EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
612858391
Author
Ding N.; Ni B.-Q.; Wang H.; Ding W.-X.; Xue R.; Lin W.; Kai Z.; Zhang
S.-J.; Zhang X.-L.
Institution
(Ding, Wang, Ding, Xue, Zhang) Department of Respiratory and Critical Care
Medicine, First Affiliated Hospital of Nanjing Medical University, 300
Guangzhou Road, Nanjing 210029, China
(Ni, Zhang) Department of Cardiovascular Surgery, First Affiliated
Hospital of Nanjing Medical University, Guangzhou 300 Road, Nanjing
210029, China
(Lin) Department of Geriatric Medicine, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
(Kai) Pancreas Center, First Affiliated Hospital of Nanjing Medical
University, Nanjing, China
Title
Obstructive sleep apnea increases the perioperative risk of cardiac valve
replacement surgery: A prospective single-center study.
Source
Journal of Clinical Sleep Medicine. 12 (10) (pp 1331-1337), 2016. Date of
Publication: 2016.
Publisher
American Academy of Sleep Medicine (2510 N. Frontage Road, Darien IL
60561, United States)
Abstract
Study Objectives: Sleep apnea is common in patients referred for cardiac
valve replacement (CVR). We aimed to determine the association of
obstructive sleep apnea (OSA) and central sleep apnea (CSA) with
perioperative events in CVR surgery in patients with rheumatic valvular
heart disease (RVHD). Methods: Between April 2010 and April 2014, 290
patients with RVHD undergoing CVR were screened for sleep apnea 1 to 7
days before CVR. Baseline medications, cardiac function, sleep parameters,
perioperative events, and related risk factors were evaluated. Results:
OSA patients had longer duration of intensive care unit (ICU) stay and
mechanical ventilation compared with no sleep-disordered breathing and CSA
patients. Patients with CSA had a higher rate of pacemaker use and higher
first dose of dobutamine in ICU. NYHA Class and the presence of OSA were
independently associated with overall worsening of postoperative recovery
(ICU stay . 25 h). Age, NYHA class, and the presence of OSA were
independently associated with postoperative respiratory insufficiency
(mechanical ventilation . 20 h). Preoperative atrial fibrillation,
pulmonary hypertension, and OSA were independently associated with
postoperative pacemaker use. Conclusions: RVHD patients with OSA have an
increased incidence of perioperative adverse events. OSA was independently
associated with overall postoperative recovery, respiratory insufficiency,
and higher rate of postoperative pacemaker use, while CSA was not
associated with postoperative events.

<2>
Accession Number
612853339
Author
Kodali S.; Thourani V.H.; White J.; Malaisrie S.C.; Lim S.; Greason K.L.;
Williams M.; Guerrero M.; Eisenhauer A.C.; Kapadia S.; Kereiakes D.J.;
Herrmann H.C.; Babaliaros V.; Szeto W.Y.; Hahn R.T.; Pibarot P.; Weissman
N.J.; Leipsic J.; Blanke P.; Whisenant B.K.; Suri R.M.; Makkar R.R.; Ayele
G.M.; Svensson L.G.; Webb J.G.; Mack M.J.; Smith C.R.; Leon M.B.
Institution
(Kodali, White, Hahn, Smith, Leon) Columbia University Medical Center, New
York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY
10032, United States
(Thourani, Babaliaros) Emory University, School of Medicine, Atlanta, GA,
United States
(Malaisrie) Northwestern University, Chicago, IL, United States
(Lim) University of Virginia, Charlottesville, VA, United States
(Greason) Mayo Clinic, Rochester, MN, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Guerrero) NorthShore University HealthSystem, Evanston, IL, United States
(Eisenhauer) Central Maine Heart and Vascular Institute, Lewiston, ME,
United States
(Eisenhauer) Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Kapadia, Suri, Svensson) Cleveland Clinic, Cleveland, OH, United States
(Kereiakes) Christ Hospital, Cincinnati, OH, United States
(Herrmann, Szeto) University of Pennsylvania, Philadelphia, PA, United
States
(Pibarot) Laval University, Quebec, QC, Canada
(Weissman) Medstar Health Research Institute, Georgetown University,
Washington, DC, United States
(Leipsic, Blanke, Webb) St Paul's Hospital, Vancouver, BC, Canada
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Ayele) Cardiovascular Research Foundation, New York, NY, United States
(Mack) Baylor Scott and White Healthcare, Plano, TX, United States
Title
Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter
aortic valve replacement in inoperable, high-risk and intermediate-risk
patients with aortic stenosis.
Source
European Heart Journal. 37 (28) (pp 2252-2262), 2016. Date of Publication:
21 Jul 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Based on randomized trials using first-generation devices,
transcatheter aortic valve replacement (TAVR) is well established in the
treatment of high-risk (HR) patients with severe aortic stenosis (AS). To
date, there is a paucity of adjudicated, prospective data evaluating
outcomes with newer generation devices and in lower risk patients. We
report early outcomes of a large, multicentre registry of inoperable, HR,
and intermediate-risk (IR) patients undergoing treatment with the
next-generation SAPIEN 3 transcatheter heart valve (THV). Methods and
results Patients with severe, symptomatic AS (583 high surgical risk or
inoperable and 1078 IR) were enrolled in a multicentre, non-randomized
registry at 57 sites in the USA and Canada. All patients received TAVR
with the SAPIEN 3 system via transfemoral (n = 1443, 86.9%) and
transapical or transaortic (n = 218, 13.1%) access routes. The rate of
30-day all-cause mortality was 2.2% in HR/inoperable patients [mean
Society of Thoracic Surgeons (STS) score 8.7%] and 1.1% in IR patients
(mean STS score 5.3%); cardiovascular mortality was 1.4 and 0.9%,
respectively. In HR/inoperable patients, the 30-day rate of
major/disabling stroke was 0.9%, major bleeding 14.0%, major vascular
complications 5.1%, and requirement for permanent pacemaker 13.3%. In IR
patients, the 30-day rate of major/disabling stroke was 1.0%, major
bleeding 10.6%, major vascular complications 6.1%, and requirement for
permanent pacemaker 10.1%. Mean overall Kansas City Cardiomyopathy
Questionnaire score increased from 47.8 to 67.8 (HR/inoperable, P <
0.0001) and 54.7 to 74.0 (IR, P < 0.0001). Overall, paravalvular
regurgitation at 30 days was none/trace in 55.9% of patients, mild in
40.7%, moderate in 3.4%, and severe in 0.0%. Mean gradients among patients
with paired baseline and 30-day or discharge echocardiograms decreased
from 45.8 mmHg at baseline to 11.4 mmHg at 30 days, while aortic valve
area increased from 0.69 to 1.67 cm². Conclusions The SAPIEN 3
THV system was associated with low rates of 30-day mortality and
major/disabling stroke as well as low rates of moderate or severe
paravalvular regurgitation. Trial Registration ClinicalTrials.gov
#NCT01314313. Copyright &#xa9; The Author 2016.

<3>
[Use Link to view the full text]
Accession Number
53231906
Author
Sia J.; Nammas W.; Niemela M.; Airaksinen J.K.E.; Lalmand J.; Laine M.;
Tedjokusumo P.; Nyman K.; Biancari F.; Karjalainen P.P.
Institution
(Sia) Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
(Nammas, Karjalainen) Heart Center, Satakunta Central Hospital, Department
of Cardiology, Sairaalantie 3, Pori FIN-28100, Finland
(Niemela) Department of Internal Medicine, Division of Cardiology,
University of Oulu, Oulu, Finland
(Airaksinen) Department of Medicine, Turku University Hospital, Turku,
Finland
(Lalmand) Department of Cardiology, CHU de Charleroi, Charleroi, Belgium
(Laine) Helsinki University Hospital, Helsinki, Finland
(Tedjokusumo) Department of Cardiology and Vascular Medicine, Dr. Hasan
Sadikin Hospital, Bandung, Indonesia
(Nyman) Department of Cardiology, Jyvaskyla Central Hospital, Jyvaskyla,
Finland
(Biancari) Division of Cardiothoracic and Vascular Surgery, Department of
Surgery, University of Oulu, Oulu, Finland
Title
Gender-based analysis of randomized comparison of bioactive versus
everolimus-eluting stents in acute coronary syndrome.
Source
Journal of Cardiovascular Medicine. 16 (3) (pp 197-203), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims: The randomized comparison of titanium-nitrideoxidecoated bioactive
stent with everolimus-eluting stent in acute coronary syndrome (BASE-ACS)
trial demonstrated an outcome of the titanium-nitride-oxide coated
bioactive stents (BASs) that was statistically noninferior to that of the
everolimus-eluting stents (EESs) at 12-month follow-up, in patients
presenting with acute coronary syndrome (ACS) who underwent early
percutaneous coronary intervention. We performed a post-hoc gender-based
analysis of the BASE-ACS trial at 24-month follow-up. Methods: A total of
827 patients (198 women) with ACS were randomly assigned to receive either
BAS or EES. The primary endpoint was a composite of cardiac death,
nonfatal myocardial infarction (MI), or ischemia-driven target lesion
revascularization. Results: Women were older, and more likely to have
diabetes and hypertension compared with men (P<0.05 for all). Moreover,
women had significantly smaller reference vessel diameter and stent
diameter (P<0.05 for all). At 24-month follow-up, the cumulative incidence
of the primary endpoint was similar between the two sex subgroups (15.2
versus 11.0%, for women versus men, respectively, P=0.13). However, the
rate of nonfatal MI was significantly higher in women compared with men
(8.6 versus 3.8%, respectively, P=0.007). After propensity score-adjusted
analysis, there was a trend toward more nonfatal MI among women (8.6
versus 4.0%, respectively, P=0.08). Moreover, among male patients, those
assigned to BAS had significantly lower nonfatal MI compared with those
assigned to EES (P=0.027). However, among patients assigned to EES, female
patients had a significantly higher rate of nonfatal MI compared with men
(P=0.02). Conclusion: In the current post-hoc gender-based analysis of the
BASE-ACS trial, the 24-month outcome of patients undergoing percutaneous
coronary intervention for ACS was slightly worse in women, compared with
men, as reflected by a trend toward more nonfatal MI events after
propensity score-adjusted analysis. Copyright &#xa9; 2015 Wolters Kluwer
Health, Inc. All rights reserved.

<4>
Accession Number
613005953
Author
Blichfeldt-Eckhardt M.R.; Laursen C.B.; Berg H.; Holm J.H.; Hansen L.N.;
Ording H.; Andersen C.; Licht P.B.; Toft P.
Institution
(Blichfeldt-Eckhardt, Berg, Holm, Hansen, Andersen, Toft) Department of
Anesthesiology and Intensive Care, Odense University Hospital, Odense,
Denmark
(Laursen) Department of Respiratory Medicine, Odense University Hospital,
Odense, Denmark
(Licht) Department of Cardiothoracic Surgery, Odense University Hospital,
Odense, Denmark
(Ording) Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark
Title
A randomised, controlled, double-blind trial of ultrasound-guided phrenic
nerve block to prevent shoulder pain after thoracic surgery.
Source
Anaesthesia. 71 (12) (pp 1441-1448), 2016. Date of Publication: 01 Dec
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Moderate to severe ipsilateral shoulder pain is a common complaint
following thoracic surgery. In this prospective, parallel-group study at
Odense University Hospital, 76 patients (aged > 18 years) scheduled for
lobectomy or pneumonectomy were randomised 1:1 using a computer-generated
list to receive an ultrasound-guided supraclavicular phrenic nerve block
with 10 ml ropivacaine or 10 ml saline (placebo) immediately following
surgery. A nerve catheter was subsequently inserted and treatment
continued for 3 days. The study drug was pharmaceutically pre-packed in
sequentially numbered identical vials assuring that all participants,
healthcare providers and data collectors were blinded. The primary outcome
was the incidence of unilateral shoulder pain within the first 6 h after
surgery. Pain was evaluated using a numeric rating scale. Nine of 38
patients in the ropivacaine group and 26 of 38 patients in the placebo
group experienced shoulder pain during the first 6 h after surgery
(absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65%
(95% CI 41-80%); p = 0.00009). No major complications, including
respiratory compromise or nerve injury, were observed. We conclude that
ultrasound-guided supraclavicular phrenic nerve block is an effective
technique for reducing the incidence of ipsilateral shoulder pain after
thoracic surgery. Copyright &#xa9; 2016 The Association of Anaesthetists
of Great Britain and Ireland

<5>
Accession Number
610177868
Author
Brewer Z.E.; Ogden W.D.; Fann J.I.; Burdon T.A.; Sheikh A.Y.
Institution
(Brewer, Ogden, Fann, Burdon, Sheikh) Department of Cardiothoracic
Surgery, Stanford University School of Medicine, Stanford, California,
United States
Title
Creation and Global Deployment of a Mobile, Application-Based Cognitive
Simulator for Cardiac Surgical Procedures.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (1) (pp 1-9), 2016.
Date of Publication: 01 Feb 2016.
Publisher
W.B. Saunders
Abstract
Several modern learning frameworks (eg, cognitive apprenticeship, anchored
instruction, and situated cognition) posit the utility of nontraditional
methods for effective experiential learning. Thus, development of novel
educational tools emphasizing the cognitive framework of operative
sequences may be of benefit to surgical trainees. We propose the
development and global deployment of an effective, mobile cognitive
cardiac surgical simulator. In methods, 16 preclinical medical students
were assessed. Overall, 4 separate surgical modules (sternotomy,
cannulation, decannulation, and sternal closure) were created utilizing
the Touch Surgery (London, UK) platform. Modules were made available to
download free of charge for use on mobile devices. Usage data were
collected over a 6-month period. Educational efficacy of the modules was
evaluated by randomizing a cohort of medical students to either module
usage or traditional, reading-based self-study, followed by a
multiple-choice learning assessment tool. In results, downloads of the
simulator achieved global penetrance, with highest usage in the USA,
Brazil, Italy, UK, and India. Overall, 5368 unique users conducted a total
of 1971 hours of simulation. Evaluation of the medical student cohort
revealed significantly higher assessment scores in those randomized to
module use versus traditional reading (75% +/- 9% vs 61% +/- 7%,
respectively; P < 0.05). In conclusion, this study represents the first
effort to create a mobile, interactive cognitive simulator for cardiac
surgery. Simulators of this type may be effective for the training and
assessment of surgical students. We investigated whether an interactive,
mobile-computing-based cognitive task simulator for cardiac surgery could
be developed, deployed, and validated. Our findings suggest that such
simulators may be a useful learning tool. Copyright &#xa9; 2016

<6>
Accession Number
609611832
Author
Agzarian J.; Fahim C.; Shargall Y.; Yasufuku K.; Waddell T.K.; Hanna W.C.
Institution
(Agzarian, Shargall, Hanna) Department of Surgery, McMaster University,
Hamilton, Ontario, Canada
(Fahim) Department of Epidemiology and Biostatistics, McMaster University,
Hamilton, Ontario, Canada
(Yasufuku, Waddell) Department of Surgery, University of Toronto, Toronto,
Canada
Title
The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A
Comprehensive Systematic Review.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (1) (pp 182-192),
2016. Date of Publication: 01 Feb 2016.
Publisher
W.B. Saunders
Abstract
The primary objective of this study is to systematically review all
pertinent literature related to robotic-assisted lung resection.
Robotic-assisted thoracic surgery (RATS) case series and studies comparing
RATS with video-assisted thoracoscopic surgery (VATS) or thoracotomy were
included in the search. In accordance with preferred reporting items for
systematic reviews and meta-analyses guidelines, 2 independent reviewers
performed the search and review of resulting titles and abstracts.
Following full-text screening, a total of 20 articles met the inclusion
criteria and are presented in the review. Amenable results were pooled and
presented as a single outcome, and meta-analyses were performed for
outcomes having more than 3 comparative analyses. Data are presented in
the following 4 categories: technical outcomes, perioperative outcomes,
oncological outcomes, and cost comparison. RATS was associated with longer
operative time, but did not result in a greater rate of conversion to
thoracotomy than VATS. RATS was superior to thoracotomy and equivalent to
VATS for the incidence of prolonged air leak and hospital length-of-stay.
Oncological outcomes like nodal upstaging and survival were no different
between VATS and RATS. RATS was more costly than VATS, with most of the
costs attributed to capital and disposable expenses of the robotic
platform. Although limited by a lack of prospective analysis, lung
resection via RATS compares favorably with thoracotomy and appears to be
no different than VATS. Prospective studies are required to determine if
there are outcome differences between RATS and VATS. Copyright &#xa9; 2016
Elsevier Inc.

<7>
Accession Number
610441758
Author
Korst R.J.; Lee B.E.
Institution
(Korst, Lee) The Daniel and Gloria Blumenthal Cancer Center, Paramus, New
Jersey, United States
(Korst) Department of Surgery, The Valley Hospital/Valley Health System,
Ridgewood, New Jersey, United States
Title
Robotic Assisted Thoracic Surgery Lobectomy versus Video Assisted Thoracic
Surgery Lobectomy: Is a Randomized Trial Really Necessary?.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (1) (pp 193-194),
2016. Date of Publication: 01 Feb 2016.
Publisher
W.B. Saunders

<8>
Accession Number
610047471
Author
Vilvanathan V.K.; Srinivas Prabhavathi Bhat B.C.; Nanjappa M.C.; Pandian
B.; Bagi V.; Kasturi S.; Bandimida S.K.
Institution
(Vilvanathan, Srinivas Prabhavathi Bhat, Nanjappa, Pandian, Bagi)
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular
Sciences & Research, Bangalore, India
(Kasturi) Interventional Cardiologist, Sunshine Heart Institute,
Hyderabad, India
(Bandimida) Researcher, Sunshine Heart Institute, Hyderabad, India
Title
A randomized placebo-controlled trial with amiodarone for persistent
atrial fibrillation in rheumatic mitral stenosis after successful balloon
mitral valvuloplasty.
Source
Indian Heart Journal. 68 (5) (pp 671-677), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier B.V.
Abstract
Objective Atrial fibrillation is the most common sustained arrhythmia in
patients with rheumatic heart disease (RHD). This study was conducted to
determine the maintenance of sinus rhythm with amiodarone therapy
following DC cardioversion (DCCV), early after successful balloon mitral
valvuloplasty (BMV). Methods Patients were randomized to amiodarone group
and placebo group and their baseline characteristics were recorded. DCCV
was done 48 h after BMV. After cardioversion, oral amiodarone was started
initially 200 mg three times a day for 2 weeks, then 200 mg twice daily
for two weeks followed by 200 mg once daily for 12 months. Patients in
placebo group received DCCV alone without preloading amiodarone. After
DCCV, they were given placebo for 12 months. Results The 3 months
follow-up period was completed by 77 patients (95%). Of them, 31 (77.5%)
patients in amiodarone group and 14 (34.1%) in placebo group remained in
sinus rhythm (SR). The 12 months follow-up period was completed by 73
patients (90.1%). Of them, 22 (55%) patients in amiodarone group and 7
(17.1%) in placebo group remained in SR. Conclusion We conclude that
amiodarone is more effective than placebo in maintenance of SR at the end
of 3 months following successful cardioversion and more patients continued
to remain in SR even at the end of 12 months without major serious adverse
effects. Copyright &#xa9; 2016

<9>
Accession Number
600407719
Author
Fellahi J.-L.; Brossier D.; Dechanet F.; Fischer M.-O.; Saplacan V.;
Gerard J.-L.; Hanouz J.-L.
Institution
(Fellahi) Department of Anesthesiology and Critical Care Medicine, Hopital
Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon,
28 avenue du Doyen Lepine, Lyon-Bron Cedex 69677, France
(Brossier, Dechanet, Fischer, Gerard, Hanouz) Department of Anesthesiology
and Critical Care Medicine, CHU de Caen, Avenue de la Cote de Nacre, Caen
14000, France
(Saplacan) Department of Cardiothoracic Surgery, CHU de Caen, Avenue de la
Cote de Nacre, Caen 14000, France
Title
Early goal-directed therapy based on endotracheal bioimpedance
cardiography: a prospective, randomized controlled study in coronary
surgery.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2014. Date
of Publication: 09 Nov 2014.
Publisher
Kluwer Academic Publishers
Abstract
The objective was to compare the impact of an early goal-directed
hemodynamic therapy based on cardiac output monitoring (Endotracheal
Cardiac Output Monitor, ECOM) with a standard of care on postoperative
outcome following coronary surgery. This prospective, controlled,
parallel-arm trial randomized 100 elective primary coronary artery bypass
grafting patients to a study group (ECOM; n = 50) or a control group
(control; n = 50). In the ECOM group, hemodynamic therapy was guided by
respiratory stroke volume variation and cardiac index given by the ECOM
system. A standard of care was used in the control. Goal-directed therapy
was started immediately after induction of anesthesia and continued until
arrival in the intensive care unit (ICU). The primary endpoint was the
time when patients fulfilled discharge criteria from hospital (possible
hospital discharge). Secondary endpoints were the hospital discharge, the
time to reach extubation, the length of stay in ICU, the number of major
adverse cardiac events, and in-hospital mortality. Patients in the ECOM
group received more often fluid loading and dobutamine. The time to reach
extubation was reduced in the ECOM group: 510 min [360-1,110] versus 570
min [320-1,520], P = 0.005. No significant differences were found between
both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI
0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI
0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based
on ECOM can reduce the time to reach extubation but fails to significantly
reduce the length of stay in hospital and the rate of major cardiac
morbidity. Copyright &#xa9; 2014 Springer Science+Business Media New York

<10>
Accession Number
613269018
Author
Esser S.; Arendt M.; Neumann T.; Eisele L.; Erbel R.; Jockel K.H.;
Holzendorf V.; Reinsch N.
Institution
(Esser) Univ Hosp Essen, Essen, Germany
(Arendt, Jockel) Inst for Med Informatics, Biometry and Epi (IMIBE), Univ
Hosp Essen, Essen, Germany
(Neumann, Erbel, Reinsch) West German Heart Cntr, Univ Hosp Essen, Essen,
Germany
(Eisele) Inst for MIMIBE, Univ Hosp Essen, Essen, Germany
(Holzendorf) Univ Leipzig, Leipzig, Germany
Title
BNP prediction of cardiovascular diseases in HIV+ patients and the general
population.
Source
Topics in Antiviral Medicine. Conference: 23rd Conference on Retroviruses
and Opportunistic Infections, CROI 2016. United States. Conference Start:
20160222. Conference End: 20160225. 24 (E-1) (pp 266), 2016. Date of
Publication: June 2016.
Publisher
International Antiviral Society
Abstract
Background: B-type Natriuretic Peptide (BNP) is elevated in patients with
congestive heart failure and is also an independent prognostic marker for
overall mortality. HIV-positive patients (HIV+) have higher BNP-levels
than general population. We investigate the association between BNP and
the incidence of cardiovascular diseases (CVD) in subjects without
prevalent CVD. Methods: We compare BNP measured at baseline and incident
CVD during the follow-up in HIV+ individuals of the HIV HEART study (HIVH)
and in controls of the populationbased Heinz Nixdorf Recall study (HNR),
both recruited from the German Ruhr area since 2000. To assess impact of
BNP (>=100pg/mL vs. <100pg/mL) on incident CVD (myocardial infarction, PCI
stent, Coronary Artery disease, Coronary Artery Bypass Graft, cardiac
death) we used the pooled data of both studies and computed Cox
proportional Hazard ratio (HR) with time to CVD or last observation and
BNP and study (HIVH vs. HNR) as predictors. Also the interaction between
BNP and affiliation to study cohort was tested. We controlled for age and
Framingham risk score (FRS) variables. Analyses were stratified by sex. We
restricted the analysis to the age range of 45 -75 years and to subjects
without prevalent CVD. Results: Our analysis data set included 268 HIV+ of
the HIVH and 3905 HNR controls (Table 1). Male HIV+ had a 3.6-fold
increased risk of incident CVD (95%-CI 1.3; 9.9, p=0.0128) compared to HNR
males and independent of the affiliation to the study cohort BNP >=100
pg/mL in male subjects was associated with a HR of 3.4 (95%-CI 2.0; 5.9,
p= <0.0001). In females, HRs were 22.9 (95%-CI 2.8; 185.5, p=0.0034) for
study cohort and 2.6 (95%-CI 1.00; 6.8, p=0.0513) for BNP >=100 pg/mL. In
both sexes no significant interaction between study cohort and BNP was
found. No other classic risk factor (HR Smoking: Male: 1.2 (95%-CI 0.8;
1.7); Female: 1.1 (95%-CI 0.6; 2.0), HR Diabetes mellitus Male: 1.8
(95%-CI 1.3; 2.7); Female: 1.5 (95%-CI 0.7; 3.1)) reached such high HRs
for CVD as BNP >=100 pg/mL and HIV-infection. Conclusions: Incidence of
CVD was higher in HIV+ compared to the general population controlling for
differences in FRS. Additionally, BNP >=100 pg/mL was independently
associated with incident CVD in HIVH and HNR. Thus, as was shown in the
general population, BNP may improve prediction of CVD also in HIV+. BNP
should be measured serially in HIV+ >= 45 years and elevated or increasing
levels should lead to intensification of care. (Table presented).

<11>
Accession Number
613236832
Author
Sintonen H.; Roine R.P.
Institution
(Sintonen) University of Helsinki, Helsinki, Finland
(Roine) University of Eastern Finland, Kuopio, Finland
Title
Comparing coronary artery disease treatment outcomes-an example based on
health-related quality of life measurements.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A658),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: To be able to allocate treatments according to need (worst off
first) and compare effectiveness of treatments of different illnesses and
service providers, the health status of patients must be measured
commensurably. We demonstrate how such an approach enables the comparison
of effectiveness of coronary artery bypass grafting provided by three
Finnish hospitals. Methods: Health-related quality of life (HRQoL) was
measured between 1999 and 2003 with the 15D instrument before and six
months after treatment in Kuopio University Hospital (KUH, n= 393), Vaasa
Central Hospital (VCH, n= 281), and Helsinki University Hospital (HUH, n=
86), respectively. The minimum clinically important change or difference
in the 15D score representing overall HRQoL on a 0-1 scale is 0.015.
Differences between and within hospitals were tested by independent and
paired samples t-tests and linear regression with some background
variables standardized. Results: At baseline, mean 15D score was in KUH
(0.752) statistically significantly (p< 0.001) and clinically importantly
lower than in VCH (0.831) or HUH (0.830). The mean six-month score was
0.858 in KUH, compared to 0.860 and 0.875 in VCH and HUH, respectively.
With gender, age and baseline 15D score standardized, the mean six-month
scores were 0.846, 0.879 and 0.877 in KUH, VCH and HUH, respectively and
the differences between KUH and both other hospitals became statistically
significant (p< 0.001) and clinically important. A clinically important
HRQoL improvement was experienced by 85.8, 59.1 and 64.0% and a clinically
important deterioration by 6.8, 25.3 and 22.1% in KUH, VCH and HUH,
respectively. Conclusions: Treatment indication and effectiveness in terms
of HRQoL, i.e., 15D score change and percentage of patients experiencing a
clinically important improvement or deterioration, varied between
hospitals. HRQoL measurements can be used to compare effectiveness of
treatment between hospitals but for fair comparisons standardization of
relevant baseline demographic and clinical parameters of patients is
needed.

<12>
Accession Number
613236795
Author
Brandao S.M.; Hueb W.; Polanczyk C.A.; Cruz L.N.; Girardi P.B.; Bocchi
E.A.
Institution
(Brandao, Hueb, Girardi, Bocchi) Heart Institute (InCor) Hospital das
Clinicas, Faculdade De Medicina, Universidade De Sao Paulo, Sao Paulo,
Brazil
(Polanczyk, Cruz) Hospital De Clinicas De Porto Alegre, Porto Alegre,
Brazil
Title
Utility measures and quality-adjusted life years in patients with
symptomatic multivessel coronary artery disease assigned to surgery,
angioplasty or medical treatment-mass ii trial.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A658),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Currently, there is scarce data from clinical trials
estimating and comparing utilities and quality-adjusted life years (QALYs)
measurements after tree usual therapeutic strategies for multivessel
coronary artery disease (CAD). This study describes and compares utility
and QALYs measures for CAD patients assigned to medical treatment (MT),
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG). Methods: Utility and QALYs were obtained from 579 patients from
MASS II study, a randomized prospective study. To obtain utilities, the
items of the 36-Item Short-Form (SF-36) were converted into a
six-dimensional health state classification system, the SF-6D. The
interviews were administered at baseline and at six, 12, 24, 36, 48 and 60
months of follow-up. Results: The median cumulative utility scores along
the five years was 0.8090 (95% CI, 0.8035-0.8090) for patients assigned to
PCI, 0.7710 (95% CI, 0.7620-0.7840) to MT and 0.7830 (95% CI,
0.7710-0.7970) to CABG, which were significantly different among all
groups (p < 0.05, Dunn test). The median cumulative QALYs along the five
years was 4.015 (95% CI, 3.9150-4.1050) for PCI, 3.8320 (95% CI,
3.7555-3.9110) to MT and 3.9840 (95% CI, 3.8815- 4.0575) to CABG.
Additionally, the median QALYs gained between PCI vs. MT was 0.183, CABG
vs. MT was 0.152 and PCI vs. CABG was 0.031. Diabetes and functional class
subgroups did not influenced the results. Conclusions: Considering the
preference-based measures as a support for decision-making process, PCI
showed to be the treatment with higher cumulative quality of life among
multivessel CAD patients compared to CABG and MT. The results presented
constitute valuable data for further cost-utility studies.

<13>
Accession Number
613236449
Author
Elhamamsy M.; Elsisi G.H.; Elmazar M.M.; Taha A.S.; Awad B.F.; Sharaf
Eldin A.M.
Institution
(Elhamamsy, Elmazar, Taha, Awad) Ain Shams University, Cairo, Egypt
(Elsisi, Sharaf Eldin) American University in Cairo, Cairo, Egypt
Title
Cost effectivess analysis for combination of aspirin and warfarin versus
warfarin alone in patients with heart valve prosthesis.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A867),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: To assess, from the perspective of the Egyptian health sector,
the cost-effectiveness of the combined use of warfarin and low-dose
aspirin (75 mg) versus that of warfarin alone in patients with mechanical
heart valve prostheses that began therapy between the ages of 15 to 50
years. Methods: An economic evaluation was conducted alongside a
randomized, controlled trial to assess the cost-effectiveness of the
combined therapy in patients with mechanical valve prostheses. A total of
316 patients with an age between 15 and 50 years were included in the
study and randomly assigned to a treatment that combined warfarin and
aspirin or that used warfarin alone. Results: Patients in the combined
therapy group had a significant longer duration of protection against the
first event. There were fewer primary events in the warfarin plus aspirin
arm than in the warfarin arm (1.4%/ year, versus 4.8%/ year), and the mean
quality-adjusted life years score in the warfarin plus aspirin arm was
higher; however, the difference did not reach conventional levels of
statistical significance. Total costs over 4 years were lower in the
combined therapy (difference, -$244; 95% CI, -$483.1 to $3.8), which
yielded an incremental cost-effectiveness ratio of -4603 for warfarin plus
aspirin. Thus, the combined therapy was dominant. Conclusions: From the
perspective of the Egyptian health sector, addition of aspirin to warfarin
is more effective and less costly than warfarin alone for patients with
mechanical valve prostheses. This combined strategy could be adopted for
patients to prevent the complications of mechanical valve prostheses. The
present study adds to the body of evidence supporting warfarin plus
aspirin option in patients with mechanical valve prostheses.

