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<1>
Accession Number
26454847
Author
Liebregts M.; Vriesendorp P.A.; Mahmoodi B.K.; Schinkel A.F.; Michels M.;
ten Berg J.M.
Institution
(Liebregts) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, the Netherlands. Electronic address:
(Vriesendorp) Department of Cardiology, Thoraxcenter, Erasmus Medical
Center, Rotterdam, the Netherlands
(Mahmoodi) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, the Netherlands
(Schinkel) Department of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, the Netherlands
(Michels) Department of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, the Netherlands
(ten Berg) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, the Netherlands
Title
A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal
Reduction Therapy in Patients With Hypertrophic Cardiomyopathy.
Source
JACC. Heart failure. 3 (11) (pp 896-905), 2015. Date of Publication: 01
Nov 2015.
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare long-term
outcomes after myectomy and alcohol septal ablation (ASA) in patients with
hypertrophic cardiomyopathy (HCM).
BACKGROUND: Surgical myectomy and ASA are both accepted treatment options
for medical therapy-resistant obstructive HCM. Previous meta-analyses only
evaluated short-term outcomes.
METHODS: A systematic review was conducted for eligible studies with a
follow-up of at least 3 years. Primary outcomes were all-cause mortality
and (aborted) sudden cardiac death (SCD). Secondary outcomes were
periprocedural complications, left ventricular outflow tract gradient, and
New York Heart Association functional class after >3 months, and
reintervention. Pooled estimates were calculated using a random-effects
meta-analysis.
RESULTS: Sixteen myectomy cohorts (n = 2,791; mean follow-up, 7.4 years)
and 11 ASA cohorts (n = 2,013; mean follow-up, 6.2 years) were included.
Long-term mortality was found to be similarly low after ASA (1.5% per
year) compared with myectomy (1.4% per year, p = 0.78). The rate of
(aborted) SCD, including appropriate implantable cardioverter
defibrillator shocks, was 0.4% per year after ASA and 0.5% per year after
myectomy (p = 0.47). Permanent pacemaker implantation was performed after
ASA in 10% of the patients compared with 4.4% after myectomy (p < 0.001).
Reintervention was performed in 7.7% of the patients who underwent ASA
compared with 1.6% after myectomy (p = 0.001).
CONCLUSIONS: Long-term mortality and (aborted) SCD rates after ASA and
myectomy are similarly low. Patients who undergo ASA have more than twice
the risk of permanent pacemaker implantation and a 5 times higher risk of
the need for additional septal reduction therapy compared with those who
undergo myectomy.

<2>
Accession Number
25068802
Author
Lalonde F.; Curnier D.Y.
Institution
(Lalonde, Curnier) 1Department of Kinesiology, University of Montreal,
Montreal, Quebec, Canada; 2University of Montreal Hospital Research Centre
(CRCHUM), Quebec, Canada; and 3Laboratory of Pathophysiology of Exercise
(LPEX), Department of Kinesiology University de Montreal, Quebec, Canada
Title
Can anaerobic performance be improved by remote ischemic preconditioning?.
Source
Journal of strength and conditioning research / National Strength &
Conditioning Association. 29 (1) (pp 80-85), 2015. Date of Publication: 01
Jan 2015.
Abstract
Remote ischemic preconditioning (RIPC) provides a substantial benefit for
heart protection during surgery. Recent literature on RIPC reveals the
potential to benefit the enhancement of sports performance as well. The
aim of this study was to investigate the effect of RIPC on anaerobic
performance. Seventeen healthy participants who practice regular physical
activity participated in the project (9 women and 8 men, mean age 28 +/- 8
years). The participants were randomly assigned to an RIPC intervention
(four 5-minute cycles of ischemia reperfusion, followed by 5 minutes using
a pressure cuff) or a SHAM intervention in a crossover design. After the
intervention, the participants were tested for alactic anaerobic
performance (6 seconds of effort) followed by a Wingate test (lactic
system) on an electromagnetic cycle ergometer. The following parameters
were evaluated: average power, peak power, the scale of perceived
exertion, fatigue index (in watt per second), peak power (in Watt), time
to reach peak power (in seconds), minimum power (in Watt), the average
power-to-weight ratio (in watt per kilogram), and the maximum
power-to-weight ratio (in watt per kilogram). The peak power for the
Wingate test is 794 W for RIPC and 777 W for the control group (p =
0.208). The average power is 529 W (RIPC) vs. 520 W for controls (p =
0.079). Perceived effort for RIPC is 9/10 on the Borg scale vs. 10/10 for
the control group (p = 0.123). Remote ischemic preconditioning does not
offer any significant benefits for anaerobic performance.

<3>
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Accession Number
26891150
Author
Lee E.-H.; Kim W.-J.; Kim J.-Y.; Chin J.-H.; Choi D.-K.; Sim J.-Y.; Choo
S.-J.; Chung C.-H.; Lee J.-W.; Choi I.-C.
Institution
(Lee, Kim, Kim, Chin, Choi, Sim, Choo, Chung, Lee, Choi) From the
Department of Anesthesiology and Pain Medicine (E.-H.L., W.-J.K., J.-Y.K.,
J.-H.C., D.-K.C., J.-Y.S., I.-C.C.) and Department of Thoracic and
Cardiovascular Surgery (S.-J.C., C.-H.C., J.-W.L.), Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea
Title
Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney
Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with
a Preoperative Albumin Level of Less Than 4.0 g/dl.
Source
Anesthesiology. 124 (5) (pp 1001-1011), 2016. Date of Publication: 01 May
2016.
Abstract
BACKGROUND: Hypoalbuminemia may increase the risk of acute kidney injury
(AKI). The authors investigated whether the immediate preoperative
administration of 20% albumin solution affects the incidence of AKI after
off-pump coronary artery bypass surgery.
METHODS: In this prospective, single-center, randomized, parallel-arm
double-blind trial, 220 patients with preoperative serum albumin levels
less than 4.0 g/dl were administered 100, 200, or 300 ml of 20% human
albumin according to the preoperative serum albumin level (3.5 to 3.9, 3.0
to 3.4, or less than 3.0 g/dl, respectively) or with an equal volume of
saline before surgery. The primary outcome measure was AKI incidence after
surgery. Postoperative AKI was defined by maximal AKI Network criteria
based on creatinine changes.
RESULTS: Patient characteristics and perioperative data except urine
output during surgery were similar between the two groups studied, the
albumin group and the control group. Urine output (median [interquartile
range]) during surgery was higher in the albumin group (550 ml [315 to
980]) than in the control group (370 ml [230 to 670]; P = 0.006). The
incidence of postoperative AKI in the albumin group was lower than that in
the control group (14 [13.7%] vs. 26 [25.7%]; P = 0.048). There were no
significant between-group differences in severe AKI, including renal
replacement therapy, 30-day mortality, and other clinical outcomes. There
were no significant adverse events.
CONCLUSION: Administration of 20% exogenous albumin immediately before
surgery increases urine output during surgery and reduces the risk of AKI
after off-pump coronary artery bypass surgery in patients with a
preoperative serum albumin level of less than 4.0 g/dl.

<4>
Accession Number
26979004
Author
Helviz Y.; Dzigivker I.; Raveh-Brawer D.; Hersch M.; Zevin S.; Einav S.
Title
Anti-Factor Xa Activity of Prophylactic Enoxaparin Regimens in Critically
Ill Patients.
Source
The Israel Medical Association journal : IMAJ. 18 (2) (pp 108-113), 2016.
Date of Publication: 01 Feb 2016.
Abstract
OBJECTIVES: To evaluate three enoxaparin prophylactic regimens in critical
care patients with and without administration of a vasopressor.
METHODS: Patients admitted to intensive care units (general and
post-cardiothoracic surgery) without renal failure received, once daily, a
subcutaneous fixed dose of 40 mg enoxaparin, a subcutaneous dose of 0.5
mg/kg enoxaparin, or an intravenous dose of 0.5 mg/kg enoxaparin. Over 5
days anti-activated factor X levels were collected before the daily
administration and 4 hours after the injection.
RESULTS: Overall, 16 patients received the subcutaneous fixed dose, 15
received the subcutaneous weight-based dosage, and 8 received the dose
intravenously. Around two-fifths (38%) of the patients received
vasopressors. There was no difference between anti-activated factor X
levels regarding vasopressor administration. However, in all three groups
the levels were outside the recommended range of 0.1 IU/ml and 0.3 IU/ml.
CONCLUSIONS: Although not influenced by vasopressor administration, the
enoxaparin regimens resulted in blood activity levels outside the
recommended range.
BACKGROUND: Enoxaparin is frequently used as prophylaxis for deep venous
thrombosis in critically ill patients.

<5>
Accession Number
25705899
Author
Billings F.T.; Petracek M.R.; Roberts L.J.; Pretorius M.
Institution
(Billings) Department of Anesthesiology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Petracek) Department of Cardiac Surgery, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Roberts) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University Medical School, Nashville, Tennessee, United States
of America; Department of Pharmacology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
(Pretorius) Division of Clinical Pharmacology, Department of Medicine,
Vanderbilt University Medical School, Nashville, Tennessee, United States
of America; Department of Anesthesiology, Vanderbilt University Medical
School, Nashville, Tennessee, United States of America
Title
Perioperative intravenous acetaminophen attenuates lipid peroxidation in
adults undergoing cardiopulmonary bypass: a randomized clinical trial.
Source
PloS one. 10 (2) (pp e0117625), 2015. Date of Publication: 2015.
Abstract
CONCLUSIONS: Intravenous acetaminophen attenuates the increase in
intraoperative plasma isofuran concentrations that occurs during CPB,
while urinary markers were unaffected.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01366976.
BACKGROUND: Cardiopulmonary bypass (CPB) lyses erythrocytes and induces
lipid peroxidation, indicated by increasing plasma concentrations of free
hemoglobin, F2-isoprostanes, and isofurans. Acetaminophen attenuates
hemeprotein-mediated lipid peroxidation, reduces plasma and urine
concentrations of F2-isoprostanes, and preserves kidney function in an
animal model of rhabdomyolysis. Acetaminophen also attenuates plasma
concentrations of isofurans in children undergoing CPB. The effect of
acetaminophen on lipid peroxidation in adults has not been studied. This
was a pilot study designed to test the hypothesis that acetaminophen
attenuates lipid peroxidation in adults undergoing CPB and to generate
data for a clinical trial aimed to reduce acute kidney injury following
cardiac surgery.
METHODS AND RESULTS: In a prospective double-blind placebo-controlled
clinical trial, sixty adult patients were randomized to receive
intravenous acetaminophen or placebo starting prior to initiation of CPB
and for every 6 hours for 4 doses. Acetaminophen concentrations measured
30 min into CPB and post-CPB were 11.9 +/- 0.6 mug/mL (78.9 +/- 3.9 muM)
and 8.7 +/- 0.3 mug/mL (57.6 +/- 2.0 muM), respectively. Plasma free
hemoglobin increased more than 15-fold during CPB, and haptoglobin
decreased 73%, indicating hemolysis. Plasma and urinary markers of lipid
peroxidation also increased during CPB but returned to baseline by the
first postoperative day. Acetaminophen reduced plasma isofuran
concentrations over the duration of the study (P = 0.05), and the
intraoperative plasma isofuran concentrations that corresponded to peak
hemolysis were attenuated in those subjects randomized to acetaminophen (P
= 0.03). Perioperative acetaminophen did not affect plasma concentrations
of F2-isoprostanes or urinary markers of lipid peroxidation.

