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<1>
Accession Number
603474528
Author
Fleckenstein J.; Kohls N.; Evtouchenko E.; Lehmeyer L.; Kramer S.; Lang
P.M.; Siebeck M.; Mussack T.; Hatz R.; Heindl B.; Conzen P.; Rehm M.;
Czerner S.; Zwissler B.; Irnich D.
Institution
(Fleckenstein, Evtouchenko, Lehmeyer, Kramer, Lang, Heindl, Conzen, Rehm,
Czerner, Zwisler, Irnich) Department of Anaesthesiology, University of
Munich, Germany
(Kohls) Division Integrative Health Promotion, University of Applied
Sciences and Arts Coburg, Germany
(Kohls) Brain, Mind and Healing Program, Samueli Institute, Alexandria,
United States
(Siebeck, Mussack, Hatz) Department of General, Visceral, Transplantation,
Vascular and Thoracic Surgery, Ludwig Maximilians University, Munich,
Germany
Title
No effect of the cyclooxygenase-2 inhibitor etoricoxib on pre-emptive and
post-operative analgesia in visceral surgery: Results of a randomized
controlled trial.
Source
European Journal of Pain (United Kingdom). 20 (2) (pp 186-195), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background Pre-emptive analgesia in perioperative care has potential
benefits for patients. The pre-emptive and postoperative analgesic effects
of the cyclooxygenase-2 inhibitor etoricoxib have been investigated using
a 2 x 2 factorial trial design. Methods According to the 2 x 2 factorial
study design, 103 patients scheduled for visceral surgery, were randomly
allocated to two groups prior to surgery. Patients could receive either
etoricoxib or placebo (to investigate pre-emptive analgesia). Subsequent
to surgery, patients randomly received either etoricoxib or placebo,
again. It follows, that four treatment modalities (continuous or replaced
intervention) result, to investigate postoperative analgesia. Main Outcome
Measure was the cumulative morphine use 48 h post-surgery. Other outcomes
included pain intensities, pain thresholds and sensory detection. Results
Eighty-six patients (female n = 42; mean age 53.82 +/- 13.61 years) were
evaluated on the basis of an intention to treat analysis. Pre-emptive
administration of 120 mg etoricoxib did not significantly reduce the
cumulative morphine dose within the first 48 h after surgery, when
compared to the administration of placebo. The analysis of the
post-operative treatment groups showed a non-significant 8% reduction in
morphine dose during the continuous administration of etoricoxib. There
were no changes in sensory perception as detected with QST before and
after surgery or between groups. Conclusions The effect of administering
etoricoxib was not superior to placebo in reducing the morphine dose
required for postoperative analgesia. The lack of changes in peripheral
nociception suggests that central algetic mechanisms are of higher impact
in the development of postoperative pain following abdominal or thoracic
surgery. Copyright &#xa9; 2015 European Pain Federation.

<2>
Accession Number
611353655
Author
Caporale R.; Geraci G.; Gulizia M.M.; Borzi M.; Colivicchi F.; Menozzi A.;
Musumeci G.; Scherillo M.; Ledda A.; Tarantini G.; Gerometta P.; Casolo
G.; Formigli D.; Romeo F.; Di Bartolomeo R.
Institution
(Caporale) U.O.C. Cardiologia Interventistica, Ospedale Civile
dell'Annunziata, Via F. Migliori 1, Cosenza 87100, Italy
(Geraci, Ledda) U.O. Cardiologia, A.O. Ospedali Riuniti Villa
Sofia-Cervello, Palermo, Italy
(Gulizia) U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di
Rilievo Nazionale e Alta Specializzazione Garibaldi, Catania, Italy
(Borzi, Romeo) U.O.C. Cardiologia e Cardiologia Interventistica,
Policlinico Tor Vergata, Roma, Italy
(Colivicchi) U.O.C. Cardiologia-UTIC, Presidio Ospedaliero San Filippo
Neri, Roma, Italy
(Menozzi) U.O. Cardiologia, Azienda Ospedaliera Universitaria di Parma,
Parma, Italy
(Musumeci) Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII,
Bergamo, Italy
(Scherillo, Formigli) Cardiologia Interventistica-UTIC, A.O. G. Rummo,
Benevento, Italy
(Tarantini) Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari,
Universita degli Studi, Padova, Italy
(Gerometta) U.O. Cardiochirurgia, Istituto Humanitas Gavazzeni, Bergamo,
Italy
(Casolo) S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU),
Italy
(Di Bartolomeo) U.O. Cardiochirurgia, Ospedale Policlinico S.
Orsola-Malpighi, Bologna, Italy
Title
ANMCO/SIC/SICI-GISE/SICCH Consensus Document: Clinical approach to
pharmacological pretreatment for patients undergoing myocardial
revascularization.
Source
Giornale Italiano di Cardiologia. 17 (6) (pp 462-490), 2016. Date of
Publication: June 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l. (Via Giovanni Valdarno 8, Roma
00138, Italy)
Abstract
The wide availability of drugs effective in reducing cardiovascular events
and the use of myocardial revascularization have greatly improved the
prognosis of patients with coronary artery disease. However, the
combination of antithrombotic drugs to be administered before the exact
knowledge of the coronary anatomy and before the consequent therapeutic
strategy can, on one hand, allow to anticipate an optimal treatment but,
on the other hand, may expose the patient to a bleeding risk not always
necessary. In patients with ST-elevation acute coronary syndrome with an
indication to primary angioplasty, the administration of unfractionated
heparin and aspirin is considered the pre-procedural standard treatment.
The upstream administration of an oral P2Y12 inhibitor, even if not
supported by randomized controlled trials, appears reasonable in view of
the very high likelihood of treatment with angioplasty. In patients with
non-ST elevation acute coronary syndrome, in which it is not always chosen
an invasive strategy, the occurrence of bleeding can significantly weigh
on prognosis, even more than the theoretical benefit of pretreatment.
Fondaparinux is the anticoagulant with the most favorable efficacy/safety
profile. Antiplatelet pretreatment must be selective, guided by the
ischemic risk conditions, the risk of bleeding and the time schedule for
coronary angiography. In patients with stable coronary artery disease,
generally treated with aspirin, pretreatment with clopidogrel is advisable
in case of already scheduled angioplasty, and it appears reasonable in
case of high likelihood, at least in patients at low bleeding risk. In
patients candidate to surgical revascularization, aspirin is typically
maintained and the oral P2Y12-inhibitor discontinued, with i.v.
antiplatelet drug bridging in selected cases. Anti-ischemic drugs are
useful in controlling symptoms, but they have no specific indications with
regard to revascularization procedures. Statins showed protective effects
on periprocedural damage and late clinical events, when administered
early. Although randomized data are lacking, it seems reasonable their
pre-procedural administration, due to potential advantages without
significant adverse effects.

<3>
Accession Number
609370885
Author
Maron M.S.; Rowin E.J.; Olivotto I.; Casey S.A.; Arretini A.; Tomberli B.;
Garberich R.F.; Link M.S.; Chan R.H.M.; Lesser J.R.; Maron B.J.
Institution
(Maron, Rowin, Link) Hypertrophic Cardiomyopathy Center, Division of
Cardiology, Tufts Medical Center, Suite 70, 800 Washington Street, Boston,
MA 02111, United States
(Olivotto, Arretini, Tomberli) Regional Referral Center for Myocardial
Disease, Azienda Ospedaliera Careggi, Florence, Italy
(Casey, Garberich, Lesser, Maron) Hypertrophic Cardiomyopathy Center,
Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
(Chan) Department of Medicine and Radiology, Cardiovascular Division, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
Title
Contemporary Natural History and Management of Nonobstructive Hypertrophic
Cardiomyopathy.
Source
Journal of the American College of Cardiology. 67 (12) (pp 1399-1409),
2016. Date of Publication: 29 Mar 2016.
Publisher
Elsevier USA
Abstract
Background Left ventricular outflow tract gradients are absent in an
important proportion of patients with hypertrophic cardiomyopathy (HCM).
However, the natural course of this important patient subgroup remains
largely unresolved. Objectives The authors systematically employed
exercise (stress) echocardiography to define those patients without
obstruction to left ventricular outflow at rest and/or under physiological
exercise and to examine their natural history and clinical course to
create a more robust understanding of this complex disease. Methods We
prospectively studied 573 consecutive HCM patients in 3 centers (44 +/- 17
years; 66% male) with New York Heart Association functional class I/II
symptoms at study entry, including 249 in whom left ventricular outflow
tract obstruction was absent both at rest and following physiological
exercise (<30 mm Hg; nonobstructive HCM) and retrospectively assembled
clinical follow-up data. Results Over a median follow-up of 6.5 years, 225
of 249 nonobstructive patients (90%) remained in classes I/II, whereas 24
(10%) developed progressive heart failure to New York Heart Association
functional classes III/IV. Nonobstructive HCM patients were less likely to
experience advanced limiting class III/IV symptoms than the 324 patients
with outflow obstruction (1.6%/year vs. 7.4%/year rest obstruction vs.
3.2%/year provocable obstruction; p < 0.001). However, 7 nonobstructive
patients (2.8%) did require heart transplantation for progression to end
stage versus none of the obstructive patients. HCM-related mortality among
nonobstructive patients was low (n = 8; 0.5%/year), with 5- and 10-year
survival rates of 99% and 97%, respectively, which is not different from
expected all-cause mortality in an age- and sex-matched U.S. population (p
= 0.15). Conclusions HCM patients with nonobstructive disease appear to
experience a relatively benign clinical course, associated with a low risk
for advanced heart failure symptoms, other disease complications, and
HCM-related mortality, and largely without the requirement for major
treatment interventions. A small minority of nonobstructive HCM patients
progress to heart transplant. Copyright &#xa9; 2016 by the American
College of Cardiology Foundation.

<4>
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Accession Number
607298533
Author
Gidwani U.K.; Goel S.
Institution
(Gidwani) Department of Cardiology, Zena and Michael A. Wiener
Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place,
New York, NY 10029, United States
(Goel) Department of Medicine, Maimonides Medical Center, Brooklyn, NY,
United States
Title
The Pulmonary Artery Catheter in 2015: The Swan and the Phoenix.
Source
Cardiology in Review. 24 (1) (pp 1-13), 2016. Date of Publication: 01 Jan
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The pulmonary artery catheter (PAC) has revolutionized the care of
critically ill patients by allowing physicians to directly measure
important cardiovascular variables at the bedside. The relative ease of
placement and the important physiological data obtained by PAC led to its
incorporation as a central tool in the management of critically ill
patients in intensive care units. Given the lack of demonstrable benefit
in randomized clinical trials, persistent questions about safety, and
recent advancements in noninvasive imaging modalities that purport to more
accurately estimate cardiovascular hemodynamics, the use of the PAC has
declined rapidly over recent years. Devised by cardiologists to measure
hemodynamic parameters in patients with acute myocardial infarction, the
PAC was quickly and enthusiastically adopted by intensivists,
anesthesiologists, surgeons, and other specialists. This unbridled
proliferation may have resulted in negative publicity surrounding the PAC.
This article systematically reviews the evolution of PACs, the results of
nonrandomized and randomized studies in various clinical conditions, the
reasons for its decline, and current indications of PAC. Copyright &#xa9;
2015 Wolters Kluwer Health, Inc. All rights reserved.

<5>
Accession Number
607881222
Author
Power J.A.; Thompson D.V.; Rayarao G.; Doyle M.; Biederman R.W.W.
Institution
(Power, Thompson, Rayarao, Doyle, Biederman) Department of Medicine
Cardiovascular Magnetic Resonance Center, Allegheny General Hospital,
Pittsburgh, PA, United States
(Power) University of Connecticut School of Dental Medicine, Farmington,
CT, United States
Title
Cardiac magnetic resonance radiofrequency tissue tagging for diagnosis of
constrictive pericarditis: A proof of concept study.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (5) (pp 1348-1355),
2016. Date of Publication: 01 May 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Invasive cardiac catheterization is the venerable "gold
standard" for diagnosing constrictive pericarditis. However, its
sensitivity and specificity vary dramatically from center to center. Given
the ability to unequivocally define segments of the pericardium with the
heart via radiofrequency tissue tagging, we hypothesize that cardiac
magnetic resonance has the capability to be the new gold standard. Methods
All patients who were referred for cardiac magnetic resonance evaluation
of constrictive pericarditis underwent cardiac magnetic resonance
radiofrequency tissue tagging to define visceral-parietal pericardial
adherence to determine constriction. This was then compared with
intraoperative surgical findings. Likewise, all preoperative cardiac
catheterization testing was reviewed in a blinded manner. Results A total
of 120 patients were referred for clinical suspicion of constrictive
pericarditis. Thirty-nine patients were defined as constrictive
pericarditis positive solely via radiofrequency tissue-tagging cardiac
magnetic resonance, of whom 21 were positive, 4 were negative, and 1 was
equivocal for constrictive pericarditis, as defined by cardiac
catheterization. Of these patients, 16 underwent pericardiectomy and were
surgically confirmed. There was 100% agreement between cardiac magnetic
resonance-defined constrictive pericarditis positivity and postsurgical
findings. No patients were misclassified by cardiac magnetic resonance. In
regard to the remaining constrictive pericarditis-positive patients
defined by cardiac magnetic resonance, 10 were treated medically,
declined, were ineligible for surgery, or were lost to follow-up.
Long-term follow-up of those who were constrictive pericarditis negative
by cardiac magnetic resonance showed no early or late crossover to the
surgery arm. Conclusions Cardiac magnetic resonance via radiofrequency
tissue tagging offers a unique, efficient, and effective manner of
defining clinically and surgically relevant constrictive pericarditis.
Specifically, no patient who was identified with constriction via cardiac
magnetic resonance underwent inappropriate sternotomy. However,
catheterization had substantial and unacceptable false-positive and
false-negative rates with important clinical ramifications. Copyright
&#xa9; 2016 The American Association for Thoracic Surgery.

<6>
Accession Number
607412871
Author
Serpa Neto A.; Schultz M.J.; Gama De Abreu M.
Institution
(Serpa Neto) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Av. Albert Einstein, 627, Sao Paulo, Brazil
(Serpa Neto) Program of Post-Graduation, Research and Innovation,
Faculdade de Medicina Do ABC, Santo Andre, Brazil
(Serpa Neto, Schultz) Department of Intensive Care, Academic Medical
Center at the University of Amsterdam, Amsterdam, Netherlands
(Schultz) Laboratory of Experimental Intensive Care and Anesthesiology
(LEICA), Academic Medical Center at the University of Amsterdam,
Amsterdam, Netherlands
(Gama De Abreu) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Carl Gustav Carus, Technische Universitat Dresden,
Dresden, Germany
(Gama De Abreu) Pulmonary Engineering Group, University Hospital Carl
Gustav Carus, Technische Universitat Dresden, Dresden, Germany
Title
Intraoperative ventilation strategies to prevent postoperative pulmonary
complications: Systematic review, meta-analysis, and trial sequential
analysis.
Source
Best Practice and Research: Clinical Anaesthesiology. 29 (3) (pp 331-340),
2015. Date of Publication: 01 Sep 2015.
Publisher
Bailliere Tindall Ltd
Abstract
For many years, mechanical ventilation with high tidal volumes
(V<inf>T</inf>) was common practice in operating theaters because this
strategy recruits collapsed lung tissue, improves ventilation-perfusion
mismatch, and thus decreases the need for high oxygen fractions. Positive
end-expiratory pressure (PEEP) was seldom used because it could cause
cardiac compromise. Increasing advances in the understanding of the
mechanisms of ventilator-induced lung injury from animal studies and
randomized controlled trials in patients with uninjured lungs in intensive
care unit and operation room have pushed anesthesiologists to consider
lung-protective strategies during intraoperative ventilation. These
strategies at least include the use of low V<inf>T</inf>, and perhaps also
the use of PEEP, which when compared to high V<inf>T</inf> with low PEEP
may prevent the occurrence of postoperative pulmonary complications
(PPCs). Such protective effects, however, are likely ascribed to low
V<inf>T</inf> rather than to PEEP. In fact, at least in nonobese patients
undergoing open abdominal surgery, high PEEP does not protect against
PPCs, and it can impair the hemodynamics. Further studies shall determine
whether a strategy consisting of low V<inf>T</inf> combined with PEEP and
recruitment maneuvers reduces PPCs in obese patients and other types of
surgery (e.g., laparoscopic and thoracic), compared to low V<inf>T</inf>
with low PEEP. Furthermore, the role of driving pressure for titrating
ventilation settings in patients with uninjured lungs shall be
investigated. Copyright &#xa9; 2015 Elsevier Ltd. All rights reserved.

<7>
Accession Number
606053980
Author
Liu Y.; Petrini M.A.
Institution
(Liu, Petrini) HOPE School of Nursing, Wuhan University, Wuhan, China
Title
Effects of music therapy on pain, anxiety, and vital signs in patients
after thoracic surgery.
Source
Complementary Therapies in Medicine. 23 (5) (pp 714-718), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Churchill Livingstone
Abstract
Objective: To examine the effectiveness of music listening on pain,
anxiety, and vital signs among patients after thoracic surgery in China.
Design and setting: A randomized controlled clinical trial was conducted
in the thoracic surgery department of two tertiary hospitals in Wuhan,
China. 112 patients were recruited and randomly assigned to either
experimental (. n=. 56) or control (. n=. 56) group respectively.
Intervention: The experimental group received standard care and a 30-min
soft music intervention for 3 days, while the control group received only
standard care. Measures include pain, anxiety, vital signs (blood
pressure, heart rate and respiratory rate), patient controlled analgesia,
and diclofenac sodium suppository use. Results: The experimental group
showed statistically significant decrease in pain, anxiety, systolic blood
pressure and heart rate over time compared to the control group, but no
significant difference were identified in diastolic blood pressure,
respiratory rate, patient controlled analgesia and diclofenac sodium
suppository use. Conclusion: The findings provide further evidence to
support the practice of music therapy to reduce postoperative pain and
anxiety, and lower systolic blood pressure and heart rate in patients
after thoracic surgery in China. Copyright &#xa9; 2015 Elsevier Ltd.

<8>
Accession Number
601030268
Author
Rautiainen S.; Lee I.-M.; Rist P.M.; Gaziano J.M.; Manson J.E.; Buring
J.E.; Sesso H.D.
Institution
(Rautiainen) Department of Institute of Environmental Medicine, Karolinska
Institutet, Stockholm, Sweden
(Rautiainen, Lee, Rist, Gaziano, Manson, Buring, Sesso) Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Rist) Department of Social and Behavioral Science, Harvard School of
Public Health, Boston, MA, United States
(Lee, Rist, Manson, Buring, Sesso) Department of Epidemiology, Harvard
School of Public Health, Boston, MA, United States
(Gaziano) VA Boston Healthcare System, Boston, MA, United States
(Rautiainen) Division of Preventive Medicine, Brigham and Women's
Hospital, 900 Commonwealth Avenue, Boston, MA 02215, United States
Title
Multivitamin use and cardiovascular disease in a prospective study of
women.
Source
American Journal of Clinical Nutrition. 101 (1) (pp 144-152), 2015. Date
of Publication: 01 Jan 2015.
Publisher
American Society for Nutrition (E-mail: staff@dues.faseb.org)
Abstract
Background: Although multivitamins are widely used, there are limited
prospective studies investigating their association with both long- and
short-term risk of cardiovascular disease (CVD). Objective: The objective
was to investigate how multivitamin use is associated with the long- and
short-term risk of CVD. Design: A prospective cohort study was conducted
of 37,193 women from the Women's Health Study aged <45 y and free of CVD
and cancer at baseline who were followed for an average of 16.2 y. At
baseline, women self-reported a wide range of lifestyle, clinical, and
dietary factors. Women were categorized into 1) no current use and 2)
current use of multivitamins. Duration and updated measures over the
course of the follow-up to address short-term effects were also
considered. Women were followed for major CVD events, including myocardial
infarction (MI), stroke, and CVD death. Results: During the follow-up,
1493 incident cases of CVD [defined as myocardial infarction (MI), stroke,
and CVD death] occurred. In multivariable analyses, multivitamin use
compared with no use was not associated with major CVD events (HR: 1.01;
95% CI: 0.89, 1.15), MI (HR: 1.04; 95% CI: 0.84, 1.27), stroke (HR: 0.99;
95% CI: 0.83, 1.18), or CVD death (HR: 1.10; 95% CI: 0.84, 1.45). A
nonsignificant inverse association was observed between baseline
multivitamin use and major CVD events among women aged >70 y
(P-interaction = 0.04) and those consuming < 3 servings/ d of fruit and
vegetables (P-interaction = 0.01). When updating information on
multivitamin use during the course of follow-up, no associations were
observed for major CVD events (HR: 0.91; 95% CI: 0.82, 1.02), MI (HR:
0.89; 95% CI: 0.74, 1.06), stroke (HR: 0.91; 95% CI: 0.78, 1.06), and CVD
death (HR: 0.91; 95% CI: 0.71, 1.16). Conclusions: In this study of
middle-aged and elderly women, neither baseline nor time-varying
multivitamin use was associated with the long-term risk of major CVD
events, MI, stroke, cardiac revascularizations, or CVD death. Additional
studies are needed to clarify the role of multivitamins on CVD. Copyright
&#xa9; 2015 American Society for Nutrition

<9>
Accession Number
608262709
Author
Matchar D.B.; Love S.R.; Jacobson A.K.; Edson R.; Uyeda L.; Phibbs C.S.;
Dolor R.J.
Institution
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar, Dolor) Division of General Internal Medicine, Department of
Medicine and Center for Clinical Health Policy Research, Duke University
Medical Center, 2400 Pratt Street, Durham, NC 27705, United States
(Matchar, Love) Health Services and Systems Research Program,
Duke-National University of Singapore Graduate Medical School, 8 College
Road, Singapore 169857, Singapore
(Jacobson) Research and Development Service (151), Jerry L. Pettis VA
Medical Center, 11201 Benton Street, Loma Linda, CA 92357, United States
(Jacobson) Department of Internal Medicine, Loma Linda Healthcare System,
Loma Linda University, 24851 Circle Drive, Loma Linda, CA 92354, United
States
(Edson, Uyeda) Cooperative Studies Program Coordinating Center (151K), VA
Palo Alto Health Care System, 701-B N. Shoreline Blvd, Mountain View, CA
94043-3208, United States
(Phibbs) Health Economics Resource Center, VA Palo Alto Health Care
System, 701-B N. Shoreline Blvd, Mountain View, CA 94043, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, 921 Campus Drive,
Stanford, CA 94305, United States
(Love) Warren Alpert Medical School of Brown University, 222 Richmond
Street, Providence, RI 02903, United States
(Phibbs) Health Economic Resource Center (152), VA Palo Alto Health Care
System, 795 Willow Road, Menlo Park, CA 94025, United States
Title
The impact of frequency of patient self-testing of prothrombin time on
time in target range within VA Cooperative Study #481: The Home INR Study
(THINRS), a randomized, controlled trial.
Source
Journal of Thrombosis and Thrombolysis. 40 (1) (pp 17-25), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Anticoagulation (AC) is effective in reducing thromboembolic events for
individuals with atrial fibrillation (AF) or mechanical heart valve (MHV),
but maintaining patients in target range for international normalized
ratio (INR) can be difficult. Evidence suggests increasing INR testing
frequency can improve time in target range (TTR), but this can be
impractical with in-clinic testing. The objective of this study was to
test the hypothesis that more frequent patient-self testing (PST) via home
monitoring increases TTR. This planned substudy was conducted as part of
The Home INR Study, a randomized controlled trial of in-clinic INR testing
every 4 weeks versus PST at three different intervals. The setting for
this study was 6 VA centers across the United States. 1,029 candidates
with AF or MHV were trained and tested for competency using ProTime INR
meters; 787 patients were deemed competent and, after second consent,
randomized across four arms: high quality AC management (HQACM) in a
dedicated clinic, with venous INR testing once every 4 weeks; and
telephone monitored PST once every 4 weeks; weekly; and twice weekly. The
primary endpoint was TTR at 1-year follow-up. The secondary endpoints
were: major bleed, stroke and death, and quality of life. Results showed
that TTR increased as testing frequency increased (59.9 +/- 16.7 %, 63.3
+/- 14.3 %, and 66.8 +/- 13.2 % [mean +/- SD] for the groups that
underwent PST every 4 weeks, weekly and twice weekly, respectively). The
proportion of poorly managed patients (i.e., TTR <50 %) was significantly
lower for groups that underwent PST versus HQACM, and the proportion
decreased as testing frequency increased. Patients and their care
providers were unblinded given the nature of PST and HQACM. In conclusion,
more frequent PST improved TTR and reduced the proportion of poorly
managed patients. Copyright &#xa9; 2014, Springer Science+Business Media
New York.

