EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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.

<2>
Accession Number
601885788
Author
Karaman Y.; Abud B.; Tekgul Z.T.; Cakmak M.; Yildiz M.; Gonullu M.
Institution
(Karaman, Cakmak, Yildiz, Gonullu) Department of Anaesthesiology and
Reanimation, Izmir Tepecik Research and Training Hospital, Izmir, Turkey
(Abud) Department of Cardiovascular Surgery, Izmir Tepecik Research and
Training Hospital, Izmir, Turkey
(Tekgul) Department of Anesthesiology and Reanimation, Izmir Bozyaka
Research and Training Hospital, Saim Cikrikci St. No:59, Bozyaka,
Karabaglar, Izmir 35170, Turkey
Title
Effects of dexmedetomidine and propofol on sedation in patients after
coronary artery bypass graft surgery in a fast-track recovery room
setting.
Source
Journal of Anesthesia. 29 (4) (pp 522-528), 2015. Date of Publication: 22
Aug 2015.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: We aim to compare the effects of propofol and dexmedetomidine
infusions on extubation times, hemodynamic and respiratory functions,
complication rates and patient satisfaction scores in patients undergoing
coronary artery bypass graft (CABG) surgery using a fast-track anesthesia
regimen for early extubation. Methods: We enrolled 64 patients who
underwent CABG surgery. Dexmedetomidine (min 0.2 micro&#32;g/kg/h-max 1.0
micro&#32;g/kg/h) and propofol (min 1.0 mg/kg/h-max 3.0 mg/kg/h) infusion
doses were titrated to give bispectral index values between 60 and 90 and
a Ramsay sedation score (RSS) between 3 and 4. Postoperative extubation
times, patient satisfaction and postoperative adverse events were
recorded. Results: The mean times to extubation were 265.94 +/- 43.1 min
for the dexmedetomidine group and 322.52 +/- 39.2 min for the propofol
group (P < 0.001). In all recordings, RSS median values for the propofol
group were significantly lower than the dexmedetomidine group (P < 0.05).
There were no differences in the incidence of postoperative adverse events
between the dexmedetomidine and propofol groups. There was a statistically
significant difference between patient satisfaction median values of the
two groups-7 (5-9) and 9 (7-10) (min-max) for the propofol and
dexmedetomidine groups, respectively (P < 0.001). Conclusion: Our results
show that dexmedetomidine can easily be preferred over propofol in
fast-track cardiac anesthesia due to its significant advantages of shorter
extubation time and higher postoperative patient satisfaction scores.
Copyright &#xa9; 2015, Japanese Society of Anesthesiologists.

<3>
Accession Number
603245335
Author
Odling Davidsson F.; Johagen D.; Appelblad M.; Svenmarker S.
Institution
(Odling Davidsson, Johagen, Appelblad, Svenmarker) Department of Surgical
and Perioperative Science, Heart Centre Umea University, Umea 901 85,
Sweden
Title
Reversal of heparin after cardiac surgery: Protamine titration using a
statistical model.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (3) (pp 710-714),
2015. Date of Publication: 01 Jun 2015.
Publisher
W.B. Saunders
Abstract
Objective To establish a statistical model for determination of protamine
dose in conjunction with cardiopulmonary bypass. Design Prospective.
Setting University hospital. Participants Ninety consecutive cardiac
surgical patients. Interventions None. Measurements and Main Results A
series of clinically oriented variables were introduced into a statistical
model for projection of the protamine dose after cardiopulmonary bypass.
The following significant predictors were identified using multivariable
regression analysis: The patient's body surface area, the administered
dose of heparin, heparin clearance, and the preoperative platelet count.
The statistical model projected the protamine dose within 3+/-23 mg of the
point-of-care test used as reference. Conclusion Protamine dosing based on
statistical modeling represents an alternative to point-of-care tests.
Copyright &#xa9; 2015 Elsevier Inc. All rights reserved.

<4>
Accession Number
602602558
Author
Paikin J.S.; Hirsh J.; Ginsberg J.S.; Weitz J.I.; Chan N.C.; Whitlock
R.P.; Pare G.; Johnston M.; Eikelboom J.W.
Institution
(Paikin, Whitlock, Eikelboom) Hamilton General Hospital, McMaster
University, Hamilton, ON, Canada
(Paikin, Hirsh, Ginsberg, Weitz, Pare, Eikelboom) Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Hirsh, Chan, Whitlock, Pare, Johnston, Eikelboom) Population Health
Research Institute, McMaster University, Hamilton, ON, Canada
(Ginsberg, Weitz, Eikelboom) Thrombosis and Atherosclerosis Research
Institute, McMaster University, Hamilton, ON, Canada
Title
Multiple daily doses of acetyl-salicylic acid (ASA) overcome reduced
platelet response to once-daily ASA after coronary artery bypass graft
surgery: A pilot randomized controlled trial.
Source
Journal of Thrombosis and Haemostasis. 13 (3) (pp 448-456), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Summary: Background: The efficacy of ASA for prevention of graft failure
following CABG surgery may be limited by incomplete platelet inhibition
due to increased post-operative platelet turnover. Objectives: To
determine whether acetyl-salicylic acid (ASA) 325 mg once-daily or 81 mg
four-times daily overcomes the impaired response to ASA 81 mg once-daily
in post-operative coronary artery bypass graft (CABG) patients. Methods:
We randomized 110 patients undergoing CABG surgery to either ASA 81 mg
once-daily, 81 mg four times daily or 325 mg once-daily and compared their
effects on serum thromboxane B<inf>2</inf> (TXB<inf>2</inf>) suppression
and arachidonate-induced platelet aggregation. Results: One hundred
patients were included in the final analysis. Platelet counts fell after
surgery, reached a nadir on day 2, and then gradually increased. Although
there was near complete suppression of TXB<inf>2</inf> on the second or
third post-operative day, TXB<inf>2</inf> levels increased in parallel
with the rise in platelet count on subsequent days. This increase was most
marked in patients receiving ASA 81 mg once-daily and less evident in
those receiving ASA four times daily. On post-operative day 4, (i) median
TXB<inf>2</inf> levels were lower with four times daily ASA than with
either ASA 81 mg once-daily (1.1 ng/mL; Quartile(Q) Q1,Q3: 0.5, 2.4 and
13.3 ng/mL; Q1,Q3: 7.8, 30.8 ng/mL, respectively; P < 0.0001) or ASA 325
mg once-daily (3.4 ng/mL; Q1,Q3: 2.0, 8.2 ng/mL; P = 0.002), and (ii) ASA
given four times daily was more effective than ASA 81 mg once-daily and
325 mg once-daily at suppressing platelet aggregation. Conclusions: Four
times daily ASA is more effective than ASA 81 and 325 mg once-daily at
suppressing serum TXB<inf>2</inf> formation and platelet aggregation
immediately following CABG surgery. Copyright &#xa9; 2014 International
Society on Thrombosis and Haemostasis.

<5>
Accession Number
603250620
Author
Ottens T.H.; Hendrikse J.; Slooter A.J.C.; Van Herwerden L.A.; Dieleman
J.M.; Van Dijk D.
Institution
(Ottens, Dieleman) Department of Anesthesiology, University Medical Centre
Utrecht, Mail Stop Q. 042313, Utrecht 3508 GA, Netherlands
(Hendrikse) Department of Radiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine, University
Medical Centre Utrecht, Utrecht, Netherlands
(Van Herwerden) Department of Cardiothoracic Surgery, University Medical
Centre Utrecht, Utrecht, Netherlands
Title
Low incidence of early postoperative cerebral edema after coronary artery
bypass grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (3) (pp 632-636),
2015. Date of Publication: 01 Jun 2015.
Publisher
W.B. Saunders
Abstract
Objective Using magnetic resonance imaging, the authors studied the
influence of a single high dose of intraoperative dexamethasone on the
severity of cerebral edema that can occur early after coronary artery
bypass grafting (CABG). It was hypothesized that high-dose intraoperative
dexamethasone reduces cerebral edema after CABG. Design Secondary analysis
in a subset of participants of the Dexamethasone for Cardiac Surgery
(DECS) trial. The DECS trial was a multicenter, randomized, double-blind,
placebo-controlled trial in 4,494 cardiac surgery patients, which studied
the effect of high-dose dexamethasone on mortality and major complications
after cardiac surgery. Setting A large university hospital in The
Netherlands. Participants Twenty adult patients who underwent CABG with
cardiopulmonary bypass (CPB) between March and November 2011.
Interventions Participants received a single intravenous dose of
dexamethasone, 1 mg/kg, or placebo, at induction of anesthesia.
Measurements and Main Results Patients underwent magnetic resonance
imaging scanning immediately after surgery. The primary outcome was the
severity of cerebral edema. Data from 18 patients (9 in each group, median
age 69 years in both groups) could be analyzed. Patients in the
dexamethasone group were (median, interquartile range 66 (53-99) minutes
on cardiopulmonary bypass v 95 (81-105) minutes in the placebo group (p =
0.11). Only 1 patient in the dexamethasone group had slight cerebral edema
(0% v 11%, p = 1.00), and edema severity did not differ between groups (p
= 1.00). Conclusions Relevant degrees of early postoperative cerebral
edema were not observed. The present study findings strongly contrasted
with older studies showing cerebral edema early after CABG in most
patients. Copyright &#xa9; 2015 Elsevier Inc. All rights reserved.

<6>
Accession Number
602650663
Author
Hudetz J.A.; Patterson K.M.; Iqbal Z.; Gandhi S.D.; Pagel P.S.
Institution
(Hudetz, Patterson, Iqbal, Gandhi, Pagel) Anesthesia Service, Clement J.
Zablocki Veterans Affairs Medical Center, 5000 W. National Avenue,
Milwaukee, WI 53295, United States
Title
Remote ischemic preconditioning prevents deterioration of short-term
postoperative cognitive function after cardiac surgery using
cardiopulmonary bypass: Results of a pilot investigation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 382-388),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective Remote ischemic preconditioning (RIPC) exerts neuroprotective
effects in models of cerebral ischemia-reperfusion injury. The authors
tested the hypothesis that RIPC decreases the incidence of postoperative
delirium and prevents deterioration of short-term postoperative cognitive
function in isoflurane-fentanyl-anesthetized patients undergoing cardiac
surgery using cardiopulmonary bypass (CPB). Design Randomized, blinded,
single-center pilot investigation. Setting Veterans Affairs Medical
Center. Participants Thirty age- and education-matched men>55 years of age
undergoing elective coronary artery or valve surgery using CPB. Fifteen
nonsurgical patients also were enrolled. Interventions RIPC was produced
after induction of anesthesia using 4 cycles of brief (5 minutes) upper
extremity ischemia (tourniquet inflation to 200 mmHg) interspersed with
5-minute periods of reperfusion (tourniquet deflation). Measurements and
Main Results The Intensive Care Delirium Screening Checklist was used to
assess delirium before and each day after surgery for as many as 5
consecutive days. Recent verbal and nonverbal memory and executive
functions were assessed before and 1 week after surgery using a standard
neuropsychometric test battery or at 1-week intervals in nonsurgical
controls. The Geriatric Depression and the Hachinski Ischemia scales were
used to identify the presence of clinical depression and vascular
dementia, respectively. No differences in delirium scores were observed
between RIPC and control groups (p = 0.54). Baseline neurocognitive scores
were similar in patients with versus without RIPC in all 3 cognitive
domains. Significant declines in performance on 2 nonverbal memory tests
(figure reconstruction and delayed figure reproduction; p = 0.001 and p =
0.003, respectively) and 1 verbal memory test (delayed story recall; p =
0.0004) were observed 1 week after surgery in patients who were not
treated with RIPC. There were no changes in performance of measures of
executive function in this group. In contrast, performance on all
cognitive tests was unchanged after compared with before surgery in
patients receiving RIPC. At least a 1-standard deviation decline from
baseline in cognitive performance was detected in figure reconstruction,
delayed figure reproduction, immediate story recall, and delayed story
recall in patients who were not exposed to RIPC. The incidence of at least
a 1-standard deviation decline in neuropsychometric tests was observed in
significantly fewer (1 v 9; p<0.0001) patients with versus without RIPC
treatment based on composite Z-scores. Overall cognitive performance after
surgery was better in patients treated with versus without RIPC (p =
0.002). Clinical depression and vascular dementia were not detected in
either group. Conclusion The results of this pilot investigation indicated
that RIPC prevented deterioration of short-term postoperative cognitive
function but were unable to detect any difference in delirium in
isoflurane-fentanyl-anesthetized patients undergoing cardiac surgery using
CPB. Copyright &#xa9; 2015 Elsevier Inc.

<7>
Accession Number
602561411
Author
Sun B.; Wang J.; Bo L.; Zang Y.; Gu H.; Li J.; Qian B.
Institution
(Sun, Zang, Gu, Qian) Department of Transfusion Medicine, Changhai
Hospital, Second Military Medical University, 168 Changhai Road, Shanghai
200433, China
(Wang) Jiangsu Key Laboratory of Anesthesiology and Jiangsu Key Laboratory
of Anesthesia and Analgesia Application Technology, Xuzhou Medical
College, Xuzhou, Jiangsu, China
(Bo, Li) Department of Anesthesiology, Changhai Hospital, Second Military
Medical University, Shanghai, China
Title
Effects of volatile vs. propofol-based intravenous anesthetics on the
alveolar inflammatory responses to one-lung ventilation: a meta-analysis
of randomized controlled trials.
Source
Journal of Anesthesia. 29 (4) (pp 570-579), 2015. Date of Publication: 22
Aug 2015.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: The aim of this meta-analysis is to compare the potential
effects of inhalation anesthetics with total intravenous anesthetics on
alveolar cytokine expression and lung-related clinical outcomes in
patients undergoing one-lung ventilation (OLV) for thoracic surgery.
Methods: We retrieved the PubMed, EMBASE, and the Cochrane Library
respectively to identify randomized controlled trials comparing different
anesthetics (volatile anesthetics vs. intravenous anesthetics) on the
pulmonary inflammatory response to OLV. The primary outcomes were the
levels of alveolar concentrations of inflammatory cytokines. Results:
Eight randomized controlled trials that included 365 patients were
screened. Overall, there were significant differences in the concentration
of alveolar inflammatory mediators between volatile group and intravenous
group, in which volatile group had lower levels of TNF-alpha (SMD -1.51;
95 % CI -2.15 to -0.87; p < 0.001), IL-6 (SMD -0.70; 95 % CI -0.99 to
-0.41; p < 0.001) and IL-8 (SMD -1.32; 95 % CI -2.20 to -0.45; p = 0.003).
The overall number of pulmonary complications in the volatile group was
smaller (RR 0.42; 95 % CI 0.23-0.77; p = 0.005) and patients in that group
had significantly abridged hospitalization stay (WMD -3.59 days; 95 % CI
-5.70 to -1.48 days; p = 0.001). Conclusions: Inhalation anesthetics might
be preferable in patients undergoing OLV for thoracic surgery and their
protective effects might work via attenuating inflammatory responses.
Copyright &#xa9; 2015, Japanese Society of Anesthesiologists.

<8>
Accession Number
604171871
Author
Kidambi S.; Mohamedali B.; Bhat G.
Institution
(Kidambi, Bhat) Division of Advanced Heart Failure and Clinical
Transplantation, Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Mohamedali) Rush University, Chicago, IL, United States
Title
Clinical outcomes in sensitized heart transplant patients bridged with
ventricular assist devices.
Source
Clinical Transplantation. 29 (6) (pp 499-505), 2015. Date of Publication:
01 Jun 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Left ventricular assist devices (LVADs) as a bridge to
transplant (BTT) have been known to cause allosensitization, as measured
by panel-reactive antibody (PRA) levels. The goal of this study was to
measure the impact of this allosensitization on outcomes. Methods:
Panel-reactive antibodies were analyzed in BTT patients, with
sensitization defined as peak PRAs > 10%. Baseline characteristics and
outcomes in the two patient groups were evaluated using descriptive
statistics, Kaplan-Meier, and regression analysis. Results: Thirty-eight
patients were included in the study (17 sensitized vs. 21 non-sensitized).
There were more women in the sensitized group (47% vs. 10%, p = 0.023).
There was no difference in mean times to high-grade acute cellular
rejection (ACR; 18.3 months in sensitized vs. 36.9 months in
non-sensitized). Five patients in the sensitized groups developed
antibody-mediated rejection (AMR) vs. 0 in the non-sensitized, and all
five patients died (Kaplan-Meier log-rank p = 0.024). There was also a
significant difference in the incidence of infection at the one- to
six-month stage (52.9% vs. 19.0%, p = 0.03). Conclusion: Sensitization
appears to have a negative effect on mortality. This mortality appears to
be concentrated in patients with AMR, and we postulate that the
development of AMR in a sensitized patient may be a predictor of
mortality. Copyright &#xa9; 2015 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd.

<9>
Accession Number
603917250
Author
Sabatine M.S.; Giugliano R.P.; Wiviott S.D.; Raal F.J.; Blom D.J.;
Robinson J.; Ballantyne C.M.; Somaratne R.; Legg J.; Wasserman S.M.; Scott
R.; Koren M.J.; Stein E.A.
Institution
(Sabatine, Giugliano, Wiviott) Sabatine at the TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St.,
Boston, MA 02115, United States
(Raal) Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
(Blom) Division of Lipidology, Department of Medicine, University of Cape
Town, Cape Town, South Africa
(Robinson) Departments of Epidemiology and Medicine, College of Public
Health, University of Iowa, Iowa City, United States
(Ballantyne) Sections of Cardiovascular Research and Cardiology,
Department of Medicine, Baylor College of Medicine, Houston, United States
(Somaratne, Legg, Wasserman, Scott) Amgen, Thousand OaksCAUnited States
(Koren) Jacksonville Center for Clinical Research, Jacksonville, FL,
United States
(Stein) Metabolic and Atherosclerosis Research Center, 5355 Medpace Way,
Cincinnati, OH 45225, United States
Title
Efficacy and safety of evolocumab in reducing lipids and cardiovascular
events.
Source
New England Journal of Medicine. 372 (16) (pp 1500-1509), 2015. Date of
Publication: 16 Apr 2015.
Publisher
Massachussetts Medical Society
Abstract
Background Evolocumab, a monoclonal antibody that inhibits proprotein
convertase subtilisin- kexin type 9 (PCSK9), significantly reduced
low-density lipoprotein (LDL) cholesterol levels in short-term studies. We
conducted two extension studies to obtain longer-term data. Methods In two
open-label, randomized trials, we enrolled 4465 patients who had completed
1 of 12 phase 2 or 3 studies ("parent trials") of evolocumab. Regardless
of studygroup assignments in the parent trials, eligible patients were
randomly assigned in a 2:1 ratio to receive either evolocumab (140 mg
every 2 weeks or 420 mg monthly) plus standard therapy or standard therapy
alone. Patients were followed for a median of 11.1 months with assessment
of lipid levels, safety, and (as a prespecified exploratory analysis)
adjudicated cardiovascular events including death, myocardial infarction,
unstable angina, coronary revascularization, stroke, transient ischemic
attack, and heart failure. Data from the two trials were combined. Results
As compared with standard therapy alone, evolocumab reduced the level of
LDL cholesterol by 61%, from a median of 120 mg per deciliter to 48 mg per
deciliter (P<0.001). Most adverse events occurred with similar frequency
in the two groups, although neurocognitive events were reported more
frequently in the evolocumab group. The risk of adverse events, including
neurocognitive events, did not vary significantly according to the
achieved level of LDL cholesterol. The rate of cardiovascular events at 1
year was reduced from 2.18% in the standard-therapy group to 0.95% in the
evolocumab group (hazard ratio in the evolocumab group, 0.47; 95%
confidence interval, 0.28 to 0.78; P = 0.003). Copyright &#xa9; 2015
Massachusetts Medical Society.

<10>
Accession Number
602765076
Author
Simmers D.; Potgieter D.; Ryan L.; Fahrner R.; Rodseth R.N.
Institution
(Simmers, Potgieter) Department of Anaesthetics, Nelson R. Mandela School
of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013,
South Africa
(Ryan, Rodseth) Department of Anaesthetics, Nelson R. Mandela School of
Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
(Fahrner) Division of General, Visceral and Vascular Surgery, University
Hospital Jena, Germany
(Rodseth) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
Title
The use of preoperative B-type natriuretic peptide as a predictor of
atrial fibrillation after thoracic surgery: Systematic review and
meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 389-395),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective To determine whether elevated preoperative B-type natriuretic
peptide (NP) measurements are an independent predictor of atrial
fibrillation (AF) in patients having thoracic surgery. Design Systematic
review and meta-analysis. Setting In-hospital and 30 days after thoracic
surgery. Participants The 742 patients who participated in the 5
observational studies. Interventions None. Measurements and Main Results
EMBASE, OVID Health Star, Ovid Medline, Cochrane Central Register of
Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest
Dissertations and Theses A&I databases were searched for all studies of
noncardiac thoracic surgery patients in whom a preoperative NP was
measured up to 1 month before surgery, and that measured the incidence of
postoperative AF. Studies were included regardless of their language,
sample size, publication status, or study design. Study quality was
evaluated using the Newcastle Ottowa Scale. The combined incidence of
postoperative AF was 14.5% (n = 108/742), and the NP thresholds used to
predict AF varied among studies. An elevated preoperative NP measurement
was associated with an OR of 3.13 (95% CI 1.38-7.12; I2 = 87%) for
postoperative AF, with the sensitivity analysis reporting an OR of 9.51
(95% CI 4.66-19.40; I2 = 0). Conclusion Patients with an elevated
preoperative NP measurement are at an increased risk of postoperative AF.
There may be value in incorporating NP measurement into existing AF risk
prediction models. Copyright &#xa9; 2015 Elsevier Inc.

<11>
Accession Number
603290647
Author
Golestaneh L.; Lindsey K.; Malhotra P.; Kargoli F.; Farkas E.; Barner H.;
Qazi R.; Schmidt A.; Rauchman M.; Al-Aly Z.; Johnson R.; Martin K.; Dagher
P.; Friedman A.; El-Achkar T.M.
Institution
(Golestaneh, Malhotra, Kargoli) Montefiore Medical Center, Albert Einstein
Medical Center, 3411 Wayne Ave, Suite 5H, Bronx, NY 10467, United States
(Lindsey, Farkas, Barner, Qazi, Schmidt, Rauchman, Johnson, Martin) St
Louis University Hospital, St Louis, MO 63110, United States
(Al-Aly) VA St Louis Health Care System, St Louis, MO 63106, United States
(Dagher, Friedman, El-Achkar) IU Health University Hospital, Indianapolis,
IN 46202, United States
Title
Acute kidney injury after cardiac surgery: is minocycline protective?.
Source
Journal of Nephrology. 28 (2) (pp 193-199), 2015. Date of Publication: 01
Apr 2015.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background and objectives: Acute kidney injury (AKI) after cardiac bypass
surgery (CABG) is common and carries a significant association with
morbidity and mortality. Since minocycline therapy attenuates kidney
injury in animal models of AKI, we tested its effects in patients
undergoing CABG. Design, setting, participants and measurements: This is a
randomized, double-blinded, placebo-controlled, multi-center study. We
screened high risk patients who were scheduled to undergo CABG in two
medical centers between Jan 2008 and June 2011. 40 patients were
randomized and 19 patients in each group completed the study. Minocycline
prophylaxis was given twice daily, at least for four doses prior to CABG.
Primary outcome was defined as AKI [0.3 mg/dl increase in creatinine (Cr)]
within 5 days after surgery. Daily serum Cr for 5 days, various clinical
and hemodynamic measures and length of stay were recorded. Results: The
two groups had similar baseline and intra-operative characteristics. The
primary outcome occurred in 52.6 % of patients in the minocycline group as
compared to 36.8 % of patients in the placebo group (p = 0.51). Peak Cr
was 1.6 +/- 0.7 vs. 1.5 +/- 0.7 mg/dl (p = 0.45) in minocycline and
placebo groups, respectively. Death at 30 days occurred in 0 vs. 10.5 % in
the minocycline and placebo groups, respectively (p = 0.48). There were no
differences in post-operative length of stay, and cardiovascular events
between the two groups. There was a trend towards lower diastolic
pulmonary artery pressure [16.8 +/- 4.7 vs. 20.7 +/- 6.6 mmHg (p = 0.059)]
and central venous pressure [11.8 +/- 4.3 vs. 14.6 +/- 5.6 mmHg (p =
0.13)] in the minocycline group compared to placebo on the first day after
surgery. Conclusions: Minocycline did not protect against AKI post-CABG.
Copyright &#xa9; 2014, Italian Society of Nephrology.

<12>
Accession Number
602690881
Author
Agarwal S.; Johnson R.I.; Shaw M.
Institution
(Agarwal, Shaw) Department of Anaesthesia and Critical Care, Liverpool
Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
(Johnson) Department of Perfusion, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
Title
Preoperative point-of-care platelet function testing in cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (2) (pp 333-341),
2015. Date of Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Objective To investigate if the use of preoperative platelet function
testing (PFT) as part of a transfusion algorithm reduced blood product
usage in coronary artery bypass surgery (CABG). Design Prospective,
randomized, controlled trial. Setting A cardiothoracic hospital.
Participants 249 patients having CABG surgery. Interventions The patients
were allocated randomly to PFT preoperatively with Multiple Electrode
Aggregometry (MEA, Group A), TEG PlateletMapping (PM, Group B) or none
(control, Group C). Post-bypass bleeding management was determined by a
transfusion algorithm. Measurements and Main Results The primary outcome
measure was blood product transfusion in the first 48 hours post-surgery.
There was a significant reduction in all blood product transfusion between
Groups A (MEA) and B (PM) and Group C (control) (median number of units
transfused, 2 (A)/2 (B)/ 4(C), p = 0.02). Those in A and B received fewer
units of red cells (median number of units, 0 (A)/1 (B) /2 (C), p = 0.006)
and fresh frozen plasma than the control Group C (median number of units,
0 (A)/0 (B)/2 (C), p<0.001), without receiving significantly more units of
platelets (median number of units, 1 (A)/1 (B)/0 (C), p = 0.11). In those
who had taken an adenosine disphosphate (ADP)-receptor antagonist within 5
days (n = 173), these results were amplified, and additionally, there was
a significant cost saving (median cost, A = 1738.53, B = 1736.96, C=
3191.80 p = 0.006). Conclusion Preoperative PFT as part of a point-of-care
testing-based transfusion algorithm led to a reduction in blood
transfusion. There is a potential cost saving in those who have taken an
ADP-receptor antagonist within 5 days. Copyright &#xa9; 2015 Elsevier Inc.

<13>
[Use Link to view the full text]
Accession Number
605251936
Author
Franzone A.; Pilgrim T.; Heg D.; Roffi M.; Tuller D.; Vuilliomenet A.;
Muller O.; Cook S.; Weilenmann D.; Kaiser C.; Jamshidi P.; Raber L.;
Stortecky S.; Wenaweser P.; Juni P.; Windecker S.
Institution
(Franzone, Pilgrim, Raber, Stortecky, Wenaweser, Windecker) Department of
Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern
CH-3010, Switzerland
(Heg, Juni) Institute of Social and Preventive Medicine, Clinical Trials
Unit, United States
(Roffi) University Hospital, Bern, Switzerland
(Roffi) Department of Cardiology, University Hospital, Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Vuilliomenet, Muller) Department of Cardiology, University Hospital,
Lausanne, Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
Title
Clinical outcomes according to diabetic status in patients treated with
biodegradable polymer sirolimus-eluting stents versus durable polymer
everolimus-eluting stents: Prespecified subgroup analysis of the
BIOSCIENCE trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002319. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES)
proved noninferior to durable polymer everolimus-eluting stents (DP-EES)
for a composite clinical end point in a population with minimal exclusion
criteria. We performed a prespecified subgroup analysis of the Ultrathin
Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer
Everolimus-Eluting Stent for Percutaneous Coronary Revascularisation
(BIOSCIENCE) trial to compare the performance of BP-SES and DP-EES in
patients with diabetes mellitus. Methods and Results-BIOSCIENCE trial was
an investigator-initiated, single-blind, multicentre, randomized,
noninferiority trial comparing BP-SES versus DP-EES. The primary end
point, target lesion failure, was a composite of cardiac death,
target-vessel myocardial infarction, and clinically indicated target
lesion revascularization within 12 months. Among a total of 2119 patients
enrolled between February 2012 and May 2013, 486 (22.9%) had diabetes
mellitus. Overall diabetic patients experienced a significantly higher
risk of target lesion failure compared with patients without diabetes
mellitus (10.1% versus 5.7%; hazard ratio [HR], 1.80; 95% confidence
interval [CI], 1.27-2.56; P=0.001). At 1 year, there were no differences
between BP-SES versus DP-EES in terms of the primary end point in both
diabetic (10.9% versus 9.3%; HR, 1.19; 95% CI, 0.67-2.10; P=0.56) and
nondiabetic patients (5.3% versus 6.0%; HR, 0.88; 95% CI, 0.58-1.33;
P=0.55). Similarly, no significant differences in the risk of definite or
probable stent thrombosis were recorded according to treatment arm in both
study groups (4.0% versus 3.1%; HR, 1.30; 95% CI, 0.49-3.41; P=0.60 for
diabetic patients and 2.4% versus 3.4%; HR, 0.70; 95% CI, 0.39-1.25;
P=0.23, in nondiabetics). Conclusions-In the prespecified subgroup
analysis of the BIOSCIENCE trial, clinical outcomes among diabetic
patients treated with BP-SES or DP-EES were comparable at 1 year.
Copyright &#xa9; 2015 American Heart Association, Inc.

<14>
Accession Number
606175972
Author
Mylotte D.; Andalib A.; Theriault-Lauzier P.; Dorfmeister M.; Girgis M.;
Alharbi W.; Chetrit M.; Galatas C.; Mamane S.; Sebag I.; Buithieu J.;
Bilodeau L.; De Varennes B.; Lachapelle K.; Lange R.; Martucci G.; Virmani
R.; Piazza N.
Institution
(Mylotte, Andalib, Theriault-Lauzier, Girgis, Alharbi, Chetrit, Galatas,
Mamane, Buithieu, Bilodeau, Martucci, Piazza) Department of Interventional
Cardiology, McGill University Health Centre, Montreal, QC, Canada
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
(Dorfmeister, Lange, Piazza) Department of Cardiac Surgery, German Heart
Center, Munich, Germany
(Sebag) Department of Cardiology, Mortimer Davis, Jewish General Hospital,
Montreal, QC, Canada
(De Varennes, Lachapelle) Department of Cardiovascular Surgery, McGill
University Health Centre, Montreal, QC, Canada
(Virmani) CVPath Institute, Gaithersburg, MD, United States
Title
Transcatheter heart valve failure: A systematic review.
Source
European Heart Journal. 36 (21) (pp 1306-1327), 2015. Date of Publication:
2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims A comprehensive description of transcatheter heart valve (THV)
failure has not been performed. We undertook a systematic review to
investigate the aetiology, diagnosis, management, and outcomes of THV
failure. Methods and results The systematic review was performed in
accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus.
Between December 2002 and March 2014, 70 publications reported 87
individual cases of transcatheter aortic valve implantation (TAVI)
failure. Similar to surgical bioprosthetic heart valve failure, we
observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural
valve failure (n = 13), and THV thrombosis (n = 15). The microbiological
profile of THV PVE was similar to surgical PVE, though one-quarter had
satellite mitral valve endocarditis, and surgical intervention was
required in 40% (75% survival). Structural valve failure occurred most
frequently due to leaflet calcification and was predominantly treated by
redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean
9+7 months post-implantation and was successfully treated by prolonged
anticoagulation in three-quarters of cases. Twonovel causes of THV
failurewere identified: lateTHVembolization (n = 18); and THV compression
(n = 7) following cardiopulmonary resuscitation (CPR). These failure modes
have not been reported in the surgical literature. Potential risk factors
for late THV embolization include low prosthesis implantation, THV
undersizing/underexpansion, bicuspid, and non-calcified anatomy.
Transcatheter heart valve embolization mandated surgery in 80% of
patients. Transcatheter heart valve compression was noted at post-mortem
in most cases. Conclusion Transcatheter heart valves are susceptible to
failure modes typical to those of surgical bioprostheses and unique to
their specific design. Transcatheter heart valve compression and late
embolization represent complications previously unreported in the surgical
literature. Copyright &#xa9; The Author 2014.

<15>
Accession Number
606175950
Author
Koertke H.; Zittermann A.; Wagner O.; Secer S.; Huth C.; Sciangula A.;
Saggau W.; Sack F.-U.; Ennker J.; Cremer J.; Musumeci F.; Gummert J.F.
Institution
(Koertke, Zittermann, Secer, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia,
Ruhr University Bochum, Bad Oeynhausen, Germany
(Koertke, Wagner, Secer) Institute of Applied Telemedicine, Heart and
Diabetes Center North Rhine-Westphalia, Ruhr University Bochum,
Georgstr.11, Bad Oeynhausen 32545, Germany
(Huth) Clinic for Thoracic and Cardiovascular Surgery, Otto von Guericke
University Magdeburg, Magdeburg, Germany
(Sciangula) Hospital Santa Anna, Catanzaro, Italy
(Saggau, Sack) Academic City Hospital, Ludwigshafen, Germany
(Ennker) Mediclin Heart Institute Lahr/Baden, University Witten-Herdecke,
Faculty of Health, School of Medicine, Lahr, Germany
(Cremer) Clinic for Cardiac and Vascular Surgery,
Christain-Albrechts-University Kiel, Kiel, Germany
(Musumeci) Azienda Ospedaliera S. Camillo Forlani, Roma, Italy
Title
Telemedicine-guided, very low-dose international normalized ratio
self-control in patients with mechanical heart valve implants.
Source
European Heart Journal. 36 (21) (pp 1297-1305), 2015. Date of Publication:
2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aim To study in patients performing international normalized ratio (INR)
self-control the efficacy and safety of an INR target range of 1.6-2.1 for
aortic valve replacement (AVR) and 2.0-2.5 for mitral valve replacement
(MVR) or double valve replacement (DVR). Methods and results In total,
1304 patients undergoing AVR, 189 undergoing MVR and 78 undergoing DVR
were randomly assigned to low-dose INR self-control (LOW group) (INR
target range, AVR: 1.8-2.8; MVR/DVR: 2.5-3.5) or very low-dose INR
self-control once a week (VLO group) and twice a week (VLT group) (INR
target range, AVR: 1.6-2.1; MVR/DVR: 2.0-2.5), with electronically guided
transfer of INR values.We compared grade III complications (major bleeding
and thrombotic events; primary end-points) and overall mortality
(secondary end-point) across the three treatment groups. Findings Two-year
freedom frombleedings in the LOW, VLO, and VLTgroupswas 96.3, 98.6, and
99.1%, respectively (P = 0.008). The corresponding values for thrombotic
eventswere 99.0, 99.8, and 98.9%, respectively (P = 0.258). The
risk-adjusted composite of grade III complicationswas in the per-protocol
population (reference: LOW-dose group) as follows: hazard ratio = 0.307
(95% CI: 0.102-0.926; P = 0.036) for the VLO group and = 0.241 (95% CI:
0.070-0.836; P = 0.025) for the VLT group. The corresponding values of
2-year mortality were = 1.685 (95% CI: 0.473-5.996; P = 0.421) for the VLO
group and = 4.70 (95% CI: 1.62-13.60; P = 0.004) for the VLT group.
Conclusion Telemedicine-guided very low-dose INR self-control is
comparable with low-dose INR in thrombotic risk, and is superior in
bleeding risk.Weekly testing is sufficient. Given the small number of MVR
and DVR patients, results are only valid for AVR patients. Copyright
&#xa9; The Author 2014.

<16>
Accession Number
601009934
Author
Stangl V.; Baldenhofer G.; Laule M.; Baumann G.; Stangl K.
Institution
(Stangl, Baldenhofer, Laule, Baumann, Stangl) Medizinische Klinik fur
Kardiologie und Angiologie, Campus Mitte, Charite - Universitatsmedizin
Berlin, Schumannstr. 20-21, Berlin 10117, Germany
(Stangl) DZHK (German Center for Cardiovascular Research), Berlin, Germany
Title
Influence of sex on outcome following transcatheter aortic valve
implantation (TAVI): Systematic review and meta-analysis.
Source
Journal of Interventional Cardiology. 27 (6) (pp 531-539), 2014. Date of
Publication: 01 Dec 2014.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background Sex differences exist in pathogenesis, clinical presentation,
and outcome in aortic stenosis (AS). However, only limited information is
available concerning sex differences in transcatheter aortic valve
implantation (TAVI). The aim of the present study is a comprehensive
meta-analysis of studies that investigate differences between men and
women in outcome after TAVI.
Methods We screened PUBMED, MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials. Inclusion criteria were: AS treated with
all forms of TAVI, studies specifically targeting sex/gender differences,
and at least 2 of the following outcome data: 30-day all-cause death,
mortality during follow-up, major vascular complications, major bleeding,
pacemaker, or stroke rate (<30 days). Studies were excluded if they
considered female gender merely in subgroup analysis.
Results We included 14 observational studies with a total of 7,973
patients (4,242 women, 3,731 men). At 30 days (12 studies, 3,044 women,
2,784 men), female sex was associated with a significantly lower mortality
rate (odds ratio [95% confidence interval] 0.78 [0.64, 0.96]). Of the 14
studies included for analysis, 12 provided data on mortality during
follow-up that likewise show a survival advantage for women (OR 0.70
[0.59, 0.82]). Whereas the major vascular complication rate was greater in
women (11 studies, 3,731 women, 3,342 men; OR 1.72 [1.41, 2.09]), major
bleeding (8 studies, 2,124 women, 2,100 men; OR 1.13 [0.95, 1.33]) was
not. Pacemaker and stroke rate were not significantly different between
the groups.
Conclusion In treatment with TAVI, there is evidence for a significantly
greater overall survival benefit in women over men. Copyright &#xa9; 2014,
Wiley Periodicals, Inc.

<17>
Accession Number
610620067
Author
Shah K.B.; Thanavaro K.L.; Tang D.G.; Quader M.A.; Mankad A.K.; Tchoukina
I.; Thacker L.R.; Smallfield M.C.; Katlaps G.; Hess M.L.; Cooke R.H.;
Kasirajan V.
Institution
(Shah, Thanavaro, Mankad, Tchoukina, Smallfield, Hess, Cooke) Division of
Cardiology, Pauley Heart Center, Virginia Commonwealth University,
Richmond, Virginia, United States
(Tang, Quader, Katlaps, Kasirajan) Department of Cardiothoracic Surgery,
Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia,
United States
(Thacker) School of Nursing, Virginia Commonwealth University, Richmond,
Virginia, United States
Title
Impact of INTERMACS Profile on Clinical Outcomes for Patients Supported
With the Total Artificial Heart.
Source
Journal of Cardiac Failure. 22 (11) (pp 913-920), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Churchill Livingstone Inc.
Abstract
Background Insufficient data delineate outcomes for Interagency Registry
for Mechanically Assisted Circulatory Support (INTERMACS) profile 1
patients with the total artificial heart (TAH). Methods We studied 66
consecutive patients implanted with the TAH at our institution from 2006
through 2012 and compared outcome by INTERMACS profile. INTERMACS profiles
were adjudicated retrospectively by a reviewer blinded to clinical
outcomes. Results Survival after TAH implantation at 6 and 12 months was
76% and 71%, respectively. INTERMACS profile 1 patients had decreased
6-month survival on the device compared with those in profiles 2-4 (74% vs
95%, log rank: P=.015). For the 50 patients surviving to heart
transplantation, the 1-year posttransplant survival was 82%. There was no
difference in 1-year survival when comparing patients in the INTERMACS 1
profile with less severe profiles (79% vs 84%; log rank test P=.7; hazard
ratio [confidence interval] 1.3 [0.3-4.8]). Conclusions Patients implanted
with the TAH as INTERMACS profile 1 had reduced survival to
transplantation compared with less sick profiles. INTERMACS profile at the
time of TAH implantation did not affect 1-year survival after heart
transplantation. Copyright &#xa9; 2016 Elsevier Inc.

<18>
Accession Number
610639540
Author
Neves A.L.; Henriques-Coelho T.; Leite-Moreira A.; Areias J.C.
Institution
(Neves, Areias) Department of Paediatric Cardiology, Sao Joao Hospital,
Porto, Portugal
(Neves, Leite-Moreira, Areias) Department of Physiology and Cardiothoracic
Surgery, Cardiovascular Research Centre, Faculty of Medicine, University
of Porto, Porto, Portugal
(Neves, Henriques-Coelho, Areias) Department of Paediatrics, Faculty of
Medicine, University of Porto, Porto, Portugal
(Henriques-Coelho) Department of Paediatric Surgery, Sao Joao Hospital,
Porto, Portugal
(Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao Hospital,
Porto, Portugal
Title
Cardiac injury biomarkers in paediatric age: Are we there yet?.
Source
Heart Failure Reviews. 21 (6) (pp 771-781), 2016. Date of Publication: 01
Nov 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The aim of this article is to evaluate the clinical utility of cardiac
injury biomarkers in paediatric age. In December 2015, a literature search
was performed (PubMed access to MEDLINE citations;
http://www.ncbi.nlm.nih.gov/PubMed/). The search strategy included the
following medical subject headings and text terms for the key words:
"cardiac injury biomarkers", "creatine kinase-MB", "myoglobin",
"troponin", "children", "neonate/s", "newborn/s", "infant/s" and
echocardiography. In the paediatric population, troponins show a good
correlation with the extent of myocardial damage following cardiac surgery
and cardiotoxic medication and can be used as predictors of subsequent
cardiac recovery and mortality. Elevation of cardiac injury biomarkers may
also have diagnostic value in cases when cardiac contusion or pericarditis
is suspected. Cardiac injury biomarkers are very sensitive markers for the
detection of myocardial injury and have been studied in healthy newborns,
after tocolysis, intrauterine growth restriction, respiratory distress and
asphyxia. The proportion of newborns with elevated troponin was higher
than that in ill infants, children, and adolescents and in healthy adults,
suggesting that myocardial injury, although clinically occult, is common
in this young age group. Results suggest that significant elevation of
cord troponin is an excellent early predictor of severity of
hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac
biomarkers may also benefit centres without on-site echocardiography with
evidence showing good correlation with echo-derived markers of myocardial
function. Further studies are needed to better clarify the role of cardiac
biomarkers in paediatric age and their correlation with echocardiographic
parameters. Copyright &#xa9; 2016, Springer Science+Business Media New
York.

<19>
Accession Number
611290765
Author
Jilaihawi H.; Chen M.; Webb J.; Himbert D.; Ruiz C.E.; Rodes-Cabau J.;
Pache G.; Colombo A.; Nickenig G.; Lee M.; Tamburino C.; Sievert H.;
Abramowitz Y.; Tarantini G.; Alqoofi F.; Chakravarty T.; Kashif M.;
Takahashi N.; Kazuno Y.; Maeno Y.; Kawamori H.; Chieffo A.; Blanke P.;
Dvir D.; Ribeiro H.B.; Feng Y.; Zhao Z.-G.; Sinning J.-M.; Kliger C.;
Giustino G.; Pajerski B.; Imme S.; Grube E.; Leipsic J.; Vahanian A.;
Michev I.; Jelnin V.; Latib A.; Cheng W.; Makkar R.
Institution
(Jilaihawi) Department of Cardiology and Cardiothoracic Surgery, NYU
Langone Medical Center, New York, New York, United States
(Chen, Feng, Zhao) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, China
(Webb, Blanke, Dvir, Pajerski, Leipsic) St. Paul's Hospital, Vancouver,
Canada
(Himbert, Vahanian) Department of Cardiology, Assistance Publique-Hopitaux
de Paris, Bichat-Claude Bernard Hospital, Paris, France
(Ruiz, Kliger, Jelnin) Lenox Hill Heart and Vascular Institute of New
York, New York, United States
(Rodes-Cabau, Ribeiro) Quebec Heart and Lung Institute, Laval University,
Quebec City, Canada
(Pache, Blanke) University Hospital Freiburg, Freiburg, Germany
(Colombo, Chieffo, Giustino, Michev, Latib) EMO-GVM Centro Cuore Columbus
and San Raffaele Scientific Institute, Milan, Italy
(Nickenig, Sinning, Grube) Department of Internal Medicine and
Cardiology/Pneumology, University of Bonn, Bonn, Germany
(Lee) Division of Cardiology, Department of Medicine, Queen Elizabeth
Hospital, Kowloon, Hong Kong
(Tamburino, Imme) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Sievert) Department of Cardiology and Vascular Medicine, CardioVasculares
Centrum Frankfurt, Frankfurt, Germany
(Abramowitz, Chakravarty, Kashif, Takahashi, Kazuno, Maeno, Kawamori,
Cheng, Makkar) Cedars-Sinai Heart Institute, Los Angeles, United States
(Tarantini) University of Padua, Padua, Italy
(Alqoofi) University of Calgary, Calgary, Canada
Title
A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.
Source
JACC: Cardiovascular Imaging. 9 (10) (pp 1145-1158), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate transcatheter aortic valve
replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS),
with a particular emphasis on TAVR-directed bicuspid aortic valve imaging
(BAVi) of morphological classification. Background TAVR has been used to
treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the
relevance of morphology. Methods In 14 centers in the United States,
Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline
cardiac computed tomography (CT) was analyzed by a dedicated Corelab.
Outcomes were assessed in line with Valve Academic Research Consortium
criteria. Results Bicommissural BAV (vs. tricommissural) accounted for
68.9% of those treated in North America, 88.9% in Europe, and 95.5% in
Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe
type) BAV accounted for 11.9% of those treated in North America, 9.4% in
Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality
(3.8%) and cerebrovascular events (3.2%) were favorable and similar among
anatomical subsets. The rate of new permanent pacemaker insertion was high
(26.2%) and similar between balloon-expandable (BE) and self-expanding
(SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to
greater permanent pacemaker insertion in BE TAVR in the presence of
coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation
(PAR) > moderate was 18.1% overall but lower at 11.5% in those with
pre-procedural CT. In the absence of pre-procedural CT, there was an
excess of PAR in BE TAVR that was not the case in those with a
pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR
included intercommissural distance for bicommissural bicuspids (odd ratio
[OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and
lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to
7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved
favorable outcomes in patients with pre-procedural CT, with the exception
of high permanent pacemaker rates for all devices and shapes. Copyright
&#xa9; 2016 American College of Cardiology Foundation

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

<21>
Accession Number
610504161
Author
Abdelazim R.; Salah D.; Labib H.A.; El Midany A.A.
Institution
(Abdelazim, Salah, Labib) Department of Anesthesiology, Intensive Care,
and Pain Management, Faculty of Medicine, Ain Shams University, Egypt
(El Midany) Department of Cardiothoracic Surgery, Faculty of Medicine, Ain
Shams University, Egypt
Title
Methylene blue compared to norepinephrine in the management of vasoplegic
syndrome in pediatric patients after cardiopulmonary bypass: a randomized
controlled study.
Source
Egyptian Journal of Anaesthesia. 32 (3) (pp 269-275), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background and aim Vasoplegic syndrome (VS) is a frequent complication
following cardiopulmonary bypass (CPB) requiring escalating dose of
vasopressor support. The guanylate cyclase inhibitor methylene blue (MB)
could be an attractive alternative treatment in such cases. This study
examines the efficacy and safety of using MB compared to the commonly used
norepinephrine in VS in pediatric population following CPB. Methods Forty
patients of pediatric age group who developed VS following CPB for
elective corrective cardiac surgeries received 0.5 mug/kg/min
norepinephrine intravenous infusion for 5 min without improvement (Time
1). Patients were randomly assigned to two equal groups. Group MB received
1.5 mg/kg methylene blue by intravenous infusion over 20 min. Group N did
not receive MB. Norepinephrine infusion was continued in both groups and
titrated according to the response of patients with a maximum dose of 2
mug/kg/min (Time 2). Heart rate, mean arterial pressure (MAP), central
venous pressure (CVP), cardiac output (CO), cardiac index (CI), mean
pulmonary artery pressure (MPAP), systemic vascular resistance (SVR) and
systemic vascular resistance index (SVRI) were calculated in both groups.
Side effects related to the study drug were recorded. Results Time 2
values of norepinephrine dose were significantly lower in MB group
compared to N group. Time 2 values of MAP were significantly higher in MB
group compared to N group with a significant decrease in HR in MB group
compared to N group. No change in the rhythm was detected in the two
groups. Time 2 values of CVP were higher in MB group compared to N group.
Time 2 values of CO and CI were significantly lower in MB group compared
to N group and SVR and SVRI were significantly higher in MB group compared
to N group. Time 2 values of MPAP were comparable in both groups and
showed no significant change. No side effects from using MB were recorded
as pulmonary edema and respiratory distress. Conclusion In this study, MB
showed superior efficacy and safety in managing VS in pediatrics following
CPB compared to the conventionally used norepinephrine. Copyright &#xa9;
2016

<22>
Accession Number
606557648
Author
Shoushtarian M.; McGlade D.P.; Delacretaz L.J.; Liley D.T.J.
Institution
(Shoushtarian, Delacretaz, Liley) Cortical Dynamics Ltd., P.O. Box 317,
North Perth, WA 6906, Australia
(McGlade) Department of Anaesthesia and Acute Pain Medicine, St. Vincent'
Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
(Liley) Brain and Psychological Sciences Research Centre, Swinburne
University of Technology, P.O. Box 218, Hawthorn, VIC 3122, Australia
Title
Evaluation of the brain anaesthesia response monitor during anaesthesia
for cardiac surgery: a double-blind, randomised controlled trial using two
doses of fentanyl.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 833-844), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
The brain anaesthesia response (BAR) monitor uses a method of EEG
analysis, based on a model of brain electrical activity, to monitor the
cerebral response to anaesthetic and sedative agents via two indices,
composite cortical state (CCS) and cortical input (CI). It was
hypothesised that CCS would respond to the hypnotic component of
anaesthesia and CI would differentiate between two groups of patients
receiving different doses of fentanyl. Twenty-five patients scheduled to
undergo elective first-time coronary artery bypass graft surgery were
randomised to receive a total fentanyl dose of either 12 mug/kg (fentanyl
low dose, FLD) or 24 mug/kg (fentanyl moderate dose, FMD), both
administered in two divided doses. Propofol was used for anaesthesia
induction and pancuronium for intraoperative paralysis. Hemodynamic
management was protocolised using vasoactive drugs. BIS, CCS and CI were
simultaneously recorded. Response of the indices (CI, CCS and BIS) to
propofol and their differences between the two groups at specific points
from anaesthesia induction through to aortic cannulation were
investigated. Following propofol induction, CCS and BIS but not CI showed
a significant reduction. Following the first dose of fentanyl, CI, CCS and
BIS decreased in both groups. Following the second dose of fentanyl, there
was a significant reduction in CI in the FLD group but not the FMD group,
with no significant change found for BIS or CCS in either group. The BAR
monitor demonstrates the potential to monitor the level of hypnosis
following anaesthesia induction with propofol via the CCS index and to
facilitate the titration of fentanyl as a component of balanced
anaesthesia via the CI index. Copyright &#xa9; 2015, Springer
Science+Business Media New York.

