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<1>
Accession Number
604841395
Author
Ferguson Z.G.; Yarborough D.E.; Jarvis B.L.; Sistino J.J.
Institution
(Ferguson, Yarborough, Jarvis, Sistino) Medical University of South
Carolina, Charleston, United States
Title
Evidence-based medicine and myocardial protection - where is the
evidence?.
Source
Perfusion (United Kingdom). 30 (5) (pp 415-422), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: Myocardial protection with cardioplegia is an integral
component of most cardiac surgical procedures, providing protection of the
heart by limiting metabolic activity and increasing the myocardium's
capacity to withstand ischemia for prolonged periods of time. Cardioplegia
has greatly affected the landscape of cardiothoracic surgery since its
introduction in the 1960s, but, to this day, there continues to be a
debate over what the ideal cardioplegic solution should be. The goal of
this analysis is to describe current practices in cardioplegia and to
point out the lack of quality human research and subsequent publications
that prevent best practices from being utilized. Methods: This study is a
systematic review of journal publications pertaining to the composition of
commonly used cardioplegic solutions. Four main types of cardioplegia were
assessed to give a narrower field of examination; specifically,
microplegia, del Nido, Custodiol HTK, and 4:1 blood cardioplegia. Other
combinations of cardioplegia, including St. Thomas's Solution and the
University of Wisconsin (UW) Solution, were considered when applicable
according to the context of the publication being reviewed. Factors being
assessed consisted of scientific validity, nature of the test subject
(isolated organ vs. animal vs. human studies), experimental setup
(retrospective trials vs. randomized clinical trials) and patient
outcomes. Results: There are very few randomized clinical trials with
human subjects comparing commonly used cardioplegic solutions. Numerous
retrospective studies exist, but often show similar intraoperative and
postoperative outcomes between the solutions. Some solutions, del Nido
cardioplegia in particular, were found to have few or no significant human
trials to back the rigor required in such a highly specialized field as
cardiovascular surgery. A wide variation in the types of surgeries and
primary outcomes were included in the publications, so it is difficult to
perform an accurate systematic review of the topic. Conclusion: Uniform
variables among different studies would be preferable for analysis of this
topic; thus, it is the researchers' recommendation that the collection of
multicenter data be undertaken in order to more fully answer this research
question. Comparative effectiveness studies to associate commonly used
solutions are needed. Without this research, surgeon preference remains
the primary determining factor for deciding which cardioplegic solution to
use. Cardioplegia selection should rely more on higher scientific
research, using evidenced-based medicine and ranking of clinical studies.
Copyright &#xa9; The Author(s) 2014.

<2>
Accession Number
604841383
Author
Chalegre S.T.; Sa M.P.B.O.; Goncalves De Rueda F.; Salerno P.R.;
Vasconcelos F.P.; Lima R.C.
Institution
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) Division of
Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco -
PROCAPE, Recife, Brazil
(Chalegre, Sa, Goncalves De Rueda, Salerno, Vasconcelos, Lima) University
of Pernambuco - UPE, Recife, Brazil
(Chalegre, Sa, Lima) Nucleus of Postgraduate and Research in Health
Sciences, Faculty of Medical Sciences FCM, Biological Sciences Institute
ICB, Recife, Brazil
(Chalegre) Universidade de Pernambuco, Faculdade de Ciencias Medicas,
Campus Universitario, Rua Arnobio Marques 310 Sto. Amaro, Recife, PE CEP
50.100-130, Brazil
Title
Central versus peripheral arterial cannulation and neurological outcomes
after thoracic aortic surgery: meta-analysis and meta-regression of 4459
patients.
Source
Perfusion (United Kingdom). 30 (5) (pp 383-388), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Thoracic aortic surgeries remain with high mortality rates,
often associated with postoperative neurological complications. The choice
of the right cannulation site is extremely important for suitable blood
supply and maintenance of vital functions, especially of the central
nervous system. Objectives: To compare the influence of central versus
peripheral arterial cannulation on neurological outcomes in patients
undergoing thoracic aortic surgery through systematic review and
meta-analysis. Methods: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS and
reference lists of relevant articles were searched for clinical studies
that reported in-hospital neurological outcomes after central or
peripheral arterial cannulation during thoracic aortic surgery procedures
until December 2013. The principal summary measures were Odds Ratio (OR)
for central compared to peripheral arterial cannulation with 95%
confidence interval (CI) and p-values considered statistically significant
when <0.05. The ORs were combined across studies, using the
DerSimonian-Laird random effects model and fixed effects model using the
Mantel-Haenszel model - both models were weighted. The meta-analysis was
completed using the software Comprehensive Meta-Analysis version 2
(Biostat Inc., Englewood, NJ). Results: Six studies were identified and
included a total of 4459 patients (1180 for central and 3279 for
peripheral cannulation). There was no significant difference between the
central and peripheral groups regarding neurological outcomes. The
meta-regression evidenced no relationship between neurological outcomes
and the variables age, sex, previous coronary event, previous neurological
event, urgency surgery, cardiopulmonary bypass time, activated clotting
time and esophageal temperature with p>0,05. Conclusion: When it comes to
neurological outcomes in patients undergoing thoracic aortic surgery,
there was no evidence that argues in favor of any choice of arterial
cannulation site, which makes us reject any superiority of one approach
over the other in this regard. Copyright &#xa9; The Author(s) 2014.

<3>
Accession Number
604841376
Author
Gong B.; Ji B.; Sun Y.; Wang G.; Liu J.; Zheng Z.
Institution
(Gong, Ji, Sun, Wang, Liu, Zheng) State Key Laboratory of Cardiovascular
Medicine, Fuwai Hospital, Chinese Academy of Medical Science, Beijing,
China
(Gong, Zheng) Department of Cardiovascular Surgery, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji, Sun, Liu) Department of Cardiopulmonary Bypass, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Wang) Department of Anesthesia, Chinese Academy of Medical Science,
Peking Union Medical College, Beijing, China
Title
Is microplegia really superior to standard blood cardioplegia? The results
from a meta-analysis.
Source
Perfusion (United Kingdom). 30 (5) (pp 375-382), 2015. Date of
Publication: 12 Jul 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Microplegia (whole blood cardioplegia with reduced volume)
retains all the advantages of blood cardioplegia (such as superior
oxygen-carrying capacity, better osmotic properties and antioxidant
capability, etc.) without the potential disadvantages of hemodilution
(such as myocardial edema). We sought to perform a systematic review and
meta-analysis to compare microplegia and standard blood cardioplegia on
the cardioprotective effects for patients undergoing coronary artery
bypass grafting (CABG). Methods: MEDLINE, EMBASE and the Cochrane Central
Register of Controlled Trials were searched for relevant controlled trials
published in English, from their inception up to May 15th, 2013. Data on
low output syndrome, spontaneous return to sinus rhythm, volume of
cardioplegia and perioperative myocardial infarction were analyzed.
Results: Five studies, totaling 296 patients, were included out of 77
retrieved citations. The microplegia group used less volume of
cardioplegia (WMD, -514.79 ml, 95%CI: -705.37 ml to -324.21 ml) when
compared with the standard blood cardioplegia group. There were no
statistical differences in the incidence of low output syndrome (RR, 0.95,
95%CI: 0.55 to 1.62), spontaneous return to sinus rhythm (RR, 1.64, 95%CI:
0.61 to 4.41) and perioperative myocardial infarction (RR, 0.62, 95%CI:
0.19 to 2.08). Conclusions: Microplegia was associated with less volume of
cardioplegia, whereas the incidence of spontaneous return to sinus rhythm
and perioperative myocardial infarction were similar, but large controlled
randomized trials are still needed to confirm this. Copyright &#xa9; The
Author(s) 2014.

<4>
Accession Number
604501694
Author
Cavallari I.; Mega S.; Goffredo C.; Patti G.; Chello M.; Di Sciascio G.
Institution
(Cavallari, Mega, Goffredo, Patti, Chello, Di Sciascio) Department of
Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del
Portillo, Rome 200 - 00128, Italy
Title
Hand-held echocardiography in the setting of pre-operative cardiac
evaluation of patients undergoing non-cardiac surgery: results from a
randomized pilot study.
Source
International Journal of Cardiovascular Imaging. 31 (5) (pp 995-1000),
2015. Date of Publication: 29 Jun 2015.
Publisher
Kluwer Academic Publishers
Abstract
Transthoracic echocardiography is not a routine test in the pre-operative
cardiac evaluation of patients undergoing non-cardiac surgery but may be
considered in those with known heart failure and valvular heart disease or
complaining cardiac symptoms. In this setting, hand-held echocardiography
(HHE) could find a potential application as an alternative to standard
echocardiography in selected patients; however, its utility in this
context has not been investigated. The aim of this pilot study was to
evaluate the conclusiveness of HHE compared to standard echocardiography
in this subset of patients. 100 patients scheduled for non-cardiac surgery
were randomized to receive a standard exam with a Philips Ie33 or a
bedside evaluation with a pocket-size imaging device (Opti-Go, Philips
Medical System). The primary endpoint was the percentage of satisfactory
diagnosis at the end of the examination referred as conclusiveness.
Secondary endpoints were the mean duration time and the mean waiting time
to perform the exams. No significant difference in terms of conclusiveness
between HHE and standard echo was found (86 vs 96 %; P = 0.08). Mean
duration time of the examinations was 6.1 +/- 1.2 min with HHE and 13.1
+/- 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a
consistent save of waiting time because it was performed the same day of
clinical evaluation whereas patients waited 10.1 +/- 6.1 days for a
standard echocardiography (P < 0.001). This study suggests the potential
role of HHE for pre-operative evaluation of selected patients undergoing
non-cardiac surgery, since it provided similar information but it was
faster and earlier performed compared to standard echocardiography.
Copyright &#xa9; 2015, Springer Science+Business Media Dordrecht.

<5>
Accession Number
602248555
Author
Marasco S.; Saxena P.
Institution
(Marasco, Saxena) CJOB Cardiothoracic Surgery Department, Alfred Hospital,
Australia
Title
Surgical rib fixation - Technical aspects.
Source
Injury. 46 (5) (pp 929-932), 2015. Date of Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Surgical rib fixation (SRF) for severe rib fracture injuries is
increasingly becoming an accepted treatment modality. There is now
adequate evidence in randomised controlled trials that rib fixation in
flail chest patients reduces ventilator times, intensive care stay and
costs of treatment in ventilator dependent patients [1-3]. Despite this,
rib fixation has not become standard of care for these patients and
remains a treatment modality practised by few centres, usually those with
large trauma loads who see high volumes of severe rib fracture injury
patients. The purpose of this article is to outline the available
prostheses, indications, operative planning and techniques of rib
fixation. Surgical approaches to rib fractures in anterior, lateral and
posterior positions are described as are the use of currently available
cortical and medullary fixation prostheses. Copyright &#xa9; 2015
Published by Elsevier Ltd. All rights reserved.

<6>
Accession Number
606888334
Author
Koutsoumpelis A.; Kouvelos G.; Peroulis M.; Tzilalis V.; Matsagkas M.
Institution
(Koutsoumpelis, Kouvelos, Peroulis, Matsagkas) Department of Surgery, Unit
of Vascular Surgery, Medical School, University of Ioannina, Ioannina
University Campus, S. Niarchos Avenue, Ioannina 45110, Greece
(Tzilalis) Division of Vascular Surgery, Department of Surgery, 401
General Military Hospital of Athens, Athens, Greece
Title
Surgical and endovascular intervention on internal carotid artery near
occlusion.
Source
International Angiology. 34 (2) (pp 172-181), 2015. Date of Publication:
April 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Therapeutic strategy for treating carotid artery near occlusion (CANO) has
been controversial. The aim of this study was to review the literature
concerning the invasive treatment of atherosclerotic CANO. A review was
conducted of the English medical literature from 1980 to 2013 using
Pub-Medand EMBASE database to find studies involving open or endovascular
management of CANO. The search identified 20 reports describing invasive
treatment of CANO encompassing 770 patients (77.7% men; mean age
66.3+/-5.2 years). A typical appearance of string sign was noted in nearly
60% of the patients. The vast majority (92.6%) were symptomatic. 479
(62.2%) patients underwent an open procedure, while 291 (38.8%) were
treated endovascularly. The technical success rate for the endovascular
procedures was 99%, while distal embolic protection devices were applied
in most patients (66%). The 30 days procedural stroke rate was 2.1% and
2.4% for open and endovascular repair respectively. During a follow-up
period spanning an average of approximately two years the ipsilateral
cerebrovascular event rate was 5% and 1.2% for open and endovascular
treatmentrespectively. Twenty five (5.2%) restenosis or occlusions were
reported for the open procedures, while 13 (5.4%) were also documented for
endovascular repair. The current literature concerning the invasive
treatment of CANO is weak and cannot support any evidence based
recommendation. The necessity to intervene as well as the best therapeutic
strategy remains controversial. This review shows that the interventionon
symptomatic CANO may consist a relatively safe and effective therapeutic
strategy with low perioperative cerebrovascular morbidity for both
treatment modalities, although durability and long-term outcomes should be
further affirmed. The low incidence of this entity and the dearth of clear
evidence support the need for a large multicenter registry to clarify the
absolute indications for intervention and define the best therapeutic
approach.

<7>
Accession Number
604905154
Author
Duan F.; Qi Z.; Liu S.; Lv X.; Wang H.; Gao Y.; Wang J.
Institution
(Duan, Qi, Lv, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital and Cardiovascular Institute, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Tsinghua University,
Peking Union Medical College, Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital and
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Tsinghua University, Peking Union
Medical College, Beijing, China
Title
Effectiveness of bone marrow mononuclear cells delivered through a graft
vessel for patients with previous myocardial infarction and chronic heart
failure: An echocardiographic study of left ventricular remodeling.
Source
Medical Ultrasonography. 17 (2) (pp 160-166), 2015. Date of Publication:
2015.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (E-mail:
dfodor@ymail.com)
Abstract
Aims: The graft of stem cells to treat ischemic cardiomyopathy is popular
in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through graft vessels to
improve left ventricular remodeling of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Material and
methods: Patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: CABG only (18
patients), or CABG with BMMNC transplantation (24 patients).
Echocardiographic parameters were measured on B-mode imaging, 3D imaging
and color flow imaging. Results Post-operative LVEDD (end-diastolic
dimension of left ventricle), LVESD (end-systolic dimension of left
ventricle), LVEDV (end-diastolic volume of left ventricle), LVESV
(end-systolic volume of left ventricle), LVEDVI (LVEDV indexed to body
surface area), LVESVI (LVESV indexed to body surface area), LV-mass (mass
of left ventricle) and LV-massI (LV-mass indexed to body surface area)
were significantly improved compared with those obtained prior to
operation in CABG+BMMNC group (al p<0.05). The same parameters were not
significantly different pre- and postoperative in the CABG group (al
p>0.05). Postoperative mitral regurgitation score was not significantly
different from those prior to operation in both groups (al p>0.05). In
Chi-square tests, LVEDD, LVESD, LVEDV, LVESV, LVEDVI, LVESVI, LV-mass,
LV-massI were determinants of the left ventricular remodeling. Conclusion:
The improvement of left ventricular remodeling in CABG+BMMNC group was
better than in the CABG group and this improvement was verified by
echocardiography.

<8>
Accession Number
602586287
Author
Taniwaki M.; Radu M.D.; Garcia-Garcia H.M.; Heg D.; Kelbaek H.; Holmvang
L.; Moschovitis A.; Noble S.; Pedrazzini G.; Saunamaki K.; Dijkstra J.;
Landmesser U.; Wenaweser P.; Meier B.; Stefanini G.G.; Roffi M.; Luscher
T.F.; Windecker S.; Raber L.
Institution
(Taniwaki, Moschovitis, Wenaweser, Meier, Stefanini, Windecker, Raber)
Department of Cardiology, Swiss Cardiovascular Center Bern, Bern
University Hospital, Bern 3010, Switzerland
(Radu, Kelbaek, Holmvang, Saunamaki) Rigshospitalet, Copenhagen, Denmark
(Garcia-Garcia) Erasmus MC, Rotterdam, Netherlands
(Heg) Clinical Trial Unit, University of Bern, Bern, Switzerland
(Noble, Roffi) University Hospital, Geneva, Switzerland
(Pedrazzini) Cardiocentro, Lugano, Switzerland
(Dijkstra) Leiden University Medical Center, Leiden, Netherlands
(Landmesser, Luscher) University Heart Center, Cardiology, University
Hospital Zurich, Zurich, Switzerland
Title
Long-term safety and feasibility of three-vessel multimodality
intravascular imaging in patients with ST-elevation myocardial infarction:
the IBIS-4 (integrated biomarker and imaging study) substudy.
Source
International Journal of Cardiovascular Imaging. 31 (5) (pp 915-926),
2015. Date of Publication: 28 Feb 2015.
Publisher
Kluwer Academic Publishers
Abstract
We assessed the feasibility and the procedural and long-term safety of
intracoronary (i.c) imaging for documentary purposes with optical
coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients
with acute ST-elevation myocardial infarction (STEMI) undergoing primary
PCI in the setting of IBIS-4 study. IBIS4 (NCT00962416) is a prospective
cohort study conducted at five European centers including 103 STEMI
patients who underwent serial three-vessel coronary imaging during primary
PCI and at 13 months. The feasibility parameter was successful imaging,
defined as the number of pullbacks suitable for analysis. Safety
parameters included the frequency of peri-procedural complications, and
major adverse cardiac events (MACE), a composite of cardiac death,
myocardial infarction (MI) and any clinically-indicated revascularization
at 2 years. Clinical outcomes were compared with the results from a cohort
of 485 STEMI patients undergoing primary PCI without additional imaging.
Imaging of the infarct-related artery at baseline (and follow-up) was
successful in 92.2 % (96.6 %) of patients using OCT and in 93.2 % (95.5 %)
using IVUS. Imaging of the non-infarct-related vessels was successful in
88.7 % (95.6 %) using OCT and in 90.5 % (93.3 %) using IVUS.
Periprocedural complications occurred <2.0 % of OCT and none during IVUS.
There were no differences throughout 2 years between the imaging and
control group in terms of MACE (16.7 vs. 13.3 %, adjusted HR1.40, 95 % CI
0.77-2.52, p = 0.27). Multi-modality three-vessel i.c. imaging in STEMI
patients undergoing primary PCI is consistent a high degree of success and
can be performed safely without impact on cardiovascular events at
long-term follow-up. Copyright &#xa9; 2015, Springer Science+Business
Media Dordrecht.

<9>
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Accession Number
53241426
Author
Picchi A.; Valente S.; Gensini G.
Institution
(Picchi) Department of Cardiology, Misericordia Hospital, Via Senese 161,
Grosseto 58100, Italy
(Valente, Gensini) Department of Medical and Surgical Critical Care,
University of Florence, Florence, Italy
Title
Therapeutic hypothermia in the intensive cardiac care unit.
Source
Journal of Cardiovascular Medicine. 16 (5) (pp 363-371), 2015. Date of
Publication: 07 May 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Therapeutic hypothermia has demonstrated to improve both survival and
neurological outcome in patients who experienced an out-of-hospital
cardiac arrest. Nevertheless, many aspects of its clinical application are
still controversial. Current guidelines recommend to cool patients who
survive a cardiac arrest due to either ventricular fibrillation or
ventricular tachycardia, whereas the beneficial effect of lowering body
temperature in nonshockable rhythms is still questionable due to the lack
of randomized controlled trial involving this subgroup of patients.
Although therapeutic hypothermia is often begun before hospital arrival,
the optimal time to start cooling is still a matter of debate.
Furthermore, different methods are available to low body temperature, but
no direct comparisons are available to establish which device performs
better than others, and a combination of external and endovascular cooling
is usually preferred. The present review is aimed at summarizing the
available evidence supporting the use in clinical practice of mild
hypothermia in comatose survivors from cardiac arrest and at evaluating
its adverse events and their treatment. &#xa9; Copyright &#xa9; 2015
Wolters Kluwer Health, Inc. All rights reserved.

<10>
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Accession Number
603470901
Author
Mark D.B.; Anstrom K.J.; Clapp-Channing N.E.; Knight J.D.; Boineau R.;
Goertz C.; Rozema T.C.; Liu D.M.; Nahin R.L.; Rosenberg Y.; Drisko J.; Lee
K.L.; Lamas G.A.
Institution
(Mark, Anstrom, Clapp-Channing, Knight, Liu) Outcomes Research Group, Duke
University Medical Center, Duke University, 2400 Pratt St, Durham, NC
27705, United States
(Lee) Duke Clinical Research Institute, Duke University Medical Center,
Duke University, Durham, NC, United States
(Boineau, Nahin, Rosenberg) National Heart, Lung, and Blood Institute,
Bethesda, MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, Kansas
City, United States
(Lamas) Columbia University Division of Cardiology, Mount Sinai Medical
Center, Miami, FL, United States
Title
Quality-of-life outcomes with a disodium EDTA chelation regimen for
coronary disease: Results from the trial to assess chelation therapy
randomized trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 7 (4) (pp 508-516),
2014. Date of Publication: 01 Jul 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-The National Institutes of Health-funded Trial to Assess
Chelation Therapy (TACT) randomized 1708 stable coronary disease patients
aged =50 years who were =6 months post-myocardial infarction (2003-2010)
to 40 infusions of a multicomponent EDTA chelation solution or placebo.
Chelation reduced the primary composite end point of mortality, recurrent
myocardial infarction, stroke, coronary revascularization, or
hospitalization for angina (hazard ratio, 0.82; 95% confidence interval,
0.69-0.99; P=0.035). Methods and Results-In a randomly selected subset of
911 patients, we prospectively collected a battery of quality-of-life
(QOL) instruments at baseline and at 6, 12, and 24 months after
randomization. The prespecified primary QOL measures were the Duke
Activity Status Index (Table I in the Data Supplement) and the Medical
Outcomes Study Short-Form 36 Mental Health Inventory-5. All comparisons
were by intention to treat. Baseline clinical and QOL variables were well
balanced in the 451 patients randomized to chelation and in the 460
patients randomized to placebo. The Duke Activity Status Index improved in
both groups during the first 6 months of therapy, but we found no evidence
for a treatment-related difference (mean difference [chelation-placebo]
during follow-up, 0.9 [95% confidence interval, -0.7 to 2.6; P=0.27]).
There was no statistically significant evidence of a treatment-related
difference in the Mental Health Inventory-5 during follow-up (mean
difference, 1.0; 95% confidence interval, -0.1 to 2.0; P=0.08). None of
the secondary QOL measures showed a consistent treatment-related
difference. Conclusions-In stable, predominantly asymptomatic coronary
disease patients with a history of myocardial infarction, EDTA chelation
therapy did not have a detectable effect on QOL during 2 years of
follow-up. Copyright &#xa9; 2014 American Heart Association, Inc.

<11>
Accession Number
53115744
Author
Witkowski A.; Jastrzebski J.; Dabrowski M.; Chmielak Z.
Institution
(Witkowski, Jastrzebski, Dabrowski, Chmielak) Interventional Cardiology
and Angiology Department, Institute of Cardiology, Warsaw, Poland
Title
Second transcatheter aortic valve implantation for treatment of suboptimal
function of previously implanted prosthesis: Review of the literature.
Source
Journal of Interventional Cardiology. 27 (3) (pp 300-307), 2014. Date of
Publication: June 2014.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives To systematically review reported cases of second transcatheter
aortic valve deployment within a previously implanted prosthesis
(TAV-in-TAV). Background TAV-in-TAV deployment is one of the rescue
strategies undertaken due to an unsuccessful or suboptimal transcatheter
aortic valve implantation (TAVI) result. Currently, there are no clear
indications for second valve implantation and outcomes of patients with 2
prostheses deployed remain poorly known. Methods The MEDLINE and PubMed
databases were searched for cases of TAV-in-TAV implantations of aortic
valve. Results Forty-three articles reporting on TAV-in-TAV deployment
were included in the review. The most frequently observed indication for
second valve implantation was aortic regurgitation (AR) occurring shortly
after TAVI. There was a strong dominance of paravalvular over
intravalvular AR, with prosthesis malposition being the main underlying
cause of TAVI failure (81% of all identified cases). Perioperative
echocardiographic images are crucial in identifying causes of failure and
helpful in optimal rescue strategy selection. Success rate of TAV-in-TAV
implantation varies from 90% to 100% with mortality rate of 0-14.3% at 30
days. Despite similar aortic valve function in follow-up, TAV-in-TAV may
be an independent predictor of increased cardiovascular mortality.
Conclusions TAV-in-TAV implantation is feasible and results in favorable
short- and mid-term outcomes in patients with acute failure of TAVI
without recourse to open-heart surgery. Further studies are needed to
establish algorithm of the management of unsuccessful or suboptimal
implantation results. (J Interven Cardiol 2014;27:300-307) &#xa9; 2014,
Wiley Periodicals, Inc.

<12>
Accession Number
53237485
Author
Healy D.A.; Khan W.A.; Wong C.S.; Moloney M.C.; Grace P.A.; Coffey J.C.;
Dunne C.; Walsh S.R.; Sadat U.; Gaunt M.E.; Chen S.; Tehrani S.; Hausenloy
D.J.; Yellon D.M.; Kramer R.S.; Zimmerman R.F.; Lomivorotov V.V.; Shmyrev
V.A.; Ponomarev D.N.; Rahman I.A.; Mascaro J.G.; Bonser R.S.; Jeon Y.;
Hong D.M.; Wagner R.; Thielmann M.; Heusch G.; Zacharowski K.; Meybohm P.;
Bein B.; Tang T.Y.
Institution
(Healy, Khan, Wong, Moloney, Grace, Coffey, Dunne) Department of Surgery,
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
(Walsh) National University of Ireland Galway, Ireland
(Sadat, Gaunt) Addenbrooke's Hospital, Cambridge, United Kingdom
(Chen) Central South University, Hunan, China
(Tehrani, Hausenloy, Yellon) Hatter Cardiovascular Institute, University
College London, United Kingdom
(Kramer, Zimmerman) Maine Medical Centre, ME, United States
(Lomivorotov, Shmyrev, Ponomarev) Novosibirsk State Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Rahman, Mascaro, Bonser) Queen Elizabeth Medical Centre, Birmingham,
United Kingdom
(Jeon, Hong) Seoul National University Hospital, Seoul, South Korea
(Wagner) St. Anne's University Hospital, Brno, Czech Republic
(Thielmann, Heusch) University Hospital Essen, Essen, Germany
(Zacharowski, Meybohm) University Hospital Frankfurt, Germany
(Meybohm, Bein) University Hospital Schleswig-Holstein, Kiel, Germany
(Tang) Changi General Hospital, Singapore, Singapore
Title
Remote preconditioning and major clinical complications following adult
cardiovascular surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 176 (1) (pp 20-31), 2014. Date of
Publication: September 2014.
Publisher
Elsevier Ireland Ltd
Abstract
Background A number of 'proof-of-concept' trials suggest that remote
ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ
injury in patients undergoing major cardiovascular surgery. To date, few
studies have involved hard clinical outcomes as primary end-points.
Methods Randomised clinical trials of RIPC in major adult cardiovascular
surgery were identified by a systematic review of electronic abstract
databases, conference proceedings and article reference lists. Clinical
end-points were extracted from trial reports. In addition, trial principal
investigators provided unpublished clinical outcome data. Results In
total, 23 trials of RIPC in 2200 patients undergoing major adult
cardiovascular surgery were identified. RIPC did not have a significant
effect on clinical end-points (death, peri-operative myocardial infarction
(MI), renal failure, stroke, mesenteric ischaemia, hospital or critical
care length of stay). Conclusion Pooled data from pilot trials cannot
confirm that RIPC has any significant effect on clinically relevant
end-points. Heterogeneity in study inclusion and exclusion criteria and in
the type of preconditioning stimulus limits the potential for
extrapolation at present. An effort must be made to clarify the optimal
preconditioning stimulus. Following this, large-scale trials in a range of
patient populations are required to ascertain the role of this simple,
cost-effective intervention in routine practice. &#xa9; 2014 Elsevier
Ireland Ltd. All rights reserved.

<13>
Accession Number
605145353
Author
Tempio D.; Pruiti G.P.; Conti S.; Romano S.A.; Tavano E.; Capodanno D.;
Liotta C.; Di Grazia A.; Tamburino C.; Calvi V.
Institution
(Tempio, Pruiti, Conti, Romano, Tavano, Capodanno, Liotta, Di Grazia,
Tamburino, Calvi) Arrhythmology OU, Ferrarotto Hospital, University of
Catania, Catania, Italy
Title
Ventricular arrhythmias in aortic valve stenosis before and after
transcatheter aortic valve implantation.
Source
Europace. 17 (7) (pp 1136-1140), 2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is a therapeutic
treatment for patients with severe aortic stenosis (AS) at high surgical
risk. Although the procedure is associated with a reduction in total
mortality, there are no data regarding changing in the incidence of
premature ventricular contractions (PVCs) and ventricular arrhythmias
(VAs) after TAVI. The aim of this study was to assess the incidence of VAs
before and after TAVI. Methods and results We enrolled 237 patients who
underwent TAVI at our centre. Ninety-one patients were excluded for the
following reasons: presence of prior permanent pacemaker (PPM) (n = 20),
new PPM implant after TAVI (n = 48), death during the follow-up period (n
= 16), and lost at follow-up (n = 7). Finally, 146 patients were included
in our analysis. The presence of VAs was evaluated in all patients
recording a 24 h Holter monitoring before the procedure and after 1 and 12
months. Ventricular arrhythmias were classified according to a modified
Lown grading system. Before the procedure, isolates PVCs (grade 1-2 of
Lown grading system) were present in 34.9% of patients (n = 51). Complex
PVCs (grade 3-4a-4b of Lown grading system) were present in 48.6% of the
population (multifocal PVCs in 32 patients, 21.9%; pairs in 25 patients,
17.1%; ventricular tachycardia in 14 patients, 9.6%). One month after the
procedure, we observed statistically significant incidence decrease of
arrhythmias of grade 3 (from 21.9 to 17.1%) and grade 4 (pairs from 17.1
to 12.3%; ventricular tachycardia from 9.6 to 4.8%). After 12 months,
there was a further significant reduction in the frequency and severity of
PVCs. In particular, 45.8% of patients had isolates PVCs (<30 in all given
hours of monitoring in 45 patients, 30.8%; higher than 30 in any hour of
monitoring in 22 patients, 15%) while the frequency of complex arrhythmias
was reduced to 16.4% (multifocal PVCs in 13 patients, 9%; couplets 8
patients, 5.5% and ventricular tachycardia in 3 patients, 2.0%). The
difference was statistically significant (P < 0.01). Conclusion This study
indicates that VAs are common in patients with AS. We observed a
significant decrease in the incidence and severity of PVCs since the first
month after TAVI. Furthermore, after 1 year follow-up there was a further
and significant reduction in the frequency of complex PVCs. This may be
related to the benefits determined by valve replacement on left
ventricular function. Copyright &#xa9; 2015 Published on behalf of the
European Society of Cardiology. All rights reserved. &#xa9; The Author
2015. For permissions please email: journals.permissions@oup.com.