<14>
Accession Number
613236197
Author
Scudeler T.L.; Hueb W.; De Soarez P.C.; Campolina A.G.; Hueb A.C.; Rezende
P.C.; Lima E.G.; Garzillo C.L.; Costa L.M.; Oikawa F.T.; Ramires J.A.;
Kalil Filho R.
Institution
(Scudeler, Hueb, Hueb, Rezende, Lima, Garzillo, Costa, Oikawa, Ramires,
Kalil Filho) Heart Institute (InCor) University of Sao Paulo, Sao Paulo,
Brazil
(De Soarez) University of Sao Paulo, Sao Paulo, Brazil
(Campolina) Cancer Institute of the State of Sao Paulo, Sao Paulo, Brazil
Title
Cost-effectiveness analysis of on-pump and off-pump stable multivessel
coronary artery bypass grafting 'mass III 5-year follow-up.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp
A652-A653), 2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: In this ancillary study from MASS III trial, costs and
effectiveness were compared between on-pump versus off-pump coronary
artery bypass graft surgery in patients with stable multivessel coronary
disease with preserved ventricular function at 5-year follow-up. Methods:
Between 2001 and 2006, 308 patients with stable multivessel coronary
artery disease and preserved ventricular function were randomized to
on-pump CABG (n= 153) or off-pump CABG (n= 155). The 2 groups were well
matched for baseline characteristics. Costs were assessed from the
perspective of the Brazilian public health care system. Costs of all
cardiovascular events and hospitalizations, medical consultations,
diagnostic tests and medications were adjusted for inflation rates for the
period until the year 2016. Costs were standardized to 2016 dollars.
Health state utilities were assessed using the SF-6D questionnaire.
Results: Both groups' quality of life improved significantly after surgery
during follow-up (p < 0.01) compared with baseline, but no differences
were found between treatment groups (Figure 1A). Although hospital stay (9
+/- 2 days vs 6 +/- 2 days, p < 0.001) and length of ICU (43 +/- 17h
vs19,5 +/- 17,8h, p < 0.001) of on-pump CABG group were higher than the
off-pump CABG group, total costs for the index hospitalization were only
$89.19 higher per patient in the onpump CABG group. Over the next 5 years,
follow-up costs were similar between two groups. Nonetheless, cumulative
5-year cost remained only $180.64 higher per patient with on-pump CABG
(Figure 1B). Conclusions: In this analysis, QoL was similarly improved in
both surgical groups. However, we found no difference in the cost-analysis
of on and off-pump procedures.

<15>
Accession Number
613236088
Author
Sharma M.; Chahar A.; Sharma J.
Institution
(Sharma, Chahar, Sharma) WHO Collaborating Centre for Priority Medical
Devices and Health Technology Policy, NHSRC, New Delhi, India
Title
A health technology assessment of single balloon valvuplasty.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp
A857-A858), 2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: This HTA aims to evaluate the clinical effectiveness of Single
Balloon Valvoloplasty in comparison to the Double Ballon Valvuloplasty in
order to assess its results in patients suffering from Mitral Stenosis.
Methods: Health technology assessment was conducted by systematically
reviewing the published literature . An electronic literature search was
performed in Cochrane, PubMed, Journal of the American College of
Cardiology databases for randomized controlled trials. RevMan 5.3 was used
for data analysis and quantitative data synthesis. Results: Out of 78
studies which were screened, 15 studies were included in the quantitative
analysis (meta-analysis). In comparison to the Double Balloon
Valvuloplasty Single Balloon Valvuloplasty significantly reduced mortality
by 17 % which is indicated by Risk Ratio (RR) 0.83 (95%CI, 0.38- 1.84).
Single Balloon Valvuloplasty is found to be 4% more effective in reducing
Mitral regurgitation Risk Ratio (RR)is 0.96(95%CI, 0.74- 1.23). Procedure
failure with single balloon Valvoloplasty is less indicated by Risk Ratio
(RR)0.98 (95%Cl ,0.89-1.07). Conclusions: Single Balloon Valvuloplasty is
clinically effective as far as the outcomes pertaining to the Mortality,
Mitral regurgitation and Procedure failure are concerned . The burden of
Rhuematic Heart Disease which thereby results in Mitral Stenosis being
high therefore Single Balloon Valvuloplasty can be a potent intervention.

<16>
Accession Number
613236011
Author
Mattos A.Z.; Schroder D.A.; Colpani V.; Restelatto L.M.; Ribeiro R.A.
Institution
(Mattos) PUC-RS, Porto Alegre, Brazil
(Schroder) Hospital De Caridade De Ijui, Ijui, Brazil
(Colpani, Ribeiro) IMED - Faculdade Meridional, Passo Fundo, Brazil
(Restelatto) Hospital De Clinicas De Porto Alegre, Porto Alegre, Brazil
Title
Transcatheter aortic valve implantation for inoperable severe aortic
stenosis-a meta-analysis.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A686),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Aortic stenosis affects more commonly the elderly, a
population whose comorbidities may prevent from performing conventional
open surgery. The aim of this study was to compare the survival of
inoperable patients with severe aortic stenosis submitted to transcatheter
aortic valve implantation (TAVI) or to standard of care. Methods: We
searched MEDLINE, Embase and the Cochrane CENTRAL for randomized
controlled trials (RCTs) comparing TAVI with standard of care in
inoperable patients. We also searched ClinicalTrials.gov and other sources
of unpublished literature. Main outcomes were 30-day and 1-year
mortalities. Meta-analyses were performed with random-effects model.
Heterogeneity was assessed by I2 statistic. Results: The search strategy
retrieved 1,748 citations. Two randomized controlled trials (448 patients)
fulfilled eligibility criteria and were therefore included in the
meta-analysis - one published in a high impact journal and another
unpublished study. The pooled risk ratio for the comparison between TAVI
and standard of care was 2.90 (95% confidence interval - CI= 1.16-7.24, p=
0.02, I2 = 0%) for 30-day mortality and 0.92 (95% CI= 0.38-2.26, p= 0.86,
I2 = 80%) for 1-year mortality. Considerable heterogeneity between studies
was detected only regarding 1-year mortality. We could not find a clear
reason for heterogeneity; such analyses were impaired by the small number
of studies and some missing information regarding study quality in the
unpublished study. Stroke, vascular complications and major bleeding were
reported in only one of the studies and were more common in the TAVI group
(p < 0.05 for these outcomes). Conclusions: Inoperable patients with
severe aortic stenosis treated with TAVI have significantly higher 30-day
mortality than those treated with standard of care. Regarding 1-year
mortality, there is no evidence of significant difference between
treatment strategies.

<17>
Accession Number
613235756
Author
Pradelli L.; Povero M.; Myers G.
Institution
(Pradelli, Povero) AdRes Srl, Torino, Italy
(Myers) Eastern Perfusion International, Dartmouth, NS, Canada
Title
Perioperative therapies reducing homologous transfusions during
cardiovascular surgery: A network meta-analysis of randomized controlled
trials.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A705),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Determine the most effective therapy or combination of
therapies minimizing homologous blood consumption during the entire
perioperative period while maximizing post-operative patient outcome.
Methods: Evidences of the Australian Patient Blood Management Guidelines
up to July 2009 were integrated with a systematic review of the literature
between July 2009 and July 2015 on Randomized Controlled Trials (RCTs) via
PubMed. Investigated outcomes were post-operative (PO) hemoglobin (Hb),
transfusion rate (TR) and total number of transfused packed red blood
cells (PRBCs). A random effect model with hierarchic structure was coded
in WinBUGS, TR was modeled on the logit scale while continuous variables
(PO Hb and mean number of PRBCs transfused) using a normal likelihood.
Results: A total of 86 RCTs were selected, comparing 48 different active
strategies that were grouped into five broad categories: [1]
auto-transfusion (AT) of processed blood through the use of either
centrifugal cell washing (CS), or intraoperative blood processed using
only an UltraFiltration device (UF), or unprocessed/unwashed blood (noCS);
[2] administration of antifibrinolytics (AA); [3] the combined use of
auto-transfusion and antifibrinolytics (AT+AA); [4] acute normovolemic
haemodilution (ANH); [5] no intervention (NT). AT+AA has the highest
probability (> 90%) to be the best technique in reducing both TR and PRBCs
transfused with high PO Hb, followed by AT alone (> 40%). In combination
with AA, the most effective AT strategy results CS; CS+AA decreases the
odds of TR: 0.36 (95% CrI 0.19-0.69) vs noCS+AA, 0.31 (95% CrI 0.11-0.88)
vs UF+AA with Bayesian p-value> 0.99; and the amount of PRBCs transfused:
-0.74 (95% CrI -1.41-0.02) vs noCS+AA, -0.9 (95% CrI -1.75-0.05) vs UF+AA
both with Bayesian p-value> 0.97. Conclusions: CS+AA may be considered the
optimum strategy for addressing perioperative blood loss; replacing CS
with other AT techniques or abolishing AA will result in increased
recourse to banked blood.

<18>
Accession Number
613234362
Author
Cadwell K.; Pooley N.; Olariu E.; Jones G.; Papageorgakopoulou C.; Fox D.
Institution
(Cadwell, Pooley, Olariu, Jones, Papageorgakopoulou, Fox) PHMR Ltd,
London, United Kingdom
Title
Making sense of clinical data reported in secondary conditions: The
epidemiology and clinical burden of hyperglycaemia.
Source
Value in Health. Conference: ISPOR 19th Annual European Congress. Austria.
Conference Start: 20161029. Conference End: 20161102. 19 (7) (pp A395),
2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Many treatments and interventions are not aimed at treating a
primary condition but rather at treating a secondary condition or symptom.
Therefore, it is often desirable to have an understanding of the
epidemiology and clinical burden of these secondary conditions. However
the estimation of key epidemiological endpoints is often confounded by
differences in study design and the definitions used for secondary
conditions. Using the example of hyperglycaemia this research investigates
how differences in study design and data reporting impact upon the
estimation of prevalence and mortality. Methods: A search strategy was
applied in Medline using a number of MeSH-based and free-text terms for
"hyperglycaemia" and "intensive care units" for the period 2010-2016. A
total of 10 studies were identified and selected that contained
epidemiological data on both the prevalence and mortality of
hyperglycaemia in the intensive care unit (ICU). Results: The 10 studies
reported data from populations with differing primary conditions
including: cardiac surgery, stroke, sepsis, diabetes, trauma, and
myocardial infarction. The reported prevalence ranged from 10% to 87%,
this large variation is most likely caused by differences in study design
including cut-off level for hyperglycaemia (> 140mg/dl in comparison to >
200 mg/dl) and underlying condition. Similarly, heterogeneity was high for
mortality (9-42%), this is likely to be due to differences in population
characteristics (e.g. diabetes status and primary condition) as well as
the time-point chosen for assessment of mortality. Conclusions: This work
highlights substantial heterogeneity across a small sample of
epidemiological data for secondary conditions such as hyperglycaemia. A
principle source of heterogeneity appears to be a lack of alignment in
data reporting and study design.

<19>
Accession Number
613014869
Author
Thyregod H.G.H.; Steinbruchel D.A.; Ihlemann N.; Ngo T.A.; Nissen H.;
Kjeldsen B.J.; Chang Y.; Hansen P.B.; Olsen P.S.; Sondergaard L.
Institution
(Thyregod, Steinbruchel, Olsen) Department of Cardiothoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Ihlemann, Ngo, Sondergaard) Department of Cardiology, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Chang) Medtronic Inc., Mounds View, MN, United States
(Hansen) Department of Cardiac Anesthesia, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Title
No clinical effect of prosthesis-patient mismatch after transcatheter
versus surgical aortic valve replacement in intermediate- and low-risk
patients with severe aortic valve stenosis at mid-term follow-up: An
analysis from the NOTION trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 721-728), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve
replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but
less common after transcatheter aortic valve replacement (TAVR) in
patients considered at high risk for death after surgery. The objectives
of this study were to determine incidence and clinical effect of PPM after
SAVR and TAVR in a primarily low-risk patient group. METHODS: Patients 70
years or older with severe isolated AVS, regardless of predicted operative
mortality risk, were consecutively randomized 1:1 to TAVR using a
self-expandable bioprosthesis (n = 145) or SAVR (n = 135). Post-procedure
PPM was graded after 3 months as follows: Not present-mild, if indexed
effective orifice area (iEOA) >0.85 cm²/m²,
moderate, if 0.65 cm²/m² < iEOA > 0.85
cm²/m² and severe, if iEOA >0.65
cm²/m². Outcomes were major adverse cardiac and
cerebrovascular events (MACCE, e.g. composite rate of all-cause death,
stroke, myocardial infarction or valve reintervention), cardiac-related
hospitalizations and New York Heart Association (NYHA) functional class
after 2 years. RESULTS: The incidence and the severity of PPM were
significantly lower after TAVR compared with SAVR (severe, moderate,
none-mild 14.0, 35.5, 50.4 vs 33.9, 36.7, 29.4%; P<0.001). PPM resulted in
similar higher mean valve gradients at 3 months for both groups. Baseline
characteristics related to severe PPM were younger age, absence of
diabetes mellitus, lower mortality-risk score for TAVR, and younger age
and higher body mass index for SAVR. At 2 years, there were numerical but
no statistically significant differences between both TAVR and SAVR
patients with severe and no severe PPM for MACCE (0.0 vs 12.8% for TAVR; P
= 0.13, and 13.5 vs 7.0% for SAVR; P = 0.27), number of cardiac-related
hospitalizations (mean +/- standard deviation 0.4 +/- 0.6 vs 0.6 +/- 0.8;
P = 0.23, and 0.4 +/- 0.8 vs 0.5 +/- 0.9; P = 0.70) and NYHA functional
class (Class I/II/III/IV: 64.7/29.4/5.9/0.0 vs 62.1/34.7/3.2/0.0%,
respectively; P = 0.91, and 71.4/25.7/2.9/0.0 vs 72.9/22.9/4.3/0.0%,
respectively; P = 0.92). CONCLUSIONS: The incidence of PPM was lower and
less severe after TAVR compared with SAVR in intermediate- and low-risk
patients with severe AVS. There were no significant differences in MACCE,
cardiac-related hospitalizations or NYHA class after 2 years for patients
with versus those without severe PPM. Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
613014868
Author
Borger M.A.; Dohmen P.M.; Knosalla C.; Hammerschmidt R.; Merk D.R.;
Richter M.; Doenst T.; Conradi L.; Treede H.; Moustafine V.; Holzhey D.M.;
Duhay F.; Strauch J.
Institution
(Borger) Columbia University Medical Center, New York, NY, United States
(Dohmen, Merk, Holzhey) Leipzig Heart Center, Leipzig, Germany
(Knosalla, Hammerschmidt) German Heart Institute Berlin, Berlin, Germany
(Richter, Doenst) Jena University Hospital, Jena, Germany
(Conradi, Treede) University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
(Moustafine, Strauch) University Hospitals of the Ruhr University of
Bochum, Bochum, Germany
(Duhay) Edwards Lifesciences LLC, Irvine, CA, United States
Title
Haemodynamic benefits of rapid deployment aortic valve replacement via a
minimally invasive approach: 1-year results of a prospective multicentre
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 713-720), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) via minimally invasive surgery
(MIS) may provide clinical benefits in patients with aortic valve disease.
A new class of bioprosthetic valves that enable rapid deployment AVR
(RDAVR) may facilitate MIS. We here report the 1-year results of a
randomized, multicentre trial comparing the outcomes for MIS-RDAVR with
those for conventional AVR via full sternotomy (FS) with a commercially
available stented aortic bioprosthesis. METHODS: A total of 100 patients
with aortic stenosis were enrolled in a prospective, multicentre,
randomized comparison trial (CADENCE-MIS). Key exclusion criteria included
AVR requiring concomitant procedures, ejection fraction of <25% and recent
myocardial infarction or stroke. Patients were randomized to undergo
MIS-RDAVR via upper hemisternotomy (EDWARDS INTUITY) or AVR via FS with a
commercially available stented valve. Procedural, early and late clinical
outcomes were assessed for both groups. Haemodynamic performance was
evaluated by an echocardiography CoreLaboratory. RESULTS: Technical
success was achieved in 94% of MIS-RDAVR patients. MIS-RDAVR was
associated with significantly reduced cross-clamp times compared with FS
(41.3 +/- 20.3 vs 54.0 +/- 20.3 min, P < 0.001). Clinical and functional
outcomes were similar at 30 days and 1 year postoperatively for both
groups. While both groups received a similarly sized implanted valve (22.9
+/- 2.1 mm MIS-RDAVR vs 23.0 +/- 2.1 mm FS-AVR; P = 0.91), MIS-RDAVR
patients had significantly lower peak gradients 1 year postoperatively
(16.9 +/- 5.3 vs 21.9 +/- 8.6 mmHg; P = 0.033) and a trend towards lower
mean gradients (9.1 +/- 2.9 vs 11.5 +/- 4.3 mmHg; P = 0.082). In addition,
MIS-RDAVR patients had a significantly larger effective orifice area 1
year postoperatively (1.9 +/- 0.5 vs 1.7 +/- 0.4 cm2; P = 0.047).
Paravalvular leaks, however, were significantly more common in the
MIS-RDAVR group (P = 0.027). CONCLUSIONS: MIS-RDAVR is associated with a
significantly reduced cross-clamp time and better valvular haemodynamic
function than FS-AVR. However, paravalvular leak rates are higher with
MIS-RDAVR. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<21>
Accession Number
613014857
Author
Umminger J.; Krueger H.; Beckmann E.; Kaufeld T.; Fleissner F.; Haverich
A.; Shrestha M.; Martens A.
Institution
(Umminger, Krueger, Beckmann, Kaufeld, Fleissner, Haverich, Shrestha,
Martens) Clinic for Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
Title
Management of early graft infections in the ascending aorta and aortic
arch: A comparison between graft replacement and graft preservation
techniques.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 660-667), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Treatment of infected thoracic aortic grafts is associated
with considerable morbidity and mortality. The replacement of an infected
graft is an effective strategy, yet a complex surgical endeavour,
especially if the aortic root or aortic arch is involved. In situ
graft-sparing surgical therapy with continuous mediastinal irrigation
after surgical debridement might offer an alternative in the management of
early graft infections in the thoracic aorta. METHODS: Between 1996 and
August 2015, 25 patients were treated in our institution for early graft
infection after thoracic aortic surgery via sternotomy. In 11 patients,
the infected prosthesis was replaced by a cryopreserved homograft or a
biological valved pericardial xenograft. In 14 patients, an attempt to
salvage the graft was made by resternotomy, aggressive debridement and
subsequent continuous mediastinal antibiotic irrigation over a course of 2
weeks, accompanied by systemic antibiotic therapy. RESULTS: In-hospital
mortality was comparable (replacement group: 2/11 = 18%, graft-sparing
group: 2/14 = 14%, P = ns). The time interval from the initial surgery was
significantly shorter in the graft-sparing group (replacement group: 165
days [range 95-300 days] and graft-sparing group: 24 days [range 15-93
days], P = 0.004]. Two patients (14%), who were treated with the
graft-sparing approach >100 days after the initial surgery, were retreated
for infection, and 1 due to an intra-aortic infection of an aortic arch
hybrid stent graft was not amenable to external irrigation (median
follow-up: 1.5 years [range 1.1-2.1 years]). One patient in the
replacement group (9%) was reoperated on due to homograft degeneration
(median follow-up: 6.0 years [3.0-8.9 years]). CONCLUSIONS: In situ
graft-sparing surgical therapy is safe and effective if diagnosis and
treatment of aortic graft infection is initiated promptly and aggressively
(ideally <1 month post-surgery). Our method produces good midterm results
(3 years). For aortic graft infections that become clinically apparent
>3-6 months after surgery, replacement of grafts with biological conduits
(homografts or pericardial xenografts) most likely remains the best
treatment option. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<22>
Accession Number
613014842
Author
Huygens S.A.; Mokhles M.M.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Mokhles, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and Management,
Erasmus University, Rotterdam, Netherlands
Title
Contemporary outcomes after surgical aortic valve replacement with
bioprostheses and allografts: sA systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 605-616), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Many observational studies have reported outcomes after surgical aortic
valve replacement (AVR), but there are no recent systematic reviews and
meta-analyses including all available bioprostheses and allografts. The
objective of this study is to provide a comprehensive and up-to-date
overview of the outcomes after AVR with bioprostheses and allografts
reported in the last 15 years. We conducted a systematic literature review
(PROSPERO register: CRD42015017041) of studies published between 2000-15.
Inclusion criteria were observational studies or randomized controlled
trials reporting on outcomes of AVR with bioprostheses (stented or
stentless) or allografts, with or without coronary artery bypass grafting
(CABG) or valve repair procedure, with study population size n > 30 and
mean follow-up length >5 years. Fifty-four bioprosthesis studies and 14
allograft studies were included, encompassing 55 712 and 3872 patients and
349 840 and 32 419 patient-years, respectively. We pooled early mortality
risk and linearized occurrence rates of valve-related events,
reintervention and late mortality in a random-effects model. Sensitivity,
meta-regression and subgroup analyses were performed to investigate the
influence of outliers on the pooled estimates and to explore sources of
heterogeneity. Funnel plots were used to investigate publication bias.
Pooled early mortality risks for bioprostheses and allografts were 4.99%
(95% confidence interval [CI], 4.44-5.62) and 5.03% (95% CI, 3.61-7.01),
respectively. The late mortality rate was 5.70%/patient-year (95% CI,
4.99-5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23-2.28)
for allografts. Pooled reintervention rates for bioprostheses and
allografts were 0.75%/patient-year (95% CI, 0.61-0.91) and
1.87%/patient-year (95% CI, 1.52-2.31), respectively. There was
substantial heterogeneity in most outcomes. Meta-regression analyses
identified covariates that could explain the heterogeneity: implantation
period, valve type, patient age, gender, pre-intervention New York Heart
Association class III/IV, concomitant CABG, study design and follow-up
length. There is possible publication bias in all outcomes. This
comprehensive systematic review and meta-analysis provides an overview of
the outcomes after AVR with bioprostheses and allografts reported during
the last 15 years. The results of this study can support patients and
doctors in the prosthetic valve choice and can be used in microsimulation
models to predict patient outcomes and estimate the cost-effectiveness of
AVR with bioprostheses or allografts compared with current and future
heart valve prostheses. Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<23>
Accession Number
612967657
Author
Massoullie G.; Bordachar P.; Irles D.; Caussin C.; Da Costa A.; Defaye P.;
Jean F.; Mechulan A.; Mondoly P.; Souteyrand G.; Pereira B.; Ploux S.;
Eschalier R.
Institution
(Massoullie, Jean, Souteyrand, Eschalier) Clermont Universite, Universite
d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI),
Clermont-Ferrand, France
(Massoullie, Jean, Souteyrand, Eschalier) Cardiology Department, CHU
Clermont-Ferrand, Clermont-Ferrand, France
(Bordachar, Ploux) Hopital Cardiologique du Haut-Leveque, CHU Bordeaux,
Universite Bordeaux, Bordeaux, France
(Irles) Cardiology Department, CH Annecy Genevois Pringy, France
(Caussin) Institut Mutualiste Montsouris, Paris, France
(Da Costa) North Hospital, Saint-Etienne, France
(Defaye) Arrhythmia Unit, Cardiology Department, University Hospital,
Grenoble, France
(Mechulan) Ramsay Generale de Sante, Hopital Prive de Clairval, Marseille,
France
(Mondoly) Federation of Cardiology, University Hospital Rangueil, Toulouse
Cedex, France
(Pereira) CHU Clermont-Ferrand, Biostatistics Unit, Clinical Research and
Innovation Direction, Clermont-Ferrand, France
Title
Prognosis assessment of persistent left bundle branch block after TAVI by
an electrophysiological and remote monitoring risk-adapted algorithm:
Rationale and design of the multicentre LBBB-TAVI Study.
Source
BMJ Open. 6 (10) (no pagination), 2016. Article Number: e010485. Date of
Publication: 01 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Percutaneous aortic valve replacement (transcatheter aortic
valve implantation (TAVI)) notably increases the likelihood of the
appearance of a complete left bundle branch block (LBBB) by direct lesion
of the LBB of His. This block can lead to high-grade atrioventricular
conduction disturbances responsible for a poorer prognosis. The management
of this complication remains controversial. Method and analysis The
screening of LBBB after TAVI persisting for more than 24 hours will be
conducted by surface ECG. Stratification will be performed by post-TAVI
intracardiac electrophysiological study. Patients at high risk of
conduction disturbances (>70 ms His-ventricle interval (HV) or presence of
infra-Hisian block) will be implanted with a pacemaker enabling the
recording of disturbance episodes. Those at lower risk (HV <70 ms) will be
implanted with a loop recorder device with remote monitoring of
cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and
implanted device follow-up will also be performed at 3, 6 and 12 months.
The primary objective is to assess the efficacy and safety of a decisional
algorithm based on electrophysiological study and remote monitoring of
CIEDs in the prediction of high-grade conduction disturbances in patients
with LBBB after TAVI. The primary end point is to compare the incidence
(rate and time to onset) of high-grade conduction disturbances in patients
with LBBB after TAVI between the two groups at 12 months. Given the
proportion of high-grade conduction disturbances (20-40%), a sample of 200
subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has
been in an active recruiting phase since September 2015 (21 patients
already included). Ethics and dissemination Local ethics committee
authorisation was obtained in May 2015. We will publish findings from this
study in a peer-reviewed scientific journal and present results at
national and international conferences. Copyright &#xa9; 2016 Published by
the BMJ Publishing Group Limited.

<24>
Accession Number
611037604
Author
Suwannasom P.; Sotomi Y.; Ishibashi Y.; Cavalcante R.; Albuquerque F.N.;
Macaya C.; Ormiston J.A.; Hill J.; Lang I.M.; Egred M.; Fajadet J.; Lesiak
M.; Tijssen J.G.; Wykrzykowska J.J.; de Winter R.J.; Chevalier B.; Serruys
P.W.; Onuma Y.
Institution
(Suwannasom, Ishibashi, Cavalcante, Onuma) ThoraxCenter, Erasmus
University Medical Center, Rotterdam, Netherlands
(Suwannasom, Sotomi, Tijssen, Wykrzykowska, de Winter) Academic Medical
Center, Amsterdam, Netherlands
(Suwannasom) Northern Region Heart Center, Maharaj Nakorn Chiang Mai
Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Albuquerque) Montefiore Medical Center, Albert Einstein College of
Medicine, New York, New York, United States
(Macaya) Hospital Universitario Clinico San Carlos, Madrid, Spain
(Ormiston) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Hill) King's College Hospital, London, United Kingdom
(Lang) Division of Cardiology, Department of Internal Medicine II, Medical
University of Vienna, Vienna, Austria
(Egred) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Fajadet) Department of Cardiology, Pasteur Hospital, Toulouse, France
(Lesiak) 1st Department of Cardiology, Medical University of Poznan,
Poland
(Chevalier) Institut Jacques Cartier, Massy, France
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of
Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting
Stent on Clinical Outcomes in the ABSORB II Trial.
Source
JACC: Cardiovascular Interventions. 9 (12) (pp 1231-1242), 2016. Date of
Publication: 27 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to investigate the relationship between
post-procedural asymmetry, expansion, and eccentricity indices of metallic
everolimus-eluting stent (EES) and bioresorbable vascular scaffold (BVS)
and their respective impact on clinical events at 1-year follow-up.
Background Mechanical properties of a fully BVS are inherently different
from those of permanent metallic stent. Methods The ABSORB II (A
bioresorbable everolimus-eluting scaffold versus a metallic
everolimus-eluting stent for ischaemic heart disease caused by de-novo
native coronary artery lesions) trial compared the BVS and metallic EES in
the treatment of a de novo coronary artery stenosis. Protocol-mandated
intravascular ultrasound imaging was performed pre- and post-procedure in
470 patients (162 metallic EES and 308 BVS). Asymmetry index (AI) was
calculated per lesion as: (1 - minimum scaffold/stent diameter/maximum
scaffold/stent diameter). Expansion index and optimal scaffold/stent
expansion followed the definition of the MUSIC (Multicenter Ultrasound
Stenting in Coronaries) study. Eccentricity index (EI) was calculated as
the ratio of minimum and maximum scaffold/stent diameter per cross
section. The incidence of device-oriented composite endpoint (DoCE) was
collected. Results Post-procedure, the metallic EES group was more
symmetric and concentric than the BVS group. Only 8.0% of the BVS arm and
20.0% of the metallic EES arm achieved optimal scaffold/stent expansion (p
< 0.001). At 1 year, there was no difference in the DoCE between both
devices (BVS 5.2% vs. EES 3.1%; p = 0.29). Post-procedural devices
asymmetry and eccentricity were related to higher event rates while there
was no relevance to the expansion status. Subsequent multivariate analysis
identified that post-procedural AI >0.30 is an independent predictor of
DoCE (hazard ratio: 3.43; 95% confidence interval: 1.08 to 10.92; p =
0.037). Conclusions BVS implantation is more frequently associated with
post-procedural asymmetric and eccentric morphology compared to metallic
EES. Post-procedural devices asymmetry were independently associated with
DoCE following percutaneous coronary intervention. However, this approach
should be viewed as hypothesis generating due to low event rates. (ABSORB
II Randomized Controlled Trial [ABSORB II]; NCT01425281) Copyright &#xa9;
2016 American College of Cardiology Foundation

<25>
Accession Number
612992878
Author
Rizik D.G.; Hermiller J.B.; Kereiakes D.J.
Institution
(Rizik) Director of Structural and Coronary Intervention, HonorHealth and
the Scottsdale-Lincoln Health Network, Scottsdale, AZ, United States
(Hermiller) Director of Interventional Cardiology and Director of
Interventional Cardiology Fellowship, St. Vincent Heart Center of Indiana,
Indianapolis, IN, United States
(Kereiakes) The Christ Hospital Heart and Vascular Center, The Lindner
Research Center, Cincinnati, OH, United States
Title
Bioresorbable vascular scaffolds for the treatment of coronary artery
disease: Clinical outcomes from randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. 88 (pp 21-30), 2016.
Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The permanent metal prosthesis common to bare metal stents (BMS) as well
as both first- and second-generation drug-eluting stents (DES) following
treatment of coronary artery disease represents a long-lasting substrate
for late adverse coronary events including restenosis, thrombosis, and
neoatherosclerosis. Following resorbtion, bioresorbable scaffolds (BRS)
may eliminate this nidus and improve late outcomes through restoration of
the vessel to more normal vascular structure and function. BRS represents
a single platform which incorporates the mechanical features of metallic
stents to provide safe and effective revascularization, suppression of
restenosis and prevention of constrictive remodeling with long-term
restoration of the treated vessel to a more natural state. The landscape
of BRS is rapidly evolving with new materials which target various
performance goals for the duration of vascular support and polymer
resorption time. The Absorb bioresorbable vascular scaffold (Absorb BVS),
recently approved by United States Food and Drug Administration, has
extensive clinical evidence to date in support of its clinical efficacy
and safety. Recently published data from well-executed randomized clinical
trials (RCTs) as part of the ABSORB Clinical development program along
with other investigator-initiated trials provide insights into the safety
and performance of this device in patients with de novo coronary lesions
as well in the setting of ST-segment elevation myocardial infarction
(STEMI). This review provides a comprehensive, outcomes based
understanding of the available evidence from RCTs that offer head-to-head
comparisons of Absorb BVS with metallic everolimus-eluting stents (EES).
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<26>
Accession Number
612992875
Author
Tamburino C.; Capranzano P.; Francaviglia B.; Ina Tamburino C.; Longo G.;
Capodanno D.
Institution
(Tamburino, Capranzano, Francaviglia, Ina Tamburino, Longo, Capodanno)
Cardiovascular Department, Ferrarotto Hospital, University of Catania,
Catania, Italy
Title
Update on clinical evidence (Part II): A summary of the main post market
studies.
Source
Catheterization and Cardiovascular Interventions. 88 (pp 31-37), 2016.
Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Bioresorbable vascular scaffolds (BVS, Absorb, Abbott Vascular, Santa
Clara, CA) received the CE mark in October 2011, and were approved by the
Food and Drug Administration in July 2016. After their introduction in
clinical practice a broad amount of post-marketing clinical experience
with BVS has been generated so far in Europe and outside the United
States. The available BVS registries differ in many aspects, including
their being single-center or multicenter, single-arm or controlled,
sponsored or investigator-initiated, published or presented at a
large-scale international meeting. This article provides an overview of
clinical results of the main post-marketing studies of BVS available.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<27>
Accession Number
613192431
Author
Ziyaeifard M.; Alizadehasl A.; Aghdaii N.; Rahimzadeh P.; Masoumi G.;
Golzari S.E.J.; Fatahi M.; Gorjipur F.
Institution
(Ziyaeifard, Aghdaii) Departments of Cardiac Anesthesiology, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Alizadehasl) Departments of Cardiology, Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Rahimzadeh) Departments of Anesthesiology and Pain Medicine, Hazrat Rasul
Medical Complex, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Masoumi) Department of Anesthesiology, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Golzari) Department of Anesthesiology and Intensive Care Medicine, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Fatahi, Gorjipur) Departments of Perfusion, Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Title
The effect of combined conventional and modified ultrafiltration on
mechanical ventilation and hemodynamic changes in congenital heart
surgery.
Source
Journal of Research in Medical Sciences. 21 (8) (no pagination), 2016.
Article Number: 112. Date of Publication: 2016.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Cardiopulmonary bypass is associated with increased fluid
accumulation around the heart which influences pulmonary and cardiac
diastolic function. The aim of this study was to compare the effects of
modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF)
on duration of mechanical ventilation and hemodynamic status in children
undergoing congenital heart surgery. Materials and Methods: A randomized
clinical trial was conducted on 46 pediatric patients undergoing
cardiopulmonary bypass throughout their congenital heart surgery.
Arteriovenous MUF plus CUF was performed in 23 patients (intervention
group) and sole CUF was performed for other 23 patients (control group).
In MUF group, arterial cannula was linked to the filter inlet through the
arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and
returned via cardioplegia line to the right atrium. Different parameters
including hemodynamic variables, length of mechanical ventilation,
Intensive Care Unit (ICU) stay, and inotrope requirement were compared
between the two groups. Results: At immediate post-MUF phase, there was a
statistically significant increase in the mean arterial pressure, systolic
blood pressure, and diastolic blood pressure (P < 0.05) only in the study
group. Furthermore, there was a significant difference in time of
mechanical ventilation (P = 0.004) and ICU stay (P = 0.007) between the
two groups. Inotropes including milrinone (P = 0.04), epinephrine (P =
0.001), and dobutamine (P = 0.002) were used significantly less frequently
for patients in the intervention than the control group. Conclusion:
Administration of MUF following surgery improves hemodynamic status of
patients and also significantly decreases the duration of mechanical
ventilation and inotrope requirement within 48 h after surgery. Copyright
&#xa9; 2016 Journal of Research in Medical Sciences.

