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<1>
Accession Number
610261982
Author
Curatolo M.
Institution
(Curatolo) Department of Anesthesiology and Pain Medicine, University of
Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195-6540,
United States
Title
Regional anesthesia in pain management.
Source
Current Opinion in Anaesthesiology. 29 (5) (pp 614-619), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review The study focuses on neural blocks with local
anesthetics in postoperative and chronic pain. It is prompted by the
recent publication of several systematic reviews and guidelines. Recent
findings For postoperative pain, the current evidence supports infusions
of local anesthetics at the surgical site, continuous peripheral nerve
blocks, and neuraxial analgesia for major thoracic and abdominal
procedures. Ultrasound guidance can improve the performance of the blocks
and different patient outcomes, although the incidence of peripheral nerve
damage is not decreased. For chronic pain, the best available evidence is
on nerve blocks for the diagnosis of facet joint pain. Further research is
needed to validate diagnostic nerve blocks for other indications.
Therapeutic blocks with only local anesthetics (greater occipital nerve
and sphenopalatine ganglion) are effective in headache. A possible
mechanism is modulation of central nociceptive pathways. Therapeutic nerve
blocks for other indications are mostly supported by retrospective studies
and case series. Summary Recent literature strongly supports the use of
regional anesthesia for postoperative pain, whereby infusions at
peripheral nerves and surgical site are gaining increasing importance.
Local anesthetic blocks are valid for the diagnosis of facet joint pain
and effective in treating headache. There is a need for further research
in diagnostic and therapeutic blocks for chronic pain. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

<2>
Accession Number
611288016
Author
Bernabe-Garcia M.; Lopez-Alarcon M.; Villegas-Silva R.; Mancilla-Ramirez
J.; Rodriguez-Cruz M.; Maldonado-Hernandez J.; Chavez-Rueda K.A.;
Blanco-Favela F.; Espinoza-Garcia L.; Lagunes-Salazar S.
Institution
(Bernabe-Garcia, Lopez-Alarcon, Rodriguez-Cruz, Maldonado-Hernandez)
Medical Research Unit in Nutrition, Av. Cuahutemoc 330, Mexico City 06725,
Mexico
(Villegas-Silva, Espinoza-Garcia, Lagunes-Salazar) Neonatal Intensive Care
Unit, Mexico City, Mexico
(Mancilla-Ramirez) Escuela Superior de Medicina, IPN, Hospital de la
Mujer, Mexico City, Mexico
(Chavez-Rueda, Blanco-Favela) Medical Research Unit in Immunology,
Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto
Mexicano Del Seguro Social, Mexico City, Mexico
(Villegas-Silva) Neonatal Intensive Care Unit, Hospital Infantil de Mexico
Federico Gomez, Paseo de la Salud, SSA, Mexico City, Mexico
Title
Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of
Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular
Surgery: An Intervention Study.
Source
Annals of Nutrition and Metabolism. 69 (1) (pp 15-23), 2016. Date of
Publication: 01 Sep 2016.
Publisher
S. Karger AG
Abstract
Background: Neonates undergoing surgery are at risk for uncontrolled
inflammatory response and adverse clinical outcomes. Docosahexaenoic acid
(DHA) ameliorates inflammation, improving clinical outcomes. However, its
effect has not been evaluated in neonates undergoing surgery. We evaluated
the effect of DHA on markers of inflammation and clinical outcomes in
neonates undergoing surgery. Methods: A double-blind clinical trial
evaluated the effect of enteral DHA (DHA group) versus sunflower oil (SO
group) perioperatively administered in neonates scheduled for
cardiovascular surgery. Inflammation was evaluated by percentage of
cells⁺ for cytokines and CD69 in mononuclear cells at baseline,
24 h and 7 days post surgery. Clinical outcomes measured were sepsis,
organ dysfunctions (ODs), length of stay in intensive care and bleeding.
Repeated measures analysis of variance and logistic regression were
applied. Results: Sixteen neonates received DHA and 18 received SO.
Cells⁺ from neonates in the DHA group showed an early increase
in receptor antagonist of interleukin (IL)-1⁺
(IL-1ra⁺) and IL-10⁺ and a late decrease in
IL-6⁺. IL-1beta⁺ and IL-10⁺ changes were
different between groups. After adjusting for confounders, less cells from
DHA group were IL-1beta⁺, IL-6⁺, IL-1ra⁺
and IL-10⁺. DHA group presented less sepsis, ODs and shorter
stay, but no difference in CD69⁺CD4⁺ cells or
bleeding between groups. Conclusions: Administration of enteral DHA
ameliorates markers of inflammation and improves clinical outcomes in
surgical neonates. Copyright &#xa9; 2016 S. Karger AG, Basel.

<3>
Accession Number
606613996
Author
Saratzis A.; Harrison S.; Barratt J.; Sayers R.D.; Sarafidis P.A.; Bown
M.J.
Institution
(Saratzis, Harrison, Sayers, Bown) Department of Cardiovascular Sciences
and NIHR Leicester Cardiovascular Biomedical Research Unit, University of
Leicester, Leicester Royal Infirmary, Leicester LE15WW, United Kingdom
(Barratt) Department of Infection, Immunity and Inflammation, University
of Leicester, Leicester, United Kingdom
(Sarafidis) Department of Nephrology, Aristotle University, Thessaloniki,
Greece
Title
Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular
Outcomes.
Source
American Journal of Nephrology. 42 (4) (pp 285-294), 2015. Date of
Publication: 27 Nov 2015.
Publisher
S. Karger AG
Abstract
Background: Acute kidney injury (AKI) has been associated with all-cause
short- and long-term mortality. However, its association with
cardiovascular (CV) events remains unclear. We sought to investigate this
in patients undergoing open (OAR) or endovascular (EVAR) abdominal aortic
aneurysm repair, as they are likely to develop both AKI and CV morbidity.
A meta-analysis was subsequently performed to confirm this in other
CV-interventions. Methods: AKI-incidence was assessed in a
multicentre-cohort of 1,068 patients undergoing EVAR (947 individuals) or
OAR electively using the 'Acute Kidney Injury Network' criteria. A
composite-endpoint was used, consisting of non-fatal myocardial infarction
(MI), stroke, vascular event, hospitalisation due to heart failure and CV
death. A systematic literature review identified studies reporting
AKI-incidence and CV events. Risk ratios (RRs) at 1 and 5 years were
combined using meta-analysis. Results: During a median follow-up of 62
months (range 11-121), AKI was associated with CV events on adjusted (for
CV risk-factors) analyses (Incidence 36% of EVAR, 32% of OAR patients;
hazard ratio 1.73, 95% CI 1.06-3.39, p = 0.03) for the overall population.
In the meta-analysis, 7 studies reported incidence of MI on 23,936
patients 1-year after coronary intervention (PCI) with a pooled RR of 1.76
(95% CI 1.45-2.83, p < 0.001); at 2 years, 3 studies reported MI incidence
on 17,773 patients after PCI with a pooled RR of 1.34 (95% CI 1.10-1.63, p
= 0.003). MI-incidence was reported 5 years after cardiac surgery by 3
studies (33,701 patients) with a pooled RR of 1.60 (95% CI 1.43-1.81).
Conclusion: AKI is associated with long-term CV events after surgery or
endovascular intervention. Copyright &#xa9; 2015 S. Karger AG, Basel.All
rights reserved.

<4>
Accession Number
607586474
Author
Manshanden J.S.J.; Gielen C.L.I.; de Borgie C.A.J.M.; Klautz R.J.M.; de
Mol B.A.J.M.; Koolbergen D.R.
Institution
(Manshanden, de Mol, Koolbergen) Department of Cardiothoracic Surgery,
Academic Medical Center (AMC), Amsterdam, Netherlands
(Gielen, Klautz, Koolbergen) Department of Cardiothoracic Surgery, Leiden
University Medical Center (LUMC), Leiden, Netherlands
(de Borgie) Clinical Research Unit, University of Amsterdam, Amsterdam,
Netherlands
Title
Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety,
Feasibility, and Effect on Blood Loss.
Source
EBioMedicine. 2 (9) (pp 1217-1223), 2015. Date of Publication: September
01, 2015.
Publisher
Elsevier
Abstract
Background: Prolonged or excessive blood loss is a common complication
after cardiac surgery. Blood remnants and clots, remaining in the
pericardial space in spite of chest tube drainage, induce high
fibrinolytic activity that may contribute to bleeding complications.
Continuous postoperative pericardial flushing (CPPF) with an irrigation
solution may reduce blood loss by preventing the accumulation of clots. In
this pilot study, the safety and feasibility of CPPF were evaluated and
the effect on blood loss and other related complications was investigated.
Methods: Between November 2011 and April 2012 twenty-one adult patients
undergoing surgery for congenital heart disease (CHD) received CPPF from
sternal closure up to 12 h postoperative. With an inflow Redivac drain
that was inserted through one of the chest tube incision holes, an
irrigation solution (NaCl 0.9% at 38 degreeC) was delivered to the
pericardial cavity using a volume controlled flushing system. Safety
aspects, feasibility issues and complications were registered. The mean
actual blood loss in the CPPF group was compared to the mean of a
retrospective group (n = 126). Results: CPPF was successfully completed in
20 (95.2%) patients, and no method related complications were observed.
Feasibility was good in this experimental setting. Patients receiving CPPF
showed a 30% (P = 0.038) decrease in mean actual blood loss 12 h
postoperatively. Conclusions: CPPF after cardiac surgery was found to be
safe and feasible in this experimental setting. The clinically relevant
effect on blood loss needs to be confirmed in a randomized clinical trial.
Copyright &#xa9; 2015 The Authors.

<5>
Accession Number
608566118
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 (E-mail: jnl.info@oup.co.uk)

<6>
Accession Number
608566081
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 (E-mail: jnl.info@oup.co.uk)
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. Copyright &#xa9; 2015 The Author.

<7>
Accession Number
603101321
Author
Anonymous
Title
Erratum: Comparison of the effect of 6% hydroxyethyl starch and gelatine
on cardiac and stroke volume index: A randomized, controlled trial after
cardiac surgery (Perfusion (United Kingdom) (2010) 104:6 (691-697) DOI
10.1177/0267659110377819).
Source
Perfusion (United Kingdom). 30 (3) (pp 263), 2015. Date of Publication: 19
Apr 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)

<8>
Accession Number
605266031
Author
Mao Z.; Zhong X.; Yin J.; Zhao Z.; Hu X.; Hackett M.L.
Institution
(Mao, Zhong, Yin, Zhao, Hu) Department of Neurology, Third Affiliated
Hospital of Sun Yat-Sen University, Multiple Sclerosis Center, 600 Tianhe
Road, Guangzhou, Guangdong Province 510630, China
(Hackett) George Institute for Global Health, University of Sydney,
Australia
(Hackett) School of Health, University of Central Lancashire, Preston,
United Kingdom
Title
Predictors associated with stroke after coronary artery bypass grafting: A
systematic review.
Source
Journal of the Neurological Sciences. 357 (1-2) (pp 1-7), 2015. Date of
Publication: 13 Mar 2015.
Publisher
Elsevier
Abstract
Background Stroke is a major cause of morbidity and mortality after
coronary artery bypass grafting (CABG). The purpose of this systematic
review was to evaluate the predictors of perioperative stroke after CABG.
Methods We reviewed the published literature on prognostic factors for
perioperative stroke after CABG in articles using multivariate regression
models. The statistical validity of prognostic models and a qualitative
synthesis were performed. Results We identified 14 studies. The
methodological quality of study reporting was variable. Overall, the
incidence of stroke after CABG was 1.1-5.7%. About 37-59% of strokes
occurred early (intraoperatively). No validated stroke outcome scale was
used to assess morbidity and mortality in any of the included studies.
Advanced age, prior (before CABG) cerebrovascular disease/stroke, prior
carotid artery stenosis, prior peripheral vascular disease, prior unstable
angina, and prolonged cardiopulmonary bypass time were found to be the
most consistent independent predictors of perioperative stroke after CABG.
Postoperative atrial fibrillations were found to be the most consistent
independent variables associated with postoperative stroke after CABG. No
association was found with hypercholesterolemia, prior myocardial infarct,
and smoking. Other risk factors, such as gender, prior hypertension,
diabetes mellitus, congestive heart failure, and chronic renal failure,
showed inconsistent results. Conclusions Seven variables (advanced age,
prior cerebrovascular disease/stroke, prior carotid artery stenosis, prior
peripheral vascular disease, prior unstable angina, prolonged
cardiopulmonary bypass time, and postoperative atrial fibrillation),
representing and high atherosclerotic burden, were found to be associated
with more perioperative stroke events. Stroke assessment scales should be
included to enable a detailed description of stroke morbidity post CABG.
Lessons learned from the present study should also help to improve the
quality and relevance of future studies on prognostic factors in stroke
after CABG. Copyright &#xa9; 2015 Elsevier B.V. All rights reserved.

<9>
Accession Number
53228605
Author
McMaster K.; Sanchez-Ramos L.; Kaunitz A.M.
Institution
(McMaster, Sanchez-Ramos, Kaunitz) Department of Obstetrics and
Gynecology, University of Florida, College of Medicine - Jacksonville,
Jacksonville, FL, United States
Title
Balancing the efficacy and safety of misoprostol: A meta-analysis
comparing 25 versus 50 micrograms of intravaginal misoprostol for the
induction of labour.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. 122 (4) (pp
468-476), 2015. Date of Publication: 01 Mar 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background The optimal dose of misoprostol for the induction of labour
remains uncertain. Objectives To compare the efficacy and safety of 25
versus 50 micrograms of intravaginal misoprostol tablets for the induction
of labour and cervical ripening. Search strategy We performed electronic
and manual searches to identify relevant randomised trials. Selection
criteria The efficacy outcomes assessed were rates of vaginal delivery
within 24 hours, delivery within one dose, and oxytocin augmentation, and
interval to delivery. The safety outcomes assessed were incidences of
tachysystole, hyperstimulation, caesarean delivery, cesarean delivery for
non-reassuring fetal heart rate (FHR), operative vaginal delivery,
abnormal 5-minute Apgar score, abnormal cord gas values, admission to a
neonatal intensive care unit (NICU), and meconium passage. Data collection
and analysis Thirteen studies (1945 women) were included. Relative risk
(RR) and 95% confidence intervals (CI) were calculated using fixed-effects
and random-effects models. Main results We found that 25 micrograms was
less efficacious, with lower rates of delivery after one dose (RR 0.59;
95% CI 0.39-0.88) and vaginal delivery within 24 hours (RR 0.88; 95% CI
0.79-0.96), and with increased rates of oxytocin augmentation (RR 1.54,
95% CI 1.36-1.75). We noted an improved safety profile with 25 micrograms,
however, with decreased rates of tachysystole (RR 0.46; 95% CI 0.35-0.61),
hyperstimulation (RR 0.5; 95% CI 0.31-0.78), caesarean deliveries for
non-reassuring FHR (RR 0.67; 95% CI 0.52-0.87), NICU admissions (RR 0.63;
95% CI 0.4-0.98), and meconium passage (RR 0.65; 95% CI 0.45-0.96).
Conclusions Although 50 micrograms of intravaginal misoprostol may be more
efficacious, safety concerns make the 25-microgram dose preferable.
Copyright &#xa9; 2014 Royal College of Obstetricians and Gynaecologists.

<10>
Accession Number
606143844
Author
Kitagawa T.; Yamamoto H.; Sentani K.; Takahashi S.; Tsushima H.; Senoo A.;
Yasui W.; Sueda T.; Kihara Y.
Institution
(Kitagawa, Yamamoto, Tsushima, Senoo, Kihara) Department of Cardiovascular
Medicine, Hiroshima University Graduate School of Biomedical and Health
Sciences, Hiroshima, Japan
(Sentani, Yasui) Department of Molecular Pathology, Hiroshima University
Institute of Biomedical and Health Sciences, Hiroshima, Japan
(Takahashi, Sueda) Department of Cardiovascular Surgery, Hiroshima
University Hospital, Hiroshima, Japan
Title
The relationship between inflammation and neoangiogenesis of epicardial
adipose tissue and coronary atherosclerosis based on computed tomography
analysis.
Source
Atherosclerosis. 243 (1) (pp 293-299), 2015. Date of Publication: November
01, 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Previous studies indicate that epicardial adipose tissue (EAT)
biologically contributes to the progression of coronary atherosclerosis.
We evaluated the relationship between EAT pathology, represented by
inflammation and neoangiogenesis, and coronary atherosclerosis on computed
tomography (CT) images. Methods: We performed CT examination in 45
patients scheduled for cardiac surgery (coronary artery bypass graft
[CABG], n = 21; non-CABG, n = 24) to assess visceral adipose tissue (VAT)
area, EAT volume, coronary calcium score (CCS), and presence of
non-calcified coronary plaque (NCP) on CT angiography. Each patient was
assessed with the numbers of CD68⁺ individual macrophages and
CD31⁺ neovessels in six random high-power fields (400x) of EAT
samples subsequently obtained during cardiac surgery. Results: In three
groups based on CCS (mild, 0-100; moderate, 101-400; severe, >400), the
moderate group had the most extensive macrophage infiltration (p = 0.0025)
and neoangiogenesis (p = 0.0036) in EAT. The patients with NCP had more
extensive macrophage infiltration (p = 0.010) and neoangiogenesis (p =
0.0043) in EAT than those without. On multivariate analysis adjusted for
age, sex, CABG versus. non-CABG, VAT area, and EAT volume, moderate CCS
and the presence of NCP showed significant correlations with increased
macrophage infiltration (beta = 0.65; p < 0.0001, and beta = 0.49; p =
0.0089, respectively) and neoangiogenesis (beta = 0.55; p = 0.0011, and
beta = 0.53; p = 0.012, respectively) in EAT. Conclusion: Inflammation and
neoangiogenesis in EAT independently correlate with moderate coronary
calcification and presence of NCP, suggesting that these two factors may
have a role in promoting coronary atherosclerosis. Copyright &#xa9; 2015
Elsevier Ireland Ltd.

<11>
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Accession Number
608789035
Author
Csorba Z.; Petak F.; Nevery K.; Tolnai J.; Balogh A.L.; Rarosi F.; Fodor
G.H.; Babik B.
Institution
(Csorba, Nevery, Balogh, Babik) Department of Anesthesiology and Intensive
Therapy, University of Szeged, Szeged, Hungary
(Petak, Tolnai, Rarosi, Fodor) Department of Medical Physics and
Informatics, University of Szeged, Koranyi Fasor 9 H-6720, Hungary
Title
Capnographic Parameters in Ventilated Patients: Correspondence with Airway
and Lung Tissue Mechanics.
Source
Anesthesia and Analgesia. 122 (5) (pp 1412-1420), 2016. Date of
Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Although the mechanical status of the lungs affects the shape
of the capnogram, the relations between the capnographic parameters and
those reflecting the airway and lung tissue mechanics have not been
established in mechanically ventilated patients. We, therefore, set out to
characterize how the mechanical properties of the airways and lung tissues
modify the indices obtained from the different phases of the time and
volumetric capnograms and how the lung mechanical changes are reflected in
the altered capnographic parameters after a cardiopulmonary bypass (CPB).
Methods: Anesthetized, mechanically ventilated patients (n = 101)
undergoing heart surgery were studied in a prospective consecutive
cross-sectional study under the open-chest condition before and 5 minutes
after CPB. Forced oscillation technique was applied to measure airway
resistance (Raw), tissue damping (G), and elastance (H). Time and
volumetric capnography were performed to assess parameters reflecting the
phase II (S<inf>II</inf>) and phase III slopes (S<inf>III</inf>), their
transition (D<inf>2min</inf>), the dead-space indices according to Fowler,
Bohr, and Enghoff and the intrapulmonary shunt. Results: Before CPB,
S<inf>II</inf> and D<inf>2min</inf> exhibited the closest (P = 0.006)
associations with H (0.65 and-0.57; P < 0.0001, respectively), whereas
S<inf>III</inf> correlated most strongly (P < 0.0001) with Raw (r = 0.63;
P < 0.0001). CPB induced significant elevations in Raw and G and H (P <
0.0001). These adverse mechanical changes were reflected consistently in
S<inf>II</inf>, S<inf>III</inf>, and D<inf>2min</inf>, with weaker
correlations with the dead-space indices (P < 0.0001). The intrapulmonary
shunt expressed as the difference between the Enghoff and Bohr dead-space
parameters was increased after CPB (95% +/- 5% [SEM] vs 143% +/- 6%; P <
0.001). Conclusions: In mechanically ventilated patients, the capnographic
parameters from the early phase of expiration (S<inf>II</inf> and
D<inf>2min</inf>) are linked to the pulmonary elastic recoil, whereas the
effect of airway patency on S<inf>III</inf> dominates over the lung tissue
stiffness. However, severe deterioration in lung resistance or elastance
affects both capnogram slopes. Copyright &#xa9; 2016 International
Anesthesia Research Society.

<12>
Accession Number
608008657
Author
Lijnen R.; Otters E.; Balak D.; Thio B.
Institution
(Lijnen) Department of Dermatology, Laurentius Hospital, Mgr.
Driessenstreet 6, Roermond 6043 CV, Netherlands
(Otters) Department of Dermatology, Radboud University Medical Center,
Netherlands
(Balak, Thio) Department of Dermatology, Erasmus Medical Centre,
Rotterdam, Netherlands
Title
Long-term safety and effectiveness of high-dose dimethylfumarate in the
treatment of moderate to severe psoriasis: A prospective single-blinded
follow-up study.
Source
Journal of Dermatological Treatment. 27 (1) (pp 31-36), 2016. Date of
Publication: 02 Jan 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: Mixtures of fumaric acid esters (FAE) are used as an oral
systemic treatment for moderate to severe psoriasis. Large clinical
studies with dimethylfumarate (DMF) monotherapy are scarce. Objectives:
The objective of this study is to assess the effectiveness and long-term
safety of high-dose DMF monotherapy in moderate to severe psoriasis.
Methods: A prospective single-blinded follow-up study was performed in a
cohort of patients treated with DMF. Patients were followed-up at fixed
intervals. Assessment of consecutive photographs was performed by two
observers. Primary outcome was a change in static physician global
assessment (PGA) score. Safety outcome was defined as incidences of
(serious) adverse events. Results: A total of 176 patients with moderate
to severe psoriasis were treated with DMF for a median duration of 28
months. The median daily maintenance dosage of 480 mg was reached after a
median of 8 months. Psoriasis activity decreased significantly by 1.7 out
of five points. A total of 152 patients reported one or more adverse
events, such as gastrointestinal complaints and flushing. Conclusions:
High-dose DMF monotherapy is an effective and safe treatment option in
moderate to severe psoriasis. It can be suggested that 50% of all patients
may benefit from high-dose DMF monotherapy. Copyright &#xa9; 2015 Informa
UK Ltd.

