions: Bilateral,
induced pulmonary collapse alone is the key factor for quick and effective
de-airing of the heart. Gradual pulmonary perfusion and ventilation, on
the other hand, appears to be less important.

<15>
Accession Number
2015363529
Author
Spoelstra-De Man A.M.E.; Smit B.; Oudemans-Van Straaten H.M.; Smulders
Y.M.
Institution
(Spoelstra-De Man, Smit, Oudemans-Van Straaten) Department of Intensive
Care, VU University Medical Centre, Amsterdam, Netherlands
(Smulders) Department of Internal Medicine, VU University Medical Centre,
Amsterdam, Netherlands
Title
Cardiovascular effects of hyperoxia during and after cardiac surgery.
Source
Anaesthesia. 70 (11) (pp 1307-1319), 2015. Date of Publication: November
2015.
Publisher
Blackwell Publishing Ltd
Abstract
During and after cardiac surgery with cardiopulmonary bypass, high
concentrations of oxygen are routinely administered, with the intention of
preventing cellular hypoxia. We systematically reviewed the literature
addressing the effects of arterial hyperoxia. Extensive evidence from
pre-clinical experiments and clinical studies in other patient groups
suggests predominant harm, caused by oxidative stress, vasoconstriction,
perfusion heterogeneity and myocardial injury. Whether these alterations
are temporary and benign, or actually affect clinical outcome, remains to
be demonstrated. In nine clinical cardiac surgical studies in low-risk
patients, higher oxygen targets tended to compromise cardiovascular
function, but did not affect clinical outcome. No data about potential
beneficial effects of hyperoxia, such as reduction of gas micro-emboli or
post-cardiac surgery infections, were reported. Current evidence is
insufficient to specify optimal oxygen targets. Nevertheless, the safety
of supraphysiological oxygen suppletion is unproven. Randomised studies
with a variety of oxygen targets and inclusion of high-risk patients are
needed to identify optimal oxygen targets during and after cardiac
surgery.

<16>
Accession Number
20160038232
Author
Protogerou C.; Fleeman N.; Dwan K.; Richardson M.; Dundar Y.; Hagger M.S.
Institution
(Protogerou) Institute of Psychology Health and Society, Department of
Health Services Research, University of Liverpool, Eleanor Rathbone
Building, 74 Bedford Street South, Liverpool L69 7ZQ, United Kingdom
(Fleeman, Dwan) Liverpool Reviews and Implementation Group, University of
Liverpool, United Kingdom
(Richardson) Liverpool Reviews and Implementation Group, Department of
Biostatistics, University of Liverpool, United Kingdom
(Dundar) Mersey Care NHS Trust, Department of Health Services Research,
University of Liverpool, United Kingdom
(Hagger) Health Psychology and Behavioural Medicine Research Group, School
of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin
University, Perth, Australia
(Protogerou) Department of Psychology, University of Cape Town, Rondebosch
7701, South Africa
Title
Moderators of the effect of psychological interventions on depression and
anxiety in cardiac surgery patients: A systematic review and
meta-analysis.
Source
Behaviour Research and Therapy. 73 (pp 151-164), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Cardiac surgery patients may be provided with psychological interventions
to counteract depression and anxiety associated with surgical procedures.
This systematic review and meta-analysis investigated whether intervention
efficacy was impacted by type of cardiac procedure/cardiac event; control
condition content; intervention duration; intervention timing; facilitator
type; and risk of bias. MEDLINE, EMBASE, and PsycINFO were searched for
randomized controlled trials comparing anxiety and depression outcomes,
pre and post psychological and cardiac interventions. Twenty-four studies
met the inclusion criteria for the systematic review (. N = 2718) and 16
of those were meta-analysed (. N = 1928). Depression and anxiety outcomes
were reduced more in interventions that lasted longer, were delivered
post-surgery, and by trained health professionals. Depression (but not
anxiety) was reduced more when the experimental intervention was compared
to an 'alternative' intervention, and when the intervention was delivered
to coronary artery bypass graft patients. Anxiety (but not depression) was
decreased more when interventions were delivered to implantable
cardioverter defibrillator patients, and were of 'high' or 'unclear' risk
of bias. In addition to estimating efficacy, future work in this domain
needs to take into account the moderating effects of intervention, sample,
and study characteristics.

<17>
Accession Number
26301654
Author
Donataccio M.P.; Puymirat E.; Parapid B.; Steg P.G.; Eltchaninoff H.;
Weber S.; Ferrari E.; Vilarem D.; Charpentier S.; Manzo-Silberman S.;
Ferrieres J.; Danchin N.; Simon T.
Institution
(Donataccio) Assistance Publique-Hopitaux de Paris (AP-HP), Hopital
Europeen Georges Pompidou, Department of Cardiology, Paris, France;
Universite Paris-Descartes, Paris France
(Puymirat) Assistance Publique-Hopitaux de Paris (AP-HP), Hopital Europeen
Georges Pompidou, Department of Cardiology, Paris, France; Universite
Paris-Descartes, Paris France; INSERM U-970, Paris, France. Electronic
address:
(Parapid) Division of Cardiology, Clinical Center of Serbia, Belgrade
University School of Medicine, Belgrade, Serbia
(Steg) AP-HP, Hopital Bichat, Department of Cardiology, Paris, France;
Universite Paris Diderot-Paris VII, France; INSERM, U-698, Paris, France
(Eltchaninoff) Hopital Charles Nicolle, Department of Cardiology, Rouen,
France; University of Rouen, France
(Weber) Universite Paris-Descartes, Paris France; AP-HP, Hopital Cochin,
Department of Cardiology, Paris, France
(Ferrari) Pasteur Hospital, Department of Cardiology, University Hospital
of Nice, Nice, France
(Vilarem) Valenciennes General Hospital, Department of Cardiology,
Valenciennes, France
(Charpentier) Purpan University Hospital, Emergency Department, Toulouse,
France; U1027, INSERM, France
(Manzo-Silberman) AP-HP, Hopital Lariboisiere, Department of Cardiology,
Paris, France
(Ferrieres) Toulouse Rangueil University Hospital, Department of
Cardiology, France; UMR1027, INSERM, France
(Danchin) Assistance Publique-Hopitaux de Paris (AP-HP), Hopital Europeen
Georges Pompidou, Department of Cardiology, Paris, France; Universite
Paris-Descartes, Paris France
(Simon) AP-HP, Hopital Saint Antoine, Department of Clinical Pharmacology,
Paris, France; INSERM, U-698, Inserm, Paris, France; UPMC-Paris 06, France
Title
In-hospital outcomes and long-term mortality according to sex and
management strategy in acute myocardial infarction. Insights from the
French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI)
2005 Registry.
Source
International journal of cardiology. 201 (pp 265-270), 2015. Date of
Publication: 15 Dec 2015.
Abstract
BACKGROUND: The early mortality of acute myocardial infarction (AMI) has
dramatically decreased in the recent past. Whether the previously reported
sex disparities in use of invasive strategies (IS) persist and translate
into differences in outcomes deserves to be examined.
METHODS: We used the data from a nationwide French prospective multicentre
registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%))
recruited in 223 centres in 2005 and followed-up for 5 years. We examined
in-hospital outcomes and 5-year mortality in patients categorized
according to sex and use of IS (i.e. coronary angiography during the
hospitalisation with a view to revascularisation).
RESULTS: IS was less frequently used in women than in men (adjusted
OR=0.66; 95% CI: 0.52-0.85), regardless of the type of AMI, age group or
risk category, while use of recommended medications was similar at 48
hours and discharge. In-hospital mortality did not differ according to
sex, whatever the age group and use of an IS. At 5 years, overall and
post-discharge mortality were similar in men and women. However, IS was
associated with lower 5-year mortality in women (HR=0.66; 95% CI:
0.51-0.86) as in men (HR=0.48; 95% CI: 0.38-0.60) and there was no
sex-strategy interaction.
CONCLUSIONS: Invasive strategy remains less frequently used in women than
in men, yet is associated with improved five-year survival irrespective of
sex. Whether reducing the sex gap in its use would translate into a higher
survival in women remains an open question.
CLINICAL TRIAL REGISTRATION: NCT 00673036.

<18>
Accession Number
27323555
Author
Naveed D.; Khan R.A.; Malik A.; Shah S.Z.; Ullah I.; Hussain A.
Title
ROLE OF MODIFIED ULTRFILTRATION IN ADULT CARDIAC SURGERY: A PROSPECTIVE
RANDOMIZED CONTROL TRIAL.
Source
Journal of Ayub Medical College, Abbottabad : JAMC. 28 (1) (pp 22-25),
2016. Date of Publication: 01 Jan 2016.
Abstract
BACKGROUND: Cardiopulmonary bypass (CPB) is associated with morbidity and
mortality. To reduce its adverse effect modified ultrafiltration is being
increasingly employed. This study is planned to evaluate the benefits of
modified ultrafiltration (MUF) in adult cardiac surgery.
METHODS: Eighty consecutive patients presenting to adult cardiac surgery
as elective case were enrolled. These patients were randomly divided in to
two groups. MUF group which received modified ultrafiltration after
separation from CPB and control group which did not receive modified
ultrafiltration. Postoperative mediastinal and chest drainage in 24 hrs,
blood products requirement, reopening, ICU stay, and mortality in 30 days
were recorded. These variables were compared between MUF group and control
group.
RESULTS: Forty patients were randomized to control group and 40 in MUF
group. Mean age was 51.15 +/- 8.90 in control group as compared to 46.95
+/- 13.24 MUF group (p = 0.1). Out of 40 patients in control group 7
(17.5%) were female while 11 (27.5%) out of total 40 were female in MUF
group. (p = .284). Mean CBP time was 120.62 +/- 20.97 in control group
versus 117.37 +/- 38.78 in MUF group (p = 0.64). Post-operative drain
output ranged from 330 ml to 1300 ml in control group and 300 ml to 780 ml
in MUF group. Mean postoperative drain output 554.25 +/- 192.57 in control
group versus 439.22 +/- 89.59 in MUF group (p = .001). Three (7.5%) out of
40 patients required re-exploration in control group versus 1 (2.5%) in
MUF group. (p = .305). Mean ICU stay was 52.80 +/- 22.37 hours in control
group versus 45.30 +/- 21.82 hours in MUF group (p = 0.133). Three (7.5%)
out of 40 patients died in control group versus 1 (2.5%) in MUF group. (p
= 0.305).
CONCLUSION: Use of modified ultrafiltration is associated with low
postoperative bleeding less requirements of blood and blood products.