<28>
Accession Number
612969829
Author
Inderbitzin D.T.; Taramasso M.; Nietlispach F.; Maisano F.
Institution
(Inderbitzin, Taramasso, Maisano) Department of Cardiovascular Surgery,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
(Nietlispach) Department of Cardiology, University Hospital Zurich,
Raemistrasse 100, Zurich CH-8091, Switzerland
Title
Percutaneous Mitral Valve Repair with MitraClip: Patient and Valve
Selection for Optimal Outcome.
Source
Current Cardiology Reports. 18 (12) (no pagination), 2016. Article Number:
129. Date of Publication: 01 Dec 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
In the real world of mitral regurgitation, the patient selection process
for MitraClip (Abbott, Abbott Park, IL, USA) to achieve optimal outcome
has become a challenge. With the opening of the Endovascular Valve
Edge-to-Edge Repair Study criteria, the implant experience was extended
towards functional mitral regurgitation and anatomically more complex
mitral pathologies in many centers worldwide. We provide a review of the
current literature to identify an appropriate patient selection process
for MitraClip therapy and suggest a simple two-dimensional decision-making
algorithm. Copyright &#xa9; 2016, Springer Science+Business Media New
York.

<29>
Accession Number
612947356
Author
Fan Z.-G.; Ding G.-B.; Li X.-B.; Gao X.-F.; Gao Y.-L.; Tian N.-L.
Institution
(Fan, Li, Gao, Gao, Tian) Department of Cardiology, Nanjing First
Hospital, Nanjing Medical University, Nanjing, China
(Ding) Department of Cardiology, Taixing People's Hospital, Yangzhou
University, Taizhou, China
(Li, Gao, Tian) Department of Cardiology, Nanjing Heart Center, Nanjing,
China
Title
The clinical outcomes of triple antiplatelet therapy versus dual
antiplatelet therapy for high-risk patients after coronary stent
implantation: A meta-analysis of 11 clinical trials and 9,553 patients.
Source
Drug Design, Development and Therapy. 10 (pp 3435-3448), 2016. Date of
Publication: 20 Oct 2016.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: The optimal antiplatelet regimen after in-coronary
intervention among patients presenting with complex coronary artery
lesions or acute coronary syndrome (ACS) has remained unclear. This study
sought to evaluate the clinical outcomes of triple antiplatelet treatment
(TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.
Methods: The PubMed, EMBASE, MEDLINE, and other Internet sources were
searched for relevant articles. The primary end point was major adverse
cardiac events (MACE), including all-cause mortality, myocardial
infarction, and target vessel revascularization. The incidence of
definite/probable stent thrombosis and bleeding were analyzed as the
safety end points. Results: Eleven clinical trials involving 9,553
patients were analyzed. The risk of MACE was significantly decreased
following TAPT after stent implantation in the ACS subgroup (odds ratio
[OR]: 0.72; 95% confidence interval [CI]: 0.61-0.85; P,0.001), which might
mainly result from the lower risk of all-cause mortality in this subset
(OR: 0.62; 95% CI: 0.48-0.80; P,0.001). The risk of bleeding was not
increased with respect to TAPT. Conclusion: TAPT after stent implantation
was associated with feasible benefits on reducing the risk of MACE,
especially on reducing the incidence of all-cause mortality among patients
suffering from ACS, without higher incidence of bleeding. Larger and more
powerful randomized trials are still warranted to prove the superiority of
TAPT for such patients. Copyright &#xa9; 2016 Fan et al.

<30>
Accession Number
612962869
Author
Kimmel S.E.; Troxel A.B.; French B.; Loewenstein G.; Doshi J.A.; Hecht
T.E.H.; Laskin M.; Brensinger C.M.; Meussner C.; Volpp K.
Institution
(Kimmel) Center for Therapeutic Effectiveness Research, University of
Pennsylvania, Philadelphia, PA, United States
(Kimmel, Troxel, French, Brensinger, Meussner) Department of Biostatistics
and Epidemiology, University of Pennsylvania, Philadelphia, PA, United
States
(Kimmel, Doshi, Hecht, Volpp) Department of Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Kimmel, Troxel, French, Loewenstein, Doshi, Volpp) Center for Health
Incentives and Behavioral Economics, Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, United States
(Loewenstein) Department of Social and Decision Sciences, Carnegie Mellon
University, Pittsburgh, PA, United States
(Laskin) Department of Pharmacy Service, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Volpp) Center for Health Equity Research and Promotion, Philadelphia
Veterans Affairs Medical Center, Philadelphia, PA, United States
(Volpp) Department of Health Care Management, University of Pennsylvania,
Philadelphia, PA, United States
(Volpp) Department of Medical Ethics and Health Policy, University of
Pennsylvania, Philadelphia, PA, United States
Title
A randomized trial of lottery-based incentives and reminders to improve
warfarin adherence: the Warfarin Incentives (WIN2) Trial.
Source
Pharmacoepidemiology and Drug Safety. 25 (11) (pp 1219-1227), 2016. Date
of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Previous research has suggested that daily lottery incentives
could improve medication adherence. Such daily incentives include implicit
reminders. However, the comparative effectiveness of reminders alone
versus daily incentives has not been tested. Methods: A total of 270
patients on warfarin were enrolled in a four-arm, multi-center, randomized
controlled trial comparing a daily lottery-based incentive, a daily
reminder, and a combination of the two against a control group (usual
care). Results: Participants in the reminder group had the lowest
percentage of time out of target international normalized ratio (INR)
range, the primary outcome, with an adjusted odds of an out-of-range INR
36% lower than among those in the control group, 95%CI [7%, 55%]. No other
group had a statistically significant improvement in anticoagulation
control relative to the control group or to each other. The only group
that had significant improvement in incorrect adherence was the lottery
group (incorrect adherence: 12.1% compared with 23.7% in the control
group, difference of -7.4% 95%CI [-14%, -0.3%]). However, there was no
relationship between changes in adherence and anticoagulation control in
the lottery group. Conclusions: Automated reminders led to the largest
improvements in anticoagulation control, although without impacting
measured adherence. Lottery-based reminders improved measured adherence
but did not lead to improved anticoagulation control. Copyright &#xa9;
2016 John Wiley & Sons, Ltd. Copyright &#xa9; 2016 John Wiley & Sons, Ltd.

<31>
Accession Number
610169430
Author
Pereg D.; Fefer P.; Samuel M.; Shuvy M.; Deb S.; Sparkes J.D.; Fremes
S.E.; Strauss B.H.
Institution
(Pereg, Fefer, Samuel, Shuvy, Sparkes, Strauss) Division of Cardiology,
Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
(Fefer) Leviev Heart Center, Sheba Hospital, Tel Hashomer, Tel Aviv
University, Tel Aviv, Israel
(Deb, Fremes) Division of Cardiovascular Surgery, Schulich Heart Program,
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
(Fremes) Department of Cardiovascular Surgery, Sunnybrook Health Sciences
Center, University of Toronto, Toronto, Ontario, Canada
(Strauss) Department of Cardiovascular Sciences, Sunnybrook Health
Sciences Center, University of Toronto, Toronto, Ontario, Canada
Title
Long-term Follow-up of Coronary Artery Bypass Patients With Preoperative
and New Postoperative Native Coronary Artery Chronic Total Occlusion.
Source
Canadian Journal of Cardiology. 32 (11) (pp 1326-1331), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Chronic total occlusions (CTOs) of native coronary arteries are
a frequent finding among patients who are referred for surgical
revascularization with coronary artery bypass grafting (CABG). The
long-term clinical significance of native coronary artery CTO identified
at baseline and 1 year after CABG is unknown. Methods All patients who
underwent 1-year follow-up angiography as part of the multicentre Radial
Artery Patency Study (RAPS) were assessed for late clinical events.
Results At a mean follow-up of 7.3 +/- 2.9 years, the study group of 388
patients had the following outcomes: 39 (10%) deaths, 6 (1.5%) cases of
nonfatal myocardial infarction, and 19 (4.9%) cases of percutaneous
coronary intervention (PCI). CTO of > 1 native coronary artery in the
baseline preoperative coronary angiogram was demonstrated in 240 (61.9%)
patients. The composite of all-cause death, nonfatal myocardial
infarction, and PCI occurred significantly more often in patients with at
least 1 preoperative CTO than in patients without a preoperative CTO (20%
vs 11%; P = 0.048). A new native coronary artery CTO 1 year after surgery
occurred in 169 (43.6%) patients. The composite of all-cause death,
nonfatal myocardial infarction, and PCI occurred significantly more often
in patients with a new CTO 1 year after CABG compared with those without a
new CTO (21.3% vs 12.8%; P = 0.028). Conclusions In patients undergoing
CABG, both preoperative CTOs and new CTOs that develop 1 year after
surgery are associated with adverse long-term clinical outcomes. Copyright
&#xa9; 2016

<32>
Accession Number
612967211
Author
Rigatto C.; Komenda P.; Tangri N.
Institution
(Rigatto, Komenda, Tangri) University of Manitoba and Chronic Disease
Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
Title
CABG or PCI: which is better for revascularization of coronary artery
disease in chronic kidney disease?.
Source
Kidney International. 90 (2) (pp 257-259), 2016. Date of Publication: 01
Aug 2016.
Publisher
Elsevier B.V.
Abstract
Chronic kidney disease (CKD) is a potent risk factor for coronary artery
disease and premature death. However, the optimal strategies for
revascularization versus medical management remain unclear. Charytan et
al. address this knowledge gap with a well-structured individual patient
meta-analysis. We discuss the implications of their findings for patients
with moderate CKD and highlight the need for randomized, controlled trials
on this issue in more severe CKD. Copyright &#xa9; 2016 International
Society of Nephrology

<33>
Accession Number
612967110
Author
Charytan D.M.; Desai M.; Mathur M.; Stern N.M.; Brooks M.M.; Krzych L.J.;
Schuler G.C.; Kaehler J.; Rodriguez-Granillo A.M.; Hueb W.; Reeves B.C.;
Thiele H.; Rodriguez A.E.; Buszman P.P.; Buszman P.E.; Maurer R.;
Winkelmayer W.C.
Institution
(Charytan, Stern, Maurer) Departments of Medicine, Brigham & Women's
Hospital, Boston, Massachusetts, United States
(Desai, Mathur) Stanford University School of Medicine, Palo Alto,
California, United States
(Brooks) University of Pittsburgh, Graduate School of Public Health,
Pittsburgh, Pennsylvania, United States
(Krzych) Department of Cardiac Anesthesiology and Intensive Care Medicine,
Medical University of Silesia, Katowice, Poland
(Schuler) Heart Center, University of Leipzig, Leipzig, Germany
(Kaehler) Department of Cardiology, Klinikum Herford, Herford, Germany
(Rodriguez-Granillo) Research Department, Centro de Estudios en
Cardiologia Intervencionista, Buenos Aires, Argentina
(Hueb) Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Thiele) University Heart Center Luebeck and German Heart Research Center
(DZHK), Luebeck, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires School of
Medicine, Buenos Aires, Argentina
(Buszman) Silesian Center for Heart Diseases, Zabrze, Poland
(Buszman, Buszman) American Heart of Poland, Katowice, Poland
(Winkelmayer) Department of Medicine, Baylor College of Medicine, Houston,
Texas, United States
Title
Reduced risk of myocardial infarct and revascularization following
coronary artery bypass grafting compared with percutaneous coronary
intervention in patients with chronic kidney disease.
Source
Kidney International. 90 (2) (pp 411-421), 2016. Date of Publication: 01
Aug 2016.
Publisher
Elsevier B.V.
Abstract
Coronary atherosclerotic disease is highly prevalent in chronic kidney
disease (CKD). Although revascularization improves outcomes, procedural
risks are increased in CKD, and unbiased data comparing coronary artery
bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are
sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we
identified randomized trials comparing these procedures. Investigators
were contacted to obtain individual, patient-level data. Ten of 27 trials
meeting inclusion criteria provided data. These trials enrolled 3993
patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were
stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, survival through
5 years was not different after CABG compared with PCI (hazard ratio [HR]
0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29,
CI 0.68-2.46). However, CKD modified the impact on survival free of
myocardial infarction: it was not different between CABG and PCI for
individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but
was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI
0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat
revascularization was reduced after CABG compared with PCI regardless, of
baseline kidney function. Results were limited by unavailability of data
from several trials and paucity of enrolled patients with stage 4-5 CKD.
Thus, our patient-level meta-analysis of individuals with CKD randomized
to CABG versus PCI suggests that CABG significantly reduces the risk of
subsequent myocardial infarction and revascularization without affecting
survival in these patients. Copyright &#xa9; 2016 International Society of
Nephrology

<34>
[Use Link to view the full text]
Accession Number
605252125
Author
Gossl M.; Kane G.C.; Mauermann W.; Holmes D.R.
Institution
(Gossl) Department of Cardiology, SSM, 700 S. Park St, Madison, WI 53715,
United States
(Kane, Holmes) Division of Cardiology, United States
(Mauermann) Department of Anesthesiology, Mayo Clinic, Rochester, MN,
United States
Title
Pulmonary hypertension in patients undergoing transcatheter aortic valve
replacement.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002253. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)

<35>
Accession Number
606559818
Author
Karaman T.; Demir S.; Dogru S.; Sahin A.; Tapar H.; Karaman S.; Kaya Z.;
Suren M.; Arici S.
Institution
(Karaman, Dogru, Sahin, Tapar, Karaman, Kaya, Suren, Arici) Department of
Anesthesiology and Reanimation, Gaziosmanpasa University School of
Medicine, Tokat 60100, Turkey
(Demir) Department of Ophthalmology, Gaziosmanpasa University School of
Medicine, Tokat, Turkey
Title
The effect of anesthesia depth on the oculocardiac reflex in strabismus
surgery.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 889-893), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
The aim of this study was to investigate the effect of the bispectral
index (BIS) guided depth of anesthesia to inhibition of the oculocardiac
reflex (OCR) during pediatric strabismus surgery. Patients between the
ages of 3 and 16 years who were scheduled for elective strabismus surgery
were randomly assigned to two groups. In Group 1 (n: 32), the BIS values
of the patients were maintained at <50; in Group 2 (n: 28), the BIS values
of the patients were maintained at levels greater than or equal to 50 with
4-7 % desflurane in a 50 % O<inf>2</inf>-air mixture by titrating the
concentration during the surgery. The heart rates, presence of
dysrhythmia, anticholinergic drug usage and the type of the operated extra
ocular muscle were recorded. The incidence of OCR was 25 % in Groups 1 and
64.3 % in Group 2, (p < 0.05). Moreover, the incidence of OCR in group 2
was higher in medial rectus (MR) traction (78.9 %) than in lateral rectus
(LR) traction (33.3 %) (p = 0.035), with no significant difference in
Group 1 between MR (21.1 %) and LR (26.7 %) tractions (p = 0.83). We found
that the lower BIS values are associated with the lower incidence of OCR
in pediatric patients undergoing strabismus surgery. And our findings
confirmed that the deeper anesthesia has a protective effect against the
OCR. Copyright &#xa9; 2015, Springer Science+Business Media New York.

<36>
Accession Number
606557648
Author
Shoushtarian M.; McGlade D.P.; Delacretaz L.J.; Liley D.T.J.
Institution
(Shoushtarian, Delacretaz, Liley) Cortical Dynamics Ltd., P.O. Box 317,
North Perth, WA 6906, Australia
(McGlade) Department of Anaesthesia and Acute Pain Medicine, St. Vincent'
Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
(Liley) Brain and Psychological Sciences Research Centre, Swinburne
University of Technology, P.O. Box 218, Hawthorn, VIC 3122, Australia
Title
Evaluation of the brain anaesthesia response monitor during anaesthesia
for cardiac surgery: a double-blind, randomised controlled trial using two
doses of fentanyl.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 833-844), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
The brain anaesthesia response (BAR) monitor uses a method of EEG
analysis, based on a model of brain electrical activity, to monitor the
cerebral response to anaesthetic and sedative agents via two indices,
composite cortical state (CCS) and cortical input (CI). It was
hypothesised that CCS would respond to the hypnotic component of
anaesthesia and CI would differentiate between two groups of patients
receiving different doses of fentanyl. Twenty-five patients scheduled to
undergo elective first-time coronary artery bypass graft surgery were
randomised to receive a total fentanyl dose of either 12 mug/kg (fentanyl
low dose, FLD) or 24 mug/kg (fentanyl moderate dose, FMD), both
administered in two divided doses. Propofol was used for anaesthesia
induction and pancuronium for intraoperative paralysis. Hemodynamic
management was protocolised using vasoactive drugs. BIS, CCS and CI were
simultaneously recorded. Response of the indices (CI, CCS and BIS) to
propofol and their differences between the two groups at specific points
from anaesthesia induction through to aortic cannulation were
investigated. Following propofol induction, CCS and BIS but not CI showed
a significant reduction. Following the first dose of fentanyl, CI, CCS and
BIS decreased in both groups. Following the second dose of fentanyl, there
was a significant reduction in CI in the FLD group but not the FMD group,
with no significant change found for BIS or CCS in either group. The BAR
monitor demonstrates the potential to monitor the level of hypnosis
following anaesthesia induction with propofol via the CCS index and to
facilitate the titration of fentanyl as a component of balanced
anaesthesia via the CI index. Copyright &#xa9; 2015, Springer
Science+Business Media New York.

<37>
Accession Number
606556898
Author
Moerman A.; Meert F.; De Hert S.
Institution
(Moerman, Meert, De Hert) Department of Anesthesiology, Ghent University
Hospital, De Pintelaan 185, Ghent 9000, Belgium
Title
Cerebral near-infrared spectroscopy in the care of patients during
cardiological procedures: a summary of the clinical evidence.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 901-909), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
Patients undergoing cardiological procedures generally have significant
cardiovascular morbidity, and therefore these patients might be at risk
for major periprocedural complications. The ability to closely monitor the
hemodynamic status would present a major advantage to optimize patient
care in this setting. The aim of this review is to assess the available
evidence for the use of near-infrared spectroscopy (NIRS) in the care of
patients during cardiological procedures. A systematic literature search
was conducted using electronic bibliographic databases (MEDLINE, PubMed,
EMBASE) from their first available date using the following search
strategy: (spectroscopy, near-infrared OR infrared spectroscopy OR NIRS OR
cerebral oxygen*) AND (interventional OR electrophysiological OR
catheterization OR ablation OR ICD OR defibrillator). Inclusion criteria
were limited to human studies, English language and cardiac patients. All
manuscripts concerning the use of NIRS in every area of catheterization
and electrophysiology were included. The literature search yielded eleven
observational studies and five case reports concerning the research
question. No randomized trials could be retrieved. Six studies evaluated
NIRS during supraventricular and ventricular arrhythmias, one during
transcatheter aortic valve implantations, and four studies assessed the
use of NIRS in pediatric catheterization procedures. Overall, the studies
demonstrated that NIRS provides a very quick representation of cerebral
oxygen saturation and that it might identify changes that could not be
predicted from standard hemodynamic monitoring. However, the evidence is
currently too low to conclude that NIRS can optimize patient care during
cardiological procedures. Copyright &#xa9; 2015, Springer Science+Business
Media Dordrecht.

<38>
Accession Number
613003206
Author
Ortega-Loubon C.; Fernandez-Molina M.; Carrascal-Hinojal Y.;
Fulquet-Carreras E.
Institution
(Ortega-Loubon, Fernandez-Molina, Carrascal-Hinojal, Fulquet-Carreras)
Department of Cardiac Surgery, Clinic University Hospital of Valladolid,
Ramon y Cajal, Valladolid 47003, Spain
Title
Cardiac surgery-associated acute kidney injury.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 687-698), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-recognized complication resulting with the higher morbid-mortality
after cardiac surgery. In its most severe form, it increases the odds
ratio of operative mortality 3-8-fold, length of stay in the Intensive
Care Unit and hospital, and costs of care. Early diagnosis is critical for
an optimal treatment of this complication. Just as the identification and
correction of preoperative risk factors, the use of prophylactic measures
during and after surgery to optimize renal function is essential to
improve postoperative morbidity and mortality of these patients.
Cardiopulmonary bypass produces an increased in tubular damage markers.
Their measurement may be the most sensitive means of early detection of
AKI because serum creatinine changes occur 48 h to 7 days after the
original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like
growth factor-binding protein 7 are most promising as an early diagnostic
tool. However, the ideal noninvasive, specific, sensitive, reproducible
biomarker for the detection of AKI within 24 h is still not found. This
article provides a review of the different perspectives of the CSA-AKI,
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment. We searched the
electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment, in order to
provide an exhaustive review of the different perspectives of the CSA-AKI.

<39>
Accession Number
613003194
Author
Naghipour B.; Faridaalaee G.; Shadvar K.; Bilehjani E.; Khabaz A.H.;
Fakhari S.
Institution
(Naghipour, Shadvar, Bilehjani, Khabaz, Fakhari) Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Faridaalaee) Department of Emergency Medicine, Maragheh University of
Medical Sciences, Maragheh, Iran, Islamic Republic of
Title
Effect of prophylaxis of magnesium sulfate for reduction of postcardiac
surgery arrhythmia: Randomized clinical trial.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 662-667), 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: Arrhythmia is a common complication after heart surgery and is
a major source of morbidity and mortality. Aims: This study aimed to study
the effect of magnesium sulfate (MgSO<inf>4</inf>) for reduction of
postcardiac surgery arrhythmia. Setting and Design: This study is
performed in the cardiac operating room and Intensive Care Unit (ICU) of
Shahid Madani Hospital of Tabriz (Iran) between January 1, 2014, and
September 30, 2014. This study is a double-blind, randomized controlled
trial. Materials and Methods: In Group 1 (group magnesium [Mg]), eighty
patients received 30 mg/kg MgSO<inf>4</inf>in 500 cc normal saline and in
Group 2 (group control), eighty patients received 500 cc normal saline
alone. Statistical Analysis: The occurrence of arrhythmia was compared
between groups by Chi-square and Fisher's exact test. In addition,
surgical time, length of ICU stay, and length of hospital stay were
compared by independent t-test. P< 0.05 was considered as significant.
Results: There was a significant difference in the incidence of arrhythmia
between two groups (P = 0.037). The length of ICU stay was 3.4 +/- 1.4 and
3.73 +/- 1.77 days in group MgSO<inf>4</inf>and control group,
respectively, and there was no statistically significant difference
between two groups (P = 0.2). Conclusion: Mg significantly decreases the
incidence of all type of postcardiac surgery arrhythmia and hospital
length of stay at patients undergo cardiac surgery. We offer prophylactic
administration of Mg at patients undergo cardiac surgery.

<40>
Accession Number
613003191
Author
Sahu M.K.; Singal A.; Menon R.; Singh S.P.; Mohan A.; Manral M.; Singh D.;
Devagouru V.; Talwar S.; Choudhary S.K.
Institution
(Sahu, Menon, Singh) Department of CTVS, Intensive Care for CTVS, All
India Institute of Medical Sciences, New Delhi 110029, India
(Singal, Mohan, Manral, Singh) Department of Dietetics, Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Devagouru, Talwar, Choudhary) Department of Cardiothoracic and Vascular
Surgery, All India Institute of Medical Sciences, New Delhi, India
Title
Early enteral nutrition therapy in congenital cardiac repair
postoperatively: A randomized, controlled pilot study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 653-661), 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 and Objectives: Adequate nutritional supplementation in infants
with cardiac malformations after surgical repair is a challenge.
Critically ill infants in the early postoperative period are in a
catabolic stress. The mismatch between estimated energy requirement (EER)
and the intake in the postoperative period is multifactorial, predisposing
them to complications such as immune deficiency, more infection, and
growth failure. This study aimed to assess the feasibility and efficacy of
enriched breast milk feed on postoperative recovery and growth of infants
after open heart surgery. Methodology: Fifty infants <6 months of age were
prospectively randomized in the trial for enteral nutrition (EN)
postoperatively from day 1 to 10, after obtaining the Institute Ethics
Committee's approval. They were equally divided into two groups on the
basis of the feed they received: Control group was fed with expressed
breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM +
energy supplementation/fortification with human milk fortifier (7.5 kcal/2
g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each
infant was calculated as per EER at 90 kcal/kg/day, as the target
requirement. The intra-and post-operative variables such as
cardiopulmonary bypass and aortic cross-clamp times, ventilation duration,
Intensive Care Unit (ICU), and hospital length of stay and mortality were
recorded. Anthropometric and hematological parameters and infection
control data were recorded in a predesigned pro forma. Data were analyzed
using Stata 14.1 software. Results: The duration of mechanical
ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS),
infection rate, and mortality rate were lower in the intervention group
compared to the control group although none of the differences were
statistically significant. Infants in control group needed mechanical
ventilation for about a day more (i.e., 153.6 +/- 149.0 h vs. 123.2 +/-
107.0 h; P = 0.20) than those in the intervention group. Similarly,
infants in control group stayed for longer duration in the ICU (13.2 +/-
8.9 days) and hospital (16.5 +/- 9.8 days) as compared to the intervention
group (11.0 +/- 6.1 days; 14.1 +/- 7.0 days) (P = 0.14 and 0.17,
respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days,
respectively, in the intervention group compared to control group. The
infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in
the intervention group than those in the control group. The energy intake
in the intervention group was 40 kcal more (i.e., 127.2 +/- 56.1 kcal vs.
87.1 +/- 38.3 kcal) than the control group on the 10^th
postoperative day. Conclusions: Early enteral/oral feeding after cardiac
surgery is feasible and recommended. In addition, enriching the EBM is
helpful in achieving the maximum possible calorie intake in the
postoperative period. EN therapy might help in providing adequate
nutrition, and it decreases ventilation duration, infection rate, LOIS,
LOHS, and mortality.

<41>
Accession Number
613003187
Author
Kapoor P.M.; Magoon R.; Rawat R.; Mehta Y.
Institution
(Kapoor, Magoon) Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi,
India
(Rawat) Department of Cardiac Anaesthesiology, Salalah Heart Center,
Salalah, Oman
(Mehta) Department of Anaesthesiology and Critical Care, Medanta Medicity,
Gurgaon, Haryana, India
Title
Perioperative utility of goal-directed therapy in high-risk cardiac
patients undergoing coronary artery bypass grafting: A clinical outcome
and biomarker-based study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 638-645), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid
and vasopressor/inotropic therapy by cardiac output or similar parameters
to help in early recognition and management of high-risk cardiac surgical
patients. With the aim of establishing the utility of perioperative GDT
using robust clinical and biochemical outcomes, we conducted the present
study. This multicenter randomized controlled study included 130 patients
of either sex, with European system for cardiac operative risk evaluation
>3 undergoing coronary artery bypass grafting on cardiopulmonary bypass.
The patients were randomly divided into the control and GDT group. All the
participants received standardized care; arterial pressure monitored
through radial artery, central venous pressure (CVP) through a triple
lumen in the right internal jugular vein, electrocardiogram, oxygen
saturation, temperature, urine output per hour, and frequent arterial
blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using
FloTracTM and continuous central venous oxygen saturation
(ScVO<inf>2</inf>) using PreSepTM were used in patients in the GDT group.
Our aim was to maintain the CI at 2.5-4.2 L/min/m², stroke
volume index 30-65 ml/beat/m², systemic vascular resistance
index 1500-2500 dynes/s/cm⁵/m², oxygen delivery
index 450-600 ml/min/m², continuous ScVO<inf>2</inf> >70%, and
stroke volume variation <10%; in addition to the control group parameters
such as CVP 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal ABG
values, oxygen saturation, hematocrit value >30%, and urine output >1
ml/kg/h. The aims were achieved by altering the administration of IV
fluids and doses of inotropes or vasodilators. The data of sixty patients
in each group were analyzed in view of ten exclusions. The average
duration of ventilation (19.89 +/- 3.96 vs. 18.05 +/- 4.53 h, P = 0.025),
hospital stay (7.94 +/- 1.64 vs. 7.17 +/- 1.93 days, P = 0.025), and
Intensive Care Unit (ICU) stay (3.74 +/- 0.59 vs. 3.41 +/- 0.75 days, P =
0.012) was significantly less in the GDT group, compared to the control
group. The extra volume added and the number of inotropic dose adjustments
were significantly more in the GDT group. The two groups did not differ in
duration of inotropic use, mortality, and other complications. The
perioperative continuation of GDT affected the early decline in the
lactate levels after 6 h in ICU, whereas the control group demonstrated a
settling lactate only after 12 h. Similarly, the GDT group had
significantly lower levels of brain natriuretic peptide, neutrophil
gelatinase-associated lipocalin levels as compared to the control. The
study clearly depicts the advantage of GDT for a favorable postoperative
outcome in high-risk cardiac surgical patients.