<6>
Accession Number
2015552091
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve
Replacement.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 400-409), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag
Abstract
Objective To summarize the safety of sutureless or rapid-deployment aortic
valve replacement (AVR), we performed a systematic review and
meta-analysis of single-arm studies. Methods MEDLINE and EMBASE were
searched through December 2014. Studies considered for inclusion met the
following criteria: the design was a single-arm study enrolling >50
participants; the study population consisted of patients undergoing
sutureless/rapid-deployment AVR; and main outcomes included early
(in-hospital or 30-day) mortality and/or overall survival. Results Of 250
potentially relevant articles screened initially, 11 eligible studies
enrolling a total of 2,066 patients were identified and included. The
Enable, Intuity, and Perceval bioprostheses were used in three, two, and
six studies, respectively. Mean age of patients was 77.6 years, and 56.9%
of patients were women. Mean logistic European System for Cardiac
Operative Risk Evaluation I and II were 10.5 and 7.4%, respectively.
Aortic cross-clamp times in overall patients, patients undergoing isolated
AVR, those undergoing AVR with any concomitant procedures, and those
undergoing AVR with coronary artery bypass grafting were 44.7, 41.9, 56.2,
and 51.3 minutes, respectively. Arithmetic mean of early mortality was
2.6%, and fixed-effects combined early mortality was 3.2% (95% confidence
interval, 2.5-4.2%). Arithmetic mean of 1-year survival was 89.7%, and
fixed-effects combined 1-year mortality was 10.4% (9.0-12.1%). Conclusion
Sutureless/rapid-deployment AVR is feasible and safe with approximate 3
and 10% of early and 1-year mortality, respectively. Large-size randomized
controlled trials, however, are needed to determine whether
sutureless/rapid-deployment AVR improves mortality compared with
conventional AVR.

<7>
Accession Number
2015316846
Author
Yalcinkaya A.; Diken A.I.; Aksoy E.; Lafci G.; Cicek O.F.; Kadirogullari
E.; Ulusar U.D.; Cagli K.
Institution
(Yalcinkaya, Lafci, Cicek, Kadirogullari, Cagli) Hitit University Corum
Education, Research Hospital, Turkey Yuksek Ihtisas Education and Research
Hospital, Department of Cardiovascular Surgery, Bahcelievler Mah. Camllk
Cad. No: 2, Corum 19100, Turkey
(Diken) Hitit University Corum Education and Research Hospital, Department
of Cardiovascular Surgery, Corum, Turkey
(Aksoy) Kartal Kosuyolu Education and Research Hospital, Department of
Cardiovascular Surgery, Istanbul, Turkey
(Ulusar) Akdeniz University, Faculty of Engineering, Department of
Computer Engineering, Antalya, Turkey
Title
Effect of Left Atrial Reduction on Restoration and Maintenance of Sinus
Rhythm in Patients Undergoing Mitral Valve Replacement: A Pilot Study.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 441-446), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag
Abstract
Background This pilot study aimed to evaluate the effectiveness of
posterior left atrial wall plication (T-plasty) in patients with
persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve
surgery. Materials and Methods A total of 60 patients who were scheduled
for mitral valve replacement were randomly allocated into two groups: one
would receive (Group 1; n = 32, mean age; 49.37 +/- 9.00) and one would
not receive (Group 2; n = 28; mean age 48.64 +/- 8.6) left atrial size
reduction using T-plasty technique. Patients with a clear indication for
combined procedures other than tricuspid valve disease, aortic valve
disease, and coronary artery stenosis were not included. Follow-up was
performed at 6th, 12th, and 18th months after the operation. Results After
the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in
Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF
recurrence rates were not significantly different between the groups in
three follow-ups. Restoration of sinus rhythm was significantly more
common in Group 1 patients than in Group 2 patients during follow-up.
Patients in Group 1 had lower left atrial volume indexes than those in
Group 2 at the 6th and 12th months, whereas the difference at the 18th
month was at the limit of significance. Conclusion We achieved
satisfactory results using the T-plasty technique for left atrial size
reduction in terms of mid-term restoration and preservation of normal
sinus rhythm in patients undergoing mitral valve surgery. Further study
may be justified to reveal the prognostic importance of the technique
described herein.

<8>
Accession Number
2015173002
Author
Liu Z.; He R.; Wu C.; Xia Y.
Institution
(Liu, He, Wu, Xia) Department of Cardiovascular Surgery, Zhejiang
Hospital, No.12 Lingyin Road, Hangzhou 310013, China
Title
Transfemoral versus Transapical Aortic Implantation for Aortic Stenosis
Based on No Significant Difference in Logistic EuroSCORE: A Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 374-381), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag
Abstract
Background Transcatheter aortic valve implantation (TAVI) has gained
increasing acceptance for patients with severe aortic stenosis (AS). The
present meta-Analysis was performed to assess if the transapical (TA)
approach has any benefit in reduction of mortality and complications
relative to the transfemoral (TF) approach for patients with AS. Methods
All relevant studies comparing TF-TAVI and TA-TAVI from January 2002 to
November 2013 were retrieved from Medline and Embase databases. The
relative risk (RR) and 95% confidence interval (CI) were used to evaluate
the difference between two groups. Heterogeneity assumption was assessed
by an I ² test. The random-effect model or fixed-effect model
was used to estimate summary effect based on I ² test. Results
Nine studies conformed to the predefined criteria, including 666 patients
in the TF-TAVI group and 457 patients in the TA-TAVI group. No difference
was found in all-cause mortality at 30 days and beyond 1 year between the
two groups (30 days: 9.2% versus 11.4%; RR, 0.72; 95% CI, 0.47 to 1.11; p
= 0.14 and beyond 1 year: RR, 0.96; 95% CI, 0.59 to 1.56; p = 0.86). There
was a trend toward increased incidence of stroke in patients in the
TF-TAVI group (4.7% versus 2.6%; RR, 1.64; 95% CI, 0.75 to 3.58; p =
0.21), and the incidence of vascular complication and postoperative heart
block were significantly increased in patients having TF-TAVI (vascular
complications: 14.7% versus 7.1%; RR, 2.04; 95% CI, 1.15 to 3.61; p = 0.01
and heart block: 13.4% versus 4.6%; RR, 2.53; 95% CI, 1.10 to 5.83; p =
0.03). Additionally, more patients in the TF-TAVI group required permanent
pacemaker relative to the TA-TAVI group (10.8% versus 3.4%; RR, 2.74; 95%
CI, 1.41 to 5.32; p = 0.003). Conclusions Among patients with AS with no
significant difference in logistic EuroSCORE, TA-TAVI has a lower risk of
vascular complication and postoperative heart block but a similar
incidence of stroke and mortality compared with TF-TAVI. Accordingly, TA
approach is a promising and feasible option for the patients with severe
AS.

<9>
Accession Number
20160612164
Author
Isert M.; Miesbach W.; Schuttfort G.; Weil Y.; Tirneci V.; Kasper A.;
Weber A.; Lindhoff-Last E.; Herrmann E.; Linnemann B.
Institution
(Isert, Schuttfort, Weil, Tirneci, Kasper, Weber, Lindhoff-Last,
Linnemann) Division of Vascular Medicine, Department of Internal Medicine,
Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt, Main 60590,
Germany
(Miesbach) Frankfurt Haemophilia Center, Institute of Transfusion
Medicine, Goethe University Hospital, Frankfurt, Main, Germany
(Herrmann) Institute of Biostatistics and Math, Modelling, Faculty of
Medicine, Goethe University Hospital, Frankfurt, Main, Germany
Title
Monitoring anticoagulant therapy with vitamin K antagonists in patients
with antiphospholipid syndrome.
Source
Annals of Hematology. 94 (8) (pp 1291-1299), 2015. Date of Publication:
August 2015.
Publisher
Springer Verlag
Abstract
Because of the possible interference of antiphospholipid antibodies (APL)
with the phospholipid component of thromboplastin reagents, concerns have
been raised about the validity of international normalized ratio (INR)
testing to monitor anticoagulant therapy with vitamin K antagonists in
patients with antiphospholipid syndrome (APS). To investigate the
reliability of the INR, we determined the INR using various prothrombin
time (PT) assays and compared the results with those of a chromogenic
factor X (CFX) assay. The study cohort consisted of 40 APS patients and
100 APL-negative patients who were on anticoagulant therapy for reasons
other than APS. The agreement (i.e. the percentage of patients with a
difference <0.5 INR units) between the PTderived INR and CFX-derived INR
equivalents was only moderate in both patient groups. The best agreement
with CFX-derived INR equivalents was observed for the Thromborel S reagent
in APS patients (69.1 %) and for Neoplastin Plus in APL-negative patients
(72.0%). Regarding the results for the point-of-care system CoaguChek XS,
an agreement between the INR and the CFX-derived INR equivalent was less
frequently observed in the APS patients (55.6 vs. 67.8 %; p=0.050). When
considering all 3058 pairs of INR tests within the international
sensitivity index (ISI)-calibrated range of 1.5 to 4.5 s, we did not
observe a higher variability of INR values in either the APS patient group
or the subgroup of APS patients positive for lupus coagulants compared
with the APL-negative controls. In conclusion, monitoring vitamin K
antagonists (VKA) therapy with laboratory INR measurements seems to be
suitable for the majority of APS patients.

<10>
Accession Number
20160480171
Author
Vesnina Z.V.; Lishmanov Y.B.; Alexandrova E.A.; Nesterov E.A.
Institution
(Vesnina, Lishmanov) Laboratory of Nuclear Medicine, Federal State
Budgetary Scientific Institution, Research Institute for Cardiology,
Kievskaya Street, 111a, Tomsk RU-634012, Russian Federation
(Alexandrova) Department of Cardiovascular Surgery, Federal State
Budgetary Scientific Institution, Research Institute for Cardiology,
Tomsk, Russian Federation
(Vesnina, Lishmanov, Nesterov) National Research Tomsk Polytechnic
University, Tomsk, Russian Federation
Title
Evaluation of nephroprotective efficacy of hypoxic preconditioning in
patients undergoing coronary artery bypass surgery.
Source
CardioRenal Medicine. 6 (4) (pp 328-336), 2016. Date of Publication: 01
Aug 2016.
Publisher
S. Karger AG
Abstract
Background: Nonpulsatile blood flow plays an important role in the
pathogenesis of renal dysfunction in patients with extracorporeal
circulation. In our opinion, hypoxic preconditioning (HP) can be used to
protect kidneys from postsurgical dysfunction. The aim of this study was
to evaluate nephroprotective efficacy of HP in myocardial
revascularization with extracorporeal circulation. Methods: The
randomized, controlled trial was performed in 63 patients undergoing
coronary artery bypass grafting (CABG). Thirty-three patients were
subjected to HP during CABG; 30 patients were included in the comparison
group. All patients underwent dynamic renal scintigraphy with
^99mc-diethylenetriaminepentaacetic acid and were subjected to
measuring the concentration of lipocalin in blood serum before and after
CABG. Results: After CABG, the mean values of the total glomerular
filtration rate (GFR) and GFR for each kidney significantly decreased only
in patients of the comparison group. Significant increases in the
concentration of serum neutrophil gelatinase-associated lipocalin occurred
5 h after surgery both in the group with HP (70.65 +/- 46.71 to 127.58 +/-
98.46 ng/ml) and in the comparison group (65.01 +/- 38.64 to 171.65 +/-
89.91 ng/ml). At the same time, the mean difference values between pre-
and postoperative lipocalin levels were 56.94 +/- 51.75 ng/ml in the study
group and 106.64 +/- 51.27 ng/ml in the comparison group; these
differences were highly statistically significant (0.004). Conclusion: The
results of our study showed that (i) HP exerts nephroprotection in
patients undergoing on-pump CABG, and (ii) determination of the
lipocalin-2 level can be used for early diagnosis of acute kidney injury
in cardiac surgery patients.

