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<1>
Accession Number
601244418
Author
Cramariuc D.; Rogge B.P.; Lonnebakken M.T.; Boman K.; Bahlmann E.;
Gohlke-Barwolf C.; Chambers J.B.; Pedersen T.R.; Gerdts E.
Institution
(Cramariuc, Rogge) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Rogge, Lonnebakken, Gerdts) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Boman) Research Unit, Medicine, Umeaa University, Skellefteaa, Sweden
(Bahlmann) Asklepios Clinic St. Georg, Hamburg, Germany
(Gohlke-Barwolf) Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
(Chambers) Guy's and St Thomas Hospitals, London, United Kingdom
(Pedersen) Department of Preventive Cardiology, Ulleval University
Hopital, Oslo, Norway
Title
Sex differences in cardiovascular outcome during progression of aortic
valve stenosis.
Source
Heart. 101 (3) (pp 209-214), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Women with severe aortic valve stenosis (AS) have better LV
systolic function and more concentric LV geometry than their male
counterparts. However, sex differences in cardiovascular (CV) outcome
during progression of AS have not been reported from a longitudinal
prospective study. Methods Doppler echocardiography and CV events were
recorded during a median of 4.0 years in 979 men and 632 women aged 28-86
(mean 67+/-10) years in the Simvastatin Ezetimibe in Aortic Stenosis
(SEAS) study. LV systolic function was assessed by EF and midwall
shortening (MWS). Study outcomes were ASrelated events, ischaemic CV
events and total mortality. Results The annular cumulative incidence of AS
events, ischaemic CV events and death was 8.1%, 3.4% and 2.8% in women,
and 8.9%, 4.4% and 2.4% in men, respectively. Women and men had similar AS
progression rate whether measured by peak jet velocity, mean gradient or
valve area. In multivariate analyses, female sex independently predicted
less reduction in LV MWS and EF during follow-up (both p<0.05). In
time-varying Cox analyses, women had a 40% lower rate of ischaemic CV
events (95% CI 21% to 54%), in particular, more than 50% lower rate of
stroke and coronary artery bypass grafting, and a 31% lower allcause
mortality (95% CI 1% to 51%), independent of active study treatment, age
and hypertension, as well as time-varying valve area, low systolic
function and abnormal LV geometry. AS event rate did not differ by sex.
Conclusions In the SEAS study, women and men had similar rates of AS
progression and AS-related events. However, women had lower total
mortality and ischaemic CV event rate than men independent of confounders.
Trial registration number ClinicalTrials.gov identi fier: NCT00092677.
Funding The SEAS (Simvastatin Ezetimibe in Aortic Stenosis)
Echocardiography Core Laboratory was supported by MSP Singapore Company,
LLC, Singapore, a partnership between Merck Co, and the Schering-Plough
Corporation.

<2>
Accession Number
601244405
Author
Candilio L.; Malik A.; Ariti C.; Barnard M.; Di Salvo C.; Lawrence D.;
Hayward M.; Yap J.; Roberts N.; Sheikh A.; Kolvekar S.; Hausenloy D.J.;
Yellon D.M.
Institution
(Candilio, Malik, Hausenloy, Yellon) Hatter Cardiovascular Institute,
University College London, 67 Chenies Mews, London WC1E 6HX, United
Kingdom
(Ariti) Nuffield Trust, London, United Kingdom
(Barnard, Di Salvo, Lawrence, Hayward, Yap, Roberts, Sheikh, Kolvekar)
Heart Hospital, University College London Hospital, London, United Kingdom
Title
Effect of remote ischaemic preconditioning on clinical outcomes in
patients undergoing cardiac bypass surgery: A randomised controlled
clinical trial.
Source
Heart. 101 (3) (pp 185-192), 2015. Date of Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Remote ischaemic preconditioning (RIPC), using brief cycles of
limb ischaemia/reperfusion, is a non-invasive, low-cost intervention that
may reduce perioperative myocardial injury (PMI) in patients undergoing
cardiac surgery. We investigated whether RIPC can also improve short-term
clinical outcomes. Methods One hundred and eighty patients undergoing
elective coronary artery bypass graft (CABG) surgery and/ or valve surgery
were randomised to receive either RIPC (2-5 min cycles of simultaneous
upper arm and thigh cuff inflation/deflation; N=90) or control (uninflated
cuffs placed on the upper arm and thigh; N=90). The study primary end
point was PMI, measured by 72 h area under the curve (AUC) serum
high-sensitive troponin-T (hsTnT); secondary end point included short-term
clinical outcomes. Results RIPC reduced PMI magnitude by 26% (-9.303
difference (CI - 15.618 to - 2.987) 72 h hsTnT-AUC; p=0.003) compared with
control. There was also evidence that RIPC reduced the incidence of
postoperative atrial fibrillation by 54% (11% RIPC vs 24% control;
p=0.031) and decreased the incidence of acute kidney injury by 48% (10.0%
RIPC vs 21.0% control; p=0.063), and intensive care unit stay by 1 day
(2.0 days RIPC (CI 1.0 to 4.0) vs 3.0 days control (CI 2.0 to 4.5);
p=0.043). In a post hoc analysis, we found that control patients
administered intravenous glyceryl trinitrate (GTN) intraoperatively
sustained 39% less PMI compared with those not receiving GTN, and RIPC did
not appear to reduce PMI in patients given GTN. Conclusions RIPC reduced
the extent of PMI in patients undergoing CABG and/or valve surgery. RIPC
may also have beneficial effects on short-term clinical outcomes, although
this will need to be confirmed in future studies. Trial registration
number ClinicalTrials.gov ID: NCT00397163.

<3>
Accession Number
604782838
Author
Nijenhuis V.J.; Bennaghmouch N.; van Kuijk J.-P.; Capodanno D.; ten Berg
J.M.
Institution
(Nijenhuis, Bennaghmouch, van Kuijk, ten Berg) Department of Cardiology,
St. Antonius Hospital, Nieuwegein, Netherlands
(Capodanno) Department of Cardiology, University of Catania, Catania,
Italy
Title
Antithrombotic treatment in patients undergoing transcatheter aortic valve
implantation (TAVI).
Source
Thrombosis and Haemostasis. 113 (4) (pp 674-685), 2015. Date of
Publication: 2015.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment
option for symptomatic patients with severe aortic valvular disease who
are not suitable for conventional surgical aortic valve replacement.
Despite improving experience and techniques, ischaemic and bleeding
complications after TAVI remain prevalent and impair survival in this
generally old and comorbid-rich population. Due to changing aetiology of
complications over time, antiplatelet and anticoagulant therapy after TAVI
should be carefully balanced. Empirically, a dual antiplatelet strategy is
generally used after TAVI for patients without an indication for oral
anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve
prosthesis), including aspirin and a thienopyridine. For patients on OAC,
a combination of OAC and aspirin or thienopyridine is generally used. This
review shows that current registries are unfit to directly compare
antithrombotic regimens. Small exploring studies suggest that additional
clopidogrel after TAVI only affects bleeding and not ischemic
complications. However, these studies are lack in quality in terms of
Cochrane criteria. Currently, three randomised controlled trials are
recruiting to gather more knowledge about the effects of clopidogrel after
TAVI. Copyright &#xa9; 2015 Schattauer.

<4>
Accession Number
601589588
Author
Feldman A.M.; She L.; McNamara D.M.; Mann D.L.; Bristow M.R.; Maisel A.S.;
Wagner D.R.; Andersson B.; Chiariello L.; Hayward C.S.; Hendry P.; Parker
J.D.; Racine N.; Selzman C.H.; Senni M.; Stepinska J.; Zembala M.; Rouleau
J.; Velazquez E.J.; Lee K.L.
Institution
(Feldman) Department of Medicine, Temple University School of Medicine,
3500 N. Broad Street, Philadelphia, PA 19140, United States
(Velazquez) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
(She, Lee) Duke Clinical Research Institute, Durham, NC, United States
(McNamara) Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Mann) Department of Medicine, Washington University in St. Louis School
of Medicine, St. Louis, MO, United States
(Bristow) Department of Medicine, University of Colorado at Denver,
Denver, CO, United States
(Maisel) Department of Medicine, University of California, San Diego, CA,
United States
(Selzman) Department of Surgery, University of Utah Hospital, Salt Lake
City, UT, United States
(Wagner) Laboratory of Cardiovascular Research, Luxembourg Heart
Institute, Luxembourg, Luxembourg
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chiariello) Department of Cardiac Surgery, Policlinico Tor Vergata of
Rome, Rome, Italy
(Senni) Department of Medicine, Ospedali Riuniti, Bergamo, Italy
(Hayward) Department of Cardiology, St. Vincent's Hospital, Sydney, NSW,
Australia
(Hendry) Department of Cardiac Surgery, Ottawa Heart Institute, Ottawa,
ON, Canada
(Parker) Department of Medicine, Toronto General Hospital, Toronto, ON,
Canada
(Racine, Rouleau) Department of Medicine, Montreal Heart Institute,
Montreal, QC, Canada
(Stepinska) Valvular Heart Department, National Institute of Cardiology,
Warsaw, Poland
(Zembala) Department of Cardiac Surgery, Silesian Center for Heart
Diseases, Zabrze, Poland
Title
Genetic variants are not associated with outcome in patients with coronary
artery disease and left ventricular dysfunction: Results of the genetic
substudy of the Surgical Treatment for Ischemic Heart Failure (STICH)
trials.
Source
Cardiology (Switzerland). 130 (2) (pp 69-81), 2015. Date of Publication:
24 Feb 2015.
Publisher
S. Karger AG
Abstract
Objectives and Background: We evaluated the ability of 23 genetic variants
to provide prognostic information in patients enrolled in the Genetic
Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH)
trials. Methods: Patients assigned to STICH Hypothesis 1 were randomized
to medical therapy with or without coronary artery bypass grafting (CABG).
Those assigned to STICH Hypothesis 2 were randomized to CABG or CABG with
left ventricular reconstruction. Results: In patients assigned to STICH
Hypothesis 2 (n = 714), no genetic variant met the prespecified
Bonferroni-adjusted threshold for statistical significance (p < 0.002);
however, several variants met nominal prognostic significance: variants in
the beta<inf>2</inf>-adrenergic receptor gene (beta<inf>2</inf>-AR
Gln27Glu) and in the A<inf>1</inf>-adenosine receptor gene
(A<inf>1</inf>-717 T/G) were associated with an increased risk of a
subject dying or being hospitalized for a cardiac problem (p = 0.027 and
0.031, respectively). These relationships remained nominally significant
even after multivariable adjustment for prognostic clinical variables.
However, none of the 23 genetic variants influenced all-cause mortality or
the combination of death or cardiovascular hospitalization in the STICH
Hypothesis 1 population (n = 532) by either univariate or multivariable
analysis. Conclusion: We were unable to identify the predictive genotypes
in optimally treated patients in these two ischemic heart failure
populations. Copyright &#xa9; 2015 S. Karger AG, Basel.

<5>
Accession Number
603050678
Author
Lehtinen M.; Patila T.; Kankuri E.; Lauerma K.; Sinisalo J.; Laine M.;
Kupari M.; Vento A.; Harjula A.
Institution
(Lehtinen, Patila, Vento, Harjula) Department of Cardiothoracic Surgery,
Heart and Lung Center, Helsinki University Central Hospital, Finland
(Kankuri, Harjula) Institute of Biomedicine, Pharmacology, University of
Helsinki, Finland
(Lauerma) Division of Roentgenology, HUS Medical Imaging Center, Finland
(Sinisalo, Laine, Kupari) Department of Cardiology, Heart and Lung Center,
Helsinki University Central Hospital, Helsinki, Finland
Title
Intramyocardial bone marrow mononuclear cell transplantation in ischemic
heart failure: Long-term follow-up.
Source
Journal of Heart and Lung Transplantation. 34 (7) (pp 899-905), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Background Long-term results regarding treatment of chronic ischemic heart
failure with bone marrow mononuclear cells (BMMCs) have been few. We
received encouraging results at the 1-year follow-up of patients treated
with combined coronary artery bypass grafting (CABG) and BMMCs, so we
decided to extend the follow-up. Methods The study patients had received
injections of BMMCs or vehicle into the myocardial infarction border area
during CABG in a randomized and double-blind manner. We could contact 36
of the 39 patients recruited for the original study. Pre-operatively and
after an extended follow-up period, we performed magnetic resonance
imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed
patient records from the follow-up period, and determined current quality
of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health
Survey. Results The median follow-up time was 60.7 months (interquartile
range [IQR], 45.1-72.6 months). No statistically significant difference
was detected in change of pro-B-type amino-terminal natriuretic peptide
values or in quality of life between groups. The median change in left
ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls
and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall
thickening in injected segments increased by a median of 17% (IQR, -5% to
30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p =
0.434). Scar size in injected segments increased by a median of 2% (IQR,
-7% to 19%) for controls but diminished for BMMC patients, with a median
change of -17% (IQR, -30% to -6%; p = 0.011). Conclusions In the treatment
of chronic ischemic heart failure, combining intramyocardial BMMC therapy
with CABG fails to affect cardiac function but can sustainably reduce scar
size, even in the long-term. Copyright &#xa9; 2015 International Society
for Heart and Lung Transplantation.

<6>
Accession Number
603212105
Author
Mallidi J.; Atreya A.R.; Cook J.; Garb J.; Jeremias A.; Klein L.W.; Lotfi
A.
Institution
(Mallidi, Atreya, Cook, Lotfi) Department of Medicine, Division of
Cardiology, Tufts University, Springfield, MA, United States
(Garb) Department of Medicine, Division of Biostatistics, Tufts
University, Springfield, MA, United States
(Jeremias) Department of Medicine, Division of Cardiovascular Medicine,
Stony Brook University Medical Center, Stony Brook, NY, United States
(Klein) Department of Medicine, Rush Medical College, Advocate Illinois
Masonic Medical Center, Chicago, IL, United States
Title
Long-term outcomes following fractional flow reserve-guided treatment of
angiographically ambiguous left main coronary artery disease: A
meta-analysis of prospective cohort studies.
Source
Catheterization and Cardiovascular Interventions. 86 (1) (pp 12-18), 2015.
Date of Publication: 01 Jul 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective To define the long term outcomes of Fractional Flow Reserve
(FFR) guided revascularization of ambiguous left main coronary artery
(LMCA) lesions by performing a pooled meta-analysis of all available
studies. Background Prospective studies evaluating the use of fractional
flow reserve (FFR) for clinical decision-making in ambiguous unprotected
left main coronary artery (LMCA) stenosis suggest the relative safety of
that approach, but any final conclusions are limited by small sample size.
We performed a pooled meta-analysis of studies to define the long-term
outcomes in these patients. Methods Six prospective cohort studies
involving 525 patients met the inclusion criteria. Patients underwent
revascularization (revascularization group) or medical therapy (deferred
group) based on FFR. The primary outcome was defined as rate of major
cardiovascular events (a composite of death from all causes, nonfatal
myocardial infarctions and subsequent revascularizations). The secondary
outcomes included individual components of the primary end point. Pooled
effect sizes were calculated using a fixed effects model. Results Based on
the FFR results, 217 patients (41%) underwent revascularization. There was
no statistically significant difference between the groups in the rates of
primary end point (P=0.15), all-cause mortality (P=0.06) or nonfatal
myocardial infarctions (P=0.76). However, there was a significant increase
in the rate of subsequent revascularizations in the deferred patients
(P=0.002). Conclusion The long term clinical outcomes in patients with
ambiguous LMCA stenosis for whom revascularization is deferred based on
FFR are favorable and similar to the revascularized group in terms of
overall mortality and subsequent myocardial infarctions. Copyright &#xa9;
2015 Wiley Periodicals, Inc.

<7>
Accession Number
604346936
Author
Sansone R.; Stanske B.; Keymel S.; Schuler D.; Horn P.; Saeed D.; Boeken
U.; Westenfeld R.; Lichtenberg A.; Kelm M.; Heiss C.
Institution
(Sansone, Stanske, Keymel, Schuler, Horn, Westenfeld, Kelm, Heiss)
Division of Cardiology, Pulmonology, and Vascular Medicine, University of
Dusseldorf, Medical Faculty, Moorenstrasse 5, Dusseldorf 40225, Germany
(Saeed, Boeken, Lichtenberg) Department of Cardiovascular Surgery,
University of Dusseldorf, Medical Faculty, Dusseldorf, Germany
(Lichtenberg, Kelm) Cardiovascular Research Institute, Heinrich Heine
University, University of Dusseldorf, Dusseldorf, Germany
Title
Macrovascular and microvascular function after implantation of left
ventricular assist devices in end-stage heart failure: Role of
microparticles.
Source
Journal of Heart and Lung Transplantation. 34 (7) (pp 921-932), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Background The hemodynamic vascular consequences of implanting left
ventricular assist devices (LVADs) have not been studied in detail. We
investigated the effect of LVAD implantation compared with heart
transplant (HTx) on microvascular and macrovascular function in patients
with end-stage heart failure and evaluated whether microparticles may play
a role in LVAD-related endothelial dysfunction. Methods Vascular function
was assessed in patients with end-stage heart failure awaiting HTx,
patients who had undergone implantation of a continuous-flow centrifugal
LVAD, and patients who had already received a HTx. Macrovascular function
was measured by flow-mediated vasodilation (FMD) using high-resolution
ultrasound of the brachial artery. Microvascular function was assessed in
the forearm during reactive hyperemia using laser Doppler perfusion
imaging and pulsed wave Doppler. Age-matched patients without heart
failure and without coronary artery disease (CAD) (healthy control
subjects) and patients with stable CAD served as control subjects.
Circulating red blood cell (CD253⁺), leukocyte
(CD45⁺), platelet (CD31⁺/CD41⁺), and
endothelial cell (CD31⁺/CD41^-, CD62e⁺,
CD144⁺) microparticles were determined by flow cytometry and
free hemoglobin by enzyme-linked immunosorbent assay. Results FMD and
microvascular function were significantly impaired in patients with
end-stage heart failure compared with healthy control subjects and
patients with stable CAD. LVAD implantation led to recovery of
microvascular function, but not FMD. In parallel, increased free
hemoglobin was observed along with red and white cell microparticles and
endothelial and platelet microparticles. This finding indicates
destruction of blood cells with release of hemoglobin and activation of
endothelial cells. HTx and LVAD implantation led to similar improvements
in microvascular function. FMD increased and microparticle levels
decreased in patients with HTx, whereas shear stress during reactive
hyperemia was similar in patients with LVADs and patients with HTx.
Conclusions Our data suggest that LVAD support leads to significant
improvements in microvascular perfusion and hemodynamics. However,
destruction of blood cells may contribute to residual endothelial
dysfunction potentially by increasing nitric oxide scavenging capacity.
Copyright &#xa9; 2015 International Society for Heart and Lung
Transplantation.

<8>
Accession Number
373610077
Author
Kim K.; Kim W.-J.; Choi D.-K.; Lee Y.K.; Choi I.-C.; Sim J.-Y.
Institution
(Kim, Kim, Choi, Choi, Sim) Department of Anaesthesia and Pain Medicine,
Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South
Korea
(Lee) Department of Anaesthesia and Pain Medicine, Hangang Sacred Heart
Hospital, College of Medicine, Hallym University, Seoul, South Korea
Title
The analgesic efficacy and safety of nefopam in patient-controlled
analgesia after cardiac surgery: A randomized, double-blind, prospective
study.
Source
Journal of International Medical Research. 42 (3) (pp 684-692), 2014. Date
of Publication: June 2014.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: The efficacy and side-effects of nefopam were prospectively
compared with those of fentanyl for patient-controlled analgesia (PCA)
following cardiac surgery. Methods: Patients scheduled to undergo cardiac
surgery were randomly assigned between three PCA groups (nefopam, fentanyl
or nefopam + fentanyl). Pain was assessed at rest and during movement at
12, 24, 36, 48 and 72 h after surgery using a visual analogue scale (VAS).
Total infused PCA volume, number of rescue drug injections, duration of
intubation and length of stay in the intensive care unit were recorded.
The incidence of adverse effects was noted at 48 h postoperatively.
Results: There were no significant between-group differences in VAS score,
total PCA infusion volume or number of rescue injections (n=92 per group).
Nausea was significantly more common in the fentanyl group compared with
both other groups. Conclusions: PCA with nefopam alone provides suitable
postoperative analgesia after cardiac surgery. &#xa9; The Author(s) 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

<9>
Accession Number
53281301
Author
Peguero J.G.; Arenas I.; Lamas G.A.
Institution
(Peguero, Arenas, Lamas) Columbia University Division of Cardiology at
Mount Sinai Medical Center, Miami Beach, FL, United States
Title
Chelation therapy and cardiovascular disease: Connecting scientific silos
to benefit cardiac patients.
Source
Trends in Cardiovascular Medicine. 24 (6) (pp 232-240), 2014. Date of
Publication: August 2014.
Abstract
Medical practitioners have treated atherosclerotic disease with chelation
therapy for over 50 years. Lack of strong of evidence led conventional
practitioners to abandon its use in the 1960s and 1970s. This relegated
chelation therapy to complementary and alternative medicine practitioners,
who reported good anecdotal results. Concurrently, the epidemiologic
evidence linking xenobiotic metals with cardiovascular disease and
mortality gradually accumulated, suggesting a plausible role for chelation
therapy. On the basis of the continued use of chelation therapy without an
evidence base, the National Institutes of Health released a Request for
Applications for a definitive trial of chelation therapy. The Trial to
Assess Chelation Therapy (TACT) was formulated as a 2 x 2 factorial
randomized controlled trial of intravenous EDTA-based chelation vs.
placebo and high-dose oral multivitamins and multiminerals vs. oral
placebo. The composite primary endpoint was death, reinfarction, stroke,
coronary revascularization, or hospitalization for angina. A total of 1708
post-MI patients who were 50 years or older with a creatinine of 2.0 or
less were enrolled and received 55,222 infusions of disodium EDTA or
placebo with a median follow-up of 55 months. Patients were on
evidence-based post-MI medications including statins. EDTA proved to be
safe. EDTA chelation therapy reduced cardiovascular events by 18%, with a
5-year number needed to treat (NNT) of 18. Prespecified subgroup analysis
revealed a robust benefit in patients with diabetes mellitus with a 41%
reduction in the primary endpoint (5-year NNT = 6.5), and a 43% 5-year
relative risk reduction in all-cause mortality (5-year NNT = 12). The
magnitude of benefit is such that it suggests urgency in replication and
implementation, which could, due to the excellent safety record, occur
simultaneously. &#xa9; 2014 Elsevier Inc.

<10>
Accession Number
603473468
Author
Patel N.N.; Angelini G.D.
Institution
(Patel, Angelini) Bristol Heart Institute, University of Bristol, Bristol
Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Patel, Angelini) National Heart and Lung Institute, Imperial College
London, Hammersmith Hospital, London W12 0HS, United Kingdom
Title
Pharmacological strategies for the prevention of acute kidney injury
following cardiac surgery: An overview of systematic reviews.
Source
Current Pharmaceutical Design. 20 (34) (pp 5484-5488), 2014. Date of
Publication: 01 Jan 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Context: Post cardiac surgery acute kidney injury (AKI) is common, poorly
understood and associated with a significant increase in morbidity and
mortality. Objectives: An overview of systematic reviews that have
evaluated pharmacological agents for the prevention of AKI post cardiac
surgery. Data Sources: We searched electronic databases (PubMed and the
Cochrane Database of Systematic Reviews) from inception to January 2014.
Study Selection: Systematic reviews of randomized controlled trials that
have evaluated pharmacological agents for the prevention of AKI in adult
patients undergoing cardiac surgery. Data Analysis: Numbers needed to
treat (NNT) or harm (NNH) were calculated from pooled events given in each
meta-analysis. Primary outcome measures were defined as (i) mortality,
(ii) need for renal replacement therapy (RRT), and (iii) acute kidney
injury. Results: Data from 7 systematic reviews evaluating 6 different
pharmacological renoprotective agents were included. Dopamine, fenoldopam
and N-acetylcysteine did not demonstrate any benefit in terms of
mortality, need for RRT or incidence of AKI. Atrial natriuretic peptide
reduced the need for RRT (NNT = 22 (95% CI: 13 to 73) and brain
natriuretic peptide reduced the incidence of AKI (NNT = 11 (95% CI: 6 to
32), although both agents did not demonstrate any effect on mortality.
Loop diuretics demonstrated increased incidence of AKI (NNH = 8 (95% CI: 5
to 15). Conclusion: There is a paucity of effective renoprotective agents
that can be used in adult cardiac surgical patients. There is an urgent
need to develop novel renoprotective strategies. Copyright &#xa9; 2014
Bentham Science Publishers.

<11>
Accession Number
52640187
Author
Yacoub R.; Patel N.; Lohr J.W.; Rajagopalan S.; Nader N.; Arora P.
Institution
(Yacoub) Division of Nephrology, Department of Medicine, Mount Sinai
School of Medicine, New York, NY, United States
(Patel) Division of Nephrology, VAMC, Richmond, VA, United States
(Patel) Department of Medicine, Virginia Commonwealth University,
Richmond, VA, United States
(Lohr, Arora) Division of Nephrology at VAMC, Buffalo, Department of
Medicine, SUNY at Buffalo, 3495 Bailey Ave, Buffalo, NY 14215, United
States
(Lohr, Arora) Department of Medicine, SUNY at Buffalo, NY, United States
(Rajagopalan) Medical Analytics Inc, Buffalo, NY, United States
(Nader) Department of Anesthesia at VAMC, Buffalo, NY, United States
Title
Acute kidney injury and death associated with renin angiotensin system
blockade in cardiothoracic surgery: A meta-analysis of observational
studies.
Source
American Journal of Kidney Diseases. 62 (6) (pp 1077-1086), 2013. Date of
Publication: December 2013.
Publisher
W.B. Saunders
Abstract
Background: Acute kidney injury (AKI) is a common complication after
cardiovascular surgery. The use of renin angiotensin system (RAS) blockers
preoperatively is controversial due to conflicting results of their effect
on the incidence of postoperative AKI and mortality. Study Design:
Meta-analysis of prospective or retrospective observational studies (1950
to January 2013) using MEDLINE, EMBASE, the Cochrane Library, conferences,
and ClinicalTrials.gov, without language restriction. Setting &
Population: Patients undergoing cardiovascular surgery. Selection Criteria
for Studies: Retrospective or prospective studies evaluating the effect of
preoperative use of RAS blockers in the development of postoperative AKI
and/or mortality in adult patients. Intervention: Preoperative use of RAS
blockers. RAS-blocker use was defined as long-term use of either
angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
until the day of surgery. Outcomes: The primary outcome was the
development of postoperative AKI; the secondary outcome was mortality. AKI
was defined by different authors using different criteria. Death was
ascertained in the hospital, at 30 days, or at 90 days in different
studies. Results: 29 studies were included (4 prospective and 25
retrospective); 23 of these involving 69,027 patients examined AKI, and 18
involving 54,418 patients studied mortality. Heterogeneity was found
across studies regarding AKI (I² = 82.5%), whereas studies were
homogeneous regarding mortality (I² = 20.5%). Preoperative
RAS-blocker use was associated with increased odds for both postoperative
AKI (OR, 1.17; 95% CI, 1.01-1.36; P = 0.04) and mortality (OR, 1.20; 95%
CI, 1.06-1.35; P = 0.005). Limitations: Lack of randomized controlled
trials, different definitions of AKI, different durations of follow-up
used to analyze death outcome, and inability to exclude outcome reporting
bias. Conclusions: In retrospective studies, preoperative use of RAS
blockers was associated with increased odds of postoperative AKI and
mortality in patients undergoing cardiovascular surgery. A large,
multicenter, randomized, controlled trial should be performed to confirm
these findings. &#xa9; 2013 National Kidney Foundation, Inc.

<12>
Accession Number
52776121
Author
Verma S.; Farkouh M.E.; Yanagawa B.; Fitchett D.H.; Ahsan M.R.; Ruel M.;
Sud S.; Gupta M.; Singh S.; Gupta N.; Cheema A.N.; Leiter L.A.; Fedak
P.W.M.; Teoh H.; Latter D.A.; Fuster V.; Friedrich J.O.
Institution
(Verma, Ahsan, Gupta, Gupta, Teoh, Latter) Division of Cardiac Surgery, St
Michael's Hospital Toronto, ON, Canada
(Fitchett, Cheema) Division of Cardiology, St Michael's Hospital Toronto,
ON, Canada
(Leiter, Teoh) Division of Endocrinology and Metabolism, St Michael's
Hospital Toronto, ON, Canada
(Friedrich) Departments of Critical Care and Medicine, St Michael's
Hospital Toronto, ON, Canada
(Verma, Farkouh, Fitchett, Gupta, Cheema, Leiter, Teoh, Latter, Friedrich)
Keenan Research Centre in the Li Ka Shing Knowledge Institute, St
Michael's Hospital Toronto, ON, Canada
(Farkouh) University Health Network, Toronto, ON, Canada
(Verma, Yanagawa, Latter) Department of Surgery, University of Toronto,
ON, Canada
(Farkouh, Fitchett, Sud, Gupta, Cheema, Leiter, Friedrich) Department of
Medicine, University of Toronto, ON, Canada
(Leiter) Department of Nutritional Sciences, University of Toronto, ON,
Canada
(Friedrich) Interdepartmental Division of Critical Care, University of
Toronto, ON, Canada
(Singh) Pramukhswami Medical College, Gujarat, India
(Ruel, Gupta) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Sud) Division of Critical Care, Department of Medicine, Trillium Health
Partners, Mississauga, ON, Canada
(Gupta) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Fedak) Libin Cardiovascular Institute of Alberta, University of Calgary,
Calgary, AB, Canada
(Fuster) Mount Sinai Medical Center, New York, NY, United States
(Fuster) National Center for Cardiovascular Research (CNIC), Madrid, Spain
Title
Comparison of coronary artery bypass surgery and percutaneous coronary
intervention in patients with diabetes: A meta-analysis of randomised
controlled trials.
Source
The Lancet Diabetes and Endocrinology. 1 (4) (pp 317-328), 2013. Date of
Publication: December 2013.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The choice between coronary artery bypass surgery (CABG) and
percutaneous coronary intervention (PCI) for revascularisation in patients
with diabetes and multivessel coronary artery disease, who account for 25%
of revascularisation procedures, is much debated. We aimed to assess
whether all-cause mortality differed between patients with diabetes who
had CABG or PCI by doing a systematic review and meta-analysis of
randomised controlled trials (RCTs) comparing CABG with PCI in the modern
stent era. Methods: We searched Medline, Embase, and the Cochrane Central
Register of Controlled Trials from Jan 1, 1980, to March 12, 2013, for
studies reported in English. Eligible studies were those in which
investigators enrolled adult patients with diabetes and multivessel
coronary artery disease, randomised them to CABG (with arterial conduits
in at least 80% of participants) or PCI (with stents in at least 80% of
participants), and reported outcomes separately in patients with diabetes,
with a minimum of 12 months of follow-up. We used random-effects models to
calculate risk ratios (RR) and 95% CIs for pooled data. We assessed
heterogeneity using I². The primary outcome was all-cause
mortality in patients with diabetes who had CABG compared with those who
had PCI at 5-year (or longest) follow-up. Findings: The initial search
strategy identified 3414 citations, of which eight trials were eligible.
These eight trials included 7468 participants, of whom 3612 had diabetes.
Four of the RCTs used bare metal stents (BMS; ERACI II, ARTS, SoS, MASS
II) and four used drug-eluting stents (DES; FREEDOM, SYNTAX, VA CARDS,
CARDia). At mean or median 5-year (or longest) follow-up, individuals with
diabetes allocated to CABG had lower all-cause mortality than did those
allocated to PCI (RR 0.67, 95% CI 0.52-0.86; p=0.002; I²=25%;
3131 patients, eight trials). Treatment effects in individuals without
diabetes showed no mortality benefit (1.03, 0.77-1.37; p=0.78;
I²=46%; 3790 patients, five trials;
p<inf>interaction</inf>=0.03). We identified no differences in outcome
whether PCI was done with BMS or DES. When present, we identified no clear
causes of heterogeneity. Interpretation: In the modern era of stenting and
optimum medical therapy, revascularisation of patients with diabetes and
multivessel disease by CABG decreases long-term mortality by about a third
compared with PCI using either BMS or DES. CABG should be strongly
considered for these patients. Funding: Canadian Institutes of Health
Research, Heart and Stroke Foundation of Canada, and Canada Research
Chairs programme. &#xa9; 2013 Elsevier Ltd.

<13>
Accession Number
605439646
Author
Zurakowski A.; Buszman P.P.; Milewski K.P.; Janas A.; Gorycki B.; Kondys
M.; Gasior P.; Michalak M.; Boxberger M.; Peppas A.; Granada J.F.; Buszman
P.E.
Institution
(Zurakowski, Buszman, Milewski, Janas, Gorycki, Kondys, Michalak, Buszman)
Center for Cardiovascular Research and Development, American Heart of
Poland Inc., 41 Czajek str., Katowice, Poland
(Buszman, Gasior) Silesian Center for Heart Diseases, Zabrze, Poland
(Boxberger) B.Braun, Melsungen AG, Berlin, Germany
(Peppas, Granada) Cardiovascular Research Foundation, Orangeburg, NY,
United States
Title
Stenting and Adjunctive Delivery of Paclitaxel Via Balloon Coating Versus
Durable Polymeric Matrix for de Novo Coronary Lesions: Clinical and
Angiographic Results from the Prospective Randomized Trial.
Source
Journal of Interventional Cardiology. 28 (4) (pp 348-357), 2015. Date of
Publication: 01 Aug 2015.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background There is limited comparative clinical data regarding the safety
and efficacy profile of paclitaxel delivery via balloon versus
stent-polymer matrix. In this study, we aimed to compare the clinical and
angiographic results of two different methods of paclitaxel delivery among
patients undergoing percutaneous coronary intervention (PCI) for single de
novo coronary lesions. Methods A total of 202 patients undergoing PCI due
to symptomatic heart disease and at least one significant coronary artery
lesion were prospectively enrolled in a multicenter non-inferiority trial.
Eligible patients were randomized to a revascularization with either a
paclitaxel eluting stent (PES = Coroflex Please, B.Braun) or a bare metal
stent (BMS) followed by a paclitaxel coated balloon (PCB) dilation (BMS =
Coroflex + PCB = Sequent Please, B.Braun). Clinical follow-up was obtained
at 9 months in all patients, whereas angiographic in a subset of 94
(46.5%) patients. Results The baseline characteristics were well balanced
between groups. At 9 months, the primary endpoint of in-stent late lumen
loss in BMS + PCB was comparable and non-inferior to PES (0.21 +/- 0.5 vs.
0.30 +/- 0.7 mm, respectively. P<inf>non-inf</inf> < 0.05). At 9 months,
the incidence of MACE (7.0 vs. 6.9%, HR = 1, 95%CI: 0.3-2.8; P = 0.99),
comprising the occurrence of myocardial infarction (4.9 vs. 3.0%, HR =
1.62, 95%CI: 0.4-6.5; P = 0.32), target lesion revascularization (6.9 vs.
5.0%, HR = 1.42, 95%CI: 0.4-4.4; p = 0.54) and stent thrombosis (4.9 vs.
3.0%, HR = 2.01, 95%CI: 0.5-7.4; P = 0.74) was comparable between BMS +
PCB and PES, respectively. In the BMS + PCB group, thrombosis tended to
occur within 30 days (3.9 vs. 1.0%; P = 0.38). Conclusions Paclitaxel
delivery via drug coated balloon or polymer-stent matrix achieved
comparable angiographic and clinical results among patients with de novo
coronary lesions. BMS + PCB revascularization was associated with a higher
rate of stent thrombosis when compared to newer generation drug eluting
stents, therefore, should be recommended as a bail-out for PCB alone
angioplasty. Copyright &#xa9; 2015, Wiley Periodicals, Inc.

<14>
Accession Number
607446549
Author
Luthra S.; Taggart D.P.
Institution
(Luthra) Division of Cardiac Surgery, Derriford Hospital, Plymouth
Hospitals NHS Trust, Derriford, Plymouth PL6 8DH, United Kingdom
(Taggart) Oxford Heart Centre, Oxford University Hospitals, Oxford, United
Kingdom
Title
Can the sum of pooled data from observational studies better evaluate
outcome measures for therapies in coronary artery disease?.
Source
Expert Review of Cardiovascular Therapy. 14 (2) (pp 155-162), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Randomized control trials (RCTs) are considered the gold standard in the
hierarchy of evidence based medicine. Guidelines and recommendations for
clinical practice are based on the strength of evidence in this
hierarchical tree. This article looks at the weakness of RCTs and variance
between large pooled observational data and trial results for some of the
historical trials in coronary artery disease. Observational studies can
supplement data from resource intensive RCTs. Guidelines for reporting and
analysis however need to be rigorous. It further discusses alternate
systems of hierarchies as basis for recommendations. Copyright &#xa9; 2015
Taylor & Francis.

<15>
Accession Number
607379270
Author
Gilliland S.; Brainard J.
Institution
(Gilliland, Brainard) Univsersity of Colorado, School of Medicine, Mail
Stop B113, 12401 E 17th Avenue, Aurora, CO 80045, United States
Title
Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 19 (4) (pp 302-308),
2015. Date of Publication: 01 Dec 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Postoperative pulmonary complications following cardiac and thoracic
surgery are common and associated with significant morbidity and
mortality. Noninvasive ventilation has emerged as a successful and
well-validated strategy to treat various acute medical conditions. More
recently, noninvasive ventilation has been studied in selective surgical
patient populations with the goal of preventing postoperative
complications and treating acute respiratory failure. In this clinical
review, we will briefly examine the incidence of pulmonary complications
following cardiothoracic surgery and the physiology and mechanics of acute
respiratory failure and noninvasive ventilation. We then present a
systematic review of the indications, patient selection, and current
literature investigating the specific use of noninvasive ventilation in
this population. Copyright &#xa9; SAGE Publications.

<16>
Accession Number
607379269
Author
Varghese R.; Jhang J.
Institution
(Varghese, Jhang) Icahn School of Medicine at Mount Sinai, 1 Gustave Levy
Place, Box 1028, New York, NY 10011, United States
Title
Blood Conservation in Cardiac Surgery.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 19 (4) (pp 293-301),
2015. Date of Publication: 01 Dec 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Blood transfusion is the most common procedure in cardiac surgery.
Increasing evidence exists that excess transfusions are harmful to
patients. Transfusion reactions and complications, including infection,
immune modulation, and lung injury, are known complications but
underreported; hence, their significance is often disregarded.
Furthermore, a number of randomized trials have shown that a restrictive
transfusion strategy is equal to if not better than a liberal transfusion
strategy. Despite the evidence for the use of restrictive transfusion
triggers, its dissemination in the cardiac surgical community has met with
resistance. In this review, we outline the risks of transfusion, compare
restrictive and liberal transfusion strategies in cardiac surgery, and
finally outline perioperative interventions to minimize transfusion in the
cardiac surgical patient. Copyright &#xa9; SAGE Publications.

<17>
[Use Link to view the full text]
Accession Number
50904787
Author
Nakajima J.
Institution
(Nakajima) University of Tokyo Graduate School of Medicine, Japan
Title
Surgery for secondary spontaneous pneumothorax.
Source
Current Opinion in Pulmonary Medicine. 16 (4) (pp 376-380), 2010. Date of
Publication: July 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review: Secondary spontaneous pneumothorax (SSP) can occur in
patients who are suffering from diffuse lung disease. The main cause of
SSP is chronic obstructive pulmonary disease (COPD). In contrast to
primary spontaneous pneumothorax, SSP is a potentially life-threatening
condition because patients with SSP also have limited cardiopulmonary
reserve. Prompt diagnosis and treatment of SSP are mandatory. In this
review, thoracoscopy, a less invasive surgical treatment for SSP, is
discussed from the viewpoint of postoperative morbidity, mortality, and
recurrence of SSP. Recent findings: A meta-analysis showed that
postoperative recurrence of pneumothorax is more frequently observed
following thoracoscopy than following open thoracotomy. Recent studies on
thoracoscopic surgery for SSP have shown that the rate of postoperative
morbidity is still high (15-27.7%) and thoracoscopy is sometimes replaced
with open thoracotomy because of dense pleural adhesion or inability to
maintain one-lung ventilation during surgery. However, many thoracic
surgeons prefer to perform thoracoscopic surgery for SSP because it is
less invasive than open thoracotomy. Techniques for bullectomy and
pleurodesis are currently being adapted to decrease the recurrence rate of
pneumothorax. Summary: Thoracoscopic surgery for the treatment of SSP
should be less invasive to reduce postoperative morbidity, and it should
also be more effective to reduce the recurrence of pneumothorax. &#xa9;
2010 Wolters Kluwer Health
Lippincott Williams & Wilkins.

<18>
[Use Link to view the full text]
Accession Number
608201197
Author
Budoff M.J.; Bloom S.A.; Chow B.J.W.; Chandler A.B.; Cole J.H.
Institution
(Budoff) David Geffen School of Medicine, Harbor-UCLA Medical Center,
Division of Cardiology, Los Angeles Biomedical Research Institute, 1124
West Carson Street, Los Angeles, CA 90502, United States
(Bloom) Overland ParkKSUnited States
(Chow, Chandler) Department of Medicine, University Health Care System,
Augusta, GA, United States
(Cole) MobileALUnited States
(Chow) Department of Medicine, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Title
Coronary computed tomography angiography predicts subsequent cardiac
outcome events: Results of the Visipaque CCTA registry study.
Source
Coronary Artery Disease. 26 (4) (pp 301-307), 2015. Date of Publication:
01 Dec 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives To evaluate the diagnostic performance and predictive value of
coronary computed tomography angiography (CCTA) on subsequent cardiac
outcomes. Background CCTA has been suggested as an alternative method to
invasive coronary angiography for detection of and ruling out coronary
artery disease (CAD). However, the usefulness of CCTA findings in
predicting patient outcome in routine clinical practice is still
uncertain. Materials and methods A prospective, multicenter registry study
of CCTA with a Visipaque injection 320 mg I/ml was carried out in
symptomatic patients suspected of having CAD as part of their medical
care. CCTA findings were used to guide patient management decisions.
Patient cardiac outcomes were followed at 1, 6, and 12 months after the
CCTA procedure for the occurrence of major adverse cardiac event (MACE)
(cardiac death, nonfatal myocardial infarction, or unstable angina
requiring hospitalization). All cardiac outcome events or deaths were
adjudicated independently. Results Of 874 patients (mean age=59 years; 51%
men) who received Visipaque, 857 were included in the efficacy analysis.
Using cardiac outcomes as the endpoint, the sensitivity of CCTA was 96.1,
95.8, and 94.7%, specificity was 84.5, 86.6, and 87.0%, and negative
predictive value more than 99.0% at 1, 6, and 12 months, respectively. At
12 months, the rate of MACE was 5.7% (10/174) in patients with a positive
CCTA (one or more >50% stenosis) and 0.1% (1/683) in patients with a
negative CCTA (99.9% MACE-free survival rate). The Cox proportional
hazards analysis with CCTA outcome, age, sex, reasons for CCTA, and
cardiac risk factors as covariates showed a hazard ratio of 87.6 for
positive versus negative CCTA (P=0.0001). Conclusion CCTA is a highly
accurate, noninvasive tool to detect or rule out subsequent cardiovascular
events in patients with intermediate pretest probability of CAD or an
uninterpretable/equivocal stress test. A positive CCTA finding contributed
significantly toward the prediction of subsequent MACE whereas a negative
CCTA carried excellent prognostic outcomes at 12 months. Copyright &#xa9;
2015 Wolters Kluwer Health, Inc. All rights reserved.

<19>
Accession Number
605794449
Author
Chandrasekhar J.; Hibbert B.; Ruel M.; Lam B.-K.; Labinaz M.; Glover C.
Institution
(Chandrasekhar, Hibbert, Labinaz, Glover) University of Ottawa Heart
Institute, CAPITAL Research Group, Division of Cardiology, Ottawa, ON,
Canada
(Ruel, Lam) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Chandrasekhar) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Title
Transfemoral vs Non-transfemoral Access for Transcatheter Aortic Valve
Implantation: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 31 (12) (pp 1427-1438), 2015. Date of
Publication: 2015.
Publisher
Pulsus Group Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is the
definitive therapy for high-risk patients with severe aortic stenosis. The
aim of this study was to determine the effect of non-transfemoral access
on clinical outcomes in TAVI. Methods: We conducted a computerized
literature search on SCOPUS and selected all studies published in the
English language, from 2002 until March 12 2014, that compared
transfemoral access with a non-transfemoral access cohort. Two independent
reviewers evaluated the studies and extracted data for analysis. Results:
A total 17,020 patients (11,079 transfemoral, 5941 non-transfemoral)
encompassing 28 studies underwent TAVI between 2007 to 2013. Overall, the
30-day mortality was 4.7% with the transfemoral approach and 8.1% with a
non-transfemoral approach (odds ratio [OR], 0.56; 95% confidence interval
[CI], 0.49-0.64; P < 0.01). The 1-year mortality was 16.4% with
transfemoral access and 24.8% with non-transfemoral access (OR, 0.68; 95%
CI, 0.60-0.75; P < 0.01). Transfemoral access was associated with a
greater incidence of vascular complications (OR, 2.1; 95% CI, 1.48-2.99; P
< 0.01) but a lower rate of surgical conversion (OR, 0.59; 95% CI,
0.42-0.81; P < 0.01) and similar bleeding (OR, 1.01; 95% CI, 0.81-1.27; P
= 0.91) compared with non-transfemoral access. The incidence of
cerebrovascular events was similar in both groups (1.6% vs 2.1%; OR, 0.86;
95% CI, 0.64-1.15; P = 0.31). Conclusions: Transfemoral access was
associated with lower rate of 30-day and 1-year mortality compared with
non-transfemoral access for TAVI. Randomized studies are needed to
ascertain the effect of alternative access sites on clinical outcomes in
prohibitive-risk, high-risk, and intermediate-risk populations, using
currently available technologies. Copyright &#xa9; 2015 Canadian
Cardiovascular Society.