<19>
Accession Number
20160579138
Author
Stenman M.; Holzmann M.J.; Sartipy U.
Institution
(Stenman, Sartipy) Department of Cardiothoracic Surgery and
Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
(Stenman, Sartipy) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Holzmann) Department of Emergency Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Holzmann) Department of Internal Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Association between preoperative depression and long-term survival
following coronary artery bypass surgery - A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 222 (pp 462-466), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Depression is common in patients with cardiovascular disease.
The importance of preoperative depression for long-term survival following
coronary artery bypass grafting (CABG) is not well known. The aim was to
provide a summary estimate of the association between preoperative
depression and long-term survival in adults who underwent CABG. Methods We
did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO,
Web of Science, and PubMed from inception to November, 2015, including
cohort studies with at least one month of follow-up that reported hazard
ratios (HR) and 95% confidence intervals (CI) for long-term all-cause
mortality following CABG in patients with preoperative depression compared
to non-depressed patients. Two reviewers independently extracted data on
populations, exposure, outcome, risk of bias, and quality of evidence. We
calculated HR and 95% CIs for all-cause mortality using random-effects
meta-analyses and performed subgroup and sensitivity analyses. Results
Seven studies were included with a combined study population of 89,490
patients (4002 depressed/85,488 non-depressed). All studies observed a
positive association between preoperative depression and all-cause
mortality, and in 4 studies the association was statistically significant.
Patients with depression had a pooled hazard ratio of 1.46 (95% CI:
1.23-1.73, p < 0.0001) for all-cause mortality with moderate heterogeneity
(I² = 50.1%, p = 0.061). Conclusions This systematic review and
meta-analysis indicates that patients with preoperative depression are at
increased risk for long-term, all-cause mortality following CABG compared
with those without depression. Systematic screening for depression prior
to cardiac surgery could identify those at higher risk.

<20>
Accession Number
20160580159
Author
Nudi F.; Lotrionte M.; Biasucci L.M.; Peruzzi M.; Marullo A.G.M.; Frati
G.; Valenti V.; Giordano A.; Biondi-Zoccai G.
Institution
(Nudi) Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome,
Italy
(Nudi) Ostia Radiologica, Rome, Italy
(Nudi) ETISAN, Rome, Italy
(Lotrionte, Biasucci) Division of Cardiology, Catholic University, Rome,
Italy
(Peruzzi, Marullo, Frati, Biondi-Zoccai) Department of Medico-Surgical
Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati, Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Valenti) Division of Radiology, University of Rome, Rome, Italy
(Giordano) Unita Operativa di Interventistica Cardiovascolare, Presidio
Ospedaliero Pineta Grande, Castel Volturno, Italy
(Giordano) Unita Operativa di Emodinamica, Casa di Salute Santa Lucia, San
Giuseppe Vesuviano, Italy
Title
Comparative safety and effectiveness of coronary computed tomography:
Systematic review and meta-analysis including 11 randomized controlled
trials and 19,957 patients.
Source
International Journal of Cardiology. 222 (pp 352-358), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives The clinical approach to suspected or established
coronary artery disease (CAD) has been revolutionized in the last few
decades by coronary computed tomography (coroCT). Yet, uncertainty
persists on its comparative diagnostic and clinical effectiveness. We
conducted a systematic review on randomized controlled trials (RCTs) of
coroCT. Methods We searched RCTs in PubMed and The Cochrane Library,
extracting as outcomes of interest long-term rates of death, myocardial
infarction, revascularization, and invasive coronary angiography. Effects
were estimated with risk ratios (RR) and 95% confidence intervals. Results
A total of 11 trials were included, with 19,957 patients followed for a
median of 6 months. One trial focused on screening, 3 on stable CAD, and 7
on acute CAD. Meta-analysis showed that coroCT was associated with a trend
toward fewer deaths or myocardial infarctions (RR = 0.84 [0.70-1.01])
whereas no significant difference was found for the risk of death (RR =
0.91 [0.71-1.18]). Conversely, the risk of myocardial infarction tended to
be lower with coroCT at the overall analysis (RR = 0.77 [0.59-1.02]), and
this effect reached statistical significance in studies focusing on
subjects with stable CAD (RR = 0.69 [0.49-0.99]). These potential benefits
were offset (or mediated) by a significant albeit modest increase in the
need for invasive angiography (RR = 1.36 [1.08-1.72]), and ensuing
coronary revascularization (RR = 1.76 [1.29-2.40]). Conclusions According
to the current evidence base, coroCT is associated with an increased usage
of invasive angiography and coronary revascularization when compared to
standard of care, with possible benefits on nonfatal myocardial
infarction, but without significant benefits on death or the composite of
death or myocardial infarction.

<21>
Accession Number
20160586199
Author
Sorice M.; Tritto F.P.; Sordelli C.; Gregorio R.; Piazza L.
Institution
(Sorice, Tritto, Gregorio, Piazza) Department of Cardiac Surgery, S. Anna
e S. Sebastiano Hospital, Via F. Palasciano, Caserta, CE 81100, Italy
(Sordelli) Department of Cardiothoracic Sciences, Monaldi Hospital, Second
University of Naples, Via L. Bianchi, Naples, NA 80131, Italy
Title
N-3 polyunsaturated fatty acids reduces post-operative atrial fibrillation
incidence in patients undergoing "on-pump" coronary artery bypass graft
surgery.
Source
Monaldi Archives for Chest Disease - Cardiac Series. 76 (2) (pp 93-98),
2011. Date of Publication: 2011.
Publisher
Fondazione Salvatore Maugeri (Via Ferrata 8, Pavia 27100, Italy)
Abstract
Background: The aim of this study was to evaluate the efficacy of
preoperative and postoperative therapy with n-3 polyunsaturated fatty
acids in reducing the incidence of atrial fibrillation after coronary
artery bypass graft surgery. Methods: 201 patients undergoing coronary
artery bypass graft surgery were randomized to 1) a control group (105
patients), or 2) n-3 polyunsaturated fatty acids 2 g/day group (96
patients) for at least 5 days before surgery and until hospital discharge.
Groups were further subdivided in four subgroups according to the
operative technique: "off-pump" or "on-pump". The primary end point was to
evaluate the reduced incidence of postoperative in-hospital atrial
fibrillation in the (N-3 PUFA) group. Secondary end points were the impact
of the surgical technique on the incidence of postoperative arrhythmia and
the impact of n-3 polyunsaturated fatty acids therapy on post-operative
hospital length of stay. Results: The overall incidence of post-operative
atrial fibrillation was 17.4% (35/201). The arrhythmia occurred in 11.4%
(11/96) of the patients in therapy with n-3 polyunsaturated fatty acids
and in 22.8% (24/105) in the control groups. In particular, the
statistical analysis of subgroups showed a significant reduction of
postoperative atrial fibrillation only in the group including patients
treated with n-3 polyunsaturated fatty acids undergoing "on-pump" coronary
artery bypass graft surgery. The length of hospital stay did not differ
among all groups. Conclusions: N-3 polyunsaturated fatty acids
administration significantly reduces the incidence of post-operative
atrial fibrillation in patients undergoing "on-pump" coronary artery
bypass graft surgery. N-3 polyunsaturated fatty acids therapy is not
associated with a shorter hospital stay.

<22>
Accession Number
20160571046
Author
Andreou I.; Takahashi S.; Tsuda M.; Shishido K.; Antoniadis A.P.;
Papafaklis M.I.; Mizuno S.; Coskun A.U.; Saito S.; Feldman C.L.; Edelman
E.R.; Stone P.H.
Institution
(Andreou, Antoniadis, Papafaklis, Feldman, Edelman, Stone) Cardiovascular
Division, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Andreou, Edelman) Institute for Medical Engineering and Science,
Massachusetts Institute of Technology, Cambridge, MA, United States
(Takahashi, Shishido, Mizuno, Saito) Department of Cardiovascular
Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
(Tsuda) Department of Cardiovascular Medicine, Hokkaido University,
Sapporo, Japan
(Coskun) Mechanical and Industrial Engineering, Northeastern University,
Boston, MA, United States
Title
Atherosclerotic plaque behind the stent changes after bare-metal and
drug-eluting stent implantation in humans: Implications for late stent
failure?.
Source
Atherosclerosis. 252 (pp 9-14), 2016. Date of Publication: 01 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims The natural history and the role of atherosclerotic
plaque located behind the stent (PBS) are still poorly understood. We
evaluated the serial changes in PBS following bare-metal (BMS) compared to
first-generation drug-eluting stent (DES) implantation and the impact of
these changes on in-stent neointimal hyperplasia (NIH). Methods
Three-dimensional coronary reconstruction by angiography and intravascular
ultrasound was performed after intervention and at 6-10-month follow-up in
157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99).
Results There was a significant decrease in PBS area (-7.2%; p < 0.001)
and vessel area (-1.7%; p < 0.001) after BMS and a respective increase in
both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001,
respectively). The decrease in PBS area significantly predicted neointimal
area at follow-up after BMS (beta: 0.15; 95% confidence interval [CI]:
0.10-0.20, p < 0.001) and DES (beta: 0.09; 95% CI: 0.07-0.11; p < 0.001)
implantation. The decrease in PBS area was the most powerful predictor of
significant NIH after BMS implantation (odds ratio: 1.13; 95% CI:
1.02-1.26; p = 0.02). Conclusions The decrease in PBS area after stent
implantation is significantly associated with the magnitude of NIH
development at follow-up. This finding raises the possibility of a
communication between the lesion within the stent and the underlying
native atherosclerotic plaque, and may have important implications
regarding the pathobiology of in-stent restenosis and late/very late stent
thrombosis.