<14>
[Use Link to view the full text]
Accession Number
603980220
Author
Li Q.-H.; Qi Z.; Yu Z.; Li X.-L.; Ji H.-G.; Yin J.-F.; Yi S.
Institution
(Li, Qi, Yu, Li, Ji, Yin, Yi) Department of Cardiology, Changzhou TCM
Hospital, No. 25 Heping Road, Tianning District, Changzhou, China
Title
Long-term effect of second-generation drug-eluting stents for coronary
artery disease, everolimus-eluting versus zotarolimus-eluting stents: A
meta- A nalysis.
Source
Coronary Artery Disease. 26 (3) (pp 259-265), 2015. Date of Publication:
22 Apr 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Compared with the zotarolimus-eluting stent (ZES), the
everolimus-eluting stent (EES) has reduced the risk of stent restenosis
and thrombosis as found in a number of randomized-controlled trials
(RCTs). However, the benefits have been variable. Materials and methods We
evaluate the long-term effect of EES and ZES on the risk of stent
thrombosis and target lesion revascularization in patients receiving PCI.
We identified RCTs by a systematic search of MEDLINE, EMBASE, and Cochrane
Database. Results Five RCTs (9853 patients) were included. Overall, EES
significantly reduced the risk of target lesion revascularization [odds
ratio (OR), 0.77; 95% confidence interval (CI), 0.62-0.95; P=0.01]
compared with ZES therapy. However, there was no difference in the risk of
target vessel revascularization (OR, 0.93; 95% CI, 0.78-1.10; P=0.38) and
definite/probable stent thrombosis (OR, 0.83; 95% CI, 0.56-1.25; P=0.37)
between the two groups. Furthermore, the risk of mortality (OR, 1.04; 95%
CI, 0.84-1.27; P=0.73), myocardial infarction (OR, 0.95; 95% CI,
0.74-1.23; P=0.70), and major adverse cardiac event (OR, 0.96; 95% CI,
0.84-1.10; P=0.53) was similar between the two groups. Conclusion The
new-generation Resolute-ZES and EES have a similar long-term safety and
efficacy profile. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<15>
Accession Number
600969225
Author
Smith P.K.; Puskas J.D.; Ascheim D.D.; Voisine P.; Gelijns A.C.; Moskowitz
A.J.; Hung J.W.; Parides M.K.; Ailawadi G.; Perrault L.P.; Acker M.A.;
Argenziano M.; Thourani V.; Gammie J.S.; Miller M.A.; Page P.; Overbey
J.R.; Bagiella E.; Dagenais F.; Blackstone E.H.; Kron I.L.; Goldstein
D.J.; Rose E.A.; Moquete E.G.; Jeffries N.; Gardner T.J.; O'Gara P.T.;
Alexander J.H.; Michler R.E.
Institution
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Puskas, Rose) Department of Cardiac Surgery, Mount Sinai Health System,
United States
(Ascheim, Gelijns, Moskowitz, Parides, Overbey, Bagiella, Moquete)
International Center for Health Outcomes and Innovation Research,
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, Box 1077, New York, NY 10029, United States
(Miller) Division of Cardiothoracic Surgery, Department of Surgery,
Columbia University, United States
(Goldstein, Michler) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center-Albert Einstein College of Medicine, New York,
United States
(Voisine, Dagenais) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Hopital Laval, Quebec, QC, Canada
(Perrault) Montreal Heart Institute, University of Montreal, Canada
(Page) Department of Surgery, Hopital du Sacre-Coeur de Montreal,
Montreal, Canada
(Hung) Echocardiography Core Lab, Massachusetts General Hospital, Boston,
United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery,
University of Virginia School of Medicine, Charlottesville, United States
(Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, United States
(Thourani) Clinical Research Unit, Division of Cardiothoracic Surgery,
Emory University School of Medicine, Atlanta, United States
(Gammie) University of Maryland, Baltimore, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Argenziano) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, Bethesda, MD, United States
(Jeffries) Office of Biostatistics Research, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Blackstone) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Gardner) Center for Heart and Vascular Health, Christiana Care Health
System, Newark, DE, United States
Title
Surgical treatment of moderate ischemic mitral regurgitation.
Source
New England Journal of Medicine. 371 (23) (pp 2178-2188), 2014. Date of
Publication: 04 Dec 2014.
Publisher
Massachussetts Medical Society
Abstract
Background Ischemic mitral regurgitation is associated with increased
mortality and morbidity. For surgical patients with moderate
regurgitation, the benefits of adding mitralvalve repair to
coronary-artery bypass grafting (CABG) are uncertain.
Methods We randomly assigned 301 patients with moderate ischemic mitral
regurgitation to CABG alone or CABG plus mitral-valve repair (combined
procedure). The primary end point was the left ventricular end-systolic
volume index (LVESVI), a measure of left ventricular remodeling, at 1
year. This end point was assessed with the use of a Wilcoxon rank-sum test
in which deaths were categorized as the lowest LVESVI rank.
Results At 1 year, the mean LVESVI among surviving patients was
46.1+/-22.4 ml per square meter of body-surface area in the CABG-alone
group and 49.6+/-31.5 ml per square meter in the combined-procedure group
(mean change from baseline, -9.4 and -9.3 ml per square meter,
respectively). The rate of death was 6.7% in the combined-procedure group
and 7.3% in the CABG-alone group (hazard ratio with mitral-valve repair,
0.90; 95% confidence interval, 0.38 to 2.12; P = 0.81). The rank-based
assessment of LVESVI at 1 year (incorporating deaths) showed no
significant between-group difference (z score, 0.50; P = 0.61). The
addition of mitral-valve repair was associated with a longer bypass time
(P<0.001), a longer hospital stay after surgery (P = 0.002), and more
neurologic events (P = 0.03). Moderate or severe mitral regurgitation was
less common in the combined-procedure group than in the CABG-alone group
(11.2% vs. 31.0%, P<0.001). There were no significant between-group
differences in major adverse cardiac or cerebrovascular events, deaths,
readmissions, functional status, or quality of life at 1 year.
Conclusions In patients with moderate ischemic mitral regurgitation, the
addition of mitral-valve repair to CABG did not result in a higher degree
of left ventricular reverse remodeling. Mitral-valve repair was associated
with a reduced prevalence of moderate or severe mitral regurgitation but
an increased number of untoward events. Thus, at 1 year, this trial did
not show a clinically meaningful advantage of adding mitral-valve repair
to CABG. Longer-term follow-up may determine whether the lower prevalence
of mitral regurgitation translates into a net clinical benefit. (Funded by
the National Institutes of Health and the Canadian Institutes of Health
Research; ClinicalTrials.gov number, NCT00806988.). Copyright &#xa9; 2014
Massachusetts Medical Society.

<16>
[Use Link to view the full text]
Accession Number
603471106
Author
Arnold S.V.; Lei Y.; Reynolds M.R.; Magnuson E.A.; Suri R.M.; Tuzcu E.M.;
Petersen J.L.; Douglas P.S.; Svensson L.G.; Gada H.; Thourani V.H.; Kodali
S.K.; Mack M.J.; Leon M.B.; Cohen D.J.
Institution
(Arnold, Lei, Magnuson, Cohen) Saint Luke's Mid America Heart Institute,
4401 Wornall Rd, Kansas City, MO 64111, United States
(Arnold, Magnuson, Cohen) University of Missouri, Kansas City, United
States
(Reynolds) Harvard Clinical Research Institute, Boston, MA, United States
(Suri) Mayo Clinic, Rochester, MN, United States
(Tuzcu, Svensson) Cleveland Clinic Foundation, OH, United States
(Petersen) Swedish Medical Center, Seattle, WA, United States
(Douglas) Duke University, Durham, NC, United States
(Gada, Kodali, Leon) Columbia-Presbyterian Hospital, New York, NY, United
States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Mack) Baylor Healthcare System, Plano, TX, United States
Title
Costs of periprocedural complications in patients treated with
transcatheter aortic valve replacement: Results from the placement of
aortic transcatheter valve trial.
Source
Circulation: Cardiovascular Interventions. 7 (6) (pp 829-836), 2014. Date
of Publication: 01 Dec 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-In patients with severe aortic stenosis, transcatheter aortic
valve replacement (TAVR) improves survival when compared with nonsurgical
therapy but with higher in-hospital and lifetime costs. Complications
associated with TAVR may decrease with greater experience and improved
devices, thereby reducing the overall cost of the procedure. Therefore, we
sought to estimate the effect of periprocedural complications on
in-hospital costs and length of stay of TAVR. Methods and Results-Using
detailed cost data from 406 TAVR patients enrolled in the Placement of
Aortic Transcatheter Valve (PARTNER) I trial, we developed multivariable
models to estimate the incremental cost and length of stay associated with
specific periprocedural complications. Attributable costs and length of
stay for each complication were calculated by multiplying the independent
cost of each event by its frequency in the treatment group. Mean cost for
the initial hospitalization was $79 619+/-40 570 ($50 891 excluding the
valve); 49% of patients had =1 complication. Seven complications were
independently associated with increased hospital costs, with major
bleeding, arrhythmia, and death accounting for the largest attributable
cost per patient. Renal failure and the need for repeat TAVR, although
less frequent, were also associated with substantial incremental and
attributable costs. Overall, complications accounted for $12 475 per
patient in initial hospital costs and 2.4 days of hospitalization.
Conclusions-In the PARTNER trial, periprocedural complications were
frequent, costly, and accounted for =25% of nonimplant- related hospital
costs. Avoidance of complications should improve the cost-effectiveness of
TAVR for inoperable and high-risk patients, but reductions in the cost of
uncomplicated TAVR will also be necessary for optimal efficiency.
Copyright &#xa9; 2014 American Heart Association, Inc.

<17>
Accession Number
607543893
Author
Tavilla G.; Bruggemans E.F.; Gielen C.L.; Brand A.; van den Hout W.B.;
Klautz R.J.; van Hilten J.A.
Institution
(Tavilla) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(Bruggemans) Departments of Cardiothoracic Surgery, Leiden University
Medical Centre, Leiden, The Netherlands
(Gielen) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(Brand) Centre of Clinical Transfusion Research, Sanquin Blood Supply,
Leiden, The Netherlands
(van den Hout) Departments of Medical Decision-Making, Leiden University
Medical Centre, Leiden, The Netherlands
(Klautz) Departments of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, The Netherlands
(van Hilten) Centre of Clinical Transfusion Research, Sanquin Blood
Supply, Leiden, The Netherlands
Title
Multicentre randomized clinical trial to investigate the
cost-effectiveness of an allogeneic single-donor fibrin sealant after
coronary artery bypass grafting (FIBER Study).
Source
The British journal of surgery. 102 (11) (pp 1338-1347), 2015. Date of
Publication: 01 Oct 2015.
Abstract
BACKGROUND: Reduction of blood transfusion in cardiac surgery is an
important target. The aim of this study was to investigate the
cost-effectiveness of the use of CryoSeal, an allogeneic single-donor
fibrin sealant, in patients undergoing coronary artery bypass grafting
(CABG).
METHODS: This randomized clinical study involved seven cardiac surgery
centres in the Netherlands. Patients undergoing elective isolated CABG
with the use of at least one internal thoracic artery (ITA) graft were
assigned randomly to receive either CryoSeal (5ml per ITA bed) or no
CryoSeal. Primary efficacy endpoints were units of transfused red blood
cells, fresh frozen plasma and platelet concentrates, and duration of
intensive care unit stay. Secondary efficacy endpoints were 48-h blood
loss, reoperation for bleeding, mediastinitis, 30-day mortality and
duration of hospital stay.
RESULTS: Between March 2009 and January 2012, 1445 patients were
randomized. The intention-to-treat (ITT) population comprised 1436
patients; the per-protocol (PP) population 1292. In both the ITT and the
PP analysis, no significant difference between the treatment groups was
observed for any of the primary and secondary efficacy endpoints. In
addition, no significant difference between the groups was seen in the
proportion of transfused patients. Estimated CryoSeal costs were 822 (95
per cent c.i. 808 to 836) per patient, which translated to 72,000 per
avoided transfusion (unbounded 95 per cent c.i.).
CONCLUSION: The use of the fibrin sealant CryoSeal did not result in
health benefits. Combined with the high cost per avoided transfusion, this
study does not support the implementation of routine CryoSeal use in
elective isolated CABG.
REGISTRATION NUMBER: NTR1386 ( http://www.trialregister.nl). Copyright
&#xa9; 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

<18>
Accession Number
609991773
Author
Hong K.N.; Merlo A.; Chauhan D.; Davies R.R.; Iribarne A.; Johnson E.;
Jeevanandam V.; Russo M.J.
Institution
(Hong) Department of Health Evidence and Policy, Mount Sinai School of
Medicine, New York, New York, United States
(Merlo) Case Western Reserve Medical School, Cleveland, Ohio, United
States
(Chauhan, Russo) Department of Surgery, Rutgers-New Jersey Medical School,
Newark, New Jersey, United States
(Chauhan, Russo) Cardiovascular Clinical Research Unit, Barnabas Heart
Hospitals, Newark, New Jersey, United States
(Davies) Division of Pediatric Cardiothoracic Surgery, Nemours/Alfred I.
DuPont Hospital for Children, Wilmington, Delaware, United States
(Iribarne) Department of Cardiothoracic Surgery, Dartmouth Medical Center,
Hanover, New Hampshire, United States
(Johnson, Jeevanandam) Section of Cardiac and Thoracic Surgery, Department
of Surgery, University of Chicago, Chicago, Illinois, United States
Title
Evidence supports severe renal insufficiency as a relative
contraindication to heart transplantation.
Source
Journal of Heart and Lung Transplantation. 35 (7) (pp 893-900), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background This study was conducted to determine whether survival after
orthotopic heart transplant (OHT) is associated with pre-transplant
estimated glomerular filtration rate (eGFR) and to define ranges of
pre-OHT eGFR associated with differences in post-transplant survival. The
2006 International Society for Heart and Lung Transplantation revised
listing criteria for OHT stated that chronic kidney disease, defined by an
eGFR <40 ml/min is a relative contraindication for OHT alone. The
committee noted that this recommendation was supported by consensus
opinion of experts and not data derived from a randomized trial or
non-randomized studies. Methods The United Network for Organ Sharing
provided deidentified patient-level data. The study population included
17,459 OHT recipients aged >18 years who received allografts between
January 1, 2001, and December 31, 2009. Logistic regression was used to
assess the effect of multiple variables on survival after OHT. Receiver
operating characteristic curves and stratum-specific likelihood ratios
were generated to compare 1-year survival at eGFR thresholds. The primary
outcomes measure was actuarial post-transplant survival expressed in
years. Results Regression analysis showed that a lower pre-transplant eGFR
is associated with worse post-transplant survival. Threshold analysis
demonstrated 3 distinct survival strata: eGFR < 34 ml/min, eGFR 35 to 49
ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for
patients with eGFR < 34 ml/min. They are also more likely to have
in-hospital and long-term complications. Conclusions eGFR is a strong
predictor of post-transplant survival and should be considered when
assessing patients for OHT. This analysis supports current International
Society for Heart and Lung Transplantation guidelines and suggests that
end-stage heart failure patients with an eGFR < 34 ml/min is a relative
contraindication for heart transplantation alone. Copyright &#xa9; 2016
International Society for Heart and Lung Transplantation

<19>
Accession Number
611361021
Author
Wang C.; Tang Y.-F.; Zhang J.-J.; Bai Y.-F.; Yu Y.-C.; Zhang G.-X.; Han L.
Institution
(Wang, Tang, Zhang, Bai, Yu, Zhang, Han) Department of Cardiothoracic
Surgery, Changhai Hospital, Second Military Medical University, Shanghai
200433, China
Title
Comparison of four risk scores for in-hospital mortality in patients
undergoing heart valve surgery: A multicenter study in a Chinese
population.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (5) (pp 423-428),
2016. Date of Publication: 01 Sep 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and aim of the study To compare four risk scores with regard to
their validity to predict in-hospital mortality after heart valve surgery
in a multicenter patient population of China. Materials and methods From
January 2009 to December 2012, data from 12,412 consecutive patients older
than 16 years who underwent heart valve surgery at four cardiac surgical
centers were collected and scored according to the EuroSCORE II, Ambler
risk score, NYC risk score, and STS risk score. The patients were divided
into two subgroups according to the types of valve procedures, and the
performance of the four risk scores for each group was assessed.
Calibration was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination
was tested by calculating the area under the receiver operating
characteristic (ROC) curve. Results Observed mortality was 2.09% overall.
The EuroSCORE II, Ambler score, and NYC score overpredicted observed
mortality (Hosmer-Lemeshow: P = 0.002, P < 0.0001, and P < 0.0001,
respectively) and the STS score underpredicted observed mortality
(Hosmer-Lemeshow: P = 0.001). The discriminative power in the entire
cohort for in-hospital mortality was highest for the STS score (0.735),
followed by the EuroSCORE II score (0.704), NYC score (0.693), and Ambler
score (0.674). Meanwhile, the STS score and EuroSCORE II give an accurate
prediction in patients undergoing single valve surgery compared with the
Ambler score and NYC score. However, all four risk scores give an
imprecise prediction in patients undergoing multiple valve surgery.
Conclusions Both the STS score and Euroscore II, especially the STS score,
were suitable for individual operative risk in Chinese patients undergoing
single valve surgery compared with the Ambler score and NYC score,
however, all four risk scores were not suitable for prediction in Chinese
patients undergoing multiple valve surgery. Therefore, the creation of a
new model which accurately predicts outcomes in patients undergoing
multiple valve surgery is possibly required in China. Copyright &#xa9;
2016 The Author(s)

<20>
Accession Number
611451917
Author
Anonymous
Title
Impact of renal function on the effects of LDL cholesterol lowering with
statin-based regimens: a meta-analysis of individual participant data from
28 randomised trials.
Source
The Lancet Diabetes and Endocrinology. 4 (10) (pp 829-839), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statin therapy is effective for the prevention of coronary
heart disease and stroke in patients with mild-to-moderate chronic kidney
disease, but its effects in individuals with more advanced disease,
particularly those undergoing dialysis, are uncertain. Methods We did a
meta-analysis of individual participant data from 28 trials (n=183 419),
examining effects of statin-based therapy on major vascular events (major
coronary event [non-fatal myocardial infarction or coronary death],
stroke, or coronary revascularisation) and cause-specific mortality.
Participants were subdivided into categories of estimated glomerular
filtration rate (eGFR) at baseline. Treatment effects were estimated with
rate ratio (RR) per mmol/L reduction in LDL cholesterol. Findings Overall,
statin-based therapy reduced the risk of a first major vascular event by
21% (RR 0.79, 95% CI 0.77-0.81; p<0.0001) per mmol/L reduction in LDL
cholesterol. Smaller relative effects on major vascular events were
observed as eGFR declined (p=0.008 for trend; RR 0.78, 99% CI 0.75-0.82
for eGFR >60 mL/min per 1.73 m²; 0.76, 0.70-0.81 for eGFR 45 to
<60 mL/min per 1.73 m²; 0.85, 0.75-0.96 for eGFR 30 to <45
mL/min per 1.73 m²; 0.85, 0.71-1.02 for eGFR <30 mL/min per
1.73 m² and not on dialysis; and 0.94, 0.79-1.11 for patients
on dialysis). Analogous trends by baseline renal function were seen for
major coronary events (p=0.01 for trend) and vascular mortality (p=0.03
for trend), but there was no significant trend for coronary
revascularisation (p=0.90). Reducing LDL cholesterol with statin-based
therapy had no effect on non-vascular mortality, irrespective of eGFR.
Interpretation Even after allowing for the smaller reductions in LDL
cholesterol achieved by patients with more advanced chronic kidney
disease, and for differences in outcome definitions between dialysis
trials, the relative reductions in major vascular events observed with
statin-based treatment became smaller as eGFR declined, with little
evidence of benefit in patients on dialysis. In patients with chronic
kidney disease, statin-based regimens should be chosen to maximise the
absolute reduction in LDL cholesterol to achieve the largest treatment
benefits. Funding UK Medical Research Council, British Heart Foundation,
Cancer Research UK, European Community Biomed Programme, Australian
National Health and Medical Research Council, Australian National Heart
Foundation. Copyright &#xa9; 2016 The Author(s). Published by Elsevier
Ltd. This is an Open Access article under the CC BY license

<21>
Accession Number
612750327
Author
Wang T.; Wang M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, New Zealand
(Wang) Department of Medicine, University of Auckland, New Zealand
Title
Mitral valve repair versus replacement for mitral valve endocarditis: A
meta-analysis.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S274), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve repair has superior results to replacement for
severe degenerative mitral valve disease, however in the infective
endocarditis setting, mixed results have been reported. We compared the
outcomes of mitral valve repair and replacement for infective endocarditis
in this meta-analysis. Methods: MEDLINE, Embase and Cochrane databases
from 1 January 1980 to 31 December 2015 were searched for original
studies. Two authors evaluated these studies for inclusion independently,
then data were extracted and pooled. Results: A total of 3,976 papers was
obtained from the search, 99 full-texts were reviewed, and 13 studies
which included both mitral valve repair and replacement patients involving
8,130 patients were included for analyses. Pooled rates and odds ratio
(95% confidence interval) for operative mortality of repair versus
replacement were 3.7% vs 10.9%, 0.33 (0.26-0.41). Odds ratio for long-term
mortality at 1-year (n=4) was 0.31 (0.14-0.72), and at 5 years (n=8) was
0.42 (0.25-0.69). Perioperative stroke rates and odds ratio (n=4) were
2.8% vs 3.8%, 0.75 (0.55-1.00). Five year recurrent endocarditis and
redo-operations (n=6 for both) odds ratios were 0.39 (0.10-1.58) and 0.49
(0.12-2.02) respectively. Similar results were observed when one large
study making up 85% of the meta-analysis cohort population was removed.
Conclusion: Mitral valve repair is associated with reduction in mortality
and stroke, and similar recurrent endocarditis and redo-operation rates
compared to mitral valve replacement in mitral valve endocarditis. It is
therefore preferred when feasible, similar to surgery for degenerative
mitral valve disease.

<22>
Accession Number
612750304
Author
Wang T.; Wang M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Risk scores predicting mortality in surgery of infective endocarditis: A
meta-analysis.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S296-S297), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Surgery is indicated in infective endocarditis patients with
heart failure, uncontrolled infection and prevention of systemic embolism.
Risk scores play an important role in stratification for cardiac surgery,
but have been rarely utilised in the endocarditis setting.We meta-analysed
the performance of surgical risk models in endocarditis surgery. Methods:
MEDLINE, Embase, Cochrane and Web of Science databases from 1 January 1980
to 31 December 2015 were searched. Two authors independently assessed
studies for inclusion, and then extracted data for pooled analyses.
Results: Amongst 480 articles searched, 20 full-text articles were
screened and 8 studies (1,743 cases) included for analyses. Mean EuroSCORE
was 20.2% with overall operative mortality 16.3% (O/E ratio 0.80) and
EuroSCOREII 12.3% with overall operative mortality 14.9% (O/E ratio 1.21);
other scores (STS,DeFeo, Pulsuse and Costa) were excluded as their
performance were reported in no more than one external validation study.
Areas under curve (95% confidence interval) of operative mortality were
0.76 (0.72-0.81) for EuroSCORE in seven studies and 0.79 (0.72-0.85) for
EuroSCORE II in three studies. Peto's odds ratios (95% confidence
interval) were 0.76 (0.57-1.01) for EuroSCORE and 1.25 (0.84-1.86) for
EuroSCORE II. Conclusion: The general EuroSCORE and EuroSCORE II had good
discrimination of operative mortality for endocarditis surgery, however
EuroSCORE had a trend to over-estimating operative mortality. There is a
need for further studies of general and endocarditis-specific risk scores
for endocarditis surgery, and as well as development of logistic risk
models.

<23>
Accession Number
612750211
Author
Connell C.; Gellatly R.; Zimmet A.; Bhagwat K.; Dooley M.
Institution
(Connell, Gellatly, Dooley) Department of Pharmacy, Alfred Hospital,
Melbourne, Australia
(Gellatly) Postgraduate Studies and Professional Development Unit, Faculty
of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne,
Australia
(Zimmet, Bhagwat) Department of Cardiothoracic Surgery, Alfred Hospital
and Monash University, Melbourne, Australia
(Dooley) Centre for Medicine Use and Safety, Monash University, Melbourne,
Australia
Title
Outcomes associated with the implementation of an evidence-based consensus
guideline for antithrombotic therapy for valvular heart surgery.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S294), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: The complicated choice of antithrombotic therapy after
valvular heart surgery must consider the type and location of valve, and
patient comorbidities. Published guidelines provide recommendations from
low level evidence. Therefore, an evidence-based guideline, with local
consensus was implemented at a quatenary care hospital in Melbourne. Aims
& methods: Primary outcome: concordance to the evidence-based guideline at
hospital discharge. Secondary outcomes: bleeding and thrombosis rates at
12-months. Anobservational study of 119 patients undergoing valvular heart
surgery (60 pre-guideline controls and 59 prospectively enrolled
post-guideline) was undertaken 2014-15. Adherence to the guideline was
assessed for warfarin and/or aspirin therapy, including INR target and
aspirin dose. Bleeding and thrombosis data were obtained from medical
records. Results: 119 patients underwent aortic and/or mitral
bioprosthetic/ mechanical valve replacements/repairs. Patients were
predominantly male in both cohorts with the patients being younger in the
post-guideline phase (phase-2) (64 vs. 68 years, p=0.021). Preoperative
atrial fibrillation (AF) was similar at baseline but postoperative AF was
lower in phase-2 (63% vs. 32%, p=0.001). Concordance to the guideline
occurred in 14 (33%) patients pre-guideline (phase-1) and 27 (56%)
patients in phase-2 (p=0.029). Twelve month major bleeding occurred in 10
patients (16.7%) in phase-1 and three patients (5.1%) in phase-2
(p=0.075). Thrombosis occurred in two patients (3.3%) in phase-1 and one
patient (1.7%) in phase-2 (p=1.0) Conclusion: The evidence-based consensus
guideline improved concordance to evidence-based practice, with
opportunities for further improvement. There was a trend towards reduced
bleeding in phase-2, however this study was underpowered to
comprehensively assess this outcome.

<24>
Accession Number
612750145
Author
Wang T.; Wang M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Meta-analysis of early or late surgery for infective endocarditis and
associated stroke.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S291-S292), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Surgery is recommended for infective endocarditis patients who
develop ischaemic stroke, however the optimal timing of surgery remains
controversial. In this metaanalysis, we compared the outcomes of early and
delayed cardiac surgery for infective endocarditis in this setting.
Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases from 1
January 1980 to 30 June 2015 were searched for original studies. Two
authors evaluated these studies for inclusion independently, then
extracted and pooled data for analyses. Results: Amongst 2,423 papers
obtained from the search, 23 full-texts were reviewed, and six studies
involving 701 patients were included for analyses. Early surgery was
defined as less than 7 days from diagnosis in 2 studies and less than 14
days in 4 studies. Rates and pooled odds ratio (95% confidence interval)
for operative mortality of early or late surgery set at 7 days were 13.5%
vs 10.8%, 1.40 (0.61-3.02); 14 days were 20.7% vs 13.0%, 1.95 (0.95-4.01);
and all "early or late surgery" 14.5% vs 10.2%, 1.58 (1.01-2.47). Pooled
odds ratio of early versus late surgery for long-term mortality was 2.95
(0.35-25.0), and for neurological events during follow-up, pooled odds
ratio for embolic events was 1.22 (0.33-4.56) and for intracranial
bleeding 1.55 (0.16-15.32). Conclusion: Early surgery within 1-2 weeks of
diagnosis of infective endocarditis with cerebral embolism can be safely
performed, and is not associated with statistically higher long-term
mortality or neurological events. Data is however limited and larger and
randomised studies would help to determine the optimal timing.

<25>
Accession Number
612750128
Author
Lan N.; Judkins C.
Institution
(Lan, Judkins) Fiona Stanley Hospital, Perth, Australia
Title
Medical versus surgical management of infective endocarditis in a Western
Australia tertiary hospital setting.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S291), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Infective endocarditis (IE) has high inhospital mortality.
Well-defined guidelines assist in decision making aroundmedical vs
surgical management.We describe in-hospital mortality of IE in 3 tertiary
hospitals comparing medical vs surgical management. Methods: Retrospective
analysis of IE management during realignment of cardiothoracic surgery
services was performed. Between 01/04/14 and 01/10/14, IE cases at 2
hospital sites were identified and following transfer of those services to
a new hospital site, IE cases between 01/04/15 and 01/10/15 were
identified. 56 patients were included (15 at each site pre-alignment and
26 post-alignment). Indications for surgery were based on the American
Heart Association/ American College of Cardiology guidelines. Results:
Overall IE mortality was high with 12.5% inhospital death. 21/38 patients
meeting surgical criteria underwent operative management, however, the
threshold for surgery differed between hospital sites. Those patients
meeting surgical criteria had non-significantly higher mortality (18.4% vs
0%, p=0.084). Patients meeting surgical criteria who got surgery versus
those who did not get surgery had lower in-hospital mortality (4.8% vs
35.3%, p=0.031). Overall in-hospital mortality was non-significantly lower
in the group that received surgery (4.8% vs 17.1%, p=0.237). In-hospital
mortality was lower at sites with higher rates of surgical intervention
that followed guidelines. Conclusions:We describe variation in surgical
intervention and improved in-hospital mortality outcomes when adherence to
indication for surgery guidelines are followed. We recommend cardiology
units review their surgical utilisation to optimise IE outcomes.

<26>
Accession Number
612750114
Author
Wang T.; Wang M.; Ruygrok P.
Institution
(Wang, Ruygrok) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Meta-analysis of the prognostic utility of risk models at predicting
mortality after transcatheter aortic valve implantation.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S183), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is considered
in patients with severe aortic valve disease at high risk for surgical
aortic valve replacement. Risk stratification plays a critical role in
selecting the appropriate treatment modality. We compared the prognostic
utility of surgical risk scores at predicting mortality after TAVI in this
meta-analysis. Methods: MEDLINE, Embase, Cochrane and Web of Science
databases from1 January 1980 to 31 December 2015 were searched. Studies
were systematically reviewed for inclusion, then data extracted for pooled
analyses. Results: Amongst 1688 articles searched, 47 full-text articles
were screened and 23 studies (11,936TAVI cases) included for analyses.
Areas under curve (95% confidence interval) for operative mortality were
EuroSCORE 0.61 (0.56-0.66) in 20 studies, EuroSCORE II 0.62 (0.59-0.66) in
15 studies, STS Score 0.62 (0.59-0.65) in 20 studies, Ambler Score 0.54
(0.49-0.58) in 4 studies and Parsonnet Score 0.51 (0.44-0.58) in 2
studies. Respective Peto's odds ratios (95% confidence interval) were
EuroSCORE 0.32 (0.30-0.35), EuroSCORE II 1.31 (1.14-1.50), STS 0.84
(0.76-0.94), Ambler Score 1.46 (1.09-1.96) and Parsonnet Score 0.38
(0.29-0.50). Areas under curve (95% confidence interval) for 1-year
mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.66 (0.61-0.71)
and STS Score 0.58 (0.53-0.64). Conclusion: Only the widely used
EuroSCORE, EuroSCORE II and STS Scores moderately discriminated operative
and 1-year mortality. EuroSCORE and Parsonnet score grossly over-estimated
operative mortality, while EuroSCORE II/Ambler Score and STS Score
marginally under-estimated and over-estimated operative mortality
respectively, but this varied by the level of estimated surgical risk.

