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<1>
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Accession Number
26218256
Author
Kanthimathinathan H.K.; Sundararajan S.B.; Laker S.; Scholefield B.R.;
Morris K.P.
Institution
(Kanthimathinathan, Sundararajan, Laker, Scholefield, Morris) 1PICU,
Birmingham Children's Hospital, Birmingham, United Kingdom. 2PICU, Leeds
Children's Hospital, Leeds, United Kingdom. 3University of Birmingham,
Birmingham, United Kingdom
Title
Targeting Glycemic Control After Pediatric Cardiac Surgery: The Influence
of Age on Insulin Requirement.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 16 (9) (pp 853-858), 2015. Date of Publication: 01 Nov
2015.
Abstract
OBJECTIVE: Factors influencing the development of hyperglycemia and
pattern of insulin requirement in children undergoing cardiac surgery are
poorly understood. This study investigated the impact of age on the
pattern of hyperglycemia and insulin requirement in children after cardiac
surgery.
DESIGN: Cohort study, based on a prospectively collected dataset for
patients enrolled into the Control of Hyperglycemia in Pediatric Intensive
Care trial.
SETTING: A 24-bedded multidisciplinary PICU.
PATIENTS: Children randomized to the tight glycemic control arm (target
blood glucose, 4-7 mmol/L [72-126 mg/dL]) of the Control of Hyperglycemia
in Pediatric Intensive Care trial following cardiac surgery. Children were
categorized into four age groups (neonate, 1-30 d; infant, 31-365 d; young
child, 1-5 yr; older child, 5-16 yr) for analyses of patterns of
hyperglycemia and insulin requirement over the 12-hour period following
initiation of insulin.
INTERVENTIONS: Insulin titration was performed based on blood glucose
value and rate of change of blood glucose using an algorithm developed for
the Control of Hyperglycemia in Pediatric Intensive Care trial.
MEASUREMENTS AND MAIN RESULTS: Of 92 children, 72 children (78%)
randomized to the tight glycemic control group developed hyperglycemia
(blood glucose, > 7 mmol/L [126 mg/dL]) and received insulin. Older age
was associated with higher blood glucose and a higher insulin dose per
kilogram over the first 3 hours of the study period (p < 0.02). Cumulative
insulin dose was significantly higher in older children (median, 1.3 U/kg
[range, 0.2-5.75]) compared with other age groups (neonate, 0.37
[0.05-2.2]; infant, 0.45 [0.05-2.2]; young child, 0.35 [0.05-0.81]) (p =
0.004). Age group, rather than body mass index, carbohydrate intake, or
cardiac surgery variables, was the only variable (coefficient: 1.14 +/-
0.3; p < 0.001) associated with cumulative insulin dose on multivariate
analysis.
CONCLUSIONS: When tight glycemic control is targeted in children who have
undergone cardiac surgery, children in the older child age group (5-16 yr)
require insulin at significantly higher doses. Further study is needed to
understand the mechanisms involved.

<2>
Accession Number
26395750
Author
Patel N.; Minhas J.S.; Chung E.M.
Institution
(Patel) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Patel) Leicester Cardiovascular Biomedical Research Unit, Glenfield
Hospital, Leicester, United Kingdom
(Minhas) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Minhas) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Chung) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Chung) Leicester Cardiovascular Biomedical Research Unit, Glenfield
Hospital, Leicester, United Kingdom
(Chung) Department of Medical Physics, University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Title
The Presence of New MRI Lesions and Cognitive Decline After Cardiac
Surgery: A Systematic Review.
Source
Journal of cardiac surgery. 30 (11) (pp 808-812), 2015. Date of
Publication: 01 Nov 2015.
Abstract
Patients are commonly reported to experience postoperative cognitive
decline (POCD) and new ischemic lesions following surgery, which many
researchers have hypothesised to result from emboli entering the cerebral
circulation during surgery. Modern magnetic resonance imaging techniques
have enabled clear and accurate identification of ischemic lesions.
However, difficulties in assessing subtle changes in cognitive impairment
clinically remain. The purpose of this systematic review is to discuss the
literature that has investigated cognitive outcome in relation to new
ischaemic brain lesions after cardiac surgery.

<3>
Accession Number
26507904
Author
Hollander J.E.; Gatsonis C.; Greco E.M.; Snyder B.S.; Chang A.M.; Miller
C.D.; Singh H.; Litt H.I.
Institution
(Hollander) Department of Emergency Medicine, Sidney Kimmel Medical
College of Thomas Jefferson University, Philadelphia, PA. Electronic
address: judd.hollander@jefferson.edu
(Gatsonis) Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI; Department of Biostatistics, Brown
University School of Public Health, Providence, RI
(Greco) Center for Statistical Sciences, Brown University School of Public
Health, Providence, RI
(Snyder) Center for Statistical Sciences, Brown University School of
Public Health, Providence, RI
(Chang) Department of Emergency Medicine, Sidney Kimmel Medical College of
Thomas Jefferson University, Philadelphia, PA
(Miller) Department of Emergency Medicine, Wake Forest School of Medicine,
Winston-Salem, NC
(Singh) Department of Radiology, Penn State Hershey Medical Center,
Hershey, PA
(Litt) Department of Radiology, Perelman School of Medicine of the
University of Pennsylvania, Philadelphia, PA
Title
Coronary Computed Tomography Angiography Versus Traditional Care:
Comparison of One-Year Outcomes and Resource Use.
Source
Annals of emergency medicine. 67 (4) (pp 460-468), 2016. Date of
Publication: 01 Apr 2016.
Abstract
STUDY OBJECTIVE: Three large, multicenter, randomized, clinical trials
have shown that coronary computed tomography (CT) angiography allows
efficient evaluation and safe discharge of patients with low- to
intermediate-risk chest pain who present to the emergency department (ED).
We report 1-year event rates and resource use from the American College of
Radiology Imaging Network-Pennsylvania 4005 multicenter trial.
METHODS: Patients with low- to intermediate-risk chest pain and presenting
to the ED were randomized in a 2:1 ratio to a coronary CT angiography care
pathway or traditional care. Subjects were contacted by telephone at least
1 year after ED presentation. Medical record review was performed for all
cardiac hospitalizations, procedures and diagnostic tests, and adverse
cardiac events. Our main outcome was the composite of cardiac death and
myocardial infarction within 1 year. The secondary outcome was resource
use.
RESULTS: One thousand three hundred sixty-eight patients enrolled and
1,285 (94%) had direct participant or proxy contact at 1 year. All others
had record review or death index search. From index presentation through 1
year, there was no difference between patients in the coronary CT
angiography arm versus traditional care with respect to major adverse
cardiac event (1.4% versus 1.1%; difference 0.3%; 95% CI -5.5% to 6.0%).
From hospital discharge through 1 year, there was also no difference in ED
revisits (36% versus 38%; difference -2.1%; 95% CI -7.9% to 3.7%),
hospital admissions (16% versus 17%; difference -0.9%; 95% CI -6.7% to
4.9%), or subsequent cardiac testing (13% versus 13%; difference -0.4%;
95% CI -6.2% to 5.5%). One of 640 subjects with a negative coronary CT
angiography result had a major adverse cardiac event within 1 year of
presentation (0.16%; 95% CI 0.004% to 0.87%).
CONCLUSION: A coronary CT angiography-based strategy for evaluation of
patients with low- to intermediate-risk chest pain who present to the ED
does not result in increased resource use during 1 year. A negative
coronary CT angiography result is associated with a less than 1% major
adverse cardiac event rate during the first year after testing.