<11>
Accession Number
20160630329
Author
Reeves B.C.; Pike K.; Rogers C.A.; Brierley R.C.M.; Stokes E.A.;
Wordsworth S.; Nash R.L.; Miles A.; Mumford A.D.; Cohen A.; Angelini G.D.;
Murphy G.J.
Institution
(Reeves, Pike, Rogers, Brierley, Nash, Miles) Clinical Trials and
Evaluation Unit, School of Clinical Sciences, University of Bristol,
Bristol, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Oxford, United Kingdom
(Mumford) School of Cellular and Molecular Medicine, University of
Bristol, Bristol, United Kingdom
(Cohen) Division of Specialised Services, University Hospitals Bristol NHS
Foundation Trust, Bristol, United Kingdom
(Angelini) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Leicester, United Kingdom
Title
A multicentre randomised controlled trial of transfusion indication
threshold reduction on transfusion rates, morbidity and health-care
resource use following cardiac surgery (TITRe2).
Source
Health Technology Assessment. 20 (60) (pp 1-259), 2016. Date of
Publication: August 2016.
Publisher
NIHR Journals Library
Abstract
Background: Uncertainty about optimal red blood cell transfusion
thresholds in cardiac surgery is reflected in widely varying transfusion
rates between surgeons and cardiac centres. Objective: To test the
hypothesis that a restrictive compared with a liberal threshold for red
blood cell transfusion after cardiac surgery reduces post-operative
morbidity and health-care costs. Design: Multicentre, parallel randomised
controlled trial and within-trial cost-utility analysis from a UK NHS and
Personal Social Services perspective. We could not blind health-care staff
but tried to blind participants. Random allocations were generated by
computer and minimised by centre and operation. Setting: Seventeen
specialist cardiac surgery centres in UK NHS hospitals. Participants:
Patients aged > 16 years undergoing non-emergency cardiac surgery with
post-operative haemoglobin < 9 g/dl. Exclusion criteria were: unwilling to
have transfusion owing to beliefs; platelet, red blood cell or clotting
disorder; ongoing or recurrent sepsis; and critical limb ischaemia.
Interventions: Participants in the liberal group were eligible for
transfusion immediately after randomisation (post-operative haemoglobin <
9 g/dl); participants in the restrictive group were eligible for
transfusion if their post-operative haemoglobin fell to < 7.5 g/dl during
the index hospital stay. Main outcome measures: The primary outcome was a
composite outcome of any serious infectious (sepsis or wound infection) or
ischaemic event (permanent stroke, myocardial infarction, gut infarction
or acute kidney injury) during the 3 months after randomisation. Events
were verified or adjudicated by blinded personnel. Secondary outcomes
included blood products transfused; infectious events; ischaemic events;
quality of life (European Quality of Life-5 Dimensions); duration of
intensive care or high-dependency unit stay; duration of hospital stay;
significant pulmonary morbidity; all-cause mortality; resource use, costs
and cost-effectiveness. Results: We randomised 2007 participants between
15 July 2009 and 18 February 2013; four withdrew, leaving 1000 and 1003 in
the restrictive and liberal groups, respectively. Transfusion rates after
randomization were 53.4% (534/1000) and 92.2% (925/1003). The primary
outcome occurred in 35.1% (331/944) and 33.0% (317/962) of participants in
the restrictive and liberal groups [odds ratio (OR) 1.11, 95% confidence
interval (CI) 0.91 to 1.34; p = 0.30], respectively. There were no
subgroup effects for the primary outcome, although some sensitivity
analyses substantially altered the estimated OR. There were no differences
for secondary clinical outcomes except for mortality, with more deaths in
the restrictive group (4.2%, 42/1000 vs. 2.6%, 26/1003; hazard ratio 1.64,
95% CI 1.00 to 2.67; p = 0.045). Serious post-operative complications
excluding primary outcome events occurred in 35.7% (354/991) and 34.2%
(339/991) of participants in the restrictive and liberal groups,
respectively. The total cost per participant from surgery to 3 months
postoperatively differed little by group, just 182 less (standard error
488) in the restrictive group, largely owing to the difference in red
blood cells cost. In the base-case cost-effectiveness results, the point
estimate suggested that the restrictive threshold was cost-effective;
however, this result was very uncertain partly owing to the negligible
difference in quality-adjusted life-years gained. Conclusions: A
restrictive transfusion threshold is not superior to a liberal threshold
after cardiac surgery. This finding supports restrictive transfusion due
to reduced consumption and costs of red blood cells. However, secondary
findings create uncertainty about recommending restrictive transfusion and
prompt a new hypothesis that liberal transfusion may be superior after
cardiac surgery. Reanalyses of existing trial datasets, excluding all
participants who did not breach the liberal threshold, followed by a
meta-analysis of the reanalysed results are the most obvious research
steps to address the new hypothesis about the possible harm of red blood
cell transfusion..

<12>
Accession Number
20160624074
Author
Safaei N.; Sheikhalizadeh M.A.; Badalzadeh R.
Institution
(Safaei) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Sheikhalizadeh, Badalzadeh) Department of Physiology, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Title
Effect of ischemic postconditioning on myocardial protection in patients
undergoing coronary artery bypass grafting surgery with cardiopulmonary
bypass.
Source
Journal of Cardiovascular and Thoracic Research. 8 (2) (pp 65-71), 2016.
Date of Publication: 2016.
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Reperfusion injury is a well-known phenomenon following
restoration of the coronary circulation after coronary artery bypass
grafting (CABG) that impairs myocardial function. In order to control the
severity of this injury, we aimed to investigate the effect of a new
conditioning strategy namely ischemic postconditioning (IPOC) along with
controlled aortic root reperfusion (CARR) on myocardial protection in CABG
surgery with cardiopulmonary bypass. Methods: In a doubled blind clinical
trial study, 51 patients undergoing first-time elective CABG were randomly
divided in three groups: CARR, IPOC, and combination of IPOC and CARR. At
the end of procedure and just before aortic cross-clamp removal,
reperfusion was started as following: In CARR-receiving groups, the
reperfusion was started with low perfusion pressures for 10 minutes, and
in IPOC-receiving groups, three cycles of 1 minute episodes of ischemia
separated by 1 minute episodes of reperfusion was applied as
postconditioning protocol. Left ventricular ejection fraction (EF) (by
echocardiography), inotrope requirement index, and myocardial arrhythmias
were measured up to 72 hours after operation. Results: Echocardiography
revealed that the recovery of EF after operation in IPOC group was
significantly higher than those of two other groups (P < 0.05). Inotropic
support requirement was significantly lower in IPOC groups. In addition,
the incidence of atrial and ventricular arrhythmias after opening of
aortic clamp and in intensive care unit (ICU) as well as recovery time of
cardiac rhythm upon reperfusion were lowered by administration of IPOC, as
compared with CARR group. Conclusion: The study suggests that IPOC may
provide clinical benefits against reperfusion injury in patients
undergoing CABG surgery and maintain the post ischemic left ventricular
performance.

<13>
Accession Number
20160625703
Author
Dieberg G.; Smart N.A.; King N.
Institution
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
Title
Minimally invasive cardiac surgery: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 223 (pp 554-560), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Minimally invasive (MI) cardiac surgery was introduced to
reduce problems associated with a full sternotomy. This meta-analysis
aimed to investigate the effects of minimally invasive cardiac surgery on
a range of clinical outcomes. Methods To identify potential studies
(randomised/prospective clinical trials) systematic searches were carried
out. The search strategy included the concepts of "minimally invasive" OR
"MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This
was followed by a meta-analysis investigating cross-clamp time,
cardiopulmonary bypass (CPB) time, operation time, ventilation time,
intensive care unit (ICU) stay, hospital stay, incidence of myocardial
infarction and of stroke/neurologic complications. Results Eight studies
(9 intervention groups), totalling 596 participants were analysed. MI
cardiac surgery was associated with a shorter ICU stay mean difference
(MD) - 0.7 days (95% confidence interval (CI) - 1.23 to - 0.18, p = 0.009)
and longer cross-clamp MD 6.7 min (95% CI 1.24 to 12.17, p = 0.02), CPB MD
26.68 min (95% CI 10.31 to 43.05, p = 0.001), and operation times MD 55.03
min (95% CI 22.76 to 87.31, p = 0.0008). However no differences were found
in the ventilation time MD - 3.94 h (95% CI - 8.09 to 0.21, p = 0.06),
length of hospital stay MD - 1.14 days (95% CI - 3.11 to 0.83, p = 0.26)
and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI
0.49 to 7.9, p = 0.34) or stroke/neurologic complications OR 0.67 (95% CI
0.11 to 4.05, p = 0.66). Conclusions Minimally invasive cardiac surgery is
as safe as conventional surgery and could reduce costs due to a shorter
period spent in ICU.

<14>
Accession Number
20160617752
Author
Sun H.-Y.; Alexander B.D.; Huprikar S.; Forrest G.N.; Bruno D.; Lyon G.M.;
Wray D.; Johnson L.B.; Sifri C.D.; Razonable R.R.; Morris M.I.; Stoser V.;
Wagener M.M.; Singh N.
Institution
(Sun) Department of Internal Medicine, National Taiwan University
Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
(Republic of China)
(Alexander) Duke University Medical Center, Durham, NC, United States
(Huprikar) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Forrest) University of Maryland School of Medicine, Baltimore, United
States
(Bruno) Department of Internal Medicine, Hospital Universitario Fundacion
Favaloro, Buenos Aires, Argentina
(Lyon) Department of Medicine, Emory University, Atlanta, United States
(Wray) Medical University of South Carolina, Charleston, United States
(Johnson) St John Medical Center, Detroit, MI, United States
(Sifri) Department of Medicine, University of Virginia, Charlottesville,
United States
(Razonable) Department of Medicine, Mayo Clinic, Rochester, MN, United
States
(Morris) Miller School of Medicine, University of Miami, Florida, United
States
(Stoser) Department of Medicine, Northwestern University, Chicago, IL,
United States
(Wagener, Singh) Veterans Affairs Medical Center, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA 15240, United States
(Forrest) Oregon Health and Science University, Portland, United States
Title
Predictors of immune reconstitution syndrome in organ transplant
recipients with cryptococcosis: Implications for the management of
immunosuppression.
Source
Clinical Infectious Diseases. 60 (1) (pp 36-44), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Oxford University Press
Abstract
Background. Risk factors including how changes in immunosuppression
influence the occurrence of immune reconstitution syndrome (IRS) in solid
organ transplant (SOT) recipients with cryptococcosis have not been fully
defined. Methods. SOT recipients with cryptococcosis were identified and
followed for 12 months. IRS was defined based on previously proposed
criteria. Results. Of 89 SOT recipients, 13 (14%) developed IRS. Central
nervous system (CNS) disease (adjusted odds ratio [AOR], 6.23; P = .03)
and discontinuation of calcineurin inhibitor (AOR, 5.11; P = .02) were
independently associated with IRS. Only 2.6% (1/13) of the patients
without these risk factors developed IRS compared with 18.8% (6/32) with 1
risk factor, and 50% (6/12) with both risk factors (X² for
trend, P = .0001). Among patients with CNS disease, those with
neuroimaging abnormalities (P = .03) were more likely to develop IRS,
irrespective of serum or CSF cryptococcal antigen titers and fungemia.
Graft rejection after cryptococcosis was observed in 15.4% (2/13) of the
patients with IRS compared with 2.6% (2/76) of those without IRS (P =
.07). Conclusions. We determined variables that pose a risk for IRS and
have shown that discontinuation of calcineurin inhibitors was
independently associated with 5-fold increased risk of IRS in transplant
recipients with cryptococcosis.