<27>
Accession Number
612750103
Author
Wang T.; Wang M.; Ruygrok P.
Institution
(Wang, Ruygrok) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Title
Meta-analysis of mitraclip versus mitral valve surgery for severe
symptomatic mitral regurgitation.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S182-S183), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
Background: Mitral valve surgery (MVS) is recommended for severe
symptomatic mitral regurgitation (MR). The recent introduction of
percutaneous Mitraclip procedure especially in high risk patients adds
another dimension to MR management. We compared the characteristics and
outcomes of MitraClip and MVS in this meta-analysis. Methods: PubMed,
MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30
June 2015 were searched for original studies. Two authors evaluated these
studies for inclusion independently, then extracted and pooled data using
random-effects models. Results: Seven studies (one randomised trial and
six observational studies) were included from the 547 papers searched,
totalling 574 Mitraclip and 441 MVS procedures. Functional MR made up
47.2% of MitraClip and 59.6% of MVS (P=0.003). At baseline, mitralclip
patients were significantly older (P<0.001), more likely to have previous
cardiac surgery (P<0.001) and had lower ejection fraction (P<0.001) and
higher EuroSCORE (P<0.001). MitraClip had higher rate of at least moderate
MR postoperatively compared to MVS (15.8% vs 0.5%, P<0.001). There were no
differences in mortality (1.6% vs 3.1%, P=0.58), neurological events (0.7%
vs 1.6%, P=0.34) or re-operations for prosthetic incompetence (2.0% vs
1.0%, P=0.56) in-hospital or within 30 days respectively. At 12 months
there were no differences in mortality (11.3% vs 10.2%, P=0.41) or New
York Heart Association Class III/IV (5.7% vs 11.3%, P=0.42). Conclusion:
Patients undergoing MitraClip had higher baseline risk than MVS, but there
were no significant differences in mortality, morbidity or symptoms up to
12 months, except for higher rates of significant MR postoperatively.

<28>
Accession Number
612749889
Author
Al-Omary M.; Boyle A.
Institution
(Al-Omary, Boyle) John Hunter Hospital, Cardiology Department, Newcastle,
Australia
Title
Mural right atrial thrombus in dilated cardiomyopathy. Case report and
literature review.
Source
Heart Lung and Circulation. Conference: 64th Cardiac Society of Australia
and New Zealand Annual Scientific Meeting and the International Society
for Heart Research Australasian Section Annual Scientific Meeting 2016.
Australia. Conference Start: 20160804. Conference End: 20160807. 25 (pp
S242), 2016. Date of Publication: August 2016.
Publisher
Elsevier Ltd
Abstract
A 38-year-old male with heavy alcohol intake presented with vague symptoms
for 2 months. CT chest showed rightsided heart thrombi with ascites &
congestive cirrhosis. This promoted echocardiography, which showed a3X3cm
right atrial thrombus and dilated cardiomyopathy with poor right & left
ventricular functions. His father died at the age of 48 from an unknown
heart problem. He developed cardiogenic shock and was treated with
inotropes and heparin. His coagulation profile was deranged due to liver
disease. Cardiothoracic surgery was advised against surgical thrombectomy.
He died of cardiac arrest after 2 weeks in ICU. The autopsy confirmed
cardiomyopathy with pulmonary emboli & liver cirrhosis likely due to heart
failure. Right heart thrombi are rare & associated with high mortality
[1,2]. Most cases are associated with thromboembolic disease [3]. The
ICOPER study showed 4% of patients with pulmonary embolism had right-sided
heart thrombus [4]. However, there is reported case with dilated
cardiomyopathy [5,6]. The diagnosis is usually made by echo [3]. There is
no guide regarding the best treatment option. Anticoagulant, thrombolytic
& surgery have been reproted. Thrombolysis is associated with lower
mortality in registries [3,4], however, there is no prospective randomised
controlled trial to guide the best treatment. Thrombolysis was not used in
the patient due to coagulopathy. (Figure presented).

<29>
[Use Link to view the full text]
Accession Number
612649096
Author
Fang K.; Juan L.
Institution
(Fang, Juan) Department of Anesthesia, Anhui Provincial Hospital, Hefei,
China
Title
Comparison of the effects of dexmedetomidine-isoflurane and isoflurane
anesthesia on brain injury after cardiac valve replacement surgery.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 466), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Postoperative brain damage is a serious problems
in cardiac surgery patients. Dexmedetomidine and isoflurane have been
reported to have neuroprotective properties in animal. But no report
currently compares dexmedetomidine combined with isoflurane and isoflurane
anesthesia on brain injury after cardiac surgery. Materials & Methods: 97
patients scheduled for valve replacement surgery with cardiopulmonary
bypasses were randomly divided into 2 groups: dexmedetomidine and
isoflurane (D-I, n=50) and isoflurane alone (I, n=47). Anesthesia was
maintained with either dexmedetomidine and isoflurane or isoflurane alone
combined with sufentanil. Dexemedetomidine was infused at 0.6 mug/kg for
15 min as a bolus, followed with 0.2 mug/kg/h until the end of surgery.
The inhaled concentration of isoflurane was adjusted to keep the
bispectral index (BIS) 40-50 throughout the procedure in both groups.
Jugular blood samples were drawn for analysis of matrix metalloproteinase-
9(MMP-9) and glial fibrillary acidic protein levels(GFAP)
peri-operatively: before induction; 5 min after cardiopulmonary
bypass(CPB) onset;after CPB; the first day after operation and the second
day after operation. Plasma lactate levels in arterial and jugular venous
blood were also quantified at the same five time points. Antisaccadic eye
movement(ASEM) test and Mini-Mental State Examination(MMSE) were tested on
the day before operation and the seventh day postoperatively. Results:
Serum MMP-9 and GFAP concentration increased after CPB and decreased to
basal levels on the second morning after surgery in both groups. MMP-9
concentration in group D-I were lower on times of CPB off and the first
day after operation. However lower GFAP concentration in group D-I were
found on times of 5 min after CPB onset and CPB off. No significant
differences were found between the two groups when the difference of
arterial and jugular bulb venous blood lactate levels were compared except
5 minutes after CPB on. The MMSE score of total patients was declined
significantly from the baseline values of 26.9+/-1.4 to 25.4+/-1.5 on the
seventh day after operation(p< 0.001). The ASEM scores also decreased
significantly from the baseline values of 16.4+/-3.8 to 13.7+/-6.8
postoperatively (p< 0.001). No difference were found in postoperative MMSE
(p=0.787)and ASEM impairment (p=0.439) between the treatment groups.
Conclusion: Dexmedetomidine combined with isoflurane can decrease the
biochemical markers of brain injury but does not improve cognitive
function after cardiac surgery compared with isoflurane alone.

<30>
[Use Link to view the full text]
Accession Number
612649024
Author
Pichugin V.; Domnin S.; Kurapeev I.; Bober V.
Institution
(Pichugin) Anesthesiology and Intensive Care, Nizhny Novgorod State
Medical Academy, Nizhny Novgorod, Russian Federation
(Domnin, Bober) Anesthesiology and Intensive Care, Cardiac and Vascular
Surgery Hospital, Nizhny Novgorod, Russian Federation
(Kurapeev) Anesthesiology and Intensive Care, North West State Medical
University named I.I. Mechnikov, Saint Petersburg, Russian Federation
Title
Comparative evaluation of lungs protection techniques in adults with
pulmonary hypertension during open heart surgery.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 70), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Cardiac surgery with cardiopulmonary bypass (CPB)
twice increases pulmonary dysfunction rate (PDR) compared with off-pump
cardiac surgery (Nozawa E. et al., 2003). Pulmonary hypertension (PH)
sharply increases postoperative PDR associated with CPB (Gabriel E.A.,
Salerno T.A., 2010). The aim of our study was to evaluate oxygenated and
nonoxygenated blood pulmonary artery perfusion with reduced volumes lungs
ventilation during CPB for lungs protection compared with conventional (no
lung ventilation/ perfusion) technique for adults with PH. Materials &
Methods: 70 patients undergoing valves surgery with CPB, were randomized
in three groups. All patients had PH (mean pulmonary artery pressure was
42,2+/-5,5 mm Hg). 1-st group (27 patients) - conventional (no lung
ventilation/perfusion) technique was used, 2-nd group (24 patients) -
oxygenated blood pulmonary artery perfusion with lung ventilation were
used, 3-rd group (19 patients) - nonoxygenated blood pulmonary artery
perfusion with lung ventilation were used. We evaluated alveolar-arterial
oxygen difference (AAOD), oxygenation index (OI), PaCO<inf>2</inf>,
F-shunt parameter and lung compliance (LC) during operation. Results:
Initial data had no significant differences between groups. 1st group
patients had significantly higher AAOD (by 20.5%), lower OI (by 16.8%),
increased F-shunt (by 21.9%), lower LC (by 17.5%) after CPB. We registered
progression of these disturbances to the end of surgery (AAOD increased by
31.5%, OI decreased by 24.3%, F-shunt increased by 34.4%, LC decreased by
21.1%). PaCO<inf>2</inf> increased by 10.8% at the same stage. Such
parameters as AAOD, OI, F-shunt and LC had not differences compared with
initial levels in 2nd and 3rd group patients, but were significantly
changed compared with 1st group. At the end of operation OI and LC levels
were significantly higher in 2nd and 3rd group compared with 1st group.
There were not significant differences between patients 2nd and 3rd group
at all stages of the study. Conclusion: Pulmonary artery perfusion and
ventilation during CPB effectively preserved lungs oxygenation function,
lung complains, decreased intrapulmonary blood shunt after cardiopulmonary
bypass in patients with pulmonary hypertension. There were not significant
differences between oxygenated and nonoxygenated blood pulmonary
perfusion.

<31>
Accession Number
612648999
Author
Parab S.Y.; Sharma K.; Divatia J.V.; Yadav P.
Institution
(Parab, Sharma, Divatia, Yadav) Anesthesiology, Critical Care and Pain,
Tata Memorial Hospital, Mumbai, India
Title
A prospective randomized controlled double blind study to compare between
clinical assessment and lung ultrasonography to confirm position of double
lumen tube in elective thoracic surgeries, at tertiary care cancer
hospital.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 724), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Auscultation has been reported to be inaccurate
for confirmation of position of double lumen tube (DLT) worldwide.
Recently, lung ultrasound (LUS) has replaced stethoscope in various
aspects of perioperative care. This simple technique identifies
ventilation and collapse of the lung using 'lung sliding' & 'lung pulse'
signs.1 Lung pulse sign has been found to be 93% sensitive & 100% specific
for identification of lung atelectasis.2 We hypothesized that LUS would be
a better technique than auscultation to assess position of DLT. We aimed
to compare efficacy of auscultation versus LUS for assessment of position
of DLT. Materials & Methods: We conducted a prospective randomized
controlled double blind study including 100 adult patients undergoing
elective thoracic surgeries using DLT from November 2014 to December 2015.
After institutional ethical committee approval, patients were randomized
into Group A- where position of DLT was assessed by auscultation and group
B- where position of DLT was assessed by LUS. Auscultation was performed
by operation theatre anesthesiologist and LUS was performed by the
principal investigator. Opinions of primary assessment were noted in case
record forms. Final confirmation of DLT position was done by a blinded
independent anesthesiologist using fibreoptic bronchoscope (FOB).
Necessary adjustments were done in tube position before proceeding for
surgery. Contingency tables were analyzed to calculate sensitivity,
specificity, positive predictive value (PPV), negative predictive value
(NPV) and accuracy for both methods. Receiver Operating Characteristic
(ROC) curves were plotted to determine the predictability of each method.
Results: Excluding 9 screening failures, 91 patients were analyzed (group
A-47, group B-44). Patients in both groups did not differ in demographics.
As compared to auscultation, LUS had better sensitivity (94% versus 73%),
specificity (55% versus 37%), PPV (57% versus 35%), NPV (94% versus 75%)
and accuracy (70% versus 49%). Area under curve for LUS (0.75) was
significantly higher than that for auscultation (0.554). Patient's
perioperative outcomes were comparable in two groups. Conclusion: LUS is a
better method than auscultation in assessment of DLT position. It is a
useful adjuvant to FOB in confirmation of DLT position.

<32>
[Use Link to view the full text]
Accession Number
612648984
Author
Chen F.; Li H.
Institution
(Chen, Li) Anesthesiology, Xinqiao Hospital, Third Military Medical
University, Chongqing, China
Title
Comparison of cerebral protection between inhalation anesthetics and total
intravenous anesthesia in cardiac surgery with cardiopulmonary bypass: A
systematic review and meta-analysis.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 185), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Neurological dysfunction remains a devastating
complication after cardiac surgery with cardiopulmonary bypass (CPB).
Studies have shown that some anesthetics may produce cerebral protection
after CPB. However, the results are inconsistent between inhalation
anesthetics and total intravenous anesthesia (TIVA). Hence, we performed a
systematic literature review and meta-analysis to assess the
neuroprotective effects of inhalation anesthetics and TIVA after CPB.
Materials & Methods: Systematic literature searches were performed with
PubMed, EMBASE, Science Direct/Elsevier, CNKI and the Cochrane Library up
to January 2016 for randomized controlled trial (RCT) that studied the
cerebral protection of inhalation anaesthesia and TIVA after cardiac
surgery with CPB. Results: S100B, a marker of brain injury, during CPB or
24 h after CPB in inhalation anesthesia group was significantly lower than
that in TIVA group [WMD (95% CI): -0.43 (-0.83, -0.03); -0.32 (-0.59,
-0.05), respectively]. Moreover, intraoperative cerebral blood flow and
postoperative mini-mental state examination scores of inhalation
anesthesia group were significant higher than those of TIVA group [WMD
(95% CI): 5.11 (2.58, 7.63), 1.26 (0.04, 2.47), respectively]. There was
no significant difference between inhalation anaesthesia group and TIVA
group in CPB time, cerebral metabolic rate of oxygen consumption, jugular
bulb oxygen saturation, arteriovenous oxygen content difference and
cerebral oxygen extraction. Conclusion: Our study illustrates that
anaesthesia with volatile agents appears to provide cerebral protection
after CPB when compared with TIVA, suggesting that inhalation anesthesia
is more suitable for cardiac surgery. However, large multicentre trial is
warranted to confirm this finding.

<33>
[Use Link to view the full text]
Accession Number
612648944
Author
Hu J.
Institution
(Hu) Beijing Children's Hospital, Beijing, China
Title
Effects of low tidal-volume ventilation on pulmonary and circulation
function during alve replacement.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 718), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: To investigate the influence if low tidal volume
ventilation to the patient undergoing valve replacement on pulmonary and
ciculation function during general anesthesia. Materials & Methods: Twenty
ASAII-III patients, age 21-52 years, NYHA class 2-3, undergoing valve
replacement (7mitral valve replacement,13 mitral and aorta valve
replacement) were randomly divided into two groups according to mechanical
ventilation method(group A with a highl TV of 10ml/kg and group B with a
low TV of 6ml/kg). The patients were mechanically ventilated with pure
oxygen, I:E ratio on 1:2, oxygen flow on 2L/ml and PEEP on
5cmH<inf>2</inf>O.P<inf>ET</inf>CO<inf>2</inf> was kept on 35-40mmHg by
adjusting respiratory frequency for an equivalent ventilation in two
groups. After 30minutes of induction (T1), before the CPB(T2), and the end
of operation(T3), blood sample were taken from radial artery and pulmonary
artery for blood analysis, cardiac function were measured by Swan-ganz.
Respiratory index RI, Qs/Qt and C dysn were calculated. Results: PA-aO2,
Ri, Qs/Qt higher in A than B at T3(P<0.05). Cardiac outputs were
significantly lower in group A than B at T2 and T3(P<0.05) Conclusion: Low
tidal volume should be more preferable for the patient undergoing valve
replacement.

<34>
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Accession Number
612648882
Author
Lespron M.D.C.; Morales O.; Molina F.J.; Figueroa J.; Suarez L.; Molina
A.; Guerrero R.; Alvarez H.; Telona E.J.
Institution
(Lespron, Morales, Molina, Alvarez, Telona) Cardiovascular Anesthesia,
Ciudad de Mexico, Mexico
(Figueroa) Intensive Care Unit, Instituto Nacional de Cardiologia Ignacio
Chavez, Ciudad de Mexico, Mexico
(Suarez) Cardiovascular Anesthesia, Hospital Pemex, Tampico, Mexico
(Molina) Ophtalmology, Instituto Nacional de Rehabilitacion, Ciudad de
Mexico, Mexico
(Guerrero) Cardiovascular Anesthesia, Hospital pediatrico, Chiapas, Mexico
Title
Comparison between cerebrolysin and citicoline in the incidence of
postoperative delirium in adult cardiac surgical patients.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 53-54), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Delirium is a common complication after cardiac
surgery, with associated morbidity and mortality, and functional and
cognitive impairment. To assess postoperative delirium incidence using
cerebrolysin and citicoline in adult cardiac surgery with extracorporeal
circulation (ECC), and its incidence by age groups. Materials & Methods:
Three randomized groups were analyzed (G1 Cerebrolysin + Thiopental, G2
Citicoline + Thiopental, G3 (Control) Thiopental, administered before ECC)
with MINI MENTAL Test 24 hours after surgery using standard deviation,
correlation coefficient, chi-square test and ANOVA (SPSS Statistics 20).
Doses administered were: Cerebrolysin 4.3 gr, Citicoline 2 gr, Thiopental
5 mg/kg. Results: Study population consisted of 93 patients who underwent
coronary revascularization, valve replacement or both. MINI MENTAL Test
results were as follows: G1 (N=30) mean 27.1 (SD 2.06), G2 (N=35) 26.9
(2.44), G3 (N=28) 22.2 (1.59), with a p value 0.000 when comparing G1 and
G2 with respect to control group, with no difference between G1 and G2.
Delirium was present in 13 patients (14%). When analyzed by age group,
delirium was present in 8.3% of patients <50 years and in 17.4% of those
>50 years, without statistical significance. Conclusion: The addition of
neuroprotection with drugs like cerebrolysin or citicoline in cardiac
surgery could prevent postoperative neurological disturbances such as
delirium, without a significant difference between these 2 drugs. When
comparing delirium incidence by age group we found no statistically
significant difference between patients older or younger than 50 years,
which suggests its multifactorial origin, so that preventive measures such
as those proposed in this study with cerebrolysin or citicoline plus
thiopental before great vessel cannulation add up to other measures like
surgical technique, hypothermia, glycemic control and avoidance of a low
flow state during ECC, among others. (Figure Presented).

<35>
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Accession Number
612648723
Author
Guhabiswas R.; Narayan P.; Rupert E.
Institution
(Guhabiswas, Rupert) Anesthesiology and Critical Care Medicine, Kolkata,
India
(Narayan) Cardiac Surgery, NH Rabindranath Tagore International Institute
of Cardiac Sciences, Kolkata, India
Title
Satisfaction of cardiac surgeons with cardiac anesthesia services:
Development and validation of a pilot psychometric questionnaire.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 32), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: The role of cardiac anesthesiologists extends
beyond mere patient well being to diagnostic input and active
participation in decision making during cardiac surgery. The quality of
service provision should therefore be judged not only by patient
satisfaction but also by the satisfaction of cardiac surgeons. While
patient satisfaction surveys, accepted as a promising indicator of quality
in anesthesia services, have been extensively measured1, studies on
satisfaction of cardiac surgeons to anesthesia services remain sparse2 and
quantifying cardiac surgeon satisfaction remains a challenge. We therefore
attempted to develop a robust, validated, pilot psychometric
questionnaire, to measure satisfaction of cardiac surgeons to cardiac
anesthesia services. Materials & Methods: Institutional Ethics Committee
approval was obtained. The questionnaire was developed with the help of a
senior cardiac anesthesiologist, cardiac surgeon and a statistician.
Database search was done in PubMed and The Cochrane Library to identify
additional survey questions. The questionnaire was tested on five cardiac
surgeons for content validity, comprehensibility and identification of new
items. This generated the second version of the questionnaire with nine
socio-demographic and professional questions, 46 Likert type questions, an
abridged Marlowe Crowne Social Desirability scale and one open ended
question on suggestions to improve quality of cardiac anesthesia
services.11 questions were reversed to prevent bias of acquiescence. This
questionnaire was e-mailed to 100 cardiac surgeons in India requesting
them to participate via a web based survey application. Content validity
of the responses was tested by Aiken's content validity coefficient (V).
Internal consistency was tested with Chronbach's alpha. Relationship
between surgeons' global satisfaction score and the socio-demographic,
professional variables was assessed with Fisher's exact test. Statistical
analysis were performed using SPSS 20. Results: 52 cardiac surgeons
participated in the survey. 11 responses were rejected for incompleteness
and 2 were rejected due to high social desirability scores. 12 Likert type
questions were deleted due to low V values. Excellent Chronbach's alpha
(0.94) was obtained in the remaining 34 items. No correlation was detected
between global satisfaction score and socio-demographic, professional
variables. The commonest suggestion (17.95% of respondents) in the open
ended question was to improve dedication and a sense of responsibility in
cardiac anesthesiologists. Conclusion: The final questionnaire includes 34
variables and allows quantifying surgeon satisfaction in a reliable
fashion and is validated for the purpose.

<36>
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Accession Number
612648720
Author
Yelken B.B.; Takak O.
Institution
(Yelken, Takak) Anesthesiology and ICU, Eskisehir Osmangazi University
Medical School, Eskisehir, Turkey
Title
Evaluation of the cognitive functions after spinal anesthesia or
intravenous anesthesia administration in the geriatric patients undergoing
outpatient minor surgery.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 228), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Postoperative cognitive dysfunction (POCD) risk
increases with age and it is a major complication that results reduced
quality of life, premature retirement from work and early dependence to
social systems. It can be seen after cardiac surgery, major or minor
non-cardiac surgery either with general or regional anesthesia (1). In our
study, we aimed to investigate the effect of the intravenous anesthesia
and spinal anesthesia on postoperative cognitive functions in the elderly
patients undergoing outpatient minor surgery. Materials & Methods: This
single-center, prospective, randomized study evaluated 64 patients, aged
65 or older and ASA I-II-III, planned elective surgical procedures under
either intravenous anesthesia or spinal anesthesia. Mini Mental State
Examination (MMSE) and Montreal Cognitive Assessment (MOCA) were used in
the evaluation of cognitive functions. Cognitive functions were evaluated
24 hours preoperatively and 24 hours and 3 months postoperatively.
Patients were randomized to three groups: group I was administered
intravenous anesthesia with ketamine (1mg/kg) and midazolam (0.05 mg/kg)
(n=20), group II was administered intravenous anesthesia with midazolam
(0.05 mg/kg) and remifentanil (0.3-0.5 microg/kg) (n=21) and group III was
administered spinal anesthesia with bupivacaine (0.2 mg/kg). Results:
There was a significant decrease in group I and group III in the 24th hour
assessment of the cognitive functions with MOCA. At 3 months, group I
increased to preoperative levels but there was no change in group III. In
group II, there was no significant deterioration at 24 hours and 3 months.
Conclusion: POCD, which progress silently and can cause disorder in
memory, concentration and information processing speed is a common
complication after surgery. A few years after Dennis and Ark.'s first
human coronary artery bypass surgery in 1951, first scientific letters on
postoperative changes have been published (2).In our study, although we
observed a decrease in the POCD level in the first 24 hours, in the third
month we observed a better POCD level. As a result, POCD is a major
postoperative complication that can be seen even after outpatient minor
surgery. We suggest that spinal anesthesia is not more beneficial than
general anesthesia with intravenous or inhalation anesthetic agents in
development of POCD in geriatric patients.

<37>
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Accession Number
612648715
Author
Esmaeily M.J.
Institution
(Esmaeily) Cardiac Anesthesiologist, Isfahan, Iran, Islamic Republic of
Title
Preconditioning effect of remifentanil on myocardium in patients
undergoing on-pump coronary artery bypass graft surgery.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 31), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Several pharmacologic agents can induce ischemic
preconditioning and a number of these drugs are used in anesthesia. We
decided to measure Troponin-I as a marker of tissue ischemia, with
remifentanil preconditioning in coronary artery bypass grafting (CABG)
surgeries. In addition we compared length of ICU and hospital stay between
two groups Materials & Methods: This is a single blinded randomized
clinical trial that Fifty four patients undergoing CABG and aged< 75 years
old with EF>30%were randomized to the remifentanil group (n= 27) or
control group (n=27). Patients in remifentanil group received remifentanil
bolus of 1 mu/kg followed by an infusion at a rate of 0.5 mu/kg/ min for
30 minutes after induction and before sternotomy. Those in the control
group received 0.9% saline given at the same infusion rate. Results:
Cardiac Troponin I (cTnI) level were measured using Elisa technology and
cTnI value above 1.3 ngr/ml was considered as abnormal. The Level of
Troponin I in all patients increased in the post bypass period. There was
an increased trend of Troponin I over time in both groups(P <0.001)
although no significant difference was seen between two groups.(p
value=0.42). There was no significant difference between two groups
regarding length of ICU and hospital stay. Conclusion: It has been shown
that a short period of high dose remifentanil before cardiopulmonary
bypass did not reveal any preconditioning effect on the heart.

<38>
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Accession Number
612648709
Author
Esmaeily M.J.
Institution
(Esmaeily) Cardiac Anesthesiologist, Isfahan, Iran, Islamic Republic of
Title
Effect of colloid versus crystalloid administration in cardiopulmonary
bypass prime solution on tissue and organ perfusion.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 30), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: We evaluate the effects of tissue and organ
perfusion during and after coronary artery bypass graft surgery with
either colloid (Voluven) or crystalloid (Lactated ringer's) as prime
solution. Materials & Methods: In this prospective randomized-controlled
trial study, 70 patients undergoing on-pump coronary artery bypass graft
surgery were randomly assigned to receive either colloid (Voluven) or
crystalloid (Lactated ringer's) as prime solution, for initiation of
cardiopulmonary bypass machine procedure. Tissue and organ perfusion
markers including lactate, troponin I, liver and renal function tests and
electrolytes were measured sequentially, before induction (T1) to second
days after surgery (T5). Results: With exception of chloride and potassium
levels no any significant differences detected in other measurements, and
laboratory results were identical entirely in two groups Conclusion:
Voluven (hydroxyethyl starch, HES 130/0.4) have not significant difference
in comparison with crystalloid (Lactated ringer's) as priming solution on
the basis of organ and tissue perfusion tests assessmen.

<39>
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Accession Number
612648704
Author
Hawthorne C.; Schraag S.; Suttcliffe N.; McKelvie S.; Shaw M.; Chandran M.
Institution
(Hawthorne) Neuroanaesthesia, Institute of Neurological Sciences, Glasgow,
United Kingdom
(Schraag, McKelvie) Department of Anaesthesia and Perioperative Medicine,
Golden Jubilee National Hospital, Glasgow, United Kingdom
(Suttcliffe) Perioperative Medicine, Hamad Medical Corporation, Doha,
Qatar
(Shaw) Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, United
Kingdom
(Chandran) Department of Anaesthesia, Queen Elizabeth University Hospital,
Glasgow, United Kingdom
Title
Validation study of the covariates model for target controlled infusion of
propofol.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 554-555), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: The Marsh compartmental pharmacokinetic (PK)
model for target controlled infusion (TCI) of propofol is widely used in
total intravenous anaesthesia (TIVA). It adjusts compartment volumes and
rate constants based on body weight only. White and colleagues have
previously described an update version of the Marsh Model, the 'Covariates
Model', that adjusts for weight, gender and age[1]. We describe a
validation study of the Covariates Model. Materials & Methods: The study
received approval from the West of Scotland Research Ethics Committee.
Informed consent was gained from patients attending for elective
non-cardiac surgery requiring general anaesthesia. TCI propofol was
delivered using an Injectomat TIVA Agilia syringe pump (Fresenius Kabi)
programmed with the Covariates Model. Patients were randomised to a
low-high-low (2-5-2 mcg/ml) or high-low-high (5-2-5 mcg/ml) schedule with
plasma targets set at 0, 15 and 30 minutes. Venous and arterial blood
samples were drawn at pre-determined time points. Plasma propofol
concentrations predicted by the Injectomat pump were compared to those
predicted by the Marsh, Schnider and Covariates PK models. Performance of
the model was assessed by calculation of median performance error (MDPE)
as a measure of bias and median absolute performance error (MDAPE) as a
measure of inaccuracy[2]. Results: Twenty-nine patients were anaesthetised
according to the Covariates Model implemented by the Injectomat pump.
There were 15 males and 14 females with median age 47 years (range 28 to
75) and median weight 76 kg (range 49 to 120). A total of 199 venous blood
samples and 116 arterial blood samples were available for model
validation. The results for the Injectomat pump are presented in table 1
and a comparison with simulations of the Marsh, Schnider and Covariates
Models based on arterial blood samples is shown in figure 1. Table 1. MDPE
and MDAPE for the Covariates Model as implemented by the Injectomat pump
expressed as median (range). Conclusion: In this study, the Covariates
Model as implemented by the Injectomat pump, predicts plasma propofol
concentrations within an acceptable range of bias and inaccuracy on both
venous and arterial samples. (Figure Presented).

<40>
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Accession Number
612648603
Author
Lai V.K.W.; Lee A.; Leung P.; Chiu C.H.; Ho K.M.; Gomersall C.D.;
Underwood M.J.; Joynt G.M.
Institution
(Lai, Lee, Leung, Chiu, Ho, Gomersall, Joynt) Anaesthesia and Intensive
Care, Hong Kong, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Patient and family satisfaction levels in the intensive care unit after
elective cardiac surgery.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 150), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Patient and family satisfaction levels are
important outcomes for measuring the quality of intensive care. The
objectives of this study are to evaluate the patient and family
satisfaction levels in the intensive care unit (ICU) and to identify
parameters for quality improvement in adults undergoing elective coronary
artery bypass graft, with or without valve replacement surgery. Materials
& Methods: Data was taken from an ongoing two-group, parallel,
superiority, double blinded randomized controlled trial (n = 100) of a
preoperative patient education intervention (video and ICU tour) versus
standard education (control). The 24-item Family Satisfaction in the ICU1
and its adapted patient version, were given to a family member and the
patient respectively on the third day after surgery to measure their
perspectives on the level of satisfaction with overall ICU care and
information/decision-making in the ICU. Results: The overall satisfaction
scores and subscores on satisfaction with overall ICU care and
information/decision-making between groups are comparable to a Swiss
study2 (Table 1). Lower satisfaction levels in both patient and family
members were associated with lower ratings for "consistency of
information" and "inclusion in decision-making" items. In contrast,
"concern and caring given by ICU staff" was associated with higher
satisfaction levels in both groups. Conclusion: Overall, our patients and
family members were moderately satisfied but areas such as "consistency of
information" and "inclusion in decision-making" can be improved upon.
(Table Presented).