<23>
Accession Number
20160579642
Author
Yang Y.; Lei J.; Huang W.; Lei H.
Institution
(Yang, Lei, Huang, Lei) Department of Cardiology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
Title
Efficacy and safety of biodegradable polymer sirolimus-eluting stents
versus durable polymer drug-eluting stents: A meta-analysis of randomized
trials.
Source
International Journal of Cardiology. 222 (pp 486-493), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background A meta-analysis was performed to investigate the safety and
efficacy of biodegradable polymer sirolimus-eluting stents (BP-SESs)
compared with durable polymer drug-eluting stents (DP-DESs). Methods
Online databases, including PubMed, EMBASE and the Cochrane Library, were
searched for randomized controlled trials that compared BP-SESs and
DP-DESs and reported rates of overall and cardiac mortality, myocardial
infarction (MI), stent thrombosis (ST), target lesion revascularization
(TLR), target vessel revascularization (TVR) and late lumen loss (LLL).
Results A total of 15 studies investigating 14,187 patients were included
in the meta-analysis. The BP-SESs significantly reduced the risk of late
ST (OR: 0.57; 95% CI: 0.33-0.98; p = 0.04), very late ST (OR: 0.53; 95%
CI: 0.29-0.97; p = 0.04) and in-stent LLL (MD: - 0.06, 95% CI: - 0.11 to -
0.01; p = 0.01) compared with the DP-DESs but did not improve mortality
(OR: 0.95; 95% CI: 0.81-1.11; p = 0.52), cardiac mortality (OR: 0.89; 95%
CI: 0.72-1.10; p = 0.27), MI (OR: 0.90; 95% CI: 0.76-1.08; p = 0.27), TLR
(OR: 0.95; 95% CI: 0.81-1.11; p = 0.51), TVR (OR: 0.96; 95% CI: 0.81-1.13;
p = 0.62) or in-segment LLL (MD: - 0.03, 95% CI: - 0.06-0.01; p = 0.10).
Conclusions In this meta-analysis of randomized controlled trials, the
BP-SESs were superior to the DP-DESs in terms of late ST, very late ST and
in-stent LLL. Further large randomized controlled trials with long-term
follow-up are required to validate the benefits of BP-SESs.

<24>
Accession Number
20160580204
Author
Han R.; Yin X.; Zheng M.; Sun K.; Liu X.; Tian Y.; Yang X.
Institution
(Han, Liu, Yin, Zheng, Liu, Tian, Yang) Heart Center, Beijing Chao-Yang
Hospital, Capital Medical University, Beijing 100020, China
(Sun) Department of Radiology, Cardiovascular Institute and Fu Wai
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Xi-Cheng District, Beijing 100037, China
Title
Effect of remote ischemic preconditioning on myocardial injury and
inflammatory response induced by ablation for atrial fibrillation: A
randomized controlled trial.
Source
International Journal of Cardiology. 222 (pp 396-400), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has been suggested to
reduce postoperative release of cardiac and inflammatory markers in
patients undergoing cardiac surgery. This study aimed to evaluate the
effect of RIPC on nonischemic myocardial damage and inflammatory response
in patients undergoing radiofrequency catheter ablation for paroxysmal
atrial fibrillation (AF). Methods Seventy-two patients with
drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation
were randomized into RIPC or control groups. RIPC (intermittent arm
ischemia through four cycles of 5-min inflation and 5-min deflation of a
blood-pressure cuff) was performed once daily on 2 consecutive days before
the ablation and immediately before ablation. Cardiac troponin-I (cTnI),
high-sensitive C-reactive protein (hs-CRP), and interleukin (IL)-6 levels
were measured before RIPC/sham RIPC, after the ablation, and 24 and 72 h
later. The early recurrence of atrial fibrillation (ERAF) in the two
groups was observed over the subsequent 3 months. Results Radiofrequency
ablation resulted in a significant rise in cTnI, hs-CRP, and IL-6 in both
groups, which persisted for 72 h. The RIPC group showed a lower increase
in cTnI (P < 0.001), hs-CRP (P = 0.003), and IL-6 (P = 0.008) than the
control and tended to have a lower risk of ERAF (hazard ratio [HR] = 0.77,
95% confidence interval [CI]: 0.32-1.88). Conclusions These results show
that RIPC before ablation for paroxysmal AF significantly reduces the
increase in cTnI, hs-CRP, and IL-6 associated with the procedure and
results in a lower risk of ERAF. These findings suggest that RIPC could
provide cardioprotection against nonischemic myocardial damage.

<25>
Accession Number
20160584395
Author
Kim T.K.; Cho Y.J.; Lim C.-W.; Min J.J.; Choi E.-K.; Hong D.M.; Jeon Y.
Institution
(Kim, Cho, Hong, Jeon) Seoul National University Hospital, Department of
Anaesthesiology and Pain medicine, Daehakro 101, Jongno-gu, Seoul 110-744,
South Korea
(Lim) Cheorwon Gil Hospital, Department of Anaesthesiology and Pain
Medicine, Gangwon-Do, South Korea
(Min) Samsung Medical Centre, Department of Anaesthesiology and Pain
Medicine, Seoul, South Korea
(Choi) Seoul National University Hospital, Department of Internal
Medicine, Seoul, South Korea
Title
Effect of ramosetron on QTc interval: A randomised controlled trial in
patients undergoing off-pump coronary artery bypass surgery.
Source
BMC Anesthesiology. 16 (1) (no pagination), 2016. Article Number: 56. Date
of Publication: 03 Aug 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Ramosetron is a relatively new 5-hydroxytryptamine three
receptor antagonist with higher binding affinity and more prolonged
duration of action compared to ondansetron. The present study was
performed to evaluate the effects of ramosetron on QTc interval and
possible cardiovascular adverse effects in patients undergoing cardiac
surgery. Method: A total of 114 patients who underwent off-pump coronary
artery bypass surgery were enrolled in this randomised placebo-controlled
trial. Patients were allocated into two groups that received intravenous
injection of 0.3 mg ramosetron or normal saline during induction of
anaesthesia. QTc intervals were measured before the operation,
intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min
after injection of ramosetron or normal saline), at the end of the
operation, and on postoperative day 1. Results: There were no differences
in mean QTc interval between groups at every time point. However, maximal
change in QTc interval during surgery was higher in the ramosetron group
than the placebo group (25.1 +/- 22.0 vs. 17.5 +/- 14.5 ms, 95 % CI
0.34-14.78, P = 0.040). Also, there were more patients with a QTc interval
increase of > 60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6-18.0, P
= 0.021). There were no significant differences in cardiovascular
complications. Conclusions: Ramosetron administered during induction of
anaesthesia may affect maximal change in QTc interval during off-pump
coronary artery bypass surgery. Ramosetron should be used with caution in
high risk patients for developing Torsades de Pointes. Trial registration:
ClinicalTrials.gov NCT02139241. Registered November 12, 2013

<26>
[Use Link to view the full text]
Accession Number
20160571188
Author
Bohula E.A.; Bonaca M.P.; Braunwald E.; Aylward P.E.; Corbalan R.; De
Ferrari G.M.; He P.; Lewis B.S.; Merlini P.A.; Murphy S.A.; Sabatine M.S.;
Scirica B.M.; Morrow D.A.
Institution
(Bohula, Bonaca, Braunwald, He, Murphy, Sabatine, Scirica, Morrow)
Department of Medicine, Harvard Medical School, Brigham and Women's
Hospital, Boston, MA, United States
(Aylward) South Australian Health and Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
(Corbalan) Division of Cardiovascular Diseases, School of Medicine,
Pontificia Universidad Catolica de Chile, Santiago, Chile
(De Ferrari) Department of Cardiology, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Lewis) Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School
of Medicine, Technion, Haifa, Israel
(Merlini) IV Divisione Cardiologia, Azienda Ospedaliera Niguarda Ca'
Granda, Milan, Italy
Title
Atherothrombotic Risk Stratification and the Efficacy and Safety of
Vorapaxar in Patients with Stable Ischemic Heart Disease and Previous
Myocardial Infarction.
Source
Circulation. 134 (4) (pp 304-313), 2016. Date of Publication: 26 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with stable ischemic heart disease and previous
myocardial infarction (MI) vary in their risk for recurrent cardiovascular
events. Atherothrombotic risk assessment may be useful to identify
high-risk patients who have the greatest potential to benefit from more
intensive secondary preventive therapy such as treatment with vorapaxar.
Methods: We identified independent clinical indicators of atherothrombotic
risk among 8598 stable, placebo-treated patients with a previous MI
followed up for 2.5 years (median) in TRA 2degreeP-TIMI 50 [Thrombin
Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic
Events-TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348;
MK-5348) were assessed by baseline risk among patients with previous MI
without prior stroke or transient ischemic attack for whom there is a
clinical indication for vorapaxar. End points were cardiovascular death,
MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open
Occluded Coronary Arteries) severe bleeding. Results: The 9 independent
risk predictors were age, diabetes mellitus, hypertension, smoking,
peripheral arterial disease, previous stroke, previous coronary bypass
grafting, heart failure, and renal dysfunction. A simple integer-based
scheme using these predictors showed a strong graded relationship with the
rate of cardiovascular death/MI/ischemic stroke and the individual
components (P for trend <0.001 for all). High-risk patients (>3 risk
indicators; 20% of population) had a 3.2% absolute risk reduction in
cardiovascular disease/MI/ischemic stroke with vorapaxar, and
intermediate-risk patients (1-2 risk indicators; 61%) had a 2.1% absolute
risk reduction (P<0.001 each), translating to a number needed to treat of
31 and 48. Bleeding increased across risk groups (P for trend<0.01);
however, net clinical outcome was increasingly favorable with vorapaxar
across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9%
with both treatments in high-risk patients. Conclusions: Stratification of
baseline atherothrombotic risk can assist with therapeutic decision making
for vorapaxar use for secondary prevention after MI. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT00526474.