<15>
[Use Link to view the full text]
Accession Number
20160617633
Author
Une D.; Al-Atassi T.; Kulik A.; Voisine P.; Le May M.; Ruel M.
Institution
(Une, Al-Atassi, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, 40 Ruskin St, Ottawa, ON, Canada
(Le May) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Kulik) Lynn Heart and Vascular Institute, Boca Raton, FL, United States
(Voisine) Division of Cardiac Surgery, Hopital Laval, Quebec City, QC,
Canada
(Ruel) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Impact of clopidogrel plus aspirin versus aspirin alone on the progression
of native coronary artery disease after bypass surgery analysis from the
Clopidogrel after Surgery for Coronary Artery DiseasE (CASCADE) randomized
trial.
Source
Circulation. 130 (11 Supplement 1) (pp S12-S18), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The effects of dual antiplatelet therapy with aspirin and
clopidogrel on the progression of native coronary artery disease after
coronary artery bypass grafting are unknown. Methods and Results-In the
Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a
total of 113 patients were randomized to receive aspirin plus clopidogrel
or aspirin plus placebo for 1 year after coronary artery bypass grafting.
In this secondary analysis, the 92 patients who underwent preoperative and
1-year postoperative angiograms at 2 centers had each of their coronary
stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1
[25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and
grade 5 [99%-100%]). We compared the incidence and degree of evolving
coronary artery disease between the 2 treatment groups. A total of 543
preoperative stenoses and occlusions were quantified and followed. At
1-year postoperatively, there were 103 evolving (94 worsened, 9 improved)
and 22 new lesions. The right coronary artery territory and sites proximal
to a graft were more commonly associated with worsening coronary artery
disease (PU0.02). There were no differences in clinical events between
treatment groups, and the proportion of patients with evolving or new
lesions was also similar (70% versus 74%, aspirin-clopidogrel versus
aspirin-placebo, respectively; P=0.8). However, in evolving or new
lesions, the mean grade change (1.1+/-1.0 versus 1.6+/-1.1, respectively;
P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were
lower in the aspirin-clopidogrel group. Conclusions-The addition of
clopidogrel to aspirin correlates with less worsening of native coronary
artery disease 1 year after coronary artery bypass grafting. These
findings may help guide post-coronary artery bypass grafting antiplatelet
therapy.

<16>
Accession Number
20160427214
Author
Spadaccio C.; Nappi F.; Al-Attar N.; Sutherland F.W.; Acar C.; Nenna A.;
Trombetta M.; Chello M.; Rainer A.
Institution
(Spadaccio, Al-Attar, Sutherland) Department of Cardiothoracic Surgery,
Golden Jubilee National Hospital, Agamemnon Street Clydebank, Glasgow G81
4DY, United Kingdom
(Spadaccio, Al-Attar) College of Medical, Veterinary and Life Sciences,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, United Kingdom
(Nappi) Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis,
Paris, France
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
(Nenna, Chello) Department of Cardiovascular Sciences
, University Campus Bio-Medico of Rome, Roma, Italy
(Trombetta, Rainer) CIR-Laboratory of Tissue Engineering, Universita
Campus Bio-Medico di Roma, Roma, Italy
Title
Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta
Replacement with Dacron Grafts. Not All That Glitters Is Gold.
Source
Journal of Cardiovascular Translational Research. 9 (4) (pp 334-342),
2016. Date of Publication: 01 Aug 2016.
Publisher
Springer New York LLC
Abstract
Synthetic grafts are widely used in cardiac and vascular surgery since the
mid-1970s. Despite their general good performance, inability of mimicking
the elastomechanical characteristics of the native arterial tissue, and
the consequent lack of adequate compliance, leads to a cascade of
hemodynamic and biological alterations deeply affecting cardiovascular
homeostasis. Those concerns have been reconsidered in more contemporaneous
surgical and experimental reports which also triggered some research
efforts in the tissue engineering field towards the realization of
biomimetic arterial surrogates. The present review focuses on the
significance of the "compliance mismatch" phenomenon occurring after
aortic root or ascending aorta replacement with prosthetic grafts and
discusses the clinical reflexes of this state of tissue incompatibility,
as the loss of the native elastomechanical properties of the aorta can
translate into detrimental effects on the normal efficiency of the aortic
root complex with impact in the long-term results of patients undergoing
aortic replacement.

<17>
[Use Link to view the full text]
Accession Number
20160322952
Author
Li Y.; Wang C.; Zuo G.; Wang K.; Cao Z.; Du X.
Institution
(Li, Wang, Zuo, Wang, Cao, Du) Department of Cardiology, Tianjin Fifth
Central Hospital, No. 41 Zhejiang Road, Tianjin 300450, China
Title
Drug-eluting balloons in the treatment of de-novo coronary lesions: A
meta-analysis of randomized-controlled trials.
Source
Coronary Artery Disease. 27 (6) (pp 467-477), 2016. Date of Publication:
01 Sep 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Aim The aim of this meta-analysis was to evaluate the efficacy of
drug-eluting balloons (DEBs) plus bare-metal stents (BMS) for the
treatment of de-novo coronary lesions. Methods and results Eleven trials
involving 1279 patients were included in this study. The main endpoints
were as follows: late lumen loss (LLL), binary restenosis, stent
thrombosis (ST), and major adverse cardiovascular events (MACEs). The
definition of MACEs was a composite of death, myocardial infarction (MI),
and target lesion revascularization (TLR). Compared with BMS alone, DEB
plus BMS showed a lower risk for LLL (P=0.007) and MACEs (P=0.010). There
were no significant differences in binary restenosis (P=0.212), ST
(P=0.199), death (P=0.141), MI (P=0.439), and TLR (P=0.340). Compared with
drug-eluting stents (DES), DEB plus BMS could increase the risk of LLL
(P=0.002) and MACEs (P=0.026). The risks of binary restenosis (P=0.113),
ST (P=0.832), death (P=0.115), MI (P=0.831), and TLR (P=0.111) were
similar between DEB plus BMS and DES. Conclusion DEB plus BMS was better
than BMS alone in reducing LLL and MACEs, especially when dilatation was
performed after stenting for de-novo coronary lesions, but it was inferior
to DES. Therefore, the treatment strategy with DEB plus BMS should not be
recommended for de-novo coronary lesions, except for patients who have
contraindications for DES.

<18>
Accession Number
20160588443
Author
Stokes E.A.; Wordsworth S.; Bargo D.; Pike K.; Rogers C.A.; Brierley
R.C.M.; Angelini G.D.; Murphy G.J.; Reeves B.C.
Institution
(Stokes, Wordsworth, Bargo) Nuffield Department of Population Health,
Health Economics Research Centre, University of Oxford, Oxford, United
Kingdom
(Bargo) Eli Lilly and Company Limited, Lilly House, Basingstoke,
Hampshire, United Kingdom
(Pike, Rogers, Brierley, Reeves) Clinical Trials and Evaluation Unit,
School of Clinical Sciences, University of Bristol, Bristol, United
Kingdom
(Angelini) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Murphy) Dept. of Cardiovasc. Sciences and NIHR Leicester Biomedical
Research Unit in Cardiovascular Medicine, University of Leicester,
Leicester, United Kingdom
Title
Are lower levels of red blood cell transfusion more cost-effective than
liberal levels after cardiac surgery? Findings from the TITRe2 randomised
controlled trial.
Source
BMJ Open. 6 (8) (no pagination), 2016. Article Number: e011311. Date of
Publication: 01 Jul 2016.
Publisher
BMJ Publishing Group
Abstract
Objective To assess the incremental cost and cost-effectiveness of a
restrictive versus a liberal red blood cell transfusion threshold after
cardiac surgery. Design A within-Trial cost-effectiveness analysis with a
3-month time horizon, based on a multicentre superiority randomised
controlled trial from the perspective of the National Health Service (NHS)
and personal social services in the UK. Setting 17 specialist cardiac
surgery centres in UK NHS hospitals. Participants 2003 patients aged >16a
..years undergoing non-emergency cardiac surgery with a postoperative
haemoglobin of <9a ..g/dL. Interventions Restrictive (transfuse if
haemoglobin <7.5a ..g/dL) or liberal (transfuse if haemoglobin <9a ..g/dL)
threshold during hospitalisation after surgery. Main outcome measures
Health-related quality of life measured using the EQ-5D-3L to calculate
quality-Adjusted life years (QALYs). Results The total costs from surgery
up to 3a ..months were 17a ..945 and 18a ..127 in the restrictive and
liberal groups (mean difference is a '182, 95% CI a '1108 to 744). The
cost difference was largely attributable to the difference in the cost of
red blood cells. Mean QALYs to 3a ..months were 0.18 in both groups
(restrictive minus liberal difference is 0.0004, 95% CI a '0.0037 to
0.0045). The point estimate for the base-case cost-effectiveness analysis
suggested that the restrictive group was slightly more effective and
slightly less costly than the liberal group and, therefore,
cost-effective. However, there is great uncertainty around these results
partly due to the negligible differences in QALYs gained. Conclusions We
conclude that there is no clear difference in the cost-effectiveness of
restrictive and liberal thresholds for red blood cell transfusion after
cardiac surgery. Trial registration number ISRCTN70923932; Results.

<19>
Accession Number
20160619949
Author
Taksaudom N.; Cheewinmethasiri J.; Chittawatanarat K.; Nawarawong W.;
Ko-Iam W.; Sudthiviseschai P.
Institution
(Taksaudom, Chittawatanarat, Nawarawong, Ko-Iam) Department of Surgery,
Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
(Cheewinmethasiri) Cardiovascular and Thoracic Surgery Unit, Department of
Surgery, Lampang Hospital, Lampang, Thailand
(Sudthiviseschai) Department of Pharmacy, Maharaj Nakorn Chiang Mai
Hospital, Chiang Mai, Thailand
Title
Magnesium sulfate reduces incidence of atrial fibrillation after coronary
arterial bypass surgery: What is the proper dose? A randomized trial.
Source
Journal of the Medical Association of Thailand. 99 (7) (pp 794-802), 2016.
Date of Publication: July 2016.
Publisher
Medical Association of Thailand
Abstract
Background: Atrial fibrillation (AF) is a common complication after
cardiac surgery and impacts length of hospital stay, greater utilization
of health care resources, and increases morbidity and mortality. Magnesium
sulfate (MgSO<inf>4</inf>) has been well documented in its effect of AF
reduction after cardiac surgery especially in coronary artery bypass
grafting (CABG) but the dosages are still not settled. Material and
Method: Eighty-eight elective CABG cases were randomized to receive a high
dose (10 gm) or low dose (5 gm) MgSO<inf>4</inf> and were blinded into
bottle 1 (n = 46) and bottle 2 (n = 42). Patients were closely observed
with continuous ECG monitoring in the first 24 hours then observed for
clinical symptoms until discharge. Results: The demographic data were
comparable except for a higher body weight in the high dose group
(60.21+/-11.32 kg vs. 65.85+/-12.2 kg, p = 0.03) and higher incidence of
diabetes in high dose group (52.4% vs. 28.3%, p = 0.02). Intraoperative
data were similar. No complications were related to MgSO<inf>4</inf>
except one patient in the high dose group that experienced flushing and
abdominal discomfort during administration. Immediate postoperative serum
magnesium was higher in the high dose group but rapidly returned to
similar level one day postoperatively. AF occurred in nine patients
(10.23%), four in the low dose and five in the high dose group and there
was no statistical significance (p = 0.62). Conclusion: Current data
suggested the safety and effectiveness of MgSO<inf>4</inf> for the
reduction of the incidence of AF during postoperative CABG surgery.
However, there was no statistical difference between the dosages of
MgSO<inf>4</inf> supplement. The 5-gm-MgSO<inf>4</inf> supplement was
effective in AF prevention and could avoid the adverse effect from high
dose MgSO<inf>4</inf> infusion. Clinical trials registration number:
TCTR20140122001.