<41>
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Accession Number
612648597
Author
Howell V.
Institution
(Howell) Department of Anaesthesia, CCBRT Disability Hospital, Dar es
Salaam, Tanzania
Title
Effectiveness of interventions aimed at improving anaesthesia and
perioperative outcomes in low and middle income countries: A systematic
review and meta-analysis.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 748), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: With the changing global burden of disease,
surgery is increasingly being seen as a global health priority. However,
perioperative outcomes from surgery are noticeably worse in low-income and
lower-middle-income countries (LMICs). In high-income countries a focus on
patient safety and quality improvement has led to advancements in care,
but evidence from these countries is often unsuitable for translation to
LMICs. This systematic review aims to review and analyse the evidence for
interventions intended to improve perioperative outcomes in LMICs.
Materials & Methods: Medline, Embase, CINAHL Plus, Global Health, LILACS
and African Index Medicus databases were searched to find intervention
studies from LMICs published after 1990 that were aimed at improving
perioperative outcomes. In addition Google Scholar, ReliefWeb, MSF Field
Research and Clinical Trials websites were searched. Randomised and
non-randomised controlled trials, cohort studies and before-and-after
studies that involved patients undergoing general or regional anaesthesia,
but not cardiac surgery, were all included. The primary outcome of
interest was perioperative mortality. Included studies were assessed for
quality against GRADE criteria, and the Cochrane Collaboration's tool for
assessing risk of bias was also used. Results: 3515 articles were
screened, with 26 full text articles read. 3 studies were included in the
review, which undertook interventions in 7 hospitals in 6 low or
middle-income countries. All 3 studies evaluated implementing the WHO
Surgical Safety Checklist in the perioperative period. One study also
introduced pulse oximetry. The meta-analyses show a statistically
significant reduction in any postoperative complication (Risk Ratio 0.55,
95% Confidence Interval 0.40-0.76), and in surgical site infections (RR
0.43, 95% CI 0.29-0.66) following introduction of the checklist. There was
no statistically significant impact on mortality (RR 0.71, 95% CI
0.46-1.10). All studies were graded as very low quality evidence.
Conclusion: This review highlights the paucity of studies from LMICs that
examine the impact of interventions on perioperative mortality. However,
it does strengthen the evidence that implementation of the WHO Surgical
Safety Checklist in LMICs may reduce postoperative complications and
surgical site infections.

<42>
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Accession Number
612648575
Author
Punjasawadwong Y.; Pipanmekaporn T.; Wongpakaran N.
Institution
(Punjasawadwong, Pipanmekaporn) Anesthgesiology, Chiang Mai, Thailand
(Wongpakaran) Psychiatry, Faculty of Medicine, Chiang Mai University,
Chiang Mai, Thailand
Title
Optimized anesthesia to reduce incidence of postoperative delirium in
elderly undergoing elective, non-cardiac surgery: A randomized controlled
trial.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 211), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Delirium is one of common post operative
complications, particularly in the elderly surgical patients, which can
affect the postoperative outcomes. The study was conducted to determine
the effect of BIS-guided anesthesia on the incidence of postoperative
delirium compared with the standard general anesthesia without BIS
monitoring. Materials & Methods: After approval of the ethic committee,
Faculty of Medicine, Chiang Mai patients aged 65 years or scheduled for
non-cardiac surgery under general anesthesia. The control group (n=70)
received standard general anesthesia without bispectral index monitoring.
The study group (n=70) received general anesthesia guided by bispectral
index (BIS) between 40 and 60. BIS monitoring was blinded in the control
group. Delirium was assessed using Confusing Assessment Method for the ICU
(CAM-ICU) and Confusing Assessment Method (CAM) by trained research
assistants, who were blinded to the allocated groups at baseline, 2 hours,
24, 48, and 72 hours after the surgery. Unpaired-t test and chi-square
test were analyzed as appropriate. p <0.05 was considered statistically
significant. Results: All patients were extubated at the end of the
operation and completed the study. Baseline characteristics of patients in
both groups were comparable. Patients in control group had higher
incidence of delirium compared to those in BIS group (2.9% versus 1.4%)
but did not reach the statistically significant level at p = 0.05. Time to
BIS values < 40 in control group was significantly longer than those in
BIS group 5 (0-10) minutes versus 10 (2-60) minutes, p value = 0.007).
Conclusion: Despite lower incidence of postoperative delirium in the BIS
group compared with the control group, this study failed to demonstrate
the statistical significance difference at p=0.05. This may be due to the
low incidence of postoperative incidence of delirium in our setting.
Further large study is required to determine the impact of BIS-guided
anesthesia on the incidence of postoperative delirium in surgical patients
with high risk of POD.

<43>
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Accession Number
612648559
Author
Punjasawadwong Y.; Chau-in W.; Laopaiboon M.; Punjasawadwong S.
Institution
(Punjasawadwong, Punjasawadwong) Anesthgesiology, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
(Chau-in) Anesthgesiology, Khon Kaen, Thailand
(Laopaiboon) Biostatistics and Demography, Faculty of Medicine, Khon Kaen
University, Khon Kaen, Thailand
Title
Processed electroencephalogram indices for amelioration of cognitive
dysfunction following non-cardiac and non-neurosurgical procedures: A
systematic review.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 209-210), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Postoperative cognitive dysfunction (POCD) can
complicate a patient's postoperative recovery in several ways. Optimised
doses of anaesthetics as guided by processed electroencephalogram indices
may minimise POCD. This preliminary report is based on a review (1)which
is under development and has not been published to address whether
optimised anaesthesia guided by processed EEG indices can reduce the risk
of POCD in non-cardiac surgical or non-neurosurgical patients undergoing
general anaesthesia compared with standard practice where only clinical
signs are used. Materials & Methods: The methods and analysis were done in
accordance with our recent published protocol (1).We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) in The Cochrane Library
(issue4 2015), MEDLINE OvidSP (1990 to October 2015), EMBASE OvidSP (1990
to October 2015). Two authors independently examined all studies to select
those which met the inclusion criteria for assessing methodological
quality. We resolved disagreements by a consensus meeting between the
three authors. If considered appropriate, we pooled the results of
comparable groups of trials by a meta-analysis. Results: From the initial
search of 4068 abstracts, only five studies fulfilled the inclusion
criteria. Three studies (2,3,4) used Mini Mental State Exam (MMSE) and
battery of neuropsychological tests and defined POCD as a decline in the
POCD Z score of greater than 1.96 SD in at least two domains. By using a
fixed effect model, we found a significant effect of anaesthesia guided by
processed EEG indices on reducing risk of POCD at 12 weeks ((2047
participants; risk ratio (RR) 0.71, 95% confidence interval (CI) 0.53 to
0.96)) (see figure) but failed to demonstrate this effect on POCD at one
week ((1985 participants; risk ratio (RR) 0.63, 95% confidence interval
(CI) 0.69 to 1.01)). Conclusion: Optimised doses of anaesthetics as guided
by processed EEG indices may reduce risk of POCD at 12 weeks. More studies
are needed to elucidate the effect on early POCD (1 week) and late POCD
(52 weeks). (Table Presented).

<44>
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Accession Number
612648528
Author
Murniece S.; Stepanovs J.; Skudre A.; Mamaja B.
Institution
(Murniece, Stepanovs, Skudre, Mamaja) Departement of Anaesthesiology, Riga
Eastern University hospital, Riga, Latvia
Title
Regional cerebral oxygen saturation changes during neurosurgical spine
procedures in prone position using near infrared spectroscopy, our first
experience.
Source
Anesthesia and Analgesia. Conference: 16th World Congress of
Anaesthesiologists, WCA 2016. Hong Kong. Conference Start: 20160828.
Conference End: 20160902. 123 (3 Supplement 2) (pp 205), 2016. Date of
Publication: September 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Objectives: Near infrared spectroscopy mainly used in cardiac
surgery, has gained its actuality in other fields. Maintained adequate
cerebral oxygenation during surgery prevents complications like cognitive
dysfunction, stroke, organ failure. Neurosurgery is a complex medical
field covering a wide range of procedures not only on brain but also on
spine. The aim of the study was to perform a systematic review to
determine whether spinal surgery in prone position impact cerebral
oxygenation. Materials & Methods: A systematic review was undertaken to
determine whether spinal surgery in prone position impact cerebral
oxygenation. Relevant publications were found using PubMed database.
Search strategy included MeSH terms: (Spectroscopy, Near-
Infrared),(Monitoring),(Spine/surgery),(Prone position). We have had 15
patients undergoing spinal surgery. Cerebral oxygen saturation (rScO2) was
monitored using INVOS 4100. Heart rate, NIBP, EtCO2, SpO2 were also
monitored. We compared mini mental status examination (MMSE) before,1 day
after surgery, rate of postoperative complications, days spent in ICU.
Results: 309 articles were found. All the articles were screened for
eligibility. Only 3 articles met all the criteria. Fuchs et al1 (2000) in
his study included 48 patients for lumbar discectomy. There were no
significant changes in rScO2 from baseline values during supine with head
left/ right, prone, sitting position after 1,3,5 min in anesthetised and
awake volunteers. Deiner et al2 (2014) had 205 patients (> 68y). 63
patients had spinal surgery in prone position, 142- surgery lying supine.
Results showed desaturation 2.3 times more often for patients in prone
position. Andersen et al3 (2014) had 52 patients undergoing spinal surgery
in prone position hypothesing that head rotation >45o would affect rScO2.
The neutral head position is recommended. Our first 15 patients' results
showed medium rScO2 during surgery left side(L)74.56%, right
side(R)74.37%. Lying supine L 75.25%, R 74.10%, in prone position L
75.05%, R 74.49%, returning back on spine L 74.42%, R 74.04%. Two patients
showed rScO2 decrease more than 8% from baseline after turning to prone
position (71.5% supine to 66.5% prone; 87.0% supine to 81.6% prone). One
patient with stroke in anamnesis showed initial values 18% lower than
medium. No changes in MMSE, no incidence of stroke, organ dysfunction were
observed, no patients were admitted to ICU. Conclusion: Based on
literature patients in prone position experience decrease in cerebral
oxygen saturation more often than patients lying supine. Decrease from
baseline values are not significant and prone position is commonly well
tolerated.

<45>
Accession Number
612630186
Author
Zhang H.; Liu Y.; Bin J.; Qiu S.; Chen F.
Institution
(Zhang, Liu) Department of Medical Ultrasound, Second Affiliated Hospital
of Guangzhou Medical University, Guangzhou, Guangdong, China
(Bin) Southern Medical University, Guangzhou, Guangdong, China
(Qiu, Chen) Department of Cardiology, Nanfang Hospital of Southern Medical
University, Guangzhou, Guangdong, China
Title
Meta-analysis of two different surgical treatments of ischaemic mitral
regurgitation with the same outcome: Mitral valve repair vs mitral valve
replacement.
Source
Acta Cardiologica. 71 (5) (pp 573-580), 2016. Date of Publication: 2016.
Publisher
Acta Cardiologica (Weldadigheidsstraat 49, Leuven B-3000, Belgium)
Abstract
Background Mitral valve replacement (MVR) and mitral valve repair (MVP)
are the most common clinical treatment for ischaemic mitral insufficiency
(IMR). But controversy exists on the optimal surgical strategy for IMR.
Methods A literature search was performed in OvidSP, PubMed and Cochrane
Library to find articles comparing MVP versus MVR for the treatment of
IMR. A meta-analysis was performed for the differences in short- and
long-term survival. Secondary outcomes analysed the postoperative left
ventricular diastolic diameter (LVDD), left ventricular ejection fraction
(LVEF) and the New York Heart Association (NYHA) class. Results Out of the
584 studies, we only included 12 articles. A total of 2953 patients were
enrolled, including 1731 patients in the MVP group and 1222 patients in
the MVR group. The total number of bioprosthesis valves was 1.2 times
(631/535) the number of mechanical valves. After surgery, LVDD and LVEF
had improved and the proportion of NYHA III-IV class declined, but the
differences between the two groups were not significant (P > 0.05).
Shortterm survival in the MVP group was higher than that in the MVR group
(odds ratio [OR], 0.44; 95% confidence interval [CI] 0.32-0.60; P <
0.00001). Long-term survival was similar in both two groups (hazard ratio
[HR], 0.86; 95% CI 0.68-1.10, P = 0.24). Conclusion Both MVP and MVR can
play a role in reducing IMR and improving left ventricular function. The
short-term survival of MVP is better than MVR but long-term survival is
similar. Further exploration is needed to install optimal treatment of IMR
and individualized therapy. Copyright &#xa9; 2016, Acta Cardiologica. All
rights reserved.

<46>
Accession Number
612627839
Author
Backhoff D.; Kerst G.; Peters A.; LUDemann M.; Frische C.; Horndasch M.;
Hessling G.; Paul T.; Krause U.
Institution
(Backhoff, Paul, Krause) Department of Pediatric Cardiology,
Georg-August-University, Gottingen, Germany
(Kerst, Peters, LUDemann) Pediatric Heart Center,
Justus-Liebig-University, Giesen, Germany
(Frische) Department of Pediatric Cardiology, University Children's
Hospital, Tubingen, Germany
(Horndasch, Hessling) German Heart Center, Technical University, Munchen,
Germany
Title
Internal Cardioverter Defibrillator Indications and Therapies after Atrial
Baffle Procedure for d-Transposition of the Great Arteries: A Multicenter
Analysis.
Source
PACE - Pacing and Clinical Electrophysiology. 39 (10) (pp 1070-1076),
2016. Date of Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Sudden cardiac death (SCD) is the most important cause of late
mortality after atrial baffle procedure for d-transposition of the great
arteries (d-TGA). Experience with internal cardioverter defibrillator
(ICD) therapy in this population is limited. We conducted a multicenter
cohort study to determine the current state of ICD therapy in individuals
after atrial baffle procedure. Methods: Demographic and clinical data as
well as data on device implantation, programming, ICD discharges, and
complications after atrial baffle procedure for d-TGA from four German
centers were analyzed retrospectively. Results: ICD implantation was
undertaken in 33 subjects. ICD implantation was undertaken as primary
prevention in 29 (88%) and secondary prevention in four (12%) individuals.
There were 21 (64%) subjects with atrial reentrant tachycardia (IART).
During a median follow-up of 4.8 years, seven appropriate ICD therapies
were delivered in three (10%) individuals with primary prevention
indication. No appropriate shocks were documented in subjects with
secondary prevention indication. A total of 12 inappropriate ICD
discharges occurred in eight (24%) individuals due to IART (n = 6) or lead
failure (n = 2). ICD-related complications were noted in seven individuals
(21%): lead dislodgement/failure in five (15%) and ICD infection in two
subjects (6%). Conclusions: The majority of individuals received an ICD
for primary prevention of SCD, thus representing a liberal attitude of
physicians for ICD implantation. During a median follow-up of 4.8 years,
the rate of appropriate ICD therapies was low and clearly exceeded by
inappropriate ICD discharges. Lead failure and IART were present in >20%
of the individuals and were frequent reasons for inappropriate ICD
discharges. Facing these results, rigorous treatment of IART and careful
ICD programming seems mandatory. Copyright &#xa9; 2016 Wiley Periodicals,
Inc.

<47>
Accession Number
603879729
Author
Teismann I.K.; Oelschlager C.; Werstler N.; Korsukewitz C.; Minnerup J.;
Ringelstein E.B.; Dziewas R.
Institution
(Teismann) Department of Sleep Medicine and Neuromuscular Disorders,
Albert-Schweitzer-Campus 1, Building A1, Munster DE-48149, Germany
(Oelschlager) Department of Neurology, Evangelisches Krankenhaus
Bielefeld, Bielefeld, Germany
(Werstler, Korsukewitz, Minnerup, Ringelstein, Dziewas) Department of
Neurology, Munster, Germany
Title
Discontinuous versus continuous weaning in stroke patients.
Source
Cerebrovascular Diseases. 39 (5-6) (pp 269-277), 2015. Date of
Publication: 09 Jun 2015.
Publisher
S. Karger AG
Abstract
Background: An increasing number of stroke patients have to be supported
by mechanical ventilation in intensive care units (ICU), with a relevant
proportion of them requiring gradual withdrawal from a respirator. To
date, weaning studies have focused merely on mixed patient groups, COPD
patients or patients after cardiac surgery. Therefore, the best weaning
strategy for stroke patients remains to be determined. Methods: Here, we
designed a prospective randomized controlled study comparing adaptive
support ventilation (ASV), a continuous weaning strategy, with biphasic
positive airway pressure (BIPAP) in combination with spontaneous breathing
trials, a discontinuous technique, in the treatment of stroke patients.
The primary endpoint was the duration of the weaning process. Results:
Only the 40 (out of 54) patients failing in an initial spontaneous
breathing trial (T-piece test) were included into the study; the failure
proportion is considerably larger compared to previous studies. Eligible
patients were pseudo-randomly assigned to one of the two weaning groups.
Both groups did not differ regarding age, gender, and severity of stroke.
The results showed that the median weaning duration was 10.7 days (+/-SD
7.0) in the discontinuous weaning group, and 8 days (+/-SD 4.5) in the
continuous weaning group (p < 0.05). Conclusions: To the best of our
knowledge, this is the first clinical study to show that continuous
weaning is significantly more effective compared to discontinuous weaning
in mechanically ventilated stroke patients. We suppose that the reason for
the superiority of continuous weaning using ASV as well as the bad
performance of our patients in the 2 h T-piece test is caused by the
patients' compliance. Compared to patients on surgical and medical ICUs,
neurological patients more often suffer from reduced vigilance, lack of
adverse-effects reflexes, dysphagia, and cerebral dysfunction. Therefore,
stroke patients may profit from a more gradual withdrawal of weaning.
Copyright &#xa9; 2015 S. Karger AG, Basel.

<48>
Accession Number
605444070
Author
Szeto W.Y.; Svensson L.G.; Rajeswaran J.; Ehrlinger J.; Suri R.M.; Smith
C.R.; Mack M.; Miller D.C.; McCarthy P.M.; Bavaria J.E.; Cohn L.H.; Corso
P.J.; Guyton R.A.; Thourani V.H.; Lytle B.W.; Williams M.R.; Webb J.G.;
Kapadia S.; Tuzcu E.M.; Cohen D.J.; Schaff H.V.; Leon M.B.; Blackstone
E.H.
Institution
(Szeto) Division of Cardiovascular Surgery, University of Pennsylvania
Health System, Philadelphia, PA, United States
(Svensson, Rajeswaran, Leon, Blackstone) Placement of Aortic Transcatheter
Valves Publications Office, Cleveland, OH, United States
(Svensson, Suri, Lytle, Blackstone) Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, OH, United States
(Rajeswaran, Ehrlinger, Blackstone) Department of Thoracic and
Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
(Smith) Department of Surgery, Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Mack) Cardiovascular Surgery, Baylor Scott White Health, Plano, TX,
United States
(Miller) Department of Cardiovascular Surgery, Falk Cardiovascular
Research Center, Stanford University School of Medicine, Stanford, CA,
United States
(McCarthy) Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL,
United States
(Bavaria) Division of Thoracic Surgery, University of Pennsylvania Health
System, Philadelphia, PA, United States
(Cohn) Department of Surgery, Brigham and Women's Hospital, Boston, MA,
United States
(Corso) Department of Cardiac Surgery, Medstar Washington Hospital Center,
Washington, DC, United States
(Guyton, Thourani) Department of Surgery, Division of Cardiothoracic
Surgery, Emory University Hospital, Atlanta, GA, United States
(Williams) Department of Cardiothoracic Surgery, New York University,
Langone Medical Center, New York, NY, United States
(Webb) Division of Cardiology, Department of Medicine, St Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Cohen) Division of Cardiology, St. Luke's Mid-America Heart Institute,
Kansas City, MO, United States
(Schaff) Cardiac Surgery, Mayo Clinic, Rochester, MN, United States
(Leon) Center for Interventional Vascular Therapy, Division of Cardiology,
Department of Medicine, Columbia University Medical Center, New York
Presbyterian Hospital, New York, NY, United States
Title
Appropriate patient selection or health care rationing? Lessons from
surgical aortic valve replacement in the Placement of Aortic Transcatheter
Valves i trial Read at the 95th Annual Meeting of the American Association
for Thoracic Surgery, Seattle, Washington, April 25-29.
Source
Journal of Thoracic and Cardiovascular Surgery. 150 (3) (pp 557-568e11),
2015. Date of Publication: 01 Sep 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The study objectives were to (1) compare the safety of
high-risk surgical aortic valve replacement in the Placement of Aortic
Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons
national benchmarks; (2) reference intermediate-term survival to that of
the US population; and (3) identify subsets of patients for whom aortic
valve replacement may be futile, with no survival benefit compared with
therapy without aortic valve replacement. Methods From May 2007 to October
2009, 699 patients with high surgical risk, aged 84 +/- 6.3 years, were
randomized in PARTNER-IA; 313 patients underwent surgical aortic valve
replacement. Median follow-up was 2.8 years. Survival for therapy without
aortic valve replacement used 181 PARTNER-IB patients. Results Operative
mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal
failure 5.8% (expected 12%), sternal wound infection 0.64% (expected
0.33%), and prolonged length of stay 26% (expected 18%). However,
calibration of observed events in this relatively small sample was poor.
Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively,
lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but
higher than 53%, 32%, 21%, and 14%, respectively, in patients without
aortic valve replacement. Risk factors for death included smaller body
mass index, lower albumin, history of cancer, and prosthesis-patient
mismatch. Within this high-risk aortic valve replacement group, only the
8% of patients with the poorest risk profiles had estimated 1-year
survival less than that of similar patients treated without aortic valve
replacement. Conclusions PARTNER selection criteria for surgical aortic
valve replacement, with a few caveats, may be more appropriate, realistic
indications for surgery than those of the past, reflecting contemporary
surgical management of severe aortic stenosis in high-risk patients at
experienced sites. Copyright &#xa9; 2015 The American Association for
Thoracic Surgery.

<49>
Accession Number
602889778
Author
O'Sullivan K.E.; Hurley E.T.; Segurado R.; Sugrue D.; Hurley J.P.
Institution
(O'Sullivan, Hurley, Sugrue, Hurley) Heart Team, Mater Private Hospital,
Dublin, Ireland
(Segurado) CSTAR Centre for Statistical Training and Research, University
College Dublin, Ireland
Title
Transaortic TAVI is a valid alternative to transapical approach.
Source
Journal of Cardiac Surgery. 30 (5) (pp 381-390), 2015. Date of
Publication: 01 May 2015.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background and Aim Transcatheter aortic valve implantation (TAVI) can be
performed via a number of different anatomical approaches based on patient
characteristics and operator choice. The aim of this study was to compare
procedural outcomes between transaortic (TAo) and transapical (TA)
approaches in an effort to establish whether any differences exist.
Methods A systematic review and meta-analysis of the current literature
reporting outcomes for patients undergoing TAo and TA TAVI was performed
to compare outcomes using each vascular approach to valve deployment.
Results A total of 10 studies and 1736 patients were included. A total of
193 patients underwent TAo and 1543 TA TAVI. No significant difference in
30-day mortality was identified (TAo 9.4, TA 10.4 p = 0.7). There were no
significant differences identified between TAo and TA TAVI in procedural
success rate (96.3% vs. 93.7% p = 0.3), stroke and transient ischemic
attack (TIA) incidence (1.8% vs. 2.3% p = 0.7), major bleed (5.8% vs. 5.5%
p = 0.97) or pacemaker insertion rates (6.1% vs. 7.4% p = 0.56). In
addition, the incidence of clinically significant paravalvular
regurgitation (PVR) was the same between groups (6.7% vs. 11% p = 0.43).
Conclusion Comparison of TAo and TA approaches revealed equivalent
outcomes in 30-day mortality, procedural success, major bleeding,
stroke/TIA incidence, pacemaker insertion rates and paravalvular leak.
Heart teams should be familiar with the use of both TA and TAo access and
tailor their selection on a case-to-case basis. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<50>
Accession Number
612620607
Author
Watanabe Y.; Kozuma K.; Hioki H.; Kawashima H.; Nara Y.; Kataoka A.;
Shirai S.; Tada N.; Araki M.; Takagi K.; Yamanaka F.; Yamamoto M.;
Hayashida K.
Institution
(Watanabe, Kozuma, Hioki, Kawashima, Nara, Kataoka) Department of
Cardiology, Teikyo University School of Medicine, Tokyo, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Kanagawa, Japan
(Takagi) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Yamanaka) Department of Cardiology, Shonan Kamakura General Hospital,
Kanagawa, Japan
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
(Yamamoto) Department of Cardiology, Nagoya Heart Center, Aichi, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Comparison of Results of Transcatheter Aortic Valve Implantation in
Patients With Versus Without Active Cancer.
Source
American Journal of Cardiology. 118 (4) (pp 572-577), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The aim of this study was to evaluate postprocedural and midterm outcomes
of transcatheter aortic valve implantation (TAVI) in patients with aortic
stenosis and active cancer. From October 2013 to August 2015, a total of
749 patients undergoing TAVI using the Edwards Sapien XT prosthesis
(Edwards Lifesciences, Irvine, California) were prospectively included in
the OCEAN-TAVI registry from 8 Japanese centers. A total of 47 patients
(44.7% men; median age 83 years) had active cancer. The transfemoral
approach was implemented in 85.1% of patients in the cancer group and
78.1% in the noncancer group (p = 0.22). The occurrence of major vascular
complication (4.3% vs 7.5%, p = 0.24), life-threatening bleeding (2.1% vs
7.1%, p = 0.15), and major bleeding (8.5% vs 13%, p = 0.38) was similar
between the cancer and noncancer groups. No significant differences were
observed regarding device success (100% vs 96.2%, p = 0.17) or 30-day
survival (95.7% vs 97.3%, p = 0.38). No difference in midterm survival was
found between the patients with cancer and without cancer (log-rank, p =
0.42), regardless of advanced or limited cancer (log-rank, p = 0.68). In a
multivariable Cox proportional hazard regression analysis, cancer
metastasis was one of the most significant predictors of late mortality
(hazard ratio 4.73, 95% CI 1.12 to 20.0; p = 0.035). In conclusion,
patients with cancer with severe aortic stenosis who underwent TAVI had
similar acute outcomes and midterm survival rates compared with patients
without cancer. Cancer metastasis was associated with increased mortality
after TAVI. Copyright &#xa9; 2016 Elsevier Inc.

<51>
Accession Number
612620587
Author
Skelding K.A.; Yakubov S.J.; Kleiman N.S.; Reardon M.J.; Adams D.H.; Huang
J.; Forrest J.K.; Popma J.J.
Institution
(Skelding) Department of Cardiology, Geisinger Health System, Danville,
Pennsylvania, United States
(Yakubov) Department of Cardiology, Riverside Methodist Hospital,
Columbus, Ohio, United States
(Kleiman) Department of Cardiology, Houston-Methodist-Debakey Heart and
Vascular Center, Houston, Texas, United States
(Reardon) Department of Cardiothoracic Surgery, Houston-Methodist-Debakey
Heart and Vascular Center, Houston, Texase, United States
(Adams) Department of Cardiothoracic Surgery, Mount Sinai Medical Center,
New York, New York, United States
(Huang) Coronary and Structural Heart Department, Statistics Medtronic,
Mounds View, Minnesota, United States
(Forrest) Department of Cardiology, Yale University School of Medicine,
New Haven, Connecticut, United States
(Popma) Department of Cardiology, Beth Israel Deaconess Medical Center,
Boston, Massachusetts, United States
Title
Transcatheter Aortic Valve Replacement Versus Surgery in Women at High
Risk for Surgical Aortic Valve Replacement (from the CoreValve US High
Risk Pivotal Trial).
Source
American Journal of Cardiology. 118 (4) (pp 560-566), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The objective of this study was to compare outcomes in women after
surgical aortic valve replacement (SAVR) versus transcatheter aortic valve
replacement (TAVR) using a self-expanding prosthesis in patients with
severe aortic stenosis who were at high risk for SAVR. Although registries
and meta-analyses have suggested that TAVR is of considerable benefit in
women, perhaps even more so than in men, a rigorous evaluation of TAVR
with a self-expanding valve versus SAVR in women from a randomized trial
has not been performed. Patients with severe aortic stenosis were
randomized 1:1 to either TAVR or SAVR. Outcomes at 1 year are reported.
Treatment was attempted in a total of 353 women (183 TAVR and 170 SAVR).
Baseline characteristics and predicted risk of the 2 groups were
comparable, although the frequency of diabetes mellitus was lower in
patients undergoing TAVR (33.3% vs 45.3%; p = 0.02). TAVR-treated patients
experienced a statistically significant 1-year survival advantage compared
with SAVR patients (12.7% vs 21.8%; p = 0.03). The composite all-cause
mortality or major stroke rate also favored TAVR (14.9% vs 24.2%; p =
0.04). Quality of life, as measured by the Kansas City Cardiomyopathy
Questionnaire summary score, for both the TAVR and SAVR groups increased
significantly from baseline to 1 year. In conclusion, female TAVR patients
had lower 1-year mortality and lower 1-year all-cause mortality or major
stroke compared with women undergoing SAVR, with both cohorts experiencing
improved quality of life. Further studies specifically in women are
warranted to validate these findings. Copyright &#xa9; 2016 Elsevier Inc.

<52>
Accession Number
612540940
Author
Ozguler I.M.; Uysal A.; Ustunel L.; Burma O.
Institution
(Ozguler, Uysal, Burma) Firat University Hospital, Department of
Cardiovascular Surgery, Elazig, Turkey
(Ustunel) Elazig State Hospital, Department of Cardiovascular Surgery,
Elazig, Turkey
Title
Treatment approaches to coronary artery fistulae: A single center trial.
Source
International Journal of the Cardiovascular Academy. 2 (3) (pp 147-150),
2016. Date of Publication: 01 Sep 2016.
Publisher
Society of Cardiovascular Academy (E-mail: info@scai.org)
Abstract
Background A coronary artery fistula (CAF) is a sizable communication
between a coronary artery, bypassing the myocardial capillary bed and
entering either a chamber of the heart or any segment of the systemic or
pulmonary circulation. It accounts for 0.27-0.40% of all cardiac defects.
Patients and methods The study included 6 CAF patients hospitalized
between January 2010 and June 2016. The mean patient age was 52.6. The
sites of origin of the fistulae were from the left coronary artery in 4,
from the right coronary artery in 1 and from right and left coronary
arteries in 1 patient/patients. In all patients the site of termination
was the pulmonary artery. The fistulae were closed surgically in 4
patients who also had accompanying cardiac pathology (3 patients with
coronary artery disease and 1 patient with mitral stenosis) and in 2
patients without additonal coronary pathology with coil embolization
performed in the angiography unit. In the surgically treated group, with
cardiopulmonary bypass the fistula opening was closed through pulmonary
arteriotomy in 2 patients and fistula was ligated epicardially in 2
patients. Moreover, in the surgical group of 4 patients, coronary artery
bypass grafting was performed on 3 patients with coronary artery disease,
and mitral valve replacement on 1 patient with mitral stenosis. Results
All patients had no pathological symptoms and findings in the follow-up
controls one and three months after the surgery. Conclusion We suggest
that CAF in patients with additional cardiac pathology should be treated
surgically and others by performing coil embolization. Copyright &#xa9;
2016 Elsevier B.V.