<20>
Accession Number
603436824
Author
Phan K.; Wong S.; Phan S.; Ha H.; Qian P.; Yan T.D.
Institution
(Phan, Yan) The Collaborative Research (CORE) Group, Macquarie University
Hospital Clinic, Macquarie University, Suite 302, 2 Technology Place,
Sydney, NSW 2109, Australia
(Wong) Gosford Hospital, Gosford, Australia
(Phan, Phan) Sydney Medical School, University of Sydney, Sydney,
Australia
(Phan, Ha) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Phan, Qian) Department of Cardiology, Westmead Hospital, Sydney,
Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Title
Transcatheter Aortic Valve Implantation (TAVI) in Patients With Bicuspid
Aortic Valve Stenosis - Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 24 (7) (pp 649-659), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a feasible
interventional technique for severe aortic stenosis in patients who are
deemed inoperable or at high surgical risk. There is limited evidence for
the safety and efficacy of TAVI in patients with bicuspid aortic valves
(BAV), the most common congenital valve abnormality. In many TAVI trials,
patients with BAV have been contraindicated due to concerns surrounding
abnormal valve geometry, leading to malfunction or malpositioning. A
systematic review and meta-analysis was conducted in order to assess the
current evidence and relative merits of TAVI in aortic stenosis patients
with BAV. Method: From six electronic databases, seven articles including
149 BAV and 2096 non-BAV patients undergoing TAVI were analysed. Results:
Between the BAV and no-BAV cohorts, there was no difference in 30-day
mortality (8.3% vs 9.0%; P=0.68), post-TAVI mean peak gradients (weighted
mean difference, 0.36. mmHg; P=0.55), moderate or severe paravalvular leak
(25.7% vs 19.9%; P=0.29), pacemaker implantations (18.5% vs 27.9%;
P=0.52), life-threatening bleeding (8.2% vs 13.9%; P=0.33), major bleeding
(20% vs 16.8%; P=0.88), conversion to conventional surgery (1.9% vs 1.2%;
P=0.18) and vascular complications (8.6% vs 10.1%; P=0.32). Conclusions:
Preliminary short and mid-term pooled data from observation studies
suggest that TAVI is feasible and safe in older patients with BAV. While
future randomised trials are not likely, larger adequately-powered
multi-institutional studies are warranted to assess the long-term
durability and complications associated with TAVI in older BAV patients
with severe aortic stenosis. Copyright &#xa9; 2015.

<21>
Accession Number
373461597
Author
MacFadyen R.J.
Institution
(MacFadyen) Internal Medicine/Staff Cardiologist, Ballarat Health and
University of Melbourne, Ballarat, Australia
Title
Associations and clinical significance in meta-analysis: When are the
deductions too presumptive?.
Source
Journal of the Royal College of Physicians of Edinburgh. 44 (2) (pp
131-132), 2014. Date of Publication: 2014.
Publisher
Royal College of Physicians of Edinburgh (E-mail: k.oneill@rcpe.ac.uk)
Abstract
This meta-analysis of publications over an approximate ten-year period
from 2002-12 looked at mortality after coronary presentations. A total of
487 reports were studied and 48 were assessed for the impact of nominal
'off hours' (night and weekends) presentation for catheter-based
revascularisation for ST elevation myocardial infarction (STEMI). Smaller
studies tended to show increased mortality off hours, larger samples
little or no adverse effect. The net impact, using a random effect
meta-analysis model, was a statistically significant 2-4% mortality
excess. This was linked by the authors to an increase in hospital 'door to
balloon' times. Data on time to recognition and hospital presentation were
not available but were said to be shorter off hours as seen in other
publications. More adverse effects were seen off hours in non-North
American centres and was associated with a reduced door to balloon time in
North American registries. The authors go on to suggest these observations
have implications for the assessment of quality of care by hospitals (and
staff) and should guide 'value based purchasing' on the basis of off hours
performance. The limitations - lack of randomisation, inconsistent
definition of 'off hours', high heterogeneity, publication bias,
overlapping patients - were all felt to be offset by the statistical power
of analysis (more than one million patients from the 48 publications
included). The authors considered that previous failed attempts to confirm
the adverse off hours effect on mortality were due to a lack of
statistical power. &#xa9; 2014 Royal College of Physicians of Edinburgh.

<22>
Accession Number
612782592
Author
Heilmann C.; Stotz U.; Burbaum C.; Feuchtinger J.; Leonhart R.; Siepe M.;
Beyersdorf F.; Fritzsche K.
Institution
(Heilmann) Department of Cardiovascular Surgery, Heart Center, University
of Freiburg, Freiburg, Germany
(Stotz) Department of Psychosomatic Medicine and Psychotherapy, Medical
Center, University of Freiburg, Freiburg, Germany
(Burbaum) Institute of Psychology, University of Freiburg, Freiburg,
Germany
(Feuchtinger) Quality and Development in Nursing Care, Medical Center,
University of Freiburg, Freiburg, Germany
(Leonhart) Institute of Psychology, University of Freiburg, Freiburg,
Germany
(Siepe) Department of Cardiovascular Surgery, Heart Center, University of
Freiburg, Freiburg, Germany
(Beyersdorf) Department of Cardiovascular Surgery, Heart Center,
University of Freiburg, Freiburg, Germany
(Fritzsche) Department of Psychosomatic Medicine and Psychotherapy,
Medical Center, University of Freiburg, Freiburg, Germany
Title
Short-term intervention to reduce anxiety before coronary artery bypass
surgery--a randomised controlled trial.
Source
Journal of clinical nursing. 25 (3-4) (pp 351-361), 2016. Date of
Publication: 01 Feb 2016.
Abstract
AIMS AND OBJECTIVES: The aim of this study was to evaluate an intervention
with individualised information and emotional support before coronary
artery bypass grafting in a controlled randomised trial.
BACKGROUND: Anxiety is a typical phenomenon in patients who are to undergo
cardiac surgery. Preoperative anxiety has been shown to correlate to
adverse postoperative outcomes. Emotional support could be an effective
measure to reduce preoperative anxiety.
DESIGN AND METHODS: Patients with planned first coronary artery bypass
grafting were randomised into an intervention group (n = 139) and a
control group (n = 114). The patients of the control group were routinely
informed as usual. The patients of the intervention group received a
dialogue with individualised information and emotional support one day
before surgery in addition to standard care. This intervention of ~30
minutes was based on a supportive psychotherapy model and was delivered by
trained nurses. The primary outcome was the change in anxiety before
operation. The secondary outcomes consisted of changes in postoperative
anxiety, time on intensive care unit and in-hospital mortality.
RESULTS: Significantly reduced anxiety was found in the intervention group
patients compared to control patients before coronary artery bypass
grafting (p < 0.001) and five days after surgery (p < 0.001). Both groups
did not differ in in-hospital mortality and duration of stay in the
intensive care unit.
CONCLUSIONS: Our short-term psychosocial intervention in patients
undergoing coronary artery bypass grafting had a beneficial effect on
reducing pre- and postoperative anxiety that was better than routine
information alone.
RELEVANCE TO CLINICAL PRACTICE: These results advocate training for nurses
and physicians to provide emotional support to patients before coronary
artery bypass grafting. Copyright &#xa9; 2016 John Wiley & Sons Ltd.

<23>
[Use Link to view the full text]
Accession Number
612076428
Author
Resor C.D.; Nathan A.; Kereiakes D.J.; Yeh R.W.; Massaro J.M.; Cutlip
D.E.; Steg P.G.; Hsieh W.-H.; Mauri L.
Institution
(Resor, Mauri) Department of Medicine, Division of Cardiology, Center for
Clinical Biometrics, Harvard Medical School, Cardiovascular Medicine,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Yeh, Cutlip, Hsieh, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Nathan) Division of Cardiology, University of Pennsylvania Medical
Center, Philadelphia, United States
(Yeh, Cutlip) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Massaro) Department of Biostatistics, Boston University School of Public
Heath, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
Title
Impact of Optimal Medical Therapy in the Dual Antiplatelet Therapy Study.
Source
Circulation. 134 (14) (pp 989-998), 2016. Date of Publication: 04 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Continued dual antiplatelet therapy and optimal medical
therapy (OMT) improve outcomes in selected patient populations with
established coronary heart disease, but whether OMT modifies the treatment
effect of dual antiplatelet therapy is unknown. Methods: The DAPT (Dual
Antiplatelet Therapy) Study, a double-blind trial, randomly assigned 11
648 patients who had undergone coronary stenting and completed 1 year of
dual antiplatelet therapy without major bleeding or ischemic events to an
additional 18 months of continued thienopyridine or placebo. OMT was
defined as a combination of statin, beta-blocker, and
angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use
in patients with an American College of Cardiology/American Heart
Association class I indication for each medication. Per protocol, all
patients were treated with 75 to 325 mg aspirin daily. End points included
myocardial infarction, major adverse cardiovascular and cerebrovascular
events, and Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries moderate or severe bleeding events.
Results: Of 11 643 randomly assigned patients with complete medication
data, 63% were on OMT. Between 12 and 30 months, continued thienopyridine
reduced myocardial infarction in comparison with placebo in both groups
(on OMT 2.1% versus 3.3%, hazard ratio [HR], 0.64; 95% confidence interval
[CI], 0.48-0.86; P=0.003; off OMT 2.2% versus 5.2%, HR, 0.41; CI,
0.29-0.58; P<0.001; interaction P=0.103). Comparing continued
thienopyridine versus placebo, rates of major adverse cardiovascular and
cerebrovascular events were 4.2% versus 5.0% among patients on OMT (HR,
0.82; CI, 0.66-1.02; P=0.077) and 4.5% versus 7.0% among those off OMT
(HR, 0.63; CI, 0.49-0.82; P<0.001; interaction P=0.250); rates of bleeding
for thienopyridine versus placebo in patients on OMT were 2.2% versus 1.0%
(HR, 2.13; CI, 1.43-3.17; P<0.001), and in patients off OMT were 2.8%
versus 2.2% (HR, 1.30; CI, 0.88-1.92; P=0.189; interaction P=0.073).
Overall, patients on OMT had lower rates of myocardial infarction (2.7%
versus 3.7%, P=0.003), major adverse cardiovascular and cerebrovascular
events (4.6% versus 5.7%, P=0.007), and bleeding (1.6% versus 2.5%,
P<0.001) in comparison with patients off OMT. Rates of stent thrombosis
(0.8% versus 1.0%, P=0.171) and death (1.6% versus 1.9%, P=0.155) did not
differ. Conclusions: Continued thienopyridine therapy reduced the rate of
myocardial infarction regardless of OMT status and had consistent effects
on reduction in major adverse cardiovascular and cerebrovascular events
and increased bleeding. Copyright &#xa9; 2016 American Heart Association,
Inc.

<24>
[Use Link to view the full text]
Accession Number
612344068
Author
Karkouti K.; Callum J.; Wijeysundera D.N.; Rao V.; Crowther M.; Grocott
H.P.; Pinto R.; Scales D.C.; Achen B.; Brar S.; Morrison D.; Wong D.;
Bussieres J.S.; De Waal T.; Harle C.; De Medicis E.; McAdams C.; Syed S.;
Tran D.; Waters T.
Institution
(Karkouti) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, University of Toronto, 3EN, Toronto,
ON M5G 2C4, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, Sunnybrook
Health Sciences Centre, University of Toronto, Canada
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, University Health Network, University of Toronto, Li Ka
Shing Knowledge Institute of St. Michael's Hospital, Canada
(Rao) Division of Cardiac Surgery, Department of Surgery, Toronto General
Hospital, University Health Network, University of Toronto, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, Canada
(Pinto) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, Interdepartmental Division of Critical Care, University of
Toronto, Canada
(Karkouti, Wijeysundera, Rao) Peter Munk Cardiac Centre, University Health
Network, Toronto, Canada
(Achen) Department of Anesthesia, University Hospital, Edmonton, AB,
Canada
(Brar, Morrison, Wong) Department of Anesthesia, Royal Columbian Hospital,
New Westminster, BC, Canada
(Bussieres) Department of Anesthesia, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
(De Waal) Department of Anesthesia, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Harle) Department of Anesthesia, London Health Sciences Centre (LHSC),
University Hospital, London, ON, Canada
(De Medicis) Department of Anesthesia, Sherbrooke Hopital Fleurimont
(CHUS), Sherbrooke, QC, Canada
(McAdams) Department of Anesthesia, Alberta Health Science Centre,
Calgary, AB, Canada
(Syed) Department of Anesthesia, Hamilton Health Sciences Centre (HHSC),
McMaster University, Hamilton, ON, Canada
(Tran) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Waters) Department of Anesthesia, VCH Vancouver Coastal Health (UBC),
Vancouver, BC, Canada
Title
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge
Clustered Randomized Controlled Trial.
Source
Circulation. 134 (16) (pp 1152-1162), 2016. Date of Publication: 18 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiac surgery is frequently complicated by coagulopathic
bleeding that is difficult to optimally manage using standard hemostatic
testing. We hypothesized that point-of-care hemostatic testing within the
context of an integrated transfusion algorithm would improve the
management of coagulopathy in cardiac surgery and thereby reduce blood
transfusions. Methods: We conducted a pragmatic multicenter stepped-wedge
cluster randomized controlled trial of a point-of-care-based transfusion
algorithm in consecutive patients undergoing cardiac surgery with
cardiopulmonary bypass at 12 hospitals from October 6, 2014, to May 1,
2015. Following a 1-month data collection at all participating hospitals,
a transfusion algorithm incorporating point-of-care hemostatic testing was
sequentially implemented at 2 hospitals at a time in 1-month intervals,
with the implementation order randomly assigned. No other aspects of care
were modified. The primary outcome was red blood cell transfusion from
surgery to postoperative day 7. Other outcomes included transfusion of
other blood products, major bleeding, and major complications. The
analysis adjusted for secular time trends, within-hospital clustering, and
patient-level risk factors. All outcomes and analyses were prespecified
before study initiation. Results: Among the 7402 patients studied, 3555
underwent surgery during the control phase and 3847 during the
intervention phase. Overall, 3329 (45.0%) received red blood cells, 1863
(25.2%) received platelets, 1645 (22.2%) received plasma, and 394 (5.3%)
received cryoprecipitate. Major bleeding occurred in 1773 (24.1%)
patients, and major complications occurred in 740 (10.2%) patients. The
trial intervention reduced rates of red blood cell transfusion (adjusted
relative risk, 0.91; 95% confidence interval, 0.85-0.98; P=0.02; number
needed to treat, 24.7), platelet transfusion (relative risk, 0.77; 95%
confidence interval, 0.68-0.87; P<0.001; number needed to treat, 16.7),
and major bleeding (relative risk, 0.83; 95% confidence interval,
0.72-0.94; P=0.004; number needed to treat, 22.6), but had no effect on
other blood product transfusions or major complications. Conclusions:
Implementation of point-of-care hemostatic testing within the context of
an integrated transfusion algorithm reduces red blood cell transfusions,
platelet transfusions, and major bleeding following cardiac surgery. Our
findings support the broader adoption of point-of-care hemostatic testing
into clinical practice. Clinical Trial Registration: URL:
http://www.clinicaltrials.gov. Unique identifier: NCT02200419. Copyright
&#xa9; 2016 American Heart Association, Inc.

<25>
Accession Number
607428768
Author
Kosour C.; Dragosavac D.; Antunes N.; Almeida de Oliveira R.A.R.; Martins
Oliveira P.P.; Wilson Vieira R.
Institution
(Kosour) Department of Nursing, Federal University of Alfenas, Alfenas,
Brazil
(Kosour, Dragosavac, Antunes, Martins Oliveira, Wilson Vieira) Department
of Surgery, School of Medical Sciences, State University of Campinas
(Unicamp), Campinas, Barao Geraldo, Brazil
(Almeida de Oliveira) Pontifical University Catholic of Campinas
(PUC-Campinas), Campinas, Brazil
Title
Effect of Ultrafiltration on Pulmonary Function and Interleukins in
Patients Undergoing Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 884-890),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of ultrafiltration on interleukins,
TNF-alpha levels, and pulmonary function in patients undergoing coronary
artery bypass grafting (CABG). Design Prospective, randomized, controlled
trial. Setting University hospital. Participants Forty patients undergoing
CABG were randomized into a group assigned to receive ultrafiltration (UF)
during cardiopulmonary bypass (CPB) or into another group (control) that
underwent the same procedure but without ultrafiltration. Methods
Interleukins and TNF-alpha levels, pulmonary gas exchange, and ventilatory
mechanics were measured in the preoperative, intraoperative, and
postoperative periods. Interleukins and TNF-alpha also were analyzed in
the perfusate of the test group. Measurements and Main Results There were
increases in IL-6 and IL-8 at 30 minutes after CPB and 6, 12, 24, and 36
hours after surgery, along with an increase in TNF-alpha at 30 minutes
after CPB and 24, 36, and 48 hours after surgery in both groups. IL-1
increased at 30 minutes after CPB and 12 hours after surgery, while IL-6
increased 24 and 36 hours after surgery in the UF group. The analysis of
the ultrafiltrate showed the presence of TNF-alpha and traces of IL-1beta,
IL-6, and IL-8. There were alterations in the oxygen index,
alveolar-arterial oxygen difference, deadspace, pulmonary static
compliance and airway resistance after anesthesia and sternotomy, as well
as in airway resistance at 6 hours after surgery in both groups, with no
difference between them. Conclusions Ultrafiltration increased the serum
level of IL-1 and IL-6, while it did not interfere with gas exchange and
pulmonary mechanics in CABG. Copyright &#xa9; 2016 Elsevier Inc.

<26>
Accession Number
612450117
Author
James C.; Millar J.; Horton S.; Brizard C.; Molesworth C.; Butt W.
Institution
(James, Millar, Butt) Department of Intensive Care, Royal Children's
Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia
(James, Millar, Horton, Molesworth, Butt) Murdoch Children's Research
Institute, Melbourne, Australia
(Horton) Perfusion Department, Royal Children's Hospital, Melbourne,
Australia
(Brizard) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
(Butt) Department of Paediatrics, University of Melbourne, Melbourne,
Australia
Title
Nitric oxide administration during paediatric cardiopulmonary bypass: a
randomised controlled trial.
Source
Intensive Care Medicine. 42 (11) (pp 1744-1752), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Cardiopulmonary bypass induces an ischaemia-reperfusion injury
and systemic inflammatory response, which contributes to low cardiac
output syndrome following cardiac surgery. Exogenous nitric oxide during
cardiopulmonary bypass has shown potential to ameliorate such injury. We
undertook a large randomised controlled trial to investigate the clinical
effects of administering nitric oxide to the cardiopulmonary bypass
circuit in children. Methods: After written informed consent, children
were randomised to receive 20 ppm nitric oxide to the gas inflow of the
cardiopulmonary bypass oxygenator, or standard conduct of bypass. Results:
101 children received nitric oxide and developed low cardiac output
syndrome less frequently (15 vs. 31 %, p = 0.007) than the 97 children who
did not receive nitric oxide. This effect was most marked in children aged
less than 6 weeks of age (20 vs. 52 %, p = 0.012) and in those aged 6
weeks to 2 years (6 vs. 24 %, p = 0.026), who also had significantly
reduced ICU length of stay (43 vs. 84 h, p = 0.031). Low cardiac output
syndrome was less frequent following more complex surgeries if nitric
oxide was administered (17 vs. 48 %, p = 0.018). ECMO was used less often
in the nitric oxide group (1 vs. 8 %, p = 0.014). Conclusions: Delivery of
nitric oxide to the oxygenator gas flow during paediatric cardiopulmonary
bypass reduced the incidence of low cardiac output syndrome by varying
degrees, according to age group and surgery complexity. Clinical Trial
Registration: ACTRN12615001376538. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg and ESICM.

<27>
Accession Number
611693098
Author
Penny-Dimri J.C.; Cochrane A.D.; Perry L.A.; Smith J.A.
Institution
(Penny-Dimri, Cochrane, Perry, Smith) Department of Surgery (School of
Clinical Sciences at Monash Health), Monash University and Department of
Cardiothoracic Surgery, Monash Health, Melbourne, Vic., Australia
Title
Characterising the Role of Perioperative Erythropoietin for Preventing
Acute Kidney Injury after Cardiac Surgery: Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. 25 (11) (pp 1067-1076), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ltd
Abstract
Background The role of perioperative erythropoietin (EPO) for preventing
cardiac surgery associated acute kidney injury (CSA-AKI) remains uncertain
with published trials producing conflicting results. Perspective into the
factors at work is needed, due to ongoing uncertainty. Methods We
undertook the systematic review and meta-analysis of randomised-controlled
trials (RCTs) using random-effects modelling. The primary outcome was
safety and efficacy of perioperative EPO to prevent CSA-AKI and the
secondary outcomes were change in serum creatinine, urinary neutrophil
gelatinase-associated lipocalin, time in ICU, rates of postoperative
transfusions, haemodialysis, and mortality. Subgroup analysis explored the
effect of the timing of the EPO dose in relation to surgery, the dose
response, and the impact of the preoperative risk for CSA-AKI for the
patient group. Results Six RCTs were included, which totalled 473
participants. Erythropoietin administration did not reduce the incidence
of CSA-AKI compared with controls (OR: 0.69, 95% CI: 0.35 to 1.36, P=0.28;
I²=64%, P=0.001), however, subgroup analysis suggested
administrating EPO before anaesthesia was correlated with a reduction in
CSA-AKI (OR: 0.27, 95% CI: 0.13 to 0.54, P=0.0002; I²=0%,
P=0.98). Additionally, in low risk populations, perioperative EPO
administration correlated with significant reduction in CSA-AKI when
compared to controls (OR: 0.25, 95% CI: 0.11 to 0.56, P=0.0008;
I²=0%, P=0.86). Conclusion Our findings suggest that
administering EPO before anaesthesia is emerging as an important factor
for efficacy. Erythropoietin may have a role in preventing CSA-AKI,
however, additional high-quality prospective studies are warranted,
particularly aimed at describing the methodological components, such as
the timing and size of the dose, which potentiate the cytoprotective
effect of EPO in the clinical setting. Copyright &#xa9; 2016 Australian
and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<28>
Accession Number
610173231
Author
Solberg O.G.; Stavem K.; Ragnarsson A.; Ioanes D.; Arora S.; Endresen K.;
Benth J.S.; Gullestad L.; Gude E.; Andreassen A.K.; Aaberge L.
Institution
(Solberg, Ragnarsson, Arora, Endresen, Gullestad, Gude, Andreassen,
Aaberge) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Solberg, Stavem, Benth) Faculty of Medicine, University of Oslo, Oslo,
Norway
(Stavem) Department of Pulmonary Medicine, Akershus University Hospital,
Lorenskog, Norway
(Stavem, Benth) HOKH, Research Centre, Akershus University Hospital,
Lorenskog, Norway
(Ioanes) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Centre and Centre for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Index of microvascular resistance after early conversion from calcineurin
inhibitor to everolimus in heart transplantation: A sub-study to a 1-year
randomized trial.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 1010-1017), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Microvascular function in transplanted hearts can be evaluated
by methods used in routine left heart catheterization follow-up after
heart transplantation (HTx). This sub-study of a randomized study compared
the effects of everolimus (EVR) and calcineurin inhibitor (CNI) treatment
on microvascular function as expressed by the index of microvascular
resistance (IMR) at 1 year after HTx. A secondary objective was to compare
the change in IMR from 7-11 weeks to 1 year after HTx between randomized
groups. Methods There were 70 HTx recipients included and randomly
assigned to combination therapy (EVR and CNI with early CNI withdrawal) vs
conventional CNI treatment. Coronary physiologic assessment was performed
7-11 weeks and 1 year after HTx. A linear mixed model was used to assess
the group difference at 1 year and the difference in IMR change between
7-11 weeks and 1 year after HTx. Results At 1 year, there was no
significant difference in IMR between the EVR group (17.5 mm Hg.sec +/-
8.9) (mean +/- SD) and the CNI group (14.9 mm Hg.sec +/- 6.6, p = 0.17).
The difference in IMR change between the 2 treatment arms was 1.6 mm
Hg.sec (95% confidence interval, -2.8 to 5.9; p = 0.49). Spearman's rank
correlation coefficient at 1 year after HTx between IMR and maximal
intimal thickness as assessed with intravascular ultrasound in the left
anterior descending artery was -0.13 (p = 0.28). Conclusions In this
prospective, open, randomized study comparing early CNI withdrawal with
mammalian target of rapamycin inhibitors immunosuppression during the
first year after HTx, early transition from CNI-based immunosuppression to
EVR-based treatment did not result in differences in microvascular
function as assessed by the IMR. Copyright &#xa9; 2016 International
Society for Heart and Lung Transplantation

<29>
Accession Number
609745889
Author
Morris A.A.; Kransdorf E.P.; Coleman B.L.; Colvin M.
Institution
(Morris) Division of Cardiology, Emory University, Atlanta, Georgia,
United States
(Kransdorf) Division of Cardiovascular Diseases, Cedars-Sinai Heart
Institute, Beverly Hills, California, United States
(Coleman) Nursing Research and Development, Cedars Sinai Medical Center,
Los Angeles, California, United States
(Colvin) Division of Cardiology, University of Michigan, Ann Arbor,
Michigan, United States
Title
Racial and ethnic disparities in outcomes after heart transplantation: A
systematic review of contributing factors and future directions to close
the outcomes gap.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 953-961), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
The demographics of patients undergoing heart transplantation in the
United States have shifted over the last 10 years, with an increasing
number of racial and ethnic minorities undergoing heart transplant.
Multiple studies have shown that survival of African American patients
after heart transplantation is lower compared with other ethnic groups. We
review the data supporting the presence of this outcome disparity and
examine the multiple mechanisms that contribute. With an increasingly
diverse population in the United States, knowledge of these disparities,
their mechanisms, and ways to improve outcomes is essential. Copyright
&#xa9; 2016 International Society for Heart and Lung Transplantation

<30>
Accession Number
610663691
Author
Werner N.; Zeymer U.; Schneider S.; Bauer T.; Gerckens U.; Linke A.; Hamm
C.; Sievert H.; Eggebrecht H.; Zahn R.
Institution
(Werner, Zeymer, Zahn) Medizinische Klinik B, Klinikum Ludwigshafen,
Ludwigshafen, Germany
(Zeymer, Schneider) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Bauer) Medizinische Klinik I, Universitatsklinikum Giesen, Giesen,
Germany
(Gerckens) Klinik fur Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonn,
Germany
(Linke) Klinik fur Kardiologie, Herzzentrum, Leipzig, Germany
(Hamm) Abteilung fur Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Germany
(Sievert) CardioVasculares Centrum Frankfurt, Frankfurt, Germany
(Eggebrecht) Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
Title
Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic
Valve Implantation: Results From the German TAVI Registry.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 644-653),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a safe and effective treatment for patients with severe, symptomatic
aortic valve stenosis at high surgical risk over the last years. However,
besides its minimal invasive character, TAVI still is an invasive
procedure usually performed in a population, carrying a substantial risk
for vascular complications, like stroke. Stroke is known to be a rare but
serious complication of transvascular interventions in clinical practice,
which is associated with high morbidity and mortality rates. Despite broad
clinical research in many fields of TAVI over the last years, only sparse
data still exist on the incidence and clinical risk factors of stroke
complicating TAVI in clinical practice today. Methods: We analyzed data of
1.413 TAVIs, which were enrolled at 30 sites into the prospective and
multicenter German TAVI Registry from January 2009 until June 2010.
Results: The overall incidence of cerebrovascular events complicating TAVI
was 3.2% (n = 45/1.413) in a real-world population today. 40% of all
cerebrovascular events were classified as transient ischemic attacks (TIA)
with symptoms lasting < 24 hr (18/45) and 60% were classified as stroke
with symptoms persisting > 24 hr (27/45). All strokes complicating TAVI of
50% were classified as major strokes leading to notable disability in
patients, who survive this complication (Modified Ranking Scale 3-6).
In-hospital mortality rate in patients with stroke/TIA was 28.9%, compared
to 6.9% in patients without stroke/TIA and 1-year mortality rate 46.7%
versus 18.6%, respectively. In multivariate analysis, prior stroke and
renal impairment were found as the only independent predictors for stroke
complicating TAVI. Conclusions: Stroke complicating TAVI is a serious
complication with a clinically relevant incidence even in daily practice
leading to a fivefold increase in 30-day-mortality rate, as well as a
significant increase in morbidity and disability in patients, who survive
this devastating complication. Further research is needed to identify risk
factors and ways to reduce stroke after TAVI. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<31>
Accession Number
609147989
Author
Zhou X.; Yu J.; Li L.; Gloy V.L.; Nordmann A.; Tiboni M.; Li Y.; Sun X.
Institution
(Zhou, Yu, Li, Li, Sun) Chinese Evidence-based Medicine Center, West China
Hospital, Sichuan University, Chengdu, China
(Li, Li, Sun) Clinical Research and Evaluation Unit, West China Hospital,
Sichuan University, Chengdu, China
(Gloy, Nordmann) Basel Institute of Clinical Epidemiology & Biostatistics,
University Hospital Basel, Hebelstrasse 10, Basel, Switzerland
(Tiboni) Saint Joseph's Hospital and McMaster University, Hamilton, ON,
Canada
(Sun) Center for Evidence-Based Medicine and Clinical Research, Taihe
Hospital, Hubei University of Medicine, Shiyan, Hubei 44200, China
Title
Effects of Bariatric Surgery on Mortality, Cardiovascular Events, and
Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis.
Source
Obesity Surgery. 26 (11) (pp 2590-2601), 2016. Date of Publication: 01 Nov
2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The long-term effects of bariatric surgery have yet to be
established, and a number of important studies have recently emerged. This
systematic review aimed to assess the effects of bariatric surgery on
all-cause mortality, cardiovascular events, and cancer compared to
non-surgical treatment. Methods: We searched PubMed, EMBASE, and CENTRAL
up to July 13, 2015, and included randomized controlled trials (RCTs) and
non-randomized controlled studies comparing bariatric surgery versus
non-surgical treatment and reporting data on the three defined outcomes at
1 year or longer. We analyzed RCTs and non-randomized controlled studies,
respectively. Results: Eleven RCTs, 4 non-randomized controlled trials,
and 17 cohort studies were included. The randomized evidence suggested
substantial uncertainty regarding the effects on all-cause mortality
(0/382 vs. 1/287; 7 studies), cancer (OR 0.77, 95 % CI 0.22 to 2.71; 4
studies), and cardiovascular events (no data). The pooled adjusted
estimates from non-randomized studies suggested that, compared to the
control, the surgical group had lower risk of all-cause mortality (OR
0.55, 95 % CI 0.46 to 0.65; 10 studies), cancer (OR 0.74, 95 % CI 0.65 to
0.85; 2 studies), and cardiovascular events (MI: OR 0.71, 95 % CI 0.54 to
0.94; stroke: OR 0.66, 95 % CI 0.49 to 0.89; and their composite: OR 0.67,
95 % CI 0.54 to 0.83; 1 study). Conclusions: In conclusion, bariatric
surgery could reduce all-cause mortality and probably reduce the risk of
any type of cancer. The inference was, however, based on studies with
limited methodological rigor. Uncertainty remains regarding the effects on
cardiovascular events. Copyright &#xa9; 2016, Springer Science+Business
Media New York.

<32>
Accession Number
610469777
Author
El-Baraky I.A.; Abbassi M.M.; Marei T.A.; Sabry N.A.
Institution
(El-Baraky, Abbassi, Sabry) Clinical Pharmacy Department, Faculty of
Pharmacy, Cairo, Egypt
(Marei) Anaesthiology Department, Faculty of Medicine, Cairo University,
Cairo, Egypt
Title
Obesity Does Not Affect Propofol Pharmacokinetics During Hypothermic
Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 876-883),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objective Because of the lack of data regarding the impact of obesity on
propofol pharmacokinetics in patients undergoing cardiac surgery using
hypothermic cardiopulmonary bypass (CPB), the authors sought to explore
propofol pharmacokinetics and develop a predictive pharmacokinetic model
that characterizes and predicts propofol pharmacokinetics in this
population. Design A prospective, observational study. Setting A teaching
hospital. Participants The study comprised 17 obese and 17 control
(nonobese) patients undergoing hypothermic CPB. Intervention None.
Measurements and Main Results Patients mainly underwent valve surgery. On
initiation of hypothermic CPB (28degreeC-32degreeC), patients received a
propofol (1%) bolus (1 mg/kg) immediately followed by a 2 mg/kg/h
infusion. Blood samples were withdrawn at the following times: before
dosing; 1, 3, 5, and 7 minutes after the propofol bolus dose; every 20
minutes during infusion; just before discontinuation of the infusion; and
at 1, 3, 5, 7, 10, 20, 30, and 60 minutes after discontinuation of the
infusion. The plasma propofol concentration was determined using
high-performance liquid chromatography, and then data were imported into
Monolix (Lixoft, Antony, France) for population pharmacokinetic modeling
and pharmacokinetic parameters estimation. A 2-compartment pharmacokinetic
model with age as a covariate on the peripheral volume of distribution
(V<inf>2</inf>) best described the pooled data. The pooled data was
internally evaluated successfully to describe and predict propofol
pharmacokinetics in the addressed population. Propofol clearance,
intercompartmental clearance, and central volume of distribution were 805
mL/min, 1140 mL/min and 18.8 L, respectively. V<inf>2</inf> was calculated
as 9.86xexp.(1.88x[age/40]) L. Conclusion Propofol pharmacokinetic
parameters were similar in obese and nonobese patients undergoing
hypothermic CPB. Age was the major determinant of propofol V<inf>2</inf>
in the obese population. Copyright &#xa9; 2016 Elsevier Inc.

<33>
Accession Number
604621957
Author
Virk S.A.; Tian D.H.; Liou K.; Pathan F.; Villanueva C.; Akhunji Z.; Cao
C.
Institution
(Virk, Tian, Cao) Systematic Review Unit, Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
(Villanueva) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
(Akhunji, Cao) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Villanueva, Cao) University of New South Wales, Sydney, Australia
Title
Systematic review of percutaneous coronary intervention and transcatheter
aortic valve implantation for concomitant aortic stenosis and coronary
artery disease.
Source
International Journal of Cardiology. 187 (pp 453-455), 2015. Date of
Publication: 04 Jun 2015.
Publisher
Elsevier Ireland Ltd

<34>
Accession Number
610439711
Author
Curi-Curi P.J.; Springall del Villar M.R.; Gomez-Garcia L.; Gonzalez
Vergara B.; Calderon-Colmenero J.; Ramirez-Marroquin S.; Cervantes-Salazar
J.L.
Institution
(Curi-Curi, Ramirez-Marroquin, Cervantes-Salazar) Departamento de Cirugia
Cardiaca Pediatrica y de Cardiopatias Congenitas, Instituto Nacional de
Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Springall del Villar, Gomez-Garcia) Departamento de Inmunologia,
Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Gonzalez Vergara) Departamento de Perfusion, Instituto Nacional de
Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Calderon-Colmenero) Departamento de Cardiologia Pediatrica, Instituto
Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
Title
Operatory impact of modified ultrafiltration in pediatric congenital heart
disease patients operated with cardiopulmonary bypass.
Source
Cirugia Cardiovascular. 23 (4) (pp 179-186), 2016. Date of Publication: 01
Jul 2016.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
Introduction and objectives The use of modified ultrafiltration procedure
in paediatric cardiac surgery with cardiopulmonary bypass in order to
reduce the systemic inflammatory response is controversial. The aim of
this study is to demonstrate the usefulness of this procedure for removing
pro-inflammatory substances in non-neonatal paediatric patients with
non-complex congenital heart disease. Additionally, we aimed to determine
its effects on haemoconcentration and in lactate and fluid removal.
Methods A clinical trial was designed that included non-neonatal
paediatric patients weighing >5 kg with non-complex congenital heart
disease and underwent surgery with cardiopulmonary bypass over a period of
one year. They were randomised into a problem group (with modified
ultrafiltration) and a control group (without it), and blood samples were
taken in order to measure concentrations of interleukins (6 and 10), C3d
and C4d complement fractions at the following times: baseline, before
cardiopulmonary bypass, after it, after modified ultrafiltration, from the
ultrafiltration concentrate, and on discharge from the operating room.
Endpoints were defined in terms of morbidity and mortality,
pro-inflammatory substances, lactate removal, fluid balance, and
haemoconcentration. Results A total of 13 patients were included in the
problem group and 15 in the control group. A significantly lower serum
IL-6, IL-10, and lactate at the end of cardiopulmonary bypass, were
observed in the problem group, as well as a greater fluid removal,
lactate, and C4d concentration in the ultrafiltration product. Conclusions
Modified ultrafiltration may benefit non-neonatal paediatric patients with
congenital heart disease operated on with cardiopulmonary bypass, as it is
able to decrease serum concentration of IL-6, IL-10, and lactate.
Additionally, it can help to filter C4d and remove excess fluid, thus a
greater haemoconcentration. Therefore, its routine use is recommended when
the haemodynamic conditions are favourable. Copyright &#xa9; 2016 Sociedad
Espanola de Cirugia Toracica-Cardiovascular

<35>
Accession Number
612897544
Author
Vershinina E.; Ryabova T.R.; Repin A.N.
Institution
(Vershinina, Ryabova, Repin) State Research Institute of Cardiology of
Tomsk, Department of Rehabilitation, Tomsk, Russian Federation
Title
Pharmaco-invasive approach aimed at preservation of the left ventricular
function in patients with stable coronary artery disease on the top of
carbohydrate metabolism disorders.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2016.
France. Conference Start: 20160614. Conference End: 20160615. 23 (pp S11),
2016. Date of Publication: September 2016.
Publisher
SAGE Publications Inc.
Abstract
Topic: Cardiac rehabilitation Introduction: the coronary artery disease
(CAD) treatment in type 2 DM patients remains a major issue for
cardiologists. Despite significant advances in medical and invasive
treatment, including implantation of drug-eluting stents, the patients
still have high morbidity and mortality due to progression of
atherosclerosis and HF even after percutaneous or surgical
revascularization. Purpose: the aim of our study was to investigate the
effect of the metabolic agent trimetazidine (TMZ) on the left ventricular
function in patients with CAD on the top of carbohydrate metabolism
disorders, who underwent elective percutaneous coronary intervention
(PCI). Methods: an open label, prospective, randomized clinical trial was
conducted in 63 patients stable CAD on the top of carbohydrate metabolism
disorders. All patients underwent elective coronary stenting. The patients
of the main group (n = 32) received TMZ 35 mg bid in addition to standard
therapy for 2 weeks before and 1 year after the procedure. In control
group patients (n = 31), PCI and the following follow-up were performed on
the top of standard therapy only, without the use of metabolic agents. At
baseline, two groups did not differ significantly in terms of the severity
of myocardial ischemia, clinical and medical history data, degree of
carbohydrate metabolism disorder, as well as concomitant treatments,
pharacteristics of coronary artery lesions and performed PCI. The
echocardiography was performed twice: at baseline and at 12 months of
follow-up. Results: despite the performed PCI, the carbohydrate metabolism
disorders in CAD are associated with a significant deterioration in the
regional contractility of myocardium and reduction in the LV pump function
at the follow-up (WMSI increase by 8.3% and LV SVI decrease by 7.25% at 12
months after the intervention, compared with baseline). Long-term
treatment with myocardial cytoprotector in this patients results in a
significant improvement in the contractile function of the LV myocardium
in the long-term, according to the EchoCG data (LV EDI decrease by 5.5%,
LV ESI decrease by 4.4%, LVEF increase by 2.5% at 12 months after the
intervention, compared with baseline). The improvement in the myocardial
function during the long-term treatment with TMZ is evidenced clinically
by a longer distance walked during the 6MWT (+18.4% vs. the standard
treatment group). Conclusion: the pharmaco-invasive approach, namely the
addition of a metabolic agent trimetazidine to the standard therapy in
patients with carbohydrate metabolism, undergoing the elective PCI,
contributes to the preservation of myocardial function.

<36>
Accession Number
612897488
Author
Marina Breysse M.; Navarro Claros E.; Lopez Lluva M.T.; Piqueras Flores
J.; Jurado Roman A.; Sanchez Perez I.; Pinilla Echeverri N.; Focaccio
Tejada C.A.; Gonzalez Garcia A.; Alfonso J.M.; Rayo Gutierrez M.; Crespin
Crespin M.; Morales Acuna F.; Benezet J.; Lozano Ruiz-Poveda F.
Institution
(Marina Breysse, Piqueras Flores) University General Hospital of Ciudad
Real, Cardiology Department, Ciudad Real, Spain
(Navarro Claros) University General Hospital of Ciudad Real, Department of
Family and Community Medicine, Ciudad Real, Spain
(Lopez Lluva, Jurado Roman, Sanchez Perez) University General Hospital of
Ciudad Real, Intervencional Cardiology Department, Ciudad Real, Spain
(Pinilla Echeverri) Mcmaster University, Interventional Cardiology Fellow,
ON, Canada
(Focaccio Tejada) University Hospital Dr Negrin, Anesthesiology
Department, Las Palmas De Gran Canaria, Spain
(Gonzalez Garcia) University Hospital Ramon y Cajal De Madrid, Heart
Failure and Vascular Risk Unit, Department of Internal Medicine, Madrid,
Spain
(Alfonso) National Centre for Cardiovascular Research (CNIC), Madrid,
Spain
(Rayo Gutierrez, Crespin Crespin) Hospital Santa Barbara, Cardiology
Department, Puertollano, Spain
(Morales Acuna) Indiana State University, Applied Medicine and
Rehabilitation Department, Terre Haute, United States
(Benezet) General Hospital of Jerez, Interventional Cardiology Department,
Cadiz, Spain
(Lozano Ruiz-Poveda) Hospital General De Ciudad Real, University of
Castilla-La Mancha (UCLM), Interventional Cardiology Department, Ciudad
Real, Spain
Title
Treatment cessation of dual antiplatelet therapy after percutaneous
coronary intervention and clinical events during follow-up.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2016.
France. Conference Start: 20160614. Conference End: 20160615. 23 (pp S37),
2016. Date of Publication: September 2016.
Publisher
SAGE Publications Inc.
Abstract
Topic: Cardiac rehabilitation Introduction: dual antiplatelet therapy
duration after percutaneous coronary angioplasty is controversial.
Purpose: this study aims to quantify antiplatelet therapy duration in
clinical practice and to assess associations between different modes of
dual antiplatelet therapy cessation and cardiovascular events. Methods:
multicenter prospective observational registry of patients undergoing
percutaneous coronary angioplasty with stent implantation in 4 Spanish
hospitals between January 2010 and January 2015. Out off 6086 coronary
angiogram procedures and 2325 patients undergoing angioplasty with stent
implantation, 669 patients were randomized. We examined the effect of dual
antiplatelet therapy cessation mode on adverse events: mortality, hospital
readmission, myocardial infarction, new coronary revascularisation,
stroke, major bleeding and stent thrombosis. Results: over 2.6+/-1.5 years
follow-up, 310 (50.9%) patients were classified as recommended therapy
discontinuation (group I), 92 (15.1%) as disruption (group II) and 207
(34%) as prolonged maintenance of dual antiplatelet therapy (group III).
They maintained double antiplatelet therapy for 13.7+/-9.6, 7.7+/-6.1 and
26.3+/-12.4 months respectively. Differences were observed on:
cardiovascular readmission 33(10.6%), 11(12.0%) and 45(21.7%) in groups I,
II and III (p=0.002); new revascularisation 11(3.5%), 6(6.5%) and
33(15.9%) respectively (p<0.001); all-cause mortality 14(4.5%), 10(10.9%)
and 41(19.8%) (p <0.001) and cardiovascular mortality 2(0.6%), 2(2.2%) and
8(3.9%) (p=0.035). After multivariate analysis, age OR 1.09 (95% CI
1.06-1.12) and belonging to group III OR 6.68 (95% CI 3.39- 13.16) were
predictors of mortality whereas beta-blocker treatment was protective OR
0.37 (95% CI 0.20-0.70). Conclusions: for patients undergoing percutaneous
coronary intervention, no-adherence to dual antiplatelet therapy medical
recommendations increases morbidity and mortality.