<4>
Accession Number
26875901
Author
Xiao L.-B.; Zhang Y.-H.; Zhou J.-W.; Yang M.; Ling Y.-P.; Gao Z.-S.; Wang
Y.-S.
Institution
(Xiao, Zhang, Zhou, Yang, Ling, Gao, Wang) Cardio-Thoracic Surgery
Department, Cangzhou Center Hospital, Cangzhou, China. drzhoujiwu@163.com
Title
The clinical research of off-pump coronary artery bypass grafting by small
incision at the left chest.
Source
European review for medical and pharmacological sciences. 20 (2) (pp
305-310), 2016. Date of Publication: 2016.
Abstract
OBJECTIVE: To explore the clinical value of off-pump coronary artery
bypass grafting by small incision at the left chest, and develop a better
surgical regimen for coronary heart disease patients.
PATIENTS AND METHODS: 201 coronary heart disease patients who need
coronary artery bypass grafting were required and randomly divided into 2
groups including a control group and an observation group. There were 107
cases in the control group who received coronary bypass grafting by
extracorporeal circulation; there were 103 cases in the observation group
who received off-pump coronary bypass grafting by small incision at the
left chest. The duration of the mechanism ventilation, length of stay in
ICU, hospitalization time, postoperative drainage volume, and the
occurrence rate of complications were recorded and compared.
RESULTS: The duration of mechanism ventilation, length of stay in ICU,
hospitalization time and postoperative drainage volume in the control
group were (19.21 +/- 1.33) hours, (5.08 +/- 0.57) days, (21.20 +/- 2.34)
days and (997.68 +/- 96.35) mL, which were (7.73 +/- 0.74) hours, (2.83
+/- 0.16) days, (15.67 +/- 1.18) days and (901.53 +/- 89.32) mL in the
observation group respectively, with statistical difference between the
two groups (p<0.05). The occurrence rates of renal insufficiency and
arrhythmia were both 6.54% and 0.97% in the control group and the
observation group, respectively. The occurrence rates of postoperative
renal insufficiency and arrhythmia in the observation group were both
significantly lower than those in the control group, with statistical
significance analysis (p < 0.05). Postoperative low cardiac output, second
thoracotomy, cerebrovascular disease, pulmonary infection, perioperative
cardiac infarction and mortality did not display a significant difference
between the two groups (p > 0.05).
CONCLUSIONS: Off-pump coronary artery bypass grafting by small incision at
the left chest is a surgical method with less injury and fast recovery,
which can be used as the preferred therapeutical method for the coronary
heart disease patients who need coronary artery bypass grafting.

<5>
Accession Number
20160599145
Author
Visconti G.; Focaccio A.; Donahue M.; Golia B.; Marzano A.; Donnarumma E.;
Ricciardelli B.; Selvetella L.; Marino L.; Briguori C.
Institution
(Visconti, Focaccio, Donahue, Golia, Marzano, Ricciardelli, Briguori)
Laboratory of Interventional Cardiology, Department of Cardiology, Clinica
Mediterranea, Naples, Italy
(Donnarumma) IRCCS SDN, Naples, Italy
(Selvetella) Department of Vascular Surgery, Clinica Mediterranea, Naples,
Italy
(Marino) Department of Cardiac Surgery, Clinica Mediterranea, Naples,
Italy
Title
RenalGuard System for the prevention of acute kidney injury in patients
undergoing transcatheter aortic valve implantation.
Source
EuroIntervention. 11 (14) (pp e1658-e1661), 2016. Date of Publication:
April 2016.
Publisher
EuroPCR
Abstract
Aims: We aimed to assess whether the RenalGuardTM System is effective in
preventing acute kidney injury (AKI) following transcatheter aortic valve
implantation (TAVI). Methods and results: Forty-eight consecutive patients
with chronic kidney disease (CKD) scheduled for TAVI were assigned to: 1)
hydration with sodium bicarbonate solution (Control group), or 2)
hydration with RenalGuard Therapy (RenalGuard group). Hypotension was
defined as periprocedural mean blood pressure <55 mmHg. The primary
endpoint was the occurrence of AKI (i.e., an increase of >0.3 mg/dL in the
serum creatinine concentration at seven days). AKI occurred in 10/26
(38.5%) patients in the Control group and in 1/22 (4.5%) patients in the
RenalGuard group (p=0.005, odds ratio [OR] 0.076, 95% confidence interval
[CI]: 0.009-0.66). RenalGuard Therapy protected against AKI (OR 0.71, 95%
CI: 0.07-0.775, p=0.026), whereas post-procedural hypotension (OR 3.88,
95% CI: 1.06-14.24, p=0.040), and contrast media volume (OR 3.65, 95% CI:
1.15-5.75, p=0.043) increased the risk of AKI. Conclusions: This
non-randomised pilot study suggests that RenalGuard Therapy may be
effective in preventing AKI in CKD patients undergoing TAVI.

<6>
Accession Number
20160601691
Author
Dieberg G.; Smart N.A.; King N.
Institution
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
Title
On- vs. off-pump coronary artery bypass grafting: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 223 (pp 201-211), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background To reduce complications during coronary artery bypass grafting
(CABG) off-pump CABG was introduced; however, results have been mixed. The
aim of this work was to conduct a systematic review and meta-analysis of
off-pump vs. on-pump CABG. Methods To identify potential studies
systematic searches were carried out using various databases. The search
strategy included the key concepts of "cardiopulmonary bypass" AND
"coronary artery bypass grafting" AND "off pump". This was followed by a
meta-analysis investigating post-operative atrial fibrillation, myocardial
infarction, < 30 day mortality, stroke, ventilation time, intensive care
unit (ICU) stay and hospital stay. Results Fifty four studies (59
intervention groups), totalling 16,261 participants were analysed. Off
pump CABG led to a significantly lower incidence of post-operative atrial
fibrillation odds ratio (OR) 0.87 (95% confidence interval [CI] 0.78 to
0.97, p = 0.01), but no differences in either myocardial infarction OR
0.98 (95% CI 0.82 to 1.15, p = 0.77) or < 30 day mortality OR 0.85 (95% CI
0.68 to 1.06, p = 0.16). There was a strong trend towards a reduced
incidence of stroke OR 0.77 (95% CI 0.59 to 1.00, p = 0.05); however this
did not quite reach significance. Ventilation time mean difference (MD) -
3.78 h (95% CI - 4.75 to - 2.82, p < 0.00001); ICU stay MD - 0.34 days
(95% CI - 0.50 to - 0.17, p < 0.0001); and hospital stay MD - 0.9 days
(95% CI - 1.25 to - 0.56, p < 0.00001) were all significantly shorter in
the off-pump group. Conclusions Off-pump CABG has some benefits over
on-pump CABG, particularly in relation to post-operative atrial
fibrillation.