<23>
Accession Number
611257060
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
Percutaneous Closure of Paravalvular Regurgitation After Transcatheter
Aortic Valve Implantation: A Systematic Review.
Source
Clinical Cardiology. 39 (10) (pp 608-614), 2016. Date of Publication: 01
Oct 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Paravalvular regurgitation (PVR) remains one of the drawbacks of
transcatheter aortic valve implantation (TAVI). Details of percutaneous
closure (PCC) of PVR after TAVI remain obscure. We aimed to explore the
patient characteristics, procedural details, closure devices used, and
outcomes of PCC after TAVI. A systematic search of the MEDLINE/PubMed and
Embase databases from January 2002 to September 2015 was conducted.
Reports considered to include same patient were excluded and only the
studies with largest cohorts were included. A total of 14 studies
including 58 patients (61 cases) were included in the study. A
balloon-expandable (BE) valve was used more frequently compared with a
self-expandable (SE) valve (72.6% vs 27.4%, respectively). The mean
success rate was 86.9% (100% and 77.8%, respectively; P = 0.097). The
median number of closure devices used was 1 (range, 1-4) and did not
differ between SE and BE valves (P = 0.71). Mean time from index procedure
to PCC did not differ between SE and BE valves (295 +/- 380 days vs 379
+/- 353 days; P = 0.71). Seven patients had history of valve-in-valve and
6 patients had procedural success. Among the patients with available
follow-up data (94.8%), there were 15 deaths (27.3%). Percutaneous closure
of PVR after TAVI had a high success rate in selected patients in both BE
and SE valves. The success rate, timing, and number of closure devices
were similar between BE and SE valves. However, prognosis remains fairly
poor. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<24>
Accession Number
611275712
Author
Keeling W.B.; Sundt T.; Leacche M.; Okita Y.; Binongo J.; Lasajanak Y.;
Aklog L.; Lattouf O.M.
Institution
(Keeling, Binongo, Lasajanak, Lattouf) Division of Cardiothoracic Surgery,
Emory University, Atlanta, Georgia
(Sundt) Division of Cardiothoracic Surgery, Massachusetts General
Hospital, Boston, Massachusetts, United States
(Leacche) Division of Cardiothoracic Surgery, Brigham and Women's
Hospital, Boston, Massachusetts, United States
(Okita) Division of Cardiothoracic Surgery, Kobe University, Kobe, Japan
(Aklog) Pavilion Holdings Group, New York, United Kingdom
Title
Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus:
A Multi-Institutional Study.
Source
Annals of Thoracic Surgery. 102 (5) (pp 1498-1502), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Surgical pulmonary embolectomy (SPE) has been sparingly used
for the successful treatment of massive and submassive pulmonary emboli.
To date, all data regarding SPE have been limited to single-center
experiences. The purpose of this study was to document short-term outcomes
after SPE for acute pulmonary emboli (PE) at four high-volume
institutions. Methods A retrospective review of multiple local Society of
Thoracic Surgeons databases of adults undergoing SPE from 1998 to 2014 for
acute PE was performed (n = 214). Demographic, operative, and outcomes
data were collected and analyzed. Patients were summarily categorized as
having either massive or submassive PEs based on the presence or absence
of preoperative vasopressors. Results A total of 214 patients with acute
PE were treated by SPE. The mean age was 56.0 +/- 14.5 years, and 92
(43.6%) patients were female. Of those, 176 (82.2%) PEs were submassive
and 38 (17.8%) were massive. Fifteen (7.0%) patients underwent concomitant
cardiac procedures, with 10 (4.7%) having simultaneous valvular
interventions and 5 (2.4%) undergoing concomitant bypass grafting.
Cardiopulmonary bypass (CPB) was used for all cases. Cardioplegic arrest
was used for 80 (37.4%) patients. The median CPB and aortic cross clamp
times were 71.5 (interquartile range [IQR], 47.0-109.5) and 46.0 (IQR,
26.0-74.5), respectively. Notably, only 25 (11.7%) patients died in the
hospital. Mortality was highest among the 28 patients who experienced
preoperative cardiac arrest (9, 32.1%) Conclusions These data represent
the first multicenter experience with SPE for acute pulmonary emboli.
Surgical pulmonary embolectomy for acute massive and submassive PE is safe
and can be performed with acceptable in-hospital outcomes; the procedure
should be included in the multimodality treatment of life-threatening
pulmonary emboli. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<25>
Accession Number
53276671
Author
Petricevic M.; Kopjar T.; Gasparovic H.; Milicic D.; Svetina L.; Zdilar
B.; Boban M.; Mihaljevic M.Z.; Biocina B.
Institution
(Petricevic, Kopjar, Gasparovic, Svetina, Mihaljevic, Biocina) Department
of Cardiac Surgery, University of Zagreb School of Medicine, University
Hospital Center Zagreb, Kispaticeva 12, Zagreb 10000, Croatia
(Milicic) Department of Cardiovascular Diseases, University of Zagreb
School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
(Zdilar) Department of Surgery, University Hospital "Sveti Duh", Zagreb,
Croatia
(Boban) Department of Cardiology, Medical School University of Rijeka and
Osijek, University Hospital "Thalassotherapia Opatija", Opatija, Croatia
Title
Impact of aspirin resistance on outcomes among patients following coronary
artery bypass grafting: exploratory analysis from randomized controlled
trial (NCT01159639).
Source
Journal of Thrombosis and Thrombolysis. 39 (4) (pp 522-531), 2015. Date of
Publication: 01 May 2015.
Publisher
Kluwer Academic Publishers
Abstract
Individual variability in the response to aspirin, has been established by
various platelet function assays, however, the clinical relevance of
aspirin resistance (AR) in patients undergoing coronary artery bypass
grafting (CABG) has to be evaluated. Our working group conducted a
randomized controlled trial (NCT01159639) with the aim to assess impact of
dual antiplatelet therapy (APT) on outcomes among patients with AR
following CABG. Patients that were aspirin resistant on fourth
postoperative day (POD 4) were randomly assigned to receive either dual
APT with clopidogrel (75 mg) plus aspirin (300 mg)-intervention arm or
monotherapy with aspirin (300 mg)-control arm. This exploratory analysis
compares clinical outcomes between aspirin resistant patients allocated to
control arm and patients that have had adequate platelet inhibitory
response to aspirin at POD 4. Both groups were treated with 300 mg of
aspirin per day following surgery. We sought to evaluate the impact of
early postoperative AR on outcomes among patients following CABG.
Exploratory analysis included a total number of 325 patients. Of those,
215 patients with adequate response to aspirin and 110 patients with AR
allocated to aspirin monotherapy following randomization protocol. The
primary efficacy end point (MACCEs-major adverse cardiac and
cardiovascular events) occurred in 10 and 6 % of patients with AR and with
adequate aspirin response, respectively (p = 0.27). Non-significant
differences were observed in bleeding events occurrence. Subgroup analysis
of the primary end point revealed that aspirin resistant patients with BMI
> 30 kg/m² tend to have a higher occurrence of MACCEs 18 versus
5 % (relative risk 0.44 [95 % CI 0.16-1.16]; p = 0.05). This exploratory
analysis did not reveal significant impact of aspirin resistance on
outcomes among patients undergoing CABG. Further, sufficiently powered
studies are needed in order to evaluate clinical relevance of AR in
patients undergoing CABG. Copyright &#xa9; 2014, Springer Science+Business
Media New York.

<26>
Accession Number
613015419
Author
MacDonald Z.D.; Yousef A.; Simard T.; Russo J.J.; Feder J.; Froeschl M.V.;
Dick A.; Glover C.; Burwash I.G.; Hibbert B.; Labinaz M.
Institution
(MacDonald, Yousef, Simard, Russo, Feder, Froeschl, Dick, Glover, Burwash,
Hibbert, Labinaz) OttawaONCanada
Title
Transcatheter aortic valve implantation (TAVI) in native aortic valve
regurgitation: A systematic review.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S100), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) has redefined
the treatment strategy in patients with severe aortic stenosis. However,
small case reports have been published about its performance in patients
suffering from native aortic regurgitation (NAVR) with prohibitive or high
risk for surgical intervention. OBJECTIVE: This is the first systematic
review conducted in the literature to evaluate the safety and feasibility
of TAVI in patients with NAVR. METHODS: All published articles and
abstracts in English language were systematically reviewed between 2002
and 2016 in Medline, Embase, Pubmed, Cochrane Controlled Trials Register
(CCTR) and Cochrane Database of Systematic Reviews (CDSR). We have only
included patients with pure severe aortic regurgitation who underwent
TAVI. Primary endpoint is device success. Secondary endpoint included
procedural complications (paravalvular leak AR2+, major bleeding, stroke,
acute myocardial infarction, acute kidney injury, pacemaker insertion) and
early and late clinical outcomes (30 day and one year mortality rate,
cardiovascular mortality rate and NYHA I/II). RESULTS: A total of 176
patients were included from 31 studies. The majority of patients (92.2%)
are reported to have NYHA class III/IV, with a mean STS score and
Log-Euroscore of 9.5% and 23.8% respectively. Majority of patients (55.4%)
received first generation self-expandable valve. Device success was
reported in 85.8% of patients. Secondary endpoint showed no procedural
death, myocardial infarction or annulus rupture. PVL 2+ was noted in
17.6%, stroke rate of 1.5%, major bleeding in 11.4%, and pacemaker in
10.7%. A 30 day and 1 year mortality rate of 9.6% and 21.3% were found
respectively. More than 80% of patients had remarkable improvement in
their shortness of breath with NYHA I/ II at 30 days. CONCLUSION: In this
cohort study of patients with aortic regurgitation and prohibitive
surgical risk, TAVI seems feasible and with reasonable safety outcome.

<27>
Accession Number
613015347
Author
Chan A.; Wong D.; Latham T.; Charania J.; Drescher L.
Institution
(Chan, Wong, Latham, Charania, Drescher) New WestminsterBCCanada
Title
Comparison of mechanically expanded and self-expanding transcatheter
aortic valve prostheses.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S126-S127), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The latest generation mechanically expanded Lotus Valve System
offers potential benefits over the self-expanding CoreValve and Evolut-R
System by having full repositionability and adaptive seal that reduce the
risk of coronary obstruction and paravalvular regurgitation. There has
been no comparative data of the two valve systems in the real world
practice. METHODS: From 01/2013 to 04/2016, 172 patients underwent
transcatheter aortic valve implantation in our institution. All clinical
and procedural data were prospectively recorded. All endpoints were
defined according to Valve Academic Research Consortium-2. RESULTS: A
total of 140 patients received self-expanding transcatheter heart valves
(120 Corevalve and 20 Evolut-R) and 32 patients received Lotus Valve. The
overall age (84.8+/-5.8 years), gender (43% females), and the Society of
Thoracic Surgeons Predicted Risk of Mortality (6.7+/-4.8%) were similar
between the 2 groups. Device success was 100% for the Lotus group and
87.9% for the self-expanding cohort (p=0.04), and the difference was
largely driven by the lower rate of moderate-severe paraprosthetic
regurgitation (0% vs 10.7%, respectively; p=0.07). The rates of all-cause
mortality (0% vs 0.3%, respectively; p=1.0), stroke (0% vs 1.4%,
respectively; p=1.0), coronary obstruction (0% vs 2%, respectively;
p=1.0), and new pacemaker implantation (28% vs 23%, respectively; p=0.63),
were similar at 30 days in the Lotus and self-expanding valve cohorts.
Significantly higher proportion of patients in the Lotus group underwent
the procedure under conscious sedation as compared to those receiving the
self-expanding valve (72% vs 24%, respectively; p<0.01), without the need
of transesophageal echocardiography monitoring during the prosthesis
deployment. CONCLUSION: In this non-randomized comparison within the
high-surgical risk cohort undergoing transcatheter aortic valve
implantation, the mechanically expanded Lotus Valve was associated with a
higher rate of device success than the self-expanding prostheses, largely
related to the more accurate positioningwhich in turn resulted in less
incidence of significant paraprosthetic regurgitation. A large randomized
study with a longer term follow-up will be needed to confirm the clinical
significance of this observation.

<28>
Accession Number
613015338
Author
Lin L.; Conway J.; Alvarez S.; Goot B.; Tham E.B.; Colen T.; Kutty S.;
Khoo N.S.
Institution
(Lin, Conway, Alvarez, Goot, Tham, Colen, Kutty, Khoo) EdmontonABCanada
Title
Right ventricular strain rate prior to stage 2 palliation (Glenn) improves
test sensitivity and negative predictive value for death or
transplantation in children with hypoplastic left heart syndrome.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S184), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Right ventricular (RV) dysfunction is a risk factor for
mortality in children with hypoplastic left heart syndrome (HLHS). RV
fractional area change (FAC) < 35% is the current two-dimensional
echocardiographic standard for denoting RV dysfunction. Speckle tracking
echocardiography strain rate (SR) is increasingly recognized as a measure
of ventricular contractility. The objective of this study is to assess the
sensitivity and specificity of RV FAC and SR prior to Glenn operation for
predicting death or heart transplantation. METHODS: We prospectively
recruited 43 children with HLHS who successfully underwent their Glenn
surgery. RV FAC and longitudinal (long) and circumferential (circ) strain
(S) and SR were measured on echocardiograms performed at an average of 28
days prior to their Glenn surgery. Patients were divided into those alive
(Group 1) and those who died or underwent heart transplantation (Group 2)
at latest follow up. Echocardiographic analyses comparing groups were
performed blinded to outcome. Receiver Operating Characteristic area under
the curve for S and SR were plotted and cutoff values optimizing
sensitivity and specificity were derived. RESULTS: The subtypes of HLHS
included mitral and aortic stenosis (11), mitral stenosis and aortic
atresia (20) and mitral and aortic atresia (12). The cohort contained 28
male patients (65%). The mean follow-up was 5.4 +/- 2.3 years. There were
35 patients in Group 1 and 8 patients in Group 2 with 6 deaths and 2
transplantations. Group 2 had reduced long and circ SR and RV FAC (Table
1a). RV FAC < 35% had 50% sensitivity and 94% specificity with 67%
positive predictive value and 89% negative predictive value for predicting
death/ transplantation. The addition of either long SR > -0.97 1/s (AUC
0.82, p < 0.001) or circ SR > -0.86 1/s (AUC is 0.83, p < 0.001) increased
test sensitivity and negative predictive value for predicting death or
transplantation (Table 1b). CONCLUSION: In children with hypoplastic left
heart syndrome, reduced RV FAC is specific, but not sensitive for
predicting death or transplantation following Glenn operation. The
addition of long or circ SR by speckle tracking echocardiography increased
sensitivity and improved negative predictive value. SR in combination with
RV FAC may be a useful tool for medium term prognostication in HLHS
patients and warrants further investigation. (Table Presented).

<29>
Accession Number
613015314
Author
Mazine A.; Laurin C.; Han Yee Yu M.; Iriart X.; Khairy P.; Roubertie F.;
Poirier N.C.
Institution
(Mazine, Laurin, Han Yee Yu, Iriart, Khairy, Roubertie, Poirier)
TorontoONCanada
Title
Indications and midterm outcomes of geriatric congenital cardiac surgery:
A multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S183-S184), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: The prevalence of adult congenital heart disease (ACHD) is
increasing. There is a paucity of data regarding surgical treatment of
congenital heart defects in patients 60 years of age and older. The
purpose of this study was to examine the surgical indications and midterm
clinical and echocardiographic results of surgical intervention in this
patient population. METHODS: Clinical and echocardiographic data were
retrospectively gathered from a surgical database of ACHD in two tertiary
academic centers. Patients with isolated congenital aortic valve disease
were excluded from the present analysis. The median follow-up was 26
months (IQR 3-55 months). RESULTS: Between 2000 and 2015, 91 consecutive
patients (mean 67+/-5 years; range 60-82 years) underwent surgery for a
congenital cardiac defect. Thirty-seven patients (41%) were in NYHA
class-III/IV. The mean preoperative EuroSCORE II was 4.1+/-6.1% (range
0.6-44.2%). Nineteen patients (21%) had undergone previous cardiac
surgery. Cardiac diagnoses included Ebstein anomaly in 7 patients,
atrioventricular septal defect in 13, secundum atrial septal defect (ASD)
in 23, sinus venosus ASD in 24, pulmonary stenosis/ Tetralogy of Fallot in
12, coarctation in 2, and coronary anomalies in 2, and miscellaneous
defects in 8. Preoperative echocardiography revealed moderate tricuspid
regurgitation (TR) in 30 patients (33%), and severe TR in 20 (22%), with a
calculated mean systolic pulmonary artery pressure (sPAP) of 44+/-15 mmHg
(range: 20-104 mmHg). Operative mortality occurred in 3 patients (4%). The
cause of death was cardiogenic shock in 2 patients and respiratory failure
in 1. In addition, one patient with documented Child B cirrhosis died 2
months postoperatively of aspergillosis peritonitis. The median ICU stay
was 2 days (IQR 1-4). Thirty-three patients (36%) received a blood product
transfusion. Postoperative morbidity included arrhythmias necessitating
medication in 22 patients (24%), pericardial effusion drainage in 4 (4%),
acute renal insufficiency in 6 (7%), and a permanent pacemaker
implantation in 2 (2%). At last follow-up, only 2 patients were in NYHA
functional class >II/IV. Follow-up echocardiography showed residual
moderate TR in 11 patients, severe TR in 3, with a mean estimated sPAP of
35+/-13 mmHg (range 12-72 mm Hg). CONCLUSION: The majority of our
geriatric ACHD patients underwent surgery for either shunt lesions or
right heart valve lesions. Despite this high predicted risk of mortality,
our data demonstrate that surgery can be performed safely in this patient
population. Surgical therapy led to improvement in functional status,
systolic PAP and TR at intermediate follow-up.

<30>
Accession Number
613015306
Author
Belley-Cote E.P.; Connolly S.J.; Brady K.; Singal R.K.; Healey J.; Lamy
A.; Balasubramanian K.; Devereaux P.J.; Whitlock R.P.
Institution
(Belley-Cote, Connolly, Brady, Singal, Healey, Lamy, Balasubramanian,
Devereaux, Whitlock) HamiltonONCanada
Title
Surgical ablation of atrial fibrillation in 11 countries: The LAAOS III
trial.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S98), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Atrial fibrillation (AF) ablation can be performed at the time
of cardiac surgery. However, uncertainty persists regarding its efficacy,
optimal patient selection, and the choice of lesion set. METHODS: LAAOS
III is an ongoing international randomized controlled trial of surgical
left atrial appendage occlusion versus no occlusion in patients with a
history of AF undergoing cardiac surgery. In this trial, the conduct of AF
ablation is at the discretion of the local surgeon. We compared the
characteristics of enrolled patients with at least 6 months of follow-up,
including the conduct of surgical AF ablation and specific lesion sets,
energy used, and outcomes. RESULTS: Of the 1541 randomized patients, 880
had completed 6 months of follow-up. In the 36 centres in 11 countries, AF
ablation rates varied from 0% to 100%. Sixtyone of 127 surgeons (48%)
performed AF ablation in 293 (33%) patients. Patients who underwent AF
ablation were significantly younger (70+/-9 years vs. 73+/-9 years;
p<0.01) and more likely to require isolated valve surgery (relative risk
[RR] 1.4; 95% confidence interval [CI] 1.1, 1.8; p<0.01). Patients with
paroxysmal AF were more likely to be ablated (paroxysmal 169/453 [37%] vs.
non-paroxysmal 123/420 [29%], p=0.01). AF was present on the baseline ECG
in 56% (164/293) of ablation patients and in 57% (331/583) of non-ablation
patients (p=0.82). In patients with concomitant AF ablation, surgeons
performed bi-atrial ablation in 125 (43%) patients, complete left atrial
ablation in 98 patients (33%) and pulmonary vein isolation in 70 patients
(24%). Radiofrequency was the most frequently used energy (69%) followed
by cryotherapy (19%), cut and sew (11%), and laser and microwave (1%).
Exit block confirmation was performed in 98 patients (33%). At the latest
follow-up, significantly more patients who had undergone AF ablation were
taking anti-arrhythmic drugs (31% vs 13%, p<0.001). Sinus rhythm was more
common in the ablated patients at hospital discharge (57% vs. 43%; RR 1.3;
95% CI [1.2, 1.5]; p<0.01), 30 days of follow-up (41% vs. 28% RR 1.4; 95%
CI [1.2, 1.7]; p<0.01 ), and 6 months (30% vs. 21% RR 1.4; 95% CI [1.1,
1.8]; p<0.01). CONCLUSION: The use of surgical AF ablation ranges from 0%
to 100% across 36 sites in 11 countries. In an international cardiac
surgery trial recruiting AF patients, 33% undergo concomitant AF ablation.
Most surgeons perform bi-atrial lesions and use radiofrequency ablation.
AF ablation modestly reduces AF recurrence.

<31>
Accession Number
613015277
Author
McClure G.R.; Belley-Cote E.P.; Dvirnik N.; An K.; Fortin G.; Jaffer I.;
Spence J.; Singal R.K.; Whitlock R.P.
Institution
(McClure, Belley-Cote, Dvirnik, An, Fortin, Jaffer, Spence, Singal,
Whitlock) HamiltonONCanada
Title
Surgical atrial fibrillation ablation: A systematic review of randomized
trials.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S97), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Surgical ablation for atrial fibrillation significantly
improves maintenance of sinus rhythm and is recommended as a concomitant
procedure in patients undergoing cardiac surgery. However, a recent
randomized trial (RCT) suggested harm by surgical ablation with an almost
threefold increase in the requirement for permanent pacemaker
postablation. The small to medium size published trials lack power to
assess for patient-important outcomes such as mortality, stroke, and
pacemaker requirement. We performed a systematic review and meta-analysis
to evaluate the efficacy and safety of surgical AF ablation. METHODS:
Wesearched CochraneCENTRAL,MEDLINE and EMBASE from inception to July 2015
for RCTs evaluating surgical AF ablation, including any lesion set, versus
no surgical AF ablation in adults with AF undergoing any type of cardiac
surgery. We performed reference screening, full-text eligibility
assessment, risk of bias evaluation and data collection independently and
in duplicate. We evaluated the risk of bias for individual studies with
the modified Cochrane tool and we pooled data using a random effects model
in Revman 5.3. We evaluated the overall quality of evidence with the GRADE
framework. RESULTS: We identified 22 studies (including 1668 patients)
meeting eligibility criteria. Sixteen included studies were considered at
high risk of bias. SurgicalAF ablationwas associated with more freedom
from AF at 12 months (RR 2.35, 95% CI [1.92 to 2.88], p<0.001, I2 = 46%,
low quality). However, no significant difference was seen in mortality (RR
0.99, 95% CI [0.68 to 1.43], I2=0%,moderate quality), stroke (RR1.19, 95%
CI [0.59 to 2.39], p=, 0.63, I2=0% moderate quality), and pacemaker
implantation (RR 1.27, 95% CI [0.82 to 1.98], p=0.28, I2= 3%, high
quality). When comparing pulmonary vein isolation (PVI) and Cox Maze
lesion sets, no significant difference was seen in freedom from AF at 12
months (p for interaction=0.06), mortality (p for interaction=0.87) or
stroke (p for interaction=0.21)). However, Cox Maze procedures conferred a
significantly increased risk of pacemaker requirement (RR 3.01, 95%CI[1.54
to 5.88], p=0.001, I2=0%) while PVI lesion sets did not (RR 1.04,
95%CI[0.65 to 1.66], p=0.52, I2=0%), this difference was significant (p
for interaction=0.01). CONCLUSION: Surgical AF ablation concomitant to
cardiac surgery improved freedom from AF on follow-up. However,
patient-important outcomes including mortality and stroke did not differ
between groups. Maze procedures when compared to PVI showed no difference
in freedom from AF, mortality or stroke but was associated with a
significantly increased risk of pacemaker requirement. (Figure Presented).

<32>
Accession Number
613004430
Author
Halloran P.; Kim D.; Loupy A.; Van-Huyen J.-P.D.; Bruneval P.; Potena L.;
Leone O.; Reeve J.
Institution
(Potena, Leone) University of Bologna, Bologna, Italy
(Loupy, Van-Huyen) Necker Hospital, Paris, France
(Bruneval) Hopitaux De Paris, Paris, France
(Halloran, Kim, Reeve) University of Alberta, Edmonton, AB, Canada
Title
A molecular microscope diagnostic system (MMDx) for heart transplant
biopsies developed from the molecular phenotypes of rejection in kidney
transplants.
Source
Transplantation. Conference: 26th International Congress of the
Transplantation Society, TTS 2016. Hong Kong. Conference Start: 20160818.
Conference End: 20160823. 100 (7 Supplement 1) (pp S294-S295), 2016. Date
of Publication: July 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
The diagnosis of heart transplant rejection by histology in endomyocardial
biopsies (EMB) is challenging. A molecular system (MMDx) has been
developed to assess both T cell-mediated (TCMR) and antibody-mediated
(ABMR) rejection in kidney transplant biopsies. The present project
adapted the MMDx derived in kidney transplant biopsies to heart transplant
EMBs. We collected a single bite from 331 standard-of-care EMBs from three
centers and processed them on Affymetrix microarrays. EMB diagnoses were
assessed by histology using ISHLT guidelines. To develop diagnostic tests
for EMBs, the genes most highly associated with Rejection, ABMR, and TCMR
in kidney transplants were used to perform semi-supervised clustering on
the EMBs. Figure 1 shows that the multivariate distribution of these genes
was highly conserved between kidney biopsies (left panel) and heart
biopsies (right panel). The biopsies segregated into three overlapping
molecular clusters in the discovery set, roughly corresponding to
histologic diagnoses of TCMR, ABMR, and No Rejection (figure 2). Some
histology ABMR and TCMR (particularly TCMR1) biopsies were molecularly No
Rejection. Two-thirds of the biopsies were used as a discovery set, and
the remaining third as a validation set. A predictive model for
probability of ABMR, TCMR, or no rejection, based on the molecular
distribution of biopsies in the discovery set, was used to assign scores
to the biopsies in the validation set. These were distributed similarly to
those in the discovery set. Biopsies designated as ABMR by the molecular
test showed reasonably good agreement with histology, and were highly
associated with HLA antibody. There was considerable less agreement
between molecular and histologic TCMR, supporting concerns that the
current histologic ISHLT assessment of EMBs is poorly predictive of true
TCMR. We conclude that the MMDx can interpret rejection in EMBs, and the
results show strong molecular similarity to rejection in kidney biopsies.
The results also raise concerns about the accuracy of histologic
assessment, particularly of TCMR, but open the possibility of using the
molecular classification as a reference standard to improve conventional
assessments of EMBs. (Figure Presented).

<33>
Accession Number
613004225
Author
Fraga B.; Sousa A.; Janeiro M.; Martins D.; Carvalho N.; Marinho J.;
Teixeira A.; Nogueira G.; Menezes I.; Anjos R.
Institution
(Fraga) Department of Pediatrics, Hospital Do Divino Espirito Santo de
Ponta Delgada, E.P.E., Sao Miguel (Acores), Portugal
(Sousa, Martins, Carvalho, Marinho, Teixeira, Nogueira, Menezes, Anjos)
Hospital de Santa Cruz, CHLO E.P.E., Lisboa, Portugal
(Janeiro) Department of Pediatrics, Hospital Prof. Doutor Fernando
Fonseca, E.P.E, Lisboa, Portugal
Title
Quality of life in children after surgery for congenital heart disease -
Univentricular heart and Tetralogy of Fallot.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp
S98-S99), 2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Introduction: In the last decades there has been an outstanding
improvement in survival of children with congenital heart disease,
including children with complex forms, such as univentricular heart (UH).
Nevertheless, this group of diseases is associated with a significant
long-term morbidity. The aim of this work was to evaluate quality of life
(QL) of children who underwent surgery for UH and a simpler cyanotic
lesion, tetralogy of Fallot (ToF) and compared the two groups with normal
values obtained previously in children with the same age. Methods: We
performed a cross sectional, descriptive study. We assessed QL of children
with UH and ToF aged 8-12, using the Peds QLTM 4th version for parents.
This is a QL questionnaire validated for this age group in our population.
Additional data such as number of surgeries, cardiac catheterizations and
hospital admissions were also assessed. Results: 37 children with
congenital heart disease participated in the study, including 21 with UH
and 16 with ToF (60 children were randomly selected to participate but 23
were excluded due to unavailability to participate). Mean number of
surgeries (ToF: 1.5, UH:2.76), catheterizations (ToF: 1.31, UH:2.45) and
total admissions (ToF: 3.25, UH:6.04) in the 2 groups were significantly
different (p <0.01). The results of total indices of QL and of subscales
are presented in Table 1. Conclusions: Children with UH had lower QL
indices in all categories, however there was no significant difference
between this group and the ToF group. Compared to healthy children, ToF
group had lower scores in all categories except emotional performance,
however the only significantly lower score was school performance.
Children with UH had lower scores than healthy children in all categories,
particularly in physical, school and total QL scores. Mean number of
cardiac surgeries, cardiac catheterizations and total number of
hospitalizations were higher in the group of children with UH,
contributing to a lower QL score. These results are in accordance with the
known higher long term morbidity of UH. [TABLE PRESENTED].

<34>
Accession Number
613004200
Author
Knirsch W.; Mayer K.; Tuura R.; Scheer I.; Beck I.; Bauer J.; Wetterling
K.; Hahn A.; Hofmann K.; Reich B.; Latal B.
Institution
(Knirsch, Mayer) Paediatric Cardiology, Germany
(Mayer, Tuura, Scheer) Diagnostic Imaging, MR Center, Germany
(Beck, Latal) Child Development Center, Germany
(Knirsch, Mayer, Tuura, Scheer, Beck, Latal) Children's Research Center,
University Children's Hospital, Zurich, Switzerland
(Bauer, Hofmann, Reich) Paediatric Heart Center, University Hospital,
Giessen, Germany
(Wetterling) Child Development Center, Frankfurt/Main, Germany
(Hahn) Paediatric Neurology, University Hospital, Giessen, Germany
Title
Cerebral MR morphometry and neurodevelopmental outcome in children before
fontan procedure at 2 years of age - White and grey matter volumes are
larger after Hybrid procedure.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp
S36-S37), 2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Objectives: Advances in cardiac surgery and intensive care have reduced
mortality in patients with congenital heart disease (CHD). Improvement of
neurodevelopmental outcome is one of the most important goals for children
with complex CHD. Delayed brain development has been described
preoperatively in newborns with CHD, affecting mainly white matter (WM)
structures. Perioperative complications may additionally cause brain
injury. We set out to study brain volumes in children with hypoplastic
left heart syndrome (HLHS) or univentricular heart (UVH) at the age of 2
years prior to Fontan surgery. Methods: Prospective two-center
cross-sectional study. Cerebral MRI (21 Zurich patients: 3 Tesla GEMR750
scanner; 23 Giessen patients: 3 Tesla Magnetom Verio B17 Siemens scanner;
FreeSurfer image analysis) was performed before Fontan. Morphometric
findings were correlated with results from the Bayley Scales of Infant and
Toddler Development III (Bayley III). Results: 44 patients (male 28; age
mean 26.7+/-3.9 months) with HLHS (25/44) and non-HLHS (19/44) were
included, treated by Hybrid or Norwood procedure. The average brain
volumes derived were: 909.1 +/-83 ml for total brain volume, 277.1+/- 30
ml for WM, 610.5 +/-59 ml for gray matter (GM), and 42.7+/-5ml for
subcortical GM. Ventricular CSF volume was larger in patients with
abnormal neurologic examination (i.e. tonus and/or abnormal reflexes) and
correlated with poorer Bayley III scores (CSS: rSpearman's Rho= -.31, p=
.043; LCS: rSpearman's Rho= -.40, p= .009, MCS: rSpearman's Rho=-.31, p
=.04). Brain volumes did not differ between type of UVH (HLHS vs.
non-HLHS; p values all >.07). Subcortical GM (p =0.01) and WM (p=.05)
volumes were larger in patients receiving Hybrid procedure as first
surgery. However, patients after Hybrid did not show significantly higher
Bayley III scores (p >.69). Brain volumes were not different in infants
with cerebral lesions compared to those without (p-values all >.38)
Conclusions: Cerebral MR morphometry is a good tool to measure brain
volumes in children with CHD. In children undergoing Fontan procedure,
larger ventricular CSF volume correlates negatively with
neurodevelopmental outcome. WM brain volume loss was associated with the
surgical approach, but not with the subtypes of CHD. Perioperative
management in combination with routine neurodevelopmental follow up
programs are needed to further improve outcome.

<35>
Accession Number
613004096
Author
Knirsch W.; Mayer K.; Scheer I.; Tuura R.; Beck I.; Bauer J.; Wetterling
K.; Hahn A.; Hofmann K.; Latal B.; Reich B.
Institution
(Knirsch, Mayer) Paediatric Cardiology, Germany
(Mayer, Scheer, Tuura) Diagnostic Imaging, MR Center, Germany
(Beck, Latal) Child Development Center, Germany
(Knirsch, Mayer, Scheer, Tuura, Beck, Latal) Children's Research Center,
University Children's Hospital Zurich, Switzerland
(Bauer, Hofmann, Reich) Paediatric Heart Center, University Hospital,
Giessen, Germany
(Wetterling) Child Development Center, Frankfurt/Main, Germany
(Hahn) Paediatric Neurology, University Hospital Giessen, Germany
Title
Cerebral MRI findings and neurodevelopmental outcome in children before
Fontan procedure at 2 years of age - Enlargement of liquor spaces
influences outcome.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp S13),
2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Objectives: Children with complex congenital heart disease undergoing
neonatal cardiac surgery are at risk for neurodevelopmental impairment,
especially in univentricular heart malformations. Neonatal cerebral MRI
findings show pre- and postoperative cerebral injuries such as white
matter injury and cerebral stroke. We focussed on the long term impact of
cerebral injuries comparing cerebral MRI findings and neurodevelopmental
outcome at two years of age. Methods: In a prospective multicenter
cross-sectional study we analysed consecutive patients with hypoplastic
left heart syndrome (HLHS) or with UVH before Fontan procedure. Patients
were palliated either by Hybrid or Norwood procedure. Neurodevelopmental
outcome was investigated by Bayley Scales of Infant and Toddler
Development III (Bayley III) and compared to findings of cerebral MRI scan
before Fontan procedure. Results: 48 patients (male 32; age mean
26.6+/-3.8 months) with HLHS (n=26) and non-HLHS (n =22) were included. 44
patients were treated first by Hybrid procedure (n = 25), Norwood
procedure (n =7) and shunt or banding procedure without cardiopulmonary
bypass (n =12) before bidirectional cavopulmonary anastomosis (n =48). In
Bayley III Scales, median cognitive scale (CCS) 100 (range 65-120),
language scale (LCS) 97 (68-124) and motor composite scale (MCS) 97
(55-124) were only inferior compared to norm data for LCS (Z=-2.2, p=
.025). 36.2% (17/47) of patients showed disease-related intracranial
lesions: isolated ventriculomegaly in 3, minimal (<2mm) white matter
lesions in 5, cerebral stroke (less one third of vascular supply
territory) in 9. The latter two findings where additionally associated
with liquor spaces enlargement in 7 patients. Therefore, the enlargement
of inner and/or outer liquor spaces was the most frequent pathologic MRI
finding and was associated with lower scores in all subscales of Bayley
III (CCS: p =.020; LCS: p= .002; MCS: p =.013). Conclusions: Despite an
overall good neurodevelopmental outcome before Fontan procedure 36.2% of
patient exhibit intracranial lesions on cerebral MR Scan. Enlargement of
inner or outer liquor spaces seems to be the major contributing factor of
poor neurodevelopmental outcome. Improved perioperative management and
neurodevelopmental follow up programs are needed in this patient group to
detect neurological deficit early and to further improve quality of life.

<36>
Accession Number
613004084
Author
Krupickova S.; Fraisse A.; Ghez O.
Institution
(Krupickova, Fraisse, Ghez) Royal Brompton and Harefield Hospital, London,
United Kingdom
Title
Outcome of symptomatic partial atrioventricular septal defect
necessitating repair during infancy.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp
S55-S56), 2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Background: Patients with partial atrioventricular septal defect are
typically asymptomatic and electively repaired at pre-school age. We
sought to analyse the mortality, re-operation rate and risk factors with
adverse outcome of symptomatic infants with partial atrioventricular
septal defect necessitating repair during infancy in one UK centre in
recent era(2000-15). Methods: The inclusion criteria were as follows:1.
partial atrioventricular septal defect, 2. heart failure unresponsive to
medical treatment, and 3. bi-ventricular repair during the first year of
life. Thirteen patients (6males), who had undergone corrective surgery at
a median age of 197(16-346) days, were included. Seven patients had an
associated syndrome: Down(n = 3), trisomy 47XXX(n= 1), Noonan (n= 1) and
VACTERL (n =1). Five patients required either surgery (4 coarctation
repair) or transcatheter intervention (1balloon angioplasty of pulmonary
artery) before primary repair. One patient with tracheobronchomalacia
required cardiopulmonary resuscitation before repair. Results: Median
weight at primary repair was 5.1 kg(3.3-7.5 kg), median hospital stay 19
days (4-128 days). Five patients had unfavorable anatomy of the left
atrioventricular valve: the leaflets were severely dysplastic in 2 cases,
mildly dysplastic in 1 case, 1 patient had unusual orientation of the zone
of apposition and 1 patient small left atrioventricular valvar annulus.
One patient died 68 days after primary repair from a noncardiac cause.
Five patients (42%) were reoperated at a median interval of 2.8 years
(33days-8.3years), including left atrioventricular valvar repair for
severe regurgitation in 3 cases, relief of subaortic (n = 1) and pulmonary
vein stenosis (n = 1). One patient required repetitive left
atrioventricular valve repair, followed by mechanical valve replacement
and pacemaker implantation. The probability of developing severe left
atrioventricular valvar regurgitation 10 years after primary repair in
patients with unfavorable anatomy was 100% and 0% in patients with
favorable anatomy (p <0.01). After a median follow-up of 3.8years, all
patients were asymptomatic from the cardiac point of view and no patient
had a severe atrioventricular valvar regurgitation. Conclusion: Although
the in-hospital mortality is not negligible in patients necessitating
repair of partial atrioventricular septal defect in infancy, the long term
outcome is favorable with no reported mortality and good functional
status. The rate of re-operation mainly due to severe left
atrioventricular valvar regurgitation is high in patients with dysplastic
valve.

<37>
Accession Number
613003942
Author
Marwali E.; Boom C.; Djer M.; Setiabudy R.; Suryaatmadja M.; Munasir Z.;
Batubara J.; Sastroasmoro S.; Haas N.; Portman M.
Institution
(Marwali, Boom) Department of Cardiology-Vascular Medicine, National
Cardiovascular Center Harapan Kita, University of Indonesia, Jakarta,
Indonesia
(Djer, Setiabudy, Suryaatmadja, Munasir, Batubara, Sastroasmoro) Cipto
Mangunkusumo Hospital and Faculty of Medicine, University of Indonesia,
Jakarta, Indonesia
(Haas) Department for Pediatric Cardiology and Intensive Care, Ludwig
Maximilians University, Klinikum Grosshadern, Munich, Germany
(Portman) Seattle Children's Hospital, University of Washington, Seattle,
WA, United States
Title
Oral triidothyronine supplementation increases lactate-pyruvate ratio as a
marker of effective availability of energy substrates.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp
S26-S27), 2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Background: The incidence of euthyroid sick syndrome (ESS) was thought to
be closely related to low cardiac output syndrome (LCOS) after congenital
heart disease (CHD) surgery. Thyroid hormones exert their action on
cardiovascular function by improving lactate and pyruvate utilization as
effective energy substrates for mitochondrial respiratory function.
Objectives: To provide evidence that oral T3 can prevent and ameliorate
ESS, thus subsequently reduce the incidence of LCOS, decrease serum
lactate levels and lactate-pyruvate ratio as a marker of effective
utilization of energy substrates. Methods: The study was a single center,
randomized, double blind, and controlled clinical trial. It was conducted
in children, <3 years of age undergoing corrective open heart surgery. The
treatment group received oral T3 supplementation 1 mug/kgBW while the
placebo group received saccharum lactis every 6 hours from the induction
of anaesthesia until 60 hours after the first dose. Results: A total of
171 participants were enrolled to the study. ESS was already found in
22.2% before surgery and in 89% at 24 hours post cross clamp removal (FT3
less than 2.5 pg/mL). LCOS was higher in the placebo than the treatment
group with a significant difference at 6 hours post cross clamp removal
(37% vs. 20% respectively, odds ratio of 2.28 (1.15-4.52), p =0.02. At 1
hour after cross clamp removal the serum lactate levels were significantly
lower in the treatment group compared to placebo (1.50 (1.27- 1.83) and
1.70 (1.55-2.23) mmol/L, respectively, p= 0.04). There was an increase of
lactate-pyruvate ratio at 1 hour post cross clamp removal in the treatment
group without LCOS compared to those with LCOS [20.99 (15.82-31.56) vs.
12.61(8.89-18.67), respectively, p =0.04] and in the placebo group at 24
hours post cross clamp removal [35.22 (22.08-65.75) vs.17.05
(11.84-26.07)], respectively, p= 0.01). Conclusion: Oral T3 prophylaxis
could prevent and ameliorate ESS, which subsequently reduced LCOS after
cardiac surgery. An increased lactate-pyruvate ratio in the treatment
group may be a sign of an early increased pyruvate utilization for energy
substrate.

<38>
Accession Number
613003860
Author
Raissadati A.; Nieminen H.; Haukka J.; Jokinen E.; Sairanen H.
Institution
(Raissadati, Nieminen, Jokinen, Sairanen) Department of Surgery and
Cardiology, Hospital for Children and Adolescents, Helsinki University
Central Hospital, Helsinki, Finland
(Haukka) Hjelt Institute, Faculty of Medicine, University of Helsinki,
Helsinki, Finland
Title
Late causes of death after congenital cardiac surgery - A population-based
six-decade study with 98% follow-up.
Source
Cardiology in the Young. Conference: 50th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC.
Italy. Conference Start: 20160601. Conference End: 20160604. 26 (pp
S3-S4), 2016. Date of Publication: May 2016.
Publisher
Cambridge University Press
Abstract
Introduction (or Basis or Objectives): Survival after paediatric
congenital cardiac surgery is lower than the general population, but has
improved significantly during recent decades. Consequently, the number of
adults with congenital heart defects (CHD) has surpassed paediatric
patients. The majority of patients require lifelong follow-up. Information
regarding causes of death late after surgery would benefit follow-up among
these patients. We investigated whether late modes of death after surgery
for CHD's have changed in recent years and how they compare to rates among
the general population. Methods: We obtained data retrospectively from a
nation-wide CHD database, including paediatric patients who underwent
cardiac surgery at<15 years of age at one of five university- or one
district hospital in Finland 1953-2009. The Finnish population registry
supplied patient survival status. We categorised modes of death into
CHD-related and non-CHD-related deaths using ICD diagnostic codes. Modes
of death among the study population were compared to those among a sex-,
age-, birth-time-, and hospital district-matched control population
supplied by Statistics Finland. Results: Between 1953 and 2009, 10,964
patients underwent 13,876 operations, with 98% follow-up (10,692). The
longest follow-up was 60 years. Early (< 30 days) and late mortality were
5.7% (612 patients) and 11% (1,130 patients), respectively. The incidence
of CHD-related death correlated with defect severity. Fatal heart failure
(17% with pulmonary hypertension) was themost commonmode of CHD-related
death, but decreased among those undergoing surgery 1990-2009 (Table 1).
The incidence of sudden death was zero after surgery for ASD, VSD, TOF,
and TGA 1990-2009 (Table 1). Deaths due to respiratory, neurological,
endocrine and metabolic disease were significantly more common among study
patients than the general population. Pneumonia constituted the majority
of non- CHD-related deaths among the study population. Conclusions: Sudden
death and fatal heart failure after congenital cardiac surgery decreased
markedly among study patients, but remained a significant cause of death
among patients operated for severe cardiac defects, warranting life-long
surveillance. Pneumonia requires immediate diagnosis and treatment among
these patients. [TABLE PRESENTED].

<39>
Accession Number
613002532
Author
Haque N.; Dasgupta M.; Naqvi R.M.
Institution
(Haque, Dasgupta, Naqvi) Western University, Canada
Title
A systematic review on the efficacy of ondansetron in the prevention and
treatment of post-operative delirium.
Source
European Geriatric Medicine. Conference: 12th International Congress of
the European Union Geriatric Medicine Society, EUGMS 2016. Portugal.
Conference Start: 20161005. Conference End: 20161007. 7 (pp S20-S21),
2016. Date of Publication: October 2016.
Publisher
Elsevier Masson SAS
Abstract
Introduction: Post-operative delirium (POD) affects up to 50% of
surgeries. It is associated with higher rates of functional decline and
death. Serotonin may play a role in POD. Ondansetron is a serotonin
antagonist with a favourable safety profile, and could represent a
therapeutic and preventive option in POD. Methods: We performed a
systematic review of MedLine, EMBASE, CENTRAL and PsychINFO from inception
to December 2015. Initial screening identified 622 abstracts and three
randomized controlled trials (RCTs) met inclusion criteria. Results: Two
RCTs examined ondansetron for the treatment of POD. One study administered
haloperidol 5 mg or ondansetron 8 mg intravenously (IV) as a single dose
to 80 delirious patients post cardiac surgery (mean age 71). Both had
similar reductions in their average delirium score and patients with
persistent delirium. Another study administered ondansetron 4 mg or
haloperidol 5 mg IV twice daily to 96 postoperative delirious patients for
three consecutive days (mean age 31). Both groups had similar delirium
rates after administration. However the ondansetron group received a
higher total dose of rescue haloperidol. Finally, one RCT examined
prophylactic ondansetron versus placebo to prevent POD in 106 orthopedic
patients (mean age 71). They administered 8 mg of ondansetron or placebo
IV once daily for five days postoperatively. There were significantly less
delirious patients in the ondansetron group starting on day 3 and
persisting to day 5. Key conclusions: Ondansetron appears to be an
efficacious agent for the prevention and treatment of POD. Further large
RCTs of high quality are needed to confirm these results.

