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<1>
Accession Number
607668755
Author
Mihos C.G.; Larrauri-Reyes M.; Santana O.
Institution
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, United States
(Larrauri-Reyes, Santana) Columbia University Division of Cardiology,
Mount Sinai Heart Institute, Miami Beach, FL, United States
Title
A Meta-Analysis of Ring Annuloplasty Versus Combined Ring Annuloplasty and
Subvalvular Repair for Moderate-to-Severe Functional Mitral Regurgitation.
Source
Journal of Cardiac Surgery. 31 (1) (pp 31-37), 2016. Date of Publication:
01 Jan 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background A ring annuloplasty (Ring) for moderate-to-severe functional
mitral regurgitation (MR) is associated with suboptimal outcomes, and
adjunctive subvalvular repair techniques (Ring + Subvalvular) have been
advocated to improve repair durability. However, the outcomes of this
strategy are not clearly defined. Methods A systematic review was
performed to identify studies that compared a Ring versus Ring +
Subvalvular repair for the treatment of moderate-to-severe functional MR.
A meta-analysis was conducted on clinical outcomes and echocardiographic
measures of follow-up MR and left ventricular reverse remodeling. Risk
ratio (RR) and mean difference (MD) were calculated by the Mantel-Haenszel
and Inverse Variance methods under a fixed or random effects model, as
appropriate. Results Seven non-randomized studies were identified, with a
total of 531 patients (Ring = 301, Ring + Subvalvular = 230). At follow-up
(range 30-47 months), a Ring + Subvalvular repair was associated with a
lower mortality (RR = 0.59, 95%confidence interval [CI] 0.37-0.94, p =
0.03), greater freedom from moderate or greater MR (RR = 0.44, 95%CI
0.27-0.72, p = 0.001), and improved left ventricular end-diastolic
diameter (MD = -3.49 mm, 95%CI -5.45 to -1.53, p = 0.0005) and New York
Heart Association functional class (MD = -0.25, 95%CI -0.42 to -0.08, p =
0.004). A trend toward a reduced risk of reoperation for recurrent MR was
noted with a combined Ring + Subvalvular repair (RR = 0.28, 95%CI
0.06-1.22, p = 0.09). Finally, a Ring + Subvalvular repair did not impact
operative mortality or follow-up left ventricular ejection fraction.
Conclusion A combined Ring + Subvalvular repair for moderate-to-severe
functional MR can be safely performed, and may improve mid-term outcomes,
as compared with Ring alone. doi: 10.1111/jocs.12662 (J Card Surg
2016;31:31-37) Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<2>
Accession Number
608459567
Author
Andreas M.; Doll N.; Livesey S.; Castella M.; Kocher A.; Casselman F.;
Voth V.; Bannister C.; Palacios J.F.E.; Pereda D.; Laufer G.; Czesla M.
Institution
(Andreas, Kocher, Laufer) Department of Surgery, Division of Cardiac
Surgery, Medical University of Vienna, Vienna, Austria
(Doll, Voth, Czesla) Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
(Livesey, Bannister) Department of Cardiothoracic Surgery, Southampton
General Hospital, Southampton, United Kingdom
(Castella, Palacios, Pereda) Department of Cardiovascular Surgery,
Institut Clinic del Torax, Hospital Clinic, University of Barcelona,
Barcelona, Spain
(Casselman) Department of Cardiovascular and Thoracic Surgery, OLV Clinic,
Aalst, Belgium
Title
Safety and feasibility of a novel adjustable mitral annuloplasty ring: A
multicentre European experience.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 249-254), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Recurrent mitral regurgitation is a significant problem after
mitral valve repair in patients with functional valve disease. We report
the safety and feasibility of a novel adjustable mitral annuloplasty
device that permits downsizing of the anterior-posterior diameter late
after initial surgery. METHODS: In this multicentre, non-randomized,
observational register, patients with moderate or severe mitral
regurgitation undergoing surgical mitral valve repair with the MiCardia
EnCorSQTM Mitral Valve Repair system were evaluated. Patient
characteristics, operative specifications and results as well as
postoperative follow-up were collected for all five centres. RESULTS:
Ninety-four patients with a median age of 71 (64-75) years (EuroSCORE II
6.7 +/- 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and
15% degenerative disease) were included. Operative mortality was 1% and
the 1-year survival was 93%. Ring adjustment was attempted in 12 patients
at a mean interval of 9 +/- 6 months after surgery. In three of these
attempts, a technical failure occurred. In 1 patient, mitral regurgitation
was reduced two grades, in 2 patients mitral regurgitation was reduced one
grade and in 6 patients, mitral regurgitation did not change
significantly. The mean grade of mitral regurgitation changed from 2.9 +/-
0.9 to 2.1 +/- 0.7 (P = 0.02). Five patients were reoperated after 11 +/-
9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION: We
conclude that this device may provide an additional treatment option in
patients with functional mitral regurgitation, who are at risk for
reoperation due to recurrent mitral regurgitation. Clinical results in
this complex disease were ambiguous and patient selection seems to be a
crucial step for this device. Further trials are required to estimate the
clinical value of this therapeutic concept. Copyright &#xa9; The Author
2015.

<3>
Accession Number
608459565
Author
Shrestha M.; Fischlein T.; Meuris B.; Flameng W.; Carrel T.; Madonna F.;
Misfeld M.; Folliguet T.; Haverich A.; Laborde F.
Institution
(Shrestha, Haverich) Cardio-thoracic, Transplantation and Vascular
Surgery, Hannover Medical School, Hannover, Germany
(Fischlein) Klinikum Nuernberg, Paracelsus Medical University Nuremberg,
Nuremberg, Germany
(Meuris, Flameng) Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium
(Carrel) Inselspital, Bern, Switzerland
(Madonna) Hospital Cardiologique Du Haut-Leveque, Pessac, France
(Misfeld) Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie,
Leipzig, Germany
(Folliguet, Laborde) Cardiac Medico-Surgical Department, Institute
Mutualiste Montsouris, Paris, France
Title
European multicentre experience with the sutureless Perceval valve:
Clinical and haemodynamic outcomes up to 5 years in over 700 patients.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 234-241), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: This report summarizes the 5-year clinical and haemodynamic
data from three prospective, European multicentre trials with the Perceval
sutureless aortic valve. METHODS: From April 2007 to August 2012, 731
consecutive patients (mean age: 78.5 years; 68.1% females; mean logistic
EuroSCORE 10.9%) underwent AVR with the Perceval valve in 25 European
centres. Isolated AVR was performed in 498 (68.1%) patients. A minimally
invasive approach was performed in 189 (25.9%) cases. The cumulative
follow-up was 729 patients-years. RESULTS: In isolated AVR, mean
cross-clamp and cardiopulmonary bypass times were 30.8 and 50.8 min in
full sternotomy, and 37.6 and 64.4 min in the minimally invasive approach,
respectively. Early cardiac-related deaths occurred in 1.9%. Overall
survival rates at 1 and 5 years were 92.1 and 74.7%, respectively. Major
paravalvular leak occurred in 1.4% and 1% at early and late follow-up,
respectively. Significant improvement in clinical status was observed
postoperatively in the majority of patients. Mean and peak gradients
decreased from 42.9 and 74.0 mmHg preoperatively, to 7.8 and 16 mmHg at
the 3-year follow-up. LV mass decreased from 254.5 to 177.4 g at 3 years.
CONCLUSIONS: This European multicentre experience, with the largest cohort
of patients with sutureless valves to date, shows excellent clinical and
haemodynamic results that remain stable even up to the 5-year follow-up.
Even in this elderly patient cohort with 40% octogenarians, both early and
late mortality rates were very low. There were no valve migrations,
structural valve degeneration or valve thrombosis in the follow-up. The
sutureless technique is a promising alternative to biological aortic valve
replacement. Copyright &#xa9; The Author 2015.

<4>
Accession Number
608459561
Author
Sievers H.-H.; Stierle U.; Charitos E.I.; Takkenberg J.J.M.; Horer J.;
Lange R.; Franke U.; Albert M.; Gorski A.; Leyh R.G.; Riso A.; Sachweh J.;
Moritz A.; Hetzer R.; Hemmer W.
Institution
(Sievers, Stierle, Charitos) Department of Cardiac and Thoracic Vascular
Surgery, University of Lubeck, Lubeck, Germany
(Takkenberg) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Horer, Lange) Department of Cardiovascular Surgery, German Heart Centre
Munich, Munich, Germany
(Franke, Albert) Department of Cardiac and Vascular Surgery,
Robert-Bosch-Hospital, Stuttgart, Germany
(Gorski, Leyh) Department of Cardiothoracic and Thoracic Vascular Surgery,
University Hospital Wurzburg, Wurzburg, Germany
(Riso, Sachweh) Paediatric Cardiology/Paediatric Cardiac Surgery,
University Heart Center, Hamburg, Germany
(Moritz) Department of Thoracic and Cardiovascular Surgery, Johann
Wolfgang Goethe University, Frankfurt, Germany
(Hetzer) Department of Cardiothoracic and Vascular Surgery, German Heart
Institute Berlin, Berlin, Germany
(Hemmer) Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart,
Stuttgart, Germany
Title
A multicentre evaluation of the autograft procedure for young patients
undergoing aortic valve replacement: Update on the German Ross Registry.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 212-218), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Conventional aortic valve replacement (AVR) in young, active
patients represents a suboptimal solution in terms of long-term survival,
durability and quality of life. The aim of the present work is to present
an update on the multicentre experience with the pulmonary autograft
procedure in young, adult patients. METHODS: Between 1990-2013, 1779 adult
patients (1339 males; 44.7 +/- 11.6 years) underwent the pulmonary
autograft procedure in 8 centres. All patients underwent prospective
clinical and echocardiographic examinations annually. The mean follow-up
was 8.3 +/- 5.1 years (range 0-24.3 years) with a total cumulative
follow-up of 14 288 years and 662 patients having a follow-up of at least
10 years. RESULTS: The early (30-day) mortality rate was 1.1% (n = 19).
Late (>30 day) survival of the adult population was comparable with the
ageand gender-matched general population (observed deaths: 101, expected
deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15
years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from
homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall
freedom from reoperation was 94.9, 91.1 and 82.7%, respectively.
Longitudinal modelling of functional valve performance revealed a low
(<5%) probability of a patient being in higher autograft regurgitation
grades throughout the first decade. Similarly, excellent homograft
function was observed throughout the first 15 years. CONCLUSION: The
autograft principle results in postoperative long-term survival comparable
with that of the age- and gender-matched general population and
reoperation rates within the 1%/patient-year boundaries and should be
considered in young, active patients who want to avoid the shortcomings of
conventional prostheses. Copyright &#xa9; The Author 2015.

<5>
Accession Number
608459558
Author
Shi W.Y.; Hayward P.A.; Fuller J.A.; Tatoulis J.; Rosalion A.; Newcomb
A.E.; Buxton B.F.
Institution
(Shi, Hayward, Buxton) Department of Cardiac Surgery, Austin Hospital,
Melbourne, VIC, Australia
(Hayward, Fuller, Buxton) Victorian Heart Centre, Epworth Hospital,
Melbourne, VIC, Australia
(Hayward, Tatoulis, Rosalion, Newcomb, Buxton) Department of Surgery,
University of Melbourne, Melbourne, VIC, Australia
(Tatoulis) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Rosalion, Newcomb) Department of Cardiothoracic Surgery, St Vincent's
Hospital, Melbourne, VIC, Australia
Title
Is the radial artery associated with improved survival in older patients
undergoing coronary artery bypass grafting? An analysis of a multicentre
experience.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 196-202), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Studies suggest that the radial artery (RA) may exhibit
superior patency compared with the saphenous vein (SV). It is unclear
whether older patients undergoing coronary artery bypass grafting (CABG)
derive any survival benefit from the use of RAs. We sought to evaluate
this using a multicentre database. METHODS: From 1995 to 2010, 6059
patients with three-vessel coronary artery disease underwent primary
isolated CABG at 8 centres. A study cohort of 4006 patients was formed
with 3220 (80%) receiving at least 1 RA to supplement a single in situ
internal thoracic artery (RA group) while 786 (20%) received only veins to
supplement a single ITA (SV group). In the RA group, bilateral RAs were
used in 1418 (44%) cases, while total arterial revascularization was
achieved in 1859 (58%). RAs were mostly grafted to the left circumflex and
right coronary territories. Survival data were obtained using the National
Death Index and propensity-score matching was used for risk adjustment.
Separate propensity-score analyses were conducted for the 2149 patients
(1645 RA, 504 SV) who were 70 years or older. RESULTS: Patients receiving
RAs were younger (mean age in years RA: 68 +/- 9.7 vs SV: 71 +/- 7.9, P <
0.001) and less likely to have cerebrovascular disease, obstructive
airways disease, myocardial infarction within 7 days and left-main
coronary disease. At 30 days, RA patients experienced reduced unadjusted
mortality (49 of 3220, 1.5% vs 25 of 786, 3.2%, P = 0.004). At 15 years,
the RA group showed superior unadjusted survival (51 +/- 1.1 vs 35 +/-
1.9%, P < 0.001). After propensity-score matching of 507 patient pairs,
there was comparable 30-day mortality between groups (RA: 9, 1.8 vs SV:
14, 2.8%, P = 0.41). However, at 15 years, the RA group still showed
superior survival (42 +/- 2.6 vs 35 +/- 2.5%, P = 0.008). Among those 70
years and older (327 matched pairs), despite similar 30-day mortality (RA:
6, 1.8% vs SV: 10, 3.1%, P = 0.42), RA patients again exhibited improved
survival (35 +/- 3.3 vs 22 +/- 2.8%, P = 0.004) at 15 years. CONCLUSIONS:
This multicentre analysis suggests that the use of an RA is associated
with a survival benefit in older patients undergoing CABG. Copyright
&#xa9; The Author 2015.

<6>
Accession Number
608459549
Author
Cazavet A.; Alacoque X.; Marcheix B.; Chaufour X.; Rousseau H.; Glock Y.;
Leobon B.
Institution
(Cazavet, Marcheix, Glock, Leobon) Department of Cardiovascular Surgery,
University Hospital of Toulouse, Toulouse, France
(Alacoque) Department of Anesthesia and Intensive Care, University
Hospital of Toulouse, Toulouse, France
(Chaufour) Department of Vascular Surgery, University Hospital of
Toulouse, Toulouse, France
(Rousseau) Department of Interventional Radiology, University Hospital of
Toulouse, Toulouse, France
Title
Aortic arch aneurysm: Short- and mid-term results comparing open arch
surgery and the hybrid procedure.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 134-140), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Open arch surgery for aortic arch aneurysm was historically
associated with a high risk of postoperative morbi-mortality. Improved
operative techniques have now lowered the incidence of these complications
but in parallel, hybrid arch procedures have emerged. Nowadays, very
little data are available about their mid-term results compared with open
surgery. METHODS: From January 2002 to January 2014, 46 patients had
treatment for an exclusive aortic arch aneurysm including 25 open arch
surgeries and 21 type I hybrid arch procedures in our institution. All
cases involved arch aneurysms involving at least one carotid artery (Zone
0 and Zone 1). Aneurysms of the distal arch and descending aorta were
excluded (Zone 2 and beyond). Results from a retrospective database are
reported. There were no patients lost to the follow-up. RESULTS: There was
no significant difference in preoperative comorbidities between the two
groups. The incidence of in-hospital mortality was similar at 20% (5/25)
for open surgery and 19% (4/21) for hybrid procedure (P = 0.830). The
incidence of permanent cerebral neurological deficit was comparable at
17.4% (4/23) for open surgery and 21.1% (4/19) for hybrid procedure (P =
1). Median survival was 109.5 months for open surgery and 56.3 months for
hybrid procedure. Freedom from all-cause mortality was 78, 63, 63 and 57%
at 1, 3, 5 and 7 years, respectively in the open surgical group. Freedom
from all-cause mortality was 74, 55, 46 and 28% at 1, 3, 5 and 7 years,
respectively in the hybrid group. Survival rates and incidence of major
adverse cardiac and cerebro-vascular event between open surgery and hybrid
procedure were not statistically different (P = 0.530 and P = 0.325,
respectively). However, incidence of reintervention was in favour of open
surgery [14.5 vs 44.8% at 7 years, P = 0.045; 95% confidence interval:
(0.06-0.97)]. CONCLUSIONS: The type I hybrid arch procedure fails to
demonstrate better results compared with open surgery, regarding
morbi-mortality at the short- and mid-term follow-up. Moreover, it
increases the risk of reintervention. Patients treated by this technique
must undergo a closer follow-up because of this risk. Larger randomized
studies are needed to better define the exact indications of this therapy.
Copyright &#xa9; The Author 2015.

<7>
Accession Number
608459547
Author
Russo C.F.; Mariscalco G.; Colli A.; Sante P.; Nicolini F.; Miceli A.;
Chiara B.D.; Beghi C.; Gerosa G.; Glauber M.; Gherli T.; Nappi G.; Murzi
M.; Molardi A.; Merlanti B.; Vizzardi E.; Bonadei I.; Coletti G.;
Carrozzini M.; Gelsomino S.; Caiazzo A.; Lorusso R.
Institution
(Russo, Chiara, Merlanti) Cardio-Thoraco-Vascular Department, Niguarda
Hospital, Milan, Italy
(Mariscalco, Beghi) Department of Heart and Vessels, Cardiac Surgery
Unit-Ospedale di Circolo, Varese, Italy
(Colli, Gerosa, Carrozzini) Cardiac Surgery, Universita of Padova Medical
School, Padova, Italy
(Sante, Nappi, Caiazzo) II Universita of Napoli Medical School, Ospedale
Monaldi, Napoli, Italy
(Nicolini, Gherli, Molardi) Cardiac Surgery, Universita of Parma Medical
School, Parma, Italy
(Miceli, Glauber, Murzi) Fondazione Toscana G. Monasterio, Massa, Italy
(Vizzardi, Bonadei) Cardiology Units, Spedali Civili, Brescia, Italy
(Coletti, Lorusso) Cardiac Surgery, Spedali Civili, Brescia, Italy
(Gelsomino) Department Heart and Vessels, Careggi Hospital, Firenze, Italy
Title
Italian multicentre study on type A acute aortic dissection: A 33-year
follow-up.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 125-131), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Despite substantial progress in surgical techniques and
perioperative management, the treatment and long-term follow-up of type A
acute aortic dissection (AAD) still remain a major challenge. The
objective of this retrospective, multicentre study was to assess in a
large series of patients the early and long-term results after surgery for
type A AAD. METHODS: We analysed the preoperative, intraoperative and
postoperative conditions of 1.148 consecutive patients surgically treated
in seven large referral centres from 1981 to 2013. We applied to each
patient three different multi-parameter risk profiles (preadmission risk,
admission risk and post-surgery risk) in order to compare risk factors and
outcome. Long-term Kaplan-Meier survival was evaluated. RESULTS: The
median age was 64 years and the male population was predominant (66%).
Identified diagnosis of collagen disease was present in 9%, and Marfan
syndrome in 5%. Bicuspid aortic valve was present in 69 patients (6%).
Previous cardiac surgery was identified in 10% of the patients. During
surgery, the native aortic valve was preserved in 72% of the cases,
including leaflet resuspension in 23% and David operation in 1.2%.
Considering aortic valve replacement (AVR: 28%), bioprosthesis
implantation was performed in 14.7% of the subjects. Neurological
impairment at discharge was shown in 23% of the cases among which 21% of
patients had new neurological impairment versus preoperative conditions.
The overall 30-day mortality rate was 25.7%. All risk profiles remained
independently associated with in-hospital mortality. During the available
follow-up of hospital survivors (median: 70 months, interquartile range:
34-113, maximum: 396), cardiac-related death occurred in 7.9% of the
subjects. The cumulative survival rate for cardiac death was 95.3% at 5
years, 92.8% at 10 years and 52.8% at 20 years. Severe aortic
regurgitation (AR) (grade 3-4) at the time of surgery showed to be a
significant risk factor for reintervention during the follow-up (P <
0.001). Among risk profiles, only the preadmission risk was independently
associated with late mortality after multivariate analysis. Unexpectedly,
there was no difference in freedom from cardiac death between patients
with and without AVR. CONCLUSIONS: Although surgery for type A has
remained challenging over more than three decades, there is a positive
trend in terms of hospital mortality and long-term follow-up. About 90% of
patients were free from reoperation in the long term, although late AR
remains a critical issue, suggesting that a thorough debate on surgical
options, assessment and results of a conservative approach should be
considered. Copyright &#xa9; The Author 2015.

<8>
Accession Number
608459507
Author
Fiorelli A.; Izzo A.C.; Frongillo E.M.; Prete A.D.; Liguori G.; Di
Costanzo E.; Vicidomini G.; Santini M.
Institution
(Fiorelli, Izzo, Frongillo, Prete, Vicidomini, Santini) Thoracic Surgery
Unit, Second University of Naples, Naples, Italy
(Liguori) Anestesiology and Intensive Care Unit, Cardarelli Hospital,
Naples, Italy
(Di Costanzo) Anestesiology and Intensive Care Unit, Monaldi Hospital,
Naples, Italy
Title
Efficacy of wound analgesia for controlling post-thoracotomy pain: A
randomized double-blind study.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 339-347), 2016.
Date of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Continuous wound infusion of local anaesthetics has been
successfully applied for postoperative pain control in several procedures
but, surprisingly, it is underused in thoracic surgery. We aimed to
investigate the effects of wound analgesia associated with systemic
patient-controlled analgesia in patients undergoing lung cancer resection
with muscle-sparing thoracotomy. METHODS: Sixty consecutive patients
undergoing lung cancer resection via standard muscle-sparing thoracotomy
were randomized into two groups (wound analgesia and placebo groups).
Bupivacaine in the wound group and free-saline solution in the placebo
group were injected using a multiholed catheter connected to an
elastomeric pump inserted at the end of operation between the pericostal
sutures and the serratus muscle and removed 48 h after. The inter-group
differences were assessed by the following criteria: (i) level of
cytokines [IL-6, IL-10 and tumour necrosis factor-alpha (TNF-alpha)]; (ii)
pain on a visual analogue scale at rest and after coughing; (iii) recovery
of respiratory functions (flow expiratory volume in 1 s % and forced vital
capacity %) and (iv) narcotic medication consumption at different time
points of the postoperative course. RESULTS: Five out of a total of 60
patients were excluded from the final analysis. Thus, the wound and
placebo groups comprised 27 and 28 patients, respectively. The wound group
compared with the placebo group had a significant decrease of IL-6 (P <
0.001), IL-10 (P < 0.001) and TNF-alpha (P < 0.001) blood concentration
levels, pain scores at rest (P < 0.001) and after coughing (P = 0.01), and
a reduction of additional morphine intake (P = 0.03) and Ketorolac (P =
0.01) during the entire postoperative course. The recovery of the flow
expiratory volume in one second % (P = 0.01) and the forced vital capacity
% (P = 0.02) was also better in the wound than in the placebo group.
CONCLUSIONS: Our data prove that wound analgesia is an effective, easy and
safe procedure. It significantly reduces systemic inflammatory markers,
pain scores and opioid intake; and accelerates the recovery of respiratory
function. Catheter placement does not require particular manoeuvres by the
surgeon nor does the elastomeric pump need any adjustment or care by
physicians or nurses. Copyright &#xa9; The Author 2015.