<7>
Accession Number
20160575549
Author
Meesters M.I.; Veerhoek D.; De Lange F.; De Vries J.-W.; De Jong J.R.;
Romijn J.W.A.; Kelchtermans H.; Huskens D.; Van Der Steeg R.; Thomas
P.W.A.; Burtman D.T.M.; Van Barneveld L.J.M.; Vonk A.B.A.; Boer C.
Institution
(Meesters, De Jong, Romijn, Van Der Steeg, Thomas, Burtman, Boer)
Department of Anaesthesiology, VU University Medical Centre, Amsterdam,
Netherlands
(Veerhoek, Van Barneveld, Vonk) Cardio-thoracic Surgery, VU University
Medical Centre, Amsterdam, Netherlands
(De Lange, De Vries) Department of Anaesthesiology, Department of Cardiac
Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
(Kelchtermans, Huskens) Synapse B. V., Maastricht, Netherlands
Title
Effect of high or low protamine dosing on postoperative bleeding following
heparin anticoagulation in cardiac surgery a randomised clinical trial.
Source
Thrombosis and Haemostasis. 116 (2) (pp 251-261), 2016. Date of
Publication: August 2016.
Publisher
Schattauer GmbH
Abstract
While experimental data state that protamine exerts intrinsic
anticoagulation effects, protamine is still frequently overdosed for
heparin neutralisation during cardiac surgery with cardiopulmonary bypass
(CPB). Since comparative studies are lacking, we assessed the influence of
two protamine-to-heparin dosing ratios on perioperative haemostasis and
bleeding, and hypothesised that protamine overdosing impairs the
coagulation status following cardiac surgery. In this open-label,
multicentre, single-blinded, randomised controlled trial, patients
undergoing on-pump coronary artery bypass graft surgery were assigned to a
low (0.8; n=49) or high (1.3; n=47) protamine-to-heparin dosing group. The
primary outcome was 24-hour blood loss. Patient haemostasis was monitored
using rotational thromboelasto-metry and a thrombin generation assay. The
low protamine-to-heparin dosing ratio group received less protamine (329
+/- 95 vs 539 +/- 117 mg; p<0.001), while post-protamine activated
clotting times were similar among groups. The high dosing group revealed
increased intrinsic clotting times (236 +/- 74 vs 196 +/- 64 s; p=0.006)
and the maximum post-protamine thrombin generation was less suppressed in
the low dosing group (38 +/- 40% vs 6 +/- 9%; p=0.001). Postoperative
blood loss was increased in the high dosing ratio group (615 ml; 95%> CI
500-830 ml vs 470 ml; 95%> CI 420-530 ml; p=0.021) when compared to the
low dosing group, respectively. More patients in the high dosing group
received fresh frozen plasma (11%> vs 0%>; p=0.02) and platelet
concentrate (21%> vs 6%>; p=0.04) compared to the low dosing group. Our
study confirms in vitro data that abundant protamine dosing is associated
with increased postoperative blood loss and higher transfusion rates in
cardiac surgery.

<8>
Accession Number
20160591066
Author
Kowalewski M.; Suwalski P.; Pawliszak W.; Benetti F.; Raffa G.M.; Malvindi
P.G.; Carrel T.; Paparella D.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz,
Poland
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, United
States
(Benetti) Division of Cardiothoracic Surgery, University of Pittsburgh,
Pittsburgh, PA, United States
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Switzerland
(Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
Title
Risk of stroke with "no-touch" - As compared to conventional off-pump
coronary artery bypass grafting. An updated meta-analysis of observational
studies.
Source
International Journal of Cardiology. 222 (pp 769-771), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd

<9>
Accession Number
20160582183
Author
Zhao N.; Xu J.; Singh B.; Yu X.; Wu T.; Huang Y.
Institution
(Zhao) Beijing Obstetrics and Gynecology Hospital, Capital Medical
University, Department of Anesthesiology, Beijing, China
(Zhao, Yu, Huang) Peking Union Medical College Hospital, Chinese Academy
of Medical Sciences and Peking Union Medical College, Department of
Anesthesiology, Beijing 100730, China
(Xu) Peking Union Medical College Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Emergency Department, No.1,
Shuaifuyuan, Dongcheng District, Beijing 100730, China
(Singh) University of North Dakota School of Medicine and Health Sciences,
1919 Elm Street N, Fargo, ND 58103, United States
(Wu) West China Hospital, Sichuan University, Chinese Clinical Trial
Registry, Chinese Ethics Committee of Registering Clinical Trials, No. 37,
Guo Xue Xiang, Chengdu, Sichuan 610041, China
Title
Nitrates for the prevention of cardiac morbidity and mortality in patients
undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD010726. Date of Publication: 04 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Cardiac complications are not uncommon in patients undergoing
non-cardiac surgery, especially in patients with coronary artery disease
(CAD) or at high risk of CAD. Perioperative cardiac complications can lead
to mortality and morbidity, as well as higher costs for patient care.
Nitrates, which are among the most commonly used cardiovascular drugs,
perform the function of decreasing cardiac preload while improving cardiac
blood perfusion. Sometimes, nitrates are administered to patients
undergoing non-cardiac surgery to reduce the incidence of cardiac
complications, especially for patients with CAD. However, their effects on
patients' relevant outcomes remain controversial. Objectives: * To assess
effects of nitrates as compared with other interventions or placebo in
reducing cardiac risk (such as death caused by cardiac factors, angina
pectoris, acute myocardial infarction, acute heart failure and cardiac
arrhythmia) in patients undergoing non-cardiac surgery. * To identify the
influence of different routes and dosages of nitrates on patient outcomes.
Search methods: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, EMBASE and the Chinese BioMedical Database
until June 2014. We also searched relevant conference abstracts of
important anaesthesiology or cardiology scientific meetings, the database
of ongoing trials and Google Scholar. We reran the search in January 2016.
We added three potential new studies of interest to the list of "Studies
awaiting classification' and will incorporate them into our formal review
findings for the review update. Selection criteria: We included randomized
controlled trials (RCTs) comparing nitrates versus no treatment, placebo
or other pharmacological interventions in participants (15 years of age
and older) undergoing non-cardiac surgery under any type of anaesthesia.
Data collection and analysis: We used standard methodological procedures
as expected by Cochrane. Two review authors selected trials, extracted
data from included studies and assessed risk of bias. We resolved
differences by discussion and, when necessary, sought help and suggestions
from a third review author. We used a random-effects model for data
analysis. Main results: We included 27 randomized controlled trials (RCTs)
(8244 participants analysed). Investigators reported 12 different
comparisons of three different nitrates (nitroglycerin, isosorbide
dinitrate and nicorandil) versus no treatment, placebo or other
pharmacological interventions. All participants were older than 15 years
of age. More than half of the trials used general anaesthesia. Surgical
procedures in most trials were at low to moderate risk for perioperative
cardiac complications. Only two comparisons including three studies
reported the primary outcome - all-cause mortality up to 30 days post
operation. Researchers reported other morbidity outcomes and adverse
events in a variable and heterogeneous way, resulting in limited available
data for inclusion in the meta-analysis. We determined that the overall
methodological quality of included studies was fair to low, in accordance
with risk of bias in most domains. In summary, we found no difference in
the primary outcome - all-cause mortality up to 30 days post operation -
when nitroglycerin was compared with no treatment (one study, 60
participants, 0/30 vs 1/30; (risk ratio (RR) 0.33, 95% confidence interval
(CI) 0.01 to 7.87, very low-quality evidence based on GRADE criteria) or
with placebo (two studies, 89 participants, 1/45 vs 0/44; RR 2.81, 95% CI
0.12 to 63.83, very low-quality evidence). Regarding our secondary
outcomes, we noted no statistically significant differences in angina
pectoris, acute myocardial infarction, acute heart failure, cardiac
arrhythmia or cardiac arrest in any comparisons. In comparisons versus
nitroglycerin, although more events of cardiac ischaemia were observed in
participants receiving no treatment or placebo, we found no statistically
significant differences in any comparisons, except the comparison of
nicorandil versus placebo. One study revealed a potential dose-dependent
protective effect of nicorandil for cardiac ischaemia. Adverse events were
reported in a heterogeneous way among the comparisons. In general, more
participants treated with nitrates had hypotension, tachycardia and
headache, but investigators reported no statistically significant
differences between groups in any comparisons. Authors' conclusions: This
systematic review suggests that nitroglycerin or isosorbide dinitrate is
not associated with improvement in mortality and cardiac complications
among patients undergoing non-cardiac surgery. Limited evidence suggests
that nicorandil may reduce the risk of cardiac ischaemia in participants
undergoing non-cardiac surgery. Additional studies are needed to
consolidate the evidence. However, the data included in many of the
analyses in this review are sparse - that is, adequate data are few -
resulting in very low power to detect differences between nitrates and
comparators. Thus, a more objective conclusion would state that available
evidence is insufficient to show whether nitrates are associated with
improvement in mortality and cardiac complications among patients
undergoing non-cardiac surgery. Over the past decade, no high-quality
studies have focused on association of cardiac mortality and morbidity
with use of nitrates during non-cardiac surgery. This review underlines
the need for well-designed trials in this field.