<13>
Accession Number
604421495
Author
Krogstad L.E.B.; Slagsvold K.H.; Wahba A.
Institution
(Krogstad, Slagsvold, Wahba) Faculty of Medicine, Norwegian University of
Science and Technology, Aseboen 5, Alesund 6017, Norway
(Slagsvold, Wahba) Department of Cardiothoracic Surgery, St. Olav's
Hospital, Trondheim University Hospital, Norway
Title
Remote ischemic preconditioning and incidence of postoperative atrial
fibrillation.
Source
Scandinavian Cardiovascular Journal. 49 (3) (pp 117-122), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Informa Healthcare (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives. Although remote ischemic preconditioning (RIPC) has shown
favorable effects on ischemia-reperfusion injury, much remains unknown of
its mechanisms and clinical significance. We hypothesized that RIPC would
reduce the incidence of postoperative atrial fibrillation (POAF) following
coronary artery bypass graft (CABG) surgery. In addition, we investigated
whether RIPC could induce alterations of circulating microRNA in blood
plasma. Design. This is a single-center, double-blind, randomized
controlled trial. 92 adult patients referred for first-time isolated CABG
surgery were randomly assigned to either RIPC (n = 45) or control (n =
47). The RIPC-stimulus comprised three 5-min cycles of upper arm ischemia,
induced by inflating a blood pressure cuff to 200 mmHg, with an
intervening 5 min reperfusion. Heart rhythm was assessed by telemetry.
MicroRNA expression was assessed in plasma by real-time polymerase chain
reaction. Results. Of the 92 patients included in the study, 27 patients
developed POAF (29%). 17 of these patients belonged to the RIPC group
(38%), and 10 to the control group (21%). There were no significant
alterations of microRNA expression. Conclusions. We did not observe a
reduced incidence of POAF by RIPC before CABG surgery. Larger multi-center
studies may be necessary to further clarify this issue. Copyright &#xa9;
2015 Informa Healthcare.

<14>
Accession Number
603200001
Author
Ambrosini V.; Sorropago G.; Laurenzano E.; Golino L.; Casafina A.; Schiano
V.; Gabrielli G.; Ettori F.; Chizzola G.; Bernardi G.; Spedicato L.;
Armigliato P.; Spampanato C.; Furegato M.
Institution
(Ambrosini, Sorropago, Laurenzano, Golino, Casafina, Schiano) Montevergine
Clinic, Mercogliano, Italy
(Gabrielli) University Hospital Ospedali Riuniti, Ancona, Italy
(Ettori, Chizzola) Spedali Civili University Hospital, Brescia, Italy
(Bernardi, Spedicato) University Hospital S. Maria Misericordia, Udine,
Italy
(Armigliato, Furegato) Istituto Italiano Ricerche Mediche, Verona, Italy
(Spampanato) Telethon Institute of Genetics and Medicine (TIGEM), Naples,
Italy
(Golino) Moriggia-Pelascini Hospital, Gravedona, Como, Italy
Title
Early outcome of high energy Laser (Excimer) facilitated coronary
angioplasty ON hARD and complex calcified and balloOn-resistant coronary
lesions: LEONARDO Study.
Source
Cardiovascular Revascularization Medicine. 16 (3) (pp 141-146), 2015. Date
of Publication: 01 Apr 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aim: An innovative xenon-chlorine (excimer) pulsed laser catheter (ELCA
X80) has been recently used for the treatment of complex coronary lesions,
as calcified stenosis, chronic total occlusions and non-compliant plaques.
Such complex lesions are difficult to adequately treat with balloon
angioplasty and/or intracoronary stenting. The aim of this study was to
examine the acute outcome of this approach on a cohort of patients with
coronary lesions. Methods and Results: Eighty patients with 100 lesions
were enrolled through four centers, and excimer laser coronary angioplasty
was performed on 96 lesions (96%). Safety and effectiveness data were
compared between patients treated with standard laser therapy and those
treated with increased laser therapy. Laser success was obtained in 90
lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and
clinical success in was obtained in 87 lesions (90.6%). There was no
perforation, major side branch occlusion, spasm, no-reflow phenomenon,
dissection nor acute vessel closure. Increased laser parameters were used
successfully for 49 resistant lesions without complications. Conclusions:
This study suggests that laser-facilitated coronary angioplasty is a
simple, safe and effective device for the management of complex coronary
lesions. Furthermore, higher laser energy levels delivered by this
catheter improved the device performance without increasing complications.
Copyright &#xa9; 2015.

<15>
Accession Number
606044437
Author
Chong C.-R.; Drury N.E.; Licari G.; Frenneaux M.P.; Horowitz J.D.; Pagano
D.; Sallustio B.C.
Institution
(Chong, Drury, Licari, Horowitz, Sallustio) Cardiology and Clinical
Pharmacology Departments, Basil Hetzel Institute, Queen Elizabeth
Hospital, Woodville South, SA, Australia
(Chong, Horowitz) Medicine, University of Adelaide, Adelaide, SA,
Australia
(Drury, Pagano) Department of Cardiothoracic Surgery, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
(Drury, Pagano) School of Clinical and Experimental Medicine, University
of Birmingham, Birmingham, United Kingdom
(Frenneaux) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Licari, Sallustio) Pharmacology, University of Adelaide, Adelaide, SA,
Australia
Title
Stereoselective handling of perhexiline: Implications regarding
accumulation within the human myocardium.
Source
European Journal of Clinical Pharmacology. 71 (12) (pp 1485-1491), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Perhexiline is a prophylactic anti-ischaemic agent with weak
calcium antagonist effect which has been increasingly utilised in the
management of refractory angina. The metabolic clearance of perhexiline is
modulated by CYP2D6 metaboliser status and stereoselectivity. The current
study sought to (1) determine whether the acute accumulation of
perhexiline in the myocardium is stereoselective and (2) investigate the
relationship between duration of short-term therapy and the potential
stereoselective effects of perhexiline within myocardium. Method: Patients
(n = 129) from the active arm of a randomised controlled trial of
preoperative perhexiline in cardiac surgery were treated with oral
perhexiline for a median of 9 days. Correlates of atrial and ventricular
concentrations of enantiomers were sought via univariate followed by
multivariate analyses. Results: Myocardial uptake of both (+) and (-)
perhexiline was greater in ventricles than in atria, and there was more
rapid clearance of (-) than (+) perhexiline. The main determinants of
atrial uptake of both (+) and (-) perhexiline were the plasma
concentrations [(+) perhexiline: beta = -0.256, p = 0.015; (-)
perhexiline: beta = -0.347, p = 0.001] and patients' age [(+) perhexiline:
beta = 0.300, p = 0.004; (-) perhexiline: beta = 0.288, p = 0.005]. Atrial
uptake of (+) enantiomer also varied directly with duration of therapy
(beta = 0.228, p = 0.025), while atrial uptake of (-) perhexiline varied
inversely with simultaneous heart rate (beta = -0.240, p = 0.015).
Conclusion: (1) Uptake of both perhexiline enantiomers into atrium is
greater with advanced age and displays evidence of both saturability and
minor stereoselectivity. (2) Atrial uptake of (-) perhexiline may
selectively modulate heart rate reduction. Copyright &#xa9; 2015
Springer-Verlag Berlin Heidelberg.

<16>
Accession Number
600428897
Author
Ozturk T.; Onur E.; Cerrahoglu M.; Calgan M.; Nizamoglu F.; Civi M.
Institution
(Ozturk, Nizamoglu, Civi) Department of Anaesthesiology and Reanimation,
Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey
(Onur, Calgan) Department of Biochemistry, Celal Bayar University, Faculty
of Medicine, Manisa 45020, Turkey
(Cerrahoglu) Department of Cardiovascular Surgery, Celal Bayar University,
Faculty of Medicine, Manisa 45020, Turkey
Title
Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid
gelatin in patients undergoing coronary surgery.
Source
Cytokine. 74 (1) (pp 69-75), 2015. Date of Publication: July 01, 2015.
Publisher
Academic Press
Abstract
Objectives: Compare the effects on inflammatory (TNF-alpha, IL-6, IL-8 and
IL-10) and immunologic (CD3⁺, CD4⁺, CD8⁺,
CD11b⁺, CD16⁺/56⁺ T cells and total
lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4%
modified fluid gelatin, or crystalloid when used as volume replacement
fluids for acute normovolemic hemodilution (a blood conservation
technique) in coronary artery bypass graft patients. Methods: Thirty
patients undergoing coronary artery bypass graft surgery were randomized
to receive Isolyte S (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group
HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic
hemodilution. Blood samples were taken immediately after induction of
anaesthesia (T0), and 2h (T1), 12h (T2), 24h (T3), and 48h (T4) after
separation from cardiopulmonary bypass. TNF-alpha, IL-6, IL-8 and IL-10
levels were determined with commercially available ELISA kits.
CD3⁺ (mature T cells), CD4⁺ (T helper cells),
CD8⁺ (suppressor cytotoxic T cells),
CD16⁺/56⁺ (natural killer lymphocytes), and
CD11b⁺ (Mac-1, adhesion receptor) levels were measured using
flow-cytometry reagents. The CD4⁺:CD8⁺ ratio was
calculated. Results: Between-group comparisons showed significantly higher
levels of TNF-alpha at T1 (2h after weaning from cardiopulmonary bypass)
in Group HES compared to Group ISO (p=0.003). IL-8 was significantly lower
in Group HES than Group GEL at T1 (p=0.0005). IL-10 was significantly
higher in Group HES than in Group GEL at T1 (p=0.0001). The
CD4⁺:CD8⁺ ratio in Group ISO was significantly lower
than that in Group HES at T2 (p=0.003). CD11b⁺ levels in Group
HES were also higher than those in Group GEL and group ISO at T2, but not
significantly. CD16/56⁺ levels in Group HES were higher than
those in Group GEL at T2 (p<0.003). No excessive hemorrhage occurred in
any patient. Mediastinal drainage during the first 24h after surgery in
Group HES (347+/-207mL) was not significantly different from that of Group
GEL (272+/-177mL) or Group ISO (247+/-109) (p>0.05). Conclusion:
Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and
increased anti-inflammatory responses to a greater degree than gelatin
solution and isolyte S. The use of hydroxyethyl starch, compared to
gelatin solution and isolyte S, resulted in less decrease in the
CD4⁺:CD8⁺ ratio, suggesting less immunosuppression.
Copyright &#xa9; 2014 Elsevier Ltd.

<17>
Accession Number
603878975
Author
Zhang N.; Lei J.; Liu Q.; Huang W.; Xiao H.; Lei H.
Institution
(Zhang, Huang, Xiao, Lei) Department of Cardiology, First Affiliated
Hospital, Chongqing Medical University, 1 Youyi Road, Yuzhong, Chongqing
400016, China
(Liu) Center for Clinical Research, First Affiliated Hospital, Chongqing
Medical University, China
(Lei) First Affiliated Hospital, Chongqing Medical University, Chongqing,
China
Title
The effectiveness of preoperative trimetazidine on myocardial preservation
in coronary artery bypass graft patients: A systematic review and
meta-Analysis.
Source
Cardiology (Switzerland). 131 (2) (pp 86-96), 2015. Date of Publication:
01 Jun 2015.
Publisher
S. Karger AG
Abstract
Coronary artery bypass grafting (CABG) is a key and effective surgical
treatment modality for coronary artery disease. Unfortunately,
ischemia-reperfusion injury during and after CABG can lead to reversible
and irreversible myocardial damage. Trimetazidine
[1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic
anti-ischemic agent with demonstrated cardioprotective effects; however,
its effects with respect to myocardial preservation in CABG patients
remain unclear. Methods: We conducted a systematic review and
meta-Analysis of randomized controlled trials (RCTs) to investigate the
effectiveness of myocardial preservation of preoperative trimetazidine
therapy in CABG patients by assessing the postoperative levels of several
blood-based biochemical markers of myocardial injury, including creatine
kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine
phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were
classified into two subgroup analyses by the timing of sample collection
(either <12 or >12 h after CABG). Results: Six RCTs were finally included
in the meta-Analysis. The pooled effect sizes showed significantly lower
postoperative levels of CK, CK-MB, TnT and TnI in the
trimetazidine-treated CABG patients relative to control CABG patients.
However, there were no significant differences in the postoperative CPK
levels between trimetazidine-treated CABG patients relative to control
CABG patients. In both the <12 and >12 h post-CABG subgroup analyses,
significant differences in CK, CK-MB, TnT and TnI were detected between
the trimetazidine-treated CABG patients relative to control CABG patients.
Conclusions: Preoperative trimetazidine therapy appears to have a positive
effect on myocardial preservation in CABG patients. Copyright &#xa9; 2015
S. Karger AG, Basel.

<18>
Accession Number
372709330
Author
Kufner S.; Byrne R.A.; de Waha A.; Schulz S.; Joner M.; Laugwitz K.-L.;
Kastrati A.
Institution
(Kufner, Byrne, de Waha, Schulz, Joner, Kastrati) Deutsches Herzzentrum,
Technische Universitat, Munich, Germany
(Laugwitz) Medizinische Klinik, Klinikum rechts der Isar, Technische
Universitat, Munich, Germany
(Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular Research),
Partner site Munich Heart Alliance, Munich, Germany
Title
Sirolimus-eluting versus paclitaxel-eluting stents in diabetic and
non-diabetic patients within sirolimus-eluting stent restenosis: Results
from the ISAR-DESIRE 2 trial.
Source
Cardiovascular Revascularization Medicine. 15 (2) (pp 69-75), 2014. Date
of Publication: March 2014.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Concern exists relating to potential attenuated efficacy of
limus-eluting stents in patients with diabetes mellitus. In this respect
diabetic patients with sirolimus-eluting stent (SES) failure requiring
reintervention may be expected to derive particular benefit from a
treatment-switch to paclitaxel-eluting stent (PES) implantation.
Objective: The aim of the current report was to investigate outcomes of
patients with SES restenosis randomized to treatment with SES (same stent
strategy) or PES (switch stent strategy) in the pre-specified subgroups of
patients with and without diabetes mellitus. Methods: In the setting of
ISAR-DESIRE 2 trial, 450 patients with clinically significant SES
restenosis were randomly assigned to receive either SES or PES. The
primary end point was in-stent late loss at 6-8. month follow-up
angiography. Secondary endpoints were binary angiographic restenosis
(diameter stenosis >. 50%) and target lesion revascularization (TLR), the
composite of death or myocardial infarction (MI) and definite stent
thrombosis at 12. months. Results: Of 450 patients enrolled, 162 (36.0%)
had a diagnosis of diabetes mellitus. In patients with diabetes 86
patients were randomly assigned to SES versus 76 to PES. In patients
without diabetes 139 were assigned to SES versus 149 to PES. Late loss was
comparable between SES and PES both in patients with diabetes
(0.38+/-0.59mm vs. 0.37+/-0.59mm; p=0.97) and without (0.41+/-0.67mm vs.
0.38+/-0.6mm; p=0.98; p<inf>interaction</inf>=0.89). Similarly binary
restenosis was comparable between SES and PES in patients with diabetes
(19.0% vs. 26.0%; p=0.32) or without (18.9% vs. 17.8%; p=0.98;
p<inf>interaction</inf>=0.36). TLR, death or MI and definite stent
thrombosis were also similar in SES versus PES treatment groups regardless
of diabetes status. Conclusions: In cases of SES-restenosis, treatment
with either repeat SES or switch to PES was associated with a comparable
degree of efficacy, regardless of diabetic status. &#xa9; 2014 Elsevier
Inc.

<19>
Accession Number
612123594
Author
Trikha R.; Kowey P.R.
Institution
(Trikha, Kowey) aLankenau Institute for Medical Research, Wynnewood, Pa.,
and bJefferson Medical College, Philadelphia, Pa., USA
Title
Practical Considerations for the Nonvitamin K Antagonist Oral
Anticoagulants.
Source
Cardiology (Switzerland). (pp 115-124), 2016. Date of Publication: 06 Sep
2016.
Publisher
S. Karger AG
Abstract
Objectives: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin
K antagonist oral anticoagulants (NOACs) approved for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical
trials demonstrated NOACs were as effective as warfarin in the prevention
of stroke or systemic embolism and associated with decreased incidences of
intracranial bleeding. Additionally, NOACs provide quicker onset of
action, simpler dosing, more predictable pharmacokinetic profiles, and
decreased food and drug interactions compared with warfarin. Despite the
advantages of NOACs, the lack of knowledge may limit their use in clinical
practice. Methods: A search was performed on the terms 'atrial
fibrillation' and 'dabigatran', 'apixaban', 'edoxaban', or 'rivaroxaban'
to identify relevant papers; large randomized clinical trials,
meta-analyses, and treatment guideline recommendations were given
preference. Searches to identify registries, treatment guidelines, and
meta-analyses relevant to patient subgroups were also employed. Results:
Dosing recommendations, initiation of treatment, and applications in
patients who undergo NVAF procedures, have mechanical heart valves, or
experience other cardiovascular conditions such as myocardial infarction,
previous stroke, and valvular heart disease are summarized. The
NOAC-specific reversal approaches are also discussed. Conclusions: Several
important factors should be considered regarding the adequate use of
NOACs, especially in patients with renal impairment or cardiovascular
conditions other than NVAF. Copyright &#xa9; 2016 S. Karger AG, Basel

<20>
Accession Number
612111171
Author
Grzymala-Lubanski B.; Svensson P.J.; Renlund H.; Jeppsson A.; Sjalander A.
Institution
(Grzymala-Lubanski, Sjalander) Department of Public Health and Clinical
Medicine, Umea University, Umea, Sweden
(Svensson) Department of Coagulation Disorders, University of Lund, Malmo,
Sweden
(Renlund) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Goteborg, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
Title
Warfarin treatment quality and prognosis in patients with mechanical heart
valve prosthesis.
Source
Heart. (no pagination), 2016. Date of Publication: September 02, 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To study the impact of time in therapeutic range (TTR) and
international normalised ratio (INR) variability on the risk of
thromboembolic events, major bleeding complications and death after
mechanical heart valve (MHV) implantation. Additionally, the importance of
different target INR levels was elucidated. Methods A retrospective,
non-randomised multicentre cohort study including all patients with
mechanical heart valve (MVH) prosthesis registered in the Swedish National
Quality Registry Auricula from 2006 to 2011. Data were merged with the
Swedish National Patient Registry, SWEDEHEART and Cause of Death Registry.
Results In total 4687 ordination periods, corresponding to 18 022
patient-years on warfarin, were included. High INR variability (above mean
>0.40) or lower TTR (<70%) was associated with a higher risk of bleeding
(rate per 100 years 4.33 (95% CI 3.87 to 4.82) vs 2.08 (1.78 to 2.41); HR
2.15 (1.75 to 2.61) and 5.13 (4.51 to 5.82) vs 2.30 (2.03 to 2.60); HR
2.43 (2.02 to 2.89)), respectively. High variability and low TTR combined
was associated with an even higher risk of bleedings (rate per 100 years
4.12 (95% CI 3.68 to 4.51) vs 2.02 (1.71 to 2.30); HR 2.16 (1.71 to 2.58)
and 4.99 (4.38 to 5.52) vs 2.36 (2.06 to 2.60); HR 2.38 (2.05 to 2.85))
compared with the best group. Higher treatment intensity (mean INR 2.8-3.2
vs 2.2-2.7) was associated with higher rate of bleedings (2.92 (2.39 to
3.47) vs 2.48 (2.21 to 2.77); HR 1.29 (1.06 to 1.58)), death (3.36 (2.79
to 4.02) vs 1.89 (1.64 to 2.17), HR 1.65 (1.31 to 2.06)) and complications
in total (6.61 (5.74 to 7.46) vs 5.65 (5.20 to 6.06); HR 1.24 (1.06 to
1.41)) after adjustment for MHV position, age and comorbidity. Conclusions
A high warfarin treatment quality improves outcome after MHV implantation,
both measured with TTR and INR variability. No benefit was found with
higher treatment intensity (mean INR 2.8- 3.2 vs 2.2-2.7). Copyright
&#xa9; 2016 BMJ Publishing Group Ltd & British Cardiovascular Society.

