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<1>
Accession Number
605898802
Author
Zou Y.; Hu C.; Ye W.; Fan L.; Xu L.; Zhang A.
Institution
(Zou, Xu, Zhang) Department of Cardiology, First Affiliated Hospital,
Jinan University, 613Wangpu Street, Guangzhou 510630, China
(Zou, Hu, Ye, Fan) Internal Medicine, Guangdong Women and Children
Hospital, Guangzhou, Guangdong, China
Title
Long-term clinical efficacy and safety of adding cilostazol to dual
antiplatelet therapy after drug-eluting stent implantation in coronary
arteries: A meta-analysis of randomized controlled trials.
Source
Thrombosis Research. 136 (5) (pp 870-877), 2015. Date of Publication:
November 2015.
Publisher
Elsevier Ltd
Abstract
Objective To assess the long-term clinical efficacy and safety of adding
cilostazol (TAT) to conventional dual antiplatelet therapy (DAT) for
patients undergoing drug-eluting stent (DES) implantation in coronary
arteries. Methods We performed PUBMED, MEDLINE, EMBASE, and Cochrane
CENTRAL searches for randomized clinical trials of TAT versus DAT in
patients after DES implantation with criteria to include trials with a
follow-up of more than 6 months. Results Seven RCTs with a total of 3487
patients were included in this review. The meta-analysis showed that TAT
was associated with a significant reduction in major adverse cardiac
events (MACEs) (relative risk (RR) = 0.66; 95% CI = 0.50-0.88), target
lesion revascularization (TLR) (RR = 0.61, 95% CI = 0.43-0.84), target
vessel revascularization (TVR) (RR = 0.53, 95% CI = 0.37-0.75), in-stent
restenosis (RR = 0.64, 95% CI = 0.44-0.85), in-segment restenosis (RR =
0.58, 95% CI = 0.43-0.79, P <.01), in-stent late loss (LL) (standardized
mean difference (SMD) = - 0.21, 95% CI = 0.32-0.17), and in-segment LL
(SMD = - 0.27, 95% CI = - 0.38-0.16). TAT also did not appear to
significantly alter any of the other meta-analysis secondary efficacy
outcomes and had similar rates of bleeding, but TAT had significantly
higher rates of rash, gastrointestinal side-effects, headache and drug
discontinuation. Conclusions Compared with standard DAT, the long-term use
of TAT in patients after DES implantation gave more benefits in reducing
the incidence of MACEs, TLR, TVR, in-stent and in-segment LL and
restenosis without increasing bleeding but was associated with an increase
in minor adverse events. Copyright &#xa9; 2015 Elsevier Ltd. All rights
reserved.

<2>
Accession Number
608278139
Author
Erdil N.; Eroglu T.; Akca B.; Disli O.M.; Yetkin O.; Colak M.C.; Erdil F.;
Battaloglu B.
Institution
(Erdil, Disli, Colak, Battaloglu) Department of Cardiovascular Surgery,
Turgut Ozal Medical Center, Inonu University, Faculty of Medicine,
Malatya, Turkey
(Eroglu) Department of Cardiovascular Surgery, Kayseri State Hospital,
Kayseri, Turkey
(Akca) Department of Cardiovascular Surgery, Kilis State Hospital, Kilis,
Turkey
(Yetkin) Department of Pulmonary and Sleep Medicine, Turgut Ozal Medical
Center, Inonu University, Faculty of Medicine, Malatya, Turkey
(Erdil) Department of Anesthesiology and Reanimation, Turgut Ozal Medical
Center, Inonu University, Faculty of Medicine, Malatya, Turkey
(Erdil, Eroglu, Akca, Disli, Yetkin, Colak, Erdil, Battaloglu) Inonu
University, Faculty of Medicine, Turkey
Title
The effects of N-acetylcysteine on pulmonary functions in patients
undergoing on-pump coronary artery surgery: A double blind placebo
controlled study.
Source
European Review for Medical and Pharmacological Sciences. 20 (1) (pp
180-187), 2016. Date of Publication: 2016.
Publisher
Verduci Editore (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To investigate the effects of N-acetylcysteine (NAC) on
pulmonary function tests and arterial blood gases in patients undergoing
on-pump coronary artery surgery. PATIENTS AND METHODS: The effect of NAC
was assessed within the scope of a prospective, single center,
double-blind, placebo-controlled, parallel group study. Eighty-two
patients undergoing coronary artery bypass grafting were randomized into
two groups to receive either placebo (group 1, n = 40) or NAC (group 2,
n=42). Both the NAC group and the placebo-receiving control group also
included a COPD subgroup consist ing of pat ients wi th an FEV1/FVC ratio
of < 0.7 and an FEV1 value of 50- 80%. Pulmonary function tests were
performed preoperatively and on postoperative day 60. RESULTS: Both groups
were similar with respect to age, gender, preoperative risk factors,
ejection fraction (EF), mean cross-clamp time, ventilation time, intensive
care unit (ICU) stay, atrial fibrillation (AF) and hospital stay (p >
0.05). Postoperative FVC and FEV1 values in group 1 and the postoperative
FEV1, FEV1/FVC and FEF 25-75 values in group 2 were lower in comparison to
their preoperative values. However, in both group 1 and 2, the decreases
observed in these parameters were not statistically significant (p >
0.05). In the COPD subgroup of group 1, a postoperative decrease was
observed in the FEV1 and FEF25-75 values, with the FEV1 decreasing by
4.55%, and the FEF25-75 decreasing by 4.2% (p < 0.05). In the COPD
subgroup of group 2, no significant decrease was observed in the pulmonary
function test values (p > 0.05). CONCLUSIONS: This study demonstrated that
NAC administration in COPD patients undergoing on-pump coronary artery
surgery resulted in the preservation of pulmonary functions.

<3>
Accession Number
607576425
Author
Hanke J.S.; Rojas S.V.; Avsar M.; Bara C.; Ismail I.; Haverich A.;
Schmitto J.D.
Institution
(Hanke, Rojas, Avsar, Bara, Ismail, Haverich, Schmitto) Department of
Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical
School, Hannover, Germany
Title
HeartWare left ventricular assist device for the treatment of advanced
heart failure.
Source
Future Cardiology. 12 (1) (pp 17-26), 2016. Date of Publication: January
2016.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
The importance of mechanical circulatory support in the therapy of
advanced heart failure is steadily growing. The rapid developments in the
field of mechanical support are characterized by continuous
miniaturization and enhanced performance of the assist devices, providing
increased pump durability and prolonged patient survival. The HeartWare
left ventricular assist device system (HeartWare Inc., Framingham, MA,
USA) is a mechanical ventricular assist device with over 8000
implantations worldwide. Compared with other available assist devices it
is smaller in size and used in a broad range of patients. The possibility
of minimally invasive procedures is one of the major benefits of the
device - allowing implants and explants, as well as exchanges of the
device with reduced surgical impact. We present here a review of the
existing literature on the treatment of advanced heart failure using the
HeartWare left ventricular assist device system. Copyright &#xa9; 2016
Future Medicine Ltd.

<4>
Accession Number
607576408
Author
Cheng-Torres K.A.; Desai K.P.; Sidhu M.S.; Maron D.J.; Boden W.E.
Institution
(Cheng-Torres, Sidhu, Boden) Division of Cardiology, Department of
Medicine, Albany Medical Center, NY 10021, United States
(Cheng-Torres, Sidhu, Boden) Albany Stratton VA Medical Center, 113
Holland Avenue, Albany, NY 12208, United States
(Cheng-Torres, Sidhu, Boden) Albany Medical College, 47 New Scotland
Avenue, Albany, NY 12208, United States
(Desai) Department of Medicine, Johns Hopkins School of Medicine, Johns
Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224,
United States
(Maron) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University, Stanford, CA 94305, United States
Title
Conservative versus invasive stable ischemic heart disease management
strategies: What do we plan to learn from the ISCHEMIA trial?.
Source
Future Cardiology. 12 (1) (pp 35-44), 2016. Date of Publication: January
2016.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Over the past decade, landmark randomized clinical trials comparing
initial management strategies in stable ischemic heart disease (SIHD) have
demonstrated no significant reduction in 'hard' end points (all-cause
mortality, cardiac death or myocardial infarction) with one strategy
versus another. The main advantage derived from early revascularization is
improved short-term quality of life. Nonetheless, questions remain
regarding how best to manage SIHD patients, such as whether a high-risk
subgroup can be identified that may experience a survival or myocardial
infarction benefit from early revascularization, and if not, when should
diagnostic catheterization and revascularization be performed. The
International Study of Comparative Health Effectiveness with Medical and
Invasive Approaches trial is designed to address these questions by
randomizing SIHD patients with at least moderate ischemia to an initial
conservative strategy of optimal medical therapy or an initial invasive
strategy of optimal medical therapy plus cardiac catheterization and
revascularization. Copyright &#xa9; 2016 Future Medicine Ltd.

<5>
Accession Number
607226402
Author
Mathew P.J.; Sailam S.; Sivasailam R.; Thingnum S.K.S.; Puri G.D.
Institution
(Mathew, Sailam, Sivasailam, Puri) Department of Anaesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh PIN-160012, India
(Thingnum) Department of Cardiothoracic Surgery, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Title
Performance of target-controlled infusion of propofol using two different
pharmacokinetic models in open heart surgery - A randomised controlled
study.
Source
Perfusion (United Kingdom). 31 (1) (pp 45-53), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
We compared the performance of a propofol target-controlled infusion (TCI)
using Marsh versus PGIMER models in patients undergoing open heart
surgery, in terms of measured plasma levels of propofol and objective
pharmacodynamic effect. Methods: Twenty-three, ASA II/III adult patients
aged 18-65 years and scheduled for elective open heart surgery received
Marsh or PGIMER (Postgraduate Institute of Medical Education and Research)
pharmacokinetic models of TCI for the induction and maintenance of
anaesthesia with propofol in a randomized, active-controlled,
non-inferiority trial. The plasma levels of propofol were measured at
specified time points before, during and after bypass. Results: The
performances of both the models were similar, as determined by the error
(%) in maintaining the target plasma concentrations: MDPE of -5.0 (-12.0,
5.0) in the PGIMER group vs -6.4 (-7.7 to 0.5) in the Marsh group and
MDAPE of 9.1 (5, 15) in the PGIMER group vs 8 (6.7, 10.1) in the Marsh
group. These values indicate that both models over-predicted the plasma
propofol concentration. Conclusions: The new pharmacokinetic model based
on data from Indian patients is comparable in performance to the
commercially available Marsh pharmacokinetic model. Copyright &#xa9; SAGE
Publications.

<6>
Accession Number
607226285
Author
Stanzel R.D.P.; Henderson M.
Institution
(Stanzel, Henderson) Nova Scotia Health Authority, Canada
Title
Clinical evaluation of contemporary oxygenators.
Source
Perfusion (United Kingdom). 31 (1) (pp 15-25), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Advances in cardiopulmonary bypass equipment have played a critical role
in improving outcomes for cardiac surgery patients. Recent advancements
include reduced priming volumes, biocompatible coatings and gaseous
microemboli handling, as well as the incorporation of an arterial filter
into the oxygenator. The purpose of this study was to conduct a
comprehensive clinical evaluation of adult oxygenators on the market.
Oxygenators assessed included the Sorin Synthesis (n = 30), the Sorin
Inspire 6F (n = 10) and Inspire 8F (n = 30), the Terumo FX15 (n = 13) and
FX25 (n = 30), the Maquet Quadrox-i (n = 30) and the Medtronic Fusion (n =
30). Parameters assessed included functional prime volumes, gas exchange,
pressure gradients and the effects on patient hematology. The Synthesis
had the largest functional prime volume (1426 ml), the FX15 the lowest
(956 ml). The Inspire 6F, 8F and Fusion had the greatest O<inf>2</inf>
transfer. The Sorin oxygenators required the lowest sweep gas flows to
obtain a PaCO<inf>2</inf> of 40 mmHg. The Sorin oxygenators had the
largest pressure gradients. While no differences were observed for
hemoglobin and platelet levels post cross-clamp removal, the Sorin
Synthesis and Inspire 8F had the largest increases in white blood cell
(WBC) counts (122% and 141% of baseline, respectively) and neutrophils
(162% and 185% of baseline, respectively). The data demonstrate that no
single product is superior in all aspects. The choice of ideal oxygenator
depends on the aspect(s) of oxygenator performance the perfusion team
believes most clinically acceptable based on available data. Copyright
&#xa9; SAGE Publications.

<7>
Accession Number
607226258
Author
Chew S.T.H.; Ng R.R.G.; Liu W.; Goh S.G.; Caleb M.G.; Ti L.K.
Institution
(Chew) Department of Anaesthesiology, Singapore General Hospital, 20
College Road, Academia, Level 5, Singapore 169856, Singapore
(Chew) Department of Cardiovascular and Metabolic Disorders, Duke-National
University of Singapore, Graduate Medical School, Singapore, Singapore
(Ng, Liu, Ti) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Goh, Caleb) Department of Cardiac, Thoracic and Vascular Surgery,
National University Heart Centre, Singapore, Singapore
(Ti) Department of Anaesthesia, National University Health System,
Singapore, Singapore
Title
Miniaturized versus conventional cardiopulmonary bypass and acute kidney
injury after cardiac surgery.
Source
Perfusion (United Kingdom). 31 (1) (pp 60-67), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Acute kidney injury (AKI) is a serious complication after
coronary artery bypass grafting (CABG). There are conflicting reports
whether a miniaturized cardiopulmonary bypass (MCPB) system is associated
with a lower AKI incidence compared with conventional cardiopulmonary
bypass (CCPB). It is unknown if AKI risk factors differ between the two
groups. We assessed if MCPB decreases AKI after CABG and compared the risk
factors between both groups. Methods: Sixty-eight Asian patients
presenting for elective CABG at a tertiary heart centre were enrolled.
They were randomly assigned to MCPB (n=34) or CCPB group (n=34) and
followed up in a single-blinded, prospective, randomized, controlled
trial. The primary outcome was Acute Kidney Injury Network stage 1 AKI.
Results: The AKI incidence was 21.5% and was not significantly different
between patients undergoing MCPB versus CCPB (21.9% versus 21.2%,
p=0.948). The first CPB haematocrit was independently associated with AKI
in the MCPB group (Relative Risk [RR]=0.484, 95% Confidence Interval
[CI]=0.268-0.876, p=0.016); post-operative blood loss and inflammation
were independently associated with AKI in the CCPB group (RR=1.005,
95%CI=1.003-1.007, p<0.001; RR=1.018, 95%CI=1.010-1.028, p<0.001).
Conclusion: The MCPB system is not associated with a lower incidence of
AKI in Asian patients undergoing CABG. Risk factors for AKI differed
between patients using the MCPB and CCPB systems. Copyright &#xa9; SAGE
Publications.

<8>
Accession Number
607226250
Author
Valooran G.J.; Nair S.K.; Chandrasekharan K.; Simon R.; Dominic C.
Institution
(Valooran, Nair, Chandrasekharan) Department of Cardiovascular and
Thoracic Surgery, Rajagiri Hospital, Chunangamvely, Aluva, Kochi, Kerala,
India
(Simon, Dominic) Perfusion, Department of Cardiovascular and Thoracic
Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India
Title
Del Nido cardioplegia in adult cardiac surgery - Scopes and concerns.
Source
Perfusion (United Kingdom). 31 (1) (pp 6-14), 2016. Date of Publication:
01 Jan 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
The convenience offered by a single-dose cardioplegia strategy is the
avoidance of interruption of the flow of surgery and, more importantly, a
significant reduction in the cross-clamp time. del Nido cardioplegia is an
extracellular cardioplegic solution which serves these purposes and has
been used successfully in pediatric cardiac surgery. The subsequent
extrapolation of its use in adult cardiac surgery has returned encouraging
results, as evidenced by recent literature. The use of del Nido
cardioplegia in adults has been reported to shorten the cross-clamp time,
cardiopulmonary bypass time and overall operating time. Intraoperative
peak glucose value and insulin requirement have also been reported to be
lower with del Nido cardioplegia, which can have prognostic significance.
There have been reports of lesser incidence of atrial fibrillation and the
number of defibrillations required with use of this technique. However,
some unique concerns still remain. The lack of prospective randomized
trials, the trend of elevation in CKMB (as reported by one study) and the
need for a protocol-based approach to its use in adults are to be given
due consideration while adopting its use in adults. This review attempts
to have an overview on del Nido cardioplegia, its advantages, the recent
studies comparing it with conventional cardioplegia techniques and the
potential areas of concern with its use in adult cardiac surgery.
Copyright &#xa9; SAGE Publications.

<9>
Accession Number
605144130
Author
Zawar B.; Mehta Y.; Juneja R.; Arora D.; Raizada A.; Trehan N.
Institution
(Zawar, Mehta, Juneja, Arora, Raizada, Trehan) Institute of Critical Care
Anesthesiology, Sector 38, Gurgaon, Haryana, India
Title
Nonanalgesic benefits of combined thoracic epidural analgesia with general
anesthesia in high risk elderly off pump coronary artery bypass patients.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 385-391), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Epidural anesthesia is a central neuraxial block technique with many
applications. It is a versatile anesthetic technique, with applications in
surgery, obstetrics and pain control. Its versatility means it can be used
as an anesthetic, as an analgesic adjuvant to general anesthesia, and for
postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery
triggers a systemic stress response as seen in coronary artery bypass
grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general
anesthesia (GA) attenuates the stress response to CABG. There is Reduction
in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor
necrosis factor-Alpha( TNF alpha), interleukin-6 and leucocyte count.
Design: A prospective randomised non blind study. Setting: A clinical
study in a multi specialty hospital. Participants: Eighty six patients.
Material and Methods/intervention: The study was approved by hospital
research ethics committee and written informed consent was obtained from
all patients. Patients were randomised to receive either GA plus epidural
(study group) or GA only (control group). Inclusion Criteria (for
participants) were-Age > 70 years, Patient posted for OPCAB surgery, and
patient with comorbidities (diabetes mellitus, chronic obstructive
pulmonary disease, cerebrovascular disease, peripheral vascular disease,
renal dysfunction). Serum concentration of Interlukin:-6, TNF alpha,
cortisol, Troponin-I, CK-MB, and HsCRP (highly sensitive C reactive
protein), was compared for both the group and venous blood samples were
collected and compared just after induction, at day 2, and day 5
postoperatively. Time to mobilization, extubation, total intensive care
unit stay and hospital stay were noted and compared. Independent t test
was used for statistical analysis. Primary Outcomes: Postoperative
complications, total intensive care unit stay and hospital stay. Secondary
Outcome: Stress response. Result: Study group showed decreased
Interlukin-6 at day 2, TNF alpha at day 2 and 5,troponin I at day 5, and
decreased total hospital stay ( p > 0.05). Conclusion: Thoracic epidural
anesthesia decreases stress and inflammatory response to surgery and
decreases hospital stay. However a large multicentre study may be needed
to confirm it. Copyright &#xa9; 2015 Annals of Cardiac Anaesthesia.

<10>
Accession Number
605144006
Author
Kadam S.; Tailor K.; Kulkarni S.; Mohanty S.; Joshi P.; Rao S.
Institution
(Kadam, Tailor) Departments of Pediatric Cardiac Anaesthesia, Kokilaben
Dhirubhai Ambani Hospital, Medical Research Centre, Mumbai, Maharashtra
400053, India
(Kulkarni) Pediatric Cardiology, India
(Mohanty, Rao) Pediatric Cardiac Surgery, India
(Joshi) Pediatric Cardiac Intensive Care, Kokilaben Dhirubhai Ambani
Hospital, Medical Research Centre, Mumbai, Maharashtra, India
Title
Effect of dexmeditomidine on postoperative junctional ectopic tachycardia
after complete surgical repair of tetralogy of Fallot: A prospective
randomized controlled study.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 323-328), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Incidence of junctional ectopic tachycardia (JET) after repair of
tetralogy of Fallot (TOF) is 5.6-14%. Dexmeditomidine is a alpha-2
adrenoceptor agonist modulates the release of catecholamine, resulting in
bradycardia and hypotension. These effects are being explored as a
therapeutic option for the prevention of perioperative tachyarrhythmia. We
undertook this study to examine possible preventive effects of
dexmedetomidine on postoperative JET and its impact on the duration of
ventilation time and length of Intensive Care Unit stay. Methods: After
obtaining approval from the hospitals ethics committee and written
informed consent from parents, this quasi-randomized trial was initiated.
Of 94 patients, 47 patients received dexmedetomidine (dexmedetomidine
group) and 47 patients did not receive the drug (control group). Results:
Dexmedetomidine group had more number of complex variants like TOF with an
absent pulmonary valve or pulmonary atresia (P = 0.041). Hematocrit on
cardiopulmonary bypass (CPB), heart rate while coming off from CPB and
inotrope score was significantly low in the dexmedetomidine group compared
to control group. The incidence of JET was significantly low in
dexmedetomidine group (P = 0.040) compared to control group. Conclusions:
Dexmedetomidine may have a potential benefit of preventing perioperative
JET. Copyright &#xa9; 2015 Annals of Cardiac Anaesthesia.

<11>
Accession Number
605144004
Author
Karlekar A.; Bharati S.; Saxena R.; Mehta K.
Institution
(Karlekar, Bharati, Saxena) Departments of Anaesthesiology, Critical Care,
Fortis Escorts Heart Institute, Okhla Road, New Delhi, India
(Mehta) Departments of Physiotherapy, Fortis Escorts Heart Institute, New
Delhi, India
Title
Assessment of feasibility and efficacy of Class IV laser therapy for
postoperative pain relief in off-pump coronary artery bypass surgery
patients: A pilot study.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 317-322), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Laser therapy, for its established analgesic properties with minimal side
effects, has been used for the treatment of chronic pain. However, it has
not been used for the treatment of acute postoperative pain. This pilot
study was designed to assess the feasibility and efficacy of Class IV
laser on postoperative pain relief following off-pump coronary artery
bypass graft (OPCABG) surgery, as a component of multimodal analgesia
(MMA) technique. Methods: This open observational prospective study
comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG
through sternotomy. For postoperative analgesia, they were subjected to
laser therapy subjected to laser therapy in addition to the standard
institutional pain management protocol comprising of IV infusion/bolus of
tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain
intensity was measured by Verbal Rating Scale (VRS). The laser therapy was
scheduled as once a day regime for three consecutive postoperative days
(PODs) starting on POD 1, 30 min following tracheal extubation. The
subsequent laser applications were also scheduled at the same time of the
day as on day 1 if VRS was >5. 10 W Class IV laser was applied over 150
cm² sternal wound area for 150 s. VRS was used to assess pain
severity and was recorded for statistical analysis using Friedman Test.
Results: The mean (standard deviation [SD]) VRS of all the 100 patients
just before application of the first dose of laser was 7.31 (0.94) while
on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h
respectively following first dose of laser. The change of VRS over first
24 h among all the 100 patients was statistically significant (P = 0.000).
Laser was re-applied in 40 patients whose VRS was >5 (mean [SD]-6.38
[0.868]) at 24^th h. After receiving the 2^nd dose of
laser the VRS scores fell significantly (P = 0.000) and became 0 at
54^th h. No patients required 3^rd dose of the laser.
No patient required rescue analgesic while on laser therapy. Conclusion:
Class IV laser can be an effective technique for postoperative analgesia
following OPCABG surgery through sternotomy when included as a component
of MMA technique. Copyright &#xa9; 2015 Annals of Cardiac Anaesthesia.

<12>
Accession Number
605143991
Author
Desai P.; Kane D.; Sarkar M.
Institution
(Desai, Kane, Sarkar) Department of Anesthesiology, Seth GSMC, KEM
Hospital, Mumbai, Maharashtra, India
Title
Cardioversion: What to choose? Etomidate or propofol.
Source
Annals of Cardiac Anaesthesia. 18 (3) (pp 306-311), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Electrical cardioversion is a short painful procedure to regain normal
sinus rhythm requiring anaesthesia for haemodynamic stability, sedation,
analgesia and early recovery. Aims: To compare propofol and etomidate as
sedatives during cardioversion. Settings and Design: Single centred,
prospective and randomized single blind study comprising 60 patients.
Subjects and Methods: Patients more than 18 years, American Society of
Anesthesiologists I/II/III grades undergoing elective cardioversion,
randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus
followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1
mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 mu
g/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP
[SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate,
Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed
at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of
hypotension, respiratory depression and side effects were compared.
Statistical analysis used: Student's unpaired t-test, Chi-square test and
Mann-Whitney test. P > 0.05 was taken as significant. Results: Group P
showed significant fall in SBP, DBP, and mean BP at 2 min after
cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred
more with propofol (P > 0.05). Group E showed better ARS at 1, 2, 5, 10,
15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7
s Group E) indicated longer recovery with propofol. Left atrial size
(35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P
vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%)
showed significant difference. Conclusions: Etomidate/fentanyl is superior
over propofol/fentanyl during cardioversion for quick recovery and
haemodynamic stability. Copyright &#xa9; 2015 Annals of Cardiac
Anaesthesia.