<10>
Accession Number
20160599159
Author
Wang L.; Bi Y.; Cao M.; Ma R.; Wu X.; Ding W.; Liu Y.; Yu Q.; Zhang Y.;
Jiang H.; Sun Y.; Tong D.; Guo L.; Dong Z.; Tian Y.; Kou J.; Shi J.
Institution
(Wang, Bi, Yu, Dong, Tian) Department of Cardiology, Harbin Medical
University, Harbin, China
(Cao, Ma, Wu, Zhang, Liu, Tong, Guo, Shi) Department of Hematology, The
First Hospital, Harbin Medical University, Harbin, China
(Ding, Zhang, Jiang, Kou) Department of Cardiology, The Second Hospital,
Harbin Medical University, Harbin, China
(Sun) Department of Nephropathy, The First Hospital, Harbin Medical
University, Harbin, China
(Shi) Cardiothoracic Surgery Division, Brigham and Women's Hospital, VA
Boston Healthcare System, Harvard Medical School, Boston, MA, United
States
Title
Microparticles and blood cells induce procoagulant activity via
phosphatidylserine exposure in NSTEMI patients following stent
implantation.
Source
International Journal of Cardiology. 223 (pp 121-128), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Relatively little is known about the role of phosphatidylserine
(PS) in procoagulant activity (PCA) in patients with non-ST-elevated
myocardial infarction (NSTEMI) after stent implantation. This study was
designed to evaluate whether exposed PS on microparticles (MPs) and blood
cells were involved in the hypercoagulable state in NSTEMI patients with
stent implantation. Methods NSTEMI patients (n= 90) and healthy controls
(n = 20) were included in our study. PS exposure on MPs and blood cells
was analyzed with flow cytometer and confocal microscope. PCA was
evaluated by clotting time, purified coagulation complex assays and fibrin
production assays. Results Baseline levels of MPs and PS⁺ blood
cells were significantly higher (P < 0.001) in the patients than in
controls. After stent implantation, a remarkable increase was observed in
both MPs and PS⁺ blood cells. Specifically, PS⁺ MPs,
PS⁺ platelets and erythrocytes peaked at 18 h following stent
implantation, while PS⁺ leukocytes peaked on day 2. In
addition, circulating MPs (mostly derived from platelets, leukocytes,
erythrocytes and endothelial cells) cooperating with PS⁺ blood
cells, contributed to markedly shortened coagulation time and markedly
increased FXa/thrombin/fibrin (all P < 0.01) generation in patient group.
Moreover, blockade of exposed PS on MPs and cells with lactadherin
inhibited PCA by approximately 70%. Conclusions Our results suggest that
PS⁺ MPs and blood cells play a procoagulant role in NSTEMI
patients following stent implantation. Blockade of PS prior to stenting
could become a novel therapeutic modality for the prevention of thrombosis
in these patients.

<11>
Accession Number
20160591075
Author
Haussig S.; Mangner N.; Dwyer M.G.; Lehmkuhl L.; Lucke C.; Woitek F.;
Holzhey D.M.; Mohr F.W.; Gutberlet M.; Zivadinov R.; Schuler G.; Linke A.
Institution
(Haussig, Mangner, Lehmkuhl, Lucke, Woitek, Holzhey, Mohr, Gutberlet,
Schuler, Linke) University of Leipzig, Heart Center, Department of
Internal Medicine/Cardiology, Struempellstrasse 39, Leipzig 04289, Germany
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, Department of
Neurology, University of Buffalo, Buffalo, NY, United States
(Mohr, Linke) Leipzig Heart Institute, Leipzig, Germany
Title
Effect of a cerebral protection device on brain lesions following
transcatheter aortic valve implantation in patients with severe aortic
stenosis: The CLEAN-TAVI randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 316 (6) (pp 592-601),
2016. Date of Publication: 09 Aug 2016.
Publisher
American Medical Association
Abstract
IMPORTANCE: Stroke remains a major predictor of mortality after
transcatheter aortic valve implantation (TAVI). Cerebral protection
devices might reduce brain injury as determined by diffusion-weighted
magnetic resonance imaging (DWMRI). OBJECTIVE: To determine the effect of
a cerebral protection device on the number and volume of cerebral lesions
in patients undergoing TAVI. DESIGN, SETTING, AND PARTICIPANTS:
Investigator-initiated, single center, blinded, randomized clinical trial
in higher-risk patients with severe aortic stenosis undergoing TAVI at the
University of Leipzig Heart Center. Brain MRI was performed at baseline, 2
days, and 7 days after TAVI. Between April 2013 and June 2014, patients
were randomly assigned to undergo TAVI with a cerebral protection device
(filter group) or without a cerebral protection device (control group).
The last 1-month follow-up occurred in July 2014. INTERVENTIONS: TAVI with
or without a cerebral protection device (filter system). MAIN OUTCOMES AND
MEASURES: The primary end pointwas the numerical difference in new
positive postprocedure DWMRI brain lesions at 2 days after TAVI in
potentially protected territories. The first hierarchical secondary
outcome was the difference in volume of new lesions after TAVI in
potentially protected territories. RESULTS: Among the 100 enrolled
patients, mean (SD) age was 80.0 (5.1) years in the filter group (n = 50)
and 79.1 (4.1) years in the control group (n = 50), and the mean (SD)
procedural risk scores (logistic EuroScores) were 16.4%(10.0%) in the
filter group and 14.5% (8.7%) in the control group. For the primary end
point, the number of new lesions was lower in the filter group, 4.00
(interquartile range [IQR], 3.00-7.25) vs 10.00 (IQR, 6.75-17.00) in the
control group (difference, 5.00 [IQR, 2.00-8.00]; P <.001). For the first
hierarchical secondary end point, new lesion volume after TAVI was lower
in the filter group (242mm³ [95%CI, 159-353]) vs in the control
group (527mm³ [95%CI, 364-830]) (difference, 234mm³
[95%CI, 91-406]; P =.001). Considering adverse events, 1 patient in the
control group died prior to the 30-day visit. Life-threatening hemorrhages
occurred in 1 patient in the filter group and 1 in the control group.
Major vascular complications occurred in 5 patients in the filter group
and 6 patients in the control group. One patient in the filter group and 5
in the control group had acute kidney injury, and 3 patients in the filter
group had a thoracotomy. CONCLUSIONS AND RELEVANCE: Among patients with
severe aortic stenosis undergoing TAVI, the use of a cerebral protection
device reduced the frequency of ischemic cerebral lesions in potentially
protected regions. Larger studies are needed to assess the effect of
cerebral protection device use on neurological and cognitive function
after TAVI and to devise methods that will provide more complete coverage
of the brain to prevent new lesions.