<27>
Accession Number
20160594814
Author
Thapa S.; Pattanshetty R.B.
Institution
(Thapa) Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
(Pattanshetty) Institute of Physiotherapy, KLEU, Belgaum, Karnataka, India
Title
Effect of chair aerobics as low intensity exercise training on heart rate,
blood pressure and six minute walk distance in post coronary artery bypass
graft surgery patients through phase i cardiac rehabilitation.
Source
Nepalese Heart Journal. 13 (1) (pp 19-23), 2016. Date of Publication:
2016.
Publisher
Cardiac Society of Nepal
Abstract
Background and Aims: Cardiac Rehabilitation after Coronary arteries bypass
graft (CABG) surgery is known to have several favorable effects. Aerobics
exercise in the form of chair aerobics shown to have beneficial effects
with little evidence. The purpose of the present study was to demonstrate
the effect of chair aerobics as low intensity exercise training in heart
rate, blood pressure and six minute walk distance in post CABG patients
during phase I cardiac rehabilitation. Methods: It was a single centre,
prospective study carried out in Indian tertiary care set-up. Fifty
patients post CABG patients were included. Chair aerobics as a low
intensity exercise training was given. Pre and post-exercise outcome
measurements in the form of heart rate, blood pressure and six-minute walk
distance test were recorded. Results: The study showed statistically
significant difference in systolic blood pressure (p= 0.018), heart rate
(p<0.001) and increase in six minute walk distance (p<0.001). Conclusion:
: Chair aerobics as low intensity exercise training demonstrated
improvement in heart rate, systolic blood pressure and six minute walk
distance test in subjects with CABG through phase I cardiac
rehabilitation.

<28>
Accession Number
20160583819
Author
Witberg G.; Lavi I.; Assa H.V.; Orvin K.; Assali A.; Kornowski R.
Institution
(Witberg, Lavi, Assa, Orvin, Assali, Kornowski) Department of Cardiology,
Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
(Witberg, Lavi, Assa, Orvin, Assali, Kornowski) Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
Title
Insights from 2D and 3D quantitative angiographic assessment of
bioresorbable everolimus-eluting vascular scaffolds.
Source
Israel Medical Association Journal. 18 (7) (pp 381-385), 2016. Date of
Publication: July 2016.
Publisher
Israel Medical Association (2 Twin Towers,11th Floor,35 Jabotinsky
Street,PO Box 3566, Ramat Gan 52135, Israel)
Abstract
Background: Bioresorbable vascular scaffold (BVS) is a promising
technology that potentially offers several advantages over contemporary
coronary drug-eluting stents (DES). Crucial to BVS implantation is the
correct choice of scaffold size (diameter and length) in order to avoid
"geographic miss" in length, provide the maximal support to the vessel
wall, and avoid leaving "free-floating" foreign material in the coronary
vasculature. Objectives: To assess the optimal method for measuring
coronary stenosis prior to BVS implantation. Methods: We compared the
performance of two quantitative coronary angiography assessment (QCA)
techniques: two dimensional real-time QCA (2D-QCA) and offline 3D QCA
(3D-QCA) for the evaluation of coronary lesions in patients enrolled in a
multicenter randomized controlled trial of BVS vs. metallic stents, by
calculating the weighted kappa value for agreement regarding optimal BVS
size with the reference method - CoreLab offline 2D-QCA measurements. In
addition, we collected 2 year clinical outcomes (death/myocardial
infarction/repeat revascularization/scaffold thrombosis) in BVS-implanted
patients. Results: In 17 patients with available CoreLab data, the
weighted kappa for agreement for 3D-QCA was significantly better than for
2D-QCA (0.90, 95%CI 0.72-1.00 vs. 0.439, 95%CI 0.16-0.77). The rate of
clinical events at 2 years was low (9.5%). Conclusions: Initial experience
in a small group of carefully selected patients at our institution
suggests that the use of BVS for coronary revascularization is associated
with a low rate of adverse events in suitable patients. 3D-QCA may be
superior to 2D-QCA analysis in terms of reproducibility, and results in
more patients receiving optimal size BVS.

<29>
Accession Number
20160576610
Author
Polymeropoulos E.; Bagos P.; Papadimitriou M.; Rizos I.; Patsouris E.;
Toumpoulis I.
Institution
(Polymeropoulos) Cardiology Department Red Cross Hospital, Athens, Greece
(Bagos) Department of Computer Science and Biomedical Informatics,
University of Thessaly, Lamia, Greece
(Papadimitriou) Internal Medicine Department, Laiko Hospital, Athens,
Greece
(Rizos) Cardiology Department, Attiko Hospital, Athens, Greece
(Patsouris) Department of Pathology, Medical School of the National
University of Athens, Greece
(Toumpoulis) Cardiac Surgery Department, Attiko Hospital, Athens, Greece
Title
Vitamin C for the prevention of postoperative atrial fibrillation after
cardiac surgery: A meta-analysis.
Source
Advanced Pharmaceutical Bulletin. 6 (2) (pp 243-250), 2016. Date of
Publication: 2016.
Publisher
Tabriz University of Medical Sciences (Daneshgah St, Tabriz 5166614713,
Iran, Islamic Republic of)
Abstract
Purpose: Several studies have investigated the administration of vitamin C
(vitC) for the prevention of postoperative atrial fibrillation (AF) after
cardiac surgery. However, their findings were inconsistent. The purpose of
this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for
the prevention of postoperative AF in cardiac surgery. Methods: A
systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library,
and clinical trial registries, was performed. 9 studies, published from
August 2001 to May 2015, were included, with a total of 1,037 patients.
Patients were randomized to receive vitC, or placebo. Results: Cardiac
surgery patients who received vitC as prophylaxis, had a significantly
lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340
- 0.673, P < 10^-4). No significant heterogeneity was detected
across the analyzed studies (I²=21.7%), and no publication bias
or other small study-related bias was found. Conclusion: Our findings
suggest that VitC is effective as prophylaxis for the prevention of
postoperative AF. The administration of vitC may be considered in all
patients undergoing cardiac surgery.

<30>
Accession Number
20160582563
Author
Kokoska L.A.; Wilhelm S.M.; Garwood C.L.; Berlie H.D.
Institution
(Kokoska) United Physicians Inc., Bingham Farms, MI, United States
(Wilhelm, Garwood) Department of Pharmacy, Harper University Hospital,
Detroit Medical Center, Detroit, MI, United States
(Wilhelm, Garwood, Berlie) Department of Pharmacy Practice, Eugene
Applebaum College of Pharmacy and Health Sciences, Wayne State University,
Detroit, MI, United States
(Berlie) Health Centers of Detroit Medical Group, Detroit, MI, United
States
Title
Aspirin for primary prevention of cardiovascular disease in patients with
diabetes: A meta-analysis.
Source
Diabetes Research and Clinical Practice. 120 (pp 31-39), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Aspirin use for primary prevention of cardiovascular disease (CVD) is
controversial, especially in patients with diabetes. The objective of this
meta-analysis was to evaluate aspirin's safety and efficacy for primary
prevention of CVD [fatal or nonfatal myocardial infarction (MI), fatal or
nonfatal stroke, angina, transient ischemic attack (TIA), peripheral
artery disease (PAD) and revascularization] in patients with diabetes.
Methods A literature search was conducted using the terms cardiovascular
disease, aspirin, diabetes mellitus to identify trials of patients with
diabetes who received aspirin for primary prevention of CVD. Study sample
size, and ischemic and bleeding events were extracted and analyzed using
RevMan 5.2.7. Results In total, 6 studies (n = 10,117) met criteria.
Aspirin doses ranged from 100 mg every other day to 650 mg daily.
Follow-up ranged from 3.6 to 10.1 years. In patients with diabetes, there
was no difference between aspirin and placebo with respect to the risk of
all cause mortality (OR 0.93, 95% CI 0.81-1.06), or individual
atherosclerotic events compared to placebo. There were no differences in
bleeding (OR 2.53, 95% CI 0.77-8.34), GI bleeding (OR 2.14, 95% CI
0.63-7.33) or hemorrhagic stroke rates (OR 0.90, 0.34-2.33) between
groups. Conclusions It remains unclear whether aspirin may reduce the
occurrence of a first atherosclerotic event or mortality in patients with
diabetes. More research on this use of aspirin in patients with diabetes
is required to supplement currently available research.