<13>
Accession Number
605365020
Author
Asha S.E.; Cooke A.; Walter E.; Weaver J.
Institution
(Asha, Cooke, Walter) Emergency Department, St. George Hospital, Gray St,
Kogarah, Sydney, NSW 2217, Australia
(Asha, Weaver) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Weaver) Cardiology Department, St. George Hospital, Sydney, NSW,
Australia
Title
Three-month outcome of patients with suspected acute coronary syndrome
using point-of-care cardiac troponin-T testing compared with
laboratory-based cardiac troponin-T testing: A randomised trial.
Source
Emergency Medicine Journal. 32 (8) (pp 601-607), 2015. Date of
Publication: 01 Aug 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The aim of this randomised trial was to determine clinical
outcomes in patients suspected of an acute coronary syndrome (ACS) who had
cardiac troponin-T measured by point-of-care (POC) compared with
laboratory-based cardiac troponin-T testing. A secondary aim was to
describe the correlation between the two troponin assays. Methods: Adults
suspected of ACS were allocated to have troponin processed by POC or
laboratory analyser. The primary outcome was a composite of acute
myocardial infarction, coronary revascularisation, cardiac arrest and
mortality at 3 months. Paired troponins taken on participants allocated to
POC were used to determine correlation between troponin values obtained
from laboratory and POC analysers. Results: There were 452 participants.
30 (13.1%) of 229 participants allocated to POC had at least one primary
outcome event compared with 29 (13.0%) of 223 allocated to laboratory
testing, a difference of 0.1% (95% CI -6.2% to 6.4%, p=0.98). Of 215
available paired troponins results, both analysers gave congruent results
in 196 (91%) cases. The POC troponin was negative when the laboratory
sample was positive in 16 (7%) cases. The POC troponin was positive when
the laboratory sample was negative in 3 (1%) samples. Passing-Bablok
regression analysis demonstrated both a constant and proportional
difference between the two analytic methods. Conclusions: Among patients
suspected of an ACS, we found no evidence for a difference in adverse
outcome when POC troponin was used in comparison with laboratory troponin.
Due to the small sample size, an absolute difference of up to 6% in
adverse outcome is possible. Trial registration number:
ANZCTR#12612000319875. Copyright &#xa9; 2015, BMJ Publishing Group. All
rights reserved.

<14>
Accession Number
604586044
Author
Campos C.M.; Van Klaveren D.; Farooq V.; Simonton C.A.; Kappetein A.-P.;
Sabik J.F.; Steyerberg E.W.; Stone G.W.; Serruys P.W.
Institution
(Campos, Van Klaveren, Kappetein, Steyerberg, Serruys) Erasmus University
Medical Center, s-Gravendijkwal 230, Rotterdam 3015, Netherlands
(Campos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Farooq) Manchester Heart Centre, Manchester Royal Infirmary, Central
Manchester University Hospitals NHS Trust, Manchester, United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Sabik) Department of Cardiothoracic Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, United States
(Stone) Columbia University Medical Center, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Long-term forecasting and comparison of mortality in the Evaluation of the
Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization (EXCEL) trial: Prospective
validation of the SYNTAX Score II.
Source
European Heart Journal. 36 (20) (pp 1231-1241), 2015. Date of Publication:
21 May 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To prospectively validate the SYNTAX Score II and forecast the
outcomes of the randomized Evaluation of the Xience Everolimus-Eluting
Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization (EXCEL) Trial. Methods and results Evaluation of the
Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization is a prospective, randomized
multicenter trial designed to establish the efficacy and safety of
percutaneous coronary intervention (PCI) with the everolimus-eluting stent
compared with coronary artery bypass graft (CABG) surgery in subjects with
unprotected left-main coronary artery (ULMCA) disease and low-intermediate
anatomical SYNTAX scores (<33). After completion of patient recruitment in
EXCEL, the SYNTAX Score II was prospectively applied to predict 4-year
mortality in the CABG and PCI arms. The 95% prediction intervals (PIs) for
mortality were computed using simulation with bootstrap resampling (10 000
times). For the entire study cohort, the 4-year predicted mortalities were
8.5 and 10.5% in the PCI and CABG arms, respectively [odds ratios (OR)
0.79; 95% PI 0.43-1.50). In subjects with low (a 22) anatomical SYNTAX
scores, the predicted OR was 0.69 (95% PI 0.34-1.45); in intermediate
anatomical SYNTAX scores (23-32), the predicted OR was 0.93 (95% PI
0.53-1.62). Based on 4-year mortality predictions in EXCEL, clinical
characteristics shifted long-term mortality predictions either in favour
of PCI (older age, male gender and COPD) or CABG (younger age, lower
creatinine clearance, female gender, reduced left ventricular ejection
fraction). Conclusion The SYNTAX Score II indicates at least an equipoise
for long-term mortality between CABG and PCI in subjects with ULMCA
disease up to an intermediate anatomical complexity. Both anatomical and
clinical characteristics had a clear impact on long-term mortality
predictions and decision making between CABG and PCI. Copyright &#xa9; The
Author 2015.

<15>
Accession Number
606124408
Author
Patti G.; Bennett R.; Seshasai S.R.K.; Cannon C.P.; Cavallari I.; Chello
M.; Nusca A.; Mega S.; Caorsi C.; Spadaccio C.; Keun On Y.; Mannacio V.;
Berkan O.; Yilmaz M.B.; Katrancioglu N.; Ji Q.; Kourliouros A.; Baran C.;
Pasceri V.; Akar A.R.; Kaski J.C.; Di Sciascio G.; Ray K.K.
Institution
(Patti, Cavallari, Chello, Nusca, Mega, Di Sciascio) Department of
Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
(Bennett, Seshasai, Kaski, Ray) Cardiovascular Sciences Research Centre,
St George's University of London, Cranmer Terrace, London SW170RE, United
Kingdom
(Cannon) Cardiovascular Division, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Caorsi) Cardiovascular Department, Clinica Las Condes, Hospital Clinico
de la Fuerza Aerea de Chile, Las Condes, Chile
(Spadaccio) Cardiovascular Diseases and Cardiac Surgery Departments,
University Hospital UZ Leuven, Leuven, Belgium
(Spadaccio) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
(Keun On) Department of Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Mannacio) Department of Cardiac Surgery, University of Naples Federico
II, Naples, Italy
(Berkan) Department of Cardiovascular Surgery, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Yilmaz, Katrancioglu) Department of Cardiology, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Ji) Department of Thoracic Cardiovascular Surgery, Tongji University,
Tongji Hospital, Shanghai, China
(Kourliouros) Department of Cardiothoracic Surgery, King's College
Hospital, London, United Kingdom
(Baran, Akar) Department of Cardiovascular Surgery, Heart Center, Ankara
University School of Medicine, Dikimevi, Turkey
(Pasceri) Interventional Cardiology, San Filippo Neri Hospital of Rome,
Rome, Italy
Title
Statin pretreatment and risk of in-hospital atrial fibrillation among
patients undergoing cardiac surgery: A collaborative meta-analysis of 11
randomized controlled trials.
Source
Europace. 17 (6) (pp 855-863), 2015. Date of Publication: 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Statin pretreatment in patients undergoing cardiac surgery is
understood to prevent postoperative atrial fibrillation (AF). However,
this is based on observational and limited randomized trial evidence,
resulting in uncertainty about any genuine anti-arrhythmic benefits of
these agents in this setting.We therefore aimed to quantify precisely the
association between statin pretreatment and postoperative AF among
patients undergoing cardiac surgery. Methods and results A detailed search
of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012)was
conducted, followed by a review of the reference lists of published
studies and correspondence with trial investigators to obtain
individual-participant data for meta-analysis. Evidence was combined
across prospective, randomized clinical trials that compared the risk of
postoperative AF among individuals randomized to statin pretreatment or
placebo/control medication before elective cardiac surgery. Postoperative
AF was defined as episodes of AF lasting >5 min. Overall, 1105
participants from 11 trials were included; of them, 552 received statin
therapy preoperatively. Postoperative AF occurred in 19% of these
participants when compared with 36% of those not treated with statins
(odds ratio 0.41, 95% confidence interval 0.31-0.54, P < 0.00001, using a
random-effects model). Atrial fibrillation prevention by statin
pretreatmentwas consistent across different subgroups. Conclusion
Short-term statin pretreatment may reduce the risk of postoperative AF
among patients undergoing cardiac surgery. Copyright &#xa9; The Author
2015. All rights reserved.

<16>
Accession Number
608383546
Author
Teixeira R.; Vieira M.J.; Ribeiro M.A.; Goncalves L.; Gersh B.J.
Institution
(Teixeira, Ribeiro) Departamento de Medicina, Servico de Cardiologia,
Hospital Beatriz Angelo, Loures, Portugal
(Teixeira, Vieira, Goncalves) Universidade de Coimbra, Coimbra, Portugal
(Goncalves) Servico de Cardiologia, Centro Hospitalar e Universitario de
Coimbra, Hospital Geral, Coimbra, Portugal
(Gersh) Division of Cardiovascular Disease and Internal Medicine, Mayo
Clinic, Rochester, United States
Title
Prognosis following acute coronary syndromes according to prior coronary
artery bypass grafting: Meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (6) (pp 518-527),
2015. Date of Publication: 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: Conduct a meta-analysis to study the prognostic influence of a
previous coronary artery bypass grafting (CABG) in patients admitted for
an acute coronary syndrome (ACS). Methods: A systematic review of the
literature was performed using electronic reference databases through
January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar
and references cited in other studies). Studies in which ACS outcomes with
a previous history of CABG were compared with ACS outcomes with no history
of previous CABG were considered for inclusion. The main endpoints of
interest were mortality and non-fatal acute myocardial infarction. Data
was aggregated at three follow-up times using random-effects meta-analysis
models. Results: Twenty-four studies were included which provided 387,181
patients for analysis. Previous CABG ACS patients were older, more
diabetic and had a more frequent history of a previous myocardial
infarction. Pooled in-hospital mortality was higher for the previous CABG
ACS patients (OR 1.22 [1.04-1.44], p<0.01, I² 88%). The pooled
adjusted OR showed no significant differences for the two groups (adjusted
OR 1.13 [0.93-1.37], p=0.22, I² 92%). Previous CABG ACS patient
had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02,
I² 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01,
I² 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01,
I² 0%) long-term mortality. Both the in-hospital and the
long-term re-infarction rates were higher for the previous CABG ACS
patients. Conclusions: According to our data, ACS patients with previous
CABG history had a higher risk for short- and longterm adverse events.
Copyright &#xa9; The European Society of Cardiology 2014.

<17>
Accession Number
606884285
Author
Kleinbongard P.; Neuhauser M.; Thielmann M.; Kottenberg E.; Peters J.;
Jakob H.; Heusch G.
Institution
(Kleinbongard, Heusch) Institute for Pathophysiology, Westdeutsches Herz
und Gefasszentrum, Universitatsklinikum Essen, Hufelandstrasse 55, Essen
DE-45122, Germany
(Thielmann, Jakob) Department of Thoracic and Cardiovascular Surgery, West
German Heart and Vascular Center Essen, University Hospital Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
University Hospital Essen, Germany
(Kottenberg, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitat Duisburg-Essen, Essen, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
Title
Confounders of Cardioprotection by Remote Ischemic Preconditioning in
Patients Undergoing Coronary Artery Bypass Grafting.
Source
Cardiology (Switzerland). 133 (2) (pp 128-133), 2016. Date of Publication:
01 Jan 2016.
Publisher
S. Karger AG
Abstract
Objectives: Remote ischemic conditioning (RIC) by repetitive blood
pressure cuff inflation/deflation around a limb provides cardioprotection
in patients undergoing coronary artery bypass grafting (CABG).
Cardioprotection is confounded by risk factors, comorbidities and
comedications. We aimed to identify confounders that possibly attenuate
the protection provided by RIC. Methods: In a retrospective analysis of
our single-center, randomized, double-blind trial of patients undergoing
elective CABG with/without RIC prior to ischemic cardioplegic arrest, we
analyzed demographics, medications and intraoperative variables. The
primary end point was myocardial injury, as reflected by the area under
the curve for serum troponin I (TnI) from baseline to 72 h after surgery.
Results: In models with 2 independent variables and in the multivariate
analysis, age and aortic cross-clamp time impacted on TnI release.
Subgroup analyses confirmed RIC-induced protection in all age tertiles.
There was no protection with an aortic cross-clamp time . 56 min
(RIC/control = 1.026 not significant), but there was protection with 57.75
min (RIC/control = 0.757; p = 0.0348) and . 76 min (RIC/control = 0.735; p
= 0.0277). Gender, A-blockers, statins, angiotensin-converting enzyme
(ACE) inhibitors or angiotensin receptor blockers (ARBs) and
intraoperative nitroglycerine did not impact on TnI release. Conclusion:
Age, gender,-blockers, statins, ACE inhibitors, ARBs and intraoperative
nitroglycerine have no significant impact on RIC-induced cardioprotection
during CABG. However, greater myocardial ischemia/reperfusion injury at
longer cross-clamp time facilitates the detection of protection by RIC.
Copyright &#xa9; 2015 S. Karger AG, Basel.

<18>
Accession Number
607627600
Author
Butler C.R.; O'Hare A.M.
Institution
(Butler, O'Hare) Department of Medicine, Seattle, WA, United States
(Butler, O'Hare) Division of Hospitalist Medicine, Harborview Medical
Center, University of Washington, Seattle, WA, United States
(Butler, O'Hare) Hospital and Specialty Medicine Service, Nephrology
Section, VA Puget Sound Healthcare System, Division of Nephrology,
Seattle, WA, United States
Title
Considerations in Applying the Results of Randomized Controlled Clinical
Trials to the Care of Older Adults With Kidney Disease in the Clinical
Setting: The SHARP Trial.
Source
Advances in Chronic Kidney Disease. 23 (1) (pp 29-35), 2016. Date of
Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
The Study of Heart and Renal Protection (SHARP) found that treatment with
ezetemibe and low-dose simvastatin reduced the incidence of major
atherosclerotic events in patients with kidney disease. Due to the paucity
of evidence-based interventions that lower cardiovascular morbidity in
this high-risk population, the SHARP trial will likely have a large impact
on clinical practice. However, applying the results of clinical trials
conducted in select populations to the care of individual patients in
real-world settings can be fraught with difficulty. This is especially
true when caring for older adults with complex comorbidity and limited
life expectancy. These patients are often excluded from clinical trials,
frequently have competing health priorities, and may be less likely to
benefit and more likely to be harmed by medications. We discuss key
considerations in applying the results of the SHARP trial to the care of
older adults with CKD in real-world clinical settings using guiding
principles set forth by the American Geriatrics Society's Expert Panel on
the Care of Older Adults with Multimorbidity. Using this schema, we
emphasize the importance of evaluating trial results in the unique context
of each patient's goals, values, priorities, and circumstances. Copyright
&#xa9; 2016.

<19>
Accession Number
608459506
Author
Bender B.; Murthy V.; Chamberlain R.S.
Institution
(Bender, Chamberlain) Saint George's University School of Medicine,
Grenada
(Bender) Department of Internal Medicine, Hahnemann University Hospital,
Philadelphia, PA, United States
(Murthy, Chamberlain) Department of Surgery, Saint Barnabas Medical
Center, Livingston, NJ, United States
(Chamberlain) Department of Surgery, Rutgers University, New Jersey
Medical School, Newark, NJ, United States
Title
The changing management of chylothorax in the modern era.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 18-24), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Initial conservative therapy is applied to all cases of chylothorax (CTx)
with expected excellent outcomes. The indication for aggressive surgical
treatment of early CTx remains uncertain and requires rigorous scientific
scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize
the leak and assess thoracic duct patency as well as to differentiate
partial from complete thoracic duct transection. The aetiology of the CTx,
flow rate and patient condition dictate the preferred management.
Octreotide/somatostatin and etilefrine therapy is highly efficacious in
the conservative management of CTx. For patients in whom conservative
management fails, those who are good surgical candidates, and those in
whom the site of the leak is well identified, surgical repair and/or
ligation using minimally invasive techniques is highly successful with
limited adverse outcomes. Similarly, if the site of the chylous effusion
cannot be well visualized, a thoracic duct ligation via video-assisted
thoracic surgery is the gold standard approach. A pleuroperitoneal or less
often a pleurovenous shunt is a final option and may be curative in some
patients. Copyright &#xa9; The Author 2015.

<20>
Accession Number
608459502
Author
Pilarczyk K.; Boening A.; Jakob H.; Langebartels G.; Markewitz A.; Haake
N.; Heringlake M.; Trummer G.
Institution
(Pilarczyk, Jakob) Department of Thoracic and Cardiovascular Surgery, West
German Heart Centre Essen, University Hospital Essen, Essen, Germany
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giessen, Germany
(Langebartels) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Cologne, Germany
(Markewitz) Department of Cardiovascular Surgery, Bundeswehr Central
Hospital, Koblenz, Germany
(Haake) Department of Cardiovascular Surgery, School of Medicine,
University of Schleswig-Holstein, Kiel, Germany
(Heringlake) Department of Anesthesiology, University of Lubeck, Lubeck,
Germany
(Trummer) Department of Cardiovascular Surgery, Heart Center Freiburg
University, Freiburg, Germany
Title
Preoperative intra-aortic counterpulsation in high-risk patients
undergoing cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 5-17), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
In contrast to the results of previous studies, recent randomized
controlled trials (RCTs) failed to show a benefit of prophylactic aortic
counterpulsation in high-risk patients undergoing cardiac surgery. The
present analysis aims to redefine the effects of this treatment modality
in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google
Scholar and reference lists of relevant articles were searched for
full-text articles of RCTs in English or German. Assessments for
eligibility, relevance, study validity and data extraction were performed
by two reviewers independently using prespecified criteria. The primary
outcome was hospital mortality. A total of nine eligible RCTs with 1171
patients were identified: 577 patients were treated preoperatively with
intra-aortic balloon pump (IABP) and 594 patients served as controls. The
pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the
intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629;
P < 0.001). The pooled analyses of five RCTs including only patients
undergoing isolated on-pump coronary artery bypass grafting (n[IABP] =
348, n[control] = 347) also showed a statistically significant improvement
in mortality for preoperative IABP implantation (fixed-effects model: OR
0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital
mortality from two randomized off-pump trials was 0.556 (fixed-effects
model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic
counterpulsation was associated with a significant reduction in low
cardiac output syndrome (LCOS) in the total population (fixed-effects
model: OR 0.330, 95% CI 0.214- 0.508, P < 0.001) as well as in the
subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI
0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump
population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238).
Preoperative IABP implantation was associated with a reduction of
intensive care unit (ICU) stay in all investigated populations with a
greater effect in the total population [fixed-effects model: standard mean
difference (SMD) -0.931 +/- 0.198, P < 0.001] as well as in the subgroup
of CAGB patients (fixedeffects model: SMD -1.240 +/- 0.156, P < 0.001),
compared with the off-pump group (fixed-effects model: SMD -0.723 +/-
0.128, P < 0.001). Despite contradictory results from recent trials, the
present study confirms the findings of previous meta-analyses that
prophylactic aortic counterpulsation reduces hospital mortality, incidence
of LCOS and ICU requirement in high-risk patients undergoing on-pump
cardiac surgery. However, owing to small sample sizes and the lack of a
clear-cut definition of high-risk patients, an adequately powered,
prospective RCT is necessary to find a definite answer to the question, if
certain groups of patients undergoing cardiac surgery benefit from a
prophylactic IABP insertion. Copyright &#xa9; The Author 2015.

<21>
Accession Number
607115424
Author
Rogers J.H.; Bolling S.F.
Institution
(Rogers) University of California, Davis Medical Center, Division of
Cardiovascular Medicine, 4860 Y Street, Sacramento, CA 95817, United
States
(Bolling) University of Michigan Cardiovascular Center, 1500 East Medical
Center Drive, Ann Arbor, MI 48109, United States
Title
Approaches to the management of functional tricuspid regurgitation.
Source
Journal of Comparative Effectiveness Research. 4 (6) (pp 665-676), 2015.
Date of Publication: November 2015.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Functional tricuspid regurgitation (FTR) is an acquired valvular
abnormality that is most frequently encountered during the evaluation and
operative management of left-sided heart failure and left heart valve
disease. Observational studies have demonstrated that uncorrected
significant FTR during mitral valve surgery can result in inferior early
and late outcomes due to progression of FTR and underlying right heart
failure. The 2012 ESC/EACTS and 2014 ACC/AHA guidelines strongly encourage
the surgical correction of greater than mild tricuspid regurgitation or
tricuspid annular dilation greater than 4 cm in patients undergoing
left-sided valve surgery. Prospective randomized trials are needed to
bolster the evidence behind the current recommendations. Percutaneous
therapies in development may eventually result in less invasive options
for treating FTR. Copyright &#xa9; 2015 Future Medicine Ltd.

<22>
[Use Link to view the full text]
Accession Number
607152735
Author
Brinkman W.T.; Squiers J.J.; Filardo G.; Arsalan M.; Smith R.L.; Moore D.;
Mack M.J.; Dimaio J.M.
Institution
(Brinkman, Arsalan, Smith, Moore, Mack, Dimaio) Heart Hospital Baylor
Plano, Plano, TX, United States
(Squiers, Filardo, Dimaio) Department of Epidemiology, Baylor Scott and
White Health, Dallas, TX, United States
Title
Perioperative outcomes, transfusion requirements, and inflammatory
response after coronary artery bypass grafting with off-pump,
mini-extracorporeal, and on-pump circulation techniques.
Source
Journal of Investigative Medicine. 63 (8) (pp 916-920), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Mini-extracorporeal circulation (MECC) units were developed to
reduce postoperative morbidity, transfusion requirements, and inflammation
associated with conventional on-pump coronary artery bypass (ONCAB)
surgery without the technical demands of the off-pump (OPCAB) technique.
We compared perioperative outcomes and inflammatory mediation among OPCAB,
MECC, and ONCAB techniques. Methods We prospectively enrolled 102 patients
undergoing elective isolated coronary bypass grafting. Perfusion methods
were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood
samples were collected to measure serum inflammatory markers. Results
There were no operative deaths or strokes. Total red blood cell (RBC)
products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and
1.235 units, respectively. Adjusted (by splined Society of Thoracic
Surgeons operative risk score) analysis showed no statistically
significant differences in mean RBC product use among the different
operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311;
MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk
score and baseline level) mean plasma level differences (24 hours
postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95%
confidence interval [95% CI], 106.23-129.54) and for MECC (124.88; 95% CI,
113.45-136.32) were significantly higher than for ONCAB (98.82; 95% CI,
86.40-111.24). No significant adjusted differences (P = 0.304) in
interleukin-6 level changes were observed. Conclusions Off-pump coronary
artery bypass and MECC did not significantly reduce mean total RBC
transfusion requirements. Off-pump coronary artery bypass and MECC were
associated with greater C-reactive protein elevation than ONCAB,
suggestive of an increased inflammatory response to each of these
techniques. Copyright &#xa9; 2015 Lippincott Williams & Wilkins.

<23>
Accession Number
606534600
Author
Ng M.S.Y.; Ng A.S.Y.; Chan J.; Tung J.-P.; Fraser J.F.
Institution
(Ng, Ng, Tung, Fraser) Critical Care Research Group, The Prince Charles
Hospital, Rode Road, Chermside, Brisbane, QLD, Australia
(Ng, Ng, Chan, Tung, Fraser) School of Medicine, The University of
Queensland, Herston, Brisbane, QLD, Australia
(Ng, Tung) Research and Development, Australian Red Cross Blood Service,
Kelvin Grove, Brisbane, QLD, Australia
Title
Effects of packed red blood cell storage duration on post-transfusion
clinical outcomes: a meta-analysis and systematic review.
Source
Intensive Care Medicine. 41 (12) (pp 2087-2097), 2015. Date of
Publication: 05 Oct 2015.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: There is substantial conjecture regarding the clinical
significance of packed red blood cell (PRBC) changes that occur during in
vitro storage. Here, we present a meta- and systematic analysis of adult
studies published between 1994 and 2015 with the aim of updating existing
quantitative reviews and providing a comprehensive cover of the six most
commonly studied outcomes-mortality, infection, renal dysfunction,
multiple organ dysfunction syndrome (MODS), thrombotic complications and
prolonged hospital length of stay. Methods: Computerised searches of
Pubmed and EMBASE identified publications that reported target outcomes
and PRBC storage duration prior to transfusion. Bibliographies of relevant
literature were manually searched to incorporate missed studies.
Randomised controlled trial (RCT) data was meta-analysed using a random
effects model with Cochrane Collaboration Review Manager (RevMan) version
5.1 software. Observational investigations were systematically reviewed.
Results: Sixty-four papers were selected covering 462,581 patients with
the majority of studies being observational in nature. Meta-analysis of
eight RCTs demonstrated a trend towards decreased mortality with stored
PRBC transfusion; albeit this effect was not statistically significant (OR
0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care
unit (ICU), cardiac surgery and trauma patients; observational studies
suggested that prolonged storage may be correlated with increased
mortality. Trauma and cardiac surgery patients appeared to be most
susceptible to the potential infectious complications of stored PRBCs.
Stored PRBCs were unlikely to affect thrombotic complications or hospital
length of stay. There were inadequate data to determine whether stored
PRBCs had clinically relevant effects on renal dysfunction and MODS.
Conclusion: Although literature presents a concerning picture of potential
storage complications, current findings are too inconsistent to drive
changes in clinical practice. Results from current RCTs will likely play a
role in PRBC age guidelines for cardiac surgery and ICU patients. However,
these studies may be less efficacious at detecting small effects that are
limited to specific subpopulations. Copyright &#xa9; 2015, Springer-Verlag
Berlin Heidelberg and ESICM.