<9>
Accession Number
601114425
Author
Tregay J.; Wray J.; Bull C.; Franklin R.C.; Daubeney P.; Barron D.J.;
Brown K.; Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway. Copyright
&#xa9; Cambridge University Press 2014.

<10>
Accession Number
609393495
Author
Alten J.A.; Rhodes L.A.; Tabbutt S.; Cooper D.S.; Graham E.M.; Ghanayem
N.; Marino B.S.; Figueroa M.I.; Chanani N.K.; Jacobs J.P.; Donohue J.E.;
Yu S.; Gaies M.
Institution
(Alten, Rhodes) Department of Pediatric Cardiology, Section of Cardiac
Critical Care Medicine, University of Alabama at Birmingham, 1700 6th
Avenue South, Birmingham, AL 35233, United States
(Tabbutt) Department of Pediatrics, Benioff Children's Hospital,
University of California, San Francisco, CA, United States
(Cooper) Heart Institute Cincinnati, Children's Hospital Medical Center,
Cincinnati, OH, United States
(Graham) Department of Pediatric Cardiology, Medical University of South
Carolina, Charleston, SC, United States
(Ghanayem) Department of Pediatrics, Children's Hospital of Wisconsin,
Medical College of Wisconsin, Milwaukee, WI, United States
(Marino) Department of Pediatric Cardiology and Medical Social Sciences,
Northwestern University, Ann and Robert H. Lurie Children's Hospital of
Chicago, Evanston, IL, United States
(Figueroa) Department of Pediatric Cardiology, University of Tennessee
Health Science Center, Memphis, TN, United States
(Chanani) Department of Pediatric Cardiology, Emory University, Children's
Healthcare of Atlanta, Atlanta, GA, United States
(Jacobs) Division of Cardiovascular Surgery, Department of Surgery, Johns
Hopkins All Children's Heart Institute, St Petersburg, Tampa, Orlando, FL,
United States
(Jacobs) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, Baltimore, MD, United States
(Donohue, Yu, Gaies) Division of Cardiology, Department of Pediatrics and
Communicable Diseases, C.S. Mott Children's Hospital, Ann Arbor, MI,
United States
Title
Perioperative feeding management of neonates with CHD: Analysis of the
Pediatric Cardiac Critical Care Consortium (PC⁴) registry.
Source
Cardiology in the Young. 25 (8) (pp 1593-1601), 2015. Date of Publication:
01 Dec 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction The optimal perioperative feeding strategies for neonates
with CHD are unknown. In the present study, we describe the current
feeding practices across a multi-institutional cohort. Methods Inclusion
criteria for this study were as follows: all neonates undergoing cardiac
surgery admitted to the cardiac ICU for > 3/424 hours preoperatively
between October, 2013 and July, 2014 in the Pediatric Cardiac Critical
Care Consortium registry. Results The cohort included 251 patients from
eight centres. The most common diagnoses included the following:
hypoplastic left heart syndrome (17%), coarctation/aortic arch hypoplasia
(18%), and transposition of the great arteries (22%); 14% of the patients
were <37weeks of gestational age. The median total hospital length of stay
was 21 days (interquartile range (IQR) 14-35) and overall mortality was
8%. Preoperative feeding occurred in 133 (53%) patients. The overall
preoperative feeding rates across centres ranged from 29 to 79%.
Postoperative feeds started on median day 2 (IQR 1-4); for patients with
hypoplastic left heart syndrome postoperative feeds started on median day
4. Postoperative feeds were initiated in 89 (35%) patients before
extubation (range across centres: 21-61%). The median cardiac ICU
discharge feeding volume was 108 cc/kg/day, varying across centres. The
mean discharge weight was 280 g above birth weight, ranging from +100 to
430 g across centres. A total of 110 (44%) patients had discharge feeding
tubes, ranging from 6 to 80% across centres, and 40/110 patients had
gastrostomy/enterostomy tubes placed. In addition, eight (3.2%) patients
developed necrotising enterocolitis-three preoperatively and five
postoperatively. Conclusion In this cohort, neonatal feeding practices and
outcomes appear to vary across diagnostic groups and institutions. Only
half of the patients received preoperative enteral nutrition; almost half
had discharge feeding tubes. Multi-institutional collaboration is
necessary to determine feeding strategies associated with best clinical
outcomes. Copyright &#xa9; 2015 Cambridge University Press.

<11>
Accession Number
609393385
Author
Kansy A.; Ebels T.; Schreiber C.; Jacobs J.P.; Tobota Z.; Maruszewski B.
Institution
(Kansy, Tobota, Maruszewski) Children's Memorial Health Institute,
Department for Pediatric Cardiothoracic Surgery, Al. Dzieci Polskich 20,
Warsaw 04-830, Poland
(Ebels) University Medical Center Groningen, Groningen, Netherlands
(Schreiber) Department of Cardiovascular Surgery, German Heart Center
Munich, Technical University Munich, Munich, Germany
(Jacobs) Division of Cardiovascular Surgery, Johns Hopkins All Children's
Heart Institute, All Children's Hospital, Saint Petersburg, Tampa,
Orlando, FL, United States
(Jacobs) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, Baltimore, MD, United States
Title
Higher programmatic volume in paediatric heart surgery is associated with
better early outcomes.
Source
Cardiology in the Young. 25 (8) (pp 1572-1578), 2015. Date of Publication:
01 Dec 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective Previous analyses have suggested an association between centre
volume and in-hospital mortality, post-operative complications, and
mortality in those patients who suffer from a complication. We sought to
determine the nature of this association using a multicentre cohort.
Methods All the patients, aged 18 years or younger, undergoing heart
surgery at centres participating in the European Congenital Heart Surgeons
Database (2003-2013) were included. Programmes were grouped as follows:
small <150; medium 150-250; large 251-349; very large >350. Multivariable
logistic regression was used to identify the differences between groups
with the adjusted in-hospital mortality, onset of any and/or major
complication, and in-hospital mortality in those patients with any and/or
major complication. The outcomes were adjusted for patient specific risk
factors and surgical risk factors. Results The data set consisted of
119,345 procedures performed in 99 centres. Overall, in-hospital mortality
was 4.63%; complications occurred in 23.4% of the patients. In-hospital
mortality in patients with complications was 13.82%. Multivariable
logistic regression showed that the risk of in-hospital death was higher
in low-and medium-volume centres (p<0.001). The rate of the occurrence of
any post-operative complication in small, medium, and large programmes was
lower compared with very large centres (p<0.001). Low-and medium-volume
centres were associated with significantly higher mortality in patients
with any complication (p<0.001). Conclusions Our analysis showed that the
risk of in-hospital mortality was lower in higher-volume centres. Although
the risk of complications is higher in high-volume centres, the mortality
associated with complications that occurred in these centres was lower.
Copyright &#xa9; 2015 Cambridge University Press.

<12>
Accession Number
608913302
Author
Barbash I.M.; Barbanti M.; Webb J.; Molina-Martin De Nicolas J.;
Abramowitz Y.; Latib A.; Nguyen C.; Deuschl F.; Segev A.; Sideris K.;
Buccheri S.; Simonato M.; Rosa F.D.; Tamburino C.; Jilaihawi H.; Miyazaki
T.; Himbert D.; Schofer N.; Guetta V.; Bleiziffer S.; Tchetche D.; Imme
S.; Makkar R.R.; Vahanian A.; Treede H.; Lange R.; Colombo A.; Dvir D.
Institution
(Barbash, Segev, Guetta) Leviev Heart Center, Sheba Medical Center, Tel
Aviv University, Ramat Gan, Israel
(Barbanti, Buccheri, Tamburino, Imme) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Webb, Simonato, Dvir) Department of Cardiology, St Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Molina-Martin De Nicolas, Rosa, Tchetche) Groupe CardioVasculaire
Interventionnel, Clinique Pasteur, Toulouse, France
(Abramowitz, Jilaihawi, Makkar) Cedars-Sinai Medical Center, Cedars-Sinai
Heart Institute, Los Angeles, CA, United States
(Latib, Miyazaki, Colombo) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy
(Nguyen, Himbert, Vahanian) Department of Cardiology,
Bichat-Claude-Bernard Hospital, UniversitCrossed D Sign Paris VII, Paris,
France
(Deuschl, Schofer, Treede) Department of Cardiovascular Surgery,
University Heart Center, Hamburg, Germany
(Sideris, Bleiziffer, Lange) Clinic for Cardiovascular Surgery, German
Heart Centre, Munich, Germany
Title
Comparison of vascular closure devices for access site closure after
transfemoral aortic valve implantation.
Source
European Heart Journal. 36 (47) (pp 3370-3379), 2015. Date of Publication:
14 Dec 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background The majority of transcatheter aortic valve implantation (TAVI)
procedures are currently performed by percutaneous transfemoral approach.
The potential contribution of the type of vascular closure device to the
incidence of vascular complications is not clear. Aim To compare the
efficacy of a Prostar XL-vs. Perclose ProGlide-based vascular closure
strategy. Methods The ClOsure device iN TRansfemoral aOrtic vaLve
implantation (CONTROL) multi-center study included 3138 consecutive
percutaneous transfemoral TAVI patients, categorized according to vascular
closure strategy: Prostar XL-(Prostar group) vs. Perclose ProGlide-based
vascular closure strategy (ProGlide group). Propensity-score matching was
used to assemble a cohort of patients with similar baseline
characteristics. Results Propensity matching identified 944 well-matched
patients (472 patient pairs). Composite primary end point of major
vascular complications or in-hospital mortality occurred more frequently
in Prostar group when compared with ProGlide group (9.5 vs. 5.1%, P =
0.016), and was driven by higher rates of major vascular complication (7.4
vs. 1.9%, P < 0.001) in the Prostar group. However, in-hospital mortality
was similar between groups (4.9 vs. 3.5%, P = 0.2). Femoral artery
stenosis occurred less frequently in the Prostar group (3.4 vs. 0.5%, P =
0.004), but overall, Prostar use was associated with higher rates of major
bleeding (16.7 vs. 3.2%, P < 0.001), acute kidney injury (17.6 vs. 4.4%, P
< 0.001) and with longer hospital stay (median 6 vs. 5 days, P = 0.007).
Conclusions Prostar XL-based vascular closure in transfemoral TAVI
procedures is associated with higher major vascular complication rates
when compared with ProGlide; however, in-hospital mortality is similar
with both devices. Copyright &#xa9; 2015 Published on behalf of the
European Society of Cardiology. All rights reserved.

<13>
Accession Number
608913271
Author
Douglas P.S.; Pontone G.; Hlatky M.A.; Patel M.R.; Norgaard B.L.; Byrne
R.A.; Curzen N.; Purcell I.; Gutberlet M.; Rioufol G.; Hink U.; Schuchlenz
H.W.; Feuchtner G.; Gilard M.; Andreini D.; Jensen J.M.; Hadamitzky M.;
Chiswell K.; Cyr D.; Wilk A.; Wang F.; Rogers C.; De Bruyne B.
Institution
(Douglas, Patel, Chiswell, Cyr) Duke Clinical Research Institute, Duke
University School of Medicine, 7022 North Pavilion DUMC, Durham, NC 27715,
United States
(Pontone, Andreini) Centro Cardiologico Monzino, IRCCS, University of
Milan, Milan, Italy
(Hlatky) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, CA, United States
(Norgaard, Jensen) Department of Cardiology, Aarhus University Hospital,
Aarhus Skejby, Denmark
(Byrne, Hadamitzky) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
(Curzen) University Hospital Southampton NHS Trust, Southampton, United
Kingdom
(Purcell) Freeman Hospital, Newcastle Upon Tyne, United Kingdom
(Gutberlet) University of Leipzig Heart Centre, Leipzig, Germany
(Rioufol) Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
(Hink) Department of Cardiology, Johannes Gutenberg University Hospital,
Mainz, Germany
(Schuchlenz) LKH Graz West, Graz, Austria
(Feuchtner) Department of Radiology, Innsbruck Medical University,
Innsbruck, Austria
(Gilard) Department of Cardiology, Cavale Blanche Hospital, Brest, France
(Wilk, Wang, Rogers) HeartFlow, Redwood City, CA, United States
(De Bruyne) Cardiovascular Centre Aalst, Aalst, Belgium
Title
Clinical outcomes of fractional flow reserve by computed tomographic
angiography-guided diagnostic strategies vs. usual care in patients with
suspected coronary artery disease: The prospective longitudinal trial of
FFR<inf>CT</inf>: Outcome and resource impacts study.
Source
European Heart Journal. 36 (47) (pp 3359-3367), 2015. Date of Publication:
14 Dec 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In symptomatic patients with suspected coronary artery disease (CAD),
computed tomographic angiography (CTA) improves patient selection for
invasive coronary angiography (ICA) compared with functional testing. The
impact of measuring fractional flow reserve by CTA (FFR<inf>CT</inf>) is
unknown. Methods and results At 11 sites, 584 patients with new onset
chest pain were prospectively assigned to receive either usual testing (n
= 287) or CTA/FFR<inf>CT</inf> (n = 297). Test interpretation and care
decisions were made by the clinical care team. The primary endpoint was
the percentage of those with planned ICA in whom no significant
obstructive CAD (no stenosis >50% by core laboratory quantitative analysis
or invasive FFR < 0.80) was found at ICA within 90 days. Secondary
endpoints including death, myocardial infarction, and unplanned
revascularization were independently and blindly adjudicated. Subjects
averaged 61 +/- 11 years of age, 40% were female, and the mean pre-Test
probability of obstructive CAD was 49 +/- 17%. Among those with intended
ICA (FFR<inf>CT</inf>-guided = 193; usual care = 187), no obstructive CAD
was found at ICA in 24 (12%) in the CTA/FFR<inf>CT</inf> arm and 137 (73%)
in the usual care arm (risk difference 61%, 95% confidence interval 53-69,
P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4
mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after
receiving CTA/FFR<inf>CT</inf> results. Among those with intended
non-invasive testing, the rates of finding no obstructive CAD at ICA were
13% (CTA/FFR<inf>CT</inf>) and 6% (usual care; P = 0.95). Clinical event
rates within 90 days were low in usual care and CTA/FFR<inf>CT</inf> arms.
Conclusions Computed tomographic angiography/fractional flow reserve by
CTA was a feasible and safe alternative to ICA and was associated with a
significantly lower rate of invasive angiography showing no obstructive
CAD. Copyright &#xa9; 2015 The Author 2015. Published by Oxford University
Press on behalf of the European Society of Cardiology.

<14>
Accession Number
611592814
Author
Kularatna S.; Byrnes J.; Mervin M.C.; Scuffham P.A.
Institution
(Kularatna, Byrnes, Mervin, Scuffham) Centre for Applied Health Economics,
School of Medicine, Griffith University, Australia
(Kularatna, Byrnes, Mervin, Scuffham) Population and Social Health
Research Program, Menzies Health Institute Queensland, Griffith
University, Australia
Title
Health technology assessments reporting cost-effectiveness of
transcatheter aortic valve implantation.
Source
International Journal of Technology Assessment in Health Care. 32 (3) (pp
89-96), 2016. Date of Publication: 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objectives: Made available since 2002, transcatheter aortic valve
implantation (TAVI) is a minimally invasive new intervention which can
provide significant survival improvement to patients with aortic stenosis.
However, TAVI is expensive and currently not reimbursed by many
governments. Some governments and institutions have been conducting health
technology assessments (HTAs) to inform their reimbursement decisions. The
aim of the present study is to review HTAs that have relied on a
cost-effectiveness analysis to inform reimbursement decisions of TAVI.
Methods: A systematic literature review was conducted among published
literature as well as reports released by HTA agencies. Predetermined
inclusion and exclusion criteria, following the Preferred Reporting System
for Systematic Reviews and Meta-Analysis guidelines, were used to select
relevant HTAs. The selected papers were assessed against the Consolidated
Health Economic Evaluation Reporting Standards. Results: HTAs on TAVI from
three countries were available for this review: Canada, Belgium, and the
United Kingdom. All three HTAs used the Placement of Aortic Transcatheter
Valve (PARTNER) trial data with Markov models to estimate the incremental
cost effectiveness ratio. The three HTAs recommended conditional
reimbursement for TAVI for otherwise inoperable patients. The HTAs did not
use clear methods to estimate the health-related utility which ultimately
affected their cost-effectiveness results. The UK HTA showed the best
value for money (US$20,416 per quality-adjusted life-year). Conclusion:
All studies found TAVI to be more costly and less effective for high-risk
patients suitable for surgery, whereas TAVI was consistently found to be
cost effective for otherwise inoperable patients. Copyright &#xa9;
Cambridge University Press 2016.

<15>
Accession Number
607082837
Author
Kunihara T.
Institution
(Kunihara) The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku,
Tokyo 106-0031, Japan
Title
Annular management during aortic valve repair: a systematic review.
Source
General Thoracic and Cardiovascular Surgery. 64 (2) (pp 63-71), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Annuloplasty is considered to play a key role to control aortic valve
regurgitation (AR) and prevent recurrence of AR after aortic valve repair,
because aortic root dilatation has emerged as a risk factor for recurrence
of AR. Various modifications of annuloplasty have been advocated, however,
none of them has become standardized. Thus in this review they are
outlined and classified (internal/external, with/without ring,
rigid/flexible ring), and their advantages and disadvantages are
clarified. Their clinical outcomes seem currently acceptable in general,
and external flexible annuloplasty has been performed more frequently with
favorable outcomes. However, they are still performed for a minority of
patients by special experienced teams with limited follow-up periods.
Therefore, it seems too early to determine the superiority or inferiority
of each approach. We must carefully conduct evaluation to clarify which
approach will become reproducible, effective, and standardized. Copyright
&#xa9; 2015, The Japanese Association for Thoracic Surgery.

<16>
Accession Number
607131627
Author
Hascoet S.; Jalal Z.; Baruteau A.; Mauri L.; Chalard A.; Bouzguenda I.;
Piechaud J.-F.; Thambo J.-B.; Lefort B.; Guerin P.; Le Gloan L.; Acar P.;
Houeijeh A.; Godart F.; Fraisse A.
Institution
(Hascoet, Jalal, Baruteau, Mauri, Chalard, Bouzguenda, Piechaud, Thambo,
Lefort, Guerin, Le Gloan, Acar, Houeijeh, Godart, Fraisse) Grp. de
Catheterisme Interventionnel Pediat. et Congenitale/filiale de Cardiologie
Pediat. et Congenitale de la Soc. Francaise de Cardiologie, France
(Hascoet, Acar) Paediatric and Congenital Cardiology, Children's Hospital,
Paul-Sabatier University, Toulouse, France
(Hascoet) Inserm UMR 1048, Equipe 8-I2MC, Institut des Maladies
Metaboliques et Cardiovasculaires, Paul-Sabatier University, Toulouse,
France
(Hascoet) Department of Cardiology, Rangueil Hospital, Paul-Sabatier
University, Toulouse, France
(Hascoet) M3C Marie-Lannelongue Hospital, Paediatric and Congenital
Cardiac Surgery, Paris Sud University, Paris, France
(Jalal, Baruteau, Thambo) Paediatric and Congenital Cardiology, Haut
Leveque Hospital, M3C CHU de Bordeaux, Bordeaux, France
(Baruteau) Inserm UMR 1087, CNRS UMR6291, Institut du Thorax, Nantes
University, Nantes, France
(Mauri, Fraisse) Paediatric and Congenital Cardiology, La Timone Hospital,
M3C CHU de Marseille, Marseille, France
(Chalard) Gabriel-Montpied Hospital, M3C CHRU de Clermont-Ferrand,
Clermont-Ferrand, France
(Bouzguenda, Piechaud) Institut Jacques-Cartier, Massy, France
(Lefort) Clocheville Hospital, M3C CHRU de Tours, Tours, France
(Guerin, Le Gloan) Nord Laennec Hospital, M3C CHU de Nantes, Nantes,
France
(Houeijeh, Godart) Albert-Calmette Hospital, M3C CHRU de Lille, Lille,
France
(Fraisse) Royal Brompton Hospital, London, United Kingdom
Title
Stenting in paediatric and adult congenital heart diseases: A French
multicentre study in the current era.
Source
Archives of Cardiovascular Diseases. 108 (12) (pp 650-660), 2015. Date of
Publication: 2015.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background.-Many stents are used off-label during the management of
congenital heartdiseases (CHD).Aims.-To describe indications for, results
of, and adverse events associated with stenting inCHD in current
practice.Methods.-Participation in this study was proposed to all
catheterization laboratories thatspecialize in CHD in France (M3C
network). All paediatric and adult CHD cases with stentimplantation in
2013 were included retrospectively.Results.-Overall, 207 stents were
implanted in 151 patients across 11 centres. Median age was13.7 years
(range, 5 days to 70.1 years). Main procedure indications were branch
pulmonaryartery angioplasty (n = 46, 29.1%), aortic (re)coarctation
stenting (n = 43, 27.2%), percutaneouspulmonary valve implantation (n =
32, 20.2%) and ductus arteriosus stenting (n = 14, 8.9%). Themain stents
implanted were the CP StentTM(n = 61, 29.5%), the MaxTMLD stent (n = 43,
20.8%),the Valeo stent (n = 28, 13.5%) and valved stents (n = 30, 14.5%).
Procedures were consideredsuccessful in 96.8% of cases (95% confidence
interval [CI] 92.8-99.0%). Adverse events wereobserved in 23 procedures
(14.7%, 95% CI 9.5-21.0%). Ductus arteriosus stenting (odds ratio12.4, 95%
CI 2.0-77.5; P < 0.01) and pulmonary revalvulation (odds ratio 5.9, 95% CI
1.1-32.3;P = 0.04) were risk markers for stent-related adverse
events.Conclusions.-Stents are used in various CHD catheterization
procedures, from infancy to adultage. The adverse events rate is
significant and is related to the type of procedure. Copyright &#xa9; 2015
Elsevier Masson SAS. Tous droits reserves.