<31>
Accession Number
20160577439
Author
Zhou C.; Jeon Y.; Meybohm P.; Zarbock A.; Young P.J.; Li L.; Hausenloy
D.J.
Institution
(Zhou, Li) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
(Jeon) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, Daehakro 101, Seoul 110-744, South Korea
(Meybohm) Department of Anesthesiology, Intensive Care Medicine, and Pain
Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt
60590, Germany
(Zarbock) Department of Anesthesiology, Critical Care Medicine and Pain
Therapy, University Hospital Munster, Albert- Schweitzer-Campus 1, Gebaude
A1, Munster 48149, Germany
(Young) Wellington Hospital, Capital and Coast District Health Board,
Private Bag 7902, Wellington 6242, New Zealand
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Hausenloy) The National Institute of Health Research University College
London Hospitals Biomedical Research Centre, London, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Title
Renoprotection by remote ischemic conditioning during elective coronary
revascularization: A systematic review and meta-analysis of randomized
controlled trials.
Source
International Journal of Cardiology. 222 (pp 295-302), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic conditioning (RIC) has been recognized an
emerging non-invasive approach for preventing acute kidney injury (AKI) in
patients undergoing either elective coronary artery bypass graft (CABG)
surgery or percutaneous coronary intervention (PCI). On the other hand,
accumulating evidence has indicated the involving role of pre-CABG
contrast usage for coronary angiography in post-surgery AKI risk. Along
with the shortening time delay of CABG after coronary angiography, and the
prevalent hybrid coronary revascularization (HCR), the AKI prevention by
RIC has faced challenges following coronary revascuralization. Methods
Randomized controlled trials (RCTs) were searched from Pubmed, EMBase, and
Cochrane library (until May 2016). The primary outcome was postoperative
AKI. The second outcomes were included the requirement for renal
replacement therapy (RRT), and in-hospital or 30-day mortality. Results
Twenty eligible RCTs (CABG, 3357 patients; PCI, 1501 patients) were
selected. RIC significantly halved the incidence of AKI following PCI when
compared with controls [n = 1501; odds ratio (OR) = 0.51; 95% CI, 0.32 to
0.82; P = 0.006; I² = 29.6%]. However, RIC did not affect the
incidence of AKI following CABG (n = 1850; OR = 0.94; 95% CI, 0.73 to
1.19; P = 0.586; I² = 12.4%). The requirement for RRT and
in-hospital mortality was not affected by RIC in CABG (n = 2049, OR =
1.04, P = 0.87; n = 1920, OR = 0.89, P = 0.7; respectively). Conclusions
Our meta-analysis suggests that RIC for preventing AKI following CABG has
faced with challenges in terms of AKI, the requirement for RRT, and
mortality. However, RIC shows a renoprotective benefit for PCI. Hence, our
findings may infer the preserved renal effects of RIC in CABG with
preconditioning before the coronary angiography, or in HCR.

<32>
[Use Link to view the full text]
Accession Number
20160571938
Author
Ahmed E.A.; Montalti R.; Nicolini D.; Vincenzi P.; Coletta M.; Vecchi A.;
Mocchegiani F.; Vivarelli M.
Institution
(Ahmed, Montalti, Nicolini, Vincenzi, Coletta, Vecchi, Mocchegiani,
Vivarelli) Hepatobiliary and Abdominal Transplantation Surgery, Department
of Experimental and Clinical Medicine, Polytechnic University of Marche,
A.O.U. 'Ospedali Riuniti', via Conca 71, Ancona 60126, Italy
(Ahmed) Hepatobiliary and Pancreatic Surgery Unit, General Surgery
Department, Sohag University, Sohag, Egypt
Title
Fast track program in liver resection: A PRISMA-compliant systematic
review and meta-analysis.
Source
Medicine (United States). 95 (28) (no pagination), 2016. Article Number:
e4154. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: FT program (FT) is a multimodal approach used to enhance
postoperative rehabilitation and accelerate recovery. It was 1st described
in open heart surgery, then modified and applied successfully in
colorectal surgery. FT program was described in liver resection for the
1st time in 2008. Although the program has become widely accepted, it has
not yet been considered the standard of care in liver surgery. Objectives:
we performed this systematic review and meta-analysis to evaluate the
impact of using the FT program compared to the traditional care (TC), on
the main clinical and surgical outcomes for patients who underwent
elective liver resection. Methods: PubMed/Medline, Scopus, and Cochran
databases were searched to identify eligible articles that compared FT
with TC in elective liver resection to be included in this study. Subgroup
meta-analysis between laparoscopic and open surgical approaches to liver
resection was also conducted. Quality assessment was performed for all the
included studies. Odds ratios (ORs) and mean differences (MDs) were
considered as a summary measure of evaluating the association in this
meta-analysis for dichotomous and continuous data, respectively. A 95%
confidence interval (CI) was reported for both measures. I² was
used to assess the heterogeneity across studies. Results: From 2008 to
2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were
identified, including 394 and 416 patients in the FT and TC groups,
respectively. The length of hospital stay (LoS) was markedly shortened in
both the open and laparoscopic approaches within the FT program (P <
0.00001). The reduced LoS was accompanied by accelerated functional
recovery (P = 0.0008) and decreased hospital costs, with no increase in
readmission, morbidity, or mortality rates. Moreover, significant results
were found within the FT group such as reduced operative time (P = 0.03),
lower intensive care unit admission rate (P < 0.00001), early bowel
opening (P < 0.00001), and rapid normal diet restoration (P < 0.00001).
Conclusion: FT program is safe, feasible, and can be applied successfully
in liver resection. Future RCTs on controversial issues such as multimodal
analgesia and adherence rate are needed. Specific FT guidelines should be
developed for liver resection.

<33>
Accession Number
20160570167
Author
Altarabsheh S.E.; Deo S.V.; Dunlay S.M.; Obeidat Y.M.; Erwin P.J.;
Rababa'h A.; Sarabhu N.; Navale S.; Cho Y.H.; Lamba H.K.; Markowitz A.H.;
Park S.J.
Institution
(Altarabsheh) Department of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, Harrington
Heart and Vascular Institute, University Hospitals, Cleveland, OH, United
States
(Dunlay) Division of Cardiology, Mayo Clinic, Rochester, MN, United States
(Obeidat) Department of Cardiac Surgery, Al-Mouwasat Hospital, Al-Dammam,
Saudi Arabia
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Rababa'h) Department of Clinical Pharmacy, Jordan University of Science
and Technology, Irbid, Jordan
(Sarabhu) Division of Nephrology, University Hospitals, Cleveland, OH,
United States
(Navale) Department of Epidemiology and Biostatistics, Case Western
Reserve University, Cleveland, OH, United States
(Cho) Division of Cardiovascular Surgery, Samsung Hospitals, Sungkyunkwang
School of Medicine, Seoul, South Korea
(Lamba) Department of Cardiothoracic Surgery, Louis Stokes Veterans
Affairs, Cleveland, OH, United States
Title
Tissue valves are preferable for patients with end-stage renal disease: an
aggregate meta-analysis.
Source
Journal of Cardiac Surgery. 31 (8) (pp 507-514), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc.
Abstract
BACKGROUND: Valve selection in patients with end-stage renal disease
(ESRD) is uncertain. We performed a systematic review and meta-analysis to
compare clinical outcome in ESRD patients undergoing valve replacement.
METHODS: We systematically searched multiple databases (2000-October 2015)
to identify original studies comparing adverse events between mechanical
and biological valve replacement in ESRD patients. End-points studied
were: postoperative mortality, bleeding events, need for re-operation, and
late survival. A random-effect inverse-variance weighted analysis was
performed; event rates are compared as odds ratio (OR and 95% confidence
interval) and hazard ratios (HR) for time-to-event data. Mechanical valve
and tissue valve replacement were considered as study and control cohorts,
respectively. RESULTS: Fifteen retrospective studies (5523 mechanical and
1600 tissue valve) were included in our meta-analysis. Early mortality was
comparable (OR 1.15 [0.77; 1.72]; p = 0.49). The mean follow-up among
studies ranged from 1.6-15 years. Bleeding was significantly higher after
mechanical valve replacement (OR 2.55 [1.53; 4.26]; p = 0.0003).
Structural valve degeneration was present in only 0.6% patients after a
tissue valve replacement. Overall survival after valve replacement was
poor (median 2.61 years); valve choice did not influence this outcome
(pooled HR 0.87 [0.73; 1.04]; p = 0.14). CONCLUSION: Operative mortality
in ESRD patients is comparable between mechanical and tissue valve
replacement. Major bleeding episodes are significantly higher after
mechanical valve replacement but structural degeneration in tissue valves
during the follow-up period is low. Based on the findings from this
meta-analysis, we would recommend using tissue valves in patients with
ESRD.

<34>
Accession Number
20160574470
Author
Li M.; Zou H.; Xu G.
Institution
(Li) Jiangxi Medical College, Nanchang University, China
(Zou) Medical Center of the Graduate School, Nanchang University, China
(Xu) Department of Nephrology, Second Affiliated Hospital, Nanchang
University, Jiangxi 330006, China
Title
The prevention of statins against AKI and mortality following cardiac
surgery: A meta-analysis.
Source
International Journal of Cardiology. 222 (pp 260-266), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective It is universally acknowledged that acute kidney injury (AKI)
often comes following cardiac surgery with severe morbidity and mortality.
The impact of statins on the incidence of AKI and mortality after cardiac
surgery are controversial, therefore, it is urgent to explore the source
of heterogeneity via the subgroup analysis. Methods We searched PubMed,
ISI and Elsevier to May 31st 2016 for studies which investigated the
effects of statins relevant to this theme. Statistical analysis was using
RevMan5.2 and Stata12.0. The outcomes were the occurrence of AKI and the
mortality after cardiac surgery. For the first time, we discussed the
source of heterogeneity on the basis of the characters of patients in the
following subgroup analysis. Results A total of 17 studies with 18,684
statins and 24,033 non-statin users were included. The meta-analysis
suggested that statins not only reduced the occurrence of AKI [Odds Ratio
(OR) 0.72, 95% Confidence Interval (CI) 0.55-0.94)] in the subjects
without high risk factors, also decreased the mortality of the patients
suffering AKI (OR 0.40, 95% CI 0.22-0.72). Conclusion Patients undergoing
cardiac surgery might benefit from statins by reducing the occurrence of
AKI and the mortality of the patients suffering AKI.