<24>
Accession Number
53225209
Author
Torregrosa I.; Montoliu C.; Urios A.; Andres-Costa M.J.; Gimenez-Garzo C.;
Juan I.; Puchades M.J.; Blasco M.L.; Carratala A.; Sanjuan R.; Miguel A.
Institution
(Torregrosa, Juan, Puchades, Miguel) Servicio de Nefrologia, Hospital
Clinico Universitario de Valencia, Av Blasco Ibanez 17, Valencia 46010,
Spain
(Torregrosa, Puchades, Miguel) Departamento de Medicina, Universidad de
Valencia, Valencia, Spain
(Montoliu, Urios, Andres-Costa) Fundacion Investigacion Clinico de
Valencia Instituto de Investigacion Sanitaria, INCLIVA, Valencia, Spain
(Montoliu) Departamento de Patologia, Seccion Histologia, Facultad de
Medicina y Odontologia, Universidad de Valencia, Valencia, Spain
(Gimenez-Garzo) Laboratorio de Neurobiologia, Centro Investigacion
Principe Felipe, Valencia, Spain
(Blasco, Sanjuan) Unidad Coronaria, Hospital Clinico Universitario de
Valencia, Valencia, Spain
(Carratala) Laboratorio de Bioquimica Clinica y Patologia Molecular,
Hospital Clinico Universitario de Valencia, Valencia, Spain
Title
Urinary KIM-1, NGAL and L-FABP for the diagnosis of AKI in patients with
acute coronary syndrome or heart failure undergoing coronary angiography.
Source
Heart and Vessels. 30 (6) (pp 703-711), 2015. Date of Publication: 01 Nov
2015.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Acute kidney injury (AKI) is a common complication after coronary
angiography. Early biomarkers of this disease are needed since increase in
serum creatinine levels is a late marker. To assess the usefulness of
urinary kidney injury molecule-1 (uKIM-1), neutrophil
gelatinase-associated lipocalin (uNGAL) and liver-type fatty acid-binding
protein (uL-FABP) for early detection of AKI in these patients, comparing
their performance with another group of cardiac surgery patients.
Biomarkers were measured in 193 patients, 12 h after intervention. In the
ROC analysis, AUC for KIM-1, NGAL and L-FABP was 0.713, 0.958 and 0.642,
respectively, in the coronary angiography group, and 0.716, 0.916 and
0.743 in the cardiac surgery group. Urinary KIM-1 12 h after intervention
is predictive of AKI in adult patients undergoing coronary angiography,
but NGAL shows higher sensitivity and specificity. L-FABP provides
inferior discrimination for AKI than KIM-1 or NGAL in contrast to its
performance after cardiac surgery. This is the first study showing the
predictive capacity of KIM-1 for AKI after coronary angiography. Further
studies are still needed to answer relevant questions about the clinical
utility of biomarkers for AKI in different clinical settings. Copyright
&#xa9; 2014, Springer Japan.

<25>
[Use Link to view the full text]
Accession Number
359774908
Author
Concato J.; Peduzzi P.; Huang G.D.; O'Leary T.J.; Kupersmith J.
Institution
(Concato) Clinical Epidemiology Research Center, VA Connecticut Healthcare
System, 950 Campbell Ave, Mailcode 151B, West Haven, CT 06516, United
States
(Peduzzi) Cooperative Studies Program Coordinating Center, Veterans
Affairs (VA) Connecticut Healthcare System, West Haven, United States
(Concato) Schools of Medicine, United States
(Peduzzi) Public Health, Yale University, New Haven, CT, United States
(Huang, O'Leary) VA Cooperative Studies Program Central Office, United
States
(Huang, O'Leary, Kupersmith) Office of Research and Development, Veterans
Health Administration, Washington, DC, United States
Title
Comparative effectiveness research: What kind of studies do we need?.
Source
Journal of Investigative Medicine. 58 (6) (pp 764-769), 2010. Date of
Publication: August 2010.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Comparative effectiveness research (CER) is increasingly popular, yet
discussions of its conduct and consequences often overlook the extensive
history of comparing different therapeutic options in patient-oriented
research. In particular, research in the Department of Veterans Affairs
(VA) has included a decades-long focus on generating information that can
enhance medical decision making and improve health outcomes. Categories of
such research include multisite randomized controlled trials (conducted by
the Cooperative Studies Program) and observational studies involving
either primary or secondary data collection. As representative examples
from cardiology, a landmark VA clinical trial published in the 1970s
evaluated the benefits of coronary artery bypass grafting surgery among
patients with angina; a VA trial initiated in the 1990s, and identified
formally as CER, demonstrated that percutaneous coronary intervention is
not superior to optimal medical therapy; and a database investigation
using information from the VA electronic medical record system in the
2000s found that use of proton pump inhibitor medication is associated
with the attenuation of the benefits of clopidogrel among patients
hospitalized for acute coronary syndrome. A review of these (and other)
selected projects, based on their type of study design, serves to
highlight the strengths, limitations, and potential of CER. Copyright
&#xa9; 2010 by The American Federation for Medical Research.

<26>
Accession Number
607616755
Author
Taha S.; Moretti C.; D'Ascenzo F.; Van Mieghem N.M.; Omede P.; Montefusco
A.; Ghany M.A.; Fouaad D.; Demitry S.; Zoccai G.B.; Gaita F.
Institution
(Taha) Citta della Salute e della Scienza Hospital, Division of Cardiology
1, University of Turin, Italy; Assuit University Hospital, Egypt.
Electronic address: esmaeil.salma@gmail.com
(Moretti) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(D'Ascenzo) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Van Mieghem) Department of Interventional Cardiology Thoraxcenter,
Erasmus Medical Center, Rotterdam, The Netherlands
(Omede) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Montefusco) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
(Ghany) Assuit University Hospital, Egypt
(Fouaad) Assuit University Hospital, Egypt
(Demitry) Assuit University Hospital, Egypt
(Zoccai) Division of Cardiology, Rome, Italy
(Gaita) Citta della Salute e della Scienza Hospital, Division of
Cardiology 1, University of Turin, Italy
Title
Impact of residual coronary artery disease on patients undergoing TAVI: A
meta-analysis of adjusted observational studies.
Source
International journal of cardiology. 181 (pp 77-80), 2015. Date of
Publication: 15 Feb 2015.

<27>
Accession Number
607257827
Author
Yamamoto S.; Hotta K.; Ota E.; Mori R.; Matsunaga A.
Institution
(Yamamoto) Department of Rehabilitation, Shinshu University Hospital,
Nagano, Japan
(Yamamoto, Matsunaga) Department of Rehabilitation Sciences, Graduate
School of Medical Sciences, Kitasato University, Kanagawa, Japan
(Hotta) Department of Biomedical Sciences, College of Medicine, Florida
State University, Tallahassee, FL, United States
(Ota, Mori) Department of Health Policy, National Center for Child Health
and Development, Tokyo, Japan
Title
Effects of resistance training on muscle strength, exercise capacity, and
mobility in middle-aged and elderly patients with coronary artery disease:
A meta-analysis.
Source
Journal of Cardiology. 68 (2) (pp 125-134), 2016. Date of Publication: 01
Aug 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Resistance training (RT) is a core component of cardiac
rehabilitation. We investigated the effects of RT on exercise capacity,
muscle strength, and mobility in middle-aged and elderly patients with
coronary artery disease (CAD). Methods We searched for randomized
controlled trials of RT versus usual care, or combined RT and aerobic
training (AT) versus AT alone, and identified 440 trials in total from
inception to January 2014. Participants who had myocardial infarction,
coronary revascularization, angina pectoris or CAD were included in the
analysis. Those who had heart failure, heart transplants with either
cardiac resynchronization therapy or implantable defibrillators were
excluded. Results Twenty-two trials totaling 1095 participants were
analyzed. We performed random-effects meta-analysis. In middle-aged
participants, RT increased lower extremity muscle strength [standardized
mean difference (SMD): 0.65, 95% confidence interval (CI): 0.35 to 0.95],
upper extremity muscle strength (SMD: 0.73, 95% CI: 0.48 to 0.99) and peak
oxygen consumption (VO<inf>2</inf>) [weight mean difference (WMD): 0.92
mL/kg/min, 95% CI: 0.12 to 1.72], but did not improve mobility compared
with the control. In elderly participants, RT increased lower extremity
muscle strength (SMD: 0.63, 95% CI: 0.05 to 1.21), upper extremity muscle
strength (SMD: 1.18, 95% CI: 0.56 to 1.80), and peak VO<inf>2</inf> (WMD:
0.70 mL/kg/min, 95% CI: 0.03 to 1.37), and improved mobility (SMD: 0.61,
95% CI: 0.21 to 1.01) compared with the control. Conclusions Resistance
training could increase exercise capacity and muscle strength in
middle-aged and elderly patients, and mobility in elderly patients, with
CAD. Copyright &#xa9; 2015 Japanese College of Cardiology

<28>
Accession Number
612346444
Author
Tang C.-Y.; Wu C.; Zhu Y.-P.; Ye C.; Zhao Q.; Yu L.-F.
Institution
(Tang, Wu, Zhu, Ye, Zhao, Yu) Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, China
Title
Endoscopic evaluation of gastroduodenal mucosal injury in patients taking
12-month different antiplatelet therapies after coronary artery bypass
grafting sugery: A randomized comparison trial.
Source
Journal of Digestive Diseases. Conference: 16th Congress of
Gastroenterology China, CGC 2016. China. Conference Start: 20160922.
Conference End: 20160924. 17 (pp 50), 2016. Date of Publication: September
2016.
Publisher
Blackwell Publishing
Abstract
Backgroud Despite obvious advantages of dual antiplatelet therapy (DAPT),
the rate of gastrointestinal (GI) bleeding related to the use of
antiplatelet drugs is independently associated with mortality and ischemic
complications. Endoscopic ulcers may be an early step in a biological
progression from mucosal injury to symptomatic ulcer and ulcer
complication (eg, bleeding). It appears to be a valid surrogate marker of
clopidogrel-induced mucosal injury. Recently, new guidelines
recommendation on the use of ticagrelor plus aspirin has been formulated
as the first choice for patients underwent either percutaneous coronary
intervention or coronary artery bypass grafting (CABG) surgery. However,
the characteristics of endoscopic findings in ticagrelor users remain
unclear and less information is available for the clinical characteristics
and upper GI lesions in users treated with new DAPT. Methods Five hundred
patients following CABG were randomly assigned into three groups (DACAB
study, NCT 02201771), including aspirin or ticagrelor monotherapy group
and ticagrelor plus aspirin group. After 12-months different antiplatelet
treatment, both esophagogastroduodenoscopy (EGD) and 13C-Urea Breath Test
(13C-UBT) are performed in 270 patients enrolled in Ruijin hospital with
their consent. The grade of gastroduodenal mucosal injury is assessed
according to the modified Lanza score (MLS). The MLS will be graded and
independently validated by a single endoscopy specialist who was blinded
to any other information about the subjects. In this scoring system, there
are 6 grades of gastroduodenal mucosal injury from 0 (normal mucosa) to 5
(ulcer). In this study, comprehensive results of gastroduodenal mucosal
injury (marked as G0- 5D0-5) will be further divided into 5 levels as
following. Level I: no visible mucosal injury (G0D0); Level II: erythema
or petechiae or erosive lesions were found only in one area of stomach or
proximal duodenum (G1-2D0/G0D1-2); Level IIIa: erosive lesions were found
in two areas of stomach and/or proximal duodenum (G2- 3D1-3/G1-3D2-3);
Level IIIb: the diameter of an ulcer is from 3 to 5 mm; Level IVa: erosive
lesions were found in more than two areas of stomach and proximal duodenum
(G4D1-3/G1-3D4); Level IVb: the diameter of an ulcer is from 5 to 20 mm;
Level V: the diameter of an ulcer is more than 20 mm. Level III and above
is considered as severe gastroduodenal mucosal injury. Concomitant use of
proton pump inhibitors (PPIs) in each patient was recorded. Results From
August 2015 to May 2016, 160 of 181 patients finished the follow-up, 91.9%
(147/160) of whom underwent EGD and 13C-UBT. The upper GI mucosal injury
of Level III and above is much more serious in the ticagrelor plus aspirin
group (38.0%, 19/50), compared with that in aspirin (31.3%, 15/48) or
ticagrelor (28.6%, 14/49) monotherapy group, respectively. All patients
were prescribed with 1-month PPIs after CABG. In addition, 60.5% (89/147)
of them were treated with PPIs for 3 months. Among 25 patients with
history of peptic ulcers, only 28.0% (7/17) of them were treated with PPIs
for more than 6 months. Until now, 33.3% (49/147) of patients have
positive result of 13C-UBT. However, only one patient finished the
eradication therapy. Conclusions This is the first time to observe how
different antiplatelet strategies influence potentially serious harm on
gastroduodenal mucosa by endoscopy in patients following CABG surgery with
or without GI symptoms. It seems that Chinese patient rarely concomitant
use of antiplatelet therapy with PPIs more than 6 months, even those with
a history of peptic ulcer, demonstrating an unmet need for effective
prophylactic treatment to decrease the risk of upper GI bleeding.

<29>
Accession Number
608878220
Author
Toutouzas K.; Latsios G.; Stathogiannis K.; Drakopoulou M.; Synetos A.;
Sanidas E.; Mastrokostopoulos A.; Trantalis G.; Kaitozis O.; Lazaros G.;
Yuecel S.; Gerckens U.; Grube E.; Tousoulis D.
Institution
(Toutouzas, Latsios, Stathogiannis, Drakopoulou, Synetos,
Mastrokostopoulos, Trantalis, Kaitozis, Lazaros, Tousoulis) First
Department of Cardiology, Hippokration Hospital, Athens Medical School,
Athens, Greece
(Sanidas) Cardiology Department, Laikon Hospital, Athens, Greece
(Yuecel, Gerckens) Gemeinschaftskrankenhaus Bonn, Germany
(Grube) University Hospital, Dept. of Medicine II, Bonn, Germany
Title
One-year outcomes after direct transcatheter aortic valve implantation
with a self-expanding bioprosthesis. A two-center international
experience.
Source
International Journal of Cardiology. 202 (pp 631-635), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Balloon aortic valvuloplasty (BAV) is considered to be an
essential part of the transcatheter aortic valve implantation (TAVI)
procedure and is being performed routinely. At present there is
insufficient long-term data as to the benefits of routine BAV prior to
TAVI. Aim: The aim of this study was to evaluate the safety of direct TAVI
and the mortality rate at 1-year in patients undergoing TAVI with or
without BAV with a self-expanding bioprosthesis. Methods: Between January
2008 and September 2013 consecutive patients undergoing TAVI with the
Medtronic CoreValve in two experienced centers in Athens, Greece and in
Siegburg, Germany were studied. All data were prospectively collected and
retrospectively analyzed. Primary endpoint was mortality at 1 year.
Procedural data and clinical data (bleeding, vascular complications and
echocardiographic parameters) were analyzed. Results: A total of 210
patients undergoing TAVI were evaluated (non-direct = 120 patients, direct
= 90 patients). All-cause mortality at 30 days and at 1 year was similar
in both groups (4% in non-direct versus 2% in direct, p = 0.6 and 15% in
non-direct versus 11% in direct, p = 0.5, respectively). Device success
rate was similar in both groups (77% in non-direct versus 83% in direct, p
= 0.2). Major vascular complications were comparable for both groups (5%
in non-direct versus 3% in direct, p = 0.5). The direct group had less
moderate/severe paravalvular leakage than the non-direct group after the
device implantation (7% versus 33%, p< 0.01). Conclusions: Performing
direct TAVI with the self-expanding bioprosthesis is safe and feasible
showing similar mortality rates compared to patients undergoing non-direct
TAVI at 30 days and at 1-year. Copyright &#xa9; 2015 Elsevier Ireland Ltd.
All rights reserved.

<30>
Accession Number
612244138
Author
Liu X.; Zhang K.; Wang W.; Xie G.; Fang X.
Institution
(Liu, Zhang, Wang, Xie, Fang) Department of Anesthesiology and Intensive
Care Medicine, First Affiliated Hospital, School of Medicine, Zhejiang
University, 79 Qingchun Road, Hangzhou 310003, China
Title
Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery
compared to propofol: A randomized controlled trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 298. Date of
Publication: 21 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation occurs frequently in patients following
cardiac surgery and can be a cause of increased morbidity and mortality.
The use of dexmedetomidine to prevent atrial fibrillation is unclear. The
present study was designed to evaluate the effect of dexmedetomidine
sedation on the incidence of atrial fibrillation after cardiac surgery.
Methods: Upon arrival to the intensive care unit (ICU), cardiac surgery
patients without prior atrial fibrillation or flutter were randomized to
receive either dexmedetomidine (0.2-1.5 mug/kg/h) or propofol (0.3-3
mg/kg/h) open-label titrated to a target Richmond agitation-sedation scale
of 0 to -3. Our primary endpoint was the incidence of postoperative atrial
fibrillation, and the secondary end points were the length of ICU stay,
length of hospital stay, and hospital costs. Results: Atrial fibrillation
occurred in 6 of 44 patients (13.6 %) in the dexmedetomidine group
compared to 16 of 44 patients (36.4 %) in the propofol group (odds ratio =
0.28; 95 % confidence interval, 0.10, 0.80; P = 0.025). The median
(interquartile range) length of ICU stay in the dexmedetomidine group was
significantly lower than in the propofol group (2.9 (2.4-3.5) vs 3.5
(2.7-4.5 days, P = 0.008), with a trend toward a decrease in median
hospital costs (86,367 vs 77,874 Chinese yuan; P = 0.068). The incidence
of hypotension was higher in the dexmedetomidine group than in the
propofol group (25/44 (56.8 %) vs 13/44 (29.5 %); P = 0.017). Conclusions:
Dexmedetomidine sedation reduced the incidence of new-onset postoperative
atrial fibrillation and shortened the length of ICU stay in patients after
cardiac surgery compared to propofol sedation. Dexmedetomidine treatment
was associated with more episodes of hypotension. Trial registration:
chictr.org.cn: ChiCTR-IPR-16008231, retrospectively registered: April 6,
2016. This trial was not prospectively registered due to a lack of
importance applied to trial registration. Copyright &#xa9; 2016 The
Author(s).

<31>
Accession Number
607362278
Author
Gewirtz H.
Institution
(Gewirtz) Department of Medicine (Cardiology Division), Massachusetts
General Hospital, Harvard Medical School, Cardiac Unit/Yawkey 5E, 55 Fruit
Street, Boston, MA 02114, United States
Title
Functional Versus Anatomic Imaging of CAD: Lessons Learned from Recent
Clinical Trials.
Source
Current Cardiology Reports. 18 (1) (pp 1-7), 2016. Article Number: 4. Date
of Publication: 01 Jan 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Recent clinical trials directed at imaging of coronary artery disease
(CAD) have demonstrated a paradigm shift away from endpoints related to
detection of CAD in favor of those related to clinical outcomes. The
objective of such trials has been to determine whether physiological
metrics are superior to anatomical ones for guiding therapy and improving
outcomes in patients with known or suspected CAD. The present review
focuses on selected trials in this area in particular DEFER, FAME 1 and 2,
a meta-analysis comparing FFR to anatomically guided treatment outcomes
and COURAGE SPECT MPI sub study. The rationale for using physiological as
opposed to anatomical endpoints to optimize patient management, in
particular coronary revascularization decisions, is emphasized. The
results of the FFR-based trials are concordant and indicate physiological
metrics are superior to anatomical ones for guiding therapy and improving
clinical outcomes in patients with known or suspected CAD. Copyright
&#xa9; 2015, Springer Science+Business Media New York.

<32>
Accession Number
612143853
Author
Bakos Z.; Ostenfeld E.; Markstad H.; Werther-Evaldsson A.; Roijer A.;
Arheden H.; Carlsson M.; Borgquist R.
Institution
(Bakos, Borgquist) Arrhythmia Clinic, Lund University, Skane University
Hospital, Getingevagen 4, Lund 221 85, Sweden
(Ostenfeld, Arheden, Carlsson) Center For Medical Imaging and Physiology,
Department of Clinical Physiology, Lund University and Skane University
Hospital, Lund 221 85, Sweden
(Markstad) Center for Medical Imaging and Physiology, Lund University,
Skane University Hospital, Getingevagen 4, Lund 221 85, Sweden
(Werther-Evaldsson, Roijer) Clinic for Heart Failure and Valvular Disease,
Lund University, Skane University Hospital, Getingevagen 4, Lund 221 85,
Sweden
Title
A comparison between radial strain evaluation by speckle-tracking
echocardiography and cardiac magnetic resonance imaging, for assessment of
suitable segments for left ventricular lead placement in cardiac
resynchronization therapy.
Source
Europace. 16 (12) (pp 1779-1786), 2014. Date of Publication: 08 Oct 2014.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: A cut-off of 9.8% maximum speckle-tracking radial strain in the
segment with the latest mechanical delay has been proposed as predictive
for selecting the best left ventricular lead placement for positive
response on cardiac resynchronization therapy (CRT).However, pacing
transmural scar should be avoided, and the purpose of this studywas to
evaluate the ability of echocardiographic radial strain to predict the
presence of scar in the left ventricle segments. Methods and results: A
total of 404 left ventricular segments were analysed, from 34 patients
eligible for CRT. Pre-operative cardiac magnetic resonance (CMR) and
echocardiography were performed, and maximal strain values from
echocardiography speckle tracking were compared with CMR data. Hypokinesia
and strain values showed a strong correlation (P < 0.001). Even though
segments with CMR-verified scar had lower strain values than segments
without scar (14.8+/-7 vs. 16.0+/-10), the predictive value of the
proposed 9.8% cut-off was low (sensitivity 33% and specificity 72%). Scar
burden was higher in ischaemic patients (13.5 vs. 5.3% P = 0.0001).
Relative difference in strain values (target segment strain compared with
the average strain value of the adjacent segments) was higher if there was
transmural scar in the target segment as compared with a hypokinetic but
viable target segment (87 vs. 38% difference, P = 0.03). Conclusion:
Speckle tracking radial strain should ideally be complemented by CMR for
accurate assessment of viability, especially for patients with ischaemic
aetiology of heart failure where transmural scar is more common.
Comparison of strain values with the adjacent segments may be helpful for
assessing viability. Published on behalf of the European Society of
Cardiology. All rights reserved. Copyright &#xa9; The Author 2014.

<33>
Accession Number
612073913
Author
Calancie B.; Donohue M.L.; Harris C.B.; Canute G.W.; Singla A.; Wilcoxen
K.G.; Moquin R.R.
Institution
(Calancie, Singla, Wilcoxen) 750 E. Adams St., IHP #1213, Syracuse, NY
13210, United States
(Donohue) Cell and Developmental Biology, SUNY Upstate Medical University,
United States
(Harris) Syracuse Orthopedic Specialists, United States
(Canute, Moquin) Crouse Neurosciences, Syracuse, NY, United States
Title
Implantation of thoracic pedicle screws: A blinded and randomized clinical
study. Part 1. Methods and alarm criteria Clinical article.
Source
Journal of Neurosurgery: Spine. 20 (6) (pp 675-691), 2014. Date of
Publication: 2014.
Publisher
American Association of Neurological Surgeons (E-mail:
jnevro@virginia.edu)
Abstract
Reports of the accuracy of existing neuromonitoring methods for detecting
or preventing medial malpositioning of thoracic pedicle screws have varied
widely in their claimed effectiveness. The object of this study was to
develop, test, and validate a novel neuromonitoring method for preventing
medial malpositioning of pedicle screws in the thoracic spine during
surgery. Methods. This is a prospective, blinded and randomized study
using a novel combination of input (4-pulse stimulus trains delivered
within the pedicle track) and output (evoked electromyography from leg
muscles) to detect pedicle track trajectories that-once implanted with a
screw-would cause that screw to breach the pedicle's medial wall and
encroach upon the spinal canal. For comparison, the authors also used
screw stimulation as an input and evoked electromyogram from intercostal
and abdominal muscles as output measures. Intraoperative
electrophysiological findings were compared with postoperative CT scans by
multiple reviewers blinded to patient identity or intraoperative findings.
Results. Data were collected from 71 patients, in whom 802 screws were
implanted between the T-1 and L-1 vertebral levels. A total of 32 screws
ended up with screw threads encroaching on the spinal canal by at least 2
mm. Pulse-Train stimulation within the pedicle track using a ball-Tipped
probe and electromyography from lower limb muscles correctly predicted all
32 (100%) of these medially malpositioned screws. The combination of
pedicle track stimulation and electromyogram response from leg muscles
proved to be far more effective in predicting these medially malpositioned
screws than was direct screw stimulation and any of the target muscles
(intercostal, abdominal, or lower limb muscles) we monitored. Based on
receiver operating characteristic analysis, the combination of 10-mA
(lower alarm) and 15-mA stimulation intensities proved most effective for
detection of pedicle tracks that ultimately gave rise to medially
malpositioned screws. Additional results pertaining to the impact of
feedback of these test results on surgical decision making are provided in
the companion report. Conclusions. This novel neuromonitoring approach
accurately predicts medially malpositioned thoracic screws. The approach
could be readily implemented within any surgical program that is already
using contemporary neuromonitoring methods that include transcranial
stimulation for monitoring motor evoked potentials. Copyright &#xa9; AANS,
2014.