<10>
Accession Number
605513374
Author
Etnel J.R.G.; Takkenberg J.J.M.; Spaans L.G.; Bogers A.J.J.C.; Helbing
W.A.
Institution
(Etnel, Takkenberg, Spaans, Bogers) Department of Cardio-Thoracic Surgery,
Erasmus MC, Rotterdam, Netherlands
(Etnel, Spaans, Helbing) Department of Pediatrics, Division of Cardiology,
Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
Title
Paediatric subvalvular aortic stenosis: A systematic review and
meta-analysis of natural history and surgical outcome.
Source
European Journal of Cardio-thoracic Surgery. 48 (2) (pp 212-220), 2015.
Article Number: ezu423. Date of Publication: 01 Aug 2015.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Sub-valvular aortic stenosis (SAS) is a common form of left ventricular
outflow tract (LVOT) obstruction, which can lead to aortic valve damage.
Although surgery for SAS is an accepted treatment, the timing of surgical
intervention of SAS remains controversial. This review aims to establish
an overview of the natural history and outcome after surgery and factors
associated with prognosis in paediatric SAS patients. We searched PubMed
and EMBASE for studies that reported factors that negatively affected the
prognosis of patients with SAS. Studies were included if they were written
in English, published between 1 January 1997 and 31 December 2012 and the
mean patient age was < 18 years at the time of study entry. Studies were
excluded if the study size was < 20 patients. A distinction was made
between natural history and surgical cohorts. Twenty-four studies were
included in this review, encompassing a total of 809 natural history and
1476 surgical patients. Fifty-one percent of natural history patients
required surgery. After surgery, there was a substantial reoperation rate.
Higher LVOT gradient and the presence of aortic regurgitation (AR) were
identified as the foremost independent predictors of a worse outcome.
Valve-to-membrane distance was also found to be associated with prognosis,
although the results were contradictory. This systematic review underlines
the importance of LVOT gradient, aortic valve-to-membrane distance and AR
in surgical decision-making in paediatric SAS patients. There is need for
collaborative effort to further study the optimal timing of surgery based
on LVOT gradient, valve-to-membrane distance and the presence of AR.
Copyright &#xa9; The Author 2014, 2015. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<11>
Accession Number
605513372
Author
Phan K.; Xie A.; Kumar N.; Wong S.; Medi C.; La Meir M.; Yan T.D.
Institution
(Phan, Xie, Yan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan) Westmead Hospital, Sydney Medical School, University of Sydney,
Sydney, Australia
(Kumar, La Meir) Department of Cardiothoracic Surgery and Cardiology,
Academic Hospital Maastricht, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(Wong) Gosford District Hospital, Gosford, Australia
(Medi, Yan) Department of Cardiology and Cardiothoracic Surgery, Royal
Prince Alfred Hospital, Sydney, Australia
(La Meir) University Hospital Brussels, Brussels, Belgium
Title
Comparing energy sources for surgical ablation of atrial fibrillation: A
Bayesian network meta-analysis of randomized, controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 48 (2) (pp 201-211), 2015.
Article Number: ezu408. Date of Publication: 01 Aug 2015.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Simplified maze procedures involving radiofrequency, cryoenergy and
microwave energy sources have been increasingly utilized for surgical
treatment of atrial fibrillation as an alternative to the traditional
cut-and-sew approach. In the absence of direct comparisons, a Bayesian
network meta-analysis is another alternative to assess the relative effect
of different treatments, using indirect evidence. A Bayesian meta-analysis
of indirect evidence was performed using 16 published randomized trials
identified from 6 databases. Rank probability analysis was used to rank
each intervention in terms of their probability of having the best
outcome. Sinus rhythm prevalence beyond the 12-month follow-up was similar
between the cut-and-sew, microwave and radiofrequency approaches, which
were all ranked better than cryoablation (respectively, 39, 36, and 25 vs
1%). The cut-and-sew maze was ranked worst in terms of mortality outcomes
compared with microwave, radiofrequency and cryoenergy (2 vs 19, 34, and
24%, respectively). The cut-and-sew maze procedure was associated with
significantly lower stroke rates compared with microwave ablation [odds
ratio < 0.01; 95% confidence interval 0.00, 0.82], and ranked the best in
terms of pacemaker requirements compared with microwave, radiofrequency
and cryoenergy (81 vs 14, and 1, < 0.01% respectively). Bayesian rank
probability analysis shows that the cut-and-sew approach is associated
with the best outcomes in terms of sinus rhythm prevalence and stroke
outcomes, and remains the gold standard approach for AF treatment. Given
the limitations of indirect comparison analysis, these results should be
viewed with caution and not over-interpreted. Copyright &#xa9; The Author
2014, 2015. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<12>
Accession Number
610882955
Author
Zughaft D.J.L.; Hyllen S.; Harnek J.; Nozohoor S.; Bjursten H.; Gotberg M.
Institution
(Zughaft, Harnek, Gotberg) Departments of Coronary Heart Disease,
Anesthesia and Intensive Care, Skane University Hospital, Lund University,
Lund, Sweden
(Zughaft, Harnek, Gotberg) Departments of Cardiology, Anesthesia and
Intensive Care, Skane University Hospital, Lund University, Getingev 1-5,
Lund SE-221 85, Sweden
(Hyllen, Nozohoor, Bjursten) Departments of Cardiothoracic Surgery,
Anesthesia and Intensive Care, Skane University Hospital, Lund University,
Lund, Sweden
Title
Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in
Transcatheter Aortic Valve Replacement: The TAVR-CHILL Trial.
Source
Therapeutic Hypothermia and Temperature Management. 5 (4) (pp 209-216),
2015. Date of Publication: 2015.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
The safety, feasibility, and hemodynamic effects of mild hypothermia (MH)
induced by transnasal cooling were studied in transcatheter aortic valve
replacement (TAVR). MH is a common therapy following cardiac arrest and
seems to have favorable effects in myocardial infarction and on
hemodynamic stability. In TAVR, hemodynamic instability is common during
rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to
hypothermia or normothermia. Hemodynamic endpoints were mean arterial
blood pressure and required dosage of vasoactive and inotropic drugs.
Patients were followed up at 6 months. All patients in the MH group (n=10)
reached the target temperature of 34degreeC before first rapid pacing.
Tympanic and urinary bladder temperature remained significantly lower in
the MH group during the procedure. No adverse effects of cooling were
observed. Mean arterial pressure was higher in the MH group (90+/-20 mm
Hg) than in the control group (71+/-13 mm Hg) at the start of the
procedure, at first rapid pacing (94+/-19 vs. 80+/-16 mm Hg), and at
balloon aortic valvuloplasty (90+/-17 vs. 73+/-14 mm Hg). Less
norepinephrine was administered to the hypothermia group. Transnasal
cooling during TAVR was safe and well tolerated. We observed a more stable
hemodynamic profile in the MH group, indicated by higher blood pressure
and lower levels of vasoactive drugs required. A larger study of patients
with severe ventricular dysfunction is required to more comprehensively
investigate the hemodynamic effects of transnasal cooling in TAVR. &#xa9;
Copyright 2015, Mary Ann Liebert, Inc. 2015.

<13>
Accession Number
603599007
Author
Kim J.B.; Yang D.H.; Kang J.-W.; Jung S.-H.; Choo S.J.; Chung C.H.; Song
J.-K.; Lee J.W.
Institution
(Kim, Jung, Choo, Chung, Lee) Department of Thoracic and Cardiovascular
Surgery, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
(Yang, Kang) Department of Radiology, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, South Korea
(Song) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Title
Left atrial function following surgical ablation of atrial fibrillation:
Prospective evaluation using dual-source cardiac computed tomography.
Source
Yonsei Medical Journal. 56 (3) (pp 608-616), 2015. Date of Publication:
2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: The Maze procedure has shown excellent efficacy in the
elimination of atrial fibrillation (AF); however, little is known about
the quality of functional recovery in the left atrium (LA) following
successful sinus rhythm conversion by the Maze procedure. Materials and
Methods: We prospectively enrolled 12 patients (aged 52.5+/-10.1 years, 1
female) with valvular AF undergoing mitral valve surgery combined with the
Maze procedure. Parameters of LA function in three anatomic compartments
[anterior, posterior, and LA appendage (LAA)] were evaluated using
electrocardiography-gated dual-source cardiac CT at one month and at six
months after surgery. Twelve subjects matched by age, gender, and body
surface area served as controls. Results: At one month after surgery,
ejection fraction (EF) and emptying volume (EV) of the LA were 14.9+/-7.4%
and 21.3+/-9.7 mL, respectively, and they were significantly lower than
those of the control group (EF, 47.9+/-11.2%; EV, 46.0+/-10.7%; p<0001).
These values did not significantly change throughout late periods (p=0.22
and 0.21, respectively). Functional contributions of the anterior,
posterior, and appendage compartments (EV of each compartment/overall EV)
were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA
preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection
(n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects
(p<0.001). Conclusion: Contractile functions of the LA significantly
decreased after the Maze procedure. Functional contributions of three
compartments of the LA were also altered. The influence of LAA
preservation on postoperative LA functions needs to be evaluated through
studies of larger populations. Copyright &#xa9; Yonsei University College
of Medicine 2015.

<14>
Accession Number
608588976
Author
Keh Y.S.; Yap J.; Yeo K.K.; Koh T.H.; Eeckhout E.
Institution
(Keh, Yap, Yeo, Koh) Department of Cardiology, National Heart Centre
Singapore, Singapore, Singapore
(Yeo) Duke-NUS Graduate Medical School, Singapore, Singapore
(Eeckhout) Division of Cardiology, Centre Hospitalier Universitaire
Vaudois, Lausanne, Switzerland
Title
Clinical Outcomes of Bioresorbable Scaffold in Coronary Artery Disease: A
Systematic Literature Review.
Source
Journal of Interventional Cardiology. 29 (1) (pp 57-69), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We aim to perform a systematic literature review on all
studies reporting the clinical outcomes of the use of bioresorbable
scaffolds (BRS) in different settings of coronary artery disease (CAD).
Background: BRS are designed to provide early support of the vessel wall
postangioplasty, deliver antiproliferative agents to prevent excessive
hyperplastic healing responses and finally "disappear" when no longer
required. Emerging data have provided evidence of their use in specific
clinical scenarios. Methods: A comprehensive literature search was
performed by 2 independent reviewers utilizing MEDLINE, EMBASE, and
Cochrane Library databases. The only 2 CE marked BRS: everolimus-eluting
Bioresorbable vascular scaffold ABSORB BVS and the myolimus-eluting
DESolve Bioresorbable Coronary Scaffold (BCS) System were included.
Results: The studies were categorized into: ST elevation myocardial
infarction (STEMI), stable CAD, and "all-comers" group. Thirty-one studies
were included; 8 in STEMI patients (all ABSORB), 15 in stable CAD
patients. In the STEMI group (n = 606), acute procedural success ranged
from 96% to 100%, cardiac mortality 0-9.1%, recurrent MI and stent
thrombosis rates were 0-4.3%. In the stable CAD group, the 13 ABSORB
studies (n = 3259) demonstrated cardiac mortality rate of 0-0.6%,
recurrent MI rate 0-4.5%, and stent thrombosis rate 0-4.3% Conclusions:
Current clinical data suggest the BRS, especially the ABSORB BVS, may
represent a reasonable alternative to DES in uncomplicated coronary
anatomy. Copyright &#xa9; 2015, Wiley Periodicals, Inc.

<15>
Accession Number
608588971
Author
Lesiak M.; Araszkiewicz A.; Grajek S.; Colombo A.; Lalmand J.; Carstensen
S.; Namiki A.; Tobaru T.; Merkely B.; Moreno R.; Barbato E.; Wijns W.;
Saito S.
Institution
(Lesiak, Araszkiewicz, Grajek) 1st Department of Cardiology, University of
Medical Sciences, Dluga 1/2, Poznan 61-848, Poland
(Colombo) Cardiac Cath Lab., Interventional Cardiology Unit, EMO GVM
Centro Cuore, Columbus, San Raffaele Hospital, Milan, Italy
(Lalmand) Department of Cardiology, CHU de Charleroi, Charleroi, Belgium
(Carstensen) Department of Cardiology, Roskilde University Hospital,
Roskilde, Denmark
(Namiki) Department of Cardiology, Kanto Rosai Hospital, Kawasaki, Japan
(Tobaru) Department of Cardiology, Sakakibara Heart Institute, Tokyo,
Japan
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Moreno) Department of Interventional Cardiology, University Hospital la
Paz, Madrid, Spain
(Barbato, Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Barbato) Departement of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Saito) Department of Cardiology, Catheterization Laboratory, Shonan
Kamakura General Hospital, Kamakura, Japan
Title
Long Coronary Lesions Treated with Thin Strut Bioresorbable Polymer Drug
Eluting Stent: Experience from Multicentre Randomized CENTURY II Study.
Source
Journal of Interventional Cardiology. 29 (1) (pp 47-56), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: to assess performance of new, bioresorbable polymer
sirolimus-eluting stent (BP-SES), in patients with long coronary lesions
(LL) and to compare it to permanent polymer everolimus-eluting stent
(PP-EES). Background: LL have been associated with worse clinical outcomes
in percutaneous coronary interventions (PCI). The impact of lesion length
on the outcomes of drug eluting stent (DES) implantations is not as clear.
Methods: In the frame of a randomized, multicentre CENTURY II study, out
of 1119 patients enrolled, 182 patients had LL (defined as >25 mm), and
were assigned randomly to treatment with BP-SES (101) or PP-EES (81).
Primary endpoint was target lesion failure (TLF, composite of cardiac
death, target vessel related myocardial infarction [MI], and target lesion
revascularization [TLR]) at 9 months. All data were 100% monitored and
adverse events were adjudicated by an independent clinical event
committee. Results: The baseline patient and lesion characteristics were
similar in the 2 study arms. At 9-months, the rates of cardiac death (2.0%
vs 1.2%; P = 0.70), MI (3.0% vs 4.9%; P = 0.49) and clinically driven TLR
(2.0% vs 3.7%; P = 0.48) and TLF (6.9% vs 8.6%; P = 0.67) were similar for
BP-SES and PP-EES, respectively. There was no stent thrombosis (ST) in
BP-SES group up to 9 months, while 1 case (1.2%) of ST was recorded in
PP-EES group (P = 0.44). Conclusions: Patients with LL showed similar
clinical outcomes when treated with Ultimaster BP-SES and Xience PP-EES.
Copyright &#xa9; 2015, Wiley Periodicals, Inc.

<16>
Accession Number
601498743
Author
Simonen P.; Lommi J.; Hallikainen M.; Helske-Suihko S.; Werkkala K.;
Kupari M.; Kovanen P.T.; Gylling H.
Institution
(Simonen, Werkkala, Kupari) Heart and Lung Center, Helsinki University
Central Hospital, Helsinki, Finland
(Lommi, Helske-Suihko, Kovanen) Wihuri Research Institute, Helsinki,
Finland
(Hallikainen, Gylling) Institute of Public Health and Clinical Nutrition,
University of Eastern Finland, Kuopio, Finland
(Gylling) Department of Medicine, Division of Internal Medicine,
University of Helsinki, Helsinki, Finland
Title
Dietary plant stanols or sterols neither accumulate in stenotic aortic
valves nor influence their structure or inflammatory status.
Source
Clinical Nutrition. 34 (6) (pp 1251-1257), 2015. Date of Publication: 01
Dec 2015.
Publisher
Churchill Livingstone
Abstract
Background & aims: Consumption of plant stanols and plant sterols
decreases LDL cholesterol level and increases serum concentrations of
plant stanols/sterols, but it is practically unexplored whether also their
tissue concentrations increase. Thus, the aim of this study was to assess
whether consuming plant stanols/sterols increases their concentrations in
stenotic aortic valves and affect the valvular structure (collagen and
elastin) or inflammation (macrophages and mast cells). Methods: In a
randomized, double-blind controlled intervention patients with severe
aortic stenosis consumed margarine without (n = 11) or with 2 g of plant
stanols (n = 12) or sterols (n = 13) until valve replacement surgery (2.6
months, on average). The effects of sitostanol and sitosterol on the
expression and secretion of proinflammatory cytokines by cultured aortic
valve myofibroblasts were also assessed. Results: Control-related
LDL-cholesterol was diminished by 16% (p < 0.05) by plant stanol and by
11% (NS) by plant sterol consumption, respectively. In the resected
valves, cholesterol, plant stanol and sterol levels were similar in all
groups. Consumed plant stanols or sterols had no effect on valvular
structure or mast cell or macrophage numbers in valves. Incubation of
cultured myofibroblasts derived from stenotic valves with sitostanol or
sitosterol decreased mRNA expression of the monocyte chemotactic protein-1
(p < 0.05) and interleukin-1 beta (p < 0.05). Conclusions: In this study,
plant stanol/sterol consumption did not affect cholesterol, plant stanol
or sterol levels in stenotic aortic valves; neither did they influence the
structure or the inflammatory status of the valves. However, these
findings need to be confirmed in a larger-scale intervention.
ClinicalTrials.govRegister. NCT00738933. Copyright &#xa9; 2015 Elsevier
Ltd and European Society for Clinical Nutrition and Metabolism.

<17>
Accession Number
607379005
Author
Oh J.K.; Little S.H.; Abdelmoneim S.S.; Reardon M.J.; Kleiman N.S.; Lin
G.; Bach D.; Gillam L.; Kar B.; Coselli J.; Sengupta P.P.; Grewal K.;
Chang J.; Chang Y.; Boulware M.; Adams D.H.; Popma J.J.
Institution
(Oh, Abdelmoneim, Lin) Mayo Clinic, Gonda 6210, 200 1st Street, SW,
Rochester, MN 55905, United States
(Little, Reardon, Kleiman) Houston-Methodist-Debakey Heart and Vascular
Center, Houston, TX, United States
(Bach) University of Michigan Medical Center, Ann Arbor, MI, United States
(Gillam) Morristown Memorial Hospital, Morristown, NJ, United States
(Kar, Coselli) Saint Luke's Episcopal Hospital, Texas Medical Center,
Houston, TX, United States
(Sengupta, Adams) Mount Sinai Health System, New York, NY, United States
(Grewal) Riverside Methodist Hospital, Columbus, OH, United States
(Chang) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Chang, Boulware, Popma) Medtronic, Minneapolis, MN, United States
Title
Regression of Paravalvular Aortic Regurgitation and Remodeling of
Self-Expanding Transcatheter Aortic Valve: An Observation from the
CoreValve U.S. Pivotal Trial.
Source
JACC: Cardiovascular Imaging. 8 (12) (pp 1364-1375), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to describe the natural history and
clinical importance of paravalvular aortic regurgitation (PVAR) after
CoreValve transcatheter aortic valve replacement (TAVR) and to relate
these findings to the structural and hemodynamic changes documented by
serial echocardiographic analysis. Background PVAR after TAVR with the
self-expanding CoreValve bioprosthesis has been shown to regress over
time, but the time course and the mechanism of PVAR regression has not
been completely characterized. Methods Patients with severe aortic
stenosis who underwent CoreValve TAVR and followed up to 1 year in the
multicenter CoreValve U.S. Pivotal Trial (Safety and Efficacy Study of the
Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic
Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve
Replacement) were studied. Serial echocardiography studies were analyzed
by an echocardiographic core laboratory. Annular sizing ratio was
calculated from computed tomography measurements. Paired, as well as
total, data were compared. Results The CoreValve was implanted in 634
patients with a mean age of 82.7 +/- 8.4 years. After a marked improvement
noted at discharge, aortic valve velocity, mean gradient, and effective
orifice area further improved significantly at 1 month (2.08 +/- 0.45 m/s
vs. 1.99 +/- 0.46 m/s, p < 0.0001, 9.7 +/- 4.4 mm Hg vs. 8.9 +/- 4.6 mm
Hg, p < 0.0001, and 1.78 +/- 0.51 cm² vs. 1.85 +/- 0.58
cm², p = 0.03, respectively). The improvement was sustained
through 1 year. PVAR was moderate or severe in 9.9%, and of 36 patients
with moderate PVAR at discharge and paired data, 30 (83%) improved at
least 1 grade of regurgitation at 1 year. Annular sizing ratio was
significantly associated with the degree of PVAR. Conclusions There was
further improvement in aortic prosthetic valve hemodynamics and regression
of PVAR up to 1 year compared with discharge after TAVR with CoreValve.
These changes are possibly due to remodeling and outward expansion of the
self-expandable CoreValve with nitinol frame. (Safety and Efficacy Study
of the Medtronic CoreValve System in the Treatment of Symptomatic Severe
Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic
Valve Replacement [Medtronic CoreValve U.S. Pivotal Trial]; NCT01240902)
Copyright &#xa9; 2015 American College of Cardiology Foundation.

<18>
Accession Number
607160641
Author
Linde J.J.; Hove J.D.; Sorgaard M.; Kelbaek H.; Jensen G.B.; Kuhl Jo.T.;
Hindso L.; Kober L.; Nielsen W.B.; Kofoed K.F.
Institution
(Linde, Hove, Jensen, Nielsen) Department of Cardiology, Hvidovre
Hospital, University of Copenhagen, Hvidovre, Denmark
(Linde, Sorgaard, Kuhl, Hindso, Kober, Kofoed) Department of Cardiology,
Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
(Hove) Center for Functional and Diagnostic Imaging and Research, Hvidovre
Hospital, University of Copenhagen, Hvidovre, Denmark
(Kelbaek) Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
(Kofoed) Department of Radiology, Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Linde) Department of Cardiology, Hvidovre University Hospital, Kettegard
Alle 30, Hvidovre 2650, Denmark
Title
Long-Term Clinical Impact of Coronary CT Angiography in Patients with
Recent Acute-Onset Chest Pain: The Randomized Controlled CATCH Trial.
Source
JACC: Cardiovascular Imaging. 8 (12) (pp 1404-1413), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of the CATCH (CArdiac cT in the treatment of acute
CHest pain) trial was to investigate the long-term clinical impact of a
coronary computed tomographic angiography (CTA)-guided treatment strategy
in patients with recent acute-onset chest pain compared to standard care.
Background The prognostic implications of a coronary CTA-guided treatment
strategy have not been compared in a randomized fashion to standard care
in patients referred for acute-onset chest pain. Methods Patients with
acute chest pain but normal electrocardiograms and troponin values were
randomized to treatment guided by either coronary CTA or standard care
(bicycle exercise electrocardiogram or myocardial perfusion imaging). In
the coronary CTA-guided group, a functional test was included in cases of
nondiagnostic coronary CTA images or coronary stenoses of borderline
severity. The primary endpoint was a composite of cardiac death,
myocardial infarction (MI), hospitalization for unstable angina pectoris
(UAP), late symptom-driven revascularizations, and readmission for chest
pain. Results We randomized 299 patients to coronary CTA-guided strategy
and 301 to standard care. After inclusion, 24 patients withdrew their
consent. The median (interquartile range) follow-up duration was 18.7
(range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients
(11%) had a primary endpoint versus 47 patients (16%) in the standard care
group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to
0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization
for UAP, and late symptom-driven revascularization) was observed in 5
patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14
patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven
revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI:
0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were
insignificant (p = 0.06). Conclusions A coronary CTA-guided treatment
strategy appears to improve clinical outcome in patients with recent
acute-onset chest pain and normal electrocardiograms and troponin values
compared to standard care with a functional test. (Cardiac-CT in the
Treatment of Acute Chest Pain [CATCH]; NCT01534000) Copyright &#xa9; 2015
American College of Cardiology Foundation.