<17>
Accession Number
611862093
Author
Bangalore S.; Singh A.; Toklu B.; DiNicolantonio J.J.; Croce K.; Feit F.;
Bhatt D.L.
Institution
(Bangalore, Singh, Toklu, Feit) New York University School of Medicine,
New York, NY, United States
(DiNicolantonio) Saint Luke's Mid America Heart Institute, Kansas City,
MO, United States
(Croce, Bhatt) Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
Title
Efficacy of cilostazol on platelet reactivity and cardiovascular outcomes
in patients undergoing percutaneous coronary intervention: Insights from a
meta-analysis of randomised trials.
Source
Open Heart. 1 (1) (no pagination), 2014. Article Number: e000068. Date of
Publication: 2014.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Cilostazol overcomes high on-treatment platelet reactivity
(HTPR) and reduces adverse cardiovascular (CV) outcomes after percutaneous
coronary intervention (PCI). However, the role for triple antiplatelet
therapy (TAPT) with cilostazol in addition to aspirin and clopidogrel
after PCI is not well defined. Methods: We conducted a
MEDLINE/EMBASE/CENTRAL search for randomised trials, until May 2014,
evaluating TAPT compared with dual antiplatelet therapy (DAPT) of aspirin
and clopidogrel alone in patients undergoing PCI and reporting platelet
reactivity and/or CV outcomes. The primary platelet reactivity outcome was
differences in platelet reactivity unit (PRU) with secondary outcomes of
%platelet inhibition and rate of HTPR. The primary CV outcome was major
adverse cardiovascular events (MACE), with secondary outcomes of death,
cardiovascular death, myocardial infarction, stent thrombosis (ST), target
lesion revascularisation (TLR) and target vessel revascularisation (TVR)
as well as safety outcomes of bleeding and drug discontinuations. Results:
In 17 trials that evaluated platelet reactivity outcomes, the mean PRU
value was 47.73 units lower with TAPT versus DAPT (95% CI -61.41 to
-34.04, p<0.0001; mean PRU 182.90 vs 232.65). TAPT also increased platelet
inhibition by 12.71% (95% CI 10.76 to 14.67, p<0.0001), and led to a 60%
reduction in the risk of HTPR (relative risk=0.40; 95% CI 0.30 to 0.53)
compared with DAPT. Moreover, among the 34 trials that evaluated CV
outcomes, TAPT reduced the risk of MACE (incident rate ratio (IRR)=0.68;
95% CI 0.60 to 0.78), TLR (IRR=0.57; 95% CI 0.44 to 0.73), TVR (IRR=0.69;
95% CI 0.59 to 0.81) and ST (IRR=0.63; 95% CI 0.40 to 0.98) with no
difference for other outcomes including bleeding, even in trials using
drug-eluting stents. Drug discontinuation due to adverse effects was,
however, higher with TAPT vs DAPT (IRR=1.59; 95% CI 1.32 to 1.91).
Conclusions: In patients undergoing PCI, addition of cilostazol to DAPT
results in decreased platelet reactivity and a significant reduction in CV
outcomes including ST, even in the drug-eluting stent era. Copyright
&#xa9; 2014, BMJ Publishing Group. All rights reserved.

<18>
Accession Number
611862136
Author
Nagaraja V.; Raval J.; Eslick G.D.; Ong A.T.L.
Institution
(Nagaraja) Prince of Wales Clinical School, University of New South Wales,
Prince of Wales Hospital, Australia
(Raval, Ong) Department of Cardiology, Blacktown Hospital, Australia
(Nagaraja, Eslick) Whiteley-Martin Research Centre, Discipline of Surgery,
University of Sydney, Nepean Hospital, Sydney, NSW, Australia
Title
Transcatheter versus surgical aortic valve replacement: A systematic
review and meta-analysis of randomised and non-randomised trials.
Source
Open Heart. 1 (1) (no pagination), 2014. Article Number: e000013. Date of
Publication: 2014.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Many patients deemed inoperable for surgical aortic valve
replacement (SAVR) have been treated successfully by transcatheter
aortic-valve replacement (TAVR). This meta-analysis is designed to
evaluate the performance of TAVR in comparison with SAVR. Methods: A
systematic search was conducted using MEDLINE, PubMed, EMBASE, Current
Contents Connect, the Cochrane library, Google Scholar, Science Direct and
Web of Science. Original data were abstracted from each study and used to
calculate a pooled OR and 95% CI. Results: Among three randomised
controlled trials (RCTs), differences between the two cohorts were not
statistically significant for the frequency of stroke (OR=1.94, 95%
CI=0.813 to 4.633), incidence of myocardial infarction (MI), (OR=0.765,
95% CI=0.05 to 11.76) 30-day mortality rate, 1-year mortality rate (0.82,
95% CI=0.62 to 1.09) and acute kidney injury incidence rate. The non-RCTs
demonstrated that the TAVR group had an amplified frequency aortic
regurgitation at discharge (OR=5.465, 95% CI=3.441 to 8.680). While
differences between the two cohorts were not statistically significant for
the incidence of MI (OR=0.697, 95% CI=0.22 to 2.21), stroke (OR=0.575, 95%
CI=0.263 to 1.259), acute renal failure requiring haemodialysis (OR=0.943,
95% CI=0.276 to 3.222), 30-day mortality (OR=0.869, 95% CI=0.621 to 1.216)
and the need for a pacemaker (OR=1.832, 95% CI=0.869 to 3.862), a lower
incidence of patients needing transfusion (OR=0.349, 95% CI=0.121 to
1.005) and new-onset atrial fibrillation (OR=0.296, 95% CI=0.124 to 0.706)
was seen in the TAVR group. Conclusions: Randomised and observational
evidence adjusted on the baseline patient's characteristics finds a
similar risk for 30 days mortality, 1-year mortality, stroke, MI and acute
kidney injury in TAVR and SAVR. Copyright &#xa9; 2014, BMJ Publishing
Group. All rights reserved.

<19>
Accession Number
611028981
Author
Doenst T.; Struning C.; Moschovas A.; Gonzalez-Lopez D.; Essa Y.; Kirov
H.; Diab M.; Faerber G.
Institution
(Doenst, Struning, Moschovas, Gonzalez-Lopez, Essa, Kirov, Diab, Faerber)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Erlanger Allee 101, Jena 07747, Germany
Title
Cardiac surgery 2015 reviewed.
Source
Clinical Research in Cardiology. 105 (10) (pp 801-814), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2015, almost 19,000 published references can be found in
PubMed when entering the search term "cardiac surgery". The last year has
been again characterized by lively discussions in the fields where classic
cardiac surgery and modern interventional techniques overlap. Lacking
evidence in the field of coronary revascularization with either
percutaneous coronary intervention or bypass surgery has been added. As in
the years before, CABG remains the gold standard for the revascularization
of complex stable triple-vessel disease. Plenty of new information has
been presented comparing the conventional to transcatheter aortic valve
implantation (TAVI) demonstrating similar short- and mid-term outcomes at
high and low risk, but even a survival advantage with transfemoral TAVI at
intermediate risk. In addition, there were many relevant and interesting
other contributions from the purely operative arena. This review article
will summarize the most pertinent publications in the fields of coronary
revascularization, surgical treatment of valve disease, heart failure
(i.e., transplantation and ventricular assist devices), and aortic
surgery. While the article does not have the expectation of being complete
and cannot be free of individual interpretation, it provides a condensed
summary that is intended to give the reader "solid ground" for up-to-date
decision-making in cardiac surgery. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<20>
[Use Link to view the full text]
Accession Number
610667757
Author
Xu X.; Li S.-X.; Lin H.; Normand S.-L.T.; Lagu T.; Desai N.; Duan M.;
Kroch E.A.; Krumholz H.M.
Institution
(Xu) Department of Obstetrics, Gynecology and Reproductive Sciences, Yale
School of Medicine, New Haven, CT, United States
(Xu, Li, Desai, Krumholz) Center for Outcomes Research and Evaluation,
Yale-New Haven Hospital, 1 Church Street, New Haven, CT 06510, United
States
(Lin) Department of Biostatistics, Yale School of Public Health, New
Haven, CT, United States
(Normand) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(Normand) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Lagu) Division of General Medicine, Tufts University School of Medicine,
Boston, MA, United States
(Lagu) Baystate Medical Center, Springfield, MA, United States
(Desai, Krumholz) Section of Cardiovascular Medicine, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, United States
(Duan) Premier Inc., Charlotte, NC, United States
(Kroch) Leonard Davis Institute of Health Economics, University of
Pennsylvania, Philadelphia, PA, United States
(Kroch) Booz Allen Hamilton Inc., McLean, VA, United States
(Krumholz) Robert Wood Johnson Foundation Clinical Scholars Program,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Title
Hospital phenotypes in the management of patients admitted for acute
myocardial infarction.
Source
Medical Care. 54 (10) (pp 929-936), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To characterize hospital phenotypes by their combined
utilization pattern of percutaneous coronary interventions (PCI), coronary
artery bypass grafting (CABG) procedures, and intensive care unit (ICU)
admissions for patients hospitalized for acute myocardial infarction
(AMI). Research Design: Using the Premier Analytical Database, we
identified 129,138 hospitalizations for AMI from 246 hospitals with the
capacity for performing open-heart surgery during 2010-2013. We calculated
year-specific, risk-standardized estimates of PCI procedure rates, CABG
procedure rates, and ICU admission rates for each hospital, adjusting for
patient clinical characteristics and within-hospital correlation of
patients. We used a mixture modeling approach to identify groups of
hospitals (ie, hospital phenotypes) that exhibit distinct longitudinal
patterns of risk-standardized PCI, CABG, and ICU admission rates. Results:
We identified 3 distinct phenotypes among the 246 hospitals: (1) high PCI
- low CABG - high ICU admission (39.2% of the hospitals), (2) high PCI -
low CABG - low ICU admission (30.5%), and (3) low PCI - high CABG -
moderate ICU admission (30.4%). Hospitals in the high PCI - low CABG -
high ICU admission phenotype had significantly higher risk-standardized
inhospital costs and 30-day risk-standardized payment yet similar
risk-standardized mortality and readmission rates compared with hospitals
in the low PCI - high CABG - moderate ICU admission phenotype. Hospitals
in these phenotypes differed by geographic region. Conclusions: Hospitals
differ in how they manage patients hospitalized for AMI. Their distinctive
practice patterns suggest that some hospital phenotypes may be more
successful in producing good outcomes at lower cost. Copyright &#xa9; 2016
Wolters Kluwer Health, Inc. All rights reserved.

<21>
Accession Number
607445354
Author
McHugh K.E.; Pasquali S.K.; Hall M.A.; Scheurer M.A.
Institution
(McHugh, Scheurer) Medical University of South Carolina, 165 Ashley
Avenue, MSC 915, Charleston, SC 29425, United States
(Pasquali) University of Michigan CS Mott Children's Hospital, Ann Arbor,
MI, United States
(Hall) Children's Hospital Association, Overland Park, KS, United States
Title
Impact of postoperative complications on hospital costs following the
Norwood operation.
Source
Cardiology in the Young. 26 (7) (pp 1303-1309), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction Patients undergoing the Norwood operation consume
considerable healthcare resources; however, detailed information regarding
factors impacting hospitalisation costs is lacking. We evaluated the
association of postoperative complications with hospital costs. Methods In
the present study, we utilised a unique data set consisting of
prospectively collected clinical data from the Pediatric Heart Network
Single Ventricle Reconstruction trial linked at the patient level with
cost data for 10 hospitals participating in the Children's Hospital
Association Case Mix database during the trial period. The relationship
between complications and cost was modelled using linear regression,
accounting for the skewed distribution of cost, adjusting for
within-centre clustering and baseline patient characteristics. Results A
total of 334 eligible Norwood records (97.5%) were matched between data
sets. Overall, 82% suffered from at least one complication (median 2; with
a range from 0 to 33). Those with complications had longer postoperative
length of stay (25 versus 12 days, p<0.001), more total ventilator days (7
versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus
3.4%, p<0.006). Mean adjusted hospital cost in those with a complication
was $190,689 (95% CI $111,344-$326,577) versus $120,584 (95% CI
$69,246-$209,983) in those without complications (p=0.002). Costs
increased with the number of complications (1-2 complications=$132,800
versus 3-4 complications=$182,353 versus 5 complications=$309,372
[p<0.001]). Conclusions This merged data set of clinical trial and cost
data demonstrated that postoperative complications are common following
the Norwood operation and are associated with worse clinical outcomes and
higher costs. Efforts to reduce complications in this population may lead
to improved outcomes and cost savings. Copyright &#xa9; Cambridge
University Press 2015.

<22>
Accession Number
609136807
Author
Amedro P.; Basquin A.; Gressin V.; Clerson P.; Jais X.; Thambo J.-B.;
Guerin P.; Cohen S.; Bonnet D.
Institution
(Amedro) Pediatric and Congenital Cardiology, Arnaud de Villeneuve
University Hospital, PhyMedexp, INSERM U1046, CNRS UMR 9214, University of
Montpellier, 37, avenue du Doyen Gaston Giraud, Montpellier Cedex 5 34295,
France
(Amedro) Department of Public Health, EA3279 Self-perceived Health
Assessment Research Unit, Aix-Marseille University, Marseille, France
(Basquin) Pediatric and Congenital Cardiology, University Hospital,
Rennes, France
(Gressin) Actelion Pharmaceuticals France, Paris, France
(Clerson) Orgametrie Biostatistics, Roubaix, France
(Jais) Bicetre University Hospital, Le Kremlin-Bicetre, France
(Thambo) Pediatric and Congenital Cardiology, Haut-Leveque University
Hospital, Bordeaux, France
(Guerin) Pediatric and Congenital Cardiology, Guillaume and Rene Laennec
University Hospital, Nantes, France
(Cohen) Adult Congenital Heart Disease Unit, M3C-George Pompidou European
Hospital, AP-HP, Paris Descartes University, France
(Cohen) INSERM-UMRS 1138, Cordelier Research Center, Team 22, France
(Bonnet) Pediatric and Congenital Cardiology, M3C-Necker University
Hospital, AP-HP, Paris Descartes University, Paris, France
Title
Health-related quality of life of patients with pulmonary arterial
hypertension associated with CHD: The multicentre cross-sectional ACHILLE
study.
Source
Cardiology in the Young. 26 (7) (pp 1250-1259), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The aim of this study was to assess health-related quality of
life in patients with pulmonary arterial hypertension associated with CHD
and correlations with clinical status. Methods This prospective
cross-sectional observational study included CHD patients with pulmonary
arterial hypertension in 14 tertiary-care centres in France. We used two
health-related quality of life questionnaires - SF-36 and Cambridge
Pulmonary Hypertension Outcome Review (CAMPHOR) - and one
anxiety/depression Hospital Anxiety and Depression Scale (HADS)
questionnaire. Results Clinical data were collected for the 208 included
patients (mean age: 42.6 years, range from 15.1 to 85.8 years, 69.7%
female). Most patients were in NYHA functional class II (48.1%) and III
(37.5%). Patients' phenotype was classified as Eisenmenger syndrome
(70.7%), pulmonary arterial hypertension associated with
systemic-to-pulmonary shunts (12.0%), with small defects (3.4%), or after
corrective cardiac surgery (13.9%). In total, 76.4% of the patients were
receiving pulmonary arterial hypertension-specific treatments. SF-36
scores showed impairment compared with normalised data. Health-related
quality of life scores were significantly lower in females than in males
for most dimensions of both questionnaires and were independent of the
patients' phenotype, even after gender adjustment - except for CAMPHOR
functioning - but significantly depended on NYHA functional class. The
Hospital Anxiety and Depression Scale (HADS) scores suggested anxiety and
depression associated with increasing NYHA functional class but
independent of patients' phenotype. NYHA functional class, 6-minute walk
distance, HADS, gender, and recent stressful event significantly affected
quality of life in the multivariate analysis. Conclusions This study
showed impairment of quality of life in a large cohort of patients with
pulmonary arterial hypertension associated with CHD with both generic and
specific questionnaires. NYHA functional class and HADS scores were
predictive of most quality of life scores. Copyright &#xa9; Cambridge
University Press 2016.

<23>
Accession Number
611521903
Author
Jones P.M.; Bainbridge D.; Chu M.W.A.; Fernandes P.S.; Fox S.A.; Iglesias
I.; Kiaii B.; Lavi R.; Murkin J.M.
Institution
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Department of Anesthesia &
Perioperative Medicine, University of Western Ontario, London, ON, Canada
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Schulich School of Medicine &
Dentistry, The University of Western Ontario, London, ON, Canada
(Jones, Bainbridge) Program in Critical Care, Department of Medicine, The
University of Western Ontario, London, ON, Canada
(Jones) Department of Epidemiology & Biostatistics, University of Western
Ontario, London, ON, Canada
(Chu, Fox, Kiaii) Division of Cardiac Surgery, Department of Surgery, The
University of Western Ontario, London, ON, Canada
(Fernandes) Clinical Perfusion Services, Cardiac Care, London Health
Sciences Centre, London, ON, Canada
(Jones) University Hospital - London Health Sciences Centre, Room C3-110,
339 Windermere Rd, London, ON N6A 5A5, Canada
Title
Comparison of isoflurane and sevoflurane in cardiac surgery: a randomized
non-inferiority comparative effectiveness trial.
Source
Canadian Journal of Anesthesia. 63 (10) (pp 1128-1139), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Volatile anesthetics possess cardioprotective properties, but it
is unknown if the cardioprotective effects extend equally to all members
of the class. Although sevoflurane is a relatively newer anesthetic than
isoflurane, its introduction into practice was not preceded by a
head-to-head comparison with isoflurane in a trial focusing on clinically
important outcomes. Our objective was to determine whether sevoflurane was
non-inferior to isoflurane on a clinically important primary outcome in a
heterogeneous group of adults undergoing cardiac surgery. Methods: This
was a pragmatic randomized non-inferiority comparative effectiveness
clinical trial in 464 adults having coronary artery bypass graft and/or
single valve surgery during November 2011 to March 2014. The intervention
was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n
= 233) administered at a dose of 0.5-2.0 MAC throughout the entire
operation. All caregivers were blinded except for the anesthesiologist and
perfusionist. The primary outcome was a composite of intensive care unit
(ICU) length of stay > 48 hr and all-cause 30-day mortality. We
hypothesized that sevoflurane would be non-inferior to isoflurane
(non-inferiority margin < 10% based on an expected event rate of 25%).
Secondary outcomes included prolonged ICU stay, 30- and 365-day all-cause
mortality, inotrope or vasopressor usage, new-onset hemodialysis or atrial
fibrillation, stroke, and readmission to the ICU. Results: No losses to
follow-up occurred. The primary outcome occurred in 25% of sevoflurane
patients and 30% of isoflurane patients (absolute difference, -5.4%;
one-sided 95% confidence interval, 1.4), thus non-inferiority was
declared. Sevoflurane was not superior to isoflurane for the primary
outcome (P = 0.21) or for any secondary outcomes. Conclusion: Sevoflurane
is non-inferior to isoflurane on a composite outcome of prolonged ICU stay
and all-cause 30-day mortality. Sevoflurane is not superior to isoflurane
on any other of the clinically important outcomes. This trial was
registered at clinicaltrials.gov; NCT01477151. Copyright &#xa9; 2016, The
Author(s).

<24>
Accession Number
611532987
Author
Denault A.Y.; Bussieres J.S.; Arellano R.; Finegan B.; Gavra P.; Haddad
F.; Nguyen A.Q.N.; Varin F.; Fortier A.; Levesque S.; Shi Y.; Elmi-Sarabi
M.; Tardif J.-C.; Perrault L.P.; Lambert J.
Institution
(Denault, Elmi-Sarabi) Department of Anesthesia, Montreal Heart Institute,
Universite de Montreal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec, QC, Canada
(Arellano) Department of Anesthesiology, Kingston General Hospital,
Queen's University, Kingston, ON, Canada
(Finegan) Department of Anesthesiology, Edmonton Heart Institute,
University of Alberta, Edmonton, AB, Canada
(Haddad) Department of Cardiology, Stanford Cardiovascular Institute,
Stanford, CA, United States
(Gavra, Nguyen, Varin) Faculty of Pharmacy, Universite de Montreal,
Montreal, QC, Canada
(Fortier, Levesque) Montreal Health Innovations Coordinating Center
(MHICC), Montreal, QC, Canada
(Shi, Tardif) Department of Medicine, Montreal Heart Institute, Universite
de Montreal, Montreal, QC, Canada
(Perrault) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Lambert) Department of Social and Preventive Medicine, School of Public
Health, Universite de Montreal, Montreal, QC, Canada
Title
A multicentre randomized-controlled trial of inhaled milrinone in
high-risk cardiac surgical patients.
Source
Canadian Journal of Anesthesia. 63 (10) (pp 1140-1153), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Inhaled milrinone (iMil) has been used for the treatment of
pulmonary hypertension (PH) but its efficacy, safety, and prophylactic
effects in facilitating separation from cardiopulmonary bypass (CPB) and
preventing right ventricular (RV) dysfunction have not yet been evaluated
in a clinical trial. The purpose of this study was to investigate if iMil
administered before CPB would be superior to placebo in facilitating
separation from CPB. Methods: High-risk cardiac surgical patients with PH
were randomized to receive iMil or placebo after the induction of
anesthesia and before CPB. Hemodynamic parameters and RV function were
evaluated by means of pulmonary artery catheterization and transesophageal
echocardiography. The groups were compared for the primary outcome of the
level of difficulty in weaning from CPB. Among the secondary outcomes
examined were the reduction in the severity of PH, the incidence of RV
failure, and mortality. Results: Of the 124 patients randomized, the mean
(standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline
mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The
use of iMil was associated with increases in cardiac output (P = 0.03) and
a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless,
there was no difference in the combined incidence of difficult or complex
separation from CPB between the iMil and control groups (30% vs 28%,
respectively; absolute difference, 2%; 95% confidence interval [CI], -14
to 18; P = 0.78). There was also no difference in RV failure between the
iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI,
-13 to 12; P = 0.94). Mortality was increased in patients with RV failure
vs those without (22% vs 2%, respectively; P < 0.001). Conclusion: In
high-risk cardiac surgery patients with PH, the prophylactic use of iMil
was associated with favourable hemodynamic effects that did not translate
into improvement of clinically relevant endpoints. This trial was
registered at ClinicalTrials.gov; identifier: NCT00819377. Copyright
&#xa9; 2016, Canadian Anesthesiologists' Society.