<40>
Accession Number
613002507
Author
Pratesi A.; Baldasseroni S.; Barucci R.; Pallante R.; Foschini A.;
Venturini S.; Mannarino G.; Nucci V.; Burgisser C.; Marchionni N.;
Fattirolli F.
Institution
(Pratesi, Baldasseroni, Barucci, Pallante, Foschini, Venturini, Mannarino,
Nucci, Burgisser, Marchionni, Fattirolli) Department of Experimental and
Clinical Medicine, Careggi University Hospital, University of Florence,
Florence, Italy
(Burgisser, Fattirolli) Cardiac Rehabilitation Unit, Careggi University
Hospital, Florence, Italy
Title
Effects of cardiac rehabilitation in maintaining physical performance of
patients aged >75 years over the long-term period, after an acute coronary
syndrome or heart surgery.
Source
European Geriatric Medicine. Conference: 12th International Congress of
the European Union Geriatric Medicine Society, EUGMS 2016. Portugal.
Conference Start: 20161005. Conference End: 20161007. 7 (pp S20), 2016.
Date of Publication: October 2016.
Publisher
Elsevier Masson SAS
Abstract
Background: There are few data about effectiveness of cardiac
rehabilitation (CR) in promoting durable functional recovery and adherence
to secondary cardiovascular prevention in elderly. Aim of our study was to
evaluate if Home-Based exercise program is more effective than usual care
after in-Hospital CR in maintaining long-term effects on physical
performance in elderly, after acute coronary syndrome or heart surgery.
Methods: At the end of four weeks CR program, 160 patients aged >75 years
were enrolled in the study and were randomized in usual care group
(standard follow-up visits at 6 and 12 months) and intervention group
(specific set of exercises detailed and recorded in a log book, with a
reinforcement session at the CR-centre each month for the first 6 months).
The patients were evaluated at the entry and at discharge of CR, at 6- and
12-months follow-up, measuring with VO2peak
(cardiopulmonary-exercise-testing), distance walked (6-Minute Walking
test) and Torque peak (isokinetic dynamometer). Results: there were no
significant differences between 2 groups with mean age 80 +/- 4 ys. After
adjustment for age, sex, and test value at the entry in CR program, in
ANOVA for repeated measure, all the patients substantially maintained the
improvement obtained with CR in all three physical performance indexes at
12 months follow up, and the intervention group had a slightly lower
reduction respect to control. Key conclusions: our findings suggest that
elderly treated with a CR program substantially maintain their functional
status after a cardiac event, without further significant improvement with
our Home-based exercise program.

<41>
Accession Number
613002155
Author
Mannarino G.; Van Der Velde N.; Thibodeau M.-P.; Baan J.; Van Mourik M.;
Masson J.B.; Vis M.M.; Bramlage P.; Kurucova J.; Thoenes M.; Michel J.-P.;
Schoenenberger A.; Ungar A.
Institution
(Mannarino, Ungar) Unit of Geriatric Cardiology and Medicine, University
of Florence, Italy
(Van Der Velde, Van Mourik) Internal Medicine, Section of Geriatric
Medicine, Academic Medical Center, Amsterdam, Netherlands
(Thibodeau, Masson) University of Montreal, CHUM-Hopital Notre- Dame,
Montreal, Canada
(Baan, Vis) Cardiology, Academic Medical Center, Amsterdam, Netherlands
(Bramlage) Institute for Pharmacology und Preventive Medicine,
Cloppenburg, Germany
(Kurucova, Thoenes) Edwards Lifesciences, Nyon, Switzerland
(Michel) Geneva Medical School and University Hospitals, Switzerland
(Schoenenberger) Geriatrie Universitat Bern, Inselspital, Bern,
Switzerland
Title
Transcatheter aortic valve implantation registry with comprehensive
geriatric assessment.
Source
European Geriatric Medicine. Conference: 12th International Congress of
the European Union Geriatric Medicine Society, EUGMS 2016. Portugal.
Conference Start: 20161005. Conference End: 20161007. 7 (pp S15-S16),
2016. Date of Publication: October 2016.
Publisher
Elsevier Masson SAS
Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) has become a
viable alternative to surgical aortic valve implantation in high-risk and
inoperable patients. Procedural results and medium term outcomes are,
however, strongly affected by the overall health state of an individual
patient and this is not sufficiently covered by a standardized cardiology
assessment. For this reason we aimed to investigate the impact of a
comprehensive geriatric assessment (CGA) on the accuracy of the prognosis
and the clinical benefits of TAVI in this population. Methods:
Multicentre, multinational registry in patients undergoing TAVI.
Co-primary objectives are to establish predictive value of CGA
(Multidimensional-Prognostic-Index [MPI], short-physical-performance-
battery [SPPB], SilverCode) for mortality and/or hospitalization and to
demonstrate changes in the CGA after TAVI. Results: A total of 72 patients
with a mean age of 85.4 +/- 2.9 years and a EuroScore II of 9.7 +/- 8.3%
were enrolled. Three months after TAVI 94.8% were classed NYHA I/II (18.8%
at baseline; p < 0.001), the MPI was 0.29 +/- 0.12, SPPB 7.6 +/- 2.9 (p <
0.001), and SilverCode 21.1 +/- 7.9 (vs. 0.32 +/- 0.10, 5.6 +/- 3.3 and
22.0 +/- 7.3 at baseline). Eight patients reached the combined endpoint of
death/stroke within 3 months. These patients had a higher MPI and a lower
SPPB at baseline, compared to those without (MPI: 0.103 [95%CI, 0.031 to
0.176; p=0.006]; SPPB: -3.962 [95%CI, -6.228 to -1.696%; p = 0.001]). In
the multivariate analysis, a high SPPB at baseline was associated with a
reduced risk for stroke and/or death within 3 months after TAVI.
Conclusion: The results suggest that it might by beneficial to include CGA
into the pre-TAVI assessment to improve outcomes. Lower SPPB performance
appears to best predict poor outcomes within 3 months after TAVI.

<42>
Accession Number
613015528
Author
Spence J.; Belley-Cote E.; Ma K.; Donald S.; Centofanti J.; Hussain S.;
Gupta S.; Devereaux P.; Whitlock R.
Institution
(Spence, Belley-Cote, Ma, Donald, Centofanti, Hussain, Gupta, Devereaux,
Whitlock) DundasONCanada
Title
Efficacy and safety of inhaled anesthetic for postoperative sedation
during mechanical ventilation in adult cardiac surgery patients: A
systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S301-S302), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Volatile anesthetics have pharmacokinetic and pharmacodynamic
properties that are ideally suited to the cardiac surgical ICU. Since the
development of the Anesthetic Conserving Device (AnaCONDaTM, Sedana
Medical, Uppsala, Sweden), their use in this setting has increased.
Randomized trials have shown it to be associated with shorter time to
extubation and, in the cardiac surgery population, lower postoperative
biomarker peak, suggesting a potential therapeutic benefit. Existing
studies have been underpowered to show an impact on ICU or hospital
length-of-stay (LOS), major adverse cardiovascular events (MACE) or
mortality. As such, we undertook a systematic review and meta-analysis,
emphasizing their efficacy and safety in the context of a fasttrack
approach to postoperative care. METHODS: We searched MEDLINE, EMBASE,
Cochrane Library, ISI Web of Science, and Clinicaltrials.gov for
randomized controlled trials in postoperative, adult, cardiac surgical
patients comparing inhaled anesthetic with intravenous sedation. Crossover
studies were excluded. No language or date of publication restrictions
were applied. Primary outcomes of interest were time to extubation, ICU
LOS, and hospital LOS. Secondary outcomes included postoperative troponin
peak, MACE, and kidney injury, effectiveness of sedation, and inpatient
costs. References were screened independently and in duplicate, and
studies deemed to be potentially relevant were evaluated for inclusion by
full-text review. Risk of bias was assessed using the Cochrane tool. Data
were meta-analysed using RevMan 5.3 software (Cochrane Collaboration,
Oxford, United Kingdom) and the overall quality of evidence for each
outcome was evaluated using the GRADE framework. RESULTS: 8 studies
including 610 patients met eligibility criteria. Studies were assessed as
having a high risk of bias because blinding and per protocol analysis.
Outcomes are summarized in Figure 1 below. Volatile anesthetic sedation
was associated with a shorter time to extubation, both after ICU admission
(SMD 76 minutes, 95% CI 150-2, very low quality evidence) and
discontinuation of sedation (SMD 74 minutes, 95% CI 126-23, moderate
quality evidence). There was no difference in ICU or hospital LOS. Peak
troponin levels were significantly lower (SMD 0.72ng/mL, 95% 1.2-0.2, high
quality evidence) in the volatile anesthetic group. Studies varied in
their reporting of MACE, which were summarized narratively. CONCLUSION:
Volatile sedation is associated with shorter time to extubation, though
this does not translate to shorter ICU or hospital LOS. Though it was
associated lower postoperative troponin levels, further study is needed to
evaluate whether this surrogate outcome has an impact on morbidity or
mortality. (Table presented).

<43>
Accession Number
613015487
Author
Afilalo J.; Kim S.; O'Brien S.; Brennan J.M.; Edwards F.H.; Mack M.J.;
McClurken J.B.; Cleveland J.C.; Smith P.K.; Shahian D.M.; Alexander K.P.
Institution
(Afilalo, Kim, O'Brien, Brennan, Edwards, Mack, McClurken, Cleveland,
Smith, Shahian, Alexander) MontrealQCCanada
Title
Gait speed and operative mortality in older adults following cardiac
surgery.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S244-S245), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Prediction of operative risk is a critical step in
decision-making for cardiac surgery. Existing risk models may be improved
by integrating a measure of frailty such as 5-meter gait speed to better
capture the heterogeneity of the older adult population. Previous studies
suggested that gait speed was predictive of surgical complications, albeit
with limited sample sizes underpowered to detect differences in mortality.
Thus, we sought to determine the association of 5-meter gait speed with
operative mortality in older adults undergoing cardiac surgery. METHODS:
We conducted a prospective cohort study at 119 centres participating in
the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from
2011 to 2014. The 5-meter gait speed test was performed in patients aged
60 years or older undergoing coronary artery bypass, aortic valve surgery,
mitral valve surgery, and combined procedures. The endpoints of interest
were all-cause mortality during the first 30 days after surgery;
secondarily, a composite outcome of mortality or major morbidity during
the index hospitalization. RESULTS: The cohort consisted of 15,171 cardiac
surgery patients including 2,481 octogenarians. The median age was 71
years and 31% were female. Compared to patients in the fastest gait speed
tertile (>1.00 m/s), operative mortality was increased for those in the
middle tertile (0.83-1.00 m/s; OR 1.77, 95% CI 1.34 to 2.34) and slowest
tertile (<0.83 m/s; OR 3.16, 95% CI 2.31 to 4.33). After adjusting for the
STS predicted risk of mortality and the surgical procedure, gait speed
remained independently predictive of operative mortality (OR 1.11 per 0.1
m/s decrease gait speed, 95% CI 1.07 to 1.16). Gait speed was also
predictive of the composite outcome of mortality or major morbidity (OR
1.03 per 0.1 m/s decrease gait speed, 95% CI 1.00 to 1.05). Addition of
gait speed to the STS predicted risk resulted in a c-statistic change of
0.005 and an integrated discrimination improvement of 0.003. CONCLUSION:
Gait speed is an independent predictor of adverse outcomes after cardiac
surgery, with each 0.1 m/s decrease conferring an 11% relative increase in
mortality. Gait speed can be used to refine estimates of operative risk,
to support decision-making, and, since incremental value is modest when
used as a sole criterion for frailty, to screen older adults that could
benefit from further geriatric assessment.

<44>
Accession Number
613017081
Author
Giambruno V.; Hafiz A.; Fox S.; Jeanmart H.; Cook R.; Khaliel F.; Teefy
P.; Sridhar K.; Lavi S.; Bagur R.; Iglesias I.; Jones P.; Harle C.;
Bainbridge D.; Chu M.; Kiaii B.
Institution
(Giambruno, Hafiz, Fox, Jeanmart, Cook, Khaliel, Teefy, Sridhar, Lavi,
Bagur, Iglesias, Jones, Harle, Bainbridge, Chu, Kiaii) LondonONCanada
Title
Hybrid coronary revascularization: A promising coronary revascularization
technique. The Canadian experience with long-term follow up.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S96), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Hybrid Coronary Revascularization (HCR) is offered as an
alternative strategy for patients with multivessel coronary artery disease
(CAD). It combines the advantages of both surgical and percutaneous
revascularization eliminating at the same time the disadvantages of both
procedures. In fact, this evolving revascularization technique utilizes
the survival benefit conferred by the left internal thoracic artery (LITA)
graft to the left anterior descending coronary artery (LAD) while
providing the patients with complete and truly minimally invasive
revascularization with PCI to the non-LAD vessels. The objective of this
study was to assess graft and stent patency at 6 months, rate of bleeding,
ICU and hospital stay, rate of reintervention and long term clinical
follow up. METHODS: From March 2004 to March 2016 a total of 209 patients
(61.7+/-11.0 years; 163 males and 46 females) underwent robotic-assisted
minimally invasive direct coronary artery bypass (RADCAB) graft of the
LITA to the LAD and PCI in a non-LAD vessel in a single or two stage, in
three different centres. Patients underwent 6 months angiographic follow
up. The average clinical follow up was 77.82+/-41.4 months. RESULTS:
Successful HCR occurred in 202 of the 209 patients (7 patients required
intraoperative conversion to conventional coronary artery bypass). 152
patients underwent simultaneous surgical and percutaneous intervention. 19
patient underwent PCI before surgery, 38 patient underwent PCI after
surgery. 195 patients were treated with drug-eluting stents, whereas 14
patients were treated with bare metal stents. No in-hospital mortality
occurred. The average ICU stay was 1+/-1 days and the average hospital
stay was 5+/-2 days. Only 12.9% of patients required a blood transfusion.
Six-month coronary angiogram follow up has been performed in 95 patients.
Angiographic evaluation demonstrated a LITA anastomotic patency of 97.9%
and stent patency of 92.6%. At 77.8+/-41.4 months clinical follow up
demonstrated 95.7% survival, 92.8% freedom from angina, 90.9% freedom from
any form of coronary revascularization (PCI of LITA-to-LAD anastomosis was
performed in 5 patients, in one case the anastomosis was surgically
revised and PCI was repeated in 13 patients). CONCLUSIONS: Hybrid
revascularization appears to be a promising and safe revascularization
strategy. It provides selected patients with an alternative, functionally
complete revascularization with minimal surgical trauma and good longterm
clinical outcomes. However, randomized prospective trials comparing HCR
with conventional CABG procedures or multivessel PCI will be necessary to
further evaluate the effectiveness of this alternative coronary artery
revascularization technique.

<45>
Accession Number
613016559
Author
Toeg H.; French D.; Glibert S.; Rubens F.
Institution
(Toeg, French, Glibert, Rubens) OttawaONCanada
Title
Incidence of sternal wound infection following tracheostomy in cardiac
surgery patients: A systematic review and meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S229), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections (SWI) after cardiac surgery.
METHODS: All studies reporting the incidence of SWI after tracheostomy in
cardiac surgery patients were collected and analyzed. Subgroup analyses
determined a priori included timing of tracheostomy and type of procedure
(open versus percutaneous). All analyses used the random effects model. A
meta-regression analysis was performed on the proportion of SWI and number
of days between tracheostomy and initial cardiac surgery. RESULTS: A total
of 13 studies met inclusion criteria. The incidence of SWI across all
studies reported was 7% (95% CI (confidence interval)[4, 10]). The
percutaneous tracheostomy group had a SWI proportion of 3% (95% CI [1, 8])
while the open tracheostomy group had a SWI proportion of 9% (95% CI [5,
14]). The incidence of SWI with early (< 14 days)(7%; (95% CI [3,11])
versus late (+/- 14 days)(7%; (95% CI[4,10]) tracheostomy was similar.
Meta-regression demonstrated no significant relationship between incidence
of SWI and number of days between tracheostomy and initial cardiac surgery
(R2=6.13%, p=0.72). CONCLUSION: The incidence of SWI following
tracheostomy in cardiac surgery patients remains high at 7 % (95% CI
[4,10]). Either open or percutaneous tracheostomy following cardiac
surgery is a feasible option since the incidence of SWI is comparable.
Further studies are needed to determine which strategy (open versus
percutaneous; early versus late) generates faster patient recovery and
lowers overall cost.

<46>
Accession Number
613016536
Author
Travale I.; Drake K.
Institution
(Travale, Drake) Hamilton Health Sciences, Hamilton, ON, Canada
Title
Haloperidol prophylaxis in cardiac surgery for patients at risk of
delirium: A randomized placebocontrolled pilot study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S315), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
Post Cardiotomy Delirium (PCD) is a devastating neuropsychic complication
resulting from imbalances in neurotransmitters that regulate cognition.
Risk factors include cognitive impairment, previous stroke/TIA, atrial
fibrillation, and advanced age. Incidence rates are as high as 78% and are
associated with an increase in morbidity and mortality, adverse events,
and length of stay. The purpose of this pilot RCT was to determine the
safety and feasibility of haloperidol prophylaxis to inform future
research in cardiac surgery. This pilot study utilized a double-blind,
randomized, placebocontrolled trial methodology replicating a previous
study in the hip surgery population. Primary outcomes were safety and
feasibility, secondary outcomes included PCD incidence, duration, and
severity. Patients undergoing sternotomy were eligible if age > 70 yrs. or
60-69 yrs. with >1 risk factors for PCD. Twenty-five patients were
enrolled. There were 4 adverse events, none related to the treatment.
Feasibility related to recruitment proved difficult, but the protocol was
simple. Patients in the treatment group had lower MoCA scores (24.44 vs.
26.18) higher euroSCOREs (4.44 vs. 3.95) and higher severity scores (30
vs. 19.7). Overall PCD incidence was 28% with no statistical difference
between groups. Finally, the study was safe but feasibility was a
challenge. The PCD incidence and duration did not differ unlike severity,
but the treatment group was at higher risk for PCD. There are many
limitations to the study since it was not powered to detect secondary
outcomes. Future studies should include a larger sample size to detect the
true effect of the proposed treatment.

<47>
Accession Number
613015787
Author
Pacheco C.; Marquis-Gravel G.; Tremblay-Gravel M.; Couture E.; Avram R.;
Desplantie O.; Bibas L.; Simard F.; Berube L.; Ducharme A.; Jolicoeur M.;
Tournoux F.
Institution
(Pacheco, Marquis-Gravel, Tremblay-Gravel, Couture, Avram, Desplantie,
Bibas, Simard, Berube, Ducharme, Jolicoeur, Tournoux) MontrealQCCanada
Title
Right ventricular remodeling in peripartum cardiomyopathy: Insights from a
provincial multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S193), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare, serious
condition affecting previously healthy young women. Most of the past
studies at the early stage of the PPCM reported echocardiographic data
only on the left ventricle (LV). Right ventricular (RV) remodeling is a
strong predictor ourvival in heart failure (HF) patients, however its
prevalence in PPCM is uncertain. We sought to characterize RV remodeling
in PPCM and to determine whether its presence correlates with LV
dysfunction. METHODS: We conducted a retrospective multicenter study,
identifying 38 patients with PPCM, defined as HF presenting between
1-month antepartum to 5-months post partum, without an alternative cause.
Echocardiogram at diagnosis was available for offline analysis in 22
patients. A single operator was blinded to clinical data and outcomes. RV
function using tricuspid annular plan systolic excursion (TAPSE) and
fractional area change (FAC) and structural remodeling (RV dimensions)
were assessed in addition to the data on LV remodeling. RESULTS: Patients
were 30+/-7y old and PPCM was diagnosed after delivery in all patients.
The median time between delivery and diagnosis was 6 [2-35] days. The
majority (68%, n=15) were severely symptomatic with NYHA class 4 symptoms,
and 32% (n=7) required temporary mechanical support. One heart
transplantation and one death occurred during the initial hospitalization.
The LV had a mean end diastolic (LVEDD) diameter of 56+/-8 mm, with severe
dilatation in 32% (n=7). Mean LV ejection fraction (EF) was 35+/-12% and
64% had LVEF <40%. Dimensions of the RV in the parasternal long axis view
(PLAX) and in the apical view were 30+/-5mm and 36+/-5mm, respectively,
enlarged in at least one dimension for 7 (32%) patients (2 patients had
both dimensions increased). In terms of RV function, mean TAPSE was
19+/-2mm and FAC 35+/-13%. TAPSE was abnormal in 41% (n=9) of the patients
and FAC in 50% (n=11). Seven patients (32%) had abnormally low values in
both parameters. There was a significant correlation between LVEDD and
RVPLAX dimension (Figure, panel A) as well as between LVEF and FAC (panel
B). CONCLUSION: In our cohort, RV dilation and dysfunction at the early
stage of PPCM occurred in about one third of the patients. Its severity
correlated with LV abnormalities, suggesting that PPCM may cause important
biventricular dysfunction in a proportion of patients. To our knowledge,
this is the first Canadian data concerning detailed echocardiographic
assessment of RV remodeling in PPCM. (Figure Presented).

<48>
Accession Number
613015980
Author
Basuoni A.M.; El-Naggar W.M.; Mahdy M.A.; Al-Kaffas S.H.
Institution
(Basuoni, El-Naggar, Mahdy, Al-Kaffas) CairoEgypt
Title
Effect of intra-coronary (IC) tirofiban following aspiration thrombectomy
on infarct size, in patients with large anterior ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S253), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Thrombus embolization during percutaneous coronary
intervention (PCI) in ST-segment elevation myocardial infarction (STEMI)
is common and RESULTS in sub-optimal myocardial perfusion and increased
infarct size. Two strategies proposed to reduce distal embolization and
improve outcomes after primary PCI are bolus intra-coronary (IC) Tirofiban
and manual Aspiration Thrombectomy. OBJECTIVE: To evaluate effect of
Intra-coronary delivery of bolus Tirofiban following Aspiration
Thrombectomy on reduction of infarct size using cardiac magnetic resonance
imaging (cMRI) in patients with large anterior STEMI undergoing primary
PCI. METHODS: A Prospective single-blind randomized controlled trial was
conducted between August, 2014 and November, 2015. 50 patients with large
anterior STEMI were screened at 2 sites in one country (Egypt). Aspiration
Thrombectomy was performed in all patients using a 6 F aspiration
catheter. Patients were randomized to IC Tirofiban (Study group) and no IC
Tirofiban (control group). To ensure high intra-thrombus drug
concentrations, a 0.25-mg/kg bolus of Tirofiban was administered locally
at the site of the infarct lesion via the aspiration catheter after
flushing of the aspiration catheter well. Assessment of final TIMI flow
and myocardial blush was done by blinded observer. OUTCOMES: Primary end
point: Infarct Size at 30 Days measured by cMRI. Secondary end point:
Myocardial blush grade at the end of the PCI procedure. Major Adverse
Cardiac Events (MACE) at 30 days defined as re-infarction, stroke, severe
heart failure and death. Bleeding risk was assessed using TIMI (major and
minor) risk scores. RESULTS: Evaluable MRI results at 30 days where
present in only 40 of 50 patients (80%), with the most common reasons for
missing data being patient re-infarction prior to 30 days and inability to
tolerate the procedure. Patients randomized to IC Tirofiban compared with
no IC Tirofiban had a significant reduction at 30 days infarct size
(median, 15451 mm3-IQR, 17404 mm3-n=20) vs (median, 43828 mm3-IQR, 49599
mm3-n=20) P value= 0.002. Patients randomized to IC Tirofiban compared
with no IC Tirofiban had no significant difference at post PCI Myocardial
blush grade (P value= 0.67). CONCLUSIONS: In patients with large anterior
STEMI presenting early after symptom onset and undergoing primary PCI,
infarct size at 30 days was significantly reduced by bolus IC Tirofiban
delivered to the infarct lesion site following manual Aspiration
Thrombectomy. There is no significance in MACE at 30 days between patients
received bolus IC Tirofiban and patients who did not receive. (Table
presented).

<49>
Accession Number
613016152
Author
AlTurki A.; Marafi M.; Cardinale D.; Blackwell R.H.; Bessissow A.; Essebag
V.; Healey J.S.; Huynh T.
Institution
(AlTurki, Marafi, Cardinale, Blackwell, Bessissow, Essebag, Healey, Huynh)
MontrealQCCanada
Title
Risk of stroke associated with atrial fibrillation after non-cardiac
surgery: Insights from a meta-analysis of randomized controlled studies
and observational studies.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S255-S256), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Post-operative atrial fibrillation (POAF) is a frequent
occurrence after non-cardiac surgery. Due to its generally short duration,
it remains uncertain whether POAF after non-cardiac surgery is associated
with increased risk of stroke. Therefore, we aim to elucidate the risk of
stroke associated with POAF following non-cardiac surgery by a
meta-analysis of randomized controlled studies and observational studies.
METHODS: We searched MEDLINE, EMBASE, Web of Science, Scopus and
clinicaltrials.gov from inception up to April 1 2016, for all studies that
reported strokes in patients who developed POAF following non-cardiac
surgery (no language restriction). Two reviewers independently performed
the literature search and extraction. We used a random-effects model to
summarize the studies. RESULTS: From a total of 4364 abstracts screened,
we retained 13 studies enrolling 1,694,663 patients for the final
analyses. 16,061 patients had POAF, in whom the mean ages ranged from
60-72 years and females ranged from 21%-41%. In addition, 30%-72% were
hypertensive, 11%-33% were diabetic and 15%-50% had coronary artery
disease. In comparison, 1,678,602 patients did not have POAF. Their mean
ages ranged from 56-72 years, females ranged from 22%-60%. Moreover,
22%-70% were hypertensive, 7%-31% were diabetic and 10%-40% had coronary
artery disease. There were four randomized controlled studies, two
prospective and 7 retrospective cohort studies. At one month follow-up,
POAF was associated with approximately three times increase in risk of
short-term stroke [odds ratio (OR): 3.09 (95% Confidence intervals (CI):
2.14-4.46); n=9 studies]. POAF was associated with approximately four
times increase in long-term risk of stroke with OR: 3.97(95% CI:
3.46-4.57) in four studies with +/-12-month follow-up. Combining all 13
studies, the overall increase in risk of stroke associated with POAF was
3.84 (95% CI: 3.38-4.38) (Figure 1). CONCLUSIONS: POAF was associated with
increased short and long-term risk of stroke after non-cardiac surgery.
Future studies are needed to evaluate the impact of anticoagulation in
decreasing the risk of stroke in these patients. (Table presented).

<50>
Accession Number
613016125
Author
Laberge A.; Brassard P.; Arsenault B.; Costerousse O.; Poirier P.;
Bertrand O.; Despres J.; Piche M.
Institution
(Laberge, Brassard, Arsenault, Costerousse, Poirier, Bertrand, Despres,
Piche) QuebecQCCanada
Title
Positive effect of the PPAR-gamma agonist rosiglitazone on hemodynamic
response to exercise in type 2 diabetic men after coronary artery bypass
graft surgery: A 1-yr randomized study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S223-S224), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: To assess the effects of a 1-yr treatment with the
PPAR-agonist rosiglitazone on the hemodynamic response to exercise in
post-coronary artery bypass graft (CABG) surgery male patients with type 2
diabetes (T2D). METHODS: A total of 116 men (age: 64+/-7 years) with T2D
(HbA1c: 6.6+/-0.8 %) who underwent CABG were randomly assigned to a
PPAR-agonist (rosiglitazone; 8mg/day) (n=57) or placebo (n=59) for a
12-month period. Body fat composition and distribution were assessed at
baseline and at 12 months. Hemodynamic response to exercise was evaluated
during a maximal treadmill test. Exercise-induced hypertension (EIH) was
defined asmaximal systolic blood pressure (BP) (SBP)+/-220 mmHg and/or
maximal diastolic blood pressure (DBP) +/- 100 mmHg. Insulin resistance
was estimated usingHOMA-IRindex. RESULTS: An increase in BMI (32.0+/-4.5
vs. 30.7+/-4.1 kg/m2, p<0.0001) andwaist circumference (WC) (109+/-12 vs.
107+/-12 cm, p=0.004) was observed at 12 months in the rosiglitazone
group, mostly attributed to increased subcutaneous adipose tissue (AT)
(SAT) (1718+/-743 vs. 1463+/-623 cm3, p<0.0001)with no change in visceral
AT (VAT) (2024+/-584 vs. 2075+/-586 cm3, p=0.41). PPAR-agonist treated
patients displayed improvements in HbA1c (6.3+/-0.7 vs. 6.6+/-0.8 %,
p=0.007) and insulin resistance (3.9+/-2.4 vs. 6.0+/-3.4, p<0.0001) as
well as in several cardiometabolic parameters such as triglycerides
(p=0.0284), HDL-cholesterol (p<0.0001), free fatty acids (p=0.001) and
adiponectin levels (p<0.0001). In addition, resting BP (SBP: 135+/-18 vs.
141+/-16 mmHg, p=0.008; DBP: 71+/-9 vs. 77+/-9 mmHg), p<0.0001) and
maximal exercise DBP (84+/-15 vs. 89+/-15 mmHg, p=0.01) were reduced in
the PPAR-agonist group. Maximal exercise SBP tended to decrease (189+/-33
vs. 195+/-29 mmHg, p=0.07), whereas maximal exercise duration was
unchanged (702+/-54 vs 708+/-42 seconds, p=0.39). The proportion of men
with EIH decreased (25 vs. 39 %) in the PPAR-agonist group. In the
sub-group with EIH at baseline, resting DBP (p=0.001), resting
rate-pressure product (p=0.03), maximal exercise SBP (p=0.06) and DBP
(p=0.008), as well as recovery DBP (p=0.05) were all reduced. CONCLUSION:
Treatment with the PPAR-gamma agonist rosiglitazone for 1-yr was
associated with a preferential accumulation of SAT that had no adverse
effects on hemodynamic response to exercise in T2D men. In fact,
rosiglitazone improved baseline BP and BP exercise response at 12-month
follow-up, such positive effect being even more pronounced among the
subgroup of men who initially had EIH.

<51>
Accession Number
613016106
Author
Anonymous
Title
69th Annual Meeting of the Canadian Cardiovascular Society.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (no pagination), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
The proceedings contain 490 papers. The topics discussed include:
comparison of thermodilution and indirect fick cardiac outputs in
pulmonary artery hypertension; characterization of circulating and
neutrophil derived pro- and antiinflammatory biomarkers in patients with
various heart failure phenotypes; perinatal hemodynamic profile in fetuses
with vein of galen aneurysmal malformation; nitroglycerine derived
fractional flow reserve for the assessment of intermediate coronary
lesions; is there gender discrimination in coronary revascularization? a
single center retrospective analysis of multiple arterial coronary
grafting; comparative effectiveness analysis of hybrid coronary
revascularization versus off-pump coronary artery bypass grafting: single
center experience with long-term follow up; prognostic value of magnetic
resonance imaging in clinically silent cardiac sarcoidosis: a
meta-analysis; and bicuspid aortic valve repair: external aortic valve
annuloplasty.

<52>
Accession Number
613016412
Author
Plourde B.; Kuriachan V.; Rothschild J.M.; Exner D.V.
Institution
(Plourde, Kuriachan, Rothschild, Exner) CalgaryABCanada
Title
Transvenous laser lead extractions: Risk factors for mortality and
complications derived from a single centre experience.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S288-S289), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Transvenous laser lead extractions (TLLE) are deemed safe and
efficient procedures albeit performed in highrisk patient. Previous
studies have established procedural efficacy but with a narrow focus on
the peri-procedural period. The objective of the present report is to
document mortality, complication rates and risk factors in a broader
perspective. METHODS: All adult patients who underwent TLLE in a single
tertiary centre between January 2012 and December 2015 were analyzed.
Baseline demographics, device information, surgical procedures, hospital
stay, and follow up data were collected through provincial electronic
database and hospital charts. Follow up was extended to the first device
clinic visit, hospital stay or death, whichever came first. RESULTS:
During the observation period, 159 TLLE were performed in 155 patients.
Median age was 64+/-16.3 years and the majority of patients were men
(74%). Forty percent of extracted systems were pacemakers, 43% were
defibrillators (ICD) and 16% were cardiac resynchronization therapy
defibrillators (CRT-D). There were 274 leads extracted (average of
1.7+/-0.8 leads by procedure). Average lead duration was 99+/-57.6 months
(range 5 to 370 months). Complete system extraction was done in 133
(83.6%) procedures, some leads were abandoned in 25 (15.7%) procedures.
Clinical success was achieved in 152 procedures (95.6%), partial success
in 6 (3.8%) and 1 procedure (0.6%) was unsuccessful. Median follow up was
29+/-15.4 months during which 21 (13.2%) patients died. Amongst those, 7
were in-hospital deaths including one peri-procedural death. In univariate
analysis, statistically significant risk factors for mortality were age,
atrial fibrillation/flutter, chronic kidney disease, hypertension, and
hemoglobin level. In multivariate analysis, only hemoglobin level (10 g/L
increments) increased significantly the risk of mortality (OR 1.42 95% CI
[1.11-1,81], p=0.005). There were 48 (30,2%) procedures with at least one
complication. Individual complication rate remains low (Table 1). Overall,
the most common complication was re-operation for lead dislodgement (12,
7,5%) which occurred more frequently in patients who had TLLE for system
upgrade (9; 75%, p= 0,018). Statistically significant univariate risk
factors for overall complications included age, history of cardiac surgery
and atrial fibrillation/flutter however, no risk factors were
statistically significant in multivariate analysis. For major
complications, age greater than 65 years significantly increased the risk
(OR 3,19 95% CI [1.04-9.86], p=0.043). CONCLUSION: TLLE are complex
procedures done in patients with significant co-existing illnesses. Not
surprisingly the overall mortality and complications rates are high
although procedure-related death and serious complications remain
relatively low given the patient population.

<53>
Accession Number
613016384
Author
Harris K.C.; Schubert S.; Voss C.; Balbacid E.; Hosking M.C.
Institution
(Harris, Schubert, Voss, Balbacid, Hosking) VancouverBCCanada
Title
Impact of optical coherence tomography on management of pediatric heart
transplant recipients: Data from the international pediatric OCT registry.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S84-S85), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a leading risk factor
for graft failure and mortality in pediatric cardiac transplant
recipients. Optical coherence tomography (OCT) is a high-resolution
intravascular imaging technique that has shown promise at detecting early
signs of CAV which are not yet detectable by conventional angiography. We
established an International Pediatric OCT Registry to: 1) evaluate the
impact of OCT on clinical care; and 2) document the safety profile of this
technique across pediatric centres. METHODS: We established an
International Pediatric OCT Registry from three centres in Canada (BC
Children's Hospital Vancouver), Germany (Deutsches Herzzentrum Berlin) and
Spain (Hospital Universitario La Paz, Madrid). Participating sites input
relevant patient demographics (age, sex, diagnosis), clinical data, and
cardiac catherization procedural data (indication for OCT, technical
aspects, case complications) directly to a secure online research database
(REDCap). OCT images were quantitatively and qualitatively analyzed at the
core imaging laboratory at BC Children's Hospital, Canada. Coronary
angiograms were read centrally with investigators blinded to the OCT
results. RESULTS: The International Pediatric OCT Registry includes n=115
cardiac catherization cases including n=85 children (12.5+/-4.5 yrs; 59%
male), of whom most were cardiac transplant recipients (n=75, 5.4+/-4.9
yrs at Tx). Indication for OCT was routine surveillance (85%) or follow-up
of CAV (15%). OCT findings lead to changes in medical management in 20% of
cases, including changes to pharmacological therapy or changes to
surveillance frequency. Severe intimal thickening was angiographically
silent in 60% of cases. In 67% of patients who had intensification of
their immunosuppression this was done on the basis of OCT findings alone
as selective coronary angiography was normal. Overall, 5% of cases were
associated with minor intra-procedural complications (predominantly
transient ECG changes including ST elevation or T wave inversion); there
were two cases of arrhythmias requiring intervention. There were no post
procedural complications observed. CONCLUSION: OCT imaging provides
additional anatomic insight to coronary changes in pediatric heart
transplant recipients at risk of CAV. These data result in changes to
medical management in 20% of cases. The safety profile of OCT is similar
to that of selective coronary angiography in children. The impact of OCT
on long-term outcomes in this patient population remains unknown but it
appears to have the potential to improve early diagnosis and management of
CAV.

<54>
Accession Number
613016697
Author
Travale I.L.; Drake K.A.; Power P.; Schoenberg J.; Toito F.; Lamy A.
Institution
(Travale, Drake, Power, Schoenberg, Toito, Lamy) HamiltonONCanada
Title
Haloperidol prophylaxis in cardiac surgery for patients at risk for
delirium: A randomized placebocontrolled pilot study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S231), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Post Cardiotomy Delirium (PCD) is a devastating
neuropsychologic complication resulting from imbalances in
neurotransmitters that regulate cognition. Risk factors include cognitive
impairment, previous stroke/TIA, atrial fibrillation, and advanced age.
Incidence rates can be as high as 78% and are associated with an increase
in morbidity, mortality, adverse events, and LOS. METHODS: This pilot
study utilized a double-blind, randomized, placebo-controlled trial
methodology. Primary outcomes were safety and feasibility. Secondary
outcomes included PCD incidence, duration, and severity. Patients
undergoing sternotomy were eligible if age > 70 yrs. or 60-69 yrs. with >1
risk factor for PCD. Twenty-five patients were enrolled in this pilot
study. RESULTS: There were 4 adverse events, 2 in each arm, but none were
related to the treatment. Feasibility related to recruitment proved
difficult. Patient concerns included not wanting to take additional
medications, believing they would not get confused, not enough time to
decide, and concerns over side effects of Haloperidol. Logistical issues
included competition with other studies, timing of consent, completion of
pre-operative MoCA, timely administration of study drug, and
incomplete/missed documentation. The overall PCD incidence rate was 28%
and higher in the treatment group (33% vs. 23%). The average duration of
delirium was higher in the placebo group (2.3 days vs. 1.75 days).
Similarly, the placebo group had higher delirium severity scores than the
treatment group (30 vs. 19.75). Despite randomization, patients in the
treatment group had lower pre-operative MoCA scores (24.44 vs. 26.18),
higher EuroSCOREs (4.44 vs. 3.95), and higher transfusion rates (4.1 vs
1.6). Patients in the placebo group had more hypertension (92% vs. 67%),
diabetes (62% vs. 17%) and positive smoking history (69% vs. 50%).
CONCLUSION: The study was safe, but feasibility was a challenge. All
adverse events were not related to treatment, but patients were reluctant
to enroll in the study because of the use of an antipsychotic and not
having family members present to render an opinion. The overall PCD
incidence was low considering the enrolment of a high-risk population. The
treatment group was at higher risk for PCD but had fewer average days of
delirium than the placebo group. Severity scores higher in the placebo
group possibly reflect the treatment's effect, but the sample size was too
small and thus it limited the power to detect secondary outcomes to make
this inference. Future studies should include a larger sample size to
detect the true effect of the proposed treatment.

<55>
Accession Number
613016221
Author
Nery P.B.; Roux J.F.; Sarrazin J.F.; Lam B.K.; Nair G.M.; Samardhi H.;
Redpath C.J.; Sadek M.M.; Green M.S.; Birnie D.H.
Institution
(Nery, Roux, Sarrazin, Lam, Nair, Samardhi, Redpath, Sadek, Green, Birnie)
OttawaONCanada
Title
Prevalence of pulmonary vein electrical reconnection after surgical atrial
fibrillation ablation: A multicenter study.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S256-S257), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
INTRODUCTION: Surgical ablation of atrial fibrillation (AF) is often
performed in patients undergoing concomitant cardiac surgery. While
surgical AF ablation is associated with a reduction in AF burden, there is
limited data on its effectiveness in achieving durable pulmonary vein (PV)
electrical isolation. The goal of this study was to assess the status of
PV to left atrium (LA) electrical conduction in subjects experiencing
recurrent atrial arrhythmias after surgical AF ablation. METHODS: We
evaluated consecutive patients presenting with recurrent atrial
arrhythmias after surgical AF ablation from 3 tertiary care centers.
Subjects referred for subsequent electrophysiological study (EPS) and
catheter ablation were included. The status of PV-LA conduction post
surgical ablation was evaluated using a multipolar circular catheter at
EPS. RESULTS: Twenty-five patients were identified, 7 of whom were
diagnosed with right atrial flutter. LA mapping was completed in 14
subjects, and 56 pulmonary veins were evaluated. Baseline characteristics
were the following: Nine (64%) subjects were male; mean age at the time of
EPS was 59+/-9 years; mean LA volume was 48+/-15.8 ml/m2; and average LVEF
was 49+/-8%. Ten subjects (71%) underwent concomitant mitral valve surgery
at the time of surgical ablation. The median time from surgical ablation
to EPS was 31 months. Indications for repeat ablation included LA flutter
(n=10; 71%) and AF (n=4; 29%). At repeat EPS, 45/56 (80%) PVs were
electrically connected to LA in 13 (93%) subjects. PV-LA electrical
connection was observed in 4 PVs in 9 (64%) patients, 3 PVs in one (7%)
and in two ipsilateral PVs in 3 (21%). All PVs were electrically isolated
in one (7%) patient. There was no correlation between the indication for
repeat ablation and the status of PV-LA conduction. CONCLUSION: Pulmonary
vein reconnection is common in patients presenting with recurrent atrial
arrhythmias post surgical AF ablation. This data highlights the challenges
in achieving durable PV isolation. Prospective studies are needed to
confirm these findings.

<56>
Accession Number
613016329
Author
Hosking M.C.; Schubert S.; Voss C.; Balbacid E.; Harris K.C.
Institution
(Hosking, Schubert, Voss, Balbacid, Harris) VancouverBCCanada
Title
Quantitative assessment of intimal thickening using optical coherence
tomography - Relationship to cardiac allograft vasculopathy.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S84), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a cause of graft
failure and mortality in pediatric heart transplant recipients. Optical
coherence tomography (OCT) is an ultra high-resolution intravascular
imaging technique that can detect angiographically silent coronary
changes. We sought to characterize OCT-derived parameters indicative of
evolving CAV in pediatric heart transplant patients. METHODS: We extracted
data from the International Pediatric OCT Registry, which includes
pediatric heart transplant recipients who underwent OCT imaging (St Jude
Medical) during cardiac catherization procedures in Canada, Germany and
Spain. For quantitative OCT analyses, we identified 10-20 cross-sectional
frames that were >1 mm apart and measured cross-sectional area (CSA) for
the intima and media, as well as maximal intimal thickness. We measured
the maximal intimal thickness and a median value for the intima to media
CSA ratio (I/M). CAV classification was determined by angiography which
was evaluated by investigators blinded to the OCT findings. RESULTS: We
included 57 pediatric heart transplant patients (age at Tx 5.1+/-4.6yrs;
age at OCT 13.1+/-.3.5yrs; 62%male) who had OCT performed in 93 coronary
arteries (n=40 RCA; n=24 LAD;n=25 LCx; n=4 other coronary artery). We
measured 14+/-3 cross-sectional frames over an average vessel segment
length of 24+/-11mm. Maximal intimal thickness was 0.21+/-0.1mm, with 6
vessels (in 6 patients) presenting with severe intimal thickening
(>0.4mm). All 6 cases presented with abnormal I/M, but only 2 had
concurrent abnormal angiographic findings consistent with CAV; all 6 cases
had a history of biopsy-confirmed rejection. Maximal intimal thickness was
not related to sex, age at Tx, time since Tx, age at OCT, preexisting
diagnosis of CAV or previous biopsy-confirmed rejection. Maximal thickness
was significantly higher in those who had a concurrent biopsy-confirmed
episode of rejection (n=10 patients; 0.31+/-0.2 vs 0.19+/-0.1mm; p=0.025),
or newly diagnosed CAV (n=2 patients; 0.47+/-0.3 vs. 0.20+/-0.1mm,
p<0.001). Overall, I/M was 1.3+/-0.4, with 82% of vessels presenting with
an abnormal I/M (>1). I/M was not related to sex, age at Tx, time since
Tx, age at OCT, previous or current diagnosis of CAV, or episode of
biopsy-confirmed rejection. CONCLUSION: Mild intimal thickening is common
in pediatric heart transplant recipients. Severe intimal thickening is
rare but is more common in those with a new diagnosis of CAV. Prospective
serial evaluation may better determine pediatric cutoffs for intimal
thickness that is predictive of the future development of CAV.
Intravascular imaging technology may provide an opportunity for early
intervention in the setting of evolving CAV.

<57>
Accession Number
613016300
Author
Murphy T.; Forgie R.; MacLeod J.; Brown C.; Hassan A.; Pelletier M.
Institution
(Murphy, Forgie, MacLeod, Brown, Hassan, Pelletier) Saint JohnNBCanada
Title
Severe coagulopathy after cardiac surgery: Is FEIBA a viable therapy?.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S113), 2016. Date of
Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: FEIBA (Factor VIII Inhibitor Bypassing Activity) is a
potentially important therapy for patients with uncontrollable bleeding
after cardiac surgery. The objective of this study was to evaluate the
safety and efficacy of FEIBA for the treatment of persistent coagulopathy
following cardiac surgery. METHODS: From Jan 2008 to June 2015, patients
who underwent cardiac surgery and also received either intraoperative or
postoperative FEIBA were identified utilizing an institutional database of
prospectively gathered data. All patients received tranexamic acid while
on cardiopulmonary bypass, followed by protamine administration once
weaned from bypass. All patients initially received fresh frozen plasma
and platelets for persistent coagulopathy. If bleeding persisted beyond
this, FEIBA was used as adjuvant therapy. The intraoperative
characteristics and postoperative results of those patients were extracted
and analyzed. RESULTS: During the study period, 5551 patients had cardiac
surgery, of which 276 (5.0%) received FEIBA for refractory bleeding. Most
received FEIBA either intraoperatively (Group 1, n=120) or postoperatively
(Group 2, n=133), while some received both intra- and postoperative doses
(n=23). All patients received FEIBA only after failure of conventional
therapy. Patient characteristics and results are found in Table 1. Group 1
patients were more likely to require an emergent procedure (p<0.001) and
85% underwent complex or combination procedures (p<0.001). Cardiopulmonary
bypass and cross clamp times were longer (p<0.001) in Group 1. FEIBA was
effective in expediting hemostasis and chest closure. These patients had a
low reoperation rate (1.7%) but a high rate of significant complications,
including neurological injury and renal failure, partly indicative of
their complex presentation. Group 2 patients were less likely to require
emergent or complex procedures, with 47% requiring isolated CABG or valve
surgery. Their bypass and cross clamp times were shorter, and bleeding was
only problematic after arriving to the ICU. For most, postoperative chest
tube hourly output decreased significantly after FEIBA (363 +/- 314 ml/hr
before FEIBA, 69 +/- 61 ml/hr after FEIBA). While 14.2% required
re-exploration, CNS and myocardial injuries were low (1.5% and 0%).
Mortality was high in both groups, reflecting the complex nature of their
diagnoses and procedures. CONCLUSION: This is the largest reported series
of FEIBA administration for the treatment of diffuse coagulopathy in
cardiac surgery. While deemed clinically effective in controlling
perioperative bleeding, high complication rates were observed. Definitive
safety and efficacy standards will need to be established through a
randomized controlled trial. (Table Presented).