<53>
[Use Link to view the full text]
Accession Number
612540718
Author
Valkenburg A.J.; Calvier E.A.M.; Van Dijk M.; Krekels E.H.J.; O'Hare B.P.;
Casey W.F.; Mathot R.A.A.; Knibbe C.A.J.; Tibboel D.; Breatnach C.V.
Institution
(Valkenburg, Van Dijk, Tibboel) Intensive Care and Department of Pediatric
Surgery, Erasmus University Medical Center-Sophia Children's Hospital,
Rotterdam, Netherlands
(Calvier, Krekels, Knibbe) Division of Pharmacology, Leiden Academic
Centre for Drug Research, Leiden University, Leiden, Netherlands
(O'Hare, Casey, Breatnach) Department of Anesthesia and Critical Care
Medicine, Our Lady's Children's Hospital, Dublin, Ireland
(Mathot) Department of Pharmacy, Academic Medical Center, Amsterdam,
Netherlands
(Knibbe) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Pharmacodynamics and Pharmacokinetics of Morphine after Cardiac Surgery in
Children with and Without Down Syndrome.
Source
Pediatric Critical Care Medicine. 17 (10) (pp 930-938), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To compare the pharmacodynamics and pharmacokinetics of IV
morphine after cardiac surgery in two groups of children - those with and
without Down syndrome. Design: Prospective, single-center observational
trial. Setting: PICU in a university-affiliated pediatric teaching
hospital. Patients: Twenty-one children with Down syndrome and 17 without,
3-36 months old, scheduled for cardiac surgery with cardiopulmonary
bypass. Interventions: A loading dose of morphine (100 mug/kg) was
administered after coming off bypass; thereafter, morphine infusion was
commenced at 40 mug/kg/hr. During intensive care, nurses regularly
assessed pain and discomfort with validated observational instruments
(COMFORT-Behavior scale and Numeric Rating Scale - for pain). These scores
guided analgesic and sedative treatment. Plasma samples were obtained for
pharmacokinetic analysis. Measurements and Main Results: Median
COMFORT-Behavior and Numeric Rating Scale scores were not statistically
significantly different between the two groups. The median morphine
infusion rate during the first 24 hours after surgery was 31.3 mug/kg/hr
(interquartile range, 23.4-36.4) in the Down syndrome group versus 31.7
mug/kg/hr (interquartile range, 25.1-36.1) in the control group (p =
1.00). Population pharmacokinetic analysis revealed no statistically
significant differences in any of the pharmacokinetic variables of
morphine between the children with and without Down syndrome. Conclusions:
This prospective trial showed that there are no differences in
pharmacokinetics or pharmacodynamics between children with and without
Down syndrome if pain and distress management is titrated to effect based
on outcomes of validated assessment instruments. We have no evidence to
adjust morphine dosing after cardiac surgery in children with Down
syndrome. &#xa9; Copyright 2016 by the Society of Critical Care Medicine
and the World Federation of Pediatric Intensive and Critical Care
Societies.

<54>
Accession Number
612521490
Author
Chemtob R.A.; Eskesen T.G.; Moeller-Soerensen H.; Perner A.; Ravn H.B.
Institution
(Chemtob, Moeller-Soerensen, Ravn) Department of Cardiothoracic
Anaesthesiology, University hospital of Copenhagen, Rigshospitalet,
Copenhagen, Denmark
(Eskesen, Perner) Department of Intensive Care, University hospital of
Copenhagen, Rigshospitalet, Copenhagen, Denmark
Title
Systematic review of the association of venous oxygenation and outcome in
adult hospitalized patients.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1367-1378), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Adequate tissue oxygenation is necessary to maintain organ
function. Low venous oxygen saturation may reflect impaired tissue
oxygenation, and may be used as a predictive tool and a therapeutic target
to improve the care of critically ill patients. We therefore conducted a
systematic review of the existing literature reflecting these aspects.
Methods: We searched electronic databases in January 2016 for relevant
studies on venous oxygen saturation for treatment guidance and patient
outcome. We sub-grouped results based on patient groups and setting.
Results: The search resulted in 5590 papers of which 42 studies were
deemed relevant. The majority of the studies in cardiac and abdominal
surgery patients showed associations between low venous oxygen saturation
and increased mortality and morbidity, in particular increased length of
intensive care. However, the cut-off level for low venous oxygen
saturation varied between < 55 and 70% and all studies had high risk of
bias. In patients with septic shock, recent randomized trials showed no
benefit of early resuscitation guided by venous oxygen saturation.
Conclusion: Low venous oxygen saturation may be associated with increased
mortality, morbidity and length of intensive care in patients following
cardiac or abdominal surgery. However, the wide range of cut-off levels
and low quality of evidence hampers the clinical application. In patients
with septic shock, the present evidence does not support goal-directed
therapy using venous oxygen saturation during early resuscitation.
Copyright &#xa9; 2016 The Acta Anaesthesiologica Scandinavica Foundation.
Published by John Wiley & Sons Ltd

<55>
Accession Number
612521465
Author
Pesonen E.; Keski-Nisula J.; Andersson S.; Palo R.; Salminen J.; Suominen
P.K.
Institution
(Pesonen) Division of Anaesthesiology, Peijas Hospital, Department of
Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland
(Keski-Nisula, Palo, Suominen) Division of Anaesthesiology, Children's
Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Andersson) Children's Hospital, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Salminen) Department of Paediatric Surgery, Children's Hospital, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
Title
High-dose methylprednisolone and endothelial glycocalyx in paediatric
heart surgery.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1386-1394), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Corticosteroids are used in paediatric heart surgery to
attenuate systemic inflammatory response. Glycocalyx regulates vascular
permeability, shear stress and cell adhesion on the endothelium.
Syndecan-1 serves as a biomarker of glycocalyx degradation. Hydrocortisone
decreased endothelial glycocalyx degradation in an experimental model. Our
hypothesis was that high-dose methylprednisolone decreases glycocalyx
degradation as measured by plasma sydecan-1 concentration in children
undergoing cardiac surgery. Methods: Two double-blinded, randomized,
placebo-controlled trials were conducted. In the first trial ('neonatal
trial'), 40 neonates undergoing open heart surgery received either 30
mg/kg intravenous methylprednisolone (n = 20) or placebo (n = 20). In the
second trial ('VSD trial'), 45 infants and very young children, undergoing
ventricular or atrioventricular septal defect correction received one of
the following: 30 mg/kg of methylprednisolone intravenously after
anaesthesia induction (n = 15), 30 mg/kg methylprednisolone in the
cardiopulmonary bypass prime solution (n = 15) or placebo (n = 15). Plasma
syndecan-1 concentrations were measured. Results were expressed both as
absolute concentrations and in relative concentrations as multiples of the
baseline values of syndecan-1. Results: There were no statistically
significant differences between the neonate trial groups for absolute
syndecan-1 concentrations. However, operative administration of
methylprednisolone to neonates significantly reduced the relative
increases of syndecan-1 at weaning from cardiopulmonary bypass (P = 0.008)
and at 6 h post-operatively (P = 0.018). There were no statistically
significant differences in absolute or relative increases of syndecan-1
between the VSD trial study groups. Conclusion: High-dose
methylprednisolone reduces shedding of glycocalyx in neonates after
complex cardiac surgery but not in older infants after repair of VSD/AVSD
with shorter ischaemia times. Copyright &#xa9; 2016 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<56>
Accession Number
612521437
Author
Franck M.; Nerlich K.; Neuner B.; Schlattmann P.; Brockhaus W.R.; Spies
C.D.; Radtke F.M.
Institution
(Franck, Nerlich, Neuner, Brockhaus, Spies, Radtke) Department of
Anaesthesiology and Intensive Care Medicine, Campus-Virchow-Klinikum and
Campus Charite Mitte, Charite - Universitatsmedizin Berlin, Berlin,
Germany
(Schlattmann) Department of Medical Statistics, Informatics and
Documentation, University Hospital Jena, Jena, Germany
(Radtke) Anaestesiafdelingen, Naestved Sygehus, Naestved, Denmark
Title
No convincing association between post-operative delirium and
post-operative cognitive dysfunction: a secondary analysis.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1404-1414), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Post-operative delirium and post-operative cognitive
dysfunction (POCD) are both common but it has not been clarified how
closely they are associated. We aimed to assess the possible relationship
in a secondary analysis of data from the 'Surgery Depth of anaesthesia and
Cognitive outcome'- study. Methods: We included patients aged > 60 years
undergoing non-cardiac surgery planned for longer than 60 min. Delirium
was assessed according to the Diagnostic and Statistical Manual of Mental
Disorders IV criteria in the post-anaesthesia care unit (PACU) as well as
within the first week after surgery. Cognitive function was assessed with
a neuropsychological test battery. Multivariable analysis of POCD was
performed with consideration of predisposing and precipitating factors.
Results: Of 1277 randomized patients, 850 (66.6%) had complete data.
Delirium was found in 270 patients (32.9% of 850). We detected POCD in 162
(20.9% of 776) at 1 week and in 52 (9.4% of 553) at 3 months. In
multivariable analysis (n = 808), delirium had no overall effect on POCD
(P = 0.30). Patients with no delirium in PACU but with postoperative
delirium within 7 days had an increased risk of POCD at 3 months (OR =
2.56 (95%-confidence interval: 1.07-6.16), P = 0.035). No significant
association was found for the other subgroups. Conclusions: There is no
clear evidence that postoperative delirium is independently associated
with POCD up to 3 months. Copyright &#xa9; 2016 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<57>
Accession Number
612460532
Author
Vannucci F.; Gonzalez-Rivas D.
Institution
(Vannucci) Department of Thoracic Surgery, Hospital Federal do Andarai,
Rio de Janeiro, Brazil
(Vannucci) Department of Thoracic Surgery, Hospital Central da Policia
Militar (HCPM), Rio de Janeiro, Brazil
(Gonzalez-Rivas) Department of Thoracic Surgery and Lung Transplant,
Coruna University Hospital, Coruna, Spain
(Gonzalez-Rivas) Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna,
Spain
(Gonzalez-Rivas) Department of Thoracic Surgery, Shanghai Pulmonary
Hospital, Tongji University School of Medicine, Shanghai, China
Title
Is VATS lobectomy standard of care for operable non-small cell lung
cancer?.
Source
Lung Cancer. 100 (pp 114-119), 2016. Date of Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is
being increasingly applied worldwide in the last few years. Since its
introduction, many publications have been providing strong evidences that
this minimally invasive approach is feasible, safe and oncologically
efficient; offering to patients several advantages over traditional open
thoracotomy, particularly for early-stage disease (I and II). The
application of VATS for locally advanced disease treatment has also been
largely described, but probably requires a further level of experience,
which is more likely to be found in reference centers, with skilled
experts. Although a large multi-institutional prospective
randomized-controlled trial is the best way to confirm the superiority of
one technique over another, such study comparing VATS versus open
lobectomy for lung cancer is unlikely to ever come out. And in this
scenario, retrospective data remains as the most reliable source of
scientific information. Based on a literature review, the main objective
of this article is to discuss to what extent VATS lobectomy can be
considered the gold standard in the surgical treatment of lung cancer,
taking into account the most important comparison aspects between the
minimally invasive approach and open thoracotomy technique. This review
addresses questions regarding lymph node dissection, oncologic efficacy,
extended resections beyond standard lobectomy, post-operative
complications/pain/quality of life, survival rates and the present limits
of indication (and contraindication) for VATS, in order to define the real
role of this technique on the surgical treatment of lung cancer in a
minimally invasive, but safe and effective manner. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<58>
Accession Number
612609112
Author
De Donato G.; Setacci F.; Galzerano G.; Mele M.; Ruzzi U.; Setacci C.
Institution
(De Donato, Setacci, Galzerano, Mele, Ruzzi, Setacci) Unit of Vascular
Surgery, Department of Medicine, Surgery and Neuroscience, University of
Siena, Viale Bracci, Siena 53100, Italy
Title
The use of cilostazol in patients with peripheral arterial disease:
Results of a national physician survey.
Source
Journal of Cardiovascular Surgery. 57 (3) (pp 457-465), 2016. Date of
Publication: June 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Although international guidelines recommend cilostazol as
first-line therapy for peripheral arterial disease (PAD) because it
improves the symptoms and quality of life, it remains an underused agent
for amputation-free survival. The objective of this study was to evaluate
the practice among Italian physicians of the use of cilostazol in patients
suffering from peripheral arterial disease (PAD). METHODS: For the present
study, a cross-sectional survey was carried out. Physicians specialized in
the medical and/or surgical treatment of PAD and who prescribe cilostazol
regularly were invited to a phone interview. A nationally-representative
probability sample of hospital-based physicians who diagnose and treat
patients with PAD was randomly selected among the members of the Italian
Physicians' Association. RESULTS: Out of a total of 641 physicians
contacted, 250 of them (39%) accepted to take part in this survey. Reasons
of survey refusal were the non-attitude to prescribe cilostazol (45%), or
unspecified motivations (16%). Among the 250 physicians participating the
survey: 120 were vascular surgeons, 80 internal medicine doctors, 50
angiologists. Cilostazol was suggested in 79% of patients with symptomatic
intermittent claudication, and in 30% of patients who had undergone
revascularization. The majority of physicians stated to prescribe
cilostazol at recommended dosage of 100 mg bid (46.4%). The principal
reason to suggest a reduced drug dosage was to limit early side effect at
the time of treatment onset, but the increase to the full dose of
cilostazol is suggested by 91.3% of interviewed within 4 weeks.
Sixty-three percent of physicians affirmed to prescribe cilostazol as a
continuous treatment for a mean of 4 months, while a lifelong treatment
was suggested by 17.6% of participants. CONCLUSIONS: Among physicians who
habitually prescribe cilostazol adherence to the recommended drug dosage
and length of treatment is high. The prescription of cilostazol is
particularly appreciated in patients with symptomatic intermittent
claudication, even before any noninvasive diagnosis of PAD, and before any
invasive therapy. Finally a relevant number of physicians regularly
prescribe cilostazol also after revascularization, advocating the
anti-restenotic properties of the drug.

<59>
Accession Number
612609092
Author
Guerrero M.; Urena M.; Pursnani A.; Wang D.D.; Vahanian A.; O'Neill W.;
Feldman T.; Himbert D.
Institution
(Guerrero, Pursnani, Feldman) Division of Cardiology, Evanston Hospital,
North Shore University Health System, 2650 Ridge Ave, Evanston, IL 60201,
United States
(Urena, Vahanian, Himbert) Department of Cardiology, Bichat Hospital,
Paris, France
(Wang, O'Neill) Institute of Structural Heart Disease, Henry Ford Health
System, Detroit, IL, United States
Title
Balloon expandable transcatheter heart valves for native mitral valve
disease with severe mitral annular calcification.
Source
Journal of Cardiovascular Surgery. 57 (3) (pp 401-409), 2016. Date of
Publication: June 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Patients with mitral annular calcification (MAC) have high surgical risk
for mitral valve replacement due to associated comorbidities and technical
challenges related to calcium burden, precluding surgery in many patients.
Transcatheter mitral valve replacement (TMVR) with the compassionate use
of balloon expandable aortic transcatheter heart valves has been used in
this clinical scenario. The purpose of this review was to summarize the
early experience including successes and failures reported. TMVR might
evolve into an acceptable alternative for selected patients with severe
MAC who are not candidates for conventional mitral valve surgery. However,
this field is at a very early stage and the progress will be significantly
slower than the development of transcatheter aortic valve replacement due
to the complexity of the mitral valve anatomy and its pathology.
Optimizing patient selection process by using multimodality imaging tools
to accurately measure the mitral valve annulus and evaluate the risk of
left ventricular outflow tract obstruction is essential to minimize
complications. Strategies for treating and preventing left ventricular
outflow tract obstruction are being tested. Similarly, carefully selecting
candidates avoiding patients at the end of their disease process, might
improve the overall outcomes.

<60>
Accession Number
612609085
Author
Dudiy Y.; Brownlee A.; Ruiz C.E.
Institution
(Dudiy, Brownlee, Ruiz) Hackensack University Medical Center, Joseph M.
Sanzari Children's Hospital, 30 Prospect Avenue, Hackensack, NJ 07601,
United States
Title
The spectrum of transcatheter mitral valve replacement devices.
Source
Journal of Cardiovascular Surgery. 57 (3) (pp 393-400), 2016. Date of
Publication: June 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Mitral regurgitation is the most common valvular heart disease. The gold
standard for patients not suitable for valve repair is a surgical valve
replacement. A significant proportion of patients, however are not
referred for surgery due to comorbidities, advanced age or severe LV
dysfunction. Transcatheter mitral valve replacement may be a viable
therapeutic option for these high risk patients. With improvements in
technology and data on the durability of the transcatheter mitral valve,
this technology has the potential to be used in a lower risk population. A
number of transcatheter systems have emerged recently and are at different
stages of investigation. In this review, we outline the key elements and
challenges of the transcatheter mitral valve design as well as the status
of devices that have reached First in Man status.

<61>
Accession Number
612379737
Author
Hong J.H.; Jung S.W.
Institution
(Hong, Jung) Keimyung University, School of Medicine, South Korea
Title
Fluoroscopically guided thoracic interlaminar epidural injection: A
comparative epidurography study using 2.5 mL and 5 mL of contrast dye.
Source
Pain Physician. 19 (7) (pp E1013-E1018), 2016. Date of Publication:
September-October 2016.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Thoracic epidural anesthesia (TEA) is frequently used to
maintain intraoperative analgesia. After injecting the initial bolus dose
of epidural local anesthetics (LA), intermittent injection of LA through
an epidural catheter is required to maintain the intraoperative analgesia.
For intermittent epidural administration, usually 2 - 5 mL of LA has been
used. However, no studies have suggested an optimal volume of LA of TEA
for intermittent epidural administration of TEA. Objective: We focused on
identifying an optimal volume of LA of TEA using epidurography of the
thoracic level with 2 different volumes of contrast dye. Study Design:
Prospective, randomized study. Setting: An interventional pain management
practice in South Korea. Methods: After Institutional Review Board
approval, 70 patients undergoing thoracic epidural catheterization for
upper abdominal and thoracic surgery were randomly assigned to one of the
2 contrast dye volume groups of 35 patients each (A, 2.5 mL and B, 5.0
mL). Epidurography was evaluated to confirm how many spinal segments were
covered by contrast dye. The spreads in the cephalad and caudad directions
were also evaluated. Results: The total number of vertebral segments
evaluated by contrast dye were 7.5 +/- 2.0, and 8.4 +/- 2.6, respectively
in groups A and B. The number of patients who showed contrast dye spread
of more than 5 vertebral segments was 34/35 (97%) in both groups. Group B
resulted in higher contrast dye distribution in the cephalad direction
compared to group A (T2.6 vs. T3.6). Limitations: We used a test dose of
contrast dye to confirm the contrast was in epidural space, not
intrathecal or vascular, before injection of the main dose of contrast
dye. The present study did not include the volume of test dose.
Conclusion: The volume of 2.5 mL for intermittent epidural administration
would be enough for the analgesic effect of upper abdominal and thoracic
surgery while avoiding excessive upper thoracic and cervical spread.
Copyright &#xa9; 2016, American Society of Interventional Pain Physicians.
All rights reserved.

<62>
Accession Number
612375354
Author
Kalogianni A.; Almpani P.; Vastardis L.; Baltopoulos G.; Charitos C.;
Brokalaki H.
Institution
(Kalogianni, Almpani) Faculty of Nursing, Technological Educational
Institute of Athens, Ag. Spiridona Str, Aigaleo, Athens 122 10, Greece
(Vastardis) Intensive Care Unit of Department of Cardiac Surgery,
Evangelismos General Hospital, Athens, Greece
(Baltopoulos, Brokalaki) Faculty of Nursing, National and Kapodistrian
University of Athens, Greece
(Charitos) Cardiothoracic Surgery Department, Evangelismos, General
Hospital of Athens, Greece
Title
Can nurse-led preoperative education reduce anxiety and postoperative
complications of patients undergoing cardiac surgery?.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 447-458), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effect of preoperative education on anxiety and
postoperative outcomes of cardiac surgery patients remains unclear. Aim:
The aim of the study was to estimate the effectiveness of a nurse-led
preoperative education on anxiety and postoperative outcomes. Methods: A
randomised controlled study was designed. All the patients who were
admitted for elective cardiac surgery in a general hospital in Athens with
knowledge of the Greek language were eligible to take part in the study.
Patients in the intervention group received preoperative education by
specially trained nurses. The control group received the standard
information by the ward personnel. Measurements of anxiety were conducted
on admission-A, before surgery-B and before discharge-C by the state-trait
anxiety inventory. Results: The sample consisted of 395 patients
(intervention group: 205, control group: 190). The state anxiety on the
day before surgery decreased only in the intervention group (34.0 (8.4)
versus 36.9 (10.7); P=0.001). The mean decrease in state score during the
follow-up period was greater in the intervention group (P=0.001). No
significant difference was found in the length of stay or readmission.
Lower proportions of chest infection were found in the intervention group
(10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression
revealed that education and score in trait anxiety scale on admission are
independent predictors of a reduction in state anxiety. Conclusion:
Preoperative education delivered by nurses reduced anxiety and
postoperative complications of patients undergoing cardiac surgery, but it
was not effective in reducing readmissions or length of stay. Copyright
&#xa9; European Society of Cardiology.

<63>
Accession Number
612375350
Author
Hojskov I.E.; Moons P.; Hansen N.V.; Greve H.; Olsen D.Bae.; La Cour So.;
Glud C.; Winkel P.; Lindschou J.; Egerod I.; Christensen A.V.; Berg S.K.
Institution
(Hojskov, Greve, Olsen, Christensen, Berg) Rigshospitalet, Copenhagen
University Hospital, Heart Centre, Thoracic Clinic, Blegdamsvej 9,
Copenhagen DK-2100, Denmark
(Moons) KU Leuven, University of Leuven, Department of Public Health and
Primary Care, KU Leuven, Belgium
(Hansen, La Cour) Centre for Research in Existence and Society, University
of Copenhagen, Denmark
(Glud, Winkel, Lindschou) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Rigshospitalet, Copenhagen University Hospital,
Denmark
(Egerod) Trauma Centre, Rigshospitalet, Copenhagen University Hospital,
Denmark
Title
Early physical training and psycho-educational intervention for patients
undergoing coronary artery bypass grafting. The SheppHeart randomized 2 x
2 factorial clinical pilot trial.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 425-437), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Patients undergoing coronary artery bypass graft surgery often
experience a range of problems and symptoms such as immobility, pain and
insufficient sleep. Results from trials investigating testing in-hospital
physical exercise or psychological intervention have been promising.
However, no randomized clinical trials have tested a comprehensive
rehabilitation programme consisting of both physical exercise and
psycho-education in the early rehabilitation phase. Aims: The aims of the
present SheppHeart pilot randomized clinical trial were to evaluate the
feasibility of patient recruitment, patient acceptance of the
intervention, safety and tolerability of the intervention. Methods and
design: Sixty patients admitted for coronary artery bypass graft were
randomized 1:1:1:1 to: 1) physical exercise plus usual care, or 2)
psycho-educational intervention plus usual care, or 3) physical exercise
and psycho-educational plus usual care, or 4) usual care alone during a
four week period after surgery. Results: The acceptability of trial
participation was 67% during the three month recruitment period. In the
physical exercise groups, patients complied with 59% of the total expected
training sessions during hospitalization. Nine patients (30%) complied
with >75% and nine patients (30%) complied with 50% of the planned
exercise sessions. Eleven patients (42%) participated in >75% of the four
consultations and six patients (23%) participated in 50% of the
psycho-educational programme. Conclusion: Comprehensive phase one
rehabilitation combining physical exercise and psycho-education in
coronary artery bypass graft patients shows reasonably high inclusion,
feasibility and safety. Copyright &#xa9; European Society of Cardiology.

<64>
Accession Number
612375319
Author
Doering L.V.; McGuire A.; Eastwood J.-A.; Chen B.; Bodan R.C.; Czer L.S.;
Irwin M.R.
Institution
(Doering, Eastwood, Chen) School of Nursing, University of California,
Factor Building 4-266, 700 Tiverton Ave, Los Angeles, CA 90095, United
States
(McGuire) School of Nursing, California State University, Long Beach,
United States
(Bodan) School of Nursing, California State University, Fullerton, United
States
(Czer) Cedars-Sinai Heart Institute, United States
(Irwin) Cousins Center for Psychoneuroimmunology, University of
California, United States
Title
Cognitive behavioral therapy for depression improves pain and perceived
control in cardiac surgery patients.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 417-424), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Depression after cardiac surgery (CS) is associated with
increased pain and decreased sleep quality. While cognitive behavioral
therapy (CBT) aimed at depression is effective in relieving depressive
symptoms after cardiac surgery, little is known about its ability to
ameliorate other common postoperative problems that affect recovery and
quality of life. Aims: The purpose of this study was to evaluate the
effects of CBT for depression on pain severity, pain interference, sleep,
and perceived control in patients recovering from CS. Methods: Depressed
patients recovering from CS were randomized to receive either eight weeks
of CBT or usual care. At baseline and post-intervention, patients
completed questionnaires for depressive symptoms, pain, sleep, and
perceived control. Group comparisons were conducted using t-tests or chi
square analysis. Repeated measures analysis was used to assess the effect
of the intervention in changes over time. Results: The sample (n=53)
included 16.9% women and had a mean age of 67.8+/-9.2 years. CBT for
depression increased perceived control (p<0.001) and decreased pain
interference (p=0.02) and pain severity (p=0.03). Group effects remained
significant (p<0.05) for perceived control and pain interference and a
trend was observed for pain severity (p<0.10) after controlling for
variables that differed at baseline. There were no group differences in
sleep disturbance over time. Conclusions: A depression-focused CBT
intervention yields benefits in other common postoperative problems,
specifically improved perceived control and decreased pain in depressed
cardiac surgery patients. Copyright &#xa9; European Society of Cardiology.

<65>
[Use Link to view the full text]
Accession Number
612286771
Author
Fletcher D.; Stamer U.M.; Pogatzki-Zahn E.; Zaslansky R.; Tanase N.V.;
Perruchoud C.; Kranke P.; Komann M.; Lehman T.; Lavand homme P.;
Vercauteren M.; Meissner W.; Iohom G.; Cinnella G.; Aurilio C.; Belii A.;
Filipescu D.; Rehberg-Klug B.; Decostered I.; Suter M.R.; Blumenthal S.;
Puig M.; Garcia-Filoso A.; Brandner B.; Varvinskiy A.M.; Lisnyy I.; Kuchyn
I.
Institution
(Fletcher) Department of Anaesthesiology Raymond Poincare Hospital,
Garches, APHP, Universite Versailles St Quentin, Inserm 987, Service D
Anesthesie Reanimation, Hopital Raymond Poincare AP-HP, 104 boulevard
Raymond Poincare, Garches 92380, France
(Stamer) Department of Anaesthesiology and Pain Medicine, Inselspital and
Department of Clinical Research, University of Bern, Bern, Switzerland
(Pogatzki-Zahn) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Munster UKM, Munster, Germany
(Zaslansky, Komann) Department of Anaesthesiology, University Hospital,
Jena, Germany
(Tanase) Department of Anaesthesiology, Central University, Emergency
Military Hospital, Bucharest, Romania
(Perruchoud) Department of Anaesthesiology and Pain Management, Hospital
of Morges and University Hospital Center of Lausanne, Lausanne,
Switzerland
(Kranke) Department of Anaesthesia and Critical Care, University Hospitals
of Wurzburg, Wurzburg, Germany
(Lehman) Department of Biostatistics, Friedrich-Schiller-University, Jena,
Germany
(Lehman) Clinical Trial Network, European Society of Anaesthesiology,
Brussels, Belgium
(Lavand homme) Cliniques Universitaires Saint-Luc, Brussels, Belgium
(Vercauteren) Universiteit Antwerpen, Belgium
(Fletcher) Hopital Raymond Poincare, Garches, France
(Kranke) Universitatsklinikum Wurzburg, Germany
(Meissner) Universitatsklinik Jena, Germany
(Pogatzki-Zahn) Universitatsklinik Munster, Germany
(Iohom) Cork University Hospital, Cork, Ireland
(Cinnella) Policlinico Ospedali Riuniti, Foggia, Italy
(Aurilio) Seconda Universitadegli Studi di Napoli, Italy
(Belii) National Scientific and Practical Center for Emergency Medicine,
Chisinau, Moldova
(Filipescu) Emergency Institute Prof. Dr CC Iliescu, Bucharest, Romania
(Tanase) Central University, Emergency Military Hospital Dr Carol Danila,
Bucharest, Romania
(Stamer) Inselspital, University of Bern, Switzerland
(Rehberg-Klug) Hopitaux Universitaires de Geneve, Switzerland
(Decostered, Suter) Centre Hospitalier Universitaire Vaudois, Lausanne,
Switzerland
(Perruchoud) EHC Hopital de Morges, University Hospital Center of
Lausanne, Lausanne, Switzerland
(Blumenthal) Stadtspital Triemli, Zurich, Switzerland
(Puig) Hospital Del Mar, Barcelona, Spain
(Garcia-Filoso) Hospital Universitario San Juan, Alicante, Spain
(Brandner) University College London Hospitals, United Kingdom
(Varvinskiy) Torbay Hospital, Torqay, United Kingdom
(Lisnyy) National Cancer Institute, Kiev, Ukraine
(Kuchyn) City Clinical Hospital, Kiev, Ukraine
Title
Chronic postsurgical pain in Europe: An observational study.
Source
European Journal of Anaesthesiology. 32 (10) (pp 725-734), 2015. Date of
Publication: October 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is an important clinical
problem. Prospective studies of the incidence, characteristics and risk
factors of CPSP are needed. OBJECTIVES The objective of this study is to
evaluate the incidence and risk factors of CPSP. DESIGN A multicentre,
prospective, observational trial. SETTING Twenty-one hospitals in 11
European countries. PATIENTS Three thousand one hundred and twenty
patients undergoing surgery and enrolled in the European registry PAIN
OUT. MAIN OUTCOME MEASURES Pain-related outcome was evaluated on the first
postoperative day (D1) using a standardised pain outcome questionnaire.
Review at 6 and 12 months via e-mail or telephonic interview used the
Brief Pain Inventory (BPI) and the DN4 (Douleur Neuropathique four
questions). Primary endpoint was the incidence of moderate to severe CPSP
(numeric rating scale, NRS >3/10) at 12 months. RESULTS For 1044 and 889
patients, complete data were available at 6 and 12 months. At 12 months,
the incidence of moderate to severe CPSP was 11.8% (95% CI 9.7 to 13.9)
and of severe pain (NRS >6) 2.2% (95% CI 1.2 to 3.3). Signs of neuropathic
pain were recorded in 35.4% (95% CI 23.9 to 48.3) and 57.1% (95% CI 30.7
to 83.4) of patients with moderate and severe CPSP, respectively.
Functional impairment (BPI) at 6 and 12 months increased with the severity
of CPSP (P<0.01) and presence of neuropathic characteristics (P<0.001).
Multivariate analysis identified orthopaedic surgery, preoperative chronic
pain and percentage of time in severe pain on D1 as risk factors. A 10%
increase in percentage of time in severe pain was associated with a 30%
increase of CPSP incidence at 12 months. CONCLUSION The collection of data
on CPSP was feasible within the European registry PAIN OUT. The incidence
of moderate to severe CPSP at 12 months was 11.8%. Functional impairment
was associated with CPSP severity and neuropathic characteristics. Risk
factors for CPSP in the present study were chronic preoperative pain,
orthopaedic surgery and percentage of time in severe pain on D1. TRIAL
REGISTRATION Clinicaltrials.gov identifier: NCT01467102. Copyright &#xa9;
2015 European Society of Anaesthesiology. All rights reserved.