<37>
Accession Number
612897486
Author
Jankowski P.J.; Pajak A.; Lukaszewska A.; Wolfshaut-Wolak R.;
Kloch-Badelek M.; Lysek R.; Kawecka-Jaszcz K.; Czanecka D.
Institution
(Jankowski, Lukaszewska, Kloch-Badelek, Kawecka-Jaszcz, Czanecka)
Jagiellonian University Medical College, Department of Cardiology,
Interventional Electrocardiology and Hypertension, Krakow, Poland
(Pajak, Wolfshaut-Wolak, Lysek) Institute of Public Health, Epidemiology
and Population Studies Department, Jagiellonian Univesity Medical College,
Krakow, Poland
Title
Factors related to the effectiveness of hypercholesterolemia treatment
following hospitalization due to CAD. The project was supported by the
National Science Center grant(decision No DEC-2011/03/B/N27/06101.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2016.
France. Conference Start: 20160614. Conference End: 20160615. 23 (pp S50),
2016. Date of Publication: September 2016.
Publisher
SAGE Publications Inc.
Abstract
Topic: Risk factors: others Background: Statins reduce cardiovascular risk
in patients with coronary artery disease (CAD). However, only minority of
CAD patients achieves recommended blood LDL cholesterol (LDL-C)
concentration. Aim: to identify factors related to uncontrolled LDL-C
following hospitalization due to CAD. Methods: Five hospitals with
departments of cardiology, serving the city and surrounding districts in
southern part of Poland, participated in the study. Consecutive patients
at age <80 years, hospitalized due to an acute coronary syndrome or for a
myocardial revascularization procedure were recruited and interviewed 6-18
months after hospitalization in 2011-2013. Results: Overall, 83.6%
patients were taking a statin, 2.1% a fibrate, and 0.5% ezetimibe. Out of
562 analyzed patients 71.9% had LDL-C >1.8 mmol/l and 10.3% >4.0 mmol/l.
Uncontrolled LDL-C (>1.8 mmol/l) was related to age (OR per 10 years
increase = 0.77, 95% CI: 0.62-0.97, male sex (OR=0.64, 95% CI: 0.43 -
0.97), smoking OR=1.80, 95% CI: 1.04 - 3.12, high blood pressure (OR=1.56,
95% CI: 1.04 - 2.33) and high fasting glucose OR=(0.55, 95% CI: 0.32 -
0.94) whereas very high LDL-C (>4.0 mmol/l) was related to age (OR=0.46,
95% CI: 0.31-0.66), education (OR=0.89, 95% CI: 0.80 - 0.99), professional
activity (OR=0.21, 95% CI: 0.07 - 0.63), participation in cardiac
rehabilitation program OR=0.37, 95% CI: 0.17 - 0.83), and high blood
pressure (OR=2.50, 95% CI: 1.38 - 4.56). The results were similar after
exclusion patients not taking statins. Conclusion: In CAD patients poor
control of hypercholesterolemia accumulates with worse control of other
risk factors (with exception to diabetes) and is related to younger age,
female sex, low education, professional inactivity and non-participation
in rehabilitation program.

<38>
Accession Number
612897228
Author
Asmussen S.; Przkora R.; Maybauer D.M.; Sanfilippo F.; Jennings K.; Fraser
J.F.; Maybauer M.O.
Institution
(Asmussen) Department of Anaesthesiology, University Hospital of Ruhr,
University Bochum, Bochum, Germany
(Asmussen, Maybauer, Jennings, Maybauer) University of Texas Medical
Branch, Galveston, TX, United States
(Asmussen, Fraser, Maybauer) University of Queensland, Australia
(Przkora) University of Florida, Gainesville, FL, United States
(Sanfilippo) St. George Hospital, London, United Kingdom
(Maybauer) Manchester University Hospitals NHS FT, Manchester Heart
Centre, Manchester Royal Infirmary and University of Manchester,
Manchester, United Kingdom
Title
Assisted electro acupuncture reduces inflammatory response after open
heart surgery.
Source
Shock. Conference: 8th Congress of the International Federation of Shock
Societies. Japan. Conference Start: 20161003. Conference End: 20161005. 46
(4 Supplement 2) (pp 60-61), 2016. Date of Publication: October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Acupuncture treatment is well known in China for over 2,500
years and is used worldwide as analgesic treatment in patients with acute
and chronic pain. Previous studies showed that acupuncture might be
beneficial as a supplement to general anesthesia (GA). Aim of this study
was to perform a systematic review and meta-analysis to assess the level
of evidence for the clinical use of electro acupuncture (EA) in addition
to GA in regard of the response of the inflammatory system in patients
undergoing open-heart surgery. Methods: The systematic literature search
in Medline yielded a total of 220 citations, published between 1965 and
December 31st, 2015. No systematic review or meta-analyses on this topic
matched our search criteria. Each article of any language was assessed and
rated for the methodological quality of the studies, using the
recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM).
Results: Three prospective randomized controlled clinical trials of
evidence level 2 with a total of 120 patients matched our search criteria.
Three pro-inflammatory markers Interleukin 2 (IL-2), IL-6, and tumor
necrosis factor alpha (TNFa) where investigated as well as one
anti-inflammatory cytokine. Each trial studied three of the four markers.
IL-10 was examined by three trials, the remaining markers were studied by
two trials each. The results for the pro-inflammatory cytokines IL-6 and
TNFa showed a tendency towards lower values in patients received EA+GA vs
GA, only TNFa reached significant levels: EA+GA 49 patients, Control 51
patients, Standardized difference in means 0.753, SE 0.284, Variance
0.080, lower limit 0.197, upper limit 1.309, Z-Value 2.656, P-Value 0.008.
This result was consistent with significantly higher values of
anti-inflammatory IL-10 for EA+GA vs GA: EA+GA 59 patients, Control 61
patients, Standardized difference in means -0.893, SE 0.447, Variance
0.196, lower limit -1.760, upper limit -0.026, Z-Value -2.018, P-Value
0.044. Whereas the level of the IL-2 presented significantly higher values
in EA+GA (P < 0.05). Conclusions: We conclude that electro acupuncture in
combination with general anesthesia can be beneficial in regard of
reducing the immune response compared to the sole use of general
anesthesia in patients undergoing cardiac surgery. Further prospective
investigations are needed to study these effects in regard of length of
hospital stay and potential additional economical benefits.

<39>
Accession Number
612897136
Author
Asmussen S.; Maybauer D.M.; Przkora R.; Sanfilippo F.; Jennings K.; Fraser
J.F.; Maybauer M.O.
Institution
(Asmussen) University Hospital of Ruhr, University Bochum, Bochum, Germany
(Asmussen, Maybauer, Jennings, Maybauer) University of Texas Medical
Branch, Galveston, TX, United States
(Asmussen, Fraser, Maybauer) University of Queensland, Australia
(Przkora) University of Florida, Gainesville, FL, United States
(Sanfilippo) St. George Hospital, London, United Kingdom
(Maybauer) Manchester University Hospitals, NHS FT, Manchester Heart
Centre, Manchester Royal Infirmary and University, Manchester, United
Kingdom
Title
Electro acupuncture reduces need for vasoactive drugs after cardiac
surgery.
Source
Shock. Conference: 8th Congress of the International Federation of Shock
Societies. Japan. Conference Start: 20161003. Conference End: 20161005. 46
(4 Supplement 2) (pp 54), 2016. Date of Publication: October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Acupuncture has a long history in China for over 2,500 years
and is used worldwide as analgesic treatment in patients with acute and
chronic pain. Recent studies showed that acupuncture might also be
beneficial as a analgesic supplement to general anesthesia (GA). Aim of
this study was to perform a systematic review and metaanalysis to assess
the level of evidence for the clinical use of electro acupuncture (EA) in
addition to GA in patients that underwent openheart surgery about the need
for vasoactive drugs on ICU post surgery and the levels for myocardial
tissue marker Troponin I following cardiac surgery. Methods: The
systematic literature search in Medline, Cochrane Library, and Web of
Science yielded a total of 220 citations, published between 1965 and
December 31st, 2015. No systematic review or metaanalyses on this topic
matched our search criteria. Each article of any language was assessed and
rated for the methodological quality of the studies, using the
recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM).
Results: Three prospective randomized controlled clinical trials with a
total of 180 patients matched our search criteria. The need for
postoperative vasoactive drugs in cardiac surgery was significantly lower
in the group that received EA+GA vs. GA alone: Odds ratio 5.618, lower
limit 2.166, upper limit 14.571, Z-Value 3.550, P-Value <0.001. The
amounts of cardiac Troponin I measured 24hrs post surgery were
significantly lower in EA+GA group vs GA (n = 89 vs n = 91). Std
difference in means 0.761, SE 0.256, Lower limit 0.259, upper limit 1.262,
P-Value 0.003. Conclusions: We conclude that electro acupuncture in
combination with general anesthesia can be beneficial in regard of
reducing postoperative circulatory instability shown by lower need for
vasoactive drug support. In the following significantly lower values of
cardiac tissue marker Troponin I might represent a less severe myocardial
tissue damage. Further prospective investigations are needed to study
these effects in regard of length of hospital stay and potential
additional economical benefits.

<40>
Accession Number
612897903
Author
Prijic S.; Kosutic J.; Vukomanovic V.; Prijic A.; Vujic A.; Jovicic B.;
Ninic S.; Kuburovic V.
Institution
(Prijic, Kosutic, Vukomanovic, Jovicic, Ninic, Kuburovic) Mother and Child
Health Institute of Serbia, Belgrade, Serbia
(Prijic) Medical Center Dr D. Misovic - Dedinje, Belgrade, Serbia
(Vujic) Clinical Center Kragujevac - Pediatric Clinic, Serbia
Title
Meta-analysis of carvedilol versus conventional treatment in children with
systemic ventricle systolic dysfunction.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S169-S170), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Numerous randomized clinical trials in adults with chronic
heart failure demonstrated favorable effect of beta-blockers. Treatment in
children with systemic ventricle systolic dysfunction includes
betablockers (carvedilol), although benefit was not recognized
sufficiently (mainly due to limited number of pediatric patients).
Methods: We performed meta-analysis, aimed to compare carvedilol and
conventional treatment (i.e. digoxin, diuretics, ACE inhibitors) with
respect to clinical and echocardiographic outcome in children with chronic
heart failure due to impaired systemic ventricle systolic function. We
have systematically searched the Medline/PubMed and Cochrane Library for
the prospective/observational clinical trials on carvedilol and standard
treatment efficacy in pediatric (up to 18 years) heart failure patients.
Mean differences for continuous variables, odds ratios for dichotomous
outcomes, heterogeneity between studies and publication bias were
calculated using Cochrane Review Manager (Rev Man 5.2). Results: After
screening of 391 publications, total of 8 prospective/ observational
studies (with 516 patients)met established criteria. At the start of
studies, there were no differences in the left ventricular enddiastolic
diameter (p=0.17), ejection fraction (p=0.99) and fractional shortening
(p=0.30) between groups. However, at the end of studies, significantly
better ejection fraction (difference 5.2%; 95% CI: 2.4- 7.9%; p=0.0003)
and fractional shortening (difference 3.4%; 95% CI: 1.7-5.1%; p <0.0001)
was demonstrated in the carvedilol vs. control group. Decrease in the
end-diastolic diameter was better during the carvedilol treatment, but
without statistical significance. Odds ratio for chronic heart failure
related mortality/heart transplantation secondary to carvedilol was 0.52
(95% CI: 0.28-0.97; p=0.04), with non-significant heterogeneity between
studies and no impact of publication bias. Our analysis showed that
carvedilol could prevent 1 death/heart transplantation by treating 14
pediatric patients with impaired systemic ventricle systolic function. In
addition, odds ratios for clinical improvement and worsened clinical
outcome secondary to carvedilol were 1.54 (95% CI: 0.98-2.43; p=0.06) and
0.60 (95% CI: 0.36-1.00; p=0.05) respectively. Conclusions: To the best of
our knowledge, our meta-analysis demonstrated, for the first time,
clinical outcome and mortality/ heart transplantation benefits in
carvedilol vs. conventional treatment group of pediatric patients with
chronic heart failure.

<41>
Accession Number
612897830
Author
Villemain O.; Bonnet D.; Vergnat M.; Ladouceur M.; Lambert V.; Jalal Z.;
Vouhe P.; Et Belli E.
Institution
(Villemain, Bonnet, Ladouceur, Jalal, Vouhe) M3C-Necker Enfants malades,
Universite Paris Descartes, Sorbonne, Paris Cite, Paris, France
(Vergnat, Lambert, Et Belli) Centre Chirurgical Marie Lannelongue, M3C,
Universite Paris Sud, Le Plessis Robinson, France
Title
Double outlet right ventricle with non-committed ventricular septal
defect.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S167), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objective: The management of Double Outlet Right Ventricle (DORV)
associated with anatomically non-committed Ventricular Septal Defect
(NCVSD) constitutes a surgical challenge. The limits for, and the specific
outcomes after anatomical versus univentricular repair still remain to be
established. Methods: Between 1993 and 2011, 35 consecutive patients
presenting with DORV/NC-VSD and 2 adequately sized ventricles were
included into the study at two centers forming the National Referral
Center. The selection criteria included the absence of outflow tract VSD:
21 inlet (4 complete atrio-ventricular septal defect (AVSD)), 9 muscular
and 5 perimembraneous. RVOTO was present in 18/35 (51%). Twenty patients
had undergone 25 initial palliative procedures. Results: Anatomical repair
by means of intraventricular baffle construction was performed in 23
(Group l) at a median age of 10.5 months. VSD was surgically enlarged in
11 (48%). An associated RVOT reconstruction was required in 11 and
Arterial Switch Operation (ASO) was done in 5. The remaining 12 patients
underwent univentricular palliative repair (Group ll). There were 4
hospital deaths (11.4%): 3 in Group l and one in Group ll (p= .06). 8/20
survivors of group l patients underwent 13 reoperations after a median
delay of 24 months, with subaortic stenosis being the main cause for
reoperation (6/8). There was one late death in group 2. At last visit, all
survivors were in NYHA class l-ll. Ten years actuarial survival rate and
freedom from reoperation were respectively 74.7+/-5% and 58+/-5% in Group
l, and, 80 +/-7% and 71 +/-7% in Group ll. Univariate analysis showed that
AVSD and/or isolated mitral cleft were associated with death (p=.04) and
need for reoperation (p= .038). Conclusions: Despite the need for complex
procedure and the high incidence of reoperation for subaortic obstruction,
our results suggested the long-term advantages of anatomical repair in
DORV with NCVSD. The presence of associated AVSD and/or isolated mitral
cleft was the only risk factors for mortality and reoperation.

<42>
Accession Number
612897829
Author
Helm P.; Korten M.-A.; Abdul-Khaliq H.; Asfour B.; Baumgartner H.; Diller
G.-P.; Tutarel O.; Kececioglu D.; Bauer U.M.M.
Institution
(Helm, Korten, Bauer) National Register for Congenital Heart Defects,
Berlin, Germany
(Abdul-Khaliq) Saarland University Medical Center, Department of
Paediatric Cardiology, Homburg, Germany
(Asfour) Children's Heart Centre Sankt Augustin, Department of Paediatric
Cardiothoracic Surgery, Sankt Augustin, Germany
(Baumgartner, Diller) Munster University Hospital, Center for Adults with
Congenital Heart Defects, Munster, Germany
(Tutarel) Hannover Medical School, Centre for Internal Medicine,
Department of Cardiology and Angiology, Hannover, Germany
(Kececioglu) Heart and Diabetes Center NRW, Center for Congenital Heart
Defects, Bad Oeynhausen, Germany
(Bauer) Competence Network for Congenital Heart Defects, Berlin, Germany
Title
The German national register for congenital heart defects: A clinical
register that can serve as an important basis for studies on rare
diseases.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S30-S31), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Congenital heart defects (CHD) represent the most frequent
congenital disease in humans. They are characterised by a high variability
of different heart malformations, of which each single group is extremely
rare. Due to this, multicenter research is necessary to achieve
significant results. For this purpose, a nationwide clinical register has
been initiated by the German societies of paediatric cardiology,
cardiology and heart surgery. Methods: The National Register for
Congenital Heart Defects is an individual-related clinical register
featuring a broad informed consent given by its participants. Congenital
and acquired cardiac diagnoses, as well as courses of disease, operations
and catheter based interventions are recorded on the basis of medical
reports. Coding takes place according to the International Paediatric and
Congenital Cardiac Code. A central database system facilitates contacting
patients and relatives for surveys and studies at any time. The range of
diagnoses of currently 32,079 living patients is presented here. Results:
The average age is 15.6 years (SD= 13.1, minimum< 1 year; maximum 94
years). The sex distribution is well-balanced (16,182 [50.4%] male; 15,897
[49.6%] female). The distribution of main diagnoses approximates
prevalence data as assumed according to available literature. Thus,
representative studies are feasible. Among the secondary diagnoses,
chromosome anomalies such as Down's syndrome, Turner syndrome and DiGeorge
syndrome stand out. Preterm delivery and Eisenmenger's syndrome can be
cited as significant concomitant features. Conclusions: The clinical
register comprises data on a variety of patients with CHD. These data can
be used as a basis for epidemiological, clinical and genetic studies. Due
to its considerable extent and thus the option to reach unusually high
patient numbers for even rare diagnoses, the register also represents a
unique platform for research projects beyond Germany. (Table Presented).

<43>
Accession Number
612897789
Author
Duong P.; Smith J.H.; Ferguson L.P.
Institution
(Duong, Smith, Ferguson) Freeman Hospital, Newcastle upon Tyne, United
Kingdom
Title
Extracorporeal membrane oxygenation (ECMO) to aid cardiopulmonary
resuscitation in children for cardiac arrest occurring on the paediatric
cardiology ward.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S165), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: The use of ECMO rescue therapy for children suffering
cardiac arrest (ECPR) has been mostly limited to arrests occurring within
the ICU, operating room or catheterisation laboratory. At present,
published evidence does not support ECPR for arrest occurring on the ward.
We hypothesised that with good quality CPR and rapid ECPR deployment,
similar survival would be achievable in patients with cardiac disease who
arrest on the ward. Since 2005, we have had a policy of activating ECPR
for paediatric cardiology ward arrests. Our objective is to review the
outcome in this population. Methods: Freeman Hospital is a paediatric
cardiac surgical centre that undertakes 250-300 open surgical cases per
year and one of two centres in UK undertaking heart transplantation. Ward
nursing and medical staff underwent simulation training in ECPR and were
taught to activate the team for cardiac arrest of duration >5 min.
Perfusion and surgical staff were in-house during weekdays and on-call
during weekday out-of-hours and weekends. Patients were transferred to ICU
or operating room for cannulation. Patients aged<16 years who suffered
cardiac arrest on paediatric cardiology ward and received ECPR between
2005 and 2015 were identified. ECPR was defined as ECMO established during
CPR. In addition, a patient suffering intermittent multiple arrests during
cannulation was also defined as ECPR. Survival and Paediatric Cerebral
Performance Category at hospital discharge were determined from the
medical record. Results: Five children, aged 2d to 13 y, received ECPR
after cardiac arrest on the cardiology ward during 10-year period. Of
these, 2 had end-stage heart failure complicating congenital heart
disease, 2 were medical patients and one was post-surgery. The median
duration of CPR prior to ECMO was 57 min (range 45-93 min). Of the five
patients, 2 (40%) survived to discharge. The two survivors were
neurologically intact at hospital discharge (PCPC 1). Both survivors
underwent transplantation during the admission following ECPR. Two
patients developed brain death complicating cerebral oedema and one
patient died due to VAD-related haemorrhage during bridge to
transplantation. Conclusion: Although a rare event, children who suffer
cardiac arrest on cardiology ward can survive neurologically intact with
ECPR despite prolonged periods of resuscitation.

<44>
Accession Number
612897725
Author
El Kaffas R.M.H.; El Sisi A.; Mamdouh N.; Esmat A.; Al Sisi H.
Institution
(El Kaffas, El Sisi) Department of Pediatric Cardiology MD, Cairo
University Pediatric Hospital, Cairo, Egypt
(Mamdouh, Esmat) Department of Pediatric Cardiology, Ain Shams University
Pediatric Hospital, Cairo, Egypt
(Al Sisi) Department of Cardiothoracic Surgery, Cairo University Hospital,
Egypt Kids Hospital, Cairo, Egypt
Title
Long term follow up of bidirectional cavopulmonary anastomosis patients:
Multi-institutional study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S107), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: The bidirectional cavopulmonary shunt is a step towards the
Fontan operation in palliation of patients with singleventricle heart. The
Fontan procedure is performed with children between three and five years
of age. In Egypt, there is a delayed age of children undergoing Fontan
procedure due to long waiting lists and budget restraints on pediatric
cardiac surgeries. Aim of the work: To assess long term follow up of
patients with bidirectional cavopulmonary shunt and to determine the
clinical and hemodynamic effects of delayed Fontan procedure. Methods: A
total of 125 patients with bidirectional cavopulmonary shunts from three
centers: Cairo university, Ain Shams university and Egypt kids hospital
were followed up from January 2012 till July 2014. At follow up, mean age
was 7.5 (1.7-16 years) and weight was 23.05 (9-58 kg). Males were 61.5%,
64% had single ventricle morphology, 76% had additional pulmonary flow and
38.5% had prior palliative cardiac surgery. Results: The mean age at
Cavopulmonary shunt was 2.98 years (0.4 - 12 years). NYHA was class I in
82% and II in 15%, mean oxygen saturation was 81% (60-95). Cardiac
catheterization was done in 45%, mean Glenn pressure was 15.5 (6-28 mmHg)
and mean Nakata index was 287 (108-910). Catheter interventions were done
in 15%; seven patients had procedures to minimize the extrapulmonary flow:
closure of the shunts, collaterals, patent ductus arteriosuus and/or
device occlusion of the forward flow, while eight patients had balloon
and/or stent of pulmonary arteries, superior vena cava (SVC) or pulmonary
veins. Three patients had occlusion of venoatrial collaterals and/or left
SVC to coronary sinus. The only significant difference was intensive care
unit (ICU) stay which was shorter in patients with additional pulmonary
flow (P value 0.016), and mean Glenn pressure which was lower in patients
with single ventricle (P value less than 0.001). Mean survival was 11.33
years with 4% late mortality. Conclusion: Cavopulmonary shunt can be a
long term palliative procedure for patients with single ventricle
morphology in developing countries when Fontan operation cannot be done on
time due to economic restraints.

<45>
Accession Number
612897698
Author
Walavalkar V.; Evers E.; Pujar S.; Viralam K.; Mayia S.; Frerich S.;
Collin John C.; Shekhar Rao S.; Chinnaswamy Reddy C.; Prinzen F.W.;
Delhaas T.; Vanagt W.Y.
Institution
(Walavalkar, Pujar, Viralam, Mayia, Collin John, Shekhar Rao, Chinnaswamy
Reddy) Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore,
India
(Evers, Frerich, Prinzen, Delhaas, Vanagt) Cardiovascular Research
Institute Maastricht CARIM, Maastricht University Medical Center MUMC,
Maastricht, Netherlands
Title
Pre-operative Sildenafil administration in children undergoing cardiac
surgery; a randomized placebo-controlled preconditioning study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S162), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Sildenafil has strong cardiac preconditioning properties in
animal studies and is known to have a safe side effect profile in
children. Therefore, we evaluated the use of sildenafil preconditioning to
reduce postoperative myocardial injury in children undergoing surgical
ventricular septum defect (VSD) closure. Methods: Randomized, double blind
study. Children (1-17 years) undergoing VSD closure were randomized into
three groups: Placebo (Control group), preconditioning with 0.06 mg/kg
(Sild- L group) or 0.6 mg/kg sildenafil (Sild-H group). Measurements of
cardiac injury (CK-MB and troponin I), inflammatory response (IL-6 and
TNF-alpha), bypass and ventilation weaning times, inotropy score, and
echocardiographic function were made pre-and postoperatively. Data
expressed as median (range), p< 0.05 considered significant. Results:
Thirty-nine patients were studied (13/group). Aortic cross clamp time was
similar with 27 (18-85) and 27 (12-39) minutes in the Control and Sild-L
groups, respectively, but significantly longer with 39 (20-96) minutes in
the Sild-H group. Area under the curve of CK-MB release was 1105
(620-1855) ng/mL in the Control group, showed a tendency to be higher in
the Sild-L group with 1672 (564-2767) ng/mL, and was significantly higher
in the Sild-H group with 1695 (1252-3377) ng/mL. There were no differences
in inflammatory response markers, cardiopulmonary bypass and ventilation
weaning times, inotropy scores, and echocardiographic function between the
groups. Conclusion: Sildenafil does not reduce myocardial injury in
children undergoing cardiac surgery, nor does it alter cardiac function,
inotropic needs, or postoperative course. A paradoxical subclinical
increase in cardiac enzyme release after sildenafil preconditioning cannot
be excluded.

<46>
Accession Number
612897676
Author
Bonnet M.; Laux D.; Di Filippo S.; Vaksmann G.; Iserin L.; Thambo J.-B.;
Bonnet D.; Godart F.
Institution
(Bonnet, Godart) Centre Hospitalier Regional, Universitaire De Lille,
Lille, France
(Laux) Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
(Di Filippo) Centre Hospitalier, Universitaire De Lyon, Lyon, France
(Vaksmann) Cabinet De Cardiologie Vendome-Cardio, Lille, France
(Iserin) Hopital Europeen Georges Pompidou, Paris, France
(Thambo) Centre Hospitalier, Universitaire De Bordeaux, Bordeaux, France
(Bonnet) Hopital Necker - Enfants Malades, Paris, France
Title
Outcomes after protein-losing enteropathy in univentricular hearts: A
multicenter study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S3), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: Protein-losing enteropathy (PLE) is a rare but severe
complication after Fontan surgery in patients with univentricular hearts
(UVH). Outcomes are compromised since mortality is high and treatment
efficiency appears limited. Methods: This was a retrospective
observational study carried out in sixteen Pediatric Cardiology Centres in
France. All UVH patients diagnosed with PLE after Fontan type surgery such
as atriopulmonary/ atrioventricular anastomosis or
intracardiac/extracardiac total cavopulmonary connection were included.
The study period went from 1988 until 2014. Results: PLE was diagnosed in
thirty-five patients at a median age of 9.7 years. Median delay after
Fontan type surgery was 3.6 years. At diagnosis, cardiac catheterization
revealed a hemodynamic dysfunction of the Fontan circulation in 63% (n=
22/35). Treatment modalities included medical treatment alone (e.g.
oral/topic steroids, Calciparine, sildenafil) in 46% (n=16/25) or combined
treatment options (interventional or/and surgical therapy associated to
medical treatment) in the other 54% (n= 19/35). Treatment was considered
to be efficient in case of normalization of albumin level (>30 g/l).
Medical treatment alone led to complete recovery in 13% (n = 2/16), to
transient improvement in 31% (n= 5/16) and to no improvement in 56% of
patients (n= 9/ 16). No patient treated medically died but two (13%) were
finally transplanted (one recovery, one transient improvement). Combined
treatment modalities led to 21% recoveries (n= 4/19) and to 37% transient
improvements (n =7/19). No improvement was noted in 42% of patients (n
=8/19). 21% (n= 4/19) in this treatment group died.16% (n =3/19) finally
underwent heart transplantation but all three subsequently died (one early
death, two late deaths). Five and 10 years survival of the whole cohort
were 89.7% (CI95%:+/- 11.3%) and 74.9% (CI95%:+/-21.3%) respectively.
Median follow-up was 4.5 years [0.5-21.7]. At last visit, 75% of survivors
(n =21/28) were in functional NYHA class I/II. However, 75% still had
patent hypoalbuminemia and 61% received specific medical therapy for PLE.
Conclusions: Despite decreased mortality, PLE remains a significant burden
after Fontan surgery since complete recovery is rare and treatment
modalities remain unsatisfying. Heart transplantation is an ultimate
therapeutic option but carries a high risk. Further studies are needed to
develop innovative treatment strategies and improve outcomes.

<47>
Accession Number
612897639
Author
Kovacevic A.; Ohman A.; Tulzer G.; Herberg U.; Dangel J.; Bartrons J.;
Carvalho J.S.; Fesslova V.; Jicinska H.; Sarkola T.; Toler A.J.; Mellander
M.; Gardiner H.M.
Institution
(Kovacevic, Carvalho, Gardiner) Department of Paediatric and Congenital
Cardiology, Royal Brompton and Harefield Hospital, NHS Foundation Trust,
London, United Kingdom
(Kovacevic) Department of Paediatric and Congenital Cardiology, University
of Heidelberg, Heidelberg, Germany
(Ohman) Department of Women's and Children's Health, Uppsala University,
Sweden
(Tulzer) Department of Paediatric Cardiology, Children's Heart Centre,
Linz, Austria
(Herberg) Department of Paediatric Cardiology, University Hospital Bonn,
Germany
(Dangel) Perinatal Cardiology Clinic, 2nd Department of Obstetrics and
Gynecology, Medical University of Warsaw, Poland
(Bartrons) Department of Paediatric Cardiology, Hospital Clinic, Sant
Johan de Deu, Barcelona, Spain
(Carvalho) Fetal Medicine Unit, St. George's Hospital NHS Trust, London,
United Kingdom
(Fesslova) Center of Fetal Cardiology, Policlinico San Donato IRCSS,
Milan, Italy
(Jicinska) University Hospital, Masaryk University Brno, Czech Republic
(Sarkola) Children's Hospital, University of Helsinki, Central Hospital,
Helsinki, Finland
(Toler) Department of Data Analytics, Southern New Hampshire University,
Manchester, NH, United States
(Mellander) Department of Paediatric Cardiology, Queen Silva Children's
Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
(Gardiner) Department of Reproductive Biology, Faculty of Medicine, Queen
Charlotte's and Chelsea Hospital, United Kingdom
(Gardiner) Fetal Center Children's Memorial Hermann Hospital, University
of Texas, Houston, TX, United States
Title
Does reversal of flow in the fetal aortic arch in second trimester aortic
stenosis predict hypoplastic left heart syndrome?.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S1-S2), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Fetal aortic valvuloplasty (FV) has been proposed as an
effective therapy to prevent progression from aortic stenosis to
hypoplastic left heart syndrome (HLHS). Reversal of aortic arch flow in
second trimester is thought predictive of HLHS without FV. We hypothesized
that reversed arch flow does not predict HLHS. Methods: In a retrospective
multicenter and multinational study (2005-2012) 214 fetuses with aortic
stenosis were enrolled into a hybrid case-control and repeated samples
cohort. Liveborn surgical candidates undergoing FV or without FV (natural
history, NH) were matched for between +/- one Z-score for mitral valve
(MV) and aortic valve (AoV) diameters, left ventricular inlet length (LV)
and retrograde arch flow at 23+/-3 gestational weeks, producing best match
cohorts for each. Outcome measures were survival with biventricular
circulation (BV) at four years. We analysed outcomes using Cox
proportional hazards regressions and Kaplan Meier curves. Results: FV was
performed in 67/214, technically successful in 59 (88.0%). FV-related
deaths occurred in 7/67 (10.4%). Overall 151/214 (71%) were live-born,
including unknown outcomes in 5 and no surgery in 16. Kaplan Meier curves
show no significant difference in survival and in BV for case-control
groups matched for retrograde arch flow and mitral valve, aortic valve or
left ventricle inlet length Z-scores at 4 years after birth (Figure 1
a-c). Conclusions: The results from this multicenter study, matching for
similar morphology and reversed arch flow in second trimester, showed that
those with and without FV had similar BV outcomes and failed to show that
reversed arch flow predicts HLHS. (Figure Presented).

<48>
Accession Number
612897622
Author
Chuang Y.-C.
Institution
(Chuang) National Taiwan University Hospital, Taiwan (Republic of China)
Title
A narrative review of early nutrition in infant after cardiovascular
surgery.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S179), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Early nutrition is important for neonate or infant with
congenital heart disease. However, few have been known about the knowledge
of nutrition in neonate or infant after their complex heart surgery in
critical care. Methods: This study was conducted in a narrative literature
review method. A comprehensive search of four electronic databases
(PUBMIED, MEDLINE, CIHNAL, Cochrane Library) was undertaken between 1990
to 2014. Inclusion criteria were research papers related to outcomes in
pediatric patients after cardiovascular surgery, incorporating enteral
feeding or nutrition in critic care. Results: Eighteen research articles
and two review articles met the criteria were selected to be discussed.
Three themes were emerged from the literature review: (1) Variance affects
the weight in congenital heart infants. (2) Implementing advancement and
progressive feeding protocol after surgery could be benefit on decreasing
hospital or ICU length of stay, gaining weight at discharge, avoiding on
incidence of necrotizing enterocolitis and better life of quality on
sleep. (3) Addressing on home-monitoring or project after discharge to
Norwood stage II. Conclusions: Most research has been addressed on the
nutrition in infant with congenital heart disease in their recovery period
after cardiovascular surgery except for patients in critical care. The
future research could be focused on approaching the knowledge of factors
associated successful enteral feeding or initial feeding time in neonate
or infant after cardiovascular surgery in critical care.

<49>
Accession Number
612898171
Author
Van Den Hoven A.; Eicken A.; Aboulhosn J.; De Bruin C.; Duijnhouwer A.L.;
Demulier L.; Chessa M.; Uebing A.; Van Den Bosch A.E.; Witsenburg M.;
Roos-Hesselink J.W.
Institution
(Van Den Hoven, Van Den Bosch, Witsenburg, Roos-Hesselink) Erasmus MC,
Netherlands
(Eicken) German Heart Centre Munich, Germany
(Aboulhosn) UCLA, United States
(De Bruin) CCHMC, United States
(Duijnhouwer) UMC Radboud, Netherlands
(Demulier) UZ Gent, Belgium
(Chessa) IRCCS Policlinico San Donato, Italy
(Uebing) RBHT, United Kingdom
Title
Stent implantation in aortic coarctation in turner syndrome: A safety
analysis.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S59-S60), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Stent implantation has proven to be a safe and effective way
for the treatment of coarctation in adolescents and adults. Turner
Syndrome is a genetic disorder marked by a partial or complete absence of
one X-chromosome. CoA occurs in approximately 17% of Turner patients.
Also, the aortic wall composition is abnormal in Turner Syndrome (TS).
Changes in vascular smooth muscle cells, elastin and Figure. collagen
fiber and cystic medial wall necrosis, as found in Marfan syndrome, make
patients with TS vulnerable to aortic dissection. Therefore concerns exist
about coarctation stenting in TS. Methods: In this multi-center
retrospective study, all patients with Turner syndrome and a coarctation
of the aorta, treated with percutaneous stent implantation, were included.
The adverse events at short and long-term follow-up and qualitative
parameters concerning the stent implantation were assessed. Results: A
total of 17 patients with 18 stenting procedures from 8 centers were
included. Age at intervention (mean+/- sd) was 22 (+/-17,4) years. The
coarctation diameter preintervention was 8,1 (+/-3) mm and increased to
13,1 (+/-4,2). The peak gradient decreased (median (range)) from 24 (6-45)
to 0 (0-20) mmHg. Baseline and intervention characteristics are included
in table 1. At short term (<30days after the intervention) dissection of
the descending aorta occurred in 2 patients (11%), of which 1 was fatal
(5,5%). Both of these patients underwent covered stent implantation. The
mean follow-up was approximately 8 years. Two additional patients died
during follow-up due to non-related cardiac causes. One patient died
awaiting aortic valve replacement showing a large thrombus located near
the mitral valve at autopsy, the other patient died due to progressive
heart failure. Conclusions: These results suggest that, despite the use of
covered stents, coarctation stenting in TS carries a higher risk than in
non TS individuals. A prospective study is warranted, including evaluation
with pre and post procedural CT or MR imaging to better define specific
risk factors. (Figure Presented).

<50>
Accession Number
612898124
Author
Leonardi B.; Chinali M.; Ait-Ali L.; De Luca E.; Secinaro A.; Festa P.;
Albanese S.; Pongiglione G.
Institution
(Leonardi, Chinali, De Luca, Secinaro, Albanese, Pongiglione) Bambino Gesu
Children's Hospital, IRCCS Rome, Italy
(Ait-Ali, Festa) Istituto IFC-CNR, Massa-Pisa, Italy
Title
Right ventricle behavior over time in repaired Tetralogy of Fallot
patients.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S138), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: The progression of right ventricle (RV) dilation, mainly due
to pulmonary regurgitation (PR) after Tetralogy of Fallot repair (rToF)
with transannular (TP) or infundibular (IP) patch, varies among patients.
The onset of RV dysfunction, due to its progressive dilation, is still
difficult to predict. Pulmonary valve replacement (PVR) does not seem to
affect RV function, if already impaired. Understanding the rate of
progression of RV dilation over time could help identify the right timing
for PVR in order to prevent RV dysfunction. Methods: 118 rToF patients
(mean age 19,7+/- 10,8 years, 59% men) with TP or IP underwent repeated
cardiac magnetic resonance (CMR) exams at two centers in Italy between
March 2008 and March 2014. Data regarding date of surgery and type of
correction were collected, in addition to CMR parameters (RV/LV dimension
and function, pulmonary trunk/arteries stenosis, tricuspid regurgitation
and restrictive pattern flow in the pulmonary artery). Results: In the
whole population RV volume barely increased over time, paired with a
slight RV ejection fraction reduction. TP patients (86% of whole
population) showed a significantly higher rate (p= 0,002) of RV dilation
(36%) compared to IP ones (19%) and a lower rate of RV reduction (3% vs
25%). RV dilation was not significantly correlated with the type of first
surgery (palliative shunt vs repair) or the time elapsed from surgery.
Eventually pulmonary trunk/arteries stenosis or restrictive pattern did
not significantly influence RV changes over time. Conclusion: RV dilation
did not progress consistently in the majority of our rToF patients, being
nearly stable over time. Significant increase in RV dimensions and
concurrent impairment in function was observed in a subgroup of patients
mainly composed of TP correction, regardless of the presence of a
palliative shunt. The mild reduction in RV volume over time occurred in a
small subgroup, without any significant correlation with RV restrictive
physiology pattern.

<51>
Accession Number
612898098
Author
Pickardt T.; Abdul-Khaliq H.; Berger F.; Cesnjevar R.; Daehnert I.;
Dittrich S.; Hoff K.; Horer J.; Kececioglu D.; Korten M.; Kramer H.H.;
Krane M.; Laser K.T.; Photiadis J.; Poryo M.; Rentzsch A.; Salameh A.;
Schalinski A.; Scheewe J.; Schubert S.; Stiller B.; Toka O.; Bauer U.M.M.
Institution
(Pickardt, Korten, Schalinski, Bauer) Register and Competence Network for
Congenital Heart Defects, Berlin, Germany
(Abdul-Khaliq, Poryo, Rentzsch) Saarland University/Homburg, Dep. of
Pediatric Cardiology, Germany
(Berger, Schubert) German Heart Institute Berlin, Dep. of Congenital Heart
Disease/Pediatric Cardiology, Germany
(Cesnjevar) Universitatsklinikum Erlangen, Dep. of Pediatric Cardiac
Surgery, Germany
(Daehnert, Salameh) Heart Center Universitat Leipzig, Dep. of Pediatric
Cardiology, Germany
(Dittrich, Toka) Universitatsklinikum Erlangen, Dep. of Pediatric
Cardiology, Germany
(Hoff, Kramer, Scheewe) Universitatsklinikum Schleswig- Holstein/Kiel,
Dep. of Congenital Heart Disease and Pediatric Cardiology, Germany
(Horer, Krane) German Heart Center Munich, Dep. of Cardiovascular Surgery,
Division of Experimental Surgery, Germany
(Kececioglu, Laser) HDZ-NRW Bad Oeynhausen, Dep. of Pediatric Cardiology
and Congenital Heart Disease, Germany
(Photiadis) German Heart Institute Berlin, Dep. of Surgery for Congenital
Heart Disease/Pediatric Cardiac Surgery, Germany
(Stiller) Universitatsklinikum Freiburg, Dep. of Congenital Heart Disease
and Pediatric Cardiology, Germany
(Berger, Hoff, Horer, Kramer, Krane, Photiadis, Scheewe, Schubert) DZHK
(German Centre for Cardiovascular Research) Partner Site, Germany
Title
A German biobank for congenital heart defects.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S99), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
A multicentre biobank infrastructure was established in order to support
current and future scientific investigations in the field of congenital
heart defects (CHD) and cardiovascular diseases. The biobank is an
integral part of the German Registry for congenital heart defects and
collects DNA from patients plus parents (trios) and affected families, and
cardiac tissue from patients undergoing heart surgery. So far, eight
ethics committees in Germany have approved the CHDBiobank concept that
implies indefinite storage of samples and their use in on-going and in
still undefined future studies. Compliance with data privacy regulations
have been confirmed by the BerlinOfficial for Data Protection. Currently,
pediatric cardiology/heart surgery departments of eight hospitals in
Germany are involved. The CHD-Biobank is centrally managed by the Registry
team that is responsible for the validation of clinical/phenotype data,
the compliance with legal and ethical regulations, the implementation of
state-of-the-science protocols for sample acquisition, processing and
storage, and the implementation and efficient use of software solutions
for data and biomaterial management. The CHD-Biobank operates 1. a central
ID management using uniform coding systems (including barcoded sample
containers) and a central onlineaccessible database platform 2. a central
facility for blood/DNA processing, storage and dissemination of samples
(partnership with the Charite-Berlin centralized Biomaterialbank ZeBanC)
3. a decentralized sample collection structure for cardiac tissue samples
that need to be stored in liquid nitrogen gas phase (below -150oC). The
DNA collection currently comprises samples from approximately 3,600
participants covering a wide range of CHDphenotypes. The collection
includes 420 trios and 150 families with more than one affected member.
The cardiac tissue collection comprises approx. 1200 tissue samples from
500 patients with open heart surgery. The rising number of requests for
collaboration from numerous research institutions (in addition to various
German institutions also Newcastle Genetic Medicine, WT Sanger Institute
Cambridge) can be regarded as an indication for the high quality of the
CHDBiobank infrastructure, sample logistics and phenotype database.

<52>
Accession Number
612898007
Author
Weber R.W.; Oxenius A.; Attenhofer C.H.; Greutmann M.; Biaggi P.;
Burkhardt B.; Tobler D.; Valsangiacomo Buechel E.R.
Institution
(Weber, Oxenius, Burkhardt, Valsangiacomo Buechel) Children's Heart
Center, University Children's Hospital, Zurich, Switzerland
(Weber, Oxenius, Burkhardt, Valsangiacomo Buechel) Children's Research
Center, University Children's Hospital, Zurich, Switzerland
(Oxenius, Attenhofer, Greutmann) University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Attenhofer, Biaggi) Cardiovascular Center, Klinik im Park, Zurich,
Switzerland
(Tobler) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
Title
Volume and function of the right ventricle in ebstein anomaly:
Knowledge-based three dimensional reconstruction of echocardiographic
images compared to cardiac magnetic resonance.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S14), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objectives: Quantification of right ventricular (RV) volume in Ebstein
anomaly is challenging, given the different degrees of displacement of the
tricuspid valve (TV). Echocardiographic knowledge-based 3D reconstruction
(3DR) of RV volumes has been validated in normal and dilated RV. We sought
to assess feasibility of 3DR in Ebstein patients and to compare the RV
volumes with volumes obtained by cardiac magnetic resonance (CMR).
Methods: Ebstein patients with and without TV reconstruction were
prospectively recruited in 4 centres and underwent 3DR and CMR in our core
lab on the same day. Patients with pacemaker or Fontan palliation were
excluded. Knowledge-based 3DR was performed with VentripointTM
Diagnostics, USA. RV volumes were calculated using 3DR and the summation
disc method on short axis images (saCMR) and on axial images (axCMR) by
two independent experienced observers. Intermodality differences were
assessed using correlation coefficient and Bland-Altman analysis and
expressed as % mean difference +/-standard deviation and 95% limits of
agreement. Results: Eighteen patients underwent 3DR and CMR examination.
3DR was feasible in 78% of the patients, image quality being insufficient
in 4/18. In 14 patients significant correlation was present for all RV
volumes among all imaging modalities. RVEDV in 3DR correlated best with
saCMR with a mean difference of 0.6+/- 5.4% (-11/10). Agreement between
3DR and axCMR was 4.8 +/- 9.4% (-23/13.6), between axCMR and saCMR 4.2
+/-6.8% (-9/17). For RVESV agreement was good between 3DR and saCMR -1.9
+/- 9.4% (-20/16), weaker between 3DR and axCMR was 6.5 +/-13% (-32/19),
and between both CMR methods 4.6 +/-14% (-24/33). Reasonable agreement was
found for RV EF% between 3DR and saCMR 0.9 +/-5.1% (-9/11). In contrast
wide limits of agreement were observed between 3DR and axCMR 1.7+/- 8.9%
(-16/19) and between saCMR and axCMR -0.9+/- 9.7% (-19/18). Conclusions:
3DR echocardiography is feasible in Ebstein anomaly patients. 3DR RVEDV
measurements show good agreement with saCMR and axCMR. Limits of agreement
for RVESV and RV EF% are wider, but still comparable with published ranges
obtained by CMR. Since volumes obtained by different techniques are not
interchangeable, we recommend to use consistently the same modality for
follow up of Ebstein anomaly patients.

<53>
Accession Number
612897974
Author
Latus H.; Nassar M.; Hachmann P.; Wong J.; Hussain T.; Apitz C.; Akintuerk
H.; Salih C.; Austin C.; Anderson D.; Bauer J.; Razavi R.; Schranz D.;
Greil G.
Institution
(Latus, Hachmann, Apitz, Akintuerk, Bauer, Schranz) Pediatric Heart
Center, University Children's Hospital, Giessen, Germany
(Nassar, Salih, Austin, Anderson) Department of Pediatric Cardiac Surgery,
Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust,
London, United Kingdom
(Wong, Hussain, Razavi, Greil) Division of Imaging Sciences and Biomedical
Engineering, King's College London, London, United Kingdom
(Wong, Hussain, Razavi, Greil) Department of Pediatric Cardiology, Evelina
Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London,
United Kingdom
Title
Cardiac magnetic resonance assessment of right ventricular performance
after stage 2 palliation for hypoplastic left heart syndrome: A dual
center study comparing the Norwood and Hybrid approach.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S13-S14), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objectives: Stage 1 palliation of hypoplastic left heart syndrome (HLHS)
can be achieved either by the Norwood (NW) procedure or the Hybrid (HY)
approach. These procedures result in different hemodynamic profiles that
may have an impact on ventricular performance in the long term.
Accordingly, the aim of this study was to compare CMR data of HLHS
patients after stage 2 who underwent either a NW or the HY strategy in two
European centres. Methods: HLHS patients after stage 2 palliation who
underwent an initial classic NW operation using a BT shunt (n =38, mean
age 2.4 +/- 0.7 years) or the HY approach consisting of bilateral
pulmonary artery banding and arterial duct stenting (n = 38, mean age 2.1
+/-1.0 years, p =0.12) were included. The CMR protocol consisted of cine
assessment of right ventricular (RV) size and function. Feature tracking
analysis was performed to quantify RV strain and intraventricular
synchrony parameters. Results: NW patients had significantly larger RV
enddiastolic volumes (91 +/-24 vs 84+/- 33 ml/m²; p= 0.03) and
higher indexed stroke volumes (53+/-12 vs 47+/- 12 ml/m², p=
0.01) compared to the HY group whereas global pump function (ejection
fraction 59+/- 10 vs 58+/- 9%; p =0.71) and cardiac output (4.8 +/- 1.2 vs
4.9 +/-1.2 l/min/m², p =0.27) did not differ between the two
groups. In the HY group RV circumferential (-15.1+/- 6.2 vs -18.4 +/-5.8%,
p= 0.01) and radial strain (13.1 +/-7.8 vs 21.1+/- 9.7%, p< 0.001) was
lower and intraventricular dysynchrony significantly increased (88+/- 48
vs 51+/-24 ms, p< 0.001 and 97+/-59 vs 59+/- 49 ms, p <0.001). No
difference was found in longitudinal strain (-14.3+/- 5.4 vs -16.5
+/-5.7%, p =0.08) and dysynchrony (85.4+/-31.9 vs 81.6+/-38.1 ms, p=
0.78). Conclusions: The initial palliative strategy in HLHS patients has
significant effects on ventricular size and performance at mid-term
follow-up. Future studies comparing the two approaches are necessary to
assess whether the observed differences determine functional outcome in
the long-term.