<35>
Accession Number
20160406087
Author
Fink-Neuboeck N.; Lindenmann J.; Bajric S.; Maier A.; Riedl R.; Weinberg
A.M.; Smolle-Juettner F.M.
Institution
(Fink-Neuboeck, Lindenmann, Bajric, Maier, Smolle-Juettner) Division of
Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
(Riedl) Institute for Medical Informatics, Statistics and Documentation,
Medical University Graz, Graz, Austria
(Weinberg) Department of Orthopedics and Orthopedic Surgery, Medical
University Graz, Graz, Austria
Title
Clinical impact of interleukin 6 as a predictive biomarker in the early
diagnosis of postoperative systemic inflammatory response syndrome after
major thoracic surgery: A prospective clinical trial.
Source
Surgery (United States). 160 (2) (pp 443-453), 2016. Date of Publication:
01 Aug 2016.
Publisher
Mosby Inc.
Abstract
Background Postoperative systemic inflammatory response syndrome and
sepsis are associated with high morbidity and mortality rates. Early
detection of postoperative systemic inflammatory response syndrome
improves the outcome. The aim of this study was to evaluate the
feasibility of interleukin 6 as a predictive biomarker in the early
diagnosis of postoperative systemic inflammatory response syndrome after a
major thoracic operation. Methods A total of 94 patients were enrolled in
this prospective, clinical, single-center study. The enrolled subjects
underwent either lung resection or esophageal operation. Interleukin 6,
procalcitonin, C-reactive protein, and leucocytes were measured
sequentially before, during, and after the operation. These levels were
compared between patients who developed postoperative systemic
inflammatory response syndrome and those who did not. Results The
enrollees who completed the study included of 55 males (79.7%) and 14
females (20.3%) with a mean age of 60.9 years. Twenty patients (29.0%)
developed systemic inflammatory response syndrome at a median time of 33.0
hours postoperatively. In cases of postoperative systemic inflammatory
response syndrome, interleukin 6 was the most predictive biomarker,
showing a striking increase on the day of operation and preceding the
median onset of postoperative systemic inflammatory response syndrome,
which occurred the next day (P < .001). Peak procalcitonin and C-reactive
protein occurrence were significantly delayed at 24 hours (P = .012) and
48 hours (P = .012). There was no mortality 30 days postoperatively.
Conclusion Interleukin 6 is a reliable predictor of postoperative systemic
inflammatory response syndrome, and it is able to detect postoperative
system inflammatory response syndrome before the onset of related clinical
symptoms. When identifying patients at high risk, it would be beneficial
to include interleukin 6 in conventional postoperative monitoring,
particularly after extended surgical resection.

<36>
[Use Link to view the full text]
Accession Number
20160079621
Author
Deschamps A.; Hall R.; Grocott H.; David Mazer C.; Choi P.T.; Turgeon
A.F.; De Medicis E.; Bussieres J.S.; Hudson C.; Syed S.; Seal D.; Herd S.;
Lambert J.; Denault A.
Institution
(Deschamps, Denault) Department of Anesthesiology, Montreal Heart
Institute, 5000 rue Belanger, Montreal, QC H1T 1C8, Canada
(Denault) Department of Intensive Care Medicine, Montreal Heart Institute,
University of Montreal, Montreal, QC, Canada
(Hall) Department of Anesthesiology and Critical Care Medicine, Queen
Elizabeth II Health Science Centre, Dalhousie University, Halifax, Canada
(Grocott) Department of Anesthesiology, University of Manitoba, St.
Boniface Hospital, Winnipeg, MN, Canada
(David Mazer) Department of Anesthesia, University of Toronto, Keenan
Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Toronto, ON, Canada
(Choi) Department of Anesthesiology Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, and Population Health and Optimal
Health Practices, CHU de Quebec Research Center, CHU de Quebec, Universite
Laval, Quebec City, QC, Canada
(De Medicis) Department of Anesthesiology, CHU de Sherbrooke, Universite
de Sherbrooke, Sherbrooke, QC, Canada
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Universite Laval, QC, Canada
(Hudson) Department of Anesthesiology, Ottawa Heart Institute, University
of Ottawa, Ottawa, ON, Canada
(Syed) Department of Anesthesiology, McMaster University, Hamilton, ON,
Canada
(Seal) Department of Anesthesiology, Calgary Foothills Hospital,
University of Calgary, Calgary, AB, Canada
(Herd) Department of Anesthesiology, Vancouver General Hospital,
University of British Columbia, Vancouver, BC, Canada
(Lambert) Department of Social and Preventive Medicine, University of
Montreal, Montreal, QC, Canada
Title
Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation
during high-risk cardiac surgery a randomized controlled feasibility
trial.
Source
Anesthesiology. 124 (4) (pp 826-836), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cerebral oxygen desaturation during cardiac surgery has been
associated with adverse perioperative outcomes. Before a large multicenter
randomized controlled trial (RCT) on the impact of preventing
desaturations on perioperative outcomes, the authors undertook a
randomized prospective, parallel-arm, multicenter feasibility RCT to
determine whether an intervention algorithm could prevent desaturations.
Methods: Eight Canadian sites randomized 201 patients between April 2012
and October 2013. The primary outcome was the success rate of reversing
cerebral desaturations below 10% relative to baseline in the intervention
group. Anesthesiologists were blinded to the cerebral saturation values in
the control group. Intensive care unit personnel were blinded to cerebral
saturation values for both groups. Secondary outcomes included the area
under the curve of cerebral desaturation load, enrolment rates, and a
30-day follow-up for adverse events. Results: Cerebral desaturations
occurred in 71 (70%) of the 102 intervention group patients and 56 (57%)
of the 99 control group patients (P = 0.04). Reversal was successful in 69
(97%) of the intervention group patients. The mean cerebral desaturation
load (SD) in the operating room was smaller for intervention group
patients compared with control group patients (104 [217] %.min vs. 398
[869] %.min, mean difference,-294; 95% CI,-562 to-26; P = 0.03). This was
also true in the intensive care unit (P = 0.02). There were no differences
in adverse events between the groups. Conclusions: Study sites were
successful in reversal of desaturation, patient recruitment,
randomization, and follow-up in cardiac surgery, supporting the
feasibility of conducting a large multicenter RCT.

<37>
Accession Number
20160579961
Author
Payne R.E.; Aldwinckle J.; Storrow J.; Kong R.S.; Lewis M.E.
Institution
(Payne) Department of Trauma and Orthopaedic Surgery, University Hospital
Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United
Kingdom
(Aldwinckle) Department of Cardiology, University Hospital Coventry and
Warwickshire, Coventry, United Kingdom
(Storrow) Intensive Care, Heartlands Hospital, Birmingham, United Kingdom
(Kong, Lewis) Cardiac Surgery, Royal Sussex County Hospital, Brighton,
United Kingdom
Title
RIPC remains a promising technique for protection of the myocardium during
open cardiac surgery: A meta-analysis and systematic review.
Source
Heart Surgery Forum. 18 (2) (pp E74-E80), 2015. Date of Publication: 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Remote ischemic preconditioning (RIPC) is the process of
inducing brief ischemia in a tissue to prevent ischemic damage in another.
This preconditioning can be induced simply by inflating a blood pressure
cuff on a limb. Previous randomized controlled trials (RCT) have suggested
that RIPC may infer myocardial protection during open cardiac surgery. One
method of assessing the degree of myocardial damage incurred in these
studies is to assay troponin concentration. Troponin is a cardiac enzyme
released by damaged myocardiocytes. With the recent publication of several
large RCTs in this area, a meta-analysis of the evidence was undertaken.
Methods: A systematic search of PubMed, EMBASE, and clinicaltrials.gov.uk
was conducted using MeSH terms "ischaemic preconditioning" and "cardiac
surgery." RCTs that examined post-surgery troponin concentrations were
included in this review. The primary outcome investigated was troponin
levels at six hours post-cardiac surgery. Secondary outcomes included six
to eight hour and twenty-four hour troponin release. Results: Thirteen
RCTs, comprising 1398 participants, were identified for inclusion in this
meta-analysis. Twelve hour postoperative troponin was significantly
reduced by RIPC, standardized mean difference 1.29 (95% CI 0.34-2.24). Six
to eight and twenty-four hour troponin were also significantly reduced,
standardized mean differences 1.23 (95% CI 0.62-1.84) and 1.25 (95% CI
0.31-2.19) respectively. Conclusion: The reduction in troponin
concentration suggests that RIPC reduces myocardial damage during open
cardiac surgery, however, the degree of bias in the studies assessed may
have had a significant impact on this result.

<38>
Accession Number
20160581533
Author
Silvain J.; Storey R.F.; Cayla G.; Esteve J.-B.; Dillinger J.-G.; Rousseau
H.; Tsatsaris A.; Baradat C.; Salhi N.; Hamm C.W.; Lapostolle F.; Lassen
J.F.; Collet J.-P.; Ten Berg J.M.; Van 'T Hof A.W.; Montalescot G.
Institution
(Silvain, Collet, Montalescot) Universite Paris 06 INSERM-UMRS 1166,
Institut de Cardiologie, Pitie-Salpetriere University Hospital (AP-HP),
Paris, France
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Cayla) Service de Cardiology, CHU Caremeau, Nimes, France
(Esteve) CHU de la Reunion, Reunion - Le Raincy-Montfermeil, Montfermeil,
France
(Dillinger) Department of Cardiology, INSERM U942 Hopital Lariboisiere,
AP-HP Paris Diderot University, Paris, France
(Rousseau) Unite de Recherche Clinique, Hopital Lariboisiere, Paris,
France
(Tsatsaris, Baradat) AstraZeneca, Rueil Malmaison, France
(Salhi) AstraZeneca, Luton, United Kingdom
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Lapostolle) SAMU 93, Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus N, Denmark
(Ten Berg) Department of Cardiology, St Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Van 'T Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
Title
P2Y<inf>12</inf> receptor inhibition and effect of morphine in patients
undergoing primary PCI for ST-segment elevation myocardial infarction: The
PRIVATE-ATLANTIC study.
Source
Thrombosis and Haemostasis. 116 (2) (pp 369-378), 2016. Date of
Publication: August 2016.
Publisher
Schattauer GmbH
Abstract
PRIVATE-ATLANTIC (P2Y<inf>12</inf> Receptor Inhibition with VASP Testing
using Elisa kit during the ATLANTIC study) is a pre-specified substudy of
the randomised, double-blind ATLANTIC trial in patients with ST-segment
elevation myocardial infarction, designed to help interpret the main trial
results. The primary objective of ATLANTIC was to assess coronary
reperfusion prior to percutaneous coronary intervention (PCI) with prevs
in-hospital ticagrelor 180 mg loading dose (LD). PRIVATE-ATLANTIC assessed
platelet inhibition in 37 patients by measurement of
vasodilator-associated stimulated phosphoprotein (VASP) platelet
reactivity index (PRI) and VerifyNow platelet reactivity units (PRU)
before angiogram (T1), immediately after PCI (T2), 1 (T3), and 6 (T4)
hours (h) after PCI, and before next study drug administration (T5). The
median time difference between the two ticagrelor LD was 41 minutes.
Platelet reactivity was unaffected at T1 when measured by VASP-PRI (89.8
vs 93.9% for pre- and in-hospital ticagrelor, respectively; p = 0.18) or
PRU (239 vs 241; p = 0.82). Numerical differences were apparent at T2 and
maximal at T3. Morphine administration significantly delayed onset of
platelet inhibition at T3 (VASP-PRI 78.2 vs 23.4%% without morphine; p =
0.0116) and T4 (33.1 vs 11.0%>; p = 0.0057). In conclusion, platelet
inhibition in ATLANTIC was unaffected by pre-hospital ticagrelor
administration at the time of initial angiogram due to the short transfer
delay. The maximum difference in platelet inhibition was detected 1 h
after PCI (T3). Morphine administration was associated with delayed onset
of action of ticagrelor and appeared more important than timing of
ti-cagrelor administration.