<25>
[Use Link to view the full text]
Accession Number
611108381
Author
Urschel S.; West L.J.
Institution
(Urschel, West) Department of Pediatrics, Stollery Children's Hospital,
University of Alberta, Walter MacKenzie Center 8440-112 Street, Edmonton,
AB T6G 2B7, Canada
Title
ABO-incompatible heart transplantation.
Source
Current Opinion in Pediatrics. 28 (5) (pp 613-619), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review ABO-incompatible (ABOi) heart transplantation (HTx) in
young children has evolved from an experimental approach to a standard
allocation option in many countries. Clinical and immunological research
in ABOi transplantation has revealed insight into the immature immune
system and its role in superior graft acceptance in childhood and
antigen-specific tolerance. Recent findings Multicenter experience has
confirmed equal actuarial survival, freedom from rejection, and graft
vasculopathy comparing ABOi with ABO-compatible HTx. Observations of
reduced antibody production and B-cell immunity toward the donor blood
group have been confirmed in long-term follow-up. Mechanisms contributing
to tolerance in this setting involve the interplay between B-cells and the
complement system and the development of B-cell memory. Better
characterization of the ABH polysaccharide antigens has improved
diagnostic methods and clinical assessment of blood group antibodies.
Boundaries regarding age, immune maturity, and therapeutic interventions
to extend the applicability of ABOi HTx have been explored and resulted in
data that may be useful for HTx patients beyond infancy and ABOi
transplantation of other organs. Tolerance of ABH antigens possibly
extends to HLA response. Summary The review provides insight into the
clinical evolution of ABOi HTx and associated immunologic discoveries.
Current experiences and boundaries are discussed together with recent and
potential future developments for utilization in other patient and age
groups. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<26>
[Use Link to view the full text]
Accession Number
607896193
Author
Giustino G.; Baber U.; Salianski O.; Sartori S.; Stone G.W.; Leon M.B.;
Aquino M.; Stefanini G.G.; Steg P.G.; Windecker S.; O'Donoghue M.; Wijns
W.; Serruys P.W.; Valgimigli M.; Morice M.-C.; Camenzind E.; Weisz G.;
Smits P.C.; Kandzari D.; Von Birgelen C.; Dangas G.D.; Cha J.Y.; Galatius
S.; Jeger R.V.; Kimura T.; Mikhail G.W.; Itchhaporia D.; Mehta L.; Ortega
R.; Kim H.-S.; Kastrati A.; Genereux P.; Chieffo A.; Mehran R.
Institution
(Giustino, Baber, Salianski, Sartori, Aquino, O'Donoghue, Dangas, Cha,
Mehran) Zena and Michael A. Wiener Cardiovascular Institute,
Interventional Cardiovascular Research and Clinical Trials Center, Icahn
School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York
City, NY 10029, United States
(Stone, Leon, Genereux) Division of Cardiology, Columbia University
Medical Center, New York City, NY, United States
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Serruys) Department of Cardiology, ErasmusMC, Rotterdam, Netherlands
(Morice) Department of Cardiology and Cardiovascular Surgery, Institut
Cardiovasculaire, Paris Sud, France
(Wijns) Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis
Ziekenhuis, Aalst, Belgium
(Camenzind) Deparment of Cardiology, Institut Lorrain du Coeur et des
Vaisseaux (ILCV), University Hospital Nancy-Brabois Vandoeuvre-les-Nancy,
France
(Steg) Departement Hospitalo Universitaire Fibrose, Inflammation et
REmodelage, Assistance Publique-Hopitaux de Paris, Universite Paris
Diderot, Paris, France
(Smits) Maasstad Hospital, Rotterdam, Netherlands
(Kandzari) Department of Cardiology, Piedmont Heart Institute, Atlanta,
GA, United States
(Von Birgelen) Department of Cardiology, Thoraxcentrum Twente, Enschede,
Netherlands
(Galatius) Department of Cardiology, Gentofte University Hospital,
Hellerup, Denmark
(Jeger) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Kimura) Department of Cardiology, Kyoto University Graduate School of
Medicine, Kyoto, Japan
(Mikhail) Department of Cardiology, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Itchhaporia) Department of Cardiology, Hoag Memorial Hospital
Presbyterian, Newport Beach, CA, United States
(Mehta) Department of Cardiology, Ohio State University Medical Center,
Columbus, OH, United States
(Ortega) Society of Cardiovascular Angiography and Interventions,
Washington, DC, United States
(Kim) Department of Cardiology, Seoul National University Main Hospital,
Seoul, South Korea
(Valgimigli) Department of Cardiology, University of Ferrara, Ferrara,
Italy
(Kastrati) Department of Cardiology, Herzzentrum, Munich, Germany
(Chieffo) Cardio-Thoracic Department, San Raffaele Scientific Institute,
Milan, Italy
(Weisz) Department of Cardiology, Shaare Zedek Medical Center, Jerusalem,
Israel
(Weisz) Columbia University Medical Center, New York, NY, United States
(Stefanini) Division of Clinical and Interventional Cardiology, Humanitas
Research Hospital, Rozzano, Milan, Italy
Title
Safety and efficacy of new-generation drug-eluting stents in women at high
risk for atherothrombosis: From the women in innovation and drug-eluting
stents collaborative patient-level pooled analysis.
Source
Circulation: Cardiovascular Interventions. 9 (1) (no pagination), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The safety and efficacy of new-generation drug-eluting stents
(DES) in women with multiple atherothrombotic risk (ATR) factors is
unclear. Methods and Results - We pooled patient-level data for women
enrolled in 26 randomized trials. Study population was categorized based
on the presence or absence of high ATR, which was defined as having
history of diabetes mellitus, prior percutaneous or surgical coronary
revascularization, or prior myocardial infarction. The primary end point
was major adverse cardiovascular events defined as a composite of
all-cause mortality, myocardial infarction, or target lesion
revascularization at 3 years of follow-up. Out of 10 449 women included in
the pooled database, 5333 (51%) were at high ATR. Compared with women not
at high ATR, those at high ATR had significantly higher risk of major
adverse cardiovascular events (15.8% versus 10.6%; adjusted hazard ratio:
1.53; 95% confidence interval: 1.34-1.75; P=0.006) and all-cause
mortality. In high-ATR risk women, the use of new-generation DES was
associated with significantly lower risk of 3-year major adverse
cardiovascular events (adjusted hazard ratio: 0.69; 95% confidence
interval: 0.52-0.92) compared with early-generation DES. The benefit of
new-generation DES on major adverse cardiovascular events was uniform
between high-ATR and non-high-ATR women, without evidence of interaction
(P<inf>interaction</inf>=0.14). At landmark analysis, in high-ATR women,
stent thrombosis rates were comparable between DES generations in the
first year, whereas between 1 and 3 years, stent thrombosis risk was lower
with new-generation devices. Conclusions - Use of new-generation DES even
in women at high ATR is associated with a benefit consistent over 3 years
of follow-up and a substantial improvement in very-late thrombotic safety.
Copyright &#xa9; 2016 American Heart Association, Inc.

<27>
Accession Number
612079337
Author
Wong W.-T.; Lai V.K.W.; Chee Y.E.; Lee A.
Institution
(Wong, Lai, Lee) The Chinese University of Hong Kong, Department of
Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New
Territories, Hong Kong
(Chee) Queen Mary Hospital, Department of Anaesthesiology, Pokfulam, Hong
Kong
(Lee) The Chinese University of Hong Kong, Hong Kong Branch of The Chinese
Cochrane Centre, The Jockey Club School of Public Health and Primary Care,
Faculty of Medicine, Shatin, New Territories, Hong Kong
Title
Fast-track cardiac care for adult cardiac surgical patients.
Source
Cochrane Database of Systematic Reviews. 2016 (9) (no pagination), 2016.
Article Number: CD003587. Date of Publication: 12 Sep 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Fast-track cardiac care is a complex intervention involving
several components of care during cardiac anaesthesia and in the
postoperative period, with the ultimate aim of early extubation after
surgery, to reduce length of stay in the intensive care unit and in the
hospital. Safe and effective fast-track cardiac care may reduce hospital
costs. This is an update of a Cochrane review first published in 2003,
updated in 2012 and updated now in 2016. Objectives: To determine the
safety and effectiveness of fast-track cardiac care compared with
conventional (not fast-track) care in adult patients undergoing cardiac
surgery. Fast-track cardiac care intervention includes administration of
low-dose opioid-based general anaesthesia or use of a time-directed
extubation protocol, or both. Search methods: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE
(January 2012 to May 2015), Embase (January 2012 to May 2015), the
Cumulative Index to Nursing and Allied Health Literature (CINAHL; January
2012 to May 2015) and the Institute for Scientific Information (ISI) Web
of Science (January 2012 to May 2015), along with reference lists of
articles, to identify additional trials. We applied no language
restrictions. Selection criteria: We included all randomized controlled
trials of adult cardiac surgical patients (coronary artery bypass grafts,
aortic valve replacement, mitral valve replacement) that compared
fast-track cardiac care and conventional (not fast-track) care groups. We
focused on the following fast-track interventions, which were designed for
early extubation after surgery: administration of low-dose opioid-based
general anaesthesia during cardiac surgery and use of a time-directed
extubation protocol after surgery. The primary outcome was risk of
mortality. Secondary outcomes included postoperative complications,
reintubation within 24 hours of surgery, time to extubation, length of
stay in the intensive care unit and in the hospital, quality of life after
surgery and hospital costs. Data collection and analysis: Two review
authors independently assessed trial quality and extracted study data. We
contacted study authors for additional information. We calculated a Peto
odds ratio (OR) for risk of mortality and used a random-effects model to
report risk ratio (RR), mean difference (MD) and 95% confidence intervals
(95% CIs) for all secondary outcomes. Main results: We included 28 trials
(4438 participants) in the updated review. We considered most participants
to be at low to moderate risk of death after surgery. We assessed two
studies as having low risk of bias and 11 studies high risk of bias.
Investigators reported no differences in risk of mortality within the
first year after surgery between low-dose versus high-dose opioid-based
general anaesthesia groups (OR 0.53, 95% CI 0.25 to 1.12; eight trials,
1994 participants, low level of evidence) and between a time-directed
extubation protocol versus usual care (OR 0.80, 95% CI 0.45 to 1.45; 10
trials, 1802 participants, low level of evidence). Researchers noted no
significant differences between low-dose and high-dose opioid-based
anaesthesia groups in the following postoperative complications:
myocardial infarction (RR 0.98, 95% CI 0.48 to 1.99; eight trials, 1683
participants, low level of evidence), stroke (RR 1.17, 95% CI 0.36 to
3.78; five trials, 562 participants, low level of evidence) and tracheal
reintubation (RR 1.77, 95% CI 0.38 to 8.27; five trials, 594 participants,
low level of evidence). Comparisons with usual care revealed no
significant differences in the risk of postoperative complications
associated with a time-directed extubation protocol: myocardial infarction
(RR 0.59, 95% CI 0.27 to 1.31; eight trials, 1378 participants, low level
of evidence), stroke (RR 0.85, 95% CI 0.33 to 2.16; 11 trials, 1646
participants, low level of evidence) and tracheal reintubation (RR 1.34,
95% CI 0.74 to 2.41; 12 trials, 1261 participants, low level of evidence).
Although levels of heterogeneity were high, low-dose opioid anaesthesia
was associated with reduced time to extubation (reduction of 4.3 to 10.5
hours, 14 trials, 2486 participants, low level of evidence) and length of
stay in the intensive care unit (reduction of 0.4 to 7.0 hours, 12 trials,
1394 participants, low level of evidence). Use of a time-directed
extubation protocol was associated with reduced time to extubation
(reduction of 3.7 to 8.8 hours, 16 trials, 2024 participants, low level of
evidence) and length of stay in the intensive care unit (reduction of 3.9
to 10.5 hours, 13 trials, 1888 participants, low level of evidence).
However, these two fast-track care interventions were not associated with
reduced total length of stay in the hospital (low level of evidence).
Authors' conclusions: Low-dose opioid-based general anaesthesia and
time-directed extubation protocols for fast-track interventions have risks
of mortality and major postoperative complications similar to those of
conventional (not fast-track) care, and therefore appear to be safe for
use in patients considered to be at low to moderate risk. These fast-track
interventions reduced time to extubation and shortened length of stay in
the intensive care unit but did not reduce length of stay in the hospital.
Copyright &#xa9; 2016 The Cochrane Collaboration.

<28>
Accession Number
612224674
Author
Ibrahim M.; Menna C.; Andreetti C.; Puyo C.; Maurizi G.; D'andrilli A.;
Ciccone A.M.; Massullo D.; Vanni C.; Berardi G.; Baldini R.; Rendina E.A.
Institution
(Ibrahim, Andreetti, Maurizi, D'andrilli, Ciccone, Vanni, Rendina)
Division of Thoracic Surgery, Sapienza University of Rome, Sant'Andrea
Hospital, Via di Grottarossa, Rome 1035-00189, Italy
(Menna) Division of Thoracic Surgery, University of L'Aquila, G. Mazzini
Hospital of Teramo, Teramo, Italy
(Puyo) Department of Anesthesiology, Washington University in St. Louis,
St. Louis, MO, United States
(Massullo) Division of Anesthesiology, Sapienza University of Rome,
Sant'Andrea Hospital, Rome, Italy
(Berardi) Division of General Surgery, Sapienza University of Rome,
Sant'Andrea Hospital, Rome, Italy
(Baldini) Department of Statistics, Faculty of Medicine and Psychology,
Sapienza University of Rome, Rome, Italy
Title
Does a multimodal No-Compression suture technique of the intercostal space
reduce chronic postthoracotomy pain? A prospective randomized study.
Source
Journal of Thoracic Oncology. 11 (9) (pp 1460-1468), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Introduction: Chronic postthoracotomy pain is a significant adverse
outcome of thoracic surgery. We evaluated with a prospective randomized
trial the effect of a multimodal no-compression suture technique of the
intercostal space on postoperative pain occurrence in patients undergoing
minithoracotomy. Methods: Patients undergoing a muscle-sparing lateral
minithoracotomy for different thoracic diseases were randomly divided into
two groups: 146 patients received intercostal muscle flap harvesting and
pericostal nocompression "edge" suture (the IMF group), and 151 patients
received a standard suture technique associated with an intrapleural
intercostal nerve block (the IINB group). Pain scores and interference of
pain with daily activities were assessed by using the Italian version of
the Brief Pain Inventory on day 1, and at 1 to 6 months postoperatively.
The results of pulmonary function tests (spirometry and the 6-minute
walking test ) were evaluated preoperatively and at 1 and 6 months
postoperatively. Results: Postthoracotomy pain scores throughout the first
postoperative day were significantly lower in the IMF group. After 1 and 6
months, patients in the IMF group had a significantly lower average pain
score (p = 0.001). There were no significant differences in pain
interference scores at each evaluation time point in either group.
However, differences were shown in lung function test results at 1 and 6
months postoperatively (the forced expiratory volume in 1 second in the
IINB group averaged 68.8 +/- 17.4% of predicted value and 72.8 +/- 10.5%,
respectively, and in the IMF group it averaged 83.1 +/- 7.4% and 86.4 +/-
12.8%, respectively [p = 0.023 and 0.013, respectively]; the 6-minute
walking test results in the IINB group averaged 311.1 +/- 51.0 and 329.9
+/- 54.8 m, respectively, and those in the IMF group averaged 371.2 +/-
54.8 and 395.7 +/- 56.4 m, respectively [p = 0.0001]). Conclusions: The
multimodal no-compression suture technique is a rapid and feasible
procedure that reduces the intensity of early and chronic postthoracotomy
pain. Copyright &#xa9; 2016 International Association for the Study of
Lung Cancer. Published by Elsevier Inc. All rights reserved.

<29>
Accession Number
612240265
Author
Mipatrini D.; Mannocci A.; Pizzi C.; La Torre G.
Institution
(Mipatrini, Mannocci, La Torre) Department of Public Health and Infectious
Diseases, 'Sapienza' University of Rome, Piazzale Aldo Moro 5, Rome 00185,
Italy
(Pizzi) School of Pharmacy and Medicine, 'Sapienza' University of Rome,
Italy
(Pizzi) S. Camillo-Forlanini Hospital, Rome, Italy
Title
School-based anti-smoking intervention for physiotherapy students: A
three-year non-randomized trial.
Source
Journal of Preventive Medicine and Hygiene. 57 (2) (pp E91-E94), 2016.
Date of Publication: 2016.
Publisher
Pacini Editore S.p.A. (Via A. Gherardesca 1, Ospedaletto (Pisa) 56121,
Italy)
Abstract
Introduction. The aim of the study was to assess the efficacy of a
school-based intervention for reducing tobacco consumption among
physiotherapy students. Materials and methods. This controlled trial
involved two groups of physiotherapy students: a treatment group (A) and a
control group (B). Treatment consisted of a seminar on smoking-related
diseases (3 hours) and training (at least 10 months) in a respiratory
diseases or thoracic surgery unit. The control group (B) did not undergo
any treatment. The main outcome was the prevalence of smokers. Follow-up
lasted 3 years. Results. Groups A and B comprised 78 and 72 students,
respectively. The two groups did not differ in terms of gender
distribution, mean age, prevalence of smokers and nicotine dependence. In
group A, the prevalence of smoking declined from 36% to 33% between T0 and
T1 (3 years), the relative risk (RR) at T1 being 0.93 (95% CI: 0.6-1.44).
In group B, the prevalence increased from 28% to 35% between T0 and T1,
with a RR at T1 of 1.26 (0.76- 2.11). The prevalence reduction
"attributable" to the intervention in group A 7.7%, while a 27.8% increase
in prevalence "attributable" to the absence of intervention was found in
group B. However, the differences were not statistically significant.
Conclusions. School-based interventions seem to be effective in reducing
the prevalence of smoking among healthcare students. Further studies on
larger samples and with standardized methodology are required in order to
confirm these preliminary findings.

<30>
Accession Number
611975166
Author
Saari T.I.; Ihmsen H.; Mell J.; Frohlich K.; Fechner J.; Schuttler J.;
Jeleazcov C.
Institution
(Saari, Ihmsen, Mell, Frohlich, Fechner, Schuttler, Jeleazcov)
Anasthesiologische Klinik, Universitatsklinikum Erlangen,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Krankenhausstrasse 12,
Erlangen D-91054, Germany
(Saari) Department of Anaesthesiology, Intensive Care, Emergency Care and
Pain Medicine, University of Turku, Turku University Hospital, PO Box 52
(Kiinamyllynkatu 4-8), Turku 20521, Finland
Title
Influence of intensive care treatment on the protein binding of sufentanil
and hydromorphone during pain therapy in postoperative cardiac surgery
patients.
Source
British Journal of Anaesthesia. 113 (4) (pp 677-687), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background: Our objective was to evaluate the effect of intensive care
treatment on the protein binding of sufentanil and hydromorphone in
cardiac surgery patients during postoperative analgesia using a
target-controlled infusion (TCI) and patient-controlled analgesia (PCA).
Methods: Fifty adult patients were enrolled in this prospective randomized
study; of which, 49 completed the study (age range 40-81 yr). Sufentanil
was administered as an analgesic intraoperatively, and hydromorphone was
dosed after operation with TCI and PCA until 8 a.m. on the first
postoperative day. Arterial plasma samples were collected for drug and
protein concentration measurements up to 24 h after cardiac surgery.
Corresponding patient data were collected from the electronic patient data
system. After explorative data analysis with principal component analysis,
multivariate regression analysis and non-linear mixed effects modelling
was used to study the effect of treatment on protein binding. Results:
Data of 35 patients were analysed. The median protein binding of
sufentanil and hydromorphone was 88.4% (IQ range 85.7-90.5%) and 11.6% (IQ
range 9.5-14.3%), respectively. Free fraction of sufentanil increased
towards the end of the study period, whereas hydromorphone free fraction
remained nearly constant. The total sufentanil concentration and volume
balance were identified as significant covariates for the protein binding
of sufentanil. For the protein binding of hydromorphone, no significant
covariate effects were found. Conclusions: Sufentanil protein binding was
significantly dependent on changes in the total drug concentration and
volume balance addressing the importance of adequate dosing and
fluid-guided therapy. Hydromorphone protein binding was nearly constant
throughout the study period. Copyright &#xa9; The Author 2014. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<31>
[Use Link to view the full text]
Accession Number
610261982
Author
Curatolo M.
Institution
(Curatolo) Department of Anesthesiology and Pain Medicine, University of
Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195-6540,
United States
Title
Regional anesthesia in pain management.
Source
Current Opinion in Anaesthesiology. 29 (5) (pp 614-619), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review The study focuses on neural blocks with local
anesthetics in postoperative and chronic pain. It is prompted by the
recent publication of several systematic reviews and guidelines. Recent
findings For postoperative pain, the current evidence supports infusions
of local anesthetics at the surgical site, continuous peripheral nerve
blocks, and neuraxial analgesia for major thoracic and abdominal
procedures. Ultrasound guidance can improve the performance of the blocks
and different patient outcomes, although the incidence of peripheral nerve
damage is not decreased. For chronic pain, the best available evidence is
on nerve blocks for the diagnosis of facet joint pain. Further research is
needed to validate diagnostic nerve blocks for other indications.
Therapeutic blocks with only local anesthetics (greater occipital nerve
and sphenopalatine ganglion) are effective in headache. A possible
mechanism is modulation of central nociceptive pathways. Therapeutic nerve
blocks for other indications are mostly supported by retrospective studies
and case series. Summary Recent literature strongly supports the use of
regional anesthesia for postoperative pain, whereby infusions at
peripheral nerves and surgical site are gaining increasing importance.
Local anesthetic blocks are valid for the diagnosis of facet joint pain
and effective in treating headache. There is a need for further research
in diagnostic and therapeutic blocks for chronic pain. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

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

<33>
[Use Link to view the full text]
Accession Number
612017020
Author
Lin W.-C.; Ho C.-H.; Tung L.-C.; Ho C.-C.; Chou W.; Wang C.-H.
Institution
(Lin, Chou) Department of Physical Medicine and Rehabilitation, Chi Mei
Medical Center, Tainan, Taiwan (Republic of China)
(Ho) Department of Medical Research, Chi Mei Medical Center, Chia Nan
University of Pharmacy and Science, Tainan, Taiwan (Republic of China)
(Tung) Department of Physical Medicine and Rehabilitation, Chi Mei Medical
Center, Chung Shan Medical University, Taichung, Taiwan (Republic of
China)
(Ho) Department of Physical Medicine and Rehabilitation, Chi Mei Medical
Center, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
(Republic of China)
(Chou) Department of Recreation and Health Care Management, Chia Nan
University of Pharmacy and Science, Tainan, Taiwan (Republic of China)
(Wang) School of Physical Therapy, Chung Shan Medical University, Chung
Shan Medical University Hospital, 110, Section 1, Taichung, Taiwan
(Republic of China)
Title
Differences between women and men in phase i cardiac rehabilitation after
acute myocardial infarction a nationwide population-based analysis.
Source
Medicine (United States). 95 (3) (no pagination), 2016. Article Number:
e2494. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Although numerous studies have investigated genderrelated differences in
patients who have had an acute myocardial infarction (AMI), few studies
have examined the gender-related differences among inpatients receiving
Phase I inpatient cardiac rehabilitation following AMI. Using data from
the Taiwan National Health Insurance Research Database, this study
analyzed 6713 adult patients who received inpatient cardiac rehabilitation
following AMI between 2002 and 2011. The differences in comorbidity,
medical service use, and prognosis between the male and female patients
were analyzed to determine whether the comorbidities affecting their
prognoses differed. Female patients accounted for 23.18% of the sample,
had a higher average age, and exhibited severe comorbidities; furthermore,
they had significantly more days of hospitalization and days in an
intensive care unit than did male patients. The gender-related differences
in hospital mortality rate and 30-day mortality rate were nonsignificant,
but female patients exhibited a significantly higher 1-year mortality
rate. Moreover, the risk for 1-year mortality was higher among female
patients with moderate or severe renal disease (odds ratio: 1.94, 95%
confidence interval: 1.29-2.92) than among their male counterparts.
However, the 1-year mortality rate for the female patients did not
increase after all risk factors were adjusted. Gender-related differences
in age, comorbidity, and prognosis were confirmed in AMI patients
receiving Phase I inpatient cardiac rehabilitation. In addition,
gender-related differences were observed in the comorbidity risk factors
affecting prognosis. However, being female did not affect the prognosis.
Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights reserved.