<21>
Accession Number
612098253
Author
Harle T.; Zeymer U.; Hochadel M.; Zahn R.; Kerber S.; Zrenner B.;
Schachinger V.; Lauer B.; Runde T.; Elsasser A.
Institution
(Harle, Elsasser) Klinik fur Kardiologie, Klinikum Oldenburg gGmbH,
European Medical School Oldenburg-Groningen, Carl von Ossietzky
Universitat Oldenburg, Rahel-Straus-Str. 10, Oldenburg 26133, Germany
(Zeymer, Zahn) Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen,
Germany
(Zeymer, Hochadel) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Kerber) Klinik fur Kardiologie, Herz- und Gefas-Klinik GmbH, Bad Neustadt
a. d., Haale, Germany
(Zrenner) Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut,
Germany
(Schachinger) Klinikum Fulda, Medizinische Klinik I, Fulda, Germany
(Lauer) Klinik fur Kardiologie, Zentralklinik Bad Berka, Bad Berka,
Germany
(Runde) Klinikum Wetzlar, Medizinische Klinik I, Wetzlar, Germany
Title
Real-world use of fractional flow reserve in Germany: results of the
prospective ALKK coronary angiography and PCI registry.
Source
Clinical Research in Cardiology. (pp 1-11), 2016. Date of Publication: 06
Sep 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: There is growing evidence for beneficial prognostic and
economic effects of FFR-guided treatment of stable coronary artery
disease. We sought to evaluate the real-world use of FFR measurements in
patients undergoing elective coronary angiography. Methods and results: We
analyzed the data of the prospective ALKK coronary angiography and PCI
registry including data of 38 hospitals from January 2010 to December
2013. A total of 100,977 patients undergoing coronary angiography were
included. In 3240 patients (3.2 %) intracoronary pressure measurement was
performed. There was a wide range of use of FFR measurement in the
different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients
with suspected or known coronary artery disease (median 2.7 %, quartiles
0.9 and 5.3 %), with a successive increase of use over time during the
study period. Overall, it was performed in 3.2 % of coronary
angiographies. Use in patients with three-vessel disease (2.5 %) and
recommendation for bypass surgery (1.6 %) was less frequent. In procedures
without PCI, dose area product was higher in the FFR group (2641 cGy x
cm² vs. 2368 cGy x cm², p < 0.001), while it was
lower in procedures with ad hoc PCI (4676 cGy x cm² vs. 5143
cGy x cm², p < 0.001). The performing center turned out to be
the strongest predictor. Conclusions: The use of FFR measurement was very
heterogeneous between different hospitals and in general relatively low,
in particular in patients with multivessel disease or recommendation for
bypass surgery, but there was a positive trend during the study period.
Technically, FFR measurement was not associated with an increased
periprocedural complication rate. Copyright &#xa9; 2016 Springer-Verlag
Berlin Heidelberg

<22>
Accession Number
612097776
Author
Vroomen M.; Pison L.
Institution
(Vroomen, Pison) Department of Cardiology, Maastricht University Medical
Center, PO Box 5800, Maastricht, Netherlands
(Vroomen, Pison) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Title
Hybrid ablation for atrial fibrillation: a systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. (pp 1-10), 2016. Date
of Publication: 09 Sep 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hybrid ablation for AF is performed in a growing number of
centers. Due to absence of guidelines, operative approaches and
perioperative care differ per center. In this review, an overview of
findings from published studies on hybrid ablations is given, and related
topics are discussed (e.g., one- and two-stage approaches, lesion sets,
and patient management). Methods: A systematic literature search was
performed in the PubMed and Embase databases. All identified articles were
screened and checked for eligibility by the two authors. Results: Twelve
studies describing a total of 563 patients were selected. Due to
substantial differences in approaches (one-stage, two-stage, sequential),
surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal,
transabdominal), energy sources (unipolar, bipolar), lesion sets (applying
left or right atrial lesions), periprocedural care and endpoints
(monitoring, definition of recurrence), and success rates (sinus rhythm
after a mean of 26 months) are difficult to compare and varied from 27 %
(without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies
using bipolar devices, success rates with the use of antiarrhythmic drugs
were at least 71 %. Major complications such as bleeding, sternotomy, and
death occurred in 7 % of the total population (of which ten complications,
16 %, occurred in the concomitant cardiac surgery hybrid group).
Conclusion: The field of AF ablation has dramatically changed over the
past years, with one of the most recent developments the hybrid AF
ablation. Lack of matching data hinders drawing conclusions and creating
guidelines. Early results however are encouraging. More data are awaiting
and needed. Copyright &#xa9; 2016 The Author(s)

<23>
Accession Number
612122942
Author
Guclu C.Y.; Unver S.; Aydinli B.; Kazanci D.; Dilber E.; Ozgok A.
Institution
(Guclu, Unver, Aydinli, Kazanci, Dilber, Ozgok) Turkiye Yuksek Ihtisas
Education and Research Hospital, Clinic of Anesthesia and Reanimation,
Ankara, Turkey
Title
The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during
cardiopulmonary bypass - Randomized trial.
Source
Advances in Clinical and Experimental Medicine. 23 (6) (pp 919-924), 2014.
Date of Publication: 01 Nov 2014.
Publisher
Wroclaw University of Medicine
Abstract
Background. Neuropsychological and neurological deficits are still major
causes of mortality and morbidity after cardiac surgery. These
complications are thought to be caused by embolisms and cerebral hypoxia.
Thus, continuous neuromonitoring is essential during cardiac surgery due
to cerebral oxygen desaturation during different periods. Near-infrared
spectrophotometry (NIRS), a non-invasive method, appears to offer many
advantages for monitoring cerebral oxygenation and hemodynamics.
Desaturation of cerebral oxygen may occur at the beginning of
cardiopulmonary bypass (CPB) or during the low perfusion and rewarming
stages if not corrected. Objectives. This study was designed to assess the
effects of sevoflurane on cerebral protection during CPB. Material and
Methods. Eighty patients were divided into two groups. Anesthesia was
maintained either with fentanyl and midazolam (total intravenous
anesthesia, TIVA) or with one minimum alveolar concentration of
sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute
decrease in saturation of 20% from baseline cerebral saturation. When
desaturation occurred, PaCO<inf>2</inf>, hematocrit and PaO<inf>2</inf>
levels were checked and corrected. If desaturation continued, anesthetic
depth was increased to reserve saturation with 50-100 mg of propofol. NIRS
values and hemodynamics were recorded at predetermined time intervals.
Results. Cerebral oxygen saturation values on the right side were higher
in the sevoflurane group than in the TIVA group. The values on the left
side were higher in the sevoflurane group than in the TIVA group, and
meaningful differences were seen at the lowest temperature and at
36degreeC. Conclusions. Oxygen saturation was higher in the sevoflurane
group than in the TIVA group. Thus, the effect of sevoflurane was useful
for maintaining cerebral oxygen saturation during CBP. &#xa9; Copyright by
Wroclaw Medical University.

<24>
Accession Number
612073913
Author
Calancie B.; Donohue M.L.; Harris C.B.; Canute G.W.; Singla A.; Wilcoxen
K.G.; Moquin R.R.
Institution
(Calancie, Singla, Wilcoxen) 750 E. Adams St., IHP #1213, Syracuse, NY
13210, United States
(Donohue) Cell and Developmental Biology, SUNY Upstate Medical University,
United States
(Harris) Syracuse Orthopedic Specialists, United States
(Canute, Moquin) Crouse Neurosciences, Syracuse, NY, United States
Title
Implantation of thoracic pedicle screws: A blinded and randomized clinical
study. Part 1. Methods and alarm criteria Clinical article.
Source
Journal of Neurosurgery: Spine. 20 (6) (pp 675-691), 2014. Date of
Publication: 2014.
Publisher
American Association of Neurological Surgeons (E-mail:
jnevro@virginia.edu)
Abstract
Reports of the accuracy of existing neuromonitoring methods for detecting
or preventing medial malpositioning of thoracic pedicle screws have varied
widely in their claimed effectiveness. The object of this study was to
develop, test, and validate a novel neuromonitoring method for preventing
medial malpositioning of pedicle screws in the thoracic spine during
surgery. Methods. This is a prospective, blinded and randomized study
using a novel combination of input (4-pulse stimulus trains delivered
within the pedicle track) and output (evoked electromyography from leg
muscles) to detect pedicle track trajectories that-once implanted with a
screw-would cause that screw to breach the pedicle's medial wall and
encroach upon the spinal canal. For comparison, the authors also used
screw stimulation as an input and evoked electromyogram from intercostal
and abdominal muscles as output measures. Intraoperative
electrophysiological findings were compared with postoperative CT scans by
multiple reviewers blinded to patient identity or intraoperative findings.
Results. Data were collected from 71 patients, in whom 802 screws were
implanted between the T-1 and L-1 vertebral levels. A total of 32 screws
ended up with screw threads encroaching on the spinal canal by at least 2
mm. Pulse-Train stimulation within the pedicle track using a ball-Tipped
probe and electromyography from lower limb muscles correctly predicted all
32 (100%) of these medially malpositioned screws. The combination of
pedicle track stimulation and electromyogram response from leg muscles
proved to be far more effective in predicting these medially malpositioned
screws than was direct screw stimulation and any of the target muscles
(intercostal, abdominal, or lower limb muscles) we monitored. Based on
receiver operating characteristic analysis, the combination of 10-mA
(lower alarm) and 15-mA stimulation intensities proved most effective for
detection of pedicle tracks that ultimately gave rise to medially
malpositioned screws. Additional results pertaining to the impact of
feedback of these test results on surgical decision making are provided in
the companion report. Conclusions. This novel neuromonitoring approach
accurately predicts medially malpositioned thoracic screws. The approach
could be readily implemented within any surgical program that is already
using contemporary neuromonitoring methods that include transcranial
stimulation for monitoring motor evoked potentials. Copyright &#xa9; AANS,
2014.

<25>
Accession Number
612035215
Author
Testa L.; Latib A.; Rossi M.L.; De Marco F.; De Carlo M.; Fiorina C.;
Oreglia J.; Petronio A.S.; Ettori F.; De Servi S.; Klugmann S.; Ussia
G.P.; Tamburino C.; Panisi P.; Brambilla N.; Colombo A.; Presbitero P.;
Bedogni F.
Institution
(Testa, Panisi, Brambilla, Bedogni) Istituto Clinico S. Ambrogio, Milan
20149, Italy
(Latib, Colombo) San Raffaele Hospital and EMO-GVM Centro Cuore Columbus,
Milan, Italy
(Rossi, Presbitero) Istituto Clinico Humanitas, Rozzano, Italy
(De Marco, Oreglia, Klugmann) Niguarda Ca Granda Hospital, Milan, Italy
(De Carlo, Petronio) Azienda Ospedaliero- Universitaria Pisana, Pisa,
Italy
(Fiorina, Ettori) Cardiothoracic Department, Spedali Civili, Brescia,
Italy
(De Servi) Azienda Ospedaliera Legnano, Legnano, Italy
(Ussia, Tamburino) Ferrarotto Hospital, Catania, Italy
Title
CoreValve implantation for severe aortic regurgitation: A multicentre
registry.
Source
EuroIntervention. 10 (6) (pp 739-745), 2014. Date of Publication: 01 Oct
2014.
Publisher
EuroPCR
Abstract
Aims: We sought to evaluate the outcome of transcatheter aortic valve
replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in
inoperable patients presenting with severe aortic regurgitation (AR),
compared to in patients treated for severe native aortic stenosis (AS).
Methods and results: From October 2008 to January 2013, 1,557 consecutive
patients undergoing CRS-TAVR, of whom 26 (1.6%) presented with AR, were
prospectively followed. Compared with patients with AS, patients with AR
were significantly younger (mean age 73+/-10 vs. 82+/-6, p=0.02), more
frequently in NYHA Class III/IV (95% vs. 73%, p=0.01) and had a higher
incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31% vs. 10%,
p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device
success was lower in the AR group (79% vs. 96%, p=0.006). At one month,
patients treated for AR had a higher overall mortality (23% vs. 5.9%; OR
4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3% vs. 4%, OR 4.01
[2.40-7.66], p<0.001). Results were consistent at 12 months: overall
mortality (31% vs. 19%, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality
(19.2% vs. 6%, HR 3.1 [2.09-8.22], p<0.001). Conclusions: CRS-TAVR for AR
is associated with a significantly higher mortality compared to CRS-TAVR
for AS. Considering the ominous prognosis of these patients when treated
medically, TAVR may be a reasonable choice in selected patients. In this
regard, conventional risk scores have an inadequate predictive value.
Copyright &#xa9; Europa Digital & Publishing 2014. All rights reserved.

<26>
Accession Number
612079337
Author
Wong W.-T.; Lai V.K.W.; Chee Y.E.; Lee A.
Institution
(Wong, Lai, Lee) The Chinese University of Hong Kong, Department of
Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New
Territories, Hong Kong
(Chee) Queen Mary Hospital, Department of Anaesthesiology, Pokfulam, Hong
Kong
(Lee) The Chinese University of Hong Kong, Hong Kong Branch of The Chinese
Cochrane Centre, The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, Shatin, New Territories, Hong Kong
Title
Fast-track cardiac care for adult cardiac surgical patients.
Source
Cochrane Database of Systematic Reviews. 2016 (9) (no pagination), 2016.
Article Number: CD003587. Date of Publication: 12 Sep 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Fast-track cardiac care is a complex intervention involving
several components of care during cardiac anaesthesia and in the
postoperative period, with the ultimate aim of early extubation after
surgery, to reduce length of stay in the intensive care unit and in the
hospital. Safe and effective fast-track cardiac care may reduce hospital
costs. This is an update of a Cochrane review first published in 2003,
updated in 2012 and updated now in 2016. Objectives: To determine the
safety and effectiveness of fast-track cardiac care compared with
conventional (not fast-track) care in adult patients undergoing cardiac
surgery. Fast-track cardiac care intervention includes administration of
low-dose opioid-based general anaesthesia or use of a time-directed
extubation protocol, or both. Search methods: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE
(January 2012 to May 2015), Embase (January 2012 to May 2015), the
Cumulative Index to Nursing and Allied Health Literature (CINAHL; January
2012 to May 2015) and the Institute for Scientific Information (ISI) Web
of Science (January 2012 to May 2015), along with reference lists of
articles, to identify additional trials. We applied no language
restrictions. Selection criteria: We included all randomized controlled
trials of adult cardiac surgical patients (coronary artery bypass grafts,
aortic valve replacement, mitral valve replacement) that compared
fast-track cardiac care and conventional (not fast-track) care groups. We
focused on the following fast-track interventions, which were designed for
early extubation after surgery: administration of low-dose opioid-based
general anaesthesia during cardiac surgery and use of a time-directed
extubation protocol after surgery. The primary outcome was risk of
mortality. Secondary outcomes included postoperative complications,
reintubation within 24 hours of surgery, time to extubation, length of
stay in the intensive care unit and in the hospital, quality of life after
surgery and hospital costs. Data collection and analysis: Two review
authors independently assessed trial quality and extracted study data. We
contacted study authors for additional information. We calculated a Peto
odds ratio (OR) for risk of mortality and used a random-effects model to
report risk ratio (RR), mean difference (MD) and 95% confidence intervals
(95% CIs) for all secondary outcomes. Main results: We included 28 trials
(4438 participants) in the updated review. We considered most participants
to be at low to moderate risk of death after surgery. We assessed two
studies as having low risk of bias and 11 studies high risk of bias.
Investigators reported no differences in risk of mortality within the
first year after surgery between low-dose versus high-dose opioid-based
general anaesthesia groups (OR 0.53, 95% CI 0.25 to 1.12; eight trials,
1994 participants, low level of evidence) and between a time-directed
extubation protocol versus usual care (OR 0.80, 95% CI 0.45 to 1.45; 10
trials, 1802 participants, low level of evidence). Researchers noted no
significant differences between low-dose and high-dose opioid-based
anaesthesia groups in the following postoperative complications:
myocardial infarction (RR 0.98, 95% CI 0.48 to 1.99; eight trials, 1683
participants, low level of evidence), stroke (RR 1.17, 95% CI 0.36 to
3.78; five trials, 562 participants, low level of evidence) and tracheal
reintubation (RR 1.77, 95% CI 0.38 to 8.27; five trials, 594 participants,
low level of evidence). Comparisons with usual care revealed no
significant differences in the risk of postoperative complications
associated with a time-directed extubation protocol: myocardial infarction
(RR 0.59, 95% CI 0.27 to 1.31; eight trials, 1378 participants, low level
of evidence), stroke (RR 0.85, 95% CI 0.33 to 2.16; 11 trials, 1646
participants, low level of evidence) and tracheal reintubation (RR 1.34,
95% CI 0.74 to 2.41; 12 trials, 1261 participants, low level of evidence).
Although levels of heterogeneity were high, low-dose opioid anaesthesia
was associated with reduced time to extubation (reduction of 4.3 to 10.5
hours, 14 trials, 2486 participants, low level of evidence) and length of
stay in the intensive care unit (reduction of 0.4 to 7.0 hours, 12 trials,
1394 participants, low level of evidence). Use of a time-directed
extubation protocol was associated with reduced time to extubation
(reduction of 3.7 to 8.8 hours, 16 trials, 2024 participants, low level of
evidence) and length of stay in the intensive care unit (reduction of 3.9
to 10.5 hours, 13 trials, 1888 participants, low level of evidence).
However, these two fast-track care interventions were not associated with
reduced total length of stay in the hospital (low level of evidence).
Authors' conclusions: Low-dose opioid-based general anaesthesia and
time-directed extubation protocols for fast-track interventions have risks
of mortality and major postoperative complications similar to those of
conventional (not fast-track) care, and therefore appear to be safe for
use in patients considered to be at low to moderate risk. These fast-track
interventions reduced time to extubation and shortened length of stay in
the intensive care unit but did not reduce length of stay in the hospital.
Copyright &#xa9; 2016 The Cochrane Collaboration.

<27>
Accession Number
612025256
Author
Buggeskov K.B.; Sundskard M.M.; Jonassen T.; Andersen L.W.; Secher N.H.;
Ravn H.B.; Steinbruchel D.A.; Jakobsen J.C.; Wetterslev J.
Institution
(Buggeskov, Sundskard, Andersen, Ravn) Department of Cardiothoracic
Anesthesiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
(Jonassen) Department of Biomedical Sciences, Panum inst, University of
Copenhagen, Copenhagen, Denmark
(Secher) Department of Anesthesiology, Rigshospitalet, Copenhagen, Denmark
(Steinbruchel) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen, Denmark
(Jakobsen, Wetterslev) The Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Rigshospitalet, Copenhagen, Denmark
(Jakobsen) Department of Cardiology, Holbaek Hospital, Denmark
Title
Pulmonary artery perfusion versus no pulmonary perfusion during
cardiopulmonary bypass in patients with COPD: A randomised clinical trial.
Source
BMJ Open Respiratory Research. 3 (1) (no pagination), 2016. Article
Number: e000146. Date of Publication: 01 Sep 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Absence of pulmonary perfusion during cardiopulmonary bypass
(CPB) may be associated with reduced postoperative oxygenation. Effects of
active pulmonary artery perfusion were explored in patients with chronic
obstructive pulmonary disease (COPD) undergoing cardiac surgery. Methods:
90 patients were randomised to receive pulmonary artery perfusion during
CPB with either oxygenated blood (n=30) or
histidine-tryptophanketoglutarate (HTK) solution (n=29) compared with no
pulmonary perfusion (n=31). The coprimary outcomes were the inverse
oxygenation index compared at 21 hours after starting CPB and
longitudinally in a mixed-effects model (MEM). Secondary outcomes were
tracheal intubation time, serious adverse events, mortality, days alive
outside the intensive care unit (ICU) and outside the hospital. Results:
21 hours after starting CPB patients receiving pulmonary artery perfusion
with normothermic oxygenated blood had a higher oxygenation index compared
with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to
1.83; p=0.04). The blood group had also a higher oxygenation index both
longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69;
p=0.007) compared with the HTK group. The latest result corresponds to a
difference in the arterial partial pressure of oxygen of 23 mm Hg with a
median fraction of inspired oxygen of 0.32. Yet the blood or HTK groups
did not demonstrate a longitudinally higher oxygenation index compared
with no pulmonary perfusion (MEM, p=0.57 and 0.17). Similarly, at 21 hours
there was no difference in the oxygenation index between the HTK group and
those no pulmonary perfusion (MD 0.06; 95% CI -0.73 to 0.86; p=0.87).
There were no statistical significant differences between the groups for
the secondary outcomes. Discussion: Pulmonary artery perfusion with
normothermic oxygenated blood during cardiopulmonary bypass appears to
improve postoperative oxygenation in patients with COPD undergoing cardiac
surgery. Pulmonary artery perfusion with hypothermic HTK solution does not
seem to improve postoperative oxygenation. Copyright &#xa9; 2016, BMJ
Publishing Group. All rights reserved.

<28>
Accession Number
612155636
Author
Andersen J.G.; Grepperud S.; Klow N.-E.; Johansen O.
Institution
(Andersen) Oslo University Hospital Ulleval, X-Ray Department, Norway
(Grepperud) Oslo University, Institute of Health and Society, Faculty of
Medicine, Norway
(Klow) Oslo University Hospital Ulleval, X-Ray Department, The University
of Oslo, Norway
(Johansen) The Section for Interventional Cardiology, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
Title
Effects on length of stay and costs with same-day retransfer to the
referring hospitals for patients with acute coronary syndrome after
angiography and/or percutaneous coronary intervention.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (4) (pp 375-380),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Fast track interventions may generate benefits for patients
and hospitals by representing a potential for shorter hospital stay. The
aim of this study was to investigate how same-day retransfers to the
referring hospital after angiographic examination and/or percutaneous
coronary intervention (PCI) at the PCI centre affected length of stay and
hospital treatment costs for patients with acute coronary syndrome.
Methods and results: Three hundred and ninety-nine consecutive admitted
patients were prospectively randomized to ordinary care with overnight
stay or fast track with same-day retransfer. Length of stay at both the
PCI centre and the referring hospital after the stay at the PCI centre
were recorded. Costs at the PCI centre related to examinations and
treatments were also collected. The ordinary care group included 206
patients and the fast track group 193 patients. Forty-six per cent
underwent PCI and 10% coronary artery bypass graft (CABG) in the ordinary
care group. In the fast track group 40% had PCI and 6% CABG. Length of
stay was reduced at the PCI centre from a median 1.25 days for the
ordinary care group to median 0.24 days for the FT group (p<0.001). Length
of stay at the PCI centre was significantly reduced after selective
coronary angiography and PCI but not for patients undergoing CABG. No
significant difference was identified in length of stay for the referring
hospitals. Total median treatment costs were reduced from NOK23,657
(US$3838) for the ordinary care group to NOK15,730 (US$2552) for the fast
track group (p<0.001). The main contributor to this reduction was shorter
length of stay and the corresponding reduction in ward costs at the PCI
centre. Conclusions: We conclude that fast-track intervention with
same-day retransfer for patients with acute coronary syndrome to the
referring hospital reduced length of stay and the hospital treatment costs
for patients undergoing selective coronary angiography and PCI. Copyright
&#xa9; The European Society of Cardiology 2015.

<29>
Accession Number
612132041
Author
Zokaei A.; Aghdaei N.; Ahmadi S.J.
Institution
(Zokaei, Aghdaei, Ahmadi) School of Medicine, Kermanshah University of
Medical Sciences, Kermanshah, Iran, Islamic Republic of
Title
The effect of various amount of heparin on analysis of arterial blood gas
in adult patients undergoing open heart surgery.
Source
Research Journal of Medical Sciences. 10 (4) (pp 191-193), 2016. Date of
Publication: 2016.
Publisher
Medwell Journals (E-mail: medwellonline@gmail.com)
Abstract
There are still questions regarding the effect of heparin on the accuracy
of blood gas determination. The different dilutions of heparin may affect
arterial blood gas analysis differently. The aim of the present study is
to assess the effects of the different volumes of heparin added to blood
sample of patients undergoing Coronary Artery Bypass Graft (CABG) surgery
or valvular surgery. This randomized clinical trial was performed on 70
patients who were candidates for elective cardiac procedures including
CABG surgery orvalvular surgery. From each patient three simultaneous
blood samples were collected each with one of the three amounts of heparin
(50, 200 and 500 units) by using a 1-cc blood sample with a 5-cc syringe.
There was no significant differences in the three groups receiving the
different amounts of heparin in terms of PH (p = 0.629), PaO<inf>2</inf>
(p = 0.711) and O<inf>2</inf> saturation (p = 0.965) while the three
indices of PaCO<inf>2</inf> (p = 0.008), HC0<inf>3</inf> (p = 0.001) and
base excess (p = 0.001) all reduced by the increase in heparin volume in
the syringes. Laboratory parameters such as serum sodium (Na) gradually
increased (p = 0.004) by increasing in syringe the volume of heparin in
the syringe while serum potassium (K), serum hemoglobin and serum
hematocrit significantly decreased (p<0.05). Lactate level was independent
to of the volume of heparin in the syringe (p = 0.231). Copyright &#xa9;
Medwell Journals, 2016.