<42>
Accession Number
613003182
Author
El-Shmaa N.S.; El Amrousy D.; El Feky W.
Institution
(El-Shmaa) Department of Anesthesia and Surgical ICU, Faculty of Medicine,
Tanta University, Tanta, Egypt
(El Amrousy) Department of Pediatrics, Tanta University Hospital, Tanta,
Egypt
(El Feky) Department of Cardiothoracic Surgery, Tanta University Hospital,
Tanta, Egypt
Title
The efficacy of pre-emptive dexmedetomidine versus amiodarone in
preventing postoperative junctional ectopic tachycardia in pediatric
cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 614-620), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to assess the effectiveness of
pre-emptive dexmedetomidine versus amiodarone in preventing junctional
ectopic tachycardia (JET) in pediatric cardiac surgery. Design: This is a
prospective, controlled study. Setting: This study was carried out at a
single university hospital. Subjects and Methods: Ninety patients of both
sexes, American Society of Anesthesiologists Physical Status II and III,
age range from 2 to 18 years, and scheduled for elective cardiac surgery
for congenital and acquired heart diseases were selected as the study
participants. Interventions: Patients were randomized into three groups
(30 each). Group I received dexmedetomidine 1 mcg/kg diluted in 100 ml of
normal saline intravenously (IV) over a period of 20 min, and the infusion
was completed 10 min before the induction followed by a 0.5 mcg/kg/h
infusion for 72 h postoperative, Group II received amiodarone 5 mg/kg
diluted in 100 ml of normal saline IV over a period of 20 min, and the
infusion was completed 10 min before the induction followed by a 10-15
mcg/kg/h infusion for 72 h postoperative, and Group III received 100 ml of
normal saline IV. Primary outcome was the incidence of postoperative JET.
Secondary outcomes included vasoactive-inotropic score, ventilation time
(VT), pediatric cardiac care unit stay, hospital length of stay, and
perioperative mortality. Measurements and Main Results: The incidence of
JET was significantly reduced in Group I and Group II (P = 0.004) compared
to Group III. Heart rate while coming off from cardiopulmonary bypass
(CPB) was significantly low in Group I compared to Group II and Group III
(P = 0.000). Mean VT, mean duration of Intensive Care Unit stay, and
length of hospital stay (day) were significantly short (P = 0.000) in
Group I and Group II compared to Group III (P = 0.000). Conclusion:
Perioperative use of dexmedetomidine and amiodarone is associated with
significantly decreased incidence of JET as compared to placebo without
significant side effects.

<43>
Accession Number
613003179
Author
Soliman R.; Zohry G.
Institution
(Soliman, Zohry) Department of Anesthesia, Cairo University, Cairo, Egypt
Title
The myocardial protective effect of dexmedetomidine in high-risk patients
undergoing aortic vascular surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 606-613), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to assess the effect of
dexmedetomidine in high-risk patients undergoing aortic vascular surgery.
Design: A randomized prospective study. Setting: Cairo University, Egypt.
Materials and Methods: The study included 150 patients undergoing aortic
vascular surgery. Intervention: The patients were classified into two
groups (n = 75). Group D: The patients received a loading dose of 1 mug/kg
dexmedetomidine over 15 min before induction and maintained as an infusion
of 0.3 mug/kg/h to the end of the procedure. Group C: The patients
received an equal volume of normal saline. The medication was prepared by
the nursing staff and given to anesthetist blindly. Measurements: The
monitors included the heart rate, mean arterial blood pressure, central
venous pressure, electrocardiogram (ECG), serum troponin I level,
end-tidal sevoflurane, and total dose of morphine in addition
transthoracic echocardiography to the postoperative in cases with elevated
serum troponin I level. Main Results: The dexmedetomidine decreased heart
rate and minimized the changes in blood pressure compared to control group
(P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia
reflected by troponin I level, ECG changes, and the development of new
regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased
the requirement for nitroglycerin and norepinephrine compared to control
group (P < 0.05). The incidence of hypotension and bradycardia was
significantly higher with dexmedetomidine (P < 0.05). Conclusion: The
dexmedetomidine is safe and effective in patients undergoing aortic
vascular surgery. It decreases the changes in heart rate and blood
pressure during the procedures. It provides cardiac protection in
high-risk patients reflected by decreasing the incidence of myocardial
ischemia and serum level of troponin. The main side effects of
dexmedetomidine were hypotension and bradycardia.

<44>
Accession Number
612939954
Author
Saxton A.T.; Poenaru D.; Ozgediz D.; Ameh E.A.; Farmer D.; Smith E.R.;
Rice H.E.
Institution
(Saxton, Smith, Rice) Duke Global Health Institute, Duke University
Medical Center, Durham, NC, United States
(Poenaru) McMaster Paediatric Surgery Research Collaborative, Dept. of
Surgery, McMaster University, Hamilton, Canada
(Ozgediz) Yale-New Haven Hospital, New Haven, CT, United States
(Ameh) Department of Surgery, National Hospital, Abuja, Nigeria
(Farmer) University of California-Davis Health System, Davis, CA, United
States
Title
Economic analysis of children's surgical care in low- and middle-income
countries: A systematic review and analysis.
Source
PLoS ONE. 11 (10) (no pagination), 2016. Article Number: e0165480. Date of
Publication: October 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Understanding the economic value of health interventions is
essential for policy makers to make informed resource allocation
decisions. The objective of this systematic review was to summarize
available information on the economic impact of children's surgical care
in low- and middle-income countries (LMICs). Methods We searched MEDLINE
(Pubmed), Embase, and Web of Science for relevant articles published
between Jan. 1996 and Jan. 2015. We summarized reported cost information
for individual interventions by country, including all costs, disability
weights, health outcome measurements (most commonly disability-adjusted
life years [DALYs] averted) and costeffectiveness ratios (CERs). We
calculated median CER as well as societal economic benefits (using a human
capital approach) by procedure group across all studies. The
methodological quality of each article was assessed using the Drummond
checklist and the overall quality of evidence was summarized using a scale
adapted from the Agency for Healthcare Research and Quality. Findings We
identified 86 articles that met inclusion criteria, spanning 36 groups of
surgical interventions. The procedure group with the lowest median CER was
inguinal hernia repair ($15/ DALY). The procedure group with the highest
median societal economic benefit was neurosurgical procedures ($58,977).
We found a wide range of study quality, with only 35% of studies having a
Drummond score >7. Interpretation Our findings show that many areas of
children's surgical care are extremely cost-effective in LMICs, provide
substantial societal benefits, and are an appropriate target for enhanced
investment. Several areas, including inguinal hernia repair, trichiasis
surgery, cleft lip and palate repair, circumcision, congenital heart
surgery and orthopedic procedures, should be considered "Essential
Pediatric Surgical Procedures" as they offer considerable economic value.
However, there are major gaps in existing research quality and methodology
which limit our current understanding of the economic value of surgical
care. Copyright &#xa9; 2016 Saxton et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.

<45>
Accession Number
612919221
Author
Giustino G.; Mehran R.; Veltkamp R.; Faggioni M.; Baber U.; Dangas G.D.
Institution
(Giustino, Mehran, Faggioni, Baber, Dangas) Interventional Cardiovascular
Research and Clinical Trials, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Veltkamp) Department of Stroke Medicine, Division of Brain Sciences,
Imperial College, London, United Kingdom
Title
Neurological Outcomes With Embolic Protection Devices in Patients
Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (20) (pp 2124-2133), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate the efficacy and
safety of intraprocedural embolic protection (EP) during transcatheter
aortic valve replacement (TAVR). Background Randomized controlled trials
(RCTs) investigating the efficacy of EP devices during TAVR were
relatively underpowered. Methods A systematic review and study-level
meta-analysis was performed of randomized controlled trials that tested
the efficacy and safety of EP during TAVR. Trials using any type of EP and
TAVR vascular access were included. Primary imaging efficacy endpoints
were total lesion volume and number of new ischemic lesions. Primary
clinical efficacy endpoints were any deterioration in National Institutes
of Health Stroke Scale and Montreal Cognitive Assessment scores at
hospital discharge. Primary analyses were performed using the
intention-to-treat approach. Results Four randomized clinical trials
(total n = 252) were included. Use of EP was associated with lower total
lesion volume (standardized mean difference -0.65; 95% confidence interval
[CI]: -1.06 to -0.25; p = 0.002) and smaller number of new ischemic
lesions (standardized mean difference -1.27; 95% CI: -2.45 to -0.09; p =
0.03). EP was associated with a trend toward lower risk for deterioration
in National Institutes of Health Stroke Scale score at discharge (risk
ratio: 0.55; 95% CI: 0.27 to 1.09; p = 0.09) and higher Montreal Cognitive
Assessment score (standardized mean difference 0.40; 95% CI: 0.04 to 0.76;
p = 0.03). Risk for overt stroke and all-cause mortality were
nonsignificantly lower in the EP group. Conclusions Use of EP seems to be
associated with reductions in imaging markers of cerebral infarction and
early clinical neurological effectiveness in patients undergoing TAVR.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<46>
Accession Number
610639540
Author
Neves A.L.; Henriques-Coelho T.; Leite-Moreira A.; Areias J.C.
Institution
(Neves, Areias) Department of Paediatric Cardiology, Sao Joao Hospital,
Porto, Portugal
(Neves, Leite-Moreira, Areias) Department of Physiology and Cardiothoracic
Surgery, Cardiovascular Research Centre, Faculty of Medicine, University
of Porto, Porto, Portugal
(Neves, Henriques-Coelho, Areias) Department of Paediatrics, Faculty of
Medicine, University of Porto, Porto, Portugal
(Henriques-Coelho) Department of Paediatric Surgery, Sao Joao Hospital,
Porto, Portugal
(Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao Hospital,
Porto, Portugal
Title
Cardiac injury biomarkers in paediatric age: Are we there yet?.
Source
Heart Failure Reviews. 21 (6) (pp 771-781), 2016. Date of Publication: 01
Nov 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The aim of this article is to evaluate the clinical utility of cardiac
injury biomarkers in paediatric age. In December 2015, a literature search
was performed (PubMed access to MEDLINE citations;
http://www.ncbi.nlm.nih.gov/PubMed/). The search strategy included the
following medical subject headings and text terms for the key words:
"cardiac injury biomarkers", "creatine kinase-MB", "myoglobin",
"troponin", "children", "neonate/s", "newborn/s", "infant/s" and
echocardiography. In the paediatric population, troponins show a good
correlation with the extent of myocardial damage following cardiac surgery
and cardiotoxic medication and can be used as predictors of subsequent
cardiac recovery and mortality. Elevation of cardiac injury biomarkers may
also have diagnostic value in cases when cardiac contusion or pericarditis
is suspected. Cardiac injury biomarkers are very sensitive markers for the
detection of myocardial injury and have been studied in healthy newborns,
after tocolysis, intrauterine growth restriction, respiratory distress and
asphyxia. The proportion of newborns with elevated troponin was higher
than that in ill infants, children, and adolescents and in healthy adults,
suggesting that myocardial injury, although clinically occult, is common
in this young age group. Results suggest that significant elevation of
cord troponin is an excellent early predictor of severity of
hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac
biomarkers may also benefit centres without on-site echocardiography with
evidence showing good correlation with echo-derived markers of myocardial
function. Further studies are needed to better clarify the role of cardiac
biomarkers in paediatric age and their correlation with echocardiographic
parameters. Copyright &#xa9; 2016, Springer Science+Business Media New
York.

<47>
[Use Link to view the full text]
Accession Number
612075867
Author
Liu G.; Ding M.; Chiuve S.E.; Rimm E.B.; Franks P.W.; Meigs J.B.; Hu F.B.;
Sun Q.
Institution
(Liu, Ding, Chiuve, Rimm, Franks, Hu, Sun) Department of Nutrition,
Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Boston, MA
02115, United States
(Rimm, Hu) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, 665 Huntington Ave., Boston, MA 02115, United States
(Chiuve) Division of Preventive Medicine, Department of Medicine, Brigham,
United States
(Rimm, Hu, Sun) Channing Division of Network Medicine, Department of
Medicine, Brigham, United States
(Rimm, Hu, Sun) Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Franks) Department of Clinical Sciences, Genetic and Molecular
Epidemiology Unit, Lund University, Sweden
(Franks) Skane University Hospital Malmo, Sweden
(Franks) Department of Public Health and Clinical Medicine, Faculty of
Medicine, Umea University, Sweden
(Meigs) Division of General Internal Medicine, Department of Medicine,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
(Meigs) Program in Medical and Population Genetics, Broad Institute,
Cambridge, MA, United States
Title
Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4,
High-Molecular-Weight Adiponectin, and Cardiovascular Mortality among Men
with Type 2 Diabetes: A 22-Year Prospective Study.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 36 (11) (pp
2259-2267), 2016. Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective - To examine select adipokines, including fatty acid-binding
protein 4, retinol-binding protein 4, and high-molecular-weight (HMW)
adiponectin in relation to cardiovascular disease (CVD) mortality among
patients with type 2 diabetes mellitus. Approach and Results - Plasma
levels of fatty acid-binding protein 4, retinol-binding protein 4, and HMW
adiponectin were measured in 950 men with type 2 diabetes mellitus in the
Health Professionals Follow-up Study. After an average of 22 years of
follow-up (1993-2015), 580 deaths occurred, of whom 220 died of CVD. After
multivariate adjustment for covariates, higher levels of fatty
acid-binding protein 4 were significantly associated with a higher CVD
mortality: comparing extreme tertiles, the hazard ratio and 95% confidence
interval of CVD mortality was 1.78 (1.22-2.59; P trend=0.001). A positive
association was also observed for HMW adiponectin: the hazard ratio (95%
confidence interval) was 2.07 (1.42-3.06; P trend=0.0002), comparing
extreme tertiles, whereas higher retinol-binding protein 4 levels were
nonsignificantly associated with a decreased CVD mortality with an hazard
ratio (95% confidence interval) of 0.73 (0.50-1.07; P trend=0.09). A
Mendelian randomization analysis suggested that the causal relationships
of HMW adiponectin and retinol-binding protein 4 would be directionally
opposite to those observed based on the biomarkers, although none of the
Mendelian randomization associations achieved statistical significance.
Conclusions - These data suggest that higher levels of fatty acid-binding
protein 4 and HMW adiponectin are associated with elevated CVD mortality
among men with type 2 diabetes mellitus. Biological mechanisms underlying
these observations deserve elucidation, but the associations of HMW
adiponectin may partially reflect altered adipose tissue functionality
among patients with type 2 diabetes mellitus. Copyright &#xa9; 2016
American Heart Association, Inc.

<48>
Accession Number
612989259
Author
Amin S.M.; Elmawy M.G.E.
Institution
(Amin, Elmawy) Departments of Anesthesiology and Surgical Intensive Care,
Faculty of Medicine, Tanta University, Egypt
Title
Optimizing surgical field during cochlear implant surgery in children:
Dexmedetomidine versus Esmolol.
Source
Egyptian Journal of Anaesthesia. 32 (3) (pp 255-261), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background The field of cochlear implantation has been expanding rapidly
and it has been hailed as one of the greatest advances in otology. The
technique of anesthesia plays a crucial role in success of cochlear
implant surgery as the anesthesiologist has to produce conditions which
facilitate surgery by inducing bloodless operative field. Study objective
To determine the efficacy of dexmedetomidine versus esmolol usage as an
adjunct to induce controlled hypotension in children undergoing cochlear
implant surgery. Design Clinical trial study. Setting Operating room in a
university hospital. Patients 70 children aged 2-4 years scheduled for
cochlear implant surgery under general anesthesia. Patients were randomly
allocated according to drugs used into two equal groups (35 patients in
each group). Interventions: Group (D): The patients in this group received
a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by
continuous infusion 0.2-0.5 ug/kg/h after induction of anesthesia but
before surgery. Group (E): The patients in this group received a bolus
dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion
100-300 ug/kg/min after induction of anesthesia but before surgery.
Measurements Heart rate, Mean Arterial blood Pressure, Quality of surgical
field, operative time, adverse events. Main results The quality of
surgical field was comparable between both groups in all times of
measurements. The time to first analgesic request was statistically
significant longer in group (D) than in group (E) and the total tramadol
consumption was statistically significant less in group (D) than in group
(E). Conclusions In our study both dexmedetomidine and esmolol were
effective in reducing MABP, and lowering the heart rate providing dry
surgical field and ensured good surgical condition during cochlear implant
surgery in pediatric patients. Copyright &#xa9; 2016

<49>
Accession Number
612941123
Author
Evans L.W.; Van Woerden H.; Davies G.R.; Fone D.
Institution
(Evans, Davies) Public Health Wales Observatory, Public Health Wales,
Carmarthen, United Kingdom
(Van Woerden) NHS Highland, Inverness, United Kingdom
(Fone) Division of Population Medicine, School of Medicine, Cardiff
University, Cardiff, United Kingdom
Title
Impact of service redesign on the socioeconomic inequity in
revascularisation rates for patients with acute myocardial infarction: A
natural experiment and electronic record-linked cohort study.
Source
BMJ Open. 6 (10) (no pagination), 2016. Article Number: e011656. Date of
Publication: 01 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aim: To investigate the impact of service redesign in the provision of
revascularisation procedures on the historical socioeconomic inequity in
revascularisation rates for patients with acute myocardial infarction
(AMI). Design: Natural experiment and retrospective cohort study using
linked data sets in the Secure Anonymised Information Linkage databank.
Non-randomised intervention: An increase in the capacity of
revascularisation procedures and service redesign in the provision of
revascularisation in late 2011 to early 2012. Setting: South Wales cardiac
network, Census 2011 population 1 359 051 aged 35 years and over.
Participants: 9128 participants admitted to an NHS hospital with a first
AMI between 1 January 2010 and 30 June 2013, with 6-months follow-up. Main
outcome measure: Hazard ratios (HRs) for the time to revascularisation for
deprivation quintiles, age, gender, comorbidities, ruralurban
classification and revascularisation facilities of admitting hospital.
Results: In the preintervention period, there was a statistically
significant decreased adjusted risk of revascularisation for participants
in the most deprived quintile compared to the least deprived quintile (HR
0.80; 95% CI 0.69 to 0.92, p=0.002). In the postintervention period, the
increase in revascularisation rates was statistically significant in all
quintiles, and there was no longer any statistically significant
difference in the adjusted revascularisation risk between the most and the
least deprived quintile (HR 1.04; 95% CI 0.89 to 1.20, p<0.649). However,
inequity persisted for those aged 75 years and over (HR 0.40; 95% CI 0.35
to 0.46, p<0.001) and women (HR 0.77; 95% CI 0.70 to 0.86, p<0.001).
Conclusions: Socioeconomic inequity of access to revascularisation was no
longer apparent following redesign of revascularisation services in the
south Wales cardiac network, although inequity persisted for women and
those aged 75+ years. Increasing the capacity of revascularisation did not
differentially benefit participants from the least deprived areas.

<50>
Accession Number
600060323
Author
Tie H.-T.; Luo M.-Z.; Luo M.-J.; Zhang M.; Wu Q.-C.; Wan J.-Y.
Institution
(Tie, Zhang, Wu) Department of Cardiothoracic Surgery, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Luo, Wan) Chongqing Key Laboratory of Biochemistry and Molecular
Pharmacology, Chongqing Medical University, Chongqing 400016, China
(Luo) The Children's Hospital of Chongqing Medical University, Chongqing
400016, China
Title
Sodium bicarbonate in the prevention of cardiac surgery-associated acute
kidney injury: A systematic review and meta-analysis.
Source
Critical Care. 18 (5) (no pagination), 2014. Article Number: 517. Date of
Publication: September 12, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Sodium bicarbonate (SBIC) was reported to be a promising
approach to prevent cardiac surgery-associated acute kidney injury
(CSA-AKI). However, the results remain controversial. We conducted a
systematic review and meta-analysis to evaluate the efficacy and safety of
SBIC on the prevention of CSA-AKI in adult patients undergoing cardiac
surgery.Methods: PubMed, EMbase, Web of science, EBSCO, and Cochrane
library databases were systematically searched. Randomized controlled
trials (RCTs) assessing the effect of SBIC versus placebo on the
prevention of CSA-AKI in adult patients undergoing cardiac surgery were
included. Two investigators independently searched articles, extracted
data, and assessed the quality of included studies. The primary outcome
was the incidence of CSA-AKI. Meta-analysis was performed using
random-effects models.Results: Five RCTs involving 1079 patients were
included in the meta-analysis. Overall, compared with placebo, SBIC was
not associated with a reduced risk of CSA-AKI (relative risk [RR] 0.99;
95% confidence interval [CI] 0.78 to 1.24; P = 0.911). SBIC failed to
alter the clinical outcomes of hospital length of stay (weighted mean
difference [WMD] 0.23 days; 95%CI -0.88 to 1.33 days; P = 0.688), renal
replacement therapy (RR 0.94; 95%CI 0.49 to 1.82; P = 0.861), hospital
mortality (RR 1.37; 95%CI 0.46 to 4.13; P = 0.572), postoperative atrial
fibrillation (RR 1.02; 95%CI 0.65 to 1.61; P = 0.915). However, SBIC was
associated with significant increased risks in longer duration of
ventilation (WMD 0.64 hours; 95%CI 0.16 to 1.11 hours; P = 0.008), longer
ICU length of stay (WMD 2.06 days; 95%CI 0.54 to 3.58 days; P = 0.008),
and increased incidence of alkalemia (RR 2.21; 95%CI 1.42 to 3.42; P
<0.001).Conclusions: SBIC could not reduce the incidence of CSA-AKI.
Contrarily, SBIC prolongs the duration of ventilation and ICU length of
stay, and increases the risk of alkalemia. Thus, SBIC should not be
recommended for the prevention of CSA-AKI and perioperative SBIC infusion
should be administrated with caution. Copyright &#xa9; 2014 Tie et al.;
licensee BioMed Central Ltd.

<51>
Accession Number
610504161
Author
Abdelazim R.; Salah D.; Labib H.A.; El Midany A.A.
Institution
(Abdelazim, Salah, Labib) Department of Anesthesiology, Intensive Care,
and Pain Management, Faculty of Medicine, Ain Shams University, Egypt
(El Midany) Department of Cardiothoracic Surgery, Faculty of Medicine, Ain
Shams University, Egypt
Title
Methylene blue compared to norepinephrine in the management of vasoplegic
syndrome in pediatric patients after cardiopulmonary bypass: a randomized
controlled study.
Source
Egyptian Journal of Anaesthesia. 32 (3) (pp 269-275), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background and aim Vasoplegic syndrome (VS) is a frequent complication
following cardiopulmonary bypass (CPB) requiring escalating dose of
vasopressor support. The guanylate cyclase inhibitor methylene blue (MB)
could be an attractive alternative treatment in such cases. This study
examines the efficacy and safety of using MB compared to the commonly used
norepinephrine in VS in pediatric population following CPB. Methods Forty
patients of pediatric age group who developed VS following CPB for
elective corrective cardiac surgeries received 0.5 mug/kg/min
norepinephrine intravenous infusion for 5 min without improvement (Time
1). Patients were randomly assigned to two equal groups. Group MB received
1.5 mg/kg methylene blue by intravenous infusion over 20 min. Group N did
not receive MB. Norepinephrine infusion was continued in both groups and
titrated according to the response of patients with a maximum dose of 2
mug/kg/min (Time 2). Heart rate, mean arterial pressure (MAP), central
venous pressure (CVP), cardiac output (CO), cardiac index (CI), mean
pulmonary artery pressure (MPAP), systemic vascular resistance (SVR) and
systemic vascular resistance index (SVRI) were calculated in both groups.
Side effects related to the study drug were recorded. Results Time 2
values of norepinephrine dose were significantly lower in MB group
compared to N group. Time 2 values of MAP were significantly higher in MB
group compared to N group with a significant decrease in HR in MB group
compared to N group. No change in the rhythm was detected in the two
groups. Time 2 values of CVP were higher in MB group compared to N group.
Time 2 values of CO and CI were significantly lower in MB group compared
to N group and SVR and SVRI were significantly higher in MB group compared
to N group. Time 2 values of MPAP were comparable in both groups and
showed no significant change. No side effects from using MB were recorded
as pulmonary edema and respiratory distress. Conclusion In this study, MB
showed superior efficacy and safety in managing VS in pediatrics following
CPB compared to the conventionally used norepinephrine. Copyright &#xa9;
2016

<52>
Accession Number
613139992
Author
Aldemir M.; Keles I.; Karalar M.; Tecer E.; Adali F.; Pektas M.B.; Parlar
A.I.; Darcin O.T.
Institution
(Aldemir, Tecer, Adali, Darcin) Department of Cardiovascular Surgery,
Afyon Kocatepe University, Afyonkarahisar, Turkey
(Keles, Karalar) Department of Urology, Afyon Kocatepe University,
Afyonkarahisar, Turkey
(Pektas) Department of Pharmacology, Faculty of Medicine, Afyon Kocatepe
University, Afyonkarahisar, Turkey
(Parlar) Department of Cardiovascular Surgery, Akut Kalp Damar Hospital,
Izmir, Turkey
Title
Nebivolol compared with metoprolol for erectile function in males
undergoing coronary artery bypass graft.
Source
Anatolian Journal of Cardiology. 16 (2) (pp 131-136), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The aim of this study was to evaluate erectile function in
males undergoing coronary artery bypass graft (CABG) while on two
different adrenoceptor beta-blocker regimens, namely nebivolol and
metoprolol. We hypothesize that the negative effects of cardiopulmonary
bypass on erectile function may be possibly attenuated by preferring a
vasodilating selective beta 1-blocker, nebivolol, to metoprolol as an
antiischemic and antiarrhythmic agent in males undergoing CABG. Methods:
This randomized, double-blind, prospective clinical study was conducted in
patients scheduled for CABG surgery between February 2012 and June 2014. A
total of 60 consecutive patients who met inclusion criteria were
randomized and divided into the following two groups: N group, which
received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks
after surgery or M group, which received 50 mg of metoprolol orally for
the same period. All patients were evaluated by the erectile function
domain of the International Index of Erectile Function-5 (IIEF-5) at the
time of admission (before starting the beta-blocker) and 3 months after
surgery. Results: In the metoprolol group, the mean IIEF-5 score decreased
significantly from a baseline of 15.2+/- 5.8 to 12.9+/- 5.8 (p< 0.001),
but in the nebivolol group, this difference was not significant (from a
baseline 12.9+/- 5.5 to 12.4+/- 5.5, p=0.053). In all patients, the mean
IIEF-5 score decreased significantly from a baseline of 14.0+/- 5.7 to
12.6+/- 5.6 (p< 0.001). Conclusion: Although erectile function in males
undergoing CABG surgery decreases when metoprolol is used, nebivolol
exerts protective effects on erectile function against the disruptive
effects of cardiopulmonary bypass in patients undergoing CABG. Copyright
&#xa9; 2016 by Turkish Society of Cardiology.