<58>
Accession Number
613016624
Author
Ben Ali W.; Ducruet T.; El-Hamamsy I.; Bouchard D.; Poirier N.C.
Institution
(Ben Ali, Ducruet, El-Hamamsy, Bouchard, Poirier) MontrealQCCanada
Title
Long term results of paediatric ross procedure: A new methodology of
timeto-event data meta-analysis.
Source
Canadian Journal of Cardiology. Conference: 69th Annual Meeting of the
Canadian Cardiovascular Society. Canada. Conference Start: 20161022.
Conference End: 20161025. 32 (10 Supplement 1) (pp S170-S171), 2016. Date
of Publication: October 2016.
Publisher
Pulsus Group Inc.
Abstract
BACKGROUND: Ross procedure has been used for over 40 years in the surgical
management of irreparable aortic valve disease in children. Little
clinical long-term information is available regarding the durability of
the autograft in the aortic position and the pulmonary conduit substitute.
Moreover, there is no fully established methodology to perform
time-to-event data meta-analysis. The aim of study was to develop a new
methodology to perform such meta-analysis and therefore pool the long term
results of paediatric Ross procedure. METHODS: Pubmed, Medline, Embase and
Internet were searched for eligible studies published until December 2015.
Data extraction was conducted by 4 independent authors. Kaplan Meier (KM)
curves reproduced in each paper were digitized. We developed with the
support of Cochrane Canada an algorithm to derive the original patient
time-to-event data and the censored informations. Derived KM curves were
graphically checked with the original ones and validated with an accuracy
of 99%. The KM data from different studies were stored together and
Statistical methods for time-to-event data were employed to analyze
outcomes at follow-up, including the KM estimator with the log-rank test.
Results were stratified in term of age at intervention (neonate versus
pediatric) and era of surgery (enrolment before and after 2010). RESULTS:
A total of 9 studies were eligible for the metaanalysis (1022 patients).
The KM estimates of survival at 10 and 15 years were, respectively, 91%
[95% CI 89% to 93%] and 90% [95% CI 88% to 92%]. Pooled mortality was
significantly higher in the neonate subgroup (log-rank p value : 0.01).
Pooled freedom from reoperation at 5, 10 and 15 years were respectively
87% [95% CI 85% to 89%], 78% [95% CI 74% to 82%] and 60% [95% CI 54% to
66%]. Pooled freedom from autograft reoperation at 5, 10 and 15 years were
respectively 97% [95% CI 95% to 99%], 91% [95% CI 89% to 93%] and 83% [95%
CI 79% to 87%]. The freedom from overall reoperation and autograft
reoperation were significantly higher in the recent series subgroup (
logrank p value respectively 0.002 and 0.007). CONCLUSION: The new
developed methodology gives an objective appraisal of time-to-event data
and is actually validated by Cochrane collaboration. Present meta-analysis
validates the Ross procedure as low risk palliative procedure for isolated
aortic valve or complex left heart obstruction in children, with good
early and late survival. Durability limitations become apparent by the end
of the first postoperative decade.

<59>
Accession Number
613015309
Author
Banque M.F.; Requiron-Sy M.D.; Ribu R.
Institution
(Banque) Chong Hua Hospital, Philippine Heart Center Pediatric
Pulmonology, Quezon City, Philippines
(Requiron-Sy) Philippine Heart Center, Section of Pediatric Pulmonology,
Quezon City, Philippines
(Ribu) Philippine Heart Center, Thoracic and Cardiovascular Surgery,
Quezon City, Philippines
Title
Rudhe syndrome: Reversible shunt related lobar emphysema-how far to
investigate? A report of cases and systematic review of literature.
Source
Paediatric Respiratory Reviews. Conference: 12th International Congress on
Pediatric Pulmonology. Spain. Conference Start: 20130629. Conference End:
20130701. 14 (pp S85), 2013. Date of Publication: July 2013.
Publisher
W.B. Saunders Ltd
Abstract
Background: Congenital large hyperlucent lobe or lobar emphysema (LE) in
earlier literatures is not uncommon in children with congenital heart
diseases (CHD). Rudhe syndrome, coined in 2010, refers to reversible shunt
related lobar emphysema. Methods: We reviewed four patients with
concomitant LE and CHD. The medical records were evaluated with reference
to age, CHD, pulmonary function, radiographic findings, pulmonary artery
(PA) pressure, clinical signs and symptoms, surgical management and
outcome after surgery. We also reviewed 21 literatures on LE with CHD.
Results: Three of the 4 patients had left to right shunts with
hyperlucency on chest radiograph, pulmonary hypertension on 2D
echocardiogram, dilated PAs and chamber enlargements. They underwent
cardiac surgery and noted resolution of the lung hyperinflation with
complete resolution of clinical symptoms after 6 months. One underwent TOF
correction with lung tacking, also with radiographic resolution of the
lung hyperinflation, however this patient died of sepsis. The literature
review consisted of 13 subjects. The three most common cardiac lesions
associated with LE are VSD, PDA and TOF with absent pulmonary valve. One
hundred of the 137 underwent cardiac surgery without lobectomy. Resolution
of airway obstruction and lung hyperinflation were noted as early as 3
months post surgery. Conclusion: The findings of reversible airway
obstruction and LE post cardiac surgery made us believe that the emphysema
is secondary to the shunt. Earlier correction of cardiac lesion improved
the prognosis. Keywords: Rudhe Syndrome, Reversible Shunt Related Lobar
Emphysema, Congenital Heart Disease.

<60>
Accession Number
612985596
Author
Tang C.; Yu L.; Zhu Y.; Ye C.; Zhao Q.
Institution
(Tang, Yu) Departments of Gastroenterology, Ruijin Hospital, China
(Zhu, Ye, Zhao) Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong
University, China
Title
Investigation of gastroduodenal mucosal injury in different antiplatelet
drug users after Coronary Artery Bypass Grafting.
Source
Journal of Gastroenterology and Hepatology (Australia). Conference: Asia
Pacific Digestive Week, APDW 2016. Japan. Conference Start: 20161102.
Conference End: 20161105. 31 (pp 50), 2016. Date of Publication: November
2016.
Publisher
Blackwell Publishing
Abstract
Objectives: To elucidate the current status of gastroduodenal mucosal
injury induced by different antiplatelet drugs in patients after Coronary
Artery Bypass Grafting (CABG). Methods: Five hundred patients following
CABG were randomly assigned into three groups, including aspirin or
ticagrelor monotherapy group and ticagrelor plus aspirin group (DACAB
trial, NCT 02201771). Among them, 270 patients enrolled in Ruijin hospital
would undergo esophagogastroduodenoscopy (EGD) with their consent at 12th
month. The grade of gastroduodenal mucosal injury would be assessed
according to the modified Lanza Endoscopic Scoring System. This research
has been approved by the ethical committee of Ruijin hospital. Results:
From August 2015 to April 2016, 146 of 163 patients finished the
follow-up, of whom 91.8% (134/146) underwent EGD. The prevalence of
multiple gastroduodenal lesions is higher in the ticagrelor plus aspirin
group (36.2%, 17/47), compared with that in aspirin (27.9%, 12/43) or
ticagrelor (29.5%, 13/44) monotherapy group, respectively. Among them,
complex gastroduodenal mucosal injuries were detected in 66.7% (28/42)
populations, the double of single location of mucosal injuries with 11.9%
(5/42) in stomach and 21.4% (9/42) in duodenum. Conclusions: It seems that
gastroduodenal injuries in patients with antiplatelet therapies are more
serious than expected, even in monotherapy, which are mainly shown as
complex injuries. Further researches involving intestine are needed to
clarify different locations of gastrointestinal injuries to better guide
the prevention from GI bleeding. (Figure Presented).

<61>
Accession Number
612983715
Author
Berbrayer D.
Institution
(Berbrayer) University of Toronto Sunnybrook HSC, Toronto, ON, Canada
Title
Controversies of scoliosis management in duchenne muscular dystrophy.
Source
PM and R. Conference: 2016 Annual Assembly of the American Academy of
Physical Medicine and Rehabilitation, AAPM and R 2016. United States.
Conference Start: 20161020. Conference End: 20161023. 8 (9 Supplement) (pp
S151-S152), 2016. Date of Publication: September 2016.
Publisher
Elsevier Inc.
Abstract
Objective: To review current surgical treatment for scoliosis treatment in
Duchenne muscular dystrophy and determine if function and respiratory
status is improved. Design: Evidence based review. Setting: University
Teaching Hospital. Participants: Pediatric - children less than 18 years.
Interventions: An exhaustive literature review-PubMed and Embase,
Cochrane, and NIH clinical trials databases was performed to evaluate role
of anaesthesia and scoliosis, role of types of surgery and risk of
complications, surgical impact on respiratory function and cardiovascular
function and risk of surgical complications, impact of osteoporosis and
surgery and impact of gross motor function and respiratory status after
scoliosis surgery. Main Outcome Measures: Impact on function with surgery.
Results: Published Consensus statement of American College of Respiratory
Physicians suggest: need for intensive care unit, do not use depolarizing
muscle relaxants, need for cardiology consult and use intravenous and not
gas agents. Cochrane database tested whether spinal surgery is effective
in increasing survival, improving respiratory function, improving quality
of life and overall functioning; and whether spinal surgery is associated
with severe adverse effects. Since there were no randomized controlled
clinical trials available to evaluate the effectiveness of scoliosis
surgery in people with Duchenne muscular dystrophy, no evidence-based
recommendation can be made for clinical practice. People with scoliosis
should be informed about the uncertainty of benefits and potential risks
of surgery for scoliosis. Complications of scoliosis surgery (overall 35%)
include: delayed paraparesis, pedicle screw misplacement or migration,
infection, pseudoarthosis and death 7%. With loss of flexibility after
spinal instrumentation, there exist challenges in custom seating which
compromises function at the wheelchair level. Conclusions: 1. High
Incidence of osteoporosis with use of steroids makes outcome of surgery in
DMD doubtful. 2. There are major risks of anaesthesia and cardiac risks
with surgery. 3. Surgery carries risk of complications including fatality
in Duchenne Muscular Dystrophy. 4. Cochrane data base found no randomized
controlled clinical trials available to evaluate the effectiveness of
scoliosis surgery in people with Duchenne muscular dystrophy and no
evidence-based recommendation can be made for clinical practice 5. Surgery
does not improve posture in Duchenne dystrophy but may worsen physical
functioning even at wheelchair level 6. There is no evidence respiratory
is improved after scoliosis surgery in Duchenne dystrophy.

<62>
Accession Number
612966351
Author
Bauer U.M.M.; Pickardt T.; Asfour B.; Baumgartner H.; Bahlmann J.; Berger
F.; Breithardt G.; De Haan F.; Hetzer R.; Hofbeck M.; Kececioglu D.;
Klaassen S.; Kramer H.H.; Nurnberg J.H.; Sarikouch S.; Schmaltz A.A.;
Abdul-Khaliq H.
Institution
(Bauer, Pickardt) Competence Network for Congenital Heart Defects CNCHD
Central Office, Berlin, Germany
(Asfour, Bahlmann, Berger, Breithardt, De Haan, Hetzer, Hofbeck, Klaassen,
Kramer, Nurnberg, Sarikouch, Schmaltz, Abdul-Khaliq) CNCHD Steering
Committee, Germany
(Asfour, Baumgartner, Bahlmann, De Haan, Hetzer, Kececioglu, Schmaltz)
National Register for Congenital Heart Defects Management Board, Germany
Title
Establishment of a german research network for congenital heart defects.
Source
Cardiology in the Young. Conference: 48th 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 and Asia-Pacific Pediatric Cardiac Society. Finland.
Conference Start: 20140521. Conference End: 20140524. 24 (pp S59), 2014.
Date of Publication: May 2014.
Publisher
Cambridge University Press
Abstract
Objectives: The Competence Network for Congenital Heart Defects (CNCHD)
was established to facilitate multicentre medical und socio-medical
research in the field of congenital heart defects (CHD), which is intended
to lead to an improvement of health care and out-come for this relatively
new and continuously rising patient group. Due to the characteristics of
this disease (high variability of morphological heart defects, chronic
illness), the network infrastructure has to overcome specific challenges
such as research in underage patients or the implementation of a legal
framework for longterm storage of data and biomaterial. Methods and
Results: The CNCHD succeeded in implementing a sustainable research
infrastructure involving all important stakeholders throughout Germany.
The infrastructure is built around the non-profit registered association
National Register for Congenital Heart Defects (NRCHD e. V.) that provides
a dynamic and flexible IT-platform for different types of databasesystems
for register studies and a multicentre biorepository that collects
blood-derived DNA and cardiac tissue from heart surgery. Thanks to central
patient and ID management, data of different formats and recorded at
different times can be clearly assigned to respective patients, thus
allowing multicentre and longitudinal investigations. Electronic case
report forms and remote data entry are used to centrally collect and store
the data. Specific role based access rights management can be implemented
for decentralised data entry by different users (physicians, researchers,
documentation staff, monitors, sample laboratory etc.), e.g. within the
scope of multicentre studies. This enables the integration of national and
international research units, which is of particular importance with
regard to recruiting new cooperation partners. In January 2014 the
National Register comprises 46.333 participants. The majority (64%) is
underage, sex is evenly distributed. Simple heart lesions represent 38%,
moderate 52%, and severe/complex 10%. The DNA collection currently
comprises samples from aproximately 3000 participants covering a wide
range of CHD phenotypes. The collection includes also trios
(patient+unaffected parents) and families with more than one affected
member. Conclusions: The CNCHD provides a comprehensive basis for
high-level research in the field of CHD with high standards of ethics,
data privacy, IT management and sample logistics.

<63>
Accession Number
612966261
Author
Kapusta L.; Tamir A.; Houri S.; Raucher Sternfeld A.; Cohen I.; Drukman
O.; Yakobi D.; Sharau G.G.; Goldman B.G.; Sasson L.
Institution
(Sasson, Kapusta, Tamir, Houri, Raucher Sternfeld, Cohen, Drukman, Yakobi,
Sharau, Goldman, Sasson) Save a Child's Heart, Holon, Israel
(Kapusta) Dept. of Pediatric Cardiology, Tel-Aviv Sourasky Medical Center,
Tel Aviv University, Tel Aviv, Israel
(Kapusta) Children's Heart Center, Radboud University, Nijmegen Medical
Centre, Nijmegen, Netherlands
(Tamir, Raucher Sternfeld) Pediatric Cardiology Unit, Wolfson Medical
Center, Affiliated with Sackler School of Medicine, Holon, Israel
(Houri, Cohen) Pediatric Intensive Care Unit, Wolfson Medical Center,
Affiliated with Sackler School of Medicine, Holon, Israel
(Sasson, Drukman, Yakobi, Sasson) Cardiothoracic Surgery Dept, Wolfson
Medical Center, Affiliated with Sackler School of Medicine, Holon, Israel
(Sharau) Bugado Medical Center, Mwanza, Tanzania
(Goldman) Sunnybrook Health Science Centre, University of Toronto,
Toronto, Canada
Title
Surgical management of chronic rheumatic mitral valve disease in children:
Single-center experience.
Source
Cardiology in the Young. Conference: 48th 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 and Asia-Pacific Pediatric Cardiac Society. Finland.
Conference Start: 20140521. Conference End: 20140524. 24 (pp S149-S150),
2014. Date of Publication: May 2014.
Publisher
Cambridge University Press
Abstract
Introduction: The lack of consistency in approaches to surgical care of
pediatric patients with chronic rheumatic mitral valve disease is of
significant concern. International reports are based on small numbers of
children with mixed morphology, different age at surgical correction,
patients with or without previous heart surgery and various operative
techniques and materials. The purpose of this study was to assess the
immediate (short-term) outcome of this subgroup at one tertiary center.
The primary outcome was in-hospital mortality. Secondary outcomes included
need for mitral valve reoperation (secondary repair or replacement) during
the same admission, utilization of postoperative mechanical circulatory
support, duration of postoperative mechanical ventilation period and
length of intensive care unit stay. Methods: Prospectively collected data
on preoperative, operative and postoperative outcomes of pediatric
patients undergoing surgical repair of their rheumatic valve(s) between
2007 and 2012 was retrospectively analyzed. Results: Forty-four mainly
African patients, screened by international medical teams, were referred
for mitral valve surgery, of who 41 underwent consecutive primary
rheumatic mitral valve repair. No patient had prior surgery. Only two
patients (4.9%) were scheduled for primary mitral valve replacement.
However, two patients needed mitral valve replacement at initial surgery.
Sixteen patients underwent concurrent tricuspid valve repair and another
five aortic valve repair at the primary mitral valve operation. Early
death occurred in two patients with mitral valve replacement after failure
to wean from heart lung bypass despite immediate use of Extra Corporal
Membrane Oxygenator. Secondary outcomes included four patients who needed
mitral valve reoperation (repair n=1, replacement n=3) during the same
admission. Only one patient underwent aortic valve replacement at the same
time as the mitral valve re-operation. The median postoperative mechanical
ventilation period and intensive care stay was one day (range 1-10) and
3.5 days (range 2-25), respectively. No other death occurred before the
patients returned to their referring countries. Conclusions: In young
patients with severe rheumatic heart disease of the mitral valve, valve
repair is the preferred approach. The present short term results regarding
mortality and morbidity are encouraging.

<64>
Accession Number
612966230
Author
Menzel C.; Bangen U.; Schneider M.; Trieschmann U.
Institution
(Menzel, Bangen) Department of Paediatric Cardiology, University Hospital
of Cologne - Heart Center, Cologne, Germany
(Schneider, Trieschmann) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital of Cologne, Cologne, Germany
Title
Chest ultrasound vs. Chest X-ray in pediatric patients after congenital
cardiac surgery-a comparative study.
Source
Cardiology in the Young. Conference: 48th 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 and Asia-Pacific Pediatric Cardiac Society. Finland.
Conference Start: 20140521. Conference End: 20140524. 24 (pp S148-S149),
2014. Date of Publication: May 2014.
Publisher
Cambridge University Press
Abstract
Introduction: Postoperative management of patients with congenital heart
disease requires imaging techniques to recognize complications like
pleural effusions, pneumothoraces, pneumonia, atelectases or pulmonary
venous congestion. Imaging techniques are as well used for verification of
correct positions of chest tubes, central venous lines and endotracheal
tubes. The most common technique to identify intrathoracic pathologies is
chest X-ray, but particularly in pediatric patients radiation exposure is
detrimental. Chest ultrasound is fast, repeatable and harmless, and has
been increasingly used in pediatric patients in the last years. Yet it is
unknown if ultrasound, for selected indications, is equivalent to chest
X-ray. Prospective studies concerning this topic on pediatric patients
following congenital heart surgery are still missing. Methods:
Prospective, blinded study on 50 pediatric patients following congenital
cardiac surgery since May 2013. Evaluation of the chest ultrasound
examination on first postoperative morning not knowing the corresponding,
routinely performed, chest X-ray. Analysis of the findings of both imaging
techniques according to the question whether the pathologies diagnosed by
X-ray can adequately be seen by ultrasound. Purpose of our study is to
find out if the number of X-ray images and thus radiation exposure to the
patients may be reduced by the use of ultrasound. Results: Yet 42 of 50
patients are completed. Expected end of our study will be in February
2014, final results will be presented on the AEPC meeting. Preliminary
results: 19 pts. with atelectases (2 not diagnosed by ultrasound, 13 not
diagnosed by X-ray), 16 pts. with pleural effusions (all diagnosed by
ultrasound, 14 not diagnosed by X-ray), 2 pts. with minor pneumothoraces
(none diagnosed by ultrasound, all by X-ray), 24 pts. with mild pulmonary
venous congestion and 2 pts. with pulmonary infiltrations. Conclusions:
Preliminary findings show that major postoperative problems as atelectases
and pleural effusions were more frequently diagnosed by ultrasound than by
X-ray. Diagnosis of pulmonary venous congestion and pneumonia require
chest X-ray, but correspond to clinical symptoms if relevant. Chest
ultrasound should be daily routine after congenital cardiac surgery. Chest
Xray should be considered for special indications, if clinical symptoms
appear.

<65>
Accession Number
612966118
Author
Ewert P.; Al-Halees Z.; Biernacka E.K.; Pongiglione G.; Haas N.; Mullen
M.; Schubert S.; Odemis E.; Birk E.; Mandinov L.; Gewillig M.
Institution
(Ewert) German Heart Center, Munich, Germany
(Al-Halees) King Faisal Specialist Hospital, Riyadh, Saudi Arabia
(Biernacka) Institute of Cardiology, Warsaw, Poland
(Pongiglione) Ospedale Pediatrico Bambino Gesu, Rome, Italy
(Haas) Heart and Diabetes Centre North-Rhine Westphalia, Bad Oeynhausen,
Germany
(Mullen) Royal Brompton Hospital, London, United Kingdom
(Schubert) Deutsches Herzzentrum, Berlin, Germany
(Odemis) Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital,
Istanbul, Turkey
(Birk) Children's Medical Center of Israel, Petah Tikva, Israel
(Mandinov) Edwards Lifesciences, Irvine, United States
(Gewillig) University Hospital Gasthuisberg, Leuven, Belgium
Title
One year follow-up of the PREMIER multicenter registry for the edwards
SAPIEN Pulmonic transcatheter heart valve: An interim report.
Source
Cardiology in the Young. Conference: 48th 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 and Asia-Pacific Pediatric Cardiac Society. Finland.
Conference Start: 20140521. Conference End: 20140524. 24 (pp S29), 2014.
Date of Publication: May 2014.
Publisher
Cambridge University Press
Abstract
Introduction: PREMIER is a single arm, multi-center registry assessing the
safety and efficacy of the commercially available Edwards SAPIENTM
Pulmonic Valve for treatment of patients with conduit failure in the right
ventricular outflow tract (RVOT), or moderate to severe pulmonary
regurgitation with or without stenosis. One year follow-up has been
completed for the first 99 patients and an interim analysis was carried
out. Methods: The Edwards SAPIENTM Pulmonic 23mm and 26mm valves were
implanted in the pulmonary position in 131 patients with a dysfunctional
RVOT. Enrolment has been completed and patients are being followed up
annually throughout 5 years. If valves were implanted before the registry
initiation, data were recorded retrospectively starting with the first
commercial implant at the site. Results: The mean patient age was
27.3+/-12.9 years, and 35.9% of patients were female. A total of 46
patients (35.4%) underwent prior conduit implantation, 12 patients (9.2%)
underwent the Ross procedure, 41 patients (31.5%) underwent prior
pulmonary valve repair. NYHA class was <II in 63.0% of patients, pulmonary
regurgitation was grade 3+ or 4+ in 75.2% of patients and the mean RVOT
gradient was 39.5+/-22.2mm Hg. The procedural success rate was 92.4%. The
mean procedure and fluoroscopy time was 179.0+/-71.3 min and 38.1+/-26.4
min, respectively. The survival at 1 year after the valve implantation was
100%. There were no valve stent fractures, no re-interventions or
reoperations. Adverse events occurred in 19.1% of patients. Of the 40
adverse events reported, only 6 were considered serious with right
pulmonary artery rupture treated with surgery being the most significant
one. At 1-year, 68.9% of subjects with complete echocardiographic
evaluation (51/74) had none/trace pulmonary regurgitation, 25.7% had mild
and 5.5% (4/74) had moderate (n=3) or severe (n=1) pulmonary
regurgitation. At 1-year, follow up the RVOT gradient decreased
significantly by 14.9+/-16.8mmHg (p<0.0001). Conclusions: This interim
reports suggests that the Edwards SAPIENTM valve can be implanted safely
in the pulmonary position with very low risk and significantly improve
pulmonary regurgitation and RVOT gradient at 1-year. Further evaluation
and long term follow-up is in progress to validate the clinical
implications of this promising treatment for patients with dysfunctional
RVOT.

<66>
Accession Number
612965993
Author
Leonardi B.; Ait-Alia L.; Chinali M.; Festa P.; Trocchio G.L.; Stragnaro
N.; Crepaz R.; Secinaro A.; Cantarutti N.; Albanese S.; Pongiglione G.
Institution
(Leonardi, Chinali, Secinaro, Cantarutti, Albanese, Pongiglione) Ospedale
Pediatrico Bambino Gesu, Roma, Italy
(Ait-Alia) Istituto IFCCNR Massa, Pisa, Italy
(Festa) U.O. Cardiologia Pediatrica Fondazione Gabriele Monastero-CNR,
Massa, Italy
(Trocchio, Stragnaro) Cardiovascular Department, Istituto Giannina
Gaslini, Genova, Italy
(Crepaz) Serv Cardiologia pediatrica Osp Regionale Bolzano, Italy
Title
Determinants of pulmonary valve replacement indication in repaired
Tetralogy of Fallot patients: A multicenter experience.
Source
Cardiology in the Young. Conference: 48th 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 and Asia-Pacific Pediatric Cardiac Society. Finland.
Conference Start: 20140521. Conference End: 20140524. 24 (pp S23-S24),
2014. Date of Publication: May 2014.
Publisher
Cambridge University Press
Abstract
Introduction: Repaired Tetralogy of Fallot (rToF) patients often need
pulmonary valve replacement (PVR) due to progressive right ventricular
(RV) dilation and biventricular dysfunction. Cardiac magnetic resonance
(CMR) represents the gold standard to evaluate RV size and function aiding
definition of PVR timing. Determinants of PVR have not yet been described.
Methods: We enrolled patients who underwent hemodynamic evaluation by CMR
late after ToF repair (by either transanular or infundibular RV outflow
tract reconstruction) in five paediatric cardiology centers, between March
2003 and March 2013. Surgical data (time and types of repair) and CMR
parameters were collected. Indications to PVR change to single center.
Results: 495 patients (60% males) aged 21+/-11 (range 2-67) years were
included. Mean age at repair was 30.4+/-54.2 (range 0.2- 574.8) months. In
the majority of cases (77%) transanular patch was the type of surgical
correction performed. Among the study population 222 patients (47%) had RV
end-diastolic volume indexed for bsa (RVEDVi) >150 mL/m2 and/or RVEF <47%,
whose 70% were males and 86% with transanular patch (TP) repair. In
multivariate logistic regression, in TP group, presence of RVEDVi >150
mL/m2 and/or RVEF <47% was significantly correlated with time elapsed from
correction to MRI examination (p=0.017) (figure 1a) and to grade of
pulmonary regurgitation (PR) (p=0.008). In addition, mean RV EF and LV EF
were mildly lower in TP as compared to infundibular patch (IP) group (both
p<0.05). In IP group RV dilation was not related to time from surgical
correction (p5NS) (figure 1b), but only to grade of PR and to the presence
of significant tricuspid regurgitation (p=0.022 and p=0.032,
respectively). Conclusions: The mechanism underling RV dilation in rToF
patients appears to have significant differences in the two groups.
Indeed, time from surgical repair seem to have a significant impact only
in the TP group while tricuspid regurgitation seem to be crucial in the
other. Longitudinal follow-up studies are needed to define the role of
each factors involved in RV dilation in predicting the adverse outcomes of
rToF patients. (Figure Presented).

<67>
Accession Number
612834036
Author
Smit K.F.; Brevoord D.; Hert S.; Mol B.A.; Kerindongo R.P.; Dieren S.;
Schlack W.S.; Hollmann M.W.; Weber N.C.; Preckel B.
Institution
(Smit, Brevoord, Kerindongo, Dieren, Schlack, Hollmann, Weber, Preckel)
Academic Medical Centre (AMC), Laboratory of Experimental Intensive Care
and Anesthesiology (L.E.I.C.A.), Department of Anesthesiology,
Meibergdreef 9, Amsterdam 1100 DD, Netherlands
(Mol) Academic Medical Centre (AMC), Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
(Hert) Ghent University, Department of Anesthesiology, Ghent, Belgium
Title
Effect of helium pre- or postconditioning on signal transduction kinases
in patients undergoing coronary artery bypass graft surgery.
Source
Journal of Translational Medicine. 14 (1) (no pagination), 2016. Article
Number: 294. Date of Publication: 14 Oct 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The noble gas helium induces pre- and postconditioning in
animals and humans. Volatile anesthetics induce cardioprotection in humans
undergoing coronary artery bypass graft (CABG) surgery. We hypothesized
that helium induces pre- and postconditioning in CABG-patients, affecting
signaling molecules protein kinase C-epsilon (PKC-epsilon), p38 mitogen
activated protein kinase (p38 MAPK), extracellular signal-regulated kinase
1/2 (ERK-1/2) and heat shock protein 27 (HSP-27) within cardiac tissue,
and reducing postoperative troponin levels. Methods: After ethical
approval and informed consent, 125 elective patients undergoing CABG
surgery were randomised into this prospective, placebo controlled,
investigator blinded, parallel arm single-centre study. Helium
preconditioning (3 x 5 min of 70 % helium and 30 % oxygen) was applied
before aortic cross clamping; postconditioning (15 min of helium) was
applied before release of the aortic cross clamp. Signaling molecules were
measured in right atrial appendix specimens. Troponin-T was measured at 4,
12, 24 and 48 h postoperatively. Results: Baseline characteristics of all
groups were similar. Helium preconditioning did not significantly alter
the primary outcome (molecular levels of kinases PKC-epsilon and HSP-27,
ratio of activated p38 MAPK or ERK 1/2). Postoperative troponin T was 11
arbitrary units [5, 31; area-under-the-curve (interquartile range)] for
controls, and no statistically significant changes were observed after
helium preconditioning [He-pre: 11 (6, 18)], helium postconditioning
[He-post: 11 (8, 15)], helium pre- and postconditioning [He-PP: 14 (6,
20)] and after sevoflurane preconditioning [APC: 12 (8, 24), p = 0.13]. No
adverse effects related to study treatment were observed in this study.
Conclusions: No effect was observed of helium preconditioning,
postconditioning or the combination thereof on activation of p38 MAPK, ERK
1/2 or levels of HSP27 and PKC-epsilon in the human heart. Helium pre- and
postconditioning did not affect postoperative troponin release in patients
undergoing CABG surgery. Clinical trial number Dutch trial register (
http://www.trialregister.nl/ ) number NTR1226 Copyright &#xa9; 2016 The
Author(s).

<68>
Accession Number
612815749
Author
Ngai K.M.G.
Title
Can cardiovascular magnetic resonance, myocardial perfusion scintigraphy,
or nice guidelines prevent unnecessary angiography?.
Source
Journal of Clinical Outcomes Management. 23 (10) (pp 444-446), 2016. Date
of Publication: October 2016.
Publisher
Turner White Communications Inc.

<69>
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.

<70>
Accession Number
604434239
Author
Sorensen H.; Grocott H.P.; Secher N.H.
Institution
(Sorensen, Secher) Department of Anesthesia, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Grocott) Department of Anesthesia & Perioperative Medicine, University of
Manitoba, Winnipeg, MB, Canada
Title
Near infrared spectroscopy for frontal lobe oxygenation during
non-vascular abdominal surgery.
Source
Clinical Physiology and Functional Imaging. 36 (6) (pp 427-435), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Purpose: Cerebral deoxygenation, as determined by near infrared
spectroscopy (NIRS), seems to predict postoperative complications
following cardiac surgery. We identify the type of non-vascular abdominal
surgery associated with cerebral deoxygenation and/or hyperoxygenation,
how such deviations affect patient outcome, and whether maintained
cerebral oxygenation improves outcome. Methods: A systematic literature
search was performed on PubMed, EMBASE, Web of Science and
Clinicaltrials.gov. Results: A total of 901 patients from 24 publications
are described. A decrease in NIRS (>15% relative to baseline) manifested
with reverse Trendelenburg's positioning and in 24% (median) of especially
elderly patients undergoing open surgery and demonstrated a correlation to
hospital stay (LOS). However, if cerebral deoxygenation was reversed
promptly, improved postoperative cognitive function (28 versus 26;
mini-mental state examination) and reduced LOS (14 versus 23 days) were
seen. Also, during liver transplantation (LTx), impaired cerebral
autoregulation (25%), cerebral deoxygenation in the anhepatic phase (36%)
and cerebral hyperoxygenation with reperfusion of the grafted liver (14%)
were identified by NIRS and could lead to adverse neurological outcome,
that is seizures, transient hemiparesis and stroke. Conclusion: NIRS seems
important for predicting neurological complications associated with LTx.
Also, surgery in reverse Trendelenburg's position and in other types of
abdominal surgery about one-fourth of the patients are subjected to
episodes of cerebral deoxygenation that seems to predict a poor outcome.
Although there are currently only few studies available for patients going
through abdominal surgery, the available evidence points to that it is an
advantage to maintain the NIRS-determined cerebral oxygenation. Copyright
&#xa9; 2015 Scandinavian Society of Clinical Physiology and Nuclear
Medicine. Published by John Wiley & Sons Ltd

<71>
Accession Number
612907562
Author
Jones T.K.; Rome J.J.; Armstrong A.K.; Berger F.; Hellenbrand W.E.;
Cabalka A.K.; Benson L.N.; Balzer D.T.; Cheatham J.P.; Eicken A.;
McElhinney D.B.
Institution
(Jones) Seattle Children's Hospital, Seattle, Washington, United States
(Rome) The Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania, United States
(Armstrong, Cheatham) Nationwide Children's Hospital, Columbus, Ohio,
United States
(Berger) Deutsches Herzzentrum Berlin and Charite-Universitaetsmedizin
Berlin, Berlin, Germany
(Hellenbrand) Yale University School of Medicine, New Haven, Connecticut,
United States
(Cabalka) Mayo Clinic College of Medicine, Rochester, Minnesota, United
States
(Benson) The Hospital for Sick Children, Toronto, Canada
(Balzer) St. Louis Children's Hospital, St. Louis, Missouri, United States
(Eicken) German Heart Center Munich, Munich, Germany
(McElhinney) Lucille Packard Children's Hospital Stanford, Palo Alto,
California, United States
Title
Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation
in Patients With Right Ventricular Volume/Pressure Overload.
Source
Journal of the American College of Cardiology. 68 (14) (pp 1525-1535),
2016. Date of Publication: 04 Oct 2016.
Publisher
Elsevier USA
Abstract
Background Tricuspid regurgitation (TR) is a common and important
comorbidity in patients with postoperative right ventricular outflow tract
(RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter
pulmonary valve replacement (TPVR) has become a useful tool in the
management of postoperative RVOT obstruction and PR, but it is unknown
whether relief of the right ventricular volume and/or pressure overload by
TPVR will have a beneficial effect on TR, as is often seen with surgical
pulmonary valve replacement. Objectives This study sought to assess the
prevalence of and factors associated with significant TR in patients
undergoing TPVR for RVOT obstruction or PR. Methods Data were combined
from 3 prospective multicenter trials of patients referred for TPVR.
Follow-up data through 5 years post-implantation were analyzed. Results Of
300 patients studied, 77 (25.6%) had moderate or severe TR at baseline.
After TPVR, TR severity was improved in 65% of those patients, and more
than one-half had mild TR or less TR at discharge. Of 13 patients with
severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and
beyond. Moderate or severe baseline TR was associated with shorter freedom
from RVOT reintervention after TPVR. Conclusions In this prospective
multicenter study of post-operative patients with RVOT obstruction and/or
PR, TR was common. In patients with significant baseline TR, TPVR resulted
in clinically relevant acute reductions in TR that persisted over at least
5 years of follow-up. These observations support the application of TPVR
therapy in patients with RVOT obstruction or PR who are anatomically
suitable, even in the setting of significant concomitant TR. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<72>
Accession Number
612843323
Author
Kato T.S.; Nakamura H.; Murata M.; Kuroda K.; Suzuki H.; Yokoyama Y.;
Shimada A.; Matsushita S.; Yamamoto T.; Amano A.
Institution
(Kato, Nakamura, Murata, Kuroda, Yokoyama, Shimada, Matsushita, Yamamoto,
Amano) Heart Center, Juntendo University, Department of Cardiovascular
Surgery, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Suzuki) Juntendo University School of Medicine, Division of Nephrology,
Department of Internal Medicine, Bunkyo-ku, Tokyo, Japan
Title
The effect of tolvaptan on renal excretion of electrolytes and urea
nitrogen in patients undergoing coronary artery bypass surgery.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 181. Date of Publication: 13 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Adequate fluid management is an important component of patient
care following cardiac surgery. Our aim in this study was to determine the
benefits of tolvaptan, an oral selective vasopressin-2 receptor antagonist
that causes electrolyte-free water diuresis, in postoperative fluid
management. We prospectively examined the effect of tolvaptan on renal
excretion of electrolytes and urea nitrogen in cardiac surgery patients.
Methods: Patients undergoing coronary artery bypass surgery were
randomized to receive conventional loop diuretics (Group C, n = 30) or
conventional loop diuretic therapy plus tolvaptan (Group T, n = 27).
Fractional excretions of sodium (FENA), potassium (FEK) and urea nitrogen
(FEUN) were measured in both groups during post-surgical hospitalization.
Results: Urine output was greater with tolvaptan (Group T) than without it
(Group C), and some patients in Group C required intravenous as well as
oral loop diuretics. Serum sodium concentrations decreased after surgery
in Group C, but were unchanged in Group T (postoperative day [POD] 3,
139.8 +/- 3.5 vs. 142.3 +/- 2.6 mEq/L, p = 0.006). However, postoperative
FENA values in Group C did not decrease, and the values were similar in
both groups. Serum potassium levels remained lower and FEK values remained
higher than the preoperative values, but only in Group C (all p < 0.05).
BUN increased postoperatively in both groups, but it remained higher than
its preoperative value only in Group C (all p < 0.01). Group T showed an
initial increase in BUN, which peaked and then returned to its
preoperative value within a week. The FEUN increased postoperatively in
both groups, but the change was more pronounced in Group T (POD7, 52.7 +/-
9.3 vs. 58.2 +/- 6.5 %, p = 0.025). Conclusions: Renal excretion of sodium
and potassium reflects the changes in serum concentration in patients
treated with tolvaptan. Patients treated only with loop diuretics showed a
continuous excretion of sodium and potassium that led to electrolyte
imbalance, whereas the combination of loop diuretics and tolvaptan
increased renal urea nitrogen elimination. Tolvaptan therefore appears to
be an effective diuretic that minimally affects serum electrolytes while
adequately promoting the elimination of urea nitrogen from the kidneys in
patients undergoing coronary artery bypass surgery. Trial registration:
The present study is registered with the UMIN Clinical Trials Registry
(ID: UMIN000011039) Copyright &#xa9; 2016 The Author(s).

<73>
Accession Number
612655119
Author
Sakurai R.; Burazor I.; Bonneau H.N.; Kaneda H.
Institution
(Sakurai) Department of Healthcare Information Management, The University
of Tokyo Hospital, Tokyo, Japan
(Burazor) Cardiac Rehabilitation Department, Institute for Rehabilitation,
Belgrade, Serbia
(Bonneau) Highlands Consulting, Inc., San Jose, CA, United States
(Kaneda) Okinaka Memorial Institute for Medical Research, Tokyo, Japan
Title
Long-term outcomes of biodegradable polymer biolimus-eluting stents versus
durable polymer everolimus-eluting stents: A meta-analysis of randomized
controlled trials.
Source
International Journal of Cardiology. 223 (pp 1066-1071), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Both biodegradable polymer biolimus-eluting stents (BP-BES) and
biocompatible durable polymer everolimus-eluting stents (DP-EES) have been
developed to decrease the risk of late adverse events. However, their
efficacy and safety beyond 1 year after stent deployment still remain
controversial. Methods We conducted a meta-analysis on randomized
controlled trials (RCTs) comparing BP-BES with DP-EES in patients
undergoing percutaneous coronary intervention in long-term follow up
(beyond 1 year), and compared the pooled estimates with those in mid-term
follow up (within 1 year). Results Eight RCTs were included in this
meta-analysis. The risks in BP-BES versus DP-EES of death (odds ratio
(OR): 1.06, 95% confidence interval (CI): 0.86-1.31, p = 0.557 for
long-term; OR: 1.09, 95% CI: 0.76-1.56, p = 0.645 for mid-term),
myocardial infarction (OR: 1.06, 95% CI: 0.84-1.35, p = 0.628 for
long-term; OR: 1.04, 95% CI: 0.81-1.33, p = 0.778 for mid-term), and
definite or probable stent thrombosis (OR: 0.89, 95% CI: 0.51-1.57, p =
0.695 for long-term; OR: 1.36, 95% CI: 0.66-2.81, p = 0.400 for mid-term)
were comparable in each follow up, respectively. In contrast, the risk of
target vessel revascularization (TVR) tended to be higher in BP-BES as
compared to DP-EES in long-term follow up (OR: 1.15, 95% CI: 0.97-1.37, p
= 0.098 for long-term; OR: 1.09, 95% CI: 0.87-1.36, p = 0.447 for
mid-term). Conclusions Although the overall clinical outcomes were similar
between BP-BES and DP-EES, BP-BES may be associated with higher risk of
TVR up to 3 years after stent deployment compared with DP-EES. Further
studies are warranted in larger populations of patients during longer-term
follow up. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<74>
Accession Number
612703952
Author
Sotomi Y.; Cavalcante R.; van Klaveren D.; Ahn J.-M.; Lee C.W.; de Winter
R.J.; Wykrzykowska J.J.; Onuma Y.; Steyerberg E.W.; Park S.-J.; Serruys
P.W.
Institution
(Sotomi, de Winter, Wykrzykowska) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Cavalcante, Onuma) ThoraxCenter, Erasmus Medical Center, Rotterdam,
Netherlands
(van Klaveren, Steyerberg) Department of Public Health, Erasmus Medical
Center, Rotterdam, Netherlands
(Ahn, Lee, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
Individual Long-Term Mortality Prediction Following Either Coronary
Stenting or Bypass Surgery in Patients With Multivessel and/or Unprotected
Left Main Disease: An External Validation of the SYNTAX Score II Model in
the 1,480 Patients of the BEST and PRECOMBAT Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (15) (pp 1564-1572), 2016. Date of
Publication: 08 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to validate the SYNTAX (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score
II mortality prediction model after percutaneous coronary intervention
(PCI) or coronary artery bypass grafting in a large pooled population of
patients with multivessel coronary disease (MVD) and/or unprotected left
main disease (UPLMD) enrolled in the PRECOMBAT (Bypass Surgery Versus
Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main
Coronary Artery Disease) and BEST (Artery Bypass Surgery and
Everolimus-Eluting Stent Implantation in the Treatment of Patients with
Multivessel Coronary Artery Disease) randomized controlled trials.
Background For patients with MVD and/or UPLMD, the choice of the best
revascularization strategy remains challenging. Methods Pooled individual
patient-level data from PRECOMBAT and BEST were used to assess calibration
and discrimination of the SYNTAX score II prediction model for all-cause
mortality after PCI and coronary artery bypass grafting at 4-year
follow-up. The study population comprised 1,480 patients (600 with UPLMD,
880 with MVD). Results The overall incidence of all-cause mortality was
6.1% after a median follow-up period of 4.9 years. Validation plots showed
good model calibration overall and across treatment groups but tended to
overestimate all-cause mortality in the highest risk quintiles of patients
in the whole population and the PCI arm. The SYNTAX score II showed
moderate discrimination ability for the whole population (C index = 0.685)
but better for patients receiving PCI than CABG (C index = 0.718 vs. 0.662
in patients with UPLMD, C index = 0.700 vs. 0.661 in those with MVD).
Observed all-cause mortality was higher when the treatment received was at
variance with that recommended by the model and similar when it was
concordant. Conclusions The SYNTAX score II has good calibration but only
moderate discrimination ability for long-term mortality prediction in this
randomized population. This score provides an important tool to help guide
the heart team's decision-making process regarding the selection of the
best revascularization strategy for patients with MVD and/or UPLMD.
(Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in
Patients With Left Main Coronary Artery Disease, NCT00422968; Bypass
Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel
Coronary Artery Disease, NCT00997828) Copyright &#xa9; 2016 American
College of Cardiology Foundation

<75>
Accession Number
612943862
Author
Mrkobrada M.; Hill M.D.; Chan M.T.V.; Sigamani A.; Cowan D.; Kurz A.;
Sessler D.I.; Jacka M.; Graham M.; Dasgupta M.; Dunlop V.; Emery D.J.;
Gulka I.; Guyatt G.; Heels-Ansdell D.; Murkin J.; Pettit S.; Sahlas D.J.;
Sharma M.; Srinathan S.; St John P.; Tsai S.; Gelb A.W.; O'Donnell M.; Siu
D.; Chiu P.W.Y.; Sharath V.; George A.; Devereaux P.J.
Institution
(Mrkobrada, Dasgupta, Murkin, Sharma) University of Western Ontario, 339
Windermere Road B9-100, London, ON N6A 5A5, Canada
(Hill) University of Calgary, Calgary, AB, Canada
(Chan, Siu, Chiu) Chinese University of Hong Kong, Hong Kong
(Sigamani, Sharath, George) St John's Medical College, St John's Research
Institute, Bangalore, India
(Cowan, Guyatt, Heels-Ansdell, Sahlas, Sharma, O'Donnell, Devereaux)
McMaster University, Hamilton, ON, Canada
(Kurz, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Jacka, Graham, Emery) University of Alberta Hospital, Edmonton, AB,
Canada
(Dunlop, Pettit) Population Health Research Institute, Hamilton, ON,
Canada
(Gulka) London Health Sciences, London, ON, Canada
(Srinathan, St John) University of Manitoba, Winnipeg, MB, Canada
(Tsai) Hamilton Health Sciences, Hamilton, ON, Canada
(Gelb) University of California, San Francisco, CA, United States
Title
Covert stroke after non-cardiac surgery: A prospective cohort study.
Source
British Journal of Anaesthesia. 117 (2) (pp 191-197), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Overt stroke after non-cardiac surgery has a substantial impact
on the duration and quality of life. Covert stroke in the non-surgical
setting is much more common than overt stroke and is associated with an
increased risk of cognitive decline and dementia. Little is known about
covert stroke after non-cardiac, non-carotid artery surgery. Methods We
undertook a prospective, international cohort study to determine the
incidence of covert stroke after non-cardiac, non-carotid artery surgery.
Eligible patients were >65 yr of age and were admitted to hospital for at
least three nights after non-cardiac, non-carotid artery surgery. Patients
underwent a brain magnetic resonance study between postoperative days 3
and 10. The main outcome was the incidence of perioperative covert stroke.
Results We enrolled a total of 100 patients from six centres in four
countries. The incidence of perioperative covert stroke was 10.0% (10/100
patients, 95% confidence interval 5.5-17.4%). Five of the six centres that
enrolled patients reported an incident covert stroke, and covert stroke
was found in patients undergoing major general (3/27), major orthopaedic
(3/41), major urological or gynaecological (3/22), and low-risk surgery
(1/12). Conclusions This international multicentre study suggests that 1
in 10 patients >65 yr of age experiences a perioperative covert stroke. A
larger study is required to determine the impact of perioperative covert
stroke on patient-important outcomes. Clinical trial registration
NCT01369537. Copyright &#xa9; 2016 The Author 2016.

<76>
Accession Number
612935616
Author
Silva J.D.A.; Ariente L.C.; Roza B.A.; Mucci S.
Institution
(Silva) Transplant and Organ Uptake Multiprofessional Program-COREMU,
Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Ariente) Hospital do Rim and Nephrology Department, Universidade Federal
de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Roza) Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo,
Sao Paulo, Sao Paulo, Brazil
(Mucci) Psychiatry Department, Universidade Federal de Sao Paulo, Sao
Paulo, Sao Paulo, Brazil
Title
Evidence of the Association Between Psychology and Tissue and Organ
Transplantation in Brazil.
Source
Transplantation Proceedings. 48 (7) (pp 2258-2261), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background The addition of psychologists to organ transplant teams is
still new in Brazil. In seeking the efficient performance of this
professional, the knowledge of the scientific production and the
development of research in the area is fundamental. In this sense, this
study aims to survey the Brazilian scientific research that has
investigated the psychologic aspects involved in tissue and organ
transplantation. Methods A literature narrative review was performed with
the use of the "Transplante AND Psicologia" descriptors in the Biblioteca
Virtual em Saude and the CAPES Journal Portal. Results Fifty-three
articles were found, of which 22 met the inclusion criteria: publications
dating from 2000 to 2014 and the main topic of interest of the studies
being quality of life, followed by organ donation. The instruments used
most frequently were interviews developed by the researchers and the SF-36
Quality of Life Questionnaire. Conclusions Recent Brazilian studies on the
association between psychology and transplantation are still scarce,
possibly because of the recent addition of psychologists to
transplantation teams. Therefore, it is suggested that more scientific
research is made in the area and that the objects of study are more
varied, to ensure adequacy of the psychologist to meet the specific
demands of organ and tissue transplantation process. Copyright &#xa9; 2016
Elsevier Inc.