<20>
Accession Number
20160591729
Author
Choi Y.S.; Bae M.K.; Kim S.H.; Park J.-E.; Kim S.Y.; Oh Y.J.
Institution
(Choi, Kim, Park, Kim, Oh) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Bae) Department of Thoracic and Cardiovascular Surgery, National Health
Insurance Service Ilsan Hospital, Goyang, South Korea
Title
Effects of alveolar recruitment and positive end-expiratory pressure on
oxygenation during one-lung ventilation in the supine position.
Source
Yonsei Medical Journal. 56 (5) (pp 1421-1427), 2015. Date of Publication:
01 Sep 2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Hypoxemia during one-lung ventilation (OLV) remains a serious
problem, particularly in the supine position. We investigated the effects
of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP)
on oxygenation during OLV in the supine position. Materials and Methods:
Ninety-nine patients were randomly allocated to one of the following three
groups: a control group (ventilation with a tidal volume of 8 mL/kg), a
PEEP group (the same ventilatory pattern with a PEEP of 8 cm
H<inf>2</inf>O), or an AR group (an AR maneuver immediately before OLV
followed by a PEEP of 8 cm H<inf>2</inf>O). The tidal volume was reduced
to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory
variables, and hemodynamic variables were recorded 15 min into TLV
(TLV<inf>baseline</inf>), 15 and 30 min after OLV (OLV<inf>15</inf> and
OLV<inf>30</inf>), and 10 min after re-establishing TLV
(TLV<inf>end</inf>). Results: Ultimately, 92 patients were analyzed. In
the AR group, the arterial oxygen tension was higher at TLV<inf>end</inf>,
and the physiologic dead space was lower at OLV<inf>15</inf> and
TLV<inf>end</inf> than in the control group. The mean airway pressure and
dynamic lung compliance were higher in the PEEP and AR groups than in the
control group at OLV<inf>15</inf>, OLV<inf>30</inf>, and
TLV<inf>end</inf>. No significant differences in hemodynamic variables
were found among the three groups throughout the study period. Conclusion:
Recruitment of both lungs with subsequent PEEP before OLV improved
arterial oxygenation and ventilatory efficiency during video-assisted
thoracic surgery requiring OLV in the supine position.

<21>
Accession Number
20160614604
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Jouryabi A.; Kanani G.;
Sheikhani N.N.; Haghighi M.; Atrkarroushan Z.; Biazar G.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Jouryabi) Fellowship of Anesthesia
in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
(Kanani, Sheikhani) Department of Cardaic Surgery, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Haghighi) Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences (GUMS), Rasht, Iran,
Islamic Republic of
(Biazar) Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
Title
Effects of low-dose selenium on the inflammatory response in coronary
artery bypass graft surgery: A clinical trial.
Source
Iranian Red Crescent Medical Journal. 18 (8) (no pagination), 2016.
Article Number: e37918. Date of Publication: August 2016.
Publisher
Kowsar Medical Publishing Company
Abstract
Background: Coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to
the development of myocardial damage and dysfunction. It is suggested that
selenium (Se), an essential trace element, has a protective role against
oxidative stress. Decreased intraoperative Se levels might be an
independent predictive factor for postoperative multiorgan failure. In
spite of its proposed advantages, however, the optimal timing and dosage
are not well known. Objectives: To determine whether 600 mug of
intravenous Se administration before induction of anesthesia for CABG
surgery could attenuate inflammatory reactions in an Iranian population.
Methods: This randomized triple-blind clinical trial took place in the
department of cardiac surgery of an academic hospital affiliated with
Guilan University of Medical Sciences (GUMS) from May 2015 to September
2015. Eighty-eight eligible patients scheduled for elective on-pump CABG
surgery were divided into two groups using randomized fixed quadripartite
blocks. They received either an intravenous bolus of 600 mug Se before
induction of anesthesia, or normal saline as a placebo. We had four
measurement time-points: just before induction of anesthesia (T0),
immediately after the end of CPB (T1), 24 hours after surgery (T2), and 48
hours after surgery (T3). Interleukin 6 (IL-6), tumor necrosis
factor-alpha (TNF-alpha), and C-reactive protein (CRP) serum levels were
measured using the enzyme-linked immunosorbent assay (ELISA). Results:
Data from a total of 81 patients were analyzed: group S (n = 41) and group
C (n = 40). There was no significant difference between the two groups
with regard to baseline characteristics. In both groups, CPB caused
markedly increased IL-6, TNF-alpha, and CRP plasma concentrations compared
with baseline (P = 0.0001). However, the pattern of changes was not
significantly different between group S (P = 0.068) and group C (P =
0.26). The IL-6 and TNF-alpha change trends were significant in each group
(P=0.0001). However, comparing the two groups showed no significant
difference. With regard to IL-6, there was no significant difference
between the two groups at the time-points of T1 (P = 0.34), T2 (P = 0.17),
and T3 (P = 0.056), and the same was found for TNF-alpha at T1 (P = 0.34),
T2 (P = 0.17), and T3 (P = 0.056). With regard to CRP, the trend of the
changes was significant in each group (P = 0.0001). However, comparing two
groups showed a borderline significant difference between them at T1 (P =
0.039), but not at T2 (P = 0.075) or T3 (P = 0.11). Conclusions: This
study revealed that the administration of 600 mug of intravenous Se
immediately before induction of anesthesia was safe, but when compared to
a placebo, no predominant clinical effects or modifications in the
systemic inflammatory response induced by on-pump CABG were observed.

<22>
Accession Number
20160617502
Author
De Servi S.; Goedicke J.; Ferlini M.; Palmerini T.; Syvanne M.;
Montalescot G.
Institution
(De Servi, Ferlini) Division of Cardiology and Coronary Care Unit,
Fondazione Policlinico San Matteo, Pavia, Italy
(Goedicke) Scientific Consulting for Pharmaceutical Industry and CROs,
Hamburg, Germany
(Palmerini) Cardiovascular Department, Policlinico S. Orsola, Bologna,
Italy
(Syvanne) Finnish Heart Association, Helsinki, Finland
(Montalescot) UPMC Sorbonne Universites, ACTION Study Group, INSERM-UMRS
1166, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP), Paris,
France
Title
Prasugrel versus clopidogrel in acute coronary syndromes treated with PCI:
Effects on clinical outcome according to culprit artery location.
Source
International Journal of Cardiology. 223 (pp 632-638), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Acute coronary syndrome (ACS) mortality increases when the
culprit lesion is in the left anterior descending (LAD) artery. We
investigated the effects of prasugrel versus clopidogrel according to site
of culprit lesion causing ACS treated with percutaneous coronary
intervention (PCI) in the TRITON-TIMI 38 study. Methods Patients were
divided into three groups based on the native coronary artery culprit
lesion location. The LAD artery group included also patients with the
culprit lesion in the left main (LM) artery. Results In the whole ACS
population, prasugrel recipients had lower rates of the primary endpoint
that included cardiovascular (CV) death, non-fatal myocardial infarction
(MI) or non-fatal stroke without significant differences across vessel
groups. CV death was significantly decreased with prasugrel in the whole
ACS population (p = 0.03) and in ST-elevation MI (STEMI) patients
undergoing primary PCI (p = 0.04), with pronounced differences in favour
of prasugrel versus clopidogrel when the LAD-LM was the culprit vessel
(relative risk reduction 50% in the whole ACS population, 57% in STEMI
treated with primary PCI, p for interaction 0.07 and 0.08 respectively).
Conclusions Prasugrel effects were particularly favourable when LAD-LM was
the culprit vessel, resulting in CV mortality reduction in the whole ACS
population and in STEMI patients when treated with primary PCI.

<23>
Accession Number
20160617495
Author
Musa T.A.; Uddin A.; Fairbairn T.A.; Dobson L.E.; Steadman C.D.; Kidambi
A.; Ripley D.P.; Swoboda P.P.; McDiarmid A.K.; Erhayiem B.; Garg P.;
Blackman D.J.; Plein S.; McCann G.P.; Greenwood J.P.
Institution
(Musa, Uddin, Fairbairn, Dobson, Kidambi, Ripley, Swoboda, McDiarmid,
Erhayiem, Garg, Plein, Greenwood) Multidisciplinary Cardiovascular
Research Centre & The Division of Cardiovascular and Diabetes Research,
Leeds Institute for Cardiovascular and Metabolic Medicine, University of
Leeds, Leeds, United Kingdom
(Steadman, McCann) Department of Cardiovascular Sciences, University of
Leicester, Cardiovascular Research Centre and the National Institute of
Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield
General Hospital, Leicester, United Kingdom
(Blackman) Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary,
Leeds, United Kingdom
Title
Right ventricular function following surgical aortic valve replacement and
transcatheter aortic valve implantation: A cardiovascular MR study.
Source
International Journal of Cardiology. 223 (pp 639-644), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective The response of the RV following treatment of aortic stenosis is
poorly defined, reflecting the challenge of accurate RV assessment.
Cardiovascular magnetic resonance (CMR) is the established reference for
imaging of RV volumes, mass and function. We sought to define the impact
of transcatheter aortic valve implantation (TAVI) and surgical aortic
valve replacement (SAVR) upon RV function in patients treated for severe
aortic stenosis using CMR. Methods A 1.5T CMR scan was performed
preoperatively and 6 months postoperatively in 112 (56 TAVI, 56 SAVR; 76
+/- 8 years) high-risk severe symptomatic aortic stenosis patients across
two UK cardiothoracic centres. Results TAVI patients were older (80.4 +/-
6.7 vs. 72.8 +/- 7.2 years, p < 0.05) with a higher STS score (2.13 +/-
0.73 vs. 5.54 +/- 3.41%, p < 0.001). At 6 months, SAVR was associated with
a significant increase in RV end systolic volume (33 +/- 10 vs. 37 +/- 10
ml/m², p = 0.008), and decrease in RV ejection fraction (58 +/-
8 vs. 53 +/- 8%, p = 0.005) and tricuspid annular plane systolic excursion
(22 +/- 5 vs. 14 +/- 3 mm, p < 0.001). Only 4 (7%) SAVR patients had new
RV late gadolinium hyper-enhancement with no new cases seen in the TAVI
patients at 6 months. Longer surgical cross-clamp time was the only
predictor of increased RV end systolic volume at 6 months. Post-TAVI,
there was no observed change in RV volumes or function. Over a maximum 6.3
year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had
died (p = 0.001). On multivariable Cox analysis, the RV mass at 6 m
post-TAVI was independently associated with all-cause mortality (HR 1.359,
95% CI 1.108-1.666, p = 0.003). Conclusions SAVR results in a
deterioration in RV systolic volumes and function associated with longer
cross-clamp times and is not fully explained by suboptimal RV protection
during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes
or function.