<34>
Accession Number
612013189
Author
Gao K.; Sachdeva R.; Goldstein B.H.; Lang S.; Petit C.J.
Institution
(Gao, Sachdeva, Goldstein, Lang, Petit) Emory University School of
Medicine, 1405 Clifton Road, Atlanta, GA 30322, United States
Title
Aortic Valve Morphology Correlates with Left Ventricular Systolic Function
and Outcome in Children with Congenital Aortic Stenosis Prior to Balloon
Aortic Valvuloplasty.
Source
Journal of Invasive Cardiology. 28 (9) (pp 381-388), 2016. Date of
Publication: September 2016.
Publisher
HMP Communications
Abstract
OBJECTIVES: We sought to determine the relationship between aortic valve
morphology and left ventricular (LV) systolic function in children with
aortic stenosis (AS) prior to balloon aortic valvuloplasty (BAV).
BACKGROUND: Both aortic valve morphology and LV systolic function have
been linked with outcomes in children with congenital AS undergoing BAV.
The relationship between aortic valve morphology and LV function is poorly
defined despite their importance in regard to outcomes. METHODS: We
performed a retrospective multicenter cohort study of 89 AS patients who
underwent BAV between 2007-2013. Pre-BAV echocardiograms were analyzed
for: aortic valve opening (AVO); aortic valve type (true bicuspid,
functionally bicuspid, or unicuspid); maximal raphe length; aortic valve
leaflet symmetry; and valve angle of excursion. The primary endpoint was
low function, defined as LV shortening fraction (LVSF) <28%. RESULTS:
Median patient age was 0.17 years (interquartile range [IQR], 0.10-10.74
years) and the median aortic valve mean gradient was 47.00 mm Hg (IQR,
36.75-56.00 mm Hg). Multivariate analysis demonstrated that low AVO
(P<.03) was associated with reduced LV function, independent of age or
aortic valve gradient (R2 < .652). Bicuspid aortic valve (P<.07) was
associated with improved LV function compared with functionally unicuspid
aortic valve. Low AVO <0.10 was associated with higher adverse outcome.
CONCLUSION: LV systolic function is most significantly influenced by
degree of valve stenosis. Qualitative aspects such as valve type may also
affect LV systolic function. Further study may elucidate whether aortic
valve morphology or LV function is the principal predictor of response to
BAV and of late outcomes after BAV.

<35>
Accession Number
612013176
Author
Lee M.S.; Shlofmitz E.; Shlofmitz R.; Sahni S.; Martinsen B.; Chambers J.
Institution
(Lee, Sahni) UCLA Medical Center, 100 Medical Plaza, Los Angeles, CA
90095, United States
(Shlofmitz) North Shore University Hospital, Manhasset, NY, United States
(Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
(Martinsen) Cardiovascular Systems, Inc, St. Paul, MN, United States
(Chambers) Metropolitan Heart and Vascular Institute, Mercy Hospital,
Minneapolis, MN, United States
Title
Outcomes after Orbital Atherectomy of Severely Calcified Left Main
Lesions: Analysis of the ORBIT II Study.
Source
Journal of Invasive Cardiology. 28 (9) (pp 364-369), 2016. Date of
Publication: September 2016.
Publisher
HMP Communications
Abstract
OBJECTIVES: The ORBIT II trial reported excellent outcomes in patients
with severely calcified coronary lesions treated with orbital atherectomy.
Severe calcification of the left main (LM) artery represents a complex
coronary lesion subset. This study evaluated the safety and efficacy of
coronary orbital atherectomy to prepare severely calcified protected LM
artery lesions for stent placement. METHODS: The ORBIT II trial was a
prospective, multicenter clinical trial that enrolled 443 patients with
severely calcified coronary lesions in the United States. The major
adverse cardiac event (MACE) rate through 2 years post procedure, defined
by cardiac death, myocardial infarction (CK-MB >3x upper limit of normal
with or without a new pathologic Q-wave) and target-vessel
revascularization, was compared in the LM and non-left main (NLM) groups.
RESULTS: Among the 443 patients, a total of 10 underwent orbital
atherectomy of protected LM artery lesions. At 2 years, there was no
significant difference in the 2-year MACE rate in the LM and NLM groups
(30.0% vs 19.1%, respectively; P<.36). Cardiac death was low in both
groups (0% vs 4.4%, respectively; P<.99). Myocardial infarction occurred
within 30 days in both groups (10.0% vs 9.7%, respectively; P<.99). Severe
dissection, perforation, persistent slow flow, and persistent no reflow
did not occur in the LM group. Abrupt closure occurred in 1 patient in the
LM group. CONCLUSIONS: Orbital atherectomy for patients with heavily
calcified LM coronary artery lesions is safe and feasible. Further studies
are needed to assess the safety and efficacy of orbital atherectomy in
patients with severely calcified LM artery lesions.

<36>
Accession Number
611958128
Author
Thiago L.; Tsuji S.R.; Nyong J.; Puga M.E.S.; Gois A.F.T.; Macedo C.R.;
Valente O.; Atallah A.N.
Institution
(Thiago) Marilia Medical School, Department of Education in Health
Sciences, Marilia, Brazil
(Tsuji) Marilia Medical School, Department of Psychiatry and Evidence
Based Health Actions, Av. Monte Carlo, 800, Marilia 17519-030, Brazil
(Nyong) University College London, Institute of Health Informatics, 222
Euston Road, London NW1 2DA, United Kingdom
(Puga, Macedo, Valente, Atallah) Centro de Estudos de Saude Baseada em
Evidencias e Avaliacao Tecnologica em Saude, Brazilian Cochrane Centre,
Rua Borges Lagoa, 564 cj 63, Sao Paulo 04038-000, Brazil
(Gois) Escola Paulista de Medicina, Universidade Federal de Sao Paulo,
Brazilian Cochrane Centre, Rua Pedro de Toledo, 598, Sao Paulo 04039-001,
Brazil
Title
Statins for aortic valve stenosis.
Source
Cochrane Database of Systematic Reviews. 2016 (9) (no pagination), 2016.
Article Number: CD009571. Date of Publication: 05 Sep 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Aortic valve stenosis is the most common type of valvular
heart disease in the USA and Europe. Aortic valve stenosis is considered
similar to atherosclerotic disease. Some studies have evaluated statins
for aortic valve stenosis. Objectives: To evaluate the effectiveness and
safety of statins in aortic valve stenosis. Search methods: We searched
the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE,
Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases
were searched from their inception to 24 November 2015. We also searched
trials in registers for ongoing trials. We used no language restrictions.
Selection criteria: Randomised controlled clinical trials (RCTs) comparing
statins alone or in association with other systemic drugs to reduce
cholesterol levels versus placebo or usual care. Data collection and
analysis: Primary outcomes were severity of aortic valve stenosis
(evaluated by echocardiographic criteria: mean pressure gradient, valve
area and aortic jet velocity), freedom from valve replacement and death
from cardiovascular cause. Secondary outcomes were hospitalisation for any
reason, overall mortality, adverse events and patient quality of life. Two
review authors independently selected trials for inclusion, extracted data
and assessed the risk of bias. The GRADE methodology was employed to
assess the quality of result findings and the GRADE profiler (GRADEPRO)
was used to import data from Review Manager 5.3 to create a 'Summary of
findings' table. Main results: We included four RCTs with 2360
participants comparing statins (1185 participants) with placebo (1175
participants). We found low-quality evidence for our primary outcome of
severity of aortic valve stenosis, evaluated by mean pressure gradient
(mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80;
participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to
0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06,
95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality
evidence showed no effect on freedom from valve replacement with statins
(risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies =
4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75
to 1.09; participants = 2204; studies = 3; moderate-quality evidence).
Low- and very low-quality evidence showed uncertainty around the effect of
statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15;
participants = 2297; studies = 3; low-quality evidence) and
hospitalisation for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants
= 155; study = 1; very low-quality evidence). None of the four included
studies reported on overall mortality and patient quality of life.
Authors' conclusions: Result findings showed uncertainty surrounding the
effect of statins for aortic valve stenosis. The quality of evidence from
the reported outcomes ranged from moderate to very low. These results give
support to European and USA guidelines (2012 and 2014, respectively) that
so far there is no clinical treatment option for aortic valve stenosis.
Copyright &#xa9; 2016 The Cochrane Collaboration.

<37>
Accession Number
610373091
Author
Hu X.; Xu G.
Institution
(Hu, Xu) Department of Anesthesiology, Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi 330006, China
Title
Does Anesthesia Cause Postoperative Cognitive Decline?.
Source
Medical Principles and Practice. 25 (5) (pp 497), 2016. Date of
Publication: 01 Aug 2016.
Publisher
S. Karger AG

<38>
Accession Number
612036279
Author
Gargiulo G.; Sannino A.; Capodanno D.; Barbanti M.; Buccheri S.; Perrino
C.; Capranzano P.; Indolfi C.; Trimarco B.; Tamburino C.; Esposito G.
Institution
(Gargiulo, Perrino, Trimarco, Esposito) Department of Advanced Biomedical
Sciences, Division of Cardiology, Federico II University of Naples, Via
Pansini 5, Naples 80131, Italy
(Sannino) Baylor Research Institute, Baylor Heart and Vascular Hospital,
621 North Hall Street, Dallas, TX 75226, United States
(Capodanno, Barbanti, Buccheri, Capranzano, Tamburino) Department of
General Surgery and Medical-Surgical Specialties, University of Catania,
C/o Ospedale Ferrarotto, Via Salvatore Citelli 31, Catania 95124, Italy
(Indolfi) Department of Medical and Surgical Sciences and URT Consiglio
Nazionale delle Ricerche, Magna Graecia University, Viale Europa,
Catanzaro 88100, Italy
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: A Systematic review and meta-analysis.
Source
Annals of Internal Medicine. 165 (5) (pp 334-344), 2016. Date of
Publication: 06 Sep 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The comparative benefits and harms of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for
patients with aortic stenosis are unclear. Purpose: To compare clinical
outcomes, including early (<30- day) and midterm (<1-year) mortality, in
adults with severe aortic stenosis undergoing either TAVI or SAVR. Data
Sources: MEDLINE, Cochrane, and Scopus databases (without language
restrictions) from April 2002 to 5 April 2016; multiple registries and Web
sites; scientific meeting presentations. Study Selection: Five randomized
trials and 31 observational matched studies comparing mortality outcomes
after TAVI or SAVR. Data Extraction: Two investigators independently
extracted study data and rated risk of bias. Data Synthesis: 16 638
patients were analyzed. Overall, there was no statistically significant
difference between TAVI and SAVR in early (odds ratio [OR], 1.01 [95% CI,
0.81 to 1.26]) or midterm (OR, 0.96 [CI, 0.81 to 1.14]) all-cause
mortality. Analyses restricted to trials (early: OR, 0.80 [CI, 0.51 to
1.25]; midterm: OR, 0.90 [CI, 0.64 to 1.26]) were inconclusive, with wide
CIs, whereas analyses of matched studies were similar to the overall
results. Transfemoral TAVI provided mortality benefits over SAVR in
trials. Analyses restricted to studies of patients at low to intermediate
risk showed statistically nonsignificant reductions in early (OR, 0.67
[CI, 0.42 to 1.07]) and midterm (OR, 0.91 [CI, 0.67 to 1.23]) mortality
with TAVI. Incidence of periprocedural myocardial infarction, major
bleeding, acute kidney injury, and newonset atrial fibrillation was lower
with TAVI, but risk for pacemaker implantation, vascular complications,
and paravalvular leak increased. Overall, there was a statistically
nonsignificant increased risk in long-term (2- To 5-year) all-cause
mortality with TAVI (OR, 1.28 [CI, 0.97 to 1.69]), whereas long-term
mortality outcomes in patients at low to intermediate risk were
inconclusive, with wide CIs (OR, 1.06 [CI, 0.59 to 1.91]). Limitation: The
number of trials was limited, and study designs and patient
characteristics were heterogeneous. Conclusion: Compared with SAVR, TAVI
may have similar or better early and midterm outcomes for adults with
aortic stenosis, including those at low to intermediate risk. Copyright
&#xa9; 2016 American College of Physicians.

<39>
Accession Number
611974879
Author
Hansson E.C.; Rexius H.; Dellborg M.; Albertsson P.; Jeppsson A.
Institution
(Hansson, Rexius, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Dellborg) Department of Medicine, Sahlgrenska University Hospital/ostra,
Gothenburg, Sweden
(Dellborg, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Albertsson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Coronary artery bypass grafting-related bleeding complications in
real-life acute coronary syndrome patients treated with clopidogrel or
ticagrelor.
Source
European Journal of Cardio-thoracic Surgery. 46 (4) (pp 699-705), 2014.
Date of Publication: 01 Oct 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Ticagrelor reduces thrombotic events compared with clopidogrel
in patients with acute coronary syndrome, but may also increase bleeding
complications. Coronary artery bypass grafting (CABG)-related bleeding
complications have not previously been compared in clopidogrel and
ticagrelor-treated patients outside the controlled environment of clinical
trials. METHODS: Four hundred and five consecutive CABG patients with
acute coronary syndrome were included in a prospective observational
study. The patients were treated with aspirin and ticagrelor (n = 173) or
aspirin and clopidogrel (n = 232). Ticagrelor/clopidogrel was discontinued
5 days before surgery whenever deemed possible. Major bleeding
complications according to modified blood conservation using
antifibrinolytics in a randomized trial criteria (postoperative blood loss
>1500 ml/12 h, re-exploration, red blood cell transfusion >10 units or
death because of bleeding) were compared in all patients and when
ticagrelor/clopidogrel was discontinued >5 days (n = 280), 2-4 days (n =
40) or 0-1 day before surgery (n = 85). RESULTS: Major bleeding
complications did not differ significantly between ticagrelor- and
clopidogrel-treated patients when all patients were compared (14.5 vs
13.8%, P = 0.89). Likewise, there were no significant differences between
ticagrelor and clopidogrel when either drug was discontinued >5 days
before surgery (6.8 vs 9.9%, P = 0.40) or 2-4 days before surgery (6.3 vs
25.0%, P = 0.21). When ticagrelor/ clopidogrel was discontinued 0-1 day
before surgery, there was a strong trend towards higher incidence of major
bleeding in ticagrelortreated patients (41.0 vs 21.7%, P = 0.063).
CONCLUSIONS: There was no difference in major bleeding complications
overall or when ticagrelor or clopidogrel was used in accordance with
guidelines. In patients on dual antiplatelet medication up to 1 day before
surgery, there tended to be more bleeding complications in
ticagrelor-treated patients. Copyright &#xa9; The Author 2014. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<40>
Accession Number
612193616
Author
Piccolo R.; Eitel I.; Galasso G.; Dominguez-Rodriguez A.; Iversen A.Z.;
Abreu-Gonzalez P.; Windecker S.; Thiele H.; Piscione F.
Institution
(Piccolo, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Eitel, Thiele) University Heart Center Lubeck, Medical Clinic II,
University of Lubeck, Lubeck, Germany
(Galasso, Piscione) Department of Medicine and Surgery, University of
Salerno, Salerno, Italy
(Dominguez-Rodriguez) Hospital Universitario de Canarias, Facultad de
Ciencias de la Salud, Universidad Europea de Canarias Tenerife, Spain
(Iversen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Abreu-Gonzalez) Department of Physiology, Universidad de La Laguna,
Tenerife, Spain
Title
1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients
Undergoing Primary Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. 68 (7) (pp 727-738), 2016.
Date of Publication: 2016.
Publisher
Elsevier USA
Abstract
Background Diabetic patients are at increased risk for future
cardiovascular events after ST-segment elevation myocardial infarction
(STEMI). Administration of an intracoronary abciximab bolus during primary
percutaneous coronary intervention (PCI) may be beneficial in this
high-risk subgroup. Objectives This study sought to report the 1-year
clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI
patients with and without diabetes randomized to intracoronary or
intravenous abciximab bolus at the time of primary PCI. Methods
Patient-level data from 3 randomized trials were pooled. The primary
endpoint was the composite of death or reinfarction. Comprehensive CMR
imaging was performed in 1 study. Results Of 2,470 patients, 473 (19%) had
diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was
significantly reduced in diabetic patients randomized to intracoronary
abciximab compared with those randomized to intravenous bolus (9.2% vs.
17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to
0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the
primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR: 0.95;
95% CI: 0.68 to 1.33; p = 0.77), resulting in a significant interaction (p
= 0.034). Among diabetic patients, intracoronary versus intravenous
abciximab bolus was associated with a significantly reduced risk of death
(5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and
definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08
to 0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was
significantly increased only in diabetic patients randomized to
intracoronary compared with intravenous abciximab (54.4; interquartile
range: 35.1 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p =
0.011; p for interaction vs. no diabetes = 0.016). Conclusions In diabetic
patients with STEMI, the administration of intracoronary abciximab
improved the effectiveness of primary PCI compared with the intravenous
bolus. Copyright &#xa9; 2016 American College of Cardiology Foundation

<41>
Accession Number
611976235
Author
Gou D.; Zhao L.; Li D.
Institution
(Gou, Zhao) Department of Cardiology, The Traditional Chinese Medicine
Affiliated Hospital of Southwest Medical University, Luzhou, China
(Li) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Title
Efficacy and safety of tirofiban in patients with non-ST segment elevation
acute coronary syndromes: A systemic review and meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 9 (8) (pp
15091-15104), 2016. Date of Publication: 30 Aug 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective:This study aims to systemically evaluate the efficacy and safety
of tirofiban in patients with non-ST segment elevation acute coronary
syndromes (NSTE ACS). Methods: The randomized controlled trials (RCTs) and
cohort studies were searched from PubMed and Ovid until Mar. 2016, chosen
and extracted by 2 reviewers independently, and cross-checked and assessed
in the quality and methodology. All data were given meta-analysis by using
stata software 11.0. Results: A total of 19 documents with 8582 patients
were finally enrolled. The primary endpoint showed that, there was no
difference in all-cause mortality between NSTE ACS patients treated with
tirofiban compared with those treated with placebo or others (RR=0.80, 95%
CI: 0.64 to 1.01, P=0.066, P for heterogeneity =0.85, I²=0%).
The second endpoint showed that tirofiban reduced the occurrence of the
composite of major adverse cardiovascular events (MACE) both in-hospital
follow-up (RR=0.76, 95% CI: 0.61 to 0.96, P=0.018, P for heterogeneity
=0.069, I²=40.8%), 30-day follow-up (RR=0.71, 95% CI: 0.59 to
0.85, P=0.000, P for heterogeneity =0.006, I²=58.2%) and >
3-month follow-up (RR=0.65, 95% CI: 0.48 to 0.86, P=0.003, P for
heterogeneity =0.007, I²=75.2%), as compared with control
group, and the differences were statistically significant. The safety
endpoint showed tirofiban was associated with higher bleeding risk
(RR=1.31, 95% CI: 0.13 to 1.51, P=0.000, P for heterogeneity =0.997,
I²=0%) in NSTE ACS patients compared with the control group.
Conclusion: Tirofiban has a definite role in improving the outcomes of
patients with non-ST segment elevation acute coronary syndromes. However,
treatment with tirofiban provided no significant benefit on all-cause
mortality in NSTE ACS patients. Furthermore, tirofiban was associated with
higher bleeding risk in NSTE ACS patients. However, no fatal bleeding was
observed in included studies. This study demonstrated that as a new
generation of antiplatelet drugs, the early application of tirofiban can
effectively and safely improve outcomes in NSTE ACS patients. Copyright
&#xa9; 2016, E-Century Publishing Corporation. All rights reserved.