<19>
Accession Number
607207809
Author
Ruderman I.; Sevastos J.; Anthony C.; Ruygrok P.; Chan W.; Javorsky G.;
Bergin P.; Snell G.; Menahem S.
Institution
(Ruderman, Menahem) Department of Renal Medicine, Alfred Hospital,
Melbourne, VIC, Australia
(Sevastos, Anthony) Department of Cardiology, Alfred Hospital, Melbourne,
VIC, Australia
(Ruygrok) Department of Respiratory Medicine, St Vincent's Hospital,
Melbourne, VIC, Australia
(Chan, Javorsky) Department of Renal Medicine, St Vincent's Hospital,
Sydney, NSW, Australia
(Bergin) Department of Cardiology, The Prince Charles Hospital, Brisbane,
QLD, Australia
(Snell) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
Title
Outcomes of simultaneous heart-kidney and lung-kidney transplantations:
The Australian and New Zealand experience.
Source
Internal Medicine Journal. 45 (12) (pp 1236-1241), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Background: Heart or lung transplantation alone in individuals with
significant pre-existing renal impairment results in high mortality and
morbidity. Simultaneous heart-kidney (SHK) or simultaneous lung-kidney
(SLK) transplantation may be considered in patients with dual organ
failure not suitable for single organ transplantation. Aim: We aimed to
outline the Australian and New Zealand experience of SHK and SLK
transplantations, focussing on patient characteristics and survival.
Methods: We analysed all SHK and SLK transplants performed in four centres
across Australia and New Zealand between 1990 and 2014. Results: Over the
study period, 35 SHK and 3 SLK transplants were performed across 4
transplant centres. Mean age at transplantation for SHK transplants was 45
years, and for SLK transplant was 27 years. The most common aetiology of
renal failure was glomerulonephritis. Most SHK transplant patients (77%)
required renal replacement therapy prior to transplantation, with only one
of the three patients undergoing SLK transplant, dialysis dependent.
One-year survival for the cohort was 79%, which is lower than reported for
single organ transplantation. However, 5- and 10-year survivals of 76% and
68%, respectively, were comparable. Isolated renal graft loss was seen in
five patients, with only one patient successfully re-transplanted and the
rest commencing dialysis. Conclusion: The Australian and New Zealand
experience of SHK and SLK includes 38 patients with a high 1-year
mortality, but excellent 5- and 10-year survivals. Based on this, it seems
reasonable to continue to offer combined organ transplantation to select
patients with dual organ failure. Copyright &#xa9; 2015 Royal Australasian
College of Physicians.

<20>
Accession Number
607381280
Author
Ghodraty M.R.; Hasani V.; Bagheri-Aghdam A.; Zamani M.M.; Pournajafian A.;
Rokhtabnak F.; Kholdebarin A.; Nader N.D.
Institution
(Ghodraty, Bagheri-Aghdam, Zamani, Pournajafian, Rokhtabnak, Kholdebarin)
Department of Anesthesiology, Firoozghar Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Hasani) Department of Anesthesiology, Rasoul Akram Medical Complex, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Nader) Department of Anesthesiology & Perioperative Care, VA Western NY
Healthcare System, SUNY-Buffalo, Buffalo, NY, United States
Title
Remifentanil infusion during emergence moderates hemodynamic and cough
responses to the tracheal tube: A randomized controlled trial.
Source
Journal of Clinical Anesthesia. 33 (pp 514-520), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To examine the severity of cough and straining at the time of
emergence from anesthesia. Design Double-blind randomized,
placebo-controlled study. Setting University-affiliated hospital. Patients
Sixty-two American Society of Anesthesiologists 2 patients undergoing
craniotomy and excision of supratentorial cerebral tumors. Intervention
Intravenous infusion of remifentanil (REM) at 0.05 mug/kg/min or normal
saline (NS) upon termination of the surgical procedure. Measurements Heart
rate (HR) and mean arterial pressure (MAP) along with the frequency and
severity of cough response (Modified Minogue Scale) to the endotracheal
tube were recorded at different time points. The frequency of cough and
straining was analyzed with chi² tests. HRs and MAP were
analyzed by repeated-measures analysis of variance between REM and NS
groups. Main Results There was no case of significant cough in the REM
group, and all of the patients in the NS group developed some extent of
cough varying from mild retching to severe coughing episodes (P <.001).
Both the HR and MAPs were consistently lower in the REM group compared to
the NS group. Conclusion Infusion of REM at the end of craniotomy
procedures results in significant reduction of the frequency and severity
of coughing and straining. Compared to placebo, REM moderates increases in
MAP upon emergence from general anesthesia until the time of extubation.
Copyright &#xa9; 2015

<21>
Accession Number
611532893
Author
Klinger R.Y.; Cooter M.; Berger M.; Podgoreanu M.V.; Stafford-Smith M.;
Ortel T.L.; Welsby I.J.; Levy J.H.; Rinder H.M.; Newman M.F.; Mathew J.P.;
For the Neurologic Outcomes Research Group (NORG) of The Duke Heart Center
Institution
(Klinger, Cooter, Berger, Podgoreanu, Stafford-Smith, Welsby, Levy,
Newman, Mathew) Department of Anesthesiology, Duke University Medical
Center, Box 3094, Durham, NC 27710, United States
(Ortel) Departments of Pathology, Hematology, and Medicine, Duke
University Medical Center, Durham, NC, United States
(Rinder) Departments of Medicine and Laboratory Medicine, Yale University,
New Haven, CT, United States
Title
Effect of intravenous lidocaine on the transcerebral inflammatory response
during cardiac surgery: a randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 63 (11) (pp 1223-1232), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Postoperative cognitive dysfunction (POCD) occurs frequently
after cardiac surgery. The pathophysiology of POCD remains elusive, but
previous work showed that intravenous lidocaine may be protective against
POCD, possibly by modulating cerebral inflammation. We hypothesized that
intravenous lidocaine would attenuate the cerebral inflammatory response
to cardiopulmonary bypass (CPB) by reducing the transcerebral activation
gradients of platelets, leukocytes, and/or platelet-leukocyte conjugates.
Methods: We studied 202 patients undergoing cardiac surgery with CPB in
this prospective randomized double-blinded placebo-controlled trial.
Subjects were randomized to receive either intravenous lidocaine (bolus +
48-hr infusion) or placebo (identical infusion volume and duration).
Paired jugular venous and radial arterial blood samples were drawn at
several time points and analyzed by fluorescence-activated cell sorting to
identify activated platelets and platelet-leukocyte conjugates.
Transcerebral activation gradients were calculated by subtracting arterial
values from venous values and were compared between groups using repeated
measures regression models with covariate adjustment for age, sex, surgery
type, and CPB duration. Results: Beginning after aortic cross-clamp
release and peaking ten minutes after the termination of CPB, the mean
(SD) transcerebral activation gradient of platelet-monocyte conjugates
decreased in lidocaine-treated vs placebo-treated patients [-1.84 (11.47)
mean linear fluorescence intensity (MLFI) vs 1.46 (13.88) MLFI,
respectively; mean difference, -4.08 MLFI; 95% confidence interval, -7.86
to -0.29; P = 0.03). No difference was seen at any time point for
activated platelets or for platelet-neutrophil conjugates. Conclusion:
While lidocaine did not affect the systemic or transcerebral activation of
platelets or leukocytes, we did observe a reduction in the transcerebral
activation of platelet-monocyte conjugates after aortic cross-clamp
release. This may be a manifestation of reduced cerebral inflammation
during cardiopulmonary bypass in response to treatment with lidocaine.
This trial was registered at ClinicalTrials.gov (NCT00938964). Copyright
&#xa9; 2016, Canadian Anesthesiologists' Society.

<22>
[Use Link to view the full text]
Accession Number
52988460
Author
Yagi M.; Hosogane N.; Okada E.; Watanabe K.; Machida M.; Tezuka M.;
Matsumoto M.; Asazuma T.
Institution
(Yagi, Machida, Asazuma) Department of Orthopedic Surgery, National Center
for Musculoskeletal Disorders, Murayama Medical Center, 2-37-1 Gakuen,
Musashi-Murayama City Tokyo, Japan
(Hosogane, Matsumoto) Department of Orthopedics, Keio University School of
Medicine, Tokyo, Japan
(Okada, Tezuka) Department of Orthopedics, Saiseikai Central Hospital,
Tokyo, Japan
(Watanabe) Department of Advanced Therapy for Spine and Spinal Cord
Disorders, Keio University School of Medicine, Tokyo, Japan
Title
Factors affecting the postoperative progression of thoracic kyphosis in
surgically treated adult patients with lumbar degenerative scoliosis.
Source
Spine. 39 (8) (pp E521-E528), 2014. Date of Publication: 15 Apr 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design. A retrospective case series of patients treated surgically
for degenerative lumbar scoliosis (DLS). Objective. To determine incidence
and risk factors of progressive global thoracic kyphosis (pGTK) after
surgery for DLS. Summary of Background Data. Sagittal balance affects the
surgical treatment of spinal deformity in adults. Little is known about
the loss of sagittal balance due to pGTK, or about the risk factors for
pGTK, after surgery for DLS. Methods. We reviewed records from a
multicenter database of adults with DLS, treated with posterior spinal
fusion. Inclusion required an age of 50 years or more at the time of
surgery, an upper instrumented vertebra at T9 and below, more than 5 fused
segments, and at least 2 years of follow-up. We included 73 patients with
a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of
3.6 years (range, 2-11 yr). Independent risk factors for pGTK were
identified by logistic regression analysis. Results. Significant pGTK,
defined as an increase in thoracic kyphosis of more than 10 degree from
before surgery to the time of final follow-up, was observed in 41% of the
patients. Loss of the sagittal vertical axis was larger in patients with
pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger
lumbar lordosis correction in patients with pGTK. Multivariate logistic
regression analysis identified an age greater than 75 (odds ratio, 5.53; P
= 0.02, 95% confidence interval [1.4-22.4]) and sacropelvic fusion (odds
ratio = 2.66, P = 0.02, 95% confidence interval [1.5-11.1]) as independent
risk factors for pGTK. Conclusion. The pGTK incidence after surgery for
DLS was 41%. Age, sacropelvic fusion, and a larger sagittal correction
were identified as pGTK risk factors. Long-term follow-up will provide
more data on the clinical impact of pGTK in elderly patients. Copyright
&#xa9; 2014 Lippincott Williams &Wilkins.

<23>
Accession Number
612479852
Author
Mammen C.; Jetton J.; Boohaker L.; Griffin R.; Askenazi D.
Institution
(Mammen) University of BC, Children's and Women's Health Center,
Vancouver, Canada
(Jetton) University of Iowa, Iowa City, IA, United States
(Boohaker, Griffin, Askenazi) University of Alabama at Birmingham,
Birmingham, United States
Title
Assessment of worldwide acute kidney injury epidemiology in neonates
(AWAKEN): Incidence and outcomes from an international multi-center cohort
study.
Source
Pediatric Nephrology. Conference: 17th Congress of the International
Pediatric Nephrology Association. Brazil. Conference Start: 20160920.
Conference End: 20160924. 31 (10) (pp 1735), 2016. Date of Publication:
October 2016.
Publisher
Springer Verlag
Abstract
Objectives: Single center studies report neonatal acute kidney injury
(AKI) incidence of 12-70%; neonates with AKI appear to have worse
outcomes. These findings prompted the formation of the Neonatal Kidney
Collaborative (NKC) and the development and implementation of the AWAKEN
study. The objective of this study is to assess the incidence of neonatal
AKI and its association with outcomes in a large, multi-national cohort
Methods: NKC includes 24 institutions from 4 countries (USA, Canada,
Australia and India). Neonatal intensive care unit (NICU) admissions from
Jan 1 to Mar 31, 2014 were screened. Inclusion criteria need for
intravenous (IV) fluids >48 hrs. Exclusion criteria: 1) admission at > 2
weeks of age, 2) congenital heart disease requiring surgical repair at < 7
days of age, 3) lethal chromosomal anomaly, 4) death within 48 hours of
admission, 5) severe congenital kidney disease. AKI was defined as either
urine output (UOP) < 1 mL/ kg/hr during any 24 hour period from days 2-7
of life, a rise in serumcreatinine (SCr) of 0.3 mg/dL from previous lowest
value and/or receipt of renal replacement therapy. Results: Of 4,274
screened neonates, 2163 met study criteria in whom 143 (6.5%) had
insufficient SCr and UOP data, 765 (35.4%) had AKI, and 1257 (58.1%) did
not have AKI. Subjects diagnosed with AKI had higher mortality than those
without AKI (58/765 (8.4%) vs. 21/1257 (1.7%) (OR = 4.8; 95% CI = 2.9
-8.0); P< 0.001) and prolonged length of stay (LOS) (45.8 +/- 45.1 vs.
23.2 +/- 22.1 days, P < 0.0001). (Table) Conclusions: Our study
demonstrated that at least 35.4% of infants admitted to NICU who required
IV fluids develop AKI. Subjects with AKI have worse increased risk of
death and longer LOS. Our data contribute to the growing evidence that
neonatal AKI is common, with significant impact on clinical outcomes.
Further analysis of this robust database is underway. (Table Presented).

<24>
Accession Number
612454373
Author
Van Schil P.
Institution
(Van Schil) University Hospital Antwerp, Department of Thoracic and
Vascular Surgery, Edegem, Belgium
Title
Against the motion.
Source
Radiotherapy and Oncology. Conference: 2016 Annual Conference of the
European Society for Radiotherapy and Oncology, ESTRO 35. Italy.
Conference Start: 20160429. Conference End: 20160503. 119 (pp S140-S141),
2016. Date of Publication: April 2016.
Publisher
Elsevier Ireland Ltd
Abstract
For early-stage non-small cell lung cancer (NSCLC) surgical resection
remains the treatment of choice providing excellent long-term results (1).
Recently, stereotactic body radiotherapy (SBRT) has become an alternative
treatment for localized NSCLC (2). SBRT has mainly been applied for
functionally in operable patients with severe cardiopulmonary morbidity.
Currently, there is an ongoing debate whether SBRT is also a valid
oncological treatment for low-risk patients who are operable from a
technical and functional perspective. No large randomized studies are
available directly comparing SBRT and surgical resection with systematic
lymph node dissection. Several trials closed prematurely due to poor
accrual. From a thoracic surgical point of view several concerns emerge
when applying SBRT to operable early-stage NSCLC: precise pathology is not
obtained in all cases, information on locoregional lymph node involvement
is not always available making it difficult to recommend adjuvant
chemotherapy in specific cases, and rather troublesome, different criteria
are used when comparing results of surgery and SBRT, mainly in relation to
local recurrence (3,4). Moreover, thoracic surgeons are more and more
dealing with "salvage surgery" after previous radiotherapy when no other
therapeutic options are available (5). Technically, these resections may
be very challenging due to technical difficulties during dissection of the
hilar region not encountered during primary intervention. These procedures
should be performed in dedicated thoracic centres with a large experience.
Due to the lack of clear evidence, different opinions are expressed in
present-day literature. In a pooled analysis of two randomised trials
comparing SBRT with lobectomy for stage I NSCLC that closed prematurely
due to poor accrual, the authors concluded that SBRT can be considered a
valid treatment option for operable stage I NSCLC (6). However, because of
small patient sample size and short follow-up time, they indicate that
further randomized studies should be performed before more definite
recommendations can be made (6). A different conclusion was reached in a
recent propensity score analysis matching 41 patients who underwent
videoassisted (VATS) lobectomy with 41 patients treated with SBRT for
stage I NSCLC (7). Significant differences were found in overall survival,
cause-specific survival, recurrence-free survival, local and distant
control favouring VATS lobectomy. Conclusion of this study was that VATS
lobectomy may offer a significantly better long-term outcome than SBRT in
potentially operable patients with biopsy-proven clinical stage I NSCLC.
Another propensity score analysis compared SBRT with sublobar resection
for stage I NSCLC in patients at high risk for lobectomy (8). In 53
matched pairs the difference in overall survival was not significant and
the cumulative incidence of cause-specific death was comparable between
both groups. Conclusion of this study was that SBRT can be an alternative
treatment option to sublobar resection for patients with severe
comorbidity who cannot tolerate alobectomy due to functional impairment
(8). In June 2015 the "Comite del'Evolution des Pratiques en Oncologie
(CEPO) from Quebec, Canada published recommendations regarding the use of
SBRT (9). For medically operable patients with T1-2N0M0 NSCLC surgery
remains the standard treatment due to the lack of high-level evidence and
valid comparative data. For medically inoperable patients withT1-2N0M0
NSCLC or medically operable patients who refuse surgery, SBRT should be
preferred to external beam radiotherapy. In the latter cases a biological
equivalent dose (BED) of at least 100 Gy should be administered. The
choice ofusing SBRT should be discussed within a multidisciplinary tumor
board. Radiotherapy should not be considered for patients whose life
expectancy is very limited because of comorbidities. In summary, main
points are: surgical resection remains the treatment of choice for
operable early-stage NSCLC SBRT may be considered for functionally
compromised patients who cannot tolerate lobectomy. further high-level
evidence is needed which requires close cooperation between radiation
oncologists and thoracic surgeons to design comparative trials with clear
inclusion criteria and unequivocal definitions of endpoints.

<25>
[Use Link to view the full text]
Accession Number
612424322
Author
Mc Ardle B.; Shukla T.; Nichol G.; Dekemp R.A.; Bernick J.; Guo A.; Lim
S.P.; Davies R.A.; Haddad H.; Duchesne L.; Hendry P.; Masters R.; Ross H.;
Freeman M.; Gulenchyn K.; Racine N.; Humen D.; Benard F.; Ruddy T.D.; Chow
B.J.; Mielniczuk L.; Dasilva J.N.; Garrard L.; Wells G.A.; Beanlands
R.S.B.
Institution
(Mc Ardle, Shukla, Dekemp, Bernick, Guo, Lim, Davies, Haddad, Duchesne,
Hendry, Masters, Ruddy, Chow, Mielniczuk, Dasilva, Garrard, Wells,
Beanlands) Molecular Function and Imaging Program, National Cardiac PET
Centre, Division of Cardiology, Department of Medicine, Canada
(Mc Ardle, Shukla, Dekemp, Bernick, Guo, Lim, Davies, Haddad, Duchesne,
Hendry, Masters, Ruddy, Chow, Mielniczuk, Dasilva, Garrard, Wells,
Beanlands) Division of Cardiac Surgery, Department of Surgery, Cardiac
Research Methods Centre, University of Ottawa, Heart Institute, University
of Ottawa, Canada
(Nichol) Department of Medicine, Division of General Internal Medicine,
University of Washington, Harborview Center for Prehospital Emergency
Care, Seattle, United States
(Ross, Freeman) Department of Medicine, Divisions of Cardiology,
University Health Network, St Michael's Hospital, University of Toronto,
Canada
(Gulenchyn) ES Garnett Memorial PET Center, Department of Nuclear
Medicine, Hamilton Health Sciences, Canada
(Racine) Department of Medicine, Division of Cardiology, Montreal Heart
Institute, Canada
(Humen) Department of Medicine, Division of Cardiology, London Health
Sciences Centre, Canada
(Benard) Department of Molecular Oncology, University of British Columbia,
Vancouver, Canada
(Benard) Department of Nuclear Medicine and Radiobiology, Division of
Nuclear Medicine, Centre Hospitalier Universitaire de Sherbrooke, Canada
Title
Long-Term Follow-Up of Outcomes with F-18-Fluorodeoxyglucose Positron
Emission Tomography Imaging-Assisted Management of Patients with Severe
Left Ventricular Dysfunction Secondary to Coronary Disease.
Source
Circulation: Cardiovascular Imaging. 9 (9) (no pagination), 2016. Article
Number: e004331. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Whether viability imaging can impact long-term patient
outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and
Recovery Following Revascularization) showed a nonsignificant trend toward
improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron
emission tomography (PET)-assisted strategy in patients with suspected
ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose
PET recommendations, outcome benefit was observed. Long-term outcomes of
viability imaging-assisted management have not previously been evaluated
in a randomized controlled trial. Methods and Results - PARR-2 randomized
patients with severe left ventricular dysfunction and suspected CAD being
considered for revascularization or transplantation to standard care (n=
195) versus PET-assisted management (n=197) at sites participating in
long-term follow-up. The predefined primary outcome was time to composite
event (cardiac death, myocardial infarction, or cardiac hospitalization).
After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the
standard care arm experienced the composite event (hazard ratio for time
to composite event =0.82 [95% confidence interval 0.62-1.07]; P=0.15).
When only patients who adhered to PET recommendations were included, the
hazard ratio for the time to primary outcome was 0.73 (95% confidence
interval 0.54-0.99; P=0.042). Conclusions - After a 5-year follow-up in
patients with left ventricular dysfunction and suspected CAD, overall,
PET-assisted management did not significantly reduce cardiac events
compared with standard care. However, significant benefits were observed
when there was adherence to PET recommendations. PET viability imaging may
be best applied when there is likely to be adherence to imaging-based
recommendations. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier: NCT00385242. Copyright
&#xa9; 2016 American Heart Association, Inc.

<26>
Accession Number
612347697
Author
Magri D.; Re F.; Limongelli G.; Agostoni P.; Zachara E.; Correale M.;
Mastromarino V.; Santolamazza C.; Casenghi M.; Pacileo G.; Valente F.;
Morosin M.; Musumeci B.; Pagannone E.; Maruotti A.; Uguccioni M.; Volpe
M.; Autore C.
Institution
(Magri, Mastromarino, Santolamazza, Casenghi, Musumeci, Pagannone, Volpe,
Autore) Department of Clinical and Molecular Medicine, University of Rome
"La Sapienza", Rome, Italy
(Re, Zachara, Uguccioni) Cardiology Division, Cardiac Arrhythmia Center
and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
(Limongelli, Pacileo, Valente) Cardiology SUN, Monaldi Hospital, II
University of Naples, Naples, Italy
(Agostoni, Morosin) "Monzino" Cardiologic Center, IRCCS, Milan, Italy
(Agostoni) Department of Clinical Sciences and Community Health,
University of Milan, Milan, Italy
(Correale) Department of Cardiology, University of Foggia, Foggia, Italy
(Morosin) Cardiovascular Department, "Ospedali Riuniti" Trieste and
Postgraduate School Cardiovascular Sciences, University of Trieste,
Tieste, Italy
(Maruotti) Department of Economic, Political Sciences and Modern Languages
"Libera Universita-SS Maria Assunta", Rome, Italy
(Maruotti) Centre for Innovation and Leadership in Health Sciences,
University of Southampton, Southampton, United Kingdom
(Volpe) IRCCS-Neuromed, Pozzilli, IS, Italy
Title
Heart failure progression in hypertrophic cardiomyopathy - Possible
insights from cardiopulmonary exercise testing.
Source
Circulation Journal. 80 (10) (pp 2204-2211), 2016. Date of Publication:
2016.
Publisher
Japanese Circulation Society
Abstract
Background: Heart failure (HF) progression and its complications represent
major emergent concerns in hypertrophic cardiomyopathy (HCM). We
investigated the possible adjunctive role of cardiopulmonary exercise
testing (CPET) in predicting HF-related events. An exercise-derived risk
model, the HYPertrophic Exercise-derived Risk HF (HYPER<inf>HF</inf>), has
been developed. Methods and Results: A multicenter cohort of 620
consecutive HCM outpatients was recruited and followed (2007 to 2015). The
endpoint was death from HF, cardiac transplantation, NYHA III-IV class
progression, severe functional deterioration leading to hospitalization
for septal reduction, and hospitalization for HF worsening. During a
median follow-up of 3.8 years (25-75th centile: 2.3-5.3 years), 84
patients reached the endpoint. Peak circulatory power (peak oxygen
consumption * peak systolic blood pressure), ventilatory efficiency and
left atrial diameter were independently associated with the endpoint and,
accordingly, integrated into the HYPER<inf>HF</inf> model (C index: 0.849;
best cutoff value equal to 15%). Conclusions: CPET is useful in the
evaluation of HCM patients. In this context, the HYPER<inf>HF</inf> score
might allow early identification of those patients at high risk of HF
progression and its complications. Copyright &#xa9; 2016, Japanese
Circulation Society. All rights reserved.