<34>
Accession Number
612234154
Author
Bramlage P.; Strauch J.; Schrofel H.
Institution
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Strauch) Clinic for Cardiosurgery and Thoracic Surgery,
Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil, Bochum,
Germany
(Schrofel) Clinic for Cardiac Surgery, Karlsruhe, Germany
Title
Balloon expandable transcatheter aortic valve implantation with or without
pre-dilation of the aortic valve - rationale and design of a multicenter
registry (EASE-IT).
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 160. Date of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: In patients with severe calcific aortic stenosis, balloon
aortic valvuloplasty (BAV) is routinely performed in order to pre-dilate
the stenosed aortic valve prior to transcatheter aortic valve implantation
(TAVI). Although pre-dilation is considered to be essential for the
preparation of the valve landing zone, there is no clear evidence to
support its clinical value. In contrast, BAV has been suggested to be
linked to several complications. Notably, while preliminary evidence has
supported the feasibility and safety of TAVI without pre-dilation, larger
studies directly comparing the benefit/risk profile of TAVI in the
presence and absence of pre-dilation are required. Methods/Design:
Therefore, a prospective, two-armed, multicenter registry (EASE-IT) was
designed to obtain essential data concerning procedural success rates,
adverse events, and mortality in a large cohort of patients undergoing
transapical (TA)-TAVI using the Edwards SAPIEN 3 balloon expandable heart
valves with and without pre-ballooning. Discussion: Data provided by
EASE-IT will be used to assess the relevance of BAV during the TAVI
procedure and to investigate associations between patient characteristics
and outcomes. Therefore, results obtained from the EASE-IT registry could
contribute to reduced rates of TAVI-associated morbidity and mortality in
patients with severe, calcific aortic stenosis. Copyright &#xa9; 2014
Bramlage et al.

<35>
Accession Number
612233838
Author
Polderman J.A.W.; Houweling P.L.; Hollmann M.W.; DeVries J.H.; Preckel B.;
Hermanides J.
Institution
(Polderman, Hollmann, Preckel, Hermanides) Department of Anaesthesiology,
Academic Medical Centre, Postbus 22660, Amsterdam 1100 DD, Netherlands
(Houweling) Department of Anaesthesiology, Diakonessenhuis, Bosboomstraat
1, Utrecht 3582 KE, Netherlands
(DeVries) Department of Internal Medicine, Academic Medical Centre,
Postbus 22660, Amsterdam 1100 DD, Netherlands
Title
Study protocol of a randomised controlled trial comparing perioperative
intravenous insulin, GIK or GLP-1 treatment in diabetes-PILGRIM trial.
Source
BMC Anesthesiology. 14 (1) (no pagination), 2014. Article Number: 91. Date
of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Diabetes mellitus (DM) is associated with poor outcome after
surgery. The prevalence of DM in hospitalised patients is up to 40%,
meaning that the anaesthesiologist will encounter a patient with DM in the
operating room on a daily basis. Despite an abundance of published glucose
lowering protocols and the known negative outcomes associated with
perioperative hyperglycaemia in DM, there is no evidence regarding the
optimal intraoperative glucose lowering treatment. In addition, protocol
adherence is usually low and protocol targets are not simply met.
Recently, incretins have been introduced to lower blood glucose. The main
hormone of the incretin system is glucagon-like peptide-1 (GLP-1). GLP-1
increases insulin and decreases glucagon secretion in a glucose-dependent
manner, resulting in glucose lowering action with a low incidence of
hypoglycaemia. We set out to determine the optimal intraoperative
treatment algorithm to lower glucose in patients with DM type 2 undergoing
non-cardiac surgery, comparing intraoperative glucose-insulin-potassium
infusion (GIK), insulin bolus regimen (BR) and GPL-1 (liragludite, LG)
treatment. Methods/Design: This is a multicentre randomised open label
trial in patients with DM type 2 undergoing non-cardiac surgery. Patients
are randomly assigned to one of three study arms; intraoperative
glucose-insulin-potassium infusion (GIK), intraoperative sliding-scale
insulin boluses (BR) or GPL-1 pre-treatment with liraglutide (LG).
Capillary glucose will be measured every hour. If necessary, in all study
arms glucose will be adjusted with an intravenous bolus of insulin.
Researchers, care givers and patients will not be blinded for the assigned
treatment. The main outcome measure is the difference in median glucose
between the three study arms at 1 hour postoperatively. We will include
315 patients, which gives us a 90% power to detect a 1 mmol l^-1
difference in glucose between the study arms. Discussion: The PILGRIM
trial started in January 2014 and will provide relevant information on the
perioperative use of GLP-1 agonists and the optimal intraoperative
treatment algorithm in patients with diabetes mellitus type 2. Trial
registration: ClinicalTrials.gov, NCT02036372. Copyright &#xa9; 2014
Polderman et al.

<36>
Accession Number
612280147
Author
Buckingham S.A.; Taylor R.S.; Jolly K.; Zawada A.; Dean S.G.; Cowie A.;
Norton R.J.; Dalal H.M.
Institution
(Buckingham, Dalal) Department of Research, Development and Innovation,
Royal Cornwall, Hospitals NHS Trust, Truro, United Kingdom
(Taylor, Dean, Dalal) Institute of Health Research (Primary Care),
University of Exeter Medical School, Exeter, Devon, United Kingdom
(Jolly) Institute for Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
(Zawada) Agency for Health Technology Assessment and Tariff System,
Warsaw, Poland
(Cowie) Cardiac Rehabilitation, University Hospital Ayr, Ayr, United
Kingdom
(Norton) Institute of Bioengineering, School of Engineering and Materials
Science, Queen Mary University of London, London, United Kingdom
Title
Home-based versus centre-based cardiac rehabilitation: Abridged Cochrane
systematic review and meta-analysis.
Source
Open Heart. 3 (2) (no pagination), 2016. Article Number: e000463. Date of
Publication: 01 Sep 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To update the Cochrane review comparing the effects of
home-based and supervised centre-based cardiac rehabilitation (CR) on
mortality and morbidity, quality of life, and modifiable cardiac risk
factors in patients with heart disease. Methods Systematic review and
meta-analysis. The Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to
October 2014, without language restriction. Randomised trials comparing
home-based and centre-based CR programmes in adults with myocardial
infarction, angina, heart failure or who had undergone coronary
revascularisation were included. Results 17 studies with 2172 patients
were included. No difference was seen between home-based and centre-based
CR in terms of: mortality (relative risk (RR) 0.79, 95% CI 0.43 to 1.47);
cardiac events; exercise capacity (mean difference (MD) -0.10, -0.29 to
0.08); total cholesterol (MD 0.07-mmol/L, -0.24 to 0.11); low-density
lipoprotein cholesterol (MD -0.06-mmol/L, -0.27 to 0.15); triglycerides
(MD -0.16-mmol/L, -0.38 to 0.07); systolic blood pressure (MD 0.2-mm-Hg,
-3.4 to 3.8); smoking (RR 0.98, 0.79 to 1.21); health-related quality of
life and healthcare costs. Lower high-density lipoprotein cholesterol (MD
-0.07-mmol/L, -0.11 to -0.03, p=0.001) and lower diastolic blood pressure
(MD -1.9-mm-Hg, -0.8 to -3.0, p=0.009) were observed in centre-based
participants. Home-based CR was associated with slightly higher adherence
(RR 1.04, 95% CI 1.01 to 1.07). Conclusions Home-based and centre-based CR
provide similar benefits in terms of clinical and health-related quality
of life outcomes at equivalent cost for those with heart failure and
following myocardial infarction and revascularisation. Copyright &#xa9;
Published by the BMJ Publishing Group Limited.

<37>
Accession Number
612316476
Author
Stewart M.H.; Stephen Jenkins J.
Institution
(Stewart, Stephen Jenkins) Department of Cardiology, Ochsner Clinic
Foundation, New Orleans, LA, United States
Title
The evolving role of percutaneous mitral valve repair.
Source
Ochsner Journal. 16 (3) (pp 270-276), 2016. Date of Publication: Fall
2016.
Publisher
Ochsner Clinic (E-mail: ocjournal@ochsner.org)
Abstract
Background: Mitral regurgitation (MR) is the second leading cause of
valvular heart disease in the United States behind aortic stenosis. The
percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been
approved in the United States since 2013 as an alternative to traditional
mitral valve surgery. However, many questions are left unanswered about
when to perform this procedure and whom to perform it on. Methods: We
reviewed major published literature on the MitraClip from 2003-2016 to
help guide clinical decision-making. A PubMed search was conducted using
the phrase "mitraclip" or "percutaneous mitral valve repair" to identify
relevant articles pertaining to the clip as well as surgical valve repair.
Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve
Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the
MitraClip but did not prove its superiority to surgical repair in the
population studied. Numerous subsequent registries have suggested that the
success of the MitraClip varies with the patient population studied. The
currently enrolling Cardiovascular Outcomes for Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients with Functional
MR (COAPT) trial hopes to answer some of these questions. Conclusion: The
MitraClip is a new and exciting technology for percutaneously treating
disease processes traditionally managed with surgery. The future of the
clip and its patient population is dependent on further studies. Copyright
&#xa9; Academic Division of Ochsner Clinic Foundation.

<38>
Accession Number
612310578
Author
Vandvik P.O.; Guyatt G.
Institution
(Vandvik) Institute of Health and Society, University of Oslo, Oslo,
Norway
(Guyatt) McMaster University, Hamilton, ON, Canada
Title
Review: In severe aortic stenosis, TAVI and conventional surgery do not
differ for < 30-day or < 1-year mortality.
Source
Annals of Internal Medicine. 165 (6) (pp JC31), 2016. Date of Publication:
20 Sep 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<39>
Accession Number
612328834
Author
Okumura N.; Jhund P.S.; Gong J.; Lefkowitz M.P.; Rizkala A.R.; Rouleau
J.L.; Shi V.C.; Swedberg K.; Zile M.R.; Solomon S.D.; Packer M.; Mcmurray
J.J.V.
Institution
(Okumura, Jhund, Mcmurray) BHF Cardiovascular Research Centre, University
of Glasgow, 126 University Pl, Glasgow G12 8TA, United Kingdom
(Gong, Lefkowitz, Rizkala, Shi) Novartis Pharmaceutical Corporation, East
Hanover, NJ, United States
(Rouleau) Institut de Cardiologie de Montreal, Universitede Montreal,
Montreal, QC, Canada
(Swedberg) Department of Molecular and Clinical Medicine, University of
Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Zile) Medical University of South Carolina, RHJ Department of Veterans
Administration Medical Center, Charleston, SC, United States
(Solomon) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Packer) Baylor Heart and Vascular Institute, Baylor University Medical
Center, Dallas, TX, United States
Title
Effects of sacubitril/valsartan in the PARADIGM-HF trial (Prospective
Comparison of ARNI with ACEI to Determine Impact on Global Mortality and
Morbidity in Heart Failure) according to background therapy.
Source
Circulation: Heart Failure. 9 (9) (no pagination), 2016. Article Number:
003212. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In the PARADIGM-HF trial (Prospective Comparison of ARNI with
ACEI to Determine Impact on Global Mortality and Morbidity in Heart
Failure), the angiotensin receptor neprilysin inhibitor
sacubitril/valsartan was more effective than the angiotensin-converting
enzyme inhibitor enalapril in patients with heart failure and reduced
ejection fraction. We examined whether this benefit was consistent
irrespective of background therapy. Methods and Results - We examined the
effect of study treatment in the following subgroups: diuretics (yes/no),
digitalis glycoside (yes/no), mineralocorticoid receptor antagonist
(yes/no), and defibrillating device (implanted defibrillating device,
yes/no). We also examined the effect of study drug according to
beta-blocker dose (>50% and <50% of target dose) and according to whether
patients had undergone previous coronary revascularization. We analyzed
the primary composite end point of cardiovascular death or heart failure
hospitalization, as well as cardiovascular death. Most randomized patients
(n=8399) were treated with a diuretic (80%) and beta-blocker (93%); 47% of
those taking a beta-blocker were treated with >50% of the recommended
dose. In addition, 4671 (56%) were treated with a mineralocorticoid
receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a
defibrillating device; 2640 (31%) had undergone coronary
revascularization. Overall, the sacubitril/valsartan versus enalapril
hazard ratio for the primary composite end point was 0.80 (95% confidence
interval, 0.73-0.87; P<0.001) and for cardiovascular death was 0.80
(0.71-0.89; P<0.001). The effect of sacubitril/valsartan was consistent
across all subgroups examined. The hazard ratio for primary end point
ranged from 0.74 to 0.85 and for cardiovascular death ranged from 0.75 to
0.89, with no treatment-by-subgroup interaction. Conclusions - The benefit
of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor,
was consistent regardless of background therapy and irrespective of
previous coronary revascularization or beta-blocker dose. Copyright &#xa9;
2016 American Heart Association, Inc.

<40>
[Use Link to view the full text]
Accession Number
610667757
Author
Xu X.; Li S.-X.; Lin H.; Normand S.-L.T.; Lagu T.; Desai N.; Duan M.;
Kroch E.A.; Krumholz H.M.
Institution
(Xu) Department of Obstetrics, Gynecology and Reproductive Sciences, Yale
School of Medicine, New Haven, CT, United States
(Xu, Li, Desai, Krumholz) Center for Outcomes Research and Evaluation,
Yale-New Haven Hospital, 1 Church Street, New Haven, CT 06510, United
States
(Lin) Department of Biostatistics, Yale School of Public Health, New
Haven, CT, United States
(Normand) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(Normand) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Lagu) Division of General Medicine, Tufts University School of Medicine,
Boston, MA, United States
(Lagu) Baystate Medical Center, Springfield, MA, United States
(Desai, Krumholz) Section of Cardiovascular Medicine, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, United States
(Duan) Premier Inc., Charlotte, NC, United States
(Kroch) Leonard Davis Institute of Health Economics, University of
Pennsylvania, Philadelphia, PA, United States
(Kroch) Booz Allen Hamilton Inc., McLean, VA, United States
(Krumholz) Robert Wood Johnson Foundation Clinical Scholars Program,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Title
Hospital phenotypes in the management of patients admitted for acute
myocardial infarction.
Source
Medical Care. 54 (10) (pp 929-936), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To characterize hospital phenotypes by their combined
utilization pattern of percutaneous coronary interventions (PCI), coronary
artery bypass grafting (CABG) procedures, and intensive care unit (ICU)
admissions for patients hospitalized for acute myocardial infarction
(AMI). Research Design: Using the Premier Analytical Database, we
identified 129,138 hospitalizations for AMI from 246 hospitals with the
capacity for performing open-heart surgery during 2010-2013. We calculated
year-specific, risk-standardized estimates of PCI procedure rates, CABG
procedure rates, and ICU admission rates for each hospital, adjusting for
patient clinical characteristics and within-hospital correlation of
patients. We used a mixture modeling approach to identify groups of
hospitals (ie, hospital phenotypes) that exhibit distinct longitudinal
patterns of risk-standardized PCI, CABG, and ICU admission rates. Results:
We identified 3 distinct phenotypes among the 246 hospitals: (1) high PCI
- low CABG - high ICU admission (39.2% of the hospitals), (2) high PCI -
low CABG - low ICU admission (30.5%), and (3) low PCI - high CABG -
moderate ICU admission (30.4%). Hospitals in the high PCI - low CABG -
high ICU admission phenotype had significantly higher risk-standardized
inhospital costs and 30-day risk-standardized payment yet similar
risk-standardized mortality and readmission rates compared with hospitals
in the low PCI - high CABG - moderate ICU admission phenotype. Hospitals
in these phenotypes differed by geographic region. Conclusions: Hospitals
differ in how they manage patients hospitalized for AMI. Their distinctive
practice patterns suggest that some hospital phenotypes may be more
successful in producing good outcomes at lower cost. Copyright &#xa9; 2016
Wolters Kluwer Health, Inc. All rights reserved.

<41>
Accession Number
612297680
Author
Habib A.
Institution
(Habib) Department of Intensive Care, Adult Cardiac Intensive Care Unit,
Prince Sultan Cardiac Centre, Prince Sultan Military Medical City, Post
Office Box 7897-X966, Riyadh 11159, Saudi Arabia
(Habib) Department of Critical Care Medicine, Faculty of Medicine, Cairo
University, Cairo, Egypt
Title
Comparison of low- and high-dose recombinant activated factor VII for
postcardiac surgical bleeding.
Source
Indian Journal of Critical Care Medicine. 20 (9) (pp 497-503), 2016. Date
of Publication: September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Aim of the Study: A retrospective observational study to compare safety
and efficacy of high and low doses of recombinant activated factor VIIa
(rFVIIa) in severe postcardiac surgical bleeding. Patients and Methods:
From 2004 to 2014, all patients who received rFVIIa for bleeding after
cardiac surgery were included and arranged in two groups; Group 1: Low
dose (40-50 mcg/kg) (n = 98) and Group 2: High dose (90-120 mcg/kg) (n =
156). Results: There was no significant difference in demographic and
surgical characteristics of both groups on admission to Cardiac Surgical
Intensive Care Unit (CSICU). There was no significant difference between
the two groups regarding the reduction in chest tube bleeding in the first
6 h or the transfusion requirement in the 24 h after admission to CSICU. A
total of 15 patients (5.9%) had thromboembolic adverse events. (Seven
(7.1%) patients in Group 1 compared to 8 (5.1%) patients in Group 2, P =
0.58). There were no significant differences in all-cause mortality at 30
days (2% in Group 1 vs. 3.2% in Group 2, P = 0.6) and at hospital
discharge between the two study groups (6.1% in Group 1 vs. 8.3% in Group
2, P = 0.5), respectively. There was no significant difference between the
two groups regarding the need for re-exploration, days on mechanical
ventilation, CSICU, or hospital stay. Conclusion: In this report, Low-dose
rFVIIa showed equivalent efficacy and safety to high-dose rFVIIa. Further
prospective randomized studies are needed to confirm these findings.
Copyright &#xa9; 2016 Indian Journal of Critical Care Medicine Published
by Wolters Kluwer - Medknow.

<42>
Accession Number
607374629
Author
Jacob K.A.; De Heer L.M.; De Heer F.; Kluin J.
Institution
(Jacob, De Heer, De Heer, Kluin) Department of Cardiothoracic Surgery,
University Medical Centre Utrecht, Utrecht, Netherlands
Title
Chronic alcoholic donors in heart transplantation: A mortality
meta-analysis.
Source
International Journal of Cardiology. 191 (pp 7-10), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd

<43>
Accession Number
607374462
Author
Sterling L.H.; Windle S.B.; Filion K.B.; Eisenberg M.J.
Institution
(Sterling, Windle, Filion, Eisenberg) Division of Clinical Epidemiology,
Lady Davis Institute for Medical Research, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Sterling, Filion, Eisenberg) Faculty of Medicine, McGill University,
Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, 3755 Cote Ste-Catherine Road, Suite H-421.1, Montreal, QC H3T
1E2, Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
Title
Pharmacological management strategies for stroke prevention following
transcatheter aortic valve replacement: A systematic review.
Source
International Journal of Cardiology. 191 (pp 303-311), 2015. Date of
Publication: 15 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background The most appropriate pharmacological treatment for stroke
prevention after transcatheter aortic valve replacement (TAVR) is unclear.
We performed a systematic review of randomized controlled trials (RCTs)
and observational studies examining the effect of various pharmacological
treatment regimens on rates of stroke, bleeding, and death after TAVR.
Methods We searched Cochrane Library, Embase, and Medline for RCTs and
observational studies comparing > 2 antithrombotic regimens in TAVR
patients. Included antithrombotic regimens were defined as one or more
antiplatelet agents (aspirin, clopidogrel, prasugrel, or ticagrelor)
and/or anticoagulants (vitamin K antagonists or novel oral
anticoagulants). Results Eight studies (2 RCTs and 6 observational
studies) met our inclusion criteria (n = 1598). Rates of major stroke
ranged from 0% to 5.6% with no detected differences between treatment
arms. All-cause mortality ranged from 5% to 15%, and no differences in
mortality were detected between therapies. A consistent pattern of
reduction in major or life-threatening bleeding was found with a single
antiplatelet therapy (SAPT) compared to dual antiplatelet therapy (DAPT).
However, this difference only reached statistical significance in a single
cohort study (risk ratio 0.24; 95% confidence interval 0.12, 0.46). No
differences between anticoagulant therapies were detected for any
endpoint. Overall, studies were underpowered to detect differences between
treatment groups. Conclusion Similar rates of stroke, bleeding, and
mortality were found among most studies. A trend towards reduced rates of
major or life-threatening bleeding when comparing SAPT to DAPT was found.
Numbers of events were small, highlighting the need for larger studies on
which to base pharmacological recommendations post-TAVR. Copyright &#xa9;
2015 Elsevier Ireland Ltd.

<44>
Accession Number
606572674
Author
Houtekie L.; Moerman D.; Bourleau A.; Reychler G.; Detaille T.; Derycke
E.; De Clety S.C.
Institution
(Houtekie, Moerman, Detaille, Derycke, De Clety) Pediatric Critical Care
Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
(Moerman) Department of Physical Medicine and Rehabilitation, Cliniques
Universitaires Saint-Luc, Brussels, Belgium
(Bourleau) Department of Physical Medicine and Rehabilitation, Centre
Hospitalier Universitaire Dinant-Mont-Godinne, Yvoir, Belgium
(Reychler) Service de Pneumologie, Cliniques Universitaires Saint-Luc,
Pole de Pneumologie, ORL and Dermatologie, Universite Catholique de
Louvain, and the Institut de Recherche Experimentale et Clinique,
Brussels, Belgium
Title
Feasibility study on neurally adjusted ventilatory assist in noninvasive
ventilation after cardiac surgery in infants.
Source
Respiratory Care. 60 (7) (pp 1007-1014), 2015. Date of Publication: 01 Jul
2015.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Our objective was to evaluate the feasibility, the quality of
synchronization, and the influence on respiratory parameters of the
noninvasive neurally adjusted ventilatory assist (NIV-NAVA) mode in
infants after cardiac bypass surgery. We conducted a prospective,
randomized cross-over study in infants undergoing noninvasive ventilation
(NIV) after cardiac surgery. METHODS: Subjects were 10 infants < 5 kg.
After extubation, subjects underwent 2 consecutive ventilatory modes after
randomization into groups. In the CPAP first group, the subjects were
ventilated first in nasal CPAP-1 and then in NIV-NAVA-2 for 30 min in each
mode. In the NIV-NAVA first group, periods were reversed. All children
were ventilated using the same interface. RESULTS: The analysis of curves
showed a synchronization rate of 99.3% for all respiratory cycles. The
rate of pneumatic inspiratory trigger was 3.4%. Asynchronies were
infrequent. Some typical respiratory patterns (continuous effort and
discontinuous inspiration) were found at rates of 10.9% and 31.1%,
respectively. The respiratory trends showed a lower maximum diaphragmatic
electrical activity (EA<inf>di(max)</inf>) in NIV-NAVA periods compared
with CPAP periods (P <.001 in the beginning of periods). The breathing
frequency decreased significantly during the nasal CPAP-2 and NIV-NAVA-1
periods (P <.05). The inspiratory pressure increased significantly during
the NIV-NAVA-1 and NIV-NAVA-2 periods (P <.05), but there was no
significant difference for each parameter when comparing _ values between
the beginning and the end of each period. The EAdi signal was easy to
obtain in all subjects, and no major side effects were associated with the
use of NIV-NAVA. CONCLUSIONS: NIV-NAVA allows good synchronization in
bi-level NIV in infant cardiac subjects weighing < 5 kg. The analysis of
respiratory parameters shows that NIV NAVA decreases the work of breathing
more effectively than nasal CPAP. The study shows some typical respiratory
patterns in infants. Copyright &#xa9; 2015 Daedalus Enterprises.

<45>
Accession Number
601114425
Author
Tregay J.; Wray J.; Bull C.; Franklin R.C.; Daubeney P.; Barron D.J.;
Brown K.; Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway. Copyright
&#xa9; Cambridge University Press 2014.