<53>
Accession Number
612989116
Author
Amara W.; Naccache S.; Akret C.; Cheggour S.; M'Zoughi S.; Galuscan G.;
Dompnier A.
Institution
(Amara, Naccache) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue
du General-Leclerc, Montfermeil 93370, France
(Akret, Dompnier) Centre hospitalier Annecy-Genevois, 1, avenue de
l'Hopital, Epagny Metz-Tessy 74370, France
(Cheggour, M'Zoughi) Centre hospitalier d'Avignon, 305, rue
Raoul-Follereau, Avignon 84000, France
(Galuscan) Centre hospitalier Andre-Mignot, 177, rue de Versailles, Le
Chesnay 78150, France
Title
Safety of device implantation under antipatelet therapy with ticagrelor:
About 20 cases.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 318-321), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Management of antiplatelet therapy at the time of device
implantation remains controversial. This study aimed to assess the risk of
bleeding complications in patients receiving ticagrelor at the time of
cardiac device surgery. Methods We performed a multicentre (n = 4),
retrospective study from January 2015 to January 2016. The survey included
all patients (pts) treated with ticagrelor before undergoing pacemaker,
implantable cardioverter-defibrillator (ICD) implantation or generator
replacement. We report hemorrhagic post-procedural complications at 1
month. A significant bleeding complication was defined as pocket hematoma
requiring a surgical evacuation or prolonged hospitalization, hemothorax,
pericardial effusion, or tamponade. Results A total of 20 patients
underwent a permanent pacemaker or ICD implantation while taking a
combination of antipatelet therapy with ticagrelor and aspirin. The mean
age of the patients was 65 +/- 9 years, 95% were male, 25% of patients
were diabetics, 55% had hypertension and 50% presented a history of heart
failure. All the patients had a history of acute coronary syndrome [6
(4-26) months before the procedure]. The majority of implanted devices
were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple
chambers ICDs. Subclavian venous approach was utilized in 9 patients. The
mean duration of procedure was 60 minutes. One per-procedure bleeding was
described due to high venous pressure, without post-procedure hematoma. A
post-procedure pocket hematoma has been experienced by one patient. The
subclavian approach was used for the 2 patients. No blood transfusion was
needed for these 2 cases. Conclusion Ticagrelor treatment at the time of
heart rhythm device procedures does not seem to be associated with an
increased risk of significant bleeding complications. In our study, 2
patients experienced nonsignificant bleeding complications. Copyright
&#xa9; 2016 Elsevier Masson SAS

<54>
Accession Number
612989094
Author
Moini C.; Sidia B.; Poindron D.; Fiorina L.; Farge A.; Amara W.; El Issa
M.
Institution
(Moini, Sidia, Poindron, Fiorina, El Issa) Unite de rythmologie et de
stimulation cardiaque, hopital d'Antony, 1, rue Velpeau, Antony 92160,
France
(Moini, Poindron, Fiorina) Unite de rythmologie et de stimulation
cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, Melun
77000, France
(Moini) Service de cardiologie, centre hospitalier de Melun, 2, rue
Freteau-de-Peny, Melun cedex 77011, France
(Farge) Unite de chirurgie cardiaque, hopital Jacques-Cartier, 6, avenue
du Noyer-Lambert, Massy 91300, France
(Amara) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du
General-Leclerc, Montfermeil 93370, France
Title
Cardiac permanent pacemaker after transcatheter aortic valve implantation:
A predictive and scientific review.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 346-351), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide
technique in the field of treating aortic stenosis. One of the main side
effects linked to the technique are mostly attached to rhythm
disturbances, such as atrioventricular (AV) and intraventricular blocks.
Consequently, a pacemaker implantation is often required. That
implantation rate is estimated between 8 and 30%, depending on the valve
chosen. Thanks to main meta analysis on the subject, it has been managed
to isolate the following risks factors for AV block development:
preoperative right bundle branch block (RBBB: the most powerful element),
complete AV block during the procedure, male gender, a so-called porcelain
aorta, the absence of previous valvular surgery, the aortic annulus size
(i.e when that size is inferior to the valve's one) and the QRS duration
after the procedure (the superior threshold has been set at 128 ms for the
Corevalve). The currently recommendations advice to implant a pacemaker
are as followed: high grade AV block (in the main studies, the
implantation occurs within the 5 days after the TAVI), complete and
transient AV block during the TAVI, second degree AV block and RBBB
associated with first degree AV block. Our article aims to review the
arrhythmic issues of TAVI. Copyright &#xa9; 2016 Elsevier Masson SAS

<55>
Accession Number
612988954
Author
Gentile F.; Lundberg G.; Hultgren R.
Institution
(Gentile, Lundberg, Hultgren) Department of Vascular Surgery A2:01,
Karolinska University Hospital, Stockholm 171 76, Sweden
(Lundberg, Hultgren) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Gentile) Royal London Hospital, Whitechapel Road, London E1 1BB, United
Kingdom
Title
Outcome for Endovascular and Open Procedures in Infrapopliteal Lesions for
Critical Limb Ischemia: Registry Based Single Center Study.
Source
European Journal of Vascular and Endovascular Surgery. 52 (5) (pp
643-649), 2016. Date of Publication: 01 Nov 2016.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background To describe the risk factor distribution and outcome
for patients with critical limb ischemia (CLI) due to infrapopliteal
arterial lesions treated by endovascular or open procedures, with special
consideration of diabetic patients. Methods Data were collected from the
Swedish Vascular Registry, Swedvasc, covering all procedures performed on
549 consecutive patients between May 2008 and January 2014 at the
Karolinska University Hospital. Diagnosis of ischemic rest pain and/or
tissue loss and treatment of infrapopliteal arterial occlusive disease
were considered. Analysis was performed on the first procedure during the
observation period, "endo" or "open". Amputation rate and death from any
cause were recorded as the primary outcome measures. Subgroup analysis was
performed on diabetic patients. Results Patient demographics did not
differ between the endo (n = 430) and open (n = 114) cohorts. Wound
complications requiring treatment within 30 days were more common in
patients treated with open procedures (32% vs. 1% for endo; p < .001), as
well as stroke and myocardial infarction. Amputation rates were higher at
30 days in the open group (7% vs. 2%; p = .012) but similar at 1 year (10%
vs. 7%; p = .206). Mortality was similar at 30 days (p = .400) and 1 year
(p = .860). Median survival at the end of the observation period was 43
months for endo and 56 months for open patients (p = .055). Patients with
diabetes treated with open procedures had more complications at 30 days
and a higher rate of transfemoral amputations at 1 year compared with
non-diabetic patients. Conclusion This non-randomized registry based study
shows similar outcomes regarding amputation and survival rate in a large
group of patients treated for infrapopliteal CLI with endovascular or open
procedures, although more post-operative complications were reported in
the open group. These findings support the continued use of both
treatments while stressing the importance of minimizing surgical trauma to
reduce wound complications. Copyright &#xa9; 2016 European Society for
Vascular Surgery

<56>
Accession Number
613127821
Author
De Vecchis R.; Baldi C.; Palmisani L.
Institution
(De Vecchis) Cardiology Unit, Napoli, Italy
(Palmisani) Presidio Sanitario Intermedio "Elena d'Aosta", Napoli, Italy
(Baldi) Heart Department, Interventional Cardiology, A.O.U. "San Giovanni
di Dio e Ruggi D'Aragona", Salerno, Italy
Title
Protective effects of methotrexate against ischemic cardiovascular
disorders in patients treated for rheumatoid arthritis or psoriasis: Novel
therapeutic insights coming from a meta-analysis of the literature data.
Source
Anatolian Journal of Cardiology. 16 (1) (pp 2-9), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The association between chronic use of methotrexate and
decreased risk of ischemic cardiovascular events (CVE) among patients with
psoriatic or rheumatoid arthritis (RA) was investigated using a systematic
review and meta-analysis. Methods: The studies should have recruited
adults receiving methotrexate, followed up for at least one year.
Moreover, studies should have reported "hard" cardiovascular endpoints, by
evaluating the cardiovascular outcomes of the habitual users of the drug
or of new users compared with patients with the same disease who had never
used methotrexate. The outcome of interest was the overall pooled odds
ratio (OR) of major adverse cardiovascular events, i.e., a composite of
new- onset angina, acute coronary syndrome, need for percutaneous or
surgical coronary revascularization, stroke, and cardiovascular death. The
study was performed according to the PRISMA statement. Results: Seven
observational studies, mostly engaging patients with RA, were included in
the meta-analysis. The pooled odds ratio (OR) was 0.73 (95% CI=0.70- 0.77
p<0.001). When stratified meta-analysis models were assessed, the pooled
OR was 0.80 (95% CI=0.66-0.97; p=0.022) for studies adjusting for clinical
severity of RA. Furthermore, the OR was even more significant after
adjustment for concomitant use of other drugs specific for RA (OR=0.71,
95% CI=0.67-0.75, p<0.001). Conclusion: Methotrexate at low doses, such
those used for maintenance therapy of RA, predicted a decreased risk of
CVE. Since methotrexate doesn't interfere with blood lipids, platelet
aggregation or insulin resistance, the protective association may
originate from mechanisms other than those exerted by antiplatelet drugs
or statins. Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<57>
Accession Number
612964878
Author
Levin A.; Sklyuev S.; Felker I.; Tceymach E.; Krasnov D.
Institution
(Levin, Sklyuev) Clinical Department, Novosibirsk TB Research Institute,
Ohotskaya St 81a, Novosibirsk 630110, Russian Federation
(Felker, Krasnov) Scientific Department, Novosibirsk TB Research
Institute, Novosibirsk, Russian Federation
(Tceymach) Altai Medical State University, Operative Surgery and
Topographic Anatomy Department, Barnaul, Russian Federation
Title
Endobronchial valve treatment of destructive multidrugresistant
tuberculosis.
Source
International Journal of Tuberculosis and Lung Disease. 20 (11) (pp
1539-1545), 2016. Date of Publication: 01 Nov 2016.
Publisher
International Union against Tubercul. and Lung Dis.
Abstract
BACKGROUND: In accordance with the existing hypothesis, the application of
an endobronchial valve (EbV) leads to selective curative atelectasis of
the affected part of the lung, contributing to early closure of cavities.
OBJECTIVE: To assess the effect of EbV treatment on the course of
tuberculosis (TB). METHODS: We compared the efficacy of EbV treatment and
complex second-line treatment in treating patients with destructive
pulmonary multidrug-resistant TB (MDR-TB). Bacteriological conversion and
closure of cavities were selected as criteria to assess the effectiveness
of EbV application. A total of 102 patients with destructive MDR-TB were
enrolled into the study and randomly divided into two groups: 49 patients
had an EbV installed (intervention group) and 53 patients received complex
second-line treatment (control group). Complex chemotherapy was
administered to both groups throughout the study period. RESULTS: The cure
rate in the short- and long-term follow-up periods in the intervention
group was shown to be much higher, 95.9% by bacteriological conversion and
67.3% by cavity closure. On comparison with the control group, this was
respectively 37.7% and 20.7% (P < 0.0001). CONCLUSIONS: The application of
EbV treatment can significantly improve the effectiveness of second-line
chemotherapy regimens in MDR-TB patients. Copyright &#xa9; 2016 The Union.

<58>
Accession Number
613139512
Author
Basaran O.; Beton O.; Dogan V.; Tekinalp M.; Aykan A.C.; Kalaycioglu E.;
Bolat I.; Tasar O.; Safak O.; Kalcik M.; Yaman M.; Altun I.; Soylu M.O.;
Kirma C.; Biteker M.; Inci S.; Altintas B.; Kalkan S.; Karadeniz F.O.;
Tekkesin A.I.; Cakilli Y.; Turkkan C.; Hamidi M.; Demir V.; Gursoy M.O.;
Ozturk M.T.; Aksan G.; Seyis S.; Balli M.; Alici M.H.; Bozyel S.; Calik
F.; Karaca O.; Helvaci F.; Akay K.; Canga Y.; Celebi S.; Altuntas E.;
Ayturk M.; Gunes H.M.; Bezgin T.; Aksakal A.; Cakal B.; Colak A.; Kaplan
O.; Tatlisu A.; Gozubuyuk G.; Demirelli S.; Kaya A.; Rencuzogullari I.;
Bayram Z.; Simsek Z.; Civan M.; Batgharel U.; Ata A.E.; Gol G.; Mert G.O.;
Mert K.U.; Degirmencioglu A.; Candan O.; Celebi O.O.; Dogan C.; Yavuz F.;
Ulucan S.; Arisoy A.; Sahin B.D.; Ermis E.; Gokaslan S.; Pektas I.;
Tanindi A.; Tekin K.; Sancar K.M.; Cekic E.G.; Basaran N.F.
Institution
(Basaran, Dogan, Altun, Soylu, Biteker) Department of Cardiology, Faculty
of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
(Beton) Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet
University, Sivas, Turkey
(Tekinalp) Department of Cardiology, Kahramanmaras Necip Fazil State
Hospital, Kahramanmaras, Turkey
(Aykan, Kalaycioglu) Department of Cardiology, Trabzon Ahi Evren Chest
Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
(Bolat) Department of Cardiology, Fethiye State Hospital, Fethiye, Turkey
(Tasar) Department of Cardiology, Elazig Education and Research Hospital,
Elazig, Turkey
(Safak) Department of Cardiology, Burdur State Hospital, Burdur, Turkey
(Kalcik) Department of Cardiology, Iskilip Atif Hoca State Hospital,
Corum, Turkey
(Yaman) Department of Cardiology, Samsun Education and Research Hospital,
Samsun, Turkey
(Kirma) Department of Cardiology, Kartal Kosuyolu Heart Education and
Research Hospital, Istanbul, Turkey
(Inci) AksarayTurkey
(Altintas) DiyarbakirTurkey
(Kalkan) Balikesir-GonenTurkey
(Karadeniz) SanliurfaTurkey
(Tekkesin, Cakilli, Turkkan, Aksan, Bozyel, Karaca, Helvaci, Canga, Gunes,
Bayram, Simsek, Civan, Batgharel, Gol, Degirmencioglu, Gokaslan)
IstanbulTurkey
(Hamidi) BalikesirTurkey
(Demir) YozgatTurkey
(Gursoy) IzmirTurkey
(Ozturk, Celebi, Ayturk, Celebi, Tanindi) AnkaraTurkey
(Seyis, Balli, Calik, Colak, Pektas) MersinTurkey
(Altuntas, Kaya, Yavuz) GaziantepTurkey
(Akay, Bezgin, Cakal) KocaeliTurkey
(Alici, Ata) BingolTurkey
(Aksakal) SamsunTurkey
(Kaplan, Gozubuyuk, Dogan) MalatyaTurkey
(Tatlisu) SivasTurkey
(Demirelli, Sahin, Ermis) ErzurumTurkey
(Rencuzogullari) KarsTurkey
(Mert, Mert, Sancar, Cekic, Basaran) MuglaTurkey
(Candan) UsakTurkey
(Ulucan) KonyaTurkey
(Arisoy) TokatTurkey
(Tekin) BatmanTurkey
Title
ReAl-life multicenter survey evaluating stroke prevention strategies in
non-valvular atrial fibrillation (RAMSES study).
Source
Anatolian Journal of Cardiology. 16 (10) (pp 734-741), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Data regarding stroke prevention strategies in non-valvular
atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs).
This study aimed to evaluate real-life stroke prevention strategies for
NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods:
We established a cross-sectional, multicenter, nationwide registry of NVAF
patients. All consecutive atrial fibrillation (AF) patients and without
mechanical heart valves or rheumatic mitral stenosis (but including those
with any degree of mitral regurgitation) were enrolled in the ReAl-life
Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study;
ClinicalTrials.gov identifier NCT02344901) in Turkey. Baseline demographic
data, medical history, and medications prescribed for NVAF treatment were
collected. Univariate analyses were performed for continuous variables,
and the chi-square test was used for categorical variables. Results: In
total, 6273 patients from 29 provinces of Turkey were enrolled in the
study between February and May 2015, with the contribution of 83
investigators. The mean age was 69.6+/-10.7 years; 56% of the patients
were females, and one-fifth of the patients had at least one comorbid
disease, the most common being hypertension (69%). The mean CHA2DS2-VASc
and HAS-BLED scores were 3.3+/-1.6 and 1.6+/-1.1, respectively. The rate
of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA).
Conclusion: The RAMSES study showed a higher prevalence of OAC use among
NVAF patients than that reported in previous studies. Although NOACs were
preferred over VKAs in daily cardiology practice, there is a need for
improved OAC therapies for NVAF patients. Copyright &#xa9; 2016 by Turkish
Society of Cardiology.

<59>
Accession Number
612980210
Author
Digesu C.S.; Wiesel O.; Vaporciyan A.A.; Colson Y.L.
Institution
(Digesu, Wiesel, Colson) Division of Thoracic Surgery, Department of
Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis
Street, Boston, MA 02155, United States
(Vaporciyan) Division of Surgery, Department of Thoracic and
Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center,
1515 Holcombe Boulevard, Box 1489, Houston, TX 77030, United States
Title
Management of Sarcoma Metastases to the Lung.
Source
Surgical Oncology Clinics of North America. 25 (4) (pp 721-733), 2016.
Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
For decades, surgical resection of pulmonary metastases has been
performed; despite limited randomized data, surgery is increasingly
accepted as an integral part in the management of metastatic disease.
Long-term results indicate resection is potentially curative with
significantly improved survival following complete resection. Recurrence,
however, is not uncommon with many patients undergoing repeat resection.
With advancing surgical technique and adjuvant therapies, patients with
high or recurrent tumor burden are increasingly afforded disease control
and potential cure. In this review, the prognostic characteristics of
pulmonary metastases from sarcoma, preoperative evaluation, operative
technique, long-term outcomes, and management of complex patients are
highlighted. Copyright &#xa9; 2016 Elsevier Inc.

<60>
[Use Link to view the full text]
Accession Number
612979724
Author
Ohye R.G.; Schranz D.; D'Udekem Y.
Institution
(Ohye) University of Michigan, C. S. Mott Children's Hospital, 1540 E
Hospital Dr/SPC 4204, Ann Arbor, MI 48109-4204, United States
(Schranz) Pediatric Heart Center, Justus Liebig University Giessen,
Germany
(D'Udekem) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
Title
Current therapy for hypoplastic left heart syndrome and related single
ventricle lesions.
Source
Circulation. 134 (17) (pp 1265-1279), 2016. Date of Publication: 25 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Universally fatal only 4 decades ago, the progress in the 3-stage
palliation of hypoplastic left heart syndrome and related single right
ventricular lesions has drastically improved the outlook for these
patients. Although the stage II operation (hemi-Fontan or bidirectional
Glenn) and stage III Fontan procedure have evolved into relatively
low-risk operations, the stage I Norwood procedure remains one of the
highest-risk and costliest common operations performed in congenital heart
surgery. Yet, despite this fact, experienced centers now report hospital
survivals of >90% for the Norwood procedure. This traditional 3-stage
surgical palliation has seen several innovations in the past decade aimed
at improving outcomes, particularly for the Norwood procedure. One
significant change is a renewed interest in the right
ventricle-to-pulmonary artery shunt as the source of pulmonary blood flow,
rather than the modified Blalock-Taussig shunt for the Norwood. The
multi-institutional Single Ventricle Reconstruction trial randomly
assigned 555 patients to one or the other shunt, and these subjects
continue to be followed closely as they now approach 10 years
postrandomization. In addition to modifications to the Norwood procedure,
the hybrid procedure, a combined catheter-based and surgical approach,
avoids the Norwood procedure in the newborn period entirely. The initial
hybrid procedure is then followed by a comprehensive stage II, which
combines components of both the Norwood and the traditional stage II, and
later completion of the Fontan. Proponents of this approach hope to
improve not only short-term survival, but also potentially longer-term
outcomes, such as neurodevelopment, as well. Regardless of the approach,
traditional surgical staged palliation or the hybrid procedure, survivals
have vastly improved, and large numbers of these patients are surviving
not only through their Fontan in early childhood, but also into
adolescence and young adulthood. As this population grows, it becomes
increasingly important to understand the longer-term outcomes of these
Fontan patients, not only in terms of survival, but also in terms of the
burden of disease, neurodevelopmental outcomes, psychosocial development,
and quality of life. Copyright &#xa9; 2016 American Heart Association,
Inc.

<61>
[Use Link to view the full text]
Accession Number
612979680
Author
Kurlansky P.; Herbert M.; Prince S.; Mack M.
Institution
(Kurlansky) Columbia University, 650 W 168th Street, New York, NY 10032,
United States
(Herbert, Prince) Medical City Dallas Hospital, Dallas, TX, United States
(Mack) Baylor Health Care System, Plano, TX, United States
Title
Coronary artery bypass graft versus percutaneous coronary intervention.
Source
Circulation. 134 (17) (pp 1238-1246), 2016. Date of Publication: 25 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Multiple studies have compared coronary artery bypass graft
(CABG) with percutaneous coronary interventions (PCI) for coronary
revascularization. There is considerable evidence that adherence to
medical therapy can affect the outcomes of therapeutic interventions.
However, the long-term influence of compliance with recommended medical
therapy on the comparative outcomes of CABG versus PCI remains to be
defined. Methods: All non-ST-segment-elevation myocardial infarction
patients undergoing coronary revascularization in an 8-hospital network
were followed for up to 8 years to determine medication history and major
adverse cardiac events: all-cause mortality, nonfatal myocardial
infarction, and reintervention. All mortalities were checked against the
Social Security Death Index. Survival curves were derived with
Kaplan-Meier methods; hazard ratios were calculated with the Cox
proportional hazard model; and propensity score matching was used to
account for differences in patient selection. Results: Among the 973 CABG
and 2255 PCI patients, Kaplan-Meier major adverse cardiac event-free
survival curves demonstrated a significant benefit for antiplatelet,
lipid-lowering, and beta-blocker therapy in both the CABG and PCI groups
(P=0.001 for all 3 medications). Cox regression identified compliance with
optimal medical therapy as a more powerful predictor of major adverse
cardiac event-free survival than choice of therapy (hazard ratio for
noncompliance=2.79; 95% confidence limits, 2.19-3.54; P<0.001; hazard
ratio for PCI versus CABG=1.68, 95% confidence limits, 138-2.04; P<0.001).
In propensity-matched patients, CABG outcomes were superior to PCI
outcomes in patients nonadherent to optimal medical therapy (P=0.001) but
were not different in patients adherent to optimal medical therapy
(P=0.574). Conclusions: Regardless of coronary revascularization strategy,
medication adherence has a dramatic effect on long-term outcome. Among
comparable patients who adhere to optimal medical therapy, outcomes of PCI
and CABG may not differ; however, among nonadherent patients, CABG affords
better major adverse cardiac event-free survival. Therefore, patient
compliance with medical therapy may inform clinical decision making and
should be incorporated into all future comparative studies of comparative
coronary revascularization strategies. Copyright &#xa9; 2016 American
Heart Association, Inc.

<62>
Accession Number
613105037
Author
Liet J.-M.; Barriere F.; Gaillard-Le Roux B.; Bourgoin P.; Legrand A.;
Joram N.
Institution
(Liet, Barriere, Gaillard-Le Roux, Bourgoin, Legrand, Joram) Hopital
Femme-Enfant-Adolescent, University Hospital Center of Nantes (CHU),
Pediatric Intensive Care Unit, 38 bd Jean-Monnet, Nantes 44093, France
(Legrand) CIC-INSERM 1413, University of Nantes, Nantes, France
Title
Physiological effects of invasive ventilation with neurally adjusted
ventilatory assist (NAVA) in a crossover study.
Source
BMC Pediatrics. 16 (1) (no pagination), 2016. Article Number: 180. Date of
Publication: 08 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of
assisted mechanical ventilation that delivers inspiratory pressure
proportionally to the electrical activity of the diaphragm. To date, no
pediatric study has focused on the effects of NAVA on hemodynamic
parameters. This physiologic study with a randomized cross-over design
compared hemodynamic parameters when NAVA or conventional ventilation (CV)
was applied. Methods: After a baseline period, infants received NAVA and
CV in a randomized order during two consecutive 30-min periods. During the
last 10 min of each period, respiratory and hemodynamic parameters were
collected. No changes in PEEP, FiO<inf>2</inf>, sedation or inotropic
doses were allowed during these two periods. The challenge was to keep
minute volumes constant, with no changes in blood CO<inf>2</inf> levels
and in pH that may affect the results. Results: Six infants who had
undergone cardiac surgery (mean age 7.8 +/- 4.1 months) were studied after
parental consent. Four of them had low central venous oxygen saturation
(ScvO<inf>2</inf> < 65 %). The ventilatory settings resulted in similar
minute volumes (1.7 +/- 0.4 vs. 1.6 +/- 0.6 ml/kg, P = 0.67) and in
similar tidal volumes respectively with NAVA and with CV. There were no
statistically significant differences on blood pH levels between the two
modes of ventilation (7.32 +/- 0.02 vs. 7.32 +/- 0.04, P = 0.34).
Ventilation with NAVA delivered lower peak inspiratory pressures than with
CV: -32.7 % (95 % CI: -48.2 to -17.1 %, P = 0.04). With regard to
hemodynamics, systolic arterial pressures were higher using NAVA: +8.4 %
(95 % CI: +3.3 to +13.6 %, P = 0.03). There were no statistically
significant differences on cardiac index between the two modes of
ventilation. However, all children with a low baseline ScvO<inf>2</inf>
(<65 %) tended to increase their cardiac index with NAVA compared to CV:
2.03 +/- 0.30 vs. 1.91 +/- 0.39 L/min.m² (median +/-
interquartile, P = 0.07). Conclusions: This pilot study raises the
hypothesis that NAVA could have beneficial effects on hemodynamics in
children when compared to a conventional ventilatory mode that delivered
identical PEEP and similar minute volumes. Trial registration:
ClinicalTrials.gov Identifier: NCT01490710. Date of registration: December
7, 2011. Copyright &#xa9; 2016 The Author(s).

<63>
Accession Number
612973121
Author
Cayla G.; Cuisset T.; Silvain J.; Leclercq F.; Manzo-Silberman S.;
Saint-Etienne C.; Delarche N.; Bellemain-Appaix A.; Range G.; El Mahmoud
R.; Carrie D.; Belle L.; Souteyrand G.; Aubry P.; Sabouret P.; du Fretay
X.H.; Beygui F.; Bonnet J.-L.; Lattuca B.; Pouillot C.; Varenne O.; Boueri
Z.; Van Belle E.; Henry P.; Motreff P.; Elhadad S.; Salem J.-E.; Abtan J.;
Rousseau H.; Collet J.-P.; Vicaut E.; Montalescot G.
Institution
(Cayla, Lattuca) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier Universitaire de Nimes, Universite de Montpellier, Nimes,
France
(Cuisset, Bonnet) Department of Cardiology, Centre Hospitalier
Universitaire Timone, Marseille, France
(Cuisset, Bonnet) INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and
Risk of Thrombosis, Faculty of Medicine, Aix-Marseille University,
Marseille, France
(Silvain, Sabouret, Collet, Montalescot) Sorbonne Universite-Paris 06,
ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Leclercq) Departement de Cardiologie, Centre Hospitalier Universitaire
Montpellier, Montpellier, France
(Manzo-Silberman, Henry) Service de Cardiologie, Hopital Lariboisiere,
Paris, France
(Saint-Etienne) Service de Cardiologie, Centre Hospitalier Universitaire
Tours, Tours, France
(Delarche) Hopital Francois Mitterrand, Centre Hospitalier de Pau, Pau,
France
(Bellemain-Appaix) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier d'Antibes-Juans-Les-Pins, Antibes, France
(Range) Service de Cardiologie, Les Hopitaux de Chartres, Le Coudray,
Chartres, France
(El Mahmoud) Hopital Ambroise Pare, Boulogne-Billancourt, France
(Carrie) Service de Cardiologie, Centre Hospitalier Universitaire
Toulouse, Toulouse, France
(Belle) Service de Cardiologie, Centre Hospitalier d'Annecy, Annecy,
France
(Souteyrand, Motreff) Service de Cardiologie, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Aubry, du Fretay, Abtan) Service de Cardiologie, Hopital Bichat Claude
Bernard, Paris, France
(Beygui) ACTION Study Group, Service de Cardiologie, Centre Hospitalier
Universitaire de Caen, Caen, France
(Pouillot) Clinique Sainte Clotilde, Saint Denis de La Reunion, La
Reunion, France
(Varenne) Service de Cardiologie, Hopital Cochin, Paris, France
(Boueri) Service de Cardiologie de Bastia, Centre Hospitalier de Bastia,
Bastia, France
(Van Belle) Service de Cardiologie, Centre Hospitalier Universitaire de
Lille, Lille, France
(Elhadad) Centre Hospitalier de Lagny Marne la Vallee, Jossigny, France
(Salem) Department of Pharmacology, CIC-1421, INSERM U1166-ICAN, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rousseau, Vicaut) ACTION Study Group, Unite de Recherche Clinique,
Lariboisiere, Paris, France
Title
Platelet function monitoring to adjust antiplatelet therapy in elderly
patients stented for an acute coronary syndrome (ANTARCTIC): an
open-label, blinded-endpoint, randomised controlled superiority trial.
Source
The Lancet. 388 (10055) (pp 2015-2022), 2016. Date of Publication: 22 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Elderly patients are at high risk of ischaemic and bleeding
events. Platelet function monitoring offers the possibility to
individualise antiplatelet therapy to improve the therapeutic risk-benefit
ratio. We aimed to assess the effect of platelet function monitoring with
treatment adjustment in elderly patients stented for an acute coronary
syndrome. Methods We did this multicentre, open-label, blinded-endpoint,
randomised controlled superiority study at 35 centres in France. Patients
aged 75 years or older who had undergone coronary stenting for acute
coronary syndrome were randomly assigned (1:1), via a central interactive
voice-response system based on a computer-generated permuted-block
randomisation schedule with randomly selected block sizes, to receive oral
prasugrel 5 mg daily with dose or drug adjustment in case of inadequate
response (monitoring group) or oral prasugrel 5 mg daily with no
monitoring or treatment adjustment (conventional group). Randomisation was
stratified by centre. Platelet function testing was done 14 days after
randomisation and repeated 14 days after treatment adjustment in patients
in the monitoring group. Study investigators and patients were not masked
to treatment allocation, but allocation was concealed from an independent
clinical events committee responsible for endpoint adjudication. The
primary endpoint was a composite of cardiovascular death, myocardial
infarction, stroke, stent thrombosis, urgent revascularisation, and
Bleeding Academic Research Consortium-defined bleeding complications
(types 2, 3, or 5) at 12 months' follow-up. We did analysis by intention
to treat. This trial is registered with ClinicalTrials.gov, number
NCT01538446. Findings Between March 27, 2012, and May 19, 2015, we
randomly assigned 877 patients to the monitoring group (n=442) or the
conventional group (n=435). The primary endpoint occurred in 120 (28%)
patients in the monitoring group compared with 123 (28%) patients in the
conventional group (hazard ratio [HR], 1.003, 95% CI 0.78-1.29; p=0.98).
Rates of bleeding events did not differ significantly between groups.
Interpretation Platelet function monitoring with treatment adjustment did
not improve the clinical outcome of elderly patients treated with coronary
stenting for an acute coronary syndrome. Platelet function testing is
still being used in many centres and international guidelines still
recommend platelet function testing in high-risk situations. Our study
does not support this practice or these recommendations. Funding Eli Lilly
and Company, Daiichi Sankyo, Stentys, Accriva Diagnostics, Medtronic, and
Fondation Coeur et Recherche. Copyright &#xa9; 2016 Elsevier Ltd

<64>
Accession Number
612967201
Author
Brat K.; Tothova Z.; Merta Z.; Taskova A.; Homolka P.; Vasakova M.;
Skrickova J.; Sramek V.; Olson L.J.; Cundrle I.
Institution
(Brat, Merta, Skrickova) Department of Respiratory Diseases, University
Hospital Brno, Brno, Czech Republic
(Brat, Merta, Homolka, Skrickova) Faculty of Medicine, Masaryk University,
Brno, Czech Republic
(Tothova, Vasakova) Department of Respiratory Medicine, Thomayer Hospital,
Prague, Czech Republic
(Taskova) Department of Thoracic Surgery, Thomayer Hospital, Prague, Czech
Republic
(Homolka) Department of Sports Medicine and Rehabilitation, St. Anne's
University Hospital, Brno, Czech Republic
(Homolka, Cundrle) International Clinical Research Center, St. Anne's
University Hospital, Brno, Czech Republic
(Sramek, Cundrle) Department of Anesthesiology and Intensive Care, St.
Anne's University Hospital, Brno, Czech Republic
(Olson) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
Title
Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in
Patients Undergoing Thoracic Surgical Procedures.
Source
Annals of Thoracic Surgery. 102 (5) (pp 1725-1730), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Ventilatory efficiency (VE/VCO<inf>2</inf> slope [minute
ventilation to carbon dioxide output slope]) has been shown to predict
morbidity and mortality in lung resection candidates. Patients with
increased VE/VCO<inf>2</inf> during exercise also exhibit an increased
VE/VCO<inf>2</inf> ratio and a decreased end-tidal CO<inf>2</inf> at rest.
This study hypothesized that ventilatory values at rest predict
respiratory complications and death in patients undergoing thoracic
surgical procedures. Methods Inclusion criteria for this retrospective,
multicenter study were thoracotomy and cardiopulmonary exercise testing as
part of routine preoperative assessment. Respiratory complications were
assessed from the medical records (from the hospital stay or from the
first 30 postoperative days). For comparisons, Student's t test or the
Mann-Whitney U test was used. Logistic regression and receiver operating
characteristic analyses were performed for evaluation of measurements
associated with respiratory complications. Data are summarized as mean +/-
SD; p <0.05 is considered significant. Results Seventy-six subjects were
studied. Postoperatively, respiratory complications developed in 56 (74%)
patients. Patients with postoperative respiratory complications had
significantly lower resting tidal volume (0.8 +/- 0.3 vs 0.9 +/- 0.3L; p =
0.03), lower rest end-tidal CO<inf>2</inf> (28.1 +/- 4.3vs 31.5 +/- 4.2 mm
Hg; p < 0.01), higher resting VE/VCO<inf>2</inf> ratio (45.1 +/- 7.1 vs
41.0 +/- 6.4; p = 0.02), and higher VE/VCO<inf>2</inf> slope (34.9 +/- 6.4
vs 31.2 +/- 4.3; p = 0.01). Logistic regression (age and sex adjusted)
showed resting end-tidal CO<inf>2</inf> to be the best predictor of
respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06
to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting
end-tidal CO<inf>2</inf> may identify patients at increased risk for
postoperative respiratory complications of thoracic surgical procedures.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<65>
Accession Number
612967122
Author
Trzeciak P.; Wozakowska-Kaplon B.; Niedziela J.; Gierlotka M.; Hawranek
M.; Lekston A.; Wasilewski J.; Polonski L.; Gasior M.
Institution
(Trzeciak, Niedziela, Gierlotka, Hawranek, Lekston, Wasilewski, Polonski,
Gasior) Third Department of Cardiology, SMDZ in Zabrze, Medical University
of Silesia, Katowice, Poland
(Wozakowska-Kaplon) First Clinical Department of Cardiology,
Swietokrzyskie Centre of Cardiology, Kielce, Poland
(Wozakowska-Kaplon) University of Health Sciences, Jan Kochanowski
University, Kielce, Poland
Title
Comparison of Inhospital and 12- and 36-Month Outcomes After Acute
Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS
Registry).
Source
American Journal of Cardiology. 118 (9) (pp 1300-1305), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The study was aimed to compare the characteristics and inhospital and 12-
and 36-month outcomes of men and women <40 years with acute coronary
syndrome (ACS). The analysis involved 932 patients <40 years with ACS in
the Silesia region enrolled into the ongoing, prospective Polish Registry
of Acute Coronary Syndromes from January 2006 to December 2014. The
composite end point involved death, recurrence of ACS, a need for
percutaneous coronary intervention, and coronary artery bypass graft
surgery within 12 and 36 months after ACS. Compared with men, women <40
years were less frequently smokers (66.1% vs 55.4%, p = 0008), had older
average age (35.6 +/- 4.2 vs 34.7 +/- 4.4, p = 0.002), more often had
unstable angina at admission (29.1% vs 19.3%, p <0.001), and less
frequently had ST-elevation myocardial infarction: 41.3% versus 51.3%, p =
0.02, at admission. There was no significant difference in the mortality
(4.8% vs 3.1%, p = 0.29) and the composite end point (21.6% vs 16.0%, p =
0.14) within 12 months after ACS. Compared with men, women had a higher
incidence of the composite end point (28.4% vs 20.1%, p = 0.04) and
indicated a tendency of a higher mortality within the 36-month follow-up
period (9.2% vs 5.0%, p = 0.055). Female gender turned out to be an
independent risk factor of death in the multivariate analysis (hazard
ratio 2.76, 95% confidence interval 1.21 to 6.31, p <0.016). In
conclusion, women had a higher incidence of the composite end point and
showed a tendency toward a higher mortality than the men within the
36-month follow-up period. Copyright &#xa9; 2016 Elsevier Inc.