<30>
Accession Number
612124923
Author
Nasreen A.; Khuwaja A.M.; Akhtar P.; Amjad N.; Rao Z.A.
Institution
(Nasreen, Khuwaja, Akhtar, Amjad) National Institute of Cardiovascular
Diseases, Bahria University Medical and Dental College, Rafiqui Shaheed
Road, Karachi, Pakistan
(Rao) Department Anesthesiology, Bahria University Medical and Dental
College, Sailor Street, Karachi, Pakistan
Title
A randomized comparison of ultrasound guided versus direct palpation
method of radial artery cannulation techniques in adult patients
undergoing open heart surgery.
Source
Anaesthesia, Pain and Intensive Care. 20 (1) (pp 38-42), 2016. Date of
Publication: January-March 2016.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Background & Objective: The use of two dimensional ultrasound technique
allows radial artery cannulation to take place under real time
visualization and may increase the success rate of first time pass of the
needle and reduce the complications of the invasive procedure compared to
traditional palpation and trial method. We aimed to compare the success
rate of radial arterial catheter insertion at first attempt and average
time for successful first attempt by traditional palpation method with
ultrasound guided technique in adult patients undergoing open heart
surgery. Methodology: A randomized study was conducted at our hospital
during a 12 months period from 1st January 2014 to 31 st December 2014.
After taking permission from hospital ethical committee, one hundred adult
patients were enrolled in whom radial artery cannulation was required
prior to open heart surgical procedures including CABG, valvular heart
disease, atrial septal and ventricular septal defect repairs and total
correction. Patients were divided in two equal groups. In Group I radial
artery cannulation was performed by ultrasound guidance and in Group II it
was done by palpation method; in both groups Seldinger technique was used.
Demographic and medical data were recorded in both groups. Heart rate, and
invasive blood pressure monitoring was done in the arm in which the
catheter was going to be inserted. Allen test with the help of pulse
oximeter was also performed in all patients for detecting adequacy of
ulnar artery flow. Time to first successful cannulation and the number of
attempts were noted. Computer software SPSS 19.0 was used for data
statistical analysis, the Chi-square/Fisher's exact test used for the
comparison of qualitative/categorical variable in between groups.
Student's t-Test used for comparison of quantitative / continuous
variables in between groups. Results: Average time to first successful
attempt was 72.4 +/- 23.0 sec vs. 94.6 +/- 13.7 sec in Group I and II
respectively (p=0.001). Average number of attempts at same radial artery
was significandy less in ultrasound group (1.4 +/- 1.0) as compared to
palpation group (2.0 +/- 0.7) (p=0.001). Ultrasound group (Group 1) had
successful insertion at the first attempt in 36 (72%) patients, as
compared to 32 (64%) patients in (Group II), but the difference was
statistically not significant (p = 0.391). Conclusion: Average time for
successful first attempt was significandy less for radial artery
cannulation performed by two dimensional ultrasound guidance as compared
to palpation method; however, it did not significandy increase the success
rate of first time cannulation of radial artery.

<31>
Accession Number
612114848
Author
Heiberg J.; El-Ansary D.; Royse C.F.; Royse A.G.; Alsaddique A.A.; Canty
D.J.
Institution
(Heiberg, Royse, Canty) Department of Anaesthesia and Pain Management,
Royal Melbourne Hospital, Melbourne, VIC, Australia
(El-Ansary) Department of Physiotherapy, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Royse) Department of Surgery, Royal Melbourne Hospital, Melbourne, VIC,
Australia
(Alsaddique) Department of Cardiothoracic Surgery, King Fahad Cardiac
Centre, Riyadh, Saudi Arabia
Title
Transthoracic and transoesophageal echocardiography: a systematic review
of feasibility and impact on diagnosis, management and outcome after
cardiac surgery.
Source
Anaesthesia. 71 (10) (pp 1210-1221), 2016. Date of Publication: 01 Oct
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Transthoracic and transoesophageal echocardiography are increasingly used
as tools to improve clinical assessment following cardiac surgery.
However, most physicians are not trained in echocardiography, and there is
no widespread agreement on the feasibility, indications or effect on
outcome of transthoracic or transoesophageal echocardiography for patients
after cardiac surgery. We performed a systematic review of electronic
databases for focused transthoracic and transoesophageal echocardiography
after cardiac surgery which revealed 15 full-text articles. They
consistently reported that echocardiography is feasible, whether performed
by a novice or expert, and frequently resulted in important changes in
diagnosis of cardiac abnormalities and their management. However, most
were observational studies and there were no well-designed trials
investigating the impact of echocardiography on outcome. We conclude that
both transthoracic and transoesophageal echocardiography are useful
following cardiac surgery. Copyright &#xa9; 2016 The Association of
Anaesthetists of Great Britain and Ireland

<32>
Accession Number
612061872
Author
Veronesi G.; Novellis P.; Voulaz E.; Alloisio M.
Institution
(Veronesi, Novellis, Voulaz, Alloisio) Thoracic Surgery Division,
Humanitas Cancer Center, Rozzano, Italy
Title
Robot-assisted surgery for lung cancer: State of the art and perspectives.
Source
Lung Cancer. 101 (pp 28-34), 2016. Date of Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
The robotic surgical system is the result of a long process of development
aimed at producing a natural extension of the surgeon's eyes and hands via
the intermediation of a computer. In this way, the ease of movement
obtained with open surgery is summated with the advantages of the
minimally invasive technique. Since 2000, when the first robotic system
for surgery was introduced, robot-assisted thoracic surgery (RATS) has
been adopted by an increasing number of centres around the world, and
today is used in ~10% of lobectomies in the US. Here, we review the
characteristics and function of the robotic system available today
(namely, Intuitive Surgical Inc.'s da Vinci Surgical System), outline the
different techniques for major lung resection via RATS, compare RATS with
video-assisted thoracoscopic surgery (VATS) and thoracotomy, and speculate
on future developments. To date, no randomized trials have reported
comparative data on RATS vs. VATS/thoracotomy for lung cancer.
Retrospective analysis comparing RATS vs. thoracotomy have revealed
advantages for the former, especially shorter hospital stays and a lower
complication rate, but RATS produces similar or only slightly better
results to VATS, the two being minimally invasive techniques with no need
for rib separation. A few studies have reported RATS to be safer than
VATS, with less conversions for bleeding, less complications; in others,
it was associated with lower postoperative consumption of pain killers and
quicker return of patients to normal activity. In addition, lymphnode
upstaging has been shown to be higher with RATS than with VATS, with a
similar rate as thoracotomy. The main disadvantage of RATS is the higher
costs of instrumentation. Nevertheless, the future will probably see
reductions in the costs and improvements in the instrumentation,
integration with 3D imaging to improve virtual reality, and more patients
benefitting from minimally invasive procedures for lung malignancies.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<33>
[Use Link to view the full text]
Accession Number
612113902
Author
Anonymous
Title
Erratum: 2016 ACC/AHA guideline focused update on duration of dual
antiplatelet therapy in patients with coronary artery disease: A report of
the American College of Cardiology/American Heart Association Task Force
on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI
Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA guideline
for coronary artery bypass graft surgery, 2012
ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management
of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline
for the management of ST-elevation myocardial infarction, 2014 AHA/ACC
guideline for the management of patients With Non-ST-elevation acute
coronary syndromes, and 2014 ACC/AHA guidelineon perioperative
cardiovascular evaluation and management of patients undergoing noncardiac
surgery (Circulation (2016) 134 (e123-e155) DOI:
10.1161/CIR.0000000000000404).
Source
Circulation. 134 (10) (pp e192-e194), 2016. Date of Publication: 06 Sep
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article by Levine et al, "2016 ACC/AHA Guideline Focused Update on
Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery
Disease: A Report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice Guidelines: An Update of the
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011
ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012
ACC/AHA/ACP/AATS/PCNA/ SCAI/STS Guideline for the Diagnosis and Management
of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline
for the Management of STElevation Myocardial Infarction, 2014 AHA/ACC
Guideline for the Management of Patients With Non-ST-Elevation Acute
Coronary Syndromes, and 2014 ACC/ AHA Guideline on Perioperative
Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac
Surgery," which published online March 29, 2016, and appeared in the
September 6, 2016, issue of the journal (Circulation. 2016;134:e123-e155.
DOI: 10.1161/CIR.0000000000000404.), several corrections were needed. 1.
On pages e124 and e134, corrections have been made to the section 5 title:
In the table of contents and the text, the section title read, "CABG:
Recommendations." It has been updated to read, "Recommendations for
Duration of DAPT in Patients Undergoing CABG." In the recommendations
table, the table title read, "Recommendations for CABG." It has been
updated to read, "Recommendations for Duration of DAPT in Patients
Undergoing CABG." 2. On pages e124 and e135, corrections have been made to
the section 6 title: In the table of contents and the text, the section
title read, "SIHD: Recommendations." It has been updated to read,
"Recommendations for Duration of DAPT in Patients With SIHD." In the
recommendations table, the table title read, "Recommendations for SIHD."
It has been updated to read, "Recommendations for Duration of DAPT in
Patients With SIHD." 3. On page e124, right-hand column, second paragraph,
the second sentence read, "This process entails delineation of a
recommendation addressing a specific clinical question, followed by
concise text (ideally <500 words) and hyperlinked to supportive evidence."
It has been updated to read, "This process entails delineation of a
recommendation addressing a specific clinical question, followed by
concise text (ideally <250 words per recommendation) and hyperlinked to
supportive evidence." 4. On page e127, left-hand column, first paragraph,
the last sentence read, "See the ERC systematic review report, "Duration
of Dual Antiplatelet Therapy: A Systematic Review for the 2016 Guideline
Update," for the complete evidence review report.30" It has been updated
to read, "See the ERC systematic review report, "Duration of Dual
Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline
Focused Update on Duration of Dual Antiplatelet Therapy in Patients With
Coronary Artery Disease" for the complete evidence review report.30" 5. On
page e127, left-hand column, fourth paragraph, the last sentence read,
"This document was approved for publication by the governing bodies of the
ACC and the AHA and was endorsed by the American Association for Thoracic
Surgery, American Society of Anesthesiologists, Preventive Cardiovascular
Nurses Association, Society for Cardiovascular Angiography and
Interventions, Society of Cardiovascular Anesthesiologist, and the Society
of Thoracic Surgeons." It has been updated to read, "This document was
approved for publication by the governing bodies of the ACC and the AHA
and was endorsed by the American Association for Thoracic Surgery,
American Society of Anesthesiologists, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions,
Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons,
and Society for Vascular Surgery." 6. On page e130, in Figure 1, the text
in the cell in the third row, second column of the algorithm read, "No Hx
PCI or recent CABG". It has been updated to read, "No Hx of MI, PCI or
recent (within 12 mo) CABG." 7. On page e133, in section 4.1, in the
recommendations table titled "Recommendations for Duration of DAPT in
Patients With SIHD Treated With PCI," several corrections have been made:
The Class I, LOE A recommendation 1 read, "In patients with SIHD treated
with DAPT after BMS implantation, P2Y12 inhibitor therapy with clopidogrel
should be given for a minimum of 1 month.94,95" It has been updated to
read, "In patients with SIHD treated with DAPT after BMS implantation,
P2Y12 inhibitor therapy (clopidogrel) should be given for a minimum of 1
month.94,95" The Class I, LOE B-R, recommendation 2 read, "In patients
with SIHD treated with DAPT after DES implantation, P2Y12 inhibitor
therapy with clopidogrel should be given for at least 6
months.17,18,21,30,96,97" It has been updated to read, "In patients with
SIHD treated with DAPT after DES implantation, P2Y12 inhibitor therapy
(clopidogrel) should be given for at least 6 months.17,18,21,30,96,97" The
Class I, LOE B-NR recommendation 3 read, "In patients treated with DAPT,
the recommended daily dose of aspirin is 81 mg (range, 75 mg to 100
mg).56-60,75-78" It has been updated to read, "In patients treated with
DAPT, a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is
recommended.56-60,75-78" 8. On page e133, in section 4.2, right-hand
column, in the recommendations table titled "Recommendations for Duration
of DAPT in Patients With ACS Treated With PCI," the Class I, LOE B-NR
recommendation 2 read, "In patients treated with DAPT, the recommended
daily dose of aspirin is 81 mg (range, 75 mg to 100 mg).56-60,75-78" It
has been updated to read, "In patients treated with DAPT, a daily aspirin
dose of 81 mg (range, 75 mg to 100 mg) is recommended.56-60,75-78" 9. On
page e135, in section 6, right-hand column, in the recommendations table
titled "Recommendations for Duration of DAPT in Patients With SIHD," the
classification for recommendation 2, "In patients with SIHD treated with
DAPT after DES implantation, P2Y12 inhibitor therapy (clopidogrel) should
be given for at least 6 months.17,18,21,30,96,97" read, LOE "B-NR." It has
been updated to read, LOE "B-R." 10. On page e137, in section 7.1,
right-hand column, in the recommendations table titled "Recommendations
for Duration of DAPT in Patients With ACS Treated With Medical Therapy
Alone," several corrections have been made: The Class I, LOE B-R
recommendation 1 read, "In patients with ACS who are managed with medical
therapy alone (without revascularization or fibrinolytic therapy) and
treated with DAPT, P2Y12 inhibitor therapy (either clopidogrel or
ticagrelor) should be continued for at least 12 months.52,71,140,141" It
has been updated to read, "In patients with ACS who are managed with
medical therapy alone (without revascularization or fibrinolytic therapy)
and treated with DAPT, P2Y12 inhibitor therapy (clopidogrel or ticagrelor)
should be continued for at least 12 months.52,71,140,141" The Class IIa,
LOE B-R recommendation 3 read, "In patients with NSTE-ACS who are managed
with medical therapy alone (without revascularization or fibrinolytic
therapy) treated with DAPT, it is reasonable to use ticagrelor in
preference to clopidogrel for maintenance P2Y12 inhibitor therapy.53,71"
It has been updated to read, "In patients with NSTE-ACS who are managed
with medical therapy alone (without revascularization or fibrinolytic
therapy) and treated with DAPT, it is reasonable to use ticagrelor in
preference to clopidogrel for maintenance P2Y12 inhibitor therapy.53,71"
11. On page e139, in Figure 4, the text in the cell in the second row,
second column read, "No Hx of MI, PCI or recent CABG." It has been updated
to read, "No Hx of MI, PCI or recent (within 12 mo) CABG." 12. On page
e151, in Appendix 2, the employment for Joseph S. Alpert read, "University
of Arizona Health Sciences Center- Professor of Medicine, Head of
Department of Medicine." It has been updated to read, "University of
Arizona Health Sciences Center- Clinical Professor of Medicine, Head of
Department of Medicine." 13. In the Data Supplement, page 20, Data
Supplement 7, "RCTs Comparing Antiplatelet Therapy With Anticoagulant
Therapy in Patients Undergoing Coronary Stenting," several corrections
have been made: In the first row "STARS", fourth column "Study
Intervention," Intervention 3 read, "ASA + ticagrelor." It has been
updated to read, "ASA + ticlopidine." In the first row "STARS," fifth
column "Endpoint Results," the first bullet under "1 endpoint" read "3.6%
with ASA alone; 2.7% with ASA + warfarin; 0.5% with ASA + ticagrelor
(p=0.001 for the comparison of all 3 groups)." It has been updated to
read, "3.6% with ASA alone; 2.7% with ASA + warfarin; 0.5% with ASA +
ticlopidine (p=0.001 for the comparison of all 3 groups)." These
corrections have been made to the current online version of the article,
which is available at http://
circ.ahajournals.org/content/134/10/e123.full. Copyright &#xa9; 2016
American Heart Association, Inc.

<34>
Accession Number
612009391
Author
Allende R.; Webb J.G.; Munoz-Garcia A.J.; De Jaegere P.; Tamburino C.;
Dager A.E.; Cheema A.; Serra V.; Amat-Santos I.; Velianou J.L.; Barbanti
M.; Dvir D.; Alonso-Briales J.H.; Nuis R.-J.; Faqiri E.; Imme S.; Benitez
L.M.; Cucalon A.M.; Al Lawati H.; Del Blanco B.G.; Lopez J.; Natarajan
M.K.; DeLarochelliere R.; Urena M.; Ribeiro H.B.; Dumont E.;
Nombela-Franco L.; Rodes-Cabau J.
Institution
(Allende, DeLarochelliere, Urena, Ribeiro, Dumont, Nombela-Franco,
Rodes-Cabau) QuebecHeart and Lung Institute, Laval University, Quebec
city, QC, Canada
(Webb, Barbanti, Dvir) St Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada
(Munoz-Garcia, Alonso-Briales) Hospital Universitario Virgen de la
Victoria, Malaga, Spain
(De Jaegere, Nuis, Faqiri) Thoraxcenter-Erasmus MC, Rotterdam, Netherlands
(Tamburino, Imme) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Dager, Benitez, Cucalon) Angiografia de Occidente S.A., Cali, Colombia
(Cheema, Al Lawati) St-Michael's Hospital, Toronto, ON, Canada
(Serra, Del Blanco) Hospital General Universitari Vall D'Hebron,
Barcelona, Spain
(Amat-Santos, Lopez) Hospital Clinico Universitario de Valladolid,
Valladolid, Spain
(Velianou, Natarajan) Hamilton General Hospital, Hamilton, ON, Canada
Title
Advanced chronic kidney disease in patients undergoing transcatheter
aortic valve implantation: Insights on clinical outcomes and prognostic
markers froma large cohort of patients.
Source
European Heart Journal. 35 (38) (pp 2685-2696), 2014. Date of Publication:
07 Oct 2014.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aim Theaimof this studywastodeterminetheeffects ofadvancedchronic
kidneydisease(CKD)onearlyandlateoutcomes after transcatheter aortic valve
implantation (TAVI), and to evaluate the predictive factors of poorer
outcomes in such patients. Methods and results This was a multicentre
study including a total of 2075 consecutive patients who had undergone
TAVI. Patients were grouped according the estimated glomerular filtration
rate as follows: CKD stage 1-2 (>60 mL/min/1.73 m²; n = 950),
stage 3 (30-59 mL/min/1.73 m²; n= 924), stage 4 (15.29
mL/min/1.73 m²; n= 134) and stage 5 (,15 mL/ min/1.73
m² or dialysis; n= 67). Clinical outcomes were evaluated at
30-days and at follow-up (median of 15 [6.29] months) and defined
according to the VARC criteria. Advanced CKD (stage 4.5) was an
independent predictor of 30-day major/life-threatening bleeding (P= 0.001)
and mortality (P= 0.027), and late overall, cardiovascular and
noncardiovascular mortality (P < 0.01 for all). Pre-existing atrial
fibrillation (HR: 2.29, 95% CI: 1.47.3.58, P= 0.001) and dialysis therapy
(HR: 1.86, 95% CI: 1.17.2.97, P= 0.009)were the predictors of mortality in
advanced CKDpatients, with a mortality rate as high as 71% at 1-year
follow-up in those patients with these 2 factors. Advanced CKD patients
who had survived at 1-year follow-up exhibited both a significant
improvement inNYHAclass (P < 0.001) and no deterioration in valve
hemodynamics (P= NS for changes in mean gradient and valve area over
time). Conclusions AdvancedCKDwas associatedwith a higher rate of early
and latemortality and bleeding events followingTAVI,with AFand dialysis
therapy determining a higher risk in these patients. Themortality rate of
patientswith both factorswas unacceptably high and this should be taken
into account in the clinical decision-making process in this challenging
group of patients. Copyright &#xa9; The Author 2014.

<35>
Accession Number
612173174
Author
Maharramova M.; Taylor K.
Institution
(Maharramova, Taylor) Hospital for Sick Children, Anesthesia Department,
Toronto, Canada
Title
The effect of caudal anesthesia on postoperative outcomes in pediatric
cardiac surgery patients.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e34), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Caudal Anesthesia is a common technique in
pediatrics, due to its high success and low complication rates.
Increasingly pediatric cardiac surgery patients are 'fast-tracked' to
early extubation, which results in reduced: ventilator associated
complications, sedative use, parental stress, reduced length of stay (LOS)
and costs.1 However, these benefits have not been systematically examined.
Therefore, we performed a systematic review of the literature. Methods: A
librarian assisted literature search of MEDLINE, Embase, Web of Science
and hand-searching references was performed to locate randomized or
controlled clinical trials. Any caudal medication was included. Early
extubation, pain scores, hemodynamics, stress response and LOS were
examined. Results: Sixteen studies were identified (n=1759). Caudal
medications included dexmedetomidine, bupivacaine, sufentanil, morphine,
fentanyl and neostigmine. Seven studies reported earlier extubation in
patients with caudal anesthesia. Cardio-pulmonary bypass (CPB) and
surgical duration mitigate early extubation anesthetic strategies. Three
studies showed reduced pain scores and need for opiates, while one study
showed no difference. Two studies showed a reduction in stress response,
and two studies showed improved hemodynamics. Four studies showed reduced
hospital LOS. Conclusions: Caudal anesthesia, although safe and popular in
pediatrics, has only modest experience in cardiac surgery. Caudal
anesthesia may be favorable for early extubation, improved pain and
hemodynamics and reduced LOS. Being limited by heterogeneous populations,
variable painmeasurement scales and variable endpoints for extubation, our
review suggests caudal anesthesia facilitated earlier extubation with
lower pain scores and some reduction in LOS. Older patients with short CPB
times are most likely to benefit.