<77>
Accession Number
612776573
Author
Giraud K.; Pontin M.; Sharples L.D.; Fletcher P.; Dalgleish T.; Eden A.;
Jenkins D.P.; Vuylsteke A.
Institution
(Giraud) Cognitive Research Unit, Research and Development Department,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Pontin) Critical Care Unit, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Sharples) Leeds Institute of Clinical Trials Research, Faculty of
Medicine and Health, University of Leeds, Leeds, United Kingdom
(Fletcher) Department of Psychiatry, School of Clinical Medicine,
University of Cambridge, Cambridge, United Kingdom
(Dalgleish) Cognition, Emotion, and Mental Health Programme, Medical
Research Council Cognition and Brain Sciences Unit, Cambridge, United
Kingdom
(Eden) Physiotherapy Department, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Jenkins) Cardiac Services, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Vuylsteke) Department of Cardiothoracic Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Title
Use of a structured mirrors intervention does not reduce delirium
incidence but may improve factual memory encoding in cardiac surgical ICU
patients aged over 70 years: A pilot time-cluster randomized controlled
trial.
Source
Frontiers in Aging Neuroscience. 8 (SEP) (no pagination), 2016. Article
Number: 228. Date of Publication: 28 Sep 2016.
Publisher
Frontiers Research Foundation (E-mail: info@frontiersin.org)
Abstract
Introduction: Post-operative delirium remains a significant problem,
particularly in the older surgical patient. Previous evidence suggests
that the provision of supplementary visual feedback about ones environment
via the use of a mirror may positively impact on mental status and
attention (core delirium diagnostic domains). We aimed to explore whether
use of an evidence-based mirrors intervention could be effective in
reducing delirium and improving post-operative outcomes such as factual
memory encoding of the Intensive Care Unit (ICU) environment in older
cardiac surgical patients. Methods: This was a pilot time-cluster
randomized controlled trial at a 32-bed ICU, enrolling 223 patients aged
70 years and over, admitted to ICU after elective or urgent cardiac
surgery from October 29, 2012 to June 23, 2013. The Mirrors Group received
a structured mirrors intervention at set times (e.g., following change in
mental status). The Usual Care Group received the standard care without
mirrors. Primary outcome was ICU delirium incidence; secondary outcomes
were ICU delirium days, ICU days with altered mental status or
inattention, total length of ICU stay, physical mobilization (balance
confidence) at ICU discharge, recall of factual and delusional ICU
memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and
acceptability of the intervention. Results: The intervention was not
associated with a significant reduction in ICU delirium incidence
[Mirrors: 20/115 (17%); Usual Care: 17/108 (16%)] or duration [Mirrors: 1
(1-3); Usual Care: 2 (1-8)]. Use of the intervention on ICU was predictive
of significantly higher recall of factual (but not delusional) items at 12
weeks after surgery (p = 0.003) and acceptability was high, with
clinicians using mirrors at 86% of all recorded hourly observations. The
intervention did not significantly impact on other secondary outcomes.
Conclusion: Use of a structured mirrors intervention on the post-operative
ICU does not reduce delirium, but may result in improved factual memory
encoding in older cardiac surgical patients. This effect may occur via
mechanisms unrelated to delirium, altered mental status, or inattention.
The intervention may provide a new means of improving outcomes in patients
at risk of post-ICU anxiety and/or Post-Traumatic Stress Disorder.
Copyright &#xa9; 2016 Giraud, Pontin, Sharples, Fletcher, Dalgleish, Eden,
Jenkins and Vuylsteke.

<78>
Accession Number
609833350
Author
Amann M.; Ferenc M.; Valina C.M.; Bomicke T.; Stratz C.; Leggewie S.;
Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Amann, Ferenc, Valina, Bomicke, Stratz, Leggewie, Trenk, Neumann,
Hochholzer) Department of Cardiology and Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Title
Validation of a P2Y<inf>12</inf>-receptor specific whole blood platelet
aggregation assay.
Source
Platelets. 27 (7) (pp 668-672), 2016. Date of Publication: 02 Oct 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Testing of P2Y<inf>12</inf>-receptor antagonist effects can support
clinical decision-making. However, most platelet function assays use only
ADP as agonist which is not P2Y<inf>12</inf>-receptor specific. For this
reason P2Y<inf>12</inf>-receptor specific assays have been developed by
adding prostaglandin E1 (PGE1) to reduce ADP-induced platelet activation
via the P2Y<inf>1</inf>-receptor. The present study sought to evaluate a
P2Y<inf>12</inf>-receptor specific assay for determination of
pharmacodynamic and clinical outcomes. This study enrolled 400 patients
undergoing coronary stenting after loading with clopidogrel or prasugrel.
ADP-induced platelet reactivity was assessed by whole blood aggregometry
at multiple time points with a standard ADP assay (ADPtest) and a
P2Y<inf>12</inf>-receptor specific assay (ADPtest HS, both run on
Multiplate Analyzer, Roche Diagnostics). Patients were clinically followed
for 1 month and all events adjudicated by an independent committee. In
total, 2084 pairs of test results of ADPtest and ADPtest HS were available
showing a strong correlation between results of both assays (r = 0.96, p <
0.001). These findings prevailed in multiple prespecified subgroups (e.g.,
age; body mass index; diabetes). Calculated cutoffs for ADPtest HS and the
established cutoffs of ADPtest showed a substantial agreement for
prediction of ischemic and hemorrhagic events with a Cohen's kappa of 0.66
and 0.66, respectively. The P2Y<inf>12</inf>-receptor specific ADPtest HS
assay appears similarly predictive for pharmacodynamic and clinical
outcomes as compared to the established ADPtest assay indicating its
applicability for clinical use. Further evaluation in large cohorts is
needed to determine if P2Y<inf>12</inf>-receptor specific testing offers
any advantage for prediction of clinical outcome. Copyright &#xa9; 2016
Taylor & Francis.

<79>
Accession Number
609833255
Author
Gurbel P.A.; Bliden K.P.; Tantry U.S.; Monroe A.L.; Muresan A.A.; Brunner
N.E.; Lopez-Espina C.G.; Delmenico P.R.; Cohen E.; Raviv G.; Haugen D.L.;
Ereth M.H.
Institution
(Gurbel, Bliden, Tantry) Inova Heart and Vascular Institute, Falls Church,
VA, United States
(Monroe) Magee Women's Hospital of UPMC, Pittsburgh, PA, United States
(Haugen, Ereth) Mayo Clinic, Rochester, MN, United States
(Muresan, Brunner, Cohen, Raviv) Coramed Technologies, Niles, IL, United
States
(Lopez-Espina, Delmenico) Haemonetics Corporation, Braintree, MA, United
States
Title
First report of the point-of-care TEG: A technical validation study of the
TEG-6S system.
Source
Platelets. 27 (7) (pp 642-649), 2016. Date of Publication: 02 Oct 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Thrombelastography (TEG) measured by the TEG5000 Hemostasis Analyzer is an
established but the labor-intensive method for assessing global
hemostasis. The first true point-of-care TEG, the TEG6s system, uses
resonance-frequency viscoelasticity measurements and a disposable
multi-channel microfluidic cartridge to assess hemostasis and response to
antiplatelet therapy. TEG assays (n = 5,100) were performed on the blood
of healthy volunteers (n = 157) and patients undergoing coronary
revascularization at three hospitals (n = 300). The results from the TEG6s
were compared with the conventional TEG5000 in accordance with Clinical
and Laboratory Standards Institute (CLSI) and FDA recommendations.
Precision testing was conducted using blood from healthy donors, all
assays were run for 5 consecutive days in duplicate using multiple
operators, lots, and instruments. Reference ranges were comparable between
the TEG systems. Deming regression analysis demonstrated a strong
correlation between the two systems for the standard hemostasis tests (R r
= 0.932, MA r = 0.972, LY30 r = 0.938). Method comparison analysis showed
an acceptable agreement between PlateletMapping (PM) assays for measuring
arachidonic acid (indicator of aspirin response)- and adenosine
diphosphate (indicator of P2Y<inf>12</inf> inhibitor response)-induced
platelet aggregation (total agreement = 90%, and 72%, respectively). TEG6s
precision testing yielded low variability (CV 0-13%) in all measures. The
new point-of-care TEG6s is associated with greater ease of use than the
TEG5000 and provides precise results. The results correlated between
methods for all variables. TEG6s is a promising device for near-patient
hemostasis monitoring and future trials of personalized therapy designed
to reduce bleeding and thrombosis. Copyright &#xa9; Taylor & Francis.

<80>
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

<81>
Accession Number
612771859
Author
Govatsmark R.E.S.; Sneeggen S.; Karlsaune H.; Slordahl S.A.; Bonaa K.H.
Institution
(Govatsmark, Bonaa) Department of Public Health and General Practice,
Norwegian University of Science and Technology, Trondheim, Norway
(Govatsmark, Sneeggen, Karlsaune, Slordahl, Bonaa) Department of Medical
Quality Registries, St. Olav's University Hospital, Trondheim, Norway
(Bonaa) Clinic for Heart Disease, St. Olav's University Hospital,
Trondheim, Norway
Title
Interrater reliability of a national acute myocardial infarction register.
Source
Clinical Epidemiology. 8 (pp 305-312), 2016. Date of Publication: 17 Aug
2016.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand)
Abstract
Background: Disease-specific registers may be used for measuring and
improving healthcare and patient outcomes, and for disease surveillance
and research, provided they contain valid and reliable data. The aim of
this study was to assess the interrater reliability of all variables in a
national myocardial infarction register. Methods: We randomly selected 280
patients who had been enrolled from 14 hospitals to the Norwegian
Myocardial Infarction Register during the year 2013. Experienced audit
nurses, who were blinded to the data about the 280 patients already in the
register, completed the Norwegian Myocardial Infarction paper forms for
240 patients by review of medical records. We then extracted all
registered data on the same patients from the Norwegian Myocardial
Infarction Register. To compare the interrater reliability between the
register and the audit nurses, we calculated intraclass correlations
coefficient for continuous variables, Cohen's kappa and Gwet's first
agreement coefficient (AC<inf>1</inf>) for nominal variables, and
quadratic weighted Cohen's kappa and Gwet's second AC for ordinal
variables. Results: We found excellent (AC<inf>1</inf> >0.80) or good
(AC<inf>1</inf> 0.61-0.80) agreement for most variables, including date
and time variables, medical history, investigations and treatments during
hospitalization, medication at discharge, and ST-segment elevation or
non-ST-segment elevation acute myocardial infarction. However, only
moderate agreement (AC<inf>1</inf> 0.41-0.60) was found for family history
of coronary heart disease, diagnostic electrocardiography, and
complications during hospitalization, whereas fair agreement
(AC<inf>1</inf> 0.21-0.40) was found for acute myocardial infarction
location. A high percentage of missing data was found for symptom onset,
family history, body mass index, infarction location, and new Q-wave.
Conclusion: Most variables in Norwegian Myocardial Infarction Register had
excellent or good reliability. However, some important variables had lower
reliability than expected or had missing data. Precise definitions of data
elements and proper training of data abstractors are necessary to ensure
that clinical registries contain valid and reliable data. Copyright &#xa9;
2016 Govatsmark et al.

<82>
Accession Number
612908478
Author
Ribeiro H.B.; Orwat S.; Hayek S.S.; Larose E.; Babaliaros V.; Dahou A.; Le
Ven F.; Pasian S.; Puri R.; Abdul-Jawad Altisent O.; Campelo-Parada F.;
Clavel M.-A.; Pibarot P.; Lerakis S.; Baumgartner H.; Rodes-Cabau J.
Institution
(Ribeiro, Larose, Dahou, Le Ven, Pasian, Puri, Abdul-Jawad Altisent,
Campelo-Parada, Clavel, Pibarot, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Orwat, Baumgartner) Division of Adult Congenital and Valvular Heart
Disease, Department of Cardiovascular Medicine, University Hospital
Muenster, Muenster, Germany
(Hayek, Babaliaros, Lerakis) Emory University School of Medicine, Atlanta,
Georgia, United States
Title
Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 68 (6) (pp 577-585), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Residual aortic regurgitation (AR) following transcatheter
aortic valve replacement (TAVR) is associated with greater mortality; yet,
determining AR severity post-TAVR using Doppler echocardiography remains
challenging. Cardiovascular magnetic resonance (CMR) is purported as a
more accurate means of quantifying AR; however, no data exist regarding
the prognostic value of AR as assessed by CMR post-TAVR. Objectives This
study sought to evaluate the effect of AR assessed with CMR on clinical
outcomes post-TAVR. Methods We included 135 patients from 3 centers. AR
was quantified using regurgitant fraction (RF) measured by phase-contrast
velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler
echocardiography at a median of 6 days post-TAVR. Median follow-up was 26
months. Clinical outcomes included mortality and rehospitalization for
heart failure. Results Moderate-severe AR occurred in 17.1% and 12.8% of
patients as measured by echocardiography and CMR, respectively. Higher RF
post-TAVR was associated with increased mortality (hazard ratio: 1.18 for
each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001)
and the combined endpoint of mortality and rehospitalization for heart
failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence
interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant
incremental predictive value; CMR performed a median of 40 days post-TAVR
had a greater association with post-TAVR clinical events compared with
early echocardiography (p < 0.01). RF >30% best predicted poorer clinical
outcomes (p < 0.001 for either mortality or the combined endpoint of
mortality and heart failure rehospitalization). Conclusions Worse
CMR-quantified AR was associated with increased mortality and poorer
clinical outcomes following TAVR. Quantifying AR with CMR may identify
patients with AR who could benefit from additional treatment measures.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<83>
Accession Number
612908445
Author
Van Belle E.; Hengstenberg C.; Lefevre T.; Kupatt C.; Debry N.; Husser O.;
Pontana F.; Kuchcinski G.; Deliargyris E.N.; Mehran R.; Bernstein D.;
Anthopoulos P.; Dangas G.D.
Institution
(Van Belle, Debry) Department of Cardiology, Centre Hospitalier Regional
Universitaire (CHRU) Lille and Unite Mixte de Recherche (UMR1011), Lille,
France
(Hengstenberg, Husser) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Hengstenberg) Deutsches Zentrum fur Herz-Kreislauf-Forschung E.V. (DZHK),
partner site Munich Heart Alliance, Munich, Germany
(Lefevre) Institut Cardio Vasculaire Paris Sud, Paris, France
(Kupatt) Ludwig Maximilian University of Munich (LMU) Munich, Munich,
Germany
(Pontana, Kuchcinski) Department of Radiology, CHRU Lille, Lille, France
(Deliargyris, Bernstein) The Medicines Company, Parsippany, New Jersey,
United States
(Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York, United States
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Cerebral Embolism During Transcatheter Aortic Valve Replacement: The
BRAVO-3 MRI Study.
Source
Journal of the American College of Cardiology. 68 (6) (pp 589-599), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Cerebral embolization is a frequent complication after
transcatheter aortic valve replacement (TAVR). We hypothesized that
cerebral embolization may be reduced by anticoagulation with bivalirudin
during TAVR. Objectives This study sought to determine the proportion of
patients with new cerebral embolus after TAVR and to investigate whether
parenteral procedural anticoagulation strategies affect cerebral
embolization. Methods The BRAVO (Effect of Bivalirudin on Aortic Valve
Intervention Outcomes)-3 randomized trial compared bivalirudin with
unfractionated heparin in patients undergoing transfemoral TAVR. A
prospective cerebral magnetic resonance imaging (MRI) substudy was
conducted in 4 sites; 60 patients were imaged with brain MRI after TAVR.
Primary endpoint was proportion of patients with new cerebral emboli on
MRI. Secondary endpoints included quantitative MRI analyses of cerebral
lesions and neurological outcomes at 48 h and 30 days. Results Patients
were randomized to bivalirudin (n = 29) versus heparin (n = 31). The
proportion of patients with new cerebral emboli on MRI did not differ
between bivalirudin and heparin groups (65.5% vs. 58.1%; p = 0.55). Groups
were similar for median number of emboli per patient (1 [interquartile
range (IQR): 0 to 3] vs. 1 [IQR: 0 to 1]; p = 0.08), total volume of
emboli (45 [IQR: 0 to 175] mm³ vs. 33 [IQR: 0 to 133]
mm³; p = 0.86), or proportion of patients with a clinical
neurological deficit at 48 h or 30 days. All patients who presented
clinically with stroke had evidence of new emboli on MRI. Conclusions This
study documented cerebral embolization in nearly two-thirds of patients
during contemporary TAVR. There were no significant differences in
cerebral embolization for bivalirudin versus heparin anticoagulation
during TAVR. (Open-Label, Randomized Trial in Patients Undergoing TAVR to
Determine Safety and Efficacy of Bivalrudin vs. UFH [BRAVO-2/3];
NCT01651780) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<84>
Accession Number
612727419
Author
May A.M.; Blackwell T.; Stone K.L.; Cawthon P.M.; Sauer W.H.; Varosy P.D.;
Redline S.; Koo B.B.; Mehra R.
Institution
(May) Division of Pulmonary, Critical Care, and Sleep Medicine, University
Hospitals Case Medical Center, Cleveland, OH, United States
(Blackwell, Stone, Cawthon) California Pacific Medical Center Research
Institute, San Francisco, CA, United States
(Sauer, Varosy) Electrophysiology Section, University of Colorado Anschutz
Medical Campus, Denver, CO, United States
(Varosy) VA Eastern Colorado Health Care System, Denver, CO, United States
(Varosy) Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver,
CO, United States
(Redline) Division of Sleep Medicine, Brigham and Women's Hospital and
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Koo) Department of Neurology, Yale School of Medicine, New Haven, CT,
United States
(Mehra) Neurologic Institute, Cleveland Clinic Lerner College of Medicine
of Case Western Reserve University, Cleveland, OH, United States
Title
Longitudinal relationships of periodic limb movements during sleep and
incident atrial fibrillation.
Source
Sleep Medicine. 25 (pp 78-86), 2016. Date of Publication: 01 Sep 2016.
Publisher
Elsevier B.V.
Abstract
Objectives This study aimed to examine relationship between periodic limb
movements during sleep (PLMS) and incident atrial fibrillation/flutter
(AF). Methods Prospective multicenter cohort (n=2273: adjudicated AF
group; n=843: self-reported AF group) of community-dwelling men without
prevalent AF were followed for an average of 8.3 years (adjudicated) and
6.5 years (self-reported). PLMS index (PLMI, <5 (ref), >5 to <30, >30) and
PLM arousal index (PLMAI, <1 (ref), >1 to <5, >5) were measured by
polysomnography. Incident adjudicated and self-reported AF were analyzed
by Cox proportional hazards and logistic regression, respectively, and
adjusted for age, clinic, race, body mass index (BMI), alcohol use,
cholesterol level, cardiac medications, pacemaker, apnea-hypopnea index,
renal function, and cardiac risk. The interaction of age and PLMS was
examined. Results In this primarily Caucasian (89.8%) cohort of older men
(mean age 76.1+/-5.5 years) with BMI of 27.2+/-3.7, there were 261 cases
(11.5%) of adjudicated and 85 cases (10.1%) of self-reported incident AF.
In the overall cohort, PLMI and PLMAI were not associated with adjudicated
or self-reported AF. There was some evidence of an interaction of age and
PLMI (p=0.08, adjudicated AF) and PLMAI (p<0.06, both outcomes). Among men
aged >76 years, the highest PLMI tertile was at increased risk of
adjudicated AF (>30 vs. <5; hazard ratio (HR)=1.63, 1.01-2.63) and the
middle PLMAI tertile predicted increased risk of both outcomes (1 to <5
vs. <1; adjudicated, HR=1.65, 1.05-2.58; self-reported HR=5.76,
1.76-18.84). No such associations were found in men aged <76 years.
Conclusions Although PLMS do not predict AF incidence in the overall
cohort, the findings suggest PLMS increases incident AF risk in the older
subgroup. Copyright &#xa9; 2016 Elsevier B.V.

<85>
Accession Number
612949033
Author
Chaudhri M.S.; Shah M.U.A.; Asghar M.I.; Siddiqi R.; Janjua A.M.; Iqbal A.
Institution
(Chaudhri, Shah, Asghar, Janjua, Iqbal) Department of Cardiac Surgery,
Armed Forces Institute of Cardiology and National Institute of Heart
Diseases (AFIC-NIHD), Rawalpindi, Pakistan
(Siddiqi) Department of Cardio-Thoracic Anesthesia, Armed Forces Institute
of Cardiology and National Institute of Heart Diseases (AFIC-NIHD),
Rawalpindi, Pakistan
Title
Skeletonization of left internal mammary artery in coronary artery bypass
grafting.
Source
Journal of the College of Physicians and Surgeons Pakistan. 26 (9) (pp
736-739), 2016. Date of Publication: 2016.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare mean per-operative flow capacity between
skeletonized and pedicled left internal mammary artery (LIMA) in patients
undergoing coronary artery bypass grafting (CABG) surgery. Study Design:
Randomized control trial. Place and Duration of Study: Department of
Cardiac Surgery, Armed Forces Institute of Cardiology and National
Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from
February to August, 2013. Methodology: Patients undergoing CABG for
coronary artery disease, under 80 years, excluded by the exclusion
criteria; and fulfilling the inclusion criteria were randomly assigned to
two groups of 70 each. One group underwent skeletonized and the other
underwent pedicled technique of LIMA harvesting. Free flow was checked
just before anastamosis of each LIMA to the LAD, manually in blood flow in
ml per minute during cardiopulmonary bypass by allowing it to bleed into a
100 ml container over 20 seconds. A specialized proforma was used to
record the age, gender, weight, disease, type of IMA used, and free flow
of the IMA. Data was analyzed using SPSS 18. Results: The mean age of the
patients was 57.16 years in 40 patients, ranging from 36 to 75 years.
Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and
triple vessel coronary artery disease, respectively. There was
significantly higher free flow in the skeletonized group than the pedicled
group (p=0.04). Conclusion: Skeletonized IMA had superior flow to pedicled
IMA in addition to its traditional proven advantages, which justifies its
further use as a conduit for myocardial revascularization.

<86>
Accession Number
603097835
Author
Beer L.; Szerafin T.; Mitterbauer A.; Debreceni T.; Maros T.; Dworschak
M.; Roth G.A.; Ankersmit H.J.
Institution
(Beer, Mitterbauer, Ankersmit) Department of Thoracic Surgery, Medical
University of Vienna, Wahringer Gurtel 18-20, Vienna A-1090, Austria
(Beer, Mitterbauer, Ankersmit) Christian Doppler Laboratory for Cardiac
and Thoracic Diagnosis and Regeneration, Vienna, Austria
(Szerafin, Debreceni, Maros) Department of Cardiac Surgery, Institute of
Cardiology, Medical and Health Science Centre, University of Debrecen,
Hungary
(Dworschak, Roth) Department of Anesthesiology, General Intensive Care and
Pain Medicine, Medical University of Vienna, Vienna, Austria
Title
Low tidal volume ventilation during cardiopulmonary bypass reduces
postoperative chemokine serum concentrations.
Source
Thoracic and Cardiovascular Surgeon. 62 (8) (pp 677-682), 2015. Date of
Publication: 2015.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Open-heart surgery with cardiopulmonary bypass (CPB) is
associated with a generalized immune response and postoperative lung
dysfunction. Chemokines are involved in the pathogenesis of postoperative
lung dysfunction. We investigated whether continued mechanical ventilation
during CPB has an impact on chemokine serum concentrations. Methods A
total of 30 patients undergoing coronary artery bypass graft operation
were randomized to either continuous ventilated group (n = 15) or
nonventilated group (n = 15). Blood samples were drawn at the beginning
and at the end of surgery and on the 5 consecutive days. Serum CCL2, CCL4,
and CCL20 concentrations were measured and given as mean +/- standard
deviation. Results Chemokine concentrations were elevated at the end of
surgery in both groups. CCL2 and CCL4 levels returned to baseline on
postoperative day (POD)-1 in the ventilation group and stayed elevated in
the nonventilation group. CCL4 serum levels were significantly lower in
ventilated-group patients on POD-1 (10.9 [39.0] vs. 153.2 [168.1]; p =
0.005), POD-2 (16.8 [36.8] vs. 147.9 [165.4]; p = 0.019), POD-3 (14.2
[24.0] vs. 97.9 [87.1]; p = 0.005), and POD-5 (6.5 [25.0] vs. 33.6 [38.4];
p = 0.045). Conclusion Continued mechanical ventilation during CPB results
in reduced CCL4 concentrations on POD-1 to -5. Copyright &#xa9; 2015 Georg
Thieme Verlag KG Stuttgart, New York.

<87>
Accession Number
600738356
Author
Zhang Y.; Zeng Z.; Cao Y.; Du X.; Wan Z.
Institution
(Zhang, Zeng, Cao, Du, Wan) Department of Emergency, West China School of
Medicine, Sichuan University, Chengdu, Sichuan, China
Title
Effect of urinary protease inhibitor (ulinastatin) on cardiopulmonary
bypass: A meta-analysis for China and Japan.
Source
PLoS ONE. 9 (12) (no pagination), 2014. Article Number: e113973. Date of
Publication: 11 Dec 2014.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objectives: A meta-analysis was conducted to investigate the effects of
ulinastatin treatment on adult patients undergoing cardiac surgery under
cardiopulmonary bypass (CPB). Methods: Seven electronic databases were
searched for reports of randomized, controlled trials conducted up to
February 2014 in which patients undergoing cardiac surgery with CPB were
administered ulinastatin in the perioperative period. Results: Fifty-two
studies with 2025 patients were retained for analysis. The results showed
that the ulinastatin can attenuate the plasma levels of pro-inflammatory
cytokines and enhance the anti-inflammatory cytokine levels in patients
undergoing cardiac surgery with CPB. Meanwhile, the ulinastatin had a
significant beneficial effect on myocardial injury. The mean differences
(MD) and 95% confidence intervals (95% CI) of biochemical markers were
-63.54 (-79.36, -47.72) for lactate dehydrogenase, -224.99 (-304.83,
-145.14) for creatine kinase, -8.75 (-14.23, -3.28) for creatine
kinase-MB, and -0.14 (-0.20, -0.09] for troponin I (all P<0.01). However,
neither hemodynamics nor cardiac function improved significantly, except
that the MD and 95% CI of mean arterial pressure were 2.50 (0.19, 4.80)
(P=0.03). There were no statistically significant differences in the use
of inotropes, postoperative bleeding, postoperative complications, the
intensive care unit (ICU) stay, and the hospital stay; however, the
frequency of auto resuscitation increased significantly (OR 1.98, 95%CI
1.19 to 3.30, P<0.01), the duration of intubation (MD -1.58, 95%CI -2.84
to -0.32, P<0.01) and the duration of mechanical ventilation (MD -3.29,
95%CI -4.41 to -2.17, P<0.01) shortened significantly in patients who were
treated with ulinastatin. Conclusions: Ulinastatin can reduce the plasma
levels of pro-inflammatory cytokines and elevate anti-inflammatory
cytokine in patients from China and Japan undergoing cardiac surgery with
CPB. Ulinastatin treatment may have protective effects on myocardial
injury, and can increase the frequency of auto resuscitation, shorten the
duration of intubation and mechanical ventilation. Copyright &#xa9; 2014
Zhang et al.

<88>
Accession Number
604760831
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Nugara F.; Yu L.-M.;
Flather M.
Institution
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, United Kingdom
(Altman, Yu) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Altman, Yu) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Botnar Research Centre, Oxford, United Kingdom
(Gray) Department of Public Health, Health Economics Research Centre,
University of Oxford, Headington, Oxford, United Kingdom
(Lees, Nugara, Flather) Clinical Trials and Evaluation Unit, Royal
Brompton and Harefield NHS Trust, London, United Kingdom
(Lees, Flather) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
Title
Effects of on-pump and off-pump surgery in the arterial revascularization
trial.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 1059-1065), 2014.
Article Number: ezu349. Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The Arterial Revascularization Trial (ART) is a randomized
comparison of bilateral internal mammary artery (BIMA) versus single
internal mammary artery (SIMA) grafting in coronary artery bypass graft
(CABG) surgery and is one of the largest randomized trials of surgery ever
conducted. ART is also one of the largest studies of contemporary CABG
with a high proportion of off-pump surgeries (41%). The objective of this
post hoc analysis was to evaluate the surgical process and 1-year outcomes
for surgery performed on-pump compared with off-pump. METHODS: ART
randomized 3102 patients with multivessel coronary artery disease (CAD) to
SIMA or BIMA grafts to determine if BIMA grafts have an additional
survival advantage at 10 years. The 1-year interim analysis showed an
overall very low mortality and major morbidity rate irrespective of
whether the procedure was with an SIMA or BIMA. The surgical process and
1-year outcomes were analysed according to whether surgery was performed
on-pump or off-pump. RESULTS: Baseline variables were not statistically
significantly different between on- and off-pump surgery within each
treatment group after taking account of the effects of clustering by
individual surgeons. At both 30 days and 1 year, there was a low incidence
of death (1.2%, 2.3%), stroke (1.1%, 1.7%), myocardial infarction (MI)
(1.4%, 1.9%), repeat revascularization (0.5%, 1.5%) and wound
reconstruction (1.2%). A similar average number of grafts were performed
with on- and off-pump surgery (median = 3), but the duration of surgery
was 20-30 min and ventilation time ~2 h shorter with off-pump surgery.
Blood loss and platelet transfusions were lower in the off-pump group,
with no difference in the need for balloon pump or renal support. Sternal
wound reconstruction was similar with off-pump surgery in the SIMA group
(0.5 vs 0.6%) and lower with off-pump surgery in the BIMA group (1.4 vs
2.2%). Repeat revascularization was marginally higher in off-pump patients
at 30 days (0.8 vs 0.3%) and at 1 year (1.7 vs 1.3%). CONCLUSIONS: The
outcomes of contemporary CABG are excellent with low mortality, stroke,
myocardial infarction and need for wound reconstruction and repeat
revascularization whether performed on-pump or off-pump. CLINICAL TRIAL
REGISTRATION: Controlled-trials.com (ISRCTN46552265). Copyright &#xa9; The
Author 2014. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<89>
Accession Number
604760725
Author
Etz C.D.; Weigang E.; Hartert M.; Lonn L.; Mestres C.A.; Di Bartolomeo R.;
Bachet J.E.; Carrel T.P.; Grabenwoger M.; Schepens M.A.A.M.; Czerny M.
Institution
(Etz) Department of Cardiac Surgery, Herzzentrum Leipzig-University
Hospital, Germany
(Etz) Mount Sinai School of Medicine, New York, NY, United States
(Weigang) Department of Vascular and Endovascular Surgery, Evangelisches
Krankenhaus St. Hubertus, Berlin, Germany
(Hartert) Department of Cardiothoracic and Vascular Surgery, University of
Mainz, Mainz, Germany
(Lonn) Department of Vascular Surgery and Cardiovascular Radiology,
Faculty of Health Science, Rigshospitalet Copenhagen, Copenhagen, Denmark
(Mestres) Department of Cardiovascular Surgery, Hospital Clinic Barcelona,
Spain
(Mestres) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
(Di Bartolomeo) Department of Cardiovascular Surgery, Policlinico
Sant'Orsola-Malpighi, Universita di Bologna, Bologna, Italy
(Bachet) Nogent sur MarneFrance
(Carrel) Department of Cardiovascular Surgery, Inselspital, University
Hospital Bern, Bern, Switzerland
(Grabenwoger) Department of Cardiovascular Surgery, Hospital Hietzing,
Vienna, Austria
(Schepens) Department of Cardiothoracic Surgery, AZ Sant-Jan, Brugge,
Belgium
(Czerny) Department of Cardiovascular Surgery, University Hospital Zurich,
Zurich, Switzerland
(Czerny) Department of Cardiovascular Surgery, University Heart Center
Freiburg - Bad Krozingen, Freiburg, Germany
Title
Contemporary spinal cord protection during thoracic and thoracoabdominal
aortic surgery and endovascular aortic repair: A position paper of the
vascular domain of the European association for cardio-thoracic surgery.
Source
European Journal of Cardio-thoracic Surgery. 47 (6) (pp 943-957), 2014.
Article Number: ezv142. Date of Publication: 01 Sep 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and
endovascular descending thoracic and thoracoabdominal repair. Neurological
outcomes have improved coincidentially with the introduction of
neuroprotective measures. However, SCI (paraplegia and paraparesis)
remains the most devastating complication. The aim of this position paper
is to provide physicians with broad information regarding spinal cord
blood supply, to share strategies for shortening intraprocedural spinal
cord ischaemia and to increase spinal cord tolerance to transitory
ischaemia through detection of ischaemia and augmentation of spinal cord
blood perfusion. This study is meant to support physicians caring for
patients in need of any kind of thoracic or thoracoabdominal aortic repair
in decision-making algorithms in order to understand, prevent or reverse
ischaemic SCI. Information has been extracted from focused publications
available in the PubMed database, which are cohort studies, experimental
research reports, case reports, reviews, short series and meta-analyses.
Individual chapters of this position paper were assigned and after
delivery harmonized by Christian D. Etz, Ernst Weigang and Martin Czerny.
Consequently, further writing assignments were distributed within the
group and delivered in August 2014. The final version was submitted to the
EJCTS for review in September 2014. Copyright &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<90>
Accession Number
605028722
Author
Buggeskov K.B.; Jakobsen J.C.; Secher N.H.; Jonassen T.; Andersen L.W.;
Steinbruchel D.A.; Wetterslev J.
Institution
(Buggeskov, Andersen) The Heart Centre, Rigshospitalet, Department of
Cardiothoracic Anaesthesiology, 4142, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Jakobsen, Wetterslev) Centre for Clinical Intervention Research,
Rigshospitalet, The Copenhagen Trial Unit, 7812, Blegdamsvej 9, Copenhagen
DK-2100, Denmark
(Secher) Rigshospitalet, Department of Anaesthesiology, 2041, Blegdamsvej
9, Copenhagen DK-2100, Denmark
(Jonassen) University of Copenhagen, Department of Biomedical Sciences,
The Panum Institute, Blegdamsvej 3, Copenhagen DK-2200, Denmark
(Steinbruchel) The Heart Centre, Rigshospitalet, Department of
Cardiothoracic Surgery, 2152, Blegdamsvej 9, Copenhagen DK-2100, Denmark
Title
Detailed statistical analysis plan for the pulmonary protection trial.
Source
Trials. 15 (1) (no pagination), 2014. Article Number: 510. Date of
Publication: December 23, 2014.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Pulmonary dysfunction complicates cardiac surgery that
includes cardiopulmonary bypass. The pulmonary protection trial evaluates
effect of pulmonary perfusion on pulmonary function in patients suffering
from chronic obstructive pulmonary disease. This paper presents the
statistical plan for the main publication to avoid risk of outcome
reporting bias, selective reporting, and data-driven results as an update
to the published design and method for the trial. Results: The pulmonary
protection trial is a randomized, parallel group clinical trial that
assesses the effect of pulmonary perfusion with oxygenated blood or
CustodiolTM HTK (histidine-tryptophan-ketoglutarate) solution versus no
pulmonary perfusion in 90 chronic obstructive pulmonary disease patients.
Patients, the statistician, and the conclusion drawers are blinded to
intervention allocation. The primary outcome is the oxygenation index from
10 to 15minutes after the end of cardiopulmonary bypass until 24hours
thereafter. Secondary outcome measures are oral tracheal intubation time,
days alive outside the intensive care unit, days alive outside the
hospital, and 30- and 90-day mortality, and one or more of the following
selected serious adverse events: pneumothorax or pleural effusion
requiring drainage, major bleeding, reoperation, severe infection,
cerebral event, hyperkaliemia, acute myocardial infarction, cardiac
arrhythmia, renal replacement therapy, and readmission for a
respiratory-related problem. Conclusions: The pulmonary protection trial
investigates the effect of pulmonary perfusion during cardiopulmonary
bypass in chronic obstructive pulmonary disease patients. A preserved
oxygenation index following pulmonary perfusion may indicate an effect and
inspire to a multicenter confirmatory trial to assess a more clinically
relevant outcome. Trial registration: ClinicalTrials.gov identifier:
NCT01614951, registered on 6 June 2012 Copyright &#xa9; 2014 Buggeskov et
al.

<91>
Accession Number
605988672
Author
Yetgin T.; van Kranenburg M.; ten Cate T.; Duncker D.J.; de Boer M.-J.;
Diletti R.; van Geuns R.-J.M.; Zijlstra F.; Manintveld O.C.
Institution
(Yetgin, van Kranenburg, Duncker, Diletti, van Geuns, Zijlstra,
Manintveld) Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam,
Netherlands
(Yetgin, Duncker, Zijlstra) Interuniversity Cardiology Institute of the
Netherlands, ICIN-KNAW, Utrecht, Netherlands
(ten Cate, de Boer) Department of Cardiology, UMC St. Radboud, Nijmegen,
Netherlands
(van Geuns) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
Title
Ischemic Postconditioning After Routine Thrombus Aspiration During Primary
Percutaneous Coronary Intervention: Rationale and Design of the
POstconditioning Rotterdam Trial.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 508-514),
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: Whether ischemic postconditioning (IPOC) immediately after
routine thrombus aspiration (TA) reduces infarct size (IS) in patients
with ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (PPCI) has not been established. Study
design: The POstconditioning Rotterdam Trial (PORT) is a dual-center,
prospective, open-label, randomized trial with blinded endpoint evaluation
enrolling 72 subjects with first-time STEMI, and an occluded
infarct-related artery (IRA) without collaterals undergoing PPCI. Subjects
are randomized 1:1 to a strategy of IPOC immediately after TA followed by
stenting of the IRA or to conventional percutaneous coronary intervention
(PCI), including TA followed by stenting of the IRA (controls). Cardiac
magnetic resonance imaging (MRI) is performed at 3-5 days after STEMI and
at 3 months. The primary endpoint is IS at 3 months measured by delayed
enhancement MRI. Other secondary endpoints include MRI-derived
microvascular obstruction (MVO), left ventricular ejection fraction,
myocardial salvage index, enzymatic IS, ST-segment resolution, myocardial
blush grade, microcirculatory resistance, inflammation markers, and
clinical events through 3-month follow-up. Conclusions: PORT is testing
the hypothesis that adding IPOC (against lethal reperfusion injury) to TA
(against distal embolization and MVO) is cardioprotective and reduces
ultimate IS in STEMI patients undergoing PPCI (Dutch Trial Register
identifier: NTR4040). &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9;
2015 Wiley Periodicals, Inc.

<92>
Accession Number
608745934
Author
Yildirim A.; Goktekin O.; Gorgulu S.; Norgaz T.; Akkaya E.; Aydin U.; Unal
Aksu H.; Bakir I.
Institution
(Yildirim, Akkaya, Unal Aksu) Cardiology Department, Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
(Goktekin) Cardiology Department, Bezmialem University Medical Faculty,
Istanbul, Turkey
(Gorgulu, Norgaz) Cardiology Department, Acibadem University Medical
Faculty, Istanbul, Turkey
(Aydin, Bakir) Cardiovascular Surgery Department, Mehmet Akif Ersoy Chest
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
Title
A New Specific Device in Transcatheter Prosthetic Paravalvular Leak
Closure: A Prospective Two-Center Trial.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 618-624),
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: This study sought to compare various outcomes among a new
specifically designed transcatheter paravalvular leak closure (TPVLC)
device and the devices that are being utilized off-label. Methods: Between
April 2012 and January 2015, in a prospective two-center study, 52
patients who needed surgical reintervention due to a hemodynamically
significant prosthetic paravalvular leak were studied. This study
population was divided into two groups. Group I was composed of 32
patients who underwent paravalvular leak (PVL) closure with the currently
available devices that are being utilized off-label, while group II
consisted of 20 patients who were treated with the new specifically
designed Occlutech PVL device. Results: Demographic and clinical variables
indicated a higher rate of atrial fibrillation (P = 0.027) and chronic
obstructive airway disease (P = 0.009) in group II. The apical approach
was the most commonly used intervention route used for group II (P =
0.019). The procedural success rate was 100% (29 of 29 leaks) in group II
while the rate was 92% (39 of 42 leaks) in group I. However, more
secondary events were observed in group I, but they did not reach
statistical significance (8 vs. 1, P = 0.064). Conclusions: With its high
procedural success rate and encouraging outcome results, the Occlutech
device seems to satisfy the expectations of a specifically designed PVL
closure device. &#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<93>
Accession Number
612921060
Author
Alatawi F.O.
Institution
(Alatawi) Department of Medicine, Madinah Cardiac Center, Taibah
University, Almadinah Almunawwarah, Malaysia
Title
Heart disease during pregnancy in the KSA: A suggested plan.
Source
Journal of Taibah University Medical Sciences. 11 (5) (pp 405-412), 2016.
Date of Publication: 01 Oct 2016.
Publisher
Elsevier B.V.
Abstract
Objectives Congenital heart disease in pregnancy is a leading cause of
maternal death in developed countries while rheumatic fever is the
commonest cause of valvular disease in pregnancy in developing countries.
Improvement in neonatal and paediatric cardiac surgery has increased the
incidence of congenital heart disease in pregnancy worldwide. Published
data regarding heart disease in pregnancy (HDP) in KSA are scant and
relatively old. This study examines the current status of HDP in KSA and
describes the rationale and design of the suggested plan for HDP in KSA,
i.e., the Registry Of Saudi Heart Disease And Pregnancy (ROSHDAP). Methods
A systematic search was conducted through the ProQuest MEDLINE
database using the keyword phrase "cardiovascular disease in pregnancy".
An extensive literature review about heart disease in pregnancywas
performed. Results There are only 4 available Saudi studies of HDP. The
ROSHDAP study is expected to establish a foundation for Saudi research in
this field and will create an extensive database that will enrich
knowledge about HDP. All Saudi women with HDP who wish to participate are
eligible for enrolment in the registry. Five phases are planned for the
registry, and data will be collected prospectively, confidentially, and
electronically. The data will be transmitted from participating centres to
a central coordinating office for data management and analysis. Conclusion
The ROSHDAP study suggested in this article will provide contemporary data
on HDP in KSA that will promote research and encourage evidence-based
medical care of pregnant women with heart disease. Copyright &#xa9; 2016
The Author

<94>
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.

<95>
Accession Number
610663667
Author
Eftychiou C.; Barmby D.S.; Wilson S.J.; Ubaid S.; Markwick A.J.; Makri L.;
Blaxill J.M.; Spratt J.C.; Gunning M.; Greenwood J.P.
Institution
(Eftychiou, Barmby, Makri, Blaxill, Greenwood) Department of Cardiology,
Leeds General Infirmary, Leeds, United Kingdom
(Wilson) Department of Cardiology, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
(Ubaid, Markwick, Gunning) Department of Cardiology, University Hospital
of North Staffordshire, Stoke-on-Trent, United Kingdom
(Spratt) Department of Cardiology, Forth Valley Royal, Edinburgh, United
Kingdom
(Greenwood) Division of Cardiovascular and Diabetes Research, Leeds
Institute of Cardiovascular and Metabolic Medicine, University of Leeds,
Leeds, United Kingdom
Title
Cardiovascular Outcomes Following Rotational Atherectomy: A UK Multicentre
Experience.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 546-553),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To identify factors associated with outcomes following
rotational atherectomy (RA). Background: RA is an effective way to
mechanically modify heavily calcified lesions before stenting; however its
outcomes are not well defined. Methods and Results: Retrospective
evaluation of all patients who underwent RA in three large UK centers
(Leeds General Infirmary (LGI), Royal Infirmary of Edinburgh (RIE) and
University Hospital of North Staffordshire (UHNS)) from March 2005 to
January 2013. Five hundred and eighteen patients had RA with median
follow-up period of 22 months. About 68.3% were male, 28.7% had DM and
34.6% were treated because of ACS. Stents were deployed in 97.3% of the
patients while 30.7% of the procedures were performed transradially.
Maximum burr was <1.75 mm in 85.5% and the mean SYNTAX score was 19.5 +/-
11.6. Peri-procedural complications occurred in 6.4% and vascular access
complications in 1.9%. Outcomes in the follow-up period were: MACE 17.8%,
cardiac death 7.1%, MI 11.7%, TVR 7.5%, all-cause death 13.7%, definite
stent thrombosis (ST) 1.4% and stroke 2.9%. Patients with intermediate and
high SYNTAX scores were more likely to suffer MACE, cardiac death, MI,
all-cause death and ST. Patients with a SYNTAX score >32 were also more
likely to have a peri-procedural complication. Multiple logistic
regression analysis showed that the presence of PVD (P = 0.026, OR = 2.0),
DM (P = 0.008, OR = 2.1), ACS presentation (P = 0.011, OR = 2.1) and
SYNTAX score >23 (P = 0.02, OR = 1.9) had a significant association with
MACE. Conclusions: RA is safe and effective, with high rate of procedural
success and relatively low incidence of MACE. PVD, DM, ACS presentation
and SYNTAX score were significant predictors for MACE. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<96>
Accession Number
607624527
Author
Tebaldi M.; Biscaglia S.; Fineschi M.; Manari A.; Menozzi M.; Secco G.G.;
Di Lorenzo E.; D'Ascenzo F.; Fabbian F.; Tumscitz C.; Ferrari R.; Campo G.
Institution
(Tebaldi, Biscaglia, Tumscitz, Ferrari, Campo) Cardiovascular Institute,
Azienda Ospedaliero-Universitaria Di Ferrara, Cona, Ferrara, Italy
(Fineschi) Department of Cardiology, University Medical Hospital of Siena,
Siena, Italy
(Manari) Department of Cardiology, Santa Maria Nuova Hospital,
Reggio-Emilia, Italy
(Menozzi) Department of Cardiology, Ospedale Degli Infermi, Rimini, Italy
(Secco) Division of Cardiology, "Santi Antonio E Biagio E Cesare Arrigo"
Hospital, Alessandria, Italy
(Di Lorenzo) Department of Heart and Vessels, S.G. Moscati Hospital,
Avellino, Italy
(D'Ascenzo) Division of Cardiology Citta Della Salute E Della Scienza,
Hospital University of Turin, Turin, Italy
(Fabbian) Clinica Medica, Departement of Medical Science, University of
Ferrara, Cona, Ferrara, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science
Foundation, Cotignola, Italy
(Campo) Laboratorio per Le Tecnologie Delle Terapie Avanzate (LTTA)
Center, Ferrara, Italy
Title
Fractional Flow Reserve Evaluation and Chronic Kidney Disease: Analysis
From a Multicenter Italian Registry (the FREAK Study).
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 555-562),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To establish if the presence of chronic kidney disease (CKD)
influences fractional flow reserve (FFR) value in patients with
intermediate coronary stenosis. Background: FFR-guided coronary
revascularization reduces cardiac adverse events in patients with coronary
artery disease. CKD impairs microcirculation and increases cardiovascular
risk. Whether CKD presence may limit FFR accuracy is unknown. Methods: We
used data from a multicenter prospective registry enrolling 1.004 patients
undergoing FFR evaluation for intermediate stenosis. We assessed the
relationship between clinical and angiographic variables and FFR
measurement. CKD was defined as CrCl value <45 ml/min. FFR value was
considered potentially flow-limiting, and therefore positive, if <0.80.
The index of microcirculatory resistance (IMR) was calculated in 20
patients stratified according CrCl value (single-center substudy).
Results: FFR measurement was positive in 395 (39%) patients. Overall, 131
(13%) patients had CKD. Patients with CrCl <45 ml/min showed significantly
higher FFR values as compared to the others (0.84 +/- 0.07 vs. 0.81 +/-
0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl
<45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes
(HR 1.07, 95%CI 1.008-1.13, p = 0.03), left anterior descending (HR 1.35,
95%CI 1.27-1.43, p < 0.001) and CrCl <45 ml/min (HR 0.92, 95%CI 0.87-0.97,
p = 0.005) emerged as independent predictors of FFR measurement.
Accordingly, IMR values were higher in patients with CrCl <45 ml/min (32 U
[28245] vs. 16 U [11220], p < 0.01). Conclusions: FFR and IMR measurements
differ between CKD patients and those with normal renal function.
Flow-limiting FFR is less frequent in patients with CrCl <45 ml/min.
&#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<97>
Accession Number
612675378
Author
Carson J.L.; Stanworth S.J.; Roubinian N.; Fergusson D.A.; Triulzi D.;
Doree C.; Hebert P.C.
Institution
(Carson) Rutgers Robert Wood Johnson Medical School, Division of General
Internal Medicine, 125 Paterson Street, New Brunswick, NJ 08903, United
States
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
(Roubinian) Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa,
ON K1Y 4E9, Canada
(Fergusson) Ottawa Hospital Research Institute, Clinical Epidemiology
Program, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
(Triulzi) University of Pittsburgh, The Institute for Transfusion
Medicine, Five Parkway Center, 875 Greentree Road, Pittsburgh, PA 15220,
United States
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Hebert) University of Montreal Hospital Research Centre, Centre for
Research, 900 rue St-Denis, local R04-402 Tour Viger, Montreal, QC H2X
0A9, Canada
Title
Transfusion thresholds and other strategies for guiding allogeneic red
blood cell transfusion.
Source
Cochrane Database of Systematic Reviews. 2016 (10) (no pagination), 2016.
Article Number: CD002042. Date of Publication: 12 Oct 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: There is considerable uncertainty regarding the optimal
haemoglobin threshold for the use of red blood cell (RBC) transfusions in
anaemic patients. Blood is a scarce resource, and in some countries,
transfusions are less safe than others because of a lack of testing for
viral pathogens. Therefore, reducing the number and volume of transfusions
would benefit patients. Objectives: The aim of this review was to compare
30-day mortality and other clinical outcomes in participants randomized to
restrictive versus liberal red blood cell (RBC) transfusion thresholds
(triggers) for all conditions. The restrictive transfusion threshold uses
a lower haemoglobin level to trigger transfusion (most commonly 7 g/dL or
8 g/dL), and the liberal transfusion threshold uses a higher haemoglobin
level to trigger transfusion (most commonly 9 g/dL to 10 g/dL). Search
methods: We identified trials by searching CENTRAL (2016, Issue 4),
MEDLINE (1946 to May 2016), Embase (1974 to May 2016), the Transfusion
Evidence Library (1950 to May 2016), the Web of Science Conference
Proceedings Citation Index (1990 to May 2016), and ongoing trial
registries (27 May 2016). We also checked reference lists of other
published reviews and relevant papers to identify any additional trials.
Selection criteria: We included randomized trials where intervention
groups were assigned on the basis of a clear transfusion 'trigger',
described as a haemoglobin (Hb) or haematocrit (Hct) level below which a
red blood cell (RBC) transfusion was to be administered. Data collection
and analysis: We pooled risk ratios of clinical outcomes across trials
using a random-effects model. Two people extracted the data and assessed
the risk of bias. We conducted predefined analyses by clinical subgroups.
We defined participants randomly allocated to the lower transfusion
threshold as 'restrictive transfusion' and to the higher transfusion
threshold as 'liberal transfusion'. Main results: A total of 31 trials,
involving 12,587 participants, across a range of clinical specialities
(e.g. surgery, critical care) met the eligibility criteria. The trial
interventions were split fairly equally with regard to the haemoglobin
concentration used to define the restrictive transfusion group. About half
of them used a 7 g/dL threshold, and the other half used a restrictive
transfusion threshold of 8 g/dL to 9 g/dL. The trials were generally at
low risk of bias .Some items of methodological quality were unclear,
including definitions and blinding for secondary outcomes. Restrictive
transfusion strategies reduced the risk of receiving a RBC transfusion by
43% across a broad range of clinical specialties (risk ratio (RR) 0.57,
95% confidence interval (CI) 0.49 to 0.65; 12,587 participants, 31 trials;
high-quality evidence), with a large amount of heterogeneity between
trials (I2 = 97%). Overall, restrictive transfusion strategies did not
increase or decrease the risk of 30-day mortality compared with liberal
transfusion strategies (RR 0.97, 95% CI 0.81 to 1.16, I2 = 37%; N =
10,537; 23 trials; moderate-quality evidence) or any of the other outcomes
assessed (i.e. cardiac events (low-quality evidence), myocardial
infarction, stroke, thromboembolism (high-quality evidence)). Liberal
transfusion did not affect the risk of infection (pneumonia, wound, or
bacteraemia). Authors' conclusions: Transfusing at a restrictive
haemoglobin concentration of between 7 g/dL to 8 g/dL decreased the
proportion of participants exposed to RBC transfusion by 43% across a
broad range of clinical specialities. There was no evidence that a
restrictive transfusion strategy impacts 30-day mortality or morbidity
(i.e. mortality at other points, cardiac events, myocardial infarction,
stroke, pneumonia, thromboembolism, infection) compared with a liberal
transfusion strategy. There were insufficient data to inform the safety of
transfusion policies in certain clinical subgroups, including acute
coronary syndrome, myocardial infarction, neurological injury/traumatic
brain injury, acute neurological disorders, stroke, thrombocytopenia,
cancer, haematological malignancies, and bone marrow failure. The findings
provide good evidence that transfusions with allogeneic RBCs can be
avoided in most patients with haemoglobin thresholds above 7 g/dL to 8
g/dL. Copyright &#xa9; 2016 The Cochrane Collaboration. Published by John
Wiley & Sons, Ltd.