<54>
Accession Number
612898314
Author
Wright P.
Institution
(Wright) Royal Brompton Hospital, London, United Kingdom
Title
First UK multicenter study to review the Efficacy of Nutritional Treatment
Strategies in the Management of Post-cardiothoracic surgical chylothorax.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S177-S178), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: *Incidence of chylothorax has increased 0.9%-1.5% to 6.6% *No
agreement regarding efficacy of Long Chain Triglyceride (LCT) reduction in
reducing chylous output Aim: 1 - Primary aim: Investigate daily LCT
intakes throughout the entire course of diet therapy and compare against
the nationally accepted guidelines. 2 - Secondary Aims: To investigate the
efficacy of diet therapy changes and reducing LCT intakes upon drain
output. To compare participating centre guidelines Methods: A multi-centre
prospective observational study conducted between January 2013 and January
2014 reviewing routine diet therapy of paediatric congenital heart
patients diagnosed with chylothorax. Daily LCT intakes and drain outputs
were recorded. Regression analysis investigated relationships between feed
type and drain output, the effect of age and LCT intakes on the
relationship between feed and output and the effect of LCT intake on
output. Results: 51 children enrolled <18 months of age. 5 children died.
68% of chylothoraces resolved with standard first line diet therapy.20%
resolved with> 2 changes to diet therapy. Feeds: Feed 1:Reduced LCT
formula (Monogen), Feed 2: Fat free modular feed with IV intralipids, Feed
3: TPN and Feed 4=Reduced LCT (solid diet) *When feed 1 and 4 were
compared: Feed 4 had a significant effect (p=0.005) on output. When
correcting for the effect of LCT and age, feed 4 gives a higher output
than feed 1 by 0.58mls for every unit increase in age, therefore the
effects of LCT are marginally significant. *In patients who received >2
types of diet therapy but only received feeds 1,3 and 4 there was a
significant (p=<0.001) decrease in drain output with feed 3 after
correcting for the effect of LCT intake *In patients that received> 2
types of diet therapy and received feed type 2 there was a decrease in
drain output but this was not significant (p=0.13) however the small
sample size was 8 children in the group that received feed 2 *Logistic
regression showed there was no effect of output on survival after
correcting for LCT and age *This investigation identified that the Royal
Brompton Hospital was the only hospital to use a three staged diet therapy
approach thereby avoiding direct transition to TPN. All other centres
proceeded to TPN if standard diet therapy failed. Conclusion: 1. Children
who respond to standard diet therapy all exceeded the nationally accepted
guideline with no reoccurrence of symptoms. 2. LCT free enteral feeds can
reduce drain output and avoid the use of TPN as per step 2 of the Royal
Brompton guideline. 3. The duration and timing of diet therapy could
potentially be reduced to 4 weeks in patients that respond to standard
diet therapy treatment. 4. Further investigation is required to establish
evidence based effective guidelines for the management of this high risk
post operative complication.

<55>
Accession Number
612870483
Author
Hejazi R.; Kandel P.; DeVault K.R.
Institution
(Hejazi, Kandel, DeVault) Mayo Clinic, Jacksonville, FL, United States
Title
Prevalence and incidence of gastroparesis in post lung and heart/lung
transplantation: A systematic review and mata-analysis.
Source
American Journal of Gastroenterology. Conference: 81st Annual Scientific
Meeting of the American College of Gastroenterology. United States.
Conference Start: 20161021. Conference End: 20161026. 111 (pp S250), 2016.
Date of Publication: October 2016.
Publisher
Nature Publishing Group
Abstract
Introduction: Gastrointestinal complications including gastroesophageal
reflux, esophageal dysmotility and gastroparesis are common in lung &
heart/lung transplantation (LT & H/LT) and may negatively influence
long-term outcome. The prevalence (P) and incidence (I) of DGE in post LT
and H/LT is not well defined and may vary according to the criteria used
to define its presence and the population under study. We sought to
perform a systematic review to answer this question. Methods: A systematic
review/meta-analysis to estimate the P & I of DGE/GP in LT and H/LT.
MEDLINE and EMBASE were searched up to May 2016. Studies were eligible if
they contained >10 adults (>16 years) and reported P or I of GP.
Eligibility assessment and data extraction were performed independently by
2 reviewers in a double-blind fashion. Data were extracted to estimate the
P and I of GP using a broad definition of typical GP symptoms and
confirmed with gastric emptying study (GES) measured by a standardized
scintigraphic method. Data were pooled to give overall P & I of GP with a
95% confidence interval (CI) of all eligible studies. Results: The search
yielded 1579 citations. A total of 14 studies were eligible for inclusion
and provided data for this analysis. Eleven studies were from US and 3
others from Spain, Switzerland and Netherlands. Mean age was 40 +/- 12
(SD) years with 54% male. The pooled P of GP in total of 1421 patient with
LT was 26% (95% CI; 23%-28%) and of 57 patients with H/LT was 64% (95% CI;
51%-76%). Single or double lung transplant did not differ in P of GP (p<
0.05). The pooled I of new onset GP in 561 LT (4 studies wih pre &post
transplant GES)was 20% (95% CI; 16%- 23%). Only one study provided the I
of 50% of GP in combined H/LT. Presence of GP did not correlate with the
etiologies of LT and H/LT, except an increased rate of GP in LT due to
cystic fibrosis (p < 0.05) Conclusion: The P of GP, using a combination of
symptoms and GES, is 26 and 57 percent in LT and H/ LT, respectively.
Higher rate of GP in H/LT could be explained by more comorbidities,
vigorous immunosuppressive therapy and more complex nature of surgery with
higher chance of post-surgical GP. LT secondary to cystic fibrosis has a
higher rate of GP and could be due to reported higher rate of GP in
pre-transplant status. There is a need for population-based prevalence
studies with standardized pre & post-transplant GES to properly estimate
the clinical significance of GP in LT and H/LT.

<56>
Accession Number
612777220
Author
Kemta Lekpa F.; Kwimatouo Lekpa A.F.
Institution
(Kemta Lekpa) Rheumatology, Douala General Hospital, Douala, Cameroon
(Kwimatouo Lekpa) Pharmacie et Medicaments, Public Health Ministry,
Yaounde, Cameroon
Title
Evidence of the use of colchicine are more numerous in cardiology and
hepato-gastroenterology than in rheumatology: A systematic literature
review of clinical trials.
Source
Annals of the Rheumatic Diseases. Conference: Annual European Congress of
Rheumatology of the European League Against Rheumatism, EULAR 2016. United
Kingdom. Conference Start: 20160608. Conference End: 20160611. 75 (pp
375-376), 2016. Date of Publication: June 2016.
Publisher
BMJ Publishing Group
Abstract
Background: Colchicine has been used for millennia to treat acute gout
flare, but numerous other conditions have been proposed for the use of
this "eau medicinale", including familial Mediterranean fever, Behcet's
disease and pericarditis. Objectives: To investigate the efficacy and
safety of colchicine whatever the indication. Methods: A literature search
of MEDLINE, EMBASE and Cochrane library databases was performed for human
studies without language restriction from inception to January 2016, using
the followings key-words: "colchicine", "clinical trial", "clinical
controlled trials", "randomized controlled trials". We did not impose any
date or language restrictions in the search. We also handsearched
reference lists of identified studies. Results: The process of selection
of studies is presented in Figure 1. Of the 477 articles reviewed, 106
were analyzed including 77 randomized controlled trials, 2 nonrandomized
controlled trials and 27 open studies. The subjects studied were chronic
liver disease (n=13), primary biliary cirrhosis (n=11), post cardiac
surgery syndromes (n=11), pericarditis (n=9), coronary syndromes and other
heart disease (n=6), Familial Mediterranean fever (n=5), Behcet's disease
(n=5), amyloidosis (n=4), gout (n=3), knee osteoarthritis (n=3),
constipation (n=3), lung fibrosis (n=3), psoriasis and psoriatic arthritis
(n=3), asthma (n=3), primary sclerosing cholangitis (n=2), low back pain
(n=2), proliferative vitreoretinopathy (n=2), recurrent aphthous
stomatitis (n=2). Other indications have been evaluated in one clinical
trial (Graves' ophthalmopathy, oral mucositis during hematological
malignancies, Peyronie's disease, hidradinitis suppurativa, acne vulgaris,
chronic bullous dermatosis, actinic keratosis, cutaneous leukocytoclastic
vasculitis, finger clubbing and hypertrophic osteoarthropathy, pustulosis
palmaris and plantaris, scleroderma, penile condylomata acuminate, mixed
cryoglobulinemia, allergic rhinitis, delayed urticaria). Table 1
summarizes the main directions of colchicine in clinical trials. The most
common adverse events were gastrointestinal intolerance. Conclusions:
Although acute gout is the major indication for use of colchicine, only 3
clinical trials are available for gout and no for other crystal-induced
arthritis. Evidence are limited for knee osteoarthritis, low back pain and
psoriatic arthritis. Clinical trials published are dominated by the
treatement of heart diseases (especially pericarditis), systemic diseases
(primary biliary cirrhosis, Familial Mediterranean fever, Behcet's
disease) and others chronic liver diseases.

<57>
Accession Number
610219153
Author
Gaies M.; Pasquali S.K.; Donohue J.E.; Dimick J.B.; Limbach S.; Burnham
N.; Ravishankar C.; Ohye R.G.; Gaynor J.W.; Mascio C.E.
Institution
(Gaies, Pasquali) Department of Pediatrics and Communicable Diseases,
University of Michigan Medical School, Ann Arbor, Michigan, United States
(Donohue) Michigan Congenital Heart Outcomes Research and Discovery Unit,
Ann Arbor, Michigan, United States
(Dimick) Department of Surgery, University of Michigan Medical School, Ann
Arbor, Michigan, United States
(Limbach, Burnham, Gaynor, Mascio) Division of Cardiac Surgery, The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United
States
(Ravishankar) Department of Pediatrics, Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, Pennsylvania, United States
(Ohye) Department of Cardiac Surgery, University of Michigan Medical
School, Ann Arbor, Michigan, United States
Title
Seminal Postoperative Complications and Mode of Death After Pediatric
Cardiac Surgical Procedures.
Source
Annals of Thoracic Surgery. 102 (2) (pp 628-635), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Understanding the seminal complications leading to death after
pediatric cardiac surgical procedures may provide opportunities to reduce
mortality. This study analyzed all deaths at two pediatric cardiac
surgical programs and developed a method to identify the seminal
complications and modes of death. Methods Trained nurses abstracted all
cases of in-hospital mortality meeting inclusion criteria from each site
over 5 years (2008 to 2012). Complication definitions were consistent with
those of a multicenter clinical registry. An adjudication committee
assigned a seminal complication in each case (the complication initiating
the cascade of events leading to death). Seminal complications were
grouped into categories to designate "mode of death." The epidemiology of
seminal complications and of mode of death was described. Results In 191
subjects, low cardiac output syndrome (71% of all subjects), cardiac
arrest (52%), and arrhythmia (48%) were the most common complications. The
committee assigned low cardiac output syndrome (30%), failure to separate
from bypass (16%), and cardiac arrest (12%) most frequently as seminal
complications. Seminal complications occurred a median 2 hours
(interquartile range [IQR], 0 to 35 hours) postoperatively. Patients
experienced a median of seven (IQR, 3 to 12) additional complications
before death at a median of 15 days (IQR, 4 to 46). Systemic circulatory
failure was the most common mode of death (51%), followed by inadequate
pulmonary blood flow (13%) and cardiac arrest (12%). Conclusions Seminal
complications occurred early postoperatively, and systemic circulatory
failure was the most common mode of death. Our classification system is
likely scalable for subsequent multicenter analysis to understand
cause-specific mortality variation across hospitals and to drive quality
improvement. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<58>
Accession Number
610217864
Author
Yamasaki M.; Deb S.; Tsubota H.; Moussa F.; Kiss A.; Cohen E.A.;
Radhakrishnan S.; Dubbin J.; Ko D.; Schwartz L.; Fremes S.E.
Institution
(Yamasaki, Deb, Tsubota, Moussa, Cohen, Radhakrishnan, Dubbin, Ko, Fremes)
The Schulich Heart Centre, Sunnybrook Health Sciences Centre, University
of Toronto, Toronto, Ontario, Canada
(Deb, Kiss, Fremes) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Kiss) Sunnybrook Research Institute, Toronto, Ontario, Canada
(Schwartz) Department of Medicine, University Health Network, Toronto,
Ontario, Canada
Title
Comparison of Radial Artery and Saphenous Vein Graft Stenosis More Than 5
Years After Coronary Artery Bypass Grafting.
Source
Annals of Thoracic Surgery. 102 (3) (pp 712-719), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Graft stenosis may be associated with future graft failure. The
purpose of this investigation was to compare graft stenosis between radial
artery (RA) grafts and saphenous vein grafts (SVGs) at least 5 years
postoperatively using the multicenter Radial Artery Patency Study (RAPS)
data. Methods Two hundred thirty-four patients underwent late invasive
angiography after coronary artery bypass operations. The study population
consists of 163 patients with thrombolysis in myocardial infarction (TIMI)
3 flow of both the RA graft and study SVGs. Angiograms were reviewed
centrally and in a blinded fashion. Graft stenosis was recorded for the
proximal anastomosis, graft body, and distal anastomosis; significant
stenosis was defined as greater than or equal to 50%. Major adverse
cardiac events (MACE) were reported in patients with and those without
significant graft stenosis. Results There was no difference in significant
graft stenosis of the patent RA grafts and SVGs (14 of 163 [8.6%] versus
19 of 163 [11.7%]) or in the proximal anastomosis (5 of 163 [3.1%] versus
5 of 163 [3.1%]), graft body (6 of 163 [3.7%] versus 13 of 163 [8.0%]), or
distal anastomosis (4 of 163 [2.5%] versus 5 of 163 [3.1%]) considered
separately. However, the overall burden of graft body disease was higher
in SVGs (p = 0.03). MACE was higher in patients with significant graft
stenosis than in patients without stenosis (10 of 28 [35.7%] versus 7 of
135 [5.2%]; p < 0.0001). Conclusions There was no significant difference
in the rates of significant stenosis of patent RA grafts and SVGs more
than 5 years postoperatively. However, the burden of graft body stenosis
was less in RA grafts compared with SVGs, suggesting that the RA grafts
will continue to outperform the SVGs late after operation. Copyright
&#xa9; 2016 The Society of Thoracic Surgeons

<59>
Accession Number
610217837
Author
Keski-Nisula J.; Pesonen E.; Olkkola K.T.; Ahlroth T.; Puntila J.;
Andersson S.; Neuvonen P.J.; Suominen P.K.
Institution
(Keski-Nisula, Ahlroth, Suominen) Department of Anesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Pesonen) Department of Anesthesiology, Intensive Care, and Pain Medicine,
Meilahti Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Olkkola) Department of Anesthesiology, Intensive Care, Emergency Care and
Pain Medicine, University of Helsinki and Helsinki University Hospital,
Helsinki, Finland
(Puntila) Department of Pediatric Surgery, Children's Hospital, University
of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Andersson) Department of Neonatal Intensive Care, Children's Hospital,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Hospital, Helsinki, Finland
Title
High-Dose Methylprednisolone Has No Benefit Over Moderate Dose for the
Correction of Tetralogy of Fallot.
Source
Annals of Thoracic Surgery. 102 (3) (pp 870-876), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background The optimal dose of methylprednisolone during pediatric open
heart surgical procedures is unknown. This study compared the
antiinflammatory and cardioprotective effects of high and lower doses of
methylprednisolone in children undergoing cardiac operations. Methods
Thirty children, between 1 and 18 months old and undergoing total
correction of tetralogy of Fallot, were randomized in double-blind fashion
to receive either 5 or 30 mg/kg of intravenous methylprednisolone after
anesthesia induction. Plasma concentrations of methylprednisolone,
interleukin-6 (IL-6), IL-8, and IL-10, troponin T, and glucose were
measured at anesthesia induction before administration of the study drug,
at 30 minutes on cardiopulmonary bypass (CPB), just after weaning from
CPB, and at 6 hours after CPB. Troponin T and blood glucose were also
measured on the first postoperative morning. Results Significantly higher
methylprednisolone concentrations were measured in patients receiving 30
mg/kg of methylprednisolone at 30 minutes on CBP, after weaning from CPB
and at 6 hours after CPB (p < 0.001). No differences were detected in
IL-6, IL-8, IL-10, or troponin concentrations at any time point. Blood
glucose levels were significantly higher in patients receiving 30 mg/kg of
methylprednisolone at 6 hours after CPB (p = 0.04) and on the first
postoperative morning (p = 0.02). Conclusions Based on the measured
concentrations of interleukins or troponin T, a 30 mg/kg dose of
methylprednisolone during pediatric open heart operations does not offer
any additional antiinflammatory or cardioprotective benefit over a 5 mg/kg
dose. Higher dose of methylprednisolone exposes patients more frequently
to hyperglycemia. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<60>
Accession Number
608676204
Author
Xu Z.; Fan J.; Luo X.; Zhang W.-B.; Ma J.; Lin Y.-B.; Ma S.-H.; Chen X.;
Wang Z.-P.; Ou J.-S.; Zhang X.
Institution
(Xu, Zhang, Ma, Ma, Wang, Ou, Zhang) Division of Cardiac Surgery, The
First Affiliated Hospital of Sun-Yat-sen University, Guangdong, China
(Fan, Luo, Chen) Division of Obstetrics and Gynecology, The First
Affiliated Hospital of Jinan University, China
(Lin) Guangdong Cardiovascular Institute, Guangdong Academy of Medical
Sciences, Guangdong General Hospital, China
Title
Anticoagulation Regimens During Pregnancy in Patients With Mechanical
Heart Valves: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 32 (10) (pp 1248.e1-1248.e9), 2016. Date
of Publication: 01 Oct 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Managing anticoagulation in pregnant women with mechanical
heart valves remains challenging. Our aim was to evaluate the
effectiveness and safety of 4 regimens in these women. Methods Relevant
studies published before June 2015 were collected in several databases and
analyzed with RevMan version 5.3 and SPSS version 19.0. Four regimens were
defined as follows: a regimen of a vitamin K antagonist (VKA) throughout
pregnancy; a heparin (H)/VKA regimen using VKAs except for unfractionated
heparin (UFH) or low molecular weight heparin (LMWH) during 6-12 weeks of
pregnancy; a LMWH regimen of adjusted LMWH doses throughout pregnancy; and
a UFH regimen of adjusted UFH doses throughout pregnancy. The low warfarin
dose in the VKA regimen was defined as 5 mg/d or less. Results Fifty-one
studies comprising 2113 pregnancies in 1538 women were included. The rate
of fetal wastage was significantly higher in the high warfarin dose
subgroup than in the low dose one. Compared with the H/VKA regimen, the
rate of maternal major thromboembolic event in the low-dose VKA regimen
group was significantly lower, although the fetal outcomes were similar.
Compared with the H/VKA regimen, the rate of fetal wastage in the LMWH
regimen group was significantly lower, and the maternal outcomes were
similar. The UFH regimen presented the worst maternal and fetal outcomes.
Conclusions In the absence of large prospective trials, this meta-analysis
showed that the VKA regimen should be best for pregnant women with a low
warfarin dose, and the H/VKA regimen might be reasonable for those with a
high warfarin dose. The LMWH regimen could be used for those who refuse
VKA. Copyright &#xa9; 2016 Canadian Cardiovascular Society

<61>
Accession Number
612707067
Author
De Bonis M.; Lapenna E.; Buzzatti N.; La Canna G.; Denti P.; Pappalardo
F.; Schiavi D.; Pozzoli A.; Cioni M.; Di Giannuario G.; Alfieri O.
Institution
(De Bonis, Lapenna, Buzzatti, La Canna, Denti, Pappalardo, Schiavi,
Pozzoli, Cioni, Di Giannuario, Alfieri) Department of Cardiac Surgery,
IRCCS San Raffaele Hospital, Vita e Salute San Raffaele University, Milan,
Italy
Title
Optimal results immediately after MitraClip therapy or surgical
edge-to-edge repair for functional mitral regurgitation: Are they really
stable at 4 years?.
Source
European Journal of Cardio-thoracic Surgery. 50 (3) (pp 488-494), 2016.
Article Number: ezw093. Date of Publication: 01 Sep 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Recurrent mitral regurgitation (MR) is common after surgical
and percutaneous (MitraClip) treatment of functional MR (FMR). However,
the Everest II trial suggested that, in patients with secondary MR and
initially successful MitraClip therapy, the results were sustained at 4
years and were comparable with surgery in terms of late efficacy. The aim
of this study was to assess whether both those findings were confirmed by
our own experience. METHODS: We reviewed 143 patients who had an initial
optimal result (residual MR < 1+ at discharge) after MitraClip therapy (85
patients) or surgical edge-to-edge (EE) repair (58 patients) for severe
secondary MR (mean ejection fraction 28 +/- 8.5%). Patients with MR > 2+
at hospital discharge were excluded. The two groups were comparable. Only
age and logistic EuroSCORE were higher in the MitraClip group. RESULTS:
Follow-up was 100% complete (median 3.2 years; interquartile range
1.8;6.1). Freedom from cardiac death at 4 years (81 +/- 5.2 vs 84 +/-
4.6%, P = 0.5) was similar in the surgical and MitraClip group. The
initial optimal MitraClip results did not remain stable. At 1 year, 32.5%
of the patients had developed MR > 2+ (P = 0.0001 compared with
discharge). Afterwards, patients with an echocardiographic follow-up at 2
years (60 patients), 3 years (40 patients) and 4 years (21 patients)
showed a significant increase in the severity of MR compared with the
corresponding 1 year grade (all P < 0.01). Freedom from MR > 3+ at 4 years
was 75 +/- 7.6% in the MitraClip group and 94 +/- 3.3% in the surgical one
(P = 0.04). Freedom from MR > 2+ at 4 years was 37 +/- 7.2 vs 82 +/- 5.2%,
respectively (P = 0.0001). Cox regression analysis identified the use of
MitraClip as a predictor of recurrence of MR > 2+ [hazard ratio (HR) 5.2,
95% confidence interval (CI) 2.5-10.8, P = 0.0001] as well as of MR > 3
(HR 3.5, 95% CI 0.9-13.1, P = 0.05). CONCLUSIONS: In patients with FMR and
optimal mitral competence after MitraClip implantation, the recurrence of
significant MR at 4 years is not uncommon. This study does not confirm
previous observations reported in the Everest II randomized controlled
trial indicating that, if the MitraClip therapy was initially successful,
the results were sustained at 4 years. When compared with the surgical EE
combined with annuloplasty, MitraClip therapy provides lower efficacy at 4
years. Copyright &#xa9; The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<62>
Accession Number
612707053
Author
Navarra E.; Mosala Nezhad Z.; Bollen X.; Gielen C.-E.; Mastrobuoni S.; De
Kerchove L.; Raucent B.; Astarci P.
Institution
(Navarra, Mosala Nezhad, Gielen, Mastrobuoni, De Kerchove, Astarci)
Cardiovascular and Thoracic Surgery Department, Saint-Luc Hospital,
Catholic University of Louvain, Brussels, Belgium
(Bollen, Raucent) Center for Research in Mechatronics, Catholic University
of Louvain, Leuven la Neuve, Belgium
Title
Endovascular resection of the native aortic valve before transcatheter
aortic valve implantation: State of the art and review.
Source
European Journal of Cardio-thoracic Surgery. 50 (3) (pp 406-410), 2016.
Article Number: ezw027. Date of Publication: 01 Sep 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Transcatheter aortic valve implantation was introduced into clinical
practice in 2002 as a rescue approach in patients presenting with
symptomatic severe aortic stenosis but not eligible for conventional
aortic valve replacement. This technique allows implantation of a balloon
expandable bioprosthesis without resection of the native aortic valve.
Several complications are described as a consequence of the residual
highly calcified valve being squeezed against the aortic wall by the stent
of the implant. This can result in deformation of the metal stent and
paravalvular leakage, risk of occlusion of the coronary ostia, or central
and peripheral embolization of valvular debris. To avoid these
complications, many authors suggest the possibility to resect and remove
the native aortic valve before transcatheter aortic valve implantation. In
this field, different authors have described possible techniques and
different sources of energy to resect the calcified valve. In this
article, we review the development of these experimental techniques and
discuss future prospects in this field. Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<63>
Accession Number
612789203
Author
Soeiro A.M.; e Silva P.G.M.B.; Roque E.A.C.; Bossa A.S.; Cesar M.C.;
Simoes S.A.; Okada M.Y.; Leal T.C.A.T.; Pedroti F.C.M.; de Oliveira M.T.
Institution
(Soeiro, Bossa, Cesar, Leal, de Oliveira) Unidade Clinica de Emergencia,
Instituto do Coracao (InCor) do Hospital das Clinicas da Universidade de
Sao Paulo, Sao Paulo, SP, Brazil
(e Silva, Simoes, Okada) Hospital TotalCor, Sao Paulo, SP, Brazil
(Roque, Pedroti) Hospital Metropolitano, Serra, ES, Brazil
Title
Fondaparinux versus enoxaparin - Which is the best anticoagulant for acute
coronary syndrome? - Brazilian registry data.
Source
Arquivos Brasileiros de Cardiologia. 107 (3) (pp 239-244), 2016. Date of
Publication: September 2016.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Recent studies have shown fondaparinux's superiority over
enoxaparin in patients with non-ST elevation acute coronary syndrome
(ACS), especially in relation to bleeding reduction. The description of
this finding in a Brazilian registry has not yet been documented.
Objective: To compare fondaparinux versus enoxaparin in in-hospital
prognosis of non-ST elevation ACS. Methods: Multicenter retrospective
observational study. A total of 2,282 patients were included (335 in the
fondaparinux group, and 1,947 in the enoxaparin group) between May 2010
and May 2015. Demographic, medication intake and chosen coronary treatment
data were obtained. Primary outcome was mortality from all causes.
Secondary outcome was combined events (cardiogenic shock, reinfarction,
death, stroke and bleeding). Comparison between the groups were done
through Chi-Square test and T test. Multivariate analysis was done through
logistic regression, with significance values defined as p < 0.05.
Results: With regards to treatment, we observed the performance of a
percutaneous coronary intervention in 40.2% in the fondaparinux group, and
in 35.1% in the enoxaparin group (p = 0.13). In the multivariate analysis,
we observed significant differences between fondaparinux and enoxaparin
groups in relation to combined events (13.8% vs. 22%. OR = 2.93, p =
0.007) and bleeding (2.3% vs. 5.2%, OR = 4.55, p = 0.037), respectively.
Conclusion: Similarly to recently published data in international
literature, fondaparinux proved superior to enoxaparin for the Brazilian
population, with significant reduction of combined events and bleeding.
Copyright &#xa9; 2016, Arquivos Brasileiros de Cardiologia. All rights
reserved.

<64>
Accession Number
610888718
Author
Hickey P.A.; Pasquali S.K.; Gaynor J.W.; He X.; Hill K.D.; Connor J.A.;
Gauvreau K.; Jacobs M.L.; Jacobs J.P.; Hirsch-Romano J.C.
Institution
(Hickey, Connor) Department of Nursing Patient Care Services, Boston
Children's Hospital, Boston, Massachusetts, United States
(Pasquali) Department of Pediatrics, University of Michigan Medical
School, Ann Arbor, Michigan, United States
(Gaynor) Department of Surgery, The Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania, United States
(He, Hill) Duke Clinical Research Institute, Durham, North Carolina,
United States
(Gauvreau) Department of Cardiology, Boston Children's Hospital, Boston,
Massachusetts, United States
(Jacobs) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, Maryland, United States
(Jacobs) Johns Hopkins Children's Heart Surgery, All Children's Hospital,
St. Petersburg, Florida, United States
(Hirsch-Romano) Department of Cardiac Surgery, University of Michigan
Medical School, Ann Arbor, Michigan, United States
Title
Critical Care Nursing's Impact on Pediatric Patient Outcomes.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1375-1380), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Background Previous studies have demonstrated the effect of adult nursing
skill mix, staffing ratios, and level of education on patient deaths,
complication rates, and failure to rescue (FTR). To date, only one known
study had examined the effect of nursing experience and education on
postoperative pediatric cardiac operations. Methods Nursing survey data
were linked to The Society of Thoracic Surgeons (STS) Congenital Heart
Surgery Database for patients undergoing cardiac operations (2010 to
2011). Logistic regression models were used to estimate associations of
nursing education and years of clinical experience with in-hospital
mortality rates, complication rates, and FTR. Generalized estimating
equations and robust standard error estimates were used to account for
within-center correlation of outcomes. Results Among 15,463 patients (29
hospitals), the in-hospital mortality rate was 2.8%, postoperative
complications occurred in 42.4%, and the FTR rate was 6.4%. After
covariate adjustment, pediatric critical care units with a higher
proportion of nurses with a Bachelor of Science degree or higher had lower
odds of complication (odds ratio for 10% increase, 0.85; 95% confidence
interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of
nurses with more than 2 years of experience had lower mortality rates
(odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99;
p = 0.025). Conclusions This is the first study to demonstrate that higher
levels of nursing education and experience are significantly associated
with fewer complications after pediatric cardiac operations and aligns
with our previous findings on their association with reduced deaths. These
results provide data for pediatric hospital leaders and reinforce the
importance of organization-wide mentoring strategies for new nurses and
retention strategies for experienced nurses. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons

<65>
Accession Number
612700005
Author
Jaroszewski D.E.; Temkit M.; Ewais M.M.; Luckritz T.C.; Stearns J.D.;
Craner R.C.; Gaitan B.D.; Ramakrishna H.; Thunberg C.A.; Weis R.A.; Myers
K.M.; Merritt M.V.; Rosenfeld D.M.
Institution
(Jaroszewski, Ewais, Myers, Merritt) Department of Surgery, Division of
Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ,
United States
(Temkit) Department of Biostatistics, Mayo Clinic Hospital, Phoenix, AZ,
United States
(Luckritz) Department of Pharmacy, Mayo Clinic Hospital, Phoenix, AZ,
United States
(Stearns, Craner, Gaitan, Ramakrishna, Thunberg, Weis, Rosenfeld)
Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, United
States
Title
Randomized trial of epidural vs. subcutaneous catheters for managing pain
after modified Nuss in adults.
Source
Journal of Thoracic Disease. 8 (8) (pp 2102-2110), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Minimally invasive repair of pectus excavatum (MIRPE) is now
performed in adults. Managing adult patients' pain postoperatively has
been challenging due to increased chest wall rigidity and the pressure
required for supporting the elevated sternum. The optimal pain management
regimen has not been determined. We designed this prospective, randomized
trial to compare postoperative pain management and outcomes between
thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump
catheters (On-Q). Methods: Patients undergoing MIRPE (modified Nuss)
underwent random assignment to TEA or On-Q group. Both groups received
intravenous, patient-controlled opioid analgesia, with concomitant
delivery of local anesthetic. Primary outcomes were length of stay (LOS),
opioid use, and pain scores. Results: Of 85 randomly assigned patients, 68
completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0-58.0)
years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally
matched for preoperative variables; however, the On-Q arm had more
patients (60.3%). No significant differences were found between groups in
mean daily pain scores (P=0.52), morphine-equivalent opioid usage
(P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55).
Thirteen patients randomized to TEA refused the epidural and withdrew from
the study because they perceived greater benefit of the On-Q system.
Conclusions: Postoperative pain management in adults after MIRPE can be
difficult. Both continuous local anesthetic delivery by TEA and On-Q
catheters with concomitant, intravenous, patient-controlled anesthesia
maintained acceptable analgesia with a reasonable LOS. In our cohort,
there was preference for the On-Q system for pain management. Copyright
&#xa9; Journal of Thoracic Disease. All rights reserved.

<66>
Accession Number
612699979
Author
Kocher G.J.; Gstrein N.; Jaroszewski D.E.; Ewais M.M.; Schmid R.A.
Institution
(Kocher, Gstrein, Schmid) Division of General Thoracic Surgery, University
Hospital Bern/Inselspital, Bern, Switzerland
(Jaroszewski, Ewais) Division of Cardiothoracic Surgery, Mayo Clinic, AZ,
United States
Title
Nuss procedure for repair of pectus excavatum after failed Ravitch
procedure in adults: Indications and caveats.
Source
Journal of Thoracic Disease. 8 (8) (pp 1981-1985), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Recurrence of pectus excavatum (PE) is not an uncommon problem
after open repair using the Ravitch technique. The optimal approach for
redo surgery is still under debate, especially in adults with less chest
wall pliability. Aim of this study was to investigate the usefulness and
efficacy of the minimally invasive Nuss technique for repair of recurrent
PE after conventional open repair. Methods: We performed a retrospective
multicentre review of 20 adult patients from University Hospital Bern
(n=6) and the US Mayo Clinic (n=14) who underwent minimally invasive
repair of recurrent PE after unsuccessful prior Ravitch procedure.
Results: Mean patient age at primary open correction was 21 years, with
recurrence being evident after a mean duration of 10.5 years (range,
0.25-47 years). Mean age at redo surgery using the Nuss technique was 31
years, with a mean Haller index of 4.7 before and 2.5 after final
correction. Main reason for redo surgery was recurrent or persistent
deformity (100%), followed by chest pain (75%) and exercise intolerance
(75%). No major intraoperative or postoperative complications occurred and
successful correction was possible in all patients. Conclusions: Although
the procedure itself is more challenging, the minimally invasive Nuss
technique can be safely and successfully used for repair of recurrent PE
after failed open surgery. In our series final results were good to
excellent in the majority of patients without major complications or
recurrence. Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<67>
Accession Number
612686772
Author
Kappetein A.P.; Serruys P.W.; Sabik J.F.; Leon M.B.; Taggart D.P.; Morice
M.-C.; Gersh B.J.; Pocock S.J.; Cohen D.J.; Wallentin L.; Ben-Yehuda O.;
Van Es G.-A.; Simonton C.A.; Stone G.W.
Institution
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, PO Box 2040, Rotterdam, CA 3000, Netherlands
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Leon, Ben-Yehuda, Stone) Department of Medicine, Columbia University
Medical Center, Cardiovascular Research Foundation, New York, NY, United
States
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Massy, France
(Gersh) Department of Cardiovascular Diseases, Mayo Clinic College of
Medicine, Mayo Clinic, Rochester, MN, United States
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Wallentin) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Van Es) Cardialysis, Rotterdam, Netherlands
(Simonton) Abbott Vascular, Santa Clara, CA, United States
Title
Design and rationale for a randomised comparison of everolimus-eluting
stents and coronary artery bypass graft surgery in selected patients with
left main coronary artery disease: The EXCEL trial.
Source
EuroIntervention. 12 (7) (pp 861-872), 2016. Date of Publication:
September 2016.
Publisher
EuroPCR
Abstract
Aims: Coronary artery bypass graft (CABG) surgery is the standard of care
for revascularisation of patients with left main coronary artery disease
(LMCAD). Recent studies have suggested that percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) may provide comparable
outcomes in selected patients with LMCAD without extensive CAD. We
therefore designed a trial to investigate whether PCI with XIENCE
cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in
non-inferior or superior clinical outcomes to CABG in selected patients
with LMCAD. Methods and results: The Evaluation of XIENCE versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization
(EXCEL) trial is a prospective, open-label, multicentre, international
study of 1,900 randomised subjects. Patients with significant LMCAD with a
SYNTAX score <32 and local Heart Team consensus that the subject is
appropriate for revascularisation by both PCI and CABG are consented and
randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo
follow-up for five years. The primary endpoint is the three-year composite
rate of death, stroke or myocardial infarction, assessed at a median
follow-up of at least three years (with at least two-year follow-up in all
patients), powered for sequential non-inferiority and superiority testing.
Conclusions: The EXCEL study will define the contemporary roles of CABG
and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and
intermediate SYNTAX scores. Copyright &#xa9; 2016 Europa Digital &
Publishing. All rights reserved.

<68>
Accession Number
612667786
Author
Puskas J.D.; Halkos M.E.; DeRose J.J.; Bagiella E.; Miller M.A.; Overbey
J.; Bonatti J.; Srinivas V.S.; Vesely M.; Sutter F.; Lynch J.; Kirkwood
K.; Shapiro T.A.; Boudoulas K.D.; Crestanello J.; Gehrig T.; Smith P.;
Ragosta M.; Hoff S.J.; Zhao D.; Gelijns A.C.; Szeto W.Y.; Weisz G.;
Argenziano M.; Vassiliades T.; Liberman H.; Matthai W.; Ascheim D.D.
Institution
(Puskas, Ascheim) Department of Cardiovascular Surgery, Icahn School of
Medicine at Mount Sinai Cardiovascular Institute, New York, New York,
United States
(Puskas) Mount Sinai Heart at Mount Sinai Beth Israel, New York, New York,
United States
(Halkos, Vassiliades, Liberman) Emory University, Atlanta, Georgia
(DeRose, Srinivas) Division of Cardiothoracic Surgery, Department of
Surgery, Montefiore-Einstein Heart Center, Bronx, New York, United States
(Bagiella, Overbey, Kirkwood, Gelijns, Ascheim) Department of Population
Health Science and Policy, Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Miller) National Heart, Lung, and Blood Institute, Bethesda, Maryland,
United States
(Bonatti) Department of Cardiothoracic Surgery, Cleveland Clinic Abu
Dhabi, Abu Dhabi, United Arab Emirates
(Vesely) Division of Cardiothoracic Surgery, Department of Surgery,
University of Maryland, Baltimore, Maryland, United States
(Sutter, Shapiro) Lankenau Hospital, Philadelphia, Pennsylvania, United
States
(Lynch, Boudoulas, Crestanello) Ohio State University, Columbus, Ohio,
United States
(Gehrig, Smith) Duke University, Durham, North Carolina, United States
(Ragosta) University of Virginia, Charlottesville, Virginia, United States
(Hoff) Vanderbilt Heart Institute, Nashville, Tennessee, United States
(Zhao) Wake Forest University, Winston-Salem, North Carolina, United
States
(Szeto, Matthai) University of Pennsylvania, Philadelphia, Pennsylvania,
United States
(Weisz, Argenziano) Columbia University, New York, New York, United States
(Vassiliades) Medtronic, Inc., Fridley, Minnesota, United States
Title
Hybrid Coronary Revascularization for the Treatment of Multivessel
Coronary Artery Disease: A Multicenter Observational Study.
Source
Journal of the American College of Cardiology. 68 (4) (pp 356-365), 2016.
Date of Publication: 26 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Hybrid coronary revascularization (HCR) combines minimally
invasive surgical coronary artery bypass grafting of the left anterior
descending artery with percutaneous coronary intervention (PCI) of
non-left anterior descending vessels. HCR is increasingly used to treat
multivessel coronary artery disease that includes stenoses in the proximal
left anterior descending artery and at least 1 other vessel, but its
effectiveness has not been rigorously evaluated. Objectives This National
Institutes of Health-funded, multicenter, observational study was
conducted to explore the characteristics and outcomes of patients
undergoing clinically indicated HCR and multivessel PCI for
hybrid-eligible coronary artery disease, to inform the design of a
confirmatory comparative effectiveness trial. Methods Over 18 months, 200
HCR and 98 multivessel PCI patients were enrolled at 11 sites. The primary
outcome was major adverse cardiac and cerebrovascular events (MACCE)
(i.e., death, stroke, myocardial infarction, repeat revascularization)
within 12 months post-intervention. Cox proportional hazards models were
used to model time to first MACCE event. Propensity scores were used to
balance the groups. Results Mean age was 64.2 +/- 11.5 years, 25.5% of
patients were female, 38.6% were diabetic, and 4.7% had previous stroke.
Thirty-eight percent had 3-vessel coronary artery disease, and the mean
SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was 19.7
+/- 9.6. Adjusted for baseline risk, MACCE rates were similar between
groups within 12 months post-intervention (hazard ratio [HR]: 1.063; p =
0.80) and during a median 17.6 months of follow-up (HR: 0.868; p = 0.53).
Conclusions These observational data from this first multicenter study of
HCR suggest that there is no significant difference in MACCE rates over 12
months between patients treated with multivessel PCI or HCR, an emerging
modality. A randomized trial with long-term outcomes is needed to
definitively compare the effectiveness of these 2 revascularization
strategies. (Hybrid Revascularization Observational Study; NCT01121263)
Copyright &#xa9; 2016 American College of Cardiology Foundation

<69>
Accession Number
612667772
Author
Hermiller J.B.; Yakubov S.J.; Reardon M.J.; Deeb G.M.; Adams D.H.; Afilalo
J.; Huang J.; Popma J.J.
Institution
(Hermiller) St. Vincent's Heart Center of Indiana, Indianapolis, Indiana,
United States
(Yakubov) Riverside Methodist Hospital, Columbus, Ohio, United States
(Reardon) Houston-Methodist-Debakey Heart and Vascular Center, Houston,
Texas, United States
(Deeb) University of Michigan Medical Center, Ann Arbor, Michigan, United
States
(Adams) Mount Sinai Health System, New York, New York, United States
(Afilalo) Jewish General Hospital, McGill University, Montreal, Quebec,
Canada
(Huang) Medtronic, Minneapolis, Minneapolis, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, Massachusetts,
United States
Title
Predicting Early and Late Mortality After Transcatheter Aortic Valve
Replacement.
Source
Journal of the American College of Cardiology. 68 (4) (pp 343-352), 2016.
Date of Publication: 26 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Few studies have examined the impact of novel indices of
comorbidity, frailty, and disability on outcomes after transcatheter
aortic valve replacement (TAVR). Objectives This study analyzed patients
from the Medtronic CoreValve U.S. Pivotal Trial program to develop a
simple scoring system that incorporates standard and novel predictor
variables. Methods A multidisciplinary heart team used objective criteria,
such as The Society of Thoracic Surgeons Predicted Risk of Mortality (STS
PROM), and subjective criteria to assess patients' eligibility for TAVR.
The analysis included 3,687 patients randomly divided (2:1) into a
derivation cohort (n = 2,482) and a validation cohort (n = 1,205). The
study evaluated predictors of all-cause death, which were used to
calculate a risk score for each patient. Results The overall mortality
rate was 5.8% at 30 days and 22.8% at 1 year. Home oxygen use, assisted
living, albumin levels <3.3 g/dl, and age >85 years predicted death at 30
days. Home oxygen use, albumin levels <3.3 g/dl, falls in the past 6
months, STS PROM score >7%, and severe (>5) Charlson comorbidity score
predicted death at 1 year. A simple scoring system created on the basis of
these multivariable predictors effectively stratified risk at 30 days and
1 year into low-risk, moderate-risk, and high-risk subsets. This score
showed a 3-fold difference in mortality rates for the low-risk and
high-risk subsets at 30 days (3.6% and 10.9%, respectively) and 1 year
(12.3% and 36.6%, respectively). The 1-year mortality model was more
stable than the 30-day model (C-statistics: 0.79 vs. 0.75). Conclusions A
simple score dominated by novel predictors of outcome effectively
stratified early and late mortality rates in extreme-risk and high-risk
patients and may assist in selecting appropriate candidates for TAVR.
(Safety and Efficacy Study of the Medtronic CoreValve System in the
Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High
Risk Subjects Who Need Aortic Valve Replacement; NCT01240902) Copyright
&#xa9; 2016 American College of Cardiology Foundation

<70>
Accession Number
612637901
Author
Treasure T.
Institution
(Treasure) Clinical Operational Research Unit, University College London,
London, United Kingdom
Title
Videothoracoscopic resection for lung cancer: Moving towards a "standard
of care".
Source
Journal of Thoracic Disease. 8 (8) (pp E772-E774), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Videothoracic surgery for lung cancer is now an established practice but
there is a division of opinion between surgeons whose aim is to spare all
patients a thoracotomy and those who have not adopted videoscopic methods
for routine lobectomy. The latter remain in the majority; most patients at
present have a thoracotomy. Surgeons from Europe and America met in
Catania, Sicily at the 3rd Mediterranean Symposium on Thoracic Surgical
Oncology to explore the evidence and the routes to making
videothoracoscopic surgery a standard of care. Evidence from one completed
randomized controlled trial (RCT) and several propensity score matching
studies indicate that less invasive surgery is at least as safe as
thoracotomy. By the accepted standards of an oncological lobectomy which
include clearance of the primary cancer and the intended lymphadenectomy
or sampling, the operations are equivalent. Clinical effectiveness in
achieving long-term cancer free survival is likely. However, the
co-existance of videothoracoscopy has encouraged smaller nonmuscle cutting
incisions and the avoidance of rib spreading, narrowing whatever gap there
may have been in terms of the patients' experience. Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<71>
Accession Number
612637855
Author
Kang S.-J.; Mintz G.S.
Institution
(Kang) Department of Cardiology, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
Title
Outcomes with intravascular ultrasound-guided stent implantation: A
meta-analysis of randomized trials in the era of drug-eluting stents.
Source
Journal of Thoracic Disease. 8 (8) (pp E841-E843), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)

<72>
Accession Number
612475578
Author
Siemieniuk R.A.; Agoritsas T.; Manja V.; Devji T.; Chang Y.; Bala M.M.;
Thabane L.; Guyatt G.H.
Institution
(Siemieniuk, Agoritsas, Manja, Devji, Chang, Thabane, Guyatt) Department
of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main
St West, Hamilton, ON L8S 4L8, Canada
(Siemieniuk) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Agoritsas) Division General Internal Medicine, Division of Clinical
Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
(Manja) Department of Internal Medicine, State University of New York at
Buffalo, Buffalo, NY, United States
(Manja) VA WNY Health Care System at Buffalo, Department of Veterans
Affairs, Buffalo, NY, United States
(Bala) Department of Hygiene and Dietetics, Jagiellonian University
Medical College, Krakow, Poland
Title
Transcatheter versus surgical aortic valve replacement in patients with
severe aortic stenosis at low and intermediate risk: Systematic review and
meta-analysis.
Source
BMJ (Online). 354 (no pagination), 2016. Article Number: i5130. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To examine the effect of transcatheter aortic valve implantation
(TAVI) versus surgical replacement of an aortic valve (SAVR) in patients
with severe aortic stenosis at low and intermediate risk of perioperative
death. Design Systematic review and meta-analysis. Data sources Medline,
Embase, and Cochrane CENTRAL. Study selection Randomized trials of TAVI
compared with SAVR in patients with a mean perioperative risk of death
<8%. Review methods Two reviewers independently extracted data and
assessed risk of bias for outcomes important to patients that were
selected a priori by a parallel guideline committee, including patient
advisors. We used the GRADE system was used to quantify absolute effects
and quality of evidence. Results 4 trials with 3179 patients and a median
follow-up of two years were included. Compared with SAVR, transfemoral
TAVI was associated with reduced mortality (risk difference per 1000
patients: -30, 95% confidence interval -49 to -8, moderate certainty),
stroke (-20, -37 to 1, moderate certainty), life threatening bleeding
(-252, -293 to -190, high certainty), atrial fibrillation (-178, -150 to
-203, moderate certainty), and acute kidney injury (-53, -39 to -62, high
certainty) but increased short term aortic valve reintervention (7, 1 to
21, moderate certainty), permanent pacemaker insertion (134, 16 to 382,
moderate certainty), and moderate or severe symptoms of heart failure (18,
5 to 34, moderate certainty). Compared with SAVR, transapical TAVI was
associated higher mortality (57, -16 to 153, moderate certainty, P=0.015
for interaction between transfemoral versus transapical TAVI) and stroke
(45, -2 to 125, moderate certainty, interaction P=0.012). No study
reported long term follow-up, which is particularly important for
structural valve deterioration. Conclusions Many patients, particularly
those who have a shorter life expectancy or place a lower value on the
risk of long term valve degeneration, are likely to perceive net benefit
with transfemoral TAVI versus SAVR. SAVR, however, performs better than
transapical TAVI, which is of interest to patients who are not candidates
for transfemoral TAVI.