<36>
Accession Number
612172985
Author
Parras T.
Institution
(Parras) Department of Anesthesia, St Georges Hospital, London, United
Kingdom
Title
Con: When regional anesthesia is used for breast surgerya paravertebral
block is better than a PECS block!.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e21-e22), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Breast cancer is the most common cancer affecting women, accounting for
31% of all new cancer cases in the female population (1). Breast cancer
surgeries cause significant acute pain and may progress to chronic pain
states in 25% to 60% of patients (2). Acute postoperative pain is an
integral risk factor in the development of chronic postmastectomy pain;
40% of women will have severe acute postoperative pain after breast cancer
surgery, whereas 50% will develop chronic postmastectomy pain with
impaired quality of life. Regional anesthesia techniques have provided
better-quality acute-pain control and subsequently less chronic pain (3).
Several forms of regional techniques like local anesthetic infiltration,
intercostals nerve block, epidural block, and paravertebral block (PVB)
have been used for management of pain after breast surgery. Thoracic
paravertebral injection of local anesthetic at multiple levels (C7- T6) or
as a single injection at T4 in conjunction with intraoperative sedation is
safe and effective for surgical anesthesia in a majority of patients
undergoing major breast surgery (4). Ipsilateral PVB have been used to
provide analgesia for breast surgery, but this block may be not suitable
in all breast surgeries (5). Coveney et al (6) reported that inadequacy of
block after multiple injections was 15%, while Pusch et al (7) reported
that the inadequacy of block was 19% after single injection during
axillary dissection. The Pecs block is an easy and reliable superficial
block described by Blanco (8) that targets the lateral and median pectoral
nerves at an interfascial plane between the pectoralis major and minor. It
can be used for different breast operations but we mainly use it for
breast expanders and subpectoral prosthesis. Pecs II or Pecs I modified
aims to block the lateral branches of the intercostal nerves (T2-T6), long
thoracic nerve, and intercostobrachial nerves. It has been described for
providing analgesia for breast surgeries including lumpectomy, wide
excisions, axillary clearances, sentinel node dissection, and several
types of mastectomies (9). A recently published clinical study has shown
the effectiveness of combined Pecs I and II blocks in breast surgeries
(10). Major breast surgery involving axilla, it seems necessary to block
pectoralis nerves and intercostobrachiallis nerves separately. The
pectoral nerves aremajor nerves arising from the brachial plexus
innervating the pectoral muscles. The lateral pectoral nerve arises most
commonly from C5, C6 and C7 and the median pectoral nerve from C8 and T1,
not being able to be blocked performing a paravertebral block. PVB for
surgical anesthesia is associated with less pain during the immediate
postoperative period, as well as less postoperative nausea and vomiting,
and greater patient satisfaction compared with general anesthesia (11).
Similarly, lower pain scores were observed in patients undergoing modified
radical mastectomy (MRM) with preemptive Pecs I and II blocks than in the
controls. Perioperative opioid use, including intraoperative fentanyl as
well as postoperative morphine, was lower in the Pecs group. This study
also revealed lower opioid-related adverse effects with lower sedation and
PONV scores in the Pecs group. Moreover, PACU and hospital stays were
shorter in the Pecs group compared with that in the control group (12). A
prospective randomized study comparing Pecs vs PVB showed that Pecs block
performed in patients before MRM resulted in less postoperative morphine
consumption in the first 24 h with lower intensity of pain in the first 12
h in comparison with PVB. Intraoperative fentanyl consumption was
significantly lower in patients of Pecs group in comparison with PVB
group. Patients' satisfaction was almost comparable between both
techniques in respect to postoperative analgesia (13). Regarding the
complications, empyema, tumor occupying the thoracic paravertebral space
are some of the few contraindications for PVB. Concerns about epidural
hematoma have led to the proliferation of widely accepted practice
guidelines when providing neuraxial anesthetic techniques. The degree to
which these same risks hold true for the provision of paravertebral
anesthesia remains controversial. A coagulopathy, bleeding disorder or
therapeutic anticoagulation are considered as relative contraindications
for thoracic PVB (14). One must exercise caution in patients with
kyphoscoliosis and patientswho have had previous thoracotomy. Chest
deformity in the former may predispose to thecal or pleural puncture,
whereas obliteration of the thoracic PVS by scar tissue and adhesion of
the lung to the chest wall in the latter may predispose to pleural and
pulmonary puncture. Nevertheless, Pecs blocks should be considered if any
of these contraindications or concerns for performing a PVB appear. Pecs
are peripheral and superficial blocks with no contraindications to be
performed if the patient has any coagulopathy. Moreover, they are ideal
for patients with spinal or chest deformity or had any previous thoracic
surgery. It is difficult to know the complication rate of PVB, Richardson
et al (4) estimated it to be 5%, whereas Coveney et al (6) retrospectively
reviewed 156 consecutive cases of PVB using the multiple-injection
technique and noted that complications occurred in only four cases (2.6%).
Reported complications are also rare, and include pleural puncture (0.8%),
pneumothorax (0.5%), inadvertent vascular puncture (3.8% to 6.8%),
hypertension (4.6%), hypotension (4.0%); haematoma (2.4%), pain at site of
skin puncture (1.3%), signs of epidural, or intrathecal spread (1.0%) in
paravertebral block (11). Inadvertent pleural puncture is uncommon and may
or may not result in a pneumothorax. Transient ipsilateral or bilateral
Horner syndrome can also develop. Medial spread through the intervertebral
foramen into the epidural space has been observed fluoroscopically (15).
No reports of mortality due to the PVB technique itself were found in the
literature (11). One potential concern with PVB is that because of the
close relationship of the paravertebral space to the parietal pleura and
central neuraxial structures, incorrect needle placement may result in
lung injury including pleural puncture and pneumothorax, or epidural
spread or spinal anesthesia. On the other hand, the potential
complications of Pecs blocks are intravascular injection, due to proximity
of the acromiothoracic artery, that runs in the fascial plane between
pectoralis major and minor muscles. We need to be aware of the risk of
local anesthetic systemic toxicity, in the casewe are performing bilateral
blocks, we must check the total amount of local anesthetic administered.
In Pecs II, the pleura is located underneath the serratus anterior muscle
and easily visualized between two ribs. Placing the tip of the needle when
pectoralis minor ends and serratus anterior appears, and aiming the rib,
the risk of piercing the pleura is very low. There are no vital structures
that could be damaged around the target point for Pecs blocks. More
potential disadvantages of the PVB are the potential need of multiple
injections, sedation should be convenient as the injection could be
painful, the patient position must be sitting or lateral, and in our
experience comparing with Pecs blocks, PVB technique requires a longer
learning curve and the success rate is lower. Meanwhile Pecs block covers
from intercostal nerves from T3 to T6 with no need of multiple injections.
Sedation is not required, as Pecs I, II blocks are fascial blocks and we
do not need to identify any nerve in the scanning, therefore there is no
advantage of performing the block with the patient awake. The patient
position is in supine, making the technique easier. Our experience in
teaching Pecs technique and performing a successful block, shows the
learning curve is shorter than others blocks as interscalene, sciatic
blocks or PVB. As explained above, PVB does not block medial and lateral
pectoral, intercostobrachialis, long thoracic, or thoracodorsal nerves.
Therefore, during breast surgeries involving axillary dissection, lack of
adequate analgesia is definitely coexisting. In conclusion, Pecs is a
potential analgesic technique alternative to PVB after breast surgery,
with lower potential complications rate, avoiding the sideeffect profile
of the PVB. Pending more randomized controlled clinical trials comparing
PVBs versus Pecs blocks.

<37>
Accession Number
612172981
Author
Yoshida T.; Watanabe Y.; Hashimoto T.; Ohta A.; Furutani K.; Nakamoto T.;
Baba H.
Institution
(Yoshida, Nakamoto) Kansai Medical University Hospital, Department of
Anesthesiology, Hirakata-city, Japan
(Watanabe, Furutani, Baba) Niigata University, Graduate School of Medical
and Dental Sciences, Division of Anesthesiology, Niigata-city, Japan
(Hashimoto) Nagaoka ChuoGeneral Hospital, Department of Anesthesiology,
Nagaoka-city, Japan
(Ohta) Niigata University, Graduate School of Medical and Dental Sciences,
Department of Radiology and Radiation Oncology, Niigata-city, Japan
Title
Effects of cathetertip location on the spread of sensory block caused bya
continuous thoracic paravertebral block: A prospective, randomized,
controlled, double-blind study.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e78-e79), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Single injections in the ventral region of the
thoracic paravertebral space (TPVS) tend to generate a multi-segmental
longitudinal spreading pattern. We examined the hypothesis that continuous
thoracic paravertebral block (CTPVB) administered through a catheter
inserted into the ventral region of the TPVS allows a wider sensory block
dispersion. Methods: This study was approved by the Research Ethics
Committee of our institute, and 50 consecutive patients undergoing
video-assisted thoracic surgeries were enrolled. Before the surgery, an
infusion catheter was inserted into the TPVS adjacent to either the
parietal pleura (P group) or internal intercostal membrane (I group),
using an ultrasound-guided intercostal transverse approach, according to a
randomized allocation schedule. After the surgery, a chest radiograph was
obtained after injection of radiopaque dye through the catheter.
Thereafter, CTPVB with 0.25% levobupivacaine was initiated at 8 mL/h. The
primary outcome was the number of blocked dermatomes 24 h after surgery.
The secondary outcomes included the number of segments covered by the dye.
A p value < 0.05 was considered statistically significant. Results: The
median (interquartile range [range]) number of blocked dermatomes 24 h
after the surgery was 3 (2.75-4 [1-6]) in the P group (n = 22) and 2
(1.5-3 [0-7]) in the I group (n = 25) (p = 0.04). No significant
differences were found in the other outcomes between the groups.
Conclusions: CTPVB administered using the catheter inserted adjacent to
the parietal pleura allows awider sensory block dispersion compared to the
catheter inserted adjacent to the internal intercostal membrane.

<38>
Accession Number
612172890
Author
Rawal N.
Institution
(Rawal) Department of Clinical Medicine, Division of Anaesthesiology and
Intensive Care, University Hospital Orebro, Orebro, Sweden
Title
Regional anaesthesia and outcome: Infiltrative techniques.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e9-e10), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Regional techniques are well-accepted as the most effective methods to
treat postoperative pain. There is good evidence that such techniques are
associated with improved postoperative outcome. The question is which
regional technique improves outcome the most, clearly the knowledge of
risk-benefit ratio of different regional techniques is crucial before
making the choice. In the opinion of this author, there is increasing
evidence that infiltrative techniques, often surgeon-delivered, meet the
above criteria and are the most practical way forward. Epidural technique
is no longer the gold standard for managing postoperative pain and it's
use is decreasing (see separate abstract elsewhere in this issue).
Peripheral nerve blocks provide excellent analgesia and their use is
increasing, especially with the widespread application of
ultrasound-guided techniques, but this increase is from a very low base.
For example, a recent US database report from over 400 acute care
hospitals with 191,570 patients undergoing total knee arthroplasty (one of
the commonest indication for peripheral nerve blocks) showed that only
12.1%of patients received postoperative analgesia with peripheral nerve
blocks(1). Data from France and elsewhere is equally disappointing (2).
Anaesthesiologists have known about the many benefits of peripheral blocks
for decades but routine use of these techniques remains restricted to a
minority of institutions. In the opinion of this author every patient
undergoing surgery should have a local anaesthesia-based multimodal
postoperative pain management strategy. If, for whatever reason,
peripheral blocks are not possible then surgeon-administered infiltrative
techniques are an excellent alternative. Indeed, current evidence suggests
that these techniques can be as effective in a large variety of surgical
procedures. Infiltrative techniques are simple and the least invasive of
all regional techniques for postoperative pain management. Depending on
the surgical procedure, they can be stand-alone or part of multimodal
regimens. These techniques can be single-dose infiltration or catheter
infusions for prolonged analgesia. Catheter wound infusions(CWI) have also
been used in the home envoirnment for ambulatory surgery patients since
1997(3) The widespread use of this modality has also revealed some
confusing aspects of the technique. In the literature the termCWI is
frequently used, however Surgical Site Catheter Infusion (SSCI) would
bemore appropriate because catheters have been placed directly in the
surgical wound as well as at deeper sites including sub-or supra fascial,
subacromial, epicapsular, intraarticular, preperitoneal, intraperitoneal,
intraosseus etc(2). Similarly, Local Infiltration Analgesia (LIA) was
introduced exclusively for hip and knee joint arthroplasty but gets
confused with other infiltrative techniques, it might be preferable to use
the term Periarticular Infiltration (PA) This abstract will take up the
four commonest approaches to infiltrative techniques for managing
postoperative pain: a)wound infiltration and CWI, b) LIA technique for THA
and TKA c) intraperitoneal for abdominal surgery and d) TAP blocks a)
Wound infiltration and CWI techniques The ease of use and safety of local
anaesthetic infiltration is wellrecognized. Direct application of local
anaesthetic to surgical site is a rational approach to block pain
transmission from afferent nociceptive barrage. Local anaesthetics also
inhibit injury-mediated inflammatory response and therefore may reduce the
risk of hyperalgesia. Several meta-analyses have reported about the
efficacy of this technique across a variety of surgical procedures (4-8) A
systematic review of 44 RCTs showed that CWI techniques provided effective
analgesia at rest and with movement, reduced opioid consumption, and
increased patient satisfaction. A shorter hospital stay was also reported
in some studies. No major adverse effects were noted, the wound infection
rates were similar to those in the control group. CWI was effective across
many surgical procedures such as abdominal, cardiothoracic and orthopaedic
(4) A more recent meta-analysis of 14 RCTs(n=756) with ropivacaine for CWI
showed consistent evidence of effective analgesia and opioid-sparing when
used for surgical procedures such as THA, TKA, major abdominal and cardiac
surgery (5). Another meta-analysis of 9 RCTS compared CWI with epidural
analgesia in abdominal surgery including liver resection, colorectal
surgery and repair of aortic aneurysm. It concluded that CWI was
associated with comparable pain scores both at rest and during movement up
to 48h, and with less urinary retention (6). For C. Section CWI is
recommended by the PROSPECT evidence-based recommendations(7) and also by
a recent meta-analysis (8). It is emphasized that the technique is not
effective after all surgeries. There is evidence that the benefits of CWI
are not impressive when used in patients undergoing laparoscopic
cholecystectomy (intraperitoneal technique is better, see below) and spine
surgery. b) LIA technique for THA and TKA This technique is discussed in
more detail in another abstract in this issue of the journal. Very
briefly, there are several meta-analyses showing that this technique is
effective for both THA and TKA surgery(9-13). One of these concludes that
LIA may not be necessary if multimodal analgesia techniques are used (9).
However, no evidence was provided to support this claim. The reader is
referred to the abstract "LIA is ineffective for THA- CON" regarding
details of the above meta-analyses and about the unimpressive literature
and risks of multimodal analgesia. Comparative studies have shown that in
many studies LIA is as good or better than other regional techniques such
as epidural, intrathecal morphine and femoral nerve block (9-13) both for
TKA and THA. c) Intraperitoneal administration of local anaesthetics In a
meta-analysis of 30 RCTs, intraperitoneal use of local anaesthetics in
laparoscopic cholecystectomy was shown to reduce pain, opioid use and need
for rescue analgesia(14). Another meta-analysis of infiltrative techniques
(CWI, TAP, intraperitoneal) versus placebo or routine analgesia for
colorectal surgery concluded that infiltrative techniques were associated
with lower pain scores, reduced opioid requirements, shorter length of
stay and no increase in complications (15) Catheter positioning seems
important, preperitoneal for open colorectal surgery and subfascial for C.
Section(16) d) TAP blocks Due to the ease of administration and efficacy
TAP infiltration has been used successfully for a variety of surgical
procedures such as bowel surgery, appendectomy, hernia repair, C. Section
and gynaecological surgery. There is an extensive quantity of safety and
efficacy data which has allowed several metaanalyses and a Cochrane review
(16).

<39>
Accession Number
612172846
Author
Rawal N.
Institution
(Rawal) Department of Clinical Medicine, Division of Anaesthesiology and
Intensive Care, University Hospital Orebro, Orebro, Sweden
Title
Pro.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e6-e7), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
For decades, epidural analgesia (EA) has been considered the gold standard
for postoperative pain management after major surgery. However, the
benefits are less impressive after more rigorous evaluation of previous
data and with results from newer meta-analyses(1). For example, EAhas been
promoted as an essential component of Enhanced Recovery After Surgery
(ERAS) protocols for colorectal surgery. However, there is no convincing
evidence that EAis an essential component of ERAS protocols. It appears
that the success of ERAS programmes for colorectal surgery (and other
less-well studied surgeries) is primarily a result of a structured,
protocol-based team approach and a modified attitude towards postoperative
rehabilitation goals. Pain relief is important, but it?s role seems to be
secondary. There is no convincing evidence that epidural technique is
essential or any better than simple local anaesthetic-based infiltrative
techniques(2) PROSPECT group recommendations are evidence-based and
surgical procedure-specific that take risk-benefit into consideration.
PROSPECT does not recommend EA for any of the following procedures in
spite of documented analgesic efficacy: laparoscopic cholecystectomy,
hysterectomy, C. Section, THA, TKA, laparoscopic colorectal surgery. For
open thoracotomy paravertebral block is considered equally effective with
lower risk of adverse effects (3). Multiple meta-analyses show that there
are many evidence-based regional anaesthesia alternatives to EA that are
equally effective but less invasive. These include paravertebral blocks
for thoracotomy, intraperitoneal infusions for major abdominal procedures,
femoral nerve blocks and LIA technique for TKA and THA, continuous wound
catheter infusions (CWI) for a variety of surgical procedures (major
abdominal, cardiothoracic, orthopaedic) and TAP blocks for bowel surgery,
hernia repair, C. Section, gynaecological surgery (2-9). A meta-analysis
compared CWI with EA for abdominal surgery (liver resection, colorectal
surgery, aortic aneurysm) and concluded thatCWI was associated with
comparable analgesia at rest and with movement up to 48h with less urinary
retention(10). A recent literature review concluded that EA can no longer
be considered as a standard of care after routine surgery (11). Fig 1 is
an example of how analgesic techniques have changed over the last 3
decades or so for analgesia after TKA, this trend of moving away
fromepidural tomore peripheral regional techniques is applicable for
almost all types of surgeries. Several studies and editorials have
reported that the risks of severe neurological complications with EA are
higher than previously believed. For example a recent audit study of over
35,000 patients from USA reported the risk of epidural haematoma as
1:5,400, cardiac arrest 1:5000, epidural abscess 1:27,000, (12). In making
the decision to use EA the failure rates have to be taken into
consideration. These can vary from32%to about 50%.To be considered
successful, epidurals need to facilitate early postoperative mobilization
("walking epidural") and function effectively for the entire duration of
treatment (typically 48-72 h). This has to be balanced against the costs
of labour-intensive monitoring requirements Inmany hospitals such patients
are nursed in high dependency units(HDUs) or ICUs which add substantially
to the costs. Only institutional audits can guide the clinicians if their
EA risk-benefit ratios are acceptable. Since very few institutions perform
such audits, success rates remain unclear. The reasons for the diminishing
role of EA are shown in the table below (2): 1) New data question earlier
EA studies showing reduced morbidity and mortality. Some recent studies
show increased morbidity with EA. 2) The increasing trend of changing from
open to minimal-invasive and endoscopic surgical techniques has reduced or
eliminated the need for EA. Many previous inpatient surgeries are now day
case or overnight stay procedures 3) Even without EA the risks of
postoperative pulmonary complications have decreased over the years due to
overall improvements in postoperative rehabilitation and physiotherapy
routines. Benefits of EA over systemic opioids less impressive than in the
past. 4) Epidural failure rates can be very high (30-47%).Most
anaesthesiologists unaware of their failure rates on day 1, day 2, day 3,
because regular audits are rarely performed 5) Widespread use of
new-generation prophylactic anticoagulants creates many practical
obstacles for EA catheter management 6) Risk of side effects of EA such as
hypotension and urinary retention are quite high, this can delay
postoperative mobilization and rehabilitation 7) Convincing new evidence
that many far less invasive regional anaesthesia techniques are equally
effective 8) Recent literature shows that the risks of serious
neurological complications and death are greater than previously believed
9) Monitoring requirements are labour intensive (at many institutions
patients nursed in high-dependency units or ICU). 10) No convincing
cost-effectiveness data in spite of years of EA use 11) Litigation
concerns due to risks of severe neurological complications. Closed claims
data show EA at top of all regional techniques. (Figure Presented).

<40>
Accession Number
612172781
Author
Hutchins J.; Grandelis A.; Dudeja V.; Jensen E.
Institution
(Hutchins, Grandelis) University of Minnesota, Anesthesiology,
Minneapolis, United States
(Dudeja, Jensen) University of Minnesota, Surgery, Minneapolis, United
States
Title
Ultrasound guided bilateral para vertebral catheters versus thoracic
epidural analgesia for post-operative pain control in open pancreatic
surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 35th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2016.
Netherlands. Conference Start: 20160907. Conference End: 20160910. 41 (5
Supplement 1) (pp e88), 2016. Date of Publication: September - October
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: Studies have shown paravertebral catheters to be a
viable method for postoperative pain control in thoracic surgery but
currently, no studies have compared epidural analgesia to bilateral
continuous paravertebral infusions in open pancreatic surgery. The primary
objective of this study was to determine the effect of epidural analgesia
and continuous paravertebral infusions on postoperative maximal pain
scores. Methods: This was an prospective randomized controlled trial
comparing the effectiveness of mid thoracic (T8-9) epidurals to bilateral
(T8-9) paravertebral catheters in patients undergoing open pancreatic
surgery. Patients had their epidurals or paravertebral catheters placed
preoperatively and infusions started intraoperatively. They were followed
for 4 days after surgery by a blinded observer who evaluated pain scores,
modality related complications, opioid use, and length of stay. Results:
50 patients were enrolled with 25 in each arm. There was no difference in
baseline characteristics between the two groups. There were no significant
differences in post-operative pain scores, opioid use, non opioid use, and
length of stay between the two groups. There were less modality related
complications in the paravertebral group compared to the epidural group.
There were no serious adverse events in either group. Conclusions:
Paravertebral catheters provide a similar level of analgesic benefit and
less modality related complications when compared tomid thoracic epidurals
for patients undergoing open pancreatic surgery.

<41>
[Use Link to view the full text]
Accession Number
611774985
Author
Gunn T.; Paone G.; Emery R.W.; Ferraris V.A.
Institution
(Gunn) Department of Surgery, University of Kentucky, Lexington, KY,
United States
(Paone) Cardiac Surgery, Henry Ford Hospital, Detroit, MI, United States
(Emery) St Joseph's Hospital, St. Paul, MN, United States
(Ferraris) Division of Cardiovascular and Thoracic Surgery, University of
Kentucky, College of Medicine, Lexington, KY, United States
Title
The case for a conservative approach to blood transfusion management in
cardiac surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 11 (3) (pp 157-164), 2016. Date of Publication: 23 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Limiting blood transfusion in cardiac operations is a wellmeaning goal of
perioperative care. Potential benefits include decreasing morbidity and
limiting procedural costs. It is difficult to identify transfusion as the
cause of adverse outcomes. The need for transfusion may identify a sicker
patient population at greater risk for a worse outcome that may or may not
be related to the transfusion. We reviewed the indications for and adverse
effects of blood transfusion in patients undergoing cardiac procedures to
provide a balanced approach tomanagement of blood resources in this
population. We reviewed current literature, including systematic reviews
and practice guidelines, to synthesize a practice management plan in
patients having cardiac operations. Several prospective randomized studies
and large population cohort studies compared a postoperative restrictive
transfusion policy to a more liberal policy and found very little
difference in outcomes but decreased costs with a restrictive policy.
Evidence-based practice guidelines and implementation standards provide
robust intervention plans that can limit harmful effects of transfusion
and provide safe and effective procedure outcomes. A restrictive
transfusion policy seems to be safe and effective but does not necessarily
provide better outcome in most patient cohorts. The implications of these
findings suggest that many discretionary transfusions could be avoided. A
subset of high-risk patients could undoubtedly benefit from a more liberal
transfusion policy, but the definition of high risk is ill defined.
Copyright &#xa9; 2016 by the International Society for Minimally Invasive
Cardiothoracic Surgery.