<98>
Accession Number
607178564
Author
Elgendy I.Y.; Wen X.; Mahmoud A.; Bavry A.A.
Institution
(Elgendy, Wen, Mahmoud, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Bavry) North Florida/South Georgia Veterans Health Systems, Gainesville,
FL, United States
Title
Complete Versus Culprit-Only Revascularization for Patients With
Multi-Vessel Disease Undergoing Primary Percutaneous Coronary
Intervention: An Updated Meta-Analysis of Randomized Trials.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 501-505),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform an updated meta-analysis to determine whether
complete revascularization of significant coronary lesions at the time of
primary percutaneous coronary intervention (PCI) would be associated with
better outcomes compared with culprit-only revascularization. Background:
Individual trials have demonstrated conflicting evidence regarding the
optimum revascularization strategy at the time of primary PCI. Methods:
Clinical trials that randomized ST elevation myocardial infarction (STEMI)
patients with multi-vessel disease to a complete versus culprit-only
revascularization strategy were included. Random effects summary risk
ratios (RR) were constructed using a DerSimonian-Laird model. The primary
outcome of interest was mortality or myocardial infarction (MI). Results:
A total of seven trials with 1,939 patients were included in the analysis.
Compared with culprit-only revascularization, complete revascularization
was associated with a non-significant reduction in the risk of mortality
or MI (RR 0.69, 95% confidence interval (CI) 0.42-1.12, P = 0.14).
Complete revascularization was associated with a reduced risk of major
adverse cardiac events (MACE) (RR 0.61, 95% CI 0.45-0.81, P < 0.001), due
to a significant reduction in urgent revascularization (RR 0.46, 95% CI
0.29-0.70, P < 0.001). The risk of major bleeding and contrast-induced
nephropathy was similar with both approaches (RR 0.83, 95% CI 0.41-1.71, P
= 0.62, and RR 0.94, 95% CI 0.42-2.12, P = 0.82). Conclusions: Complete
revascularization of all significant coronary lesions at the time of
primary PCI was associated with a reduction in the risk of MACE due to
reduction in the risk of urgent revascularization. This approach appears
to be safe, with no excess major bleeding, or contrast-induced
nephropathy. &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<99>
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.

<100>
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)

<101>
Accession Number
612698693
Author
Netuka I.; Kvasnicka T.; Kvasnicka J.; Hrachovinova I.; Ivak P.; Marecek
F.; Bilkova J.; Malikova I.; Jancova M.; Maly J.; Sood P.; Sundareswaran
K.S.; Connors J.M.; Mehra M.R.
Institution
(Netuka, Ivak, Maly) Department of Cardiac Surgery, Institute for Clinical
and Experimental Medicine, Prague, Czech Republic
(Netuka) Second Department of Surgery, First Faculty of Medicine, Charles
University of Prague, Prague, Czech Republic
(Kvasnicka, Kvasnicka, Bilkova, Malikova) Thrombotic Centre and Central
Hematology Laboratory, Institute of Medical Biochemistry and Laboratory
Diagnostics of the General University Hospital and First Faculty of
Medicine of Charles University of Prague, Prague, Czech Republic
(Hrachovinova, Marecek) NRL for Hemostasis, Institute of Hematology and
Blood Transfusion, Prague, Czech Republic
(Ivak) Third Faculty of Medicine, Charles University of Prague, Prague,
Czech Republic
(Jancova) Laboratory Methods, Institute for Clinical and Experimental
Medicine, Prague, Czech Republic
(Sood, Sundareswaran) St. Jude Medical, Minneapolis, Minnesota, United
States
(Connors) Department of Hematology, Brigham and Women's Hospital, Boston,
Massachusetts, United States
(Mehra) Heart and Vascular Center, Brigham and Women's Hospital and
Harvard Medical School, Boston, Massachusetts, United States
Title
Evaluation of von Willebrand factor with a fully magnetically levitated
centrifugal continuous-flow left ventricular assist device in advanced
heart failure.
Source
Journal of Heart and Lung Transplantation. 35 (7) (pp 860-867), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Contemporary continuous-flow left ventricular assist devices
(CF-LVADs) are associated with degradation of von Willebrand factor (vWF)
high-molecular-weight multimers (HMWMs), a critical factor supporting
platelet function. We hypothesized that the HeartMate 3 fully magnetically
levitated LVAD, designed to reduce circulatory shear stress, favorably
influences these hemostatic parameters. Methods Fifteen consecutive
HeartMate 3 LVAD patients were compared with 11 consecutive HeartMate II
controls. Serial plasma samples were collected pre-implant and on Days 2,
7, 30 and 45 post-operatively. Changes in vWF HMWMs were evaluated by 2
independent, study-blind hematologists and confirmed using
densitometry-based computerized software. Ristocetin cofactor (RiCO) and
vWF antigen (vWF Ag) were measured using standard protocols with
enzyme-linked immunosorbent assay. Results HeartMate 3 patients and
HeartMate II controls had a mean age of 67.3 +/- 1.4 and 52.8 +/- 2.5
years, respectively (INTERMACS Profiles 2 to 4 in 93.3% and 91%,
respectively). HeartMate 3 group demonstrated a significantly greater
preservation of HMWMs compared with the HeartMate II group, with the most
prominent decrease occurring by Day 2 post-operatively and sustained
through 45 days (71.94% vs 31.16%, p = 0.001). Laboratory values
(normalized to baseline) for RiCO activity, vWF Ag and RiCO:vWF Ag ratio
remained in the functional range with no statistically significant
differences observed between groups. Conclusion The HeartMate 3 LVAD is
associated with enhanced hemocompatibility compared with the HeartMate II
LVAD, as demonstrated by the improved preservation of vWF HMWMs, In
contrast, effects on HMWM degradation appeared to be dissociated from
functional attributes. Further confirmation of these findings in
randomized clinical trials is warranted. Copyright &#xa9; 2016
International Society for Heart and Lung Transplantation

<102>
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.

<103>
Accession Number
612923171
Author
Calcagno S.; Lucisano L.; Mancone M.; Cavallo E.; Pennacchi M.; Stio R.E.;
Sardella G.
Institution
(Calcagno, Lucisano, Mancone, Cavallo, Pennacchi, Stio, Sardella)
Department of Cardiovascular Respiratory, Nephrologic, Anesthesiologic and
Geriatric Sciences, Umberto i Hospital, Sapienza University of Rome,
Policlinico Umberto i, Viale del Policlinico 155, Rome 00186, Italy
Title
Bleeding versus thrombosis: Role of short DAPT in complex lesions.
Source
Minerva Cardioangiologica. 63 (6) (pp 533-546), 2015. Date of Publication:
December 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Therapy with dual antiplatelet agents, defined as the combination of a
platelet P2Y12 inhibitor and aspirin, is required to prevent thrombotic
complications, after percutaneous coronary intervention (PCI) with stent
implantation. Usually current guidelines recommend administration of dual
antiplatelet therapy (DAPT) following percutaneous revascularization with
drug-eluting stent (DES) for a period of at least 12 months or for 6 to 12
months in patients not at high risk. Nevertheless, the treatment of
stable/unstable coronary artery disease with DES implantation increasing
largely, the optimal duration of DAPT is still unclear. The duration of
DAPT after coronary stenting has been evaluated in recent randomized
studies with conflicting results. The administration of long period of
DAPT is a strategy to reduce thrombosis events but largely increase the
hemorrhagic ones. Otherwise, shorter DAPT period is protective about
bleeds with consequently increased ischemic events. In addition, as new
DES carry a lower risk of stent thrombosis (ST) compared with the
first-generation DES and possibly even bare-metal stents, a shift toward
better protection from ST may have an effect on the duration and the
intensity of DAPT. Whether the duration of DAPT should be shorter or
longer than the currently recommended 6 to 12 months is analyzed in this
review, drawing on results from the most recent studies and meta-analysis.

<104>
Accession Number
612579373
Author
Singh B.; Treece J.M.; Murtaza G.; Bhatheja S.; Lavine S.J.; Paul T.K.
Institution
(Singh, Bhatheja, Lavine, Paul) Department of Internal Medicine, Division
of Cardiology, East Tennessee State University, Johnson City, TN, United
States
(Treece, Murtaza) Department of Internal Medicine, East Tennessee State
University, Johnson City, TN, United States
Title
Aortic Dissection in a Healthy Male Athlete: A Unique Case with
Comprehensive Literature Review.
Source
Case Reports in Cardiology. 2016 (no pagination), 2016. Article Number:
6460386. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
A young otherwise healthy 27-year-old male who has been using anabolic
steroids for a long time developed Type I aortic dissection associated
with heavy weightlifting. The patient did not have a recent history of
trauma to the chest, no history of hypertension, and no illicit drug use.
He presented with severe chest pain radiating to back and syncopal event
with exertion. Initial vitals were significant for blood pressure of 80/50
mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and
oxygen saturation of 92% on room air. Physical exam was significant for
elevated jugular venous pressure, muffled heart sounds, and cold
extremities with diminished pulses in upper and absent pulses in lower
extremities. Bedside echocardiogram showed aortic root dilatation and
cardiac tamponade. STAT computed tomography (CT) scan of chest revealed
dissection of ascending aorta. Cardiothoracic surgery was consulted and
patient underwent successful repair of ascending aorta. Hemodynamic stress
of weightlifting can predispose to aortic dissection. Aortic dissection is
a rare but often catastrophic condition if not diagnosed and managed
acutely. Although rare, aortic dissection needs to be in the differential
when a young weightlifter presents with chest pain as a delay in diagnosis
may be fatal. Copyright &#xa9; 2016 Balraj Singh et al.

<105>
Accession Number
612842838
Author
Davidson L.J.; Davidson C.J.
Institution
(Davidson, Davidson) Division of Cardiology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Title
Stroke Prevention: Let's Prepare for Generation X TAVR.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 653-655),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Stroke leads to significant morbidity, disability, and mortality after
TAVR. CKD and prior stroke are risk factors for stroke. Stratification of
stroke risk would improve outcomes associated with TAVR. Ongoing
prospective randomized trials on embolic protection and post implant
anticoagulation are promising strategies to reduce stroke risk and new
brain MRI lesions. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<106>
Accession Number
612922714
Author
Santucci A.; Gargiulo G.; Ariotti S.; Marino M.; Magnani G.; Baldo A.;
Piccolo R.; Franzone A.; Valgimigli M.
Institution
(Santucci, Gargiulo, Ariotti, Marino, Magnani, Baldo, Piccolo, Franzone,
Valgimigli) Department of Cardiology, Bern University Hospital, Bern 3010,
Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(Ariotti, Valgimigli) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
Title
Radial versus femoral approach in STEMI: What do we know so far?.
Source
Minerva Cardioangiologica. 64 (3) (pp 219-237), 2016. Date of Publication:
June 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Radial approach has been used since 1989 to perform coronary angiography
as an alternative to femoral access. During past decades, the development
of dedicated equipment has led to high efficacy also in complex
procedures. ST elevation myocardial infarction (STEMI) is known to be a
high bleeding risk setting and in turn bleeding events can negatively
impact on outcomes. Observational studies have demonstrated feasibility,
efficacy and safety of radial approach when compared to femoral access in
STEMI patients, with benefit in bleeding rates. These advantages have also
been described in specific populations such as in the elderly and in
patients with cardiogenic shock. Some large randomized trials have been
conducted to assess outcomes of transradial access versus transfemoral
access, with RIVAL and MATRIX representing the largest two studies. The
RIVAL documented a significant reduction in access site-related
complications in the global population of acute coronary syndrome (ACS)
patients, with also lower mortality and net clinical adverse events
(NACE), mainly driven by significant reduction of bleeding and all-cause
mortality, in the STEMI sub-group. Overall, the MATRIX trial confirmed
that radial access decreased bleeding and all-cause death thus reducing
the rate of NACE and supporting the transradial access as the one to be
preferred in ACS patients. Clinical advantages of radial access have been
also tested in smaller randomized trials corroborating the evidence of
radial access as a highly recommendable alternative to femoral access in
the setting of primary percutaneous coronary intervention (p-PCI). The
current evidence suggests that radial access should become the default
access for patients with ACS undergoing invasive management. Copyright
&#xa9; 2016 Edizioni Minerva Medica.

<107>
Accession Number
612922155
Author
Sharma D.; Ramsewak A.; Manoharan G.; Spence M.S.
Institution
(Sharma, Manoharan, Spence) Royal Victoria Hospital, Belfast Health and
Social Care Trust, Belfast, Northern Ireland BT12 6BA, United Kingdom
(Ramsewak) Altnagelvin Hospital, Londonderry, Northern Ireland, United
Kingdom
Title
Efficacy of RADPAD protection drape in reducing radiation exposure to the
primary operator during Transcatheter Aortic Valve Implantation (TAVI).
Source
Minerva Cardioangiologica. 64 (1) (pp 41-46), 2016. Date of Publication:
February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: The efficacy of RADPAD (a sterile, lead-free drape) has been
demonstrated to reduce the scatter radiation to the primary operator
during fluoroscopic procedures. However, the use of the RADPAD during TAVI
procedures has not been studied. Transcatheter aortic valve implantation
(TAVI) is now an established treatment for patients with symptomatic
severe aortic stenosis who are deemed inoperable or at high risk for
conventional surgical aortic valve replacement (AVR). Consequently the
radiation exposure to the patient and the interventional team from this
procedure has become a matter of interest and importance. Methods to
reduce radiation exposure to the interventional team during this procedure
should be actively investigated. In this single center prospective study,
we determined the radiation dose during this procedure and the efficacy of
RADPAD in reducing the radiation dose to the primary operator. METHODS:
Fifty consecutive patients due to undergo elective TAVI procedures were
identified. Patients were randomly assigned to undergo the procedure with
or without the use of a RADPAD drape. There were 25 patients in each group
and dosimetry was performed at the left eye level of the primary operator.
The dosimeter was commenced at the start of the procedure, and the dose
was recorded immediately after the end of the procedure. Fluoroscopy times
and DAP were also recorded prospectively. RESULTS: Twenty-five patients
underwent transfemoral TAVI using a RADPAD and 25 with no-RADPAD. The mean
primary operator radiation dose was significantly lower in the RADPAD
group at 14.8 mSv vs. 24.3 mSv in the no-RADPAD group (P=0.008). There was
no significant difference in fluoroscopy times or dose-area products
between the two patient groups. The dose to the primary operator relative
to fluoroscopy time (RADPAD: slope=0.325; no RADPAD: slope=1.148; analysis
of covariance F=7.47, P=0.009) and dose area product (RADPAD:
slope=0.0007; no RADPAD: slope=0.002; analysis of covariance F=7.38;
P=0.009) was smaller in the RADPAD group compared to no-RADPAD group.
CONCLUSIONS: Use of a RADPAD significantly reduces radiation exposure to
the primary operator during TAVI procedures. Copyright &#xa9; 2016
EDIZIONI MINERVA MEDICA.

<108>
Accession Number
612922103
Author
Banker D.; Ahuja A.; Sanadhya H.; Purohit C.; Chandra S.; Sethi R.; Khare
R.; Kothari S.; Thakkar A.
Institution
(Banker, Ahuja) Banker Heart Institute, Old Padra Rd, Diwalipura,
Vadodara, Gujarat 390015, India
(Sanadhya, Purohit) Geetanjali Cardiac Center, Geetanjali Hospital,
Udaipur, India
(Chandra, Sethi, Khare) Department of Cardiology, King George's Medical
University, Uttar Pradesh, India
(Kothari, Thakkar) Department of Clinical Trials, Sahajanand Medical
Technologies Pvt. Ltd., Surat, India
Title
Clinical performance of biodegradable polymer-coated sirolimus-eluting
stents in unselected real-world population with coronary artery disease:
Results from the multicenter CORE Registry.
Source
Minerva Cardioangiologica. 64 (1) (pp 9-14), 2016. Date of Publication:
February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: The main aim of the CORE Registry was to evaluate clinical
performance of the Supralimus-Core biodegradable polymer-coated
sirolimus-eluting cobalt-chromium stent (Sahajanand Medical technologies
Pvt. Ltd., Surat, India) in unselected real-world patients. METHODS: This
was a multicenter, retrospective, non-randomized, single-arm study. A
total of 376 consecutive patients treated with the Supralimus-Core between
April 2010 and June 2014 were enrolled. The primary-end point of the
registry was major adverse cardiac events (MACE), which is a composite of
cardiac death, target lesion revascularization (TLR), target vessel
revascularization (TVR), myocardial infarction (MI) and stent thrombosis
(ST). Clinical follow-up were scheduled at 30-day and 6-month. RESULTS:
The mean age of enrolled patients was 54.6+/-10.3 years. A total of 444
lesions were treated successfully with 457 stents (1.0+/-0.2 per lesion).
The average stent length and diameter was 24.0+/-8.0 mm and 3.0+/-0.33 mm,
respectively. Out of total patients, 300 (79.8%) were male. Diabetes,
hypertension and chronic totally occluded lesions were found in 95
(25.3%), 102 (27.1%) and 125 (28.2%) patients, respectively, reflecting
high-risk patients involvement. The incidence of MACE at 30-day and
6-month was found to be in 4 (1.1 %) and 4 (1.1%) patients, respectively.
The TLR and ST was found in 1 (0.3 %) and 1 (0.3 %) patient respectively
at 6-month follow-up. CONCLUSIONS: The lower incidence of MACE, TLR and ST
clearly delineates safety and efficacy of Supralimus-Core
sirolimus-eluting stent in "real-world" patients with complex coronary
lesions. Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<109>
Accession Number
609991773
Author
Hong K.N.; Merlo A.; Chauhan D.; Davies R.R.; Iribarne A.; Johnson E.;
Jeevanandam V.; Russo M.J.
Institution
(Hong) Department of Health Evidence and Policy, Mount Sinai School of
Medicine, New York, New York, United States
(Merlo) Case Western Reserve Medical School, Cleveland, Ohio, United
States
(Chauhan, Russo) Department of Surgery, Rutgers-New Jersey Medical School,
Newark, New Jersey, United States
(Chauhan, Russo) Cardiovascular Clinical Research Unit, Barnabas Heart
Hospitals, Newark, New Jersey, United States
(Davies) Division of Pediatric Cardiothoracic Surgery, Nemours/Alfred I.
DuPont Hospital for Children, Wilmington, Delaware, United States
(Iribarne) Department of Cardiothoracic Surgery, Dartmouth Medical Center,
Hanover, New Hampshire, United States
(Johnson, Jeevanandam) Section of Cardiac and Thoracic Surgery, Department
of Surgery, University of Chicago, Chicago, Illinois, United States
Title
Evidence supports severe renal insufficiency as a relative
contraindication to heart transplantation.
Source
Journal of Heart and Lung Transplantation. 35 (7) (pp 893-900), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background This study was conducted to determine whether survival after
orthotopic heart transplant (OHT) is associated with pre-transplant
estimated glomerular filtration rate (eGFR) and to define ranges of
pre-OHT eGFR associated with differences in post-transplant survival. The
2006 International Society for Heart and Lung Transplantation revised
listing criteria for OHT stated that chronic kidney disease, defined by an
eGFR <40 ml/min is a relative contraindication for OHT alone. The
committee noted that this recommendation was supported by consensus
opinion of experts and not data derived from a randomized trial or
non-randomized studies. Methods The United Network for Organ Sharing
provided deidentified patient-level data. The study population included
17,459 OHT recipients aged >18 years who received allografts between
January 1, 2001, and December 31, 2009. Logistic regression was used to
assess the effect of multiple variables on survival after OHT. Receiver
operating characteristic curves and stratum-specific likelihood ratios
were generated to compare 1-year survival at eGFR thresholds. The primary
outcomes measure was actuarial post-transplant survival expressed in
years. Results Regression analysis showed that a lower pre-transplant eGFR
is associated with worse post-transplant survival. Threshold analysis
demonstrated 3 distinct survival strata: eGFR < 34 ml/min, eGFR 35 to 49
ml/min, and eGFR > 49 ml/min. Graft survival at all times is decreased for
patients with eGFR < 34 ml/min. They are also more likely to have
in-hospital and long-term complications. Conclusions eGFR is a strong
predictor of post-transplant survival and should be considered when
assessing patients for OHT. This analysis supports current International
Society for Heart and Lung Transplantation guidelines and suggests that
end-stage heart failure patients with an eGFR < 34 ml/min is a relative
contraindication for heart transplantation alone. Copyright &#xa9; 2016
International Society for Heart and Lung Transplantation

<110>
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.

<111>
Accession Number
613025583
Author
Cheng X.; Tong J.; Hu Q.; Chen S.; Yin Y.; Liu Z.
Institution
(Cheng) Department of Cardiology, The Second Affiliated Hospital/The
Second Clinical Institute, Chongqing Medical University, Chongqing, China
(Tong) Department of Cardiology, The Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
Department of Respirology, The Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
(Hu) Department of Clinical Laboratory, The Third People's Hospital of
Chongqing, Chongqing, China
(Chen) Department of Cardiology, The Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
Cardiology/Medicine, Shanghai First People's Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
(Yin) Department of Cardiology, The Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
(Liu) Department of Cardiology, The Second Affiliated Hospital/The Second
Clinical Institute, Chongqing Medical University, Chongqing, China
liuzeng666@163.com
Title
Meta-analysis of the effects of preoperative renin-angiotensin system
inhibitor therapy on major adverse cardiac events in patients undergoing
cardiac surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 47 (6) (pp 958-966),
2015. Date of Publication: 01 Jun 2015.
Abstract
The purpose of this meta-analysis was to assess the role of preoperative
renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac
events (MACE) in patients undergoing cardiac surgery. The Medline,
Cochrane Library and Embase databases were searched for clinical studies
published up to May 2014. Studies that evaluated the effects of
preoperative RASI therapy in cardiac surgery were included. Odds ratio
(OR) estimates were generated under a random-effects model. After a
literature search in the major databases, 18 studies were identified
[three randomized prospective clinical trials (RCTs) and 15 observational
trials] that reported outcomes of 54 528 cardiac surgery patients with (n
= 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy.
Pool analysis indicated that preoperative RASI therapy was not associated
with a significant reduction of early all-cause mortality [OR: 1.01; 95%
confidence interval (CI) 0.88-1.15, P = 0.93; I(2) = 25%], myocardial
infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I(2) = 16%), or stroke
(OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I(2) = 38%). Meta-regression
analysis confirmed that there was a strong negative correlation between
the percentage of diabetics and early all-cause mortality (P = 0.03).
Furthermore, preoperative RASI therapy significantly reduced mortality in
studies containing a high proportion of diabetic patients (OR: 0.84; 95%
CI 0.71-0.99, P = 0.04; I(2) = 0%). In conclusion, our meta-analysis
indicated that although preoperative RASI therapy was not associated with
a lower risk of MACE in cardiac surgery patients, it might provide
benefits for diabetic patients. Copyright &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<112>
Accession Number
613091822
Author
Anonymous
Title
Association of the magnitude of weight loss and changes in physical
fitness with long-term cardiovascular disease outcomes in overweight or
obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD
randomised clinical trial.
Source
The Lancet Diabetes and Endocrinology. 4 (11) (pp 913-921), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Findings from the Look AHEAD trial showed no significant
reductions in the primary outcome of cardiovascular disease incidence in
adults with type 2 diabetes randomly assigned to an intensive lifestyle
intervention for weight loss compared with those randomly assigned to
diabetes support and education (control). We examined whether the
incidence of cardiovascular disease in Look AHEAD varied by changes in
weight or fitness. Methods Look AHEAD was a randomised clinical trial done
at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to
April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76
years with type 2 diabetes were assigned (1:1) to an intensive lifestyle
intervention or diabetes support and education. In this observational,
post-hoc analysis, we examined the association of magnitude of weight loss
and fitness change over the first year with incidence of cardiovascular
disease. The primary outcome of the trial and of this analysis was a
composite of death from cardiovascular causes, non-fatal acute myocardial
infarction, non-fatal stroke, or admission to hospital for angina. The
secondary outcome included the same indices plus coronary artery bypass
grafting, carotid endartectomy, percutaneous coronary intervention,
hospitalisation for congestive heart failure, peripheral vascular disease,
or total mortality. We adjusted analyses for baseline differences in
weight or fitness, demographic characteristics, and risk factors for
cardiovascular disease. The Look AHEAD trial is registered with
ClinicalTrials.gov, number NCT00017953. Findings For the analyses related
to weight change, we excluded 311 ineligible participants, leaving a
population of 4834; for the analyses related to fitness change, we
excluded 739 participants, leaving a population of 4406. In analyses of
the full cohort (ie, combining both study groups), over a median 10.2
years of follow-up (IQR 9.5-10.7), individuals who lost at least 10% of
their bodyweight in the first year of the study had a 21% lower risk of
the primary outcome (adjusted hazard ratio [HR] 0.79, 95% CI 0.64-0.98;
p=0.034) and a 24% reduced risk of the secondary outcome (adjusted HR
0.76, 95% CI 0.63-0.91; p=0.003) compared with individuals with stable
weight or weight gain. Achieving an increase of at least 2 metabolic
equivalents in fitness change was associated with a significant reduction
in the secondary outcome (adjusted HR 0.77, 95% CI 0.61-0.96; p=0.023) but
not the primary outcome (adjusted HR 0.78, 0.60-1.03; p=0.079). In
analyses treating the control group as the reference group, participants
in the intensive lifestyle intervention group who lost at least 10% of
their bodyweight had a 20% lower risk of the primary outcome (adjusted HR
0.80, 95% CI 0.65-0.99; p=0.039), and a 21% lower risk of the secondary
outcome (adjusted HR 0.79, 95% CI 0.66-0.95; p=0.011); however, change in
fitness was not significantly associated with a change in the primary
outcome. Interpretation The results of this post-hoc analysis of Look
AHEAD suggest an association between the magnitude of weight loss and
incidence of cardiovascular disease in people with type 2 diabetes. These
findings suggest a need to continue to refine approaches to identify
individuals who are most likely to benefit from lifestyle interventions
and to develop strategies to improve the magnitude of sustained weight
loss with lifestyle interventions. Funding US National Institute of
Diabetes and Digestive and Kidney Diseases. Copyright &#xa9; 2016 Elsevier
Ltd

<113>
Accession Number
613091203
Author
Xu X.; Yang X.; Li S.; Luo M.; Qing Y.; Zhou X.; Xue J.; Qiu J.; Li Y.
Institution
(Xu, Yang, Luo, Qing, Zhou, Xue, Qiu, Li) Research Center for Medicine and
Social Development, Innovation Center for Social Risk Governance in
Health, School of Public Health and Management, Chongqing Medical
University, Chongqing, China
(Li) Department of Anesthesiology, The Children's Hospital of Chongqing
Medical University, Chongqing, China
Title
Risk factors of lower respiratory tract infection in patients after
tracheal intubation under general anesthesia in the Chinese health care
system: A meta-analysis.
Source
American Journal of Infection Control. 44 (11) (pp e215-e220), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Lower respiratory tract infection (LRTI) after tracheal
intubation under general anesthesia poses a serious threat to worldwide
health care systems, especially those in developing countries. However, a
significant number of studies have found inconsistent results in their
investigation of the corresponding risk factors. Methods Relevant articles
published up to September 2015 were retrieved from PubMed, Ovid, Embase,
China National Knowledge Infrastructure, Chinese Biological Medical
Database, China Science and Technology Journal Database, and Wanfang Data.
The z test was used to determine the significance of the pooled odds ratio
(OR). ORs and 95% confidence intervals were used to compare the risk
factors of LRTI after intubation under general anesthesia. Results Fifteen
case-control studies that included 27,304 participants were identified. We
identified the following variables as independent risk factors: duration
of general anesthesia >3hours (OR, 2.45), age >60 years (OR, 2.35), normal
endotracheal tube (OR, 1.63), deep intubation (OR, 2.66), unpracticed
intubation (OR, 2.61), postoperative extubation time >2hours (OR, 3.76),
smoking history (OR, 3.02), chronic respiratory disease history (OR,
2.30), incomplete extubation indication (OR, 3.54), thoracic or
craniocerebral surgery (OR, 1.90), and emergent surgery (OR, 2.54).
Conclusions Eleven risk factors, including surgery, anesthesia, and health
condition, were related to LRTI after intubation under general anesthesia.
Given the limitations of this study, well-designed epidemiologic studies
with a large sample size should be performed in the future. Copyright
&#xa9; 2016 Association for Professionals in Infection Control and
Epidemiology, Inc.

<114>
Accession Number
613090494
Author
Sullivan P.G.; Wallach J.D.; Ioannidis J.P.A.
Institution
(Sullivan, Wallach, Ioannidis) Department of Health Research and Policy,
Meta-Research Innovation Center at Stanford, Stanford University,
Stanford, California, United States
(Ioannidis) Departments of Medicine and Statistics, Stanford University,
Stanford, California, United States
Title
Meta-Analysis Comparing Established Risk Prediction Models (EuroSCORE II,
STS Score, and ACEF Score) for Perioperative Mortality During Cardiac
Surgery.
Source
American Journal of Cardiology. 118 (10) (pp 1574-1582), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
A wide variety of multivariable risk models have been developed to predict
mortality in the setting of cardiac surgery; however, the relative utility
of these models is unknown. This study investigated the literature related
to comparisons made between established risk prediction models for
perioperative mortality used in the setting of cardiac surgery. A
systematic review was conducted to capture studies in cardiac surgery
comparing the relative performance of at least 2 prediction models cited
in recent guidelines (European System for Cardiac Operative Risk
Evaluation [EuroSCORE II], Society for Thoracic Surgeons 2008 Cardiac
Surgery Risk Models [STS] score, and Age, Creatinine, Ejection Fraction
[ACEF] score) for the outcomes of 1-month or inhospital mortality. For
articles that met inclusion criteria, we extracted information on study
design, predictive performance of risk models, and potential for bias.
Meta-analyses were conducted to calculate a summary estimate of the
difference in AUCs between models. We identified 22 eligible studies that
contained 33 comparisons among the above models. Meta-analysis of
differences in AUCs revealed that the EuroSCORE II and STS score performed
similarly (with a summary difference in AUC = 0.00), while outperforming
the ACEF score (with summary differences in AUC of 0.10 and 0.08,
respectively, p <0.05). Other metrics of discrimination and calibration
were presented less consistently, and no study presented any metric of
reclassification. Small sample size and absent descriptions of missing
data were common in these studies. In conclusion, the EuroSCORE II and STS
score outperform the ACEF score on discrimination. Copyright &#xa9; 2016

<115>
Accession Number
613090473
Author
Lansky A.J.; Brown D.; Pena C.; Pietras C.G.; Parise H.; Ng V.G.; Meller
S.; Abrams K.J.; Cleman M.; Margolis P.; Petrossian G.; Brickman A.M.;
Voros S.; Moses J.; Forrest J.K.
Institution
(Lansky, Pietras, Ng, Cleman, Forrest) Division of Cardiology, Department
of Internal Medicine, Yale University School of Medicine, New Haven,
Connecticut, United States
(Lansky, Pietras, Parise, Meller) Department of Cardiology, Yale
Cardiovascular Research Group, New Haven, Connecticut, United States
(Brown) Department of Cardiology, The Heart Hospital, Baylor Plano, Plano,
Texas, United States
(Pena) Department of Cardiology, Baptist Cardiac and Vascular Institute,
Baptist Hospital of Miami, Miami, Florida, United States
(Abrams) Department of Radiology, Baptist Hospital of Miami, Miami,
Florida, United States
(Margolis) Keystone Heart Ltd., Herzliya, Israel
(Petrossian) Department of Cardiology, St. Francis Hospital, Roslyn, New
York, United States
(Brickman) Department of Neurology, Taub Institute for Research on
Alzheimer's Disease and the Aging Brain, College of Physicians and
Surgeons, Columbia University, New York, New York, United States
(Voros) Global Institute for Research, Richmond, Virginia, United States
(Moses) Department of Cardiology, Columbia University Medical Center, New
York, New York, United States
Title
Neurologic Complications of Unprotected Transcatheter Aortic Valve
Implantation (from the Neuro-TAVI Trial).
Source
American Journal of Cardiology. 118 (10) (pp 1519-1526), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cerebral embolization during transcatheter aortic valve implantation
(TAVI) can lead to a spectrum of clinically relevant manifestations,
ranging from overt stroke to mild neurologic or cognitive deficits and
subclinical cerebral infarcts. This study sought to determine the
frequency of neurologic injury, cerebral ischemic lesions, and cognitive
dysfunction in subjects undergoing contemporary commercial TAVI in the
United States. Neuro-TAVR is the first prospective, multicenter study to
use serial systematic neurologic and cognitive assessments and
diffusion-weighted magnetic resonance imaging (at 4 +/- 2 days after
procedure) to investigate the incidence and severity of neurologic injury
after contemporary unprotected TAVI in the United States. A total of 44
consecutive patients underwent TAVI at 5 US sites. Diffusion-weighted
magnetic resonance imaging lesions were detected in 94%, with a mean of
10.4 +/- 15.3 lesions per subject and a median total lesion volume of 295
mm³ (interquartile range 71.6 to 799.6 mm³). New
neurologic impairment (worsening in National Institutes of Health Stroke
Scale score from baseline with new cerebral lesions) occurred in 22.6% (7
of 31) of subjects at discharge and 14.8% (4 of 27) at 30 days. In
addition, cognitive decrements from baseline were identified by the
Montreal Cognitive Assessment in 33% (12 of 36) of subjects at discharge
and 41% (13 of 32) at 30 days. In conclusion, this contemporary cohort of
US patients confirms that TAVI results in cerebral infarction in most
patients and that 1 in 5 patients have measurable neurologic impairment
and 1 in 3 patients have decrease in cognitive measures by Montreal
Cognitive Assessment score after TAVI, reinforcing the need for methods to
mitigate the risk of brain injury during TAVI. Copyright &#xa9; 2016

<116>
Accession Number
612969829
Author
Inderbitzin D.T.; Taramasso M.; Nietlispach F.; Maisano F.
Institution
(Inderbitzin, Taramasso, Maisano) Department of Cardiovascular Surgery,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
(Nietlispach) Department of Cardiology, University Hospital Zurich,
Raemistrasse 100, Zurich CH-8091, Switzerland
Title
Percutaneous Mitral Valve Repair with MitraClip: Patient and Valve
Selection for Optimal Outcome.
Source
Current Cardiology Reports. 18 (12) (no pagination), 2016. Article Number:
129. Date of Publication: 01 Dec 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
In the real world of mitral regurgitation, the patient selection process
for MitraClip (Abbott, Abbott Park, IL, USA) to achieve optimal outcome
has become a challenge. With the opening of the Endovascular Valve
Edge-to-Edge Repair Study criteria, the implant experience was extended
towards functional mitral regurgitation and anatomically more complex
mitral pathologies in many centers worldwide. We provide a review of the
current literature to identify an appropriate patient selection process
for MitraClip therapy and suggest a simple two-dimensional decision-making
algorithm. Copyright &#xa9; 2016, Springer Science+Business Media New
York.

<117>
Accession Number
612969489
Author
Landoni G.; Zangrillo A.; Lomivorotov V.V.; Likhvantsev V.; Ma J.; De
Simone F.; Fominskiy E.
Institution
(Landoni, Zangrillo, De Simone, Fominskiy) Department of Anaesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Milan,
Italy
(Lomivorotov, Fominskiy) Department of Anaesthesia and Intensive Care,
Academician en Meshalkin Novosibirsk State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Centre for Anaesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Cardiac protection with phosphocreatine: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 637-647),
2016. Date of Publication: October 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Phosphocreatine (PCr) plays an important role in the energy metabolism of
the heart and a decrease in its intracellular concentration results in
alteration of myocardium energetics and work. We conducted a meta-analysis
of all randomized and matched trials that compared PCr with placebo or
standard treatment in patients with coronary artery disease or chronic
heart failure or in those undergoing cardiac surgery. We systematically
searched PubMed/Medline, Embase, Cochrane Central Register of Controlled
Trials and Google Scholar up to 1 November 2015, for pertinent trials. The
primary outcome was all-cause mortality. Secondary outcomes included
inotrope use, ejection fraction (EF), peak creatinine kinase-myocardial
band (CK-MB) release and the incidence of major arrhythmias, as well as
spontaneous recovery of the heart performance in the subgroup of patients
undergoing cardiac surgery with cardiopulmonary bypass. We pooled odds
ratio (OR) and mean difference (MD) using fixed- and random effects
models. We identified 41 controlled trials, of them 32 were randomized.
Patients receiving PCr had lower all-cause mortality when compared with
the control group [61/1731 (3.5%) vs 177/1667 (10.6%); OR: 0.71, 95% CI:
0.51-0.99; P = 0.04; I² = 0%; with 3400 patients and 22 trials
included]. Phosphocreatine administration was associated with higher LVEF
(MD: 3.82, 95% CI: 1.18-6.46; P = 0.005; I² = 98%), lower peak
CK-MB release (MD: -6.08, 95% CI: -8.01, -4.15; P < 0.001; I² =
97%), lower rate of major arrhythmias (OR: 0.42; 95% CI: 0.27-0.66; P <
0.001; I² = 0%), lower incidence of inotropic support (OR:
0.39, 95% CI: 0.25-0.61; P < 0.001; I² = 56%) and a higher
level of spontaneous recovery of the heart performance after
cardiopulmonary bypass (OR: 3.49, 95% CI: 2.28-5.35; P < 0.001;
I² = 49%) when compared with the control group. In a mixed
population of patients with coronary artery disease, chronic heart failure
or in those undergoing cardiac surgery, PCr may reduce all-cause
short-term mortality. In addition, PCr administration was associated with
improved cardiac outcomes. Owing to the pharmacological plausibility of
this effect and to the concordance of the beneficial effects of PCr on
several secondary but important outcomes and survival, there is urgent
need for a large multicentre randomized trial to confirm these findings.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery.

<118>
Accession Number
612994839
Author
Worth L.J.; Epi G.D.; Bull A.L.; Spelman T.; Brett J.; Richards M.J.
Institution
(Worth, Epi, Bull, Spelman, Brett, Richards) Victorian Healthcare
Associated Infection Surveillance System (VICNISS) Coordinating Centre,
Doherty Institute, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
Title
Diminishing Surgical Site Infections in Australia: Time Trends in
Infection Rates, Pathogens and Antimicrobial Resistance Using a
Comprehensive Victorian Surveillance Program, 2002-2013.
Source
Infection Control and Hospital Epidemiology. 36 (4) (pp 409-416), 2015.
Date of Publication: 2015.
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
OBJECTIVE. To evaluate time trends in surgical site infection (SSI) rates
and SSI pathogens in Australia. DESIGN. Prospective multicenter
observational cohort study. SETTING. A group of 81 Australian healthcare
facilities participating in the Victorian Healthcare Associated Infection
Surveillance System (VICNISS). PATIENTS. All patients underwent surgeries
performed between October 1, 2002, and June 30, 2013. National Healthcare
Safety Network SSI surveillance methods were employed by the infection
prevention staff at the participating hospitals. INTERVENTION.
Procedure-specific risk-adjusted SSI rates were calculated.
Pathogen-specific and antimicrobial-resistant (AMR) infections were
modeled using multilevel mixed-effects Poisson regression. RESULTS. A
total of 183,625 procedures were monitored, and 5,123 SSIs were reported.
Each year of observation was associated with 11% risk reduction for
superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI],
0.88-0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90-0.93),
and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93-0.97).
Overall, 3,318 microbiologically confirmed SSIs were reported. Of these
SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%)
with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections,
and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the
most frequently identified pathogen, and a statistically significant
increase in infections due to ceftriaxone-resistant Escherichia coli was
observed (RR, 1.37; 95% CI, 1.10-1.70). CONCLUSIONS. Standardized SSI
surveillance methods have been implemented in Victoria, Australia. Over an
11-year period, diminishing rates of SSIs have been observed, although AMR
infections increased significantly. Our findings facilitate the refinement
of recommended surgical antibiotic prophylaxis regimens and highlight the
need for a more expansive national surveillance strategy to identify
changes in epidemiology. Copyright &#xa9; 2015 by The Society for
Healthcare Epidemiology of America. All rights reserved.

<119>
Accession Number
613006878
Author
Schoonbeek R.C.; Pieper P.G.; van Slooten Y.J.; Freling H.G.; Sieswerda
G.T.; van Dijk A.P.J.; Jongbloed M.R.M.; Post M.C.; Bouma B.J.; Berger
R.M.F.; Ebels T.; van Melle J.P.
Institution
(Schoonbeek, Pieper, van Slooten, Freling, Berger, van Melle) Department
of Cardiology, University Medical Center Groningen, University of
Groningen, Groningen, Netherlands
(Schoonbeek, van Slooten, Ebels) Department of Thoracic Surgery,
University Medical Center Groningen, University of Groningen, Groningen,
Netherlands
(Freling) Department of Radiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
(van Slooten, Freling) Interuniversity Cardiology Institute of the
Netherlands, Utrecht, Netherlands
(Sieswerda) University Medical Center Utrecht, Utrecht, Netherlands
(van Dijk) Radboud University Medical Center, Nijmegen, Netherlands
(Jongbloed) Leiden University Medical Center, Leiden, Netherlands
(Post) St. Antonius Hospital, Nieuwegein, Netherlands
(Bouma) Academic Medical Center, Amsterdam, Netherlands
Title
NT-proBNP and exercise capacity in adult patients with congenital heart
disease and a prosthetic valve: A multicentre PROSTAVA study.
Source
Netherlands Heart Journal. 24 (11) (pp 653-665), 2016. Date of
Publication: November 2016.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Objectives N-terminal B-type natriuretic peptide (NT-proBNP) is an
important biomarker for the detection of heart failure. Adults with
congenital heart disease (ACHD) and a prosthetic heart valve are at risk
for heart failure. This study aimed to determine the value of NT-proBNP in
ACHD patients with a prosthetic valve and investigate its relationship
with cardiac function and exercise capacity. Methods In this multi-centre
cross-sectional observational study, data regarding medical history,
echocardiography, exercise testing (VO<inf>2</inf>peak) and laboratory
blood evaluation (including NT-proBNP) were collected in ACHD patients
with a single prosthetic valve (either homografts, heterografts or
mechanical valves). Results A total of 306 ACHD patients with pulmonary
valve replacement (PVR, n = 139), aortic valve replacement (n = 141),
mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5)
were investigated. The majority of patients (77 %) were in NYHA class I or
II. Elevated NT-proBNP levels (cut-off >125 pg/ml) were found in 50 % of
the patients, with the highest levels in patients with mitral valve
replacements. In this study population, NT-proBNP levels were associated
with gender (p = 0.029) and VO<inf>2</inf>max (p < 0.001). In PVR
patients, NT-proBNP levels were associated with lower VO<inf>2</inf>peak,
also after adjustment for age, gender and age at valve replacement in a
multivariate model (p = 0.015). Conclusions In patients with ACHD and a
prosthetic valve, elevated NT-proBNP levels are frequently observed
despite preserved NYHA class. In PVR patients, a higher NT-proBNP level
was associated with a lower VO<inf>2</inf>peak. These results may be of
importance in the ongoing discussion about the timing of valve replacement
in patients with CHD. Copyright &#xa9; The Author(s) 2016.