<42>
Accession Number
611930961
Author
Qi B.; Wang S.; An L.; Su Z.; Zhang Z.
Institution
(Qi, An, Su, Zhang) Department of Anesthesiology, Huai'an First People's
Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
(Wang) Department of Anesthesiology, Huaiyin Hospital of Huaian City,
Huai'an, Jiangsu 223300, China
Title
Measuring incisor-carina distance by fiberoptic bronchoscopy to guide the
placement of a left-sided double-lumen endobronchial tube.
Source
International Journal of Clinical and Experimental Medicine. 9 (7) (pp
14448-14452), 2016. Date of Publication: 30 Jul 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
The aim of this randomized observational study was to evaluate the effect
of measuring the incisor-carina distance by fiberoptic bronchoscopy in
guiding the placement of a left-sided double-lumen endobronchial tube.
Fifty patients (American Society of Anesthesiologists class I-II)
undergoing elective thoracic procedures requiring single-lung ventilation
using a left-sided double-lumen endobronchial tube were evaluated.
Patients were randomly divided into either group M, in which a left-sided
double-lumen endobronchial tube was placed by measuring the incisor-carina
distance with fiberoptic bronchoscopy, or group B, in which the
endobronchial tube was placed by blind insertion and then confirmed with
fiberoptic bronchoscopy. After placement, tube position was assessed by
fiberoptic bronchoscopy and cases requiring adjustment were recorded. The
intubation time and postoperative adverse reactions related to intubation
were also recorded. We conclude that compared with blind placement, this
method can reduce total intubation time, increase the rate of accurate
placement, and reduce the incidence of adverse reactions related to
intubation. It is relatively simple and reliable, and is useful in
clinical application. Copyright &#xa9; 2016, E-Century Publishing
Corporation. All rights reserved.

<43>
[Use Link to view the full text]
Accession Number
612113902
Author
Anonymous
Title
Erratum: 2016 ACC/AHA guideline focused update on duration of dual
antiplatelet therapy in patients with coronary artery disease: A report of
the American College of Cardiology/American Heart Association Task Force
on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI
Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA guideline
for coronary artery bypass graft surgery, 2012
ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management
of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline
for the management of ST-elevation myocardial infarction, 2014 AHA/ACC
guideline for the management of patients With Non-ST-elevation acute
coronary syndromes, and 2014 ACC/AHA guidelineon perioperative
cardiovascular evaluation and management of patients undergoing noncardiac
surgery (Circulation (2016) 134 (e123-e155) DOI:
10.1161/CIR.0000000000000404).
Source
Circulation. 134 (10) (pp e192-e194), 2016. Date of Publication: 06 Sep
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article by Levine et al, "2016 ACC/AHA Guideline Focused Update on
Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery
Disease: A Report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice Guidelines: An Update of the
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011
ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012
ACC/AHA/ACP/AATS/PCNA/ SCAI/STS Guideline for the Diagnosis and Management
of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline
for the Management of STElevation Myocardial Infarction, 2014 AHA/ACC
Guideline for the Management of Patients With Non-ST-Elevation Acute
Coronary Syndromes, and 2014 ACC/ AHA Guideline on Perioperative
Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac
Surgery," which published online March 29, 2016, and appeared in the
September 6, 2016, issue of the journal (Circulation. 2016;134:e123-e155.
DOI: 10.1161/CIR.0000000000000404.), several corrections were needed. 1.
On pages e124 and e134, corrections have been made to the section 5 title:
In the table of contents and the text, the section title read, "CABG:
Recommendations." It has been updated to read, "Recommendations for
Duration of DAPT in Patients Undergoing CABG." In the recommendations
table, the table title read, "Recommendations for CABG." It has been
updated to read, "Recommendations for Duration of DAPT in Patients
Undergoing CABG." 2. On pages e124 and e135, corrections have been made to
the section 6 title: In the table of contents and the text, the section
title read, "SIHD: Recommendations." It has been updated to read,
"Recommendations for Duration of DAPT in Patients With SIHD." In the
recommendations table, the table title read, "Recommendations for SIHD."
It has been updated to read, "Recommendations for Duration of DAPT in
Patients With SIHD." 3. On page e124, right-hand column, second paragraph,
the second sentence read, "This process entails delineation of a
recommendation addressing a specific clinical question, followed by
concise text (ideally <500 words) and hyperlinked to supportive evidence."
It has been updated to read, "This process entails delineation of a
recommendation addressing a specific clinical question, followed by
concise text (ideally <250 words per recommendation) and hyperlinked to
supportive evidence." 4. On page e127, left-hand column, first paragraph,
the last sentence read, "See the ERC systematic review report, "Duration
of Dual Antiplatelet Therapy: A Systematic Review for the 2016 Guideline
Update," for the complete evidence review report.30" It has been updated
to read, "See the ERC systematic review report, "Duration of Dual
Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline
Focused Update on Duration of Dual Antiplatelet Therapy in Patients With
Coronary Artery Disease" for the complete evidence review report.30" 5. On
page e127, left-hand column, fourth paragraph, the last sentence read,
"This document was approved for publication by the governing bodies of the
ACC and the AHA and was endorsed by the American Association for Thoracic
Surgery, American Society of Anesthesiologists, Preventive Cardiovascular
Nurses Association, Society for Cardiovascular Angiography and
Interventions, Society of Cardiovascular Anesthesiologist, and the Society
of Thoracic Surgeons." It has been updated to read, "This document was
approved for publication by the governing bodies of the ACC and the AHA
and was endorsed by the American Association for Thoracic Surgery,
American Society of Anesthesiologists, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions,
Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons,
and Society for Vascular Surgery." 6. On page e130, in Figure 1, the text
in the cell in the third row, second column of the algorithm read, "No Hx
PCI or recent CABG". It has been updated to read, "No Hx of MI, PCI or
recent (within 12 mo) CABG." 7. On page e133, in section 4.1, in the
recommendations table titled "Recommendations for Duration of DAPT in
Patients With SIHD Treated With PCI," several corrections have been made:
The Class I, LOE A recommendation 1 read, "In patients with SIHD treated
with DAPT after BMS implantation, P2Y12 inhibitor therapy with clopidogrel
should be given for a minimum of 1 month.94,95" It has been updated to
read, "In patients with SIHD treated with DAPT after BMS implantation,
P2Y12 inhibitor therapy (clopidogrel) should be given for a minimum of 1
month.94,95" The Class I, LOE B-R, recommendation 2 read, "In patients
with SIHD treated with DAPT after DES implantation, P2Y12 inhibitor
therapy with clopidogrel should be given for at least 6
months.17,18,21,30,96,97" It has been updated to read, "In patients with
SIHD treated with DAPT after DES implantation, P2Y12 inhibitor therapy
(clopidogrel) should be given for at least 6 months.17,18,21,30,96,97" The
Class I, LOE B-NR recommendation 3 read, "In patients treated with DAPT,
the recommended daily dose of aspirin is 81 mg (range, 75 mg to 100
mg).56-60,75-78" It has been updated to read, "In patients treated with
DAPT, a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is
recommended.56-60,75-78" 8. On page e133, in section 4.2, right-hand
column, in the recommendations table titled "Recommendations for Duration
of DAPT in Patients With ACS Treated With PCI," the Class I, LOE B-NR
recommendation 2 read, "In patients treated with DAPT, the recommended
daily dose of aspirin is 81 mg (range, 75 mg to 100 mg).56-60,75-78" It
has been updated to read, "In patients treated with DAPT, a daily aspirin
dose of 81 mg (range, 75 mg to 100 mg) is recommended.56-60,75-78" 9. On
page e135, in section 6, right-hand column, in the recommendations table
titled "Recommendations for Duration of DAPT in Patients With SIHD," the
classification for recommendation 2, "In patients with SIHD treated with
DAPT after DES implantation, P2Y12 inhibitor therapy (clopidogrel) should
be given for at least 6 months.17,18,21,30,96,97" read, LOE "B-NR." It has
been updated to read, LOE "B-R." 10. On page e137, in section 7.1,
right-hand column, in the recommendations table titled "Recommendations
for Duration of DAPT in Patients With ACS Treated With Medical Therapy
Alone," several corrections have been made: The Class I, LOE B-R
recommendation 1 read, "In patients with ACS who are managed with medical
therapy alone (without revascularization or fibrinolytic therapy) and
treated with DAPT, P2Y12 inhibitor therapy (either clopidogrel or
ticagrelor) should be continued for at least 12 months.52,71,140,141" It
has been updated to read, "In patients with ACS who are managed with
medical therapy alone (without revascularization or fibrinolytic therapy)
and treated with DAPT, P2Y12 inhibitor therapy (clopidogrel or ticagrelor)
should be continued for at least 12 months.52,71,140,141" The Class IIa,
LOE B-R recommendation 3 read, "In patients with NSTE-ACS who are managed
with medical therapy alone (without revascularization or fibrinolytic
therapy) treated with DAPT, it is reasonable to use ticagrelor in
preference to clopidogrel for maintenance P2Y12 inhibitor therapy.53,71"
It has been updated to read, "In patients with NSTE-ACS who are managed
with medical therapy alone (without revascularization or fibrinolytic
therapy) and treated with DAPT, it is reasonable to use ticagrelor in
preference to clopidogrel for maintenance P2Y12 inhibitor therapy.53,71"
11. On page e139, in Figure 4, the text in the cell in the second row,
second column read, "No Hx of MI, PCI or recent CABG." It has been updated
to read, "No Hx of MI, PCI or recent (within 12 mo) CABG." 12. On page
e151, in Appendix 2, the employment for Joseph S. Alpert read, "University
of Arizona Health Sciences Center- Professor of Medicine, Head of
Department of Medicine." It has been updated to read, "University of
Arizona Health Sciences Center- Clinical Professor of Medicine, Head of
Department of Medicine." 13. In the Data Supplement, page 20, Data
Supplement 7, "RCTs Comparing Antiplatelet Therapy With Anticoagulant
Therapy in Patients Undergoing Coronary Stenting," several corrections
have been made: In the first row "STARS", fourth column "Study
Intervention," Intervention 3 read, "ASA + ticagrelor." It has been
updated to read, "ASA + ticlopidine." In the first row "STARS," fifth
column "Endpoint Results," the first bullet under "1 endpoint" read "3.6%
with ASA alone; 2.7% with ASA + warfarin; 0.5% with ASA + ticagrelor
(p=0.001 for the comparison of all 3 groups)." It has been updated to
read, "3.6% with ASA alone; 2.7% with ASA + warfarin; 0.5% with ASA +
ticlopidine (p=0.001 for the comparison of all 3 groups)." These
corrections have been made to the current online version of the article,
which is available at http://
circ.ahajournals.org/content/134/10/e123.full. Copyright &#xa9; 2016
American Heart Association, Inc.

<44>
Accession Number
612125933
Author
Galappatthy P.; Waniganayake Y.C.; Sabeer M.I.M.; Wijethunga T.J.;
Galappatthy G.K.S.; Ekanayaka R.A.I.
Institution
(Galappatthy) University of Colombo, Department of Pharmacology and
Pharmacy, Faculty of Medicine, Kynsey Road, PO Box 271, Colombo, Sri Lanka
(Waniganayake, Sabeer, Wijethunga, Galappatthy, Ekanayaka) National
Hospital of Sri Lanka, Institute of Cardiology, Colombo, Sri Lanka
Title
Leg edema with (S)-amlodipine vs conventional amlodipine given in triple
therapy for hypertension: A randomized double blind controlled clinical
trial.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 168. Date of Publication: 01 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Leg edema is a common adverse effect of dihydropyridine
Calcium Channel Blockers (CCB) that may need dose reduction or drug
withdrawal, adversely affecting the antihypertensive efficacy. Leg edema
is reported to occur less often with (S)-amlodipine compared to
conventional racemic amlodipine. We aimed to find the incidence of leg
edema as a primary outcome and antihypertensive efficacy with
(S)-amlodipine compared to conventional amlodipine. Methods: This
prospective, double-blind, controlled clinical trial randomized 172
hypertensive patients, not controlled on beta-blockers (BB) and
angiotensin converting enzyme inhibitors/angiotensin receptor blockers
(ACEI/ARB), to either conventional amlodipine (5-10 mg; n = 86) or
(S)-amlodipine (2.5-5 mg; n = 86), while continuing their previous
anti-hypertensive medications. Sample was sufficient to find a difference
in edema between the interventions with 80 % power at 5 % significance
level. Intension to treat analysis (ITT) for safety data and per protocol
analysis for efficacy data was performed. Fischer's exact test was applied
to observe difference between responder rates and proportions of subjects
having peripheral edema in the two groups. Pitting edema test scores were
compared using Mann-Whitney test. Results: Altogether 146 patients
(amlodipine, n = 76 and (S)-amlodipine, n = 70) completed 120 days
treatment. Demographic variables and treatment adherence were comparable
in the two groups. Incidence of new edema after randomization was 31.40 %
in test group and 46.51 % in control group [p = 0.03; absolute risk
reduction (ARR) = 15.1 %; Number Needed to Treat (NNT) = 7, ITT analysis].
Pitting edema score and patient rated edema score increased significantly
in the control compared to test group (p = 0.038 and 0.036 respectively)
after treatment period. Edema scores increased significantly in the
control group from baseline (p < 0.0001). Responders in blood pressure
were 98.57 % in test and 98.68 % in control group. Most common adverse
events (AE) were pitting edema and increased urinary frequency. Incidence
of all AEs other than edema was similar in both groups. Two serious AEs
occurred unrelated to therapy. Biochemical and ECG parameters in the two
groups were comparable. Conclusions: In hypertensive patients not
controlled on prior BB and ACEI/ARB therapy, addition of (S)-amlodipine
besylate at half the dose of conventional amlodipine provides better
tolerability with reduced incidence of peripheral edema, and equal
antihypertensive efficacy compared to amlodipine given at usual doses.
Trial registration: Sri Lanka Clinical Trials registry: www.slctr.lk,
SLCTR/2013/006 Copyright &#xa9; 2016 The Author(s).

<45>
Accession Number
612213004
Author
Page M.J.; Moher D.
Institution
(Page) School of Public Health and Preventive Medicine, Monash University,
Australia
(Page) School of Social and Community Medicine, University of Bristol,
United Kingdom
(Moher) Centre for Practice Changing Research, Ottawa Hospital Research
Institute, Canada
(Moher) School of Epidemiology, Public Health and Preventive Medicine,
Faculty of Medicine, University of Ottawa, Canada
Title
Mass Production of Systematic Reviews and Meta-analyses: An Exercise in
Mega-silliness?.
Source
Milbank Quarterly. 94 (3) (pp 515-519), 2016. Date of Publication: 01 Sep
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)

<46>
Accession Number
612062665
Author
Vitarelli A.; Mangieri E.; Capotosto L.; Tanzilli G.; D'Angeli I.; Toni
D.; Azzano A.; Ricci S.; Placanica A.; Rinaldi E.; Mukred K.; Placanica
G.; Ashurov R.
Institution
(Vitarelli, Mangieri, Capotosto, Tanzilli, D'Angeli, Toni, Azzano, Ricci,
Placanica, Rinaldi, Mukred, Placanica, Ashurov) Sapienza University, Via
Lima 35, Rome 00198, Italy
Title
Echocardiographic findings in simple and complex patent foramen ovale
before and after transcatheter closure.
Source
European Heart Journal Cardiovascular Imaging. 15 (12) (pp 1377-1385),
2014. Date of Publication: 2014.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Percutaneous closure of patent foramen ovale (PFO) in cryptogenic
cerebrovascular events is an alternative to medical therapy. The
interpretation of residual shunts after implantation of different devices
for PFO with different morphologies is controversial. Methods and results
Transcatheter PFO closurewas performed in 123 patients with a history of
>1 paradoxical embolism using three different devices: Amplatzer (n = 46),
Figulla Occlutech (n = 41), and Atriasept Cardia (n = 36). Fifty-six
patients presented with simple PFO and 67 patients had complex
morphologies. All patients were studied with contrast enhanced
transesophageal echocardiography (TEE) before interventional procedure and
thereafter at 1 and 6 months and every 6-12 months in case of incomplete
closure. Definite closure was confirmed in at least two consecutive TEE
studies. Various PFO morphologies were identified by TEE before device
implantation. The device size to PFO diameter ratio was significantly
increased in patients with complex PFO compared with those patients with a
simple PFO morphology (P < 0.05). The difference between the closure rate
of S-PFO and C-PFO concerning each device type was significant (Amplatzer
P = 0.0027, Figulla P = 0.0043, and Atriasept P < 0.01). The mean
follow-up period was 3.4 years (median 2.7 years) with a cerebrovascular
re-event rate of 2.4% per year. In three patients, thrombi were detected
in the 6-month TEE controls and resolved after medical therapy. In three
other patients, the implantation of an adjunctive device was necessary for
residual shunt. Conclusion In our series of patients, the closure rate was
dependent on PFO morphology more than occluder size and type. An
adjunctive device was implanted in selected cases. Published on behalf of
the European Society of Cardiology. All rights reserved. Copyright
&#xa9;The Author 2014.

<47>
Accession Number
611288016
Author
Bernabe-Garcia M.; Lopez-Alarcon M.; Villegas-Silva R.; Mancilla-Ramirez
J.; Rodriguez-Cruz M.; Maldonado-Hernandez J.; Chavez-Rueda K.A.;
Blanco-Favela F.; Espinoza-Garcia L.; Lagunes-Salazar S.
Institution
(Bernabe-Garcia, Lopez-Alarcon, Rodriguez-Cruz, Maldonado-Hernandez)
Medical Research Unit in Nutrition, Av. Cuahutemoc 330, Mexico City 06725,
Mexico
(Villegas-Silva, Espinoza-Garcia, Lagunes-Salazar) Neonatal Intensive Care
Unit, Mexico City, Mexico
(Mancilla-Ramirez) Escuela Superior de Medicina, IPN, Hospital de la
Mujer, Mexico City, Mexico
(Chavez-Rueda, Blanco-Favela) Medical Research Unit in Immunology,
Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto
Mexicano Del Seguro Social, Mexico City, Mexico
(Villegas-Silva) Neonatal Intensive Care Unit, Hospital Infantil de Mexico
Federico Gomez, Paseo de la Salud, SSA, Mexico City, Mexico
Title
Beneficial Effects of Enteral Docosahexaenoic Acid on the Markers of
Inflammation and Clinical Outcomes of Neonates Undergoing Cardiovascular
Surgery: An Intervention Study.
Source
Annals of Nutrition and Metabolism. 69 (1) (pp 15-23), 2016. Date of
Publication: 01 Sep 2016.
Publisher
S. Karger AG
Abstract
Background: Neonates undergoing surgery are at risk for uncontrolled
inflammatory response and adverse clinical outcomes. Docosahexaenoic acid
(DHA) ameliorates inflammation, improving clinical outcomes. However, its
effect has not been evaluated in neonates undergoing surgery. We evaluated
the effect of DHA on markers of inflammation and clinical outcomes in
neonates undergoing surgery. Methods: A double-blind clinical trial
evaluated the effect of enteral DHA (DHA group) versus sunflower oil (SO
group) perioperatively administered in neonates scheduled for
cardiovascular surgery. Inflammation was evaluated by percentage of
cells⁺ for cytokines and CD69 in mononuclear cells at baseline,
24 h and 7 days post surgery. Clinical outcomes measured were sepsis,
organ dysfunctions (ODs), length of stay in intensive care and bleeding.
Repeated measures analysis of variance and logistic regression were
applied. Results: Sixteen neonates received DHA and 18 received SO.
Cells⁺ from neonates in the DHA group showed an early increase
in receptor antagonist of interleukin (IL)-1⁺
(IL-1ra⁺) and IL-10⁺ and a late decrease in
IL-6⁺. IL-1beta⁺ and IL-10⁺ changes were
different between groups. After adjusting for confounders, less cells from
DHA group were IL-1beta⁺, IL-6⁺, IL-1ra⁺
and IL-10⁺. DHA group presented less sepsis, ODs and shorter
stay, but no difference in CD69⁺CD4⁺ cells or
bleeding between groups. Conclusions: Administration of enteral DHA
ameliorates markers of inflammation and improves clinical outcomes in
surgical neonates. Copyright &#xa9; 2016 S. Karger AG, Basel.