<46>
[Use Link to view the full text]
Accession Number
53136951
Author
Adie S.; Ma D.; Harris I.A.; Naylor J.M.; Craig J.C.
Institution
(Adie, Ma, Harris, Naylor) Orthopaedic Department, Liverpool Hospital,
South Western Sydney Clinical School, University of New South Wales,
Locked Bag 7103, Liverpool BC, NSW 1871, Australia
(Adie, Harris, Naylor) Whitlam Orthopaedic Research Centre, Ingham
Institute for Applied Medical Research, Liverpool, NSW, Australia
(Craig) School of Public Health, University of Sydney, Sydney, NSW,
Australia
(Craig) Centre for Kidney Research, Children's Hospital at Westmead,
Sydney, Australia
Title
Quality of conduct and reporting of meta-analyses of surgical
interventions.
Source
Annals of Surgery. 261 (4) (pp 685-694), 2015. Date of Publication: April
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Meta-analyses are useful tools for summarizing surgical
evidence as they aim to encompassmultiple sources of information on a
particular research question, but they may be prone to methodological and
reporting biases. We evaluated the conduct and reporting of meta-analyses
of surgical interventions. Methods and Findings: We performed a systematic
review of 150 metaanalyses of randomized trials of surgical interventions
published between January 2010 and June 2011. A comprehensive search
strategy was executed using MEDLINE, EMBASE, and the Cochrane Database of
Systematic Reviews. Data were independently extracted by 2 authors using
the PRISMA statement (preferred reporting items for systematic reviews and
meta-analyses, a standardized quality of reporting guideline) and AMSTAR
(a tool for methodological quality). Descriptive statistics were used for
individual items, and as a measure of overall compliance, PRISMA and
AMSTAR scores were calculated as the sum of adequately reported domains. A
median of 8 trials (interquartile range = 8) was included in each
meta-analysis. One third of all meta-analyses had an author with a
background in epidemiology and/or statistics. Forty-four percent were
published in PRISMA-endorsing journals with a median impact factor of 3.5.
There was moderate compliance with PRISMA, with an average of 71% of items
reported, but poorer compliance with AMSTAR, with 48% of items adequately
described, on average. Conclusions: Substantial gaps in the conduct and
reporting of meta-analyses within the surgical literature exist, mainly in
the specification of aims and/or objectives, the use of preplanned
protocols, and the evaluation of potential bias at the review (rather than
trial) level. Editorial insistence on using reporting guidelines would
improve this situation. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.
All rights reserved.

<47>
Accession Number
604508938
Author
Legutko J.; Yamawaki M.; Costa R.A.; Costa M.A.
Institution
(Legutko) Institute of Cardiology, 2nd Department of Cardiology,
Jagiellonian University Medical, College, 17, Kopernika St, Krakow 31-501,
Poland
(Yamawaki) Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
(Costa) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Costa) Center for Research and Innovation, UH Harrington Heart and
Vascular Institute, Case Western Reserve University, Cleveland, OH, United
States
Title
IVUS in bifurcation stenting: What have we learned?.
Source
EuroIntervention. 11 (pp V55-V58), 2015. Date of Publication: 01 May 2015.
Publisher
EuroPCR
Abstract
Coronary angiography is unable to visualise the atherosclerotic
involvement of the arterial wall. Bifurcation lesions are particularly
difficult to assess by angiography because overlapping mother and daughter
vessels often obscure the lesion and carina. On the contrary, IVUS imaging
allows for precise, real-time, crosssectional assessment of all
bifurcation lesion segments, enabling measurements of luminal and vessel
areas. Moreover, IVUS evaluation of stent expansion, apposition and edge
problems is also superior to angiographic assessment. In spite of the lack
of adequately powered randomised trials, there is growing evidence from
large registries and meta-analyses showing better acute and long-term
outcomes of DES implantation guided by IVUS, in comparison to
angiography-guided procedures. In this review, we summarise current
scientific evidence, the European Society of Cardiology recommendations
and the European Bifurcation Club consensus for the use of IVUS in
bifurcation stenting. Copyright &#xa9; 2015 Europa Digital & Publishing.
All rights reserved.

<48>
Accession Number
601266217
Author
Wild C.; Erdos J.; Zechmeister I.
Institution
(Wild, Erdos, Zechmeister) Ludwig Boltzmann Institute for Health
Technology Assessment (LBI-HTA), Garnisongasse 7/20, Vienna 1090, Austria
Title
Contrasting clinical evidence for market authorisation of cardio-vascular
devices in Europe and the USA: A systematic analysis of 10 devices based
on Austrian pre-reimbursement assessments.
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 157. Date of Publication: November 04, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: European medical device regulation is under scrutiny and will
be re-regulated with stricter rules concerning requirements for clinical
evidence for high-risk medical devices. It is the aim of this study to
analyse the differences between Europe and USA in dealing with risks and
benefits of new cardio-vascular devices. Methods: Since no information is
available on clinical data used by the Notified Body for CE-marking, data
from Austrian pre-reimbursement assessments close to European market
approval were used as proxy and compared with clinical data available at
time of market approval by FDA in the USA. Results: 10 cardio-vascular
interventions with 27 newly CE approved medical devices were analysed. The
time lag between market authorisation in Europe and in the USA is 3 to 7
years. Only 7 CE-marked devices also hold a FDA market approval, 7 further
devices are in FDA approved ongoing efficacy trials. For 4 of the
CE-marked devices the FDA market application or the approval-trial was
either suspended due to efficacy or safety concerns or the approval was
denied. Evidence available at time of CE-marking are most often
case-series or small feasibility RCTs, while large RCTs and only in rare
cases prospective cohort studies are the basis of FDA approvals.
Additionally, the FDA often requires post-approval studies for high-risk
devices. Conclusions: Market authorisation based on mature clinical data
deriving from larger RCTs and longer follow-ups do not only change the
perspective on the risk-benefit ratio, but also secures real patient
benefit and safety and assures payers of investing only in truly
innovative devices. Copyright &#xa9; 2014 Wild et al.

<49>
Accession Number
612040138
Author
Meyer D.B.; Jacobs J.P.; Hill K.; Wallace A.S.; Bateson B.; Jacobs M.L.
Institution
(Meyer) Division of Cardiothoracic Surgery, Cohen Children's Medical
Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park,
NY, United States
(Jacobs, Jacobs) Division of Cardiac Surgery, Johns Hopkins All Children's
Heart Institute, All Children's and Florida Hospital for Children, Johns
Hopkins School of Medicine, St Petersburg, FL, United States
(Hill, Wallace) Duke Clinical Research Institute, Duke University School
of Medicine, Durham, NC, United States
(Bateson) Division of Surgery, Children's Hospital of Georgia, Medical
College of Georgia, Augusta, GA, United States
Title
Variation in Perfusion Strategies for Neonatal and Infant Aortic Arch
Repair: Contemporary Practice in the STS Congenital Heart Surgery
Database.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 7 (5) (pp
638-644), 2016. Date of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Regional cerebral perfusion (RCP) is used as an adjunct or
alternative to deep hypothermic circulatory arrest (DHCA) for neonates and
infants undergoing aortic arch repair. Clinical studies have not
demonstrated clear superiority of either strategy, and multicenter data
regarding current use of these strategies are lacking. We sought to
describe the variability in contemporary practice patterns for use of
these techniques. Methods: The Society of Thoracic Surgeons Congenital
Heart Surgery Database (2010-2013) was queried to identify neonates and
infants whose index operation involved aortic arch repair with
cardiopulmonary bypass. Perfusion strategy was classified as isolated
DHCA, RCP (with less than or equal to ten minutes of DHCA), or mixed (RCP
with more than ten minutes of DHCA). Data were analyzed for the entire
cohort and stratified by operation subgroups. Results: Overall, 4,523
patients (105 centers) were identified; median age seven days
(interquartile range: 5.0-13.0). The most prevalent perfusion strategy was
RCP (43%). Deep hypothermic circulatory arrest and mixed perfusion
accounted for 32% and 16% of cases, respectively. In all, 59% of
operations involved some period of RCP. Regional cerebral perfusion was
the most prevalent perfusion strategy for each operation subgroup. Neither
age nor weight was associated with perfusion strategy, but reoperations
were less likely to use RCP (31% vs 45%, P <.001). The combined duration
of RCP and DHCA in the RCP group was longer than the DHCA time in the DHCA
group (45 vs 36 minutes, P <.001). Conclusion: There is considerable
variability in practice regarding perfusion strategies for arch repair in
neonates and infants. In contemporary practice, RCP is the most prevalent
perfusion strategy for these procedures. Use of DHCA is also common.
Further investigation is warranted to ascertain possible relative merits
of the various perfusion techniques. Copyright &#xa9; The Author(s) 2016.

<50>
Accession Number
611853326
Author
Atehortua Lopez L.H.; Mendoza R.; Urrego A.; Escobar J.F.; Jaimes Barragan
F.A.
Institution
(Atehortua Lopez) Hospital Universitario de Sanvicente Fundacion,
Universidad de Antioquia, UCI Cardiovascular, Medellin, Colombia
(Mendoza, Urrego, Escobar) Universidad de Antioquia, Medicina Critica y
Cuidado Intensivo, Medellin, Colombia
(Jaimes Barragan) Unversidad de Antioquia, Medicina Interna, Medellin,
Colombia
Title
Effects of hypertonic saline (7.5%) on lactate clearance compared with
normal saline (0.9%) after on pump cardiovascular surgery. a randomized
controlled trial.
Source
Intensive Care Medicine Experimental. 3 (no pagination), 2015. Article
Number: A953. Date of Publication: 2015.
Publisher
SpringerOpen

<51>
Accession Number
612234115
Author
Bramlage P.; Romano M.; Bonaros N.; Cocchieri R.; Jagielak D.; Frank D.;
Bapat V.
Institution
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Bahnhofstrasse 20, Cloppenburg 49661, Germany
(Romano) Institut Hospitalier Jacques Cartier, Massy, France
(Bonaros) Universitatsklink fur Herzchirurgie, Medizinische Universitat
Innsbruck, Innsbruck, Austria
(Cocchieri) Heart Center, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Jagielak) Department of Cardiac and Vascular Surgery, Medical University
of Gdansk, Gdansk, Poland
(Frank) Department of Internal Medicine III (Cardiology and Angiology)
UKSH, Campus, Kiel, Germany
(Bapat) St Thomas' Hospital, London, United Kingdom
Title
Transaortic transcatheter aortic valve implantation - rationale and design
of the multicenter, multinational prospective ROUTE registry.
Source
BMC Cardiovascular Disorders. 14 (1) (no pagination), 2014. Article
Number: 152. Date of Publication: 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transaortic transcatheter aortic valve implantation (TAo-TAVI)
is a recently developed approach that provides an alternative delivery
route for valve replacement in patients with vascular abnormalities or
existing comorbidities. While initial studies have shown the principal
efficacy and safety, the real world effectiveness and safety of this
approach remains to be fully assessed. Methods/Design: In this regard, the
Registry Of the Utilization of the TAo-TAVI approach using the Edwards
SAPIEN Valve (ROUTE) represents the first multicenter, multinational
prospective documentation of the course and outcome of patients with
severe calcific aortic stenosis (AS) undergoing TAo-TAVI. ROUTE commenced
in February 2013 with the goal of consecutively enrolling 300 patients at
up to 22 sites across Europe. The primary objective of ROUTE is to
determine the 30-day mortality associated with TAo-TAVI using the Edwards
SAPIEN THV (Edwards Lifesciences, Irvine, CA). In addition, ROUTE aims to
quantify complications, predictors of patient outcome and the value of CT
guided valve sizing. Discussion: Findings from this landmark registry will
provide important information regarding procedural success rates and early
mortality in patients undergoing TAo-TAVI. Copyright &#xa9; 2014 Bramlage
et al.

<52>
Accession Number
612009522
Author
Rivoirard R.; Chargari C.; Tronec J.-C.; Falk A.T.; Guy J.-B.; Eddekkaoui
H.; Lahmar R.; Pacaut C.; Mery B.; Assouline A.; Auberdiac P.; Moriceau
G.; Gonthier R.; Guillota A.; Merrouche Y.; Magne N.
Institution
(Rivoirard, Pacaut, Mery, Moriceau, Guillota, Merrouche) Department of
Medical Oncology, Lucien Neuwirth Cancer Institute, Saint Priest-En-Jarez,
France
(Chargari) Department of Radiotherapy, Instruction Armed Val-de-Grace
Hospital, Paris, France
(Tronec, Guy, Eddekkaoui, Lahmar, Magne) Department of Radiotherapy,
Lucien Neuwirth Cancer Institute, Saint Priest-En-Jarez, France
(Falk) Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
(Assouline) Department of Radiotherapy, Clinical Centre of Porte de Saint
Cloud, Boulogne-Billancourt, France
(Auberdiac) Department of Radiotherapy, Clinique Claude Bernard, Albi,
France
(Gonthier) Department of Clinical Gerontology, University Hospital of
Saint-Etienne, Charity Hospital, France
(Magne) Department of Radiotherapy, Institut de Cancerologie Lucien
Neuwirth, 108 bis, avenue Albert Raimond - BP 60008, Saint-Priest en Jarez
Cedex FR-42271, France
Title
General management of nonagenarian patients: A review of the literature.
Source
Swiss Medical Weekly. 144 (no pagination), 2014. Article Number: w14059.
Date of Publication: 2014.
Publisher
EMH Swiss Medical Publishers Ltd. (E-mail: verlag@emh.ch)
Abstract
The number of nonagenarian people in the world is steadily growing. This
phenomenon will increase in future years: in 2050, world population
prospects estimate 71.16 million people aged 90 years or older. The two
main causes of death among people aged 85 years or more in Europe in 2003
were cardiovascular and cerebrovascular diseases and cancers. However, the
elderly are often excluded from clinical trials; they are underrepresented
in clinical registries and especially nonagenarians. Care (medical,
surgical, oncology) of these very elderly is currently insufficiently
based on scientific recommendations. For the physician, the choice to
treat or not to treat very elderly patients (for fear of side effects) is
difficult. Oncology is particularly affected by this problem. Here we
review these different fields of internal medicine management of
nonagenarian patients with a special focus on oncology and on
comprehensive geriatric assessment as a base for all care decision taking.

<53>
Accession Number
612222931
Author
Kim C.A.; Rasania S.P.; Afilalo J.; Popma J.J.; Lipsitz L.A.; Kim D.H.
Institution
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Beth Israel Deaconess Medical
Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical
School, Harvard School of Public Health, Boston, MA, United States
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Jewish General Hospital,
McGill University, Montreal, QC, Canada
(Kim, Rasania, Afilalo, Popma, Lipsitz, Kim) Geisinger Medical Center,
Danville, PA, United States
(Kim) Division of Gerontology, Beth Israel Deaconess Medical Center, 110
Francis Street, Suite 1B, Boston, MA 02215, United States
Title
Functional status and quality of life after transcatheter aortic valve
replacement a systematic review.
Source
Annals of Internal Medicine. 160 (4) (pp 243-254), 2014. Date of
Publication: 18 Feb 2014.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The functional and quality-of-life benefits of transcatheter
aortic valve replacement (TAVR) have not been established. Purpose: To
evaluate the changes in functional status and quality of life after TAVR.
Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials from 1 January 2002 to 30 September 2013. Study
Selection: Studies of TAVR that reported the New York Heart Association
(NYHA) class, Short Form-12/36 Health Survey physical and mental component
summary (points), or other measures of functional status. Data Extraction:
Two reviewers independently extracted the mean change (follow-up minus
baseline) in primary outcomes. Because of substantial heterogeneity, data
were not pooled; the range of mean change was summarized. Data Synthesis:
We identified 60 observational studies (56 pre-post comparison and 4
head-to-head comparative studies) and 2 randomized, controlled trials (11
205 patients). Most studies showed a clinically important decrease in NYHA
class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months
(range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36
Health Survey physical component score was clinically important over 12
months (range, 4.9 to 26.9 points), and the change in mental component
score was smaller (range, 1.0 to 8.9 points). Clinically important
improvements were seen in other diseasespecific measures but were less
consistently seen in general health measures. Limitations: Comparative
evidence is limited by few head-to-head studies. Survivor bias may have
overestimated the benefits. Conclusion: Transcatheter aortic valve
replacement provides clinically important benefits in physical function
and disease-specific measures of quality of life but modest benefits in
psychological and general health measures. More comparative studies on
functional status and quality of life are needed for informed treatment
decision making. Copyright &#xa9; 2014 American College of Physicians.

<54>
Accession Number
612299411
Author
Zarea K.; Maghsoudi S.; Dashtebozorgi B.; Hghighizadeh M.H.; Javadi M.
Institution
(Zarea, Dashtebozorgi) Chronic Disease Care Research Center, Nursing and
Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Maghsoudi) Alzahra Heart Charity Hospital, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Hghighizadeh) School of Health, Ahvaz Jundishapur University of Medical
Sciences, Iran, Islamic Republic of
(Javadi) Research Center for Nursing and Midwifery Care in Family Health,
School of Nursing and Midwifery, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
Title
The impact of peplau's therapeutic communication model on anxiety and
depression in patients candidate for coronary artery bypass.
Source
Clinical Practice and Epidemiology in Mental Health. 10 (1) (pp 159-165),
2014. Date of Publication: 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background and Objective: Anxiety and depression are among the
psychological disorders in heart surgeries. Establishing a simple
communication is essential to reduce anxiety and depression. Hence, the
objective of the present studywas to examine the impact of Peplau
therapeutic communication model on anxiety and depression in patients, who
were candidate for coronary artery bypass in Al-Zahra Heart Hospital,
Shiraz during 2012-2013. Methods: This is a clinical trial in which 74
patients were randomly divided into intervention and control groups, each
consisted of 37 patients. Anxiety and depression levels were assessed
before, and two and four months after intervention using the Hospital
Anxiety and Depression Scale (HADS). Seven therapeutic communication
sessions were held in four stages. Data were analyzed with the SPSS
(version 16) using analysis of covariance. Results: The mean anxiety and
depression levels decreased in the intervention group after the
therapeutic communication (p<0.01). Anxiety scores in the intervention
group before and after intervention were 10.23 and 9.38, respectively.
While the corresponding scores in the control group were 10.26 and 11.62,
respectively. Depression scores in the intervention group before and after
intervention were 11 and 9.13, respectively. The corresponding scores in
the control group were 11.30 and 12.08, respectively. Conclusion: The
results demonstrated the positive role of therapeutic communication in
reducing anxiety and depression of the patients. Therefore, the
therapeutic communication is recommended as a simple, cost effective and
efficient method in this area. Zarea et al.

<55>
Accession Number
612259260
Author
Fan Y.; Zhang D.; Xiang D.
Institution
(Fan, Zhang, Xiang) Department of Cardiac Surgery, The People's Hospital
of Guizhou Province, Guiyang, Guizhou 550002, China
Title
Delayed protective effect of telmisartan on lung ischemia/reperfusion
injury in valve replacement operations.
Source
Experimental and Therapeutic Medicine. 12 (4) (pp 2577-2581), 2016. Date
of Publication: October 2016.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
The present study aimed to investigate the delayed protective effect of
telmisartan on lung ischemic/reperfusion injury in patients undergoing
heart valve replacement operations. In total, 180 patients diagnosed with
rheumatic valve diseases were randomly divided into the telmisartan (T),
captopril (C) and placebo (P) groups. In the telmisartan group, the
patients were pretreated with telmisartan (1 mg/kg/day), at the time
period 96-48 h before the operation, whereas in the C group, the patients
were treated with captopril (1 mg/kg/day) at the time period 96-48 h prior
to the operation control group. Each drug treatment group included a
corresponding placebo treatment. The variables pulmonary vascular
resistance (PVR) and A-aDO<inf>2</inf> were measured prior to CPB and at
1, 3, 6 and 12 h after CPB. Pulmonary neutrophil (PMN) count in the left
and right atrium blood as well as SOD malondialdehyde (MDA), NO,
angiotensin II (AngII) value in the left atrium blood, were measured 30
min prior to and after CPB. The PVR parameters of the telmisartan and
captopril groups were significantly lower than those of the placebo group
(P<0.05). The A-aDO<inf>2</inf> values in the telmisartan and captopril
groups were significantly lower than those in the placebo group at 1, 3
and 6 h following CPB treatment. The difference between the right and left
atrium blood PMN was significantly lower in the telmisartan and captopril
intervention groups compared to that in the placebo group 30 min following
CPB treatment. The left atrium blood SOD and NO values were significantly
higher, whereas the MDA value was significantly lower in the telmisartan
group compared to the control group 30 min following CPB treatment. As for
AngII, there was no difference between the C and T groups, compared with
the P group. In the two groups 30 min after treatment with CPB, 24
patients experienced varying degrees of cough, with the telmisartan group
showing a significant difference (P<0.05). The hospitalization time was
compared in the three groups of patients and it was found to be
significantly shorter in the telmisartan group than the captopril and
placebo groups (P<0.05). In conclusion, it was found that for the time
period 96-48 h before heart valve replacement operations telmisartan (1
mg/kg/day) delayed the protective effect on lung ischemia/reperfusion
injury in patients with rheumatic valve diseases. The results of the
present study indicated that the protective effect may be associated with
the increment of endogenetic NO and the enhanced ability against lipid
peroxidation. Copyright &#xa9; 2016, Spandidos Publications. All rights
reserved.

<56>
Accession Number
612259176
Author
Zhang X.; Shen C.; Zhai S.; Liu Y.; Yue W.-W.; Han L.
Institution
(Zhang, Shen, Zhai) Shandong Provincial Hospital Affiliated to Shandong
University, Ji'nan, Shandong 250021, China
(Liu) Laiwu Health School, Laiwu, Shandong 271100, China
(Yue, Han) The Fourth People's Hospital of Ji'nan, Ji'nan, Shandong
250021, China
Title
A meta-analysis of the effects of beta-adrenergic blockers in chronic
heart failure.
Source
Experimental and Therapeutic Medicine. 12 (4) (pp 2489-2496), 2016. Date
of Publication: October 2016.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece)
Abstract
Adrenergic beta-blockers are drugs that bind to, but do not activate
beta-adrenergic receptors. Instead they block the actions of
beta-adrenergic agonists and are used for the treatment of various
diseases such as cardiac arrhythmias, angina pectoris, myocardial
infarction, hypertension, headache, migraines, stress, anxiety, prostate
cancer, and heart failure. Several meta-analysis studies have shown that
beta-blockers improve the heart function and reduce the risks of
cardiovascular events, rate of mortality, and sudden death through chronic
heart failure (CHF) of patients. The present study identified results from
recent meta-analyses of beta-adrenergic blockers and their usefulness in
CHF. Databases including Medline/Embase/Cochrane Central Register of
Controlled Trials (CENTRAL), and PubMed were searched for the periods May,
1985 to March, 2011 and June, 2013 to August, 2015, and a number of
studies identified. Results of those studies showed that use of
beta-blockers was associated with decreased sudden cardiac death in
patients with heart failure. However, contradictory results have also been
reported. The present meta-analysis aimed to determine the efficacy of
beta-blockers on mortality and morbidity in patients with heart failure.
The results showed that mortality was significantly reduced by
beta-blocker treatment prior to the surgery of heart failure patients. The
results from the meta-analysis studies showed that beta-blocker treatment
in heart failure patients correlated with a significant decrease in
long-term mortality, even in patients that meet one or more exclusion
criteria of the MERIT-HF study. In summary, the findings of the current
meta-analysis revealed beneficial effects different beta-blockers have on
patients with heart failure or related heart disease. Copyright &#xa9;
2016, Spandidos Publications. All rights reserved.