<12>
Accession Number
20160591050
Author
Rogers L.; Cochrane E.; Blundell D.; Zakkar M.
Institution
(Rogers, Zakkar) Department of Cardiothoracic Surgery, Bristol Heart
Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Cochrane, Blundell) Department of Cardiac Surgery, Leeds General
Infirmary, Leeds, United Kingdom
Title
What is the optimum method of weaning intra-aortic balloon pumps?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (2) (pp 310-313),
2016. Date of Publication: 01 Aug 2016.
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: is weaning an
intra-aortic balloon pump by volume superior to ratio reduction in terms
of failure of weaning, inotropic support and haemodynamic parameters? A
total of 667 papers were identified as a result of the search described
below. Six papers were relevant to the question asked. The author, date
and country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses of the papers are tabulated. Little
published evidence exists, although weaning by ratio is more common
particularly in high-volume centres. The published data highlight the
heterogeneity of weaning protocols not only between countries but also
between hospitals in the same country. Current evidence is unable to
establish any difference in clinical outcomes including mortality,
reinsertion of intra-aortic balloon pumps and requirement for inotropic
support between weaning by ratio, volume weaning and abrupt cessation.
Despite this, the only randomized trial demonstrates improved haemodynamic
profiles in those weaned by volume weaning. In addition, given the
difficulty in obtaining clear clinical outcomes, N-terminal pro-brain
natriuretic peptide and central venous oxygen saturation may be useful as
surrogate markers for successful weaning.

<13>
Accession Number
20160589550
Author
Vasques F.; Kinnunen E.-M.; Pol M.; Mariscalco G.; Onorati F.; Biancari F.
Institution
(Vasques) Department of Medicine, Anesthesia and Intensive Care Unit,
Padua University Hospital, Padua, Italy
(Kinnunen, Biancari) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Pol) Institute of Anatomy, First Faculty of Medicine, Charles University
in Prague, Prague, Czech Republic
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Glenfield Hospital, Leicester, United Kingdom
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
Title
Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic
review and meta-analysis of comparative studies.
Source
Transfusion. 56 (8) (pp 2146-2153), 2016. Date of Publication: 01 Aug
2016.
Publisher
Blackwell Publishing Inc.
Abstract
BACKGROUND: The objective was to evaluate the early outcome after adult
cardiac surgery in Jehovah's Witnesses (JWs) compared with controls not
refusing blood transfusions. STUDY DESIGN AND METHODS: A literature review
was performed through PubMed, Scopus, and Google Scholar to identify any
comparative study evaluating the outcome of JWs and patients not refusing
blood transfusion after adult cardiac surgery. RESULTS: Six studies
comparing the outcome of 564 JWs and 903 controls fulfilled the inclusion
criteria of this study. All series included a matched control cohort.
Baseline characteristics of these two cohorts were similar, but JWs had
higher hemoglobin (Hb) levels as reported in three studies. Pooled
analysis of postoperative outcomes showed that JWs had higher
postoperative levels of Hb (data from four studies: mean, 11.5 g/L vs. 9.8
g/L; p < 0.001) and significantly less postoperative blood loss (mean, 402
mL vs. 826 mL; p < 0.001) compared to controls. JWs and controls had
similar early outcome. However, JWs had a nonsignificant trend toward
decreased early mortality (2.6% vs. 3.6%; p = 0.318), reoperation for
bleeding (3.2% vs. 4.7%; p = 0.070), atrial fibrillation (9.9% vs. 14.3%;
p = 0.056), stroke (2.2% vs. 3.1%; p = 0.439), myocardial infarction (0.4%
vs. 1.4%; p = 0.203), and length of stay in the intensive care unit (1.5
days vs. 2.0 days; p = 0.081). CONCLUSION: JWs undergoing adult cardiac
surgery have a nonsignificant trend toward better early outcome than
controls receiving or not blood transfusions. The suboptimal quality of
available studies prevents conclusive results on the possible benefits of
a transfusion-free strategy in patients not refusing blood transfusion.

<14>
Accession Number
20160572366
Author
Naito R.; Miyauchi K.; Daida H.; Morimoto T.; Hiro T.; Kimura T.; Nakagawa
Y.; Yamagishi M.; Ozaki Y.; Matsuzaki M.
Institution
(Naito, Miyauchi, Daida) Department of Cardiovascular Medicine, Juntendo
University School of Medicine, Tokyo, Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Hyogo, Japan
(Hiro) Division of Cardiology, Department of Medicine, Nihon University
School of Medicine, Tokyo, Japan
(Kimura) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Nakagawa) Department of Cardiology, Tenri Hospital, Nara, Japan
(Yamagishi) Division of Cardiovascular Medicine, Kanazawa University
Graduate School of Medicine, Kanazawa, Japan
(Ozaki) Division of Cardiology, Fujita Health University, Toyoake, Japan
(Matsuzaki) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
Title
Impact of total risk management on coronary plaque regression in diabetic
patients with acute coronary syndrome.
Source
Journal of Atherosclerosis and Thrombosis. 23 (8) (pp 922-931), 2016. Date
of Publication: 2016.
Publisher
Japan Atherosclerosis Society
Abstract
Aim: Diabetic patients with coronary artery disease have a high incidence
of cardiovascular events, which was associated with increased coronary
plaque volume. Low-density lipoprotein cholesterol (LDL-C) and blood
pressure (BP) play pivotal roles in the progression of coronary plaque.
Several trials have shown that intervention for a single risk factor
reduced the development of coronary plaque progression. However, it
remained uncertain whether total risk management for LDL-C, BP, and
glycosylated Hb (HbA1c) has a beneficial effect on coronary plaque volume
in diabetic patients. Methods: This study was a sub-study of the JAPAN-ACS
that was a prospective, randomized, openlabel trial that evaluated the
impact of intensive lipid-lowering therapy on coronary plaque volume in
patients with acute coronary syndrome (ACS). Among a total of 252
patients, 73 diabetic patients were analyzed. We examined the impact of
total risk management (LDL-C <80 mg/dL, systolic BP <130 mmHg, and HbA1c
<6.5%) on changes in coronary plaque volume. The patients were divided
into four groups according to the number of risk factors that achieved the
target value. Results: Baseline characteristics were similar among the
groups. The degree of coronary plaque regression was greater in patients
who achieved total risk management. The number of risk factors that
achieved the target level was associated with the extent of the coronary
plaque volume reduction in a dose-dependent manner. Conclusion: Total risk
management that focused on LDL-C, BP, and HbA1c had a beneficial impact on
the coronary plaque regression in diabetic patients with ACS.