<120>
Accession Number
613003206
Author
Ortega-Loubon C.; Fernandez-Molina M.; Carrascal-Hinojal Y.;
Fulquet-Carreras E.
Institution
(Ortega-Loubon, Fernandez-Molina, Carrascal-Hinojal, Fulquet-Carreras)
Department of Cardiac Surgery, Clinic University Hospital of Valladolid,
Ramon y Cajal, Valladolid 47003, Spain
Title
Cardiac surgery-associated acute kidney injury.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 687-698), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-recognized complication resulting with the higher morbid-mortality
after cardiac surgery. In its most severe form, it increases the odds
ratio of operative mortality 3-8-fold, length of stay in the Intensive
Care Unit and hospital, and costs of care. Early diagnosis is critical for
an optimal treatment of this complication. Just as the identification and
correction of preoperative risk factors, the use of prophylactic measures
during and after surgery to optimize renal function is essential to
improve postoperative morbidity and mortality of these patients.
Cardiopulmonary bypass produces an increased in tubular damage markers.
Their measurement may be the most sensitive means of early detection of
AKI because serum creatinine changes occur 48 h to 7 days after the
original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like
growth factor-binding protein 7 are most promising as an early diagnostic
tool. However, the ideal noninvasive, specific, sensitive, reproducible
biomarker for the detection of AKI within 24 h is still not found. This
article provides a review of the different perspectives of the CSA-AKI,
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment. We searched the
electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment, in order to
provide an exhaustive review of the different perspectives of the CSA-AKI.

<121>
Accession Number
613003194
Author
Naghipour B.; Faridaalaee G.; Shadvar K.; Bilehjani E.; Khabaz A.H.;
Fakhari S.
Institution
(Naghipour, Shadvar, Bilehjani, Khabaz, Fakhari) Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Faridaalaee) Department of Emergency Medicine, Maragheh University of
Medical Sciences, Maragheh, Iran, Islamic Republic of
Title
Effect of prophylaxis of magnesium sulfate for reduction of postcardiac
surgery arrhythmia: Randomized clinical trial.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 662-667), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Arrhythmia is a common complication after heart surgery and is
a major source of morbidity and mortality. Aims: This study aimed to study
the effect of magnesium sulfate (MgSO<inf>4</inf>) for reduction of
postcardiac surgery arrhythmia. Setting and Design: This study is
performed in the cardiac operating room and Intensive Care Unit (ICU) of
Shahid Madani Hospital of Tabriz (Iran) between January 1, 2014, and
September 30, 2014. This study is a double-blind, randomized controlled
trial. Materials and Methods: In Group 1 (group magnesium [Mg]), eighty
patients received 30 mg/kg MgSO<inf>4</inf>in 500 cc normal saline and in
Group 2 (group control), eighty patients received 500 cc normal saline
alone. Statistical Analysis: The occurrence of arrhythmia was compared
between groups by Chi-square and Fisher's exact test. In addition,
surgical time, length of ICU stay, and length of hospital stay were
compared by independent t-test. P< 0.05 was considered as significant.
Results: There was a significant difference in the incidence of arrhythmia
between two groups (P = 0.037). The length of ICU stay was 3.4 +/- 1.4 and
3.73 +/- 1.77 days in group MgSO<inf>4</inf>and control group,
respectively, and there was no statistically significant difference
between two groups (P = 0.2). Conclusion: Mg significantly decreases the
incidence of all type of postcardiac surgery arrhythmia and hospital
length of stay at patients undergo cardiac surgery. We offer prophylactic
administration of Mg at patients undergo cardiac surgery.

<122>
Accession Number
613003191
Author
Sahu M.K.; Singal A.; Menon R.; Singh S.P.; Mohan A.; Manral M.; Singh D.;
Devagouru V.; Talwar S.; Choudhary S.K.
Institution
(Sahu, Menon, Singh) Department of CTVS, Intensive Care for CTVS, All
India Institute of Medical Sciences, New Delhi 110029, India
(Singal, Mohan, Manral, Singh) Department of Dietetics, Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Devagouru, Talwar, Choudhary) Department of Cardiothoracic and Vascular
Surgery, All India Institute of Medical Sciences, New Delhi, India
Title
Early enteral nutrition therapy in congenital cardiac repair
postoperatively: A randomized, controlled pilot study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 653-661), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background and Objectives: Adequate nutritional supplementation in infants
with cardiac malformations after surgical repair is a challenge.
Critically ill infants in the early postoperative period are in a
catabolic stress. The mismatch between estimated energy requirement (EER)
and the intake in the postoperative period is multifactorial, predisposing
them to complications such as immune deficiency, more infection, and
growth failure. This study aimed to assess the feasibility and efficacy of
enriched breast milk feed on postoperative recovery and growth of infants
after open heart surgery. Methodology: Fifty infants <6 months of age were
prospectively randomized in the trial for enteral nutrition (EN)
postoperatively from day 1 to 10, after obtaining the Institute Ethics
Committee's approval. They were equally divided into two groups on the
basis of the feed they received: Control group was fed with expressed
breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM +
energy supplementation/fortification with human milk fortifier (7.5 kcal/2
g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each
infant was calculated as per EER at 90 kcal/kg/day, as the target
requirement. The intra-and post-operative variables such as
cardiopulmonary bypass and aortic cross-clamp times, ventilation duration,
Intensive Care Unit (ICU), and hospital length of stay and mortality were
recorded. Anthropometric and hematological parameters and infection
control data were recorded in a predesigned pro forma. Data were analyzed
using Stata 14.1 software. Results: The duration of mechanical
ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS),
infection rate, and mortality rate were lower in the intervention group
compared to the control group although none of the differences were
statistically significant. Infants in control group needed mechanical
ventilation for about a day more (i.e., 153.6 +/- 149.0 h vs. 123.2 +/-
107.0 h; P = 0.20) than those in the intervention group. Similarly,
infants in control group stayed for longer duration in the ICU (13.2 +/-
8.9 days) and hospital (16.5 +/- 9.8 days) as compared to the intervention
group (11.0 +/- 6.1 days; 14.1 +/- 7.0 days) (P = 0.14 and 0.17,
respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days,
respectively, in the intervention group compared to control group. The
infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in
the intervention group than those in the control group. The energy intake
in the intervention group was 40 kcal more (i.e., 127.2 +/- 56.1 kcal vs.
87.1 +/- 38.3 kcal) than the control group on the 10^th
postoperative day. Conclusions: Early enteral/oral feeding after cardiac
surgery is feasible and recommended. In addition, enriching the EBM is
helpful in achieving the maximum possible calorie intake in the
postoperative period. EN therapy might help in providing adequate
nutrition, and it decreases ventilation duration, infection rate, LOIS,
LOHS, and mortality.

<123>
Accession Number
613003187
Author
Kapoor P.M.; Magoon R.; Rawat R.; Mehta Y.
Institution
(Kapoor, Magoon) Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi,
India
(Rawat) Department of Cardiac Anaesthesiology, Salalah Heart Center,
Salalah, Oman
(Mehta) Department of Anaesthesiology and Critical Care, Medanta Medicity,
Gurgaon, Haryana, India
Title
Perioperative utility of goal-directed therapy in high-risk cardiac
patients undergoing coronary artery bypass grafting: A clinical outcome
and biomarker-based study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 638-645), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid
and vasopressor/inotropic therapy by cardiac output or similar parameters
to help in early recognition and management of high-risk cardiac surgical
patients. With the aim of establishing the utility of perioperative GDT
using robust clinical and biochemical outcomes, we conducted the present
study. This multicenter randomized controlled study included 130 patients
of either sex, with European system for cardiac operative risk evaluation
>3 undergoing coronary artery bypass grafting on cardiopulmonary bypass.
The patients were randomly divided into the control and GDT group. All the
participants received standardized care; arterial pressure monitored
through radial artery, central venous pressure (CVP) through a triple
lumen in the right internal jugular vein, electrocardiogram, oxygen
saturation, temperature, urine output per hour, and frequent arterial
blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using
FloTracTM and continuous central venous oxygen saturation
(ScVO<inf>2</inf>) using PreSepTM were used in patients in the GDT group.
Our aim was to maintain the CI at 2.5-4.2 L/min/m², stroke
volume index 30-65 ml/beat/m², systemic vascular resistance
index 1500-2500 dynes/s/cm⁵/m², oxygen delivery
index 450-600 ml/min/m², continuous ScVO<inf>2</inf> >70%, and
stroke volume variation <10%; in addition to the control group parameters
such as CVP 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal ABG
values, oxygen saturation, hematocrit value >30%, and urine output >1
ml/kg/h. The aims were achieved by altering the administration of IV
fluids and doses of inotropes or vasodilators. The data of sixty patients
in each group were analyzed in view of ten exclusions. The average
duration of ventilation (19.89 +/- 3.96 vs. 18.05 +/- 4.53 h, P = 0.025),
hospital stay (7.94 +/- 1.64 vs. 7.17 +/- 1.93 days, P = 0.025), and
Intensive Care Unit (ICU) stay (3.74 +/- 0.59 vs. 3.41 +/- 0.75 days, P =
0.012) was significantly less in the GDT group, compared to the control
group. The extra volume added and the number of inotropic dose adjustments
were significantly more in the GDT group. The two groups did not differ in
duration of inotropic use, mortality, and other complications. The
perioperative continuation of GDT affected the early decline in the
lactate levels after 6 h in ICU, whereas the control group demonstrated a
settling lactate only after 12 h. Similarly, the GDT group had
significantly lower levels of brain natriuretic peptide, neutrophil
gelatinase-associated lipocalin levels as compared to the control. The
study clearly depicts the advantage of GDT for a favorable postoperative
outcome in high-risk cardiac surgical patients.

<124>
Accession Number
613003182
Author
El-Shmaa N.S.; El Amrousy D.; El Feky W.
Institution
(El-Shmaa) Department of Anesthesia and Surgical ICU, Faculty of Medicine,
Tanta University, Tanta, Egypt
(El Amrousy) Department of Pediatrics, Tanta University Hospital, Tanta,
Egypt
(El Feky) Department of Cardiothoracic Surgery, Tanta University Hospital,
Tanta, Egypt
Title
The efficacy of pre-emptive dexmedetomidine versus amiodarone in
preventing postoperative junctional ectopic tachycardia in pediatric
cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 614-620), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to assess the effectiveness of
pre-emptive dexmedetomidine versus amiodarone in preventing junctional
ectopic tachycardia (JET) in pediatric cardiac surgery. Design: This is a
prospective, controlled study. Setting: This study was carried out at a
single university hospital. Subjects and Methods: Ninety patients of both
sexes, American Society of Anesthesiologists Physical Status II and III,
age range from 2 to 18 years, and scheduled for elective cardiac surgery
for congenital and acquired heart diseases were selected as the study
participants. Interventions: Patients were randomized into three groups
(30 each). Group I received dexmedetomidine 1 mcg/kg diluted in 100 ml of
normal saline intravenously (IV) over a period of 20 min, and the infusion
was completed 10 min before the induction followed by a 0.5 mcg/kg/h
infusion for 72 h postoperative, Group II received amiodarone 5 mg/kg
diluted in 100 ml of normal saline IV over a period of 20 min, and the
infusion was completed 10 min before the induction followed by a 10-15
mcg/kg/h infusion for 72 h postoperative, and Group III received 100 ml of
normal saline IV. Primary outcome was the incidence of postoperative JET.
Secondary outcomes included vasoactive-inotropic score, ventilation time
(VT), pediatric cardiac care unit stay, hospital length of stay, and
perioperative mortality. Measurements and Main Results: The incidence of
JET was significantly reduced in Group I and Group II (P = 0.004) compared
to Group III. Heart rate while coming off from cardiopulmonary bypass
(CPB) was significantly low in Group I compared to Group II and Group III
(P = 0.000). Mean VT, mean duration of Intensive Care Unit stay, and
length of hospital stay (day) were significantly short (P = 0.000) in
Group I and Group II compared to Group III (P = 0.000). Conclusion:
Perioperative use of dexmedetomidine and amiodarone is associated with
significantly decreased incidence of JET as compared to placebo without
significant side effects.

<125>
Accession Number
613003179
Author
Soliman R.; Zohry G.
Institution
(Soliman, Zohry) Department of Anesthesia, Cairo University, Cairo, Egypt
Title
The myocardial protective effect of dexmedetomidine in high-risk patients
undergoing aortic vascular surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 606-613), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to assess the effect of
dexmedetomidine in high-risk patients undergoing aortic vascular surgery.
Design: A randomized prospective study. Setting: Cairo University, Egypt.
Materials and Methods: The study included 150 patients undergoing aortic
vascular surgery. Intervention: The patients were classified into two
groups (n = 75). Group D: The patients received a loading dose of 1 mug/kg
dexmedetomidine over 15 min before induction and maintained as an infusion
of 0.3 mug/kg/h to the end of the procedure. Group C: The patients
received an equal volume of normal saline. The medication was prepared by
the nursing staff and given to anesthetist blindly. Measurements: The
monitors included the heart rate, mean arterial blood pressure, central
venous pressure, electrocardiogram (ECG), serum troponin I level,
end-tidal sevoflurane, and total dose of morphine in addition
transthoracic echocardiography to the postoperative in cases with elevated
serum troponin I level. Main Results: The dexmedetomidine decreased heart
rate and minimized the changes in blood pressure compared to control group
(P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia
reflected by troponin I level, ECG changes, and the development of new
regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased
the requirement for nitroglycerin and norepinephrine compared to control
group (P < 0.05). The incidence of hypotension and bradycardia was
significantly higher with dexmedetomidine (P < 0.05). Conclusion: The
dexmedetomidine is safe and effective in patients undergoing aortic
vascular surgery. It decreases the changes in heart rate and blood
pressure during the procedures. It provides cardiac protection in
high-risk patients reflected by decreasing the incidence of myocardial
ischemia and serum level of troponin. The main side effects of
dexmedetomidine were hypotension and bradycardia.

<126>
Accession Number
613014869
Author
Thyregod H.G.H.; Steinbruchel D.A.; Ihlemann N.; Ngo T.A.; Nissen H.;
Kjeldsen B.J.; Chang Y.; Hansen P.B.; Olsen P.S.; Sondergaard L.
Institution
(Thyregod, Steinbruchel, Olsen) Department of Cardiothoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Ihlemann, Ngo, Sondergaard) Department of Cardiology, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Chang) Medtronic Inc., Mounds View, MN, United States
(Hansen) Department of Cardiac Anesthesia, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Title
No clinical effect of prosthesis-patient mismatch after transcatheter
versus surgical aortic valve replacement in intermediate- and low-risk
patients with severe aortic valve stenosis at mid-term follow-up: An
analysis from the NOTION trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 721-728), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve
replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but
less common after transcatheter aortic valve replacement (TAVR) in
patients considered at high risk for death after surgery. The objectives
of this study were to determine incidence and clinical effect of PPM after
SAVR and TAVR in a primarily low-risk patient group. METHODS: Patients 70
years or older with severe isolated AVS, regardless of predicted operative
mortality risk, were consecutively randomized 1:1 to TAVR using a
self-expandable bioprosthesis (n = 145) or SAVR (n = 135). Post-procedure
PPM was graded after 3 months as follows: Not present-mild, if indexed
effective orifice area (iEOA) >0.85 cm²/m²,
moderate, if 0.65 cm²/m² < iEOA > 0.85
cm²/m² and severe, if iEOA >0.65
cm²/m². Outcomes were major adverse cardiac and
cerebrovascular events (MACCE, e.g. composite rate of all-cause death,
stroke, myocardial infarction or valve reintervention), cardiac-related
hospitalizations and New York Heart Association (NYHA) functional class
after 2 years. RESULTS: The incidence and the severity of PPM were
significantly lower after TAVR compared with SAVR (severe, moderate,
none-mild 14.0, 35.5, 50.4 vs 33.9, 36.7, 29.4%; P<0.001). PPM resulted in
similar higher mean valve gradients at 3 months for both groups. Baseline
characteristics related to severe PPM were younger age, absence of
diabetes mellitus, lower mortality-risk score for TAVR, and younger age
and higher body mass index for SAVR. At 2 years, there were numerical but
no statistically significant differences between both TAVR and SAVR
patients with severe and no severe PPM for MACCE (0.0 vs 12.8% for TAVR; P
= 0.13, and 13.5 vs 7.0% for SAVR; P = 0.27), number of cardiac-related
hospitalizations (mean +/- standard deviation 0.4 +/- 0.6 vs 0.6 +/- 0.8;
P = 0.23, and 0.4 +/- 0.8 vs 0.5 +/- 0.9; P = 0.70) and NYHA functional
class (Class I/II/III/IV: 64.7/29.4/5.9/0.0 vs 62.1/34.7/3.2/0.0%,
respectively; P = 0.91, and 71.4/25.7/2.9/0.0 vs 72.9/22.9/4.3/0.0%,
respectively; P = 0.92). CONCLUSIONS: The incidence of PPM was lower and
less severe after TAVR compared with SAVR in intermediate- and low-risk
patients with severe AVS. There were no significant differences in MACCE,
cardiac-related hospitalizations or NYHA class after 2 years for patients
with versus those without severe PPM. Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<127>
Accession Number
613014868
Author
Borger M.A.; Dohmen P.M.; Knosalla C.; Hammerschmidt R.; Merk D.R.;
Richter M.; Doenst T.; Conradi L.; Treede H.; Moustafine V.; Holzhey D.M.;
Duhay F.; Strauch J.
Institution
(Borger) Columbia University Medical Center, New York, NY, United States
(Dohmen, Merk, Holzhey) Leipzig Heart Center, Leipzig, Germany
(Knosalla, Hammerschmidt) German Heart Institute Berlin, Berlin, Germany
(Richter, Doenst) Jena University Hospital, Jena, Germany
(Conradi, Treede) University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
(Moustafine, Strauch) University Hospitals of the Ruhr University of
Bochum, Bochum, Germany
(Duhay) Edwards Lifesciences LLC, Irvine, CA, United States
Title
Haemodynamic benefits of rapid deployment aortic valve replacement via a
minimally invasive approach: 1-year results of a prospective multicentre
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 713-720), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) via minimally invasive surgery
(MIS) may provide clinical benefits in patients with aortic valve disease.
A new class of bioprosthetic valves that enable rapid deployment AVR
(RDAVR) may facilitate MIS. We here report the 1-year results of a
randomized, multicentre trial comparing the outcomes for MIS-RDAVR with
those for conventional AVR via full sternotomy (FS) with a commercially
available stented aortic bioprosthesis. METHODS: A total of 100 patients
with aortic stenosis were enrolled in a prospective, multicentre,
randomized comparison trial (CADENCE-MIS). Key exclusion criteria included
AVR requiring concomitant procedures, ejection fraction of <25% and recent
myocardial infarction or stroke. Patients were randomized to undergo
MIS-RDAVR via upper hemisternotomy (EDWARDS INTUITY) or AVR via FS with a
commercially available stented valve. Procedural, early and late clinical
outcomes were assessed for both groups. Haemodynamic performance was
evaluated by an echocardiography CoreLaboratory. RESULTS: Technical
success was achieved in 94% of MIS-RDAVR patients. MIS-RDAVR was
associated with significantly reduced cross-clamp times compared with FS
(41.3 +/- 20.3 vs 54.0 +/- 20.3 min, P < 0.001). Clinical and functional
outcomes were similar at 30 days and 1 year postoperatively for both
groups. While both groups received a similarly sized implanted valve (22.9
+/- 2.1 mm MIS-RDAVR vs 23.0 +/- 2.1 mm FS-AVR; P = 0.91), MIS-RDAVR
patients had significantly lower peak gradients 1 year postoperatively
(16.9 +/- 5.3 vs 21.9 +/- 8.6 mmHg; P = 0.033) and a trend towards lower
mean gradients (9.1 +/- 2.9 vs 11.5 +/- 4.3 mmHg; P = 0.082). In addition,
MIS-RDAVR patients had a significantly larger effective orifice area 1
year postoperatively (1.9 +/- 0.5 vs 1.7 +/- 0.4 cm2; P = 0.047).
Paravalvular leaks, however, were significantly more common in the
MIS-RDAVR group (P = 0.027). CONCLUSIONS: MIS-RDAVR is associated with a
significantly reduced cross-clamp time and better valvular haemodynamic
function than FS-AVR. However, paravalvular leak rates are higher with
MIS-RDAVR. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<128>
Accession Number
613014842
Author
Huygens S.A.; Mokhles M.M.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Mokhles, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and Management,
Erasmus University, Rotterdam, Netherlands
Title
Contemporary outcomes after surgical aortic valve replacement with
bioprostheses and allografts: sA systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 605-616), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Many observational studies have reported outcomes after surgical aortic
valve replacement (AVR), but there are no recent systematic reviews and
meta-analyses including all available bioprostheses and allografts. The
objective of this study is to provide a comprehensive and up-to-date
overview of the outcomes after AVR with bioprostheses and allografts
reported in the last 15 years. We conducted a systematic literature review
(PROSPERO register: CRD42015017041) of studies published between 2000-15.
Inclusion criteria were observational studies or randomized controlled
trials reporting on outcomes of AVR with bioprostheses (stented or
stentless) or allografts, with or without coronary artery bypass grafting
(CABG) or valve repair procedure, with study population size n > 30 and
mean follow-up length >5 years. Fifty-four bioprosthesis studies and 14
allograft studies were included, encompassing 55 712 and 3872 patients and
349 840 and 32 419 patient-years, respectively. We pooled early mortality
risk and linearized occurrence rates of valve-related events,
reintervention and late mortality in a random-effects model. Sensitivity,
meta-regression and subgroup analyses were performed to investigate the
influence of outliers on the pooled estimates and to explore sources of
heterogeneity. Funnel plots were used to investigate publication bias.
Pooled early mortality risks for bioprostheses and allografts were 4.99%
(95% confidence interval [CI], 4.44-5.62) and 5.03% (95% CI, 3.61-7.01),
respectively. The late mortality rate was 5.70%/patient-year (95% CI,
4.99-5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23-2.28)
for allografts. Pooled reintervention rates for bioprostheses and
allografts were 0.75%/patient-year (95% CI, 0.61-0.91) and
1.87%/patient-year (95% CI, 1.52-2.31), respectively. There was
substantial heterogeneity in most outcomes. Meta-regression analyses
identified covariates that could explain the heterogeneity: implantation
period, valve type, patient age, gender, pre-intervention New York Heart
Association class III/IV, concomitant CABG, study design and follow-up
length. There is possible publication bias in all outcomes. This
comprehensive systematic review and meta-analysis provides an overview of
the outcomes after AVR with bioprostheses and allografts reported during
the last 15 years. The results of this study can support patients and
doctors in the prosthetic valve choice and can be used in microsimulation
models to predict patient outcomes and estimate the cost-effectiveness of
AVR with bioprostheses or allografts compared with current and future
heart valve prostheses. Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<129>
Accession Number
612939954
Author
Saxton A.T.; Poenaru D.; Ozgediz D.; Ameh E.A.; Farmer D.; Smith E.R.;
Rice H.E.
Institution
(Saxton, Smith, Rice) Duke Global Health Institute, Duke University
Medical Center, Durham, NC, United States
(Poenaru) McMaster Paediatric Surgery Research Collaborative, Dept. of
Surgery, McMaster University, Hamilton, Canada
(Ozgediz) Yale-New Haven Hospital, New Haven, CT, United States
(Ameh) Department of Surgery, National Hospital, Abuja, Nigeria
(Farmer) University of California-Davis Health System, Davis, CA, United
States
Title
Economic analysis of children's surgical care in low- and middle-income
countries: A systematic review and analysis.
Source
PLoS ONE. 11 (10) (no pagination), 2016. Article Number: e0165480. Date of
Publication: October 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Understanding the economic value of health interventions is
essential for policy makers to make informed resource allocation
decisions. The objective of this systematic review was to summarize
available information on the economic impact of children's surgical care
in low- and middle-income countries (LMICs). Methods We searched MEDLINE
(Pubmed), Embase, and Web of Science for relevant articles published
between Jan. 1996 and Jan. 2015. We summarized reported cost information
for individual interventions by country, including all costs, disability
weights, health outcome measurements (most commonly disability-adjusted
life years [DALYs] averted) and costeffectiveness ratios (CERs). We
calculated median CER as well as societal economic benefits (using a human
capital approach) by procedure group across all studies. The
methodological quality of each article was assessed using the Drummond
checklist and the overall quality of evidence was summarized using a scale
adapted from the Agency for Healthcare Research and Quality. Findings We
identified 86 articles that met inclusion criteria, spanning 36 groups of
surgical interventions. The procedure group with the lowest median CER was
inguinal hernia repair ($15/ DALY). The procedure group with the highest
median societal economic benefit was neurosurgical procedures ($58,977).
We found a wide range of study quality, with only 35% of studies having a
Drummond score >7. Interpretation Our findings show that many areas of
children's surgical care are extremely cost-effective in LMICs, provide
substantial societal benefits, and are an appropriate target for enhanced
investment. Several areas, including inguinal hernia repair, trichiasis
surgery, cleft lip and palate repair, circumcision, congenital heart
surgery and orthopedic procedures, should be considered "Essential
Pediatric Surgical Procedures" as they offer considerable economic value.
However, there are major gaps in existing research quality and methodology
which limit our current understanding of the economic value of surgical
care. Copyright &#xa9; 2016 Saxton et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.

<130>
Accession Number
613012228
Author
Prescott E.; Meindersma E.P.; Van Der Velde A.E.; Gonzalez-Juanatey J.R.;
Iliou M.C.; Ardissino D.; Zoccai G.B.; Zeymer U.; Prins L.F.; Vant Hof
A.W.J.; Wilhelm M.; De Kluiver E.P.
Institution
(Prescott) Department of Cardiology, University of Copenhagen, Denmark
(Meindersma, Van Der Velde, Vant Hof, De Kluiver) Isala Heart Centre,
Dokter van Heesweg 2, Zwolle 8025AB, Netherlands
(Meindersma) Department of Cardiology, Radboud University, Netherlands
(Gonzalez-Juanatey) Department of Cardiology, University Hospital,
Santiago-de-Compostella, Spain
(Iliou) Department of Cardiac Rehabilitation, Assistance Publique Hopitaux
de Paris, France
(Ardissino) Department of Cardiology, Parma University Hospital, Italy
(Zoccai) Department of Medico-Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Latina, Italy
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Prins) Diagram B.V., Netherlands
(Wilhelm) Department of Cardiology, Universitat Bern, Switzerland
(Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli,
Italy
Title
A EUropean study on effectiveness and sustainability of current Cardiac
Rehabilitation programmes in the Elderly: Design of the EU-CaRE randomised
controlled trial.
Source
European Journal of Preventive Cardiology. 23 (2_suppl) (pp 27-40), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Cardiac rehabilitation (CR) is an evidence-based intervention
to increase survival and quality of life. Yet studies consistently show
that elderly patients are less frequently referred to CR, show less uptake
and more often drop out of CR programmes. Design The European study on
effectiveness and sustainability of current cardiac rehabilitation
programmes in the elderly (EU-CaRE) project consists of an observational
study and an open prospective, investigator-initiated multicentre
randomised controlled trial (RCT) involving mobile telemonitoring guided
CR (mCR). Objective The aim of EU-CaRE is to map the efficiency of current
CR of the elderly in Europe, and to investigate whether mCR is an
effective alternative in terms of efficacy, adherence and sustainability.
Methods and results The EU-CaRE study includes patients aged 65 years or
older with ischaemic heart disease or who have undergone heart valve
surgery. A total of 1760 patients participating in existing CR programmes
in eight regions of Europe will be included. Of patients declining regular
CR, 238 will be included in the RCT and randomised in two study arms. The
experimental group (mCR) will receive a personalised home-based programme
while the control group will receive no advice or coaching throughout the
study period. Outcomes will be assessed after the end of CR and at 12
months follow-up. The primary outcome is VO<inf>2peak</inf> and secondary
outcomes include variables describing CR uptake, adherence, efficacy and
sustainability. Conclusion The study will provide important information to
improve CR in the elderly. The EU-CaRE RCT is the first European
multicentre study of mCR as an alternative for elderly patients not
attending usual CR. Copyright &#xa9; European Society of Cardiology.

<131>
Accession Number
612967657
Author
Massoullie G.; Bordachar P.; Irles D.; Caussin C.; Da Costa A.; Defaye P.;
Jean F.; Mechulan A.; Mondoly P.; Souteyrand G.; Pereira B.; Ploux S.;
Eschalier R.
Institution
(Massoullie, Jean, Souteyrand, Eschalier) Clermont Universite, Universite
d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI),
Clermont-Ferrand, France
(Massoullie, Jean, Souteyrand, Eschalier) Cardiology Department, CHU
Clermont-Ferrand, Clermont-Ferrand, France
(Bordachar, Ploux) Hopital Cardiologique du Haut-Leveque, CHU Bordeaux,
Universite Bordeaux, Bordeaux, France
(Irles) Cardiology Department, CH Annecy Genevois Pringy, France
(Caussin) Institut Mutualiste Montsouris, Paris, France
(Da Costa) North Hospital, Saint-Etienne, France
(Defaye) Arrhythmia Unit, Cardiology Department, University Hospital,
Grenoble, France
(Mechulan) Ramsay Generale de Sante, Hopital Prive de Clairval, Marseille,
France
(Mondoly) Federation of Cardiology, University Hospital Rangueil, Toulouse
Cedex, France
(Pereira) CHU Clermont-Ferrand, Biostatistics Unit, Clinical Research and
Innovation Direction, Clermont-Ferrand, France
Title
Prognosis assessment of persistent left bundle branch block after TAVI by
an electrophysiological and remote monitoring risk-adapted algorithm:
Rationale and design of the multicentre LBBB-TAVI Study.
Source
BMJ Open. 6 (10) (no pagination), 2016. Article Number: e010485. Date of
Publication: 01 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Percutaneous aortic valve replacement (transcatheter aortic
valve implantation (TAVI)) notably increases the likelihood of the
appearance of a complete left bundle branch block (LBBB) by direct lesion
of the LBB of His. This block can lead to high-grade atrioventricular
conduction disturbances responsible for a poorer prognosis. The management
of this complication remains controversial. Method and analysis The
screening of LBBB after TAVI persisting for more than 24 hours will be
conducted by surface ECG. Stratification will be performed by post-TAVI
intracardiac electrophysiological study. Patients at high risk of
conduction disturbances (>70 ms His-ventricle interval (HV) or presence of
infra-Hisian block) will be implanted with a pacemaker enabling the
recording of disturbance episodes. Those at lower risk (HV <70 ms) will be
implanted with a loop recorder device with remote monitoring of
cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and
implanted device follow-up will also be performed at 3, 6 and 12 months.
The primary objective is to assess the efficacy and safety of a decisional
algorithm based on electrophysiological study and remote monitoring of
CIEDs in the prediction of high-grade conduction disturbances in patients
with LBBB after TAVI. The primary end point is to compare the incidence
(rate and time to onset) of high-grade conduction disturbances in patients
with LBBB after TAVI between the two groups at 12 months. Given the
proportion of high-grade conduction disturbances (20-40%), a sample of 200
subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has
been in an active recruiting phase since September 2015 (21 patients
already included). Ethics and dissemination Local ethics committee
authorisation was obtained in May 2015. We will publish findings from this
study in a peer-reviewed scientific journal and present results at
national and international conferences. Copyright &#xa9; 2016 Published by
the BMJ Publishing Group Limited.

<132>
Accession Number
612958922
Author
Dong K.; Song Y.; Li X.; Ding J.; Gao Z.; Lu D.; Zhu Y.
Institution
(Dong, Zhu) The 2nd Jiangsu Province Hospital of TCM, Nanjing University
of Chinese Medicine, Department of Respiration, No.155, Hanzhong Road,
Nanjing, China
(Song, Gao, Lu) Shanghai Daopei Hospital, Fudan University, Shanghai,
China
(Li) BenQ Medical Center, Nanjing Medical University, Department of
Radiotherapy, Nanjing, Jiangsu Province 210019, China
(Ding) National Institute on Aging, NIH, Laboratory of Epidemiology and
Population Science, 7201 Wisconsin Ave, Suite 3C-309, Bethesda, MD 20814,
United States
Title
Pentasaccharides for the prevention of venous thromboembolism.
Source
Cochrane Database of Systematic Reviews. 2016 (10) (no pagination), 2016.
Article Number: CD005134. Date of Publication: 31 Oct 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Venous thromboembolism (VTE) is a common condition with
potentially serious and life-threatening consequences. The standard method
of thromboprophylaxis uses an anticoagulant such as low molecular weight
heparin (LMWH) or warfarin. In recent years, another type of
anticoagulant, pentasaccharide, an indirect factor Xa inhibitor, has shown
good anticoagulative effect in clinical trials. Three types of
pentasaccharides are available: short-acting fondaparinux, long-acting
idraparinux and idrabiotaparinux. Pentasaccharides cause little
heparin-induced thrombocytopenia and are better tolerated than
unfractionated heparin, LMWH and warfarin. However, no consensus has been
reached on whether pentasaccharides are superior or inferior to other
anticoagulative methods. Objectives: To assess effects of pentasaccharides
versus other methods of thromboembolic prevention (thromboprophylaxis) in
people who require anticoagulant treatment to prevent venous
thromboembolism. Search methods: The Cochrane Vascular Information
Specialist (CIS) searched the Specialised Register (last searched March
2016) and the Cochrane Central Register of Controlled Trials (CENTRAL;
2016, Issue 2). The CIS searched trial databases for details of ongoing
and unpublished studies. Review authors searched LILACS (Latin American
and Caribbean Health Sciences) and the reference lists of relevant studies
and reviews identified by electronic searches. Selection criteria: We
included randomised controlled trials on any type of pentasaccharide
versus other anticoagulation methods (pharmaceutical or mechanical) for
VTE prevention. Data collection and analysis: Two review authors
independently selected trials, assessed methodological quality and
extracted data in predesigned tables. Main results: We included in this
review 25 studies with a total of 21,004 participants. All investigated
fondaparinux for VTE prevention; none investigated idraparinux or
idrabiotaparinux. Studies included participants undergoing abdominal
surgery, thoracic surgery, bariatric surgery or coronary bypass surgery;
acutely ill hospitalised medical patients; people requiring rigid or
semirigid immobilisation; and those with superficial venous thrombosis.
Most studies focused on orthopaedic patients. We lowered the quality of
the evidence because of heterogeneity between studies and a small number
of events causing imprecision. When comparing fondaparinux with placebo,
we found less total VTE (risk ratio (RR) 0.24, 95% confidence interval
(CI) 0.15 to 0.38; 5717 participants; 8 studies; I² = 64%; P <
0.00001), less symptomatic VTE (RR 0.15, 95% CI 0.06 to 0.36; 6503
participants; 8 studies; I² = 0%; P < 0.0001), less total DVT
(RR 0.25, 95% CI 0.15 to 0.40; 5715 participants; 8 studies; I²
= 67%; P < 0.00001), less proximal DVT (RR 0.12, 95% CI 0.04 to 0.39; 2746
participants; 7 studies; I² = 64%; P = 0.0004) and less total
pulmonary embolism (PE) (RR 0.16, 95% CI 0.04 to 0.62; 6412 participants;
8 studies; I² = 0%; P = 0.008) in the fondaparinux group. The
quality of the evidence was moderate for total VTE, total DVT and proximal
DVT, and high for symptomatic VTE and total PE. When fondaparinux was
compared with LMWH, analyses indicated that fondaparinux reduced total VTE
and DVT (RR 0.55, 95% CI 0.42 to 0.73; 9339 participants; 11 studies;
I² = 64%; P < 0.0001; and RR 0.54, 95% CI 0.40 to 0.71; 9356
participants; 10 studies; I² = 67%; P < 0.0001, respectively),
and showed a trend toward reduced proximal DVT (RR 0.58, 95% CI 0.33 to
1.02; 8361 participants; 9 studies; I² = 53%; P = 0.06).
Symptomatic VTE (RR 1.03, 95% CI 0.65 to 1.63; 12240 participants; 9
studies; I² = 35%; P = 0.90) and total PE (RR 1.24, 95% CI 0.65
to 2.34; 12350 participants; 10 studies; I² = 0%; P = 0.51)
indicated no difference between fondaparinux and LMWH. The quality of the
evidence was moderate for total VTE, symptomatic VTE, total DVT and total
PE, and low for proximal DVT. We showed that fondaparinux increased major
bleeding compared with both placebo and LWMH (RR 2.56, 95% CI 1.48 to
4.44; 6659 participants; 8 studies; I² = 0%; P = 0.0008;
moderate-quality evidence; and RR 1.38, 95% CI 1.09 to 1.75; 12,501
participants; 11 studies; I² = 24%; P = 0.008; high-quality
evidence, respectively). All-cause mortality was not different between
fondaparinux and placebo or LMWH (RR 0.76, 95% CI 0.48 to 1.22; 6674
participants; 8 studies; I² = 14%; P = 0.26; moderate-quality
evidence; and RR 0.88, 95% CI 0.63 to 1.22; 12,400 participants; 11
studies; I² = 0%; P = 0.44; moderate-quality evidence,
respectively). One study compared fondaparinux with variable and fixed (1
mg per day) doses of warfarin after elective hip or knee replacement
surgery and showed no difference in primary and secondary outcomes between
fondaparinux and both variable and fixed doses of warfarin. The quality of
the evidence was very low. One small study compared fondaparinux with
edoxaban in patients with severe renal impairment undergoing lower-limb
orthopaedic surgery and reported no thromboembolic events, major bleeding
events or deaths in either group. The quality of the evidence was very
low. One small study compared fondaparinux with mechanical
thromboprophylaxis. Results showed no difference in total VTE and total
DVT between fondaparinux and mechanical thromboprophylaxis. This study
reported no cases pertaining to the other outcomes of this review. The
quality of the evidence was low. There were insufficient studies to permit
meaningful conclusions for subgroups of clinical conditions other than
orthopaedic surgery. Authors' conclusions: Moderate to high quality
evidence shows that fondaparinux is effective for short-term prevention of
VTE when compared with placebo. It can reduce total VTE, DVT, total PE and
symptomatic VTE, and does not demonstrate a reduction in deaths compared
with placebo. Low to moderate quality evidence shows that fondaparinux is
more effective for short-term VTE prevention when compared with LMWH. It
can reduce total VTE and total DVT and does not demonstrate a reduction in
deaths when compared with LMWH. However, at the same time, moderate to
high quality evidence shows that fondaparinux increases major bleeding
when compared with placebo and LMWH. Therefore, when fondaparinux is
chosen for the prevention of VTE, attention should be paid to the person's
bleeding and thrombosis risks. Most data were derived from patients
undergoing orthopaedic surgery. Therefore, the conclusion predominantly
pertains to these patients. Data on fondaparinux for other clinical
conditions are sparse. Copyright &#xa9; 2016 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<133>
Accession Number
612919221
Author
Giustino G.; Mehran R.; Veltkamp R.; Faggioni M.; Baber U.; Dangas G.D.
Institution
(Giustino, Mehran, Faggioni, Baber, Dangas) Interventional Cardiovascular
Research and Clinical Trials, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Veltkamp) Department of Stroke Medicine, Division of Brain Sciences,
Imperial College, London, United Kingdom
Title
Neurological Outcomes With Embolic Protection Devices in Patients
Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (20) (pp 2124-2133), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate the efficacy and
safety of intraprocedural embolic protection (EP) during transcatheter
aortic valve replacement (TAVR). Background Randomized controlled trials
(RCTs) investigating the efficacy of EP devices during TAVR were
relatively underpowered. Methods A systematic review and study-level
meta-analysis was performed of randomized controlled trials that tested
the efficacy and safety of EP during TAVR. Trials using any type of EP and
TAVR vascular access were included. Primary imaging efficacy endpoints
were total lesion volume and number of new ischemic lesions. Primary
clinical efficacy endpoints were any deterioration in National Institutes
of Health Stroke Scale and Montreal Cognitive Assessment scores at
hospital discharge. Primary analyses were performed using the
intention-to-treat approach. Results Four randomized clinical trials
(total n = 252) were included. Use of EP was associated with lower total
lesion volume (standardized mean difference -0.65; 95% confidence interval
[CI]: -1.06 to -0.25; p = 0.002) and smaller number of new ischemic
lesions (standardized mean difference -1.27; 95% CI: -2.45 to -0.09; p =
0.03). EP was associated with a trend toward lower risk for deterioration
in National Institutes of Health Stroke Scale score at discharge (risk
ratio: 0.55; 95% CI: 0.27 to 1.09; p = 0.09) and higher Montreal Cognitive
Assessment score (standardized mean difference 0.40; 95% CI: 0.04 to 0.76;
p = 0.03). Risk for overt stroke and all-cause mortality were
nonsignificantly lower in the EP group. Conclusions Use of EP seems to be
associated with reductions in imaging markers of cerebral infarction and
early clinical neurological effectiveness in patients undergoing TAVR.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<134>
Accession Number
612989259
Author
Amin S.M.; Elmawy M.G.E.
Institution
(Amin, Elmawy) Departments of Anesthesiology and Surgical Intensive Care,
Faculty of Medicine, Tanta University, Egypt
Title
Optimizing surgical field during cochlear implant surgery in children:
Dexmedetomidine versus Esmolol.
Source
Egyptian Journal of Anaesthesia. 32 (3) (pp 255-261), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background The field of cochlear implantation has been expanding rapidly
and it has been hailed as one of the greatest advances in otology. The
technique of anesthesia plays a crucial role in success of cochlear
implant surgery as the anesthesiologist has to produce conditions which
facilitate surgery by inducing bloodless operative field. Study objective
To determine the efficacy of dexmedetomidine versus esmolol usage as an
adjunct to induce controlled hypotension in children undergoing cochlear
implant surgery. Design Clinical trial study. Setting Operating room in a
university hospital. Patients 70 children aged 2-4 years scheduled for
cochlear implant surgery under general anesthesia. Patients were randomly
allocated according to drugs used into two equal groups (35 patients in
each group). Interventions: Group (D): The patients in this group received
a bolus dose of dexmedetomidine 0.5 ug/kg over 10 min followed by
continuous infusion 0.2-0.5 ug/kg/h after induction of anesthesia but
before surgery. Group (E): The patients in this group received a bolus
dose of esmolol 0.5 mg/kg over 10 min followed by continuous infusion
100-300 ug/kg/min after induction of anesthesia but before surgery.
Measurements Heart rate, Mean Arterial blood Pressure, Quality of surgical
field, operative time, adverse events. Main results The quality of
surgical field was comparable between both groups in all times of
measurements. The time to first analgesic request was statistically
significant longer in group (D) than in group (E) and the total tramadol
consumption was statistically significant less in group (D) than in group
(E). Conclusions In our study both dexmedetomidine and esmolol were
effective in reducing MABP, and lowering the heart rate providing dry
surgical field and ensured good surgical condition during cochlear implant
surgery in pediatric patients. Copyright &#xa9; 2016

<135>
Accession Number
612989116
Author
Amara W.; Naccache S.; Akret C.; Cheggour S.; M'Zoughi S.; Galuscan G.;
Dompnier A.
Institution
(Amara, Naccache) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue
du General-Leclerc, Montfermeil 93370, France
(Akret, Dompnier) Centre hospitalier Annecy-Genevois, 1, avenue de
l'Hopital, Epagny Metz-Tessy 74370, France
(Cheggour, M'Zoughi) Centre hospitalier d'Avignon, 305, rue
Raoul-Follereau, Avignon 84000, France
(Galuscan) Centre hospitalier Andre-Mignot, 177, rue de Versailles, Le
Chesnay 78150, France
Title
Safety of device implantation under antipatelet therapy with ticagrelor:
About 20 cases.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 318-321), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Management of antiplatelet therapy at the time of device
implantation remains controversial. This study aimed to assess the risk of
bleeding complications in patients receiving ticagrelor at the time of
cardiac device surgery. Methods We performed a multicentre (n = 4),
retrospective study from January 2015 to January 2016. The survey included
all patients (pts) treated with ticagrelor before undergoing pacemaker,
implantable cardioverter-defibrillator (ICD) implantation or generator
replacement. We report hemorrhagic post-procedural complications at 1
month. A significant bleeding complication was defined as pocket hematoma
requiring a surgical evacuation or prolonged hospitalization, hemothorax,
pericardial effusion, or tamponade. Results A total of 20 patients
underwent a permanent pacemaker or ICD implantation while taking a
combination of antipatelet therapy with ticagrelor and aspirin. The mean
age of the patients was 65 +/- 9 years, 95% were male, 25% of patients
were diabetics, 55% had hypertension and 50% presented a history of heart
failure. All the patients had a history of acute coronary syndrome [6
(4-26) months before the procedure]. The majority of implanted devices
were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple
chambers ICDs. Subclavian venous approach was utilized in 9 patients. The
mean duration of procedure was 60 minutes. One per-procedure bleeding was
described due to high venous pressure, without post-procedure hematoma. A
post-procedure pocket hematoma has been experienced by one patient. The
subclavian approach was used for the 2 patients. No blood transfusion was
needed for these 2 cases. Conclusion Ticagrelor treatment at the time of
heart rhythm device procedures does not seem to be associated with an
increased risk of significant bleeding complications. In our study, 2
patients experienced nonsignificant bleeding complications. Copyright
&#xa9; 2016 Elsevier Masson SAS

<136>
Accession Number
612989094
Author
Moini C.; Sidia B.; Poindron D.; Fiorina L.; Farge A.; Amara W.; El Issa
M.
Institution
(Moini, Sidia, Poindron, Fiorina, El Issa) Unite de rythmologie et de
stimulation cardiaque, hopital d'Antony, 1, rue Velpeau, Antony 92160,
France
(Moini, Poindron, Fiorina) Unite de rythmologie et de stimulation
cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, Melun
77000, France
(Moini) Service de cardiologie, centre hospitalier de Melun, 2, rue
Freteau-de-Peny, Melun cedex 77011, France
(Farge) Unite de chirurgie cardiaque, hopital Jacques-Cartier, 6, avenue
du Noyer-Lambert, Massy 91300, France
(Amara) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du
General-Leclerc, Montfermeil 93370, France
Title
Cardiac permanent pacemaker after transcatheter aortic valve implantation:
A predictive and scientific review.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 346-351), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide
technique in the field of treating aortic stenosis. One of the main side
effects linked to the technique are mostly attached to rhythm
disturbances, such as atrioventricular (AV) and intraventricular blocks.
Consequently, a pacemaker implantation is often required. That
implantation rate is estimated between 8 and 30%, depending on the valve
chosen. Thanks to main meta analysis on the subject, it has been managed
to isolate the following risks factors for AV block development:
preoperative right bundle branch block (RBBB: the most powerful element),
complete AV block during the procedure, male gender, a so-called porcelain
aorta, the absence of previous valvular surgery, the aortic annulus size
(i.e when that size is inferior to the valve's one) and the QRS duration
after the procedure (the superior threshold has been set at 128 ms for the
Corevalve). The currently recommendations advice to implant a pacemaker
are as followed: high grade AV block (in the main studies, the
implantation occurs within the 5 days after the TAVI), complete and
transient AV block during the TAVI, second degree AV block and RBBB
associated with first degree AV block. Our article aims to review the
arrhythmic issues of TAVI. Copyright &#xa9; 2016 Elsevier Masson SAS

<137>
Accession Number
612973121
Author
Cayla G.; Cuisset T.; Silvain J.; Leclercq F.; Manzo-Silberman S.;
Saint-Etienne C.; Delarche N.; Bellemain-Appaix A.; Range G.; El Mahmoud
R.; Carrie D.; Belle L.; Souteyrand G.; Aubry P.; Sabouret P.; du Fretay
X.H.; Beygui F.; Bonnet J.-L.; Lattuca B.; Pouillot C.; Varenne O.; Boueri
Z.; Van Belle E.; Henry P.; Motreff P.; Elhadad S.; Salem J.-E.; Abtan J.;
Rousseau H.; Collet J.-P.; Vicaut E.; Montalescot G.
Institution
(Cayla, Lattuca) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier Universitaire de Nimes, Universite de Montpellier, Nimes,
France
(Cuisset, Bonnet) Department of Cardiology, Centre Hospitalier
Universitaire Timone, Marseille, France
(Cuisset, Bonnet) INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and
Risk of Thrombosis, Faculty of Medicine, Aix-Marseille University,
Marseille, France
(Silvain, Sabouret, Collet, Montalescot) Sorbonne Universite-Paris 06,
ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Leclercq) Departement de Cardiologie, Centre Hospitalier Universitaire
Montpellier, Montpellier, France
(Manzo-Silberman, Henry) Service de Cardiologie, Hopital Lariboisiere,
Paris, France
(Saint-Etienne) Service de Cardiologie, Centre Hospitalier Universitaire
Tours, Tours, France
(Delarche) Hopital Francois Mitterrand, Centre Hospitalier de Pau, Pau,
France
(Bellemain-Appaix) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier d'Antibes-Juans-Les-Pins, Antibes, France
(Range) Service de Cardiologie, Les Hopitaux de Chartres, Le Coudray,
Chartres, France
(El Mahmoud) Hopital Ambroise Pare, Boulogne-Billancourt, France
(Carrie) Service de Cardiologie, Centre Hospitalier Universitaire
Toulouse, Toulouse, France
(Belle) Service de Cardiologie, Centre Hospitalier d'Annecy, Annecy,
France
(Souteyrand, Motreff) Service de Cardiologie, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Aubry, du Fretay, Abtan) Service de Cardiologie, Hopital Bichat Claude
Bernard, Paris, France
(Beygui) ACTION Study Group, Service de Cardiologie, Centre Hospitalier
Universitaire de Caen, Caen, France
(Pouillot) Clinique Sainte Clotilde, Saint Denis de La Reunion, La
Reunion, France
(Varenne) Service de Cardiologie, Hopital Cochin, Paris, France
(Boueri) Service de Cardiologie de Bastia, Centre Hospitalier de Bastia,
Bastia, France
(Van Belle) Service de Cardiologie, Centre Hospitalier Universitaire de
Lille, Lille, France
(Elhadad) Centre Hospitalier de Lagny Marne la Vallee, Jossigny, France
(Salem) Department of Pharmacology, CIC-1421, INSERM U1166-ICAN, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rousseau, Vicaut) ACTION Study Group, Unite de Recherche Clinique,
Lariboisiere, Paris, France
Title
Platelet function monitoring to adjust antiplatelet therapy in elderly
patients stented for an acute coronary syndrome (ANTARCTIC): an
open-label, blinded-endpoint, randomised controlled superiority trial.
Source
The Lancet. 388 (10055) (pp 2015-2022), 2016. Date of Publication: 22 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Elderly patients are at high risk of ischaemic and bleeding
events. Platelet function monitoring offers the possibility to
individualise antiplatelet therapy to improve the therapeutic risk-benefit
ratio. We aimed to assess the effect of platelet function monitoring with
treatment adjustment in elderly patients stented for an acute coronary
syndrome. Methods We did this multicentre, open-label, blinded-endpoint,
randomised controlled superiority study at 35 centres in France. Patients
aged 75 years or older who had undergone coronary stenting for acute
coronary syndrome were randomly assigned (1:1), via a central interactive
voice-response system based on a computer-generated permuted-block
randomisation schedule with randomly selected block sizes, to receive oral
prasugrel 5 mg daily with dose or drug adjustment in case of inadequate
response (monitoring group) or oral prasugrel 5 mg daily with no
monitoring or treatment adjustment (conventional group). Randomisation was
stratified by centre. Platelet function testing was done 14 days after
randomisation and repeated 14 days after treatment adjustment in patients
in the monitoring group. Study investigators and patients were not masked
to treatment allocation, but allocation was concealed from an independent
clinical events committee responsible for endpoint adjudication. The
primary endpoint was a composite of cardiovascular death, myocardial
infarction, stroke, stent thrombosis, urgent revascularisation, and
Bleeding Academic Research Consortium-defined bleeding complications
(types 2, 3, or 5) at 12 months' follow-up. We did analysis by intention
to treat. This trial is registered with ClinicalTrials.gov, number
NCT01538446. Findings Between March 27, 2012, and May 19, 2015, we
randomly assigned 877 patients to the monitoring group (n=442) or the
conventional group (n=435). The primary endpoint occurred in 120 (28%)
patients in the monitoring group compared with 123 (28%) patients in the
conventional group (hazard ratio [HR], 1.003, 95% CI 0.78-1.29; p=0.98).
Rates of bleeding events did not differ significantly between groups.
Interpretation Platelet function monitoring with treatment adjustment did
not improve the clinical outcome of elderly patients treated with coronary
stenting for an acute coronary syndrome. Platelet function testing is
still being used in many centres and international guidelines still
recommend platelet function testing in high-risk situations. Our study
does not support this practice or these recommendations. Funding Eli Lilly
and Company, Daiichi Sankyo, Stentys, Accriva Diagnostics, Medtronic, and
Fondation Coeur et Recherche. Copyright &#xa9; 2016 Elsevier Ltd

<138>
Accession Number
612980210
Author
Digesu C.S.; Wiesel O.; Vaporciyan A.A.; Colson Y.L.
Institution
(Digesu, Wiesel, Colson) Division of Thoracic Surgery, Department of
Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis
Street, Boston, MA 02155, United States
(Vaporciyan) Division of Surgery, Department of Thoracic and
Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center,
1515 Holcombe Boulevard, Box 1489, Houston, TX 77030, United States
Title
Management of Sarcoma Metastases to the Lung.
Source
Surgical Oncology Clinics of North America. 25 (4) (pp 721-733), 2016.
Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
For decades, surgical resection of pulmonary metastases has been
performed; despite limited randomized data, surgery is increasingly
accepted as an integral part in the management of metastatic disease.
Long-term results indicate resection is potentially curative with
significantly improved survival following complete resection. Recurrence,
however, is not uncommon with many patients undergoing repeat resection.
With advancing surgical technique and adjuvant therapies, patients with
high or recurrent tumor burden are increasingly afforded disease control
and potential cure. In this review, the prognostic characteristics of
pulmonary metastases from sarcoma, preoperative evaluation, operative
technique, long-term outcomes, and management of complex patients are
highlighted. Copyright &#xa9; 2016 Elsevier Inc.