<42>
[Use Link to view the full text]
Accession Number
611774668
Author
Glauber M.; Moten S.C.; Quaini E.; Solinas M.; Folliguet T.A.; Meuris B.;
Miceli A.; Oberwalder P.J.; Rambaldini M.; Teoh K.H.T.; Bhatnagar G.;
Borger M.A.; Bouchard D.; Bouchot O.; Clark S.C.; Dapunt O.E.; Ferrarini
M.; Fischlein T.J.M.; Laufer G.; Mignosa C.; Millner R.; Noirhomme P.;
Pfeiffer S.; Ruyra-Baliarda X.; Shrestha M.L.; Suri R.M.; Troise G.;
Gersak B.
Institution
(Glauber, Quaini, Miceli, Ferrarini) Clinical and Research Hospital IRCCSY
Gruppo Ospedaliero San Donato, Istituto Clinico Sant'Ambrogio, Via
Faravelli, 16, Milano 20149, Italy
(Moten) Austin Health and Royal Melbourne Hospital, Melbourne, Australia
(Solinas) Ospedale Del Cuore G. Pasquinucci, Fondazione Toscana G.
Monasterio, Massa, Italy
(Folliguet) Centre Hospitalo-Universitaire Brabois ILCV, Nancy, France
(Meuris) U.Z. Gasthuisberg, Leuven, Belgium
(Oberwalder) Unniversitat Kilinik, Graz, Austria
(Rambaldini) Ospedale DiMantova, Mantua, Italy
(Teoh) Southlake Regional Health Centre, McMaster University, Hamilton,
Canada
(Bhatnagar) Trillium Cardiovascular Associates, Mississauga, ON, Canada
(Borger) Columbia University Medical Center, New York, NY, United States
(Bouchard) University of Montreal, Montreal, QC, Canada
(Bouchot) CHU le Bocage, Dijon, France
(Clark) Freeman Hospital, Newcastle, United Kingdom
(Dapunt) Klinikum Oldenburg, Oldenburg, Germany
(Fischlein) Klinikum Nuernberg, Nuremberg, Germany
(Laufer, Pfeiffer) Medizinische Universitaet Innsbruck, Innsbruck, Austria
(Mignosa) Ospedale Ferrarotto, Catania, Italy
(Millner) Blackpool Victoria Hospital, Blackpool, United Kingdom
(Noirhomme) Cliniques Universitaires St-Luc, Brussels, Belgium
(Ruyra-Baliarda) Hospital University Germans Trias i Pujol, Barcelona,
Spain
(Shrestha) Medizinischen Hochschule Hannover, Hannover, Germany
(Suri) Mayo Clinic, Rochester, MN, United States
(Troise) Fondazione Poliambulanza, Brescia, Italy
(Gersak) University Medical Center Ljubljana, Ljubljana, Slovenia
Title
International expert consensus on sutureless and rapid deployment valves
in aortic valve replacement using minimally invasive approaches.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 11 (3) (pp 165-173), 2016. Date of Publication: 23 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: To define the benefit of sutureless and rapid deployment valves
in current minimally invasive approaches in isolated aortic valve
replacement. Methods: A panel of 28 international experts with expertise
in both minimally invasive aortic valve replacement and rapid deployment
valveswas constituted. After thorough literature review, the experts rated
evidence-based recommendations in a modified Delphi approach. Results: No
guideline could be retrieved. Thirty-three clinical trials and 9
systematic reviews could be identified for detailed text analysis to
obtain a total of 24 recommendations. After rating by the experts 12,
final recommendations were identified: preoperative computed tomographic
scan as well as intraoperative transesophageal echocardiography are highly
recommended. Suitable annular sizes are 19 to 27 mm. There is a
contraindication for bicuspid valves only for type 0 and for annular
abscess or destruction due to infective endocarditis. The use of
sutureless and rapid deployment valves reduces extracorporeal circulation
and aortic cross-clamp time and leads to less early complications as
prolonged ventilation, blood transfusion, atrial fibrillation, pleural
effusions, paravalvular leakages and aortic regurgitation, and renal
replacement therapy, respectively. These clinical outcomes result in
reduced intensive care unit and hospital stay and reduced costs. The use
of sutureless and rapid deployment valves will lead to a higher adoption
rate of minimally invasive approaches in aortic valve replacement. Respect
should be taken to a necessary short learning curve for both sutureless
and minimally invasive programs. Conclusions: Sutureless and rapid
deployment aortic valve replacement together with minimally invasive
approaches offers an attractive option in aortic valve placement for
patients requiring biological valve replacement. Copyright &#xa9; 2016 by
the International Society for Minimally Invasive Cardiothoracic Surgery.

<43>
Accession Number
612022859
Author
Liu P.; Qiao W.-H.; Sun F.-Q.; Ruan X.-L.; Al Shirbini M.; Hu D.; Chen S.;
Dong N.-G.
Institution
(Liu, Qiao, Sun, Ruan, Al Shirbini, Hu, Chen, Dong) Department of
Cardiovascular Surgery, Union Hospital, Huazhong University of Science and
Technology, Wuhan, China
Title
Should a Mechanical or Biological Prosthesis Be Used for a Tricuspid Valve
Replacement? A Meta-Analysis.
Source
Journal of Cardiac Surgery. 31 (5) (pp 294-302), 2016. Date of
Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim of the Study: The prosthesis of choice for a tricuspid
valve replacement is still unkown. This meta-analysis was undertaken to
review the results of mechanical and bioprosthetic valves in the tricuspid
position. Methods: We identified all relevant studies published in the
past 20 years (from January 1, 1995 to December 31, 2014) through the
Embase, Current Contents, and PubMed databases. The hazard ratio and its
95% confidence limits were utilized to evaluate time-to-event related
effects of surgical procedures. The Q-statistic, Index of Inconsistency
test, funnel plots, and Egger's test were used to assess the degree of
heterogeneity and publication bias. Random effects models were used, and
study quality was also assessed. Results: In our meta-analysis, 22 studies
published from 1995 to 2014 were reviewed and 2630 patients and 14,694
follow-up years were analyzed. No statistically significant difference was
identified between mechanical and biological valves in terms of survival,
reoperation, and prosthetic valve failure. The respective pooled hazard
ratio estimates were 0.95 (0.79 to 1.16, p = 0.62, I² = 29%),
1.20 (0.84 to 1.71, p = 0.33, I² = 0%), and 0.35 (0.06 to 2.01,
p = 0.24, I² = 0%). A higher risk of thrombosis was found in
mechanical tricuspid valve prostheses (3.86, 1.38 to 10.82, p = 0.01,
I² = 0%). Conclusions: No statistically significant difference
was identified between mechanical and biological valves in terms of
survival, reoperation, or prosthetic valve failure, but mechanical
tricuspid valve prostheses had a higher risk of thrombosis. doi:
10.1111/jocs.12730 (J Card Surg 2016;31:294-302). Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<44>
Accession Number
612089993
Author
Bintcliffe O.J.; Lee G.Y.C.; Rahman N.M.; Maskell N.A.
Institution
(Bintcliffe, Maskell) Academic Respiratory Unit, School of Clinical
Sciences, University of Bristol, Bristol, United Kingdom
(Lee) Centre for Asthma, Allergy & Respiratory Research, School of
Medicine & Pharmacology, University of Western Australia, Perth, Australia
(Rahman) Oxford Centre for Respiratory Medicine, Oxford NIHR Biomedical
Research Centre, Churchill Hospital, Oxford, United Kingdom
Title
The management of benign non-infective pleural effusions.
Source
European Respiratory Review. 25 (141) (pp 303-316), 2016. Date of
Publication: 01 Sep 2016.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
The evidence base concerning the management of benign pleural effusions
has lagged behind that of malignant pleural effusions in which recent
randomised trials are now informing current clinical practice and
international guidelines. The causes of benign pleural effusions are
broad, heterogenous and patients may benefit from individualised
management targeted at both treating the underlying disease process and
direct management of the fluid. Pleural effusions are very common in a
number of non-malignant pathologies, such as decompensated heart failure,
and following coronary artery bypass grafting. Pleural fluid analysis
forms an important basis of the diagnostic evaluation, and more specific
assays and imaging modalities are helpful in specific subpopulations.
Options for management beyond treatment of the underlying disorder,
whenever possible, include therapeutically aspirating the fluid, talc
pleurodesis and insertion of an indwelling pleural catheter. Randomised
trials will inform clinicians in the future as to the risks and benefits
of these options providing a guide as to how best to manage patient
symptoms in this challenging clinical setting. Copyright &#xa9; ERS 2016.

<45>
Accession Number
612089932
Author
Tarricone R.; Boscolo P.R.; Armeni P.
Institution
(Tarricone, Boscolo, Armeni) CERGAS, Centre for Research on Social and
Healthcare Management, Bocconi University, Milan, Italy
(Tarricone) Dept of Policy Analysis and Public Management, Bocconi
University, Milan, Italy
Title
What type of clinical evidence is needed to assess medical devices?.
Source
European Respiratory Review. 25 (141) (pp 259-265), 2016. Date of
Publication: 01 Sep 2016.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
The objective of this mini-review is to discuss the role of real-world
studies as a source of clinical evidence when experimental studies, such
as randomised controlled trials (RCTs), are not available. Waiting for RCT
evidence when the technology is diffusing could be anti-economical,
inefficient from the policy perspective and methodologically questionable.
We explain how real-world studies could provide relevant evidence to
decision makers. Matching techniques are discussed as a viable solution
for bias reduction. We describe a case study concerning a
cost-effectiveness analysis based on real-world data of a technology
already in use: Mitraclip combined with medical therapy versus medical
therapy alone in patients with moderate-to-severe mitral regurgitation.
The CEA has encountered the scepticism of most reviewers, due not to the
statistical methodology but to the fact that the study was observational
and not experimental. Editors and reviewers converged in considering
real-world economic evaluations premature in the absence of a RCT, even if
in the meantime the technology had been implanted >30 000 times. We
believe there is a need to acknowledge the importance of real-world
studies, and engage the scientific community in the promotion and use of
clinical evidence produced through observational studies. Copyright &#xa9;
ERS 2016.

<46>
Accession Number
612077609
Author
Higashigaito K.; Schmid T.; Puippe G.; Morsbach F.; Lachat M.; Seifert B.;
Pfammatter T.; Alkadhi H.; Husarik D.B.
Institution
(Higashigaito, Schmid, Puippe, Morsbach, Pfammatter, Alkadhi, Husarik)
Institute of Diagnostic and Interventional Radiology, United States
(Lachat) Division of Vascular Surgery, University Hospital Zurich,
University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland
(Seifert) Department of Biostatistics, Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Zurich, Switzerland
Title
CT angiography of the aorta: Prospective evaluation of individualized
low-volume contrast media protocols.
Source
Radiology. 280 (3) (pp 960-968), 2016. Date of Publication: September
2016.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To prospectively develop individualized low-volume contrast media
(CM) protocols adapted to tube voltage in patients undergoing computed
tomographic (CT) angiography of the aorta. Materials and Methods: The
study was approved by the institutional review board and local ethics
committee. All patients provided written informed consent. CT angiography
was performed by using automated attenuation-based tube voltage selection
(ATVS) (range, 70-150 kVp; 10-kVp increments). Iodine attenuation curves
from an ex vivo experiment in a phantom were used to design CM protocols
for CT angiography of the thoracoabdominal aorta in 129 consecutive
patients (hereafter, cohort A). Further modified CM protocols based on
results in cohort A were designed with the aim of homogeneous vascular
attenuation of 300-350 HU across tube voltages and were applied to another
61 consecutive patients (cohort B). Three independent blinded radiologists
assessed subjective image quality, and one reader determined objective
image quality. The Kruskal-Wallis test was performed to test for
differences in subjective image quality, and linear regression was
performed to test for differences in objective image quality between the
automatically selected tube voltages. Results: Experiments revealed tube
voltage-dependent iodine attenuation curves, which were used to determine
the CM protocols in cohort A; these ranged from 68 mL at 110 kVp to 45 mL
at 80 kVp. In both cohorts, ATVS selected 80 kVp in 62 patients, 90 kVp in
84, 100 kVp in 33, and 110 kVp in 11. In cohort A, image quality that was
satisfactory or better was attained in 126 (98%) of 129 patients who had
no significant differences in subjective image quality between tube
voltages (P = .106) but who did have significant differences in
attenuation and contrast-to-noise ratio (CNR) (P , .001 for both). In
cohort B, the furthermodified CM protocol (from 33 mL at 80 kVp to 68 mL
at 110 kVp) yielded image quality that was satisfactory or better in all
61 (100%) patients, without significant differences in subjective image
quality (P = .178), and without significant differences between tube
voltage and attenuation (P = .108), noise (P = .250), or CNR (P = .698).
Conclusion: Individualized low-volume CM protocols based on automatically
selected tube voltages are feasible and yield diagnostic image quality for
CT angiography of the aorta. Copyright &#xa9; RSNA, 2016.

<47>
Accession Number
611891748
Author
Zambetti B.R.; Garrett E.
Institution
(Zambetti, Garrett) Department of Cardiovascular Surgery, University of
Tennessee Health Science Center, Memphis, TN, United States
Title
Plasmacytic aortitis with occlusion of the right coronary artery.
Source
American Journal of Case Reports. 17 (pp 549-552), 2016. Date of
Publication: 29 Jul 2016.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Unusual clinical course Background: Inflammation of the aortic
wall, known as aortitis, is a rare clinical entity which is frequently
asymptomatic, or identified when the patient presents with an aortic
aneurysm or dissection. It is most often caused by infection or autoimmune
vasculitides such as giant cell or Takayasu's arteritis. Case Report: The
case presented is that of a 55-year-old man with symptomatic occlusion of
the right coronary artery caused by a plasmacytic aortitis suggestive of
IgG4 disease, which was successfully treated with coronary artery bypass
grafting and an ascending aortic graft. Conclusions: A review of the
current literature emphasizes how poorly the etiology and natural history
of plasmacytic aortitis is understood. Copyright &#xa9; Am J Case Rep,
2016.

<48>
[Use Link to view the full text]
Accession Number
611321827
Author
Mihos C.G.; Pineda A.M.; Santana O.
Institution
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, United States
(Pineda, Santana) Columbia University, Division of Cardiology, Mount Sinai
Heart Institute, Miami Beach, FL, United States
Title
A meta-analysis of early versus delayed surgery for valvular infective
endocarditis complicated by embolic ischemic stroke.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 11 (3) (pp 187-192), 2016. Date of Publication: 23 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: An embolic ischemic stroke occurs in 10% to 40% of patients
with valvular infective endocarditis (IE) and confers significant
morbidity. The optimal timing of valve surgery in this population is not
well defined. Methods:With the use of PubMed, EMBASE, Ovid, and Cochrane
databases, a systematic review identified 14 studies through October 2015
that compared early versus delayed surgery for valvular IE complicated by
an ischemic stroke. Early surgery was defined as 3 days or less in one, 7
days or less in eight, and 14 days or less in five studies. Risk ratios
(RRs) were calculated by the Mantel-Haenszel method under a fixed- or
random-effects model, for the outcomes of perioperative stroke, operative
mortality, and 1-year survival. Results: A total of 833 patients (early
surgery, 330; delayed surgery, 503) were included. The majority of
operations were for aortic and/or mitral valve IE, with prosthetic valve
IE present in 0%to 60%. Infection with Staphylococcus aureus ranged from
19% to 66%, and heart failure prevalence at the time of operation was 24%
to 66%. Early surgery was associated with an increased risk of operative
mortality (RR, 1.72; 95% confidence interval [CI], 1.27-2.34; P = 0.0005),
which was significant regardless of surgery within the first 7 days (RR,
2.19; 95% CI, 1.45-3.31; P = 0.0002) or 14 days (RR, 1.72; 95% CI,
1.12-2.64; P = 0.01) after stroke. Surgical timing did not affect the risk
of perioperative ischemic or hemorrhagic stroke or 1-year survival.
Conclusions: In patients with valvular IE complicated by ischemic stroke,
early surgery is associated with an increased risk of operative mortality,
with no observed benefit in 1-year survival. Copyright &#xa9; 2016 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<49>
Accession Number
608566129
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 (E-mail: jnl.info@oup.co.uk)
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. Copyright &#xa9;
2015 The Author.

<50>
Accession Number
606803241
Author
Deuse T.; Bara C.; Barten M.J.; Hirt S.W.; Doesch A.O.; Knosalla C.;
Grinninger C.; Stypmann J.; Garbade J.; Wimmer P.; May C.; Porstner M.;
Schulz U.
Institution
(Deuse, Barten) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Martinistr 52, Hamburg 20246, Germany
(Bara) Division of Cardiovascular, Thoracic and Transplantation Surgery,
Hannover Medical School, Carl-Neuberg-Strase 1, Hannover 30625, Germany
(Barten, Garbade) Department of Cardiac Surgery, University Hospital
Leipzig, Heart Center, Strumpellstrase 39, Leipzig, Germany
(Hirt) Department of Cardiothoracic Surgery, University Hospital
Regensburg, Franz-Josef-Straus-Allee 11, Regensburg 93053, Germany
(Doesch) Department of Cardiology, University Hospital Heidelberg, Im
Neuenheimer Feld 400, Heidelberg 69120, Germany
(Knosalla) Department of Cardiovascular and Thoracic Surgery, German Heart
Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Grinninger) Department of Cardiac Surgery, Munich Transplantation Center,
Klinikum Groshadern LMU, Marchioninistrase 15, Munich 81377, Germany
(Stypmann) Department of Cardiovascular Medicine, Division of Cardiology,
University Hospital Munster, Albert-Schweitzer-Strase 33, Munster 48149,
Germany
(Wimmer, May, Porstner) Novartis Pharma GmbH, Roonstrase 25, Nuremberg
90429, Germany
(Schulz) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, Bad
Oeynhausen 32545, Germany
Title
The MANDELA study: A multicenter, randomized, open-label, parallel group
trial to refine the use of everolimus after heart transplantation.
Source
Contemporary Clinical Trials. Part B. 45 (pp 356-363), 2015. Date of
Publication: November 01, 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In recent years a series of trials has sought to define the optimal
protocol for everolimus-based immunosuppression in heart transplantation,
with the goal of minimizing exposure to calcineurin inhibitors (CNIs) and
harnessing the non-immunosuppressive benefits of everolimus. Randomized
studies have demonstrated that immunosuppressive potency can be maintained
in heart transplant patients receiving everolimus despite marked CNI
reduction, although very early CNI withdrawal may be inadvisable. A
potential renal advantage has been shown for everolimus, but the optimal
time for conversion and the adequate reduction in CNI exposure remain to
be defined. Other reasons for use of everolimus include a substantial
reduction in the risk of cytomegalovirus infection, and evidence for
inhibition of cardiac allograft vasculopathy, a major cause of graft loss.
The ongoing MANDELA study is a 12-month multicenter, randomized,
open-label, parallel-group study in which efficacy, renal function and
safety are compared in approximately 200 heart transplant patients.
Patients receive CNI therapy, steroids and everolimus or mycophenolic acid
during months 3 to 6 post-transplant, and are then randomized at month 6
post-transplant (i) to convert to CNI-free immunosuppression with
everolimus and mycophenolic acid or (ii) to continue reduced-exposure CNI,
with concomitant everolimus. Patients are then followed to month 18
post-transplant The rationale and expectations for the trial and its
methodology are described herein. Copyright &#xa9; 2015 Elsevier Inc.

<51>
Accession Number
606482886
Author
Routledge H.; Sastry S.
Institution
(Routledge) Worcestershire Royal Hospital, Worcester, United Kingdom
(Sastry) Wythenshawe Hospital, Manchester, United Kingdom
Title
Radial Versus Femoral Access for Acute Coronary Syndromes.
Source
Current Cardiology Reports. 17 (12) (no pagination), 2015. Article Number:
117. Date of Publication: 01 Dec 2015.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
The feasibility and safety of transradial coronary intervention was
demonstrated soon after the description of the transfemoral approach,
despite which the use of the femoral artery still dominates in acute
coronary syndrome intervention. The advantages of using the radial artery
are virtual elimination of access site complications and an important
reduction in bleeding, both of which are of utmost importance to the
patient with myocardial infarction. Randomised controlled trials have now
documented what seems inherent; that transradial intervention should bring
with it an advantage in terms of morbidity and mortality in this cohort.
The potential disadvantages in terms of speed of procedure and radiation
exposure are negated by operator experience. Registries have illustrated
that conversion on a large scale from the femoral to the transradial
approach is safe and saves lives, most convincingly so in acute coronary
syndrome intervention. This review discusses the potential benefits and
risks of the alternative access sites in acute patients and explores how
these are borne out in the published data. Copyright &#xa9; 2015, Springer
Science+Business Media New York.

<52>
Accession Number
603556317
Author
Luo T.; Ni Y.
Institution
(Luo, Ni) Department of Cardiovascular Surgery, First Affiliated Hospital
College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou,
Zhejiang 310003, China
Title
Short-term and long-term postoperative safety of off-pump versus on-pump
coronary artery bypass grafting for coronary heart disease: A
meta-analysis for randomized controlled trials.
Source
Thoracic and Cardiovascular Surgeon. 63 (4) (pp 319-327), 2015. Date of
Publication: 24 Mar 2015.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Objective The aim was to compare the short-term (30 days after surgery)
and long-term (over 6 months' follow-up) postoperative safety of off-pump
and on-pump coronary artery bypass grafting (CABG) for patients with
coronary heart disease (CHD). Methods Relevant randomized controlled
trials (RCTs) were obtained from PubMed, Embase, Springer, Ovid, and
Cochrane library up to July 2013. Odds ratios (ORs) with their 95%
confidence intervals (CIs) were used to access effect sizes. Results Seven
RCTs involving 9,128 patients were included. Results suggested no
significant difference in all the short-term outcomes (mortality, OR =
0.90, 95% CI: 0.69 to 1.16, p = 0.41; myocardial infarction, OR = 0.95,
95% CI: 0.79 to 1.15, p = 0.61; stroke, OR = 0.78, 95% CI: 0.56 to 1.07, p
= 0.12; renal failure, OR = 0.84, 95% CI: 0.60 to 1.18, p = 0.43;
revascularization: OR = 1.95, 95% CI: 0.79 to 4.85, p = 0.15) and some
long-term outcomes (mortality, OR = 1.02, 95% CI: 0.86 to 1.22, p = 0.81;
myocardial infarction, OR = 0.86, 95% CI: 0.70 to 1.04, p = 0.12; stroke,
OR = 0.89, 95% CI: 0.67 to 1.19, p = 0.44) between off-pump and on-pump
CABG. However, off-pump CABG had a significantly higher revascularization
rate (OR = 1.45; 95% CI: 1.02 to 2.06; p = 0.04) than on-pump CABG in
long-term follow-up. Conclusion Short-term postoperative safety was
similar between off-pump and on-pump CABG. A high revascularization rate
was the drawback of off-pump CABG for CHD patients in long-term follow-up.
Copyright &#xa9; 2015 Georg Thieme Verlag KG Stuttgart. New York.