<39>
Accession Number
20160566251
Author
Ahn J.; Park S.K.; Park T.S.; Kim J.H.; Yun E.; Kim S.-P.; Lee H.W.; Oh
J.-H.; Choi J.H.; Cha K.S.; Hong T.J.; Lee S.Y.; Lee H.C.
Institution
(Ahn, Park, Park, Lee, Oh, Choi, Cha, Hong, Lee) Division of Cardiology,
Department of Internal Medicine, Pusan National University Hospital, 179
Gudeok-ro, Seo-gu, Busan 49241, South Korea
(Kim) Department of Internal Medicine, Busan Medical Center, Busan, South
Korea
(Yun) Department of Biostatistics, Pusan National University Hospital,
Busan, South Korea
(Kim) Department of Cardiovascular Surgery, Pusan National University
Hospital, Busan, South Korea
(Lee) Family Medicine Clinic and Research Institute of Convergence of
Biomedical Science and Technology, Pusan National University Yangsan
Hospital, Yangsan, South Korea
(Lee) Medical Education Unit and Medical Research Institute, Pusan
National University, School of Medicine, Yangsan, South Korea
Title
Effect of n-3 polyunsaturated fatty acids on regression of coronary
atherosclerosis in statin treated patients undergoing percutaneous
coronary intervention.
Source
Korean Circulation Journal. 46 (4) (pp 481-489), 2016. Date of
Publication: July 2016.
Publisher
Korean Society of Circulation
Abstract
Background and Objectives: Statins remain the mainstay of secondary
coronary artery disease (CAD) prevention, but n-3 polyunsaturated fatty
acids (omega-3 PUFA) display biological effects that may also reduce the
risk of atherosclerosis and CAD. However, data on the possible
antiatherosclerotic benefits of adding omega-3 PUFA to statin therapy are
limited. This study aimed to investigate the potential additive effects of
omega-3 PUFA on regression of atherosclerosis in CAD patients receiving
statin therapy and stent implantation. Subjects and Methods: Seventy-four
CAD patients undergoing percutaneous coronary intervention (PCI) with
stent implantation were enrolled, prescribed statins, and randomly
assigned to two groups: n-3 group (omega-3 PUFA 3 g/day, n=38) or placebo
group (placebo, n=36). All patients completed the study follow-up
consisting of an intravascular ultrasound at baseline and at 12 months.
Results: There was no difference in the baseline characteristics and
distribution of other medications. No significant differences were
observed in primary endpoints, including changes in atheroma volume index
(-12.65% vs. -8.51%, p=0.768) and percent atheroma volume (-4.36% vs.
-9.98%, p=0.526), and in secondary endpoints including a change in
neointimal volume index (7.84 vs. 4.94 mm³/mm, p=0.087).
Conclusion: omega-3 PUFA had no definite additional effect on the
regression of coronary atherosclerosis when added to statin in CAD
patients undergoing PCI.

<40>
Accession Number
20160570186
Author
Bruch L.; Zadura M.; Waliszewski M.; Platonic Z.; Eranen J.; Scheller B.;
Gotting B.; Herberger D.; Palmieri C.; Sinicropi G.; Motz W.
Institution
(Bruch) Unfallkrankenhaus Berlin, Berlin, Germany
(Zadura, Motz) Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH and Co.
KG, Karlsburg, Germany
(Waliszewski, Herberger) Medical Scientific Affairs B.Braun Vascular
Systems, Berlin, Germany
(Platonic) Clinical Hospital Center Rijeka, Rijeka, Croatia
(Eranen) Pohjois-Karjalan Keskussairaala 1, Kokkola, Finland
(Scheller) Universitatsklinikum des Saarlandes, Homburg/Saar, Germany
(Gotting) Christliches Krankenhaus Quakenbruck gGmbH, Quakenbruck, Germany
(Palmieri) Ospedale del Cuore G. Pasquinucci, Massa, Italy
(Sinicropi) Policlinico Le Scotte Siena, Italy
Title
Results From the International Drug Coated Balloon Registry for the
Treatment of Bifurcations. Can a Bifurcation Be Treated Without Stents?.
Source
Journal of Interventional Cardiology. 29 (4) (pp 348-356), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: This observational study assessed the 9-month clinical
outcomes in patients with coronary bifurcation lesions suitable for
drug-coated balloon (DCB) angioplasty. It was the intention to use DCB's
without additional stenting (DCB-only strategy) in selected patients for
this chosen strategy. Bail-out main branch (MB) and/or side branch (SB)
stenting, however, were permissible when flow limiting dissections or
excessive recoil occurred. Background: A multitude of interventional
strategies have been studied to treat bifurcation lesions. With the
availability of DCB angioplasty, investigators have been using this
interventional tool with the optional implantation of bare metal stents
(BMS). Methods: This study is an international, prospective, multicenter
registry enrolling patients with coronary bifurcation lesions including a
side branch >2 mm in diameter. Patients with stable angina and documented
ischemia or selected forms of unstable angina due to a culprit bifurcation
lesion of any Medina classification type were recruited. The primary
endpoint was clinically driven target-lesion revascularization (TLR) at 9
months. Secondary endpoints included 9-month major adverse cardiac events
(death, myocardial infarction, or TLR), technical success, in-hospital
outcomes and vessel thrombosis rates. Results: A total 127 patients 66.1
+/- 10.1 years of age were enrolled. Demographic characteristics were
80.3% (102/127) male gender, 31.5% (40/127) diabetes, 91.3% (116/127)
hypertension, 7.1% (9/127) ST-elevation myocardial infarction (STEMI), and
9.4% (12/127) non ST-elevation myocardial infarction (NSTEMI). The 130
lesions were treated with 184 DCB's and 64 BMS. In 53.8% (70/130) of all
lesions the DCB-only strategy could be used while 34.6% (45/130) of
lesions had at least 1 stent (BMS) in the main branch, 8.5% (11/130) had
at least 1 stent in the side branch and 3.1% (4/130) needed at least 1
stent in the main and side branch. 94.5% patients (121/127) were available
for follow-up after 9.8 +/- 2.0 months. The TLR rate was 4.6% in the
absence of any thrombotic events in the treated vessels whereas the
9-month MACE rate was 6.2%. Conclusion: This observational study suggests
that the DCB-only strategy is safe and effective to treat selected
bifurcations while benefiting from a shortened dual antiplatelet therapy
(DAPT).

<41>
Accession Number
20160570184
Author
Moon J.; Kang W.C.; Kim S.; Kim M.G.; Oh P.C.; Park Y.M.; Chung W.-J.;
Choi D.Y.; Lee J.Y.; Lee Y.-B.; Hwang H.Y.; Ahn T.
Institution
(Moon, Kang, Kim, Kim, Oh, Park, Chung) Cardiology Division, Department of
Internal Medicine, Gachon Cardiovascular Research Institute, Gachon
University Gil Medical Center, Incheon, South Korea
(Choi) Department of Pediatrics, Gachon University Gil Medical Center,
Incheon, South Korea
(Lee, Ahn) Department of Anesthesiology, Gachon University Gil Medical
Center, Incheon, South Korea
(Lee) Department of Neurology, Gachon University Gil Medical Center,
Incheon, South Korea
(Hwang) Department of Radiology, Gachon University Gil Medical Center,
Incheon, South Korea
Title
Comparison of Outcomes after Device Closure with Transseptal Puncture and
Standard Technique in Patients with Patent Foramen Ovale and Ischemic
Events.
Source
Journal of Interventional Cardiology. 29 (4) (pp 400-405), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: The purpose of this study was to compare the effectiveness of
device closure with the transseptal puncture and standard technique in
patients with patent foramen ovale (PFO) and ischemic events. Methods:
Eighty-two consecutive patients (men: 60 patients, mean age: 45.2 years)
who underwent PFO closure with the Amplatzer PFO Occluder were enrolled.
PFO closure with the transseptal puncture was performed in 22 patients
(transseptal puncture technique, group I). In the remaining patients (n =
60), PFO closure was performed with the standard technique (group II). The
co-primary end points were the incidence of significant residual shunt on
follow-up transesophageal echocardiography (TEE) and a composite of death,
stroke, transient ischemic attack (TIA), and peripheral embolism. Results:
Baseline characteristics were similar between the two groups. On TEE,
despite similar grade of interatrial right-to-left shunt, shunt at
rest/septal hypermobility was less common in group I than in group II
(40.9% vs. 72.9%, P < 0.010). The device was successfully implanted in all
patients. On follow-up TEE, significant residual shunt was more common in
group I than in group II (28.6% vs. 4.3%, P = 0.021). In addition,
composite of death, stroke, TIA, or peripheral embolism was more common in
group I than in group II (13.6% vs. 0%, P = 0.017) during the follow-up
period (mean 25.4 months). Conclusion: Compared to the standard technique,
PFO closure with the transseptal puncture technique showed higher
incidence of residual shunt and ischemic events. Therefore, this technique
might be considered in only highly selected patients as the last option.