<24>
[Use Link to view the full text]
Accession Number
20160615423
Author
Li Y.; Wang X.; Lv Q.; Wang J.; Yang Y.; He L.; Yuan L.; Zhang L.; Xie M.
Institution
(Li, Wang, Lv, Wang, Yang, He, Yuan, Zhang, Xie) Department of Ultrasound,
Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1277# Jiefang Ave, Wuhan 430022, China
Title
Impact of surgical correction of tetralogy of fallot on short-term right
and left ventricular function as determined by 2-dimensional speckle
tracking echocardiography.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4426. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Right ventricular (RV) and left ventricular (LV) dysfunction is an
important determinant of poor clinical status in repaired patients with
tetralogy of Fallot (TOF). The purpose of our study is to assess the
impact of surgical repair on short-term RV and LV function by
2-dimensional speckle tracking echocardiography (STE). Sixty-seven
patients (median age 12 months) with TOF before and 6 months after repair
and 35 healthy subjects were studied. The patients were divided into the
younger (age at surgery <12 months) and older (age at surgery >12 months)
subgroups. RV and LV global longitudinal systolic strain and strain rate
(SR), and LV global circumferential and radial systolic strain and SR were
measured by STE. After repair, RV longitudinal strain and SR increased in
the younger patients, whereas RV longitudinal SR was decreased in the
older patients. LV deformation parameters were unchanged in all patients.
In the multivariate analysis, patients with better RV and LV deformation
parameters preoperatively were identified to have better RV and LV strain
and SR postoperatively (P < 0.05 for all). The surgical approach of the
pulmonary valve ring was predictive of RV and LV systolic function
postoperatively (P < 0.05 for all). After TOF repair, short-term RV
function improvement is identified in the younger but not in the older
patients, whereas LV function is unchanged in all patients. The
preoperative RV and LV deformational indices are the determinant of
postoperative biventricular function improvement. STE appears to be a
valuable tool for assessment of biventricular function after congenital
heart disease surgery.

<25>
[Use Link to view the full text]
Accession Number
20160615359
Author
Rasmussen K.C.; Secher N.H.; Pedersen T.
Institution
(Rasmussen, Secher) Department of Anesthesiology, Rigshospitalet,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Pedersen) Center of Head and Orthopaedic Surgery, Rigshospitalet,
University of Copenhagen, Denmark
Title
Effect of perioperative crystalloid or colloid fluid therapy on
hemorrhage, coagulation competence, and outcome: A systematic review and
stratified meta-analysis.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4498. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: A meta-analysis concerning perioperative coagulation
competence, hemorrhage, and outcome was conducted including the use of
hydroxyethyl starches (HESs), dextran, or albumin versus administration of
a crystalloid as control to assess the efficacy and safety of colloids and
crystalloids for fluid administration during major elective surgery.
Surgery was restricted to cardiovascular and noncardiovascular surgery,
and HESs were stratified to HES 130/0.4 and HES 200/0.5. Methods: We
searched Cochrane Central Register of Controlled Trials, MEDLINE, ISI Web
of Science, EMBASE, conference proceedings, reference lists, and databases
of ongoing trials. Results: Thirty one primary clinical randomized
controlled trials included 2287 patients undergoing major surgery from
January 2000 to August 2015. The perioperative changes in coagulation
competence were measured by thromboelastography (TEG) maximum amplitude
(MA) in 9 studies administering crystalloids versus HES and in 4 studies
administering albumin versus HES. All studies but 1 disclosed increased
reduction in TEG-MA following HES administration (P = 0.0001 and 0.0002).
The total loss of blood was reported in 17 studies in which crystalloids
were compared to HES and 12 studies reported increased blood loss after
administration of HES (P < 0.003). When administering albumin versus HES,
6 studies reported reduced hemorrhage associated with albumin
administration (P = 0.005). Reoperation was not significantly reduced by
the use of crystalloids, but may be more frequent after HESs compared to
albumin (P < 0.03). In this analysis, more patients admitted to
administration of HESs were exposed to decrease coagulation competence,
compared to perioperative crystalloids and albumin administration.
Conclusion: This stratified meta-analysis showed that increased blood loss
was found in noncardiovascular surgery among patients receiving HES
compared with crystalloids, followed by a marked reduction in TEG-MA, and
infusion of 3rd-generation HES products did not influence the results
significantly.

<26>
[Use Link to view the full text]
Accession Number
20160615356
Author
Meybohm P.; Choorapoikayil S.; Wessels A.; Herrmann E.; Zacharowski K.;
Spahn D.R.
Institution
(Meybohm, Choorapoikayil, Wessels, Zacharowski) Department of
Anesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Germany
(Herrmann) Institute for Anesthesiology, University and University
Hospital Zurich, Zurich, Switzerland
(Spahn) Institute of Biostatistics and Mathematical Modelling, Goethe
University Frankfurt, Germany
Title
Washed cell salvage in surgical patients: A review and meta-analysis of
prospective randomized trials under PRISMA.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4490. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cell salvage is commonly used as part of a blood conservation
strategy. However concerns among clinicians exist about the efficacy of
transfusion of washed cell salvage. Methods: We performed a meta-analysis
of randomized controlled trials in which patients, scheduled for all types
of surgery, were randomized to washed cell salvage or to a control group
with no cell salvage. Data were independently extracted, risk ratio (RR),
and weighted mean differences (WMD) with 95% confidence intervals (CIs)
were calculated. Data were pooled using a random effects model. The
primary endpoint was the number of patients exposed to allogeneic red
blood cell (RBC) transfusion. Results: Out of 1140 search results, a total
of 47 trials were included. Overall, the use of washed cell salvage
reduced the rate of exposure to allogeneic RBC transfusion by a relative
39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average
saving of 0.20 units of allogeneic RBC per patient (weighted mean
differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk
of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced
length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11;
P < 0.001), but did not significantly affect risk of mortality (RR = 0.92;
95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be
observed in the number of patients exposed to re-operation, plasma,
platelets, or rate of myocardial infarction and stroke. Conclusions:
Washed cell salvage is efficacious in reducing the need for allogeneic RBC
transfusion and risk of infection in surgery.

<27>
Accession Number
20160615354
Author
Byun S.H.; Kang S.H.; Kim J.H.; Ryu T.; Kim B.J.; Jung J.Y.
Institution
(Byun, Kang, Kim, Ryu, Kim, Jung) Department of Anesthesiology and Pain
Medicine, School of Medicine, Catholic University of Daegu, 33,
Duryugongwonro 17-gil, Nam-gu, Daegu 42472, South Korea
Title
Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing
double-lumen tube displacement during lateral positioning in thoracic
surgery: A prospective, randomized controlled study.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4486. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Double-lumen endotracheal tubes (DLTs) are often displaced
during change from the supine to the lateral decubitus position. The aim
of this study was to determine whether Rescuefix, a recently developed
tube-holder device, is more effective than the traditional tape-tying
method for tube security during lateral positioning. Methods: Patients
were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T)
group (n = 22). After intubation with a left-sided DLT and adjustment of
the appropriate DLT position using a fiberoptic bronchoscope, the DLT was
fixed firmly at the side of the mouth by either Rescuefix or Durapore
tape. "Tracheal depth" (from the tracheal carina to the elbow connector of
the DLT) and "bronchial depth" (from the left bronchial carina to the
elbow connector of the DLT) were measured in the supine position using the
fiberoptic bronchoscope. After positional change, tracheal and bronchial
depths were measured as described above. As the primary endpoint,
displacement of the DLT during positional change was evaluated by
obtaining the difference in depths measured when the patient was in the
supine and lateral decubitus positions. In addition, after lateral
positioning of the patient, any requirement for repositioning the DLT was
recorded. Results: After lateral positioning, there were no significant
differences in changes in tracheal and bronchial depths between the groups
(tracheal depth 6.1 +/- 4.4 mm [R group] and 9.1 +/- 5.6 mm [T group], P =
0.058; bronchial depth 6.5 +/- 4.4 mm [R group], and 8.5 +/- 4.6 mm [T
group], P = 0.132). Although the amount of change in tracheal and
bronchial depths was not different between the groups, the need to
reposition the DLT was significantly lower in the R group than in the T
group (32% vs 68%, P = 0.016). Conclusion: This study demonstrated that
use of Rescuefix did not reduce the amount of DLT displacement, but it did
significantly lower the incidence of DLT repositioning compared with the
tape-tying method. Therefore, Rescuefix appears to be an effective
alternative to minimizing DLT displacement during lateral positioning in
thoracic surgery. Trial registration: http://cris.nih.go.kr identifier:
KCT0001949.

<28>
Accession Number
20160580406
Author
Heydari B.; Abdullah S.; Pottala J.V.; Shah R.; Abbasi S.; Mandry D.;
Francis S.A.; Lumish H.; Ghoshhajra B.B.; Hoffmann U.; Appelbaum E.; Feng
J.H.; Blankstein R.; Steigner M.; McConnell J.P.; Harris W.; Antman E.M.;
Jerosch-Herold M.; Kwong R.Y.
Institution
(Heydari, Abdullah, Shah, Abbasi, Mandry, Feng, Blankstein, Steigner,
Jerosch-Herold, Kwong) Department of Medicine, Noninvasive Cardiovascular
Imaging Section, Cardiovascular Division, Harvard Medical School, Brigham
and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
(Heydari, Abdullah, Shah, Abbasi, Mandry, Feng, Antman, Kwong)
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Pottala, Harris) Department of Internal Medicine, Sanford School of
Medicine, University of South Dakota, Sioux Fall, SD, United States
(Shah, Francis) Division of Cardiology, Department of Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Lumish, Ghoshhajra, Hoffmann) Department of Radiology, Massachusetts
General Hospital, Boston, MA, United States
(Appelbaum) Cardiovascular Division, Department of Medicine, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(McConnell) Health Diagnostic Laboratory Inc., Richmond, VA, United States
(Harris) OmegaQuant Analytics, LLC, Sioux Falls, SD, United States
Title
Effect of omega-3 acid ethyl esters on left ventricular remodeling after
acute myocardial infarction.
Source
Circulation. 134 (5) (pp 378-391), 2016. Date of Publication: 02 Aug 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Omega-3 fatty acids from fish oil have been associated with
beneficial cardiovascular effects, but their role in modifying cardiac
structures and tissue characteristics in patients who have had an acute
myocardial infarction while receiving current guideline-based therapy
remains unknown. Methods: In a multicenter, double-blind,
placebo-controlled trial, participants presenting with an acute myocardial
infarction were randomly assigned 1:1 to 6 months of high-dose omega-3
fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging
was used to assess cardiac structure and tissue characteristics at
baseline and after study therapy. The primary study endpoint was change in
left ventricular systolic volume index. Secondary endpoints included
change in noninfarct myocardial fibrosis, left ventricular ejection
fraction, and infarct size. Results: By intention-to-treat analysis,
patients randomly assigned to omega-3 fatty acids experienced a
significant reduction of left ventricular systolic volume index (-5.8%,
P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in
comparison with placebo. Per-protocol analysis revealed that those
patients who achieved the highest quartile increase in red blood cell
omega-3 index experienced a 13% reduction in left ventricular systolic
volume index in comparison with the lowest quartile. In addition, patients
in the omega-3 fatty acid arm underwent significant reductions in serum
biomarkers of systemic and vascular inflammation and myocardial fibrosis.
There were no adverse events associated with high-dose omega-3 fatty acid
therapy. Conclusions: Treatment of patients with acute myocardial
infarction with high-dose omega-3 fatty acids was associated with
reduction of adverse left ventricular remodeling, noninfarct myocardial
fibrosis, and serum biomarkers of systemic inflammation beyond current
guideline-based standard of care.