<57>
Accession Number
612290572
Author
Indraratna P.; Tian D.H.; Yan T.D.; Doyle M.P.; Cao C.
Institution
(Indraratna, Tian, Yan, Cao) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, Australia
(Indraratna) Department of Cardiology, St George Hospital, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Yan) Department of Cardiothoracic, Royal Prince Alfred Hospital, Sydney,
Australia
(Doyle, Cao) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: A meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 224 (pp 382-387), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) has become a
widely utilized method of treatment of severe aortic valve stenosis. The
present meta-analysis included all published relevant randomized
controlled trials (RCTs) and aimed to compare the safety and efficacy of
TAVI compared to surgical aortic valve replacement (AVR). Method Nine
electronic databases were comprehensively searched. Eligible studies were
required to be randomized controlled trials which reported comparative
endpoints on both TAVI and AVR. Results Five published RCTs were included
in the meta-analysis. A total of 3828 patients were studied. The overall
mortality and stroke rates at 30 days and 1 year were not significantly
different between TAVI and AVR. Patients undergoing TAVI were more likely
to experience vascular complications, aortic regurgitation and permanent
pacemaker insertion, however, they were less likely to encounter acute
renal failure and major haemorrhage. Conclusions The data suggest that
TAVI is a safe and efficacious alternative to surgical aortic valve
replacement in judiciously selected patients. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<58>
Accession Number
609136807
Author
Amedro P.; Basquin A.; Gressin V.; Clerson P.; Jais X.; Thambo J.-B.;
Guerin P.; Cohen S.; Bonnet D.
Institution
(Amedro) Pediatric and Congenital Cardiology, Arnaud de Villeneuve
University Hospital, PhyMedexp, INSERM U1046, CNRS UMR 9214, University of
Montpellier, 37, avenue du Doyen Gaston Giraud, Montpellier Cedex 5 34295,
France
(Amedro) Department of Public Health, EA3279 Self-perceived Health
Assessment Research Unit, Aix-Marseille University, Marseille, France
(Basquin) Pediatric and Congenital Cardiology, University Hospital,
Rennes, France
(Gressin) Actelion Pharmaceuticals France, Paris, France
(Clerson) Orgametrie Biostatistics, Roubaix, France
(Jais) Bicetre University Hospital, Le Kremlin-Bicetre, France
(Thambo) Pediatric and Congenital Cardiology, Haut-Leveque University
Hospital, Bordeaux, France
(Guerin) Pediatric and Congenital Cardiology, Guillaume and Rene Laennec
University Hospital, Nantes, France
(Cohen) Adult Congenital Heart Disease Unit, M3C-George Pompidou European
Hospital, AP-HP, Paris Descartes University, France
(Cohen) INSERM-UMRS 1138, Cordelier Research Center, Team 22, France
(Bonnet) Pediatric and Congenital Cardiology, M3C-Necker University
Hospital, AP-HP, Paris Descartes University, Paris, France
Title
Health-related quality of life of patients with pulmonary arterial
hypertension associated with CHD: The multicentre cross-sectional ACHILLE
study.
Source
Cardiology in the Young. 26 (7) (pp 1250-1259), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The aim of this study was to assess health-related quality of
life in patients with pulmonary arterial hypertension associated with CHD
and correlations with clinical status. Methods This prospective
cross-sectional observational study included CHD patients with pulmonary
arterial hypertension in 14 tertiary-care centres in France. We used two
health-related quality of life questionnaires - SF-36 and Cambridge
Pulmonary Hypertension Outcome Review (CAMPHOR) - and one
anxiety/depression Hospital Anxiety and Depression Scale (HADS)
questionnaire. Results Clinical data were collected for the 208 included
patients (mean age: 42.6 years, range from 15.1 to 85.8 years, 69.7%
female). Most patients were in NYHA functional class II (48.1%) and III
(37.5%). Patients' phenotype was classified as Eisenmenger syndrome
(70.7%), pulmonary arterial hypertension associated with
systemic-to-pulmonary shunts (12.0%), with small defects (3.4%), or after
corrective cardiac surgery (13.9%). In total, 76.4% of the patients were
receiving pulmonary arterial hypertension-specific treatments. SF-36
scores showed impairment compared with normalised data. Health-related
quality of life scores were significantly lower in females than in males
for most dimensions of both questionnaires and were independent of the
patients' phenotype, even after gender adjustment - except for CAMPHOR
functioning - but significantly depended on NYHA functional class. The
Hospital Anxiety and Depression Scale (HADS) scores suggested anxiety and
depression associated with increasing NYHA functional class but
independent of patients' phenotype. NYHA functional class, 6-minute walk
distance, HADS, gender, and recent stressful event significantly affected
quality of life in the multivariate analysis. Conclusions This study
showed impairment of quality of life in a large cohort of patients with
pulmonary arterial hypertension associated with CHD with both generic and
specific questionnaires. NYHA functional class and HADS scores were
predictive of most quality of life scores. Copyright &#xa9; Cambridge
University Press 2016.

<59>
[Use Link to view the full text]
Accession Number
612272253
Author
De Vries F.E.E.; Wallert E.D.; Solomkin J.S.; Allegranzi B.; Egger M.;
Dellinger E.P.; Boermeester M.A.
Institution
(De Vries, Wallert, Boermeester) Department of Surgery, Academic Medical
Centre Amsterdam, PO Box 22660, Amsterdam 1100, Netherlands
(Solomkin) Department of Surgery, University of Cincinnati College of
Medicine, Cincinnati, OH, United States
(Allegranzi) Infection Prevention and Control Global Unit, Service
Delivery and Safety, World Health Organization, Geneva, Switzerland
(Egger) Institute of Social and Preventive Medicine, University of Bern,
Switzerland
(Dellinger) Department of Surgery, University of Washington, Seattle, WA,
United States
Title
A systematic review and meta-analysis including GRADE qualification of the
risk of surgical site infections after prophylactic negative pressure
wound therapy compared with conventional dressings in clean and
contaminated surgery.
Source
Medicine (United States). 95 (36) (no pagination), 2016. Article Number:
e4673. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Systematically review and Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) studies on prophylactic
negative pressure wound therapy (pNPWT) to prevent surgical site
infections (SSIs). Introduction: pNPWT has been suggested as a new method
to prevent wound complications, specifically SSIs, by its application on
closed incisional wounds. Methods: This review was conducted as part of
the development of the Global Guidelines for prevention of SSIs
commissioned by World Health Organization in Geneva. PubMed, Embase,
CENTRAL, CINAHL, and the World Health Organization database between
January 1, 1990 and October 7, 2015 were searched. Inclusion criteria were
randomized controlled trials and observational studies comparing pNPWT
with conventional wound dressings and reporting on the incidence of SSI.
Meta-analyses were performed with a random effect model. GRADE Pro
software was used to qualify the evidence. Results: Nineteen articles
describing 21 studies (6 randomized controlled trials and 15
observational) were included in the review. Summary estimate showed a
significant benefit of pNPWT over conventional wound dressings in reducing
SSIs in both randomized controlled trials and observational studies, odds
ratio of 0.56 (95% confidence interval, 0.32-0.96; P=0.04) and odds ratio
of 0.30 (95% confidence interval, 0.22-0.42; P<0.00001), respectively.
This translates into lowering the SSI rate from 140 to 83 (49-135) per
1000 patients and from 106 to 34 (25-47) per 1000 patients, respectively.
In stratified analyses, these results were consistent in both clean and
clean-contaminated procedures and in different types of surgery, however
results were no longer significant for orthopaedic/trauma surgery. The
level of evidence as qualified with GRADE was however low. Conclusions:
Low-quality evidence indicates that prophylactic NPWT significantly
reduces the risk of SSIs. Copyright &#xa9; 2016 the Author(s). Published
by Wolters Kluwer Health, Inc. All.

<60>
Accession Number
612225174
Author
Avgousti S.; Christoforou E.G.; Panayides A.S.; Voskarides S.; Novales C.;
Nouaille L.; Pattichis C.S.; Vieyres P.
Institution
(Avgousti) Cyprus University of Technology, Nursing Department, School of
Health and Science, 30 Archbishop Kyprianou Street, Limassol 3036, Cyprus
(Christoforou) University of Cyprus, Department of Electrical and Computer
Engineering, 75 Kalipoleos Street, P.O. BOX 20537, Nicosia 1678, Cyprus
(Panayides) Imperial College, Department of Electrical and Electronic
Engineering, South Kensington Campus, London SW7 2AZ, United Kingdom
(Voskarides) Cyprus University of Technology, Department of Electrical
Engineering, Computer Engineering and Informatics, 30 Archbishop Kyprianou
Street, Lemesos 3036, Cyprus
(Novales, Nouaille, Vieyres) Laboratoire PRISME-Universite d'Orleans, 63
Avenue de Lattre de Tassigny, Bourges 18020, France
(Panayides, Pattichis) University of Cyprus, Department of Computer
Science, 75 Kalipoleos Street, P.O. BOX 20537, Nicosia 1678, Cyprus
Title
Medical telerobotic systems: Current status and future trends.
Source
BioMedical Engineering Online. 15 (1) (no pagination), 2016. Article
Number: 96. Date of Publication: 12 Aug 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Teleoperated medical robotic systems allow procedures such as surgeries,
treatments, and diagnoses to be conducted across short or long distances
while utilizing wired and/or wireless communication networks. This study
presents a systematic review of the relevant literature between the years
2004 and 2015, focusing on medical teleoperated robotic systems which have
witnessed tremendous growth over the examined period. A thorough insight
of telerobotics systems discussing design concepts, enabling technologies
(namely robotic manipulation, telecommunications, and vision systems), and
potential applications in clinical practice is provided, while existing
limitations and future trends are also highlighted. A representative
paradigm of the short-distance case is the da Vinci Surgical System which
is described in order to highlight relevant issues. The long-distance
telerobotics concept is exemplified through a case study on diagnostic
ultrasound scanning. Moreover, the present review provides a
classification into short- and long-distance telerobotic systems,
depending on the distance from which they are operated. Telerobotic
systems are further categorized with respect to their application field.
For the reviewed systems are also examined their engineering
characteristics and the employed robotics technology. The current status
of the field, its significance, the potential, as well as the challenges
that lie ahead are thoroughly discussed. Copyright &#xa9; 2016 The
Author(s).

<61>
Accession Number
611028981
Author
Doenst T.; Struning C.; Moschovas A.; Gonzalez-Lopez D.; Essa Y.; Kirov
H.; Diab M.; Faerber G.
Institution
(Doenst, Struning, Moschovas, Gonzalez-Lopez, Essa, Kirov, Diab, Faerber)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Erlanger Allee 101, Jena 07747, Germany
Title
Cardiac surgery 2015 reviewed.
Source
Clinical Research in Cardiology. 105 (10) (pp 801-814), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2015, almost 19,000 published references can be found in
PubMed when entering the search term "cardiac surgery". The last year has
been again characterized by lively discussions in the fields where classic
cardiac surgery and modern interventional techniques overlap. Lacking
evidence in the field of coronary revascularization with either
percutaneous coronary intervention or bypass surgery has been added. As in
the years before, CABG remains the gold standard for the revascularization
of complex stable triple-vessel disease. Plenty of new information has
been presented comparing the conventional to transcatheter aortic valve
implantation (TAVI) demonstrating similar short- and mid-term outcomes at
high and low risk, but even a survival advantage with transfemoral TAVI at
intermediate risk. In addition, there were many relevant and interesting
other contributions from the purely operative arena. This review article
will summarize the most pertinent publications in the fields of coronary
revascularization, surgical treatment of valve disease, heart failure
(i.e., transplantation and ventricular assist devices), and aortic
surgery. While the article does not have the expectation of being complete
and cannot be free of individual interpretation, it provides a condensed
summary that is intended to give the reader "solid ground" for up-to-date
decision-making in cardiac surgery. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<62>
Accession Number
607445354
Author
McHugh K.E.; Pasquali S.K.; Hall M.A.; Scheurer M.A.
Institution
(McHugh, Scheurer) Medical University of South Carolina, 165 Ashley
Avenue, MSC 915, Charleston, SC 29425, United States
(Pasquali) University of Michigan CS Mott Children's Hospital, Ann Arbor,
MI, United States
(Hall) Children's Hospital Association, Overland Park, KS, United States
Title
Impact of postoperative complications on hospital costs following the
Norwood operation.
Source
Cardiology in the Young. 26 (7) (pp 1303-1309), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction Patients undergoing the Norwood operation consume
considerable healthcare resources; however, detailed information regarding
factors impacting hospitalisation costs is lacking. We evaluated the
association of postoperative complications with hospital costs. Methods In
the present study, we utilised a unique data set consisting of
prospectively collected clinical data from the Pediatric Heart Network
Single Ventricle Reconstruction trial linked at the patient level with
cost data for 10 hospitals participating in the Children's Hospital
Association Case Mix database during the trial period. The relationship
between complications and cost was modelled using linear regression,
accounting for the skewed distribution of cost, adjusting for
within-centre clustering and baseline patient characteristics. Results A
total of 334 eligible Norwood records (97.5%) were matched between data
sets. Overall, 82% suffered from at least one complication (median 2; with
a range from 0 to 33). Those with complications had longer postoperative
length of stay (25 versus 12 days, p<0.001), more total ventilator days (7
versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus
3.4%, p<0.006). Mean adjusted hospital cost in those with a complication
was $190,689 (95% CI $111,344-$326,577) versus $120,584 (95% CI
$69,246-$209,983) in those without complications (p=0.002). Costs
increased with the number of complications (1-2 complications=$132,800
versus 3-4 complications=$182,353 versus 5 complications=$309,372
[p<0.001]). Conclusions This merged data set of clinical trial and cost
data demonstrated that postoperative complications are common following
the Norwood operation and are associated with worse clinical outcomes and
higher costs. Efforts to reduce complications in this population may lead
to improved outcomes and cost savings. Copyright &#xa9; Cambridge
University Press 2015.

<63>
Accession Number
612256226
Author
Chen J.; Tang B.; Lin Y.; Ru Y.; Wu M.; Wang X.; Chen Q.; Chen Y.; Wang J.
Institution
(Chen, Lin, Ru, Wu, Chen, Wang) Department of Cardiology, Sun Yat-sen
Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
(Chen, Lin, Ru, Wu, Chen, Wang) Guangdong Province Key Laboratory of
Arrhythmia and Electrophysiology, Guangzhou, China
(Tang, Wang, Chen) Intelligent Computing Research Center, Harbin Institute
of Technology, Shenzhen Graduate School, Shenzhen, China
Title
Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict
Adverse Cardiovascular Events after Stent Implantation: A Systematic
Review and Meta-Analysis.
Source
Angiology. 67 (9) (pp 820-828), 2016. Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
To compare the predicative ability of SYNTAX (Synergy between PCI with
Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse
cardiac events (MACEs) after stent implantation in patients with coronary
artery disease (CAD). Studies were identified by electronic and manual
searches. Twenty-six studies were included in the meta-analysis. The
pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality
(ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95%
CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year
ACM pooled C-statistics for clinical SYNTAX scores were significantly
higher at 0.77 and 0.71, respectively (Ps <.05). Both scoring systems
predicted 1- and 5-year MACE equally well. The pooled risk ratio of the
SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI:
1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the
risk of major adverse cardiac and cerebrovascular events in each risk
stratum. The SYNTAX score demonstrated minimal discrimination in
predicting 1- or 5-year adverse cardiovascular events after percutaneous
coronary intervention in patients with CAD. The clinical SYNTAX score
could further improve the predictive capability for ACM but not MACE.
Copyright &#xa9; The Author(s) 2015.

<64>
Accession Number
608878204
Author
Roberts E.B.; Perry R.; Booth J.; Sigwart U.; Stables R.H.
Institution
(Roberts) University Hospitals of Leicester, Leicester NIHR Cardiovascular
Biomedical Research Unit, Glenfield Hospital, Leicester LE3 9QP, United
Kingdom
(Perry, Stables) Liverpool Heart and Chest Hospital NHS Foundation Trust,
Thomas Drive, Liverpool L14 3PE, United Kingdom
(Booth) Clinical Trials and Evaluation Unit, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, United Kingdom
(Sigwart) Cardiology Center, University Hospital of Geneva, 24 Rue Micheli
du Crest, Geneva 1211, Switzerland
Title
Adverse events following percutaneous and surgical coronary
revascularisation: Analysis of non-MACE outcomes in the Stent or Surgery
(SoS) Trial.
Source
International Journal of Cardiology. 202 (pp 7-12), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: To analyse adverse events requiring or prolonging
hospitalisation in the Stent or Surgery (SoS) trial. Background: Many
adverse events following coronary revascularisation are non-major adverse
cardiovascular events (non-MACE). Trials comparing percutaneous coronary
intervention (PCI) and coronary artery bypass surgery (CABG) have reported
rates of mortality and MACE only. Material and methods: Comparisons
between PCI and CABG groups in the SOS trial were by intention to treat.
For patients with non-fatal/non-MACE, number of events per 100 patient
years follow-up and duration of hospital stay were assessed. Competing
risk analysis was used to illustrate temporal pattern of adverse outcomes.
Results: During 2y median follow up, 1 one or more adverse event occurred
in 47.3% (231) of the PCI group and 53% (265) of the CABG group (p =
0.086). Non-fatal/non-MACE occurred in 11.9% of the PCI group and 38.6% of
the CABG group (p < 0.001). Non-fatal/non-MACE per 100 patient years
follow-up was 17.49 (PCI) and 35.04 (CABG), rate ratio 2.0, 95% CI 1.7 to
2.4, p < 0.001. Cumulative non-fatal/non-MACE associated hospital stays
were 1387 and 3287 days in PCI and CABG groups respectively. Median
duration of hospitalisation per non-fatal/non-MACE was 5 days
(interquartile range 2 to 11.75 days) in the PCI group and 6 days
(interquartile range 2 to 12 days) in the CABG group, p = 0.245.
Conclusions: CABG had lower cumulative incidence of fatal or MACE
outcomes, higher cumulative incidence of non-fatal/non-MACE outcomes, and
longer cumulative hospitalisation periods compared to the PCI group.
Copyright &#xa9; 2015 Elsevier Ireland Ltd. All rights reserved.

<65>
Accession Number
603956445
Author
Chen Z.; Rong L.
Institution
(Chen, Rong) Department of Spine Surgery, Third Affiliated Hospital of Sun
Yat-sen University, No. 600, Tianhe Road, Guangzhou 510630, China
Title
Comparison of combined anterior-posterior approach versus posterior-only
approach in treating adolescent idiopathic scoliosis: a meta-analysis.
Source
European Spine Journal. 25 (2) (pp 363-371), 2016. Date of Publication: 01
Feb 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Choosing a surgical approach to treat adolescent idiopathic
scoliosis (AIS) is still controversial. To compare the effectiveness and
safety of combined anterior-posterior approach to posterior-only approach,
we conducted a meta-analysis. Methods: We searched electronic database for
relevant studies that compared anterior-posterior approach with posterior
approach in AIS. Then data extraction and quality assessment were
conducted. We used RevMan 5.1 for data analysis. A random effects model
was used for heterogeneous data, while a fixed effect model was used for
homogeneous data. Results: A total of ten non-randomized controlled
studies involving 872 patients were included. There was no significant
difference in Cobb angle (95 % CI -0.33 to 4.91, P = 0.09) and
percent-predicted FEV1 (95 % CI -6.79 to 4.54, P = 0.70) between the two
groups. In subgroup analysis, the kyphosis angle correction was
significantly higher than posterior group in severe subgroup (95 % CI
0.72-6.50, P = 0.01), while no significant difference was found in
no-restriction subgroup (95 % CI -2.75 to 5.42, P = 0.52). Patients in
posterior group obtained a better percent-predicted FVC than those in
anterior-posterior group (95 % CI -13.18 to -4.74, P < 0.0001).
Significant less complication rate (95 % CI 2.75-17.49, P < 0.0001), blood
loss (95 % CI 363.28-658.91, P < 0.00001), operative time (95 % CI
2.65-3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98-22.94, P
= 0.02) were found in posterior group. Conclusions: Posterior-only
approach can achieve similar coronal plane correction and
percent-predicted FEV1 compared to combined anterior-posterior approach.
The posterior approach even does better in sagittal correction in severe
AIS patients. Significantly less complication rate, blood loss, operative
time, length of hospital stay and better percent-predicted FVC are also
achieved by posterior-only approach. Posterior-only approach seems to be
effective and safe in treating AIS for experienced surgeons. Copyright
&#xa9; 2015, Springer-Verlag Berlin Heidelberg.

<66>
[Use Link to view the full text]
Accession Number
607997926
Author
D'Ascenzo F.; Abu-Assi E.; Raposeiras-Roubin S.; Henriques J.P.S.; Saucedo
J.; Gonzalez-Juanatey J.R.G.; Wilton S.B.; Kikkert W.J.; Nunez-Gil I.;
Ariza-Sole A.; Song X.; Alexopoulos D.; Liebetrau C.; Kawaji T.; Moretti
C.; Huczek Z.; Nie S.-P.; Fujii T.; Correia L.C.; Kawashiri M.-A.;
Garcia-Acuna J.M.; Southern D.; Alfonso E.; Terol B.; Garay A.; Zhang D.;
Chen Y.; Xanthopoulou I.; Osman N.; Mollmann H.; Shiomi H.; Giordana F.;
Scarano S.; Gaita F.; Kowara M.; Filipiak K.J.; Wang X.; Yan Y.; Fan
J.-Y.; Ikari Y.; Nakahayshi T.; Sakata K.; Yamagishi M.; Kalpak O.; Kedev
S.
Institution
(D'Ascenzo, Moretti, Giordana, Scarano, Gaita) Dipartimento di Scienze
Mediche, Divisione di Cardiologia, University of Turin, Citta della Salute
e della Scienza, Corso Bramante 88/90, Torino 10126, Italy
(Abu-Assi, Raposeiras-Roubin, Gonzalez-Juanatey, Garcia-Acuna) University
Clinical Hospital, Santiago de Compostela, Spain
(Henriques, Kikkert) University Academic Medical Center, Amsterdam,
Netherlands
(Saucedo) NorthShore University Hospital, Chicago, IL, United States
(Wilton, Southern) Libin Cardiovascular Institute of Alberta, Calgary, AB,
Canada
(Nunez-Gil, Alfonso) San Carlos Hospital, Madrid, Spain
(Ariza-Sole, Garay) Bellvitge Hospital, Barcelona, Spain
(Song, Zhang, Chen) Anzhen Hospital, Beijing, China
(Alexopoulos, Xanthopoulou) University Patras Hospital, Athens, Greece
(Liebetrau, Osman, Mollmann) Kerckhoff Heart and Thorax Center, Frankfurt,
Germany
(Kawaji, Shiomi) University Clinical Hospital, Kyoto, Japan
(Huczek, Kowara, Filipiak) University Clinical Hospital, Warsaw, Poland
(Nie, Wang, Yan, Fan) Institute of Heart, Lung and Blood Vessel Disease,
Beijing, China
(Fujii, Ikari) Tokai University School of Medicine, Tokyo, Japan
(Correia) University Bahian Medical School, Salvador, Brazil
(Kawashiri, Nakahayshi, Sakata, Yamagishi) Division of Cardiovascular
Medicine, Kanazawa University Graduate, School of Medicine, Kanazawa,
Japan
(Kalpak, Kedev) University Clinic of Cardiology, Skopje, Macedonia
Title
BleeMACS: Rationale and design of the study.
Source
Journal of Cardiovascular Medicine. 17 (10) (pp 744-749), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Bleeding events after an acute coronary syndrome have a
negative impact on prognosis. Available risk scores are limited by
suboptimal accuracy, prediction of only in-hospital events and absence of
patients treated with new antiplatelet agents in the current era of
widespread use of percutaneous coronary intervention. Design The BleeMACS
(Bleeding complications in a Multicenter registry of patients discharged
after an Acute Coronary Syndrome) project is a multicenter
investigatorinitiated international retrospective registry that enrolled
more than 15 000 patients discharged with a definitive diagnosis of acute
coronary syndrome and treated with percutaneous revascularization. The
primary end point is the incidence of major bleeding events requiring
hospitalization and/or red cell transfusion concentrates within 1 year. An
integer risk score for bleeding within the first year after hospital
discharge will be developed from a multivariate competing-risks
regression. Conclusion The BleeMACS registry collaborative will allow
development and validation of a risk score for prediction of major
bleeding during follow-up for patients receiving contemporary therapies
for acute coronary syndrome. Copyright &#xa9; 2016 Italian Federation of
Cardiology.

<67>
Accession Number
611521903
Author
Jones P.M.; Bainbridge D.; Chu M.W.A.; Fernandes P.S.; Fox S.A.; Iglesias
I.; Kiaii B.; Lavi R.; Murkin J.M.
Institution
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Department of Anesthesia &
Perioperative Medicine, University of Western Ontario, London, ON, Canada
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Schulich School of Medicine &
Dentistry, The University of Western Ontario, London, ON, Canada
(Jones, Bainbridge) Program in Critical Care, Department of Medicine, The
University of Western Ontario, London, ON, Canada
(Jones) Department of Epidemiology & Biostatistics, University of Western
Ontario, London, ON, Canada
(Chu, Fox, Kiaii) Division of Cardiac Surgery, Department of Surgery, The
University of Western Ontario, London, ON, Canada
(Fernandes) Clinical Perfusion Services, Cardiac Care, London Health
Sciences Centre, London, ON, Canada
(Jones) University Hospital - London Health Sciences Centre, Room C3-110,
339 Windermere Rd, London, ON N6A 5A5, Canada
Title
Comparison of isoflurane and sevoflurane in cardiac surgery: a randomized
non-inferiority comparative effectiveness trial.
Source
Canadian Journal of Anesthesia. 63 (10) (pp 1128-1139), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Volatile anesthetics possess cardioprotective properties, but it
is unknown if the cardioprotective effects extend equally to all members
of the class. Although sevoflurane is a relatively newer anesthetic than
isoflurane, its introduction into practice was not preceded by a
head-to-head comparison with isoflurane in a trial focusing on clinically
important outcomes. Our objective was to determine whether sevoflurane was
non-inferior to isoflurane on a clinically important primary outcome in a
heterogeneous group of adults undergoing cardiac surgery. Methods: This
was a pragmatic randomized non-inferiority comparative effectiveness
clinical trial in 464 adults having coronary artery bypass graft and/or
single valve surgery during November 2011 to March 2014. The intervention
was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n
= 233) administered at a dose of 0.5-2.0 MAC throughout the entire
operation. All caregivers were blinded except for the anesthesiologist and
perfusionist. The primary outcome was a composite of intensive care unit
(ICU) length of stay > 48 hr and all-cause 30-day mortality. We
hypothesized that sevoflurane would be non-inferior to isoflurane
(non-inferiority margin < 10% based on an expected event rate of 25%).
Secondary outcomes included prolonged ICU stay, 30- and 365-day all-cause
mortality, inotrope or vasopressor usage, new-onset hemodialysis or atrial
fibrillation, stroke, and readmission to the ICU. Results: No losses to
follow-up occurred. The primary outcome occurred in 25% of sevoflurane
patients and 30% of isoflurane patients (absolute difference, -5.4%;
one-sided 95% confidence interval, 1.4), thus non-inferiority was
declared. Sevoflurane was not superior to isoflurane for the primary
outcome (P = 0.21) or for any secondary outcomes. Conclusion: Sevoflurane
is non-inferior to isoflurane on a composite outcome of prolonged ICU stay
and all-cause 30-day mortality. Sevoflurane is not superior to isoflurane
on any other of the clinically important outcomes. This trial was
registered at clinicaltrials.gov; NCT01477151. Copyright &#xa9; 2016, The
Author(s).