<66>
Accession Number
612966804
Author
Yang J.; Zhang J.; Cui W.; Liu F.; Xie R.; Gu G.; Zheng H.; Lu J.; Yang
X.; Zhang G.; Wang Q.; Geng X.
Institution
(Yang, Zhang, Cui, Liu, Xie, Yang, Gu, Zheng, Lu, Yang, Zhang, Wang, Geng)
Department of Cardiology, The Second Hospital of Hebei Medical University,
Shijiazhuang, China
Title
Cardioprotective effects of single oral dose of nicorandil before
selective percutaneous coronary intervention.
Source
Anatolian Journal of Cardiology. 15 (2) (pp 125-131), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Nicorandil, an opener of ATP-sensitive K+ channels, was used to
treat angina in patients with coronary artery disease. In this study, we
aim to investigate the cardioprotective effects of single oral dose of
nicorandil in patients undergoing selective percutaneous coronary
intervention (PCI). Methods: One hundred and thirty-eight patients with
acute coronary syndrome undergoing PCI from July 2011 to October 2012 were
randomly divided into control group (group 1, n=47), 10 mg oral nicorandil
group (group 2, n=45), and 20 mg oral nicorandil group (group 3, n=46)
about 2 hours before procedure, respectively. Cardiac troponin I (cTnI)
levels were determined at 20 ~ 24 hours after PCI. Results: There was a
significant difference in the rate of any cTnI elevation among the three
groups (group 1: 36.17%, group 2: 20.00%, group 3: 15.22%, p=0.0176). With
respect to the frequency of cTnI elevation >3 and 5x the upper limit of
normal (ULN), there also had statistical difference among the three groups
(17.02% in group 1, 8.89% in group 2, and 4.35% in group 3, respectively
for cTnI elevation >3x ULN, p=0.0428; 12.77% in group 1, 6.67% in group 2,
and 2.17% in group 3, respectively, for cTnI elevation >5x ULN, p=0.0487).
Logistic regression analysis showed that LVEF (OR=0.915, 95%
CI=0.853-0.981) and the use of nicorandil (OR=0.516, 95% CI=0.267-0.996)
before PCI were independent protective factors of myocardial injury.
Conclusion: Single oral dose of nicorandil (10 mg, 20 mg) 2 hours before
the PCI procedure could decrease the incidence of peri-procedure
myocardial injury and PCI-related myocardial infarction. Copyright &#xa9;
2015 by Turkish Society of Cardiology.

<67>
Accession Number
613259544
Author
Foreman P.M.; Naftel R.P.; Moore T.A.; Hadley M.N.
Institution
(Foreman, Hadley) Department of Neurosurgery, University of Alabama at
Birmingham, 510 20th St. S, FOT 1062, Birmingham, AL 35294-3410, United
States
(Naftel) Department of Neurological Surgery, Vanderbilt University,
Nashville, TN, United States
(Moore) Department of Anesthesia, University of Alabama, Birmingham, AL,
United States
Title
The lateral extracavitary approach to the thoracolumbar spine: A case
series and systematic review.
Source
Journal of Neurosurgery: Spine. 24 (4) (pp 570-579), 2016. Date of
Publication: April 2016.
Publisher
American Association of Neurological Surgeons (E-mail:
jnevro@virginia.edu)
Abstract
OBJECT: Since its introduction in 1976, the lateral extracavitary approach
(LECA) has been used to access ventral and ventrolateral pathology
affecting the thoracolumbar spine. Reporting of outcomes and complications
has been inconsistent. A case series and systematic review are presented
to summarize the available data. METHODS: A retrospective review of
medical records was performed, which identified 65 consecutive patients
who underwent LECA for the treatment of thoracolumbar spine and spinal
cord pathology. Cases were divided according to the presenting pathology.
Neurological outcomes and complications were detailed. In addition, a
systematic review of outcomes and complications in patients treated with
the LECA as reported in the literature was completed. RESULTS: Sixty-five
patients underwent the LECA to the spine for the treatment of thoracic
spine and spinal cord pathology. The most common indication for surgery
was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were
excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were
worse. Two patients (3.1%) experienced a complication. The systematic
review revealed comparable neurological outcomes (74.9% improved) but a
notably higher complication rate (32.2%). CONCLUSIONS: The LECA provides
dorsal and unilateral ventrolateral access to and exposure of the
thoracolumbar spine and spinal cord while allowing for posterior
instrumentation through the same incision. Although excellent neurological
results can be expected, the risk of pulmonary complications should be
considered. Copyright &#xa9;AANS, 2016.

<68>
Accession Number
613254797
Author
Ozturk S.; Sacar M.; Baltalarli A.; Ozturk I.
Institution
(Ozturk) Department of Cardiovascular Surgery, Dr. Siyami Ersek
Cardiothoracic and Vascular Surgery Education and Research Hospital,
Istanbul, Turkey
(Sacar) Department of Cardiovascular Surgery, 18 Mart Univesity, Faculty
of Medicine, Canakkale, Turkey
(Baltalarli) Department of Cardiovascular Surgery, Pamukkale Univesity,
Faculty of Medicine, Denizli, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Title
Effect of the type of cardiopulmonary bypass pump flow on postoperative
cognitive function in patients undergoing isolated coronary artery
surgery.
Source
Anatolian Journal of Cardiology. 16 (11) (pp 875-880), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Pulsatile flow, generated by a pump during cardiopulmonary
bypass, has been accepted as more physiological in coronary artery bypass
grafting surgery (CABG). Therefore, we aimed to investigate the effects of
pulsatile and nonpulsatile flow on postoperative cognitive function and to
review relationship with the biomarkers S100beta and neuron-specific
enolase (NSE). Methods: Patients who underwent isolated CABG were included
this prospective, randomized, double-blind study, which was performed
between March 2010 and December 2010. Patients were divided into two
groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow.
Blood samples were collected 1 day before surgery and in the sixth
postoperative hour for the analysis of S100beta and NSE. In addition,
Mini- Mental State Examination (MMSE) was performed during preoperative
period and on third postoperative day. Outcomes were determination of
effects of pump flow type on cognitive function and relationships with
concentrations of S100beta and NSE. Results: Forty patients were included.
No differences were observed between the groups with respect to
complications, mortality, S100beta (Group I: 1.9+/-0.2 mu/L; Group II:
2.0+/-0.2 mu/L), NSE (Group I: 12.5+/-0.8 mu/L; Group II: 12.4+/-0.7
mu/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and
postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was
observed between MMSE scores and concentrations of S100beta (r=-0.032) and
NSE (r=-0.423) (p>0.05). Conclusion: There was no difference between types
of pump flow for POCD and no relationship between cognitive dysfunction
and S100beta and NSE concentrations. Pump flow type does not affect NSE
concentrations. Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<69>
Accession Number
613253848
Author
El-Boghdadly K.; Madjdpour C.; Chin K.J.
Institution
(El-Boghdadly, Chin) Department of Anesthesia, Toronto Western Hospital,
University of Toronto, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
(Madjdpour) Anaesthetics Department, Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and
Wear NE29 8NH, United Kingdom
Title
Thoracic paravertebral blocks in abdominal surgery - A systematic review
of randomized controlled trials.
Source
British Journal of Anaesthesia. 117 (3) (pp 297-308), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as
part of a multimodal analgesic strategy for thoracic and breast surgery
and have gained popularity with the advent of ultrasound guidance.
However, this role is poorly defined in the context of abdominal surgery.
We performed a systematic review of randomized controlled trials, to
clarify the impact of TPVB on perioperative analgesic outcomes in adult
abdominal surgery. We identified 20 published trials involving a total of
1044 patients that met inclusion criteria; however there was significant
heterogeneity in terms of type of surgery, TPVB technique, comparator
groups and study quality. Pain scores and opioid requirements in the early
postoperative period were generally improved when compared with systemic
analgesia, but there was insufficient evidence for any definitive
conclusions regarding comparison with epidural analgesia or other
peripheral block techniques, or the benefit of continuous TPVB techniques.
The reported primary block failure rate was 2.8% and the incidence of
complications was 1.2% (6/504); there were no instances of pneumothorax.
TPVB therefore appears to be a promising analgesic technique for abdominal
surgery in terms of efficacy and safety. But further well-designed and
adequately powered studies are needed to confirm its utility, particularly
with respect to other regional anaesthesia techniques. Copyright &#xa9;
The Author 2016. Published by Oxford University Press on behalf of the
British Journal of Anaesthesia.

<70>
Accession Number
613271791
Author
Su X.; Meng Z.-T.; Wu X.-H.; Cui F.; Li H.-L.; Wang D.-X.; Zhu X.; Zhu
S.-N.; Maze M.; Ma D.
Institution
(Su, Meng, Wu, Cui, Wang) Department of Anaesthesiology and Critical Care
Medicine, Peking University First Hospital, Beijing, China
(Zhu) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Li, Zhu) Department of Critical Care Medicine, Peking University Third
Hospital, Beijing, China
(Maze) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, CA, United States
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Title
Dexmedetomidine for prevention of delirium in elderly patients after
non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.
Source
The Lancet. 388 (10054) (pp 1893-1902), 2016. Date of Publication: 15 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a postoperative complication that occurs frequently
in patients older than 65 years, and presages adverse outcomes. We
investigated whether prophylactic low-dose dexmedetomidine, a highly
selective alpha<inf>2</inf> adrenoceptor agonist, could safely decrease
the incidence of delirium in elderly patients after non-cardiac surgery.
Methods We did this randomised, double-blind, placebo-controlled trial in
two tertiary-care hospitals in Beijing, China. We enrolled patients aged
65 years or older, who were admitted to intensive care units after
non-cardiac surgery, with informed consent. We used a computer-generated
randomisation sequence (in a 1:1 ratio) to randomly assign patients to
receive either intravenous dexmedetomidine (0.1 mug/kg per h, from
intensive care unit admission on the day of surgery until 0800 h on
postoperative day 1), or placebo (intravenous normal saline).
Participants, care providers, and investigators were all masked to group
assignment. The primary endpoint was the incidence of delirium, assessed
twice daily with the Confusion Assessment Method for intensive care units
during the first 7 postoperative days. Analyses were done by
intention-to-treat and safety populations. This study is registered with
Chinese Clinical Trial Registry, www.chictr.org.cn, number
ChiCTR-TRC-10000802. Findings Between Aug 17, 2011, and Nov 20, 2013, of
2016 patients assessed, 700 were randomly assigned to receive either
placebo (n=350) or dexmedetomidine (n=350). The incidence of postoperative
delirium was significantly lower in the dexmedetomidine group (32 [9%] of
350 patients) than in the placebo group (79 [23%] of 350 patients; odds
ratio [OR] 0.35, 95% CI 0.22-0.54; p<0.0001). Regarding safety, the
incidence of hypertension was higher with placebo (62 [18%] of 350
patients) than with dexmedetomidine (34 [10%] of 350 patients; 0.50,
0.32-0.78; p=0.002). Tachycardia was also higher in patients given placebo
(48 [14%] of 350 patients) than in patients given dexmedetomidine (23 [7%]
of 350 patients; 0.44, 0.26-0.75; p=0.002). Occurrence of hypotension and
bradycardia did not differ between groups. Interpretation For patients
aged over 65 years who are admitted to the intensive care unit after
non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly
decreases the occurrence of delirium during the first 7 days after
surgery. The therapy is safe. Funding Braun Anaesthesia Scientific
Research Fund and Wu Jieping Medical Foundation, Beijing, China. Study
drugs were manufactured and supplied by Jiangsu Hengrui Medicine Co, Ltd,
Jiangsu, China. Copyright &#xa9; 2016 Elsevier Ltd

<71>
Accession Number
613270946
Author
Ghanta R.K.; Kron I.L.
Institution
(Ghanta, Kron) Division of Thoracic and Cardiovascular Surgery, Department
of Surgery, University of Virginia, Charlottesville, VA, United States
Title
Patient-prosthesis mismatch: Surgical aortic valve replacement versus
transcatheter aortic valve replacement in high risk patients with aortic
stenosis.
Source
Journal of Thoracic Disease. 8 (10) (pp E1441-E1443), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve
has an effective orifice area (EOA) less than that of a native valve. A
recent study by Zorn and colleagues evaluated the incidence and
significance of PPM in high risk patients with severe aortic stenosis who
were randomized to transcatheter aortic valve replacement (TAVR) or
surgical aortic valve replacement (SAVR). TAVR is associated with
decreased incidence of severe PPM compared to traditional SAVR valves.
Severe PPM increases risk for death at 1 year postoperatively in high risk
patients. The increased incidence of PPM is largely due to differences in
valve design and should encourage development of newer SAVR valves to
reduce risk for PPM. In addition more vigorous approaches to root
enlargement in small annulus should be performed with SAVR to prevent PPM.
Copyright &#xa9; Journal of Thoracic Disease. All rights reserved.

<72>
Accession Number
613270940
Author
Klemm W.; Frese S.; Leschber G.; Nemat A.; Wilhelm T.
Institution
(Klemm, Frese, Leschber) Department of Thoracic Surgery, ELK Berlin Chest
Hospital, Berlin, Germany
(Nemat) Division of Thoracic Surgery, Sana Krankenhaus Gerresheim,
Dusseldorf, Germany
(Wilhelm) Department of Otolaryngology, Head/Neck and Facial Plastic
Surgery, Sana Kliniken Leipziger Land, Borna, Germany
Title
Transoral endoscopic mediastinal surgery (TOEMS)-results of a first
clinical study for scarless mediastinal lymph node biopsies.
Source
Journal of Thoracic Disease. 8 (10) (pp 2717-2723), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Video-assisted mediastinoscopy (VAM) represents the standard
procedure for mediastinal lymph node biopsies. This operation results in a
scar at prominent position at the anterior neck. Since there is a trend to
less invasive procedures, natural orifice transluminal endoscopic surgery
(NOTES) was introduced to different fields of surgery. Based on NOTES we
developed a new approach for mediastinoscopy: transoral endoscopic
mediastinal surgery (TOEMS). In previous studies using human cadavers and
living pigs the feasibility of TOEMS was shown. It was unclear whether
TOEMS could be safely applied in patients requiring mediastinal lymph node
biopsies. Methods: We conducted a clinical phase I study recruiting ten
patients with unclear mediastinal lymphadenopathy not resolved by prior
bronchoscopy. All patients underwent TOEMS for mediastinal lymph node
biopsy. The duration of the procedure and complications were monitored. In
addition, all patients were examined for pain, swallowing dysfunction and
sensation disturbance. Results: TOEMS was accomplished in eight patients.
In two patients operation was converted to VAM due to technical problems.
Mediastinal lymph nodes were dissected in all patients who finished with
TOEMS. On average, two separate lymph stations were reached by TOEMS.
Duration of the procedure was 159+/-22 min. Permanent palsy of the right
recurrent laryngeal nerve was noticed in one patient postoperatively.
Conclusions: This is the first report for a human application of NOTES in
thoracic surgery. In fact, transoral endoscopic surgery seems to be a
feasible approach for mediastinal lymph node biopsies. Further studies are
needed to show whether this procedure has an advantage over VAM in terms
of pain, complications and accessibility of mediastinal lymph node
stations. Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<73>
Accession Number
613234060
Author
Opolski M.P.; Staruch A.D.; Jakubczyk M.; Min J.K.; Gransar H.; Staruch
M.; Witkowski A.; Kepka C.; Kim W.-K.; Hamm C.W.; Mollmann H.; Achenbach
S.
Institution
(Opolski, Staruch, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jakubczyk) Institute of Econometrics, Warsaw School of Economics, Warsaw,
Poland
(Min) Department of Radiology, The New York-Presbyterian Hospital and
Weill Cornell Medical College, New York, New York, United States
(Gransar) Department of Imaging and Division of Cardiology, Department of
Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
(Staruch) Medical University of Warsaw, Warsaw, Poland
(Kepka) Department of Coronary and Structural Heart Diseases, Institute of
Cardiology, Warsaw, Poland
(Kim, Hamm, Mollmann) Department of Cardiology, Kerckhoff Heart Center,
Bad Nauheim, Germany
(Hamm) Department of Cardiology and Angiology, Justus-Liebig University of
Giessen, Giessen, Germany
(Achenbach) Department of Internal Medicine 2 (Cardiology), University of
Erlangen, Erlangen, Germany
Title
CT Angiography for the Detection of Coronary Artery Stenoses in Patients
Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 9 (9) (pp 1059-1070), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study aimed to evaluate the diagnostic accuracy of
coronary computed tomography angiography (CTA) for detecting coronary
artery stenoses in patients with valvular heart disease undergoing valve
surgery. Background Coronary CTA is currently not routinely recommended
for detecting coronary artery stenoses before cardiac valve surgery.
However, recent improvements in computed tomography technology may enable
the identification of the most appropriate candidates for coronary CTA
before valve surgery. Methods A systematic review was performed of PubMed,
EMBASE, and the Cochrane databases for all studies that used >16-detector
row computed tomography scanning to perform coronary CTA in patients with
valvular heart disease scheduled for valve surgery and validated the
results against invasive angiography. Summary diagnostic accuracies were
calculated by using a bivariate random effects model, and a generalized
linear mixed model was applied for heterogeneity analysis. Results
Seventeen studies analyzing 1,107 patients and 12,851 coronary segments
were included. Patient-based analysis revealed a pooled sensitivity of 93%
(95% confidence interval [CI]: 86 to 97), specificity of 89% (95% CI: 86
to 91), a negative likelihood ratio (LR) of 0.07 (95% CI: 0.04 to 0.16),
and a positive LR of 8.44 (95% CI: 6.49 to 10.99) for coronary CTA to
identify individuals with stenosis >50%. Specificity and positive LR were
higher in patients without aortic stenosis (AS) versus those with AS (96%
vs. 87% and 21.2 vs. 7.4, respectively), as well as with >64 detectors
versus <64 detectors (90% vs. 86% and 9.5 vs. 6.9). Heterogeneity analysis
revealed a significant impact of AS and the number of detectors on
specificity of CTA. Conclusions Coronary CTA using currently available
technology is a reliable imaging alternative to invasive angiography with
excellent sensitivity and negative LR for the detection of significant
coronary stenoses in patients undergoing cardiac valve surgery. The
specificity of coronary CTA may be decreased against the background of AS
(Computed Tomography Angiography for the Detection of Coronary Artery
Disease in Patients Referred for Cardiac Valve Surgery: A Meta-Analysis;
CRD42015016213) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<74>
Accession Number
613231151
Author
Yoon S.-H.; Lefevre T.; Ahn J.-M.; Perlman G.Y.; Dvir D.; Latib A.;
Barbanti M.; Deuschl F.; De Backer O.; Blanke P.; Modine T.; Pache G.;
Neumann F.-J.; Ruile P.; Arai T.; Ohno Y.; Kaneko H.; Tay E.; Schofer N.;
Holy E.W.; Luk N.H.V.; Yong G.; Lu Q.; Kong W.K.F.; Hon J.; Kao H.-L.; Lee
M.; Yin W.-H.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Lee C.W.;
Park S.-W.; Kim H.-S.; Butter C.; Khalique O.K.; Schaefer U.; Nietlispach
F.; Kodali S.K.; Leon M.B.; Ye J.; Chevalier B.; Leipsic J.; Delgado V.;
Bax J.J.; Tamburino C.; Colombo A.; Sondergaard L.; Webb J.G.; Park S.-J.
Institution
(Yoon, Ahn, Park, Kang, Lee, Kim, Lee, Park, Park) Division of Cardiology,
University of Ulsan, Asan Medical Center, Seoul, Korea, United States
(Lefevre, Arai, Chevalier) Generale de Sante, Institut Cardiovasculaire
Paris Sud, Hopital Prive Jacques Cartier, Massy, France
(Perlman, Dvir, Blanke, Ye, Leipsic, Webb) Department of Cardiology, St
Paul's Hospital, University of British Columbia, Vancouver, British
Columbia, Canada
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, San Raffaele Scientific Institute, Italy San Raffaele Hospital,
Milan, Italy
(Barbanti, Ohno, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Deuschl, Schofer, Schaefer) Department for General and Interventional
Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf
(UKE), Hamburg, Germany
(De Backer, Luk, Sondergaard) The Heart Centre, Rigshospitalet University
Hospital, Copenhagen, Denmark
(Modine) Department of Cardiovascular Surgery, Hospital Cardiologique,
Lille, France
(Pache) Department of Radiology, Section of Cardiovascular Radiology,
University of Freiburg, Bad Krozingen, Germany
(Neumann, Ruile) Department of Cardiology & Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Kaneko, Butter) Heart Center Brandenburg in Bernau, Bernau, Germany
(Tay, Kong, Hon) Department of Cardiology, National University Heart
Centre, Singapore
(Holy, Nietlispach) University Heart Center, Cardiology and Cardiovascular
Surgery, University Hospital Zurich, Zurich, Switzerland
(Yong) Division of Cardiology, Royal Perth Hospital, Perth, Western
Australia, Australia
(Lu) Division of Vascular Surgery, Changhai Hospital, Shanghai, China
(Kong) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Kao, Delgado, Bax) Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
(Yin) Division of Cardiology, Heart Center, Cheng Hsin General Hospital,
Taipei, Taiwan (Republic of China)
(Kim) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Khalique, Kodali, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, New York, United States
Title
Transcatheter Aortic Valve Replacement With Early- and New-Generation
Devices in Bicuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. 68 (11) (pp 1195-1205),
2016. Date of Publication: 13 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Few studies have evaluated the clinical outcomes of
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic valve stenosis (AS). Particularly, limited data exist comparing the
results of TAVR with new-generation devices versus early-generation
devices. Objectives This study sought to evaluate the clinical outcomes of
TAVR for bicuspid AS with early- and new-generation devices. Methods The
Bicuspid TAVR Registry is an international multicenter study enrolling
consecutive patients with bicuspid AS undergoing TAVR between April 2005
and May 2015. Results Of 301 patients, 199 patients (71.1%) were treated
with early-generation devices (Sapien XT [Edwards Lifesciences
Corporation, Irvine, California]: n = 87; CoreValve [Medtronic,
Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices
(Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston
Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean
Society of Thoracic Surgeons score was 4.7 +/- 5.2 without significant
differences between groups (4.6 +/- 5.1 vs. 4.9 +/- 5.4; p = 0.57).
Overall, all-cause mortality rates were 4.3% at 30 days and 14.4% at 1
year. Moderate or severe paravalvular leak was absent and significantly
less frequent with new-generation compared to early-generation devices
(0.0% vs. 8.5%; p = 0.002), which resulted in a higher device success rate
(92.2% vs. 80.9%; p = 0.01). There were no differences between early- and
new-generation devices in stroke (2.5% vs. 2.0%; p > 0.99),
life-threatening bleeding (3.5% vs. 2.9%; p > 0.99), major vascular
complication (4.5% vs. 2.9%; p = 0.76), stage 2 to 3 acute kidney injury
(2.5% vs. 2.9%; p > 0.99), early safety endpoints (15.1% vs. 10.8%; p =
0.30), and 30-day all-cause mortality (4.5% vs. 3.9%; p > 0.99).
Conclusions The clinical outcomes of TAVR in patients with bicuspid AS
were favorable. New-generation devices were associated with less
paravalvular leak and, hence, a higher device success rate than
early-generation devices. (The Bicuspid Aortic Stenosis Following
Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR];
NCT02394184) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<75>
Accession Number
613239389
Author
Herrmann J.L.; Goldberg L.A.; Khan A.M.; Partington S.L.; Brothers J.A.;
Mascio C.E.; Spray T.L.; Kim Y.Y.; Fuller S.
Institution
(Herrmann) Division of Cardiac Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Herrmann, Goldberg, Mascio, Spray, Fuller) Division of Cardiothoracic
Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Khan, Partington, Kim) Division of Cardiovascular Medicine, Hospital of
the University of Pennsylvania, Philadelphia, PA, United States
(Brothers) Division of Cardiology, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Title
A Comparison of Perioperative Management of Anomalous Aortic Origin of a
Coronary Artery Between an Adult and Pediatric Cardiac Center.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 7 (6) (pp
721-726), 2016. Date of Publication: 01 Nov 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) presents
in varying age-groups. Assuming management algorithms differ between
pediatric and adult institutions, we compared the perioperative management
of patients with AAOCA at two such centers. Methods: A retrospective
review was conducted at a pediatric and an adult institution of patients
14 years or older who underwent surgical repair of AAOCA between January
2000 and May 2014. Results: Twenty patients from the pediatric center
(median age: 16.5 years, range: 14-18 years) and nine patients from the
adult center (median age: 40 years, range: 37-52 years) were included. An
anomalous aortic origin of a right coronary artery was the most frequent
pathology at each institution. Chest pain was the most common presenting
symptom at both institutions. Preoperative echocardiography was performed
in 95% patients at the pediatric center and in 100% of patients at the
adult center. Cardiac catheterization was utilized more frequently at the
adult center, and cardiac magnetic resonance imaging more commonly
employed at the pediatric center. Isolated coronary unroofing was
performed in 19 of 20 cases at the pediatric center and in only 2 (22%)
cases at the adult institution, both by congenitally trained cardiac
surgeons. More concomitant cardiac procedures were performed at the adult
center with associated longer operative times and hospital stays.
Conclusion: Management strategies for AAOCA vary depending on both
patient-specific factors and expertise of the managing team. Further
studies are needed to optimally standardize diagnostic and treatment
pathways regardless of location venue. Copyright &#xa9; 2016, &#xa9; The
Author(s) 2016.

<76>
Accession Number
613239044
Author
Shivanna S.; Priye S.; Singh D.; Jagannath S.; Mudassar S.; Reddy D.P.
Institution
(Shivanna, Priye, Singh, Jagannath, Mudassar, Reddy) Department of Cardiac
Anaesthesiology, Vydehi Institute of Medical Sciences and Research Centre,
Bengaluru, Karnataka, India
Title
Efficacy of methylprednisolone and lignocaine on propofol injection pain:
A randomised, double-blind, prospective study in adult cardiac surgical
patients.
Source
Indian Journal of Anaesthesia. 60 (11) (pp 848-851), 2016. Date of
Publication: November 2016.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Propofol (2, 6-di-isopropylphenol) used for the
induction of anaesthesia often causes mild to severe pain or discomfort on
injection. We designed this double-blind study to compare the efficacy of
methylprednisolone and lignocaine in reducing the pain of propofol
injection in patients scheduled for cardiac surgery. Methods: A total of
165 adult patients, scheduled for elective cardiac surgery, were divided
into three groups: saline (group S, n = 55), lignocaine 20 mg (Group L, n
= 55) and methylprednisolone 125 mg diluted into 2 ml of distilled water
(Group MP, n = 55). Drugs were administered after tourniquet application
and occlusion was released after 1 min and 1/4^th of the total
dose of propofol (2 mg/kg) was administered at the rate of 0.5 ml/s. Pain
on propofol injection was evaluated by four-point verbal rating scale.
Statistical methods used included Student's t-test and Chi-square
test/Fisher's exact test. Results: The overall incidence of pain was 70.9%
in the saline group, 30.9% in the lignocaine group and 36.4% in the
methylprednisolone group. The intensity of pain was significantly less in
patients receiving methylprednisolone and lignocaine than those receiving
saline (P < 0.012). Conclusion: Pre-treatment with intravenous
methylprednisolone was found to be as effective as lignocaine in reducing
propofol injection-induced pain. Copyright &#xa9; 2016 Indian Journal of
Anaesthesia.

<77>
Accession Number
613239042
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Statistics and Community Medicine,
Minoufiya Faculty of Medicine, Shebin Elkoam, Egypt
Title
A randomised controlled trial comparing the effects of propofol with
isoflurane in patients with diastolic dysfunction undergoing coronary
artery bypass graft surgery.
Source
Anaesthesia. 71 (11) (pp 1308-1316), 2016. Date of Publication: 01 Nov
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
There is a strong association between pre-operative diastolic dysfunction
and difficulty in weaning from cardiopulmonary bypass. We compared the
effects of propofol and isoflurane on left ventricular diastolic function
in patients with pre-existing diastolic dysfunction undergoing coronary
artery bypass grafting. We randomly allocated 60 patients to receive
either propofol or isoflurane anaesthesia, and assessed left ventricular
diastolic function using transoesophageal echocardiography. We measured
early (E), late (A) diastolic velocities, E/A ratio, A-wave duration and
deceleration time using pulsed wave Doppler, and early (Em), late (Am)
diastolic velocities of the mitral annulus, Em/Am ratio and isovolumetric
relaxation time using tissue Doppler. We measured pulmonary venous flow
velocity and recorded values for the peak systolic flow velocity (S), peak
diastolic flow velocity (D), S/D ratio, peak reverse atrial flow velocity
and duration of reverse atrial flow. All data were recorded immediately
after tracheal intubation as a baseline, 5 min before sternotomy
(T<inf>1</inf>), 5 min before aortic cannulation (T<inf>2</inf>) and 15
min after weaning from cardiopulmonary bypass (T<inf>3</inf>). Both
propofol and isoflurane improved left ventricular diastolic function as
evidenced by significant increases in E/A ratios, and significant
decreases in deceleration time and isovolumetric relaxation time; the
improvement was greater in the isoflurane group (between groups, p = 0.001
for both E/A ratio and deceleration time at T<inf>1</inf> and
T<inf>2</inf> and p = 0.006 for isovolumetric relaxation time at both
T<inf>1</inf> and T<inf>2</inf>). Furthermore, Em/Am ratio, S, D and S/D
ratios were significantly better in the isoflurane group. The
administration of isoflurane during cardiac surgery improves diastolic
function comparatively more than propofol. Copyright &#xa9; 2016 The
Association of Anaesthetists of Great Britain and Ireland

<78>
Accession Number
613134763
Author
Siegel A.J.; Bhatti N.A.; Wasfy J.H.
Institution
(Siegel, Bhatti) Divisions of General Internal Medicine, Massachusetts
General Hospital, Boston, MA, United States
(Siegel, Bhatti, Wasfy) Harvard Medical School, Boston, MA, United States
(Wasfy) Divisions of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
Title
Reprising Ramadan-related angina pectoris: A potential strategy for risk
reduction.
Source
American Journal of Case Reports. 17 (pp 841-844), 2016. Date of
Publication: 10 Nov 2016.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Unusual clinical course Background: A preponderance of evidence
supports short-term aspirin usage to reduce transiently increased
cardiovascular risk in clinical conditions that promote acute myocardial
ischemia. Case Report: We report on the case of a 69-year-old male of
Muslim Indian heritage with multiple cardiovascular risk factors who
experienced the onset of angina pectoris while fasting for Ramadan for
more than 16 hours daily for 30 days in July 2015. While symptom free for
2 months on medical management after ending his fast, he underwent
quadruple coronary artery bypass surgery for severe 4-vessel disease
following an acute anterior myocardial infarction. A percutaneous coronary
intervention with stent placement was subsequently required for persistent
myocardial ischemia on stress-MIBI testing due to occlusion of the graft
to left anterior descending artery. Presently asymptomatic, he decided to
forgo fasting for Ramadan in June 2016. Conclusions: Based on this case,
measures for primary cardiovascular prevention among the 1.2 billion
susceptible males at similar high short-term cardiac risk while fasting
for Ramadan are proposed. The value of aspirin for attenuating high
short-term cardiovascular risk in clinical conditions conferring transient
inflammatory stress is considered. Low-dose aspirin usage at evening meals
while fasting for Ramadan is prudent for primary cardiovascular protection
of males who may have non-obstructive coronary atherosclerosis to mitigate
the risk for rupture of potentially vulnerable plaques. Based in part on
conclusive evidence for protection of middle-aged males from first
myocardial infarction in a randomized prospective primary prevention
trial, this measure is concordant with recommendations from sub-specialty
societies for primary cardiovascular prevention for persons at
above-average risk demonstrated by validated biomarkers and from the
United States Preventive Services Task Force. Copyright &#xa9; Am J Case
Rep.