<15>
Accession Number
20160584796
Author
Cheng J.; Gao J.; Shuai X.; Wang G.; Tao K.
Institution
(Cheng, Gao, Shuai, Wang, Tao) Department of Gastrointestinal Surgery,
Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, Hubei, China
Title
The comprehensive summary of surgical versus non-surgical treatment for
obesity: A systematic review and meta-analysis of randomized controlled
trials.
Source
Oncotarget. 7 (26) (pp 39216-39230), 2016. Date of Publication: 2016.
Publisher
Impact Journals LLC
Abstract
Background: Bariatric surgery has emerged as a competitive strategy for
obese patients. However, its comparative efficacy against non-surgical
treatments remains ill-defined, especially among nonseverely obese crowds.
Therefore, we implemented a systematic review and meta-analysis in order
for an academic addition to current literatures. Methods: Literatures were
retrieved from databases of PubMed, Web of Science, EMBASE and Cochrane
Library. Randomized trials comparing surgical with nonsurgical therapies
for obesity were included. A Revised Jadad's Scale and Risk of Bias
Summary were employed for methodological assessment. Subgroups analysis,
sensitivity analysis and publication bias assessment were respectively
performed in order to find out the source of heterogeneity, detect the
outcome stability and potential publication bias. Results: 25 randomized
trials were eligibly included, totally comprising of 1194 participants.
Both groups displayed well comparability concerning baseline parameters (P
> 0.05). The pooled results of primary endpoints (weight loss and diabetic
remission) revealed a significant advantage among surgical patients rather
than those receiving non-surgical treatments (P < 0.05). Furthermore,
except for certain cardiovascular indicators, bariatric surgery was
superior to conventional arms in terms of metabolic secondary parameters
(P < 0.05). Additionally, the pooled outcomes were confirmed to be stable
by sensitivity analysis. Although Egger's test (P < 0.01) and Begg's test
(P<0.05) had reported the presence of publication bias among included
studies, "Trim-and-Fill" method verified that the pooled outcomes remained
stable. Conclusion: Bariatric surgery is a better therapeutic option for
weight loss, irrespective of follow-up duration, surgical techniques and
obesity levels.

<16>
Accession Number
20160473061
Author
Prokopchuk-Gauk O.; Rosin M.W.; Mycyk T.R.; Lim H.J.; Brose K.
Institution
(Prokopchuk-Gauk) Department of Pathology and Laboratory Medicine,
University of Saskatchewan, Saskatoon, SK, Canada
(Rosin) Clinical Perfusion, Royal University Hospital, Saskatoon, SK,
Canada
(Mycyk) Division of Cardiac Surgery, Department of Surgery, University of
Saskatchewan, Saskatoon, SK, Canada
(Lim) Department of Community Health and Epidemiology, University of
Saskatchewan, Saskatoon, SK, Canada
(Brose) Division of Hematology, Department of Medicine, University of
Saskatchewan, Saskatoon, SK, Canada
(Prokopchuk-Gauk, Mycyk, Brose) Royal University Hospital, Saskatoon, SK,
Canada
Title
Dual-route tranexamic acid to reduce blood loss in coronary artery bypass
graft surgery: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. 63 (9) (pp 1110-1111), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Springer New York LLC

<17>
Accession Number
20160463694
Author
Garcia Gigorro R.; Renes Carreno E.; Mayordomo S.; Marin H.; Perez Vela
J.L.; Corres Peiretti M.A.; Montejo Gonzalez J.C.
Institution
(Garcia Gigorro, Renes Carreno, Perez Vela, Corres Peiretti) Intensive
Care Medicine Department, Cardiac Intensive Care Unit Division, Madrid,
Spain
(Mayordomo) Cardiology Department, Hospital Universitario 12 de Octubre,
Madrid, Spain
(Marin, Montejo Gonzalez) Intensive Care Medicine Department, Hospital
Universitario 12 de Octubre, Madrid, Spain
Title
Evaluation of right ventricular function after cardiac surgery: The
importance of tricuspid annular plane systolic excursion and right
ventricular ejection fraction.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (2) (pp 613-620),
2016. Date of Publication: 01 Aug 2016.
Publisher
Mosby Inc.
Abstract
Objective The evaluation of right ventricular systolic function is
essential to the hemodynamic management of critically ill cardiac
patients. Nevertheless, assessment of right ventricular function remains
problematic. We sought to analyze the correlation between tricuspid
annular plane systolic excursion (TAPSE) and right ventricular ejection
fraction (RVEF) in the assessment of global and regional right ventricular
function, respectively. Methods This was a prospective study of 61 cardiac
surgical patients. TAPSE was measured with transthoracic echocardiography
and RVEF was obtained by a thermodilution pulmonary artery catheter. Both
measurements were estimated simultaneously during the early postoperative
period. Patients with previously identified severe tricuspid insufficiency
were excluded from the study to avoid confounding results. Results The
etiologies for cardiac surgery were surgical pulmonary
thromboendarterectomy in 19 patients, valve replacement in 17 patients,
heart transplant in 13 patients, and coronary artery bypass graft in 9
patients. Mean RVEF and TAPSE were 26.2% +/- 9.7% and 11.4 +/- 4 mm,
respectively. RVEF and TAPSE showed a significant correlation (r = 0.73, P
< .001). Weak reverse relationships between TAPSE or RVEF with afterload
hemodynamic parameters, mean pulmonary artery pressure, or pulmonary
vascular resistance were elucidated. Conclusions TAPSE is a robust measure
of right ventricular function that correlates with RVEF assessed by
pulmonary artery catheter. A noninvasive method such as echocardiography
can guide and support invasive monitoring of right ventricular function in
cardiac surgical patients.

<18>
Accession Number
2015378175
Author
Roth C.; Berger R.; Scherzer S.; Krenn L.; Gangl C.; Dalos D.; Delle-Karth
G.; Neunteufl T.
Institution
(Roth, Berger, Scherzer, Krenn, Gangl, Dalos, Delle-Karth, Neunteufl)
Department of Internal Medicine II, Cardiology, Medical University of
Vienna, Vienna, Austria
(Berger) Department of Internal Medicine I, Cardiology and Nephrology,
Hospital of St. John of God, Eisenstadt, Austria
(Delle-Karth) Department of Internal Medicine IV, Cardiology, Hospital of
Hietzing, Vienna, Austria
(Neunteufl) Department of Internal Medicine I, Cardiology, University
Hospital of Krems, Krems an der Donau, Austria
(Neunteufl) Karl Landsteiner Private University for Health Sciences, Krems
an der Donau, Austria
Title
Comparison of magnetic wire navigation with the conventional wire
technique for percutaneous coronary intervention of chronic total
occlusions: a randomised, controlled study.
Source
Heart and Vessels. 31 (8) (pp 1266-1276), 2016. Date of Publication: 01
Aug 2016.
Publisher
Springer-Verlag Tokyo
Abstract
Wire crossing of a chronic total coronary occlusion (CTO) is time
consuming and limited by the amount of contrast agent and time of
radiation exposure. Magnetic wire navigation (MWN) might accelerate wire
crossing by maintaining a coaxial vessel orientation. This study compares
MWN with the conventional approach for recanalization of CTOs. Forty
symptomatic patients with CTO were randomised to MWN (n = 20) or
conventional approach (n = 20) for antegrade crossing of the occlusion. In
the intention-to-treat analysis, MWN showed a shorter crossing time (412
versus 1131 s; p = 0.001), and, consequently, lower usage of contrast
agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation
exposure (dose-area product: 29 versus 80 Gy*cm²; p = 0.002)
during wire crossing compared to the conventional approach. Accordingly,
in the per-protocol analysis, the wire-crossing rate was, in trend, higher
using the conventional approach (17 of 31) compared to MWN (9 of 28; p =
0.08). The use of MWN for revascularisation of CTOs is feasible and
reduces crossing time, use of contrast agent, and radiation exposure.
However, due to a broader selection of wires, the conventional approach
enables wire crossing in cases failed by MWN and seems to be the more
successful choice.