<48>
Accession Number
612160647
Author
Bocksch W.; Grossmann B.; Geisler T.; Steeg M.; Droppa M.; Jorbenadze R.;
Haap M.; Gawaz M.; Fateh-Moghadam S.
Institution
(Bocksch, Grossmann, Geisler, Steeg, Droppa, Jorbenadze, Gawaz,
Fateh-Moghadam) Department of Medicine III (Cardiovascular Disease),
Eberhard-Karls-Universitaet Tuebingen, Germany
(Haap) Department of Medicine IV, Eberhard-Karls-Universitaet Tuebingen,
Germany
Title
Clinical outcome and paravalvular leakage of the new balloon-expandable
Edwards Sapien 3 valve in comparison to its predecessor model (Edwards
Sapien XT) in patients undergoing transfemoral aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. 88 (3) (pp 466-475),
2016. Date of Publication: 01 Sep 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of this study was to compare the 30-day procedural,
clinical and echocardiographic outcome of the new balloon-expandable
Edwards Sapien 3 (ES3) valve with the Edwards Sapien XT (ESXT).
Background: Post-implant paravalvular leaks (PVL) after transfemoral
aortic valve replacement (TAVR) resulting in residual aortic regurgitation
(AR) are a major limitation for long term outcome. New TAVR-devices have
to eliminate this problem. Methods: Transfemoral TAVR was performed in 209
consecutive intermediate-high-risk surgical patients (pts) with
symptomatic aortic stenosis (ESXT n = 102, ES3 n = 107). Transthoracic
echocardiography (TTE) and 3-dimensional computed tomography were used for
valve size selection. Primary endpoint of the study was none/trace AR
derived by TTE 30-days after TAVR. Results: All pts underwent successfully
TAVR with a combined device success of 100/102 (99%) in ESXT and 107/107
(100%) in ES3 pts. Fluoroscopy time (ESXT 11.8 +/- 0.5 min vs. ES3 10.0
+/- 0.5 min, P = 0.003) and contrast (ESXT 188.9 +/- 5.6 mL vs. ES3 170.4
+/- 4.7 mL, P = 0.04) were significantly lower in ES3 patients. 30-day
clinical events did not differ. Transvalvular mean pressure gradients were
significantly reduced to 7.4 +/- 0.8 mmHg after ESXT and to 10.1+/- 0.4
mmHg after ES3 implantation. After 30 days none/trace AR was found in
34.3% (n = 35) of all ESXT pts in contrast to 89.7% (n = 96) of all ES3
patients. Moderate-to-severe AR was found rarely (ESXT 2.9% vs. ES3 0%, P
= 0.073). Conclusions: Although there was no significant difference in 30
day mortality, the newer ES3 valve reduced significantly residual
paravalvular leakage. &#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<49>
Accession Number
612160577
Author
Pineda A.M.; Chandra R.; Gowani S.A.; Santana O.; Mihos C.G.; Kirtane
A.J.; Stone G.W.; Kurlansky P.; Smith C.R.; Beohar N.
Institution
(Pineda, Chandra, Gowani, Santana, Mihos, Beohar) Columbia University
Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach,
FL, United States
(Kirtane, Stone, Kurlansky, Smith) Columbia University Medical Center, New
York, NY, United States
Title
Completeness of revascularization and its impact on the outcomes of a
staged approach of percutaneous coronary intervention followed by
minimally invasive valve surgery for patients with concomitant coronary
artery and valvular heart disease.
Source
Catheterization and Cardiovascular Interventions. 88 (3) (pp 329-337),
2016. Date of Publication: 01 Sep 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: A staged approach of percutaneous coronary intervention (PCI)
followed by minimally invasive valve surgery (MIVS) is an alternative to
the conventional combined coronary artery bypass and valve surgery for
patients with concomitant coronary artery and valve disease. Limited data
exist on degree of the completeness of revascularization achieved with
this approach and its impact on outcomes. Methods: A total of 138
patients, who underwent a staged approach between January 2009 and June
2013, were retrospectively evaluated. Coronary angiograms were reviewed by
two cardiologists blinded to outcomes and were then categorized into two
groups: complete or incomplete revascularization, which was defined as >1
major epicardial coronary arteries of at least 2.0 mm diameter with >70%
untreated obstruction after the index PCI and before MIVS. Results:
Complete and incomplete revascularization was achieved in 105 (76%) and 33
(24%) patients, respectively. The patients with incomplete
revascularization had a lower ejection fraction, a higher STS score, and
more prior myocardial infarctions and multi-vessel coronary artery
disease. There were no differences in the post-operative complications,
30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a
median follow-up of 29 months, incompletely revascularized patients had a
higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05).
Conclusions: In patients undergoing a staged approach of PCI followed by
MIVS, incomplete revascularization did not significantly impact the short
or mid-term survival, but was associated with an increased incidence of
acute coronary syndrome at follow-up. &#xa9; 2015 Wiley Periodicals, Inc.
Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<50>
Accession Number
610664043
Author
Wilson W.M.; Walsh S.J.; Yan A.T.; Hanratty C.G.; Bagnall A.J.; Egred M.;
Smith E.; Oldroyd K.G.; Mcentegart M.; Irving J.; Strange J.; Douglas H.;
Spratt J.C.
Institution
(Wilson) University of Melbourne, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Walsh, Hanratty, Douglas) Belfast Health and Social Care Trust, Belfast,
United Kingdom
(Yan) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Bagnall, Egred) Freeman Hospital, Newcastle upon Tyne, Tyne and Wear,
United Kingdom
(Bagnall, Egred) Institute of Cellular Medicine, Newcastle University,
Newcastle upon Tyne, United Kingdom
(Smith) London Chest Hospital (Barts Health Centre, Barts Health NHS
Trust, London, United Kingdom
(Oldroyd, Mcentegart, Spratt) Golden Jubilee National Hospital, Glasgow,
United Kingdom
(Irving) Ninewells Hospital, Dundee, United Kingdom
(Strange) Bristol Heart Institute, Bristol, United Kingdom
(Spratt) Edinburgh Heart Centre, Edinburgh, United Kingdom
(Spratt) Forth Valley Acute Hospitals, Larbert FK54WR, United Kingdom
Title
Hybrid approach improves success of chronic total occlusion angioplasty.
Source
Heart. 102 (18) (pp 1486-1493), 2016. Date of Publication: September 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Treatment options for coronary chronic total occlusions (CTO)
are limited, with low historical success rates from percutaneous coronary
intervention (PCI). We report procedural outcomes of CTO PCI from 7
centres with dedicated CTO operators trained in hybrid approaches
comprising antegrade/retrograde wire escalation (AWE/RWE) and dissection
re-entry (ADR/RDR) techniques. Methods Clinical and procedural data were
collected from consecutive unselected patients with CTO between 2012 and
2014. Lesion complexity was graded by the Multicentre CTO Registry of
Japan ( J-CTO) score, with >2 defined as complex. Success was defined as
thrombolysis in myocardial infarction 3 flow with <30% residual stenosis,
subclassified as at first attempt or overall. Inhospital complications and
30-day major adverse cardiovascular events (MACEs, death/myocardial
infarction/unplanned target vessel revascularisation) were recorded.
Results 1156 patients were included. Despite high complexity (mean J-CTO
score 2.5+/-1.3), success rates were 79% (first attempt) and 90% (overall)
with 30-day MACE of 1.6%. AWE was highly effective in less complex lesions
( J-CTO <1 94% success vs 79% in J-CTO score >2). ADR/RDR was used more
commonly in complex lesions ( J-CTO<1 15% vs J-CTO >2 56%). Need for
multiple approaches during each attempt increased with lesion complexity
(17% J-CTO <1 vs 48% J-CTO >2). Lesion modification ('investment
procedures') at the end of unsuccessful first attempts increased the
chance of subsequent success (96% vs 71%). Conclusions Hybrid-Trained
operators can achieve overall success rates of 90% in real world practice
with acceptable MACE. Use of dissection re-entry and investment procedures
maintains high success rates in complex lesions. The hybrid approach
represents a significant advance in CTO treatment.

<51>
Accession Number
611901828
Author
Skowasch D.; Fertl A.; Schwick B.; Schafer H.; Hellmann A.; Herth F.J.F.
Institution
(Skowasch) Department of Internal Medicine II - Pneumology, University of
Bonn, Sigmund-Freud-Strasse 25, Bonn DE-53127, Germany
(Fertl) Klinik fur Innere Medizin/Pneumologie, Krankenhaus Martha-Maria,
Munich, Germany
(Schwick) Lungenklinik, Medizinisches Zentrum Stadteregion Aachen,
Wurselen, Germany
(Schafer) Innere Medizin, SHG-Kliniken Volklingen, Volklingen, Germany
(Hellmann) Zentrum fur Pneumologie, Onkologie und Schlafmedizin, Augsburg,
Germany
(Herth) Pneumology and Critical Care Medicine, Thoraxklinik and
Translational Lung Research Center Heidelberg, University of Heidelberg,
Heidelberg, Germany
Title
A Long-Term Follow-Up Investigation of Endobronchial Valves in Emphysema
(the LIVE Study): Study Protocol and Six-Month Interim Analysis Results of
a Prospective Five-Year Observational Study.
Source
Respiration. 92 (2) (pp 118-126), 2016. Date of Publication: 01 Sep 2016.
Publisher
S. Karger AG
Abstract
Background: Randomized controlled trials indicate that significant lung
volume reduction (ELVR) can be obtained with Zephyr valves by occluding
the target lobe in the absence of collateral ventilation, leading to
relevant functional benefits in advanced emphysema patients. Objectives:
To observe the long-term effects of endobronchial valve (EBV) implantation
in emphysema patients screened by Chartis assessment in the context of
daily pulmonology practice. Methods: The LIVE Study is a prospective,
observational, open-label, single-arm, multicenter trial conducted in
Germany. 498 patients included in this interim analysis were enrolled
between July 2, 2012, and September 16, 2014. The 6-month follow-up visit
data were recorded for 343 patients (safety population), and complete data
sets were available for 321 treated patients (efficacy population) - 56.4%
male, age: 64.5 years, forced expiratory volume in 1 s (FEV<inf>1</inf>) %
predicted: 31.3%, residual volume (RV) % predicted: 252%. Results:
Efficacy results at 6 months: FEV<inf>1</inf> (l) increased by +100 ml
(+11.9%), RV (l) decreased by -0.42 liter, and the COPD Assessment Test
score decreased by -3.14 points (each p < 0.0001). Safety outcomes: A
total of 66 adverse events (AEs; with 50 serious AEs - SAEs) were reported
in 55 patients (16%) during the hospital stay for EBV placement -
pneumothorax (35 cases), chronic obstructive pulmonary disease (COPD)
exacerbation (5 cases), and pneumonia (4 cases). During the subsequent
6-month follow-up window, 170 SAEs were recorded in 125 patients (36.4%),
predominantly COPD exacerbation (53% of the SAEs). Conclusion: The current
results of this large-scale German observational study performed in the
context of daily practice further demonstrates that ELVR with Zephyr
valves is an effective and well-tolerated treatment option in advanced
emphysema. Copyright &#xa9; 2016 S. Karger AG, Basel.

<52>
Accession Number
612111105
Author
Cuisset T.; Noc M.
Institution
(Cuisset) Departement de Cardiologie, CHU Timone, Marseille F-13385,
France
(Cuisset) INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis,
Aix-Marseille Universite, Faculte de Medecine, Marseille, France
(Noc) Center for Intensive Internal Medicine, University Medical Center,
Ljubljana, Slovenia
Title
Multivessel PCI in STEMI: Ready to be the recommended strategy?.
Source
EuroIntervention. 10 (t) (pp T47-T54), 2014. Date of Publication: 2014.
Publisher
EuroPCR
Abstract
Multivessel obstructive coronary artery disease is observed in about half
of the STEMI patients undergoing primary PCI. Optimal management of
non-culprit lesions in these settings continues to be a matter of debate
and no consensus has been reached. Lack of robust scientific data led to
significant heterogeneity in practice among different centres and
countries. In general, three approaches have been defined in
haemodynamically stable patients: an aggressive approach with non-culprit
PCI during the index procedure, an intermediate approach with non-culprit
PCI or CABG as a staged procedure during the index hospital stay or within
30 days, and a conservative approach with non-culprit PCI/CABG only in
case of refractory symptoms or objective detection of ischaemia. Based on
available data and subsequent post hoc pooled analysis, an intermediate
approach has been considered as an accepted option and often adopted.
Conversely, the recent PRAMI study results (Preventive Angioplasty in
Acute Myocardial Infarction) suggested that an aggressive approach
(including non-culprit PCI during the index procedure) provided better
clinical outcome than the conservative "culprit only" approach. It is,
however, as yet unknown if the aggressive approach used in the PRAMI study
is also better than the traditionally advocated intermediate approach with
angiographically or FFR-driven staged non-culprit revascularisation. The
purpose of this review is to discuss the available evidence and integrate
it into daily clinical decision making. Copyright &#xa9; Europa Digital &
Publishing 2014. All rights reserved.

<53>
Accession Number
612164956
Author
Ke J.-D.; Hou H.-J.; Wang M.; Zhang Y.-J.
Institution
(Ke, Hou, Wang, Zhang) Department of Anesthesiology, Friendship Hospital,
Capital Medical University, Beijing 100050, China
Title
The comparison of anesthesia effect of lung surgery through video-assisted
thoracic surgery: A meta-analysis.
Source
Journal of cancer research and therapeutics. 11 (pp C265-C270), 2015. Date
of Publication: 01 Nov 2015.
Abstract
OBJECTIVE: The epidural anesthesia and general anesthesia are the most
commonly used in lung surgery through video-assisted thoracic surgery
(VATS). Each of these methods has their advantages and disadvantages, so
the aim of this meta-analysis is to identify which anesthesia is more
conducive to lung surgery under VATS and rehabilitation of patients.
MATERIALS AND METHODS: The Cochrane Library Database (Issue 12, 2013),
PubMed (1966-2015), and China National Knowledge Infrastructure
(1950-2015) were searched without language restrictions. Meta-analyses
were conducted using Review Manager 5.2 software (The Cochrane
Collaboration, Software Update, Oxford). We calculated odds ratio (OR) and
its confidence interval (95% CI) to estimate the difference between
epidural anesthesia and general anesthesia through finishing of the
collected data.
RESULTS: Due to our search results, 7 studies were included in our study.
Studies among them show that different contents of these articles are not
all the same about research direction. Our findings suggested that
epidural anesthesia had more advantages than general anesthesia for
operative time (mean difference = - 23.85, 95% CI: - 29.67-- 18.03, P =
0.0001). More than that, epidural anesthesia showed a good surgical
outcome on postoperative hospital stay (mean difference = - 0.43, 95% CI:
- 0.85-- 0.01, P = 0.04) than general anesthesia. But we found that there
were no different on numbers of people with complications (OR = 0.45, 95%
CI: 0.23-0.89, P = 0.97) and headache occurrence (OR = 2.69, 95% CI:
0.62-11.70, P = 0.91) between epidural anesthesia and general anesthesia.
CONCLUSION: These results indicated that epidural anesthesia can save
operating time and postoperative hospital stay time. But epidural
anesthesia and general anesthesia have the same effect on complications.

<54>
Accession Number
612290572
Author
Indraratna P.; Tian D.H.; Yan T.D.; Doyle M.P.; Cao C.
Institution
(Indraratna, Tian, Yan, Cao) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, Australia
(Indraratna) Department of Cardiology, St George Hospital, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Yan) Department of Cardiothoracic, Royal Prince Alfred Hospital, Sydney,
Australia
(Doyle, Cao) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: A meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 224 (pp 382-387), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) has become a
widely utilized method of treatment of severe aortic valve stenosis. The
present meta-analysis included all published relevant randomized
controlled trials (RCTs) and aimed to compare the safety and efficacy of
TAVI compared to surgical aortic valve replacement (AVR). Method Nine
electronic databases were comprehensively searched. Eligible studies were
required to be randomized controlled trials which reported comparative
endpoints on both TAVI and AVR. Results Five published RCTs were included
in the meta-analysis. A total of 3828 patients were studied. The overall
mortality and stroke rates at 30 days and 1 year were not significantly
different between TAVI and AVR. Patients undergoing TAVI were more likely
to experience vascular complications, aortic regurgitation and permanent
pacemaker insertion, however, they were less likely to encounter acute
renal failure and major haemorrhage. Conclusions The data suggest that
TAVI is a safe and efficacious alternative to surgical aortic valve
replacement in judiciously selected patients. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<55>
[Use Link to view the full text]
Accession Number
612312537
Author
Bashir J.; Fedoruk L.M.; Ofiesh J.; Karim S.S.; Tyers G.F.O.
Institution
(Bashir, Karim) St Paul's Hospital, Department of Cardiovascular Surgery,
University of British Columbia, No 458B, 1081 Burrard St, Vancouver V6Z
1Y6, Canada
(Fedoruk, Ofiesh) Royal Jubilee Hospital, Department of Cardiovascular
Surgery, University of Victoria, BC, Canada
(Tyers) Vancouver Coastal Health, Department of Cardiovascular Surgery,
University of British Columbia, Vancouver, Canada
Title
Classification and Surgical Repair of Injuries Sustained during
Transvenous Lead Extraction.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (9) (no pagination),
2016. Article Number: e003741. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Injuries to cardiac and venous structures during pacemaker
and defibrillator lead extraction are serious complications that have been
studied poorly. The incidence of these injuries is unknown but likely
underestimated. No systematic multicenter review of these injuries or
their management has been undertaken. Methods and Results - We
interrogated our mandatory administrative database for all excimer laser
extractions that sustained a cardiac or venous injury in the province of
British Columbia. Injuries were classified according to presentation and
compared with respect to nature of injury, type of repair, utilization of
cardiopulmonary bypass, and outcome. Of 1082 excimer laser extractions
over 19 years, 33 sustained an injury (3.0%). The majority of injuries
occurred in women (21/33; 63.6%), and median age of oldest lead extracted
was 10.8 (7.5, 12.2) years. A type 1 presentation, defined as circulatory
collapse, was found in 12/33 patients (36.4%). A type 2 presentation,
defined as progressive hypotension responsive to treatment, was found in
20/33 patients (60.6%). Over half the patients had a moderate or large
injury, and cardiopulmonary bypass was required in 13 patients with
extensive injury. Despite the presence of devastating injuries, the
immediate availability of aggressive salvage measures resulted in a
survival of 87.9% of patients at 30 days. Conclusions - The immediate
availability of a cardiovascular surgeon, perfusionist, and
cardiopulmonary bypass pump facilitates lifesaving repair of injuries
sustained during laser lead extraction. The size and complexity of injury
correlates closely with the presentation, blood loss, and need for
cardiopulmonary bypass to facilitate repair. Copyright &#xa9; 2016
American Heart Association, Inc.

<56>
Accession Number
612316476
Author
Stewart M.H.; Stephen Jenkins J.
Institution
(Stewart, Stephen Jenkins) Department of Cardiology, Ochsner Clinic
Foundation, New Orleans, LA, United States
Title
The evolving role of percutaneous mitral valve repair.
Source
Ochsner Journal. 16 (3) (pp 270-276), 2016. Date of Publication: Fall
2016.
Publisher
Ochsner Clinic (E-mail: ocjournal@ochsner.org)
Abstract
Background: Mitral regurgitation (MR) is the second leading cause of
valvular heart disease in the United States behind aortic stenosis. The
percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been
approved in the United States since 2013 as an alternative to traditional
mitral valve surgery. However, many questions are left unanswered about
when to perform this procedure and whom to perform it on. Methods: We
reviewed major published literature on the MitraClip from 2003-2016 to
help guide clinical decision-making. A PubMed search was conducted using
the phrase "mitraclip" or "percutaneous mitral valve repair" to identify
relevant articles pertaining to the clip as well as surgical valve repair.
Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve
Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the
MitraClip but did not prove its superiority to surgical repair in the
population studied. Numerous subsequent registries have suggested that the
success of the MitraClip varies with the patient population studied. The
currently enrolling Cardiovascular Outcomes for Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
MR (COAPT) trial hopes to answer some of these questions. Conclusion: The
MitraClip is a new and exciting technology for percutaneously treating
disease processes traditionally managed with surgery. The future of the
clip and its patient population is dependent on further studies. Copyright
&#xa9; Academic Division of Ochsner Clinic Foundation.

<57>
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.

<58>
Accession Number
612234154
Author
Bramlage P.; Strauch J.; Schrofel H.
Institution
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Strauch) Clinic for Cardiosurgery and Thoracic Surgery,
Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil, Bochum,
Germany
(Schrofel) Clinic for Cardiac Surgery, Karlsruhe, Germany
Title
Balloon expandable transcatheter aortic valve implantation with or without
pre-dilation of the aortic valve - rationale and design of a multicenter
registry (EASE-IT).
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 160. Date of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients with severe calcific aortic stenosis, balloon
aortic valvuloplasty (BAV) is routinely performed in order to pre-dilate
the stenosed aortic valve prior to transcatheter aortic valve implantation
(TAVI). Although pre-dilation is considered to be essential for the
preparation of the valve landing zone, there is no clear evidence to
support its clinical value. In contrast, BAV has been suggested to be
linked to several complications. Notably, while preliminary evidence has
supported the feasibility and safety of TAVI without pre-dilation, larger
studies directly comparing the benefit/risk profile of TAVI in the
presence and absence of pre-dilation are required. Methods/Design:
Therefore, a prospective, two-armed, multicenter registry (EASE-IT) was
designed to obtain essential data concerning procedural success rates,
adverse events, and mortality in a large cohort of patients undergoing
transapical (TA)-TAVI using the Edwards SAPIEN 3 balloon expandable heart
valves with and without pre-ballooning. Discussion: Data provided by
EASE-IT will be used to assess the relevance of BAV during the TAVI
procedure and to investigate associations between patient characteristics
and outcomes. Therefore, results obtained from the EASE-IT registry could
contribute to reduced rates of TAVI-associated morbidity and mortality in
patients with severe, calcific aortic stenosis. Copyright &#xa9; 2014
Bramlage et al.

<59>
Accession Number
612234115
Author
Bramlage P.; Romano M.; Bonaros N.; Cocchieri R.; Jagielak D.; Frank D.;
Bapat V.
Institution
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Romano) Institut Hospitalier Jacques Cartier, Massy, France
(Bonaros) Universitatsklink fur Herzchirurgie, Medizinische Universitat
Innsbruck, Innsbruck, Austria
(Cocchieri) Heart Center, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Jagielak) Department of Cardiac and Vascular Surgery, Medical University
of Gdansk, Gdansk, Poland
(Frank) Department of Internal Medicine III (Cardiology and Angiology)
UKSH, Campus, Kiel, Germany
(Bapat) St Thomas' Hospital, London, United Kingdom
Title
Transaortic transcatheter aortic valve implantation - rationale and design
of the multicenter, multinational prospective ROUTE registry.
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 152. Date of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transaortic transcatheter aortic valve implantation (TAo-TAVI)
is a recently developed approach that provides an alternative delivery
route for valve replacement in patients with vascular abnormalities or
existing comorbidities. While initial studies have shown the principal
efficacy and safety, the real world effectiveness and safety of this
approach remains to be fully assessed. Methods/Design: In this regard, the
Registry Of the Utilization of the TAo-TAVI approach using the Edwards
SAPIEN Valve (ROUTE) represents the first multicenter, multinational
prospective documentation of the course and outcome of patients with
severe calcific aortic stenosis (AS) undergoing TAo-TAVI. ROUTE commenced
in February 2013 with the goal of consecutively enrolling 300 patients at
up to 22 sites across Europe. The primary objective of ROUTE is to
determine the 30-day mortality associated with TAo-TAVI using the Edwards
SAPIEN THV (Edwards Lifesciences, Irvine, CA). In addition, ROUTE aims to
quantify complications, predictors of patient outcome and the value of CT
guided valve sizing. Discussion: Findings from this landmark registry will
provide important information regarding procedural success rates and early
mortality in patients undergoing TAo-TAVI. Copyright &#xa9; 2014 Bramlage
et al.