<79>
Accession Number
613223949
Author
Poulin M.-F.; Deka A.; Mohamedali B.; Schaer G.L.
Institution
(Poulin) Division of Cardiovascular Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Deka, Mohamedali, Schaer) Division of Cardiology, Department of Medicine,
Rush University Medical Center, Chicago, IL, United States
Title
Clinical benefits of stem cells for chronic symptomatic systolic heart
failure: A systematic review of the existing data and ongoing trials.
Source
Cell Transplantation. 25 (11) (pp 1911-1923), 2016. Date of Publication:
2016.
Publisher
Cognizant Communication Corporation (3 Hartsdale Road, Elmsford NY
10523-3701, United States)
Abstract
The benefits of stem cell therapy for patients with chronic symptomatic
systolic heart failure due to ischemic and nonischemic cardiomyopathy (ICM
and NICM, respectively) are unclear. We performed a systematic review of
major published and ongoing trials of stem cell therapy for systolic heart
failure and compared measured clinical outcomes for both types of
cardiomyopathy. The majority of the 29 published studies demonstrated
clinical benefits of autologous bone marrow-derived mesenchymal stem cells
(BM-MSCs). Left ventricular ejection fraction (LVEF) was improved in the
majority of trials after therapy. Cell delivery combined with coronary
artery bypass grafting was associated with the greatest improvement in
LVEF. Left ventricular end-systolic volume (or diameter), New York Heart
Association functional classification, quality of life, and exercise
capacity were also improved in most studies after cell therapy. Most ICM
trials demonstrated a significant improvement in perfusion defects,
infarct size, and myocardial viability. Several larger clinical trials
that are in progress employ alternative delivery modes, cell types, and
longer follow-up periods. Stem cells are a promising therapeutic modality
for patients with heart failure due to ICM or NICM. More data are required
from larger blinded trials to determine which combination of cell type and
delivery mode will yield the most benefit with avoidance of harm in these
patient populations. Copyright &#xa9; 2016 Cognizant, LLC.

<80>
Accession Number
613217600
Author
Gerardin B.; Collet J.-P.; Mustafic H.; Bellemain-Appaix A.; Benamer H.;
Monsegu J.; Teiger E.; Livarek B.; Jaffry M.; Lamhaut L.; Fleischel C.;
Aubry P.
Institution
(Gerardin) Centre Chirurgical Marie Lannelongue, 133, avenue de la
resistance, Le-Plessis-Robinson-Paris 92350, France
(Collet) Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR-S 1166,
Institut de Cardiologie, PitieSalpetriere Hospital, AP-HP, Paris, France
(Mustafic) Hopital Universitaire de Geneve, rue Gabrielle Perret-Gentil,
Geneve 14 1211, Switzerland
(Bellemain-Appaix) Centre Hospitalier la Fontonne, 107 avenue de Nice,
Antibes 06600, France
(Benamer) Hopital Foch, 40 rue Worth, Suresnes 92151, France
(Monsegu) Groupe Hospitalier Mutualiste de Grenoble, 8, rue du Dr
Calmette, Grenoble 38000, France
(Teiger) Centre Hospitalo-universitaire Henri Mondor, 51 av du marechal de
Lattre de Tassigny, Creteil 94000, France
(Livarek) Hopital Andre Mignot, 177, rue de Versailles, Le Chesnay 78150,
France
(Jaffry, Lamhaut) SAMU 75: Hopital Necker, 149 Rue de Sevres, 75015 Paris,
France, France
(Fleischel) SAMU 92: Hopital de Garches, 104 boulevard Raymond Poincare,
Garches 92380, France
(Aubry) Centre Hospitalo-universitaire Bichat - Claude Bernard, 46 rue
Huchard, Paris 75018, France
Title
Registry on acute cardiovascular events during endurance running races:
The prospective RACE Paris registry.
Source
European Heart Journal. 37 (32) (pp 2531-2541), 2016. Date of Publication:
21 Aug 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aim: Long distance running races are associated with a low risk of
life-threatening events much often attributed to hypertrophic
cardiomyopathy. However, retrospective analyses of aetiology lack
consistency. Methods and results: Incidence and aetiology of
life-threatening/fatal events were assessed in long distance races in the
prospective Registre des Accidents Cardiaques lors des courses d'Endurance
(RACE Paris Registry) from October 2006 to September 2012. Characteristics
of life-threatening/fatal events were analysed by interviewing survivors
and reviewing medical records including post-mortem data of each case.
Seventeen life-threatening events were identified of 511 880 runners of
which two were fatal. The vast majority were cardiovascular events (13/17)
occurring in experienced male runners [mean (+/-SD) age 43 +/- 10 years],
with infrequent cardiovascular risk factors, atypical warning symptoms
prior to the race or negative treadmill test when performed. Acute
myocardial ischaemia was the predominant aetiology (8 of 13) and led to
immediate myocardial revascularization. All cases with initial shockable
rhythm survived. There was no difference in event rate according to
marathons vs. half-marathons and events were clustered at the end of the
race. A meta-analysis of all available studies including the RACE Paris
registry (n = 6) demonstrated a low prevalence of life-threatening events
(0.75/100 000) and that presentation with non-shockable rhythm [OR = 29.9;
95% CI (4.0-222.5), P = 0.001] or non-ischaemic aetiology [OR = 6.4; 95%
CI (1.4-28.8), P = 0.015] were associated with case-fatality. Conclusion:
Life-threatening/fatal events during long distance races are rare, most
often unpredictable and mainly due to acute myocardial ischaemia.
Presentation with non-shockable rhythm and non-ischaemic aetiology are the
major determinant of case fatality. Published on behalf of the European
Society of Cardiology. All rights reserved. Copyright &#xa9; 2015 The
Author.

<81>
Accession Number
613216272
Author
Arora S.; Misenheimer J.A.; Jones W.; Bahekar A.; Caughey M.; Ramm C.J.;
Caranasos T.G.; Yeung M.; Vavalle J.P.
Institution
(Arora, Jones) Campbell University School of Osteopathic Medicine, 212
Aldenwood Place, Apex, NC 27539, United States
(Arora, Bahekar) Cape Fear Valley Medical Center, Fayetteville, NC, United
States
(Misenheimer, Caughey, Ramm, Caranasos, Yeung, Vavalle) University of
North Carolina, Chapel Hill, NC, United States
Title
Transcatheter versus surgical aortic valve replacement in intermediate
risk patients: A meta-Analysis.
Source
Cardiovascular Diagnosis and Therapy. 6 (3) (pp 241-249), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved in patients with high or prohibited surgical risk for surgery for
treatment of severe symptomatic aortic stenosis. Prospective studies
examining the benefits of TAVR in intermediate risk patients are ongoing.
Other smaller studies including lower risk patients have been conducted,
but further meta-Analysis of these studies is required to draw more broad
comparisons. Methods: A Medline search was conducted using standard
methodology to search for clinical trials and observational studies
including intermediate risk patients. We limited our meta-Analysis to
studies matching patient populations by propensity scores or randomization
and examined clinical outcomes between TAVR and surgical aortic valve
replacement (SAVR). Results: Analysis of the TAVR and SAVR cohorts
revealed no significant differences in the outcomes of 30-day [OR (95%
CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75,
1.23)]. A trend towards benefit with TAVR was noted in terms of
neurological events and myocardial infarction (MI) without statistical
significance. A statistically significant decrease in risk of
post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52
(0.27, 0.99)] was observed, but so was a significantly higher rate of
pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23,
13.12)]. Conclusions: We conclude that in intermediate risk patients
undergoing aortic valve replacement, the risk of mortality, neurological
outcomes, and MI do not appear to be significantly different between TAVR
and SAVR. However, there appears to be a significant reduction in risk of
acute renal failure at the expense of an increased risk of requiring a
permanent pacemaker in low and intermediate risk patients undergoing TAVR
compared to SAVR. Copyright &#xa9; Cardiovascular Diagnosis and Therapy.
All rights reserved.

<82>
Accession Number
613203890
Author
Rauch B.; Davos C.H.; Doherty P.; Saure D.; Metzendorf M.-I.; Salzwedel
A.; Voller H.; Jensen K.; Schmid J.-P.
Institution
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Bremserstr. 79,
Haus M, Ludwigshafen am Rhein D-67063, Germany
(Davos) Cardiovascular Research Laboratory, Biomedical Research
Foundation, Academy of Athens, Greece
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Saure, Jensen) Institute of Medical Biometry and Informatics (IMBI),
University of Heidelberg, Germany
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Institute
of General Practice, University of Dusseldorf, Germany
(Salzwedel, Voller) Centre of Rehabilitation Research, University of
Potsdam, Germany
(Schmid) Department of Cardiology Spital Tiefenau, Switzerland
Title
The prognostic effect of cardiac rehabilitation in the era of acute
revascularisation and statin therapy: A systematic review and
meta-analysis of randomized and non-randomized studies - The Cardiac
Rehabilitation Outcome Study (CROS).
Source
European Journal of Preventive Cardiology. 23 (18) (pp 1914-1939), 2016.
Date of Publication: 01 Dec 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The prognostic effect of multi-component cardiac rehabilitation
(CR) in the modern era of statins and acute revascularisation remains
controversial. Focusing on actual clinical practice, the aim was to
evaluate the effect of CR on total mortality and other clinical endpoints
after an acute coronary event. Design Structured review and meta-analysis.
Methods Randomised controlled trials (RCTs), retrospective controlled
cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs)
evaluating patients after acute coronary syndrome (ACS), coronary artery
bypass grafting (CABG) or mixed populations with coronary artery disease
(CAD) were included, provided the index event was in 1995 or later.
Results Out of n = 18,534 abstracts, 25 studies were identified for final
evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702
patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed
populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in
design, biometrical assessment of results and potential confounders was
evident. CCSs evaluating ACS patients showed a significantly reduced
mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95%
confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds
ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac
Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral
results. CR participation was also associated with reduced mortality after
CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations.
Conclusions CR participation after ACS and CABG is associated with reduced
mortality even in the modern era of CAD treatment. However, the
heterogeneity of study designs and CR programmes highlights the need for
defining internationally accepted standards in CR delivery and scientific
evaluation. Copyright &#xa9; European Society of Cardiology.

<83>
Accession Number
613198250
Author
Shin D.-H.; Hong S.-J.; Mintz G.S.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Hong M.-K.
Institution
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Department of Internal Medicine,
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul,
South Korea
(Hong) Department of Internal Medicine, Sanggye Paik Hospital, Inje
University, Seoul, South Korea
(Mintz) Cardiovascular Research Foundation, New York, New York, United
States
(Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Effects of Intravascular Ultrasound-Guided Versus Angiography-Guided
New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With
Individual Patient-Level Data From 2,345 Randomized Patients.
Source
JACC: Cardiovascular Interventions. 9 (21) (pp 2232-2239), 2016. Date of
Publication: 14 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to evaluate the clinical usefulness
of intravascular ultrasound (IVUS)-guided new-generation drug-eluting
stent (DES) implantation using a meta-analysis of individual patient-level
data from randomized trials. Background Published randomized trials that
compare IVUS-guided versus angiography-guided new-generation DES
implantation are scarce. Methods Searches of the MEDLINE, Embase, and
Cochrane databases were performed to find randomized trials that compared
IVUS-guided versus angiography-guided new-generation DES implantation. A
total of 2,345 patients from 3 randomized trials were identified, and all
patients were treated for long lesions or chronic total occlusions.
Individual patient-level data were obtained. The primary endpoint was a
major adverse cardiac event, a composite of cardiac death, myocardial
infarction, or stent thrombosis. An intention-to-treat analysis and per
protocol analysis were performed. Results By 1 year post-procedure, major
adverse cardiac events had occurred in 0.4% of the patients who underwent
IVUS-guided DES implantation versus 1.2% of those who underwent
angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95%
confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided
group, favorable clinical outcomes were observed for myocardial infarction
(0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of
IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI:
0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance,
IVUS-guided new-generation DES implantation was associated with favorable
outcomes in terms of major adverse cardiac events, the composite of
cardiac death, myocardial infarction, or stent thrombosis. These findings
must be interpreted only for complex lesions, because all identified
patients had long lesions or chronic total occlusions. Copyright &#xa9;
2016 American College of Cardiology Foundation

<84>
Accession Number
613197549
Author
Kim D.H.; Kim C.A.; Placide S.; Lipsitz L.A.; Marcantonio E.R.
Institution
(Kim, Kim, Lipsitz) Beth Israel Deaconess Medical Center, 110 Francis
Street, Boston, MA 02215, United States
(Placide) Albert Einstein College of Medicine, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Marcantonio) Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United
States
Title
Preoperative frailty assessment and outcomes at 6 months or later in older
adults undergoing cardiac surgical procedures: A systematic review.
Source
Annals of Internal Medicine. 165 (9) (pp 650-660), 2016. Date of
Publication: 01 Nov 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Frailty assessment may inform surgical risk and prognosis not
captured by conventional surgical risk scores. Purpose: To evaluate the
evidence for various frailty instruments used to predict mortality,
functional status, or major adverse cardiovascular and cerebrovascular
events (MACCEs) in older adults undergoing cardiac surgical procedures.
Data Sources: MEDLINE and EMBASE (without language restrictions), from
their inception to 2 May 2016. Study Selection: Cohort studies evaluating
the association between frailty and mortality or functional status at 6
months or later in patients aged 60 years or older undergoing major or
minimally invasive cardiac surgical procedures. Data Extraction: 2
reviewers independently extracted study data and assessed study quality.
Data Synthesis: Mobility, disability, and nutrition were frequently
assessed domains of frailty in both types of procedures. In patients
undergoing major procedures (n = 18 388; 8 studies), 9 frailty instruments
were evaluated. There was moderate-quality evidence to assess mobility or
disability and very-low-to lowquality evidence for using a multicomponent
instrument to predict mortality or MACCEs. No studies examined functional
status. In patients undergoing minimally invasive procedures (n = 5177; 17
studies), 13 frailty instruments were evaluated. There was moderate-to
high-quality evidence for assessing mobility to predict mortality or
functional status. Several multicomponent instruments predicted mortality,
functional status, or MACCEs, but the quality of evidence was low to
moderate. Multicomponent instruments that measure different frailty
domains seemed to outperform single-component ones. Limitation:
Heterogeneity of frailty assessment, limited generalizability of
multicomponent frailty instruments, few validated frailty instruments, and
potential publication bias. Conclusion: Frailty status, assessed by
mobility, disability, and nutritional status, may predict mortality at 6
months or later after major cardiac surgical procedures and functional
decline after minimally invasive cardiac surgery. Copyright &#xa9; 2016
American College of Physicians.

<85>
Accession Number
613196284
Author
Lotfi A.S.; Eftekhari H.; Atreya A.R.; Kashikar A.; Sivalingam S.K.;
Giannoni M.; Visintainer P.; Engelman D.
Institution
(Lotfi, Eftekhari, Atreya, Sivalingam, Giannoni) Department of Cardiology,
Baystate Medical Center, Tufts University School of Medicine, Springfield,
MA 01199, United States
(Kashikar) Department of Anesthesiology, Baystate Medical Center, Tufts
University School of Medicine, Springfield, MA 01199, United States
(Visintainer) Department of Epidemiology and Biostatistics, Baystate
Medical Center, Tufts University School of Medicine, Springfield, MA
01199, United States
(Engelman) Department of Cardiac Surgery, Baystate Medical Center, Tufts
University School of Medicine, Springfield, MA 01199, United States
Title
Randomized controlled trial of remote ischemic preconditioning and atrial
fibrillation in patients undergoing cardiac surgery.
Source
World Journal of Cardiology. 8 (10) (pp 615-622), 2016. Date of
Publication: 2016.
Publisher
Baishideng Publishing Group Co (E-mail: bpg@baishideng.com)
Abstract
AIM To study whether remote ischemic preconditioning (RIPC) has an impact
on clinical outcomes, such as post-operative atrial fibrillation (POAF).
METHODS This was a prospective, single-center, single-blinded,randomized
controlled study. One hundred and two patients were randomized to receive
RIPC (3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm
after induction of anesthesia) or no RIPC (control). Primary outcome was
POAF lasting for five minutes or longer during the first seven days after
surgery. Secondary outcomes included length of hospital stay, incidence of
inpatient mortality, myocardial infarction, and stroke. RESULTS POAF
occurred at a rate of 54% in the RIPC group and 41.2% in the control group
(P = 0.23). No statistically significant differences were noted in
secondary outcomes between the two groups. CONCLUSION This is the first
study in the United States to suggest that RIPC does not reduce POAF in
patients with elective or urgent cardiac surgery. There were no
differences in adverse effects in either group. Further studies are
required to assess the relationship between RIPC and POAF. Copyright
&#xa9; 2016 Baishideng Publishing Group Inc. All rights reserved.

<86>
Accession Number
613193257
Author
Abd-Allah A.H.; El-Rahman Mohamed A.A.; Amin S.M.; Selim S.; Allam M.
Institution
(Abd-Allah, El-Rahman Mohamed, Amin, Allam) Department of Cardiothoracic
Surgery, Faculty of Medicine, Cairo University, Egypt
(Selim) Department of Chest Diseases, Faculty of Medicine, Cairo
University, Egypt
Title
Immediate pulmonary dysfunction in ischemic heart disease patients
undergoing off-pump versus on-pump CABG.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (1) (pp
15-20), 2016. Date of Publication: 01 May 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Many studies have shown important changes in lung function
tests after coronary artery surgeries. It is controversial if off-pump
surgery can give a better and shorter recovery than the on-pump. The aim
of this work was to study immediate early pulmonary dysfunction in
ischemic heart disease patients undergoing off-pump versus on-pump
coronary artery bypass grafting (CABG) in order to evaluate pulmonary
dysfunction caused by cardio-pulmonary bypass (CPB) in patients undergoing
on-pump CABG. Patients and method: A prospective randomized study was
carried out on 40 patients submitted to coronary artery surgery at Kasr
El-Aini University Hospital, Cairo, Egypt. They were randomly divided into
two groups; group A: 20 patients undergoing CABG using heart-lung machine
(on-pump), and group B: 20 patients undergoing off-pump CABG. All patients
had: spirometric evaluation, 6 min walk test pre-operatively and at the
post-operative fifth day. Measurement of arterial blood gases (ABGs) and
calculation of P/F ratio was recorded pre-operative, post-induction and
post CABG. Post-operative intensive care unit (ICU) events were also
assessed. Results: Post-operative spirometric data and 6 min walk distance
decreased in both groups, when compared to pre-operative values, with
significant differences between the two groups. No significant reduction
in arterial oxygen pressure (PaO2), carbon dioxide pressure
(PaCO<inf>2</inf>) and P/F Ratio occurred post-operatively. Conclusion:
Pulmonary functions deteriorate significantly after coronary artery
revascularization with and without CPB, but to a significant greater
reduction among those on-pump than among those off-pump surgeries.
Copyright &#xa9; 2016, The Egyptian Society of Cardio-thoracic Surgery.

<87>
Accession Number
613103366
Author
McClure G.R.; Belley-Cote E.P.; Singal R.K.; Jaffer I.H.; Dvirnik N.; An
K.R.; Fortin G.; Spence J.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Dvirnik, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Singal) Department of Surgery, University of Manitoba, Manitoba, ON,
Canada
(Singal) I.H. Asper Clinical Research Institute, Winnipeg, MB, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, Hamilton, ON, Canada
(Jaffer, Dvirnik, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
Title
Surgical ablation of atrial fibrillation: A protocol for a systematic
review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 6 (11) (no pagination), 2016. Article Number: e013273. Date of
Publication: 01 Nov 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Atrial fibrillation (AF) affects 10% of patients undergoing
cardiac surgery and is an independent risk factor for all-cause mortality,
ischaemic stroke and heart failure. Surgical AF ablation has been shown to
significantly improve maintenance of sinus rhythm, however, small to
medium size trials conducted to date lack the power required to assess
patient-important outcomes such as mortality, stroke, heart failure and
health-related quality of life. Moreover, a recent randomised trial (RCT)
suggested harm by surgical AF ablation with an almost threefold increase
in the requirement for permanent pacemaker postablation. We aim to perform
a systematic review and meta-analysis to evaluate efficacy and safety of
surgical AF ablation compared to no surgical ablation. Methods and
analysis: We will search Cochrane CENTRAL, MEDLINE and EMBASE for RCTs
evaluating the use of surgical AF ablation, including any lesion set,
versus no surgical AF ablation in adults with AF undergoing any type of
cardiac surgery. Outcomes of interest include mortality, embolic events,
quality of life, rehospitalisation, freedom from AF and adverse events,
including need for pacemaker and worsening heart failure. Independently
and in duplicate, reviewers will screen references, assess eligibility of
potentially relevant studies using predefined eligibility criteria and
collect data using prepiloted forms. We will pool data using a random
effects model and present results as relative risk with 95% CIs for
dichotomous outcomes and as mean difference with 95% CI for continuous
outcomes. We will assess risk of bias using the Cochrane Collaboration
tool, and quality of evidence with the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach. Ethics and
dissemination: Our results will help guide clinical practice by providing
the most comprehensive analysis of risks and benefits associated with the
procedure. Our results will be disseminated through publication in
peer-reviewed journals and conference presentations.

<88>
Accession Number
613193237
Author
Qulisy E.A.; Fakiha A.; Debis R.S.; Jamjoom A.A.; Elassal A.A.; Al-Radi
O.O.
Institution
(Qulisy, Fakiha, Debis, Elassal, Al-Radi) Abdullah Bakhsh Children's Heart
Center, Department of Surgery, Faculty of Medicine, King Abdulaziz
University, Jeddah, Saudi Arabia
(Jamjoom, Al-Radi) Division of Cardiovascular Surgery, The Cardiovascular
Department, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
(Elassal) Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig
University, Zagazig, Egypt
Title
Custodiol versus blood cardioplegia in pediatric cardiac surgery,
two-center study.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (1) (pp
38-42), 2016. Date of Publication: 01 May 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Cold blood cardioplegia is widely used as a method of
myocardial protection in pediatric cardiac surgery. Operative interruption
to administer cardioplegia and need for repeated administration and
occasional direct coronary ostial cannulation are considered a drawbacks
of this technique. Custodiol, a crystalloid solution, has been used in
children as an alternative cardioplegia solution with the potential
advantage of single dose administration with equivalent myocardial
protection. We sought to compare the outcomes of cold blood cardioplegia
versus Custodiol cardioplegia in pediatric cardiac surgery. Methods: A
retrospective cohort study was performed between November 1st, 2013 and
June 30th, 2014. All children who underwent heart surgery at two
institutions with the use of cardiopulmonary bypass and cardioplegia were
included. Patients were identified from a prospective database and
additional data were collected from operative report and electronic and
paper charts. Continuous data were represented as median and interquartile
range, and tested withWilcoxon rank-sum test. Categorical data were
represented as proportions, and tested with Pearson test. A composite
endpoint of all cause death, Low Cardiac Output Syndrome (LCOS), Acute
Kidney Injury (AKI), and significant arrhythmia was analyzed with a
multiple logistic regression model adjusted for complexity using the Risk
Adjustment of Congenital Heart Surgery-1 (RACHS-1) categories. A p-value
of less than 0.05 was considered to be significant. Results: Blood
cardioplegia was administered in 88 (57.1%) patients, and Custodiol
cardioplegia was administered in 66 (42.9%) patients according to
surgeon's preference. In the risk adjusted comparison of the composite
outcome of all-cause death, LCOS, AKI and significant arrhythmia,
Custodiol cardioplegia was found to be an independent predictor of an
adverse outcome, OR 3.17 (95% CI 1.41-7.14, P-value = 0.0054).
Conclusions: Custodial cardioplegia is associated with less optimal
myocardial protection and higher adverse outcomes compared to cold blood
cardioplegia in children undergoing cardiac surgery. A randomized
comparison is warranted. Copyright &#xa9; 2016, The Egyptian Society of
Cardio-thoracic Surgery.

<89>
Accession Number
613254036
Author
Collins R.; Reith C.; Emberson J.; Armitage J.; Baigent C.; Blackwell L.;
Blumenthal R.; Danesh J.; Smith G.D.; DeMets D.; Evans S.; Law M.;
MacMahon S.; Martin S.; Neal B.; Poulter N.; Preiss D.; Ridker P.; Roberts
I.; Rodgers A.; Sandercock P.; Schulz K.; Sever P.; Simes J.; Smeeth L.;
Wald N.; Yusuf S.; Peto R.
Institution
(Collins, Reith, Emberson, Armitage, Baigent, Blackwell, Preiss, Peto)
Clinical Trial Service Unit and Epidemiological Studies Unit and MRC
Population Health Research Unit, Nuffield Department of Population Health,
University of Oxford, Oxford, UK
(Blumenthal, Martin) Ciccarone Center for the Prevention of Heart Disease,
Division of Cardiology, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
(Danesh) MRC/BHF Cardiovascular Epidemiology Unit, Department of Public
Health and Primary Care, University of Cambridge, Cambridge, UK
(Smith) MRC Integrative Epidemiology Unit, University of Bristol, Bristol,
UK
(DeMets) Department of Biostatistics and Medical Informatics, University
of Wisconsin, Madison, WI, USA
(Evans) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, University of London, London, UK
(Roberts) Clinical Trials Unit, London School of Hygiene and Tropical
Medicine, University of London, London, UK
(Smeeth) Department of Non-Communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, University of London, London, UK
(Law, Wald) Wolfson Institute of Preventive Medicine, Barts and The London
School of Medicine and Dentistry, Queen Mary University of London, London,
UK
(MacMahon, Neal, Rodgers) The George Institute for Global Health,
University of Sydney, Sydney, Australia
(Simes) National Health and Medical Research Council Clinical Trial
Centre, University of Sydney, Sydney, Australia
(Poulter) International Centre for Circulatory Health and Imperial
Clinical Trials Unit, Imperial College London, London, UK
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, UK
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, USA
(Sandercock) Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
(Schulz) University of North Carolina School of Medicine, University of
North Carolina, Chapel Hill, NC, USA
(Yusuf) Hamilton Health Sciences and McMaster University, Hamilton, ON,
Canada
Title
Interpretation of the evidence for the efficacy and safety of statin
therapy.
Source
The Lancet. (no pagination), 2016. Date of Publication: 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
This Review is intended to help clinicians, patients, and the public make
informed decisions about statin therapy for the prevention of heart
attacks and strokes. It explains how the evidence that is available from
randomised controlled trials yields reliable information about both the
efficacy and safety of statin therapy. In addition, it discusses how
claims that statins commonly cause adverse effects reflect a failure to
recognise the limitations of other sources of evidence about the effects
of treatment. Large-scale evidence from randomised trials shows that
statin therapy reduces the risk of major vascular events (ie, coronary
deaths or myocardial infarctions, strokes, and coronary revascularisation
procedures) by about one-quarter for . each mmol/L reduction in LDL
cholesterol during . each year (after the first) that it continues to be
taken. The absolute benefits of statin therapy depend on an individual's
absolute risk of occlusive vascular events and the absolute reduction in
LDL cholesterol that is achieved. For example, lowering LDL cholesterol by
2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg,
atorvastatin 40 mg daily, costing about 2 per month) for 5 years in 10 000
patients would typically prevent major vascular events from occurring in
about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive
vascular disease (secondary prevention) and in 500 patients (ie, 5%
absolute benefit) who are at increased risk but have not yet had a
vascular event (primary prevention). Statin therapy has been shown to
reduce vascular disease risk during each year it continues to be taken, so
larger absolute benefits would accrue with more prolonged therapy, and
these benefits persist long term. The only serious adverse events that
have been shown to be caused by long-term statin therapy-ie, adverse .
effects of the statin-are myopathy (defined as muscle pain or weakness
combined with large increases in blood concentrations of creatine kinase),
new-onset diabetes mellitus, and, probably, haemorrhagic stroke.
Typically, treatment of 10 000 patients for 5 years with an effective
regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of
myopathy (one of which might progress, if the statin therapy is not
stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases
of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of
these side-effects on major vascular events has already been taken into
account in the estimates of the absolute benefits. Statin therapy may
cause symptomatic adverse events (eg, muscle pain or weakness) in up to
about 50-100 patients (ie, 0.5-1.0% absolute harm) per 10 000 treated for
5 years. However, placebo-controlled randomised trials have shown
definitively that almost all of the symptomatic adverse events that are
attributed to statin therapy in routine practice are not actually caused
by it (ie, they represent misattribution). The large-scale evidence
available from randomised trials also indicates that it is unlikely that
large absolute excesses in other serious adverse events still await
discovery. Consequently, any further findings that emerge about the
effects of statin therapy would not be expected to alter materially the
balance of benefits and harms. It is, therefore, of concern that
exaggerated claims about side-effect rates with statin therapy may be
responsible for its under-use among individuals at increased risk of
cardiovascular events. For, whereas the rare cases of myopathy and any
muscle-related symptoms that are attributed to statin therapy generally
resolve rapidly when treatment is stopped, the heart attacks or strokes
that may occur if statin therapy is stopped unnecessarily can be
devastating. Copyright &#xa9; 2016 Elsevier Ltd.