<27>
Accession Number
612361286
Author
Song P.S.; Song Y.B.; Lee J.M.; Hahn J.-Y.; Choi S.-H.; Choi J.-H.; Lee
S.H.; Park K.W.; Kim H.-S.; Jang Y.; Seung K.B.; Oh J.H.; Gwon H.-C.
Institution
(Song) Division of Cardiology, Department of Internal Medicine, Inje
University Haeundae Paik Hospital, Busan, South Korea
(Song, Lee, Hahn, Choi, Choi, Lee, Gwon) Division of Cardiology,
Department of Medicine, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, South Korea
(Park, Kim) Seoul National University Hospital, Seoul, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
(Seung) Catholic University Kangnam St. Mary's Hospital, Seoul, South
Korea
(Oh) Samsung Changwon Hospital, Sungkyunkwan University School of
Medicine, Changwon, South Korea
Title
Major Predictors of Long-Term Clinical Outcomes After Percutaneous
Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent
Strategy: Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1879-1886), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study investigated the long-term outcomes and predictors
of target vessel failure (a composite of cardiac death, myocardial
infarction, stent thrombosis, or target vessel revascularization) in
patients with bifurcation lesion treated by percutaneous coronary
intervention (PCI) utilizing the 2-stent strategy with a drug-eluting
stent (DES). Background There are limited data on outcomes of the 2-stent
strategy in bifurcation PCI. Methods Patient-level pooled analysis was
performed with patients undergoing PCI with 2-stent strategy from the
Korean Bifurcation Pooled Cohorts. Results A total of 951 patients (70.7%
men) with a median age of 64 years underwent bifurcation PCI with the
2-stent strategy. True bifurcation was observed in 73.2% of patients and
39.1% of patients had left main bifurcation lesions. The crush technique
was used most frequently (44.4%) and final kissing ballooning was
performed in 83.6%. The 3-year cumulative incidence of target vessel
failure, cardiac death, myocardial infarction, stent thrombosis, and
target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%,
respectively. The independent predictors of target vessel failure were
left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence
interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted
HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95%
CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12
to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to
0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to
0.68). Conclusions 2-stent strategy with DES is associated with feasible
procedural and acceptable long-term clinical outcomes in bifurcation PCI.
Several characteristics were identified as important periprocedural
predictors of long-term adverse outcomes. Copyright &#xa9; 2016 American
College of Cardiology Foundation

<28>
Accession Number
609898280
Author
Kilic A.; Ohkuma R.; Grimm J.C.; Magruder J.T.; Sussman M.; Schneider
E.B.; Whitman G.J.R.
Institution
(Kilic, Ohkuma, Grimm, Magruder, Sussman, Schneider, Whitman) Division of
Cardiac Surgery, Department of Surgery, Johns Hopkins Medical
Institutions, Baltimore, MD, United States
(Whitman) Division of Cardiac Surgery, Johns Hopkins Hospital, 1800
Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287, United States
Title
A novel score to estimate the risk of pneumonia after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (5) (pp 1415-1421),
2016. Date of Publication: 01 May 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The purpose of this study was to derive and validate a risk
score for pneumonia (PNA) after cardiac surgery. Methods Adults undergoing
cardiac surgery between 2005 and 2012 were identified in a
single-institution database. The primary outcome was postoperative PNA.
Patients were randomly assigned to training and validation sets in a 3:1
ratio. A multivariable model was constructed incorporating univariate pre-
and intraoperative predictors of PNA in the training set. Points were
assigned to significant risk factors in the multivariable model based on
their associated regression coefficients. Results A total of 6222 patients
were included. The overall rate of postoperative PNA was 4.5% (n = 282). A
33-point score incorporating 6 risk factors (age, chronic lung disease,
peripheral vascular disease, cardiopulmonary bypass time, intraoperative
red blood cell transfusion, and pre- or intraoperative intra-aortic
balloon pump) was generated. The model used to generate the score in the
training set was robust in predicting PNA (c = 0.72, P <.001). Predicted
rates of PNA increased exponentially with increasing risk score, ranging
from 1.2% (score = 0) to 59% (score = 33). There was significant
correlation between predicted rates of PNA based on the training cohort
and actual rates of pneumonia in the validation cohort in weighted
regression analysis (r = 0.74, P <.001). The composite score outperformed
the STS prolonged ventilation model in predicting PNA in the validation
cohort (c-index 0.76 vs 0.71, respectively). Conclusions This 33-point
risk score is strongly predictive of postoperative PNA after cardiac
surgery. The composite score has utility in tailoring perioperative
management and in targeting diagnostic and preventative interventions.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery.

<29>
Accession Number
607283063
Author
Avila-Alvarez A.; Del Cerro Marin M.J.; Bautista-Hernandez V.
Institution
(Avila-Alvarez) Department of Neonatology, Complexo Hospitalario
Universitario de A Coruna, A Coruna, (CHUAC), A Coruna, Spain
(Del Cerro Marin) Department of Pediatric Cardiology, Hospital
Universitario Ramon y Cajal, Madrid, Spain
(Bautista-Hernandez) Department of Cardiovascular Surgery, Complexo
Hospitalario Universitario A Coruna (CHUAC), Congenital and Structural
Heart Disease, Instituto de Investigacion Biomedica A Coruna (INIBIC), A
Coruna, Spain
Title
Pulmonary vasodilators in the management of low cardiac output syndrome
after pediatric cardiac surgery.
Source
Current Vascular Pharmacology. 14 (1) (pp 37-47), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Pulmonary hypertension is among the causes of low cardiac output syndrome
after neonatal and pediatric cardiac surgery. In the setting of transient
postoperative myocardial dysfunction, even a moderate elevation of
pulmonary pressure can result in heart dysfunction and circulatory
collapse. Although, specific pharmacological manipulation of pulmonary
vascular resistance is frequently required in the perioperative period,
there is no widely standardized management. In this review, a systematic
literature search of PubMed and MEDLINE databases using relevant terms was
performed. All clinical trials and relevant manuscripts, along with
important physiological, pharmacological, and evidence-based
considerations involving the use of pulmonary vasodilators in the
management of low cardiac output syndrome after cardiac surgery were
reviewed. This article addresses the fifth of eight topics comprising the
special issue entitled "Pharmacologic strategies with afterload reduction
in low cardiac output syndrome after pediatric cardiac surgery". Copyright
&#xa9; 2016 Bentham Science Publishers.

<30>
Accession Number
607283023
Author
Epting C.L.; McBride M.E.; Wald E.L.; Costello J.M.
Institution
(Epting, McBride, Wald, Costello) From the Divisions of Cardiology and
Critical Care, Departments of Pediatrics, Ann & Robert H. Lurie Children's
Hospital of Chicago, Northwestern University Feinberg School of Medicine,
Chicago, IL 60611, United States
(Epting) Departments of Pathology, Ann & Robert H. Lurie Children's
Hospital of Chicago, Northwestern University Feinberg School of Medicine,
Chicago, IL 60611, United States
Title
Pathophysiology of post-operative low cardiac output syndrome.
Source
Current Vascular Pharmacology. 14 (1) (pp 14-23), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Low cardiac output syndrome frequently complicates the post-operative care
of infants and children following cardiac surgery. The onset of low
cardiac output follows a predictable course in the hours following
cardiopulmonary bypass, as myocardial performance declines in the face of
an elevated demand for cardiac output. When demand outstrips supply, shock
ensues, and early recognition and intervention can decrease mortality.
Multifactorial in etiology, this article will discuss the pathophysiology
of low cardiac output syndrome, including myocardial depression following
bypass, altered cardiac loading conditions, and inflammation driving a
hypermetabolic state. Contributions from altered neurohormonal, thyroid,
and adrenal axes will also be discussed. Sources included the clinical
experiences of four cardiac intensivists, supported throughout by primary
sources and relevant reviews obtained through PubMed searches and from
seminal textbooks in the field. This article addresses the second of eight
topics comprising the special issue entitled "Pharmacologic strategies
with afterload reduction in low cardiac output syndrome after pediatric
cardiac surgery". Copyright &#xa9; 2016 Bentham Science Publishers.

<31>
Accession Number
612361290
Author
Abtan J.; Steg P.G.; Stone G.W.; Mahaffey K.W.; Gibson C.M.; Hamm C.W.;
Price M.J.; Abnousi F.; Prats J.; Deliargyris E.N.; White H.D.; Harrington
R.A.; Bhatt D.L.
Institution
(Abtan, Steg) DHU (Departement Hospitalo-Universitaire)-FIRE (Fibrosis,
Inflammation, REmodelling), Hopital Bichat, AP-HP (Assistance
Publique-Hopitaux de Paris), Universite Paris-Diderot, Sorbonne-Paris
Cite, FACT (French Alliance for Cardiovascular clinical Trials), An F-CRIN
network, INSERM U-1148, Paris, France
(Steg) NLHI, ICMS, Royal Brompton Hospital, Imperial College, London,
United Kingdom
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York, New York, United States
(Mahaffey, Harrington) Stanford Center for Clinical Research (SCCR);
Department of Medicine; Stanford School of Medicine, Stanford, California,
United States
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Harvard Medical School, Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price, Abnousi) Scripps Clinic and Scripps Translational Science
Institute, La Jolla, California, United States
(Prats, Deliargyris) The Medicines Company, Parsippany, New Jersey, United
States
(White) University of Auckland, Auckland City Hospital, Auckland, New
Zealand
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
Title
Efficacy and Safety of Cangrelor in Preventing Periprocedural
Complications in Patients With Stable Angina and Acute Coronary Syndromes
Undergoing Percutaneous Coronary Intervention: The CHAMPION PHOENIX Trial.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1905-1913), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to examine the safety and
efficacy of cangrelor in patients with stable angina (SA) or acute
coronary syndrome (ACS). Background The CHAMPION PHOENIX (A Clinical Trial
Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who
Require Percutaneous Coronary Intervention) trial demonstrated that
cangrelor significantly reduced periprocedural ischemic events in
all-comer percutaneous coronary intervention with a modest increase in
mild and moderate bleeding. Whether this benefit is consistent across SA
and ACS has not been explored fully. Methods The CHAMPION PHOENIX trial
compared periprocedural administration of cangrelor or clopidogrel, with
either a 300- or 600-mg loading dose for the prevention of periprocedural
complications in patients undergoing percutaneous coronary intervention.
Among the 10,942 patients in the modified intention to treat population,
6,358 patients were classified as having SA, and 4,584 patients had ACS
(including unstable angina, non ST-segment elevation myocardial infarction
and ST-segment elevation myocardial infarction) at randomization. The
primary composite endpoint was death, myocardial infarction,
ischemia-driven revascularization, or stent thrombosis at 48 h. A key
secondary endpoint was stent thrombosis, and the primary safety endpoint
was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Coronary Arteries) severe bleeding. Results
Cangrelor consistently reduced the primary endpoint in SA and ACS (odds
ratio [OR]: 0.83 [95% confidence interval (CI): 0.67 to 1.01] and OR: 0.71
[95% CI: 0.52 to 0.96], respectively; interaction p = 0.41). Cangrelor
also consistently reduced stent thrombosis in SA and ACS (OR: 0.55 [95%
CI: 0.30 to 1.01] and OR: 0.67 [95% CI: 0.42 to 1.06], respectively;
interaction p = 0.62). The impact of cangrelor on GUSTO severe/moderate
bleeding was also similar for SA and ACS (OR: 1.49 [95% CI: 0.67 to 3.33]
and OR: 1.79 [95% CI: 0.79 to 4.07], respectively; interaction p = 0.75).
Conclusions The benefits and risks of cangrelor were consistent in
patients with SA and ACS. (A Clinical Trial Comparing Cangrelor to
Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary
Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]; NCT01156571) Copyright
&#xa9; 2016 American College of Cardiology Foundation

<32>
[Use Link to view the full text]
Accession Number
612076286
Author
Calvert P.A.; Northridge D.B.; Malik I.S.; Shapiro L.; Ludman P.; Qureshi
S.A.; Mullen M.; Henderson R.; Turner M.; Been M.; Walsh K.P.; Casserly
I.; Morrison L.; Walker N.L.; Thomson J.; Spence M.S.; Mahadevan V.S.;
Hoye A.; Maccarthy P.A.; Daniels M.J.; Clift P.; Davies W.R.; Adamson
P.D.; Morgan G.; Aggarwal S.K.; Ismail Y.; Ormerod J.O.M.; Khan H.R.;
Chandran S.S.; De Giovanni J.; Rana B.S.; Ormerod O.; Hildick-Smith D.
Institution
(Calvert, Shapiro, Davies, Rana) Department of Cardiology, Lakeside
Crescent, Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE,
United Kingdom
(Calvert, Ludman, Clift, De Giovanni) Queen Elizabeth Hospital, University
Hospitals Birmingham, Birmingham, United Kingdom
(Calvert, Clift) Institute of Translational Medicine, University of
Birmingham, Birmingham, United Kingdom
(Northridge) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Malik) Imperial College NHS Trust, London, United Kingdom
(Qureshi, Morgan) Evelina Children's Hospital, London, United Kingdom
(Mullen) Heart Hospital, London, United Kingdom
(Henderson, Khan) Nottingham University Hospital, Nottingham, United
Kingdom
(Turner, Ismail) Bristol Heart Institute, Bristol, United Kingdom
(Been) University Hospital Coventry, Coventry, United Kingdom
(Walsh) Mater Misericordiae University Hospital, Dublin, Ireland
(Casserly) Mater Private Hospital, Dublin, Ireland
(Morrison, Aggarwal) Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Walker) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Thomson) Leeds General Infirmary, Leeds, United Kingdom
(Spence) Royal Victoria Hospital, Belfast, United Kingdom
(Mahadevan) Manchester Royal Infirmary, Manchester, United Kingdom
(Hoye) Castle Hill Hospital, Hull, United Kingdom
(Maccarthy) King's College London, London, United Kingdom
(Daniels, Ormerod, Ormerod) John Radcliffe Hospital, Oxford, United
Kingdom
(Chandran, Hildick-Smith) Royal Sussex County Hospital, Brighton, United
Kingdom
Title
Percutaneous device closure of paravalvular leak.
Source
Circulation. 134 (13) (pp 934-944), 2016. Date of Publication: 27 Sep
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Paravalvular leak (PVL) occurs in 5% to 17% of patients
following surgical valve replacement. Percutaneous device closure
represents an alternative to repeat surgery. Methods: All UK and Ireland
centers undertaking percutaneous PVL closure submitted data to the UK PVL
Registry. Data were analyzed for association with death and major adverse
cardiovascular events (MACE) at follow-up. Results: Three hundred eight
PVL closure procedures were attempted in 259 patients in 20 centers
(2004-2015). Patient age was 67+/-13 years; 28% were female. The main
indications for closure were heart failure (80%) and hemolysis (16%).
Devices were successfully implanted in 91% of patients, via radial (7%),
femoral arterial (52%), femoral venous (33%), and apical (7%) approaches.
Nineteen percent of patients required repeat procedures. The target valve
was mitral (44%), aortic (48%), both (2%), pulmonic (0.4%), or
transcatheter aortic valve replacement (5%). Preprocedural leak was severe
(61%), moderate (34%), or mild (5.7%) and was multiple in 37%. PVL
improved postprocedure (P<0.001) and was none (33.3%), mild (41.4%),
moderate (18.6%), or severe (6.7%) at last follow-up. Mean New York Heart
Association class improved from 2.7+/-0.8 preprocedure to 1.6+/-0.8
(P<0.001) after a median follow-up of 110 (7-452) days. Hospital mortality
was 2.9% (elective), 6.8% (in-hospital urgent), and 50% (emergency)
(P<0.001). MACE during follow-up included death (16%), valve surgery (6%),
late device embolization (0.4%), and new hemolysis requiring transfusion
(1.6%). Mitral PVL was associated with higher MACE (hazard ratio [HR],
1.83; P=0.011). Factors independently associated with death were the
degree of persisting leak (HR, 2.87; P=0.037), New York Heart Association
class (HR, 2.00; P=0.015) at follow-up and baseline creatinine (HR, 8.19;
P=0.001). The only factor independently associated with MACE was the
degree of persisting leak at follow-up (HR, 3.01; P=0.002). Conclusion:
Percutaneous closure of PVL is an effective procedure that improves PVL
severity and symptoms. Severity of persisting leak at follow-up is
independently associated with both MACE and death. Percutaneous closure
should be considered as an alternative to repeat surgery. Copyright &#xa9;
2016 American Heart Association, Inc.

<33>
Accession Number
612361292
Author
Pan M.; Ojeda S.; Villanueva E.; Chavarria J.; Romero M.; Mazuelos F.;
Segura J.; Carrasco F.; Hidalgo F.; Lopez Aguilera J.; Rodriguez S.;
Puente M.; Suarez de Lezo J.
Institution
(Pan, Ojeda, Villanueva, Chavarria, Romero, Suarez de Lezo, Mazuelos,
Segura, Carrasco, Hidalgo, Lopez Aguilera, Rodriguez, Puente, Suarez de
Lezo) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba (IMIBIC), Cordoba, Spain
Title
Structural Damage of Jailed Guidewire During the Treatment of Coronary
Bifurcation Lesions: A Microscopic Randomized Trial.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1917-1924), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to compare the safety (resistance to damage)
and efficacy (ability to cross the side branch) of polymer-coated and
non-polymer-coated guidewires in the jailed wire technique used during the
percutaneous treatment of bifurcation lesions. Background The jailed wire
technique is a useful strategy in the treatment of bifurcation lesions by
provisional stenting. However, these wires can be damaged or even be
broken during their removal. Methods We performed a randomized study in
patients with bifurcation lesions treated by provisional stenting. The
jailed wire technique was mandatory, and the types of guidewires,
polymer-coated (n = 115) and non-polymer-coated (n = 120), were
randomized. After the procedures, the wires were evaluated by stereoscopic
microscopy. The induced damage in the wires was classified as follows: no
damage, mild, moderate, or severe. Results The clinical characteristics
were similar between patients treated with polymer-coated or
non-polymer-coated wires. Polymer-coated wires were significantly (p <
0.001) more resistant to retrieval damage (only 2 wires showed mild
damage) than were non-polymer-coated wires. However, 63 (55%) of the
non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had
mild, moderate, and severe damage, respectively. Additionally, the jailed
length of the wire was a factor contributing to the degree of wire damage.
The time of side branch wiring was shorter in the polymer-coated wire
group (19 +/- 40 s vs. 42 +/- 72 s; p < 0.05). Conclusions Jailed wires
during interventional procedures of bifurcation lesions commonly showed
microscopic damage. Polymer-coated wires were more resistant to retrieval
damage and were more efficient in crossing the side branch ostium than
non-polymer-coated wires. (Jailed Wire Technique in the Treatment of
Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study;
NCT02516891) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<34>
Accession Number
612353113
Author
Hemmrich M.; Peterson E.D.; Thomitzek K.; Weitz J.I.
Institution
(Hemmrich, Thomitzek) Bayer Pharma AG, Berlin, Germany
(Peterson) Duke Clinical Research Institute, Durham, NC, United States
(Weitz) McMaster University, Thrombosis and Atherosclerosis Research
Institute, Hamilton, ON, Canada
Title
Spotlight on unmet needs in stroke prevention: The PIONEER AF-PCI,
NAVIGATE ESUS and GALILEO trials.
Source
Thrombosis and Haemostasis. 116 (pp S33-S40), 2016. Date of Publication:
2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Atrial fibrillation (AF) is a major healthcare concern, being associated
with an estimated five-fold risk of ischaemic stroke. In patients with AF,
anticoagulants reduce stroke risk to a greater extent than acetylsalicylic
acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel.
Non-vitamin K antagonist oral anticoagulants (NOACs) are now a
widely-accepted therapeutic option for stroke prevention in non-valvular
AF (NVAF). There are particular patient types with NVAF for whom treatment
challenges remain, owing to sparse clinical data, their high-risk nature
or a need to harmonise anticoagulant and antiplatelet regimens if
co-administered. This article focuses on three randomised controlled
trials (RCTs) that are investigating the utility of rivaroxaban, a direct,
oral, factor Xa inhibitor, in additional areas of stroke prevention where
data for anticoagulants are lacking: oPenlabel, randomized, controlled,
multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a
dose-adjusted oral vitamin K antagonist treatment (PIONEER AF-PCI); New
Approach riVaroxoban Inhibition of factor Xa in a Global trial vs Aspirin
to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE
ESUS); and Global study comparing a rivAroxaban-based antithrombotic
strategy to an antipLatelet-based strategy after transcatheter aortIc
vaLve rEplacement to Optimize clinical outcomes (GALILEO). Data from these
studies present collaborative efforts to build upon existing
registrational Phase III data for rivaroxaban, driving the need for
effective and safe treatment of a wider range of patients for stroke
prevention. Copyright &#xa9; Schattauer 2016.