<73>
Accession Number
610767145
Author
Allen M.S.; Blackmon S.H.; Nichols F.C.; Cassivi S.D.; Harmsen W.S.;
Lechtenberg B.; Pierson K.; Wigle D.A.; Shen K.R.
Institution
(Allen, Blackmon, Nichols, Cassivi, Lechtenberg, Pierson, Wigle, Shen)
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic,
Rochester, Minnesota, United States
(Harmsen) Division of Biomedical Statistics and Informatics, Department of
Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States
Title
Optimal Timing of Urinary Catheter Removal After Thoracic Operations: A
Randomized Controlled Study.
Source
Annals of Thoracic Surgery. 102 (3) (pp 925-930), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background There are very few randomized trials confirming the belief that
prolonged urinary catheterization increases urinary tract infections, and
none of these have included a comparative analysis of patients with an
epidural catheter in place. The aim of this prospective randomized trial
was to determine if removal of the urinary catheter within 48 hours after
a thoracic operation, as required by the Surgical Care Improvement Project
(SCIP) Measure 9, leads to increases in urinary tract reintervention and
lower rates of urinary tract infections. Methods From February 2012 to
August 2014, patients undergoing a general thoracic surgical procedure in
whom an epidural catheter was placed for analgesia were eligible for
inclusion in the trial. Patients were randomized to urinary catheter
removal within 48 hours of the operation completion or 6 hours after
epidural catheter removal. Results The study enrolled 374 patients, 217
men (58%) and 157 women (42%). The 247 eligible and evaluated patients,
141 (57.1%) men and 106 (42.9%) women, were a median age of 61.5 years
(range, 21 to 87 years). There were no statistically significant
differences in any of the preoperative or operative categories between the
two groups. Median length of stay was 5 days (range, 2 to 42 days) for all
patients, and there was no difference between the two groups.
Postoperatively, 19 patients (7.7%) required urinary catheter reinsertion
after it was removed. A significantly greater number of patients in the
early removal group required reinsertion of the urinary catheter (15
[12.4%] vs 4 [3.2%]); p = 0.0065). Patients whose urinary catheter was
removed within 48 hours of the operation had a much higher rate of bladder
scans postoperatively (59.5% [n = 72]) and required more in-and-out
catheterization than those whose urinary catheter was removed 6 hours
after the epidural analgesia was discontinued (31.0% [n = 39]; p <
0.0001). The only documented urinary tract infection in the entire cohort
occurred in a patient whose urinary catheter was removed within 48 hours
after the operation. No urinary tract infections developed in the 126
patients whose urinary catheter remained in place until the epidural
catheter was removed. Conclusions In a randomized control trial, patients
with an epidural catheter in place after a general thoracic surgical
operation have a higher rate of urinary problems when the urinary catheter
is removed early, while the epidural catheter is still in place, compared
with patients whose urinary catheter is removed after the epidural
analgesia is discontinued. Copyright &#xa9; 2016 The Society of Thoracic
Surgeons

<74>
Accession Number
610457646
Author
Castelvecchio S.; Menicanti L.; Garatti A.; Tramarin R.; Volpe M.;
Parolari A.
Institution
(Castelvecchio, Menicanti, Garatti) Department of Cardiac Surgery, IRCCS
Policlinico San Donato, Milan, Italy
(Tramarin, Volpe) Department of Cardiac Rehabilitation, IRCCS Policlinico
San Donato, Milan, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico San Donato, Milan, Italy
(Parolari) Department of Biomedical Sciences for Health, Universita Degli
Studi di Milano, Milan, Italy
Title
Myocardial Revascularization for Patients With Diabetes: Coronary Artery
Bypass Grafting or Percutaneous Coronary Intervention?.
Source
Annals of Thoracic Surgery. 102 (3) (pp 1012-1022), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Patients affected by diabetes usually have extensive coronary artery
disease. Coronary revascularization has a prominent role in the treatment
of coronary artery disease in the expanding diabetic population. However,
diabetic patients undergoing coronary artery bypass grafting or
percutaneous coronary intervention experience worse outcomes than
nondiabetic patients. Several studies comparing coronary artery bypass
grafting vs percutaneous coronary intervention in subgroups of diabetic
patients demonstrated a survival advantage and fewer repeat
revascularization procedures with an initial surgical strategy. This
review summarizes the current state of evidence comparing the
effectiveness and safety of coronary artery bypass grafting and
percutaneous coronary intervention in diabetic patients. Copyright &#xa9;
2016

<75>
Accession Number
609405133
Author
Maree A.O.; Margey R.J.; Selzer F.; Bajrangee A.; Jneid H.; Marroquin
O.C.; Mulukutla S.R.; Laskey W.K.; Jacobs A.K.
Institution
(Maree, Jacobs) Division of Cardiology, Boston Medical Center and Boston
University School of Medicine, United States
(Margey) Division of Cardiology, Massachusetts General Hospital and
Harvard Medical School, United States
(Selzer) Department of Epidemiology, Division of Cardiology, University of
Pittsburgh, United States
(Maree, Bajrangee) Division of Cardiology, St James's Hospital and Trinity
College, Dublin, Ireland
(Jneid) Division of Cardiology, Michael E. DeBakey VA Medical Center and
Baylor College of Medicine, United States
(Marroquin, Mulukutla) Division of Cardiology, University of Pittsburgh
Medical Center, United States
(Laskey) Division of Cardiology, The University of New Mexico School of
Medicine, United States
Title
Renal insufficiency, bleeding and prescription of discharge medication in
patients undergoing percutaneous coronary intervention in the National
Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.
Source
Cardiovascular Revascularization Medicine. 17 (5) (pp 302-307), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aims To establish the relationship between renal insufficiency, bleeding
and prescription of cardiovascular medication. Methods and results This
was a prospective, multi-center, cohort study of consecutive patients
undergoing PCI during three NHLBI Dynamic Registry recruitment waves.
Major and minor bleeding, access site bleeding and rates of prescription
of cardiovascular medication at discharge were determined based on
estimated glomerular filtration rate (eGFR). Renal insufficiency was an
independent predictor of major adverse cardiovascular events (MACE).
Bleeding events and access site bleeding requiring transfusion were
significantly associated with degrees of renal insufficiency (p < 0.001).
There was an incremental decline in prescription of cardiovascular
medication at discharge proportionate to the degree of renal impairment
(aspirin, thienopyridine, statin, coumadin (overall p < 0.001), beta
blocker (overall p = 0.003), ACE inhibitor (overall p = 0.02). Bleeders
were less likely to be discharged on a thienopyridine (95.4% versus 89.9%
for bleeding, p < 0.001 and 95.3% versus 87.9% for access site bleeding, p
= 0.005), but not aspirin (96.3% versus 96.2%, p = 0.97 and 96.3% versus
93.6%, p = 0.29 respectively). Failure to prescribe anti-platelet therapy
at discharge was strongly associated with increased MACE at one year.
Conclusions Renal insufficiency is associated with bleeding in patients
undergoing PCI. Patients with renal insufficiency are less likely to
receive recommended discharge pharmacotherapy. Copyright &#xa9; 2016
Elsevier Inc.

<76>
Accession Number
610347341
Author
Pickardt T.; Niggemeyer E.; Bauer U.M.M.; Abdul-Khaliq H.
Institution
(Pickardt, Niggemeyer, Bauer) National Register for Congenital Heart
Defects, Berlin 13353, Germany
(Abdul-Khaliq) Saarland University Medical Center, Department of
Paediatric Cardiology, Homburg 66421, Germany
(Bauer, Abdul-Khaliq) Competence Network for Congenital Heart Defects,
Berlin 13353, Germany
Title
A Biobank for Long-term and Sustainable Research in the Field of
Congenital Heart Disease in Germany.
Source
Genomics, Proteomics and Bioinformatics. 14 (4) (pp 181-190), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Beijing Genomics Institute (E-mail: gongw@genomics.org.cn)
Abstract
Congenital heart disease (CHD) is the most frequent birth defect (0.8%-1%
of all live births). Due to the advance in prenatal and postnatal early
diagnosis and treatment, more than 90% of these patients survive into
adulthood today. However, several mid- and long-term morbidities are
dominating the follow-up of these patients. Due to the rarity and
heterogeneity of the phenotypes of CHD, multicenter registry-based studies
are required. The CHD-Biobank was established in 2009 with the aim to
collect DNA from patients and their parents (trios) or from affected
families, as well as cardiovascular tissues from patients undergoing
corrective heart surgery for cardiovascular malformations.
Clinical/phenotype data are matched to the International Paediatric and
Congenital Cardiac Code (IPCCC) and the International Statistical
Classification of Diseases and Related Health Problems 10th Revision
(ICD-10). The DNA collection currently comprises samples from
approximately 4200 participants with a wide range of CHD phenotypes. The
collection covers about 430 trios and 120 families with more than one
affected member. The cardiac tissue collection comprises 1143 tissue
samples from 556 patients after open heart surgery. The CHD-Biobank
provides a comprehensive basis for research in the field of CHD with high
standards of data privacy, IT management, and sample logistics. Copyright
&#xa9; 2016

<77>
Accession Number
610790052
Author
Tanaka Y.; Miyamoto T.; Naito Y.; Yoshitake S.; Sasahara A.; Miyaji K.
Institution
(Tanaka, Miyamoto, Naito, Yoshitake, Sasahara) Department of
Cardiovascular Surgery, Gunma Children's Medical Center, Shibukawa, Japan
(Miyaji) Department of Cardiovascular Surgery, Kitasato University
Hospital, Sagamihara, Japan
Title
Randomized Study of a New Noninvasive Skin Closure Device for Use After
Congenital Heart Operations.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1368-1374), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Background We report a new, noninvasive Zip surgical skin closure device
(ZipLine Medical, Campbell, CA). This device is considered to have good
cosmetic outcomes after operations and reduces surgical time. In this
study, skin closure using the Zip device was compared with subcuticular
sutures and the usefulness and safety of this new device was evaluated.
Methods This was a prospective, randomized study of 214 patients who
underwent cardiac operations through a median sternotomy from June 2014 to
December 2015. In 136 patients, this was a first operation group of which
71 patients underwent Zip surgical skin closure (Zip group), and 65
patients underwent subcuticular sutures (suture group). In 78 patients,
this was a reoperation group, of which 42 patients were in the Zip group
and 36 patients were in the suture group. Cosmetic results using the
Vancouver Scar Scale were evaluated separately in the first operation
group and reoperation group. Results There were significant differences in
the total Vancouver Scar Scale score between the first operation group (p
< 0.001) and reoperation group (p = 0.007). The skin closure time was
significantly shorter in the Zip group than in the suture group (113.0 +/-
9.1 seconds vs 375.9 +/- 60.2 seconds, p < 0.001). No significant
differences were found regarding the rate of surgical site infection
between the groups. Complications peculiar to this device included skin
discoloration (0.9%), epidermolysis (0.9%), and exfoliation of the device
(1.8%); however, no serious complications developed. Conclusions In
congenital heart operations through a median sternotomy, the Zip surgical
skin closure device was an excellent choice for improving the cosmetic
appearance and reducing the wound closure time. In addition, it proved to
be a device that could be used safely. Copyright &#xa9; 2016 The Society
of Thoracic Surgeons

<78>
Accession Number
610626268
Author
Shafiq A.; Jang J.-S.; Kureshi F.; Fendler T.J.; Gosch K.; Jones P.G.;
Cohen D.J.; Bach R.; Spertus J.A.
Institution
(Shafiq, Kureshi, Fendler, Gosch, Jones, Cohen, Spertus) Cardiovascular
Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City,
Missouri, United States
(Shafiq, Kureshi, Fendler, Jones, Cohen, Spertus) Division of Cardiology,
University of Missouri, Kansas City, Missouri, United States
(Jang) Division of Cardiology, Inje University Busan Paik Hospital, Busan,
South Korea
(Bach) Division of Cardiology, Washington University School of Medicine,
St. Louis, Missouri, United States
Title
Predicting Likelihood for Coronary Artery Bypass Grafting After
Non-ST-Elevation Myocardial Infarction: Finding the Best Prediction Model.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1304-1311), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Background Up to half of patients with non-ST-elevation myocardial
infarction (NSTEMI) do not receive dual antiplatelet therapy before
angiography "pretreatment" because of the risk of increased bleeding if
coronary artery bypass grafting (CABG) operation is needed. Several models
have been published that predict the likelihood of CABG after NSTEMI, but
they have not been independently validated. The purpose of this study was
to validate these models and improve the best one. Methods We studied
patients with NSTEMI who were enrolled in the 24-center Translational
Research Investigating Underlying Disparities in Acute Myocardial
Infarction Patients' Health Status (TRIUMPH) registry between 2005 and
2008. Previous CABG prediction models were assessed using c-statistics and
calibration assessments to determine the best model. Variables from
TRIUMPH likely to be associated with CABG were tested to see whether they
could improve the best model's performance. Results Among 2,473 patients
with NSTEMI, 11.8% underwent in-hospital CABG. C-statistics for the
Modified Thrombolysis in Myocardial Infarction, Treat Angina With
Aggrastat and Determine the Cost of Therapy With an Invasive or
Conservative Strategy-Thrombolysis in Myocardial Infarction 18, Poppe, and
Global Risk of Acute Coronary Events (GRACE) models were 0.54, 0.61, 0.61,
and 0.62, respectively. The GRACE model showed the best discrimination and
calibration. From the TRIUMPH registry, preselected variables were added
to the GRACE model but did not significantly improve model discrimination.
A GRACE model risk score of less than 9 had high sensitivity (96%), thus
making it useful for predicting patients with NSTEMI who were at low risk
for requiring CABG, which included approximately 21% of patients with
NSTEMI. Conclusions This study could not improve on the GRACE model, which
had the best predictive value for identifying a need for CABG after NSTEMI
with a broader range of predicted risk levels and high sensitivity,
especially in patients with scores lower than 9. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons

<79>
Accession Number
612633097
Author
Schwann T.A.; Habib J.R.; Khalifeh J.M.; Nauffal V.; Bonnell M.; Clancy
C.; Engoren M.C.; Habib R.H.
Institution
(Schwann, Bonnell, Clancy) Department of Surgery, University of Toledo
College of Medicine, Toledo, Ohio, United States
(Schwann, Engoren) Mercy Saint Vincent Medical Center, Toledo, Ohio,
United States
(Habib, Khalifeh, Nauffal, Habib) Department of Internal Medicine,
Outcomes Research Unit and Vascular Medicine Program, American University
of Beirut, Beirut, Lebanon
(Nauffal) Department of Medicine, Johns Hopkins Medical Institutes,
Baltimore, Maryland, United States
(Engoren) Department of Anesthesiology, University of Michigan, Ann Arbor,
Michigan, United States
Title
Effects of Blood Transfusion on Cause-Specific Late Mortality After
Coronary Artery Bypass Grafting-Less Is More.
Source
Annals of Thoracic Surgery. 102 (2) (pp 465-473), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Red blood cell transfusion after coronary artery bypass graft
surgery has been associated with increased late all-cause death. Yet,
whether this association is, first, independent of the packed red blood
cells and perioperative morbidity association, and second, of a cardiac
versus noncardiac etiology remains unknown. Methods We analyzed patients
undergoing coronary artery bypass graft surgery at two Ohio hospitals (n =
6,947) from 1994 to 2007. Salvage operations and patients with
preoperative renal failure were excluded. Long-term outcomes and leading
cause of death (cardiac, noncardiac, all cause) were derived from the US
Social Security Death Index and later from Ohio Department of Health Death
Index. Fifteen-year mortality cumulative incidence functions were compared
for transfusion groups (yes, n = 2,540; no, n = 4,806) overall, and then
stratified based on perioperative complications status (yes, n = 2,638;
no, n = 4,708). Comprehensive, 32 covariates, risk-adjusted transfusion
effects were estimated by competing risk regression. Results were
confirmed by propensity score adjusted analysis. Results Perioperative
transfusions and complications occurred in 33.9% and 35.2% of patients,
respectively. In all, 3,108 deaths (48.1%) have been documented (median
time to death, 7.43 years). Both transfusion rates (25.6% versus 49.1%, p
< 0.001) and deaths (58.2% versus 38.5%, p < 0.001) were more frequent
among complications patients. Red blood cells transfusion increased
intermediate to late mortality risk overall (15-year adjusted hazard ratio
[AHR] 1.21, 95% confidence interval [CI]: 1.11 to 1.31), and for
complications (AHR 1.24, 95% CI: 1.11 to 1.39) and no complications (AHR
1.16, 95% CI: 1.03 to 1.31). The increased mortality was true for cardiac
and noncardiac etiologies (AHR 1.19, 95% CI: 1.03 to 1.36, and AHR 1.14,
95% CI: 1.01 to 1.29, respectively). Red blood cell transfusion increased
mostly cardiac deaths (AHR 1.38, 95% CI: 1.14 to 1.66) among the
complications group, and noncardiac mortality (AHR 1.24, 95% CI: 1.05 to
1.47) for the no complications group. A parallel propensity matched
sensitivity analysis confirmed these findings. Conclusions Perioperative
red blood cells transfusion is associated with significant adverse late
death effects among both complicated patients and noncomplicated patients,
principally seen between 0 and 5 years postoperatively, and is driven by
both increased cardiovascular and noncardiovascular mortality. Further
studies are needed to elucidate the mechanisms behind these findings,
including their potential dose dependence. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons

<80>
Accession Number
612633060
Author
Crocker E.; Beggs T.; Hassan A.; Denault A.; Lamarche Y.; Bagshaw S.;
Elmi-Sarabi M.; Hiebert B.; Macdonald K.; Giles-Smith L.; Tangri N.; Arora
R.C.
Institution
(Crocker) Faculty of Medicine, University of Manitoba, Winnipeg, Canada
(Beggs) School of Medicine, Royal College of Surgeons in Ireland, Dublin,
Ireland
(Hassan) Saint John Regional Hospital, Saint John, Canada
(Denault, Lamarche, Elmi-Sarabi) Montreal Heart Institute, Montreal,
Canada
(Bagshaw) Faculty of Medicine and Dentistry and School of Public Health,
University of Alberta, Edmonton, Canada
(Hiebert) St. Boniface Hospital, Winnipeg, Canada
(Macdonald, Giles-Smith) University of Manitoba Libraries, Winnipeg,
Canada
(Tangri) Seven Oaks General Hospital Renal Program, Winnipeg, Canada
(Tangri) Section of Nephrology, Department of Medicine, University of
Manitoba, Winnipeg, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, Canada
Title
Long-Term Effects of Postoperative Delirium in Patients Undergoing Cardiac
Operation: A Systematic Review.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1391-1399), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Delirium is an acute syndrome that involves fluctuating changes in
attention and cognition. Although delirium is the most common neurologic
complication after cardiac operation, data about its impact on long-term
outcomes are lacking. The purpose of this systematic review was to examine
the effect of postoperative delirium (PoD) on long-term outcomes,
including morbidity, probability of death, cognitive decline,
institutionalization, and health-related quality of life (HRQoL) in
patients undergoing cardiac operation. After performing this systematic
review we determined that PoD after cardiac operation is associated with
an increased risk of probability of death and readmission to the hospital
and a decrease in cognitive function, overall function, and HRQoL.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<81>
Accession Number
612633059
Author
He G.-W.; Taggart D.P.
Institution
(He) Department of Cardiovascular Surgery and Center for Basic Medical
Research, TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin and Zhejiang
University and The Affiliated Hospital of Hangzhou Normal University,
Hangzhou, China, Department of Surgery, Oregon Health and Science
University, Portland, Oregon, United States
(Taggart) Department of Cardiothoracic Surgery, Oxford University, United
Kingdom
Title
Antispastic Management in Arterial Grafts in Coronary Artery Bypass
Grafting Surgery.
Source
Annals of Thoracic Surgery. 102 (2) (pp 659-668), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Arterial grafts have long-term patency superior to vein grafts but have a
tendency to develop spasm that can lead to potentially life-threatening
complications. A perfect antispastic protocol should include advanced
surgical technique and adequate pharmacologic methods. All pharmacologic
vasodilator drugs relax the vessel through specific mechanisms, and
therefore, there is no perfect, single best vasodilator to prevent or
treat spasm of the arterial graft against all mechanisms of contraction.
One of the choices is to use a combination of pharmacologic vasodilators
targeting different mechanisms of spasm to obtain the reliable and best
effect. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<82>
Accession Number
612632993
Author
Mihos C.G.; Pineda A.M.; Capoulade R.; Santana O.
Institution
(Mihos, Capoulade) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts, United States
(Pineda, Santana) Columbia University Division of Cardiology, Mount Sinai
Heart Institute, Miami Beach, Florida, United States
Title
A Systematic Review of Mitral Valve Repair With Autologous Pericardial
Leaflet Augmentation for Rheumatic Mitral Regurgitation.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1400-1405), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
A systematic review was conducted to assess the efficacy of mitral valve
repair using glutaraldehyde-treated autologous pericardial leaflet
augmentation for rheumatic mitral regurgitation (MR). Five retrospective
studies were identified, which included 196 patients with moderate or
greater MR. There was 1 operative death (0.5%). At a mean follow-up of 3.2
+/- 2.2 years, moderate or greater MR reoccurred in 22 patients (11.2%),
reoperation was required in 9 (4.6%), and the cumulative survival was
98.9%. Finally, outcomes were similar between the patients who underwent
augmentation of the anterior vs the posterior mitral leaflet. Pericardial
leaflet augmentation is a viable technique for the treatment of rheumatic
MR. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<83>
Accession Number
612609043
Author
Candilio L.
Institution
(Candilio) Hatter Cardiovascular Institute, University College London, 67
Chenies Mews, London WC1E 6HX, United Kingdom
Title
Reducing myocardial infarct size by remote ischemic conditioning.
Source
Heart and Metabolism. (70) (pp 36-39), 2016. Date of Publication: July
2016.
Publisher
Les Laboratoires Seriver (50 Rue Carnot, F-92284, Suresnes Cedex, France)
Abstract
Ischemic heart disease is the leading cause of death and morbidity in the
world, and ST-segment elevation myocardial infarction (STEMI) remains
associated with a significant mortality rate and complications noted at
1-year follow-up, despite prompt coronary reperfusion achieved with either
thrombolysis or primary percutaneous coronary intervention (PPCI). It is
therefore clear that novel cardioprotective strategies are required to
improve clinical outcomes in these subjects; in this regard, remote
ischemic conditioning (RIC), a phenomenon by which brief episodes of
transient limb ischemia-reperfusion are able to protect a distant or
"remote" organ or tissue from a sustained period of ischemia, has been
demonstrated as a promising low-cost therapeutic strategy in order to
reduce myocardial injury and improve clinical outcomes in these patients.
In the current article, we provide an updated review of randomized
clinical trials investigating the effects of RIC in patients presenting
with STEMI.

<84>
Accession Number
612507752
Author
Colson P.H.; Gaudard P.; Fellahi J.-L.; Bertet H.; Faucanie M.; Amour J.;
Blanloeil Y.; Lanquetot H.; Ouattara A.; Picot M.C.
Institution
(Colson, Gaudard) Department of Anesthesiology and Critical Care Medicine,
Arnaud de Villeneuve Academic Hospital, Montpellier University,
Montpellier, France
(Colson) Institut de Genomique Fonctionnelle, Endocrinology Department,
CNRS UMR5203, INSERM U1191, University of Montpellier, Montpellier 34094,
France
(Gaudard) PhyMedExp, University of Montpellier, INSERM U1046, CNRS
UMR9214, Montpellier, Cedex 5 34295, France
(Fellahi) Department of Anesthesiology and Critical Care Medicine, Louis
Pradel Academic Hospital, Lyon Bron, France
(Bertet, Faucanie, Picot) Clinical Research and Epidemiology Unit,
Academic Hospital, Montpellier, France
(Bertet, Picot) Clinical Investigation Center, Academic Hospital,
Montpellier, France
(Amour) Department of Anaesthesiology and Critical Care Medicine, Sorbonne
University, UPMC Univ. Paris 06, UMR INSERM 1166 and Post-Genomic
Platform, IHU ICAN, Paris, France
(Blanloeil) Department of Anaesthesiology and Critical Care Medicine,
Laennec Academic Hopital, Nantes, France
(Lanquetot) Department of Anaesthesiology and Critical Care Medicine,
Academic Hospital, Poitiers, France
(Ouattara) Department of Anaesthesiology and Critical Care Medicine II,
Academic Hospital, Bordeaux-Pessac, France
Title
Active bleeding after cardiac surgery: A prospective observational
multicenter study.
Source
PLoS ONE. 11 (9) (no pagination), 2016. Article Number: e0162396. Date of
Publication: September 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Main Objectives: To estimate the incidence of active bleeding after
cardiac surgery (AB) based on a definition directly related on blood flow
from chest drainage; to describe the AB characteristics and its
management; to identify factors of postoperative complications. Methods:
AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours
within the first 24 hours or in case of reoperation for hemostasis during
the first 12 postoperative hours. The definition was applied in a
prospective longitudinal observational study involving 29 French centers;
all adult patients undergoing cardiac surgery with cardiopulmonary bypass
were included over a 3-month period. Perioperative data (including blood
product administration) were collected. To study possible variation in
clinical practice among centers, patients were classified into two groups
according to the AB incidence of the center compared to the overall
incidence: "Low incidence" if incidence is lower and "High incidence" if
incidence is equal or greater than overall incidence. Logistic regression
analysis was used to identify risk factors of postoperative complications.
Results: Among 4,904 patients, 129 experienced AB (2.6%), among them 52
reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and
1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB
varied between centers (0 to 16%) but was independent of incentre cardiac
surgical experience. Comparisons between groups according to AB incidence
showed differences in postoperative management. Body surface area,
preoperative creatinine, emergency surgery, postoperative acidosis and red
blood cell transfusion were risk factors of postoperative complication.
Conclusions: A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the
first 24 hours or early reoperation for hemostasis seems a relevant
definition of AB. This definition, independent of transfusion, adjusted to
body weight, may assess real time bleeding occurring early after surgery.
Copyright &#xa9; 2016 Colson 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.

<85>
Accession Number
612507637
Author
Mota J.M.; Sousa L.G.; Riechelmann R.P.
Institution
(Mota, Sousa, Riechelmann) Instituto do Cancer do Estado de Sao Paulo,
University of Sao Paulo 01246-000, Brazil
Title
Complications from carcinoid syndrome: Review of the current evidence.
Source
ecancermedicalscience. 10 (no pagination), 2016. Article Number: 662. Date
of Publication: 08 Aug 2016.
Publisher
Cancer Intelligence (E-mail: info@cancerintelligence.com)
Abstract
Patients with well-differentiated neuroendocrine tumours may develop
carcinoid syndrome (CS), which is characterised by flushing, abdominal
cramps, diarrhoea, and bronchospasms. In this scenario, long-term
secretion of vasoactive substances - serotonin, tachynins, and others, may
induce fibrogenic responses in local or distant tissues, leading to
complications such as carcinoid heart disease (CHD), mesenteric and/or
retroperitoneal fibrosis. Rare cases of lung/pleural fibrosis and
scleroderma have also been described. Despite it not being well described
yet, current evidence suggests the pathogenesis of such fibrogenic
complications relies on signalling through 5-HT<inf>2B</inf> and
TGF-beta1. Medical management is still very limited and lacks prospective
and randomised studies for definitive recommendations. Surgical procedures
remain the best definitive treatment option for CHD and abdominal
fibrosis. Recently, cognitive impairment has also been described as a
potential consequence of CS. This review critically discusses the
literature concerning the epidemiology, pathogenesis, clinical features,
diagnosis, and treatment options for CS-related long-term complications.
Copyright &#xa9; the authors; licensee ecancermedicalscience.

<86>
Accession Number
612502114
Author
Mori H.; Maeda A.; Wakabayashi K.; Sato T.; Sasai M.; Tashiro K.; Iso Y.;
Ebato M.; Suzuki H.
Institution
(Mori, Maeda, Wakabayashi, Sato, Sasai, Tashiro, Iso, Ebato, Suzuki)
Department of Cardiology, Showa University Fujigaoka Hospital, Japan
Title
The effect of cilostazol on endothelial function as assessed by
flow-mediated dilation in patients with coronary artery disease.
Source
Journal of Atherosclerosis and Thrombosis. 23 (10) (pp 1168-1177), 2016.
Date of Publication: 2016.
Publisher
Japan Atherosclerosis Society
Abstract
Aim: The vascular endothelium plays a key role in the pathophysiology of
atherosclerosis. Flowmediated dilation (FMD) is a novel way of assessing
endothelial function. Cilostazol is a unique antiplatelet drug that also
has the potential to improve endothelial function. The objective of this
present study was to investigate the effects of cilosatzol on endothelial
function as assessed by FMD. Methods: Fifty-one patients with coronary
artery disease (CAD) were assigned to one of two groups: the
Cilostazol(<inf>+</inf>) group (with cilostazol) and
Cilostazol(<inf>-</inf>) group (without cilostazol). In addition to
conventional dual antiplatelet therapy with aspirin and
clopidogrel/ticlopidine, the Cilostazol(<inf>+</inf>) group
(n<inf>=</inf>27) was also given cilostazol (100 mg/day). The
Cilostazol(<inf>-</inf>) group (n<inf>=</inf>24) did not receive
cilostazol. FMD was assessed at enrollment and after 6-9 months. Results:
The FMD of both the Cilostazol(<inf>+</inf>) and Cilostazol(<inf>-</inf>)
groups remained similar at 5.2 (interquartile range: 3.8-8.5) to 5.4
(interquartile range: 4.2-6.7) (P<inf>=</inf>0.29) and 5.0 (interquartile
range: 3.6-6.4) to 4.9 (interquartile range: 4.0-7.0) (P<inf>=</inf>0.38),
respectively. However, the diameters of the baseline and maximal brachial
arteries tended to increase in the Cilostazol(<inf>+</inf>) group
(baseline: 4.2<inf>+/-</inf>0.7 to 4.4<inf>+/-</inf>0.7,
P<inf>=</inf>0.18; maximal: 4.5<inf>+/-</inf>0.7 to 4.6<inf>+/-</inf>0.7
P<inf>=</inf>0.22), whereas that of the Cilostazol(-) group tended to
decrease (baseline: 4.1<inf>+/-</inf>0.6 to 3.9<inf>+/-</inf>0.5,
P<inf>=</inf>0.10; maximal: 4.3<inf>+/-</inf>0.7 to 4.1<inf>+/-</inf>0.5,
P<inf>=</inf>0.05). The rates of change in the baseline diameter
(Cilostazol(<inf>+</inf>): 3.7<inf>+/-</inf>9.8% vs.
Cilostazol(-):<inf>-</inf>3.8<inf>+/-</inf>12.2%, P<inf>=</inf>0.03) and
maximal diameter
(Cilostazol(<inf>+</inf>):<inf>+</inf>3.1<inf>+/-</inf>8.9% vs.
Cilostazol(-):<inf>-</inf>4.4<inf>+/-</inf>12.0%, P<inf>=</inf>0.02) were
significantly different. Conclusion: Although cilostazol didn't affect the
FMD, there was a significant difference in the rates of change in baseline
and maximal brachial artery diameter. This may have a beneficial effect in
patients with cardiovascular disease. Copyright &#xa9; 2016 Japan
Atherosclerosis Society.

<87>
Accession Number
612718593
Author
Lee R.; Vassallo P.; Kruse J.; Malaisrie S.C.; Rigolin V.; Andrei A.-C.;
McCarthy P.
Institution
(Lee) Center for Comprehensive Cardiovascular Care, Saint Louis
University, St Louis, Mo, United States
(Vassallo, Kruse, Malaisrie, Rigolin, Andrei, McCarthy) Bluhm
Cardiovascular Institute, Northwestern University, Chicago, Ill, United
States
Title
A randomized, prospective pilot comparison of 3 atrial appendage
elimination techniques: Internal ligation, stapled excision, and surgical
excision.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp 1075-1080),
2016. Date of Publication: 01 Oct 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Elimination of the left atrial appendage (LAA) attempts to
reduce stroke in patients with atrial fibrillation (AF). A retrospective
review suggests that various surgical techniques are often unsuccessful
and may leave a stump or gap. In a pilot study, we prospectively evaluated
3 surgical techniques with long-term follow up to define effectiveness.
Methods At a single institution, 28 patients undergoing concomitant AF
surgery were randomized prospectively into 1 of 3 techniques of LAA
elimination: internal suture ligation (IL), external stapled excision
(StEx), and surgical excision (SxEx). The success of LAA elimination was
assessed by transesophageal echocardiography (TEE) in all patients at the
time of surgery. Failure of LAA closure consisted of either a stump
(residual appendage tissue >1 cm in maximum length) or a gap (persistent
flow between the left atrium [LA] and the LAA). Failure was treated
intraoperatively when recognized. Late follow-up was obtained using a TEE
at a mean of 0.4 years in 21/28 (75%) of patients. Results Early failure
was recognized and treated in 1 patient in the IL group (13%), 6 patients
in the StEx group (60%), and 2 patients in the SxEx group (20%) (P = .06).
On follow-up TEE, 4 of 7 patients in the IL group (57%) had developed
gaps, 3 of whom (43%) with greater than mild flow. No patients in the StEx
or SxEx groups had a gap (P = .03). In late follow-up, 1 of 7 patients in
the IL group (14%) had a stump, compared with 2 of 8 (25%) in the StEx
group and 3 of 6 (50%) in the SxEx group (P = .35). The overall failure
rate was 57%: 5 of 8 (63%) in the IL group, 6 of 10 (60%) in the StEx
group, and 5 of 10 (50%) in the SxEx group (P = .85). No patient had a
stroke at any time during follow-up. Conclusions LAA elimination is often
incomplete and goes undetected. If the LAA is eliminated at the time of
surgery, then TEE should be used intraoperatively to assess effectiveness
and reintervention performed if warranted. Late assessment for
completeness of closure should be considered before cessation of
anticoagulation until more effective LAA techniques can be developed.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<88>
Accession Number
612718521
Author
Benedetto U.; Gaudino M.; Caputo M.; Tranbaugh R.F.; Lau C.; Di Franco A.;
Ng C.; Girardi L.N.; Angelini G.D.
Institution
(Benedetto, Caputo, Angelini) Bristol Heart Institute, University of
Bristol, School of Clinical Sciences, Bristol, United Kingdom
(Gaudino, Tranbaugh, Lau, Di Franco, Girardi) Department of Cardiothoracic
Surgery, Weill Cornell Medical College, New York, NY, United States
(Ng) National University of Singapore, Singapore
Title
Right internal thoracic artery versus radial artery as the second best
arterial conduit: Insights from a meta-analysis of propensity-matched data
on long-term survival.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp
1083-1091.e15), 2016. Date of Publication: 01 Oct 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective(s) We conducted a meta-analysis of propensity score-matching
(PSM) studies comparing long-term survival of patients receiving right
internal thoracic artery (RITA) versus radial artery (RA) as a second
arterial conduit for coronary artery bypass grafting. Methods A literature
search was conducted using MEDLINE, EMBASE, and Web of Science to identify
relevant articles. Primary endpoint was long-term mortality. Secondary
endpoints were operative mortality, incidence of sternal wound infection,
and repeat revascularization. Binary events were pooled using the
DerSimonian and Laird method. For time-to-event outcomes, estimates of log
hazard ratio (HR) and standard errors obtained were combined using the
generic inverse-variance method. Results A total of 8 PSM studies were
finally selected including 15,374 patients (RITA, 6739; RA, 8635) with
2992 matched pairs for final comparison. Mean follow-up time ranged from
45 to 168 months. When compared with RA, RITA was associated with a lower
risk reduction of late death (HR, 0.75; 95% confidence interval [CI],
0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI,
0.16-0.85; P = .03). On the other hand, RITA did not increase operative
mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was
associated with an increased risk of sternal wound complication when
pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with
skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). Conclusions The
present PSM data meta-analysis suggests that the use of RITA compared with
RA was associated with superior long-term survival and freedom from repeat
revascularization, with similar operative mortality and incidence of
sternal wound complication when the skeletonized harvesting technique was
used. Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<89>
Accession Number
612475575
Author
Foroutan F.; Guyatt G.H.; O'Brien K.; Bain E.; Stein M.; Bhagra S.; Sit
D.; Kamran R.; Chang Y.; Devji T.; Mir H.; Manja V.; Schofield T.;
Siemieniuk R.A.; Agoritsas T.; Bagur R.; Otto C.M.; Vandvik P.O.
Institution
(Foroutan, Guyatt, Sit, Kamran, Chang, Devji, Mir, Manja, Siemieniuk,
Agoritsas) Department of Clinical Epidemiology and Biostatistics, McMaster
University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
(Foroutan, O'Brien, Bain, Stein, Bhagra, Schofield) Heart
Failure/Transplant Program, Toronto General Hospital, University Health
Network, Toronto, ON, Canada
(Manja) Department of Internal Medicine, State University of New York at
Buffalo, Buffalo, United States
(Manja) VA WNY Health Care System at Buffalo, Department of Veterans
Affairs, United States
(Siemieniuk) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Agoritsas) Division of General Internal Medicine, Division of Clinical
Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
(Bagur) Division of Cardiology, London Health Sciences Centre, Department
of Epidemiology and Biostatistics, Western University, London, ON N6A 5W9,
Canada
(Otto) Division of Cardiology, Department of Medicine, University of
Washington School of Medicine, Seattle, WA, United States
(Vandvik) Department of Internal Medicine, Innlandet Hospital
Trust-division Gjovik, Norway
(Vandvik) Institute of Health and Society, Faculty of Medicine, University
of Oslo, Norway
Title
Prognosis after surgical replacement with a bioprosthetic aortic valve in
patients with severe symptomatic aortic stenosis: Systematic review of
observational studies.
Source
BMJ (Online). 354 (no pagination), 2016. Article Number: i5065. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To determine the frequency of survival, stroke, atrial
fibrillation, structural valve deterioration, and length of hospital stay
after surgical replacement of an aortic valve (SAVR) with a bioprosthetic
valve in patients with severe symptomatic aortic stenosis. Design
Systematic review and meta-analysis of observational studies. Data sources
Medline, Embase, PubMed (non-Medline records only), Cochrane Database of
Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. Study
selection Eligible observational studies followed patients after SAVR with
a bioprosthetic valve for at least two years. Methods Reviewers,
independently and in duplicate, evaluated study eligibility, extracted
data, and assessed risk of bias for patient important outcomes. We used
the GRADE system to quantify absolute effects and quality of evidence.
Published survival curves provided data for survival and freedom from
structural valve deterioration, and random effect models provided the
framework for estimates of pooled incidence rates of stroke, atrial
fibrillation, and length of hospital stay. Results In patients undergoing
SAVR with a bioprosthetic valve, median survival was 16 years in those
aged 65 or less, 12 years in those aged 65 to 75, seven years in those
aged 75 to 85, and six years in those aged more than 85. The incidence
rate of stroke was 0.25 per 100 patient years (95% confidence interval
0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to
4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at
10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of
hospital stay was 12 days (95% confidence interval 9 to 15). Conclusion
Patients with severe symptomatic aortic stenosis undergoing SAVR with a
bioprosthetic valve can expect only slightly lower survival than those
without aortic stenosis, and a low incidence of stroke and, up to 10
years, of structural valve deterioration. The rate of deterioration
increases rapidly after 10 years, and particularly after 15 years.

<90>
Accession Number
611440464
Author
Kaw R.; Hernandez A.V.; Pasupuleti V.; Deshpande A.; Nagarajan V.; Bueno
H.; Coleman C.I.; Ioannidis J.P.A.; Bhatt D.L.; Blackstone E.H.
Institution
(Kaw) Department of Hospital Medicine, Medicine Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Kaw) Department of Outcomes Research, Anesthesiology Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Hernandez) Health Outcomes and Clinical Epidemiology Section, Department
of Quantitative Health Sciences, Lerner Research Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Deshpande) Medicine Institute Center for Value Based Care Research,
Cleveland Clinic, Cleveland, Ohio, United States
(Blackstone) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Hernandez) School of Medicine, Universidad Peruana de Ciencias Aplicadas
(UPC), Lima, Peru
(Pasupuleti) Department of Medicine, Case Western Reserve University,
Cleveland, Ohio, United States
(Nagarajan) Department of Cardiovascular Medicine, University of Virginia,
Charlottesville, Va, United States
(Bueno) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Bueno) Department of Cardiology, Hospital Universitario 12 de Octubre,
Madrid, Spain
(Bueno) University of Connecticut School of Pharmacy, Storrs, Conn, United
States
(Coleman) Universidad Complutense de Madrid, Madrid, Spain
(Ioannidis) Department of Medicine, Stanford Prevention Research Center,
Stanford University School of Medicine, Stanford, Calif, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, Mass, United States
Title
Effect of diastolic dysfunction on postoperative outcomes after
cardiovascular surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (4) (pp 1142-1153),
2016. Date of Publication: 01 Oct 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The objective of this study was to investigate the effect of
preoperative diastolic dysfunction on postoperative mortality and
morbidity after cardiovascular surgery. Methods We systematically searched
for articles that assessed the prognostic role of diastolic dysfunction on
cardiovascular surgery in PubMed, Cochrane Library, Web of Science,
Embase, and Scopus until February 2016. Twelve studies (n = 8224) met our
inclusion criteria. Because of the scarcity of outcome events,
fixed-effects meta-analysis was performed via the Mantel-Haenszel method.
Results Preoperative diagnosis of diastolic dysfunction was associated
with greater postoperative mortality (odds ratio [OR], 2.41; 95%
confidence interval [CI], 1.54-3.71; P < .0001), major adverse cardiac
events (OR, 2.07; 95% CI, 1.55-2.78; P < .0001), and prolonged mechanical
ventilation (OR, 2.08; 95% CI, 1.04-4.16; P = .04) compared with patients
without diastolic dysfunction among patients who underwent cardiovascular
surgery. The odds of postoperative myocardial infarction (OR, 1.29; 95%
CI, 0.82-2.05; P = .28) and atrial fibrillation (OR, 2.67; 95% CI,
0.49-14.43; P = .25) did not significantly differ between the 2 groups.
Severity of preoperative diastolic dysfunction was associated with
increased postoperative mortality (OR, 21.22; 95% CI, 3.74-120.33; P =
.0006) for Grade 3 diastolic dysfunction compared with patients with
normal diastolic function. Inclusion of left ventricular ejection fraction
(LVEF) <40% accompanying diastolic dysfunction did not further impact
postoperative mortality (P = .27; I² = 18%) compared with
patients with normal LVEF and diastolic dysfunction. Conclusions Presence
of preoperative diastolic dysfunction was associated with greater
postoperative mortality and major adverse cardiac events, regardless of
LVEF. Mortality was significantly greater in grade III diastolic
dysfunction. Copyright &#xa9; 2016 The American Association for Thoracic
Surgery

<91>
Accession Number
612595972
Author
Ivy D.
Institution
(Ivy) Section of Pediatric Cardiology, Children's Hospital Colorado,
University of Colorado School of Medicine, 13123 East 16th Avenue, B100,
Aurora, CO 80045, United States
Title
Pulmonary Hypertension in Children.
Source
Cardiology Clinics. 34 (3) (pp 451-472), 2016. Date of Publication: 01 Aug
2016.
Publisher
W.B. Saunders
Abstract
The prevalence of PH is increasing in the pediatric population, because of
improved recognition and increased survival of patients, and remains a
significant cause of morbidity and mortality. Recent studies have improved
the understanding of pediatric PH, but management remains challenging
because of a lack of evidence-based clinical trials. The growing
contribution of developmental lung disease requires dedicated research to
explore the use of existing therapies as well as the creation of novel
therapies. Adequate study of pediatric PH will require multicenter
collaboration due to the small numbers of patients, multifactorial disease
causes, and practice variability. Copyright &#xa9; 2016 Elsevier Inc.