<19>
Accession Number
611700351
Author
Li Y.; Verkouw K.; Tabtabai S.; Barrios R.; Gill R.; Koo J.; Marboe C.;
Rodriguez E.; Tan C.; De Marco T.; Estep J.; Hanna M.; Maurer M.; Patel
J.; Selby V.; Semigran M.; Stone J.
Institution
(Li, Verkouw, Tabtabai, Semigran, Stone) Massachusetts General Hospital,
Boston, MA, United States
(Barrios, Estep) Methodist Hospital, Houston, TX, United States
(Gill, De Marco, Selby) University of California San Francisco, San
Francisco, CA, United States
(Koo, Patel) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Marboe, Maurer) Columbia University Medical Center, New York, NY, United
States
(Rodriguez, Tan, Hanna) Cleveland Clinic, Cleveland, OH, United States
Title
Using gastrointestinal biopsy to predict outcome in patients evaluated for
cardiac transplantation for amyloidosis: A report from the international
consortium on cardiac amyloidosis transplantation (iCCAT).
Source
American Journal of Transplantation. Conference: 16th American Transplant
Congress, ATC 2016 United States. Conference Start: 20160611 Conference
End: 20160615. 16 (pp 555-556), 2016. Date of Publication: June 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Heart transplant (HT) is an established therapy for heart failure due to
amyloidosis. The utility of gastrointestinal (GI) biopsy in predicting
patient outcomes and guiding HT patient selection in this setting is
unclear. We assessed 122 GI biopsies (stomach=32, duodenum=42,
colorectal=48) from 60 patients undergoing HT evaluation for amyloidosis
(AL=54, ATTR=6) at 6 medical centers. 50 patients were waitlisted, and 26
received a HT. The amyloid deposition was scored on a semiquantitative
scale (0-3) in the mucosa, non-vascular submucosa, and vasculature. The
frequency of mucosal involvement (87% v 33%, p=0.008), submucosal
involvement (81% v 20%, p=0.01), and grade 3 vascular involvement (69% v
0%, p=0.002) were higher in AL than ATTR. In AL patients, compared with
colon biopsies, duodenal biopsies were more frequently positive for
amyloid (100% v 86%, p=0.03) and had higher vascular scores (mean 2.7 v
2.1, p=0.02), and stomach biopsies had higher submucosal scores (1.8 v
1.0, p=0.02). For AL patients, amyloid scores were compared with outcome
data from the iCCAT registry. The amyloid scores did not correlate with
survival to HT as a binary outcome. Amyloid in the submucosa at any site
was associated with decreased waitlist survival (p=0.04). The presence of
mucosal amyloid (grade 1-3) was not associated with any outcome examined.
There was a trend toward decreased overall survival from time of
evaluation with grade 2-3 mucosal amyloid in the duodenum (p=0.06), and a
trend toward decreased post-transplant survival with grade 2-3 mucosal
amyloid at any site (p=0.07). In conclusion, duodenal biopsy has greater
sensitivity than colorectal biopsy for identifying AL amyloidosis, and
moderate to severe duodenal mucosal amyloid deposition may predict
decreased survival in AL amyloidosis patients being evaluated for HT.
Future larger studies will be necessary to confirm these findings.

<20>
Accession Number
611699818
Author
Chandraker A.; Kobashigawa J.; Stehlik J.; Givertz M.; Pierson R.; Pinney
S.; Joren M.; Nissen S.; Guleria I.; Morrison Y.; Armstrong B.; Bridges
N.; Sayegh M.; Starling R.
Institution
(Chandraker, Kobashigawa, Stehlik, Givertz, Pierson, Pinney, Joren,
Nissen, Guleria, Morrison, Armstrong, Bridges, Sayegh, Starling) Brigham
and Women's Hospital, Boston, MA, United States
Title
Rituximab induction in cardiac transplantation is associated with
accelerated coronary artery vasculopathy: CTOT11.
Source
American Journal of Transplantation. Conference: 16th American Transplant
Congress, ATC 2016 United States. Conference Start: 20160611 Conference
End: 20160615. 16 (pp 403), 2016. Date of Publication: June 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose The NIH-funded study CTOT11: Prevention of Cardiac Allograft
Vasculopathy Using Rituximab (RIT) Therapy in Cardiac Transplantation, was
a randomized clinical trial in non-sensitized primary heart transplant
(HTX) recipients designed to determine whether B cell depletion would
attenuate the development of coronary artery vasculopathy (CAV). Methods
CTOT-11 was a placebo controlled, multicenter, double-blinded study which
randomized 163 HTX with PRA <10% to RIT 1000 mg IV or matching placebo
(PLAC) on days 0 and 12 post-transplant. Primary outcome was change in
percent atheroma volume (PAV) from baseline to one year measured by
intravascular ultrasound (IVUS). Secondary outcomes included treated
episodes of acute rejection, de novo anti HLA antibodies, effector/memory
and Treg subsets, and phenotypic differentiation of B cells. Results 163
HTX were enrolled with no significant differences between RIT and PLAC
groups in the following characteristics: mean age 55 yrs, 85% male, 78%
white, 45% mechanical circulatory support, 47% UNOS status 1A, 41%
ischemic etiology, 23% diabetes, 20% CMV D+R-, average ischemic time 3.1
hours. 92.6% received maintenance CNI, MMF, steroids; 2.5% azathioprine;
4.9% mTOR inhibitor. Mortality at 12 months was 3.4% RIT vs 6.8% PLAC,
p=0.47; there were no retransplants or PTLD. The rate of treated rejection
was 24.7% RIT vs 32.4% PLAC, p=0.28. Paired IVUS measures were available
at baseline and 1 year in 86 subjects (49 RIT, 37 PLAC). The mean (+/-SD)
increase in PAV at 12 mos was 6.8 +/- 8.2% RIT vs 1.9 +/- 4.4% PLAC
(p=0.0019). (Figure presented) Conclusions We hypothesized that RIT would
result in a reduction in PAV change compared to PLAC. Unexpectedly, we
observed a significant increase in PAV change with RIT compared to PLAC
(delta PAV =4.8%). Survival and treated rejection at 1 year were not
different. While these findings require further study, RIT should be used
with caution as induction therapy in primary unsensitized HTX patients.

<21>
Accession Number
611699668
Author
Halloran P.; Kim D.; Loupy A.; Duong Van-Huyen J.-P.; Bruneval P.; Potena
L.; Leone O.; Reeve J.
Institution
(Halloran, Kim, Reeve) University of Alberta, Edmonton, Canada
(Loupy, Duong Van-Huyen) Necker Hospital, Paris, France
(Bruneval) Hopitaux De Paris, Paris, France
(Potena, Leone) Bologna University, Bologna, Italy
Title
Development and validation of a molecular microscope diagnostic system
(MMDX) for heart transplant biopsies.
Source
American Journal of Transplantation. Conference: 16th American Transplant
Congress, ATC 2016 United States. Conference Start: 20160611 Conference
End: 20160615. 16 (pp 332), 2016. Date of Publication: June 2016.
Publisher
Blackwell Publishing Ltd
Abstract
The diagnosis of heart transplant rejection by histology in endomyocardial
biopsies (EMB) is challenging. A molecular system (MMDx) has been
developed to assess both T cell-mediated (TCMR) and antibody-mediated
(ABMR) rejection in kidney transplant biopsies. The present project
adapted the MMDx derived in kidney transplant biopsies to heart transplant
EMBs. We collected a single bite from 331 standard-of-care EMBs from three
centers and processed them on Affymetrix microarrays. EMB diagnoses were
assessed by histology using ISHLT guidelines. To develop rejection tests
for heart, the genes most highly associated with Rejection, ABMR, and TCMR
in kidney transplants were used to perform semi-supervised clustering on
the EMBs. Two-thirds of the biopsies were used as a discovery set, and the
remaining third as a validation set. The biopsies segregated into three
overlapping molecular clusters in the discovery set (fig 1A), roughly
corresponding to histologic diagnoses of TCMR (A3), ABMR (A2), and No
Rejection (A1) (fig 1B). Some histology ABMR and TCMR biopsies were
molecularly No Rejection. Cluster scores in the validation set were
assigned using a predictive model based on the molecular distribution of
biopsies in the discovery set. Diagnostic performance was similar in the
discovery and validation sets. Biopsies designated as ABMR by the
molecular test showed reasonably good agreement with histology, and were
highly associated with HLA antibody. There was less agreement between
molecular and histologic TCMR, supporting concerns that the current
histologic assessment of EMBs is poorly predictive of true TCMR. We
conclude that the MMDx can provide a new basis for classifying
endomyocardial biopsies and a new reference point for improving the
assessment by histology. (Figure Presented).