<60>
Accession Number
612233838
Author
Polderman J.A.W.; Houweling P.L.; Hollmann M.W.; DeVries J.H.; Preckel B.;
Hermanides J.
Institution
(Polderman, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Academic Medical Centre, Postbus 22660, Amsterdam 1100 DD, Netherlands
(Houweling) Department of Anaesthesiology, Diakonessenhuis, Bosboomstraat
1, Utrecht 3582 KE, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
Postbus 22660, Amsterdam 1100 DD, Netherlands
Title
Study protocol of a randomised controlled trial comparing perioperative
intravenous insulin, GIK or GLP-1 treatment in diabetes-PILGRIM trial.
Source
BMC Anesthesiology. 14 (1) (no pagination), 2014. Article Number: 91. Date
of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Diabetes mellitus (DM) is associated with poor outcome after
surgery. The prevalence of DM in hospitalised patients is up to 40%,
meaning that the anaesthesiologist will encounter a patient with DM in the
operating room on a daily basis. Despite an abundance of published glucose
lowering protocols and the known negative outcomes associated with
perioperative hyperglycaemia in DM, there is no evidence regarding the
optimal intraoperative glucose lowering treatment. In addition, protocol
adherence is usually low and protocol targets are not simply met.
Recently, incretins have been introduced to lower blood glucose. The main
hormone of the incretin system is glucagon-like peptide-1 (GLP-1). GLP-1
increases insulin and decreases glucagon secretion in a glucose-dependent
manner, resulting in glucose lowering action with a low incidence of
hypoglycaemia. We set out to determine the optimal intraoperative
treatment algorithm to lower glucose in patients with DM type 2 undergoing
non-cardiac surgery, comparing intraoperative glucose-insulin-potassium
infusion (GIK), insulin bolus regimen (BR) and GPL-1 (liragludite, LG)
treatment. Methods/Design: This is a multicentre randomised open label
trial in patients with DM type 2 undergoing non-cardiac surgery. Patients
are randomly assigned to one of three study arms; intraoperative
glucose-insulin-potassium infusion (GIK), intraoperative sliding-scale
insulin boluses (BR) or GPL-1 pre-treatment with liraglutide (LG).
Capillary glucose will be measured every hour. If necessary, in all study
arms glucose will be adjusted with an intravenous bolus of insulin.
Researchers, care givers and patients will not be blinded for the assigned
treatment. The main outcome measure is the difference in median glucose
between the three study arms at 1 hour postoperatively. We will include
315 patients, which gives us a 90% power to detect a 1 mmol l^-1
difference in glucose between the study arms. Discussion: The PILGRIM
trial started in January 2014 and will provide relevant information on the
perioperative use of GLP-1 agonists and the optimal intraoperative
treatment algorithm in patients with diabetes mellitus type 2. Trial
registration: ClinicalTrials.gov, NCT02036372. Copyright &#xa9; 2014
Polderman et al.

<61>
Accession Number
612297680
Author
Habib A.
Institution
(Habib) Department of Intensive Care, Adult Cardiac Intensive Care Unit,
Prince Sultan Cardiac Centre, Prince Sultan Military Medical City, Post
Office Box 7897-X966, Riyadh 11159, Saudi Arabia
(Habib) Department of Critical Care Medicine, Faculty of Medicine, Cairo
University, Cairo, Egypt
Title
Comparison of low- and high-dose recombinant activated factor VII for
postcardiac surgical bleeding.
Source
Indian Journal of Critical Care Medicine. 20 (9) (pp 497-503), 2016. Date
of Publication: September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Aim of the Study: A retrospective observational study to compare safety
and efficacy of high and low doses of recombinant activated factor VIIa
(rFVIIa) in severe postcardiac surgical bleeding. Patients and Methods:
From 2004 to 2014, all patients who received rFVIIa for bleeding after
cardiac surgery were included and arranged in two groups; Group 1: Low
dose (40-50 mcg/kg) (n = 98) and Group 2: High dose (90-120 mcg/kg) (n =
156). Results: There was no significant difference in demographic and
surgical characteristics of both groups on admission to Cardiac Surgical
Intensive Care Unit (CSICU). There was no significant difference between
the two groups regarding the reduction in chest tube bleeding in the first
6 h or the transfusion requirement in the 24 h after admission to CSICU. A
total of 15 patients (5.9%) had thromboembolic adverse events. (Seven
(7.1%) patients in Group 1 compared to 8 (5.1%) patients in Group 2, P =
0.58). There were no significant differences in all-cause mortality at 30
days (2% in Group 1 vs. 3.2% in Group 2, P = 0.6) and at hospital
discharge between the two study groups (6.1% in Group 1 vs. 8.3% in Group
2, P = 0.5), respectively. There was no significant difference between the
two groups regarding the need for re-exploration, days on mechanical
ventilation, CSICU, or hospital stay. Conclusion: In this report, Low-dose
rFVIIa showed equivalent efficacy and safety to high-dose rFVIIa. Further
prospective randomized studies are needed to confirm these findings.
Copyright &#xa9; 2016 Indian Journal of Critical Care Medicine Published
by Wolters Kluwer - Medknow.

<62>
Accession Number
612222931
Author
Kim C.A.; Rasania S.P.; Afilalo J.; Popma J.J.; Lipsitz L.A.; Kim D.H.
Institution
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Beth Israel Deaconess Medical
Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical
School, Harvard School of Public Health, Boston, MA, United States
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Jewish General Hospital,
McGill University, Montreal, QC, Canada
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Geisinger Medical Center,
Danville, PA, United States
(Kim) Division of Gerontology, Beth Israel Deaconess Medical Center, 110
Francis Street, Suite 1B, Boston, MA 02215, United States
Title
Functional status and quality of life after transcatheter aortic valve
replacement a systematic review.
Source
Annals of Internal Medicine. 160 (4) (pp 243-254), 2014. Date of
Publication: 18 Feb 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The functional and quality-of-life benefits of transcatheter
aortic valve replacement (TAVR) have not been established. Purpose: To
evaluate the changes in functional status and quality of life after TAVR.
Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials from 1 January 2002 to 30 September 2013. Study
Selection: Studies of TAVR that reported the New York Heart Association
(NYHA) class, Short Form-12/36 Health Survey physical and mental component
summary (points), or other measures of functional status. Data Extraction:
Two reviewers independently extracted the mean change (follow-up minus
baseline) in primary outcomes. Because of substantial heterogeneity, data
were not pooled; the range of mean change was summarized. Data Synthesis:
We identified 60 observational studies (56 pre-post comparison and 4
head-to-head comparative studies) and 2 randomized, controlled trials (11
205 patients). Most studies showed a clinically important decrease in NYHA
class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months
(range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36
Health Survey physical component score was clinically important over 12
months (range, 4.9 to 26.9 points), and the change in mental component
score was smaller (range, 1.0 to 8.9 points). Clinically important
improvements were seen in other diseasespecific measures but were less
consistently seen in general health measures. Limitations: Comparative
evidence is limited by few head-to-head studies. Survivor bias may have
overestimated the benefits. Conclusion: Transcatheter aortic valve
replacement provides clinically important benefits in physical function
and disease-specific measures of quality of life but modest benefits in
psychological and general health measures. More comparative studies on
functional status and quality of life are needed for informed treatment
decision making. Copyright &#xa9; 2014 American College of Physicians.

<63>
Accession Number
612259260
Author
Fan Y.; Zhang D.; Xiang D.
Institution
(Fan, Zhang, Xiang) Department of Cardiac Surgery, The People's Hospital
of Guizhou Province, Guiyang, Guizhou 550002, China
Title
Delayed protective effect of telmisartan on lung ischemia/reperfusion
injury in valve replacement operations.
Source
Experimental and Therapeutic Medicine. 12 (4) (pp 2577-2581), 2016. Date
of Publication: October 2016.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
The present study aimed to investigate the delayed protective effect of
telmisartan on lung ischemic/reperfusion injury in patients undergoing
heart valve replacement operations. In total, 180 patients diagnosed with
rheumatic valve diseases were randomly divided into the telmisartan (T),
captopril (C) and placebo (P) groups. In the telmisartan group, the
patients were pretreated with telmisartan (1 mg/kg/day), at the time
period 96-48 h before the operation, whereas in the C group, the patients
were treated with captopril (1 mg/kg/day) at the time period 96-48 h prior
to the operation control group. Each drug treatment group included a
corresponding placebo treatment. The variables pulmonary vascular
resistance (PVR) and A-aDO<inf>2</inf> were measured prior to CPB and at
1, 3, 6 and 12 h after CPB. Pulmonary neutrophil (PMN) count in the left
and right atrium blood as well as SOD malondialdehyde (MDA), NO,
angiotensin II (AngII) value in the left atrium blood, were measured 30
min prior to and after CPB. The PVR parameters of the telmisartan and
captopril groups were significantly lower than those of the placebo group
(P<0.05). The A-aDO<inf>2</inf> values in the telmisartan and captopril
groups were significantly lower than those in the placebo group at 1, 3
and 6 h following CPB treatment. The difference between the right and left
atrium blood PMN was significantly lower in the telmisartan and captopril
intervention groups compared to that in the placebo group 30 min following
CPB treatment. The left atrium blood SOD and NO values were significantly
higher, whereas the MDA value was significantly lower in the telmisartan
group compared to the control group 30 min following CPB treatment. As for
AngII, there was no difference between the C and T groups, compared with
the P group. In the two groups 30 min after treatment with CPB, 24
patients experienced varying degrees of cough, with the telmisartan group
showing a significant difference (P<0.05). The hospitalization time was
compared in the three groups of patients and it was found to be
significantly shorter in the telmisartan group than the captopril and
placebo groups (P<0.05). In conclusion, it was found that for the time
period 96-48 h before heart valve replacement operations telmisartan (1
mg/kg/day) delayed the protective effect on lung ischemia/reperfusion
injury in patients with rheumatic valve diseases. The results of the
present study indicated that the protective effect may be associated with
the increment of endogenetic NO and the enhanced ability against lipid
peroxidation. Copyright &#xa9; 2016, Spandidos Publications. All rights
reserved.

<64>
Accession Number
612259176
Author
Zhang X.; Shen C.; Zhai S.; Liu Y.; Yue W.-W.; Han L.
Institution
(Zhang, Shen, Zhai) Shandong Provincial Hospital Affiliated to Shandong
University, Ji'nan, Shandong 250021, China
(Liu) Laiwu Health School, Laiwu, Shandong 271100, China
(Yue, Han) The Fourth People's Hospital of Ji'nan, Ji'nan, Shandong
250021, China
Title
A meta-analysis of the effects of beta-adrenergic blockers in chronic
heart failure.
Source
Experimental and Therapeutic Medicine. 12 (4) (pp 2489-2496), 2016. Date
of Publication: October 2016.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
Adrenergic beta-blockers are drugs that bind to, but do not activate
beta-adrenergic receptors. Instead they block the actions of
beta-adrenergic agonists and are used for the treatment of various
diseases such as cardiac arrhythmias, angina pectoris, myocardial
infarction, hypertension, headache, migraines, stress, anxiety, prostate
cancer, and heart failure. Several meta-analysis studies have shown that
beta-blockers improve the heart function and reduce the risks of
cardiovascular events, rate of mortality, and sudden death through chronic
heart failure (CHF) of patients. The present study identified results from
recent meta-analyses of beta-adrenergic blockers and their usefulness in
CHF. Databases including Medline/Embase/Cochrane Central Register of
Controlled Trials (CENTRAL), and PubMed were searched for the periods May,
1985 to March, 2011 and June, 2013 to August, 2015, and a number of
studies identified. Results of those studies showed that use of
beta-blockers was associated with decreased sudden cardiac death in
patients with heart failure. However, contradictory results have also been
reported. The present meta-analysis aimed to determine the efficacy of
beta-blockers on mortality and morbidity in patients with heart failure.
The results showed that mortality was significantly reduced by
beta-blocker treatment prior to the surgery of heart failure patients. The
results from the meta-analysis studies showed that beta-blocker treatment
in heart failure patients correlated with a significant decrease in
long-term mortality, even in patients that meet one or more exclusion
criteria of the MERIT-HF study. In summary, the findings of the current
meta-analysis revealed beneficial effects different beta-blockers have on
patients with heart failure or related heart disease. Copyright &#xa9;
2016, Spandidos Publications. All rights reserved.

<65>
Accession Number
612256226
Author
Chen J.; Tang B.; Lin Y.; Ru Y.; Wu M.; Wang X.; Chen Q.; Chen Y.; Wang J.
Institution
(Chen, Lin, Ru, Wu, Chen, Wang) Department of Cardiology, Sun Yat-sen
Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Chen, Lin, Ru, Wu, Chen, Wang) Guangdong Province Key Laboratory of
Arrhythmia and Electrophysiology, Guangzhou, China
(Tang, Wang, Chen) Intelligent Computing Research Center, Harbin Institute
of Technology, Shenzhen Graduate School, Shenzhen, China
Title
Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict
Adverse Cardiovascular Events after Stent Implantation: A Systematic
Review and Meta-Analysis.
Source
Angiology. 67 (9) (pp 820-828), 2016. Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
To compare the predicative ability of SYNTAX (Synergy between PCI with
Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse
cardiac events (MACEs) after stent implantation in patients with coronary
artery disease (CAD). Studies were identified by electronic and manual
searches. Twenty-six studies were included in the meta-analysis. The
pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality
(ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95%
CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year
ACM pooled C-statistics for clinical SYNTAX scores were significantly
higher at 0.77 and 0.71, respectively (Ps <.05). Both scoring systems
predicted 1- and 5-year MACE equally well. The pooled risk ratio of the
SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI:
1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the
risk of major adverse cardiac and cerebrovascular events in each risk
stratum. The SYNTAX score demonstrated minimal discrimination in
predicting 1- or 5-year adverse cardiovascular events after percutaneous
coronary intervention in patients with CAD. The clinical SYNTAX score
could further improve the predictive capability for ACM but not MACE.
Copyright &#xa9; The Author(s) 2015.

<66>
Accession Number
612220945
Author
Ferri L.A.; Morici N.; Grosseto D.; Tortorella G.; Bossi I.; Sganzerla P.;
Cacucci M.; Sibilio G.; Tondi S.; Toso A.; Ferrario M.; Gandolfo N.;
Ravera A.; Mariani M.; Corrada E.; Di Ascenzo L.; Petronio A.S.; Cavallini
C.; Moffa N.; De Servi S.; Savonitto S.
Institution
(Ferri, Savonitto) Division of Cardiology, Ospedale Manzoni, Lecco, Italy
(Morici, Bossi) First Division of Cardiology-Interventional Cardiology,
Ospedale Niguarda, Milan, Italy
(Grosseto) Division of Cardiology, Ospedale Infermi, Rimini, Italy
(Tortorella) Division of Cardiology, IRCCS Arcispedale S. Maria Nuova,
Reggio Emilia, Italy
(Sganzerla) Division of Cardiology, Ospedale Treviglio-Caravaggio,
Treviglio, Italy
(Cacucci) Division of Cardiology, Ospedale Maggiore, Crema, Italy
(Sibilio) Division of Cardiology, Ospedale S. Maria delle Grazie,
Pozzuoli, Italy
(Tondi) Division of Cardiology, Ospedale Baggiovara, Modena, Italy
(Toso) Division of Cardiology, Ospedale S. Stefano, Prato, Italy
(Ferrario) IRCCS Fondazione Policlinico S. Matteo, Division of Cardiology,
Pavia, Italy
(Gandolfo) Division of Cardiology, Ospedale Mauriziano, Torino, Italy
(Ravera) Division of Cardiology, Ospedale Ruggi D' Aragona, Salerno, Italy
(Mariani) Division of Cardiology, Ospedale Civile, Legnano, Italy
(Corrada) Cardiovascular Department, Humanitas Clinical and Research
Center, Rozzano, Italy
(Di Ascenzo) Ospedale di Portogruaro, Division of Cardiology, Portogruaro,
Italy
(Petronio) Cardiothoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Cardiac Catheterization Laboratory,
Pisa, Italy
(Cavallini) Division of Cardiology, Ospedale S. Maria della Misericordia,
Perugia, Italy
(Moffa) Mediolanum Cardio Research, Milan, Italy
(De Servi) Cardiovascular Department IRCCS Multimedica, Sesto San
Giovanni, Italy
Title
A comparison of reduced-dose prasugrel and standard-dose clopidogrel in
elderly patients with acute coronary syndromes undergoing early
percutaneous revascularization: Design and rationale of the randomized
Elderly-ACS 2 study.
Source
American Heart Journal. 181 (pp 101-106), 2016. Date of Publication: 01
Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Elderly patients display higher on clopidogrel platelet
reactivity as compared with younger patients. Treatment with prasugrel 5
mg has been shown to provide more predictable and homogenous antiplatelet
effect, as compared with clopidogrel, suggesting the possibility of
reducing ischemic events after an acute coronary syndrome (ACS) without
increasing bleeding. Study design The Elderly-ACS 2 study is a
multicenter, randomized, parallel-group, open-label trial designed to
demonstrate the superiority of a strategy of dual antiplatelet treatment
using a reduced 5-mg daily dose of prasugrel over a standard strategy with
a daily clopidogrel dose of 75 mg in patients older than 74 years with ACS
(either ST- or non-ST-elevation myocardial infarction) undergoing early
percutaneous revascularization. The primary end point is the composite of
all-cause mortality, myocardial reinfarction, disabling stroke, and
rehospitalization for cardiovascular causes or bleeding within 1 year.
Taking advantage of the planned size of 2,000 patients, the secondary
objective is to assess the prognostic impact of selected prerandomization
variables (age, sex, diabetic status, serum creatinine level,
electrocardiogram changes, abnormal troponin levels, basal and residual
SYNergy between percutaneous coronary intervention with TAXus and cardiac
surgery [SYNTAX] score). Conclusion The Elderly-ACS 2 study is a
multicenter, randomized trial comparing a strategy of dual antiplatelet
therapy with a reduced dose of prasugrel with a standard dose of
clopidogrel in elderly patients with ACS undergoing percutaneous
revascularization (the Elderly ACS 2 trial: NCT01777503). Copyright &#xa9;
2016 Elsevier Inc.

<67>
Accession Number
612214993
Author
Merchant Q.; Siddiqui N.U.R.; Rehmat A.; Amanullah M.; Ul Haq A.; Hasan B.
Institution
(Merchant) Medical College, Aga Khan University, Karachi, Pakistan
(Siddiqui, Ul Haq, Hasan) Department of Pediatrics and Child Health, Aga
Khan University, Karachi, Pakistan
(Rehmat) Department of Nursing, Aga Khan University, Karachi, Pakistan
(Amanullah) Department of Surgery, Aga Khan University, Karachi, Pakistan
Title
Comparison of Enteral versus Intravenous Potassium Supplementation in
hypokalaemia in postcardiac surgery paediatric cardiac intensive care
patients: Prospective open label randomised control trial (EIPS).
Source
BMJ Open. 4 (no pagination), 2014. Article Number: e005124. Date of
Publication: 2014.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Hypokalaemia is frequently encountered in the daily clinical
practices of a paediatric cardiac intensive care unit (PCICU). It is a
strong independent predictor of mortality in patients with heart failure.
Thus, prompt potassium replacement therapy holds pivotal importance in
therapy for hypokalaemia. Although intravenous potassium replacement
(IVPR) in hypokalaemia is the preferred route in most intensive care
settings, it is associated with known safety risks and can lead to
arrhythmias, cardiac arrest and death if inappropriately administered.
Enteral potassium replacement (EPR), with its superior safety profile, may
be a better alternative to IVPR. Outcome: Primary outcome To compare the
efficacy EPR and IVPR for treatment of hypokalaemia. Secondary outcome
measures include a comparison of adverse effects (hyperkalaemia,
diarrhoea, gastrointestinal bleeds, nausea and vomiting) after EPR and
IVPR and a comparison of the number of dose/s required to achieve
resolution of hypokalaemia for each episode of hypokalaemia. Methods and
analysis: The Enteral Versus Intravenous Potassium Supplementation trial
is designed as a randomised, controlled, non-blinded trial with two arms.
Intervention arms will be block randomised on alternate weeks for IVPR and
EPR. Recruited patients will receive treatment accordingly. For analysis,
the percentage change in serum potassium levels in mEq/L after each event
of potassium replacement in both arms will be used as an end point to
compare the efficacy EPR and IVPR for treatment of hypokalaemia. Study
setting: The study will be conducted at the PCICU at the Aga Khan
University Hospital, Karachi. Ethics and dissemination: This study has
been approved by the Ethics Review Committee and Clinical Trials Unit at
The Aga Khan University with respect to scientific content and compliance
with applicable research and human subjects regulations. Trial
registration number: This trial is registered at Clinical Trials.Gov.
Registration number: NCT02015962. Copyright &#xa9; 2014, BMJ Publishing
Group. All rights reserved.

<68>
Accession Number
612245929
Author
Mavrakanas T.A.; Charytan D.M.
Institution
(Mavrakanas) aGeneral Internal Medicine Division, Geneva University
Hospitals, Geneva, Switzerland bRenal Division, Brigham & Women's
Hospital, Harvard Medical School, Boston, Massachusetts, USA
Title
Cardiovascular complications in chronic dialysis patients.
Source
Current Opinion in Nephrology and Hypertension. (no pagination), 2016.
Date of Publication: 14 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
PURPOSE OF REVIEW: This review article focuses on the most significant
cardiovascular complications in dialysis patients [sudden cardiac death
(SCD), acute coronary syndromes, heart failure, and atrial fibrillation].
RECENT FINDINGS: Current and ongoing research aims to quantify the rate
and pattern of significant arrhythmia in dialysis patients and to
determine the predominant mechanism of SCD. Preliminary findings from
these studies suggest a high rate of atrial fibrillation and that
bradycardia and asystole may be more frequent than ventricular arrhythmia
as a cause of sudden death. A recently published matched cohort study in
dialysis patients who received a defibrillator for primary prevention
showed that there was no significant difference in mortality rates between
defibrillator-treated patients and propensity-matched controls. Two
randomized controlled trials are currently recruiting participants and
will hopefully answer the question of whether implantable or wearable
cardioverter defibrillators can prevent SCD. An observational study using
United States Renal Data System data demonstrated how difficult it is to
keep hemodialysis patients on warfarin, as more than two-thirds
discontinued the drug during the first year. The ISCHEMIA-CKD trial may
provide answers about the optimal strategy for the treatment of
atherosclerotic coronary disease in patients with advanced chronic kidney
disease. SUMMARY: The article reviews the diagnosis of acute coronary
syndromes in dialysis patients, current literature on myocardial
revascularization, and data on fatal and nonfatal cardiac arrhythmia. The
new classification of heart failure in end-stage renal disease is
reviewed. Finally, available cohort studies on warfarin for stroke
prevention in dialysis patients with atrial fibrillation are reviewed.
Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights reserved.