<35>
Accession Number
612393394
Author
Mehta R.H.; Van Diepen S.; Meza J.; Bokesch P.; Leimberger J.D.;
Tourt-Uhlig S.; Swartz M.; Parrotta J.; Jankowich R.; Hay D.; Harrison
R.W.; Fremes S.; Goodman S.G.; Luber J.; Toller W.; Heringlake M.; Anstrom
K.J.; Levy J.H.; Harrington R.A.; Alexander J.H.
Institution
(Mehta, Meza, Leimberger, Tourt-Uhlig, Swartz, Harrison, Anstrom, Levy,
Alexander) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Van Diepen, Parrotta, Fremes, Goodman) Canadian VIGOUR Centre, University
of Alberta, Edmonton, Canada, Canada
(Bokesch, Jankowich, Hay) Tenax Therapeutics, Morrisville, NC, United
States
(Luber) Franciscan Health System, Tacoma, WA, United States
(Toller) University of Graz, Graz, Austria
(Heringlake) University of Lubeck, Lubeck, Germany
(Harrington) Stanford University School of Medicine, Stanford, CA, United
States
Title
Levosimendan in patients with left ventricular systolic dysfunction
undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study
design of the Levosimendan in Patients with Left Ventricular Systolic
Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass
(LEVO-CTS) trial.
Source
American Heart Journal. 182 (pp 62-71), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Low cardiac output syndrome is associated with increased mortality and
occurs in 3% to 14% of patients undergoing cardiac surgery on
cardiopulmonary bypass (CPB). Levosimendan, a novel calcium sensitizer and
K<inf>ATP</inf> channel activator with inotropic, vasodilatory, and
cardioprotective properties, has shown significant promise in reducing the
incidence of low cardiac output syndrome and related adverse outcomes in
patients undergoing cardiac surgery on CPB. Methods LEVO-CTS is a phase 3
randomized, controlled, multicenter study evaluating the efficacy, safety,
and cost-effectiveness of levosimendan in reducing morbidity and mortality
in high-risk patients with reduced left ventricular ejection fraction
(<35%) undergoing cardiac surgery on CPB. Patients will be randomly
assigned to receive either intravenous levosimendan (0.2 mug
kg^-1 min^-1 for the first hour followed by 0.1 mug/kg
for 23 hours) or matching placebo initiated within 8 hours of surgery. The
co-primary end points are (1) the composite of death or renal replacement
therapy through day 30 or perioperative myocardial infarction, or
mechanical assist device use through day 5 (quad end point tested at alpha
< .01), and (2) the composite of death through postoperative day 30 or
mechanical assist device use through day 5 (dual end point tested at alpha
< .04). Safety end points include new atrial fibrillation and death
through 90 days. In addition, an economic analysis will address the
cost-effectiveness of levosimendan compared with placebo in high-risk
patients undergoing cardiac surgery on CPB. Approximately 880 patients
will be enrolled at approximately 60 sites in the United States and Canada
between July 2014 and September 2016, with results anticipated in January
2017. Conclusion LEVO-CTS, a large randomized multicenter clinical trial,
will evaluate the efficacy, safety, and cost-effectiveness of levosimendan
in reducing adverse outcomes in high-risk patients undergoing cardiac
surgery on CPB. Clinical Trial Registration:ClinicalTrials.gov
(NCT02025621). Copyright &#xa9; 2016

<36>
[Use Link to view the full text]
Accession Number
612357996
Author
Kapadia S.; Agarwal S.; Miller D.C.; Webb J.G.; MacK M.; Ellis S.;
Herrmann H.C.; Pichard A.D.; Tuzcu E.M.; Svensson L.G.; Smith C.R.;
Rajeswaran J.; Ehrlinger J.; Kodali S.; Makkar R.; Thourani V.H.;
Blackstone E.H.; Leon M.B.
Institution
(Kapadia, Agarwal, Ellis, Tuzcu, Svensson, Rajeswaran, Ehrlinger,
Blackstone) Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Miller) Stanford University, Medical School, CA, United States
(Webb) St. Paul's Hospital, University of British Columbia, United States
(MacK) Baylor Scott and White Health, Plano, TX, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia,
United States
(Pichard) MedStar Washington Hospital Center, DC, United States
(Smith, Kodali, Leon) Columbia University, Medical Center, New
York-Presbyterian Hospital, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Emory University, Atlanta, GA, United States
Title
Insights into Timing, Risk Factors, and Outcomes of Stroke and Transient
Ischemic Attack after Transcatheter Aortic Valve Replacement in the
PARTNER Trial (Placement of Aortic Transcatheter Valves).
Source
Circulation: Cardiovascular Interventions. 9 (9) (no pagination), 2016.
Article Number: e002981. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Prior studies of stroke and transient ischemic attack (TIA)
after transcatheter aortic valve replacement (TAVR) are limited by
reporting and follow-up variability. This is a comprehensive analysis of
time-related incidence, risk factors, and outcomes of these events.
Methods and Results-From April 2007 to February 2012, 2621 patients, aged
84+/-7.2 years, underwent transfemoral (TF; 1521) or transapical (TA;
1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves;
as-treated), including the continued access registry. Stroke and TIA were
identified by protocol and adjudicated by a Clinical Events Committee.
Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58
[3.8%]; TA 29 [2.7%]; P=0.09), 85% within 1 week. Instantaneous stroke
risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2
weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10
[0.67%]; TA 3 [0.27%]; P>0.17). Stroke and TIA were associated with lower
1-year survival than expected (TF 47% after stroke versus 82%, and 64%
after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA
versus 83%). Risk factors for early stroke after TA-TAVR included more
postdilatations, pure aortic stenosis without regurgitation, and possibly
more pacing runs, earlier date of procedure, and no dual antiplatelet
therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke
early after TF-TAVR. Conclusions-Risk of stroke or TIA is highest early
after TAVR and is associated with increased 1-year mortality.
Modifications of TAVR, emboli-prevention devices, and better
intraprocedural pharmacological protection may mitigate this risk.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00530894.

<37>
[Use Link to view the full text]
Accession Number
612357988
Author
Hildick-Smith D.; Behan M.W.; Lassen J.F.; Chieffo A.; Lefevre T.;
Stankovic G.; Burzotta F.; Pan M.; Ferenc M.; Bennett L.; Hovasse T.;
Spence M.S.; Oldroyd K.; Brunel P.; Carrie D.; Baumbach A.; Maeng M.;
Skipper N.; Louvard Y.
Institution
(Hildick-Smith, Bennett, Skipper) Cardiac Centre, Brighton and Sussex
University Hospitals, Edinburgh Heart Centre, Edinburgh EH164SA, United
Kingdom
(Behan) Edinburgh Heart Centre, United Kingdom
(Lassen, Maeng) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Chieffo) Department of Cardiology, San Raffaele Scientific Institute,
Milan, Italy
(Lefevre, Hovasse, Louvard) Institute Cardiovasculaire Paris Sud, Hospital
Prive Jacques Cartier, Massy, France
(Stankovic) Department of Cardiology, Clinical Centre of Serbia, Belgrade,
Serbia
(Stankovic) Medical Faculty, University of Belgrade, Serbia
(Burzotta) Institute of Cardiology, Catholic University of the Sacred
Heart, Rome, Italy
(Pan) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba, Spain
(Ferenc) University Heart Center Freiburg, Bad Krozingen, Germany
(Spence) Department of Cardiology, Royal Victoria Hospital, Belfast,
United Kingdom
(Oldroyd) Department of Cardiology, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Brunel) Department of Cardiology, Clinique de Fontaine-les-Djon, France
(Carrie) Department of Cardiology, Rangueil Hospital, Toulouse, France
(Baumbach) Bristol Heart Institute, United Kingdom
Title
The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized
Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte
Strategy in Large Caliber True Bifurcations.
Source
Circulation: Cardiovascular Interventions. 9 (9) (no pagination), 2016.
Article Number: e003643. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-For the treatment of coronary bifurcation lesions, a
provisional strategy is superior to systematic 2-stent techniques for the
most bifurcation lesions. However, complex anatomies with large side
branches (SBs) with significant ostial disease length are considered by
expert consensus to warrant a 2-stent technique upfront. This consensus
view has not been scientifically assessed. Methods and Results-Symptomatic
patients with large caliber true bifurcation lesions (SB diameter >2.5 mm)
and significant ostial disease length (>5 mm) were randomized to either a
provisional T-stent strategy or a dual stent culotte technique. Two
hundred patients aged 64+/-10 years, 82% male, were randomized in 20
European centers. The clinical presentations were stable coronary disease
(69%) and acute coronary syndromes (31%). SB stent diameter (2.67+/-0.27
mm) and length (20.30+/-5.89 mm) confirmed the extent of SB disease.
Procedural success (provisional 97%, culotte 94%) and kissing balloon
inflation (provisional 95%, culotte 98%) were high. Sixteen percent of
patients in the provisional group underwent T-stenting. The primary end
point (a composite of death, myocardial infarction, and target vessel
revascularization at 12 months) occurred in 7.7% of the provisional
T-stent group versus 10.3% of the culotte group (hazard ratio, 1.02; 95%
confidence interval, 0.78-1.34; P=0.53). Procedure time, X-ray dose, and
cost all favored the simpler procedure. Conclusions-When treating complex
coronary bifurcation lesions with large stenosed SBs, there is no
difference between a provisional T-stent strategy and a systematic 2-stent
culotte strategy in a composite end point of death, myocardial infarction,
and target vessel revascularization at 12 months. Clinical Trial
Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT
01560455. Copyright &#xa9; 2016 American Heart Association, Inc.

<38>
Accession Number
612333993
Author
Pressler A.; Christle J.W.; Lechner B.; Grabs V.; Haller B.; Hettich I.;
Jochheim D.; Mehilli J.; Lange R.; Bleiziffer S.; Halle M.
Institution
(Pressler, Christle, Lechner, Grabs, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische
Universitat Munchen, Munich, Germany
(Haller) Institute for Medical Statistics and Epidemiology, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Hettich) Department of Pneumology, University Hospital Freiburg,
Freiburg, Germany
(Jochheim, Mehilli) Cardiology Department, Munich University Clinic,
Munich, Germany
(Mehilli, Halle) DZHK (German Center for Cardiovascular Research), partner
site Munich Heart Alliance, Munich, Germany
(Lange, Bleiziffer) Clinic for Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
(Halle) Else Kroner-Fresenius-Zentrum am Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
Title
Exercise training improves exercise capacity and quality of life after
transcatheter aortic valve implantation: A randomized pilot trial.
Source
American Heart Journal. 182 (pp 44-53), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Transcatheter aortic valve implantation (TAVI) is increasingly
applied for aortic stenosis in elderly patients with impaired mobility and
reduced quality of life. These patients may particularly benefit from
postinterventional exercise programs, but no randomized study has
evaluated the safety and efficacy of exercise in this population. Methods
In a prospective pilot study, 30 patients after TAVI (mean age, 81 +/- 6
years, 44% female, 83 +/- 34 days postintervention) were randomly
allocated 1:1 to a training group (TG) performing 8 weeks of supervised
combined endurance and resistance exercise or to usual care. The formal
primary efficacy end point was between-group difference in change in peak
oxygen uptake assessed by cardiopulmonary exercise testing; secondary end
points included muscular strength, 6-minute walk distance, and quality of
life (Kansas City Cardiomyopathy Questionnaire and Medical Outcomes Study
12-Item Short-Form Health Survey questionnaires). Safety was assessed by
documenting training-related adverse events, prosthesis, and renal
function. Results Significant changes in favor of TG were observed for
peak oxygen uptake (group difference, 3.7 mL/min per kg [95% CI, 1.1-6.3;
P = .007]), muscular strength (bench press, 6 kg [95% CI, 3-10; P = .002];
rowing, 7 kg [95% CI, 3-11; P < .001]; pulldown, 9 kg [95% CI, 4-14; P =
.001]; shoulder press, 5 kg [95% CI, 1-8; P = .008]; leg press, 17 kg [95%
CI 6-28; P = .005]), components of quality of life (Kansas City
Cardiomyopathy Questionnaire physical limitation, 19.2 [95% CI, 4.1-34.2;
P = .015]; symptom burden, 12.3 [95% CI, 0.5-24.0; P = .041]; clinical
summary, 12.4 [3.4-21.4; P = .009]), but not for other questionnaire
subscales and 6-minute walk distance (15 m [95% CI, -23 to 53; P = .428]).
Three dropouts unrelated to exercise occurred (TG = 2; usual care, = 1);
prosthesis and renal function were not affected by the exercise
intervention. Conclusions In patients after TAVI, exercise training
appears safe and highly effective with respect to improvements in exercise
capacity, muscular strength, and quality of life. Clinical Trial
Registration: Clinicaltrials.gov NCT01935297. Copyright &#xa9; 2016
Elsevier Inc.

<39>
Accession Number
607973042
Author
Paparella D.; Di Mauro M.; Bitton Worms K.; Bolotin G.; Russo C.; Trunfio
S.; Scrofani R.; Antona C.; Actis Dato G.; Casabona R.; Colli A.; Gerosa
G.; Renzulli A.; Serraino F.; Scrascia G.; Zaccaria S.; De Bonis M.;
Taramasso M.; Delgado L.; Tritto F.; Marmo J.; Parolari A.; Myaseodova V.;
Villa E.; Troise G.; Nicolini F.; Gherli T.; Whitlock R.; Conte M.; Barili
F.; Gelsomino S.; Lorusso R.; Sciatti E.; Marinelli D.; Di Giammarco G.;
Calafiore A.M.; Sheikh A.; Alfonso J.J.; Glauber M.; Miceli A.
Institution
(Paparella, Conte) U.O. di Cardiochirurgia, Universita di Bari Aldo Moro,
Italy
(Di Mauro) U.O. Cardiologia, Universita dell'Aquila, Italy
(Bitton Worms, Bolotin) Department of Cardiac Surgery, Rambam Medical
Centre, Haifa, Israel
(Russo, Trunfio) U.O. Cardiochirurgia Ospedale Niguarda Milano, Italy
(Scrofani, Antona) U.O. di Chirurgia Cardiovascolare, Ospedale Polo
Universitario Luigi Sacco, Milano, Italy
(Actis Dato, Casabona) U.O. Cardiochirurgia, Ospedale Mauriziano, Torino,
Italy
(Colli, Gerosa) U.O. di Cardiochirurga, Dipartimento di Scienze
Cardio-toraco-vascolare, Universita di Padova, Italy
(Renzulli, Serraino) Divisione di Cardiochirurgia, Universita della Magna
Grecia, Catanzaro, Italy
(Scrascia, Zaccaria) U.O. Cardiochirurgia, Ospedale Vito Fazzi, Lecce,
Italy
(De Bonis, Taramasso) U.O. Cardiochirurgia, Ospedale San Raffele, Milano,
Italy
(Delgado) Ospedale Universitario Germans Trias y Pujol, Badalona, Spain
(Tritto, Marmo) U.O. Cardiochirurgia, Ospedale S. Anna e S. Sebastiano,
Caserta, Italy
(Parolari) Divisione di Cardiochirurgia, IRCCS San Donato, San Donato
Milanese, Italy
(Myaseodova) Unita di Ricerca Clinica in Aterotrombosi, Centro
Cardiologico Monzino, Milano, Italy
(Villa, Troise) Divisione di Cardiochirurgia, Ospedale Poliambulanza,
Brescia, Italy
(Nicolini, Gherli) Unita di Cardiochirurgia, Dipartimento di Medicina
Clinica e Sperimentale, Universita di Parma, Italy
(Whitlock) Division of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
(Barili) Division of Cardiac Surgery, Santa Croce Hospital, Cuneo, Italy
(Gelsomino) Experimental Surgery, Heart and Vessels Department, Careggi
Hospital, Firenze, Italy
(Lorusso, Sciatti) U.O. Cardiochirurgia, Spedali Civili, Brescia, Italy
(Marinelli, Di Giammarco) U.O. di Cardiochirurgia, Universita di Chieti,
Chieti, Italy
(Calafiore, Sheikh, Alfonso) Department of Adult Cardiac Surgery, Prince
Sultan Cardiac Center, Riyadh, Saudi Arabia
(Glauber, Miceli) U.O. Cardiochirurgia, Ospedale Monasterio, Massa, Italy
Title
Antiplatelet versus oral anticoagulant therapy as antithrombotic
prophylaxis after mitral valve repair.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (5) (pp 1302-1308e1),
2016. Date of Publication: 01 May 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To verify the rate of thromboembolic and hemorrhagic
complications during the first 6 months after mitral valve repair and to
assess whether the type of antithrombotic therapy influenced clinical
outcome. Methods Retrospective data were retrieved from 19 centers.
Inclusion criteria were isolated mitral valve repair with ring
implantation. Exclusion criteria were ongoing or past atrial fibrillation
and any combined intraoperative surgical procedures. The study cohort
consisted of 1882 patients (aged 58 +/- 15 years; 36% women), and included
1517 treated with an oral anticoagulant (VKA group) and 365 with
antiplatelet drugs (APLT group). Primary efficacy outcome was the
incidence of arterial thromboembolic events within 6 months and primary
safety outcome was the incidence of major bleeding within 6 months.
Propensity matching was performed to obtain 2 comparable cohorts (858 vs
286). Results No differences were detected for arterial embolic
complications in matched cohort (1.6% VKA vs 2.1% APLT; P =.50).
Conversely, patients in the APLT group showed lower incidence of major
bleeding complications (3.9% vs 0.7%; P =.01). Six-month mortality rate
was significantly higher in the VKA group (2.7% vs 0.3%; P =.02).
Multivariable analysis in the matched cohort found VKA as independent
predictor of major bleeding complications and mortality at 6 months.
Conclusions Vitamin K antagonist therapy was not superior to antiplatelet
therapy to prevent thromboembolic complications after mitral valve repair.
Our data suggest that oral anticoagulation may carry a higher bleeding
risk compared with antiplatelet therapy, although these results should be
confirmed in an adequately powered randomized controlled trial. Copyright
&#xa9; 2016 The American Association for Thoracic Surgery.

<40>
Accession Number
612480485
Author
Campelo-Parada F.; Regueiro A.; Dumont E.; DeLarochelliere R.; Paradis
J.-M.; Mohammadi S.; Doyle D.; Rodes-Cabau J.
Institution
(Campelo-Parada, Regueiro, Dumont, DeLarochelliere, Paradis, Mohammadi,
Doyle, Rodes-Cabau) Quebec Heart & Lung Institute, Laval University,
Quebec City, QC, Canada
Title
Embolic protection in patients undergoing transaortic transcatheter aortic
valve replacement: initial experience with the TriGuard HDH embolic
deflection device.
Source
Journal of Cardiac Surgery. 31 (10) (pp 617-622), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Stroke remains one of the most worrisome complications
following transcatheter aortic valve replacement (TAVR). This pilot study
evaluates the safety, feasibility, and exploratory efficacy of the
TriGuard HDH embolic deflection device (Keystone Heart Ltd., Caesarea,
Israel) in patients undergoing transaortic TAVR. METHODS: A total of 10
patients (median age: 81 years, STS score: 9.6 +/- 5.6%) undergoing
transaortic TAVR were included. All 30-day events were recorded and
defined according to Valve Academic Research Consortium-2 criteria.
Cerebral diffusion-weighted magnetic resonance imaging exams were planned
preprocedure and within 10 days post-TAVR. The results of the magnetic
resonances were analyzed in an independent core laboratory blinded to
clinical data. Neurocognitive evaluation tests (Montreal Cognitive
Assessment, Cogstate, Digit Symbol Substitution Test, Word Fluency Test,
and Trailmaking tests) were performed at baseline, and within 10 and 30
days post-TAVR. RESULTS: The TriGuard HDH device was successfully deployed
in all patients without complications. There was one procedural major
vascular complication unrelated to the study device, and no clinically
apparent stroke events were observed at 30-day follow-up. Cerebral
diffusion weighted magnetic resonance imaging exams were performed in six
patients at 7.5 +/- 1.9 days post-TAVR showing the presence of new
ischemic lesions in five patients (83.3%), which were single lesions in
60% of these individuals. Paired neurocognitive evaluation tests
demonstrated no significant changes in neurocognitive parameters over
time. CONCLUSIONS: This study shows the safety and feasibility of using
the TriGuard HDH embolic protection device in transaortic TAVR. Further
studies are warranted to determine the efficacy of embolic protection in
this population. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<41>
Accession Number
612335526
Author
Zheng L.; Fan Q.-M.; Wei Z.-Y.
Institution
(Zheng, Fan, Wei) Department of Cardiovascular Surgery, Yantai Yuhuangding
Hospital, No.20 Yuhuangding East Road, Yantai 264000, China
Title
Serum S-100beta and NSE levels after off-pump versus on-pump coronary
artery bypass graft surgery.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 70. Date of Publication: 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: We aimed to evaluate serum levels of S-100 beta (S-100beta)
and neuron specific enolase (NSE) in patients with coronary heart disease
(CHD) after off-pump versus on-pump coronary artery bypass graft (CABG)
surgery. Methods: The PubMed (~2013) and the Chinese Biomedical Database
(CBM) (1982 ~ 2013) were searched without language restrictions. After
extraction of relevant data from selected studies, meta-analyses were
conducted using STATA software (Version 12.0, Stata Corporation, College
Station, Texas USA). Possible sources of heterogeneity were examined
through univariate and multivariate meta-regression analyses and verified
by Monte Carlo Simulation. Results: Eleven studies with a total of 411 CHD
patients met the inclusion criteria. Our meta-analysis showed no
significant difference in serum S-100beta and NSE levels between the
on-pump group and the off-pump group before surgery. In the on-pump group,
there was a significant difference in serum S-100beta levels of CHD
patients between before and after surgery, especially within the first 24
h after surgery. Furthermore, in the on-pump group, there was a
significant difference in serum NSE levels of CHD patients between before
and after surgery, particularly at 0 h after surgery. In the off-pump
group, there was an obvious difference in serum S-100beta levels between
before and after surgery, especially within 24 h after surgery. Our
results also demonstrated that serum S-100beta and NSE levels of CHD
patients in the on-pump group were significantly higher than those of
patients in the off-pump group, especially within 24 h after surgery.
Conclusions: Our findings provide empirical evidence that off-pump and
on-pump CABG surgeries may increase serum S-100beta and NSE levels in CHD
patients, which was most prominent within 24 h after on-pump CABG surgery.
Copyright &#xa9; 2015 Zheng et al.

<42>
Accession Number
603703552
Author
Mavrakanas T.A.; Chatzizisis Y.S.
Institution
(Mavrakanas) McGill University Health Center, Montreal, Canada
(Mavrakanas) General Internal Medicine Division, Geneva University
Hospitals, Geneva, Switzerland
(Chatzizisis) Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
Title
Bivalirudin in stable angina and acute coronary syndromes.
Source
Pharmacology and Therapeutics. 152 (pp 1-10), 2015. Date of Publication:
29 Jun 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
A parenteral anticoagulant is indicated in patients with acute coronary
syndromes. Which anticoagulant should be preferred in each setting is not
clearly established. Bivalirudin administration was considered in acute
coronary syndromes after several clinical trials showed decreased bleeding
risk with its use compared with the association of unfractionated heparin
(UFH) with glycoprotein IIb/IIIa inhibitors (GPIs). Most recent data
demonstrate that the bleeding benefit identified in the previous studies
was not due to bivalirudin's properties but to higher bleeding incidence
in the comparator arm due to the disproportional use of GPIs with heparin.
This paper reviews clinical evidence on bivalirudin as anticoagulant in
stable angina and acute coronary syndromes. Copyright &#xa9; 2015 Elsevier
Ltd. All rights reserved.

<43>
[Use Link to view the full text]
Accession Number
612286941
Author
Malik S.; Kassai B.; Cochat P.
Institution
(Malik, Kassai, Cochat) Hospices Civils de Lyon, EPICIME-CIC 1407 Research
Unit, INSERM, Reference Center for Rare Renal Diseases, Department of
Pediatrics, Universite Claude-Bernard Lyon 1, Lyon, France
(Malik, Kassai) Faculte de Medecine Laennec, Universite Claude-Bernard
Lyon 1, France
(Cochat) Service de Nephrologie Rhumatologie Dermatologie Pediatriques,
Hopital Femme Mere Enfant, Bron, France
Title
Overview of pediatric organ transplantation: Current opinion and future
perspectives on immunosuppression.
Source
Current Opinion in Organ Transplantation. 20 (5) (pp 527-535), 2015. Date
of Publication: October 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review: The main aim of this review is to highlight the current
advances and significant challenges associated with pediatric organ
transplantation, and to explore future perspectives. Recent findings:
Pediatric organ transplantation has greatly improved survival and
management of pathological conditions resistant to therapeutic
interventions in pediatric populations with end-stage organ failure, and
is regarded as a treatment of choice. Advent of immunosuppressive
therapies has significantly enhanced the care of these patients and graft
survival rates, but the long-term risks of these therapeutic interventions
are not well recognized and promote numerous challenges particularly in
the pediatric population, due to their off-label use and significant
adverse effects that may impact growth, skeletal development, and quality
of life. Data regarding the safety of these drugs in children are scare
due to the lack of randomized clinical trials in this age group, mainly
because of issues related to conducting clinical trials in children and to
the small number of pediatric transplantation cases per year. Summary: It
is important to generate registries of pediatric patients with organ
transplantation for conducting observational studies, which might provide
information for designing future RCTs and new insights toward improving
the survival rates and long-term predictors of response. Copyright &#xa9;
2015 Wolters Kluwer Health, Inc. All rights reserved.