<22>
Accession Number
611699589
Author
Webber S.; Addonizio L.; Blume E.; Dipchand A.; Shaddy R.; Feingold B.;
Canter C.; Hsu D.; Mahle W.; Zeevi A.; Much K.; Ikle D.; Diop H.; Odim J.
Institution
(Webber) Vanderbilt, Nashville, United States
(Addonizio) Columbia Univ., New York, United States
(Blume) Boston Children's, Boston, United States
(Dipchand) Sick Kids, Toronto, Canada
(Shaddy) CHOP, Philadelphia, United States
(Feingold, Zeevi) CHP of UPMC, Pittsburgh, United States
(Canter) Washington Univ., St. Louis, United States
(Hsu) Children's Hospital, Montefiore, NYC, United States
(Mahle) CHOA, Atlanta, United States
(Much, Ikle) Rho, Chapel Hill, United States
(Diop, Odim) NIAID/NIH, Bethesda, United States
Title
Pediatric heart transplantation across a positive cross-match is
associated with high rates of AMR but no difference in short term graft
loss, dysfunction and death (CTOTC-04 study).
Source
American Journal of Transplantation. Conference: 16th American Transplant
Congress, ATC 2016 United States. Conference Start: 20160611 Conference
End: 20160615. 16 (pp 331), 2016. Date of Publication: June 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Sensitization is common in pediatric heart transplant (HT) candidates.
Waitlist mortality is high if a prospective -ve CDC-crossmatch (XM) is
required, but HT across a +ve XM is considered high risk for rejection &
graft loss. CTOTC-04 is a multicenter prospective study assessing the
impact of pre-HT sensitization on HT outcomes. Methods: We prospectively
recruited consecutive candidates (<21 yr) at 8 pediatric centers. Pts were
categorized as non-sensitized (cohort A) or sensitized (cohort B) defined
as pre-HT +ve Luminex screen with ³1 anti-HLA Ab at
³1000 MFI confirmed by single antigen beads. Cohort B XM +ve
pts were identified at HT. Immunosuppression was standardized
(thymoglobulin with tacrolimus/MMF maintenance). XM +ve pts also received
periop Ab removal, maintenance steroids, IVIG. Primary endpoint was 1 yr
incidence rate of composite of death, reHT, and rejection with hemodynamic
compromise. Results:317 were screened, 290 consented & 240transplanted.
Cohort A (n=97;40%) had mean age 7.0+/-6.8 yr at HT, 45% male and 34% with
congenital heart disease (CHD). Cohort B (n=143;60%) comprised 16 XM +ve
recipients 8.0+/-6.8 yr, 69% male, 81% CHD, and 127 XM -ve, 7.6+/-6.4 yr,
58% male, 49% CHD. Incidence rates of the primary endpoint did not
statistically differ; cohort A 5.2% (CI:1.7%, 11.6%), cohort B +ve XM
12.5% (1.6%, 38.4%), cohort B -ve XM 11.8% (6.8%, 18.7%), p=0.161.
Individual components of the primary endpoint did not differ, but 1-year
incidence rate of AMR was higher in the +ve XM group (37.5%) compared to
cohort A (4.1%) and cohort B -ve XM (15.0%), p0.001. Conclusions: In the
short-term, the composite endpoint did not differ based on sensitization
or XM status despite varying rates of AMR. Subsequent analyses will assess
outcomes based on MFI of DSA and long-term follow-up will assess late
graft / pt outcomes.

<23>
Accession Number
611699418
Author
Zuckerman W.; Feingold B.; Zeevi A.; Bentlejewski C.; Addonizio L.; Blume
E.; Canter C.; Dipchand A.; Hsu D.; Shaddy R.; Mahle W.; Much K.;
Armstrong B.; Ikle D.; Diop H.; Odim J.; Webber S.
Institution
(Zuckerman, Addonizio) Columbia Univ., New York City, United States
(Feingold, Zeevi, Bentlejewski) Univ. of Pittsburgh, Pittsburgh, United
States
(Blume) Boston Children's Hospital, Boston, United States
(Canter) Washington Univ., St. Louis, United States
(Dipchand) Sick Kids, Toronto, Canada
(Hsu) Children's Hospital, Montefiore, NY, United States
(Shaddy) Children's Hospital of Philadelphia, Philadelphia, United States
(Mahle) CHOA, Atlanta, United States
(Much, Armstrong, Ikle) Rho, Chapel Hill, United States
(Diop, Odim) NIAID/NIH, Bethesda, United States
(Webber) Vanderbilt Univ., Nashville, United States
Title
Solid phase assay demonstrates high rates of allosensitization in
pediatric heart recipients.
Source
American Journal of Transplantation. Conference: 16th American Transplant
Congress, ATC 2016 United States. Conference Start: 20160611 Conference
End: 20160615. 16 (pp 210), 2016. Date of Publication: June 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Allosensitization is a risk factor for rejection, vasculopathy and graft
loss. CTOTC-04 is a prospective study assessing the impact of
sensitization on a composite of death, retx and rejection with hemodynamic
compromise. We report sensitization status of enrolled candidates and
explore associations with pt characteristics. We prospectively recruited
consecutive listed children at 8 centers. Serial protocol blood draws for
core lab assessment of anti-HLA antibody (Ab) was performed. Sensitization
was defined as positive Luminex screen with ³1 anti-HLA Ab at
³1000 MFI confirmed using single antigen beads. Univariate
associations of sensitization with pt characteristics were sought. Of 318
screened candidates, 291 were enrolled. Age at listing was 6.7 yrs (2
d-20.0 yrs) and weight 27.6 kg (2.4-133.0 kg); 55% were male, 58% white &
20% black. Diagnoses were CHD in 50% & cardiomyopathy in 48%. At least 1
prior sensitizing event was present in 73% (prior heart surgery 57%,
transfusion 57%, VAD/ECMO 29%, homograft 16%, prior HT 6%, pregnancy
0.3%). 240 received HT. By local evaluation, 143/240 (60%) were
sensitized. At HT, 16 had a positive CDC crossmatch. Core lab Ab was
available in 237/240; 122 (51%) were sensitized. Among sensitized pts, 48%
had Ab with maximum MFI at 1000-3999, 17% at 4000- 7999, and 34% at >8000.
Univariate analyses showed sensitization associated with CHD (53 vs. 35%,
p=0.004), prior heart surgery (66 vs. 43%, p<0.001), transfusion (60 vs
46%, p=0.034), homograft placement (25 vs 6%, p<0.001), HT (10 vs 2%;
p=0.008), and male gender (64 vs 42%, p<0.001). Using solid phase assay,
pre-HT sensitization is very common in children, even those without CHD.
Risk factors traditionally associated with sensitization persist.
Long-term follow-up offers a unique opportunity to understand the role
played by Ab on late outcomes.