<90>
Accession Number
613247585
Author
Hajjar L.A.; Vincent J.L.; Gomes Galas F.R.B.; Rhodes A.; Landoni G.;
Osawa E.A.; Melo R.R.; Sundin M.R.; Grande S.M.; Gaiotto F.A.;
Pomerantzeff P.M.; Dallan L.O.; Franco R.A.; Nakamura R.E.; Lisboa L.A.;
de Almeida J.P.; Gerent A.M.; Souza D.H.; Gaiane M.A.; Fukushima J.T.;
Park C.L.; Zambolim C.; Rocha Ferreira G.S.; Strabelli T.M.; Fernandes
F.L.; Camara L.; Zeferino S.; Santos V.G.; Piccioni M.A.; Jatene F.B.;
Costa Auler J.O.; Filho R.K.
Institution
(Hajjar) From the Surgical Intensive Care Unit, Department of
Cardiopneumology (L.A.H., F.R.B.G.G., E.A.O., R.R.M., M.R.S., S.M.G.,
R.A.F., R.E.N., J.P.d.A., A.M.G., D.H.S., M.A.G., J.T.F., C.L.P., C.Z.,
G.S.R.F., F.L.F., L.C., S.Z., V.G.S.P., M.A.P., J.O.C.A.) and Divisions of
Cardiovascular Surgery (F.A.G., P.M.P., L.O.D., L.A.L., F.B.J.),
Infectious Diseases (T.M.S.), and Cardiology (R.K.F.), Heart Institute
(InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de
Sao Paulo, Sao Paulo, Brazil; Department of Intensive Care, Erasme
University Hospital, Universite de Bruxelles, Brussels, Belgium (J.L.V.);
Department of Intensive Care Medicine, St George's Healthcare NHS Trust
and St George's University of London, London, United Kingdom (A.R.);
Department of Anes
Title
Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock After
Cardiac Surgery: The VANCS Randomized Controlled Trial.
Source
Anesthesiology. (no pagination), 2016. Date of Publication: 11 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Vasoplegic syndrome is a common complication after cardiac
surgery and impacts negatively on patient outcomes. The objective of this
study was to evaluate whether vasopressin is superior to norepinephrine in
reducing postoperative complications in patients with vasoplegic syndrome.
METHODS:: This prospective, randomized, double-blind trial was conducted
at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil,
between January 2012 and March 2014. Patients with vasoplegic shock
(defined as mean arterial pressure less than 65 mmHg resistant to fluid
challenge and cardiac index greater than 2.2 l . min . m) after cardiac
surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or
norepinephrine (10 to 60 mug/min) to maintain arterial pressure. The
primary endpoint was a composite of mortality or severe complications
(stroke, requirement for mechanical ventilation for longer than 48 h, deep
sternal wound infection, reoperation, or acute renal failure) within 30
days. RESULTS:: A total of 330 patients were randomized, and 300 were
infused with one of the study drugs (vasopressin, 149; norepinephrine,
151). The primary outcome occurred in 32% of the vasopressin patients and
in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95%
CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found
a lower occurrence of atrial fibrillation in the vasopressin group (63.8%
vs. 82.1%; P = 0.0004) and no difference between groups in the rates of
digital ischemia, mesenteric ischemia, hyponatremia, and myocardial
infarction. CONCLUSIONS:: The authors' results suggest that vasopressin
can be used as a first-line vasopressor agent in postcardiac surgery
vasoplegic shock and improves clinical outcomes. Copyright &#xa9; by 2016,
the American Society of Anesthesiologists, Inc. Wolters Kluwer Health,
Inc. All Rights Reserved.

<91>
Accession Number
613247537
Author
Basaran O.; Dogan V.; Beton O.; Tekinalp M.; Aykan A.C.; Kalaycioglu E.;
Bolat I.; Tasar O.; Safak O.; Kalcik M.; Yaman M.; Inci S.; Altintas B.;
Kalkan S.; Kirma C.; Biteker M.; Karadeniz F.O.; Tekkesin A.I.; Cakilli
Y.; Turkkan C.; Hamidi M.; Demir V.; Gursoy M.O.; Ozturk M.T.; Aksan G.;
Seyis S.; Balli M.; Alici M.H.; Bozyel S.; Altun I.; Calik F.; Karaca O.;
Helvaci F.; Akay K.; Canga Y.; Celebi S.; Altuntas E.; Ayturk M.; Gunes
H.M.; Bezgin T.; Aksakal A.; Cakal B.; Colak A.; Kaplan O.; Tatlisu A.;
Gozubuyuk G.; Demirelli S.; Kaya A.; Rencuzogullari I.; Bayram Z.; Simsek
Z.; Civan M.; Batgharel U.; Ata A.E.; Gol G.; Mert G.O.; Mert K.U.;
Degirmencioglu A.; Candan O.; Celebi O.O.; Dogan C.; Yavuz F.; Ulucan S.;
Arisoy A.; Sahin B.D.; Ermis E.; Gokaslan S.; Pektas I.; Tanindi A.; Tekin
K.; Sancar K.M.; Cekic E.G.; Basaran N.F.
Institution
(Basaran, Dogan, Biteker) Department of Cardiology, Faculty of Medicine,
Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Ozsoy
Cad., Mugla 48000, Turkey
(Beton) Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet
University, Sivas, Turkey
(Tekinalp) Department of Cardiology, Kahramanmaras Necip Fazil State
Hospital, Kahramanmaras, Turkey
(Aykan, Kalaycioglu) Department of Cardiology, Trabzon Ahi Evren Chest
Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
(Bolat) Department of Cardiology, Fethiye State Hospital, Mugla, Turkey
(Tasar) Department of Cardiology, Elazig Education and Research Hospital,
Elazig, Turkey
(Safak) Department of Cardiology, Burdur State Hospital, Burdur, Turkey
(Kalcik) Department of Cardiology, Iskilip Atif Hoca State Hospital,
Iskilip, Turkey
(Yaman) Department of Cardiology, Samsun Education and Research Hospital,
Samsun, Turkey
(Inci) Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
(Altintas) Department of Cardiology, Diyarbakir Gazi Yasargil Education
and Research Hospital, Diyarbakir, Turkey
(Kalkan) Department of Cardiology, Gonen State Hospital, Gonen, Turkey
(Kirma) Kartal Kosuyolu Heart Education and Research Hospital, Istanbul,
Turkey
Title
Impact of valvular heart disease on oral anticoagulant therapy in
non-valvular atrial fibrillation: results from the RAMSES study.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-9), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The definition of non-valvular atrial fibrillation (NVAF) is
controversial. We aimed to assess the impact of valvular heart disease on
stroke prevention strategies in NVAF patients. The RAMSES study was a
multicenter and cross-sectional study conducted on NVAF patients
(ClinicalTrials.gov identifier NCT02344901). The study population was
divided into patients with significant valvular disease (SVD) and
non-significant valvular disease (NSVD), whether they had at least one
moderate valvular disease or not. Patients with a mechanical prosthetic
valve and mitral stenosis were excluded. Baseline characteristics and oral
anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF,
there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant
valvular disease was mitral regurgitation (58.1%), followed by aortic
regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had
higher CHA<inf>2</inf>DS<inf>2</inf>VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0;
5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p =
0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of
NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035).
When the patients with SVD were analyzed separately, the mean
CHA<inf>2</inf>DS<inf>2</inf>VASc and HAS-BLED scores were higher in
patients with mitral regurgitation compared to patients with aortic
regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0
(2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p
< 0.001, respectively]. In patients with SVD, 65.7% of mitral
regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis
patients were on OAC therapy. One out of three NVAF patients had at least
one moderate valvular heart disease with the predominance of mitral
regurgitation. Patients with SVD were at greater risk of stroke and
bleeding compared to patients with NSVD. Although patients with mitral
regurgitation should be given more aggressive anticoagulant therapy due to
their higher risk of stroke, they are undertreated compared to patients
with aortic valve diseases. Copyright &#xa9; 2016 Springer
Science+Business Media New York

<92>
Accession Number
613228302
Author
Hallifax R.J.; Yousuf A.; Jones H.E.; Corcoran J.P.; Psallidas I.; Rahman
N.M.
Institution
(Hallifax, Yousuf, Corcoran, Psallidas, Rahman) Oxford Centre for
Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
(Jones) Faculty of Health Sciences, School of Social and Community
Medicine, University of Bristol, Bristol, UK
Title
Effectiveness of chemical pleurodesis in spontaneous pneumothorax
recurrence prevention: A systematic review.
Source
Thorax. (no pagination), 2016. Date of Publication: November 01, 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Spontaneous pneumothorax is a common pathology. International
guidelines suggest pleurodesis for non-resolving air leak or recurrence
prevention at second occurrence. This study comprehensively reviews the
existing literature regarding chemical pleurodesis efficacy. Design We
systematically reviewed the literature to identify relevant randomised
controlled trials (RCTs), case-control studies and case series. We
described the findings of these studies and tabulated relative recurrence
rates or ORs (in studies with control groups). Meta-analysis was not
performed due to substantial clinical heterogeneity. Results Of 560
abstracts identified by our search strategy, 50 were included in our
systematic review following screening. Recurrence rates in patients with
chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc
poudrage (four studies (n=249)) provided recurrence rates of between 2.5%
and 10.2% with the only RCT suggesting an OR of 0.10 compared with
drainage alone. In comparison, talc administration during video-assisted
thoracic surgery (VATS) from eight studies (n=2324) recurrence was between
0.0% and 3.2%, but the RCT did not demonstrate a significant difference
compared with bleb/bullectomy alone. Minocycline appears similarly
effective post-VATS (recurrence rates 0.0-2.9%). Prolonged air leak and
recurrence prevention using tetracycline via chest drain (n=726) is likely
to provide recurrence rates between 13.0% and 33.3% and autologous blood
patch pleurodesis (n=270) between 15.6% and 18.2%. Conclusions Chemical
pleurodesis postsurgical treatment or via thoracoscopy appears to be most
effective. Evidence for definitive success rates of each agent is limited
by the small number of randomised trials or other comparative studies.
Copyright &#xa9; 2016 BMJ Publishing Group Ltd & British Thoracic Society.

<93>
Accession Number
613224245
Author
Vakil K.; Duval S.; Cogswell R.; Eckman P.; Levy W.C.; Anand I.; Dardas
T.; Adabag S.
Institution
(Vakil, Anand, Adabag) Cardiovascular Division, Veterans Affairs Medical
Center, Minneapolis, Minnesota
(Vakil, Duval, Cogswell, Anand, Adabag) Cardiovascular Division,
University of Minnesota Medical School, Minneapolis, Minnesota
(Eckman) Division of Cardiology, Minneapolis Heart Institute, Minneapolis,
Minnesota
(Levy, Dardas) Division of Cardiology, University of Washington, Seattle,
Washington
Title
Impact of Implantable Cardioverter-Defibrillators on Waitlist Mortality
Among Patients Awaiting Heart Transplantation. An UNOS/OPTN Analysis.
Source
JACC: Clinical Electrophysiology. (no pagination), 2016. Date of
Publication: April 12, 2016.
Publisher
Elsevier Inc
Abstract
Objectives: This study sought to assess the impact of implantable
cardioverter-defibrillators (ICDs) on waitlist mortality in patients
listed for heart transplantation (HT). Background: The impact of ICDs on
preventing sudden cardiac death in patients awaiting HT has not been
studied in large multicenter cohorts. Furthermore, whether ICDs benefit
patients with a left ventricular assist device (LVAD) is unknown. Methods:
Adults (age >18 years) listed for first-time HT in the United States
between January 1, 1999, and September 30, 2014, were retrospectively
identified from the United Network for Organ Sharing registry. The primary
predictor variable was the presence of an ICD at the time of listing.
Primary outcome variable was all-cause waitlist mortality. Results: Data
on 32,599 patients (mean age 53 +/- 12 years, 77% male, 70% Caucasian)
were analyzed. During median follow-up of 154 days, 3,638 patients (11%)
died on the waitlist (9% in ICD group vs. 15% in no-ICD group; p <
0.0001), whereas 63% underwent HT. Having an ICD at listing was associated
with an adjusted 13% relative reduction in mortality (hazard ratio: 0.87;
95% confidence interval: 0.80 to 0.94). In the subgroup of patients with
LVAD (n = 9,478), having an ICD was associated with an adjusted 19%
relative reduction in mortality (hazard ratio: 0.81; 95% confidence
interval: 0.70 to 0.94). Conclusions: ICD use was associated with improved
survival on the HT waitlist in patients with or without LVADs. These
findings strengthen the current guideline recommendations of using ICDs in
nonhospitalized patients awaiting HT and provide new insight into the
effectiveness of ICDs on survival in LVAD-supported patients. Copyright
&#xa9; 2016 American College of Cardiology Foundation.

<94>
Accession Number
613216203
Author
Burrage M.; Moore P.; Cole C.; Cox S.; Lo W.C.; Rafter A.; Garlick B.;
Garrahy P.; Mundy J.; Camuglia A.
Institution
(Burrage, Moore, Cole, Cox, Lo, Garrahy, Mundy, Camuglia) Department of
Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
(Burrage, Moore, Cole, Cox, Lo, Rafter, Garlick, Garrahy, Mundy, Camuglia)
University of Queensland, Brisbane, QLD, Australia
(Cox, Rafter, Garlick, Camuglia) The Wesley Hospital, Brisbane, QLD,
Australia
Title
Transcatheter Aortic Valve Replacement is Associated with Comparable
Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length
of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. (no pagination), 2016. Date of Publication:
July 18, 2016.
Publisher
Elsevier Ltd
Abstract
Background: Aortic valve replacement is indicated in patients with severe
symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement
(TAVR) has evolved as a potential strategy in a growing proportion of
patients in preference to surgical aortic valve replacement (SAVR). This
meta-analysis aims to assess the differential outcomes of TAVR and SAVR in
patients enrolled in published randomised controlled trials (RCTs).
Methods: A systematic literature search of Cochrane Library, EMBASE, OVID,
and PubMed MEDLINE was performed. Randomised controlled trials of patients
with severe AS undergoing TAVR compared with SAVR were included. Clinical
outcomes and procedural complications were assessed. Results: Five RCTs
with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed.
There was no statistically significant difference in combined rates of
all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%;
OR 0.83; 95% CI: 0.64-1.08; P = 0.17) or at 12 months (17.2% vs 19.2%; OR
0.87; 95% CI: 0.73-1.03; P = 0.29). No statistically significant
difference was seen for death or stroke separately at any time point
although a numerical trend in favour of TAVR for both was recorded. Length
of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7
days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P = 0.0007).
Major vascular complications were more frequent in patients undergoing
TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but
major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR
0.34; 95% CI: 0.22-0.52; P = <0.00001). Conclusions: Transcatheter aortic
valve replacement and SAVR are associated with overall similar rates of
death and stroke among patients in intermediate to high-risk cohorts but
with reduced length of in-patient hospital stay. Copyright &#xa9; 2016.

<95>
Accession Number
613216126
Author
Verma D.R.; Pershad Y.; Pershad A.; Fang K.; Gellert G.; Morris M.F.
Institution
(Verma, Pershad, Fang, Gellert, Morris) Cardiovascular Institute, Banner
University Medical Center, Phoenix
(Verma, Pershad) Division of Interventional Cardiology, Banner University
Medical Center, Phoenix
(Pershad, Morris) Department of Radiology, Banner University Medical
Center, Phoenix
(Fang) Division of Cardiothoracic Surgery, Banner University Medical
Center, Phoenix
(Gellert) Department of Anesthesiology, Banner University Medical Center,
Phoenix
Title
Impact of institutional volume and experience with CT interpretation on
sizing of transcatheter aortic valves: A multicenter retrospective study.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2016. Date of
Publication: August 14, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Computed tomography (CT) has become the standard imaging
modality for pre-procedural aortic annular sizing prior to transcatheter
aortic valve replacement (TAVR). We hypothesized that the accuracy of CT
derived annular measurements would be greater at sites with higher TAVR
procedural volume. Methods: Within a large integrated health system, TAVR
was performed at low (<40 cases), intermediate (40-75 cases), and
high-volume sites (>75 cases). 181 patients underwent TAVR with a Sapien
XT transcatheter heart valve (THV). Two blinded experienced readers
independently remeasured the annulus on CT and compared their measurements
to site reported measurements. Hypothetical THV sizes were chosen based on
measurements from site CT reports and independent readers' measurements,
and compared to the implanted THV size. Results: Correlation between site
reported measurements and independent readers measurements of mean annulus
size varied between low-volume (r = 0.31, p = 0.18), intermediate-volume
(r = 0.34, p = 0.01), and high-volume sites (r = 0.96, p. <. 0.01). On
multivariate analysis, interpretation of >20 CT scans (OR 0.29; 95% CI
0.03-0.81; p 0.02) and high-volume site (OR 0.16; 95% CI 0.10-0.82; p
0.02) were associated with reduced mismatch between the site predicted THV
size and independent readers predicted THV size. Mismatch between site
predicted THV size and implanted THV size was associated with a worse
30-day composite of mortality, dialysis-dependent renal failure,
cerebrovascular accident, new permanent pacemaker, and hospital
readmission (55.3 vs. 38.7%; p = 0.05). Conclusions: Accuracy of CT aortic
annular sizing is improved with higher individual experience and site TAVR
volume. These findings should be confirmed in larger, prospective studies.
Copyright &#xa9; 2016 Elsevier Inc.

<96>
Accession Number
613210196
Author
Chan J.L.; Kobashigawa J.A.; Reich H.J.; Ramzy D.; Thottam M.M.; Yu Z.;
Aintablian T.L.; Liou F.; Patel J.K.; Kittleson M.M.; Czer L.S.; Trento
A.; Esmailian F.
Institution
(Chan, Kobashigawa, Reich, Ramzy, Thottam, Yu, Aintablian, Liou, Patel,
Kittleson, Czer, Trento, Esmailian) Cedars-Sinai Heart Institute, Los
Angeles, California, USA
(Chan, Reich, Ramzy, Trento, Esmailian) Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, California, USA
Title
Intermediate outcomes with ex-vivo allograft perfusion for heart
transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2016. Date of
Publication: 2016.
Publisher
Elsevier USA
Abstract
Background: The Organ Care System, an ex-vivo heart perfusion platform,
represents an alternative to the current standard of cold organ storage
that sustains the donor heart in a near-physiologic state. It is unknown
whether using the Organ Care System influences 2-year outcomes after heart
transplantation. We reviewed our institutional experience to compare
2-year outcomes for patients randomized to the Organ Care System or
standard cold storage. Methods: Between 2011 and 2013, heart transplant
candidates from a single tertiary-care medical center enrolled within the
PROCEED II trial were randomized to either standard cold storage or the
Organ Care System. Outcomes assessed included 2-year survival, freedom
from cardiac allograft vasculopathy (CAV), non-fatal major cardiac events
(NF-MACE), biopsy-proven cellular rejection (CMR) and biopsy-proven
antibody-mediated rejection (AMR). Results: Thirty-eight patients were
randomized to the Organ Care System (n = 19) or cold storage group (n =
19). There was no significant difference in 2-year patient survival (Organ
Care System: 72.2%; cold storage: 81.6%; . p = 0.38). Similarly, there
were no differences in freedom from CAV, NF-MACE, CMR or AMR. The Organ
Care System group had significantly longer total ischemia time (361 +/- 96
minutes vs 207 +/- 50 minutes; . p < 0.001) and shorter cold ischemia time
(134 +/- 45 minutes vs 207 +/- 50 minutes; . p < 0.001) compared with the
cold storage group. Conclusion: The Organ Care System did not appear to be
associated with significant differences in intermediate results compared
with conventional strategies. These results suggest that this ex-vivo
allograft perfusion system is a promising and valid platform for donor
heart transportation. Copyright &#xa9; 2016 International Society for
Heart and Lung Transplantation.

<97>
Accession Number
613204495
Author
Noiseux N.; Mansour S.; Weisel R.; Stevens L.-M.; Der Sarkissian S.; Tsang
K.; Crean A.M.; Larose E.; Li S.-H.; Wintersperger B.; Vu M.Q.; Prieto I.;
Li R.-K.; Roy D.C.; Yau T.M.
Institution
(Noiseux, Stevens, Prieto) Division of Cardiac Surgery, Centre Hospitalier
de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
(Noiseux, Mansour, Stevens, Der Sarkissian, Vu) Centre Hospitalier de
l'Universite de Montreal Research Center (CRCHUM), Montreal, Quebec,
Canada
(Noiseux, Stevens, Der Sarkissian, Prieto, Roy) Department of Surgery,
Universite de Montreal, Montreal, Quebec, Canada
(Mansour) Division of Cardiology, Centre Hospitalier de l'Universite de
Montreal (CHUM), Montreal, Quebec, Canada
(Mansour) Department of Medicine, Universite de Montreal, Montreal,
Quebec, Canada
(Larose) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(Weisel, Tsang, Crean, Li, Wintersperger, Li, Yau) Peter Munk Cardiac
Centre, University Health Network, Toronto, Ontario, Canada
(Weisel, Tsang, Li, Li, Yau) Department of Surgery, Division of
Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
(Crean, Wintersperger) Division of Medical Imaging, University of Toronto,
Toronto, Ontario, Canada
(Roy) Department of Hematology, Hopital Maisonneuve-Rosemont (HMR),
Montreal, Quebec, Canada
Title
The IMPACT-CABG trial: A multicenter, randomized clinical trial of
CD133⁺ stem cell therapy during coronary artery bypass grafting
for ischemic cardiomyopathy.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: May 03, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The IMPACT-CABG trial is the first North American multicenter
phase II randomized study of intramyocardial delivery of autologous
CD133⁺ stem cells in patients with chronic ischemic
cardiomyopathy undergoing coronary artery bypass grafting. The primary
objective was to demonstrate safety, including freedom from major adverse
cardiac events. The secondary objective was to evaluate feasibility of
same-day autologous cell preparation. Although the trial was not powered
to evaluate LV function, exploratory data were collected. Methods: After 7
open-label patients who received cells, patients randomly received stem
cells or placebo (N = 40 total, 20 per center). After completion of
coronary anastomoses, up to 10 million CD133⁺,
CD34⁺, CD45⁺ triple-positive cells or placebo were
injected into the infarct and border zones. Patients were followed up
clinically and underwent magnetic resonance imaging preoperatively and
after 6 months. Results: There were no procedural complications from bone
marrow isolation and cell injection, no in-hospital mortality, and no
protocol-related complications. Four patients had transient renal
insufficiency, with 1 death during 6-month follow-up. Magnetic resonance
imaging revealed that left ventricular volumes and ejection fractions
improved in all patients (no difference between groups). Conclusions: The
trial successfully met both primary and secondary objectives,
demonstrating that same-day isolation and autologous CD133⁺
cell delivery with coronary artery bypass grafting is safe and feasible.
The positive findings support a larger randomized, multicenter trial, with
higher numbers of transplanted cells to demonstrate beneficial effects.
The upcoming IMPACT-CABG II trial will evaluate higher cell doses and
pharmacologic enhancement to determine whether these cells improve
perfusion and myocardial function. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery.

<98>
Accession Number
613201732
Author
Sharma V.; Rao V.; Manlhiot C.; Boruvka A.; Fremes S.; Wasowicz M.
Institution
(Sharma, Wasowicz) Department of Anesthesia and Pain Management, Toronto
General Hospital, Toronto, Ontario, Canada
(Rao) Department of Surgery, Peter Munk Cardiac Centre, University Health
Network, Toronto, Ontario, Canada
(Manlhiot, Boruvka) Cardiovascular Data Management Centre, University of
Toronto, Toronto, Ontario, Canada
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook
Health Sciences Centre, Toronto, Ontario, Canada
Title
A derived and validated score to predict prolonged mechanical ventilation
in patients undergoing cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: February 01, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Prolonged mechanical ventilation after cardiac surgery imposes
a significant burden on the patient in terms of morbidity as well as a
financial burden on the hospital. We undertook a retrospective analysis of
2 prospectively collected databases developed in tertiary cardiac care
centers to derive and validate a risk index predicting prolonged
mechanical ventilation after cardiac surgery. Methods: We studied a
retrospective cohort of 32,045 patients undergoing cardiac surgery in 2
hospitals in Toronto, Canada. The development cohort consisted of 21,661
patients at Toronto General Hospital. Data Sunnybrook Health Sciences
Centre, Toronto, Canada, with 10,384 patients, served as an institutional
validation cohort. We operationally characterized prolonged mechanical
ventilation as the duration from surgery completion to extubation
exceeding 48 hours. Results: Prolonged postoperative mechanical
ventilation rates in the development and validation cohort were 6% and 7%,
respectively. Multivariable regression in the development cohort showed
that the following factors were strong predictors of prolonged mechanical
ventilation after cardiac surgery: previous cardiac surgery, lower left
ventricular ejection fraction, shock, surgery involving repair of
congenital heart disease, and cardiopulmonary bypass time. The
intraoperative multivariable model retained good discrimination in the
validation cohort, achieving a c statistic of 0.787. Conclusions:
Prolonged mechanical ventilation after cardiac surgery can be accurately
predicted by readily available pre- and intraoperative information.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery.

<99>
Accession Number
613194453
Author
Katz M.; Carlos Bacelar Nunes Filho A.; Caixeta A.; Antonio Carvalho L.;
Sarmento-Leite R.; Alves Lemos Neto P.; Eduardo Koenig Sao Thiago L.; Dias
Dourado Oliveira A.; Antonio Marino M.; Tadeu Tumelero R.; Antonio Perin
M.; Abizaid A.; Tarasoutchi F.; Sandoli de Brito F.
Institution
(Katz, Carlos Bacelar Nunes Filho, Caixeta, Antonio Perin, Abizaid,
Tarasoutchi, Sandoli de Brito) Hospital Israelita Albert EinsteinSao
Paulo, SP Brazil
(Antonio Carvalho) Hospital Pro-CardiacoRio de Janeiro, RJ Brazil
(Sarmento-Leite) Instituto de Cardiologia do Rio Grande do
Sul/Universidade Federal de Ciencias da Saude de Porto AlegrePorto Alegre,
RS Brazil
(Alves Lemos Neto, Tarasoutchi) Heart Institute (InCor), University of Sao
Paulo Medical SchoolSao Paulo, SP Brazil
(Eduardo Koenig Sao Thiago) Hospital S.O.S CardioFlorianopolis, SC Brazil
(Eduardo Koenig Sao Thiago) Instituto de Cardiologia de Santa CatarinaSao
Jose, SC Brazil
(Dias Dourado Oliveira) Hospital Santa Izabel da Santa Casa de
Misericordia da BahiaSalvador, BA Brazil
(Antonio Marino) Hospital Madre TeresaBelo Horizonte, MG Brazil
(Tadeu Tumelero) Associacao Hospitalar Beneficente Sao Vicente de
PauloPasso Fundo, RS Brazil
(Abizaid) Instituto Dante Pazzanese de CardiologiaSao Paulo, SP Brazil
Title
Gender-related differences on short- and long-term outcomes of patients
undergoing transcatheter aortic valve implantation.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2016.
Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study aimed to compare gender-related differences in
outcomes of patients undergoing TAVI over a long-term follow-up period.
Background: Transcatheter aortic valve implantation (TAVI) has been
considered the standard therapy for patients with inoperable or high-risk
symptomatic aortic stenosis. The influence of gender-related differences
in outcomes of patients undergoing TAVI is currently on debate. Methods:
From January 2008 to January 2015, 819 patients (49% men) underwent TAVI
and were included in a multicenter Brazilian registry. Patients were
followed-up and clinical outcomes were evaluated according to the updated
Valve Academic Research Consortium-2 criteria. Results: Mean follow-up was
497+/-478 days. Compared with women, men had a lower rate of major or
life-threatening bleeding (12.0% vs. 20.6%; HR=0.57 [95CI% 0.40-0.81];
P=0.001), and major vascular complications (6% vs. 11.7%; HR=0.50 [95CI%
0.31-0.82]; P=0.004). At 30 days, all-cause mortality was lower in men
than in women (6.5% vs. 11.5%; P=0.013), however, cumulative all-cause
mortality was similar between groups (25.9% vs. 29.7%, men and women,
respectively, HR=0.92 [95CI% 0.71-1.19]; P=0.52) over the entire follow-up
period. By adjusted Cox regression model, renal function, diabetes,
peripheral artery disease, and chronic obstructive pulmonary disease
(COPD) remained independently predictors of all-cause mortality.
Conclusions: In this large-scale study evaluating patients undergoing
TAVI, 30-day mortality was higher among women than men driven by
significant higher rates of major or life-threatening bleeding and major
vascular complications. However, all-cause mortality on long-term
follow-up was similar between groups. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<100>
Accession Number
613193506
Author
Barba-Navarro R.; Tapia-Silva M.; Garza-Garcia C.; Lopez-Giacoman S.;
Melgoza-Toral I.; Vazquez-Rangel A.; Bazua-Valenti S.; Bobadilla N.;
Wasung de Lay M.; Baranda F.; Chawla L.S.; Gamba G.; Madero M.
Institution
(Barba-Navarro, Tapia-Silva, Garza-Garcia, Lopez-Giacoman, Melgoza-Toral,
Vazquez-Rangel, Bazua-Valenti, Wasung de Lay, Baranda, Madero)
Departamento de Nefrologia, Instituto Nacional de Cardiologia Ignacio
Chavez, Mexico City, Mexico
(Bobadilla, Gamba) Departamento de Nefrologia y Metabolismo Mineral,
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran,
Mexico City, Mexico
(Chawla) Division of Intensive Care Medicine and Nephrology, Department of
Medicine, Veterans Affairs Medical Center, Washington, DC
(Gamba) Molecular Physiology Unit, Instituto de Investigaciones
Biomedicas, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
Title
The Effect of Spironolactone on Acute Kidney Injury After Cardiac Surgery:
A Randomized, Placebo-Controlled Trial.
Source
American Journal of Kidney Diseases. (no pagination), 2016. Date of
Publication: January 25, 2016.
Publisher
W.B. Saunders
Abstract
Background: Cardiac surgery-related acute kidney injury (AKI) is a common
postoperative complication that greatly increases morbidity and mortality.
There are currently no effective interventions to prevent AKI associated
with cardiac surgery. Experimental data have shown that administration of
the mineralocorticoid receptor blocker spironolactone prevents renal
injury induced by ischemia-reperfusion in rats. The objective of this
study was to test whether short-term perioperative administration of oral
spironolactone could reduce the incidence of AKI in cardiac surgical
patients. Study Design: Randomized, double-blinded, placebo-controlled
trial. Setting & Participants: Data were collected from April 2014 through
July 2015 at the National Heart Institute in Mexico. 233 patients were
included; 115 and 118 received spironolactone or placebo, respectively.
Intervention: Spironolactone or placebo once at a dose of 100. mg 12 to 24
hours before surgery and subsequently 3 further doses of 25. mg in
postoperative days 0, 1, and 2 were administered. Outcomes: Patients were
followed up for 7 days or until discharge from the intensive care unit
(ICU). The primary end point was AKI incidence defined by KDIGO criteria.
Secondary end points included requirement of renal replacement therapy,
ICU length of stay, and ICU mortality. Data were analyzed according to the
intention-to-treat principle. Results: Mean age was 53.2. +/-. 15 years,
mean serum creatinine level was 0.9. +/-. 0.2. mg/dL, median Thakar score
for estimation of AKI risk was 2 (IQR, 1-3), and 25% had diabetes. The
incidence of AKI was higher for the spironolactone group (43% vs 29%; . P
= 0.02). No significant differences were found for secondary end points.
Limitations: Single center, AKI was mostly driven by AKI stage 1, planned
sample size was not achieved, and there was no
renin-angiotensin-aldosterone system washout period. Conclusions: Our
trial demonstrated that spironolactone was not protective for AKI
associated with cardiac surgery and there may be a trend toward risk.
Copyright &#xa9; 2016 National Kidney Foundation, Inc.