<44>
[Use Link to view the full text]
Accession Number
612253172
Author
Lin B.; Shi J.-S.; Zhang H.-S.; Xue C.; Zhang B.; Guo Z.-M.
Institution
(Lin, Shi, Zhang, Xue, Guo) Department of Orthopaedics, 175th Hospital of
PLA, Orthopaedics Center of PLA, Southeast Hospital of Xiamen University,
Zhangzhou, Fujian 363000, China
(Zhang) Department of Orthopaedics, Ganzhou People's Hospital, Ganzhou,
Jiangxi, China
Title
Subscapularis transthoracic versus posterolateral approaches in the
surgical management of upper thoracic tuberculosis a prospective,
randomized controlled study.
Source
Medicine (United States). 94 (47) (pp e1900), 2015. Date of Publication:
November 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The objective of the present study was to evaluate the clinical,
radiological, and functional outcomes of a subscapularis transthoracic
surgical approach and a posterolateral surgical approach with debridement,
bone graft fusion, and internal fixation for the treatment of upper
thoracic tuberculosis. There is currently debate over the best surgical
approach for the treatment of upper thoracic tuberculosis. Traditionally,
the subscapularis transthoracic approach has been preferred; however, the
posterolateral approach has gained popularity in the past few years. A
prospective, consecutive cohort of 43 upper thoracic tuberculosis patients
with a mean age of 39 years (range: 20-52 years) was followed up for a
minimum of 12 months (range: 12-60 months). Patients were randomly divided
into 2 groups. Group A (n=21) was treated by the subscapularis
transthoracic approach and group B (n=22) was treated by the
posterolateral approach. All cases were evaluated for clinical,
radiological, and functional outcomes. Intraoperative blood loss,
operative duration, intraoperative and postoperative complications,
hospital stay, the cure rate, fusion time, and the Frankel scale were used
for clinical and functional evaluation, whereas the kyphosis angle was
used for radiological evaluation. Grafted bones were fused by 10 months in
all cases. There was no statistically significant difference between
groups before surgery in terms of gender, age, segmental tuberculosis,
erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb's angle
(P>0.05). The average operative duration for Group B was lower than that
of Group A. There were no significant differences in intraoperative blood
loss, intraoperative and postoperative complications, hospital stay,
grafted bone fusion time, or cure rate between groups (P>0.05). The Cobb's
angle correction rate for group B (68.5%) was significantly better than
that of group A (30.9%). The neurological score showed significant
postoperative improvement in both groups, with no significant difference
between the groups. The subscapularis transthoracic approach and the
posterolateral approach with debridement, bone graft fusion, and internal
fixation are both sufficient and satisfactory for the surgical treatment
of upper thoracic tuberculosis. However, the posterolateral approach is
superior to the subscapularis transthoracic approach in terms of surgical
trauma, operative time, and kyphosis correction. Copyright &#xa9; 2015
Wolters Kluwer Health, Inc. All rights reserved.

<45>
Accession Number
612296230
Author
Bangalore S.; Toklu B.; Kotwal A.; Volodarskiy A.; Sharma S.; Kirtane
A.J.; Feit F.
Institution
(Bangalore, Toklu, Volodarskiy, Feit) New York University School of
Medicine, New York, NY 10016, United States
(Kotwal) University of Massachusetts, Worcester, MA, United States
(Sharma) Lincoln Medical Center, Bronx, NY, United States
(Kirtane) Columbia University Medical Center, New York-Presbyterian
Hospital, New York, NY, United States
Title
Anticoagulant therapy during primary percutaneous coronary intervention
for acute myocardial infarction: A meta-analysis of randomized trials in
the era of stents and P2Y<inf>12</inf> inhibitors.
Source
BMJ (Online). 349 (no pagination), 2014. Article Number: g6419. Date of
Publication: 2014.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To investigate the relative benefits of unfractionated heparin,
low molecular weight heparin(LMWH), fondaparinux, and bivalirudin as
treatment options for patients with ST segment elevation myocardial
infarction undergoing percutaneous coronary intervention (PCI). Design
Mixed treatment comparison and direct comparison meta-analysis of
randomized trials in the era of stents and P2Y<inf>12</inf> inhibitors.
Data sources and study selection A search of Medline, Embase, Cochrane
Central Register of Controlled Trials (CENTRAL) for randomized trials
comparing unfractionated heparin plus glycoprotein IIb/IIIa
inhibitor(GpIIb/IIIa inhibitor), unfractionated heparin, bivalirudin,
fondaparinux, or LMWH plus GpIIb/IIIa inhibitor for patients undergoing
primary PCI. Outcomes The primary efficacy outcome was short term (in
hospital or within 30 days) major adverse cardiovascular event; the
primary safety outcome was short term major bleeding. Results We
identified 22 randomized trials that enrolled 22 434 patients. In the
mixed treatment comparison models, when compared with unfractionated
heparin plus GpIIb/IIIa inhibitor, unfractionated heparin was associated
with a higher risk of major adverse cardiovascular events (relative risk
1.49 (95% confidence interval 1.21 to 1.84), as were bivalirudin (relative
risk 1.34 (1.01 to 1.78)) and fondaparinux (1.78 (1.01 to 3.14)). LMWH
plus GpIIb/IIIa inhibitor showed highest treatment efficacy, followed (in
order) by unfractionated heparin plus GpIIb/IIIa inhibitor, bivalirudin,
unfractionated heparin, and fondaparinux. Bivalirudin was associated with
lower major bleeding risk compared with unfractionated heparin plus
GpIIb/IIIa inhibitor (relative risk 0.47 (0.30 to 0.74)) or unfractionated
heparin (0.58 (0.37 to 0.90)). Bivalirudin, followed by unfractionated
heparin, LMWH plus GpIIb/IIIa inhibitor, unfractionated heparin plus
GpIIb/IIIa inhibitor, and fondaparinux were the hierarchy for treatment
safety. Results were similar in direct comparison meta-analyses:
bivalirudin was associated with a 39%, 44%, and 65% higher risk of
myocardial infarction, urgent revascularization, and stent thrombosis
respectively when compared with unfractionated heparin with or without
GpIIb/IIIa inhibitor. However, bivalirudin was associated with a 48% lower
risk of major bleeding compared with unfractionated heparin plus
GpIIb/IIIa inhibitor and 32% lower compared with unfractionated heparin
alone. Conclusions In patients undergoing primary PCI, unfractionated
heparin plus GpIIb/IIIa inhibitor and LMWH plus GpIIb/IIIa inhibitor were
most efficacious, with the lowest rate of major adverse cardiovascular
events, whereas bivalirudin was safest, with the lowest bleeding. These
relationships should be considered in selecting anticoagulant therapies in
patients undergoing primary PCI.

<46>
Accession Number
370470770
Author
Abizaid A.; Ormiston J.A.; Fajadet J.; Mauri L.; Schofer J.; Verheye S.;
Dens J.; Thuesen L.; Macours N.; Qureshi A.C.; Spaulding C.
Institution
(Abizaid) Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
(Ormiston) North Shore Hospital, Auckland, New Zealand
(Fajadet) Clinique Pasteur, Toulouse, France
(Mauri) Harvard Clinical Research Institute, Boston, MA, United States
(Schofer) Herzkatheterlabor und Praxisklinik, Hamburg, Germany
(Verheye) Middelheim Hospital, Antwerp, Belgium
(Dens) Ziekenhuis Oost-Limburg, Genk, Belgium
(Thuesen) Skejby Sygehus, Aarhus, Denmark
(Macours, Qureshi) Clinical Research, Cordis Corporation, Waterloo,
Belgium
(Macours, Qureshi) Clinical Research, Cordis Corporation, Bridgewater, NJ,
United States
(Spaulding) Hopital Europeen Georges Pompidou, Assistance Publique
Hopitaux de Paris, Paris Descartes University, Paris, France
Title
Two-year follow-up of the NEVO ResElution-I(NEVO RES-I) trial: A
randomised, multicentre comparison of the NEVO sirolimus-eluting coronary
stent with the TAXUS Liberte paclitaxel-eluting stent in de novo native
coronary artery lesions.
Source
EuroIntervention. 9 (6) (pp 721-729), 2013. Date of Publication: October
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: To assess the two-year clinical follow-up of the NEVO RES-1 study, a
randomised comparison between the NEVOTM sirolimus-eluting coronary stent
system (NEVO SES) and the TAXUS LiberteTM paclitaxel-eluting stent (TAXUS
PES). Methods and results: NEVO RES-I randomised 394 patients with single
de novo lesions with a maximum length of 28 mm and diameter of 2.5-3.5 mm
to NEVO SES (n=202) versus TAXUS PES (n=192). Six-month angiographic
results demonstrated the superiority of the NEVO SES over the TAXUS PES
for the primary endpoint, in-stent late loss. At one year, MACE (death,
emergent CABG, TLR, and MI) in the NEVO SES group was 6.1% versus 10.6% in
the TAXUS PES group (p=0.139). After two years, MACE was 7.2% in the NEVO
SES group versus 13.0% in TAXUS PES group (p=0.086). Corresponding rates
of TLR were 3.6% versus 7.6% (p=0.116). No ARC-defined definite or
probable stent thromboses (ST) were reported with NEVO SES while two
occurred with TAXUS PES. Conclusions: While not designed or powered for
clinical endpoints, individual and composite clinical endpoints
numerically favoured the NEVO SES over the TAXUS PES, with continued
separation over time up to two years. No ARC-defined definite or probable
ST was reported in the NEVO SES group at two years. Clinical trial
identifier: NCT00606333 http://www.clinicaltrials.gov &#xa9; Europa
Digital & Publishing 2013. All rights reserved.

<47>
Accession Number
612326844
Author
Tian X.; Wang Q.; Guo R.; Xu L.; Chen Q.M.; Hou Y.
Institution
(Tian, Wang, Hou) Department of Cardiology, Qianfoshan Hospital of
Shandong University, Jinan City, China
(Guo) Department of Physiology, Nanjing University of Chinese Medicine,
Nanjing City, China
(Xu) College of Medicine, Weifang Medical University, Weifang City, China
(Chen) Department of Pharmacology, College of Medicine, University of
Arizona, Tucson, AZ, United States
Title
Effects of paroxetine-mediated inhibition of GRK2 expression on depression
and cardiovascular function in patients with myocardial infarction.
Source
Neuropsychiatric Disease and Treatment. 12 (pp 2333-2341), 2016. Date of
Publication: 13 Sep 2016.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Paroxetine is a selective serotonin reuptake inhibitor
utilized in the treatment of depression and anxiety disorders. Recent
studies have identified paroxetine as a G protein-coupled receptor
kinase-2 (GRK2) inhibitor capable of reversing cardiac dysfunction and
remodeling in experimental models of acute myocardial infarction (AMI). We
determine the clinical importance of paroxetine on cardiac functions in
patients having AMI with depression (AMID) in comparison with fluoxetine,
an unrelated selective serotonin reuptake inhibitor that does not inhibit
GRK2. Methods: Diagnosis of depression was based on the 17-item Hamilton
Depression Scale and Self-rating Depression Scale in AMI patients after
hospital admission. AMID patients were randomly assigned to paroxetine or
fluoxetine for treatment of depression. Heart rate variability and cardiac
function were evaluated. GRK2 protein levels were measured using
peripheral lymphocytes and Western blot. Results: GRK2 expression in AMID
patients was significantly higher than that in AMI patients without
depression. In AMID patients, GRK2 levels were positively correlated with
the 17-item Hamilton Depression Scale and the Self-rating Depression Scale
scores, and negatively correlated with heart rate variability. Treatment
of AMID patients with paroxetine significantly reduced the expression of
GRK2, normalized the autonomic nervous system function, and improved
cardiac performance. In contrast, fluoxetine normalized the autonomic
nervous system but did not reduce the expression of GRK2 nor improved
cardiac performance. Conclusion: This study suggests that paroxetine is
effective for improving cardiac function in patients with AMID and such
effect correlates with GRK2 reduction. Copyright &#xa9; 2016 Tian et al.

<48>
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.

<49>
Accession Number
610892281
Author
Barilla F.; Pannarale G.; Torromeo C.; Paravati V.; Acconcia M.C.;
Tanzilli G.; Mangieri E.; Dominici T.; Martino F.; Pannitteri G.; Gaudio
C.
Institution
(Barilla, Pannarale, Torromeo, Paravati, Acconcia, Tanzilli, Mangieri,
Dominici, Pannitteri, Gaudio) Department of Cardiovascular, Respiratory,
Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University
of Rome, Rome, Italy
(Martino) Department of Pediatrics and Child Neuropsychiatry, Sapienza
University of Rome, Rome, Italy
(Barilla) Cardiac Intensive Care Unit "B", Dipartimento Cuore e Grossi
Vasi "Attilio Reale", Sapienza University of Rome, Viale del Policlinico
155, Rome 00161, Italy
Title
Ivabradine in Patients with ST-Elevation Myocardial Infarction Complicated
by Cardiogenic Shock: A Preliminary Randomized Prospective Study.
Source
Clinical Drug Investigation. 36 (10) (pp 849-856), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer International Publishing
Abstract
Background and objective: An elevated heart rate (HR) is an independent
risk factor for mortality and morbidity in patients with acute heart
failure (HF). The purpose of this study was to evaluate the impact of
ivabradine, a selective HR-lowering agent, in patients with cardiogenic
shock (CS) complicating ST-elevation acute myocardial infarction (AMI).
Methods: Patients with post-AMI CS were randomized to standard treatment
(SDT, 28 patients) or to standard treatment plus ivabradine (I + SDT, 30
patients). In the presence of orotracheal intubation (OTI), ivabradine was
administered by nasogastric intubation. HR, BP, New York Heart Association
(NYHA) class, NT-proBNP, left ventricular ejection fraction (LVEF) and
diastolic function (LVDF) were monitored at specific times after the onset
of AMI. The primary (surrogate) end-point was the in-hospital halving of
plasma NT-proBNP levels. The secondary end-points were cardiovascular
death, hospital re-admission for worsening HF, and clinical and
haemodynamic improvement. Results: Treatment groups were statistically
similar with regard to age, gender distribution, cardiovascular risk
factors, number of diseased vessels and overall treated lesions, AMI site
and occurrence of OTI. In-hospital mortality was double in the SDT group
in comparison with the I + SDT group (14.3 vs. 6.7 %), but the difference
was not statistically significant. HR, BP, NT-proBNP and LVEF favorably
changed in both groups, but the change was more relevant in the I + SDT
group. LVDF significantly changed only in the I + SDT group (p < 0.01).
Patients in the I + SDT group did not experience adverse effects.
Conclusion: Ivabradine in CS complicating AMI is safe, is associated with
a short-term favourable outcome and can be effectively administered by
nasogastric intubation. Copyright &#xa9; 2016, Springer International
Publishing Switzerland.

<50>
Accession Number
612358144
Author
Ammar A.; Mahmoud K.; Kasemy Z.; Helwa M.
Institution
(Ammar, Mahmoud) Anesthesiology Department, Minoufiya Faculty of Medicine,
Minoufiya University, 2 Yaseen Abdel-Ghaffar Street, Shibin Al Kawm,
Minoufiya 32511, Egypt
(Kasemy) Statistics and Community Medicine Department, Minoufiya Faculty
of Medicine, Minoufiya University, Minoufiya, Egypt
(Helwa) Clinical Pathology Department, Minoufiya Faculty of Medicine,
Minoufiya University, Minoufiya, Egypt
Title
Cardiac and renal protective effects of dexmedetomidine in cardiac
surgeries: A randomized controlled trial.
Source
Saudi Journal of Anaesthesia. 10 (4) (pp 395-401), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Cardiac and renal injuries are common insults after cardiac
surgeries that contribute to perioperative morbidity and mortality.
Dexmedetomidine has been shown to protect several organs against
ischemia/reperfusion-(I/R) induced injury. We performed a randomized
controlled trial to assess the effect of dexmedetomidine on cardiac and
renal I/R injury in patients undergoing cardiac surgeries. Materials and
Methods: Fifty patients scheduled for elective cardiac surgeries were
randomized to dexmedetomidine group that received a continuous infusion of
dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 mug/kg
over 15 min, followed by 0.5 mug/kg/h) until 6 h after surgery, whereas
the control group received an equivalent volume of physiological saline.
Primary outcome measures included myocardial-specific proteins
(troponin-I, creatine kinase-MB), urinary-specific kidney proteins
(N-acetyl-beta-D-glucosaminidase, alpha-1-microglobulin, glutathione
transferase-pi, glutathione transferase alpha), serum proinflammatory
cytokines (tumor necrosis factor alpha and interleukin-1 beta),
norepinephrine, and cortisol levels. They were measured within 5 min of
starting anesthesia (T<inf>0</inf>), at the end of surgery
(T<inf>1</inf>), 12 h after surgery (T<inf>2</inf>), 24 h after surgery
(T<inf>3</inf>), 36 h postoperatively (T<inf>4</inf>), and 48 h
postoperatively (T<inf>5</inf>). Furthermore, creatinine clearance and
serum cystatin C were measured before starting surgery as a baseline, and
at days 1, 4, 7 after surgery. Results: Dexmedetomidine reduced cardiac
and renal injury as evidenced by lower concentration of
myocardial-specific proteins, kidney-specific urinary proteins, and
pro-inflammatory cytokines. Moreover, it caused higher creatinine
clearance and lower serum cystatin C. Conclusion: Dexmedetomidine provided
cardiac and renal protection during cardiac surgery. Copyright &#xa9; 2016
Saudi Journal of Anesthesia Published by Wolters Kluwer - Medknow.

<51>
Accession Number
612297135
Author
Chen S.-L.; Han Y.-L.; Chen L.-L.; Qiu C.-G.; Jiang T.-M.; Tao L.; Zeng
H.; Li L.; Xia Y.; Gao C.; Santoso T.; Paiboon C.; wang Y.; Kwan T.W.;
Zhang J.-J.; Ye F.; Tian N.-L.; Liu Z.-Z.; Lin S.; Lu C.; Wen S.; Hong L.;
Zhang Q.; Sheiban I.; Xu Y.; Wang L.; Chen S.-Y.; Li Z.; Cheng G.; Cui L.
Institution
(Chen, Tian, Liu) Division of Cardiology, Nanjing First Hospital, Nanjing
Medical University, Nanjing, Jiangsu, China
(Han) Division of Cardiology, Shenyang Northen Hospital, Shenyang,
Liaonin, China
(Chen) Division of Cardiology, United Hospital, Fujian Medical University,
Fuzhou, Fujian, China
(Qiu) Division of Cardiology, First Hospital, Zhengzhou University,
Zhengzhou, China
(Jiang) Division of Cardiology, Armed Police Medical University, Tianjin,
China
(Tao) Division of Cardiology, Xijin Hospital, 4th Military Medical
University, China
(Zeng) Division of Cardiology, Wuhan Tongji Hospital, United Medical
University, China
(Li) Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
Guangdong, China
(Xia) Division of Cardiology, Xuzhou Medical University affiliated
Hospital, Xuzhou, China
(Gao) Division of Cardiology, Henan Provincial People's Hospital,
Zhenzhou, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia Medical School, Jakarta, Indonesia
(Paiboon) Division of Cardiology, Bankok General Hospital, Bangkok,
Thailand
(wang) Division of Cardiology, Zhongshan Hospital, Xiamen University,
Xiamen, China
(Kwan) Division of Cardiology, Beth Israel Hospital, New York, NY, United
States
(Zhang, Ye, Lin) Division of Cardiology, Nanjing Heart Center, Nanjing,
Jiangsu, China
(Lu) Division of Cardiology, Tianjin 1st Central Hospital, Tianjin, China
(Wen) Division of Cardiology, Daqin Oil General Hospital, Daqin,
Heilongjiang, China
(Hong) Division of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, China
(Zhang) Division of Cardiology, Shanghai Ruijing Hospital, Shanghai
Communication University, Shanghai, China
(Sheiban) Division of cardiology, Turino University Hospital, Turino,
Italy
(Xu) Division of Cardiology, Shanghai 10th People's Hospital, Shanghai
Tongji University, Shanghai, China
(Wang) Division of Cardiology, Beijing Chaoyang Hospital, Beijing, China
(Chen) Division of Cardiology, Xuchang People's Hospital, Henan, China
(Li) Division of Cardiology, Liaoning Provincial People's Hospital,
Shenyang, China
(Cheng) Division of Cardiology, Huaihe Hospital, Henan University,
Kaifeng, China
(Cui) Division of Cardiology, Shandong Provincial Hospital, Shandong
University, Jinan, China
Title
Design and rationale for the treatment effects of provisional side branch
stenting and DK crush stenting techniques in patients with unprotected
distal left main coronary artery bifurcation lesions (DKCRUSH V) Trial.
Source
Clinical Trials and Regulatory Science in Cardiology. 22 (pp 4-9), 2016.
Date of Publication: 01 Oct 2016.
Publisher
Elsevier
Abstract
Background Provisional stenting (PS) is effective for great majority of
patients with coronary bifurcation lesions. Double kissing (DK) crush
approach demonstrated significant reduction of target lesion
revascularization (TLR) for patients with more complex bifurcation lesion
when compared with PS. Furthermore, DK crush technique was associated with
lower rate of composite major adverse cardiac event (MACE),
revascularization and stent thrombosis (ST) for patients with unprotected
distal left main coronary artery bifurcation lesions (ULMb), compared to
culotte stenting approach. The DKCRUSH V trial is designed to elucidate
the benefits of DK crush over PS in patients with ULMb. Study design
DKCRUSH V is a randomized, prospective, multinational clinical trial
designed to evaluate the efficacy and safety of DK crush over PS for
patients with ULMb. Subjects with Medina 1,1,1 or 0,1,1 ULMb will be
randomized in a 1:1 fashion to PS or DK crush. The primary endpoint is
target lesion failure (TLF) including target vessel myocardial infarction,
cardiac death and TLR. Other endpoints address individual event of primary
endpoint, and target vessel revascularization. The safety objective is the
ST. Recruitment began in January 2012 and was completed in December 2015;
484 patients were randomized. The trial will continue until at least 56
adjudicated primary endpoints occur. Conclusions The DKCRUSH V study is
investigating if DK crush approach versus PS will reduce the incidence of
TLF in patients with symptomatic ULMb. Copyright &#xa9; 2016 The Authors

<52>
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.

<53>
Accession Number
610583378
Author
Karjalainen P.P.; Airaksinen J.K.E.; de Belder A.; Romppanen H.; Kervinen
K.; Sia J.; Laine M.; Nammas W.
Institution
(Karjalainen, Nammas) Heart Center, Satakunta Central Hospital, Pori,
Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
(de Belder) Department of Cardiology, Brighton and Sussex University
Hospital NHS Trust, Brighton, United Kingdom
(Romppanen, Kervinen) Medical Research Center, Oulu University Hospital,
and University of Oulu, Oulu, Finland
(Sia) Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
(Laine) Helsinki University Hospital, Helsinki, Finland
Title
Long-term outcome of early percutaneous coronary intervention in diabetic
patients with acute coronary syndrome: insights from the BASE ACS trial.
Source
Annals of Medicine. 48 (5) (pp 376-383), 2016. Date of Publication: 03 Jul
2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: The BASE ACS trial demonstrated an outcome of
titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior
to everolimus-eluting stents (EES) in patients with acute coronary
syndrome (ACS). We performed a post-hoc analysis of diabetic versus
non-diabetic patients from the trial. Methods: We randomised 827 patients
(1:1) with ACS to receive either BAS or EES. The primary endpoint was
major adverse cardiac events (MACE): a composite of cardiac death,
non-fatal myocardial infarction (MI) or ischaemia-driven target lesion
revascularisation (TLR). Follow-up was planned yearly through 7 years.
Results: Of 827 patients, 140 (16.9%) were diabetic; of these, 36 (25.7%)
were insulin-treated. Mean follow-up duration was 4.2 +/- 1.9 years. MACE
was more frequent in diabetics versus non-diabetics (23.6% versus 13.7%,
respectively, p = 0.003), mainly driven by more frequent cardiac death
(7.9% versus 2.2%, respectively, p = 0.002). The rates of non-fatal MI,
ischaemia-driven TLR were comparable (p > 0.05 for all). In diabetic
patients, MACE was comparable between the two stent arms (18.5% versus
28.0%, for BAS versus EES, respectively, p = 0.18). Conclusions: Diabetic
patients treated with early percutaneous coronary intervention for ACS had
worse long-term outcome, compared with non-diabetics, mainly driven by
more frequent cardiac death. The long-term outcome of BAS was comparable
to EES in diabetics. Key Messages Diabetic patients presenting with acute
coronary syndrome who were treated with early percutaneous coronary
intervention had worse long-term clinical outcome, compared with
non-diabetics, mainly driven by a high incidence of cardiac death. Age
independently predicted both major adverse cardiac events and cardiac
death in diabetic patients. The long-term clinical outcome of
titanium-nitride-oxide-coated bioactive stents was comparable to that of
everolimus-eluting stents in the diabetic, as well as in the non-diabetic
subgroup. Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor &
Francis Group.