<42>
Accession Number
20160570183
Author
Cruz-Gonzalez I.; Rama-Merchan J.C.; Calvert P.A.; Rodriguez-Collado J.;
Barreiro-Perez M.; Martin-Moreiras J.; Diego-Nieto A.; Hildick-Smith D.;
Sanchez P.L.
Institution
(Cruz-Gonzalez, Rama-Merchan, Rodriguez-Collado, Barreiro-Perez,
Martin-Moreiras, Diego-Nieto, Sanchez) University Hospital of Salamanca,
IBSAL, Salamanca, Spain
(Calvert) Queen Elizabeth Hospital, University Hospitals Birmingham and
Institute of Translational Medicine, University of Birmingham, United
Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, United Kingdom
Title
Percutaneous Closure of Paravalvular Leaks: A Systematic Review.
Source
Journal of Interventional Cardiology. 29 (4) (pp 382-392), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Paravalvular leak (PVL) is an uncommon yet serious complication associated
with the implantation of mechanical or bioprosthetic surgical valves and
more recently recognized with transcatheter aortic valves implantation
(TAVI). A significant number of patients will present with symptoms of
congestive heart failure or haemolytic anaemia due to PVL and need further
surgical or percutaneous treatment. Until recently, surgery has been the
only available therapy for the treatment of clinically significant PVLs
despite the significant morbidity and mortality associated with
re-operation. Percutaneous treatment of PVLs has emerged as a safe and
less invasive alternative, with low complication rates and high technical
and clinical success rates. However, it is a complex procedure, which
needs to be performed by an experienced team of interventional
cardiologists and echocardiographers. This review discusses the current
understanding of PVLs, including the utility of imaging techniques in PVL
diagnosis and treatment, and the principles, outcomes and complications of
transcatheter therapy of PVLs.

<43>
Accession Number
20160344463
Author
Otsuki S.; Brugaletta S.; Sabate M.; Shiratori Y.; Gomez-Monterrosas O.;
Scalone G.; Romero-Villafane S.; Hernandez-Enriquez M.; Freixa X.;
Martin-Yuste V.; Masotti M.
Institution
(Otsuki, Brugaletta, Sabate, Shiratori, Gomez-Monterrosas, Scalone,
Romero-Villafane, Hernandez-Enriquez, Freixa, Martin-Yuste, Masotti)
Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS,
University of Barcelona, Spain
Title
Overtime evaluation of the vascular HEALing process after
everolimus-eluting stent implantation by optical coherence tomography. The
HEAL-EES study.
Source
Cardiovascular Revascularization Medicine. 17 (4) (pp 241-247), 2015. Date
of Publication: 31 Oct 2015.
Publisher
Elsevier Inc.
Abstract
Purpose Second-generation drug-eluting stent (DES) have shown a better
safety and efficacy as compared to first generation DES due to an improved
vascular healing process. This process has not been so far evaluated in
vivo in an overtime fashion by optical coherent tomography (OCT). We
sought to evaluate the vascular healing process after everolimus-eluting
stent (EES) implantation at 6, 9 and 12 months, by OCT. Methods
Consecutive 36 patients undergoing percutaneous coronary intervention with
EES were randomized 1:1:1 to receive OCT imaging at 6 (group A), 9 (group
B) or 12-month follow-up (group C). One patient from group C was excluded
because of target lesion revascularization at 1-month, whereas 5 patients
withdraw the informed consent. Finally, 30 patients were analyzed. Results
Neointimal thickness was not different between 3 groups (group A: 99.50
[94.06-127.79] mum, group B: 107.26 [83.48-133.59] mum, group C: 127.67
[102.51-138.49] mum; p = 0.736). Although the percentage of "uncovered
struts" was significantly higher in group A as compared to the other
groups (8.0% vs. 4.4% vs. 2.9%, respectively; p = 0.180), the ratio of
uncovered to total struts per section < 30% was similar between 3 groups
(0.3% vs. 0.3% vs. 0%, respectively; p = 1.000). Conclusion Healing
process following EES implantation seems almost completed at 6-month
follow-up. These data, which need to be confirmed in a larger study, may
support the decision to shorten dual antiplatelet therapy.

<44>
Accession Number
611620759
Author
Weinberg R.L.; Yun H.; Shah R.V.; Corbett J.R.; Hulten E.; Murthy V.L.
Institution
(Weinberg, Yun, Corbett, Murthy) University of Michigan, Ann Arbor, MI,
United States
(Shah) Massachusetts General Hospital, Boston, MA, United States
(Hulten) Walter Reed National Military Medical Center, Bethesda, MD,
United States
Title
18f-fluorodeoxyglucose PET/CT is a sensitive and specific test for
diagnosis of prosthetic valve and cardiac implantable electrical device
infective endocarditis.
Source
Journal of Nuclear Cardiology. Conference: 21st Annual Scientific Session
of the American Society of Nuclear Cardiolog United States. Conference
Start: 20160922 Conference End: 20160925. 23 (4) (pp 904), 2016. Date of
Publication: August 2016.
Publisher
Springer New York LLC
Abstract
Background: Infective endocarditis affecting cardiac implantable
electronic devices (CIED) and prosthetic valves (PV) is increasingly
common and is associated with substantial morbidity and mortality.
Application of the modified Duke criteria for the diagnosis of CIED or PV
endocarditis is challenging due to the relative insensitivity of
echocardiography, particularly during the early stages.
18F-fluorodeoxyglucose (FDG) PET/CT is emerging as method with improved
accuracy for PV and CIED infective endocarditis, although most studies to
date have been modest in size. Methods: We systematically searched PubMed
for studies reporting the accuracy of 18F-FDG PET/CT to diagnose CIED or
PV endocarditis. Effect sizes, patient, and study characteristics were
abstracted. We performed meta-analysis of the overall sensitivity (Se) and
specificity (Sp) using bivariate mixed-effects binary regression with
fixed (device studies) and random (prosthetic valve studies) effects
models. Results: 493 patients from 15 studies were included. On a per
patient level, the overall Se was 84% (95% CI 78-89%), Sp 89% (95% CI 90-
95%), and AUC 0.93 (95% CI 0.90-0.95). There was substantial variability
in the imaging protocol and preparation of patients for their 18FFDG
PET/CT scan, and only 5 of 15 studies addressed nonspecific myocardial
uptake of 18F-FDG. 9 studies (n = 321) evaluated CIED with Se 88% (95% CI
82-92%), Sp 91% (95% CI 82-96%), and AUC 0.94 (95% CI 0.92-0.96). 6
studies (n = 170) of PV infection demonstrated Se 77% (95% CI 65-86%), Sp
83% (95% CI 64-93%, AUC 0.87 (95% CI 0.84-0.90). Conclusion: 18F-FDG
PET/CT is a highly accurate method for the diagnosis of prosthetic valve
and cardiac implantable electronic device infective endocarditis. Further
studies are required to elucidate optimal protocols and to establish
whether clinical outcomes are improved by early application of 18F-FDG
PET/CT. (Figure Presented).

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Accession Number
611615636
Author
Sosorburam T.; Yao L.; Xiao P.
Institution
(Sosorburam, Yao) Anesthesiology, Tongji Medical College, Wuhan, China
(Xiao) ICU, Tongji Medical College, Wuhan, China
Title
Neurological complications in icu after on-pump cardiac surgery: A Chinese
study.
Source
Journal of Cerebral Blood Flow and Metabolism. Conference: 27th
International Symposium on Cerebral Blood Flow, Metabolism and Function
and 12th International Conference on Quantification of Brain Function with
PET Canada. Conference Start: 20150627 Conference End: 20150630. 36 (pp
806-807), 2016. Date of Publication: June 2016.
Publisher
Nature Publishing Group
Abstract
Objectives: Despite having advanced medical care and surgical techniques,
neurological complications remain significant causes of postoperative
mortality and morbidity in patients underwent cardiac surgery. Whether
anesthetic drugs influence the outcome or not is still unclear. Therefore,
we conduct the research to determine effects of different anesthetic
drugs. Method: The study was conducted at Union Hospital, China from May
2013 to December 2014. Total 120 patients, who are undergoing on-pump
cardiac surgeries without any history of cerebrovascular diseases are
recruited. The subjects randomly selected into two most commonly used
anesthetic agents groups: volatile anesthetic/VA/ or total intravenous
anesthetic/TIVA/ groups. Evaluation of major neurological and
physiological dysfunctions were recorded until the patient discharged from
the hospital. Comparisons between the groups were analyzed using the
t-Student test, and P values of less than 0.05 were considered
statistically significant. Results: There was no significant difference
found between the demographics data, intraoperative monitoring and
cerebral protective measures between the groups. The incidence of
postoperative stroke and postoperative delirium were 2.5% and 5.8% in TIVA
group and 3.7% and 6.4% in VA group. Early mortality was higher in VA
(4.3% vs 3.5%). Multivariate analysis revealed that postoperative
cognitive disorder was associated with longer duration of cardiopulmonary
bypass (mean time 132+/-2.4min in VA vs 118+/-4.8min in TIVA). Another
significant difference was transient ischemic attack, which was 7.1% in VA
and 6.5% in TIVA. The hospital length of stay and ICU stay were longer in
VA group (14.1 and 5.2 days vs 12.3 and 6.2 days). Conclusion: TIVA
associated with lower postoperative mortality and morbidity than VA. The
advantage of TIVA over VA is evident regarding interference with
neurological and cognitive disorders. However, all the potential
neuroprotective effect of TIVA cannot be measured by single anesthetic
drug or technique, TIVA appears to be the first choice for on-pump cardiac
surgery. We suggest further systemic and multi-centered study should be
conducted to implement guidelines regarding the neuroprotective
anesthesia.