<68>
Accession Number
608878279
Author
Yong M.S.; Coffey S.; Prendergast B.D.; Marasco S.F.; Zimmet A.D.;
McGiffin D.C.; Saxena P.
Institution
(Yong, Marasco, Zimmet, McGiffin, Saxena) Department of Cardiothoracic
Surgery, Alfred Hospital, 55 Commercial Road, Prahran, Melbourne 3181,
Australia
(Coffey, Prendergast) Department of Cardiology, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
Title
Surgical management of tricuspid valve endocarditis in the current era: A
review.
Source
International Journal of Cardiology. 202 (pp 44-48), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
The incidence of isolated tricuspid valve infective endocarditis is
increasing. Medical management is the mainstay of treatment but surgical
intervention is required in a subset of patients. Surgical treatment
options include valve excision and replacement or valve reconstruction. We
searched PubMed and the Cochrane library to identify articles to be
included in this review of surgical outcomes. References of selected
articles were crosschecked for other relevant studies. Surgical management
of tricuspid valve endocarditis can be achieved with satisfactory
outcomes. However, the optimal indication and timing of surgery remain
unclear, and the frequent association with intravenous drug use
complicates management. Repair techniques are preferable though there is
no clear evidence supporting one method over another. Crown Copyright 2015
Published by Elsevier Ireland Ltd. All rights reserved.

<69>
Accession Number
607226064
Author
Healy D.A.; Boyle E.; McCartan D.; Bourke M.; Medani M.; Ferguson J.;
Yagoub H.; Bashar K.; O'Donnell M.; Newell J.; Canning C.; McMonagle M.;
Dowdall J.; Cross S.; O'Daly S.; Manning B.; Fulton G.; Kavanagh E.G.;
Burke P.; Grace P.A.; Moloney M.C.; Walsh S.R.
Institution
(Healy, Bashar, Canning, Kavanagh, Burke, Grace) Department of Vascular
Surgery, University Hospital Limerick, Limerick, Ireland
(Boyle, Manning, Fulton) Department of Surgery Cork, University Hospital,
Cork, Ireland
(McCartan, Bourke, Medani, McMonagle, Dowdall, Cross) Department of
Surgery, University Hospital Waterford, Waterford, Ireland
(Ferguson, Yagoub) Department of Medicine, Graduate Entry Medical School,
University of Limerick, Limerick, Ireland
(O'Donnell, Newell, O'Daly) Clinical Research Facility, National
University of Ireland Galway, Galway, Ireland
(Moloney) Health Research Institute, University of Limerick, Limerick,
Ireland
(Walsh) Department of Surgery, National University of Ireland Galway,
Galway, Ireland
Title
A multicenter pilot randomized controlled trial of remote ischemic
preconditioning in major vascular surgery.
Source
Vascular and Endovascular Surgery. 49 (8) (pp 220-227), 2015. Date of
Publication: 01 Nov 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
A pilot randomized controlled trial that evaluated the effect of remote
ischemic preconditioning (RIPC) on clinical outcomes following major
vascular surgery was performed. Eligible patients were those scheduled to
undergo open abdominal aortic aneurysm repair, endovascular aortic
aneurysm repair, carotid endarterectomy, and lower limb revascularization
procedures. Patients were randomized to RIPC or to control groups. The
primary outcome was a composite clinical end point comprising any of
cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac
arrest, congestive cardiac failure, cerebrovascular accident, renal
failure requiring renal replacement therapy, mesenteric ischemia, and
urgent cardiac revascularization. Secondary outcomes were components of
the primary outcome and myocardial injury as assessed by serum troponin
values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14
(14.1%) of 99 RIPC group patients (P =.446). There were no significant
differences in secondary outcomes. Our trial generated data that will
guide future trials. Further trials are urgently needed. Copyright &#xa9;
The Author(s) 2015.

<70>
Accession Number
606885856
Author
Paixao A.R.M.; Ayers C.R.; El Sabbagh A.; Sanghavi M.; Berry J.D.; Rohatgi
A.; Kumbhani D.J.; McGuire D.K.; Das S.R.; De Lemos J.A.; Khera A.
Institution
(Paixao, Ayers, El Sabbagh, Sanghavi, Berry, Rohatgi, Kumbhani, McGuire,
Das, De Lemos, Khera) Department of Internal Medicine, University of Texas
Southwestern Medical Center, Dallas, TX, United States
(Paixao, Ayers, Sanghavi, Berry, Rohatgi, Kumbhani, McGuire, Das, De
Lemos, Khera) Division of Cardiology, University of Texas Southwestern
Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8830, United
States
(Ayers, Berry) Department of Clinical Sciences, University of Texas
Southwestern Medical Center, Dallas, TX, United States
Title
Coronary artery calcium improves risk classification in younger
populations.
Source
JACC: Cardiovascular Imaging. 8 (11) (pp 1285-1293), 2015. Date of
Publication: November 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to assess the effect of coronary artery
calcium (CAC) on coronary heart disease (CHD) risk prediction in a younger
population. Background CAC measured by computed tomography improves CHD
risk classification in older adults, but the effectiveness of CAC in
younger populations has not been fully assessed. Methods In the DHS
(Dallas Heart Study), a multiethnic probability-based population sample,
traditional CHD risk factors and CAC were measured in participants without
baseline cardiovascular disease or diabetes. Incident CHD - defined as CHD
death, myocardial infarction, or coronary revascularization - was assessed
over a median follow-up of 9.2 years. Predicted CHD risk was assessed with
a Weibull model inclusive of traditional risk factors before and after the
addition of CAC as ln(CAC + 1). Participants were divided into 3 10-year
risk categories, <6%, 6% to <20%, and >20%, and the net reclassification
improvement (NRI) was calculated. We also performed a random-effects
meta-analysis of NRI from previous studies inclusive of older individuals.
Results The analysis comprised 2,084 participants; mean age was 44.4 +/-
9.0 years. CAC was independently associated with incident CHD (hazard
ratio per SD: 1.90, 95% confidence interval [CI] 1.51 to 2.38; p < 0.001).
The addition of CAC to the traditional risk factor model resulted in
significant improvement in the C-statistic (delta = 0.03; p = 0.003).
Among participants with CHD events, the addition of CAC resulted in net
correct upward reclassification of 21%, and among those without CHD, a net
correct downward reclassification of 0.5% (NRI: 0.216, p = 0.012). Results
remained significant when the outcome was restricted to CHD death and
myocardial infarction and when individuals with diabetes were included.
The NRI observed in this study was similar to the pooled estimate from
previous studies (0.200, 95% CI: 0.140 to 0.258) and the addition of our
study to the meta-analysis did not result in significant heterogeneity
(I² = 0%). Conclusions CAC scoring also improves CHD risk
classification in younger adults. Copyright &#xa9; 2015 American College
of Cardiology Foundation.

<71>
Accession Number
612392987
Author
Wang L.-D.; Gao X.; Li J.-Y.; Yu H.-Y.; Su H.-W.; Liu L.-Z.; Qi J.
Institution
(Wang, Gao, Li, Yu, Su, Liu, Qi) Department of General Surgery, Laiwu
Hospital Affiliated to Taishan Medical University, Laiwu, China E-mail :
suhaiwen999@126.com
Title
Effects of preemptive analgesia with parecoxib sodium on haemodynamics and
plasma stress hormones in surgical patients with thyroid carcinoma.
Source
Asian Pacific journal of cancer prevention : APJCP. 16 (9) (pp 3977-3980),
2015. Date of Publication: 2015.
Abstract
BACKGROUND: To investigate the effects of preemptive analgesia with
parecoxib sodium on haemodynamics and plasma stress hormones in surgical
patients with thyroid carcinoma.
MATERIALS AND METHODS: Fifty-seven patients with thyroid carcinoma who
underwent thyroidectomy selectively in Laiwu Hospital Affiliated to
Taishan Medical University and Binzhou People's Hospital were selected and
randomly divided into three groups, 19 cases in each group. The control
group was intravenously injected 0.9% sodium chloride injection before
anesthesia induction; trial group I was intravenously injected with
parecoxib sodium 20 min before anesthesia induction; based on trial group
I, trial group II was injected with parecoxib sodium again 12 h after
surgery. The levels of plasma norepinephrine (NE), cortisol (Cor) and
blood glucose before, 12 and 24 h after surgery and changes of
haemodynamics before surgery, at the end of surgery and 12, 24 and 48 h
after surgery were compared in the three groups. Besides, visual analogue
scale (VAS) scores were recorded 4, 8, 12 and 24 h after surgery.
RESULTS: 12 and 24 h after surgery, the levels of plasma NE and Cor in
three groups rose dramatically (P<0.05 or (P<0.01); The levels of plasma
NE and Cor in trial groups I and II were evidently lower than in control
group (P<0.05 or P<0.01), and those in trial group II slightly lower than
in trial group I. 12 h after surgery, the heart rates (HR) and systolic
pressures (SBP) in trial groups I and II increased obviously by comparison
to surgery before (P<0.05 or P<0.01), but gradually returned to the
preoperative level. HR, SBP and diastolic pressures (DBP) in trial groups
I and II at the end of surgery and 12 h after surgery were all lower than
in the control group, and significant differences were present (P<0.05 or
(P<0.01). At 4, 8, 12 and 24 h after surgery, VAS scores in trial groups I
and II were markedly lower than in the control group ((P<0.05 or (P<0.01),
the scores in trial group II being the lowest.
CONCLUSIONS: Combined application of parecoxib sodium for preemptive
analgesia before anesthesia and after surgery can effectively reduce the
levels of plasma stress hormones and improve analgesic effects in surgical
patients with thyroid carcinoma, and without conspicuous impact on
haemodynamics.

<72>
Accession Number
612325421
Author
Laferton J.A.; Auer C.J.; Shedden-Mora M.C.; Moosdorf R.; Rief W.
Institution
(Laferton) a Department of Clinical Psychology and Psychotherapy ,
Philipps University of Marburg , Gutenbergstrase 18, 35032 Marburg ,
Germany
(Auer) a Department of Clinical Psychology and Psychotherapy , Philipps
University of Marburg , Gutenbergstrase 18, 35032 Marburg , Germany
(Shedden-Mora) b Department of Psychosomatic Medicine and Psychotherapy ,
University Medical Center Hamburg Eppendorf , Hamburg , Germany
(Moosdorf) c Department of Cardiovascular Surgery , Heart Centre, Philipps
University of Marburg , Marburg , Germany
(Rief) a Department of Clinical Psychology and Psychotherapy , Philipps
University of Marburg , Gutenbergstrase 18, 35032 Marburg , Germany
Title
Optimizing preoperative expectations in cardiac surgery patients is
moderated by level of disability: the successful development of a brief
psychological intervention.
Source
Psychology, health & medicine. 21 (3) (pp 272-285), 2016. Date of
Publication: 2016.
Abstract
Patients' expectations have shown to be a major psychological predictor of
health outcome in cardiac surgery patients. However, it is unclear whether
patients' expectations can be optimized prior to surgery. This study
evaluates the development of a brief psychological intervention focusing
on the optimization of expectations and its effect on change in patients'
expectations prior to cardiac surgery. Ninety patients scheduled for
coronary artery bypass graft were randomly assigned to (1) standard
medical care, (2) additional expectation manipulation intervention (EMI),
and (3) additional attention control group. Therapists' fidelity to
intervention manuals and patients satisfaction with the intervention were
assessed for both active intervention conditions. Patients' expectations
about post-surgical disability, treatment control, personal control, and
disease duration were assessed before and after the psychological
intervention. Demographical, medical, and psychosocial characteristics and
disability were assessed at baseline. Treatment fidelity and patient
satisfaction was very high in both intervention conditions. Only patients
receiving EMI developed higher personal control expectations and longer
(more realistic) expectations of disease duration. The effect of
intervention group on patients' disability expectations and patients'
personal control expectations was moderated by patient's level of
disability. EMI patients with low to moderate disability developed
positive expectations whereas patients with high disability did not. This
study shows the successful development of a short psychological
intervention that was able to modify patients' expectations, especially in
those with low to moderate disability. Given the robust association of
expectations and surgery outcome, such an intervention might offer the
opportunity to enhance patients' health following cardiac surgery.

<73>
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

<74>
[Use Link to view the full text]
Accession Number
612287125
Author
Medeiros D.N.M.; Ferranti J.F.; Delgado A.F.; De Carvalho W.B.
Institution
(Medeiros, Ferranti) Pediatric Intensive Care Unit, Hospital Municipal Dr.
Moises Deutsch-M Boi Mirim, Av. Albert Einstein, 627/701, Sao Paulo
05652-900, Brazil
(Medeiros) Pediatric Intensive Care Unit, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Delgado, De Carvalho) Pediatric Intensive Care Department, Instituto da
Crianca, Sao Paulo, Brazil
Title
Colloids for the initial management of severe sepsis and septic shock in
pediatric patients a systematic review.
Source
Pediatric Emergency Care. 31 (11) (pp e11-e16), 2015. Date of Publication:
November 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aim: The goal of this study was to perform a systematic review of the
literature assessing the use of colloids for the initial treatment of
severe sepsis and septic shock in pediatric patients. Design: The PICO
[Patient, Intervention, Comparison, Outcome] method was used for the
selection of studies, and the Cochrane Bias Tool was used to analyze the
quality of the selected studies. Data Search: Relevant studies were sought
using the following databases: EMBASE (1980 to March 2014), PubMed (1970
to March 2014), Cochrane (1980 to March 2014), Web of Science, and Scopus.
Searches used the following key words: isotonic solution, crystalloid,
saline solution, colloid, resuscitation, fluid therapy, sepsis and septic
shock, starch, and gelatin. The filters children and clinical trial were
used when possible. Review Method: Study selection was performed by 1
examiner. The selected articles were analyzed by 2 examiners who validated
the articles according to the Cochrane Bias Tool. Discrepancies were
resolved by consensus or by a third examiner. Result: A total of 110
articles were selected based on the key words. Of these, 99 were excluded
because they assessed postoperative follow-up, burn cases, cardiac
surgery, or nutritional therapy or were review articles, guidelines, or
editorials. One study was included after an analysis of previous reviews.
A total of 12 articles were selected for analysis because they were
reports of clinical trials conducted with prospective cohorts and they
analyzed the use of crystalloids and colloids or colloids only in the
initial treatment of severe sepsis or septic shock in children and
adolescents. The total number of patients was 4375, and they ranged in age
from 2 months to 15 years, with most patients between 5 and 15 years. Five
studies assessed patients diagnosed with malaria, 5 assessed patients with
dengue shock syndrome, 1 studied febrile diseases, and 1 examined the
progression of patients with septic shock caused by various causes.
Conclusions: The studies analyzed did not find evidence to suggest that
the use of colloids is superior to crystalloids. In some studies, the
fluid volume needed to achieve initial stabilization was smaller in the
group given colloids. Crystalloids are the preferred therapeutic option
because of their effectiveness, low cost, and wide availability. Colloids
may be the first choice in cases of malaria when the central nervous
system is affected. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All
rights reserved.

<75>
Accession Number
612379737
Author
Hong J.H.; Jung S.W.
Institution
(Hong, Jung) Keimyung University, School of Medicine, South Korea
Title
Fluoroscopically guided thoracic interlaminar epidural injection: A
comparative epidurography study using 2.5 mL and 5 mL of contrast dye.
Source
Pain Physician. 19 (7) (pp E1013-E1018), 2016. Date of Publication:
September-October 2016.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Thoracic epidural anesthesia (TEA) is frequently used to
maintain intraoperative analgesia. After injecting the initial bolus dose
of epidural local anesthetics (LA), intermittent injection of LA through
an epidural catheter is required to maintain the intraoperative analgesia.
For intermittent epidural administration, usually 2 - 5 mL of LA has been
used. However, no studies have suggested an optimal volume of LA of TEA
for intermittent epidural administration of TEA. Objective: We focused on
identifying an optimal volume of LA of TEA using epidurography of the
thoracic level with 2 different volumes of contrast dye. Study Design:
Prospective, randomized study. Setting: An interventional pain management
practice in South Korea. Methods: After Institutional Review Board
approval, 70 patients undergoing thoracic epidural catheterization for
upper abdominal and thoracic surgery were randomly assigned to one of the
2 contrast dye volume groups of 35 patients each (A, 2.5 mL and B, 5.0
mL). Epidurography was evaluated to confirm how many spinal segments were
covered by contrast dye. The spreads in the cephalad and caudad directions
were also evaluated. Results: The total number of vertebral segments
evaluated by contrast dye were 7.5 +/- 2.0, and 8.4 +/- 2.6, respectively
in groups A and B. The number of patients who showed contrast dye spread
of more than 5 vertebral segments was 34/35 (97%) in both groups. Group B
resulted in higher contrast dye distribution in the cephalad direction
compared to group A (T2.6 vs. T3.6). Limitations: We used a test dose of
contrast dye to confirm the contrast was in epidural space, not
intrathecal or vascular, before injection of the main dose of contrast
dye. The present study did not include the volume of test dose.
Conclusion: The volume of 2.5 mL for intermittent epidural administration
would be enough for the analgesic effect of upper abdominal and thoracic
surgery while avoiding excessive upper thoracic and cervical spread.
Copyright &#xa9; 2016, American Society of Interventional Pain Physicians.
All rights reserved.

<76>
Accession Number
612375354
Author
Kalogianni A.; Almpani P.; Vastardis L.; Baltopoulos G.; Charitos C.;
Brokalaki H.
Institution
(Kalogianni, Almpani) Faculty of Nursing, Technological Educational
Institute of Athens, Ag. Spiridona Str, Aigaleo, Athens 122 10, Greece
(Vastardis) Intensive Care Unit of Department of Cardiac Surgery,
Evangelismos General Hospital, Athens, Greece
(Baltopoulos, Brokalaki) Faculty of Nursing, National and Kapodistrian
University of Athens, Greece
(Charitos) Cardiothoracic Surgery Department, Evangelismos, General
Hospital of Athens, Greece
Title
Can nurse-led preoperative education reduce anxiety and postoperative
complications of patients undergoing cardiac surgery?.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 447-458), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effect of preoperative education on anxiety and
postoperative outcomes of cardiac surgery patients remains unclear. Aim:
The aim of the study was to estimate the effectiveness of a nurse-led
preoperative education on anxiety and postoperative outcomes. Methods: A
randomised controlled study was designed. All the patients who were
admitted for elective cardiac surgery in a general hospital in Athens with
knowledge of the Greek language were eligible to take part in the study.
Patients in the intervention group received preoperative education by
specially trained nurses. The control group received the standard
information by the ward personnel. Measurements of anxiety were conducted
on admission-A, before surgery-B and before discharge-C by the state-trait
anxiety inventory. Results: The sample consisted of 395 patients
(intervention group: 205, control group: 190). The state anxiety on the
day before surgery decreased only in the intervention group (34.0 (8.4)
versus 36.9 (10.7); P=0.001). The mean decrease in state score during the
follow-up period was greater in the intervention group (P=0.001). No
significant difference was found in the length of stay or readmission.
Lower proportions of chest infection were found in the intervention group
(10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression
revealed that education and score in trait anxiety scale on admission are
independent predictors of a reduction in state anxiety. Conclusion:
Preoperative education delivered by nurses reduced anxiety and
postoperative complications of patients undergoing cardiac surgery, but it
was not effective in reducing readmissions or length of stay. Copyright
&#xa9; European Society of Cardiology.

<77>
Accession Number
612375350
Author
Hojskov I.E.; Moons P.; Hansen N.V.; Greve H.; Olsen D.Bae.; La Cour So.;
Glud C.; Winkel P.; Lindschou J.; Egerod I.; Christensen A.V.; Berg S.K.
Institution
(Hojskov, Greve, Olsen, Christensen, Berg) Rigshospitalet, Copenhagen
University Hospital, Heart Centre, Thoracic Clinic, Blegdamsvej 9,
Copenhagen DK-2100, Denmark
(Moons) KU Leuven, University of Leuven, Department of Public Health and
Primary Care, KU Leuven, Belgium
(Hansen, La Cour) Centre for Research in Existence and Society, University
of Copenhagen, Denmark
(Glud, Winkel, Lindschou) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Rigshospitalet, Copenhagen University Hospital,
Denmark
(Egerod) Trauma Centre, Rigshospitalet, Copenhagen University Hospital,
Denmark
Title
Early physical training and psycho-educational intervention for patients
undergoing coronary artery bypass grafting. The SheppHeart randomized 2 x
2 factorial clinical pilot trial.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 425-437), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Patients undergoing coronary artery bypass graft surgery often
experience a range of problems and symptoms such as immobility, pain and
insufficient sleep. Results from trials investigating testing in-hospital
physical exercise or psychological intervention have been promising.
However, no randomized clinical trials have tested a comprehensive
rehabilitation programme consisting of both physical exercise and
psycho-education in the early rehabilitation phase. Aims: The aims of the
present SheppHeart pilot randomized clinical trial were to evaluate the
feasibility of patient recruitment, patient acceptance of the
intervention, safety and tolerability of the intervention. Methods and
design: Sixty patients admitted for coronary artery bypass graft were
randomized 1:1:1:1 to: 1) physical exercise plus usual care, or 2)
psycho-educational intervention plus usual care, or 3) physical exercise
and psycho-educational plus usual care, or 4) usual care alone during a
four week period after surgery. Results: The acceptability of trial
participation was 67% during the three month recruitment period. In the
physical exercise groups, patients complied with 59% of the total expected
training sessions during hospitalization. Nine patients (30%) complied
with >75% and nine patients (30%) complied with 50% of the planned
exercise sessions. Eleven patients (42%) participated in >75% of the four
consultations and six patients (23%) participated in 50% of the
psycho-educational programme. Conclusion: Comprehensive phase one
rehabilitation combining physical exercise and psycho-education in
coronary artery bypass graft patients shows reasonably high inclusion,
feasibility and safety. Copyright &#xa9; European Society of Cardiology.

<78>
Accession Number
612375319
Author
Doering L.V.; McGuire A.; Eastwood J.-A.; Chen B.; Bodan R.C.; Czer L.S.;
Irwin M.R.
Institution
(Doering, Eastwood, Chen) School of Nursing, University of California,
Factor Building 4-266, 700 Tiverton Ave, Los Angeles, CA 90095, United
States
(McGuire) School of Nursing, California State University, Long Beach,
United States
(Bodan) School of Nursing, California State University, Fullerton, United
States
(Czer) Cedars-Sinai Heart Institute, United States
(Irwin) Cousins Center for Psychoneuroimmunology, University of
California, United States
Title
Cognitive behavioral therapy for depression improves pain and perceived
control in cardiac surgery patients.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 417-424), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Depression after cardiac surgery (CS) is associated with
increased pain and decreased sleep quality. While cognitive behavioral
therapy (CBT) aimed at depression is effective in relieving depressive
symptoms after cardiac surgery, little is known about its ability to
ameliorate other common postoperative problems that affect recovery and
quality of life. Aims: The purpose of this study was to evaluate the
effects of CBT for depression on pain severity, pain interference, sleep,
and perceived control in patients recovering from CS. Methods: Depressed
patients recovering from CS were randomized to receive either eight weeks
of CBT or usual care. At baseline and post-intervention, patients
completed questionnaires for depressive symptoms, pain, sleep, and
perceived control. Group comparisons were conducted using t-tests or chi
square analysis. Repeated measures analysis was used to assess the effect
of the intervention in changes over time. Results: The sample (n=53)
included 16.9% women and had a mean age of 67.8+/-9.2 years. CBT for
depression increased perceived control (p<0.001) and decreased pain
interference (p=0.02) and pain severity (p=0.03). Group effects remained
significant (p<0.05) for perceived control and pain interference and a
trend was observed for pain severity (p<0.10) after controlling for
variables that differed at baseline. There were no group differences in
sleep disturbance over time. Conclusions: A depression-focused CBT
intervention yields benefits in other common postoperative problems,
specifically improved perceived control and decreased pain in depressed
cardiac surgery patients. Copyright &#xa9; European Society of Cardiology.