<54>
Accession Number
612344918
Author
Karakisi S.O.; Kunt A.G.; Bozok A.; Cankaya D.; Kocakulak M.; Muabak U.;
Sargon M.F.; Ergene A.; Lhan G.; Karamustafa H.; Tufekci N.; Ener E.
Institution
(Karakisi, Bozok, Ergene, Lhan, Karamustafa, Tufekci) Department of
Cardiovascular Surgery, Faculty of Medicine, Recep Tayyip Erdogan
University, Training and Research Hospital, Rize, Turkey
(Kunt, Ener) Department of Cardiovascular Surgery, Faculty of Medicine,
Yldrm Beyazd University, Ataturk Training and Research Hospital, Ankara,
Turkey
(Cankaya, Kocakulak) Department of Biomedical Engineering, Baskent
University, Ankara, Turkey
(Muabak) Department of Immunology, Gulhane Military Medical Academy and
School of Medicine, Ankara, Turkey
(Sargon) Department of Anatomy, Faculty of Medicine, Hacettepe University,
Ankara, Turkey
Title
Humoral immune response and coated or uncoated oxygenators during
cardiopulmonary bypass surgery.
Source
Cardiovascular Journal of Africa. 27 (4) (pp 242-245), 2016. Date of
Publication: July-August 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Aim: To investigate and compare uncoated and phosphorylcholine-coated
oxygenators in terms of induction of humoral immune response during
coronary artery bypass surgery. Methods: A total of 20 consecutive
patients who underwent coronary artery bypass surgery were randomly
distributed into two groups according to the type of oxygenator used
during surgery. Group 1 consisted of 10 patients who were operated on
using phosphorylcholine-coated oxygenators. Group 2 contained 10 patients
who underwent surgery using uncoated oxygenators. Blood and oxygenator
fibre samples were obtained and compared in terms of immunoglobulins (IgG,
IgM), complements (C3c, C4), serum total protein and albumin levels using
electron microscopy and flow cytometry. Results: In group 1, levels of
IgM, IgG, total protein and serum albumin were significantly increased at
the end of cardiopulmonary bypass (CPB) compared to those at the beginning
of CPB. In group 2, C3c and C4 levels at the beginning of CPB were found
to be significantly higher than at the end. Electron microscopic
examination of oxygenator fibres demonstrated that
phosphorylcholine-coated fibres were less likely to be adsorbed by serum
proteins and complements than the uncoated fibres. Conclusion: Our results
indicate that phosphorylcholine-coated oxygenators seemed to induce
humoral immune response to a lesser extent than uncoated oxygenators
during coronary artery bypass procedures.

<55>
Accession Number
612265871
Author
Wang Y.; Tao Y.
Institution
(Wang, Tao) Department of Pediatrics, West China Second University
Hospital, Sichuan University, No.20, Section 3, Renmin Nan Lu, Chengdu,
Sichuan Province 610041, China
(Wang) Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases
and Birth Defects, Ministry Education, West China Second University
Hospital, Sichuan University, Sichuan, China
Title
Diagnosis and treatment of congenital abdominal aortic aneurysm: A
systematic review of reported cases.
Source
Orphanet Journal of Rare Diseases. 10 (1) (no pagination), 2015. Article
Number: 4. Date of Publication: 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Congenital abdominal aortic aneurysm (AAA) is distinctly rare
in infants and children and carries a high mortality rate. Our objective
was to summarize the experience of the diagnosis and treatment in patients
with congenital AAA. Methods: Reported cases of congenital AAA published
prior to November 8, 2014, were identified through PubMed, EMBASE, Web of
Science, and reference lists. All selected cases were evaluated for main
clinical characteristics. Results: Twenty-six cases of congenital AAA were
identified in the English language literature. Congenital AAA occurred
primarily in children under three years old, but it was also found in
young adults and fetuses. With regards to the localization, the great
majority of congenital AAA was infrarenal AAA. The majority of the AAA
patients lacked specific symptoms, and a painless pulsatile abdominal mass
was the most common clinical presentation. The diagnosis of AAA was based
on ultrasound scanning in twenty-five cases, multi-slice spiral computed
tomography angiography (MSCTA) in sixteen cases, and magnetic resonance
angiography (MRA) in nine cases. Histopathological analyses were available
in seven cases. Seven patients received conservative management. Surgical
treatment was performed in seventeen cases, and open repair with an
artificial graft was the main surgical intervention. The mortality
associated with congenital AAA was high (30.76%). Ruptured aneurysm and
renal failure were the main causes of death. Conclusions: Good outcomes
can be achieved in children with early identification of congenital AAA
and individualized surgical repair with grafts. Copyright &#xa9; 2015 Wang
and Tao.; licensee BioMed Central.

<56>
[Use Link to view the full text]
Accession Number
607372120
Author
Bittl J.A.; He Y.; Lang C.D.; Dangas G.D.
Institution
(Bittl) Cardiac Catherization Laboratory, Munroe Regional Medical Center,
1221 SE 5th St, Ocala, FL, United States
(He) Office of Research and Methodology, National Center for Health
Statistics, Hyattsville, MD, United States
(Lang) Division of Cardiology, Eastern Maine Medical Center, Bangor, ME,
United States
(Dangas) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Title
Factors Affecting Bleeding and Stent Thrombosis in Clinical Trials
Comparing Bivalirudin with Heparin during Percutaneous Coronary
Intervention.
Source
Circulation: Cardiovascular Interventions. 8 (12) (no pagination), 2015.
Article Number: e002789. Date of Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Patients treated with bivalirudin in randomized clinical trials
of percutaneous coronary intervention generally have less bleeding but
more acute stent thrombosis (ST) than do patients treated with heparin,
but differences have varied among trials. Methods and Results-We modeled
the risk of major hemorrhage and ischemic outcomes 30 days after
percutaneous coronary intervention by treatment assignment and the use of
adjunctive therapies in 18 randomized clinical trials enrolling 41 871
patients. Overall bivalirudin caused less major bleeding (odds ratio [OR],
0.64; 95% confidence interval [CI], 0.53-0.76), more ST (OR, 1.58; 95% CI,
1.19-2.09), and no difference in mortality (OR, 0.93; 95% CI, 0.77-1.14)
than heparin. A risk-benefit analysis identified 19 fewer bleeds and 5
more STs for every 1000 patients treated with bivalirudin in place of
heparin. No significant bleeding advantage of bivalirudin over heparin
could be identified in randomized clinical trials when transradial access
(OR, 0.89; 95% CI, 0.57-1.41) and planned glycoprotein IIb/IIIa inhibitors
were used with bivalirudin in the majority of patients (OR, 1.07; 95% CI,
0.87-1.31). The use of prasugrel or ticagrelor eliminated bleeding
differences (OR, 0.80; 95% CI, 0.63-1.03) but did not reduce the risk of
ST after bivalirudin (OR, 2.20; 95% CI, 1.48-3.27).
Conclusions-Substituting bivalirudin for heparin conferred a tradeoff
between bleeding and ST. Transradial access, adjunctive glycoprotein
IIb/IIIa inhibitors, and potent P2Y12 inhibitors attenuated the bleeding
advantage of bivalirudin over heparin but had no apparent effect on early
ST. New approaches to reduce bleeding and ischemic complications during
percutaneous coronary intervention warrant further investigation.

<57>
Accession Number
607393194
Author
Puttagunta H.; Holt S.G.
Institution
(Puttagunta) Royal Melbourne Hospital, Melbourne, Australia
(Holt) The University of Melbourne, Melbourne, Australia
Title
Peritoneal dialysis for heart failure.
Source
Peritoneal Dialysis International. 35 (6) (pp 645-649), 2015. Date of
Publication: November 2015.
Publisher
Multimed Inc.
Abstract
Heart failure (HF) is a common and important cause of morbidity and
mortality in the elderly, imposing a significant burden on healthcare
systems. Better management of ischemic heart disease has resulted in
increased survival and growth in the number of prevalent heart failure
patients, but co-existing renal impairment complicates management and
limits traditional therapeutic options. Ultrafiltration (UF) techniques
have shown promise in the treatment of diuretic-resistant HF, but the
early successes of extracorporeal treatments has not been confirmed by
randomized trials. Peritoneal dialysis (PD) may be cheaper and provide
more effective UF therapy in selected patients and this review examines
the issues surrounding the use of PD for such patients. Whist many
nephrologists are enthusiastic about the use of this technique, making a
more cogent case for PD in this setting for cardiologists is likely to
need a combined strategy of demonstrating improvement in individual cases
and further study of potential medicoeconomic benefits. Copyright &#xa9;
2015 International Society for Peritoneal Dialysis.

<58>
Accession Number
612122942
Author
Guclu C.Y.; Unver S.; Aydinli B.; Kazanci D.; Dilber E.; Ozgok A.
Institution
(Guclu, Unver, Aydinli, Kazanci, Dilber, Ozgok) Turkiye Yuksek Ihtisas
Education and Research Hospital, Clinic of Anesthesia and Reanimation,
Ankara, Turkey
Title
The effect of sevoflurane vs. TIVA on cerebral oxygen saturation during
cardiopulmonary bypass - Randomized trial.
Source
Advances in Clinical and Experimental Medicine. 23 (6) (pp 919-924), 2014.
Date of Publication: 01 Nov 2014.
Publisher
Wroclaw University of Medicine
Abstract
Background. Neuropsychological and neurological deficits are still major
causes of mortality and morbidity after cardiac surgery. These
complications are thought to be caused by embolisms and cerebral hypoxia.
Thus, continuous neuromonitoring is essential during cardiac surgery due
to cerebral oxygen desaturation during different periods. Near-infrared
spectrophotometry (NIRS), a non-invasive method, appears to offer many
advantages for monitoring cerebral oxygenation and hemodynamics.
Desaturation of cerebral oxygen may occur at the beginning of
cardiopulmonary bypass (CPB) or during the low perfusion and rewarming
stages if not corrected. Objectives. This study was designed to assess the
effects of sevoflurane on cerebral protection during CPB. Material and
Methods. Eighty patients were divided into two groups. Anesthesia was
maintained either with fentanyl and midazolam (total intravenous
anesthesia, TIVA) or with one minimum alveolar concentration of
sevoflurane and fentanyl. Cerebral desaturation was defined as an absolute
decrease in saturation of 20% from baseline cerebral saturation. When
desaturation occurred, PaCO<inf>2</inf>, hematocrit and PaO<inf>2</inf>
levels were checked and corrected. If desaturation continued, anesthetic
depth was increased to reserve saturation with 50-100 mg of propofol. NIRS
values and hemodynamics were recorded at predetermined time intervals.
Results. Cerebral oxygen saturation values on the right side were higher
in the sevoflurane group than in the TIVA group. The values on the left
side were higher in the sevoflurane group than in the TIVA group, and
meaningful differences were seen at the lowest temperature and at
36degreeC. Conclusions. Oxygen saturation was higher in the sevoflurane
group than in the TIVA group. Thus, the effect of sevoflurane was useful
for maintaining cerebral oxygen saturation during CBP. &#xa9; Copyright by
Wroclaw Medical University.

<59>
Accession Number
612550874
Author
Mans C.M.; Reeve J.C.; Elkins M.R.
Institution
(Mans) Physiotherapy Department, Waikato Hospital, Hamilton, New Zealand
(Reeve) Division of Rehabilitation and Occupation Studies, AUT University,
Auckland, New Zealand julie.reeve@aut.ac.nz
(Elkins) Royal Prince Alfred Hospital, Sydney, Australia
Title
Postoperative outcomes following preoperative inspiratory muscle training
in patients undergoing cardiothoracic or upper abdominal surgery: a
systematic review and meta analysis.
Source
Clinical rehabilitation. 29 (5) (pp 426-438), 2015. Date of Publication:
01 May 2015.
Abstract
OBJECTIVE: To evaluate whether preoperative inspiratory muscle training is
effective in preventing postoperative pulmonary complications and reducing
length of hospital stay in people undergoing cardiothoracic or upper
abdominal surgery.
DATA SOURCES: Medline, CINAHL, AMED, PsychINFO, Scopus, PEDro, and the
Cochrane Library.
REVIEW METHODS: A systematic review and meta analysis of randomized
controlled trials (or quasi-randomized controlled trials) investigating a
form of preoperative inspiratory muscle training, compared with sham or no
inspiratory muscle training. Participants were adults (16years and over)
awaiting elective open cardiac, thoracic, or upper abdominal surgery.
Methodological quality was assessed using the PEDro scale.
RESULTS: Eight studies involving 295 participants were eligible for
inclusion. The trained group had significantly higher maximal inspiratory
pressure at the end of the preoperative training period (mean difference:
15cmH2O, 95% confidence interval (CI): 9 to 21). This benefit was
maintained through the early postoperative period, when lung function also
recovered significantly more quickly in the trained group. Inspiratory
muscle training also substantially reduced postoperative pulmonary
complications (relative risk 0.48, 95% CI 0.26 to 0.89). Although not
statistically significant, length of hospital stay also tended to favour
the trained group. There were no statistically significant differences
between the groups for the remaining outcomes. Participant satisfaction
with inspiratory muscle training was high.
CONCLUSION: Preoperative inspiratory muscle training significantly
improves respiratory (muscle) function in the early postoperative period,
halving the risk of pulmonary complications. The training does not
increase length of stay, but more data are required to confirm whether it
reduces length of stay. Copyright &#xa9; The Author(s) 2014.

<60>
Accession Number
612590608
Author
Wilczynski M.; Wybraniec M.T.; Milewski K.; Sanak M.; Wita K.; Buldak L.;
Kondys M.; Buszman P.; Bochenek A.
Institution
(Wilczynski, Bochenek) Department of Cardiac Surgery, Medical University
of Silesia, 47 Ziolowa St, Katowice 40-635, Poland
(Wybraniec, Wita) First Department of Cardiology, School of Medicine in
Katowice, Medical University of Silesia, Katowice, Poland
(Milewski, Kondys, Buszman, Bochenek) Center for Cardiovascular Research
and Development, American Heart of Poland, Katowice, Poland
(Sanak) Division of Molecular Biology and Clinical Genetics, Jagiellonian
University Medical College, Krakow, Poland
(Buldak) Department of Internal Medicine and Clinical Pharmacology,
Medical University of Silesia, Katowice, Poland
Title
Eptifibatide infusion versus placebo in high risk patients with non-ST
segment elevation acute coronary syndromes managed with urgent coronary
artery bypass graft surgery. A prospective multicenter randomized
placebo-controlled clinical trial.
Source
Journal of Cardiovascular Surgery. 57 (1) (pp 100-110), 2016. Date of
Publication: February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: This randomized prospective clinical trial aimed to evaluate
safety and efficacy of preoperative use of eptifibatide in high risk
patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS),
requiring urgent coronary artery bypass graft surgery (CABG). METHODS: A
total of 140 patients with NSTE-ACS eligible for urgent surgical
revascularization received either eptifibatide (bolus plus infusion) 12-48
hours prior to surgery (N.=72 patients) or placebo (normal saline; N.=68
patients) followed by routinely administered enoxaparin and aspirin.
Patients were regarded as unsuitable for percutaneous coronary
intervention by the heart team. CABG was performed 4 hours after
discontinuation of eptifibatide or placebo infusion. The primary end point
was major adverse cardiac and cerebrovascular events (MACCE) defined as
death, nonfatal myocardial infarction (MI), stroke and the need for
rehospitalization due to recurrent ischemia at 12-month follow-up.
Secondary endpoints included MACCE rate at 1 month, bleeding
complications, platelet inhibition efficacy and correlation of platelet
activity with MACCE rate. RESULTS: Cumulative one year MACCE rate was 35%
vs. 14% in the control and treated group respectively (P=0.012). Mortality
rate at 30 days follow-up was 10% vs. 3% (P=0.021) and was not changed at
12-month follow-up. There was a significant difference between both groups
regarding perioperative MI (22% vs. 8%, P=0.03). The rates of stroke,
blood loss and blood transfusion were similar in both groups. CONCLUSION:
Preoperative use of eptifibatide vs. placebo is linked to significantly
reduced 12-month MACCE rate in patients with NSTEACS requiring urgent
CABG, while it simultaneously seems not to confer a greater risk of
postoperative bleeding.

<61>
Accession Number
612590603
Author
Xu Z.; Wang Z.-P.; Ou J.-S.; Yin S.-L.; Liu L.-J.; Zhang X.
Institution
(Xu, Wang, Ou, Yin, Zhang) Division of Cardiac Surgery, First Affiliated
Hospital of Sun Yat-sen University, 58 Zhong Shan Road II, Guangzhou,
Guangdong 510080, China
(Liu) Division of Cardiology, First Affiliated Hospital of Sun Yat-sen
University, Guangzhou, Guangdong, China
Title
Is low anticoagulation intensity more beneficial for patients with
bileaflet mechanical mitral valves? A meta-Analysis.
Source
Journal of Cardiovascular Surgery. 57 (1) (pp 90-99), 2016. Date of
Publication: February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: For the mitral valve replacement (MVR) using the lowest
thrombogenic risk bileaflet valves (St. Jude Medical [St Paul, MN, USA],
Carbomedics [Austin, TX, USA] and On-X [Austin, TX, USA]), excellent
results can be achieved by adopting the anticoagulation intensity (median
INRP<2.5) which is lower than the recommended intensity (INR:2.5~3.5). Our
aim was to provide a pooled estimate of potential benefit from clinical
studies using low anticoagulation intensity and high intensity in these
patients. METHODS: Relevant studies published before February 2014 were
searched through a number of digital databases (MEDLINE, EMBASE, Cochrane
Library, etc.). They were pooled by SPSS19.0 using the random effect
method in three fields: occurrence rate of major thromboembolism, major
hemorrhage and major total events. Fourteen studies with 3595 patients
were included. The follow-up period was 12,846.6 patient-years. RESULTS:
Pooled estimates indicated reduction in major hemorrhage (RR:0.420, 95%CI:
0.296~0.595, PP<0.001) and major total events (RR: 0.738, 95%CI:
0.604~0.902, P=0.003) in the low intensity group. No difference was noted
in major thromboembolism (RR: 1.045, 95%CI: 0.814~1.341, P=0.75).
CONCLUSION: Compared with the recommended high intensity, low
anticoagulation intensity (median INRP<2.5) may be more beneficial for the
MVR patients using the lowest thrombogenic risk bileaflet valves. We
recommended an INR between 2.0 and 2.5, with a median INR of 2.3 for these
MVR patients.

<62>
Accession Number
612460532
Author
Vannucci F.; Gonzalez-Rivas D.
Institution
(Vannucci) Department of Thoracic Surgery, Hospital Federal do Andarai,
Rio de Janeiro, Brazil
(Vannucci) Department of Thoracic Surgery, Hospital Central da Policia
Militar (HCPM), Rio de Janeiro, Brazil
(Gonzalez-Rivas) Department of Thoracic Surgery and Lung Transplant,
Coruna University Hospital, Coruna, Spain
(Gonzalez-Rivas) Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna,
Spain
(Gonzalez-Rivas) Department of Thoracic Surgery, Shanghai Pulmonary
Hospital, Tongji University School of Medicine, Shanghai, China
Title
Is VATS lobectomy standard of care for operable non-small cell lung
cancer?.
Source
Lung Cancer. 100 (pp 114-119), 2016. Date of Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is
being increasingly applied worldwide in the last few years. Since its
introduction, many publications have been providing strong evidences that
this minimally invasive approach is feasible, safe and oncologically
efficient; offering to patients several advantages over traditional open
thoracotomy, particularly for early-stage disease (I and II). The
application of VATS for locally advanced disease treatment has also been
largely described, but probably requires a further level of experience,
which is more likely to be found in reference centers, with skilled
experts. Although a large multi-institutional prospective
randomized-controlled trial is the best way to confirm the superiority of
one technique over another, such study comparing VATS versus open
lobectomy for lung cancer is unlikely to ever come out. And in this
scenario, retrospective data remains as the most reliable source of
scientific information. Based on a literature review, the main objective
of this article is to discuss to what extent VATS lobectomy can be
considered the gold standard in the surgical treatment of lung cancer,
taking into account the most important comparison aspects between the
minimally invasive approach and open thoracotomy technique. This review
addresses questions regarding lymph node dissection, oncologic efficacy,
extended resections beyond standard lobectomy, post-operative
complications/pain/quality of life, survival rates and the present limits
of indication (and contraindication) for VATS, in order to define the real
role of this technique on the surgical treatment of lung cancer in a
minimally invasive, but safe and effective manner. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<63>
Accession Number
612521490
Author
Chemtob R.A.; Eskesen T.G.; Moeller-Soerensen H.; Perner A.; Ravn H.B.
Institution
(Chemtob, Moeller-Soerensen, Ravn) Department of Cardiothoracic
Anaesthesiology, University hospital of Copenhagen, Rigshospitalet,
Copenhagen, Denmark
(Eskesen, Perner) Department of Intensive Care, University hospital of
Copenhagen, Rigshospitalet, Copenhagen, Denmark
Title
Systematic review of the association of venous oxygenation and outcome in
adult hospitalized patients.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1367-1378), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Adequate tissue oxygenation is necessary to maintain organ
function. Low venous oxygen saturation may reflect impaired tissue
oxygenation, and may be used as a predictive tool and a therapeutic target
to improve the care of critically ill patients. We therefore conducted a
systematic review of the existing literature reflecting these aspects.
Methods: We searched electronic databases in January 2016 for relevant
studies on venous oxygen saturation for treatment guidance and patient
outcome. We sub-grouped results based on patient groups and setting.
Results: The search resulted in 5590 papers of which 42 studies were
deemed relevant. The majority of the studies in cardiac and abdominal
surgery patients showed associations between low venous oxygen saturation
and increased mortality and morbidity, in particular increased length of
intensive care. However, the cut-off level for low venous oxygen
saturation varied between < 55 and 70% and all studies had high risk of
bias. In patients with septic shock, recent randomized trials showed no
benefit of early resuscitation guided by venous oxygen saturation.
Conclusion: Low venous oxygen saturation may be associated with increased
mortality, morbidity and length of intensive care in patients following
cardiac or abdominal surgery. However, the wide range of cut-off levels
and low quality of evidence hampers the clinical application. In patients
with septic shock, the present evidence does not support goal-directed
therapy using venous oxygen saturation during early resuscitation.
Copyright &#xa9; 2016 The Acta Anaesthesiologica Scandinavica Foundation.
Published by John Wiley & Sons Ltd

<64>
Accession Number
612521465
Author
Pesonen E.; Keski-Nisula J.; Andersson S.; Palo R.; Salminen J.; Suominen
P.K.
Institution
(Pesonen) Division of Anaesthesiology, Peijas Hospital, Department of
Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland
(Keski-Nisula, Palo, Suominen) Division of Anaesthesiology, Children's
Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Andersson) Children's Hospital, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Salminen) Department of Paediatric Surgery, Children's Hospital, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
Title
High-dose methylprednisolone and endothelial glycocalyx in paediatric
heart surgery.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1386-1394), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Corticosteroids are used in paediatric heart surgery to
attenuate systemic inflammatory response. Glycocalyx regulates vascular
permeability, shear stress and cell adhesion on the endothelium.
Syndecan-1 serves as a biomarker of glycocalyx degradation. Hydrocortisone
decreased endothelial glycocalyx degradation in an experimental model. Our
hypothesis was that high-dose methylprednisolone decreases glycocalyx
degradation as measured by plasma sydecan-1 concentration in children
undergoing cardiac surgery. Methods: Two double-blinded, randomized,
placebo-controlled trials were conducted. In the first trial ('neonatal
trial'), 40 neonates undergoing open heart surgery received either 30
mg/kg intravenous methylprednisolone (n = 20) or placebo (n = 20). In the
second trial ('VSD trial'), 45 infants and very young children, undergoing
ventricular or atrioventricular septal defect correction received one of
the following: 30 mg/kg of methylprednisolone intravenously after
anaesthesia induction (n = 15), 30 mg/kg methylprednisolone in the
cardiopulmonary bypass prime solution (n = 15) or placebo (n = 15). Plasma
syndecan-1 concentrations were measured. Results were expressed both as
absolute concentrations and in relative concentrations as multiples of the
baseline values of syndecan-1. Results: There were no statistically
significant differences between the neonate trial groups for absolute
syndecan-1 concentrations. However, operative administration of
methylprednisolone to neonates significantly reduced the relative
increases of syndecan-1 at weaning from cardiopulmonary bypass (P = 0.008)
and at 6 h post-operatively (P = 0.018). There were no statistically
significant differences in absolute or relative increases of syndecan-1
between the VSD trial study groups. Conclusion: High-dose
methylprednisolone reduces shedding of glycocalyx in neonates after
complex cardiac surgery but not in older infants after repair of VSD/AVSD
with shorter ischaemia times. Copyright &#xa9; 2016 The Acta
Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons
Ltd