<92>
Accession Number
607221464
Author
Deininger S.; Hoenicka M.; Muller-Eising K.; Rupp P.; Liebold A.; Koenig
W.; Gorki H.
Institution
(Deininger, Hoenicka, Muller-Eising, Rupp, Liebold, Gorki) Department of
Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center,
Albert-Einstein-Allee 23, Ulm 89081, Germany
(Koenig) Department of Internal Medicine II - Cardiology, University of
Ulm Medical Center, Ulm, Germany
Title
Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A
Prospective Randomized Trial Comparing Three Surgical Techniques.
Source
Thoracic and Cardiovascular Surgeon. 64 (7) (pp 561-568), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Cardiopulmonary bypass procedure is associated with an
increased risk of renal impairment. To which extent structural damage
causes functional decline is unknown. We evaluated perioperative kidney
injury and function in patients treated with conventional extracorporeal
circulation (CECC), minimized extracorporeal circulation (MECC), and
off-pump coronary artery bypass grafting (OPCAB). Methods Blood and urine
samples, collected at baseline and up to 72 hours after surgery from
patients of the HEPCON trial (DRKS00007580, 120 patients randomized for
heparin management and for surgical technique), were analyzed for
differences in renal injury and function. Neutrophil gelatinase-associated
lipocalin, alpha glutathione S-transferase, liver fatty acid-binding
protein, and kidney injury molecule-1 were measured as urinary protein
markers of renal tubular injury. Serum creatinine, blood urea levels, and
estimated glomerular filtration rate were determined to monitor renal
function. Results Markers of tubular injury differed significantly between
surgical technique groups early after surgery, indicating the most
detrimental effect in CECC. Hemolysis and hemodilution correlated with
these early changes. A late rise did not show intergroup differences. Time
courses of renal function parameters, as well as the development of acute
kidney injury in 15 patients (13.5%), were irrespective of surgical
technique. Heparin management did not influence renal parameters.
Conclusion During coronary artery bypass grafting, CECC temporarily
induces more tubular injury than MECC or OPCAB. However, late changes of
renal function parameters occur irrespective of extracorporeal perfusion
mode and even in off-pump surgery. Copyright &#xa9; Georg Thieme Verlag
KGStuttgart . New York.

<93>
Accession Number
612668931
Author
Kim A.Y.; Jung S.Y.; Choi J.Y.; Kim G.B.; Kim Y.-H.; Shim W.S.; Kang
I.-S.; Jung J.W.
Institution
(Kim, Jung, Choi, Jung) Division of Pediatric Cardiology, Severance
Cardiovascular Hospital, Yonsei University College of Medicine, 50-1
Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Kim) Seoul National University Children's Hospital, Seoul, South Korea
(Kim) Ulsan University Asan Medical Center, Seoul, South Korea
(Shim) Gangwon National University, Chuncheon, South Korea
(Kang) Sungkyunkwan University Samsung Medical Center, Seoul, South Korea
Title
Retrospective multicenter study of respiratory syncytial virus prophylaxis
in Korean children with congenital heart diseases.
Source
Korean Circulation Journal. 46 (5) (pp 719-726), 2016. Date of
Publication: September 2016.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: We conducted a review of current data on
respiratory syncytial virus (RSV) prophylaxis with palivizumab, in Korean
children with congenital heart diseases (CHD). In 2009, the Korean
guideline for RSV prophylaxis had established up to five shots monthly per
RSV season, only for children <1 year of age with hemodynamic significance
CHD (HS-CHD). Subjects and Methods: During the RSV seasons in 2009-2015,
we performed a retrospective review of data for 466 infants with CHD,
examined at six centers in Korea Results: Infants received an average of
3.7+/-1.9 (range, 1-10) injections during the RSV season. Fifty-seven
HS-CHD patients (12.2%) were hospitalized with breakthrough RSV
bronchiolitis, with a recurrence in three patients, one year after the
initial check-up. Among patients with simple CHD, only five (1.1%)
patients received one additional dose postoperatively, as per the
limitations set by the Korean guideline. Among the 30 deaths (6.4%), five
(1.1%) were attributed to RSV infection; three to simple CHD, one to
Tetralogy of Fallot, and one to hypertrophic cardiomyopathy (HCM). Of the
three HCM patients that exceeded guidelines for RSV prophylaxis, two
(66.6%) were hospitalized, and one died of RSV infection (33.3%).
Conclusion: In accordance to the Korean guideline, minimal injections of
palivizumab were administered to patients having HS-CHD <one year of age
during the RSV season; the risk of RSV infection remains significant among
children with simple CHD, cardiomyopathy, and children above the age of
one year with HS-CHD. &#xa9; Copyright 2016 The Korean Society of
Cardiology.

<94>
Accession Number
612750590
Author
De La Torre Hernandez J.M.; Moreno R.; Lee D.-H.; Garcia Del Blanco B.;
Sanmartin J.C.; Garcia Blas S.; Serra Garcia V.; Gaviria K.; Garcia I.;
Zueco J.
Institution
(De La Torre Hernandez, Lee, Garcia, Zueco) Cardiovascular Department,
Marques de Valdecilla University Hospital, Unidad de Hemodinamica y
Cardiologia Intervencionista, Valdecilla Sur Santander 39008, Spain
(Moreno, Garcia Blas) Cardiovascular Department, Hospital Vall d'Hebron,
Barcelona, Spain
(Garcia Del Blanco, Serra Garcia) Cardiovascular Department, Hospital La
Paz, Madrid, Spain
(Sanmartin, Gaviria) Cardiovascular Department, Policlinica Guipuzcoa y
Hospital Arantzazu Donostia, San Sebastian, Spain
Title
The routine use of surgical exposure approach for trans-femoral
implantation of the balloon expandable aortic prosthesis is associated to
a low rate of vascular complications.
Source
Journal of Cardiovascular Surgery. 57 (4) (pp 615-619), 2016. Date of
Publication: August 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: The most frequent complications of transfemoral aortic valve
implantation are vascular (15-25%) and are related to an increase in
mortality. We sought to assess the rate of vascular complications, its
treatment and outcomes using a surgical approach for transfemoral
implantation of Edwards-SAPIEN (Edwards Lifescience, Irvine, CA, USA)
aortic valve. METHODS: We have conducted a multicenter registry including
4 hospitals using a systematic surgical exposure approach. Vascular
complications have been collected following the definitions of the Valve
Academic Research Consortium. RESULTS: From 2008 to 2013 a total of 312
consecutive patients have been included. Vascular complications were
reported in 22 (7%), among those 6 (1.9%) were major whereas 16 (5.1%)
were minor. Patients suffering vascular complications had significantly
more previous history of peripheral vascular disease. All but one major
complications occurred in women, aged 82-88 and with chronic renal
failure. Hospital stay was longer in cases suffering complications
(17.8+/-11 days vs. 9+/-7 days; PO.0001). The 30 days mortality was 13.6%
in patients with vascular complications, 33.3% in patients with major
complications and 5.5% in patients with no complications (P=0.05).
CONCLUSIONS: In this registry, the systematic use of a surgical exposure
of the femoral artery for TAVR has been associated with a lower rate of
vascular complications. Copyright &#xa9; 2015 EDIZIONI MINERVA MEDICA.

<95>
Accession Number
612750584
Author
Kitrou P.; Karnabatidis D.; Katsanos K.
Institution
(Kitrou, Karnabatidis) Department of Interventional Radiology, Patras
University Hospital, School of Medicine, Patras, Greece
(Katsanos) Department of Interventional Radiology, Guy's and St. Thomas'
Hospitals, NHS Foundation Trust, King's Health Partners, London SE1 7EH,
United Kingdom
Title
Drug-coated balloons are replacing the need for nitinol stents in the
superficial femoral artery.
Source
Journal of Cardiovascular Surgery. 57 (4) (pp 569-577), 2016. Date of
Publication: August 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Amassed evidence from several randomized controlled trials and high
quality meta-analyses clearly support the primary use of paclitaxel-coated
balloons (PCB) in the superficial femoral artery over traditional plain
balloon angioplasty or primary bare nitinol stenting with significantly
lower vascular restenosis, less need for repeat procedures, improved
quality of life and potential cost savings for the healthcare system.
Stents may be reserved for bail-out in case of a suboptimal dilatation
result, and for selected more complex lesions, or in case of critical limb
ischemia in order to eliminate vessel recoil and maximize immediate
hemodynamic gain. Debulking atherectomy remains unproven, but holds a lot
of promise in particular in combination with PCBs, in order to improve
compliance of the vessel wall by plaque removal, allow for a better
angioplasty result and optimize drug transfer and bioavailability. The
present overview summarizes and discusses current evidence about
femoropopliteal PCB angioplasty compared to the historical standard of
plain old balloon angioplasty and bare nitinol stents. Available evidence
is appraised in the context of clinically meaningful results, relevant
unresolved issues are highlighted, and future trends are discussed.
Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<96>
Accession Number
612628285
Author
de Wilde R.B.P.; de Wit F.; Geerts B.F.; van Vliet A.L.; Aarts L.P.H.J.;
Vuyk J.; Jansen J.R.C.
Institution
(de Wilde, Jansen) Department of Intensive Care, Leiden University Medical
Centre, Leiden, Netherlands
(de Wit, Geerts, van Vliet, Aarts, Vuyk) Department of Anaesthesiology,
Leiden University Medical Centre, Leiden, Netherlands
Title
Non-invasive continuous arterial pressure and pulse pressure variation
measured with Nexfin in patients following major upper
abdominal surgery: a comparative study.
Source
Anaesthesia. 71 (7) (pp 788-797), 2016. Date of Publication: 01 Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We compared the accuracy and precision of the non-invasive
Nexfin device for determining systolic, diastolic, mean
arterial pressure and pulse pressure variation, with arterial blood
pressure values measured from a radial artery catheter in 19 patients
following upper abdominal surgery. Measurements were taken at baseline and
following fluid loading. Pooled data results of the arterial blood
pressures showed no difference between the two measurement modalities.
Bland-Altman analysis of pulse pressure variation showed significant
differences between values obtained from the radial artery catheter and
Nexfin finger cuff technology (mean (SD) 1.49 (2.09)%, p < 0.001,
coefficient of variation 24%, limits of agreement -2.71% to 5.69%). The
effect of volume expansion on pulse pressure variation was identical
between methods (concordance correlation coefficient 0.848). We consider
the Nexfin monitor system to be acceptable for use in patients after major
upper abdominal surgery without major cardiovascular compromise or
haemodynamic support. Copyright &#xa9; 2016 The Association of
Anaesthetists of Great Britain and Ireland

<97>
Accession Number
612628124
Author
Moerman A.; Van Eeckhout C.; Vanderstraeten K.; De Somer F.; Van Belleghem
Y.; De Hert S.
Institution
(Moerman, Van Eeckhout, De Hert) Department of Anaesthesiology, Ghent
University Hospital, Gent, Belgium
(De Somer, Van Belleghem) Department of Cardiac Surgery, Ghent University
Hospital, Gent, Belgium
(Vanderstraeten) Ghent University, Gent, Belgium
Title
The effect of hydroxyethyl starch 6% 130/0.4 compared with gelatin on
microvascular reactivity.
Source
Anaesthesia. 71 (7) (pp 798-805), 2016. Date of Publication: 01 Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We compared the effects on microvascular reactivity of hydroxyethylstarch
(Volulyte) and gelatin (Geloplasma) during acute
haemodilution. The hypothesis was that Volulyte would provide better
microvascular reactivity than Geloplasma. Forty patients undergoing
elective cardiac surgery were randomly assigned to receive either Volulyte
or Geloplasma as the exclusive priming solution of the cardiopulmonary
bypass. To evaluate microvascular reactivity, postocclusive reactive
hyperaemia was examined before and after cardiopulmonary bypass.
Microvascular reactivity assessments included the rate of the occlusion
and reperfusion slopes and reperfusion times. After cardiopulmonary
bypass, increases in reperfusion time were significantly smaller in the
Volulyte group (3 (-27 to 9 [-35 to 33]%) vs 29 (-17 to 76 [-34 to 137]%)
in the Geloplasma group, p = 0.02 between groups). Rate of reperfusion
increased in the Volulyte group (26 (-17 to 43 [-59 to 357])%), whereas it
decreased in the Geloplasma group (-22 (-47 to 16 [-84 to 113])%), p =
0.02 between groups. The shorter reperfusion times and increased
reperfusion rate suggest that Volulyte maintains better microvascular
reactivity than Geloplasma. Copyright &#xa9; 2016 The Association of
Anaesthetists of Great Britain and Ireland

<98>
Accession Number
612627021
Author
Ma L.; Xiang J.
Institution
(Ma, Xiang) Department of Thoracic Surgery, Fudan University Shanghai
Cancer Center, Shanghai, China
(Ma, Xiang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
Title
Clinical outcomes of video-assisted thoracic surgery and stereotactic body
radiation therapy for early-stage non-small cell lung cancer: A
meta-analysis.
Source
Thoracic Cancer. 7 (4) (pp 442-451), 2016. Date of Publication: 01 Jul
2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: We compared video-assisted thoracoscopic surgery (VATS)
lobectomy and stereotactic body radiation therapy (SABR) to explore
clinical outcomes in the treatment of patients with early stage NSCLC.
Methods: Major medical databases were systematically searched to identify
studies on VATS and SBRT published between January 2010 and October 2015.
English publications of stage I and II NSCLC with adequate patients and
SBRT doses were included. A multivariate random effects model was used to
perform meta-analysis to compare overall survival (OS) and disease-free
survival (DFS) between VATS and SBRT, adjusting for median age and
operable patient numbers. Results: Thirteen VATS (3436 patients) and 24
SBRT (4433) studies were eligible. The median age and follow-up duration
was 68 years and 42 months for VATS and 74 years and 29.4 months for SBRT
patients. After adjusting for the proportion of operable patients and
median age, the estimated OS rates at one, two, three, and five years with
VATS were 94%, 89%, 84%, and 69% compared with 96%, 94%, 89%, and 82% for
SBRT. The estimated DFS rates at one, two, three, and five years with VATS
were 97%, 93%, 87%, and 77% compared with 86%, 80%, 73%, and 58% for SBRT.
Conclusion: Before adjustment, patients treated with SBRT had poorer
clinical outcomes compared to those treated with VATS. A substantial
difference between median age and operability exists between patients
treated with SBRT and VATS. After adjusting for these differences, OS and
DFS did not differ significantly between the two techniques. Copyright
&#xa9; 2016 The Authors. Thoracic Cancer published by China Lung Oncology
Group and John Wiley & Sons Australia, Ltd

<99>
Accession Number
612621771
Author
Heron N.; Kee F.; Donnelly M.; Cardwell C.; Tully M.A.; Cupples M.E.
Institution
(Heron, Kee, Donnelly, Cardwell, Tully, Cupples) Department of General
Practice, Centre for Public Health, School of Medicine, Dentistry and
Biomedical Science, Queen's University, Dunluce Health Centre, 1 Dunluce
Avenue, Belfast BT9 7HR, United Kingdom
(Heron, Kee, Donnelly, Cardwell, Tully, Cupples) UK Clinical Research
Collaboration, Centre of Excellence for Public Health (Northern Ireland),
Institute of Clinical Science B, Royal Victoria Hospital, Belfast, United
Kingdom
Title
Behaviour change techniques in home-based cardiac rehabilitation: A
systematic review.
Source
British Journal of General Practice. 66 (651) (pp e747-e757), 2016. Date
of Publication: October 2016.
Publisher
Royal College of General Practitioners (E-mail: info@rcgp.co.uk)
Abstract
Background Cardiac rehabilitation (CR) programmes offering secondary
prevention for cardiovascular disease (CVD) advise healthy lifestyle
behaviours, with the behaviour change techniques (BCTs) of goals and
planning, feedback and monitoring, and social support recommended. More
information is needed about BCT use in home-based CR to support these
programmes in practice. Aim To identify and describe the use of BCTs in
home-based CR programmes. Design and setting Randomised controlled trials
of home-based CR between 2005 and 2015 were identified by searching
MEDLINE, Embase, PsycINFO, Web of Science, and Cochrane Database. Method
Reviewers independently screened titles and abstracts for eligibility.
Relevant data, including BCTs, were extracted from included studies. A
meta-analysis studied risk factor change in home-based and comparator
programmes. Results From 2448 studies identified, 11 of good
methodological quality (10 on post-myocardial infarction, one on heart
failure, 1907 patients) were included. These reported the use of 20
different BCTs. Social support (unspecified) was used in all studies and
goal setting (behaviour) in 10. Of the 11 studies, 10 reported
effectiveness in reducing CVD risk factors, but one study showed no
improvement compared to usual care. This study differed from effective
programmes in that it didn't include BCTs that had instructions on how to
perform the behaviour and monitoring, or a credible source. Conclusion
Social support and goal setting were frequently used BCTs in home-based CR
programmes, with the BCTs related to monitoring, instruction on how to
perform the behaviour, and credible source being included in effective
programmes. Further robust trials are needed to determine the relative
value of different BCTs within CR programmes. Copyright &#xa9; British
Journal of General Practice.

<100>
Accession Number
604799146
Author
Scherr D.; Derval N.; Sohal M.; Pascale P.; Wright M.; Jadidi A.; Komatsu
Y.; Roten L.; Wilton S.B.; Pedersen M.; Ramoul K.; Miyazaki S.; Shah A.;
Linton N.; Manninger M.; Denis A.; Hocini M.; Sacher F.; Haissaguerre M.;
Jais P.; Knecht S.
Institution
(Scherr, Derval, Pascale, Wright, Jadidi, Komatsu, Roten, Wilton,
Pedersen, Ramoul, Miyazaki, Shah, Linton, Denis, Hocini, Sacher,
Haissaguerre, Jais, Knecht) Hopital Cardiologique du Haut Leveque,
Universite Victor-Segalen Bordeaux, Pessac, France
(Scherr, Manninger) Division of Cardiology, Department of Medicine,
Medical University of Graz, Austria
(Sohal, Wright) Kings College London BHF Centre, Cardiovascular Division,
. Thomas Hospital, Lambeth Wing, St, London SE1 7EH, United Kingdom
Title
Length of the mitral isthmus but not anatomical location of ablation line
predicts bidirectional mitral isthmus block in patients undergoing
catheter ablation of persistent atrial fibrillation: A randomized
controlled trial.
Source
Journal of Cardiovascular Electrophysiology. 26 (6) (pp 629-634), 2015.
Date of Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Importance of Line and Length for Mitral Isthmus Introduction Mitral
isthmus (MI) ablation is an effective option in patients undergoing
ablation for persistent atrial fibrillation (AF). Achieving bidirectional
conduction block across the MI is challenging, and predictors of MI
ablation success remain incompletely understood. We sought to determine
the impact of anatomical location of the ablation line on the efficacy of
MI ablation. Methods and Results A total of 40 consecutive patients (87%
male; 54 +/- 10 years) undergoing stepwise AF ablation were included. MI
ablation was performed in sinus rhythm. MI ablation was performed from the
left inferior PV to either the posterior (group 1) or the anterolateral
(group 2) mitral annulus depending on randomization. The length of the MI
line (measured with the 3D mapping system) and the amplitude of the EGMs
at 3 positions on the MI were measured in each patient. MI block was
achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in
group 2 (P = NS). Total MI radiofrequency time (18 +/- 7 min vs. 17 +/- 8
min; P = NS) was similar between groups. Patients with incomplete MI block
had a longer MI length (34 +/- 6 mm vs. 24 +/- 5 mm; P < 0.001), a higher
bipolar voltage along the MI (1.75 +/- 0.74 mV vs. 1.05 +/- 0.69 mV; P <
0.01), and a longer history of continuous AF (19 +/- 17 months vs. 10 +/-
10 months; P < 0.05). In multivariate analysis, decreased length of the MI
was an independent predictor of successful MI block (OR 1.5; 95% CI
1.1-2.1; P < 0.05). Conclusions Increased length but not anatomical
location of the MI predicts failure to achieve bidirectional MI block
during ablation of persistent AF. Copyright &#xa9; 2015 Wiley Periodicals,
Inc.

<101>
Accession Number
612436941
Author
Leaver H.A.; Craig S.R.; Rotondo D.; Walker W.S.
Institution
(Leaver) Cell Biology R&D, SNBTS, Clinical Neurosciences Edinburgh
University, United Kingdom
(Craig) Department of Cardiothoracic Surgery, Golden Jubilee Hospital,
Glasgow, United Kingdom
(Rotondo) Strathclyde Institute of Pharmacy & Biomedical Sciences,
Strathclyde University, Glasgow, United Kingdom
(Walker) Division of Cardiothoracic Surgery, Royal Infirmary, Edinburgh,
United Kingdom
Title
Blood immunoglobulins, complement and TNF receptor following minimally
invasive surgery in patients undergoing pulmonary lobectomy.
Source
Current Metabolomics. 2 (3) (pp 196-203), 2014. Date of Publication: 01
Jan 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
The reasons for improved survival following minimally invasive surgery
remain elusive. Circulating mediators link surgical trauma, vascular and
tissue homeostasis. Acute phase reactants, leukocytes and leukocyte
Reactive Oxygen Species (ROS) are affected differentially by minimally
invasive video-assisted thoracic surgery (VATS). Also, immunoglobulins,
complement, TNF receptor and P-selectin changes have been observed, but
the influence of minimally invasive surgery on these opsonins is less well
defined. In this prospective randomised trial, 41 patients were randomly
assigned to minimally invasive or open thoracic surgery, and
immunoglobulins and vascular endothelial damage biomarkers were analysed.
Humoral mediators (blood IgG, IgM, IgA; complement fragments C3, C4, and
complement haemolytic index of activation CH50; TNF receptors I, II and
P-selectin) were analysed before and 2, 5 and 7 days after surgery.
Post-surgical changes in individual patients were determined. Substantial
immunoglobulin decreases followed minimally invasive and open surgery.
Decreased IgG, IgM and IgE were detected 2 days after surgery, and IgG and
IgM after 7 days. These changes were greater than haemodilution, reaching
greater significance in open surgery patients. Immunoglobulin decreases
followed lymphocyte decreases. In contrast, increased complement and
inflammatory endothelial cell signals (C3 and C4, soluble TNFR-II) were
detected 7 days after surgery. In both groups, increased C3 and TNFR-II
followed early acute phase reactants CRP, IL-6 and ROS. Acute phase
reactants and CD4/CD8 lymphocytes were factors most attenuated in patients
undergoing minimally invasive thoracic surgery (VATS). This study suggests
local trauma mediators are better biomarkers than circulating opsonins in
defining the response to minimally invasive surgery, and a systems
approach, comparing individual metabolic responses, is effective in small
patient groups. Copyright &#xa9; 2014 Bentham Science Publishers.

<102>
Accession Number
53017361
Author
Zhang Y.-J.; Zhu L.-L.; Bourantas C.V.; Iqbal J.; Dong S.-J.; Campos C.M.;
Li M.-H.; Ye F.; Tian N.-L.; Garcia-Garcia H.M.; Serruys P.W.; Chen S.-L.
Institution
(Zhang, Zhu, Li, Ye, Tian, Chen) Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Zhang, Bourantas, Iqbal, Campos, Garcia-Garcia, Serruys) Erasmus Medical
Center, Rotterdam, Netherlands
(Iqbal) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Dong) Soochow University, Suzhou, China
(Campos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
Title
The impact of everolimus versus other rapamycin derivative-eluting stents
on clinical outcomes in patients with coronary artery disease: A
meta-analysis of 16 randomized trials.
Source
Journal of Cardiology. 64 (3) (pp 185-193), 2014. Date of Publication:
2014.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Everolimus-eluting stent (EES) are considered to have better
clinical outcomes than other rapamycin derivative-eluting stents; however,
the individual trials may not have sufficient power to prove it. This
meta-analysis aimed to compare clinical outcomes of EES against other
rapamycin derivative-eluting stents. Methods: We searched Medline, the
Cochrane Library, and other internet sources, without language or date
restrictions for articles comparing clinical outcomes between EES and
other rapamycin derivative-eluting stents. Safety endpoints were stent
thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI).
Efficacy endpoints were major adverse cardiac events (MACE), target lesion
revascularization (TLR), and target vessel revascularization (TVR).
Results: We identified 16 randomized controlled trials with 23,481
patients and a weighted mean follow-up of 18 months. Compared with other
rapamycin derivative-eluting stents, EES were associated with a
significant reduction in definite ST [relative risk (RR): 0.45; 95%
confidence interval (CI): 0.30-0.69; p < 0.001] and TLR (RR: 0.87; 95% CI:
0.77-0.99; p = 0.03). EES also showed a non-significant trend toward
reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p = 0.06).
However, both groups had similar rates of mortality (RR: 0.95; 95% CI:
0.82-1.09; p = 0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p = 0.43), and MACE
(RR: 0.94; 95% CI: 0.87-1.02; p = 0.35). The stratified analysis of the
included trials showed that EES was associated with significantly lower
rate of definite ST compared with either zotarolimus-eluting stent (p =
0.012) or sirolimus-eluting stent (p = 0.006), but not biolimus-eluting
stent (p = 0.16). In longer follow-up (>1 year) stratification, EES was
associated with a significant reduction in risk of definite ST (p <
0.001). Conclusions: EES is associated with a significant reduction in
definite ST and TLR for treating patients with coronary artery disease,
compared with a pooled group of other rapamycin derivative-eluting stents.
Biolimus-eluting stent had similar safety and efficacy for treating
patients with coronary artery disease, compared with the EES. Copyright
&#xa9; 2014 Japanese College of Cardiology.

<103>
Accession Number
52853252
Author
Steg P.G.; Van'T Hof A.; Clemmensen P.; Lapostolle F.; Dudek D.; Hamon M.;
Cavallini C.; Gordini G.; Huber K.; Coste P.; Thicoipe M.; Nibbe L.;
Steinmetz J.; Ten Berg J.; Eggink G.J.; Zeymer U.; Campo Dell'Orto M.;
Kanic V.; Deliargyris E.N.; Day J.; Schuette D.; Hamm C.W.; Goldstein P.
Institution
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, Hopital Bichat, 46
rue H.Huchard, 75018 Paris, France
(Steg) INSERM U-698, Paris, France
(Steg) Departement Hospitalo-Universitaire FIRE, Hopital Bichat,
Assistance Publique - Hopitaux de Paris, Paris, France
(Van'T Hof) Deparment of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Clemmensen) Department of Cardiology, University of Copenhagen, Heart
Center, Copenhagen, Denmark
(Lapostolle) SAMU 93 - UF Recherche-Enseignement-Qualite, Paris, France
(Lapostolle) Hopital Avicenne, Bobigny, France
(Lapostolle) Universite Paris 13, Sorbonne Paris Cite, Paris, France
(Dudek) Jagiellonian University Medical College, Krakow, Poland
(Hamon) Universite de Caen, France, INSERM U 744, Institut Pasteur de
Lille, Caen, France
(Cavallini) Ospedale S. Maria della Misericordia, Azienda Ospedaliera,
Perugia, Italy
(Cavallini, Gordini) Rianimazione-118 Ospedale Maggiore, Azienda USL di
Bologna, Italy
(Huber) 3rd Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Coste) Cardiology Hospital, University of Bordeaux, Bordeaux, France
(Thicoipe) University Hospital of Bordeaux, SAMU, Bordeaux, France
(Nibbe) Department of Nephrology and Medical Intensive Care, Charite -
Campus Virchow, Universitatsmedizin, Berlin, Germany
(Steinmetz) Department of Anaesthesia 4231, HOC, Rigshospitalet,
Copenhagen, Denmark
(Ten Berg) St Antonius Hospital, Nieuwegein, Netherlands
(Eggink) RAV IJsselvecht, Zwolle (EMS Service Zwolle area), Netherlands
(Zeymer) Klinikum Ludwigshafen, Ludwigshafen, Germany
(Campo Dell'Orto, Hamm) Department of Cardiology, Kerckhoff Clinic and
Thoraxcenter, Benekestr., Bad Nauheim, Germany
(Kanic) Cardiology and Angiology Department, University Medical Centre
Maribor, Maribor, Slovenia
(Deliargyris) Medicines Company Ltd., Parsippany NJ, United States
(Day, Schuette) Medicines Company Ltd., Abingdon Oxfordshire, United
Kingdom
(Goldstein) Emergency Department, SAMU, Lille University Hospital, Lille,
France
Title
Design and methods of European Ambulance Acute Coronary Syndrome
Angiography Trial (EUROMAX): An international randomized open-label
ambulance trial of bivalirudin versus standard-of-care anticoagulation in
patients with acute ST-segment-elevation myocardial infarction transferred
for primary percutaneous coronary intervention.
Source
American Heart Journal. 166 (6) (pp 960-967.e6), 2013. Date of
Publication: December 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background In patients with ST-segment elevation myocardial infarction
(STEMI) triaged to primary percutaneous coronary intervention (PCI),
anticoagulation often is initiated in the ambulance during transfer to a
PCI site. In this prehospital setting, bivalirudin has not been compared
with standard-of-care anticoagulation. In addition, it has not been tested
in conjunction with the newer P2Y<inf>12</inf> inhibitors prasugrel or
ticagrelor. Design EUROMAX is a randomized, international, prospective,
open-label ambulance trial comparing bivalirudin with standard-of-care
anticoagulation with or without glycoprotein IIb/IIIa inhibitors in 2200
patients with STEMI and intended for primary percutaneous coronary
intervention (PCI), presenting either via ambulance or to centers where
PCI is not performed. Patients will receive either bivalirudin given as a
0.75 mg/kg bolus followed immediately by a 1.75-mg/kg per hour infusion
for >30 minutes prior to primary PCI and continued for >4 hours after the
end of the procedure at the reduced dose of 0.25 mg/kg per hour, or
heparins at guideline-recommended doses, with or without routine or
bailout glycoprotein IIb/IIIa inhibitor treatment according to local
practice. The primary end point is the composite incidence of death or
non-coronary-artery-bypass-graft related protocol major bleeding at 30
days by intention to treat. Conclusion The EUROMAX trial will test whether
bivalirudin started in the ambulance and continued for 4 hours after
primary PCI improves clinical outcomes compared with guideline-recommended
standard-of-care heparin-based regimens, and will also provide information
on the combination of bivalirudin with prasugrel or ticagrelor. &#xa9;
2013 Mosby, Inc.

<104>
Accession Number
612722028
Author
Mirmansoori A.; Farzi F.; Sedighinejad A.; Imantalab V.; Mohammadzadeh A.;
Roushan Z.A.; Tehran S.G.; Nemati M.; Dehghan A.
Institution
(Mirmansoori, Farzi, Sedighinejad, Imantalab, Mohammadzadeh, Tehran,
Nemati, Dehghan) Anesthesiology Research Center, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Roushan) Department of Statistics, Guilan University of Medical Sciences,
Rasht, Iran, Islamic Republic of
Title
The effect of desmopressin on the amount of bleeding in patients
undergoing coronary artery bypass graft surgery with a cardiopulmonary
bypass pump after taking anti-platelet medicine.
Source
Anesthesiology and Pain Medicine. 6 (5) (no pagination), 2016. Article
Number: e39226. Date of Publication: October 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Coronary artery bypass grafting (CABG) is a common surgical
intervention at the end-stages of coronary artery occlusion disease.
Despite the effectiveness of CABG, it may have particular complications,
such as bleeding during and after surgery. So far, there have been many
drugs used to reduce bleeding. Objectives: This study aimed at
investigating the effects of desmopressin on the amount of bleeding in
patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who
were taking anti-platelet medicine. Methods: One hundred patients
scheduled for elective CABG with a CPBP were included in a prospective,
placebo-controlled, double-blinded clinical trial study. They were
randomly divided into two groups. One group received desmopressin (40 mug)
and the other group received a placebo (isotonic saline). Seven patients
were excluded from the study, and 47 and 46 patients participated in the
desmopressin and control groups, respectively. The methods of monitoring
and the anesthetic techniques were similar in both groups, and all
surgeries were performed by one surgeon. Variables including age, gender,
pump time, aortic clamp time, duration of surgery, complications (e.g.,
nausea and vomiting, blood pressure changes), the necessity to receive
blood products, and coagulation tests (prothrombin time, partial
thromboplastin time, international normalized ratio, and bleeding time)
were assessed. Data were statistically analyzed with SPSS software version
17. Results: There wasnosignificant difference between the groups
regarding age, gender, pumptime, clamp time, duration of surgery,
complications, and the changes in hemoglobin and coagulation test
measurements (P > 0.05). No significant difference was noted between the
groups regarding the rate of bleeding after surgery (359.3 +/- 266.2 in
group D vs. 406.3 +/- 341.6 in group P (control group); P = 0.208).
However, the platelet changes after surgery in both groups were
significantly different. The analysis revealed that the rate of
thrombocytopenia after surgery was higher in the control group (P =
0.012). Conclusions: Our study showed that desmopressin could not reduce
the amount of blood loss after CABG. Also, desmopressin did not have a
significant effect on coagulation status. Therefore, based on the results
of our study, it seems that the use of this medication cannot be a helpful
for patients with any indication for CABG. Copyright &#xa9; 2016, Kowsar
Medical Publishing Company. All rights reserved.

<105>
Accession Number
612721942
Author
Kamalipour H.; Ahmadi S.; Kamali K.; Moaref A.; Shafa M.; Kamalipour P.
Institution
(Kamalipour, Ahmadi) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kamali) Medical Imaging Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Moaref) Department of Cardiology, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Kamalipour) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Title
Ultrasound for localization of central venous catheter: A good alternative
to chest X-ray?.
Source
Anesthesiology and Pain Medicine. 6 (5) (pp 1-7), 2016. Article Number:
e38834. Date of Publication: October 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Chest radiography after central venous catheter (CVC)
insertion is the mainmethod of verifying the catheter location. Despite
the widespread use of radiography for detecting catheter position, x-ray
may not always be readily available, especially in the operating room.
Objectives: We aimed to compare contrast-enhanced ultrasonography (CEUS)
and chest radiography for detecting the correct location of CVCs. Methods:
One hundred sixteen consecutive patients with indications for CVC before
cardiac surgery were enrolled in this observational study. After catheter
insertion, CEUS was performed. Portable radiography was obtained
postoperatively in the intensive care unit. Sensitivity, specificity, and
predictive values were determined by comparing the ultrasonography results
with radiographic findings as a reference standard. Results: Chest
radiography revealed 16 CVC misplacements: two cases of intravascular and
14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter
malpositionings in the RA, while it could not recognize seven catheter
placements correctly. CEUS showed two false RA misplacements and five
falsely correct CVC positions. A sensitivity of 98% and specificity of 69%
were achieved for CEUS in detecting CVC misplacements. Positive and
negative predictive values were 95% and 85%, respectively. The interrater
agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).
Conclusions: Despite close concordance between ultrasonography and chest
radiography, CEUS is not a suitable alternative for standard chest
radiography in detecting CVC location; however, considering its high
sensitivity and acceptable specificity in our study, its usefulness as a
triage method for detecting CVC location on a real-time basis in the
operating room cannot be ignored. Copyright &#xa9; 2016, Kowsar Medical
Publishing Company. All rights reserved.

<106>
Accession Number
612718254
Author
Fominskiy E.; Nepomniashchikh V.A.; Lomivorotov V.V.; Monaco F.; Vitiello
C.; Zangrillo A.; Landoni G.
Institution
(Fominskiy, Nepomniashchikh, Monaco, Vitiello, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Fominskiy, Lomivorotov) Department of Anesthesia and Intensive Care,
Academician EN Meshalkin Novosibirsk State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Zangrillo, Landoni) Vita-Salute San Raffaele University of Milan, Milan,
Italy
Title
Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1196-1204),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objectives To investigate the efficacy and safety of fibrinogen
concentrate (FC) in surgical patients. Design Meta-analysis of randomized
controlled studies (RCTs). Setting Perioperative. Participants Adult and
pediatric surgical patients. Interventions A search of PubMed/Medline,
Embase, Cochrane Central Register of Controlled Trials, Transfusion
Evidence Library, Google Scholar, and the proceedings from major
international anesthesiology meetings up to February 1, 2016 for RCTs that
compared FC with placebo or other comparators. Measurements and Main
Results The primary outcome was all-cause mortality. Pooled risk ratios
and mean differences (MDs) were computed with either fixed-effects or
random-effects models. The study included 14 RCTs comprising 1,035
patients; the majority of patients underwent cardiac surgery. All-cause
mortality was lower in the fibrinogen group (4/432 [0.9%] v 15/430 [3.5%];
risk ratio 0.26; 95% confidence interval [CI] 0.09-0.78; p = 0.02;
heterogeneity statistic (l2) = 0%). The use of FC was associated with
reduced bleeding (MD -127 mL; 95% CI -207 to -47; p = 0.002; I2= 54%) and
a lower number of red blood cells units transfused versus comparator (MD
-0.9; 95% CI -1.3 to -0.5; p<0.001; I2 = 42%). There were no differences
in the rates of thrombotic events and myocardial infarction. Conclusions
In surgical patients, FC was associated with reduced bleeding and a lower
number of red blood cell units transfused, and it also might reduce
mortality. However, none of the analyzed trials was powered for estimation
of survival and adverse events with FC use. Half of the included studies
were of high or moderate risk of bias. The evidence primarily came from
cardiac surgery settings. Copyright &#xa9; 2016 Elsevier Inc.

<107>
Accession Number
612718129
Author
Likhvantsev V.V.; Landoni G.; Levikov D.I.; Grebenchikov O.A.; Skripkin
Y.V.; Cherpakov R.A.
Institution
(Likhvantsev, Grebenchikov, Skripkin) Anesthesiology and Intensive Care
Department, Moscow Regional Research and Clinical Institute, Moscow,
Russian Federation
(Landoni) Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific
Institute, Vita-Salute San Raffaele University, Milan, Italy
(Levikov) Cardiology Intensive Care Unit, V.A. Negovsky Research Institute
of Reanimatology, Moscow, Russian Federation
(Cherpakov) Anesthesiology and Intensive Care Department, V.A. Negovsky
Research Institute of Reanimatology, Moscow, Russian Federation
Title
Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary
Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1221-1227),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objective Several studies have suggested that the cardioprotective effects
of halogenated anesthetics in cardiac surgery result in reduced cardiac
biomarker release compared with total intravenous anesthesia (TIVA). These
findings came from relatively small randomized clinical trials and
meta-analyses. The authors of this study hypothesized that the beneficial
effects of volatile anesthetics translate into a reduced length of
hospital stay after coronary artery bypass grafting surgery (CABG) with
cardiopulmonary bypass. Design A randomized controlled trial. Setting Two
university hospitals. Participants Adult patients undergoing elective CABG
surgery with cardiopulmonary bypass. Interventions Patients were assigned
randomly to 2 following groups: propofol-based TIVA group (n = 431) and
sevoflurane group (n = 437). Measurements and Main Results The primary
endpoint was hospital length of stay, and the secondary endpoint included
postoperative troponin T and N-terminal pro-brain natriuretic peptide
release and mortality. In the sevoflurane group, a reduced length of
hospital stay was observed compared with the propofol-based TIVA group (10
[9-11] days v 14 [10-16], p<0.001) as were reductions in cardiac troponin
T release (0.18 ng/mL v 0.57 ng/mL at 24 hours, p<0.001), in N-terminal
pro-brain natriuretic peptide release (633 pg/mL v 878 pg/mL at 24 hours,
p<0.001; 482 pg/mL v 1,036 pg/mL at 48 hours, p<0.001), and in mortality
at 1-year follow up (17.8% v 24.8%, p = 0.03). Conclusions Anesthesia with
sevoflurane reduced cardiac biomarker release and length of hospital stay
after CABG with cardiopulmonary bypass surgery compared with
propofol-based TIVA with a possible reduction in 1-year mortality.
Copyright &#xa9; 2016 Elsevier Inc.

<108>
Accession Number
612717893
Author
D'Errigo P.; Ranucci M.; Covello R.D.; Biancari F.; Rosato S.; Barbanti
M.; Onorati F.; Tamburino C.; Santoro G.; Grossi C.; Santini F.; Bontempi
K.; Fusco D.; Seccareccia F.
Institution
(D'Errigo, Rosato) National Centre for Epidemiology, Surveillance and
Health Promotion, Istituto Superiore di Sanita, Rome, Italy
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and
ICU-IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
(Covello) Department of Anesthesia and Intensive Care, Ospedale di Busto
Arsizio, Varese, Italy
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland
(Barbanti, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Onorati) Division of Cardiac Surgery, University of Verona Medical
School, Verona, Italy
(Santoro) Division of Cardiology, Careggi Hospital, Florence, Italy
(Grossi, Seccareccia) Division of Cardiac Surgery, ASO S. Croce e Carle,
Cuneo, Italy
(Santini) Division of Cardiac Surgery, IRCCS University Hospital San
Martino IST Genova, Genova, Italy
(Bontempi, Fusco) Department of Epidemiology, Lazio Regional Health
Service, Rome, Italy
Title
Outcome After General Anesthesia Versus Monitored Anesthesia Care in
Transfemoral Transcatheter Aortic Valve Replacement.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1238-1243),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objective To evaluate outcomes of monitored anesthesia care (MAC) compared
with general anesthesia (GA) in patients undergoing transfemoral
transcatheter aortic valve replacement (TAVR). Design Secondary analysis
from the observational and prospective OBSERVANT (OBservational Study of
Effectiveness of avR-taVi procedures for severe Aortic steNosis Treatment)
study. Setting Multicenter study, including Italian hospitals performing
TAVR interventions. Participants One thousand four hundred ninety-four
patients with severe and symptomatic aortic stenosis. Interventions
Transfemoral TAVR under general or local anesthesia. Measurements and Main
Results A propensity score procedure was applied, and 310 pairs were
matched with similar baseline characteristics (EuroSCORE II: local
anesthesia 6.6+/-5.9% v general anesthesia 7.0+/-7.7%, p = 0.430). MAC was
associated with similar 30-day mortality compared with GA (3.9% v 4.8%, p
= 0.564). TAVR was performed under MAC without any increased risk of other
adverse events. The risk of paravalvular regurgitation>mild was similar
between the study groups (MAC 49.5% v general anesthesia 57.0%, p =
0.858). Two patients receiving on MAC had severe paravalvular
regurgitation, whereas this complication was not observed after GA.
Permanent pacemaker implantation was 19.1% in the MAC group v 14.8% in the
GA group (p = 0.168). Mean intensive care unit stay was 3.5 days for the
GA group v 2.9 days for the MAC group (p = 0.086). A similar 3-year
survival rate was observed (MAC 69.4% v GA 69.9%, p = 0.966). Conclusions
Transfemoral TAVR can be performed under MAC with similar immediate and
late outcomes as compared with GA. A possible risk of severe paravalvular
regurgitation and pacemaker implantation with TAVR under MAC requires
further investigation. Copyright &#xa9; 2016 Elsevier Inc.

<109>
Accession Number
609610960
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Rasmussen L.A.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Rasmussen, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus,
Denmark, United States
Title
Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track
Possibilities in Cardiac Surgery-A Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1212-1220),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objective Progressive cost containment has resulted in a growing interest
for fast-track cardiac surgery. Ventilation time and length of stay (LOS)
in the intensive care unit (ICU) are important factors in patient
turnover, a more efficient use of resources, and early patient
mobilization. However, LOS in ICU is not an objective measure because, in
addition to medical factors, patient discharge may be guided by logistics
and policy, and thus more objective measures are warranted. The authors
hypothesized that remifentanil compared with sufentanil would reduce
ventilation time and LOS in the ICU and that remifentanil would have
beneficial effects on the overall quality of recovery. Design A
randomized, prospective study. Participants Sixty patients scheduled for
elective coronary artery bypass grafting with or without aortic valve
replacement. Setting A university hospital. Interventions Patients were
assigned randomly to receive either remifentanil or sufentanil combined
with propofol. Measurements and Main Results Patients with ejection
fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and
severe pulmonary or arterial hypertension were excluded. The primary
outcome variables were ventilation time and time to eligibility of
discharge from the cardiac recovery unit. Secondary outcomes were actual
LOS in the cardiac recovery unit and quality of recovery. The groups were
comparable in selected demographics and perioperative parameters. There
were no differences in ventilation time or eligible ICU discharge time
between the groups. Remifentanil patients received more morphine than did
the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No
difference was found in pharmacologic support or use of a pacemaker.
Conclusion In a fast-track protocol, remifentanil did not seem to be
superior to a standard moderate- to high-dose sufentanil regimen.
Copyright &#xa9; 2016 Elsevier Inc.