<66>
Accession Number
612299461
Author
McNeely C.A.; Vassileva C.M.
Institution
(McNeely, Vassileva) Department of Cardiothoracic Surgery, Southern
Illinois University School of Medicine, Springfield, IL, United States
Title
Long-term outcomes of mitral valve repair versus replacement for
degenerative disease: A systematic review.
Source
Current Cardiology Reviews. 11 (2) (pp 157-162), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The short-term advantage of mitral valve repair versus replacement for
degenerative disease has been extensively documented. These advantages
include lower operative mortality, improved survival, better preservation
of leftventricular function, shorter post-operative hospital stay, lower
total costs, and fewer valve-related complications, including
thromboembolism, anticoagulation-related bleeding events and late
prosthetic dysfunction. More recent written data are available indicating
the long-term advantage of repair versus replacement. While at some
institutions, the repair rate for degenerative disease may exceed 90%, the
national average in 2007 was only 69%. Making direct comparisons between
mitral valve repair and replacement using the available studies does
present some challenges however, as there are often differences in
baseline characteristics between patient groups as well as other
dissimilarities between studies. The purpose of this review is to
systematically summarize the long-term survival and reoperation data of
mitral valve repair versus replacement for degenerative disease. A PubMed
search was done and resulted in 12 studies that met our study criteria for
comparing mitral valve repair versus replacement for degenerative disease.
A systematic review was then conducted abstracting survival and
reoperation data. Copyright &#xa9; 2015 Bentham Science Publishers.

<67>
[Use Link to view the full text]
Accession Number
52988460
Author
Yagi M.; Hosogane N.; Okada E.; Watanabe K.; Machida M.; Tezuka M.;
Matsumoto M.; Asazuma T.
Institution
(Yagi, Machida, Asazuma) Department of Orthopedic Surgery, National Center
for Musculoskeletal Disorders, Murayama Medical Center, 2-37-1 Gakuen,
Musashi-Murayama City Tokyo, Japan
(Hosogane, Matsumoto) Department of Orthopedics, Keio University School of
Medicine, Tokyo, Japan
(Okada, Tezuka) Department of Orthopedics, Saiseikai Central Hospital,
Tokyo, Japan
(Watanabe) Department of Advanced Therapy for Spine and Spinal Cord
Disorders, Keio University School of Medicine, Tokyo, Japan
Title
Factors affecting the postoperative progression of thoracic kyphosis in
surgically treated adult patients with lumbar degenerative scoliosis.
Source
Spine. 39 (8) (pp E521-E528), 2014. Date of Publication: 15 Apr 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design. A retrospective case series of patients treated surgically
for degenerative lumbar scoliosis (DLS). Objective. To determine incidence
and risk factors of progressive global thoracic kyphosis (pGTK) after
surgery for DLS. Summary of Background Data. Sagittal balance affects the
surgical treatment of spinal deformity in adults. Little is known about
the loss of sagittal balance due to pGTK, or about the risk factors for
pGTK, after surgery for DLS. Methods. We reviewed records from a
multicenter database of adults with DLS, treated with posterior spinal
fusion. Inclusion required an age of 50 years or more at the time of
surgery, an upper instrumented vertebra at T9 and below, more than 5 fused
segments, and at least 2 years of follow-up. We included 73 patients with
a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of
3.6 years (range, 2-11 yr). Independent risk factors for pGTK were
identified by logistic regression analysis. Results. Significant pGTK,
defined as an increase in thoracic kyphosis of more than 10 degree from
before surgery to the time of final follow-up, was observed in 41% of the
patients. Loss of the sagittal vertical axis was larger in patients with
pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger
lumbar lordosis correction in patients with pGTK. Multivariate logistic
regression analysis identified an age greater than 75 (odds ratio, 5.53; P
= 0.02, 95% confidence interval [1.4-22.4]) and sacropelvic fusion (odds
ratio = 2.66, P = 0.02, 95% confidence interval [1.5-11.1]) as independent
risk factors for pGTK. Conclusion. The pGTK incidence after surgery for
DLS was 41%. Age, sacropelvic fusion, and a larger sagittal correction
were identified as pGTK risk factors. Long-term follow-up will provide
more data on the clinical impact of pGTK in elderly patients. Copyright
&#xa9; 2014 Lippincott Williams &Wilkins.

<68>
Accession Number
612590608
Author
Wilczynski M.; Wybraniec M.T.; Milewski K.; Sanak M.; Wita K.; Buldak L.;
Kondys M.; Buszman P.; Bochenek A.
Institution
(Wilczynski, Bochenek) Department of Cardiac Surgery, Medical University
of Silesia, 47 Ziolowa St, Katowice 40-635, Poland
(Wybraniec, Wita) First Department of Cardiology, School of Medicine in
Katowice, Medical University of Silesia, Katowice, Poland
(Milewski, Kondys, Buszman, Bochenek) Center for Cardiovascular Research
and Development, American Heart of Poland, Katowice, Poland
(Sanak) Division of Molecular Biology and Clinical Genetics, Jagiellonian
University Medical College, Krakow, Poland
(Buldak) Department of Internal Medicine and Clinical Pharmacology,
Medical University of Silesia, Katowice, Poland
Title
Eptifibatide infusion versus placebo in high risk patients with non-ST
segment elevation acute coronary syndromes managed with urgent coronary
artery bypass graft surgery. A prospective multicenter randomized
placebo-controlled clinical trial.
Source
Journal of Cardiovascular Surgery. 57 (1) (pp 100-110), 2016. Date of
Publication: February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: This randomized prospective clinical trial aimed to evaluate
safety and efficacy of preoperative use of eptifibatide in high risk
patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS),
requiring urgent coronary artery bypass graft surgery (CABG). METHODS: A
total of 140 patients with NSTE-ACS eligible for urgent surgical
revascularization received either eptifibatide (bolus plus infusion) 12-48
hours prior to surgery (N.=72 patients) or placebo (normal saline; N.=68
patients) followed by routinely administered enoxaparin and aspirin.
Patients were regarded as unsuitable for percutaneous coronary
intervention by the heart team. CABG was performed 4 hours after
discontinuation of eptifibatide or placebo infusion. The primary end point
was major adverse cardiac and cerebrovascular events (MACCE) defined as
death, nonfatal myocardial infarction (MI), stroke and the need for
rehospitalization due to recurrent ischemia at 12-month follow-up.
Secondary endpoints included MACCE rate at 1 month, bleeding
complications, platelet inhibition efficacy and correlation of platelet
activity with MACCE rate. RESULTS: Cumulative one year MACCE rate was 35%
vs. 14% in the control and treated group respectively (P=0.012). Mortality
rate at 30 days follow-up was 10% vs. 3% (P=0.021) and was not changed at
12-month follow-up. There was a significant difference between both groups
regarding perioperative MI (22% vs. 8%, P=0.03). The rates of stroke,
blood loss and blood transfusion were similar in both groups. CONCLUSION:
Preoperative use of eptifibatide vs. placebo is linked to significantly
reduced 12-month MACCE rate in patients with NSTEACS requiring urgent
CABG, while it simultaneously seems not to confer a greater risk of
postoperative bleeding.

<69>
Accession Number
612590603
Author
Xu Z.; Wang Z.-P.; Ou J.-S.; Yin S.-L.; Liu L.-J.; Zhang X.
Institution
(Xu, Wang, Ou, Yin, Zhang) Division of Cardiac Surgery, First Affiliated
Hospital of Sun Yat-sen University, 58 Zhong Shan Road II, Guangzhou,
Guangdong 510080, China
(Liu) Division of Cardiology, First Affiliated Hospital of Sun Yat-sen
University, Guangzhou, Guangdong, China
Title
Is low anticoagulation intensity more beneficial for patients with
bileaflet mechanical mitral valves? A meta-Analysis.
Source
Journal of Cardiovascular Surgery. 57 (1) (pp 90-99), 2016. Date of
Publication: February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: For the mitral valve replacement (MVR) using the lowest
thrombogenic risk bileaflet valves (St. Jude Medical [St Paul, MN, USA],
Carbomedics [Austin, TX, USA] and On-X [Austin, TX, USA]), excellent
results can be achieved by adopting the anticoagulation intensity (median
INRP<2.5) which is lower than the recommended intensity (INR:2.5~3.5). Our
aim was to provide a pooled estimate of potential benefit from clinical
studies using low anticoagulation intensity and high intensity in these
patients. METHODS: Relevant studies published before February 2014 were
searched through a number of digital databases (MEDLINE, EMBASE, Cochrane
Library, etc.). They were pooled by SPSS19.0 using the random effect
method in three fields: occurrence rate of major thromboembolism, major
hemorrhage and major total events. Fourteen studies with 3595 patients
were included. The follow-up period was 12,846.6 patient-years. RESULTS:
Pooled estimates indicated reduction in major hemorrhage (RR:0.420, 95%CI:
0.296~0.595, PP<0.001) and major total events (RR: 0.738, 95%CI:
0.604~0.902, P=0.003) in the low intensity group. No difference was noted
in major thromboembolism (RR: 1.045, 95%CI: 0.814~1.341, P=0.75).
CONCLUSION: Compared with the recommended high intensity, low
anticoagulation intensity (median INRP<2.5) may be more beneficial for the
MVR patients using the lowest thrombogenic risk bileaflet valves. We
recommended an INR between 2.0 and 2.5, with a median INR of 2.3 for these
MVR patients.

<70>
Accession Number
612316077
Author
Baumert M.; Pamula Y.; Martin J.; Kennedy D.; Ganesan A.; Kabir M.; Kohler
M.; Immanuel S.A.
Institution
(Baumert, Immanuel) School of Electrical and Electronic Engineering,
University of Adelaide, Adelaide, Australia
(Pamula, Martin, Kennedy) Dept of Respiratory and Sleep Medicine, Women's
and Children's Hospital, Adelaide, Australia
(Kennedy, Kohler) Childrens Research Centre, School of Paediatrics and
Reproductive Health, University of Adelaide, Adelaide, Australia
(Ganesan) Centre for Heart Rhythm Disorders, University of Adelaide, Royal
Adelaide Hospital, Adelaide, Australia
(Kabir) Oregon Health & Science University, Portland, OR, United States
(Kohler) School of Psychology, Social Work and Social Policy, University
of South Australia, Adelaide, Australia
Title
The effect of adenotonsillectomy for childhood sleep apnoea on
cardiorespiratory control.
Source
ERS Monograph. 2 (2) (no pagination), 2016. Article Number: 00003-2016.
Date of Publication: 01 Apr 2016.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
The efficacy of adenotonsillectomy for relieving obstructive sleep apnoea
symptoms in children has been firmly established, but its precise effects
on cardiorespiratory control are poorly understood. In 375 children
enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo
either adenotonsillectomy (n=194) or a strategy of watching waiting
(n=181), respiratory rate, respiratory sinus arrhythmia and heart rate
were analysed during quiet, non-apnoeic and non-hypopnoeic breathing
throughout sleep at baseline and at 7 months using overnight
polysomnography. Children who underwent early adenotonsillectomy
demonstrated an increase in respiratory rate postsurgery while the
watchful waiting group showed no change. Heart rate and respiratory sinus
arrhythmia were comparable between both arms. On assessing
cardiorespiratory variables with regard to normalisation of clinical
polysomnography findings during follow-up, heart rate was reduced in
children who had resolution of obstructive sleep apnoea syndrome, while no
differences in their respiratory rate or respiratory sinus arrhythmia were
observed. Adenotonsillectomy for obstructive sleep apnoea increases
baseline respiratory rate during sleep. Normalisation of apnoea-hypopnoea
index, spontaneously or via surgery, lowers heart rate. Considering the
small average effect size, the clinical significance is uncertain.
Copyright &#xa9; ERS 2016.

<71>
Accession Number
612270079
Author
Thadani U.
Institution
(Thadani) Department of Medicine, Cardiovascular Section, University of
Oklahoma HSC and VA Medical Center, OU Health Sciences Center, 920 Stanton
L Young Boulevard, Room WP3010, Oklahoma City, OK 73104, United States
Title
Management of Stable Angina - Current Guidelines: A Critical Appraisal.
Source
Cardiovascular Drugs and Therapy. 30 (4) (pp 419-426), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Guidelines provide recommendations to improve patient outcomes, but many
of the recommendations made for treating patients with stable angina are
opinion based rather than evidence based. Risk stratification to predict
patients at an increased risk of myocardial infarction (MI) and sudden
ischemic death, and selection of patients for possible revascularization,
is based on expert opinion. Randomized trials have compared optimal
medical therapy to revascularization, after the coronary anatomy was
known, and yet routine coronary angiography to exclude left main disease
is not recommended. What exactly is optimal antianginal treatment varies
considerably from one country's guideline recommendations to another. None
of the antianginal drugs reduce mortality or MI and these drugs are
equally effective in treating angina pectoris; and yet beta-blockers and
calcium channel blockers are recommended as first line therapy. Double and
triple therapy with different classes of antianginal drugs is also expert
opinion based rather than evidence based. Recommendations to reduce the
incidence of MI and sudden death are appropriate; however the use of a
potent, high dose statin, is recommended by AHA/ACC and NICE guidelines
for all patients with ischemic heart disease, while the European
guidelines recommend a target LDL goal in patients with coronary artery
disease (CAD). Management of patients with stable angina pectoris with
normal coronary arteries remains ambiguous. This short review critically
appraises the recommendations for managing patients with stable angina
pectoris. Copyright &#xa9; 2016, Springer Science+Business Media New York.

<72>
Accession Number
612590521
Author
Buyukates M.; Barut F.; Aktunc E.
Institution
(Buyukates) Department of Cardiovascular Surgery, Bulent Ecevit
University, School of Medicine, Kozlu, Zonguldak 67600, Turkey
(Barut) Department of Pathology, Bulent Ecevit University, School of
Medicine, Zonguldak, Turkey
(Aktunc) Department of Family Medicine, Bulent Ecevit University, School
of Medicine, Zonguldak, Turkey
Title
The comparison of traditional and modified harvesting techniques of left
internal mammary artery regarding endothelin-1/2/3 expression and free
flow capacity.
Source
Journal of Cardiovascular Surgery. 56 (6) (pp 913-918), 2015. Date of
Publication: December 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Aim. We have conducted this study to seek and observe visual clues through
immunohistochemical staining for differences in Et-1/2/3 expression and
the free-low capacity measuring the blood flow through grafts, in the left
internal mammary artery grafts prepared either with clipped or nonclipped
techniques. Methods. A total of 40 consecutive patients with a diagnosis
of coronary artery disease who would benefit from elective coronary artery
bypass graft surgery were randomised into two groups consisting 20
patients each. Left internal mammary artery was harvested by a traditional
clipped (control group) and a modified nonclipped (study group) technique
in each of the groups. All harvested arterial segments were evaluated for
luminal endothelial integrity through hematoxylin&eosin and
immunohistochemical staining. Results. The free-low capacity of left
internal mammary artery grafts were significantly higher in nonclipped
arteries when compared with that of clipped ones (P=0.001). The arterial
lumen of the nonclipped segments were visibly more dilated than the
clipped ones. Nonclipped segments presented a lighter immunostaining for
Et-1/2/3 when compared with the clipped ones (P<0.001). Conclusion. We
believe that lesser endothelial damage caused by the lower intraluminal
pressure in modifiedly harvested left internal mammary artery segments has
positive implications on intraoperative and postoperative cardiac events
related to graft vasospasm, especially related with endothelins. We
recommend modified left internal mammary artery harvesting in patients
going under coronary artery bypass graft operation.

<73>
Accession Number
612519799
Author
Wielandner A.; Beitzke D.; Schernthaner R.; Wolf F.; Langenberger C.;
Stadler A.; Loewe C.
Institution
(Wielandner, Beitzke, Schernthaner, Wolf, Langenberger, Loewe) Department
of Radiology, Medical University of Vienna, Vienna, Austria
(Stadler) Department of Radiology, Krankenhaus Hietzing, Vienna, Austria
Title
Is ECG triggering for motion artefact reduction in dualsource CT
angiography of the ascending aorta still required with high-pitch
scanning? The role of ECG-gating in highpitch dual-source CT of the
ascending aorta.
Source
British Journal of Radiology. 89 (1064) (no pagination), 2016. Article
Number: 20160174. Date of Publication: 2016.
Publisher
British Institute of Radiology (E-mail: publications@bir.org.uk)
Abstract
Objective: To compare electrocardiographic (ECG)- triggered high-pitch
(HP) dual-source CT angiography (CTA) with non-ECG-triggered HP CTA of the
aorta, particularly the ascending aorta, with regard to image quality,
motion artefacts, contrast-to-noise ratio (CNR), signal-to-noise ratio
(SNR) and radiation dose. Methods: 59 consecutive patients who had been
referred for CTA for known or suspected aortic disease, previous aortic
intervention or planned transapical or transfemoral aortic valve
implantation were prospectively included. Patients underwent CTAs with HP,
using a dual-source CTA system, with [control group (Group A); n=30] or
without (Group B; n=29) ECG triggering after randomization. For
evaluation, image quality and a motion artefact score (MAS) were assessed
in a blinded fashion at different predefined anatomic regions. CNR and SNR
were measured at the same levels. Radiation dose estimates and contrast
enhancement were compared between the two groups. Results: There were no
significant differences for image quality and MAS. The intra-arterial
contrast resolution was significantly higher at the level of the aortic
arch and descending aorta in the non-triggered group (CNR values,
p=0.002-0.018). No significant differences in the radiation dose were
found. Conclusion: Non-triggered HP dual-source CTA provided comparable
results with regard to image quality, MAS, CNR, SNR and radiation doses
compared with ECG-triggered HP CTA. Therefore, ECG triggering of the
ascending aorta might be obviated when HP scanning is available. Advances
in knowledge: HP dual-source CTA might obviate ECG triggering in the
ascending aorta. Nontriggered HP CTA of the ascending aorta provides an
excellent image quality. Copyright &#xa9; 2016 The Authors.

<74>
Accession Number
607257827
Author
Yamamoto S.; Hotta K.; Ota E.; Mori R.; Matsunaga A.
Institution
(Yamamoto) Department of Rehabilitation, Shinshu University Hospital,
Nagano, Japan
(Yamamoto, Matsunaga) Department of Rehabilitation Sciences, Graduate
School of Medical Sciences, Kitasato University, Kanagawa, Japan
(Hotta) Department of Biomedical Sciences, College of Medicine, Florida
State University, Tallahassee, FL, United States
(Ota, Mori) Department of Health Policy, National Center for Child Health
and Development, Tokyo, Japan
Title
Effects of resistance training on muscle strength, exercise capacity, and
mobility in middle-aged and elderly patients with coronary artery disease:
A meta-analysis.
Source
Journal of Cardiology. 68 (2) (pp 125-134), 2016. Date of Publication: 01
Aug 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Resistance training (RT) is a core component of cardiac
rehabilitation. We investigated the effects of RT on exercise capacity,
muscle strength, and mobility in middle-aged and elderly patients with
coronary artery disease (CAD). Methods We searched for randomized
controlled trials of RT versus usual care, or combined RT and aerobic
training (AT) versus AT alone, and identified 440 trials in total from
inception to January 2014. Participants who had myocardial infarction,
coronary revascularization, angina pectoris or CAD were included in the
analysis. Those who had heart failure, heart transplants with either
cardiac resynchronization therapy or implantable defibrillators were
excluded. Results Twenty-two trials totaling 1095 participants were
analyzed. We performed random-effects meta-analysis. In middle-aged
participants, RT increased lower extremity muscle strength [standardized
mean difference (SMD): 0.65, 95% confidence interval (CI): 0.35 to 0.95],
upper extremity muscle strength (SMD: 0.73, 95% CI: 0.48 to 0.99) and peak
oxygen consumption (VO<inf>2</inf>) [weight mean difference (WMD): 0.92
mL/kg/min, 95% CI: 0.12 to 1.72], but did not improve mobility compared
with the control. In elderly participants, RT increased lower extremity
muscle strength (SMD: 0.63, 95% CI: 0.05 to 1.21), upper extremity muscle
strength (SMD: 1.18, 95% CI: 0.56 to 1.80), and peak VO<inf>2</inf> (WMD:
0.70 mL/kg/min, 95% CI: 0.03 to 1.37), and improved mobility (SMD: 0.61,
95% CI: 0.21 to 1.01) compared with the control. Conclusions Resistance
training could increase exercise capacity and muscle strength in
middle-aged and elderly patients, and mobility in elderly patients, with
CAD. Copyright &#xa9; 2015 Japanese College of Cardiology

<75>
[Use Link to view the full text]
Accession Number
612287125
Author
Medeiros D.N.M.; Ferranti J.F.; Delgado A.F.; De Carvalho W.B.
Institution
(Medeiros, Ferranti) Pediatric Intensive Care Unit, Hospital Municipal Dr.
Moises Deutsch-M Boi Mirim, Av. Albert Einstein, 627/701, Sao Paulo
05652-900, Brazil
(Medeiros) Pediatric Intensive Care Unit, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Delgado, De Carvalho) Pediatric Intensive Care Department, Instituto da
Crianca, Sao Paulo, Brazil
Title
Colloids for the initial management of severe sepsis and septic shock in
pediatric patients a systematic review.
Source
Pediatric Emergency Care. 31 (11) (pp e11-e16), 2015. Date of Publication:
November 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aim: The goal of this study was to perform a systematic review of the
literature assessing the use of colloids for the initial treatment of
severe sepsis and septic shock in pediatric patients. Design: The PICO
[Patient, Intervention, Comparison, Outcome] method was used for the
selection of studies, and the Cochrane Bias Tool was used to analyze the
quality of the selected studies. Data Search: Relevant studies were sought
using the following databases: EMBASE (1980 to March 2014), PubMed (1970
to March 2014), Cochrane (1980 to March 2014), Web of Science, and Scopus.
Searches used the following key words: isotonic solution, crystalloid,
saline solution, colloid, resuscitation, fluid therapy, sepsis and septic
shock, starch, and gelatin. The filters children and clinical trial were
used when possible. Review Method: Study selection was performed by 1
examiner. The selected articles were analyzed by 2 examiners who validated
the articles according to the Cochrane Bias Tool. Discrepancies were
resolved by consensus or by a third examiner. Result: A total of 110
articles were selected based on the key words. Of these, 99 were excluded
because they assessed postoperative follow-up, burn cases, cardiac
surgery, or nutritional therapy or were review articles, guidelines, or
editorials. One study was included after an analysis of previous reviews.
A total of 12 articles were selected for analysis because they were
reports of clinical trials conducted with prospective cohorts and they
analyzed the use of crystalloids and colloids or colloids only in the
initial treatment of severe sepsis or septic shock in children and
adolescents. The total number of patients was 4375, and they ranged in age
from 2 months to 15 years, with most patients between 5 and 15 years. Five
studies assessed patients diagnosed with malaria, 5 assessed patients with
dengue shock syndrome, 1 studied febrile diseases, and 1 examined the
progression of patients with septic shock caused by various causes.
Conclusions: The studies analyzed did not find evidence to suggest that
the use of colloids is superior to crystalloids. In some studies, the
fluid volume needed to achieve initial stabilization was smaller in the
group given colloids. Crystalloids are the preferred therapeutic option
because of their effectiveness, low cost, and wide availability. Colloids
may be the first choice in cases of malaria when the central nervous
system is affected. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All
rights reserved.

<76>
Accession Number
612481745
Author
Vavuranakis M.; Siasos G.; Zografos T.; Oikonomou E.; Vrachatis D.;
Kalogeras K.; Papaioannou T.; Kolokathis M.-A.; Moldovan C.; Tousoulis D.
Institution
(Vavuranakis, Siasos, Zografos, Oikonomou, Vrachatis, Kalogeras,
Papaioannou, Kolokathis, Moldovan, Tousoulis) 1st Department of
Cardiology, 'Hippokration' Hospital, University of Athens Medical School,
Athens, Greece
(Siasos) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Title
Dual or single antiplatelet therapy after transcatheter aortic valve
implantation? A systematic review and meta-analysis.
Source
Current Pharmaceutical Design. 22 (29) (pp 4596-4603), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has undeniably
earned a prestigious post in the quiver of interventional cardiologists
against symptomatic severe aortic stenosis. Cerebrovascular events are
listed within the most frequent complications. Methods: We performed a
systematic search of EMBASE, MEDLINE, and the Cochrane library from
inception to March 2016 for the following search terms (transcatheter AND
antiplatelet) OR (transcatheter AND antithrombotic) to retrieve studies of
dual antiplatelet treatment (DAPT) and single antiplatelet treatment
(SAPT) in patients after TAVI to study thrombotic, hemorrhagic and
cardiovascular events at 30 days post procedure. From a total of 208
records 4 studies met inclusion criteria. Results: In the included
studies, 286 patients were enrolled in the DAPT group and 354 patients in
the SAPT group. There was no difference in all-cause mortality,
cardiovascular mortality, stroke, and myocardial infraction 30 days post
TAVI between DAPT and SAPT. However, patients in the DAPT group had a
significantly increased incidence of lethal and major bleeding at 30 days
of follow-up and the incidence of the combined end-point of stroke,
spontaneous MI, all-cause mortality and major bleeding was significantly
higher in the DAPT group in comparison to the SAPT group. Conclusion: DAPT
compared to SAPT in patients after TAVI increases incidence of hemorrhagic
events with no benefits in terms of thrombotic events and cardiovascular
mortality. However, these data must be interpreted cautiously and the
choice of DAPT over SAPT must be based on an individual patient
characteristic according to medical practice criteria. Copyright &#xa9;
2016 Bentham Science Publishers.

<77>
Accession Number
612481734
Author
Siasos G.; Mourouzis K.; Oikonomou E.; Vavuranakis M.; Vogiatzi G.;
Briasoulis A.; Papageorgiou N.; Papaioannou T.G.; Zografos T.;
Papapanagiotou A.; Papavassiliou A.G.; Stefanadis C.; Tousoulis D.
Institution
(Siasos) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School and Harvard-MIT Biomedical Engineering Center,
Massachusetts Institute of Technology, Boston, MA, United States
(Siasos, Mourouzis, Oikonomou, Vavuranakis, Vogiatzi, Briasoulis,
Papageorgiou, Papaioannou, Zografos, Tousoulis) Department of Cardiology,
'Hippokration' General Hospital, National and Kapodistrian University of
Athens, School of Medicine, Athens, Greece
(Papapanagiotou, Papavassiliou) Department of Biological Chemistry,
University of Athens Medical School, Athens, Greece
(Stefanadis) MYSM School Of Medicine, Yale University, New Haven, CT,
United States
Title
Duration of dual antiplatelet therapy after coronary stenting.
Source
Current Pharmaceutical Design. 22 (29) (pp 4583-4595), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Dual antiplatelet therapy (DAPT) is one of the cornerstones of
coronary artery disease (CAD) treatment. Standard DAPT requires one of,
P2Y12 receptor inhibitors, clopidogrel, prasugrel or ticagrelor as an
adjunct therapy to aspirin administration. The decision over DAPT duration
depends on the evaluation of thrombotic risk and the assessment of the
probability for major bleeding events. Methods: The goal of this work was
to identify which would be the appropriate combination of antiplatelet
agents and the optimal duration of DAPT, based on the patient's medical
history and clinical characteristics. A thorough search of PubMed and the
Cochrane Database was conducted in order to identify randomized controlled
trials, observational studies, current ESC and ACC/AHA guidelines and
novel articles on the subject. Results: The decision over DAPT duration is
based on a careful approach which requires the evaluation of thrombotic
risk and the assessment of the probability for major bleeding events. A
series of aspects and special conditions may influence the duration of
DAPT after stenting e.g. the type of the implanted stent (DES or BMS) or
if the commencement of DAPT is administered in the context of an acute
coronary syndrome or in the setting of stable CAD. Current guidelines can
assist clinicians in making decisions but treating patients in special
groups e.g. with diabetes mellitus or the elderly people can be very
demanding. Conclusion: Studies which examined optimal DAPT duration,
displayed controversial results, mainly observed because of the
discrepancy and heterogeneity between different study designs or the
decision of a great proportion of investigators to statistically test for
non-inferiority. A careful, patient-centered approach, which considers
thrombotic risk versus the risk for bleeding complications and other
individual characteristics and comorbidities, is required when deciding
DAPT duration. Copyright &#xa9; 2016 Bentham Science Publishers.

<78>
Accession Number
612502022
Author
Lee M.S.; Shlofmitz E.; Nguyen H.; Shlofmitz R.A.
Institution
(Lee, Nguyen) UCLA Medical Center, Los Angeles, CA, United States
(Shlofmitz) Northwell Health, Manhasset, NY, United States
(Shlofmitz) St. Francis Hospital-The Heart Center, Roslyn, NY, United
States
Title
Outcomes in Diabetic Patients Undergoing Orbital Atherectomy System.
Source
Journal of Interventional Cardiology. 29 (5) (pp 491-495), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We evaluated the angiographic and clinical outcomes of orbital
atherectomy to treat severely calcified coronary lesions in diabetic and
non-diabetic patients. Background: Diabetics have increased risk for
death, myocardial infarction, and target vessel revascularization after
percutaneous coronary intervention. Severely calcified coronary lesions
are associated with increased cardiac events. Orbital atherectomy
facilitates stent delivery and optimizes stent expansion by modifying
severely calcified plaque. Outcomes in diabetic patients who undergo
orbital atherectomy have not been reported. Methods: Our retrospective
multicenter registry included 458 consecutive real-world patients with
severely calcified coronary arteries who underwent orbital atherectomy.
The primary safety endpoint was the rate of major adverse cardiac and
cerebrovascular events at 30 days. Results: Diabetics represented 42.1%
(193/458) of the entire cohort. The primary endpoint was similar in
diabetics and non-diabetics (1.0% vs. 3.0%%, P = 0.20), as were 30-day
rates of death (0.5% vs. 1.9%, P = 0.41), myocardial infarction (0.5% vs.
1.5%, P = 0.40), target vessel revascularization (0% vs. 0%, P = 1), and
stroke (0% vs. 0.4%, P > 0.9). Angiographic complications and stent
thrombosis rate were low and did not differ between the 2 groups.
Conclusion: Diabetics represented a sizeable portion of patients who
underwent orbital atherectomy. Diabetics who had severely calcified
coronary arteries and underwent orbital atherectomy had low event rates
that were similar to non-diabetics. Orbital atherectomy appears to be a
viable treatment strategy for diabetic patients. Randomized trials with
longer-term follow-up are needed to determine the ideal treatment strategy
for diabetics. Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<79>
Accession Number
612437468
Author
Fender E.A.; Kiani J.G.; Holmes D.R.
Institution
(Fender, Kiani, Holmes) Department of Cardiovascular Diseases, Mayo
Clinic, 200 1st Street SW, Rochester, MN 55905, United States
Title
Left Atrial Appendage Closure for Stroke Prevention in Atrial
Fibrillation.
Source
Current Atherosclerosis Reports. 18 (11) (no pagination), 2016. Article
Number: 65. Date of Publication: 01 Nov 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Anticoagulant therapy effectively reduces the incidence
of stroke in patients with atrial fibrillation (AF) but is underutilized
and frequently contraindicated. The left atrial appendage (LAA) is the
primary site of thrombus formation in AF patients. Surgical and
percutaneous appendage closure has been evaluated as a site-specific
therapy to reduce systemic thromboembolism. Recent Findings: We will
review LAA closure techniques, examine recent outcome data, and discuss
the indications for, and potential complications of, each approach.
Summary: Randomized data examining surgical LAA closure and epicardial
closure with the LARIAT device are lacking. High quality, randomized data
supports the efficacy of the WATCHMAN device for stroke prevention in
patients with AF. Copyright &#xa9; 2016, Springer Science+Business Media
New York.

<80>
Accession Number
612353110
Author
Cappato R.; Welsh R.
Institution
(Cappato) Arrhythmia and Electrophysiology Research Center, Humanitas
Clinical and Research Center, Rozzano, Italy
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Title
Exploring unmet needs in venous and arterial thromboembolism with
rivaroxaban.
Source
Thrombosis and Haemostasis. 116 (pp S2-S12), 2016. Date of Publication:
2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
The vast clinical research programme for the direct, oral factor Xa
inhibitor rivaroxaban has generated a wealth of data since the first
rivaroxaban approval in 2008 for the prevention of venous thrombo-embolism
(VTE) in patients undergoing elective hip or knee replacement surgery.
While rivaroxaban is widely used across a spectrum of seven indications,
there is continuous commitment to investigating its wider benefits in new
indications and attempts to refine current evidence. Key data from
recently completed randomised controlled trials (RCTs) have shown that
rivaroxaban is a feasible anticoagulation option for patients with
non-valvular atrial fibrillation (NVAF) undergoing cardioversion or
catheter ablation. Now, a number of Phase II and III RCTs are underway
that seek to uncover further roles for rivaroxaban in patients at risk of
thrombosis and aim to improve quality of life. This article will introduce
and provide context for these RCTs in the contemporary management of
arterial and venous thromboembolism in the following underserved areas:
Patients with both NVAF and acute coronary syndrome (ACS) requiring
percutaneous coronary intervention (PCI); patients with embolic stroke of
undetermined source (ESUS); patients who require transcatheter aortic
valve replacement (TAVR); patients with acute or chronic coronary artery
disease (CAD; including those with heart failure [HF]); those at risk of
or suffering from cancer-associated thrombosis (CAT) and those requiring
long-term anticoagulation. It is hoped that this collection of studies
provides clarity around the use of rivaroxaban as a fundamental component
of antithrombotic therapy in an array of clinical situations. Copyright
&#xa9; Schattauer 2016.

<81>
Accession Number
612342036
Author
Nicholson G.; Gandra S.R.; Halbert R.J.; Richhariya A.; Nordyke R.J.
Institution
(Nicholson, Halbert, Nordyke) ICON, El Segundo, United States
(Gandra, Richhariya) Amgen Inc., Thousand Oaks, CA, United States
Title
Patient-level costs of major cardiovascular conditions: A review of the
international literature.
Source
ClinicoEconomics and Outcomes Research. 8 (pp 495-506), 2016. Date of
Publication: 21 Sep 2016.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand)
Abstract
Objective: Robust cost estimates of cardiovascular (CV) events are
required for assessing health care interventions aimed at reducing the
economic burden of major adverse CV events. This review synthesizes
international cost estimates of CV events. Methods: MEDLINE database was
searched electronically for English language studies published during
2007-2012, with cost estimates for CV events of interest - unstable
angina, myocardial infarction, heart failure, stroke, and CV
revascularization. Included studies provided at least one estimate of
patient-level direct costs in adults for any identified country.
Information on study characteristics and cost estimates were collected.
All costs were adjusted for inflation to 2013 values. Results: Across the
114 studies included, the average cost was US $6,466 for unstable angina,
$11,664 for acute myocardial infarction, $11,686 for acute heart failure,
$11,635 for acute ischemic stroke, $37,611 for coronary artery bypass
graft, and $13,501 for percutaneous coronary intervention. The ranges for
cost estimates varied widely across countries with US cost estimate being
at least twice as high as European Union costs for some conditions. Few
studies were found on populations outside the US and European Union.
Conclusion: This review showed wide variation in the cost of CV events
within and across countries, while showcasing the continuing economic
burden of CV disease. The variability in costs was primarily attributable
to differences in study population, costing methodologies, and reporting
differences. Reliable cost estimates for assessing economic value of
interventions in CV disease are needed. Copyright &#xa9; 2016 Nicholson et
al.

<82>
Accession Number
608719832
Author
Frymoyer A.; Su F.; Grimm P.C.; Sutherland S.M.; Axelrod D.M.
Institution
(Frymoyer, Su, Grimm, Sutherland, Axelrod) Department of Pediatrics,
Stanford University, Stanford, CA, United States
Title
Theophylline Population Pharmacokinetics and Dosing in Children Following
Congenital Heart Surgery With Cardiopulmonary Bypass.
Source
Journal of Clinical Pharmacology. 56 (9) (pp 1084-1093), 2016. Date of
Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB)
frequently develop acute kidney injury due to renal ischemia.
Theophylline, which improves renal perfusion via adenosine receptor
inhibition, is a potential targeted therapy. However, children undergoing
cardiac surgery and CPB commonly have alterations in drug
pharmacokinetics. To help understand optimal aminophylline (salt
formulation of theophylline) dosing strategies in this population, a
population-based pharmacokinetic model was developed using nonlinear
mixed-effects modeling (NONMEM) from 71 children (median age 5 months; 90%
range 1 week to 10 years) who underwent cardiac surgery requiring CPB and
received aminophylline as part of a previous randomized controlled trial.
A 1-compartment model with linear elimination adequately described the
pharmacokinetics of theophylline. Weight scaled via allometry was a
significant predictor of clearance and volume. In addition, allometric
scaled clearance increased with age implemented as a power maturation
function. Compared to prior reports in noncardiac children, theophylline
clearance was markedly reduced across age. In the final population
pharmacokinetic model, optimized empiric dosing regimens were developed
via Monte Carlo simulations. Doses 50% to 75% lower than those recommended
in noncardiac children were needed to achieve target serum concentrations
of 5 to 10 mg/L. Copyright &#xa9; 2016, The American College of Clinical
Pharmacology

<83>
Accession Number
607332438
Author
Yano H.; Horinaka S.; Ishikawa M.; Ishimitsu T.
Institution
(Yano, Horinaka, Ishikawa, Ishimitsu) Department of Cardiology, Nasu Red
Cross Hospital, Ohtawara, Tochigi 324-8686, Japan
(Yano, Horinaka, Ishikawa, Ishimitsu) Department of Cardiology and
Nephrology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan
Title
The efficacy of everolimus-eluting stent implantation in patients with
ST-segment elevation myocardial infarction: outcomes of 2-year clinical
follow-up.
Source
Heart and Vessels. 31 (10) (pp 1609-1615), 2016. Date of Publication: 01
Oct 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
First-generation drug-eluting stents (DES) demonstrated delay in vascular
healing and increase in incidence of late and very late stent thrombosis
compared with bare-metal stents (BMS). Second-generation DES, however,
have shown a reduction of late and very late stent thrombosis compared
with first-generation DES. Thus, we decided to evaluate whether the
second-generation everolimus-eluting stent (EES) has an advantage over BMS
in Japanese patients with ST-segment elevation myocardial infarction
(STEMI). This study was conducted in two centers, retrospective,
non-randomized and observational design in patients with STEMI.
Three-hundred eighty patients were randomly selected to receive EES (198
patients) or cobalt-chromium BMS (182 patients). The primary endpoints
were cardiac death, recurrent myocardial infarction (MI), target lesion
revascularization (TLR), target vessel revascularization (TVR), and stent
thrombosis (ST). At 2 years, the rates of TLR, TVR, and recurrent MI were
significantly lower in the EES group than in the BMS group (TLR 1.5 vs.
8.3 %, p < 0.05; TVR 2.5 vs. 9.4 %, p < 0.05; recurrent MI 1.0 vs. 4.1 %,
p < 0.05), and the rate of ST was also significantly lower in the EES
group than in the BMS group (0.5 vs. 4.3 %, p < 0.05). Thus, major adverse
cardiac events defined at the composite cardiac death, MI, TLR, TVR, or ST
were significantly lower in EES group than in BMS group (3.0 vs. 9.9 %, p
= 0.008). The rate of cardiac death, however, did not differ between both
groups. In STEMI patients, EES may be associated with improved
outcomes-specifically, a significant reduction in TVR, ST, and recurrent
MI compared to BMS throughout 2 years. Copyright &#xa9; 2015, Springer
Japan.

<84>
[Use Link to view the full text]
Accession Number
612710967
Author
Ciolac E.G.; Castro R.E.; Greve J.M.; Bacal F.; Bocchi E.A.; Guimaraes
G.V.
Institution
(Ciolac, Castro, Greve, Bacal, Bocchi, Guimaraes) 1Exercise and Chronic
Disease Research Laboratory, Physical Education Department, School of
Sciences, Sao Paulo State University - UNESP, Bauru, BRAZIL; 2Heart
Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade
de Sao Paulo, Sao Paulo, BRAZIL; 3Institute of Orthopedics and
Traumatology, Hospital das Clinicas da Faculdade de Medicina da
Universidade de Sao Paulo, Sao Paulo, BRAZIL
Title
Prescribing and Regulating Exercise with RPE after Heart Transplant: A
Pilot Study.
Source
Medicine and science in sports and exercise. 47 (7) (pp 1321-1327), 2015.
Date of Publication: 01 Jul 2015.
Abstract
PURPOSE: The objective of this study is to analyze the use of the 6-20 RPE
scale for prescribing and self-regulating heated water-based exercise
(HEx) and land-based exercise (LEx) in heart transplant recipients.
METHODS: Fifteen (five females) clinically stable heart transplant
recipients (time since surgery = 4.0 +/- 2.5 yr) age 46.7 +/- 11.8 yr
underwent a symptom-limited maximal graded exercise test on a treadmill to
determine their HR at anaerobic threshold (HRAT), respiratory compensation
point (HRRCP), and maximal effort (HRmax). After a week, patients were
randomized to perform 30 min of both HEx (walking inside the pool) and LEx
(treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE
scale and had their HR measured every 4 min. The interval between sessions
was 48-72 h.
RESULTS: No significant differences between sessions were found in the
average HR during HEx and LEx. Patients showed a delay in HR increase
during both interventions, with the stabilization beginning after 8 min of
exercise. Exercise HR was maintained between the HRAT and HRRCP (in the
aerobic exercise training zone) for the most part of both HEx (72% of HR
measurements) and LEx (66% of HR measurements). Only a few HR measurements
stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx =
21%) during both exercise sessions.
CONCLUSION: Exercise HR was maintained in the aerobic exercise training
zone (between HRAT and HRRCP) for the most part of both sessions,
suggesting that the 6-20 RPE scale may be an efficient tool for
prescribing and self-regulating HEx and LEx in heart transplant
recipients.

<85>
Accession Number
612723491
Author
Tasca G.; Martino A.S.; Giannico F.; Riva B.; Redaelli P.; Lobiati E.;
Triggiani M.; Galanti A.; Gamba A.
Title
Hemodynamic comparison between Trifecta and Freestyle valves implanted in
small aortic roots. One-year echocardiographic results from a prospective
randomized study.
Source
The Journal of heart valve disease. 24 (3) (pp 360-367), 2015. Date of
Publication: 01 May 2015.
Abstract
BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement in patients with
a small aortic root may be associated to high residual gradients. In such
patients, both stentless valves and aortic annulus enlargement can reduce
these residual gradients. Several studies have reported that Trifecta
valves yield very good hemodynamic results. The aim of the present study
was to compare the hemodynamic performance of Trifecta vs. Freestyle
valves at one year in patients with an aortic annulus < 2.3 cm.
METHODS: Between September 2011 and September 2013, 40 patients with a
native aortic annulus diameter < 2.3 cm and average age of 81 +/- 4 years,
were randomized to receive either a St-Jude Trifecta stented prosthesis
(20 patients) or a Medtronic Freestyle stentless prosthesis (20 patients).
RESULTS: No differences between Trifecta and Freestyle were found at one
year in mean gradient s: 6.1 +/- 3 mmHg and 6.6 +/- 3 mmHg (p = 0.796);
effective ori fice area: 1.82 +/- 0.3 mmHg and 1.76 +/- 0.4 mmHg (p =
0.676) or regression of left ventricular mass: - 25% +/- 14 vs. -19% +/-
16 (p = 0.204), respectively. Only moderate patient -pro sthesis mismatch
was found, which affected 3 patient s in each group.
CONCLUSION: At one year both stentless and stented prostheses yielded
comparable hemodynamic results. These data suggest that Trifecta
implantation is a valid means of avoiding patient -prosthesis mismatch in
aortic valve replacement in elderly patients with a small native aortic
annulus.

<86>
Accession Number
612722609
Author
Taylor R.S.; Dalal H.; Jolly K.; Zawada A.; Dean S.G.; Cowie A.; Norton
R.J.
Institution
(Taylor, Dalal, Jolly, Zawada, Dean, Cowie, Norton) Institute of Health
Research, University of Exeter Medical School, Exeter, UK, EX2 4SG
Title
Home-based versus centre-based cardiac rehabilitation.
Source
The Cochrane database of systematic reviews. 8 (pp CD007130), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Cardiovascular disease is the most common cause of death
globally. Traditionally, centre-based cardiac rehabilitation programmes
are offered to individuals after cardiac events to aid recovery and
prevent further cardiac illness. Home-based cardiac rehabilitation
programmes have been introduced in an attempt to widen access and
participation. This is an update of a review originally published in 2009.
OBJECTIVES: To compare the effect of home-based and supervised
centre-based cardiac rehabilitation on mortality and morbidity,
health-related quality of life, and modifiable cardiac risk factors in
patients with heart disease.
SEARCH METHODS: To update searches from the previous Cochrane review, we
searched the Cochrane Central Register of Controlled Trials (CENTRAL, The
Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1
2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to
October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked
reference lists of included trials and recent systematic reviews. No
language restrictions were applied.
SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared
centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports
centre) with home-based programmes in adults with myocardial infarction
(MI), angina, heart failure or who had undergone revascularisation.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed the
eligibility of the identified trials and data were extracted by a single
author and checked by a second. Authors were contacted where possible to
obtain missing information.
MAIN RESULTS: Seventeen trials included a total of 2172 participants
undergoing cardiac rehabilitation following an acute MI or
revascularisation, or with heart failure. This update included an
additional five trials on 345 patients with heart failure. Authors of a
number of included trials failed to give sufficient detail to assess their
potential risk of bias, and details of generation and concealment of
random allocation sequence were particularly poorly reported. In the main,
no difference was seen between home- and centre-based cardiac
rehabilitation in outcomes up to 12 months of follow up: mortality
(relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P =
0.46, fixed-effect), cardiac events (data not poolable), exercise capacity
(standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P =
0.29, random-effects), modifiable risk factors (total cholesterol: mean
difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47,
random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L,
95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure:
mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92,
random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79
to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not
poolable). Small outcome differences in favour of centre-based
participants were seen in high density lipoprotein cholesterol (MD = -0.07
mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides
(MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect,
diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P =
0.0009, fixed-effect). In contrast, in home-based participants, there was
evidence of a marginally higher levels of programme completion (RR = 1.04,
95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the
programme (not poolable). No consistent difference was seen in healthcare
costs between the two forms of cardiac rehabilitation.
AUTHORS' CONCLUSIONS: This updated review supports the conclusions of the
previous version of this review that home- and centre-based forms of
cardiac rehabilitation seem to be equally effective for improving the
clinical and health-related quality of life outcomes in low risk patients
after MI or revascularisation, or with heart failure. This finding,
together with the absence of evidence of important differences in
healthcare costs between the two approaches, supports the continued
expansion of evidence-based, home-based cardiac rehabilitation programmes.
The choice of participating in a more traditional and supervised
centre-based programme or a home-based programme should reflect the
preference of the individual patient. Further data are needed to determine
whether the effects of home- and centre-based cardiac rehabilitation
reported in these short-term trials can be confirmed in the longer term. A
number of studies failed to give sufficient detail to assess their risk of
bias.

<87>
Accession Number
612722587
Author
Kuhn E.W.; Slottosch I.; Wahlers T.; Liakopoulos O.J.
Institution
(Kuhn, Slottosch, Wahlers, Liakopoulos) Department of Cardiothoracic
Surgery, Heart Center, University of Cologne, Kerpener Strasse 62,
Cologne, Germany, 50924
Title
Preoperative statin therapy for patients undergoing cardiac surgery.
Source
The Cochrane database of systematic reviews. 8 (pp CD008493), 2015. Date
of Publication: 2015.
Abstract
BACKGROUND: Patients referred to cardiac surgery for cardiovascular
disease are at significant risk for the development of major postoperative
adverse events despite significant advances in surgical techniques and
perioperative care. Statins (5-hydroxy-3-methylglutaryl-co-enzyme A
(HMG-CoA) reductase inhibitors) have gained a pivotal role in the primary
and secondary prevention of coronary artery disease and are thought to
improve perioperative outcomes in patients undergoing cardiac surgery.
This review is an updated version of a review that was first published in
2012.
OBJECTIVES: To determine the effectiveness of preoperative statin therapy
in patients undergoing cardiac surgery.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) (2013, Issue 11), MEDLINE (1950 to November 2013 Week 3),
EMBASE (1980 to 3 December 2013 (Week 48)) and the metaRegister of
Controlled Trials. Additionally, we searched ongoing trials through the
National Research Register, the ClinicalTrials.gov registry and grey
literature. We screened online conference indices from relevant scientific
meetings (2006 to 2014) to look for eligible trials. We applied no
language restrictions.
SELECTION CRITERIA: All randomised controlled trials comparing any statin
treatment before cardiac surgery, for any given duration and dose, versus
no preoperative statin therapy (standard of care) or placebo.
DATA COLLECTION AND ANALYSIS: Two review authors evaluated trial quality
and extracted data from titles and abstracts identified by electronic
database searches according to predefined criteria. Accordingly, we
retrieved full-text articles of potentially relevant studies that met the
inclusion criteria to assess definitive eligibility for inclusion. We
reported effect measures as odds ratios (ORs) or weighted mean differences
(WMDs) with 95% confidence intervals (95% CIs).
MAIN RESULTS: We identified 17 randomised controlled studies including a
total of 2138 participants undergoing on-pump or off-pump cardiac surgical
procedures, and added to this review six studies with 1154 additional
participants. Pooled analysis showed that statin treatment before surgery
reduced the incidence of postoperative atrial fibrillation (AF) (OR 0.54,
95% CI 0.43 to 0.67; P value < 0.01; 12 studies, 1765 participants) but
failed to influence short-term mortality (OR 1.80, 95% CI 0.38 to 8.54; P
value = 0.46; two studies, 300 participants) or postoperative stroke (OR
0.70, 95% CI 0.14 to 3.63; P value = 0.67; two studies, 264 participants).
In addition, statin therapy was associated with a shorter stay for
patients on the intensive care unit (ICU) (WMD -3.19 hours, 95% CI -5.41
to -0.98; nine studies, 721 participants) and in the hospital (WMD -0.48
days, 95% CI -0.78 to -0.19; 11 studies, 1137 participants) when
significant heterogeneity was observed. Results showed no reduction in
myocardial infarction (OR 0.48, 95% CI 0.21 to 1.13; seven studies, 901
participants) or renal failure (OR 0.57, 95% CI 0.30 to 1.10; five
studies, 467 participants) and were not affected by subgroup analysis.
Trials investigating this safety endpoint reported no major or minor
perioperative side effects of statins.
AUTHORS' CONCLUSIONS: Preoperative statin therapy reduces the odds of
postoperative atrial fibrillation (AF) and shortens the patient's stay on
the ICU and in the hospital. Statin pretreatment had no influence on
perioperative mortality, stroke, myocardial infarction or renal failure,
but only two of all included studies assessed mortality. As analysed
studies included mainly individuals undergoing myocardial
revascularisation, results cannot be extrapolated to patients undergoing
other cardiac procedures such as heart valve or aortic surgery.

<88>
Accession Number
612725647
Author
Guizilini S.; Viceconte M.; Esperanca G.T.; Bolzan D.W.; Vidotto M.;
Moreira R.S.; Cancio A.A.; Gomes W.J.
Institution
(Guizilini) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Viceconte) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Esperanca) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Bolzan) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Vidotto) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Moreira) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Cancio) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
(Gomes) Sao Paulo Hospital, Escola Paulista de Medicina, Universidade
Federal de Sao Paulo, Sao Paulo, SP, Brazil
Title
Pleural subxyphoid drain confers better pulmonary function and clinical
outcomes in chronic obstructive pulmonary disease after off-pump coronary
artery bypass grafting: a randomized controlled trial.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 29 (4) (pp 588-594), 2014. Date of
Publication: 01 Oct 2014.
Abstract
OBJECTIVE: To evaluate the lung function and clinical outcome in severe
chronic obstructive pulmonary disease in patients undergoing off-pump
coronary artery bypass grafting with left internal thoracic artery graft,
comparing the pleural drain insertion in the intercostal versus subxyphoid
region.
METHODS: A randomized controlled trial. Chronic obstructive pulmonary
disease patients were randomized into two groups according pleural drain
site: II group (n=27) - pleural drain in intercostal space; SI group
(n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced
Vital Capacity - and Forced expiratory volume in 1 second) were obtained
on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from
preoperative until postoperative day 5 (POD5) was performed for monitoring
respiratory events, such as atelectasis and pleural effusion. Pulmonary
shunt fraction and pain score was evaluate preoperatively and on
postoperative day 1.
RESULTS: In both groups there was a significant decrease of the spirometry
values (Forced Vital Capacity and Forced expiratory volume in 1 second)
until POD5 (P<0.05). However, when compared, SI group presented less
decrease in these parameters (P<0.05). Pulmonary shunt fraction was
significantly lower in SI group (P<0.05). Respiratory events, pain score,
orotracheal intubation time and postoperative length of hospital stay were
lower in the SI group (P<0.05).
CONCLUSION: Subxyphoid pleural drainage in severe Chronic obstructive
pulmonary disease patients determined better preservation and recovery of
pulmonary capacity and volumes with lower pulmonary shunt fraction and
better clinical outcomes on early postoperative off-pump coronary artery
bypass grafting.

<89>
Accession Number
612725549
Author
Erdil N.; Kaynak M.; Donmez K.; Disli O.M.; Battaloglu B.
Institution
(Erdil) Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
(Kaynak) Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
(Donmez) Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
(Disli) Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
(Battaloglu) Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
Title
Nebivolol in preventing atrial fibrillation following coronary surgery in
patients over 60 years of age.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 29 (4) (pp 581-587), 2014. Date of
Publication: 01 Oct 2014.
Abstract
OBJECTIVE: Postoperative atrial fibrillation is a common complication
after cardiac surgery, with an incidence as high as 20-50%. Increased age
is associated with a significant increase in postoperative atrial
fibrillation risk. This common complication is associated with higher
morbidity and mortality rates. The aim of this study was to assess the
efficacy of nebivolol in preventing atrial fibrillation following coronary
artery bypass surgery in patients over 60 years of age.
METHODS: In this prospective randomized study, 200 patients who were
candidates for elective coronary artery bypass surgery were divided into
two groups. The first group was administered with nebivolol and the second
group was administered with metoprolol. Treatment was initiated four days
prior to surgery, and patients were monitored for atrial fibrillation
until discharge. Forty-one patients received 50 mg metoprolol succinate
daily, which was initiated minimum 4 days before surgery.
RESULTS: Demographic data were similar in both groups. The incidence of
postoperative atrial fibrillation in both groups was similar, with no
significant difference being identified [n=20 (20%); n=18 (18%), P=0.718;
respectively]. There were not any mortality at both groups during study.
Inotropic agent requirement at ICU was similar for both groups [n=12
(12%), n=18 (18%), P=0.32].
CONCLUSION: We compared the effectiveness of nebivolol and metoprolol in
decreasing the incidence of postoperative atrial fibrillation, and
determined that nebivolol was as effective as metoprolol in preventing
postoperative atrial fibrillation at patients. Nebivolol may be the drug
of choice due to its effects, especially after elective coronary artery
bypass surgery.

<90>
Accession Number
612660920
Author
Donohue J.M.; Belnap B.H.; Men A.; He F.; Roberts M.S.; Schulberg H.C.;
Reynolds C.F.; Rollman B.L.
Institution
(Donohue) Department of Health Policy and Management, University of
Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
(Belnap) Division of General Internal Medicine, Center for Research on
Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA,
USA
(Men) Department of Health Policy and Management, University of Pittsburgh
Graduate School of Public Health, Pittsburgh, PA, USA
(He) Department of Psychiatry, University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA
(Roberts) Department of Health Policy and Management, University of
Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Division
of General Internal Medicine, Center for Research on Health Care,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, USA
(Reynolds) Department of Psychiatry, University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA
(Rollman) Division of General Internal Medicine, Center for Research on
Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA,
USA. Electronic address: rollmanbl@upmc.edu
Title
Twelve-month cost-effectiveness of telephone-delivered collaborative care
for treating depression following CABG surgery: a randomized controlled
trial.
Source
General hospital psychiatry. 36 (5) (pp 453-459), 2014. Date of
Publication: 01 Sep 2014.
Abstract
OBJECTIVE: To determine the 12-month cost-effectiveness of a collaborative
care (CC) program for treating depression following coronary artery bypass
graft (CABG) surgery versus physicians' usual care (UC).
METHODS: We obtained 12 continuous months of Medicare and private medical
insurance claims data on 189 patients who screened positive for depression
following CABG surgery, met criteria for depression when reassessed by
telephone 2 weeks following hospitalization (nine-item Patient Health
Questionnaire >10) and were randomized to either an 8-month centralized,
nurse-provided and telephone-delivered CC intervention for depression or
to their physicians' UC.
RESULTS: At 12 months following randomization, CC patients had $2068 lower
but statistically similar estimated median costs compared to UC (P=.30)
and a variety of sensitivity analyses produced no significant changes. The
incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838)
per additional quality-adjusted life-year (QALY), and there was 90%
probability it would be cost-effective at the willingness to pay threshold
of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane
also demonstrated a 68% probability of CC "dominating" UC (more QALYs at
lower cost).
CONCLUSIONS: Centralized, nurse-provided and telephone-delivered CC for
post-CABG depression is a quality-improving and cost-effective treatment
that meets generally accepted criteria for high-value care. Copyright
&#xa9; 2014 Elsevier Inc. All rights reserved.

<91>
Accession Number
612728934
Author
Landoni G.; Zangrillo A.; Lomivorotov V.V.; Likhvantsev V.; Ma J.; De
Simone F.; Fominskiy E.
Institution
(Landoni, Zangrillo, De Simone, Fominskiy) Department of Anaesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesia and Intensive Care,
Academician en Meshalkin Novosibirsk, State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Centre for Anaesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Cardiac protection with phosphocreatine: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 637-646),
2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Phosphocreatine (PCr) plays an important role in the energy metabolism of
the heart and a decrease in its intracellular concentration results in
alteration of myocardium energetics and work. We conducted a meta-analysis
of all randomized and matched trials that compared PCr with placebo or
standard treatment in patients with coronary artery disease or chronic
heart failure or in those undergoing cardiac surgery. We systematically
searched PubMed/Medline, Embase, Cochrane Central Register of Controlled
Trials and Google Scholar up to 1 November 2015, for pertinent trials. The
primary outcome was all-cause mortality. Secondary outcomes included
inotrope use, ejection fraction (EF), peak creatinine kinase-myocardial
band (CK-MB) release and the incidence of major arrhythmias, as well as
spontaneous recovery of the heart performance in the subgroup of patients
undergoing cardiac surgery with cardiopulmonary bypass. We pooled odds
ratio (OR) and mean difference (MD) using fixed- and random effects
models. We identified 41 controlled trials, of them 32 were randomized.
Patients receiving PCr had lower all-cause mortality when compared with
the control group [61/1731 (3.5%) vs 177/1667 (10.6%); OR: 0.71, 95% CI:
0.51-0.99; P = 0.04; I² = 0%; with 3400 patients and 22 trials
included]. Phosphocreatine administration was associated with higher LVEF
(MD: 3.82, 95% CI: 1.18-6.46; P = 0.005; I² = 98%), lower peak
CK-MB release (MD: -6.08, 95% CI: -8.01, -4.15; P < 0.001; I² =
97%), lower rate of major arrhythmias (OR: 0.42; 95% CI: 0.27-0.66; P <
0.001; I² = 0%), lower incidence of inotropic support (OR:
0.39, 95% CI: 0.25-0.61; P < 0.001; I² = 56%) and a higher
level of spontaneous recovery of the heart performance after
cardiopulmonary bypass (OR: 3.49, 95% CI: 2.28-5.35; P < 0.001;
I² = 49%) when compared with the control group. In a mixed
population of patients with coronary artery disease, chronic heart failure
or in those undergoing cardiac surgery, PCr may reduce all-cause
short-term mortality. In addition, PCr administration was associated with
improved cardiac outcomes. Owing to the pharmacological plausibility of
this effect and to the concordance of the beneficial effects of PCr on
several secondary but important outcomes and survival, there is urgent
need for a large multicentre randomized trial to confirm these findings.
Copyright &#xa9; 2016 The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<92>
Accession Number
612728932
Author
Ammirati E.; Cipriani M.G.; Varrenti M.; Colombo T.; Garascia A.; Cannata
A.; Pedrazzini G.; Benazzi E.; Milazzo F.; Oliva F.; Gagliardone M.P.;
Russo C.F.; Frigerio M.
Institution
(Ammirati, Cipriani, Varrenti, Colombo, Garascia, Cannata, Pedrazzini,
Milazzo, Oliva, Gagliardone, Russo, Frigerio) 'De Gasperis' Cardio Center,
Niguarda Ca' Granda Hospital, Transplant Center, Piazza Ospedale Maggiore
3, Milan 20162, Italy
(Benazzi) Coordinamento Trapianti North Italy Transplantation Program
(NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan,
Italy
Title
A prospective comparison of mid-term outcomes in patients treated with
heart transplantation with advanced age donors versus left ventricular
assist device implantation.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 584-592),
2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES In Europe, the age of heart donors is constantly increasing.
Ageing of heart donors limits the probability of success of heart
transplantation (HTx). The aim of this study is to compare the outcome of
patients with advanced heart failure (HF) treated with a continuous-flow
left ventricular assist device (CF-LVAD) with indication as bridge to
transplantation (BTT) or bridge to candidacy (BTC) versus recipients of
HTx with the donor's age above 55 years (HTx with donors >55 years).
METHODS we prospectively evaluated 301 consecutive patients with advanced
HF treated with a CF-LVAD (n = 83) or HTx without prior bridging (n = 218)
in our hospital from January 2006 to January 2015. We compared the outcome
of CF-LVAD-BTT (n = 37) versus HTx with donors >55 years (n = 45) and the
outcome of CF-LVAD-BTT plus BTC (n = 62) versus HTx with donors >55 years
at the 1- and 2-year follow-up. Survival was evaluated according to the
first operation. RESULTS The perioperative (30-day) mortality rate was 0%
in the LVAD-BTT group vs 20% (n = 9) in the HTx group with donors >55
years (P = 0.003). Perioperative mortality occurred in 5% of the
LVAD-BTT/BTC patients (n = 3) and in 20% of the HTx with donors >55 year
group (P = 0.026). Kaplan-Meier curves estimated a 2-year survival rate of
94.6% in CF-LVAD-BTT vs 68.9% in HTx with donors >55 years [age- and
sex-adjusted hazard ratio (HR) 0.25; 95% confidence interval (CI)
0.08-0.81; P = 0.02 in favour of CF-LVAD]. Considering the post-HTx
outcome, a trend in favour of CF-LVAD-BTT was also observed (age- and
sex-adjusted HR 0.45; 95% CI 0.17-1.16; P = 0.09 in favour of CF-LVAD),
whereas CF-LVAD-BTT/BTC showed a similar survival at 2 years compared with
HTx with donors >55 years, both censoring the follow-up at the time of HTx
and considering the post-HTx outcome. CONCLUSIONS Early and mid-term
outcomes of patients treated with a CF-LVAD with BTT indication seem
better than HTx with old donors. It must be emphasized that up to 19% of
patients in the CF-LVAD/BTT group underwent transplantation in an urgent
condition due to complications related to the LVAD. At the 2-year
follow-up, CF-LVAD with BTT and BTC indications have similar outcome than
HTx using old heart donors. These results must be confirmed in a larger
and multicentre population and extending the follow-up. Copyright &#xa9;
2016 The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<93>
Accession Number
612721145
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Tahernejad M.; Mahdavi P.;
Karimi-Bondarabadi A.A.; Dehghan A.-M.; Rahimizadeh E.; Haddad F.;
Ghodratipour Z.; Sarrafan-Chaharsoughi Z.; Shahidzadeh A.; Ghanei A.;
Lotfaliani M.; Zeriouh M.; Weymann A.; Popov A.-F.; Sabashnikov A.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Tahernejad, Mahdavi, Shahidzadeh,
Karimi-Bondarabadi, Dehghan, Rahimizadeh, Ghodratipour,
Sarrafan-Chaharsoughi, Shahidzadeh, Ghanei, Lotfaliani) Cardiovascular
Research Center, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Haddad) Department of Physiology, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Zeriouh, Weymann, Popov, Sabashnikov) Department of Cardiothoracic
Transplantation and Mechanical Circulatory Support, Royal Brompton &
Harefield NHS Foundation Trust, London, United Kingdom
(Weymann) Department of Thoracic and Cardiovascular Surgery, University
Hospital Heidelberg, Heidelberg, Germany
Title
Impact of antioxidant supplementations on cardio-renal protection in
cardiac surgery: an updated and comprehensive meta-analysis and systematic
review.
Source
Cardiovascular Therapeutics. 34 (5) (pp 360-370), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
This systematic review with meta-analysis sought to determine the strength
of evidence in terms of the impact of common antioxidant supplementations,
such as N-acetylcysteine (NAC), vitamin C, and polyunsaturated fatty acids
(PUFA) on perioperative outcomes after cardiac surgery with particular
focus on the incidence of atrial fibrillation (AF) and acute kidney injury
(AKI) with associated mortality. A total of 29 trials were identified that
reported incidence of AF and 17 trials that reported incidence of AKI.
Pooled analysis reported that NAC (OR=0.5; P=.001), vitamin C (OR=0.4;
P=.001), and PUFA (OR=0.8; P=.01) administration were associated with
significantly reduced incidence of AF. In terms of postoperative AKI, only
NAC was shown to be a beneficial supplement that was able to significantly
reduce the incidence of AKI (OR=0.7; P=.01), and NAC could also
significantly decrease overall mortality (OR=0.3; P=.03) following cardiac
surgery. The use of NAC in patients undergoing cardiac surgery should be
strongly recommended due to its combined cardio-renal protective effects
and reduced mortality. Also, PUFA and vitamin C might be able to
significantly decrease the incidence of arrhythmia; however,
reno-protective effects and impact on overall mortality of these
supplements seem to be less impressive. Copyright &#xa9; 2016 John Wiley &
Sons Ltd

<94>
Accession Number
612667847
Author
Abdul-Jawad Altisent O.; Durand E.; Munoz-Garcia A.J.; Nombela-Franco L.;
Cheema A.; Kefer J.; Gutierrez E.; Benitez L.M.; Amat-Santos I.J.; Serra
V.; Eltchaninoff H.; Alnasser S.M.; Elizaga J.; Dager A.; Garcia del
Blanco B.; Ortas-Nadal M.D.R.; Marsal J.R.; Campelo-Parada F.; Regueiro
A.; del Trigo M.; Dumont E.; Puri R.; Rodes-Cabau J.
Institution
(Abdul-Jawad Altisent, Ortas-Nadal, Campelo-Parada, Regueiro, del Trigo,
Dumont, Puri, Rodes-Cabau) Cardiology Department, Quebec Heart and Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Durand, Eltchaninoff) Cardiology Department, University Hospital of
Rouen, Hospital Charles Nicolle, Rouen, France
(Munoz-Garcia) Cardiology Department, Hospital Universitario Virgen de la
Victoria, Universidad de Malaga, Malaga, Spain
(Nombela-Franco) Cardiology Department, Hospital Universitario Clinico San
Carlos, Madrid, Spain
(Cheema, Alnasser) Cardiology Department, St. Michael's Hospital, Toronto
University, Toronto, Ontario, Canada
(Kefer) Cardiology Department, Saint Luc University Hospital, Brussels,
Belgium
(Gutierrez, Elizaga) Cardiology Department, Instituto de Investigacion
Sanitaria Gregorio Maranon, Madrid, Spain
(Benitez, Dager) Cardiology Department, Clinica de Occidente de Cali,
Valle del Cauca, Colombia
(Amat-Santos) Cardiology Department, Hospital Clinico Universitario de
Valladolid, Valladolid, Spain
(Serra, Garcia del Blanco, Marsal) Cardiology Department, Hospital
Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona,
Spain
(Marsal) CIBER of Epidemiology and Public Health (CIBERESP), Barcelona,
Spain
Title
Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating
Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve
Replacement.
Source
JACC: Cardiovascular Interventions. 9 (16) (pp 1706-1717), 2016. Date of
Publication: 22 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to examine the risk of ischemic events and
bleeding episodes associated with differing antithrombotic strategies in
patients undergoing transcatheter aortic valve replacement (TAVR) with
concomitant atrial fibrillation (AF). Background Guidelines recommend
antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke.
However, data on the efficacy and safety of this recommendation in the
setting of a concomitant indication for oral anticoagulation (due to
atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce.
Methods A multicenter evaluation comprising 621 patients with AF
undergoing TAVR was undertaken. Post-TAVR prescriptions were used to
determine the antithrombotic regimen used according to the following 2
groups: monotherapy (MT) with VKA (n = 101) or multiple antithrombotic
therapy (MAT) with VKA plus 1 or 2 antiplatelet agents (aspirin or
clopidogrel; n = 520). Endpoint definitions were in accordance with Valve
Academic Research Consortium-2 criteria. The rate of stroke, major adverse
cardiovascular events (stroke, myocardial infarction, or cardiovascular
death), major or life-threatening bleeding events, and death were assessed
by a Cox multivariate model regression survival analysis according to the
antithrombotic regime used. Results During a median follow-up of 13 months
(interquartile range: 3 to 31 months) there were no differences between
groups in the rate of stroke (MT: 5%, MAT: 5.2%; adjusted hazard ratio
[HR]: 1.25; 95% confidence interval [CI]: 0.45 to 3.48; p = 0.67), major
adverse cardiovascular events (MT: 13.9%, MAT: 16.3%; adjusted HR: 1.33;
95% CI: 0.75 to 2.36; p = 0.33), and death (MT 22.8%, MAT: 19.2%; adjusted
HR: 0.93; 95% CI: 0.58 to 1.50; p = 0.76). A higher risk of major or
life-threatening bleeding was found in the MAT group (MT: 14.9%, MAT:
24.4%; adjusted HR: 1.85; 95% CI: 1.05 to 3.28; p = 0.04). These results
remained similar when patients receiving VKA plus only 1 antiplatelet
agent (n = 463) were evaluated. Conclusions In TAVR recipients prescribed
VKA therapy for AF, concomitant antiplatelet therapy use appears not to
reduce the incidence of stroke, major adverse cardiovascular events, or
death, while increasing the risk of major or life-threatening bleeding.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<95>
Accession Number
612579373
Author
Singh B.; Treece J.M.; Murtaza G.; Bhatheja S.; Lavine S.J.; Paul T.K.
Institution
(Singh, Bhatheja, Lavine, Paul) Department of Internal Medicine, Division
of Cardiology, East Tennessee State University, Johnson City, TN, United
States
(Treece, Murtaza) Department of Internal Medicine, East Tennessee State
University, Johnson City, TN, United States
Title
Aortic Dissection in a Healthy Male Athlete: A Unique Case with
Comprehensive Literature Review.
Source
Case Reports in Cardiology. 2016 (no pagination), 2016. Article Number:
6460386. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
A young otherwise healthy 27-year-old male who has been using anabolic
steroids for a long time developed Type I aortic dissection associated
with heavy weightlifting. The patient did not have a recent history of
trauma to the chest, no history of hypertension, and no illicit drug use.
He presented with severe chest pain radiating to back and syncopal event
with exertion. Initial vitals were significant for blood pressure of 80/50
mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and
oxygen saturation of 92% on room air. Physical exam was significant for
elevated jugular venous pressure, muffled heart sounds, and cold
extremities with diminished pulses in upper and absent pulses in lower
extremities. Bedside echocardiogram showed aortic root dilatation and
cardiac tamponade. STAT computed tomography (CT) scan of chest revealed
dissection of ascending aorta. Cardiothoracic surgery was consulted and
patient underwent successful repair of ascending aorta. Hemodynamic stress
of weightlifting can predispose to aortic dissection. Aortic dissection is
a rare but often catastrophic condition if not diagnosed and managed
acutely. Although rare, aortic dissection needs to be in the differential
when a young weightlifter presents with chest pain as a delay in diagnosis
may be fatal. Copyright &#xa9; 2016 Balraj Singh et al.

<96>
Accession Number
612700970
Author
Wallen M.P.; Skinner T.L.; Pavey T.G.; Hall A.; Macdonald G.A.; Coombes
J.S.
Institution
(Wallen, Skinner, Coombes) Centre for Research on Exercise, Physical
Activity and Health (CRExPAH), School of Human Movement and Nutrition
Sciences, The University of Queensland, Brisbane, Queensland, Australia
(Macdonald) School of Medicine, The University of Queensland, Brisbane,
Queensland, Australia
(Macdonald) Department of Gastroenterology and Hepatology, Princess
Alexandra Hospital, Brisbane, Queensland, Australia
(Hall) Department of Anaesthesia, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
(Pavey) School of Exercise and Nutrition Sciences, Queensland University
of Technology, Brisbane, Queensland, Australia
Title
Safety, adherence and efficacy of exercise training in solid-organ
transplant candidates: A systematic review.
Source
Transplantation Reviews. 30 (4) (pp 218-226), 2016. Date of Publication:
01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Background Patients awaiting solid-organ transplantation may be encouraged
to undertake exercise training to improve pre- and post-transplant
outcomes. However, the safety, adherence and efficacy of exercise training
in this population remain unclear. Methods All randomized, non-randomized
and non-controlled trials of exercise training interventions in
solid-organ transplant candidates were included. The Cochrane risk of bias
tool and a modified Newcastle-Ottawa scale were used to assess procedural
quality. Safety was defined as the number of reported adverse events
during exercise training. Adherence was evaluated from session attendance,
and efficacy as changes in cardiorespiratory fitness (CRF), exercise
capacity, muscular strength, health-related quality of life (HR-QoL) and
lung function. Results Eleven studies involving 874 patients were
included: four randomized controlled, one non-randomized controlled and
six non-controlled trials. Six studies included heart transplant
candidates and five involved patients awaiting lung transplantation. Three
trials included aerobic-only training, one incorporated resistance-only
exercise and seven combined modalities. Twelve adverse events were
reported with four due to exercise, although methods to collect these data
were often omitted. Exercise adherence ranged from 82.5% to 100%, but was
poorly described. No significant between-group changes attributable to
exercise training were demonstrated. However, significant within-group
improvements in CRF, exercise capacity, muscular strength, lung function
and HR-QoL were observed. Conclusions Patients awaiting heart or lung
transplant appear to tolerate exercise training despite the larger number
of adverse events compared to other high-risk populations. Exercise
training demonstrated within-group benefits for several outcomes, with no
significant between-group differences. Randomized controlled trials with
sufficient statistical power are required for all solid-organ transplant
candidates. Copyright &#xa9; 2016 Elsevier Inc.

<97>
Accession Number
612668605
Author
Kolodziej M.; Kurzawski J.; Janion-Sadowska A.; Gierlotka M.; Polonski L.;
Gasior M.; Sadowski M.
Institution
(Kolodziej, Kurzawski, Janion-Sadowska) Department of Interventional
Cardiology, SWietokrzyskie Cardiology Centre, Ul. Grunwaldzka 45, Kielce
25-736, Poland
(Gierlotka, Polonski, Gasior) Department of Cardiology, Silesian Centre
for Heart Diseases, Medical University of Silesia in Katowice, Zabrze,
Poland
(Sadowski) Department of Pathophysiology and Infection Microbiology,
Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland
Title
Mortality of women with ST-segment elevation myocardial infarction and
cardiogenic shock - Results from the PL-ACS registry.
Source
Medical Studies/Studia Medyczne. 32 (3) (pp 157-163), 2016. Date of
Publication: 2016.
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Introduction: Gender-related differences are well elucidated in ST-segment
elevation myocardial infarction (STEMI) patients. However, data on
patients with cardiogenic shock (CS) are scarce and do not indicate the
cause-effect relationship. Aim of the research: To evaluate the
differences between women and men with CS complicating STEMI and to
identify factors which determine the prognosis in the female group.
Material and methods: A total of 3589 consecutive patients with CS were
selected from a large, multicenter national registry on 57 400 consecutive
STEMI patients. Results: Women had a greater time delay from symptom onset
to treatment (admission within the first 2 h, 37.1% vs. 44.8%; p < 0.001).
They were also less likely to undergo interventional treatment (40.4% vs.
48.1%; p < 0.001) and to receive coronary stenting (86.8% vs. 90.1%; p =
0.045), glycoprotein IIb/IIIa inhibitors (15.3% vs. 20.1%; p < 0.001) and
clopidogrel (46.3% vs. 53.6%; p < 0.001). In the female patients
in-hospital and 12-month mortality were higher than in their male
counterparts (55% vs. 45.8%; p < 0.001 and 72.5% vs. 63.8%; p < 0.001,
respectively). Women with cardiogenic shock were less likely to receive
optimal therapy than men, which resulted in a poor clinical outcome.
Conclusions: This should encourage medical professionals to apply advanced
therapeutic strategies without gender bias. Only if there are no
gender-related discrepancies in the management of patients with
cardiogenic shock may the beneficial impact of invasive treatment be
fairly assessed and the hypothesis that more guideline-Adherent treatment
of women results in better outcomes be validated.

<98>
Accession Number
612646029
Author
Soon J.; Sulaiman N.; Park J.K.; Kueh S.-H.A.; Naoum C.; Murphy D.; Ellis
J.; Hague C.J.; Blanke P.; Leipsic J.
Institution
(Soon, Sulaiman, Kueh, Murphy, Ellis, Hague, Blanke, Leipsic) Dept of
Radiology and Centre for Heart Valve Innovation, St Paul's Hospital,
Vancouver, Canada
(Naoum) Cardiology Department, Concord Hospital, The University of Sydney,
Australia
(Park) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, Goyang, South Korea
Title
The effect of a whole heart motion-correction algorithm on CT image
quality and measurement reproducibility in Pre-TAVR aortic annulus
evaluation.
Source
Journal of Cardiovascular Computed Tomography. 10 (5) (pp 386-390), 2016.
Date of Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Motion correction (MC) algorithms have been shown to improve
image quality, interpretability and diagnostic accuracy in coronary CT
angiography. We sought to determine whether MC extended to the whole heart
would demonstrate improved image quality and reproducibility of aortic
annular measurements in pre-TAVR CT. Materials and methods Twenty-two
consecutive contrast enhanced CT data sets acquired for pre TAVR
evaluation using retrospective ECG synchronization during a single heart
beat were retrospectively identified. Image data sets were obtained from
raw data acquired at 35% and 75% of the R-R interval using both standard
(STD) and motion corrected (MC) reconstruction algorithms. Four data sets
(2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers
for aortic annular area, short and long axis, perimeter and average
diameter. Image quality was graded using a 5 point Likert score (1 and 2
non diagnostic, 5 excellent). Statistical analysis was performed using
Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's
concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75%
MC. Results Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%,
there was a significant improvement in image quality for MC (Likert score
3.3 +/- 0.9 STD vs. 3.9 +/- 0.7 MC, p < 0.007). While B-A analysis
demonstrated narrower interobserver agreement for aortic annular area
(bias 0.03 vs 0.02 cm², range -0.32 to 0.39 cm² vs
-0.50 to 0.55 cm²), and perimeter (bias 0.3 vs 0.3 mm, range
-3.1 to 3.8 mm vs -4.6 to 5.3 mm), this was not statistically significant
by concordance correlation coefficient. At 75%, there was no significant
difference in image quality (Likert score 3.3 +/- 0.9 vs. 3.5 +/- 0.76, p
= 0.454) or annular measurement agreement intervals. Conclusion Motion
correction algorithms may yield significant improvements of image quality
in systolic CT data sets of the heart. Further validation studies are
required to determine the effect on annular measurements and translation
into clinical practice. Copyright &#xa9; 2016 Society of Cardiovascular
Computed Tomography

<99>
Accession Number
612646542
Author
Guerrero M.; Dvir D.; Himbert D.; Urena M.; Eleid M.; Wang D.D.; Greenbaum
A.; Mahadevan V.S.; Holzhey D.; O'Hair D.; Dumonteil N.; Rodes-Cabau J.;
Piazza N.; Palma J.H.; DeLago A.; Ferrari E.; Witkowski A.; Wendler O.;
Kornowski R.; Martinez-Clark P.; Ciaburri D.; Shemin R.; Alnasser S.;
McAllister D.; Bena M.; Kerendi F.; Pavlides G.; Sobrinho J.J.; Attizzani
G.F.; George I.; Nickenig G.; Fassa A.-A.; Cribier A.; Bapat V.; Feldman
T.; Rihal C.; Vahanian A.; Webb J.; O'Neill W.
Institution
(Guerrero, Feldman) Department of Medicine, Division of Cardiology,
Evanston Hospital, Evanston, Illinois, United States
(Dvir, Webb) Center for Heart Valve Innovation, St. Paul's Hospital,
Vancouver, British Columbia, Canada
(Himbert, Urena, Vahanian) Cardiology Department, Bichat-Claude Bernard
Hospital, Paris, France
(Eleid, Rihal) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota, United States
(Wang, Greenbaum, O'Neill) Department of Medicine, Division of Cardiology,
Henry Ford Hospital, Detroit, Michigan, United States
(Mahadevan) Department of Medicine, Division of Cardiology, University of
California San Francisco, San Francisco, California, United States
(Holzhey) Department of Cardiac Surgery, Leipzig Heart Center, Leipzig,
Germany
(O'Hair) Department of Surgery, Aurora St. Luke's Medical Center,
Milwaukee, Wisconsin, United States
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, Quebec, Canada
(Piazza) Department of Interventional Cardiology, McGill University Health
Centre, Montreal, Quebec, Canada
(Palma) Department of Cardiovascular Surgery, Escola Paulista de Medicina,
Sao Paolo, Brazil
(DeLago) Department of Medicine, Division of Cardiology, Albany Medical
Center Hospital, Albany, New York, United States
(Ferrari) Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano,
Switzerland
(Witkowski) Department of Interventional Cardiology & Angiology, Institute
of Cardiology, Warsaw, Poland
(Wendler) Department of Surgery, King's College Hospital, London, United
Kingdom
(Kornowski) Department of Medicine, Division of Cardiology, Rabin Medical
Center, Petah Tikva, Israel
(Martinez-Clark) Department of Medicine, Division of Cardiology,
Angiografia de Occidente, Cali, Colombia
(Ciaburri) Department of Surgery, Saint Francis Medical Center, Peoria,
Illinois, United States
(Shemin) Department of Surgery, UCLA Medical Center, Los Angeles,
California, United States
(Alnasser) Department of Medicine, Division of Cardiology, St. Michael's
Hospital, Toronto, Canada
(McAllister) Department of Medicine, Division of Cardiology, The Iowa
Heart Center, Des Moines, Iowa, United States
(Bena) Department of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Bratislava, Slovakia
(Kerendi) Department of Surgery, Heart Hospital of Austin, Austin, Texas,
United States
(Pavlides) Department of Medicine, Division of Cardiology, The Nebraska
Medical Center, Omaha, Nebraska, United States
(Sobrinho) Department of Surgery, Complexo Hospitalar de Niteroi, Niteroi,
Brazil
(Attizzani) The Valve and Structural Heart Interventional Center,
University Hospitals Case Medical Center, Cleveland, Ohio, United States
(George) Columbia Heart Valve Center, New York Presbyterian
Hospital-Columbia University Medical Center, New York, New York, United
States
(Nickenig) Heart Center, University of Bonn, Bonn, Germany
(Fassa) Department of Medicine, Division of Cardiology, Hopital de La
Tour, Geneva, Switzerland
(Cribier) Department of Cardiology, University of Rouen's Charles Nicolle
Hospital, Rouen, France
(Bapat) Department of Cardiology and Cardiac Surgery, St. Thomas'
Hospital, London, United Kingdom
Title
Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With
Severe Mitral Annular Calcification: Results From the First Multicenter
Global Registry.
Source
JACC: Cardiovascular Interventions. 9 (13) (pp 1361-1371), 2016. Date of
Publication: 11 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the outcomes of the early
experience of transcatheter mitral valve replacement (TMVR) with
balloon-expandable valves in patients with severe mitral annular
calcification (MAC) and reports the first large series from a multicenter
global registry. Background The risk of surgical mitral valve replacement
in patients with severe MAC is high. There are isolated reports of
successful TMVR with balloon-expandable valves in this patient population.
Methods We performed a multicenter retrospective review of clinical
outcomes of patients with severe MAC undergoing TMVR. Results From
September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR
with compassionate use of balloon-expandable valves. Mean age was 73 +/-
13 years, 66% were female, and mean Society of Thoracic Surgeons score was
14.4 +/- 9.5%. The mean mitral gradient was 11.45 +/- 4.4 mm Hg and the
mean mitral area was 1.18 +/- 0.5 cm². SAPIEN valves (Edwards
Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%,
SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access
was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%.
Technical success according to Mitral Valve Academic Research Consortium
criteria was achieved in 46 (72%) patients, primarily limited by the need
for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract
obstruction with hemodynamic compromise. Mean mitral gradient
post-procedure was 4 +/- 2.2 mm Hg, paravalvular regurgitation was mild or
absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular =
12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data
available were in New York Heart Association functional class I or II at
30 days (n = 25). Conclusions TMVR with balloon-expandable valves in
patients with severe MAC is feasible but may be associated with
significant adverse events. This strategy might be an alternative for
selected high-risk patients with limited treatment options. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<100>
Accession Number
612488217
Author
Becattini C.; Sembolini A.; Paciaroni M.
Institution
(Becattini, Sembolini, Paciaroni) Internal and Cardiovascular Medicine -
Stroke Unit, University of Perugia, Italy
Title
Resuming anticoagulant therapy after intracerebral bleeding.
Source
Vascular Pharmacology. 84 (pp 15-24), 2016. Date of Publication: 01 Sep
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The clinical benefit of resuming anticoagulant treatment after an
anticoagulants-associated intracranial hemorrhage (ICH) is debated. No
randomized trial has been conducted on this particular clinical issue. The
risk of ICH recurrence from resuming anticoagulant therapy is expected to
be higher after index lobar than deep ICH and in patients with not
amendable risk factors for ICH. Retrospective studies have recently shown
improved survival with resumption of treatment after index
anticoagulants-associated ICH. Based on these evidences and on the risk
for thromboembolic events without anticoagulant treatment, resumption of
anticoagulation should be considered in all patients with mechanical heart
valve prosthesis and in those with amendable risk factors for
anticoagulants-associated ICH. Resumption with direct oral anticoagulants
appears a reasonable option for non-valvular atrial fibrillation (NVAF)
patients at moderate to high thromboembolic risk after deep ICH and for
selected NVAF patients at high thromboembolic risk after lobar ICH. For
VTE patients at high risk for recurrence, resumption of anticoagulation or
insertion of vena cava filter should be tailored on the estimated risk for
ICH recurrence. Copyright &#xa9; 2016 Elsevier Inc.

<101>
Accession Number
612732470
Author
Gueret P.; Combe S.; Krezel C.; Fuseau E.; van Giersbergen P.L.M.; Petitou
M.; Neuhart E.
Institution
(Gueret) Haemostasis Department, University Hospital Pontchaillou, 2 rue
Henri Le Guilloux, Rennes Cedex 35033, France
(Combe) University Hospital Cochin, Paris, France
(Krezel, Petitou, Neuhart) Endotis Pharma, Romainville, Paris, France
(Fuseau) EMF Consulting, Aix en Provence, France
(van Giersbergen) Van Giersbergen Consulting, Wuenheim, France
(Gueret) GETBO EA 3878, Brest, France
Title
Neutralization of EP217609, a new dual-action FIIa/FXa anticoagulant, by
its specific antidote avidin: a phase I study.
Source
European Journal of Clinical Pharmacology. (pp 1-14), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Introduction: EP217609 is a representative of a new class of synthetic
parenteral anticoagulants with a dual mechanism of action. It combines in
a single molecule a direct thrombin inhibitor and an indirect factor Xa
inhibitor. EP217609 can be neutralized by a specific antidote avidin,
which binds to the biotin moiety of EP217609. Purpose: The primary
objective was to assess the neutralization of EP217609 by avidin in
healthy subjects. Secondary objectives were to define the optimal avidin
monomer/EP217609 molar ratio to achieve an adequate neutralization of
EP217609 and to assess the safety and tolerability of EP217609 and avidin.
Methods: Healthy subjects (n = 36) were randomized to a 3 by 3 replicated
Latin square design between 3 EP217609 doses (4, 8, 12 mg) and 3 avidin
monomer/EP217609 molar ratios (1:1; 2:1; 3:1). EP217609 was administered
as a single intravenous bolus, and avidin as a 30-min intravenous
infusion, starting 90 min after EP217609 administration. Results: Overall,
EP217609 and avidin were well tolerated. One subject experienced a benign
and transient typical pseudo-allergic reaction. The administration of
EP217609 resulted in dose-dependent increases in pharmacodynamic markers.
Avidin triggered a rapid and irreversible neutralization of EP217609
without rebound effect. Adequate neutralization of the anticoagulant
activity was achieved with both 2:1 and 3:1 avidin monomer/EP217609 molar
ratios. All safety parameters did not show any treatment-emergent
clinically relevant changes or abnormalities in any dose group.
Conclusions: These results will allow further investigation in patients
requiring a neutralizable anticoagulant as those undergoing cardiac
surgery. Study registration: EudraCT number 2010-020216-10. Copyright
&#xa9; 2016 Springer-Verlag Berlin Heidelberg

<102>
Accession Number
612731695
Author
Som A.; Maitra S.; Bhattacharjee S.; Baidya D.K.
Institution
(Som, Maitra, Bhattacharjee, Baidya) Department of Anaesthesiology, Pain
Medicine and Critical Care, All India Institute of Medical Sciences, New
Delhi 110029, India
Title
Goal directed fluid therapy decreases postoperative morbidity but not
mortality in major non-cardiac surgery: a meta-analysis and trial
sequential analysis of randomized controlled trials.
Source
Journal of Anesthesia. (pp 1-16), 2016. Date of Publication: 13 Oct 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Background and aims: Optimum perioperative fluid administration may
improve postoperative outcome after major surgery. This meta-analysis and
systematic review has been aimed to determine the effect of dynamic goal
directed fluid therapy (GDFT) on postoperative morbidity and mortality in
non-cardiac surgical patients. Material and methods: Meta-analysis of
published prospective randomized controlled trials where GDFT based on
non-invasive flow based hemodynamic measurement has been compared with a
standard care. Data from 41 prospective randomized trials have been
included in this study. Results: Use of GDFT in major surgical patients
does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 %
CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14;
95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI
-0.28, 0.04; p = 0.14). However, number of patients having at least one
postoperative complication is significantly lower with use of GDFT (OR
0.57; 95 % CI 0.43, 0.75; p < 0.0001). Abdominal complications (p =
0.008), wound infection (p = 0.002) and postoperative hypotension (p =
0.04) are also decreased with used of GDFT as opposed to a standard care.
Though patients who received GDFT were infused more colloid (p < 0.0001),
there is no increased risk of heart failure or pulmonary edema and renal
failure. Conclusion: GDFT in major non- cardiac surgical patients has
questionable benefit over a standard care in terms of postoperative
mortality, length of hospital stay and length of ICU stay. However,
incidence of all complications including wound infection, abdominal
complications and postoperative hypotension is reduced. Copyright &#xa9;
2016 Japanese Society of Anesthesiologists

<103>
Accession Number
612636007
Author
Ando T.; Briasoulis A.; Holmes A.A.; Takagi H.; Slovut D.P.
Institution
(Ando) Department of Internal MedicineMount Sinai Beth IsraelIcahn School
of Medicine at Mount SinaiNew York, New York
(Briasoulis) Division of CardiologyWayne State University/Detroit Medical
CenterDetroit, Michigan
(Holmes) Leon H. Charney Division of CardiologyNYU Langone Medical
CenterNew York, New York
(Takagi) Department of Cardiovascular SurgeryShizuoka Medical
CenterShizuokaJapan
(Slovut) Department of Cardiothoracic and Vascular SurgeryMontefiore
Medical CenterAlbert Einstein College of MedicineBronx, New York
(Slovut) Division of CardiologyMontefiore Medical CenterAlbert Einstein
College of MedicineBronx, New York
Title
Percutaneous versus surgical cut-down access in transfemoral transcatheter
aortic valve replacement: A meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: The transfemoral (TF) approach has become the preferred
approach for transcatheter aortic valve replacement (TAVR) because of its
low risk profile. However, the relative safety of the percutaneous
approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim
was to compare the outcomes between PC versus SC access in patients
undergoing TF-TAVR using a meta-analysis. METHODS: We conducted a
systematic electronic database search for studies reporting major and
minor vascular complications (VC), major and minor bleeding, and
perioperative all-cause mortality, in PC versus SC TF-TAVR cases.
Complications were reported based on the Valve Academic Research
Consortium criteria. A random-effects model was used to calculate odds
ratios and 95% confidence intervals. RESULTS: Eight observational cohort
studies and one randomized control trial (2513 patients in PC and 1767
patients in SC) were included in the analysis. Major and minor VC, as well
as bleeding complications, were comparable between the two approaches. The
need for surgical intervention for VC was comparable between PC and SC.
There was no difference in perioperative all-cause mortality. CONCLUSIONS:
PC and SC have similar safety profiles and outcomes when used
appropriately in selected patients. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.