<65>
Accession Number
612521437
Author
Franck M.; Nerlich K.; Neuner B.; Schlattmann P.; Brockhaus W.R.; Spies
C.D.; Radtke F.M.
Institution
(Franck, Nerlich, Neuner, Brockhaus, Spies, Radtke) Department of
Anaesthesiology and Intensive Care Medicine, Campus-Virchow-Klinikum and
Campus Charite Mitte, Charite - Universitatsmedizin Berlin, Berlin,
Germany
(Schlattmann) Department of Medical Statistics, Informatics and
Documentation, University Hospital Jena, Jena, Germany
(Radtke) Anaestesiafdelingen, Naestved Sygehus, Naestved, Denmark
Title
No convincing association between post-operative delirium and
post-operative cognitive dysfunction: a secondary analysis.
Source
Acta Anaesthesiologica Scandinavica. 60 (10) (pp 1404-1414), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: Post-operative delirium and post-operative cognitive
dysfunction (POCD) are both common but it has not been clarified how
closely they are associated. We aimed to assess the possible relationship
in a secondary analysis of data from the 'Surgery Depth of anaesthesia and
Cognitive outcome'- study. Methods: We included patients aged > 60 years
undergoing non-cardiac surgery planned for longer than 60 min. Delirium
was assessed according to the Diagnostic and Statistical Manual of Mental
Disorders IV criteria in the post-anaesthesia care unit (PACU) as well as
within the first week after surgery. Cognitive function was assessed with
a neuropsychological test battery. Multivariable analysis of POCD was
performed with consideration of predisposing and precipitating factors.
Results: Of 1277 randomized patients, 850 (66.6%) had complete data.
Delirium was found in 270 patients (32.9% of 850). We detected POCD in 162
(20.9% of 776) at 1 week and in 52 (9.4% of 553) at 3 months. In
multivariable analysis (n = 808), delirium had no overall effect on POCD
(P = 0.30). Patients with no delirium in PACU but with postoperative
delirium within 7 days had an increased risk of POCD at 3 months (OR =
2.56 (95%-confidence interval: 1.07-6.16), P = 0.035). No significant
association was found for the other subgroups. Conclusions: There is no
clear evidence that postoperative delirium is independently associated
with POCD up to 3 months. Copyright &#xa9; 2016 The Acta Anaesthesiologica
Scandinavica Foundation. Published by John Wiley & Sons Ltd

<66>
Accession Number
612519799
Author
Wielandner A.; Beitzke D.; Schernthaner R.; Wolf F.; Langenberger C.;
Stadler A.; Loewe C.
Institution
(Wielandner, Beitzke, Schernthaner, Wolf, Langenberger, Loewe) Department
of Radiology, Medical University of Vienna, Vienna, Austria
(Stadler) Department of Radiology, Krankenhaus Hietzing, Vienna, Austria
Title
Is ECG triggering for motion artefact reduction in dualsource CT
angiography of the ascending aorta still required with high-pitch
scanning? The role of ECG-gating in highpitch dual-source CT of the
ascending aorta.
Source
British Journal of Radiology. 89 (1064) (no pagination), 2016. Article
Number: 20160174. Date of Publication: 2016.
Publisher
British Institute of Radiology (E-mail: publications@bir.org.uk)
Abstract
Objective: To compare electrocardiographic (ECG)- triggered high-pitch
(HP) dual-source CT angiography (CTA) with non-ECG-triggered HP CTA of the
aorta, particularly the ascending aorta, with regard to image quality,
motion artefacts, contrast-to-noise ratio (CNR), signal-to-noise ratio
(SNR) and radiation dose. Methods: 59 consecutive patients who had been
referred for CTA for known or suspected aortic disease, previous aortic
intervention or planned transapical or transfemoral aortic valve
implantation were prospectively included. Patients underwent CTAs with HP,
using a dual-source CTA system, with [control group (Group A); n=30] or
without (Group B; n=29) ECG triggering after randomization. For
evaluation, image quality and a motion artefact score (MAS) were assessed
in a blinded fashion at different predefined anatomic regions. CNR and SNR
were measured at the same levels. Radiation dose estimates and contrast
enhancement were compared between the two groups. Results: There were no
significant differences for image quality and MAS. The intra-arterial
contrast resolution was significantly higher at the level of the aortic
arch and descending aorta in the non-triggered group (CNR values,
p=0.002-0.018). No significant differences in the radiation dose were
found. Conclusion: Non-triggered HP dual-source CTA provided comparable
results with regard to image quality, MAS, CNR, SNR and radiation doses
compared with ECG-triggered HP CTA. Therefore, ECG triggering of the
ascending aorta might be obviated when HP scanning is available. Advances
in knowledge: HP dual-source CTA might obviate ECG triggering in the
ascending aorta. Nontriggered HP CTA of the ascending aorta provides an
excellent image quality. Copyright &#xa9; 2016 The Authors.

<67>
Accession Number
612590521
Author
Buyukates M.; Barut F.; Aktunc E.
Institution
(Buyukates) Department of Cardiovascular Surgery, Bulent Ecevit
University, School of Medicine, Kozlu, Zonguldak 67600, Turkey
(Barut) Department of Pathology, Bulent Ecevit University, School of
Medicine, Zonguldak, Turkey
(Aktunc) Department of Family Medicine, Bulent Ecevit University, School
of Medicine, Zonguldak, Turkey
Title
The comparison of traditional and modified harvesting techniques of left
internal mammary artery regarding endothelin-1/2/3 expression and free
flow capacity.
Source
Journal of Cardiovascular Surgery. 56 (6) (pp 913-918), 2015. Date of
Publication: December 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Aim. We have conducted this study to seek and observe visual clues through
immunohistochemical staining for differences in Et-1/2/3 expression and
the free-low capacity measuring the blood flow through grafts, in the left
internal mammary artery grafts prepared either with clipped or nonclipped
techniques. Methods. A total of 40 consecutive patients with a diagnosis
of coronary artery disease who would benefit from elective coronary artery
bypass graft surgery were randomised into two groups consisting 20
patients each. Left internal mammary artery was harvested by a traditional
clipped (control group) and a modified nonclipped (study group) technique
in each of the groups. All harvested arterial segments were evaluated for
luminal endothelial integrity through hematoxylin&eosin and
immunohistochemical staining. Results. The free-low capacity of left
internal mammary artery grafts were significantly higher in nonclipped
arteries when compared with that of clipped ones (P=0.001). The arterial
lumen of the nonclipped segments were visibly more dilated than the
clipped ones. Nonclipped segments presented a lighter immunostaining for
Et-1/2/3 when compared with the clipped ones (P<0.001). Conclusion. We
believe that lesser endothelial damage caused by the lower intraluminal
pressure in modifiedly harvested left internal mammary artery segments has
positive implications on intraoperative and postoperative cardiac events
related to graft vasospasm, especially related with endothelins. We
recommend modified left internal mammary artery harvesting in patients
going under coronary artery bypass graft operation.

<68>
Accession Number
612436941
Author
Leaver H.A.; Craig S.R.; Rotondo D.; Walker W.S.
Institution
(Leaver) Cell Biology R&D, SNBTS, Clinical Neurosciences Edinburgh
University, United Kingdom
(Craig) Department of Cardiothoracic Surgery, Golden Jubilee Hospital,
Glasgow, United Kingdom
(Rotondo) Strathclyde Institute of Pharmacy & Biomedical Sciences,
Strathclyde University, Glasgow, United Kingdom
(Walker) Division of Cardiothoracic Surgery, Royal Infirmary, Edinburgh,
United Kingdom
Title
Blood immunoglobulins, complement and TNF receptor following minimally
invasive surgery in patients undergoing pulmonary lobectomy.
Source
Current Metabolomics. 2 (3) (pp 196-203), 2014. Date of Publication: 01
Jan 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The reasons for improved survival following minimally invasive surgery
remain elusive. Circulating mediators link surgical trauma, vascular and
tissue homeostasis. Acute phase reactants, leukocytes and leukocyte
Reactive Oxygen Species (ROS) are affected differentially by minimally
invasive video-assisted thoracic surgery (VATS). Also, immunoglobulins,
complement, TNF receptor and P-selectin changes have been observed, but
the influence of minimally invasive surgery on these opsonins is less well
defined. In this prospective randomised trial, 41 patients were randomly
assigned to minimally invasive or open thoracic surgery, and
immunoglobulins and vascular endothelial damage biomarkers were analysed.
Humoral mediators (blood IgG, IgM, IgA; complement fragments C3, C4, and
complement haemolytic index of activation CH50; TNF receptors I, II and
P-selectin) were analysed before and 2, 5 and 7 days after surgery.
Post-surgical changes in individual patients were determined. Substantial
immunoglobulin decreases followed minimally invasive and open surgery.
Decreased IgG, IgM and IgE were detected 2 days after surgery, and IgG and
IgM after 7 days. These changes were greater than haemodilution, reaching
greater significance in open surgery patients. Immunoglobulin decreases
followed lymphocyte decreases. In contrast, increased complement and
inflammatory endothelial cell signals (C3 and C4, soluble TNFR-II) were
detected 7 days after surgery. In both groups, increased C3 and TNFR-II
followed early acute phase reactants CRP, IL-6 and ROS. Acute phase
reactants and CD4/CD8 lymphocytes were factors most attenuated in patients
undergoing minimally invasive thoracic surgery (VATS). This study suggests
local trauma mediators are better biomarkers than circulating opsonins in
defining the response to minimally invasive surgery, and a systems
approach, comparing individual metabolic responses, is effective in small
patient groups. Copyright &#xa9; 2014 Bentham Science Publishers.

<69>
Accession Number
612481745
Author
Vavuranakis M.; Siasos G.; Zografos T.; Oikonomou E.; Vrachatis D.;
Kalogeras K.; Papaioannou T.; Kolokathis M.-A.; Moldovan C.; Tousoulis D.
Institution
(Vavuranakis, Siasos, Zografos, Oikonomou, Vrachatis, Kalogeras,
Papaioannou, Kolokathis, Moldovan, Tousoulis) 1st Department of
Cardiology, 'Hippokration' Hospital, University of Athens Medical School,
Athens, Greece
(Siasos) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Title
Dual or single antiplatelet therapy after transcatheter aortic valve
implantation? A systematic review and meta-analysis.
Source
Current Pharmaceutical Design. 22 (29) (pp 4596-4603), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has undeniably
earned a prestigious post in the quiver of interventional cardiologists
against symptomatic severe aortic stenosis. Cerebrovascular events are
listed within the most frequent complications. Methods: We performed a
systematic search of EMBASE, MEDLINE, and the Cochrane library from
inception to March 2016 for the following search terms (transcatheter AND
antiplatelet) OR (transcatheter AND antithrombotic) to retrieve studies of
dual antiplatelet treatment (DAPT) and single antiplatelet treatment
(SAPT) in patients after TAVI to study thrombotic, hemorrhagic and
cardiovascular events at 30 days post procedure. From a total of 208
records 4 studies met inclusion criteria. Results: In the included
studies, 286 patients were enrolled in the DAPT group and 354 patients in
the SAPT group. There was no difference in all-cause mortality,
cardiovascular mortality, stroke, and myocardial infraction 30 days post
TAVI between DAPT and SAPT. However, patients in the DAPT group had a
significantly increased incidence of lethal and major bleeding at 30 days
of follow-up and the incidence of the combined end-point of stroke,
spontaneous MI, all-cause mortality and major bleeding was significantly
higher in the DAPT group in comparison to the SAPT group. Conclusion: DAPT
compared to SAPT in patients after TAVI increases incidence of hemorrhagic
events with no benefits in terms of thrombotic events and cardiovascular
mortality. However, these data must be interpreted cautiously and the
choice of DAPT over SAPT must be based on an individual patient
characteristic according to medical practice criteria. Copyright &#xa9;
2016 Bentham Science Publishers.

<70>
Accession Number
612481734
Author
Siasos G.; Mourouzis K.; Oikonomou E.; Vavuranakis M.; Vogiatzi G.;
Briasoulis A.; Papageorgiou N.; Papaioannou T.G.; Zografos T.;
Papapanagiotou A.; Papavassiliou A.G.; Stefanadis C.; Tousoulis D.
Institution
(Siasos) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School and Harvard-MIT Biomedical Engineering Center,
Massachusetts Institute of Technology, Boston, MA, United States
(Siasos, Mourouzis, Oikonomou, Vavuranakis, Vogiatzi, Briasoulis,
Papageorgiou, Papaioannou, Zografos, Tousoulis) Department of Cardiology,
'Hippokration' General Hospital, National and Kapodistrian University of
Athens, School of Medicine, Athens, Greece
(Papapanagiotou, Papavassiliou) Department of Biological Chemistry,
University of Athens Medical School, Athens, Greece
(Stefanadis) MYSM School Of Medicine, Yale University, New Haven, CT,
United States
Title
Duration of dual antiplatelet therapy after coronary stenting.
Source
Current Pharmaceutical Design. 22 (29) (pp 4583-4595), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Dual antiplatelet therapy (DAPT) is one of the cornerstones of
coronary artery disease (CAD) treatment. Standard DAPT requires one of,
P2Y12 receptor inhibitors, clopidogrel, prasugrel or ticagrelor as an
adjunct therapy to aspirin administration. The decision over DAPT duration
depends on the evaluation of thrombotic risk and the assessment of the
probability for major bleeding events. Methods: The goal of this work was
to identify which would be the appropriate combination of antiplatelet
agents and the optimal duration of DAPT, based on the patient's medical
history and clinical characteristics. A thorough search of PubMed and the
Cochrane Database was conducted in order to identify randomized controlled
trials, observational studies, current ESC and ACC/AHA guidelines and
novel articles on the subject. Results: The decision over DAPT duration is
based on a careful approach which requires the evaluation of thrombotic
risk and the assessment of the probability for major bleeding events. A
series of aspects and special conditions may influence the duration of
DAPT after stenting e.g. the type of the implanted stent (DES or BMS) or
if the commencement of DAPT is administered in the context of an acute
coronary syndrome or in the setting of stable CAD. Current guidelines can
assist clinicians in making decisions but treating patients in special
groups e.g. with diabetes mellitus or the elderly people can be very
demanding. Conclusion: Studies which examined optimal DAPT duration,
displayed controversial results, mainly observed because of the
discrepancy and heterogeneity between different study designs or the
decision of a great proportion of investigators to statistically test for
non-inferiority. A careful, patient-centered approach, which considers
thrombotic risk versus the risk for bleeding complications and other
individual characteristics and comorbidities, is required when deciding
DAPT duration. Copyright &#xa9; 2016 Bentham Science Publishers.

<71>
Accession Number
612342036
Author
Nicholson G.; Gandra S.R.; Halbert R.J.; Richhariya A.; Nordyke R.J.
Institution
(Nicholson, Halbert, Nordyke) ICON, El Segundo, United States
(Gandra, Richhariya) Amgen Inc., Thousand Oaks, CA, United States
Title
Patient-level costs of major cardiovascular conditions: A review of the
international literature.
Source
ClinicoEconomics and Outcomes Research. 8 (pp 495-506), 2016. Date of
Publication: 21 Sep 2016.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand)
Abstract
Objective: Robust cost estimates of cardiovascular (CV) events are
required for assessing health care interventions aimed at reducing the
economic burden of major adverse CV events. This review synthesizes
international cost estimates of CV events. Methods: MEDLINE database was
searched electronically for English language studies published during
2007-2012, with cost estimates for CV events of interest - unstable
angina, myocardial infarction, heart failure, stroke, and CV
revascularization. Included studies provided at least one estimate of
patient-level direct costs in adults for any identified country.
Information on study characteristics and cost estimates were collected.
All costs were adjusted for inflation to 2013 values. Results: Across the
114 studies included, the average cost was US $6,466 for unstable angina,
$11,664 for acute myocardial infarction, $11,686 for acute heart failure,
$11,635 for acute ischemic stroke, $37,611 for coronary artery bypass
graft, and $13,501 for percutaneous coronary intervention. The ranges for
cost estimates varied widely across countries with US cost estimate being
at least twice as high as European Union costs for some conditions. Few
studies were found on populations outside the US and European Union.
Conclusion: This review showed wide variation in the cost of CV events
within and across countries, while showcasing the continuing economic
burden of CV disease. The variability in costs was primarily attributable
to differences in study population, costing methodologies, and reporting
differences. Reliable cost estimates for assessing economic value of
interventions in CV disease are needed. Copyright &#xa9; 2016 Nicholson et
al.

<72>
Accession Number
612353110
Author
Cappato R.; Welsh R.
Institution
(Cappato) Arrhythmia and Electrophysiology Research Center, Humanitas
Clinical and Research Center, Rozzano, Italy
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Title
Exploring unmet needs in venous and arterial thromboembolism with
rivaroxaban.
Source
Thrombosis and Haemostasis. 116 (pp S2-S12), 2016. Date of Publication:
2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
The vast clinical research programme for the direct, oral factor Xa
inhibitor rivaroxaban has generated a wealth of data since the first
rivaroxaban approval in 2008 for the prevention of venous thrombo-embolism
(VTE) in patients undergoing elective hip or knee replacement surgery.
While rivaroxaban is widely used across a spectrum of seven indications,
there is continuous commitment to investigating its wider benefits in new
indications and attempts to refine current evidence. Key data from
recently completed randomised controlled trials (RCTs) have shown that
rivaroxaban is a feasible anticoagulation option for patients with
non-valvular atrial fibrillation (NVAF) undergoing cardioversion or
catheter ablation. Now, a number of Phase II and III RCTs are underway
that seek to uncover further roles for rivaroxaban in patients at risk of
thrombosis and aim to improve quality of life. This article will introduce
and provide context for these RCTs in the contemporary management of
arterial and venous thromboembolism in the following underserved areas:
Patients with both NVAF and acute coronary syndrome (ACS) requiring
percutaneous coronary intervention (PCI); patients with embolic stroke of
undetermined source (ESUS); patients who require transcatheter aortic
valve replacement (TAVR); patients with acute or chronic coronary artery
disease (CAD; including those with heart failure [HF]); those at risk of
or suffering from cancer-associated thrombosis (CAT) and those requiring
long-term anticoagulation. It is hoped that this collection of studies
provides clarity around the use of rivaroxaban as a fundamental component
of antithrombotic therapy in an array of clinical situations. Copyright
&#xa9; Schattauer 2016.

<73>
Accession Number
612477238
Author
Brown K.L.; Pagel C.; Brimmell R.; Bull K.; Davis P.; Franklin R.C.;
Hoskote A.; Khan N.; Rodrigues W.; Thorne S.; Smith L.; Chigaru L.; Utley
M.; Wray J.; Tsang V.; Mclean A.
Institution
(Brown, Bull, Hoskote, Smith, Chigaru, Wray, Tsang) Cardiac, Critical Care
and Respiratory Division, Great Ormond Street Hospital NHS Foundation
Trust, London, United Kingdom
(Pagel, Utley) Clinical Operational Research Unit, University College
London, London, United Kingdom
(Brimmell) Department Paediatric Cardiology and Cardiac Surgery, Evelina
London Children's Hospital, London, United Kingdom
(Davis) Paediatric Intensive Care Unit, Bristol Royal Hospital for
Children, Bristol, United Kingdom
(Franklin) Paediatric Cardiology Department, Royal Brompton and Harefield
NHS Foundation Trust, London, United Kingdom
(Khan) Department of Cardiac Surgery, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Rodrigues, Mclean) Departments of Paediatric Intensive Care and
Paediatric Cardiac Surgery, Royal Hospital for Children at Yorkhill,
Glasgow, United Kingdom
(Thorne) Department of Cardiology, University Hospital Birmingham,
Birmingham, United Kingdom
Title
Definition of important early morbidities related to paediatric cardiac
surgery.
Source
Cardiology in the Young. (pp 1-10), 2016. Date of Publication: 29 Sep
2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background: Morbidity is defined as a state of being unhealthy or of
experiencing an aspect of health that is "generally bad for you", and
postoperative morbidity linked to paediatric cardiac surgery encompasses a
range of conditions that may impact the patient and are potential targets
for quality assurance. Methods: As part of a wider study, a
multi-disciplinary group of professionals aimed to define a list of
morbidities linked to paediatric cardiac surgery that was prioritised by a
panel reflecting the views of both professionals from a range of
disciplines and settings as well as parents and patients. Results: We
present a set of definitions of morbidity for use in routine audit after
paediatric cardiac surgery. These morbidities are ranked in priority order
as acute neurological event, unplanned re-operation, feeding problems, the
need for renal support, major adverse cardiac events or never events,
extracorporeal life support, necrotising enterocolitis, surgical site of
blood stream infection, and prolonged pleural effusion or chylothorax. It
is recognised that more than one such morbidity may arise in the same
patient and these are referred to as multiple morbidities, except in the
case of extracorporeal life support, which is a stand-alone constellation
of morbidity. Conclusions: It is feasible to define a range of paediatric
cardiac surgical morbidities for use in routine audit that reflects the
priorities of both professionals and parents. The impact of these
morbidities on the patient and family will be explored prospectively as
part of a wider ongoing, multi-centre study. Copyright &#xa9; Cambridge
University Press 2016 This is an Open Access article, distributed under
the terms of the Creative Commons Attribution licence
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted
re-use, distribution, and reproduction in any medium, provided the
original work is properly cited.

<74>
Accession Number
612450117
Author
James C.; Millar J.; Horton S.; Brizard C.; Molesworth C.; Butt W.
Institution
(James, Millar, Butt) Department of Intensive Care, Royal Children's
Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia
(James, Millar, Horton, Molesworth, Butt) Murdoch Children's Research
Institute, Melbourne, Australia
(Horton) Perfusion Department, Royal Children's Hospital, Melbourne,
Australia
(Brizard) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
(Butt) Department of Paediatrics, University of Melbourne, Melbourne,
Australia
Title
Nitric oxide administration during paediatric cardiopulmonary bypass: a
randomised controlled trial.
Source
Intensive Care Medicine. (pp 1-9), 2016. Date of Publication: 30 Sep 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Cardiopulmonary bypass induces an ischaemia-reperfusion injury
and systemic inflammatory response, which contributes to low cardiac
output syndrome following cardiac surgery. Exogenous nitric oxide during
cardiopulmonary bypass has shown potential to ameliorate such injury. We
undertook a large randomised controlled trial to investigate the clinical
effects of administering nitric oxide to the cardiopulmonary bypass
circuit in children. Methods: After written informed consent, children
were randomised to receive 20 ppm nitric oxide to the gas inflow of the
cardiopulmonary bypass oxygenator, or standard conduct of bypass. Results:
101 children received nitric oxide and developed low cardiac output
syndrome less frequently (15 vs. 31 %, p = 0.007) than the 97 children who
did not receive nitric oxide. This effect was most marked in children aged
less than 6 weeks of age (20 vs. 52 %, p = 0.012) and in those aged 6
weeks to 2 years (6 vs. 24 %, p = 0.026), who also had significantly
reduced ICU length of stay (43 vs. 84 h, p = 0.031). Low cardiac output
syndrome was less frequent following more complex surgeries if nitric
oxide was administered (17 vs. 48 %, p = 0.018). ECMO was used less often
in the nitric oxide group (1 vs. 8 %, p = 0.014). Conclusions: Delivery of
nitric oxide to the oxygenator gas flow during paediatric cardiopulmonary
bypass reduced the incidence of low cardiac output syndrome by varying
degrees, according to age group and surgery complexity. Clinical Trial
Registration: ACTRN12615001376538. Copyright &#xa9; 2016 Springer-Verlag
Berlin Heidelberg and ESICM