<110>
Accession Number
610187115
Author
Daudin M.; Tattevin P.; Lelong B.; Flecher E.; Lavoue S.; Piau C.; Ingels
A.; Chapron A.; Daubert J.-C.; Revest M.
Institution
(Daudin, Lelong, Flecher, Ingels, Daubert) Department of Cardio-Thoracic
and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
(Tattevin, Lavoue, Revest) Department of Infectious Disease and Intensive
Care Unit, Pontchaillou University Hospital, Rennes, France
(Tattevin, Revest) CIC Inserm 0203, Rennes-1 University, France
(Tattevin, Revest) Inserm U835, Rennes-1 University, France
(Piau) Department of Bacteriology, Pontchaillou University Hospital,
Rennes, France
(Chapron) Department of General Medicine, Pontchaillou University
Hospital, Rennes, France
Title
Characteristics and prognosis of pneumococcal endocarditis: a case-control
study.
Source
Clinical Microbiology and Infection. 22 (6) (pp 572.e5-572.e8), 2016. Date
of Publication: 01 Jun 2016.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Case series have suggested that pneumococcal endocarditis is a rare
disease, mostly reported in patients with co-morbidities but no underlying
valve disease, with a rapid progression to heart failure, and high
mortality. We performed a case-control study of 28 patients with
pneumococcal endocarditis (cases), and 56 patients with non-pneumococcal
endocarditis (controls), not matched for sex and age, during the years
1991-2013, in one referral centre. Alcoholism (39.3% versus 10.7%; p
<0.01), smoking (60.7% versus 21.4%; p <0.01), the absence of previously
known valve disease (82.1% versus 60.7%; p 0.047), heart failure (64.3%
versus 23.2%; p <0.01) and shock (53.6% versus 23.2%; p <0.01) were more
common in pneumococcal than in non-pneumococcal endocarditis. Cardiac
surgery was required in 64.3% of patients with pneumococcal endocarditis,
much earlier than in patients with non-pneumococcal endocarditis (mean
time from symptom onset, 14.1 +/- 18.2 versus 69.0 +/- 61.1 days).
In-hospital mortality rates were similar (7.1% versus 12.5%).
Streptococcus pneumoniae causes rapidly progressive endocarditis requiring
life-saving early cardiac surgery in most cases. Copyright &#xa9; 2016
European Society of Clinical Microbiology and Infectious Diseases

<111>
Accession Number
609716723
Author
Akgul A.; Guner B.; Cirak M.; Celik D.; Hergunsel O.; Bedirhan S.
Institution
(Akgul) Faculty of Health Science, Department of Gerontology, Faculty of
Health Sciences, Istanbul University, Istanbul 34740, Turkey
(Akgul) Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk
Training and Research Hospital, Istanbul, Turkey
(Guner, Hergunsel, Bedirhan) Department of Anesthesiology, Bakirkoy Dr.
Sadi Konuk Training and Research Hospital, Istanbul, Turkey
(Cirak) Department of Neurosurgery, Bakirkoy Dr. Sadi Konuk Training and
Research Hospital, Istanbul, Turkey
(Celik) Department of Physiotherapy and Rehabilitation, Faculty of Health
Sciences, Istanbul University, Istanbul, Turkey
Title
The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A
Preliminary Study.
Source
Thoracic and Cardiovascular Surgeon. 64 (7) (pp 581-588), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Single-session hypnosis has never been evaluated as a
premedication technique in patients undergoing coronary artery bypass
grafting (CABG). The aim of the present study was to evaluate the
beneficial effects of clinical hypnotherapy on perioperative anxiety, pain
perception, sedation, and necessity for ventilator assistance in patients
undergoing CABG. Methods Double-blind, randomized, clinical trial was
performed. Forty-four patients undergoing CABG surgery were randomized
into two groups. The patients in group A received preprocedural hypnosis
by an anesthesiologist. Patients in group B (control) had only information
on the surgical intervention by the same anesthesiologist.
State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI)
were performed preoperatively in both groups. Visual analog scale (VAS)
and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th,
8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety
level, analgesic drug consumption, and duration of ventilator assistance
and intensive care unit (ICU) stay were also documented. Results When
anxiety and depression levels were compared, significantly lower STA-I and
BDI values were detected in group A after hypnotherapy (p = 0.001, p =
0.001, respectively). Significantly less total doses of remifentanil (34.4
+/- 11.4 vs. 50.0 +/- 13.6 mg) and morphine (4.9 +/- 3.3 vs. 13.6 +/- 2.7
mg) were administered in group A in the postoperative period. Ventilator
assistance duration (6.8 +/- 2.0 vs. 8.9 +/- 2.7 hours) was also shorter
in group A when compared with that in group B (p = 0.007). Conclusion
Hypnosis session prior to surgery was an effective complementary method in
decreasing presurgical anxiety, and it resulted in better pain control as
well as reduced ventilator assistance following CABG surgery. Copyright
&#xa9; Georg Thieme Verlag KGStuttgart . New York.

<112>
[Use Link to view the full text]
Accession Number
607208915
Author
Peng Y.; Zhang W.; Zhou X.; Ji Y.; Kass I.S.; Han R.
Institution
(Peng, Zhang, Zhou, Ji, Han) Department of Anesthesiology, Beijing Tiantan
Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng
District, Beijing 100050, China
(Kass) Department of Anesthesiology, State University of New York,
Downstate Medical Center, Brooklyn, NY, United States
(Kass) Department of Physiology and Pharmacology, State University of New
York, Downstate Medical Center, Brooklyn, NY, United States
Title
Lidocaine did not reduce neuropsychological-cognitive decline in patients
6 months after supratentorial tumor surgery: A randomized, controlled
trial.
Source
Journal of Neurosurgical Anesthesiology. 28 (1) (pp 6-13), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
There is equivocal evidence examining cognitive improvement in response to
lidocaine during cardiac surgery; however, no study has examined its
effect on postoperative neuropsychological-cognitive decline after
supratentorial tumor surgery. Methods: Ninety-four patients scheduled for
supratentorial craniotomy were enrolled. Patients received either a dose
of lidocaine (2%) via an intravenous bolus (1.5 mg/kg) after induction
followed by an infusion at a rate of 2 mg/kg/h until the end of surgery
(Lidocaine group) or the same volume of normal saline. The
neuropsychological-cognitive decline was evaluated using the following
tests: the Mini-Mental State Examination, the
Information-Memory-Concentration test, the Hamilton Rating Scale for
Depression, and the Hamilton Rating Scale for Anxiety. The cerebral oxygen
extraction ratio and the difference in lactic acid levels between the bulb
of the jugular vein and a peripheral artery were measured. Results: Eighty
patients completed the neuropsychological tests, with 40 patients in each
group. The incidence of postoperative decline at up to 6 months in the
Lidocaine group was not significantly different than that in the Normal
saline group. When the 2 cognitive tests were examined independent of the
other tests, there was no difference between groups at 6 months. The
cerebral oxygen extraction ratio was significantly lower in the Lidocaine
group after surgery (P<0.05), and the arteriovenous difference of lactic
acid was lower in the Lidocaine group (P<0.05). Conclusions:
Intraoperative infusion of lidocaine does not significantly decrease the
incidence of postoperative neuropsychological-cognitive decline in
patients 6 months after supratentorial tumor surgery. Copyright &#xa9;
2015 Wolters Kluwer Health, Inc. All rights reserved.

<113>
Accession Number
607429832
Author
Larsen L.H.; Kofoed K.F.; Carstensen H.G.; Dalsgaard M.; Ersboll M.K.;
Kober L.; Hassager C.
Institution
(Larsen, Dalsgaard, Ersboll, Kober, Hassager) Department of Cardiology,
Rigshospitalet, University of Copenhagen, Denmark
(Kofoed) Departments of Radiology and Cardiology, Rigshospitalet,
University of Copenhagen, Denmark
(Carstensen) Department of Cardiology, Gentofte Hospital, University of
Copenhagen, Denmark
Title
Prognostic value of multi-detector computed tomography in asymptomatic
aortic valve stenosis.
Source
International Journal of Cardiology. 203 (pp 331-337), 2016. Date of
Publication: 15 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Multi-Detector Computed Tomography (MDCT) is a high-resolution
imaging technique with potential additive value in the evaluation of
patients with aortic valve stenosis (AS). We aimed to assess the
prognostic value of MDCT in asymptomatic patients with AS compared to
conventional transthoracic echocardiography (TTE). Methods 116 patients
with asymptomatic AS (Vmax > 2.5 m/s assessed by clinical screening TTE,
LVEF > 50%) were examined with TTE (Vivid e9) and MDCT (Aquilion 320) on
the same day. The treating physician was blinded for research protocol
defined imaging results. Outcome was defined as indication for aortic
valve replacement (AVR) determined by the treating physician or sudden
cardiac death. Results The mean age was 72 (8) years, 27% were women, mean
AVA by TTE was 1.01 (0.30) cm². Median follow up time was 27
(IQR 19-44) months. Forty seven patients (41%) developed indication for
AVR. No patients suffered a sudden cardiac death. AVA and aortic valve
calcification were significant univariable predictors of AVR when measured
by both TTE and MDCT, whereas left ventricular mass was only significant
measured by MDCT. Significant coronary artery disease by MDCT tended to
predict future indication for AVR, but this did not reach statistical
significance (HR: 1.79 (95% CI 0.96-3.44), p = 0.08). Conclusion MDCT
derived AVA can be of use as an alternative to TTE derived AVA in patients
with asymptomatic AS to predict future clinical indication for AVR.
Copyright &#xa9; 2015 Elsevier Ireland Ltd. All rights reserved.

<114>
Accession Number
609468728
Author
El-Saed A.; Al-Jardani A.; Althaqafi A.; Alansari H.; Alsalman J.; Al
Maskari Z.; El Gammal A.; Al Nasser W.; Al-Abri S.S.; Balkhy H.H.
Institution
(El-Saed, Balkhy) Infection Prevention and Control Department, King
Abdulaziz Medical City, Riyadh, Saudi Arabia
(El-Saed, Al-Jardani, Alsalman, Al-Abri, Balkhy) Gulf Cooperation Council
States and World Health Organization Collaborating Center for Infection
Prevention & Control, Saudi Arabia
(El-Saed) Community Medicine Department, Faculty of Medicine, Mansoura
University, Mansoura, Egypt
(Al-Jardani, Al Maskari, Al-Abri) Infection Prevention and Control, Royal
Hospital, Muscat, Oman
(Althaqafi, Balkhy) King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia
(Althaqafi) Infection Prevention and Control, King Abdulaziz Medical City,
Jeddah, Saudi Arabia
(Alansari, Alsalman) Infection Prevention and Control, Salmaniya Medical
Complex, Manama, Bahrain
(El Gammal) Infection Prevention and Control, King Abdulaziz Hospital, Al
hassa, Saudi Arabia
(Al Nasser) Infection Prevention and Control, Imam Abdulrahman bin Faisal
Hospital, Dammam, Saudi Arabia
Title
Ventilator-associated pneumonia rates in critical care units in 3 Arabian
Gulf countries: A 6-year surveillance study.
Source
American Journal of Infection Control. 44 (7) (pp 794-798), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Data estimating the rates of ventilator-associated pneumonia
(VAP) in critical patients in Gulf Cooperation Council (GCC) countries are
very limited. The aim of this study was to estimate VAP rates in GCC
hospitals and to compare rates with published reports of the U.S. National
Healthcare Safety Network (NHSN) and International Nosocomial Infection
Control Consortium (INICC). Methods VAP rates and ventilator utilization
between 2008 and 2013 were calculated from aggregate VAP surveillance data
using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi
Arabia, Oman, and Bahrain. The standardized infection ratios of VAP in GCC
hospitals were compared with published reports of the NHSN and INICC.
Results A total of 368 VAP events were diagnosed during a 6-year period
covering 76,749 ventilator days and 134,994 patient days. The overall VAP
rate was 4.8 per 1,000 ventilator days (95% confidence interval, 4.3-5.3),
with an overall ventilator utilization of 0.57. The VAP rates showed a
wide variability between different types of intensive care units (ICUs)
and were decreasing over time. After adjusting for the differences in ICU
type, the risk of VAP in GCC hospitals was 217% higher than NHSN hospitals
and 69% lower than INICC hospitals. Conclusions The risk of VAP in ICU
patients in GCC countries is higher than pooled U.S. VAP rates but lower
than pooled rates from developing countries participating in the INICC.
Copyright &#xa9; 2016 Association for Professionals in Infection Control
and Epidemiology, Inc.

<115>
Accession Number
612672036
Author
Dieleman J.M.; Van Dijk D.
Institution
(Dieleman, Van Dijk) Department of Anaesthesiology, Intensive Care and
Emergency Medicine, University Medical Center, Utrecht, Netherlands
Title
Corticosteroids for cardiac surgery: A summary of two large randomised
trials.
Source
Netherlands Journal of Critical Care. 24 (5) (pp 6-10), 2016. Date of
Publication: September 2016.
Publisher
Netherlands Society of Intensive Care (E-mail: post@nvic.nl)
Abstract
The postoperative systemic inflammatory response syndrome that is
associated with cardiac surgery and the use of cardiopulmonary bypass may
contribute to postoperative organ dysfunction and complications. Two
recent multicentre randomised clinical trials evaluated the prophylactic
use of high-dose corticosteroids to suppress the postoperative
inflammatory response in a total of 12,001 cardiac surgery patients. The
studies were negative on their primary endpoint, and showed a blend of
benefit and harm on secondary endpoints. For dexamethasone, its overall
pulmonary benefit was probably the most marked effect, which was
demonstrable at multiple levels. There also appeared to be an
age-dependent effect of corticosteroids with younger patients (<65 years)
with a lower risk of mortality and older patients (>80 years) with an
increased risk of mortality when receiving steroids. The differential
effects of corticosteroids on patient outcomes between the different age
groups may be based on a decreasing intensity of the systemic inflammatory
response with advancing age. Future studies should be designed to identify
those individual patients who are more susceptible to developing an
excessive inflammatory response, and who may receive benefit from
anti-inflammatory treatment. Copyright &#xa9; 2016, Netherlands Society of
Intensive Care. All rights reserved.

<116>
Accession Number
607381280
Author
Ghodraty M.R.; Hasani V.; Bagheri-Aghdam A.; Zamani M.M.; Pournajafian A.;
Rokhtabnak F.; Kholdebarin A.; Nader N.D.
Institution
(Ghodraty, Bagheri-Aghdam, Zamani, Pournajafian, Rokhtabnak, Kholdebarin)
Department of Anesthesiology, Firoozghar Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Hasani) Department of Anesthesiology, Rasoul Akram Medical Complex, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Nader) Department of Anesthesiology & Perioperative Care, VA Western NY
Healthcare System, SUNY-Buffalo, Buffalo, NY, United States
Title
Remifentanil infusion during emergence moderates hemodynamic and cough
responses to the tracheal tube: A randomized controlled trial.
Source
Journal of Clinical Anesthesia. 33 (pp 514-520), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To examine the severity of cough and straining at the time of
emergence from anesthesia. Design Double-blind randomized,
placebo-controlled study. Setting University-affiliated hospital. Patients
Sixty-two American Society of Anesthesiologists 2 patients undergoing
craniotomy and excision of supratentorial cerebral tumors. Intervention
Intravenous infusion of remifentanil (REM) at 0.05 mug/kg/min or normal
saline (NS) upon termination of the surgical procedure. Measurements Heart
rate (HR) and mean arterial pressure (MAP) along with the frequency and
severity of cough response (Modified Minogue Scale) to the endotracheal
tube were recorded at different time points. The frequency of cough and
straining was analyzed with chi² tests. HRs and MAP were
analyzed by repeated-measures analysis of variance between REM and NS
groups. Main Results There was no case of significant cough in the REM
group, and all of the patients in the NS group developed some extent of
cough varying from mild retching to severe coughing episodes (P <.001).
Both the HR and MAPs were consistently lower in the REM group compared to
the NS group. Conclusion Infusion of REM at the end of craniotomy
procedures results in significant reduction of the frequency and severity
of coughing and straining. Compared to placebo, REM moderates increases in
MAP upon emergence from general anesthesia until the time of extubation.
Copyright &#xa9; 2015

<117>
Accession Number
604902597
Author
Erlinge D.; Gotberg M.; Noc M.; Lang I.; Holzer M.; Clemmensen P.; Jensen
U.; Metzler B.; James S.; Botker H.E.; Omerovic E.; Koul S.; Engblom H.;
Carlsson M.; Arheden H.; Ostlund O.; Wallentin L.; Klos B.; Harnek J.;
Olivecrona G.K.
Institution
(Erlinge, Gotberg, Koul, Harnek) Department of Cardiology, Clinical
Sciences, Lund University, Lund S-221 85, Sweden
(Noc) Center for Intensive Internal Medicine, Ljubljana, Slovenia
(Lang, Holzer) Department of Cardiology, Medical University of Vienna,
Vienna, Austria
(Lang, Holzer) Department of Emergency Medicine, Medical University of
Vienna, Vienna, Austria
(Clemmensen, Olivecrona) Department of Cardiology, Nykoebing F Hospital,
Nykoebing F, Denmark
(Jensen) Cardiology Unit, Department of Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Metzler) Department of Cardiology, University Hospital for Internal
Medicine, Innsbruck, Austria
(James, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Botker) Department of Cardiology, Aarhus University Hospital Skejby,
Aarhus, Denmark
(Omerovic) Department of Cardiology, Sahlgrenska University, Gothenburg,
Sweden
(Engblom, Carlsson, Arheden) Department of Clinical Physiology, Lund
University, Lund, Sweden
(Ostlund) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(Klos) Philips Healthcare, San Diego, CA, United States
Title
Therapeutic Hypothermia for the Treatment of Acute Myocardial
Infarction-Combined Analysis of the RAPID MI-ICE and the CHILL-MI Trials.
Source
Therapeutic Hypothermia and Temperature Management. 5 (2) (pp 77-84),
2015. Date of Publication: 01 Jun 2015.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
In the randomized rapid intravascular cooling in myocardial infarction as
adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid
endovascular catheter core cooling combined with cold saline as an adjunct
to percutaneous coronary intervention for the treatment of acute
myocardial infarction CHILL-MI studies, hypothermia was rapidly induced in
conscious patients with ST-elevation myocardial infarction (STEMI) by a
combination of cold saline and endovascular cooling. Twenty patients in
RAPID MI-ICE and 120 in CHILL-MI with large STEMIs, scheduled for primary
percutaneous coronary intervention (PCI) within <6 hours after symptom
onset were randomized to hypothermia induced by rapid infusion of 600-2000
mL cold saline combined with endovascular cooling or standard of care.
Hypothermia was initiated before PCI and continued for 1-3 hours after
reperfusion aiming at a target temperature of 33degreeC. The primary
endpoint was myocardial infarct size (IS) as a percentage of myocardium at
risk (IS/MaR) assessed by cardiac magnetic resonance imaging at 4+/-2
days. Patients randomized to hypothermia treatment achieved a mean core
body temperature of 34.7degreeC before reperfusion. Although significance
was not achieved in CHILL-MI, in the pooled analysis IS/MaR was reduced in
the hypothermia group, relative reduction (RR) 15% (40.5, 28.0-57.6 vs.
46.6, 36.8-63.8, p=0.046, median, interquartile range [IQR]). IS/MaR was
predominantly reduced in early anterior STEMI (0-4h) in the hypothermia
group, RR=31% (40.5, 28.8-51.9 vs. 59.0, 45.0-67.8, p=0.01, median, IQR).
There was no mortality in either group. The incidence of heart failure was
reduced in the hypothermia group (2 vs. 11, p=0.009). Patients with large
MaR (>30% of the left ventricle) exhibited significantly reduced IS/MaR in
the hypothermia group (40.5, 27.0-57.6 vs. 55.1, 41.1-64.4, median, IQR;
hypothermia n=42 vs. control n=37, p=0.03), while patients with MaR<30%
did not show effect of hypothermia (35.8, 28.3-57.5 vs. 38.4, 27.4-59.7,
median, IQR; hypothermia n=15 vs. control n=19, p=0.50). The prespecified
pooled analysis of RAPID MI-ICE and CHILL-MI indicates a reduction of
myocardial IS and reduction in heart failure by 1-3 hours with
endovascular cooling in association with primary PCI of acute STEMI
predominantly in patients with large area of myocardium at risk.
(ClinicalTrials.gov id NCT00417638 and NCT01379261). &#xa9; Copyright
2015, Mary Ann Liebert, Inc.

<118>
[Use Link to view the full text]
Accession Number
605251920
Author
Hamon M.; Coste P.; Van'T Hof A.; Ten Berg J.; Clemmensen P.; Tabone X.;
Benamer H.; Kristensen S.D.; Cavallini C.; Marzocchi A.; Hamm C.; Kanic
V.; Bernstein D.; Anthopoulos P.; Deliargyris E.N.; Steg P.G.
Institution
(Hamon) Department of Clinical Research, University of Caen, Ave Cote de
Nacre, Caen, Normandie 14033, France
(Coste) Department of Cardiology, Centre Hospitalier Universitaire
Bordeaux, Universite de Bordeaux, Pessac, France
(Van'T Hof) Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Clemmensen) Department of Cardiology, University of Copenhagen,
Copenhagen, Denmark
(Tabone) Department of Cardiology, Hopital Jacques Coeur, Bourges, France
(Benamer) Department of Cardiology, Hopital de la Roseraie, Aubervilliers,
France
(Kristensen) Department of Cardiology, Aarhus University, Aarhus, Denmark
(Cavallini) Department of Cardiology, S.Maria della Misericordia
University Hospital, Perugia, Italy
(Marzocchi) Department of Cardiology, Cardiologia Azienda
Ospedaliero-Universitaria, Bologna, Italy
(Hamm) Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad
Nauheim, Germany
(Kanic) Department of Cardiology, Medical Centre Maribor, Maribor,
Slovenia
(Bernstein, Anthopoulos, Deliargyris) Medicines Company, Parsippany, NJ,
United States
(Steg) Universite Paris-Diderot, Departement Hospitalo, Universitaire
Fibrosis Inflammation Remodeling, Paris, France
(Steg) French Alliance for Cardiovascular Trials, Paris, France
(Steg) National Heart Lung Institute, Royal Brompton Hospital, Imperial
College, London, United Kingdom
Title
Impact of arterial access site on outcomes after primary percutaneous
coronary intervention: Prespecified subgroup analysis from the EUROMAX
trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002049. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX),
bivalirudin improved 30-day clinical outcomes with reduced major bleeding
compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We
assessed whether choice of access site (radial or femoral) had an impact
on 30-day outcomes and whether it interacted with the benefit of
bivalirudin. Methods and Results-In EUROMAX, choice of arterial access was
left to operator discretion. Overall, 47% of patients underwent radial and
53% femoral access. Baseline risk was higher in the femoral access group.
Unadjusted proportions for the primary outcome (death or noncoronary
artery bypass graft protocol major bleeding at 30 days) were lower with
radial access, however, without differences in major or major plus minor
bleeding proportions. After multivariable adjustment, ischemic outcomes
were no longer different between access site groups, except for a lower
risk of stroke in radial patients. Bivalirudin was associated with lower
proportions of the primary outcome in both the radial (odds ratio, 0.58;
95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95%
CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly
lower in the bivalirudin group both in the radial-and femoral-treated
patients but no significant difference was observed in ischemic outcomes.
In multivariable analysis, bivalirudin emerged as the only independent
predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74;
P=0.002). Conclusions-In this prespecified analysis from EUROMAX, radial
access was preferred in lower risk patients and did not improve clinical
outcomes. Bivalirudin was associated with less bleeding irrespective of
access site. Copyright &#xa9; 2015 American Heart Association, Inc.

<119>
Accession Number
601749219
Author
Wynne D.G.; Rampat R.; Trivedi U.; De Belder A.; Hill A.; Hutchinson N.;
Hildick-Smith D.
Institution
(Wynne, Rampat, Trivedi, De Belder, Hill, Hutchinson, Hildick-Smith)
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern
Road Brighton, East Sussex BN2 5BE, United Kingdom
Title
Transradial secondary arterial access for transcatheter aortic valve
implantation: Experience and limitations.
Source
Heart Lung and Circulation. 24 (7) (pp 682-685), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Elsevier Ltd
Abstract
Objectives: The transradial approach limits vascular complications in
coronary interventions. The same may be true for transcatheter aortic
valve implantation (TAVI). We present our experience using secondary
transradial arterial access. Methods: Secondary transradial arterial
access has been our default strategy for TAVI since 2007. Procedural data
is collected prospectively. We assessed procedural success and
complications. Results: Data from 282 patients aged 81. +/-. 5.2yrs was
examined. Secondary arterial access was transradial (74%), femoral (24%)
and none (2%). Secondary femoral access was reserved for failed radial
access (3%), anatomical anomalies (4%), operator preference (7%), trial
requirements (6%) or proctor preference (4%). The principal pathology was
aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination
(2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were
delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian
(3.9%) or transapical approaches (1.8%). Significant vascular
complications occurred in 25 cases (9.4%), including surgical repair of a
failed percutaneous closure device (n=16), ilio-femoral dissection (n=3),
iliac perforations (n=3), plaque disruption (n=1) and false aneurysm
(n=2), one of which was from the secondary femoral access site. There was
no local vascular complication from the secondary radial site.
Conclusions: The transradial secondary access route for TAVI is safe and
effective. The transradial route may limit vascular access complications
from secondary transfemoral access. Copyright &#xa9; 2015.

<120>
Accession Number
53171101
Author
Sakamoto A.; Hamasaki T.; Kitakaze M.
Institution
(Sakamoto) Department of Anesthesiology and Pain Medicine, Graduate School
of Medicine, Nippon Medical School, Tokyo 113-8603, Japan
(Hamasaki) Department of Biomedical Statistics, Osaka University Graduate
School of Medicine, Suita 565-0871, Japan
(Kitakaze) Department of Cardiovascular Medicine, Research and Development
Initiative Center, National Cerebral and Cardiovascular Center, Suita,
Osaka 565-8565, Japan
Title
Perioperative Landiolol Administration reduces Atrial Fibrillation after
Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
Advances in Therapy. 31 (4) (pp 440-450), 2014. Date of Publication: 01
Apr 2014.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is one of the most
common complications after cardiac surgery. Patients who develop POAF have
a prolonged stay in the intensive care unit and hospital and an increased
risk of postoperative stroke. Many guidelines for the management of
cardiac surgery patients, therefore, recommend perioperative
administration of beta-blockers to prevent and treat POAF. Landiolol is an
ultra-short acting beta-blocker, and some randomized controlled trials of
landiolol administration for the prevention of POAF have been conducted in
Japan. This meta-analysis evaluated the effectiveness of landiolol
administration for the prevention of POAF after cardiac surgery. Methods:
The Medline/PubMed and BioMed Central databases were searched for
randomized controlled trials comparing cardiac surgery patients who
received perioperative landiolol with a control group (saline
administration, no drug administration, or other treatment). Two
independent reviewers selected the studies for inclusion. Data regarding
POAF and safety outcomes were extracted. Odds ratios (ORs) with 95%
confidence intervals (CIs) were calculated using the Mantel-Haenszel
method (fixed effects model). Results: Six trials with a total of 560
patients were included in the meta-analysis. Landiolol administration
significantly reduced the incidence of POAF after cardiac surgery (OR
0.26, 95% CI 0.17-0.40). The effectiveness of landiolol administration was
similar in three groups: all patients who underwent coronary artery bypass
grafting (CABG) (OR 0.27, 95% CI 0.17-0.43), patients who underwent CABG
compared with a control group who received saline or nothing (OR 0.28, 95%
CI 0.17-0.45), and all patients who underwent cardiac surgery compared
with a control group who received saline or nothing (OR 0.27, 95% CI
0.17-0.42). Only two adverse events associated with landiolol
administration were observed (2/302, 0.7%): hypotension in one patient and
asthma in one patient. Conclusion: Landiolol administration reduces the
incidence of POAF after cardiac surgery and is well tolerated. Copyright
&#xa9; 2014, The Author(s).

<121>
Accession Number
612844694
Author
Fanari Z.; Weiss S.A.; Zhang W.; Sonnad S.S.; Weintraub W.S.
Institution
(Fanari) Division of Cardiology, Christiana Care Health System, Newark,
DE, USA zfanari@christianacare.org
(Weiss) Division of Cardiology, Christiana Care Health System, Newark, DE,
USA
(Zhang) Value Institute, Christiana Care Health System, Newark, DE, USA
(Sonnad) Value Institute, Christiana Care Health System, Newark, DE, USA
(Weintraub) Division of Cardiology, Christiana Care Health System, Newark,
DE, USA Value Institute, Christiana Care Health System, Newark, DE, USA
Title
Meta-analysis of three randomized controlled trials comparing coronary
artery bypass grafting with percutaneous coronary intervention using
drug-eluting stenting in patients with diabetes.
Source
Interactive cardiovascular and thoracic surgery. 19 (6) (pp 1002-1007),
2014. Date of Publication: 01 Dec 2014.
Abstract
OBJECTIVES: Coronary artery bypass grafting (CABG) was found to be the
preferred strategy of revascularization in patients with diabetes in the
bare-metal stent (BMS) era. The introduction of drug-eluting stents (DESs)
led to a significant reduction in the rates of repeat revascularization
(RRV) when compared with BMSs. We did a collaborative analysis of data
from randomized controlled trials in the contemporary era to compare CABG
versus percutaneous coronary intervention using DESs in diabetic patients.
METHODS: We performed a systematic review and meta-analysis from
randomized trials in the contemporary era comparing PCI with DESs with
CABG in diabetic patients with multivessel disease. A comprehensive
literature search (1 January 2003 to 18 May 2013) identified randomized
controlled trials that reported long-term outcomes comparing PCI using
DESs with CABG in 2974 diabetic patients.
RESULTS: At 1 year, PCI was associated with a significant increase in the
incidence of RRV [2.48 (1.56-3.94); P <0.0001], lower incidence of stroke
[relative risk (RR) = 0.43 (0.19-0.81); P = 0.017], and no difference in
death or myocardial infarction (MI). At 5 years, PCI was still associated
with a lower incidence of stroke, but was associated with a significant
increase in the incidence of death [RR = 1.36 (1.11-1.66); P = 0.0033] and
MI [RR = 2.01 (1.54-2.62); P <0.0001].
CONCLUSIONS: In patients with diabetes, PCI was associated with no
difference in death and MI at 1 year. However, at 5 years, PCI was
associated with a higher incidence of death and MI. PCI was associated
with a higher incidence of RRV but a lower incidence of stroke. Copyright
&#xa9; The Author 2014. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<122>
Accession Number
612844654
Author
Mansur Ad.eP.; Hueb W.A.; Takada J.Y.; Avakian S.D.; Soares P.R.; Garzilo
C.L.; Kalil Filho R.; Ramires J.A.
Institution
(Mansur) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil apmansur@usp.br
(Hueb) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Takada) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Avakian) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Soares) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Garzilo) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Kalil Filho) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Ramires) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
Title
Long-term follow-up of a randomized, controlled clinical trial of three
therapeutic strategies for multivessel stable coronary artery disease in
women.
Source
Interactive cardiovascular and thoracic surgery. 19 (6) (pp 997-1001),
2014. Date of Publication: 01 Dec 2014.
Abstract
OBJECTIVES: Coronary artery disease is the leading cause of death in
women. The proposed treatments for women are similar to those for men.
However, in women with multivessel stable coronary artery disease and
normal left ventricular function, the best treatment is unknown.
METHODS: A post hoc analysis of the MASS II study with 10 years of
follow-up, mean (standard deviation) 6.8 (3.7) years, enrolled between May
1995 and May 2000, evaluated 188 women with chronic stable multivessel
coronary artery disease who underwent medical treatment, percutaneous
coronary intervention or coronary artery bypass graft surgery. Primary
end-points were incidence of total mortality, Q-wave myocardial
infarction, or refractory angina. Data were analysed according to the
intention-to-treat principle.
RESULTS: Women treated with percutaneous coronary intervention and medical
treatment had more primary events than those treated with coronary artery
bypass graft surgery, respectively, of 34, 44 and 22% (P = 0.003).
Survival rates at 10 years were 72% for coronary artery bypass graft
surgery, 72% for percutaneous coronary intervention and 56% for medical
treatment (P = 0.156). For the composite end-point, Cox regression
analysis adjusted for age, diabetes, hypertension, treatment allocation,
prior myocardial infarction, smoking, number of vessels affected and total
cholesterol, had a higher incidence of primary events with medical
treatment than with coronary artery bypass graft surgery [hazard ratio
(HR) = 2.38 (95% confidence interval (CI): 1.40-4.05); P = 0.001], a lower
incidence with percutaneous coronary intervention than with medical
treatment [HR = 0.60 (95% CI: 0.38-0.95); P = 0.031] but no differences
between coronary artery bypass graft surgery and percutaneous coronary
intervention. Regarding death, a protective effect was observed with
percutaneous coronary intervention compared with medical treatment [HR =
0.44 (95% CI: 0.21-0.90); P = 0.025].
CONCLUSIONS: Percutaneous coronary intervention and coronary artery bypass
graft surgery compared with medical treatment had better results after 10
years of follow-up. Copyright &#xa9; The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<123>
Accession Number
612844581
Author
Li J.; Wang J.; Li T.
Institution
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China
(Wang) Cardiovascular Center of Hainan Medical College, Affiliated
Hospital of Hainan Medical College, Haikou, China
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China litf79997@aliyun.com
Title
Interposed abdominal compression-cardiopulmonary resuscitation after
cardiac surgery.
Source
Interactive cardiovascular and thoracic surgery. 19 (6) (pp 985-989),
2014. Date of Publication: 01 Dec 2014.
Abstract
OBJECTIVES: The management of cardiac arrest after cardiac surgery differs
from the management of cardiac arrest under other circumstances. In other
studies, interposed abdominal compression-cardiopulmonary resuscitation
(IAC-CPR) resulted in a better outcome compared with conventional CPR. The
aim of the present study was to determine the feasibility, safety and
efficacy of IAC-CPR compared with conventional CPR in patients with
cardiac arrest after cardiac surgery.
METHODS: Data on all cardiac surgical patients who suffered a sudden
cardiac arrest during the first 24 h after surgery were collected
prospectively. Cardiac arrest was defined as the cessation of cardiac
mechanical activity with the absence of a palpable central pulse, apnoea
and unresponsiveness, including ventricular fibrillation, asystole and
pulseless electrical activity. Forty patients were randomized to either
conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially
performed by compressing the abdomen midway between the xiphoid and the
umbilicus during the relaxation phase of chest compression. If spontaneous
circulation was not restored after 10-15 min, the surgical team would
immediately proceed to resternotomy. The endpoints of the study were
safety, return of spontaneous circulation (ROSC) >5 min, survival to
hospital discharge and survival for 6 months.
RESULTS: With IAC-CPR, there were more patients in terms of ROSC, survival
to hospital discharge, survival for 6 months and fewer CPR-related
injuries compared with patients who underwent conventional CPR.
CONCLUSIONS: IAC-CPR is feasible and safe and may be advantageous in cases
of cardiac arrest after cardiac surgery. Copyright &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<124>
Accession Number
612844448
Author
Lehtinen M.; Patila T.; Vento A.; Kankuri E.; Suojaranta-Ylinen R.; Poyhia
R.; Harjula A.
Title
Prospective, randomized, double-blinded trial of bone marrow cell
transplantation combined with coronary surgery - perioperative safety
study.
Source
Interactive cardiovascular and thoracic surgery. 19 (6) (pp 990-996),
2014. Date of Publication: 01 Dec 2014.
Abstract
OBJECTIVES: We present here a sub-study of our prospective, randomized,
double-blinded trial of bone marrow mononuclear cell (BMMC)
transplantation with coronary artery bypass surgery (CABG)
(ClinicalTrials.gov Identifier: NCT00418418), evaluating our secondary
end-point concerning hospital stay as well as perioperative morbidity.
Injecting a substantial amount of biologically active cells into a
diseased myocardium inspires concerns for safety, a concern overlooked in
previous trials.
METHODS: We evaluated the immediate perioperative effects of
intramyocardial injection of autologous BMMCs combined with CABG. In a
randomized double-blinded manner, 39 patients received injections either
of BMMCs (n = 20) or of vehicle medium (n = 19). The patients'
haemodynamics, arterial blood gases, systemic vein oxygen level, blood
glucose, acid-base balance, lactate, haemoglobin, body temperature and
diuresis, as well as medications needed, were recorded in the operating
theatre and in the intensive care unit (ICU) every 4 h throughout the
first postoperative 24 h.
RESULTS: No dissimilarities in these parameters were detectable. In the
ICU, the median need for adrenaline was 0.0086 micro&#32;g/kg/min (first
quartile 0.0000, third quartile 0.0204) for controls and 0.0090
micro&#32;g/kg/min (0.0000, 0.0353) for BMMC patients (P = 0.757); for
noradrenaline, 0.0586 micro&#32;g/kg/min (0.0180, 0.0888) for controls and
0.0279 micro&#32;g/kg/min (0.0145, 0.0780) for BMMC patients (P = 0.405).
The median stay at the ICU was 2 days for both groups (1, 2 for controls;
1, 3 for BMMCs; P = 0.967). Within the first postoperative day, one
control patient had an elevated level of creatine kinase-myocardial band
fraction mass (CK-MBm) up to >100 micro&#32;g/l; no BMMC patient showed
elevated CK-MBm levels (P = 0.474).
CONCLUSIONS: Both intramyocardial BMMC and placebo injections appear safe
during surgery and immediate ICU stay after treatment of heart failure.
Copyright &#xa9; The Author 2014. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<125>
Accession Number
612768704
Author
Ceviker K.; Canikoglu M.; Tatlioglu S.; Bagdatli Y.
Institution
(Ceviker) Assistant Proffesor, Isparta Suleyman Demirel University,
Faculty of Medicine, Department of Cardiovascular Surgery, Isparta
(Canikoglu) Kocaeli Derince Training and Research Hospital, Department of
Cardiovascular Surgery, Kocael
(Tatlioglu) Infection Control Nurse, Istanbul University, Institute of
Cardiology, Infection Control Committee, Istanbul
(Bagdatli) Proffesor, Istanbul University, Cerrahpasa Faculty of Medicine,
Department of Microbiology, Istanbul
Title
Reducing the pathogen burden and promoting healing with polyhexanide in
non-healing wounds: a prospective study.
Source
Journal of wound care. 24 (12) (pp 582-586), 2015. Date of Publication: 01
Dec 2015.
Abstract
OBJECTIVE: Polyhexamethylene biguanide (PHMB) is a novel wound antiseptic
solution that has a broad antimicrobial spectrum and wound healing
promoting effect, with minimal side effects. The aim of present study was
to demonstrate the efficacy of the PHMB on the bacterial burden of
non-healing wounds, the reduction in wound size or closure of the wound in
comparison to Ringer's lactate solution (RLS) after 21 days of wound
dressing. A second objective was to investigate the differences in the
C-reactive protein (CRP) levels and white blood cell (WBC) counts between
the two groups.
METHOD: In this prospective and open-cohort clinical study, patients who
underwent cardiac surgery between July 2006 and August 2008 were included
and placed in one of two groups, PHMB or RLS, by the block randomisation
method. A wound care team, consisting of two surgeons, a wound care nurse
and a microbiologist, was created. Classic moist dressings and wet
compresses during dressing changes were applied at least once a day or as
needed. During the 21 days of hospitalisation the team collected data on
the wound healing status daily, on infection parameters every third day,
and wound tissue for culture weekly.
RESULTS: There were 40 patients recruited of which 9 were excluded,
leaving 31 in the intention-to-treat analysis. Of these 15 received PHMB
and 16 received RLS. Overall 17 of 31 (66.7% PHMB group, 43.8% RLS group,
p=0.181) patients were treated successfully by closure of surgically
sutured wounds or healing by secondary intention, the wound tissue
cultures of 19 of 31 patients (47.4% PHMB, 52.6% RLS, p=0.886) were
negative, and wound size of all the patients were significantly reduced in
clinical observations. Although the CRP levels were reduced significantly
within group comparisons in both groups (p<0.001), it was significantly
lower after 12 days (p<0.05) in the PHMB group compared with the RLS
group.
CONCLUSION: The results of this study emphasise that the successful
treatment of chronic non-healing wounds require a multidisciplinary team
approach under the control of a wound care specialist. Whatever the
disinfectant used, consistency in the approach to treatment may be more
important. We suggest that increasing the use of PHMB and adoption of this
team approach in other cardiac centres or other populations may decrease
the healing period, especially in chronic non-healing wounds.

<126>
Accession Number
612704050
Author
Chieffo A.; Petronio A.S.; Mehilli J.; Chandrasekhar J.; Sartori S.;
Lefevre T.; Presbitero P.; Capranzano P.; Tchetche D.; Iadanza A.;
Sardella G.; Van Mieghem N.M.; Meliga E.; Dumonteil N.; Fraccaro C.;
Trabattoni D.; Mikhail G.W.; Sharma S.; Ferrer M.C.; Naber C.; Kievit P.;
Faggioni M.; Snyder C.; Morice M.C.; Mehran R.
Institution
(Chieffo) Department of Cardiology, San Raffaele Scientific Institute,
Milan, Italy
(Petronio, Faggioni) Department of Cardiology, AOUP Cisanello, University
Hospital, Pisa, Italy
(Mehilli) Department of Cardiology, Ludwig-Maximilians-University of
Munich, Munich, Germany
(Chandrasekhar, Sartori, Faggioni, Snyder, Mehran) The Zena and Michael A.
Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai,
New York, New York, United States
(Lefevre, Morice) Department of Cardiology, Institut Hospitalier Jacques
Cartier, Ramsay Generale de Sante, Massy, France
(Presbitero) Department of Cardiology, Istituto Clinico Humanitas; Milan,
Italy
(Capranzano) Department of Cardiology, University of Catania, Catania,
Italy
(Tchetche) Department of Cardiology, Clinique Pasteur, Toulouse, France
(Iadanza) Department of Cardiology, Azienda Ospedaliera Universitaria
Senese, Policlinico Le Scotte, Siena, Italy
(Sardella) Department of Cardiology, Policlinico "Umberto I", "Sapienza"
University of Rome, Rome, Italy
(Van Mieghem) Department of Cardiology, Erasmus Medical Center,
Thoraxcenter, Rotterdam, Netherlands
(Meliga) Department of Cardiology, Mauriziano Hospital, Turin, Italy
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Fraccaro) Department of Cardiology, University of Padova, Padova, Italy
(Trabattoni) Department of Cardiology, Centro Cardiologico Monzino, Milan,
Italy
(Mikhail) Department of Cardiology, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
(Sharma) Department of Cardiology, Mount Sinai Hospital, New York, New
York, United States
(Ferrer) Department of Cardiology, Hospital Universitario Miguel Servet,
Zaragoza, Spain
(Naber) Department of Cardiology, Contilia Heart and Vascular Centre,
Elisabeth Krankenhaus, Essen, Germany
(Kievit) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
Title
Acute and 30-Day Outcomes in Women After TAVR: Results From the WIN-TAVI
(Women's INternational Transcatheter Aortic Valve Implantation) Real-World
Registry.
Source
JACC: Cardiovascular Interventions. 9 (15) (pp 1589-1600), 2016. Date of
Publication: 08 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to examine the safety and performance of
transcatheter aortic valve replacement (TAVR) using an all-female registry
and to further explore the potential impact of female sex-specific
characteristics on clinical outcomes after TAVR. Background Although women
comprise 50% of patients with symptomatic severe aortic stenosis
undergoing TAVR, the optimal treatment strategy remains undetermined.
Methods The WIN-TAVI (Women's INternational Transcatheter Aortic Valve
Implantation) registry is a multinational, prospective, observational
registry of women undergoing TAVR for aortic stenosis, conducted without
any external funding. The primary endpoint was the Valve Academic Research
Consortium (VARC)-2 early safety endpoint at 30 days (composite of
mortality, stroke, major vascular complication, life-threatening bleeding,
stage 2 or 3 acute kidney injury, coronary artery obstruction, or repeat
procedure for valve-related dysfunction). Results Between January 2013 and
December 2015, 1,019 women were enrolled across 19 European and North
American centers. The mean patient age was 82.5 +/- 6.3 years, mean
EuroSCORE I was 17.8 +/- 11.7% and mean Society of Thoracic Surgeons score
was 8.3 +/- 7.4%. TAVR was performed via transfemoral access in 90.6% and
new-generation devices were used in 42.1%. In more than two-thirds of
cases, an Edwards SAPIEN 23 mm (Edwards Lifesciences, Irvine, California)
or Medtronic CoreValve <26 mm (Medtronic Inc., Minneapolis, Minnesota)
device was implanted. The 30-day VARC-2 composite endpoint occurred in
14.0% with 3.4% all-cause mortality, 1.3% stroke, 7.7% major vascular
complications, and 4.4% VARC life-threatening bleeding. The independent
predictors of the primary endpoint were age (odds ratio [OR]: 1.04; 95%
confidence interval [CI]: 1.00 to 1.08), prior stroke (OR: 2.02; 95% CI:
1.07 to 3.80), left ventricular ejection fraction <30% (OR: 2.62; 95% CI:
1.07 to 6.40), new device generation (OR: 0.59; 95% CI: 0.38 to 0.91), and
history of pregnancy (OR: 0.57; 95% CI: 0.37 to 0.85). Conclusions Women
enrolled in this first ever all-female TAVR registry with collection of
female sex-specific baseline parameters, were at intermediate-high risk
and experienced a 30-day VARC-2 composite safety endpoint of 14.0% with a
low incidence of early mortality and stroke. Randomized assessment of TAVR
versus surgical aortic valve replacement in intermediate risk women is
warranted to determine the optimal strategy. Copyright &#xa9; 2016
American College of Cardiology Foundation

<127>
[Use Link to view the full text]
Accession Number
612853486
Author
Zhang Y.; Zhang X.; Chi D.; Wang S.; Wei H.; Yu H.; Li Q.; Liu B.
Institution
(Zhang, Zhang, Chi, Wang, Yu, Li, Liu) Department of Anesthesiology, West
China Hospital of Sichuan University, No. 37, Wai Nan Guo Xue Xiang,
Chengdu, Sichuan 610041, China
(Wei) Department of Anesthesiology, First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
Title
Remote ischemic preconditioning for prevention of acute kidney injury in
patients undergoing on-pump cardiac surgery a systematic review and
meta-analysis.
Source
Medicine (United States). 95 (37) (no pagination), 2016. Article Number:
e3465. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury
(AKI). However, results of studies evaluating the effect of RIPC on AKI
after cardiac surgery have been controversial and contradictory. The aim
of this meta-analysis is to examine the association between RIPC and AKI
after on-pump cardiac surgery. The authors searched relevant studies in
PubMed, EMBASE, and the Cochrane Library through December 2015. We
considered for inclusion all randomized controlled trials that the role of
RIPC in reducing AKI and renal replacement therapy (RRT) among patients
underwent on-pump cardiac surgical procedures. We collected the data on
AKI, initiation of RRT, serum creatinine (sCr) levels, and in-hospital
mortality. Random-and fixed-effect models were used for pooling data.
Nineteen trials including 5100 patients were included. The results of this
meta-analysis showed a significant benefit of RIPC for reducing the
incidence of AKI after cardiac interventions (odds ratio [OR]= 0.84; 95%
confidence interval [CI], 0.73-0.98; P = 0.02). No significant difference
was found in the incidence of RRT between RIPC and control (OR, 0.76, 95%
CI, 0.46-1.24; P= 0.36). In addition, compared with standard medical care,
RIPC showed no significant difference in postoperative sCr (IV 0.07; 95%
CI,-0.03 to 0.16; P = 0.20; postoperative day 1; IV 0.00; 95% CI,-0.08 to
0.09; P= 0.92; postoperative day 2; IV 0.04; 95% CI,-0.05 to 0.12; P=
0.39; postoperative day 3), and inhospital mortality (OR, 1.21, 95% CI,
0.64-2.30; P = 0.56). According to the results from present meta-analysis,
RIPC was associated with a significant reduction AKI after on-pump cardiac
surgery but incidence of RRT, postoperative sCr, and in-hospital
mortality. Further high-quality randomized controlled trials and
experimental researches comparing RIPC are desirable. Copyright &#xa9;
2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights
reserved.