<29>
Accession Number
20160615598
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Hvidovre Hospital, University of Copenhagen, Department of
Anaesthesiology and Intensive Care Medicine, Kettegard Alle 30, Hvidovre
2650, Denmark
(Wetterslev) Department 7812, Rigshospitalet, Copenhagen University
Hospital, Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Moller) University of Copenhagen Herlev Hospital, The Cochrane
Anaesthesia, Critical and Emergency Care Group, Herlev Ringvej, Herlev
2730, Denmark
(Afshari) Rigshospitalet, Copenhagen University Hospital, Juliane Marie
Centre - Anaesthesia and Surgical Clinic Department 4013, Copenhagen,
Denmark
Title
Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor
haemostatic treatment versus usual care in adults or children with
bleeding.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD007871. Date of Publication: 22 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Severe bleeding and coagulopathy are serious clinical
conditions that are associated with high mortality. Thromboelastography
(TEG) and thromboelastometry (ROTEM) are increasingly used to guide
transfusion strategy but their roles remain disputed. This review was
first published in 2011 and updated in January 2016. Objectives: We
assessed the benefits and harms of thromboelastography (TEG)-guided or
thromboelastometry (ROTEM)-guided transfusion in adults and children with
bleeding. We looked at various outcomes, such as overall mortality and
bleeding events, conducted subgroup and sensitivity analyses, examined the
role of bias, and applied trial sequential analyses (TSAs) to examine the
amount of evidence gathered so far. Search methods: In this updated review
we identified randomized controlled trials (RCTs) from the following
electronic databases: Cochrane Central Register of Controlled Trials
(CENTRAL; 2016, Issue 1); MEDLINE; Embase; Science Citation Index
Expanded; International Web of Science; CINAHL; LILACS; and the Chinese
Biomedical Literature Database (up to 5 January 2016). We contacted trial
authors, authors of previous reviews, and manufacturers in the field. The
original search was run in October 2010. Selection criteria: We included
all RCTs, irrespective of blinding or language, that compared transfusion
guided by TEG or ROTEM to transfusion guided by clinical judgement, guided
by standard laboratory tests, or a combination. We also included
interventional algorithms including both TEG or ROTEM in combination with
standard laboratory tests or other devices. The primary analysis included
trials on TEG or ROTEM versus any comparator. Data collection and
analysis: Two review authors independently abstracted data; we resolved
any disagreements by discussion. We presented pooled estimates of the
intervention effects on dichotomous outcomes as risk ratio (RR) with 95%
confidence intervals (CIs). Due to skewed data, meta-analysis was not
provided for continuous outcome data. Our primary outcome measure was
all-cause mortality. We performed subgroup and sensitivity analyses to
assess the effect based on the presence of coagulopathy of a TEG- or
ROTEM-guided algorithm, and in adults and children on various clinical and
physiological outcomes. We assessed the risk of bias through assessment of
trial methodological components and the risk of random error through TSA.
Main results: We included eight new studies (617 participants) in this
updated review. In total we included 17 studies (1493 participants). A
total of 15 trials provided data for the meta-analyses. We judged only two
trials as low risk of bias. The majority of studies included participants
undergoing cardiac surgery. We found six ongoing trials but were unable to
retrieve any data from them. Compared with transfusion guided by any
method, TEG or ROTEM seemed to reduce overall mortality (7.4% versus 3.9%;
risk ratio (RR) 0.52, 95% CI 0.28 to 0.95; I² = 0%, 8 studies,
717 participants, low quality of evidence) but only eight trials provided
data on mortality, and two were zero event trials. Our analyses
demonstrated a statistically significant effect of TEG or ROTEM compared
to any comparison on the proportion of participants transfused with pooled
red blood cells (PRBCs) (RR 0.86, 95% CI 0.79 to 0.94; I² = 0%,
10 studies, 832 participants, low quality of evidence), fresh frozen
plasma (FFP) (RR 0.57, 95% CI 0.33 to 0.96; I² = 86%, 8
studies, 761 participants, low quality of evidence), platelets (RR 0.73,
95% CI 0.60 to 0.88; I² = 0%, 10 studies, 832 participants, low
quality of evidence), and overall haemostatic transfusion with FFP or
platelets (low quality of evidence). Meta-analyses also showed fewer
participants with dialysis-dependent renal failure. We found no difference
in the proportion needing surgical reinterventions (RR 0.75, 95% CI 0.50
to 1.10; I² = 0%, 9 studies, 887 participants, low quality of
evidence) and excessive bleeding events or massive transfusion (RR 0.38,
95% CI 0.38 to 1.77; I² = 34%, 2 studies, 280 participants, low
quality of evidence). The planned subgroup analyses failed to show any
significant differences. We graded the quality of evidence as low based on
the high risk of bias in the studies, large heterogeneity, low number of
events, imprecision, and indirectness. TSA indicates that only 54% of
required information size has been reached so far in regards to mortality,
while there may be evidence of benefit for transfusion outcomes. Overall,
evaluated outcomes were consistent with a benefit in favour of a TEG- or
ROTEM-guided transfusion in bleeding patients. Authors' conclusions: There
is growing evidence that application of TEG- or ROTEM-guided transfusion
strategies may reduce the need for blood products, and improve morbidity
in patients with bleeding. However, these results are primarily based on
trials of elective cardiac surgery involving cardiopulmonary bypass, and
the level of evidence remains low. Further evaluation of TEG- or
ROTEM-guided transfusion in acute settings and other patient categories in
low risk of bias studies is needed.

<30>
Accession Number
20160615600
Author
Huffman M.D.; Karmali K.N.; Berendsen M.A.; Andrei A.-C.; Kruse J.;
Mccarthy P.M.; Malaisrie S.C.
Institution
(Huffman, Karmali) Northwestern University Feinberg School of Medicine,
Departments of Preventive Medicine and Medicine (Cardiology), 680 N. Lake
Shore Drive, Suite 1400, Chicago, IL 60611, United States
(Berendsen) Northwestern University, Galter Health Sciences Library, 303
E. Chicago Avenue, Chicago, IL 60611, United States
(Andrei) Northwestern University, Department of Surgery, 676 N.Saint Clair
St., Suite 1700, Chicago, IL 60611, United States
(Kruse) Northwestern Medicine, Bluhm Cardiovascular Institute, 201 East
Huron, Galter 11-140, Chicago, IL 60611, United States
(Mccarthy) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
(Malaisrie) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
Title
Concomitant atrial fibrillation surgery for people undergoing cardiac
surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD011814. Date of Publication: 22 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: People with atrial fibrillation (AF) often undergo cardiac
surgery for other underlying reasons and are frequently offered
concomitant AF surgery to reduce the frequency of short- and long-term AF
and improve short- and long-term outcomes. Objectives: To assess the
effects of concomitant AF surgery among people with AF who are undergoing
cardiac surgery on short-term and long-term (12 months or greater)
health-related outcomes, health-related quality of life, and costs. Search
methods: Starting from the year when the first "maze" AF surgery was
reported (1987), we searched the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March
2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database
of Abstracts of Reviews of Effects (DARE, April 2015), and Health
Technology Assessment Database (HTA, March 2016). We searched trial
registers in April 2016. We used no language restrictions. Selection
criteria: We included randomised controlled trials evaluating the effect
of any concomitant AF surgery compared with no AF surgery among adults
with preoperative AF, regardless of symptoms, who were undergoing cardiac
surgery for another indication. Data collection and analysis: Two review
authors independently selected studies and extracted data. We evaluated
the risk of bias using the Cochrane 'Risk of bias' tool. We included
outcome data on all-cause and cardiovascular-specific mortality, freedom
from atrial fibrillation, flutter, or tachycardia off antiarrhythmic
medications, as measured by patient electrocardiographic monitoring
greater than three months after the procedure, procedural safety, 30-day
rehospitalisation, need for post-discharge direct current cardioversion,
health-related quality of life, and direct costs. We calculated risk
ratios (RR) for dichotomous data with 95% confidence intervals (CI) using
a fixed-effect model when heterogeneity was low (I² < 50%) and
random-effects model when heterogeneity was high (I² > 50%). We
evaluated the quality of evidence using the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) framework to create a
'Summary of findings' table. Main results: We found 34 reports of 22
trials (1899 participants) with five additional ongoing studies and three
studies awaiting classification. All included studies were assessed as
having high risk of bias across at least one domain. The effect of
concomitant AF surgery on all-cause mortality was uncertain when compared
with no concomitant AF surgery (7.0% versus 6.6%, RR 1.14, 95% CI 0.81 to
1.59, I² = 0%, 20 trials, 1829 participants, low-quality
evidence), but the intervention increased freedom from atrial
fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic
medications > three months (51.0% versus 24.1%, RR 2.04, 95% CI 1.63 to
2.55, I² = 0%, eight trials, 649 participants, moderate-quality
evidence). The effect of concomitant AF surgery on 30-day mortality was
uncertain (2.3% versus 3.1%, RR 1.25 95% CI 0.71 to 2.20, I² =
0%, 18 trials, 1566 participants, low-quality evidence), but the
intervention increased the risk of permanent pacemaker implantation (6.0%
versus 4.1%, RR 1.69, 95% CI 1.12 to 2.54, I² = 0%, 18 trials,
1726 participants, moderate-quality evidence). Investigator-defined
adverse events, including but limited to, need for surgical re-exploration
or mediastinitis, were not routinely reported but were not different
between the two groups (other adverse events: 24.8% versus 23.6%, RR 1.07,
95% CI 0.85 to 1.34, I² = 45%, nine trials, 858 participants),
but the quality of this evidence was very low. Authors' conclusions: For
patients with AF undergoing cardiac surgery, there is moderate-quality
evidence that concomitant AF surgery approximately doubles the risk of
freedom from atrial fibrillation, atrial flutter, or atrial tachycardia
off anti-arrhythmic drugs while increasing the risk of permanent pacemaker
implantation. The effects on mortality are uncertain. Future, high-quality
and adequately powered trials will likely affect the confidence on the
effect estimates of AF surgery on clinical outcomes.

<31>
Accession Number
611887988
Author
Amin R.; McWilliams N.; Lee D.; Altaf F.; Virani F.; Dickinson K.; Walker
D.; Sharp A.; Gerber R.
Institution
(Amin) Kings NHS Trust, United Kingdom
(McWilliams, Lee, Altaf, Virani, Dickinson, Walker, Gerber) ESHT, United
Kingdom
(Sharp) Royal Devon, Exeter NHS Trust, United Kingdom
Title
Triple therapy anticoagulation following percutaneous coronary
intervention (PCI) with novel oral anticoagulants (NOAC) is safe and has
no adverse effects on bleeding post procedure when compared to triple
therapy with vitamin K antagonist (VKA).
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2016
United Kingdom. Conference Start: 20160606 Conference End: 20160608. 102
(pp A25), 2016. Date of Publication: June 2016.
Publisher
BMJ Publishing Group
Abstract
Introduction Following PCI, dual antiplatelet therapy (DAPT) is indicated
for prevention of stent thrombosis. An increasing number of patients also
require long term oral anticoagulation for stroke prevention in atrial
fibrillation, for mechanical heart valves and venous thromboembolism.
Bleeding rates are historically higher in patients on triple therapy
anticoagulation when compared to those on DAPT. Since the introduction of
NOAC, there are a variety of combinations of triple therapy
anticoagulation that patients (Figure presented) can be commenced on
following PCI; however the bleeding risks between these groups are yet to
be compared. Methods We retrospectively studied 853 patients who underwent
PCI in one centre from 2013-2014. Of these, 103 patients required triple
therapy, 49 with a Vitamin K antagonist (VKA) and 54 with NOAC. The
primary endpoint was 12 month bleeding complications as categorised by the
Bleeding Academic Research Consortium (BARC). The secondary endpoint was
major adverse cardiovascular and cardiac events (MACCE). Results Of those
on Triple Therapy Anticoagulation, 69% of patients were male and 32% were
aged 75 or above. The indications for anticoagulation were AF (74%),
Venous Thromboembolism (12%), left ventricular thrombus (13%) and
mechanical heart valve (1%) Of those anticoagulated for AF, 95% had a
CHA2ds2-VASc score greater than 2. 29% of PCI was performed for NSTEACS
and 17% for ST segment elevation MI. In the VKA category there was 12%
minor bleeding compared to 22% in NOAC group (p0.0419). There was no
significant difference between TIMI Major and BARC bleeding between the
two groups. MACCE in the VKA group was 12% and in the NOAC group 5% of
which. (p = 0.0412) Conclusion There is no significant difference in the
bleeding risk between patients taking triple therapy anticoagulation
following PCI with a NOAC or a VKA. Patients requiring triple therapy
anticoagulation following PCI have significantly less risk of MACCE at 12
month follow up with NOAC compared to VKA. (Figure presented).

<32>
Accession Number
611887856
Author
Brown O.; Rossington J.; Clark A.; Hoye A.
Institution
(Brown) Hull York Medical School, United Kingdom
(Rossington, Clark, Hoye) Hull and East Yorkshire Hospital, NHS Trust,
United Kingdom
Title
A systematic review of the clinical applications of cardiogoniometry in
cardiovascular disease.
Source
Heart. Conference: British Cardiovascular Society Annual Conference 2016
United Kingdom. Conference Start: 20160606 Conference End: 20160608. 102
(pp A67-A68), 2016. Date of Publication: June 2016.
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiogoniometry (CGM) is a novel method of 3-D
electrocardiographic (ECG) assessment, which has previously been shown to
have significant diagnostic accuracy at identifying patients with stable
coronary artery disease (CAD) and acute coronary syndromes (ACS). However,
there is considerable variation of reported diagnostic accuracy of CGM
depending on the gold standard test used to compare it to. The aim of our
review is to identify what is diagnostic accuracy of CGM at identifying
stable CAD and ACS, and identify other novel clinical applications of the
technology. Methods Using a pre-defined search strategy, electronic
databases (MEDLINE and Embase) were searched for papers published between
1946-June 2015 and reference lists were pursued. For inclusion, papers had
to be original research articles that investigated the clinical
application of CGM. Sixteen publications were identified from our search;
seven investigated the diagnostic accuracy of CGM to identify stable CAD;
one investigated the diagnostic accuracy of CGM to identify ACS; one
investigated CGM as a screening tool for cardiac allograft vasculopathy in
heart transplant patients and seven investigated specific CGM parameters
without commenting on diagnostic accuracy. If data was available and
suitable for collation, it was pooled to calculate a comprehensive
overview on markers of diagnostic accuracy, which included sensitivity and
specificity. Results When looking at studies investigating the diagnostic
accuracy of CGM to identify stable CAD the figures of diagnostic accuracy
varied: Sensitivity (64-89%) and specificity (64%-82%), however CGM
consistently outperformed 12-lead ECG in terms of sensitivity (29-76%) and
was comparable in terms of specificity (18-95%). The collated data pooled
for our analysis included 772 patients, of which 473 had stable CAD. Our
analysis showed CGM has a sensitivity of 70% and specificity of 82% at
identifying stable CAD, being significantly more accurate than 12-lead
ECG. The one study identified investigating the diagnostic accuracy of CGM
to identify ACS included patients with non-ST segment elevation ACS and
used multiple comparators including 12-lead ECG. It showed that the
sensitivity and specificity of CGM to identify non- ST segment elevation
ACS was 69% and 54% respectively, having significantly higher sensitivity
than 12-lead ECG. The diagnostic accuracy reported for CGM to detect
cardiac allograft vasculopathy was 100% and 88% respectively for
sensitivity and specificity. Conclusion CGM has superior diagnostic
accuracy to 12-lead ECG at identifying patients with stable CAD and is
significantly more sensitive than 12-lead ECG at identifying patients with
non-ST segment elevation ACS. It may have an important role in screening
patients with stable CAD and those with acute chest pain.

<33>
Accession Number
611870352
Author
Ding H.; Tran M.Q.; Shein S.S.; Li H.; Ahuja S.P.
Institution
(Ding, Tran, Shein, Li, Ahuja) Case Western Reserve University, Cleveland,
OH, United States
(Ding, Ahuja) Rainbow Babies and Children's Hospital, Department of
Pediatrics, Division of Hematology Oncology, Cleveland, OH, United States
(Tran, Shein) Rainbow Babies and Children's Hospital, Department of
Pediatrics, Division of Critical Care Medicine, Cleveland, OH, United
States
Title
Hospital acquired venous thromboembolism in critically ill post-operative
children.
Source
American Journal of Hematology. Conference: 3rd Biennial Summit of the
Thrombosis and Hemostasis Societies of North America, THSNA 2016 United
States. Conference Start: 20160414 Conference End: 20160416. 91 (9) (pp
E377), 2016. Date of Publication: September 2016.
Publisher
Wiley-Liss Inc.
Abstract
Background: Hospital acquired venous thromboembolism (HA-VTE) in Pediatric
Intensive Care Unit (PICU) patients is associated with central venous
catheter (CVC) use. A risk factor for HA-VTE in PICU patients with CVC is
post-operative status. However, data for prevalence of HA-VTE for specific
surgical categories as well as associations with clinical outcomes are
lacking. Objective: To identify a population at high risk of HA-VTE
development in critically ill post-operative children through
interrogation of a large multicenter database. Methods: With Institutional
Review Board approval, the Virtual PICU database (Virtual Pediatric
Systems, LLC), a large multicenter database, was interrogated for children
<18 years old who were admitted between 01/2009 - 09/2014 with a
documented specific surgical procedure and who had a CVC present during
PICU care. Data pertaining to specific congenital heart disease surgeries
and the exact timing of VTE diagnosis were unavailable. Only "active" VTE
that were "not present on admission" were considered HA-VTE in our
analyses. Exclusion criteria were prior VTE, and PICU length of stay >1
year. Variables extracted included demographics, type of surgery, primary
diagnosis category, and Pediatric Index of Mortality (PIM2) score. Chi
squared and Wilcoxon rank-sum were used to identify variables associated
with outcomes, which were then included in multivariate models. Our
primary outcome was diagnosis of HA-VTE and secondary outcome was PICU
mortality. Data are shown as median (IQR), n (%) and OR, (95% CI).
Results: Among 28,590 post-operative PICU patients, the median age was
3.25 years (0.52-11.1), 54.9% were male, median PIM2 score was -4.1
([-4.75]-[-2.95]), and length of stay was 5.1 days (2.0-11.7). The overall
prevalence of HA-VTE in this group was 655 (2.29%). Univariate analysis
revealed the following surgical categories to be associated with HA-VTE (p
<0.001) with the following prevalences: cardiac catheterization 292
(6.43%), mechanical circulatory support 29 (9.5%), otorhinolaryngologic
procedure 125 (3.25%), orthopedic procedure 36 (0.98%), plastic surgery 63
(3.67%), thoracic surgery 90 (3.36%), vascular surgery 23 (4.36%), and
general surgery 180 (2.13%). Multivariate analysis showed increased risk
of HA-VTE in patients undergoing cardiac catheterization (2.56,
[2.18-3.02]), mechanical circulatory support (1.69, [1.11-2.56]),
otorhinolaryngologic 1.24, [1.03-1.53]), plastic surgery (1.91,
[1.46-2.50]), thoracic surgery (1.66, [1.32-2.08]), and vascular surgery
(1.94, [1.24-3.02]). In a sub-group analysis, the risk of acquiring HA-VTE
was significantly higher in children who had cardiac catheterization and
at least one additional procedure (4.52, [3.57-5.72]) as compared to
non-surgical patients. Mortality rate for critically ill surgical patients
with no HA-VTE was 5.88% vs 14.05% with HA-VTE, and 10.73% in cardiac
catheterization patients with no HA-VTE vs 21.23% with HA-VTE (p <0.001).
Conclusions: This large, multicenter database identified surgical
categories that are independently associated with HA-VTE development in
post-operative, critically ill children. Cardiac catheterization may
confer disproportionately increased risks for HA-VTE development,
especially when these children undergo additional procedures during PICU
care. Critically ill children undergoing surgical procedures, especially
cardiac catheterization, may represent an ideal population to study
prophylactic anti-coagulation therapy.

<34>
Accession Number
611868338
Author
Munabi N.; Swanson J.; Auslander A.; Sanchez P.; Davidson Ward S.L.; Magee
W.
Institution
(Munabi, Swanson, Magee) Division of Plastic and Reconstructive Surgery,
Keck School of Medicine of USC, Los Angeles, CA, United States
(Auslander) Division of Plastic and Reconstructive Surgery, Children's
Hospital Los Angeles, Los Angeles, CA, United States
(Sanchez) CHLA/USC, Los Angeles, CA, United States
(Davidson Ward) Children's Hospital Los Angeles, Los Angeles, CA, United
States
Title
Incidence of congenital heart disease in nonsyndromic cleft lip and/or
palate: A systematic review of the literature.
Source
Cleft Palate-Craniofacial Journal. Conference: 73rd Annual Meeting of the
American Cleft Palate-Craniofacial Association United States. Conference
Start: 20160404 Conference End: 20160409. 53 (4) (pp e128), 2016. Date of
Publication: July 2016.
Publisher
American Cleft Palate Craniofacial Association
Abstract
Background/Purpose: Surgery for nonsyndromic cleft lip and/or palate
(CL/P) is typically delayed until at least 3 months of age, in part to
allow for the attenuation of cardiopulmonary anesthesia risks present in
the newborn period. However, it is unclear how frequently congenital heart
disease (CHD) occurs in patients with nonsyndromic CL/P, the significance
of CHD if present, and whether the clinical impact of CHD attenuates with
growth and time. These questions bear both on the necessity and timing of
preoperative evaluation by a pediatrician, and on whether initial surgical
treatment can be safely performed at an earlier age. This study sought to
better define the incidence and severity of CHD in nonsyndromic CL/P, and
the appropriate pre-operative evaluations and subsequent implications for
surgery. Methods/Descriptions: A systematic review of the literature from
1980 to September 2015 in the PubMed database was performed adhering to
PRISMA guidelines. Studies describing rates of CHD in patients with CL/P
were reviewed, and were included if nonsyndromic patients were analyzed as
a distinct study cohort. Emphasis of analysis was placed on incidence and
severity of CHD, and impact on cleft management and standard treatment
algorithms. Results: Three studies, which collectively analyzed a total of
3694 patients with nonsyndromic CL/P, met inclusion criteria. Pooled
analysis revealed a 7.25% (n=268) incidence of CHD in this population
(range 6.25% to 24.5%), which was higher than the reported non-cleft
population (<10/1000, OR of CHD in CL/P 7.74, 95% CI 1.08-55.7). Septal
defects (n=204/268, 76.1%) were the most common variants of CHD. All three
studies observed that more extensive clefts tended to be associated with
higher risk of CHD. Two studies stratified patients by cleft type, and
found that CHD was least prevalent in isolated cleft lip (n=24/768, 3.1%),
compared to isolated cleft palate (n=110/1287, 8.5%) and combined cleft
lip and palate (n=143/1499, 9.5%). No study commented on how a diagnosis
of CHD influenced surgical approaches to or complications in cleft
management. Conclusions: CHD appears to have greater incidence in
nonsyndromic patients with CL/P compared to patients without clefts. We
interpret this high rate to affirm the importance of pre-operative
evaluation by a pediatrician, particularly for isolated cleft palate or
cleft lip and palate. Further studies are needed to elucidate the optimal
management and any impact of delaying surgery in patients with a diagnosis
of CHD, and to better understand the need for pre-operative cardiac
screening in these patients.