<79>
Accession Number
612299461
Author
McNeely C.A.; Vassileva C.M.
Institution
(McNeely, Vassileva) Department of Cardiothoracic Surgery, Southern
Illinois University School of Medicine, Springfield, IL, United States
Title
Long-term outcomes of mitral valve repair versus replacement for
degenerative disease: A systematic review.
Source
Current Cardiology Reviews. 11 (2) (pp 157-162), 2015. Date of
Publication: 01 Jan 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The short-term advantage of mitral valve repair versus replacement for
degenerative disease has been extensively documented. These advantages
include lower operative mortality, improved survival, better preservation
of leftventricular function, shorter post-operative hospital stay, lower
total costs, and fewer valve-related complications, including
thromboembolism, anticoagulation-related bleeding events and late
prosthetic dysfunction. More recent written data are available indicating
the long-term advantage of repair versus replacement. While at some
institutions, the repair rate for degenerative disease may exceed 90%, the
national average in 2007 was only 69%. Making direct comparisons between
mitral valve repair and replacement using the available studies does
present some challenges however, as there are often differences in
baseline characteristics between patient groups as well as other
dissimilarities between studies. The purpose of this review is to
systematically summarize the long-term survival and reoperation data of
mitral valve repair versus replacement for degenerative disease. A PubMed
search was done and resulted in 12 studies that met our study criteria for
comparing mitral valve repair versus replacement for degenerative disease.
A systematic review was then conducted abstracting survival and
reoperation data. Copyright &#xa9; 2015 Bentham Science Publishers.

<80>
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.

<81>
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.

<82>
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.

<83>
Accession Number
612433655
Author
Rex C.E.; Heiberg J.; Klaaborg K.-E.; Hjortdal V.E.
Institution
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Cardiothoracic & Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
Title
Health-related quality-of-life after transapical transcatheter aortic
valve implantation.
Source
Scandinavian Cardiovascular Journal. (pp 1-6), 2016. Date of Publication:
27 Sep 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a
well-established treatment for aortic valve stenosis in high-risk patients
and indications have been continuously expanding to also include
intermediate-risk patients. However, in low-risk patients, experiences are
still sparse and although clinical outcomes have been shown favorable
results, HRQoL has remained unexplored. The aim of this report was to
describe the long-term health-related quality-of-life (HRQoL) in low-risk
patients randomized to TA-TAVI or surgical aortic valve replacement
(SAVR). Methods. In a prospective, randomized trial, patients with aortic
valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was
performed through a mini thoracotomy with the introduction of prosthesis
via the apex of the heart and antegradely advancement over the pre-dilated
native valve. SAVR was performed during cardiopulmonary bypass with
resection of the native valve and replacement with a prosthesis valve
through a median sternotomy. Afterwards, patients were followed yearly
with echocardiography and HRQoL assessment. Results. A total of 58
patients were included; 29 patients for TA-TAVI and 29 patients for SAVR.
The only difference in HRQoL was found in the physical component summary
after 1 year; 44+/-9 in the TA-TAVI group compared with 36+/-9 in the SAVR
group, p=.03. There were no differences in any of the remaining timepoints
in neither physical nor mental component summary, p=.19 and p=.98,
respectively, and there were no differences in survival during the 5
years. Conclusions. In low-risk patients with aortic valve stenosis
undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR
during a 5-year follow-up period. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group

<84>
Accession Number
612422315
Author
Kim T.K.; Nam K.; Cho Y.J.; Min J.J.; Hong Y.J.; Park K.U.; Hong D.M.;
Jeon Y.
Institution
(Kim, Cho, Min, Hong, Jeon) Department of Anaesthesiology and Pain
Medicine Seoul National University Hospital Seoul Korea
(Nam) Cheoncheon Public Health Subcentre Jangsu Health Centre and County
Hospital Jangsu Jeollabuk-do Korea
(Hong, Park) Department of Laboratory Medicine Seoul National University
Bundang Hospital Seongnam Gyeongi-do Korea
Title
Microvascular reactivity and endothelial glycocalyx degradation when
administering hydroxyethyl starch or crystalloid during off-pump coronary
artery bypass graft surgery: A randomised trial.
Source
Anaesthesia. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The infusion of fluids to patients may affect tissue microcirculation and
the endothelial glycocalyx. However, the effects of hydroxyethyl starch
and crystalloid on endothelial glycocalyx degradation and microvascular
reactivity have not been evaluated in detail. We hypothesised that
hydroxyethyl starch may cause less endothelial glycocalyx degradation and
better microvascular reactivity than that caused by crystalloid. We
randomly allocated 120 patients undergoing off-pump coronary artery bypass
graft surgery to receive up to 20 ml.kg^-1 of either
hydroxyethyl starch 670/0.75 or crystalloid for intra-operative fluid
resuscitation. Crystalloid was then infused to meet ongoing fluid
requirements. During the peri-operative period, vascular occlusion tests
were performed to assess microvascular reactivity, and serum syndecan-1
was measured as an index of endothelial glycocalyx degradation. The median
(IQR [range]) fluid infused during surgery was significantly less in the
hydroxyethyl starch group than the crystalloid group; 2800 (2150-3550
[1400-7300]) vs. 3925 (3100-4725 [1900-6700]) ml, respectively, p < 0.001.
Vascular occlusion test parameters, including tissue oxygen saturation,
occlusion and recovery slope did not differ significantly between the
groups. Peri-operative changes in syndecan-1 were not significantly
different between the groups. We conclude that, in patients undergoing
off-pump coronary artery bypass graft surgery, compared with crystalloid,
the use of hydroxyethyl starch 670/0.75 did not result in significant
differences in microvascular reactivity or endothelial glycocalyx
degradation. Copyright &#xa9; The Association of Anaesthetists of Great
Britain and Ireland.

<85>
Accession Number
612365074
Author
Cavalcante R.; Sotomi Y.; Zeng Y.; Lee C.W.; Ahn J.-M.; Collet C.;
Tenekecioglu E.; Suwannasom P.; Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Zeng, Tenekecioglu, Suwannasom, Onuma) Erasmus University
Medical Center, Rotterdam, The Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Collet, Suwannasom) Academic Medical Center, University of
Amsterdam, Amsterdam, The Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, UK
Title
Coronary bypass surgery versus stenting in multivessel disease involving
the proximal left anterior descending coronary artery.
Source
Heart. (no pagination), 2016. Date of Publication: September 20, 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective In patients with multivessel disease and proximal left anterior
descending artery (LAD) involvement, the best revascularisation strategy
is still unclear. We assess outcomes after coronary artery bypass graft
surgery (CABG) and percutaneous coronary intervention (PCI) with
drug-eluting stents in a pooled analysis of individual patient-level data
of the SYNTAX and BEST randomised trials. Design Proximal LAD involvement
was defined by any lesion > 50% diameter stenosis in the arterial segment
starting from the left-main bifurcation up to (and including) the origin
of the first major septal branch. The primary endpoint was the composite
of all-cause death, myocardial infarction (MI) or stroke at 5 years of
follow-up. Results The present study population comprises 1166 patients of
which 577 were randomised to PCI and 589 to CABG. Baseline characteristics
were well balanced across study arms. The primary endpoint occurred in 94
(16.3%) patients in the PCI arm and in 68 (11.5%) patients in the CABG arm
(HR 1.43; 95%CI 1.05 to 1.95; p=0.026). CABG was also associated with a
significantly lower rate of cardiac death (p=0.007), MI (p<0.001),
allcause revascularisation (p<0.001) and major adverse cardiovascular and
cerebrovascular events (all-cause death, MI, stroke, revascularisation)
(p<0.001). The rates of allcause mortality (p=0.06) and stroke (p=0.09)
were not statistically different between the two groups. The overall study
results for the primary outcome were consistent across several subgroups.
Conclusions In patients with multivessel disease with proximal LAD
involvement, CABG is associated with lower rates of the safety composite
endpoint of death, MI or stroke as compared with PCI with drug-eluting
stents at 5 years of follow-up (number needed to treat=21). Copyright
&#xa9; 2016 BMJ Publishing Group Ltd & British Cardiovascular Society.

<86>
Accession Number
612362404
Author
Barile L.; Fominskiy E.; Di Tomasso N.; Alpizar Castro L.E.; Landoni G.;
de Luca M.; Bignami E.; Sala A.; Zangrillo A.; Monaco F.
Institution
(Barile) From the *Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy; +Department of Cardiac
Surgery, Vita-Salute San Raffaele University, Milan, Italy; ++Department
of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk
State Budget Research Institute of Circulation Pathology, Novosibirsk,
Russia; and Department of Anesthesia, Mexico Hospital, San Jose, Costa
Rica.
Title
Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell
Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of
Randomized Trials.
Source
Anesthesia and Analgesia. (no pagination), 2016. Date of Publication: 23
Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: To better understand the role of acute normovolemic
hemodilution (ANH) in a surgical setting with high risk of bleeding, we
analyzed all randomized controlled trials (RCTs) in the setting of cardiac
surgery that compared ANH with standard intraoperative care. The aim was
to assess the incidence of ANH-related number of allogeneic red blood cell
units (RBCu) transfused. Secondary outcomes included the rate of
allogeneic blood transfusion and estimated total blood loss. METHODS::
Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH
group and 1187 in the control group) were included in our meta-analysis
using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE.
RESULTS:: Patients in the ANH group received fewer allogeneic RBCu
transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25
to -0.34; P = .001; I = 95.1%). Patients in the ANH group were overall
transfused less with allogeneic blood when compared with controls (356/845
[42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio =
0.74; 95% CI, 0.62 to 0.87; P < .0001; I = 72.5%), and they experienced
less postoperative blood loss (388 mL in ANH versus 450 mL in control;
mean difference = -0.64; 95% CI, -0.97 to -0.31; P < .0001; I = 91.8%).
CONCLUSIONS:: ANH reduces the number of allogeneic RBCu transfused in the
cardiac surgery setting together with a reduction in the rate of patients
transfused with allogeneic blood and with a reduction of bleeding.
Copyright &#xa9; 2016 International Anesthesia Research Society

<87>
Accession Number
612362080
Author
Pearson K.L.; Hall N.J.
Institution
(Pearson) Department of General Surgery, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Pearson, Hall) University Surgery Unit, Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
(Hall) Department of Paediatric Surgery and Urology, Southampton
Children's Hospital, Southampton, United Kingdom
Title
What is the role of enhanced recovery after surgery in children? A scoping
review.
Source
Pediatric Surgery International. (pp 1-9), 2016. Date of Publication: 27
Sep 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Enhanced recovery after surgery (ERAS) pathways are standard
practice in adult specialties resulting in improved outcomes. It is
unclear whether ERAS principles are applicable to Paediatric Surgery. We
performed a scoping review to identify the extent to which ERAS has been
used in Paediatric Surgery, the nature of interventions, and outcomes.
Methods: Pubmed, Cochrane library, Google Scholar, and Embase were
searched using the terms enhanced recovery, post-operative
protocol/pathway, fast track surgery, and paediatric surgery. Studies were
excluded if they did not include abdominal/thoracic/urological procedures
in children. Results: Nine studies were identified (2003-2014; total 1269
patients): three case control studies, one retrospective review and five
prospective implementations, no RCTs. Interventional elements identified
were post-operative feeding, mobilisation protocols, morphine-sparing
analgesia, reduced use of nasogastric tubes and urinary catheters.
Outcomes reported included post-operative length of stay (LOS), time to
oral feeding and stooling, complications, and parent satisfaction.
Fast-track programmes significantly reduced LOS in 6/7 studies, time to
oral feeding in 3/3 studies, and time to stooling in 2/3 studies.
Conclusion: The use of ERAS pathways in Paediatric surgery appears very
limited but such pathways may have benefits in children. Prospective
studies should evaluate interventions used in adult ERAS on appropriate
outcomes in the paediatric setting. Copyright &#xa9; 2016 Springer-Verlag
Berlin Heidelberg

<88>
Accession Number
612361864
Author
Phan K.; Haswell J.M.; Xu J.; Assem Y.; Mick S.L.; Kapadia S.R.; Cheung
A.; Ling F.S.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan) 1. Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia 2. Faculty of Medicine, University of Sydney, Sydney,
Australia 3. Faculty of Medicine, University of New South Wales, Sydney,
Australia 4. Division of Cardiovascular Diseases, University of Rochester
Medical Center, Rochester, NY, USA 5. Department of Thoracic and
Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH, USA 6. Department of Cardiovascular Medicine, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, USA 7. Division of
Cardiothoracic Surgery, St. Paul's Hospital, University of British
Columbia, Vancouver, BC, Canada 8. Department of Cardiothoracic Surgery,
Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia 9.
Division of Cardiac
Title
Percutaneous transcatheter interventions for aortic insufficiency in
continuous-flow left ventricular assist device patients: A systematic
review and meta-analysis.
Source
ASAIO Journal. (no pagination), 2016. Date of Publication: 22 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
De novo progressive aortic insufficiency (AI) is a side effect frequently
related to prolonged support with continuous-flow left ventricular assist
devices (CF-LVAD). Its progression can result in recurrent clinical heart
failure symptoms and significantly increased mortality. Recently,
percutaneous intervention methods such as transcatheter aortic valve
replacement (TAVR) and percutaneous occluder devices have emerged,
However, given the very scarce global experience with these approaches,
evidence in the literature is lacking. We sought to assess the outcomes of
CF-LVAD patients who had undergone percutaneous intervention for AI.A
systematic search of six databases from inception to April 2016 was
performed by two independent reviewers. Eligible studies were those that
included series or cases where patients had percutaneous transcatheter
interventions for aortic insufficiency in continuous-flow left ventricular
assist device patients. Data was extracted and meta-analyzed from the
identified studiesA total of 29 patients from 15 published studies and 3
unpublished records were included in the analysis. Mean patient age was
56.6 +/- 13.7 years and 72.4% were male. The etiology of heart failure
resulting in LVAD placement was ischemic cardiomyopathy in 17.2%. The two
intervention groups were TAVR (27.6%) and occluder devices (72.4%). A
transfemoral approach (69%), apical approach (10%), brachial approach
(7%), subclavian approach (3%) and mini-sternotomy (3%) were used. The
pre-intervention AI grade was severe with a median grade of 4
[interquartile range, 4-4]. Post operatively the AI grade improved
significantly to a median grade of 0 [0-2]. At long term follow up the AI
grade was still trivial with a median AI grade of 1 [0-1]. Subgrouping the
treatments into the occluder device and TAVR, it was found that both
interventional techniques were similarly effective in reducing the AI
grade from severe to trivial. In terms of complications, from the occluder
group, two patients were complicated with device migration and another two
with transient hemolysis. In the TAVR cohort, two patients experienced
device migration and another had significant post-implant perivalvular
leakage.Our results indicate that percutaneous interventions for AI in
CF-LVAD patients with TAVR and closure devices demonstrate similar
efficacy in significantly reducing severe AI. Current results are
encouraging, potentiating viability as a treatment option, particularly in
non-surgical candidates. Future research with larger patient cohorts and
comparative controls is required to sufficiently evaluate the efficacy of
this technique and promote its widespread acceptance as a mainstay
treatment. Copyright &#xa9; 2016 by the American Society for Artificial
Internal Organs

<89>
Accession Number
612361767
Author
Sun E.Y.; Jadotte Y.T.; Halperin W.
Institution
(Sun) Internal Medicine Resident Physician (Dr Sun), University of North
Carolina, Chapel Hill, North Carolina; New Jersey Medical School (Dr
Halperin), School of Public Health, Newark Campus (Dr Halperin), and
School of Nursing, Newark Campus (Dr Jadotte); Northeast Institute for
Evidence Synthesis and Translation, School of Nursing (Dr Jadotte),
Rutgers University, Newark, New Jersey; Department of Family, Population
and Preventive Medicine (Dr Jadotte), Stony Brook University; Stony Brook,
New York.
Title
Disparities in Cardiac Rehabilitation Participation in the United States:
A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2016. Date of Publication: 26 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE:: Phase 2 cardiac rehabilitation (CR) is a class I recommendation
for all patients following an acute cardiac event or cardiac surgery
according to the The American Heart Association and the American College
of Cardiology Foundation. Studies have shown that there are differences in
cardiac rehabilitation participation rates between sociodemographic
groups. The purpose of this systematic review and meta-analyses was to
synthesize quantitative data on the relationship between outpatient
cardiac rehabilitation (OCR) attendance and various sociodemographic
factors. METHODS:: We conducted a search of PubMed, PsycINFO, CINAHL,
Google Scholar, Dissertations & Theses A&I, and conference abstracts for
observational studies conducted in the United States that fit our
inclusion criteria. A total of 21 studies were included in our final
review and meta-analyses. RESULTS:: Our meta-analyses showed that overall,
attenders were younger than nonattenders (mean difference=-3.74 years, 95%
CI =-5.87 to -1.61) and the odds of participation were lower among females
(OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school degree or
less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or self-payers (OR
= 0.32; 95% CI = 0.14-0.71). Full- or part-time employees were more likely
to participate than those not employed (OR = 1.45; 95% CI = 1.08-1.95).
CONCLUSIONS:: Our systematic review and meta-analyses showed that there
are significant sociodemographic disparities in CR participation. On the
basis of this knowledge, clinicians and policy makers should focus on
identifying and eliminating barriers to participation. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

<90>
Accession Number
612357080
Author
Dionne A.; Bakloul M.; Manlhiot C.; McCrindle B.W.; Hosking M.; Houde C.;
Pepelassis D.; Dahdah N.
Institution
(Dionne, Bakloul, Dahdah) Division of Pediatric Cardiology (6 - Bloc 9),
CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montreal, QC H3T 1C5,
Canada
(Manlhiot, McCrindle) Division of Pediatric Cardiology, Department of
Pediatrics, University of Toronto, The Hospital for Sick Children,
Toronto, ON, Canada
(Hosking) Division of Pediatric Cardiology, BC Children's Hospital,
Vancouver, BC, Canada
(Houde) Division of Pediatric Cardiology, Quebec, QC, Canada
(Pepelassis) Division of Pediatric Cardiology, Health Science Center,
Winnipeg, MB, Canada
Title
Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention
after Kawasaki Disease: The Pediatric Canadian Series.
Source
Pediatric Cardiology. (pp 1-8), 2016. Date of Publication: 23 Sep 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Coronary artery (CA) aneurysms are serious complications of Kawasaki
disease (KD) responsible for ischemic events. Percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) are reported
with limited data on indications and comparative efficacy. Retrospective
multicenter comparison of CA intervention following KD is performed in
this study. Twenty two cases were available from 5 centers, of whom 11
underwent CABG, 10 PCI and 1 systemic thrombolysis. Age at intervention
(8.3 +/- 3.9 vs 11.3 +/- 4.9 years, p = 0.14) and interval from diagnosis
(5.6 +/- 4.1 vs 6.5 +/- 4.7 years, p = 0.64) were similar between CABG and
PCI. Interventions were based on angiography in 15 patients or cardiac
event in 7, with no difference between CABG and PCI (p = 0.24). Patients
with CABG were more likely to undergo multivessel intervention (73 vs 10
%, p = 0.006). None of the patients needed reintervention after CABG,
compared to 6 after PCI and 1 after systemic thrombolysis (p = 0.004).
Signs of ischemia on stress testing or MIBI were present in 15 patients
before intervention and persisted in 9 patients following last
intervention, in a significantly higher proportion after CABG than PCI (80
vs 17 %, p = 0.01). In this series, CABG, which mostly involved
multivessel intervention, was superior to PCI. Nevertheless, larger-scale
studies may help define patient selection criteria for a beneficial PCI
approach. Copyright &#xa9; 2016 Springer Science+Business Media New York

<91>
Accession Number
612344068
Author
Karkouti K.; Callum J.; Wijeysundera D.N.; Rao V.; Crowther M.; Grocott
H.P.; Pinto R.; Scales D.C.
Institution
(Karkouti) 1 Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, University of Toronto, Toronto,
Canada; 2 Department of Laboratory Medicine and Pathobiology, Sunnybrook
Health Sciences Centre, University of Toronto, Toronto, Canada; 3
Department of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, and Li Ka Shing
Knowledge Institute of St. Michael's Hospital, Toronto, Canada; 4 Division
of Cardiac Surgery, Department of Surgery, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, Canada; 5
Department of Pathology and Molecular Medicine, McMaster University,
Hamilton, Canada; 6 Department of Anesthesia and Perioperative Medicine,
University of Manitoba, Winn
Title
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge
Clustered Randomized Controlled Trial.
Source
Circulation. (no pagination), 2016. Date of Publication: 22 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Cardiac surgery is frequently complicated by coagulopathic
bleeding that is difficult to optimally manage using standard hemostatic
testing. We hypothesized that point-of-care hemostatic testing within the
context of an integrated transfusion algorithm would improve the
management of coagulopathy in cardiac surgery and thereby reduce blood
transfusions. METHODS-: We conducted a pragmatic multi-centered
stepped-wedge cluster randomized controlled trial of a POC-based
transfusion algorithm in consecutive patients undergoing cardiac surgery
with cardiopulmonary bypass at 12 hospitals from Oct 6, 2014 to May 1,
2015. Following a 1-month data collection at all participating hospitals,
a transfusion algorithm incorporating point-of-care hemostatic testing was
sequentially implemented at 2 hospitals at a time in 1-month intervals,
with the implementation order randomly assigned. No other aspects of care
were modified. The primary outcome was red cell transfusion from surgery
to postoperative day seven. Other outcomes included transfusion of other
blood products, major bleeding, and major complications. The analysis
adjusted for secular time-trends, within-hospital clustering, and
patient-level risk factors. All outcomes and analyses were pre-specified
before study initiation. RESULTS-: Among the 7402 patients studied, 3555
underwent surgery during the control phase and 3847 during the
intervention phase. Overall, 3329 (45.0%) received red cells, 1863 (25.2%)
received platelets, 1645 (22.2%) received plasma, and 394 (5.3%) received
cryoprecipitate. Major bleeding occurred in 1773 (24.1%) patients and
major complications occurred in 740 (10.2%) patients. The trial
intervention reduced rates of red cell transfusion (adjusted relative risk
[RR], 0.91; 95% CI, 0.85 to 0.98; P = 0.02; Number needed to treat [NNT]
24.7), platelet transfusion (RR, 0.77; 95% CI, 0.68 to 0.87; P < 0.001;
NNT 16.7), and major bleeding (RR, 0.83; 95% CI, 0.72 to 0.94; P = 0.004;
NNT 22.6), but had no effect on other blood product transfusions or major
complications. CONCLUSIONS-: Implementation of point-of-care hemostatic
testing within the context of an integrated transfusion algorithm reduces
red cell transfusions, platelet transfusions, and major bleeding following
cardiac surgery. Our findings support the broader adoption of
point-of-care hemostatic testing into clinical practice. CLINICAL TRIAL
REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier:
NCT02200419. Copyright &#xa9; 2016 by the American College of Cardiology
Foundation and the American Heart Association, Inc.

<92>
Accession Number
612327511
Author
Fernandes G.A.; Lima A.C.G.; Gonzaga I.C.A.; de Barros Araujo R.; de
Oliveira R.A.; Nicolau R.A.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Sao Paulo, Brazil
(Fernandes, Gonzaga) Uninovafapi College, Teresina, Piaui, Brazil
(Lima) University of Piaui State (UESPI), Teresina, Piaui, Brazil
(de Barros Araujo) Cardiac Surgery Department, Santa Maria Hospital,
Teresina, Piaui, Brazil
(de Oliveira) Uninovafapi College and University of Piaui State (UESPI),
Teresina, Piaui, Brazil
(Fernandes) Vitorino Orthigues Fernandes Street, 6123, Teresina, Piaui
64073-505, Brazil
Title
Low-intensity laser (660 nm) on sternotomy healing in patients who
underwent coronary artery bypass graft: a randomized, double-blind study.
Source
Lasers in Medical Science. (pp 1-7), 2016. Date of Publication: 20 Sep
2016.
Publisher
Springer-Verlag London Ltd
Abstract
The aim of this study was to analyze the healing effects of low-level
laser therapy (LLLT) on the longitudinal sternotomy incisions of patients
who underwent coronary artery bypass graft (CABG). The volunteers were
randomized into three groups of equal size (n = 30): control, placebo, and
laser (lambda = 660 nm and spatial average energy fluency [SAEF] = 1.06
J/cm²). The patients in the laser group underwent irradiation
on postoperative days 2, 4, 6, and 8, and their sternotomy incisions were
photographed immediately after the surgery and 8 days later for analysis.
Three researchers who were blinded to the patient treatment groups
analyzed the incision photographs to assess hyperemia and wound closure on
the day of hospital discharge (eighth postoperative day). The sternotomy
incisions in the LLLT group demonstrated less hyperemia, incisional
bleeding, and dehiscence (p < 0.005). Copyright &#xa9; 2016
Springer-Verlag London