<53>
Accession Number
607405237
Author
Rittger H.; Waliszewski M.; Brachmann J.; Hohenforst-Schmidt W.; Ohlow M.;
Brugger A.; Thiele H.; Birkemeyer R.; Kurowski V.; Schlundt C.; Zimmermann
S.; Lonke S.; Von Cranach M.; Markovic S.; Daniel W.G.; Achenbach S.;
Wohrle J.
Institution
(Rittger, Hohenforst-Schmidt, Lonke) Medizinische Klinik i, Klinikum
Fuerth, Jakob-Henle-Strasse 1, Fuerth D-90766, Germany
(Waliszewski) Medical Scientific Affairs, B. Braun Vascular Systems,
Berlin, Germany
(Brachmann) Medizinische Klinik II, Klinikum Coburg, Coburg, Germany
(Ohlow) Klinik fur Kardiologie, Zentralklinikum Bad Berka, Bad Berka,
Germany
(Brugger) Klinik fur Kardiologie, Klinikum Kulmbach, Kulmbach, Germany
(Thiele) Medizinische Klinik II, Universitatsklinikum Lubeck, Lubeck,
Germany
(Birkemeyer) Herzklinik Ulm, Ulm, Germany
(Kurowski) Abteilung fur Innere Medizin/Kardiologie, Krankenhaus
Molln-Ratzeburg, Molln-Ratzeburg, Germany
(Schlundt, Daniel, Achenbach) Medizinische Klinik 2, Universitatsklinikum
Erlangen, Erlangen, Germany
(Zimmermann) Klinik fur Innere/Medizin Kardiologie, Diakonissenhaus
Flensburg, Flensburg, Germany
(Von Cranach) Klinik fur Neurologie, Universitatsklinikum Freiburg,
Freiburg, Germany
(Markovic, Wohrle) Klinik fur Innere Medizin II, Universitatsklinikum Ulm,
Ulm, Germany
Title
Long-term outcomes after treatment with a paclitaxel-coated balloon versus
balloon angioplasty: Insights from the PEPCAD-DES study (Treatment of
Drug-eluting Stent [DES] In-Stent Restenosis with SeQuent Please
Paclitaxel-Coated Percutaneous Transluminal Coronary Angioplasty [PTCA]
Catheter).
Source
JACC: Cardiovascular Interventions. 8 (13) (pp 1695-1700), 2015. Date of
Publication: 01 Nov 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The intention this PEPCAD-DES (Treatment of Drug-eluting Stent
[DES] In-Stent Restenosis With SeQuent Please Paclitaxel Eluting
Percutaneous Transluminal Coronary Angioplasty [PTCA] Catheter) study
update was to demonstrate the safety and efficacy of paclitaxel-coated
balloon (PCB) angioplasty in patients with DES-ISR at 3 years. Background
In the PEPCAD-DES trial late lumen loss and the need for repeat target
lesion revascularization (TLR) was significantly reduced with PCB
angioplasty compared with plain old balloon angioplasty (POBA) in patients
with drug-eluting stent in-stent restenosis (DES-ISR) at 6 months. We
evaluated whether the clinical benefit of reduced TLR and major adverse
cardiac events (MACE) was maintained up to 3 years. Methods A total of 110
patients with DES-ISR in native coronary arteries with reference diameters
ranging from 2.5 mm to 3.5 mm and lesion lengths <22 mm were randomized to
treatment with either PCB or POBA in a multicenter, randomized,
single-blind clinical study. With a 2:1 randomization, 72 patients were
randomized to the PCB group and 38 patients to the POBA group. At
baseline, there were lesions with at least 2 stent layers in PCB (52.8%,
38 of 72) and POBA (55.3%, 21 of 38) patients. Results At 36 months, the
TLR rates were significantly lower in the PCB group compared with the POBA
control group (19.4% vs. 36.8%; p = 0.046). Multiple TLRs in individual
patients were more frequent in the POBA group compared with the PCB group
(more than 1 TLR: POBA, 13.2%; PCB, 1.4%; p = 0.021). The 36-month MACE
rate was significantly reduced in the PCB group compared with the POBA
group (20.8% vs. 52.6%, log-rank p = 0.001). Conclusions PCB angioplasty
was superior to POBA for the treatment of DES-ISR patients in terms of
MACE and TLR for up to 36 months. There was no late catch-up phenomenon.
(Treatment of Drug-eluting Stent [DES] In-Stent Restenosis With SeQuent
Please Paclitaxel Eluting Percutaneous Transluminal Coronary Angioplasty
[PTCA] Catheter [PEPCAD-DES]; NCT00998439). Copyright &#xa9; 2015 American
College of Cardiology Foundation.

<54>
Accession Number
607405201
Author
Nombela-Franco L.; Trigo M.D.; Morrison-Polo G.; Veiga G.; Jimenez-Quevedo
P.; Abdul-Jawad Altisent O.; Campelo-Parada F.; Biagioni C.; Puri R.;
Delarochelliere R.; Dumont E.; Doyle D.; Paradis J.-M.; Quiros A.; Almeria
C.; Gonzalo N.; Nunez-Gil I.; Salinas P.; Mohammadi S.; Escaned J.;
Fernandez-Ortiz A.; Macaya C.; Rodes-Cabau J.
Institution
(Nombela-Franco, Morrison-Polo, Jimenez-Quevedo, Biagioni, Quiros,
Almeria, Gonzalo, Nunez-Gil, Salinas, Escaned, Fernandez-Ortiz, Macaya)
Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
(Trigo, Veiga, Abdul-Jawad Altisent, Campelo-Parada, Puri,
Delarochelliere, Dumont, Doyle, Paradis, Mohammadi, Rodes-Cabau) Quebec
Heart and Lung Institute, 2725 chemin Ste-Foy, Quebec City, QC G1V 4G5,
Canada
Title
Incidence, causes, and predictors of early (<30 days) and late unplanned
hospital readmissions after transcatheter aortic valve replacement.
Source
JACC: Cardiovascular Interventions. 8 (13) (pp 1748-1757), 2015. Date of
Publication: 01 Nov 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to determine the incidence, causes,
and predictors of unplanned hospital readmissions after transcatheter
aortic valve replacement (TAVR). Background Data regarding unplanned
hospital readmissions after TAVR in a real-world all-comers population are
scarce. Methods A total of 720 consecutive patients undergoing TAVR at 2
centers who survived the procedure, were included. Median follow-up was 23
months (interquartile range [IQR]: 12 to 39 months), available in 99.9% of
the initial population. The occurrence, timing, and causes of hospital
readmission within the first year post-TAVR were obtained in all cases.
Early and late readmissions were defined as those occurring <30 days and
>30 days to 1 year post-TAVR, respectively. Results There were 506
unplanned readmissions in 316 patients (43.9%) within the first year
post-TAVR (median time: 63 days; IQR: 19 to 158 days post-discharge). Of
these, early readmission occurred in 105 patients (14.6%), and 118
patients (16.4%) had multiple (>2) readmissions. Readmissions were due to
noncardiac and cardiac causes in 59% and 41% of cases, respectively.
Noncardiac readmissions included, in order of decreasing frequency,
respiratory, infection, and bleeding events as the main causes, whereas
heart failure and arrhythmias accounted for most cardiac readmissions. The
predictors of early readmission were periprocedural major bleeding
complications (p = 0.001), anemia (p = 0.019), lower left ventricular
ejection fraction (p = 0.042), and the combined presence of antiplatelet
and anticoagulation therapy at hospital discharge (p = 0.014). The
predictors of late readmission were chronic obstructive pulmonary disease
(p = 0.001), peripheral vascular disease (p = 0.023), chronic renal
failure (p = 0.013), and atrial fibrillation (p = 0.012). Early
readmission was an independent predictor of mortality during the follow-up
period (hazard ratio: 1.56, 95% confidence interval: 1.02 to 2.39, p =
0.043). Conclusions The readmission burden after TAVR in an all-comers
population was high. Nearly one-fifth of the patients were readmitted
early after hospital discharge, increasing the risk of mortality at
follow-up. Reasons for readmission were split between noncardiac and
cardiac causes, with respiratory causes and heart failure as the main
diagnoses in each group, respectively. Whereas early readmissions were
mainly related to periprocedural bleeding events, most late readmissions
were secondary to baseline patient comorbidities. These results underscore
the importance of and provide the basis for implementing specific
preventive measures to reduce readmission rates after TAVR. Copyright
&#xa9; 2015 American College of Cardiology Foundation.

<55>
Accession Number
612000694
Author
Schulman-Marcus J.; Feldman D.N.; Rao S.V.; Prasad A.; McCoy L.; Garratt
K.; Kim L.K.; Minutello R.M.; Wong S.-C.; Vora A.N.; Singh H.S.; Wojdyla
D.; Mohsen A.; Bergman G.; Swaminathan R.V.
Institution
(Schulman-Marcus) Department of Medicine, Weill Cornell Medical College,
New York, United States
(Feldman, Rao, Kim, Minutello, Wong, Singh, Bergman, Swaminathan)
Greenberg Division of Cardiology, Weill Cornell Medical College, 520 E
70th St, Starr 431, New York, NY 10021, United States
(McCoy, Vora, Wojdyla) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Prasad) Cardiac Research Centre, St George's Hospital, London, United
Kingdom
(Garratt) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
(Mohsen) William Beaumont Health System, Royal Oak, MI, United States
Title
Characteristics of patients undergoing cardiac catheterization before
noncardiac surgery a report from the national cardiovascular data registry
cathPCI registry.
Source
JAMA Internal Medicine. 176 (5) (pp 611-618), 2016. Date of Publication:
May 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Many patients undergo cardiac catheterization and/or
percutaneous coronary intervention (PCI) before noncardiac surgery even
though these procedures are not routinely indicated. Data on this cohort
of patients are limited. OBJECTIVE To describe the characteristics,
angiographic findings, and treatment patterns of clinically stable
patients undergoing cardiac catheterization and/or PCI before noncardiac
surgery in a large national registry. DESIGN, SETTING, AND PARTICIPANTS
This study is a retrospective, descriptive analysis of National Cardiac
Data Registry CathPCI Registry diagnostic catheterization and PCI data
from July 1, 2009, through December 31, 2014. Data analysis was performed
from April 21, 2015, to January 4, 2016. The study included 194 444
patients from 1046 sites who underwent coronary angiography before
noncardiac surgery. Patients with acute coronary syndrome, cardiogenic
shock, cardiac arrest, or emergency catheterization were excluded. MAIN
OUTCOMES AND MEASURES Demographic characteristics, preprocedure
noninvasive testing results, angiographic findings, and treatment
recommendations are summarized. Among the 27 838 patients who underwent
PCI, procedural details, inpatient outcomes, and discharge medications are
reported. RESULTS Of the 194 444 included patients, 113 590 (58.4%) were
male, the median age was 65 years (interquartile range, 57-73 years), and
162 532 (83.6%) were white. Most were overweight or obese (152 849
[78.6%]), and 78 847 (40.6%) had diabetes mellitus. Most patients were
asymptomatic (117 821 [60.6%]), although 112 302 (57.8%) had been taking
antianginal medications within 2 weeks of the procedure. Prior noninvasive
stress testing was reported in 126 766 (65.2%), and results were positive
in 109 458 (86.3%) of those with stress data. Obstructive disease was
present in 93 447 (48.1%). After diagnostic angiography, revascularization
with PCI or bypass surgery was recommended in 46 380 patients (23.8%) in
the overall cohort, 27 191 asymptomatic patients (23.1%), and 45 083
patients with obstructive disease (48.3%). In the 27 191 patients
undergoing PCI, 367 treated lesions (1.3%) were in the left main artery
and 3831 (13.8%) in the proximal left anterior descending artery. A total
of 11 366 patients (40.8%) received drug-eluting stents. Complications
occurred in a few patients, with a catheterization-related mortality rate
of 0.05%. CONCLUSIONS AND RELEVANCE In the largest contemporary US cohort
reported to date, most patients undergoing diagnostic catheterization
before noncardiac surgery are asymptomatic. The discovery of obstructive
coronary artery disease is common, and although randomized clinical trials
have found no benefit in outcomes, revascularization is recommended in
nearly half of these patients. The overall findings highlight management
patterns in this population and the need for greater evidence-based
guidelines and practices. Copyright 2016 American Medical Association. All
rights reserved.

<56>
Accession Number
612060240
Author
Lee S.; Abd-Elsayed A.
Institution
(Lee) University of Cincinnati College of Medicine, University of
Cincinnati, Cincinnati, OH, United States
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin School
of Medicine and Public Health, Madison, WI, United States
Title
Some Non-FDA Approved Uses for Neuromodulation: A Review of the Evidence.
Source
Pain Practice. 16 (7) (pp 935-947), 2016. Date of Publication: 01 Sep
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Neuromodulation, including spinal cord stimulation and
peripheral nerve field stimulation, has been used with success in treating
several painful conditions. The FDA approved the use of neuromodulation
for a few indications. We review evidence for neuromodulation in treating
some important painful conditions that are not currently FDA approved.
Methods: This review included an online web search for only clinical
trials testing the efficacy of neuromodulation in treating coronary artery
disease, peripheral vascular disease (PVD), headache, and peripheral field
stimulation. Results: Our systematic literature search found 10, 6, and 3
controlled studies relating to coronary artery disease, PVD, and headache,
respectively. Our review also included 5 noncontrolled studies relating to
peripheral field stimulation, as no controlled studies had been completed.
Conclusion: This review article shows compelling evidence based on
clinical trials that neuromodulation can be of benefit for patients with
serious painful conditions that are not currently approved by the FDA.
Copyright &#xa9; 2015 World Institute of Pain

<57>
Accession Number
612060236
Author
Cle-Ovejero A.; Valmaseda-Castellon E.
Institution
(Cle-Ovejero) University of Barcelona Dental School, Spain
(Valmaseda-Castellon) Barcelona University Dental School, IDIBELL
Institute, Spain
Title
Haemostatic agents in apical surgery. A systematic review.
Source
Medicina Oral, Patologia Oral y Cirugia Bucal. 21 (5) (pp e652-e657),
2016. Date of Publication: September 2016.
Publisher
Medicina Oral, Patologia Oral y Cirugia Bucal (E-mail:
medicina@medicinaoral.com)
Abstract
Background: Blood presence in apical surgery can prevent the correct
vision of the surgical field, change the physical properties of filling
materials and reduce their sealing ability. Objectives: To describe which
are the most effective and safest haemostatic agents to control bleeding
in patients undergoing apical surgery. Material and Methods. We carried
out a systematic review, using Medline and Cochrane Library databases, of
human clinical studies published in the last 10 years. Results: The agents
that proved more effective in bleeding control were calcium sulphate
(100%) and collagen plus epinephrine (92.9%) followed by ferric sulphate
(60%), gauze packing (30%) and collagen (16.7%). When using aluminium
chloride (Expasyl), over 90% of the apical lesions improved, but this
agent seemed to increase swelling. Epinephrine with collagen did not
significantly raise either blood pressure or heart rate. Conclusions:
Despite the use of several haemostatic materials in apical surgery, there
is little evidence on their effectiveness and safety. The most effective
haemostatic agents were calcium sulphate and epinephrine plus collagen.
Epinephrine plus collagen did not seem to significantly raise blood
pressure or heart rate during surgery. Aluminium chloride did not increase
postoperative pain but could slightly increase postoperative swelling.
Randomized clinical trials are needed to assess the haemostatic
effectiveness and adverse effects of haemostatic materials in apical
surgery. Copyright &#xa9; Medicina Oral S. L.

<58>
Accession Number
608878157
Author
Chan M.Y.; Du X.; Eccleston D.; Ma C.; Mohanan P.P.; Ogita M.; Shyu K.-G.;
Yan B.P.; Jeong Y.-H.
Institution
(Chan) Department of Medicine, Yong Loo Lin School of Medicine, National
University of Singapore, National University Heart Centre, National
University Health System, Singapore, Singapore
(Du, Ma) Beijing AnZhen Hospital, Capital Medical University, Beijing,
China
(Eccleston) University of Melbourne, Melbourne, VIC, Australia
(Mohanan) West Fort Hospital, Thrissur, India
(Ogita) Juntendo University School of Medicine, Tokyo, Japan
(Shyu) Shin Kong Wu Ho-Su Memorial Hospital, Taiwan (Republic of China)
(Yan) Chinese University of Hong Kong (Prince of Wales Hospital), Hong
Kong, Hong Kong
(Jeong) Gyeongsang National University Hospital, Gyeongsang National
University School of Medicine, Jinju, South Korea
Title
Acute coronary syndrome in the Asia-Pacific region.
Source
International Journal of Cardiology. 202 (pp 861-869), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
More than 4.2 billion inhabitants populate the Asia-Pacific region. Acute
coronary syndrome (ACS) is now a major cause of death and disability in
this region with in-hospital mortality typically exceeding 5%. Yet, the
region still lacks consensus on the best approach to overcoming its
specific challenges in reducing mortality from ACS. The Asia-Pacific Real
world evIdenCe on Outcome and Treatment of ACS (APRICOT) project reviewed
current published and unpublished registry data, unmet needs in ACS
management and possible approaches towards improving ACS-related mortality
in the region. There was striking heterogeneity in the use of invasive
procedures, pharmacologic practice (hospitalization/post-discharge), and
in short- and long-term clinical outcomes across healthcare systems; this
heterogeneity was perceived to be far greater than in Western Europe or
the United States. 'Benchmark' short-term clinical outcomes are preferred
over long-term outcomes due to difficulties in follow-up, recording and
maintenance of medication adherence in a geographically large and
culturally diverse region. Key 'barriers' towards improving outcomes
include patient education (pain awareness, consequences of missing
medication and secondary prevention), geographical landscape (urban vs.
metropolitan), limited long-term adherence to guideline-based management
and widespread adoption of cost-based rather than value-based healthcare
systems. Initiatives to overcome these barriers should include
implementation of pre-hospital management strategies, toolkits to aid
in-hospital treatment, greater community outreach with online
patient/physician education and telemedicine, sustainable economic models
to improve accessibility to effective pharmacotherapies and the
acquisition of high-quality 'real-world' regional data to tailor secondary
prevention initiatives that meet the unique needs of countries in this
region. Copyright &#xa9; 2015 The Authors. Published by Elsevier Ireland
Ltd.

<59>
Accession Number
608878155
Author
Ellingsrud C.; Agewall S.
Institution
(Ellingsrud, Agewall) Department of Cardiology, Oslo University Hospital
Ulleval, Institute of Clinical Sciences, University of Oslo, Oslo, Norway
Title
Morphine in the treatment of acute pulmonary oedema - Why?.
Source
International Journal of Cardiology. 202 (pp 870-873), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Morphine has for a long time, been used in patients with acute pulmonary
oedema due to its anticipated anxiolytic and vasodilatory properties,
however a discussion about the benefits and risks has been raised
recently. A literature search in Medline and Embase using the keywords
"pulmonary oedema" OR "lung oedema" OR "acute heart failure" AND
"morphine" was performed. A certain vasodilation has been described after
morphine administration, but the evidence for this mechanism is relatively
poor and morphine-induced anxiolysis may possibly be the most important
factor of morphine in pulmonary oedema and therefore some authors have
suggested benzodiazepines as an alternative treatment. Respiratory
depression seems to be a less relevant clinical problem according to the
literature, whereas vomiting is common, which may cause aspiration. In the
largest outcome study, based on the ADHERE registry, morphine given in
acute decompensated heart failure was an independent predictor of
increased hospital mortality, with an odds ratio of 4.8 (95% CI:
4.52-5.18, p < 0.001). Other, smaller studies have shown a significant
association between morphine administration and mortality, which was lost
after adjusting for confounding factors. Morphine is still used for
pulmonary oedema in spite of poor scientific background data. A
randomised, controlled study is necessary in order to determine the effect
- and especially the risk - when using morphine for pulmonary oedema.
Since the positive effects are not sufficiently documented, and since the
risk for increased mortality cannot be ruled out, one can advocate that
the use should be avoided. Copyright &#xa9; 2015 Elsevier Ireland Ltd. All
rights reserved.

<60>
Accession Number
611974779
Author
Paparella D.; Guida P.; Di Eusanio G.; Caparrotti S.; Gregorini R.;
Cassese M.; Fanelli V.; Speziale G.; Mazzei V.; Zaccaria S.; De Luca
Tupputi Schinosa L.; Fiore T.
Institution
(Paparella, De Luca Tupputi Schinosa) Division of Cardiac Surgery,
Department of Emergency and Organ Transplant, University of Bari Aldo
Moro, Bari, Italy
(Guida) Puglia Health Regional Agency, Bari, Italy
(Di Eusanio, Gregorini) Department of Cardiac Surgery, Citta di Lecce
Hospital, Lecce, Italy
(Caparrotti, Mazzei) Department of Cardiac Surgery, Villa Bianca Hospital,
Bari, Italy
(Cassese) Department of Cardiac Surgery, Santa Maria Hospital, Bari, Italy
(Fanelli) Department of Cardiac Surgery, Villa Verde Hospital, Taranto,
Italy
(Speziale) Department of Cardiac Surgery, Anthea Hospital, Bari, Italy
(Zaccaria) Department of Cardiac Surgery, Vito Fazzi Hospital, Lecce,
Italy
(Fiore) Division of Anesthesia, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
Title
Risk stratification for in-hospital mortality after cardiac surgery:
External validation of EuroSCORE II in a prospective regional registry.
Source
European Journal of Cardio-thoracic Surgery. 46 (5) (pp 840-848), 2014.
Date of Publication: 01 Nov 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To evaluate performance of the European System for Cardiac
Operation Risk Evaluation (EuroSCORE II), to assess the influence of model
updating and to derive a hierarchical tree for modelling the relationship
between EuroSCORE II risk factors and hospital mortality after cardiac
surgery in a large prospective contemporary cohort of consecutive adult
patients. METHODS: Data on consecutive patients, who underwent on-pump
cardiac surgery or off-pump coronary artery bypass graft intervention,
were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination,
calibration, re-estimation of EuroSCORE II coefficients and hierarchical
tree analysis of risk factors were assessed. RESULTS: Out 6293 procedures,
6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital
mortality rate of 4.85% and EuroSCORE II of 4.40 +/- 7.04%. The area under
the receiver operator characteristic curve (0.830) showed good
discriminative ability of EuroSCORE II in distinguishing patients who died
and those who survived. Calibration of EuroSCORE II was preserved with
lower predicted than observed risk in the highest EuroSCORE II deciles. At
logistic regression analysis, the complete revision of the model had most
of reestimated regression coefficients not statistically different from
those in the original EuroSCORE II model. When missing values were
replaced with the mean EuroSCORE II value according to urgency and weight
of intervention, the risk score confirmed discrimination and calibration
obtained over the entire sample. A recursive tree-building algorithm of
EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1%
of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2
and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk
(mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good
agreement between observed events and predicted frequencies by EuroSCORE
II, whereas those at greater risk showed an underestimation of expected
mortality. CONCLUSIONS: This study demonstrates that EuroSCORE II is a
good predictor of hospital mortality after cardiac surgery in an external
validation cohort of contemporary patients from a multicentre prospective
regional registry. The EuroSCORE II predicts hospital mortality with a
slight underestimation in high-risk patients that should be further and
better evaluated. The EuroSCORE II variables as a risk tree provides
clinicians and surgeons a practical bedside tool for mortality risk
stratification of patients at low, intermediate and high risk for hospital
mortality after cardiac surgery. Copyright &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<61>
Accession Number
612012997
Author
Keller E.J.; Malaisrie S.C.; Kruse J.; McCarthy P.M.; Carr J.C.; Markl M.;
Barker A.J.; Collins J.D.
Institution
(Keller, Carr, Markl, Barker, Collins) Department of Radiology,
Northwestern University, 737 N. Michigan Ave, Chicago, IL 60611, United
States
(Malaisrie, Kruse, McCarthy) Division of Surgery-Cardiac Surgery,
Northwestern University, Chicago, IL, United States
(Markl, Barker) Department of Biomedical Engineeringy, Northwestern
University, Evanston, IL, United States
Title
Reduction of aberrant aortic haemodynamics following aortic root
replacement with a mechanical valved conduit.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (3) (pp 416-423),
2016. Date of Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Previous work suggests that aortic root and valve prostheses
alter blood flow patterns in the ascending aorta, creating aberrant
haemodynamics compared with those of healthy volunteers. Various valve
designs have been proposed to better restore physiological haemodynamics.
In this study, magnetic resonance imaging (MRI) was used to non-invasively
assess three-dimensional (3D) ascending aortic haemodynamics after aortic
root replacement (ARR) with a mechanical valved conduit postulated to
create less turbulent blood flow. METHODS Ten patients (40 +/- 9 years)
underwent transthoracic echocardiography and contrast-enhanced
multidimensional four-dimensional (4D) flow MRI at 1.5 T after ARR with an
On-X mechanical valved conduit. Preoperative 4D flow MRI was available in
7 patients. Ten age- and gender-matched healthy volunteers (42 +/- 13
years) were also analysed to characterize physiological flow. The presence
of vortex/helix formation was graded by two blinded observers. Peak
transvalvular pressure gradients were computed using the simplified
Bernoulli equation. Patients' postoperative pressure gradients and
helicity/vorticity grades were compared with preoperative gradients and
those from healthy volunteers. RESULTS Intra- and interobserver ratings
showed good agreement (kappa = 0.93, P < 0.01 and kappa = 0.84, P < 0.01,
respectively). Highly helical and/or vortical flow was observed in all
patients preoperatively, which was significantly reduced postoperatively
(P < 0.01 and <0.01, respectively), restoring similar flow patterns
similar to those seen in volunteers (P = 0.56 and 0.56). Peak
transvalvular pressure gradients (DELTAP) were also significantly reduced
[43 +/- 21 vs 12 +/- 7 mmHg, P < 0.05 (Echo); 48 +/- 22 vs 16 +/- 9 mmHg,
P < 0.05 (MRI)], but remained significantly higher than those of
volunteers (6 +/- 1 mmHg, P < 0.01). CONCLUSIONS Preliminary evidence
suggests that ARR with an On-X mechanical valve significantly reduces
aberrant aortic haemodynamics, producing flow patterns that resemble those
in healthy volunteers. Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<62>
Accession Number
612012964
Author
Grabert S.; Lange R.; Bleiziffer S.
Institution
(Grabert, Lange, Bleiziffer) Department of Cardiovascular Surgery, German
Heart Center Munich, Clinic at the Technical University, Lazarettstrase
36, Munich 80636, Germany
Title
Incidence and causes of silent and symptomatic stroke following surgical
and transcatheter aortic valve replacement: A comprehensive review.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (3) (pp 469-476),
2016. Date of Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Stroke associated with aortic valve replacement in calcific aortic
stenosis, either via transcatheter implantation (TAVR) or via surgical
replacement (SAVR), is one of the most devastating complications. However,
data concerning the clinical impact and incidence of clinical and silent
stroke complicating SAVR and TAVR are varying. This comprehensive review
of the literature explores the genuine incidence of neurological events
after these procedures. Additionally, potential factors responsible for
the discrepancies in stroke rates in the current literature are analysed
and a lack of uniform neurological definitions and standardized
neurological assessments revealed. Current stroke rates after TAVR show a
decline from 7 to 1.7-4.8% in recent studies. Randomized studies comparing
TAVR with SAVR yielded initially a significantly higher stroke rate after
TAVR procedures as opposed to SAVR. Recently published data showed
opposite results with strokes being higher following SAVR. Current data
concerning stroke after surgical valve replacement report significantly
higher rates of clinical strokes (17%) than previously mentioned in the
literature (<4.9%). Silent cerebral lesions were detected in 68-93% after
TAVR and 38-54% after SAVR. A broader application of cerebral protection
devices may help to reduce embolic cerebral events. Copyright &#xa9; 2016
The Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<63>
Accession Number
612012898
Author
Poon S.S.; Estrera A.; Oo A.; Field M.
Institution
(Poon, Oo, Field) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest Hospital, Liverpool, United Kingdom
(Estrera) Department of Cardiothoracic and Vascular Surgery, Memorial
Hermann Heart and Vascular Institute, Houston, TX, United States
Title
Is moderate hypothermic circulatory arrest with selective antegrade
cerebral perfusion superior to deep hypothermic circulatory arrest in
elective aortic arch surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (3) (pp 462-468),
2016. Date of Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether moderate
hypothermia circulatory arrest with selective antegrade cerebral perfusion
(SACP) is more beneficial than deep hypothermic circulatory arrest in
elective aortic arch surgery. Altogether, 1028 papers were found using the
reported search, of which 6 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. There were four retrospective observational studies,
one prospective randomized controlled trial and one meta-analysis study.
There were no local or neuromuscular complications related to axillary
arterial cannulation reported. In the elective setting, four studies
showed that the in-hospital mortality for moderate hypothermia is
consistently low, ranging from 1.0 to 4.3%. In a large series of hemiarch
replacement comparing 682 cases of deep hypothermia with 94 cases of
moderate hypothermia with SACP, 20 cases (2.8%) of permanent neurological
deficit were reported, compared to 3 cases (3.2%) in moderate hypothermia.
Three observational studies and a meta-analysis study did not identify an
increased risk of postoperative renal failure and dialysis following
either deep or moderate hypothermia although a higher incidence of stroke
was reported in the meta-analysis study with deep hypothermia (12.7 vs
7.3%). Longer cardiopulmonary bypass time and circulatory arrest time were
reported in four studies for deep hypothermia, suggesting an increased
time required for systemic cooling and rewarming in that group. Overall,
these findings suggested that in elective aortic arch surgery, moderate
hypothermia with selective antegrade cerebral perfusion adapted to the
duration of circulatory arrest can be performed safely with acceptable
mortality and morbidity outcomes. The risk of spinal cord and visceral
organ complications is low with the use of this cerebral adjunct. Current
studies did not identify an advantage in terms of postoperative bleeding
when compared with deep hypothermia. The moderate hypothermia strategy
reduced operative time without increasing the mortality and morbidity of
surgery. Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<64>
Accession Number
611853500
Author
Ozturk N.K.; Baki E.D.; Kavakli A.S.; Sahin A.S.; Ayoglu R.U.; Karaveli
A.; Emmiler M.; Inanoglu K.; Karsli B.
Institution
(Ozturk, Kavakli, Sahin, Karaveli, Inanoglu) Department of Anesthesiology
and Reanimation, Antalya Education and Research Hospital, Varlyk
Mahallesi, Kazim Karabekir Cadde, Antalya 07100, Turkey
(Baki) Department of Anesthesiology and Reanimation, Afyon Kocatepe
University, Faculty of Medicine, Afyon, Turkey
(Ayoglu, Emmiler) Department of Cardiovascular Surgery, Antalya Education
and Research Hospital, Antalya 07100, Turkey
(Karsli) Department of Algology, Akdeniz University, Faculty of Medicine,
Antalya 07100, Turkey
Title
Comparison of transcutaneous electrical nerve stimulation and Parasternal
block for postoperative pain management after cardiac surgery.
Source
Pain Research and Management. 2016 (no pagination), 2016. Article Number:
4261949. Date of Publication: 2016.
Publisher
Pulsus Group Inc.
Abstract
Background: Parasternal block and transcutaneous electrical nerve
stimulation (TENS) have been demonstrated to produce effective analgesia
and reduce postoperative opioid requirements in patients undergoing
cardiac surgery. Objectives: To compare the effectiveness of TENS and
parasternal block on early postoperative pain after cardiac surgery.
Methods: One hundred twenty patients undergoing cardiac surgery were
enrolled in the present randomized, controlled prospective study. Patients
were assigned to three treatment groups: parasternal block, intermittent
TENS application, or a control group. Results: Pain scores recorded 4h, 5
h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block
group than in the TENS and control groups. Totalmorphine consumption was
also lower in the parasternal block group than in the TENS and control
groups. It was also significantly lower in the TENS group than in the
control group. There were no statistical differences among the groups
regarding the extubation time, rescue analgesic medication, length of
intensive care unit stay, or length of hospital stay. Conclusions:
Parasternal block was more effective than TENS in themanagement of early
postoperative pain and the reduction of opioid requirements in patients
who underwent cardiac surgery through median sternotomy.This trial is
registered with Clinicaltrials.gov number NCT02725229. Copyright &#xa9;
2016 Nilgun Kavrut Ozturk et al.

<65>
Accession Number
606984756
Author
Donato A.
Institution
(Donato) Reading Health System, Reading, PA, United States
Title
In AF requiring warfarin interruption, no anticoagulation bridging was
noninferior to bridging for thromboembolism.
Source
Annals of Internal Medicine. 163 (10) (pp JC5), 2015. Date of Publication:
17 Nov 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<66>
Accession Number
611956033
Author
Gargiulo G.; Valgimigli M.
Institution
(Gargiulo, Valgimigli) Department of Cardiology Inselspital, University of
Bern, Berna, Svizzera 3010, Switzerland
Title
Antithrombotic therapy in patients undergoing transcatheter aortic valve
implantation.
Source
Giornale Italiano di Cardiologia. 17 (6 Supplement 2) (pp 4S-10S), 2016.
Date of Publication: June 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l. (Via Giovanni Valdarno 8, Roma
00138, Italy)
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a valid
alternative to surgical replacement in patients with severe aortic
stenosis. Bleeding and cerebral ischemic events remain frequent
complications of this procedure during the periprocedural period and at
follow-up with a severe impact on survival. Therefore, there is growing
interest towards the optimal antithrombotic therapy to manage patients
undergoing TAVI. International guidelines support the adoption of a dual
antiplatelet therapy after TAVI, although there is heterogeneity in the
suggested duration and the concomitant association with an oral
anticoagulant in patients with specific indications, mainly those with
atrial fibrillation. Recent data have questioned the benefits of adding
clopidogrel to aspirin, showing a slight increase in bleeding compared
with aspirin therapy alone. Importantly, recent studies have also
underlined the risks of valve thrombosis and the potential benefits of
oral anticoagulant therapy in patients undergoing TAVI. Currently, large
randomized trials are ongoing and are expected to provide relevant
information to guide recommendations on the most appropriate
antithrombotic therapy in these patients. Tailored therapy based on the
patient's risk profile remains relevant in daily clinical practice.
Copyright &#xa9; 2016 Il Pensiero Scientifico Editore.

<67>
Accession Number
612012500
Author
Lagny M.-G.; Gothot A.; Hans G.A.; Koch J.-N.; Blaffart F.; Hella D.;
Donneau A.-F.; Roediger L.; Lecut C.; Pincemail J.; Cheramy-Bien J.-P.;
Defraigne J.-O.
Institution
(Lagny, Koch, Blaffart, Hella, Pincemail, Cheramy-Bien, Defraigne)
Division of Cardio-vascular and Thoracic Surgery, University of Liege
Hospital (ULg CHU), Avenue de lHopital, 1, Liege B-4000, Belgium
(Gothot, Lecut) Haematology Department, University of Liege Hospital,
Liege, Belgium
(Hans, Roediger) Division of Anaesthesiology, University of Liege
Hospital, Liege, Belgium
(Donneau) Biostatistics, Public Health Department, University of Liege,
Liege, Belgium
Title
Efficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte
removal from shed mediastinal blood: A randomized controlled trial.
Source
Perfusion (United Kingdom). 31 (7) (pp 544-551), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Re-transfusion of lipid particles and activated leucocytes
with shed mediastinal blood (SMB) can aggravate cardiopulmonary
bypass-associated inflammation and increase the embolic load. This study
evaluated the fat and leucocyte removal capacity of the RemoweLL
cardiotomy reservoir. Methods: Forty-five patients undergoing elective
on-pump cardiac surgery were randomly allocated to filtration of SMB using
the RemoweLL or the Admiral cardiotomy reservoir. The primary outcome was
a drop in leucocytes and lipid particles obtained with the two filters.
The effect of the filters on other blood cells and inflammatory mediators,
such as myeloperoxidase (MPO), was also assessed. Results: The RemoweLL
cardiotomy filter removed 16.5% of the leucocytes (p<0.001) while no
significant removal of leucocytes was observed with the Admiral (p=0.48).
The percentage reductions in lipid particles were similar in the two
groups (26% vs 23%, p=0.2). Both filters similarly affected the level of
MPO (p=0.71). Conclusion: The RemoweLL filter more effectively removed
leucocytes from SMB than the Admiral. It offered no advantage in terms of
lipid particle clearance. Copyright &#xa9; SAGE Publications.

<68>
Accession Number
612012419
Author
Soylu E.; Harling L.; Ashrafian H.; Attaran S.; Athanasiou C.; Punjabi
P.P.; Casula R.; Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Attaran, Athanasiou, Punjabi, Casula,
Athanasiou) Department of Surgery and Cancer, Imperial College London,
QEQM Building, St. Marys Hospital, Praed Street, London W2 1NY, United
Kingdom
Title
A systematic review of the safety and efficacy of distal coronary artery
anastomotic devices in MIDCAB and TECAB surgery.
Source
Perfusion (United Kingdom). 31 (7) (pp 537-543), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Minimally invasive direct coronary artery bypass (MIDCAB) and
totally endoscopic coronary artery bypass (TECAB) techniques may improve
recovery and reduce hospital stay following coronary artery bypass surgery
(CABG). However, working in a limited space with indirect visualisation
would greatly benefit from a simple, high-quality and reproducible
automated distal anastomotic method. Several devices have been developed;
however, their uptake has been limited due to uncertainty around their
impact on patient outcomes. Methods: A systematic review of the literature
identified six studies, incorporating 139 subjects undergoing MIDCAB or
TECAB surgery using a distal anastomotic device. Results: The overall
30-day mortality was 0.7% (1/137). No cardiac specific mortality was
observed. For each outcome of perioperative myocardial infarction (MI),
postoperative stroke and haemorrhage, only a single event was observed for
each (n=1/136, 1/138 and 1/136, respectively). The overall device failure
rates were low, with the use of additional sutures only reported in a
single case with the Magnetic Vascular Port (MVP) device. Anastomotic time
ranged from a mean of 3.32 minutes with the MVP device to 20 minutes with
the C-Port device. Conclusions: These results demonstrate the overall
acceptable early outcomes of distal anastomotic devices for use in
minimally invasive coronary bypass surgery. Future research should focus
on designing adequately powered, comparative, randomised trials, focusing
on major adverse cardiac and cerebrovascular events (MACCE) outcomes in
both the short and long-term, with clear case-by-case reasons for device
failure and a comparison of anastomotic times. In this way, we may
determine whether such devices will facilitate the minimal access and
robotic coronary procedures of the future. Copyright &#xa9; SAGE
Publications.

<69>
Accession Number
611943575
Author
Chakravarty T.; Van Belle E.; Jilaihawi H.; Noheria A.; Testa L.; Bedogni
F.; Ruck A.; Barbanti M.; Toggweiler S.; Thomas M.; Khawaja M.Z.; Hutter
A.; Abramowitz Y.; Siegel R.J.; Cheng W.; Webb J.; Leon M.B.; Makkar R.R.
Institution
(Chakravarty, Jilaihawi, Abramowitz, Siegel, Cheng, Makkar) Cedars-Sinai
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California,
United States
(Van Belle) Department of Cardiology, University Hospital, Lille, France
(Noheria) Department of Cardiology, Mayo Clinic, Rochester, Minnesota,
United States
(Testa, Bedogni) Department of Cardiology, Clinical Institute S. Ambrogio,
Milan, Italy
(Ruck) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
(Barbanti) Department of Cardiology, University of Catania, Catania, Italy
(Barbanti, Webb) St. Paul's Hospital, Vancouver, Canada
(Toggweiler) Luzerner Kantonsspital, Lucerne, Switzerland
(Thomas, Khawaja) Guys and St. Thomas' Hospital, London, United Kingdom
(Hutter) German Heart Center, Munich, Germany
(Leon) Columbia University Medical Center, New York-Presbyterian Hospital,
New York, New York, United States
Title
Meta-Analysis of the Impact of Mitral Regurgitation on Outcomes After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 115 (7) (pp 942-949), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Significant mitral regurgitation (MR) constitutes an important co-existing
valvular heart disease burden in the setting of aortic valve stenosis.
There are conflicting reports on the impact of significant MR on outcomes
after transcatheter aortic valve implantation (TAVI). We evaluated the
impact of MR on outcomes after TAVI by performing a meta-analysis of 8
studies involving 8,927 patients reporting TAVI outcomes based on the
presence or absence of moderate-severe MR. Risk ratios (RRs) were
calculated using the inverse variance random-effects model. None-mild MR
was present in 77.8% and moderate-severe MR in 22.2% of the patients. The
presence of moderate-severe MR at baseline was associated with increased
mortality at 30 days (RR 1.35, 95% confidence interval [CI] 1.14 to 1.59,
p = 0.003) and 1 year (RR 1.24, 95% CI 1.13 to 1.37, p <0.0001). The
increased mortality associated with moderate-severe MR was not influenced
by the cause of MR (functional or degenerative MR; RR 0.90, 95% CI 0.62 to
1.30, p = 0.56). The severity of MR improved in 61 +/- 6.0% of patients
after TAVI. Moderate-severe residual MR, compared with none-mild residual
MR after TAVI, was associated with significantly increased 1-year
mortality (RR 1.48, 95% CI 1.31 to 1.68, p <0.00001). In conclusion,
baseline moderate-severe MR and significant residual MR after TAVI are
associated with an increase in mortality after TAVI and represent an
important group to target with medical or transcatheter therapies in the
future. Copyright &#xa9; 2015 Elsevier Inc.

<70>
Accession Number
612131042
Author
Yi J.; Gong Y.; Quan X.; Huang Y.
Institution
(Yi) Department of Anesthesiology, Chinese Academy of Medical Science,
Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street,
Beijing, 100730, P.R of China. easyue@163.com
(Gong) Department of Anesthesiology, Chinese Academy of Medical Science,
Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street,
Beijing, 100730, P.R of China. yh2087@163.com
(Quan) Department of Anesthesiology, Chinese Academy of Medical Science,
Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street,
Beijing, 100730, P.R of China. quan79102@188.com
(Huang) Department of Anesthesiology, Chinese Academy of Medical Science,
Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street,
Beijing, 100730, P.R of China. garybeijing@163.com
Title
Comparison of the Airtraq laryngoscope and the GlideScope for double-lumen
tube intubation in patients with predicted normal airways: a prospective
randomized trial.
Source
BMC anesthesiology. 15 (pp 58), 2015. Date of Publication: 2015.
Abstract
BACKGROUND: The Airtraq laryngoscope and the GlideScope are commonly used
in many airway scenarios. However, their features have not been fully
described for double-lumen tube intubation. A prospective randomized study
was designed to compare their intubation performances in thoracic surgery
patients.
METHODS: Seventy ASA physical status I and II patients with predicted
normal airway were scheduled for thoracic surgeries with double-lumen tube
intubation. They were randomly assigned to one of two groups and intubated
with either the Airtraq laryngoscope (group A, n=35) or the GlideScope
(group G, n=35). Airway assessments were performed prior to anesthesia,
and all patients were induced with a standard anesthetic regimen. The
Cormack-Lehane grades were initially evaluated with a Macintosh
laryngoscope and subsequently with the group-specific laryngoscope before
intubation. Intubation time was recorded as the primary outcome. The
Cormack-Lehane grade, the success of the first intubation attempt, the
intubation difficulty scales and ease of tube advancement were noted.
Hemodynamic variables during intubation and incidence of post-operative
sore throat were documented as well.
RESULTS: The intubation time of group A was shorter than that of group G
(36.6+/-20.2 s vs. 54.6+/-25.7 s, p=0.002). The Cormack-Lehane grade
(I/II/III/IV) was significantly better in group A (33/2/0/0 vs. 28/7/0/0,
p=0.042). The mean arterial pressure and heart rate rose to higher levels
during intubation with the GlideScope than with the Airtraq laryngoscope.
The success of the first intubation attempt and the intubation difficulty
scales were comparable between the two groups. The numbers of patients who
experienced postoperative sore throat were similar (6 vs. 8) in the two
groups.
CONCLUSIONS: Compared with the GlideScope, the specially designed Airtraq
laryngoscope might be more suitable for double-lumen tube intubations in
patients with predicted normal airway.
TRIAL REGISTRATION: www.chictr.org Identifier: ChiCTR-TRC-11001628.

<71>
Accession Number
612104120
Author
Straub N.; Bauer E.; Agarwal S.; Meybohm P.; Zacharowski K.; Hanke A.A.;
Weber C.F.
Title
Cost-Effectiveness of POC Coagulation Testing Using Multiple Electrode
Aggregometry.
Source
Clinical laboratory. 62 (6) (pp 1167-1178), 2016. Date of Publication:
2016.
Abstract
BACKGROUND: The economic effects of Point-of-Care (POC) coagulation
testing including Multiple Electrode Aggregometry (MEA) with the
Multiplate device have not been examined.
METHODS: A health economic model with associated clinical endpoints was
developed to calculate the effectiveness and estimated costs of
coagulation analyses based on standard laboratory testing (SLT) or POC
testing offering the possibility to assess platelet dysfunction using
aggregometric measures. Cost estimates included pre- and perioperative
costs of hemotherapy, intra- and post-operative coagulation testing costs,
and hospitalization costs, including the costs of transfusion-related
complications.
RESULTS: Our model calculation using a simulated true-to-life cohort of
10,000 cardiac surgery patients assigned to each testing alternative
demonstrated that there were 950 fewer patients in the POC branch who
required any transfusion of red blood cells. The subsequent numbers of
massive transfusions and patients with transfusion-related complications
were reduced with the POC testing by 284 and 126, respectively. The
average expected total cost in the POC branch was 288 Euro lower for every
treated patient than that in the SLT branch.
CONCLUSIONS: Incorporating aggregometric analyses using MEA into
hemotherapy algorithms improved medical outcomes in cardiac surgery
patients in the presented health economic model. There was an overall
better economic outcome associated with POC testing compared with SLT
testing despite the higher costs of testing.