<139>
[Use Link to view the full text]
Accession Number
612979724
Author
Ohye R.G.; Schranz D.; D'Udekem Y.
Institution
(Ohye) University of Michigan, C. S. Mott Children's Hospital, 1540 E
Hospital Dr/SPC 4204, Ann Arbor, MI 48109-4204, United States
(Schranz) Pediatric Heart Center, Justus Liebig University Giessen,
Germany
(D'Udekem) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
Title
Current therapy for hypoplastic left heart syndrome and related single
ventricle lesions.
Source
Circulation. 134 (17) (pp 1265-1279), 2016. Date of Publication: 25 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Universally fatal only 4 decades ago, the progress in the 3-stage
palliation of hypoplastic left heart syndrome and related single right
ventricular lesions has drastically improved the outlook for these
patients. Although the stage II operation (hemi-Fontan or bidirectional
Glenn) and stage III Fontan procedure have evolved into relatively
low-risk operations, the stage I Norwood procedure remains one of the
highest-risk and costliest common operations performed in congenital heart
surgery. Yet, despite this fact, experienced centers now report hospital
survivals of >90% for the Norwood procedure. This traditional 3-stage
surgical palliation has seen several innovations in the past decade aimed
at improving outcomes, particularly for the Norwood procedure. One
significant change is a renewed interest in the right
ventricle-to-pulmonary artery shunt as the source of pulmonary blood flow,
rather than the modified Blalock-Taussig shunt for the Norwood. The
multi-institutional Single Ventricle Reconstruction trial randomly
assigned 555 patients to one or the other shunt, and these subjects
continue to be followed closely as they now approach 10 years
postrandomization. In addition to modifications to the Norwood procedure,
the hybrid procedure, a combined catheter-based and surgical approach,
avoids the Norwood procedure in the newborn period entirely. The initial
hybrid procedure is then followed by a comprehensive stage II, which
combines components of both the Norwood and the traditional stage II, and
later completion of the Fontan. Proponents of this approach hope to
improve not only short-term survival, but also potentially longer-term
outcomes, such as neurodevelopment, as well. Regardless of the approach,
traditional surgical staged palliation or the hybrid procedure, survivals
have vastly improved, and large numbers of these patients are surviving
not only through their Fontan in early childhood, but also into
adolescence and young adulthood. As this population grows, it becomes
increasingly important to understand the longer-term outcomes of these
Fontan patients, not only in terms of survival, but also in terms of the
burden of disease, neurodevelopmental outcomes, psychosocial development,
and quality of life. Copyright &#xa9; 2016 American Heart Association,
Inc.

<140>
[Use Link to view the full text]
Accession Number
612979680
Author
Kurlansky P.; Herbert M.; Prince S.; Mack M.
Institution
(Kurlansky) Columbia University, 650 W 168th Street, New York, NY 10032,
United States
(Herbert, Prince) Medical City Dallas Hospital, Dallas, TX, United States
(Mack) Baylor Health Care System, Plano, TX, United States
Title
Coronary artery bypass graft versus percutaneous coronary intervention.
Source
Circulation. 134 (17) (pp 1238-1246), 2016. Date of Publication: 25 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Multiple studies have compared coronary artery bypass graft
(CABG) with percutaneous coronary interventions (PCI) for coronary
revascularization. There is considerable evidence that adherence to
medical therapy can affect the outcomes of therapeutic interventions.
However, the long-term influence of compliance with recommended medical
therapy on the comparative outcomes of CABG versus PCI remains to be
defined. Methods: All non-ST-segment-elevation myocardial infarction
patients undergoing coronary revascularization in an 8-hospital network
were followed for up to 8 years to determine medication history and major
adverse cardiac events: all-cause mortality, nonfatal myocardial
infarction, and reintervention. All mortalities were checked against the
Social Security Death Index. Survival curves were derived with
Kaplan-Meier methods; hazard ratios were calculated with the Cox
proportional hazard model; and propensity score matching was used to
account for differences in patient selection. Results: Among the 973 CABG
and 2255 PCI patients, Kaplan-Meier major adverse cardiac event-free
survival curves demonstrated a significant benefit for antiplatelet,
lipid-lowering, and beta-blocker therapy in both the CABG and PCI groups
(P=0.001 for all 3 medications). Cox regression identified compliance with
optimal medical therapy as a more powerful predictor of major adverse
cardiac event-free survival than choice of therapy (hazard ratio for
noncompliance=2.79; 95% confidence limits, 2.19-3.54; P<0.001; hazard
ratio for PCI versus CABG=1.68, 95% confidence limits, 138-2.04; P<0.001).
In propensity-matched patients, CABG outcomes were superior to PCI
outcomes in patients nonadherent to optimal medical therapy (P=0.001) but
were not different in patients adherent to optimal medical therapy
(P=0.574). Conclusions: Regardless of coronary revascularization strategy,
medication adherence has a dramatic effect on long-term outcome. Among
comparable patients who adhere to optimal medical therapy, outcomes of PCI
and CABG may not differ; however, among nonadherent patients, CABG affords
better major adverse cardiac event-free survival. Therefore, patient
compliance with medical therapy may inform clinical decision making and
should be incorporated into all future comparative studies of comparative
coronary revascularization strategies. Copyright &#xa9; 2016 American
Heart Association, Inc.

<141>
Accession Number
612967201
Author
Brat K.; Tothova Z.; Merta Z.; Taskova A.; Homolka P.; Vasakova M.;
Skrickova J.; Sramek V.; Olson L.J.; Cundrle I.
Institution
(Brat, Merta, Skrickova) Department of Respiratory Diseases, University
Hospital Brno, Brno, Czech Republic
(Brat, Merta, Homolka, Skrickova) Faculty of Medicine, Masaryk University,
Brno, Czech Republic
(Tothova, Vasakova) Department of Respiratory Medicine, Thomayer Hospital,
Prague, Czech Republic
(Taskova) Department of Thoracic Surgery, Thomayer Hospital, Prague, Czech
Republic
(Homolka) Department of Sports Medicine and Rehabilitation, St. Anne's
University Hospital, Brno, Czech Republic
(Homolka, Cundrle) International Clinical Research Center, St. Anne's
University Hospital, Brno, Czech Republic
(Sramek, Cundrle) Department of Anesthesiology and Intensive Care, St.
Anne's University Hospital, Brno, Czech Republic
(Olson) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
Title
Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in
Patients Undergoing Thoracic Surgical Procedures.
Source
Annals of Thoracic Surgery. 102 (5) (pp 1725-1730), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Ventilatory efficiency (VE/VCO<inf>2</inf> slope [minute
ventilation to carbon dioxide output slope]) has been shown to predict
morbidity and mortality in lung resection candidates. Patients with
increased VE/VCO<inf>2</inf> during exercise also exhibit an increased
VE/VCO<inf>2</inf> ratio and a decreased end-tidal CO<inf>2</inf> at rest.
This study hypothesized that ventilatory values at rest predict
respiratory complications and death in patients undergoing thoracic
surgical procedures. Methods Inclusion criteria for this retrospective,
multicenter study were thoracotomy and cardiopulmonary exercise testing as
part of routine preoperative assessment. Respiratory complications were
assessed from the medical records (from the hospital stay or from the
first 30 postoperative days). For comparisons, Student's t test or the
Mann-Whitney U test was used. Logistic regression and receiver operating
characteristic analyses were performed for evaluation of measurements
associated with respiratory complications. Data are summarized as mean +/-
SD; p <0.05 is considered significant. Results Seventy-six subjects were
studied. Postoperatively, respiratory complications developed in 56 (74%)
patients. Patients with postoperative respiratory complications had
significantly lower resting tidal volume (0.8 +/- 0.3 vs 0.9 +/- 0.3L; p =
0.03), lower rest end-tidal CO<inf>2</inf> (28.1 +/- 4.3vs 31.5 +/- 4.2 mm
Hg; p < 0.01), higher resting VE/VCO<inf>2</inf> ratio (45.1 +/- 7.1 vs
41.0 +/- 6.4; p = 0.02), and higher VE/VCO<inf>2</inf> slope (34.9 +/- 6.4
vs 31.2 +/- 4.3; p = 0.01). Logistic regression (age and sex adjusted)
showed resting end-tidal CO<inf>2</inf> to be the best predictor of
respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06
to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting
end-tidal CO<inf>2</inf> may identify patients at increased risk for
postoperative respiratory complications of thoracic surgical procedures.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<142>
Accession Number
612967110
Author
Charytan D.M.; Desai M.; Mathur M.; Stern N.M.; Brooks M.M.; Krzych L.J.;
Schuler G.C.; Kaehler J.; Rodriguez-Granillo A.M.; Hueb W.; Reeves B.C.;
Thiele H.; Rodriguez A.E.; Buszman P.P.; Buszman P.E.; Maurer R.;
Winkelmayer W.C.
Institution
(Charytan, Stern, Maurer) Departments of Medicine, Brigham & Women's
Hospital, Boston, Massachusetts, United States
(Desai, Mathur) Stanford University School of Medicine, Palo Alto,
California, United States
(Brooks) University of Pittsburgh, Graduate School of Public Health,
Pittsburgh, Pennsylvania, United States
(Krzych) Department of Cardiac Anesthesiology and Intensive Care Medicine,
Medical University of Silesia, Katowice, Poland
(Schuler) Heart Center, University of Leipzig, Leipzig, Germany
(Kaehler) Department of Cardiology, Klinikum Herford, Herford, Germany
(Rodriguez-Granillo) Research Department, Centro de Estudios en
Cardiologia Intervencionista, Buenos Aires, Argentina
(Hueb) Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Thiele) University Heart Center Luebeck and German Heart Research Center
(DZHK), Luebeck, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires School of
Medicine, Buenos Aires, Argentina
(Buszman) Silesian Center for Heart Diseases, Zabrze, Poland
(Buszman, Buszman) American Heart of Poland, Katowice, Poland
(Winkelmayer) Department of Medicine, Baylor College of Medicine, Houston,
Texas, United States
Title
Reduced risk of myocardial infarct and revascularization following
coronary artery bypass grafting compared with percutaneous coronary
intervention in patients with chronic kidney disease.
Source
Kidney International. 90 (2) (pp 411-421), 2016. Date of Publication: 01
Aug 2016.
Publisher
Elsevier B.V.
Abstract
Coronary atherosclerotic disease is highly prevalent in chronic kidney
disease (CKD). Although revascularization improves outcomes, procedural
risks are increased in CKD, and unbiased data comparing coronary artery
bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are
sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we
identified randomized trials comparing these procedures. Investigators
were contacted to obtain individual, patient-level data. Ten of 27 trials
meeting inclusion criteria provided data. These trials enrolled 3993
patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were
stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, survival through
5 years was not different after CABG compared with PCI (hazard ratio [HR]
0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29,
CI 0.68-2.46). However, CKD modified the impact on survival free of
myocardial infarction: it was not different between CABG and PCI for
individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but
was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI
0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat
revascularization was reduced after CABG compared with PCI regardless, of
baseline kidney function. Results were limited by unavailability of data
from several trials and paucity of enrolled patients with stage 4-5 CKD.
Thus, our patient-level meta-analysis of individuals with CKD randomized
to CABG versus PCI suggests that CABG significantly reduces the risk of
subsequent myocardial infarction and revascularization without affecting
survival in these patients. Copyright &#xa9; 2016 International Society of
Nephrology

<143>
Accession Number
612964836
Author
Bach D.S.; Patel H.J.; Kolias T.J.; Deeb G.
Institution
(Bach, Kolias) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Michigan, Ann Arbor, MI, United States
(Patel, Deeb) Division of Adult Cardiac Surgery, Department of Cardiac
Surgery, University of Michigan, Ann Arbor, MI, United States
Title
Randomized comparison of exercise haemodynamics of Freestyle, Magna Ease
and Trifecta bioprostheses after aortic valve replacement for severe
aortic stenosis.
Source
European Journal of Cardio-thoracic Surgery. 50 (2) (pp 361-367), 2016.
Article Number: ezv493. Date of Publication: 01 Aug 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The purpose of this study was to compare haemodynamics at rest
and during exercise after clinically indicated aortic valve replacement
(AVR) for aortic stenosis among patients randomly assigned to one of three
haemodynamically excellent bioprostheses. METHODS: In a single-centre,
prospective trial, 60 patients undergoing clinically indicated AVR were
randomly assigned to Freestyle, Magna Ease or Trifecta bioprostheses. Six
months after surgery, patients underwent supine bicycle stress
echocardiography for the assessment of aortic valve haemodynamics.
RESULTS: There were 5 protocol deviations from random valve assignments,
and 4 patients did not return for follow-up stress echo, yielding a study
group of 56 patients (17 Freestyle, 21 Magna Ease, 18 Trifecta; median age
70 [interquartile range (IQR) 63-78 years], 37 (66%) men). There were no
statistically significant differences between groups in valve size,
concomitant procedures or exercise variables. Resting haemodynamics
revealed significant differences between groups in mean gradient
[Freestyle 7 (IQR 5-9) mmHg, Magna Ease 9 (IQR 7-11) mmHg, Trifecta 5 (IQR
4-8) mmHg; P = 0.04], effective orifice area (EOA) [2.5 (IQR 2.2-2.7), 2.1
(IQR 1.7-2.3) and 2.6 (IQR 2.3-2.8), respectively; P = 0.02] and EOA index
[1.22 (IQR 1.11-1.32), 1.02 (IQR 0.89-1.14) and 1.31 (IQR 1.00-1.42),
respectively; P = 0.03]; in each case, Trifecta had better haemodynamics
compared with Magna Ease. With exercise, significant differences between
groups were evident in peak velocity at 50 watts and peak exercise; mean
gradient at 25 watts, 50 watts and maximal exercise; and EOA at 25 watts
and at peak exercise; all with haemodynamic superiority of Trifecta
compared with Magna Ease. There were no statistically significant
differences between Trifecta and Freestyle haemodynamics at rest or with
exercise. CONCLUSIONS: In a prospective, randomized study comparing
haemodynamics after Freestyle, Magna Ease and Trifecta, all three valves
exhibited good haemodynamics at rest and with exercise. There were small
but significant differences between groups, with favourable haemodynamics
associated with Trifecta compared to Magna Ease, and no significant
differences between Trifecta and Freestyle. The Trifecta valve appears to
offer haemodynamics similar to a stentless valve without the technical
complexity of stentless valve implantation. Copyright &#xa9; The Author
2016. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<144>
Accession Number
612964723
Author
Kopjar T.; Gasparovic H.; Mestres C.A.; Milicic D.; Biocina B.
Institution
(Kopjar, Gasparovic, Biocina) University of Zagreb School of Medicine,
Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb,
Croatia
(Mestres) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
(Milicic) University of Zagreb School of Medicine, Department of
Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb,
Croatia
Title
Meta-analysis of concomitant mitral valve repair and coronary artery
bypass surgery versus isolated coronary artery bypass surgery in patients
with moderate ischaemic mitral regurgitation.
Source
European Journal of Cardio-thoracic Surgery. 50 (2) (pp 212-222), 2016.
Article Number: ezw022. Date of Publication: 01 Aug 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Ischaemic mitral regurgitation (IMR) is a complication of coronary artery
disease with normal chordal and leaflet morphology. Controversy surrounds
the issue of appropriate surgical management of moderate IMR. With the
present meta-analysis, we aimed to determine whether the addition of
mitral valve (MV) repair to coronary artery bypass grafting (CABG)
improved clinical outcome over CABG alone in patients with moderate IMR.
Databases were searched for studies reporting on clinical outcomes after
CABG and MV repair or CABG alone for moderate IMR. Clinical end-points
were operative mortality, survival, New York Heart Association (NYHA)
class >2 and MR grade >2 at last follow-up. A total of five observational
and four randomized controlled trials (RCTs) were identified. The mean
follow-up was 2.7 years. An analysis of all studies revealed increased
operative risk in the concomitant CABG and MV repair group (risk ratio
[RR] 2.02 [95% confidence interval (CI) 1.15, 3.56], P = 0.01,
I² = 0%). However, an analysis of RCTs only showed that the
operative risk was equivalent [RR 1.05 (95% CI 0.34, 3.30), P = 0.93,
I² = 0%]. Pooled hazard ratio (HR) on survival did not favour
either procedure [all studies: HR 1.08 (95% CI 0.77, 1.50), P = 0.66,
I² = 0%; RCTs only: HR 0.89 (95% CI 0.47, 1.70), P = 0.73,
I² = 0%]. The incidence of exercise intolerance quantified as
NYHA class >2 was similar between groups (all studies: RR 0.72 (95% CI
0.42, 1.24), P = 0.24, I² = 77%; RCTs only: RR 0.61 (95% CI
0.24, 1.55), P = 0.30, I² = 83%]. Risk of residual MR grade >2
was higher in the CABG only group [all studies: RR 0.30 (95% CI 0.16,
0.60), P < 0.001, I² = 83%; RCTs only: RR 0.20 (95% CI 0.04,
0.90), P = 0.04, I² = 72%]. There is neither increased
operative mortality nor survival benefit associated with concomitant CABG
and MV repair for IMR of moderate degree over CABG alone. Further studies
with long-term follow-up data and sub-group analyses of current data are
needed to define a subset of patients whose survival and functional status
may improve with the concomitant MV repair. Copyright &#xa9; The Author
2016. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<145>
Accession Number
612902847
Author
Chaudhri M.S.; Shah M.U.A.; Asghar M.I.; Siddiqi R.; Janjua A.M.; Iqbal A.
Institution
(Chaudhri, Shah, Asghar, Janjua, Iqbal) Department of Cardiac Surgery,
Armed Forces Institute of Cardiology and National Institute of Heart
Diseases (AFIC-NIHD), Rawalpindi, Pakistan
(Siddiqi) Cardio-Thoracic Anesthesia, Armed Forces Institute of Cardiology
and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan
Title
Skeletonization of left internal mammary artery in coronary artery bypass
grafting.
Source
Journal of the College of Physicians and Surgeons Pakistan. 26 (9) (pp
736-739), 2016. Date of Publication: September 2016.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare mean per-operative flow capacity between
skeletonized and pedicled left internal mammary artery (LIMA) in patients
undergoing coronary artery bypass grafting (CABG) surgery. Study Design:
Randomized control trial. Place and Duration of Study: Department of
Cardiac Surgery, Armed Forces Institute of Cardiology and National
Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from
February to August, 2013. Methodology: Patients undergoing CABG for
coronary artery disease, under 80 years, excluded by the exclusion
criteria; and fulfilling the inclusion criteria were randomly assigned to
two groups of 70 each. One group underwent skeletonized and the other
underwent pedicled technique of LIMA harvesting. Free flow was checked
just before anastamosis of each LIMA to the LAD, manually in blood flow in
ml per minute during cardiopulmonary bypass by allowing it to bleed into a
100 ml container over 20 seconds. A specialized proforma was used to
record the age, gender, weight, disease, type of IMA used, and free flow
of the IMA. Data was analyzed using SPSS 18. Results: The mean age of the
patients was 57.16 years in 40 patients, ranging from 36 to 75 years.
Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and
triple vessel coronary artery disease, respectively. There was
significantly higher free flow in the skeletonized group than the pedicled
group (p=0.04). Conclusion: Skeletonized IMA had superior flow to pedicled
IMA in addition to its traditional proven advantages, which justifies its
further use as a conduit for myocardial revascularization.

<146>
Accession Number
613099930
Author
Kashani R.; Bowles C.; Sareh S.; Toppen W.; Ou R.; Shemin R.; Benharash P.
Institution
(Kashani, Bowles, Sareh, Toppen, Ou, Shemin, Benharash) Division of
Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at
the University of California Los Angeles, Los Angeles, CA
Title
Use of preoperative aspirin in combined coronary and valve operations.
Source
Surgery (United States). (no pagination), 2016. Date of Publication: 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: The aim of this study was to determine the relationship
between preoperative aspirin use and postoperative outcomes in patients
undergoing combined coronary artery bypass grafting and valve operations.
Methods: All combined coronary artery bypass grafting and valve procedures
from 2008 to 2015 at our institution were identified. After exclusions,
patients were stratified according to those that received preoperative
aspirin and those who did not. Propensity score methodology was used to
match the 2 groups using baseline and operative characteristics. Logistic
regression models were then developed to assess differences in
postoperative outcomes between groups. Results: Of the 563 patients
identified, 534 met inclusion criteria: preoperative aspirin = 327
(61.2%), no preoperative aspirin = 207 (38.8%). After propensity matching,
194 patient pairs were analyzed, with no significant differences in
preoperative characteristics. No significant differences were observed
between the preoperative aspirin and no preoperative aspirin groups in
rates of 30-day mortality (3.6% vs 4.1%, . P = 1.00), major adverse
cardiovascular events (23.2% vs 24.2%, . P = .91), or 30-day readmission
(12.4% vs 11.9%, . P = 1.00), among others. Conclusion: Preoperative
aspirin use in patients undergoing combined coronary artery bypass
grafting and valve operations was not associated with significant
differences in major postoperative outcomes. Large-scale, randomized
trials are needed to better establish the role of preoperative aspirin in
this population. Copyright &#xa9; 2016 Elsevier Inc.

<147>
Accession Number
613094478
Author
Farag M.; Patil N.P.; Sabashnikov A.; Arif R.; Szabo G.; Kallenbach K.;
Ruhparwar A.; Karck M.; Brenner T.; Hofer S.; Weymann A.
Institution
(Farag, Arif, Szabo, Kallenbach, Ruhparwar, Karck, Weymann) Department of
Cardiac SurgeryHeart and Marfan Center, University of HeidelbergHeidelberg
Germany
(Patil) Department of Cardiothoracic SurgeryRoyal Brompton and Harefield
NHS Foundation Trust, HarefieldMiddlesex, London UK
(Sabashnikov) Department of Cardiothoracic Surgery, Heart CenterUniversity
of CologneCologne
(Brenner, Hofer) Department of AnesthesiologyHeidelberg University
HospitalHeidelberg Germany
(Kallenbach) INCCI HAERZ ZENTERLuxembourg
Title
Comparison of Two Miniaturized Cardiopulmonary Bypass Systems Regarding
Inflammatory Response.
Source
Artificial Organs. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Cardiopulmonary bypass (CPB) is a known mediator of systemic inflammatory
response. Extracorporeal circulations are undergoing continuous
modifications and optimizations to achieve better results. Hence we aim to
compare the inflammatory response associated with two recent miniature
extracorporeal circulation systems during normothermic CPB. We measured
plasma levels of cytokines including interleukin (IL)-1beta, IL-6, IL-10,
tumor necrosis factor-alpha, migration inhibitory factor (MIF), receptor
for advanced glycation endproduct, and cluster of differentiation 40
ligand in 60 consecutive patients during the first 24 h after CPB. The
patients were prospectively randomized to one of three trial groups:
patients in group A were operated with the minimal extracorporeal
circulation circuit (MECC, Maquet, Rastatt, Germany), group B operated
with the extracorporeal circulation circuit optimized (ECC.O, Sorin,
Italy), and group C operated with a conventional extracorporeal circuit
(CECC, Maquet). Arterial blood samples were collected at intervals before,
30 min after initiation, and after termination of CPB. Further samples
were collected 6 and 24 h after CPB. IL-10 levels were significantly
raised in the CECC group as compared with either of the mini ECC-circuits
with a peak concentration at 6 h postoperatively. Human MIF concentrations
were significantly higher in the CECC group starting 30 min after CPB and
peaking at the end of CPB. The overall reduction in cytokine
concentrations in the mini-ECC groups correlated with a lower need for
blood transfusion in MECC and a shorter mechanical ventilation time for
ECC.O. Normothermic CPB using minimally invasive extracorporeal
circulation circuits can reduce the inflammatory response as measured by
cytokine levels, which may be beneficial for perioperative preservation of
pulmonary function and hemostasis in low risk patients. Copyright &#xa9;
2016 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<148>
Accession Number
613085635
Author
Gil-Juanmiquel L.; Gratacos M.; Castilla-Fernandez Y.; Piqueras J.; Baust
T.; Raguer N.; Balcells J.; Perez-Hoyos S.; Abella R.F.; Sanchez-de-Toledo
J.
Institution
(Gil-Juanmiquel) 1Pediatric Intensive Care Unit, Department of Pediatrics,
Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona,
Barcelona, Spain. 2Department of Clinical Neurophysiology, Hospital
Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona,
Spain. 3Department of neonatology, Hospital Universitari Vall d'Hebron,
Universitat Autonoma de Barcelona, Barcelona, Spain. 4Department of
Pediatric Radiology, Hospital Universitari Vall d'Hebron, Universitat
Autonoma de Barcelona, Barcelona, Spain. 5Cardiac Intensive Care Unit,
Department of Critical Care Medicine, Children's Hospital of Pittsburgh,
University of Pittsburgh, Pittsburgh, PA. 6Unit of Clinical Research
Support, Vall d'Hebron Research Institute,
Title
Bedside Ultrasound for the Diagnosis of Abnormal Diaphragmatic Motion in
Children After Heart Surgery.
Source
Pediatric Critical Care Medicine. (no pagination), 2016. Date of
Publication: 28 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: To assess the utility of bedside ultrasound combining B- and
M-mode in the diagnosis of abnormal diaphragmatic motion in children after
heart surgery. DESIGN:: Prospective post hoc blinded comparison of
ultrasound performed by two different intensivists and fluoroscopy results
with electromyography. SETTING:: Tertiary university hospital. SUBJECTS::
Children with suspected abnormal diaphragmatic motion after heart surgery.
INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Abnormal
diaphragmatic motion was suspected in 26 children. Electromyography
confirmed the diagnosis in 20 of 24 children (83.3%). The overall
occurrence rate of abnormal diaphragmatic motion during the study period
was 7.5%. Median patient age was 5 months (range, 16 d to 14 yr).
Sensitivity and specificity of chest ultrasound performed at the bedside
by the two intensivists (91% and 92% and 92% and 95%, respectively) were
higher than those obtained by fluoroscopy (87% and 83%). Interobserver
agreement (k) between both intensivists was 0.957 (95% CI, 0.87-100).
CONCLUSIONS:: Chest ultrasound performed by intensivists is a valid tool
for the diagnosis of diaphragmatic paralysis, presenting greater
sensitivity and specificity than fluoroscopy. Chest ultrasound should be
routinely used after pediatric heart surgery given its reliability,
reproducibility, availability, and safety. Copyright &#xa9;2016The Society
of Critical Care Medicine and the World Federation of Pediatric Intensive
and Critical Care Societies

<149>
Accession Number
613084377
Author
Rossini R.; Angiolillo D.J.; Musumeci G.; Capodanno D.; Lettino M.;
Trabattoni D.; Pilleri A.; Calabria P.; Colombo P.; Bernabo P.; Ferlini
M.; Ferri M.; Tarantini G.; De Servi S.; Savonitto S.
Institution
(Rossini, Musumeci) Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII
Bergamo Italy
(Angiolillo) College of Medicine-Jacksonville, University of
FloridaJacksonville, Florida; Division of Cardiology, University of
Florida College of Medicine-Jacksonville; Jacksonville, FL-USA
(Capodanno) Dipartimento Di Cardiologia, Ospedale Ferrarotto, Universita
Di Catania Italy
(Lettino) U.O.C. Cardiologia Clinica I, Istituto Clinico HumanitasRozzano,
(MI) Italy; Dipartimento Cardiovascolare, Humanitas Research Hospital,
Rozzano, Milano, Italy
(Trabattoni) Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico
Monzino, IRCCS, Universita Degli Studi Di MilanoMilano Italy
(Pilleri) SSD Centro di valutazione e consulenza cardiologica, Azienda
Ospedaliera Brotzu, Presidio San MicheleCagliari Italy
(Calabria) UO Emodinamica, Ospedale Misericordia, Grosseto USL Toscana
Sudest Italy
(Colombo) Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale
MetropolitanoMilano Italy
(Bernabo) Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera
Genova Italy
(Ferlini, De Servi) SC Cardiologia, Fondazione IRCCS Policlinico San
MatteoPavia Italy
(Ferri) S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS Reggio
Emilia Italy
(Tarantini) Dipartimento Di Scienze Cardiache, Toraciche E Vascolari,
Universita Di PadovaItalia
(Savonitto) Dipartimento Cardiovascolare, Ospedale A. Manzoni Lecco Italy
Title
Antiplatelet therapy and outcome in patients undergoing surgery following
coronary stenting: Results of the surgery after stenting registry.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2016.
Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of the present study was to define the feasibility and
clinical impact of complying with national consensus recommendations on
perioperative management of antiplatelet therapy in patients with coronary
stents undergoing cardiac and noncardiac surgery. Background: There are
limited evidence-based recommendations on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. Methods: The
recommendations provided by the national consensus document were applied
in a multicenter, prospective registry of consecutive patients with prior
coronary stenting undergoing any type of surgery at 19 hospitals in Italy.
The primary end-point was in-hospital net adverse clinical events (NACE)
represented by the composite of all-cause death, myocardial infarction,
probable/definite stent thrombosis and Bleeding Academic Research
Consortium (BARC) grade >3 bleeding. Patients were followed for 30 days.
Results: A total of 1,082 patients were enrolled. Adherence to consensus
recommendations occurred in 85% of the cases. Perioperative aspirin and
dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases,
respectively. In-hospital NACE rate was 12.7%, being significantly higher
in patients undergoing cardiac surgery (36.3% vs. 7.3%, P<0.01), mainly
due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar
(3.5% vs. 3.5%, P=NS) in patients undergoing cardiac and noncardiac
surgery, whereas BARC >3 bleeding events were significantly higher with
cardiac surgery (36.3% vs. 5.6%, P<0.01). Conclusions: The results of this
registry demonstrate the safety and feasibility of applying a national
consensus document on the perioperative management of antiplatelet therapy
in stented patients undergoing surgery. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<150>
Accession Number
613084171
Author
Li M.; Xue L.; Sun H.; Xu S.
Institution
(Li, Xu) Department of*Cardiovascular Surgery, The First Affiliated
Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi,
China
(Xue) +Department of Laboratory, The Second Affiliated Hospital of Medical
College of Xi'an Jiaotong University, Xi'an Shaanxi, China
(Sun) ++Tumour Hospital of Shaanxi Province, Xi'an Shaanxi, China
Title
Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion
Injury in Patients With Rheumatic Valvular Heart Disease Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: The authors used L-carnitine as an ingredient in cardioplegic
solution during valve replacement surgery to investigate the protective
effect of L-carnitine on myocardial ischemia-reperfusion injury (MIRI) and
its possible mechanism. Design: Prospective, randomized study. Setting: A
tertiary-care hospital. Participants: The study comprised 90 patients
undergoing valve replacement under cardiopulmonary bypass. Interventions:
Patients were divided randomly into 3 groups. L-carnitine was added to the
crystalloid cardioplegic solution for experimental group 1 (3 g/L) and
experimental group 2 (6 g/L), whereas no L-carnitine was used in the
control group. The remainder of the treatment was identical for all 3
groups. Measurements and Main Results: Serum was collected from each
patient 1 hour before the surgery and at 2, 6, 24, and 72 hours after
unclamping the aorta, and tissue samples were obtained before cardiac
arrest and after unclamping the aorta. The postoperative levels of serum
aspartate aminotransferase, creatine kinase, creatine kinase-MB isozyme,
and lactic acid dehydrogenase and the apoptotic index were all lower in
the 2 experimental groups than those in the control group. In addition,
each of the aforementioned serum enzyme levels and the apoptotic index in
all 3 groups significantly increased after unclamping the aorta compared
with baseline levels taken before surgery. Bcl-2 expression was higher and
Bax was lower in the 2 experimental groups compared with those of the
control group after unclamping the aorta. However, there was no
significant difference in all the postoperative indices between the 2
experimental groups. Conclusion: L-carnitine may reduce cardiopulmonary
bypass-induced myocardial apoptosis through modulating the expressions of
Bcl-2 and Bax, resulting in a protective effect from MIRI. Copyright
&#xa9; 2016 Elsevier Inc.

<151>
Accession Number
613011746
Author
Aytekin B.; Unal E.U.; Demir A.; Aksu U.; Caliskan A.; Vardar K.; Toraman
F.; Saritas A.
Institution
(Aytekin, Unal, Caliskan, Saritas) Department of Cardiovascular Surgery,
Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
(Demir) Department of Anesthesiology and Reanimation, Turkey Yuksek
Ihtisas Training and Research Hospital, Ankara, Turkey
(Aksu, Vardar) Department of Biology, Science Faculty, Istanbul
University, Istanbul, Turkey
(Toraman) Department of Anesthesiology and Reanimation, University of
Acibadem, Istanbul, Turkey
Title
Unilateral Antegrade Cerebral Perfusion and Moderate Hypothermia:
Assessing Safety With Novel Biomarkers.
Source
Heart Lung and Circulation. (no pagination), 2016. Date of Publication:
January 06, 2016.
Publisher
Elsevier Ltd
Abstract
Background: Antegrade cerebral perfusion in aortic surgery is a
well-established brain protection method. Open distal anastomosis during
aortic surgery has some well-known advantages. Antegrade cerebral
perfusion allows repair to some extent of the aortic arch, even in
isolated ascending aortic aneurysm. The present study aims to investigate
the adequacy of contralateral perfusion with novel oxidative stress
parameters during unilateral antegrade cerebral perfusion. Method: The
study included 30 consecutive patients undergoing thoracic aortic surgery
with unilateral antegrade cerebral perfusion (uACP) under moderate
hypothermia (28degree C). Blood samples from right and left jugular vein
were obtained at four time intervals during surgery (after the anaesthetic
induction - Phase 1, at the beginning of cardiopulmonary bypass - Phase 2,
15^th minute of uACP - Phase 3 and after weaning from
cardiopulmonary bypass - Phase 4). Novel oxidative stress parameters
(advanced oxidation protein products, sialic acid, thiol reagents and
ischaemia-modified serum albumin), blood gas analysis, and serum glucose
and lactate levels were measured. In addition, intraoperative and early
postoperative follow-up parameters were recorded. Results: Mean unilateral
antegrade cerebral perfusion time was observed to be 16.4. +/-. 5.9. min
(9 - 46. min). No significant differences between right and left
hemispheres were observed in novel oxidative parameters or biochemical
values. There was only one temporary neurological deficit (3.3%) in the
patient group. Conclusions: The present study demonstrated that open
distal anastomosis for hemiarch repair can be performed safely with
unilateral antegrade cerebral perfusion under moderate hypothermia with
both clinical outcome and novel biomarkers. Copyright &#xa9; 2016
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

<152>
Accession Number
613005953
Author
Blichfeldt-Eckhardt M.R.; Laursen C.B.; Berg H.; Holm J.H.; Hansen L.N.;
Ording H.; Andersen C.; Licht P.B.; Toft P.
Institution
(Blichfeldt-Eckhardt, Berg, Holm, Hansen, Andersen, Toft) Department of
Anesthesiology and Intensive Care Odense University Hospital Odense
Denmark
(Laursen) Department of Respiratory Medicine Odense University Hospital
Odense Denmark
(Licht) Department of Cardiothoracic Surgery Odense University Hospital
Odense Denmark
(Ording) Department of Anaesthesiology Vejle Hospital Vejle Denmark
Title
A randomised, controlled, double-blind trial of ultrasound-guided phrenic
nerve block to prevent shoulder pain after thoracic surgery.
Source
Anaesthesia. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Moderate to severe ipsilateral shoulder pain is a common complaint
following thoracic surgery. In this prospective, parallel-group study at
Odense University Hospital, 76 patients (aged > 18 years) scheduled for
lobectomy or pneumonectomy were randomised 1:1 using a computer-generated
list to receive an ultrasound-guided supraclavicular phrenic nerve block
with 10 ml ropivacaine or 10 ml saline (placebo) immediately following
surgery. A nerve catheter was subsequently inserted and treatment
continued for 3 days. The study drug was pharmaceutically pre-packed in
sequentially numbered identical vials assuring that all participants,
healthcare providers and data collectors were blinded. The primary outcome
was the incidence of unilateral shoulder pain within the first 6 h after
surgery. Pain was evaluated using a numeric rating scale. Nine of 38
patients in the ropivacaine group and 26 of 38 patients in the placebo
group experienced shoulder pain during the first 6 h after surgery
(absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65%
(95% CI 41-80%); p = 0.00009). No major complications, including
respiratory compromise or nerve injury, were observed. We conclude that
ultrasound-guided supraclavicular phrenic nerve block is an effective
technique for reducing the incidence of ipsilateral shoulder pain after
thoracic surgery. Copyright &#xa9; The Association of Anaesthetists of
Great Britain and Ireland.

<153>
Accession Number
612988453
Author
Campo G.; Pavasini R.; Maietti E.; Tonet E.; Cimaglia P.; Scillitani G.;
Bugani G.; Serenelli M.; Zaraket F.; Balla C.; Trevisan F.; Biscaglia S.;
Sassone B.; Galvani M.; Ferrari R.; Volpato S.
Institution
(Campo, Pavasini, Tonet, Cimaglia, Scillitani, Bugani, Serenelli, Zaraket,
Balla, Trevisan, Biscaglia, Ferrari) Cardiology Unit, Cardiovascular
Institute, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8,
Cona, FE 44124, Italy
(Campo, Ferrari) Laboratorio per le Tecnologie delle Terapie Avanzate
(LTTA) Center, Ferrara, Italy
(Maietti, Volpato) Department of Medical Science, University of Ferrara,
Ferrara, Italy
(Sassone) Division of Cardiology, Cento Hospital, Ferrara, Italy
(Galvani) Unita Operativa di Cardiologia, Ospedale GB Morgagni, Forli,
Italy
(Ferrari) Maria Cecilia Hospital, GVM Care & Research, E.S.: Health
Science Foundation, Cotignola, Italy
Title
The frailty in elderly patients receiving cardiac interventional
procedures (FRASER) program: rational and design of a multicenter
prospective study.
Source
Aging Clinical and Experimental Research. (pp 1-9), 2016. Date of
Publication: 28 Oct 2016.
Publisher
Springer International Publishing
Abstract
Background: Frailty has become a high-priority issue in cardiovascular
medicine because of the aging of cardiovascular patients. Simple and
reproducible tools to assess frailty in elderly patients are clearly on
demand. Their application may help physicians in the selection of invasive
and medical treatments and in the timing and modality of the follow-up.
The frailty in elderly patients receiving cardiac interventional
procedures (FRASER) program is designed with the aim to validate the use
of the short physical performance battery (SPPB) as prognostic tools in
patients admitted to hospital for acute coronary syndrome (ACS). Methods:
The FRASER program is a multicenter prospective study involving 4 Italian
cardiology units. The FRASER program enrolls only patients aged >70 years.
The core of the FRASER program includes patients admitted to hospital for
ACS. The aims are (1) to describe SPPB distribution before hospital
discharge and (2) to investigate the prognostic role of SPPB score. The
primary outcome is a composite of 1-year all-cause mortality and hospital
readmission for any cause. Ancillary analyses will be focused on different
study populations (patients hospitalized for arrhythmias or acute heart
failure or symptomatic severe aortic stenosis) and on different tools to
assess frailty (multidimensional prognostic index, clinical frailty score,
grip strength). Discussion: The FRASER program will fill critical gaps in
the knowledge regarding the link between frailty, cardiovascular disease,
interventional procedures and outcome and will help physicians in the
generation of a more personalized risk assessment and in the
identification of potential targets for interventions. Copyright &#xa9;
2016 Springer International Publishing Switzerland

<154>
Accession Number
612988452
Author
Hsu C.H.; Haac B.; McQuillan K.A.; Tisherman S.A.; Scalea T.M.; Stein D.M.
Institution
(Hsu) R Adams Cowley Shock Trauma Center, University of Maryland School of
Medicine, Baltimore, MD
Title
Outcome of suicidal hanging patients and the role of targeted temperature
management in hanging-induced cardiac arrest.
Source
Journal of Trauma and Acute Care Surgery. (no pagination), 2016. Date of
Publication: 25 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: No specific treatment is available for hanging-induced cardiac
arrest (CA). We hypothesized that targeted temperature management (TTM)
may improve the outcome of hanging-induced CA patients at hospital
discharge. METHODS: A retrospective chart review of our trauma registry
from January 1999 to September 2015 was conducted to identify patients >18
years with hanging as their injury type. All TTM was performed to achieve
32-34degreeC for 24 hours. The survival and Cerebral Performance Category
(CPC) scores at hospital discharge were determined. RESULTS: We identified
138 patients. Their average age was 32.1 +/- 10.0; 81.3% were male, and
69.8% were Caucasian. The mortality rate was 15.2% (21/138). Overall,
79.7% (110/138) of the near-hanging patients did not sustain
out-of-hospital CA (non-CA), and 1.8% of them (2/110) received TTM. All
110 non-CA patients survived to hospital discharge and 99.1% (109/110) had
good neurologic outcome. The remaining 20.3% (28/138) of hanging patients
suffered out-of-hospital CA; 6 of these patients were dead-on-arrival and
thus excluded from further analysis. TTM was performed for 40.9% (9/22) of
the remaining CA patients; 44.4% (4/9) of TTM CA patients survived to
hospital discharge versus 23.1% (3/13) of non-TTM CA patients. There were
no significant differences between the overall survival and patients
discharged with good neurologic outcome between the TTM and non-TTM CA
groups. CONCLUSIONS: Non-CA near-hanging patients are more likely to have
favorable outcome than the CA patients. Our study was not large enough to
detect survival and neurologic outcome differences between the TTM and
non-TTM CA groups. A multicenter retrospective study is underway to
determine the impact of TTM on the outcome of hanging-induced CA patients.
LEVEL OF EVIDENCE: Therapeutic study, level IV; prognostic study, level IV
Copyright &#xa9; 2016 Lippincott Williams & Wilkins, Inc.

<155>
Accession Number
612978344
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai New York, New York
(Takagi) Department of Cardiovascular Surgery Shizuoka Medical Center
Shizuoka Japan
Title
The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block
Following Transcatheter Aortic Valve Implantation: A Meta-analysis.
Source
Clinical Cardiology. (no pagination), 2016. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
New-onset persistent left bundle branch block (NOP-LBBB) is one of the
most common conduction disturbances after transcatheter aortic valve
implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically
negative impact after TAVI. To find out, we conducted a systematic
literature search of the MEDLINE/PubMed and Embase databases.
Observational studies that reported clinical outcomes of NOP-LBBB patients
after TAVI were included. The random-effects model was used to combine
odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence
intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios
when available. A total of 4049 patients (807 and 3242 patients with and
without NOP-LBBB, respectively) were included. Perioperative (in-hospital
or 30-day) and midterm all-cause mortality and midterm cardiovascular
mortality were comparable between the groups. The NOP-LBBB patients
experienced a higher rate of permanent pacemaker implantation (HR: 2.09,
95% confidence interval: 1.12-3.90, P = 0.021, I² = 83%) during
midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher
permanent pacemaker implantation but did not negatively affect the midterm
prognosis. Therefore, careful observation during the follow-up is
required. Copyright &#xa9; 2016 Wiley Periodicals, Inc.