<128>
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.

<129>
Accession Number
612846321
Author
Cruz J.E.; Thomas Z.; Lee D.; Moskowitz D.M.; Nemeth J.
Institution
(Cruz) Ernest Mario School of Pharmacy at Rutgers, The State University of
New Jersey, Piscataway, NJ, United States
(Cruz) Clinical Coordinator of Internal Medicine at Englewood Hospital and
Medical Center (EHMC), Englewood, NJ, United States
(Thomas) Global Health Science at The Medicines Company, Parsippany, NJ,
United States
(Lee) EHMC, United States
(Moskowitz) Pharmacy and Therapeutics at EHMC, United States
(Nemeth) EHMC, United States
Title
Therapeutic interchange of clevidipine for sodium nitroprusside in cardiac
surgery.
Source
P and T. 41 (10) (pp 635-639), 2016. Date of Publication: October 2016.
Publisher
Medi Media USA Inc (780 Township Line Road, Yardley PA 19067, United
States)
Abstract
Background: Generic price inflation has resulted in rising acquisition
costs for sodium nitroprusside (SNP), an agent historically described as
the drug of choice for the treatment of perioperative hypertension in
cardiac surgery. Purpose: To describe the implementation and cost
avoidance achieved by utilizing clevidipine as an alternative to SNP in
cardiac surgery patients at a 520-bed community teaching hospital that
performs more than 300 cardiac surgeries each year. Methods: A
multidisciplinary team inclusive of anesthesiologists, intensivists,
pharmacists, and surgeons collaborated to develop a therapeutic
interchange for SNP in cardiac surgery patients. Consistent with current
guidelines for therapeutic interchange, the goal was to encourage a less
expensive alternative that was demonstrated to be at least therapeutically
equivalent to SNP based on data derived from clinical trials published in
peer-reviewed literature. A comprehensive literature review identified
clevidipine as an alternative to SNP for perioperative hypertension in
cardiac surgery. Nicardipine was considered as well, but was not chosen as
a substitute due to lack of strong evidence and comparative data with SNP.
Results: Clevidipine was implemented successfully in our cardiac surgery
patients and will result in a net cost avoidance of approximately $300,000
in 2016. This is thought to be driven largely by the difference in
acquisition cost between clevidipine and SNP. The operating room in our
institution no longer keeps SNP stocked in anesthesia trays as a result of
the success of our interchange. No requests have been made to return to
the SNP standard. Conclusion: Through effective communication and
multidisciplinary collaboration, our institution was able to develop an
evidence-based and effective therapeutic interchange program for SNP.
Copyright &#xa9; 2016, Medi Media USA Inc. All rights reserved.

<130>
Accession Number
612825480
Author
Sajgalik P.; Grupper A.; Edwards B.S.; Kushwaha S.S.; Stulak J.M.; Joyce
D.L.; Joyce L.D.; Daly R.C.; Kara T.; Schirger J.A.
Institution
(Sajgalik, Grupper, Edwards, Kushwaha, Kara, Schirger) Division of
Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
(Stulak, Joyce, Joyce, Daly) Division of Cardiovascular Surgery, Mayo
Clinic, Rochester, MN, United States
(Sajgalik, Kara) Department of Internal Medicine, Cardioangiology,
International Clinical Research Center, St. Anne's University Hospital,
Brno, Czech Republic
Title
Current Status of Left Ventricular Assist Device Therapy.
Source
Mayo Clinic Proceedings. 91 (7) (pp 927-940), 2016. Date of Publication:
01 Jul 2016.
Publisher
Elsevier Ltd
Abstract
Congestive heart failure (HF) remains a serious burden in the Western
World. Despite advances in pharmacotherapy and resynchronization, many
patients have progression to end-stage HF. These patients may be
candidates for heart transplant or left ventricular assist device (LVAD)
therapy. Heart transplants are limited by organ shortages and in some
cases by patient comorbidities; therefore, LVAD therapy is emerging as a
strategy of bridge to transplant or as a destination therapy in patients
ineligible for transplant. Patients initially ineligible for a transplant
may, in certain cases, become eligible for transplant after physiologic
improvement with LVAD therapy, and a small number of patients with an LVAD
may have sufficient recovery of myocardial function to allow device
explantation. This clinically oriented review will describe (1) the most
frequently used pump types and aspects of the continuous-flow physiology
and (2) the clinical indications for and the shift toward the use of LVADs
in less sick patients with HF. Additionally, we review complications of
LVAD therapy and project future directions in this field. We referred to
the Interagency Registry for Mechanically Assisted Circulatory Support,
landmark trials, and results from recently published studies as major
sources in obtaining recent outcomes, and we searched for related
published literature via PubMed. This review focuses primarily on clinical
practice for primary care physicians and non-HF cardiologists in the
United States. Copyright &#xa9; 2016 Mayo Foundation for Medical Education
and Research

<131>
Accession Number
612825441
Author
Attizzani G.F.; Ohno Y.; Latib A.; Petronio A.S.; Giannini C.; Ettori F.;
Fiorina C.; Bedogni F.; Brambilla N.; Bruschi G.; Colombo P.; Presbitero
P.; Fiorilli R.; Poli A.; Barbanti M.; Colombo A.; Tamburino C.
Institution
(Attizzani, Ohno, Barbanti) Department of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Tamburino) Department of Cardiology, University of Catania, Catania,
Italy
(Latib, Colombo) Department of Cardiology, Scientific Institute S.
Raffaele, Milan, Italy
(Petronio) Department of Cardiology, Azienda Ospedaliera Pisana, Pisa,
Italy
(Giannini) Department of Cardiology, Ospedali Civili, Brescia, Italy
(Ettori, Fiorina) Department of Cardiology, Policlinico San Donato, San
Donato, Italy
(Bedogni, Brambilla) Department of Cardiology, Niguarda Ca'Granda
Hospital, Milan, Italy
(Bruschi, Colombo) Department of Cardiology, Clinical Institute Humanitas,
Milan, Italy
(Presbitero) Department of Cardiology, Azienda Ospedaliera San Camillo
Forlanini Hospital, Rome, Italy
(Fiorilli, Poli) Department of Cardiology, Ospedale Civile, Legnano, Italy
Title
Age-Related Differences in 1- and 12-Month Outcomes in Patients Undergoing
Transcatheter Aortic Valve Implantation (from a Large Multicenter Data
Repository).
Source
American Journal of Cardiology. 118 (7) (pp 1024-1030), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Scarce data are available on the impact of age on transcatheter aortic
valve implantation (TAVI) outcomes. We therefore, analyzed 1,845
consecutive patients from 9 Italian centers who underwent TAVI with the
Corevalve Revalving System from September 2007 to March 2014; patients
were dichotomized according to their age in the date of the procedure, as
follows: 75 to 85 years old and >85 years old. End points were defined
according to Valve Academic Research Consortium definitions. In-hospital,
30-day, and 1-year clinical and echocardiographic data were available for
100% of the patients included. Propensity matching was performed.
Procedural success rates were high (>94%) and comparable between groups.
Although worse baseline renal function was observed in the older group,
the incidence of acute kidney injury after procedure was comparable (17.1%
and 17.4%, respectively for the 75- to 85- and >85-year-old group, p =
0.877); importantly, >99% of acute kidney injury episodes in both groups
were grades 1 and 2. Procedural complications rates were low without
between-group differences. In-hospital death (3.7% and 4.6%, p = 0.379)
and stroke/transient ischemic attack (1.9% and 1.9%, respectively, p =
0.960) were comparable. The 1-year death rates were 14.9% and 17.2% (p =
0.197) in the 75- to 85- and >85-year-old group, respectively.
Cardiovascular death was observed in 7.8% and 7% (p = 0.542), while
stroke/transient ischemic attack was demonstrated in 5.2% and 4.4% (p =
0.496), respectively. Results were sustained after propensity matching. In
conclusion, advanced age did not negatively impact the outcomes of TAVI
through 1-year after procedure. Copyright &#xa9; 2016 Elsevier Inc.

<132>
Accession Number
612825379
Author
Muralidharan A.; Thiagarajan K.; Van Ham R.; Gleason T.G.; Mulukutla S.;
Schindler J.T.; Jeevanantham V.; Thirumala P.D.
Institution
(Muralidharan) College of Literature, Science, and the Arts, University of
Michigan, Ann Arbor, Michigan, United States
(Thiagarajan, Thirumala) Department of Neurological Surgery, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, United States
(Van Ham, Thirumala) Department of Neurological Surgery, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Mulukutla, Schindler) Heart and Vascular Institute, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, Oklahoma, United
States
Title
Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 118 (7) (pp 1031-1045), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe
method with decreasing incidence of perioperative stroke. There is a void
in literature concerning the impact of stroke after TAVI in predicting
30-day stroke-related mortality. The primary aim of this meta-analysis was
to determine whether perioperative stroke increases risk of stroke-related
mortality after TAVI. Online databases, using relevant keywords, and
additional related records were searched to retrieve articles involving
TAVI and stroke after TAVI. Data were extracted from the finalized studies
and analyzed to generate a summary odds ratio (OR) of stroke-related
mortality after TAVI. The stroke rate and stroke-related mortality rate in
the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of
2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of
29,043). Summary OR of stroke-related mortality after TAVI was estimated
to be 6.45 (95% confidence interval 3.90 to 10.66, p <0.0001). Subgroup
analyses were performed among age, approach, and valve type. Only 1
subgroup, transapical TAVI, was not significantly associated with
stroke-related mortality (OR 1.97, 95% confidence interval, 0.43 to 7.43,
p = 0.42). A metaregression was conducted among females, New York Heart
Association class III/IV status, previous stroke, valve type, and
implantation route. All failed to exhibit any significant associations
with the OR. In conclusion, perioperative strokes after TAVI are
associated with >6 times greater risk of 30-day stroke-related mortality.
Transapical TAVI is not associated with increased stroke-related mortality
in patients who suffer from perioperative stroke. Preventative measures
need to be taken to alleviate the elevated rates of stroke after TAVI and
subsequent direct mortality. Copyright &#xa9; 2016 Elsevier Inc.

<133>
Accession Number
612824889
Author
Jelacic S.; Bollag L.; Bowdle A.; Rivat C.; Cain K.C.; Richebe P.
Institution
(Jelacic, Bollag, Bowdle, Rivat, Richebe) Department of Anesthesiology and
Pain Medicine, United States
(Cain) Biostatistics, University of Washington School of Public Health,
Seattle, WA, United States
Title
Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery
Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A
Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 997-1004),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objectives The authors hypothesized that intravenous acetaminophen as an
adjunct analgesic would significantly decrease 24-hour postoperative
opioid consumption. Design Double-blind, randomized, placebo-controlled
trial. Setting A single academic medical center. Participants The study
was comprised of 68 adult patients undergoing cardiac surgery.
Interventions Patients were assigned randomly to receive either 1,000 mg
of intravenous acetaminophen or placebo immediately after anesthesia
induction, at the end of surgery, and then every 6 hours for the first 24
hours in the intensive care unit, for a total of 6-1,000 mg doses.
Measurements and Main Results The primary outcome was 24-hour
postoperative opioid consumption. The secondary outcomes included 48-hour
postoperative opioid consumption, incisional pain scores, opioid-related
adverse effects, length of mechanical ventilation, length of intensive
care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48
hours postoperatively. The mean+/-standard deviation postoperative 24-hour
opioid consumption expressed in morphine equivalents was significantly
less in the acetaminophen group (45.6+/-29.5 mg) than in the placebo group
(62.3+/-29.5 mg), representing a 27% reduction in opioid consumption (95%
CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and
opioid-related adverse effects between the 2 groups. A significantly
greater number of patients in the acetaminophen group responded "very
much" and "extremely well" when asked how their overall pain experience
met their expectation (p = 0.038). Conclusions The administration of
intravenous acetaminophen during cardiac surgery and for the first 24
hours postoperatively reduced opioid consumption and improved patient
satisfaction with their overall pain experience but did not reduce opioid
side effects. Copyright &#xa9; 2016 Elsevier Inc.

<134>
[Use Link to view the full text]
Accession Number
612824667
Author
Zhu G.; Huang Y.; Wei D.; Shi Y.
Institution
(Zhu, Huang, Wei, Shi) Department of Respiratory and Critical Care
Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Title
Efficacy and safety of noninvasive ventilation in patients after
cardiothoracic surgery A PRISMA-compliant systematic review and
meta-analysis.
Source
Medicine (United States). 95 (38) (no pagination), 2016. Article Number:
e4734. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Noninvasive ventilation (NIV) is a promising therapeutic
strategy after cardiothoracic surgery. This study aimed to meta-analyze
the efficacy and safety of NIV as compared to conventional management
after cardiothoracic surgery. Methods: PubMed, EMBASE, and Cochrane
Library databases were searched for randomized controlled trials (RCTs)
comparing NIV with conventional management after cardiothoracic surgery.
Relative risk (RR), standard mean difference (SMD), and 95% confidence
intervals (CIs) were used to measure the efficacy and safety of NIV using
random-effects model. Heterogeneity was evaluated using the Q statistic.
Results: This study included 14 RCTs (1740 patients) for the evaluation of
efficacy and safety of NIV as compared to conventional management after
cardiothoracic surgery. Overall, NIV had minimal effect on the risk of
mortality (RR: 0.64; 95% CI: 0.36-1.14; P= 0.127), endotracheal intubation
(RR: 0.52; 95% CI: 0.24-1.11; P=0.090), respiratory (RR: 0.70; 95% CI:
0.47-1.30; P=0.340), cardiovascular (RR: 0.81; 95% CI: 0.54-1.22;
P=0.306), renal (RR: 0.70; 95% CI: 0.26-1.92; P=0.491), and other
complications (RR: 0.72; 95% CI: 0.38-1.36; P=0.305), respiratory rate
(SMD:-0.10; 95% CI:-1.21-1.01; P=0.862), heart rate (SMD:-0.27; 95%
CI:-0.76-0.22; P=0.288), PaO2/FiO2 ratio (SMD: 0.34; 95% CI:-0.17-0.85;
P=0.194), PaCO2 (SMD: 0.83; 95% CI:-0.12-1.77; P=0.087), systolic pressure
(SMD:-0.04; 95% CI:-0.25-0.17; P=0.700), pH (SMD:-0.01; 95% CI:-0.44-0.43;
P=0.974), length of ICU stay (SMD:-0.19; 95% CI:-0.47-0.08; P=0.171), and
hospital stay (SMD:-0.31; 95% CI:-1.00-0.38; P=0.373). Sensitivity
analysis showed that NIV was associated with higher levels of
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (SMD: 0.52; 95% CI: 0.00-1.05;
P=0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI:
0.22-0.66; P=0.001). Conclusion: As compared to conventional management,
the use of NIV after cardiothoracic surgery improved patient's oxygenation
and decreased the need for endotracheal intubation, without significant
complications. Copyright &#xa9; 2016 the Author(s). Published by Wolters
Kluwer Health, Inc. All rights reserved.

<135>
Accession Number
612630765
Author
Spitzer E.; Van Mieghem N.M.; Pibarot P.; Hahn R.T.; Kodali S.; Maurer
M.S.; Nazif T.M.; Rodes-Cabau J.; Paradis J.-M.; Kappetein A.-P.;
Ben-Yehuda O.; van Es G.-A.; Kallel F.; Anderson W.N.; Tijssen J.; Leon
M.B.
Institution
(Spitzer, Van Mieghem, Kappetein) Erasmus Medical Center, Rotterdam,
Netherlands
(Spitzer) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(Pibarot, Rodes-Cabau, Paradis) Quebec Heart & Lung Institute, Laval
University, Quebec City, Quebec, Canada
(Hahn, Kodali, Maurer, Nazif, Leon) Columbia University Medical Center,
NY, United States
(Hahn, Kodali, Nazif, Ben-Yehuda, Leon) Cardiovascular Research
Foundation, NY, United States
(van Es, Tijssen) European Cardiovascular Research Institute, Rotterdam,
Netherlands
(Kallel) Edwards Lifesciences, Irvine, CA, United States
(Anderson) Independent Consultant, Lake Forest, CA, United States
Title
Rationale and design of the Transcatheter Aortic Valve Replacement to
UNload the Left ventricle in patients with ADvanced heart failure (TAVR
UNLOAD) trial.
Source
American Heart Journal. 182 (pp 80-88), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Coexistence of moderate aortic stenosis (AS) in patients with
heart failure (HF) with reduced ejection fraction is not uncommon.
Moderate AS increases afterload, whereas pharmacologic reduction of
afterload is a pillar of contemporary HF management. Hypothesis Unloading
the left ventricle by reducing the transaortic gradient with transfemoral
transcatheter aortic valve replacement (TAVR) may improve clinical
outcomes in patients with moderate AS and HF with reduced ejection
fraction. Study design The TAVR UNLOAD (NCT02661451) is an international,
multicenter, randomized, open-label, clinical trial comparing the efficacy
and safety of TAVR with the Edwards SAPIEN 3 Transcatheter Heart Valve in
addition to optimal heart failure therapy (OHFT) vs OHFT alone in patients
with moderate AS (defined by a mean transaortic gradient >20 mm Hg and <40
mm Hg, and an aortic valve area >1.0 cm² and <1.5
cm² at rest or after dobutamine stress echocardiography) and
reduced ejection fraction. A total of 600 patients will be randomized in a
1:1 fashion. Clinical follow-up is scheduled at 1, 6, and 12 months, and 2
years after randomization. The primary end point is the hierarchical
occurrence of all-cause death, disabling stroke, hospitalizations related
to HF, symptomatic aortic valve disease or nondisabling stroke, and the
change in the Kansas City Cardiomyopathy Questionnaire at 1 year.
Secondary end points capture effects on clinical outcome, biomarkers,
echocardiographic parameters, and quality of life. Summary The TAVR UNLOAD
trial aims to test the hypothesis that TAVR on top of OHFT improves
clinical outcomes in patients with moderate AS and HF with reduced
ejection fraction. Copyright &#xa9; 2016 Elsevier, Inc.

<136>
Accession Number
612669984
Author
Gaspari R.; Weekes A.; Adhikari S.; Noble V.E.; Nomura J.T.; Theodoro D.;
Woo M.; Atkinson P.; Blehar D.; Brown S.M.; Caffery T.; Douglass E.;
Fraser J.; Haines C.; Lam S.; Lanspa M.; Lewis M.; Liebmann O.; Limkakeng
A.; Lopez F.; Platz E.; Mendoza M.; Minnigan H.; Moore C.; Novik J.; Rang
L.; Scruggs W.; Raio C.
Institution
(Gaspari, Blehar, Mendoza) University of Massachusetts Medical School,
Worcester, MA, United States
(Weekes, Lewis) Carolinas Medical Center, Charlotte, NC, United States
(Adhikari) University of Arizona, Tucson, AZ, United States
(Noble, Douglass) Massachusetts General Hospital, Boston, MA, United
States
(Nomura) Christiana Care Health System, Newark, DE, United States
(Theodoro) Washington University School of Medicine, St. Louis, MO, United
States
(Woo) University of Ottawa, Ottawa, ON, Canada
(Atkinson, Fraser) Dalhousie University, Saint John, NB, Canada
(Brown, Lanspa) Intermountain Medical Center and University of Utah, Salt
Lake City, UT, United States
(Caffery) LSU Health Sciences Center, Baton Rouge, LA, United States
(Haines, Raio) North Shore University Hospital, Manhasset, NY, United
States
(Lam) Advocate Christ Medical Center, Chicago, IL, United States
(Liebmann) Brown University, Providence, RI, United States
(Limkakeng, Lopez) Duke University School of Medicine, Durham, NC, United
States
(Platz) Brigham and Women's Hospital, Boston, MA, United States
(Minnigan) Indiana University, Indianapolis, IN, United States
(Moore) Yale University School of Medicine, New Haven, CT, United States
(Novik) NYU Bellevue Hospital, New York, NY, United States
(Rang) Kingston General Hospital, Kingston, ON, Canada
(Scruggs) Castle Hospital, Kailua, HI, United States
Title
Emergency department point-of-care ultrasound in out-of-hospital and in-ED
cardiac arrest.
Source
Resuscitation. 109 (pp 33-39), 2016. Date of Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Point-of-care ultrasound has been suggested to improve outcomes
from advanced cardiac life support (ACLS), but no large studies have
explored how it should be incorporated into ACLS. Our aim was to determine
whether cardiac activity on ultrasound during ACLS is associated with
improved survival. Methods We conducted a non-randomized, prospective,
protocol-driven observational study at 20 hospitals across United States
and Canada. Patients presenting with out-of-hospital arrest or in-ED
arrest with pulseless electrical activity or asystole were included. An
ultrasound was performed at the beginning and end of ACLS. The primary
outcome was survival to hospital admission. Secondary outcomes included
survival to hospital discharge and return of spontaneous circulation.
Findings 793 patients were enrolled, 208 (26.2%) survived the initial
resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%)
survived to hospital discharge. Cardiac activity on US was the variable
most associated with survival at all time points. On multivariate
regression modeling, cardiac activity was associated with increased
survival to hospital admission (OR 3.6, 2.2-5.9) and hospital discharge
(OR 5.7, 1.5-21.9). No cardiac activity on US was associated with
non-survival, but 0.6% (95% CI 0.3-2.3) survived to discharge. Ultrasound
identified findings that responded to non-ACLS interventions. Patients
with pericardial effusion and pericardiocentesis demonstrated higher
survival rates (15.4%) compared to all others (1.3%). Conclusion Cardiac
activity on ultrasound was the variable most associated with survival
following cardiac arrest. Ultrasound during cardiac arrest identifies
interventions outside of the standard ACLS algorithm. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<137>
Accession Number
612689956
Author
Farsad B.F.; Janipour M.; Totonchi Z.; Gorjipour F.; Oroji Omid S.
Institution
(Farsad, Totonchi, Gorjipour, Oroji Omid) Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Janipour) Department of Clinical Pharmacy, Pharmaceutical Sciences
Branch, Islamic Azad University, Tehran, Iran, Islamic Republic of
Title
Effects of Dexmedetomidine on surgical stress responses at patients under
CABG.
Source
Biosciences Biotechnology Research Asia. 13 (3) (pp 1537-1545), 2016. Date
of Publication: September 2016.
Publisher
Oriental Scientific Publishing Company
Abstract
Cardiopulmonary bypass (CPB) surgery with extracorporeal circulation
produce changes in the immune system and plasma levels of inflammatory
cytokines. we hypothesize that Dexmedetomidine as an adjuvant , modulates
the inflammatory response after CABG. In a prospective, randomized, blind
study, 31 patients were assigned to Dexmedetomidine (Dex) group and
compared with control group of 30 patients. Dex was administered at a
loading dose of 0.5 mug/kg for 10 min , followed by a continuous infusion
of 0.5 mug/kg per hour until the completion of CABG with CPB . The
endpoints used to assess inflammatory responses to mini - CPB were plasma
tumor necrosis factor (TNF) - a , interleukin (IL - 6 ) and interleukin (
IL - 10) levels. The inflammatory markers (IL - 6 , IL - 10 , TNF - a )
were determined after Dex administration , before CPB and 24 hours after
admission to ICU. Biochemical factors including glucose , creatinine ,
lactate , BUN, AST , ALT , LDH were determined before CPB, immediately
after entering the ICU , 24 hr , 48 hr and 72 hr post admission to ICU.
Hemodynamic variables were also determined. Dex group was associated with
a significant reduction in urea and creatinine. There were no significant
differences in glucose, lactate, liver enzymes, LDH , IL - 6, IL - 10 and
hemodynamic variables. In contrast, the surgery - induced increase in TNF
- a levels in the Dex group was significantly higher compared with the
control group.

<138>
Accession Number
612650365
Author
Ranucci M.; Baryshnikova E.; Crapelli G.B.; Rahe-Meyer N.; Menicanti L.;
Frigiola A.; Castelvecchio S.; Pistuddi V.; Trimarchi S.; Carlucci C.;
Varrica A.; Satriano A.; Rovere M.T.L.
Institution
(Ranucci, Baryshnikova, Crapelli) Department of Cardiothoracic, Vascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
(Menicanti, Frigiola) Department of Cardiac Surgery, IRCCS Policlinico San
Donato, Milan, Italy
(Rahe-Meyer) Clinic for Anesthesiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(Ranucci, Baryshnikova, Menicanti, Frigiola, Castelvecchio, Pistuddi,
Trimarchi, Carlucci, Varrica, Satriano) San Donato Milanese, Milan, Italy
(Rovere) Montescano, Pavia, Italy
Title
Randomized, double-blinded, placebo-controlled trial Of fibrinogen
concentrate supplementation after complex cardiac surgery.
Source
Journal of the American Heart Association. 4 (6) (no pagination), 2015.
Article Number: e002066. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Postoperative bleeding after heart operations is still a common
finding, leading to allogeneic blood products transfusion. Fibrinogen and
coagulation factors deficiency are possible determinants of bleeding. The
experimental hypothesis of this study is that a first-line fibrinogen
supplementation avoids the need for fresh frozen plasma (FFP) and reduces
the need for any kind of transfusions. Methods and Results--This was a
single-center, prospective, randomized, placebo-controlled, double-blinded
study. One-hundred sixteen patients undergoing heart surgery with an
expected cardiopulmonary bypass duration >90 minutes were admitted to the
study. Patients in the treatment arm received fibrinogen concentrate after
protamine administration; patients in the control arm received saline
solution. In case of ongoing bleeding, patients in the treatment arm could
receive prothrombin complex concentrates (PCCs) and those in the control
arm saline solution. The primary endpoint was avoidance of any allogeneic
blood product. Patients in the treatment arm had a significantly lower
rate of any allogeneic blood products transfusion (odds ratio, 0.40; 95%
confidence interval, 0.19 to 0.84, P=0.015). The total amount of packed
red cells and FFP units transfused was significantly lower in the
treatment arm. Postoperative bleeding was significantly (P=0.042) less in
the treatment arm (median, 300 mL; interquartile range, 200 to 400 mL)
than in the control arm (median, 355 mL; interquartile range, 250 to 600
mL). Conclusions--Fibrinogen concentrate limits postoperative bleeding
after complex heart surgery, leading to a significant reduction in
allogeneic blood products transfusions. No safety issues were raised.
Copyright &#xa9; 2015 The Authors.

<139>
Accession Number
612775364
Author
Guo C.; Mei J.; Liu C.; Deng S.; Pu Q.; Lin F.; Liu L.
Institution
(Guo, Mei, Liu, Deng, Pu, Lin, Liu) Department of Thoracic Surgery, West
China Hospital, Sichuan University, Chengdu 610041, China
(Guo, Mei, Liu, Deng, Pu, Lin, Liu) Western China Collab Innovation Center
for Early Diagnosis, Multidisciplinary Therapy of Lung Cancer, Sichuan
University, Chengdu 610041, China
Title
Video-assisted thoracic surgery compared with posterolateral thoracotomy
for mediastinal bronchogenic cysts in adult patients.
Source
Journal of Thoracic Disease. 8 (9) (pp 2504-2511), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Mediastinal bronchogenic cyst (MBC) is the most common primary
cystic lesion of the mediastinum. This study aimed to investigate the
efficacy and safety of video-assisted thoracic surgery (VATS) compared
with posterolateral thoracotomy (PLT) for the treatment of MBCs in a large
series. Methods: Patients with MBCs who underwent surgical resection
between August 2005 and December 2015 were identified from the electronic
database of the Department of Thoracic Surgery, West China Hospital. The
patient demographic characteristics, intraoperative findings,
postoperative outcomes and follow-up information were reviewed and
analyzed. Results: A total of 99 patients underwent cystectomy were
enrolled for the present study. Of those patients, 65 underwent VATS
cystectomy (VATS group) and 34 underwent PLT cystectomy (PLT group) during
the same period. The VATS group had shorter operative time than the PLT
group (108.77+/-47.81 vs. 144.62+/-55.16, P=0.001), less intraoperative
blood loss (median 20 vs. 100 mL, P<0.001), and less pleural drainage of
the first three days after surgery (median 240 vs. 400 mL, P=0.002). In
addition, the length of postoperative hospital stay and duration of chest
drainage for the VATS group was also shorter than those of the PLT group
(4.94+/-2.01 vs. 8.64+/-5.52 days, P=0.001; 2.52+/-1.29 vs. 3.71+/-1.55
days, P < 0.001, respectively). No statistical significance was revealed
among the two groups with regard to the maximum diameter of the cysts,
pleural atresia, incomplete resection, surgery-related complications,
duration of intensive care unit stay, and postoperative complications.
Conclusions: Both VATS and PLT are reliable approaches for the surgical
resection of MBCs. The VATS approach is superior to PLT with shorter
operative time, shorter duration of chest drainage, shorter postoperative
hospital stay, less intraoperative blood loss, and less pleural drainage
of the first three days after surgery. We conclude that VATS should be the
preferred approach for the treatment of MBCs. Copyright &#xa9; Journal of
Thoracic Disease.

<140>
Accession Number
612775291
Author
Anonymous
Title
Erratum: Transcatheter valve-in-valve implantation versus reoperative
conventional aortic valve replacement: A systematic review [J Thorac Dis,
8, (2016), (E83-E93)] doi: 10.3978/j.issn.2072-1439.2016.01.44.
Source
Journal of Thoracic Disease. 8 (9) (pp E1111), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
In the article that appeared on Page E83-E93, Vol 8, No 1 (January 2016)
Issue of the Journal of Thoracic Disease (1), there is an error of Kevin
Phan's degree as "BS, MD". The degree should have been shown as
"BSc(Adv)". The publisher regrets the error. Copyright &#xa9; Journal of
Thoracic Disease.

<141>
Accession Number
612653837
Author
Anonymous
Title
Erratum: A retrospective multicenter study on long-term prevalence of
chronic pain after cardiac surgery (European Journal of Cancer Prevention
(2015) 16 (768-774)).
Source
Journal of Cardiovascular Medicine. 16 (12) (no pagination), 2015. Date of
Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The order of authors' first names and surnames was unfortunately reversed
and appeared incorrectly in this article1 as Marcassa Claudio, Faggiano
Pompilio, Greco Cesare, Ambrosetti Marco, Temporelli Pier Luigi. The names
should instead appear as Claudio Marcassa, Pompilio Faggiano, Cesare
Greco, Marco Ambrosetti, Pier L. Temporelli. &#xa9; Copyright 2015 Wolters
Kluwer Health, Inc. All rights reserved.

<142>
[Use Link to view the full text]
Accession Number
612341959
Author
Anonymous
Title
Erratum: Sodium bicarbonate infusion to reduce cardiac surgery-associated
acute kidney injury: A phase II multicenter double-blind randomized
controlled trial (Critical Care Medicine (2013) 41 (1599-1607)).
Source
Critical Care Medicine. 42 (10) (pp e691), 2014. Date of Publication:
October 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article beginning on page 1599 in the July 2013 issue, there were
several errors, which are outlined below. On page 1602, in the first
paragraph of "Other Outcomes", in lines 6-7, the text should read "....and
90-day mortality (4 [2%] vs 5 [2%]); p = 0.06)." On page 1605, in Table 4,
in the 'Died in ICU, n (%)' row, the 'Sodium Bicarbonate' column should
read "3 (1.4)" and the 'Sodium Chloride' column should read "4 (1.9)".
Additionally, the p value column should read "0.69". On page 1605, in
Table 4, in the 'Died by day 90, n (%)' row, the 'Sodium Bicarbonate'
column should read "4 (1.9)" and the 'Sodium Chloride' column should read
"5 (2.4)". Additionally, the p value column should read "0.72".

<143>
Accession Number
612864761
Author
Buia A.; Stockhausen F.; Filmann N.; Hanisch E.
Institution
(Buia) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Ginnheimer Str. 3, Frankfurt 60487, Germany
(Stockhausen) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Frankfurt, Germany
(Filmann) Department of Medicine, Institute of Biostatistics and
Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
(Hanisch) Department of Visceral and Thoracic Surgery, Asklepios Klinik
Langen, Academic Teaching Hospital, Goethe-University Frankfurt, Langen,
Germany
Title
3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of
standardised black box training in laparoscopic surgery.
Source
Langenbeck's Archives of Surgery. (pp 1-5), 2016. Date of Publication: 19
Oct 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: 3D imaging is an upcoming technology in laparoscopic surgery, and
recent studies have shown that the modern 3D technique is superior in an
experimental setting. Methods: All 14 members of the Asklepios Klinik
Langen Department of Visceral and Thoracic Surgery, as well as two
gynaecologists, were asked to undertake 2D vs. 3D laparoscopic black box
skill training. The black box training was adapted to the "fundamentals of
laparoscopic surgery" programme provided by the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). First, the participants
categorised themselves as beginner, advanced or expert in laparoscopic
surgery. Then, they were randomised in terms of whether the black box
training commenced with 2D or 3D vision. The exercises included peg
transfer with the dominant hand and the non-dominant hand (with and
without transfer between the graspers), needle capping and cutting a
sutured knot. The time taken to complete these exercises was measured.
After the training, each participant was asked to describe his/her
personal impression of the imaging systems employed. Results: Overall, for
the participants in all groups, the time required for all exercises showed
a significant advantage for 3D imaging (3D vs. 2D; Wilcoxon matched pair
test; mean 68.0 +/- 94.9 s (3D) vs. 90.1 +/- 69.4 s (2D); p = 0.002).
Regarding the subgroups, the experts significantly improved their time in
completing the exercises in 3D vs. 2D by a margin of 25.8 % (mean 30.8 +/-
20.1 s (3D) vs. 41.5 +/- 25.0 s (2D); p = 0.010). In the group of advanced
surgeons, the results were similar, showing an improvement of 23.6 % for
3D, but without significance (mean 61.5 +/- 41.1 s (3D) vs. 80.4 +/- 72.8
s (2D); p = 0.123). The results for the beginner group also showed an
improvement in the 3D exercises of 24.8 %; here, the result also showed a
trend towards 3D but did not reach significance (mean 93.9 +/- 90.7 s (3D)
vs. 124.8 +/- 118.72 (2D); p = 0.062). Conclusion: In our opinion, 3D
imaging could be an advantage in laparoscopic surgery, especially in the
surgical education of upcoming surgical generations. To determine whether
these ex vivo results can be transferred to the clinical situation, our
group has initiated a randomised controlled study. Copyright &#xa9; 2016
Springer-Verlag Berlin Heidelberg

<144>
Accession Number
612819573
Author
Goudar S.P.; Baker G.H.; Chowdhury S.M.; Reid K.J.; Shirali G.; Scheurer
M.A.
Institution
(Goudar, Reid, Shirali) Ward Family Heart Center Children's Mercy Hospital
Kansas City, Missouri
(Baker, Chowdhury, Scheurer) Department of Pediatrics Division of
Pediatric Cardiology Medical University of South Carolina Charleston South
Carolina
Title
Interpreting measurements of cardiac function using vendor-independent
speckle tracking echocardiography in children: A prospective, blinded
comparison with catheter-derived measurements.
Source
Echocardiography. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Adult studies demonstrate that echocardiographic measurements
of cardiac function using speckle tracking correlate with invasive
measurements, but such data in the pediatric population are sparse. Our
aim was to compare speckle-derived measures of cardiac function to
measurements routinely obtained by cardiac catheterization in children.
Methods: Echocardiograms were performed on the day of cardiac
catheterization. Using Tomtec 2D Cardiac Performance Analysis,
longitudinal strain (LS), longitudinal strain rate (LSR), early diastolic
LSR, and ejection fraction (EF) for the right and left ventricle (RV and
LV) were calculated via speckle tracking. Global LS and LSR were
calculated for the LV. These results were compared to cardiac index,
maximum ventricular dp/dt (max dp/dt), ventricular end-diastolic pressure
(EDP), and pulmonary capillary wedge pressure (PCWP) obtained by
fluid-filled catheters. A blinded observer performed all echo
measurements. Results: Fifty studies were performed on 28 patients ages 4
months to 20 years old. Their diagnoses included cardiac transplant (48
studies), repaired AV septal defect (1), and dilated cardiomyopathy (1).
RVEDP ranged from 2 to 22 mm Hg (median=6) and PCWP ranged from 6 to 32
mmHg (median 10). LV global LS and LV 2-chamber LSR by speckle-tracking
negatively correlated with LV max dp/dt (LV global LS R=-.83, P=.001; LV
2-chamber LSR R=-.69, P=.009). RV LS weakly correlated with max dp/dt
(R=.363, P=.002). Early diastolic strain rate did not correlate with EDP
in either ventricle. Conclusion: Speckle-derived measurements of function
in the LV have stronger correlation than the RV to catheter-derived
measures. LV global LS has the strongest correlation with invasive
function measures in children. Copyright &#xa9; 2016, Wiley Periodicals,
Inc.

<145>
Accession Number
612817756
Author
Reek S.
Institution
(Reek) Electrophysiology Service, Hirslanden Klinik Aarau, Aarau,
Switzerland
Title
The wearable defibrillator: current technology, indications and future
directions.
Source
Current Opinion in Cardiology. (no pagination), 2016. Date of Publication:
15 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE OF REVIEW: The wearable cardioverter-defibrillator has been
available for over a decade. In recent years, the device has been
prescribed increasingly for a wide range of indications. The purpose of
this review is to describe the technical and clinical aspects of the
wearable cardioverter-defibrillator. The available literature on safety,
efficacy and cost-effectiveness is reviewed, and indications for use will
be discussed. RECENT FINDINGS: The wearable cardioverter-defibrillator has
been used successfully in more than 100?000 patients for a variety of
indications. These include high-risk patients after myocardial infarction
or revascularization or with heart failure and newly diagnosed
cardiomyopathy. It has also been used to bridge the time period of
postponed implantable cardioverter-defibrillator implantation or
reimplantation, or until heart transplantation. It has been shown that the
device safely and effectively terminates ventricular tachycardia and
fibrillation with high first shock success. Patient compliance has been
high. Although no randomized trial has been published yet, several
guidelines recommend wearable cardioverter-defibrillator use in different
patient populations and clinical scenarios. SUMMARY: The wearable
cardioverter-defibrillator effectively bridges a limited time period in
patients with a real or perceived high risk for sudden cardiac arrest and
may become a helpful tool for risk stratification to better select
patients for primary prevention implantable cardioverter-defibrillator
placement. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<146>
Accession Number
612817458
Author
Daoulah A.; Alama M.N.; Elkhateeb O.E.; Al-Murayeh M.; Al-Kaabi S.;
Al-Faifi S.M.; Alosaimi H.M.; Lotfi A.; Asiri K.S.; Elimam A.M.;
Abougalambo A.S.; Murad W.; Haddara M.M.; Dixon C.M.; Alsheikh-Ali A.A.
Institution
(Daoulah) aCardiovascular Department bInternal Medicine Department,
Section of Pulmonology cInternal Medicine Department, King Faisal
Specialist Hospital and Research Center dCardiology Unit, King Abdul Aziz
University Hospital, Jeddah eCardiac Center, King Abdullah Medical City,
Makkah fCardiovascular Department, Armed Forces Hospital Southern Region,
Khamis Mushayt, Kingdom of Saudi Arabia gCardiology Department, Zayed
Military Hospital hDivision of Adult Cardiology, College of Medicine,
Institute of Cardiac Sciences, Mohammed Bin Rashid University of Medicine
and Health Sciences iDivision of Adult Cardiology, College of Medicine,
Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
jAnesthesia Department kEmergency Department, King Faisal Specialist
Hospital and Research Cen
Title
Widowhood and severity of coronary artery disease: a multicenter study.
Source
Coronary Artery Disease. (no pagination), 2016. Date of Publication: 04
Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
OBJECTIVES: The aim of this study was to assess the association of
widowhood with the severity and extent of coronary artery disease (CAD),
and whether it is modified by sex or socioeconomic status. PATIENTS AND
METHODS: A total of 1068 patients undergoing coronary angiography at five
centers in Saudi Arabia and the United Arab Emirates were included in the
study. CAD was defined as more than 70% lumen stenosis in a major
epicardial vessel or more than 50% in the left main coronary artery.
Multivessel disease was defined as more than one diseased vessel. RESULTS:
Of 1068 patients, 65 (6%) were widowed. Widowed patients were older
(65+/-15 vs. 59+/-12), more likely to be female (75 vs. 25%), less likely
to be smokers (18 vs. 47%), of lower economic and education status, and
more likely to have undergone coronary angiography for urgent/emergent
indications (75 vs. 61%) (P<0.05 for all). There was a significant
association between widowhood and the number of coronary arteries with
more than 70% lumen stenosis. Consequently, such a high degree of lumen
stenosis in those who were widowed was more likely to require coronary
artery bypass graft surgery (38 vs. 16%; P<0.01). After adjusting for
baseline differences, widowhood was associated with a significantly higher
odds of CAD [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI)
1.2-10.5] and multivessel disease (adjusted OR 4.6; 95% CI 2.2-9.6), but
not left main disease (adjusted OR 1.3; 95% CI 0.5-3.1). All associations
were consistent in men and women and not modified by age, community
setting (urban vs. rural), employment, income, or educational levels
(Pinteraction>0.1 for all). CONCLUSION: Widowhood is associated with the
severity and extent of CAD. The association is not modified by sex or
socioeconomic status. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.
All rights reserved.

<147>
Accession Number
612793078
Author
Cho Y.J.; Bae J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Bae, Kim, Hong, Seo, Bahk, Jeon) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, 101 Daehak-ro,
Jongno-gu, Seoul 03080, South Korea
Title
Microcirculation measured by vascular occlusion test during
desflurane-remifentanil anesthesia is superior to that in
propofol-remifentanil anesthesia in patients undergoing thoracic surgery:
subgroup analysis of a prospective randomized study.
Source
Journal of Clinical Monitoring and Computing. (pp 1-9), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Springer Netherlands
Abstract
General anesthesia can affect microcirculatory properties. However,
differential effects on the microcirculation according to the anesthetic
technique used during thoracoscopic surgery have not been well documented.
We conducted a randomized clinical trial in which the effects of
desflurane and propofol, both with remifentanil, on systemic arterial
oxygenation during one-lung ventilation were compared in patients
undergoing thoracoscopic surgery. As a subgroup analysis, we compared the
effects of two commonly used anesthetic techniques,
desflurane-remifentanil (n = 52) and propofol-remifentanil (n = 48), on
tissue oxygen saturation using a vascular occlusion test in patients
undergoing thoracoscopic surgery. Tissue oxygen saturation was higher in
the desflurane than the propofol group (mean +/- standard deviation, 83
+/- 6 vs. 80 +/- 9, 84 +/- 6 vs. 76 +/- 10, and 87 +/- 7 vs. 77 +/- 10 %
at 30 and 60 min of one-lung ventilation and at two-lung ventilation;
adjusted p = 0.026, <0.001, and <0.001, respectively). The recovery slope
during the vascular occlusion test, reflecting microvascular reperfusion
adequacy, was higher in the desflurane than the propofol group during
surgery (mean difference, 0.5 %/s; 95 % CI 0.0-0.9 %/s; p = 0.037).
Desflurane-remifentanil anesthesia is associated with better
microcirculation than propofol-remifentanil anesthesia in patients
undergoing thoracoscopic surgery. Copyright &#xa9; 2016 Springer
Science+Business Media Dordrecht

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Accession Number
612771058
Author
MacKay E.J.; Patel P.A.; Gutsche J.T.; Weiss S.J.; Augoustides J.G.
Institution
(MacKay, Patel, Gutsche, Weiss, Augoustides) Cardiovascular and Thoracic
Section, Anesthesiology and Critical Care, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA
Title
Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in
Perioperative Cardiovascular Practice: An Evidence-Based Review for the
Cardiovascular Anesthesiologist.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders